Can demographic and anthropometric characteristics predict clinical improvement in patients with chronic non-specific low back pain?

Objective

To identify potential prognostic factors that may predict clinical improvement of patients treated with different physical therapy interventions in the short-term.

Does the number of musculoskeletal pain sites predict work disability? A 14-year prospective study

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.     

Can antiemetics really relieve pain?

The analgesic properties of 2 antiemetic agents—metoclopramide and ondansetron—were investigated in studies which showed that metoclopramide may decrease postoperative opioid requirements, but the analgesic effect of ondansetron is controversial. The postoperative effects of metoclopramide and ondansetron on pain in patients undergoing laminectomy were evaluated. Forty six patients were randomized into 3 groups: group M, which consisted of 15 patients who received intravenous (IV) metoclopramide 0.5 mg 30 minutes before surgery; group O, which consisted of 16 patients who received ondansetron IV 0.1 mg 30 minutes before surgery; and group C, which consisted of 15 patients who received the same volume of saline IV 30 minutes before surgery. The efficacy and duration of analgesia were assessed using a visual analogue scale (VAS) at 0, 0.5, 1, 3, 6, and 24 hours after surgery. Hemodynamic parameters, additional analgesic requirements, and adverse effects were recorded for the study groups. Diclofenac 75 mg was administered intramuscularly as a rescue analgesic during the postoperative period. VAS scores were lower in the metoclopramide group than in the ondansetron and control groups (P < .05, each). The patients in the ondansetron and control groups required much more diclofenac than the patients in the metoclopramide group (P < .05). Metoclopramide administered preoperatively provided postoperative analgesia in patients undergoing elective laminectomy     

Does preoperative anxiety level predict postoperative pain?

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PREOPERATIVE ANXIETY is a common component of the surgical experience, and increased levels of anxiety may alter a patient's surgical course and cause increased postoperative pain.

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A REVIEW OF THE LITERATURE was undertaken to evaluate the presence and significance of any correlation between preoperative anxiety and postoperative pain.

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ALTHOUGH INCONSISTENCY was found in the articles that were reviewed, most of the available evidence revealed a positive correlation between preoperative anxiety and postoperative pain.

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FURTHER STUDIES SHOULD be conducted to establish the correlation between preoperative anxiety and postoperative pain and to determine appropriate nursing interventions. AORN J 85 (March 2007) 589-604. © AORN, Inc, 2007.

     

Can we predict poor recovery from recent-onset nonspecific low back pain? A systematic review

This systematic review of prospective cohort studies investigated the evidence for prognostic factors for poor recovery in recent-onset nonspecific low back pain (NSLBP). Medline, Cinahl, Embase, PsychINFO, and AMED databases were searched and citation tracking was performed. Fifty studies met the inclusion criteria. Bivariate and multivariable prognostic factor/outcome associations were extracted. Two reviewers independently performed data extraction and method quality assessment. Where data were available, odds ratios for bivariate associations were calculated and meta-analysis was performed on comparable prognostic factor/outcome associations. Despite the number of studies that have investigated these prognostic factors, uncertainty remains regarding which factors are associated with particular outcomes, the strength of those associations and the extent of confounding between prognostic factors. This uncertainty is the result of the disparate methods that have been used in these investigations, incomplete and contradictory findings, and an inverse relationship between study quality and the reported strength of these associations. The clinical implication is that the formation of clinically useful predictive models remains dependent on further high-quality research. The research implications are that subsequent studies can use the findings of this review to inform prognostic factor selection, and that prognostic studies would ideally be designed to enhance the capacity for findings to be pooled with those of other studies.     

Does chronic pain predict future psychological distress?

