Medication Quantification Scale Version III: update in medication classes and revised detriment weights by survey of American Pain Society Physicians.

UNLABELLED: The Medication Quantification Scale (MQS) is an instrument with potential clinical and research applications for quantifying medication regimen use in chronic pain populations. The MQS was developed in 1992 and updated in 1998 (MQS II) as a tool to co-quantify 3 relevant aspects of medications prescribed for chronic nonmalignant pain: drug class, dosage, and detriment (risk). This 2003 version (MQS III) is the third iteration of the scale, featuring new detriment weights determined by surveying all physician members of the American Pain Society in the United States via mail. A total of 248 physicians (18%) responded with their opinion as to the detriment of 22 mechanistically distinct medication classes. Overall, the physician ratings of detriment weight were relatively consistent (alpha = .84). The increased number of survey responses encompassed a wide range of disciplines, thus reducing discipline bias and introducing several important changes to MQS scoring. Some medication classes previously rated with low detriment weights (eg, nonsteroidal anti-inflammatory drugs) increased in detriment weight (from 2 to 3.4), whereas other classes previously given high weights (eg, "strong" opioids) received lower detriment ratings (from 5 to 3.4) in this survey. The MQS III must now be validated in clinical and research applications. PERSPECTIVE: The MQS is a tool to objectively quantify pain. It computes a single numeric value for a patient's pain medication profile. This number can be used by both clinicians and researchers to track pain levels through a treatment course or research study.

Increased systemic catecholamines in complex regional pain syndrome and relationship to psychological factors: a pilot study.

We have demonstrated that subjects with complex regional pain syndrome (CRPS) have asymmetric venous pool plasma concentrations of norepinephrine (NE) when affected and unaffected limbs are compared, with most demonstrating decreased NE levels in the affected limb. This pilot study explored whether systemic venous plasma catecholamine levels in CRPS subjects with sympathetically maintained pain (SMP) differ from those found in healthy volunteers. We also explored whether catecholamine levels were correlated with scores on psychometric measures of depression, anxiety, and personality. Venous blood samples from 33 CRPS/SMP patients (from unaffected limbs) and 30 healthy control subjects were assayed for plasma NE and epinephrine (E) concentrations. Plasma NE levels were significantly higher in the CRPS group (P < 0.001). Statistical comparisons of E levels across groups did not achieve significance (P < 0.06), although 52% of CRPS/SMP patients had E levels exceeding the 95% confidence interval based on control data. Significant positive correlations were found between E levels and scores on the Beck Depression Inventory and Scales 1, 3, and 6 on the Minnesota Multiphasic Personality Inventory-2 (all P < 0.05). This preliminary work suggests that increased NE and E levels in CRPS/SMP patients may result from the pain of CRPS, consequent affective distress, or both. Alternatively, our findings could reflect premorbid adrenergic hyperactivity caused by affective, endocrine, or other pathology, which might predispose these individuals to develop the syndrome. Definitive studies are needed to examine these hypotheses in detail.