Variation In Pain Intensity Research Articles

Factors Associated with Disability and Pain Intensity among Patients Presenting to a Sports Medicine Practice

PURPOSE:Psychological factors play an important role in the difference between physical impairment and the magnitude of disability. This study addressed the primary null hypothesis that there is no independent association between magnitude of disability and symptoms of depression, controlling for other factors among patients presenting to a tertiary care sports medicine practice. METHODS: In this cross-sectional study, 116 patients participated that presented to one of two orthopaedic sports surgeons or a physiatrist. The mean age was 43 years. We used Patient Reported Outcome Measurement Information System Computer Adaptive Tests (PROMIS CAT) to measure: limitations of physical function, symptoms of depression and coping strategies in response to pain. We used an 11-point measure of pain intensity from 0 to 10 and reported patient’s physical activity status. Multivariable regression analysis was performed to identify which factors have the strongest independent influence on disability and pain intensity. RESULTS:In bivariate analysis, we found an association between symptoms of depression and disability. In multivariable analysis, we found that symptoms of depression was not independently associated with disability. However, we did find a strong independent association between coping strategies in response to pain and disability (p <0.001, partial R-squared = 0.35), that explains 50% of the variability of disability in the final model. Also in bivariate analysis, we found an association between symptoms of depression and pain intensity, although, there was no independent association in multivariable analysis. However, there was a strong independent association between coping strategies in response to pain and pain intensity (p < 0.001, partial R-squared = 0.22), that explains, along with age and female race, 50% of the variability of pain intensity in the final model. CONCLUSIONS:The variation in pain intensity and magnitude of disability in patients presenting to a sports specialist is not associated with symptoms of depression, however, we found a strong association with coping strategies in response to pain. Interventions to optimize coping strategies (self-efficacy) may decrease the magnitude of disability and pain intensity in patients presenting to a sports medicine practice.

Perceived stress and musculoskeletal pain are prevalent and significantly associated in adolescents: an epidemiological cross-sectional study.

BackgroundLong-term musculoskeletal pain and negative stress are health risks with adverse long-term health effects, and these health risks seem to increase among young people. The mechanisms behind this are unclear. There is a need for a better understanding of perceived stress and musculoskeletal pain among adolescents, in order to improve health promotion and treatment approaches in this group.MethodsObjectives were to evaluate the current prevalence of perceived stress and musculoskeletal pain in 15 and 16 year olds, to explore stress-pain associations and the probability that perceived stress (PSQ) was related to the reporting of pain and variations in pain, and to investigate possible differences in stress between different types of musculoskeletal pain in the adolescents. A cross-sectional study was conducted. Elementary schools participated. The outcomes were stress (Perceived stress questionnaire; PSQ) and musculoskeletal pain (pain/no pain, pain sites, pain duration and pain intensity (Visual analogue scale; VAS).ResultsFifty-one point two percent (N = 422) reported pain, of which 70.8 % reported long-term pain. Some more girls (57.9 %) reported pain. 22.0 % of the study population reported moderate to severe stress (PSQ ≥ 0.45), of which 79.6 % were bothered by pain (Pearson Chi-square 38.47, p ≤ .001). All stress and pain variables were significantly associated (p < .01). The strongest association appeared between pain intensity (VAS) and stress (PSQ) (r = 0.40). Perceived stress (PSQ) was associated with the reporting of pain among the adolescents (Odds Ratio [OR] 1.68) and could explain some of the variation in pain intensity (VAS; β = 0.15, p < .001) and number of pain sites (β = 0.14, p < .01), according to the regression analyses. There were no mean differences in stress (PSQ) between different types of musculoskeletal pain.ConclusionsThere was high prevalence of musculoskeletal pain, long-term pain and moderate to severe stress (PSQ ≥ 0.45) in this study sample. Perceived stress (PSQ) was related to the reporting of musculoskeletal pain among the adolescents and could explain some of the variation in pain intensity (VAS) and number of pain sites. There were no differences in stress levels (PSQ) between different types of musculoskeletal pain in the adolescents.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2414-x) contains supplementary material, which is available to authorized users.

