Can the outcome of spinal cord stimulation in chronic complex regional pain syndrome type I patients be predicted by catastrophizing thoughts?

BACKGROUND: In this study, we examined whether pain catastrophizing is a predictor of spinal cord stimulation (SCS) outcome in patients with complex regional pain syndrome type I (CRPS-I). METHODS: Participants in this prospective cohort study were 32 patients with chronic CRPS-I, who received permanent SCS after a positive response to test stimulation. Baseline assessment was performed before test stimulation and included questions on demographic variables, disease information, pain intensity, pain catastrophizing, and health-related quality of life (QOL). Follow-up assessment was performed 9 mo after final implantation and included pain intensity, global perceived effect (GPE), and QOL. Successful SCS outcome was defined as a reduction of pain intensity of at least 50% on a visual analog scale or "much improved" or "total pain relief" on GPE. RESULTS: After 9 months, 38% of the patients had a successful outcome in reduced pain intensity and 53% of the patients in GPE. In addition, improvements were apparent on several of the domains of QOL. However, no evidence was found for the predictive value of pain catastrophizing on the efficacy of SCS in reduction of pain intensity, GPE, or QOL. CONCLUSIONS: This study showed that the efficacy of SCS in reduction of pain intensity, GPE, and QOL in a well-defined chronic CRPS-I population was not predicted by pain catastrophizing. Therefore, we conclude that a high level of pain catastrophizing in patients with CRPS-I is not a contraindication for SCS treatment.

Test--retest stability of the Pain Catastrophizing Scale and the Tampa Scale for Kinesiophobia in chronic pain over a longer period of time.

The objective of this study was to investigate the test-retest stability of the Pain Catastrophizing Scale (PCS), the Tampa Scale for Kinesiophobia (TSK) and their subscales in chronic pain patients over relatively long period of times like those that are most often seen in clinical practice. Fifty non-malignant chronic pain patients filled out the PCS and TSK twice with a mean interval between testing of 52 days. Both assessment instruments showed sufficient test-retest stability, even with long time intervals between testing.

Randomised controlled trial of cervical radiofrequency lesions as a treatment for cervicogenic headache [ISRCTN07444684].

BACKGROUND: Cervicogenic headache (CEH) is a unilateral headache localised in the neck or occipital region, projecting to the frontal and temporal regions. Since the pathogenesis of this syndrome appears to have an anatomical basis in the cervical region, several surgical procedures aimed at reducing the nociceptive input on the cervical level, have been tested. We developed a sequence of various cervical radiofrequency neurotomies (facet joint denervations eventually followed by upper dorsal root ganglion neurotomies) that proved successful in a prospective pilot trial with 15 CEH patients. To further evaluate this sequential treatment program we conducted a randomised controlled trial METHODS: 30 patients with cervicogenic headache according to the Sjaastad diagnostic criteria, were randomised. 15 patients received a sequence of radiofrequency treatments (cervical facet joint denervation, followed by cervical dorsal root ganglion lesions when necessary), and the other 15 patients underwent local injections with steroid and anaesthetic at the greater occipital nerve, followed by transcutaneous electrical nerve stimulation (TENS) when necessary. Visual analogue scores for pain, global perceived effects scores, quality of life scores were assessed at 8, 16, 24 and 48 weeks. Patients also kept a headache diary. RESULTS: There were no statistically significant differences between the two treatment groups at any time point in the trial. CONCLUSION: We did not find evidence that radiofrequency treatment of cervical facet joints and upper dorsal root ganglions is a better treatment than the infiltration of the greater occipital nerve, followed by TENS for patients fulfilling the clinical criteria of cervicogenic headache.

Quality of life in chronic pain is more associated with beliefs about pain, than with pain intensity.

OBJECTIVES: The objectives of this study were to investigate pain cognitions and quality of life of chronic pain patients referred to a multi-disciplinary university pain management clinic and to search for predictors of quality of life. METHODS: A heterogeneous group of 1208 chronic pain patients referred to the Maastricht university hospital pain clinic participated in this cross-sectional study. At the initial assessment, all patients completed a set of questionnaires on demographic variables, cause, location, pain intensity (McGill pain questionnaire, MPQ), pain coping and beliefs (pain coping and cognition list, PCCL), pain catastrophising (pain catastrophising scale, PCS) and eight dimensions of quality of life (Rand-36). RESULTS: The results showed that the present sample of heterogeneous pain patients reported low quality of life on each domain and significantly lower scores than has been found in previous studies with other Dutch chronic pain populations. Patients with low back pain and multiple pain localisations experienced most functional limitations. Women reported more pain, more catastrophising thoughts about pain, more disability and lower vitality and general health. When tested in a multiple regression analysis, pain catastrophising turned out to be the single most important predictor of quality of life. Especially social functioning, vitality, mental health and general health are significantly associated with pain catastrophising. CONCLUSIONS: Patients from a multi-disciplinary university pain clinic experience strikingly low quality of life, whereby low back pain patients and patients with multiple pain localisations have the lowest quality of life. Pain catastrophising showed the strongest association with quality of life, and stronger than pain intensity.