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Barbero M, Piff M, Evans D, Falla D. Do metrics derived from self-reported and clinician-reported pain drawings agree for individuals with chronic low back pain? Musculoskelet Sci Pract 2023; 68:102871. [PMID: 37832508 DOI: 10.1016/j.msksp.2023.102871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Clinicians commonly use pain drawings to define the spatial extent and location of a person's pain, but limited research has investigated who should perform the drawing. OBJECTIVES To establish the inter-rater reliability of pain extent and location derived from three sets of pain drawings for people with chronic low back pain: one self-reported and two clinician-reported. Additionally, convergent validity of pain extent was assessed using the same dataset. DESIGN Repeated-measures cross-sectional study. METHOD Fifteen patients with chronic low back pain and a pool of eight clinicians were involved to assess the reliability of pain extent and location extracted by self-report and clinician-reported pain drawings. Inter-rater reliability of pain extent was computed using intraclass correlation coefficients (ICC) and Bland Altman analysis. Convergent validity of pain extent was assessed using Spearman's rank correlation. Inter-rater reliability of pain location was assessed using the Jaccard similarity index. RESULTS The inter-reliability analysis for pain extent, derived from self-reported and clinician-reported pain drawings, revealed ICC scores ranging from 0.39 to 0.51, all with wide confidence intervals. The mean Jaccard similarity indexes computed for pain location ranged from 0.60 to 0.65. Moderate to good correlation was found for pain extent derived by the sets of pain drawings. CONCLUSIONS Inter-rater reliability of pain extent and pain location derived from self-reported and clinician-reported pain drawings is poor in patients with chronic low back pain. The lack of reliability is also confirmed when considering only clinician-reported PDs. The convergent validity analysis of pain extent revealed that the two pain drawing approaches measure a similar construct.
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Affiliation(s)
- Marco Barbero
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland.
| | - Matthew Piff
- Nuffield Health, Epsom, United Kingdom; Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - David Evans
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
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Overton M, Swain N, Falling C, Gwynne-Jones D, Fillingim R, Mani R. Activity-related pain predicts pain and functional outcomes in people with knee osteoarthritis: A longitudinal study. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2023; 3:1082252. [PMID: 36713644 PMCID: PMC9880771 DOI: 10.3389/fpain.2022.1082252] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/19/2022] [Indexed: 01/14/2023]
Abstract
Knee Osteoarthritis (OA) is a prevalent musculoskeletal condition, commonly resulting in pain and disability. However, pain and disability in this population are poorly related with the degree of structural joint damage. Underlying pain mechanisms, including activity-related pain and sensitization assessed via Quantitative Sensory Testing (QST), may better predict pain and functional outcomes of those with knee OA. Therefore, the aim of this study was to explore whether activity-related pain and sensitization assessed via QST predict future pain, function, fatigue, physical performance and quality of life outcomes in those living in the community with knee OA. Eighty-six participants with knee OA were recruited in Dunedin, New Zealand. Those eligible to participate underwent baseline testing including QST as well as measures of activity-related pain including Movement-evoked Pain (MEP) and Sensitivity to Physical Activity (SPA). Outcome measures exploring pain, function, fatigue and quality of life outcomes were collected at baseline, and two follow-up periods (two and nine weeks). Univariable linear regression models were developed followed by multivariable linear regression models for each prognostic marker adjusting for age, gender, BMI, OA duration, baseline pain intensity and socioeconomic status. Activity-related measures of pain, including MEP and SPA, demonstrated predictive associations with pain and functional outcomes prospectively in those with knee OA. Therefore, those demonstrating activity-related pain are at future risk of greater pain, disability and reduced quality of life. Larger, externally validated longitudinal studies are required which include individuals with more severe knee OA.
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Affiliation(s)
- Mark Overton
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand,Correspondence: Mark Overton
| | - Nicola Swain
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Carrie Falling
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - David Gwynne-Jones
- Department of Surgical Sciences, Otago School of Medicine, University of Otago, Dunedin, New Zealand
| | - Roger Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), Department of Community Dentistry and Behavioural Science, University of Florida, Gainesville, FL, United States
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Radoslovich SS, Smith S, Haag C, Carlson H, Carlson N, Ensrud E, Yoo JU. Insurance and Employment Status Are Correlated With the Presence of Waddell Signs. Am J Phys Med Rehabil 2022; 101:746-752. [PMID: 35859289 DOI: 10.1097/phm.0000000000001903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to determine whether employment or insurance status is associated with the presence and number of Waddell signs. DESIGN In this cross-sectional study, adult low back pain patients were seen at a tertiary academic center for thoracic or lumbar back pain, due to a degenerative condition. Frequency data were compared with contingency table analysis, including χ2 and logistic regression. RESULTS Of 462 patients, 26% had any Waddell signs and 10% had clinically significant Waddell signs. Nonemployed patients had a higher prevalence of Waddell signs than employed and retired patients (P = 0.0004 and P = 0.001, respectively). Subgroups of Medicaid participants as well as patients with secondary gain issues, including worker's compensation and motor vehicle accident, had a higher prevalence of 1+ Waddell signs than patients of other insurances (P < 0.0001 and P = 0.01, respectively). Medicaid participants had a higher prevalence of 3+ Waddell signs than other insurances (P = 0.002). CONCLUSIONS The presence of Waddell signs is associated with employment and insurance status. This suggests that social factors may affect patients' perceptions of their thoracic or low back pain. Clinicians aware of these factors can provide individualized care to their patients prone to poor outcomes.
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Affiliation(s)
- Stephanie S Radoslovich
- From the Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
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Assessing physical workload among people with musculoskeletal disorders: validity and reliability of the physical workload questionnaire. BMC Musculoskelet Disord 2022; 23:282. [PMID: 35331205 PMCID: PMC8944019 DOI: 10.1186/s12891-022-05222-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Demands of physical work are related to musculoskeletal disorders, and hence, important to assess. The Physical Workload Questionnaire (PWQ) is based on 26 items related to physical workload. The PWQ has been translated into Norwegian, but its psychometric properties have not yet been tested. The aim of this study was to assess the validity and reliability of the PWQ among patients with musculoskeletal disorders. Methods A cross-sectional study with a test-retest design was conducted to assess construct validity (structural validity and hypothesis testing) and reliability (internal consistency and test-retest reliability) among employed patients with musculoskeletal disorders. Exploratory factor analysis was performed to assess the structural validity and number of items to be included in the Norwegian version of the PWQ. Hypothesis testing was assessed by 14 a priori hypotheses (“known” group, convergent and discriminant validity). Internal consistency was evaluated using Cronbach’s alpha and test-retest reliability by Intraclass Correlation Coefficient (ICC2.1), Standard Error of Measurement (SEMagreement) and Smallest Detectable Change (SDC95%ind). Results In total, 115 patients with a mean age (SD) of 46 (9) years were included, of which 48 were included in the reliability analyses. Exploratory factor analysis resulted in two subscales: “Heavy physical work” (15 items, range 0–100) and “Long-lasting postures and repetitive movements” (7 items, range 0–100). No floor or ceiling effects were seen in the subscales. Twelve of the 14 (85%) predefined hypotheses were confirmed. The internal consistency with Cronbach’s alpha was 0.94 and 0.85 on subscales 1 and 2, respectively. Test-retest reliability analyses demonstrated an ICC2.1 of 0.96 (95% CI 0.88, 0.98) and 0.92 (95% CI 0.81, 0.96), SEM of 6.9 and 10.0 and SDC95%ind of 19.2 and 27.7 of subscales 1 and 2, respectively. Conclusions The Norwegian version of the PWQ demonstrated good validity and reliability and can be used to evaluate physical workload in patients with musculoskeletal disorders. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05222-y.
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Rabey M, Buldo B, Duesund Helland M, Pang C, Kendell M, Beales D. Significant other interactions in people with chronic low back pain: Subgrouping and multidimensional profiles. Br J Pain 2021; 16:326-340. [DOI: 10.1177/20494637211062045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Back pain is complex. Social support and significant other interactions influence the pain experience. Purpose: To statistically derive subgroups of people with chronic low back pain based upon their interactions with significant others, and profile subgroups across multidimensional variables. Research Design: Longitudinal cohort study. Study Sample: People with chronic axial low back pain ( n = 262). Data Collection and Analysis: Latent class analysis of significant other interaction data was used to derive subgroups of people with chronic low back pain. Subgroups were profiled across baseline multidimensional variables and one-year follow-up pain intensity, disability and bothersomeness. Results: Three clusters were identified: Cluster 1 (7.6%) characterised by the lowest distracting, punishing and solicitous interactions. Cluster 2 (16.0%) characterised by the highest distracting and solicitous responses and social support. Cluster 3 (76.3%) characterised by the highest punishing and lowest social support. Cluster 1 reported less disability than Clusters 2 and 3. Mindfulness was significantly different across all subgroups with Cluster 1 being most mindful and Cluster 3 least mindful. Depression, anxiety and stress were significantly higher in Cluster 3 than Cluster 1. Pain catastrophising was higher for Cluster 2 than Clusters 1 and 3. Cluster 2 had lower pressure pain threshold than Clusters 1 and 3. Conclusions: These results support the association between significant other interactions and the experience of back pain. Considering significant other interactions in clinical practice may be important for managing some people’s presentation.
