Anesth Analg 2001 Oct;93(4):1025-31
Department of Surgical Center, The Institute of Medical Science, and the Department of Anesthesiology, The University of Tokyo, Tokyo, Japan.
[Medline record in process]
Both midazolam, a benzodiazepine gamma-aminobutyric acid type A receptor agonist, and clonidine, an alpha(2)-adrenergic receptor agonist, induce spinally-mediated analgesia. We investigated the analgesic interaction of spinally-administered midazolam and clonidine in their effects on acute and inflammatory nociception. Rats implanted with lumbar intrathecal catheters were injected intrathecally with saline (control), midazolam (1 to 100 &mgr;g), or clonidine (0.1 to 3 &mgr;g) to test for their responses to thermal stimulation to the tail (tail-flick test) and subcutaneous formalin injection into the hind paw (formalin test). The effects of the combination of midazolam and clonidine on both stimuli were tested by isobolographic analysis by using the 50% effective doses. The general behavior and motor function were examined as side effects. When combined, the 50% effective doses of midazolam (clonidine) decreased from 1.57 &mgr;g (0.26 &mgr;g) to 0.29g (0.05 &mgr;g) in the tail-flick test and from 1.34 &mgr;g (0.12 &mgr;g) and 1.21 &mgr;g (0.13 &mgr;g) to 0.05 &mgr;g (0.005 &mgr;g) and 0.13 &mgr;g (0.015 &mgr;g) in Phase 1 and 2 of the formalin test, respectively. Side effects did not increase by using the combination. These results suggest a favorable combination of intrathecal midazolam and clonidine in the management of acute and inflammatory pain after proper neurotoxicologic studies. IMPLICATIONS: Spinally-administered midazolam, a benzodiazepine, and clonidine, an alpha(2)-adrenergic receptor agonist, have significant synergistic effects on thermally-induced acute and formalin-induced inflammatory pain.
PMID: 11574377, UI: 21458232
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Anesthesiology 2001 Sep;95(3):578-84
Department of Medicine V and Center for Clinical Pharmacology, Aarhus University Hospital, Denmark. jg@farm.au.dk
BACKGROUND: Painful trauma results in a disturbed metabolic state with impaired insulin sensitivity, which is related to the magnitude of the trauma. The authors explored whether pain per se influences hepatic and extrahepatic actions of insulin. METHODS: Ten healthy male volunteers underwent two randomly sequenced hyperinsulinemic-euglycemic (insulin infusion rate, 0.6 mU x kg(-1) x min(-1) for 180 min) clamp studies 4 weeks apart. Self-controlled painful electrical stimulation was applied to the abdominal skin for 30 min, to a pain intensity of 8 on a visual analog scale of 0-10, just before the clamp procedure (study P). In the other study, no pain was inflicted (study C). RESULTS: Pain reduced whole-body insulin-stimulated glucose uptake from 6.37+/-1.87 mg x kg(-1) x min(-1) (mean +/- SD) in study C to 4.97+/-1.38 mg x kg(-1) x min(-1) in study P (P < 0.01) because of a decrease in nonoxidative glucose disposal, as determined by indirect calorimetry (2.47+/-0.88 mg x kg(-1) x min(-1) in study P vs. 3.41+/-1.03 mg x kg(-1) x min(-1) in study C; P < 0.05). Differences in glucose oxidation rates were not statistically significant. The suppression of isotopically determined endogenous glucose output during hyperinsulinemia tended to be decreased after pain (1.67+/-0.48 mg x kg(-1) x min(-1) in study P vs. 2.04+/-0.45 mg x kg(-1) x min(-1) in study C; P = 0.06). Pain elicited a twofold to threefold increase in serum cortisol (P < 0.01), plasma epinephrine (P < 0.05), and serum free fatty acids (P < 0.05). Similarly, circulating concentrations of glucagon and growth hormone tended to increase during pain. CONCLUSIONS: Acute severe pain decreases insulin sensitivity, primarily by affecting nonoxidative glucose metabolism. It is conceivable that the counterregulatory hormonal response plays an important role. This may indicate that pain relief in stress states is important for maintenance of normal glucose metabolism.
