Showing papers on "Pain scale published in 1995"

Which outcome measures should be used in rheumatoid arthritis clinical trials

Abstract: Objective. To determine the discriminant validity of the core set of outcome measures proposed by the American College of Rheumatology (ACR) and the Outcome Measures in Clinical Trials (OMERACT) conference committee to be used in clinical trials of rheumatoid arthritis (RA). Methods. Utilizing data from a multicenter randomized double-blind clinical trial of low-dose cyclosporine and placebo in RA, we estimated the relative efficiency (RE) of measures to detect a treatment effect (relative to tender joint count, which was assigned a value of 1). Four pain measures (10-cm visual analog scale [VAS], 5-point categorical scale, Health Assessment Questionnaire [HAQ] pain index, Arthritis Impact Measurement Scales [AIMS] pain score) and 3 quality-of-life measures (Problem Elicitation Technique [PET], HAQ, AIMS) were compared. Results. Physician and patient global measures were the most responsive instruments, although neither was statistically superior to tender joint count. Swollen joint count, grip strength, pain measured on a 10-cm VAS, and functional status as measured by the PET and HAQ were all of intermediate responsiveness. Morning stiffness, 5-point pain scale, and erythrocyte sedimentation rate were the least responsive instruments. Conclusion. This study provides further evidence to support the core set of outce measures proposed by the ACR and OMERACT.

Measuring health status in psoriatic arthritis: the Health Assessment Questionnaire and its modification.

Abstract: Objective The Health Assessment Questionnaire (HAQ) has proven to be a reliable and valid measure of outcome for a variety of arthritides A recent modification of HAQ for spondyloarthropathy (HAQ-S) has also been reported Our purpose was to evaluate the HAQ and HAQ-S as outcome measures in the assessment of patients with psoriatic arthritis (PsA) Methods The HAQ, including HAQ-S was administered to all patients attending our Psoriatic Arthritis Clinic between June and December, 1993 Clinical and radiological assessments were performed according to a standard protocol that measures disease activity, fibrositic tender points (TP), disease severity and damage Analysis was performed using SAS for the PC Results The patient population included 114 patients, 70 men and 44 women with a mean age of 493 years and a mean arthritis duration of 151 years The mean HAQ score was 050, while the mean HAQ-S score was 053 (scores range 0 to 3 for this instrument) The overall HAQ and HAQ-S disability scores were highly correlated with several clinical measures of function, including grip strength (r = -063 and -059, respectively) American College of Rheumatology functional class (r = 059 and 060, respectively), as well as the number of fibrositic TP (r = 054 and 057, respectively) These disability scores also correlated highly with the overall number of actively inflamed joints (r = 049 and 050, respectively); however, they correlated only moderately or poorly with other measures of disease activity such as morning stiffness, total number of joint effusions, erythrocyte sedimentation rate (ESR) and the PASI score for psoriasis and with all measures of disease severity A similar pattern of correlations was found between the individual subscales of the HAQ and HAQ-S and the clinical measures of function, activity, and severity, as well as between the pain scale and the various clinical measures However, the correlations are generally lower Conclusion Our data suggest that HAQ and HAQ-S capture clinical measures of function and pain in PsA but do not correlate with disease severity The HAQ and its modification for spondyloarthropathy may reflect fibromyaglia as a measure of pain and tenderness in these patients Thus, the clinical assessment of disease activity and both clinical and radiological assessments of joint damage remain important outcome measures in PsA

Self-administered nitrous oxide and a hematoma block for analgesia in the outpatient reduction of fractures in children.

Abstract: We prospectively studied the efficacy and safety of self-administered nitrous oxide combined with a hematoma block in 100 children who had a closed reduction of a fracture in the emergency department. No child was excluded from the study because of the type of fracture. The average Children's Hospital of Eastern Ontario pain score (CHEOPS), as determined by the emergency-medicine physician who observed the reduction, was 6.8 points (range, 4 to 12 points). The average grade for pain, as recalled by the patient and indicated on a visual-analogue pain scale that ranged from 0 to 10 points, was 6.5 points before the patient received any analgesia and 1.2 points immediately after reduction of the fracture and application of a cast. Ninety-seven patients obtained an analgesic effect from the combination of nitrous oxide and a hematoma block. The three remaining children obtained no effect, and the fracture was reduced with use of general anesthesia. Three additional reductions were technically unsuccessful because of rotational or angular malalignment, and a second reduction was performed with general anesthesia. There were no complications such as vomiting, respiratory depression, a change in the oxygen-saturation level, infection, or nerve injury. We concluded that self-administration of nitrous oxide combined with use of a hematoma block is a safe and effective technique of analgesia for the outpatient reduction of fractures in children.

