The present study investigated whether the conceptualization of hip and knee osteoarthritis pain implicit in the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Medical Outcomes Study Short-Form 36 (SF-36) scales is complete, or whether the addition of another scale, such as the Short-Form McGill Pain Questionnaire (MPQ-SF), provides a more complete characterization. Furthermore, the impact that mental health symptoms and catastrophizing had on these scales was investigated.
Before hip and knee arthroplasty, 200 patients completed surveys of demographic data, the WOMAC pain scale, the MPQ-SF, the SF-36 Bodily Pain scale, the Pain Catastrophizing Scale and the Hospital Anxiety and Depression Scale. Correlations between scales were calculated and linear regression modelling was used to determine the impact of mental health and catastrophizing on these three pain measures.
A strong correlation between the WOMAC and SF-36 pain scales (r=−0.70) was found; however, both correlated only moderately with the MPQ-SF (r=0.36 and r=−0.36, respectively). Linear regression modelling showed that the Pain Catastrophizing Scale significantly predicted a greater score on all three pain scales (P<0.05).
The addition of the MPQ-SF appears to add to a more complete quantification of the pain experience in hip and knee osteoarthritis.
Arthroplasty; Catastrophizing; Mental health; Osteoarthritis; Pain
The Short Form McGill Pain Questionnaire (SF-MPQ) is an abbreviated version of McGill Pain Questionnaire (MPQ) developed for pragmatic reasons to improve the clinical utility of the MPQ. Although the SF-MPQ has been used in more than 250 published studies, few studies have examined the core constructs it measures. The objective of this study was to evaluate in a sample with burn injuries whether the factor structure of the SF-MPQ is consistent with the theoretic pain constructs it purports to measure. Participants (n = 338) met American Burn Association's criteria for major burn injury and had a mean total body surface area burned of 14%. They were mostly male (70.1%) and Caucasian (63.4%) with an average age of 41.25 years. There were 2 primary findings. First, confirmatory factor analysis yielded fit index values demonstrating viability of a 2-factor, oblique, solution composed of sensory and affective latent constructs. These findings were consistent with previous work and the theoretic constructs. Second, results from a relatively new model consisting of 8 SF-MPQ items demonstrated potential viability for measuring similar constructs.
Objective. To examine inter-relationships among arthritis (A), work (W) and personal life (P) roles and their reciprocal influences, especially experiences of role balance/imbalance among individuals with inflammatory arthritis (IA) and OA.
Methods. Eight focus groups were conducted with 24 women and 16 men (aged 29–72 years). A purposive sample was recruited from community advertising. Eligibility included current employment or having been employed within the previous year. Participants were asked about ways arthritis, work and personal life roles intersected and their impact. A standardized questionnaire collected demographic, symptom and employment data for descriptive purposes.
Results. Participants noted that having arthritis affected their identity and intersected with work and personal roles, creating role overload, role conflict, role strain and role facilitation. Role overload highlighted that arthritis both affected and was impacted by work and personal life (A → W; A → P; W → A; P → A). Role conflict focused on A → W and A → P difficulties, whereas role facilitation emphasized the positive impact of work and personal life roles on arthritis (W → A; P → A). Role strain was pervasive and arose from numerous sources. Personal strategies (e.g. positive framing) and contextual factors (e.g. support) were important in contributing to or ameliorating role balance/imbalance.
Conclusions. By comprehensively examining multiple types of role balance/imbalance and the context within which it occurs, this study identifies gaps in patient-oriented measurement of the impact of arthritis and areas of need in the development of arthritis intervention.
arthritis; employment; participation; work–family conflict; role overload; role conflict; role strain; role facilitation
The present study examined the association between positive traits, pain catastrophizing, and pain perceptions. We hypothesized that pain catastrophizing would mediate the relationship between positive traits and pain. First, participants (n = 114) completed the Trait Hope Scale, the Life Orientation Test- Revised, and the Pain Catastrophizing Scale. Participants then completed the experimental pain stimulus, a cold pressor task, by submerging their hand in a circulating water bath (0º Celsius) for as long as tolerable. Immediately following the task, participants completed the Short-Form McGill Pain Questionnaire (MPQ-SF). Pearson correlation found associations between hope and pain catastrophizing (r = −.41, p < .01) and MPQ-SF scores (r = −.20, p < .05). Optimism was significantly associated with pain catastrophizing (r = −.44, p < .01) and MPQ-SF scores (r = −.19, p < .05). Bootstrapping, a non-parametric resampling procedure, tested for mediation and supported our hypothesis that pain catastrophizing mediated the relationship between positive traits and MPQ-SF pain report. To our knowledge, this investigation is the first to establish that the protective link between positive traits and experimental pain operates through lower pain catastrophizing.
