Rating Scale For Pain Intensity Research Articles

Cross-cultural adaptation and psychometric properties of the Thai version of the patient-reported outcomes measurement information system short form– depression 8a in individuals with chronic low back pain

BackgroundThe study aimed to cross-culturally adapt the Patient-Reported Outcomes Measurement Information System Short Form v1.0 - Depression 8a (PROMIS SF v1.0 - Depression 8a) into Thai and evaluate its psychometric properties in individuals with chronic low back pain (CLBP).MethodsThe PROMIS SF v1.0– Depression 8a was translated and cross-culturally adapted into Thai using the Functional Assessment of Chronic Illness Therapy translation methodology. Two hundred and sixty-nine individuals with CLBP completed the Thai version of PROMIS SF v1.0– Depression 8a (T-PROMIS-D-8a) scale and a set of measures assessing validity criterion domains. Structural validity, internal consistency, and test-retest reliability at a 7-day interval of the T-PROMIS-D-8a scale were computed and its construct validity was evaluated by computing correlations with the Thai version of Patient Health Questionnaire-9 (T-PHQ-9), Numeric Rating Scale of pain intensity (T-NRS), and Fear Avoidance Beliefs Questionnaire (T-FABQ).ResultsData from 269 participants were analyzed. Most participants were women (70%), and the sample had a mean age of 42.5 (SD 16.6) years. The findings supported the unidimensionality, internal consistency (Cronbach’s alpha = 0.94), and test-retest reliability (ICC [2,1] = 0.86) of the T-PROMIS-D-8a. A floor effect was observed for 16% of the sample. Associations with the T-PHQ-9, T-NRS, and T-FABQ supported the construct validity of the T-PROMIS-D-8a.ConclusionsThe T-PROMIS-D-8a was successfully translated and culturally adapted. The findings indicated that the scale is reliable and valid for assessing depression in Thai individuals with CLBP.

Does Revision Carpal Tunnel Release Result in Long-Term Outcomes Equivalent to Single Carpal Tunnel Release? A Matched Case-Control Analysis.

The aims of this study were to evaluate long-term patient-reported outcomes after revision carpal tunnel release (CTR); compare these outcomes with those of patients who had a single CTR and a comparable age, sex, race, type of initial surgery, and follow-up time; and assess which factors are associated with worse patient-reported outcomes after revision CTR. The authors retrospectively identified 7351 patients who had a single CTR and 113 patients who had a revision CTR for carpal tunnel syndrome between January of 2002 and December of 2015 at five academic urban hospitals. Of these 113 revision CTR cases, 37 patients completed a follow-up questionnaire including the Boston Carpal Tunnel Questionnaire (BCTQ), the Numerical Rating Scale for Pain Intensity, and satisfaction score. Those who completed the follow-up questionnaire were randomly matched to five controls (patients who had a single CTR) based on age, sex, race, type of initial surgery, and follow-up time. Of these 185 matched controls, 65 completed the follow-up questionnaire. A linear mixed effects model using matched sets as a random effect showed that patients who had a revision CTR had a higher total BCTQ score, Numerical Rating Scale for Pain Intensity score, and a lower satisfaction score at time of follow-up than patients who had a single CTR. Multivariable linear regression showed that thenar muscle atrophy before the revision surgery was independently associated with more pain after revision surgery. Patients improve after revision CTR, but generally have more pain, have a higher BCTQ score, and are less satisfied at long-term follow-up compared with patients who had a single CTR.

EUS-guided versus percutaneous liver biopsy: A prospective randomized clinical trial.

Prospective studies comparing EUS-guided liver biopsy (EUS-LB) to percutaneous LB (PC-LB) are scarce. We compared the efficacy and safety of EUS-LB with those of PC-LB in a prospective randomized clinical trial. Between 2020 and 2021, patients were enrolled and randomized (1:1 ratio). The primary outcome was defined as the proportion of patients with ≥11 complete portal tracts (CPTs). The sample size (n = 80) was calculated based on the assumption that 60% of those in the EUS-LB and 90% of those in the PC-LB group will have LB with ≥11 CPTs. The secondary outcomes included proportion of patients in whom a diagnosis was established, number of CPTs, pain severity (Numeric Rating Scale-Pain Intensity), duration of hospital stay, and adverse events. Eighty patients were enrolled (median age, 53 years); 67.5% were female. Sixty percent of those in the EUS-LB and 75.0% of those in the PC-LB group met the primary outcome (P = 0.232). The median number of CPTs was higher in the PC-LB (17 vs 13; P = 0.031). The proportion of patients in whom a diagnosis was established was similar between the groups (92.5% [EUS-LB] vs 95.0% [PC-LB]; P = 1.0). Patients in the EUS-LB group had less pain severity (median Numeric Rating Scale-Pain Intensity, 2.0 vs 3.0; P = 0.003) and shorter hospital stay (2.0 vs 4.0 hours; P < 0.0001) compared with the PC-LB group. No patient experienced a serious adverse event. EUS-guided liver biopsy was safe, effective, better tolerated, and associated with a shorter hospital stay.

