Am J Emerg Med 2002 Mar;20(2):79-82
Departments of Emergency Medicine, Medical Technology and Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan City, Taiwan, R.O.C.
[Medline record in process]
Recent investigations suggest that oxidative stress markers are useful in the evaluation of some types of abdominal pathology. We hypothesized that the severity of abdominal pain is correlated with oxidative stress as quantified by total antioxidant capacity (TAC) and malondialdehyde (MDA). The objective of this study was to determine the plasma TAC and MDA levels in patients with acute abdominal pain and to examine their relation to abdominal emergency. We recruited 128 patients presenting with acute abdominal pain at the emergency department. Medical history, vital signs and laboratory data were collected on arrival. TAC and MDA levels were determined using serums obtained from the initial blood sampling. Patients with acute abdominal pain had lower levels of TAC and higher levels of MDA than normal control. When patients were grouped according to whether they were discharged early (less than 24 hours) or hospitalized longer than 24 hours, Patients with hospital stay > 24 hours had significantly elevated pulse rate, temperature, leukocyte count, and C reactive protein (CRP) and lower TAC. No significant difference was found in age, sex, temperature, respiratory rate, blood pressure, and MDA level. Multivariate logistic regression analysis revealed that CRP and TAC were significant indicators of quantitative variables for disposition. This study found a correlation exists between oxidative stress and disease severity in patients with abdominal pain. This suggests that TAC might be useful as a guide for patient disposition in the emergency department. (Am J Emer Med 2002;20:79-82. Copyright 2002, Elsevier Science (USA). All rights reserved.)
PMID: 11880867, UI: 21868137
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Br J Anaesth 2002 Feb;88(2):227-33
Department of Anaesthesia, McMaster University, Hamilton, Canada.
BACKGROUND: Ketorolac is approved for the relief of postoperative pain but concerns have been raised over a possible risk of serious adverse effects and death. Two regulatory reviews in Europe on the safety of ketorolac found the data were inconclusive and lacked comparison with other non-steroidal anti-inflammatory drugs. The aim of this study was to compare the risk of serious adverse effects with ketorolac vs diclofenac or ketoprofen in adult patients after elective major surgery. METHODS: This prospective, randomized multicentre trial evaluated the risks of death, increased surgical site bleeding, gastrointestinal bleeding, acute renal failure, and allergic reactions, with ketorolac vs diclofenac or ketoprofen administered according to their approved parenteral and oral dose and duration of treatment. Patients were followed for 30 days after surgery. RESULTS: A total of 11,245 patients completed the trial at 49 European hospitals. Of these, 5634 patients received ketorolac and 5611 patients received one of the comparators. 155 patients (1.38%) had a serious adverse outcome, with 19 deaths (0. 17%), 117 patients with surgical site bleeding (1.04%), 12 patients with allergic reactions (0.12%), 10 patients with acute renal failure (0.09%), and four patients with gastrointestinal bleeding (0.04%). There were no differences between ketorolac and ketoprofen or diclofenac. Postoperative anticoagulants increased the risk of surgical site bleeding equally with ketorolac (odds ratio=2.65, 95% CI=1.51-4.67) and the comparators (odds ratio=3.58, 95% CI=1.93-6.70). Other risk factors for serious adverse outcomes were age, ASA score, and some types of surgery (plastic/ear, nose and throat, gynaecology, and urology). CONCLUSION: We conclude that ketorolac is as safe as ketoprofen and diclofenac for the treatment of pain after major surgery.
PMID: 11883386, UI: 21867438
Br J Anaesth 2001 Oct;87(4):577-83
Department of Anaesthesiology and Intensive Care, Herlev University Hospital, Copenhagen County, Denmark.
In a double blind study we have investigated the effects of epidural local anaesthesia (LA), when added to general anaesthesia (GA) and postoperative paracetamol and NSAID, on postoperative pain and gastrointestinal function in patients undergoing open hysterectomy. Sixty patients were randomized into three study groups: GA, and postoperative paracetamol and NSAID (GA, n=20); GA, paracetamol, NSAID, intraoperative epidural lidocaine and 24-h postoperative epidural saline (Saline, n=20); or GA, paracetamol, NSAID, intraoperative epidural lidocaine and 24-h postoperative epidural bupivacaine (Bupi, n=20). Patients were observed for 72 h postoperatively. Pain at rest, during cough, and mobilization, request for supplementary morphine, and time to first postoperative flatus, was reduced in patients receiving 24-h postoperative epidural anaesthesia, compared with the two other groups. However, these effects of epidural LA, were not sustained beyond the period of infusion, and no differences in PONV, time to first postoperative defecation, mobilization or time to discharge from hospital were observed between groups. A 24 h postoperative epidural infusion with bupivacaine, when added to postoperative paracetamol and NSAID, reduces pain and opioid requirements, but has only limited effects on gastrointestinal function and patient recovery.
PMID: 11878727, UI: 21867515
Br J Anaesth 2001 Dec;87(6):942
Publication Types:
PMID: 11878705, UI: 21867493
Br J Anaesth 2001 Dec;87(6):935-6
Departement d'Anesthesie et Reanimation, Centre Hospitalier Universitaire de Bicetre, Le Kremlin Bicetre, France.
We describe a case of a 9-yr-old child with sickle cell disease complicated by abdominal vaso-occlusive crisis and priapism. Both complications were successfully treated with a combination of epidural local anesthetics and morphine.
PMID: 11878700, UI: 21867488
Br J Anaesth 2002 Feb;88(2):199-214
Department of Surgical Gastroenterology, Hvidovre University Hospital, Denmark.
