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Immich F, de Araújo LP, da Gama RR, da Rosa WLDO, Piva E, Rossi-Fedele G. Fifteen years of engine-driven nickel-titanium reciprocating instruments, what do we know so far? An umbrella review. AUST ENDOD J 2024; 50:409-463. [PMID: 38923176 DOI: 10.1111/aej.12870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Abstract
Numerous systematic reviews (SRs) have produced conflicting findings on engine-driven nickel-titanium reciprocating instruments (reciprocating instruments) since Yared's seminal study 15 years ago. This umbrella review analysed SRs examining the clinical and laboratory evidence regarding reciprocating instruments for root canal treatment. SRs that evaluated qualitatively and/or quantitatively the outcomes postoperative pain, oral health-related quality of life (OHRQoL), shaping ability, debris extrusion, microbial load, endotoxins reduction, cyclic fatigue, file fracture, dentinal cracks and root canal filling removal were included. The AMSTAR 2 tool was used to evaluate SRs quality, while the ROBIS tool to assess risk of bias (RoB). Forty SRs were included. The SRs revealed predominantly 'high' RoB and 'critically low' quality. Most focused on technical outcomes, exhibiting significant methodological and statistical heterogeneity. Findings suggest comparable efficacy between reciprocating and rotary instruments. However, due to the scarcity of high-quality evidence, future well-designed studies and reviews considering core outcome measures are needed.
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Affiliation(s)
- Felipe Immich
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Lucas Peixoto de Araújo
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
- School of Dentistry, Catholic University of Pelotas, Pelotas, Brazil
| | | | | | - Evandro Piva
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
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Kirkland SW, Visser L, Meyer J, Junqueira DR, Campbell S, Villa-Roel C, Friedman BW, Essel NO, Rowe BH. The effectiveness of parenteral agents for pain reduction in patients with migraine presenting to emergency settings: A systematic review and network analysis. Headache 2024; 64:424-447. [PMID: 38644702 DOI: 10.1111/head.14704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 01/16/2024] [Accepted: 01/29/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVES To assess the comparative effectiveness and safety of parenteral agents for pain reduction in patients with acute migraine. BACKGROUND Parenteral agents have been shown to be effective in treating acute migraine pain; however, the comparative effectiveness of different approaches is unclear. METHODS Nine electronic databases and gray literature sources were searched to identify randomized clinical trials assessing parenteral agents to treat acute migraine pain in emergency settings. Two independent reviewers completed study screening, data extraction, and Cochrane risk-of-bias assessment, with differences being resolved by adjudication. The protocol of the review was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018100096). RESULTS A total of 97 unique studies were included, with most studies reporting a high or unclear risk of bias. Monotherapy, as well as combination therapy, successfully reduced pain scores prior to discharge. They also increased the proportion of patients reporting pain relief and being pain free. Across the pain outcomes assessed, combination therapy was one of the higher ranked approaches and provided robust improvements in pain outcomes, including lowering pain scores (mean difference -3.36, 95% confidence interval [CI] -4.64 to -2.08) and increasing the proportion of patients reporting pain relief (risk ratio [RR] 2.83, 95% CI 1.74-4.61). Neuroleptics and metoclopramide also ranked high in terms of the proportion of patients reporting pain relief (neuroleptics RR 2.76, 95% CI 2.12-3.60; metoclopramide RR 2.58, 95% CI 1.90-3.49) and being pain free before emergency department discharge (neuroleptics RR 4.8, 95% CI 3.61-6.49; metoclopramide RR 4.1, 95% CI 3.02-5.44). Most parenteral agents were associated with increased adverse events, particularly combination therapy and neuroleptics. CONCLUSIONS Various parenteral agents were found to provide effective pain relief. Considering the consistent improvements across various outcomes, combination therapy, as well as monotherapy of either metoclopramide or neuroleptics are recommended as first-line options for managing acute migraine pain. There are risks of adverse events, especially akathisia, following treatment with these agents. We recommend that a shared decision-making model be considered to effectively identify the best treatment option based on the patient's needs.
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Affiliation(s)
- Scott W Kirkland
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Lloyd Visser
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Jillian Meyer
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | | | - Sandra Campbell
- Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Cristina Villa-Roel
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Benjamin W Friedman
- Department of Emergency Medicine, Albert Einstein College of Medicine, New York, New York, USA
| | - Nana Owusu Essel
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Brian H Rowe
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- School of Public Health, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
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Robinson CL, Phung A, Dominguez M, Remotti E, Ricciardelli R, Momah DU, Wahab S, Kim RS, Norman M, Zhang E, Hasoon J, Orhurh V, Viswanath O, Yazdi C, Chen GH, Simopoulos TT, Gill J. Pain Scales: What Are They and What Do They Mean. Curr Pain Headache Rep 2024; 28:11-25. [PMID: 38060102 DOI: 10.1007/s11916-023-01195-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE OF REVIEW It is essential to have validated and reliable pain measurement tools that cover a wide range of areas and are tailored to individual patients to ensure effective pain management. The main objective of this review is to provide comprehensive information on commonly used pain scales and questionnaires, including their usefulness, intended purpose, applicability to different patient populations, and associated advantages and disadvantages. RECENT FINDINGS Acute pain questionnaires typically focus on measuring the severity of pain and the extent of relief achieved through interventions. Chronic pain questionnaires evaluate additional aspects such as pain-related functional limitations, psychological distress, and psychological well-being. The selection of an appropriate pain scale depends on the specific assessment objectives. Additionally, each pain scale has its strengths and limitations. Understanding the differences among these pain scales is essential for selecting the most appropriate tool tailored to individual patient needs in different settings. CONCLUSION Medical professionals encounter challenges in accurately assessing pain. Physicians must be familiar with the different pain scales and their applicability to specific patient population.
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Affiliation(s)
- Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Anh Phung
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Moises Dominguez
- Department of Neurology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Edgar Remotti
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ryan Ricciardelli
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - D Uju Momah
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephanie Wahab
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rosa S Kim
- Department of General Surgery, Georgetown University Hospital, MedStar, Washington, DC, USA
| | | | - Evan Zhang
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jamal Hasoon
- Department of Anesthesiology, Critical Care and Pain Medicine, UTHealth McGovern Medical School, Houston, TX, USA.
| | - Vwaire Orhurh
- University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA
- MVM Health, East Stroudsburg, PA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Cyrus Yazdi
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Grant H Chen
- Department of Anesthesiology, Critical Care and Pain Medicine, UTHealth McGovern Medical School, Houston, TX, USA
| | - Thomas T Simopoulos
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jatinder Gill
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Svensson E, Lund I. Painful differences between different pain scale assessments: The outcome of assessed pain is a matter of the choices of scale and statistics. Scand J Pain 2024; 24:sjpain-2023-0113. [PMID: 38502712 DOI: 10.1515/sjpain-2023-0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/21/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES Perceived pain is a multi-factorial subjective variable, commonly measured by numeric rating scales, verbal descriptive scales (VDS), or by a position on an analogue line (VAS). A major question is whether an individual's VAS and VDS pain assessments, on the same occasion, could be comparable. The aim was to compare continuous and discretized VAS pain data with verbal descriptive pain datasets from the Oswestry Disability Index (ODI) and the European Quality of Life Scale (EQ-5D) in paired pain datasets. METHODS The measurement level of data from any type of scale assessments is ordinal, having rank-invariant properties only. Non-parametric statistical methods were used. Two ways of discretizing the VAS-line to VAS-intervals to fit the number of the comparing VDS-categories were used: the commonly used (equidistant VAS,VDS)-pairs and the (unbiased VAS,VDS)-pairs of pain data. The comparability of the (VAS,VDS)-pairs of data of perceived pain was studied by the bivariate ranking approach. Hence, each pair will be regarded as ordered, disordered, or tied with respect to the other pairs of data. The percentage agreement, PA, the measures of disorder, D, and of order consistency, MA, were calculated. Total interchangeability requires PA = 1 and MA = 1. RESULTS The wide range of overlapping of (VAS,VDS)-pairs indicated that the continuous VAS data were not comparable to any of the VDS pain datasets. The percentage of agreement, PA; in the (equidistant VAS,ODI) and (equidistant VAS, EQ-5D) pairs were 38 and 49%, and the order consistency, MA, was 0.70 and 0.80, respectively. Corresponding results for the (unbiased VAS,VDS)-pairs of pain data were PA: 54 and 100%, and MA: 0.77 and 1.0. CONCLUSION Our results confirmed that perceived pain is the individual's subjective experience, and possible scale-interchangeability is only study-specific. The pain experience is not possible to be measured univocally, but is possible for the individual to rate on a scale.
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Affiliation(s)
- Elisabeth Svensson
- Department of Statistics and Informatics, Örebro University, SE-701 82 Örebro, Sweden
| | - Iréne Lund
- Department of Physiology and Pharmacology, Karolinska Institutet, SE-171 77, Stockholm, Sweden
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Li P, Bai Y, Yuan Q, Man Q, Xing C, Ren Y, Zhang K. Efficacy and safety of CT-guided 125I seed implantation by coplanar template as a salvage therapy for vertebral metastases after failure of external beam radiation therapy: a retrospective study. Front Oncol 2023; 13:1084904. [PMID: 37188195 PMCID: PMC10175603 DOI: 10.3389/fonc.2023.1084904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Purpose To evaluate the efficacy safety of computed tomography (CT)-guided 125I seed implantation by coplanar template for vertebral metastases after failure of external beam radiation therapy (EBRT). Material and methods Retrospective analysis of the clinical outcomes of 58 patients with vertebral metastases after failure of EBRT, who underwent 125I seed implantation as a salvage treatment with a CT-guided coplanar template-assisted technique from January 2015 to January 2017. Results The mean post-operative NRS score decreased significantly at T4w (3.5 ± 0.9, p<0.01), T8w (2.1 ± 0.9, p<0.01), T12w (1.5 ± 0.7, p< 0.01) and T6m (1.2 ± 0.6, p< 0.01) respectively. The local control rates after 3, 6, 9 and 12 months were 100% (58/58), 93.1% (54/58), 87.9% (51/58), and 81% (47/58), respectively. The median overall survival time was 18.52months (95% CI, 16.24-20.8), and 1- and 2-year survival rates were 81% (47/58) and 34.5% (20/58), respectively. By performing a paired t-test analysis, there was no significant difference in D90, V90, D100, V100, V150, V200, GTV volume, CI, EI and HI between preoperative and postoperative (p>0.05). Conclusions 125I seed implantation can be used as a salvage treatment for patients with vertebral metastases after failure of EBRT.
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Outcomes of distal ulna locking plate in management of unstable distal ulna fractures: a prospective case series. Arch Orthop Trauma Surg 2022; 143:3137-3144. [PMID: 35849186 DOI: 10.1007/s00402-022-04549-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/03/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Given the absence of a satisfying plate system to deal with multifragmentary or subcapital distal ulnar fractures, the Distal Ulna Locking Plate (DUL, I.T.S. GmbH, Graz, Austria) could become a useful treatment option. This study aimed to evaluate the results of this anatomically pre-contoured plate regarding patients with unstable or displaced distal ulnar fractures. METHODS In a prospective clinical trial, 20 patients (18 female, two male; mean age 70 years (24-91 years)) with unstable or displaced distal ulna fractures between December 2010 and August 2015 were analyzed. All patients were treated with open reduction and internal fixation using the DUL. They were evaluated at three follow-up appointments at 3, 6 and 12 months postoperatively regarding their bone healing, ulnar variance (UV), range of motion (ROM) and grip strength. Patient related outcomes were measured using the Disability of the Arm, Shoulder and Hand (DASH), the Patient Rated Wrist Evaluation (PRWE) questionnaires, and the Visual Analogue Scale (VAS). The results after one year were compared to the outcome of the healthy contralateral side. RESULTS All fractures treated with open reduction and internal fixation using the Distal Ulna Locking Plate healed within 6 months and showed stable ulnar variances after surgery. ROM (rotational plane 81.1 ± 9.0°, sagittal plane 55.1 ± 14.6°, frontal plane 33.0 ± 9.4°) and grip strength (18.7 ± 7.1 N) at the follow-up after 12 month had similar values compared with the uninjured side. The mean DASH score (36.4 ± 29.0), the PRWE-score (14.5 ± 27.0), and the VAS (at rest 0.5 ± 1.1, during activity 1.2 ± 2.4) after one year had no significant difference to the uninjured side. The surgeon's overall satisfaction rate regarding plate handling reached 81.8%. CONCLUSION Stabilization of unstable distal ulna fractures using the DUL restores nearly normal anatomy and function. Its pre-countered design, volar placement, and enhanced stability present a satisfying plate system. TRIAL REGISTRATION The trial was retrospectively Registered at www. CLINICALTRIALS gov on 16 December 2021 (Trial Registration Number: NCT05329012).
