Chronic low back pain in older adults: prevalence, reliability, and validity of physical examination findings

OBJECTIVES: To develop a structured physical examination protocol that identifies common biomechanical and soft-tissue abnormalities for older adults with chronic low back pain (CLBP) that can be used as a triage tool for healthcare providers and to test the interobserver reliability and discriminant validity of this protocol. DESIGN: Cross-sectional survey and examination. SETTING: Older adult pain clinic. PARTICIPANTS: One hundred eleven community-dwelling adults aged 60 and older with CLBP and 20 who were pain-free. MEASUREMENTS: Clinical history for demographics, pain duration, previous lumbar surgery or advanced imaging, neurogenic claudication, and imaging clinically serious symptoms. Physical examination for scoliosis, functional leg length discrepancy, pain with lumbar movement, myofascial pain (paralumbar, piriformis, tensor fasciae latae (TFL)), regional bone pain (sacroiliac joint (SIJ), hip, vertebral body), and fibromyalgia. RESULTS: Scoliosis was prevalent in those with (77.5%) and without pain (60.0%), but prevalence of SIJ pain (84% vs 5%), fibromyalgia tender points (19% vs 0%), myofascial pain (96% vs 10%), and hip pain (48% vs 0%) was significantly different between groups (P < .001). Interrater reliability was excellent for SIJ pain (0.81), number of fibromyalgia tender points (0.84), and TFL pain (0.81); good for scoliosis (0.43), kyphosis (0.66), lumbar movement pain (0.75), piriformis pain (0.71), and hip disease by internal rotation (0.56); and marginal for leg length (0.00) and paravertebral pain (0.39). CONCLUSION: Biomechanical and soft tissue pathologies are common in older adults with CLBP, and many can be assessed reliably using a brief physical examination. Their recognition may save unnecessary healthcare expenditure and patient suffering.     

Measuring pain as the 5th vital sign does not improve quality of pain management

BACKGROUND: To improve pain management, the Veterans Health Administration launched the "Pain as the 5th Vital Sign" initiative in 1999, requiring a pain intensity rating (0 to 10) at all clinical encounters. OBJECTIVE: To measure the initiative's impact on the quality of pain management. DESIGN: We retrospectively reviewed medical records at a single medical center to compare providers' pain management before and after implementing the initiative and performed a subgroup analysis of patients reporting substantial pain (> or =4) during a postimplementation visit. PARTICIPANTS: Unique patient visits selected from all 15 primary care providers of a general medicine outpatient clinic. MEASUREMENTS: We used 7 process indicators of quality pain management, based on appropriately evaluating and treating pain, to assess 300 randomly selected visits before and 300 visits after implementing the pain initiative. RESULTS: The quality of pain care was unchanged between visits before and after the pain initiative (P>.05 for all comparisons): subjective provider assessment (49.3% before, 48.7% after), pain exam (26.3%, 26.0%), orders to assess pain (11.7%, 8.3%), new analgesic (8.7%, 11.0%), change in existing analgesics (6.7%, 4.3%), other pain treatment (11.7%, 13.7%), or follow-up plans (10.0%, 8.7%). Patients (n=79) who reported substantial pain often did not receive recommended care: 22% had no attention to pain documented in the medical record, 27% had no further assessment documented, and 52% received no new therapy for pain at that visit. CONCLUSIONS: Routinely measuring pain by the 5th vital sign did not increase the quality of pain management. Patients with substantial pain documented by the 5th vital sign often had inadequate pain management.     

Variation in pain related to systemic lupus erythematosus (SLE): a 7-year follow-up study

