Does smoking status affect multidisciplinary pain facility treatment outcome?

Objectives: Smoking may be a major problem in chronic low back pain (LBP) patients. The goal of this study was to determine whether smoking status affected multidisciplinary pain facility treatment outcome.

Design: As part of a grant study, chronic LBP patients identified themselves as either current smokers (N = 81) or current nonsmokers (N = 140), and were compared by chi-square for employment status at 1, 6, 12, and 24 months after multidisciplinary pain facility treatment.

What percentage of chronic nonmalignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors? A structured evidence-based review.

Design: This is a structured evidence-based review of all available studies on the development of abuse/addiction and aberrant drug-related behaviors (ADRBs) in chronic pain patients (CPPs) with nonmalignant pain on exposure to chronic opioid analgesic therapy (COAT).

Objectives: To determine what percentage of CPPs develop abuse/addiction and/or ADRBs on COAT exposure.

Method: Computer and manual literature searches yielded 79 references that addressed this area of study.

Can the neuropathic pain scale discriminate between non-neuropathic and neuropathic pain?

Objectives: 1) To determine if the neuropathic pain scale (NPS) can be used to classify chronic pain patients (CPPs) as having primarily neuropathic vs non-neuropathic pain, and furthermore; 2) to determine what, if any, cut-off score can be used to reliably make this determination.

Design: A total of 305 CPPs consecutive admissions to The Rosomoff Pain Center were administered the NPS and were assigned a diagnosis according to the physical examination and all available test results. CPPs with a diagnosis of chronic radiculopathy and spondylolysis/degenerative arthritis were segregated into two groups for the purposes of having a group representative of neuropathic pain (chronic radiculopathy) and non-neuropathic pain (spondylolysis/degenerative arthritis).

Variables associated with current smoking status in chronic pain patients.

Objectives: Smokers may report more pain and may be at greater risk for psychiatric comorbidity. Smoking may be a major problem in chronic pain patients (CPPs). The goal of this study was to determine if pain and psychiatric comorbidity are associated with smoking status in CPPs.

Medicolegal rounds: medicolegal issues and alleged breaches of standards of medical care in a patient motor vehicle accident allegedly related to chronic opioid analgesic therapy.

The objective of this medicolegal case report is to present the details of the case of a chronic pain patient (CPP) who was placed on chronic opioid analgesic therapy (COAT) and was involved in a motor vehicle accident, alleged in litigation to be related to COAT. COAT standards are in a process of evolution, and this process is influenced by recent literature developments. We aim to present both the plaintiffs and defendant's expert witnesses' opinions on whether the defendant physician fell below the "standard" in allowing the CPP to drive.

Chronic pain and the measurement of personality: do states influence traits?

Study Design: This is a structured evidence-based review of all available studies on the effect of pain, (a state phenomenon) on the measurement of personality characteristics (a trait phenomenon).

Objectives: To determine whether pain treatment changes trait scores.

Summary Of Background Data: Recent evidence from the psychiatric literature indicates that the measurement of personality characteristics (traits) can be affected or changed by the presence of state psychiatric disorders, for example, depression.

Lidocaine 5% patch: an open-label naturalistic chronic pain treatment trial and prediction of response.

Objective: There have been a few open-label nonplacebo reports on the successful use of lidocaine 5% patch (L5P) for other types of pain besides postherpetic neuralgia, such as chronic low back pain. With the these reports, we began to utilize L5P routinely for chronic pain patients (CPPs) with various pain diagnoses. The purpose of this report was to describe the results of a retrospective review of this open-label naturalistic L5P chronic pain treatment trial and to attempt to delineate predictors of perceived clinical response.

Multidisciplinary pain facility treatment outcome for pain-associated fatigue.

Objectives: Fatigue is frequently found in chronic pain patients (CPPs) and may be etiologically related to the presence of pain. Fishbain et al. have recently demonstrated that chronic low back pain (LBP) and chronic neck pain patients are more fatigued than controls.

