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At least 667 records · Page 37Linked to original sources

PubMed2005

Responsiveness of the Roland-Morris Disability Questionnaire: consequences of using different external criteria.

OBJECTIVE: To determine the consequences of using different external criteria on responsiveness of the Roland-Morris Disability Questionnaire (RMDQ) in patients with chronic low back pain. DESIGN: Questionnaire measures before and after rehabilitation treatment. SETTING: Rehabilitation centre. SUBJECTS: Patients with nonspecific chronic low back pain, referred for treatment. MAIN MEASURES: The RMDQ was used to assess self-reported functional status. The used external criteria were: (1) global perceived effect of change in complaints; (2) global perceived effect of change in ability to take care of oneself; (3) change in rating of pain intensity; (4) smallest real difference. Standardized response means, pooled effect sizes and receiver operating curves were calculated to determine responsiveness and to enable comparison of effect sizes with the thresholds of Cohen. RESULTS: Standardized response means ranged from 1.33 to 3.45, pooled effect sizes ranged from 1.50 to 2.81, and areas under curves ranged from 0.76 to 1.00, dependent on the used external criterion. CONCLUSIONS: All pooled effect sizes were well above 0.80, and all other statistics were high, indicating good responsiveness of the RMDQ. However, considerable differences were found in responsiveness, when using different external criteria in a same study population. Therefore, it can be concluded that the magnitude of the responsiveness statistic depends on the used external criteria.

Activities of Daily Living↗

PubMed1999

[Gonarthrosis in primary care: can analytical and radiological tests de done away with?].

OBJECTIVES: To evaluate if the rheumatologic clinical criteria established for the diagnosis of knee osteoarthritis are valid in primary care and if it is possible to do without the laboratory and radiologic criteria. DESIGN: Descriptive study of the agreement between the diagnosis exclusively clinical and the clinical, laboratory and radiologic diagnosis according the American Rheumatism Association (ARA) criteria. SETTING: Population of the health area of Talavera de la Reina (Toledo). PATIENTS: People with one or both knees non referred pain during the previous month, in spite of their characteristics, length or periodicity. MEASUREMENTS AND RESULTS: The ARA and R.D. Altman clinical diagnosis criteria of knee osteoarthritis were applied to the sample and they were compared with the diagnosis obtained with the clinical, laboratory and radiological criteria (reference diagnosis). The clinical diagnosis of knee osteoarthritis was established according the ARA criteria in 93% cases, according Altman in 86% and according the reference diagnosis in 87%. The sensibility and positive predictive value obtained using both clinical criteria are high, but the specificity is very low. CONCLUSIONS: The clinical criteria can be used in primary care, although they have a low specificity. It could be necessary to establish new criteria to ameliorate the specificity and the handling of these patients in primary care, to avoid unnecessary explorations.

Adult↗

PubMed1995

Shoulder pain: a diagnostic dilemma.

The etiology of shoulder pain can usually be placed into one of five categories: fracture and/or contusion, shoulder separation involving the clavicle, instability of the glenohumeral joint, impingement syndrome involving the rotator cuff or biceps tendinitis, and frozen shoulder. Non-shoulder pathology, such as cervical strain, thoracic outlet syndrome and referred pain from phrenic nerve irritation, should be excluded when evaluating patients presenting with shoulder pain. After inflammatory or infectious arthritis has been ruled out, the history should point to either acute trauma or an overuse injury. Physical examination may provide information about neurovascular status, palpable tenderness, range of motion, strength, instability and impingement. Radiographic studies are usually indicated in patients with a history of trauma, but they are often not necessary in the initial evaluation of overuse injuries. Magnetic resonance imaging and arthrograms should be reserved for patients who have not responded to six to eight weeks of conservative treatment and are candidates for surgery.

Acromioclavicular Joint↗

PubMed1992

A simplified method of laparoscopic presacral neurectomy for the treatment of central pelvic pain due to endometriosis.

