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Objective. To evaluate current opioid prescribing patterns nationally and regionally across several northern New England states and compare with prescription data on an institutional level over a twoyear period, between 2013 and 2014. Design, Setting, and Subjects. The IMS Health National Prescription Audit (NPA) database was used to obtain prescription data from US retail pharmacies between 2013 and 2014. Methods. Our study compared noninjectable opioid dispensing between two time periods: January-June 2013 and July-December 2014. Opioid prescription data were obtained nationally and in New Hampshire, Vermont, Maine, and Massachusetts. Institutional prescription data were supplied by Dartmouth Hitchcock Medical Center (DHMC) and University of Vermont Medical Center (UVMC) pharmacies. Results. There was a 3.4% (P50.81) decrease in opioid prescriptions filled nationally. Among New England states, opioid prescribing decreased in Maine (25.20%, P50.72), Massachusetts (24.4%, P50.78), and Vermont (22.2%, P50.89) but increased in New Hampshire by 1.3% (P50.94). Examination of local institutional opioid utilization revealed a 13.6% decline in prescriptions filled at UVMC, and only a 0.4% decrease at DHMC. Conclusions. The review of opioid prescriptions filled in 2013-14 suggests that national opioid utilization may be reaching a plateau. Initiatives such as prescription monitoring programs, prescriber opioid education, addiction treatment programs, public addiction awareness, and availability of medical cannabis may play a role in interstate variability of opioid use. National and regional data served as a benchmark for local institutional comparison, laying groundwork for efforts to explore areas where opioids can be prescribed more judiciously. [ABSTRACT FROM AUTHOR]

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. 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. 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). 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the concurrent validity of the short form of an interactive computerized quality of life (ICQOL-SF) measure for patients with chronic pain. Methods. The ICQOL-SF, consisting of one global and four separate domains of quality of life, was administered to 300 chronic pain patients in two pain centers. Participants also completed the full 21-item interactive computerized quality of life (ICQOL) program, a computerized version of the World Health Organization Quality of Life Scale (WHOQOL-BREF), and a computerized assessment of pain (CAP) program. In a second study, an independent group of 336 chronic pain patients completed the ICQOL-SF, the WHOQOL-BREF, and the CAP. Results. The ICQOL-SF in both studies demonstrated adequate concurrent validity with the WHOQOL-BREF ( r = 0.75) and the CAP ( r = 0.84). The five-item ICQOL-SF was also highly correlated with the full ICQOL ( r = 0.90). Surprisingly, older individuals with more formal education and longer pain duration reported better quality of life. Number of past surgeries was negatively correlated with quality of life. Conclusions. The five-item short-form interactive computerized method to assess quality of life demonstrates adequate concurrent validity and would be a useful, brief software measure in the assessment of persons with chronic pain. Additional studies are needed to determine the reliability and sensitivity to change of the ICQOL-SF. [ABSTRACT FROM AUTHOR]

Objective. This monograph is intended to clarify the clinical problem of chronic pain in cancer patients. Design. A pertinent literature review on chronic pain syndromes in cancer patients was undertaken using Medline. Further, the treatment strategies for cancer versus chronic pain are contrasted and clarified. Results. With increasing cancer survivorship come new challenges in patient care. In the United States, the cancer-related death rate has dropped by 1.1% per year from 1993–2002. Seventy-five percent of children and two out of three adults will survive cancer, whereas 50 years ago just one out of four survived. The net effect of these trends and opportunities is a large and rapidly growing population of persons living longer with cancer and/or as cancer survivors. While agreement exists on the best strategies for assessment and treatment of most acute cancer pain syndromes, little consensus exists on the treatment of chronic pain in the patient with slowly progressive cancer or the cancer survivor. Conclusions. The landscape of “cancer pain” is shifting quickly into a chronic pain situation in many instances, thereby blurring previous lines of distinction in treatment strategies most suited for “chronic” versus “malignant” pain. Adopting chronic pain treatment strategies including pharmacologic and other pain control techniques, rehabilitation care, and psychological coping strategies may lead to optimal outcomes. Lastly, as cancer evolves into a chronic illness, with co-morbid conditions, recurrent cancer, and treatment toxicities from repeated antineoplastic therapies, pain management challenges in the oncologic patient continue to increase in complexity. [ABSTRACT FROM AUTHOR]

