The Bournemouth Questionnaire for Neck Pain: Cross-cultural Adaptation, Reliability, and Validity of the Turkish Version.

OBJECTIVE: The aim of this study was first to translate and culturally adapt the BQN, and then to investigate the validity and reliability of the Turkish version of the BQN in Turkish individuals with chronic neck pain. METHODS: The English version of the BQN was translated into Turkish with permission from its authors. That translation was assessed using 85 participants with a mean age of 46.75 years who had chronic neck pain. At the same time, the participants were assessed sociodemographically and with the Neck Disability Index (NDI) and the Neck Pain and Disability Scale (NPAD). A test-retest procedure was performed with 62 participants who underwent a second assessment with the BQN within 24 hours of the first assessment, to test its reliability. RESULTS: Internal consistency was strong and all Cronbach alpha values were between 0.97 and 0.99. The BQN showed high test-retest reliability (intraclass correlation coefficient ˃ 0.92) for all domains. The total mean (± standard deviation) scores for the 3 questionnaires were as follows: BQN, 30.9 (± 11.18); NPAD, 48.16 (± 12.93); NDI, 17.85 (± 6.29). The results of the Turkish version of the BQN illustrated adequate external construct validity and sensitivity. A Turkish translation of the test has not previously been available for chronic pain. CONCLUSION: The BQN was successfully translated and culturally adapted into Turkish. The reliability and validity were tested against the NPAD and the NDI. The Turkish version of the BQN is multidimensional, short, practical, and suitable for use with individuals with neck pain.

Cross-Cultural Adaptation and Validation of the Nepali Version of the Pelvic Girdle Questionnaire.

OBJECTIVE: The purpose of this study was to translate, cross-culturally adapt, and assess the reliability and validity of the Pelvic Girdle Questionnaire (PGQ) in pregnant Nepalese women. METHODS: The cross-cultural adaptation process was conducted according to the Guillemin guidelines. Reliability and validity were assessed using cross-sectional design. The participants responded to questionnaires of sociodemographics, the Nepali version of the PGQ, the Oswestry Disability Index, the Patient-Specific Functional Scale, the 5-item version of the Edinburgh Depression Scale, and the Numerical Pain Rating Scale. The internal consistency was assessed with Cronbach's alpha. The test-retest reliability was calculated using the intraclass correlation coefficient and smallest detectable change. Construct validity was assessed by testing 9 a priori hypotheses that examine correlations between the PGQ activity and symptom subscales, and also among the PGQ subscales and Oswestry Disability Index, Numerical Pain Rating Scale, Patient-Specific Functional Scale, and 5-item version of the Edinburgh Depression Scale. Spearman and Pearson's correlation were used to assess the correlations. RESULTS: A sample of 111 pregnant women were included in the study. The Cronbach's alpha for the Nepali version of the total PGQ was good (α = 0.83), and the test-retest reliability was acceptable (ICC2.1, 0.72) with a measurement error of SDC95% 18.6 points. Seven of the 9 hypotheses found support, which confirms acceptable construct validity of the Nepali PGQ. CONCLUSION: The Nepali version of the PGQ is a reliable and valid tool for assessing pelvic girdle pain in pregnant Nepalese women.

Psychometric Properties of the Multidimensional Impression of Change in a Cohort of Pediatric Patients With Pain.

OBJECTIVES: This study assessed the utility of the Multidimensional Patient Impression of Change (MPIC) questionnaire in a pediatric pain population after interdisciplinary treatment. DESIGN: Observational study with retrospective chart review. The observed treatment program included psychological counseling, relaxation training, physical therapy, occupational therapy, and physician management. SETTING: Outpatient pain management center affiliated with an academic rehabilitation hospital. PARTICIPANTS: A heterogeneous group of pediatric patients with chronic pain (N=202) who completed an interdisciplinary pain management program. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measures assessing pain, mood, development, social functioning, physical functioning, and family functioning were administered pre- and posttreatment, and the MPIC was administered posttreatment. RESULTS: Statistically significant improvements were observed in all outcomes (P<.05). The majority of patients perceived themselves to be improved (minimally to very much) in all clinical domains of the MPIC, ranging from 60% (medication efficacy) to 96% (coping with pain). The MPIC ratings were significantly correlated with improvements in most of the outcome measures. The MPIC domains accounted for more than half of the unique variance in predictive models when added to the Patient Global Impression of Change, and most of the variance when added to the models first. CONCLUSIONS: The MPIC was found to be an effective screening tool for assessing patient perceived progress in a pediatric chronic pain population.

