The objective was to investigate the 3-year course of secondary chronic headaches (?15days per month for at least 3months) in the general population. An age and gender stratified random sample of 30,000 persons aged 30-44years from the general population received a mailed questionnaire. All with self-reported chronic headache, 517 in total, were interviewed by neurological residents. The questionnaire response rate was 71%. The rate of participation in the initial and follow-up interview was 74% (633/852) and 87% (83/95) respectively. The International Classification of Headache Disorders was used, and then in the next step the Cervicogenic Headache International Study Group and American Academy of Otolaryngology criteria were used in relation to cervicogenic headache (CEH) and headache attributed to chronic rhinosinusitis (HACRS). Of those followed-up, 40 had headache attributed to head and/or neck trauma (chronic posttraumatic headache), 0 had CEH and 0 had HACRS according to the ICHD-II criteria, while 18 had CEH according to the Cervicogenic Headache International Study Group's criteria, and 37 had HACRS according to the criteria of the American Academy of Otolaryngology. The headache index (frequency×intensity×duration) was significantly reduced from baseline to follow-up in chronic posttraumatic headache and HACRS, but not in CEH. We conclude that secondary chronic headaches seem to have various course dependent of subtype. Recognizing the different types of secondary chronic headaches is of importance because it might have management implications.
In order to investigate the significance and outcome of self-reported pain and fibromyalgia (FM) in a female population, 214 women with initially self-reported pain were interviewed and examined in 1990 and 1995. In 1990 the sample was categorised into four pain status groups: 46 individuals (21%) with nonchronic (recurrent) pain, 69 (32%) with chronic regional pain 42 (20%) with chronic multifocal pain and 57 with chronic widespread pain (CWP). The last group comprised 39 (18%) women with FM, fulfilling the American College of Rheumatology 1990 criteria. The frequency of tender points, associated symptoms called historical variables and individuals with low education increased statistically significantly with increasing pain status. In 1995, 48 women had non-chronic pain (23%), 46 (21%) chronic regional pain, 39 (18%) chronic multifocal pain and 81 (38%) CWP; of these, 71 (33%) had FM. Eleven of the 39 women initially with FM no longer fulfilled the criteria. The risk of developing CWP among the 157 individuals with initially a lower pain status was statistically higher in women with chronic multifocal pain than in women with less pain extension. Self-reported pain constitutes a continuum of pain severity and thus of clinical and social significance. The overall outcome was poor with an increase of individuals with CWP and FM. The prognosis of chronic multifocal pain, CWP and FM was especially poor. About half of the women with non-chronic pain or chronic regional pain did not deteriorate. However, because the process of developing FM started with localised pain in most cases, self-reported pain of any severity confers a risk for developing FM. Identifying possible risk factors for FM are at present under study and will be presented separately in another report.
The aim of the study was to evaluate the outcome 6 years after completing a multiprofessional 8-week rehabilitation programme regarding the following objectives: (1) return to work, (2) level of activity and (3) pain intensity. Of 149 patients attending a rehabilitation programme, 122 were followed up after 6 years, through a structured telephone interview, and their present work situation, level of activity, sleeping habits, their estimated pain intensity and consumption of analgesics were recorded. The questions presented were the same as they had answered before entering the programme. The return-to-work rate was compared to 79 patients in a control group. At the 6-year follow-up, compared to before entering the programme, 52% had returned to work (P
A valid method for classifying chronic pain patients into more homogenous groups could be useful for treatment planning, that is, which treatment is effective for which patient, and as a marker when evaluating treatment outcome. One instrument that has been used to derive subgroups of patients is the Multidimensional Pain Inventory (MPI). The primary aim of this study was to evaluate a classification method based on the Swedish version of the MPI, the MPI-S, to predict sick leave among chronic neck and back pain patients for a period of 7 years after vocational rehabilitation. As hypothesized, dysfunctional patients (DYS), according to the MPI-S, showed a higher amount of sickness absence and disability pension expressed in days than adaptive copers (AC) during the 7-years follow-up period, even when adjusting for sickness absence prior to rehabilitation (355.8days, 95% confidence interval, 71.7; 639.9). Forty percent of DYS patients and 26.7% of AC patients received disability pension during the follow-up period. However, this difference was not statistically significant. Further analyses showed that the difference between patient groups was most pronounced among patients with more than 60days of sickness absence prior to rehabilitation. Cost-effectiveness calculations indicated that the DYS patients showed an increase in production loss compared to AC patients. The present study yields support for the prognostic value of this subgroup classification method concerning long-term outcome on sick leave following this type of vocational rehabilitation.
Fibromyalgia (FM) is a pain condition with associated symptoms contributing to distress. The Fibromyalgia Survey Diagnostic Criteria and Severity Scale (FSDC) is a patient-administered questionnaire assessing diagnosis and symptom severity. Locations of body pain measured by the Widespread Pain Index (WPI), and the Symptom Severity scale (SS) measuring fatigue, unrefreshing sleep, cognitive and somatic complaints provide a score (0-31), measuring a composite of polysymptomatic distress. The reliability and validity of the translated French version of the FSDC was evaluated.
