It is believed by many researchers that little attention has been given to patients' perceptions of the impact of chronic pain on their lives. In recognition of this need, G. Frank Lawlis, C. Edward McCoy, and David K. Selby developed the Dallas Pain Questionnaire (DPQ) to assess the amount of chronic pain that affects four aspects (daily activities, work-leisure activities, anxiety-depression, and social interest) of the patients' lives. The present study, conducted to validate the DPQ's statistical properties, first reviews the literature addressing the various theories and varieties of pain, its opiates, and the two current approaches to quantify pain. This study included a total of 143 subjects. Clinical subjects were 104 inpatients in the Spinal and Chronic Pain Center at Medical Arts Hospital and 15 chronic pain outpatients released to work. Normal subjects consisted of staffing personnel (n = 13) and flight assistance employees (U = 11)- Both clinical and normal groups completed the DPQ. The Minnesota Multiphasic Personality Inventory (MMPI) was administered only to the clinical population. Results suggest that the DPQ is both externally reliable (stability reliability coefficient of .970) as well as an internally consistent instrument. Two factors emerged from factor structure analysis. Factor one (63.2% of variance) represents functional activities. Factor two (8.3% of variance) represents emotional capacities. A correlation analysis suggests the concurrent validity of the psychological and functional factors of the DPQ. A t-test demonstrated that chronic pain patients have significantly higher DPQ's scores than normals. Because these findings support its psychometric properties, the DPQ appears to have utility for clinical and research purposes. The findings, limitations, and implications of this study are detailed, as are suggestions for future research.

Aim of the Study The aim of this study was to determine if the nursing interventions of patient education and multidisciplinary coordination of care were able to improve pain control in the cancer patient in an acute hospital setting. Background of the Study The role of the nurse in cancer pain management has been defined as being that of an educator, coordinator of care and advocate. A nurse with adequate knowledge of pain and its application to the cancer population and functioning in the role as defined is believed to be able to overcome many of the barriers that exist in implementing adequate analgesia and improve pain management in cancer patients. Design of the Study A randomized experimental control group design was utilized. The study comprised 3 experimental groups and one control group incorporating pre and post testing. The Intervention of the Study Experimental group one: subjects received education regarding their pain management which was tailored to meet their specific needs. Experimental group two: subjects underwent a pain assessment and construction of a care plan which was communicated verbally to the treating medical and nursing team and followed up with a written report which was documented in the history and sent to the treating medical physician. Experimental group three: subjects received the combined interventions administered to groups one and two. Control group four: subjects were assessed and all information was record in the same manner as for the experimental groups. The control group received their usual care during the study and their pain scores were measured at the same time intervals as the three experimental groups. Instrumentation The Wisconsin Brief Pain Questionnaire was used for the assessment of all subjects. The McGill Pain Questionnaire was used as the outcome measure following intervention. Data Analysis A one-way analysis of variance was used to detect the differences between the intervention groups and the control group. T-Tests were used to detect the differences between the groups incorporating a Bonferroni adjustment for frequent T tests. Results The main effect demonstrated a significant difference between the treatment groups and control at a significance level of 0.002. T-Tests showed no significant difference between control and communication groups and no significant difference between education and combined groups. A significant difference was detected between education and control and between combined and control. Conclusions Nursing interventions of patient education, coordination of care and advocacy can significantly improve cancer pain management. Intervention was tailored to meet the specific patient needs based on findings from the assessment and was dependent upon an adequate knowledge base. The nursing intervention of education was the most powerful of the three intervention types and its success was in tailoring to each individual. However, it is believed that with further recognition of the role of the nurse as coordinator of care will lead to greater improvements in cancer pain management.

