To the Editor: I read with interest the special article by Mackin et al.1 This article, produced by nine members of the AAN Ethics, Law and Humanities Committee, stated the following: “Neurologists should provide adequate evaluation … personally or through timely referral,” be “educated about chronic pain,” “consider alternative methods of analgesia,” “keep adequate records,” and “understand the law.” The article adds nothing to an area that badly needs attention. I often encounter patients with unexplained chronic pain. “Adequate, timely, educated …” assessment has turned up nothing. Fibromyalgia and sympathetically mediated pain are considered. Physicians, having had adequate training in pain, …
{"title":"Ethical considerations for neurologists in the management of chronic pain","authors":"T. Holmlund","doi":"10.1212/WNL.59.3.473","DOIUrl":"https://doi.org/10.1212/WNL.59.3.473","url":null,"abstract":"To the Editor:\u0000\u0000I read with interest the special article by Mackin et al.1 This article, produced by nine members of the AAN Ethics, Law and Humanities Committee, stated the following: “Neurologists should provide adequate evaluation … personally or through timely referral,” be “educated about chronic pain,” “consider alternative methods of analgesia,” “keep adequate records,” and “understand the law.”\u0000\u0000The article adds nothing to an area that badly needs attention.\u0000\u0000I often encounter patients with unexplained chronic pain. “Adequate, timely, educated …” assessment has turned up nothing. Fibromyalgia and sympathetically mediated pain are considered. Physicians, having had adequate training in pain, …","PeriodicalId":146967,"journal":{"name":"Neurology: Journal of the American Heart Association","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2001-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124827432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Hershey, S. Powers, Anna‐Liisa B. Vockell, S. LeCates, M. Kabbouche, M. Maynard
BackgroundFor adults, disability produced by migraines has been assessed with a migraine-specific disability tool—MIDAS. The objective of this study was to develop and validate a similar tool that accurately depicts the disability of headaches in school-age children and adolescents. MethodsA six-question tool (PedMIDAS) was developed and administered to patients attending a tertiary referral center for pediatric headaches. Internal consistency and test/retest reliability were assessed. Validity was assessed by correlating scores with headache frequency, severity, and duration. Changes in the total score in response to treatment were assessed in a portion of the patients. ResultsThe PedMIDAS questionnaire was administered to 441 patients for a total of 724 trials. The mean score at the initial visit was 44.3 ± 47.9, whereas the overall mean score was 25.1 ± 36.5. A 2-week test/retest reliability assessment for 56 patients confirmed the stability of the instrument with a Pearson coefficient of 0.80. The correlation of the PedMIDAS score with frequency, severity, and duration had Pearson’s coefficient values of 0.58, 0.27, and 0.23. The PedMIDAS score was reduced to 20.0 ± 32.3 (p < 0.0001) at the first follow-up assessment with subsequent continued reduction. ConclusionsThe PedMIDAS questionnaire provided a developmentally sensitive, reliable, and valid assessment of the disability of childhood and adolescent headaches. This questionnaire provides a tool to assess the impact of migraines in children and to monitor response to treatment. Further research should focus on additional validation of the PedMIDAS using a larger population and sampling from other populations (e.g., primary care and community samples).
{"title":"PedMIDAS: Development of a questionnaire to assess disability of migraines in children","authors":"A. Hershey, S. Powers, Anna‐Liisa B. Vockell, S. LeCates, M. Kabbouche, M. Maynard","doi":"10.1212/WNL.57.11.2034","DOIUrl":"https://doi.org/10.1212/WNL.57.11.2034","url":null,"abstract":"BackgroundFor adults, disability produced by migraines has been assessed with a migraine-specific disability tool—MIDAS. The objective of this study was to develop and validate a similar tool that accurately depicts the disability of headaches in school-age children and adolescents. MethodsA six-question tool (PedMIDAS) was developed and administered to patients attending a tertiary referral center for pediatric headaches. Internal consistency and test/retest reliability were assessed. Validity was assessed by correlating scores with headache frequency, severity, and duration. Changes in the total score in response to treatment were assessed in a portion of the patients. ResultsThe PedMIDAS questionnaire was administered to 441 patients for a total of 724 trials. The mean score at the initial visit was 44.3 ± 47.9, whereas the overall mean score was 25.1 ± 36.5. A 2-week test/retest reliability assessment for 56 patients confirmed the stability of the instrument with a Pearson coefficient of 0.80. The correlation of the PedMIDAS score with frequency, severity, and duration had Pearson’s coefficient values of 0.58, 0.27, and 0.23. The PedMIDAS score was reduced to 20.0 ± 32.3 (p < 0.0001) at the first follow-up assessment with subsequent continued reduction. ConclusionsThe PedMIDAS questionnaire provided a developmentally sensitive, reliable, and valid assessment of the disability of childhood and adolescent headaches. This questionnaire provides a tool to assess the impact of migraines in children and to monitor response to treatment. Further research should focus on additional validation of the PedMIDAS using a larger population and sampling from other populations (e.g., primary care and community samples).","PeriodicalId":146967,"journal":{"name":"Neurology: Journal of the American Heart Association","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2001-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134517486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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