Continuous Intravenous Ketamine for Pain Control After Tibial or Femoral Osteotomy.

The purpose of this case series is to evaluate the potential of continuous intravenous ketamine administration as part of a multimodal strategy to reduce opioid requirements after high tibial osteotomy (HTO) and distal femoral osteotomy (DFO). We examined the average postoperative numerical rating scale pain intensity score from admission to the postanesthesia care unit to 8am of the first postoperative day of four patients who underwent HTO or DFO. Pain scores were analyzed as the time-weighted sum of pain intensity differences using the trapezoidal rule of the curve, resulting in an area under the curve (AUC). Patient A had an AUC of 2,828 over 1,180 minutes with an average pain score of 2.4/10. Patient B had an AUC of 1,418 over 1,285 minutes with an average pain score of 1.1/10. Patient C had an AUC of 4,217 over 1,155 minutes with an average pain score of 3.7/10. Patient D had an AUC of 4,498 over 1,030 minutes with an average pain score of 4.4/10. All were able to go home on postoperative day 1. This novel perioperative pain pathway including multiple non-opioid pain adjuncts and a low-dose continuous ketamine infusion is an effective method for pain management in knee periarticular osteotomies. Level 4; Case Series.

DANTE Study: The First Randomized, Double-Blind, Placebo and Active-Controlled, Parallel Arm Group Study Evaluating the Analgesic Efficacy and Safety of Dexketoprofen TrometAmol aNd Tramadol Hydrochloride Oral FixEd Dose Combination on Moderate to Severe Acute Pain in Patients with Acute Low Back Pain-Rationale and Design.

IntroductionDespite a wide range of treatment approaches and the availability of treatment recommendations or guidelines, no consensus on the most effective pharmacological therapy of low back pain (LBP) has been reached yet. Therefore, additional clinical evidence, particularly if built upon a rigorous clinical trial design, an evidence-based medication choice, and broader inclusion criteria better acknowledging the heterogeneity and intrinsic variability of LBP is needed. The DANTE study has been designed to comprehensively assess the analgesic efficacy and tolerability of dexketoprofen/tramadol (DKP/TRAM) 75/25 mg in a large cohort of patients with moderate to severe acute LBP.MethodsThe DANTE study is a phase IV, multicenter, randomized, double-blind, double-dummy parallel group, placebo, and active controlled study. The DANTE study encompasses a single-dose phase (day 1, t0–t8h) and a multiple-dose phase (from t8h to 8 h after intake of last dose at day 5). The DANTE study population includes patients naïve to LBP or patients with previous history of LBP experiencing a new episode of moderate to severe intensity with or without radiculopathy. The clinical phase of the DANTE study started in September 2020 and the anticipated completion date is April 2022.Planned OutcomesThe primary endpoint is the time to first achieve a numeric rating scale-pain intensity (NRS-PI) score of < 4 or a pain intensity reduction ≥ 30% from drug intake up to 8 h after the first dose (t8h). Secondary objectives aim are: (1) to evaluate the analgesic efficacy of TRAM/DKP 75/25 mg versus TRAM 100 mg after the first dose; (2) to evaluate the analgesic efficacy of TRAM/DKP 75/25 mg versus TRAM 100 mg after the multiple doses (from t8h until day 5, multiple dose); and (3) to assess the safety and tolerability of the TRAM/DKP 75/25 mg fixed combination after single and multiple doses.DANTE Study RegistrationEudraCT number: 2019-003656-37.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40122-022-00407-8.

Cannabis and cannabinoids for symptomatic treatment for people with multiple sclerosis.

Cannabis and cannabinoids for symptomatic treatment for people with multiple sclerosis.

