scholarly journals Entraining alpha activity using visual stimulation in patients with chronic musculoskeletal pain. A feasibility study

2020 ◽  
Author(s):  
Laura J. Arendsen ◽  
James Henshaw ◽  
Christopher A. Brown ◽  
Manoj Sivan ◽  
Jason R. Taylor ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Musculoskeletal Pain ◽  
Feasibility Study ◽  
Rating Scale ◽  
Visual Stimulation ◽  
Numerical Rating Scale ◽  
Alpha Activity ◽  
Chronic Musculoskeletal Pain ◽  
Alpha Power

AbstractEntraining alpha activity with rhythmic visual, auditory, and electrical stimulation can reduce experimentally induced pain. However, evidence for alpha entrainment and pain reduction in patients with chronic pain is limited. This feasibility study investigated whether visual alpha stimulation can increase alpha power in patients with chronic musculoskeletal pain and secondarily, if chronic pain was reduced following stimulation. In a within-subject design, 22 patients underwent 4-minute periods of stimulation at 10 Hz (alpha), 7 Hz (high-theta, control), and 1 Hz (control) in a pseudo-randomized order. Patients underwent stimulation both sitting and standing and verbally rated their pain before and after each stimulation block on a 0-10 numerical rating scale. Global alpha power was significantly higher during 10 Hz compared to 1 Hz stimulation when patients were standing (t = −6.08, p <.001). On a more regional level, a significant increase of alpha power was found in the right-middle and left-posterior region when patients were sitting. With respect to our secondary aim, no significant reduction of pain intensity and unpleasantness was found. However, only the alpha stimulation resulted in a minimal clinically important difference in at least 50% of participants for pain intensity (50%) and unpleasantness ratings (65%) in the sitting condition. This study provides initial evidence for the potential of visual stimulation as a means to enhance alpha activity in patients with chronic musculoskeletal pain. The brief period of stimulation was insufficient to reduce chronic pain. This study is the first to provide evidence that a brief period of visual stimulation at alpha frequency can significantly increase alpha power in patients with chronic musculoskeletal pain. Further study is warranted to investigate optimal dose and individual stimulation parameters to achieve pain relief in these patients.

scholarly journals Entraining Alpha Activity Using Visual Stimulation in Patients With Chronic Musculoskeletal Pain: A Feasibility Study

2020 ◽  
Vol 14 ◽  
Author(s):  
Laura J. Arendsen ◽  
James Henshaw ◽  
Christopher A. Brown ◽  
Manoj Sivan ◽  
Jason R. Taylor ◽  
...  
Keyword(s):  
Musculoskeletal Pain ◽  
Feasibility Study ◽  
Visual Stimulation ◽  
Alpha Activity ◽  
Chronic Musculoskeletal Pain

Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale

2004 ◽  
Vol 8 (4) ◽  
pp. 283-291 ◽  
Author(s):  
Fausto Salaffi ◽  
Andrea Stancati ◽  
Carlo Alberto Silvestri ◽  
Alessandro Ciapetti ◽  
Walter Grassi
Keyword(s):  
Pain Intensity ◽  
Musculoskeletal Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Chronic Musculoskeletal Pain ◽  
Numerical Rating

What is the clinical relevance of the Numerical rating scale for pain?

2018 ◽  
Author(s):  
Felicia Cox
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Clinical Importance ◽  
Patient Global Impression ◽  
Numerical Rating ◽  
Group A ◽  
Clinically Significant ◽  
Global Impression Of Change

The landmark paper discussed in this chapter is ‘Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale’, published by Farrar et al. in 2001. The numerical rating scale is now the standard instrument used in chronic pain studies to measure pain intensity. Farrar et al. determined the changes in pain intensity that were clinically significant for studies of chronic pain while measuring the patient’s global impression of change. The paper used pooled data from ten recent studies of pregabalin in 2,724 subjects. The authors reported a consistent relationship between pain intensity and patient global impression of change, regardless of study, disease type, age, sex, study result, or treatment group. A reduction of approximately two points on the numerical rating scale, or of 30% in the global impression of change of pain intensity, represented a clinically important difference.

scholarly journals Clinical Effectiveness and Cost-effectiveness of Videoconference-Based Integrated Cognitive Behavioral Therapy for Chronic Pain: Randomized Controlled Trial (Preprint)

2021 ◽  
Author(s):  
Kayoko Taguchi ◽  
Noriko Numata ◽  
Rieko Takanashi ◽  
Ryo Takemura ◽  
Tokiko Yoshida ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cognitive Behavioral Therapy ◽  
Pain Intensity ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Brief Pain Inventory ◽  
Cognitive Behavioral ◽  
Pain Interference