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Govas P, Ketchum A, Kazi R, Gordon BR, Carroll BT. Pain Intensity Assessment Scales for Dermatologic Surgery Patients: A Systematic Review. Dermatol Surg 2022; 48:232-238. [PMID: 34923536 DOI: 10.1097/dss.0000000000003353] [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: 11/25/2022]
Abstract
BACKGROUND Pain assessment plays an important role in dermatologic surgery. The numeric rating scale (NRS), visual analog scale (VAS), verbal rating scale (VRS), and Faces Pain Scale (FPS) are commonly used scales for pain measurement. Conflicting evidence exists regarding the use of each. Prompt pain recognition and treatment during procedures result in higher patient satisfaction. OBJECTIVE Determine the most applicable scale for acute pain measurement in dermatologic surgery. MATERIALS AND METHODS This systematic review was performed in accordance with PRISMA-Supplemental Digital Content 4, http://links.lww.com/DSS/A976 (PROSPERO; CRD42018091058). PubMed, Cochrane, EMBASE, Scopus, and Web of Science were searched between April 24, 2018, and May 06, 2018. The search query consisted of pain, pain measurement (NRS, VAS, VRS, and FPS), and assessment/comparison. The inclusion criteria included English language literature with primary/secondary outcome objectives directly comparing ≥2 pain scales in acute pain (age: 13+). Study end points included interscale correlations, patient preferences, provider preferences, study author recommendations, and failure rates. RESULTS Eight hundred seven studies were retrieved: A total of 42 studies were included. The visual analog scale (n = 42) was most studied, followed by NRS (n = 29), VRS (n = 27), and FPS (n = 11). 93.1% studies showed a high statistical correlation between VAS and NRS. Patients preferred NRS (n = 8/11), followed by FPS (n = 3/11), VRS (n = 2/11), and VAS (n = 1/11). Study authors recommended NRS/VAS (n = 8/19), VRS (n = 6/19), and FPS (n = 1/19). Providers preferred NRS (n = 2/3) and VRS (n = 1/3). The visual analog scale had the highest failure rate (n = 11/12). CONCLUSION The numeric rating scale is most applicable for dermatologic surgery because of reported patient and provider preferences, lowest failure rates, and most frequent study author recommendations.
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Affiliation(s)
- Panayiota Govas
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Andrea Ketchum
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rashek Kazi
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Beth R Gordon
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Bryan T Carroll
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
- Department of Dermatology, University Hospitals of Cleveland, Cleveland, Ohio
- Department of Pharmacology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Saber SM, Alfadag AMA, Nawar NN, Plotino G, Hassanien EES. Instrumentation Kinematics Does Not Affect Bacterial Reduction, Post-Operative Pain and flare-ups: A Randomized Clinical Trial. Int Endod J 2022; 55:405-415. [PMID: 35100456 DOI: 10.1111/iej.13695] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 11/25/2022]
Abstract
AIM This randomized clinical trial aimed to assess the effect of instrumentation kinematics (reciprocation or continuous rotation) on bacterial reduction, post-operative pain and incidence of flare-ups after root canal treatment of single-rooted mandibular premolars with asymptomatic apical periodontitis. METHODOLOGY Sixty-six patients were included in this prospective, parallel, randomized clinical trial. Patients were randomly allocated into two groups (N=33) according to the kinematics of the shaping instrument: WaveOne Gold (WO) used in reciprocation or One Shape (OS) used in continuous rotation. Under complete asepsis, bacterial samples were taken before (S1) and after (S2) a standard cleaning and shaping protocol. Evaluation of bacterial reduction was done by both culture technique and quantitative real-time polymerase chain reaction (qPCR) analysis. Post-operative pain was evaluated using the visual analog scale (VAS) after 24, 48- and 72-hours following treatment, while flare-ups were recorded as a binary outcome (Yes/No). Independent and paired t-tests were used for inter and intragroup comparisons for bacterial count data respectively. For post-operative pain score, intergroup comparisons were analyzed using Mann-Whitney U test while intragroup comparisons were analyzed using Friedman test followed by pairwise comparisons utilizing Wilcoxon signed rank test with Bonferroni correction. The significance level was set at p≤0.05 within all tests. RESULTS All the allocated participants received the intervention and were analyzed. The comparison between culture and qPCR methods showed that qPCR analysis demonstrated significantly higher pre-instrumentation baseline bacterial count (p<0.05). The percentage of bacterial reduction, detected by either method, significantly decreased after instrumentation using either rotation or reciprocation kinematics (p<0.05). However, the difference between the WOG or OS files was statistically non-significant (p>0.05). The intra-group comparisons showed a significant reduction in post-operative pain with time (p<0.05) for both groups. However, the inter-group comparison demonstrated that the difference in post-operative pain after the use of either WOG or OS was statistically non-significant (p>0.05). The incidence of flare-ups between both groups was also not-significant (p=1). CONCLUSIONS Shaping kinematics, either rotation or reciprocation motions, had no impact on bacterial reduction and the incidence of post-operative pain and flare-ups after root canal preparation of single-rooted premolars with asymptomatic apical periodontitis.
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Affiliation(s)
- Shehabeldin Mohamed Saber
- Department of Endodontics, Ain Shams University, Cairo, Egypt.,Department of Endodontics, The British University, El-Shorouk city, Egypt
| | | | - Nawar Naguib Nawar
- Department of Endodontics, The British University, El-Shorouk city, Egypt
| | | | - Ehab El-Sayed Hassanien
- Department of Endodontics, Ain Shams University, Cairo, Egypt.,El-Galala University, El-Galala city, Egypt
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Lubejko ST, Graham RD, Livrizzi G, Schaefer R, Banghart MR, Creed MC. The role of endogenous opioid neuropeptides in neurostimulation-driven analgesia. Front Syst Neurosci 2022; 16:1044686. [PMID: 36591324 PMCID: PMC9794630 DOI: 10.3389/fnsys.2022.1044686] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Due to the prevalence of chronic pain worldwide, there is an urgent need to improve pain management strategies. While opioid drugs have long been used to treat chronic pain, their use is severely limited by adverse effects and abuse liability. Neurostimulation techniques have emerged as a promising option for chronic pain that is refractory to other treatments. While different neurostimulation strategies have been applied to many neural structures implicated in pain processing, there is variability in efficacy between patients, underscoring the need to optimize neurostimulation techniques for use in pain management. This optimization requires a deeper understanding of the mechanisms underlying neurostimulation-induced pain relief. Here, we discuss the most commonly used neurostimulation techniques for treating chronic pain. We present evidence that neurostimulation-induced analgesia is in part driven by the release of endogenous opioids and that this endogenous opioid release is a common endpoint between different methods of neurostimulation. Finally, we introduce technological and clinical innovations that are being explored to optimize neurostimulation techniques for the treatment of pain, including multidisciplinary efforts between neuroscience research and clinical treatment that may refine the efficacy of neurostimulation based on its underlying mechanisms.
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Affiliation(s)
- Susan T. Lubejko
- Department of Neurobiology, School of Biological Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Robert D. Graham
- Department of Anesthesiology, Pain Center, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Giulia Livrizzi
- Department of Neurobiology, School of Biological Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Robert Schaefer
- Department of Anesthesiology, Pain Center, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Matthew R. Banghart
- Department of Neurobiology, School of Biological Sciences, University of California, San Diego, La Jolla, CA, United States
- *Correspondence: Matthew R. Banghart,
| | - Meaghan C. Creed
- Department of Anesthesiology, Pain Center, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
- Department of Neuroscience, Washington University in St. Louis, St. Louis, MO, United States
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, United States
- Meaghan C. Creed,
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Khadka J, Schoneveld PG, Pesudovs K. Comparing the measurement properties of visual analogue and verbal rating scales. Ophthalmic Physiol Opt 2021; 42:205-217. [PMID: 34786749 DOI: 10.1111/opo.12917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Utilising Rasch analysis on the Keratoconus Outcome Research Questionnaire (KORQ) data, we explored the hypothesis that the KORQ with discrete verbal rating scale (VRS) would demonstrate better psychometric properties and provide less noise in measurement than with a visual analogue scale (VAS). METHODS The KORQ is a keratoconus-specific patient-reported outcome measure; it has activity limitation and symptoms scales. The KORQ scales with two different rating scales (VAS and a discrete 4-response VRS) were completed by self-administration by people with keratoconus. For each KORQ scale, Rasch analysis-based psychometric properties were compared between the two versions. Rasch analysis was also used to optimise rating scale functioning when disordered thresholds were observed. RESULTS 118 (mean age ± SD, 46.4 ± 0.4 years) and 169 (45.4 ± 14.7 years) people completed the KORQ with VAS and VRS, respectively. Both scales demonstrated high measurement precision. However, the VAS rating scale was disordered (6 out of 11 categories dysfunctional) and had two misfitting items. Conversely, the VRS had ordered categories and no misfitting items. For the disordered VAS, ordering was achieved only after collapsing 11 categories into four categories. In comparison to the KORQ with VRS, the repaired VAS had lower measurement precision, test information, variance explained by the measure, poor targeting, and reduced measurement range. CONCLUSIONS The KORQ demonstrated superior psychometric properties when measured using a VRS than with a VAS. This illustrates the advantages of verbal rating scales for a patient-reported outcome measurement over a visual analogue scale.
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Affiliation(s)
- Jyoti Khadka
- Health and Social Care Economics Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | | | - Konrad Pesudovs
- The University of New South Wales, Sydney, New South Wales, Australia
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Gamborg S, Öberg S, Rosenberg J. Long-term pain relief after groin hernia repair for sports groin: A nationwide cohort study. Scand J Surg 2021; 111:14574969211044030. [PMID: 34657510 DOI: 10.1177/14574969211044030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The groin is a complex anatomical area with multiple structures that can be injured and cause pain. One condition with groin pain is the so-called "sports groin," which can be treated with a groin hernia repair even though no hernia is present. The aim of this study was to assess the prevalence of chronic groin pain several years after a groin hernia repair performed in patients with a sports groin. METHODS This nationwide cohort study included adults who had a groin hernia repair for a sports groin through the years 1998-2011. The patients were identified through the Danish Hernia Database and in surgical records. Patients were asked to fill out four questionnaires several years after the repair: a visual analogue scale, the Activity Assessment Scale, the Inguinal Pain Questionnaire, and a questionnaire about treatment satisfaction. RESULTS Of 118 contacted patients, 71 gave informed consent and were included in the study (60%), and of these the response rate was 100%. The questionnaires were filled out median 14 years after surgery. Most of the patients were pain-free in the operated groin (87%), and only a few had physical impairment caused by groin pain (20%). Prior to surgery, 79% had groin pain that they could not ignore. Overall, 90% of the patients were satisfied with the treatment. CONCLUSIONS Most patients were pain-free and without physical impairment several years after groin hernia repair for a sports groin and with high satisfaction rate.
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Affiliation(s)
- Sara Gamborg
- Center for Perioperative Optimization Department of Surgery Herlev Hospital University of Copenhagen Herlev Ringvej 75 2730 Herlev Denmark
| | - Stina Öberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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12
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Laakso JT, Silvola J, Hirvonen T, Suutarla S, Kivekäs I, Saarinen R, Haavisto L, Laitakari J, Aarnisalo AA, Dietz A, Jero J, Hytönen M, Sinkkonen ST. Development of otology specific outcome measure: Ear Outcome Survey-16 (EOS-16). J Otol 2021; 16:150-157. [PMID: 34220984 PMCID: PMC8241709 DOI: 10.1016/j.joto.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE An important outcome measure of patient care is the impact on the patient's health-related quality of life (HRQoL). Current ear-specific HRQoL instruments are designed for one diagnosis and emphasize different subdivisions such as symptoms, hearing problems, psychosocial impact, and the need for care. The optimal length of the recall period has not been studied. For these reasons, a new survey is needed that would cover most chronic ear diseases. METHODS A preliminary 24-item survey (EOS-24) was created. Untreated adult patients (included n = 186) with one of seven different chronic otologic conditions from all university hospitals in Finland were recruited to respond to EOS-24 and the 15D general HRQoL instrument. The recruiting otologists evaluated the severity of the disease and the disability caused by it. A control group was recruited. Based on the patients' responses in different diagnosis groups, the items were reduced according to pre-defined criteria. The resulting survey was validated using a thorough statistical analysis. RESULTS The relevance and necessity of the original 24 items were thoroughly investigated, leading to the exclusion of 8 items and the modification of 1. The remaining 16 items were well-balanced between subdivisions and were useful in all seven diagnosis groups, thus constituting the final instrument, EOS-16. The most suitable recall period was three months. CONCLUSIONS EOS-16 has been created according to the HRQoL survey guidelines with a versatile nationwide patient population. The survey has been validated and can be used for a wide range of chronic ear diseases as a HRQoL instrument.
