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50 citations found

1: Anesth Analg 2002 Nov;95(5):1361-72, table of contents

Does an acute pain service improve postoperative outcome?

Werner MU, Soholm L, Rotboll-Nielsen P, Kehlet H.

Acute Pain Service, Department of Anesthesiology 532, Hvidovre University Hospital, 2650 Hvidovre, Denmark. madswerner@medscape.com

Publication Types:

Review
Review, Academic

PMID: 12401627 [PubMed - indexed for MEDLINE]

2: Anesth Analg 2002 Nov;95(5):1358-60, table of contents Related Articles, Links: Venous malformations associated with central pain: report of a case.

Cohen SP, Abdi S.

Department of Anesthesiology, Pain Management Center, Walter Reed Army Medical Center, Washington, DC, USA. steven.cohen@med.nyu.edu

IMPLICATIONS: The authors describe an unusual case of central pain (CP) that resulted from giant venous hemangiomas. The patient was treated with a variety of medications, including the N-methyl-D-aspartate antagonist dextromethorphan. We report the first known association between venous malformations and CP and briefly describe why the use of dextromethorphan in this disorder requires further evaluation.

PMID: 12401626 [PubMed - indexed for MEDLINE]

3: Anesth Analg 2002 Nov;95(5):1351-7, table of contents Related Articles, Links

Attenuation of pain in a randomized trial by suppression of peripheral nociceptive activity in the immediate postoperative period.

Gordon SM, Brahim JS, Dubner R, McCullagh LM, Sang C, Dionne RA.

National Institute of Dental and Craniofacial Research/NIH, 19 Center Drive, Room 1N-117, Bethesda, MD 20892, USA.

Peripheral neuronal barrage from tissue injury produces central nervous system changes that contribute to the maintenance of postoperative pain. The therapeutic approaches to blocking these central changes remain controversial, because previous studies have not differentiated presurgical interventions from those administered after tissue injury, yet before pain onset. In this study, we evaluated the relative contributions of blockade of nociceptive input during surgery or during the immediate postoperative period on pain suppression. Subjects were randomly allocated to one of four groups: preoperative 2% lidocaine, postoperative 0.5% bupivacaine, both, or placebo injections. General anesthesia was induced and third molars extracted. Pain was assessed over 4 h and at 24 and 48 h. The beta-endorphin in blood samples increased twofold during surgery, which is indicative of activation of the peripheral nociceptive barrage in response to painful stimuli. Pain was decreased in the immediate postoperative period in the bupivacaine groups, whereas it increased in the lidocaine group over time. Pain intensity was less 48 h after surgery in the groups whose postoperative pain was blocked by the administration of bupivacaine, but no effect was demonstrated for the preoperative administration of lidocaine alone. These results in the oral surgery pain model suggest that minimizing the peripheral nociceptive barrage during the immediate postoperative period decreases pain at later time periods. In contrast, blocking the intraoperative nociceptive barrage does not appear to contribute significantly to the subsequent reduction in pain. IMPLICATIONS: Suppression of postoperative pain immediately after surgery attenuates the pain experienced 1 to 2 days after surgery. These findings suggest that pain after minor surgery can be prevented by blocking the development of pain processes that amplify pain for days after surgery.

Publication Types:

Clinical Trial
Randomized Controlled Trial

PMID: 12401625 [PubMed - indexed for MEDLINE]

4: Anesth Analg 2002 Nov;95(5):1297-9, table of contents Related Articles, Links

A comparison of metoclopramide and lidocaine for preventing pain on injection of diazepam.

Majedi H, Rabiee M, Khan ZH, Hassannasab B.

Department of Anesthesiology, Babol University of Medical Sciences, Babol, Iran. majedi@hbi.or.ir

We compared the ability of metoclopramide with IV lidocaine pretreatment to abolish pain from a diazepam injection. In a randomized, prospective, double-blinded, placebo-controlled clinical trial, 159 patients (ASA physical status I and II), aged 20-70 yr old, were allocated to one of three groups. Placebo and study drugs were injected IV immediately before 0.1 mg/kg of diazepam into a dorsal hand vein. Patients in Groups 1, 2, and 3 received 2 mL of placebo, 2 mL of lidocaine 1%, and 2 mL of metoclopramide (10 mg), respectively. The patient's response was graded using a 4-point scale. Any score other than 0 represented pain on injection. We observed that the incidence of pain on diazepam injection was 83% in the placebo group, which was decreased to 70% and 39% in patients pretreated with metoclopramide and lidocaine, respectively. Although there was no significant difference in the incidence of pain in Groups 1 and 3 (P > 0.05), Group 3 showed significantly less patients with severe pain scores than Group 1 as diazepam was injected (P < 0.000). Group 2 showed a significantly less frequent incidence of pain than the saline (P < 0.000) and the metoclopramide (P < 0.002) groups as diazepam was injected. The intensity of pain in Group 2 was significantly less than Group 3 (P = 0.012). The intensity of diazepam injection pain was intense with placebo as compared with other groups (P < 0.000). Metoclopramide, rather than lidocaine pretreatment, may be a reasonable analgesic alternative for painful injections. IMPLICATIONS: Metoclopramide, rather than lidocaine pretreatment, may be a reasonable analgesic alternative to decrease pain from a diazepam injection, especially when there is a medical condition in which lidocaine should be used very cautiously.

Publication Types:

Clinical Trial
Randomized Controlled Trial

PMID: 12401614 [PubMed - indexed for MEDLINE]

5: Anesth Analg 2002 Nov;95(5):1293-6, table of contents Related Articles, Links

Ephedrine reduces the pain from propofol injection.

Cheong MA, Kim KS, Choi WJ.

Department of Anesthesiology, Hanyang University Hospital, #17 Haengdang dong, Sungdong gu, Seoul 133 792, Korea.

One hundred seventy-six patients (ASA physical status I or II) presenting for elective surgery were randomly allocated into six study groups to compare the incidence of propofol-induced pain after pretreatment with different doses of ephedrine as compared with lidocaine. Patients in Group P (n = 30) received saline placebo; patients in Group L (n = 30) received 2% lidocaine 40 mg; patients received ephedrine 30 microg/kg (Group E30, n = 28), 70 microg/kg (Group E70, n = 30), 110 microg/kg (Group E110, n = 30), and 150 microg/kg (Group E150, n = 28), respectively, followed 30 s later by propofol 2.5 mg/kg. A blinded anesthesiologist asked the patient to evaluate the pain score (verbal rating scale and face pain scale). The incidence and intensity of pain was less in the lidocaine and ephedrine groups than in the placebo group (P < 0.01). Before tracheal intubation, the arterial blood pressure was decreased in the P and L groups, and after intubation, hemodynamics were increased in the E110 and E150 groups, respectively (P < 0.05). We concluded that pretreatment with a small dose of ephedrine (30 and 70 microg/kg) reduced the incidence and intensity of propofol-induced pain with a lesser decrease in arterial blood pressure than from propofol alone in lidocaine pretreatment. IMPLICATIONS: Propofol is a widely used IV anesthetic for the induction of anesthesia, but it often causes local pain when administered into peripheral veins. A small dose of ephedrine reduces the incidence and intensity of the pain without significant adverse hemodynamic effects during induction.

Publication Types:

Clinical Trial
Randomized Controlled Trial

PMID: 12401613 [PubMed - indexed for MEDLINE]

6: Anesth Analg 2002 Nov;95(5):1258-62, table of contents Related Articles, Links: Acute postoperative pain management at home after ambulatory surgery: a French pilot survey of general practitioners' views.

Robaux S, Bouaziz H, Cornet C, Boivin JM, Lefevre N, Laxenaire MC.

Department of Anesthesiology and Critical Care Medicine, School of Medicine, University Hospital of Nancy, 29 avenue du Marechal de Lattre de Tassigny, 54035 Nancy Cedex, France.

IMPLICATIONS: We assessed the views of French general practitioners concerning pain relief at home after ambulatory surgery in a cross-sectional prospective survey. The results revealed that there is need for improvement, mainly in prescribing more suitable analgesic protocols and optimizing postdischarge relationships between physicians.

PMID: 12401607 [PubMed - indexed for MEDLINE]

7: Anesth Analg 2002 Nov;95(5):1224-9, table of contents Related Articles, Links

The reliability and validity of the Face, Legs, Activity, Cry, Consolability observational tool as a measure of pain in children with cognitive impairment.

Voepel-Lewis T, Merkel S, Tait AR, Trzcinka A, Malviya S.

