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Anesth Analg 2002 Sep;95(3):781
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PMID: 12198075, UI: 22186462
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Anesth Analg 2002 Sep;95(3):746-50, table of contents
Department of Anesthesiology, University of Louvain, St. Luc Hospital, av. Hippocrate 10-1821, 1200 Brussels, Belgium.
In this study we evaluated the analgesic efficacy of combined deep and superficial cervical plexus block in patients undergoing thyroidectomy under general anesthesia. For this purpose, 39 patients undergoing elective thyroid surgery were randomized to receive a bilateral combined deep and superficial cervical block (14 mL per side) with saline (Group 1; n = 13), ropivacaine 0.5% (Group 2; n = 13), or ropivacaine 0.5% plus clonidine 7.5 microg/mL (Group 3; n = 13). Deep cervical plexus block was performed with a single injection (8 mL) at the C3 level. Superficial cervical plexus block consisted of a subcutaneous injection (6 mL) behind the lateral border of the sternocleidomastoid muscle. During surgery, the number of additional alfentanil boluses was significantly reduced in Groups 2 and 3 compared with Group 1 (1.3 +/- 1.0 and 1.1 +/- 1.0 vs 2.6 +/- 1.0; P < 0.05). After surgery, the opioid and non-opioid analgesic requirements were also significantly reduced in Groups 2 and 3 (P < 0.05) during the first 24 h. Except for one patient in Group 3, who experienced transient anesthesia of the brachial plexus, no side effect was noted in any group. We conclude that combined deep and superficial cervical plexus block is an effective technique to alleviate pain during and immediately after thyroidectomy. IMPLICATIONS: Combined deep and superficial cervical plexus block is an effective technique to reduce opioid requirements during and after thyroid surgery.
PMID: 12198064, UI: 22186451
Anesth Analg 2002 Sep;95(3):741-5, table of contents
Department of Anesthesia, Women's College Hospital Campus, Sunnybrook and Women's College Health Sciences Center, University of Toronto, 76 Grenville Street, Toronto, Ontario, M5S 1B2 Canada. pamela.angle@swchsc.on.ca
Whereas nonsteroidal antiinflammatory drugs augment spinal morphine on Day l, the analgesia gained by simply combining these drugs with conventional "on request" oral regimens on Day 2 is less clear. In this trial, we randomized 80 women undergoing elective cesarean delivery with spinal morphine (0.2 mg) to receive naproxen (500 mg) or placebo every 12 h after surgery. Both groups received conventional therapy with acetaminophen with codeine (on request) and rescue IM opioids. Incision pain on sitting (IPS), incision pain at rest, uterine cramping, and gas pain were evaluated with visual analog scales (0-100). Worst interval pain (0-10), analgesic use, and side effects were measured over 72 h. At 36 h (primary outcome), naproxen use was associated with reductions in IPS (38.2 +/- 26.0 versus 51.4 +/- 25.7; P = 0.05), incision pain at rest, uterine cramping, and worst interval pain scores. Clinically modest, statistically significant reductions in IPS (P = 0.0001) and opioid use were found over time (P < 0.0l). Reductions in the incidence of inadequate analgesia and improvements in overall pain relief (P = 0.0006) on Day l did not persist on Day 2 (overall pain relief, P = 0.057; inadequate analgesia, 24% naproxen versus 27% controls; P = 1.00). The addition of regular doses of naproxen to conventional oral pain therapy after cesarean delivery leads to reductions in IPS at 36 h and pain over Day 2 but does not reduce the incidence of inadequate analgesia. IMPLICATIONS: This randomized trial suggests that adding regular doses of naproxen to conventional "on request" acetaminophen and codeine therapy provides small reductions in pain on the second day after cesarean delivery. The greatest effects occur at 36 h, when pain peaks.
PMID: 12198063, UI: 22186450
Anesth Analg 2002 Sep;95(3):723-7, table of contents
Department of Anesthesia and Intensive Care, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Untreated pain during the transportation of patients after minor trauma is a common problem in emergency medicine. Because paramedics usually are not allowed to perform invasive procedures or to give drugs for pain treatment, a noninvasive, nondrug-based method would be helpful. Acupressure is a traditional Chinese treatment for pain that is based on pain relief followed by a short mechanical stimulation of specific points. Consequently, we tested the hypothesis that effective pain therapy is possible by paramedics who are trained in acupressure. In a double-blinded trial we included 60 trauma patients. We randomly assigned them into three groups ("true points," "sham-points," and "no acupressure"). An independent observer, blinded to the treatment assignment, recorded vital variables and visual analog scales for pain and anxiety before and after treatment. At the end of transport, we asked for ratings of overall satisfaction. For statistical evaluation, one-way analysis of variance and the Scheffe F test were used. P < 0.05 was considered statistically significant. Morphometric and demographic data and potential confounding factors such as age, sex, pain, anxiety, blood pressure, and heart rate before treatment did not differ among the groups. At the end of transport we found significantly less pain, anxiety, and heart rate and a greater satisfaction in the "true points" groups (P < 0.01). Our results show that acupressure is an effective and simple-to-learn treatment of pain in emergency trauma care and leads to an improvement of the quality of care in emergency transport. We suggest that this technique is easy to learn and risk free and may improve paramedic-based rescue systems. IMPLICATIONS: We tested, in a double-blinded manner, the hypothesis that acupressure could be an effective pain therapy in minor-trauma patients. Our results show that acupressure is an effective and simple-to-learn treatment of pain in emergency medical care and can improve the quality of care.
PMID: 12198060, UI: 22186447
Anesth Analg 2002 Sep;95(3):674-715
Department of Anesthesia and Pain Management, Royal North Shore Hospital and University of Sydney, Sydney, Australia.
PMID: 12198058, UI: 22186445
Anesth Analg 2002 Sep;95(3):639-44, table of contents
Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Postfach 21 73 52, D-67073 Ludwigshafen, Germany. Dr.A.Lehmann@web.de
In this prospective, randomized study we compared bispectral index (BIS), hemodynamics, time to extubation, and the costs of target-controlled infusion (TCI) and manually-controlled infusion (MCI) of propofol. Forty patients undergoing first-time implantation of a cardioverter-defibrillator were included. Anesthesia was performed with remifentanil (0.2-0.3 micro g. kg(-1). min(-1)) and propofol. Propofol was used as TCI (plasma target concentration, 2.5-3.5 micro g/mL; n = 20) or MCI (3.0-4.0 mg. kg(-1). h(-1); n = 20). BIS, heart rate, and arterial blood pressure were measured at six data points: T1, before anesthesia; T2, after intubation; T3, after skin incision; T4, after first defibrillation; T5, after third defibrillation; and T6, after extubation. There were no significant hemodynamic differences between the two groups. BIS was significantly lower at T3 and T4 in the TCI group than in the MCI group. The mean dose of propofol was larger in TCI patients (5.8 +/- 1.4 mg. kg(-1). h(-1)) than in the MCI patients (3.7 +/- 0.6 mg. kg(-1). h(-1)) (P < 0.05), whereas doses of remifentanil did not differ. Time to extubation did not differ between the two groups (TCI, 13.7 +/- 5.3 min; MCI, 12.3 +/- 3.5 min). One patient in the MCI group had signs of intraoperative awareness without explicit memory after first defibrillation (BIS before shock, 49; after shock, 83). Costs were significantly less in the MCI group (34.83 US dollars) than in the TCI group (39.73 US dollars). BIS failed to predict the adequacy of anesthesia for the next painful stimulus. IMPLICATIONS: In this prospective, randomized study, bispectral index (BIS), hemodynamics, time to extubation, and costs of target-controlled infusion (TCI) and manually-controlled infusion of propofol were compared. TCI increased the amount of propofol used. BIS failed to predict the adequacy of anesthesia for the next painful stimulus.