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Affiliation(s)
- Martin Rabey
- Curtin enAble Institute and Curtin School of Allied Health Curtin University, Perth, WA, Australia
- Thrive Physiotherapy, Guernsey
| | - Brendan Buldo
- Curtin enAble Institute and Curtin School of Allied Health Curtin University, Perth, WA, Australia
| | - Magnus Duesund Helland
- Curtin enAble Institute and Curtin School of Allied Health Curtin University, Perth, WA, Australia
| | - Courtenay Pang
- Curtin enAble Institute and Curtin School of Allied Health Curtin University, Perth, WA, Australia
| | - Michelle Kendell
- Curtin enAble Institute and Curtin School of Allied Health Curtin University, Perth, WA, Australia
| | - Darren Beales
- Curtin enAble Institute and Curtin School of Allied Health Curtin University, Perth, WA, Australia
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Rabey M, Kendell M, Koren S, Silva I, Watts L, Wong C, Slater H, Smith A, Beales D. Do chronic low back pain subgroups derived from dynamic quantitative sensory testing exhibit differing multidimensional profiles? Scand J Pain 2021; 21:474-484. [PMID: 33639047 DOI: 10.1515/sjpain-2020-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/15/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The relationship of pain sensitivity with pain and disability in low back pain (LBP) is complicated. It has been suggested increased understanding of dynamic quantitative sensory testing (QST) might be useful in increasing understanding of these relationships. This study aimed to create subgroups based on participant responses to dynamic QST, profile these subgroups based on multidimensional variables (including clinical measures of pain and disability, psychological and lifestyle variables and static QST), and investigate the association of subgroup membership with levels of pain intensity, LBP-related disability and disability risk at 12-month follow up. METHODS Participants (n=273) with dominant axial chronic non-specific LBP with duration of pain >3 months were included in this study. At baseline, eligible participants completed a self-report questionnaire to collect demographic, clinical, psychological and lifestyle data prior to dynamic and static QST. Dynamic QST measures were conditioned pain modulation (CPM) and temporal summation (TS). At 12-months follow up, clinical data were collected, including pain intensity and LBP-related disability. Sub-groups were formed by cross-tabulation. Analysis was undertaken to profile dynamic QST subgroup on demographic, clinical, psychological, lifestyle and static QST measures. Associations between dynamic QST subgroups and follow-up clinical variables were examined. RESULTS Based on dynamic QST, participants were allocated into four subgroups; normal CPM and normal TS (n=34, 12.5%); normal CPM and facilitated TS (n=6, 2.2%); impaired CPM and normal TS (n=186, 68.1%); impaired CPM and facilitated TS (n=47, 17.2%). At baseline no differences were demonstrated between subgroups across most clinical variables, or any psychological or lifestyle measures. The two subgroups with impaired CPM were more likely to have a higher number of painful body areas. Cold pain sensitivity was heightened in both the subgroups with facilitated TS. Subgroups did not differ across pain intensity, LBP-related disability and disability risk stratification at follow-up. CONCLUSIONS The profiles of people with axial LBP did not vary significantly across dynamic QST subgroups, save for those in groups with impaired CPM being more likely to have more widespread symptoms and those with facilitated TS having heightened cold pain sensitivity. Further, subgroup membership was not related to future pain and disability. The role of dynamic QST profiles in LBP remains unclear. Further work is required to understand the role of pain sensitivity in LBP. The utility of dynamic QST subgrouping might not be in determining of future disability. Future research might focus on treatment modifying effects of dynamic QST subgroups.
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Affiliation(s)
- Martin Rabey
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia.,Thrive Physiotherapy, Guernsey, Guernsey
| | - Michelle Kendell
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Shani Koren
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Isabela Silva
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Lauren Watts
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Chris Wong
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Helen Slater
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Darren Beales
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
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Sehgal N, Gordon DB, Hetzel S, Backonja MM. Colored Pain Drawing as a Clinical Tool in Differentiating Neuropathic Pain from Non-Neuropathic Pain. PAIN MEDICINE 2021; 22:596-605. [PMID: 33200188 DOI: 10.1093/pm/pnaa375] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES This is a prospective, blinded, case-control study of patients with chronic pain using body diagrams and colored markers to show the distribution and quality of pain and sensory symptoms (aching, burning, tingling, numbness, and sensitivity to touch) experienced in affected body parts. METHODS Two pain physicians, blinded to patients' clinical diagnoses, independently reviewed and classified each colored pain drawing (CPD) for presence of neuropathic pain (NeuP) vs. non-neuropathic pain (NoP). A clinical diagnosis (gold standard) of NeuP was made in 151 of 213 (70.9%) enrolled patients. RESULTS CPD assessment at "first glance" by both examiners resulted in correctly categorizing 137 (64.3% by examiner 1) and 156 (73.2% by examiner 2) CPDs. Next, classification of CPDs by both physicians, using predefined criteria of spatial distribution and quality of pain-sensory symptoms, improved concordance to 212 of 213 CPDs (Kappa = 0.99). The diagnostic ability to correctly identify NeuP and NoP by both examiners increased to 171 (80.2%) CPDs, with 80.1% sensitivity and 80.6% specificity (Kappa = 0.56 [95% confidence interval: 0.44-0.68]). The severity scores for pain and sensory symptoms (burning, tingling, numbness, and sensitivity to touch) on the Neuropathic Pain Questionnaire were significantly elevated in NeuP vs. NoP (P < 0.001). CONCLUSIONS This study demonstrates good performance characteristics of CPDs in identifying patients with NeuP through the use of a simple and easy-to-apply classification scheme. We suggest use of CPDs as a bedside screening tool and as a method for phenotypic profiling of patients by the quality and distribution of pain and sensory symptoms.
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Affiliation(s)
- Nalini Sehgal
- Department of Orthopedics and Rehabilitation Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Debra B Gordon
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Scott Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin, USA
| | - Miroslav Misha Backonja
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.,Department of Neurology, University of Washington, Seattle, Washington, USA
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Ali SM, Lau WJ, McBeth J, Dixon WG, van der Veer SN. Digital manikins to self-report pain on a smartphone: A systematic review of mobile apps. Eur J Pain 2021; 25:327-338. [PMID: 33113241 PMCID: PMC7839759 DOI: 10.1002/ejp.1688] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Chronic pain is the leading cause of disability. Improving our understanding of pain occurrence and treatment effectiveness requires robust methods to measure pain at scale. Smartphone-based pain manikins are human-shaped figures to self-report location-specific aspects of pain on people's personal mobile devices. METHODS We searched the main app stores to explore the current state of smartphone-based pain manikins and to formulate recommendations to guide their development in the future. RESULTS The search yielded 3,938 apps. Twenty-eight incorporated a pain manikin and were included in the analysis. For all apps, it was unclear whether they had been tested and had end-user involvement in the development. Pain intensity and quality could be recorded in 28 and 13 apps, respectively, but this was location specific in only 11 and 4. Most manikins had two or more views (n = 21) and enabled users to shade or select body areas to record pain location (n = 17). Seven apps allowed personalising the manikin appearance. Twelve apps calculated at least one metric to summarise manikin reports quantitatively. Twenty-two apps had an archive of historical manikin reports; only eight offered feedback summarising manikin reports over time. CONCLUSIONS Several publically available apps incorporated a manikin for pain reporting, but only few enabled recording of location-specific pain aspects, calculating manikin-derived quantitative scores, or generating summary feedback. For smartphone-based manikins to become adopted more widely, future developments should harness manikins' digital nature and include robust validation studies. Involving end users in the development may increase manikins' acceptability as a tool to self-report pain. SIGNIFICANCE This review identified and characterised 28 smartphone apps that included a pain manikin (i.e. pain drawings) as a novel approach to measure pain in large populations. Only few enabled recording of location-specific pain aspects, calculating quantitative scores based on manikin reports, or generating manikin feedback. For smartphone-based manikins to become adopted more widely, future studies should harness the digital nature of manikins, and establish the measurement properties of manikins. Furthermore, we believe that involving end users in the development process will increase acceptability of manikins as a tool for self-reporting pain.
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Affiliation(s)
- Syed Mustafa Ali
- Centre for Epidemiology Versus ArthritisUniversity of ManchesterManchesterUK
- Centre for Health InformaticsDivision of Informatics, Imaging and Data SciencesUniversity of ManchesterManchesterUK
- NIHR Manchester Musculoskeletal Biomedical Research CentreCentral Manchester University Hospitals NHS Foundation TrustManchesterUK
| | - Wei J. Lau
- Manchester Academic Health Science Centre (MAHSC)University of ManchesterManchesterUK
| | - John McBeth
- Centre for Epidemiology Versus ArthritisUniversity of ManchesterManchesterUK
- Centre for Health InformaticsDivision of Informatics, Imaging and Data SciencesUniversity of ManchesterManchesterUK
- NIHR Manchester Musculoskeletal Biomedical Research CentreCentral Manchester University Hospitals NHS Foundation TrustManchesterUK
| | - William G. Dixon
- Centre for Epidemiology Versus ArthritisUniversity of ManchesterManchesterUK
- Centre for Health InformaticsDivision of Informatics, Imaging and Data SciencesUniversity of ManchesterManchesterUK
- NIHR Manchester Musculoskeletal Biomedical Research CentreCentral Manchester University Hospitals NHS Foundation TrustManchesterUK
| | - Sabine N. van der Veer
- Centre for Epidemiology Versus ArthritisUniversity of ManchesterManchesterUK
- Centre for Health InformaticsDivision of Informatics, Imaging and Data SciencesUniversity of ManchesterManchesterUK
- NIHR Manchester Musculoskeletal Biomedical Research CentreCentral Manchester University Hospitals NHS Foundation TrustManchesterUK
- Manchester Academic Health Science Centre (MAHSC)University of ManchesterManchesterUK
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O’Neill S, Jensen TS, Kent P. Computerized quantification of pain drawings. Scand J Pain 2019; 20:175-189. [DOI: 10.1515/sjpain-2019-0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/20/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background and aims
Using a computer algorithm to quantify pain drawings could be useful, especially when large numbers of drawings need to be assessed. Whilst informal visual assessment of pain drawings can give clinicians a quick impression of the extent of pain and its location, formal quantification of pain drawings by computer for research purposes is not necessarily trivial. The current study compared seven different approaches to quantification in a large sample of clinical spinal pain drawings.
Methods
A large number (n = 55,720) of pain drawings were extracted from the SpineData database, a clinical registry of spinal pain patients in the Region of Southern Denmark. Drawings were analyzed both as pixel (raster) and vector based images, with different approaches based on the raw pain drawing, simple encircling polygons, convex-hull encircling polygons and discrete anatomical regions. Data were analyzed using principal component analysis, correlation and linear regression, as well as informal visual inspection of outlier pain drawings.
