Pain questionnaire development focusing on cross-cultural equivalence to the original questionnaire: the Japanese version of the Short-Form McGill Pain Questionnaire

Uniportal video-assisted thoracic surgery versus open thoracotomy for chronic pain after surgery: a prospective cohort study

PURPOSE

The potential of uniportal video-assisted thoracic surgery (U-VATS) to reduce chronic pain after thoracic surgery (CPTS) compared to open thoracotomy (OT) remains unexplored. This prospective study aims to assess the incidence of CPTS following U-VATS or OT and identify associated risk factors.

METHODS

Patients undergoing thoracic surgery were recruited from March 2021 to March 2022, categorized by surgical approach (U-VATS vs. OT). Standard clinical protocols for surgery, anesthesia, and analgesia were followed. Pain symptoms were assessed using the Short-form McGill Pain Questionnaire, with follow-ups up to 6 months. Perioperative factors influencing CPTS at 3 months were analyzed through univariate and multivariate methods.

RESULTS

A total of 694 patients were analyzed. Acute pain after thoracic surgery (APTS) was significantly less severe in the U-VATS group (p < 0.001). U-VATS patients exhibited a lower incidence of CPTS at 3 months (63.4% vs. 80.1%, p < 0.001), with reduced severity among those experiencing CPTS (p = 0.007) and a decreased occurrence of neuropathic pain (p = 0.014). Multivariate analysis identified OT incision, moderate to severe APTS (excluding moderate static pain at 24 h postoperative), nocturnal surgery, and lung surgery as risk factors for CPTS.

CONCLUSION

This study underscores the potential of U-VATS to reduce both the incidence and severity of CPTS at 3 months compared to OT. Furthermore, it highlights risk factors for CPTS, including OT incision, inadequately managed APTS, lung surgery, and nocturnal surgery. These findings emphasize the importance of considering surgical approach and perioperative pain management strategies to mitigate the burden of CPTS.

Immersive VR for upper-extremity rehabilitation in patients with neurological disorders: a scoping review

BACKGROUND

Neurological disorders, such as stroke and chronic pain syndromes, profoundly impact independence and quality of life, especially when affecting upper extremity (UE) function. While conventional physical therapy has shown effectiveness in providing some neural recovery in affected individuals, there remains a need for improved interventions. Virtual reality (VR) has emerged as a promising technology-based approach for neurorehabilitation to make the patient's experience more enjoyable. Among VR-based rehabilitation paradigms, those based on fully immersive systems with headsets have gained significant attention due to their potential to enhance patient's engagement.

METHODS

This scoping review aims to investigate the current state of research on the use of immersive VR for UE rehabilitation in individuals with neurological diseases, highlighting benefits and limitations. We identified thirteen relevant studies through comprehensive searches in Scopus, PubMed, and IEEE Xplore databases. Eligible studies incorporated immersive VR for UE rehabilitation in patients with neurological disorders and evaluated participants' neurological and motor functions before and after the intervention using clinical assessments.

RESULTS

Most of the included studies reported improvements in the participants rehabilitation outcomes, suggesting that immersive VR represents a valuable tool for UE rehabilitation in individuals with neurological disorders. In addition, immersive VR-based interventions hold the potential for personalized and intensive training within a telerehabilitation framework. However, further studies with better design are needed for true comparison with traditional therapy. Also, the potential side effects associated with VR head-mounted displays, such as dizziness and nausea, warrant careful consideration in the development and implementation of VR-based rehabilitation programs.

CONCLUSION

This review provides valuable insights into the application of immersive VR in UE rehabilitation, offering the foundation for future research and clinical practice. By leveraging immersive VR's potential, researchers and rehabilitation specialists can design more tailored and patient-centric rehabilitation strategies, ultimately improving the functional outcome and enhancing the quality of life of individuals with neurological diseases.

Cross-Cultural Validation of the Arabic Short-Form McGill Pain Questionnaire (SF-MPQ): Libyan Version in Patients With Musculoskeletal Pain

Background

The Short-form McGill Pain Questionnaire (SF-MPQ) is a widely used tool for assessing musculoskeletal pain, both in research and clinical practice. However, a culturally appropriate Arabic version for the Libyan context has not been available. This study aims to translate the SF-MPQ, and to examine its reliability and validity for assessing musculoskeletal pain in Libya.

