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Adam F, Chatellier G, Alfonsi P. Assessment of the concordance between DN4 scores performed by the patient (self-assessment) or by the physician (hetero-assessment) to detect subacute neuropathic postoperative pain. Eur J Pain 2024; 28:1095-1100. [PMID: 38243671 DOI: 10.1002/ejp.2241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/26/2023] [Accepted: 01/06/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Centres dedicated to chronic postsurgical pain (CPSP) have been developed, but delays for accessing to it are generally long. Teleconsultation might be a means to facilitate access to care by allowing an initial triage. CPSPs are neuropathic pain in around half of the cases and their diagnosis is mainly based on the score obtained from validated questionnaires. Among them, those requiring a neurological examination (i.e. the Douleur Neuropathique en 4 questions [DN4]) have a better sensitivity and specificity, and should be preferred. However, effectiveness of a remote neurological examination remains to be established. The aim of this observational study is to check during a face-to-face consultation if, after a short training, a naïve patient is capable to self-assess the clinical signs of neuropathic sensations. METHODS Thirty patients with suspected neuropathic pain were seen in a face-to-face postoperative pain consultation. Before examination, the patient was instructed to fill the DN4 questionnaire, including the neurological examination. Once explanations were given and checked, the patient was left and completed it alone. Then, the pain physician performed the DN4 questionnaire. Inter-rater reliability between patient and pain physician was assessed for each item and for DN4 score with the Kappa coefficient. RESULTS For each item of the DN4 questionnaire, Kappa coefficients were between 0.74 and 1, and could be considered as excellent. For DN4 ≥ 4, the Kappa coefficient was 0.86. CONCLUSIONS Our results suggest that after a short training, a naïve patient is capable of recognizing and diagnosing symptoms of neuropathic pain. SIGNIFICANCE Our results suggest that self-assessment, carried out after brief training and using a simple tool, provides results comparable to those obtained by a specialist physician to diagnose symptoms of neuropathic pain. If the results of the current study are confirmed on a larger scale, self-assessment will help improve access to specialized chronic pain care by better orienting patients and opening up access to teleconsultations.
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Affiliation(s)
- Frédéric Adam
- Department of Anesthesiology, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Gilles Chatellier
- Clinical Research Unit, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Pascal Alfonsi
- Department of Anesthesiology, Groupe Hospitalier Paris Saint-Joseph, Paris, France
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Gao CX, Menssink J, Campbell TCH, Smith CL, Ikin JF, Lane T, Abramson MJ, Carroll M. Somatic symptoms, psychological distress and trauma after disasters: lessons from the 2014 Hazelwood mine fire and 2019-20 Black Summer bushfires. BMC Public Health 2023; 23:1573. [PMID: 37596570 PMCID: PMC10436633 DOI: 10.1186/s12889-023-16501-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 08/10/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Wildfires cause significant physical and mental ill-health. How physical and mental symptoms interact following wildfire smoke exposure is unclear, particularly in the context of repeated exposures. In this cross-sectional study we investigated how posttraumatic stress and general psychological distress associated with somatic symptoms in a community exposed to multiple smoke events. METHODS A random weighted sample of 709 adults exposed to smoke during the 2014 Hazelwood coal mine fire in south-eastern Australia completed a survey in 2020. The survey coincided with the Black Summer wildfires that caused a similar period of smoke haze in the region. Participants self-reported somatic symptoms (PHQ-15) and mine fire-related posttraumatic stress (IES-R) experienced over the previous week, general psychological distress (K10) experienced over the previous four weeks, lifetime health diagnoses and demographic information. Associations between posttraumatic stress, general psychological distress, and each PHQ-15 somatic symptom were analysed using ordinal logistic regression models. RESULTS Overall, 36.2% of participants reported moderate- or high-level somatic symptomology. The most frequent somatic symptoms were fatigue, limb pain, trouble sleeping, back pain, headaches, and shortness of breath. After controlling for confounding factors, general psychological distress and posttraumatic stress were independently associated with all somatic symptoms (except menstrual problems in females for posttraumatic stress). CONCLUSIONS Results highlight the high prevalence of somatic symptoms and their association with general psychological distress and posttraumatic stress within a community in the midst of a second large-scale smoke event. It is essential that healthcare providers and public health authorities consider the interconnections of these conditions when supporting communities affected by climate-related disasters.