Results
Eighty-one percent of the variance could be explained by the first principal component, which we interpreted as the true score variance, i.e. the variance attributable to differences in pain area between individuals. The second principal component explained 10% of the variance and was loaded differentially by polygon-based methods and non-polygon-based methods. Correlations between the different approaches ranged from 0.66 to 1.00. Some approaches correlated so strongly as to be interchangeable, others tended to bias area estimates significantly. Visual inspection of outlier pain drawing indicated that when the different approaches to quantification yielded different results, characteristic patterns could be identified in the style and patterns of those pain drawings.
Conclusions
The different approaches reflected the same underlying construct (pain area), but could not be relied upon to produce the same area estimates and were affected by the interaction between drawing style and quantification approach. To some extend, the “correct” choice of quantification method is specific to and dictated by the style of each pain drawing. A differentiated approach is required in which the results of quantification and the drawing style are considered in combination. We provide suggestions for such differentiated approaches taking into account the nature of the drawing data (raster vs. vector) and the method of analysis (partly vs completely automated).
Implications
The chosen method of quantifying pain drawings in combination with the drawing style of the individual patient, can impact the resulting area estimate to a significant degree. These issues should be considered before undertaking computerized area estimation of pain drawings.
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Affiliation(s)
- Søren O’Neill
- Spine Center of Southern Denmark, Lillebælt Hospital , Middelfart , Denmark
- Institute of Regional Health Research , University of Southern Denmark , Odense , Denmark , Phone: +4540432004
| | - Tue Secher Jensen
- Diagnostic Imaging, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital , Silkeborg , Denmark
- Department of Clinical Medicine , Aarhus University , Aarhus , Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics , University of Southern Denmark , Odense , Denmark
| | - Peter Kent
- School of Physiotherapy and Exercise Science , Curtin University , Perth , Australia
- Department of Sports Science and Clinical Biomechanics , University of Southern Denmark , Odense , Denmark
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Abstract
BACKGROUND Spine surgery patients have difficulty comprehending the patient education aimed at preparing for surgery. PURPOSE To assess the effect of a specific preoperative education approach (Knowledge Test Feedback Intervention, KTFI) on patients' verbal and visual understanding of their surgery. METHODS In this randomized controlled trial, the intervention group (n = 50) went through the KTFI and routine education, whereas the control group (n = 50) received only routine patient education. Written description of the surgical procedure and drawing of incision were used as outcome measures at baseline, at hospitalization, at discharge, and 3 and 6 months after surgery. RESULTS At baseline, half of the participants showed verbal and visual understanding of their surgery. During follow-up, understanding improved significantly with no statistically significant differences between the groups. CONCLUSION Spinal stenosis patients' understanding of their surgical procedure is imperfect. Patient educators need to ensure patient learning by evaluating comprehension outcomes.
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Rabey M, Smith A, Kent P, Beales D, Slater H, O'Sullivan P. Chronic low back pain is highly individualised: patterns of classification across three unidimensional subgrouping analyses. Scand J Pain 2019; 19:743-753. [PMID: 31256070 DOI: 10.1515/sjpain-2019-0073] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/12/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Chronic low back pain (CLBP) is a complex disorder where central and peripheral nociceptive processes are influenced by factors from multiple dimensions associated with CLBP (e.g. movement, pain sensitivity, psychological). To date, outcomes for treatments matched to unidimensional subgroups (e.g. psychologically-based) have been poor. Therefore, unidimensional subgrouping may not reflect the complexity of CLBP presentations at an individual level. The aim of this study was therefore to explore patterns of classification at an individual level across the three previously-published, data-driven, within-dimension subgrouping studies. METHODS Cross-sectional, multidimensional data was collected in 294 people with CLBP. Statistical derivation of subgroups within each of three clinically-important dimensions (pain sensitivity, psychological profile, pain responses following repeated spinal bending) was briefly reviewed. Patterns of classification membership were subsequently tabulated across the three dimensions. RESULTS Of 27 possible patterns across these dimensions, 26 were represented across the cohort. CONCLUSIONS This result highlights that while unidimensional subgrouping has been thought useful to guide treatment, it is unlikely to capture the full complexity of CLBP. The amount of complexity important for best patient outcomes is currently untested. IMPLICATIONS For clinicians this study highlights the high variability of presentations of people with CLBP at the level of the individual. For example, clinician's should not assume that those with high levels of pain sensitivity will also have high psychological distress and have pain summation following repeated spinal bending. A more flexible, multidimensional, clinically-reasoned approach to profile patient complexity may be required to inform individualised, patient-centred care. Such individualised care might improve treatment efficacy. This study also has implications for researchers; highlighting the inadequacy of unidimensional subgrouping processes and methodological difficulties in deriving subgroups across multidimensional data.
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Affiliation(s)
- Martin Rabey
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia
| | - Peter Kent
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia
| | - Darren Beales
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia
| | - Helen Slater
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia
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Predicting self-reported disability level by a number of pain sites marked on pain drawing. Int J Rehabil Res 2018; 41:276-279. [DOI: 10.1097/mrr.0000000000000293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yoo JU, McIver TC, Hiratzka J, Carlson H, Carlson N, Radoslovich SS, Gernhart T, Boshears E, Kane MS. The presence of Waddell signs depends on age and gender, not diagnosis. Bone Joint J 2018; 100-B:219-225. [PMID: 29437065 DOI: 10.1302/0301-620x.100b2.bjj-2017-0684.r2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to determine if positive Waddell signs were related to patients’ demographics or to perception of their quality of life. Patients and Methods This prospective cross-sectional study included 479 adult patients with back pain from a university spine centre. Each completed SF-12 and Oswestry Disability Index (ODI) questionnaires and underwent standard spinal examinations to elicit Waddell signs. The relationship between Waddell signs and age, gender, ODI, Mental Component Score (MCS), and Physical Component Score (PCS) scores was determined. Results Of the 479 patients, 128 (27%) had at least one positive Waddell sign. There were significantly more women with two or more Waddell signs than men. The proportion of patients with at least one positive Waddell sign increased with age until 55 years, and then declined rapidly; none had a positive sign over the age of 75 years. Functional outcome scores were significantly worse in those with a single Waddell sign (p < 0.01). With one or more Waddell signs, patients’ PCS and ODI scores indicated a perception of severe disability; with three or more Waddell signs, patients’ MCS scores indicated severe disability. With five Waddell signs, ODI scores indicated that patients perceived themselves as crippled. Conclusion Positive Waddell signs, a potential indicator of central sensitization, indicated a likelihood of having functional limitations and an impaired quality of life, particularly in young women. Cite this article: Bone Joint J 2018;100-B:219–25.
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Affiliation(s)
- J. U. Yoo
- Oregon Health & Science University, 3181 South West Sam Jackson Park Road, Portland, Oregon 97239, USA
| | - T. C. McIver
- St. Cloud Orthopaedics, Spine Centre, 1901
Connecticut
Avenue South, Sartell, Minnesota
56388, USA
| | - J. Hiratzka
- Oregon Health & Science University, 3181 South West Sam Jackson Park Road, Portland, Oregon 97239, USA
| | - H. Carlson
- Oregon Health & Science University, 3181 South West Sam Jackson Park Road, Portland, Oregon 97239, USA
| | - N. Carlson
- Oregon Health & Science University, 3181 South West Sam Jackson Park Road, Portland, Oregon 97239, USA
| | - S. S. Radoslovich
- Oregon Health & Science University, 3181 South West Sam Jackson Park Road, Portland, Oregon 97239, USA
| | - T. Gernhart
- Oregon Health & Science University, 3181 South West Sam Jackson Park Road, Portland, Oregon 97239, USA
| | - E. Boshears
- Oregon Health & Science University, 3181 South West Sam Jackson Park Road, Portland, Oregon 97239, USA
| | - M. S. Kane
- Oregon Health & Science University, 3181 South West Sam Jackson Park Road, Portland, Oregon 97239, USA
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Storheim K, Espeland A, Grøvle L, Skouen JS, Aßmus J, Anke A, Froholdt A, Pedersen LM, Haugen AJ, Fors T, Schistad E, Lutro O, Marchand GH, Kadar T, Vetti N, Randen S, Nygaard ØP, Brox JI, Grotle M, Zwart JA. Antibiotic treatment In patients with chronic low back pain and Modic changes (the AIM study): study protocol for a randomised controlled trial. Trials 2017; 18:596. [PMID: 29246188 PMCID: PMC5732434 DOI: 10.1186/s13063-017-2306-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 11/01/2017] [Indexed: 11/25/2022] Open
Abstract
Background A previous randomised controlled trial (RCT) of patients with chronic low back pain (LBP) and vertebral bone marrow (Modic) changes (MCs) on magnetic resonance imaging (MRI), reported that a 3-month, high-dose course of antibiotics had a better effect than placebo at 12 months’ follow-up. The present study examines the effects of antibiotic treatment in chronic LBP patients with MCs at the level of a lumbar disc herniation, similar to the previous study. It also aims to assess the cost-effectiveness of the treatment, refine the MRI assessment of MCs, and further evaluate the impact of the treatment and the pathogenesis of MCs by studying genetic variability and the gene and protein expression of inflammatory biomarkers. Methods/design A double-blinded RCT is conducted at six hospitals in Norway, comparing orally administered amoxicillin 750 mg, or placebo three times a day, over a period of 100 days in patients with chronic LBP and type I or II MCs at the level of a MRI-confirmed lumbar disc herniation within the preceding 2 years. The inclusion will be stopped when at least 80 patients are included in each of the two MC type groups. In each MC type group, the study is designed to detect (β = 0.1, α = 0.05) a mean difference of 4 (standard deviation 5) in the Roland Morris Disability Questionnaire score between the two treatment groups (amoxicillin or placebo) at 1-year follow-up. The study includes cost-effectiveness measures. Blood samples are assessed for security measures and for possible inflammatory mediators and biomarkers at different time points. MCs are evaluated on MRI at baseline and after 12 months. A blinded intention-to-treat analysis of treatment effects will be performed in the total sample and in each MC type group. Discussion To ensure the appropriate use of antibiotic treatment, its effect in chronic LBP patients with MCs should be re-assessed. This study will investigate the effects and cost-effectiveness of amoxicillin in patients with chronic LBP and MCs at the level of a disc herniation. The study may also help to refine imaging and characterise the biomarkers of MCs. Trial registration ClinicalTrials.gov, ID: NCT02323412. Registered on 21 November 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2306-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kjersti Storheim
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital Ullevål, Pb 4950, Nydalen, 0424, Oslo, Norway.
