Characterization and burden of localized back pain versus back pain with chronic overlapping pain conditions.

BACKGROUND: Chronic low back pain (cLBP) is the most common cause of years lived with disability (YLD). Chronic overlapping pain conditions (COPCs) is a relatively new taxonomy for widespread pain. Researchers have postulated that patients with COPCs have more pain-related impact than those with isolated pain conditions. We know little about the combination of COPCs with cLBP. This study aims to characterize patients with isolated cLBP compared to those with cLBP and associated COPCs across multiple domains of physical, psychological, and social functioning. METHODS: Using Stanford's CHOIR registry-based learning health system, we performed a cross-sectional study on patients with localized cLBP (group L) versus cLBP with COPCs (group W). We used demographic, PROMIS (Patient-Reported Outcomes Measurement Information System), and legacy survey data to characterize the physical, psychological, social, and global health outcomes. We further subdivided the COPCs into intermediate and severe based on the number of body regions involved. We used descriptive statistics and generalized linear regression models to characterize and compare the pain groups. RESULTS: Among 8783 patients with cLBP, 485 (5.5%) had localized cLBP (Group L) without widespread pain. Compared to Group L, patients in Group W were more likely to be females, younger, and reported longer duration of pain. Although the mean pain scores were significantly higher in group W, this difference did not appear clinically significant (average pain scores MD -0.73, 95% CI [-0.91 to -0.55]). Group W had significantly worse outcomes in all PROMIS outcomes. However, outcomes with large clinical differences (Cohen's d > 0.5) were fatigue (MD = -7.0, 95% CI [-8.0 to -6.1]); sleep impairment (MD = -6.2, 95% CI [-7.1 to -5.3]); sleep disturbance (MD = -5.3, 95% CI [-6.2 to -4.5]); pain behavior (MD = -2.2, 95% CI [-2.5 to -1.8]); physical function (MD = 4.0, 95% CI [3.2-5.0]); pain interference (MD = -3.4, 95% CI [-4.0 to -2.8]); and anxiety (MD = -4.9, 95% CI [-5.7 to -4.0]). Adjusted analysis controlling for age, gender, BMI category, and duration of pain confirmed worsening of all outcomes with more widespread pain. CONCLUSION: COPCs are a common presentation with cLBP. The combination of COPCs with cLBP is associated with significantly worse physical, psychological, social, and global health outcomes. This information may identify patients with COPCs and cLBP to optimally risk and treatment stratify their care and individualize their management.

Analgesic Effectiveness of Motor-sparing Nerve Blocks for Total Knee Arthroplasty: A Network Meta-analysis.

BACKGROUND: The analgesic effectiveness of contemporary motor-sparing nerve blocks used in combination for analgesia in total knee arthroplasty is unclear. This network meta-analysis was conducted to evaluate the analgesic effectiveness of adding single-injection or continuous adductor canal block (ACB) with or without infiltration of the interspace between the popliteal artery and the capsule of the posterior knee (iPACK) to intraoperative local infiltration analgesia (LIA), compared to LIA alone, after total knee arthroplasty. METHODS: Randomized trials examining the addition of single-injection or continuous ACB with or without single-injection block at the iPACK to LIA for total knee arthroplasty were considered. The two primary outcomes were area-under-the-curve pain scores over 24 to 48 h and postoperative function at greater than 24 h. Secondary outcomes included rest pain scores at 0, 6, 12, and 24 h; opioid consumption (from 0 to 24 h and from 25 to 48 h); and incidence of nausea/vomiting. Network meta-analysis was conducted using a frequentist approach. RESULTS: A total of 27 studies (2,317 patients) investigating the addition of (1) single-injection ACB, (2) continuous ACB, (3) single-injection ACB and single-injection block at the iPACK, and (4) continuous ACB and single-injection block at the iPACK to LIA, as compared to LIA alone, were included. For area-under-the-curve 24- to 48-h pain, the addition of continuous ACB with single-injection block at the iPACK displayed the highest P-score probability (89%) of being most effective for pain control. The addition of continuous ACB without single-injection block at the iPACK displayed the highest P-score probability (87%) of being most effective for postoperative function. CONCLUSIONS: The results suggest that continuous ACB, but not single-injection ACB and/or single-injection block at the iPACK, provides statistically superior analgesia when added to LIA for total knee arthroplasty compared to LIA alone. However, the magnitude of these additional analgesic benefits is clinically questionable.

