Prevalence of neuropathic pain in the foot and ankle patients

Category: Other Introduction/Purpose: The management of pain in patients with foot and ankle pain can be challenging. Cumulative data suggest that, in addition to nociceptive mechanisms, other neuropathic mechanisms can contribute to pain in a subset of people with osteoarthritis. Neuropathic mechanism include central sensitization or peripheral neuropathic hyper activated pain. Heterogeneous pain mechanisms may explain variable responses to recommended pain therapies. Accurate classification of pain phenotype using clinically feasible tools has potential to improve pain management. The PainDETECT score, a validated patient-report questionnaire was developed to identify neuropathic pain. A recent study found a prevalence of 23% of neuropathic pain following ORIF of Ankle fractures. The purpose of this study is to examine the prevalence of neuropathic pain (NP) in a variety of foot and ankle disorders. Methods: This is a cross-sectional study investigating the prevalence of NP in a population of patients undergoing foot and ankle surgery. The patient cohort will include 500 patients. Patients were prospectively reviewed, prior to their surgery, using a patient-self-report questionnaire (painDETECT). Patients’ demographics, diagnosis, comorbidities and functional scores were also prospectively collected. painDETECT score of less than 13 was considered as Nociceptive, score of more than 18 was considered as Neuropathic. Scores of 12 to 18 were considered as Unclear. ANOVA and Student’s t-tests were performed to compare the pain VAS scores, duration of pain prior to surgery, severity of the disease and the prevalence of NP, and among different foot and ankle procedures (bone versus tissue, elective versus trauma) and procedural regions (hindfoot/ankle, midfoot, forefoot). Results: A total of 116 patients were included in this preliminary study. 9 patients (7.7%) were diagnosed with neuropathic pain and 24 (20.6%) were Unclear according to their results in the painDETECT. There were 28 patients scheduled for surgery due to recent trauma, none of which had neuropathic pain. One patient with neuropathic pain was scheduled for excision of Morton’s neuroma and 2 patients for removal of foreign body or hardware. There was no significant correlation with age, BMI or smoking status nor with the patients’ functional scores. Patients with NP described their worst and current level of pain significantly higher than those with nociceptive pain. (9.4 Vs 7.4 for worst pain and 6.9 Vs 4.6 for current level in a scale from 0-10, p-value<0.05). Conclusion: A considerable number of the patients with foot and ankle problems requiring surgeries also has pain of a neuropathic mechanism. It is more common in chronic pain than in trauma. This should be evaluated pre-op and taken into attention when deciding on a surgical intervention or pain management.

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Re-assessing the Validity of the Opioid Risk Tool in a Tertiary Academic Pain Management Center Population

Pain Medicine ◽

10.1093/pm/pnx332 ◽

2018 ◽

Vol 19 (7) ◽

pp. 1382-1395 ◽

Cited By ~ 5

Author(s):

Meredith R Clark ◽

Robert W Hurley ◽

Meredith C B Adams

Keyword(s):

Pain Management ◽

Smoking Status ◽

Low Risk ◽

The Self ◽

Self Report ◽

Drug Misuse ◽

Aberrant Behavior ◽

Cross Sectional ◽

Risk Patients ◽

Aberrant Behaviors

AbstractObjectiveTo analyze the validity of the Opioid Risk Tool (ORT) in a large. diverse population.DesignA cross-sectional descriptive study.SettingAcademic tertiary pain management center.SubjectsA total of 225 consecutive new patients, aged 18 years or older.MethodsData collection included demographics, ORT scores, aberrant behaviors, pain intensity scores, opioid type and dose, smoking status, employment, and marital status.ResultsIn this population, we were not able to replicate the findings of the initial ORT study. Self-report was no better than chance in predicting those who would have an opioid aberrant behavior. The ORT risk variables did not predict aberrant behaviors in either gender group. There was significant disparity in the scores between self-reported ORT and the ORT supplemented with medical record data (enhanced ORT). Using the enhanced ORT, high-risk patients were 2.5 times more likely to have an aberrant behavior than the low-risk group. The only risk variable associated with aberrant behavior was personal history of prescription drug misuse.ConclusionsThe self-report ORT was not a valid test for the prediction of future aberrant behaviors in this academic pain management population. The original risk categories (low, medium, high) were not supported in the either the self-reported version or the enhanced version; however, the enhanced data were able to differentiate between high- and low-risk patients. Unfortunately, without technological automation, the enhanced ORT suffers from practical limitations. The self-report ORT may not be a valid tool in current pain populations; however, modification into a binary (high/low) score system needs further study.