The purpose of this study was to validate the Spanish version of the Dallas Pain Questionnaire (DPQ). Not only does the DPQ offer the potential of statistical and clinical diagnostic value but also is easily interpretable across cultural lines. No such instrument has presently been validated for the Mexican-American population. A total of 81 Spanish speaking subjects participated in this study. Of these subjects, 56 were classified as chronic pain patients by nature of their medical diagnosis and duration of pain. The 25 normal subjects were family members of the chronic pain patients and members of the Northern New Mexico Hispanic community chosen at random. Hypothesis one predicted that reliability would be obtained on Spanish speaking populations based on test-retest with correlation coefficients of the items. The second hypothesis predicted that the Spanish DPQ would have content validity or consistent internal structure on those items that measure the trait or behavior of interest based upon factor analysis approaches and internal consistency measures. Hypothesis three predicted that the Spanish version of the DPQ would significantly correlate with the English version of the DPQ on all four factors. All four hypotheses were supported. The Spanish DPQ showed reliability over time based on test-retest. The statistics revealed an internally reliable test, alpha coefficient analysis and factor analysis. The validity was supported by significant correlations with the English DPQ and discrimination between chronic and nonchronic pain patients. While all four hypotheses were upheld, interpretation of the present findings should be moderated by recognition of the limitations of the studies. Future studies should test larger samples to improve confidence in the psychometric properties of the instrument. Still notable limitations of the questionnaire are that the Spanish DPQ is a form that is more accurately viewed as a global measure.

A dissertation completed in partial compliance with the requirements for a Master's Degree in Technology Chiropractic, Durban Institute of Technology, 2006. / Neck pain is a common problem, globally, as well as in South Africa. Zulu is the first language of a very large proportion of the South African population, and as such, addressing the needs of this population group with respect to neck pain is a priority. Many reliable pain indexes exist in English to record the degree of disability with regards to neck pain. These are invaluable tools in aiding the health practitioner to assess the progress of treatment and the severity of the patient's disability. Two of the most credible and frequently used indexes are the Canadian Memorial Chiropractic College Neck Disability Index (CMCC NDl) and the Short Form McGill Pain Questionnaire (SFMPQ). However, no such scale exists in Zulu. The purpose of this pilot investigation was, firstly, to analyze and critique the Zulu translations of the CMCC NDl and the SFMPQ in order to establish their face validity. Secondly, to establish their concurrent validity ensuring that the translated questionnaires are specific and sensitive enough to use as tools in data collection when compared to their English counterparts. Thirdly, to make recommendations for further improvement in terms of the Zulu questionnaires and lastly, to make recommendations for further studies for improvement in terms of the use of these questionnaires as research tools amongst the Zulu speaking population of South Africa. Firstly, the CMCC NDl and the SFMP questionnaires were translated into Zulu by means of a focus group. These versions were then assessed by means of a focus (or discussion) group, to assess their face validity. Changes were made to the original translations according to the recommendations of this group. These versions were then assessed with regards to their concurrent validity with the original English versions. Fifty volunteers, who were literate in both English and Zulu and who have suffered with neck pain, filled in both the Zulu and English versions of both questionnaires. / M

ABSTRACT The two disorders of Restless Legs Syndrome (RLS) and Periodic Limb Movements (PLM) are well recognised as fairly common neurological disorders. The presentation is of a sensory and motor component suggestive of a state of hyperexcitability of the nervous system. The underlying abnormality is believed to involve a dopamine deficiency but many of characteristics of the disorders have not been adequately described or quantified. I investigated, firstly, the possible reasons for the gender bias in the prevalence studies and found that women were more likely to have some associated conditions which may be related to RLS as well as a higher symptom load when compared to men subjects with RLS. I then looked at the problems of analysing the sensations occurring in RLS. Due to the lack of an adequate measuring tool and the possibility of a relationship between the sensations of RLS and those of pain, I used a validated descriptive pain questionnaire (the McGill pain questionnaire) to measure the sensations of RLS. Subjects with RLS were able to describe the sensations with the pain questionnaire and severity indices calculated from the McGill correlated well with measures of RLS severity but not with other intensity measures for pain. In the area of motor events I investigated the possibility of creating a classification system for the muscle activations documented as PLM. I recorded multiple muscle groups in the legs during sleep and devised a classification using sequence of activation and timing of activations from the different muscles. I also used the classification to show subtle changes in the leg activation patterns associated with change in sleep stage.