Pregnancy and delivery characteristics and outcomes in Northwestern Syria: A prospective cohort study.

OBJECTIVE: Detail a picture of the current pregnancy and delivery characteristics and outcomes in Northwestern Syria. METHODS: This is a prospective observational study, using an electronic health information system, from four healthcare centers in two provinces in Northwestern Syria. We classified the population into two groups: Displaced people are those who live inside refugee camps; and residents are housed outside the camps. RESULTS: We analyzed data from 21 294 pregnant women. Among them 69.6% were displaced. Less than 1% of all care met the standard WHO's antenatal guidelines, and 3.9% met the focused WHO guidelines. Displaced women were more likely to have no antenatal visits (35.8% vs. 25.4%). We found a high rate of anemia (45.8%), prevalence of adolescent pregnancy (20.7%), cesarean-section (25.2%), preterm birth (4.2%), low birth weight (8.3%), and newborn mortality rate within 24 hours of birth (1.2%). Preterm births were more likely to occur in women who had no record of antenatal visits (4.2%) and the prevalence decreased with the increasing number of antenatal visits. CONCLUSION: We found huge deficiency in perinatal care among all women in this region. We found high cesarean-section rate, anemia, premature birth, newborn mortality within 24 h of birth, and high adolescent pregnancy.

Transitional Pain Medicine; New Era, New Opportunities, and New Journey.

Chronic postsurgical pain (CPSP), also known as persistent postsurgical pain (PPSP), is pain that develops or increases in intensity after a surgical procedure and lasts more than 3 months. Transitional pain medicine is the medical field that focuses on understanding the mechanisms of CPSP and defining risk factors and developing preventive treatments. Unfortunately, one significant challenge is the risk of developing opioid use dependence. Multiple risk factors have been discovered, with the most common, and modifiable, being uncontrolled acute postoperative pain; preoperative anxiety and depression; and preoperative site pain, chronic pain, and opioid use.

Clinical Approach to Chronic Pain due to Perioperative Nerve Injury.

Perioperative nerve injuries are common and may be prevented. The estimated incidence of perioperative nerve injury is 10% to 50%. However, most of these injuries are minor and self-recovering. Severe injuries account for up to 10%. Potential mechanisms of injury are nerve stretch, compression, hypoperfusion, direct nerve trauma, or injury during vessel cannulation. Nerve injury pain usually presents as neuropathic pain ranging from mild to severe mononeuropathy and extends to the disabling complex regional pain syndrome. This review provides a clinical approach to subacute and chronic pain secondary to perioperative nerve injury, presentation, and management.

Pragmatic Comparative Effectiveness Trials and Learning Health Systems in Pain Medicine: Opportunities and Challenges.

Large randomized clinical trials or aggregates of clinical trials represent the highest levels of clinical evidence because they minimize different sources of confounding and bias. The current review provides an in-depth discussion of the challenges faced and methods we can use to overcome these obstacles to tailor novel designs of pragmatic effectiveness trials to pain medicine. The authors describe their experiences with an open-source learning health system to collect high-quality evidence and conduct pragmatic clinical trials within a busy academic pain center.

Application of multidisciplinary team conference for neuromodulation candidates facilitates patient selection and optimization.

Introduction: Psychological evaluation is required by insurance companies in the United States prior to proceeding with a spinal cord stimulation or a dorsal root ganglion stimulation trial. Since January 2017, we implemented a Multidisciplinary Team Conference for Neuromodulation in our center to facilitate the collaboration between pain physicians and psychologists and to optimize screening of neuromodulation candidates. This study aims to report the impact of this team conference on improvement of neuromodulation outcome in our center. Methods: Appropriateness of neuromodulation were discussed in the team conference after initial visit with the pain specialist and psychological evaluation. For this study, we prospectively and retrospectively collected data on neuromodulation candidates who went through the team conference and those who did not as controls. Results: We discussed 461 patients in the team conference sessions from January 2017 to July 2023. Out of these, a spinal cord stimulator or a dorsal root ganglion stimulator trial was performed in 164 patients with 80.5% (132 cases) trial success rate leading to 140 implants. Out of these implants, 26 (18.6%) explanted and 21 (15%) required revision in 41 (29.3%) patients. We performed neuraxial neuromodulation trial for 70 patients without going through the team conference from January 2016 to July 2023 with a trial success rate of 45.7% (32 cases). In this group, 7 (21.9%) and 6 (18.8%) patients underwent explant and revision. The differences between the groups were statistically significant for trial success rate (odds ratio of 4.9 with p-value of <0.01) but not for explant (odds ratio of 0.8 with p-value of 0.627) or revision (odds ratio of 0.8 with p-value of 0.595). Conclusion: Implementing Multidisciplinary Team Conference increased trial success rate in our center. Team conference provides therapeutic benefit for patients, and also provides the opportunity for an educational discussion for trainees.