PMID: 11575527, UI: 21459348
Anesthesiology 2001 Sep;95(3):573-4
Publication Types:
PMID: 11575525, UI: 21459346
BMJ 2001 Sep 8;323(7312):572
PMID: 11573488, UI: 21456769
PMID: 11573487, UI: 21456766
BMJ 2001 Sep 8;323(7312):571-2
PMID: 11573486, UI: 21456765
BMJ 2001 Sep 8;323(7312):570
PMID: 11573481, UI: 21456760
Br J Anaesth 2001 Feb;86(2):236-40
Service d'Anesthesie-Reanimation, Hjpital Tenon, Assistance Publique Hjpitaux de Paris, France.
In this double-blind randomized study we compared a group of 15 patients undergoing thoracotomy who received a spinal injection of sufentanil 20 microg combined with morphine (200 microg) after induction of general anaesthesia with a control group of the same size. Post-operative pain was rated on a visual analogue scale (VAS) and a verbal rating scale at rest and with a VAS on coughing. In the recovery room, patients received titrated i.v. morphine until the VAS score was <30, and were followed by patient-controlled analgesia (PCA) for 72 h. The intrathecal sufentanil and morphine group had a lower intra-operative requirement for i.v. sufentanil and needed less i.v. morphine for titration in the recovery room. I.v. PCA morphine consumption and pain scores were lower in the active group than in the control group during the first 24 h. There were no differences after this time. Spirometric data (peak expiratory flow, forced vital capacity and forced expiratory volume in 1 s) were similar in the two groups. We conclude that the combination of intrathecal sufentanil and morphine produces analgesia of rapid onset and with a duration of 24 h.
PMID: 11573666, UI: 21457569
Br J Anaesth 2001 Apr;86(4):535-9
Abteilung fur Anasthesie und Intensivmedizin, Kreisklinik Langen, Germany.
We determined the incidence of persistent back pain (PBP) after non-obstetrical spinal anaesthesia (SPA) and investigated factors predisposing to such pain in a prospective 1 yr follow-up study in 245 patients undergoing elective general or trauma surgery (218 patients undergoing single SPA, 27 undergoing two to six SPAs). All patients received a first questionnaire 3 months after the last SPA, and those reporting PBP after 3 months were sent a second questionnaire I year after the operation. Variables were PBP before and within 5 days, at 3 months and I year after SPA, patient satisfaction with SPA, patient characteristics and technical data. Statistical analysis was by contingency tables with Fisher's exact test and an unpaired t-test with logistic regression (P < 0.001 after Bonferroni correction was taken as significant). The response rate in patients who had a single SPA was 56% (122/218). Twenty-three of these 122 patients (18.9%) complained of back pain before SPA compared with 12/122 (10.7%, P = 0.0015) within 5 days after SPA. After 3 months, 15/122 patients (12.3%) reported PBP with 14 complaining of PBP before SPA (P < 0.0001), corresponding to an incidence of new PBP of 1/122 (0.8%). Multiple logistic regression revealed that pre-existing back pain was the only variable associated with PBP after 3 months (P < 0.0001). Patient characteristics and technical factors were not associated with PBP. Nine of the 15 patients with PBP after 3 months returned the second questionnaire: four still reported PBP (three of these had suffered from PBP before SPA). Despite PBP after 3 months, 13/15 patients said they would opt for SPA again. The response rate and results in patients who had had multiple SPAs were similiar to those who had had a single SPA.
PMID: 11573628, UI: 21457531
Br J Anaesth 2001 Jun;86(6):874-6
Department of Anaesthesia, Hakujikai Memorial Hospital, Tokyo, Japan.
We examined the analgesic effects of orally administered clonidine on pain induced by injection of propofol (Diprivan; 2,6-diisopropyl phenol). Female patients (n=81) were randomly allocated to one of two groups: oral clonidine (5.5 microg kg(-1)) followed by i.v. propofol and a control group given placebo followed by i.v. propofol. The median pain score in the group receiving clonidine, using a four-point scale (0=no pain, 1=minimal pain, 2=moderate pain, 3=severe pain) was 1 (0-2), significantly lower than in the control group [2 (1-3), median (25-75 percentiles), P<0.001].
PMID: 11573599, UI: 21457502
Br J Anaesth 2001 Jun;86(6):871-3
Department of Anaesthesiology, Copenhagen University Hospital, Herlev, Denmark.
