scholarly journals AB0771 DAPSA REMISSION/LOW DISEASE ACTIVITY IS ASSOCIATED WITH LOW PSAID12 IN PSORIATIC ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1683.2-1684
Author(s):  
C. García-Porrúa ◽  
L. Fernández-Dominguez ◽  
J. L. Guerra-Vazquez ◽  
J. A. Mosquera Martínez ◽  
J. Pinto-Tasende
Keyword(s):  
Clinical Practice ◽  
Psoriatic Arthritis ◽  
Disease Duration ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Univariate Analysis ◽  
Cross Sectional ◽  
Mean Values ◽  
Patient Reported ◽  
Clinical Records

Background:Psoriatic arthritis (PsA) has a prevalence of 0.17% in North-Western of Spain and patients suffer this disease have significant impact on daily life due to articular, dermatological and psychological symptoms. DAPSA VLDA/LDA (≤14) is a therapeutic goal recommended by EULAR for clinical practice.Objectives:Our aim was to assess the relationship between DAPSA index and PsAID questionnaire in routine clinical practice.Methods:We performed a cross-sectional study of patient and physician reported outcomes. We obtained clinical information of patients with PsA attending clinic from October 2018 to October 2019. Data were collected from clinical records concerning age, gender, disease duration, joint counts, dactylitis, enthesitis, body surface area (BSA) of psoriasis, laboratory results (ESR and CRP), HAQ, PsAID12, pain and global assessment from patient with numerical rating scale (NRS) and DAPSA index. Data were analysed using SPSS21. Logistic regression was used to assess patient reported outcomes which were associated with DAPSA VLDA/LDA.Results:Data were available for 210 patient visits, 43% females. DAPSA≤14 was in 143 patients (68.1%) and was associated with higher disease duration, OR 1.079 (1.020-1.142, 95% CI), p 0.008. DAPSA index was not associated with BSA (r 0.126, p 0.176).PsAID12 was evaluated in 156 patients and we saw that patients with DAPSA≤14 had significantly lower PsAID12 (mean 1.7 ± SD 1.7 vs. 3.9 ± 2.1), p< 0.0001. PsAID12 of less than 4 is considered a good outcome and all items of PsAID12 (Figure 1, mean values for NRS) were less than 4 in patients with DAPSA≤14. All components of PsAID12 except item 3 (skin problems) were associated with DAPSA≤14 on univariate analysis but only pain remained independent predictor on multiple regression analysis (p< 0.0001).Conclusion:In these PsA patients, DAPSA VLDA/LDA was associated with higher disease duration and with lower PsAID12. Pain is dominant symptom in patients with psoriatic arthritis, even in those with DAPSA≤14, and skin problems are not good represented in DAPSA index.References:[1]Gossec L, Ann Rheum Dis. 2014;73(6):1012–1019.[2]Di Carlo, et al: PsAID-12 in clinical setting. J Rheum 2017; 44:3Acknowledgments:SOGAREDisclosure of Interests:Carlos García-Porrúa: None declared, Luis Fernández-Dominguez: None declared, Jose L. Guerra-Vazquez: None declared, José Antonio Mosquera Martínez: None declared, Jose Pinto-Tasende Consultant of: Janssen, Novartis, Speakers bureau: Lilly, Janssen, Novartis, BMS, Pfizer, Celgene

scholarly journals AB0823 MINIMAL DISEASE ACTIVITY IN PSORIATIC ARTHRITIS IS ASSOCIATED WITH LOW IMPACT OF DISEASE ON PSAID12 QUESTIONAIRE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1715.2-1715
Author(s):  
J. A. Mosquera Martínez ◽  
C. García-Porrúa ◽  
L. Fernández-Dominguez ◽  
J. L. Guerra-Vazquez ◽  
J. Pinto-Tasende
Keyword(s):  
Clinical Practice ◽  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Disease Duration ◽  
Rating Scale ◽  
Univariate Analysis ◽  
Minimal Disease Activity ◽  
Patient Reported ◽  
Minimal Disease ◽  
Clinical Records

