Ann Intern Med 2002 May 21;136(10):I36
[Medline record in process]
PMID: 12020157, UI: 22014994
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Ann Intern Med 2002 May 21;136(10):758-9
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PMID: 12020144, UI: 22014981
Ann Intern Med 2002 May 21;136(10):713-22
Department of Clinical Epidemiology, Cabrini Hospital, Victoria, Australia. Jan.Hoving@med.monash.edu.au
BACKGROUND: Neck pain is a common problem, but the effectiveness of frequently applied conservative therapies has never been directly compared. OBJECTIVE: To determine the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner. DESIGN: Randomized, controlled trial. SETTING: Outpatient care setting in the Netherlands. PATIENTS: 183 patients, 18 to 70 years of age, who had had nonspecific neck pain for at least 2 weeks. INTERVENTION: 6 weeks of manual therapy (specific mobilization techniques) once per week, physical therapy (exercise therapy) twice per week, or continued care by a general practitioner (analgesics, counseling, and education). MEASUREMENTS: Treatment was considered successful if the patient reported being "completely recovered" or "much improved" on an ordinal six-point scale. Physical dysfunction, pain intensity, and disability were also measured. RESULTS: At 7 weeks, the success rates were 68.3% for manual therapy, 50.8% for physical therapy, and 35.9% for continued care. Statistically significant differences in pain intensity with manual therapy compared with continued care or physical therapy ranged from 0.9 to 1.5 on a scale of 0 to 10. Disability scores also favored manual therapy, but the differences among groups were small. Manual therapy scored consistently better than the other two interventions on most outcome measures. Physical therapy scored better than continued care on some outcome measures, but the differences were not statistically significant. CONCLUSION: In daily practice, manual therapy is a favorable treatment option for patients with neck pain compared with physical therapy or continued care by a general practitioner.
PMID: 12020139, UI: 22014976
Br J Anaesth 2002 Mar;88(3):379-83
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong SAR, People's Republic of China.
BACKGROUND: In a prospective, randomized, double-blind, placebo-controlled trial, we investigated the effect of adding meperidine 10 mg to intrathecal bupivacaine on the duration of early postoperative analgesia in 40 patients having elective Caesarean section under spinal anaesthesia. METHODS: Patients received intrathecal injection of 0.5% hyperbaric bupivacaine 2.0 ml plus either normal saline 0.2 ml (saline group) or 5% meperidine 0.2 ml (meperidine group). After operation, all patients were given i.v. patient-controlled analgesia using morphine. RESULTS: The duration of effective analgesia, defined as the time from intrathecal injection to first patient-controlled analgesia demand, was greater in the meperidine group (mean 234 min, 95% confidence interval 200-269 min) compared with the saline group (mean 125 min, 95% confidence interval 111-138 min; P<0.001). The 24 h morphine requirement was similar in the two groups. The meperidine group had a greater incidence of intraoperative nausea or vomiting compared with the saline group (11 vs 3; P=0.02). CONCLUSION: Addition of meperidine 10 mg to intrathecal bupivacaine for Caesarean section is associated with prolonged postoperative analgesia but with greater intraoperative nausea and vomiting.
PMID: 11990270, UI: 21985649
Lancet 2002 May 11;359(9318):1655-60
Klinik fur Neurologie Christian-Albrechts-Universitat Kiel, Kiel, Germany
Background Complex regional pain syndromes can be relieved by sympathetic blockage. The mechanisms of sympathetically maintained pain (SMP) are unclear. We aimed to establish the effect of physiological sympathetic cutaneous vasoconstrictor activity on pain and hyperalgesia in patients with complex regional pain syndromes.Methods High and low cutaneous vasoconstrictor activity was produced by whole-body cooling and warming (thermal suit) in 13 patients with type I disease and in ten controls. The degree of cutaneous vasoconstrictor discharge was monitored by measurement of skin blood flow and temperature at the arm and leg. Local skin temperature at the affected region was fixed at 35 degrees C. Pain was quantified during high and low cutaneous vasoconstrictor activity (intensity of spontaneous pain, area of mechanical hyperalgesias, heat-pain thresholds). Furthermore, pain was measured before and after diagnostic sympathetic blockage to identify patients with SMP and sympathetically independent pain.Findings In patients with SMP, intensity of spontaneous pain significantly increased, by 22%, and spatial distribution of mechanical dynamic and punctate hyperalgesia increased by 42% and 27%, respectively, during high sympathetic activity compared with low activity. Heat-pain thresholds did not differ during high and low cutaneous vasoconstrictor activity (cold and warm state, 43.6 degrees C vs 44.6 degrees C). Pain relief after sympathetic blockage correlated with augmentation of spontaneous pain after experimental stimulation of cutaneous vasoconstrictor activity (r=0.6, p=0.0244).Interpretation We have shown that in complex regional pain syndromes with SMP, physiological activation of cutaneous vasoconstrictor neurons projecting to the painful arm or leg enhances spontaneous pain and hyperalgesia. We postulate that there is a pathological interaction between sympathetic and afferent neurons within the skin.
