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Am J Emerg Med 2003 Jan;21(1):68-70
Emergency Department, Carmel Medical Center, Haifa, Israel.
The emergency physician's (EP) fast and correct diagnosis of patients with chest pain is crucial for preventing inappropriate discharge and dire consequences. To determine which factors affect admission decisions in the ED, we studied epidemiologic characteristics of both discharged and admitted patients, and the percentage of discharged patients who returned to the ED with acute myocardial infarction. The study included 185 patients seen in the ED because of chest pain between July 1 and 31, 1997 (every third day not included). Ninety patients were admitted: 36.7% were admitted for "observation of chest pain" and 63.3% met the criteria for active coronary heart disease. A form was used to collect personal data, medical history, risk factors, clinical examination, electrocardiogram interpretation, laboratory data, and admittance decision. EPs' diagnosis of cardiac chest pain demonstrated a sensitivity of 93.4%, a specificity of 73.4%, and a positive predictive value of 63.3%. Sensitivity for diagnosing acute myocardial infarct was 100%, with no erroneous discharges. The EP's ability to integrate the medical history information, including risk factors and pain characteristics, had a marked influence on the admittance decision. Efforts to reduce missed diagnoses are warranted. Copyright 2003, Elsevier Science (USA). All rights reserved.)
PMID: 12563585, UI: 22449936
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Am J Emerg Med 2003 Jan;21(1):43-4
Department of Emergency Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, NY 10467, USA. souffle@banet.net
The study was to determine the effect of preexisting pain on the perception of a painful stimulus. We conducted a cross-section study at an urban ED using convenience sampling. Adult patients who had a 20-g IV catheter placed as part of their ED care were eligible for the study. Patients were excluded for the following reasons: more than one IV attempt, altered mental status, visual impairment, intoxication, or a physical abnormality at the IV site. Patients were asked to indicate on a 10-cm visual analog scale (VAS) the amount of pain they had at baseline immediately before IV placement. They were then asked to indicate on a separate VAS the amount of pain caused by the IV placement. Correlation between baseline pain and pain of the IV was assessed using Pearson's rho. One hundred patients were enrolled in the study. The pain of IV placement did not differ significantly by gender, race, who placed the IV, or the location of the IV. The correlation between baseline pain and pain of the IV placement was poor (rho =.14, confidence interval:-.06-.33). The response to a standardized painful stimulus among ED patients does not correlate highly with the severity of preexisting pain. Copyright 2003, Elsevier Science (USA). All rights reserved.)
PMID: 12563579, UI: 22449930
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BMJ 2003 Feb 8;326(7384):301
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PMID: 12574030, UI: 22461141
Br J Anaesth 2003 Jan;90(1):53-7
Department of Anaesthesiology and Intensive Care, Hospital Bichat, 46 Rue Henri Huchard, F-75018 Paris, France. hawakeita@club-internet.fr
BACKGROUND: The goal of this study was to evaluate the effectiveness on postoperative pain, and cognitive impact, of patient-controlled analgesia (PCA) compared with subcutaneous (s.c.) injections of morphine in elderly patients undergoing total hip replacement (THR). METHODS: Forty patients older than 70 yr were randomly assigned to two different postoperative analgesic techniques for 48 h: i.v. PCA morphine (dose, 1 mg; lockout interval, 8 min; PCA group) or regular s.c. morphine injections (SC group). Postoperative pain was assessed at rest and when moving, using a visual analogue scale (VAS) every 4 h. A Mini Mental Status (MMS) examination was used to assess cognitive functions before surgery, at 2 h, 24 h and 48 h after surgery, and at hospital discharge. Side-effects were also recorded systematically during the first 48 h after surgery. RESULTS: The PCA group showed significantly lower pain scores than the SC group both at rest and during mobilization. However, the clinical significance of pain scores was weak. There was no intergroup difference in postoperative MMS scores. The incidence of side-effects was similar in both groups. CONCLUSIONS: We conclude that in healthy elderly subjects undergoing THR, the flexibility of the analgesic regimen is more important than the route of administration with regard to efficacy, adverse effects and recovery of cognitive function.