PMID: 12198052, UI: 22186439
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BMJ 2002 Sep 14;325(7364):588-91
PMID: 12228139, UI: 22215486
BMJ 2002 Aug 31;325(7362):468
School of Physiotherapy, University of Sydney, PO Box 170, Lidcombe, New South Wales 1825, Australia. R.Herbert@fhs.usyd.edu.au
OBJECTIVE: To determine the effects of stretching before and after exercising on muscle soreness after exercise, risk of injury, and athletic performance. METHOD: Systematic review. DATA SOURCES: Randomised or quasi-randomised studies identified by searching Medline, Embase, CINAHL, SPORTDiscus, and PEDro, and by recursive checking of bibliographies. MAIN OUTCOME MEASURES: Muscle soreness, incidence of injury, athletic performance. RESULTS: Five studies, all of moderate quality, reported sufficient data on the effects of stretching on muscle soreness to be included in the analysis. Outcomes seemed homogeneous. Stretching produced small and statistically non-significant reductions in muscle soreness. The pooled estimate of reduction in muscle soreness 24 hours after exercising was only 0.9 mm on a 100 mm scale (95% confidence interval -2.6 mm to 4.4 mm). Data from two studies on army recruits in military training show that muscle stretching before exercising does not produce useful reductions in injury risk (pooled hazard ratio 0.95, 0.78 to 1.16). CONCLUSIONS: Stretching before or after exercising does not confer protection from muscle soreness. Stretching before exercising does not seem to confer a practically useful reduction in the risk of injury, but the generality of this finding needs testing. Insufficient research has been done with which to determine the effects of stretching on sporting performance.
PMID: 12202327, UI: 22190494
Br J Anaesth 2002 Jul;89(1):184-5; discussion 185
PMID: 12173230, UI: 22163574
Cancer 2002 Sep 1;95(5):1085-93
Psycho-Oncology Division, National Cancer Center Research Institute East, Chiba, Japan.
BACKGROUND: Despite serious concern over the suicidality of cancer patients in clinical oncology practice, few studies have addressed this issue. The purpose of the current study was to investigate the prevalence and predictive factors of suicidal ideation in patients with unresectable lung carcinoma in a follow-up setting. METHODS: Patients with newly diagnosed unresectable nonsmall cell lung carcinoma participated in this study. Their suicidal ideation was assessed 6 months after disclosure of the cancer diagnosis. Predictive factors for suicidal ideation were investigated by assessing a broad range of biomedical and psychosocial factors between the time of disclosure and start of cancer therapy (baseline) and 6 months after disclosure of the cancer diagnosis (follow-up). RESULTS: Although strong suicidal ideation was rare in this population, 13 (15%) of the 89 subjects who completed the baseline and follow-up ratings had some degree of suicidal ideation 6 months after disclosure of the cancer diagnosis. Univariate analysis revealed that significant predictive factors for suicidal ideation were pain at baseline, declining physical function, and the development of a depressive disorder. Multivariate analysis indicated that pain at baseline (odds ratio [OR] = 3.72, 95% confidence interval [CI] = 1.12-14.69, P = 0.04) and the development of a depressive disorder (OR =27.97, 95% CI = 5.18-214.14, P = 0.0003) were the final significant predictive factors. CONCLUSIONS: Suicidal ideation among unresectable lung carcinoma patients should not be neglected because it is not rare. Comprehensive care consisting of at least earlier pain management and appropriate psychiatric intervention is indispensable to prevent subsequent suicidal ideation. Copyright 2002 American Cancer Society.
PMID: 12209695, UI: 22197490
Eur J Pharmacol 2002 Sep 20;451(3):279-86
Department of Pharmacology, University of Melbourne, Melbourne, Victoria 3010, Australia. scottdav@bigpond.net.au
[Medline record in process]
Agents which decrease conductance of N-type voltage-gated Ca(2+) channels have been shown to attenuate measures of neuropathic pain in animal models and to provide symptom relief in humans. The omega-conotoxins have demonstrated efficacy but have a low therapeutic index. We have investigated the effects of a new omega-conotoxin, CVID (AM-336), and compared them with omega-conotoxin GVIA (SNX-124), omega-conotoxin MVIIA (SNX-111) and morphine in a spinal nerve ligation model of neuropathic pain in the rat. The ED(50) (and 95% CI) for attenuation of tactile allodynia by intrathecal administration for omega-conotoxin CVID, GVIA, MVIIA and morphine was 0.36 (0.27-0.48), 0.12 (0.06-0.24), 0.32 (0.23-0.45) and 4.4 (2.9-6.5) microg/kg, respectively. Only morphine significantly prolonged acute tail flick responses (ED(50) 2.3 (1.1-4.9) microg/kg). Of the omega-conotoxins, omega-conotoxin CVID showed the highest ratio of efficacy to behavioural toxicity. These observations show that intrathecal omega-conotoxins are effective in attenuating tactile allodynia in the rat without significantly affecting acute nociceptive responses. Omega-conotoxin CVID had similar potency to omega-conotoxin MVIIA but showed less toxicity in the therapeutic range. Copyright 2002 Elsevier Science B.V.
PMID: 12242089, UI: 22226612
J Pain Symptom Manage 2002 Aug;24(2):265-9
Hertzberg Palliative Care Institute and the Center to Advance Palliative Care, Mount Sinai School of Medicine, New York, NY 11029, USA.
PMID: 12231160, UI: 22218357
J Pain Symptom Manage 2002 Aug;24(2):257-64
Oxford International Center for Palliative Care, WHO Collaborative Centre for Palliative Care, Churchill Hospital, Oxford, UK.
PMID: 12231159, UI: 22218356
J Pain Symptom Manage 2002 Aug;24(2):233-5
Palliative Care Development Institute, Ljubljana, Slovenia.
PMID: 12231154, UI: 22218351
J Pain Symptom Manage 2002 Aug;24(2):231-2
Palliative Care Department, National Cancer Institute, Bratislava, Slovakia.
PMID: 12231153, UI: 22218350
J Pain Symptom Manage 2002 Aug;24(2):225-7
Hospice Casa Sperantei and National Association for Palliative Care, Brasov, Romania.
PMID: 12231151, UI: 22218348
J Pain Symptom Manage 2002 Aug;24(2):215-21
Palliative Care Department, Karol Marcinkowski University of Medical Sciences, Poznan, Poland.
PMID: 12231149, UI: 22218346
J Pain Symptom Manage 2002 Aug;24(2):205-7
Faculty of Nursing, Kaunas University of Medicine, Kaunas, Lithuania.
PMID: 12231146, UI: 22218343
J Pain Symptom Manage 2002 Aug;24(2):200-4
The Lebanese Pain and Palliative Care Initiative, Beirut, Lebanon.