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The Prevalence of Bruxism and Associated Occupational Stress in Saudi Arabian Fighter Pilots

Oman Medical Journal ◽

10.5001/omj.2022.47 ◽

2021 ◽

Author(s):

Khalifa S. Al-Khalifa

Keyword(s):

Occupational Stress ◽

Smoking Status ◽

Saudi Arabian ◽

Cross Sectional Study ◽

Self Report ◽

Short Version ◽

P Value ◽

International Consensus ◽

Cross Sectional ◽

Final Sample

Objective: To assess the prevalence of bruxism and occupational stress among Saudi Arabian fighter pilots. Methods: This was an observational, cross-sectional study where 110 fighter pilots were compared with 110 control non-pilots. The data collection was carried out between February 2018 and May, 2019. Once subjects consented to the study, they completed a self-administered questionnaire and clinical data were collected from each subject. The short version of Karasek's Demand-Control questionnaire comprising of 11 questions (5 for demand and 6 for control) was used to measure occupational stress. The assessment of bruxism was confirmed using the noninstrumental approach of the International consensus on the assessment of bruxism that included both clinical examination and self-report of diurnal or nocturnal bruxism. A logistic regression test was performed with bruxism as the dependent variable controlling for occupational stress, type of occupation and smoking status. P value < 0.05 was considered statistically significant. Results: The final sample had an overall bruxism prevalence of 41.8%, with pilots having higher percentage than non-pilots (52.7% and 30.9%, respectively). Pilots were more under occupational stress and exhibited more bruxism compared to non-pilots (OR = 2.2, 95% CI =1.3-3.9 and OR = 2.5, 95% CI =1.4-4.3, respectively). Conclusion: Within the limitations of this study, pilots demonstrated significantly higher occupational stress and bruxism than non-pilots. Pilots were four times more likely to have stress and bruxism compared to non-pilots. Further investigations are necessary to examine a possible causal relationship between occupational stress and bruxism.

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Evaluation of full cup test and numeric pain rating scale in the assessment of orofacial pain

International Journal of Oral Health Dentistry ◽

10.18231/j.ijohd.2021.057 ◽

2021 ◽

Vol 7 (4) ◽

pp. 292-295

Author(s):

Roland Prethipa P ◽

Jimsha V K ◽

Jonathan Daniel M

Keyword(s):

Pain Assessment ◽

Rating Scale ◽

Orofacial Pain ◽

Study Data ◽

Self Report ◽

P Value ◽

Pain Rating ◽

Cross Sectional ◽

Numeric Pain Rating Scale ◽

Pain Rating Scale

Pain intensity is a common outcome domain assessed in pain clinical trials. The patient’s self-report is the gold standard and it appears to be embedded in everyday clinical practice. Most often pain assessment is considered to be the cornerstone for ideal treatment.The aim of this study was to assess the dental patients’ level of pain using Full Cup Test (FCT) and Numeric Pain Rating Scale (NPRS), and to compare and validate the Full Cup Test in the assessment of orofacial pain with Numeric Pain Rating Scale.A total of sixty patients presenting with various forms of orofacial pain were included in this cross-sectional study. Data collected include the patient demographic details and the diagnosis of each case was made after proper history taking, clinical examination and radiographic investigation. Pain assessment was done for each patient using both numeric pain rating scale and full cup test.All the data were analysed using inferential statistics Mann Whitney test and the analysis was carried out with SPSS 17.The comparison of mean pain scores using full cup test and numeric pain rating scale shows there was significant differences between acute and chronic pain with P- value of 0.023 and 0.005 respectively. FCT had shown 83 percent sensitivity and 94 percent specificity.Patients who presented with either acute or chronic dental conditions experienced moderate to severe level of pain. FCT is useful for both evaluating and discerning changes in pain and it can be used as a tool in pain assessment.

