Treatment Outcomes for Workers Compensation Patients in a US‐Based Interdisciplinary Pain Management Program

Objectives: Assess the efficacy of an outpatient‐based interdisciplinary pain rehabilitation program for patients with active workers compensation claims. Patients: Data were available for 101 patients, primarily with chronic low back pain (75%), who participated in the program. Methods: Treatment included a 4‐week (Monday to Friday), 8‐hours/day graded progressive program that included individual and group therapies (pain psychology, physical therapy, occupational therapy, relaxation training/biofeedback, aerobic conditioning, pool therapy, vocational counseling, patient education and medical management). Outcome measures included program completion status, release‐to‐work status, return‐to‐work status, total scores on the Beck Depression Inventory, State‐Trait Anxiety Inventory, Pain Catastrophizing Scale, and the McGill Pain Questionnaire Visual Analogue Scale (MPQ VAS). The majority of the patients (65%) graduated from the program. Pre‐postoutcome data were available for those who graduated from the program. For noncompleters, last obtained MPQ VAS was compared with their initial MPQ VAS scores. Results: Of those completing the program, most patients (91%)were released to return to work; with 80% released to full‐time status and 11% released to gradual return. Approximately half (49%) of the program completers returned to work. Paired‐samples t‐tests showed that program completers had significant reductions in depression (P = 0.000), pain‐related catastrophizing (P = 0.033), and pain intensity (P = 0.000), but not in anxiety (P = 0.098). Interestingly, the last obtained (at early discharge/withdrawal) pain intensity scores (M = 70.33) were higher than at baseline (M = 61.20) in the noncompleters. This difference was not statistically significant (P = 0.127) but may be clinically meaningful. Discussion: Our results support the efficacy of an outpatient‐based 4‐week interdisciplinary pain rehabilitation program in decreasing emotional distress, reducing pain intensity, and improving return‐to‐work status in the majority of completers in this challenging population. Patients reporting increased pain at discharge or those discharged early may have been due to operant factors.     

Pain assessment: differences in quality and intensity of the words pain, ache and hurt

A study was undertaken to investigate if the concepts pain, ache and hurt differ from each other in intensity and quality and to identify discriminating semantic correlates for each of these concepts. Forty-one nurses with different backgrounds in nursing and 12 patients with chronic pain syndrome were included in the study. The methods used were a questionnaire, the visual analogue scale (VAS), and the McGill Pain Questionnaire (MPQ). There was a statistically significant difference in the intensity of the words pain, ache and hurt on both the VAS and the MPQ. Pain was shown to have the highest intensity, followed by ache with hurt having the lowest. Semantic correlates consisting of sensory and affective words which best discriminate between the concepts pain, ache and hurt were identified. Semantic correlates for pain were: cutting, crushing, tearing, sharp, dreadful, killing, torturing and suffocating: for ache were: aching, pulling, gnawing, irritating, annoying, troublesome, exhausting, unbearable and terrifying; for hurt were: pricking, pinching, stinging, sore, fearful, unhappy.     

Validity and reliability of Turkish version of the Pain Attitudes and Beliefs Scale for Physiotherapists

Abstract

Background: The initial purpose of this study was to perform a linguistic and cultural translation of the Pain Attitudes and Beliefs Scale for Physiotherapists into the Turkish language. Following the translation process the primary purpose of the study was to examine the validity and reliability of the Turkish version of Pain Attitudes and Beliefs Scale for Physiotherapists. Materials and methods: A survey study design was used. The Turkish version of Pain Attitudes and Beliefs Scale for Physiotherapists was developed. A pilot test was performed and a final version was completed. Participants were recruited to examine the reliability and validity of the new instrument. Participants received an online survey package with the PABS-PT-TR and Turkish Version of the Tampa Scale for Kinesiophobia. Results: A total of 51 physiotherapists (response rate 60.7%) completed the PABS-PT-TR and Turkish Version of the Tampa Scale for Kinesiophobia and 28 physiotherapists completed the retest. Factor analysis was conducted to determine the construct of the scale. Two factors emerged: one focused on biomedical orientation and the second on biopsychosocial orientation. The test–retest reliability (ICC) for the biomedical scale was 0.81 (95% CI?=?0.60–0.91) and 0.82 (95% CI?=?0.61–0.91) for the biopsychosocial scale. Internal consistency for the “biomedical” scale was Cronbach’s α?=?0.72 and α?=?0.59 for the biopsychosocial scale. When the relationship between PABS-PT-TR and TSK was investigated, r value was 0.39 (p?<?0.05) indicating fair convergent validity. These results indicated that the PABS-PT-TR shows construct validity. Conclusion: The PABS-PT-TR appears to have good test–retest reliability, acceptable to good internal consistency, and acceptable construct validity.     