PMID: 12231145, UI: 22218342
J Pain Symptom Manage 2002 Aug;24(2):197-9
Department of Comprehensive Regional Medical Services, Saitama Medical School, Saitama, Japan.
PMID: 12231144, UI: 22218341
J Pain Symptom Manage 2002 Aug;24(2):194-6
Floriani Foundation and the National Committee for Palliative Care, Milan, Italy.
PMID: 12231143, UI: 22218340
J Pain Symptom Manage 2002 Aug;24(2):191-3
Pain and Palliative Care Clinic, Medical College, Calicut, Kerala, India.
PMID: 12231142, UI: 22218339
J Pain Symptom Manage 2002 Aug;24(2):183-7
Pain Clinic, Department of Anesthesiology, University of Cologne, Cologne, Germany.
PMID: 12231140, UI: 22218337
J Pain Symptom Manage 2002 Aug;24(2):177-9
Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
PMID: 12231138, UI: 22218335
J Pain Symptom Manage 2002 Aug;24(2):173-6
Division of Palliative Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.
PMID: 12231137, UI: 22218334
J Pain Symptom Manage 2002 Aug;24(2):136-46
University of Wisconsin-Madison Medical School, Madison, WI 53706, USA.
PMID: 12231131, UI: 22218328
J Pain Symptom Manage 2002 Aug;24(2):97-101
World Health Organization and The International Association for the Study of Pain, Oslo, Norway.
PMID: 12231125, UI: 22218322
Lancet 2002 Aug 10;360(9331):426
Brain Research Institute, Vienna University Medical School, A-1090 Vienna, Austria. juergen.sandkuehler@univie.ac.at
PMID: 12241712, UI: 22226969
Pain 2002 Sep;99(1-2):367
Department of Medical Psychology, University Hospital Maastricht, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
The aim of the present study was to examine the association between pain catastrophizing and general health status in a Dutch adult community sample, including various subgroups of people with musculoskeletal pain in the analyses. For exploratory reasons this study partly replicated previous studies of the factor structure, reliability, and validity of the Pain Catastrophizing Scale (PCS).Results demonstrated that across different pain subgroups, catastrophizing uniquely contributed variance to the prediction of the various aspects of general health status beyond the variance explained by pain intensity, age, gender, and chronicity. Across subgroups strongest associations were found between catastrophizing and mental health, general health perception, social functioning, and vitality. Furthermore, the association between catastrophizing and the various aspects of general health status was not moderated by the chronicity of the pain.Results of the confirmatory factor analysis statistically confirmed a three-factor model of the PCS, which was invariant across different subgroups of people with musculoskeletal pain. Inter-factor correlations were high, and the incremental explanatory power of the three-factor model over that of a one-factor model was only marginal. This implies that a one-factor model might be justifiable as well, at least in the general community. Across various pain subgroups the reliability of the PCS total and subscales was adequate. Additional evidence for the concurrent validity of the PCS was found as well.
PMID: 12237216, UI: 22222894
Pain 2002 Sep;99(1-2):359
Department of Physiology and Cell Biology, College of Medicine and Public Health, The Ohio State University, 304 Hamilton Hall, 1645 Neil Avenue, College of Medicine and Public Health, 43210, Columbus, OH, USA
Drugs that inhibit reuptake of monoamines are frequently used to treat pain syndromes, e.g. neuropathy or fibromyalgia, where mechanical allodynia is present. Several lines of evidence suggest the involvement of supraspinal sites of action of these drugs. However, a direct study of supraspinal serotonin (5-HT) or norepinephrine (NE) release in an animal model in which allodynia is expressed, e.g. neuropathy, has not been done. The ventrobasal (VB) thalamus and the hypothalamus are major supraspinal projection regions for spinal neurons that transmit nociceptive information and are innervated by monoaminergic fibers. This study determined if peripheral neuropathy would induce changes in extracellular monoamines in VB thalamus and hypothalamus. Male Sprague-Dawley rats had spinal nerve roots L5 and L6 tightly ligated (neuropathic rats; NP) or sham (SHAM) surgery; contralateral and ipsilateral VB thalamus and contralateral hypothalamus were dialyzed with modified artificial cerebral spinal fluid (aCSF), with and without fluoxetine. NP rats had significantly decreased 5-HT content in dialysates of the contralateral VB thalamus compared with SHAM rats with (82% decrease) or without (63% decrease) fluoxetine in the perfusion medium over the 180 min of the study. There were no differences in the ipsilateral VB thalamus. In contrast, release of 5-HT was unchanged in the hypothalamic dialysates of SHAM vs. NP rats. NE release was not different in dialysates of either the VB thalamus or hypothalamus of SHAM vs. NP rats. Synthesis of 5-HT, as assessed by accumulation of 5-hydroxytrytophan after treatment with an L-amino acid decarboxylase inhibitor, was not different between NP and SHAM rats in VB thalamic and hypothalamic brain tissue. This study is the first to demonstrate changes in monoamine release supraspinally in NP rats. The differential effect between VB thalamus and hypothalamus suggests that a terminal field change may be involved. Putative mechanisms for mediating this change include alterations of GABA-ergic systems and/or plasticity related to alterations in N-methyl-D-aspartate receptor activation and nitric oxide release related to afferent hyperactivity induced by neuropathic pain.
PMID: 12237215, UI: 22222893
Pain 2002 Sep;99(1-2):349
Department of Psychology, Dalhousie University and Pediatric Pain Research Lab, IWK Health Centre, 5850 University Avenue, Nova Scotia, B3J 3G9, Halifax, Canada
The non-communicating children's pain checklist (NCCPC) has displayed preliminary validity and reliability for measuring pain in children with severe cognitive impairments (Dev Med Child Neurol 42 (2000) 609). This study provides evidence of the psychometric properties of a revised NCCPC (NCCPC-R) with a larger cohort of children. Caregivers of 71 children with severe cognitive impairments (aged 3-18) conducted observations of their children using the NCCPC-R during a time of pain and a time without pain. Fifty-five caregivers completed a second set of observations. The score results on the NCCPC-R were: internally consistent, significantly related to pain intensity ratings provided by caregivers, consistent over time, sensitive to pain, and specific to pain. Analyses of children's individual scores indicated up to 95% of their scores were consistent. Receiver operating characteristic curves suggest a score of 7 or greater on the NCCPC-R as indicative of pain in children with cognitive impairments, with 84% sensitivity and up to 77% specificity. These results provide evidence of NCCPC-R having excellent psychometric properties.
