Functional disability in paediatric patients with recurrent abdominal pain

Background Recurrent abdominal pain (RAP) is common in childhood, affecting approximately 12% of children and adolescents. Children with RAP tend to experience impairments in functioning, such as increased school absences, anxiety and depression. Methods The current study investigated the potential influences on the relation between functional disability and RAP in 100 school‐aged children. A series of hierarchical regression analyses were conducted to test two models: main effects and moderation of the relation between abdominal pain symptoms, child anxiety, child depression, maternal emotional distress, maternal encouragement of child illness behaviour and functional disability. Results The results indicated support for abdominal pain symptoms and child depression in predicting functional disability. The results also indicated that child anxiety and child depression each moderated the relation between pain symptoms and functional disability. Conclusions Implications of the findings are discussed in terms of potential influences on the development of functional disability in youth.     

功能性腹痛儿童人格特点和父母教养方式评价

【目的】探讨功能性腹痛(functional abdominal pain,FAP)儿童人格特点及父母教养方式,为临床诊治提供参考。【方法】对52例FAP患儿和41例健康儿童,分别进行艾森克人格问卷、父母教养方式问卷调查。对腹痛症状和父母教养方式、艾森克人格各因子进行相关分析。【结果】FAP儿童具有不良的父母教养方式和人格特点。FAP症状积分与教养方式因子F1、M1值及人格因子E值呈显著负相关(P0.05);与教养方式因子F3、M2值及人格因子P、N值呈显著正相关(P0.05)。【结论】儿童FAP与人格个性特点、父母教养方式密切相关     

Psychological factors affecting isokinetic trunk strength testing in patients with work-related chronic low back pain

Psychological factors are assumed to play a major role in pain-related work disability. Assessment of pain-related disability using a functional capacity evaluation, usually includes assessment of trunk strength and range of motion. Isokinetic strength testing is a method used to measure strength and function of isolated muscles and has been reported to be an objective, quantifiable assessment of trunk function. Given that psychological factors are purported to play a role in pain-related disability, it would be important to assess their influence on measurement of physical function. The present study was conducted to assess the influence of psychological variables on isokinetic trunk strength performance. One hundred and eighty-six consecutive male outpatients referred to a work-rehabilitation center were given a functional capacity evaluation. All patients had been out of work for at least 3 months with the chief complaint of low back pain. The evaluation included isokinetic trunk strength testing and measurement of psychological variables (pain levels, distress, pain coping, pain behavior, somatization, expectation to return to work) that have been known to contribute to pain-related disability. Data analyses revealed significant correlations among psychological variables and measures of trunk strength and function. The findings provide support for a relationship between psychological variables and isokinetic strength testing performance.     

Idiopathic pain and depression

This report summarizes research on the hypothesis that idiopathic chronic pain syndromes and depressive disorders share certain common pathogenetic mechanisms. There is increasing evidence that this may be partly true. Not only do chronic pain syndromes respond to treatment with antidepressants, but there are also striking clinical similarities between these syndromes and depressive syndromes. However, important differences do exist (e.g., the courses of these disorders are usually dissimilar). Family studies show that affective disorders are common in first-degree relatives of patients with idiopathic pain syndromes, but it is impossible to conclude from this that clear-cut genetic factors are of importance. Factors common to both syndromes include common personality traits, shortened rapid eye movements in sleep EEG, hypercortisolaemia and pathological dexamethasone suppression tests, low levels of melatonin in serum and urine and high levels of endorphins and Fraction I in cerebro-spinal fluid. One important common pathogenetic mechanism seems to be disturbances in the serotoninergic system.     

Functional restoration for chronic low back pain: Changes in depression,cognitive distortion,and disability

In the present study, 107 patients (72 males and 35 females) completed self-report measures of depression, distortion, disability, and pain intensity at three points during their rehabilitation: (1) admission to a 3-week comprehensive functional restoration program, (2) discharge from the comprehensive phase, and (3) 4–6 weeks later at their first post-program evaluation. Various range-of-motion measures were also collected at these same times using inclinometry. Results demonstrated significant improvements on all measures which were maintained into follow-up. Patients were also subsequently grouped into depressed and non-depressed at admission, and both groups demonstrated significant improvement across time. Additionally, patients were divided into high and low distortion groups. High general cognitive distortion patients did not show improvement on 3 of the 5 range of motion, or pain intensity scores, although they did improve on their depression, distortion, and disability scores. Findings also suggested thatlow back pain-related cognitive distortion may be considered a state or situational factor, whereasgeneral cognitive distortion appears to be more of a trait characteristic.     

