Pain outcome measures.

Pain is a complex, multi-dimensional experience that is usually associated with local tissue damage or may be referred from a distant site. Classically, pain is viewed as having sensory, affective, and cognitive components. To assess pain, however, the clinician or the researcher must use the most appropriate measure for the given situation. Many pain outcome measures are currently in use. Some of these are simple uni-dimensional scales, whereas others adopt a more multi-dimensional approach. Pain is rarely measured in isolation but must instead be put into the context of the whole person and that person's functional ability. All these factors should be borne in mind in the evaluation of pain in the hand. This paper discusses pain measurement instruments and makes recommendations for assessment of pain in the hand.

The efficacy of cryotherapy following arthroscopic knee surgery.

Cryotherapy has historically been used as a treatment following knee surgery. In the literature, there is little evidence of beneficial effects which support this practice. This study examined the effects of cryotherapy treatments on 45 subjects following minor arthroscopic knee surgery. Subjects were randomized to one of two treatment groups and the assessor remained blind to treatment group allocation. Subjects performed a 1-week home program of either cryotherapy and exercises or exercises alone. One week following surgery, a statistically significant difference was found between the groups for the affective dimension of the McGill pain questionnaire, medication consumption, compliance, and weight-bearing status. No significant differences were found between the groups for other outcome variables. These results indicate that the addition of cryotherapy to a regime of exercises following arthroscopic knee surgery produced benefits of increased compliance, improved weight-bearing status, and lower prescription medication consumption.

The cooling effects of electroacupuncture on the skin temperature of the hand.

Electroacupuncture (EA) has been reported to induce changes in skin temperature; however, it is not clear whether high- and low-frequency EA produce similar effects. Therefore, the purpose of this study was to investigate the effects of EA on the skin temperature of the hand and finger in normal subjects. Twenty-one subjects received high-frequency EA (100 Hz) and low-frequency EA (4 Hz) at the Large Intestine 4 and Small Intestine 3 acupuncture points, as well as a no-treatment control condition. The results showed that the skin temperature following high- and low-frequency EA produced significant cooling effects at both sites as compared with the no-treatment control condition during the stimulation period (p < 0.05). These data show that EA produces significant changes in skin temperature that may be of benefit in pathologic conditions that are accompanied by an increase in local circulation.

The efficacy of dexamethasone iontophoresis for the treatment of rheumatoid arthritic knees: a pilot study.

OBJECTIVE: To examine the efficacy of dexamethasone sodium phosphate (DEX) iontophoresis for the treatment of rheumatoid arthritis (RA) of the knee, and to obtain statistical information for a future randomized controlled trial (RCT). METHODS: Ten subjects with RA, ranging in age from 34-75, were randomly assigned to either the experimental or placebo group. Iontophoresis treatments were given to both groups on days 1, 3, and 5. Five subjects in the experimental group received a mixture of 1 ml of DEX (4 mg/ml) and 1 ml of injectable sterile water; those in the placebo group received 2 ml of saline solution. Pain on movement, at rest, and on pressure, active joint count, and active range of motion, were evaluated on days 1, 5, and 20. The patient's global assessment of treatment efficacy was also assessed on days 5 and 20. Mann-Whitney U tests and Friedman two-way analyses of variance were performed for statistical analyses. RESULTS: Pain at rest was found to be statistically different between the two groups (P = 0.0317). Statistical significance was also found over time for pain on movement within the experimental group (P = 0.0224). CONCLUSION: The results suggest that DEX iontophoresis is more effective than placebo in relieving pain at rest and on movement in the RA knee. Based on the study data, a total of 40 subjects will be required for an RCT of a similar nature.

The effects of transcutaneous electrical nerve stimulation on skin temperature in asymptomatic subjects.

BACKGROUND AND PURPOSE: Several studies have evaluated the effects of transcutaneous electrical nerve stimulation (TENS) on skin temperature. The results of these studies, however, remain controversial. This study examined the effects of two modes of TENS, compared with a control condition, on skin temperature of the hand and finger. SUBJECTS: Twenty-four asymptomatic subjects (23 female, 1 male) with no previous experience with TENS participated. The subjects ranged in age from 19 to 28 years (means = 23.0, SD = 2.44). METHODS: All subjects participated in a 4-Hz TENS session, a 100-Hz TENS session, and a control (no TENS) session. Electrodes were placed on the medial and lateral aspects of the dorsal surface of the left hand. Each session consisted of a 60-minute stabilization period, a 30-minute stimulation period, and a 30-minute follow-up period. Hand temperature was measured using infrared thermography, and finger temperature was measured using a skin thermistor. RESULTS: Mean hand temperature after low-frequency TENS was 1.69 degrees C warmer than the mean hand temperature following the high-frequency TENS and 1.60 degrees C warmer than after the control condition. No differences in the finger temperature were found among the three conditions. CONCLUSION AND DISCUSSION: High-intensity, low-frequency TENS prevented cooling of the hand. High- and low-frequency TENS had no effect on finger temperature.

