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Anesthesiology 2002 Feb;96(2):514; discussion 514-5
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PMID: 11818792, UI: 21676125
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PMID: 11818791, UI: 21676124
Br J Anaesth 2002 Jan;88(1):72-7
Sir Humphrey Davy Department of Anaesthesia, Bristol Royal Hospital for Children, UK.
BACKGROUND: The analgesics used for paediatric tonsillectomy may be associated with side-effects such as sedation, respiratory depression and vomiting (opioids) or increased bleeding [non-steroidal anti-inflammatory drugs (NSAIDs)]. In our institution, we employ a combination of paracetamol, NSAID and opioid, although there is no published evidence of analgesic benefit from adding NSAIDs to paracetamol in children. METHODS: This randomized, double-blinded clinical study examined the analgesic effectiveness of combining paracetamol (20 mg kg(-1)) with rofecoxib (0.625 mg kg(-1)), ibuprofen (5 mg kg(-1)) or placebo as premedication for (adeno)tonsillectomy (n=98) in children aged 3-15 yr. Intravenous fentanyl 1-2 microg kg(-1) was given intraoperatively. Regular oral paracetamol (15 mg kg(-1), 4 hourly) was given after operation and could be supplemented on request from the child with oral ibuprofen 5 mg kg(-1) or oral codeine 1 mg kg(-1). The primary outcome variable was need for early supplementary analgesia (within 2 h after surgery). RESULTS: The addition of ibuprofen to paracetamol reduced the need for early analgesia from 72% to 38% of children (difference 34%; 95% confidence interval 4-64%). The addition of rofecoxib to paracetamol did not significantly alter the need for early analgesia (68 vs 72%). Pain scores were higher in those children who required early analgesia. There were no differences between the groups in operative blood loss or complications, total 24-h analgesic consumption, pain scores at 4 and 8 h, vomiting or antiemetic use. CONCLUSION: This study provides evidence to support the combination of ibuprofen (but not rofecoxib) with paracetamol for perioperative analgesia in children.
PMID: 11881888, UI: 21873321
Pain 2002 Mar;96(1-2):219-20
Department of Emergency Medicine; Hospital of the University of Pennsylvania, 3400 Spruce Street, 19104-4283, Philadelphia, PA, USA
[Medline record in process]
PMID: 11932081, UI: 21930566
Pain 2002 Mar;96(1-2):217-8
Walton Centre for Neurology and Neurosurgery, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK
PMID: 11932079, UI: 21930564
Pain 2002 Mar;96(1-2):216-7
University of Medicine and Dentistry of NJ, 183, South Orange Avenue, BHSB F1512, 07103, Newark, NJ, USA
PMID: 11932078, UI: 21930563
Pain 2002 Mar;96(1-2):215-6
Multidisciplinary Pain Center and Department of Psychiatry, University Hospitals, K.U. Leuven, Weligerveld 1, B-3212, Lubbeek, Belgium
PMID: 11932077, UI: 21930562
Pain 2002 Mar;96(1-2):197-204
Department of Behavioral Sciences, School of Medicine, University of Minnesota, 10 University Avenue, 55812 2487, Duluth, MN, USA
Research has demonstrated that women report more pain than men, and clinical observations suggest that attenuated adrenocortical activity is associated with high pain sensitivity. The extent to which cortisol concentrations and hemodynamics contribute to gender differences in pain sensitivity has not been investigated. Thirty-four women and 31 men performed the hand cold pressor test (CPT). Participants rated their pain every 15 s during a 90-s CPT and a 90-s post-CPT recovery period and reported pain using the McGill Pain Questionnaire (MPQ). Salivary cortisol samples and cardiovascular measures were collected prior to, during, and after the CPT. Women reported greater pain than men during and after the CPT and on the MPQ (Ps<0.01). CPT disrupted the expected diurnal decline in cortisol, as shown by a significant increase in cortisol concentration post-CPT (P<0.01) in men and women. Regression analyses revealed that pre-CPT cortisol concentrations predicted lower pain reports during and after CPT in men only (P<0.01). Systolic blood pressure (BP) and stroke volume correlated negatively with pain reports only in women (Ps<0.05). Controlling for potential confounding variables did not alter these relationships. The negative association between pre-CPT cortisol and pain perception in men and the association between BP and pain in women demonstrate different physiological predictors of pain perception in men and women.
