Transforaminal Injections of Platelet-Rich Plasma Compared with Steroid in Lumbar radiculopathy: A Prospective, Double-Blind Randomized Study.

Purpose: To evaluate and compare the clinical efficacy of transforaminal steroid and platelet-rich plasma (PRP) injections in patients with discogenic lumbar radiculopathy. Methods: 60 patients were randomized to be treated with single transforaminal injection of PRP (n = 29) or steroid (methylprednisolone acetate [n = 31]). Clinical assessment was done with Visual analogue scale (VAS), modified Oswestry low back pain disability index (MODI), and straight leg raise test (SLRT). Baseline assessment of outcomes was done followed by post-intervention evaluation at 1, 3, and 6 months. Both groups had similar baseline characteristics. Results: There was a significant statistical improvement of VAS and MODI in both groups at follow-up (P < 0.05). In PRP group, minimal clinically important change (> 2 cm difference of mean for VAS and > 10-point change in MODI) for both outcome scores was achieved at all follow-up intervals (1, 3, 6 months), while as in steroid group, it was seen only at 1 and 3 months for both VAS and MODI. On intergroup comparison, better results were seen in steroid group at 1 month (P < 0.001 for both VAS and MODI), and in PRP group at 6 months (P < 0.001 for both VAS and MODI) with non-significant difference at 3 months (P = 0.605 for MODI and P = 0.612 for VAS). More than 90% tested SLRT negative in PRP group and 62% in steroid group at 6 months. No serious complications were seen. Conclusion: Transforaminal injections of PRP and steroid improve short-term (up to 3 months) clinical outcome scores in discogenic lumbar radiculopathy, but clinically meaningful improvements sustaining for 6 months were provided by PRP only.

The Dutch language version of the Pain Disability Index (PDI-DLV): psychometric properties in breast cancer patients.

BACKGROUND: Pain after breast cancer surgery is a common and disabling problem. A reliable and valid questionnaire to assess pain-related disability is the Pain Disability Index (0-70). However, properties of the Dutch version (PDI-DLV) have never been investigated in this population. OBJECTIVE: To assess psychometric properties of the PDI-DLV after breast cancer surgery. METHODS: For reliability, relative and absolute reliability were calculated with a one-week test-retest interval, as well as internal consistency. Moreover, content and construct validity were examined to evaluate validity. RESULTS: One hundred twenty-three women were included. Relative reliability was good (intraclass correlation coefficient = 0.80). Standard error of measurement and minimal detectable change (absolute reliability) were 5.57 and 15.45 points, respectively. The mean difference between two measurements was -1.98 points, with 95% limits of agreement equal to 13.19 and -17.15. The within-subjects coefficient of variation was 59%. Internal consistency was confirmed (α = 0.87). The PDI-DLV was scored as understandable and complete (content validity). Construct validity was supported by confirmation of more than 75% of the tested hypotheses and of the one-factor model. CONCLUSION: The PDI-DLV is a valid questionnaire to assess pain-related disability 1 year after breast cancer surgery. Although absolute reliability is disputable, its good relative reliability allows evaluating changes between subjects.

The Pain Disability Index: Effects of performance and symptom validity in mild traumatic brain injury litigants with persistent Post-Concussion pain complaints.

OBJECTIVE: Objectives of the current study were to cross validate the Pain Disability Index (PDI) as a measure of symptom validity in a large sample of mild traumatic brain injury (MTBI) litigants with persistent post-concussive pain complaints, and investigate the effects of performance and symptom validity testing on PDI scores. METHODS: Participants included 91 adults who underwent a comprehensive neuropsychological examination. Criterion groups were formed based upon their performance on stand-alone measures of cognitive performance validity (PVT), and the MMPI-2-RF Symptom Validity Scale (FBS-r) as a measure of symptom validity (SVT). RESULTS: Participants who failed PVT and SVT scored significantly higher on the PDI compared to participants who passed both. Failing both was associated with a large effect size. Failing PVT, but passing SVT, was associated with a medium effect on PDI scores, while passing PVT, but failing SVT demonstrated a small effect. A PDI cutscore of 49 was associated with .90 specificity and .47 sensitivity. CONCLUSION: The PDI demonstrates external validity as a self-report measure of symptom validity in MTBI litigants with persistent post-concussive pain complaints. A dose response relationship exists between PVT, SVT and PDI scores. Forensic examiners should include both PVT and SVT to optimize clinical decision making when evaluating MTBI litigants with complaints of pain-related disability years post-incident.