The French FSDC was administered twice to 73 FM patients, and was correlated with measures of symptom status including: Fibromyalgia Impact Questionnaire (FIQ), Health Assessment Questionnaire (HAQ), McGill Pain Questionnaire (MPQ), and a visual analogue scale (VAS) for global severity and pain. Test-retest reliability, internal consistency, and construct validity were evaluated.
Test-retest reliability was between .600 and .888 for the 25 single items of the FSDC, and .912 for the total FSDC, with all correlations significant (p?
Cites: Qual Life Res. 2002 Sep;11(6):583-9212206579
Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark; Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark; Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark; ITmedico, Aarhus, Denmark; Perinatal Epidemiology Research Unit, Aarhus University Hospital, Aarhus, Denmark; and Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
?? Spinal cord stimulation (SCS) is increasingly gaining widespread use as a treatment for chronic pain. A widely used electronic registry could play a pivotal role in improving this complex and cost-?intensive treatment. We aimed to construct a comprehensive, universally available data base for SCS.
?? The design considerations behind a new online data base for SCS are presented; basic structure, technical issues, research applications, and future perspectives are described.
?? The Aarhus Neuromodulation Database covers core SCS treatment parameters, including procedure-?related details and complications, and features recording of key success parameters such as pain intensity, work status, and quality of life. It combines easy access to patient information with exhaustive data extraction options, and it can readily be adapted and expanded to suit different needs, including other neuromodulation treatment modalities.
?? We believe that the data base described in this article offers a powerful and versatile data collection tool suited for both clinicians and researchers in the field. The basic data base structure is immediately available on a no?-cost basis, and we invite our colleagues to make use of the data base as part of the efforts to further the field of neuromodulation.
To compare the abductor muscle function and trochanteric tenderness in patients operated with hemiarthroplasty using the direct lateral (DL) or posterolateral (PL) approach for displaced femoral neck fracture.
Prospective cohort study.
A secondary teaching hospital.
We enrolled 183 hips operated with hemiarthroplasty for displaced femoral neck fracture using the DL or PL approach.
Preoperatively, we evaluated the Harris hip score (HHS) and European Quality of Life-5 Dimensions (EQ-5D). At 1 year postoperatively, lucid patients were clinically examined to evaluate the Trendelenburg sign, abductor muscle strength with a dynamometer, and trochanteric tenderness with an electronic algometer. The 1-year HHS and EQ-5D were documented.
The primary outcome was the incidence of postoperative Trendelenburg sign, whereas the secondary outcomes included patients' reported limp, abductor muscle strength, trochanteric tenderness, HHS, and EQ-5D.
There were 48 patients (24 in the DL group and 24 in the PL group) who attended the 1-year clinical follow-up. The 2 groups were comparable (P > 0.05). The DL group showed a higher incidence of the Trendelenburg sign (9/24 vs. 1/24, P = 0.02) and limp (12/24 vs. 2/24, P = 0.004). Further analysis with logistic regression showed the surgical approach to be the only factor that resulted in the increment. No differences regarding HHS, EQ-5D, abductor muscle strength, algometer pressure pain threshold, and radiologic measurements were found (P > 0.05).
The incidence of the Trendelenburg sign and limp were significantly higher in the DL approach although this seemed not to influence abductor muscle strength or the incidence of trochanteric tenderness or compromise the clinical outcome.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Pain, among the most common symptoms of cancer, impacts on multiple domains of wellbeing. Significant numbers of patients continue to experience pain despite pharmacological interventions. Although there is evidence to suggest that acceptance of pain is related to better wellbeing among patients with chronic nonmalignant pain, little is known about acceptance of cancer pain. The purpose of this cross-sectional study was to determine the correlates of pain acceptance in 81 patients with advanced cancer and pain. Demographic, disease, and treatment-related information was collected, and patients completed measures of pain, physical, psychological, and social/relational wellbeing and pain acceptance. Multivariate regression models, using backward elimination, determined the correlates of each subscale of the Chronic Pain Acceptance Questionnaire separately. Activity Engagement was negatively associated with depressive symptoms. Pain Willingness was negatively associated with pain catastrophizing. Parents living with children had lower Pain Willingness scores than non-parents. These relationships were independent of pain severity and physical functioning. These preliminary results suggest that acceptance of cancer pain is related to better psychological wellbeing and that there may be a relational element, with parents at risk of experiencing difficulty in adapting to ongoing cancer pain. These data lay the groundwork for future research and interventions designed to enhance quality of life for patients with advanced cancer and pain.
This article aims to show how a discourse and communication based approach in the context of the care of the elderly provides a basis for reflecting on pain. Based on six hours of data from talk encounters between care professionals and elderly clients, an activity analysis of institutional settings and categorization of interactional discourse was undertaken. The focus was: (a) how elderly people initiated painful accounts, and (b) how the professionals oriented to such accounts. It is found that pain-talks are governed by the institutional practice of different phases:framing; mapping troubles and symptoms; clients' self presentations; counseling, and concluding. This phase structure exemplifies knowledge of communicative activities and is part of practical knowledge which the party, or at least the professional, is expected to become acquainted with. A thematic interactional map of critical moments related to pain as (a) social death and hope, and (b) presentation of self as past and self as present emerges. The caring aspect is to support hope and to change the focus from social death to life and recovering. In foregrounding health, it is important for the elderly people to affirm their identity of themselves as being good and honest persons.