We have previously shown that most patients with systemic lupus erythematosus (SLE) reported low degree of SLE-related pain. However, 24% of the patients reported high degree of SLE-related pain, more fatigue, anxiety and depression, and worse health-related quality of life (HRQoL). To explore SLE-related pain, the presence of long-standing widespread pain, and patient-reported outcomes (PROs) after 7 years. Sixty-four out of 84 patients participated in a 7-year follow-up of the original survey and completed the same questionnaires answered at inclusion: pain (VAS 100 mm), fatigue (MAF), HRQoL (SF-36), anxiety and depression (HADS), and, if appropriate, a pain-drawing. Differences between inclusion and follow-up (change) were calculated. The patients with a low degree of SLE-related pain at inclusion reported no changes at follow-up in pain and PROs except for worsening in physical function in SF-36, median change (IQR) 0 (??10 to 5), p?=?0.024. Half of the patients with high degree of pain at inclusion reported decreased pain at follow-up, median change (IQR) 45 (35 to 65), p?=?0.021; fatigue, 8 (8 to 17), p?=?0.018; anxiety, 4 (1 to 4), p?=?0.035; and depression, 4 (2 to 5), p?=?0.018 and improvements in most dimensions of SF-36. The remaining half of the patients reported no changes regarding pain and PROs except for a worsening in vitality in SF-36, 20 (15 to 35), p?=?0.0018. All patients with remaining high level of pain indicated long-standing widespread pain. After 7 years, a subgroup of patients with SLE reported remaining high level of SLE-related pain and a high symptom burden, including long-standing widespread pain. Such patients require more observant attention to receive appropriate treatment.     

The Bath Ankylosing Spondylitis Activity and Function Indices (BASDAI and BASFI) and their correlation with main symptoms experienced by patients with spondyloarthritis

With the aim of assessing whether the Bath Ankylosing Spondylitis Activity and Function Indices (BASDAI and BASFI) are reliable measures of disease activity and function in patients with spondyloarthritides (SpAs), 341 patients with SpA (representing ankylosing spondylitis (14.5%), psoriatic arthritis (27.3%), enteropathic arthritis (6.3%), reactive arthritis (4.9%), and undifferentiated arthritis (46.5%) were asked to complete the BASDAI and BASFI. They were asked to report what their main problems associated with the disease were from a list of seven symptoms: fatigue, neck pain, upper back pain, lower back pain, stiffness, joint pain or swelling, and pain with pressure on joints. Correlations between the main symptoms experienced by patients with SpAs and the indices, defined by Spearman’s correlation coefficient, showed that BASDAI best correlated with neck pain [BASDAI 2 and total BASDAI score correlate strongly (p = 0.003 and 0.001, respectively), and BASDAI 1, 4, and 5 correlate moderately (p = 0.03, 0.02, and 0.01, respectively)], followed by stiffness, upper back pain, pain with pressure, lower back pain, fatigue, and joint pain. Stiffness correlated strongly with nine of ten items on BASFI (BASFI 1 showed moderate correlation, p = 0.01), followed by upper back pain (four of ten items correlated strongly, three of ten correlated moderately), neck pain (three of ten tasks correlated strongly and four of ten correlated moderately), lower back pain (one task correlated strongly, five moderately), joint pain and swelling (four tasks correlated moderately), fatigue (three tasks correlated moderately), and pain with pressure (two tasks correlated moderately). BASDAI and BASFI only partly reflect disease activity and patients’ functional capacity in SpAs. An alternate instrument is required to assess SpA disease activity and functional capacity more precisely.     

Self-reported management of pain in hospitalized patients: link between process and outcome

PURPOSE: Hospitalized patients commonly experience pain. We investigated the association between patients' reported use of recommended pain management practices and overall pain relief. METHODS: All adult patients discharged during a 1-month period from a Swiss teaching hospital were invited to complete a mailed survey that included the Picker patient experience questionnaire, questions on pain relief during hospitalization, and questions on various procedures that are recommended as standards of pain management. RESULTS: Of 2156 eligible patients, 1518 (70%) participated. Sixty-nine percent (n = 1050) had experienced pain during their hospital stay, of whom 71% (n = 697/978) reported complete pain relief. After adjustment for sex, age, general health, and hospital department, pain relief was associated independently with availability of physicians (odds ratio [OR] = 11; 95% confidence interval [CI]: 3.3 to 36 for excellent vs. poor availability), having received information about pain and its management (OR = 2.8; 95% CI: 1.8 to 4.2), regular pain assessment (OR = 1.8; 95% CI: 1.2 to 2.8), modification of pain treatment when ineffective (OR = 3.0; 95% CI: 1.6 to 5.6), and waiting less than 10 minutes for pain medications (OR = 3.5; 95% CI: 1.9 to 6.6). CONCLUSION: Patient reports that recommended pain management procedures had been used were associated with better self-reported pain relief among hospitalized patients.     