Objective. To investigate whether grouping of patients with back pain into similar behavioral patient profiles using SF-36 scores is predictive of outcome following 1-year treatment in a multidisciplinary spine center beginning with referral for epidural steroid injection. Design. A prospective observational study was conducted on 81 consecutive patients selected for epidural steroid injections by independent physicians following common institutional criteria. Each patient completed a baseline SF-36 questionnaire as well as a numerical response pain scale. The initial SF-36 data were used to place each patient into one of three subgroups (Highly Functional, Emotional Adapters, and Dysfunctional). Follow-up SF-36 and numerical response pain scale questionnaires were completed by the patients at 1 month and 12 months following the initial epidural steroid injection. Results. Results revealed significant improvement among all three patient subgroups following multidisciplinary treatment at both 1 month and 12 months. Few differences in outcome occurred among the subgroups. Conclusion. The SF-36-determined subgroups did not predict response to a multidisciplinary pain clinic. All three subgroups showed similar improvement following treatment. [ABSTRACT FROM AUTHOR]

. Computerized software holds the potential for the novel assessment of the pain experience of patients with chronic pain not available through traditional paper-and-pencil methods. The aim of this study was to test the feasibility and discriminant validity of a dynamic computer-administered program for the assessment of pain. . Three computer-administered programs were created to assess the intensity (dynamic visual analog scale DVAS]), character (dynamic verbal ratings), and location (dynamic pain drawings) of pain. The programs were administered to 115 chronic pain patients recruited from a hospital-based pain management program and 115 age- and gender-matched healthy individuals without pain. The healthy controls were instructed to respond as if they had chronic pain. . Analyses showed pain patient DVAS pain intensity ratings to be significantly higher than ratings by the healthy group. Patients selected more words in describing their pain, rated those words higher, and marked significantly more pain locations than the comparison group. However, no differences were found in the DVAS ratings of emotional impact between patients and healthy individuals. . Chronic pain patients were shown to differ from healthy individuals in their assessments of degree of pain intensity and pain location with the use of a novel computerized pain assessment program. Although further investigations are needed, these initial findings support the use of computer methods for the effective assessment of pain. [ABSTRACT FROM AUTHOR]

ABSTRACT objective. The purpose of this study was to describe the reliability and validity of an interac- tive computer method that assesses the quality of life of patients in chronic pain and healthy individuals. methods. A software program to assess 21 aspects of quality of life was administered to 88 pain patients on two occasions separated by an average of 30 days. Comparison data were obtained from 105 healthy individuals retested after an average of 16 days. results. For both groups, moderate test-retest correlations occurred for mean ratings based on an aggregation of data for all variables, single global ratings, and single ratings of individual variables. Patients in chronic pain scored significantly lower on all quality of life variables than did healthy individuals. High correlations were obtained between mean ratings from the present study and those from an earlier investigation using the same method. conclusions. The interactive computer method is both reliable and valid as a means to assess quality of life for patients in chronic pain as well as for healthy individuals. [ABSTRACT FROM AUTHOR]

Objective. This study presents information on the development of an interactive computer-based rating method of quality of life that assesses the multidimensional impact of chronic pain on the individual. Method. A software program assessing 20 categories of quality of life was created and administered to 103 chronic pain patients. Comparison data were obtained from 103 matched healthy controls. Results. High variability was found among pain patients in their ratings of quality of life, and pain patients rated all categories lower than controls. Three groups emerged from a cluster analysis of the data reflecting high, mixed, and low ratings of satisfaction with quality of life. Conclusions. The rating method was convenient, was easy for the patient to understand, and took very little time to administer. Further investigation of the validity and reliability of this tool is needed. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue including one by Arthur Stone Joan Broaderic on the real time data collection for pain and another by Gilbert Fanciullo about a computerized method to assess paint in children.