We investigated the effects of i.v. magnesium on secondary hyperalgesia following heat/capsaicin stimulation in human volunteers. Twenty-five volunteers were included in this double blind, randomized, crossover study. Sensitization was induced in the volunteers, who were then subjected to either i.v. saline or magnesium sulphate. No analgesic or antihyperalgesic effect could be demonstrated in sensitized skin during infusion of magnesium. In contrast, painfulness of thermal stimulation was increased in normal skin. These results suggest that i.v. magnesium has no important analgesic effects in clinically relevant doses.
PMID: 11573598, UI: 21457501
J Pain Symptom Manage 2001 Oct;22(4):872-8
Pain Management and Anesthesia, Royal Marsden NHS Trust, London, United Kingdom
This paper describes a project for the establishment of a cancer pain clinic in a developing country. The project was conducted according to guidelines from the World Health Organization and utilized a link with an existing cancer pain clinic in the UK. The principal methods used for establishing the new pain clinic included: an assessment of barriers to effective cancer pain control, teaching programs for nurses and trainee doctors, educational links with a UK cancer pain clinic, and analgesic guidelines and introduction of a pain assessment tool. As a result of these interventions, a new cancer pain clinic was founded. The methods used serve as one possible model for establishing cancer pain treatment facilities in developing countries.
PMID: 11576804, UI: 21460925
J Pain Symptom Manage 2001 Oct;22(4):862-71
Department of Neurological Science, University of Liverpool, Liverpool, United Kingdom
Continuous intrathecal infusion of analgesic drugs by implantable pumps is recognized as an established treatment option for patients with chronic pain resistant to oral or parenteral medication. Polyanalgesia, the simultaneous use of more than one intrathecal analgesic drug, is practiced relatively often, but there are only a few published clinical studies on intrathecal polyanalgesia for chronic nonmalignant pain. This pilot study represents a long-term evaluation of a treatment regimen consisting of intrathecal morphine admixed with bupivacaine, clonidine, or midazolam in patients with chronic nonmalignant back and leg pain due to degenerative lumbar spinal disease. Twenty-six adult patients have been treated by intrathecal programmable pump-controlled infusion of analgesic drugs and followed for up to 3.5 years (27 +/- 11 months). Combination of morphine with a second drug was used in 10 cases, morphine with 2 additional drugs in 12 cases, and morphine with 3 additional drugs in 4 cases. Mean daily doses at 24 months after pump implantation were 6.2 +/- 2.8 mg for morphine, 2.5 +/- 1.5 mg for bupivacaine, 0.06 +/- 0.03 mg for clonidine, and 0.8 +/- 0.4 mg for midazolam. Nineteen patients reported excellent or good long-term treatment results, 6 patients had sufficient results, and only 1 patient complained of poor therapeutic efficacy. No long-term clinical side effects of intrathecal polyanalgesia were noted. Mean morphine dose had to be increased from 1.2 mg at baseline to 5.1 mg at 24 months due to tolerance development and disease progression. This experience suggests that intrathecal polyanalgesia employing morphine combined with additional nonopioid drugs can have a favorable analgesic efficacy in patients with complex chronic pain of spinal origin, and lacks major drug-related complications.
PMID: 11576803, UI: 21460924
J Pain Symptom Manage 2001 Oct;22(4):834-42
McCulloch House, Monash Medical Center and Department of Medicine, Monash University, Clayton, Australia
The results of a novel approach to the use of ketamine in refractory cancer pain are reported. In this prospective, multicenter, unblinded, open-label audit, 39 patients (with a total of 43 pains) received a short duration (3 to 5 days) ketamine infusion. The initial dose of 100 mg/24 hr was escalated if required to 300 mg/24 hr and then to a maximum dose of 500 mg/24hr. The overall response rate was 29/43 (67%). Analysis of results according to pain mechanisms showed that 15/17 somatic and 14/23 neuropathic pains responded. In 5 patients who appeared to respond, it is possible that another concurrent intervention may have contributed in whole or part for the pain relief observed. After cessation of ketamine, 24/29 maintained good pain control, with a maximum documented duration of eight weeks. However, 5 of the initial 29 responders experienced a recurrence of pain within 24 hours, and ketamine was recommenced. Of these, 2 underwent another intervention for pain control while 3 continued on ketamine until their deaths between two and four weeks later. Twelve patients reported adverse psychomimetic effects, with the incidence rising with increasing dose. Four of these were non-responders and the ketamine was stopped. Eight were responders, and in 3 the adverse effects were rendered acceptable with dose reduction; the other 5 rejected a dose reduction. The results reported suggest the need for further investigation of the place of ketamine in cancer pain management.