Use of IMMPACT domains in clinical trials of acupuncture for chronic pain: A methodological survey.

Acupuncture is one of the therapeutic resources used for the management of chronic pain. Variability in outcome measurements in randomized clinical trials of non-oncologic chronic pain (RCT-NOCP) generates inconsistencies in determining effects of treatments. The objective of this survey was to assess the adherence to the recommendations made by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) in the measurement of RCT-NOCP of acupuncture. This methodological research made a systematic search for eligible studies from different sources of information. Eligible studies included those with number of patients ≥100, who randomized and allocated patients with chronic non-oncologic pain to be treated with acupuncture or with "sham" acupuncture, or non-acupuncture. This research included the recommendations for IMMPACT in the measurement of RCT-NOCP: presence of outcomes pain, physical function, emotional state and improvement perception of patient, the source of the outcome information pain and the tools used to measure such domains. From a total of 1,386 studies, 24 were included in this survey. Eleven studies presented low risk of bias. Pain outcome was measured in 23 studies, physical function in 22 studies, emotional state in 14 studies and improvement perception of patient in one study. As for the pain outcome, the patient was the information source in 50% of the studies. The measurement tools recommended for IMMPACT were included in eight studies (35%) that evaluated pain, one study that evaluated the emotional state (7%), and one study that evaluated the improvement perception and satisfaction of patient. It was observed that studies which did not adhere to the recommendations had more favorable results for acupuncture in the outcome pain. This study concludes that randomized clinical trials that used acupuncture to manage chronic pain failed to adhere to IMMPACT recommendations. Clinical societies and IMMPACT do not share the same recommendations. This fact reflects in the diversity of outcomes and instruments adopted in the studies, making it difficult to compare the results.

Development of an Evidence-Based Practical Diagnostic Checklist and Corresponding Clinical Exam for Low Back Pain.

OBJECTIVE: The purpose of this study was to use scientific evidence to develop a practical diagnostic checklist and corresponding clinical exam for patients presenting with low back pain (LBP). METHODS: An iterative process was conducted to develop a diagnostic checklist and clinical exam for LBP using evidence-based diagnostic criteria. The checklist and exam were informed by a systematic review focused on summarizing current research evidence for office-based clinical evaluation of common conditions causing LBP. RESULTS: Diagnostic categories contained within the checklist and exam include nociceptive pain, neuropathic pain, and sensitization. Nociceptive pain subcategories include discogenic, myofascial, sacroiliac, and zygapophyseal (facet) joint pain. Neuropathic pain categories include neurogenic claudication, radicular pain, radiculopathy, and peripheral entrapment (piriformis and thoracolumbar syndrome). Sensitization contains 2 subtypes, central and peripheral sensitization. The diagnostic checklist contains individual diagnostic categories containing evidence-based criteria, applicable examination procedures, and checkboxes to record clinical findings. The checklist organizes and displays evidence for or against a working diagnosis. The checklist may help to ensure needed information is obtained from a patient interview and exam in a variety of primary spine care settings (eg, medical, chiropractic). CONCLUSION: The available evidence informs reasonable working diagnoses for many conditions causing or contributing to LBP. A practical diagnostic process including an exam and checklist is offered to guide clinical evaluation and demonstrate evidence for working diagnoses in clinical settings.

Mapping the Affective Dimension of Embodiment With the Sensation Manikin: Validation Among Chronic Pain Patients and Modification by Mindfulness-Oriented Recovery Enhancement.

