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USING A COMBINED SENSOR FOR P.C. GENERATED DATA IN MEASURING PAIN: A LITERATURE REVIEW RATIONAL USING ABSTRACT CITATIONS FROM SCIENTIFIC STUDIES.

Jocelyn W. Cowie, Ponderosa Pines Clinic/Spa, PO Box 1495, Grand Forks, BC VOH 1 HO, Canada

Aim of Investigation: The purpose of this study is to determine the usefulness of a multi-path pain measurement device.

Patients with pain have Sensory Evoked Potential (SEP). Al-gometers are used to measure lowered Pain Pressure Thresholds (PPT). Standard diagnosis for fibromyalgia diagnosis is lowered PPT in 11 of the 18 trigger point.

"Sonography" or "phonomyrography" for the detection of tissue crepitus. Sounds are elicited during joint mobilization. Well studied in association with TMJ. "Thermography," "myothermo-grams," and "vidiothermography" heat associated with inflammation is a common pain factor too microscopic to locate with manual palpation.

"Electromyograph, electro-diagnosis-electromyogram" used in investigating the function of nerves and muscle. The sympathetic nervous system SNS generates and sustains certain types of pain syndromes. Specialists in pain management have sought tools for investigating the SNS. EMG, galvanic skin resistance acupuncture location devices, lie detector test equipment, and biofeedback are used to detect moisture measurements in assessment of SNS dysfunction.

"Pitting devices" leave visual dents when prodded with a dull blunt object in the area of inflammation.

Temperature, Moisture, CREPITUS, and PPT's are proven independently as pain measurement devices. Using an objective multi-path diagnostic tool for measuring soft tissue pain coupled with P.C. software allows for statistical outcome measurements. Recognized questionnaires along with internet data bases may be the next generation of clinically evaluating pain and identifying cost effective treatment.

PSYCHO-BEHAVIORAL CHARACTERISTICS OF CHRONIC PAIN PATIENTS WITH ACCIDENT INSURANCE AND THEIR PROGNOSTIC OUTCOME

Yuichi Yamauchi'. Tadaaki Tomiie2, Hiroshi Aoyama2, Fumihito Taguchi3, 'Division of Psychosomatic Medicine, Miyagi Chuou Hospital, 'Dept of Human Behavioral Science, Tohoku Univ Med School, Tohoku Rosai Hospital, Japan

Aim of Investigation: To make post-traumatic pain patients recover from labor accident and restore their worksite as soon as possible, we tried to apply an intensive treatment program. The purpose of our study was to examine both psycho-behavioral backgrounds of the patients and to evaluate prognostic outcome.

Methods: Subjects examined were the patients of mean ages (SD) of 43 2 (21 males, 6 females) ranged 24 to 64 years old. Most of them consisted of those referred from orthopedic Dept, diagnosed as post-traumatic complaints with a certain musculoskeletal injury (Group A). Psychologically however, ca. 80% of them were the cases with accident neuroses. The treatment outcome of the patients were compared with that of age- and sex-matched control of non-accident pain patients (Group B).

Results: In the A group, cases with lower education (p=0.074), and of longer morbid duration (p=0.043) were more predominant than the B group. By our treatment program, we helped them to be aware of the pain mechanism after injury. About half of them were successful in getting over their illness. In contrast, 85% of efficacy rate was obtained in the B group (p-=0.022).

Conclusions: Prognostic outcome of the patients with accident insurance could be rather effectively raised by the therapeutic intervention as cognitive-behavioral modification including NAI-K-AN-coupled fasting therapy.

QUALITY OF LIFE IN PAIN PATIENTS (PART I): A MULTICENTER CROSS-SECTIONAL STUDY

H.U. Gerbershagen , G. Lindena ' DRK Pain Center Mainz, 'Mundipharma GmbH, Limburg FRG

Aim of Investigation: To investigate health-related quality of life (QOL) in relation to pain history, diagnoses and chronifi cation status.