OBJECTIVE: To describe optimal procedures and preliminary results for videolaparoscopic presacral neurectomy as part of the surgical treatment of endometriosis associated with intractable dysmenorrhoea. DESIGN: Observational study with follow up for at least one year. SETTING: Subspecialty practice: Endometriosis Clinic and Centre for Special Pelvic Surgery. SUBJECTS: Eighty five women (18-45 years) with endometriosis and intractable pain, referred because medical and surgical management had failed. Subjects without a central (midline) component to their discomfort were excluded. INTERVENTIONS: Excision and vaporization of endometriotic pathology was followed by presacral neurectomy. OUTCOME MEASURES: During surgery, severity of endometriosis was assessed using revised American Fertility Society scoring. Overall pelvic pain and dysmenorrhoea relief were determined by office visit, telephone interview and questionnaire at a minimum of one year postoperatively. RESULTS: There were no operative complications and all women left hospital within 24 h of surgery. Overall pain relief was reported by 49 (94%) of 52 patients followed. The other three subjects noted no pain abatement. Dysmenorrhoea was reduced in 48 (92%) whereas four (8%) women claimed no relief. CONCLUSIONS: Laparoscopic presacral neurectomy is an option for treating dysmenorrhoea and pelvic pain in selected women, but is indicated only if medical management has failed. Videolaparoscopic presacral neurectomy using the CO2 laser is safe in trained hands. Pain relief achieved is within the range reported for laparotomy.

Adolescent↗

PubMed1993

A Pain Rating Scale and a Pain Behavior Checklist for clinical use: development, norms, and the consistency score.

A Pain Rating Scale [PRS] and a Pain Behavior Checklist [PBC] were developed for use during a clinical pain interview. Norms were based on 395 chronic pain patients referred for pain management. The PRS obtained ratings of present pain, and worst and least pain during the previous 30 days. The PBC recorded 16 pain behaviors during the 45- to 60-min interview. Normative data were given for seven measures: (1) worst pain rating, past month; (2) least pain rating, past month; (3) present pain rating; (4) difference between worst and least pain ratings; (5) pain behavior score; (6) total pain score (based on Nos. 1, 2, 3, and 5), and (7) consistency score. The consistency score reflects the agreement (or discrepancy) between the pain behavior and present pain ratings. A moderate overall relationship was found between pain behavior and present pain ratings (r = 0.46, p < 0.001). The frequency of good agreement between pain behavior and present pain ratings was unaffected by sex, race, age, pain site, type of injury, duration of pain, legal representation, and evaluating psychologist; but it varied markedly with conscious symptom magnification. Patients seen as consciously exaggerating pain (n = 127) gave higher pain ratings (all p values < 0.001); and had frequent (64.6%) discrepancies between their pain report and pain behavior compared to others (14.2%). The report of present pain was unrelated to pain behavior for conscious exaggerators (r = 0.04, NS); in contrast there was a moderately high relationship for other patients (r = 0.68, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗

PubMed1992

Patellar resurfacing for patellofemoral arthritis.

Knee pain referable to the patellofemoral articulation is common in the general population. It remains a troubling problem for the orthopedic surgeon. Frequently, initial therapy, involving activity modification, anti-inflammatory medications, and isometric quadriceps strengthening, is successful in relieving symptoms. Surgical intervention is normally reserved for those patients with pain that is resistant to these modalities. Unfortunately, none of the various surgical options has proved to be totally dependable, durable, or reproducible. The results of isolated patellar and patellofemoral resurfacing procedures have been guarded. Patellar resurfacing appears to be most beneficial in younger patients with severe anterior knee pain. These individuals should be clearly warned that there is a relatively high likelihood that they will require additional surgical treatment or patellectomy at a later date. Fortunately, patellar resurfacing does not preclude patellectomy from being easily performed. Patellofemoral resurfacing, however, involves more overall involvement of the knee joint. This makes patellectomy less likely to be a successful salvage procedure. Despite our observations that knees with primary patellofemoral arthritis do not do as well after total knee replacement as those with tibio-femoral arthritis, this procedure remains the best treatment option. The durability and predictability of total knee arthroplasty are well documented. Its results far surpass those reported for isolated resurfacing procedures. With regard to patellar resurfacing as part of total knee arthroplasty, we recommend resurfacing all patellae. The literature, although not conclusive, lends support to this practice. Avoidance of metal-backed patellar components and special attention to technical details should decrease the complications associated with patellar resurfacing in future studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthritis↗

PubMed1976

Stimulus-evoked pain in teeth.