Within-Day Variability of Pain and Its Relation to Quality of Life in Children with Juvenile Primary Fibromyalgia Syndrome

AbstractObjective: To determine the variability in pain intensity experienced by children with Juvenile Primary Fibromyalgia Syndrome (JPFS) and to relate within-day patterns of pain to children’s quality of life.Subjects and methods: Pain intensity was self-reported on a 0–10 cm visual analog scale by 46 young subjects with JPFS using a daily booklet chart three times a day for seven days. Forty-six healthy children and adolescents matched by age and sex were randomly recruited as controls from a pediatric clinic on a voluntary basis. Variability in pain during the day was investigated using a multidimensional pain survey that was completed three times daily in a printed booklet for one week and was related in the primary evaluation to scores for tender points and pediatric quality of life (PedsQL v 4.0).Results: Variations in pain intensity were observed during the day in patients with JPFS. The majority of JPFS patients (67%) had a high Average Absolute Change (AAC) in pain (>1 VAS unit), and a lower q...

An analysis of the variability of breakthrough pain intensity in patients with cancer.

The management of breakthrough pain in patients with cancer (BTPc) generally includes an initial titration of breakthrough pain medication to an effective dose, followed by the use of that dose in all subsequent episodes. This strategy presumes that an individual patient has a degree of consistency of pain during repeat episodes; however, that presumption has not been formally assessed. To examine the variation in pain intensity of BTPc episodes within individual patients and across patients. Data were pooled from 2 randomized, double-blind, crossover studies that used fentanyl pectin nasal spray (FPNS) vs comparator to relieve BTPc. Eligible patients were adults with an Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2 and adequately controlled background pain. The FPNS dose was titrated prior to a double-blind treatment consisting of 10 episodes. Pain intensity was reported on an 11-point numeric scale in which 0 = no pain and 10 = worst possible pain. Inter- and intrapatient variabilities of baseline pain intensity scores per episode were analyzed by analysis of covariance via a mixed-effect model. The influences of demographics and ECOG grade at study entry were assessed. Mean baseline pain intensity score was 7.3 (standard deviation, 1.76; range, 2-10) across 1,399 BTPc episodes in 152 patients. The interpatient variability of baseline pain intensity scores was 75.96%; intrapatient variability was 20.64%. Fixed terms for demographics and ECOG grade did not significantly influence baseline pain intensity score (≤ 5% level). This was a post hoc analysis. Baseline pain intensity scores during episodes of BTPc vary widely between patients, but vary little within individual patients; this supports the use of a consistent maintenance dosage of analgesia for BTPc, once it has been titrated to an effective dose. The study was funded by Archimedes Development Ltd.

Pain management following new and long-standing spinal cord injury

The aim of the study was to examine variations in pain intensity during the day experienced by patients with spinal cord injury. Fourteen consecutive patients had clinical and demographic data recorded. Pain intensity was recorded using a Graphic Rating Scale (GRS) at 2-3-h intervals. Patients were grouped according to maximum GRS into mild and severe groups at assessment (T0). Changes of one-third in GRS were deemed clinically significant. Eight men and six women (mean age 53.1; SD 16.5; range 28-75) were studied. Seven patients with mild pain tended to deteriorate and those with severe pain to improve. Eight patients demonstrated clinically significant changes. These findings suggest inadequate pain control early morning for one group and increasing pain during the day for another. Use of such simple scores over time would enhance pain rehabilitation for all spinal cord injury patients. Usual GRS reporting may mask clinically significant, treatable, changes in pain.

CORR Insights®: The Peripheral Neuronal Phenotype is Important in the Pathogenesis of Painful Human Tendinopathy: A Systematic Review