BACKGROUND: Quantitative reviews of postoperative pain management have demonstrated that the number of patients needed to treat for one patient to achieve at least 50% pain relief (NNT) is 2.7 for ibuprofen (400 mg) and 4.6 for paracetamol (1000 mg), both compared with placebo. However, direct comparisons between paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) have not been extensively reviewed. The aims of this review are (i) to compare the analgesic and adverse effects of paracetamol with those of other NSAIDs in postoperative pain, (ii) to compare the effects of combined paracetamol and NSAID with those of either drug alone, and (iii) to discuss whether the adverse effects of NSAIDs in short-term use are justified by their analgesic effects, compared with paracetamol. METHODS: Medline (1966 to January 2001) and the Cochrane Library (January 2001) were used to perform a systematic, qualitative review of postoperative pain studies comparing paracetamol (minimum 1000 mg) with NSAID in a double-blind, randomized manner. A quantitative review was not performed as too many studies of high scientific standard (27 out of 41 valid studies, including all major surgery studies) would have been excluded. RESULTS: NSAIDs were clearly more effective in dental surgery, whereas the efficacy of NSAIDs and paracetamol seemed without substantial differences in major and orthopaedic surgery, although firm conclusions could not be made because the number of studies was limited. The addition of an NSAID to paracetamol may confer additional analgesic efficacy compared with paracetamol alone, and the limited data available also suggest that paracetamol may enhance analgesia when added to an NSAID, compared with NSAIDs alone. CONCLUSION: Paracetamol is a viable alternative to the NSAIDs, especially because of the low incidence of adverse effects, and should be the preferred choice in high-risk patients. It may be appropriate to combine paracetamol with NSAIDs, but future studies are required, especially after major surgery, with specific focus on a potential increase in side-effects from their combined use.
PMID: 11878654, UI: 21867436
Br J Anaesth 2001 Nov;87(5):727-32
In a double-blind study, we investigated the effects of postoperative epidural local anaesthetic, with or without addition of epidural morphine, on postoperative pain and gastrointestinal function in patients scheduled for radical hysterectomy and pelvic lymphadenectomy. Forty patients were randomized into two study groups: 48-h postoperative epidural 0.2% bupivacaine 8 ml h(-1) (bupi group) or 48-h postoperative epidural 0.2% bupivacaine/morphine 50 microg at 4 ml h(-1) (bupi/morph group). Patients were observed for at least 96 h after surgery. No differences in pain at rest, during cough or mobilization were observed. Patients in the bupi group requested a significant greater amount of supplementary analgesics, but times to first flatus and defaecation were reduced compared with patients in the bupi/morph group. Itching was a significant problem in patients in the bupi/morph group. No differences in postoperative nausea and vomiting, mobilization or time to discharge from hospital were observed between groups. The addition of morphine to postoperative epidural bupivacaine has only limited effect on pain relief and increases time to normalization of gastrointestinal function.
PMID: 11878523, UI: 21867299
Br J Anaesth 2001 Nov;87(5):681-3
PMID: 11878516, UI: 21867292
Clin J Pain 2002 Mar-Apr;18(2):132-5
Assistant Professor of Anesthesiology, Medical Faculty, Anesthesiology and Reanimation Department, Pamukkale University, Denizli, Turkey.
OBJECTIVE: Meralgia paresthetica is a syndrome of pain or dysesthesia or both in the anterolateral thigh, caused by entrapment of the lateral femoral cutaneous nerve at the anterior superior iliac spine. The aim of this report is to emphasize that meralgia paresthetica can be confused with low-back pain. PATIENT: A 21-year-old man was admitted to hospital because of low-back and thigh pain. He had a history of low-back pain. Physical examination and radiologic studies for low-back pain and radiculopathy showed no pathologic findings. It was suspected that the most likely cause was lateral femoral cutaneous neuropathy, caused by the wide military belt he continuously wore tightly around his waist. INTERVENTIONS: The nerve was blocked with 10 ml of bupivacaine 0.25%, which provided immediate pain relief. A nonsteroidal anti-inflammatory drug was administered orally. RESULTS: After 15 days of bed rest and 45 days without the belt, he was completely symptom-free. CONCLUSIONS: It is important to be rigorous in investigating the etiology of low-back pain. Meralgia paresthetica can mimic low-back pain because of the similarity of the symptoms. It can be treated by conservative or ablative therapeutic interventions; however, conservative methods should be considered primarily.
PMID: 11882778, UI: 21876849
Clin J Pain 2002 Mar-Apr;18(2):128-31
Staff member (general practitioner), Associate Professor of Anesthesia and Director, and Staff member (anesthesiologist), Multidisciplinary Pain Management Center, Department of Anesthesia, Valencia University General Hospital, Valencia, Spain.
OBJECTIVES: The case here presented adequately reflects the difficulties involved in the treatment of pain in patients where the neuropathic component of pain predominates, and shows the different therapeutic steps that may be taken-from surgery and radiotherapy, to the administration of different drugs via the spinal route, to, finally, the presently little-used option of a direct intraventricular access. CONCLUSIONS: Spinal tumors are infrequent, but pose great difficulties for the management and control of the pain they cause. The utility of the spinal route as an early approach for the provision of adequate analgesia seems clear. However, it also appears to lose efficacy with time, and dose incrementing and/or the addition of drugs that enhance the analgesic action of morphine are not always effective. In such selected cases, the intraventricular route may constitute a useful alternative, allowing improved symptoms control with lower morphine doses, and the use of the system previously implanted for intrathecal spinal infusion.
PMID: 11882777, UI: 21876848
Clin J Pain 2002 Mar-Apr;18(2):122-7
Departments of Neurology, Internal Medicine, and Neurophysiology, University Hospital of Linkoping, Linkoping, Sweden.
OBJECTIVES: To study pain characteristics and peripheral nerve involvement in patients with painful diabetic and nondiabetic polyneuropathy in comparison with patients with nonpainful polyneuropathy. PATIENTS AND METHODS: Fifty-five patients with polyneuropathy (37 with painful polyneuropathy, of whom 19 had diabetes and 18 had no diabetes; and 18 with painless polyneuropathy of different etiologies) were examined clinically using quantitative sensory tests and neurophysiology. Pain intensity and characteristics were analyzed by daily ratings on a 10-step verbal scale and by a questionnaire. RESULTS: Most patients experienced pain of more than one character. There was no clear difference in character or duration of pain between patients with and without diabetes. The mean value of the daily rating of pain intensity showed that pain was more severe in the evenings than in the mornings and that diabetic patients reported worse pain than nondiabetic patients. Thirty-two of the 37 patients with pain had paresthesias and/or dysesthesias, whereas only 7 of 18 patients without pain had paresthesias. Pain was always located in the feet, and, in most patients, also in the lower part of the legs. Some patients also experienced pain in the hands. Tactile sensibility, measured by quantitative tests, was more affected in both diabetic and nondiabetic patients with painful polyneuropathy compared with patients without pain (p = 0.02). Temperature, pain, and vibratory sensibility were equally affected in all patient groups. Nerve conduction velocity, amplitudes, and distal latency were equally affected in the pain group as compared with the control group, indicating that both thin and thick nerve afferents are affected in patients with painful as well as nonpainful polyneuropathy and that etiology has no clear impact on nerve involvement. CONCLUSIONS: Neuropathy pain was always located in the feet and more severe in diabetic patients compared with patients with neuropathy pain of other etiologies. The authors also found evidence for a greater tactile sensibility involvement in patients with neuropathy pain, irrespective of etiology, whereas other quantitative sensibility and neurography parameters were equally affected in all patient groups.
