Marius A. Kemler

The Impact of Chronic Pain on Life in the Household

To study what happens in a family where one member suffers from chronic pain, we quantitatively assessed the effect of chronic pain resulting from complex regional pain syndrome type 1 (CRPS) on 1) employment status, 2) time allocation, 3) additional domestic help, and 4) out-of-pocket expenses of Dutch patients (n = 50) and their spouses (n = 43). This study is the first to measure the effect of chronic pain on time allocation by means of a diary assessment technique. The results were compared with normative values for the Dutch population overall. In households containing a male patient, the total employment full time equivalent (FTE) decreased by 47% (P = 0.05), with the result that the mean household income decreased by

Health-related quality of life in chronic refractory reflex sympathetic dystrophy (complex regional pain syndrome type I)

4,000 (P = 0.01). In those with a female patient, there was a reduction in FTE of 29% (P < 0.05), causing a decrease of the mean household income by

Diagnosing sensory abnormalities with either normal values or values from contralateral skin: Comparison of two approaches in complex regional pain syndrome I

2,000 (p < 0.001). As compared with controls, patients were found to spend less time on paid employment, and to invest more time in household maintenance and housekeeping. Of 50 patients, 35 received a mean of 4.5 hours per week of domestic help. The mean out-of-pocket expenses related to CRPS amounted

Relapsing ulcerative colitis associated with spinal cord stimulation.

1,350 per patient per year. Spouses were forced to invest more time on housekeeping and household maintenance, which resulted in less time for personal needs and leisure activities. There were only small differences in time allocation between cases where the sufferer was male or female and, similarly, only minor variation between hand-affected or foot-affected patients. Households with either male or hand-affected patients did prove to have higher out-of-pocket expenses as compared with households containing female or foot-affected patients. Those containing female or hand-affected patients required more domestic help than households either with male or foot-affected patients. The present study demonstrates that chronic pain due to CRPS has a profound impact on many aspects of the lives of both patients and their spouses.

Thermal thresholds in complex regional pain syndrome type I: sensitivity and repeatability of the methods of limits and levels

The aim of this study was to find out which aspects of health-related quality of life (HRQL), measured with generic instruments, are important to patients with reflex sympathetic dystrophy (RSD) affecting the arm or leg. The Sickness Impact Profile 68 (SIP68), the Nottingham Health Profile (NHP), and the EuroQol-5D (EQ-5D) were completed by 54 patients suffering from RSD (33 arm, 21 leg). The scores of the three questionnaires for patients with an affected arm or leg are presented. Aspects relevant to patients with RSD of the arm include the NHP1 dimensions of pain (mean score: 63%), sleep (58%), and energy (45%), and the EQ-5D dimensions of pain (67% extreme), usual activities (76% some problems), and self care (76% some problems). Aspects relevant to patients with RSD of the leg include the SIP68 dimensions of social behavior (51%) and mobility control (46%), the NHP 1 dimensions of pain (mean score: 86%), mobility (54%), energy (53%), and sleep (52%), and the EQ-5D dimensions of mobility (81% some problems), pain (71% extreme), and usual activities (71% some problems). The study showed that applying generic HRQL instruments and measuring treatment effect with the dimensions scoring high provides a responsive instrument which at the same time gains information concerning dimensions not maximally responsive to a specific disease. Some dimensions which, on the basis of their label, might be expected to be important were found not to be so. After using this approach, clinicians can more directly focus treatment on specific areas that have been shown to affect a patients HRQL.

HLA-DQ1 associated with reflex sympathetic dystrophy

BACKGROUNDnTo diagnose sensory abnormalities, patient values can be compared with values of the general population (absolute approach) or to values measured at contralateral homologous skin (relative approach). The current study gives normal values for both approaches and compares the advantages of each method by applying the technique to patients with complex regional pain syndrome type I (CRPS I).nnnMETHODSnIn 50 healthy control subjects, sensory and pain thresholds were measured for pressure, warmth, and cold on both wrists and both feet. In 53 patients with unilateral CRPS I (33 hand, 20 foot), the same assessments were conducted twice, at an interval of 1 month.nnnRESULTSnIn control subjects, contralateral homologous sides have approximately the same sensitivity, supporting the validity of the relative approach in patients. Hypoesthesia and allodynia can be diagnosed by either the absolute or relative approach, whereas hyperesthesia and hypoalgesia can only be identified with the relative approach. The two approaches obtain different results in 20% of cases. Age, gender, and subject criteria may influence the absolute but not the relative approach. Both approaches are comparable with regard to reproducibility. Frequency distributions of sensory abnormalities in chronic CRPS I are presented. The most frequent diagnoses were cold allodynia and mechanical hypoesthesia and allodynia.nnnCONCLUSIONSnTo divide sensory characteristics into a binary classification of normal and abnormal, the relative approach is the best choice, with the exception of cases in which the contralateral homologous side is absent or affected by disease. The authors recommend the relative approach for both research and clinical purposes.

Spinal cord stimulation in complex regional pain syndrome: cervical and lumbar devices are comparably effective

Spinal cord stimulation is an increasingly popular form of pain treatment. An electrode positioned on the dorsal aspect of the spinal cord at the level of the nerve roots from the painful area stimulates the spinal cord. Current from the electrode is supplied by a pulse generator in the lower anterior abdominal wall. Spinal cord stimulation has not previously been associated with ulcerative colitis. A man with left-sided ulcerative colitis in remission experienced two successive relapses related to the use of a spinal cord stimulation system. After removal of the system, remission returned and remained. This case suggests that electrical current may influence the course of ulcerative colitis.

Which patients with chronic reflex sympathetic dystrophy are most likely to benefit from physical therapy

OBJECTIVESnTo study whether the method of levels (MLE) or the method of limits (MLI) is preferable as a method of measuring thermal perception thresholds in patients with complex regional pain syndrome type I (CRPS I).nnnMETHODSnPerception thresholds for warmth and cold were measured twice, with both MLE and MLI, at a 1 month interval, both at unaffected and affected wrists (n=33) or feet (n=20) of patients with CRPS I of one extremity.nnnRESULTSn(1) Sensitivity for pathology was equal for both methods. (2) The agreement between thresholds measured by both methods was low at all locations, except for the unaffected wrist. Since thresholds measured with the MLI always contain reaction time artefacts, this lack of agreement favours the MLE. (3) At both unaffected and affected wrists, the MLE showed significantly better coefficients of repeatability as compared to the MLI for both sensations. However, at both unaffected and affected feet, there was no preference for either method as far as threshold measurement repeatability was concerned.nnnCONCLUSIONSnAbnormal thermal perception thresholds occurred in 20% (foot) to 36% (wrist) of the CRPS I patients on the affected side and in 15% (foot, wrist) on the unaffected side. The MLE is considered to be the preferable method to assess thermal perception thresholds in CRPS I.