Pain in Osteochondral Lesions of the Ankle – an Investigation Based on Data from the German Cartilage Registry (KnorpelRegister DGOU)

2018 ◽  
Vol 156 (02) ◽  
pp. 160-167
Author(s):  
Daniel Körner ◽  
Philipp Kohler ◽  
Steffen Schröter ◽  
Aline Naumann ◽  
Markus Walther ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Rating Scale ◽  
Surgical Techniques ◽  
Numeric Rating Scale ◽  
The Other ◽  
Osteochondral Lesions ◽  
Preoperative Pain ◽  
Female Patients ◽  
The One ◽  
Cartilage Therapy

Abstract Background The aim of the study was to investigate parameters influencing the preoperative pain intensity in patients with osteochondral lesions of the ankle. The evaluation covered patient-related parameters such as age, sex, body mass index (BMI), as well as defect-related parameters, such as localisation, size and stage (according to the classification of the International Cartilage Repair Society [ICRS] and the Berndt-Harty-Loomer classification). We also examined the correlation between the different surgical techniques and additional factors, such as debridement of an impingement or stabilisation of the ankle on the one hand, and the preoperative pain intensity on the other. Material and Methods 259 patients with osteochondral lesions of the ankle were operated in 32 clinical centres between October 2014 and December 2016 and enrolled consecutively in the German Cartilage Registry (KnorpelRegister DGOU). 151 patients were available for analysis. The preoperative pain intensity was assessed at the time of surgery with online questionnaires, using the Numeric Rating Scale for pain (NRS). Results The median preoperative pain intensity in the complete study population (n = 151) was 3 (range 0 – 10). There was no correlation between the age and the preoperative pain intensity (ρ = − 0.06). Further, there was not detected a difference between the two genders according to the preoperative pain intensity (p = 0.31). In female patients a higher BMI correlated with a higher preoperative pain intensity (ρ = 0.16). Within the group of patients with a solitary treated talus lesion there was no difference according to the preoperative pain intensity between the different localizations of the defect (medial vs. lateral talus) (p = 0.82). Within the group of patients with a solitary treated talus or tibia lesion there was no correlation between the defective area or the lesion stage according to the ICRS classification on the one hand, and the preoperative pain intensity on the other (ρ = 0.09, and ρ = 0.04, respectively). According to the Berndt-Harty-Loomer classification a higher lesion stage (stage four and five) was associated with a higher preoperative pain intensity (ρ = 0.13). There was no difference according to the preoperative pain intensity between the group of patients that received a debridement of a bony or soft tissue impingement in addition to the cartilage therapy and the group of patients without this kind of additional therapy (p = 0.10). Further, there was no difference according to the preoperative pain intensity between the group of patients that received a stabilisation of the ankle joint in addition to the cartilage therapy and the group of patients without a stabilisation procedure (p = 0.83). Conclusion Osteochondral lesions of the ankle can be associated with a moderate and in some cases high pain intensity. In female patients a higher BMI is associated with a higher pain intensity. Further, a higher lesion stage according to the Berndt-Harty-Loomer classification is associated with a higher pain intensity, which highlights the clinical relevance of this classification.

scholarly journals P030: Acute pain resolution after an emergency department visit: a 14-day trajectory analysis

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S73-S74
Author(s):  
R. Daoust ◽  
J. Paquet ◽  
A. Cournoyer ◽  
E. Piette ◽  
J. Morris ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Acute Pain ◽  
Linear Models ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
The Other ◽  
Future Research ◽  
Intensity Level ◽  
Opioid Prescription ◽  
Mild Pain