Investigation of Effectiveness of Two Different Kinesiotaping Techniques in Myofascial Pain Syndrome: An Open-Label Randomized Clinical Trial

Myofascial pain syndrome is a regional musculoskeletal pain syndrome characterized by trigger points. Although there are widely accepted treatment modalities, there is no gold standard treatment. Kinesiotaping represents an interesting modality in the treatment of musculoskeletal disorders and attracts attention with studies emerging in the recent years, but in spite of the proposed benefits of kinesiotaping, its efficacy is still unclear, thus further studies evaluating the effectiveness of kinesiotaping are needed. We aimed to investigate, not only the effectiveness of kinesiotaping applied with the space correction and muscle inhibition techniques (compared to the home exercise program in reducing pain and improving functional status and quality of life in female patients with myofascial pain syndrome related to active trigger points in the upper trapezius), but also to evaluate the superiority of the 2 techniques over each other. An open-label randomized clinical trial with a parallel assignment intervention model. The physical medicine and rehabilitation clinics in Istanbul University, Istanbul Faculty of Medicine. Seventy-one female patients with the complaint of pain in the upper trapezius region, diagnosed with myofascial pain syndrome, and having at least one active trigger point in the upper trapezius fibers, were randomly assigned by a computer program to 1 of the 3 groups: kinesiotaping with the space correction technique (KSCT, n = 20), kinesiotaping with the muscle inhibition technique (KMIT, n = 24), and the home exercise program alone (control group [CG], n = 27). The patients were evaluated by the numerical rating scale for pain intensity, the neck disability index for functional status, and the 36-Item Short-Form Health Survey for quality of life in the beginning of the study and at the first, second, and sixth weeks (1-month follow-up). Kinesiotaping was associated with lower pain intensity levels (P = 0.019 at the first week and P = 0.026 at the second week) and better functional status (P = 0.011 at the second week) and it was effective in increasing quality of life by improving physical functions and general health (P = 0.033 and P = 0.003 at the second week, respectively) earlier than in the CG. Role limitations due to physical factors improved in the KMIT group earlier than in the other groups (P = 0.022 at the second week). Being performed in a limited number of female patients only, absence of a placebo group, and lack of blinded assessments. Both kinesiotaping methods were associated with lower pain intensity levels and better functional status and were effective in increasing quality of life by improving physical functions and general health earlier than the home exercise program. There was no significant difference between the kinesiotaping methods, except for role limitations due to the physical factors domain of SF-36 which was improved in the KMIT group earlier than in the KSCT group and CGs.

Changes in Trunk Variability and Stability of Gait in Patients with Chronic Low Back Pain: Impact of Laboratory versus Daily-Living Environments.

BackgroundIndividuals with chronic low back pain (CLBP) experience changes in gait control due to pain and/or fear. Although CLBP patients’ gait has been performed in laboratory environments, changes in gait control as an adaptation to unstructured daily living environments may be more pronounced than the corresponding changes in laboratory environments. We investigated the impacts of the environment and pathology on the trunk variability and stability of gait in CLBP patients.MethodsCLBP patients (n=20) and healthy controls with no low-back pain history (n=20) were tasked with walking in a laboratory or daily-living environment while wearing an accelerometer on the low back. We calculated the stride-to-stride standard deviation and multiscale sample entropy as indices of “gait variability” and the maximum Lyapunov exponent as an index of “gait stability” in both the anterior-posterior and medial-lateral directions. The participants were assessed on the numerical rating scale for pain intensity, the Tampa Scale for Kinesiophobia, and the Roland–Morris Disability Questionnaire for quality of life (QOL).ResultsIn a repeated-measures ANOVA, the standard deviation was affected by environment in the anterior-posterior direction and by group and environment in the medial-lateral direction. Multiscale sample entropy showed no effect in the anterior-posterior direction and showed both effects in the medial-lateral direction. Maximum Lyapunov exponents showed both effects in the anterior-posterior direction, but none in the medial-lateral direction. These changes of trunk motor control by CLBP patients were found to be related to pain intensity, fear of movement, and/or QOL in the daily-living environment but not in the laboratory environment.ConclusionThese results revealed that CLBP patients exhibit changes in trunk variability and stability of gait depending on the environment, and they demonstrated that these changes are related to pain, fear, and QOL. We propose useful accelerometer-based assessments of qualitative gait in CLBP patients’ daily lives, as it would provide information not available in a general practice setting.