Background:Psoriatic arthritis (PsA) has a prevalence of 0.58% in Spain and patients suffer this disease have significant impact on daily life due to articular, dermatological and psychological symptoms. To reach minimal disease activity (MDA) is a therapeutic goal recommended by EULAR for clinical practice.Objectives:Our aim was to assess the relationship between MDA and PsAID questionnaire in routine clinical practice.Methods:We performed a cross-sectional study of patient and physician reported outcomes. We obtained clinical information of patients with PsA attending clinic from October 2018 to October 2019. Data were collected from clinical records concerning age, gender, disease duration, joint counts, dactylitis, enthesitis, body surface area (BSA) of psoriasis, laboratory results (ESR and CRP), HAQ, PsAID12, pain and global assessment from patient with numerical rating scale (NRS) and MDA status. Data were analysed using SPSS21. Logistic regression was used to assess patient reported outcomes which were associated with achieving MDA.Results:Data were available for 210 patient visits, 57% males. MDA 5/7 was reached in 118 patients (56.2%) and MDA7/7 in 58 (27.6%). Age and gender were not associated with reach MDA. Higher disease duration was associated with MDA, OR 1.062 (1.012-1.114, 95% CI), p 0.015.PsAID12 was evaluated in 156 patients and all components were associated with reach MDA. Patients in MDA had significantly lower PsAID12 than those were not in MDA (mean 1.5 ± SD 1.5 vs. 3.8 ± 2.1), p< 0.0001. PsAID12 of less than 4 is considered a good outcome and individual components of PsAID12 (Figure 1, mean values for NRS) were less than 4 in patients with MDA.Figure 1.All components of PsAID12 were associated with MDA on univariate analysis but only pain and functional capacity remained independent predictors on multiple regression analysis (p< 0.0001 and p0.008 respectively).Percentage of BSA was associated with skin component of PsAID12 (p<0.0001) and with shame component (p0.001).Conclusion:In these PsA patients, MDA was reached mainly in patients with higher disease duration. MDA is a relevant treatment target in PsA, with markedly lower PsAID12 in patients in MDA. Pain and functional discapacity are dominant symptoms in patients with psoriatic arthritis, even in those in MDA. Skin affection is associated with skin and shame components on the PsAID12.References:[1]Queiro R et al. Arthritis Res Ther. 2017 Mar 29;19(1):72.Acknowledgments:SOGAREDisclosure of Interests:José Antonio Mosquera Martínez: None declared, Carlos García-Porrúa: None declared, Luis Fernández-Dominguez: None declared, Jose L. Guerra-Vazquez: None declared, Jose Pinto-Tasende Consultant of: Janssen, Novartis, Speakers bureau: Lilly, Janssen, Novartis, BMS, Pfizer, Celgene

scholarly journals Fatigue numeric rating scale validity, discrimination and responder definition in patients with psoriatic arthritis

RMD Open ◽  
2020 ◽  
Vol 6 (1) ◽  
pp. e000928 ◽  
Author(s):  
Dafna Gladman ◽  
Peter Nash ◽  
Hitoshi Goto ◽  
Julie A Birt ◽  
Chen-Yen Lin ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Clinical Practice ◽  
Psoriatic Arthritis ◽  
Psychometric Properties ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Routine Clinical Practice ◽  
Patient Reported ◽  
Test Retest Reliability ◽  
Numeric Rating

ObjectivesThis study assessed the psychometric properties of the fatigue numeric rating scale (NRS) and sought to establish values for clinically meaningful change (responder definition).MethodsUsing disease-specific clinician-reported and patient-reported data from two randomised clinical trials of patients with psoriatic arthritis (PsA), the fatigue NRS was evaluated for test–retest reliability, construct validity and responsiveness. A responder definition was also explored using anchor-based and distribution-based methods.ResultsTest–retest reliability analyses supported the reproducibility of the fatigue NRS in patients with PsA (intraclass correlation coefficient=0.829). Mean (SD) values at baseline and week 2 were 5.7 (2.2) and 5.7 (2.4), respectively. Supporting construct validity of the fatigue NRS, moderate-to-large correlations with other assessments measuring similar concepts as measured by Sackett’s conventions were demonstrated. Fatigue severity was reduced when the underlying disease activity was improved and reductions remained consistent at week 12 and 24. A 3-point improvement was identified as being optimal for demonstrating a level of clinically meaningful improvement in fatigue NRS after 12–24 weeks of treatment.ConclusionsFatigue NRS is a valid and responsive patient-reported outcome instrument for use in patients with PsA. The established psychometric properties from this study support the use of fatigue NRS in clinical trials and in routine clinical practice. Robust validation of reliability for use in routine clinical practice in treating patients with active PsA in less active disease states and other more diverse ethnic groups is needed.

