Articles: pain-measurement.
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Clinical biomechanics · Nov 2003
Clinical TrialForce and time recording for validating the sacroiliac distraction test.
The present aim was to investigate whether applied force and time interval of force exposure during the sacroiliac distraction test could discriminate subjects with sacroiliitis pain from healthy subjects. ⋯ There is a need for objective evaluation methods in manual tests that are easy to perform. Recording force and its time interval may be a step towards standardising pain-provocation sacroiliac joint tests.
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This paper reports on the findings of a pilot study that collated and categorised a range of Welsh-medium chronic pain descriptors and their conceptually equivalent English translations in order to provide a preliminary basis for chronic pain assessment amongst patients in the bilingual community of North West Wales. The results demonstrate the unique and complex nature of individual pain experiences and the challenges of meaningful interpretation, particularly when patient and practitioner do not share a common preferred language. Detailed analysis of the descriptors provided valuable insight into the patient's world, revealing cultural patterns of beliefs and behaviours as well as the suffering associated with chronic pain. Implications for improving chronic pain assessment amongst bilingual speakers are explored.
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The objective of this study was to adapt the concept of 'episode-free day', a metric for measuring symptom relief in daily units, to the clinical outcome literature for persistent pain. The episode-free day metric is widely used in other medical literature, but no analogous measure exists in pain literature. Prior focus groups with this population suggested that a 'Day of Manageable Pain Control' was an appropriate name for the metric. ⋯ For both patient samples, '5' was the cut-point that optimally distinguished groups on pain-related interference. '5-8' and '5-7' were double cut-point solutions that optimally divided LBP and OA samples into three categories (e.g. lowest, medium and highest average pain), respectively. Derived cut-points were confirmed using a variety of measures of functional disability. Together with research that showed that average pain ratings of approximately 5 and below permit increased function and quality of life in patients with moderate to severe low back pain and osteoarthritis, our findings provide support for the use of 0-5 on a 0-10 numeric average pain severity scale as one possible criterion for a Manageable Day.
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Pharmaceutical research · Nov 2003
The use of clinical trial simulation to support dose selection: application to development of a new treatment for chronic neuropathic pain.
Pregabalin is being evaluated for the treatment of neuropathic pain. Two phase 2 studies were simulated to determine how precisely the dose that caused a one-point reduction in the pain score could be estimated. The likelihood of demonstrating at least a one-point change for each available dose strength was also calculated. ⋯ Doses that identify predefined response may be imprecisely estimated, suggesting that replication of a similar outcome may be elusive in a confirmatory study. Quantification of this precision provides a rationale for phase 2 trial design and dose selection for confirmatory studies.
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Most clinical studies of pain in dementia have focused on assessment procedures that are sensitive to pain in "demented" or "cognitively impaired" elderly patients. The neuropathology of dementia has not played a major part in pain assessment. In this review, the neuropathological effects of dementia on the medial and the lateral pain systems are discussed. ⋯ The results of the studies reviewed show that, although the subtypes of dementia show common neuropathological features (such as atrophy and white-matter lesions), the degree by which they occur and affect pain-related areas determine the pattern of changes in pain experience. More specifically, in AD and even more so in frontotemporal dementia, a decrease in the motivational and affective components of pain is generally present whereas vascular dementia might be characterised by an increase in affective pain experience. Future studies should combine data from experimental pain studies and neuropathological information for pain assessment in dementia.