OBJECTIVE: Mindfulness-based interventions target novel pain relief mechanisms not captured by legacy pain scales, including 1) cultivating awareness of pleasant and neutral sensations proximal to unpleasant sensations and 2) interoceptively mapping sensation location and spatial distribution. METHODS: We created a digital sensation manikin (SM) by overlaying a human figure silhouette with a grid of 469 "sensation" pixels. A series of five research questions examined the SM's discriminant validity, construct validity, incremental validity, convergence with an objective measure of pain attentional bias, and sensitivity to a mindfulness-based psychological treatment, Mindfulness-Oriented Recovery Enhancement (MORE). A sample of opioid treated chronic pain patients (n = 108; age, 53.79 (12.94) years; female, 65%) was recruited to answer research questions 1 to 5, and a sample of healthy controls (n = 91; age, 36.47 (13.50) years; female, 55%) was recruited as the comparison group for research question 1. RESULTS: Chronic pain patients reported significantly more unpleasant sensations than did healthy controls (p < .001, d = 1.23) and significantly fewer pleasant sensations (p = .001, d = 0.50). The SM also evidenced expected relationships with multiple measures of pain (r = 0.26-0.29) and well-being (r = -0.21 to 0.28), uniquely predicted pain interference (ß = -0.18), and exhibited a significant association with pain attentional bias (r = 0.25). Finally, mindfulness-based intervention via MORE significantly increased the ratio of pleasant to unpleasant sensations reported by chronic pain patients relative to an active control condition (p = .036, d = 0.51). CONCLUSIONS: This study supports the SM's validity and indicates that assessing both pleasant and unpleasant sensations broadens the scope of pain measurement. Although the SM would benefit from further optimization, its continued use is likely to contribute to improved assessment and treatment options for chronic pain patients.

Exploring the prevalence and construct validity of high-impact chronic pain across chronic low-back pain study samples.

BACKGROUND CONTEXT: The US National Pain Strategy focused attention on high-impact chronic pain and its restrictions. Although many interventions have been studied for chronic low-back pain, results are typically reported for heterogeneous samples. To better understand chronic pain and target interventions to those who most need care, more granular classifications recognizing chronic pain's impact are needed. PURPOSE: To test whether chronic pain impact levels can be identified in chronic low-back pain clinical trial samples, examine the baseline patient mix across studies, and evaluate the construct validity of high-impact chronic pain. STUDY DESIGN/SETTING: Descriptive analyses using 12 large study datasets. PATIENT SAMPLES: Chronic low-back pain patients in nonsurgical, nonpharmacologic trials in the US, Canada, and UK. OUTCOME MEASURES: Preference-based health utilities from the SF-6D and EQ-5D, employment status and absenteeism. METHODS: We used two logistic regression models to predict whether patients had high-impact chronic pain and whether the remainder had low- or moderate-impact chronic pain. We developed these models using two datasets. Models with the best predictive power were used to impute impact levels for six other datasets. Stratified by these estimated chronic pain impact levels, we characterized the case mix of patients at baseline in each dataset, and summarized their health-utilities and work productivity. This study was funded by a National Center for Complementary and Integrative Medicine grant. The authors have no potential conflicts of interest. RESULTS: The logistic models had excellent predictive power to identify those with high-impact chronic pain. Although studies were all of chronic low-back pain patients, the baseline mix of patients varied widely. Across all datasets, utilities, and productivity were similar for those with high-impact chronic pain and worsened as chronic pain impact increased. CONCLUSIONS: There is a need to better categorize chronic pain patients to allow the targeting of optimal interventions for those with each level of chronic pain impact.

Oral Glucose and Listening to Lullaby to Decrease Pain in Preterm Infants Supported with NCPAP: A Randomized Controlled Trial.

