Effect of music therapy among hospitalized patients with chronic low back pain: a controlled, randomized trial]

OBJECTIVE: To evaluate the influence of music therapy in hospitalized patients with chronic low back pain. METHODS: A controlled, randomized study (N = 65). During a stationary rehabilitation stay of 12 days, 65 patients with low back pain were randomized to receive on alternate months standardized physical therapy plus 4 music therapy sessions between day 1 and day 5 (intervention group; N = 33) or standardized physical therapy alone (control group; N =32). Scores for pain (as measured on a visual analogue scale [VAS]), disability (Oswestry index) and anxiety and depression (as measured on the hospital anxiety and depression scale [HAD]) were collected on day 1, 5 and 12. Pain intensity was also evaluated on a VAS just before and after music therapy sessions. RESULTS: Introduced music therapy sessions during a stationary rehabilitation stay in patients with chronic low back pain reduce pain (-2.0+/-2.7 vs -1.8+/-2.6) but not significantly. However, music therapy significantly (p < 0.01) reduced disability as measured on the Owestry index between day 1 and day 5 (-11.8+/-17.8 vs -2.5+/-9.4), anxiety (-3.5+/-3.7 vs -0.9+/-2.7) and depression (-2.1+/-3.0 vs 0.6+/-2.4). The immediate effect on pain intensity (VAS score) was confirmed (p < 0.001). CONCLUSION: Our results confirmed the effectiveness of music therapy for hospitalized patients with chronic low back pain. Music therapy can be a useful complementary treatment in chronic pain and associated anxiety-depression and behavioural consequences.     

Quantitative determination of serum serotonin in the diagnosis of tension headache

A comprehensive psychometric testing and measurement of the serum levels of serotonin by enzyme immunoassay were made before and after treatment with the antidepressant Prodep in 76 patients with chronic tension headache. The patients generally had cephalgia and moderate depression, which were associated with the lower blood concentration of serotonin. A course of antidepressant therapy with Prodep ameliorated headache and depression in the presence of higher serum serotonin levels. Serum serotonin may be regarded as a marker of the severity of pain and depression in patients with chronic tension headache and be an objective indicator of the efficiency of antidepressant therapy.     

Psychometric properties of the MOS (Medical Outcomes Study) Sleep Scale in patients with neuropathic pain.

OBJECTIVE: This study assessed the psychometric properties of the MOS Sleep Scale in neuropathic pain (NeP). METHODS: Psychometric properties were tested in patients with neuropathic pain enrolled in a prospective study exploring the effectiveness of gabapentin for 3 months. Participants also completed scales for pain intensity, anxiety, depression, disability, and health-related quality of life. Feasibility, reliability, validity and sensitivity to change were measured in this study. RESULTS: Six-hundred-three patients [58.4+/-14.4 years (65.1% female), mean+/-SD] with pain for 1.2+/-3.3 years were included. The MOS Sleep Scale was acceptable (items with missing data <10% and floor and ceiling effects <50% per item and <15% per domain) and reliable (Cronbach's alpha between 0.64 and 0.87, and test-retest intraclass correlation coefficients between 0.79 and 0.91, p<0.001 for all cases). After adjusting for confounders, the MOS Sleep Scale was able to distinguish between sex, present pain intensity, level of disability and presence of anxiety or depression. Correlations with other scales were moderate; rho-coefficients between -0.21 and 0.57 (p<0.01, all cases). The scale was sensitive to change after treatment with gabapentin; after adjusting, responders (50% reduction in baseline pain) showed a decrease in sleep problems index of -25.6+/-14.3 points vs. -12.1+14.5 points in nonresponders (F=80.5, df=1/398, p<0.0001). Score reduction in summary index and subscales correlated significantly with pain intensity reduction (Pearson r-coefficients between 0.428 and 0.116, p<0.01, all cases). CONCLUSIONS: The MOS Sleep Scale showed good psychometric properties and was sensitive to changes in patients with NeP of broad aetiology.     