Introduction: The objective of the study was to evaluate the acute pain intensity evolution in ED discharged patients using Group-based trajectory modeling (GBTM). This method identified patient groups with similar profiles of change over time without assuming the existence of a particular pattern or number of groups. Methods: This was a prospective cohort study of ED patients aged ≥18 years with an acute pain condition (≤ 2 weeks) and discharged with an opioid prescription. Patients completed a 14-day diary assessing daily pain intensity level (0-10 numeric rating scale) and pain medication use. Results: Among the 372 included patients, six distinct post-ED pain intensity trajectories were identified: two started with severe levels of pain, one remained with severe pain intensity (12.6% of the sample) and the other ended with moderate pain intensity level (26.3%). Two other trajectories had severe initial pain, one decreased to mild pain (21.7%) and the other to no-pain (13.8%). Another trajectory had moderate initial pain which decreased to a mild level (15.9%) and the last one started with mild pain intensity and had no pain at the end of the 14-day (9.7%). The pain trajectory patterns were significantly associated with age, type of painful conditions, pain intensity at ED discharge, and with opioid consumption. Conclusion: Acute pain resolution following an ED visit seems to progress through six different trajectory patterns that are more informative than simple linear models and could be useful to adapt acute pain management in future research.

scholarly journals Pre-Hospital Pain Management in Children with Injuries: A Retrospective Cohort Study

2021 ◽  
Vol 10 (14) ◽  
pp. 3056
Author(s):  
Ada Holak ◽  
Michał Czapla ◽  
Marzena Zielińska
Keyword(s):  
Pain Management ◽  
Pain Intensity ◽  
Pain Assessment ◽  
Rating Scales ◽  
Rating Scale ◽  
Low Frequency ◽  
Numeric Rating Scale ◽  
Health Concern ◽  
School Age Children ◽  
Medical Teams

Background: The all-too-frequent failure to rate pain intensity, resulting in the lack of or inadequacy of pain management, has long ceased to be an exclusive problem of the young patient, becoming a major public health concern. This study aimed to evaluate the methods used for reducing post-traumatic pain in children and the frequency of use of such methods. Additionally, the methods of pain assessment and the frequency of their application in this age group were analysed. Methods: A retrospective analysis of 2452 medical records of emergency medical teams dispatched to injured children aged 0–18 years in the area around Warsaw (Poland). Results: Of all injured children, 1% (20 out of 2432) had their pain intensity rated, and the only tool used for this assessment was the numeric rating scale (NRS). Children with burns most frequently received a single analgesic drug or cooling (56.2%), whereas the least frequently used method was multimodal treatment combining pharmacotherapy and cooling (13.5%). Toddlers constituted the largest percentage of patients who were provided with cooling (12%). Immobilisation was most commonly used in adolescents (29%) and school-age children (n = 186; 24%). Conclusions: Low frequency of pain assessment emphasises the need to provide better training in the use of various pain rating scales and protocols. What is more, non-pharmacological methods (cooling and immobilisation) used for reducing pain in injured children still remain underutilized.

Painful diabetic polyneuropathy and quality of life in Danish type 2 diabetic patients

2017 ◽  
Vol 16 (1) ◽  
pp. 173-173 ◽  
Author(s):  
Sandra Sif Gylfadottir ◽  
Diana Hedevang Christensen ◽  
Sia Kromann Nicolaisen ◽  
Reimar Wernich Thomsen ◽  
Jens Steen Nielsen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pain Intensity ◽  
Rating Scale ◽  
Diabetic Polyneuropathy ◽  
Numeric Rating Scale ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Type 2 Diabetic

