Pain measures and cut-offs – ‘no worse than mild pain’ as a simple, universal outcome
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TLDR
The patient had pain that was borderline severe, and it was not treated, and for him the reasons behind the failure were of little interest.Abstract:
Now admittedly the patient in question had undergone a life-saving operation in a brand new hospital staffed by some wonderful and talented people. However, a pain score of 6/10 is not mild, but borderline between moderate and severe, and the patient did need something for that. Was the nurse ignorant of what pain scores meant, or was it just that caring professionals typically underestimate patients’ pain [1]? Both these questions are deserving of research, but for this patient, the only point is that the system failed him, and for him the reasons behind the failure were of little interest. He had pain that was borderline severe, and it was not treated. This is not uncommon. A fairly recent survey of Italian hospital wards came to the hardly original conclusion that those wards in which less analgesic was prescribed had higher rates of patients experiencing severe pain than those where more analgesics were prescribed [2]; Fig. 1 shows the clear inverse relationship between the presence of severe pain and the percentage of patients treated for their pain. There is a wealth of evidence that pain is poorly treated, and that significant proportions of patients suffer from moderate or severe pain, whether it is acute pain in hospital [3] or chronic pain in the community [4, 5]. Barriers to progress are many and varied, but one particular and important barrier is a degree of confusion about pain scoring systems and what they mean. How does a simple categorical verbal rating system (no pain, mild, moderate, severe) relate to a 100-mm visual analogue scale (VAS) or an 11-point numerical rating scale (NRS)? Does it matter what the anchors are at each end? Where are the boundaries for moderate or severe pain? What is the minimal clinically significant difference? Does it matter whether the scale has been ‘validated’ in Welsh, or Farsi, or Urdu? All of which makes for terrific grist forread more
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Journal ArticleDOI
Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11).
Rolf-Detlef Treede,Winfried Rief,Antonia Barke,Qasim Aziz,Michael I. Bennett,Rafael Benoliel,Milton Cohen,Stefan Evers,Nanna B. Finnerup,Michael B. First,Maria Adele Giamberardino,Stein Kaasa,Beatrice Korwisi,Eva Kosek,Patricia Lavand'homme,Michael K. Nicholas,Serge Perrot,Joachim Scholz,Stephan A. Schug,Stephan A. Schug,Blair H. Smith,Peter Svensson,Peter Svensson,Johan W.S. Vlaeyen,Johan W.S. Vlaeyen,Shuu Jiun Wang,Shuu Jiun Wang +26 more
TL;DR: In conditions such as fibromyalgia or nonspecific low-back pain, chronic pain may be conceived as a disease in its own right; in this proposal, this subgroup is called “chronic primary pain,” and in 6 other subgroups, pain is secondary to an underlying disease.
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Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews.
TL;DR: The quality of evidence was low due to participant numbers, length of intervention and follow‐up, and the evidence for any adverse effects or harm associated with physical activity and exercise interventions, though even these statistically significant results had only small‐to‐moderate effect sizes.
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Topical capsaicin (high concentration) for chronic neuropathic pain in adults
TL;DR: The information the authors have suggests that low-concentration topical capsaicin is without meaningful effect beyond that found in placebo creams; given the potential for bias from small study size, this makes it unlikely that it has any meaningful use in clinical practice.
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Cannabis‐based medicines for chronic neuropathic pain in adults
TL;DR: To assess the efficacy, tolerability, and safety of cannabis-based medicines (herbal, plant-derived, synthetic) compared to placebo or conventional drugs for conditions with chronic neuropathic pain in adults, randomised, double-blind controlled trials are selected.
Journal ArticleDOI
Gabapentin for chronic neuropathic pain in adults
Philip J Wiffen,Sheena Derry,Rae Frances Bell,Andrew S.C. Rice,Thomas R. Tölle,Tudor Phillips,R Andrew Moore +6 more
TL;DR: Gabapentin is commonly used to treat neuropathic pain (pain due to nerve damage) and adverse effects in adults as discussed by the authors, and it has been shown that patients with substantial pain relief (at least 50% pain relief over baseline or very much improved on Patient Global Impression of Change scale (PGIC)) were more common with gabapentin than with placebo.
References
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TL;DR: The results indicate that if a patient records a baseline VAS score in excess of 30 mm they would probably have recorded at least moderate pain on a 4‐point categorical scale.
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