Class of 2013 Abstract / Specific Aims: To assess influence of PCS and FPQ-III on pain tolerance as well as SNPs TRPA1(rs11988795), COMT (rs4646312, rs6269) and FAAH(rs 932816, rs4141964, rs2295633). Methods: A Pain Catastrophizing Scale (PCS) and Fear of Pain Questionnaire (FPQ-III) were completed by a total of 89 healthy adults. A genetic analysis from cheek swabs was performed for single nucleotide polymorphisms(SNPs) within genes: TRPA1, COMT, and FAAH. A cold-pressor test involving the non-dominant hand inserted in circulating water kept at 1-3 degrees Celsius was used and the duration of time subjects were able to leave their hand in the water (pain tolerance) was measured as the primary outcome. Linear regression analysis was used to identify predictors of pain tolerance. Main Results: The subjects were 58% female, the majority were Caucasian (51%) with 26% Asian, 14% Hispanic and 9% other. The mean pain tolerance was 121 ± 66 seconds and regression analysis showed female sex (p=0.001), Asian race (p=0.001), PCS score (<0.001) and FPQ-III score (p=0.014) were associated with decreased pain tolerance while the SNPs were not.      Conclusion: Psychological factors and patient demographics are associated with pain tolerance but the single nucleotide polymorphisms evaluated were not. Future pain studies should utilize a psychological assessment to adjust for this as a confounder.

Introduction: Identifying patients at risk for chronic musculoskeletal pain can inform evaluation and treatment decisions. The ability of physical therapists to assess patients’ risk for chronic pain without use of validated tools has been questioned. The Ӧrebro Musculoskeletal Pain Questionnaire (OMPQ) is used to determine risk for chronic pain. Methods: The aim of this pragmatic study was to prospectively quantify the agreement between physical therapists’ assessment of patients’ risk for chronic symptoms compared to the OMPQ. Patients were asked to complete the OMPQ during the initial visit. Physical therapists, blinded to OMPQ risk classification, carried out their usual patient assessment procedures. The physical therapists rated patients as either high or low risk for chronic pain based on their clinical assessment. Agreement between therapist and OMPQ was determined using Cohen’s Kappa (κ) and screening accuracy compared clinician risk to the OMPQ risk classification (reference standard) by way of contingency table analysis. Results: Ninety-six (96) patients’ risk classifications and 15 corresponding physical therapists’ risk estimates were available for analysis. The OMPQ identified a 47% prevalence for high risk of chronic pain. Agreement (κ and 95% confidence interval) between physical therapist rating and OMPQ was slight, κ = 0.272 (0.033–0.421), p = .026. Therapists’ sensitivity and specificity (95% CI) for determining risk classifications were 60.0% (44.3–74.3) and 62.8% (48.1–75.6), respectively. The positive and negative likelihood ratios (95% CI) were 1.61 (1.05–2.47) and 0.64 (0.42–0.97). Discussion: The use of validated self-report questionnaires are recommended to supplement clinician prognosis for patients at risk of chronic musculoskeletal pain.

Introduction: Entry-level physical therapist education on pain has been described as lacking. Calls have been made to include pain science courses to address this knowledge gap. Methods: Physical therapist students’ pain knowledge and attitudes were measured using the revised Neurophysiology of Pain Questionnaire (rNPQ) and Pain Attitudes and Beliefs Scale for Physical Therapists (PABS-PT), respectively. Univariate ANOVAs, with post hoc pairwise comparison and effect sizes, were used to measure these aspects over time. Results: Pain knowledge and clinician beliefs were significantly different (p < 0.001) at various curricular timepoints. rNPQ scores increased from 1st to 2nd year (effect size: 1.10), remained similar between years 2 and 3, and improved following the pain course (effect size: 1.25). Biomedical beliefs were similar during years 1, 2 and 3, and declined following the pain course (effect size: 1.56). Conversely, psychosocial belief scores increased from 1st to 2nd year (effect size: 0.82), remained similar between years 2 and 3, and increased following the pain course (effect size: 1.08). Discussion/Conclusions: Physical therapist education, without a dedicated pain science course, may be insufficiently preparing students to treat patients in pain. Educators should consider adopting a dedicated pain science course or substantially bolstering embedded curricular pain content to promote best practice in pain treatment.

