European Journal of Pain
1090-3801
1532-2149
Mỹ
Cơ quản chủ quản: WILEY , Wiley-Blackwell
Lĩnh vực:
Medicine (miscellaneous)Anesthesiology and Pain Medicine
Các bài báo tiêu biểu
Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale Abstract Objectives . To determine the minimal clinically important difference (MCID) of changes in chronic musculoskeletal pain intensity that is most closely associated with improvement on the commonly used and validated measure of the patient's global impression of change (PGIC), and to estimate the dependency of the MCID on the baseline pain scores.Methods . This was a prospective cohort study assessing patient's pain intensity by the numerical rating scale (NRS) at baseline and at the 3 month follow‐up, and by a PGIC questionnaire. A one unit difference at the lowest end of the PGIC (“slightly better”) was used to define MCID as it reflects the minimum and lowest degree of improvement that could be detected. In addition we also calculated the NRS changes best associated with “much better” (two units). In order to characterize the association between specific NRS change scores (raw or percent) and clinically important improvement, the sensitivity and specificity were calculated by the receiver operating characteristic (ROC) method. PGIC was used as an external criterion to distinguish between improved or non‐improved patients.Results . 825 patients with chronic musculoskeletal pain (233 with osteoarthritis of the knee, 86 with osteoarthritis of the hip, 133 with osteoarthritis of the hand, 290 with rheumatoid arthritis and 83 with ankylosing spondylitis) were followed up. A consistent relationship between the change in NRS and the PGIC was observed. On average, a reduction of one point or a reduction of 15.0% in the NRS represented a MCID for the patient. A NRS change score of −2.0 and a percent change score of −33.0% were best associated with the concept of “much better” improvement. For this reason these values can be considered as appropriate cut‐off points for this measure. The clinically significant changes in pain are non‐uniform along the entire NRS. Patients with a high baseline level of pain on the NRS (score of >7 cm), who experienced either a slight improvement or a higher level of response, had absolute raw and percent changes greater that did patients in the lower cohort (score of less than 4 cm).Conclusions . These results are consistent with the recently published findings generated by different methods and support the use of a “much better” improvement on the pain relief as a clinically important outcome. A further confirmation in other patient populations and different chronic pain syndromes will be needed.
Tập 8 Số 4 - Trang 283-291 - 2004
Recommendations on terminology and practice of psychophysical DNIC testing
Tập 14 Số 4 - Trang 339-339 - 2010
The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: A systematic review Abstract Background It has been suggested that health care professional (HCP ) attitudes and beliefs may negatively influence the beliefs of patients with low back pain (LBP ), but this has not been systematically reviewed. This review aimed to investigate the association between HCP attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of this patient population. Methods Electronic databases were systematically searched for all types of studies. Studies were selected by predefined inclusion criteria. Methodological quality was appraised and strength of evidence was determined. Results Seventeen studies from eight countries which investigated the attitudes and beliefs of general practitioners, physiotherapists, chiropractors, rheumatologists, orthopaedic surgeons and other paramedical therapists were included. There is strong evidence that HCP beliefs about back pain are associated with the beliefs of their patients. There is moderate evidence that HCPs with a biomedical orientation or elevated fear avoidance beliefs are more likely to advise patients to limit work and physical activities, and are less likely to adhere to treatment guidelines. There is moderate evidence that HCP attitudes and beliefs are associated with patient education and bed rest recommendations. There is moderate evidence that HCP fear avoidance beliefs are associated with reported sick leave prescription and that a biomedical orientation is not associated with the number of sickness certificates issued for LBP . Conclusion: HCPs need to be aware of the association between their attitudes and beliefs and the attitudes and beliefs and clinical management of their patients with LBP .
Tập 16 Số 1 - Trang 3-17 - 2012
Efficacy of classification‐based cognitive functional therapy in patients with non‐specific chronic low back pain: A randomized controlled trial Abstract Background Non‐specific chronic low back pain disorders have been proven resistant to change, and there is still a lack of clear evidence for one specific treatment intervention being superior to another. Methods This randomized controlled trial aimed to investigate the efficacy of a behavioural approach to management, classification‐based cognitive functional therapy, compared with traditional manual therapy and exercise. Linear mixed models were used to estimate the group differences in treatment effects. Primary outcomes at 12‐month follow‐up were O swestry D isability I ndex and pain intensity, measured with numeric rating scale. Inclusion criteria were as follows: age between 18 and 65 years, diagnosed with non‐specific chronic low back pain for >3 months, localized pain from T 12 to gluteal folds, provoked with postures, movement and activities. O swestry D isability I ndex had to be >14% and pain intensity last 14 days >2/10. A total of 121 patients were randomized to either classification‐based cognitive functional therapy group n = 62) or manual therapy and exercise group (n > = 59). Results The classification‐based cognitive functional therapy group displayed significantly superior outcomes to the manual therapy and exercise group, both statistically (p < 0.001) and clinically. For O swestry D isability I ndex, the classification‐based cognitive functional therapy group improved by 13.7 points, and the manual therapy and exercise group by 5.5 points. For pain intensity, the classification‐based cognitive functional therapy improved by 3.2 points, and the manual therapy and exercise group by 1.5 points. Conclusions The classification‐based cognitive functional therapy produced superior outcomes for non‐specific chronic low back pain compared with traditional manual therapy and exercise.