Department of Anesthesiology, Section of Pediatrics, C. S. Mott Children's Hospital, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0211, USA. terriv@umich.edu

Pain assessment remains difficult in children with cognitive impairment (CI). In this study, we evaluated the validity and reliability of the Face, Legs, Activity, Cry, Consolability (FLACC) tool for assessing pain in children with CI. Each child's developmental level and ability to self-report pain were evaluated. The child's nurse observed and scored pain with the FLACC tool before and after analgesic administration. Simultaneously, parents scored pain with a visual analog scale, and scores were obtained from children who were able to self-report pain. Observations were videotaped and later viewed by nurses blinded to analgesics and pain scores. One-hundred-forty observations were recorded from 79 children. FLACC scores correlated with parent scores (P < 0.001) and decreased after analgesics (P = 0.001), suggesting good validity. Correlations of total scores (r = 0.5-0.8; P < 0.001) and of each category (r = 0.3-0.8; P < 0.001), as well as measures of exact agreement (kappa = 0.2-0.65), suggest good reliability. Test-retest reliability was supported by excellent correlations (r = 0.8-0.883; P < 0.001) and categorical agreement (r = 0.617-0.935; kappa = 0.400-0.881; P < 0.001). These data suggest that the FLACC tool may be useful as an objective measure of postoperative pain in children with CI. IMPLICATIONS: The FLACC pain assessment tool may facilitate reliable and valid observational pain assessment in children with cognitive impairment who cannot self-report their pain. Objective pain assessment is important to facilitate effective postoperative pain management in these vulnerable children.

Publication Types:

Clinical Trial
Randomized Controlled Trial

PMID: 12401598 [PubMed - indexed for MEDLINE]

8: Anesth Analg 2002 Nov;95(5):1215-8, table of contents Related Articles, Links

Caudal neostigmine, bupivacaine, and their combination for postoperative pain management after hypospadias surgery in children.

Abdulatif M, El-Sanabary M.

Department of Anesthesiology, Cairo University, Cairo, Egypt. abdulatif@hotmail.com

In a randomized, double-blinded study, we examined the analgesic efficacy of caudal neostigmine, bupivacaine, or a mixture of both drugs in 60 children. After the induction of general anesthesia, children were allocated randomly into three groups (n = 20) to receive a caudal injection of either 0.25% bupivacaine 1 mL/kg, with or without neostigmine 2 micro g/kg, or neostigmine 2 micro g/kg in normal saline 1 mL/kg. Intraoperatively, children receiving caudal bupivacaine or a bupivacaine/neostigmine mixture maintained hemodynamic stability, required less inhaled anesthetics, and had a shorter recovery time compared with the caudal neostigmine alone. Postoperatively, the caudal bupivacaine/neostigmine mixture resulted in superior analgesia compared with the other two groups. Recovery to first rescue analgesic times were (mean +/- SD) 22.8 +/- 2.9 h, 8.1 +/- 5.9 h, and 5.2 +/- 2.1 h in the bupivacaine/neostigmine, bupivacaine, and neostigmine groups, respectively (P < 0.001). In addition, the bupivacaine and neostigmine groups received more doses of paracetamol than the bupivacaine/neostigmine group to maintain adequate analgesia in the first 24 postoperative h. Postoperative vomiting occurred in 25%, 10%, and 30% in the caudal bupivacaine/neostigmine, bupivacaine, and neostigmine groups, respectively (P < 0.01). We conclude that caudal neostigmine 2 micro g/kg provides postoperative analgesia comparable to caudal bupivacaine in children undergoing hypospadias repair surgery. IMPLICATIONS: Caudal neostigmine 2 micro g/kg provides postoperative analgesia comparable to caudal bupivacaine in children undergoing hypospadias repair surgery. Co-administration of the two drugs is associated with extended postoperative analgesia and reduced need for supplementary analgesics.

Publication Types:

Clinical Trial
Randomized Controlled Trial

PMID: 12401596 [PubMed - indexed for MEDLINE]

9: Anesth Analg 2002 Oct;95(4):1009-11, table of contents Related Articles, Links: Dissociative mental state in a patient with an intrathecal drug administration system.

Loughrey JP, Nedeljkovic SS.

Department of Anesthesia, Pain, and Perioperative Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, Massachusetts 02115, USA. jloughrey@partners.org

IMPLICATIONS: We describe a patient with acute mental status changes, which resolved on removal of medication from the reservoir of a Synchromed intrathecal pump. This report highlights the potential adverse mental affects of chronic spinal infusions for pain therapy and discusses pitfalls in toxicology analysis using immunoassay.

PMID: 12351285 [PubMed - indexed for MEDLINE]

10: Anesth Analg 2002 Oct;95(4):985-91, table of contents Related Articles, Links

The analgesic effect of gabapentin and mexiletine after breast surgery for cancer.

Fassoulaki A, Patris K, Sarantopoulos C, Hogan Q.

Department of Anesthesiology, Aretaieion Hospital, Medical School, University of Athens, Greece. afassou1@otenet.gr

We investigated the analgesic efficacy of mexiletine and gabapentin on acute and chronic pain associated with cancer breast surgery in 75 patients. They were randomized to receive, in a double-blinded manner, mexiletine 600 mg/d, gabapentin 1200 mg/d, or placebo for 10 days. Anesthesia was standardized, and all patients had access to routine postoperative analgesics on demand. The visual analog scale score assessed pain at rest and after movement. Three months later, all patients were interviewed to identify intensity of chronic pain and analgesic requirements. Mexiletine and gabapentin reduced codeine consumed from the second to tenth day by 50% (P = 0.029; P = 0.018 and P = 0.035 for mexiletine versus control and gabapentin versus control comparisons, respectively). Total paracetamol consumption was also reduced during the same time (P = 0.0085; P = 0.007 and P = 0.011 for the mexiletine and gabapentin groups when compared with the control, respectively). Pain at rest and after movement was reduced by both drugs on the third postoperative day. Pain after movement also was reduced by gabapentin between the second and fifth postoperative day. Three months later, the incidence of chronic pain, its intensity, and need for analgesics were not affected by either treatment. However, burning pain was more frequent in the control group (P = 0.033). IMPLICATIONS: Patients undergoing breast surgery for cancer may develop chronic pain. We evaluated the effect of mexiletine and gabapentin on the acute and chronic pain after breast surgery for cancer. Both drugs reduced the postoperative analgesic requirements, and particularly, gabapentin reduced pain after movement. The overall incidence of chronic pain was unaffected except for burning pain.

Publication Types:

Clinical Trial
Randomized Controlled Trial

PMID: 12351281 [PubMed - indexed for MEDLINE]

11: Anesth Analg 2002 Oct;95(4):973-8, table of contents Related Articles, Links

The effect of chronic oral desipramine on capsaicin-induced allodynia and hyperalgesia: a double-blinded, placebo-controlled, crossover study.

Wallace MS, Barger D, Schulteis G.

Department of Anesthesiology, University of California, San Diego, La Jolla 92093, USA. mswallace@ucsd.edu

The tricyclic antidepressants are often used for the treatment of neuropathic pain. In this study, we evaluated one of these drugs on human cutaneous experimental pain. A randomized, double-blinded, placebo-controlled, crossover design methodology was conducted. Subjects participated in 2 14-day study sessions separated by a 7-day washout period. One session was with desipramine and one with placebo. At baseline, Day 7, and Day 15, quantitative sensory testing was performed to thermal and mechanical stimuli. On Day 15 only, intradermal capsaicin was injected on the volar aspect of the forearm followed by an assessment of pain and hyperalgesia. Oral desipramine had no significant effect on acute sensory thresholds, pain, secondary hyperalgesia, or flare response induced by intradermal capsaicin. Mean peak plasma levels of desipramine were within the therapeutic range for the treatment of depression. This study further supports a lack of effect of the tricyclic antidepressants on acute nociception and experimentally-induced secondary hyperalgesia. IMPLICATIONS: Human experimental pain models have recently been developed; however, the efficacy of the tricyclic antidepressants (TCA) in these models has not been systematically studied. This investigation provides further validation of human experimental pain models and demonstrates that the chronic delivery of a TCA has no effect on human experimental pain.

Publication Types:

Clinical Trial
Randomized Controlled Trial

PMID: 12351279 [PubMed - indexed for MEDLINE]

12: Anesth Analg 2002 Oct;95(4):923-9, table of contents Related Articles, Links

Propofol in a medium- and long-chain triglyceride emulsion: pharmacological characteristics and potential beneficial effects.

Theilen HJ, Adam S, Albrecht MD, Ragaller M.

Department of Anesthesiology and Intensive Care Medicine, University Hospital of the Technical University of Dresden, Dresden, Germany. theilen@rcs.urz.tu-dresden.de

Hypertriglyceridemia is a possible unwanted effect during long-term propofol sedation while using a formulation containing long-chain triglycerides (LCT) from soybean oil. The use of propofol formulated in a solvent consisting of medium-chain triglycerides (MCT) and LCT might reduce the risk. Because a new solvent may affect the pharmacological profile of propofol, in this prospective, randomized, controlled, and double-blinded study we compared the pharmacodynamic and kinetic characteristics of propofol diluted in MCT/LCT fat solution with those of propofol formulated in LCT fat emulsion. In addition, serum triglyceride levels were measured during and after the administration of both drugs. Thirty patients likely to require mechanical ventilation over at least 48 h were randomized to receive either propofol 2% MCT/LCT (Group 1) or propofol 2% LCT (Group 2). Infusion rates of propofol (2.34 +/- 0.83 mg. kg(-1). h(-1) in Group 1 versus 2.31 +/- 0.6 mg. kg(-1). h(-1) in Group 2), the plasma propofol concentrations during infusion (0.95 +/- 0.53 versus 0.98 +/- 0.32 micro g/mL), and the concentrations and arousal behavior after discontinuation of the drug did not show significant differences. Plasma triglyceride concentrations during sedation did not differ between the groups, whereas there was a tendency toward a more rapid triglyceride elimination in Group 1 after termination of the propofol administration. IMPLICATIONS: Propofol diluted in an emulsion of medium- and long chain-triglycerides shows equivalent pharmacological properties during long-term sedation compared with its hitherto well known formulation containing long-chain triglycerides only. In addition, potential favorable effects on the plasma triglyceride profile could be found.