Do the second-generation "atypical neuroleptics" have analgesic properties? A structured evidence-based review.

Study Design: This is a structured, evidence-based review of all available studies on the potential effectiveness of the atypical neuroleptics for the treatment of pain (analgesia). To determine what evidence, if any, exists for, or against, the effectiveness of the atypical neuroleptics for analgesia.

Summary Of Background Data: There has been significant controversy over whether the conventional neuroleptics (non-atypicals) have analgesic properties.

Is there a relationship between nonorganic physical findings (Waddell signs) and secondary gain/malingering?

This is a structured evidence based review of all available studies addressing the concept of nonorganic findings (Waddell signs) and their potential relationship to secondary gain and malingering. The objective of this review is to determine what evidence, if any, exists for a relationship between Waddell signs and secondary gain and malingering. Waddell signs are a group of 8 physical findings divided into 5 categories, the presence of which has been alleged at times to indicate the presence of secondary gain and malingering.

Modafinil for the treatment of pain-associated fatigue: review and case report.

Fatigue is a symptom that is frequently found in chronic pain patients with low back pain and/or neck pain. At the present time, no specific psychopharmacological treatment for this problem has been identified. Modafinil is a wakefulness-promoting agent that the FDA has approved for the treatment of excessive daytime sleepiness associated with narcolepsy.

Are patients with chronic low back pain or chronic neck pain fatigued?

Objectives: The objectives of this study were the following: to determine if fatigue is present in chronic low back pain (LBP) and chronic neck pain patients to a greater extent than in controls (nonpatients); to determine which variables are associated with the presence of fatigue; and to determine which of the above chronic pain patient (CPP) groups is more fatigued. To the authors' knowledge, this is the first such study in the literature.

Design: Totals of 175 chronic LBP and 33 chronic neck pain patients completed the Multidimensional Fatigue Inventory (MFI), Neuropathic Pain Scale (NPS), and Beck Depression Inventory rating scales on admission.

Identifying patients at risk for loss to follow-up after pain center treatment.

Objective: This study was designed to identify, at admission to a pain treatment facility, characteristics of patients who will be lost to follow-up after treatment completion.

Method: Patients were divided into 3 groups depending on how they responded to the 12-month follow-up. The analysis was a between-subjects design using prospective data collected at a comprehensive pain treatment facility.

Pain-determined dissociation episodes.

Objectives: Dissociation disorders are a group of conditions characterized by a disruption of integrated function of consciousness, memory, or perception. The purpose of this report is to describe the impact of increased pain levels on the genesis of two types of dissociation disorders, dissociative fugue ( DF) and dissociative identity disorder ( DID), in patients with chronic pain ( PWCP). DESIGN/PATIENTS/INTERVENTIONS/OUTCOME MEASURES: From November 1992 to July 2000, 2 DID and 4 DF patients were identified from 2,544 consecutive PWCP evaluated and/or treated at the University of Miami Comprehensive Pain and Rehabilitation Center.

Millon behavioral health inventory scores of patients with chronic pain associated with myofascial pain syndrome.

Objectives: Normative data for the coping styles and psychogenic attitudes of the Millon Behavioral Health Inventory (MBHI) for male and female chronic pain patients (CPPs) with mixed pain diagnoses have previously been reported and compared with normative MBHI manual data. However, results from other studies have suggested that CPPs with myofascial pain syndrome (MPS) may need to be considered as a distinct group in psychiatric/psychological studies. The purpose of the present study was then to provide normative data for each MBHI scale for male and female CPPs with MPS and to compare these data with MBHI manual norms for similarities and differences.

Does the conscious exaggeration scale detect deception within patients with chronic pain alleged to have secondary gain?

Objectives: The illness behavior questionnaire (IBQ) is a test battery developed by Pilowsky to detect what he has termed abnormal illness behavior, which includes malingering. The IBQ has been widely utilized in patients with chronic pain (PWCP). Clayer developed a 21-item scale out of the IBQ, which he termed the conscious exaggeration (CE) scale.