PMID: 11932075, UI: 21930560
Pain 2002 Mar;96(1-2):189-96
Department of Psychosomatics and Psychotherapy, Georg-August-University Goettingen, von-Siebold-Strasse 5, 37075, Goettingen, Germany
There is some evidence for the efficacy of acupuncture in chronic low-back pain (LBP), but it remains unclear whether acupuncture is superior to placebo. In a randomized, blinded, placebo-controlled trial, we evaluated the effect of traditional acupuncture in chronic LBP. A total of 131 consecutive out-patients of the Department of Orthopaedics, University Goettingen, Germany, (age=48.1 years, 58.5% female, duration of pain: 9.6 years) with non-radiating LBP for at least 6 months and a normal neurological examination were randomized to one of three groups over 12 weeks. Each group received active physiotherapy over 12 weeks. The control group (n=46) received no further treatment, the acupuncture group (n=40) received 20 sessions of traditional acupuncture and the sham-acupuncture group (n=45) 20 sessions of minimal acupuncture.Changes from baseline to the end of treatment and to 9-month follow-up were assessed in pain intensity and in pain disability, and secondary in psychological distress and in spine flexion, compared by intervention groups.Acupuncture was superior to the control condition (physiotherapy) regarding pain intensity (P=0.000), pain disability (P=0.000), and psychological distress (P=0.020) at the end of treatment. Compared to sham-acupuncture, acupuncture reduced psychological distress (P=0.040) only. At 9-month follow-up, the superiority of acupuncture compared to the control condition became less and acupuncture was not different to sham-acupuncture.We found a significant improvement by traditional acupuncture in chronic LBP compared to routine care (physiotherapy) but not compared to sham-acupuncture. The trial demonstrated a placebo effect of traditional acupuncture in chronic LBP.
PMID: 11932074, UI: 21930559
Pain 2002 Mar;96(1-2):163-75
Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, QC H3A 1B1, Montreal, Canada
Vulvar vestibulitis syndrome (VVS) is a common cause of dyspareunia in pre-menopausal women. Little is known about sensory function in the vulvar vestibule, despite Kinsey's assertion that it is important for sexual sensation. We examined punctate tactile and pain thresholds to modified von Frey filaments in the genital region of women with VVS and age- and contraceptive-matched pain-free controls. Women with VVS had lower tactile and pain thresholds around the vulvar vestibule and on the labium minus than controls, and these results were reliable over time. Women with VVS also had lower tactile, punctate pain, and pressure-pain tolerance over the deltoid muscle on the upper arm, suggesting that generalized systemic hypersensitivity may contribute to VVS in some women. In testing tactile thresholds, 20% of trials were blank, and there was no group difference in the false positive rate, indicating that response bias cannot account for the lower thresholds. Women with VVS reported significantly more catastrophizing thoughts related to intercourse pain, but there was no difference between groups in catastrophizing for unrelated pains. Pain intensity ratings for stimuli above the pain threshold increased in a parallel fashion with log stimulus intensity in both groups, but the ratings of distress were substantially greater in the VVS group than in controls at equivalent levels of pain intensity. The data imply that VVS may reflect a specific pathological process in the vestibular region, superimposed on systemic hypersensitivity to tactile and pain stimuli.