Publication Types:

Clinical Trial
Randomized Controlled Trial

PMID: 12351269 [PubMed - indexed for MEDLINE]

13: Anesthesiology 2002 Nov;97(5):1254-62 Related Articles, Links: Role of prostaglandin receptor EP1 in the spinal dorsal horn in carrageenan-induced inflammatory pain.

Nakayama Y, Omote K, Namiki A.

Department of Anesthesiology, Sapporo Medical University School of Medicine, Japan.

BACKGROUND: Prostaglandin E2 (PGE2) and the receptor for PGE2 (EP receptor) are key factors contributing to the generation of hyperalgesia caused by inflammation. The current study was designed to investigate the roles of PGE2 and EP1 receptors in the spinal cord in the development and maintenance of inflammatory pain, using behavioral, microdialysis, and intracellular calcium ion concentration ([Ca2+]i) assays. METHODS: Inflammation was induced by an injection of carrageenan into the plantar surface of the rat hind paw. The effects of inflammation were evaluated at the time points of 3 h (early phase) and 15 h (late phase) after carrageenan injection. In behavioral assays, withdrawal thresholds to mechanical stimuli were evaluated. The effect of an intrathecally administered selective EP1 antagonist, ONO-8711, on the carrageenan-induced hyperalgesia was examined. Using a spinal microdialysis method, PGE2 concentration in the spinal dorsal horn was measured. In [Ca2+]i assays, we measured [Ca2+]i in the spinal dorsal horn in transverse spinal slices and examined the effects of pretreatment with ONO-8711. Sensitivities of the changes in [Ca2+]i to PGE2 perfusion were also assessed. RESULTS: Mechanical hyperalgesia and paw edema were observed in both the early and late phases. The hyperalgesia was inhibited by intrathecal ONO-8711 in the late, but not early, phase. The concentration of PGE2 in the spinal dorsal horn increased in the late phase. The [Ca2+]i in the dorsal horn increased on the ipsilateral side to the inflammation in the late, but not early phase. This increase was suppressed by the pretreatment with ONO-8711. Magnitude of the increase in [Ca2+]i on the ipsilateral side in response to PGE2 perfusion was greater in the late phase than in the early phase. CONCLUSION: The results suggested that activation of spinal EP1 receptors was crucial in the carrageenan-induced mechanical hyperalgesia in the late phase. It seems that some of the mechanisms underlying inflammation-induced plastic changes are mediated by time-dependent increase in PGE2 concentration, activation of EP1 receptors, and increase in [Ca2+]i in the spinal dorsal horn.

PMID: 12411813 [PubMed - indexed for MEDLINE]

14: Anesthesiology 2002 Nov;97(5):1234-44 Related Articles, Links

Long-term pain and activity during recovery from major thoracotomy using thoracic epidural analgesia.

Ochroch EA, Gottschalk A, Augostides J, Carson KA, Kent L, Malayaman N, Kaiser LR, Aukburg SJ.

Department of Anesthesia, University of Pennsylvania Medical Center, Philadelphia, USA.

BACKGROUND: Pain following thoracotomy can persist for years with an undetermined impact on quality of life. Factors hypothesized to modulate this painful experience include analgesic regimen, gender, and type of incision. METHODS: A total of 157 generally healthy patients of both genders scheduled for segmentectomy, lobectomy, or bilobectomy through a posterolateral or muscle-sparing incision were randomly assigned to receive thoracic epidural analgesia initiated prior to incision or at the time of rib approximation. Pain and activity scores were obtained 4, 8, 12, 24, 36, and 48 weeks after surgery. RESULTS: Overall, there were no differences in pain scores between the control and intervention groups during hospitalization (P >or= 0.165) or after discharge (P>or= 0.098). The number of patients reporting pain 1 yr following surgery (18 of 85; 21.2%) was not significantly different (P = 0.122) from the number reporting preoperative pain (15 of 120; 12.5%). During hospitalization, women reported greater pain than men (worst pain, P= 0.007; average pain, P= 0.016). Women experienced fewer supraventricular tachydysrhythmias (P = 0.013) and were thus discharged earlier (P = 0.002). After discharge women continued to report greater discomfort than men (P <or= 0.016), but did not differ from men in their level of physical activity (P = 0.241). CONCLUSIONS: Initiation of thoracic epidural analgesia prior to incision or the use of a muscle-sparing incision did not significantly impact pain or physical activity. Although women reported significantly greater pain during hospitalization and after discharge, they experienced fewer complications, were more likely to be discharged from the hospital sooner, and were just as active after discharge as men.

Publication Types:

Clinical Trial
Randomized Controlled Trial

PMID: 12411810 [PubMed - indexed for MEDLINE]

15: Anesthesiology 2002 Oct;97(4):1027; discussion 1029-31 Related Articles, Links

Comment on:

Anesthesiology. 2001 Nov;95(5):1054-67.

Epidural anesthesia and analgesia: is there really no benefit?

Karanikolas M, Kalauokalani D, Swarm R.

Publication Types:

Comment
Letter

PMID: 12357182 [PubMed - indexed for MEDLINE]

16: Anesthesiology 2002 Oct;97(4):989-1004 Related Articles, Links

Comment in:

Anesthesiology. 2002 Oct;97(4):776-7.

Practical guidelines for acute care of victims of bioterrorism: conventional injuries and concomitant nerve agent intoxication.

Ben Abraham R, Rudick V, Weinbroum AA; Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine.

Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Israel.

Publication Types:

Guideline
Review
Review, Tutorial

PMID: 12357169 [PubMed - indexed for MEDLINE]

17: Anesthesiology 2002 Oct;97(4):814-9 Related Articles, Links: Does the A118G polymorphism at the mu-opioid receptor gene protect against morphine-6-glucuronide toxicity?

Lotsch J, Zimmermann M, Darimont J, Marx C, Dudziak R, Skarke C, Geisslinger G.

pharmazentrum-frankfurt, Department of Clinical Pharmacology, Johann Wolfgang Goethe-University, Frankfurt, Germany. j.loetsch@em.uni-franfurt.de

BACKGROUND: Some, but not all, patients with renal dysfunction suffer from side effects after morphine administration because of accumulation of the active metabolite morphine-6-glucuronide (M6G). The current study aims to identify genetic causes that put patients at risk for, or protect them from, opioid side effects related to high plasma M6G. Candidate genetic causes are the single nucleotide polymorphism (SNP) A118G of the mu-opioid-receptor gene (OPRM1), which has recently been identified to result in decreased potency of M6G, and mutations in the MDR1-gene coding P-glycoprotein, of which morphine and M6G might be a substrate. METHODS: Two men, aged 87 and 65 yr, with renal failure (creatinine clearance of 6 and 9 ml/min) received 30 mg/day oral morphine for pain treatment. Both patients had sufficient analgesia from morphine. However, while one patient tolerated morphine well despite high plasma M6G of 1735 nM, in the patient with M6G plasma concentrations of 941 nM it caused severe sleepiness and drowsiness. Patients were genotyped for known SNPs of the OPRM1 and MDR1 genes. RESULTS: The patient who tolerated morphine well despite high plasma M6G was a homozygous carrier of the mutated G118 allele of the mu-opioid-receptor gene, which has been previously related to decreased M6G potency. In contrast, the patient who suffered from side effects was "wild-type" for this mutation. No other differences were found between the OPRM1 and MDR1 genes. CONCLUSIONS: The authors hypothesize that the A118G single nucleotide polymorphism of the mu-opioid-receptor is among the protective factors against M6G-related opioid toxicity. The observation encourages the search for pharmacogenetic reasons that cause interindividual variability of the clinical effects of morphine.

PMID: 12357145 [PubMed - indexed for MEDLINE]

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19: Br J Anaesth 2002 Sep;89(3):409-23 Related Articles, Links

Effectiveness of acute postoperative pain management: I. Evidence from published data.

Dolin SJ, Cashman JN, Bland JM.

Pain Clinic, St Richard's Hospital, Chichester PO19 4E, UK.