Risk for violent behavior in patients with chronic pain: evaluation and management in the pain facility setting.

Objective: Recent evidence indicates that physicians are at high risk for patient-perpetrated violence. The objectives of this article, in association with case reports of patients with chronic pain (PWCP), are the following: to review the literature and determine if pain physicians could be at risk for PWCP-perpetrated violence; to review the current evaluation and management procedures for potentially violent patients; and to identify some situations specific to PWCPs that can heighten the risk of PWCP-perpetrated violence.

Design: Previous literature on patient-perpetrated violence against physicians was reviewed.

Clonazepam open clinical treatment trial for myofascial syndrome associated chronic pain.

Objective: A number of case reports and nonplacebo controlled studies have documented the efficacy of clonazepam (Klonopin) in the treatment of a number of chronic pain syndromes including lancinating and neuropathic/deafferentation pain. There are, however, no data on the efficacy of clonazepam for chronic pain (CP) associated with myofascial pain syndrome (MFPS). Therefore, we wish to report the results of an open clinical treatment trial of clonazepam for CP associated with MFPS.

Evidence-based data from animal and human experimental studies on pain relief with antidepressants: a structured review.

Objective: It has been hypothesized that serotonin reuptake inhibitor antidepressants (ADs) are only weakly antinociceptive but augment noradrenergic (NA) antinociception. Thus, ADs with combined serotonergic (SN) and NA activity, (i.e.

Genetic testing for enzymes of drug metabolism: does it have clinical utility for pain medicine at the present time? A structured review.

Study Design: This is a structured review of genomic (genetic) testing for enzymes of drug metabolism.

Objectives: Recently, industry began offering genomic testing for enzymes of drug metabolism. As such, the objective of this review was to determine if genomic testing for enzymes of drug metabolism has any imminent clinical relevance for the practice of pain medicine.

Relationships between functional capacity measures and baseline psychological measures in chronic pain patients.

The extent to which baseline psychological measures, pain, and compensation status are related to admission and posttreatment functional capacity and employment outcome was investigated. Four pass/fail functional capacity tests based on the DOT (Dictionary of Occupational Titles) classification system and previously shown to be predictive of treatment outcome in chronic pain patients were analyzed in relation to baseline measures of depression, state and trait anxiety, and perceived stress. Statistical tests of all measures with employment level at admission to treatment, 1 month follow-up and at long-term follow-up were also performed.

Can patients taking opioids drive safely? A structured evidence-based review.

A structured evidence-based literature review was completed to determine if there was epidemiological evidence of an association of opioid use and intoxicated driving, motor vehicle accidents (MVA) and MVA fatalities; to rate the quality of this research evidence according to Agency for Health Care Policy and Research (AHCPR) type of evidence and strength and consistency of the evidence rating scales; and according to this evidence determine whether patients taking opioids can drive safely. Relevant references were located from Medline, Psychological Abstracts, Science Citation Index and the National Library of Medicine Data Query databases by appropriate subject headings. A manual search was also performed utilizing the reference lists of the retrieved articles.

Is the location of nondermatomal sensory abnormalities (NDSAs) related to pain location?

Objectives: Nondermatomal sensory abnormalities (NDSAs) are alleged to be nonorganic physical findings, where one finds diminished sensation to light touch, pinprick, and, sometimes, other modalities fitting a "nondermatomal pattern." The presence of NDSAs has historically been classified as a conversion symptom. We wished to determine if, in chronic pain patients (CPPs), NDSA location was associated with pain location.

Do the proposed cervicogenic headache diagnostic criteria demonstrate specificity in terms of separating cervicogenic headache from migraine?

Diagnostic criteria for cervicogenic headache (CH) have been proposed. These criteria are controversial in that they appear to overlap or include characteristics that usually are attributed to migraine headache (MH). Whether these criteria are specific enough to separate CH patients from MH patients remains to be controversial.