Worst Pain Level Research Articles

The Behavioral Adaptations and Barriers of Patients Employing Non-Pharmacological Strategies for Cancer Pain Management-A Qualitative Study.

The use of non-pharmacological strategies to complement pharmacological approaches can enhance cancer pain management by promoting patient autonomy and increasing management effectiveness. This study aimed to explore the required behavioral adaptations and situational barriers that cancer patients encounter when utilizing non-pharmacological strategies to manage pain. We adopted an exploratory-descriptive qualitative research approach, purposive sampling, and semi-structured interview guidelines to conduct face-to-face interviews with 18 cancer patients experiencing moderate or severe levels of worst pain. Data were analyzed using inductive content analysis to explore patients' experiences. Five themes described the behavioral adaptations of patients using non-pharmacological strategies to deal with cancer pain: finding complementary therapies, utilizing assistive skills, adapting to assistive skills, diverting attention, and seeking help. Situational barriers faced by patients include being in the workplace or in a climate-affected environment. Behavioral adaptation is necessary for non-pharmacological strategies to coping with cancer pain. The behavioral skills can help the patients to overcome situational barriers to engagement with these strategies. Thus, health professionals are expected to help the patients acquire adequate behavioral adaptation and skills for self-pain management, and assess the effectiveness of the strategies.

The Use of Cannabidiol in Patients With Low Back Pain Caused by Lumbar Spinal Stenosis: An Observational Study.

Background Spinal stenosis is a degenerative narrowing of the spinal canal with encroachment on the neural structures by surrounding bone and soft tissue. This chronic low back condition can cause restrictions in mobility, impairment of daily activities, opioid dependence, anxiety, depression, and reduced quality of life. Spinal stenosis can be treated through surgical and nonsurgical methods, but neither has proven consistently reliable. Cannabidiol (CBD) has also been observed to have anxiolytic, anti-inflammatory, antiemetic, and antipsychotic behaviors. CBD may provide greater nonsurgical treatment options for the pain associated with spinal stenosis while minimizing the need for opioids. An observational study was undertaken to assess the effects of CBD on patients suffering from chronic spinal stenosis. Methodology This observational study was investigator-initiated and designed to determine the effect of hemp-derived CBD gel caps for patients with spinal stenosis related to low back pain and leg pain relative to patient outcomes, medication utilization, and quality of life outcome measures. A total of six physician visits would be required where a set of surveys would be filled out each four weeks apart. Results The study population consisted of 48 patients. The patient population's age ranged from 63 to 95 years and was normally distributed, with a mean age of 75 ± 7.13 years. The sex distribution was 33% male and 67% female patients. The pain was broken down between the six visits for each of the following four questions: pain right now, usual pain level during the week, best pain level during the week, and worst pain level during the week. Usual pain levels (p < 0.001) and worst pain levels (p < 0.005) demonstrated statistically significant improvement over time, while pain right now (p > 0.05) and best pain level (p > 0.05) stayed consistent throughout without statistical significance. Conclusions This open-label, prospective, observational study found that treatment with hemp-derived CBD gel caps was associated with significant improvements in pain scores and several quality-of-life measures for patients with lumbar spinal stenosis.

Health Outcomes among Adults Initiating Medical Cannabis for Chronic Pain: A 3-month Prospective Study Incorporating Ecological Momentary Assessment (EMA).

In response to the need of more rigorous data on medical cannabis and chronic pain, we conducted a 3-month prospective study incorporating ecological momentary assessment (EMA) to examine the effects of medical cannabis on pain, anxiety/depression, sleep, and quality of life. Data were collected from 46 adults (Mean age=55.7±11.9, 52.2% male) newly initiating medical cannabis treatment for chronic pain. Participants completed a baseline survey, EMA for approximately 1 week pre- and up to 3 weeks post- medical cannabis treatment, and a 3-month follow-up survey. The self-reported EMA data (2535 random and 705 daily assessments) indicated significant reductions in momentary pain intensity (b = −16.5, p < .001, 16.5 points reduction on 0–100 visual analog) and anxiety (b = −0.89, p < .05), and significant increase in daily sleep duration (b = 0.34, p < .01) and sleep quality (b = 0.32, p <.001) after participants initiated medical cannabis for a few weeks. At 3 months, self-reported survey data showed significantly lower levels of worst pain (t = −2.38, p < .05), pain interference (t = −3.82, p < .05), and depression (t = −3.43, p < .01), as well as increased sleep duration (t = 3.95, p < .001), sleep quality (t = −3.04, p < .01), and quality of life (t = 4.48, p < .001) compared to baseline. In our sample of primarily middle-aged and older adults with chronic pain, medical cannabis was associated with reduced pain intensity/inference, lower anxiety/depression, and improved sleep and quality of life.