PMID: 11576800, UI: 21460921
Lancet 2001 Sep 15;358(9285):897
[Record supplied by publisher]
PMID: 11567716
N Engl J Med 2001 Sep 27;345(13):981-6
PMID: 11575291, UI: 21442328
Pain 2001 Oct;94(1):121-2
Sollentuna Palliative Home Care Team, PAH, Box 474, S-191 24, Sollentuna, Sweden
A 15-year-old boy suffering from a degenerative neurometabolic disorder was treated in a palliative home care unit. Opioid administered by continuous intravenous infusion gave excellent relief from headache, muscle pain and pain from renal calculi. He continued to complain of burning pain in response to tactile stimuli. A prior quantitative sensory test had shown changes in sensation. Intravenous adenosine (ADO) infusions were given weekly. After 5 weeks of infusions, there was no recurrence of pain between treatments. ADO infusions were continued for 7 months without any side effects or signs of tolerance to the drug. There are indications that ADO may play a role as a modulator of neuropathic and nociceptive pain. In this case with pronounced allodynia, our interpretation is that neuropathic mechanisms were responsible and that ADO infusions played an important role in controlling pain.
PMID: 11576751, UI: 21461213
Pain 2001 Oct;94(1):113-9
Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 604, 14642, Rochester, NY, USA
The results of a considerable number of recent prospective studies have demonstrated that greater acute pain severity in herpes zoster patients is associated with a significantly greater risk of developing postherpetic neuralgia (PHN). Only a few studies have examined the relationships between acute pain severity and demographic characteristics and clinical features of patients with herpes zoster, however, and the results of these studies have been inconsistent. To clarify these relationships, data from 1778 herpes zoster patients studied within 72h of rash onset in four clinical trials of the antiviral agent famciclovir were examined. Univariate and multivariate analyses indicated that greater acute pain severity was significantly associated with greater age, female sex, greater rash severity, the presence of a prodrome, and primary involvement of non-trigeminal dermatomes. These results demonstrate that three of the established risk factors for PHN - older age, greater rash severity, and the presence of a prodrome - are also associated with more severe acute pain assessed soon after rash onset in patients with herpes zoster. The results of this study are consistent with the recommendation that herpes zoster patients who are older, who have had a prodrome, or who have severe rash or severe acute pain should be targeted for interventions designed to prevent PHN.
PMID: 11576750, UI: 21461212
Pain 2001 Oct;94(1):85-100
School of Psychology, University of Shahed, P.O. Box 14155-7137, Tehran, Iran
This study examined the relationship between pain self-efficacy beliefs and a range of pain behaviours, as measured by the pain behaviour questionnaire (PBQ), using a prospective design. A heterogeneous sample of 145 chronic pain patients completed sets of questionnaires on four occasions over a nine-month period. Multiple hierarchical regression analyses revealed that the subjects' confidence in their ability to perform a range of tasks despite pain (assessed at baseline), was predictive of total pain behaviour and avoidance behaviour over the nine-month study period. This finding was particularly significant because the analyses controlled for the possible effects of pain severity (at each measurement occasion), pain chronicity, age, gender, physical disability, depression, neuroticism and catastrophising. These findings suggest that pain self-efficacy beliefs are an important determinant of pain behaviours and disability associated with pain, over and above the effects of pain, distress and personality variables. In particular, higher pain self-efficacy beliefs are predictive of reduced avoidance behaviours over an extended period.
