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Anesth Analg 2002 Sep;95(3):627-34
Department of Anesthesiology, University of Washington, Seattle, Washington.
[Medline record in process]
Pain complicates the recovery process after ambulatory surgery. We surveyed 175 ambulatory surgery patients to determine pain severity, analgesic use, relationship of pain to duration of recovery, and the relative importance of various factors to predicting these outcomes. Multivariate regression analysis was used to determine unique contributions of predictor variables to outcome. Surgical procedures included knee arthroscopy (n = 50), hernia surgery (n = 25), pelvic laparoscopy (n = 25), transvaginal uterine surgery (n = 25), surgery for breast disease (n = 25), and plastic surgery (n = 25). Maximum pain (on a scale of 0-10) varied from 2.3 +/- 0.5 to 5.1 +/- 0.5 (mean +/- SE), depending on surgical procedure; 24% of patients had pain scores of >/=7, and 24% were delayed in Phase 1 recovery by pain. Pain scores were lower if local anesthetic or ketorolac was administered intraoperatively (22% and 26% respectively). Fentanyl dose during recovery correlated with maximum pain scores; fentanyl dose was 42% less if ketorolac was administered intraoperatively. In females, the recovery fentanyl dose increased in proportion to the intraoperative fentanyl dose. The maximum pain score was predictive of total recovery time (135, 172, and 212 min of recovery for maximum pain scores of 0-3, 4-6, and 7-10, respectively; P < 0.001). We conclude that improvements in pain therapy are warranted to improve patient comfort and to expedite recovery. IMPLICATIONS: Moderate to severe pain is common after ambulatory surgery and is a frequent cause of delayed discharge. Postoperative pain, opioid-related side effects, and time to discharge were less when nonsteroidal antiinflammatory drugs or local anesthetics were used intraoperatively to prevent pain before patient awakening.
PMID: 12198050, UI: 22186437
Other Formats:
Anesth Analg 2002 Sep;95(3):606-8
Departments of Anesthesiology and Biostatistics, Trakya University Medical Faculty, Edirne, Turkey.
IMPLICATIONS: Magnesium sulfate, 2.48 mmol, injected 20 s before the administration of propofol significantly reduced the incidence of pain caused by a propofol injection and may be useful in minimizing this common side effect.
PMID: 12198045, UI: 22186432
Anesthesiology 2002 Jun;96(6):1530; discussion 1530-1
Publication Types:
PMID: 12170077, UI: 22159361
Anesthesiology 2002 Jun;96(6):1515-7
Department of Anesthesiology, Louisiana State University Health Sciences Center and Multidisciplinary Pain Mastery Center, New Orleans, Louisiana 70112, USA. jdiaz@lsuhsc.edu
PMID: 12170068, UI: 22159352
Ann Fr Anesth Reanim 2002 Jun;21(6):493-508
Departement d'anesthesiologie, CHUM, Hotel-Dieu, 3840 Saint-Urbain, Montreal, Quebec, H2W 1T8, Canada. pierre.beaulieu@umontreal.ca
OBJECTIVE: To present the cannabinoid system together with recent findings on the pharmacology of these compounds in the treatment of pain. DATA SOURCES: Search through Medline database of articles published in French and English since 1966. Also use of other publications such as books on cannabis. STUDY SELECTION: All the relevant documents within the theme of this review were used. DATA EXTRACTION: All the data linked to the present topic were searched. DATA SYNTHESIS: Recent advances have dramatically increased our understanding of cannabinoid pharmacology. The psychoactive constituents of Cannabis sativa have been isolated, synthetic cannabinoids described and an endocannabinoid system identified, together with its component receptors and ligands. Strong laboratory evidence now underwrites anecdotal claims of cannabinoid analgesia in inflammatory and neuropathic pain. Sites of analgesic action have been identified in brain, spinal cord and the periphery, with the latter two presenting attractive targets for divorcing the analgesic and psychotrophic effects of cannabinoids. Clinical trials are now required, but are hindered by a paucity of cannabinoids of suitable bioavailability and therapeutic ratio. CONCLUSION: The cannabinoid system is a major target in the treatment of pain and its therapeutic potential should be assessed in the near future by the performance of new clinical trials.
PMID: 12134594, UI: 22130653
Spine 2002 Aug 15;27(16):1790-6
Department of Population Health Sciences, National Institute of Public Health, and the; National Insurance Administration, Oslo, Norway.