Pain and satisfaction with pain control in hospitalized medical patients: no such thing as low risk

BACKGROUND: Pain is common in many populations of hospitalized patients. It is unknown if any populations of hospitalized patients are at low risk for pain. We studied the prevalence of pain and satisfaction with pain control in a general medicine inpatient service to determine if this population was at low risk for pain. METHODS: We performed a prospective cohort study of 5584 hospitalized patients. Pain and pain control were assessed in a follow-up telephone survey. Predictors of pain were determined through administrative databases and patient survey. RESULTS: Of the study patients, 59% had pain (28% reported severe, 19% moderate, and 12% mild pain). Among patients with common diagnoses, those with sickle cell crisis were the most likely and those with syncope were the least likely to report significant pain (90% and 34%, respectively). Patient characteristics significantly associated with increased pain included DRG (diagnosis related group) weight (odds ratio [OR], 1.19), Charlson Index score (OR, 1.03), age older than 65 years (OR, 0.65), female sex (OR, 1.17), and education level higher than high school (OR, 1.31). Pain was reported by 28% of patients without high-risk characteristics for pain; and 82.2% of patients were satisfied, 11.1% somewhat satisfied, and 6.7% dissatisfied with their pain treatment. CONCLUSIONS: Pain was common in the study population and more patients rated their pain as severe than as moderate or mild. Pain was dispersed among diagnoses. Although most patients thought that their pain was adequately controlled, 18% of patients with pain (10% of all patients) reported that their pain was inadequately controlled. Although patient characteristics were associated with pain or dissatisfaction with pain control, they were weak predictors and significant pain was common even in populations at the lowest-risk for pain.     

Is chronic pain in adulthood related to childhood factors? A population-based case-control study of young adults

OBJECTIVE: To investigate whether recalled childhood pain experiences and illnesses are associated with chronic pain in young adults. METHODS: A cross-sectional population-based survey recruited participants aged 18-25 years for a case-control study and obtained information on current pain and recalled childhood experiences. In total, 858 respondents were classified as either non-pain controls (n = 276), non-chronic pain cases (pain for < or = 3 months in the previous 6 months, n = 435), or chronic pain cases (pain of > 3 months' duration, n = 119). RESULTS: 858 young adults responded to the survey (adjusted response rate 37%). Of the recalled exposures in childhood, family members with pain (OR 2.48, 95% CI 1.48, 4.15), having more than 2 relatives with pain during childhood (OR 3.03, 95% CI 1.44, 6.40), being admitted to hospital during childhood (OR 1.71, 95% CI 1.04, 2.80), and having more illness than one's peer group at secondary school (OR 3.98, 95% CI 1.99, 7.96) were significantly associated with having chronic pain as a young adult, after adjustment for age, sex, and current psychological distress scores. Recall bias was assessed by comparing actual and recalled admission to the neonatal intensive care unit, with no significant differences being found between the participating groups. CONCLUSION: Several associations were observed between pain status as a young adult and selected self-reported childhood experiences of illness and pain. The role of recall bias cannot be excluded in this retrospective study, but the results emphasize the importance of family and childhood experiences of pain in potentially influencing future adult pain status.     

The London Fibromyalgia Epidemiology Study: comparing the demographic and clinical characteristics in 100 random community cases of fibromyalgia versus controls.

