Size Of Painful Area Research Articles

Peripheral Nerve Field Stimulation for Chronic Back Pain: Therapy Outcome Predictive Factors.

To identify variables that influence pain reduction following peripheral nerve field stimulation (PNFS) in order to identify a potential responder profile. Exploratory univariate and multivariate (random forest) analyses were performed separately on 2 randomized controlled trials and a registry; all included patients with chronic back pain, mainly failed back surgery syndrome. An international expert panel judged the clinical relevance of variables to identify responders by consensus. Variables identified that may help predict PNFS success in patients with back pain include patient and pain characteristics (age, time since onset of pain and spinal surgery, pain medication history, position and size of pain area, pain severity, mixed nociceptive/neuropathic pain, health-related quality of life, depression, functional disability, and leg pain status), implant procedure variables (the number and position of leads, paresthesia coverage, and amount of pain relief during the trial), and programming (number of programs, cathodes, and anodes; pulse rate; pulse width; and percentage of device usage). While these analyses are exploratory and restricted to a limited sample size, they suggest variables that may play a role in predicting a therapeutic response. These results, however, are informative only and should be cautiously interpreted. Future research to validate the variables in a clinical study is needed.

The Efficacy of Ultrasound-facilitated Electrical Stimulation as an Adjunct to Exercise in Treating Chronic Neck and Shoulder Pain

AbstractObjective: To evaluate the effectiveness of ultrasound [US]-facilitated electrical stimulation [US/ES] of thoracic spine area trigger points [TrPs] as an adjunct to exercise/electrical stimulation therapy alone in patients with chronic neck and shoulders pain.Methods: Subjects were randomly allocated into two treatment groups; one group to receive classic treatment [exercise plus ES] and the second group in which the classic treatment was supplemented with US/ES treatment of TrPs in the upper trunk area on the painful side. Participants were tested for pain intensity using a visual analog scale [VAS] for pain, Box plots [Box], Margolis' scoring system [size of pain area], and pain self-efficacy questionnaire [PSEQ].Results: Forty two male and female patients, aged 27 and 76 years, entered the study and 39 patients [34 women and five men; aged 51.8 ± 10 years] completed the study. The group that received the additional US/ES treatment exhibited greater improvements in pain intensity [Box, p = 0.05;...

A double-blind placebo-controlled investigation into the effects of interferential therapy on experimentally induced pain using a cross-over design

AbstractObjectivesTo investigate the analgesic effect of interferential therapy (IFT) on experimentally induced anterior knee pain.MethodsA double-blind placebo-controlled investigation was undertaken on 10 healthy subjects. Anterior knee pain was induced by an injection of hypertonic saline into the medial infrapatellar fat pad. Immediately, following the injection, subjects received 20 minutes of each of the following conditions: control, placebo IFT, 4 Hz IFT, or 100 Hz IFT, in random order on four separate days. Pain severity and the size of the painful region every 30 seconds were recorded until pain ceased. The location of the pain was recorded at 2, 7, and 12 minutes after the painful injection using a standardized figure of the knee divided into nine segments.ResultsThere was no effect of condition on pain severity, size of painful area, maximum reported pain severity, maximum size of painful area, duration of pain, total pain severity, and the total size of the painful area (all P > 0.09). There ...

Nummular headache with and without exacerbations: Comparative characteristics in a series of 72 patients*

Apart from the characteristic chronic head pain in a coin-shaped circumscribed area, superimposed exacerbations have been described from early reports of nummular headache (NH). In a prospective series, we aim to compare the demographic and clinical characteristics between cases of exacerbations (ENH) and non-exacerbations (NENH) in NH. Seventy-two NH patients (44 female, 28 male) attending a headache outpatient office. As eight patients presented with bifocal NH we analysed 80 painful areas; 47 (58.8%) presented in situ exacerbations. Mean intensity of exacerbations was 7.5 ± 1.6 and they lasted 5.7 ± 11.6 minutes. Exacerbation quality was mostly stabbing. We found no differences between ENH and NEHN groups in age at onset, baseline pain intensity, size of painful area, allodynia or other sensory symptoms, or baseline pain quality. There were no differences between populations with respect to relief with symptomatic therapy, requirement of preventative therapy and its response to preventatives. In situ exacerbations superimposed on baseline pain are frequent in NH and might be included in diagnostic criteria. No statistically significant differences were found between ENH and NENH cases in demographic and nosological characteristics, or needing or response to therapy, but these sample sizes are small.

Computer-aided surface estimation of pain drawings – intra- and inter-rater reliability

Pain drawings are often utilized in the documentation of pain conditions. The aim here was to investigate intra- and inter-rater reliability of area measurements performed on pain drawings consecutively, using the computer program Quantify One. Forty-eight patients with chronic nonmalignant pain had shaded in their experienced pain on the front and back views of a pain drawing. The templates were scanned and displayed on a 17-inch computer screen. Two independent examiners systematically encircled the shaded-in areas of the pain drawings with help of a computer mouse, twice each on two separate days, respectively. With this method it is possible to encircle each marked area and to obtain immediate details of its size. The total surface area (mm2) was calculated for each pain drawing measurement. Each examiner measured about 2400 areas, and as a whole, the number of areas measured varied only by 3%. The intra-rater reliability was high with intraclass correlation coefficients 0.992 in Examiner A and 0.998 in Examiner B. The intra-individual absolute differences were small within patients within one examiner as well as between the two examiners. The inter-rater reliability was also high. Still, significant differences in the absolute mean areas (13%) were seen between the two examiners in the second to fourth measurement sessions, indicating that one of the examiners measured systematically less. The measurement error was ≤10%, indicating that use of the program would be advantageous both in clinical practice and in research, but if repeated, preferably with the same examiner. Since pain drawings with this method are digitized, high quality data without loss of information is possible to store in electronic medical records for later analysis, both regarding precise location and size of pain area. We conclude that the computer program Quantify One is a reliable method to calculate the areas of pain drawings.

Depression and anxiety are not related to nummular headache

Nummular headache (NH) is a clinical picture characterized by head pain that is exclusively felt in a round, elliptical, or oval area of the head. Although there is evidence supporting an organic origin for NH, some authors question this origin, hypothesizing a potential role for psychological factors. Our aims were to investigate the differences in anxiety and depression between NH patients and healthy controls, and to analyse if these conditions were related to pain parameters in NH patients. The Beck depression inventory (BDI-II) and the trait anxiety scale from state-trait anxiety inventory (STAI) were administered to 26 patients with NH and 34 comparable matched controls. No significant interactions between group (NH patients, controls) in either depression (U = 391; p = 0.443) or anxiety levels (U = 336; p = 0.113) were found. Both groups showed similar scores in the BDI-II (patients: 3.9 ± 2.9; controls: 3.46 ± 3.15) and STAI (patients: 17.23 ± 10.3; controls: 13.5 ± 7.9). Moreover, neither depression nor anxiety showed association with mean pain intensity, pain intensity in exacerbations, size of pain area, or pain frequency. Our study demonstrated that self-reported depression and anxiety were not related to the presence of NH. Further, longitudinal studies are still needed to elucidate the role of mood state in the course of NH.