Human Studies

To determine whether sociodemographic factors are associated with heterogeneity in pain evolution in inflammatory rheumatic diseases (IRDs) after accounting for disease-specific characteristics in a system with universal health care.

: Identifying patients at risk for chronic musculoskeletal pain can inform evaluation and treatment decisions. The ability of physical therapists to assess patients' risk for chronic pain without use of validated tools has been questioned. The Ӧrebro Musculoskeletal Pain Questionnaire (OMPQ) is used to determine risk for chronic pain. The aim of this pragmatic study was to prospectively quantify the agreement between physical therapists' assessment of patients' risk for chronic symptoms compared to the OMPQ. Patients were asked to complete the OMPQ during the initial visit. Physical therapists, blinded to OMPQ risk classification, carried out their usual patient assessment procedures. The physical therapists rated patients as either high or low risk for chronic pain based on their clinical assessment. Agreement between therapist and OMPQ was determined using Cohen's Kappa (κ) and screening accuracy compared clinician risk to the OMPQ risk classification (reference standard) by way of contingency table analysis. Ninety-six (96) patients' risk classifications and 15 corresponding physical therapists' risk estimates were available for analysis. The OMPQ identified a 47% prevalence for high risk of chronic pain. Agreement (κ and 95% confidence interval) between physical therapist rating and OMPQ was slight, κ = 0.272 (0.033-0.421), = .026. Therapists' sensitivity and specificity (95% CI) for determining risk classifications were 60.0% (44.3-74.3) and 62.8% (48.1-75.6), respectively. The positive and negative likelihood ratios (95% CI) were 1.61 (1.05-2.47) and 0.64 (0.42-0.97). The use of validated self-report questionnaires are recommended to supplement clinician prognosis for patients at risk of chronic musculoskeletal pain.

Purpose of this study was to examine the discriminative properties of the three-item PEG questionnaire for grading impact of non-dental orofacial pain.286 consecutive patients with orofacial pain of non-dental origin filled out the PEG questionnaire and Graded Chronic Pain Scale (GCPS, version 2). Correlation between the PEG and GCPS scores, internal consistency of the PEG, and differences between groups were examined statistically (level of significance: p≤0.05).The mean(±SD) age of the 213 patients (158 female) who were included in the analysis was 43.1(±16.7) years. Of the sample, 48.8%(n=104) had some degree of orofacial pain-related disability (mean overall characteristic pain intensity: 51.2±23.2, average overall PEG score: 4.3±2.7, average PHQ-9 score: 8.2±6.5). No significant differences were found between the sexes for any score. Number of disability points (GCPS) and overall PEG score showed a strong and positive correlation (Spearman's ρ=0.77, p<0.001). The internal consistency of the PEG questionnaire was high (Cronbach's α=0.86).Assuming three different levels of orofacial pain-related disability (mild, moderate, and severe), we obtained overall accuracy of 69.01%, with high specificity for mild and severe cases. The three PEG groups (mild/moderate/severe) differed from each other significantly regarding their clinical grading according to the GCPS (Kruskal-Wallis, p<0.001).Analysis of the receiver operating characteristic curve showed that a single cut-off value of 3.8 points in the PEG score yields adequate validity (sensitivity=0.91; specificity=0.78). The proposed two cut-off points (upper=7, lower=4) yield low sensitivity for the upper threshold.The three-item PEG questionnaire is suitable for grading impact of non-dental orofacial pain.

To examine associations between chronic pain conditions, pain level, and subclinical/clinical anxiety in community-dwelling older adults.

This was a multicenter retrospective analysis comparing intravenous push (IVP) analgesia versus patient-controlled analgesia (PCA) in patients admitted for sickle cell pain crisis. The primary objective was to compare the analgesic management, measured in total daily morphine milligram equivalents (MME). Secondary objectives included length of hospitalization, 30-day hospital readmissions and pain scores. Of the 98 patients identified between August 2017 and August 2018, 68 patients were included in this study. There were 51% ( = 35) in the IVP group and 49% ( = 33) in the PCA group. The majority of patients were on 90 or more daily MME prior to admission. The average total daily MME was significantly higher in patients on PCA compared to IVP on the first three days of hospitalization (289 vs 146,  < 0.01). Length of hospitalization was not different between patients on IVP and PCA (7.14 vs. 6.39 days,  = 0.53). There was no difference in 30-day readmissions, average pain scores on days 1-3 of hospitalization and adverse side effects between the groups. This study showed patients on IVP had significantly lower total daily MME requirements compared to PCA within the first three calendar days of admission.