Pain in persons with postpolio syndrome: frequency, intensity, and impact

Stoelb BL, Carter GT, Abresch RT, Purekal S, McDonald CM, Jensen MP. Pain in persons with postpolio syndrome: frequency, intensity, and impact.

Objective

To describe the frequency, intensity, and impact of pain in persons with postpoliomyelitis syndrome (PPS).

Design

Retrospective, cross-sectional survey.

Setting

Community-based survey.

Participants

Convenience sample of people with PPS.

Interventions

Not applicable.

Main Outcome Measures

Overall intensity and duration of pain, pain sites, pain interference, pain treatments, and relief provided by pain treatments.

Results

A total of 91% (n=57) of the study participants (N=63) reported pain. The most frequently reported pain sites were the shoulders, lower back, legs, and hips. Participants reported pain intensity to be the greatest in the knees, legs, wrists, lower back, and head. Pain interfered most with sleep and with activities requiring a high level of musculoskeletal involvement. Respondents also reported pain problems that were more severe than those of the general population and than those of a sample of people with multiple sclerosis. Many treatments had been tried previously for pain, but continued use of treatments was reported by relatively few participants at the time of the survey.

Conclusions

The findings indicate that pain is a persistent and common problem in persons with PPS, highlighting the need for effective and accessible pain treatments for this population.     

Smoking among veterans with multiple sclerosis: prevalence correlates, quit attempts, and unmet need for services

Turner AP, Kivlahan DR, Kazis LE, Haselkorn JK. Smoking among veterans with multiple sclerosis: prevalence, correlates, quit attempts, and unmet need for services.

Objective

To describe the prevalence and correlates of smoking as well as quit attempts and unmet need for smoking cessation services in a national sample of veterans with multiple sclerosis (MS).

Design

Cross-sectional cohort study linking computerized medical record information to mailed survey data from 1999.

Setting

Veterans Health Administration (VHA).

Participants

Sixty-four percent (2994/4685) of veterans with MS who received services in VHA and also returned survey questionnaires, as well as a 20% random subsample (n=569) who completed a more extensive assessment of smoking.

Interventions

Not applicable.

Main Outcome Measures

Items assessing smoking, quit attempts, and unmet need for smoking services.

Results

Among all survey respondents with MS, 28.5% (95% confidence interval [CI], 26.9-30.2) endorsed current smoking. Of extended survey respondents, 54.5% (95% CI, 46.6-62.1) reported a quit attempt in the past year, and 59.0% (95% CI, 51.1-66.4) reported not getting needed services for smoking in the past year. In fully adjusted logistic regression, smoking was associated with younger age, lower levels of education, being unmarried, higher levels of physical pain, and poorer mental health. A quit attempt was associated with higher levels of education and greater pain intensity.

Conclusions

Smoking among veterans with MS is common, with rates similar to those for other veterans. There is substantial need for cessation services. Cessation interventions should address correlates of smoking including pain, poorer mental health, and social isolation.     

Illness and demographic correlates of chronic pain among a community-based sample of people with multiple sclerosis

Douglas C, Wollin JA, Windsor C. Illness and demographic correlates of chronic pain among a community-based sample of people with multiple sclerosis.

Objective

To investigate the prevalence, nature, and correlates of pain among a community-based sample with multiple sclerosis (MS).

Design

A cross-sectional survey and structured pain interview.

Setting

Community.

Participants

People with MS (N=219) recruited through systematic sampling from a randomly ordered MS society membership database.

Interventions

Not applicable.

Main Outcome Measures

Pain presence or absence, pain intensity (numeric rating scales), pain quality (McGill Pain Questionnaire), pain location(s) and extent (pain drawing), pain duration and frequency, provoking and relieving pain factors, and pain management techniques.