Where are We Now? Myxoid degeneration is commonly found in various attachment points of tendon or ligament to bone during the middle third of a patient’s life, regardless of his or her activity level [3]. Enthesopathies are characterized by a benign, self-limiting course [1, 4, 6], although some tendons — often previously asymptomatic — rupture and rotator cuff tendinopathy can progress to a large defect that leads to arthropathy. “Overuse” and “microtears” are appealing concepts that do not seem plausible given the epidemiology and natural history of most enthesopathies. Perhaps most puzzling is the unexplained variation in pain intensity and magnitude of disability. In the biomedical illness paradigm, we attempt to reduce illness to specific pathophysiologies, including variations in neuronal phenotype as addressed in the current study. If we can identify pathophysiology at the heart of the variations, we can intervene to correct the physiology, ultimately reducing symptoms and disability. The data in the current study indicated some alterations in nerve physiology. Unfortunately, the control groups are inadequate. It is unclear if the pathophysiology is the cause or consequence of the disease. Additionally, it is unclear if neuronal pathophysiology correlates with symptoms and disability. Where Do We Need to Go? Nociception is the pathophysiology of actual or potential tissue damage. The biochemical changes produced by pinching yourself create signals that are carried through the nerves, to the spinal cord, and the brain. Pain is the cognitive, emotional, and behavioral response to nociception. Some nociception, like a yoga stretch, is good. Some nociception, such as a burn from a hot pan, is bad. However, the vast majority of nociception is neutral. There are the aches and pains that are more common as we age. Then there are the backaches, headaches and stomach aches that are unpleasant but do not indicate any concerning pathophysiology. Addressing nociception can be fruitful. For instance, aspirin and acetaminophen can alter the nociceptive pathway and decrease pain. Yet, this can be misleading. As the number of placebo injection-controlled, double-blind, prospective, randomized trials of corticosteroid injection for lateral epicondylitis grows, it becomes increasingly difficult to escape the conclusion that our confidence in this treatment was nothing more than wishful thinking and self-deception [1, 4]. It is time to take a broader, more inclusive view of the human illness experience. We can benefit from a biopsychosocial illness paradigm. How Do We Get There? The amount of pain experienced for a given nociception is largely a matter of mindset and circumstances. Psychological (self-efficacy, catastrophic thinking, symptoms of depression, heightened illness concern) and sociological factors (culture, secondary gain, circumstantial family and life stressors), consistently account for more symptom and disability variation compared with pathophysiology measures (motion, radiological tests) [1, 5]. By studying neuropathology, we may discover additional ways to lessen the pain and disability associated with enthesopathies. I believe we may help our patients more if we find nonmedical ways to restore trust in a painful limb. As Nobel Prize-winning psychologist Daniel Kahneman demonstrated for economics [2], the key to good health may simply be making the effort to rethink our “first impressions” or intuitive interpretations of nociception and other symptoms [5].

Does postural sway change in association with manual therapeutic interventions? A review of the literature

Study designLiterature ReviewObjectivesThe objective of this literature review was to determine if postural sway changes in association with manual therapeutic interventions and to investigate whether any changes occur in healthy individuals or in association with pain intensity.Summary of Background dataImproving postural stability has been proposed as a goal of manual therapeutic interventions. So far, no literature review has addressed whether there is supportive evidence for this and if so, what factors may be associated or causative for observed sway alterations.Search methodsSeven online databases (PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, ScienceDirect and the Cochrane library) were systematically searched followed by a manual search of the retrieved papers.Selection criteriaStudies comparing postural sway derived from bipedal force plate measurements in association with a manual therapeutic intervention, ideally compared to a control group.Data collection and analysisTwo reviewers independently screened titles and abstracts for relevance, conducted the data extraction and the risk of bias assessment which was conducted using the RTI item bank. A descriptive analysis was conducted as the heterogeneous study designs prevented pooling of data.ResultsNine studies of varying methodological quality met the inclusion criteria. No direct comparison of data across the studies was possible. There was no evidence that manual interventions lead to a change in postural sway in healthy individuals regardless of the body regions addressed by the intervention. There was some indication that postural sway may change at follow-up measurements in pain sufferers; however, this may be due to variations in pain intensity rather than resulting from the intervention itself.ConclusionsThere is no conclusive scientific evidence that manual therapeutic interventions may exhibit any immediate or long-term effect on COP excursions. Any changes in sway may be attributable to decreases in pain intensity.

Dynamic, but not static, pain sensitivity predicts exercise-induced muscle pain: Covariation of temporal sensory summation and pain intensity

Cross-section studies suggest that measures of pain sensitivity, derived from quantitative sensory testing (QST), are elevated in persons with chronic pain conditions. However, little is known about whether development of chronic pain is preceded by elevated pain sensitivity or pain sensitivity increases as a result of prolonged experience of pain. Here we used QST to test static (single suprathreshold stimuli) and dynamic (temporal sensory summation) pain processing of thermal stimuli. Muscle pain was induced using high-intensity exercise (DOMS). Multi-level modeling approaches determined the daily covariation among static and dynamic QST measures and pain intensity. Variation in responses to static pain sensitivity was not associated with pain intensity from DOMS while, in contrast, variation in dynamic pain sensitivity was positively associated with variation in pain intensity from DOMS. This finding supports the use of TSS as a marker of the central pain state and potentially as an appropriate measure for treatment monitoring.

