Rape and respectability: ideas about sexual violence and social class

Women on low incomes are disproportionately represented among sexual violence survivors, yet feminist research on this topic has paid very little attention to social class. This article blends recent research on class, gender and sexuality with what we know about sexual violence. It is argued that there is a need to engage with classed distinctions between women in terms of contexts for and experiences of sexual violence, and to look at interactions between pejorative constructions of working-class sexualities and how complainants and defendants are perceived and treated. The classed division between the sexual and the feminine, drawn via the notion of respectability, is applied to these issues. This piece is intended to catalyse further research and debate, and raises a number of questions for future work on sexual violence and social class

Research designs considerations for chronic pain prevention clinical trials: IMMPACT recommendations

Although certain risk factors can identify individuals who aremost likely to develop chronic pain, few interventions to prevent chronic pain have been identified. To facilitate the identification of preventive interventions, an IMMPACTmeeting was convened to discuss research design considerations for clinical trials investigating the prevention of chronic pain. We present general design considerations for prevention trials in populations that are at relatively high risk for developing chronic pain. Specific design considerations included subject identification, timing and duration of treatment, outcomes, timing of assessment, and adjusting for risk factors in the analyses.We provide a detailed examination of 4 models of chronic pain prevention (ie, chronic postsurgical pain, postherpetic neuralgia, chronic low back pain, and painful chemotherapy-induced peripheral neuropathy). The issues discussed can, inmany instances, be extrapolated to other chronic pain conditions. These examples were selected because they are representative models of primary and secondary prevention, reflect persistent pain resulting from multiple insults (ie, surgery, viral infection, injury, and toxic or noxious element exposure), and are chronically painful conditions that are treated with a range of interventions. Improvements in the design of chronic pain prevention trials could improve assay sensitivity and thus accelerate the identification of efficacious interventions. Such interventions would have the potential to reduce the prevalence of chronic pain in the population. Additionally, standardization of outcomes in prevention clinical trials will facilitate meta-analyses and systematic reviews and improve detection of preventive strategies emerging from clinical trials

A randomized, placebo-controlled trial of bupropion sustained release in chronic low back pain

Clinical trials of the efficacy of antidepressant drugs in patients with chronic low back pain have had mixed results, possibly because of the different mechanisms of action of the drugs that have been studied. Because bupropion has a mechanism of action that differs from other antidepressants and has shown efficacy in neuropathic pain, a randomized, placebo-controlled, 2-period crossover trial was conducted to evaluate its efficacy in subjects with chronic low back pain. The primary efficacy variable was mean daily diary pain intensity ratings, and secondary pain intensity and relief outcomes included weekly pain intensity ratings, the McGill Pain Questionnaire (MPQ) Present Pain Intensity scale, pain relief ratings, and satisfaction with pain relief ratings. Adverse events were also assessed throughout the trial. Analyses were performed of an intention-to-treat sample of 44 patients, only 3 of whom met criteria for neuropathic low back pain. Daily and weekly pain intensity ratings, the MPQ Present Pain Intensity scale, and pain relief ratings were not significantly different following treatment with bupropion sustained release (SR) vs. placebo. These results suggest that bupropion SR was not significantly better than placebo in the treatment of patients with non-neuropathic chronic low back pain. © 2005 by the American Pain Society.Andersson GBJ, 1999, LANCET, V354, P581, DOI 10.1016-S0140-6736(99)01312-4; ASCHER JA, 1995, J CLIN PSYCHIAT, V56, P395; Atkinson JH, 1998, PAIN, V76, P287, DOI 10.1016-S0304-3959(98)00064-5; Atkinson JH, 1999, PAIN, V83, P137, DOI 10.1016-S0304-3959(99)00082-2; Backonja M, 1998, JAMA-J AM MED ASSOC, V280, P1831, DOI 10.1001-jama.280.21.1831; BECK AT, 1961, ARCH GEN PSYCHIAT, V4, P561; Cohen J., 1988, STAT POWER ANAL BEHA; Dworkin RH, 2003, NEUROLOGY, V60, P1274; Dworkin RH, 2005, PAIN, V113, P9, DOI 10.1016-j.pain.2004.09.012; Farrar JT, 2001, PAIN, V94, P149, DOI 10.1016-S0304-3959(01)00349-9; MAX MB, 1992, NEW ENGL J MED, V326, P1250, DOI 10.1056-NEJM199205073261904; MELZACK R, 1975, PAIN, V1, P277, DOI 10.1016-0304-3959(75)90044-5; SALERNO SM, 2002, ARCH INTERN MED, V62, P19; Schnitzer TJ, 2004, J PAIN SYMPTOM MANAG, V28, P72, DOI 10.1016-j.jpainsymman.2003.10.015; Semenchuk MR, 2001, NEUROLOGY, V57, P1583; Staiger TO, 2003, SPINE, V28, P2540, DOI 10.1097-01.BRS.0000092372.73527.BA; Turk DC, 2003, PAIN, V106, P337, DOI 10.1016-j.pain.2003.08.00133282

Outcome measures in placebo-controlled trials of osteoarthritis: responsiveness to treatment effects in the REPORT database

SummaryIntroductionTreatment response in randomized clinical trials (RCT) of osteoarthritis (OA) has been assessed by multiple primary and secondary outcomes, including pain, function, patient and clinician global measures of status and response to treatment, and various composite and responder measures. Identifying outcome measures with greater responsiveness to treatment is important to increase the assay sensitivity of RCTs.ObjectiveTo assess and compare the responsiveness of different outcome measures used in placebo-controlled RCTs of OA.Search strategyThe Resource for Evaluating Procedures and Outcomes of Randomized Trials database includes placebo-controlled clinical trials of pharmacologic treatments (oral, topical, or transdermal) for OA identified from a systematic literature search of RCTs published or publicly available before August 5, 2009, which was conducted using PubMed, the Cochrane collaboration, publicly-available websites, and reference lists of retrieved publications.Data collection and analysisData collected included: (1) pain assessed with single-item ratings and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale; (2) patient and clinician global measures of status, improvement, and treatment response; (3) function assessed by the WOMAC function subscale; (4) stiffness assessed by the WOMAC stiffness subscale; and (5) the WOMAC and Lequesne Algofunctional Index composite outcomes. Measures were grouped according to the total number of response categories (i.e., <10 categories or ≥10 categories). The treatment effect (difference in mean change from baseline between the placebo and active therapy arms) and standardized effect size (SES) were estimated for each measure in a meta-analysis using a random effects model.ResultsThere were 125 RCTs with data to compute the treatment effect for at least one measure; the majority evaluated non-steroidal anti-inflammatory drugs (NSAIDs), followed by opioids, glucosamine and/or chondroitin, and acetaminophen. In general, the patient-reported pain outcome measures had comparable responsiveness to treatment as shown by the estimates of treatment effects and SES. Treatment effects and SESs were generally higher for patient-reported global measures compared with clinician-rated global measures but generally similar for the WOMAC and Lequesne composite measures.ConclusionsComparing different outcome measures using meta-analysis and selecting those that have the greatest ability to identify efficacious treatments may increase the efficiency of clinical trials of treatments for OA. Improvements in the quality of the reporting of clinical trial results are needed to facilitate meta-analyses to evaluate the responsiveness of outcome measures and to also address other issues related to assay sensitivity