Methods: 3294 patients were evaluated in 13 pain centers of different disciplines after completion of the validated German Pain Questionnaire (GPQ; 62 complex questions) and validated QOL instruments: Questions on Satisfaction with Life (FLZ), Nottingham Health Profile (NHP), and Medical Outcomes Study's Short Form 36 (SF-36)

Results: The response rate was more than 90% of all question-items due to the inclusion of QOL questionnaires into the GPQ-set. QOL in pain patients impaired is in all dimensions according to their chronification status (I-III)and more impaired compared to patients with other chronic diseases such as heart failure, diabetes type II, or COPD. Pain intensity is high, pre-referal pain and therapeutic experiences are very extensive and of particular economic interest. There are hardly any patients in chronicity stage I in these pain centers, proving a "negative" selection of patients with difficult to treat chronic pain. 85 of these patients were treated with step III opioids according to WHO ladder.

Conclusions: This is the first German study accumulating prospec-tively and comprehensively so many perfectly documented data of pain patients. The data set -though using generic instruments only-is suited to characterize pain patients. The next multicenter research step (see also part II) will evaluate changes after onset of treatment, differences between treatments and provide data for the interdisciplinary definition of treatment strategies.

Acknowledgments: We thank the colleagues and institutions for their support and their collection of high quality data. Supported by Glaxo Wellcome, Hamburg and Mundipharma, Limburg Germany.

ACTIVITY LIMITATION DIFFERS IN CLINICAL AND EXPERIMENTAL LOW BACK PAIN.

Liv Inger Strand. RolfMoe-Nilsscn*, A. Elisabeth Ljunggren, Section of Physiotherapy Science, Univ ofBergen, 5009 Bergen, Norway.

Aim of Investigation: To compare the impact of clinical and harmless experimental low back pain on physical activity.

Methods: Therapist derived assessments of back flexibility (Sock and Pick Up tests and Finger-to-floor distance) as well as patients' reports of activity limitation and pain intensity (visual analogue scale), were obtained in 21 patients with musculoskeletal low back pain. The same assessments as well as lumbar accelerations were obtained in 14 healthy subjects with same age range, before and after the injection of 0.6% saline into back muscles.

Results: No significant difference in pain intensities (P=0.799) was found between patients (mean=5.2) and subjects at maximum experimental pain (mean=5.0). Most patients had scores indicating activity limitation on Pick Up and Sock tests (81 and 70% respeclively) Mean Finger-to-floor distance was 24.3 cm (SD=18 3) Most patients perceived limitation in related daily activities Healthy subjects were significantly less limited than patients (P<0.01) At maximum experimental pain insignificant activity limitation was registered Finger-to-floor distance decreased by mean=l 9 cm (SD=3 3) Only three subjects perceived vague restrictions at tests Decreased lumbar acceleration was linearly associated with increased pain in 12 subjects (r = -0 60 to -091).

Conclusions. The question may be asked whether the application of harmless experimental pain is a valid procedure to study the impact of pain on physical activities in clinical pain Sensitive methods like accelerometry seem to be needed to measure the influence of experimental pain on physical activities

Acknowledgment. Supported by the Nordic Academy for Advanced Study (NorFA) and the Swedish Medical Research Council

INTEGRATIVE RESEARCH OF PHYSICAL CONDITION AND MENTAL BACKGROUND IN CHRONIC PAIN

Kouichi Kitami. Hokkaido Neurosurgical Memorial Hospital, N22WI5 Chuo-Ku 060-0022, Sapporo, Japan

Aim of Investigation To correlate neurophysical aspects with psychological backgrounds for the precise assessment of chronic pain disorders

Methods Sixty-two patients examined neurological physical findings, image diagnosis, mentality backgrounds 28 men and 34 women, age from 19 to 75 (mean age 45 2) y-o Pain duration was 6 to 96 months in those 7 years Neurophysical data and image diagnosis were analyzed and classified after DSM-1V Group A (organic) Pain relates to general physical disease Group B (semiorganic) Pain relates to both mental factor and general physical disease Group C (non-organic) Pain relates to mental factors Mentality questionnaires; CMI, SDS, Egogram, MMP1 were done

Results Atypical facial pain, central pain, phantom limb pain, can salgia, chronic pain after operation, posttraumatic pain, pain after whiplash injury, etc were physical diagnoses Gp A 27, Gp B 14, Gp C 21 About 68% of all had neurotic tendency. Depression and low "A value" in Egogram also frequent and constant Neurotic-tnad and psychic-tetrad in MMP1 higher m Gp C, hypochondnacal tendency and depressive tendency relatively high in Gp A, mental defense, non-rationality, depression were high in Gp.B

Conclusion Though excluded from pain disorders in DSM-IV, Gp A had actually high hypochondnacal and depressive tendencies, so how organic, only to treat physically may become insufficient in this group Mental defense was so high that the tendency of easily failing into medical discredit was suggested on Gp B Making muscles film secondarily and developing myofascial pain from the characteristic neurotic tendency were considered the true cause of pain in Gp C

CAREGIVERS OF PATIENTS WITH CHRONIC PAIN: RESPONSES TO CAREGIVING.