BACKGROUND: This review examines the evidence from published data concerning the incidence of moderate-severe and of severe pain after major surgery, with three analgesic techniques; intramuscular (i.m.) analgesia, patient controlled analgesia (PCA), and epidural analgesia. METHODS: A MEDLINE search of the literature was conducted for publications concerned with the management of postoperative pain. Over 800 original papers and reviews were identified. Of these 212 papers fulfilled the inclusion criteria but only 165 provided usable data on pain intensity and pain relief. Pooled data on pain scores obtained from these studies, which represent the experience of a total of nearly 20,000 patients, form the basis of this review. RESULTS: Different pain measurement tools provided comparable data. When considering a mixture of three analgesic techniques, the overall mean (95% CI) incidence of moderate-severe pain and of severe pain was 29.7 (26.4-33.0)% and 10.9 (8.4-13.4)%, respectively. The overall mean (95% CI) incidence of poor pain relief and of fair-to-poor pain relief was 3.5 (2.4-4.6)% and 19.4 (16.4-22.3)%, respectively. For i.m. analgesia the incidence of moderate-severe pain was 67.2 (58.1-76.2)% and that of severe pain was 29.1 (18.8-39.4)%. For PCA, the incidence of moderate-severe pain was 35.8 (31.4-40.2)% and that of severe pain was 10.4 (8.0-12.8)%. For epidural analgesia the incidence of moderate-severe pain was 20.9 (17.8-24.0)% and that of severe pain was 7.8 (6.1-9.5)%. The incidence of premature catheter dislodgement was 5.7 (4.0-7.4)%. Over the period 1973-1999 there has been a highly significant (P < 0.0001) reduction in the incidence of moderate-severe pain of 1.9 (1.1-2.7)% per year. CONCLUSIONS: These results suggest that the UK Audit Commission (1997) proposed standards of care might be unachievable using current analgesic techniques. The data may be useful in setting standards of care for Acute Pain Services.

Publication Types:

Meta-Analysis
Review
Review, Academic

PMID: 12402719 [PubMed - indexed for MEDLINE]

20: Cancer 2002 Nov 15;95(10):2230-6 Related Articles, Links: Effect of topical morphine for mucositis-associated pain following concomitant chemoradiotherapy for head and neck carcinoma.

Cerchietti LC, Navigante AH, Bonomi MR, Zaderajko MA, Menendez PR, Pogany CE, Roth BM.

Supportive Care Division, Department of Medical Oncology, Angel H. Roffo Cancer Institute, University of Buenos Aires, Buenos Aires, Argentina. lccerchi@intramed.net.ar

BACKGROUND: Oral mucositis is the dose-limiting toxicity for patients receiving concurrent chemoradiotherapy regimens for tumors of the head and neck area. Currently, the management of established mucositis includes the use of topical anesthetics and systemic analgesics. Based on the clinical evidence of pain alleviation by topical morphine in patients with some inflammatory and painful conditions, a clinical study was undertaken to determine this effect on mucositis-associated pain. METHODS: Twenty-six patients with head and neck malignancies treated with concomitant chemoradiotherapy for head and neck carcinoma who had severe painful mucositis (World Health Organization Grade 2 or higher) were enrolled. Patients were randomly assigned to morphine mouthwash (MO; 14 patients) or magic mouthwash (MG), a mixture of equal parts of lidocaine, diphenhydramine, and magnesium aluminum hydroxide (12 patients). RESULTS: The duration of severe pain was 3.5 days less in the MO group compared with the MG group (P = 0.032). The intensity of oral pain was also significantly lower in the MO group compared with the MG group (P = 0.038). No patient in the MO group required third-step opiates for alleviation of the mouth pain. There was a significant difference in duration of severe functional impairment (P = 0.017). Five patients in the MG group complained of local side effects and only one in the MO group (P = 0.007). CONCLUSIONS: For patients with head and neck carcinomas receiving concomitant chemoradiotherapy, MO is a simple and effective treatment to decrease the severity and duration of pain and the duration of functional impairment. Copyright 2002 American Cancer Society.

PMID: 12412178 [PubMed - in process]

21: J Clin Oncol 2002 Nov 1;20(21):4361-7 Related Articles, Links: Pain and quality of life after treatment in patients with locally recurrent rectal cancer.

Esnaola NF, Cantor SB, Johnson ML, Mirza AN, Miller AR, Curley SA, Crane CH, Cleeland CS, Janjan NA, Skibber JM.

Department of Surgery, Pain Research Group, The University of Texas M.D. Anderson Cancer Center, Houston 77030-4009, USA. nesnaola@mdanderson.org

PURPOSE: Because survival in patients with locally recurrent rectal cancer (LRRC) is limited, pain control and quality of life (QOL) are important parameters. The purpose of this study was to assess the prevalence of posttreatment pain and QOL of patients with LRRC treated with nonsurgical palliation or resection and identify predictors of poor outcome. PATIENTS AND METHODS: Posttreatment pain severity and QOL were prospectively assessed in 45 patients with LRRC using the Brief Pain Inventory and Functional Assessment of Cancer Therapy-Colorectal questionnaire. RESULTS: Fifteen patients received nonsurgical palliation, and 30 patients underwent resection of their pelvic tumors. There was a significant association between higher posttreatment pain scores and worse QOL (P <.001). Patients treated with nonsurgical palliation reported moderate to severe pain beyond the third month of treatment. Resected patients reported comparable levels of pain during the first 3 postoperative years, particularly after bony resections; long-term survivors (beyond 3 years), however, reported minimal pain and good QOL. Female sex, pelvic/sciatic pain at presentation, total pelvic exenteration, and bony resection were associated with higher rates of moderate to severe posttreatment pain (P =.04, P <.001, P =.04, and P =.02, respectively). Pain at presentation was an independent predictor of posttreatment pain (odds ratio, 7.4 [95% confidence interval, 1.8 to 30.3]; P =.006). CONCLUSION: Patients with LRRC treated with nonsurgical palliation or resection experience significant levels of pain after treatment. Close posttreatment pain monitoring is warranted in patients presenting with pelvic pain, and more aggressive pain management strategies may improve posttreatment QOL.

PMID: 12409336 [PubMed - indexed for MEDLINE]

22: J Pediatr 2002 Nov;141(5):742-3; discussion 743 Related Articles, Links

Stroke prevention trial in sickle cell anemia: comments on effects of chronic transfusion on pain.

Gates A, Rogers MA, Puczynski M.

Publication Types:

Comment
Letter

PMID: 12410211 [PubMed - in process]

23: JAMA 2002 Oct 16;288(15):1905-7 Related Articles, Links

Comment on:

JAMA. 2002 Oct 16;288(15):1851-8.

Invasive vs conservative management of acute coronary syndromes: do the data support the guidelines?

Cohen DJ.

Publication Types:

Comment
Editorial

PMID: 12377091 [PubMed - indexed for MEDLINE]

24: JAMA 2002 Oct 16;288(15):1851-8 Related Articles, Links

Comment in:

JAMA. 2002 Oct 16;288(15):1905-7.

Cost and cost-effectiveness of an early invasive vs conservative strategy for the treatment of unstable angina and non-ST-segment elevation myocardial infarction.

Mahoney EM, Jurkovitz CT, Chu H, Becker ER, Culler S, Kosinski AS, Robertson DH, Alexander C, Nag S, Cook JR, Demopoulos LA, DiBattiste PM, Cannon CP, Weintraub WS; TACTICS-TIMI 18 Investigators. Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis in Myocardial Infarction.

Emory Center for Outcomes Research, Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1256 Briarcliff Rd, Suite 1N, Atlanta, GA 30306, USA. emahone@emory.edu

CONTEXT: In the Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Strategy (TACTICS)-Thrombolysis in Myocardial Infarction (TIMI) 18 trial, patients with either unstable angina or non-ST-segment elevation myocardial infarction (UA/NSTEMI) treated with the platelet glycoprotein (Gp IIb/IIIa) inhibitor tirofiban had a significantly reduced rate of major cardiac events at 6 months with an early invasive vs a conservative strategy. OBJECTIVE: To examine total 6-month costs and long-term cost-effectiveness of an invasive vs a conservative strategy. DESIGN: Randomized controlled trial including a priori economic end points. SETTING: Hospitalization for UA/NSTEMI with 6-month follow-up period. PATIENTS: A total of 2220 patients with UA/NSTEMI; economic data from 1722 patients at US-non-VA hospitals. INTERVENTION: Early invasive strategy with routine catheterization and revascularization as appropriate vs a conservative strategy with catheterization performed only for recurrent ischemia or a positive stress test. MAIN OUTCOME MEASURE: Total 6-month costs and incremental cost-effectiveness ratio. RESULTS: The average initial hospitalization costs among those in the invasive strategy group were $15714 vs $14047 among those in the conservative strategy group, a difference of $1667 (95% confidence interval [CI], $387-3091). The in-hospital costs were offset significantly at the 6-month follow-up, with an average cost in the invasive group of $6098 vs $7180 in the conservative group, a difference of $1082 (95% CI, -$2051 to $76). The average total costs at 6 months, including productivity costs, for the invasive group was $21 813 vs $21 227 for the conservative group, a $586 difference (95% CI, -$1087 to $2486). The average 6-month costs excluding productivity costs in the invasive group was $19 780 vs $19 111 in the conservative group, a difference of $670, 95% CI; (-$1035 to $2321). Estimated cost per year of life gained for the invasive strategy, based on projected life expectancy, was $12739 for the base case, and ranged from $8371 to $25769, based on model assumptions. CONCLUSIONS: In patients with UA/NSTEMI treated with the Gp IIb/IIIa inhibitor tirofiban, the clinical benefit of an early invasive strategy was achieved with a small increase in cost, yielding favorable projected estimates of cost per year of life gained. These results support the broader use of an early invasive strategy in these patients.