scholarly journals Palliative Care Patients’ Quality of Dying and Circumstances of Death—Comparison of Informal Caregivers’ and Health-Care Professionals’ Estimates

2018 ◽  
Vol 35 (7) ◽  
pp. 1023-1029 ◽  
Author(s):  
Stephanie Stiel ◽  
Maria Heckel ◽  
Kim Nikola Wendt ◽  
Martin Weber ◽  
Christoph Ostgathe
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Informal Caregivers ◽  
Absolute Difference ◽  
Mean Values ◽  
Quality Of Dying ◽  
Patient Reported

Background: Patient-reported outcomes are usually considered to be the gold standard assessment. However, for the assessment of quality of dying and death, ratings of informal caregivers (ICGs) or health-care professionals (HCPs) must be considered for ethical and methodological reasons. This article aims to present results of ICGs’ and HCPs’ estimates of the questionnaire, quality of dying and death (QoDD) on patients who died in PCUs and to compare the level of agreement of both ratings/raters. Methods: The parent validation study to this analysis assessed the ICG and HCP versions of the QoDD. Descriptive statistics are presented for each item in both versions. T tests for the estimation of differences between ICG and HCP were performed. Case-related absolute differences between estimates were analyzed regarding the extent of agreement and deviation. Results: Two hundred fifteen matched ICG and HCP ratings were analyzed. The ratings in all 6 QoDD dimensions were high; single items scored low. Mean absolute difference between both ratings was 0.33 (standard deviation [SD]: 3.08; median 0.05) on a 0 to 10 numerical rating scale and ranges between −8.24 (higher rating of ICGs compared to HCPs) and 9.33 (higher rating of HCPs compared to ICGs). Conclusions: The findings appear to show a high satisfaction with quality of dying and death as rated by ICGs and HCPs, but we suspect this might be indicative of a methodological challenge, that is, a ceiling effect in both assessments. Single low scoring items may provide important clues for improvement in end-of-life care. Although descriptive data show comparable mean values and standard deviations, the actual congruence of ratings is low. In summary, replacing one rating by another cannot be recommended.

scholarly journals AB0564 RHEUMATOLOGISTS’ VIEWS AND EXPERIENCES IN MANAGING PsA PATIENTS BASED ON TREATING TO TARGET STRATEGY: A CROSS-SECTIONAL STUDY IN CHINA

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1318.2-1319
Author(s):  
L. Xu ◽  
Z. Wang ◽  
J. Xue ◽  
M. Bai ◽  
H. Zhong ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Western Medicine ◽  
Work Experience ◽  
Tertiary Hospital ◽  
Treat To Target ◽  
Cross Sectional ◽  
Activity Assessment ◽  
High Level

Background:Psoriatic arthritis (PsA) is a chronic inflammatory arthritis with progressive, erosive destruction associated with functional impairment. Principles of treat-to-target (T2T) have been widely used in rheumatoid arthritis, which has powerfully improved patient outcomes. In 2017, the concept of T2T has proposed to apply in PsA patients. However, the awareness and implementation of evidence-based T2T treatment guidelines varies across different geographical regions of China, hospital grades, professional status and specialities.Objectives:The study aimed to investigate Rheumatologists’ views and experiences in managing PsA patients with T2T strategy in china.Methods:A cross-sectional questionnaire survey of Rheumatologists in China from 5 August to 15 August 2020 was conducted for this study. Rheumatologists were contacted by WeChat (a Chinese cell/web app) and asked to complete a web-based questionnaire anonymously. The electronic questionnaire was sent out by the internet platform of WenJuanXing via WeChat (https://www.wjx.cn/). The questionnaire was designed to collect: (a) demographic information; (b) patient management in clinical practice for Rheumatologists; (c) familiarity and application of T2T strategy in Rheumatologists. P values ≤0.05 were considered significant.Results:(1) A total of 823 rheumatologists (69.87% female, 30.13% male) provided valid answers to the questionnaire. 71.09% of the participants major in Modern Western Medicine, 28.91% major in traditional chinese medicine. A total of 75.94% worked in Grade-A Tertiary Hospital. A total of 52.73% had more than 10 years of work experience and 63.55% had High-level title. (2) More than half of the patients were followed up by 69% Rheumatologists in their daily practice. The proportion of follow-up patients increased powerfully in the group of Rheumatologists who major in Modern Western Medicine (P=0.014), work in Grade-A Tertiary Hospital (P<0.001), have more than 10 years of work experience (P<0.001) and High-level title (P<0.001). (3) 36.45% Rheumatologist thought the frequency for patient disease activity assessment was every 1 month and 53.1% was every 3 months. And 41.7% Rheumatologist prefer to use PASDAS for disease activity criteria, and only 3.6% choose MDA. (4) A total of 62.43% thought they were familiar with T2T strategy, and 83.6% Rheumatologists applied T2T strategy in clinical practice. Among 135 Rheumatologists who did not apply T2T strategy, 62.2% of Rheumatologists thought that the main barrier to T2T application was that they did not fully understand the strategy. The frequency of application of T2T strategy in clinical practice was significantly different between Rheumatologists who major in Modern Western Medicine (60.75%) and traditional chinese medicine (22.84%) (P=0.023).Conclusion:In china, the management of PsA patients need to be standardized to improve patient outcomes. And the promotion of T2T strategy in PsA need to be further strengthened.References:[1]Smolen JS, Schöls M, Braun J,et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis. 2018 Jan;77(1):3-17.[2]Tucker LJ, Ye W, Coates LC. Novel Concepts in Psoriatic Arthritis Management: Can We Treat to Target? Curr Rheumatol Rep. 2018 Sep 18;20(11):71.[3]Coates LC, Helliwell PS. Treating to target in psoriatic arthritis: how to implement in clinical practice. Ann Rheum Dis. 2016;75(4):640-643.Figure 1A. Rheumatologist priority of frequency for patient follow-up in different disease status. B. Rheumatologist priority of frequency for patient disease activity assessment in clinical practice. C. Rheumatologist priority of disease activity criteria for PsA patients.Disclosure of Interests:None declared.