Trajectories of Pain and Analgesics in Oncology Outpatients With Metastatic Bone Pain During Participation in a Psychoeducational Intervention Study to Improve Pain Management

A large number of oncology patients with bone metastasis report significant and often unrelieved pain that is associated with reduced quality of life and impaired functional status. Our research team previously assessed the efficacy of a tailored self-care psychoeducational intervention to improve pain management in these patients. Samplewide analyses demonstrated improvements in pain intensity and analgesic prescriptions. However, substantial interindividual variability was observed within the intervention group. In the current paper, hierarchical linear modeling (HLM) was used to determine factors that contributed to variability in pain intensity and analgesic prescription and intake in the sample of patients who participated in the intervention. Specifically, HLM analyses identified demographic, clinical, and psychological characteristics that predicted variation in pain intensity and analgesic prescription and intake at baseline (intercepts) and over the course of the 6-week study (trajectories). Awareness of these predictors may be particularly useful for the identification of patients who would benefit most from this type of intervention. Furthermore, these findings highlight specific aspects of the intervention that may be modified in order to further improve pain management in these patients. Perspective This paper describes the application of HLM to explain interindividual variability in pain and analgesic outcomes among oncology outpatients with metastatic bone pain who participated in a psychoeducational intervention to improve pain management. Findings identify particularly responsive subgroups, areas for improvement to the intervention, and targets for future intervention.

Predictors of Pain Intensity and Disability After Minor Hand Surgery

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

Ear acupuncture in the control of migraine pain: selecting the right acupoints by the “needle-contact test”

There is increasing evidence that somatic acupuncture can be helpful in migraine treatment, but substantial data on ear acupuncture (EAP) are still lacking. EAP can be useful both in the diagnosis and in the treatment of many medical conditions. As regards the control of migrainous pain, we present a case report in which a procedure called the "needle-contact test" is described in detail. During a migraine attack, the patient undergoes an accurate search for tender points of the outer ear by means of a specific pressure algometer. Once the most sensitive point has been identified, an acupuncture needle is placed in contact with it for about 10 s, without skin penetration. The expected effect is a quick and evident reduction of acute pain. If no appreciable variation in pain intensity occurs within the following 60 s, a second or third attempt is made on other previously identified tender points, until the point at which the patient notices a clear remission of pain is found. In this positive case, the same testing needle can be immediately used for therapy, completely penetrating the skin, and then extracted after about 30 min. Alternatively, a temporary needle can be implanted and left in situ for a variable period of time (1-15 days). This innovative technique allows the identification, with maximum accuracy, of the most effective ear acupoints on migraine pain during acute attacks.

Pain caused by photodynamic therapy of skin cancer.

Pain resulting from photodynamic therapy (PDT) of skin cancer was investigated. The study included 69 lesions (60 patients) with different types of skin tumours or precursors. Protoporphyrin IX, which is produced by the topical application of delta-aminolevulinic acid, was used as a photosensitizing agent. Twenty-three of the lesions (19 patients) were examined with a fluorescence imaging system which demarcates the tumour area from the healthy skin and visualizes the contrast between the fluorescence from healthy skin and that from the tumour. EMLA is used on all patients as part of our routine PDT protocol but despite this the major side-effect of PDT is pain during treatment. There is a large variation in pain intensity experienced by the patients, as measured by a visual analogue scale (VAS). Patients with actinic keratoses experienced more pain than those with Bowen's disease or basal cell carcinoma. The mean VAS score was higher when treating lesions located on the head than when treating lesions on the torso or the extremities. Also, treatment of large skin areas resulted in more pain than treatment of small areas, and men experienced more pain than women. The pain experienced by the patients did not correlate with treatment dose, Fitzpatrick skin type, age or fluorescence intensity.

Background pain in burn patients: routine measurement and recording of pain intensity in a burn unit

It goes without saying that pain following a burn must be treated but it is not so evident to measure and document the intensity of pain and the efficacy of treatment. Since 1994 the authors have routinely measured background pain, that is, at rest, along with temperature and pulse rate. For analysis and quality assessment a relational database programme is used in the ward. In this paper the authors' experience is reported from a consecative series of 98 patients with burn injuries who assessed the intensity of pain on a visual analogue scale. There were great intra- and inter-individual variations in pain intensity. Highest values were found during the first week of treatment when female patients experienced pain more intensively than male. For other time periods there was no statistical significant difference between the sexes. Pain intensity and severity of burn was not related except during the second week when patients with major burns had a tendency to express more pain than moderate burns. Measurement of background pain along with other routine registrations is easy and not time-consuming. Patients needing intensified pain treatment can be identified. For research and quality assessment a computerized patient register is of great help.