Prevalence of Low Back Pain and Its Related Risk Factors and Disability Following Lumbar Discectomy: A Single-Center Study.

Background Lumbar disc herniation is considered the most common cause of sciatica, which is a contributing factor to disability. Surgical management of lumbar disc herniation in the form of discectomy is superior to conservative management in terms of better recovery and pain relief. However, recurrence, residual back pain, and disability are common expected complications following surgery. Therefore, this study aims to determine the prevalence of low back pain and its related risk factors and disability following discectomy at King Fahad Hospital in the Al-Ahsa region. Methodology A cross-sectional study was conducted at King Fahad Hofuf Hospital in the Al-Ahsa region among patients who were admitted and underwent lumbar spine discectomy in the last six years either due to traumatic or degenerative causes. The study used an anonymous questionnaire consisting of the patient's sociodemographic data, medical and surgical history, spine disease history, and surgical history. The preoperative Glasgow Coma Scale score, neurological status, and American Spinal Cord Impairment Scale score were noted. In addition, immediate postoperative neurological status and minor complications were recorded. Moreover, more than six months postoperatively, the Numeric Analogue Scale and the Oswestry low back pain disability index questionnaire were administered. Results A total of 201 patients were included in the study. The majority of the patients were male (59.7%), with ages ranging from 41 to 60 years (51.7). Most patients underwent one surgery (83.6%) in the form of discectomy alone (90.5%) at L3-L4 (58.7%), for which the intervertebral disc was the most common degenerative indication for surgery. All patients (100%) had low back pain preoperatively, and most patients (50.7%) had no back pain six months postoperatively. Preoperatively, 58.2% had diminished neurological status, while only 29.9% showed a deficit postoperatively. Postoperative low back pain was significantly associated with office-based jobs (p = 0.021, 60.5%) and a high number of surgeries (p = 0.004, 74.1%). The following factors were observed to be risk factors for having lower back pain: six months postoperatively, being unemployed (p = 0.024, odds ratio = 4.38, 338% increased risk), having an office-based job (p = 0.012, odds ratio = 3.98, 298% increased risk), and the underlying cause of the problem being degenerative (p = 0.003, odds ratio = 3.34, 234% increased risk). Low back pain-related severe disability postoperatively was significantly associated with increased age >40 (28-50%; p = 0.045), female gender (p = 0.012, 44.4%), and being unemployed (p = 0.002, 51.4%). The level of disability six months postoperatively was moderate in 40.4% of the patients. Conclusions Lumbar discectomy is a successful procedure for relieving low back pain among patients with degenerative spine disease, with an improvement that involves neurological status. However, residual back pain may still occur in less than half of the patients despite appropriate management, such as being unemployed or office-based employees and having multiple spine surgeries. However, low back pain-related disability is often moderate, with increasing severity seen with increased age, being female, and being unemployed.

The Influence of Pain and Resiliency on Foot and Ankle Surgery Outcomes.