Title: A systematic review of pain assessment tools Objectives: The aim of this thesis is to create a systematic review of the most widely used multidimensional tools (questionnaires) for assessing pain in patients with nonspecific pain of the cervical and lumbar spine. From the available sources, describe their use, the purpose it was generated for, their reliability, validity, and finally arrange the questionnaires from the most used and assess their advantages and disadvantages for use in clinical practice of physiotherapist. Method: The thesis is processed through a systematic review. The subject of the thesis are pain evaluating tools, especially in the cervical and lumbar spine. The studies containing questionnaires used to assess pain in the cervical and lumbar spine were searched out. Data extraction was carried out according to pre-specified criteria. Unsatisfactory studies were excluded. After the relevant questionnaires selection a content analysis of each tool was conducted, built a systematic review of the most commonly used questionnaires and their critical evaluation. Results: On the basis of the entire set of relevant studies I described and evaluated 14 questionnaires. Five of them are designed specifically for low back pain. They are the Roland Morris Disability Questionnaire,...

<p><strong>Syfte och frågeställningar </strong></p><p>Studiens syfte var att undersöka om utförandet av en isometrisk bålstabiliseringsövning/coreövning kunde påverka upplevelsen av smärta i nacke, axlar och skuldror hos kvinnor med kronisk/långvarig idiopatisk smärta. Studiens frågeställningar var: Hur påverkar utförandet av övningen ”plankan” upplevelsen av smärta i nacke, axlar och skuldror hos deltagarna? Förändras den maximala uthålligheten i övningen mellan deltagarnas första och sista träningstillfälle? Kan interventionen fullföljas av deltagarna?</p><p><strong>Metod </strong></p><p>Fyra kvinnliga deltagare som alla hade kronisk/långvarig smärta i nacke, axlar eller skuldror utförde övningen ”plankan” som hemträningsövning under fyra veckors tid. Mängden träning dokumenterades i en träningsdagbok som deltagarna kontinuerligt fyllde i under träningsperioden. Före samt inom en vecka efter träningsperioden ifylldes en enkät med frågor om upplevd intensitet, frekvens och lokalisation av smärta. Dessutom mättes maximal uthållighet i övningen ”plankan”.</p><p><strong>Resultat </strong></p><p>Efter träningsperioden uppskattade alla deltagare med smärta i nacken en förbättring med 1-3 skalsteg i en sammanslagning av alla frågor rörande smärta i nacke. Detta innebar<strong> </strong>att förändringen mellan deltagarnas svar i före- och efterenkäten, där skalan 0-10 användes, slogs samman till ett värde. Smärta i axlarna skattades som markant förbättrad av två deltagare samt som något försämrad respektive inte förändrad av två deltagare. Endast en deltagare uppskattade sig ha smärta i skuldrorna och ingen skillnad i uppskattningen sågs mellan före- och efterenkäten. Maximal uthållighet i övningen mellan första och sista träningstillfället ökade statistiskt signifikant för alla deltagare mätt i både procent och sekunder.</p><p><strong>Slutsats</strong></p><p>Resultatet i studien tyder på att övningen kan genomföras av individer med långvarig idiopatisk smärta i nacke, axlar och skuldror utan att ökad upplevd smärta eller andra obehag uppstår samt att den maximala uthålligheten i övningen ökar genom att övningen utförs. Hur många gånger övningen måste utföras för att ge resultat på uthållighet är oklart. Trots att flera deltagare upplevde minskad smärta efter träningsperioden så kan inga slutsatser tas då deltagarantalet var litet och resultatet för interventionsgruppen inte jämförts med en kontrollgrupp. Stora variationer i utförandet av hemträningen förekom bland deltagarna och flera faktorer utöver träningsövningen kan ha påverkat förändringen i smärtupplevelse.</p>