Say My Name: Understanding the Power of Names, Correct Pronunciation, and Personal Narratives.

Introduction: Names are a reflection of identity and often have personal meaning. The chronic mispronunciation of names can undermine one's identity and be experienced as a microaggression. This workshop aims to provide historical context for names as well as resources for correct name pronunciation. Methods: We developed a 60-minute interactive virtual workshop with didactics, small-group sharing of personal experiences, and case discussions. We used an anonymous postworkshop survey to evaluate workshop effectiveness. Results: We presented the workshop at one local academic conference and two local educational conferences to learners of all levels from medical students to faculty. We collected postworkshop survey results from 78 participants of diverse racial and ethnic backgrounds. Participants reported learning historical context, ways to ask about correct name pronunciation, correcting name mispronunciation, documenting pronunciation, and sources for applications to practice. The main barriers to implementing workshop lessons included personal and structural factors. Discussion: This workshop effectively fills an educational gap by addressing the importance of correct name pronunciation in order to provide a more inclusive environment for clinicians and patients alike.

Psychometric and accuracy comparison of three commonly used questionnaires for the diagnosis of neuropathic pain.

OBJECTIVES: Diagnosis of neuropathic pain is challenging. Recently, scientists developed multiple questionnaires to expedite this diagnosis including the Self-completed Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), Douleur Neuropathique 4 questionnaire (DN4), and Neuropathic Pain Questionnaire-Short Form (NPQ-SF). MATERIALS AND METHODS: We conducted a prospective cohort study to compare the psychometric characteristics and accuracy of the three questionnaires. We assessed reliability with the Cronbach's α reliability coefficient and inter-item correlations, and validity with receiver operating characteristic (ROC) and correlation analyses. We assessed agreement between the diagnosis of the questionnaires and the reference clinical diagnosis using Cohen's kappa coefficient. RESULTS: 188 patients were analyzed: 141 (75%) had "definite neuropathic" and 47 (25%) had "nonneuropathic" pain. The NPQ-SF and S-LANSS questionnaires demonstrated acceptable reliability with Cronbach's α coefficient values of 0.54 (95% CI: 0.41-0.64) and 0.65, (95%CI: 0.57-0.72), respectively. The DN4 questionnaire demonstrated high reliability with Cronbach's α coefficient of 0.74 (95%CI: 0.68-0.79). The NPQ-SF, DN4, and S-LANSS questionnaires demonstrated "excellent" diagnostic ability with an area under the ROC curve of 0.82 (95% CI: 0.75-0.89), 0.89 (95% CI: 0.83-0.95), and 0.83 (95% CI: 0.75-0.90), respectively. Based on their optimal cutoff values, the DN4 had the highest sensitivity and lowest specificity in discriminating between neuropathic and nonneuropathic patients, while the S-LANSS had the lowest sensitivity and highest specificity. CONCLUSION: Both NPQ-SF and S-LANSS demonstrated acceptable reliability, while DN4 demonstrated high reliability. All three demonstrated excellent diagnostic validities; however, it is important to consider the sensitivity and specificity of each.

Peripheral Nerve Stimulation for Occipital Neuralgia.

