Search Results

You are looking at 1 - 10 of 13 items

  • Author: Hannu Kautiainen x
Clear All Modify Search

Abstract

Background and purpose

Fibromyalgia (FM) is a chronic pain syndrome, which affects up to 5% of the general population. The aetiology of FM is unclear. The lack of specific diagnostic laboratory tests or imaging options combined with the severe burden on both patients and society caused by the FM syndrome demands the development of valid instruments able to measure the current health status of the FM patients. The Fibromyalgia Impact Questionnaire (FIQ) is the most widely used of these instruments. Our objective was to translate the Fibromyalgia Impact Questionnaire (FIQ) into Finnish and evaluate its validity in Finnish speaking FM patients.

Methods

FIQ was translated by two bilingual researchers into the Finnish version (Finn-FIQ) and linked to the categories of International Classification of Functioning, Disability and Health (ICF). Finn-FIQ was administered to 162 patients who had prior fibromyalgia diagnoses M79.0 according to ICD-10 year 2006 version. They also filled in the Health Assessment Questionnaire (HAQ), the Rand 36-item Health Survey (RAND-36), the Beck Depression Inventory IA (BDIIA), the Chronic Pain Acceptance Questionnaire (CPAQ), the International Physical Activity Questionnaire Short Form (IPAQ), and they assessed their general well-being on a 0–100 mm visual analogue scale while attending a clinical check-up visit. Internal consistency was estimated according to Cronbach’s alpha internal consistency. An exploratory factor analysis was performed to identify related items and to show construct validity. Correlation coefficients were calculated by the Spearman method.

Results

From the 162 participants 153 were female and 9 male, 119 (73%) had an active job or were students, 21 (13%) were unemployed, 16 (10%) were retired and 6 (4%) were on sick leave.

The mean age was 47 years. The internal consistency value (95% CI) was 0.90 for the overall Finn-FIQ. The factor analysis performed for construct analysis showed that Finn-FIQ was loaded on 4 factors. These factors were loaded on components of ICF and explained 69% of total variance. Significant correlations were obtained between patients own assessments of general well-being and Finn-FIQ total score (r = 0.64 [95% CI 0.53–0.73]) and also between Finn-FIQ total score and HAQ total score (r = 0.56 [95% CI 0.44–0.66]). Finn-FIQ questions had significant correlations with RAND-36 domains.

Conclusion

Finn-FIQ is a valid and feasible instrument to mirror the functioning of FM patients according to its internal consistency, correlation to general well-being, convergent validity and response rate. It covers the main components of the ICF framework hence reflecting the whole spectrum of functioning.

Implications

In our study Finn-FIQ was proven as a valid instrument with Finnish speaking FM patients. Original FIQ and other validated translations have already confirmed their place in fibromyalgia research. After this study Finnish fibromyalgia research can be included in those using the best-known instrument in validated form and native language. Current study showed also Finn-FIQ’s ability to measure functioning of the FM patients, and it had good applicability among Finnish speaking patients. Therefore it can be recommended also for monitoring individual FM patients and their functioning for example during different treatment trials.

Abstract

Background and aims

Restless legs syndrome is a sensorimotor disorder associated with mental health conditions notably depression. Restless legs symptoms and depression are commonly associated with pain. The study investigated the influence of restless legs symptoms on musculoskeletal pain in patients with depression or with increased depressive symptoms.

Methods

A cross-sectional study of primary care patients in the Central Finland Hospital District. The prevalence of restless legs symptoms was studied in patients with depressive symptoms (n = 695) and controls without a psychiatric diagnosis (n = 410) by using a structured questionnaire. The depressive symptoms were evaluated with the Beck Depression Inventory and the psychiatric diagnosis was confirmed by means of a diagnostic interview (MINI). The prevalence and intensity of musculoskeletal pain was captured with form-based questions. A single-question screen for restless legs symptoms was applied.

Results

There was a significant difference in the prevalence of continuous widespread musculoskeletal pain between the three study groups: the controls 4.6% (95% CI: 2.8–7.1), the patients with symptoms of depression without a diagnosis 16.0% (11.7–21.1), and the patients with diagnosed depression 22.1% (18.3–23.3) (p = 0.006 after being adjusted for age, sex, smoking, use of alcohol, education years, body mass index, use of antidepressants, and physical activity, after multiple corrections, all groups were significantly different from each other). Compared with those not having restless legs symptoms, subjects with restless legs symptoms had more often continuous widespread musculoskeletal pain in the control subjects (p = 0.001; 2.3% vs. 10.5%) and in the patients with depressive symptoms without a depression diagnosis (p = 0.024; 9.1 vs. 18.7%) but not in those with diagnosed depression (p = 0.98; 19.5 vs. 19.4%). The restless legs symptoms were associated with the intensity of pain in all groups (p < 0.001).

