BMJ 2002 Mar 16;324(7338):660-1
Department of Infection and Tropical Medicine, Heartlands Hospital, Birmingham B9 5SS.
[Medline record in process]
PMID: 11895827, UI: 21892620
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Br J Anaesth 2001 Oct;87(4):635-8
Service d'Anesthesie et de Reanimation Chirurgicale, Hjpital G et R Laennec, CHU Nantes, France.
The aim of this study was to evaluate the potential analgesic effect of epidural methylprednisolone (MP) after posterolateral thoracotomy (PLT). Adult male patients undergoing PLT for lung surgery were included in a prospective, randomized, double blind study. Peroperative analgesia (bupivacaine plus sufentanil) was given by a thoracic epidural catheter associated with general anaesthesia. After surgery, patients received either MP 1 mg kg(-1) followed by a continuous epidural infusion of MP 1.5 mg kg(-1) during 48 h (MP group) or 0.9% saline as a bolus injection and continuous epidural infusion (P group). Additional morphine analgesia was administered by i.v. patient-controlled analgesia. Pain was assessed at rest and with mobilization every 4 h after operation during 48 h with a visual analogue scale (VAS). The primary end-point was the total morphine requirements during the 48 first postoperative hour. Twenty-four patients were allocated to MP (n=12) and P (n=12) groups. Characteristics of the two groups were similar. There were no differences between groups for morphine requirements (median and interquartile range) during the 48 h: 59 mg (40-78) in MP group vs 65 mg (59-93) in P group. There were no differences between groups for morphine requirements every 4 h during the 48 h and VAS for pain at rest and evoked pain. No side effects were reported. It was concluded in this small study that these results did not support the use of epidural steroids for postoperative analgesia after PLT.
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PMID: 11878738, UI: 21867526
Br J Anaesth 2001 Oct;87(4):633-5
Department of Anesthesiology, Akita University School of Medicine, Japan.
To assess the analgesic efficacy and side effects of a supplemental night-time infusion in patient-controlled epidural analgesia (PCEA) after gastrectomy, we carried out a randomized, double-blind study. The number of requests were lower (P<0.005) in the PCEA plus night-time infusion group than in the PCEA alone group during the postoperative nights. Patients who had a PCEA plus night-time continuous infusion, slept with fewer interruptions than those who had only the PCEA. VAS pain scores on coughing were significantly lower (P<0.05) in the PCEA plus infusion group than in the PCEA alone group during the night following postoperative day 1. In conclusion, a night-time infusion in PCEA following gastrectomy decreases the incidence of postoperative pain, provides a better sleep pattern, and reduces the degree of the pain associated with coughing during the night.
PMID: 11878737, UI: 21867525
Br J Anaesth 2001 Oct;87(4):570-6
Musgrave Park Hospital, Belfast, UK.
The efficacy of ropivacaine 100 mg (5 mg ml(-1)), 150 mg (7.5 mg ml(-1)) and 200 mg (10 mg ml(-1)) and bupivacaine 100 mg (5 mg ml(-1)) given by intra-articular injection into the knee after the end of surgery was studied in 72 ASA I-II patients scheduled for elective knee arthroscopy under general anaesthesia in a randomized, double-blind study. Kapake (paracetamol 1 g and codeine 60 mg) was given as a supplementary analgesic. Pain scores were assessed 1-4 h after surgery and a verbal rating scale of overall pain severity was assessed on second postoperative day. Ropivacaine or bupivacaine concentrations were determined in peripheral venous plasma up to 3 h after injection in eight patients in each group. Verbal rating pain scores were lower with ropivacaine 150 mg compared with bupivacaine 100 mg (P<0.05). There was a tendency for lower analgesic consumption and pain scores with all doses of ropivacaine (not significant). The mean (SD) maximum total plasma concentrations of ropivacaine were 0.64 (0.25), 0.78 (0.43), and 1.29 (0.46) mg litre(-1) after 100, 150 and 200 mg. The corresponding unbound concentrations were 0.018 (0.009), 0.024 (0.020) and 0.047 (0.022) mg litre(-1). Both were proportional to the dose. The maximum total concentration after bupivacaine 100 mg was 0.57 (0.36) mg litre(-1). The time to reach maximum plasma concentration was similar for all doses and varied between 20 and 180 min. All concentrations were well below the threshold for systemic toxicity.