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Affiliation(s)
- Juha T. Laakso
- Department of Otorhinolaryngology – Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Juha Silvola
- Department of Ear, Nose, and Throat – Division of Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Timo Hirvonen
- Department of Otorhinolaryngology – Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Samuli Suutarla
- Department of Otorhinolaryngology – Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Otorhinolaryngology, Kymenlaakso Central Hospital, Kotka, Finland
| | - Ilkka Kivekäs
- Department of Otorhinolaryngology – Head and Neck Surgery, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Riitta Saarinen
- Department of Otorhinolaryngology – Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Lotta Haavisto
- Department of Otorhinolaryngology – Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Jaakko Laitakari
- Department of Otorhinolaryngology – Head and Neck Surgery, Oulu University Hospital and PEDEGO Research Unit, University of Oulu and Medical Research Center Oulu, Finland
| | - Antti A. Aarnisalo
- Department of Otorhinolaryngology – Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Aarno Dietz
- Department of Otorhinolaryngology – Head and Neck Surgery, Kuopio University Hospital and University of Kuopio, Kuopio, Finland
| | - Jussi Jero
- Department of Otorhinolaryngology – Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Maija Hytönen
- Department of Otorhinolaryngology – Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Saku T. Sinkkonen
- Department of Otorhinolaryngology – Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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13
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de Aquino TN, de Faria Rosseto S, Lúcio Vaz J, de Faria Cordeiro Alves C, Vidigal FDC, Galdino G. Evaluation of respiratory and peripheral muscle training in individuals undergoing myocardial revascularization. J Card Surg 2021; 36:3166-3173. [PMID: 34085324 DOI: 10.1111/jocs.15698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the effect of peripheral muscle strength training (PMT) and respiratory muscle strength training (RMT) muscle strength training associated with conventional physical therapy on the respiratory muscle strength, functional capacity, and quality of life in the immediate postoperative period of patients undergoing coronary artery bypass graft (CABG). METHODS This was a randomized controlled trial. Eighty-three patients undergoing CABG were divided into two groups: Intervention group, patients that received PMT and RMT associated with conventional physical therapy, one session a day for 5 days; control group, patients that received conventional physical therapy, one session a day for 5 days. All patients had respiratory muscle strength, peripheral muscle strength, functional capacity, and quality of life evaluated by manovacuometry, dynamometry, 6-min walking test, and 36-item Short-Form Health Survey Questionnaire, respectively, before and 5 days after CABG. RESULTS Both groups showed a significantly reduced respiratory muscle strength after CABG; however, in the intervention group, the inspiratory muscle strength reduction was lower (confidence interval [CI] 95%: 2.29 [1.9; 27.54]). The quality of live domains for pain (CI 95%: 3.08 [5.21; 24.97]) and vitality perception (CI 95%: 2.51 [2.12; 19.53]) worsened in the control and improved in the intervention group (pain: CI 95%: 1.19 [-3.38; 13.09]; vitality CI 95%: 0.07 [-6.55; 7.04]). Both groups showed reduced functional capacity and expiratory muscle strength after CABG. CONCLUSION Conventional physical therapy combined with PMT and RMT may reduce inspiratory muscle strength loss and improve pain and vitality perception in the immediate postoperative period after CABG.
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Affiliation(s)
- Tarcísio Nema de Aquino
- Department of Motricity Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil.,Department of Rehabilitation and Cardiology of Hospital Santa Lucia, Poços de Caldas, Minas Gerais, Brazil
| | - Simone de Faria Rosseto
- Department of Motricity Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil.,Department of Rehabilitation and Cardiology of Hospital Santa Lucia, Poços de Caldas, Minas Gerais, Brazil
| | - Jaqueline Lúcio Vaz
- Department of Motricity Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil.,Department of Rehabilitation and Cardiology of Hospital Santa Lucia, Poços de Caldas, Minas Gerais, Brazil
| | | | | | - Giovane Galdino
- Department of Motricity Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
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14
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Hollman F, de Raadt WM, Wolterbeek N, van Rhijn LW, Auw Yang KG. Interchangeability of Diverse Analog Scales Used Within the Constant-Murley Score. Arthrosc Sports Med Rehabil 2021; 3:e521-e526. [PMID: 34027464 PMCID: PMC8129441 DOI: 10.1016/j.asmr.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose To assess the interchangeability of various existing answering scales within the subjective part of the Constant–Murley Score (CMS) and to determine the effect of the different answering scales on the inter- and intraobserver reliability. Methods In this prospective, single-center, cross-sectional trial, patients with shoulder problems were included from June to September 2018. Subjects recruited were 18 years or older, presented various shoulder complaints, e.g., diagnosis of osteoarthritis, subacromial pain syndrome, rotator cuff or biceps tendon problems, or frozen shoulder. An extended version of the CMS was prepared including the same questions multiple times but with varying answer scales. Six versions were made with random order of the questions. The answering scales were a verbal and paper based visual analog scale (VAS), smiley face scale, Numeric Rating Scale (NRS), and categories. Internal consistency of the various CMS, Spearman correlation coefficients, intraobserver, and interobserver agreement was assessed (ICC). Results In total, 93 patients were included. The total CMS using the paper-based VAS, smiley face score, and NRS were 46.9 ± 19.4, 45.2 ± 18.5, and 45.0 ± 18.7. Correlations of the total scores of the different versions varied from 0.98 to 0.99. CMS-category versus CMS-smiley face score and CMS-category versus CMS-NRS pain were significantly different (P = .02 and P = .01). Good internal consistency (0.76-0.79) and acceptable inter- and intraobserver reliability were found (ICC: 0.89-0.97, 0.98-0.99; P < .001). Conclusions The different answering scales for the subjective subscales within the CMS for pain, work, and recreational activity were not interchangeable on item level and significantly influenced the total CMS score. Differences were below the smallest detectable change and interpreted as not clinically relevant. Particularly on item level, data from different studies cannot be pooled and compared when different answering scales are being used. The inter- and intraobserver reliability were excellent. Level of Evidence Level I, prospective cross-sectional study.
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Affiliation(s)
- Freek Hollman
- Department of Orthopedics, St. Antonius Hospital, Utrecht, the Netherlands.,Department of Orthopedics, Maastricht University Medical Center, Maastricht, the Netherlands.,Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Wanda M de Raadt
- Department of Orthopedics, St. Antonius Hospital, Utrecht, the Netherlands
| | - Nienke Wolterbeek
- Department of Orthopedics, St. Antonius Hospital, Utrecht, the Netherlands
| | - Lodewijk W van Rhijn
- Department of Orthopedics, Maastricht University Medical Center, Maastricht, the Netherlands.,Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Kiem G Auw Yang
- Department of Orthopedics, St. Antonius Hospital, Utrecht, the Netherlands
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15
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Jones P, Lamdin R, Dalziel SR. Oral non-steroidal anti-inflammatory drugs versus other oral analgesic agents for acute soft tissue injury. Cochrane Database Syst Rev 2020; 8:CD007789. [PMID: 32797734 PMCID: PMC7438775 DOI: 10.1002/14651858.cd007789.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Acute soft tissue injuries are common and costly. The best drug treatment for such injuries is not certain, although non-steroidal anti-inflammatory drugs (NSAIDs) are often recommended. There is concern about the use of oral opioids for acute pain leading to dependence. This is an update of a Cochrane Review published in 2015. OBJECTIVES To assess the benefits or harms of NSAIDs compared with other oral analgesics for treating acute soft tissue injuries. SEARCH METHODS We searched the CENTRAL, 2020 Issue 1, MEDLINE (from 1946), and Embase (from 1980) to January 2020; other databases were searched to February 2019. SELECTION CRITERIA We included randomised or quasi-randomised controlled trials involving people with acute soft tissue injury (sprain, strain, or contusion of a joint, ligament, tendon, or muscle occurring within 48 hours of inclusion in the study), and comparing oral NSAIDs versus paracetamol (acetaminophen), opioid, paracetamol plus opioid, or complementary and alternative medicine. The outcomes were pain, swelling, function, adverse effects, and early re-injury. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for eligibility, extracted data, and assessed risk of bias. We assessed the quality of the evidence using GRADE methodology. MAIN RESULTS We included 20 studies, with 3305 participants. Three studies included children only. The others included predominantly young adults; approximately 60% were male. Seven studies recruited people with ankle sprains only. Most studies were at low or unclear risk of bias; however, two were at high risk of selection bias, three were at high risk of bias from lack of blinding, and five were at high risk of selective outcome reporting bias. Some evidence relating to pain relief was high certainty. Other evidence was either moderate, low or very low certainty, reflecting study limitations, indirectness, imprecision, or combinations of these. Thus, we are certain or moderately certain about some of the estimates, and uncertain or very uncertain of others. Eleven studies, involving 1853 participants compared NSAIDs with paracetamol. There were no differences between the two groups in pain at one to two hours (1178 participants, 6 studies; high-certainty evidence), at days one to three (1232 participants, 6 studies; high-certainty evidence), and at day seven or later (467 participants, 4 studies; low-certainty evidence). There was little difference between the groups in numbers of participants with minimal swelling at day seven or later (77 participants, 1 study; low-certainty evidence). Very low-certainty evidence from three studies (386 participants) means we are uncertain of the finding of little difference between the two groups in return to function at day seven or later. There was low-certainty evidence from 10 studies (1504 participants) that NSAIDs may slightly increase the risk of gastrointestinal adverse events compared with paracetamol. There was low-certainty evidence from nine studies (1679 participants) of little difference in neurological adverse events between the NSAID and paracetamol groups. Six studies, involving 1212 participants compared NSAIDs with opioids. There was moderate-certainty evidence of no difference between the groups in pain at one hour (1058 participants, 4 studies), and low-certainty evidence for no difference in pain at days four or seven (706 participants, 1 study). There was very low-certainty evidence of no important difference between the groups in swelling (84 participants, 1 study). Participants in the NSAIDs group were more likely to return to function in 7 to 10 days (542 participants, 2 studies; low-certainty evidence). There was moderate-certainty evidence (1143 participants, 5 studies) that NSAIDs were less likely to result in gastrointestinal or neurological adverse events compared with opioids. Four studies, involving 240 participants, compared NSAIDs with the combination of paracetamol and an opioid. The applicability of findings from these studies is in question because the dextropropoxyphene combination analgesic agents used are no longer in general use. Very low-certainty evidence means we are uncertain of the findings of no differences between the two interventions in the numbers with little or no pain at day one (51 participants, 1 study), day three (149 participants, 2 studies), or day seven (138 participants, 2 studies); swelling (230 participants, 3 studies); return to function at day seven (89 participants, 1 study); and the risk of gastrointestinal or neurological adverse events (141 participants, 3 studies). No studies reported re-injury rates. No studies compared NSAIDs with oral complementary and alternative medicines, AUTHORS' CONCLUSIONS: Compared with paracetamol, NSAIDs make no difference to pain at one to two hours and at two to three days, and may make no difference at day seven or beyond. NSAIDs may result in a small increase in gastrointestinal adverse events and may make no difference in neurological adverse events compared with paracetamol. Compared with opioids, NSAIDs probably make no difference to pain at one hour, and may make no difference at days four or seven. NSAIDs probably result in fewer gastrointestinal and neurological adverse effects compared with opioids. The very low-certainly evidence for all outcomes for the NSAIDs versus paracetamol with opioid combination analgesics means we are uncertain of the findings of no differences in pain or adverse effects. The current evidence should not be extrapolated to adults older than 65 years, as this group was not well represented in the studies.
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Affiliation(s)
- Peter Jones
- Adult Emergency Department, Auckland City Hospital, Auckland, New Zealand
| | - Rain Lamdin
- Adult Emergency Department, Auckland City Hospital, Auckland, New Zealand
| | - Stuart R Dalziel
- Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
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16
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Firdous S, Berger A, Jehangir W, Fernandez C, Behm B, Mehta ZY, Reddy A, Davis M. How Should We Assess Pain: Do Patients Prefer a Quantitative or Qualitative Scale? A Study of Patient Preferences. Am J Hosp Palliat Care 2020; 38:383-390. [PMID: 32720804 DOI: 10.1177/1049909120945599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pain perception is a subjective experience and is influenced by a variety of factors. Pain assessment tools, included the numeric pain rating scale (NRS) and the visual analog scale (VAS). A VAS qualitative (VASQ) scale asks patients their current pain level along a continuum of "Good Day," "Average Day," or "Bad Day." We had patients complete both scales and asked them their preference and reason for their choice. METHODS We identified patients 18 years of age and older, seen by Palliative medicine at Geisinger, who had cancer-associated pain of at least one-month duration. Patients filled out the study questionnaire composed of 2 questions. Characteristics of patients who preferred the VASQ were compared to those who preferred the NRS using a 2-sample t tests or Wilcoxon rank-sum tests and Pearson χ2 or Fisher exact tests. The relationship between the NRS and the VASQ used the Pearson correlation coefficient. RESULTS One hundred forty-six patients completed the questionnaire, 52.1% were female; 63.7% preferred the NRS, 31.5% preferred the VASQ. Patients who preferred the NRS reported a higher NRS rating than patients who preferred the VASQ (mean NRS rating of 6.0 compared to 5.3) but the difference was not statistically significant (P = .1531). Visual analog scale qualitative ratings were higher among patients who preferred the NRS, but the difference was not statistically different (mean rating of 5.2 vs 4.8, P = .3669). CONCLUSION Patients preferred the NRS over VASQ for pain assessment. Patients tend to rate their pain at a higher level when using NRS compared to VASQ.
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17
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Escalona-Marfil C, Coda A, Ruiz-Moreno J, Riu-Gispert LM, Gironès X. Validation of an Electronic Visual Analog Scale mHealth Tool for Acute Pain Assessment: Prospective Cross-Sectional Study. J Med Internet Res 2020; 22:e13468. [PMID: 32049063 PMCID: PMC7055746 DOI: 10.2196/13468] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 10/30/2019] [Accepted: 11/29/2019] [Indexed: 12/21/2022] Open
Abstract
Background Accurate measurement of pain is required to improve its management and in research. The visual analog scale (VAS) on paper format has been shown to be an accurate, valid, reliable, and reproducible way to measure pain intensity. However, some limitations should be considered, some of which can be implemented with the introduction of an electronic VAS version, suitable to be used both in a tablet and a smartphone. Objective This study aimed to validate a new method of recording pain level by comparing the traditional paper VAS with the pain level module on the newly designed Interactive Clinics app. Methods A prospective observational cross-sectional study was designed. The sample consisted of 102 participants aged 18 to 65 years. A Force Dial FDK 20 algometer (Wagner Instruments) was employed to induce mild pressure symptoms on the participants’ thumbs. Pain was measured using a paper VAS (10 cm line) and the app. Results Intermethod reliability estimated by ICC(3,1) was 0.86 with a 95% confidence interval of 0.81 to 0.90, indicating good reliability. Intramethod reliability estimated by ICCa(3,1) was 0.86 with a 95% confidence interval of 0.81 to 0.90, also indicating good reliability. Bland-Altman analysis showed a difference of 0.175 (0.49), and limits of agreement ranged from –0.79 to 1.14. Conclusions The pain level module on the app is highly reliable and interchangeable with the paper VAS version. This tool could potentially help clinicians and researchers precisely assess pain in a simple, economic way with the use of a ubiquitous technology.