Endoscopic approach to pancreas divisum

Abstract: Pancreas divisum has been claimed to be a harmless congenital variant or to occasionally cause acute relapsing pancreatitis (ARP), chronic pancreatitis (CP), or a chronic abdominal pain (CAP) syndrome. Both surgical and endoscopic approaches to accessory papilla decompression have been promulgated and widely disparate results reported in the literature. We retrospectively reviewed a five-year experience with dorsal pancreatic duct decompression at our institution utilizing a variety of endotherapeutic techniques. Data collected included procedural complications; patient interpretation of pre- and posttherapy pain, frequency, and intensity graded on an analog pain scale; frequency of hospitalization; and patient perception of “global” improvement to endotherapy. At a mean follow-up of 20 months, there was a statistically significant decrease in pancreatitis incidence in 15 patients with ARP (P=0.016) and 19 patients with CP (P=0.025). The frequency and intensity of chronic pain was also significantly improved (P<0.001) in the latter group. In contrast, only one of five patients with CAP and normal dorsal pancreatography and secretin tests experienced global improvement, and there was no improvement utilizing an analog pain scale (P=0.262) in the group as a whole. There was a 20% incidence of mild procedure or subsequent stent-related pancreatitis and an 11.5% accessory papilla restenosis rate. It is concluded that a subset of carefully selected patients with pancreas divisum may respond to endotherapy but that long-term follow-up will be required to define its ultimate place in the management of symptomatic patients with this anomaly.

Analgesic efficacy and safety of single-dose intramuscular ketorolac for postoperative pain management in children following tonsillectomy

Abstract: The efficacy of ketorolac, a non-steroidal anti-inflammatory drug, in the management of moderate to severe pain in adults, has led us to conduct a trial of this analgesic in children following tonsillectomy. Children were randomized to receive intramuscular (i.m.) ketorolac (1 mg/kg, EXP group, n = 45) or saline (CTL group, n = 42) at the completion of surgery. Intravenous (i.v.) fentanyl (0.5 micrograms/kg/dose) was administered in repeated doses postoperatively. Pain intensity was measured using both the Oucher and the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) to allow for comparison between self-report and behavioral measures of pain intensity. Severity of postoperative bleeding was measured using a 4-point rating scale. The EXP group had a significant reduction in total fentanyl dose (mean: 35.9 micrograms) compared to the CTL group (mean: 48.3 micrograms, t = -2.21, P 0.05). In the first hour postoperatively, the CHEOPS demonstrated significant decreases in pain intensity scores in response to opioids, in both groups. In the PACU, children were unable to provide a self-report of pain intensity potentially due to a variety of factors (e.g., emergence delirium, agitation, excitement, sedation, and/or pain). However, during the remainder of the postoperative stay, the photographic scale of the Oucher was a more valid measure of pain intensity than the CHEOPS.(ABSTRACT TRUNCATED AT 250 WORDS)

An evaluation of knee extensor and knee flexor torques and EMGs in patients with patellofemoral pain syndrome in comparison with matched controls.

Abstract: The relationship between concentric and eccentric isokinetic torques and EMGs of quadriceps and hamstring muscles in patients with unilateral patellofemoral pain was studied in 27 patients (13 males, 14 females). The patients and a group of controls matched for age, gender, and physical activity were tested on a Kin-Com dynamometer at 600/s and 1800/s angular velocity. EMGs were recorded for eight of the patients and their matched controls. In addition, the reproducibility of isokinetic measurements made under the same conditions but on different occasions in patients with patellofemoral pain was evaluated. Twenty-one patients (11 males, 10 females) underwent testing of their quadriceps and hamstring muscles two or three times on a Kin-Com dynamometer. This was performed both concentrically and eccentrically in their painful leg while the patients evaluated their knee pain using Borg's pain scale. The data show that the patients had a significantly lower agonist as well as antagonist EMG activity during knee extension measurements in their painful leg compared with the controls. However, there were no differences in either agonist or antagonist EMG activities during knee flexion measurements between the patients and the controls. The quadriceps muscle torque was considerably weaker in the patients' painful leg compared with both their asymptomatic leg and with the controls. Peak torque for knee extension was reached at a mean of 660 of knee flexion for both patients and controls. However, the patients showed a considerably wider range within which they produced their peak torque in their painful leg than in their asymptomatic and also in comparison with the controls. The hamstring muscle torque was weaker in both legs of the patients compared with the controls. There were no significant differences in knee pain according to Borg's pain scale between the isokinetic tests or within the tests. The reproducibility testing yielded no significant differences between the different testing occasions in the two muscle groups. In summary, patients with patellofemoral pain have a greatly reduced agonist and antagonist EMG activity during knee extension in their painful leg. They also have a considerably reduced quadriceps torque. Furthermore, isokinetic testing in patients with patellofemoral pain is a reproducible testing modality.