Methods

The SF-MPQ was cross-culturally adapted into Arabic using a forward-backward method. A total of 151 patients (Mean age ± SD = 40.66 ± 14) with musculoskeletal pain completed the SF-MPQ and other measures. Of these, 148 patients completed the second round of questionnaire completion two days after the first visit. The intraclass correlation coefficient (ICC) was used to examine relative test-retest reliability and Bland-Altman plots was performed to examine absolute agreement between the two assessments. Spearman's correlation was applied to assess construct validity.

Results

The Arabic translation of the SF-MPQ was linguistically equivalent, without significant discrepancies. All but two of the Arabic descriptors were used by more than 33% of the participants, indicating good item measurement equivalency. The results showed a satisfactory Cronbach's α (0.74 for the total score), which indicates good internal consistency. The ICC for the total score revealed a high correlation for the test-retest (0.91), suggesting excellent relative reliability. Bland-Altman analyses showed no significant systematic bias between the repeated measurements. There were positive statistically significant correlations among the SF-MPQ, the Visual Analog Scale, and the Fatigue Severity Scale (P < 0.001), demonstrating good construct validity.

Conclusion

These results suggest that the Arabic SF-MPQ is reliable, valid, and cross-culturally equivalent to the original SF-MPQ for evaluating musculoskeletal pain among Arabic-speaking patients in Libya. Clinicians and researchers may therefore consider using this scale, as it is easy to use and understand by different age groups. Further research is needed to confirm our findings and to test the developed Arabic version of the SF-MPQ on different patient populations.

Relationship between Nontraumatic Shoulder Disorders and Neuropathic Pain: Retrospective Observational Analyses of Clinical Features and Background Factors

Background

Accurate identification of neuropathic pain is necessary for appropriate treatment; however, the relationship between nontraumatic shoulder disorders and neuropathic pain remains unknown. Therefore, this retrospective observational study aimed to investigate the relationship, features, background factors, and prevalence of neuropathic pain among patients with nontraumatic shoulder disorders.

Methods

We evaluated 198 patients who visited our outpatient clinic, which specializes in shoulder disorders, from April 2015 to March 2016. The patients' age, sex, affected side, diagnosis, and pain duration were recorded, and the results of physical examination, including passive range of motion, impingement sign, and muscular strength assessments, were analyzed. The presence of neuropathic pain was assessed using the painDETECT questionnaire. Participants were divided into two groups according to the presence of neuropathic pain. Pain intensity was assessed using a visual analog scale, and the patient's mental status was assessed using the short-form McGill Pain Questionnaire and Hospital Anxiety and Depression Scale. The scores were compared between the groups.

Results

Neuropathic pain was observed in 7.6% of patients. The visual analog scale score for pain, short-form McGill Pain Questionnaire score, and Hospital Anxiety and Depression Scale score were significantly associated with the presence of neuropathic pain in the univariate analysis. Patient background factors and physical function were not associated with the presence of neuropathic pain. The prevalence of neuropathic pain in patients with frozen shoulder was 33.3%, which was significantly higher than that in patients with other shoulder disorders.

Conclusion

The occurrence of neuropathic pain may aggravate pain in patients with nontraumatic shoulder disorders. Neuropathic pain was not a rare condition in patients with nontraumatic shoulder disorders, particularly in those with frozen shoulder. The coexistence of neuropathic pain cannot be determined from background factors or physical function. Accurate diagnosis of neuropathic pain is essential in patients with nontraumatic shoulder disorders.