Alpha entrainment drives pain relief using visual stimulation in a sample of chronic pain patients: a proof-of-concept controlled study.

One-third of the population in the UK and worldwide struggle with chronic pain. Entraining brain alpha activity through noninvasive visual stimulation has been shown to reduce experimental pain in healthy volunteers. Neural oscillations entrainment offers a potential noninvasive and nonpharmacological intervention for patients with chronic pain, which can be delivered in the home setting and has the potential to reduce use of medications. However, evidence supporting its use in patients with chronic pain is lacking. This study explores whether (a) alpha entrainment increase alpha power in patients and (b) whether this increase in alpha correlates with analgesia. In total, 28 patients with chronic pain sat in a comfortable position and underwent 4-min visual stimulation using customised goggles at 10 Hz (alpha) and 7 Hz (control) frequency blocks in a randomised cross-over design. 64-channel electroencephalography and 11-point numeric rating scale pain intensity and pain unpleasantness scores were recorded before and after stimulation. Electroencephalography analysis revealed frontal alpha power was significantly higher when stimulating at 10 Hz when compared to 7 Hz. There was a significant positive correlation between increased frontal alpha and reduction in pain intensity (r = 0.33; P < 0.05) and pain unpleasantness (r = 0.40; P < 0.05) in the 10 Hz block. This study provides the first proof of concept that changes in alpha power resulting from entrainment correlate with an analgesic response in patients with chronic pain. Further studies are warranted to investigate dose-response parameters and equivalence to analgesia provided by medications.

Efficacy of mebeverin in treatment of abdominal pain

An original study evaluating the effectiveness and safety of mebeverin in treatment of abdominal pain in patients with irritable bowel syndrome (IBS) are presented. Materials and methods: 40 patients diagnosed with IBS, according to the Rome Criteria IV, were monitored. Patients depending on the type of therapy were divided into two groups: 20 patients of the first group had recommendations for lifestyle modification, a hypocaloric diet and took mebeverin per os at a dose of 135 mg three times a day 20 minutes before meals for a month; 20 patients of the second group received only recommendations for lifestyle modification and a hypocaloric diet. All patients were evaluated before and after treatment using the Gastrointestinal Symptom Rating Scale (GSRS), Visual-Analog Pain Intensity Rating Scale (0–10 points), SF‑36 Quality of Life Assessment Question, adverse events assessment. Colonoscopy was performed before treatment to exclude organic pathology of the colon. Results. After treatment patients in the first group had a faster and more significant relief of complaints compared to the second group, a significant improvement in the quality of life on the scales of physical and mental functioning, as well as almost complete disappearance of pain on a visual-analog scale (7.1 out of 10 points before treatment and 0.4 points after). Conclusions. Mebeverin in a dosage of 135 mg three times a day during a month contributes to a significant improvement in well-being, optimizes the quality of life of this category of patients, is effective and safe, which allows us to recommend its use as a first-line spasmolytic drug in the complex therapy of IBS, as well as in various variants of visceral abdominal pain.

A QUASI EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF ISOMETRIC EXERCISES ON QUALITY OF LIFE AMONG THE INMATES OF ELDERLY PERSONS WITH JOINT PAIN AT SELECTED HOSPITAL, DEHRADUN, UTTARAKHAND

A QUASI EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF ISOMETRIC EXERCISES ON QUALITY OF LIFE AMONG THE INMATES OF ELDERLY PERSONS WITH JOINT PAIN AT SELECTED HOSPITAL, DEHRADUN, UTTARAKHAND

Waddell (Nonorganic) Signs and Their Association With Interventional Treatment Outcomes for Low Back Pain.