Background: Resilience is the ability to recover after stressful events and has been shown to correlate with surgical outcomes. However, there has been minimal research on the impact of patient resiliency on foot and ankle surgical outcomes. This study aims to determine the predictive value of preoperative resiliency scores on surgical outcomes and investigate how this compares with the predictive value of pain scores. Methods: We conducted a retrospective review of adult patients who completed a preoperative Brief Resilience Scale (BRS) and underwent surgery between November 2019 and November 2020 with a fellowship-trained foot and ankle surgeon (N=184). Data included demographics, comorbidities, surgical details, complication and reoperation rates, pre- and postoperative opioid and benzodiazepine use, and additional patient-reported outcome measures (ie, visual analog scale [VAS], Pain Catastrophizing Scale [PCS], Pain Disability Index [PDI], Foot and Ankle Outcome Score [FAOS] pain subscale). Mean follow-up duration was 4.49 (range, 1.10-14.17) months. Results: BRS weakly correlated with decreased postoperative benzodiazepine use (P=.007). PCS magnification (P=.050) and helplessness (P=.047) subscales weakly correlated with increased follow-up duration. PDI total score and most subscores significantly correlated with an increase in at least 1 of the following: follow-up duration, or postoperative opioid or benzodiazepine use. Neither the VAS nor FAOS pain subscore correlated with any outcome. PDI total score was the strongest predictor of postoperative opioid (ß=0.334) and benzodiazepine (ß=0.315) use. Preoperative opioid users had significantly higher PDI total score (user=39.3, nonuser=24.9; P=.012) and subscores (ie, social activity, sexual behavior, self-care, life-support activities). Conclusion: BRS is an unreliable tool for predicting outcomes in foot and ankle surgery, as it only weakly correlated with decreased benzodiazepine use. Rather, given the PDI's strong associations with postoperative measures in this study, physicians should consider the value of preoperative PDI completion when predicting how foot and ankle surgery recipients will fare postoperatively. Level of Evidence: Level III, retrospective cohort study.

Validity, reliability, and factor structure of the Istanbul Low Back Pain Disability Index in axial spondyloarthritis.

OBJECTIVE: To investigate the validation and reliability of Istanbul Low Back Pain Disability Index (ILBPDI) in axial spondyloarthritis (Ax-SpA). METHODS: Patients with Ax-SpA according to The Assessment of SpondyloArthritis International Society criteria were recruited. The validation was assessed by face, content, and construct (convergent and divergent) validities, whereas the reliability was assessed by internal consistency and test-retest reliability. Factor analysis was performed. Convergent validity was assessed by correlations of ILBPDI with functional parameters (The Bath Ankylosing Spondylitis Functional Index, The Dougados Functional Index, and The Health Assessment Questionnaire). Divergent validity was assessed by correlations of ILBPDI with non-functional parameters. RESULTS: Two hundred forty patients were recruited. Cognitive debriefing showed ILBPDI to be clear, relevant, and comprehensive. Cronbach's alpha coefficient was 0.953. The test-retest reliability was good with the intraclass correlation coefficient of 0.870. ILBPDI was represented by three-factor groups of activity: axial bending, sitting/rest, and standing activities. ILBPDI had good correlations with the functional parameters (rho changes between 0.809 and 0.580), and it had poor or non-significant correlations with the non-functional parameters (absolute rho changes between 0.669 and 0.001). CONCLUSION: ILBPDI is a practical, accurate, and non-time-consuming scale which is valid and reliable to evaluate the functional disability in patients with Ax-SpA.

Methodological and interpretive concerns about Beemster et al.'s article 'The interpretation of change score of the pain disability index after vocational rehabilitation is baseline dependent': a letter to the editor.

This is a critique of Beemster et al.'s article 'The interpretation of change score of the pain disability index after vocational rehabilitation is baseline dependent' (2018). The methodological issues in question include the choices of anchor to determine the minimal important change, and the intraclass correlation coefficient on which the calculation of the standard error of measurement was based. We believe these undermine the authors' interpretation.

Kinesiophobia contributes to pain-related disability in breast cancer survivors: a cross-sectional study.

PURPOSE: Pain is one of the most prevalent problems reported by breast cancer survivors. As this long-lasting complication can result in disabilities on all different domains of functioning, we aimed to clarify the contribution of different factors (pain-related factors, psychosocial factors, and fatigue) to pain-related disability in female breast cancer survivors. METHODS: Seventy women who had completed their primary breast cancer treatment were included in this cross-sectional study. The following outcome measures were evaluated as independent variables for their contribution to pain-related disability (measured by the Pain Disability Index, with a maximum score of 70): pain intensity, self-reported symptoms of central sensitization, fatigue, illness beliefs, pain catastrophizing, and kinesiophobia. At first, bi- and multivariable regression methods were conducted. Secondly, a stepwise regression analysis was performed to determine the explained variance of the PDI. RESULTS: Mean score on the PDI was 16 at 4.5 years post-surgery. Multivariable regression analysis revealed higher levels of kinesiophobia as the main contributor to pain-related disability. Ultimately, stepwise regression showed that up to 40% of variance in pain-related disability could be explained by kinesiophobia, negative perceptions related to illness consequences, and pain catastrophizing. CONCLUSION: This study shows that breast cancer survivors portray moderate self-reported pain-related disability. Kinesiophobia emerged as the main contributor to pain-related disability at this time point, which could shine a light on the improvement of treatment modalities for pain management in this population.