STUDY DESIGN: A 7-year prospective cohort study of 34,754 employed men and women was conducted. OBJECTIVE: To determine the relative contribution of occupational risk factors, lifestyle factors, comorbidity, and psychological and social factors to the incidence of disability retirement because of back pain in the general working population. SUMMARY OF BACKGROUND DATA: Permanent occupational disability is a serious consequence of a disabling process. Although this condition is a great burden to the individual and extremely costly for society, few population-based studies exist on risk factors for obtaining disability pension because of back pain. METHODS: Patients granted back pain disability pension were ascertained from the national disability register. The exposure variables were taken from a health screening of all the inhabitants in one county: Norway. The participation rate was 72% to 90%. RESULTS: During the follow-up period, 715 individuals (2.1%) were granted a back pain disability pension. In the final combined multivariate model, the strongest predictors for future back pain disability were the occupational risk factor "physically demanding work" (odds ratio [OR], 4.1; 95% confidence interval [CI], 2.7-6.4) and the comorbidity factor "poor general health" (OR, 3.7; 95% CI, 2.4-5.8). "Feeling of being worn out" (OR, 1.7; 95% CI, 1.1-2.4), current smoking (OR, 1.4; 95% CI, 1.2-1.7), and body mass index in the upper percentile (OR, 1.6; 95% CI, 1.2-2) also predicted back pain disability pension. CONCLUSIONS: In a broad public health perspective within a European welfare system, subjects at high risk for future back pain disability pension perceived their work as constantly physically demanding, had health complaints other than back pain, and mostly felt generally tired and worn out. The results indicate that interventions directed toward the painful back alone may be unsuccessful in preventing disability pensions.
PMID: 12195073, UI: 22183172
Spine 2002 Aug 15;27(16):1783-9
Centre d'Evaluation et de Traitement de la Douleur, Hopital Saint-Antoine, INSERM Unite 88, France. anna.ozguler@st-maurice.inserm.fr
STUDY DESIGN: Individuals with low back pain were classified by cluster analysis of their responses to the Dallas Pain Questionnaire. These results enabled development of an alternative simple classification tool that yielded results close to those obtained by the cluster analysis. OBJECTIVES: To use the Dallas Pain Questionnaire to classify workers with low back pain, and to develop a practical classification tool for physicians. SUMMARY OF BACKGROUND DATA: The severity of low back pain is important information for patient management. Questionnaires exploring the multidimensional aspect of low back pain have been used to classify individuals with low back pain. The Dallas Pain Questionnaire is a short self-administered questionnaire that explores the functional and emotional aspects of chronic low back pain. It was tested in a population still at work using a simplified scoring system. METHODS: The study included 765 persons with low back pain still at work who completed the self-administered questionnaire. Of these patients, 732 could be classified by cluster analysis according to their answers to the Dallas Pain Questionnaire. A classification tool was developed to categorize them. Using external variables, the groups thus formed were compared. RESULTS: Respondents were classified into four classes: class 1 (minor disability), class 2 (intermediate disability), class 3 (disability for some physical activities), and class 4 (physical disability and emotional disturbance). External pain-related variables were clearly associated with increasing low back pain severity as measured by this classification tool. CONCLUSIONS: The Dallas Pain Questionnaire discriminated between different groups of persons with low back pain. The proposed classification uses a short, simple practical tool to assess different levels of low back pain.
PMID: 12195072, UI: 22183171
Spine 2002 Aug 15;27(16):1778-82
Unite de recherche en sante des populations, Centre de recherche du CHA de Quebec, and the Departement de Medecine Sociale et Preventive, Universite Laval, Quebec, Canada.
STUDY DESIGN: A population-based, longitudinal, mailed survey was conducted. OBJECTIVE: To investigate the 6-month incidence and determinants of clinically significant low back pain in the Saskatchewan adult population. SUMMARY OF BACKGROUND DATA: Few studies have investigated the incidence of significant low back pain in general populations. When available, such studies often differ in the assessment of pain severity. This lack of consensus in measuring pain severity results in large differences in incidence rates. METHODS: A questionnaire requesting information on low back pain and other health conditions was mailed to randomly chosen individuals, ages 20 to 69, residing in the province of Saskatchewan, Canada. Of the 1131 (55%) who responded at baseline, 848 had not experienced clinically significant low back pain during the past 6 months. Clinically significant low back pain was assessed using the Chronic Pain Questionnaire, a 7-item scale that measures the intensity of chronic pain and associated disability. Individuals with no clinically significant low back pain were followed up at 6 months. RESULTS: At the follow-up assessment, 50 individuals reported clinically significant low back pain, representing a cumulative incidence of 8% (95% confidence interval, 6-10.4). In logistic regression models, marital status, rural residency, and history of back and neck pain were associated with the onset of clinically significant low back pain. CONCLUSIONS: The 6-month incidence of clinically significant low back pain is high in Saskatchewan. It is important to prevent this condition because of the high economic and social costs associated with it.