PMID: 12237214, UI: 22222892
Pain 2002 Sep;99(1-2):323
Experimental Medicine Group, AstraZeneca, Alderley Park, Cheshire SK 10 4TG, England, Macclesfield, UK
[Record supplied by publisher]
The reproducibility and tolerability of intradermal (i.d.) administration of capsaicin as a method for eliciting human pain was assessed in healthy male volunteers (n=12). The primary endpoints for assessing pain were spontaneous pain response and areas of allodynia, pinprick hyperalgesia and neurogenic inflammation. These were recorded before, immediately after, and at regular intervals following each of four doses (250&mgr;g) of capsaicin (two per trial day). Within- and between-subject variability to the technique was assessed by measuring the maximum recorded values (max), time to maximum value (t(max)) and area under the curve (AUC((0-1h))) of each of the endpoints. Tolerability to the technique was addressed by recording adverse events.Reproducibility of the i.d. capsaicin model was demonstrated for each type of capsaicin-induced pain. Following each dose, the magnitude and profile of response and overall AUC values were similar for each parameter although some decrease in pinprick hyperalgesia was observed over time. For spontaneous pain, evidence of a period effect was observed in mean AUC data, with values increasing following the second dose of each trial day. This effect was confounded by the possibility of an arm effect, with the non-dominant arm appearing to be more sensitive to pain than the dominant arm. The data were not sufficient to confirm the existence of these effects.Between-subject variability and within-day, within-subject variability accounted for most of the variability observed in the trial. By optimising study design to eliminate these sources of variability, it was estimated that spontaneous pain and the area of allodynia would be the least variable endpoints. A positive correlation was found between the area of allodynia and area of pinprick hyperalgesia (r(2)=0.835). Overall, the model was well tolerated with no reports of adverse events.We conclude that the tolerability profile, and variability of i.d. capsaicin-induced pain is acceptable for pharmacological profiling of novel anti-nociceptive agents, with limited number of subjects.
PMID: 12237211
Pain 2002 Sep;99(1-2):313
Cognitive Neuroscience Laboratory, Department of Neurology, Hamburg University Medical School, Hamburg, Germany
Pain is processed in multiple cortical and subcortical brain areas. Subcortical structures are substantially involved in different processes that are closely linked to pain processing, e.g. motor preparation, autonomic responses, affective components and learning. However, it is unclear to which extent nociceptive information is relayed to and processed in subcortical structures. We used single-trial functional magnetic resonance imaging (fMRI) to identify subcortical regions displaying hemodynamic responses to painful stimulation. Thulium-YAG (yttrium-aluminum-granate) laser evoked pain stimuli, which have no concomitant tactile component, were applied to either hand of healthy volunteers in a randomized order. This procedure allowed identification of areas displaying differential fMRI responses to right- and left-sided stimuli. Hippocampal complex, amygdala, red nucleus, brainstem and cerebellum were activated in response to painful stimuli. Structures related to the affective processing of pain showed bilateral activation, whereas structures involved in the generation of withdrawal behavior, namely red nucleus, putamen and cerebellum displayed differential (i.e. asymmetric) responses according to the side of stimulation. This suggests that spatial information about the nociceptive stimulus is made available in these structures for the guidance of defensive and withdrawal behavior.
PMID: 12237210, UI: 22222888
Pain 2002 Sep;99(1-2):309
Medecins Sans Frontieres, 8, Rue St. Sabin, XI, Paris, France
Data on 40 upper limb amputees (11 bilateral) with regard to stump pain, phantom sensation and phantom pain is presented. All the patients lost their limbs as a result of violent injuries intended to terrorise the population and were assessed 10-48 months after the injury. All amputees reported stump pain in the month prior to interview and ten of the 11 bilateral amputees had bilateral pain. Phantom sensation was common (92.5%), but phantom pain was only present in 32.5% of amputees. Problems in translation and explanation may have influenced the low incidence of phantom pain and high incidence of stump pain. In the bilateral amputees phantom sensation, phantom pain and telescoping all showed bilateral concordance, whereas stump pain and neuromas did not show concordance. About half the subjects (56%) had lost their limb at the time of injury (primary) while the remainder had an injury, then a subsequent amputation in hospital (secondary). There was no association between the incidence of phantom pain and amputation irrespective of being primary or secondary.
PMID: 12237209, UI: 22222887
Pain 2002 Sep;99(1-2):299
Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, AB25 2AY, Aberdeen, UK
Little is known about the course of chronic pain in the community. Such information is needed for the prevention and management of chronic pain. We undertook a 4-year follow-up study of 2184 individuals living in Grampian, UK to describe patterns and predictors of change in chronic pain over time. In October 2000, participants completed a postal questionnaire including case definition questions, the chronic pain grade questionnaire, the SF-36 and socio-demographic questions. Information from this questionnaire was compared to information collected from a similar questionnaire in 1996. A response rate of 83% was achieved for the follow-up study. The overall prevalence of chronic pain (pain or discomfort present either all the time or on and off for 3 months or longer) increased from 45.5% at baseline to 53.8% at follow-up. Seventy-nine percent of those with chronic pain at baseline still had it at follow-up. The average annual incidence was 8.3% and the average annual recovery rate was 5.4%. Individuals in the study samples who are in lowest quartile of SF-36 domains - physical functioning, social functioning and bodily pain at baseline - were more likely to develop chronic pain at follow-up, and respondents who were retired were less likely to develop chronic pain. Individuals in the study samples in the lowest quartile of SF-36 domains, bodily pain and general health at baseline, were less likely to recover from their chronic pain, as were those aged 45-74 compared with those aged 25-34. We concluded that chronic pain is a common, persistent problem in the community with relatively high incidence and low recovery rates. The lack of association between onset or recovery from chronic pain and most traditional socio-demographic factors, highlights the need to broaden the range of factors included in studies of chronic pain aetiology.
PMID: 12237208, UI: 22222886
Pain 2002 Sep;99(1-2):289
Academic Unit of Psychiatry and Behavioural Sciences, School of Medicine, University of Leeds, LS2 9 JT, Leeds, UK
The Beck Depression Inventory (BDI) is widely used to assess depression in chronic pain despite doubts about its structure and therefore its interpretation. This study used a large sample of 1947 patients entering chronic pain management to establish the structure of the BDI. The sample was randomly divided to conduct separate exploratory (EFA) and confirmatory factor analyses (CFA). EFA produced many satisfactory two-factor solutions. The series of CFA generated showed reasonable fit for ten of those solutions. All included a first factor identified as negative view of the self (items: failure, guilt, self-blame, self-dislike, punishment and body image change), and a second factor identified as somatic and physical function (items: work difficulty, loss of appetite, loss of libido, fatigability, insomnia and somatic preoccupation). The remaining items (suicidal ideation, social withdrawal, dissatisfaction, sadness, pessimism, crying, indecisiveness, weight loss, irritability) loaded infrequently or not at all in the CFA solutions. They did not form a coherent factor but comprised items associated with negative affect. When compared with published data from samples of depressed patients drawn from mental health settings the mean item scores for items reflecting the negative view of the self were consistently statistically lower that that observed in samples; there was no consistent difference between the samples on the items reflecting somatic and physical function; but the mean scores for the remaining affect items were significantly greater in the mental health samples. This version of depression is strikingly different from the psychiatric model of depression (e.g. DSM-IV or ICD-10), which is primarily defined by affective disturbance, and secondarily supported by cognitive and somatic symptoms. The finding is consistent with a reconsideration of what constitutes depression in the presence of chronic pain. It also has important clinical implications: it may provide a way to distinguish depressed patients with typical cognitive biases, who require specific treatment for depression alongside pain management.