The interpretation of change score of the pain disability index after vocational rehabilitation is baseline dependent.

BACKGROUND: The Pain Disability Index (PDI) is a widely-used instrument to measure pain-related disability. The aim of this study was to assess the responsiveness and interpretation of change score of the PDI in patients with chronic musculoskeletal pain (CMP) at discharge of vocational rehabilitation. METHODS: Retrospective data of patients with CMP who attended vocational rehabilitation between 2014 and 2017 was used. The anchor-based method was used to assess the responsiveness of the total sample and of PDI baseline quartile groups. A receiver operating characteristic curve was performed, including Area Under the Curve (AUC) and Minimal Important Change (MIC). RESULTS: The PDI showed responsive to detect clinically relevant changes in pain-related disability at discharge of vocational rehabilitation (AUC 0.79). A PDI change score of 13 points (MIC 12.5) can be considered as a real change in pain-related disability for the total study sample, and a PDI change score of 7-20 points can be considered as a real change in pain-related disability for PDI lowest and highest baseline quartile scores. CONCLUSION: The PDI is responsive in patients with CMP at discharge of vocational rehabilitation. The interpretation of change score depends on PDI baseline score. Patients with a PDI baseline score of ≤27 should decrease minimal 7 points, patients with a baseline score between 28 and 42 should decrease minimal 15 points, and patients with a baseline score ≥ 43 should decrease minimal 20 points.

Deep brain stimulation for intractable neuropathic facial pain.

OBJECTIVE Deep brain stimulation (DBS) is a well-established, evidence-based therapy with FDA approval for Parkinson's disease and essential tremor. Despite the early successful use of DBS to target the sensory thalamus for intractable facial pain, subsequent studies pursuing various chronic pain syndromes reported variable efficacy, keeping DBS for pain as an investigational and "off-label" use. The authors report promising results for a contemporary series of patients with intractable facial pain who were treated with DBS. METHODS Pain outcomes for 7 consecutive patients with unilateral, intractable facial pain undergoing DBS of the ventral posteromedial nucleus of the thalamus (VPM) and the periaqueductal gray (PAG) were retrospectively reviewed. Pain was assessed preoperatively and at multiple postoperative time points using the visual analog scale (VAS), the Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2), and the Pain Disability Index (PDI). RESULTS VAS scores significantly decreased from a mean ± SD of 9.0 ± 1.3 preoperatively to 2.6 ± 1.5 at 1 year postoperatively (p = 0.001). PDI scores decreased from a mean total of 48.5 to 28.5 (p = 0.01). SF-MPQ-2 scores decreased from a mean of 4.6 to 2.4 (p = 0.03). Notably, several patients did not experience maximum improvement until 6-9 months postoperatively, correlating with repeated programming adjustments. CONCLUSIONS DBS of the VPM and PAG is a potential therapeutic option for patients suffering from severe, intractable facial pain refractory to other interventions. Improved efficacy may be observed over time with close follow-up and active DBS programming adjustments.

Percutaneous transoral clivoplasty and upper cervical vertebroplasties for multifocal skeletal lymphangiomatosis resulting in complete resolution of pain: case report.

Lymphangiomatosis is a rare congenital disorder that results in multiorgan system lymphatic invasion. Symptoms due to axial skeletal involvement can range from chronic bone pain to severe deformity resulting in radiculopathy, myelopathy, and even paralysis. The authors present a case of lymphangiomatosis of the clivus, C-1, and C-2, resulting in chronic pain. The patient was successfully treated with percutaneous transoral clivoplasty and vertebroplasty, without disease progression or return of symptoms at 2 years.

