دورية أكاديمية
أعرض في EDS

A novel tool for the assessment of pain: validation in low back pain.

التفاصيل البيبلوغرافية
العنوان: A novel tool for the assessment of pain: validation in low back pain.
المؤلفون: Joachim Scholz, Richard J Mannion, Daniela E Hord, Robert S Griffin, Bhupendra Rawal, Hui Zheng, Daniel Scoffings, Amanda Phillips, Jianli Guo, Rodney J C Laing, Salahadin Abdi, Isabelle Decosterd, Clifford J Woolf
المصدر: PLoS Medicine, Vol 6, Iss 4, p e1000047 (2009)
بيانات النشر: Public Library of Science (PLoS), 2009.
سنة النشر: 2009
المجموعة: LCC:Medicine
مصطلحات موضوعية: Medicine
الوصف: BACKGROUND: Adequate pain assessment is critical for evaluating the efficacy of analgesic treatment in clinical practice and during the development of new therapies. Yet the currently used scores of global pain intensity fail to reflect the diversity of pain manifestations and the complexity of underlying biological mechanisms. We have developed a tool for a standardized assessment of pain-related symptoms and signs that differentiates pain phenotypes independent of etiology. METHODS AND FINDINGS: Using a structured interview (16 questions) and a standardized bedside examination (23 tests), we prospectively assessed symptoms and signs in 130 patients with peripheral neuropathic pain caused by diabetic polyneuropathy, postherpetic neuralgia, or radicular low back pain (LBP), and in 57 patients with non-neuropathic (axial) LBP. A hierarchical cluster analysis revealed distinct association patterns of symptoms and signs (pain subtypes) that characterized six subgroups of patients with neuropathic pain and two subgroups of patients with non-neuropathic pain. Using a classification tree analysis, we identified the most discriminatory assessment items for the identification of pain subtypes. We combined these six interview questions and ten physical tests in a pain assessment tool that we named Standardized Evaluation of Pain (StEP). We validated StEP for the distinction between radicular and axial LBP in an independent group of 137 patients. StEP identified patients with radicular pain with high sensitivity (92%; 95% confidence interval [CI] 83%-97%) and specificity (97%; 95% CI 89%-100%). The diagnostic accuracy of StEP exceeded that of a dedicated screening tool for neuropathic pain and spinal magnetic resonance imaging. In addition, we were able to reproduce subtypes of radicular and axial LBP, underscoring the utility of StEP for discerning distinct constellations of symptoms and signs. CONCLUSIONS: We present a novel method of identifying pain subtypes that we believe reflect underlying pain mechanisms. We demonstrate that this new approach to pain assessment helps separate radicular from axial back pain. Beyond diagnostic utility, a standardized differentiation of pain subtypes that is independent of disease etiology may offer a unique opportunity to improve targeted analgesic treatment.
نوع الوثيقة: article
وصف الملف: electronic resource
اللغة: English
تدمد: 1549-1277
1549-1676
Relation: http://europepmc.org/articles/PMC2661253?pdf=render; https://doaj.org/toc/1549-1277; https://doaj.org/toc/1549-1676
DOI: 10.1371/journal.pmed.1000047
URL الوصول: https://doaj.org/article/20ee67b40969488884895284fd497959
رقم الأكسشن: edsdoj.20ee67b40969488884895284fd497959
قاعدة البيانات: Directory of Open Access Journals
الوصف
تدمد:15491277
15491676
DOI:10.1371/journal.pmed.1000047