PMID: 12237207, UI: 22222885
Pain 2002 Sep;99(1-2):281
Department of Psychology, Memorial University of Newfoundland, NF, A1B 3X9, St. John's, Canada
To obtain parents' identification and description of the behaviors, health care procedures and daily living situations associated with pain in children with cerebral palsy (CP), surveys were sent to parents of children with CP recruited via a clinic case list and a parents' newsletter. Forty-three parents completed the survey. Results indicated that children's ability to communicate pain verbally did not influence whether or not their parent reported observing pain. Most children (67%) were reported to have displayed pain within the month prior to rating. All pain behaviors on the Non-Communicating Children's Pain Checklist (Dev Med Child Neurol 40 (1998) 340) were endorsed by some parents, and few additional pain behaviors were identified, suggesting that this instrument adequately samples the pain behavior of children with CP. Assisted stretching was the daily living activity most frequently identified as painful by parents (93% of those reporting pain), and the one with the highest mean pain intensity. Needle injection (40%) was the medical and nursing procedure most frequently identified by parents as painful for their children. Range of motion manipulation was the therapy most frequently identified as painful by parents (58%), and the one with the highest mean intensity. Parents are able to observe pain in their children with CP regardless of the child's verbal fluency. Knowledge of behaviors and painful situations identified by parents can facilitate management of pain in children with CP.
PMID: 12237206, UI: 22222884
Pain 2002 Sep;99(1-2):273
Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland
The pain modulatory role of dopamine D2 receptors of the human forebrain was studied by determining the association between dopamine D2 receptor binding potential and the response to experimental pain. Nineteen healthy male volunteers participated in a dopamine D2 receptor positron emission tomography study. The extrastriatal regions of interest studied with [11C]FLB 457 as radioligand (n=11) were the anterior cingulum, the medial and lateral thalamus, the medial and lateral frontal cortex, and the medial and lateral temporal cortex. The striatal regions of interest studied with [11C]raclopride (n=8) were the caudate nucleus and the putamen. The latency to the ice water-induced cold pain threshold and tolerance were determined in a separate psychophysical test session. Moreover, the cutaneous heat pain threshold and its elevation by concurrent cold pain in the contralateral hand were determined in each subject. Cold pain threshold was inversely correlated with D2 binding potential in the right putamen and the cold pain tolerance was inversely correlated with D2 binding potential in the right medial temporal cortex. The magnitude of heat pain threshold elevation induced by concurrent cold pain was directly correlated with D2 binding potential in the left putamen. Other correlations of D2 binding potentials in varying brain regions with sensory responses were not significant. A psychophysical control study (n=10) showed that cold pain responses were identical in the right and left hand. The results indicate that dopamine D2 receptor binding potential in the human forebrain, particularly in the striatum, may be an important parameter in determining the individual cold pain response and the potential for central pain modulation. Accordingly, an individual with only few available D2 receptors in the forebrain is likely to have a high tonic level of pain suppression, combined with a low capacity to recruit more (dopaminergic) central pain inhibition by noxious conditioning stimulation.
PMID: 12237205, UI: 22222883
Pain 2002 Sep;99(1-2):253
Department of Physiotherapy Studies, Keele University, ST5 5BG, Staffordshire, UK
Transcutaneous electrical nerve stimulation (TENS) is a popular form of electrostimulation. Despite an extensive research base, there remains no consensus regarding the parameter selection required to achieve maximal hypoalgesic effects. The aim of this double blind, sham-controlled study was to investigate the relative hypoalgesic effects of different TENS parameters (frequency, intensity and stimulation site) upon experimentally induced mechanical pain.Two hundred and forty participants were recruited in order to provide statistical analysis with 80% power at alpha=0.05. Subjects were randomised to one of the six TENS groups, a control, and a sham TENS group (n=30, 15 males, 15 females, per group). TENS groups differed in their combinations of stimulation; frequency (4 or 110Hz), intensity ('to tolerance' or 'strong but comfortable') and stimulation site (segmental - over the distribution of the radial nerve or, extrasegmental - over acupuncture point 'gall bladder 34', or a combination of both segmental and extrasegmental). Pulse duration was fixed at 200&mgr;s. Stimulation was delivered for 30min and subjects were then monitored for a further 30min.Mechanical pain threshold (MPT) was measured using a pressure algometer and taken from the first dorsal interosseous muscle of the dominant hand, ipsilateral to the stimulation site. MPT measures were taken, at baseline, and at 10-min intervals for 60min. Difference scores were analysed using repeated measures and one-way ANOVA and relevant post hoc tests.Low frequency, high intensity, extrasegmental stimulation produced a rapid onset hypoalgesic effect, which increased during the stimulation period (P<0.0005 control and sham) and was sustained for 30min post-stimulation (P<0.0005(control), P=0.024(sham)). Whilst high frequency, 'strong but comfortable' intensity, segmental stimulation produced comparable hypoalgesic levels during stimulation, this effect was not sustained post-stimulation. Stimulation at a combination of the two sites did not produce any greater hypoalgesic effects. These results may have implications for the clinical use of sensory stimulation.
PMID: 12237203
Pain 2002 Sep;99(1-2):235
Division of Anaesthesiology, Geneva University Hospitals, CH-1211 14, Geneva, Switzerland
Magnesium is a physiological antagonist of both calcium and the NMDA receptor. Patients with chronic pain of a limb (>1 month's duration) were treated with two Bier's blocks (250mmHg, 10m) in a randomised, double-blind, cross-over design. They received once 20% magnesium sulphate (500mg) + lignocaine 1% (75mg), and once physiological saline + lignocaine 1% (75mg). The volume of both treatments was 10ml. Efficacy data from 49 treatments (25 magnesium, 24 placebo) could be analysed. With magnesium-lignocaine, the duration of pain relief as reported by the patients was on average 23 days (95% CI 8-38) compared with 6 days (95% CI 2-10) with lignocaine alone (P=0.043). With magnesium-lignocaine, 54.2% of patients had more than 50% pain relief compared with 25% with lignocaine alone (number-needed-to-treat 3.5, P=0.075). With magnesium-lignocaine, 20% of patients had a treatment failure (i.e. pain relief <24h) compared with 50% with lignocaine alone (number needed-to-treat 3.3, 95% CI 1.8-29, P=0.038). The magnesium-lignocaine treatment was painful in 52% of patients compared with 8% with lignocaine alone (number-needed-to-harm 2.3, 95% CI 1.5-4.5, P=0.0008). For patients with chronic limb pain, the addition of magnesium to a Bier's block with lignocaine improves and prolongs pain relief and reduces the number of treatment failures. The optimal dose of lignocaine to prevent magnesium-induced aching of the treated limb needs to be established. Bier's block with magnesium-lignocaine may provide a possible treatment alternative in these patients.