When pain occurs in teeth as a result of external stimulation it is more likely to be due to physical factors affecting the enamel and dentine than to pulp disease. The mechanisms are described, clinical conditions are mentioned and a speculative attempt is made to correlate them by introducing the idea of streaming potentials in the dentine and pulp. The pain perception threshold is considered in relation to different teeth, age, sex, lateral dominance, personality, and the area of electrode contact. The latter has proved interesting, for manipulation of it has led to possibly important findings on the nature of convergence in the trigeminal system, two-point discrimination, referred pain and somatopic representation of dental pulps in the medulla oblongata.

Age Factors↗

PubMed1994

The occurrence and inter-rater reliability of myofascial trigger points in the quadratus lumborum and gluteus medius: a prospective study in non-specific low back pain patients and controls in general practice.

The presence of a trigger point is essential to the myofascial pain syndrome. This study centres on identifying clearer criteria for the presence of trigger points in the quadratus lumborum and gluteus medius muscle by investigating the occurrence and inter-rater reliability of trigger point symptoms. Using the symptoms and signs as described by Simons' 1990 definition and two other former sets of criteria, 61 non-specific low back pain patients and 63 controls were examined in general practice by 5 observers, working in pairs. From the two major criteria of Simons' 1990 definition only 'localized tenderness' has good discriminative ability and inter-rater reliability (kappa > 0.5). This study does not find proof for the clinical usefulness of 'referred pain', which has neither of these two abilities. The criteria 'jump sign' and 'recognition', on the condition that localized tenderness is present, also have good discriminative ability and inter-rater reliability. Trigger points defined by the criteria found eligible in this study allow significant distinction between non-specific low back pain patients and controls. This is not the case with trigger points defined by Simons' 1990 criteria. Concerning reliability there is also a significant difference between the two different criteria sets. This study suggests that the clinical usefulness of trigger points is increased when localized tenderness and the presence of either jump sign or patient's recognition of his pain complaint are used as criteria for the presence of trigger points in the M. quadratus lumborum and the M. gluteus medius.

Adult↗

PubMed2005

The transition from acute to subacute and chronic low back pain: a study based on determinants of quality of life and prediction of chronic disability.

STUDY DESIGN: Follow-up study. OBJECTIVES: To document differences between acute and subacute low back pain (LBP) based on the risk of developing chronic disability and on the correlation between pain, disability, and quality of life. SUMMARY OF BACKGROUND DATA: The subacute stage should identify the time in which the risk of developing chronic disability increases and specific measures should be considered, but its definition is currently inconsistent. METHODS: 366 patients were given Visual Analog Scales (VAS) for LBP and referred pain (RP), Roland-Morris questionnaires (RMQs), and EuroQol (EQ) questionnaires on their first visit and 14 and 59 days later. RESULTS: Median duration of pain when entering the study was 4 days (P25, P75: 2,10). Simple correlations among LBP, VAS, and RMQ were r = 0.407 (day 1), 0.688 (day 15), and 0.739 (day 60). Among LBP, VAS, and EQ, r = -0.523, r = -0.701, and r = -0.760. Among RP, VAS, and RMQ, r = 0.280, r = 0.561, and r = 0.583. Between RP, VAS, and EQ, r = -0.306, r = -0.534 and r = -0.600. Between RMQ and EQ, r = -0.650, r = -0.765 and r = -0.815. In 42 patients, disability did not improve throughout the study period, and a prestudy duration of > or = 14 days was the only independent predictor. All these models were significant at the P < 0.007 level. Improvement in quality of life was more likely to occur in patients in which disability improved [odds ratio (OR), 18.29; 95% CI; 8.64, 38.73; P < 0.001]. As opposed to acute patients, in those with a prestudy duration of pain of > or = 14 days, on day 60 RP had no influence on disability, and LBP had no influence on quality of life. CONCLUSION: LBP influences disability and quality of life more than RP. Disability is predicted by pain duration and quality of life is predicted by disability, but pain severity predicts neither one of them. Changes related to determinants of disability and quality of life, and to the prediction of chronic disability, appear 14 days after the onset of pain, supporting that cutoff point for considering a patient as being subacute.