scholarly journals Identification of the Clinical Features Distinguishing Psoriatic Arthritis and Fibromyalgia

2012 ◽  
Vol 39 (4) ◽  
pp. 849-855 ◽  
Author(s):  
ANTONIO MARCHESONI ◽  
FABIOLA ATZENI ◽  
ANTONIO SPADARO ◽  
ENNIO LUBRANO ◽  
GIUSEPPE PROVENZANO ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Clinical Features ◽  
Disease Duration ◽  
Univariate Analysis ◽  
Laboratory Data ◽  
Fibromyalgia Impact Questionnaire ◽  
Somatic Symptoms ◽  
Tender Point ◽  
Antiinflammatory Drugs ◽  
Associated Symptoms

Objective.To identify the clinical features that can help to distinguish between psoriatic arthritis (PsA) and fibromyalgia (FM).Methods.Our cross-sectional study was carried out in 10 Italian rheumatology centers between January and September 2009, and enrolled all consecutive patients with PsA and FM who agreed to participate. Standard clinical and laboratory data for PsA and FM were collected from all patients. Records were made of somatic symptoms, response to nonsteroidal antiinflammatory drugs (NSAID), self-evaluated pain, general health, disability, and responses to the Fibromyalgia Impact Questionnaire. Data were statistically analyzed by univariate and multivariate analyses, and receiver-operating characteristic curves. The analysis concentrated on the clinical features shared by the 2 conditions.Results.Two hundred sixty-six patients with PsA (mean age 51.7 yrs; disease duration 10.2 yrs) and 120 patients with FM (mean age 50.2 yrs; disease duration 5.6 yrs) were evaluated. Univariate analysis showed that patients with FM had higher mean tender point and enthesitis scores, more somatic symptoms, and responded less to NSAID. Multivariate analysis showed that the presence of ≥ 6 FM-associated symptoms and ≥ 8 tender points was the best predictor of FM.Conclusion.The shared clinical features of PsA and FM that had the greatest discriminating power for FM were the number of FM-associated symptoms and tender point count.

scholarly journals HUBUNGAN KONSUMSI ASAM LEMAK OMEGA-3, AKTIVITAS FISIK DAN PERSEN LEMAK TUBUH DENGAN TINGKAT DISMENORE PADA REMAJA

2017 ◽  
Vol 6 (4) ◽  
pp. 268
Author(s):  
Famimah Famimah ◽  
Ani Margawati ◽  
Deny Yudi Fitranti
Keyword(s):  
Physical Activity ◽  
Fatty Acids ◽  
Body Fat ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Percent Body Fat ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
Cross Sectional