Geana Paula Kurita*, Ana Claudia de Oliveira*, Dma de Almeida Lopes Monteiro da Cruz. Cibele Andrucioli de Mattos Pimenta, Nursing School o fUniv of San Paulo, League Against Pain, Hospital das Clinicas of Univ of San Paulo, Av Eneas de C Aguiar, 419, Sao Paulo, 05403-000, Brazil

Aim of Investigation To describe the alterations that caregivers of chronic pain patients ascribe to the caregiving role, and the situations in which the patients are dependent

Methods. Thirty family caregivers (mean age-46 years, 93.3%-female, mean schooling-7 1 years) were interviewed. The length of the caregiver roles had the following medians 12 months (0 5-60), 7 days/week (5-7), 12 hours/day (1-24) The patients' mean age was 59 9 years, 80% was male The caregivers' reports about the patients' needs were the bases to estimate the dependence level (from 0-none to 10-total) The caregivers rated (0-10) how much the role had influenced their lives

Results' The mean rating of the daily living activity (DLA) dependence was 3 8 (SD 3.0), of the instrumental DLAs was 7 3 (SD 3 4) The situations in which the patients depended were. taking medications- 93 3%, eating, bathing, dressing, toileting, or moving themselves- from 60% to 70%, and, for at least one instrumental DLA- from 63% to 86% of the patients From 80% to 60% of the caregivers reported prejudice on sleep, job/study, leisure, humor The influences on sexual activities, plans for the future, family relationships, health, appetite, and personal care were reported by 40% to 53 3% of them The tiredncss mean rating ascribed to the role was 6 4 (SD 3 0).

Conclusion The management of chronic pain included family members as caregivers They spent many hours a week in caregiving activities, and their lives were affected in many aspects because of the role They were, at least, in risk for caregiver role strain

THE SICKNESS IMPACT PROFILE: UTILISATION IN PAIN STUDIES AND CURRENT RESEARCH IN THE COMMUNITY.

Jane Latham. Kingston Univ & St George's Hospital Medical School Faculty ofHealthcare Sciences, London SW17 OQT, UK Professor Bryn Davis, Dept of Nursing Studies, Univ of Wales College of Medicine, Cardiff CF4 4XN, UK

Aim of Investigation. To examine and compare life-style disability and resource usage of chronic pain patients with other patients in the community

Methods: A review of the utilisation of the Sickness Impact Profile for the study of pain will be presented This current study pre-identified criteria for three comparative patient groups (n=120), with a further interesting sub-group of previously unrecognised chronic pain patients (n=16). Patients were selected from two general practices in the UK The interview schedule included the Sickness Impact Profile, McGill Pain Questionnaire and a Resources Questionnaire

Results With particular reference to the Sickness Impact Profile, Group 1 (those with previously identifiable chronic pain) had consistently higher disability scores across all dimensions and the overall score when compared with the other three groups Group 4 with previously unidentified chronic pain scored more highly than either of the 'non-pain' groups, but not as highly as Group 1 Sickness Impact Profile percentage disability scores for each group will be presented with KruskdI-Wallis 1-Way Anova Scores Associations and relationships between groups and independent variables will also be highlighted.

Conclusions Whilst this is a small exploratory study, findings indicate the need for further more large scale projects regarding the long-term management of chronic pain patients Particularly in view of current legislative changes in the UK. which affect the interface of primary and secondary health/social care, priority should be placed on addressing the apparently subtle, long-term utilisation of health/social care staff and financial benefits

MEASURING THE SEVERITY OF CLINICAL PAIN USING MAGNITUDE MATCHING.