Publication Types:

Clinical Trial
Randomized Controlled Trial

PMID: 12377083 [PubMed - indexed for MEDLINE]

25: Neurology 2002 Oct 8;59(7):1015-21 Related Articles, Links

Opioids versus antidepressants in postherpetic neuralgia: a randomized, placebo-controlled trial.

Raja SN, Haythornthwaite JA, Pappagallo M, Clark MR, Travison TG, Sabeen S, Royall RM, Max MB.

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. sraja@jhmi.edu

BACKGROUND: Tricyclic antidepressants (TCA) provide less than satisfactory pain relief for postherpetic neuralgia (PHN), and the role of opioids is controversial. OBJECTIVE: To compare the analgesic and cognitive effects of opioids with those of TCA and placebo in the treatment of PHN. METHODS: Seventy-six patients with PHN were randomized in a double-blind, placebo-controlled, crossover trial. Each subject was scheduled to undergo three treatment periods (opioid, TCA, and placebo), approximately 8 weeks' duration each. Doses were titrated to maximal relief or intolerable side effects. The primary outcome measures were pain intensity (0 to 10 scale), pain relief (0 to 100%), and cognitive function. Analyses included patients who provided any pain ratings after having received at least a single dose of a study medication. RESULTS: Fifty patients completed two periods, and 44 patients completed all three. Mean daily maintenance doses were morphine 91 mg or methadone 15 mg and nortriptyline 89 mg or desipramine 63 mg. Opioids and TCA reduced pain (1.9 and 1.4) more than placebo (0.2; p < 0.001), with no appreciable effect on any cognitive measure. The trend favoring opioids over TCA fell short of significance (p = 0.06), and reduction in pain with opioids did not correlate with that following TCA. Treatment with opioids and TCA resulted in greater pain relief (38 and 32%) compared with placebo (11%; p < 0.001). More patients completing all three treatments preferred opioids (54%) than TCA (30%; p = 0.02). CONCLUSIONS: Opioids effectively treat PHN without impairing cognition. Opioids and TCA act via independent mechanisms and with varied individual effect.

Publication Types:

Clinical Trial
Randomized Controlled Trial

PMID: 12370455 [PubMed - indexed for MEDLINE]

26: Neurology 2002 Oct 8;59(7):1120; discussion 1120-1 Related Articles, Links

Comment on:

Neurology. 2001 Dec 26;57(12):2310-2.

"Atraumatic" Sprotte needle reduces the incidence of post-lumbar puncture headaches.

Toyka KV, Muller B, Reichmann H.

Publication Types:

Comment
Letter

PMID: 12370487 [PubMed - indexed for MEDLINE]

27: Pain 2002 Oct;99(3):609-10 Related Articles, Links: Reply to Dr. Clark's comment on Doverty et al., hyperalgesic responses in methadone maintenance patients (Pain 2001;90:91-96).

Doverty M, White JM, Somogyi AA, Bochner F, Ali R, Ling W.

Department of Clinical and Experimental Pharmacology, The University of Adelaide, SA 5005, Adelaide, Australia

PMID: 12406540 [PubMed - in process]

28: Pain 2002 Oct;99(3):608-9 Related Articles, Links: Comment on: Doverty et al., Hyperalgesic responses in methadone maintenance patients (Pain 2001;90;91-6).

David Clark J.

Veterans Affairs Palo Alto Health Care System, 112A, 3801 Miranda Avenue, 94304, Palo Alto, CA, USA

PMID: 12406539 [PubMed - in process]

29: Pain 2002 Oct;99(3):606-8 Related Articles, Links: Letter in reply to letter to the editor ("Is tooth extraction a good model for dental pain?").

Sabino MA, Mantyh PW.

Departments of Preventive Sciences, Neuroscience, Psychiatry and Cancer Center, Schools of Dentistry and Medicine, University of Minnesota, 55455, Minneapolis, MN, USA

PMID: 12406538 [PubMed - in process]

30: Pain 2002 Oct;99(3):605-6 Related Articles, Links: Is tooth extraction a good model for dental pain? a critic to Sabino et al. (Pain 2002;95:175-86).

Hu JW.

Faculty of Dentistry, University of Toronto, 124 Edward Street, Ontario M5G 1G6, Toronto, Canada

PMID: 12406537 [PubMed - in process]

31: Pain 2002 Oct;99(3):589-598 Related Articles, Links: Pain activation of human supraspinal opioid pathways as demonstrated by [11C]-carfentanil and positron emission tomography (PET).

Bencherif B, Fuchs PN, Sheth R, Dannals RF, Campbell JN, Frost JJ.

Department of Radiology, The Johns Hopkins University School of Medicine, JHOC 3225, 601 N Caroline Street, Baltimore, MD 21287, USA

The role of the supraspinal endogenous opioid system in pain processing has been investigated in this study using positron emission tomography imaging of [11C]-carfentanil, a synthetic, highly specific &mgr; opioid receptor (&mgr;-OR) agonist. Eight healthy volunteers were studied during a baseline imaging session and during a session in which subjects experienced pain induced by applying capsaicin topically to the dorsal aspect of the left hand. A pain-related decrease in brain &mgr;-OR binding was observed in the contralateral thalamus consistent with competitive binding between [11C]-carfentanil and acutely released endogenous opioid peptides. This decrease varied directly with ratings of pain intensity. These results suggest that the supraspinal &mgr;-opioid system is activated by acute pain and thus may play a substantial role in pain processing and modulation in pain syndromes.

PMID: 12406535 [PubMed - as supplied by publisher]

32: Pain 2002 Oct;99(3):579-87 Related Articles, Links: Does acupuncture improve the orthopedic management of chronic low back pain - a randomized, blinded, controlled trial with 3 months follow up.

Molsberger AF, Mau J, Pawelec DB, Winkler J.

Orthopedic Surgery and Research, Kasernenstr. 1b, 40213, Dusseldorf, Germany

This prospective, randomised controlled trial, with three parallel groups, patient and observer blinded for verum and sham acupuncture and a follow up of 3 months raises the question: "Does a combination of acupuncture and conservative orthopedic treatment improve conservative orthopedic treatment in chronic low back pain (LBP). 186 in-patients of a LBP rehabilitation center with a history of LBP >/=6 weeks, VAS >/=50mm, and no pending compensation claims, were selected; for the three random group 4 weeks of treatment was applied. 174 patients met the protocol criteria and reported after treatment, 124 reported after 3 months follow up. Patients were assorted 4 strata: chronic LBP, </=0.5 years, 0.5-2 years, 2-5 years, >/=5 years. Analysis was by intention to treat. Group 1 (Verum+COT) recieved 12 treatments of verum acupuncture and conservative orthopedic treatment (COT). Group 2 (Sham+COT) recieved 12 treatments of non-specific needling and COT. Group 3 (nil+COT) recieved COT alone. Verum- and Sham acupuncture were blinded against patient and examiner. The primary endpoints were pain reduction >/=50% on VAS 3 months after the end of the treatment protocol. Secondary endpoints were pain reduction >/=50% on VAS and treatment efficacy on a four-point box scale directly after the end of the treatment protocol and treatment efficacy after 3 months. In the whole sample a pain relief of >/=50% on VAS was reported directly after the end of treatment protocol: Verum+COT 65% (95%CI 51-77%), Sham+COT 34% (95%ci 22-49%), nil+COT 43% (95%ci 29-58%) - results are significant for Verum+COT over Sham+COT (P</=0.02). The results after 3 months are: Verum+COT 77% (95%ci 62-88%), Sham+COT 29% (95%ci 16-46%), nil+Cot 14% (95%ci 4-30%) - effects are significant for Verum+COT over Sham+COT (P</=0.001) and for Verum+COT over nil+COT (P<0.001). No difference was found in the mobility of the patients nor in the intake of NSAID diclofenac. Our conclusion is that acupuncture can be an important supplement of conservative orthopedic treatment in the management of chronic LBP.

PMID: 12406534 [PubMed - in process]

33: Pain 2002 Oct;99(3):567-78 Related Articles, Links: Application of a pro-inflammatory agent to the orbital portion of the rat infraorbital nerve induces changes indicative of ongoing trigeminal pain.

Benoliel R, Wilensky A, Tal M, Eliav E.

The Department of Oral Diagnosis, Oral Medicine, Oral Radiology, Hadassah School of Dental Medicine, The Hebrew University, Jerusalem, Israel

The present experiments investigated the behavioral and immunocytchemical (ICC) effects of applying complete Freund's adjuvant (CFA) to the orbital portion of the infraorbital nerve (IOn). Two control groups, the first had saline applied to the IOn and the second underwent sham operation, were included in the study. In the CFA group, significant hyper-responsiveness to von Frey (analysis of variance <0.05) and to pinprick stimulation (Kruskal Wallis <0.05) in the vibrissal pad was observed on the fourth and the fifth days post-operative (dpo). This was accompanied by a reduced bite force and altered bite patterns of similar duration. Histology of the IOn in CFA rats revealed immune cell infiltration and edema around and in the nerve trunk with only mild axonal damage confirmed by neuropeptide Y immunoreactivity in trigeminal ganglion. Histological areas of inconsistent and mild inflammation were observed in the saline group that were accompanied by similarly attenuated behavioral and ICC changes. This model of inflammation-induced neuropathic pain is highly applicable to the study of neuroinflammatory orofacial pain.