PMID: 12020526, UI: 22016292
Neurology 2002 May 14;58(9):1443; discussion 1443-4
PMID: 12011309, UI: 22007848
Pain 2002 Feb;95(3):289-90; discussion 290-1
PMID: 11839430, UI: 21829449
Reg Anesth Pain Med 2002 May-Jun;27(3):337
PMID: 12016623, UI: 22012114
Reg Anesth Pain Med 2002 May-Jun;27(3):336-7
PMID: 12016622, UI: 22012113
Reg Anesth Pain Med 2002 May;27(3):296-305
Division of Pain Medicine, Departments of Anesthesiology and Pain Medicine (S.M.F., A.M.) and Radiology (J.A.S.), University of California, Davis, Sacramento, California; and the Cancer Pain Management and Palliative Care, Beth Israel Deaconess Medical Center and Department of Anesthesia and Critical Care, Harvard Medical School (H.S.), Boston, Massachusetts.
[Record supplied by publisher]
PMID: 12016604
Reg Anesth Pain Med 2002 May-Jun;27(3):289-95
Departments of Anesthesiology and Pharmacology, "Virgen de la Arrixaca" University Hospital, General University Hospital and "Morales Meseguer" General Hospital, Murcia, Spain.
BACKGROUND AND OBJECTIVES: The aim of this study was to compare the effectiveness of 3 anesthetic creams in relieving venous puncture-related pain in children. METHODS: We performed a double-blind, randomized, prospective study in 300 patients, American Society of Anesthesiologists (ASA) I-II, aged 3 months to 10 years, scheduled for minor elective surgical procedures. These children were distributed into 3 groups, with 100 patients each, according to each type of cream applied to the back of the children's hands before performing the venous puncture: Group I was given EMLA (eutectic 2.5% lidocaine and 2.5% prilocaine mixture), group II received 4% amethocaine (4% AMET), and group III was treated with AMLI (2.5% amethocaine and 2.5% lidocaine), a new anesthetic cream developed at our hospital. Each group was further classified into 5 subgroups, with 20 patients each, according to the time length of the application of the individual cream (group A, </= 30 minutes; B, 30 minutes to 60 minutes; C, 60 minutes to 90 minutes; D, 90 minutes to 120 minutes; E, >/= 120 minutes). We evaluated pain, movement, and verbalization to puncture, as well as the appearance of adverse effects. RESULTS: Group I (EMLA), subgroup A (</= 30 minutes), experienced significantly more pain, movement, and verbalization than groups II and III. Patients in group II (4% AMET) exhibited a higher frequency of untoward effects. CONCLUSIONS: All 3 creams proved to be effective in relieving venous puncture pain in children. EMLA presented a longer latency period, 4% amethocaine showed the highest percentage of untoward effects, and AMLI exhibited a shorter latency period than EMLA, while having fewer adverse effects than 4% AMET and EMLA. Reg Anesth Pain Med 2002;27:289-295.
PMID: 12016603, UI: 22012094
Reg Anesth Pain Med 2002 May-Jun;27(3):240-1
Associate Editor, Imaging Section Regional Anesthesia and Pain Medicine Associate Professor of Anesthesiology University of Vermont College of Medicine Burlington, Vermont.
PMID: 12016594, UI: 22012085
Spine 2002 Mar 1;27(5):556-7
PMID: 11880846, UI: 21874451
Spine 2002 Mar 1;27(5):452
Twin Cities Spine Center; Minneapolis, Minnesota, USA.
PMID: 11880828, UI: 21874433
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