The rising use of injections to treat low back pain (LBP) has led to efforts to improve selection. Nonorganic (Waddell) signs have been shown to portend treatment failure for surgery and other therapies but have not been studied for minimally invasive interventions. We prospectively evaluated the association between Waddell signs and treatment outcome in 3 cohorts: epidural steroid injections (ESI) for leg pain and sacroiliac joint (SIJ) injections and facet interventions for LBP. Categories of Waddell signs included nonanatomic tenderness, pain during sham stimulation, discrepancy in physical examination, overreaction, and regional disturbances divulging from neuroanatomy. The primary outcome was change in patient-reported "average" numerical rating scale for pain intensity (average NRS-PI), modeled as a function of the number of Waddell signs using simple linear regression. Secondary outcomes included a binary indicator of treatment response. We conducted secondary and sensitivity analyses to account for potential confounders. We enrolled 318 patients: 152 in the ESI cohort, 102 in the facet cohort, and 64 in the SIJ cohort, having sufficient data for primary analysis on 308 patients. Among these, 62% (n = 192) had no Waddell signs, 18% (n = 54) had 1 sign, 11% (n = 33) had 2, 5% (n = 16) had 3, 2% (n = 7) had 4, and about 2% (n = 6) had all 5 signs. The mean change in average NRS-PI in each of these 6 groups was -1.6 ± 2.6, -1.1 ± 2.7, -1.5 ± 2.5, -1.6 ± 2.6, -1 ± 1.5, and 0.7 ± 2.1, respectively, and their corresponding treatment failure rates were 54% (102 of 192), 67% (36 of 54), 70% (23 of 33), 75% (12 of 16), 71% (5 of 7), and 83% (5 of 6). In the primary analysis, an increasing number of Waddell signs were not associated with a significant decrease in average NRS-PI (coefficient [Coef] = 0.19; 95% confidence interval [CI], -0.43 to 0.05; P = .12). A higher number of Waddell signs were associated with treatment failure, with a 1.35 increased odds of treatment failure per cumulative number of signs (P = .008). Whereas this study found no consistent relationship between Waddell signs and decreased mean pain scores, a significant relationship between the number of Waddell signs and treatment failure was observed.

Patients' quality of life after implantation of ZSI 375 artificial urinary sphincter due to stress urinary incontinence.

IntroductionThe study aimed to evaluate the outcomes of artificial urinary sphincter ZSI 375 implantation for stress urinary incontinence, focusing on quality of life assessment (QoL).Material and methodsThe study had a prospective and non-randomized design. It was conducted in two urological centres in Poland. Between July 2013 and June 2019, artificial urinary sphincter ZSI 375 was implanted in 86 consecutive men with stress urinary incontinence. The follow up was completed in December 2019. The assessment of functional results was based on number of pads used and declared to have been used by patients. The quality of life was assessed on the basis of the ICIQ-SF questionnaire (International Consultation on Incontinence Questionnaire-Short Form), SF-36 questionnaire (Short Form 36 Health Survey Questionnaire) and the severity of pain by means of the NRS (numerical rating scale of pain intensity).ResultsThe operations were performed in 86 patients aged 28 to 80 (median 69). With the median (SD; range) follow-up of 21 (20.2; 1–68) months, daily pad usage decreased significantly from ≥4 to 1.1 (±0.97 pads) per day. Seven (8.1%) patients achieved total continence, 60 (69.8%) social continence, 14 (16.3%) improvement and 5 (5.8%) failures (≥4 pads per day). 15 patients (17.5%) experienced complications after surgery. The study showed a significant improvement of QoL evaluated by ICIQ-UI SF and SF-36.ConclusionsTherapy with the use of ZSI 375 device is successfully applied in surgical management of moderate to severe male stress urinary incontinence. The life quality of patients assessed using questionnaires is at a high level.

Inhaled Methoxyflurane Provides Greater Analgesia and Faster Onset of Action Versus Standard Analgesia in Patients With Trauma Pain: InMEDIATE: A Randomized Controlled Trial in Emergency Departments

The objective of the InMEDIATE study was to evaluate the change in intensity of traumatic pain over the first 20 min in adult patients treated with methoxyflurane versus standard analgesic treatment in Spain. This the first randomized, active-controlled, multicenter trial of methoxyflurane in the emergency setting in Europe. This was a randomized, controlled study that enrolled adult patients with acute moderate to severe (score ≥4 on the 11-point Numeric Rating Scale) trauma-associated pain in 14 Spanish emergency departments. Patients were randomized 1:1 to methoxyflurane (up to 2×3 mL) or standard analgesic treatment. Coprimary endpoints were the change from baseline in Numeric Rating Scale pain intensity score during the first 20 minutes of treatment and time to first pain relief. Three hundred five patients were randomized (methoxyflurane 156; standard analgesic treatment 149). Most patients in the standard analgesic treatment group (70%) received intravenous first-step analgesics and 9.4% of patients were treated with opioids. Mean decrease from baseline in Numeric Rating Scale pain intensity score was greater for methoxyflurane than standard analgesic treatment at all points, with a significant treatment difference overall up to 20 minutes (repeated-measures model 2.47 versus 1.39; treatment difference 1.00; 95% confidence interval 0.84 to 1.32). Median time to first pain relief was significantly shorter for methoxyflurane than standard analgesic treatment (3 versus 10 minutes). Methoxyflurane achieved better patient and clinician ratings for pain control and comfort of treatment than standard analgesic treatment and exceeded patient and clinician expectations of treatment in, respectively, 77% and 72% of cases compared with 38% and 19% for standard analgesic treatment. These results support consideration of methoxyflurane as a nonnarcotic, easy-to-administer, rapid-acting, first-line alternative to currently available analgesic treatments for trauma pain.