PMID: 11576748, UI: 21461210
Pain 2001 Oct;94(1):75-84
University of Utah College of Nursing, 10 S. 2000 East Front Street, Salt Lake City, 84112-5880, UT, USA
Inadequate relief from cancer pain is an international health problem. The aim of this study was to document the prevalence and patterns of cancer pain management in the Republic of South Africa. The first phase of this study consisted of screening 263 patients to document the prevalence of cancer pain in varying settings. A total of 94 patients were experiencing cancer-related pain; this comprised 35.7% of the sample. Inpatients had a higher prevalence than outpatients, which is likely due to the fact that these patients are more acutely ill. Blacks (56.1%) had a higher prevalence of pain than whites (29.4%, P<0.005); this difference was most pronounced in the outpatient setting. Phase 2 consisted of asking 426 patients with cancer pain from different settings to complete a questionnaire that included the brief pain inventory and was designed to learn about their pain and how it was managed. Nearly one-third of the entire sample experienced 'worst pain' of severe intensity. There was little difference between the public and private cancer care centers. The lowest percentage of patients with severe 'worst pain' was in the hospice setting, but even in this group about one-fourth of the patients had peak pain that was severe. Of non-whites combined, 81% experienced 'worst pain' of moderate to severe intensity as compared to 65% of whites (P<0.001). Only 21% of patients reported that they had achieved 100% pain relief. Patients experienced interference in general activity, mood, walking, working, relations with others, sleeping, and enjoyment of life related to their pain. 30.5% of the entire sample had a negative score on the pain management index, a comparison of the most potent analgesic used by a patient relative to their worst pain. Of this group, 58.1% were experiencing severe 'worst pain'. Unrelieved cancer pain is a significant problem. Government and non-government leaders, educators, and practitioners must collaborate to address the barriers to effective pain management and to implement improvements in education, health policy, and health care delivery.
PMID: 11576747, UI: 21461209
Pain 2001 Oct;94(1):65-73
EA 1880, Functional Neurology and Epileptology Department, Hopital Neurologique, 59 Boulevard Pinel, 69003, Lyon, France
In this study we compare the intrinsic characteristics and localization of nociceptive CO(2) laser evoked potential (LEP) and non-nociceptive electrical EP (SEP) sources recorded by deep electrodes (one to two electrodes per patient, 10-15 contacts per electrode) directly implanted in the supra-sylvian cortex of 15 epileptic patients. Early CO(2) laser (N140-P170) and electrical (N60-P90) evoked potentials were recorded by all of the electrodes implanted in the supra-sylvian cortex contralateral to stimulation. SEPs and LEPs had similar waveforms and inter-peak latencies. The LEPs appeared 84+/-15ms later and were, on average, 14.2+/-22.2&mgr;V smaller than the SEPs. These differences may be accounted for by the characteristics and the sizes of the different peripheral fibers (Adelta vs. Abeta) activated by the two types of stimuli. The stereotactic Talairach coordinates of the SEP and LEP sources covered the pre- and post-rolandic upper bank of the sylvian fissure, and were not significantly different for noxious and non-noxious stimuli. The spatial distribution of these contralateral responses fits with that of the modeled sources of scalp CO(2) LEPs, magneto-encephalographic studies, and PET data from pain and vibrotactile activation studies. These results permit us to define the SII cortex as a cortical integration area of non-nociceptive and nociceptive inputs. This is supported by: (i) anatomical data reporting that the SII area receives inputs from both posterior columns and spino-thalamic pathways conveying the non-noxious and noxious information, respectively, and (ii) single cell recordings in monkeys, demonstrating that the SII area contains both nociceptive-specific neurons and wide-dynamic-range neurons receiving convergent input from nociceptive and non-nociceptive somatosensory afferents.