Thomas Lundcberg. Birgitta Bjork*, Elsebet Borg*, Carina Gustafsson*, Lisbeth Dahlin, Lena Sandin*. Sven Enksson**Dept of Surgery and Rehabilitation, Karolmska Instt/ Hospital, 171 76 Stockholm, *Multidisciplinary pain unit, Ystad-Osterlen, 271 82 Ystad

Aim of Investigation To study the differences in assessments of pain made independently with VAS, NS and an electrical stimulation, applied to the hand, as a matching stimulus

Methods' Sixty-nine patients participated in this study The patients were first asked to rate their pain using a visual analogue scale (VAS), followed by a numerical scale (NS) The number was recorded on the VAS scale and the number given is a form of magnitude production These values were recorded and then compared with the value from the noxious electrical stimulation test (magnitude matching). After obtaining the matched electrical stimulation value, the assessment procedure was again repeated

Results.

First measurement Second measurement

Before After Before After
VAS 5636 3629*** 5628 3530***
NS 1U5 96*** 126 96***
MM 138 11 S*** 127 108***

*p < 0 05. **p < 0 01, ***p < 0 005. comparing within group data before and after treatment

Conclusions: The results show that magnitude matching may serve as an alternative to VAS and NS scales Acknowledgments Supported by the Acupuncture Foundation and Cefar AB Sweden

REDUCTION OF LUMBAR ACCELERATIONS DURING WALKING CORRELATES LINEARLY WITH INCREASED MAGNITUDE OF EXPERIMENTAL LOW BACK PAIN

Rolf Moe-Nilssen*, Anne Elisabeth Liunggren. Enk Torebjork, Division of Physiotherapy Science, Faculty of Medicine, Univ of Bergen, Ulnksdal 8 c, N-5009, Norway, and Dept of Clin Neurophysiology, Univ Hospital, Uppsala S-75185 Sweden

Aim of Investigation To explore if change of accelerations of the lumbar region during walking would be useful as an indicator of back pain.

Methods: Transient low back pain was provoked by injection of 1 ml 6% hypertomc saline in the longissimus muscle at Th 12-L1 level in 20 healthy subjects Acceleration was measured during walking before and several times after the injection by a portable tnaxial accelerometer attached by a fixation belt to the dorsal mid-line at L3 level. Magnitude of pain was rated on a 0-10 ratio scale during walking until pain was no longer present Results: Lumbar acceleration sample mean was attenuated when subjects walked at maximal pain compared to pretest values (p=0.0089) and returned to pretest level when pain had disappearec (p=0 90). Regardless of the initial increase and subsequent decrease of pain after injection, there was a linear relation between pain and acceleration in 15 of the 20 subjects (0 89 ^R2 >_0 36, p < 0.002), suggesting a continuous dynamic adjustment of motor behaviour dependent on the magnitude of pain

Conclusion Since small adjustments of body accelerations in relation to pain are believed to be unconscious processes, the changes in accelerometry data seem to represent objective measures of magnitude ofexpenmentally induced low back pain, characteristic for each individual.

Acknowledgments: Supported by the Nordic Academy for Advanced Study (NorFA), the Foundation for Education and Researcl in Physiotherapy, Norway, and the Swedish Medical Research Council, Pro) 5206

DIFFERENCES IN QUALITY OF LIFE IMPAIRMENT IN CHRONIC BACK PAIN AND HEADACHE PATIENTS.

H.C. Muller-Busch'. H U. Gerbershagen2, G Lmdena2, 'Dep of Anesthesioloy and Pain Therapy, GK Havelhohe, Univ Witten/Herdecke, D-14089 Berlin, RK-Pam-Center Mainz, 'Mundipharma GmbH, Limburg, F R G

Aim of Investigation To investigate and compare quality of life 11 relation to pain diagnoses and stages ofchronicity for differences in impairment in patients with chronic low back pain and headach

Methods' 3294 patients in 13 pain centers were examined by the updated version of the DGSS questionnaire It comprised 62 ques tions to different aspects of pain and series ofQoL instruments 111 SF-36, NHP, PDI and FLZ Stages ofchronicity were calculated according to the MPSS of Gerbershagen The documented data ol 924 patients with chronic back pain and of 853 patients with head ache were compared The dimensions of the QoL instruments wei related to the stages ofchronicity and to other diagnoses

