Clinically relevant VAS pain score change in patients with acute rheumatic conditions.

INTRODUCTION: Pain assessment is a crucial step in the management of patients with rheumatic diseases. Among validated pain scores, the visual analog scale (VAS) score is the most widely used, in both clinical practice and therapeutic trials. OBJECTIVE: To determine the VAS pain score decrease that constitutes meaningful pain relief, with the goal of evaluating treatment effects. METHODS: We included patients with acute pain caused by non-malignant rheumatic conditions. Pain duration of less than 1month and a baseline VAS score greater than 50/100mm were required. Twice daily, patients evaluated pain intensity using the VAS and pain relief using a five-category verbal rating scale (VRS) where 0 indicated no pain relief and 4 excellent relief. RESULTS: Fifty patients were included. VAS score changes correlated linearly with VRS score changes (r=0.7 and P<0.001). A one-category improvement on the VRS was associated with a 20-mm decrease in the VAS score (P<0.0001) and a two-category improvement with a 40-mm decrease (P<0.0003). CONCLUSION: The dearth of published data on clinically relevant VAS pain score changes in patients with acute rheumatic pain requires further studies, in order to improve patient care and the comparability of therapeutic trials.

Central pain control.

We describe the anatomic and physiological components involved in pain physiology, with the goal of providing readers with the background information needed to understand central pain control mechanisms. These include spinal segmental controls, supraspinal excitatory and inhibitory controls, and diffuse noxious inhibitory controls (DNICs). Pain is a subjective sensation produced by an emotionally unpleasant experience considered to originate in adaptive processes taking place within neuron networks located at various levels of the central nervous system. The intensity of the components of pain is influenced by the stimulus characteristics, patient-related factors, and the setting in which the stimulus occurs. The various components of pain and the psychological and neurophysiological mechanisms that underlie the affective dimension of pain are reviewed. As a conclusion, phantom pain is used to illustrate the role for physiological systems independent from those involved in the physiology of nociception and pain, such as the motor cortex. This example highlights the extreme complexity of pain and pain control systems in humans.

Is the relationship between spondyloarthropathy and Sjögren's syndrome in women coincidental? A study of 13 cases.

OBJECTIVE: To determine the prevalence of Sjogren's syndrome (SS) in women with spondyloarthropathy (SpA). METHODS: Forty-one women with SpA manifesting as inflammatory back pain and/or peripheral arthritis were diagnosed as having ankylosing spondylitis, undifferentiated spondyloarthropathy, psoriatic arthritis, or enteropathic arthropathy based on accepted criteria. A validated questionnaire was used to look for sicca symptoms in the SpA group and in 102 controls with degenerative rheumatic diseases. Women with SpA and sicca symptoms and/or positive antinuclear antibodies (ANA) were investigated for SS by minor salivary gland biopsy. In the SpA group, the following tests were done: HLA B27; HLA DR, DQ; ENA; and serology for CMV, EBV, HIV, hepatitis B, and hepatitis C. RESULTS: Thirteen women (31.7%) met European criteria for SS, compared to three (2.9%) of the controls. Of the 41 women with SpA, 16 (39%) were ANA-positive. ANA were detected in eight of the 16 (50%) patients with SS. HLA B27 was present in 11 of the 13 (84.6%) SS patients. HLA DR 04.04 and DQ 03.03 seemed more common in SS patients, but the difference was not statistically significant. CONCLUSION: SS was far more common in the women with SpA (31.7%) than in the controls (2.9%), suggesting that the SpA-SS association may not be coincidental.