PMID: 11882776, UI: 21876847
Clin J Pain 2002 Mar-Apr;18(2):116-21
Departments of Physical Medicine and Rehabilitation and Anesthesiology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
OBJECTIVE: To determine the long-term efficacy of gabapentin as a treatment of pain after spinal cord injury. DESIGN: All patients with traumatic-onset spinal cord injury treated with gabapentin were identified and followed up using a longitudinal observational design with two contact points (6 and 36 months after the trial) using a semi-structured interview. The first follow-up interview attempted to capture all 31 patients placed on therapeutic trial. The second follow-up interview attempted to capture those reporting a favorable response (n = 14) to the therapeutic trial at the first follow-up. RESULTS: Of the 27 patients contacted at the first follow-up (87% response rate), 6 (22%) discontinued the trial secondary to intolerable side effects; therefore, the pain analgesic effects of gabapentin in these patients could not be determined. Of the remaining 21 patients, 14 (67%) reported a favorable response (i.e., a 2 or greater point reduction on a 0-10 pain-rating scale). The second follow-up interview captured 11 (79% response rate) of the 14 patients reporting a favorable response at the first interview, and 91% (10 of 11 patients) continued to report that gabapentin was an effective analgesic. There was no evidence to suggest dosing difficulties due to tolerance over the 3-year period. Sedation, dizziness, and forgetfulness were the most common side effects. CONCLUSIONS: Gabapentin may be an effective treatment of pain after spinal cord injury among those able to tolerate initial and long-term side effects.
PMID: 11882775, UI: 21876846
Clin J Pain 2002 Mar-Apr;18(2):107-15
Department of Oral and Maxillofacial Surgery and Northern Center for Human Health Care Research, University of Groningen, Groningen, The Netherlands.
BACKGROUND: There are no reports in the literature about patients with painfully restricted temporomandibular joints concerning the reliability of unidimensional and multidimensional pain scales on the basis of a generalizability and decision study. Generalizability and decision studies are designed to aid in reasoned decision-making and therefore are complementary to classic psychometric analyses, in which correlation coefficients express the reliability of a measurement design. The smallest detectable difference as an outcome of the decision study is the smallest statistically significant change that can be detected. PATIENTS: Twenty-five consecutive patients (5 males and 20 females) with painfully restricted mandibular function participated in the current study. DESIGN: Repeated measurements of three levels of unidimensional experienced pain (average, minimal, and maximal pain before the week of assessment; n = 200) and the multidimensional pain rating index of the MPQ (n = 100) were used. The measurement sessions were supervised by two observers on two separate measurement days, 1 week apart, with each measurement repeated twice. RESULTS: Inconsistency in measurement results analyzed in terms of absolute error variance (i.e., the measurement facets plus all the interactions) represented at least 24% of total variance. The smallest detectable difference of visual analog scales varied from 43 to 15 mm, depending on the amount of repetitions, whereas for the pain rating index it varied from 22.7 to 14.4 units. CONCLUSIONS: For statistically and clinically successful treatment of patients with painfully restricted temporomandibular joints, clinicians must overcome at least the smallest detectable difference and 38% of the initial average pain level.
PMID: 11882774, UI: 21876845
Clin J Pain 2002 Mar-Apr;18(2):99-106
Institute of Medical Psychology and Psychotherapy, Netherland Institute of Health Sciences (NIHES), and Department of General Practice, Erasmus University Rotterdam; Municipal Health Services; and Department of Paediatrics, University Hospital Rotterdam, Sophia Children's Hospital, Rotterdam, The Netherlands.
[Record supplied by publisher]
OBJECTIVE: Many juveniles with chronic pain of no known organic cause recover. Because adolescents whose pain persists may have chronic pain as adults, a subsample of 42 adolescents from a prevalence study in which continuation of their pain was observed throughout the study period was investigated quantitatively and qualitatively. All mothers (n = 42) completed a questionnaire on the impact of the adolescent's pain on the family. The authors tested the hypothesis that pain parameters, pain-related quality of life, and impact of pain on the family would deteriorate over time. DESIGN: Three-year follow-up questionnaires, diaries, and interviews were used. SETTING: The study was conducted in the general population in the Rotterdam area. PARTICIPANTS: Adolescents (aged 12-18 years) who indicated chronic pain in our previous prevalence study and in a diary and questionnaire each year of the 3-year follow-up were included in the study. RESULTS: The most prevalent pains were limb pain and headache. The pain intensity was mild (33 mm on a visual analog scale), very frequent (72% of all diary entries), and associated with relatively poor functional status and poor psychological and somatic functioning. The pain parameters, pain-related quality of life, and impact of pain on the family (i.e., restrictions in social life and problems in dealing with the stress of the adolescent's pain) remained surprisingly stable across the assessments. The interviews showed that pain had become part of the daily life of several adolescents, who structured their activities and sleeping hours to prevent aggravation of pain. In particular, adolescents with headache reported problems with cognitive activities, whereas those with limb pain and back pain reported problems with physical activities. CONCLUSIONS: For adolescents with persistent pain with no known organic cause, intensity and frequency of pain, quality of life, and impact of pain on the family did not change. Generally, they seemed to cope quite well with their pain. In view of these results, further studies should involve follow-up of adolescents with persistent pain into adulthood to establish the determinants of their pain and to find out whether they maintain their adaptive ways of living with their pain.
PMID: 11882773
Clin J Pain 2002 Mar-Apr;18(2):93-8
Department of Clinical Sciences and Department of Vision Sciences, State College of Optometry, State University of New York, New York, U.S.A.
