Trust in Clinical Practice: A Systematic Review

Background: The aim of this study is to gain a better understanding of the true importance of trust in clinical practice by looking at how it is formed, how it affects clinical practice, and how to improve it. Methods: Using the PRISMA-ScR checklist, a review of the literature was performed to identify research evaluating the importance of trust in the doctor-patient relationship. After thorough screening and removal of duplicates, 21 articles were used in the literature review. Results: The classifying themes that emerged in the selected articles were What Makes Trust and Effects of Trust. The theme of What Makes Trust garnered two subthemes as well: Impact of Doctor-Patient Relationship on Trust and Impact of Shared Decision-Making on Trust. Further to that, the overarching themes found were slightly more specific. They were Traits of Trust, Mistrust and Barriers to Trust, Positive Effects of Trust and the Effects of a Lack of Trust. We found that the best way to improve trust was to improve communication between the patient and the doctor. Additionally, we found that the biggest barrier to a trusting doctor patient relationship was a stigmatised condition, followed by a perception of a financially-motivated doctor. Finally, we found that a lack of trust can prevent patients from seeking and receiving proper treatment. Conclusions: With a better understanding of how trust is built and the extent of the role it plays in clinical practice, we hope that this growing knowledge can improve the practice of many doctors in the future. It is certain that more research needs to be done in this area, especially focusing on vulnerable and stigmatised populations such as chronic pain patients.

The Association between Perceived Injustice Following Traumatic Injury and Its Impact on Pain-Related, Mental Health and Functional Health Outcomes: A Systematic Review

Background: There is growing evidence suggesting that those who suffer traumatic injury display high levels of perceived injustice which impedes their recovery, both physically and mentally. Aim: The aim of this systematic review was to examine the association between perceived injustice and pain-related, mental health and functional outcomes in patients who have suffered a traumatic injury. Methods: In May 2023, a systematic review of the literature was performed on the electronic databases of PubMed, Google Scholar, Embase, and the Cochrane Database of Systemic Reviews. Papers were collected and analysed as per PRISMA guidelines for systematic reviews. The outcomes of interest were pain intensity, pain interference, disability, depression, anxiety, and quality of life. The initial search identified 59 papers. Of these papers, five studies met the inclusion criteria and were subsequently analysed (N = 1172). Each of the papers was published in peer-reviewed journals in the English language. Individuals with pain or pathology prior to the trauma and those who were not hospitalised following the trauma were excluded from the study. Results: Of the papers reviewed, each study indicated significant associations between perceived injustice and pain, disability, depression, anxiety, post-traumatic stress disorder, as well as reduced return to work status. Conclusion: This systematic review investigated the relationship between perceived injustice and pain-related, mental health, and functional outcomes in trauma patients. The results highlight the negative role that perceived injustice has on recovery following traumatic injury. Further, it provokes the need for future research regarding the implementation of therapeutic interventions and the development of predictive models of injustice.

Neuroanatomical Basis of Postoperative Pain and Assessment of Its Management in a Series of Patients Undergoing Caesarean Sections

Introduction: In recent decades, the cost of postoperative pain has been the subject of many studies based on protocols developed by scientific societies for its assessment and optimization. At the Regional Hospital of Saint-Louis (Senegal), several protocols have been developed for pain management, but no study has focused on the assessment of postoperative pain management specifically. We therefore initiated this work, the objectives of which were to remind the neuroanatomical and neurophysiological bases of postoperative pain, and to analyze the assessment and management of this pain in patients who have undergone a caesarean section. Materials and methods: This was a prospective and descriptive study, which took place in the gynecology-obstetrics department, over a period from January 2019 to July 2020. All patients who gave birth by cesarean section were included. The data was collected from a survey sheet written for this purpose. For each of the patients, the information was taken every day throughout the duration of postoperative hospitalization. Results: It appears from our work that after a cesarean section, the pain felt evolves on the first postoperative days with a peak during the second day. As in the data reported in the literature, there does not seem to be a difference in terms of pain intensity and analgesia dosage between scheduled and emergency caesarean sections. However, young age and female gender—for other types of surgeries—are risk factors associated with high postoperative pain scores. This trend is probably related to the low pain experience of tested patients. Our initial hypothesis was that acute post-operative pain after caesarean sections could be linked to defects in the perception and processing of pain by caregivers. Indeed, we have shown that awareness-raising, information, and training actions have made it possible to significantly improve the management of pain after a cesarean section. Conclusion: After a cesarean section the pain is intense, especially when the effects of the morphine wear off. However, in our context where morphine and its derivatives are only slightly used, the post-operative pain is maximal rapidly. This pain therefore needs to be researched and treated appropriately. After a campaign to raise awareness among healthcare personnel, it is possible to significantly improve the systematic administration of analgesics.