Conclusions

Restless legs symptoms were related to continuous widespread musculoskeletal pain in subjects without depressive symptoms and in patients with depressive symptoms without a depression diagnosis. Pain intensity was higher in the subjects with restless legs symptoms regardless of depressive symtoms or depression.

Implications

Clinical management of pain in patients with restless legs symptoms should include an increased focus on the prevention and treatment of either conditions.

Abstract

Background and aims

The symptoms of pain and depression often present concomitantly, but little is known as to how the different subtypes of depression affect surgical outcome. The aim of this study was to determine whether there is a difference in outcome after lumbar spine surgery between non-depressed patients and patients with different subtypes of depressive symptoms: non-melancholic (NmDS) and melancholic depression (MDS).

Methods

This was a cross-sectional postal survey. A self-made questionnaire, the Beck Depression Inventory (BDI) and the Oswestery Low Back Disability Questionnaire (ODI) were sent to patients who had undergone lumbar spine surgery in the Oulu University Hospital between June, 2005 and May, 2008. BDI ≤ 10 were further classified into NmDS or MDS.

Results

A total of 537 patients (66%) completed the survey. Of these, 361 (67%) underwent disc surgery, 85 (16%) stabilizing surgery and 91 (17%) decompression. Participants were divided into three groups: BDI< 10 N=324 (60%), NmDS N=153 (29%) and MDS N=60 (11%). The mean ODI (SD) in the BDI<1 0 group was 16 (15), in the NmDS group 36 (15), and in the MDS group 41 (18) (p<0.001). The ODI profiles were different between the groups (p<0.001). Pain was more frequent in depressive patients (88% of MDS, 81% in NmDS and 40% in BDI < 10 patients experienced pain, p<0.001). The intensity of pain and pain-related disability was lowest among the patients in the BDI <10 group and highest among the MDS patients. Regular pain medication was used by 87% of patients in the MDS group, 93% of patients in the NmDS group, and 71% of patients in the BDI< 10 group (p<0.001). Response to pain medication with NRS (0–10) was 5.6 among MDS, 5.8 among NmDS and 6.5 among BDI< 10 patients (p<0.001).

Conclusion

Different types of depressive symptoms are associated with poor outcome after lumbar spine surgery. The outcome was worst in patients suffering from the MDS subtype. This was observed in pain intensity, functional disability and response to pain medication.

Implication

It would be important to evaluate depression pre- and postoperatively. Offering a tailored rehabilitation programme to MDS patients should be considered.

© 2016 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Abstract

Background and purpose

Pulsed radiofrequency (PRF) is widely used for the treatment of chronic pain, although its mechanism of action is not known. The evidence of efficacy of PRF for neuropathic pain (NP) conditions is limited. A double-blind, randomized, sham-controlled parallel study was conducted to evaluate the efficacy and safety of PRF in the treatment of peripheral posttraumatic NP.

Methods

Forty-five patients with peripheral posttraumatic NP in their upper or lower limb were randomly assigned to receive PRF or sham treatment to the injured peripheral nerve (s) causing peripheral posttraumatic NP. Only patients whose pain intensity was at least 5 on numerical rating scale (NRS) 0–10 and who had suffered from their NP for at least 6 months were included. All patients had dynamic mechanical allodynia or pinprick hyperalgesia in their painful area. They had achieved temporary pain relief of at least 50% with a local nerve block performed at a previous visit. The primary efficacy variable was the difference in 3-day mean pain intensity score from the baseline to 3 months. Other variables included response defined as ≥30% reduction in mean pain intensity at 3 months compared to baseline, Neuropathic Pain Scale (NPS) results, health related quality of life (SF-36) and adverse effects. The skin was anesthetized with 1% lidocaine. A radiofrequency needle was introduced through the skin, and then guided to a SMK cannula (52, 100 or 144mm depending on the target nerve) with 4 or 5mm active tip (SMK-C5-4, SMK-C10-5, SMK-C15-5, Radionics®, Burlington, MA, USA). The nerve was located accurately by stimulating at 50 Hz (threshold <0.5 V). Sham treatment or PRF was applied for 120s 1–4 times at each treatment point (Radionics®, Burlington, MA, USA). The total treatment time was up to 8 min. Both patients and clinicians were blinded during the whole treatment and follow-up period.