Results Quality of life is characteristically impaired in chronic pain patients Patients with chronic back pain show stronger impairment than those with headache Differences are most evident physical function and role function and can be related to the chro-nicity stage

Conclusions Qol instruments are useful to show specific impairment in different dimensions of quality of life in chronic pain patients Follow-up studies are needed to demonstrate the influence of different treatment strategies

Acknowledgments Supported by Mundipharma and Glaxo Well-come GmbH

CROSS-VALIDATION OF A DISABILITY SCALE FOR CHRONIC TEMPOROMANDIBULAR DISORDER PAIN

Richard Ohrbach. Samuel F Dworkin, Carl Granger*, Oral Diagnostic Sciences, and Rehabilitation Medicine, Univ at Buffalo, Buffalo 14214 NY, USA, and Oral Medicine, Univ of Washington, Seattle 98195.WA.USA

Aim of Investigation. To cross-validate a disability instrument using an independent sample, and to test for construct validation Reliable and valid measurement of functional impairment associated with chronic pain such as temporomandibular disorders remains a challenge The 17-item MFIQ (Stegenga, 1993) developed for TMD pain appears to lack stable factor structure and may not provide optimal scaling We have created an 8-item scale (Man-dibular and Orofacial Disability Index, MODI) using Rasch analysis based on item response theory Items were derived from the Research Diagnostic Criteria for TMD (RDC)

Methods' Patients (n=159) with chronic pain (>6 mos) who entered into two treatment studies had complete MODI data at baseline They were also assessed at baseline for other variables using the criteria of the RDC Pearson correlations were used for discriminant and convergent validity

Results The MODI itself had internal reliability of 0 8 Consistent with prior analyses, the MODI had low correlations (r< 3) with psychological status variables (depression, anxiety), and moderate relationships (r=A - .6) with pain intensity and pain interference. New findings include moderate relationships with somatization, extent of opening, and palpation pain, and a moderate relationship (r=.7) with jaw symptoms and with total MFIQ.

Conclusions: These results provide further support for a bnef instrument that can validly measure perceived impairment or disability in jaw functioning associated with chronic pain; further support is also provided for the independence of Axis II from Axis 1 variables in the assessment of chronic pain.

Acknowledgments: Supported in part by NIDR grant DE08773, USA, & Uniform Data Systems, Buffalo.

LITHUANIAN BRIEF PAIN INVENTORY VERSION, PILOT STUDY RESULTS

R. Polianskis M.D.. Vilnius Univ Hospital "Santariskiu Klinikos"

Poorly controlled cancer pain is a significant public health problem in Lithuania. There are multiple barriers that lead to undertreatment of cancer pain. One of most important is inadequate pain assessment and as consequence - inadequate estimation of the extent of this problem. The Wisconsin WHO Collaborating Centre for Symptom Evaluation in Cancer Care has developed the Brief Pain Inventory, which measures sensory and reactive dimensions of cancer pain. It was internationally validated and is widely accepted for cancer pain evaluation in many culturally and linguistically differing countries throughout the world. The Vilnius Pain Clinic developed the study, directed to approve and validate the Brief Pain Inventory for Lithuanian patients. This paper describes results of the pilot study of 60 persons. All were outpatients, had cancer of various localisations and were directed to Pain Clinic mostly from National Cancer Centre. The Brief Pain Inventory was bi-directionally translated until English and Lithuanian versions were semantically identical. Average time of completion of questionnaire was 19 mm. and required some assistance. Maxima] pain intensity one day before visit was 7.1 points, minimal - 2.4 points, medial - 5.0 points, pain intensity during visit -4.7 points. Before visit only 16% were treated by oral morphine preparations, the overall maximal effectiveness of drugs (magnitude of pain relief) was 63%. Dimension most affected with pain was "normal work" - 9.0 points, least affected -"relations with other people" - 5.7 points. Other results, distributed by interference level were: "enjoyment of life" - 8.1 points, "mood" - 7.1 points, "general activity" - 7.0 points, "walking ability" - 6.4 points, "sleep" - 6.0 points.