Forgiveness and Chronic Pain: A Cohort Study

Background: Chronic pain is a major public health issue. It is a complex condition comprising biological, social and psychological elements, which can be challenging to manage. Forgiveness is a recognised effective intervention in various health conditions. Research has shown promising results using forgiveness as an intervention in the management of pain. This study aims to examine the relationship between forgiveness and other variables in patients suffering from chronic pain in the setting of a chronic pain clinic. Methods: Institutional ethical approval was granted for this study. Patients attending a chronic pain clinic for the first time were invited to complete a questionnaire comprising a brief socio-demographic survey and questionnaires including the Heartland Forgiveness Scale, Hospital Anxiety and Depression Scale, Pain and Anxiety Symptoms Scale and Perceived Injustice. Results: 104 adult patients were included. The mean age was 59 years. Back pain was the most common chronic pain presentation. The Heartland Forgiveness Scale (HFS) was found to have a good internal consistency among the Irish population. This study found that 55% of patients attending the pain clinic were not forgiving. Negative correlations were identified between forgiveness and pain, and forgiveness and injustice. Conclusion: The majority of patients attending a chronic pain clinic were not forgiving as measured on the HFS. There was a negative correlation between forgiveness and pain. The results have shown that forgiveness could be beneficial as a therapeutic intervention among patients attending a chronic pain clinic.

Efficacy of Low Dose Naltrexone on Pain Reduction in Chronic Pain Syndromes: A Meta Analysis

Chronic pain is a multifaceted debilitating experience often associated with significant physical and emotional burden. Low dose naltrexone (LDN) has gained attention in recent years for its potential utility in the management of fibromyalgia, irritable bowel syndrome, multiple sclerosis, and painful diabetic neuropathy. LDN’s analgesic effects have been associated with its ability to increase the production of endorphins while reducing the production of tumor necrosis factor-alpha, interleukin-6, reactive oxygen species and nitric oxide. This meta-analysis aims to systematically review and synthesize the available evidence on efficacy of LDN as an analgesic in pain syndromes, with a focus on chronic (neuro) inflammatory diseases. The goal is to provide clinicians with a more comprehensive estimate of the effectiveness of LDN as a non-opioid option for managing chronic pain and guide future research in the area. Thirteen randomized control trials, published from 1990 to 2022, were selected for the analysis that satisfied inclusion criteria. The overall effects in these studies were calculated using the standardized mean difference (SMD) between the LDN and placebo groups. We found an overall SMD of -10.77 (95% CI: -13.96 to -7.58) with a p-value of 0.002. This indicated that the LDN group experienced a statistically significant reduction in pain compared to placebo. This meta-analysis provides evidence for the potential efficacy of low dose naltrexone in reducing pain and enhancing analgesia in various pain syndromes. LDN may be a useful treatment option for patients suffering from chronic pain, particularly with fibromyalgia, multiple sclerosis, or diabetic neuropathy. However, further research is needed to confirm the efficacy and safety of low dose naltrexone for chronic pain conditions, especially with larger sample sizes, standardized dosing regimens and treatment durations.

