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Anesth Analg 2003 Feb;96(2):545-7, table of contents
Department of Anesthesiology, Pain & Perioperative Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, Massachusetts 02115, USA.
PMID: 12538210, UI: 22425373
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Anesth Analg 2003 Feb;96(2):463-8, table of contents
Department of Anesthesiology, University of South Florida, College of Medicine, Tampa, USA. taldrete@arachnoiditis.com
Since there have been side effects reported with the administration of corticosteroids epidurally, their application has been limited. Because some nonsteroidal antiinflammatory drugs have central and spinal antinociceptive actions, we have compared the effects of indomethacin (INM) given by the epidural route to methylprednisolone (MTP). This was a prospective, comparative study in an ambulatory pain care center. Two hundred six patients with recurrent low back pain (Visual Analog Scale >7) and radiculopathy after they had had 2 or more lumbar laminectomies with the diagnosis of "postlaminectomy syndrome" were randomly assigned to 1 of 3 groups. Group I (64 patients) was given 2 epidural injections of lyophilized INM 1 mg. Group II (60 patients) received 2 injections of 2 mg of INM at the same intervals. Group III (82 patients) was treated by 2 epidural injections of MTP 80 mg. In every case, the medication was diluted in 3 mL of 0.5% bupivacaine. Reductions of pain were assessed by changes in the Visual Analog Scale; physical activities, attitude, and medication intake were graded by the Pain Progress Score recorded before each treatment and 2 wk after the last. After each injection, all patients had pain relief to Visual Analog Scale <3. Increased analgesia (P < 0.05) was noted when a double dose of INM was used (Group II) or when 80 mg of MTP was given. The total average scores of the Pain Progress Score showed significant differences at the second injection in Groups II and III only. Physical activity, emotional attitudes, and medication intake were also improved but the changes were not statistically significant. In conclusion, in this group of patients, INM produced adequate analgesia in Groups I and II, with evidence suggesting that 2 mg of INM may produce a similar degree of pain relief as 80 mg of MTP after the second injection. Other nonsteroidal antiinflammatory drugs may be explored in the future for the same purpose.
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PMID: 12538197, UI: 22425360
Anesth Analg 2003 Feb;96(2):414-7, table of contents
Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France. x-capdevila@chu-montpellier.fr
PMID: 12538188, UI: 22425351
Anesth Analg 2003 Feb;96(2):396-9, table of contents
Department of Anaesthesia and Intensive Care, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong. reginachoi@hotmail.com
We conducted a prospective, randomized, double-blinded trial comparing preoperative application of EMLA cream and sodium chloride solution dorsal penile block (n = 31) with placebo cream and bupivacaine dorsal penile nerve block (n = 32) for postcircumcision analgesia. Pain was assessed using modified Children's Hospital of Eastern Ontario Pain Scale and the duration of block by the time to requirement of first dose of postoperative analgesic. There was no difference in Children's Hospital of Eastern Ontario Pain Scale between the two groups, but bupivacaine dorsal penile nerve block resulted in longer analgesia (P = 0.003). There were no local or systemic complications related to either technique, and there was a very small incidence of vomiting. We conclude that preoperative application of EMLA cream is an effective and simple method to produce postcircumcision analgesia with a very small incidence of adverse effects.
PMID: 12538184, UI: 22425347
Ann Intern Med 2003 Feb 4;138(3):208-11
University of Rochester Medical Center, Box 601, 601 Elmwood Avenue, Rochester, NY 14642.
Position statements opposing legalization of physician-assisted suicide by organizations such as the American College of Physicians-American Society of Internal Medicine rightly emphasize that palliative care should be the standard of care for the dying, and that the inadequacies that exist in its delivery should be remedied. But such position statements generally understate the limitations of palliative care to alleviate some end-of-life suffering, and they do not provide adequate guidance about how physicians should approach patients with intractable suffering who are prepared to die. In this manuscript, we briefly present data about severe suffering before death for terminally ill patients, including those enrolled in hospice programs. We also review some of what is known about requests and responses for physician-assisted suicide in Oregon and in the rest of the United States. Preliminary data from Oregon suggest that legally sanctioned access to physician-assisted suicide is used by a very small number of patients and seems to be associated with improved delivery of hospice and palliative care. Physicians of good will, deep religious convictions, and considerable palliative care experience exist on both sides of the debate about legalization of physician-assisted suicide. In an effort to respect this diversity, and to encourage our profession to continue to struggle with the genuine dilemmas faced by some patients toward the end of their lives and by their families, we argue in favor of medical organizations' taking a position of studied neutrality on this contentious issue.
PMID: 12558360, UI: 22446194
Clin Orthop 2003 Jan;(406):317-27
Department of Orthopaedic Surgery, Hospital of the University of Marmara, Istanbul, Turkey.