Results

Pain was common with some 67.1% of the sample reporting pain during the 2 weeks preceding the study. Comprehensive pain assessment revealed that a substantial subset of these subjects experience chronic pain conditions characterized by moderate-to-severe pain intensity. Among those with pain, 75% reported pain in 3 or more locations, with participants reporting an average of 4.0±1.8 distinct pain sites. Women and people with more severe MS-related disability were significantly more likely to report both the presence of pain and greater pain intensity. In contrast, being in a married or in a de facto relationship and longer time since MS diagnosis were significantly associated with lower pain intensity.

Conclusions

Given the high prevalence and nature of pain experienced by people with MS, health care providers need to approach pain with a priority similar to that given to other MS-related problems such as mobility and functional independence. Women and people with more severe MS-related disability appear to be at particular risk for significant pain problems and therefore these groups warrant particular attention, such that routine clinical assessment should trigger routine pain assessment.     

Exercise and Quality of Life Among People With Multiple Sclerosis: Looking Beyond Physical Functioning to Mental Health and Participation in Life

Turner AP, Kivlahan DR, Haselkorn JK. Exercise and quality of life among people with multiple sclerosis: looking beyond physical functioning to mental health and participation in life.

Objective

To describe the prevalence of exercise in a national sample of veterans with multiple sclerosis (MS) and the association of exercise with quality of life, including physical health, mental health, and participation restriction.

Design

Cross-sectional cohort study linking computerized medical records to mailed survey data from 1999.

Setting

Veterans Health Administration.

Participants

Veterans with MS (N=2995; 86.5% men) who received services in the Veterans Health Administration and returned survey questionnaires.

Interventions

Not applicable.

Main Outcome Measures

Demographic information, Veteran RAND 36-Item Health Survey (VR-36), self-reported exercise frequency.

Results

Among all survey respondents with MS, only 28.6% (95% confidence interval, 26.9-30.2) endorsed any exercise. In adjusted logistic regression, exercise was associated with younger age, more education, living alone, lower levels of bodily pain, and higher body mass index. After adjusting for demographic variables and medical comorbidities, exercise was associated with better physical and mental health. People who exercised reported they had better social functioning and better role functioning (participation in life despite physical and emotional difficulties).

Conclusions

Exercise in veterans with MS is uncommon. In the context of chronic illness care, the identification of exercise patterns and promotion of physical activity may represent an important opportunity to improve mental health and quality of life among people with MS. Intervention should address factors associated with lower rates of exercise including age, education, and pain.     

Outcomes of a nurse-initiated intravenous analgesic protocol for abdominal pain in an emergency department: A quasi-experimental study

Background

Abdominal pain is one of the most frequent reasons for seeking care in an emergency department. Surveys have shown that patients are not satisfied with the pain management they receive. Reasons for giving inadequate pain management may include poor knowledge about pain assessment, myths concerning pain, lack of communication between the patient and healthcare professional, and organizational limitations.

Objectives

The aim of the study was to investigate the outcome of nursing assessment, pain assessment and nurse-initiated intravenous opioid analgesic compared to standard procedure for patients seeking emergency care for abdominal pain. Outcome measures were: (a) pain intensity, (b) frequency of received analgesic, (c) time to analgesic, (d) transit time, and (e) patients’ perceptions of the quality of care in pain management.

Design

A quasi-experimental design with ABA phases was used.

Setting

The study was conducted in an emergency department at a Swedish university hospital.

Participants

Patients with abdominal pain seeking care in the emergency department were invited to participate. A total of 50, 100 and 50 patients, respectively, were included for the three phases of the study. The inclusion criteria were: ongoing abdominal pain not lasting for more than 2 days, ≥18 years of age and oriented to person, place and time. Exclusion criteria were: abdominal pain due to trauma, in need of immediate care and pain intensity scored as 9-10.

Methods

The patients’ perceptions of the quality of care in pain management in the emergency department were evaluated by means of a patient questionnaire carried out in the three study phases. The intervention phase included education, nursing assessment protocol and a range order for analgesic.