PMID: 11932072, UI: 21930557
Pain 2002 Mar;96(1-2):141-51
Institute of Physiology and Pathophysiology, Johannes Gutenberg-University, Saarstrasse 21, D-55099, Mainz, Germany
Patients with sensory disturbances of painful and non-painful character show distinct changes in touch and/or pain sensitivity. The patterns of sensory changes were compared to those of human surrogate models of neuropathic pain to assess the underlying mechanisms. We investigated 30 consecutive in-patients with dysaesthesia of various origins (peripheral, spinal, and brainstem lesions) and 15 healthy subjects. Tactile thresholds were determined with calibrated von Frey hairs (1.1mm slashed circle). Thresholds and stimulus-response functions for pricking pain were determined with a series of calibrated punctate mechanical stimulators (0.2mm slashed circle). Allodynia was tested by light stroking with a brush, Q-tip, and cotton wisp. Perceptual wind-up was tested by trains of punctate stimuli at 0.2 or 1Hz. Intradermal injection of capsaicin (n=7) and A-fiber conduction blockade (n=8) served as human surrogate models for neurogenic hyperalgesia and partial nociceptive deafferentation, respectively. Patients without pain (18/30) showed a continuous distribution of threshold shifts in the dysaesthetic skin area with a low to moderate increase in pain threshold (by 1.52+/-0.45 log(2) units). Patients with painful dysaesthesia presented as two separate groups (six patients each): one showing lowered pain thresholds (by -1.94+/-0.46 log(2) units, hyperalgesia) and the other elevated pain thresholds (by 3.02+/-0.48 log(2) units, hypoalgesia). The human surrogate model of neurogenic hyperalgesia revealed nearly identical leftward shifts in stimulus-response function for pricking pain as patients with spontaneous pain and hyperalgesia (by a factor of about 5 each). The sensory changes in the human surrogate model of deafferentation were similar to patients with hypoalgesia and spontaneous pain (rightward shift of the stimulus-response function with a decrease in slope). Perceptual wind-up did not differ between symptomatic and control areas. There was no exclusive association of any parameter obtained by quantitative sensory testing with a particular disease (of either peripheral or central origin). Our findings suggest that neuropathic pain is based on two distinct mechanisms: (I) central sensitization (neurogenic hyperalgesia; in patients with minor sensory impairment) and (II) partial nociceptive deafferentation (painful hypoalgesia; in patients with major sensory deficit). This distinction as previously postulated for postherpetic neuralgia, is obviously valid also for other conditions. Our findings emphasize the significance of a mechanism-based classification of neuropathic pain.
PMID: 11932070, UI: 21930555
Pain 2002 Mar;96(1-2):129-40
Novartis Institute for Medical Sciences, 5 Gower Place, WC1E 6BN, London, UK
This study describes the first known model of bone cancer pain in the rat. Sprague-Dawley rats receiving intra-tibial injections of syngeneic MRMT-1 rat mammary gland carcinoma cells developed behavioural signs indicative of pain, including: mechanical allodynia, difference of weight bearing between hind paws and mechanical hyperalgesia. The development of the bone tumour and structural damage to the bone was monitored by radiological analysis, quantitative measurement of mineral content and histology.Intra-tibial injections of 3x10(3) or 3x10(4) syngeneic MRMT-1 cells produced a rapidly expanding tumour within the boundaries of the tibia, causing severe remodelling of the bone. Radiographs showed extensive damage to the cortical bone and the trabeculae by day 10-14 after inoculation of 3x10(3) MRMT-1 cells, and by day 20, the damage was threatening the integrity of the tibial bone. While both mineral content and mineral density decreased significantly in the cancerous bone, osteoclast numbers in the peritumoural compact bone remained unchanged. However, tartarate-resistant acid phosphatase staining revealed a large number of polykariotic cells, resembling those of osteoclasts within the tumour. No tumour growth was observed after the injection of heat-killed MRMT-1 cells.Intra-tibial injections of 3x10(3) or 3x10(4) MRMT-1 cells, heat-killed cells or vehicle did not show changes in body weight and core temperature over 19-20 days. The general activity of animals after injection with live or heat-killed MRMT-1 cells was higher than that of the control group, however, the activity of the MRMT-1 treated group declined during the progress of the disease.Rats receiving intra-tibial injections of MRMT-1 cells displayed the gradual development of mechanical allodynia and mechanical hyperalgesia/reduced weight bearing on the affected limb, beginning on day 12-14 or 10-12 following injection of 3x10(3) or 3x10(4) cells, respectively. These symptoms were not observed in rats receiving heat-killed cells or vehicle.Behavioural data suggest a reasonable time window for evaluation of anti-nociceptive agents between day 14 and 20 after cancer cell inoculation in this model.Acute treatment with morphine (1-3mg/kg, subcutanously (s.c.)) produced a dose-dependent reduction in the response frequency of hind paw withdrawal to von Frey filament stimulation 17 or 19 days following intra-tibial injections of 3x10(3) MRMT-1 cells. A significant reduction in the difference in hind limb weight bearing was also observed. Acute treatment with celebrex (10-30mg/kg, s.c.) did not affect mechanical allodynia or difference in weight bearing in rats 20 days following treatment with 3x10(3) MRMT-1 cells.Although the pathophysiology of cancer pain is largely unknown, significant enhancement of glial fibrillary acidic protein (GFAP) staining in the corresponding segments of the ipsilateral spinal cord highlights the possible involvement of astrocytes.In summary, the induction of bone cancer in the rat by the syngeneic MRMT-1 mammary tumour cell line provides a valid pre-clinical model for pain associated with bone metastases. Significant mechanical hyperalgesia and allodynia develops in association with the progression of the tumour in the bone marrow cavity, while the general condition of the animal remains satisfactory. While acute treatment with morphine has some analgesic effect on hind limb sparing the selective COX-2 inhibitor, celebrex, has no influence on the pain-related behavioural changes in this model.