Gender-based differences in pain epidemiology, pain threshold, attitudes toward pain management, coping styles and social roles are well described, yet little is known about the chronic pain experience in women or the role race plays. A retrospective analysis of self-reported data using a secondary clinical database was performed to elucidate the relationship between race and pain severity, depression, physical disability, posttraumatic stress disorder (PTSD) as well as affective distress in women with chronic pain. White (n=1,088) and black (n=104) adult women were compared based on their responses to the McGill Pain Questionnaire, Beck Depression Inventory, Pain Disability Index, Posttraumatic Chronic Pain Test and items from the West-Haven Yale Multidisciplinary Pain Inventory. After accounting for sociodemographic, medical, psychological and physical confounders, there was no significant race effect for pain severity or affective distress. However, black women with chronic pain experience more physical impairments than white women with chronic pain (beta = 4.622; p<0.005). Except for the family/home responsibilities, similar differences were found on all PDI subscales. We also found that disability mediates the race-depression relationship such that black women are comparatively more vulnerable to depression as a result of higher disability. Due to the economic, social and emotional impact that disability has on women with chronic pain and their families, these findings have significant implications for chronic pain research as well as its management in black women.
The Short Form McGill Pain Questionnaire (SF-MPQ) is one of the most widely used instruments to assess pain. The aim of this study was to translate and culturally adapt the questionnaire for Farsi (the official language of Iran) speakers in order to test its reliability and sensitivity.
We followed Guillemin's guidelines for cross-cultural adaption of health-related measures, which include forward-backward translations, expert committee meetings, and face validity testing in a pilot group. Subsequently, the questionnaire was administered to a sample of 100 diverse chronic pain patients attending a tertiary pain and rehabilitation clinic. In order to evaluate test-retest reliability, patients completed the questionnaire in the morning and early evening of their first visit. Finally, patients were asked to complete the questionnaire for the third time after completing a standardized treatment protocol three weeks later. Intraclass correlation coefficient (ICC) was used to evaluate reliability. We used principle component analysis to assess construct validity.
Ninety-two subjects completed the questionnaire both in the morning and in the evening of the first visit (test-retest reliability), and after three weeks (sensitivity to change). Eight patients who did not finish treatment protocol were excluded from the study. Internal consistency was found by Cronbach's alpha to be 0.951, 0.832 and 0.840 for sensory, affective and total scores respectively. ICC resulted in 0.906 for sensory, 0.712 for affective and 0.912 for total pain score. Item to subscale score correlations supported the convergent validity of each item to its hypothesized subscale. Correlations were observed to range from r2 = 0.202 to r2 = 0.739. Sensitivity or responsiveness was evaluated by pair t-test, which exhibited a significant difference between pre- and post-treatment scores (p < 0.001).
The results of this study indicate that the Iranian version of the SF-MPQ is a reliable questionnaire and responsive to changes in the subscale and total pain scores in Persian chronic pain patients over time.
Short Form McGill Pain Questionnaire; Iranian version; Pain assessment; Reliability; Construct validity
Catastrophizing is reliably associated with increased reports of clinical and experimental pain. To test the hypothesis that catastrophizing may heighten pain experience by increasing nociceptive transmission through spinal gating mechanisms, the present study examined catastrophizing as a predictor of pain ratings and nociceptive flexion reflex (NFR) thresholds in 88 young adult men (n = 47) and women (n = 41). The NFR threshold was defined as the intensity of electrocutaneous sural nerve stimulation required to elicit a withdrawal response from the biceps femoris muscle of the ipsilateral leg. Participants completed an assessment of their NFR threshold and then provided pain ratings using both a numerical rating scale (NRS) and the short-form McGill pain questionnaire (SF-MPQ). Pain catastrophizing was assessed using the catastrophizing subscale of the coping strategies questionnaire (CSQ). Although catastrophizing was positively related to both NRS and SF-MPQ pain ratings, catastrophizing was not significantly related to NFR threshold. These findings suggest that differential modulation of spinal nociceptive input may not account for the relationship between catastrophizing and increased pain.