Results

The nursing assessment and the nurse-initiated intravenous opioid analgesic resulted in significant improvement in frequency of receiving analgesic and a reduction in time to analgesic. Patients perceived lower pain intensity and improved quality of care in pain management.

Conclusions

The intervention improved the pain management in the emergency department. A structured nursing assessment could also affect the patients’ perceptions of the quality of care in pain management in the emergency department.     

The effectiveness of a multidisciplinary pain management programme managing chronic pain on pain perceptions, health-related quality of life and stages of change—A non-randomized controlled study

Background

Cognitive behavioural therapy (CBT) has been useful in the treatment of chronic pain conditions for many years. Given the increasing number of persons with chronic pain and associated psychosocial problems, the development and implementation of effective interventions based on CBT is warranted.

Objectives

The aim of this study is to evaluate the effects of a multidisciplinary pain management programme on health-related quality of life (HRQL), as measured by the Short Form Health Survey (SF-36), pain perception as measured by the Brief Pain Inventory (BPI), and readiness-to-change as measured by the Pain Stages of Change Questionnaire (PSOCQ).

Design

A pretest-post-test quasi-experimental design, with waiting list controls and baseline and post-test measures, was used.

Setting

The study was conducted in the rehabilitation unit of a university hospital.

Participants

Of 117 people suffering from chronic pain, 113 completed the 8-week multidisciplinary pain management programme. The patients were consecutive referrals. Inclusion criteria were: adults (18-67 years), pain lasting over 6 months, motivation and no ongoing litigation. Exclusion criteria were affected by major mental disorders or major medical conditions requiring treatment.

Methods

The intervention was based on a cognitive behavioural approach. Therapeutic dialogues and training, combined with physical activity, were provided to a fixed plan, including homework. The programme has several features that directly address psychosocial aspects of chronic pain. Statistical and clinical significance are considered.

Results

The findings suggest that this programme has the potential to improve HRQL, reduce pain intensity and interference, and contribute to improvement in readiness-to-change. Statistically significant results are supplemented by results showing their clinical significance.

Conclusions

Improvements in HRQL, pain-related disability, and readiness-to-change suggest that the vicious cycle of chronic pain may be alleviated by our programme. As we see it, effective treatment results are about identifying and addressing the important and changeable influences maintaining pain problems such as acceptance, understanding the mind-body connection and self-management. Although further research is needed to evaluate the effectiveness of this work, such group approaches appear to represent a feasible treatment option for many patients with chronic pain.     

Prognosis of Limitations in Activities in Osteoarthritis of the Hip or Knee: A 3-Year Cohort Study

van Dijk GM, Veenhof C, Spreeuwenberg P, Coene N, Burger BJ, van Schaardenburg D, van den Ende CH, Lankhorst GJ, Dekker J, on behalf of the CARPA Study Group. Prognosis of limitations in activities in osteoarthritis of the hip or knee: a 3-year cohort study.

Objective

To describe the course of limitations in activities in elderly patients with osteoarthritis (OA) of the hip or knee over a follow-up period of 3 years, and to identify prognostic factors of the course of limitations in activities, focusing on body functions, comorbidity, and cognitive functioning.

Design

A longitudinal cohort study with 3 years of follow-up. Measurements were conducted annually. Statistical analyses included t tests, univariate regression analyses, and multivariate regression analyses.

Setting

Rehabilitation centers and hospitals (Departments of Orthopedics, Rheumatology, and Rehabilitation) in The Netherlands.

Participants

Patients (N=237) with hip or knee OA.

Interventions

Not applicable.

Main Outcome Measures

Patient-perceived change, self-reported limitations in activities measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and observed limitations in activities (timed walking test). Prognostic factors: demographic data, clinical data, body function (pain, muscle strength, range of motion [ROM]), comorbidity, and cognitive functioning (cognitive decline, memory, attention).