Abstract Background and aims Painful polyneuropathy (PPN) is a disabling complication of diabetes. This study aims to determine its prevalence and relationship with Quality of Life (QoL) in a nationwide prospective cohort of incident recently diagnosed Danish type 2 diabetic patients. Methods We sent a detailed questionnaire on neuropathy, pain and QoL to 6726 patients prospectively enrolled from general practitioners and hospital specialist outpatient clinics into the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort. Patients who reported pain in both feet and a score ≥3 on the Douleur Neuropathique (DN4) questionnaire were considered to have possible PPN. QoL and pain intensity were measured on a numeric rating scale (NRS, 0–10). The Michigan Neuropathy Screening Instrument (MNSI) was used to assess neuropathy. Results A total of 5371 (79.8%) returned a complete questionnaire. 848 (15.8%) recently diagnosed type 2 diabetic patients reported pain in both feet. Of the 619 patients with pain who completed the DN4 questionnaire, 404 (65.2%) had a DN4 score ≥ 3, corresponding to a prevalence in the total population of possible PPN of 10.3%. Mean pain intensity was 5.2 (SD 2.2) and 89% had a MNSI score ≥ 3. Patients with possible PPN had a substantially lower QoL score than those without PPN (median QoL score 6 versus 8 (p < 0.001)), also when correcting for MNSI score. Conclusions Ten percent of newly diagnosed type 2 diabetic patients in Denmark had possible PPN. Patients with PPN had lower QoL than patients without PPN.

scholarly journals Multimodal Analgesia in Perioperative Settings: Improvement Perspectives / Multimodāla Analgēzija Perioperatīvajā Periodā: Uzlabošanas Iespējas

2014 ◽  
Vol 68 (5-6) ◽  
pp. 222-227
Author(s):  
Iveta Golubovska ◽  
Aleksejs Miščuks ◽  
Ēriks Rudzītis
Keyword(s):  
Pain Management ◽  
Lower Extremity ◽  
Pain Intensity ◽  
Severe Pain ◽  
Rating Scale ◽  
Multimodal Analgesia ◽  
Numeric Rating Scale ◽  
Plexus Brachialis ◽  
Single Shot ◽  
Maximum Pain

Abstract The aim of this study was to evaluate the intensity of pain in orthopaedic hospital patients and to identify unsatisfactory pain management and possibilities for improvements in the future. Data collection included Numeric Rating Scale (NRS) scores, which characterised the intensity of pain. Maximum pain on the day of surgery, mean pain on the day of surgery (D0), and mean pain on first (D1) and second (D2) postoperative days were documented. The pain of an intensity from 0 to 3 was defined as mild pain, 4 to 6 as moderate pain, and 6 to 10 as severe pain. Maximum severe pain intensity on the day of surgery was experienced by 20.5% of patients, moderate by 45.8%, and mild by 33.6%. The reported mean pain intensity according to type of surgery was as follows: hip replacement- 2.79 ± 1.6 (D0), 2.09 ± 1.4 (D1), and 1.35 ± 1.2 (D2); knee replacement - 3.39 ± 1.7 (D0), 2.98 ± (D1), 1.82 ± 1.36, and (D2); upper extremity surgery - 3.59 ± 1.9 (D0), 3.4 ± 1.7 (D1), and 2.1 ± 1.5 (D2); lower extremity surgery - 4.1 ± 2.1 (D0), 3.49 ± 1.42 (D1), and 2.58 ± 1.4 (D2); spine surgery - 3.31 ± 1.58 (D0), 2.88 ± 1.96 (D1), and 1.83 ± 1.74 (D2). Patients in the lower extremity group experienced unacceptable mean pain. The maximum pain intensity on day of surgery was experienced by patients after single-shot plexus brachialis block anaesthesia (5.24 ± 2.4). Well-designed multimodal analgesia with special attention to single shot techniques may improve pain management and functional outcomes after orthopaedic surgery.

Electroanalgesia during a carboxytherapy procedure for cellulite: a study protocol for a randomized controlled trial

2020 ◽  
Vol 10 (5) ◽  
pp. 283-290
Author(s):  
Adria Yared Sadala ◽  
Érika Patrícia Rampazo da Silva ◽  
Richard Eloin Liebano
Keyword(s):  
Pain Intensity ◽  
Study Protocol ◽  
Rating Scale ◽  
Controlled Trial ◽  
Numeric Rating Scale ◽  
Secondary Outcome ◽  
Electrical Currents ◽  
Electrical Nerve Stimulation ◽  
Interferential Current ◽  
Clinical Trials Registry