Analgesia for the reduction of fractures in children: a comparison of nitrous oxide with intramuscular sedation.

Abstract: A prospective, randomized study was undertaken to compare the effectiveness of nitrous oxide with intramuscular sedation (meperidine and promethazine) in providing analgesia and amnesia during the reduction and treatment of children's fractures in an outpatient clinic setting. Fifteen patients received a 50:50 mixture of nitrous oxide and oxygen, and 15 received intramuscular injection. The two groups were similar in regard to gender distribution, age, and fracture types. Pain response was recorded using the Children's Hospital of Eastern Ontario (Canada) Pain Scale (CHEOPS) at the time of fracture reduction and 30 min postreduction. At the first follow-up visit a questionnaire regarding the patient's memory and subjective experience of the fracture reduction was answered. Data between the two groups were compared using the Mann-Whitney test. The CHEOPS scores, and the memory and subjective experience of the fracture reduction were similar between the two groups. Time in the outpatient department averaged 83 min for the intramuscular group and 30 min for the nitrous oxide group (p < 0.01). All of the nitrous oxide patients stated they would use nitrous oxide again, whereas only eight of 15 intramuscular patients stated they would try intramuscular sedation again. Nitrous oxide is as effective as intramuscular sedation in providing analgesia and amnesia in the treatment of children's fractures while having a more rapid onset and a shorter recovery period with greater patient acceptance.

Indices of pain intensity: construct validity among preschoolers.

Abstract: The methodologic study addressed the validity of subjective, physiologic, behavioral, and maternal indicators of pain intensity among 149 preschoolers who received immunizations at four clinics in the Southwest. Instruments used to measure children's responses included the Global Mood Scale (GMS) to measure anxiety, apical heart rate to measure physiologic response, the Wong and Baker Faces Scale to measure psychologic response, and the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) to measure behavioral response. The visual analogue scale (VAS) was used to measure mothers' perceptions of their children's pain. Results demonstrated correlations ranging between r = .27 to r = .44, p < .01 among the child's physiologic response to pain, the child's behavioral activity, and the mother's perception of pain. Correlations ranged from r = .26 to r = .30, p < .01, n = 144 among the child's verbal report of pain as measured by the Faces Scale, the mother's perception of pain, and the child's behavioral activity. The child's behavioral activity, mother's perception, and change in heart rate correlated positively with the child's anxiety. Children discriminated between anxiety and pain using the Faces Scale. More than one method may be required to fully assess the pain intensity experience by young children.

Comparison of extradural fentanyl, bupivacaine and two fentanyl-bupivacaine mixtures for pain relief after abdominal surgery

Abstract: Fentanyl 50 μg, bupivacaine 50 mg and two mixtures containing fentanyl 50 ng and bupivacaine 25 mg or 12.5 mg (0.25 and 0.125%), respectively, in a volume of 10 ml were administered via thoracic extradural catheters to 24 patients after major abdominal surgery. All patients received all four treatments, in a randomized order, so that each patient received one of the 24 possible combinations of the four treatments. Pain relief was assessed by a linear analogue pain scale and the Prince Henry Hospital pain score. The duration of pain relief, effects on ventilatory frequency, heart rate, arterial pressure and central venous pressure were also recorded. Mean reductions in the analogue pain scale for fentanyl, bupivacaine, and fentanyl in 0.25% and 0.125% bupivacaine were 80 (sem 5)%, 87 (4)%, 86 (5)% and 77 (5)%, respectively (ns). Pain scores decreased by 62(6)%, 83(5)%, 77 (6)% and 72 (6)%, respectively (ns). Mean arterial pressure decreased to 90 (2)%, 70 (2)%, 81 (2)% and 82 (3)%, respectively, of pretreatment values. In this respect, bupivacaine alone was significantly different from the three other treatments (P