Ultrasound-Guided Greater Occipital Nerve Hydrodissection for Treatment of Cervicogenic Headache: A Case Report

We describe an innovative technique of ultrasound-guided greater occipital nerve (GON) hydrodissection for treatment of cervicogenic headache and occipital neuralgia. A 35-year-old female presented to the pain clinic with severe chronic cervicogenic headache impacting her sleep, work and activities of daily living. Conservative management had failed to adequately resolve her pain. Ultrasound-guided suboccipital hydrodissection of the greater occipital nerve was performed with the patient in the prone position. After skin sterilization, the linear ultrasound transducer was oriented in a transverse orientation at the level of the C2-C3 vertebrae. The needle was advanced from medial to lateral “in-plane” under direct ultrasound visualization, until the needle was positioned at the C2 lamina. After confirming the needle tip position, 10 ml of hydrodissection fluid was injected with good visualization of distribution of the solution. The patient described immediate and significant improvement in her symptoms. She reported a sustained decrease in pain scores when followed up in the pain clinic at six and twelve weeks respectively. To the best of our knowledge this is the first application of ultrasound-guided hydrodissection of the GON for cervicogenic headache. It offers a novel, safe and effective technique to aid in the diagnosis and treatment of a common pain condition.

Ultrasound-Guided Dorsal Scapular Nerve Blockade in the Diagnosis and Management of Neck Pain

Neck pain is common and has multiple sources, but correct diagnosis and matched treatment provide the best outcomes. The first description of ultrasound-guided dorsal scapular nerve blockade using a single-shot local anesthetic technique for the diagnosis and treatment of neck pain is reported. A 38-year-old female patient presented with neck pain, and the history and clinical examination strongly suggested myofascial pain affecting the middle scalene muscle. The pain had been unresponsive to pharmacological therapy or physiotherapy. After identifying the dorsal scapular nerve (DSN) in the body of the middle scalene muscle, an ultrasound-guided nerve block was performed using a single injection of local anesthetic to alleviate the patient’s pain. It has been demonstrated that the dorsal scapular nerve can be identified in the neck and effectively blocked using ultrasound guidance. This technique has the potential to assist in the diagnosis and treatment of neck pain originating from the middle scalene muscle.

Clinical Trial Demonstrates Efficacy of Transcranial Direct Current Stimulation (tDCS) in Improving Pain Management from Post-Laminectomy Syndrome

Chronic pain, a multidimensional experience affecting individuals’ sensory, cognitive, and emotional aspects, significantly impacts their quality of life. Post-laminectomy syndrome, a condition characterized by persistent back pain following spinal surgery, often leads to disability and increased healthcare utilization. Methods: This randomized, controlled, blind clinical trial aimed to investigate the efficacy of Transcranial Direct Current Stimulation (tDCS) in managing pain from post-laminectomy syndrome in patients. Twenty-four participants were assigned to three groups: sham stimulation, active stimulation over primary motor cortex (M1), or stimulation over dorsolateral prefrontal cortex (DLPFC). Stimulation was administered for five consecutive days, 20 minutes per session, using a current of 1.5 mA through 25 cm2 electrodes. Pain intensity was assessed using Visual Analog Scale (VAS) before, during, and after intervention. Results: An ANOVA model demonstrates significant reduction in pain intensity compared to baseline in VAS, (F(7, 285) = 12.292;p 0.001;Power = 1.000;η2p = 0.534), in tDCS applied to M1, after five days of intervention. After stimulation, a significant improvement was observed in WHOQoL-Bref Quality of life item 1 (p = 0.04), considering statistical significant difference p 0.05. Correlation between the variables: quality of life, depression, anxiety and pain also demonstrates reduction in depression and anxiety according to Beck’s Depression and Anxiety Inventories (BDI and BAI), p 0.05. This effect was not observed in DLPFC stimulation group. Patients who believed they received active stimulation, in sham group, demonstrated potential for effective blinding. Conclusion: The tDCS applied to primary motor cortex effectively improved pain management and psychiatry symptoms in post-laminectomy syndrome patients. The technique’s low cost, ease of use, and high tolerability make it a promising adjuvant therapy for chronic pain conditions like post-laminectomy syndrome.