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Affiliation(s)
- Carles Escalona-Marfil
- Facultat de Ciències de la Salut de Manresa, Universitat de Vic-Universitat Central de Catalunya, Manresa, Spain.,University School of Health and Sport, University of Girona, Salt (Girona), Spain
| | - Andrea Coda
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Health Behaviour, Hunter Medical Research Institute, The University of Newcastle, Callaghan, Australia
| | | | - Lluís Miquel Riu-Gispert
- Facultat de Ciències de la Salut de Manresa, Universitat de Vic-Universitat Central de Catalunya, Manresa, Spain
| | - Xavier Gironès
- Facultat de Ciències de la Salut de Manresa, Universitat de Vic-Universitat Central de Catalunya, Manresa, Spain
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18
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Oleshchenko I, Cok OY, Iureva T, Zabolotskii D, Kripak A. Effect of pterygopalatine blockade on perioperative stress and inflammatory outcomes following paediatric cataract surgery. Reg Anesth Pain Med 2020; 45:204-208. [PMID: 31964855 DOI: 10.1136/rapm-2019-100823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/15/2019] [Accepted: 12/29/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND General anesthesia is required to perform pediatric cataract surgery. To reduce severity of surgical intervention and postoperative complications, regional techniques have been concomitantly used. The traditional regional ophthalmic techniques are retrobulbar, peribulbar and sub-Tenon blocks, which present some technical difficulties and associated complication risks. The pterygopalatine blockade has been exempt of many of these concerns as it is performed out of the orbit. The purpose of this study was to compare the analgesic and anti-inflammatory effects of the pterygopalatine blockade with retrobulbar block in children undergoing elective congenital cataract surgery. METHODS After approval of ethics committee and informed consents, patients were enrolled to the study to have either ultrasound-guided pterygopalatine block (group P) or retrobulbar block (group R), with 2 mL lidocaine 2% and 1 mL ropivacaine 0.5%. Hemodynamic monitoring was recorded throughout the perioperative period. Cortisol level and oxidation-reduction status were assessed before and after surgery. Pain and inflammatory response (Tyndall effect, corneal syndrome and edema) were assessed on the first postoperative day. RESULTS Comparative analysis demonstrated a decrease in cortisol of 123.24% (p˂0.05) and an increase in the redox coefficient of 37.7% (p˂0.05) in group P. Pain intensity was significantly higher in group R until the 16th postoperative hour. The corneal syndrome in patients in group P and group R was noted by 7.6% and in 32.1%, respectively (p˂0.05). CONCLUSION The use of the pterygopalatine blockade as a component of anesthesia in pediatric cataract surgery allows reduction of the severity of surgical stress during surgical intervention, providing intraoperative hemodynamic stability and prolonged analgesia.
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Affiliation(s)
- Irina Oleshchenko
- Anesthesiology, Irkutsk Branch of S. Fyodorov Eye Microsurgery Federal State Institution, Irkutsk, Russian Federation
| | - Oya Yalcin Cok
- Department of Anesthesiology, Baskent University, Ankara, Ankara, Turkey
| | - Tatiana Iureva
- Anesthesiology, Irkutsk Branch of S. Fyodorov Eye Microsurgery Federal State Institution, Irkutsk, Russian Federation
| | - Dmitrii Zabolotskii
- Anesthesiology and Reanimation, and Intensive Pediatric Care, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russian Federation
| | - Anna Kripak
- Anesthesiology, Irkutsk Branch of S. Fyodorov Eye Microsurgery Federal State Institution, Irkutsk, Russian Federation
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19
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Becker S, Fuchs X, Schakib-Ekbatan K, Schweiker M. What does "moderate pain" mean? Subgroups holding different conceptions of rating scales evaluate experimental pain differently. Eur J Pain 2019; 24:625-638. [PMID: 31782862 DOI: 10.1002/ejp.1514] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/22/2019] [Accepted: 11/23/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Pain ratings are almost ubiquitous in pain assessment, but their variability is high. Low correlations of continuous/numerical rating scales with categorical scales suggest that individuals associate different sensations with the same number on a scale, jeopardizing the interpretation of statistical results. We analysed individual conceptions of rating scales and whether these conceptions can be utilized in the analysis of ratings of experimental stimuli in pain-free healthy individuals and people with reoccurring/persistent pain. METHODS Using a free positioning task, healthy participants (N = 57) and people with reoccurring/persistent pain (N = 57) ad libitum positioned pain descriptors on lines representing intensity and un-/pleasantness scales. Furthermore, participants rated experimental thermal stimuli on visual analogue scales with the same end anchors. A latent class regression approach was used to detect subgroups with different response patterns in the free positioning task, indicating different conceptions of pain labels, and tested whether these subgroups differed in their ratings of experimental stimuli. RESULTS Subgroups representing different conceptions of pain labels could be described for the intensity and the un-/pleasantness scale with in part opposing response patterns in the free positioning task. Response patterns did not differ between people with and without pain, but in people with pain subgroups showed differential ratings of high intensity experimental stimuli. CONCLUSIONS Individuals' conceptions of pain labels differ. These conceptions can be quantified and utilized to improve the analysis of ratings of experimental stimuli. Identifying subgroups with different conceptions of pain descriptions could be used to improve predictions of responses to pain in clinical contexts. SIGNIFICANCE The present results provide a novel approach to incorporate individual conceptualizations of pain descriptors, which can induce large distortions in the analysis of pain ratings, in pain assessment. The approach can be used to achieve better pain estimates, representing individual conceptions of pain and achieving a better comparability between individuals but also between pain-free persons and patients with chronic pain. Particularly, in clinical settings this could improve quantification of perceived pain and the patient-clinician communication.
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Affiliation(s)
- Susanne Becker
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Mannheim, Germany.,Heidelberg Academy of Sciences and Humanities, Heidelberg, Germany
| | - Xaver Fuchs
- Heidelberg Academy of Sciences and Humanities, Heidelberg, Germany.,Biopsychology & Cognitive Neuroscience, Faculty of Psychology & Sports Science, Bielefeld University, Bielefeld, Germany
| | - Karin Schakib-Ekbatan
- Heidelberg Academy of Sciences and Humanities, Heidelberg, Germany.,Building Science Group, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Marcel Schweiker
- Heidelberg Academy of Sciences and Humanities, Heidelberg, Germany.,Building Science Group, Karlsruhe Institute of Technology, Karlsruhe, Germany
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20
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Kaufmann ME, Hofer D, Wiedemeier DB, Attin T, Schmidlin PR. Oral status and aesthetics after nonsurgical periodontal treatment: Do patient's perception and dentist's evaluation agree? Clin Exp Dent Res 2019; 5:601-610. [PMID: 31943916 PMCID: PMC9514215 DOI: 10.1002/cre2.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/05/2019] [Accepted: 07/07/2019] [Indexed: 12/03/2022] Open
Abstract
Objectives Periodontal healing is often accompanied by side effects, which may cause an aesthetic deficit. The present investigation was focussed to compare patient's subjective perception of their posttherapy aesthetics with the objective measures of the results. Materials and methods Survey results from patients (subjective parameters) on oral status and aesthetics were compared against routine clinical parameters and corresponding survey results from treating dentists (objective parameters), both before and after periodontal treatment. Subjective outcome parameters were then suitably transformed and compared with the objective ones to investigate the agreement between patients' perception and actual outcomes. Results Objective recordings of periodontal status by the dentist and subjective awareness of the patient are quite contradictory to each other for almost all participants. Further, it was found that their aesthetics in the front were better after treatment, but dentist professionals targeted for future treatment needs. Conclusions In this study, it was found that patients improved aesthetically on the upper jaw front after the therapy, which was not shared by the dentists. This discrepancy was due to the clinicians' view on more aesthetic corrective procedures than on patients' need.
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Affiliation(s)
- Manuela Elena Kaufmann
- Clinic of Conservative and Preventive Dentistry, Center of Dental MedicineUniversity of ZurichZurichSwitzerland
| | - Deborah Hofer
- Clinic of Conservative and Preventive Dentistry, Center of Dental MedicineUniversity of ZurichZurichSwitzerland
| | - Daniel B. Wiedemeier
- Statistical Services, Center of Dental MedicineUniversity of ZurichZurichSwitzerland
| | - Thomas Attin
- Clinic of Conservative and Preventive Dentistry, Center of Dental MedicineUniversity of ZurichZurichSwitzerland
| | - Patrick R. Schmidlin
- Clinic of Conservative and Preventive Dentistry, Center of Dental MedicineUniversity of ZurichZurichSwitzerland
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Weng Y, Tian L, Tedesco D, Desai K, Asch SM, Carroll I, Curtin C, McDonald KM, Hernandez-Boussard T. Trajectory analysis for postoperative pain using electronic health records: A nonparametric method with robust linear regression and K-medians cluster analysis. Health Informatics J 2019; 26:1404-1418. [PMID: 31621460 DOI: 10.1177/1460458219881339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Postoperative pain scores are widely monitored and collected in the electronic health record, yet current methods fail to fully leverage the data with fast implementation. A robust linear regression was fitted to describe the association between the log-scaled pain score and time from discharge after total knee replacement. The estimated trajectories were used for a subsequent K-medians cluster analysis to categorize the longitudinal pain score patterns into distinct clusters. For each cluster, a mixture regression model estimated the association between pain score and time to discharge adjusting for confounding. The fitted regression model generated the pain trajectory pattern for given cluster. Finally, regression analyses examined the association between pain trajectories and patient outcomes. A total of 3442 surgeries were identified with a median of 22 pain scores at an academic hospital during 2009-2016. Four pain trajectory patterns were identified and one was associated with higher rates of outcomes. In conclusion, we described a novel approach with fast implementation to model patients' pain experience using electronic health records. In the era of big data science, clinical research should be learning from all available data regarding a patient's episode of care instead of focusing on the "average" patient outcomes.
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Chronic pain after two laparoendoscopic inguinal hernia repairs compared with laparoendoscopic repair followed by the Lichtenstein repair: an international questionnaire study. Surg Endosc 2019; 34:946-953. [PMID: 31144120 DOI: 10.1007/s00464-019-06853-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/18/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The best repair of a recurrent inguinal hernia after primary laparoendoscopic repair is debatable. The aim was to assess chronic pain after two laparoendoscopic repairs in the same groin compared with Lichtenstein reoperation preceded by a laparoendoscopic repair. METHODS This cohort study included adult patients who had received two laparoendoscopic repairs (Lap-Lap) or a laparoendoscopic repair followed by the Lichtenstein repair (Lap-Lich). Eligible patients were identified in the Danish and the Swedish hernia databases. Lap-Lap was matched 1:3 with Lap-Lich, and patients were sent validated questionnaires. The primary outcome was the proportion with chronic pain-related functional impairment, compared between the two groups. Secondary outcomes included chronic pain during various activities. RESULTS In total, 74% (546 patients) responded to the questionnaires with a median follow-up since the second repair of 4.9 years (0.9-21.9 years). Regarding the primary outcome, 21% in Lap-Lap and Lap-Lich had chronic pain-related functional impairment of daily activities (p = 0.94). More patients in Lap-Lap compared with Lap-Lich reported pain ≥ 20 mm measured by the visual analog scale, 11% versus 5%, p = 0.04. However, there was no difference in the median VAS score or in the vast majority of the remaining secondary outcomes. CONCLUSIONS There was no overall difference in chronic pain between patients who had received Lap-Lap compared with Lap-Lich. Choice of operative strategy for the second repair should, therefore, not be based on risk of chronic pain.
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Öberg S, Andresen K, Baker JJ, Angenete E, Rosenberg J. Chronic pain after reoperation of an inguinal hernia with Lichtenstein or laparoscopic repair following a primary Lichtenstein repair: A nationwide questionnaire study. Am J Surg 2019; 219:701-706. [PMID: 31064656 DOI: 10.1016/j.amjsurg.2019.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/17/2019] [Accepted: 04/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim was to assess chronic pain after two Lichtenstein repairs for inguinal hernias (Lichtenstein-Lichtenstein) compared with Lichtenstein followed by a laparoscopic reoperation (Lichtenstein-Laparoscopy). METHODS In this cohort study, adults having an inguinal hernia reoperation were identified in a nationwide database. Lichtenstein-Lichtenstein was matched 1:3 with Lichtenstein-Laparoscopy and sent validated pain questionnaires. The primary outcome was difference in proportion of patients with chronic pain-related functional impairment. Secondary outcomes were differences in chronic pain prevalence and severity. RESULTS In total, 196 patients having Lichtenstein-Lichtenstein and 777 patients having Lichtenstein-Laparoscopy were included. There was no difference in the primary outcome, 26% with pain in Lichtenstein-Lichtenstein versus 19% in Lichtenstein-Laparoscopy (p = 0.051). However, a few of the secondary outcomes favored Lichtenstein-Laparoscopy. CONCLUSIONS A high proportion of patients in both groups had pain several years after the second repair. None of the analyses favored Lichtenstein-Lichtenstein, but a few of the secondary outcomes favored Lichtenstein-Laparoscopy.