Neuropathic Pain in Hand Osteoarthritis: A Cross-Sectional Study.

Symptomatic hand osteoarthritis (OA) is a severely debilitating condition. Neuropathic pain (NP) has been shown to be a factor affecting pain severity, hand function, psychological wellbeing, body schema, and the number of pain medications in people with OA of other joints. The aim of this study was to assess the prevalence of NP in symptomatic hand OA and assess its association with pain, hand function, measures of psychological wellbeing, sleep, body schema disturbances, and number of pain medications. Participants with symptomatic hand OA diagnosed through the American College of Rheumatology criteria, were recruited and completed a series of online questionnaires. These included the Douleur Neuropathique 4 interview (DN4-interview), Short Form Brief Pain Inventory (SF-BPI), Neglect-like Symptoms questionnaire, Functional Index of Hand Osteoarthritis (FIHOA), Centre for Epidemiologic Studies Depression Scale (CES-D), Pain Catastrophising Scale (PCS), and the Pittsburgh Sleep Quality Index (PSQI). Logistic regression with age, body mass index, and sex as covariates were utilised to assess differences between participants with and without NP as identified through the DN4-interview. Correlation analysis assessed the relationship between pain intensity, body schema alterations, and number of pain medications. A total of 121 participants were included in the present study. Forty-two percent of participants presented with NP. Participants with NP reported higher levels of worst pain (OR: 10.2 95% CI: 2.2 to 48.5; p = 0.007). Worst pain intensity correlated with the number of pain medications (rho = 0.2; p = 0.04), and neglect-like symptoms (rho = 0.4; p < 0.0001). No difference between phenotypes was shown for catastrophising, function, depression, neglect-like symptoms, pain interference, or sleep. A large proportion of people with symptomatic hand OA present with NP. This phenotype is characterised by greater levels of pain intensity. Pain intensity is associated with number of pain relief medications and body schema alteration. Psychological factors, hand function, and sleep do not appear to be affected by the presence of NP.

Long-term results from a randomized blinded sham- and waitlist-controlled trial of acupuncture for joint symptoms related to aromatase inhibitors in early stage breast cancer (S1200).

12018 Background: Musculoskeletal symptoms are the most common side effect of aromatase inhibitors (AIs) among breast cancer (BC) survivors. We previously reported that true acupuncture (TA) resulted in better pain outcomes than either sham acupuncture (SA) or wait-list controls (WC) at 6 weeks with durable effects through 24 weeks, with minimal toxicity. We now report the 52-week outcomes. Methods: We conducted a SWOG multicenter randomized controlled trial among postmenopausal women with early-stage BC. Patients taking an AI for ≥30 days and reporting a worst pain score of ≥3 out of 10 using the Brief Pain Inventory-Worst Pain (BPI-WP) were eligible. Subjects were randomized 2:1:1 to TA vs. SA vs. WC. Both the TA and SA protocols consisted of a 12-week intervention, with 2 sessions per week for 6 weeks, followed by 1 session per week for 6 additional weeks. At 24 weeks, all subjects remained blinded to intervention arm but were offered 10 sessions of true acupuncture. Endpoints included BPI scores, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for hips and knees, the Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH), PROMIS Pain Inventory Short Form (PI-SF), and Functional Assessment of Cancer therapy Endocrine Symptoms (FACT-ES). Results: Among 226 patients registered, 110 were randomized to TA, 59 to SA and 57 to WC. Baseline characteristics were similar among the arms. At 52 weeks, follow-up assessments were available for 91 (82.7%) TA, 53 (89.8%) SA, and 47 (82.5%) WC patients. In a linear regression adjusting for the baseline score and stratification factors, 52-week mean BPI-WP scores were 1.08 points lower (correlating with less pain) in the TA compared to SA arm (95% CI: 0.24-1.91, p =.01), and were 0.99 points lower in the TA compared to WC arm (95% CI: 0.12-1.86, p =.03). The proportion of patients experiencing a clinically meaningful (&gt;2) reduction (i.e. improvement) in BPI-WP was 64% for TA compared to 45% on SA and 53% on WC. Patients randomized to TA had reduced BPI pain interference at 52 weeks compared to SA (adjusted difference = 0.58, 95% CI: 0.00-1.16, p =.05) but not compared to WC (adjusted difference = 0.33, 95% CI: -0.28-0.93, p =.29). Also, at 52 weeks, patients randomized to TA had improved PROMIS PI-SF T-scores compared to SA (adjusted difference = 2.35, 95% CI: 0.07-4.63, p =.04) but not compared to WC (adjusted difference = 1.28, 95% CI: -1.09-3.66, p =.29). No statistically significant differences were observed in other measures. Conclusions: Women with breast cancer receiving AI therapy and treated with 12 weeks of TA for joint symptoms had reduced levels of worst pain compared to control patients, an effect that was durable through one year despite completion of protocol acupuncture at 12 weeks, and the offering of acupuncture to all participants at 24 weeks. Clinical trial information: NCT01535066.