BACKGROUND: Chronic headaches are the second most prevalent disease and second most common cause for years lived with disability worldwide. Occipital neuralgia can cause headaches or be present in addition to other more prevalent causes of headache. If these headaches fail to respond to conservative and pharmacological therapy, physicians proceed to more invasive treatments, starting with infiltration of the greater occipital nerve with local anesthetic with or without corticosteroids, followed by nerve ablation or stimulation. Occipital nerve stimulation gained more popularity as the technology improved and more pain physicians received training on interventional procedures. METHODS: In this manuscript, we are presenting our experience with ultrasound-guided implant of occipital nerve stimulators using peripheral nerve stimulator systems. After confirming appropriateness of treatment by a successful occipital nerve block (i.e., resulting in >50% relief in patients' pain intensity), we implanted five stimulator systems in three patients (two bilateral). RESULTS: We followed these patients for an average of eight months, and the average pain reduction was ∼50%. We did not observe any adverse events during or immediately after surgery. One patient developed an adverse reaction to the adhesive of the battery transmitter, but it was not severe enough to stop her from using the stimulator. CONCLUSIONS: Considering the ease of implant and minimal side effects, implant of peripheral nerve stimulators to stimulate the occipital nerve is a promising treatment modality for patients with chronic headache who present with features of occipital neuralgia. However, wider use of this treatment modality is subject to further studies.

Women's health in Northwestern Syria: Findings from Healthy-Syria 2017 study.

OBJECTIVES: Since the uprising in 2011, there have been limited health-care data from inside Syria regarding women's health. This study aimed to provide an updated account of women's health, including pregnancy, perinatal care, childbirth, and other conditions to identify obstacles and challenges to health-care delivery in Northwestern Syria. METHODS: This is a prospective data registry study, using a medical electronic records system that builds on the International Classification of Diseases, Tenth Revision (ICD-10) codes. We collected data from one medical center in Northwestern Syria during 2017. We conducted a survey to understand patients' knowledge of and barriers limiting antenatal care (ANC). RESULTS: We studied 7213 patients' health status and surveyed 134 regarding ANC. Prenatal care, delivery, and miscarriage treatment represented the most common (70%) reasons for women's health-care visits, followed by menstrual disorders (17%). From 2057 delivery records, 70% delivered vaginally and 30% required cesarean delivery. Our findings showed that 1169 (24%) of the pregnant women (4936) in 2017 were adolescents, of them 22 (0.44%) were 14 years old. Regarding ANC visits, 85% of respondents did not have a single ANC visit in the first trimester, 82% had no visits in the second trimester, and 44% had no visits in the third trimester. Thirty-one percent had no ANC visit throughout the entire pregnancy. Only 13% had postnatal care (PNC) visits. Women who live in the refugee camp are 2.7 times less likely to meet the World Health Organization (WHO) criteria for focused ANC (FANC = 4 visits) compared to those who reside in town (P < 0.001), with only 14% having met the FANC. The major barrier to ANC is related to transportation (34%), followed by factors related to the study center (29%) and knowledge and education (19%). We estimated the number of obstetrics-gynecology doctors per 1000 populations to be 0.02. CONCLUSIONS: We found a huge deficiency in ANC and PNC visits, a high adolescent birth rate, and a higher cesarean-to-vaginal delivery ratio than what is recommended by the WHO. We also found a severe shortage in the number of obstetrician-gynecologists serving this population.

Child and adolescent health in northwestern Syria: findings from Healthy-Syria 2017 study.

OBJECTIVES: Since the uprising in 2011, there has been limited health-care data from inside Syria in the academic literature. This study aims to provide an updated account of pediatric health needs in the northwestern part of Syria; this should help inform the management and delivery of health-care services in this population. METHODS: This is a prospective study, using a data registry, of all pediatric patients seen in a single center in northwestern Syria, between February and December 2017. We used international classification of diseases (ICD-10) codes to define cases, and tested several covariates, including age, sex, season of the year, and conditions of living for possible correlations with major illness categories. RESULTS: We included 11,819 patients, of whom 5,288 (45%) were male and 6,531 (55%) were female. Collectively, these patients had 23,427 encounters. Respiratory diseases were the most encountered illnesses among all age groups (6320 [27%]), except late teen females, among whom gynecological/obstetric complaints dominated. Infectious diseases caused the greatest disease burden across all age groups, with upper respiratory tract infections (URTIs), infectious diarrhea, and otitis media representing almost half (47%) of all cases in this category. Nutritional deficiencies were diagnosed in 978 patients (8%), mostly in infants and toddlers (92%). We identified 1192 (17%) cases of acute diarrhea among all age groups, making it the second most common condition after URTIs. As compared to town residents, patients living in camps for internally displaced people accounted for more cases of infectious diarrhea (58%), chronic anemia (60%), and malnutrition (66%), especially severe acute malnutrition (76% of malnutrition cases). Vaccine-preventable illnesses represented a sizable category; we reported 69 cases of hepatitis A, 2 of poliomyelitis, 9 of pertussis, 37 of varicella, 11 of mumps, 8 of rubella, and 1 case of measles. CONCLUSION: We have identified urgent health-care issues in this population, including extreme malnutrition, high rates of infectious diseases, and high rates of teenage pregnancy. Also, we observed a relapse of some vaccine-preventable illnesses, such as mumps and rubella, which are likely associated with the decline in vaccination rates.