PMID: 11932069, UI: 21930554
Pain 2002 Mar;96(1-2):41-7
Department of Neurosurgery, Johns Hopkins University, 21218, Baltimore, MD, USA
Various animal models of neuropathic pain have been developed which involve creating a lesion in a spinal root. We describe a human correlate in which patients developed a neuropathic pain syndrome after having one spinal nerve surgically divided. In some patients with brachial plexus lesions, the C7 spinal nerve from the opposite side is divided and used as a nerve transfer to re-innervate the injured brachial plexus. Of five patients that underwent this procedure, one went on to develop a transient but significant neuropathic pain problem. Extensive sensory testing in this patient 2 months after surgery revealed dysesthesia and hyperalgesia to mechanical and cooling stimuli, but not to heat stimuli in the C7 dermatome of the hand on the side of C7 section. The pain and hyperalgesia persisted during a phentolamine infusion, which produced a sympathetic blockade. Only mild parasthesia persisted at a 1 year follow up. Thus, surgical division of a single spinal nerve in humans can lead to the development of neuropathic pain.
PMID: 11932059, UI: 21930544
Pain 2002 Mar;96(1-2):1-2
Departments of Preventive Sciences, Neuroscience, Psychiatry, and Cancer Center, University of Minnesota, 55455, Minneapolis, MN, USA
PMID: 11932054, UI: 21930539
Spine 2002 Apr 15;27(8):E207-E214
Department of Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland, the Department of Physical Medicine and Rehabilitation, Kuopio University Hospital, Kuopio, Finland, the University of Kuopio, Department of Physiology, Kuopio, Finland, and the Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.
[Record supplied by publisher]
STUDY DESIGN: A test-retest design was used. OBJECTIVE: To assess interexaminer reliability of the McKenzie method for performing clinical tests and classifying patients with low back pain. SUMMARY OF BACKGROUND DATA: Clinical methods and tests classifying patients with nonspecific low back pain have been based mainly on symptom duration or extent of pain referral. The McKenzie mechanical diagnostic and classification approach is a widely used noninvasive, low-technology method of assessing patients with low back pain. However, little is known about the interexaminer reliability of the method, previous studies having yielded conflicting results. METHODS: For this study, 39 volunteers with low back pain, mean age 40 years (range, 24-55 years), were blindly assessed by two physical therapists trained in the McKenzie method. The variability of two examiners for binary decisions was expressed by the kappa coefficient, and by the proportion of observed agreement, as calculated from a 2 x 2 contingency table of concordance. RESULTS: On the basis of pure observation alone, agreement among clinical tests on the presence and direction of lateral shift was 77% (kappa = 0.2; P < 0.248) and 79% (kappa = 0.4; P < 0.003), respectively. Agreement on the relevance of lateral shift and the lateral component according to symptom responses was 85% (kappa = 0.7; P < 0.000) and 92% (kappa= 0.4; P < 0.021), respectively. Using the repeated movements and static end-range loading strategy to define the centralization phenomenon and directional preference, agreement was 95% (kappa = 0.7; P < 0.002) and 90% (kappa = 0.9; P < 0.000), respectively. When patients with low back pain were classified into the McKenzie main syndromes and into specific subgroups, agreement was 95% (kappa = 0.6; P < 0.000) and 74% (kappa = 0.7; P < 0.000), respectively. CONCLUSIONS: Interexaminer reliability of the McKenzie lumbar spine assessment in performing clinical tests and classifying patients with low back pain into syndromes were good and statistically significant when the examiners had been trained in the McKenzie method.