PMID: 12488379, UI: 22375919
Cancer 2003 Feb 15;97(4):1137
[Record supplied by publisher]
The original article to which this Erratum refers was published in Cancer (2002)95(10):2230-2236
PMID: 12569618
Clin J Pain 2002 Nov-Dec;18(6 Suppl):S177-81
Cohn Pain Management Center, North Shore University Hospital, New York University School of Medicine, Bethpage, New York 11714, USA. pargoff@optonline.net
Understanding the pathophysiology of a pain syndrome is helpful in selecting appropriate treatment strategies. Nociceptive pain is related to damage to tissues due to thermal, chemical, mechanical, or other types of irritants. Neuropathic pain results from injury to the peripheral or central nervous system. Common examples of neuropathic pain include postherpetic neuralgia, diabetic neuropathy, complex regional pain syndrome, and pain associated with spinal cord injuries. Nociceptive pain may have similar clinical characteristics to neuropathic pain. It is also possible for acute nociceptive pain to become neuropathic in nature, as with myofascial pain syndrome. A clear benefit of botulinum toxin therapy for treatment of neuropathic pain disorders is that it often relieves pain symptoms. Although the precise mechanism of pain relief is not completely understood, the injection of botulinum toxin may reduce various substances that sensitize nociceptors. As a result, botulinum toxin types A and B are now being actively studied in nociceptive and neuropathic pain disorders to better define their roles as analgesics.
PMID: 12569966, UI: 22457386
Clin J Pain 2002 Nov-Dec;18(6 Suppl):S155-62
Department of Neurology, Uniformed Services University, Bethesda, Maryland 20814, USA.
Chronic low back pain is the second most common illness reported by patients in the United States and accounts for substantial morbidity and health-care resource utilization. Many back and spine stressors can contribute to tissue injury, resulting in acute or chronic pain. In response to injury, biochemical processes that cause inflammation and nerve sensitization increase pain levels and contribute to a cycle of reactivity that further heightens patients' sensitivity to pain stimuli. Treatment of back pain depends on its severity, duration, and underlying cause. Traditional therapeutic options include exercise, oral anti-inflammatory or analgesic medication, antidepressants, physical therapy and, in severe cases, surgery. Unfortunately, dissatisfaction with treatment of back pain is common. Oral medications may not completely alleviate symptoms, and opioid analgesics must be used with caution because of their addictive properties. Surgery does not always produce relief and, in some cases, may even exacerbate the problem. Botulinum toxin, which has already been shown to alleviate pain associated with cervical dystonia and other conditions characterized by muscle spasticity, is now being studied for the treatment of back pain. Preliminary evaluations have shown that this treatment is safe and has the advantage of providing local relief directly to the site of injury or pain, without causing systemic side effects. Initial data from small trials also suggest that botulinum toxin is effective, alleviating back pain in selected patients. On the basis of these promising results, additional study in larger trials is warranted.
PMID: 12569963, UI: 22457383
Clin J Pain 2002 Nov-Dec;18(6 Suppl):S147-54
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
Botulinum toxin is approved for the treatment of muscle overactivity associated with several disorders, such as dystonias. However, control of muscle spasm often results in pain relief as well. Effective relief of pain associated with myofascial pain syndrome provides a model for the use of botulinum toxin to relieve pain associated with other types of soft-tissue syndromes, such as fibromyalgia. Although the mechanisms that trigger the pain in these syndromes vary, recent data suggest that a central neuroplastic mechanism may contribute to many complex pain syndromes. Botulinum toxin therapy may be particularly useful in soft-tissue syndromes that are refractory to traditional treatment with physical therapy, electrical muscle stimulation, and other approaches. Although not used as first-line therapy for pain relief, botulinum toxin may decrease pain long enough for patients to resume more conservative therapy. A primary benefit of treatment with botulinum toxin is its long duration of action. Several studies have demonstrated the efficacy of botulinum toxin types A and B in treating several neuropathic pain disorders. Proper patient selection, injection technique, and dosing are critical to obtaining the best outcomes in managing pain with botulinum toxin. Additional study is needed to better characterize its use for the treatment of pain.