Knee flexor strength, rate of torque development and flexibility in women and men with patellofemoral pain: Relationship with pain and the performance in the single leg bridge test

ObjectivesTo investigate the relationship between: (1) knee flexor strength, rate of torque development (RTD), and flexibility with pain level; (2) knee flexor strength and RTD with the performance in the single leg bridge test (SLBT) in women and men with patellofemoral pain (PFP). DesignCross-sectional. SettingLaboratory-based study. Participants39 women and 36 men with PFP. Main outcome measuresKnee flexor strength, RTD, and flexibility; performance in the SLBT, current, and worst pain level. ResultsModerate to strong significant negative relationships were identified between the current pain level with knee flexor strength (r = −0.57 to −0.34) and flexibility (r = −0.44 to −0.35); and between knee flexor strength and RTD with the performance in the SLBT (r = 0.34 to 0.57) in women and men with PFP. Knee flexor RTD was not related to any pain level and no significant relationships were identified between the worst pain level with knee flexor strength and flexibility in women and men with PFP. ConclusionsOur results support the potential value of assessing knee flexor strength and flexibility in women and men with PFP. The SLBT may be a useful tool to assess knee flexor muscle capacity in individuals with PFP in a clinical setting.

Effectiveness, safety, and economic evaluation of adjuvant moxibustion therapy for aromatase inhibitor-induced arthralgia of postmenopausal breast cancer stage I to III patients: Study protocol for a prospective, randomized, assessor-blind, usual-care controlled, parallel-group, pilot clinical trial.

Introduction:This study is a prospective, assessor-blinded, parallel-group, randomized controlled pilot trial to explore the effectiveness of 12-week adjuvant moxibustion therapy for arthralgia in menopausal females at stage I to III breast cancer on aromatase inhibitor (AI) administration, compared with those receiving usual care.Methods/design:Forty-six menopausal female patients with breast cancer who completed cancer therapy will be randomly allocated to either adjuvant moxibustion or usual care groups with a 1:1 allocation ratio. The intervention group will undergo 24 sessions of adjuvant moxibustion therapy with usual care for 12 weeks, whereas the control group will receive only usual care during the same period. The usual care consists of acetaminophen administration on demand and self-directed exercise education to manage AI-related joint pain. The primary outcome is the mean change of the worst pain level according to the Brief Pain Inventory—Short Form between the initial visit and the endpoint. The mean changes in depression, fatigue, and quality of life will also be compared between groups. Safety and pharmacoeconomic evaluations will also be included.Discussion:Continuous variables will be compared by an independent t test or Wilcoxon rank-sum test between the adjuvant moxibustion and usual care groups. Adverse events will be analyzed using the chi-square or Fisher exact test. The statistical analysis will be performed by a 2-tailed test at a significance level of .05.

Opioid Prescribing and Consumption Patterns following Outpatient Plastic Surgery Procedures.

Opioid overprescribing is a nationwide problem contributing to the current epidemic. This study evaluated opioid consumption, physician prescribing, and patient satisfaction with pain control following outpatient plastic surgery procedures. Patients completed a questionnaire during their first postoperative visit. The authors queried about procedure type, quantity of opioids prescribed and consumed, days to opioid cessation, prescription refills, pain scores, use of nonopioid analgesics, and satisfaction with pain control. One hundred seventy patients were included. On average, 26 tablets were prescribed and 13 were consumed. Eighty percent of patients stopped opioids by postoperative day 5. Patients rated their worst pain at 6.1 and follow-up pain at 1.9. Approximately 50 percent of patients consumed nonopioid analgesics. Ninety-six percent of patients were satisfied with their pain control. Similar findings were observed across procedure subcategories. The number of pills prescribed was not correlated with satisfaction but was predictive of worst pain level (p = 0.014). Reduction mammaplasty and abdominoplasty patients consumed the most opioids at 17 and 18.6 pills, respectively; however, first-stage alloplastic breast reconstruction had the largest percentage of patients consuming opioids at the time of follow-up (25 percent) and requiring refills (7 percent). Patients who underwent revision of their reconstructed breast reported the earliest opioid cessation, rated their pain the lowest, and were prescribed the most excess tablets. Plastic surgeons are prescribing almost double the amount of opioids consumed by patients after outpatient plastic surgery procedures. The results of this study may help guide prescribing practices.

