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

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.

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

10.1093/med/9780198834359.003.0059 ◽

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.

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Jaw Exercise Therapy and Psychoeducation to Reduce Oral Parafunctional Activities for the Management of Persistent Dentoalveolar Pain

Pain Research and Management ◽

10.1155/2018/5042067 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7

Author(s):

Izumi Makino ◽

Young-Chang Arai ◽

Shuichi Aono ◽

Masayuki Inoue ◽

Hiroki Sakurai ◽

...

Keyword(s):

Standard Deviation ◽

Combination Therapy ◽

Pain Intensity ◽

Rating Scale ◽

Numerical Rating Scale ◽

End Of Treatment ◽

Before And After ◽

Numerical Rating ◽

Therapy Treatment ◽

Nonpharmacological Treatments

Objective. To retrospectively analyze the effects of our original combination therapy treatment on patients with nonodontogenic persistent dentoalveolar pain. Methods. Twenty-one patients suffering from persistent dentoalveolar pain (nineteen females and two males; mean age ± standard deviation: 55.7 ± 19.6 years) participated in this study. They were treated with a therapy combination of jaw exercise and psychoeducation to reduce oral parafunctional activities every month. The intensity of pain in these subjects was evaluated using a numerical rating scale (NRS) before and after treatment. Results. The NRSs at the baseline ranged from 5 to 10 (median, 8), from 0 to 10 (median, 2) at one month after treatment, from 0 to 10 (median, 1) at three months after treatment, and from 0 to 10 (median, 0) at the end of treatment. Pain intensity after treatment improved significantly. Conclusion. There was a significant reduction in pain after our combination of therapies as nonpharmacological treatments, and therefore this treatment could be useful in the management of NPDP patients.

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

10.1101/2020.04.27.063339 ◽

2020 ◽

Cited By ~ 1

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.

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

10.2196/preprints.30690 ◽

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 (P=.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, df=24; P=.01). Further, significant improvement was seen in pain interference by using the Brief Pain Inventory (–9.42, 95% CI –14.47 to –4.36, df=25; P=.001) and in disability by using the Pain Disability Assessment Scale (–1.95, 95% CI –3.33 to –0.56, df=24; P=.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

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

Pain Research and Management ◽

10.1155/2014/856513 ◽

2014 ◽

Vol 19 (3) ◽

pp. 141-148 ◽

Cited By ~ 29

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.

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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

Modern Rheumatology ◽

10.1093/mr/roab035 ◽

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.

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

Journal of Medical Internet Research ◽

10.2196/30690 ◽

2021 ◽

Vol 23 (11) ◽

pp. e30690

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 (P=.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, df=24; P=.01). Further, significant improvement was seen in pain interference by using the Brief Pain Inventory (–9.42, 95% CI –14.47 to –4.36, df=25; P=.001) and in disability by using the Pain Disability Assessment Scale (–1.95, 95% CI –3.33 to –0.56, df=24; P=.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. Trial Registration University Hospital Medical Information Network UMIN000031124; https://tinyurl.com/2pr3xszb

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Efficacy of EMDR Therapy on the Pain Intensity and Subjective Distress of Cancer Patients

Journal of EMDR Practice and Research ◽

10.1891/emdr-d-20-00036 ◽

2021 ◽

Vol 15 (1) ◽

pp. 18-28

Author(s):

Naeem Abdi ◽

Mohammad Malekzadeh ◽

Zhila Fereidouni ◽

Mohammad Behnammoghadam ◽

Parisa Zaj ◽

...

Keyword(s):

Pain Intensity ◽

Rating Scale ◽

Therapeutic Option ◽

Controlled Trial ◽

Sampling Technique ◽

Control Group ◽

Subjective Distress ◽

Patients With Cancer ◽

Before And After ◽

Emdr Therapy

The present study was carried out to investigate the efficacy of eye movement desensitization and reprocessing (EMDR) therapy in treating pain and subjective distress of patients with cancer. A randomized controlled trial was performed on patients with cancer suffering from moderate to severe cancer pain in Yasuj, Iran, in 2019 and 2020. Sixty patients aged 30–60 years who fulfilled the inclusion criteria were selected using a consensus sampling technique. Patients were randomly assigned to EMDR therapy or control groups based on random block allocation. EMDR therapy was administered in six to eight daily 1-hour sessions. The control group received the standard treatment provided by the hospital. A Numeric Pain-Rating Scale (NRS) and the Subjective Units of Disturbance Scale (SUDS) were used to assess pain and subjective distress before and after the intervention in each session. The collected data were analyzed by descriptive statistics, chi-square test, and independent t test using Statistical Package for the Social Sciences (SPSS) version 24. The mean pain intensity and subjective distress score in the experimental group before and after the EMDR intervention were significantly reduced (p < .001). In the control group, no decreases in NRS and SUDS scores occurred at any time (p > .05). Differences in pain scores between the groups were statistically significant (p < .001). EMDR can effectively and sustainably reduce the pain and subjective distress experienced by patients with cancer. Thus, EMDR is a recommended therapeutic option to mitigate pain and subjective distress among patients with cancer.