Changes in psychopathology following functional restoration of chronic low back pain patients: A prospective study

Past research has consistently demonstrated high rates of psychopathology in patients disabled with chronic low back pain. The purpose of the present study was to evaluate whether functional restoration treatment of these patients would lead to significant changes in psychopathology. Fifty-six patients were evaluated for current psychiatric disorders, using a structured clinical interview for DSM-III-R disorders, upon admission to a comprehensive 3 week functional restoration program, and again at 6 months following their rehabilitation. Results clearly documented significant decreases in prevalence rates of psychiatric disorders, particularly somatoform pain disorder and major depression. Such findings demonstrate that effective rehabilitation can significantly decrease the high rates of psychopathology commonly found in chronic low back pain patients.     

肠易激综合征重叠功能性消化不良患者脑部痛觉区域研究

目的：探讨单纯肠易激综合征与肠易激综合征重叠功能性消化不良患者在直肠容积性刺激下脑部痛觉功能区域的变化差异。方法：连续收集共纳入30例入住医院诊断为单纯肠易激综合征患者（单纯组）及30例肠易激综合征重叠功能性消化不良患者（重叠组）作为病例观察对象,同时随机选择30例健康人作为正常对照组。所有受试者均行直肠容积性刺激,通过功能性磁共振（fMRI）分析直肠扩张50、100、150 mL容积情况下感觉阈值和痛觉评分。结果：单纯组与重叠组初始感觉、排便感觉及疼痛感觉阈值均低于对照组（P均〈0.05）。直肠注气100及150 mL时,单纯组与重叠组疼痛感觉明显高于对照组,差异有统计学意义（P〈0.05）;脑部疼痛区域主要集中于扣带回、岛叶、额前皮质及丘脑。直肠注气50、100、150 mL时,单纯组与重叠组疼痛兴奋面积及MRI信号强度均明显高于对照组,差异有统计学意义（P〈0.05）。结论：在直肠容积性刺激下,肠易激综合征患者存在感觉过敏,虽然其与功能性消化不良有症状的重叠,但重叠功能性消化不良并未影响其敏感性,且脑部痛觉功能区亦无明显叠加表现。     

Chronic pain in the classroom: teachers' attributions about the causes of chronic pain

BACKGROUND: School absenteeism and other impairments in school function are significant problems among children with chronic pain syndromes; yet, little is known about how chronic pain is perceived in the school setting. The purpose of this study was to examine teachers' attributions about the causes of chronic pain in adolescent students. METHODS: Classroom teachers (n = 260) read vignettes describing a hypothetical student with limb pain. They were presented with a list of possible physical and psychological causes for the pain and asked to identify the causes to which they attributed the pain. Vignettes varied by the presence or absence of (1) documented medical evidence for the pain and (2) communication from the medical team. Teachers also responded to questions assessing their responses to the student in terms of support for academic accommodations and sympathy for the student. RESULTS: Teachers tended to endorse a dualistic (ie, either physical or psychological) model for pain rather than a biopsychosocial model. Documented medical evidence supporting the pain was the most influential factor affecting teachers' attributions about chronic pain. Teachers who attributed the pain to physical causes-either in isolation or in combination with psychological causes-responded more positively toward the student. CONCLUSIONS: Many teachers lack a biopsychosocial framework through which to understand chronic pain syndromes in students. How chronic pain is described to school personnel may affect how teachers understand the pain and respond to it.     

Postmastectomy/postlumpectomy pain in breast cancer survivors

Few studies have focused on careful assessment of postmastectomy pain (PMP); a chronic neuropathic pain syndrome that can affect women postlumpectomy or postmastectomy for breast cancer (BC). Study aims were to determine the prevalence of PMP in an outpatient sample of breast cancer survivors (BCS), describe subjective and objective characteristics of PMP, and examine the relationship between PMP and quality of life. Breast cancer survivors (n = 134) participated in telephone interviews, and those reporting PMP (n = 36) were invited to a pain center for further evaluation and treatment. Results show PMP is a distinct, chronic, pain syndrome affecting 27% of BCS. Findings support the need for clinical trials evaluating the effectiveness of nonpharmacological or cognitive behavioral therapies in alleviating mild to moderate PMP.     