BACKGROUND: Preterm infants spend the early days of their lives in neonatal intensive care units, where they undergo many minor painful procedures. There are many nonpharmacologic methods that can effectively reduce the pain response of neonates who undergo routine procedures. AIMS: This study aimed to investigate whether oral glucose and listening to lullabies could bring pain relief during the removal and reinsertion of the tracheal tube and also oronasopharyngeal suctioning in premature infants to whom nasal continuous positive airway pressure was applied. DESIGN: A double-blind, randomized controlled trial. SETTING: This study was conducted in the neonatal intensive care unit in the tertiary setting between November 2012 and September 2013. PARTICIPANTS/SUBJECTS: A total of 106 preterm infants were divided into three groups, including 37 infants in the control group, 35 infants in the lullaby group, and 34 infants in the glucose group. METHODS: All preterm infants were randomly assigned to either the intervention groups or the control group. Pain responses were assessed using the Neonatal Infant Pain Scale and the Premature Infant Pain Profile. RESULTS: An assessment of the pain severity of the preterm infants after the intervention indicated that the preterm infants in the lullaby and glucose groups had lower pain, whereas the preterm infants in the control group experienced more pain (p < .05). CONCLUSION: The findings suggest that pain could be reduced significantly in preterm infants after the suggested intervention, although further studies are required to identify the benefits of lullabies or glucose in infants during other painful procedures.

Reliability and diagnostic accuracy of cervicothoracic differentiation testing and regional unloading for identifying improvement after thoracic manipulation in individuals with neck pain.

BACKGROUND & PURPOSE: The cervicothoracic differentiation test (CTDT), cervical and thoracic unloading are used clinically to guide treatment. This study sought to determine the reliability and diagnostic accuracy of these tests. METHODS: A prospective diagnostic accuracy study was performed at two outpatient clinics and one university research center. A convenience sample of 48 individuals with neck pain was recruited. Cervical and thoracic unloading tests and CTDT were performed with symptom relief considered a positive test. Pain was assessed using a visual analog pain scale (VAS) at rest and during provocative movements. The reference standard was pain relief following thoracic manipulation. Change in pain was used to identify improvement at the MCID (15 mm) and 50% improvement thresholds. RESULTS: All three tests demonstrated high levels of inter-rater reliability, K = 0.90[0.77-1.00]. Of 48 individuals who completed the study, 39 (81.3%) were improved ≥ MCID; compared to 34 (70.8%) at the 50% threshold. As a single test, the CTDT yielded the strongest diagnostic utility (at MCID threshold) based on ROC curve: AUC 0.791 s.e. 0.078; with high specificity (0.89[51.75-99.72]); LR+ 6.23 [0.97-40]; LR- 0.35 [0.20-0.58]; and PPV 96.43. Unloading tests demonstrated high sensitivity, but poor specificity and likelihood ratios. Composite tests improved specificity, but with lower accuracy and minimal changes in ROC area compared to the CTDT in isolation. CONCLUSIONS: The CTDT is a specific test with significant diagnostic utility to identify individuals who will experience immediate pain relief following thoracic manipulation. The CTDT should be considered during the clinical decision making process when treating individuals with neck pain.

Reliability of modified adheremeter and digital pressure algometer in measuring normal abdominal tissue and C-section scars.

OBJECTIVE: This study tested inter- and intrarater reliability of the digital pressure algometer and modified adheremeter and concurrent validity in the algometer in both normal abdominal tissue and in chronically painful C-section scars. STUDY DESIGN: Correlational Reliability/Validity. BACKGROUND: The algometer is used to measure pressure-pain threshold (PPT). The adheremeter is a tool to measure tissue extensibility. Painful abdominal scars are being treated successfully with soft-tissue techniques yet reliable measurement tools for this tissue have not been reported. METHODS AND MEASURES: 59 subjects with normal abdominal tissue were marked at a point 2 inches inferolateral to the umbilicus. Two separate testers measured PPT twice with an algometer and tissue extensibility in superior/left/inferior/right directions with a modified adheremeter. 29 subjects with painful C-section scars were marked at 2.5 cm intervals along the scar. A total of 115 points were measured in the same manner as above. C-section subjects also were asked to rate their pain using the numeric pain rating scale (NPRS). Each tester was blinded to all other measurements. RESULTS: For PPT, intraclass correlations (ICC's) ranged from 0.814 to 0.933 with a standard error of measurement (SEM) ranging from 1.65N to 5.9 N. For tissue mobility, ICC's ranged from 0.430 to 0.914; SEM ranging from 1.67 mm to 3.7 mm. All but 2 measures had ICCs that were good-excellent. Inferior glide in C-section tissues showed the least and multi-directional measurement the strongest reliability. The PPT had a moderate negative correlation (r = -0.551) with the NPRS. CONCLUSIONS: The algometer showed excellent inter- and intra-rater reliability on normal abdominal tissue and C-section scars. It showed moderate criterion validity when compared against the NPRS. The modified adheremeter showed good-excellent inter- and intra-rater reliability on both normal abdominal tissue and C-section scars. Both measures have clinical and research applications for women's health practitioners.