PMID: 12406533 [PubMed - in process]

34: Pain 2002 Oct;99(3):557-66 Related Articles, Links: Gabapentin in neuropathic pain syndromes: a randomised, double-blind, placebo-controlled trial.

Serpell MG.

University Department of Anaesthesia and Pain Management, Gartnavel General Hospital, 30 Shelly Court, G12 0YN, Scotland, Glasgow, UK

A double-blind, randomised, placebo-controlled 8-week study was conducted to evaluate the efficacy and safety of gabapentin in the treatment of neuropathic pain, using doses up to 2400mg/day. The study used a novel design that was symptom- rather than syndrome-based; an approach that aimed to reflect the realities of clinical practice. Participants had a wide range of neuropathic pain syndromes, with at least two of the following symptoms: allodynia, burning pain, shooting pain, or hyperalgesia. Patients were randomised to gabapentin (n=153) or placebo (n=152). Gabapentin was given in three divided doses, initially titrated to 900mg/day over 3 days, followed by two further increases, to a maximum of 2400mg/day if required by the end of week 5. The primary outcome measure was changed in average daily pain diary score (baseline versus final week). Over the 8 week study, this score decreased (i.e. improved) by 1.5 (21%) in gabapentin treated patients and by 1.0 (14%) in placebo treated patients (P=0.048, rank-based analysis of covariance). Significant differences were shown in favour of gabapentin (P<0.05) for the Clinician and Patient Global Impression of Change, and some domains of the Short Form-McGill Pain Questionnaire. Improvements were also shown in patient-reported outcomes in quality of life, as seen by significant differences in favour of gabapentin in several domains of the Short-Form-36 Health Survey. Gabapentin was well tolerated and the majority of patients completed the study (79 versus 73% for placebo). The most common adverse events were mild to moderate dizziness and somnolence, most of which were transient and occurred during the titration phase. This study shows that gabapentin reduces pain and improves some quality-of-life measures in patients with a wide range of neuropathic pain syndromes.

PMID: 12406532 [PubMed - in process]

35: Pain 2002 Oct;99(3):515-23 Related Articles, Links: Chronic pain in a biracial population of young women.

Plesh O, Crawford PB, Gansky SA.

Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, 707 Parnassus Avenue, 94143-0758, San Francisco, CA, USA

This study investigated dimensions of chronic pain and temporomandibular disorders (TMDs) in a census tract sampling of African-American and Caucasian young women enrolled (from racially congruent households) at ages 9-10 in the longitudinal multicenter National Heart Lung and Blood Institute's Growth and Health Study (NGHS). The present study, which examined participants at the California clinical NGHS center when they were 19-23 years old, investigates five commonly reported chronic pains: back, head, face/jaw, abdomen, and chest. Chronic pain grade (CPG) status based on pain self-reports (frequency, duration, severity, and interference with usual activities) is reported for each of the five pain sites. Results show that chronic pain is common in this population of young women, although based on the CPG severity scores, only a small percentage is dysfunctional. Racial differences were not found for back, head, abdomen or chest pains. However, significant racial differences were found regarding facial pain and symptoms related to TMDs above and beyond socioeconomic status (SES) (lifetime prevalence: adjusted odds ratio (aOR)=2.14 and 95% confidence interval (CI)=1.40-3.31; 6 month period prevalence: aOR=2.03 and 95% CI=1.16-3.64). Not only were facial pain and jaw symptoms reported more frequently by Caucasians compared to African-Americans controlling for SES, but they were also reported to have an earlier onset.

PMID: 12406528 [PubMed - in process]

36: Pain 2002 Oct;99(3):509-14 Related Articles, Links: The effect of high and low frequency electroacupuncture in pain after lower abdominal surgery.

Lin JG, Lo MW, Wen YR, Hsieh CL, Tsai SK, Sun WZ.

Acupuncture Research Center, China Medical College, Taichung, Taiwan, ROC

In the present study, we examined the effects of preoperative electroacupuncture (EA) at classical bilateral acupuncture points (Zusanli, also known as ST-36) on postoperative pain and opioid-related side effects. One hundred healthy consenting women undergoing lower abdominal surgery were randomly assigned to four treatment regimens: Group I (n=25), control; Group II (n=25), sham-EA (needle insertion without electrical stimulation); Group III (n=25), low-EA (2Hz of electrical stimulation); and Group IV (n=25), high-EA (100Hz of electrical stimulation). EA groups received needle insertion with or without electrical stimulation 20min prior to anesthesia. All patients received patient-controlled analgesia (PCA) of morphine postoperation. Postoperative pain was evaluated by recording (1) the time of the first required analgesic, (2) the number of PCA demands, (3) the total amount of morphine required by PCA, and (4) patients' VAS pain score. We found that the time of first analgesic requested was 10, 18, 28, and 28min in the control, sham-, low-, and high-EA groups, respectively. During the first 24h, the total amount of morphine required was decreased by 21, 43 and 61% in the sham-, low- and high-EA groups, respectively. The incidence of nausea and dizziness during the first 24h after surgery was significantly reduced in both the low-EA and high-EA groups compared with the control and sham-EA groups. We also found that sham-EA exerts a beneficial effect with respect to its pain relieving quality but not the side effect profiles. Our findings demonstrates that preoperative treatment with low-EA and high-EA can reduce postoperative analgesic requirements and associated side effects in patients undergoing lower abdominal surgery.

PMID: 12406527 [PubMed - in process]

37: Pain 2002 Oct;99(3):501-8 Related Articles, Links: Elastoviscous substances with analgesic effects on joint pain reduce stretch-activated ion channel activity in vitro.

Pena Ede L, Sala S, Rovira JC, Schmidt RF, Belmonte C.

Instituto de Neurociencias, Universidad Miguel Hernandez-CSIC, Apartado 18, 03550, San Juan de Alicante, Spain

Activation by noxious mechanical stimuli of sensory nerve fibres that signal joint pain takes place through stretch-activated ion channels, which open in response to increased membrane tension. It has been suggested that the analgesic effect of hyaluronan solutions used for intra-articular treatment of joint pain in humans are mediated by a reduction of the sensitivity of mechanosensory ion channels of nociceptive nerve terminals. We have investigated whether cross-linked hyaluronan solutions (hylans) of different elastoviscosities modify the response characteristics of stretch-activated ion channels of Xenopus laevis oocytes. Patch-clamp recordings on intact oocytes and in excised membrane patches (outside-out and inside-out configurations) were performed in Barth's solution (control condition) and after exposure to hylans of different elastoviscosities. For mechanical stimulation, monitored suction was applied through the microelectrode and the activity of stretch-activated channels was recorded. The activity of stretch-activated channels was significantly reduced in the presence of high elastoviscous hylan A (0.8% polymer content, molecular weight 6M) and of a mixture of hylan A (90% by weight) and hylan B (10% by weight), 0.9% total polymer content, a clinically used hylan product. In contrast, solutions of hylan A with the same chemical composition but reduced elastoviscosity (0.8% polymer content, molecular weight 96,000) were found ineffective. It is concluded that stretch-activated channels have a decreased mechanical sensitivity in the presence of elastoviscous solutions of hylan, but not in the presence of non-elastoviscous solutions of hylan of the same concentration. These data suggest that the analgesic effects of intra-articular injections of elastoviscous solutions of hylans are due to a reduction of the sensitivity to mechanical forces of stretch-activated channels present in the membrane of joint mechanonociceptors.

PMID: 12406526 [PubMed - in process]

38: Pain 2002 Oct;99(3):485-91 Related Articles, Links: Fear-avoidance beliefs and catastrophizing: occurrence and risk factor in back pain and ADL in the general population.

Buer N, Linton SJ.

Neurotec Department, Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden

Fear-avoidance beliefs and catastrophizing have been shown to be powerful cognitions in the process of developing chronic pain problems and there is a need for increased knowledge in early stages of pain.The objectives of this study were therefore, firstly, to examine the occurrence of fear-avoidance beliefs and catastrophizing in groups with different degrees of non-chronic spinal pain in a general population, and secondly to assess if fear-avoidance beliefs and catastrophizing were related to current ratings of pain and activities of daily living (ADL).The study was a part of a population based back pain project and the study sample consisted of 917 men and women, 35-45 years old, either pain-free or with non-chronic spinal pain. The results showed that fear-avoidance beliefs as well as catastrophizing occur in this general population of non-patients. The levels were moderate and in catastrophizing a 'dose-response' pattern was seen, such that more the catastrophizing was, the more was pain. The study showed two relationships, which were between fear-avoidance and ADL as well as between catastrophizing and pain intensity. Logistic regression analyses were performed with 95% confidence intervals and the odds ratio for fear-avoidance beliefs and ADL was 2.5 and for catastrophizing and pain 1.8, both with confidence interval above unity. The results suggest that fear-avoidance beliefs and catastrophizing may play an active part in the transition from acute to chronic pain and clinical implications include screening and early intervention.