| | - Ansgar Espeland
- Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Pb 7804, 5020, Bergen, Norway
| | - Lars Grøvle
- Department of Rheumatology, Østfold Hospital Trust, Pb 300, 1714, Grålum, Norway
| | - Jan Sture Skouen
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway.,Department of Global Public Health and Primary Care, Physiotherapy Research Group, University of Bergen, Bergen, Norway
| | - Jörg Aßmus
- Competence Center for Clinical Research, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway.,Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne Froholdt
- Department of Neurology, Rheumatology and Habilitation (NRH), Drammen Hospital, Vestre Viken Hospital Trust, Pb 800, 3004, Drammen, Norway
| | - Linda M Pedersen
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital Ullevål, Pb 4950, Nydalen, 0424, Oslo, Norway
| | - Anne Julsrud Haugen
- Department of Rheumatology, Østfold Hospital Trust, Pb 300, 1714, Grålum, Norway
| | - Terese Fors
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
| | - Elina Schistad
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Pb 4950, Nydalen, 0424, Oslo, Norway
| | - Olav Lutro
- Medical Department, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway.,Medical Department, Stavanger University Hospital, Pb 8100, 4068, Stavanger, Norway
| | - Gunn Hege Marchand
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Thomas Kadar
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway
| | - Nils Vetti
- Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Pb 7804, 5020, Bergen, Norway
| | - Sigrun Randen
- Department of Neurology, Rheumatology and Habilitation (NRH), Drammen Hospital, Vestre Viken Hospital Trust, Pb 800, 3004, Drammen, Norway
| | - Øystein Petter Nygaard
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway.,National Advisory Unit on Spinal Surgery, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Pb 4950, Nydalen, 0424, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Margreth Grotle
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital Ullevål, Pb 4950, Nydalen, 0424, Oslo, Norway.,Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, Department of Physiotherapy, Oslo, Norway
| | - John-Anker Zwart
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital Ullevål, Pb 4950, Nydalen, 0424, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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Gold JE, Punnett L, Gore RJ. Predictors of low back pain in nursing home workers after implementation of a safe resident handling programme. Occup Environ Med 2017; 74:389-395. [PMID: 27919063 PMCID: PMC5860804 DOI: 10.1136/oemed-2016-103930] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/13/2016] [Accepted: 10/19/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Healthcare workers have high rates of low back pain (LBP) related to handling patients. A large chain of nursing homes experienced reduced biomechanical load, compensation claims and costs following implementation of a safe resident handling programme (SRHP). The aim of this study was to examine whether LBP similarly declined and whether it was associated with relevant self-reported occupational exposures or personal health factors. METHODS Worker surveys were conducted on multiple occasions beginning with the week of first SRHP introduction (baseline). In each survey, the outcome was LBP during the prior 3 months with at least mild severity during the past week. Robust Poisson multivariable regression models were constructed to examine correlates of LBP cross-sectionally at 2 years (F3) and longitudinally at 5-6 years (F5) post-SRHP implementation among workers also in at least one prior survey. RESULTS LBP prevalence declined minimally between baseline and F3. The prevalence was 37% at F3 and cumulative incidence to F5 was 22%. LBP prevalence at F3 was positively associated with combined physical exposures, psychological job demands and prior back injury, while frequent lift device usage and 'intense' aerobic exercise frequency were protective. At F5, the multivariable model included frequent lift usage at F3 (relative risk (RR) 0.39 (0.18 to 0.84)) and F5 work-family imbalance (RR=1.82 (1.12 to 2.98)). CONCLUSIONS In this observational study, resident lifting device usage predicted reduced LBP in nursing home workers. Other physical and psychosocial demands of nursing home work also contributed, while frequent intense aerobic exercise appeared to reduce LBP risk.
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Affiliation(s)
- Judith E Gold
- Department of Occupational and Public Health Sciences, Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden
| | - Laura Punnett
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Rebecca J Gore
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - ProCare Research Team
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
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17
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Differing Psychologically Derived Clusters in People With Chronic Low Back Pain are Associated With Different Multidimensional Profiles. Clin J Pain 2016; 32:1015-1027. [DOI: 10.1097/ajp.0000000000000363] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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18
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Hartzell MM, Liegey-Dougall A, Kishino ND, Gatchel RJ. Utility of Pain Drawings Rated for Non-Organic Pain in Chronic Low Back Pain Populations: A Qualitative Systematic Review. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/jabr.12048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Meredith M. Hartzell
- Department of Psychology; College of Science; The University of Texas at Arlington
| | | | | | - Robert J. Gatchel
- Department of Psychology; College of Science; The University of Texas at Arlington
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19
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Tachibana T, Maruo K, Inoue S, Arizumi F, Kusuyama K, Yoshiya S. Use of pain drawing as an assessment tool of sciatica for patients with single level lumbar disc herniation. SPRINGERPLUS 2016; 5:1312. [PMID: 27547686 PMCID: PMC4978648 DOI: 10.1186/s40064-016-2981-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 08/01/2016] [Indexed: 11/26/2022]
Abstract
The objectives of this study were to examine the diagnostic accuracy of pain drawing (PD) in determining the level of involvement and to investigate how the quantitative evaluation results of PD using a grid score (GS) correlates with the results of other clinical evaluation measures in diagnosis and assessment of patients with lumber disc herniation (LDH) involving a single nerve root. Thirty-one patients with single level LDH who were diagnosed and conservatively treated by the first author constituted the study population. In order to assess the diagnostic accuracy of PD, the level of involvement as determined by PD was compared to the final diagnosis. In 26 of the 31 patients who could be followed for more than 6 months of conservative treatment, the GS in PD evaluation was compared to the score assessed by the Japanese Orthopaedic Association scoring system for low back pain (JOA score) and the visual analog scale (VAS) both before and after the treatment. The overall diagnostic accuracy of PD for the determination of the affected level averaged 68.8 %, and the accuracy was higher at the L4/5 and L5/S levels than the L2/3 and L3/4 levels. The average values of VAS and GS significantly decreased and the JOA score significantly improved after the treatment. Moreover, a significant correlation was demonstrated between the scores derived from these three evaluation measures. The present study indicated the potential usefulness of PD in clinical assessment during the treatment course.
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Affiliation(s)
- Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501 Japan
| | - Keishi Maruo
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501 Japan
| | - Shinichi Inoue
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501 Japan
| | - Fumihiro Arizumi
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501 Japan
| | - Kazuki Kusuyama
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501 Japan
| | - Shinichi Yoshiya
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501 Japan
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20
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Wolff N, Rubia K, Knopf H, Hölling H, Martini J, Ehrlich S, Roessner V. Reduced pain perception in children and adolescents with ADHD is normalized by methylphenidate. Child Adolesc Psychiatry Ment Health 2016; 10:24. [PMID: 27453723 PMCID: PMC4957360 DOI: 10.1186/s13034-016-0112-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/29/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The present study examined pain perception in children and adolescents with ADHD and the interaction between pain perception and the administration of methylphenidate (MPH) in order to generate hypotheses for further research that will help to clarify the association between ADHD diagnosis, MPH treatment and pain perception. METHODS We included 260 children and adolescents of the "German Health Interview and Examination Survey for Children and Adolescents" (KiGGS) and analyzed parent's assessments of children's pain distribution and pain perception, as well as the influence of MPH administration on pain perception in affected children and adolescents. RESULTS Pain perception was associated with ADHD and MPH administration, indicating that children and adolescents suffering from ADHD without MPH treatment were reported to have lower pain perception compared to both, healthy controls (HC) and ADHD patients medicated with MPH. CONCLUSION We suggest that reduced pain perception in children and adolescents with ADHD not medicated with MPH may lead to higher risk tolerance by misjudgments of dangerous situations, expanding the importance of MPH administration in affected children and adolescents.
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Affiliation(s)
- Nicole Wolff
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Katya Rubia
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King’s College London, London, UK
| | - Hildtraud Knopf
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Heike Hölling
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Julia Martini
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Stefan Ehrlich
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
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21
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Higuchi D. Clinical values of control over pain and pain coping strategies in surgical treatment for patients with lumbar spinal stenosis. Int J Spine Surg 2016; 10:22. [PMID: 27441180 DOI: 10.14444/3022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Control over pain and pain coping strategies are associated with pain intensity as well as psychological status and subjective disability in patients experiencing pain. The present study assessed the clinical values of control over pain and pain coping strategies in surgical treatment for patients with lumbar spinal stenosis using mediation analysis. METHODS Sixty-two patients with lumbar spinal stenosis (median age, 70 years; 34 men, 28 women) were evaluated before surgery. The pain intensity and area, psychological status/subjective disability (Japanese Orthopaedic Association Back Pain Evaluation Questionnaire), and control over pain/pain coping strategies (Coping Strategies Questionnaire) were assessed. Mediation analysis, which consisted of serial regression analyses, mainly tested whether (1) control over pain/pain coping strategies were predicted by pain characteristics and (2) control over pain/pain coping strategies predicted psychological status/subjective disability after controlling for pain characteristics. RESULTS Control over pain was predicted by pain intensity (regression coefficient, -0.33; p = 0.01); moreover, it predicted walking ability (standardized partial regression coefficient, 0.31; p = 0.01) and social function (0.38; p = 0.00) after controlling for pain intensity. Although increasing activity level, one pain coping strategy, was predicted by pain intensity (regression coefficient, -0.30; p = 0.02), it did not predict walking ability (standardized partial regression coefficient, 0.07; p = 0.53) or social function (0.13; p = 0.33) when considering pain intensity. CONCLUSIONS In this cohort, mediation analysis demonstrated that pain intensity did not directly affect perceived walking ability or social function, but did affect control over pain; moreover, control over pain affected walking ability and social function. CLINICAL RELEVANCE These findings are useful for a deep understanding of the relationships between pain and subjective disability in preoperative patients with lumbar spinal stenosis. More attention should be given to patients' thoughts about pain such as control over pain.