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A cross-sectional, non-interventional study of the correlation between insight and adherence in schizophrenia in Nepal

10.21203/rs.2.14530/v1 ◽

2019 ◽

Author(s):

Imogen Henrietta Stokes ◽

Uddhav Lama ◽

Jai Bahadar Khattri

Keyword(s):

Correlation Coefficient ◽

Living Arrangements ◽

Cultural Beliefs ◽

Self Report ◽

P Value ◽

Interventional Study ◽

Cross Sectional ◽

Need For Treatment ◽

Patient Demographics ◽

Insight Into

Abstract Background: There is a significant lack of research in the Nepalese study population on adherence in patients with schizophrenia. This cross-sectional, non-interventional study aims to re-examine the recognised correlation between insight and adherence in this population, whilst exploring the association between patient demographics and adherence to help bring understanding to how familial and environmental factors may impact adherence. Methods: Patients were recruited upon attendance to outpatient’s appointments and admission to the psychiatry department of Manipal Teaching Hospital. A self-report questionnaire was used to collect data on patient demographics, including age, ethnicity, religion, employment status, current living arrangements and education level; the Birchwood Insight Scale (BIS); and the Drug Attitude Inventory (DAI-10) score. Descriptive statistics on the demographics, BIS and DAI-10 were collated using SPSS. An analysis of variance of DAI-10 scores according to participant demographics was performed using a one-way ANOVA analysis. Correlation between the BIS and BIS subscales and the DAI-10 was tested using Pearson’s 2-tailed analysis at 0.01 significance level.Results: 19 participants consented to participate in this study with 100% data obtained. 57.9% unemployed, 63.2% living with parents and 47.4% had only a basic education. 36.8% of participants had poor insight; 84.2% of participants had poor insight into their symptoms; 78.9% of participants had poor insight into their illness and 36.8% had poor insight into their need for treatment. 52.7% of participants were poor adherers. No significant differences in DAI-10 scores were found between demographic groups. A positive correlation was found between the total BIS score and DAI-10 score (Pearson correlation coefficient of 0.585; P value = 0.009). Furthermore, the awareness of need for treatment subscale score and the DAI-10 score found a correlation coefficient of 0.609 (P value = 0.006). Conclusions: In conclusion, this study found prevalent non-adherence to medication and demonstrated that insight correlates with adherence. Although study findings did not suggest that patient demographics were associated with non-adherence, it is important to consider the possibility that these high rates of non-adherence have other contributing factors; overcoming rural health inequality, cultural beliefs regarding psychiatric illness and unaffordability remain the great challenges for the Nepalese population.

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Neuropathic pain in patients with haemophilia, that is the question

Hämostaseologie ◽

10.1055/s-0037-1619823 ◽

2015 ◽

Vol 35 (S 01) ◽

pp. S5-S9 ◽

Cited By ~ 6

Author(s):

S. Krüger ◽

T. Hilberg

Keyword(s):