Background: Dysmenorrhea or menstrual pain was a gynecological complaint due to an imbalance of progesterone in the blood resulting in pain. A woman with dysmenorrhea should consume food rich in omega-3 fatty acids such as fish oil, fish (salmon, tuna, mackerel, herring), soybeans and fruits. Low fish consumption was related with severity of dysmenorrhea. In addition, physical activity and percent body fat were also associated with severity of dysmenorrhea.Objective : To determine the correlation between consumption of omega-3 fatty acids, physical activity and percent body fat to the classification of dysmenorrhea in adolescents.Methods : Cross sectional study of 90 adolescentsselected by purposive sampling. This research was conducted in SMA N 15 and SMA N 9 Semarang. Menstrual history was measured by direct interviews and level of dysmenorrhea was measured using Numerical Rating Scale Questionnaire. Omega-3 fatty acids were measured using Food Frequency Questionnaire (FFQ) and analyzed using a nutritional software program. Physical activity was measured using A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Percent body fat was measured using Bioelectrical Impedance Analysis (BIA). Data were analyzed by Independent T test/Mann Whitney. Result : There were significant correlation in omega-3 fatty acid (p= 0,015), and percent body fat (p= 0,026). While in physical activity there was no significant correlation (p= 0,394).Conclusion : Consumption of omega-3 fatty acids and percent body fat were associated with the classification of dysmenorrhea.

The Association Between Disease Activity and Duration in Systemic Sclerosis

2010 ◽  
Vol 37 (11) ◽  
pp. 2299-2306 ◽  
Author(s):  
JENNIFER G. WALKER ◽  
RUSSELL J. STEELE ◽  
MIREILLE SCHNITZER ◽  
SUZANNE TAILLEFER ◽  
MURRAY BARON ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Disease Activity ◽  
Disease Duration ◽  
Activity Index ◽  
Disease Onset ◽  
Depression Scale ◽  
Disease Activity Index ◽  
Cross Sectional ◽  
Diffuse Disease ◽  
Patient Reported

Objective.The absence of a standardized disease activity index has been an important barrier in systemic sclerosis (SSc) research. We applied the newly derived Valentini Scleroderma Disease Activity Index (SDAI) among our cohort of patients with SSc to document changes in disease activity over time and to assess possible differences in activity between limited and diffuse disease.Methods.Cross-sectional study of a national cohort of patients enrolled in the Canadian Scleroderma Research Group Registry. Disease activity was measured using the SDAI. Depression scores were measured using the Centre for Epidemiologic Studies Depression Scale (CES-D).Results.A total of 326 out of 639 patients had complete datasets at the time of this analysis; 87% were female, of mean age 55.6 years, with mean disease duration 14.1 years. SDAI declined steeply in the first 5 years after disease onset and patients with diffuse disease had 42% higher SDAI scores than patients with limited disease with the same disease duration and depression scores (standardized relative risk 1.42, 95% CI 1.21, 1.65). Patients with higher CES-D scores had higher SDAI scores relative to patients with the same disease duration and disease subset (standardized RR 1.22, 95% CI 1.14, 1.31). Among the 10 components that make up the SDAI, only skin score (standardized OR 0.59, 95% CI 0.43, 0.82) and patient-reported change in skin (standardized OR 0.64, 95% CI 0.45, 0.92) decreased with increasing disease duration. High skin scores (standardized OR 32.2, 95% CI 15.8, 72.0) were more likely and scleredema (standardized OR 0.58, 95% CI 0.37, 0.92) was less likely to be present in patients with diffuse disease. High depression scores were associated with positive responses for patient-reported changes in skin and cardiopulmonary function.Conclusion.Disease activity declined with time and patients with diffuse disease had consistently higher SDAI scores. Depression was found to be associated with higher patient activity scores and strongly associated with patient self-response questions. The role of depression should be carefully considered in future applications of the SDAI, particularly as several components of the score rely upon patient recall.