Pain; Nociceptive flexion reflex; Catastrophizing
Post-mastectomy pain syndrome (PMPS) is a recognised complication of breast surgery although little is known about the long-term outcome of this chronic pain condition. In 1996, Smith et al identified a prevalence rate of PMPS of 43% among 408 women in the Grampian Region, Northeast Scotland. The aim of this study was to assess long-term outcome at 7–12 years postoperatively in this cohort of women, to describe the natural history of PMPS and impact of pain upon quality of life. Chronic pain and quality of life were assessed using the McGill Pain Questionnaire (MPQ) and Short Form-36 (SF-36). Of 175 women reporting PMPS in 1996, 138 were eligible for questionnaire follow-up in 2002. Mean time since surgery was 9 years (s.d. 1.8 years). A response rate of 82% (113 out of 138) was achieved; 59 out of 113 (52%) women reported continued PMPS and 54 out of 113 (48%) women reported their PMPS had resolved since the previous survey in 1996. Quality of life scores were significantly lower in women with persistent PMPS compared to those women whose pain had resolved. However, for women with persistent PMPS, SF-36 scores had improved over time. Risk factors for persistent PMPS included younger age and heavier weight. This study found that, of women reporting PMPS in 1996, half of those surveyed in 2002 continued to experience PMPS at a mean of 9 years after surgery.
breast cancer; mastectomy; post mastectomy pain; chronic pain
Preclinical evidence indicates that gene transfer to the dorsal root ganglion (DRG) using replication defective herpes simplex virus (HSV)-based vectors can reduce pain-related behavior in animal models of pain. This clinical trial was carried out to assess the safety and explore the potential efficacy of this approach in humans.
We conducted a multicenter, dose-escalation, Phase I clinical trial of NP2, a replication defective HSV-based vector expressing human preproenkephalin (PENK) in subjects with intractable focal pain caused by cancer. NP2 was injected intradermally into the dermatome(s) corresponding to the radicular distribution of pain. The primary outcome was safety. As secondary measures, efficacy of pain relief was assessed using a numeric rating scale (NRS), the Short Form McGill Pain Questionnaire (SF-MPQ) and concurrent opiate usage.
Ten subjects with moderate to severe intractable pain despite treatment with more than 200 mg/day of morphine (or equivalent) were enrolled into the study. Treatment was well tolerated with no study agent-related serious adverse events (SAE) observed at any point in the study. Subjects receiving the low dose of NP2 reported no substantive change in pain. Subjects in the middle and high dose cohorts reported pain relief as assessed by NRS and SF-MPQ.
Treatment of intractable pain with NP2 was well tolerated. There were no placebo controls in this relatively small study, but the dose-responsive analgesic effects suggest that NP2 may be effective in reducing pain and warrants further clinical investigation.
Our understanding of the effects of football code participation on low back pain (LBP) is limited. It is unclear whether LBP is more prevalent in athletic populations or differs between levels of competition. Thus it was the aim of this study to document and compare the prevalence, intensity, quality and frequency of LBP between elite and semi-elite male Australian football code participants and a non-athletic group.
A cross-sectional survey of elite and semi-elite male Australian football code participants and a non-athletic group was performed. Participants completed a self-reported questionnaire incorporating the Quadruple Visual Analogue Scale (QVAS) and McGill Pain Questionnaire (short form) (MPQ-SF), along with additional questions adapted from an Australian epidemiological study. Respondents were 271 elite players (mean age 23.3, range 17–39), 360 semi-elite players (mean age 23.8, range 16–46) and 148 non-athletic controls (mean age 23.9, range 18–39).
Groups were matched for age (p = 0.42) and experienced the same age of first onset LBP (p = 0.40). A significant linear increase in LBP from the non-athletic group, to the semi-elite and elite groups for the QVAS and the MPQ-SF was evident (p < 0.001). Elite subjects were more likely to experience more frequent (daily or weekly OR 1.77, 95% CI 1.29–2.42) and severe LBP (discomforting and greater OR 1.75, 95% CI 1.29–2.38).