Validation of the Neck Disability Index in Serbian Patients With Cervical Radiculopathy.

OBJECTIVE: The purpose of this study was to translate the Neck Disability Index into the Serbian language (NDI-S) and to investigate the validity of this version for use in Serbian population. METHODS: Fifty patients with cervical radiculopathy were enrolled in the study and completed a multidimensional questionnaire, including NDI-S. Inclusion criteria were ages between 18 and 65 years, Serbian speaking, no cognitive or hearing impairment, sharp and radiating neck and upper extremity pain that has lasted less than 12 months, radiculopathy signs evaluated by electromyoneurography and disc herniation, or spondylotic changes of cervical spine visualized on magnetic resonance imaging. Exclusion criteria were malignancy, previous cervical spine discectomy, trauma of the cervical spine and myelopathy, polyneuropathy, fibromyalgia, and psychiatric disorders. Validity was determined by the correlation of the Neck Disability Index, with pain measured by visual analogue scale, characteristics related to pain, and mental status. Also, factor structure of NDI-S was explored through factor analysis. Reliability was assessed through internal consistency (Cronbach's α and item-total correlations). RESULTS: Correlation analysis between pain and NDI-S showed significant values (P < .01). The NDI-S correlated well with patients mental status (r = 0.421, P < .01). Cronbach's α of NDI-S was 0.85, denoting excellent internal consistency of the questionnaire. Item-total correlations were significant and ranged from 0.328 to 0.789. Factor analysis demonstrated a 2-factor structure with an explained variance of 55%. CONCLUSION: The NDI-S is a valid questionnaire to measure neck and arm pain related to disability in Serbian patients with cervical radiculopathy.

Reliability of the Cervical Spine Device for the Assessment of Cervical Spine Range of Motion in Asymptomatic Participants.

OBJECTIVE: The purpose of this study was to assess the inter- and intra-assessor reliability of the cervical spine device (Formetric, DIERS International GmbH, Schlangenbad, Germany) in measuring cervical range of motion. METHODS: The cervical spine device was used to measure the cervical range of motion of 65 asymptomatic participants. Flexion-extension, right and left rotation, and right and left lateral flexion were analyzed. Two different assessors performed the measurements on the same day to estimate inter-assessor reliability and 2 days later to examine intra-assessor reliability. Intra-assessor and inter-assessor reliability was assessed using the intraclass correlation coefficient (ICC). The standard error of measurement (SEM) and the smallest detectable difference (SDD) were also estimated. RESULTS: Inter-assessor reliability ICCs for flexion + extension and total lateral flexion movements were >0.90. The ICCs for rotation movements and for left lateral flexion were >0.70. The ICCs for flexion (0.64), extension (0.58), and right lateral flexion (0.56) indicated moderate correlation. Mean SEMs ranged from 2.28° (SDD = 6.31°) for left rotation to 8.08° (SDD = 22.38°) for total rotation. As for intra-assessor test-retest reliability, all ICCs were >0.70. Mean SEMs ranged from 3.14° (SDD = 8.70°) for total lateral flexion to 7.50° (SDD = 20.77°) for extension. CONCLUSION: Both inter- and intra-observer reproducibility correlation values are moderate to high for measurements obtained using the cervical spine device.

Analysis of Test-Retest Reliability, Construct Validity, and Internal Consistency of the Brazilian Version of the Pelvic Girdle Questionnaire.