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Affiliation(s)
- Stina Öberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Kristoffer Andresen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jason J Baker
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Eva Angenete
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital Östra, Gothenburg, Sweden
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
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Meng F, Peng K, Yang JP, Ji FH, Xia F, Meng XW. Botulinum toxin-A for the treatment of neuralgia: a systematic review and meta-analysis. J Pain Res 2018; 11:2343-2351. [PMID: 30349359 PMCID: PMC6190814 DOI: 10.2147/jpr.s168650] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AIM This meta-analysis was performed to evaluate the efficacy and safety of botulinum toxin-A (BTX-A) for the treatment of neuralgia. METHODS We searched PubMed, EMBASE, and Cochrane databases to identify randomized controlled trials (RCTs) comparing BTX-A treatment with saline for alleviating neuropathic pain. Primary outcome measures were pain scores up to 24 weeks after treatment. Secondary outcomes were hours of sleep, Short Form-36 (SF-36) life quality questionnaire, and adverse events. We used Review Manager 5.3 for the data analyses. RESULTS Twelve RCTs were included (n=495). Pain scores in the BTX-A group were significantly lower compared to the saline group at 4 weeks (mean difference [MD] =-1.64, 95% CI [-3.21, -0.07], P=0.04), 12 weeks (MD =-1.49, 95% CI [-2.05, -0.93], P<0.00001), and 24 weeks (MD =-1.61, 95% CI [-2.81, -0.40], P=0.009). There were no significant differences in hours of sleep, SF-36 questionnaire, or the incidence of injection pain or hematoma between the two groups. No serious adverse events associated with BTX-A were noted. Fourteen out of 108 patients (12.9%) with trigeminal neuralgia experienced mild facial asymmetry after the BTX-A treatment. CONCLUSION Based on the current evidence, BTX-A may be an effective and safe option for the treatment of neuralgia. Due to the limited number of patients included in this meta-analysis, more trials are still needed to confirm these results.
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Affiliation(s)
- Fan Meng
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China, ,
| | - Ke Peng
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China, ,
| | - Jian-Ping Yang
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China, ,
| | - Fu-Hai Ji
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China, ,
| | - Fan Xia
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China, ,
| | - Xiao-Wen Meng
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China, ,
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Reynolds M, Driver S, Bennett M, Patel S, Rainey E, Warren AM. Examining the relationship between obesity and mental health outcomes among individuals admitted to a level I trauma centre. Clin Obes 2018; 8:337-344. [PMID: 30066450 DOI: 10.1111/cob.12264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/22/2018] [Accepted: 05/29/2018] [Indexed: 11/28/2022]
Abstract
The increased incidence of obesity in the general population translates into clinicians caring for an increased number of trauma patients with obesity. Previous research has documented the unique anatomical and physiological challenges that clinicians face when caring for trauma patients with obesity; however, little is known about psychological challenges that trauma patients with obesity may also experience in the months following injury. The aim of this study is to determine the relationship between obesity and (i) mental health, (ii) demographic and injury-related variables and (iii) quality-of-life outcomes among trauma patients between hospitalization and 3-months post-injury. This is a prospective, longitudinal study conducted between March 2012 and May 2014 at a single, level I trauma centre in the southwest United States. Inclusion criteria for this convenience sample consisted of patients who were admitted to the trauma or orthopaedic trauma service ≥24 h, medically stable, spoke English or Spanish and ≥18 years of age. In total, 455 eligible patients were consented and enrolled; 343 (70.87%) completed 3-month follow-up. The objective of this study is to investigate the relationship between obesity and mental health among trauma patients in the months following injury. Demographic and injury-related data were also collected; patients' height and weight were used to determine body mass index. Health outcomes were assessed during initial hospitalization and at 3-month follow-up and included depression, post-traumatic stress symptoms, pain and return to work. Prior to data collection, it was hypothesized that obesity would have a negative effect on mental health outcomes among patients 3 months post-injury. The final sample consisted of 343 participants; average age was 46.4 ± 17.3 years; majority male (n = 213, 63%) and Caucasian (n = 231, 69%). Patients with obesity had higher odds of screening positive for depression (odds ratio [OR] = 2.36, P = 0.02) and overweight patients had lower odds of returning to work (OR = 0.31, P = 0.01) 3 months post-injury compared to patients of normal weight (65% vs. 40%). No other significant differences were found. Results of the current study are novel in that they identify psychological challenges that overweight and trauma patients with obesity may experience. These results demonstrate the need for mental health professionals to be involved in follow-up care to extending in the months following injury.
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Affiliation(s)
- M Reynolds
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA
| | - S Driver
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA
| | - M Bennett
- Center for Clinical Effectiveness, Baylor Scott and White Health, Dallas, Texas, USA
| | - S Patel
- Physical Medicine and Rehabilitation, Salem Health Hospitals and Clinics, Salem, Oregon, USA
| | - E Rainey
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA
| | - A M Warren
- Division of Trauma, Critical Care and Acute Care, Baylor University Medical Center, Dallas, Texas, USA
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Response scale selection in adult pain measures: results from a literature review. J Patient Rep Outcomes 2018; 2:40. [PMID: 30238085 PMCID: PMC6127068 DOI: 10.1186/s41687-018-0053-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 05/20/2018] [Indexed: 11/22/2022] Open
Abstract
Background The purpose of this literature review was to examine the existing patient-reported outcome measurement literature to understand the empirical evidence supporting response scale selection in pain measurement for the adult population. Methods The search strategy involved a comprehensive, structured, literature review with multiple search objectives and search terms. Results The searched yielded 6918 abstracts which were reviewed against study criteria for eligibility across the adult pain objective. The review included 42 review articles, consensus guidelines, expert opinion pieces, and primary research articles providing insights into optimal response scale selection for pain assessment in the adult population. Based on the extensive and varied literature on pain assessments, the adult pain studies typically use simple response scales with single-item measures of pain—a numeric rating scale, visual analog scale, or verbal rating scale. Across 42 review articles, consensus guidelines, expert opinion pieces, and primary research articles, the NRS response scale was most often recommended in these guidance documents. When reviewing the empirical basis for these recommendations, we found that the NRS had slightly superior measurement properties (e.g., reliability, validity, responsiveness) across a wide variety of contexts of use as compared to other response scales. Conclusions Both empirical studies and review articles provide evidence that the 11-point NRS is likely the optimal response scale to evaluate pain among adult patients without cognitive impairment.
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Gries K, Berry P, Harrington M, Crescioni M, Patel M, Rudell K, Safikhani S, Pease S, Vernon M. Literature review to assemble the evidence for response scales used in patient-reported outcome measures. J Patient Rep Outcomes 2018; 2:41. [PMID: 30238086 PMCID: PMC6127075 DOI: 10.1186/s41687-018-0056-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 06/19/2018] [Indexed: 12/02/2022] Open
Abstract
Background In the development of patient-reported outcome (PRO) instruments, little documentation is provided on the justification of response scale selection. The selection of response scales is often based on the developers’ preferences or therapeutic area conventions. The purpose of this literature review was to assemble evidence on the selection of response scale types, in PRO instruments. The literature search was conducted in EMBASE, MEDLINE, and PsycINFO databases. Secondary search was conducted on supplementary sources including reference lists of key articles, websites for major PRO-related working groups and consortia, and conference abstracts. Evidence on the selection of verbal rating scale (VRS), numeric rating scale (NRS), and visual analogue scale (VAS) was collated based on pre-determined categories pertinent to the development of PRO instruments: reliability, validity, and responsiveness of PRO instruments, select therapeutic areas, and optimal number of response scale options. Results A total of 6713 abstracts were reviewed; 186 full-text references included. There was a lack of consensus in the literature on the justification for response scale type based on the reliability, validity, and responsiveness of a PRO instrument. The type of response scale varied within the following therapeutic areas: asthma, cognition, depression, fatigue in rheumatoid arthritis, and oncology. The optimal number of response options depends on the construct, but quantitative evidence suggests that a 5-point or 6-point VRS was more informative and discriminative than fewer response options. Conclusions The VRS, NRS, and VAS are acceptable response scale types in the development of PRO instruments. The empirical evidence on selection of response scales was inconsistent and, therefore, more empirical evidence needs to be generated. In the development of PRO instruments, it is important to consider the measurement properties and therapeutic area and provide justification for the selection of response scale type.
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Affiliation(s)
- Katharine Gries
- 1Janssen Global Services LLC, 700 US 202, Raritan Ave, Raritan, NJ 08869 USA
| | - Pamela Berry
- 1Janssen Global Services LLC, 700 US 202, Raritan Ave, Raritan, NJ 08869 USA
| | | | - Mabel Crescioni
- 3Critical Path Institute, Patient-Reported Outcome Consortium, 1730 E River Rd, Tucson, AZ 85718 USA
| | - Mira Patel
- 3Critical Path Institute, Patient-Reported Outcome Consortium, 1730 E River Rd, Tucson, AZ 85718 USA
| | - Katja Rudell
- 4Outcomes & Evidence, Global Health & Value, Pfizer Ltd, Tadworth, Surrey, UK
| | - Shima Safikhani
- 5Evidera, 7101 Wisconsin Ave. Suite 1400, Bethesda, MD 20814 USA
| | | | - Margaret Vernon
- 5Evidera, 7101 Wisconsin Ave. Suite 1400, Bethesda, MD 20814 USA
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Mittal TK, Ireland AJ, Atack NE, Leary SD, Russell JI, Deacon SA, Ness AR, Sandy JR. Outcome Measures in UCLP: The Modified 5-Year-Olds'-Index-Development and Reliability. Cleft Palate Craniofac J 2018; 56:248-256. [PMID: 29750571 DOI: 10.1177/1055665618774018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Can we reliably discriminate severity within the existing categories of the 5-Year-Olds' Index? DESIGN Retrospective method comparison and development study. SETTING School of Oral and Dental Science, University of Bristol. METHODS Dental study models of 5-year-olds with unilateral cleft lip and palate (UCLP) were collected from the archives of 2 national cleft surveys (n = 351). One hundred randomly selected models were ranked to construct the modified 5-Year-Olds' Index and also scored using a visual analogue scale (VAS). Reliability testing was performed on 51 study models. Visual analogue scale scores were used to aid statistical analysis and investigate the reliability of a VAS for outcome measurement. The modified 5-Year-Olds' Index was then applied to 198 study models of 5-year-olds with UCLP. RESULTS The modified 5-Year-Olds' Index showed excellent intra and interexaminer agreement (intraclass correlation > 0.94) and good discrimination of severity. When applied to the Cleft Care UK participants (n = 198), the modified 5-Year-Olds' Index showed good discrimination of severity within the better categories (groups 1-3) of the 5-Year-Olds' Index. Visual analogue Scale scores resulted in unacceptable variation between measurements. CONCLUSIONS The new modified 5-Year-Olds' Index is a reliable method of assessing outcomes at 5 years of age and showed improved discriminatory power between the "better" outcome categories than the original 5-Year-Olds' Index. A VAS was found to be unsuitable for assessing outcome at 5 years of age for children with UCLP.
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Affiliation(s)
- Tarun K Mittal
- 1 Derriford Hospital, Crownhill, Plymouth, United Kingdom
| | | | - Nikki E Atack
- 2 Dental School, University of Bristol, Bristol, United Kingdom.,3 Musgrove Park Hospital, Taunton, United Kingdom
| | - Sam D Leary
- 2 Dental School, University of Bristol, Bristol, United Kingdom
| | - Joyce I Russell
- 4 Alder Hey Children's Foundation Trust, Liverpool, United Kingdom
| | - Scott A Deacon
- 5 South West Cleft Service, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Andy R Ness
- 2 Dental School, University of Bristol, Bristol, United Kingdom.,6 University Hospitals Bristol, Bristol, United Kingdom
| | - Jonathan R Sandy
- 2 Dental School, University of Bristol, Bristol, United Kingdom.,6 University Hospitals Bristol, Bristol, United Kingdom
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Goldsmith ES, Taylor BC, Greer N, Murdoch M, MacDonald R, McKenzie L, Rosebush CE, Wilt TJ. Focused Evidence Review: Psychometric Properties of Patient-Reported Outcome Measures for Chronic Musculoskeletal Pain. J Gen Intern Med 2018; 33:61-70. [PMID: 29633142 PMCID: PMC5902346 DOI: 10.1007/s11606-018-4327-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Developing successful interventions for chronic musculoskeletal pain requires valid, responsive, and reliable outcome measures. The Minneapolis VA Evidence-based Synthesis Program completed a focused evidence review on key psychometric properties of 17 self-report measures of pain severity and pain-related functional impairment suitable for clinical research on chronic musculoskeletal pain. METHODS Pain experts of the VA Pain Measurement Outcomes Workgroup identified 17 pain measures to undergo systematic review. In addition to a MEDLINE search on these 17 measures (1/2000-1/2017), we hand-searched (without publication date limits) the reference lists of all included studies, prior systematic reviews, and-when available-Web sites dedicated to each measure (PROSPERO registration CRD42017056610). Our primary outcome was the measure's minimal important difference (MID). Secondary outcomes included responsiveness, validity, and test-retest reliability. Outcomes were synthesized through evidence mapping and qualitative comparison. RESULTS Of 1635 abstracts identified, 331 articles underwent full-text review, and 43 met inclusion criteria. Five measures (Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), SF-36 Bodily Pain Scale (SF-36 BPS), Numeric Rating Scale (NRS), and Visual Analog Scale (VAS)) had data reported on MID, responsiveness, validity, and test-retest reliability. Seven measures had data reported on three of the four psychometric outcomes. Eight measures had reported MIDs, though estimation methods differed substantially and often were not clinically anchored. CONCLUSIONS In this focused evidence review, the most evidence on key psychometric properties in chronic musculoskeletal pain populations was found for the ODI, RMDQ, SF-36 BPS, NRS, and VAS. Key limitations in the field include substantial variation in methods of estimating psychometric properties, defining chronic musculoskeletal pain, and reporting patient demographics. TRIAL REGISTRATION Registered in the PROSPERO database: CRD42017056610.