Relationship between knee abduction moment with patellofemoral joint reaction force, stress and self-reported pain during stair descent in women with patellofemoral pain

BackgroundIncreased external knee abduction moment has been proposed as a risk factor for patellofemoral pain. This alteration is thought to be associated with elevated patellofemoral joint reaction force and stress, however these relationships remain poorly explored. Therefore, this study aimed at comparing knee abduction moment parameters (peak, rate of moment development and impulse), patellofemoral joint reaction force and stress of women with patellofemoral pain and pain-free controls during stair descent; and investigating the relationship among these variables with self-reported pain. MethodsKinetic data was obtained by inverse-dynamics equations and a previously reported algorithmic model was used to determine patellofemoral joint reaction force and stress. Participants' worst pain in the last month and pain level during stair descent were evaluated using a visual analogue scale. FindingsWomen with patellofemoral pain presented higher peak, rate of moment development and impulse of the external knee abduction moment, patellofemoral joint reaction force and stress (p = 0.005 to 0.04, effect size = 0.52 to 0.96) during stair descent than pain-free controls. Only knee abduction moment impulse presented positive moderate correlations with worst pain level in the last month (r = 0.53, p < 000.1), pain level during stair descent (r = 0.33, p = 0.042), patellofemoral joint reaction force (r = 0.65, p < 000.1) and stress (r = 0.58, p < 000.1). InterpretationThese findings indicate that strategies aimed at decreasing external knee abduction moment impulse could reduce the load over the patellofemoral joint and improve pain of women with patellofemoral pain.

Patient-related attitudinal barriers to cancer pain management among adult Jordanian patients

To evaluate the attitudinal barriers to cancer pain management among adult Jordanian patients and to explore relationships between attitudinal barriers, pain, and demographic variables. In this descriptive correlational study a convenience sample of 150 Jordanian adults with cancer pain were recruited from the outpatient cancer clinic at a regional comprehensive cancer center in Jordan. Patients completed the Arabic version of Barriers Questionnaire (ABQ-II), the Arabic version of Brief-Pain-Inventory (ABPI), and demographic questions. More than half of participants were male (61%), had a mean age of 44 years and length of education 14.5 years. Mean (SD) ABQ-II total score was 2.3 (0.8), on a scale of 0-5, with higher scores indicating stronger barriers. Older patients had significantly more barriers, and scored higher on concerns about harmful effects and communication. Patients with higher education levels had significantly lower fatalistic beliefs. Patients with higher barriers had significantly higher levels of worst pain. Pain interference with life activities was positively correlated with the fatalism subscale. Study provides useful baseline data on barriers to management of cancer pain among Jordanian that have not been available before. This data can be used in planning and testing interventions to understand and improve patient's attitudes to cancer pain management, and allow for cross-cultural comparisons.

Post-tonsillectomy pain after using bipolar diathermy scissors or the harmonic scalpel: a randomised blinded study

ObjectiveTo compare the postoperative pain following bipolar diathermy scissors tonsillectomy (higher temperature dissection) with harmonic scalpel tonsillectomy (lower temperature dissection).MethodsSixty patients aged 7–40 years planned for tonsillectomy with no other concurrent surgery were randomised to either bipolar diathermy scissors or harmonic scalpel as surgical technique. Blinded to the surgical technique, the patients recorded their pain scores (VAS, 0–10) at awakening and the worst pain level of the day in the postoperative period. All intake of pain medication was also recorded.ResultsNo statistically significant differences were found between the two groups regarding postoperative pain levels or consumption of pain medication.ConclusionUsage of the harmonic scalpel does not render less postoperative pain following tonsillectomy when compared with usage of the bipolar diathermy scissors.