PMID: 11576746, UI: 21461208
Pain 2001 Oct;94(1):17-29
Pain Mechanisms Laboratory, Clinical Research Institute of Montreal, McGill University, Quebec, H3G 1Y6, Montreal, Canada
Coincident with nociception, both noxious chemical stimulation of the hind paw and chronic constriction injury (CCI) of the sciatic nerve produce an increase in protein kinase C (PKC) translocation in the spinal cord of rats. Noxious stimulus-induced PKC translocation likely depends on glutamate activity at either N-methyl-D-aspartate (NMDA) receptors or group I metabotropic glutamate receptors (mGluR1/5) in the spinal cord dorsal horn. This study compares nociceptive responses to, and the alterations in membrane-associated PKC, induced by noxious chemical stimulation of the hindpaw and CCI of the sciatic nerve, as well as their modulation by both NMDA and mGluR1/5 receptor antagonists. Three groups of rats were given a single intrathecal (i.t.) injection of either vehicle, dizocilpine maleate (MK-801, 60nmol), an NMDA receptor antagonist, or (S)-4-carboxyphenylglycine (S)-4CPG, (150nmol), an mGluR1/5 antagonist, 10min prior to a 50&mgr;l of 2.5% formalin injection into the ventral surface of one hind paw. Another three groups of rats were given twice daily injections of either vehicle, MK-801 (30nmol) or (S)-4CPG (90nmol) i.t. for 5 days starting 30min before CCI or sham injury of the sciatic nerve. Nociceptive responses were assessed for a 60min period after the formalin injection in the first three groups, and tests of mechanical and cold allodynia were performed on days 4, 8, 12 and 16 after CCI for the latter three groups. Furthermore, changes in the levels of membrane-associated PKC, as assayed by quantitative autoradiography of the specific binding of [3H]-phorbol 12,13-dibutyrate ([3H]-PDBu) in the dorsal horn of the lumbar spinal cord sections, were assessed in formalin-injected rats (at 5, 25 and 60min) and in neuropathic rats 5 days after CCI, treated (as above) with vehicle, MK-801 or (S)-4CPG. The results indicate that i.t. treatment with MK-801 significantly reduced nociceptive scores in the formalin test and also produced a significant suppression of formalin-induced increases in [3H]-PDBu binding in laminae I-II, III-VI and X of the lumbar spinal cord. In contrast, i.t. treatment with (S)-4CPG failed to significantly affect either nociceptive behaviours in the formalin test or formalin-induced increases in [3H]-PDBu binding in laminae I-II and III-VI of the lumbar spinal cord. On the other hand, i.t. treatment with either MK-801 or (S)-4CPG produced a significant reduction in mechanical and cold hypersensitivity, as well as [3H]-PDBu binding in laminae I-II and III-VI of the lumbar spinal cord, after CCI. These results suggest that while NMDA, but not mGluR1/5, receptors are involved in translocation of PKC and nociception in a model of persistent acute pain, both types of receptors influence the translocation of PKC in dorsal horn and mechanical and cold allodynia in a model of chronic neuropathic pain.
PMID: 11576741, UI: 21461203
Pain 2001 Oct;94(1):7-15
Department of Physical Therapy, University of Pittsburgh, 6035 Forbes Tower, 15260, Pittsburgh, PA, USA
Fear-avoidance beliefs have been identified as an important psychosocial variable in patients with chronic disability doe to low back pain. The importance of fear-avoidance beliefs for individuals with acute low back pain has not been explored. Seventy-eight subjects with work-related low back pain of less than 3 weeks'duration were studied. Measurements of pain intensity, physical impairment, disability, nonorganic signs and symptoms, and depression were taken at the initial evaluation. Fear-avoidance beliefs were measured with the work and physical activity subscales of the Fear-avoidance Beliefs Questionnaire. Disability and work status were re-assessed after 4 weeks of physical therapy. Patterns of correlation between fear-avoidance beliefs and other concurrently-measured variables were similar to those reported in patients with chronic low back pain. Fear-avoidance beliefs did not explain a significant amount of the variability in initial disability levels after controlling for pain intensity and physical impairment. Fear-avoidance beliefs about work were significant predictors of 4-week disability and work status even after controlling for initial levels of pain intensity, physical impairment, and disability, and the type of therapy received. Fear-avoidance beliefs are present in patients with acute low back pain, and may be an important factor in explaining the transition from acute to chronic conditions. Screening for fear-avoidance beliefs may be useful for identifying patients at risk of prolonged disability and work absence.
PMID: 11576740, UI: 21461202
Pain 2001 Oct;94(1):1-6
Institut fur Physiologie 1, kliuik fur Neurologie Universitatsstrasse 17, 91054, Erlangen, Germany
PMID: 11576739, UI: 21461201
Reg Anesth Pain Med 2001 Sep-Oct;26(5):394-400
Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands.
