Articles: pain-measurement.
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Multicenter Study
Impact of an Electronic Pain and Opioid Risk Assessment Program: Are There Improvements in Patient Encounters and Clinic Notes?
A comprehensive electronic self-report assessment, called PainCAS(®) (Clinical Assessment System), was developed and implemented in three clinics. PainCAS captures demographic information, pain assessment, quality-of-life variables, and contains validated, electronic versions of screeners for risk of aberrant opioid-related behaviors (the SOAPP and COMM). This investigation sought to determine the impact of PainCAS on documentation of pain and opioid risk evaluations. Exploratory hypotheses examined changes in the content of the patient-provider interaction and any impact on outcome. ⋯ Results indicate that use of the PainCAS electronic pain assessment improves documentation of chart elements in clinic notes and is associated with increased discussion of key, pain-relevant topics during the clinical visit.
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Randomized Controlled Trial
Exploring what factors mediate treatment effect: Example of the STarT Back study high-risk intervention.
Interventions developed to improve disability outcomes for low back pain (LBP) often show only small effects. Mediation analysis was used to investigate what led to the effectiveness of the STarT Back trial, a large primary care-based trial that treated patients consulting with LBP according to their risk of a poor outcome. The high-risk subgroup, randomized to receive either psychologically-informed physiotherapy (n = 93) or current best care (n = 45), was investigated to explore pain-related distress and pain intensity as potential mediators of the relationship between treatment allocation and change in disability. ⋯ Outcome was measured using the Roland-Morris Disability Questionnaire. Change in pain-related distress and pain intensity were found to have a significant mediating effect of .25 (standardized estimate, bootstrapped 95% confidence interval, .09-.39) on the relationship between treatment group allocation and change in disability outcome. This study adds to the evidence base of treatment mediation studies in pain research and the role of distress in influencing disability outcome in those with complex LBP.
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Regrettably, the list of unique analgesic tools has expanded very slowly during the past few decades. Many very promising drugs have failed once tested in clinical populations, and the associated costs of these translational failures have been extremely high. Part of this problem can be traced to the ways we select and use preclinical tools and perhaps to the way we report our findings. ⋯ In addition, many journals now require a clear statement of the experimental hypothesis, the details of the experimental methods, a description of the statistical approach to analyzing the data, and the disclosure of conflicts of interest. These new practices pose challenges to laboratory-based research groups. However, a more rigorous approach to preclinical investigations may be necessary for the successful development of new analgesics.
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OBJECTIVE : Pain catastrophizing is an important predictor of functioning and disability among individuals with chronic pain, and modification of catastrophic interpretations of pain is a proposed treatment mechanism of pain rehabilitation. The purpose of the current study is to examine the relationship between changes in catastrophic thinking and treatment outcomes for a large sample of patients with chronic pain. METHODS : 648 adult patients with chronic pain completed a 3-week intensive outpatient comprehensive pain rehabilitation program. ⋯ RESULTS : Consistent with prior research, pain catastrophizing was associated with several negative pain-related outcomes. Results of a within-subjects mediational analysis indicated that pain catastrophizing not only improved during the treatment program, but also accounted for a significant portion of the variance in the reduction of pain severity, pain interference, and depression at the end of treatment. CONCLUSIONS : This study adds further support to the position that pain catastrophizing has a detrimental role in adaptation to chronic pain, and that this construct can be successfully modified in treatment to improve patient outcomes.
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Comparative Study
Women with Chronic and Episodic Migraine Exhibit Similar Widespread Pressure Pain Sensitivity.
To investigate widespread pressure hyperalgesia in the trigemino-cervical and extra-trigeminal (distant pain-free) regions in women with episodic and chronic migraine. ⋯ This study found similar widespread pressure hypersensitivity in women with episodic or chronic migraine suggesting that central manifestations are involved both in episodic and chronic migraine.