OBJECTIVE: The purpose of this study was to evaluate test-retest reliability, construct validity, and internal consistency of the Brazilian version of the Pelvic Girdle Questionnaire (PGQ-Brazil). METHODS: Analysis of the measurement properties was carried out in 4 steps. Step 1 was the pilot study, on which basis 4 hypotheses were formulated. These hypotheses were tested during the next step (construct validity, step 2) by completion of the questionnaire by the 2 groups (in pain [n = 105] and not in pain [n = 52]). For implementation of the PGQ-Brazil in the group with pain, we calculated the internal consistency (step 3) and, 7 days later, test-retest reliability (step 4) by re-application of the instrument in this group. RESULTS: First, the PGQ-Brazil was able to discriminate between these groups (construct validity). Second, test-retest reliability (intraclass correlation coefficients for Activities subscale [0.97 with 95% confidence interval of 0.95-0.98] and Symptoms subscale [0.98 with 95% confidence interval of 0.97-0.98] and κ coefficient between 0.50 and 0.89 for the items) was found to be good; the Bland-Altman test indicated satisfactory agreement. The Rasch analysis indicated good internal consistency, and the instrument's ability to divide the participants into at least 3 levels of skills was confirmed. In contrast, a ceiling effect was observed, as 24% of pregnant women exhibited skills superior to what the PGQ-Brazil could evaluate. CONCLUSIONS: The PGQ-Brazil had good internal consistency, test-retest reliability, and construct validity in assessment of limitations in activities and symptoms of pregnant women with pelvic girdle pain.

Validity of an Alternate Hand Behind Back Shoulder Range of Motion Measurement in Patients With Shoulder Pain and Movement Dysfunction.

OBJECTIVES: The purpose of this study was to determine the criterion-related validity of a novel method of measuring hand behind back (HBB) shoulder range of motion (ROM) for evaluating pain and disability in people with shoulder pain and movement impairment. METHODS: This cross-sectional study design evaluated shoulder ROM, pain, fear-avoidance beliefs, and disability in 60 people (aged 35-70 years, 31 male) with chronic unilateral shoulder dysfunction (mean duration 15.73 weeks). Shoulder HBB ROM was measured with a bubble inclinometer in a manner that did not require the patient to disrobe. Correlations were sought between HBB ROM and other shoulder movements, as well as scores recorded on the Shoulder Pain and Disability Index (SPADI), visual analogue scale for pain, Fear Avoidance Beliefs Questionnaire (FABQ), and duration of symptoms. RESULTS: Restriction of HBB movement was significantly correlated with SPADI total disability score (r = 0.39, P < .01), flexion ROM (r = 0.30, P < .05), abduction ROM (r = 0.39, P < .01), and external rotation ROM (r = 0.60, P < .01). Other variables were not significantly correlated with HBB ROM. Multiple linear regression analysis indicated that the variance in HBB ROM was explained by the SPADI disability subscore (P = .01) but not by visual analogue scale score (P = .05), FABQ score (P = .65), or duration of symptoms (P = .73). The FABQ score was not explained by limitation in HBB ROM and shoulder movements. CONCLUSION: These findings suggest that this novel method of measuring HBB ROM could be used as a functional outcome measure in the evaluation of patients with shoulder disorders. This method could be considered as an additional or alternative where there are challenges in measuring HBB because of restrictions in undressing a patient, such as for cultural reasons.

A review of postoperative pain assessment records of nurses.

Background: Although there are many recommendations and guidelines for adequate pain assessment, the quality of postoperative pain documentation does not meet the acceptable standards. Aim: The aim of the study is to review the pain assessment and analgesic records of nurses within the first 48 h in the postoperative period. Methods: This retrospective and descriptive study was conducted in a University Hospital. The records of a total of 421 patients who underwent surgery between January 2014 and January 2015 were analysed. The data of the patients were obtained using the patient files. Results: Pain assessment scale was not used, and the pain records did not include intensity, location, duration and quality of the pain. The analgesic records indicated that the highest percentage (70.8%) of analgesic use was within the first postoperative two hours. Diclofenac sodium was the most commonly administered and recorded analgesic, while pethidine HCl was the least used one. More than half of the all analgesic injections (63.9%) were administered by intramuscular route. No non-pharmacological intervention including massage, hot­cold application, or positioning was reported in the nursing records. Conclusion: The postoperative pain was not assessed properly as recommended in the acute pain guidelines. Therefore, nurses should increase the awareness on the pain assessment records for effective pain management. In addition, the administration of the hospital should support the use of standard pain assessment and recording via electronic patient record system, continue online education courses and give feedback on the records of nurses regarding pain management.