OBJECTIVE: To identify demographic and clinical features that distinguish fibromyalgia (FM) from other chronic widespread pain. METHODS: We identified 100 confirmed FM cases, 76 widespread pain controls, and 135 general controls in a random community survey of 3395 noninstitutionalized adults living in London, Ontario. FM cases were distinguished from pain controls using the 1990 American College of Rheumatology (ACR) classification criteria for FM. RESULTS: The mean age of FM cases was 47.8 years (range 19 to 86), the same as for pain controls; 86% of FM cases were female versus 67.1% of pain controls (p < 0.01). FM cases were less educated than general controls (p = 0.03). Male and female FM cases were similar, except females were older and reported more major symptoms (both p = 0.02). FM cases reported more severe pain and fatigue, more symptoms, more major symptoms, and worse overall health than pain controls or general controls. The most commonly reported major symptoms among FM cases were musculoskeletal pain (77.3%), fatigue (77.3%), severe fatigue lasting 24 h after minimal activity (77.0%), nonrestorative sleep (65.7%), and insomnia (56.0%). Subjects with 11-14 tender points were more similar to those with 15-18 tender points than to those with 7-10 points in 11 of 14 clinical variables. On multivariate analysis, 4 symptoms distinguished FM cases from pain controls: pain severity (p = 0.004), severe fatigue lasting 24 h after minimal activity (p = 0.006), weakness (p = 0.008), and self-reported swelling of neck glands (p = 0.01). CONCLUSION: In the general population, adults who meet the ACR definition of FM appear to have distinct features compared to those with chronic widespread pain who do not meet criteria.     

Musculoskeletal pain in Japan: prevalence and interference with daily activities

We estimated the prevalence of musculoskeletal pain in five anatomical areas and their interference with daily activities (IDA) in a Japanese adult population (n = 3188). A questionnaire survey was conducted among participants in health examinations at three health care centers. On a drawing with predefined body regions, participants marked the regions affected by pain and the regions affected by IDA due to the pain, respectively. Overall prevalence of musculoskeletal pain was 41.4% (M 40.9%, F 42.2%) with a significant increase with age. Neck and shoulder area showed the highest prevalence of pain (20.3%; M 19.6%; F 21.3%), followed by lower back area (19.1%; M 20.1%; F 17.5%), hip and knee area (11.1%; M 9.1%; F 14.3%), elbow, wrist, and hand area (7.4%; M 6.6%; F 8.6%), and ankle and foot area (5.8%; M 5.5%; F 6.3%). Overall percentage of IDA in musculoskeletal pain was 20.5%. After adjustment for age and sex, the ranking of percentage of IDA in the pain was: (1) neck and shoulder area (31.0%), (2) elbow, wrist, and hand area (21.5%), (3) ankle and foot area (18.8%), (4) lower back area (17.9%), and (5) hip and knee area (17.4%). Overall percentage of treatment for musculoskeletal disorders was 6.6% (M 4.7%, F 9.7%), which remained 28.1% (M 21.6%, F 38.0%) even in those who described IDA due to pain. According to our estimates, 42.2 million (41.2%) of Japanese adults might suffer from musculoskeletal pain and 9.1 million (8.8%) might encounter IDA due to the pain. Because of high prevalence and IDA, musculoskeletal pain is one of the health problems to be given high priority in Japan.     

Efficacy of Coblation Technology in Treating Cervical Discogenic Upper Back Pain

Upper back pain originating from the cervical disk itself is defined as cervical discogenic upper back pain. Coblation procedures can provide therapeutic effects for neck and radicular pain related to contained cervical disk herniation. However, no studies have reported the performance of coblation procedures, particularly for treating cervical discogenic upper back pain. The purpose of this study was to evaluate the efficacy of coblation procedures in treating cervical discogenic upper back pain.In a prospective, clinical, observational study, 28 consecutive patients with discogenic upper back pain underwent coblation procedures on the cervical disk with a percutaneous anterior approach. Pain visual analogue scale (VAS) scores, patient responses stating significant (≥50%) pain relief, significant (≥50%) reduction in pain medicine intake and Modified MacNab criteria were adopted to evaluate the pain intensity, degree of pain relief, and functional status after 12 months of follow-up.The preoperative pain VAS score was 6.5 ± 1.1 (95% confidence interval [CI] 6.085–6.915), and the pain VAS score significantly decreased to 2.4 ± 1.3 (95% CI 1.929–2.928), 2.5 ± 1.5 (95% CI 1.963–3.109), 2.7 ± 1.4 (95% CI 2.157–3.271), 3.1 ± 1.6 (95% CI 2.457–3.686), and 3.1 ± 1.6 (95% CI 2.471–3.743) at 1 week and 1, 3, 6, and 12 months postoperatively, respectively (P < 0.05). Twenty-two (78.6%), 21 (75.0%), 20 (71.4%), 19 (67.9%), and 18 (64.3%) of the patients expressed significant pain relief at 1 week and 1, 3, 6, and 12 months postoperatively, respectively. 24 (85.7%), 23 (82.1%), 23 (82.1%), and 22 (78.6%) reported significant reduction in pain medication intake at 1, 3, 6, and 12 months postoperatively, respectively. According to the Modified MacNab criteria, the numbers of patients with “excellent” or “good” ratings were 22 (78.6%), 21 (75.0%), 20 (71.4%), and 18 (64.3%) at 1, 3, 6, and 12 months postoperatively, respectively. No serious complications were observed.The findings of this study showed that coblation is an effective, safe, minimally invasive, and less uncomfortable procedure for the treatment of discogenic upper back pain.     