Rheumatoid Arthritis ◽

Chronic Pain ◽

Neuropathic Pain ◽

Differential Diagnosis ◽

Pain Management ◽

Pain Mechanisms ◽

Number Of Patients ◽

Paindetect Questionnaire ◽

Chronic Disorders ◽

Chronic Pain Conditions

SummaryChronic pain caused by recurrent joint bleedings affects a large number of patients with haemophilia (PwH). The basis of this pain, nociceptive or neuropathic, has not been investigated so far. In other pain-related chronic disorders such as osteoarthritis or rheumatoid arthritis, initial studies showed nociceptive but also neuropathic pain features. 137 PwH and 33 controls (C) completed the painDETECT-questionnaire (pDq), which identifies neuropathic components in a person´s pain profile. Based on the pDq results, a neuropathic pain component is classified as positive, negative or unclear. A positive neuropathic pain component was found in nine PwH, but not in C. In 20 PwH an unclear pDq result was observed. In comparison to C the allocation of pDq results is statistically significant (p≤0.001). Despite various pDq results in PwH and C a similar appraisal pain quality, but on a different level, was determined. Summarising the results, there is a potential risk to misunderstand underlying pain mechanisms in PwH. In chronic pain conditions based on haemophilic arthopathy, a differential diagnosis seems to be unalterable for comprehensive and individualised pain management in PwH.

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Neuropathic Pain, Depression, and Cardiovascular Disease: A National Multicenter Study

Neuroepidemiology ◽

10.1159/000377726 ◽

2015 ◽

Vol 44 (3) ◽

pp. 130-137 ◽

Cited By ~ 14

Author(s):

Jacquelyn J. Cragg ◽

Vanessa K. Noonan ◽

Luc Noreau ◽

Jaimie F. Borisoff ◽

John K. Kramer

Keyword(s):

Cardiovascular Disease ◽

Neuropathic Pain ◽

Self Report ◽

Secondary Complications ◽

Cross Sectional ◽

Increased Risk ◽

Cord Injury ◽

Emerging Risk ◽

Potential Factors ◽

The Relationship

Background: Individuals with spinal cord injury (SCI) have a more than twofold increased risk of heart disease and stroke compared with able-bodied individuals. The increased risk appears to be in excess of the risk conferred by several well-established risk factors, including diabetes, hypertension, and sex. This raises the question whether other factors, secondary to SCI, are also contributing to the development of cardiovascular disease (CVD). Two potential factors associated with SCI and CVD are pain and depression. Both are frequently reported among individuals with SCI, develop in the acute stages of injury, and are commonly described as severe. Therefore, the primary aim of this study was to examine the relationship between pain (and types of pain) and depression with CVD among individuals with SCI. Methods: A total of 1,493 individuals (referred sample) with chronic SCI participated in a self-report cross-sectional multicenter Canada-wide survey from 2011-2012 (mean age ± standard deviation: 49.6 ± 13.9 years). Results: After adjustment for age, sex, and injury characteristics, neuropathic pain and depression were significantly and independently associated with CVD (adjusted odds ratio and 95% confidence interval: 2.27 (1.21, 4.60) for neuropathic pain; 4.07 (2.10, 7.87) for depression). In contrast to neuropathic pain, non-neuropathic pain was not significantly associated with CVD (p = 0.13). Conclusion: In conclusion, these data illustrate important interrelationships between secondary complications following SCI, as well as raise the possibility of neuropathic pain (versus nociceptive pain) as a novel and emerging risk factor for CVD.

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Exploration of pain management following implementation of WHO pain guidelines

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.19646 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 19646-19646

Author(s):

S. Subongkot ◽

S. Khounnikhom ◽

N. Pratheepawanit Johns ◽

A. Sookprasert

Keyword(s):