Comparison of tetracaine-adrenaline-cocaine (TAC) with topical lidocaine-epinephrine (TLE): Efficacy and cost

Abstract: Topical anesthesia in the form of TAC (tetracaine, adrenaline, cocaine) solution has been used for wound repair. This pilot study was designed to determine if the topical anesthesia achieved using a mixture of lidocaine (5%) and epinephrine (1:2000) (TLE) is equivalent to the topical anesthesia obtained using a solution of tetracaine (0.5%), epinephrine (1: 2000), and cocaine (10.4%) (TAC). A prospective, randomized, double-blind trial was carried out from May 1992 to August 1992 at a community-based teaching hospital Emergency Department (ED) that receives 50,000 annual visits. Patients with facial or scalp lacerations suitable for topical anesthesia presenting to the ED were included when study physicians were in attendance. Exclusion criteria included the presence of a sensory altering substance (eg, ethanol), age younger than two years, hypertension, pregnancy, allergy to any of the study's pharmacological agents, wounds greater than six hours old, grossly contaminated wounds, and wounds longer than six centimeters. Either a TAC or TLE solution was applied to lacerations before suturing. The laceration was repaired and the patient or physician evaluated the degree of pain from the procedure by using a standardized visual pain scale. A total of 35 patients were studied. Seventeen patients were in the TLE group; 18 in the TAC group. The mean ages were compared and found to be similar (P = .40) between the two test groups. The pain scale values, the diameter of tissue blanch around laceration (halo size), and the time to laceration repair from the onset of application of anesthetic were compared and no difference was shown between the TAC and TLE groups.(ABSTRACT TRUNCATED AT 250 WORDS)

The factorial structure and stability of the McGill Pain Questionnaire in patients experiencing oral mucositis following bone marrow transplantation

Abstract: The McGill Pain Questionnaire (MPQ) (Melzack 1975) is an important assessment tool for multidimensional pain measurement in both clinical practice and research. Despite widespread acceptance, empirical analyses have not consistently verified the 3 a-priori factors that guided the subclass construction of the Pain Rating Index (PRI) of the MPQ. This study compared the a-priori model with 2 qualitatively different factor models in 191 patients with oral mucositis pain at 3 days and 10 days following bone marrow transplantation. A semantic model defined by Sensory Action, Sensory Evaluation, and Affective Evaluation factors of subclass descriptor content fit better than the a-priori model and a model positing a single general pain factor. The 3 semantic PRI factors were highly intercorrelated, with the sensory factors correlating more highly with an independent visual analogue (VAS) pain scale. Standardized factor regression coefficients between the two occasions of measurement ranged between 0.4 and 0.5. Mean factor change was greatest for Sensory Evaluation and lowest for Affective Evaluation. All analyses were conducted with the LISREL 7 structural equation modeling program. Although the factor analyses indicated an unambiguous ranking of PRI models according to statistical criteria, these theoretical results generalize poorly to simple scores formed by direct addition of the PRI subclasses. Summary scores can only approximate the unobserved factors and cannot retain the fine discriminations revealed by the theoretical factors. Psychometric considerations suggest that a single PRI total score will yield better practical measurement than any scoring rules based on multiple factors.

Ketorolac versus fentanyl for postoperative pain management in outpatients

Abstract: Objective: The purpose of this study was to compare the efficacy and safety of i.v. ketorolac and fentanyl for moderate to severe postoperative pain in patients undergoing elective surgery in an ambulatory surgery unit. Design: A double-blind randomized trial. Setting: An ambulatory surgery unit in a university-affiliated hospital. Patients: Sixty-nine patients undergoing elective laparoscopy, inguinal hernia repair, or knee arthroscopy were enrolled. Intervention: Patients were randomly assigned to receive intravenous ketoroLac 30 mg (n = 38) or fentanyl 50 μg (n = 31) for moderate to severe postoperative pain. Outcome Measures: Pain, assessed using a 100-mm visual analog scale and a 5-point verbal pain scale; adverse effects, as well as vital signs were recorded every 15 min for 150 min or until discharge from the postanesthesia care unit, 6 and 24 h after discharge. Results: Pain reduction on both visual analog and verbal scales was significantly greater with fentanyl than ketorolac at 15 min. In addition, the proportion of patients requiring remedication at the 15-min time point was significantly greater in the ketorolac group. However, there were no significant differences between fentanyl and ketorolac between 30 and 150 min after surgery. Notably, pain reduction was significantly greater with ketorolac on the verbal scale at the 6 h measurement. Conclusions: Ketorolac appears not to be as effective as fentanyl in treating early postoperative pain. Although fentanyl still appears to be the drug of choice in the early postoperative period, the parenteral use of ketorolac was more effective during the later postoperative period in providing longer lasting analgesia.