BACKGROUND Cognitive behavioral therapy is known to improve the management of chronic pain. However, the components of this therapy are still being investigated and debated. OBJECTIVE This study aimed to examine the effectiveness of an integrated cognitive behavioral therapy program with new components (attention-shift, memory work, video feedback, and image training) delivered via videoconferencing. METHODS This study was unblinded and participants were recruited and assessed face-to-face in the outpatient department. We conducted a randomized controlled trial for chronic pain to compare 16 weekly videoconference-based cognitive behavioral therapy (vCBT) sessions provided by a therapist with treatment as usual (TAU). Thirty patients (age range, 22-75 years) with chronic pain were randomly assigned to either vCBT (n=15) or TAU (n=15). Patients were evaluated at week 1 (baseline), week 8 (midintervention), and week 16 (postintervention). The primary outcome was the change in pain intensity, which was recorded using the numerical rating scale at 16 weeks from the baseline. Secondary outcomes were pain severity and pain interference, which were assessed using the Brief Pain Inventory. Additionally, we evaluated disability, pain catastrophizing cognition, depression, anxiety, quality of life, and cost utility. RESULTS In the eligibility assessment, 30 patients were eventually randomized and enrolled; finally, 15 patients in the vCBT and 14 patients in the TAU group were analyzed. Although no significant difference was found between the 2 groups in terms of changes in pain intensity by the numerical rating scale scores at week 16 from baseline (<i>P</i>=.36), there was a significant improvement in the comprehensive evaluation of pain by total score of Brief Pain Inventory (–1.43, 95% CI –2.49 to –0.37, <i>df</i>=24; <i>P</i>=.01). Further, significant improvement was seen in pain interference by using the Brief Pain Inventory (–9.42, 95% CI –14.47 to –4.36, <i>df</i>=25; <i>P</i>=.001) and in disability by using the Pain Disability Assessment Scale (–1.95, 95% CI –3.33 to –0.56, <i>df</i>=24; <i>P</i>=.008) compared with TAU. As for the Medical Economic Evaluation, the incremental cost-effectiveness ratio for 1 year was estimated at 2.9 million yen (about US $25,000) per quality-adjusted life year gained. CONCLUSIONS The findings of our study suggest that integrated cognitive behavioral therapy delivered by videoconferencing in regular medical care may reduce pain interference but not pain intensity. Further, this treatment method may be cost-effective, although this needs to be further verified using a larger sample size. CLINICALTRIAL University Hospital Medical Information Network UMIN000031124; https://tinyurl.com/2pr3xszb

scholarly journals Effect of minocycline on lumbar radicular pain: a prospective pilot study

2020 ◽  
Vol 24 (3) ◽  
pp. 197-201
Author(s):  
Sanaz Sha'abani ◽  
◽  
Sasan Gazerani ◽  
Maryam Ragheb ◽  
Amir-Hossein Mirgalou-Bayat ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Emotional Experience ◽  
Life Quality ◽  
Radicular Pain ◽  
Lumbar Pain ◽  
Controlled Clinical Trial ◽  
Before And After

Introduction: Pain is an unpleasant sensory and emotional experience. Evidence suggests a role for microglia in chronic pain and inhibition of microglia leads to decrease of chronic pain intensity in animal models. Minocycline, a semisynthetic tetracycline derivative, is a selective inhibitor of microglia. Several studies have shown pain intensity improvement by minocycline in animal model of pain, but a few studies showed effectiveness on chronic pain improvement in humans. This prospective, self-controlled clinical trial investigated whether minocycline is effective for chronic pain management. Methods: Twenty-two patients, between the ages of 20 and 80 years with radicular lumbar pain with a numerical rating scale >4, who were unresponsive to other medications and had pain duration of >6 weeks were included in the trial. Results: Pain intensity, neuropathic pain and life quality scores assessed before and after treatment. All scores showed significant improvement after 2 weeks of treatment: 56%, 74% and 14%, respectively. Conclusion: Findings of this study suggest minocycline can effectively improve patients’ pain scores and quality of life, even in those with long-term duration of chronic pain and warrants further study.

scholarly journals Assessing Pain Intensity in Children with Chronic Pain: Convergent and Discriminant Validity of The 0 To 10 Numerical Rating Scale in Clinical Practice

2014 ◽  
Vol 19 (3) ◽  
pp. 141-148 ◽  
Author(s):  
Danielle Ruskin ◽  
Chitra Lalloo ◽  
Khushnuma Amaria ◽  
Jennifer N Stinson ◽  
Erika Kewley ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Clinical Practice ◽  
Pain Intensity ◽  
Discriminant Validity ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Pain Clinic ◽  
Small Range ◽  
Convergent And Discriminant Validity ◽  
Numerical Rating