Foolers in Australia have significantly more severe and frequent LBP than a non-athletic group and this escalates with level of competition.
Most research and treatment of post-breast cancer chronic pain has focused on local or regional pain problems in the operated area. The purpose of this pilot study was to compare and contrast the pain characteristics, symptom impact, health status, and quality of life of post-breast cancer surgery women with regional chronic pain versus those with widespread chronic pain.
A cross-sectional, descriptive design compared two groups of women with chronic pain that began after surgery: regional pain (n = 11) and widespread pain (n = 12). Demographics, characteristics of the surgery, as well as standardized questionnaires that measured pain (Brief Pain Inventory (BPI), Short Form McGill Pain Questionnaire (MPQ-SF)), disease impact (Fibromyalgia Impact Questionnaire (FIQ), Functional Assessment of Cancer Therapy-Breast (FACT-B)), health status (Medical Outcomes Short Form (SF-36)) and quality of life (Quality of Life Scale (QOLS)) were gathered.
There were no significant differences between the groups on any demographic or type of surgery variable. A majority of both groups described their pain as aching, tender, and sharp on the MPQ-SF. On the BPI, intensity of pain and pain interference were significantly higher in the widespread pain group. Differences between the two groups reached statistical significance on the FIQ total score as well as the FACT-B physical well-being, emotional well-being and breast concerns subscales. The SF-36 physical function, physical role, and body pain subscales were significantly lower in the widespread pain group. QOLS scores were lower in the widespread pain group, but did not reach statistical significance.
This preliminary work suggests that the women in this study who experienced widespread pain after breast cancer surgery had significantly more severity of pain, pain impact and lower physical health status than those with regional pain.
In older adults, major depressive disorder (MDD) and chronic low back pain (CLBP) are common and mutually exacerbating. We predicted that duloxetine pharmacotherapy and Depression and Pain Care Management (DPCM) would result in (1) significant improvement in MDD and CLBP and (2) significant improvements in health-related quality of life, anxiety, disability, self-efficacy, and sleep quality.
Design and Intervention:
Twelve week open-label study using duloxetine up to 120 mg/day + DPCM.
Outpatient late-life depression research clinic.
Thirty community-dwelling adults >60 years old.
Montgomery Asberg Depression Rating Scale (MADRS) and McGill Pain Questionnaire-Short Form (MPQ-SF).
46.7% (n = 14) of the sample had a depression remission. All subjects who met criteria for the depression remission also had a pain response. 93.3% (n = 28) had a significant pain response. Of the subjects who met criteria for a low back pain response, 50% (n = 14) also met criteria for the depression remission. The mean time to depression remission was 7.6 (SE = 0.6) weeks. The mean time to pain response was 2.8 (SE = 0.5) weeks. There were significant improvements in mental health-related quality of life, anxiety, sleep quality, somatic complaints, and both self-efficacy for pain management and for coping with symptoms. Physical health-related quality of life, back pain-related disability, and self-efficacy for physical functioning did not improve.
Serotonin and norepinephrine reuptake inhibitors like duloxetine delivered with DPCM may be a good choice to treat these linked conditions in older adults. Treatments that target low self-efficacy for physical function and improving disability may further increase response rates.
depression; pain; geriatric; back pain; clinical trial
The qualities of chronic neuropathic pain (NeP) may be informative about the different mechanisms of pain. We previously developed a 2-factor model of NeP that described an underlying structure among sensory descriptors on the Short-Form McGill Pain Questionnaire (SF-MPQ). The goal of this study was to confirm the correlated 2-factor model of NeP. Individual descriptive scores from the SF-MPQ were analyzed. Confirmatory factor analysis (CFA) was used to test a correlated 2-factor model. Factor 1 (stabbing pain) was characterized by high loadings on stabbing, sharp, and shooting sensory items; factor 2 (heavy pain) was characterized by high loadings on heavy, gnawing, and aching items. Results of the CFA strongly supported the correlated 2-factor model.
Diabetic peripheral neuropathy; neuropathic pain; postherpetic neuralgia; confirmatory factor analysis; regularized regression; pain qualities
Orthopaedic procedures have been reported to have the highest incidence of pain compared to other types of operations. There are limited studies in the literature that investigate postoperative pain.
