Quality of life in subgroups of individuals with whiplash-associated disorders.

BACKGROUND: The term whiplash associated disorders (WAD) includes a wide range of complaints, with neck pain as predominating symptom. Living with long term pain influences quality of life. In previous studies of other chronic pain patients, subgrouping has been made according to thermal pain thresholds measured in quantitative sensory testing (QST). AIMS: The aims of the present study are threefold, (1) to evaluate thermal pain thresholds and health related quality of life in WAD patients compared to healthy pain-free individuals, (2) to explore whether subgrouping of the WAD patients is possible according to thermal pain thresholds over trapezius, and if so (3) to explore differences between the subgroups. METHODS: Twenty-six patients with WAD and 18 healthy pain-free controls took part in the study. Thermal pain thresholds were measured in two sites (over the thenar and the trapezius muscle) using quantitative sensory testing (QST). Health related quality of life (HRQoL) was assessed using the SF-36. The visual analogue scale was used to rate pain intensity and unpleasantness related to the experimental situation. RESULTS: WAD patients are more sensitive to thermal pain, and scored lower on the SF-36 in all scales when compared with healthy pain-free individuals. After analyzing clusters (K-means algorithm) two subgroups of WAD emerge, pain insensitive and pain sensitive. The pain insensitive group differed significantly from the pain sensitive group in the Role Emotional subscale of SF-36 (p=0.025). CONCLUSIONS: Thermal pain hyperalgesia, especially for cold, seems to be a determinant for subgrouping WAD patients. These results support that such a classification of a heterogenous group could be of importance in tailoring treatment and early interventions.

Thermal thresholds and catastrophizing in individuals with chronic pain after whiplash injury.

Thermal sensitivity, thermal pain thresholds, and catastrophizing were examined in individuals with whiplash associated disorders (WAD) and in healthy pain-free participants. Quantitative sensory testing (QST) was used to measure skin sensitivity to cold and warmth and cold and heat pain thresholds over both the thenar eminence and the trapezius muscle (TrM) in 17 participants with WAD (age 50.8 +/- 11.3 years) and 18 healthy participants (age 44.8 +/- 10.2 years). The Pain Catastrophizing Scale (PCS) was used to determine pain coping strategies, and visual analogue scales were used for self-assessment of current background pain in individuals in the WAD group as well as experienced pain intensity and unpleasantness after QST and sleep quality in all participants. There were significant differences in warmth threshold and cold and heat pain thresholds of the TrM site between the WAD and pain-free groups. Significant differences between the two groups were also found for the catastrophizing dimension of helplessness in the PCS and in self-assessed quality of sleep. A correlational analysis showed that current background pain is significantly correlated with both cold discrimination and cold pain threshold in the skin over the TrM in individuals with WAD. These findings imply that thermal sensitivity is an important factor to consider in providing nursing care to individuals with WAD. Because biopsychosocial factors also influence the experience of pain in individuals with WAD, the role of nurses includes not only the description of the pain phenomenon but also the identification of relieving and aggravating factors.

Health experiences and employment status in subjects with chronic back pain: a long-term perspective.

The purpose of this study was to describe health experiences, focused on gender and return to work, in subjects with chronic low back pain in a long-term perspective. The convenient sample consisted of 12 subjects who had attended a pain rehabilitation program 6 years earlier. Typed interviews were transcribed, and a content analysis approach was used. Five categories were found: coping, root causes, control/influence, pain, and sleep. The interviews showed that the subjects expressed well-being, although pain had become part of their daily life. However, both gender and well-being group differences were identified. The women and the group with reduced well-being used the root causes category in a higher degree than the men and the well-being group did. The conclusion is that there are differences according to both gender and return to work within the subjects with chronic pain and that these differences are related to both root causes and coping pattern.

Headache and coping in a female working population.

Tension-type headache is a common disorder amongst working people and, because of its very high prevalence, represents one of the most costly ailments in modern society. To study the frequency of tension-type headache in a working female population and to investigate how females who have experienced tension-type headache cope with pain compared with the way healthy pain-free subjects cope with stress. A total of 400 females working at a university hospital in Sweden were asked about their experience of headache in the previous 3 months. Instruments used were a specific Headache Questionnaire, the Jalowiec Stress-coping Questionnaire and Coping Strategy Questionnaire. Before the study, approval from the board of directors and the employees' council was obtained. About 257 females (64.3%) answered the questionnaire and 78% of them (n = 199) reported that they had experienced headache in the previous 3 months. About 90% of the participants had never had an appointment with a doctor concerning headache and 57% reported a relationship between stress and headache. Regarding pain-coping strategy, increased pain behaviour was the most frequent strategy used. With regard to stress-coping style, a significant difference in the use of emotive style was found between females reporting headache and females not reporting headache. The results indicate that prevention programmes emphasizing stress management and coping may influence the experience of tension-type headache.