Assessment of multiple domains of pain following BNT162b2 mRNA COVID-19 vaccination

Pain at the injection site is the most frequent reaction among COVID-19 vaccine recipients, but its characteristics were not fully described yet. The purpose of this study was to investigate multiple domains of pain following BNT162b2 mRNA vaccination. We included 107 subjects undergoing primary shot of the vaccination twice into deltoid muscle with a 3-week interval. They completed 6 sessions of pain assessments, one before the first and second dose (1-0, 2-0), and 1st/7th day after the first and second dose (1-1/1-7, 2-1/2-7). Pain visual analog scale (VAS), pain distribution, and pressure pain threshold (PPT) on deltoid muscle were evaluated in each session. The mean VAS (at rest/shoulder motion) was 6.0/27.6 mm at 1-1, and 12.8/34.0 mm at 2-1. Approximately, 90% of recipients showed localized pain within the upper arm. Percentage change of PPTs at 1-1 and 2-1 was bilaterally (ipsilateral/contralateral) decreased to 87.4/89.4% and 80.6/91.0%, which was recovered to the baseline level at 1-7 and 2-7. Temporary, mild-to-moderate intensity, localized distribution, concomitant with bilateral mechanical hyperalgesia on the deltoid muscle, were typical pain characteristics following this vaccination. These findings provide a rationale that will be informative for future recipients. J. Med. Invest. 70 : 355-360, August, 2023.

The effectiveness of Pictorial Representation of Illness and Self Measure (PRISM) for the assessment of the suffering and quality of interpersonal relationships of patients with chronic pain

Background

Pictorial Representation of Illness and Self Measure (PRISM) is a tool that can be used to visualize and evaluate the burden of suffering caused by an illness. The aim of this study was to identify which aspects of the burden of chronic pain patients are associated with Self/illness separation (SIS), an indicator of the magnitude of suffering. We also examined the effectiveness of PRISM for evaluating changes in the relationships between patients and their medical care and significant others due to our inpatient treatment.

Methods

Seventy-two patients with chronic pain who were outpatients or admitted to the Department of Psychosomatic Medicine completed PRISM, depression and anxiety scales, and three types of pain-related self-assessment questionnaires (Brief Pain Inventory, Short-form McGill Pain Questionnaire, and Pain Catastrophizing Scale). Outpatients were queried at the time of outpatient visits and inpatients at the time of admission. In addition to PRISM disks related to illness, we asked each patient to place disks related to things important to them and their medical care. Of the inpatients, 31 did PRISM at the time of discharge. Among the reported important factors, which significant other was placed at the time of admission and discharge was evaluated. The distances of self/medical care separation (SMcS) and self/significant others separation (SSoS) were measured.

Results

Of the 21 scales measured, 10 showed a significant correlation with SIS. Factor analysis of these 10 scales extracted three factors, Life interferences, Negative affects, and Pain intensity. The SMcS and SSoS distances were shorter at discharge than at admission.

Conclusions

PRISM for patients with chronic pain is an integrated evaluation method that reflects three aspects of pain. By adding medical care and significant others to the usual method of placing only illness on the sheet it became possible to assess changes in the quality of interpersonal relationships.

How do neuropathic pain-like symptoms affect health-related quality of life among patients with rheumatoid arthritis?: A comparison of multiple pain-related parameters

Objectives: Rheumatoid arthritis (RA) pain is thought to be nociceptive. However, recent studies indicate that RA also involves the neuropathic pain (NP) mechanism. We examined pain features and the effect of NP-like symptoms on health-related quality of life (HRQOL) among patients with RA.Methods: The painDETECT questionnaire (PDQ) was used to evaluate NP-like symptoms among 145 outpatients with RA. Disease activity, pain quality, and HRQOL were evaluated. We compared clinical parameters between patients with and without NP-like symptoms and analyzed pain features and the effect of NP-like symptoms on HRQOL, along with multiple other pain-related parameters.Results: Thirty (20.7%) patients had NP-like symptoms (PDQ ≥13). Patient global assessment and evaluator global assessment diverged for patients with RA who had NP-like symptoms. Of the examined pain-related parameters, PDQ score (p = .038, ß = -.173) was associated with the Short-Form 36-Item Health Survey role-social component summary score, but not with the physical or mental component summary scores.Conclusion: NP-like symptoms affected HRQOL among patients with RA. There was discordance between global assessments by patients and by evaluators for patients with RA who had NP-like symptoms. Therefore, NP-like symptoms should be given somewhat more attention when treating patients with RA.

Analysis of the association between the severity of ocular and systemic pain

PURPOSE

To evaluate the relationship between the severity of ocular and systemic pain.