Development and validation of Arabic version of the Hospital Anxiety and Depression Scale.

INTRODUCTION: The Hospital Anxiety and Depression Scale (HADS) is widely used to predict and diagnose hospital anxiety and depression. It has been translated and validated in many languages, but the existing Arabic version was not validated in hospitalized patients. The aim was to translate, culturally adapt, and validate the HADS Questionnaire into Arabic language for in-patient use, especially for surgical wards. METHODS: A systematic translation process was used to translate the original English HADS into Arabic. After the pilot study, we validated our version in surgical patients at two tertiary care centers. We tested the reliability of our version using internal consistency. We examined the validity by assessing construct validity, concurrent validity (by testing the associations between HADS, Generalized Anxiety Disorder 7-item scale [GAD-7], and Major Depression Inventory [MDI]), and face validity. The questionnaire was administered before and after surgery to examine responsiveness. RESULTS: A total of 110 patients (22 men, 88 women) were included in the study. Cronbach's αs for the HADS anxiety subscale were 0.83 (95% confidence interval: 0.79- 0.88) and for the HADS depression subscale were 0.77 (0.7-0.83). Nearly 36% of the patients reported symptoms indicative of borderline or case anxiety before surgery, which decreased to 25% 1 week after surgery. HADS anxiety score was strongly correlated with GAD-7, and HADS depression score was strongly associated with MDI. Patients with higher American Society of Anesthesiologists Physical Status and those who remained hospitalized for more than 5 days were more likely to report depression symptoms. Most patients found the HADS questions to be clear and easy to understand, and thought the questionnaire items covered all their problem areas regarding their hospital anxiety and depression. CONCLUSIONS: Our Arabic version of HADS is a reliable and valid tool to assess the mood states in hospitalized patients.

Development and validation of Arabic version of the Short-Form McGill Pain Questionnaire.

INTRODUCTION: The Short-Form McGill Pain Questionnaire (SF-MPQ) is a widely used tool for qualitative and quantitative pain assessment. Our aim was to translate, culturally adapt, and validate the SF-MPQ in Arabic. METHODS: A systematic translation process was used to translate the original English SF-MPQ into Arabic. After the pilot study, we validated our version in patients with chronic pain at two tertiary care centers. We tested the reliability of our version using internal consistency and test-retest reliability. We examined the validity by assessing construct validity, concurrent validity (by investigating the associations between SF-MPQ, Brief Pain Inventory [BPI], and Self-completed Leeds Assessment of Neuropathic Symptoms and Signs [S-LANSS]), and face validity. The questionnaire was administered twice to examine responsiveness. RESULTS: A total of 142 participants (68 men and 74 women) were included in this study. Cronbach's α was 0.85 (95% confidence interval: 0.81 - 0.89), and interclass correlation coefficients were 0.71 (0.62-0.79) for the whole scale. SF-MPQ was moderately associated with patients' present pain (r = 0.55, P < 0.001) and the numerical rating scale (r = 0.42, P < 0.001). The total pain score was moderately correlated with pain severity and interference assessed with the BPI (rs = 0.39 to 0.49, all Ps < 0.001). SF-MPQ total pain score was weakly associated with neuropathic pain assessed with S-LANSS (r = 0.26, P < 0.01). Most patients found the SF-MPQ questions to be clear and easy to understand and thought the questionnaire items covered all their problem areas regarding their pain. CONCLUSION: Our translated version of SF-MPQ was reliable and valid for use among Arabic-speaking patients. The SF-MPQ is a good qualitative and quantitative assessment tool for pain but is only weakly associated with neuropathic pain.

Development and validation of Arabic version of the postoperative quality of recovery scale.