Work attendance despite headache and its economic impact: a comparison between two workplaces.

OBJECTIVE: To study work attendance despite headache in 2 different workplaces and its economic impact. BACKGROUND: Literature on the economic impact of headache traditionally has focused on direct costs. Little is known concerning headache experienced at work and its costs due to loss of effectiveness and productivity. METHOD: We sent a questionnaire to 800 employees in Sweden--400 at a technology company (private employee population) and 400 at a university hospital (public employee population). We attempted to assess the prevalence of headache, work attendance despite the presence of acute headache, and the impact of acute headache upon work effectiveness. Subjects self-scored decreased work effectiveness resulting from headache during the previous 3 months and recorded the number of days at work despite headache. From these data, we estimated the economic loss resulting from headache. RESULTS: The survey response rate was 71.5%. The prevalence of headache was 64% in the private employee population and 78% in the public employee population. Thirty-nine percent of the private employees and 57% of the public employees reported experiencing headache as a result of stress. Fifty percent reported that they went to work despite headache, and the mean number of days at work despite headache, during the previous 3 months, was 6.6 days in the private employee group and 6.1 days in the public employee group. A 25% decrease in work effectiveness was estimated, and, extrapolating from our data, we calculated the cost of lost effectiveness due to headache among employers in Sweden to be approximately 1.4 billion euros a year. CONCLUSION: The economic burden of headache experienced at work is substantial, suggesting that workplace-based treatment and prevention programs emphasizing stress management may be financially, as well as clinically, advantageous.

Coping strategies and life satisfaction in subgrouped fibromyalgia patients.

The present study describes pain- and stress-coping strategies and life satisfaction in subgroups of fibromyalgia patients. Thirty-two females with fibromyalgia syndrome (FMS) and 21 healthy pain-free women were studied. Those with FMS were classified as thermal (both heat and cold) pain sensitive or slightly cold pain sensitive based on pain thresholds determined using a Thermotest device. Global stress-coping styles, life satisfaction, and specific pain-coping strategies were measured. Patients classified as thermal pain sensitive were affected by physical symptoms to a greater extent than were those classified as slightly cold pain sensitive. The thermal pain sensitive group used more diverting attention coping strategies than the slightly cold pain sensitive group did. Separating fibromyalgia patients into subgroups might increase the potential for improving nursing care of these patients. Through the use of effective coping strategies in dealing with stress and pain, life satisfaction may also be enhanced.

Catastrophizing and health-related quality of life: a 6-year follow-up of patients with chronic low back pain.

A pain rehabilitation model that focused on emotions was implemented to influence catastrophizing by, and health-related quality of life (HRQL) for, persons with chronic low back pain. Twelve individuals, 7 men and 5 women (aged 33 to 57 years), all with long-term pain despite treatment, were included in the study and a single case research experimental design (SCRED) was used to follow the patterns of coping with pain for 6 years. The HRQL was measured before and 6 years after the intervention. Coping strategies and HRQL were evaluated with the Coping Strategy Questionnaire (CSQ) and the SF-36, respectively. The evaluation of pain coping strategies after 3 years found decreased catastrophizing, a decrease that had continued 3 years later. HRQL showed significantly improved mental health and impaired physical capacity at the 6-year follow-up. Changes in catastrophizing or in HRQL did not appear to influence self-scored bodily pain. Altered catastrophizing appeared to be a long-term process. This research indicates the need for rehabilitation programs to assess and evaluate patients' pain and their need for improved quality of life, rather than focusing only on the elimination of pain.

Background pain in fibromyalgia patients affecting clinical examination of the skin.

The purpose of this study was to investigate the relationship between on-going pain and acute thermal pain in patients suffering from chronic pain. This experimental study in cold and heat sensitivity was performed in order to test the following hypothesis: that fibromyalgia patients scoring high in current background pain tolerate less experimental thermal pain in the skin than patients with low scores. Ethical aspects of the study are discussed. The level of tolerable experimental thermal stimuli was tested and compared between the 'low-score' and the 'high-score' patients. Background pain seemed to affect the intensity of experimental cold pain. Clinical routine examinations and bodily care of the skin that might interfere with background pain in the fibromyalgia patients are discussed. Clinical practice should be carefully planned in order to assist fibromyalgia patients in understanding and coping with thermal conditions that might influence background pain.