The Clinical Importance of Changes in the 0 to 10 Numeric Rating Scale for Worst, Least, and Average Pain Intensity: Analyses of Data from Clinical Trials of Duloxetine in Pain Disorders

Farrar, John T.; Pritchett, Yili; Robinson, Michael J.; Prakash, Apurva; Chappell, Amy S.

doi:10.1016/j.jpain.2009.06.007

Cited by 201 publications

(176 citation statements)

References 27 publications

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“…Lower education is often associated to low-decision authority and heavy physical work, which are well-known prognostic factors for poor recovery [18]. The prevalence of MT1 changes in our study was 14%, which is comparable to some studies [19], while in other studies the prevalence varied from 43 to 59% [4]; however, these studies included patients who had undergone discography, which is known to accelerate Modic changes [11].…”

Section: Discussionsupporting

confidence: 78%

“…These include pain during activity and pain at rest during the previous week measured using an 11 point Numeric Rating Scale (NRS) of 0-10, where '10' reflects the worst pain imaginable and '0' no pain. The validity and reliability of NRS has been well documented [11]. The Norwegian version of the original Oswestry Disability Index (ODI version 1.0) was used to evaluate function.…”

Section: Study Measuresmentioning

confidence: 99%

“…This is a 7-item global change scale for back pain with the following categories: (1) completely recovered, (2) much better, (3) a little better, (4) no change, (5) a little worse, (6) much worse, and (7) very much worse. The scale has been validated, and we used the ratings of ''much better'' or ''completely recovered'' to define recovery [11]. We used this categorization as our main outcome.…”

Section: Study Measuresmentioning

confidence: 99%

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Are Modic changes prognostic for recovery in a cohort of patients with non-specific low back pain?

et al. 2011

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Background There is evidence for an association between Modic type 1 and pain in patients with low back pain (LBP), but little knowledge about its effect on clinical outcomes. Purpose (1) To assess the prevalence of Modic changes, (2) to determine if Modic changes influence the clinical course of LBP, and (3) to identify prognostic factors for recovery. Study design/setting Prospective clinical cohort study, with a 1-year follow-up. The treatment consisted of brief intervention and instruction in stretching. Patient's sample Two hundred and sixty-nine patients with chronic low back pain. Outcome measures Socio-demographic variables, education, profession, self-reported measures, degenerative changes on MRI. Methods Linear growth model and Cox regression analysis.Results Five percent had a normal MRI, 14 and 50% had Modic 1 and Modic 2 changes. Modic changes were not significant covariates for the clinical course of pain, function or fear avoidance beliefs. Education was a strong prognostic factor for recovery. Conclusions Modic changes did not influence the clinical course of back pain and were not prognostic factors for recovery. Education was strongly associated with recovery.

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Section: Discussionsupporting

confidence: 78%

Section: Study Measuresmentioning

confidence: 99%

Section: Study Measuresmentioning

confidence: 99%

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Are Modic changes prognostic for recovery in a cohort of patients with non-specific low back pain?

et al. 2011

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“…Tab. 1) und kann daher als klinisch relevant angesehen werden [12]. Die hier beschriebenen Befunde lassen sich gut über die Natriumkanalblockade durch die Substanz erklären.…”