OBJECTIVE: The objective was to present new visual sensorimotor findings in a patient with complex regional pain syndrome type I, formerly known as reflex sympathetic dystrophy. DESIGN: Clinical measurements were compared for the following visual sensorimotor tasks before and after 10 minutes of near visual stimulation: accommodation, vergence, and reading eye movements. PATIENT: The patient was a 19-year-old female university student with complex regional pain syndrome type I. RESULTS: All visual sensorimotor findings worsened dramatically after performance of the brief near visual task. In addition, the patient experienced severe dizziness, nausea, dull eye ache, and general fatigue, which persisted for 30 to 45 minutes following each test period. CONCLUSIONS: The patient manifested signs and symptoms of complex regional pain syndrome type I per the prior neurologic diagnosis, as well as the newly diagnosed accommodative infacility, accommodative insufficiency, convergence insufficiency, and deficits of saccades and pursuits, which were severely debilitating. The findings neither support nor refute the conventional notion of abnormal sympathetic mediation as a mechanism of fatigue and pain. However, the diagnoses of accommodative infacility and insufficiency suggest abnormal parasympathetic activation. Further investigation is needed to characterize the array of visual dysfunctions in a large sample of such patients, which may help elucidate the precise underlying neurologic causes of the sensorimotor deficits in these patients.
PMID: 11882772, UI: 21876843
Clin J Pain 2002 Mar-Apr;18(2):84-92
Research Fellow and Professor of Rehabilitation and Aged Care, Department of Rehabilitation and Aged Care, Flinders University, Bedford Park, South Australia; and Associate Professor of Rehabilitation Medicine, Rehabilitation Studies Unit, Department of Medicine, University of Sydney, Ryde, New South Wales, Australia.
OBJECTIVES: The objective was to examine the evidence to determine the optimal management of phantom limb pain in the preoperative and postoperative phase of amputations. METHODS: Trials were identified by a systematic search of MEDLINE, review articles, and references of relevant trials from the period 1966-1999, including only English-language articles. Included trials involved a control group, any intervention, and reported phantom pain as an outcome. RESULTS: Twelve trials were identified, including 375 patients whose follow-ups ranged in duration from 1 week to 2 years. Only three randomized, controlled studies with parallel groups and three randomized crossover trials were identified. Eight trials examined treatment of acute phantom pain, including epidural treatments (three trials), regional nerve blocks (three trials), treatment with calcitonin (one trial), and transcutaneous electrical nerve stimulation (one trial). Three trials demonstrated a positive impact of the intervention on phantom limb pain, but the remainder demonstrated no difference between the intervention and control groups. Four trials examined late postoperative interventions, including transcutaneous electrical nerve stimulation (two trials) and the use of Farabloc (a metal threaded sock) and ketamine (one trial each). With regard to late postoperative interventions, three of the four trials showed modest short-term reduction of phantom limb pain. There was no relation between the quality of the trial and a positive result of the intervention. CONCLUSIONS: Although up to 70% of patients have phantom limb pain after amputation, there is little evidence from randomized trials to guide clinicians with treatment. Evidence on preemptive epidurals, early regional nerve blocks, and mechanical vibratory stimulation provides inconsistent support for these treatments. There is currently a gap between research and practice in the area of phantom limb pain.
PMID: 11882771
Clin J Pain 2002 Mar-Apr;18(2):77-83
Institute for Rehabilitation Research and Development, The Rehabilitation Center, Ottawa; School of Psychology, University of Ottawa, Ottawa; and Southdown Institute, Aurora, Ontario, Canada.
OBJECTIVES: Insomnia and depression are common problems for people with chronic pain, and previous research has found that each is correlated with measures of pain and disability. The goal of this study was to examine the combined impact of major depression and insomnia on individuals with chronic pain. METHODS: The participants were patients with chronic musculoskeletal pain who underwent evaluation at an interdisciplinary treatment center. On the basis of semistructured interviews, participants were classified in three groups depending on whether they: (1) met criteria for major depression with insomnia (n = 38); (2) had insomnia without major depression (n = 58); or (3) had neither insomnia nor major depression (n = 47). The groups were then compared on self-report measures that included the McGill Pain Questionnaire, the Beck Depression Inventory, and the Multidimensional Pain Inventory. RESULTS: Participants with major depression and insomnia reported the most difficulty on measures of affective distress, life control, interference, and pain severity, although the insomniac patients without major depression also had elevated scores on some measures. In regression analyses, insomnia severity ratings did not contribute uniquely to the prediction of psychosocial problems when depression was controlled, but they did contribute to the prediction of pain severity. CONCLUSIONS: These results suggest that patients with chronic pain and concurrent major depression and insomnia report the highest levels of pain-related impairment, but insomnia in the absence of major depression is also associated with increased pain and distress.
PMID: 11882770, UI: 21876841
Clin J Pain 2002 Mar-Apr;18(2):75-6
PMID: 11882769, UI: 21876840
Spine 2002 Mar 15;27(6):660-667
Department of Occupational Medicine, Herning Hospital, Herning, the; Department of Occupational Medicine, Copenhagen County Hospital, Glostrup, the; National Institute of Occupational Health, Copenhagen, and the; Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark.
STUDY DESIGN: Cross-sectional study. OBJECTIVES: To evaluate the effect of individual characteristics and physical and psychosocial workplace factors on neck/shoulder pain with pressure tenderness in the muscles. SUMMARY OF BACKGROUND DATA: Controversy prevails about the importance of workplace factors versus individual factors in the etiology of pain in the neck and/or shoulders. METHODS: Study participants were 3123 workers from 19 plants. Physical risk factors were evaluated via video observations, and psychosocial risk factors were assessed with the job content questionnaire. Other procedures included symptom survey, clinical examination, and assessment of health-related quality of life (SF-36). The main outcome variable, neck/shoulder pain with pressure tenderness, was defined on the basis of subjective pain score and pressure tenderness in muscles of the neck/shoulder region. RESULTS: The prevalence of neck/shoulder pain with pressure tenderness was 7.0% among participants performing repetitive work and 3.8% among the referents. We found an association with high repetitiveness (prevalence ratio 1.8, 95% confidence interval 1.1-2.9), high force (2.0, 1.2-3.3), and high repetitiveness and high force (2.3, 1.4-4.0). The strongest work-related psychosocial risk was high job demands (1.8, 1.2-2.7). Increased risk was also associated with neck/shoulder injury (2.6, 1.6-4.1), female gender (1.8, 1.2-2.8), and low pressure pain threshold (1.6, 1.1-2.3). Neck/shoulder pain was strongly associated with reduced health-related quality of life. CONCLUSIONS: Work-related physical and psychosocial factors, as well as several individual risk factors, are important in the understanding of neck/shoulder pain. The findings suggest that neck/shoulder pain has a multifactorial nature. Reduced health-related quality of life is associated with subjective pain and clinical signs from the neck and shoulders. The physical workplace factors were highly intercorrelated, and so the effect of individual physical exposures could only be disentangled to a minor degree.