Acute Disease↗

PubMed1975

Pain suppression by peripheral nerve stimulation. Part I. Observations with transcutaneous stimuli.

A systematic, strict appraisal was made of 100 patients, after preliminary clinical trials suggested that some patients with pain could be helped by peripheral nerve stimulation. Transcutaneous stimulation of different nerve trunks was done with a special electrical stimulation device with various selected electrical parameters. More than half of the patients experienced some relief; in many, this effect was obtained by stimulating nerves distant from the area of referred pain. Pain relief lasted for varying periods after stimulation. The maximum benefit was noticed after certain specific parameters were reached for each patient. A few patients had response decay, gain or worsening. Results differ to some degree from previous reports. The results seem encouraging for the treatment of certain forms of intractable pain.

Adolescent↗

PubMed1984

Myofascial trigger points in persistent posttraumatic shoulder pain.

Persistent pain and disability after injuries to the shoulder sometimes create a difficult diagnostic and therapeutic problem. In many such cases, myofascial trigger points seem to cause symptoms. Three cases in which pain had persisted for eight to 33 months after injury illustrate the manifestations of posttraumatic myofascial trigger point disorders. Trigger points are located by finding discrete foci of tenderness in muscles. Trigger points may be palpably firmer than surrounding muscle, forming nodules; they may twitch in response to palpation and may refer pain to a specific area when stimulated. Failure to recognize the myofascial source of pain can lead to erroneous diagnoses of articular, neurologic, or emotional disorder. Current pathophysiologic theories about trigger points may explain the persistence and topographic spreading of pain after muscular injuries. Appropriate treatment of myofascial trigger points can relieve chronic pain and disability.

Accidents, Occupational↗

PubMed1988

Neck pain.

Six conditions cause most of the neck pain complaints seen by primary care physicians: cervical muscle strain or sprain, torticollis, acceleration injury, myofascial pain dysfunction syndrome, and cervical osteoarthritis or rheumatoid arthritis. Most of them can be diagnosed and treated by the primary care physician. Of the more unusual causes, one should not miss a clinical fracture; a herniated cervical disc, spinal cord compression from a disc, or epidural tumor; infection of the disc or the vertebral body; subluxation of the vertebral bodies; or pain referred from the chest or mediastinal structures. MRI offers new opportunity for early diagnosis of myelopathy owing to OA or RA, vertebral osteomyelitis, and metastatic involvement of cervical vertebrae.

Humans↗

PubMed1998

Interobserver reliability of detecting lumbar intervertebral disc high-intensity zone on magnetic resonance imaging and association of high-intensity zone with pain and anular disruption.