Effects of Semiconductor Cold Laser on Trigger Points of Upper Back Myofascial Pain

Abstract: The purpose of this study was to determine the effectiveness of semiconductor cold laser with different dosages on upper back myofascial trigger point pain. Thirty patients were randomly assigned into three groups. Each group consisted of 10 patients. Patients in group I received placebo treatment, patients in group II received 20 seconds laser irradiation and patients in group III received 40 seconds laser irradiation. Overall pain scale, pain scale of the most painful trigger point and the number of trigger points for each patient were measured before and after the total of six treatment sessions for data analysis. Patients in the 20 seconds and 40 seconds laser treatment groups demonstrated a significant pain relief compared with those in the placebo group. The number of trigger points did not change significantly. Possible mechanisms of laser therapy for pain relief were discussed. The semiconductor laser treatment seemed to be an effective modality for myofascial pain management but did not result in a complete relief in this study. Further studies are indicated to justify the treatment for a total pain relief and to ascertain the carry-over effect.

Postoperative pain in children

Abstract: Children of all ages have minor surgery, a recognised cause of acute pain, but little is known about the pain experiences of children postoperatively. This dissertation reports the findings of a study of postoperative pain in children of different ages, the aims of which were: to establish the existence and severity of postoperative pain in children; to examine the pain experience of children and their reactions postoperatively; to study the response of parents to pain experienced by their child; to establish the ways in which nursing and medical staff recognise postoperative pain in children; and to investigate how nursing and medical staff react to children who are in pain. The three samples were children, aged from a few months up to eleven years, who had undergone elective minor surgery (n=107), their mothers (n=85) and nursing, surgical and anaesthetic staff (n=80). The children with language skills and all mothers were interviewed on the first postoperative day. School-aged children measured their pain using self-report methods; the adapted Eland Color Tool, a faces scale and two visual analogue scales, one of which involved colour. Mothers rated their children's pain with a visual analogue scale; the researcher assessed pain in pre-school children with Revised Objective Pain Scale and in all children with a visual analogue scale. The opinions of staff about postoperative pain in children were sought in semi-structured interviews. Many children were in moderate or severe pain on their first postoperative day. Professionals routinely used informal methods of pain assessment although a number of staff knew of formal pain measures. Despite difficulties with some of the measures employed in the study, more children and mothers indicated the presence of pain with a measure than acknowledged pain verbally. Analgesic administration was infrequent. Concerns about creating opiate dependency and communication difficulties between adult groups and between adults and children were found. The responses of mothers to seeing their child in pain focused on their concern for their child and communication difficulties with staff. The implied failure of staff to recognise or relieve children's pain adequately could be attributed to lack of knowledge about pain, indicating a need to review the education of nurses and doctors. Implications for practice, education and research are postulated.

Quadriceps strength and pain during isokinetic concentric and eccentric contractions before and after arthroscopic excision of synovial plicae

Abstract: The functional efficacy of arthroscopic excision of the plica in 33 patients (27 men, six women) was assessed based on quadriceps performance and pain relief, prior to and following intervention. The concentric (C) and eccentric (E) strength of the quadriceps was measured isokinetically at low and medium velocities (30 and 120° Is) while the pain level during these efforts was recorded using the Borg modified (0-10) pain scale. Following the intervention, there was on average 16% improvement in the strength of the quadriceps of the involved side versus 5% in the uninvolved side. The effort induced pain was reduced on average 4.76 and 4.21 points during C and E contractions, respectively, which amounted to an almost absolute pain relief. In view of these findings, it is suggested that preoperative qualitative assessment of the pain during isokinetic testing together with assessment of quadriceps functional performance may be effectively and routinely integrated within the general framework of knee examination, in suspected plica pathology. The improvement of pain and quadriceps function during postoperative isokinetic reassessment confirm the hypothesis that the suprapatellar and the mediopatellar plicae are potent causes of anterior knee pain.