Materials and Methods
A prospective study of 98 patients undergoing orthopedic foot and ankle operations was undertaken to evaluate their pain experience. A Short-Form McGill Pain Questionnaire (SF-MPQ) was administered preoperatively and postoperatively.
The results showed that patients who experienced pain before the operation anticipated feeling higher pain intensity immediately postoperatively. Patients, on average, experienced higher pain intensity 3 days after the operation than anticipated. The postoperative pain intensity at 3 days was the most severe, while postoperative pain intensity at 6 weeks was the least severe. Age, gender and preoperative diagnosis (acute versus chronic) did not have a significant effect on the severity of pain that patients experienced. Six weeks following the operation, the majority of patients felt no pain. In addition, the severity of preoperative pain was highly predictive of their anticipated postoperative pain and 6-week postoperative pain, and both preoperative pain and anticipated pain predict higher immediate postoperative pain.
The intensity of patients' preoperative pain was predictive of the anticipated postoperative pain. Patients' preoperative pain and anticipated postoperative pain were independently predictive of the 3-day postoperative pain. The higher pain intensity a patient experienced preoperatively suggested that their postoperative pain severity would be greater. Therefore, surgeons should be aware of these findings when treating postoperative pain after orthopaedic foot and ankle operations.
Postoperative Pain; Pain Expectations; Foot and Ankle Surgery; SF-MPQ; Short-Form McGill Pain Questionnaire; Longitudinal Pain Study
Oral sodium channel blockers have shown mixed results in randomized controlled trials despite the known importance of sodium channels in generating pain. We hypothesized that differing baseline pain qualities (e.g. “stabbing” vs “dull”) might define specific subgroups responsive to intravenous (IV) lidocaine—a potent sodium channel blocker.
A prospective cohort study of 71 patient with chronic pain suspected of being neuropathic were recruited between January 2003 and July 2007 and underwent lidocaine infusions at Stanford University Hospital in a single-blind nonrandomized fashion. Baseline sensory pain qualities were measured with the Short-Form McGill Pain Questionnaire (SF-MPQ). Pain intensity was measured with a visual analog scale (VAS).
Factor analysis demonstrated two underlying pain quality factors among SF-MPQ sensory items: a heavy pain and a stabbing pain. Baseline heavy pain quality, but not stabbing quality predicted subsequent relief of pain intensity in response to lidocaine. In contrast, these factors did not predict divergent analgesic responses to placebo infusions. In response to each 1 mcg/mL increase in lidocaine plasma level, patients with high heavy pain quality drop their VAS 0.24 (95% CI 0.05–0.43) more points than those with low heavy pain quality (P < 0.013).
“Heavy” pain quality may indentify patients with enhanced lidocaine responsiveness. Pain quality may identify subgroups among patients with suspected neuropathic pain responsive to IV lidocaine. Further investigation is warranted to validate and extend these findings.
Lidocaine; Pain; Neuropathic Pain; Pain Quality; Sodium Channel Blockade; Intravenous Lidocaine; McGill Pain Questionnaire; Factor Analysis
First published in 1975, the McGill Pain Questionnaire (MPQ) is an often cited pain measure but there have been no systematic reviews of the MPQ in cancer populations. The objective is to evaluate the MPQ as a multidimensional measure of pain in people with cancer. A systematic search of research that used the MPQ in adults with cancer and published in English from 1975 to 2009 was conducted. Twenty-one articles retrieved through computerized searches and nine studies from manual searches met the criteria. Review of the 30 studies demonstrated that pain intensity (n=29 studies) and pain quality (n=27 studies) were measured more frequently than pain location, pattern, and behavior parameters. Measuring cancer pain using the MPQ provided insights about disease sites, magnitude of pain and the effectiveness of treatment and intervention. Additionally, the MPQ data informed speculations about pain mechanisms, emotional status, overall sensory pain experience, changes in pain over time, and alleviating and aggravating behaviors/factors. Findings supported that the MPQ was an effective multidimensional measure with good stability, content, construct, and criterion validity and showed sensitivity to treatment or known-group effects. The MPQ is a valid, reliable, and sensitive multidimensional measure of cancer pain. Cancer pain is a subjective, complex experience consisting of multiple dimensions, and measuring cancer pain with the MPQ may help clinicians to more fully understand if those dimensions of cancer pain influence each other. As a result, clinicians can provide better and effective cancer pain management.