Results

Self-reported limitations in activities measured by the WOMAC improved slightly after 3-year follow-up. In knee OA, reduced ROM at 1-year follow-up (β=.120), increased pain at 1-year follow-up (β=−.177), and higher morbidity count (β=−.180) predicted worsening of self-reported limitations in activities. In hip OA, reduced ROM at 1-year follow-up (β=.201 for hip external rotation and β=.144 for knee extension), increased pain at 1-year follow-up (β=−.134), higher morbidity count (β=−.220), or the presence of moderate to severe cardiac disease (β=−.214) and poorer cognitive functioning (β=.181) predicted worsening of self-reported limitations in activities. Performance-based limitations in activities measured by the timed walking test did not change after 3 years of follow-up. In knee OA, decreased muscle strength at 1-year follow-up (β=−.272) and higher morbidity count (β=.199) predicted worsening of performance-based limitations in activities. In hip OA, better ROM (β=.182), higher morbidity count (β=.232), or the presence of moderate to severe cardiac and eye-ear-nose-throat disease (β=.210 and β=.188, respectively) and older age (β=.355) predicted worsening of performance-based limitations in activities.

Conclusions

Overall, at the group level, limitations in activities of patients with OA of the hip or knee recruited from hospitals and rehabilitation centers seem fairly stable during the first 3 years of follow-up. However, at the level of individual patients, considerable variation occurs. Prognostic factors for worsening of limitations in activities include increased pain, reduced ROM, and decreased muscle strength at 1-year follow-up; higher morbidity count; and to a lesser extent poor cognitive functioning.     

Functional limitations and depression after traumatic brain injury: examination of the temporal relationship

Pagulayan KF, Hoffman JM, Temkin NR, Machamer JE, Dikmen SS. Functional limitations and depression after traumatic brain injury: examination of the temporal relationship.

Objective

To examine the temporal relationship between self-reported injury-related functional limitations and depressive symptomatology after traumatic brain injury (TBI).

Design

A longitudinal cohort study with 3 evaluation points.

Setting

A level I trauma center.

Participants

Adolescents and adults (N=135) with complicated mild to severe TBI (72% had complicated mild injuries) who were recruited within 24 hours of injury and then completed the measure at all 3 time points.

Interventions

Not applicable.

Main Outcome Measures

Sickness Impact Profile and Center for Epidemiological Studies−Depression Scale.

Results

Individuals who reported more depressive symptomatology consistently endorsed more injury-related difficulties, showing the strong relationship between depression and perceived psychosocial functioning. Examination of these relationships over time revealed that increased depressive symptomatology follows higher levels of perceived injury-related changes but that reports of injury-related changes are not associated with earlier depression. These findings suggest a unidirectional temporal relationship between these variables.

Conclusions

Perceived changes in daily functioning appear to influence emotional well-being over time after TBI. However, depressive symptoms do not appear to negatively impact individuals' perception of later functioning. These results further our understanding of the complicated relationship between these variables and may have important implications for treatment of depression after TBI.     

Relationship of Preinjury Caregiver and Family Functioning to Community Integration in Adults With Traumatic Brain Injury

Sady MD, Sander AM, Clark AN, Sherer M, Nakase-Richardson R, Malec JF. Relationship of preinjury caregiver and family functioning to community integration in adults with traumatic brain injury.

Objective

To investigate the relationship of preinjury caregiver and family functioning to community integration outcomes in persons with traumatic brain injury (TBI).

Design

Inception cohort.

Setting

Three TBI Model Systems inpatient rehabilitation facilities.

Participants

Persons with TBI (N=141) and their caregivers admitted to inpatient rehabilitation and followed up at 1 to 2 years after injury.

Interventions

Not applicable.

Main Outcome Measures

Community Integration Questionnaire and the Social and Occupation scales of the Craig Handicap Assessment and Reporting Technique.

Results

There were significant interactions of several preinjury caregiver and family variables with injury severity. For persons with complicated mild/moderate injury, better family functioning was associated with greater home integration, and less caregiver distress was associated with better social integration. For persons with severe injuries, greater caregiver perceived social support was associated with better outcomes in productivity and social integration.