The symptom of pain with pressure ulcers: a review of the literature

Although wound pain often is described as an important clinical factor by both patients and providers, pain associated with pressure ulcers is poorly understood. To assess the state of knowledge of pain with pressure ulcers, a systematic, integrative review of the literature was conducted to determine: 1) how pain is measured, 2) pain prevalence/incidence, and 3) factors associated with pressure ulcer pain. Bibliographic databases including MEDLINE (1966-2005), HealthSTAR (1975-2005), CINAHL (1982-2005), and seven others were searched using the terms decubitus ulcers, pressure ulcer, pressure sore, bed sore, and pain and then culled to English-language, clinical publications. Of the 417 articles recovered, 26 met the study inclusion criteria, six specifically identified pain prevalence (ranging from 37% and 100%), and none documented the incidence of pain in patients with pressure ulcers. Measurement tools used to assess pain included the Visual Analogue Scale, the Verbal Rating Scale, the Wong-Baker Facial Recognition Scale, the McGill Pain Questionnaire-Short Form, the Numerical Rating Scale, and the Present Pain Intensity scale. Pressure ulcer pain was described as a burning sensation and reported as both constant and transient. Contrary to often-held clinical opinion, the studies reviewed suggest that pain increases with pressure ulcer stage. Although a number of intrinsic and extrinsic factors were studied (eg, age, ulcer stage, and bed surfaces), no conclusions could be drawn from the available research. Because pain is an issue for individuals with pressure ulcers and may present a different profile than other sources of pain, pain assessment should become an integral part of pressure ulcer care and documented to guide pressure ulcer management.     

Characteristics of Upper Abdominal Pain in Those with Chronic Liver Disease

Chronic hepatitis has many causes. Symptoms include upper abdominal pain. To allow for a better understanding of this pain we compare HCV patients with other liver diseases and normal controls on their reporting of pain over one month and describe associations. A cross-sectional, case control study was performed. Three groups are studied: (1) normal individuals (NC) (N = 64), (2) patients with chronic liver diseases other than HCV (LD) (N = 53), and (3) HCV infection (N = 64). A dyspepsia questionnaire was utilized, which inquired about a one-month symptom presence of upper abdominal pain and associated symptoms. There was a one-month period prevalence of upper abdominal pain of 45.3% in the HCV group vs 32% in the LD and 20.3% in the NC groups (P = 0.01). The LD (22.6%) and HCV (26.6%) groups had markedly more pain that was worsened by eating compared with NC (1.6%) (P = .003). On univariate analysis, when comparing those with upper abdominal pain to those without, there was a lower age (41.3 vs 44.5), a higher BMI (30.3 vs 26), and more symptoms of fatigue, bloating, and pain worsened by eating and early satiety. On multivariate analysis, age < 50 (OR 5.1; CI 1.5–17), BMI > 30 (OR 4.1; CI 1.5–10.9), nausea (OR 4.1; CI 1.6–10.4), and pain with eating (OR 30: CI 6.7–133) predicted upper abdominal pain. In conclusion, upper abdominal pain is more commonly reported over one month in those with chronic liver diseases. That the abdominal pain worsened after meals in liver patients but not in the normal subjects was a surprise. Possible explanations for this finding are offered.     