PMID: 11884915
Spine 2002 Mar 15;27(6):654-9
Health Services Research Unit, National Institute of Public Health, Oslo, Norway.
STUDY DESIGN: Semistructured interviews, group discussions, and a mailed survey. OBJECTIVE: To identify barriers to the use of active sick leave (ASL) and to design an intervention to improve the use of ASL by patients with low back pain. SUMMARY OF BACKGROUND DATA: ASL was introduced in Norway in 1993 to encourage people on sick leave to return to modified work. With ASL the National Insurance Administration (NIA) pays 100% of wages, thereby allowing the employer to engage a substitute worker at no extra cost, in addition to the worker on ASL. Arranging ASL requires cooperation between the general practitioner (GP), employer, local NIA staff, and the patient, which may explain why ASL was used in less than 1% of the eligible sick leave cases in 1995, despite strong support from all players. METHODS: The authors conducted five in-depth interviews at a workplace where ASL was successfully implemented. Questionnaires were sent to 89 GPs, 102 workplace representatives, and 22 local NIA officers in three counties. Five patients with back pain who had used ASL were interviewed in a focus group, and 10 patients with back pain who had not used ASL were interviewed using a structured guide. Five workplaces participated in a dialogue conference. Data collection and analysis were iterative, and new data were constantly compared with the previously analyzed materials. RESULTS: About 80% of the GPs, employers, and NIA officers believed ASL is effective in reducing long-term sick leave. Among the barriers identified were lack of information, lack of time, and work flow barriers such as poor communication and coordination of activities between the players required to carry out ASL. Two strategies were designed to improve the workflow between them. A passive implementation strategy was designed to require a minimum amount of economic and administrative support. It included targeted information, clinical guidelines for low back pain, a reminder to GPs in the sick leave form, and a standardized agreement. A proactive strategy included the same four elements plus a kick-off continuing education seminar for GPs and a trained resource person to facilitate the use of ASL. CONCLUSIONS: Having all the players onside may be essential, but it is not sufficient to bring about action in workplace strategies for patients with low back pain. If early return to modified work is effective, implementing it may require interventions targeted at identified barriers.
PMID: 11884914, UI: 21882302
Spine 2002 Mar 15;27(6):647-53
Folk Medicine Centre, Kaustinen, Finland.
STUDY DESIGN: A cohort of 114 primary care patients were studied for 1 year before and 1 year after a randomized clinical trial. OBJECTIVES: To explore the therapy use, societal costs, and quality of life of patients with prolonged back pain. To compare the effects of physiotherapy, bone setting, and light exercise therapy on these measures. SUMMARY OF BACKGROUND DATA: Analyses of back pain have mostly focused on the minority of patients who cause high costs and a heavy burden on national economies. The majority with low costs have aroused less interest. The patient's choice of therapy, especially alternative medicine, has seldom been evaluated despite the increasing popularity of alternative therapies. METHODS: Data were collected from the Social Insurance Institution files, patient records, and questionnaires: the Nottingham Health Profile (NHP). RESULTS: One year before enrollment a third of the patients had consulted primary care. Half of them had had some therapy: mainly massage, physiotherapy, naprapathy, or bone setting. One third of the direct costs were spent on complementary therapies and another third on rehabilitation. Sick leaves accounted for 55% of the total costs (US$ 1029). The mean total costs slightly increased after the randomized therapies (US$ 1306). The costs of ambulatory care, with the study therapies included, were similar, whereas physiotherapy seemed the cheapest (US$ 621) and bone setting the most expensive (US$ 2072) alternative in view of the total costs. More NHP subscales were improved by physiotherapy and bone setting than by exercise. CONCLUSIONS: A third of the direct back pain costs were spent on complementary therapies. The use of health care services and absenteeism tended to decrease after a course of physiotherapy. Physiotherapy and bone setting seemed able to improve the quality of life of patients with prolonged back pain.
PMID: 11884913, UI: 21882301
Spine 2002 Mar 15;27(6):637-46
Departments of Physiotherapy and; Anatomical Sciences, University of Queensland, Brisbane, Queensland, Australia, and the; Department of Industrial, Welding and Systems Engineering, Ohio State University, Columbus, Ohio.
STUDY DESIGN: A cross-sectional case-control study. OBJECTIVES: To examine the effect of fatigue on torque output as well as electromyographic frequency and amplitude values of trunk muscles during isometric axial rotation exertion in back pain patients and to compare the results with a matched control group. SUMMARY OF BACKGROUND DATA: Back pain patients exhibited different activation strategies in trunk muscles during the axial rotation exertions. Fatigue changes of abdominal and back muscles during axial rotation exertion have not been examined in patients with back pain. METHODS: Twelve back pain patients and 12 matched controls performed isometric fatiguing axial rotation to both sides at 80% maximum voluntary contraction in a standing position. During the fatiguing exertion, electromyographic changes of rectus abdominis, external oblique, internal oblique, latissimus dorsi, iliocostalis lumborum, and multifidus were recorded bilaterally. The primary torque in the transverse plane and the coupling torques in sagittal and coronal planes were also measured. RESULTS: No difference in the endurance capacity was found between back pain and control groups. At the initial period of the exertion, back pain patients demonstrated a statistical trend (P = 0.058) of greater sagittal coupling torque as well as lower activity of rectus abdominis and multifidus and higher activity in external oblique. During the fatigue process similar changes of coupling torque were demonstrated in both sagittal and coronal planes, but a smaller fatigue rate for right external oblique, increase in median frequency for latissimus dorsi, and lesser increase in activity for back muscles were found in the back pain group compared with the control group. CONCLUSIONS: Alterations in electromyographic activation and fatigue rates of abdominal and back muscles demonstrated during the fatigue process provide insights into the muscle dysfunctions in back pain and may help clinicians to devise more rational treatment strategies.
PMID: 11884912, UI: 21882300
Spine 2002 Mar 15;27(6):596-603
Physiotherapy Program, School of Rehabilitation Sciences, University of Ottawa, the; Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa Civic Hospital,; Centre of Global Health, University of Ottawa, Institute of Population Health, Ottawa, Ontario, and; Departement des Sciences de la Sante, Universite du Quebec en Abitibi-Temicamingue, Rouyn-Noranda, Quebec, Quebec City, Quebec, Canada.