PMID: 12569962, UI: 22457382
Clin J Pain 2002 Nov-Dec;18(6 Suppl):S142-6
Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. mlew@surgery.usc.edu
Botulinum toxin has dramatically improved the treatment of a variety of neurologic disorders. Two botulinum toxin preparations are commercially available in the United States: type A (Botox) and type B (Myobloc). Current indications approved by the United States Food and Drug Administration include cervical dystonia, strabismus, blepharospasm, hemifacial spasm, and glabellar wrinkles for Botox, and cervical dystonia for Myobloc. Botulinum toxin inhibits release of acetylcholine from the neuromuscular junction, resulting in a localized paralysis when minute doses are injected. This mechanism enables botulinum toxin to alleviate symptoms of focal dystonias (which are characterized by excessive muscle contraction), and it may also, along with other theoretical mechanisms, be responsible for pain relief. Studies conducted in patients with cervical dystonia have shown that botulinum toxin effectively reduces pain associated with this disorder, suggesting that this agent may be effective in alleviating other painful syndromes.
PMID: 12569961, UI: 22457381
Clin J Pain 2002 Nov-Dec;18(6 Suppl):S125-32
Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York, 10461, USA. arezzo@aecom.yu.edu
The therapeutic effects of botulinum toxin are principally, if not exclusively, derived from an alteration in the release of acetylcholine (ACh) at pre-synaptic neurons. The rationale for how these effects could be beneficial in conditions characterized by excessive muscle contraction is clear, but the hypotheses regarding botulinum toxin-induced effects on pain are highly speculative. We explore five possible mechanisms by which botulinum toxin could directly or indirectly alter pain, including: 1) changes in the sensitivity and response patterns of group III and IV muscle nociceptors, 2) diminished activity in the gamma-motor neurons and consequent changes in muscle spindle afferents, 3) alterations in cholinergic control of vascular and autonomic functions, including neurogenic inflammation, 4) induced neuroplastic changes in the processing of afferent somatosensory activity at multiple levels of the neuroaxis, and 5) direct non-cholinergic effects on pain afferents.
PMID: 12569959, UI: 22457379
Eur J Pharmacol 2002 Jul 12;448(1):39-44
Department of Pathophysiology and Therapeutics, Faculty of Pharmaceutical Sciences, Hoshi University, 4-41, Ebara 2-chome, Shinsgawa, Tokyo 142-8501, Japan.
The role of N-methyl-D-aspartate (NMDA) receptors in supraspinal and spinal sites on the reduction of supraspinal micro-opioid receptor-induced antinociception in diabetic mice was examined. The antinociceptive effect of i.c.v. [D-Ala(2), N-MePhe(4), Gly-ol(5)]enkephalin (DAMGO, 20 pmol) in diabetic mice was significantly less than that in non-diabetic mice. The antinociceptive effect of i.c.v. DAMGO (20 pmol) was significantly and dose dependently reduced by i.c.v. (+)-5-methyl-10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5,10-imine maleate (MK-801) in both non-diabetic (0.03-0.3 nmol) and diabetic mice (0.1-3.0 nmol). While the antinociceptive effect of i.c.v. DAMGO (10 pmol) was significantly enhanced by i.c.v NMDA (0.01-0.1 nmol) in non-diabetic mice, the same doses of i.c.v. NMDA had no significant effect on the antinociceptive effect of i.c.v. DAMGO (20 pmol) in diabetic mice. In non-diabetic mice, the antinociceptive effect of DAMGO (20 pmol, i.c.v.) was dose dependently reduced by intrathecal administration of MK-801 (0.1-1.0 nmol). The antinociceptive effect of DAMGO (20 pmol, i.c.v.) was dose-dependently enhanced by MK-801 (0.1-1.0 nmol, i.t.) in diabetic mice. Furthermore, NMDA (0.1 nmol, i.t.) significantly enhanced the antinociceptive effect of DAMGO (10 pmol, i.c.v.) in non-diabetic mice. However, in non-diabetic mice, the antinociceptive effect of DAMGO (40 pmol, i.c.v.) was dose dependently reduced by NMDA (0.03-0.3 nmol, i.t.). These results suggest that NMDA receptor function in supraspinal and spinal sites appear to be modulated differently by the diabetic state, and this functional modulation may play an important role in the reduction of supraspinal micro-opioid receptor-induced antinociception in diabetic animals. Copyright 2002 Elsevier Science B.V.
PMID: 12126969, UI: 22123259
Eur J Pharmacol 2002 Jul 12;448(1):31-8
Section of Behavioural Pathophysiology, Labor di Fisiopatologia O.S., Istituto Superiore di Sanita, Viale Regina Elena, 299 I-00161, Rome, Italy.