Research Findings Using Mindfulness-Based Interventions for Chronic Pain

Chronic pain is a complex condition that is very detrimental to physical and psychological wellbeing. It carries a significant level of disability and economic burden. Pain patients frequently experience comorbid mental illness (e.g. depression, anxiety, PTSD, insomnia) and often require psychotherapeutic interventions in addition to medication management. Mindfulness-based interventions (MBIs) have emerged as a means to treat several chronic conditions (e.g. chronic pain, depression, anxiety, substance abuse, stress, insomnia). The objective of this review is to evaluate the current research on the use of MBIs in chronic pain managment. Although there are several controlled trials on the use of MBIs in chronic pain management, only a few studies were found that demonstrated significant effects on pain intensity, quality of life, as well as physical and psychological functioning. Therefore, the current evidence is mixed and there are insufficient data to definitively confirm the full impact of the use of MBIs in chronic pain conditions such as fibromyalgia, chronic low back pain, rheumatoid arthritis, and chronic musculoskeletal pain. The lack of compelling evidence at this time signals a demand for higher quality investigations in this area. Research examining MBIs and concomitant CBT may be of great value in order to synergize and strengthen patient outcomes.

Non-Operative Management of Hip Osteoarthritis

This paper reviews several non-operative and non-pharmacologic management strategies advocated for alleviating the pain and disability experienced by people with hip osteoarthritis. It analyzes whether painful debilitating hip osteoarthritis, which has no effective cure and is often progressive, may be affected positively by non-operative interventions designed to control osteoarthritis pain. Finally, it provides an integrated plan of management for ameliorating hip osteoarthritis pain and disability in light of this knowledge.

A Comparison of Subacromial Bursae Block, Suprascapular Nerve Block and Interscalene Brachial Plexus Block after Arthroscopic Shoulder Surgery

Background: The aim of this study was to compare the analgesic efficacy of subacromial bursae block (LA), suprascapular nerve block (SSB), and interscalene brachial plexus block (ISB) after arthroscopic shoulder surgery. Methods: 91 patients scheduled to undergo an arthroscopic shoulder acromioplasty under GA in an outpatient setting were included. The patients were prospectively randomized into 4 groups: 1) interscalene brachial plexus block, 2) suprascapular nerve block, 3) subacromial bursae block, 4) control group for comparison. Pain scores (VAS), supplemental analgesia, and side effects were recorded in the recoveryroom, 4 hours and 24 hours after surgery. Results: Group ISB had significantly lower pain scores at rest in the postanesthesia care unit than the SSB group (p = 0.037) and the control group (p = 0.0313). The same results were seen 4 hours follow-up. The LA group had significantly lower pain scores at rest in the postanesthesia care unit than the control group (p = 0.046) and after 4 hours follow-up significantly lower pain scores than both the SSB group (p = 0.021) and the control group (p = 0.037). After 24 hours, there were no differences between the two groups. Conclusion: In this prospective, randomized, blinded study we demonstrated that a single-dose interscalene brachial plexus block (ISB) and a subacromial bursae block (LA) are equal and the most efficient analgesic techniques after arthroscopic shoulder acromioplasty. LA is less expensive, faster and with fewer complications than ISB and therefore we suggest subacromial bursae block is an effective, safe and easy way of postoperative pain reduction after arthroscopic acromioplasty. Level of evidence: Level I. Treatment study.

Hip Joint Osteoarthritis Pain Sources and Control

Hip joint osteoarthritis, a widespread disabling disease with no known cause, produces considerable bouts of intractable pain as a result of multiple disease associated problems. This paper examines some sources of osteoarthritic hip joint pain, a poorly understood topic at best. Presented in three parts are data retrieved from several sources, including animal models. It is concluded that to improve the effectiveness of treatments designed to minimize hip osteoarthritis pain, a better understanding of the diverse origins of hip joint pain, and hip joint neurology, may permit the development of more precise as well as targeted pain strategies.