Self-Efficacy Mediates the Attachment-Pain Association in Couples with Provoked Vestibulodynia: A Prospective Study

IntroductionAttachment influences the way individuals anticipate, react, and seek support when faced with chronic pain. Although cross-sectional research indicates that attachment insecurity and pain self-efficacy are associated with pain intensity in chronic pain populations, little is known about their long-term effects on pain, and about the directionality of associations between these constructs. Furthermore, whereas attachment is a relational concept, few studies on genito-pelvic pain have espoused a couples’ perspective. AimUsing a prospective dyadic design, the present study aimed to examine the directionality of the associations among attachment dimensions, pain self-efficacy, and pain intensity in couples coping with provoked vestibulodynia (PVD). A second aim was to test whether pain self-efficacy mediated the attachment-pain association. Methods213 couples coping with PVD completed self-report questionnaires at baseline (T1) and at a 2-year follow-up (T2). Main Outcome Measure(1) Experiences in Close Relationships – Revised; (2) Painful Intercourse Self-Efficacy Scale; and (3) 10-point Numerical Rating Scale for pain intensity. ResultsAutoregressive cross-lagged models revealed that women’s greater attachment anxiety and avoidance at T1 predicted their greater pain intensity at T2. Women’s greater attachment anxiety at T1 predicted their poorer pain self-efficacy at T2, and poorer pain self-efficacy in women at T1 predicted their higher pain intensity at T2. A mediation model showed that women’s lower pain self-efficacy at T2 fully mediated the association between women’s higher attachment anxiety at T1 and their higher pain intensity at T2. Partners’ attachment dimensions did not predict their own or women’s pain self-efficacy nor pain intensity. Clinical ImplicationsResults suggest that greater attachment anxiety may contribute to women with PVD’s lower confidence that they can manage their pain, which leads to long-term persistent pain. This study highlights the importance of assessing attachment and pain self-efficacy in women with genito-pelvic pain and to consider interventions targeting these variables, as they have far-reaching consequences. Strength & LimitationsThe use of longitudinal and dyadic data inform interpersonal processes and the long-term implications of attachment and pain self-efficacy in PVD. The use of self-report measures may introduce a social desirability and recall bias. ConclusionThis prospective dyadic study adds to a body of literature on PVD and chronic pain by empirically supporting theoretical models on attachment, pain self-efficacy, and persistent pain, and supports the role of psychosocial factors in the adjustment to PVD.Charbonneau-Lefebvre V, Vaillancourt-Morel M-P, Brassard A, et al. Self-Efficacy Mediates the Attachment-Pain Association in Couples with Provoked Vestibulodynia: A Prospective Study. J Sex Med 2019;16:1803–1813.

Pragmatic cluster randomised double-blind pilot and feasibility trial of an active behavioural physiotherapy intervention for acute non-specific neck pain: a mixed-methods protocol

IntroductionNon-specific neck pain causes pain and disability and contributes substantial socioeconomic burden internationally. Up to 50% of adults experience neck pain annually, leading to reduced the quality of life. An...

What are the Implications of Excessive Internet Searches for Medical Information by Orthopaedic Patients?