PMID: 11878726, UI: 21867514
Cephalalgia 2001 Dec;21(10):980-6
Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
We conducted a two-stage population-based headache survey among subjects aged > or = 15 in Taipei, Taiwan. Subjects with chronic daily headache (CDH) in the past year were identified, interviewed and followed-up. CDH was defined as a headache frequency > 15 days/month, with a duration > 4 h/day. Of the 3377 participants, 108 (3.2%) fulfilled the criteria for CDH, with a higher prevalence in women (4.3%) than men (1.9%). TM was the most common subtype (55%), followed by CTTH (44%). Thirty-four per cent of the CDH subjects overused analgesics. At the 2-year follow-up, 35% of the CDH subjects still had CDH. The significant predictors for persistent CDH at follow-up included: older age ( > or = 40 years) (RR = 2.4), CDH onset after 32 years (RR = 1.8), CDH duration > or = 6 years (RR = 2.0), medication overuse (RR = 1.8), and "daily" headache (RR = 2.1). We found that CDH is not uncommon in the community and its prevalence is similar among different populations. Older subjects and those with medication overuse may have a more protracted course of illness.
PMID: 11843870, UI: 21833037
J Pain Symptom Manage 2002 Mar;23(3):239-55
Rehabilitation and Palliative Care Unit, National Cancer Institute of Milan, Milan, Italy
An Expert Working Group was convened under the auspices of the Steering Committee of the Research Network of the European Association of Palliative Care to review the status of the use of pain measurement tools (PMTs) in palliative care research conducted in a multilingual-multicenter setting. Based on a literature review and on the experts' opinion, the present work recommends that standardized methods should be applied for the use of PMTs in research in palliative care. Visual analogue scales, numerical rating scales, and verbal rating scales are considered valid to assess pain intensity in clinical trials and in other types of studies. Among the multidimensional questionnaires designed to assess pain, the McGill Pain Questionnaire and Brief Pain Inventory are valid in many multilingual versions. Specific recommendations for PMT use and administration, depending on the study type and aim, are reviewed. Special population requirements specific of clinical situations encountered in palliative care (elderly, terminal, cognitively impaired patients, pediatric patients) are also considered.
PMID: 11888722, UI: 21886520
J Pain Symptom Manage 2002 Mar;23(3):231-8
Pain & Policy Studies Group, University of Wisconsin Comprehensive Cancer Center, Madison, WI, USA
Preventing diversion and abuse of prescription controlled substances while ensuring their availability for legitimate medical use is an important public health goal in the United States. In one approach to preventing and identifying drug diversion, 17 states have implemented prescription monitoring programs (PMPs) to monitor the prescribing of certain controlled substances. While PMPs are not intended to interfere with legitimate prescribing, some in the pain management community feel that they negatively affect prescribing for pain management. This article describes a collaborative project initiated by the Pain & Policy Studies Group that brought together regulatory and pain management representatives twice in 1998 to share perspectives and reconcile differing views on the effects of PMPs. The ultimate goals of this project are to provide accurate information to healthcare clinicians about PMPs, better define the balance between preventing drug diversion and providing pain management, and promote continued dialog and cooperation among the groups.
PMID: 11888721, UI: 21886519
J Pain Symptom Manage 2002 Mar;23(3):221-30
Unit of Clinical Epidemiology and Trials, Biomedical Technology Assessment (Beta), Genoa, Italy
The aims of this study were to quantify the prevalence of pain among hospitalized Italian patients and to describe the potential determinants of pain in this population. All patients older than 18 years and hospitalized for at least 24 hours in one of the 30 public hospitals of the Liguria region (n = 4709) were eligible for pain assessment. Using the Brief Pain Inventory, patients with pain during the last 24 hours were asked to score the intensity of pain at the time of the interview, and the worst pain and average pain during the previous 24 hours on 0--10 rating scales. Overall, 87% (4121 / 4709) of inpatients were interviewed, and 56.6% suffered pain during the last 24 hours. Among patients with pain, the median (interquartile range) score of the worst and of the average pain during the last 24 hours was 7 (5--9) and 5 (3--6), respectively. At the time of interview, 43.1% evaluated patients suffered pain, with a median (interquartile range) of 5 (3--7). Although significant heterogeneity in the distribution of pain was observed among the hospitals, pain prevalence was unacceptably high in most cases. Age, sex, education, diagnosis, and days from surgery were significantly related to pain prevalence in univariate analyses. In a multivariable ordinal regression logistic analysis, only sex, diagnosis, days from surgery, and hospitals remain significantly associated with increased pain prevalence.
