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      Clinically significant changes in pain along the Pain Intensity Numerical Rating Scale in patients with chronic low back pain

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          Abstract

          Low back pain (LBP) is the most common cause of chronic pain. Numerous clinical scales are available for evaluating pain, but their objective criteria in the management of LBP patients remain unclear. This study aimed to determine an objective cutoff value for a change in the Pain Intensity Numerical Rating Scale (ΔPI-NRS) three months after LBP treatment. Its utility was compared with changes in six commonly used clinical scales in LBP patients: Pain Disability Assessment Scale (PDAS), Pain Self-Efficacy Questionnaire (PSEC), Pain Catastrophizing Scale (PCS), Athens Insomnia Scale (AIS), EuroQoL 5 Dimension (EQ5D), and Locomo 25. We included 161 LBP patients treated in two representative pain management centers. Patients were partitioned into two groups based on patient’s global impression of change (PGIC) three months after treatment: satisfied (PGIC = 1, 2) and unsatisfied (3–7). Multivariate logistic regression analysis was performed to explore relevant scales in distinguishing the two groups. We found ΔPI-NRS to be most closely associated with PGIC status regardless of pre-treatment pain intensity, followed by ΔEQ5D, ΔPDAS, ΔPSEC, and ΔPCS. The ΔPI-NRS cutoff value for distinguishing the PGIC status was determined by ROC analysis to be 1.3–1.8 depending on pre-treatment PI-NRS, which was rounded up to ΔPI-NRS = 2 for general use. Spearman’s correlation coefficient revealed close relationships between ΔPI-NRS and the six other clinical scales. Therefore, we determined cutoff values of these scales in distinguishing the status of ΔPI-NRS≥2 vs. ΔPI-NRS<2 to be as follows: ΔPDAS, 6.71; ΔPSEC, 6.48; ΔPCS, 6.48; ΔAIS, 1.91; ΔEQ5D, 0.08; and ΔLocomo 25, 9.31. These can be used as definitive indicator of therapeutic outcome in the management of chronic LBP patients.

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          Measurement of health status. Ascertaining the minimal clinically important difference.

          In recent years quality of life instruments have been featured as primary outcomes in many randomized trials. One of the challenges facing the investigator using such measures is determining the significance of any differences observed, and communicating that significance to clinicians who will be applying the trial results. We have developed an approach to elucidating the significance of changes in score in quality of life instruments by comparing them to global ratings of change. Using this approach we have established a plausible range within which the minimal clinically important difference (MCID) falls. In three studies in which instruments measuring dyspnea, fatigue, and emotional function in patients with chronic heart and lung disease were applied the MCID was represented by mean change in score of approximately 0.5 per item, when responses were presented on a seven point Likert scale. Furthermore, we have established ranges for changes in questionnaire scores that correspond to moderate and large changes in the domains of interest. This information will be useful in interpreting questionnaire scores, both in individuals and in groups of patients participating in controlled trials, and in the planning of new trials.
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            Theoretical perspectives on the relation between catastrophizing and pain.

            The tendency to "catastrophize" during painful stimulation contributes to more intense pain experience and increased emotional distress. Catastrophizing has been broadly conceived as an exaggerated negative "mental set" brought to bear during painful experiences. Although findings have been consistent in showing a relation between catastrophizing and pain, research in this area has proceeded in the relative absence of a guiding theoretical framework. This article reviews the literature on the relation between catastrophizing and pain and examines the relative strengths and limitations of different theoretical models that could be advanced to account for the pattern of available findings. The article evaluates the explanatory power of a schema activation model, an appraisal model, an attention model, and a communal coping model of pain perception. It is suggested that catastrophizing might best be viewed from the perspective of hierarchical levels of analysis, where social factors and social goals may play a role in the development and maintenance of catastrophizing, whereas appraisal-related processes may point to the mechanisms that link catastrophizing to pain experience. Directions for future research are suggested.
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              Validity of the Brief Pain Inventory for Use in Documenting the Outcomes of Patients With Noncancer Pain

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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: Investigation
                Role: Data curationRole: Project administration
                Role: Investigation
                Role: Data curation
                Role: Data curation
                Role: Data curationRole: Formal analysisRole: Project administrationRole: Supervision
                Role: Data curation
                Role: Data curationRole: InvestigationRole: Methodology
                Role: Data curationRole: Investigation
                Role: Data curationRole: InvestigationRole: Project administration
                Role: ConceptualizationRole: Data curation
                Role: Data curation
                Role: Data curation
                Role: Funding acquisitionRole: InvestigationRole: Project administration
                Role: Data curationRole: InvestigationRole: Project administrationRole: SupervisionRole: Validation
                Role: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administration
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                3 March 2020
                2020
                : 15
                : 3
                : e0229228
                Affiliations
                [1 ] Department of Orthopaedics Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
                [2 ] Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi, Japan
                [3 ] Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Aichi, Japan
                [4 ] Department of Pain Data Management, Aichi Medical University, Nagakute, Japan
                [5 ] Department of Anesthesiology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
                [6 ] Department of Psychiatry, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
                [7 ] Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi, Japan
                [8 ] Department of Orthopedics Surgery, Yamaguchi Rosai Hospital, Yamaguchi, Japan
                Cleveland Clinic, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-3156-0591
                http://orcid.org/0000-0002-7227-3695
                http://orcid.org/0000-0003-3774-0558
                Article
                PONE-D-19-31939
                10.1371/journal.pone.0229228
                7053735
                32126108
                c1e49788-61e5-4970-8e67-edbfd321b9f7
                © 2020 Suzuki et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 17 November 2019
                : 31 January 2020
                Page count
                Figures: 4, Tables: 6, Pages: 16
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Diagnostic Medicine
                Signs and Symptoms
                Pain
                Lower Back Pain
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Signs and Symptoms
                Pain
                Lower Back Pain
                Medicine and Health Sciences
                Pain Management
                Medicine and Health Sciences
                Health Care
                Patients
                Medicine and Health Sciences
                Neurology
                Sleep Disorders
                Dyssomnias
                Insomnia
                Biology and Life Sciences
                Psychology
                Emotions
                Anxiety
                Social Sciences
                Psychology
                Emotions
                Anxiety
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Mood Disorders
                Depression
                Medicine and Health Sciences
                Neurology
                Sleep Disorders
                Medicine and Health Sciences
                Public and Occupational Health
                Disabilities
                Custom metadata
                All relevant data are within the manuscript and its Supporting Information files.

                Uncategorized
                Uncategorized

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