Preoperative Pain, Symptoms, and Psychological Factors related to Higher Acute Pain Trajectories during Hospitalization for Total Knee Arthroplasty

ObjectivesUnrelieved postoperative pain after total knee arthroplasty (TKA) is a significant problem. This longitudinal study investigated how preoperative pain intensity, as well as a comprehensive list of preoperative and perioperative factors, influenced the severity of acute average and worst pain after TKA.MethodsPrior to surgery, 203 patients completed a demographic questionnaire, Lee Fatigue Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, and Brief Illness Perception Questionnaire. Brief Pain Inventory was completed prior to surgery as well as through postoperative days (POD) 0 to 4. Clinical data were extracted from medical records.ResultsSeveral factors were associated with higher levels of preoperative and postoperative pain. Lower preoperative average and worst pain intensity scores were associated with increases in average and worst postoperative pain from POD1 to POD4. A higher number of comorbidities, higher C-reactive protein values, and higher pain interference with function were associated with higher preoperative levels of average pain. Older age, higher fatigue levels, and higher scores on identity and emotional responses to osteoarthritis (OA) were associated with higher preoperative levels of worst pain. Lower perceived consequences of OA were associated with higher pain from POD1 to POD4. Males and patients with lower preoperative scores for average pain had higher worst pain following surgery.DiscussionPatients at higher risk for more severe postoperative pain can be identified through an assessment of pain and other risk factors identified in this study. Future research needs to test the efficacy of interventions that modify patients’ perceptions of living with OA and pain intensity before surgery on short and long term postoperative outcomes.

Vastus Medialis Hoffmann Reflex Excitability Is Associated With Pain Level, Self-Reported Function, and Chronicity in Women With Patellofemoral Pain

ObjectiveTo determine the association between the amplitude of vastus medialis (VM) Hoffmann reflex (H-reflex) and pain level, self-reported physical function, and chronicity of pain in women with patellofemoral pain (PFP). DesignCross-sectional study. SettingLaboratory of biomechanics and motor control. ParticipantsWomen diagnosed with PFP (N=15) aged 18 to 35 years. InterventionsNot applicable. Main Outcome MeasuresData on worst pain level during the previous month, self-reported physical function, and symptom duration (chronicity) were collected from the participants. Maximum evoked responses were obtained by electrical stimulation applied to the femoral nerve and peak-to-peak amplitudes of normalized maximal H-reflexes (maximal Hoffmann reflex/maximal motor wave ratios) of the VM were calculated. A Pearson product-moment correlation matrix (r) was used to explore the relations between the amplitude of VM H-reflex and worst pain during the previous month, self-reported function, and chronicity of pain. ResultsStrong negative correlations were found between the amplitude of VM H-reflex and worst pain in the previous month (r=−.71; P=.003) and chronicity (r=−.74; P=.001). A strong positive correlation was found between the amplitude of VM H-reflex and self-reported physical function (r=.62; P=.012). ConclusionsThe strong and significant relations reported in this study suggest that women with PFP showing greater VM H-reflex excitability tend to have lower pain, better physical function, and more recent symptoms. Therefore, rehabilitation strategies designed to increase the excitability of the monosynaptic stretch reflex should be considered in the treatment of women with PFP if their effectiveness is demonstrated in future studies.

Rest/activity rhythm is related to the coexistence of pain and sleep disturbance among advanced cancer patients with pain

This study aimed to explore the relationships among pain, sleep disturbance, and circadian rhythms in advanced cancer patients. This cross-sectional study was conducted in 68 cancer patients from the oncology inpatient unit of a teaching hospital. Their demographic and medical characteristics, questionnaire surveys, including Brief Pain Inventory-Chinese version and Pittsburgh Sleep Quality Index Taiwanese version, and sleep logs and actigraphic recordings in consecutive 3 days and nights were collected and analyzed. The mean (SD) scores for autocorrelation coefficient at 24 h (r24) and dichotomy index (I<O) were 0.19 (0.16) and 85.29 % (0.13 %), respectively, indicating dampened circadian rhythms in participants. The mean (SD) worst pain score was 5.47 (2.70). The sleep quality global score ranged 4 ∼ 19 with a mean (SD) of 11.19 (4.05). The worst pain levels, the Pittsburgh Sleep Quality Index (PSQI) global score, and most sleep parameters measured by actigraphy were significantly correlated with r24 and I<O. The worst pain score was significantly correlated with the PSQI global score (r = 0.69, p < 0.01). The Goodman version of the Sobel test further demonstrated that 45.77 % of the total effect was mediated by pain intensity (t = 2.76, p = 0.005). Pain was a complete mediator between circadian rhythms and sleep quality. The rest/activity rhythm influences the coexisting pain and sleep disturbances. Pain functions as a complete mediator in their relationship. Interventions that improve rest/activity rhythms may improve the management of pain and sleep disturbances in cancer patients.

Patient-reported outcome 2 years after lung transplantation: does the underlying diagnosis matter?