Symptomatic improvement in an acute, non-traumatic spine pain model with a combination of uridine triphosphate, cytidine monophosphate, and hydroxocobalamin

Rationale: In a previously published trial on spinal acute non-traumatic pain, peripheral neuro- regenerative combination of UTP, CMP and hydroxocobalamin presented unexpected analgesicproperties. Objective: To corroborate analgesiceffects of UTP, CMP and hydroxocobalamin combination in a self-paired evolutionary model. Methods: Mean VAS scores from pretreatment, V2 (5th treatment day) and V3 (10th treatment day) were plotted and statistically analyzed (ANOVA) for differences. PFQ scores from pretreatment, V2, and V3 were analyzed using the chisquare test. Results: The difference between V3 and pretreatment mean VAS scores was statistically significant (p < 0.0001). The improvement in PFQ scores throughout the study was found to be statistically significant (p < 0.0001). Conclusion: The combination of UTP, CMP and hydroxocobalamin seems to have analgesic properties in mediumterm use. The complex peripheral neu-roregenerative pharmacodynamics of this combination provides a plausible basis for this finding. Further randomized studies are needed to explore this combination for the indication of neuropathic pain due to spinal structure involvement.

Prescribing Pattern of Analgesic Drugs at Boru Meda Hospital, North East, Amhara, Ethiopia

Introduction: Pain is the sensory and emotional experience, which altered human health and well-being. When pain does not resolve, it may be associated with a serious disease, condition, or injury that needs timely medical care and also irrational prescribing of analgesics, which is possible to lead to unwanted side effects. Therefore, this study has been intended to evaluate the prescribing pattern of analgesics drugs at Boru Meda Hospital. Method: A retrospective cross sectional descriptive study was conducted. A total of 200 prescriptions containing analgesic were systematically collected by using well designed and pretested Data collection format. The necessary information was extracted from the prescription sheets by trained pharmacists and later analyzed using SPSS version 20 software. Result: Regarding prescribed analgesic acetaminophen 115 (36.9%) was the most prescribed, and then followed diclofenac 83 (26.6%) and Ibuprofen 64 (20.5%). The maximum number of analgesic drugs was administered to patients by oral rout (75%), which is followed by parenteral (19%). About dosing approach 94% acetaminophen prescribed as needed (PRN) based, whereas ibuprofen 59.4% and tramadol 40% were prescribed as twice a day (bid) based. Acute fibril illness (13.6%) was the highest reason for prescribing analgesics. Conclusion: Majority of the prescription analgesics drugs were prescribed as PRN dosing approaches with a very large percentage of oral medications. Some of the prescriptions revealed irrational prescribing of analgesics, in accordance of clinical indication, frequency of administration and combination of analgesic.

Nalbuphine versus Dexmedetomidine as an Analgesic Additive to Lidocaine in Intravenous Regional Anesthesia IVRA

Intravenous Regional Anesthesia (IVRA) is easy to administer and reliable. But delayed onset and lack of postoperative analgesia are the major limitations. Accordingly, many additives have been tried. Dexmedetomidine is a highly selective α-2 adrenoceptor agonist. Addition of dexmedetomidine to lignocaine is effective in decreasing the anesthetic requirements and prolonging the analgesic duration. On the other hand, many theories explain that opioids may exert their peripheral action through peripheral opioid receptors. The aim of the study was to compare the analgesic efficacy of nalbuphine and dexmedetomidine when used separately as adjuvants to lidocaine during IVRA with the effect of lidocaine alone. Sixty adult patients, who were scheduled for surgery of the hand or the forearm under intravenous regional anesthesia, were included in this study. The patients were randomly allocated into three equal groups. The syringes in all groups contained 3 mg/kg of lidocaine 0.5% diluted in 40 ml isotonic saline. Group C: Control group. Group D: Dexmedetomidine group, 1 mic/kg dexmedetomidine diluted was added. Group N: Nalbuphine group, 20 mg nalbuphine was added. Sensory onset time (min) as well as motor block onset time (min) were significantly shorter in Groups N (2.0 ± 1.7) (3.8 ± 2.1) respectively, and D (2.2 ± 1.8) (4.6 ± 2.2) respectively compared to Group C (3.6 ± 1.6) (7.1 ± 1.4) (P < 0.05), with no significant differences between nalbuphine and dexmedetomidine groups. Sensory and motor block recovery times (min) were significantly longer in Groups N (9.6 ± 0.7) (10.3 ± 1.2) and D (8.1 ± 1.1) (9.1 ± 2.1) when compared to Group C (3.4 ± 2.1) (3.7 ± 3.1) (P < 0.05), without significant differences between nalbuphine and dexmedetomidine. Ramsay sedation score was significantly higher (RSS = 2) in 14 patients (70%) in Group D compared to Groups C and N during the first 30 min after the release of tourniquet.