BACKGROUND: In clinical practice, children are often asked to rate their pain intensity on a simple 0 to 10 numerical rating scale (NRS). Although the NRS is a well-established measure for adults, no study has yet evaluated its validity for children with chronic pain.OBJECTIVES: To examine the convergent and discriminant validity of the NRS as it is used within regular clinical practice to document pain intensity for children with chronic pain. Interchangeability between the NRS and an analogue pain measure was also assessed.METHODS: A cohort of 143 children (mean [± SD] age 14.1±2.4 years; 72% female) rated their pain intensity (current, usual, lowest and strongest levels) on a verbally administered 0 to 10 NRS during their first appointment at a specialized pain clinic. In a separate session that occurred either immediately before or after their appointment, children also rated their pain using the validated 0 to 10 coloured analogue scale (CAS).RESULTS: NRS ratings met a priori criteria for convergent validity (r>0.3 to 0.5), correlating with CAS ratings at all four pain levels (r=0.58 to 0.68; all P<0.001). NRS for usual pain intensity differed significantly from an affective pain rating, as hypothesized (Z=2.84; P=0.005), demonstrating discriminant validity. The absolute differences between NRS and CAS pain scores were small (range 0.98±1.4 to 1.75±1.9); however, the two scales were not interchangeable.CONCLUSIONS: The present study provides preliminary evidence that the NRS is a valid measure for assessing pain intensity in children with chronic pain.

scholarly journals Pain Neuroscience Education Plus Usual Care Is More Effective than Usual Care Alone to Improve Self-Efficacy Beliefs in People with Chronic Musculoskeletal Pain: A Non-Randomized Controlled Trial

2020 ◽  
Vol 9 (7) ◽  
pp. 2195 ◽  
Author(s):  
Antonio Rondon-Ramos ◽  
Javier Martinez-Calderon ◽  
Juan Luis Diaz-Cerrillo ◽  
Francisco Rivas-Ruiz ◽  
Gina Rocio Ariza-Hurtado ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Usual Care ◽  
Pain Intensity ◽  
Musculoskeletal Pain ◽  
Outcome Measures ◽  
Self Efficacy ◽  
Efficacy Beliefs ◽  
Chronic Musculoskeletal Pain ◽  
Pain Interference ◽  
Neuroscience Education

Self-efficacy beliefs are associated with less physical impairment and pain intensity in people with chronic pain. Interventions that build self-efficacy beliefs may foster behavioral changes among this population. A non-randomized trial has been carried out to evaluate the effectiveness of pain neuroscience education (PNE) plus usual care in modifying self-efficacy beliefs, pain intensity, pain interference and analgesics consumption in people with chronic musculoskeletal pain. Participants were allocated to an experimental (PNE plus usual care, n = 49) and a control (usual care alone, n = 51) group. The primary outcome was self-efficacy beliefs (Chronic Pain Self-Efficacy Scale), and the secondary outcomes were pain intensity, pain interference (Graded Chronic Pain Scale) and analgesics consumption. The participant’s pain knowledge (revised Neurophysiology of Pain Questionnaire) after PNE intervention was also assessed to analyze its influence on every outcome measure. All the outcome measures were assessed at the baseline and at four-week and four-month follow-ups. PNE plus usual care was more effective than usual care alone to increase self-efficacy beliefs and decrease pain intensity and pain interference at all follow-up points. No differences between groups were found in terms of analgesics consumption. Knowledge of pain neurophysiology did not modify the effects of PNE plus usual care in any of the outcome measures. These results should be taken with caution because of the non-randomized nature of this design, the limited follow-ups and the uncertainty of the presence of clinical changes in self-efficacy for participants. Larger, methodological sound trials are needed.

scholarly journals Negative effect of anger on chronic pain intensity is modified by multiple mood states other than anger: A large population-based cross-sectional study in Japan

2021 ◽  
Author(s):  
Keiko Yamada ◽  
Tomoko Fujii ◽  
Yasuhiko Kubota ◽  
Kenta Wakaizumi ◽  
Hiroyuki Oka ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Short Form ◽  
Large Population ◽  
Population Based ◽  
Cross Sectional Study ◽  
Mood States ◽  
Cross Sectional