Validation of the Short-Form McGill Pain Questionnaire-2 in Younger and Older People With Cancer Pain

Pain is among the most common symptoms of cancer. Because cancer can occur at any age, it is imperative that pain assessment tools are valid for use across the adult lifespan. The Short-Form McGill Pain Questionnaire–2 (SF-MPQ-2) is a valid and reliable tool for the assessment of the multidimensional qualities of pain in people with chronic nonmalignant pain, but its psychometric properties in people with cancer pain and in older versus younger people require investigation. This study evaluated age differences in the validity, reliability, and use of the SF-MPQ-2 in 244 people with advanced cancer and pain. We confirmed the previously reported 4-factor solution in older (≥60 years) and younger (<60 years) patients. Internal consistency reliability and convergent validity were similar across age groups, although the SF-MPQ-2 sensory subscales were correlated with mental health quality of life in older, but not younger, patients. Older and younger patients selected the same words with the same intensity to describe their pain. The most commonly selected words in both age groups were aching, tiring-exhausting, sharp, and dull. These results demonstrate that the SF-MPQ-2 is appropriate for use across the adult lifespan in people with cancer pain.PerspectiveThis study demonstrated that the SF-MPQ-2 is valid for use in older and younger people with advanced cancer and pain. This measure could improve cancer pain assessment across the adult lifespan, which may lead to improved pain management.     

French translation and validation of the “Anterior Knee Pain Scale” (AKPS)

Purpose: To linguistically and cross-culturally translate the Anterior Knee Pain Scale into French and to evaluate the reliability and validity of this translated version of the questionnaire.

Methods: The translation part was performed in six stages, according to international guidelines: (i) two initial translations from English to French; (ii) synthesis of the two translations; (iii) backward translations into the original language; (iv) expert committee to compare the backward translations with the original questionnaire; (v) pre-final version testing and (VI) expert committee appraisal. To validate the French version of the Anterior Knee Pain Scale, we assessed its validity, reliability and floor/ceiling effects. To do this, volunteer patients from the French part of Belgium and from France, with patellofemoral pain were asked to answer the French version of the Anterior Knee Pain Scale at baseline and after 7?days, as well as the generic SF-36 questionnaire.

Results: The Anterior Knee Pain Scale was translated without any major difficulties. A total of 101 subjects aged 34.5?±?11.4?years (58.4% of women) were included in this study. Results indicated an excellent test-retest reliability (Intra-class correlation coefficient (ICC)?=?0.97, 95%CI: 0.96–0.98), a high internal consistency (Cronbach’s alpha = 0.87), a consistent construct validity (high correlations with the SF-36 questionnaire were found with domains related to physical function (r?=?0.80), physical role (r?=?0.70) and pain (r?=?0.64)) and low or moderate correlations with domains related to mental health (r?=?0.26), vitality (r?=?0.32) and social function (r?=?0.41). Moreover, no floor/ceiling effects have been found.

Conclusions: A valid French version of the Anterior Knee Pain Scale is now available and can be used with confidence to better assess the disease burden associated with patellofemoral pain. It was successfully cross-culturally adapted into French.

• Implications for rehabilitation

• The results on psychometric properties of the French Anterior Knee Pain Scale are comparable with six validated versions obtained for the Finnish, the Turkish, the Chinese, the Dutch, the Thai and the Persian populations.

• The French translated version of the Anterior Knee Pain Scale is a reliable and valid instrument for assessing the functional limitations associated with patellofemoral pain.

• The test–retest reliability of the French Anterior Knee Pain Scale was excellent, the internal consistency was high and the construct validity was consistent. There were no floor/ceiling effects.

     

Pain,Perceived Injustice,and Pain Catastrophizing in Chronic Pain Patients in Ireland

Chronic pain is a public health concern affecting 20% to 30% of the population of Western countries. Psychological risk factors can worsen chronic pain patients. Themes of perceived injustice (PI) and pain catastrophizing are related to poor clinical outcomes. Particularly, perceived injustice has not been assessed systematically in patients at their first presentation in chronic pain clinics in Ireland. This study aims to assess the Injustice Experience Questionnaire (IEQ)'s internal consistency in the Irish population, assess PI in patients attending a chronic pain clinic in Ireland using the IEQ, investigate pain catastrophizing through the Pain Catastrophizing Scale (PCS) and its relationship with IEQ scores, and explore their relationships with self‐reported Numeric Pain Rating Scale. One hundred adult patients were randomly selected from those attending the clinic for the first time. Eighty completed the IEQ (mean age 49 years, ranged 22 to 90 years; 59% female). The internal consistency of the IEQ was excellent (Cronbach's alpha = 0.93). Twenty‐six patients (33%) had IEQ scores classified as severe. Patients whose cause of pain was trauma or road traffic accidents were more likely to have clinically severe scores than all other causes of pain (47% vs. 23%, P = 0.03). This has clinical consequences and may have legal implications. Pain catastrophizing scores were strongly correlated with IEQ (r = 0.60, P < 0.001). The correlation between IEQ and the Numeric Pain Rating Scale was weak (r = 0.25, P = 0.048). The results suggest that the IEQ may provide an additional tool to assess psychological contributors in problematic chronic pain patients and to institute targeted therapies to improve clinical outcomes.     