In spite of the increasing evidence concerning its neurotoxicity, young human individuals are often involved in the recreational use of amphetamine-type stimulants such as 3,4-methylenedioxymethamphetamine (MDMA or "ecstasy"). A study aimed to investigate short- and long-term consequences of a repeated and intermittent MDMA administration (0, 5 or 10 mg/kg i.p., 3 days treatment history) was conducted in mice. Mice were injected at different phases in development, namely at early (28 days old), middle (38 days old) or late (52 days old) adolescence. When assessed for nociceptive response, a dose-dependent analgesia was found in middle and late adolescent mice. Carryover consequences of previous MDMA treatment were then investigated at adulthood (80 days old). In a social interaction test, levels of environment exploration and social behaviour resulted markedly increased in drug-free state as a function of drug exposure during development, whereas others behaviours were reduced. MDMA challenge (5-mg/kg dose) produced the expected hyperactivity, as well as a marked increment of hypothalamic serotonin (5-hydroxyhyptamine, 5-HT) levels. Mice treated chronically with MDMA during middle and late adolescence were associated with important reductions of the indoleamine. As a whole, these results indicate a differential long-term vulnerability to behavioural and neurotoxicant effects of MDMA as a function of the developmental stage of exposure. Copyright 2002 Elsevier Science B.V.
PMID: 12126968, UI: 22123258
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J Pain Symptom Manage 2003 Jan;25(1):74-91
Multidisciplinary Pain Center, Herlev University Hospital, Herlev, Denmark.
The two metabolites of morphine, morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G), have been studied intensively in animals and humans during the past 30 years in order to elucidate their precise action and possible contribution to the desired effects and side effects seen after morphine administration. M3G and M6G are formed by morphine glucuronidation, mainly in the liver, and are excreted by the kidneys. The metabolites are found in the cerebrospinal fluid after single as well as multiple doses of morphine. M6G binds to opioid receptors, and animal studies have demonstrated that M6G may be a more potent analgesic than morphine. Results from human studies regarding the analgesic effect of M6G are not unanimous. The potency ratio between systemic M6G and morphine in humans has not been settled, but is probably lower than previously assumed. Hitherto, only a few studies have found evidence for a contributory effect of M6G to the overall effects observed after morphine administration. Several studies have demonstrated that administration of M6G is accompanied by fewer and a milder degree of opioid-like side effects than observed after morphine administration, but most of the studies have used lower doses of M6G than of morphine. M3G displays very low affinity for opioid receptors and has no analgesic activity. Animal studies have shown that M3G may antagonize the analgesic effect of morphine and M6G, but no human studies have demonstrated this. M3G has also been connected to certain neurotoxic symptoms, such as hyperalgesia, allodynia and myoclonus, which have been observed after administration of M3G or high doses of morphine in animals. The symptoms have been reported sporadically in humans treated primarily with high doses of morphine, but the role of M3G in eliciting the symptoms is not fully elucidated.
PMID: 12565191, UI: 22454387
J Pain Symptom Manage 2003 Jan;25(1):48-52
Pain and Palliative Care Service, Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
The purpose of this study was to assess the reliability and validity of facial expressions as pain indicators in patients with severe dementia. Based on interviews with patients who could report pain, we defined characteristics of decubitus ulcers associated with reports of pain during dressing changes. We then evaluated 9 patients who had ulcers with these characteristics but were unable to communicate verbally because of severe dementia. We videotaped their facial expressions before and during their decubitus ulcer dressing change. We showed the videotape segments, in random order, to 8 medical students and 10 nurses. The 18 viewers were asked to infer the presence or absence of pain based on their observations of the patients' facial expressions and vocalizations. The dressing change of decubitus ulcers extending beyond the subcutaneous tissue, covering an area of at least 9 cm(2), and with a moist surface, was always reported as painful by study patients able to report (95% confidence interval of 69-100%). The intraclass correlation coefficient for the answers of the 18 viewers evaluating each videotape segment for the presence of pain was 0.64. Sensitivity, specificity, and positive and negative predictive values of viewers' ratings of facial expressions and vocalizations as a measure of the presence of pain were: 0.70, 0.83, 0.90, and 0.81. The intraclass correlation coefficient for the answers rating pain intensity was only 0.10, indicating only slight agreement beyond chance. Assuming dressing changes of ulcers reported as painful by communicative patients are also painful in non-verbal severely demented patients, clinician observations of facial expressions and vocalizations are accurate means for assessing the presence of pain, but not its intensity, in patients unable to communicate verbally because of advanced dementia.