Effectiveness of yoga therapy in the treatment of migraine without aura: a randomized controlled trial

BACKGROUND: Numerous studies have explored the effectiveness of complementary and alternative medicine in the treatment of migraine but there is no documented investigation of the effectiveness of yoga therapy for migraine management. OBJECTIVES: To investigate the effectiveness of holistic approach of yoga therapy for migraine treatment compared to self-care. DESIGN: A randomized controlled trial. METHODS: Seventy-two patients with migraine without aura were randomly assigned to yoga therapy or self-care group for 3 months. Primary outcomes were headache frequency (headache diary), severity of migraine (0-10 numerical scale) and pain component (McGill pain questionnaire). Secondary outcomes were anxiety and depression (Hospital anxiety depression scale), medication score. RESULTS: After adjustment for baseline values, the subjects' complaints related to headache intensity (P < .001), frequency (P < .001), pain rating index (P < .001), affective pain rating index (P < .001), total pain rating index (P < .001), anxiety and depression scores (P < .001), symptomatic medication use (P < .001) were significantly lower in the yoga group compared to the self-care group. CONCLUSION: The study demonstrated a significant reduction in migraine headache frequency and associated clinical features, in patients treated with yoga over a period of 3 months. Further study of this therapeutic intervention appears to be warranted.     

Emotional modulation of muscle pain is associated with polymorphisms in the serotonin transporter gene

The perception of pain is determined by a combination of genetic, neurobiological, cultural, and emotional factors. Recent studies have demonstrated an association between specific genotypes and pain perception. Particular focus has been given to the triallelic polymorphism in the promoter region of the serotonin transporter gene in relation to pain perception. The aim of this study was to investigate whether the modulatory effect of emotions mediated by visual stimuli on muscular pain perception is genotype dependent. A total of 150 healthy subjects were selected on the basis of their polymorphism in the serotonin transporter gene. First, visual conditioning was performed with positive, negative, and neutral pictures from the International Affective Picture System, and the unpleasantness/pleasantness of the pictures was rated. Second, visual conditioning stimuli were presented while experimental jaw muscle pain was evoked by injection of hypertonic saline into the masseter muscle, and participants continuously rated pain intensity on an electronic visual analogue scale. The pictures induced similar changes in emotions across the 3 genotype groups, and hypertonic saline evoked moderate pain levels in all participants. However, in participants with a high expression of the serotonin transporter protein, conditioning with negative pictures increased pain intensity and positive pictures decreased pain intensity when compared with neutral pictures. In contrast, there were no significant effects of the pictures on pain perception in participants with either intermediate or low expression of the protein. These results suggest that polymorphisms in the serotonin transporter gene play an important role in emotions modulation of muscle pain.     

Pain during bone marrow aspiration: prevalence and prevention

The prevalence, intensity, determinants and prevention of pain during bone marrow aspiration (BMA) in adults are not well defined. In the first part of this prospective study (observational phase), 132 adult hematological patients undergoing BMA after local anesthesia scored the procedural pain by means of a visual analogue scale (VAS). Moderate to severe pain was defined as a VAS score exceeding 30 mm. Eighty-six percent reported procedural pain. The VAS score (mean+/-SEM) was 27.2+/-2.1 mm. Thirty-six percent of patients graded the pain as moderate to severe. In a linear regression analysis, VAS score correlated positively with the duration of the procedure (P=0.029) and negatively with the age of the patient (P=0.006). In the second part of the study (interventional phase), 100 patients were randomized to 50 mg tramadol or placebo, given orally at least one hour before BMA. VAS scores during aspiration were significantly lower in tramadol recipients versus placebo recipients (16.5+/-3.0 mm and 28.8+/-3.4 mm, respectively, P=0.003). Pretreatment with tramadol reduced the percentage of patients with at least moderate pain from 40% to 20% (P=0.029). Four tramadol and 3 placebo recipients reported side effects (dizziness or sedation). In conclusion, notwithstanding local anesthesia, the great majority of adult hematological patients experience transient pain during BMA that is of at least moderate intensity in over a third. Pretreatment with tramadol lowers pain intensity significantly and is well tolerated.     

