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Objective. The objective of this preliminary investigation was to evaluate the test–retest reliability of a new pain assessment method referred to as 3-D pain mapping. Methods. In Study 1, 101 chronic noncancer pain patients from four sites reported their pain using the method on two occasions (separated by approximately 10 days). The patients marked intensity, surface location, and depth of pain on a 3-D computer display of a male or female body. The model body could be rotated in order to mark multiple pain locations. In Study 2, 25 patients from a single site were tested with a revised version of the mapping program used in Study 1. Each patient gave ratings on two occasions separated by approximately 1 week. Results. In Study 1, the intra-class correlations of the 3-D pain mapping measures were moderate to high for maximum pain intensity (0.73), vertical location of the point of maximum pain (0.94), and the number of pain marks (0.84). Correlations were low for the horizontal location of the point of maximum pain (0.56) and for the depth of pain (0.50). In Study 2, using the revised program, intra-class correlations were moderate for pain intensity (0.76), and high for the vertical (0.99) and horizontal (0.98) locations of the point of maximum pain, number of pain marks (0.89), and the depth of pain (0.84). Conclusion. Three-dimensional pain mapping enables patients to report the location and intensity of their pain on all parts of the body, and such ratings are highly reliable. Future studies are needed to determine whether the clinical value of this method can improve the accuracy of pain diagnoses and the quality of pain management.

Objective. This descriptive study compares outcome measures of a computerized assessment of pain, emotional distress, and quality of life between chronic noncancer pain patients who have received an implantable device (spinal cord stimulator or intrathecal pump; N = 143) and those who have not received a device (N = 130). Methods. Each patient marked the location of their pain on a body diagram and rated pain intensity, emotional distress, and impact of their pain on mood, sleep, and quality of life using a computerized pain assessment program. An electronic version of the Hospital Anxiety and Depression Scale (HADS) also was administered. Results. No significant differences were found on the pain variables between the two groups. Patients with an implantable device gave lower ratings (less impact) on emotional distress (p

Opioid analgesics play an important role in the management of acute and chronic pain. As such, there has been a dramatic increase in opioid prescribing over the past two decades. There are currently many practitioners who have serious concerns with prescribing because of fear of side effects, tolerability, addiction, colleague criticism, and legal sanctions and both the efficacy and safety of the use of opioids for acute and chronic pain have recently been subjected to increasing scrutiny (J Pain Symptom Manage 20(4):293–307, 2000; J Pain Symptom Manage 11(4):203–217, 1996).

This investigation determined the psychometric properties and acceptability of an animated face scale presented on a hand-held computer as a means to measure pediatric pain and mood. In study 1, 79 hospitalized, pediatric patients indicated their levels of pain by adjusting the expression of an animated cartoon face. The first objective was to determine feasibility, concurrent validity, and acceptability of the method. All patients were tested both with the Computer Face Scale and the poster format of the Wong-Baker Faces Scale. A second objective was to evaluate test-retest reliability of the method. In study 2, 50 hospitalized, pediatric patients were tested on 2 occasions, but in this case the patients used the Computer Face Scale to indicate both their pain (how much they hurt) and their mood (how they felt). Children in study 1 were able to use the Computer Face Scale to express relative amounts of pain/hurt; the method showed concurrent validity with the Wong-Baker Face Scale; and most children expressed a preference for the Computer Face Scale. The method also showed adequate test-retest reliability. In study 2, adequate test-retest reliability was demonstrated for ratings of both pain and mood. Perspective The Computer Face Scale allows the health provider to obtain reliable and valid measures of pediatric pain and mood. The method can be understood and used by children as young as 3 years and is appropriate for use with adults.