PMID: 12565188, UI: 22454384
J Pain Symptom Manage 2003 Jan;25(1):29-37
School of Nursing, Taipei Medical University, Taipai, Taiwan.
The purposes of this study were: 1) to compare performance status, mood states, and level of hope between patients with cancer pain and patients without cancer pain; and 2) to determine the relationships of pain intensity and pain interference with daily life to performance status, mood states, and level of hope. A total of 233 Taiwanese cancer patients with pain and 251 without pain participated. The self report instruments consisted of the Chinese version of the Profile of Mood States (POMS) short form, the Chinese version of the Herth Hope Index, the Brief Pain Inventory-Chinese version (BPI-C), the Chinese version of the Karnorfsy Performance Scale (KPS), and a demographic questionnaire. The major findings of this study were that cancer patients with pain reported significantly lower levels of performance status and higher levels of total mood disturbance than did cancer patients who did not experience pain after controlling for sex, disease stage, and recruitment site. In addition, patients with cancer pain experienced significantly more anger, fatigue, depression, confusion, and lethargy than did patients without pain after controlling for sex, disease stage, and recruitment site. Among patients with pain, pain intensity was significantly correlated with performance status and mood state, but not with level of hope. Pain interference with daily life was significantly correlated both with performance status, mood state, and level of hope. Pain intensity and pain interference were significantly correlated with each mood state as well as with total mood disturbance. This study has demonstrated the effect of cancer pain on patients' physical, psychological, and spiritual life and has supported the multidimensional notion of the cancer pain experience in Taiwanese patients.
PMID: 12565186, UI: 22454382
J Pain Symptom Manage 2003 Jan;25(1):9-18
West Cancer Clinic, Memphis, TN, USA.
The purpose of this study was to describe direct and indirect costs associated with pain in cancer patients and to examine potential predictors of these costs. The study surveyed cancer outpatients about direct costs resulting from pain-related hospitalizations, emergency department visits, physician office visits, and use of analgesic medications and indirect costs related to money spent on pain-related transportation, complementary methods to improve pain management, educational materials, over-the counter medication, domestic support, and childcare. Furthermore, the study examined age, marital status, race, income level, pain severity, pain interference, and presence of breakthrough pain as predictors of direct and indirect costs. Three hundred and seventy-three cancer outpatients were sampled. One hundred and forty-four cancer patients (39%) reported experiencing cancer-related pain and completed the study questionnaires. Seventy-six percent (76%) of the patients had experienced at least one pain-related cost, resulting in an average monthly direct cost of US$ 891/month per patient. Sixty-nine percent (69%) of patients had experienced some type of direct medical cost due to pain, resulting in an average total direct pain-related cost of US$ 825/month per patient. Fifty-seven percent (57%) of patients reported incurring at least one indirect pain-related expense for an average indirect cost of US$ 61/month per patient. Higher pain intensity, greater pain interference, and presence of breakthrough pain predicted higher direct and indirect medical expenses. Younger age and lower income level also predicted higher direct medical expenses.
PMID: 12565184, UI: 22454380
J Pain Symptom Manage 2003 Jan;25(1):6-7
PMID: 12565182, UI: 22454378
N Engl J Med 2003 Feb 6;348(6):510-7
Departments of Emergency Medicine, University of Michigan, Ann Arbor, and Hurley Medical Center, Flint, Mich, USA.