Chronic pain in Holocaust survivors

There is limited research on the connection between the Holocaust and chronic pain, despite evidence suggesting that medical and psychological sequelae are common in survivors. The goals of this study were: (1) to define Holocaust survivors' (n = 33) chronic pain characteristics as manifested 50 years after the war, (2) to compare survivors with controls (n = 33) who did not experience World War II atrocities, and (3) to investigate the connection between past trauma and chronic pain. Data were collected through questionnaires that included a detailed medical and pain history, visual analog scale (VAS), McGill Pain Questionnaire (MPQ), Beck Depression Inventory (BDI), Symptom Check List-90 (SCL-90), and Pain Disability Index (PDI). A comparison of variables between the two groups was conducted using multivariate analysis of variance (MANOVA) and ANOVA, and canonical discriminant analysis. Results showed that Holocaust survivors reported higher pain levels (73 +/- 18 vs. 56 +/- 21; P < 0.005), more pain sites (4.5 6 2.8 vs. 2.7 6 1.4; P < 0.05), and significantly higher depression scores (17.6 +/- 8.4 vs. 9.2 +/- 4.6; P < 0.001); they tended to utilize more medical services (5.9 +/- 3.0 vs. 5.1 +/- 2.8). Nonetheless, survivors did not regard themselves more disabled as compared with controls. They reported a higher activity level as measured by walking distance capacity, and spent significantly fewer hours resting (4.3 +/- 3.6 vs. 7 +/- 4.6; P < 0.05). This paradoxical combination of high pain intensity, moderate to severe depression, and high activity level characterizes Holocaust survivors' chronic pain. It is conceivable that by remaining active Holocaust survivors fight back their pain, distress, and depression. These findings suggest that Holocaust atrocities affect survivors' chronic pain even years later.     

Decreased Serum Interleukin-2 Level in Patients With Chronic Headache

Some cellular immune functions are impaired in cluster headache patients. Interleukin-2 (IL-2) is a polypeptide secreted by antigen or mitogen-actuated T lymphocytes that functions as a growth factor for T cells. To investigate cellular immune functions in patients with chronic headache, we measured the IL-2 concentration of sera in patients with migraine and in patients with tension-type headache. Thirteen subjects suffering from migraine without aura (5 males and 8 females, mean age: 32.8 years) and 46 subjects (20 males and 26 females, mean age: 39.7 years) with tension-type headache (TH) were selected for this study. Forty-three normal healthy volunteers composed the control group (15 males and 28 females, average age 41.6 years). The IL-2 levels of sera were determined using enzyme-linked immunosorbent assay (ELISA) techniques. The IL-2 levels of sera were 3.18 +/- 1.8 U/ml (mean +/- SD) in the healthy controls, 2.29 +/- 2.6 U/ml in the patients with migraine and 1.59 +/- 1.0 U/ml in the patients with TH. The serum level of IL-2 in the patients with migraine was significantly lower than in the controls. The serum level of IL-2 in the patients with TH was significantly lower than in the controls. The central nervous system (CNS) has been considered to be involved in the development of the immune phenomena. In the patients with TH or migraine, reduction in platelet 5-hydroxytryptamine (5-HT) levels and sympathetic hypofunction have been observed. These phenomena might reflect decrease in 5-HT levels in CNS in the patients with TH or migraine. The decreased serum IL-2 level, observed in this study, might reflect a reduction in 5-HT or catecholamine levels in CNS in the patients with migraine or TH.     

An epidemiologic comparison of pain complaints

A survey concerning common pain conditions and psychological distress was carried out among a probability sample of the adult enrollees of a large health maintenance organization in Seattle. The prevalence of pain in the prior six months was 41% for back pain; 26% for headache; 17% for abdominal pain; 12% for chest pain; and 12% for facial pain. Headache, abdominal and facial pain were less prevalent among older persons and more prevalent among females. We examined the temporal dimensions of these pain conditions, as well as intensity, treatment seeking, and activity limitation. The pain conditions were typically long standing, recurrent, of mild to moderate intensity, and usually did not limit activities. However, depending on the pain condition, 9-40% reported one or more days in the prior six months when they were unable to carry out their usual activities due to the pain problem. On average, persons with a pain condition had higher levels of anxiety, depression, and non-pain somatic symptoms as measured by the scales of the Symptom Checklist (SCL); poorer self-rating of health status; and more family stress compared to persons without a pain condition. Of these alternative measures of distress, the SCL somatization scale had the strongest independent association with pain. The increments in measures of anxiety, depression, and family stress with the presence of pain were greatest among persons with higher levels of non-pain somatic symptoms.     

Beurteilung der postoperative Schmerzintensität Selbst-versus Fremdbeurteilung

In 60 women undergoing vaginal hysterectomy, a total of 420 pain evaluations of postoperative pain intensity were performed by an observer and the patients. Pain intensity was rated by the observer on a visual analogue scale. The patients themselves evaluated their pain on a visual analogue scale and on a 101-point numerical rating scale. There was good agreement between pain intensity on the visual analogue scale and the 101-point numerical rating scale in the patients' self-assessment (r (2)=0.74;y=0.81x+11.4). The pain intensities determined by the observer on the visual analogue scale were markedly lower, on average than the patients' self-report (P<0.0001). The pain intensities rated by the observer on the visual analogue scale were on averange 37.7% of the patients' self-assessments on the visual analogue scale. The correlation between patients' self-assessments and observers' ratings was poor (r (2)=0.28;y=0.66x+31.3). There was also no clear correlation between pain intensity and heart rate or arterial blood pressure. A reliable assessment of pain intensity can only be performed by patients' self-assessment and not by observers' ratings.     