BACKGROUND: Low back pain affects a large proportion of the population. Transcutaneous electrical nerve stimulation (TENS) was introduced more than 30 years ago as an alternative therapy to pharmacologic treatments for chronic pain. However, despite its widespread use, the efficacy of TENS is still controversial. PURPOSE: The aim of this meta-analysis was to determine the efficacy of TENS in the treatment of chronic low back pain. METHODS: The authors searched MEDLINE, EMBASE, PEDro, and the Cochrane Controlled Trials Register up to June 1, 2000. Only randomized controlled clinical trials of TENS for the treatment of patients with a clinical diagnosis of chronic low back pain were included. Abstracts were excluded unless further data could be obtained from the authors. Two reviewers independently selected trials and extracted data using predetermined forms. DATA ANALYSIS: Heterogeneity was tested with Cochrane's Q test. A fixed effects model was used throughout for continuous variables, except where heterogeneity existed, in which case, a random effects model was used. Results are presented as weighted mean differences with 95% confidence intervals, where the difference between the treated and control groups was weighted by the inverse of the variance. Standardized mean differences were calculated by dividing the difference between the treated and control by the baseline variance. Standardized mean differences were used when different scales were integrated to measure the same concept. Dichotomous outcomes were analyzed with odds ratios. MAIN RESULTS: Five trials were included, with 170 subjects randomized to the placebo group receiving sham TENS and 251 subjects receiving active TENS (153 for conventional mode, 98 for acupuncture-like TENS). The schedule of treatments varied greatly between studies ranging from one treatment/day for 2 consecutive days, to three treatments/day for 4 weeks. There were no statistically significant differences between the active TENS group compared with the placebo TENS group for any outcome measures. Subgroup analysis performed onTENS application and methodologic quality did not demonstrate a significant statistical difference (P > 0.05). Remaining preplanned subgroup analysis was not conducted because of the small number of included trials and the variety of outcome measures reported. CONCLUSION: The results of the meta-analysis present no evidence to support the use or nonuse of TENS alone in the treatment of chronic low back pain. Considering the small number of studies responding to the criteria to be included in this meta-analysis, it is clear that more appropriately designed studies are needed before a final conclusion. Clinicians and researchers should consistently report the characteristics of the TENS device and the application techniques used. New trials on TENS should make use of standardized outcome measures. This meta-analysis lacked data on how TENS efficacy is affected by four important factors: type of applications, site of application, treatment duration of TENS, and optimal frequencies and intensities.
PMID: 11884907
Spine 2002 Mar 15;27(6):561-6
STUDY DESIGN: Cluster randomized controlled trial. OBJECTIVE: To evaluate the effectiveness of two strategies to improve the use of active sick leave (ASL) for patients with low back pain. SUMMARY OF BACKGROUND DATA: ASL is a public sickness benefit scheme offered to promote early return to modified work for temporarily disabled workers. It was poorly used, and the authors designed two community interventions to strengthen the implementation of ASL based on the results of a study of barriers to use among back pain patients, employers, general practitioners (GPs), and local National Insurance Administration staff. METHODS: Sixty-five municipalities in three counties in Norway, randomly assigned to a passive intervention, a proactive intervention, or a control group. The interventions were targeted at patients on sick leave for low back pain for more than 16 days (n = 6176), their GPs, employers, and local insurance officers. The passive intervention included reminders about ASL on the sick leave form that GPs must complete, a standard agreement to facilitate ASL, targeted information, and a desktop summary for GPs of clinical practice guidelines for low back pain, emphasizing the importance of advice to stay active. The proactive intervention included these elements plus a resource person to facilitate the use of ASL and a continuing education workshop for GPs. The main outcome measure reported here is the proportion of eligible patients that used ASL. RESULTS: ASL was used significantly more in the proactive intervention municipalities (17.7%) compared with the passive intervention and control municipalities (11.5%, P = 0.018). CONCLUSIONS: A passive intervention that addressed identified barriers to the use of ASL did not increase its use. Although modest, a proactive intervention did increase its use. The main impact of the intervention was through direct contact and motivating telephone calls to patients. To the extent that GPs' practice was changed, it was either patient mediated or by patients bypassing their GP.
PMID: 11884902, UI: 21882290
Spine 2002 Mar 1;27(5):E133-E138
Royal Holloway, University of London, London, United Kingdom, Maastricht University, Maastricht, The Netherlands, University of Otago, Dunedin, New Zealand, the Centre for Health Studies, Seattle, Washington, Washington University, St. Louis, Missouri and Bruce Rappaport Faculty of Medicine, Technion Haifa, Israel.
STUDY DESIGN: An amalgamated review of the current state of knowledge about psychosocial factors in low back pain (LBP), as presented at the plenary session at the Fourth International Forum on LBP Research in Primary Care (March 16-18, 2000, Israel). OBJECTIVES: To outline evidence-based theories that have lead to the identification of yellow flags (psychosocial risk factors for developing long-term disability) for nonspecific LBP. To discuss the role of clinicians in primary care in detecting and addressing these psychosocial factors and to outline future directions for research to clarify this role. SUMMARY OF BACKGROUND DATA: It is widely accepted that psychological and social factors play an important role in LBP; however, it is currently unclear which specific factors merit intervention to reduce the burden of disease. METHOD: The review is an integration based on the plenary session presented at the Fourth International Forum on LBP Research in Primary Care. The presentations included original research studies, a systematic review, and theoretical descriptions of models of risk and treatment. RESULTS: There is good evidence to support the role of psychological risk factors at early stages of LBP in the development of long-term disability. There are evidence-based theories and models that provide directions for future interventions. CONCLUSION: In the treatment of psychological factors, the role of clinicians in primary care remains unclear. Further evidence is needed to identify specific psychological risk factors, primary care tools for their identification need developing, and interventions at different stages of LBP by different professionals need to be tested.