PurposeTransplantation has the potential to produce profound effects on survival and health-related quality of life (HRQL). The inclusion of the patient’s perspective may play an important role in the assessment of the effectiveness of lung transplantation. Patient perspectives are assessed by patient-reported outcome measures, including HRQL measures. We describe how patients’ HRQL among different diagnosis groups can be used by clinicians to monitor and evaluate the outcomes associated with transplantation.MethodsConsecutive lung transplant recipients attending the lung transplant outpatient clinic in a tertiary institution completed the 15-item Health Utilities Index (HUI) questionnaire on a touchscreen computer. The results were available to clinicians at every patient visit. The HUI3 covers a range of severity and comorbidities in eight dimensions of health status. Overall HUI3 scores are on a scale in which dead = 0.00 and perfect health = 1.00; disability categories range from no disability = 1 to severe disability <0.70. Single-attribute and overall HUI3 scores were used to compare patients’ HRQL among different diagnosis groups. Random-effect models with time since transplant as a random variable and age, gender, underlying diagnoses, infections, and broncholitis obliterans syndrome as fixed variables were built to identify determinants of health status at 2-years posttransplantation.ResultsTwo hundred and fourteen lung transplant recipients of whom 61% were male with a mean age of 52 (19–75) years were included in the study. Chronic obstructive pulmonary disease and cystic fibrosis patients displayed moderate disability, while pulmonary fibrosis and pulmonary arterial hypertension patients displayed severe disability. Patients with chronic obstructive pulmonary disease had the worst pain level, whereas patients with pulmonary fibrosis had the worst emotion and cognition levels. A random-effect model confirmed that development of broncholitis obliterans syndrome was the most important determinant of health status (P = 0.03) compared to other variables, such as cytomegalovirus infections and underlying diagnoses.ConclusionDescriptions of patients’ HRQL among different diagnosis groups could be used by clinicians to assist individualized patient care.

Symptoms of Cumulative Trauma in Hand Therapy Professionals, A Descriptive Study

Sharon R. Flinn, Kimberly Couch, Amy Darragh, Division of Occupational Therapy, Ohio State University, Columbus, OH, USA; Hand Center Occupational Therapy Services, The Ohio State University, Columbus, OH, USA Purpose: Describe the physical and functional changes found in working hand therapists. Background: Several authors have identified hand therapists at risk for cumulative trauma symptoms. Harmon et al. (1997) found 73% of hand therapists had previously experienced CTD symptoms. Caragianis (2002) found 66% of hand therapists with pain were occupational injuries with the most common site of pain at MP/CMC joints of the thumb. CTS symptoms have been reported in 38-46% of hand therapists and 67-75% had engaged in protective/corrective measures (Bash & Farber, 1999; Sefcovic et al. 2000). Methods: This study was part of a larger study to document exposure to risk factors for work-related musculoskeletal symptoms among hand therapists. Quantitative measures were collected in this study on symptoms of cumulative trauma and limitations found in non-work activities. Physical functioning instruments included pain (VAS, diagrams), sensibility (SWM), motor function (composite ROM, tendon gliding), hand volume, grip, pinch strength. FDS findings of # 2cm and intrinsic tightness # .5 cm were considered normal. Average grip and pinch over three trials were calculated. Nonwork activity limitations were assessed using the Flinn Performance Screening Tool to identify valued life activities. Over 300 photographs were used to screen ADL/IADL. Results: Demographics. Twenty therapists from three hand therapy clinics were evaluated. The mean age was 47 years (SD 7.09). Total therapy experience was 23 years (SD 8.85) with hand therapy experience of 17 years (SD 7.83). All participants reported being right hand dominant. Pain. When rating least and worst pain levels, 55% reported no pain for least levels but 100% reported worst levels averaging 4.99/10. Of those reporting worst pain, 63% reported pain occurred at work, 26% at home, and 10% at work and home. The most common area of pain was dominant thumb (75%), upper back/posterior head (55%), the nondominant thumb (50%), and dominant anterior forearm (45%). A majority had pain/pulling with the Finkelstein’s maneuver on right (60%) and left (70%) thumbs. A small subgroup had positive grind test on the right (20%) and left (15%) thumbs. Sensibility. 35% reported hand paresthesias. The upper limb test was positive most often for the median nerve on right (60%) and left (40%) extremities. Over 50% had abnormal findings for the median nerve using 2.83 monofilament. 25% had decreased sensibility in radial nerve distribution and 20% in all peripheral nerves. Motor. Composite ROM was not problematic for extrinsic and intrinsic extensibility, FDS gliding, or thumb flexion-abduction. Large restrictions were found in Apply-Scratch Test on right (-6 cm) and left (-8 cm). Average strength dominant and non-dominant hands were 54/48#; lateral pinch 16/15#, and tip pinch 10/10#. Hand Volume. Hand volumes were not problematic with averages of 12ml difference between dominant/non-dominant and 1ml difference between pre-posttests. ADL Function. An average of 11 ADL limitations was reported with a range of 0-48 items. A majority of items required upper body strength or pinch. Conclusion: A majority of participants experienced specific cumulative trauma symptoms and non-work ADLs. Recommendations will be provided for improved surveillance.