INTRODUCTION: The postoperative quality of recovery scale (PostopQRS) is a widely used tool to assess the postoperative quality of recovery. Our aim was to translate, culturally adapt, and validate the PostopQRS questionnaire in Arabic. METHODOLOGY: A systematic translation process was used to translate the original English PostopQRS into Arabic. After the pilot study, the translated version was validated among patients who underwent different types of surgeries. We examined the reliability (using internal consistency) and validity of the translated version. To examine the responsiveness of the translated PostopQRS, the questionnaire was administered 6 times among the same group of patients (once before surgery as baseline measure, and 5 times after surgery, up to 1 week after surgery). RESULTS: A total of 190 patients (10 men, 180 women) were included. Internal consistencies vary across each domain and overtime, with mostly good to excellent reliability. Most patients found the PostopQRS questions to be clear and easy to understand and thought the questionnaire items covered all their problem areas regarding their quality of recovery. In general, patients showed recovery across all five domains starting from postoperative day 1 (POD1). Patients showed the fastest recovery in the emotional domain, and the proportion of recovered patients remained stable over time. Most patients were recovered in the cognitive domain by POD1. Although only a small proportion of patients were recovered in the physiological and activities of daily living domains in POD1, most patients were recovered by POD3. The proportion of patients recovered in the nociceptive domain declined initially, but more patients showed recovery by POD3 and most were recovered by POD7. Furthermore, quality of recovery was related to the extent of surgery (major vs. minor). CONCLUSION: Our translated version of PostopQRS was reliable and valid for use among Arabic-speaking patients. In addition, we showed that the PostopQRS was able to track the changes in recovery among patients in our study.

Development and validation of Arabic version of the postoperative quality of recovery-40 questionnaire.

INTRODUCTION: The postoperative quality of recovery-40 (QoR-40) is one of the most frequently used tools to assess the quality of recovery after surgery. The aim of the current study was to translate, culturally adapt, and validate the QoR-40 questionnaire in Arabic. METHODS: A systematic translation process was used to translate the original English QoR-40 into Arabic. After the pilot study, the translated version was validated among patients who underwent different types of surgeries. The reliability (using internal consistency) and validity of our translated Arabic version was examined. To investigate the responsiveness of the translated QoR-40, the questionnaire was administered five times among the same group of patients (once before surgery as baseline measure, and four times after surgery, up to 1 week after surgery). RESULTS: A total of 182 participants (7 men, 175 women) were included in the study. The QoR-40 total scale and all subscales showed excellent internal consistencies over time, with the exception of the QoR-40 pain subscale at postoperative day 1. The QoR-40 total and subscale scores were inversely associated with patients' self-report pain scores but positively correlated with patients' self-report recovery scores. Patients' QoR-40 total, comfort, emotions, and physical subscale scores increased over time after surgery, indicating a general trend of recovery over time. Patients' scores in the QoR-40 pain and support subscales remained stable over time, suggesting no substantial changes were reported in these two domains. Quality of recovery was also found to be related to patients' ages, American Society of Anesthesiologists Physical Status, and the extent of surgery (major vs. minor). Most patients found the Arabic QoR-40 questions to be clear and easy to understand and thought the questionnaire items covered all their problem areas regarding their quality of recovery. CONCLUSION: Our translated version of QoR-40 was reliable and valid for use among Arabic-speaking patients. In addition, the QoR-40 was able to assess the quality of recovery in several domains among patients who underwent surgical procedures.

Development and validation of Arabic version of the douleur neuropathique 4 questionnaire.

INTRODUCTION: The douleur neuropathique 4 (DN4) questionnaire is a widely used tool for diagnosis of neuropathic pain (NP). The aim was to translate, culturally adapt, and validate the DN4 questionnaire in Arabic. METHODS: A systematic translation process was used to translate the original English DN4 into Arabic. After the pilot study, the Arabic version was validated among patients with chronic pain in two tertiary care centers. The reliability of the translated version was examined using internal consistency, test-retest reliability, and intraclass correlation coefficients. We examined the validity of the Arabic DN4 via construct validity, concurrent validity (associations with the numeric rating scale, brief pain inventory, and Self-Completed Leeds Assessment of Neuropathic Symptoms and Signs [S-LANSS]), face validity, and diagnostic validity. To investigate the responsiveness, the translated DN4 was administered twice among the same group of patients. RESULTS: A total of 142 subjects (68 men, 74 women) were included in the study. Cronbach's α was 0.67 (95% confidence interval [CI]: 0.59-0.75), and interclass correlation coefficients was 0.81 (95% CI: 0.76-0.87). The DN4 was moderately associated with the S-LANSS questionnaire. Results showed our Arabic DN4 to have good diagnostic accuracy, with area under the curve of 0.88 (95% CI: 0.82-0.94). As with the original version, a score of ≥4 was found to be the best cut-off for the diagnosis of NP, with a sensitivity of 88.31%, specificity of 74.47%, a positive predictive value of 85%, and a negative predictive value of 80%. Most patients found the DN4 questionnaire to be clear and easy to understand, and thought the questionnaire items covered all their problem areas regarding their pain. CONCLUSION: Our Arabic version of the DN4 is a reliable and valid screening tool that can be easily administered among patients to differentiate between NP and non-NP.