Treatment- and cost-effectiveness of early intervention for acute low-back pain patients: a one-year prospective study

In an attempt to prevent acute low-back pain from becoming a chronic disability problem, an earlier study developed a statistical algorithm which accurately identified those acute low-back pain patients who were at high risk for developing such chronicity. The major goal of the present study was to evaluate the clinical effectiveness of employing an early intervention program with these high-risk patients in order to prevent the development of chronic disability at a 1-year follow-up. Approximately 700 acute low-back pain patients were screened for their high-risk versus low-risk status. On the basis of this screening, high-risk patients were then randomly assigned to one of two groups: a functional restoration early intervention group (n = 22), or a nonintervention group (n = 48). A group of low-risk subjects (n = 54) who did not receive any early intervention was also evaluated. All these subjects were prospectively tracked at 3-month intervals starting from the date of their initial evaluation, culminating in a 12-month follow-up. During these follow-up evaluations, pain disability and socioeconomic outcomes (such as return-to-work and healthcare utilization) were assessed. Results clearly indicated that the high-risk subjects who received early intervention displayed statistically significant fewer indices of chronic pain disability on a wide range of work, healthcare utilization, medication use, and self-report pain variables, relative to the high-risk subjects who do not receive such early intervention. In addition, the high-risk nonintervention group displayed significantly more symptoms of chronic pain disability on these variables relative to the initially low-risk subjects. Cost-comparison savings data were also evaluated. These data revealed that there were greater cost savings associated with the early intervention group versus the no early intervention group. The overall results of this study clearly demonstrate the treatment- and cost-effectiveness of an early intervention program for acute low-back pain patients.     

Nurse-based monitoring and management of breakthrough pain in an acute pain relief and palliative care unit

Objectives: To assess the nurses’ performance in assessing, treating, and documenting breakthrough pain (BTP) in a palliative care unit where traditionally there is continuous training.

Methods: The study was performed in an acute palliative care unit. Once a week, a research nurse examined the documentation regarding all the episodes of BTP registered in a specific pain chart, designed by the institutional nurse board, as part of the routine nurse activity.

Results: The charts of 50 consecutive eligible patients (32 M/18 F), were analysed. The mean number of episodes/patient was 3.3 (SD 1.61; range 1–7). 166 episodes occurred. The main BTP pain intensity was 7.06 (SD 0.82). In 7 episodes, pain intensity was not evaluated at T0. The pain intensity after 15 minutes after BTP medication was 3.01 (SD1.19). In 28 episodes, pain intensity was not evaluated at T15. The change in pain intensity was highly significant (P < 0.0005). BTP episodes were distributed normally through different day intervals. No relevant adverse event attributable to BTP medication was reported in the nurse diary.

Conclusion: Training in a research environment allows a good nurse capability in evaluating and treating BTP, and above all, providing documentation for each BTP episode. The theoretical work and recommendations around BTP need to be translated into day-to-day clinical practice.     

Improving acute pain management in emergency medicine

Undertreatment of pain (oligoanalgesia) in the emergency department is common, and it negatively impacts patient care. Both failure of appropriate pain assessment and the potential for unsafe analgesic use contribute to the problem. As a result, achieving satisfactory analgesia while minimizing side effects remains particularly challenging for emergency physicians, both in the emergency department and after a patient is discharged. Improvements in rapid pain assessment and in evaluation of noncommunicative populations may result in a better estimation of which patients require analgesia and how much pain is present. New formulations of available treatments, such as rapidly absorbed, topical, or intranasal nonsteroidal anti-inflammatory drug formulations or intranasal opioids, may provide effective analgesia with an improved risk–benefit profile. Other pharmacological therapies have been shown to be effective for certain pain modalities, such as the use of antidepressants for musculoskeletal pain, γ-aminobutyric acid agonists for neuropathic and postsurgical pain, antipsychotics for headache, and topical capsaicin for neuropathic pain. Nonpharmacological methods of pain control include the use of electrical stimulation, relaxation therapies, psychosocial/manipulative therapies, and acupuncture. Tailoring of available treatment options to specific pain modalities, as well as improvements in pain assessment, treatment options, and formulations, may improve pain control in the emergency department setting and beyond.     