Section: Diskussionunclassified

Topisches Ambroxol zur Behandlung neuropathischer Schmerzen

Kern

Weiser

2015

Schmerz

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Neuropathische Schmerzen sind häufig und schwer zu behandeln. Als topische Therapien sind eine funktionelle Desensibilisierung des Transient-receptor-potential-vanilloid-1(TRPV1)-Rezeptors sowie eine passagere C-Faser-Defunktionalisierung durch Capsaicin 8 % und die Blockade der neuronalen Signaltransmission durch Lidocain 5 % möglich, jedoch oft nicht ausreichend. Weitere potente und nebenwirkungsarme Inhibitoren kutaner Nozizeptoren sind als topische Therapieoptionen wünschenswert.Ambroxol ist seit 1979 für respiratorische Erkrankungen zugelassen und mittlerweile frei verkäuflich. Schon früh wurden lokalanästhetische Eigenschaften erkannt [23], weshalb ambroxolhaltige Lutschpastillen auch zur Behandlung von Halsschmerzen zugelassen sind [10]. Ein anderer Einsatz als Analgetikum erfolgte allerdings bisher nie, obwohl im Tiermodell schmerzbedingte Verhaltensweisen auch bei chronischem Schmerz unterdrückt werden [14,16,27,32].Ambroxol ist im Vergleich zu anderen Lokalanästhetika interessanterweise ein ausgesprochen potenter Blocker spannungsabhängiger Natriumkanäle (Na v ). Es hemmt Natriumkanäle mit etwa 40-fach höherer Potenz als Lidocain [47]. Zudem ist die Blockade des Natriumkanalsubtyps Na v 1.8, der bevorzugt in nozizeptiven C-Faser-Neuronen exprimiert wird [2,6,35,52], potenter als die anderer Kanalsubtypen. Da die Toxizität der Substanz vergleichsweise sehr gering ist [51,53], erschien die Verwendung einer ambroxolhaltigen halbfesten, topischen Darreichungsform ein interessanter Ansatz zur Therapie ansonsten unzureichend zu behandelnder Schmerzzustände.Wir berichten hier über eine klinisch relevante Analgesie durch topisches Ambroxol bei neuropathischem Schmerz. Material und MethodenDargelegt werden exemplarisch kasuistische Krankheitsverläufe von 7 Patienten mit bislang therapieresistenten neuropathischen Schmerzen, die von topischem Ambroxol profitierten. Sie wurden im Rahmen der ambulanten schmerztherapeutischen Arbeit in einem umschriebenen peripheren Körperareal behandelt, nachdem viele andere Behandlungsversuche mit zugelassenen Substanzen erfolglos oder nicht möglich gewesen waren. Verwendung fand eine 20 %ige Ambroxolcreme, die individuell für den Patienten pharmazeutisch hergestellt wurde (für 50,0 g: Ambroxol 10,0 g, Dimethylsulfoxid 5,0 g, Linola®-Creme ad 50,0 g). Diese Rezeptur stellte die probatorisch ermittelte Zubereitung mit der höchsten noch lösli-chen Ambroxolkonzentration dar.Testbehandlungen ErgebnisseGeschildert werden klinische Beobachtungen bei 7 Patienten (2 Frauen und 5 Männer). Die Ursachen ihrer neuropathischen Schmerzen waren: 2-mal Postzosterneuralgie, 1-mal Mononeuropathia multiplex, 1-mal postoperative Neuralgie, 1-mal Deafferenzierungsschmerz, 1-mal Phantomschmerz und 1-mal unklare Fußneuropathie.Die durchschnittlichen Schmerzen der Patienten lagen auf einer numerischen Rating-Skala (NRS) zwischen 4/10 und 6/10, die maximalen Schmerzen zwischen 6/10 und 10/10 (. Tab. 1).

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“…A responder's analysis was performed based upon a two-point reduction in a numerical rating scale (0 is no pain, 10 is severe pain) [62]. Categorical variables are summarized as frequency counts and percentages.…”

Section: Statisticsmentioning

confidence: 99%

Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements?

Shinde

Gordon

Sharma

et al. 2014

Support Care Cancer

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Background Cancer pain is complex, and despite the introduction of the WHO cancer pain ladder, few studies have looked at the prevalence of adjuvant medication use in an inpatient palliative medicine unit. In this study, we evaluate the use of adjuvant pain medications in patients admitted to an inpatient palliative care unit and whether their use affects pain scores or opiate dosing. Methods In this retrospective observational study, patients admitted to the inpatient palliative care unit over a 3-month period with a diagnosis of cancer on opioid therapy were selected. Data pertaining to demographics, diagnosis, oral morphine dose equivalent of the opioid at the time of discharge, adjuvant analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), and pain scores as reported by nurses and physicians were collected. Results Seventy-seven patients were eligible over a 3-month period, out of which 65 (84 %) were taking an adjuvant medication. The most commonly prescribed adjuvant was gabapentin (70 %). Fifty-seven percent were taking more than one adjuvant. There were more women in the group receiving adjuvants (57 vs. 17%, p=0.010). Those without adjuvants compared with those on adjuvants did not have worse pain scores on discharge as reported by physicians (0.8±0.8 vs. 1.0±0.7, p=0.58) or nurses (2.0±2.7 vs. 2.1±2.6, p=0.86). There was no difference in morphine equivalent doses of the opioid in both groups (median (min, max); 112 (58, 504) vs. 200 (30, 5,040)) at the time of discharge; 75-80 % of patients had improvement in pain scores as measured by a two-point reduction in numerical rating scale (NRS). Discussion This study shows that adjuvant medications are commonly used for treating pain in patients with cancer. More than half of study population were on two adjuvants or an adjuvant plus NSAID along with an opioid. We did not demonstrate any benefit in terms of improved pain scores or opioid doses with adjuvants, but this could reflect confounding variables and physician choice. Larger prospective studies are needed to define the opioid-sparing effects of adjuvants. Conclusion Adjuvant agents are used in over 80 % of those treated for cancer pain.

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The Clinical Importance of Changes in the 0 to 10 Numeric Rating Scale for Worst, Least, and Average Pain Intensity: Analyses of Data from Clinical Trials of Duloxetine in Pain Disorders

Cited by 201 publications

References 27 publications

Are Modic changes prognostic for recovery in a cohort of patients with non-specific low back pain?

Are Modic changes prognostic for recovery in a cohort of patients with non-specific low back pain?

Topisches Ambroxol zur Behandlung neuropathischer Schmerzen

Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements?

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