METHODS

A cross-sectional study was conducted in patients with ocular pain symptoms who were observed in Keio University Hospital between April 2017 and September 2018. Evaluations consisted of the Dry Eye-Related Quality of Life Score (DEQS), Short-Form McGill Pain Questionnaire (SF-MPQ), visual analog scale (VAS), and ophthalmologic examination, including tear breakup time measurement and Schirmer I test. The revised Asia Dry Eye Society Dry Eye Disease (DED) diagnostic criteria were used.

RESULTS

The present study involved 41 participants (31 women; mean age, 57.6 ± 17.5 years). Thirteen participants had aqueous-deficient DED, 18 participants had short tear break-up time DED, and 10 participants had no DED. Multivariate regression analysis revealed that the DEQS was significantly associated with both the SF-MPQ total (Coefficient score β = 0.92, p < 0.01) and the VAS (β = 0.25, p = 0.01). In addition, correlation analysis revealed that the DEQS had a significant positive linear correlation with both the SF-MPQ total (Spearman correlation score rs = 0.70, p < 0.01) and the VAS (rs = 0.66, p < 0.01).

CONCLUSIONS

The findings of the present study suggested that the ocular pain score was significantly associated with systemic pain score. Participants with higher systemic pain scores have an increased risk of having ocular pain.

Classification of acute pain trajectory after breast cancer surgery identifies patients at risk for persistent pain: a prospective observational study

Purpose

Predictive value and accuracy of the acute pain trajectory were compared with those of pain intensity at 1 day after the surgery for pain prevalence at 6 months after the surgery.

Materials and methods

Female patients scheduled for breast cancer surgery were eligible for this study. Patients were questioned about pain intensity daily during the 7 days after surgery. Presence of pain, its location, and intensity as well as the Japanese version of the quality of the recovery-40 (QOR-40) were determined in an interview prior to and at 6 months after the surgery. Acute pain trajectory was determined by a group-based trajectory modeling analysis that was based on the pain intensity at 1–7 days after surgery. Predictive value of the acute pain trajectory for the presence of pain at 6 months after the surgery was assessed by a logistic regression model. The predictive value was compared with pain intensity at 1 day after the surgery.

Results

A total of 123 participants completed the 6-month follow-up. The three-cluster model (mild, moderate, and severe pain) was considered to be the most statistically appropriate model for the acute pain trajectory. After 6 months, 51.2% and 8.9% of participants reported pain and severe pain, respectively. Presence of pain at 6 months after the surgery was associated with poor recovery. The severe pain cluster was significantly associated with the presence of pain at 6 months after the surgery (adjusted odds ratio, 9.40; P<0.001 vs mild pain cluster).

Conclusion

Classification of patients according to the acute pain trajectory, when compared with the classification according to pain intensity at 1 day after the surgery, made it possible to predict with better precision those patients who will develop persistent postsurgical pain.

The Relationships Between Pain-Catastrophizing Subcomponents and Multiple Pain-Related Outcomes in Japanese Outpatients with Chronic Pain: A Cross-Sectional Study

OBJECTIVES

The present study sought to examine associations between the pain-catastrophizing subcomponents and multiple pain-related outcomes in Japanese individuals with chronic pain.

METHODS

A cross-sectional study design was employed with 213 chronic pain outpatients. The participants were recruited from 3 units at a university hospital and from a pain clinic at a municipal hospital. Study measures were used to assess pain catastrophizing, anxiety, depression, pain interference, and pain severity.

RESULTS

Path analysis with multiple pain-related outcomes while controlling for age and gender revealed that the Helplessness subcomponent was associated with anxiety, depression, pain interference, and pain severity. The Magnification subcomponent was related to anxiety and depression, and the Rumination subcomponent accounted for the variance of pain interference.

DISCUSSION

The present results suggested the important role of helplessness across cultural backgrounds. It also provides guidance on the application of cognitive behavioral techniques for chronic pain management in Japan.