Musculoskeletal pain in Japan: prevalence and interference with daily activities

Abstract

We estimated the prevalence of musculoskeletal pain in five anatomical areas and their interference with daily activities (IDA) in a Japanese adult population (n = 3188). A questionnaire survey was conducted among participants in health examinations at three health care centers. On a drawing with predefined body regions, participants marked the regions affected by pain and the regions affected by IDA due to the pain, respectively. Overall prevalence of musculoskeletal pain was 41.4% (M 40.9%, F 42.2%) with a significant increase with age. Neck and shoulder area showed the highest prevalence of pain (20.3%; M 19.6%; F 21.3%), followed by lower back area (19.1%; M 20.1%; F 17.5%), hip and knee area (11.1%; M 9.1%; F 14.3%), elbow, wrist, and hand area (7.4%; M 6.6%; F 8.6%), and ankle and foot area (5.8%; M 5.5%; F 6.3%). Overall percentage of IDA in musculoskeletal pain was 20.5%. After adjustment for age and sex, the ranking of percentage of IDA in the pain was: (1) neck and shoulder area (31.0%), (2) elbow, wrist, and hand area (21.5%), (3) ankle and foot area (18.8%), (4) lower back area (17.9%), and (5) hip and knee area (17.4%). Overall percentage of treatment for musculoskeletal disorders was 6.6% (M 4.7%, F 9.7%), which remained 28.1% (M 21.6%, F 38.0%) even in those who described IDA due to pain. According to our estimates, 42.2 million (41.2%) of Japanese adults might suffer from musculoskeletal pain and 9.1 million (8.8%) might encounter IDA due to the pain. Because of high prevalence and IDA, musculoskeletal pain is one of the health problems to be given high priority in Japan.     

帕金森病伴疼痛患者临床特征及认知功能研究

 目的 探讨伴慢性疼痛的帕金森病(PD)患者疼痛类型及危险因素,并分析疼痛与认知功能的相关性。方法 116例原发性PD患者分为伴疼痛组与不伴疼痛组,统一使用PD评分量表(UPDRS)、Hoehn-Yahr(H-Y)分期,汉密顿抑郁量表(HRSD,24项)、视觉模拟评分法(VAS)、蒙特利尔认知评估量表(MoCA)等进行评估。结果 伴慢性疼痛组UPDRS各项得分、H-Y分期及HRSD得分均高于不伴疼痛组,差异均有统计学意义(P值均<0.05)。logistic回归分析显示只有HRSD得分有统计学意义(OR=1.093,P=0.007)。伴慢性疼痛PD患者的“延迟记忆”得分低于不伴疼痛患者(1.9±1.3比2.5±1.3),差异有统计学意义(P=0.020);疼痛出现在运动症状之前患者的延迟记忆得分明显低于疼痛出现于运动症状以后的患者(1.2±1.2比2.2±1.3),差异有统计学意义(P=0.015)。结论 骨骼肌疼痛是PD患者最为常见的疼痛类型,抑郁可能是导致PD合并疼痛的独立危险因素,伴慢性疼痛PD患者的认知功能损害主要表现为延迟记忆障碍。     

Pain patterns in chronic pancreatitis and chronic primary pain

BackgroundAbdominal pain is the most distressing symptom of chronic pancreatitis (CP), and current treatments show limited benefit. Pain phenotypes may be more useful than diagnostic categories when planning treatments, and the presence or absence of constant pain in CP may be a useful prognostic indicator.AimsThis cross-sectional study examined dimensions of pain in CP, compared pain in CP with chronic primary pain (CPP), and assessed whether constant pain in CP is associated with poorer outcomes.MethodsPatients with CP (N = 91) and CPP (N = 127) completed the Comprehensive Pancreatitis Assessment Tool. Differences in clinical characteristics and pain dimensions were assessed between a) CP and CPP and b) CP patients with constant versus intermittent pain. Latent class regression analysis was performed (N = 192) to group participants based on pain dimensions and clinical characteristics.ResultsCompared to CPP, CP patients had higher quality of life (p < 0.001), lower pain severity (p < 0.001), and were more likely to use strong opioids (p < 0.001). Within CP, constant pain was associated with a stronger response to pain triggers (p < 0.05), greater pain spread (p < 0.01), greater pain severity, more features of central sensitization, greater pain catastrophising, and lower quality of life compared to intermittent pain (all p values ≤ 0.001). Latent class regression analysis identified three groups, that mapped onto the following patient groups 1) combined CPP and CP-constant, 2) majority CPP, and 3) majority CP-intermittent.ConclusionsWithin CP, constant pain may represent a pain phenotype that corresponds with poorer outcomes. CP patients with constant pain show similarities to some patients with CPP, potentially indicating shared mechanisms.     