Composite Measures for Routine Clinical Practice in Psoriatic Arthritis: Testing of Shortened Versions in a UK Multicenter Study

2021 ◽  
pp. jrheum.201675
Author(s):  
William Tillett ◽  
Oliver FitzGerald ◽  
Laura C. Coates ◽  
Jon Packham ◽  
Deepak R. Jadon ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Routine Clinical Practice ◽  
Performance Characteristics ◽  
Superior Performance ◽  
Response To Treatment ◽  
Routine Practice ◽  
Composite Measures ◽  
Patient Reported

Objective To test shortened versions of the psoriatic arthritis (PsA) composite measures for use in routine clinical practice. Methods Clinical and patient-reported outcome measures (PROMs) were assessed in patients with PsA at 3 consecutive follow-up visits in a UK multicenter observational study. Shortened versions of the Composite Psoriatic Arthritis Disease Activity Index (CPDAI) and Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) Composite Exercise (GRACE) measures were developed using PROMs and tested against the Disease Activity Score in 28 joints (DAS28), composite Disease Activity in Psoriatic Arthritis, and Routine Assessment of Patient Index Data (RAPID3). Discrimination between disease states and responsiveness were tested with the t-score, standardized response mean (SRM), and effect size (ES). Data were presented to members at the GRAPPA 2020 annual meeting and members voted on the recommended composite routine practice. Results The SRM for the GRACE, 3 visual analog scale (VAS), and 4VAS were 0.67, 0.77, and 0.63, respectively, and for CPDAI and shortened CPDAI (sCPDAI) were 0.54 and 0.55, respectively. Shortened versions of the GRACE increased the t-score from 7.8 to 8.7 (3VAS) and 9.0 (4VAS), but reduced the t-score in the CPDAI/sCPDAI from 6.8 and 6.1. The 3VAS and 4VAS had superior performance characteristics to the sCPDAI, DAS28, Disease Activity in Psoriatic Arthritis, and RAPID3 in all tests. Of the members, 60% agreed that the VAS scales contained enough information to assess disease and response to treatment, 53% recommended the 4VAS for use in routine care, and 26% the 3VAS, while leaving 21% undecided. Conclusion Shortening the GRACE to VAS scores alone enhances the ability to detect status and responsiveness and has the best performance characteristics of the tested composite measures. GRAPPA members recommend further testing of the 3VAS and 4VAS in observational and trial datasets.

Predictors of chronic neuropathic pain after scoliosis surgery in children

2017 ◽  
Vol 17 (1) ◽  
pp. 339-344 ◽  
Author(s):  
Florence Julien-Marsollier ◽  
Raphaelle David ◽  
Julie Hilly ◽  
Christopher Brasher ◽  
Daphné Michelet ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Logistic Regression ◽  
Neuropathic Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Univariate Analysis ◽  
Opioid Consumption ◽  
Multivariate Logistic Regression Model ◽  
Scoliosis Surgery ◽  
Preoperative Pain

AbstractBackgroundNumerous publications describe chronic pain following surgery in both adults and children. However, data in the paediatric population are still sparse and both prevalence of chronic pain after surgery and risk factors of this complication still undetermined.MethodsWe prospectively evaluated the prevalence of chronic pain and its neuropathic pain component at 1 year following correction of idiopathic scoliosis in children less than 18 years of age. Pain was defined as the presence of pain (numerical rating scale – NRS ≥4), the presence of signs of neurologic damage within the area of surgery and the presence of the neuropathic symptoms as a DN4 (Douleur Neuropathique 4) questionnaire ≥4. Factors investigated as potentially associated with the presence of a persistent neuropathic pain were: age, weight, the presence of continuous preoperative pain over the 3 months before surgery, surgical characteristics, pain scores during the first five postoperative days, and DN4 at day 3. Statistical analysis employed univariate analysis and a multivariate logistic regression model.ResultsThirty six patients were included in the study. Nineteen (52.8%) had pain at one year after surgery. Among them 17 (48.2%) had neuropathic pain. Logistic regression found continuous pain over the 3 months preceding surgery and day 1 morphine consumption ≥0.5 mg kg-1 as independent predictors of persistent chronic pain with a neuropathic component. The overall model accuracy was 80.6 and the area under the curve of the model was 0.89 (95% confidence interval 0.78–0.99).ConclusionsThe present study found a high proportion of paediatric patients developing chronic persistent pain after surgical correction of scoliosis diformity. It allows identifying two factors associated with the occurrence of persistent chronic pain with a neuropathic component: the presence of persistent preoperative pain during the 3 months preceeding surgery and postoperative opioid consumption at day 1 –;0.5 mg kg-1ImplicationPatients scheduled for spine surgery and presenting with preoperative pain should be considered at risk of chronic pain after surgery and managed accordingly by the chronic and/or acute pain team. Postoperative opioid consumption should be lowered as possible by using multimodal analgesia and regional analgesia such as postoperative epidural analgesia.

Sign in / Sign up

Export Citation Format

Share Document