PMID: 11888720, UI: 21886518
J Pain Symptom Manage 2002 Mar;23(3):211-20
Frontier Science and Technology Research Foundation, Chestnut Hill, MA, USA
The paradox of patients who are in pain, yet satisfied with their pain management, has been previously reported. To probe this paradox, we used cross-sectional data collected in the primary care setting on cancer patients' patterns of pain and pain treatment, beliefs and expectations about pain and pain relief, willingness to report pain and take pain medication, care from the provider, and satisfaction with their pain management (n = 316). Descriptive findings were similar to other studies: more than 75% of patients were satisfied or very satisfied with their overall pain management, despite almost half of all patients reporting recent moderate to severe pain. Univariate and bivariate analyses were consistent with the hypothesis that patients may expect and are therefore satisfied with the "peak and trough" pattern of pain severity that occurs with "as-needed" administration of analgesics. However, multivariate analyses failed to directly support this hypothesis. Instead, regression analyses identified factors related to characteristics of patients' pain experiences, patients' beliefs about pain and its inevitability, the frequency that patients reported their pain, and aspects of the patient--provider relationship. Predictors of patients' satisfaction with how their primary care doctor managed their pain included: whether or not the patient was told that treating pain was an important goal, whether or not the patient reported sustained long-term pain relief, and the degree to which the patient was willing to take opioids if prescribed by the doctor or nurse (adjusted R(2) = 0.22). Qualitative data collected from patients who were in severe pain during the past three days but satisfied with their pain management (n = 88) further suggest the importance of the patient--provider relationship in shaping patient expectations. Based on these findings, we recommend that future research on outcomes in pain management place greater emphasis on the potential impact of the patient-provider relationship.
PMID: 11888719, UI: 21886517
J Pain Symptom Manage 2002 Mar;23(3):201-10
School of Nursing, University of Colorado Health Sciences Center, and Pain Consultation Service, The Children's Hospital, Denver, CO, USA
Quality improvement measurement instruments for pediatric postoperative pain management are virtually nonexistent. Without standardized instruments to measure pediatric pain management outcomes, practitioners are hampered in their efforts to improve the quality of pain management for children. In this study, instruments for children (8--12 years) and parents were developed and tested to measure the quality of children's postoperative pain management. The child (Child TQPM) and parent (Parent TQPM) Total Quality Pain Management instruments were tested with 50 parent/child dyads across two large treatment centers. The pain rating scale modified for these instruments demonstrated good criterion validity with the well established Varni/Thompson Pediatric Pain Questionnaire Visual Analogue Scale. Parent--child agreement was described for responses across instruments. Construct validity was examined through selected inter-item relationships. Psychometric analyses support the initial measurement properties of the pediatric TQPM instruments.
PMID: 11888718, UI: 21886516
J Pain Symptom Manage 2002 Mar;23(3):190-200
Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ, USA
To examine the relationship between different cancer pain management outcomes over time, 74 patients with the worst cancer related pain rated as four or greater on an 11-point numeric scale were followed weekly with the Brief Pain Inventory (BPI), and the satisfaction questionnaire and global visual analogue scale quality of life (VASQOL) for 3 weeks. Univariate and multivariate regression analyses were performed at weekly time points. The analyses indicated that pain outcomes can be categorized into separate QOL and satisfaction paths linked by the worst pain severity. In the QOL path, the worst pain severity predicted a pain interference score, which consistently predicted VASQOL. For the satisfaction path, independent predictors were pain relief at Week 1, and worst pain severity and changes in worst pain severity at Week 2. No variables predicted satisfaction at Week 3. The data suggest that satisfaction and quality of life may be independent outcomes of pain management. The timing of assessment may itself be important.
PMID: 11888717, UI: 21886515
J Pain Symptom Manage 2002 Mar;23(3):180-1
Department of Radiology, University of Calgary Department of Diagnostic Radiology Calgary Regional Health Authority, Calgary, Alberta, Canada
PMID: 11888715, UI: 21886513
J Pain Symptom Manage 2002 Mar;23(3):178-80
Department of Pain Medicine and Palliative Care Beth Israel Medical Center, New York, NY, USA
PMID: 11888714, UI: 21886512
Neurology 2002 Mar 12;58(5):831-2
Pain Relief Unit, Department of Neurosciences, Molinette Hospital, Turin, Italy.
PMID: 11889257, UI: 21886719
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