Effects of Extremely Low Frequency Magnetic Field (ELF-MF) on Formalin Induced Chronic Pain in Mice

Background: Effects of Extremely Low Frequency Magnetic Field) ELF-MF (in the elevation of blood sugar, cholesterol, triglyceride and reduction of withdrawal syndrome of morphine have been reported so far. Since pain is one of the main concerns in medicine and usually analgesic drugs are not much beneficial or cause considerable side effects, the present project was carried out with the aim of evaluating the effects of (ELF-MF (in chronic pain using formalin test in mice. Materials & Methods: In this experimental study, thirty two adult male mice were used and divided into 4 groups (n = 8). Three groups of animals exposed daily for thirty minutes to 25, 50, 75 HZ (intense 250 μT) of electromagnet field for one week, respectively and one group considered as control with no exposure. At the end of a week, formalin test was performed. Responses to formalin were observed for sixty minutes. The results were compared between tests and control group. Findings: In acute phase of formalin test, ELF-MF reduced significantly the pain scores following formalin injection at all 3 frequencies, especially at 25 and 50 HZ (p < 0.001) rather 75 HZ (p < 0.05). In chronic phase of formalin test, ELF-MF reduced pain scores at 25 and 50 HZ (p < 0.05). However, the most effective responses were obtained at 50 HZ frequency. Conclusion: The findings show that ELF-MF is effective to reduce formalin induced chronic pain in mice at both acute and chronic phases.

Perioperative Local Cooling Reduce Significantly Early Pain after Open Inguinal Hernia Repair:A Prospective Randomized Study

Pain and local complications are the major determinants of outcome after inguinal hernia repair. To evaluate the respective impact of peri-operative cooling of surgical site and usual care after open inguinal hernia repair, we performed a prospective randomized study. Methods: One hundred and eight consecutive patients with primary unilateral inguinal hernia were included the study. Repair was performed by local direct access during ambulatory surgery. The first study group underwent standard pre- and postoperative local care (control group). In the second group (cold compress group), a single-use disposable sterile cold compress was applied on the surgical site for at least 30 minutes before and 2 hours after surgery. Primary endpoints were immediate postoperative pain using a visual analogue scale, and local complications. Secondary endpoints included: analgesic drug consumption, length of hospital stay, delay to return to normal activity and patient satisfaction. Results: There was no difference concerning operative time (36.3 ± 14.0 vs 39.6 ± 7.2 minutes) and early (one-week) complications, although there was a non significant reduced incidence of hematoma and ecchymosis (0/54 versus 4/54) for the cold compress group. Analgesic drug consumption was significantly (p = 0.01) reduced. During the day of surgery and the first postoperative day, the visual analogue scale was significantly lower after cooling. There was a non-significant reduction in length of hospital stay (150 ± 37 versus 210 ± 47 min), and time to return to normal activity was shorter in the cold compress group. Conclusion: For open inguinal hernia repair, immediate pre- and post operative surgical site cooling, targeting a controlled temperature between 12?C and 15?C significantly reduced postoperative pain, analgesic drug consumption and resulted in improved immediate outcomes. This technique is safe, simple, easy to use, inexpensive and well tolerated by the patient.

The Effect of Tramadol Hydrochloride In-traarticular Injection on IL-6 Level in Patients with Tempromandibular Joint Internal Derangement