McGill Pain Questionnaire; Multidimensional Measure; Cancer; Pain; Pain scoring; Conceptualization
To examine changes in the association between pain and patient quality of life (QoL), depressive symptoms, and disability in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) at varying levels of spouse responses to pain.
One-hundred and eighty-eight men with CP/CPPS completed a questionnaire including demographic information. The outcome variables were mental QoL (SF-12 MCS), physical QoL (SF-12 PCS), depressive symptoms (Center for Epidemiological Studies Depression Scale), and disability (Pain Disability Index). Patients also reported on the types of responses they experienced from their spouses (Multidimensional Pain Inventory), and pain (Short-Form McGill Pain Questionnaire).
The association between pain and disability was stronger at higher levels of solicitous responses (e.g., “does some of my chores) (β = 0.66, p<.05) than it was at moderate (β = 0.44, p<.05) and lower (β = 0.23, ns) levels. In contrast, the association between pain and disability was stronger at lower levels (β = 0.64, p<.05) of distracting responses (e.g., “tries to get me involved in some activity”) than it was at moderate (β = 0.44, p<.05) and higher (β = 0.25, p<.05) levels.
Solicitous responses to pain increased the negative impact of pain on disability, while distracting responses to pain decreased the negative impact of pain on disability in men with CP/CPPS. Solicitous responses may be a reaction to patient pain and associated disability, or may help create or maintain the patient’s pain and disability. In either case, distracting rather than solicitous responses to patient pain are to be encouraged in symptom management.
chronic prostatitis/chronic pelvic pain syndrome; spousal responses to pain behavior; disability
Eccentric overload training seems to be a promising conservative intervention in patients with chronic Achilles tendinopathy. The efficacy of eccentric overload training on the outcome measures of pain and physical functioning are not exactly clear.
Systematic review of the literature.
Electronic databases were searched for randomised clinical trials concerning eccentric overload training in patients with chronic Achilles tendinopathy. The Delphi list was used to assess the methodological quality of the studies.
Nine clinical trials were included. Only one study had sufficient methodological quality. The included trials showed an improvement in pain after eccentric overload training. Because of the methodological shortcomings of the trials, no definite conclusion can be drawn concerning the effects of eccentric overload training in patients with chronic Achilles tendinopathy.
The effects of eccentric exercise training in patients with chronic Achilles tendinopathy on pain are promising; however, the magnitude of the effects cannot be determined. Large, methodologically sound studies from multiple sites in which functional outcome measures are included are warranted.
Back pain is commonly classified based on duration. There is currently limited information regarding differences in the clinical features of back pain between these duration-based groupings. Here, we compared the pain characteristics of patients with subacute (SBP; pain 6–16 weeks, n = 40) and chronic back pain (CBP; pain ≥ 1year, n = 37) recruited from the general population. CBP patients reported significantly higher pain intensity on the Visual Analogue Scale (VAS) compared to SBP patients. Based on this finding, we investigated group differences and their dependence on VAS for the Beck Depression Inventory (BDI), sensory and affective dimensions of the McGill Pain Questionnaire (MPQ-S and MPQ-A), Neuropathic Pain Scale (NPS) and the variability of spontaneous pain. Correction for VAS abolished significant group differences on the MPQ-S, MPQ-A and NPS. Only a significant difference in the variability of spontaneous pain was independent of VAS. Finally, whereas SBP patients displayed a higher incidence of unilateral pain radiating down the legs/buttocks, there was a shift towards more bilateral pain in CBP patients. In summary, SBP and CBP groups differ on three independent parameters: VAS ratings, pain location and temporal dynamics of spontaneous pain.
Low Back Pain; Chronic Back Pain (CBP); Subacute Back Pain (SBP); Pain Intensity; Visual Analogue Scale (VAS); McGill Pain Questionnaire (MPQ); Fractal Dimension
Specific pulsed electromagnetic fields (PEMFs) have been shown to induce analgesia (antinociception) in snails, rodents and healthy human volunteers.
The effect of specific PEMF exposure on pain and anxiety ratings was investigated in two patient populations.
A double-blind, randomized, placebo-controlled parallel design was used.