Association between composites of selected motion palpation and pain provocation tests for sacroiliac joint disorders.

BACKGROUND: The sacroiliac joint (SIJ) has been implicated as a potential source of low back and buttock pain. Several types of motion palpation and pain provocation tests are used to evaluate SIJ dysfunction. OBJECTIVE: The purpose of this study was to investigate the relationship between motion palpation and pain provocation tests in assessment of SIJ problems. DESIGN: This study is Descriptive Correlation. METHODS: 50 patients between the ages of 20 and 65 participated. Four motion palpation tests (Sitting flexion, Standing flexion, Prone knee flexion, Gillet test) and three pain provocation tests (FABER, Posterior shear, Resisted abduction test) were examined. Chi-square analysis was used to assess the relationship between results of the individuals and composites of these two groups of tests. RESULTS: No significant relationship was found between these two groups of tests. CONCLUSIONS: It seems that motion palpation tests assess SIJ dysfunction and provocative tests assessed SIJ pain which do not appear to be related.

Use of the Pain Assessment Screening Tool and Outcomes Registry in an Army Interdisciplinary Pain Management Center, Lessons Learned and Future Implications of a 10-Month Beta Test.

INTRODUCTION: The U.S. Army Comprehensive Pain Management Campaign Plan was launched in 2010 to improve pain outcomes in military populations. Interdisciplinary Pain Management Centers (IPMCs) were established at every Army medical center, each offering a robust array of treatment options including conventional and complementary and integrative medicine (CIM) pain management therapies. The Pain Assessment Screening Tool and Outcomes Registry (PASTOR) was developed to assess and track biopsychosocial aspects of pain management and to identify best treatment practices. METHODS: During a 10-month pilot test of PASTOR at one Army IPMC, active duty patients completed PASTOR at baseline and at significant junctures during their therapeutic course. RESULTS: 322 IPMC patients completed baseline and follow-up PASTOR assessments. The PASTOR outcomes were analyzed for patients who completed a 3- to 6-week CIM program, a 3-week functional restoration program, or both. For most PASTOR domains, a greater proportion of patients who completed both programs reported important improvement compared with patients who completed either program alone. CONCLUSIONS: This pilot test demonstrated the utility of using PASTOR in a military IPMC to track biopsychosocial treatment outcomes. These preliminary data will inform future comparative effectiveness analyses of pain therapies among military and veteran populations.

Combined femoral and sciatic nerve block versus femoral and local infiltration anesthesia for pain control after total knee arthroplasty: a meta-analysis of randomized controlled trials.

BACKGROUND: The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the effect of combined femoral and sciatic nerve block (SNB) versus femoral and local infiltration anesthesia (LIA) after total knee arthroplasty (TKA). METHODS: The electronic databases PubMed, Embase, Cochrane Library, and Web of Science were searched from their inception to 15 June 2016. Articles comparing combined femoral and SNB versus femoral and LIA for pain control were eligible for this meta-analysis. This systematic review and meta-analysis was performed according to the PRISMA statement criteria. The primary endpoint was the visual analogue scale (VAS) score with rest at 12, 24, and 48 h, which represents the pain control after TKA. Data regarding active knee flexion, length of hospital stay, anesthesia time, and morphine use at 24 and 48 h were also compiled. The complications of postoperative nausea and vomiting (PONV) and fall were also noted to assess the safety of morphine-sparing effects. After testing for publication bias and heterogeneity across studies, the data were aggregated for random-effects modeling when necessary. RESULTS: Seven clinical trials with 615 patients were included in the meta-analysis. The pooled results indicated that SNB was associated with a lower VAS score at 12 h (MD = -6.96; 95% CI -8.36 to -5.56; P < 0.001) and 48 h (MD = -2.41; 95% CI -3.90 to -0.91; P < 0.001) after TKA. There was no significant difference between the SNB group and the LIA group in terms of the VAS score at 24 h (MD = 0.67; 95% CI -0.31 to 1.66; P = 0.182). The anesthesia time in the LIA group was shorter than in the SNB group, and the difference was statistically significant (MD = 4.31, 95% CI 1.34 to 7.28, P = 0.004). There were no significant differences between the groups in terms of active knee flexion, length of hospital stay, morphine use, PONV, and the occurrence of falls. CONCLUSIONS: SNB may provide earlier anesthesia effects than LIA when combined femoral nerve block (FNB); however, there were no differences in morphine use, active knee flexion, and PONV between the groups. The LIA group spent less time under anesthesia, suggesting that LIA may offer a practical and potentially safer alternative to SNB.