Purpose: This study was conducted to detect IL-6 in synovial fluid in cases with TMJ internal derangement. Patients & Methods: This study was conducted on forty patients ASA class I with TMJ Internal derangement. All patients had been subjected to arthrocentesis. The synovial fluid was collected before wash and lavage was done for the affected joint. Then, the selected patients were divided randomly into two equal groups, group I: consisted of 20 patients where arthrocentesis was performed for the affected joint followed by intraarticular injection of one ml, tramadol hydrochloride. Group II: consisted of 20 patients where arthrocentesis was performed for the affected joint followed by intraarticular injection of one ml. sodium hyaluronate. Another synovial fluid sample was aspirated after one month. The interlieukin-6 receptors in the aspirated synovial fluid were measured using humans IL-6 enzyme-linked immunosorbent assay. Results: IL-6 was detected in the synovial fluid of joints with internal derangement. During follow up assessment of IL-6, the maximum decrease in IL-6 level was in the patients of group I who subjected to arthrocentesis with tramadol injection, as the mean IL-6 was (4.93 ± 1.36) followed by the patients of group II who subjected to arthrocentesis with sodium hyaluronate injection where the mean IL-6 level was (6.88 ± 1.76). There were significant p-value = (P = 0.000). Conclusions: It had been concluded that the detection of IL-6 in the synovial fluid of joints with internal derangement considered an indicator for inflammatory reaction in the joint and also the efficacy of arthrocentesis with tramadol suggested its anti-inflammatory effect.

Association between Magnetic Resonance Imaging and the Result of Medial Branch Blocks

The aim of this retrospective practice audit was to assess the correlation between painful zygapophysial joints and changes seen in magnetic resonance imaging (MRI). Patients with unilateral pain were tested with controlled medial branch blocks. The MRI scans of patients with a positive response were compared blinded with normal MRI scans. The dimensions of the joint were assessed and osteoarthritis was graded. Fifteen symptomatic patients and 15 asymptomatic patients were included and evaluated. Comparison of the joints showed that the maximum diameter of symptomatic joints was significantly larger, and the grading of osteoarthritis was significantly higher for symptomatic joints. No healthy patient was assigned a grade 3. Grades 2 and 3 were found significantly more often in symptomatic patients. Only one symptomatic joint was assigned grade 0. Grade 0 was found significantly more often in asympto-matic patients. The presented MRI technique has limited value as a diagnostic test for lumbar zygapophysial joint pain. It is not possible to detect a single symptomatic joint. However, the osteoarthritis grading for the lumbar zyg-apophysial joints might be helpful for finding predictors for negative response if the results of the rating are grade zero. Therefore, unnecessary medial branch blocks might be avoided.

A Descriptive Longitudinal Study of Chronic Pain Outcomes and Gender Differences in a Multidisciplinary Pain Management Centre

Background: The long-term outcomes of patients with chronic pain treated in a multidisciplinary pain management center remain variable. Objective: This study aims to evaluate the changes in outcomes of patient’s self-reported pain, psychosocial status, health related quality of life and gender differences following treatment in amultidisciplinary pain management centre. Design: A prospective longitudinal cross-sectional study uses questionnaires. Treatment Setting: A pragmatic and individualized patient centered approach in a tertiary level multidisciplinary pain management center. Subjects: Patients with chronic pain referred to the centre from 2004-2010. Outcome Measures: Pain Numerical Rating Scale (NRS), Pain Temporal Description (1 - 6), Pain Self- Efficacy Questionnaire (PSEQ), Depression Anxiety Stress Scales (DASS-21) and Short Form-36 (SF- 36). Follow-up questionnaires were sent at 6 and 12 months after initial assessment. Results: Mean duration of baseline chronic pain was 8.1 years and 61% of chronic pains were involving the musculoskeletal system. At 6 and 12 month follow-ups, 273 and 180 participants had been surveyed respectively. At 6-month follow-up, there were significant improvements on pain intensity (Cohen’s d = 0.8), pain self-efficacy (Cohen’s d = 0.47), depression and stress scores (Cohen’s d = 0.16) and six out of eight domains of SF-36 (Cohen’s d = 0.2 - 0.4). At 12-month follow-up, improvements were maintained on pain intensity, self-efficacy and three out of eight domains of SF-36. There were distinctive pre- and post-treatment gender differences in these outcomes and overall females showed better short- and long-term outcomes than males. Conclusion: Multidisciplinary pain management using an individualized patient centered approach remains an effective treatment for chronic pain in both the short- (6 month) and long-term (12 month). The distinctive pre- and post-treatment gender differences particularly in the psychological outcomes, suggest that it may be beneficial to further delineate and better manage vulnerable patient subgroups.