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Gruttadauria M, Hamilton C, Loring M, Dahlman M. Surgical considerations for resection of a non-communicating rudimentary uterine horn. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.12.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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McEntee K, Koenig H, Hattiangadi R, Loring M, Brockmeyer A, Dahlman M. Factors associated with burnout among minimally invasive gynecologic surgery fellows. AJOG Global Reports 2022; 2:100074. [PMID: 36276794 PMCID: PMC9563905 DOI: 10.1016/j.xagr.2022.100074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND While burnout has been identified in half of practicing physicians, no validated questionnaires have assessed burnout among minimally invasive gynecologic surgery fellows. OBJECTIVE This study aimed to assess factors associated with burnout among minimally invasive gynecologic surgery fellows. STUDY DESIGN Cross-sectional online survey including the validated Copenhagen Burnout Inventory: 100 minimally invasive gynecologic surgery fellows in the United States were invited, including the classes of 2021 and 2022. Of the 100 fellows invited, 60 fellows completed the Copenhagen Burnout Inventory survey. Descriptive statistics were used to report the demographic variables, the mean Copenhagen Burnout Inventory score, and the responses to the survey questions. Logistic and linear regression models were created to assess relationships between fellow characteristics and Copenhagen Burnout Inventory scores. RESULTS Of the 60 fellows with complete Copenhagen Burnout Inventory survey data, 73% were female, 50% were first-year, and 50% were second-year fellows. The mean Copenhagen Burnout Inventory score was 39.2 (standard deviation, 14.4), indicating moderate burnout, and 21.7% of fellows had scores >50, indicating high burnout. Personal and work-related burnout were highest, with Copenhagen Burnout Inventory scores of 47.9 (standard deviation, 16.8) and 45.1 (standard deviation, 17.6), respectively. Patient-related burnout scores were the lowest at 23.5 (standard deviation, 16.5). Factors associated with overall burnout included career choice dissatisfaction (beta, 5.6; 95% confidence interval, 0.9–10.3; P=.02) and absence of a positive and respectful work environment (beta, 5.9; 95% confidence interval, 1.0–10.9; P=.02). Fellows who were somewhat satisfied with their career choice scored 11.2 points higher than those who were highly satisfied. Fellows whose work environment was almost never positive and respectful scored 17.8 points higher than those whose work environment was always positive and respectful. Female fellows were significantly less likely to have a low Copenhagen Burnout Inventory score than male fellows (odds ratio, 0.05; 95% confidence interval, 0.004–0.3; P=.004). Only one-third of fellows reported regular individual wellness behaviors: mindfulness (23%), exercise (35%), 7 to 8 hours of sleep (37%), and recreation (27%); however, these factors were not associated with lower burnout scores. CONCLUSION Fellows had moderate to high personal and work-related burnout, whereas patient-related burnout was low. Factors associated with burnout were negative work culture, lack of control over work schedule, and decreased career satisfaction. Individual wellness behaviors were not associated with burnout, highlighting the need to look beyond individual behavior in the fight against physician burnout.
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Affiliation(s)
- Kelli McEntee
- Departments of Gynecology, Virginia Mason Franciscan Health, Seattle, WA (Drs McEntee, Hattiangadi, Loring, Brockmeyer, and Dahlman)
- Corresponding author: Kelli McEntee, MD.