A comparison of response profiles obtained on the McGill Pain Questionnaire and an adjective checklist

The response profiles on the McGill Pain Questionnaire (MPQ) were compared with those obtained from a checklist format, consisting of the 78 MPQ words arranged in random order. Both forms were administered to 3 patient groups: (a) primiparae experiencing post-episiotomy pain (n = 60); (b) outpatients attending a rheumatology clinic wisdom tooth extraction (n = 60); and (c) inpatients having undergone wisdom tooth extraction (n = 60). The order of administration was balanced, so that within each patient group 40 patients received either one of the study forms and 20 both, yielding total sample sizes of 120 and 60 for further statistical analyses. Comparison of numbers of words checked in the two formats showed considerable similarity and so for purposes of further comparison, the MPQ structure was imposed on the checklist. This permitted comparison of summary scores, with no significant differences in mean level, with the sole exception of the evaluative subscale. Comparison of individual subgroup profiles on both forms also showed considerable similarity. A second objective was to compare the format in discriminating between patient groups. It was found that the MPQ offered a higher correct classification rate, although there was little in it, with MPQ subgroup scores rather than subscale scores showing marginally better results.     

Reliability and sensitivity measures of the Greek version of the short form of the McGill Pain Questionnaire.

The translation of existing healthcare measurement scales is considered a feasible, efficient and popular approach to produce internationally comparable measures. The short form of the McGill Pain Questionnaire is one of the most widely used and translated instruments to measure the pain experience. The Greek version of the short form of the McGill Pain Questionnaire (GR-SFMPQ) has recently been developed and demonstrated satisfactory levels of internal consistency.The objective of the present study was to assess the instrument's reliability and sensitivity.Eighty patients with spinal or knee pain were included. The test-retest reliability of the instrument was estimated for measurements within the same day and after 15 days. The sensitivity of the measure was examined before and after the application of a physiotherapy therapeutic regime.The correlation coefficients (Intraclass Correlation Coefficient and Spearman's) ranged from 0.87-0.98 for within-day measurements and from 0.70-0.92 for administrations between days. All indexes of the GR-SFMPQ (total score, sensory and affective scores, total count of used words, visual analogue score, present pain index) managed consistently to detect the changes in pain experienced (p<0.05), after a therapeutic intervention, when assessing for the sensitivity of the questionnaire. An explorative discriminant analysis of the GR-SFMPQ indexes managed to correctly classify up to 85% of the patients; a classification rate comparable to the full version MPQ rating capacity.It can be argued from the results of this study that the Greek version of the SFMPQ fulfils the criteria of reliability and sensitivity to fluctuations of pain and can be utilized with confidence in cross-cultural comparative research trials.     

Efficacy of the Sustained-Release Hydromorphone in Neuropathic Pain Management: Pooled Analysis of Three Open-Label Studies

ABSTRACT

This pooled analysis was designed to determine whether the analgesic response to treatment with OROS® hydromorphone, as measured by the “pain on average” scale of the Brief Pain Inventory (BPI), was different in patients with neuropathic pain compared to those with nociceptive pain, after adjusting for differences in baseline characteristics. Three open-label studies on patients with neuropathic and nociceptive malignant and nonmalignant chronic pain were analyzed. A mixed model for repeated measures linear regression analysis was used to compare the effect of OROS® hydromorphone on patients with neuropathic and nociceptive pain, adjusting for potentially confounding factors. Data from patients with pure neuropathic pain and mixed pain were also compared. Safety and tolerability was assessed by recording the number of adverse events. The primary outcome was “pain on average” (BPI item 5) over time. Secondary outcomes were the effect of OROS® hydromorphone on other BPI items including “pain relief” and “interference with sleep.” Patients with neuropathic pain showed a similar response to treatment with OROS® hydromorphone to those patients with nociceptive pain. There was no statistically significant difference between the pain groups (difference between groups ?0.552 at visit 7; P = .060 for overall difference between groups). For some outcome variables, treatment was more effective for patients with neuropathic pain. The treatment was generally well tolerated. This pooled analysis shows that treatment with OROS® hydromorphone had similar efficacy for neuropathic and nociceptive pain.     

Cognitive appraisal and coping in chronic pain patients

Objectives: This study analyses the relationships between patients’ cognitive appraisals concerning their pain and the coping strategies they use. In addition, the way the coping strategy influences the intensity of perceived pain and impairment in these patients was studied. Methods: One hundred and twenty two patients with musculoskeletal chronic pain participated. The assessment tools were as follows: The Cognitive Appraisal Inventory for Chronic Pain Patients (CAI), the Vanderbilt Pain Management Inventory (VPMI), the McGill Pain Questionnaire (MPQ) and the Impairment and Functioning Inventory for Chronic Pain Patients (IFI). The hypothetical model was empirically tested using the LISREL 8.20 software package and the unweighted least squares method. Results: High levels of challenge appraisal were associated with low levels of passive coping and high levels of active coping strategies, whereas the harm, loss or threat appraisal predicted high use of passive coping strategies. Passive coping had three statistically significant path coefficients: high levels of passive coping were associated with low levels of functioning and high levels of pain intensity and impairment. However, high levels of active coping reported high levels of daily functioning. Discussion: By analysing the cognitive appraisals made by chronic pain patients, clinicians could make better predictions regarding the way they cope and adjust.