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Affiliation(s)
- Daisuke Higuchi
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Tasakaki, Gunma, Japan; Department of Rehabilitation, Harunaso Hospital, Tasakaki, Gunma, Japan
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22
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Bernhoff G, Landén Ludvigsson M, Peterson G, Bertilson BC, Elf M, Peolsson A. The pain drawing as an instrument for identifying cervical spine nerve involvement in chronic whiplash-associated disorders. J Pain Res 2016; 9:397-404. [PMID: 27358576 PMCID: PMC4912326 DOI: 10.2147/jpr.s104747] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Objective The aim of the study was to investigate the psychometric properties of a standardized assessment of pain drawing with regard to clinical signs of cervical spine nerve root involvement. Design This cross-sectional study included data collected in a randomized controlled study. Patients: Two hundred and sixteen patients with chronic (≥6 months) whiplash-associated disorders, grade 2 or 3, were included in this study. Methods The validity, sensitivity, and specificity of a standardized pain drawing assessment for determining nerve root involvement were analyzed, compared to the clinical assessment. In addition, we analyzed the interrater reliability with 50 pain drawings. Results Agreement was poor between the standardized pain drawing assessment and the clinical assessment (kappa =0.11, 95% CI: −0.03 to 0.20). Sensitivity was high (93%), but specificity was low (19%). Interrater reliability was good (kappa =0.64, 95% CI: 0.53 to 0.76). Conclusion: The standardized pain drawing assessment of nerve root involvement in chronic whiplash-associated disorders was not in agreement with the clinical assessment. Further research is warranted to optimize the utilization of a pain/discomfort drawing as a supportive instrument for identifying nerve involvement in cervical spinal injuries.
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Affiliation(s)
- Gabriella Bernhoff
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Maria Landén Ludvigsson
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Rehab Väst, County Council of Östergötland, Östergötland, Sweden
| | - Gunnel Peterson
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Bo Christer Bertilson
- Musculoskeletal Functions and Pain, Division of Family Medicine, NVS, Karolinska Institutet, Kista, Sweden; Academic Primary Health Care Center, Stockholm County Council, Kista, Sweden
| | | | - Anneli Peolsson
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Somatosensory nociceptive characteristics differentiate subgroups in people with chronic low back pain. Pain 2015; 156:1874-1884. [DOI: 10.1097/j.pain.0000000000000244] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Ask T, Skouen JS, Assmus J, Kvåle A. Self-Reported and Tested Function in Health Care Workers with Musculoskeletal Disorders on Full, Partial or Not on Sick Leave. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:506-517. [PMID: 25427674 PMCID: PMC4540771 DOI: 10.1007/s10926-014-9557-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE The aim of this study was to describe self-reported and physically tested function in health care workers with musculoskeletal disorders (MSDs) and to examine how function was associated with work participation. METHODS A cross-sectional study was conducted. 250 health care workers attended an evaluation where self-reported and physical function were measured. Differences between groups (full sick leave, partial sick leave, not on sick leave/working) were analyzed for categorical data (Chi square exact test) and continuous variables (Kruskal-Wallis and Mann-Whitney U tests). Logistic regression analysis was performed to examine which factors were associated with being on sick leave. RESULTS Participants on full sick leave had statistically significant poorer function compared to those working and the group on partial sick leave. Logistic regression showed that a reduced level of the physical dimension of SF-12 and a high lift test were significantly related to full sick leave (OR 0.86, p < 0.001) (OR 0.79, p = 0.002). The physical dimension of SF-12 was the only variable that was associated to partial sick leave (OR 0.91, p = 0.005). CONCLUSION Health care workers on full sick leave due to MSDs have reduced function on self-reported and physically tested function, compared to those working despite MSDs, as well as when compared to those on partial sick leave. More knowledge about work ability in occupational sub-groups is needed.
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Affiliation(s)
- Tove Ask
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, PO Box 7800, 5020, Bergen, Norway,
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25
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Affiliation(s)
- Thomas Johan Kibsgård
- Department of Orthopedics Oslo University Hospital Songsvannsveien 20, NO-0372, Oslo , Norway
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Rabey M, Beales D, Slater H, O'Sullivan P. Multidimensional pain profiles in four cases of chronic non-specific axial low back pain: An examination of the limitations of contemporary classification systems. ACTA ACUST UNITED AC 2015; 20:138-47. [DOI: 10.1016/j.math.2014.07.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/24/2014] [Accepted: 07/28/2014] [Indexed: 01/22/2023]
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Evaluative measurement properties of the patient-specific functional scale for primary shoulder complaints in physical therapy practice. J Orthop Sports Phys Ther 2014; 44:595-603. [PMID: 25029915 DOI: 10.2519/jospt.2014.5133] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Clinical measurement, longitudinal. OBJECTIVES To assess the test-retest reliability, construct validity, and responsiveness of the Patient-Specific Functional Scale (PSFS) in patients with a primary shoulder complaint. BACKGROUND Health measurement outcomes have become increasingly important for evaluating treatment. Patient-specific questionnaires are useful tools for determining treatment goals and evaluating treatment in individual patients. These questionnaires have not yet been validated in patients with nonspecific shoulder pain. METHODS Patients completed the PSFS, the numeric pain rating scale, and the Shoulder Pain and Disability Index at baseline, and after 1 week and 4 to 6 weeks. Test-retest reliability was determined using intraclass correlation coefficients. To assess convergent validity, change scores of the PSFS were correlated with the numeric pain rating scale and Shoulder Pain and Disability Index change scores. Responsiveness was assessed by calculating the area under the curve, the minimal clinically important change, and minimal detectable change, using the global rating of change as an external criterion. RESULTS Fifty patients (37 men; mean age, 47.7 years) participated in the study. Reliability was high (intraclass correlation coefficient = 0.87; 95% confidence interval [CI]: 0.72, 0.94). The correlations between the change scores of the PSFS and those of the Shoulder Pain and Disability Index and numeric pain rating scale were 0.45 (95% CI: 0.17, 0.80) and 0.55 (95% CI: 0.29, 0.73), respectively. The area under the curve for the PSFS was 0.67 (95% CI: 0.51, 0.83). The minimal detectable change and minimal clinically important change were 0.97 and 1.29 points, respectively. CONCLUSION These results suggest that the PSFS is a reliable, valid, and responsive instrument that can be used as an evaluative instrument in patients with a primary shoulder complaint.
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How fast pain, numbness, and paresthesia resolves after lumbar nerve root decompression: a retrospective study of patient's self-reported computerized pain drawing. Spine (Phila Pa 1976) 2014; 39:E529-36. [PMID: 24480941 DOI: 10.1097/brs.0000000000000240] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A single-center retrospective study. OBJECTIVE To compare the speed of recovery of different sensory symptoms, pain, numbness, and paresthesia, after lumbar nerve root decompression. SUMMARY OF BACKGROUND DATA Lumbar radiculopathy is characterized by different sensory symptoms like pain, numbness, and paresthesia, which may resolve at different rates after surgical decompression. METHODS Eighty-five cases with predominant lumbar radiculopathy treated surgically were reviewed. Oswestry Disability Index score, 36-Item Short Form Health Survey scores (Physical Component Summary and Mental Component Summary), and pain drawing at preoperative and at 6 weeks, 3 months, 6 months, and 1-year follow-up were reviewed. Recovery rate between different sensory symptoms were compared in all patients, and between the short-term compression (<6 mo) and long-term compression groups. RESULTS At baseline, 73 (85.8%) patients had pain, 63 (74.1%) had numbness, and 38 (44.7%) had paresthesia; 28 (32.9%) had all these 3 component of sensory symptoms. Mean pain score improved fastest (55.3% at 6 wk); further resolution until 1 year was slow and not significant compared with each previous visit. Both numbness and paresthesia scores showed a trend of faster recovery during the initial 6-week period (20.5% and 24%, respectively); paresthesia recovery reached a plateau at 3 months postoperatively, but numbness continued a slow recovery until 1-year follow-up. Both Oswestry Disability Index score and Physical Component Summary scores (54.02 ± 1.87 and 26.29 ± 0.93, respectively, at baseline) improved significantly compared with each previous visits at 6 weeks and 3 months postoperatively, but further improvement was insignificant. Mental Component Summary showed a similar trend but smaller improvement. The short-term compression group had faster recovery of pain than the long-term compression group. CONCLUSION In lumbar radiculopathy patients after surgical decompression, pain recovers fastest, in the first 6 weeks postoperatively, followed by paresthesia recovery that plateaus at 3 months postoperatively. Numbness recovers at a slower pace but continues until 1 year. LEVEL OF EVIDENCE 4.
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Walker BF, Losco CD, Armson A, Meyer A, Stomski NJ. The association between pain diagram area, fear-avoidance beliefs, and pain catastrophising. Chiropr Man Therap 2014; 22:5. [PMID: 24438468 PMCID: PMC3899615 DOI: 10.1186/2045-709x-22-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 11/26/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The development of clinical practice guidelines for managing spinal pain have been informed by a biopsychosocial framework which acknowledges that pain arises from a combination of psychosocial and biomechanical factors. There is an extensive body of evidence that has associated various psychosocial factors with an increased risk of experiencing persistent pain. Clinicians require instruments that are brief, easy to administer and score, and capable of validly identifying psychosocial factors. The pain diagram is potentially such an instrument. The aim of our study was to examine the association between pain diagram area and psychosocial factors. METHODS 183 adults, aged 20-85, with spinal pain were recruited. We administered a demographic checklist; pain diagram; 11-point Numerical Rating Scale assessing pain intensity; Pain Catastrophising Scale (PCS); MOS 36 Item Short Form Health Survey (SF-36); and the Fear Avoidance Beliefs Questionnaire (FABQ). Open source software, GIMP, was used to calculate the total pixilation area on each pain diagram. Linear regression was used to examine the relationship between pain diagram area and the following variables: age; gender; pain intensity; PCS total score; FABQ-Work scale score; FABQ-Activity scale score; and SF-36 Mental Health scale score. RESULTS There were no significant associations between pain diagram area and any of the clinical variables. CONCLUSION Our findings showed that that pain diagram area was not a valid measure to identify psychosocial factors. Several limitations constrained our results and further studies are warranted to establish if pain diagram area can be used assess psychosocial factors.
