Peak Pruritus Numerical Rating Scale: psychometric validation and responder definition for assessing itch in moderate‐to‐severe atopic dermatitis

Abstract Background The intense itching associated with atopic dermatitis (AD) often causes patients to experience severe sleep disturbance. Here, we describe the results of a two-phase concept elicitation and cognitive interview study to establish the content validity of a sleep disturbance numerical rating scale (SD NRS) and a Consensus Sleep Diary adapted for adults and adolescents with moderate-to-severe AD (CSD-AD©). Results In phase I, a concept elicitation conducted in 20 adults and 10 adolescents with moderate-to-severe AD revealed that the following sleep-related issues were important and relevant: nighttime awakening (87%), trouble falling asleep (73%), feeling unrested (53%), daytime fatigue or sleepiness (53%), and feeling as if they did not get enough sleep (33%). The frequency and extent of sleep disturbance varied substantially from day to day due to varying degrees of itching and flares, medication use, and changes in the weather. All participants understood the SD NRS question, with most finding it easy or very easy to understand (100% of adults and 90% of adolescents) and most understanding the anchors as intended (95% of adults, and 100% of adolescents). Most participants (94% of adults, and 90% of adolescents) indicated that they would consider a one- or two-point change meaningful on the SD NRS. The CSD-AD© was revised based on participant feedback, and tested during phase II in a convenience sample of six adults and four adolescents from phase I. The changes made to the CSD-AD© were confirmed to be relevant and understandable. All patients were able to provide an answer to each item in the CSD-AD©, and most were able to estimate the duration of nighttime awakenings, daytime naps, and dozing. Conclusions The study supported the content validity of the SD NRS and CSD-AD© in adults and adolescents with moderate-to-severe AD. It also emphasized the importance of using these instruments daily when assessing the benefit of a new treatment on sleep quality in this population.

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A 52 weeks dupilumab treatment for moderate to severe atopic dermatitis in Korea: long-term efficacy and safety in real world

Scientific Reports ◽

10.1038/s41598-021-02950-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Dong Hyek Jang ◽

Seok Jae Heo ◽

Hyung Don Kook ◽

Dong Heon Lee ◽

Hye Jung Jung ◽

...

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

Female Gender ◽

Severity Index ◽

Severe Atopic Dermatitis ◽

Factors Affecting ◽

Facial Erythema ◽

Numerical Rating ◽

Quality Of Life Index

AbstractPreviously, we have reported short term effectiveness and safety of dupilumab in Korea. In this study, we are trying to report the long-term effectiveness and safety of dupilumab in Korea. Ninety-nine patients with moderate to severe AD were analyzed. They were evaluated using Eczema Area and Severity Index (EASI), Numerical Rating Scale (NRS), Patient Oriented Eczema Measure (POEM), and Dermatology Quality of Life Index (DLQI) at baseline, week 16, 32 and 52. Efficacy outcomes showed higher improvement at 52 weeks compared with 16 weeks; high percentual reductions in EASI (88.1%), peak pruritus NRS (65.6%), POEM (67.2%), and DLQI (69.0%) compared to baseline. Proportion of patients achieving EASI 75 and 90 were 90.2% and 53.7%. POEM and DLQI had high correlation with clinical measured outcomes. In the analysis for the factors affecting achievement of EASI 90, female gender (OR 2.5), eosinophilia (OR 0.2) and elevated LDH (OR 0.07) were significantly associated. Most frequent adverse events included facial erythema (19.2%) and conjunctivitis (17.2%), which were mild/moderate and resolved during treatment. In conclusion, dupilumab treatment for 52 weeks in Korean patients with moderate-to-severe AD confirmed long term effectiveness and safety.

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Treatment of Recalcitrant Prurigo Nodularis with Dupilumab

SKIN The Journal of Cutaneous Medicine ◽

10.25251/skin.4.3.13 ◽

2020 ◽

Vol 4 (3) ◽

pp. 279

Author(s):

Matthew T Reynolds ◽

Scott M Dinehart ◽

Katlyn R Anderson ◽

Joe Gorelick

Keyword(s):

Atopic Dermatitis ◽

Side Effects ◽

Therapeutic Response ◽

Rating Scale ◽

Numerical Rating Scale ◽

Biologic Agent ◽

Dramatic Reduction ◽

Prurigo Nodularis ◽

Duration Of Therapy ◽

Numerical Rating

Objectives: Prurigo nodularis (PN) is a disease of aberrant and recalcitrant itching which is difficult to effectively manage. There are no current FDA-approved therapies for PN. The current topical and systemic medications used for this condition provide less than optimal efficacy for the majority of patients with this condition and often have unacceptable side effects. We report 4 patients who were effectively treated with dupilumab (Dupixent) for the treatment of recalcitrant PN.Methods: Four patients were treated successfully with dupilumab, a systemic biologic agent that is not immunosuppressive (Dupixent; Sanofi-Regeneron). Patients were treated with dupilumab monotherapy, without the use of other systemic immunosuppressing agents. The peak pruritus numerical rating scale (NRSi) was used to evaluate patients at weeks 0 and 4. Results: Dupilumab therapy results in a dramatic reduction in NRSi scores by week 4 and that result continues throughout the duration of therapy. This reduction in itch is seen with continuous therapy.Conclusion: Dupilumab therapy appears effective in reducing the overall itch severity in patients with PN. The usage of dupilumab as a monotherapy shows promise in the treatment of PN. The therapeutic response to dupilumab seen in PN suggests that the pathogenesis of PN may overlap with that of atopic dermatitis.