The impact of chronic pain—European patients’ perspective over 12 months

Background and methods Pain Study Tracking Ongoing Responses for a Year (PainSTORY) is a longitudinal study generating some quantitative and limited qualitative data concerning the experiences of individual patients with non-malignant chronic pain. Research was conducted across 13 European countries and a total of 294 patients completed the full evaluation process over 12 months. Adult patients (>18 years old) scoring >4 on an 11-point numeric pain rating scale (NRS-11) for most days during an average week were eligible. Four waves of interviews (W1–W4) were conducted over 12 months and information was recorded regarding pain levels, the impact of pain, pain treatment and treatment-associated side effects. Results At 3 months, 95% of respondents rated their worst pain level over the past week as >4. Most respondents had felt this pain level for ≥1 year, with 47% of patients reporting NRS-11 scores of 8–10 for >2 years. At 12 months, 93% of respondents still rated their worst pain level over the past week as >4. The overall net percentage of respondents with >4 pain intensity did not change substantially over 12 months of follow up. However, 40% (119/294) of patients felt their current pain level increased and 41% (121/294) felt their current pain level decreased during this time, with just 18% (53/294) of respondents reporting no change (1% of respondents not stated). At 3 months, 30% of respondents reported being managed by a pain specialist within the last 3 months, decreasing to 13% 9–12 months later. Patients were typically taking a combination of prescribed and non-prescribed medications; approximately 10% at W1 and 14% at 12 months were prescribed a strong opioid. Among those whose current pain level decreased over the year, a slightly lower proportion of patients were taking prescription medication (78%) at 12 months than in either the group with no change to their current pain level (85%), or the group whose pain level increased over the 12 month period (87%). Pain negatively affected quality of life, with respondents reporting difficulties with daily activities, including sleeping, walking, family and social interaction. Approximately half of respondents taking prescription medication reported suffering from ‘constipation and associated symptoms’. In spite of no change in pain intensity, 51% of patients were happy with their pain management at W4. Conclusions The heavy individual and societal burden of uncontrolled chronic pain is demonstrated in this study. This silent epidemic has not attracted the focus of attention that it deserves. Despite the significant negative impact on individual quality of life, patients evolve to a position where they believe that chronic pain is inevitable and untreatable. Implications It is clear that there is a real need for a coordinated response by healthcare providers and planners across European countries. Minimum standards of care should be developed and implemented at national level. Healthcare professionals and students of these disciplines must be educated to recognise, assess and manage pain within a reasonable timeframe. Patients who are not responding to standard measures must have rapid and easy access to a comprehensive, inter-disciplinary pain service.

PainACTION.com: An interactive self-management website for chronic back pain patients

The Internet can assist back pain patients in developing self-management skills, but available pain websites offer few interactive self-management strategies or focus on selling products. The aim of this poster is to describe the development and testing of an interactive website called painACTION.com. This randomized, controlled trial examined the hypotheses that, relative to a control condition, painACTION.com participants would report significant improvements in pain, physical functioning, emotional functioning, coping, and self-efficacy. The conditions included Experimental (eight site visits in a month plus 5 monthly boosters) and Control (treatment as usual) groups. Experimental participants were also classified as high dose and low dose based on a median split. Measures (pain, daily functioning, catastrophizing, self-efficacy, pain beliefs, emotional functioning, and work productivity) were administered at baseline, post-intervention, and three- and six-month follow-ups. Experimental participants showed decreased stress over all time points. Experimental participants with high baseline pain increased relaxation, decreased guarding, and decreased helplessness. Experimental participants recruited online evidenced decreased average pain ratings, increased coping self-statements, and decreased worst pain levels. High-dose participants showed increased coping self-statements and decreased stress. The Internet offers a potentially effective vehicle for enhancing self-management in back pain patients. Findings suggest better outcomes with a less severe (lower disability) group online compared to a clinic population. Also, participants with higher baseline pain levels and those at higher website dosages responded better to the website intervention. (The development of painACTION.com was funded by SBIR Grant #9R44DA022802-02 from the National Institute on Drug Abuse; its ongoing maintenance is funded by unrestricted grants from Endo Pharmaceuticals and King Pharmaceuticals.) The Internet can assist back pain patients in developing self-management skills, but available pain websites offer few interactive self-management strategies or focus on selling products. The aim of this poster is to describe the development and testing of an interactive website called painACTION.com. This randomized, controlled trial examined the hypotheses that, relative to a control condition, painACTION.com participants would report significant improvements in pain, physical functioning, emotional functioning, coping, and self-efficacy. The conditions included Experimental (eight site visits in a month plus 5 monthly boosters) and Control (treatment as usual) groups. Experimental participants were also classified as high dose and low dose based on a median split. Measures (pain, daily functioning, catastrophizing, self-efficacy, pain beliefs, emotional functioning, and work productivity) were administered at baseline, post-intervention, and three- and six-month follow-ups. Experimental participants showed decreased stress over all time points. Experimental participants with high baseline pain increased relaxation, decreased guarding, and decreased helplessness. Experimental participants recruited online evidenced decreased average pain ratings, increased coping self-statements, and decreased worst pain levels. High-dose participants showed increased coping self-statements and decreased stress. The Internet offers a potentially effective vehicle for enhancing self-management in back pain patients. Findings suggest better outcomes with a less severe (lower disability) group online compared to a clinic population. Also, participants with higher baseline pain levels and those at higher website dosages responded better to the website intervention. (The development of painACTION.com was funded by SBIR Grant #9R44DA022802-02 from the National Institute on Drug Abuse; its ongoing maintenance is funded by unrestricted grants from Endo Pharmaceuticals and King Pharmaceuticals.)