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Association of Serum Serotonin and Pain in Patients with Chronic Low Back Pain before and after Spinal Surgery

Pain Research and Treatment ◽

10.1155/2018/4901242 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Afshin Farhanchi ◽

Behrouz Karkhanei ◽

Negar Amani ◽

Mashhood Aghajanloo ◽

Elham Khanlarzadeh ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Low Back ◽

Significant Difference ◽

Before And After ◽

Postoperative Serum ◽

Serum Serotonin

Introduction. In this study we are aiming to evaluate the changes of serum serotonin and its association with pain in patients suffering from chronic low back pain before and after lumbar discectomy surgery. Patients and Methods. A prospective study was performed on the patients referring to the outpatient clinic in Besat hospital, Hamadan University of Medical Sciences, Hamadan, Iran, during 2016. A 2 mL fasting blood sample was collected from each patient at preoperative day 1 and postoperative day 14 and they were measured for level of serum serotonin. Besides, all patients were asked for severity of their low back pain in preoperative day 1 and postoperative day 14 and scored their pain from zero to ten using a Numerical Rating Scale. Results. Forty patients with the mean age of 47 ± 13 yrs/old (range 25–77) including 15 (37.5%) males were enrolled into the study. The overall mean score of preoperative pain was significantly decreased from 7.4 ± 2.18 (range 4–10) to the postoperative pain score 3.87 ± 2.92 (range 0–10) (P < .001). The overall levels of pre- and postoperative serum serotonin were 3.37 ± 1.27 (range 1.1–6.4) and 3.58 ± 1.32 (range .94–7.1) ng/mL, respectively, with no significant difference (P = .09). The levels of pre- and postoperative serum serotonin were significantly higher in males and patients older than 50 yrs/old compared to the females and patients younger than 50 yrs/old, respectively (P = .03 and .005, respectively). A significant inverse correlation between the postoperative levels of pain and serum serotonin was observed (r = -.36 and P = .02). Conclusion. A negative medium strength linear relationship may exist between the postoperative serum serotonin and low back pain.

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Effectiveness of Neck Myofascial Release Techniques and Exercise Therapy on Pain Intensity and Disability in Patients with Chronic Tension-Type Headache

Global Journal of Health Science ◽

10.5539/gjhs.v9n6p47 ◽

2016 ◽

Vol 9 (6) ◽

pp. 47

Author(s):

Mohammad Hosseinifar ◽

Razieh Bazghandi ◽

Zahra Azimi ◽

Bahareh Khodadadi Bohlouli

Keyword(s):

Pain Intensity ◽

Exercise Therapy ◽

Rating Scale ◽

Numerical Rating Scale ◽

Tension Type Headache ◽

Control Group ◽

Myofascial Release ◽

Headache Intensity ◽

Headache Disability ◽

Type Headache

PURPOSE: Tension type headache (TTH) is one of the most prevalent types of headache. TTH is classified as episodic if it occurs on less than 15 days a month and as chronic if it occurs more often. Tension, anxiety and depression are some etiological factors for TTH which leads to work efficiency reduction. Today the interest in non-pharmacological methods is increasing; massage is one of these approaches which has no side effects. Aim of this study was to investigate the effects of neck Myofascial Release (MFR) techniques and exercise therapy on pain intensity and disability in patients with chronic tension-type headache.METHODS: This randomized clinical trial study was investigated on 30 females suffering from TTH. Participants were randomly assigned into two equal groups (n=15). The MFR group received neck MFR massage and exercise therapy four times a week for 3 weeks, each session lasting 45 minutes. Control group had no intervention. Outcomes were headache intensity and disability measured by numerical rating scale (NRS) and headache disability index (HDI), respectively. Data was analysed through independent and pair t-test.RESULTS: Between group comparison showed significant improvement of headache intensity and disability rate in MFR group (p<0.05) than control group (p=0.000).DISCUSSION: This study provides evidences that MFR technique and exercise therapy have significant effect on patients with TTH.

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