| | - Hannah Koenig
- Research and Academics, Virginia Mason Franciscan Health, Seattle, WA (Ms Koenig)
| | - Rohan Hattiangadi
- Departments of Gynecology, Virginia Mason Franciscan Health, Seattle, WA (Drs McEntee, Hattiangadi, Loring, Brockmeyer, and Dahlman)
| | - Megan Loring
- Departments of Gynecology, Virginia Mason Franciscan Health, Seattle, WA (Drs McEntee, Hattiangadi, Loring, Brockmeyer, and Dahlman)
| | - Amy Brockmeyer
- Departments of Gynecology, Virginia Mason Franciscan Health, Seattle, WA (Drs McEntee, Hattiangadi, Loring, Brockmeyer, and Dahlman)
| | - Marisa Dahlman
- Departments of Gynecology, Virginia Mason Franciscan Health, Seattle, WA (Drs McEntee, Hattiangadi, Loring, Brockmeyer, and Dahlman)
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McEntee K, Dahlman M. Laparoscopic myomectomy of a lateral cervical fibroid with temporary uterine artery occlusion. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Hattiangadi R, McEntee K, Dahlman M. Minimally invasive approach to the management of tubo-ovarian abscesses. Curr Opin Obstet Gynecol 2021; 33:249-254. [PMID: 34155166 DOI: 10.1097/gco.0000000000000720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this publication is to review the most up-to-date literature regarding the pathogenesis, diagnosis and management of tubo-ovarian abscesses. RECENT FINDINGS Prior to the advent of broad-spectrum antibiotics, tubo-ovarian abscesses necessitated total abdominal hysterectomy and bilateral salpingo-oophorectomy. Although it carries a risk of treatment failure, antibiotic therapy enabled fertility-sparing treatment for many women. Recent studies have identified key predictors for antibiotic treatment failure, including age, BMI and abscess diameter. C-reactive protein was also found to be a strong predictor of antibiotic treatment response. Given the growing evidence of treatment failure with antibiotic therapy alone, along with increased availability and access to interventional radiology, image-guided drainage with or without catheter placement, combined with broad-spectrum antibiotics, is now considered first-line therapy. SUMMARY Tubo-ovarian abscess is a diagnostic challenge, as presentation can vary. Inadequate treatment is associated with severe morbidity and mortality. Despite adequate conservative treatment, recurrence risk is high and clinical sequelae can have devastating effects on reproductive health. Recent evidence-based developments, including a risk score system to predict antibiotic failure, serve to provide appropriately directed risk-based care. However, large-scale randomized controlled trials are needed to clarify the most appropriate treatment modalities.
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Affiliation(s)
- Rohan Hattiangadi
- Virginia Mason Medical Center, Department of Gynecology, Seattle, Washington, USA
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Hattiangadi R, Dahlman M, Szydlo D. Accuracy of Preoperative Ultrasound in Predicting Uterine Weight across Varying Uterine Pathologies. J Minim Invasive Gynecol 2020. [DOI: 10.1016/j.jmig.2020.08.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wagner EM, Dahlman M, Mihalov LS. 1692 Changes in Opiate Prescribing Patterns for Gynecologic Surgery After Implementation of Stringent Hospital Wide Prescribing Guidelines. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wagner EM, Mupombwa T, Simianu VV, Dahlman M. Laparoscopic Management of 12cm Parasitic Fibroid on the Pelvic Brim. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wagner E, Dahlman M. Laparoscopic Management of Extensive Chemical Peritonitis after Spontaneous Dermoid Rupture. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tsafrir Z, Palmer M, Dahlman M, Nawfal AK, Aoun J, Taylor A, Fisher J, Theoharis E, Eisenstein D. Long-term outcomes for different vaginal cuff closure techniques in robotic-assisted laparoscopic hysterectomy: A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2016; 210:7-12. [PMID: 27923167 DOI: 10.1016/j.ejogrb.2016.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/14/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This randomized controlled trial aimed to evaluate the outcomes of different vaginal cuff closure techniques in robotic-assisted total laparoscopic hysterectomy. STUDY DESIGN Ninety women undergoing robotic-assisted total laparoscopic hysterectomy for benign disease were randomized to three vaginal cuff closure techniques: running 2.0 V-Lock™ (Arm 1), 0 Vicryl™ figure-of-eight (Arm 2), and running 0 Vicryl™ with Lapra-Ty® (Arm 3). Patients' records were reviewed for age, body mass index, smoking status and relevant co-morbidities. Operative times for vaginal closure and total length of surgery, estimated blood loss, and peri-operative complications were collected. Patients were evaluated at 2 and 6 weeks post-operatively, and interviewed 1year following surgery by a telephone survey. Outcomes evaluated were vaginal cuff dehiscence, pain, dyspareunia and bleeding. RESULTS The study arms did not differ with respect to estimated blood loss (50mL in each arm; p=0.34), median vaginal cuff closure time (14.5, 12 and 13min, respectively; p=0.09) or readmission (p=0.55). In the 1-year follow-up (54/90 respondents; 60%), there were no significant differences among study arms for vaginal bleeding, cuff infection or dyspareunia. Only women belonging to arm 3 reported vaginal pain (0%, 0% and 23%, respectively; p=0.01). No cases of vaginal cuff dehiscence were observed. CONCLUSIONS The type of closure technique has no significant impact on patient outcomes. In the absence of a clear advantage of one technique over the others, the decision regarding the preferred method to close the vaginal cuff in robotic-assisted total laparoscopic hysterectomy should be based on surgeons' preference and cost effectiveness.