PMID: 12237201, UI: 22222879
Pain 2002 Sep;99(1-2):223
Department of Anesthesiology, Vanderbilt University School of Medicine, Suite 403-G MAB, 1211 Twenty-First Avenue South, 37232-1557, Nashville, TN, USA
The experience of anger (i.e. trait anger) and anger management style (i.e. anger-in, anger-out) are related to sensitivity to acute and chronic pain stimuli, although underlying mechanisms are unknown. This study tested whether anger variables are associated with impaired endogenous opioid antinociceptive activity, and whether these relationships differed between chronic pain patients and healthy normals. Forty-three chronic low back pain (LBP) sufferers and 45 pain-free normals received opioid blockade (8mg naloxone i.v.) or placebo blockade (saline) in randomized, counterbalanced order in separate sessions. During each session, subjects participated in a 1-min finger pressure pain task followed by an ischemic forearm pain task (maximum duration 5min), providing pain intensity ratings during and immediately following each task. As a measure of opioid antinociceptive function, drug effects were derived by subtracting placebo from blockade condition pain ratings. Multivariate general linear model analyses indicated that anger-out, but not anger-in, had significant main effects on both finger pressure drug effects (P<0.05) and ischemic task drug effects (P<0.05). As hypothesized, high anger-out scores were associated with an absence of opioid analgesia during the acute pain tasks; low anger-out scores were associated with effective opioid analgesia. A similar non-significant trend was noted for trait anger on finger pressure drug effects (P<0.06). Anger-out x LBP/normal interactions were non-significant, suggesting that links between anger-out and drug effects were similar for patients and normals. Controlling for depression did not eliminate the significant relationship between anger-out and drug effects. Findings suggest that anger-in and anger-out affect pain sensitivity through different mechanisms: only the effects of anger-out may be mediated by endogenous opioid dysfunction.
PMID: 12237200, UI: 22222878
Pain 2002 Sep;99(1-2):207
Department of Neurosurgery, School of Medicine, Johns Hopkins University, Meyer 5-109, 600 N. Wolfe Street, 21287-0817, Baltimore, MD, USA
Opioid receptors occur in locations of strategic importance within the central nervous system for modulation of pain. Is pain reduced by ongoing inhibition mediated by activation of these receptors? Experiments to date in which the opioid-receptor antagonist, naloxone, is administered during a painful event have yielded unclear results. Topically applied capsaicin can be used to induce tonic pain of moderate to severe intensity without tissue injury and is an ideal stimulus for studying acute pain modulation. We therefore conducted a placebo-controlled double-blind crossover study to investigate the effects of naloxone on capsaicin-induced pain (five men, four women, aged 29+/-5 years). Capsaicin (10%) was applied topically and subjects rated pain every 2min. The subjects were told that any drug given to them could increase, decrease, or not change their pain sensation. Pain plateaued after 20min. At 26min subjects received either naloxone or placebo in double-blind fashion. At 56min subjects received the alternative (placebo or naloxone). In a second session the order of presentation was reversed. The naloxone induced a significant increase in pain compared both to baseline (P<0.01) and placebo (P<0.01). The peak effect, reached at 12-20min after naloxone delivery, was 59% greater than placebo. This experiment suggests that acute pain is actively suppressed by endogenous opioid-receptor activation.
PMID: 12237198, UI: 22222876
Pain 2002 Sep;99(1-2):197
Department of Psychology, University of Bath, Claverton Down, BA2 7AY, Bath, UK
Facial expression of pain has rarely been researched in the context of facial expression of negative emotions with which it may occur. The main aim of the study was to investigate how pain expression resembled or differed from that of other negative emotions (fear, anger, sadness, surprise, disgust and embarrassment), using multidimensional scaling, a dimensional approach to understanding relationships among emotions. As possible misidentification of facial expressions by participants could distort those results, a judgement study as a categorical approach was conducted to examine the accuracy of identification of pain and negative emotion facial expressions. The sample was health care professionals. Identification of pain was good (unbiased hit rate 58.8%), but less than all other negative emotions. Confidence in ratings approximated accuracy of identification. Multidimensional scaling revealed two dimensions: the first distinguished embarrassment from all other emotion expressions; the second separated pain, sadness and anger from fear, surprise and disgust. Possible explanations for these findings were sought in patterns of facial action units, and in the messages conveyed by the expressions according to Fridlund's Behavioural Ecology View.
PMID: 12237197, UI: 22222875
Pain 2002 Sep;99(1-2):167
Department of Autonomic Physiology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan
We developed a mouse model of neuropathic cancer pain by inoculating Meth A sarcoma cells to the immediate proximity of the sciatic nerve in BALB/c mice. The tumor grows predictably with time and gradually compresses the nerve, thereby causing nerve injury. Time courses of thermal hyperalgesia and mechanical sensitivity to von Frey hairs were determined and signs of spontaneous pain were evaluated. We compared this model with the chronic constriction injury (CCI) model, which is a neuropathic pain model widely utilized in the rat. Furthermore, to characterize the difference in nerve injury between the two models, we performed histological examination of the nerve of the two models by light and electron microscopy.Progressive compression of the sciatic nerve by growth of a tumor mass resulted in a gradual development of thermal hyperalgesia and mechanical allodynia in the ipsilateral hind paw. Signs of spontaneous pain, such as lifting of the paw, were also observed. However, further growth of the tumor reversed the mechanical hypersensitivity and produced mechanical hyposensitivity, while thermal hyperalgesia and signs of spontaneous pain still persisted. Histologically, gradual compression by the tumor resulted in a progressive damage to both myelinated and unmyelinated fibers. However, the severity of damage to the myelinated fibers was considerably less compared to that of the CCI mice. In the CCI mice, severe damage to myelinated fibers, especially large fibers, was observed and unmyelinated fibers were damaged to a lesser degree.These results suggest that gradual compression of a nerve by a malignant tumor results in nerve damage with a profile considerably different from that of chronic constriction injury produced by loose ligation of the nerve. Our new tumor model may be useful in studies of neuropathic cancer pain due to nerve compression by malignant tumors.
PMID: 12237194, UI: 22222872
Pain 2002 Sep;99(1-2):157
Pain Management Unit, University of Bath, UK
A systematic review and subset meta-analysis of published randomised controlled trials of psychological therapies for children and adolescents with chronic pain is reported. A search of four computerised abstracting services recovered 123 papers from which 28 potential trials were identified. Eighteen met the criteria for inclusion in the review. The majority of these papers reported brief behavioural and cognitive behavioural interventions for children with headache and many were conducted in community (i.e. school) settings. Meta-analysis was applicable for 12 headache trials and one trial of recurrent abdominal pain using the Pain Index. The odds-ratio for a 50% reduction in pain was 9.62 and the number needed to treat was 2.32, indicating that the psychological treatments examined are effective in reducing the pain of headache. The quality of the 18 trials retrieved is narratively reviewed and suggestions for the development of trials in this field are made.