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Affiliation(s)
- Elizabeth S Goldsmith
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA. .,Section General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA. .,University of Minnesota School of Public Health, Minneapolis, MN, USA.
| | - Brent C Taylor
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA.,University of Minnesota School of Public Health, Minneapolis, MN, USA.,University of Minnesota Medical School, Minneapolis, MN, USA
| | - Nancy Greer
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Maureen Murdoch
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA.,Section General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA.,University of Minnesota Medical School, Minneapolis, MN, USA
| | - Roderick MacDonald
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Lauren McKenzie
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Christina E Rosebush
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Timothy J Wilt
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA.,Section General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA.,University of Minnesota Medical School, Minneapolis, MN, USA
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Alghadir AH, Anwer S, Iqbal A, Iqbal ZA. Test-retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain. J Pain Res 2018; 11:851-856. [PMID: 29731662 PMCID: PMC5927184 DOI: 10.2147/jpr.s158847] [Citation(s) in RCA: 329] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective Several scales are commonly used for assessing pain intensity. Among them, the numerical rating scale (NRS), visual analog scale (VAS), and verbal rating scale (VRS) are often used in clinical practice. However, no study has performed psychometric analyses of their reliability and validity in the measurement of osteoarthritic (OA) pain. Therefore, the present study examined the test-retest reliability, validity, and minimum detectable change (MDC) of the VAS, NRS, and VRS for the measurement of OA knee pain. In addition, the correlations of VAS, NRS, and VRS with demographic variables were evaluated. Methods The study included 121 subjects (65 women, 56 men; aged 40-80 years) with OA of the knee. Test-retest reliability of the VAS, NRS, and VRS was assessed during two consecutive visits in a 24 h interval. The validity was tested using Pearson's correlation coefficients between the baseline scores of VAS, NRS, and VRS and the demographic variables (age, body mass index [BMI], sex, and OA grade). The standard error of measurement (SEM) and the MDC were calculated to assess statistically meaningful changes. Results The intraclass correlation coefficients of the VAS, NRS, and VRS were 0.97, 0.95, and 0.93, respectively. VAS, NRS, and VRS were significantly related to demographic variables (age, BMI, sex, and OA grade). The SEM of VAS, NRS, and VRS was 0.03, 0.48, and 0.21, respectively. The MDC of VAS, NRS, and VRS was 0.08, 1.33, and 0.58, respectively. Conclusion All the three scales had excellent test-retest reliability. However, the VAS was the most reliable, with the smallest errors in the measurement of OA knee pain.
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Affiliation(s)
- Ahmad H Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Shahnawaz Anwer
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Amir Iqbal
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Zaheen Ahmed Iqbal
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Usta A, Turan G, Altun E, Hocaoglu M, Bulbul CB, Adali E. The Usefulness of CD34, PCNA Immunoreactivity, and Histopathological Findings for Prediction of Pain Persistence After the Removal of Endometrioma. Reprod Sci 2018; 26:269-277. [PMID: 29642800 DOI: 10.1177/1933719118768697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Endometriosis is an estrogen-dependent inflammatory disease that causes infertility and chronic pelvic pain. Ovarian endometrioma is the most common form of endometriosis, and conservative surgery is the main preferred therapeutic approach for endometrioma-associated symptoms. The aim of this study was to investigate the persistence of cyclic and noncyclic pelvic pain (NCPP) after endometrioma excision and their relationship to clinical and histopathological findings. In this prospective observational study, 41 symptomatic patients were evaluated for the presence of pain symptoms 3 to 6 months after endometrioma excision. Tissue specimens of endometrioma were collected during the operation and embedded in paraffin. The persistence of pain was 41.4%. Surgical excision of endometrioma significantly decreased NCPP and dysmenorrhea, but not dyspareunia ( P < .0001, P = .0001, and P = .25, respectively). Histopathological changes, including depth of endometriosis penetration into the cyst wall, the presence of macrophage infiltration, and vascularity of endometrioma cyst walls were significantly higher in patients with pain persistence than in patients without pain persistence ( P = .0034, P = .0042, and P = .0007, respectively). Moreover, proliferating cell nuclear antigen (PCNA) and CD34 immunoreactivity in both glandular and stromal cells and vascular endothelium were significantly higher in patients with pain persistence ( P = .0079 and P = .0025, respectively). Additionally, these histopathological changes and PCNA and CD34 immunoreactivity were significantly correlated with the persistence of NCPP and dysmenorrhea. The discovered differences in patients with endometrioma with or without pain persistence may indicate a possible relationship between endometrioma-associated pain and histopathological variability of endometrioma.
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Affiliation(s)
- Akin Usta
- 1 Department of Obstetrics and Gynecology, School of Medicine, Balıkesir University, Balıkesir, Turkey
| | - Gulay Turan
- 2 Department of Pathology, School of Medicine, Balıkesir University, Balıkesir, Turkey
| | - Eren Altun
- 2 Department of Pathology, School of Medicine, Balıkesir University, Balıkesir, Turkey
| | - Meryem Hocaoglu
- 3 Department of Obstetrics and Gynecology, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Cagla Bahar Bulbul
- 1 Department of Obstetrics and Gynecology, School of Medicine, Balıkesir University, Balıkesir, Turkey
| | - Ertan Adali
- 1 Department of Obstetrics and Gynecology, School of Medicine, Balıkesir University, Balıkesir, Turkey
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Cheatham SW, Kolber MJ, Mokha M, Hanney WJ. Concurrent validity of pain scales in individuals with myofascial pain and fibromyalgia. J Bodyw Mov Ther 2018; 22:355-360. [DOI: 10.1016/j.jbmt.2017.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/30/2017] [Accepted: 04/04/2017] [Indexed: 12/31/2022]
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Öberg S, Andresen K, Klausen TW, Rosenberg J. Chronic pain after mesh versus nonmesh repair of inguinal hernias: A systematic review and a network meta-analysis of randomized controlled trials. Surgery 2018; 163:1151-1159. [PMID: 29506882 DOI: 10.1016/j.surg.2017.12.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/28/2017] [Accepted: 12/05/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Chronic pain affects 10%-12% of patients after inguinal hernia repairs. Some have suggested that less foreign material may theoretically prevent pain. If the prevalence of chronic pain is less after nonmesh repairs, selected hernias might be repaired without mesh. Our aim was to clarify if nonmesh repairs are superior to mesh repairs regarding chronic pain. METHODS For this systematic review, searches were conducted in five databases. The main outcome was chronic pain reported a minimum of six months after mesh and nonmesh repair in adult patients with a primary inguinal hernia. Only randomized controlled trials (RCTs) were included. RESULTS A total of 23 RCTs with 5,444 patients were included. The median follow up was 1.4 years (range 0.5-10). Twenty-one studies reported crude chronic pain rates, and when considering moderate and severe pain, the prevalences of pain after nonmesh repairs and mesh repairs were similar: median 3.5% (0%-16.2%) versus median 2.9% (0%-27.6%), respectively. Both the meta-analyses and the network meta-analysis indicated no difference in chronic pain rates when comparing nonmesh repairs with open- and laparoscopic mesh repairs. CONCLUSION Mesh may be used without fear of causing a greater rate of chronic pain.
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Affiliation(s)
- Stina Öberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Denmark.
| | - Kristoffer Andresen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Denmark
| | - Tobias W Klausen
- Clinical Research Unit, Statistical Section, Department of Hematology, Herlev Hospital, University of Copenhagen, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Denmark
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Altered microstructure rather than morphology in the corpus callosum after lower limb amputation. Sci Rep 2017; 7:44780. [PMID: 28303959 PMCID: PMC5355997 DOI: 10.1038/srep44780] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/13/2017] [Indexed: 02/07/2023] Open
Abstract
The corpus callosum (CC) has been implicated in the reorganization of the brain following amputation. However, it is unclear which regions of the CC are involved in this process. In this study, we explored the morphometric and microstructural changes in CC subregions in patients with unilateral lower limb amputation. Thirty-eight patients and 38 age- and gender-matched normal controls were included. The CC was divided into five regions, and the area, thickness and diffusion parameters of each region were investigated. While morphometric analysis showed no significant differences between the two groups, amputees showed significant higher values in axial diffusivity, radial diffusivity and mean diffusivity in region II of the CC, which connects the bilateral premotor and supplementary motor areas. In contrast, the mean fractional anisotropy value of the fibers generated by these cortical areas, as measured by tractography, was significantly smaller in amputees. These results demonstrate that the interhemispheric pathways contributing to motor coordination and imagery are reorganized in lower limb amputees.
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Effectiveness of low-level laser therapy on pain intensity, pressure pain threshold, and SF-MPQ indexes of women with myofascial pain. Lasers Med Sci 2017; 32:419-428. [DOI: 10.1007/s10103-016-2138-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 12/26/2016] [Indexed: 10/20/2022]
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Sobas EM, Reinoso R, Cuadrado-Asensio R, Fernández I, Maldonado MJ, Pastor JC. Reliability of Potential Pain Biomarkers in the Saliva of Healthy Subjects: Inter-Individual Differences and Intersession Variability. PLoS One 2016; 11:e0166976. [PMID: 27907037 PMCID: PMC5132231 DOI: 10.1371/journal.pone.0166976] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 11/07/2016] [Indexed: 01/17/2023] Open
Abstract
AIM Salivary cortisol, α-amylase (sAA), secretory IgA (sIgA), testosterone, and soluble fraction of receptor II of TNFα (sTNFαRII) could serve as objective pain measures, but the normal variability of these potential biomarkers is unknown. PATIENTS & METHODS Saliva was collected with the passive secretion method from 34, pain-free subjects in two single samples at least 24 hours apart. Biomarker variation and intersession reliability were assessed with the intraclass correlation coefficient (ICC). Also, we calculated the within-subject standard deviation (Sw) and the reproducibility (2.77 × Sw) of intersession measures. RESULTS Salivary cortisol, sAA, sIgA, testosterone, and sTNFαRII yielded the following ICCs: 0.53, 0.003, 0.88, 0.42 and 0.83, respectively. We found no statistically significant systematic differences between sessions in any biomarker except for testosterone, which showed a decrease on the second day (p<0.001). The reproducibility for salivary cortisol, sAA, sIgA, testosterone, and sTNFαRII were 0.46 ng/ml, 12.88 U/ml, 11.7 μg/ml, 14.54 pg/ml and 18.29 pg/ml, respectively. Cortisol, testosterone and TNFαRII measurement variability showed a positive correlation with the magnitude (p<0.002), but no relationship was found for sAA and sIgA. CONCLUSIONS Salivary sIgA and sTNFαRII show a remarkable good reproducibility and, therefore, could be useful as pain biomarkers. When using the passive secretion method, intersession variations in salivary sIgA of more than 11.7 μg/ml may reflect true biomarker change. In the case of sTNFαRII this will depend of the magnitude. The estimates herein provided should help investigators and clinicians differentiate actual biomarker modification from measurement variability.
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Affiliation(s)
- Eva M. Sobas
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Escuela de Enfermería, Universidad de Valladolid, Valladolid, Spain
| | - Roberto Reinoso
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Visión I+D, Valladolid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - Rubén Cuadrado-Asensio
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapia, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - Itziar Fernández
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - Miguel J. Maldonado
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapia, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - José C. Pastor
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapia, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
- Department of Ophthalmology, Hospital Clinico Universitario, Valladolid, Spain
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Albert-Sabater JA, Martínez JM, Baste V, Moen BE, Ronda-Perez E. Comparison of menstrual disorders in hospital nursing staff according to shift work pattern. J Clin Nurs 2016; 25:3291-3299. [PMID: 27530371 DOI: 10.1111/jocn.13371] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2016] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVE To assess the association between work in a rotating shift schedule and menstruation characteristics among nurse staff in a prospective study. BACKGROUND Rotating shifts have been linked to alterations in the reproductive cycle. In the case of menstrual alterations, the conclusions are not clear. DESIGN Prospective epidemiological study with follow-up over four months. METHOD All the female nurse staff (<40 years) in a hospital were interviewed, collecting sociodemographic and employment information. They were given a menstrual diary to keep a record of their shifts and characteristics of their menstruation (duration, amount of blood, dysmenorrhoea). They had two types of shifts: (1) Rotating shift schedule (two mornings, two afternoons, one night and two days off) including morning shifts (8:00-15:00), afternoon/evening shifts (15:00-22:00) and night shifts (22:00-8:00), and (2) Day shift schedule including morning shifts (8:00-15:00) and/or afternoon/evening shifts (15:00-22:00). The crude and adjusted odds ratios with 95% confidence interval were calculated using logistic generalised estimating equations (GEE) taking into account the correlations of multiple cycles per worker. RESULTS One hundred and thirteen workers on the rotating shift and 75 on the day shift participated, and information from 730 menstrual cycles were obtained. There were no differences in prolonged duration, dysmenorrhoea, prolonged duration dysmenorrhoea and excessive bleeding among nurses on rotating shift compared to those on the day shift. For prolonged duration of menstruation, workers with more than five years on the rotating shift showed a slightly lower (nonsignificant) risk compared with those with <5 years. CONCLUSIONS Nurse staff on the rotating shift did not show increased risk of having menstrual disorders comparing with day staff. RELEVANCE TO CLINICAL PRACTICE Shifts with short rotation cycles and a progressive sequence do not appear to cause menstrual disorders in nurse staff who work rotating shifts.