Results

Forty-three patients were included in the analyses. There was no statistically significant difference between PRF and sham treatment for the primary outcome efficacy variable.

Seven patients (3 in PRF group and 4 in sham treatment group) achieved ≥30% pain relief (difference between groups was not significant). There was no statistically significant difference in the NPS or any dimension of SF-36 between the treatments. Eighteen patients reported adverse effects. They were mild and did not necessitate any treatment. Transient pain was reported by 17 patients, local irritation by 5 patients and local inflammation by 1 patient. There was no significant difference between the groups in the presence of adverse effects.

Conclusions

PRF was well tolerated, but this study failed to show efficacy of PRF over sham treatment for peripheral posttraumatic NP.

Implications

Based on our results, we do not recommend PRF for peripheral posttraumatic NP. More research of the possible use of PRF for various pain conditions is needed to determine its role in the management of prolonged pains.

ABSTRACT

Purpose

To investigate the effect of obesity on outcome in lumbar discectomy.

Methods

A cross-sectional postal survey; a self-made questionnaire, Beck depression inventory IA (BDI IA) and the Oswestry low back disability questionnaire (ODI) were sent to the patients, who had undergone lumbar disc surgery in the Oulu University Hospital between June 2005 and May 2008. Patients were divided into three groups according to BMI: normal, pre-obese and obese. The ODI was also examined in the framework of the international classification of functioning, disability and health (ICF) to investigate its ability to describe various dimensions of functioning (body structure and functions, activities and participation).

Results

The postal survey was sent to 642 patients, of whom 355 (55%) replied. Males dominated in the pre-obese (66%) and obese (62%) groups (p = 0.01). Normal-weighted and pre-obese patients had lower BDI scores compared to obese patients (mean BDI: 8.0, 7.6,11.2, respectively, p = 0.035). Total ODI score was highest in the obese group compared to normal-weighted or pre-obese (20.3,18.6,26.4, respectively, p = 0.011). When ODI was linked to the ICF there were significant differences in all activity domains (mobility, self-care and interpersonal interactions and relationships) and the mobility component of the participation domain between the weight groups.

Conclusions and implications

Obesity has an impact on outcome in lumbar discectomy. Obese patients had higher scores in BDI and ODI indicating mild mood disturbances and moderate functional disability. According to ICF, functional disability of obese patients was observed to some extent in all activity domains. Obese patients will be more frequently present for disc surgery and increased morbidity risk must be recognized. We need a strategy to rehabilitate and activate obese patients pre- and postoperatively.

Abstract

Background and aim

No studies have been published regarding the results of lumbar spine surgery a in population-based setting in Finland. Our objective was to investigate functional capacity and quality of life after lumbar spine surgery in a population-based cohort in Northern Finland, focusing on working-age patients.

Methods

This was a cross-sectional postal survey. Three questionnaires (a self-made questionnaire, the Oswestry Low Back Disability Questionnaire and the SF-36) were sent the patients aged 18-65 years who had undergone lumbar spine surgery due to disc herniation, instability or spinal stenosis in the Oulu University Hospital between June 2005 and May 2008.

Results

The postal survey was sent to 814 patients, of whom 537 patients (66%) replied. Of these, 361 (67%) underwent disc surgery, 85 (16%) stabilizing surgery and 91 (17%) decompression. Pain was absent or present only occasional in 51% in the disc surgery group, whereas it was present daily in 59% in the stabilizing surgery group and in 58% in the decompression group (P < 0.001). Axial pain was slightly more intense than radicular pain. Pain was milder in the disc surgery group compared with the stabilizing surgery and decompression groups: mean (SD) axial pain with 0-10 NRS was 4.0 (2.3), 4.7 (2.4) and 4 (2.3) respectively (P = 0.002) and radicular pain 3.5 (2.6), 4.2 (2.8), 4.5 (2.6) respectively (P < 0.001). The total ODI score (mean, SD) was 20 (17) in the disc surgery group, 35 (17) in the stabilizing surgery group and 32 (17) in the decompression group (P < 0.001). The physical dimension sum score from the SF-was 42 (11) in the disc surgery group and 34 (10) in the stabilizing surgery and decompression grou (P < 0.001). Mental sum scores did not vary significantly between the groups.