Acute effects of walking with Nordic poles in persons with mild to moderate low-back pain.

Regular walking with or without Nordic poles is effective over time at reducing discomfort in individuals with chronic low back pain (LBP). Nordic pole use increases balance and stability, distributes weight through the arms and torso, and decreases loading of the spine and lower limbs. The purpose of this study was to determine if Nordic poles would reduce perceived acute discomfort while self-paced walking in individuals with LBP. We also examined whether walking with or without poles increased heart rate (HR) and ratings of perceived exertion (RPE) or speed of movement. Subjects included 20 adults (12 males, 8 females; mean age of 45.1±16.3) who were experiencing LBP of at least six months' duration (Oswestry Disability Index (ODI): mean 17 ± 8%, range 6-36% indicating minimal to moderate disability) with no current active flare-up. Participants walked a predetermined dirt-path course (805 m or 0.5 mi) with and without poles in randomized order. Data were analyzed using a 2 X 2 repeated measures ANOVA (Condition X Time), where Condition was poles vs no poles and Time was pre- and post-walk. HR and RPE increased significantly from walking the course, whereas pain did not change. There were also no differences between walking with or without poles for pain (ODI Sec #1: 0.2 points, p=0.324), HR (4 bpm, p=0.522) and RPE (0 points, p=0.759). The mean course time (sec) was slower with poles: 617±87 vs 566±65 (p<0.001). Unexpectedly, there was a noticeable drop in pain following the warm up which was done using poles (0.9 points, p<0.001). Nordic pole use is well tolerated in those with current back pain and can be encouraged, however it cannot be recommended as a superior method of addressing acute symptoms when walking.

Accuracy of the Modified Somatic Perception Questionnaire and Pain Disability Index in the detection of malingered pain-related disability in chronic pain.

The Modified Somatic Perception Questionnaire (MSPQ) and the Pain Disability Index (PDI) are both popular clinical screening instruments in general orthopedic, rheumatologic, and neurosurgical clinics and are useful for identifying pain patients whose physical symptom presentations and disability may be non-organic. Previous studies found both to accurately detect malingered pain presentations; however, the generalizability of these results is not clear. This study used a criterion groups validation design (retrospective cohort of patients with chronic pain, n = 328) with a simulator group (college students, n = 98) to determine the accuracy of the MSPQ and PDI in detecting Malingered Pain Related Disability. Patients were grouped based on independent psychometric evidence of MPRD. Results showed that MSPQ and PDI scores were not associated with objective medical pathology. However, they accurately differentiated Not-MPRD from MPRD cases. Diagnostic statistics associated with a range of scores are presented for application to individual cases. Data from this study can inform the clinical management of chronic pain patients by screening for psychological overlay and malingering, thus alerting clinicians to the possible presence of psychosocial obstacles to effective treatment and triggering further psychological assessment and/or treatment.

Pain and Psychometric Characteristics Related to Disability Evaluation in Patients with Chronic Low Back Pain

OBJECTIVE: To evaluate the effect of compensation or secondary gain on the pain behavior and psychometric characteristics. METHOD: We examined 88 patients who complained of chronic low back pain by the various pain questionnaires, electrodiagnostic study and magnetic resonance imaging (MRI). Total patients were classified into two groups (46 patients who wanted disability evaluation and 42 patients who did not). RESULTS: Mean score of visual analogue scale, total sum of McGill pain questionnaire and pain rating index on sensory, affective and miscellaneous dimensions were significantly higher in patients related to disability compensation than those in patients without compensation. Mean scores of pain disability index and symptom checklist-90-revision were significantly higher on various subclass in patients with compensation. Various pain scales were significantly correlated to each other in both group but the severity of electrodiagnostic study and MRI findings were not related with the degree of pain index score in both group. CONCLUSION: Compensation or secondary gain affect pain behavior and psychometric characteristics in chronic low back patients. So when we evaluate or treat the patients with chronic low back pain, we should consider above results.