Tập 17 Số 6 - Trang 916-928 - 2013
Clinical course of non‐specific low back pain: A systematic review of prospective cohort studies set in primary care Abstract Background and objective Non‐specific low back pain is a relatively common and recurrent condition for which at present there is no effective cure. In current guidelines, the prognosis of acute non‐specific back pain is assumed to be favourable, but this assumption is mainly based on return to function. This systematic review investigates the clinical course of pain in patients with non‐specific acute low back pain who seek treatment in primary care. Databases and data treatment Included were prospective studies, with follow‐up of at least 12 months, that studied the prognosis of patients with low back pain for less than 3 months of duration in primary care settings. Proportions of patients still reporting pain during follow‐up were pooled using a random‐effects model. Subgroup analyses were used to identify sources of variation between the results of individual studies. Results A total of 11 studies were eligible for evaluation. In the first 3 months, recovery is observed in 33% of patients, but 1 year after onset, 65% still report pain. Subgroup analysis reveals that the pooled proportion of patients still reporting pain after 1 year was 71% at 12 months for studies that considered total absence of pain as a criterion for recovery versus 57% for studies that used a less stringent definition. The pooled proportion for Australian studies was 41% versus 69% for E uropean or US studies. Conclusions The findings of this review indicate that the assumption that spontaneous recovery occurs in a large majority of patients is not justified. There should be more focus on intensive follow‐up of patients who have not recovered within the first 3 months.
Tập 17 Số 1 - Trang 5-15 - 2013
Are changes in fear‐avoidance beliefs, catastrophizing, and appraisals of control, predictive of changes in chronic low back pain and disability? Abstract Interventions for chronic low back pain (CLBP) often attempt to modify patients' levels of catastrophizing, their fear‐avoidance beliefs, and their appraisals of control. Presumably, these interventions are based on the notion that changes in these cognitive factors are related to changes in measures of adjustment. The aim of the present study was to explore whether changes on these cognitive factors were related to changes in CLBP and disability. Fifty‐four CLBP patients completed a series of self‐report measures prior to beginning a cognitive‐behavioral based intervention and again upon discharge. Change scores (post‐treatment scoreminus pre‐treatment score) were calculated for each of the self‐report measures. The study found that changes in the cognitive factors were not significantly associated with changes in pain intensity. In contrast, reductions in fear‐avoidance beliefs about work and physical activity, as well as increased perceptions of control over pain were uniquely related to reductions in disability, even after controlling for reductions in pain intensity, age and sex. The final model explained 71% of the variance in reductions in disability.
Tập 8 Số 3 - Trang 201-210 - 2004
Processes of change in treatment for chronic pain: The contributions of pain, acceptance, and catastrophizing Abstract Cognitive‐behavioral therapy has a substantial evidence base with regard to its effectiveness for individuals with chronic pain. Historically, although there has been some investigation in to the processes by which treatment succeeds or fails, few data are available regarding the unique contributions of processes from distinct cognitive behavioral approaches and how these processes may interact to affect patient functioning. The present investigation sought to evaluate three proposed process variables that have garnered empirical support within chronic pain settings, namely: pain intensity, catastrophizing, and acceptance. Participants were 252 consecutive patients who completed treatment on an interdisciplinary pain management unit. Using multiple regression, the contributions of changes in process variables to changes in treatment outcomes were assessed. In general, changes in both acceptance and catastrophizing accounted for significant variance independent of, and larger than, that accounted for by change in pain intensity. Changes in acceptance and catastrophizing accounted for roughly equivalent amounts of variance when entered immediately following changes in pain, and when entered following one another. The potential impact of these results is discussed in relation to the particular treatment delivered. Issues relating to change at the level of frequency or content of psychological experiences are considered relative to change in the functions of these experiences.
