Pain
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The accurate, precise, and consistent assessment of pain is of particular importance in palliative care. The European Palliative Care Research Collaborative is developing a computer-based pain assessment instrument and has been evaluating the content and dimensionality of existing pain questionnaires. The most important dimensions of pain are intensity and interference. ⋯ However, there was strong evidence that the relationship between the intensity and the interference items differs markedly in palliative care patients compared to chronic pain patients. As hypothesized, there was strong correlation between intensity and interference, lending support to the possibility that, for some purposes, these dimensions may be combined to provide a higher-level summary measure of patients' pain experience. We conclude that these dimensions should be kept distinct when assessing patients in general, although for a single type of patient (such as palliative care patients), it may be possible to regard intensity and interference as contributing to an overall measure of pain severity.
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Low back pain is a widespread debilitating problem with a lifetime prevalence of 80%, with the underlying pain mechanism unknown in approximately 90% of cases. We used the painDETECT neuropathic pain screening questionnaire to identify likely pain mechanisms in 343 patients with low back pain with or without leg pain in southeastern England referred for physiotherapy. We related the identified possible pain mechanisms nociceptive, unclear, and neuropathic to standardised measures of pain severity (Numeric Rating Scale), disability (Roland Morris Low Back Pain Disability Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale), and quality of life (Short Form 36 Health Survey Questionnaire Version 2). ⋯ A total of 96% of participants with possible neuropathic pain reported pain radiating to the leg (76% below the knee); however, leg pain was still more common in patients with nociceptive pain, suggesting that leg pain is sensitive to, but not specific to, possible neuropathic pain. No relationship was demonstrated between possible neuropathic pain and evidence for or absence of nerve root compression on magnetic resonance imaging scans. These findings suggest possible neuropathic pain is less common in low back pain patients referred through primary care and clarifies the usefulness of clinical tests for identifying possible neuropathic pain.