BACKGROUND: Retrospective studies of patients with cocaine-associated chest pain suggest that a strategy of discharging patients from the emergency department after a 12-hour observation period if they do not have evidence of ischemia should be associated with a very low rate of complications. METHODS: We prospectively evaluated the safety of a 9-to-12-hour observation period in patients with cocaine-associated chest pain who were at low-to-intermediate risk of cardiovascular events. Consecutive patients who reported or tested positive for cocaine use and who received protocol-driven care in a chest-pain observation unit were included. Patients who had normal levels of troponin I, without new ischemic changes on electrocardiography, and who had no cardiovascular complications (dysrhythmias, acute myocardial infarction, or recurrent symptoms) during the 9-to-12-hour observation period were discharged from the unit. The main outcome was death from cardiovascular causes at 30 days. RESULTS: Three hundred forty-four patients with cocaine-associated chest pain were evaluated. Forty-two of these patients (12 percent) were directly admitted to the hospital. The study cohort comprised the remaining 302 patients. During the 30-day follow-up period, none of the patients died of a cardiovascular event (0 percent; 95 percent confidence interval, 0 to 0.99), and only 4 of the 256 patients for whom detailed follow-up data were available had a nonfatal myocardial infarction (1.6 percent; 95 percent confidence interval, 0.1 to 3.1). All four nonfatal myocardial infarctions occurred in patients who continued to use cocaine. CONCLUSIONS: Patients with cocaine-associated chest pain who do not have evidence of ischemia or cardiovascular complications over a 9-to-12-hour period in a chest-pain observation unit have a very low risk of death or myocardial infarction during the 30 days after discharge. Copyright 2003 Massachusetts Medical Society
PMID: 12571258, UI: 22459253
Reg Anesth Pain Med 2003 Jan-Feb;28(1):24-8
Department of Anaesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. sisur@mahidol.ac.th
BACKGROUND AND OBJECTIVES: To evaluate the effect of a 20- or 60-second instillation period using 0.5% bupivacaine with epinephrine for pain relief after pediatric inguinal herniorrhaphy and hydrocelectomy. METHODS: In a randomized, double-blind study, 103 children (aged 1 to 12 years, American Society of Anesthesiologists [ASA] physical status I or II) were allocated into 4 groups after induction of anesthesia. Group 1: normal saline 0.25 mL/kg instilled, which remained in the wound for 20 or 60 seconds before wound closure. Group 2: 0.25 mL/kg 0.5% bupivacaine with epinephrine 5 microg/mL instilled, which remained in the wound for 20 seconds. Group 3: the same quantity and dose of drug 2 instilled as group, but remained in the wound for 60 seconds. Group 4: an ilioinguinal and iliohypogastric block performed before operation using 0.5 mL/kg 0.25% bupivacaine with epinephrine. The Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Aldrete-Kroulik recovery scores were used to monitor postoperative pain and recovery status. Analgesic was given when the CHEOPS score was >/= 7 despite other supportive therapy. RESULTS: The number of patients requiring analgesics within 2 hours in group 1 (73.1%) was more than groups 2, 3, and 4 (23.1%, 20.8%, and 16%, respectively, P <.001). The median time to first analgesic in group 1 (50 minutes) was also less than groups 2, 3, and 4 (420, 525, and 425 minutes, respectively, P <.0001). CONCLUSION: 0.5% Bupivacaine with epinephrine for as short an instillation period as 20 or 60 seconds can provide a good analgesic alternative after herniorrhaphy and hydrocelectomy in pediatric patients. All studied blocks had comparable duration of action.
PMID: 12567339, UI: 22454799
Spine 2003 Feb 1;28(3):292-7
*Center for Alternative Medicine Research and Education, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Department of Medicine, Boston.
STUDY DESIGN We conducted a nationally representative random household telephone survey to assess therapies used to treat back or neck pain.OBJECTIVES The main outcome was complementary therapies used in the last year to treat back or neck pain.SUMMARY OF BACKGROUND DATA Back pain and neck pain are common medical conditions that cause substantial morbidity. Despite the presumed importance of complementary therapies for these conditions, studies of care for back and neck pain have not gathered information about the use of complementary therapies.METHODS Our nationally representative survey sampled 2055 adults. The survey gathered detailed information about medical conditions, conventional and complementary therapies used to treat those conditions, and the perceived helpfulness of those therapies.RESULTS We found that of those reporting back or neck pain in the last 12 months, 37% had seen a conventional provider and 54% had used complementary therapies to treat their condition. Chiropractic, massage, and relaxation techniques were the most commonly used complementary treatments for back or neck pain (20%, 14%, and 12%, respectively, of those with back or neck pain). Chiropractic, massage, and relaxation techniques were rated as "very helpful" for back or neck pain among users (61%, 65%, and 43%, respectively), whereas conventional providers were rated as "very helpful" by 27% of users. We estimate that nearly one-third of all complementary provider visits in 1997 (203 million of 629 million) were made specifically for the treatment of back or neck pain.CONCLUSIONS Chiropractic, massage, relaxation techniques, and other complementary methods all play an important role in the care of patients with back or neck pain. Treatment for back and neck pain was responsible for a large proportion of all complementary provider visits made in 1997. The frequent use and perceived helpfulness of commonly used complementary methods for these conditions warrant further investigation.
PMID: 12567035, UI: 22454881