Pain Management ◽

Pain Score ◽

Rating Scale ◽

Numeric Rating Scale ◽

Cross Sectional Study ◽

P Value ◽

Cross Sectional ◽

Daily Life Activities ◽

Naive Group ◽

Who Guideline

19646 Background: Pain is among the most common symptoms encountered in cancer patients and remains the first priority of care. Methods: This cross sectional study aimed to explore a pattern of pain management at KKU Hospital by utilizing a numeric rating scale (0–10). Cancer pain patients were categorized based on prior analgesic exposure into two groups; Naïve group, and Routine group. Treatments were defined according to WHO as 1) drug treatment relevant to pain severity, 2) analgesics being prescribed as around-the- clock and 3) analgesics used for break-through pain for patients receiving strong opioid. Results: From Dec 2005 to Jul 2006, 261 patients were enrolled. 93.1% (n=243) were in advanced stages and 88.5% (n=231) were in moderate to severe pain. This pain interfered with patient’s daily life activities mildly to moderately as each pain score increased (p-value<0.01). In Naive group (n=159), 32.7% (n=52) were given analgesics following the WHO on both days 1 and day 3 of admission whereas 40.2% (n=64) patients were not. A decreased pain score was greater (2.61, SD±1.5) in a group following the WHO on day 1. Additionally, a decreased pain score was greater (3.91, SD±1.8) in a group following the WHO on day 3 (p-value <0.0001). This pain score decreased was also clinically significant as pain score reduced more than 3 points. In Routine group (n=102), 32 (31.4%) were given analgesics following the WHO guideline on both day 1 and day 3 of admission. In contrast, 36 (35.3%) were not. A decreased pain score was greater (2.59, SD±1.8) in a routine group following the WHO on day 1. Moreover, a decreased pain score was greater (3.95, SD±1.8) in a group following the WHO on day 3. The clinical significance of pain score reduced was also found on day 3. Of the 261 evaluable patients, the pattern of analgesics usage following the WHO guideline was increased in both groups comparing to at the beginning of the study. Conclusions: The results demonstrated that patients who received pain management following the WHO guideline reported significantly lower pain intensity than those not following the WHO. No significant financial relationships to disclose.

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Impact of COVID-19 restrictions on alcohol consumption behaviours

BJPsych Open ◽

10.1192/bjo.2021.986 ◽

2021 ◽

Vol 7 (5) ◽

Author(s):

Emily O. C. Palmer ◽

William Trender ◽

Robin J. Tyacke ◽

Adam Hampshire ◽

Anne Lingford-Hughes

Keyword(s):

Alcohol Consumption ◽

Smoking Status ◽

Psychiatric Morbidity ◽

Group Analysis ◽

Coefficient Matrix ◽

Self Report ◽

Depression And Anxiety ◽

Cross Sectional ◽

Drinking To Cope ◽

Audit Score

Background We aimed to evaluate how coronavirus (COVID-19) restrictions had altered individual's drinking behaviours, including consumption, hangover experiences, and motivations to drink, and changing levels of depression and anxiety. Method We conducted an online cross-sectional self-report survey. Whole group analysis compared pre- versus post-COVID restrictions. A correlation coefficient matrix evaluated the associations between all outcome scores. Self-report data was compared with Alcohol Use Disorders Identification Test (AUDIT) scores from the 2014 Adult Psychiatric Morbidity Survey. Multiple linear modelling (MLM) was calculated to identify factors associated with increasing AUDIT scores and post-restriction AUDIT scores. Results In total, 346 individuals completed the survey, of which 336 reported drinking and were therefore analysed. After COVID-19 restrictions 23.2% of respondents reported an increased AUDIT score, and 60.1% a decreased score. AUDIT score change was positively correlated with change in depression (P < 0.01, r = 0.15), anxiety (P < 0.01, r = 0.15) and drinking to cope scores (P < 0.0001, r = 0.35). MLM revealed that higher AUDIT scores were associated with age, mental illness, lack of a garden, self-employed or furloughed individuals, a confirmed COVID-19 diagnosis and smoking status. Conclusions COVID-19 restrictions decreased alcohol consumption for the majority of individuals in this study. However, a small proportion increased their consumption; this related to drinking to cope and increased depression and anxiety.

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Association between Smoking and Academic Performance among Under-Graduate Students of Pakistan, A Cross-Sectional Study

10.21203/rs.2.12718/v1 ◽

2019 ◽

Author(s):

Sana Ullah ◽

Siham Sikander ◽

Mudassar Mushtaq Jawad Abbasi ◽

Syed Aftab Rahim ◽

Babar Hayat ◽

...