PMID: 12237193, UI: 22222871
Pain 2002 Sep;99(1-2):145
Institute of Physiology and Pathophysiology, Johannes Gutenberg University, Saarstrasse 21, D-55099, Mainz, Germany
Radiant heat is often used to study nociception in vivo. We now used infrared radiation generated by a diode laser stimulator (wavelength 980nm) to investigate transduction mechanisms for noxious heat stimuli in acutely dissociated dorsal root ganglion (DRG) neurons of rats in vitro. The laser stimulator offered the unique opportunity to test whether the same stimuli also elicit pain sensations in humans. A specific heat-induced current (I(heat)) was elicited in six of 13 small DRG neurons (diameter </=30&mgr;m) tested in the whole-cell configuration of the patch-clamp mode. Current responses in the seven heat-insensitive neurons were within the range explainable by the temperature dependence of the recording setup. I(heat) was characterized by: (1) non-linearity of its amplitude during a suprathreshold heat ramp as well as with stimuli of increasing intensity with an estimated threshold of 42+/-1 degrees C; (2) fast rise time and even faster decay time (t(1/2)=96.5+/-5.9 and 27.7+/-1.5ms, respectively); and (3) rate dependence of its induction. All three heat-sensitive neurons tested were also sensitive to capsaicin. The mean threshold for the induction of I(heat) was 2.8+/-0.3Jmm(-2). The threshold for the induction of action potentials by depolarizing current pulses was significantly reduced after laser stimulation, suggesting a sensitization at the transformation stage. No such change was seen in heat-insensitive neurons that underwent the same heat stimuli. The same diode laser elicited pain sensations and laser-evoked potentials in human subjects. No significant differences were seen between the pain thresholds in hairy and in glabrous skin, probably due to the deep penetration of this laser radiation. The mean pain threshold for stimuli >/=200ms in humans was 2.5+/-0.2Jmm(-2) (n=11), and did not differ from the thresholds for the induction of I(heat) in vitro. Our results indicate that I(heat) in primary sensory neurons can be activated by infrared laser pulses that are painful in humans.
PMID: 12237192
Pain 2002 Sep;99(1-2):133
Department of Anatomy and Neurobiology, Wakayama Medical University, 811-1 Kimiidera, 641-8509, Wakayama City, Japan
One of the major serotonin (5-HT) receptor subtypes expressed in the rat dorsal root ganglion (DRG) neurons is the 5-HT2A receptor. We have previously shown that 5-HT2A receptors in the peripheral sensory terminals are responsible for 5-HT-induced pain and hyperalgesia. In the present study, we characterized neurons expressing 5-HT2A receptors in the rat DRG neurons by means of in situ hybridization, immunohistochemistry, reverse transcription-polymerase chain reaction (RT-PCR) and behavioral tests. In situ hybridization on consecutive sections revealed that 5-HT2A receptor mRNA is colocalized with calcitonin-gene related peptide (CGRP) mRNA (100/104; 96.2%) but not with c-Ret mRNA (1/115; 0.9%). Signals for 5-HT2A receptor mRNA were found in 9.4+/-2.2% of normal DRG (L5) neurons, most of which were small to medium in size. Four days of complete Freund's adjuvant-induced inflammation of the hindpaw doubled the incidence of 5-HT2A receptor mRNA-expressing neurons to 19.3+/-2.8%. The level of 5-HT2A receptor mRNA in DRGs of normal and various pathological conditions was then determined by RT-PCR. The level was up-regulated by peripheral inflammation, but not by axotomy or chronic constriction of the peripheral nerve. Systemic administration of 5-HT2A receptor antagonist (Sarpogrelate HCI) produced analgesic effects on thermal hyperalgesia caused by peripheral inflammation, but failed to attenuate thermal hyperalgesia in chronic constriction injury model. These findings suggest that 5-HT2A receptors are mainly expressed in CGRP-synthesizing small DRG neurons and may be involved in the potentiation of inflammatory pain in the periphery.
PMID: 12237191, UI: 22222869
Pain 2002 Sep;99(1-2):101
Department of Rehabilitation Medicine, University of Washington School of Medicine, Box 356490, 98195-6490, Seattle, WA, USA
Reliable and valid measures of pain are essential for conducting clinical trials of pain treatments. Perhaps the most important aspect of a pain measure's validity is its sensitivity, or ability to detect changes in pain over time and due to treatment. Several factors may affect a measure's sensitivity, including the complexity of the rating task for the measure, the number of pain intensity levels assessed by the measure, the dimension of pain assessed (e.g. pain intensity vs. pain relief), and the number of individual ratings (e.g. single rating vs. composite score) used to create the measure. The purpose of this study was to compare the relative sensitivity of three measures of outcome and a composite made up of all three measures for detecting analgesic effects in two samples of persons participating in a randomized controlled trial. One hundred and twenty-three patients who had undergone knee surgery and 124 women who had undergone a laparotomy were given one of three medications in the day after their surgery: morphine, ketorolac, or placebo. Two measures of pain intensity (a visual analog scale (VAS) and a 4-point verbal rating scale (VRS)) were administered at baseline, and these measures plus a 5-point VRS of pain relief were administered at 16 additional time points up to 24h following surgery. As predicted, we found variability in the sensitivity of the outcome measures used in these studies, with the 4-point VRS showing less sensitivity than the VAS or relief ratings. However, contrary to our prediction, a composite measure of outcome made up of all three measures was not consistently superior to the individual measures for detecting treatment effects. Finally, we found that pain relief ratings were related to, but also distinct from, change in pain intensity as measured by changes in pain intensity ratings from baseline to each postmedication assessment point. These findings have important implications for the assessment of pain in clinical trials.
PMID: 12237188, UI: 22222866
Pain 2002 Sep;99(1-2):91
Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington School of Medicine, 98195-6560, Seattle, WA, USA
Patient, provider, and clinical investigator expectations concerning treatments are believed to play important roles in patient response. This study examined the association of patient and research nurse/physician pretreatment expectations of pain relief with actual pain relief, the accuracy of patient and research nurse guesses about patient medication assignment, and changes in research nurse and patient pain relief expectations over the course of a randomized double-blind trial of amitriptyline versus an active placebo for patients with chronic pain and spinal cord injuries (SCI). Patient expectations of pain relief with amitriptyline were associated significantly with actual pain decrease for patients in the amitriptyline, but not placebo, condition. Research nurse/physician expectations did not predict patient pain relief. Both patients and the research nurse were able to guess patient medication assignment at a rate significantly greater than chance. The research nurse's, but not the patients', expectations of pain relief with amitriptyline decreased significantly over the course of the study. These findings have implications for future randomized controlled trials. Fully double-blind conditions are very difficult to achieve, and it is informative to assess patient and research clinician expectations and guesses regarding medication assignment.
PMID: 12237187, UI: 22222865
Pain 2002 Sep;99(1-2):83
Department of Anesthesiology, University of Munich, Nussbaumstrasse 20, D-80336, Munich, Germany
To evaluate immediate effects of two different modes of acupuncture on motion-related pain and cervical spine mobility in chronic neck pain patients compared to a sham procedure. Thirty-six patients with chronic neck pain and limited cervical spine mobility participated in a prospective, randomized, double-blind, sham-controlled crossover trial. Every patient was treated once with needle acupuncture at distant points, dry needling (DN) of local myofascial trigger points and sham laser acupuncture (Sham). Outcome measures were motion-related pain intensity (visual analogue scale, 0-100mm) and range of motion (ROM). In addition, patients scored changes of general complaints using an 11-point verbal rating scale. Patients were assessed immediately before and after each treatment by an independent (blinded) investigator. Multivariate analysis was used to assess the effects of true acupuncture and needle site independently. For motion-related pain, use of acupuncture at non-local points reduced pain scores by about a third (11.2mm; 95% CI 5.7, 16.7; P=0.00006) compared to DN and sham. DN led to an estimated reduction in pain of 1.0mm (95% CI -4.5, 6.5; P=0.7). Use of DN slightly improved ROM by 1.7 degrees (95% CI 0.2, 3.2; P=0.032) with use of non-local points improving ROM by an additional 1.9 degrees (95% CI 0.3, 3.4; P=0.016). For patient assessment of change, non-local acupuncture was significantly superior both to Sham (1.7 points; 95% CI 1.0, 2.5; P=0.0001) and DN (1.5 points; 95% CI 0.4, 2.6; P=0.008) but there was no difference between DN and Sham (0.1 point; 95% CI -1.0, 1.2; P=0.8). Acupuncture is superior to Sham in improving motion-related pain and ROM following a single session of treatment in chronic neck pain patients. Acupuncture at distant points improves ROM more than DN; DN was ineffective for motion-related pain.