STUDY DESIGN: Retrospective analysis of a spine imaging center's records of patients with chronic low back pain referred by tertiary care facilities. OBJECTIVES: 1) To assess the interobserver reliability of detecting lumbar intervertebral disc high-intensity zone on T2-weighted magnetic resonance imaging, and 2) to assess the relation between high-intensity zone and discography or post-computed tomography in symptomatic patients with low back pain. SUMMARY OF BACKGROUND DATA: Two of the three previous studies on this subject found an association between high-intensity zone and the presence of Grade 4 anular disruption with discographic reproduction of patients' exact low back pain. METHODS: Records of patients with low back pain who had undergone lumbar spine discography injection and post-computed tomography from June 1995 to August 1996 were reviewed. Two independent observers were asked to identify the presence of an high-intensity zone from the T12-L1 disc to L5-S1 on T2-weighted magnetic resonance images. With this data, interobserver reliability was assessed with the kappa statistic. Concordant high-intensity zone results were then compared with the Dallas Discogram rating for anular disruption and to patients' subjective pain response to discography injection. With this data, the sensitivity, specificity, and predictive values of high-intensity zone for detecting disc disruption and pain response were calculated. RESULTS: The interobserver reliability for detecting a high-intensity zone in a given disc was fair to good (kappa = 0.57; 95% confidence interval = 0.44, 0.70). The sensitivity of high-intensity zone for detecting Grade 4 anular disruption and exact pain was poor (31%) but its specificity was relatively high (90%). The positive predictive value of a high-intensity zone was low (40%) for a severely disrupted and exactly painful disc. CONCLUSIONS: The interobserver reliability of detecting a high-intensity zone and the positive predictive value of the presence of a high-intensity zone for detecting a severely disrupted and exactly painful disc were much lower than previous studies have shown. The relatively low positive predictive value may be attributable to differences in sample characteristics or procedural variations, or suggest that a high-intensity zone is not indicative of exactly painful internal intervertebral disc disruption.

Adult↗

PubMed2005

Effect of dry needling of gluteal muscles on straight leg raise: a randomised, placebo controlled, double blind trial.

OBJECTIVES: To use a randomised, double blind, placebo controlled trial to establish the effect on straight leg raise, hip internal rotation, and muscle pain of dry needling treatment to the gluteal muscles in athletes with posterior thigh pain referred from gluteal trigger points. METHODS: A randomised, double blind, placebo controlled trial of 59 male runners was performed during the 2002 Australian Rules football season. Subjects were thoroughly screened and had magnetic resonance imaging of their hamstring muscles to exclude local pathology. The inclusion criterion was reproduction of recognisable posterior thigh pain with the application of digital pressure to the gluteal trigger points. Subjects randomly received either therapeutic or placebo needle treatment on one occasion at their gluteal trigger points. Range of motion and visual analogue scale data were collected immediately before, immediately after, 24 hours after, and 72 hours after the intervention. Range of motion was measured with passive straight leg raise and hip internal rotation. Visual analogue scales were completed for hamstring and gluteal pain and tightness at rest and during a running task. RESULTS: Magnetic resonance imaging scans revealed normal hamstring musculature in most subjects. Straight leg raise and hip internal rotation remained unchanged in both groups at all times. Visual analogue scale assessment of hamstring pain and tightness and gluteal tightness after running showed improvements immediately after the intervention in both groups (p = 0.001), which were maintained at 24 and 72 hours. The magnitude of this improvement was the same for therapeutic and placebo interventions. Resting muscle pain and tightness were unaffected. CONCLUSIONS: Neither dry needling nor placebo needling of the gluteal muscles resulted in any change in straight leg raise or hip internal rotation. Both interventions resulted in subjective improvement in activity related muscle pain and tightness. Despite being commonly used clinical tests in this situation, straight leg raise and hip internal rotation are not likely to help the therapist assess response to treatment. Patient reports of response to such treatment are better indicators of its success. The mechanisms by which these responses occur and the reasons for the success of the placebo needling treatment are areas for further investigation.

Acupuncture Therapy↗

PubMedDate not supplied

[Acute pain in "Don Quixote"].

