European journal of pain : EJP
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Randomized Controlled Trial
What factors influence the measurement properties of the Roland-Morris disability questionnaire?
Although the Roland disability questionnaire (RDQ) is a commonly used questionnaire for patients with low back pain (LBP), several important issues remain understudied. The purposes of this study were to investigate the impact that several parameters (length of test-retest interval, interpretation of the global perceived effect (GPE) scores, methods to estimate standard error of measurement (SEM), intervention and baseline scores) have on various measurement properties, such as agreement (Limits of Agreement (LOA), SEM(agreement)), responsiveness (area under the ROC curve, sensitivity, specificity) and interpretability (optimal cut-off point, Minimal Detectable Change), of the RDQ. RDQ was administered four times to 212 patients with chronic non-specific LBP (first consultation (T-1), eligibility check (T0), randomization/start of treatment (T1) and end of treatment (T2)). ⋯ Results revealed that agreement parameters decreased with increasing time interval between test-retest. They confirmed the influence of the interpretation of the GPE as well as of the method to calculate the SEM on the magnitude of the Minimal Detectable Change and ROC parameters. Baseline RDQ scores and the way to cluster patients with regard to baseline scores influenced mainly the optimal cut-off point and responsiveness parameters; intervention did not affect the magnitude of the Minimal Detectable Change.
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Chronic pain is often associated with comorbidities such as anxiety and depression, resulting in a low health-related quality of life. The mechanisms underlying this association are not clear, but a disturbance in the pain control systems from the brain stem has been suggested. Thirty neuropathic pain (NP) patients, 28 patients with fibromyalgia (FM), and 26 pain-free age- and gender-matched controls were included and examined with respect to mental distress (self-rated Symptom Checklist-92), depression (doctor-rated Hamilton Depression Scale and self-rated Major Depression Inventory), and anxiety (doctor-rated Hamilton Anxiety Scale and self-rated Anxiety Inventory). ⋯ However, these scores are low compared to other studies on mental distress in chronic pain patients. Only few chronic pain patients meet the diagnostic criteria for depression (NP 3.3%, FM 7.1%), and associations between pain and mental symptoms were only found in the FM group despite similar pain intensities. The findings suggest that different mechanisms are responsible for the development of mood disorders in the two patient groups.
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Despite advances in postoperative pain management, the proportion of patients with moderate to severe postoperative pain is still ranging 20-80%. In this retrospective study, we investigated 1736 patients to determine the incidence of postoperative pain in need of intervention (PPINI)defined as numeric rating scale >4 at rest in the post anaesthesia care unit early after awakening from general anaesthesia, and to identify possible risk factors. The proportion of patients with PPINI was 28.5%. ⋯ Patients with PPINI experienced significantly more PONV (10.3% vs. 6.2%, p=0.003), more psychomotor agitation (5.5% vs. 2.7%, p=0.004), needed more application of opioid in PACU (62.8% vs. 24.2%, p<0.001), stayed significantly longer in PACU (89.6min [70-120] vs. 80min [60-100], p<0.001), had a longer median length of hospital stay (6.6 days [4.0-8.8] vs. 6.0 days [3.2-7.8]], p<0.001), and longer postoperative stay (5.0 days [3.0-6.5] vs. 4.1 days [2.5-5.8], p<0.001]). Patients with PPINI required more piritramid (8.0mg [5.0-12.0] vs. 5.0mg [3.0-7.8], p<0.001) in PACU than patients without. The identification of patients at high risk for immediate postoperative pain in need of intervention would enable the formation of effective postoperative pain management programs.
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Diffusion Tensor Imaging (DTI) is a promising new imaging method allowing in vivo mapping of anatomical connections in the living human brain. We combined DTI with functional magnetic resonance imaging (fMRI) to investigate the anatomical relationships between areas involved in visceral sensations in humans. Non-painful and moderately painful rectal distensions were performed in 11 healthy women (38.4+/-3.1years). fMRI was used to analyse the changes in brain activity during both types of distension. ⋯ DTI revealed direct connections between insula, and the four areas more frequently activated in this study, i.e. ACC, thalamus, S1, S2 and PFC. The combined use of fMRI and DTI in healthy subjects during rectal distension revealed a neural network of visceral sensory perception involving the insula, thalamus, somatosensory cortices, ACC and PFC.
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Emerging evidence has indicated that adolescent chronic pain is a significant healthcare issue, the impact of which is determined by a complex interplay of biological, emotional, social, and familial factors. Recently, progress has been made in assessment of pain and functioning in adolescents with chronic pain. A next step is to evaluate whether discrete subgroups of patients exist and whether assessment measures can be used to determine subgroup membership for individual pain sufferers. ⋯ Follow-up analyses indicated significant differences among the clusters across eight of nine measures of functioning including pain intensity, healthcare utilization, school attendance, amount of weekly exercise, depression, disability, social functioning, and catastrophic thinking. A discriminant analysis was able to correctly classify over 95% of participants into the correct cluster. These results provide strong support for the derived four cluster solution, which may be useful in both clinical and research settings, as it allows for individual adolescent pain sufferers to be classified into groupings according to the severity and type of difficulties being experienced.