Keyword(s):

Academic Performance ◽

Undergraduate Students ◽

Rural Areas ◽

Urban Areas ◽

Dietary Habits ◽

Smoking Initiation ◽

Cross Sectional Study ◽

Self Report ◽

P Value ◽

Cross Sectional

Abstract Background Prevalence of smoking is on the rise and its harmful effects on every organ of body are well known. Smoking is a growing concern due to adverse effects on health, its association with academic performance is not well studied. Objectives This study aims to assess the prevalence of smoking among undergraduate students of age 18-24 years in a public sector university of Islamabad, association between smoking and academic performance and also to assess the reasons of smoking initiation among undergraduate students. Methods The study included 500 undergraduate students. A self-report structured questionnaire was used to assess smoking, dietary habits, physical activity, parent’s smoking, friend’s smoking, time spent on mobile and TV and academic performance for collection of data. Logistic regression was used for association between smoking and academic performance. Results Results of study show that 112/500 (22.4%) students were smokers among them 93/112 (34.6%) were males and 19/112 (8.2%) were females. The mean age of study participants was 21.50 years (SD: 1.72. Prevalence of smoking was higher in students belonging to rural areas 23.5% to that of urban areas 21.9%. Three major reasons of smoking initiation; 25% students stated peers and friends, 21% stated easy availability while 14% said it was fun and enjoyment they started smoking. High academic performance was found to be inversely proportional to student’s smoking; at p-value 0.000 smokers had 2.5 (1.77, 3.74) odds of lower academic performance, boys having 2.17 (1.56, 3.03) odds of lower academic performance in last semester exams. Conclusion Findings highlighted extensive cigarette smoking among undergraduate students of Islamabad. Smoking is significantly and negatively associated with academic performance.

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Gabapentinoids for treatment of neuropathic pain: a medicines usage evaluation at the Groote Schuur Hospital Chronic Pain Management Clinic

Southern African Journal of Anaesthesia and Analgesia ◽

10.36303/sajaa.2019.25.4.2253 ◽

2019 ◽

pp. 21-28 ◽

Cited By ~ 1

Author(s):

MLA Moabelo ◽

R Parker

Keyword(s):

Chronic Pain ◽

Neuropathic Pain ◽

Pain Management ◽

Somatosensory System ◽

Tricyclic Antidepressant ◽

Screening Tools ◽

Chronic Pain Management ◽

Cross Sectional ◽

Chronic Postsurgical Pain ◽

Usage Evaluation

Background: Neuropathic pain (NP), defined as pain caused by a lesion or disease of the somatosensory system, affects 6.9–10% of people worldwide. Pregabalin is currently recommended as a first line drug for NP in South Africa. Methods: A cross-sectional, retrospective, descriptive medicines usage evaluation (MUE) of pregabalin at Groote Schuur Hospital (GSH) Chronic Pain Management Clinic for the year 2017 was conducted. A MUE using a standardised data collection form was performed on 100 randomly selected patient folders. Data was summarised using descriptive statistics. Results: The majority of cases were women (76) with a mean age of 55.9 years (SD12.49). A diagnosis of NP was recorded in 58 folders and a “possible” diagnosis recorded in 7 folders. In 79 cases there was no mention of a tool/method used to diagnose NP. The most common condition diagnosed was chronic postsurgical pain with a neuropathic component (n = 16), followed by NP (n = 15). The most common initiating and current dose of pregabalin was 75 mg twice daily. In 56 patients, pregabalin was prescribed in conjunction with a tricyclic antidepressant (TCA) or selective noradrenaline reuptake inhibitor (SNRI). Patient education was documented as having taken place in 76 of cases. Conclusions: Based on this MUE we recommend the use of screening tools for the diagnosis of neuropathic pain, and a focus on the initiating dose of pregabalin. The use of a standardised assessment document and the interdisciplinary team input at this clinic appears to optimise prescribing of pregabalin in line with practice guidelines.

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