Conclusions and Implications

Outcome was good after lumbar disc operations but less favourable after stabilizing surgery and decompression regarding pain, functional capacity and quality of life. Implications. This study offers important information about outcome after lumbar spine surgery in Oulu University Hospital. It also brings out that in Finland we need systematic national spine register, with accurate pre-and postoperative data.

Abstract

Background and aims

Health-related quality of life (HRQoL) assessments have been widely used in pain medicine as they are able to reflect the subjective and multidimensional nature of chronic pain. Studies have shown a consistent impairment in HRQoL in different chronic pain conditions. However, it is not known whether HRQoL is impaired in chronic orofacial pain (OFP). The generic 15D HRQoL instrument has been shown to fare as well as or better than other generic HRQoL instruments in the study of chronic pain. The aim was to investigate HRQoL in patients with chronic OFP using the generic 15D HRQoL instrument. The validity of the instrument was tested by studying the association of the 15D data with pain interference.

Methods

One hundred fifty-one patients (mean age 50 years, SD 15 years, 119 females) were recruited from three tertiary facial pain clinics. HRQoL data of the participants were contrasted with that of an age- and gender- standardized sample of general population by comparing the mean 15D scores and profiles. The data for the general population came from the National Health 2011 Survey representing Finnish population aged 18 years and older. Pain interference was assessed using Brief Pain Inventory. Based on pain interference distribution the participants were divided into tertiles. Statistical comparison between patient and population HRQoL values were performed using Monte-Carlo-type simulations. Statistical significance for the hypothesis of linearity was evaluated by using generalized linear models.

Results

The mean 15D score of OFP patients (0.824, SD 0.113) was statistically significantly lower than that of the age- and gender-standardized general population (0.929, SD 0.019) (p < 0.001). The difference between the patients and the general population was also clinically important, i.e. over the minimum clinically important difference in the 15D score. All mean 15D dimension values were significantly lower compared with the general population values (p < 0.001 for all dimensions). The largest differences were seen in the dimensions of discomfort and symptoms (0.418, SD 0.222 vs. 0.816, SD 0.027), sleeping (0.693, SD 0.258 vs. 0.838, SD 0.029), and vitality (0.702, SD 0.221 vs. 0.884 SD 0.026). There was a statistically significant linear decrease in the 15D dimension values (p < 0.001) with increasing pain interference. The greatest differences were found on the dimensions of discomfort and symptoms, sleeping and vitality.

Conclusions

HRQoL is significantly impaired in patients with chronic OFP. A decrease in the 15D dimension values with increasing pain interference indicated convergent validity between 15D and pain interference.

Implications

The findings suggest that 15D is an appropriate instrument for use in the assessment of HRQoL in OFP patients. By showing the usefulness of the 15D, the present study may encourage further use of generic HRQoL assessments in the study of chronic OFP, and contribute e.g. to the implementation of HRQoL as one of the core outcome measures in future treatment studies on chronic OFP.

Abstract

Background and aims

Musculoskeletal pain is a common symptom and many people even with chronic pain continue to work. The aim of our study is to analyze how musculoskeletal pain affects work wellbeing by comparing work engagement in employees with or without pain, and how pain-related risk of disability is associated with work engagement. In a separate analysis, we also studied, how psychosocial factors are related to work engagement.

Methods

This is a cross-sectional study of Finnish female employees of the city of Pori, Finland (PORi To Aid Against Threats (PORTAAT) study). Data was collected by trained study nurses and self-administrated questionnaires. Work well-being was measured by work engagement using Utrecht Work Engagement Scale (UWES-9) questionnaire and the burden of pain was measured by using the short version of Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ). Study population was divided into four groups: those without pain and the groups with low (I), medium (II) or high (III) ÖMPSQ score, reflecting increasing risk of long term disability due to musculoskeletal pain. The study nurse assessed psychosocial risk factors using defined core questions.