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Affiliation(s)
- Ziv Tsafrir
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA; The Department of Gynecology, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel- Aviv, Israel.
| | - Matthew Palmer
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Marisa Dahlman
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - A Karim Nawfal
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Joelle Aoun
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Andrew Taylor
- Division of Biostatistics, Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Jay Fisher
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Evan Theoharis
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - David Eisenstein
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA
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Sangha R, Strickler R, Dahlman M, Havstad S, Wegienka G. Myomectomy to Conserve Fertility: Seven-Year Follow-Up. Journal of Obstetrics and Gynaecology Canada 2015; 37:46-51. [DOI: 10.1016/s1701-2163(15)30362-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Palmer M, Dahlman M, Eisenstein D, Theoharis E, Fisher J, Wegienka G. Outcomes of Vaginal Cuff Closure Techniques in Robotic Hysterectomy: A Prospective Randomized Trial. J Minim Invasive Gynecol 2013. [DOI: 10.1016/j.jmig.2013.08.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nawfal AK, Eisenstein D, Theoharis E, Dahlman M, Wegienka G. Vaginal cuff closure during robotic-assisted total laparoscopic hysterectomy: comparing vicryl to barbed sutures. JSLS 2013; 16:525-9. [PMID: 23484558 PMCID: PMC3558886 DOI: 10.4293/108680812x13462882736772] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
There were no differences in complications between O Vicryl™ figure-of-eight vaginal cuff closure and closure with V-Loc™ barbed sutures in this study. Background and Objectives: Empirical evidence is needed to assess clinical appropriateness of any new surgical device or material. Differences in surgical outcomes between Vicryl figure-of-8 and V-Loc barbed sutures for vaginal cuff closure during robotic hysterectomy were assessed. Methods: We examined the electronic medical records of 202 patients who underwent scheduled robotic-assisted total laparoscopic hysterectomy for benign indications, without concomitant urogynecologic procedures, between January 2008 and November 2010 at the Henry Ford Health System academic medical center. Cuff closure approach was selected by the surgeon. Data on demographics, vaginal cuff suture type, body mass index (BMI), estimated blood loss (EBL), perioperative hemoglobin change, procedure duration, hospital length of stay (LOS), specimen weight, and postoperative complications were obtained. Results: The average age was 46 y (SD = 8.0 y). Women with Vicryl figure-of-8 closures (n = 133) were more likely than women with V-Loc barbed suture closures (n = 69) to have had a LOS > 1 d (48/133, 36.1% vs. 12/69, 17.4%; chi square P = .006), greater EBL (median 75 vs. 50 mL, Wilcoxon Rank Sum=WRS P < .001), and longer procedure durations (175 vs. 135 min, WRS P < .001). These differences persisted even after considering uterine weight, BMI, smoking status, and concomitant oophorectomy. No differences with respect to the frequency of major (2 in each closure type) or minor complications were observed (P = .36). Conclusions: There were no differences in complications between the Vicryl figure-of-8 and V-Loc barbed sutures in our sample. However, the latter had lower EBL and shorter procedure duration and LOS.
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Affiliation(s)
- A Karim Nawfal
- Department of Gynecology, Obstetrics, and Women's Health, Henry Ford Hospital, Detroit, MI, USA.