The present study investigated the effects of an acute 30 min magnetic field exposure (less than or equal to 400 μTpk; less than 3 kHz) on pain (McGill Pain Questionnaire [MPQ], visual analogue scale [VAS]) and anxiety (VAS) ratings in female rheumatoid arthritis (RA) (n=13; mean age 52 years) and fibromyalgia (FM) patients (n=18; mean age 51 years) who received either the PEMF or sham exposure treatment.
A repeated measures analysis revealed a significant pre-post-testing by condition interaction for the MPQ Pain Rating Index total for the RA patients, F(1,11)=5.09, P<0.05, estimate of effect size = 0.32, power = 0.54. A significant pre-post-effect for the same variable was present for the FM patients, F(1,15=16.2, P<0.01, estimate of effect size = 0.52, power =0.96. Similar findings were found for MPQ subcomponents and the VAS (pain). There was no significant reduction in VAS anxiety ratings pre- to post-exposure for either the RA or FM patients.
These findings provide some initial support for the use of PEMF exposure in reducing pain in chronic pain populations and warrants continued investigation into the use of PEMF exposure for short-term pain relief.
Analgesia; Fibromyalgia; Pain therapy; Pulsed electromagnetic fields; Rheumatoid arthritis
Pain is the primary indication for both primary and revision total knee arthroplasty (TKA); however, most arthroplasty outcome measures do not take pain into account.
To document the prospective pain experience following TKA, with subjective pain-specific questionnaires to determine if comorbidities, preoperative pain or preoperative pain catastrophizing scores are predictive of long-term pain outcomes.
Fifty-five patients with a primary diagnosis of osteoarthritis of the knee, who were scheduled to undergo TKA, were asked to fill out the McGill Pain Questionnaire (MPQ) and the Pain Catastrophizing Scale (PCS) preoperatively and at three, 12 and 24 months follow-up. Comorbidities were extracted from the Queen Elizabeth II Health Sciences Centre health information system.
The overall response rate (return of completed questionnaires) was 84%. There was a significant decrease in the MPQ scores (P<0.05) postoperatively. PCS scores did not change over time. Receiver operating characteristic curves revealed the number of comorbidities per patient predicted the presence of pain postoperatively, as documented by the numerical rating subscale of the MPQ at 24 months (P<0.05). Receiver operating characteristic curves for pre-operative PCS and rumination subscale scores predicted the presence of pain, as measured by the Pain Rating Index subscale of the MPQ at 24 months (P<0.05). Preoperative PCS scores and comorbidities were significantly higher in the persistent pain group (P<0.05).
The number of comorbidities predicted the presence of pain at 24 months follow-up and, for the first time, preoperative PCS scores were shown to predict chronic postoperative pain. This may enable the identification of knee arthroplasty patients at risk for persistent postoperative pain, thus allowing for efficient administration of preoperative interventions to improve arthroplasty outcomes.
Catastrophizing; Comorbidity; Helplessness; Knee; Osteoarthritis; Outcomes; Pain; Rumination; Surgery; Total knee arthroplasty
Chronic low back pain (CLBP) in older adults may be disabling and therapeutically challenging, largely because of the inefficacy and/or morbidity associated with traditional pain treatment. We conducted a randomized controlled trial in 200 men and women ≥ age 65 with CLBP to evaluate the efficacy of percutaneous electrical nerve stimulation (PENS) with and without general conditioning and aerobic exercise (GCAE), for reducing pain and improving physical function. Participants were randomized to receive 1) PENS, 2) control-PENS (brief electrical stimulation to control for treatment expectancy), 3) PENS + GCAE, or 4) control-PENS + GCAE, twice a week for 6 weeks. All four groups experienced significantly reduced pain (range −2.3 to −4.1 on the McGill Pain Questionnaire short form), improved self-reported disability (range −2.1 to −3.0 on Roland scale) and improved gait velocity (0.04–0.07 m/sec), sustained at 6 months. The GCAE groups experienced significantly fewer fear avoidance beliefs immediately post-intervention and at 6 months than non-GCAE groups. There were no significant side effects. Since brief electrical stimulation (i.e., control-PENS) facilitated comparably reduced pain and improved function at 6 months as compared with PENS, the exact dose of electrical stimulation required for analgesia cannot be determined. GCAE was more effective than PENS alone in reducing fear avoidance beliefs, but not in reducing pain or improving physical function.