PMID: 12406524 [PubMed - in process]

39: Pain 2002 Oct;99(3):465-73 Related Articles, Links: Randomized controlled trial of botulinum toxin A for chronic myogenous orofacial pain.

Nixdorf DR, Heo G, Major PW.

Orofacial Pain Clinic, Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, 4048 Dentistry/Pharmacy Centre, Alberta, T6G 2N8, Edmonton, Canada

The purpose of this study was to determine whether botulinum toxin A (BTX-A) was efficacious for the treatment of chronic moderate to severe jaw muscle pain in females. This was a randomized double-blind, placebo-controlled crossover trial of BTX-A. Twenty five units injected into each temporalis muscle and 50U injected into each masseter muscle using three sites per muscle with 0.2cm(3) per site. Data were collected at baseline, 8, 16, 24 weeks, with crossover occurring at 16 weeks. Primary outcome variables were pain intensity and unpleasantness, measured by horizontal visual analog scale (VAS). Secondary outcome variables were maximum interincisal opening without and irrespective of pain, muscle palpation tenderness (12 points), and four general questions. Fifteen female patients were enrolled (18-45 years), but only ten completed the trial. Of those who finished, no statistically significant difference was found in pain intensity (P=0.10), unpleasantness (P=0.40), palpation muscle tenderness (P=0.91), or the three general questions (P=0.64, P=0.66, P=0.67). Statistical significance was achieved for maximum opening without pain (P=0.02) and irrespective of pain (P=0.005) with the BTX-A arm having a relative decreased opening. No statistically significant difference was observed in any outcome measures except maximum opening, which showed BTX-A patient opening less wide than placebo. The results do not support the use of BTX-A in the treatment of moderate to severe jaw muscle pain in this patient population.

PMID: 12406522 [PubMed - in process]

40: Pain 2002 Oct;99(3):459-63 Related Articles, Links: Catastrophizing is related to pain ratings, but not nociceptive flexion reflex threshold.

France CR, France JL, al'Absi M, Ring C, McIntyre D.

Department of Psychology, Ohio University, 245 Porter Hall, 45701, Athens, OH, USA

Catastrophizing is reliably associated with increased reports of clinical and experimental pain. To test the hypothesis that catastrophizing may heighten pain experience by increasing nociceptive transmission through spinal gating mechanisms, the present study examined catastrophizing as a predictor of pain ratings and nociceptive flexion reflex (NFR) thresholds in 88 young adult men (n=47) and women (n=41). The NFR threshold was defined as the intensity of electrocutaneous sural nerve stimulation required to elicit a withdrawal response from the biceps femoris muscle of the ipsilateral leg. Participants completed an assessment of their NFR threshold and then provided pain ratings using both a numerical rating scale (NRS) and the short-form McGill pain questionnaire (SF-MPQ). Pain catastrophizing was assessed using the catastrophizing subscale of the coping strategies questionnaire (CSQ). Although catastrophizing was positively related to both NRS and SF-MPQ pain ratings, catastrophizing was not significantly related to NFR threshold. These findings suggest that differential modulation of spinal nociceptive input may not account for the relationship between catastrophizing and increased pain.

PMID: 12406521 [PubMed - in process]

41: Pain 2002 Oct;99(3):453-8 Related Articles, Links: Orofacial pain: just another chronic pain? Results from a population-based survey.

Macfarlane TV, Blinkhorn AS, Davies RM, Ryan P, Worthington HV, Macfarlane GJ.

Turner Dental School, The University of Manchester, Manchester, UK

Features of somatisation have been shown to predict the onset of widespread body pain. This study aims to determine to what extent persons with orofacial pain syndromes share these features and to what extent they are uniquely related to oral mechanical factors. We have conducted a population-based cross-sectional survey in the South-East Cheshire area of the United Kingdom involving 2504 individuals aged 18-65 years. All participants completed a postal questionnaire which enquired about the occurrence of both orofacial pain and widespread body pain. It also enquired about potential risk factors for one or both conditions. In total, 473 subjects (23%) reported orofacial pain only, 123 (6%) widespread pain only, while 85 (4%) reported both. The number reporting both was significantly higher than would be expected if the symptoms were independent (P<0.001). Several oral mechanical factors were significantly associated with both orofacial pain and widespread body pain (grinding teeth, clicking jaw, missing teeth), while two (facial trauma, locking jaw) were specifically related to orofacial pain. Both pain syndromes were associated equally with high levels of psychological distress, indicators of somatisation and maladaptive response to illness. These results suggest that orofacial pain syndromes may commonly be a manifestation of the process of somatisation and the excess reporting of some local mechanical factors amongst persons with these symptoms, may not be uniquely associated with pain in the orofacial region.

PMID: 12406520 [PubMed - in process]

42: Pain 2002 Oct;99(3):433-42 Related Articles, Links: Controlled dilatation of the uterine cervix - an experimental visceral pain model.

Bajaj P, Drewes AM, Gregersen H, Petersen P, Madsen H, Arendt-Nielsen L.

Department of Health Science and Technology, Center for Sensory-Motor Interaction, Fredrik Bajers Vej 7 D3, Aalborg University, DK-9220, Aalborg, Denmark

Pain originating from the female reproductive organs is a substantial clinical problem to treat. Experimental models may be a tool for the study of visceral pain mechanisms and hence provide information to aid in formulating new treatment strategies. The aim was to develop and evaluate the performance and safety of a model for nociceptive stimulation of the uterine cervix by balloon dilatation using impedance planimetry. Three consecutive (repeated) dilatations at 1ml/min, an isovolumetric and a fast dilatation at 2ml/min were performed. Pilot studies were conducted in vitro on hysterectomy specimens, followed by application of the model in 14 healthy females. Subjects indicated the quality of perception and pain during dilatations by verbal reports and the McGill Pain Questionnaire (MPQ), and the intensity by a continuous electronic visual analog scale. The pain location was marked on an anatomical map. The balloon cross-sectional area (CSA) was measured simultaneously. The experimental procedure was atraumatic. Pain was evoked in all subjects, with referral to the hypogastric and low back regions. The word descriptors on the MPQ and the areas of referred sensations were similar to that seen clinically in abortion, labor and menstrual pain. The pain intensity correlated with balloon CSA (r=0.9, P<0.001). No significant differences were found for the balloon volumes (4.2, 3.8 and 3.9ml) or CSA (163, 122 and 123mm(2)) to pain threshold (PT) for repeated dilatations, suggesting the reliability of the model. There was significant correlation between the balloon volume and CSA to reach the PT for single and repeated cervical dilatations. During isovolumetric distension, greater overall pain intensity was demonstrated for the prolonged as compared to the shorter duration cervical stimulation. In conclusion, this is the first human experimental pain model for dilatation of the uterine cervix, providing a safe, controlled, quantifiable stimulus that evoked reliable pain scores. The model thus provides a new possibility to study gynecological pain and may lead to better characterization and treatment of female visceral pain syndromes.

PMID: 12406518 [PubMed - in process]

43: Pain 2002 Oct;99(3):423-31 Related Articles, Links: Acupuncture analgesia in a new rat model of ankle sprain pain.

Koo ST, Park YI, Lim KS, Chung K, Chung JM.

Marine Biomedical Institute, University of Texas Medical Branch, 77555-1069, Galveston, TX, USA

The lack of suitable experimental animal models for persistent pain showing clear acupuncture analgesia, has been the major stumbling block in the investigation of the physiological mechanisms of acupuncture analgesia. The present study developed a new rat model of ankle sprain pain and the effect of electroacupuncture (EA) on this model was examined. A common source of persistent pain in humans is the lateral ankle sprain. To model this condition, the rat's right ankle was bent repeatedly, overextending lateral ligaments, for 4min under halothane anesthesia. The rat subsequently showed swelling of the ankle and a reduced stepping force of the affected limb for the next several days. The reduced stepping force of the limb was presumably due to a painful ankle since systemic injection of morphine produced temporary improvement of weight bearing. EA was applied to the SI-6 acupuncture point on the contralateral forelimb for 30min under halothane anesthesia. After the termination of EA, behavioral tests measuring stepping force were periodically conducted during the next 4h. EA produced a 40% recovery in the stepping force of the sprained foot lasting for at least 2h. The magnitude of this improvement was equivalent to that obtained after a systemic injection of 2mg/kg of morphine and this improvement of stepping pressure was interpreted as an analgesic effect. The analgesic effect was specific to the acupuncture point since (1) the analgesic effect on the ankle sprain pain model could not be mimicked by EA applied to a nearby point, LI-4 and (2) EA applied to the SI-6 point was not effective in the knee arthritis pain model. The analgesic effect could not be blocked by systemic injection of opioid antagonists naloxone or naltrexone. These data suggest that EA produces a potent analgesic effect on the ankle sprain pain model in the rat. This analgesic effect is produced by applying EA to a site remote from the painful area in a stimulus point-specific way. The present study provides a powerful experimental animal model that can be used for investigating the unique physiological mechanisms involved in acupuncture analgesia.