ABSTRACT Objectives To investigate whether mood states other than anger can modify the association between anger and pain intensity in individuals with chronic pain. Methods We analysed 22,059 participants with chronic pain, including 214 participants with rheumatoid arthritis (RA), who completed a questionnaire. The Profile of Mood States short form (POMS-SF) was used to assess six dimensions of mood states (anger-hostility, tension-anxiety, depression-dejection, confusion, fatigue, and vigour). A numerical rating scale (NRS) assessed pain intensity. We examined the association between anger-hostility and the NRS and the relationship between POMS-SF components. Moderation analyses were used to investigate whether the five mood states other than anger-hostility modified the effect of anger-hostility on the NRS. Results Anger-hostility contributed to pain intensity. Although increased mood states other than vigour were associated with increased pain intensity, these increased mood states appeared to suppress the effect of anger-hostility on pain intensity. Increased vigour was associated with decreased pain intensity and increased the effect of anger-hostility on pain intensity. Conclusions Mood states other than anger may influence the association between anger and pain intensity in individuals with chronic pain. It is important to focus on complicated mood states and anger in individuals with chronic pain, including RA.

scholarly journals Communication of pain intensity and unpleasantness through magnitude ratings: Influence of scale type, but not sex of the participant

2021 ◽  
Author(s):  
Hadas Nahman-Averbuch ◽  
Cassidy Hughes ◽  
Marie-Eve Hoeppli ◽  
Kristina White ◽  
James Peugh ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Rating Scales ◽  
Rating Scale ◽  
Visual Stimulation ◽  
Numerical Rating Scale ◽  
Sex Discrimination ◽  
Random Order ◽  
Major Influence ◽  
Intensity Level ◽  
Noxious Heat

A critical aspect for much human pain research is the ability of participants to communicate their first person, experiential perspective to a third person observer. This communication is frequently accomplished via pain ratings. The type of scale and how participants/patients may differentially use the scale has a major influence on the communication of pain experiences. The present study examined the role of sex on the pain rating process using both noxious and innocuous stimuli and two different types of rating scales. Participants underwent noxious heat, auditory and visual stimulation paradigms. Pain intensity and unpleasantness ratings were collected using the visual analog scale (VAS) and numerical rating scale (NRS) in a random order. For noxious heat stimuli, low (44-45 degrees celsius) and high (47-48 degrees celsius) intensity stimuli were delivered. To identify if one rating scale allows better discrimination between different stimulus intensities and if this is dependent on sex, discrimination thresholds were calculated. Significant effect for rating scale and intensity level of stimuli were found for all stimulus modalities (noxious heat, auditory and visual) indicating that higher intensity and unpleasantness ratings were found using the NRS compared to the VAS. No effect of sex or interaction with sex was found. No differences in rating scale and sex were found for the discrimination thresholds. Biases in rating scales usage exist with NRS yielding higher ratings to the same stimuli. However, this bias does not appear to contribute significantly to sex differences in pain.

scholarly journals Alpha entrainment drives pain relief using visual stimulation in a sample of chronic pain patients. A proof-of-concept controlled study.

2020 ◽  
Author(s):  
Karen Lopez-Diaz ◽  
James Henshaw ◽  
Alex Casson ◽  
Christopher Brown ◽  
Jason R. Taylor ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Visual Stimulation ◽  
Pharmacological Intervention ◽  
Controlled Study ◽  
Alpha Power ◽  
Proof Of Concept ◽  
Home Setting ◽  
Non Invasive ◽  
Pain Unpleasantness

One-third of the population in the UK and worldwide struggle with chronic pain. Entraining brain alpha activity through non-invasive visual stimulation has been shown to reduce experimental pain in healthy volunteers. Neural oscillations entrainment offers a potential non-invasive and non-pharmacological intervention for patients with chronic pain, which can be delivered in the home setting and has the potential to reduce use of medications. However, evidence supporting its use in patients with chronic pain is lacking. This study explores whether a) alpha entrainment increase alpha power in patients and b) whether this increase in alpha correlates with analgesia.28 patients with chronic pain sat in a comfortable position and underwent 4-minute visual stimulation using customised goggles at 10 Hz (alpha) and 7 Hz (control) frequency blocks in a randomised cross-over design. 64-channel Electroencephalography (EEG) and 11-point Numeric Rating Scale (NRS) pain intensity and pain unpleasantness scores were recorded before and after stimulation.EEG analysis revealed frontal alpha power was significantly higher when stimulating at 10 Hz when compared to 7 Hz. There was a significant positive correlation between increased frontal alpha and reduction in pain intensity (r=0.33, p&lt;0.05) and pain unpleasantness (r=0.40, p&lt;0.05) in the 10 Hz block.This study provides the first proof of concept that changes in alpha power resulting from entrainment correlate with an analgesic response in patients with chronic pain. Further studies are warranted to investigate dose-response parameters and equivalence to analgesia provided by medications.

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