Comparative trial of botulinum toxin type A and methylprednisolone for the treatment of tension-type headache

Tension-type headache (TH) is a common condition, the pathophysiology of which remains undetermined. Evidence implicates sustained contraction of pericranial muscles to be a major cause. A recent preliminary study demonstrated the effectiveness of botulinum toxin type A (BTX-A) in patients suffering from chronic TH. To further investigate this, we performed a study to compare the efficacy of BTXA with the steroid methylprednisolone (both administered with the local anesthetic lidocaine), when administered by injection into the tender points of cranial muscles in patients with TH. A significant decrease in the median pain score (assessed using a standard visual analogue scale [VAS]) was observed at 60 days post injection of BTX-A compared with the pain score achieved following steroid therapy. All patients treated with BTX-A experienced a gradual decrease in median pain severity scores at 30 days and 60 days post treatment. The beneficial effects of BTX-A therapy continued to improve 60 days following injection, whereas the effects of steroid therapy at this time point began to decline. This study clearly demonstrates the effectiveness of BTX-A for the treatment of TH.     

Assessment of pain,depression, and anxiety by visual analogue scale in Japanese women with rheumatoid arthritis

Assessment of pain, depression, and anxiety by visual analogue scale in Japanese women with rheumatoid arthritis Visual analogue scales (VAS) of depression and anxiety were compared with standard full-length measures of these variables and with VAS of pain (VAS Pain). This was a good way to develop a practical methodology for the routine assessment of pain and affect in rheumatoid arthritis (RA) patients. The reliability of VAS Pain was studied by test-retest. The validity of VAS Pain in our sample was proved by correlations with the results of other tests. We also investigated the relationship between VAS Pain and C-reactive protein (CRP). In 145 female RA patients, VAS of depression and anxiety were significantly correlated with full-length measures of these variables, and accounted for the majority of the explained variance in VAS Pain, while the full-length standard measures contributed little more. In conclusion, VAS measurements of pain and affect were comprehensible, easily filled-out, and reliable in a sample of Japanese women with RA, and could capture some aspect of affective distress unique to RA patients.     

Pain,Anxiety, and Depression in Patients Undergoing Chronic Hemodialysis Treatment: A Multicentre Cohort Study

BackgroundPain is a considerable health concern that interferes with hemodialysis treatment outcomes and can lead to a patient developing anxiety and depression.AimsTo examine the perception of pain in patients on chronic hemodialysis therapy, and to analyze the relationship between their pain, anxiety, depression, and sociodemographic data.MethodThe research was conducted using a quantitative, observational, cross-sectional design. The study recruited 138 patients from multicentered hemodialysis units. A battery of questionnaires, including the visual analog scale (VaS) as pain intensity scale, the Hospital Anxiety and Depression Scale (HADS), and an ad hoc sociodemographic data questionnaire, were given to patients to answer during their hemodialysis sessions. A linear regression analysis was conducted to obtain the results.ResultsThe mean of pain to all participants was generally low, as per AVS scale (0-10) it was 3.6 (stanard deviation [SD] = 3.07). Women manifested lower levels of pain than men (p = .015). One in five participants in both sexes suffered from clinical anxiety and one in six participants in both sexes suffered from clinical depression. Women scored higher on both the anxiety (4.8 versus 4.2) and depression scale (6.8 versus 6.5). Those participants who manifested clinical anxiety were younger compared with those who did not (aged 56.8 versus 66.8 years). Finally, older patients (aged 68.5 years) manifested higher levels of depression.ConclusionsThe level of pain perceived by patients undergoing chronic hemodialysis therapy was generally low, especially in women. The study also demonstrated a positive association between levels of pain and anxiety and depression.     