Development and validation of Arabic version of the Neuropathic Pain Questionnaire-Short Form.

INTRODUCTION: The Neuropathic Pain Questionnaire-Short Form (NPQ-SF) is the shortest diagnostic tool for the assessment of neuropathic pain, designed with the goal to differentiate between neuropathic and nonneuropathic pain. The aim of this study was to translate, culturally adapt, and validate the NPQ-SF questionnaire in Arabic. METHODS: A systematic translation process was used to translate the original English NPQ-SF into Arabic. After the pilot study, the Arabic version was validated among patients with chronic pain in two tertiary care centers. Reliability of the translated version was examined using internal consistency, test-retest reliability, and intraclass correlation coefficient (ICC). We examined the validity of the Arabic NPQ-SF via construct validity, concurrent validity (associations with the numeric pain scale, Brief Pain Inventory, and Self-completed Leeds Assessment of Neuropathic Symptoms and Signs [S-LANSS]), face validity, and diagnostic validity. To investigate the responsiveness, the translated NPQ-SF questionnaire was administered twice among the same group of patients. RESULTS: A total of 142 subjects (68 men, 74 women) were included in the study. Cronbach's α were 0.45 (95% CI: 0.29, 0.61) and 0.48 (95% CI: 0.33, 0.63), and the ICC was 0.78 (95% CI: 0.72, 0.85). The NPQ-SF was moderately to strongly associated with the S-LANSS questionnaire. Results showed our Arabic NPQ-SF to have good diagnostic accuracy, with area under the curve of 0.76 (95% CI: 0.67, 0.84). Results from the receiver operating characteristic analysis identified a cut-off score of ≥0.52 as the best score to distinguish between patients with or without neuropathic pain, which was higher than the recommended cut-off score (≥0) in the original study. With both sensitivity and specificity of 71%. Most patients found the NPQ-SF questionnaire to be clear and easy to understand. CONCLUSION: Our translated version of NPQ-SF is reliable and valid for use, thus providing physicians a new tool with which to evaluate and diagnose neuropathic pain among Arabic-speaking patients.

Development and validation of Arabic version of the pain catastrophizing scale.

INTRODUCTION: The pain catastrophizing scale (PCS) is the most widely used tool to assess pain catastrophizing. The aim of this study was to translate, culturally adapt, and validate the PCS questionnaire in Arabic. METHODS: A systematic translation process was used to translate the original English PCS into Arabic. After the pilot study, we validated our version among patients with chronic pain at two tertiary care centers. We tested the reliability of our version using internal consistency and test-retest reliability. We examined the validity by assessing construct validity, concurrent validity (by investigating the associations with Brief Pain Inventory [BPI]), and face validity. RESULTS: A total of 113 subjects (50 men, 63 women) were included in the study. Cronbach's α was 0.94 (95% confidence interval [CI]: 0.92-0.96), and interclass correlation coefficients was 0.83 (95% CI: 0.77-0.89) for the total scale. There was no statistically significant difference in the total PCS scores between patients who reported experiencing current pain and those who did not. Among patients who reported having current pain, pain severity was weakly associated with the total PCS scores (r = 0.22, P = 0.03). PCS and its subscales were not statistically significantly associated with any of the BPI items. Nonetheless, patients who were diagnosed with neuropathic pain had statistically significantly higher scores on the total PCS, rumination, and helplessness subscales. Most patients found the PCS questions to be clear and easy to understand, and thought the questionnaire items covered all their problem areas regarding their pain catastrophizing. CONCLUSION: Our translated version of PCS is reliable and valid for use among Arabic-speaking patients.