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Affiliation(s)
- Bruce F Walker
- School of Health Professions, Murdoch University, Murdoch, Australia.
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The use of weekly text messaging over 6 months was a feasible method for monitoring the clinical course of low back pain in patients seeking chiropractic care. J Clin Epidemiol 2011; 65:454-61. [PMID: 22169083 DOI: 10.1016/j.jclinepi.2011.07.012] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 06/15/2011] [Accepted: 07/03/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study critically evaluates a new method of collecting frequent data using mobile phones and text messages. Fluctuating conditions such as low back pain (LBP) need frequent monitoring to describe the clinical course in detail and to account for individual and subgroup variations. STUDY DESIGN AND SETTING In this multicentre prospective observational study, 262 subjects with nonspecific LBP were followed with weekly text messages for 6 months, with the question "How many days this previous week has your low back pain been bothersome?" The text replies were instantly recorded in a data file to be merged with baseline and follow up data (age, gender, pain intensity, duration, and self- rated health) collected through ordinary questionnaires. The response rate, user-friendliness, and compliance of this method were evaluated. RESULTS The mean response rate for the text messages throughout the study was 82.5% and was unaffected by season. The method was found to be user friendly. Dropout was not affected by age and gender, but compliance was possibly somewhat affected by outcome. CONCLUSION Weekly text messages are a useful method of data collection to examine the clinical course of LBP in the primary care sector.
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Axén I, Bodin L, Bergström G, Halasz L, Lange F, Lövgren PW, Rosenbaum A, Leboeuf-Yde C, Jensen I. Clustering patients on the basis of their individual course of low back pain over a six month period. BMC Musculoskelet Disord 2011; 12:99. [PMID: 21586117 PMCID: PMC3125255 DOI: 10.1186/1471-2474-12-99] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 05/17/2011] [Indexed: 11/29/2022] Open
Abstract
Background Several researchers have searched for subgroups in the heterogeneous population of patients with non-specific low back pain (LBP). To date, subgroups have been identified based on psychological profiles and the variation of pain. Methods This multicentre prospective observational study explored the 6- month clinical course with measurements of bothersomeness that were collected from weekly text messages that were sent by 176 patients with LBP. A hierarchical cluster analysis, Ward's method, was used to cluster patients according to the development of their pain. Results Four clusters with distinctly different clinical courses were described and further validated against clinical baseline variables and outcomes. Cluster 1, a "stable" cluster, where the course was relatively unchanged over time, contained young patients with good self- rated health. Cluster 2, a group of "fast improvers" who were very bothered initially but rapidly improved, consisted of patients who rated their health as relatively poor but experienced the fewest number of days with bothersome pain of all the clusters. Cluster 3 was the "typical patient" group, with medium bothersomeness at baseline and an average improvement over the first 4-5 weeks. Finally, cluster 4 contained the "slow improvers", a group of patients who improved over 12 weeks. This group contained older individuals who had more LBP the previous year and who also experienced most days with bothersome pain of all the clusters. Conclusions It is possible to define clinically meaningful clusters of patients based on their individual course of LBP over time. Future research should aim to reproduce these clusters in different populations, add further clinical variables to distinguish the clusters and test different treatment strategies for them.
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Affiliation(s)
- Iben Axén
- The Karolinska Institutet, Institute of Environmental Medicine, Sweden.
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Persson AL, Garametsos S, Pedersen J. Computer-aided surface estimation of pain drawings - intra- and inter-rater reliability. J Pain Res 2011; 4:135-41. [PMID: 21647217 PMCID: PMC3100228 DOI: 10.2147/jpr.s18637] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Indexed: 11/23/2022] Open
Abstract
Pain drawings are often utilized in the documentation of pain conditions. The aim here was to investigate intra- and inter-rater reliability of area measurements performed on pain drawings consecutively, using the computer program Quantify One. Forty-eight patients with chronic nonmalignant pain had shaded in their experienced pain on the front and back views of a pain drawing. The templates were scanned and displayed on a 17-inch computer screen. Two independent examiners systematically encircled the shaded-in areas of the pain drawings with help of a computer mouse, twice each on two separate days, respectively. With this method it is possible to encircle each marked area and to obtain immediate details of its size. The total surface area (mm2) was calculated for each pain drawing measurement. Each examiner measured about 2400 areas, and as a whole, the number of areas measured varied only by 3%. The intra-rater reliability was high with intraclass correlation coefficients 0.992 in Examiner A and 0.998 in Examiner B. The intra-individual absolute differences were small within patients within one examiner as well as between the two examiners. The inter-rater reliability was also high. Still, significant differences in the absolute mean areas (13%) were seen between the two examiners in the second to fourth measurement sessions, indicating that one of the examiners measured systematically less. The measurement error was ≤10%, indicating that use of the program would be advantageous both in clinical practice and in research, but if repeated, preferably with the same examiner. Since pain drawings with this method are digitized, high quality data without loss of information is possible to store in electronic medical records for later analysis, both regarding precise location and size of pain area. We conclude that the computer program Quantify One is a reliable method to calculate the areas of pain drawings.
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Affiliation(s)
- Ann L Persson
- Rehabilitation and Research Centre for Torture Victims, Copenhagen K, Denmark
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Grotle M, Foster NE, Dunn KM, Croft P. Are prognostic indicators for poor outcome different for acute and chronic low back pain consulters in primary care? Pain 2010; 151:790-797. [PMID: 20932646 PMCID: PMC3398128 DOI: 10.1016/j.pain.2010.09.014] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 08/18/2010] [Accepted: 09/10/2010] [Indexed: 10/19/2022]
Abstract
Few studies have investigated whether prognostic indicators, which contribute to the transition from acute to chronic low back pain (LBP), are also those which contribute to continuing persistence of chronic LBP. We compared the contribution of physical, psychological and social indicators to predicting disability after one year between consulters with LBP of less than 3 months duration and more than 3 months duration. Data from two large prospective cohort studies of consecutive patients consulting with LBP in general practices were merged, providing complete data for 258 cases with acute/subacute LBP and 668 cases with chronic LBP at 12 months follow-up. There were significant differences between the two LBP groups in baseline characteristics and clinical course of disability, assessed by Roland Morris Disability Questionnaire, during the year of follow-up. Adjusted associations between potential prognostic indicators and disability at 12months were carried out in the two LBP subgroups. The final multivariable regression models showed that being non-employed, having widespread pain, a high level of Chronic Pain Grade, and catastrophising were the strongest prognostic indicators for disability at 12 months in both LBP groups. Fear of pain was significantly associated with disability in chronic LBP. Importantly, beyond baseline disability, the effect size of the other prognostic indicators for poor outcome was rather low. These findings must continue to challenge researchers to identify useful early predictors of outcome in persons with disabling back pain, as screening and targeted treatment approaches are dependent upon prognostic indicators with clinical significance.
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Affiliation(s)
- Margreth Grotle
- FORMI (Communication Unit for Musculoskeletal Disorders), Oslo University Hospital, Ullevaal, Oslo, Norway National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway Arthritis Research UK Primary Care Centre, Keele University, UK
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Vetti N, Kråkenes J, Eide GE, Rørvik J, Gilhus NE, Espeland A. Are MRI high-signal changes of alar and transverse ligaments in acute whiplash injury related to outcome? BMC Musculoskelet Disord 2010; 11:260. [PMID: 21070654 PMCID: PMC2989946 DOI: 10.1186/1471-2474-11-260] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 11/11/2010] [Indexed: 11/16/2022] Open
Abstract
Background Upper neck ligament high-signal changes on magnetic resonance imaging (MRI) have been found in patients with whiplash-associated disorders (WAD) but also in non-injured controls. The clinical relevance of such changes is controversial. Their prognostic role has never been evaluated. The purpose of this study was to examine if alar and transverse ligament high-signal changes on MRI immediately following the car accident are related to outcome after 12 months for patients with acute WAD grades 1-2. Methods Within 13 days after a car accident, 114 consecutive acute WAD1-2 patients without prior neck injury or prior neck problems underwent upper neck high-resolution proton-weighted MRI. High-signal changes of the alar and transverse ligaments were graded 0-3. A questionnaire including the impact of event scale for measuring posttraumatic stress response and questions on patients' expectations of recovery provided clinical data at injury. At 12 months follow-up, 111 (97.4%) patients completed the Neck Disability Index (NDI) and an 11-point numeric rating scale (NRS-11) on last week neck pain intensity. Factors potentially related to these outcomes were assessed using multiple logistic regression analyses. Results Among the 111 responders (median age 29.8 years; 63 women), 38 (34.2%) had grades 2-3 alar ligament changes and 25 (22.5%) had grades 2-3 transverse ligament changes at injury. At 12 months follow-up, 49 (44.1%) reported disability (NDI > 8) and 23 (20.7%) neck pain (NRS-11 > 4). Grades 2-3 ligament changes in the acute phase were not related to disability or neck pain at 12 months. More severe posttraumatic stress response increased the odds for disability (odds ratio 1.46 per 10 points on the impact of event scale, p = 0.007) and so did low expectations of recovery (odds ratio 4.66, p = 0.005). Conclusions High-signal changes of the alar and transverse ligaments close after injury did not affect outcome for acute WAD1-2 patients without previous neck problems. High-resolution upper neck MRI has limited value for the initial examination and follow-up of such patients.
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Affiliation(s)
- Nils Vetti
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.