Effect of TENS on pain, medications, and pulmonary function following coronary artery bypass graft surgery.

The efficacy of transcutaneous electrical nerve stimulation (TENS) as an adjunct to narcotic medications for the management of postoperative pain was assessed in a prospective, randomized, controlled study of patients following coronary artery bypass graft (CABG) surgery with the right or left internal thoracic artery (ITA). Forty-five male patients (mean age, 57 +/- 6 years) were randomly assigned to (1) TENS, (2) placebo TENS, or (3) control treatments (n = 15 each), following extubation and during the 24- to 72-h postoperative period. Two-way analysis of variance tests indicated no significant differences among treatment groups for (1) pain with cough, (2) narcotic medication intake, (3) FVC, (4) FEV1, and (5) PEFR (p > 0.05). However, pain at rest reported by the TENS group was significantly lower than that reported by the control group (treatment main effect; p < 0.04), although no significant differences were observed between the TENS and placebo or between the placebo and control groups (p > 0.05). All six criterion measures were characterized by significant changes over time for the entire group (n = 45; time main effect; p < 0.01), as follows: pain and medication intake were similar on days 1 and 2, but were significantly less on day 3, and pulmonary functions were significantly lower than preoperatively on day 1, decreased further on day 2, and despite an improvement on day 3, remained significantly lower than preoperative values (p < 0.01). This study suggests that the addition of TENS, applied continuously during the immediate postoperative period following CABG with ITA, may not be advantageous in pain management or the prevention of pulmonary dysfunction.

Improvements in pain responsiveness in patients with fibrositis after successful treatment with amitriptyline.

Thirty-six patients with fibrositis received low dose amitriptyline and placebo in a randomized double blind crossover study lasting 10 weeks. Amitriptyline was associated with significant changes on the outcome measures of pain, tender point sensitivity and patient assessment of well being. Clinically significant improvements for pain and tender point sensitivity and a statistically significant improvement in generalized pain responsiveness were found between patients who reported subjective improvement on amitriptyline and those who felt no change.

A comparative study of pain, sleep quality and pain responsiveness in fibrositis and myofascial pain syndrome.

Twenty patients with fibrositis and 19 patients with myofascial pain syndrome were compared with regard to pain levels, sleep quality, general pain threshold and localized pain responsiveness at fibrositic tender points. Patients with fibrositis had significantly lower pain responsiveness (p less than 0.01), lower pain threshold (p less than 0.05) and higher pain levels (p less than 0.05) than patients with myofascial pain syndrome when differences in age between the groups were controlled. No significant difference was found for sleep quality. Regional pain levels influenced local measures of pain sensitivity. A discriminant function, developed on the 4 main study variables, resulted in an almost 80% correct classification to groups.

Pain perception and personality measures as discriminators in the classification of fibrositis.

Twenty patients with fibrositis were compared to age and sex matched groups of patients with rheumatoid arthritis (RA) and normal controls regarding personality variables measured by the Basic Personality Inventory (BPI) and responsiveness to experimentally induced pain. The group with fibrositis scored significantly higher than the normal group on 4 of the BPI scales and had lower pain threshold and tolerance than the normal group. The group with RA was found to be significantly different from the normal group on hypochondriasis and pain tolerance. Using only pain and personality measures, a statistical discriminant function that was developed resulted in a 72% classification accuracy for the 3 groups studied and 85% accuracy when only the 2 clinical groups were considered.

Pain assessment.

The use of therapeutic measures which are designed primarily to modulate pain has high-lighted the need for an accurate and reliable method of pain assessment in the physiotherapy department. Some psychological considerations of pain are reviewed and different methods of pain assessment are described and discussed. The need for a practical pain assessment tool is emphasised in the ongoing assessment of the patient by the physiotherapist. A pain assessment model is proposed which can incorporate a Visual Analogue Scale, a record of analgesic intake and a record of the patient's activity level. These parameters can be recorded and displayed in graph form, which provides a clear picture of symptom relief and treatment effectiveness over a period of time.