The aim of the present study is to describe a study protocol to compare different types of analgesic electrical currents on pain intensity and sensory comfort during the application of carboxytherapy for the treatment of cellulite. Seventy five women with the presence of moderate and/or severe gluteal cellulite will be randomly allocated into three groups: carboxytherapy plus transcutaneous electrical nerve stimulation, carboxytherapy plus interferential current or carboxytherapy plus Aussie current. Pain intensity, which is the primary outcome, will be measured by a numeric rating scale (0–10). The secondary outcome is sensory comfort, which will be measured using the visual analogue scale (0–10). Trial registration: Brazilian Clinical Trials Registry: ReBEC (RBR-6z82zb) www.ensaiosclinicos.gov.br/rg/RBR-6z82zb/

scholarly journals THE DIFFERENCE OF PAIN SCALE USING NUMERIC RATING SCALE AND VISUAL ANALOG SCALE IN POST-OPERATIVE PATIENTS

2019 ◽  
Vol 7 (1) ◽  
pp. 52
Author(s):  
Natya Ayu Paluwih ◽  
Riama Marlyn Sihombing ◽  
Kinanthi Lebdawicaksaputri
Keyword(s):  
Pain Intensity ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Pain Scale ◽  
Comparative Approach ◽  
Mild Pain ◽  
Post Operative Pain ◽  
Perceived Pain ◽  
The Difference ◽  
Numeric Rating

Post-operative pain is acute and subjective therefore the perceived pain intensity will be different. In one of the western Indonesia Hospitals in measuring the pain threshold using 2 tools namely Numeric Rating Scale and Wong Baker Face. Measurement of the pain intensity can be done with NRS and VAS scale. The objective of this research was to identify the difference of pain scale using the NRS and VAS scale in post-operative patients. The research method was descriptive quantitative using comparative approach. The study was conducted on 1 November 2017 – 12 December 2017.The population of the study are the post-operative patients at the In-Patient wards in a private hospital in Western Part of Indonesia. The samples were obtained using purposive sampling with n = 41. Research instrument consists of observation sheet using NRS and VAS scale. The results showed most respondents during the first eight hours using NRS scale had mild pain (80.5%); first 16 hours had light pain (63.4%); and had mild pain in the first 24 hours (85.4%). Using VAS scale, most of the respondents on the first eight hours has mild pain (87.8%); first 16 hours has mild pain (68.3%); and has mild pain in the first 24 hours (87.8%). The conclusion of this study is there is no difference in pain scale of post-operative patients using VAS scale and NRS scale. So, hospitals can also use the VAS scale to assess pain scale in post-operative patients.

Procedure-specific Risk Factor Analysis for the Development of Severe Postoperative Pain

2014 ◽  
Vol 120 (5) ◽  
pp. 1237-1245 ◽  
Author(s):  
Hans J. Gerbershagen ◽  
Esther Pogatzki-Zahn ◽  
Sanjay Aduckathil ◽  
Linda M. Peelen ◽  
Teus H. Kappen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Postoperative Pain ◽  
Pain Intensity ◽  
Surgical Procedures ◽  
Rating Scale ◽  
Random Effect ◽  
Numeric Rating Scale ◽  
Younger Age ◽  
Severe Postoperative Pain