PMID: 12237186, UI: 22222864
Pain 2002 Sep;99(1-2):49
Department of Oral and Maxillofacial Surgery, University of Florida College of Dentistry, Box 100416, 32610-0416, Gainesville, FL, USA
We have previously shown that fibromyalgia (FMS) patients have enhanced temporal summation (windup) and prolonged decay of heat-induced second pain in comparison to control subjects, consistent with central sensitization. It has been hypothesized that sensory abnormalities of FMS patients are related to deficient pain modulatory mechanisms. Therefore, we conducted several analyses to further characterize enhanced windup in FMS patients and to determine whether it can be centrally modulated by placebo, naloxone, or fentanyl. Pre-drug baseline ratings of FMS and normal control (NC) groups were compared with determine whether FMS had higher pain sensitivity in response to several types of thermal tests used to predominantly activate A-delta heat, C heat, or cold nociceptors. Our results confirmed and extended our earlier study in showing that FMS patients had larger magnitudes of heat tap as well as cold tap-induced windup when compared with age- and sex-matched NC subjects. The groups differed less in their ratings of sensory tests that rely predominantly on A-delta-nociceptive afferent input. Heat and cold-induced windup were attenuated by saline placebo injections and by fentanyl (0.75 and 1.5 &mgr;g/kg). However, naloxone injection had the same magnitudes of effect on first or second pain as that produced by placebo injection. Hypoalgesic effects of saline placebo and fentanyl on windup were at least as large in FMS as compared to NC subjects and therefore do not support the hypothesis that pain modulatory mechanisms are deficient in FMS. To the extent that temporal summation of second pain (windup) contributes to processes underlying hyperalgesia and persistent pain states, these results indirectly suggest that these processes can be centrally modulated in FMS patients by endogenous and exogenous analgesic manipulations.
PMID: 12237183
Pain 2002 Sep;99(1-2):11
Abbott Laboratories, Neuroscience Research, Global Pharmaceutical Research and Development, 100 Abbott Park Road, 60064, Abbott Park, IL, USA
Extracellular adenosine triphosphate (ATP), acting at P2X ionotropic receptors, is implicated in numerous sensory processes. Exogenous ATP has been shown to be algogenic in both animals and humans. Research focus has been directed towards the P2X(3) receptor, as it is preferentially expressed on nociceptive C-fibers and its implication in pain processing is supported by an altered nociceptive phenotype in P2X(3) knock-out mice. In order to further characterize the role of P2X(3) receptor activation in nociception, we evaluated the effects of continuous intrathecal administration of P2X(3) antisense oligonucleotides for 7 days in the rat. P2X(3) receptor antisense oligonucleotide treatment significantly decreased nociceptive behaviors observed after injection of complete Freund's adjuvant (CFA), formalin or alphabeta-methylene ATP into the rat's hind paw. The anti-hyperalgesic effects of the antisense treatment in the CFA model of inflammatory pain were dose related. Similar effects were observed with two distinct P2X(3) antisense oligonucleotides. These behavioral effects were significantly correlated with a decrease in P2X(3) receptor protein expression in the dorsal root ganglia (DRG). In contrast, a decrease in P2X(3) receptor protein expression in the DRG did not affect nociceptive behavior in the carrageenan model of acute thermal hyperalgesia. P2X(3) receptor antisense oligonucleotide treatment also significantly reduced mechanical allodynia observed after spinal nerve ligation. Overall, the present data demonstrate that activation of P2X(3) receptors contribute to the expression of chronic inflammatory and neuropathic pain states and that relief form these forms of chronic pain might be achieved by selective blockade of P2X(3 )receptor expression or activation.
PMID: 12237180, UI: 22222858
Pain 2002 Sep;99(1-2):5
Division of Medical Oncology and Transplantation, Duke Oncology Network, Duke University Medical Center, DUMC 2989, 27710, Durham, NC, USA
PMID: 12237179, UI: 22222857
Pain 2002 Sep;99(1-2):1
Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD, USA
PMID: 12237178, UI: 22222856
Pediatrics 2002 Aug;110(2 Pt 1):389-93
Poissy Neonatal Intensive Care Unit, Poissy-Saint Germain Hospital, Poissy, France. carbajal@club-internet.fr
OBJECTIVE: Very preterm newborns undergo multiple invasive procedures. Nonpharmacological interventions are valuable alternatives for pain relief during minor procedures in neonates. Oral sucrose analgesia has been widely studied in term and preterm neonates during painful procedures. The analgesic effect of oral glucose in very preterm infants has not yet been reported. The objectives of this study were to assess the analgesic effect of orally administered glucose and to determine the synergetic analgesic effect of glucose and pacifiers during subcutaneous injections in very preterm neonates using a validated behavioral acute pain rating scale. DESIGN: Two crossover trials. SETTING: One neonatal intensive care unit in a community-based general hospital. METHODS: A prospective study was conducted in 40 very preterm neonates. Each infant received 2 treatments in a crossover manner during 2 consecutive subcutaneous injections of erythropoietin. The first trial (25 infants) was intended to compare oral 30% glucose (0.3 mL) versus placebo (0.3 mL of sterile water); the second trial (15 infants) compared oral 30% glucose (0.3 mL) versus oral 30% glucose (0.3 mL) followed by sucking a pacifier. The primary outcome measure was the evaluation of pain induced by a subcutaneous injection of erythropoietin, using Douleur Aigue Nouveau-ne scale (0 no pain, 10 maximum pain). RESULTS: Twenty-four infants completed the study in the first trial and 15 in the second one. Mean (95% confidence interval [CI]) gestational age, birth weight, postnatal age, and weight at inclusion for neonates in the first and second trial were, respectively, 28.1 (95% CI: 27.3-29.0) and 29.1 (95% CI: 27.8-30.4) weeks, 1036 (95% CI: 944-1128) and 995 (95% CI: 848-1141) g, 26.4 (95% CI: 22.4-30.3) and 26 (95% CI: 22.0-29.9) days, and 1234 (95% CI: 1120-1348) and 1209 (95% CI: 1059-1359) g. In the first trial, median (interquartile) pain scores for placebo and 30% glucose, respectively, were 7 (2.5-9.75) and 4.5 (1-6). In the second trial, median (interquartile) pain scores for 30% glucose and for 30% glucose plus pacifier, respectively, were 4 (2-7) and 4 (1-6). CONCLUSIONS: A small dose of 0.3 mL of 30% oral glucose has an analgesic effect in very preterm neonates during subcutaneous injections. This effect is clinically evident because it can be detected by a behavioral pain rating scale. The synergetic analgesic effect of glucose plus sucking a pacifier is less obvious in very preterm neonates as opposed to what other studies have showed in full-term infants.
PMID: 12165596, UI: 22155772
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