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Eisenstein D, Dahlman M, Sangha R, Orady M, Nawfal A, Havsted S, Wegienka G. Is Cervix Removal Associated with Pain, Well-Being and Satisfaction after Hysterectomy? J Minim Invasive Gynecol 2012. [DOI: 10.1016/j.jmig.2012.08.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sangha R, Nawfal K, Dahlman M, Eisenstein D, Orady M, Havstad S, Lawerence F, Wegeinka G. Is BMI Associated with Pain, Well-Being or Satisfaction in the 3 Months after Hysterectomy? J Minim Invasive Gynecol 2012. [DOI: 10.1016/j.jmig.2012.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dahlman M, Palmer M, Havstad S, Wegienka G, Eisenstein D, Bagaria M, Keerthy M, Sangha R. Fertility after Myomectomy: A Retrospective Cohort Study. J Minim Invasive Gynecol 2012. [DOI: 10.1016/j.jmig.2012.08.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sangha R, Dahlman M, Nawfal K, Eisenstein D, Orady M, Havstad S, Wegienka G, Lawrence F. Use of “Person-Centered” Analyses When Outcomes of Interest Are Not Homogeneous in Hysterectomy Patients. J Minim Invasive Gynecol 2012. [DOI: 10.1016/j.jmig.2012.08.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Dahlman M, Theoharis E, Eisenstein D. Intra-Abdominal Ultrasound in Robotic Myomectomy. J Minim Invasive Gynecol 2012. [DOI: 10.1016/j.jmig.2012.08.534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Palmer M, Dahlman M, Havstad S, Wegienka G, Sangha R, Bagaria M, Keerthy M, Eisenstein D. Fibroid Recurrences after Myomectomy: A Retrospective Cohort Study. J Minim Invasive Gynecol 2012. [DOI: 10.1016/j.jmig.2012.08.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dahlman M, Eisenstein D. Residual Endometriosis after Hysterectomy: Robotic Resection with 5mm Instruments. J Minim Invasive Gynecol 2011. [DOI: 10.1016/j.jmig.2011.08.702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Dahlman M, Orady M, Eisenstein D, Nawfal A, Wegienka G. Patient Satisfaction in the Immediate Postoperative Period after Hysterectomy. J Minim Invasive Gynecol 2011. [DOI: 10.1016/j.jmig.2011.08.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Clauw DJ, Williams D, Lauerman W, Dahlman M, Aslami A, Nachemson AL, Kobrine AI, Wiesel SW. Pain sensitivity as a correlate of clinical status in individuals with chronic low back pain. Spine (Phila Pa 1976) 1999; 24:2035-41. [PMID: 10528381 DOI: 10.1097/00007632-199910010-00013] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional study of baseline correlates of clinical pain and functional status in consecutive patients being treated for chronic low back pain. OBJECTIVES To determine if an individual's global pain sensitivity, measured by experimental pain threshold to pressure at various regions of the body, is associated with baseline measures of clinical pain and physical functioning. SUMMARY OF BACKGROUND DATA Previous studies have demonstrated that in individuals with chronic low back pain, clinical pain and functional status are significantly associated with demographic, structural, and psychosocial factors. However, a large portion of variance remains unexplained. Because pain sensitivity (tenderness) has been shown to occur as a continuum in the population, the authors sought to determine if such sensitivity might be associated with clinical status in chronic low back pain, beyond what is known regarding demographic, structural, and psychosocial factors. METHODS Forty-five patients with chronic low back pain were assessed for a variety of demographic, structural, and psychosocial factors, which previously have been shown to contribute to clinical status. In addition, all patients underwent testing for pain tolerance and threshold at various areas of the body. RESULTS Age, degree of structural abnormality observed on magnetic resonance imaging, and depressive symptoms were all significantly correlated with either clinical pain or functional status. Pain sensitivity, the target of this investigation, accounted for significant proportions of variance in functional status and pain, even after controlling for demographic, structural, and psychosocial variables. CONCLUSIONS These pilot data suggest that an individual's experimental pain threshold (a measure of tenderness) is associated with baseline functional status and pain in cases of chronic low back pain and may represent an important domain warranting further investigation.
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Affiliation(s)
- D J Clauw
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
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