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583 Psychometric validation and meaningful change threshold of the worst itching intensity numerical rating scale for use in hemodialysis patients with pruritus

Journal of Investigative Dermatology ◽

10.1016/j.jid.2018.03.591 ◽

2018 ◽

Vol 138 (5) ◽

pp. S99 ◽

Cited By ~ 1

Author(s):

C. Munera ◽

M.K. Vernon ◽

J.W. Stauffer ◽

R.H. Spencer ◽

F. Menzaghi

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

Hemodialysis Patients ◽

Psychometric Validation ◽

Meaningful Change ◽

Numerical Rating ◽

Change Threshold

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Comparing the efficacy of nebulized morphine with intravenous morphine in traumatic musculoskeletal pain management

Journal of Research in Clinical Medicine ◽

10.34172/jrcm.2020.021 ◽

2020 ◽

Vol 8 (1) ◽

pp. 21-21

Author(s):

Mani Mofidi ◽

Ali Dashti ◽

Mahdi Rezai ◽

Niloufar Ghodrati ◽

Hoorolnesa Ameli ◽

...

Keyword(s):

Pain Management ◽

Pain Relief ◽

Musculoskeletal Pain ◽

Normal Saline ◽

Rating Scale ◽

Numerical Rating Scale ◽

Vital Signs ◽

Categorical Variables ◽

Intravenous Morphine ◽

Numerical Rating

Introduction: This study was designed to compare the effectiveness of intravenous morphine with nebulized morphine in pain relief of patients referring to the emergency setting with traumatic musculoskeletal pain. Methods: This randomized, placebo-controlled and double-blind clinical study evaluated 160 patients 18 to 65 years of age with acute traumatic pain, who attended the emergency department during 2019. Subjects were assessed with Numerical Rating Scale based on inclusion and exclusion criteria and randomly divided into two groups. In one group, 80 patients received IV morphine (0.1 mg/kg+5 mL normal saline) plus an equivalent volume of IV placebo. In the second group, 80 patients received nebulized morphine (0.2 mg/kg+5 mL normal saline) plus nebulized placebo. Pain score was monitored in all patients with Numerical Rating Scale before and after intervention at baseline, 15, 30, 45, and 60-minute intervals. Patients’ vital signs and possible adverse events were evaluated in each observation time points. Finally, all participants were assessed for their satisfaction with pain management. Data were analyzed using repeated measure analysis for continuous variables and Binomial test for categorical variables Results: There was no significant difference between the demographic characteristics of patients in study groups. Pain relief between the two groups was similar during the observation (0, 15, 30, 45, 60 min) (P>0.05). There were no changes in vital signs between two groups, although the nebulized group had lower systolic blood pressure at the time-point of 15 minutes after the treatment initiation (P=0.03). Conclusion: Although Nebulized morphine has similar efficacy in comparison with IV route, nebulization might be considered as the clinically efficacious route of morphine administration with minimal side effects, providing optimal pain relief in patients.

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Comparison of Analgesic Effect of Levobupivacaine with Dexmedetomidine and Levobupivacaine for Scalp Block before Supratentorial Craniotomy: A Randomized Controlled Trial

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.10.11547 ◽

2020 ◽

Vol 103 (10) ◽

pp. 1028-1035

Keyword(s):

Postoperative Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Control Group ◽

Study Group ◽

Analgesic Requirement ◽

Supratentorial Craniotomy ◽

Numerical Rating ◽

Fentanyl Consumption ◽

Scalp Block

Background: Craniotomy causes acute and chronic pain. Uncontrolled postoperative pain may lead to adverse events. Perioperative scalp nerves block is not only effective in reducing intraoperative hemodynamic response, but it also reduces postoperative pain and postoperative analgesia requirement. Objective: To compare the benefits of adding dexmedetomidine to levobupivacaine in scalp nerves block before craniotomy for the duration of analgesia in supratentorial craniotomy. Materials and Methods: After approval by the Committee for Research, 50 supratentorial craniotomy patients were randomized into two groups. The control group received 30 mL scalp nerves block with 0.25% levobupivacaine with adrenaline 1:200,000, whereas the study group received 30 mL scalp nerves block with 0.25% levobupivacaine with adrenaline 1:200,000 plus dexmedetomidine 1 mcg/kg. The primary outcome was the time to first analgesic requirement postoperatively. The secondary outcomes included intraoperative fentanyl consumption, verbal numerical rating scale, tramadol consumption, and complications during the first 24 hours postoperatively. Results: Patients in the study group had significantly increase time to the first analgesic requirement in postoperative period and reduced intraoperative fentanyl consumption. The median time to first analgesic requirement was 555 (360 to 1,035) minutes in the study group versus 405 (300 to 520) minutes in the control group (p=0.023). Intraoperative fentanyl consumption 125 (75 to 175) mcg in the study group was significantly lower than 200 (150 to 250) mcg in the control group (p=0.02). The verbal numerical rating scale at 1, 4, 8, 12 and 24 hours postoperatively, tramadol consumption, and complications during the first 24 hours postoperatively were not statistically significant different. Conclusion: Preoperative scalp nerves block with 0.25% levobupivacaine with adrenaline (1:200,000) with dexmedetomidine 1 mcg/kg significantly increased the time to first analgesic requirement and reduced intraoperative fentanyl consumption compared to 0.25% levobupivacaine with adrenaline (1:200,000) without perioperative complications. Keywords: Scalp block, Dexmedetomidine, Post-craniotomy analgesia, Supratentorial tumor, Levobupivacaine

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