Background and Objectives: The use of radiofrequency (RF) procedures in the peripheral nervous system to treat chronic spinal pain has been the subject of controversy. Publications concerned only uncontrolled studies, and irreversible nervous tissue damage was believed to be responsible for the effect, if any. In recent years, randomized, controlled studies have appeared, which have attested to an increasing use of these techniques. This is a systematic review of randomized controlled trials on RF procedures for spinal pain. METHODS: We performed a standardized literature search for randomized, controlled trials. Three adjudicators independently registered trial methodology and outcome using validated and subject-related instruments. Interadjudicator disagreement was resolved by discussion. It was found necessary to devise additional parameters of study assessment. RESULTS: Six trials met the inclusion criteria. This small number, along with clinical and technical heterogeneity precluded statistical analysis. All studies, whether high or low quality, reported positive outcomes. CONCLUSIONS: We conclude that there is moderate evidence that RF lumbar facet denervation is more effective for chronic low back pain than placebo. Limited evidence exists for efficacy of RF neurotomy in chronic cervical zygapophyseal joint pain after flexion-extension injury. There is limited evidence that RF heating of the dorsal root ganglion is more effective than placebo in chronic cervicobrachialgia. We recommend the systematic application of our additional parameter assessments for future evaluations of RF studies. These additional parameters should also be used in the preparation of future trial protocols of RF procedures for the treatment of chronic pain. Reg Anesth Pain Med 2001;26:394-400.
PMID: 11561257, UI: 21445355
Spine 2001 Sep 1;26(17):1910-9
Johann Wolfgang Goethe University, Department of Sports Medicine, Frankfurt/Main, Germany.
STUDY DESIGN: A three-dimensional kinematic analysis of lumbar spinal movements with an ultrasonic measuring system was used to distinguish patients with chronic low back pain from those without such pain. OBJECTIVES: To investigate the effects of chronic low back pain on the three-dimensional movements of the lumbar spine, and to identify variables that would allow discrimination among patients with chronic low back pain and control subjects. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, no previous studies have described or identified altered spinal and pelvic gait kinematics caused by nonspecific chronic low back pain in all anatomic planes. METHODS: In this study, 34 participants with chronic low back pain and 22 subjects without such pain were monitored during treadmill gait. Data from the measuring system operating at 30 Hz were low-pass filtered and normalized to a percentage of the gait cycle. RESULTS: Cross-correlations showed almost identical patterns of pelvic (S1) and thoracic (T12) movement curves in all anatomic planes between groups. No statistical group differences were detected for either pelvic or thoracic oscillation amplitudes. However, Student's t test showed significantly higher coefficients of variation (P < 0.01) in all anatomic planes of patients with chronic low back pain than in healthy control patients. CONCLUSIONS: The phasic patterns and angular spinal displacements of patients with nonspecific low back pain were shown to be within normal limits. However, the patients demonstrated higher degrees of stride-to-stride variability, representing increased fluctuations in dynamic thoracic and pelvic oscillations. These findings, resulting in less than optimal gait patterns, must be considered in the rehabilitation of patients with chronic low back pain.
PMID: 11568705, UI: 21453964
Spine 2001 Sep 1;26(17):1896-903
TNO Work and Employment, Hoofddorp, the Institute for Research in Extramural Medicine and the Department of Social Medicine, Faculty of Medicine, Vrije Universiteit Amsterdam, The Netherlands.
STUDY DESIGN: A 3-year prospective cohort study among 1334 workers was conducted. OBJECTIVE: To determine whether the work-related psychosocial factors of quantitative job demands, conflicting job demands, skill discretion, decision authority, supervisor support, coworker support, and job security are risk factors for neck pain. SUMMARY OF BACKGROUND DATA: Among the various risk factors for neck pain, work-related psychosocial factors play a major role. Previous studies on risk factors for neck pain often had a cross-sectional design, and did not take both physical and psychosocial factors into account. METHODS: At baseline, data on work-related psychosocial factors were collected by means of a questionnaire. During the 3-year follow-up period, data on the occurrence of neck pain were collected by means of postal questionnaires. Individuals without neck pain at baseline were selected for the analyses. Cox regression analysis was applied to examine the relation between the work-related psychosocial factors and the cumulative incidence of neck pain. Adjustments were made for various physical factors and individual characteristics. RESULTS: The analysis included 977 patients. Altogether, 141 workers (14.4%) reported that they had experienced neck pain at least once during the 3-year follow-up period. The relation of neck pain to high quantitative job demands (relative risk [RR], 2.14; 95% confidence interval [CI], 1.28-3.58) and low coworker support (RR, 2.43; 95% CI, 1.11-5.29) was statistically significant. An increased risk was found for low decision authority in relation to neck pain (RR, 1.60; 95% CI, 0.74-3.45), but this relation was not statistically significant. CONCLUSIONS: High quantitative job demands and low coworker support are independent risk factors for neck pain. There are indications that another risk factor for neck pain is low decision authority.
