Correlation between the Neuropathic PainDETECT Screening Questionnaire and Pain Intensity in Chronic Pain Patients.

Background and Objectives: Pain is a multidimensional phenomenon with a wide range regarding the location, intensity and quality. Patients with chronic pain, in particular those suffering from mixed pain, often present a special challenge. The PainDETECT questionnaire (PD-Q) is a screening instrument designed to classify whether a patient has neuropathic pain (NP), often rated as more distressing compared to nociceptive pain. The objective of this study was to investigate whether the PD-Q score correlates with pain intensity, measured with the numeric rating scale (NRS), in chronic pain patients in an outpatient setting. Materials and Methods: A questionnaire-based study was conducted to identify the associations between the unidimensional NRS scale for pain intensity and the PD-Q score for screening of an NP component in an outpatient setting. Participants were asked to fill in the questionnaire themselves. Results: One hundred seventy-six participants completed the PD-Q questionnaire and rated pain on the NRS scale at the baseline visit. The PD-Q and NRS scores significantly correlated at the baseline visit and the 1-month follow-up visit in chronic pain patients. The identification of a neuropathic component in chronic pain may permit more targeted and effective pain management. Conclusions: The findings of our questionnaire suggest that a significant proportion of chronic pain patients had manifested features of NP at the first visit to the outpatient clinic. The PD-Q is a useful screening tool to alert clinicians of NP that may need further diagnostic evaluation or therapeutic intervention and may also help to predict treatment response. Further research is needed to investigate if a correlation is predictive of treatment response when pain therapy targets NP.

Assessment of safety and bleeding risk in the use of extracorporeal membrane oxygenation for multitrauma patients: A multicenter review.

BACKGROUND: Respiratory failure is the most common form of organ failure following traumatic injury. Previously, there have been concerns regarding extracorporeal membrane oxygenation (ECMO) use in the trauma setting because of the increased risk of bleeding and thrombotic complications. We sought to examine the management of trauma patients with ECMO and to assess the safety and outcome of its use. METHODS: Data of all patients who experienced a traumatic injury and were supported with ECMO were collected from the five National Respiratory ECMO centers in the United Kingdom over the period from December 2011 to May 2017. Primary outcome variables included 30-day and 6-month mortality and exacerbation of underlying traumatic injury after ECMO commencement. Secondary outcome variables included duration of ECMO support, thrombotic complications, and worsening of intracranial injury. RESULTS: Fifty-two patients were identified. The overall hospital mortality was 15%. The incidence of bleeding complications was 50%, the majority of these not requiring intervention. Forty patients underwent surgical management prior to ECMO commencement; only four patients required take-back to the operating theater. There was no significant difference between the bleeding and nonbleeding groups in time of injury to ECMO commencement (median difference, 4.5 days; 95% CI, -3 to 3 days; p = 0.75). There was no statistically significant difference between the bleeding and nonbleeding groups in regard to time to anticoagulation commencement after starting ECMO (median difference, - 1 hour; 95% CI, -48 to 2 hours; p = 0.29) or after trauma (median difference, - 1 day; 95% CI, -4 to 2 days; p = 0.41). Nineteen patients were diagnosed with significant neurological injury. Twelve of these patients were anticoagulated. Two patients died as a direct result of worsening neurological injury. CONCLUSIONS: Our findings suggest that the use of ECMO in trauma patients does not exacerbate primary traumatic injury regardless of anticoagulation commencement and may confer a survival benefit. Neurological injury should not be seen as an absolute contraindication to ECMO. LEVEL OF EVIDENCE: Therapeutic/Care Management, Level V.