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Affiliation(s)
- Josep Amílcar Albert-Sabater
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, Alicante, Spain
| | | | - Valborg Baste
- Uni Research Health, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bente E Moen
- Centre for International Health, University of Bergen, Bergen, Norway
| | - Elena Ronda-Perez
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, Alicante, Spain.
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Abstract
OBJECTIVE The aim of the study was to evaluate the safety and efficacy of a standardized pediatric migraine practice guideline in the emergency department (ED). METHODS Migraine Clinical Practice Guideline (MCPG) was created in collaboration with the Division of Pediatric Neurology and Pediatric Emergency Medicine. The MCPG was established on evidence-based data and best practice after a review of the literature. The MCPG was implemented for patients with a known diagnosis of migraine headaches and a verbal numeric pain score (VPS) greater than 6 on a 0 to 10 scale. Patients received intravenous saline, ketorolac, diphenhydramine, and either metoclopramide or prochlorperazine. After 40 minutes, another VPS was obtained, and if no improvement, a repeat dose of metoclopramide or prochlorperazine was administered. If after 40 minutes and minimal pain relief occurred, a consult to neurology was made. A chart review of patients enrolled in the MCPG from April 2004 to April 2013 was conducted. We recorded demographic data, vital signs, ED length of stay, initial VPS, last recorded VPS, adverse events, and admission rate. Nonparametric statistics were performed. RESULTS A total of 533 charts were identified with a discharge diagnosis of migraine headache of which 266 were enrolled in the MCPG (179 females and 87 males). Mean (SD) age was 13.9 (3.1). Mean (SD) initial VPS was 7.8 (2.0). Mean (SD) discharge VPS was 2.1 (2.8), representing a 73% reduction of pain. Twenty patients (7.5%) were admitted for status migrainosus; mean (SD) age was 14.0 (3.5) years and mean (SD) VPS was 6.3 (2.8). Mean (SD) length of stay in ED was 283 (107) minutes. No adverse events were identified. CONCLUSIONS Our MCPG was clinically safe and effective in treating children with acute migraine headaches. Our data add to the dearth of existing published literature on migraine treatment protocols in the ED setting. We recommend additional prospective and comparative studies to further evaluate the effectiveness of our protocol in this patient population.
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Elzaki WM, Abubakr NH, Ziada HM, Ibrahim YE. Double-blind Randomized Placebo-controlled Clinical Trial of Efficiency of Nonsteroidal Anti-inflammatory Drugs in the Control of Post-endodontic Pain. J Endod 2016; 42:835-42. [DOI: 10.1016/j.joen.2016.02.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 02/23/2016] [Accepted: 02/26/2016] [Indexed: 12/18/2022]
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40
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Jiang G, Li C, Wu J, Jiang T, Zhang Y, Zhao L, Evans AC, Li L, Ran S, Yin X, Wang J. Progressive Thinning of Visual Motion Area in Lower Limb Amputees. Front Hum Neurosci 2016; 10:79. [PMID: 26973497 PMCID: PMC4771768 DOI: 10.3389/fnhum.2016.00079] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 02/16/2016] [Indexed: 11/13/2022] Open
Abstract
Accumulating evidence has indicated that amputation or deafferentation of a limb induces functional or structural reorganization in the visual areas. However, the extent of the visual areas involved after lower limb amputation remains uncertain. In this investigation, we studied 48 adult patients with unilateral lower limb amputation and 48 matched healthy controls using T1-weighted magnetic resonance imaging. Template-based regions of interest analysis was implemented to detect the changes of cortical thickness in the specific visual areas. Compared with normal controls, amputees exhibited significantly lower thickness in the V5/middle temporal (V5/MT+) visual area, as well as a trend of cortical thinning in the V3d. There was no significant difference in the other visual areas between the two groups. In addition, no significant difference of cortical thickness was found between patients with amputation at different levels. Across all amputees, correlation analyses revealed that the cortical thickness of the V5/MT+ was negatively correlated to the time since amputation. In conclusion, our findings indicate that the amputation of unilateral lower limb could induce changes in the motor-related visual cortex and provide an update on the plasticity of the human brain after limb injury.
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Affiliation(s)
- Guangyao Jiang
- Department of Radiology, Southwest Hospital, Third Military Medical University , Chongqing , China
| | - Chuanming Li
- Department of Radiology, Southwest Hospital, Third Military Medical University , Chongqing , China
| | - Jixiang Wu
- Department of Rehabilitation, Southwest Hospital, Third Military Medical University , Chongqing , China
| | - Tianzi Jiang
- National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences , Beijing , China
| | - Yi Zhang
- Department of Osteology, Traditional Chinese Medical Hospital of Taian , Taian , China
| | - Lu Zhao
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University , Montreal, QC , Canada
| | - Alan C Evans
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University , Montreal, QC , Canada
| | - Lei Li
- Department of Rehabilitation, Southwest Hospital, Third Military Medical University , Chongqing , China
| | - Shuhua Ran
- Department of Radiology, Southwest Hospital, Third Military Medical University , Chongqing , China
| | - Xuntao Yin
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China; McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University , Chongqing , China
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Ergin M, Girisgin AS, Dundar ZD, Calik GS, Ertas I, Egici MT. Is it possible to objectify the visual pain scale? Pak J Med Sci 2016; 31:1527-32. [PMID: 26870129 PMCID: PMC4744314 DOI: 10.12669/pjms.316.8269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To test our hypothesis that a new modified VAS (mVAS) is superior and more objective than VAS in evaluating pain perception and treatment response between genders who have renal colic pain. METHODS The individuals in patient and control groups were first asked to mark the pain perceived during access of IV line (VASIV score). Then the patients with renal colic were asked to mark the pain they experienced before treatment (VASRC score) and at 15 and 30 minutes after the administration of the first analgesic drug. The modified VAS scores (mVAS score) were obtained by subtracting the VASIV score from VASRC score. RESULTS When VAS was used, the female patients had significantly higher level of pain at 0, 15, and 30(th) minutes than men (p = 0.012, p = 0.001, and p = 0.003, respectively). However, there was not any significant difference at 0 and 30(th) min between sexes while female patients had significantly higher level of pain scores only at 15(th) minute according to mVAS scores (p = 0.027). CONCLUSION We think that the mVAS is superior and more objective than VAS in evaluating pain perception and abolished the difference in the perceived level of pain due to gender.
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Affiliation(s)
- Mehmet Ergin
- Mehmet Ergin, MD, EP. Assistant Professor, Department of Emergency Medicine, Necmettin Erbakan University, Meram Medicine School, Konya, Turkey
| | - Abdullah Sadik Girisgin
- Abdullah Sadik Girisgin, MD, EP. Professor, Department of Emergency Medicine, Necmettin Erbakan University, Meram Medicine School, Konya, Turkey
| | - Zerrin Defne Dundar
- Zerrin Defne Dundar, MD, EP. Assistant Professor, Department of Emergency Medicine, Necmettin Erbakan University, Meram Medicine School, Konya, Turkey
| | - Goknil Saniye Calik
- Goknil Saniye Calik, MD, EP. Konya Education and Research Hospital, Emergency Medicine Department, Konya, Turkey
| | - Izzetin Ertas
- Izzetin Ertas, MD, EP. Resident Assistant, Department of Emergency Medicine, Necmettin Erbakan University, Meram Medicine School, Konya, Turkey
| | - Mehmet Taskin Egici
- Mehmet Taskin Egici, MD, EP. Resident Assistant, Emergency Medicine Department, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
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Saetra P, Fossum M, Svensson E, Cohen MZ. Evaluation of two instruments of perceived symptom intensity in palliative care patients in an outpatient clinic. J Clin Nurs 2016; 25:799-810. [PMID: 26813779 DOI: 10.1111/jocn.13100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2015] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the test-retest stability in assessments of perceived symptom intensity on the Edmonton Symptom Assessment System-revised and the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative. The possible interchangeability between the instruments and the patients' experiences of completing the instruments were also studied. BACKGROUND The two instruments assess the same symptoms, but the symptom intensity is assessed on 11-point numerical scales on the Edmonton Symptom Assessment System-revised and on four-point verbal descriptive scales on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative. Both instruments are commonly used; however, uncertainty exists about which instrument should be recommended and about the interchangeability of the instruments. DESIGN This study used a test-retest design with inter-scale comparisons. METHODS Data from 54 patients with cancer who were receiving palliative care in an oncology outpatient clinic were self-reported by the patients in the clinic, at home and when patients returned to the clinic. RESULTS The assessments on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative verbal rating scales showed a higher level of test-retest stability than the assessments on the Edmonton Symptom Assessment System-revised numerical scoring scales, indicating higher reliability. The correspondence between the verbal categories and the numerical scores of symptom intensity were low because different verbal categories were used by patients who assessed the same numerical score. CONCLUSIONS The test-retest stability in the assessments was higher on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative and the results show that assessments on the two instruments could not be used interchangeably. Therefore, the symptom instrument chosen must be specified and unchanged within a patient to improve efficacy in clinical practice. RELEVANCE TO CLINICAL PRACTICE The Edmonton Symptom Assessment System-revised or the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative can be used for initial assessments of patients, but should not be compared or used interchangeably. It is vitally important to have individual follow-up for all patients who score an instrument.
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Affiliation(s)
- Pia Saetra
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway.,Sorlandet Hospital, Arendal, Norway
| | - Mariann Fossum
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway.,Faculty of Health, School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia
| | | | - Marlene Z Cohen
- Center for Nursing Sciences, University of Nebraska Medical Center, Omaha, NE, USA
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Elfving B, Lund I, C LB, Boström C. Ratings of pain and activity limitation on the visual analogue scale and global impression of change in multimodal rehabilitation of back pain - analyses at group and individual level. Disabil Rehabil 2016; 38:2206-16. [PMID: 26728352 DOI: 10.3109/09638288.2015.1116618] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate changes in pain intensity and activity limitation, at group and individual levels, and their associations with the global impression of change after multimodal rehabilitation in patients with back pain. METHOD Patients with long-term back pain (n = 282) participated in a 4-week programme with a follow-up after 6 months. Visual analogue scales (VAS) were used to rate pain intensity and activity limitation. Global impression of change (GIC) was rated on a 7-category scale. The sign test, the Svensson method and the Spearman rank correlation were used for analyses. RESULTS Significantly lower ratings in pain and activity limitation at follow-up were found at group level. However, a large individual variability was found by the Svensson method. The correlations between GIC and changes in pain and activity limitation were rs = 0.49 and rs = 0.50, respectively. A rated GIC of at least "much better" on group level showed changes of ≥20 mm on the VAS. CONCLUSIONS At group level, lower VAS ratings were found in patients with back pain. However, a large individual variability in pain and activity limitation was also found resulting in low to moderate associations between GIC and the change in VAS ratings. The large individual variability might be due to the impreciseness in the ratings on the VAS. We have presented a critical discussion of statistical methods in connection with the VAS. Implications for Rehabilitation The use of VAS as a rating instrument may be questioned, especially for perceived pain intensity which is a too complex experience to be rated on a line without any visible categories. Single ratings of pain intensity should preferably be complemented with the ratings of activity limitation in patients with long-term back pain. Global impression of change is a suggested inclusive rating after rehabilitation. The improvement desired by the patient should preferably be determined before rehabilitation.
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Affiliation(s)
- B Elfving
- a Department of Neurobiology , Care Sciences and Society, Karolinska Institutet , Stockholm , Sweden
| | - I Lund
- b Department of Physiology and Pharmacology , Karolinska Institutet , Stockholm , Sweden
| | - Lüning Bergsten C
- a Department of Neurobiology , Care Sciences and Society, Karolinska Institutet , Stockholm , Sweden
| | - C Boström
- a Department of Neurobiology , Care Sciences and Society, Karolinska Institutet , Stockholm , Sweden
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The Plasticity of Brain Gray Matter and White Matter following Lower Limb Amputation. Neural Plast 2015; 2015:823185. [PMID: 26587289 PMCID: PMC4637496 DOI: 10.1155/2015/823185] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/25/2015] [Indexed: 11/21/2022] Open
Abstract
Accumulating evidence has indicated that amputation induces functional reorganization in the sensory and motor cortices. However, the extent of structural changes after lower limb amputation in patients without phantom pain remains uncertain. We studied 17 adult patients with right lower limb amputation and 18 healthy control subjects using T1-weighted magnetic resonance imaging and diffusion tensor imaging. Cortical thickness and fractional anisotropy (FA) of white matter (WM) were investigated. In amputees, a thinning trend was seen in the left premotor cortex (PMC). Smaller clusters were also noted in the visual-to-motor regions. In addition, the amputees also exhibited a decreased FA in the right superior corona radiata and WM regions underlying the right temporal lobe and left PMC. Fiber tractography from these WM regions showed microstructural changes in the commissural fibers connecting the bilateral premotor cortices, compatible with the hypothesis that amputation can lead to a change in interhemispheric interactions. Finally, the lower limb amputees also displayed significant FA reduction in the right inferior frontooccipital fasciculus, which is negatively correlated with the time since amputation. In conclusion, our findings indicate that the amputation of lower limb could induce changes in the cortical representation of the missing limb and the underlying WM connections.