PMID: 12406517 [PubMed - in process]

44: Pain 2002 Oct;99(3):415-22 Related Articles, Links: Orofacial pain-related communication patterns: sex and residential setting differences among community-dwelling adults.

Riley JL, Gilbert GH, Heft MW.

Division of Public Health Services and Research, College of Dentistry, P.O. Box 100404 HSC, University of Florida, 32610-0404, Gainesville, FL, USA

This study documented orofacial pain-related communication patterns among community-dwelling dentate adults, health care providers, and persons in the respondent's social network. We report communication patterns for orofacial pain by symptom (toothache pain, pain when chewing, temperature sensitivity of the teeth, painful oral sores, and jaw joint pain). The subjects for the study were 724 participants in the 42-month interview of the Florida Dental Care Study, a longitudinal study of oral health among dentate adults, age 45 and older at baseline. The data were collected using a standardized telephone interview. Pain was more likely to be discussed with a lay consultant (41-66% depending on the symptom) than a health care professional (21-62%). Consistent with studies that report females tend to rely on social networks to cope with pain, more female respondents than males reported having talked to a lay consultant about orofacial pain for most of the symptoms. We also found that rural Black adults were less likely to speak to a health care professional about their orofacial pain. The findings highlight the importance of family, friends, and neighbors within the lay consultation and support network for persons with pain. Recent interest in self-care and the use of complementary and alternative approaches to treatment suggest the importance of considering influences acting within the environment of persons with pain.

PMID: 12406516 [PubMed - in process]

45: Pain 2002 Oct;99(3):397-406 Related Articles, Links: Efficacy of systemic morphine suggests a fundamental difference in the mechanisms that generate bone cancer vs. inflammatory pain.

Luger NM, Sabino MA, Schwei MJ, Mach DB, Pomonis JD, Keyser CP, Rathbun M, Clohisy DR, Honore P, Yaksh TL, Mantyh PW.

Department of Preventive Sciences, Schools of Dentistry and Medicine, University of Minnesota, 55455, Minneapolis, MN, USA

Pain is the cancer related event that is most disruptive to the cancer patient's quality of life. Although bone cancer pain is one of the most severe and common of the chronic pains that accompany breast, prostate and lung cancers, relatively little is known about the mechanisms that generate and maintain this pain. Recently, we developed a mouse model of bone cancer pain and 16 days following tumor implantation into the intramedullary space of the femur, significant bone destruction and bone cancer pain-related behaviors were observed. A critical question is how closely this model mirrors human bone cancer pain. In the present study we show that, as in humans, pain-related behaviors are diminished by systemic morphine administration in a dose dependent fashion that is naloxone-reversible. Humans suffering from bone cancer pain generally require significantly higher doses of morphine as compared to individuals with inflammatory pain and in the mouse model, the doses of morphine required to block bone cancer pain-related behaviors were ten times that required to block peak inflammatory pain behaviors of comparable magnitude induced by hindpaw injection of complete Freund's adjuvant (CFA) (1-3mg/kg). As these animals were treated acutely, there was not time for morphine tolerance to develop and the rightward shift in analgesic efficacy observed in bone cancer pain vs. inflammatory pain suggests a fundamental difference in the underlying mechanisms that generate bone cancer vs. inflammatory pain. These results indicate that this model may be useful in defining drug therapies that are targeted for complex bone cancer pain syndromes.

PMID: 12406514 [PubMed - in process]

46: Pain 2002 Oct;99(3):385-96 Related Articles, Links: Patient-related barriers to pain management: the barriers questionnaire II (BQ-II).

Gunnarsdottir S, Donovan HS, Serlin RC, Voge C, Ward S.

School of Nursing, University of Wisconsin-Madison, K6/333, 600 Highland Avenue, 53792-2455, Madison, WI, USA

Patients' beliefs can act as barriers to optimal management of cancer pain. The Barriers Questionnaire (BQ) is a tool used to evaluate such barriers. Here, the BQ has been revised to reflect changes in pain management practices, resulting in the Barriers Questionnaire-II (BQ-II), a 27-item, self report instrument. This paper presents the results from two studies where the psychometric properties of the BQ-II were evaluated. In the first study, the responses of 27 nurses trained in pain management were compared to responses of a convenience sample of 12 patients with cancer. The results indicated that patients with cancer had higher mean scores on the BQ-II than did nurses trained in pain management. In the second study, a convenience sample of 172 patients with cancer responded to the BQ-II and a set of pain and quality of life (QOL) measures. A factor analysis supported four factors. Factor one, physiological effects, consists of 12 items addressing the beliefs that side effects of analgesics are inevitable and unmanageable, concerns about tolerance, and concerns about not being able to monitor changes in one's body when taking strong pain medications. Factor two, Fatalism, consists of three items addressing fatalistic beliefs about cancer pain and its management. Factor three, Communication, consists of six items addressing the concern that reports of pain distract the physician from treating the underlying disease, and the belief that 'good' patients do not complain of pain. The fourth and final factor, harmful effects, consists of six items addressing fear of becoming addicted to pain medication and the belief that pain medications harm the immune system. The BQ-II total had an internal consistency of 0.89, and alpha for the subscales ranged from 0.75 to 0.85. Mean (SD) scores on the total scale was 1.52 (0.73). BQ-II scores were related to measures of pain intensity and duration, mood, and QOL. Patients who used adequate analgesics for their levels of pain had lower scores on the BQ-II than did patients who used inadequate analgesics. The BQ-II is a reliable and valid measure of patient-related barriers to cancer pain management.

PMID: 12406513 [PubMed - in process]

47: Pain 2002 Oct;99(3):377-83 Related Articles, Links: Long-term effects of neonatal pain on nociceptive systems.

Lidow MS.

Department of Oral and Craniofacial Biological Sciences, University of Maryland, 5-A-12, HHH, 666 West Baltimore Street, 20201, Baltimore, MD, USA

PMID: 12406512 [PubMed - in process]

48: Pain 2002 Aug;98(3):335-8 Related Articles, Links: Continuous intraventricular clonidine infusion in controlled morphine withdrawal--case report.

Lorenz M, Hussein S, Verner L.

Department of Neurosurgery, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany. lorenz.martin@mh-hannover.de

A patient with atypical bilateral facial pain reported the loss of analgesic effect of intracerebroventricular morphine delivered continuously via an implanted pump, accompanied by intolerable adverse side effects associated with the administered high dose of morphine. Clonidine was substituted for morphine over a period of 3 weeks to achieve a drug holiday. The patient did not have significant withdrawal symptoms or major discomfort from pain, leading to a reduced quality of life during this period. Six months after the treatment, the patient continues to require a significantly lower daily dose of morphine. Morphine withdrawal with clonidine substitution produced a significant improvement in the analgesic efficacy of morphine and in the quality of life in the absence of undesirable side effects.

PMID: 12127036 [PubMed - indexed for MEDLINE]

49: Pain 2002 Aug;98(3):305-13 Related Articles, Links

Efficacy of continuous versus intermittent morphine administration after major surgery in 0-3-year-old infants; a double-blind randomized controlled trial.

van Dijk M, Bouwmeester NJ, Duivenvoorden HJ, Koot HM, Tibboel D, Passchier J, de Boer JB.

Department of Pediatric Surgery, Erasmus MC-Sophia, Rotterdam, The Netherlands. bandijk@psys.azr.nl

A randomized double-blind clinical trial compared the efficacy of 10 microg/kg/h morphine continuous intravenous infusion (CM) with that of 30 microg/kg morphine (IM) every 3h after major abdominal or thoracic surgery, in 181 infants aged 0-3 years. Efficacy was assessed by the caregiving nurses with the COMFORT 'behavior' and a visual analogue scale (VAS) for pain, every 3h in the first 24h after surgery. Random regression modeling was used to simultaneously estimate the effect of randomized group assignment, actual morphine dose (protocol dosage plus extra morphine when required), age category, surgical stress, and the time-varying covariate mechanical ventilation on COMFORT 'behavior' and the observational VAS rated pain, respectively. Overall, no statistical differences were found between CM and IM morphine administration in reducing postoperative pain. A significant interaction effect of condition with age category showed that the CM assignment was favorable for the oldest age category (1-3 years old). The greatest differences in pain response and actual morphine dose were between neonates and infants aged 1-6 months, with lower pain response in neonates who were on average satisfied with the protocol dosage of 10 microg/kg/h. Surgical stress and mechanical ventilation were not related to postoperative pain or morphine doses, leaving the inter-individual differences in pain response and morphine requirement largely unexplained.

Publication Types:

Clinical Trial
Randomized Controlled Trial

PMID: 12127032 [PubMed - indexed for MEDLINE]

50: Spine 2002 Aug 15;27(16):1709 Related Articles, Links

Comment on:

Point of view.

Hall H.

Department of Surgery; University of Toronto and Spine Services, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.

Publication Types:

Comment

PMID: 12195059 [PubMed - indexed for MEDLINE]