PMID: 11935120
Spine 2002 Apr 15;27(8):864-870
Department of Family Medicine and Community Health, the Department of Psychiatry, and the Center for Health Policy and Health Services Research University of Massachusetts Medical School, the Robert Brigham Multipurpose Arthritis and Musculoskeletal Diseases Center, Brigham and Women's Hospital, Harvard Medical School; Department of Environmental Health, Harvard School of Public Health, and Liberty Mutual Center for Research Disability.
OBJECTIVES: This pilot study explored a broad range of work-related outcomes for occupational low back injuries. METHODS: A model of occupational outcomes and a survey instrument were developed on the basis of interviews, expert opinion, and literature reviews. New Hampshire workers who had an occupational back injury a year before the study were sampled from first reports of injury and sent a mailed survey about their postinjury experiences and related factors. RESULTS: Of 251 randomly selected cases, a valid address could be identified for 121, and 99 patients responded. Almost 60% of the respondents had lost 1 week of work or more. At 1 year after injury, half of the respondents had returned to their preinjury job and employer, and 20% were unemployed, half of them because of the injury. Most working respondents reported no decrease in their work capacity. However, 68% still had pain exacerbated by work, and 47% worried that their condition would worsen with continued work. Reinjury occurred in 42% of the respondents. The work-related outcome measures were largely independent of each other. Exploratory multivariate analyses demonstrated unique patterns of factors associated with each outcome. Reinjury risk was significantly greater in respondents whose employers offered accommodations or whose postinjury jobs had greater ergonomic risk. The small sample size limited the ability to achieve statistically significant results in multivariate analyses. CONCLUSIONS: Simply measuring return to work did not appear to capture the full range of job-related consequences from occupational back injuries in this pilot evaluation. Timing of return to work, occupational ergonomic risks, and appropriate job modifications appeared to be particularly important in a safe return to the job after an occupational low back injury. Results suggest opportunities to address risk factors that may improve work outcomes.
PMID: 11935111
Spine 2002 Apr 15;27(8):812-7
University of Ottawa, Faculty of Health Sciences, School of Rehabilitation, Physiotherapy Program and Radiology Department of the Ottawa Hospital-General Campus.
STUDY DESIGN: A set of measurements was compared with an accepted gold standard using a methodologic design. OBJECTIVE: To estimate the criterion validity of the cervical range of motion device used for lateral flexion in patients with neck pain. SUMMARY OF BACKGROUND DATA: Reliability of the cervical range of motion device has been well established. At this writing, only validity for flexion and extension of the cervical spine has been investigated with this device. METHODS: The sample consisted of 24 volunteer subjects who had previously received physiotherapy for neck pain. In the radiograph department, subjects were stabilized on a chair. A first reading on the cervical range of motion device and a radiograph were taken in a neutral starting position. The subject then was asked to perform a maximal right lateral flexion, which was followed by a reading of the device and a second radiograph. The same procedures were followed for left lateral flexion. RESULTS: The cervical range of motion device demonstrated a very good linear relation with the radiograph measurements: left lateral flexion (r = 0.82,; 95% confidence interval, 0.62-0.92), right lateral flexion (r = 0.84; 95% confidence interval, 0.66-0.93). CONCLUSIONS: The cervical range of motion device showed very good validity for measurement of lateral flexion in this population of patients with neck pain. Because the reliability of the cervical range of motion device was established previously, the results of this study suggest that the device be used as an outcome measure for the cervical flexion, and for flexion and extension.
PMID: 11935102, UI: 21932958
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