Background. The Web not only can play a role in helping patients learn about their chronic pain, but can also be a source of misleading or untrue information. This study evaluates the quality of Internet information available concerning chronic pain at different sites, and determines the relation between quality and the source and character of the Websites. Methods. A survey was conducted of patients seen at the Pain Management Center at Dartmouth-Hitchcock Medical Center (DHMC). Patients with access to the Internet identified the five most common keywords they used to look up information: pain, chronic pain, back pain, arthritis, and fibromyalgia. A focus group of pain clinicians at DHMC then chose the quality criteria to evaluate Websites. The criteria consisted of 16 items in five domains: etiology, diagnosis, goals of treatment, treatment options, and substance abuse. The first two pages of links displayed by each of three major search engines then were assessed for quality. Results. A total of 240 Websites were evaluated. The mean score, the Quality Website Index (QWI), was 2.17 (SD = 3.3), (range from −16 [poorest] to +16 [best]). The overall quality of this group of Websites is rather poor, although there were several excellent sites. Websites located on the main search page had a significantly higher score than those in the sponsored section, and Websites based on standards had a significantly higher score than those that were not. Conclusion. Based on QWI scores, clinicians can recommend chronic pain Websites to provide their patients with accurate and pertinent information.

Purpose. To determine the efficacy of community-based, culturally tailored exercise intervention on the moderate and vigorous physical activity and physiologic outcomes of low-income Latino women (Latinas). Design. A randomized trial contrasted safety education to an aerobic dance intervention. Setting. Interventions were held in a “store-front” exercise site near a community clinic. Subjects. Sedentary low-income Latinas (N = 151; 18—55 years; 70% overweight/obese) were recruited. Retention was 91% for follow-up measures. Intervention. Three sessions per week of supervised aerobic dance were provided for 6 months. Controls attended 18 safety education sessions over 6 months. Measures. Physical activity and aerobic fitness (VO2max) were primary outcomes. Results. Participants in the exercise group reported more vigorous exercise (p < .001) and walking (p = .005) at post-test than controls. Aerobic dance and unsupervised activity resulted in a five-fold greater increase in relative VO2max compared with controls (p < .001). Although exercise and fitness decreased at follow-up, vigorous exercise (p = .001) and relative VO2max (p < .001) remained higher in the exercise group, suggesting maintenance at 1 year. Conclusion. Culturally tailored aerobic dance can increase vigorous physical activity, possibly generalizing to walking, and the combination can improve cardiorespiratory fitness in low-income, overweight, sedentary Latinas.

Commencing March, 2007, patients and clinicians in the DHMC Pain Center completed an Internet-based survey instrument to improve the care provided to patients and to be used for quality improvement, outcomes analysis, and research. Data acquired from patients included a personal summary, work disability history, health history, health habits survey, review of systems, and a history of present illness. For the Pain Center, the Brief Pain Inventory (BPI), SF-12v2, Screener for Opioid Abuse in Pain Patients (SOAPP), and Oswestry Disability Index (ODI) were acquired from patients. The patient survey data was made available to clinicians before the patients were seen. Clinician survey information included opioid use, an aberrant behavior survey (Modified PAD-T), treatment provided and diagnosis, as well as clinician opioid suitability data. Over a six-month period, patients completed surveys at 74.8% of their visits for a total of 3,631 surveys. The average time to complete surveys was 33 minutes. Clinicians completed surveys at 62% of their encounters for a total of 2,942 surveys. Preliminary data analysis showed that at initial versus follow-up visits there was no difference between the: Mental Component Score of the SF-12v2 (45.2 v. 45.5); the Physical Component Score of the SF-12v2 (30.8 v. 30.1); the ODI (41.8 v. 44.7); the BPI Interference Score (6.6 v. 6.4); or the BPI Severity Score (6.6 v. 6.5). Combined household income of patients seen in our center was less than $15,999 for 29.6% of our patients; $16,000$49,999 for 32.7%; $50,000$99,999 for 16.4%; $100,000$149,999 for 3.8%; $150,000$199,999 for 1.8%; “Don’t know” for 3.5%, and; “other” for 1%. No correlations have yet been calculated. To our knowledge, this is the first time large quantities of patientand clinician-generated information has been collected electronically for analysis and presented real-time to clinicians before patient encounters. Partial funding from Medtronic.