Abstract Background: Many studies have analyzed risk factors for the development of severe postoperative pain with contradictory results. To date, the association of risk factors with postoperative pain intensity among different surgical procedures has not been studied and compared. Methods: The authors selected precisely defined surgical groups (at least 150 patients each) from prospectively collected perioperative data from 105 German hospitals (2004–2010). The association of age, sex, and preoperative chronic pain intensity with worst postoperative pain intensity was studied with multiple linear and logistic regression analyses. Pooled data of the selected surgeries were studied with random-effect analysis. Results: Thirty surgical procedures with a total number of 22,963 patients were compared. In each surgical procedure, preoperative chronic pain intensity and younger age were associated with higher postoperative pain intensity. A linear decline of postoperative pain with age was found. Females reported more severe pain in 21 of 23 surgeries. Analysis of pooled surgical groups indicated that postoperative pain decreased by 0.28 points (95% CI, 0.26 to 0.31) on the numeric rating scale (0 to 10) per decade age increase and postoperative pain increased by 0.14 points (95% CI, 0.13 to 0.15) for each higher score on the preoperative chronic pain scale. Females reported 0.29 points (95% CI, 0.22 to 0.37) higher pain intensity. Conclusions: Independent of the type and extent of surgery, preoperative chronic pain and younger age were associated with higher postoperative pain. Females consistently reported slightly higher pain scores regardless of the type of surgery. The clinical significance of this small sex difference has to be analyzed in future studies.

Intensity of Withdrawal Symptoms During Opioid Taper in Patients with Chronic Pain—Individualized or Fixed Starting Dosage?

Pain Medicine ◽  
2019 ◽  
Vol 20 (12) ◽  
pp. 2438-2449 ◽  
Author(s):  
Natalia Bienek ◽  
Christoph Maier ◽  
Miriam Kaisler ◽  
Beate Michel-Lauter ◽  
Andreas Schwarzer ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Opioid Withdrawal ◽  
Withdrawal Symptoms ◽  
Chi Square ◽  
Serious Adverse Events ◽  
Chronic Noncancer Pain ◽  
Starting Dose ◽  
Noncancer Pain

AbstractObjectiveControlled opioid withdrawal is recommended for patients with chronic noncancer pain (CNCP) with insufficient pain reduction or intolerable side effects while on opioid treatment. Few studies have investigated the management of opioid withdrawal (OW). Most common are protocols with an individualized starting dosage (ISD), calculated from the last opioid intake. After two cases of overdose, we introduced a novel withdrawal protocol using a low fixed starting dosage (FSD) for safety reasons. The present study compares the intensity of withdrawal symptoms using the Subjective Opioid Withdrawal Scale (SOWS) and incidences of serious adverse events (SAE) and dropouts in each taper schedule in 195 CNCP patients with OW in an inpatient facility.MethodsTwo protocols were compared: FSD (2014–2016): N = 68, starting dose: 90 mg morphine/d; and ISD (2010–2014): N = 127, starting dose: 70% of the patient’s daily morphine equivalent dose (MED). Outcome criteria: primary: mean daily SOWS score during the first 10 days (16 questions, daily score 0–64); secondary: change in pain intensity on a numeric rating scale (0–10), rate of dropouts and SAEs. Statistics: Student test, Mann-Whitney U test, chi-square test, analysis of variance, P &lt; 0.05.ResultsThe mean daily SOWS score was lower in the FSD group (14.9 ± 9.4 vs 16.1 ± 10, P &lt; 0.05) due to a lower rate of high-intensity withdrawal symptoms (12.4% vs 17.6%, P &lt; 0.01), particularly in patients on &gt;180 mg MED (9.7% vs 18.4%, P &lt; 0.01). Pain intensity decreased after withdrawal, and the incidence of SAEs and dropouts was low in both groups.ConclusionsThe FSD protocol provides a lesser burden of withdrawal symptoms and equal patient safety. It can be recommended for OW in CNCP patients.

Statistical Models for the Analysis of Zero-Inflated Pain Intensity Numeric Rating Scale Data

2017 ◽  
Vol 18 (3) ◽  
pp. 340-348 ◽  
Author(s):  
Joseph L. Goulet ◽  
Eugenia Buta ◽  
Harini Bathulapalli ◽  
Ralitza Gueorguieva ◽  
Cynthia A. Brandt
Keyword(s):  
Pain Intensity ◽  
Statistical Models ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Rating Scale Data ◽  
Scale Data ◽  
Numeric Rating
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