Tập 11 Số 7 - Trang 779-787 - 2007
Brain changes associated with cognitive and emotional factors in chronic pain: A systematic review Abstract An emerging technique in chronic pain research is MRI , which has led to the understanding that chronic pain patients display brain structure and function alterations. Many of these altered brain regions and networks are not just involved in pain processing, but also in other sensory and particularly cognitive tasks. Therefore, the next step is to investigate the relation between brain alterations and pain related cognitive and emotional factors. This review aims at providing an overview of the existing literature on this subject. Pubmed, Web of Science and Embase were searched for original research reports. Twenty eight eligible papers were included, with information on the association of brain alterations with pain catastrophizing, fear‐avoidance, anxiety and depressive symptoms. Methodological quality of eligible papers was checked by two independent researchers. Evidence on the direction of these associations is inconclusive. Pain catastrophizing is related to brain areas involved in pain processing, attention to pain, emotion and motor activity, and to reduced top‐down pain inhibition. In contrast to pain catastrophizing, evidence on anxiety and depressive symptoms shows no clear association with brain characteristics. However, all included cognitive or emotional factors showed significant associations with resting state fMRI data, providing that even at rest the brain reserves a certain activity for these pain‐related factors. Brain changes associated with illness perceptions, pain attention, attitudes and beliefs seem to receive less attention in literature. Significance This review shows that maladaptive cognitive and emotional factors are associated with several brain regions involved in chronic pain. Targeting these factors in these patients might normalize specific brain alterations.
Tập 21 Số 5 - Trang 769-786 - 2017
Somatosensory perception and function of diffuse noxious inhibitory controls (DNIC) in patients suffering from rheumatoid arthritis The purpose was to investigate the influence of ongoing pain from an inflammatory nociceptive pain with two different disease durations on somatosensory functions and the effect of heterotopic noxious conditioning stimulation (HNCS) on ‘diffuse noxious inhibitory controls’ (DNIC) related mechanisms. Eleven patients with rheumatoid arthritis of a short duration (< 1 year) (RAI), and 10 patients with rheumatoid arthritis of longer duration (>5 years) (RA5) as well as 21 age‐and sex‐matched healthy controls participated. Pressure pain sensitivity, low threshold mechanoreceptive function and thermal sensitivity, including thermal pain, were assessed over a painful and inflamed joint as well as in a pain‐free area, i.e. the right thigh before HNCS (cold‐pressor test) and repeated at the thigh only during and following HNCS. In RAI and RA5 allodynia to pressure was seen over the joint (p < 0.02 and p < 0.001 respectively) in conjunction with hypoaesthesia to light touch (p < 0.02) and hyperaesthesia to innocuous cold (p < 0.05) in RA5. At the thigh, allodynia to pressure was found in RA5 (p < 0.002). During HNCS, the sensitivity to pressure pain decreased in patients and controls alike (p < 0.001). In conclusion, over an inflamed joint allodynia to pressure was found in both RA groups, with additional sensory abnormalities in RA5. In a non‐painful area, allodynia to pressure was found in RA5, suggesting altered central processing of somatosensory functions in RA5 patients. The response to HNCS was similar in both RA groups and controls, indicating preserved function of DNIC‐related mechanisms. © 2002 European Federation of Chapters of the International Association for the Study of Pain
Tập 6 Số 2 - Trang 161-176 - 2002
Does the number of musculoskeletal pain sites predict work disability? A 14‐year prospective study ABSTRACT Various risk factors associated with disability pensioning have been reported. This study investigated the relationship between the number of pain sites and risk of receiving a disability pension. We hypothesised that risk of work disability would increase as the number of pain sites increased, even after controlling for potential confounders. In 1990 and 2004, questionnaire on musculoskeletal pain was sent via post to six age groups in Ullensaker, Norway. Data on demographic, health and work‐related variables were also collected. After excluding individuals due to reach retirement age in 2004, we followed 1354 (66%) persons who were classified in 1990 as “employed”, “unemployed”, “homemaker”, or “student”. Among them, 176 persons had received long‐term or permanent work disability pension in 2004. Bivariate analyses showed that the prevalence of disability pensions was strongly associated with the number of pain sites. Controlling for gender and age almost unaltered the relationship. However, a model controlling for all significant confounders showed that general health and sick leave previous year captured almost all the predictive power of the number of pain sites on work disability. Since these variables could be seen as intermediate variables and not confounders, they were excluded in a new model which gave a strong “dose–response” relationship between number of pain sites and disability with a 10‐fold increase from 0 to 9–10 pain sites. The predictive validity of the number of pain sites in determining future disability renders this simple measurement useful for future research on musculoskeletal pain and functioning.
Tập 13 Số 4 - Trang 426-430 - 2009