The original version of the Brief Pain Inventory (BPI) was translated into a Malay version by the standard procedure and was then evaluated for its psychometric properties. Of 119 eligible patients, a total of 113 (95%) agreed to participate in this study. Ages ranged from 18 to 76 years and interviews were conducted between August, 2004 and November, 2004. The pain intensity items demonstrated high loading with one factor, whereas the pain interference items were loaded on another factor. Two factors explained 62% of the variance. Compared to the Karnofsky Performance Scale, the pain intensity scales had a moderate negative (Pearson's) correlation (-0.520, P < 0.001) and the pain interference scales had a high negative correlation (-0.732, P < 0.001), showing good concurrent validity. The coefficient alpha of both subscales demonstrated good internal consistency of the items. The intraclass correlation coefficient for the test-retest stability was 0.61 for the pain intensity scale and 0.88 for the pain interference scale. The Malay version of the BPI is a reliable and valid instrument for cancer pain assessment and is comparable with the original version of the BPI in terms of structure and psychometric properties.
This article illustrates a case of persistent trigeminal neuralgia in a medically compromised 65-year-old female who did not respond to pharmacotherapy. She had undergone several peripheral neurectomies as well as a failed right posterior fossa exploration that resulted in a cerebrospinal fluid leak. Persistent pain over the right external nasal area and right mental region was relieved for several hours after daily injections of bupivacaine. A trial of a single dose of 100 units of botulinum toxin type A (BOTOX) diluted in 2.5 mL saline was injected into the external nasal trigger zone (60 units) and to the mental nerve region (40 units). She achieved complete pain relief in the external nasal region for 5 months. Pain recurred and the site was again injected with 100 units of botulinum toxin type A (BOTOX). Pain relief at the mental region was partial. This was finally controlled with peripheral neurectomy. The patient was pain free with a maintenance dose of 200 mg carbamazepine daily for about 1 year, after which she elected to undergo stereotactic gamma knife radiosurgery when pain recurred at the external nasal region.
Purpose: To report a rare case of non-tuberculous mycobacterial (NTM) choroiditis masquerading as choroidal tumour, where the initial diagnosis was masked by keratitis. Casedescription: A 57-year-old heroin chaser with a pre-existing left eye blindness due to past blunt trauma presented with diffuse bacterial keratitis on the same side. Systemic examination revealed multiple non-tender cervical lymphadenopathies. B-scan ultrasonography showed a hyperechoic choroidal mass with surrounding exudative retinal detachment, resembling a choroidal tumour. However, computed tomography (CT) and magnetic resonance imaging (MRI) scan findings were suggestive of inflammatory choroidal changes. Inflammatory markers were significantly raised and infective screening was positive for HIV and Hepatitis C. Tuberculosis workup was normal. In view of intractable pain, evisceration was done and his vitreous humour was sent for polymerase chain reaction (PCR). It was reported to be positive for Mycobacterium Fortuitum. Conclusion: NTM ocular infections are rare, challenging to diagnose, and potentially sight threatening. Early recognition and prompt treatment is life and vision saving.
Marjolin's ulcers are malignancies that arise from previously traumatised, chronically inflamed or scarred skin. We present a case with childhood burns, who had repeated irritation of his forearm skin with palm oil thorns that eventually led to malignant change.