PMID: 11880850
Spine 2002 Mar 1;27(5):E128-E132
Department of Behavioral Sciences, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, the Institute for Research in Extramural Medicine, Free University, Amsterdam, the Netherlands, the Department of Family Medicine, Rappaport Faculty of Medicine, The Technion, Israel Institute of Technology, Haifa, Israel, Klalit Health Services, Haifa and Western Galilee District, Israel, the School of Postgraduate Medicine, The Medical Institute, University of Keele, Stoke-on-Trent, United Kingdom, and the Department of Family Medicine, Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
STUDY DESIGN: Review of advances in the primary care research on low back pain (LBP) from a unique international forum, and analysis of open-ended questionnaires from participants. SUMMARY OF BACKGROUND DATA: LBP continues to be one of the most common and challenging problems in primary care. It is associated with enormous costs in terms of direct health care expenditures, and indirect work and disability-related losses. OBJECTIVE: To ascertain the current status and state of the art regarding LBP in primary care. METHODS: Four reviewers independently assessed the content and implications of presentations at the Fourth International Forum for Primary Care Research on LBP, pooled the data, and then augmented it with open-ended questionnaires completed by 35 participants. RESULTS: The Fourth Forum documented the field's emergent new paradigm-a transition from thinking about back pain as a biomedical "injury" to viewing LBP as a multifactorial biopsychosocial pain syndrome. The paradigm shift has occurred in the context of increased interest in evidence-based medicine regarding LBP in primary care. The Forum demonstrated the strides taken in moving from research and evidence gathering, through guidelines and policy formulations and finally to the dissemination and implementation imperative. There was an increasing confidence among the Forum researchers that LBP can be managed successfully in primary care settings through a combination of encouraging activity, reassurance, short-term symptom control, and alteration of inappropriate beliefs about the correlations of back pain with impairment and disability. There is also recognition that a wide range of international, evidence-based guidelines now exists that have very similar messages. CONCLUSIONS: The Fourth Forum reflected a major shift in the conceptualization of LBP in primary care and an increased emphasis on implementation and dissemination of LBP research findings and clinical guidelines. Although there is a wide array of challenges ahead, the Fourth Forum provided a clear message regarding the need to focus research energies on changing practitioner behavior.
PMID: 11880849
Spine 2002 Mar 1;27(5):E121-E127
Institute for Research in Extramural Medicine, Free University, Amsterdam, the Netherlands, the Primary Care Sciences Research Centre, University of Keele, Stoke-on-Trent, United Kingdom, the Dutch Health Research and Development Council, The Hague, the Netherlands, the Netherlands Expert Center for Work-related Musculoskeletal Disorders, Erasmus University Hospital Rotterdam, the Netherlands, Department of General Practice and Primary Care, Queen Mary, University of London, London, United Kingdom, the Department of Research & Development, Dutch National Institute of Allied Health Professions, Amersfoort, the Netherlands, #Private Practice, Melbourne, Australia, and the Department of Behavioral Sciences, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
STUDY DESIGN: Description of a workshop entitled "Implementation and Dissemination: Getting Research into Practice," that was held at the Fourth International Forum on Low Back Pain Research in Primary Care, in Israel in March 2000. SUMMARY OF BACKGROUND DATA: A gap exists between research endeavors and the dissemination and implementation of new research findings. OBJECTIVES: To describe the outcomes of a workshop on implementation and dissemination of research findings. METHODS: The Fourth International Forum on Low Back Pain Research in Primary Care aimed to encourage open discussion and consensus building among leading experts in the field, and to develop a research agenda. The workshop on implementation and dissemination focused on issues surrounding the gap between research results and actual practice. These issues were introduced by several presentations. The broad conclusions of the subsequent debate are summarized in this paper as a series of responses to key questions: 1) who should do the implementation?, 2) what should researchers do to help implementation?, 3) what are the key outcomes?, and 4) what are important ingredients for successful implementation? RESULTS: There was consensus about the importance of implementation of research findings, about the ineffectiveness of merely publishing or disseminating research findings, and about the need for prospective randomized trials evaluating the cost-effectiveness of different implementation strategies. The majority view is that the health provider professions and the professional bodies are the central organizations to implement guidelines, rather than the researchers themselves. Success in getting guidelines or research results into practice is dependent on involving local health service groups, experts, and opinion leaders (both local and national). Patient-centered outcomes and cost-effectiveness of guideline implementation were considered important. It was acknowledged that there are many potentially effective ingredients for successful implementation, but a clear indication of the contents of an effective implementation strategy is still lacking. CONCLUSIONS: The plenary and workshops focused on closing the gap between research results and actual practice. As long as we do not fully understand how best to influence and change physician behavior, the choice of implementation strategies should be based on the present knowledge of potentially effective interventions and should include considerations of available resources for, and potential barriers to, implementation.
PMID: 11880848
Spine 2002 Mar 1;27(5):E109-E120
Department of Psychology, Royal Holloway, University of London, London, UK, the Spinal Research Unit, University of Huddersfield, Huddersfield, UK, the British School of Osteopathy, London, UK, and the School of Cognitive & Computer Science, University of Sussex, Sussex, UK.
STUDY DESIGN: A systematic review of prospective cohort studies in low back pain. OBJECTIVES: To evaluate the evidence implicating psychological factors in the development of chronicity in low back pain. SUMMARY OF BACKGROUND DATA: The biopsychosocial model is gaining acceptance in low back pain, and has provided a basis for screening measurements, guidelines and interventions; however, to date, the unique contribution of psychological factors in the transition from an acute presentation to chronicity has not been rigorously assessed. METHODS: A systematic literature search was followed by the application of three sets of criteria to each study: methodologic quality, quality of measurement of psychological factors, and quality of statistical analysis. Two reviewers blindly coded each study, followed by independent assessment by a statistician. Studies were divided into three environments: primary care settings, pain clinics, and workplace. RESULTS: Twenty-five publications (18 cohorts) included psychological factors at baseline. Six of these met acceptability criteria for methodology, psychological measurement, and statistical analysis. Increased risk of chronicity (persisting symptoms and/or disability) from psychological distress/depressive mood and, to a lesser extent, somatization emerged as the main findings. Acceptable evidence generally was not found for other psychological factors, although weak support emerged for the role of catastrophizing as a coping strategy. CONCLUSION: Psychological factors (notably distress, depressive mood, and somatization) are implicated in the transition to chronic low back pain. The development and testing of clinical interventions specifically targeting these factors is indicated. In view of the importance attributed to other psychological factors (particularly coping strategies and fear avoidance) there is a need to clarify their role in back-related disability through rigorous prospective studies.
PMID: 11880847
Spine 2002 Mar 1;27(5):535-537
Departments of Anesthesiology and Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.
