Clin J Pain 2001 Dec;17(4 Suppl):S128-32
School of Nursing, Faculty of Health Sciences, McMaster University, and Hamilton Health Sciences Corporation, Ontario, Canada. weirr@mcmaster.ca
BACKGROUND: With an increasing prevalence of low back pain, management can include modified work, work-conditioning, or work-hardening programs. Modified work programs, or employer's worksite interventions or clinic-based programs under medical supervision, provide a gradual increase of workload. Work-conditioning programs, or unimodal physical conditioning and function activities, promote return to work. Work-hardening programs, or graded work simulations and psychological interventions, are used as part of an interdisciplinary program addressing physical and functional needs. OBJECTIVE: The objective of the review was to determine how effective modified work programs, work hardening, and work conditioning are in the management of chronic pain disability. METHODOLOGY: The literature search identified two systematic literature reviews to provide the evidence about these interventions for disability management. RESULTS: Studies of work conditioning showed methodological variability, heterogeneous subjects, variable definitions of modified work, and limited outcome measures. Using return-to-work outcomes, 8 of the 11 studies of adequate methodological quality reported positive effects of modified work programs, mostly light duty. For work conditioning and work hardening, studies showed methodological variability combined with heterogeneous subjects, including varying times out of work and varying work ethics from different countries. Most study results were uncertain, though results of three of the four medium-quality studies were positive. CONCLUSIONS: Modified work programs may improve return-to-work rates of workers with work-related injuries for 6 months or longer (level 2). There is inadequate evidence (level 4a) to determine what particular aspects of modified work programs are helpful. Work conditioning and work hardening may or may not improve the return to work of more chronically disabled workers (level 4b).
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PMID: 11783825, UI: 21641291
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Eur J Pharmacol 2002 Apr 26;441(3):185-91
Department of Applied Pharmacology, Faculty of Pharmaceutical Sciences, Toyama Medical and Pharmaceutical University, 2630 Sugitani, 930-0194, Toyama, Japan
[Medline record in process]
The present study was conducted to clarify whether relief from cancer pain by morphine would suppress tumor growth and metastasis. When given orthotopic inoculation of B16-BL6 melanoma cells into the hind paw, C57BL/6 mice showed moderate and marked hyperalgesia on days 7-10 and from day 14 post-inoculation, respectively. The volume of inoculated hind paw was increased exponentially as a function of time from day 8 post-inoculation, a phenomena being due to melanoma growth. Lung metastasis was apparent after day 12 post-inoculation. On day 16 post-inoculation, the hyperalgesia was completely inhibited by subcutaneous injection of morphine hydrochloride (5 and 10 mg/kg). The tumor growth and lung metastasis were markedly inhibited by repeated administration of morphine (5 and 10 mg/kg daily for 6 days) and also by the neurectomy of sciatic nerve innervating the inoculated region. The results suggest that relief from cancer pain by morphine inhibits tumor growth and metastasis.
PMID: 12063091, UI: 22057745
Spine 2002 Jun 15;27(12):1312-7
Department of Orthopaedics, Goteborg University, Sahlgrenska University Hospital, Gothenburg, Sweden, the; Department of Physiology, University of Bergen, Bergen, Norway, and; AstraZeneca R&D, Sodertalje, Sweden.
STUDY DESIGN: A new way to study pain in experimental animals without handling of the animals and based on registration of spontaneous behavior using video recordings. OBJECTIVES: To evaluate if experimental disc herniation in the rat may induce changes in spontaneous behavior. SUMMARY OF BACKGROUND DATA: The knowledge regarding the basic pathophysiologic mechanisms of sciatica has increased dramatically during the last decade. However, studies have mainly assessed nerve dysfunction rather than pain. Existing methods to study pain generally comprise a certain amount of handling and registration of changes in sensory thresholds. In the present study we introduce a new way to assess pain that focuses on changes in behavior rather than on changes in thresholds. METHODS: Forty rats were divided equally into four experimental series: sham exposure of the left L4 dorsal root ganglion, exposure of the left L4 dorsal root ganglion and incision of the L4-L5 disc, exposure and slight displacement of the left L4 dorsal root ganglion, and combination of disc incision and displacement. The rats were videotaped the day before surgery and on day 1, 3, 7, 14, and 21 after surgery. Spontaneous behavior was categorized into 10 behaviors and recorded during 20 minutes of observation. RESULTS: Disc incision and displacement per se did not induce any behaviors different from that observed in the sham-operated group. In the series with the combination of disc incision and displacement there was increased focal pain, seen as increased lifting of the hind paw on the operated side and increased rotation of the head toward the operated side. This pain pattern was most pronounced the day after surgery. Fourteen days after surgery there were no detectable differences in behavior between this group and the sham group. At day 21 after surgery, however, another picture of increased immobility and decreased locomotion was seen in this group, possibly indicating more generalized pain. CONCLUSIONS: The study demonstrates that it is possible to detect changes in spontaneous behavior after experimental disc herniation. However, such changes may only be seen if disc incision and slight mechanical deformation are combined. This is in agreement with previous clinical and experimental observations. The present model allows for convenient assessment of pain in a way that focuses on spontaneous behavior rather than changes in pain thresholds and that reduces the interference of the researcher and environment on the outcome of the assessment.
PMID: 12065980, UI: 22061489
Support Care Cancer 2002 Jan;10(1):3-7
Clinique des Soins Supportifs et Palliatifs, Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium. isabelle.mancini@bordet.be
The Supportive and Palliative Care Unit of the Institut Jules Bordet officially started its activities in February 1999. Our Unit comprises eight beds (four rooms with one bed each and two rooms with two beds each). We admit advanced cancer patients presenting with severe symptoms whose control is going to require all the expertise of a multidisciplinary team. Whilst these eight beds are identified geographically in the hospital, the team's mobility assures continuity of care for patients who wish to stay in another department. The infrastructure of the Unit and its rooms allow close family members who wish to sleep close to the patients to do so. Otherwise, visits are allowed round the clock, though always with due consideration for patients' comfort. Patients are referred either by a physician working in our Institution (medical oncologist, surgeon, or radiotherapist) or by their family physicians. Less frequently, patients themselves specifically ask to be admitted to our Unit. The activity of the Unit itself during its first year of functioning can be summarized as follows. We admitted 155 advanced cancer patients, for a total number of 210 hospitalizations. Patients were admitted a median of 35 months after their diagnosis and a median of 20 days before death. Stays were generally short (median 11 days). We systematically used quantitative assessment tools (MMSQ, MDAS,EFAT and various VAS) to detect and monitor their symptoms and any complications. The main symptoms on admission were pain, anorexia, asthenia, dyspnea and anxiety/depression. Pain, nausea/vomiting, constipation and cough were controlled in almost all patients, whereas control of asthenia and anorexia was most often insufficient. In 51% of our cases the patients could be discharged home; 40% died in the unit; 4% were transferred to long-term palliative care units and 1% to other units within our Institution (4% were still hospitalized at the time of this analysis).
PMID: 11777185, UI: 21632922
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