Cross-sectional studies have consistently shown a relationship between chronic widespread pain, the clinical hallmark of fibromyalgia, and psychological distress. These studies cannot distinguish the direction of any causal relationship. Recent population based studies have reported that such pain is predictive of future distress. However, chronic pain is often associated with physical and psychological co-morbid features which may confound this relationship. The aim of this study was to examine the hypothesis that chronic widespread pain increases the risk of future distress after adjusting for the effects of possible confounding factors. A population based survey of 1953 individuals identified subjects' psychological status and whether they satisfied criteria for chronic widespread pain. At baseline co-morbid features of chronic widespread pain, including reporting other somatic symptoms, abnormal illness behaviour, health anxiety, fatigue and low levels of self-care, were measured. All subjects were followed up after 12 months to determine levels of psychological distress. Subjects with chronic widespread pain at baseline were much more likely to be distressed at follow up (OR=4.0, 95% CI (2.5,6.3)). As levels of distress at follow up may simply reflect those at baseline the association was adjusted for baseline levels of distress. Chronic widespread pain was, however, still associated with future distress although the relationship was slightly attenuated (odds ratio, OR=3.0, 95% CI (1.8,5.1)). To examine our main hypothesis a final analysis was undertaken adjusting this association for those co-morbid features assessed at baseline. Following these adjustments chronic widespread pain was no longer significantly associated with future distress (OR=1.5, 95% CI (0.8,2.9)). Chronic widespread pain was associated with increased levels of psychological distress at follow up. However, a more rigorous analysis indicated that the association between baseline pain status with future distress was explained by concomitant features of chronic pain rather than pain per se. These findings indicate that it is those persons with chronic widespread pain in the presence of other physical and psychosocial factors who will become distressed.     

Does pain severity predict stone characteristics or outcomes in emergency department patients with acute renal colic?

ObjectivesAfter initial emergency department (ED) management of acute renal colic, recurrent or ongoing severe pain is the usual pathway to ED revisits, hospitalizations and rescue interventions. If index visit pain severity is associated with stone size or with subsequent failure of conservative management, then it might be useful in identifying patients who would benefit from early definitive imaging or intervention. Our objectives were to determine whether pain severity correlates with stone size, and to evaluate its utility in predicting important outcomes.MethodsWe used administrative data and structured chart review to study all ED patients with CT proven renal colic at six hospitals in two cities over one-year. Triage nurses recorded arrival numeric rating scale (NRS) pain scores. We excluded patients with missing pain assessments and stratified eligible patients into severe (NRS 8–10) and less-severe pain groups. Stone parameters were abstracted from imaging reports, while hospitalizations and interventions were identified in hospital databases. We determined the classification accuracy of pain severity for stones >5mm and used multivariable regression to determine the association of pain severity with 60-day treatment failure, defined by hospitalization or rescue intervention.ResultsWe studied 2206 patients, 68% male, with a mean age of 49 years. Severe pain was 52.0% sensitive and 45.3% specific for larger stones >5mm. After multivariable adjustment, we found a weak negative association (adjusted OR =0.96) between pain severity and stone width. For each unit of increasing pain, the odds of a larger stone fell by 4%. Index visit pain severity was not associated with the need for hospitalization or rescue intervention within 60-days.ConclusionsPain severity is not helpful in predicting stone size or renal colic outcomes. More severe pain does not indicate a larger stone or a worse prognosis.     

The amount of postural change experienced by adolescent computer users developing seated –related upper quadrant musculoskeletal pain

Background

Improved techniques of measuring sitting posture have not led to a more comprehensive understanding of poor posture, nor its association with pain. There is also an evidence gap regarding critical thresholds of sitting postural change over time related to pain production. This paper describes postural angle changes over a 12-month period, and describes the process of placing defensible cut-points in the angle change data, to better understand associations between posture change over time, and onset of upper quadrant musculoskeletal pain (UQMP).

Can complex regional pain syndrome be painless?

While spontaneous and stimulus-evoked pain are the hallmarks of complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy, autonomic abnormalities, motor dysfunction, and trophic changes in the affected limb are additional clinical characteristics distinguishing this syndrome. Even though the exact underlying mechanisms of the syndrome remain obscure, a recent hypothesis suggests that the abnormal response of neural nociceptive tissue plays a major role in the pathogenesis of CRPS via the mechanism known as 'neurogenic inflammation'.The group of patients presented here exhibited all the clinical characteristics of CRPS but had no pain, thereby indicating that ongoing or evoked pain is not a necessary condition for CRPS to be maintained. We suggest the term complex regional painless syndrome to describe this syndrome.