Cyberchondria may be defined as heightened distress evoked through excessive searches of the internet for medical information. In healthy people, cyberchondria is associated with a greater intolerance of uncertainty and greater health anxiety. These relationships are likely bidirectional. People who have a greater intolerance of uncertainty may be more likely to search the internet for medical information and have greater health anxiety. This greater health anxiety may lead to an increased likelihood of engaging in further internet searches and greater intolerance of uncertainty. These three constructs are important for patients because they impact patient function and health care costs. We were specifically interested in understanding the role of cyberchondria in the association between intolerance of uncertainty and health anxiety among orthopaedic patients because it has not been explored before and because knowledge about these interactions could inform treatment recommendations. Does cyberchondria mediate (that is, explain) the association between intolerance of uncertainty and health anxiety in orthopaedic patients searching for medical information on the internet, after controlling for potentially confounding variables? This was a cross-sectional study of 104 patients who had searched the internet for any medical information about their current condition. A research assistant approached 155 patients attending two orthopaedic outpatient clinics, one hand and upper extremity service and one sports medicine clinic, during a 3-month period. Ten patients declined to participate and 41 patients were excluded, predominantly because they had never searched for medical information online. The patients completed the Cyberchondria Severity Scale, Intolerance of Uncertainty Scale-short version, Short Health Anxiety Inventory, and a numerical rating scale for pain intensity at baseline, as well as demographic and clinical questionnaires. We performed a series of linear regression analyses to determine whether a greater intolerance of uncertainty predicts greater cyberchondria (mediator) and whether cyberchondria predicts greater health anxiety. Although it is more appropriate to use the language of association (such as "whether cyberchondria is associated with health anxiety") in many observational studies, here, we opted to use the language of causation because this is the conventional language for studies testing statistical mediation. After controlling for potentially confounding variables including pain intensity, multiple pain conditions, and education, cyberchondria explained 33% of the variance of the effect of intolerance of uncertainty on health anxiety (95% CI, 6.98 to 114.72%; p < 0.001). Among orthopaedic patients who search the internet for medical information, a greater intolerance of uncertainty is associated with greater cyberchondria, which is associated with greater anxiety about health. Identifying patients with an intolerance of uncertainty and educating them about the negative role of compulsive searches for medical information may improve the success of orthopaedic treatment. Orthopaedic surgeons should also consider making referrals for cognitive behavioral therapy in these instances to increase the patient's tolerance of uncertainty, decrease internet searching habits, and reduce anxiety about health. Level III, prognostic study.

The adoption of person-centred care in chiropractic practice and its effect on non-specific spinal pain: An observational study

ObjectivesThe objectives of this study were to identify: 1) the extent to which final year chiropractic students used components of person-centred care in a clinical setting; and 2) determine the effect of chiropractic students’ use of person-centred care on musculoskeletal pain. Design/settingAn observational study was conducted at three Western Australian chiropractic teaching clinics. InterventionsPragmatic individualised chiropractic care was delivered to 108 adults who experienced non-specific spinal pain. Main outcome measuresThe instruments used in this study were the Consultation and Relational Empathy questionnaire, Picker Musculoskeletal Disorder Questionnaire, and Numerical Rating scale for Pain intensity. ResultsParticipants experienced reductions in pain that exceeded the level required for minimal clinically reported improvement. In addition, high levels of empathy and patient -centred care were reported. Ceiling effects for the measures assessing empathy and patient-centred care precluded analyses examining the relationship between changes in pain intensity, empathy, and patient-centred care. ConclusionsThe participants in this study displayed very positive attitudes about most aspects of the chiropractic students’ person-centred care skills. Person-centred care processes for which there was considerable scope for improvement included advice about alternative treatment options, and the adaptation of lifestyle and workplace situations to alleviate pain and enhance health. Our findings also showed that the participants experienced clinically important improvement in pain. However, the skewed nature of our dataset precluded identifying whether the students’ person-centred care skills influenced such improvement.

(406) Comparative Effectiveness of CL-108 and Ibuprofen for Acute Postoperative Pain