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Affiliation(s)
- Caroline X Gao
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - Jana Menssink
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - Timothy C H Campbell
- Monash Rural Health, Monash University, Northways Road, Churchill, VIC, 3842, Australia
| | - Catherine L Smith
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Jillian F Ikin
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Tyler Lane
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Matthew Carroll
- Monash Rural Health, Monash University, Northways Road, Churchill, VIC, 3842, Australia.
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de Castro JC, Wang D, Strakowski J, Emril DR, Chang Chien GC. Alpha-2 macroglobulin for the treatment of neuroma pain in the stump of a below-knee amputee patient. Pain Manag 2023; 13:335-341. [PMID: 37551540 DOI: 10.2217/pmt-2023-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
This case report describes the successful treatment of neuroma pain in the setting of below knee amputations using alpha-2-macroglobulin (A2M). A 34-year-old female patient presented with 9 months of stump pain despite conservative treatment. The exam revealed persistent pain through rest periods and weight-bearing status during therapy. Ultrasound showed neuroma formation with neovascularization. The patient underwent two A2M hydrodissection treatments, 2 weeks apart. The patient reported significant pain relief. Ultrasound showed decreases in neovascularization and cross-sectional area of the neuroma. The patient was able to ambulate pain-free for 2 years and reported no pain since. A2M may be a treatment for patients with neuroma pain in the setting of amputations.
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Affiliation(s)
| | | | - Jeffrey Strakowski
- The Ohio State University, Department of Physical Medicine & Rehabilitation, Columbus, OH, 43214, USA
| | - Dessy R Emril
- Medical Faculty of Universitas Syiah Kuala, Aceh, Indonesia
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Castro JCD, Wang D, Chien GCC. Regenerative medicine for neuropathic pain: physiology, ultrasound and therapies with a focus on alpha-2-macroglobulin. Pain Manag 2022; 12:779-793. [PMID: 35762220 DOI: 10.2217/pmt-2022-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The currently available drugs to treat neuropathic pain do not provide adequate pain management. As such, other treatments including stem cells, platelet-rich plasma and plasma-derived molecules such as alpha-2 macroglobulin (A2M) are being explored because they show promising potential for neuropathic pain. The various mechanisms and immunomodulatory effects could be a desirable approach in targeting neuropathic pain. This review indicates that A2M can be highly efficacious due to its conformational change during activation and specificity of action on various cytokines. Its ability to reduce neuropathic pain can further the future of neuropathic intervention. However, there is a lack of robust clinical studies and thus further research is needed to verify and expand the understanding of its therapeutic effects.
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Affiliation(s)
- Jeimylo C de Castro
- Department of Physical Medicine & Rehabilitation, The Medical City-South Luzon, Santa Rosa, Laguna, 4026, Philippines.,SMARTMD Center for Non-Surgical Pain Interventions, Makati, 1224, Philippines
| | - Daniel Wang
- Kansas City University, Kansas City, MO 64106, USA
| | - George C Chang Chien
- Pain Management, Ventura County Medical Center, Ventura, CA 93003, USA.,GCC Institute for Regenerative Medicine, Irvine, CA 92606, USA
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Abstract
PURPOSE OF REVIEW Neuropathic pain remains difficult to treat. This review provides an update regarding recent advances in therapeutic management, particularly with regards to newer drugs, neurostimulation techniques and original study designs. RECENT FINDINGS Although the mainstay of neuropathic pain management is still represented by drug therapy, particularly antidepressants and antiepileptics, the place of nonpharmacological therapy including in particular brain neuromodulation techniques has substantially increased in recent years. Newer study designs are also increasingly implemented, based on in depth phenotypic profiling to achieve more individualized therapy, or on screening strategies to decrease placebo effect and contribute to increase assay sensitivity. These approaches are now considered the most promising to decrease therapeutic failures in neuropathic pain. SUMMARY Neuropathic pain management should not be restricted to pharmacotherapy but now encompasses multiple approaches including particularly neuromodulation techniques. Multimodal assessment can also help identify predictors of the response in clinical trials in order to ensure appropriate management.
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