Results

We evaluated 702 female employees, 601 (86%) had suffered from musculoskeletal pain over the past 12 months, whereas 101 (14%) reported no pain at all. Pain was chronic (duration at least 3 months) in 465/601 (77%) subjects. Subjects with musculoskeletal pain were older, had higher BMI and were on sick leave more often than subjects without pain. Of the psychosocial risk factors, depression, type D personality, anxiety and hostility were significantly more common among subjects with musculoskeletal pain. Hypertension and the use of non-steroidal anti-inflammatory drugs were significantly more frequent in the musculoskeletal pain group. Quality of sleep and working capability were significantly better among persons without pain. Average weekly working hours were slightly higher among those with musculoskeletal pain.

In crude analysis, work engagement (UWES-9) was similar in women without pain and those with musculoskeletal pain (4.96 vs. 4.79; p = 0.091). After adjustment for age, education years, BMI, working hours and financial satisfaction, the difference between the groups became statistically significant (p = 0.036). Still, there was no difference between the groups of no-pain and low burden of pain (p = 0.21, after adjustment). Work engagement was significantly lower in the groups of medium (p = 0.024, after adjusted) and high (p < 0.001, after adjustment) burden of pain. Linearity across the Linton tertiles was significant (p < 0.001). In univariate and multivariate ordered logistic regression analyses relating study variables to the work engagement musculoskeletal pain per se did not enter in the model to explain work engagement. Work and family stress, type D personality and duration of sick leave due to pain reduced work engagement, whereas financial satisfaction, moderate and high leisure time physical activity and higher BMI improved it.

Conclusions

Among women with musculoskeletal pain psychosocial and lifestyle factors significantly correlate with work engagement, while the pain itself does not.

Implications

Special attention should be paid to the psychosocial aspects in female employees with musculoskeletal pain to improve work well-being and maintain work ability.

Abstract

Background and aims

Musculoskeletal pain among adolescents is a problem for the patients and their families and has economic consequences for society. The aim of this study is to determine the incidence of prolonged disabling musculoskeletal pain of adolescents among referrals to a pediatric rheumatology outpatient clinic and describe the patient material. The second aim is to find proper screening tools which identifies patients with a risk of pain chronification and to test whether our patients fit the Pediatric Pain Screening Tool (PPST) stratification according to Simons et al.

Methods

We selected adolescent patients with disabling, prolonged, musculoskeletal pain and calculated the incidence. Furthermore, after the patient collection, we adjusted our pain patients to PPST.

Results

The incidence of prolonged musculoskeletal pain patients at our clinic was 42/100,000 patient years (pyrs) (age 13–18; 95% CI: 29–60) during years 2010–2015. A nine-item screening tool by Simons et al. proves to be valid for our patient group and helps to identify those patients who need early, prompt treatment. The functional risk stratification by Simons et al. correlates with our patients’ functional disability.

Conclusions and implications

In order to prevent disability and to target intervention, it is necessary to have proper and rapid screening tools to find the appropriate patients in time.

Abstract

Background and aims

A targeted pain program may prevent the progression and subsequent occurrence of chronic pain in adolescents. This study tested the effectiveness of a new acceptance and commitment therapy -based pain management intervention, using physical and psychological functions as the outcomes. The objective was also to determine whether Pediatric Pain Screening Tool risk profiles function as outcome moderator in the current sample. A valid screening tool would enable the program development.

Methods

Thirty-two consecutive adolescent patients (13–17 years old) with idiopathic recurrent musculoskeletal pain completed the study. The intervention comprised acceptance and commitment therapy-oriented multidisciplinary treatment. Pediatric Pain Screening Tool, pain frequency, functional disability, school attendance, physical endurance, depressive symptoms, and catastrophizing coping style were measured before treatment (baseline) and again at 6 and 12 months after the initiation of treatment. To test the effectiveness of the new program, we also determined whether the original risk classification of each patient remained constant during the intervention.

Results

The intervention was effective for high-risk patients. In particular, the pain frequency decreased, and psychosocial measures improved. In post-intervention, the original risk classification of seven patients in the high-risk category changed to medium-risk. PPST classification acted as a moderator of the outcome of the current program.

Conclusions

The categorization highlighted the need to modify the program content for the medium-risk patients. The categorization is a good tool to screen adolescent patients with pain.

Implications

The results support using the Pediatric Pain Screening Tool in developing rehabilitation program for pediatric musculoskeletal pain patients. According to the result, for adolescent prolonged musculoskeletal pain patients the use of ACT-based intervention program is warranted.