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Whiplash Injury is More Than Neck Pain: A Population-Based Study of Pain Localization After Traffic Injury. J Occup Environ Med 2010; 52:434-40. [DOI: 10.1097/jom.0b013e3181bb806d] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Felix ER, Galoian KA, Aarons C, Brown MD, Kearing SA, Heiss U. Utility of Quantitative Computerized Pain Drawings in a Sample of Spinal Stenosis Patients. PAIN MEDICINE 2010; 11:382-9. [DOI: 10.1111/j.1526-4637.2009.00788.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Discriminative Validity of the Global Physiotherapy Examination-52 in Patients with Long-Lasting Musculoskeletal Pain versus Healthy Persons. ACTA ACUST UNITED AC 2010. [DOI: 10.1300/j094v11n03_04] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Schott GD. The cartography of pain: the evolving contribution of pain maps. Eur J Pain 2010; 14:784-91. [PMID: 20079670 DOI: 10.1016/j.ejpain.2009.12.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 12/06/2009] [Accepted: 12/17/2009] [Indexed: 11/18/2022]
Abstract
Pain maps are nowadays widely used in clinical practice. This article aims to critically review the fundamental principles that underlie the mapping of pain, to analyse the evolving iconography of pain maps and their sometimes straightforward and sometimes contentious nature when used in the clinic, and to draw attention to some more recent developments in mapping pain. It is concluded that these maps are intriguing and evolving cartographic tools which can be used for depicting not only the spatial features but also the interpretative or perceptual components and accompaniments of pain.
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Affiliation(s)
- Geoffrey D Schott
- The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
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Murphy DR, Hurwitz EL, Gerrard JK, Clary R. Pain patterns and descriptions in patients with radicular pain: does the pain necessarily follow a specific dermatome? CHIROPRACTIC & OSTEOPATHY 2009; 17:9. [PMID: 19772560 PMCID: PMC2753622 DOI: 10.1186/1746-1340-17-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Accepted: 09/21/2009] [Indexed: 02/07/2023]
Abstract
Background It is commonly stated that nerve root pain should be expected to follow a specific dermatome and that this information is useful to make the diagnosis of radiculopathy. There is little evidence in the literature that confirms or denies this statement. The purpose of this study is to describe and discuss the diagnostic utility of the distribution of pain in patients with cervical and lumbar radicular pain. Methods Pain drawings and descriptions were assessed in consecutive patients diagnosed with cervical or lumbar nerve root pain. These findings were compared with accepted dermatome maps to determine whether they tended to follow along the involved nerve root's dermatome. Results Two hundred twenty-six nerve roots in 169 patients were assessed. Overall, pain related to cervical nerve roots was non-dermatomal in over two-thirds (69.7%) of cases. In the lumbar spine, the pain was non-dermatomal in just under two-thirds (64.1%) of cases. The majority of nerve root levels involved non-dermatomal pain patterns except C4 (60.0% dermatomal) and S1 (64.9% dermatomal). The sensitivity (SE) and specificity (SP) for dermatomal pattern of pain are low for all nerve root levels with the exception of the C4 level (Se 0.60, Sp 0.72) and S1 level (Se 0.65, Sp 0.80), although in the case of the C4 level, the number of subjects was small (n = 5). Conclusion In most cases nerve root pain should not be expected to follow along a specific dermatome, and a dermatomal distribution of pain is not a useful historical factor in the diagnosis of radicular pain. The possible exception to this is the S1 nerve root, in which the pain does commonly follow the S1 dermatome.
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Ask T, Strand LI, Sture Skouen J. The effect of two exercise regimes; motor control versus endurance/strength training for patients with whiplash-associated disorders: a randomized controlled pilot study. Clin Rehabil 2009; 23:812-23. [DOI: 10.1177/0269215509335639] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To compare the effect of exercise regimes with focus on either motor control training or endurance/strength training for patients with whiplash-associated disorders in subacute phase. Design: Randomized controlled trial. Setting: An outpatient spine clinic in Norway. Participants: Twenty-five subjects with a whiplash-associated disorder still having symptoms or disability six weeks after injury. Interventions: The participants received 6—10 sessions of physiotherapy for six weeks with focus on either motor control or endurance and strength of neck muscles. Measurements: The primary outcome measure was the Neck Disability Index. Secondary outcome measures were pain intensity, neck functioning and sick leave. Results: No statistical significant differences concerning primary and secondary outcome measures were demonstrated between the groups. Approximately half of the participants in both groups obtained a clinically important change (improvement) on perceived disability assessed by Neck Disability Index at six weeks and one-year follow-up. The changes within both groups were statistically significant at six weeks, but not at one-year follow-up. For most pain-related variables clinical significant improvement was demonstrated in both groups at six weeks, but for fewer participants at one year. There was also statistical significant improvement within groups in some of the physical performance tests at one-year follow-up. Conclusion: The changes associated with motor control training and endurance/ strength training of neck muscles were similar for reduced disability, pain and for improving physical performance. With a low number of participants and no control group, however, we cannot be sure whether the improvements are due to interventions or other reasons.
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Affiliation(s)
- Tove Ask
- Outpatient Spine Clinic, Department of Physical Medicine and Rehabilitation and Department of Physiotherapy, Haukeland University Hospital, Bergen, ,
| | - Liv I Strand
- Department of Public Health and Primary Health Care, Section for Physiotherapy Science, University of Bergen and Department of Physiotherapy, Haukeland University Hospital, Bergen
| | - Jan Sture Skouen
- Outpatient Spine Clinic, Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen and Department of Public Health and Primary Health Care, Section for Physiotherapy Science, University of Bergen, Norway
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Haig AJ, Yamakawa KSJ, Parres C, Chiodo A, Tong H. A prospective, masked 18-month minimum follow-up on neurophysiologic changes in persons with spinal stenosis, low back pain, and no symptoms. PM R 2009; 1:127-36. [PMID: 19627886 PMCID: PMC2735230 DOI: 10.1016/j.pmrj.2008.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 10/15/2008] [Accepted: 10/16/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe neurophysiologic changes over time in persons with and without spinal complaints and to assess whether paraspinal denervation predicts change in stenosis on magnetic resonance imaging (MRI) and clinical course. DESIGN Prospective, controlled, masked trial. SETTING University spine program. PARTICIPANTS Persons aged 55 to 80 years, screened for polyneuropathy and determined on clinical examination to have spinal stenosis, mechanical low back pain, or no spinal symptoms. INTERVENTIONS A comprehensive codified history was obtained and subjects underwent physical examination, ambulation testing, masked electrodiagnostic testing including paraspinal mapping, and MRI, repeated at greater than 18 months. This study presents detailed technical information and additional analyses not reported previously. MAIN OUTCOME MEASUREMENTS Change in electrodiagnostic findings. Among persons with clinical stenosis, relationship of change in paraspinal mapping scores to MRI findings and clinical changes. RESULTS Of 149 initial subjects, 83 (79.3% of eligible subjects) repeated testing at 20 (+/-2 SDs) months. No significant change in limb muscle spontaneous activity or motor unit pathology was noted in any group. In 23 persons with initial diagnosis of stenosis, paraspinal mapping electromyography related to change in diagnosis over time (analysis of variance F = 3.77, P = .037), but not to most initial magnetic resonance imaging measurements or to change in spinal canal diameter. CONCLUSIONS Clinical spinal stenosis is neurophysiologically stable in most persons. Paraspinal electromyographic changes reflect large changes in clinical course, but neither neurophysiologic nor clinical changes relate to change in spinal geometry over 20 months.
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Affiliation(s)
- Andrew J Haig
- Department of Physical Medicine and Rehabilitation, The University of Michigan, Ann Arbor, MI 48108, USA.
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Tait RC, Chibnall JT, Kalauokalani D. Provider Judgments of Patients in Pain: Seeking Symptom Certainty. PAIN MEDICINE 2009; 10:11-34. [DOI: 10.1111/j.1526-4637.2008.00527.x] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Pain measurement in patients with low back pain. ACTA ACUST UNITED AC 2007; 3:610-8. [DOI: 10.1038/ncprheum0646] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Accepted: 08/01/2007] [Indexed: 11/08/2022]
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Evans S, Keenan TR. Parents with chronic pain: are children equally affected by fathers as mothers in pain? A pilot study. J Child Health Care 2007; 11:143-57. [PMID: 17494988 DOI: 10.1177/1367493507076072] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study compared the psychological and physical functioning of 12 children in each of three groups: mothers with chronic pain, fathers with chronic pain and a control, pain-free parents. Parents completed a number of questionnaires including the RAND-36 Health Status Inventory, a child health scale and the Child Behavior Checklist. Children completed the Revised Child Manifest Anxiety Scale and a scale measuring pain and sickness behaviour. Children of mothers with chronic pain reported the most physical and psychological problems, followed by children of fathers with chronic pain and children from the control group. Pain reports between children and parents with chronic pain were significantly correlated, suggesting support for a familial pain model. Social learning may explain the concordance between parent and child health in families experiencing parental chronic pain.
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Affiliation(s)
- Subhadra Evans
- Department of Health and Social Care, Brunel University, Isleworth, UK.