Conclusions

Preinjury caregiver and family characteristics interact with injury severity to affect outcomes in persons with injury. Research on outcomes should include measures of caregiver and family functioning. Early interventions targeted toward decreasing caregiver distress, increasing support, and improving family functioning may have a positive impact on later outcomes.     

Clinical Outcomes for Patients Classified by Fear-Avoidance Beliefs and Centralization Phenomenon

Werneke MW, Hart DL, George SZ, Stratford PW, Matheson JW, Reyes A. Clinical outcomes for patients classified by fear-avoidance beliefs and centralization phenomenon.

Objectives

To (1) determine the prevalence of pain pattern classification subgroups (centralization, noncentralization, and not classified) observed during the initial evaluation of patients experiencing high versus low Fear-Avoidance Beliefs Questionnaire for physical activity (FABQ-PA) scores, (2) examine the association between discharge pain intensity and functional status (FS) outcomes based on FABQ-PA and pain pattern subgroups, and (3) compare minimal clinically important improvement for FS and pain intensity for FABQ-PA and pain pattern classification subgroups.

Design

Observational cohort design.

Setting

Suburban hospital-based outpatient rehabilitation clinic.

Participants

Consecutive patients with low back syndromes (N=238, mean ± SD, 59.1±17.0y; minimum=20, maximum=91).

Interventions

Interventions were designed to match patient classification by fear-avoidance level and pain pattern.

Main Outcome Measures

Two outcome measures were assessed: patient self-reported FS and pain intensity. FS was assessed by using computerized adaptive testing methods. Maximal pain intensity was assessed by using an 11-point numeric pain scale: 0 (no pain) to 10 (worst imaginable pain).

Results

There were no differences (χ₂²=3.7, P=.16) in proportion of patients classified by pain pattern experiencing high or low fear-avoidance beliefs. After controlling for the effect of available risk-adjustment variables, only dual-level classification subgroups, symptom acuity, payer type, and intake FS or pain intensity were associated with discharge FS or pain outcomes. The highest proportion of patients achieving minimal clinically important improvement in pain and FS were reported by the following patient subgroup: centralization and low fear.

Conclusions

Pain pattern and FABQ-PA characteristics impacted rehabilitation outcomes. We recommend that both factors be considered when managing patients with low back pain in an effort to optimize rehabilitation outcomes.     

The Immediate Effects of Mobilization Technique on Pain and Range of Motion in Patients Presenting With Unilateral Neck Pain: A Randomized Controlled Trial

Kanlayanaphotporn R, Chiradejnant A, Vachalathiti R. The immediate effects of mobilization technique on pain and range of motion in patients presenting with unilateral neck pain: a randomized controlled trial.

Objective

To determine the immediate effects on both pain and active range of motion (ROM) of the unilateral posteroanterior (PA) mobilization technique on the painful side in mechanical neck pain patients presenting with unilateral symptoms.

Design

Triple-blind, randomized controlled trial.

Setting

Outpatient physical therapy, institutional clinic.

Participants

Patients (N=60), 2 physical therapists, and 1 assessor involved in this study.

Interventions

The patients were randomly allocated into either preferred or random mobilization group by using an opaque concealed envelope. The first therapist performed the screening, assessing, prescribing the spinal level(s), and the grade of mobilization. The second therapist performed the mobilization treatment according to their allocated group stated in an envelope. The assessor who was blind to the group allocation conducted the measurements of pain and active cervical ROM.

Main Outcome Measures

Pain intensity, active cervical ROM, and global perceived effect were measured at baseline and 5 minutes posttreatment.

Results

After mobilization, there were no apparent differences in pain and active cervical ROM between groups. However, within-group changes showed significant decreases in neck pain at rest and pain on most painful movement (P<0.001) with a significant increase in active cervical ROM after mobilization on most painful movement (P=0.002).