Students' knowledge of pain: a survey of four schools

The purpose of this study was to explore occupational therapy students' understanding of pain. During the 1996–7 academic year, 201 senior entry-level professional students at four universities in the northeastern United States completed a survey testing 10 common myths about assessment of persons with pain. Participants answered true or false to the 10 statements. The mean score was 61% and the number of correct answers ranged from 0% to 100%. Students scored highest in knowing that all pain is ‘real’ (88% correct) and that the patient is the best authority on pain sensation (87% correct). Students made most errors in believing that visible signs validate the existence of pain (42% correct) and that malingering is common (46% correct). This study supports the need for organized efforts to improve pain knowledge among entry-level occupational therapy students. Copyright © 1998 Whurr Publishers Ltd.     

Emergency physicians’ pain judgments: cluster analyses on scenarios of acute abdominal pain

Physicians have been found to give lower ratings of patients’ pain than do the patients themselves. We hypothesized that the physicians’ rating depends not only on the patient’s pain rating but also on other cues. We also hypothesized that these cues influence physicians’ pain treatment and urgency level. We gave to 52 emergency room physicians in Toulouse, France, 45 scenarios describing patients with acute abdominal pain, representing all combinations of 5 levels of patient’s pain rating, 3 levels of behavioral manifestations of pain, and three signs of the severity of the abdominal pathology (namely, the likelihood of appendicitis). The participants rated the patient’s pain, selected the intensity of pain treatment, and judged the degree of urgency of calling in a surgeon. In rating pain, physicians took into account the patient’s rating, behavioral manifestations of pain, and the signs of abdominal pathology. Clusters analyses showed two sets of individual differences. When rating pain and choosing pain treatment, physicians gave either a low or high weight to behavioral pain cues. In urgency judgments, physicians could be separated into those who gave considerable weight to the different levels of severity and those who did not.     

The reliability and validity of a measure of perceived functional capacity for work in chronic back pain

Psychosocial factors, including perceived disability and self-efficacy, are important determinants of outcome for individuals with chronic back pain. Consequently, there is a need for an evaluation and consideration of such factors in occupational rehabilitation. This study evaluated the reliability and validity of a tool, the Spinal Function Sort, as a measure of perceived capacity for work-related tasks with 42 rehabilitation clients with chronic back pain. Results provided support for the internal consistency (Cronbach's alpha of 0.97), test-rest reliability (ICC of 0.89) and construct validity of the Spinal Function Sort as a measure of perceived capacity for work-related tasks in persons with chronic back pain. Measures of similar constructs were significantly correlated with the Spinal Function Sort and were highly predictive of the Spinal Function Sort on multiple regression. Relationships between perceived work capacity and pain intensity and gender are discussed. The need for the consideration of perceived capacity in the evaluation and rehabilitation of persons with chronic back pain is highlighted.     

Exercise for workers with musculoskeletal pain: Does enhancing compliance decrease pain?

A low rate of compliance for exercise regimens is a difficult problem for programs aimed at treating or preventing musculoskeletal pain. In fact, the utility of exercise for common pain problems has been debated since poor compliance confounds proper program evaluation. Thus, the purpose of the present study was to evaluate the effects of a compliance enhancement measure and subsequently to assess the effects of physical activity on pain perception. Forty-eight employees (mean age=42, 20 females) currently working at two companies and who reported musculoskeletal pain, but noexercise habit voluntarily served as subjects. The Comparison Group was provided with information and free membership at a health center. The Exercise Compliance Enhancement Group met individually with a behavioral psychologist, who employed cognitive-behavioral techniques, to plan their activity program. Results showed that the Compliance Enhancement Group had a higher rate of adherence and participated in significantly more exercises over the course of 6 months than did the Comparison Group. However, analyses based on pre- and posttest gain scores showed that the differences between the groups for aerobic capacity and pain intensity were not significant. However, when compilers were compared with noncompliers, those complying with the activity program were found to have improved their aerobic capacity more than noncompliers. Yet for overall pain intensity ratings, the difference between compilers and noncompliers was still not significant. Intensity ratings made immediately before and after exercising indicated that exercise activities were related to a significant increase in pain intensity. These results indicate that compliance for exercise may be significantly improved, but the effect of exercise activities on overall pain intensity was not significant relative to the comparison group.