Pre-emptive analgesia using local anaesthesia: a study in bilaterally symmetrical surgery

Two studies were carried out in patients undergoing bilaterally symmetrical lower third molar surgery under general anaesthesia. In the first study observations were carried out in 40 patients, using McGill pain questionnaires and visual analogue scales (VAS), to assess the variation in pain intensity between the two sides in each individual on the morning after surgery. The within-patient variation in pain intensity indicated that a sample size exceeding 30 was required to show a difference of more than 10 mm on the VAS and achieve a power of 90% at the 5% level of significance. The second study was carried out to determine if local anaesthesia administered before rather than after tooth removal rendered any benefit. Each of the 38 patients acted as their own control; one side was allocated randomly to receive the local anaesthetic before operation and the other side after operation. The difference in pain between the pretreated and post-treated sides in each individual was assessed using a McGill pain questionnaire on the morning after surgery in addition to two VAS (one for each operation side) after operation, at 6 h, 1 and 6 days after surgery. There were no significant differences in pain at any time using any of the above methods.

The complexity of labor pain: experiences of 278 women.

All women giving birth over a period of 2 weeks in a major city of Sweden, except non-Swedish speaking women and those with elective Caesarean sections, were asked about their experience of pain 2 days after the birth. The sensory (pain intensity) and effective (negative or positive experience) dimensions of pain, as well as need for pain relief during labor were explored. The 278 women who returned completed questionnaires (91%) reported high levels of pain, 41% worst imaginable pain, in spite of wide use of pharmacological pain relief. Only 9% had no analgesia. Pain was not an entirely negative experience, 28% assessing it as more positive than negative, suggesting that coping with pain is a rewarding experience for some women. More than 30 different explanatory variables were included in regression analysis to explain the variation in pain intensity and pain attitude scores, but only five contributed to the respective model. Most of the variables explaining pain intensity, namely anxiety during labor, expected pain, expected birth experience, midwife support and duration of labor, differed from the variables explaining attitude to pain. These were pain intensity, anxiety, expected birth experience physical well-being during pregnancy and emergency Caesarean section. The explanatory values were relatively low, especially for the model explaining pain intensity (R2 = 15%). The findings are discussed in the light of the different character and meaning of childbirth pain compared with pain related to disease.

Long-term observation of the relation between pain intensity and serum carbamazepine concentration in elderly patients with trigeminal neuralgia

The relation between changes in pain intensity and serum carbamazepine (CBZ) concentration was studied in five elderly patients with trigeminal neuralgia. Measurement of pain intensity and serum CBZ concentration, and blood studies, were performed approximately every 2 or 3 months after initiation of CBZ therapy. Fluctuations in pain intensity were observed in four patients. In these patients, even when the serum CBZ concentration was maintained within a relatively high range, there were periods in which pain intensity increased. On the other hand, there were periods in which pain was relatively well controlled even though the CBZ concentration was relatively low. There were considerable interindividual differences in response to CBZ. The fluctuations in pain showed that the CBZ response curve varies from period to period even within an individual. It was concluded that it is essential to observe spontaneous variations in pain intensity and monitor serum CBZ during long-term administration.

Patient-controlled dose regimen of methadone for chronic cancer pain.

Fourteen patients with severe cancer pain participated in a trial of methadone given in a fixed dose (10 mg) but at intervals selected by the patients themselves during the loading phase. The aim was to achieve rapid pain relief while avoiding the risk of toxicity from accumulation of methadone. As expected, the dosage intervals increased gradually over the first few days of treatment, the daily dose decreasing from 30-80 mg on the first day to 10-40 mg at the end of the week. Plasma concentrations of methadone varied sevenfold after four to five days (0.24 to 1.75 mumol/1; 7.4 to 54.2 microgram/100 ml). Eleven patients reported complete or almost complete pain relief and elected to continue with methadone after the study. In no case was treatment withdrawn because of intoxication. From these findings a patient-controlled dosage regimen of oral methadone may be an effective and safe alternative to parenteral narcotic medication, adjusting both for individual variation in pain intensity and for pharmacokinetics.