Fibromyalgia and microglial TNF-α: Translational research using human blood induced microglia-like cells

Fibromyalgia is a refractory disease characterized by chronic intractable pain and psychological suffering, the cause of which has not yet been elucidated due to its complex pathology. Activation of immune cells in the brain called microglia has attracted attention as a potential underlying pathological mechanism in chronic pain. Until recently, however, technological and ethical considerations have limited the ability to conduct research using human microglia. To overcome this limitation, we have recently developed a technique to create human-induced microglia-like (iMG) cells from human peripheral blood monocytes. In this study, we created the iMG cells from 14 patients with fibromyalgia and 10 healthy individuals, and compared the activation of iMG cells between two groups at the cellular level. The expression of tumor necrosis factor (TNF)-α at mRNA and protein levels significantly increased in ATP-stimulated iMG cells from patients with fibromyalgia compared to cells from healthy individuals. Interestingly, there was a moderate correlation between ATP-induced upregulation of TNF-α expression and clinical parameters of subjective pain and other mental manifestations of fibromyalgia. These findings suggest that microglia in patients with fibromyalgia are hypersensitive to ATP. TNF-α from microglia may be a key factor underlying the complex pathology of fibromyalgia.

Somatosensory Feedback to the Cheek During Virtual Visual Feedback Therapy Enhances Pain Alleviation for Phantom Arms

Background. Patients who suffer from phantom limb pain can perceive tactile stimuli applied to the cheek on their affected side as if it were coming from their phantom limb, a phenomenon called “referred sensation.” Objectives. To investigate the analgesic effect produced by tactile feedback provided to the cheek during neurorehabilitation using visual feedback. Methods. Nine participants with phantom upper limb pain performed virtual reality neurorehabilitation exercises in which they repeatedly touched a target object with a virtual representation of their affected limb. We applied tactile feedback to their cheek when their virtual affected limb touched a virtual object (Cheek Condition). We also included 2 control conditions where tactile feedback was either applied to their intact hand (Intact Hand Condition) or not applied at all (No Stimulus Condition). We evaluated pain intensity on an 11-point rating scale and pain quality using the short-form McGill Pain Questionnaire before and after each rehabilitation condition. Results. The median pain-reduction rate in the Cheek Condition (33.3 ± 24.4%) was significantly higher than in the Intact Hand Condition (16.7 ± 12.3%) and the No Stimulus Condition (12.5 ± 13.5%; P < .05). Even patients who did not feel referred sensations reported significant pain reduction after the Cheek Condition. Conclusions. The analgesic effect of neurorehabilitative visual feedback during phantom limb movement is significantly improved by applying somatosensory feedback to the cheek on the affected side. Further studies are needed to extend these findings to objective pain measures and to elucidate the neural mechanisms that underlie the analgesic effect.

Pain threshold reflects psychological traits in patients with chronic pain: a cross-sectional study

Background

Chronic pain enhances sensory sensitivity and induces the biased development of psychological traits such as depression and pain catastrophizing, leading to the formation of heterogeneous conditions. Fluctuations in the sensory-related thresholds of non-injured sites (with normal peripheral tissue) in patients with chronic pain are thought to be related to central sensitization. The objectives of this study were to analyze the association between pain tolerance thresholds (PTTs) in non-injured sites and the psychological traits of patients with chronic pain and to evaluate the usefulness of PTT measures in assessments of pathological conditions related to chronic pain.

Methods

This study included 57 patients with chronic pain. The PTTs were measured in non-injured sites with quantitative sensory testing (QST) with electrical stimulation and then classified with cluster analysis. The Short-Form McGill Pain Questionnaire was used to subjectively assess pain in the injured sites. The Minnesota Multiphasic Personality Inventory (MMPI) was used to assess the patients’ psychological traits.

Results

Based on the cluster analysis of PTTs, the patients were classified into a High-Sensitivity group and an Others group consisting of the remaining patients. The results of the MMPI profiles showed that the High-Sensitivity group included significantly more patients with the Neurotic Triad pattern and no patients with the Conversion V pattern. The scores of the hypochondriasis and hysteria scales were significantly lower in the High-Sensitivity group than in the Others group.

Conclusions

This study indicated that patients with chronic pain can be classified according to PTTs in non-injured sites and suggests that patients with High-Sensitivity have characteristic psychological traits. Assessment of PTTs in non-injured sites would be useful for evaluating the psychological condition of patients with chronic pain.