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45
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Medrisk's cross-cultural adaptation: Brazilian version. J Orthop Sports Phys Ther 2015; 45:720-1. [PMID: 26323566 DOI: 10.2519/jospt.2015.0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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46
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Kjeldsen HB, Klausen TW, Rosenberg J. Preferred Presentation of the Visual Analog Scale for Measurement of Postoperative Pain. Pain Pract 2015; 16:980-984. [DOI: 10.1111/papr.12344] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/17/2015] [Indexed: 12/14/2022]
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Jones P, Dalziel SR, Lamdin R, Miles-Chan JL, Frampton C. Oral non-steroidal anti-inflammatory drugs versus other oral analgesic agents for acute soft tissue injury. Cochrane Database Syst Rev 2015:CD007789. [PMID: 26130144 DOI: 10.1002/14651858.cd007789.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Acute soft tissue injuries are common and costly. The best drug treatment for such injuries is not certain, although non-steroidal anti-inflammatory drugs (NSAIDs) are often recommended. OBJECTIVES To assess the effects (benefits and harms) of NSAIDs compared with other oral analgesics for treating acute soft tissue injuries. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (12 September 2014), the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2014 Issue 8), MEDLINE (1966 to September 2014), EMBASE (1980 to September 2014), CINAHL (1937 to November 2012), AMED (1985 to November 2012), International Pharmaceutical Abstracts (1970 to November 2012), PEDro (1929 to November 2012), and SPORTDiscus (1985 to November 2012), plus internet search engines, trial registries and other databases. We also searched reference lists of relevant articles and contacted authors of retrieved studies and pharmaceutical companies to obtain relevant unpublished data. SELECTION CRITERIA We included randomised or quasi-randomised controlled trials involving people with acute soft tissue injury (sprain, strain or contusion of a joint, ligament, tendon or muscle occurring up to 48 hours prior to inclusion in the study) and comparing oral NSAID versus paracetamol (acetaminophen), opioid, paracetamol plus opioid, or complementary and alternative medicine. The outcomes were pain, swelling, function, adverse effects and early re-injury. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed studies for eligibility, extracted data and assessed risk of bias. We assessed the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. MAIN RESULTS We included 16 trials, with a total of 2144 participants. Two studies included children only. The other 14 studies included predominantly young adults, of whom over 60% were male. Seven studies recruited people with ankle sprains only. Most studies were at low or unclear risk of bias; however, two were at high risk of selection bias, three were at high risk of bias from lack of blinding, one was at high risk of bias due to incomplete outcome data, and four were at high risk of selective outcome reporting bias. The evidence was usually either low quality or very low quality, reflecting study limitations, indirectness such from as suboptimal dosing of single comparators, imprecision, or one or more of these. Thus we are either uncertain or very uncertain of the estimates.Nine studies, involving 991 participants, compared NSAIDs with paracetamol. While tending to favour paracetamol, there was a lack of clinically important differences between the two groups in pain at less than 24 hours (377 participants, 4 studies; moderate-quality evidence), at days 1 to 3 (431 participants, 4 studies; low quality), and at day 7 or over (467 participants, 4 studies; low quality). A similar lack of difference between the two groups applied to swelling at day 3 (86 participants, 1 study; very low quality) and at day 7 or over (77 participants, 1 study; low quality). There was little difference between the two groups in return to function at day 7 or over (316 participants, 3 studies; very low quality): based on an assumed recovery of function of 804 per 1000 participants in the paracetamol group, 8 fewer per 1000 recovered in the NSAID group (95% confidence interval (CI) 80 fewer to 73 more). There was low-quality evidence of a lower risk of gastrointestinal adverse events in the paracetamol group: based on an assumed risk of gastrointestinal adverse events of 16 per 1000 participants in the paracetamol group, 13 more participants per 1000 had a gastrointestinal adverse event in the NSAID group (95% CI 0 to 35 more).Four studies, involving 958 participants, compared NSAIDs with opioids. Since a study of a selective COX-2 inhibitor NSAID (valdecoxib) that was subsequently withdrawn from the market dominates the evidence for this comparison (706 participants included in the analyses for pain, function and gastrointestinal adverse events), the applicability of these results is in doubt and we give only a brief summary. There was low quality evidence for a lack of clinically important differences between the two groups regarding pain at less than 24 hours, at days 4 to 6, and at day 7. Evidence from single studies showed a similar lack of difference between the two groups for swelling at day 3 (68 participants) and day 10 (84 participants). Return to function at day 7 or over favoured the NSAID group (low-quality), and there were fewer gastrointestinal adverse events in the selective COX-2 inhibitor NSAID group (very low quality).Four studies, involving 240 participants, compared NSAIDs with the combination of paracetamol and an opioid. The applicability of findings from these studies is partly in question because the dextropropoxyphene combination analgesic agents used are no longer in general use. While the point estimates favoured NSAID, the very low-quality evidence did not show a difference between the two interventions in the numbers with little or no pain at day 1 (51 participants, 1 study), day 3 (149 participants, 2 studies), or day 7 (138 participants, 2 studies). Very low-quality evidence showed a similar lack of difference between the two groups applied to swelling at day 3 (reported in two studies) and at day 7 (reported in two studies), in return to function at day 7 (89 participants, 1 study), and in gastrointestinal adverse events (141 participants, 3 studies).No studies compared NSAIDs with complementary and alternative medicines, and no study reported re-injury rates. AUTHORS' CONCLUSIONS There is generally low- or very low-quality but consistent evidence of no clinically important difference in analgesic efficacy between NSAIDs and other oral analgesics. There is low-quality evidence of more gastrointestinal adverse effects with non-selective NSAID compared with paracetamol. There is low- or very low-quality evidence of better function and fewer adverse events with NSAIDs compared with opioid-containing analgesics; however, one study dominated this evidence using a now unavailable COX-2 selective NSAID and is of uncertain applicability. Further research is required to determine whether there is any difference in return to function or adverse effects between both non-selective and COX-2 selective NSAIDs versus paracetamol.
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Affiliation(s)
- Peter Jones
- Adult Emergency Department, Auckland City Hospital, Auckland District Health Board, Park Road, Grafton, Auckland, New Zealand
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Aktas A, Walsh D, Kirkova J. The psychometric properties of cancer multisymptom assessment instruments: a clinical review. Support Care Cancer 2015; 23:2189-202. [PMID: 25894883 DOI: 10.1007/s00520-015-2732-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/29/2015] [Indexed: 01/29/2023]
Abstract
PURPOSE Various instruments are used to assess both individual and multiple cancer symptoms. We evaluated the psychometric properties of cancer multisymptom assessment instruments. METHODS An Ovid MEDLINE search was done. All searches were limited to adults and in English. All instruments published from 2005 to 2014 (and with at least one validity test) were included. We excluded those who only reported content validity. Instruments were categorized by the three major types of symptom measurement scales employed as follows: visual analogue (VAS), verbal rating (VRS), and numerical rating (NRS) scales. They were then examined in two areas: (1) psychometric thoroughness (number of tests) and (2) psychometric strength of evidence (validity, reliability, generalizability). We also assigned an empirical global psychometric quality score (which combined the concepts of thoroughness and strength of evidence) to rank the instruments. RESULTS We analyzed 57 instruments (17 original, 40 modifications). They varied in types of scales used, symptom dimensions measured, and time frames evaluated. Of the 57, 10 used VAS, 28 VRS, and 19 NRS. The Edmonton Symptom Assessment System (ESAS), ESAS-Spanish, Hospital Anxiety and Depression Scale (HADS), Profile of Mood States (POMS), Symptom Distress Scale (SDS), M.D. Anderson Symptom Inventory (MDASI)-Russian, and MDASI-Taiwanese were the most comprehensively tested for validity and reliability. The ESAS, ESAS-Spanish, ASDS-2, Memorial Symptom Assessment Scale (MSAS)-SF, POMS, SDS, MDASI (and some translations), and MDASI-Heart Failure all showed good validity and reliability. CONCLUSIONS The MDASI appeared to be the best overall from a psychometric perspective. This was followed by the ESAS, ESAS-Spanish, POMS, SDS, and some MDASI translations. VRS-based instruments were most common. There was a wide range of psychometric rigor in validation. Consequently, meta-analysis was not possible. Most cancer multisymptom assessment instruments need further extensive validation to establish the excellent reliability and validity required for clinical utility and meaningful research.
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Affiliation(s)
- Aynur Aktas
- Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA
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Voerman JS, Vogel I, de Waart F, Westendorp T, Timman R, Busschbach JJV, van de Looij-Jansen P, de Klerk C. Bullying, abuse and family conflict as risk factors for chronic pain among Dutch adolescents. Eur J Pain 2015; 19:1544-51. [PMID: 25752511 DOI: 10.1002/ejp.689] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2015] [Indexed: 11/05/2022]
Abstract
PURPOSE Psychosocial stress seems to serve as an important risk factor for the occurrence of pain. The present study aims to examine if early adversities, e.g. bullying, abuse and family conflict are risk factors for chronic pain in adolescents. The secondary aim of the present study was to describe the pain characteristics of chronic pain in adolescents in a community sample of Dutch adolescents. METHODS Participants in the present study were 15,220 adolescents, attending schools (grade 7 and 8) in Rotterdam, the Netherlands. Chronic pain was measured with a newly developed questionnaire; the Pain Barometer. Early adversities were measured using single-item questions from the Rotterdam Youth Monitor, a longitudinal youth health surveillance system. Cross-sectional associations between early adversities and chronic pain were investigated using logistic multilevel analysis, adjusted for potential confounding. RESULTS In school year 2010-2011, 9.2% of the 15,220 adolescents reported chronic pain. Physical abuse by others (OR = 1.51, 95% CI = 1.07-2.14), sexual abuse (OR = 1.46, 95% CI = 1.05-2.05), family conflict (OR = 1.79, 95% C = 1.61-1.99) and being bullied (OR = 1.23, 95% CI = 1.17-1.29) are more common in adolescents with chronic pain. Physical abuse (OR = 1.28, 95% CI = 0.95-1.71) by parents and parental divorce (OR = 1.07, 95% CI = 0.93-1.22) were not significantly related to chronic pain. CONCLUSIONS The results of the present study suggest that bullying, abuse and family conflict may be risk factors for chronic pain in adolescents. Early signalling these stressors might prevent chronic pain. IMPLICATIONS AND CONTRIBUTION Early adversities, i.e. physical and sexual abuse, being bullied and family conflict, might be risk factors for developing chronic pain. In addition, the present study suggests that chronic pain is common among Dutch adolescents and interferes with their daily activities. If future studies confirm our results, this knowledge can be used to improve the signalling and prevention of chronic pain in adolescents.
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Affiliation(s)
- J S Voerman
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - I Vogel
- Municipal Health Services Rotterdam-Rijnmond, the Netherlands
| | - F de Waart
- Municipal Health Services Rotterdam-Rijnmond, the Netherlands
| | - T Westendorp
- Rijndam Rehabilitation Centre, Rotterdam, the Netherlands
| | - R Timman
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - J J V Busschbach
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | | | - C de Klerk
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
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Self-rated measure of pain frequency, intensity, and burden: psychometric properties of a new instrument for the assessment of pain. J Psychiatr Res 2014; 59:155-60. [PMID: 25194231 PMCID: PMC4780842 DOI: 10.1016/j.jpsychires.2014.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 08/06/2014] [Accepted: 08/07/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND A brief, self-administered measurement of pain frequency, intensity, and burden is desirable in both research and clinical settings. We describe the development and initial psychometric properties of a new instrument, the Pain Frequency, Intensity, and Burden Scale (P-FIBS). METHODS The P-FIBS was administered to all participants (N = 302) with psychostimulant use disorders in the National Institute on Drug Abuse Clinical Trials Network's STRIDE (Stimulant Reduction Intervention using Dose Exercise) multisite trial. RESULTS The four items on the P-FIBS demonstrate high item-total correlations (range 0.70-0.85) with a high Cronbach's alpha (0.90). The P-FIBS demonstrated a strong negative correlation with the bodily pain sub-score of the Short Form Health Survey (r = -0.76, p < 0.0001) and did not correlate with a measure of cocaine (r = 0.09, p = 0.12) or methamphetamine (r = -0.06, p = 0.33) craving. CONCLUSIONS The P-FIBS demonstrates good psychometric properties. This brief measure can be used to assess pain in research settings or as a screen in clinical settings. Further research is needed to assess the measure's sensitivity to change with treatment.
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