Conclusions

The results of this study did not provide support for the preference of the unilateral PA mobilization on the painful side to the random mobilization.     

The effectiveness of progressively increasing stimulation frequency and intensity to maintain paralyzed muscle force during repetitive activation in persons with spinal cord injury

Chou L-W, Lee SC, Johnston TE, Binder-Macleod SA. The effectiveness of progressively increasing stimulation frequency and intensity to maintain paralyzed muscle force during repetitive activation in persons with spinal cord injury.

Objective

To compare the effectiveness of progressively increasing stimulation intensity, progressively increasing frequency, or progressively increasing both frequency and intensity on paralyzed quadriceps femoris muscle force maintenance during repetitive activation.

Design

Factorial design with different stimulation protocols as independent variables.

Setting

A muscle performance laboratory.

Participants

People (N=8) with spinal cord injury (SCI) (age, 14.63±1.77y).

Interventions

Not applicable.

Main Outcome Measure

Number of contractions when the peak force was 90% or more of a subject's maximal twitch force.

Results

The protocol involving progressively increasing stimulation intensity and then frequency generated more successful contractions (189.88±53.33) than progressively increasing the frequency followed by intensity (122.75±26.56 contractions). Regardless of the order, progressively increasing both intensity and frequency generated more successful contractions than progressively increasing intensity (97 contractions) or frequency (62 contractions) alone.

Conclusions

Our findings suggest that during repetitive electric activation, progressively increasing both stimulation frequency and intensity can produce more successful contractions than progressively increasing only frequency or intensity. These findings can help researchers and clinicians design more effective stimulation protocols for persons with SCI during functional electric stimulation applications.     

Pain, depression, and fatigue as a symptom cluster in advanced cancer

Context

Pain, depression, and fatigue are common symptoms in cancer populations. They often coexist and have been suggested as a specific symptom cluster. Systemic inflammation (SI) may be a possible common mechanism.

Objective

This study examined whether pain, depression, and fatigue exist as a symptom cluster in advanced cancer patients with cachexia and might be related to the presence of SI.

Methods

Secondary data analysis was undertaken of two clinical trials in patients with cancer cachexia (n = 654). Pain, depression, and fatigue were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. Plasma C-reactive protein (CRP) was measured as a marker of SI in a subgroup (n = 436). Multivariate analysis and a series of regression analyses were undertaken relating pain, depression, fatigue, and CRP.

Results

Pain, depression, and fatigue clustered, with between two and four times as many patients having all three symptoms as would be expected if the symptoms only coexist by chance (P < 0.001). CRP was not related to the symptom cluster. There was a strong relationship between the pattern of symptoms and physical functioning (P < 0.001).

Conclusion

Pain, depression, and fatigue is an identifiable symptom cluster in a cohort of cachexic cancer patients and is associated with reduced physical functioning.     

Differences in Feedforward Trunk Muscle Activity in Subgroups of Patients With Mechanical Low Back Pain

Silfies SP, Mehta R, Smith SS, Karduna AR. Differences in feedforward trunk muscle activity in subgroups of patients with mechanical low back pain.

Objective

To investigate alterations in trunk muscle timing patterns in subgroups of patients with mechanical low back pain (MLBP). Our hypothesis was that subjects with MLBP would demonstrate delayed muscle onset and have fewer muscles functioning in a feedforward manner than the control group. We further hypothesized that we would find differences between subgroups of our patients with MLBP, grouped according to diagnosis (segmental instability and noninstability).

Design

Case-control.

Setting

Laboratory.

Participants

Forty-three patients with chronic MLBP (25 instability, 18 noninstability) and 39 asymptomatic controls.

Interventions

Not applicable.

Main Outcome Measures

Surface electromyography was used to measure onset time of 10 trunk muscles during a self-perturbation task. Trunk muscle onset latency relative to the anterior deltoid was calculated and the number of muscles functioning in feedforward determined.