PMID: 12195071, UI: 22183170
Spine 2002 Aug 15;27(16):1736-41
National Agency for Health and Social Welfare, Oslo, Norway, and; GlaxoSmithKline, Neurology, Clinical Development and Medical Affairs, London, UK.
STUDY DESIGN: A systematic review was conducted within the Cochrane Collaboration Back Review Group. OBJECTIVES: To assess the effects of advice to stay active as a single treatment for patients with acute low back pain or sciatica. SUMMARY OF BACKGROUND DATA: Low back pain is a common reason for consulting a health care provider, and advice on daily activities constitutes an important part in the primary care management of low back pain. METHODS: All randomized studies available in systematic searches (electronic databases, contact with authors, reference lists) were included. Two reviewers independently selected trials for inclusion, assessed the validity of the included trials, and extracted data. Investigators were contacted to obtain missing information. RESULTS: Four trials, with a total of 491 patients, were included. In all the trials, advice to stay active was compared with advice for bed rest. Two trials were assessed as having a low risk of bias, and two as having a moderate to high risk of bias. The results were heterogeneous. The results from one high-quality trial of patients with acute, simple low back pain found small differences in functional status (weighted mean difference on a 0 to 100 scale, 6.0; 95% CI, 1.5-10.5) and length of sick leave (weighted mean difference, 3.4 days; 95% CI, 1.6-5.2) in favor of staying active, as compared with advice to stay in bed 2 days. The other high-quality trial compared advice to stay active with advice to rest in bed 14 days for patients with sciatic syndrome, and found no differences between the groups. One of the high-quality trials also compared advice to stay active with advice to engage in exercises for patients with acute, simple low back pain, and found improvement in functional status and reduced sick leave in favor of advice to stay active. CONCLUSION: The best available evidence suggests that advice to stay active alone has little beneficial effect for patients with acute, simple low back pain, and little or no effect for patients with sciatica. There is no evidence that advice to stay active is harmful for either acute low back pain or sciatica. Because there is no considerable difference between advice to stay active and advice for bed rest, and there are potential harmful effects of prolonged bed rest, it is reasonable to advise people with acute low back pain and sciatica to stay active. These conclusions are based on single trials.
PMID: 12195064, UI: 22183163
Spine 2002 Aug 15;27(16):1702-9
Back Center of Copenhagen, Denmark, the; Rheumatology Research Unit, Hvidovre University Hospital, Denmark, and the; Department of Physical Therapy, Lund University, Sweden.
STUDY DESIGN: A randomized controlled comparative trial with an 8-month follow-up period was conducted. OBJECTIVE: To compare the effect of the McKenzie treatment method with that of intensive dynamic strengthening training in patients with subacute or chronic low back pain. SUMMARY OF BACKGROUND DATA: Randomized studies indicate that the efficacy of the McKenzie method in the treatment of patients with acute or subacute low back pain is debatable. Currently, no randomized studies examining the effects of this method for patients with chronic low back pain have been published. METHODS: For this study, 260 consecutive patients with low back pain and at least 8 weeks duration of symptoms (85% of the patients had more than 3 months duration of symptoms) were randomized into two groups: Group A was treated with the McKenzie method (n = 132), and Group B was treated with intensive dynamic strengthening training (n = 128). The treatment period for both groups was 8 weeks at an outpatient clinic, followed by 2 months of self-training at home. Treatment results were recorded at the end of the treatment period at the clinic, then 2 and 8 months after. In both groups, 30% of the patients were lost to follow-up evaluation. An intention-to-treat analysis of the main effect variables, disability, and pain was performed for all the patients included in the study. A supplementary analysis of the 180 patients who completed the full treatment program also was undertaken. RESULTS: Intention-to-treat analysis showed a tendency toward a difference in reduction of disability in favor of the McKenzie group at the 2-month follow-up assessment (P = 0.04), but no differences at the end of treatment and at the 8-month follow-up evaluation. No differences in reduction of pain were observed at any time between the groups. The supplementary analysis of the patients whohad completed the full intervention showed a tendency toward a difference in favor of the McKenzie method in reduction of pain at the end of treatment (P = 0.02). This difference reached statistical significance at the 2-month follow-up assessment (P = 0.01), but no difference was found after 8 months. The supplementary analysis showed no differences between the groups with regard to reduction of disability. CONCLUSION: The McKenzie method and intensive dynamic strengthening training seem to be equally effective in the treatment of patients with subacute or chronic low back pain.
PMID: 12195058, UI: 22183157
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