Roger Goucke

Seeing it helps: Movement-related back pain is reduced by visualization of the back during movement

Objectives: The aim of this study was to determine whether visualization of the back influenced parameters of movement-related pain in people with chronic nonspecific low back pain. Methods: We used a randomized cross-over experiment in which 25 participants performed repeated lumbar spine movements under 2 conditions. In the visual feedback condition, patients were able to visualize their back as it moved by the use of mirrors. In the control condition, the mirror was covered so no visualization of the back was possible. Results: The average postmovement pain intensity after participants had moved with visual feedback was less (35.5±22.8 mm) than when they moved without visual feedback (44.7±26.0 mm). This difference was statistically significant (mean difference=9.3, 95% confidence interval: 2.8-15.7 F(1,22)=8.82, P=0.007). The average time to ease after participants had moved with visual feedback was shorter (44.5 s±53.8) than when they moved without visual feedback (94.4 s±80.7). This difference was also statistically significantly (mean difference=49.9, 95% confidence interval: 19.3-80.6, F(1,22)=8.82, P=0.003). Discussion: Patients with chronic nonspecific low back pain reported less increase in pain and faster resolution of pain when moving in an environment that enabled them to visualize their back. This is consistent with emerging research on the use of mirror visual feedback in other long-standing pain problems and suggests that similar lines of inquiry may be worth pursuing in the chronic nonspecific low back pain population.

Identification of neuropathic pain in patients with neck/upper limb pain: Application of a grading system and screening tools

Summary The NeuPSIG grading system was feasible for identification of neuropathic pain in patients with neck/upper limb pain. LANSS and painDETECT diagnostic accuracy was limited. Abstract The Neuropathic Pain Special Interest Group (NeuPSIG) of the International Association for the Study of Pain has proposed a grading system for the presence of neuropathic pain (NeP) using the following categories: no NeP, possible, probable, or definite NeP. To further evaluate this system, we investigated patients with neck/upper limb pain with a suspected nerve lesion, to explore: (i) the clinical application of this grading system; (ii) the suitability of 2 NeP questionnaires (Leeds Assessment of Neuropathic Symptoms and Signs pain scale [LANSS] and the painDETECT questionnaire [PD‐Q]) in identifying NeP in this patient cohort; and (iii) the level of agreement in identifying NeP between the NeuPSIG classification system and 2 NeP questionnaires. Patients (n = 152; age 52 ± 12 years; 53% male) completed the PD‐Q and LANSS questionnaire and underwent a comprehensive clinical examination. The NeuPSIG grading system proved feasible for application in this patient cohort, although it required considerable time and expertise. Both questionnaires failed to identify a large number of patients with clinically classified definite NeP (LANSS sensitivity 22%, specificity 88%; PD‐Q sensitivity 64%, specificity 62%). These lowered sensitivity scores contrast with those from the original PD‐Q and LANSS validation studies and may reflect differences in the clinical characteristics of the study populations. The diagnostic accuracy of LANSS and PD‐Q for the identification of NeP in patients with neck/upper limb pain appears limited.

Development and Testing of a Modified Version of the Brief Pain Inventory for Use in Residential Aged Care Facilities

OBJECTIVES: A two‐phase study was conducted to refine a version of Cleelands Brief Pain Inventory (BPI, Short Form) for use in residential aged care facilities (RACFs).

Developing recommendations for implementing the Australian Pain Society's pain management strategies in residential aged care

Objective:  This study aimed to develop recommendations and a related implementation resource ‘toolkit’ to facilitate implementation of pain management strategies in Australian Residential Aged Care Facilities (RACFs).

Persistent pelvic pain: Rising to the challenge

Persistent pelvic pain is a common condition, with up to 20% of those affected reporting severe pain. Once end organ disease has been assessed, further investigations should be minimised. Persistent pelvic pain as a hyperalgesic neuropathic pain condition must be considered in the differential diagnosis. A multidisciplinary assessment and management plan, prepared by the co‐ordinating gynaecologist in consultation with the general practitioner, physiotherapist and psychologist (with gastroenterological, urological and pain medicine specialist input as deemed appropriate), is strongly recommended.