PMID: 11568702, UI: 21453961
Spine 2001 Sep 1;26(17):1884-9
Department of Rehabilitation Sciences, the Hong Kong Polytechnic University, and the Department of Community Medicine and Unit for Behavioural Sciences, the University of Hong Kong.
STUDY DESIGN: A prospective observational study was conducted on the use of the Chinese version of the Northwick Park Neck Pain Questionnaire. OBJECTIVE: To examine the reliability, validity, and responsiveness of the Chinese version of the Northwick Park Neck Pain Questionnaire in Chinese patients with neck pain in Hong Kong. SUMMARY OF BACKGROUND DATA: There is increasing recognition that patient perspectives are essential both in making medical decisions and in judging the treatment outcomes. A valid Chinese version of a neck disability index questionnaire is urgently needed for effective and reliable evaluation of the treatment outcomes for patients with neck pain. METHODS: Two samples with 532 consecutive adult patients with neck pain from seven physiotherapy outpatient departments in Hong Kong who completed the Northwick Park Neck Pain Questionnaire were observed and measured at different intervals: at the beginning of physiotherapy, at 7 days, at 3 weeks, and 6 weeks after physiotherapy. RESULTS: The questionnaire had good content validity, very good test-retest reliability, and internal consistency (intraclass correlation coefficient, 0.95; Cronbach's alpha, 0.87). It also had good validity (Spearman correlation coefficient of 0.59 when the score was correlated with that of a generic 42-item Chinese health questionnaire) and good responsiveness (effect size of 1.11 at week 6 after treatment began). CONCLUSIONS: The Chinese version of the Northwick Park Neck Pain Questionnaire has been shown to demonstrate very good content validity, a high degree of test-retest reliability, and internal consistency. It also exhibited good construct validity and high sensitivity to changes in severity over time.
PMID: 11568699, UI: 21453958
Spine 2001 Sep 1;26(17):1879-83
Institute of Sportsscience and Clinical Biomechanics, Odense University, Denmark.
STUDY DESIGN: A cross-sectional survey of 806 pupils in Odense, Denmark was performed. This survey included children and adolescents ages 8 to 10 and 14 to 16 years obtained through two-stage cluster sampling from schools stratified according to school type, location, and socioeconomic character of the uptake area. OBJECTIVES: To establish the 1-month prevalence of neck, middle back, and low back pain and the consequences this disorder may have in relation to age and gender. SUMMARY OF BACKGROUND DATA: The differences in definitions of back pain and the variety of age groups included in previous studies make it difficult to draw clear conclusions about the onset of pain for various spinal regions in the young. METHODS: Information on back pain within the preceding month, obtained through a standardized interview of 481 children and 325 adolescents, was categorized according to area of pain, age, and gender. The consequences of back pain also were studied. RESULTS: The 1-month prevalence of back pain was 39%. Thoracic pain is most common in childhood, whereas thoracic pain and lumbar pain are equally common in adolescence. Neck pain and pain in more than one area of the spine are rare in both age groups. No gender differences were found. Of those who had back pain, 38% also reported some type of consequence, usually either visits to a medical physician or diminished physical activities. CONCLUSIONS: For clinical and research purposes, neck pain, middle back pain, and low back pain in childhood should be regarded as three specific entities. In future research the data for different age groups should be reported separately.
PMID: 11568698, UI: 21453957
Spine 2001 Aug 15;26(16):1829-31
PMID: 11493863, UI: 21385888
Spine 2001 Aug 15;26(16):1829
PMID: 11493862, UI: 21385887
Spine 2001 Aug 15;26(16):1827-9
PMID: 11493861, UI: 21385886
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