Results

Activation timing patterns (P<.01; η=.50; 1-β=.99) and number of muscles functioning in feedforward (P=.02; η=.30; 1-β=.83) were statistically different between patients with MLBP and controls. The control group activated the external oblique, lumbar multifidus, and erector spinae muscles in a feedforward manner. The heterogeneous MLBP group did not activate the trunk musculature in feedforward, but responded with significantly delayed activations. MLBP subgroups demonstrated significantly different timing patterns. The noninstability MLBP subgroup activated trunk extensors in a feedforward manner, similar to the control group, but significantly earlier than the instability subgroup.

Conclusions

Lack of feedforward activation of selected trunk musculature in patients with MLBP may result in a period of inefficient muscular stabilization. Activation timing was more impaired in the instability than the noninstability MLBP subgroup. Training specifically for recruitment timing may be an important component of the rehabilitation program.     

Neutral functional realignment orthosis prevents hand pain in patients with subacute stroke: a randomized trial

Bürge E, Kupper D, Finckh A, Ryerson S, Schnider A, Leemann B. Neutral functional realignment orthosis prevents hand pain in patients with subacute stroke: a randomized trial.

Objective

To quantify the preventive effect of a neutral functional realignment orthosis on pain, mobility, and edema of the hand in subacute hemiparetic poststroke patients with severe motor deficits.

Design

Randomized trial.

Setting

Rehabilitation center.

Participants

Poststroke patients (N=30) with subacute hemiparesis and severe deficits of the upper limb were enrolled. Fifteen patients were randomized to a standard rehabilitation program without orthosis and 15 patients received an experimental orthosis in addition to their standard rehabilitation program.

Intervention

The orthosis group wore the neutral functional realignment orthosis for at least 6 hours daily.

Main Outcome Measures

Hand pain at rest (visual analog scale), wrist range of motion (Fugl-Meyer Assessment subscale), and edema of hand and wrist (circumferences). Outcome measures were assessed at time of randomization and after 13 weeks between groups.

Results

At baseline, 2 patients in each group complained about a painful hand. After 13 weeks, 8 subjects in the control group and 1 subject in the orthosis group complained of hand pain (P=.004). Mobility and edema evolved similarly in both groups.

Conclusions

Neutral functional realignment orthoses have a preventive effect on poststroke hand pain, but not on mobility and edema in the subacute phase of recovery.     

Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points

Shah JP, Danoff JV, Desai MJ, Parikh S, Nakamura LY, Phillips TM, Gerber LH. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points.

Objectives

To investigate the biochemical milieu of the upper trapezius muscle in subjects with active, latent, or absent myofascial trigger points (MTPs) and to contrast this with that of the noninvolved gastrocnemius muscle.

Design

We used a microanalytic technique, including needle insertions at standardized locations in subjects identified as active (having neck pain and MTP), latent (no neck pain but with MTP), or normal (no neck pain, no MTP). We followed a predetermined sampling schedule; first in the trapezius muscle and then in normal gastrocnemius muscle, to measure pH, bradykinin, substance P, calcitonin gene-related peptide, tumor necrosis factor alpha, interleukin 1β (IL-1β), IL-6, IL-8, serotonin, and norepinephrine, using immunocapillary electrophoresis and capillary electrochromatography. Pressure algometry was obtained. We compared analyte concentrations among groups with 2-way repeated-measures analysis of variance.

Setting

A biomedical research facility.

Participants

Nine healthy volunteer subjects.

Interventions

Not applicable.

Main Outcome Measures

Preselected analyte concentrations.

Results

Within the trapezius muscle, concentrations for all analytes were higher in active subjects than in latent or normal subjects (P<.002); pH was lower (P<.03). At needle insertion, analyte concentrations in the trapezius for the active group were always higher (pH not different) than concentrations in the gastrocnemius muscle. At all times within the gastrocnemius, the active group had higher concentrations of all analytes than did subjects in the latent and normal groups (P<.05); pH was lower (P<.01).