STUDY DESIGN: The efficacy of intrathecal (spinal) morphine in the treatment of pain after posterior spinal fusions was assessed. OBJECTIVE: To investigate improved posterior pain control with fewer side effects in patients with posterior spinal fusions. SUMMARY OF BACKGROUND DATA: After multilevel spinal fusion with instrumentation, patients experience considerable pain that is difficult to treat. METHODS: For this study, 65 patients undergoing elective multilevel posterior spinal instrumentation were randomized to receive spinal morphine as follows: 10 &mgr;g/kg, 20 &mgr;g/kg, or none. These patients were assessed after surgery for pain control and narcotic-associated complications. RESULTS: The patients who received 20 &mgr;g/kg of spinal morphine were more comfortable immediately after surgery, remained pain free for a longer period, and required significantly less additional narcotic. These patients also had fewer respiratory complications. CONCLUSIONS: Relatively high-dose spinal morphine administration provides simple, reliable postoperative pain control after posterior spinal fusions. This may contribute to reduced postoperative respiratory morbidity and an improved outcome.
PMID: 11880840
Spine 2002 Mar 1;27(5):523-528
Groupe de Recherche Interdisciplinaire en Sante, Ecole de Readaptation, et Departement de Medecine Sociale et Preventive, Universite de Montreal, Quebec, and the Centre for Clinical Epidemiology and Community Studies SMBD Jewish General Hospital, Department of Epidemiology.
STUDY DESIGN: A prospective, repeated measures cohort study with high school students was conducted in Montreal, Canada. OBJECTIVE: To determine the incidence of neck and upper limb pain and associated risk factors in a cohort of adolescents. SUMMARY OF BACKGROUND DATA: Neck and upper limb pain is frequent in adolescents and may be associated with repetitive motion from certain activities such as playing music, working, and engaging in sports activities. METHODS: For this study, 502 students in the seventh to ninth grades in three schools were assessed. Data were collected at three times 6 months apart over a 12-month period. Students responded to a questionnaire addressing musculoskeletal health and lifestyle factors and were measured for height and weight. Neck or upper limb pain occurring at least once a week in the preceding 6 months was defined as the outcome. Multivariate methods were used to model the repeated measures dichotomous outcome as a function of engaging in physical activity, working, or playing a musical instrument, adjusted for covariates. RESULTS: The cumulative annual incidence of neck and upper limb pain was 28.4%. The risk factors for neck and upper limb pain were working (adjusted odds ratio, 1.89; 95% confidence interval, 1.11-3.32) and lower mental health score (adjusted odds ratio, 1.68; 95% confidence interval, 1.19-2). Students involved in childcare were at a higher risk for the development of pain (adjusted odds ratio, 2.25; 95% confidence interval, 1.18-4.29). CONCLUSIONS: Neck and upper limb pain is common in teenagers. Sports involvement and music participation were not risk factors for the development of neck and upper limb pain. However, pain was more likely to develop in adolescents who worked than in students who had a lower mental health score.
PMID: 11880838
Spine 2002 Mar 1;27(5):515-522
Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, the Robert Wood Johnson Clinical Scholars Program, University of North Carolina at Chapel Hill, the Department of Internal Medicine and Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, and the Department of Health Behavior, University of North Carolina at Chapel Hill.
STUDY DESIGN: A systematic review was conducted. OBJECTIVE: To identify, evaluate, and compare standard scales for assessing neck pain or dysfunction. SUMMARY OF BACKGROUND DATA: The degree of a patient's neck pain or dysfunction can be evaluated using standardized scales at the time of a clinical encounter or during the performance of clinical research protocols. The choice of a scale with the most appropriate characteristics, however, is always a challenge to clinicians and researchers. METHODS: Articles concerning scales for functional evaluation of neck pain or dysfunction were identified by computer searching of MEDLINE (January 1966 to June 1999) and CINAHL (1985 to 2000), citation tracking using the Citation Index, hand searching of relevant journals, and correspondence with experts. RESULTS: Five standard scales were found. Three scales were remarkably similar in terms of structure and psychometric properties: the Neck Disability Index, the Copenhagen Neck Functional Disability Scale, and the Northwick Park Scale. However, only the first instrument has been revalidated in different study populations. The Neck Pain and Disability Scale provides a visual template for collection of information, but its usefulness is limited if the questionnaire must be read to the patient. The Patient-Specific Functional Scale is very sensitive to functional changes in individual patients, but comparisons between patients are virtually impossible. CONCLUSIONS: The five scales identified in this study have similar characteristics. The Neck Disability Index, however, has been revalidated more times for evaluation of patient groups. For individual patient follow-up evaluation, the Patient-Specific Functional Scale has high sensitivity to change, and thus represents a good choice for clinical use. The final choice should be tailored according to the target population and the purpose of the evaluation.
PMID: 11880837
Spine 2002 Mar 1;27(5):447-51
Departments of Orthopaedics and Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
STUDY DESIGN: A prospective, randomized, double-blinded clinical trial was conducted. OBJECTIVE: To study the efficacy of piroxicam fast-dissolving dosage form in reducing postoperative pain after simple lumbar spine surgery. SUMMARY OF BACKGROUND DATA: Many reports mention the use of nonsteroidal antiinflammatory drug for relieving postoperative pain, but study still is lacking on their use in spine surgery. METHODS: For this study, 50 patients who underwent discectomy or one-level laminectomy were randomly sampled into two groups: 21 patients in the placebo control group and 29 patients in the study group. In addition to a normal postoperative analgesic regimen, each patient received placebo or piroxicam fast-dissolving dosage form (2 tablets administered sublingually 1 to 3 hours before surgery). This regimen was repeated with 2 tablets after 24 hours, then 1 tablet after 48 hours. Postoperative pain was evaluated every 6 hours by a visual analog scale for 3 days. The amount of morphine usage was measured on postoperative days 1, 2, and 3. Postoperative variables such as blood loss, length of wound, and time of operation also were recorded. RESULTS: There was no difference between the groups with respect to age, weight, height, gender, and type of operation. The postoperative pain of the study group, as measured by visual analog scale, showed significant improvement (P < 0.05) during the postoperative period 12 to 42 hours after surgery. The study group used less morphine, but their usage showed no significant difference on postoperative days 1, 2, and 3. When the visual analog scale between the types of operation was compared, the scale for the discectomy group was better than that for the laminectomy group. The results of the postoperative variables showed no difference between the groups in terms of postoperative blood loss, length of wound, and time of operation. CONCLUSIONS: Sublingual administration of piroxicam fast-dissolving dosage form after simple spine surgery is effective and efficient in relief of postoperative pain. Because of its low side effects and high toleration, piroxicam fast-dissolving dosage form may be considered as an alternative for postoperative pain control during the early postoperative period.
PMID: 11880827, UI: 21874432
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