Percepción del dolor en cistoscopia flexible con el uso de lidocaína intrauretral / Perception of pain in flexible cystoscopy using intraurethral lidocaine

OBJETIVO: La cistoscopia flexible es una técnica utilizada en el diagnóstico de la patología del tracto urinario inferior. El objetivo de este estudio es evaluar la eficacia del anestésico local intrauretral en la percepción del dolor en el paciente. MÉTODOS: Estudio observacional prospectivo no aleatorizado que incluye 142 hombres a los que se realiza cistoscopia flexible. Se dividen en dos grupos en función del uso o no de anestésico local intrauretral (Grupo 1: 70 hombres con anestésico intrauretral [lidocaína 2%]; Grupo 2: 72 hombres sin anestésico intrauretral). Se analiza escala visual analógica y cuestionario del dolor. Análisis estadístico con SPSS 17.0 y significación estadística p≤0,05. RESULTADOS: La edad media del grupo 1 fue de 64,7±10,3 años frente a 66,7±10,8 años en el grupo 2, sin diferencias significativas. La puntuación en la escala visual analógica en el grupo 1 fue 2,23±2,20 frente a 1,69±1,74 en el grupo 2 (p = 0,1). La intensidad del dolor total y actual en el cuestionario del dolor fue de 1,81 ± 0,87 y 1,66 ± 1,65, respectivamente, en el grupo 1 y de 1,72 ± 0,72 y 1,21±1,45, respectivamente, en el grupo 2 (no diferencias significativas). Tras dividir a los pacientes en función de una puntuación en la escala visual analógica ≤ 2, se observa que la causa que motivó la cistoscopia es un factor independiente asociado a la percepción del dolor, incrementando el riesgo de percibir más dolor en 1,89. CONCLUSIÓN: El uso de anestésico local como lubricante previo a cistoscopia flexible no parece disminuir el dolor y consideramos que no está indicado de rutina en esta técnica diagnóstica

OBJECTIVE: The aim of this study is to evaluate the efficacy of a local intraurethral anesthetic on the pain perceived by the patient during flexible cystoscopy. METHODS: An observational, prospective, nonrandomized, study was conducted on 142 males subjected to a flexible cystoscopy. The patients were divided into two groups: Group 1: 70 patients with intraurethral anesthetic (lidocaine 2%), and Group 2:72 patients without intraurethral anesthetic. The results were scored on a visual analog scale and a pain questionnaire and analyzed. The statistical analysis was performed using SPSS 17.0 and with a statistical significance of p ≤ 0.05. RESULTS: The mean age of Group 1 was 64.7 ± 10.3 years compared to 66.7 ± 10.8 years in Group 2, with no significant differences. The score on the visual analog scale in Group 1 was 2.23 ± 2.20 versus 1.69 ± 1.74 in Group 2 (p = 0.1). The overall and current pain intensity in the pain questionnaire was 1.81 ± 0.87 and 1.66 ± 1.65, respectively, in Group 1, and 1.72 ± 0.72 and 1.21 ± 1.45, respectively, in Group 2 (no significant differences). After dividing the patients into groups according to a visual analog scale score ≤ 2, it was observed that the cause that led to cystoscopy was an independent factor associated with the perception of pain, increasing the risk of perceiving more pain by 1.89. CONCLUSIÓN: The use of local anesthetic as a lubricant prior to flexible cystoscopy does not appear to reduce pain, and we consider that its routine use is not indicated

Capsaicina 8 % parche frente a pregabalina oral en pacientes con dolor neuropático periférico / Capsaicin 8% patch versus oral pregabalin in patients with peripheral neuropathic pain

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