Objective. The primary objective of this study was to determine initial psychometric properties and feasibility of a new Computer Face Scale for measuring pediatric pain. Drawbacks to current measurement tools include a lack of continuous variables, suboptimal mode of implementation, and difficulty interpreting results. A computer method of pediatric pain measurement is presented that addresses these problems. Basic psychometric properties, feasibility, and children’s preference when compared with Wong-Baker Faces Scale were determined. Methods. Fifty-four hospitalized, pediatric inpatients were tested using both the Computer Face Scale and the Wong-Baker Faces Scale. An additional 30 children (not hospitalized) were tested using only the Computer Face Scale. Results. Both hospitalized and nonhospitalized children between the ages of 3 and 17 years of age are able to use the Computer Face Scale to express relative amounts of pain/hurt and happiness. The Computer Face Scale shows acceptable psychometric properties and is preferred by most children. Conclusions. The Computer Face Scale offers advantages over traditional pediatric pain measurement tools. The opportunity for real time review, electronic and time-stamped recording, electronic display, and temporal comparisons of reports affords the potential for improvement in pediatric pain assessment and treatment. [ABSTRACT FROM AUTHOR]

Objective. In order to establish a diagnosis of chronic pain, emphasis is placed on a patient’s report of the pain’s intensity, location, and character. The aim of this study was to evaluate the feasibility of a computer assessment method to collect self-reports of pain that were then used in discriminant analyses to distinguish among chronic pain diagnoses. Methods. A convenience sample of 511 patients from two university-based pain clinics completed a computer pain assessment battery that elicited demographic information, pain drawings, pain and emotion intensity ratings, and intensity ratings of verbal descriptors. Patients classified themselves into one of six chronic pain diagnoses. Discriminant analyses were performed in an attempt to identify the unique features of patients’ pain experience associated with each of the diagnostic categories. Results. Pain drawings successfully classified patients into three of the diagnostic categories (back, head, and neck pain). In a second analysis, two pain descriptors (cramping and stabbing) separated rheumatoid arthritis patients from those with either fibromyalgia or neural pain. One descriptor of pain (cramping) and one descriptor of emotion (frustration) together distinguished between fibromyalgia and neural pain. Conclusions. 1) Computer assessment of a range of patient symptoms is feasible in the pain clinic. 2) Discriminant analysis based on pain drawings can distinguish among patient-reported diagnoses of back pain, headache, and neck pain. 3) Discriminant analysis based on three verbal descriptors can help to distinguish among diagnoses of fibromyalgia, neuralgia, and rheumatoid arthritis. 4) However, in general, most computerized descriptive information is not useful in distinguishing differences among pain patient diagnostic groups. [ABSTRACT FROM AUTHOR]

Pain is a complex phenomenon lacking a well-defined paradigm for diagnosis and management across medical disciplines. This is due in part to inconsistencies in the assessment of pain as well as in the measurement of related social and psychological states. Efforts to evaluate and measure pain through objective tests have been hindered by challenges such as methodological differences in data acquisition, and the lack of common, universally accepted information systems. Physicians and hospital administrators have expressed mixed reactions to the costs that inevitably accompany advances in medical technology. Nonetheless, computer systems are currently being developed for use in the quantitative assessment and management of pain, which can advance our understanding of the public health impact of pain, improve the care individual patients receive, and educate providers. The description of an interdisciplinary, integrated, health survey system illustrates the approach and highlights the advantages of using information technology in pain evaluation and management. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which emphasizes on the increasing incidence and burden of chronic cancer-related pain syndromes.