Pain in the nursing home

Pain is an understudied problem in geriatric medicine and especially among nursing home residents. The focus of this study was to describe the scope of the problem of pain in a long-term care facility. Ninety-seven subjects from a 311-bed multilevel teaching nursing home were interviewed, and charts were reviewed for pain problems and management strategies. Functional status, depression, and cognitive impairment were also evaluated. Results indicate that 71% of residents had at least one pain complaint (range, 1-4). Of subjects with pain, 34% described constant (continuous) pain and 66% described intermittent pain. Of 43 subjects with intermittent pain, 51% described pain on a daily basis. Major sources of pain included low back pain (40%), arthritis of appendicular joints (24%), previous fracture sites (14%), and neuropathies (11%). Moderately strong correlations were found between pain and infrequent attendance at recreational and social activities (r = .50). However, little correlation was observed between pain and the Yesavage Depression Scale, the Folstein Mini-Mental State Scale, or basic ADLs measured by the Katz Scale. Pain-management strategies consisted of analgesic drugs, physical therapy, and heating pads. Only 15% of patients with pain had received medication within the previous 24 hours. The findings suggest that pain is a major problem in long-term care. Strategies for pain management appear to be limited in scope and application in this setting. Important barriers were identified that influence the reporting and management of pain in this setting.     

A Comparative Study of Pain in Heart Failure and Non-Heart Failure Veterans

BackgroundProgress has been made in addressing pain in specific diseases such as cancer, but less attention has focused on understanding pain in nonmalignant states, including heart failure (HF).Methods and ResultsFrom March 2006 to June 2007, 672 veterans were surveyed and scores for the Brief Pain Inventory, pain distress, clinically significant pain levels (moderate to severe pain), and pain locations were compared using univariate and multivariate models. Fifteen percent of the final sample had HF (95/634). In our study, the HF patients were older (P < .000), reported lower levels of general health (P = .018), had more co-morbidities (P < .000), were more likely to have a history of cancer (P = .035), and suffered more chest pain and fewer headaches (P = .026, P = .03, respectively) than their non-HF cohorts. When controlling for age, co-morbidity and cancer disorders, HF and non-HF patients did not differ in pain severity, interference, distress or locations. Of the patients currently experiencing pain, 67.3% of HF patients and 68.4% of non-HF patients rated their pain as moderate or severe (pain ≥4 on a 0 to 10 scale).ConclusionsAlthough HF has not been identified as a painful condition, this study suggests the burden of pain is significant for both HF and non-HF ambulatory care patients.     

What Does Pain or Discomfort in Irritable Bowel Syndrome Mean?

Despite many studies on pain of functional gastrointestinal disorders (FGID), the pain mechanism of FGID is not well understood, and pain treatment of FGID is not established. Following our former functional dyspepsia (FD) study, we proposed two subgroups of patients with irritable bowel syndrome (IBS), pain and discomfort (not pain). The duration of disease of discomfort IBS patients was longer than that of pain IBS patients (P < 0.05) The rate of anxiety disorder of pain IBS patients tended to be higher than that of discomfort IBS patients (P = 0.07172). Fifteen (15.2%) of 99 pain IBS patients and 1 (3.4%) of 29 discomfort IBS patients overlapped FD (P < 0.1). We expected that a common psychosocial mechanism would influence both pain dyspepsia patients and pain IBS patients, however, there were some differences between these FGID patients with pain. Anxiety in IBS patients with lower gastrointestinal pain seems to be important in their treatment.