John D Markman1, Jennifer S Gewandter2, Maria E Frazer2, Christine Pittman2, Xueya Cai2, Kushang V Patel2, Babak S Jahromi2, Robert H Dworkin2, Laurie B Burke2, John T Farrar2. 1. From the Department of Neurosurgery, Translational Pain Research Program (J.D.M., M.E.F., C.P., B.S.J.), and Departments of Anesthesiology (J.S.G., R.H.D.) and Biostatistics and Computational Biology (X.C.), University of Rochester School of Medicine and Dentistry, NY; Department of Anesthesiology and Pain Medicine (K.V.P.), University of Washington, Seattle; LORA Group, LLC (L.B.B.), Royal Oak, MD; and Department of Biostatistics and Epidemiology (J.T.F.), University of Pennsylvania, Philadelphia. john_markman@urmc.rochester.edu. 2. From the Department of Neurosurgery, Translational Pain Research Program (J.D.M., M.E.F., C.P., B.S.J.), and Departments of Anesthesiology (J.S.G., R.H.D.) and Biostatistics and Computational Biology (X.C.), University of Rochester School of Medicine and Dentistry, NY; Department of Anesthesiology and Pain Medicine (K.V.P.), University of Washington, Seattle; LORA Group, LLC (L.B.B.), Royal Oak, MD; and Department of Biostatistics and Epidemiology (J.T.F.), University of Pennsylvania, Philadelphia.
Abstract
OBJECTIVES: To determine whether patients with neurogenic claudication associated with lumbar spinal stenosis would prefer a treatment that makes it possible for them to walk farther or walk with less pain; to examine associations between this treatment preference and patient-reported and in-clinic treadmill testing measures of walking ability and walking-associated pain. METHODS: In this cross-sectional study, 269 patients with neurogenic claudication were asked to report their pain intensity when walking, complete the Swiss Spinal Stenosis Questionnaire, rank their outcome preferences for treatment, and undergo standardized treadmill testing, including measures of final pain rating and time to first pain of moderate intensity (Tfirst). Descriptive statistics were used to characterize patient preferences for treatment outcome. Associations between self-report questionnaires and standardized treadmill testing outcomes were evaluated using Spearman correlations. RESULTS: Seventy-nine percent of patients expressed a preference for treatment that allowed them to walk with less pain. Preference for reduced pain was associated with higher pain during daily walking, along with a shorter Tfirst and higher final pain severity on treadmill testing. In contrast, patient preference for treatment outcome was not associated with self-reported measures of daily walking capacity or walking distance on the treadmill. CONCLUSIONS: A majority of patients with neurogenic claudication prioritized walking with reduced pain over walking farther. Reduction in pain while walking may therefore constitute a sufficient patient-focused treatment outcome for the majority of these patients. These results have implications for clinical trial design and assessment of treatment efficacy in neurogenic claudication.
OBJECTIVES: To determine whether patients with neurogenic claudication associated with lumbar spinal stenosis would prefer a treatment that makes it possible for them to walk farther or walk with less pain; to examine associations between this treatment preference and patient-reported and in-clinic treadmill testing measures of walking ability and walking-associated pain. METHODS: In this cross-sectional study, 269 patients with neurogenic claudication were asked to report their pain intensity when walking, complete the Swiss Spinal Stenosis Questionnaire, rank their outcome preferences for treatment, and undergo standardized treadmill testing, including measures of final pain rating and time to first pain of moderate intensity (Tfirst). Descriptive statistics were used to characterize patient preferences for treatment outcome. Associations between self-report questionnaires and standardized treadmill testing outcomes were evaluated using Spearman correlations. RESULTS: Seventy-nine percent of patients expressed a preference for treatment that allowed them to walk with less pain. Preference for reduced pain was associated with higher pain during daily walking, along with a shorter Tfirst and higher final pain severity on treadmill testing. In contrast, patient preference for treatment outcome was not associated with self-reported measures of daily walking capacity or walking distance on the treadmill. CONCLUSIONS: A majority of patients with neurogenic claudication prioritized walking with reduced pain over walking farther. Reduction in pain while walking may therefore constitute a sufficient patient-focused treatment outcome for the majority of these patients. These results have implications for clinical trial design and assessment of treatment efficacy in neurogenic claudication.