Causes of Aggressive Behavior in Patients With Dementia

To examine factors predicting development of aggression. Community-dwelling patients over 60 years of age in a Veterans Affairs Medical Center who had a documented ICD-9-CM code for dementia within 12 months of screening and no other dementia codes recorded for 2 preceding years but no aggressive behavior during the 12 months preceding study initiation were assessed every 4 months for 24 months for aggression, depression, pain, patient/caregiver relationship quality (mutuality), involvement in pleasant events, and caregiver burden. The study was conducted from September 5, 2003, to June 10, 2005. Of 215 patients, 89 (41%) developed aggression. In individual models, high baseline mutuality decreased risk of aggression; high burden and pain increased risk. Increases in depression and pain and declines in total mutuality also increased risk. In a full model and step-wise model, high levels of baseline caregiver burden, worst pain, and decline in mutuality over time increased risk of aggression. Many dementia patients become aggressive. Higher levels of worst pain, caregiver burden, and declining mutuality over time increase risk of aggression.

Laparoscopic Uterosacral Nerve Ablation for Alleviating Chronic Pelvic Pain&lt;subtitle&gt;A Randomized Controlled Trial&lt;/subtitle&gt;

Chronic pelvic pain is a common condition with a major effect on health-related quality of life, work productivity, and health care use. Operative interruption of nerve trunks in the uterosacral ligaments by laparoscopic uterosacral nerve ablation (LUNA) is a treatment option for patients with chronic pelvic pain. To assess the effectiveness of LUNA in patients with chronic pelvic pain. Randomized controlled trial of 487 women with chronic pelvic pain lasting longer than 6 months without or with minimal endometriosis, adhesions, or pelvic inflammatory disease, who were recruited to the study by consultant gynecological surgeons from 18 UK hospitals between February 1998 and December 2005. Follow-up was conducted by questionnaires mailed at 3 and 6 months and at 1, 2, 3, and 5 years. Bilateral LUNA or laparoscopy without pelvic denervation (no LUNA); participants were blinded to the treatment allocation. The primary outcome was pain, which was assessed by a visual analogue scale. Data concerning the 3 types of pain (noncyclical pain, dysmenorrhea, and dyspareunia) were analyzed separately as was the worst pain level experienced from any of these 3 types of pain. The secondary outcome was health-related quality of life, which was measured using a generic instrument (EuroQoL EQ-5D and EQ-VAS). After a median follow-up of 69 months, there were no significant differences reported on the visual analogue pain scales for the worst pain (mean difference between the LUNA group and the no LUNA group, -0.04 cm [95% confidence interval {CI}, -0.33 to 0.25 cm]; P = .80), noncyclical pain (-0.11 cm [95% CI, -0.50 to 0.29 cm]; P = .60), dysmenorrhea (-0.09 cm [95% CI, -0.49 to 0.30 cm]; P = .60), or dyspareunia (0.18 cm [95% CI, -0.22 to 0.62 cm]; P = .40). No differences were observed between the LUNA group and the no LUNA group for quality of life. Among women with chronic pelvic pain, LUNA did not result in improvements in pain, dysmenorrhea, dyspareunia, or quality of life compared with laparoscopy without pelvic denervation. controlled-trials.com Identifier: ISRCTN41196151.