Conclusions: cancer patients were directed to Pain Clinic when medial pain intensity was 5.0 points and was noticeably affecting social and psychological aspects of life. Pain was affecting all BPI dimensions, most of all "normal work", least - "relations with other people". Before visit only minority of cancer patients (16%) were treated by oral morphine. Overall maximal effectiveness of drugs was insufficient (pain relief only 63%).

NURSES ASSESSMENT AND DOCUMENTATION PRACTICES OF PAIN IN CHILDREN

Sanna Salantera* (SPON: P. Muittari), Dept of Nursing Science, 20014 Univ ofTurku, Finland

Aim of Investigation: This study was set out to explore how assessment and documentation of children's pain is managed by nurses in Univ hospitals in Finland.

Method: A survey was conducted to 303 nurses working in children's wards of Univ affiliated hospitals and at the same time a retrospective chart review of 50 consecutive cases of operation of acute appendicitis was carried out.

Results: Only 34% of nurses indicated that pain measurement instruments were in use in their units. "Happy-Sad-Face" -type instrument was the most common. Over 92% of the nurses told they document pain medication to charts, only 50% told to document some comment about pain and 35% would document the intensity. The assessment and documentation practices varied significantly according to nurses' age and place of work. According to the charts, children received sufficient pain medication during the first 24 hours after the operation via comfortable routes (per os or intra-venously) but after that taking care of pain was less consistent.

Conclusions: Nurses assess pain mainly by observing the child's behavior and changes in physiology. Pain measurement instruments are rarely in use and nurses are not aware of them. Child's own opinion is not documented. The documentation of pain care is unsystematic and does not support the continuity of care. There is a need for development of assessment and documentation practices in the studied hospitals.

DOES PAIN MANAGEMENT IMPROVE QUALITY OF LIFE FOR CHRONIC PAIN PATIENTS?

Suzanne Skevington. Marlene Carse-Jones*, Amanda C de C Williams, Dept. of Psychology, Univ. of Bath, Bath BA2 7AY & INPUT Pain Management Unit, St Thomas' Hospital, London, UK.

Aim of Investigation: To examine whether quality of life changes significantly during the treatment of chronic pain patients using a pain management program and if so, on which important dimensions.

Methods: 89 patients (mean age 44 years, 66% female) selected for inpatient and outpatient programs completed a new, comprehensive, quality of life profile - the WHOQOL-100 - as part of an assessment battery one week before the course and immediately following program completion.

Results: Significant improvements to quality of life were shown as a result of the program. Pain management improved patient's perceptions of their pain and discomfort, activities of daily living, cognitive abilities, self-esteem, participation in leisure and recreation, dependence on medication or treatments, positive and negative feelings, physical safety and security, the availability and quality of care, sexual activities, sleep and rest and working capacity. However quality of life did not improve on 11 of the 24 dimensions; most notably mobility and energy and fatigue.

Conclusions: The improvement of quality of life is implicit to assumptions about the outcomes of pain management programs, yet is uncommonly assessed. These results show that quality of life as measured by the WHOQOL-100 is improved across a wide range of dimensions. Lack of change on salient dimensions indicates ways in which this intervention might be improved. The results simultaneously provide evidence that the WHOQOL-100 is both valid and sensitive to clinical change and hence is an appropriate tool for monitoring treatment in chronic pain patients.

MIDAS: DEVELOPMENT AND TESTING OF THE MIGRAINE DISABILITY ASSESSMENT QUESTIONNAIRE.

Stewart WF. Lipton RB, Liberman J', Sawyer J, 'The Johns Hopkins School of Public Health, Baltimore, USA; innovative Medical Research, Maryland, USA; albert Einstein College of Medicine and the Montefiore Headache Unit, New York, USA; ''Zeneca Pharmaceutical s, Macclesfield, UK.

Aim of Investigation: To develop and test an instrument to assess headache-related disability. To be useful in clinical practice, such an instrument needs to be reliable, valid, simple to apply and score and correlate to physicians' clinical judgement.

Methods: The MIDAS Questionnaire was developed to assess headache-related disability. Headache sufferers answer five questions scoring the number of days of lost and limited activity due to migraine in three domains, over a 3-month period. The test-retest reliability and validity of the questionnaire were assessed in sepa-rate population-based studies ofmigraineurs. In addition, the external validity, clinical utility and ease of use of the questionnaire were assessed in a study with a group of 49 physicians who assessed 12 different migraine case histories.