OBJECTIVE: A descriptive analysis of references to pain symptoms in Don Quixote based on linguistic, literary, clinical, and mannerist features. METHODS AND MATERIAL: Don Quixote was read and an entry was created for each description of an injury or illness (group I/I). A second group of entries was created for each medical commentary (group C). This information was complemented using a computer search for the roots of words referring to pain symptoms, with an asterisk placed after each root to locate all word forms used. Data entries with pain references were analyzed in group I/I by examining patient, location, characteristics, causes, associated disorders, remedies, caregivers, and recovery times and in group C by examining the full text. RESULTS: Ninety-one entries were made (64 in group I/I, 27 in group c). References to pain were found in 37 entries (29 in group I/I, 8 in group C). The most commonly used words came from the roots dol (the Spanish root for dolor, or pain, among other related words) (52) and moli (for forms related to Spanish idiomatic uses of molido, suggesting severe injury) (19). All pains were due to injuries. Forty-two occasions of injury (Don Quixote 14, Sancho 9, others 19) and 51 lesions (ribs 5, back 5, other 15, unspecified 26) were mentioned. Known remedies and caregivers of the period were described, but other invented ones were also present. Associated disorders were insomnia, anxiety, rage, melancholy, functional impotence and other sexual dysfunctions. Recovery times ranged from 0 to 8 days. CONCLUSION: Pain references are subject to literary considerations. The style is simple and the descriptions are credible for the period depicted but do not meet clinical standards. Issues of current interest are treated: pain threshold and sensitivity, social influences, the placebo effect, and affective disorders.

Acute Disease↗

PubMedDate not supplied

Alexithymia and somatic amplification in chronic pain.

A controlled study was undertaken to assess alexithymia and somatic amplification among 50 medical outpatients with chronic pain referred for psychiatric consultation. Data were collected on demographics; DSM-IV diagnoses; and measures of anxiety, depression, and alexithymia, assessed with the Toronto Alexithymia Scale (TAS-20), as well as somatic amplification, assessed with the Somatosensory Amplification Scale (SAS). Data analysis revealed low scores on the TAS-20 and SAS for the pain patients, compared with a control group without pain. In this sample, depression and anxiety were the primary determinants of alexithymia and somatic amplification, rather than pain. These findings suggest that psychological markers for chronic pain may be different from those for other somatoform disorders.

Affective Symptoms↗

PubMed1995

Cervicogenic headache: a personal view.

Cervicogenic headache describes pain referred along the upper three cervical roots and is a common source of headache in the over fifties. A review of clinical features, anatomy, and investigations using neural blockade shows several clinical pictures. Diseases of the cranio-vertebral junction, e.g. syringomyelia, and tonsilar descent, can produce mechanical or hydrodynamic head and neck pain. Pre-existent migraine and tension headache may be precipitated or aggravated by cervical spondylosis, but the anatomical mechanism is unclear. Headaches which arise from and are primarily caused by disorders in the cervical spine are exemplified by spondylosis and acute whiplash injury, but are usually transient. Evidence for a cervicogenic mechanism of chronic whiplash headache is, however, lacking.

Cervical Vertebrae↗

PubMed1995

Randomised controlled trial for evaluation of fitness programme for patients with chronic low back pain.

OBJECTIVE: To evaluate a progressive fitness programme for patients with chronic low back pain. DESIGN: Single blind randomised controlled trial. Assessments were carried out before and after treatment by an observer blinded to the study and included a battery of validated measures. All patients were followed up by postal questionnaire six months after treatment. SETTING: Physiotherapy department of orthopaedic hospital. SUBJECTS: 81 patients with chronic low back pain referred from orthopaedic consultants for physiotherapy. The patients were randomly allocated to a fitness programme or control group. INTERVENTION: Both groups were taught specific exercises to carry out at home and referred to a back-school for education in back care. Patients allocated to the fitness class attended eight exercise classes over four weeks in addition to the home programme and backschool. RESULTS: Significant differences between the groups were shown in the changes before and after treatment in scores on the Oswestry low back pain disability index (P < 0.005), pain reports (sensory P < 0.05 and affective P < 0.005), self efficacy reports (P < 0.05), and walking distance (P < 0.005). No significant differences between the groups were found by the general health questionnaire or questionnaire on pain locus of control. A benefit of about 6 percentage points on the disability index was maintained by patients in the fitness group at six months. CONCLUSION: There is a role for supervised fitness programmes in the management of moderately disabled patients with chronic low back pain. Further clinical trials, however, need to be established in other centres to confirm these findings.

Adult↗