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George SZ, Bialosky JE, Wittmer VT, Robinson ME. Sex differences in pain drawing area for individuals with chronic musculoskeletal pain. J Orthop Sports Phys Ther 2007; 37:115-21. [PMID: 17416126 DOI: 10.2519/jospt.2007.2399] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVES To (1) determine the association between pain severity and pain drawing area for men and women; (2) determine if sex differences exist in pain severity or pain drawing area; (3) determine the relative influence of pain severity, anatomical location of pain, personality, and psychological coping factors on pain drawing area for men and women. BACKGROUND Pain drawings have been postulated to assist in clinical decision making regarding classification and treatment of musculoskeletal pain. Prior studies have been ambiguous on this topic, possibly because they have not considered if sex differences exist for pain drawing area. METHODS AND MEASURES One hundred twenty-six subjects referred to a multidisciplinary chronic pain clinic with chronic musculoskeletal pain were included in this study. Subjects completed a pain drawing, the Multidimensional Pain Inventory (MPI), the Coping Strategies Questionnaire (CSQ), and the Minnesota Multiphasic Personality Inventory (MMPI-2). Pearson correlations investigated the associations of pain severity and pain drawing area, independent t tests investigated sex differences in pain severity and pain drawing area, and multiple regression investigated factors that influenced pain drawing area. RESULTS P a in severity w as positively correlated with pain drawing area for men (r = 0.38, P = .003) and women (r = 0.23, P = .052), accounting for approximately 14% and 5% of the total variance, respectively. There was no significant sex difference in pain severity ratings, but women reported a significantly larger area of symptoms on the pain drawings (effect size, 0.61; P = .002). The sex difference in pain drawing area was consistent across different anatomical locations of pain. In women, the final regression model accounted for 39% (P < .001) of the variance in pain drawing area, with anatomical location of pain (beta = .42, P < .001) and hypochondriasis (beta = .31, P = .005) as the only unique predictors in the final model. In men, the regression model accounted for 27% (P = .003) of the variance in pain drawing area, with pain severity (beta = .32, P = .021) and a coping style of ignoring pain (beta = -.32, P = .018) as the only unique predictors in the final model. CONCLUSIONS Women had larger pain drawing area and this area was significantly associated with anatomical location of pain and hypochondriasis. Men had smaller pain drawing area and this area was associated with pain severity and a coping style of ignoring pain. These findings suggest that clinicians interpreting pain diagram area should consider the sex of the individual.
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Affiliation(s)
- Steven Z George
- Department of Physical Therapy, Brooks Center for Rehabilitation Studies, University of Florida, Gainesville 32610-0154, USA
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Haig AJ, Geisser ME, Tong HC, Yamakawa KSJ, Quint DJ, Hoff JT, Chiodo A, Miner JA, Phalke VV. Electromyographic and magnetic resonance imaging to predict lumbar stenosis, low-back pain, and no back symptoms. J Bone Joint Surg Am 2007; 89:358-66. [PMID: 17272451 DOI: 10.2106/jbjs.e.00704] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Magnetic resonance imaging is commonly used to diagnose lumbar spinal stenosis. Some persons without symptoms have a small lumbar spinal canal. Electrodiagnosis has been used to diagnose spinal stenosis for over sixty years, but we are aware of no masked, controlled trials of the use of electrodiagnosis for that purpose. This study was performed to evaluate the relationships of magnetic resonance imaging measures and electrodiagnostic data with the clinical syndrome of spinal stenosis. METHODS One hundred and fifty persons between the ages of fifty-five and eighty years old, including asymptomatic volunteers and persons referred for lumbar magnetic resonance imaging, underwent clinical examination, electrodiagnosis, and magnetic resonance imaging. Subjects were excluded if they had neuromuscular disease, sacral cancer, or inadequate test results, which left 126 subjects for the final analysis. The final cohort was divided into three groups--no back pain, mechanical back pain, and clinical spinal stenosis--on the basis of the impression of the examining physician, for whom the results of the magnetic resonance imaging and electrodiagnostic testing were masked. A spine surgeon also reviewed both the imaging and clinical examination data. RESULTS The examining physician's diagnosis of clinical spinal stenosis was significantly related to the neurological findings on examination (p < 0.05) and to the spine surgeon's diagnosis (p < 0.001). The diagnosis of clinical spinal stenosis was also significantly related to the presence of fibrillations on electrodiagnostic testing (p < or = 0.003), the minimum anteroposterior diameter of the spinal canal on the magnetic resonance images (p = 0.016), and the average of the two smallest spinal canal diameters (p = 0.008) on the images. Measurements on magnetic resonance imaging did not differentiate subjects with clinical spinal stenosis from controls better than chance, whereas paraspinal mapping electrodiagnosis scores did. CONCLUSIONS This prospective, controlled, masked study of electrodiagnosis and magnetic resonance imaging for older subjects showed that imaging does not differentiate symptomatic from asymptomatic persons, whereas electrodiagnosis does. We believe that radiographic findings alone are insufficient to justify treatment for spinal stenosis.
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Affiliation(s)
- Andrew J Haig
- University of Michigan Spine Program, Department of Physical Medicine and Rehabilitation, University of Michigan, 325 East Eisenhower Parkway, Ann Arbor, MI 48108, USA.
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Abstract
BACKGROUND AND PURPOSE The effectiveness of functional restoration (FR) for patients with lumbar disk herniation with associated radiculopathy (LDHR) is unclear. This case report describes how an FR program was used to rehabilitate a patient with such an injury. CASE DESCRIPTION The patient was a 26-year-old female child care worker with a 12-month history of back pain and a 4-month history of unremitting left leg symptoms. She had clinical and radiological evidence of an L5-S1 disk extrusion with associated left S1 radiculopathy. Interventions. The patient completed a 9-week FR program supervised by a physical therapist. Exercises then were continued more independently for a 2-year period at a public gymnasium. OUTCOMES Following 9 weeks of supervised FR, the patient demonstrated marked improvement in symptoms and functional ability, and resolution of neurological signs. Fourteen months after commencing FR, a follow-up magnetic resonance imaging scan demonstrated resolution of the L5-S1 disk extrusion and relief of S1 nerve root compression. Functional improvements continued and were maintained 2 years following the start of intervention. DISCUSSION A patient with chronic LDHR who underwent FR made significant improvements. Research is needed to determine the efficacy of an FR approach for treating such patients.
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Affiliation(s)
- Andrew J Hahne
- Spinal Management Clinics, Melbourne, Victoria, Australia.
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Haig AJ, Tong HC, Yamakawa KSJ, Parres C, Quint DJ, Chiodo A, Miner JA, Phalke VC, Hoff JT, Geisser ME. Predictors of pain and function in persons with spinal stenosis, low back pain, and no back pain. Spine (Phila Pa 1976) 2006; 31:2950-7. [PMID: 17139226 DOI: 10.1097/01.brs.0000247791.97032.1e] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Longitudinal masked, double-controlled cohort study. OBJECTIVES To determine prognosis and predictors of function and pain in persons with spinal stenosis. SUMMARY OF BACKGROUND DATA The clinical syndrome of spinal stenosis is common and disabling, but not clearly related to anatomic measures. Prognosis not well studied. METHODS Persons 55 to 80 years of age with and without stenosis on preliminary review of magnetic resonance imaging (MRI), and asymptomatic volunteers underwent screening, questionnaires, physical examination, ambulation testing, masked electromyogram (EMG), and masked MRI scans; these were repeated at >18 months. RESULTS Twenty-three asymptomatic, 28 back pain, and 32 clinically diagnosed stenosis subjects underwent follow-up. Although initial and follow-up diagnosis tended to agree (kappa = 0.394, P < 001), there were substantial shifts between the three groups. Among persons with clinically diagnosed stenosis, every measure trended for improvement, including significant changes in pain, ambulation, and EMG. Ambulation velocity and Pain Disability Index at follow-up were predicted by initial disability measures. Pain was predicted by initial sleep difficulty but not initial pain. EMG and MRI did not predict function or pain. CONCLUSION Clinically recognized spinal stenosis is fluctuating and largely improving, and in continuum with back pain and no symptoms. Since anatomic and neurologic deficits do not predict future function, they should not be weighed heavily in surgical risk-benefit discussions.
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Affiliation(s)
- Andrew J Haig
- Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, USA.
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Sanders NW, Mann NH, Spengler DM. Pain drawing scoring is not improved by inclusion of patient-reported pain sensation. Spine (Phila Pa 1976) 2006; 31:2735-41; discussion 2742-3. [PMID: 17077744 DOI: 10.1097/01.brs.0000244674.99258.f9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a retrospective study of 250 patients who describe low back pain with pain drawings. A computer application using artificial neural networks was designed to analyze pain drawings and evaluate the contribution of pain sensation to drawing classification. OBJECTIVE The primary goal of this study was to assess the contribution of patient recorded pain sensation marks in classifying pain drawings into one of five broadly defined categories. The hypothesis was that including pain sensation would improve classification. SUMMARY OF BACKGROUND DATA With no perfect diagnostic test for patients with low back pain, many approaches have been proposed and are used. One common diagnostic tool is the pain drawing. Several quantitative methods have been proposed to score the drawings. Some methods use pain sensation in the scoring; however, the contribution of pain sensation has not been defined. METHODS A custom computer application classified the pain drawing. Data consisted of 250 pain drawings from patients with low back pain. RESULTS Patient recorded pain sensation is not necessary in computer-based scoring of pain drawings. CONCLUSION Patient-reported pain sensation does not improve classification when quantitatively scoring pain drawings.
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Affiliation(s)
- Neal W Sanders
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37212, USA.
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Kuijer W, Groothoff JW, Brouwer S, Geertzen JHB, Dijkstra PU. Prediction of sickness absence in patients with chronic low back pain: a systematic review. JOURNAL OF OCCUPATIONAL REHABILITATION 2006; 16:439-67. [PMID: 16783530 DOI: 10.1007/s10926-006-9021-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVES To provide evidence of predictors for sickness absence in patients with non-specific chronic low back pain (CLBP), distinguishing predictors aimed at the decision to report sick (absence threshold) and decision to return to work (return to work threshold). METHODS Medical and psychological databases were searched, as well as citations from relevant reviews. In- and exclusion criteria were applied. Two reviewers assessed the methodological quality of the papers independently. RESULTS Many different predictors were studied, and few factors were studied more than once. Consistent evidence was found for own expectations of recovery only as predictor for the decision to return to work. Patients with higher expectations had less sickness absence at the moment of follow-up measurement. As expected, different predictors were found aiming at the absence threshold or the return to work threshold. Furthermore, predictors varied also with the measurement instruments used, timing of follow-up measurements, and definition of outcomes. Until now, too few studies are available to overcome several potential sources of heterogeneity. CONCLUSIONS No core set of predictors exists for sickness absence in general. The characteristics of the study including the decision to report sick or to return to work determined the influence of several predictors on sickness absence in patients with CLBP. Further research and use of a core set of measurements and uniform definitions are needed to predict sickness absence and return to work in patients with CLBP.
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Affiliation(s)
- Wietske Kuijer
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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