Development and validation of Arabic version of the Short-Form McGill Pain Questionnaire

Introduction:

The Short-Form McGill Pain Questionnaire (SF-MPQ) is a widely used tool for qualitative and quantitative pain assessment. Our aim was to translate, culturally adapt, and validate the SF-MPQ in Arabic.

Methods:

A systematic translation process was used to translate the original English SF-MPQ into Arabic. After the pilot study, we validated our version in patients with chronic pain at two tertiary care centers. We tested the reliability of our version using internal consistency and test-retest reliability. We examined the validity by assessing construct validity, concurrent validity (by investigating the associations between SF-MPQ, Brief Pain Inventory [BPI], and Self-completed Leeds Assessment of Neuropathic Symptoms and Signs [S-LANSS]), and face validity. The questionnaire was administered twice to examine responsiveness.

Results:

A total of 142 participants (68 men and 74 women) were included in this study. Cronbach's α was 0.85 (95% confidence interval: 0.81 – 0.89), and interclass correlation coefficients were 0.71 (0.62–0.79) for the whole scale. SF-MPQ was moderately associated with patients’ present pain (r = 0.55, P < 0.001) and the numerical rating scale (r = 0.42, P < 0.001). The total pain score was moderately correlated with pain severity and interference assessed with the BPI (rs = 0.39 to 0.49, all Ps < 0.001). SF-MPQ total pain score was weakly associated with neuropathic pain assessed with S-LANSS (r = 0.26, P < 0.01). Most patients found the SF-MPQ questions to be clear and easy to understand and thought the questionnaire items covered all their problem areas regarding their pain.

Conclusion:

Our translated version of SF-MPQ was reliable and valid for use among Arabic-speaking patients. The SF-MPQ is a good qualitative and quantitative assessment tool for pain but is only weakly associated with neuropathic pain.

Aetiological relationships between factors associated with postnatal traumatic symptoms among Japanese primiparas and multiparas: A longitudinal study

OBJECTIVE

this study aims to identify the aetiological relationships of psychosocial factors in postnatal traumatic symptoms among Japanese primiparas and multiparas.

DESIGN

a longitudinal, observational survey.

SETTING

participants were recruited at three institutions in Tokyo, Japan between April 2013 and May 2014. Questionnaires were distributed to 464 Japanese women in late pregnancy (> 32 gestational weeks, Time 1), on the third day (Time 2) and one month (Time 3) postpartum.

MEASUREMENTS

The Japanese Wijma Delivery Expectancy/Experience Questionnaire (JW-DEQ) version A was used to measure antenatal fear of childbirth and social support, while the Impact of Event Scale Revised (IES-R) measured traumatic stress symptoms due to childbirth.

FINDINGS

of the 464 recruited, 427 (92%) completed questionnaires at Time 1, 358 (77%) completed at Time 2, and 248 (53%) completed at Time 3. Total 238 (51%) were analysed. A higher educational level has been identified in analysed group (p=0.021) Structural equation modelling was conducted separately for primiparas and multiparas and exhibited a good fit. In both groups antenatal fear of childbirth predicted Time 2 postnatal traumatic symptoms (β=0.33-0.54, p=0.002-0.007). Antenatal fear of childbirth was associated with a history of mental illness (β=0.23, p=0.026) and lower annual income (β =-0.24, p=0.018). Among multiparas, lower satisfaction with a previous delivery was related to antenatal fear of childbirth (β =-0.28, p < 0.001).

KEY CONCLUSIONS

antenatal fear of childbirth was a significant predictor of traumatic stress symptoms after childbirth among both primiparous and multiparous women. Fear of childbirth was predicted by a history of mental illness and lower annual income for primiparous women, whereas previous birth experiences were central to multiparous women.

IMPLICATION FOR PRACTICE

the association between antenatal fear of childbirth and postnatal traumatic symptoms indicates the necessity of antenatal care. It may be important to take account of the background of primiparous women, such as a history of mental illness and their attitude towards the upcoming birth. For multiparous women, focusing on and helping them to view their previous birth experiences in a more positive light are vital tasks for midwives.