Authors: Dennis C Turk; Robert H Dworkin; Laurie B Burke; Richard Gershon; Margaret Rothman; Jane Scott; Robert R Allen; Hampton J Atkinson; Julie Chandler; Charles Cleeland; Penny Cowan; Rozalina Dimitrova; Raymond Dionne; John T Farrar; Jennifer A Haythornthwaite; Sharon Hertz; Alejandro R Jadad; Mark P Jensen; David Kellstein; Robert D Kerns; Donald C Manning; Susan Martin; Mitchell B Max; Michael P McDermott; Patrick McGrath; Dwight E Moulin; Turo Nurmikko; Steve Quessy; Srinivasa Raja; Bob A Rappaport; Christine Rauschkolb; James P Robinson; Mike A Royal; Lee Simon; Joseph W Stauffer; Gerold Stucki; Jane Tollett; Thorsten von Stein; Mark S Wallace; Joachim Wernicke; Richard E White; Amanda C Williams; James Witter; Kathleen W Wyrwich Journal: Pain Date: 2006-10-25 Impact factor: 6.961
Authors: Richard L Skolasky; Anica M Maggard; Roland J Thorpe; Stephen T Wegener; Lee H Riley Journal: Spine (Phila Pa 1976) Date: 2013-12-15 Impact factor: 3.468
Authors: John D Markman; Jennifer S Gewandter; Maria E Frazer; Nicole M Murray; Shirley A Rast; Michael P McDermott; Amit K Chowdhry; Emilie J Tomkinson; Webster H Pilcher; Kevin A Walter; Robert H Dworkin Journal: Spine (Phila Pa 1976) Date: 2015-05-15 Impact factor: 3.468
Authors: Christopher J L Murray; Charles Atkinson; Kavi Bhalla; Gretchen Birbeck; Roy Burstein; David Chou; Robert Dellavalle; Goodarz Danaei; Majid Ezzati; A Fahimi; D Flaxman; Sherine Gabriel; Emmanuela Gakidou; Nicholas Kassebaum; Shahab Khatibzadeh; Stephen Lim; Steven E Lipshultz; Stephanie London; Michael F MacIntyre; A H Mokdad; A Moran; Andrew E Moran; Dariush Mozaffarian; Tasha Murphy; Moshen Naghavi; C Pope; Thomas Roberts; Joshua Salomon; David C Schwebel; Saeid Shahraz; David A Sleet; Jerry Abraham; Mohammed K Ali; Charles Atkinson; David H Bartels; Kavi Bhalla; Gretchen Birbeck; Roy Burstein; Honglei Chen; Michael H Criqui; Eric L Ding; E Ray Dorsey; Beth E Ebel; Majid Ezzati; S Flaxman; A D Flaxman; Diego Gonzalez-Medina; Bridget Grant; Holly Hagan; Howard Hoffman; Nicholas Kassebaum; Shahab Khatibzadeh; Janet L Leasher; John Lin; Steven E Lipshultz; Rafael Lozano; Yuan Lu; Leslie Mallinger; Mary M McDermott; Renata Micha; Ted R Miller; A A Mokdad; A H Mokdad; Dariush Mozaffarian; Mohsen Naghavi; K M Venkat Narayan; Saad B Omer; Pamela M Pelizzari; David Phillips; Dharani Ranganathan; Frederick P Rivara; Thomas Roberts; Uchechukwu Sampson; Ella Sanman; Amir Sapkota; David C Schwebel; Saeid Sharaz; Rupak Shivakoti; Gitanjali M Singh; David Singh; Mohammad Tavakkoli; Jeffrey A Towbin; James D Wilkinson; Azadeh Zabetian; Jerry Abraham; Mohammad K Ali; Miriam Alvardo; Charles Atkinson; Larry M Baddour; Emelia J Benjamin; Kavi Bhalla; Gretchen Birbeck; Ian Bolliger; Roy Burstein; Emily Carnahan; David Chou; Sumeet S Chugh; Aaron Cohen; K Ellicott Colson; Leslie T Cooper; William Couser; Michael H Criqui; Kaustubh C Dabhadkar; Robert P Dellavalle; Daniel Dicker; E Ray Dorsey; Herbert Duber; Beth E Ebel; Rebecca E Engell; Majid Ezzati; David T Felson; Mariel M Finucane; Seth Flaxman; A D Flaxman; Thomas Fleming; Mohammad H Forouzanfar; Greg Freedman; Michael K Freeman; Emmanuela Gakidou; Richard F Gillum; Diego Gonzalez-Medina; Richard Gosselin; Hialy R Gutierrez; Holly Hagan; Rasmus Havmoeller; Howard Hoffman; Kathryn H Jacobsen; Spencer L James; Rashmi Jasrasaria; Sudha Jayarman; Nicole Johns; Nicholas Kassebaum; Shahab Khatibzadeh; Qing Lan; Janet L Leasher; Stephen Lim; Steven E Lipshultz; Stephanie London; Rafael Lozano; Yuan Lu; Leslie Mallinger; Michele Meltzer; George A Mensah; Catherine Michaud; Ted R Miller; Charles Mock; Terrie E Moffitt; A A Mokdad; A H Mokdad; A Moran; Mohsen Naghavi; K M Venkat Narayan; Robert G Nelson; Casey Olives; Saad B Omer; Katrina Ortblad; Bart Ostro; Pamela M Pelizzari; David Phillips; Murugesan Raju; Homie Razavi; Beate Ritz; Thomas Roberts; Ralph L Sacco; Joshua Salomon; Uchechukwu Sampson; David C Schwebel; Saeid Shahraz; Kenji Shibuya; Donald Silberberg; Jasvinder A Singh; Kyle Steenland; Jennifer A Taylor; George D Thurston; Monica S Vavilala; Theo Vos; Gregory R Wagner; Martin A Weinstock; Marc G Weisskopf; Sarah Wulf Journal: JAMA Date: 2013-08-14 Impact factor: 56.272
Authors: John D Markman; Maria E Frazer; Shirley A Rast; Michael P McDermott; Jennifer S Gewandter; Amit K Chowdhry; Kate Czerniecka; Webster H Pilcher; Lee S Simon; Robert H Dworkin Journal: Neurology Date: 2014-12-10 Impact factor: 9.910
Authors: John Markman; Jeffrey Gudin; Richard Rauck; Charles Argoff; Michael Rowbotham; Eva Agaiby; Joseph Gimbel; Nathaniel Katz; Stephen K Doberstein; Mary Tagliaferri; Lin Lu; Suresh Siddhanti; Martin Hale Journal: Pain Date: 2019-06 Impact factor: 7.926