结肠镜检查病人疼痛程度和焦虑水平的调查研究

[目的]了解结肠镜检查病人的疼痛程度和焦虑水平。[方法]选择60例结肠镜检查病人,用视觉模拟评分法(VAS)和状态焦虑问卷(SAI)评估疼痛程度和焦虑水平。[结果]结肠镜检查病人检查中经历了中等程度的疼痛,检查前后焦虑水平比较有统计学意义(P<0.05)。[结论]医护人员应重视病人的主观感受,针对性地采取措施,控制结肠镜检查病人的疼痛及焦虑。     

The occurrence of recall bias in pediatric headache: a comparison of questionnaire and diary data

OBJECTIVE: To investigate whether children and adolescents can recall prior headache complaints accurately and to study whether age, gender, headache severity, preferred coping strategies, depression, somatization, and trait anxiety are related to recall errors, causing recall bias. METHODS: A retrospective headache questionnaire and a prospective 4-week headache diary were filled out by 181 children aged 9 to 16 years who experienced headache at least weekly. In addition, several other questionnaires were administered, measuring coping strategies, depression, somatization, and trait anxiety. Headache frequency, intensity, and duration, as scored on the questionnaire and the diary, were compared using Wilcoxon tests. Regression analyses were performed to study whether age, gender, headache severity, preferred coping strategies, depression, somatization, and trait anxiety can predict the size of differences between the diary and the questionnaire. RESULTS: Compared with the diary, headache intensity and headache duration were overestimated on the questionnaire. At group level, median headache frequency as measured by the diary and the questionnaire was equal. Regarding headache frequency and headache intensity, age and headache severity were statistically related to errors in recall. For headache frequency, depression was also predictive of the size of recall error. CONCLUSIONS: Recall errors occur when children are asked to report their headaches on a retrospective questionnaire. As compared to a prospective diary, pain complaints are evaluated more negatively on a questionnaire. Other factors such as age, depression, and headache severity influence the way children and adolescents recall their headaches. To minimize bias, the use of a diary when studying recurrent headache complaints in children is recommended.     

Tension Headache: Botulinum Toxin Paralysis of Temporal Muscles

SYNOPSIS
The pathogenetic mechanism of tension headache (TH) is still unknown. The role of pericranial muscle tension in TH is also enigmatic. To evaluate this factor in chronic TH, pericranial muscles were paralysed in 6 chronic TH patients, using botulinum toxin. All patients fulfilled the IHS criteria of chronic TH associated with involvement of the pericranial muscles, but not the current criteria for cervicogenic headache. The patients were followed-up regularly with evaluation of the paralysis, changes in pain intensity, and pressure pain threshold measurements. We primarily only injected the temporal muscle on the one side, using the other side as a control. Contralateral muscles were in some cases injected at a later stage. In our study, we did not find any significant reduction in pain intensity, as measured by the visual analogue scale, nor any changes in pressure pain threshold, as measured by an algometer. On the basis of our observations, we conclude that muscle tension in these muscles possibly plays a minor role in the genesis of chronic TH. In our study, however, we have only treated a limited number of patients, and only one pericranial muscle has been injected systematically. Further studies of various neck/posterior head muscles ought to be performed in order to further evaluate a possible effect of tension in the pericranial musculature in producing this type of pain.     

Effects of massage on pain and anxiety during labour: a randomized controlled trial in Taiwan

AIMS: To investigate the effects of massage on pain reaction and anxiety during labour. BACKGROUND: Labour pain is a challenging issue for nurses designing intervention protocols. Massage is an ancient technique that has been widely employed during labour, however, relatively little study has been undertaken examining the effects of massage on women in labour. METHODS: A randomized controlled study was conducted between September 1999 and January 2000. Sixty primiparous women expected to have a normal childbirth at a regional hospital in southern Taiwan were randomly assigned to either the experimental (n=30) or the control (n=30) group. The experimental group received massage intervention whereas the control group did not. The nurse-rated present behavioural intensity (PBI) was used as a measure of labour pain. Anxiety was measured with the visual analogue scale for anxiety (VASA). The intensity of pain and anxiety between the two groups was compared in the latent phase (cervix dilated 3-4 cm), active phase (5-7 cm) and transitional phase (8-10 cm). RESULTS: In both groups, there was a relatively steady increase in pain intensity and anxiety level as labour progressed. A t-test demonstrated that the experimental group had significantly lower pain reactions in the latent, active and transitional phases. Anxiety levels were only significantly different between the two groups in the latent phase. Twenty-six of the 30 (87%) experimental group subjects reported that massage was helpful, providing pain relief and psychological support during labour. CONCLUSIONS: Findings suggest that massage is a cost-effective nursing intervention that can decrease pain and anxiety during labour, and partners' participation in massage can positively influence the quality of women's birth experiences.