Results: The MIDAS Questionnaire was shown to be highly reliable. The Spearman correlation for the total MIDAS score was 0.78. The MIDAS score was found to be highly valid when compared to a rigorous diary-based measure of disability; the overall correlation between the two measures was 0.63. In the clinical utility study, the MIDAS score correlated with physicians' assessments of medical need (r=0.69), and was directly related to the pain and disability experienced by each patient.

Conclusions: From studies completed to date, the MIDAS Questionnaire has been shown to be highly reliable, valid, easy to use and score, and correlates to physicians' clinical judgement, features that support its suitability for use in clinical practice. Use of the MIDAS Questionnaire may improve physician-patient communication about headache-related disability and favourably influence healthcare delivery for migraine patients.

Acknowledgments: Supported by Zeneca Pharmaceuticals

NEUROPATHIC PAIN - SELF-PERCEIVED PROBLEMS AND CONSEQUENCES, A QUALITATIVE STUDY.

Annette Sverker*', Gunnel Hensing*', Goran Leijon . 'Dept of Social Medicine, Faculty of Health Science, Pain and Rehabilitation Centre, Univ Hospital, S581 85 Sweden.

Aim of Investigation: Less than 50% ofneuropathic pain patients are considered to obtain acceptable pain relief by somatic methods. In these treatment resistant patients it is essential to provide alternative treatment programs, identify patients in need and when necessary carry through qualified rehabilitation programs. The aim of this study was to explore the quality of patient problems in relation to the pain.

Methods: The "Critical Incident Technique" was used in the study. 28 neuropathic pain patients participated in a 4-6 week multimodal pain treatments program. 2 patients declined participation. Patients described critical incidents, or problems, in their everyday life and in relation to their pain. Semi-structured interviews on daily life, work situation, relations to relatives, close friends and contacts with health care were performed.

Results: In the ongoing analysis, the experience ofneuropathic pain and the everyday life problems it may cause are investigated. Which consequences do these problems cause and how are they handled? How is the contact with the medical service experienced. Data from the 28 patients and additional 12 patients presently under interview will be presented.

Conclusions: The "Critical Incidence technique" as far as we know, has not been used in patient studies, we have found this technique useful. It captures, in a structured way, the character of perceived problems and experiences associated with the pain. The method is also sensitive to minor problems important to the individual person. Data from the study will increase the possibility to better understand the patients and can thus be used in the rehabilitation process.

EVALUATION OF MULTIDIMENSIONAL PSYCHOMETRIC MEASURES USED IN AN OUTPATIENT PAIN CLINIC

Hua H. Yong, Michael K. Nicholas' Univ of Melbourne, VIC 3052, "Univ of Sydney, NSW 2006, Australia.

Aim of Investigation: To examine the utility, reliability and validity of a set of common psychometric measures used to assess chronic pain patients referred to a multidisciplinary pain clinic.

Methods: Following referral, but before seeing a physician, patients completed an initial larger than normal battery of psychological tests covering such variables as mood, pain intensity, disability & pain related cognitions. A subset of these measures was repeated a week later for retest reliability.

Results: Based on a sample of 101 patients, measures deemed psy-chometrically sound and clinically useful included the Beck Depression Inventory Cognitive-Affective subscale (BDI-CA) as measure of mood status, the Multidimensional Pain Inventory Interference subscale (MPI-INT) for functional disability, the Pain Self-Efficacy Questionnaire (PSEQ) and Coping Strategies Questionnaire Catastrophising subscale (CSQ-CAT) for pain related cognitions.

Conclusions: Adequate assessment and treatment of the multiple aspects of pain and distress experienced by patients suffering chronic pain relies on accurate psychometric measurement. An evaluation of common measures employed for such purposes in a multidisciplinary pain clinic revealed that not all measures stood up to empirical scrutiny and for some, a subscale proved to be more useful than the full scale. The BDI-CA, for example, was a much more reliable and valid measure of mood status in the medically-ill population, consistent with other findings. The perceived self-efficacy measure appears to be a clinically useful tool as it was the only cognitive measure that related significantly and negatively with mood, disability and maladaptive coping strategy measures.

9th WORLD CONGRESS ON PAIN, 1999, Vienna, Austria, p. 226 - 230

   

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