Comparative effectiveness studies can provide clinically meaningful and useful evidence of drug performance. The comparative effectiveness of ibuprofen and CL-108 (hydro-codone 7.5 mg/acetaminophen 325 mg/low-dose promethazine 12.5 mg) for acute postoperative pain was examined post hoc when it was noted that all patients in the placebo treatment group in a randomized controlled trial1 had used multiple doses of ibuprofen as needed throughout the 48-hour treatment evaluation period. Pharmacologically, these were ibuprofen-treated patients. This observation provided an opportunity to compare the effectiveness of treatment with only ibuprofen or CL-108. After unilateral first metatarsal bunionectomy, patients with moderate or severe pain measured on a categorical pain intensity scale and a 0-to-10 numeric pain intensity rating scale (PI-NRS) were randomly assigned to use CL-108 or placebo under double-blind conditions. Patients were administered study medication every 4-6 hours while under observation for 48 hours and could use open-label ibuprofen 400 mg as rescue analgesic medication (without any other analgesic) every 4-6 hours as needed for pain. At regular intervals over the 48-hour treatment evaluation period, patients rated pain intensity on the PI-NRS. Summed pain intensity differences were calculated based on the patients’ pain intensity ratings (i.e., without imputation) over 24 hours and over 48 hours (SPID24, SPID48), comparing analgesic effectiveness for patients who used CL-108 (n=99) and patients in the placebo group (n=50), all of whom used ibuprofen (IBU). Over the initial 24 hours of treatment, patients using CL-108 had 127% greater SPID24 values than IBU-treated patients (75.8 and 33.4, respectively, p<0.001). Over the entire 48-hour treatment evaluation period, patients using CL-108 had 62% greater SPID48 values than IBU-treated patients (178.5 and 110.0, p<0.001). These analgesic outcomes indicate that treatment with CL-108 is more effective than as-needed ibuprofen for acute postoperative pain. Comparative effectiveness studies can provide clinically meaningful and useful evidence of drug performance. The comparative effectiveness of ibuprofen and CL-108 (hydro-codone 7.5 mg/acetaminophen 325 mg/low-dose promethazine 12.5 mg) for acute postoperative pain was examined post hoc when it was noted that all patients in the placebo treatment group in a randomized controlled trial1 had used multiple doses of ibuprofen as needed throughout the 48-hour treatment evaluation period. Pharmacologically, these were ibuprofen-treated patients. This observation provided an opportunity to compare the effectiveness of treatment with only ibuprofen or CL-108. After unilateral first metatarsal bunionectomy, patients with moderate or severe pain measured on a categorical pain intensity scale and a 0-to-10 numeric pain intensity rating scale (PI-NRS) were randomly assigned to use CL-108 or placebo under double-blind conditions. Patients were administered study medication every 4-6 hours while under observation for 48 hours and could use open-label ibuprofen 400 mg as rescue analgesic medication (without any other analgesic) every 4-6 hours as needed for pain. At regular intervals over the 48-hour treatment evaluation period, patients rated pain intensity on the PI-NRS. Summed pain intensity differences were calculated based on the patients’ pain intensity ratings (i.e., without imputation) over 24 hours and over 48 hours (SPID24, SPID48), comparing analgesic effectiveness for patients who used CL-108 (n=99) and patients in the placebo group (n=50), all of whom used ibuprofen (IBU). Over the initial 24 hours of treatment, patients using CL-108 had 127% greater SPID24 values than IBU-treated patients (75.8 and 33.4, respectively, p<0.001). Over the entire 48-hour treatment evaluation period, patients using CL-108 had 62% greater SPID48 values than IBU-treated patients (178.5 and 110.0, p<0.001). These analgesic outcomes indicate that treatment with CL-108 is more effective than as-needed ibuprofen for acute postoperative pain.

Methadone vs. morphine SR for treatment of neuropathic pain: A randomized controlled trial and the challenges in recruitment

ABSTRACT Introduction Accumulating evidence has identified a number of advantages for methadone over other opioids for the treatment of chronic pain including: agonist action at both μ and δ opioid receptors, N-methyl-d-aspartate (NMDA) antagonist activity and the ability to inhibit the reuptake of monoamines. It was hypothesized that with these three mechanisms of action methadone might be a good option for the treatment of neuropathic pain. Methods This was a double-blind randomized controlled trial comparing methadone to controlled-release morphine. The primary objective was to determine whether methadone is clinically inferior versus noninferior to morphine as an analgesic. Results We attempted recruitment at three academic pain centers over a 3-year period. In the end only 14 participants were able to be recruited; 5 withdrew and only 9 completed the trial. This study was underpowered. All participants showed a mean reduction in pain intensity according to the Numeric Rating Scale for Pain Intensity (morphine 5.86 to 4.38, methadone 6.11 to 4.5) and reported pain relief compared to pretreatment, but the sample size was too small for statistical analysis. Discussion Reasons for challenges in recruitment included tight inclusion and exclusion criteria and high participant burden. In addition, there was significant heterogeneity of patients between the three sites, leading to differences in reasons for exclusion. This included seemingly disparate reasons at the different sites, including few participants who were methadone naïve vs. avoidance or fear of opioids. In the end, we were unable to answer the question of the study.