Conclusions

We have shown the feasibility of continuous, in vivo recovery of small molecules from soft tissue without harmful effects. Subjects with active MTPs in the trapezius muscle have a biochemical milieu of selected inflammatory mediators, neuropeptides, cytokines, and catecholamines different from subjects with latent or absent MTPs in their trapezius. These concentrations also differ quantitatively from a remote, uninvolved site in the gastrocnemius muscle. The milieu of the gastrocnemius in subjects with active MTPs in the trapezius differs from subjects without active MTPs.     

Rating scale analysis of the Berg Balance Scale

Kornetti DL, Fritz SL, Chiu Y-P, Light KE, Velozo CA. Rating scale analysis of the Berg Balance Scale. Arch Phys Med Rehabil 2004;85:1128-35.

Objectives

To examine, using Rasch analysis, the rating scale performance of the Berg Balance Scale (BBS) and to describe the 45/56 cutoff score in functional terms.

Design

Retrospective chart review of BBS scores. Rasch rating scale analysis was performed on these data.

Setting

Outpatient Veterans Affairs medical center.

Participants

One hundred (99 men, 1 woman) community-dwelling veterans referred for balance deficits (age range, 64-88y).

Interventions

Not applicable.

Main outcome measure

The BBS.

Results

Condensing item-rating categories allowed the elimination of underutilized categories and constructed categories that better separated people of differing abilities. Rating pivot points were developed for each item to represent a transition between passing and failing. Following pivot-point development and rating scale rescoring, person and item measures became more evenly distributed across the BBS and resulted in changes in item difficulty order. In our sample, functional indicators of a score of at least 45/56 were a rating of passing the item “tandem stance,” as well as passing 2 of the following 3 items: “alternating foot,” “standing on one leg,” and “look behind.”

Conclusions

Our findings provide direction for improving the rating scale structure for each of the items and establish a connection between the BBS cutoff score of 45/56 and functional ability.     

The influence of psychological factors on pre-operative levels of pain intensity, disability and health-related quality of life in lumbar spinal fusion surgery patients

Objectives

To assess the extent to which perceived pain and psychological factors explain levels of disability and health-related quality of life (HRQOL) in patients scheduled for lumbar fusion surgery, and to test the hypothesis that relationships between pain intensity, mental health, fear of movement/(re)injury, disability and HRQOL are mediated by cognitive beliefs and appraisals.

Design

Cross-sectional, correlation study.

Setting

Orthopaedic outpatient setting in a tertiary hospital.

Participants

One hundred and seven chronic back pain patients scheduled for lumbar fusion surgery.

Measures

Visual analogue scale for pain intensity, Short Form 36 mental health subscale, Tampa Scale for Kinesiophobia, Back Beliefs Questionnaire, Self-efficacy Scale, Coping Strategy Questionnaire, Oswestry Disability Index and European Quality of Life Questionnaire.

Results

The group effect of multiple mediators significantly influenced the relationships between pain intensity and mental health, fear of movement/(re)injury, functional disability and HRQOL. Pain catastrophising significantly mediated the relationship between pain intensity and mental health, control over pain significantly mediated the relationship between mental health and functional disability, self-efficacy and pain outcome expectancy significantly mediated the relationship between mental health and HRQOL, and self-efficacy also significantly mediated the relationship between pain intensity, fear of movement/(re)jury and functional disability. The model explained 28, 30, 52 and 42% of the variation in mental health, fear of movement/(re)injury, functional disability and HRQOL, respectively.

Conclusions

This study highlights the strong influence and mediation roles of psychological factors on pain, mental health, fear of movement/(re)injury, disability and HRQOL in patients scheduled for lumber fusion. Future research should focus on screening as well as pre- and post-operative interventions based on these psychological factors for the potential improvement of lumber fusion surgery outcomes.