Early reports often ignored pain as an important symptom in multiple sclerosis (MS). Pain prevalence figures in MS from European countries other than Portugal range between 40 and 65%. To our knowledge there is no published data in English on pain in MS in Portugal. We describe the demographic and clinical characteristics, with an emphasis on pain, of 85 MS patients followed-up in a Portuguese hospital, contributing to pain epidemiology in MS. Patients were interviewed sequentially after their regular appointments at the MS clinic; patients with pain completed The Brief Pain Inventory and The McGill Pain Questionnaire (MPQ). The prevalence of pain found was 34%. Headache and back pain were the most common anatomical sites described, followed by upper and lower limbs. Intensity of pain in an 11-point scale was, for the maximum pain intensity 6.7 ± 1.8, for the minimum pain intensity 2.2 ± 2.0, for the mean pain intensity 4.5 ± 1.5, and for the actual pain intensity 2.4 ± 2.9. Pain interfered significantly with general activity, mood, work, social relations, and enjoyment of life. All MS patients with pain employed words from both the sensory and affective categories of the MPQ to describe it. Patient pain descriptions’ included the word “hot-burning” in 59% of the cases, common in the report of central pain, but neuropathic pain medications were only used by 10% of them. Pain is an important symptom in Portuguese patients with MS, not only because of the high prevalence found, concordant with other European countries, but also because of its interference with quality-of-life.
multiple sclerosis; pain; quality-of-life; epidemiology; Europe
Compare pain-related measures and psychosocial variables between glutamate-evoked jaw muscle pain in healthy subjects (HS) and patients with persistent myofascial temporomandibular disorder (TMD) pain.
47 female HS and 10 female patients with persistent myofascial TMD pain participated. The HS received an injection of glutamate into the masseter muscle to model persistent myofascial TMD pain. Participants filled out a coping strategies questionnaire (CSQ), the symptom checklist 90 (SCL-90) and McGill Pain Questionnaire (MPQ). Pain intensity was assessed on an electronic visual analog scale (VAS). Pain-drawing areas, Numerical Rating Scale (NRS) scores of unpleasantness, pressure pain thresholds (PPT) and tolerance (PPTOL) were measured. Unpaired t-tests and correlation tests were used for analyses.
The groups were significantly different when comparing the CSQ scores of control, decrease, diverting attention, increase of behavioral activities and somatization. The peak VAS pain, NRS of unpleasantness and MPQ scores were not significantly different between groups, but PPT and PPTOL were significantly lower in the TMD patients. Significant positive correlations were found in the TMD patients between peak VAS pain and CSQ catastrophizing score and SCL-90 somatization. The scores of PPTs and PPTOLs, in patients showed positive correlations with CSQ reinterpreting pain sensations scores and PPTs correlated with CSQ praying/hoping scores.
Glutamate-evoked pain responses in HS and persistent myofascial TMD pain have similar sensory-discriminative and affective-unpleasantness components but differ in psycho-social features. This study suggests that experimental designs based on glutamate injection into muscle can provide an appropriate model for elucidating persistent myofascial pain conditions.
Orofacial pain; temporomandibular disorders; muscle pain; glutamate; trigeminal physiology; coping strategies questionnaire; catastrophizing; experimental muscle pain model
To conduct a prospective study to determine the efficacy of self-management interventions, amitriptyline, and amitriptyline plus topical triamcinolone in reducing vulvar pain in women with vulvodynia.
This was a randomized, prospective study of 53 women between the ages of 18 and 72 with vulvodynia. Participants undertook one of three treatment interventions for a period of 12 weeks: self-management, oral amitriptyline (10–20 mg/day), or topical triamcinolone plus oral amitriptyline (10–20 mg/day). The McGill Pain Questionnaire (MPQ) was used to measure changes in qualitative pain using the pain rating index (PRI) and in quantitative pain using the present pain intensity (PPI) scale.
Of the 53 randomized subjects, 43 completed the trial. There were no statistically significant differences in PRI or PPI scores among the three treatment groups. Significant within-group differences were observed in the self-management group on the PRI and in the amitriptyline group on the PPI.
This first randomized, prospective trial suggests that self-management has a modest effect and that low-dose amitriptyline (with and without topical triamcinolone) is not effective in reducing pain in women with vulvodynia.