Relationship between Neuropathic Pain and Obesity

Objectives. Overweight negatively affects musculoskeletal health; hence obesity is considered a risk factor for osteoarthritis and chronic low back pain. This was conducted to determine if obesity affects neuropathic pain, usually considered unrelated to the weight-load on the musculoskeletal system. Methods. Using a cut-off body mass index value of 25, 44 patients with neuropathic pain were grouped into a "high-BMI" group and a "normal-BMI" group. Results. The numeric rating scale of the high-BMI group was significantly higher than that of the normal-weight group (P < 0.05). The total NPSI scores were significantly higher (P < 0.01), and the paroxysmal pain and the negative symptoms were more serious in the high-BMI group than in the normal-BMI group. The high-BMI subjects also had significantly higher SF-MPQ scores (P < 0.05). However, both physical and mental health status on the SF-36 were comparable between the groups. Discussion. Neuropathic pain that did not arise from musculoskeletal damage was higher in the high-BMI patients. Paroxysmal pain was more severe, suggesting that neural damage might be aggravated by obesity-associated inflammation. These findings should have needed to be confirmed in future studies.

Effectiveness of group cognitive behavioral therapy for somatoform pain disorder patients in Japan: A preliminary non-case-control study

AIMS

Somatoform pain disorder is associated with psychosocial dysfunction, and psychotherapies, such as cognitive behavioral therapy (CBT), are thought to provide useful interventions to address such dysfunction as well as the pain itself. However, little is known about whether CBT for somatoform pain disorder is effective, including the long-term course of the illness, in non-Western populations. We therefore tailored such a program based on an existing CBT protocol and examined its effectiveness in Japan.

METHODS

Thirty-four Japanese participants (22 women; mean age = 52.5 years) enrolled in a weekly 12-session group treatment, with 32 completing both wait-list and treatment conditions. The primary outcome measure was pain intensity. Secondary outcome measures included pain characteristics, as measured by pain catastrophizing and psychometric evaluations, including depression, anxiety, and quality of life. The patients were followed up for 12 months after treatment.

RESULTS

We found that pain intensity, anxiety, depressive symptoms, and social functioning all significantly improved after treatment compared with the wait-list period, and the improvements in pain intensity, depressive symptoms, and social functioning were sustained at 12 months following the completion of CBT. There were strong positive correlations (P < 0.01) among pre- and post-treatment changes in the affective dimension of pain, depression, anxiety, and pain catastrophizing.

CONCLUSIONS

These results show that the present CBT program was effective for Japanese patients with somatoform pain disorder and that gains were maintained over the long term. More work is needed to further clarify the effects of CBT interventions on somatoform symptoms, particularly in Japan.

Linking the Bournemouth Questionnaire for low back pain to the International Classification of Functioning, Disability and Health

PURPOSE

Understanding the content of health-related quality of life (HRQOL) questionnaires can facilitate comparison and selection of the most appropriate tool in the assessment of patients with low back pain. The International Classification of Functioning, Disability and Health (ICF), as part of the WHO-FIC, can be used as a standardised method for mapping and comparing HRQOL questionnaire content. The purpose of this study was to link the Bournemouth Questionnaire (BQ) to the ICF in order to assess and compare the content of the BQ to the brief ICF core sets for low back pain.

METHODS

The BQ was linked to the ICF following the rules described by Cieza and Stuki. Following the linking process, the results were further linked to the brief ICF core sets for low back pain.

RESULTS

The BQ covered 21 ICF categories within the domains of body functions and activities and participation. Only five meaningful concepts could not be linked to the ICF. The brief core sets for low back pain contain 35 categories, identified as important concepts in back pain patients. The BQ covered 10 of the categories of the brief core sets.

CONCLUSION

HRQOL tools provide valuable information about the health status of patients. Content comparison based on ICF provides relevant information about the concepts covered and enables selection of the appropriate clinical tools. The BQ is easy to administer and is linked to a number of important concepts contained within the ICF and to concepts considered to be important in the assessment of patients with LBP.

IMPLICATIONS FOR REHABILITATION

Selecting appropriate health-related quality of life (HRQOL) tools can prove difficult, with such a variety of them available, and each with varying content. ICF provides a standardised framework for the content assessment of HRQOL tools. Understanding the content of HRQOL tools can facilitate better tool selection and assist in the accurate assessment of patients with low back pain.