[Medline record in process]
PMID: 12579033, UI: 22466707
Clin Orthop 2003 Jan;(406):19-28
With the advent of magnetic resonance imaging and, subsequently, magnetic resonance arthrography, the imaging algorithm for hip pain has evolved considerably. Magnetic resonance imaging has supplanted bone scintigraphy as the first line imaging test after conventional radiographs in the setting of suspected occult fracture, transient marrow edema, and osteonecrosis. Computed tomography scanning and magnetic resonance imaging are invaluable for the evaluation of monarticular arthropathies such as pigmented villonodular synovitis and synovial osteochondromatosis. By combining conventional magnetic resonance imaging with capsular distention afforded by arthrography, magnetic resonance arthrography has become the imaging examination of choice for disorders of the acetabular labrum and for the evaluation of articular cartilage at the hip.
PMID: 12578996, UI: 22466670
Clin Orthop 2003 Jan;(406):11-8
Hip pain is a common problem seen by orthopaedic surgeons. The current authors provide an approach to the patient with hip pain, including important information to be gained from the history and physical examination and relevant radiographic studies and laboratory tests. A differential diagnosis for patients presenting with the complaint of hip pain and indications for hip arthroscopy are provided.
PMID: 12578995, UI: 22466669
JAMA 2003 Feb 5;289(5):617
Stanford Medical School, Stanford, Calif, USA.
PMID: 12578502, UI: 22467074
Lancet 2003 Feb 8;361(9356):531
Department of Neurology, District Hospital Kufstein, A-6330, Kufstein, Austria
PMID: 12583974, UI: 22472381
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N Engl J Med 2003 Feb 13;348(7):630-7
Dermatology Clinical Investigations Unit, Department of Dermatology, Massachusetts General Hospital, Boston, USA.
PMID: 12584372, UI: 22472409
Neurology 2003 Feb 11;60(3):521-3
Department of Neurology, Tenri Hospital, Tenri, Nara, Japan.
PMID: 12578947, UI: 22467170
Pain 2003 Feb;101(3):299-306
Department of Medical, Clinical and Experimental Psychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
In chronic pain patients, preoccupation with or attention to pain is associated with pain-related fear and perceived pain severity. The current study investigated psychometric properties of the pain vigilance and awareness questionnaire (PVAQ). An exploratory factor analysis on Dutch fibromyalgia patients indicated that a two-factor solution was most suitable. The first factor could be referred to as attention to pain and the second factor was interpreted as attention to changes in pain. A confirmatory factor analysis, testing three different factor structures in two independent samples (Dutch fibromyalgia patients and American pain patients with various diagnoses) showed that the goodness-of-fit indicators for all models were satisfactory. The existence of the previously reported intrusion subscale of the PVAQ as a unique construct within the PVAQ was discussed. This subscale should be further extended by non-reverse-keyed items. With regard to the convergent validity, the PVAQ was highly correlated with related constructs such as the pain catastrophizing scale (PCS), pain anxiety symptoms scale (PASS), and Tampa scale of kinesiophobia (TSK). The attention to pain subscale was significantly stronger associated with these pain-related measures than the attention to changes in pain subscale, indicating that attention to changes in pain is a distinctive construct. The uniqueness of the attention to changes in pain subscale was also supported by an exploratory factor analysis on all items of the PVAQ, PCS, PASS, and TSK which showed that all items from that scale loaded on one separate factor. Overall, the PVAQ showed good internal consistency. Implications for future research and treatment interventions are discussed.
PMID: 12583873, UI: 22472577
Pain 2003 Feb;101(3):291-8
Department of Psychology, West Virginia University, P.O. Box 6040, 26506-6040, Morgantown, WV, USA
According to a fear-avoidance model of chronic pain, disability is largely determined by the erroneous belief that an increase in activity level is potentially harmful. Further, recent literature suggests that excessive fears regarding physical activities contribute to significant disability. However, the relation of changes in these fears to functional work capabilities has gone largely uninvestigated. The present study examined how changes in physical capability for work were related to changes in pain severity and fear-avoidance beliefs for general physical and work-specific activities, as well as investigating whether an interdisciplinary treatment program for chronic pain was associated with changes in these specific fears in 65 individuals with chronic pain. Results revealed that significant decreases in fear and pain levels occurred from pre- to post-treatment, in addition to increases in physical capability for work. Further, changes in work-specific fears were more important than changes in pain severity and fear of physical activity in predicting improved physical capability for work. These results expand previous research, which has found a relation between self-reported disability and fear-avoidance beliefs, by demonstrating the relation with fear of work to actual work-related behaviors.
PMID: 12583872, UI: 22472576
Pain 2003 Feb;101(3):275-82
Department of Clinical Oral Physiology, Institute of Odontology, Karolinska Institutet, Box 4064, SE-141 04, Huddinge, Sweden
We have previously reported that the level of 5-HT in the masseter muscle is increased in patients with fibromyalgia as compared with healthy subjects and that high intramuscular level of 5-HT is associated with muscle pain. We have also reported that injection of the 5-HT(3) receptor antagonist granisetron (GRA) into the masseter muscle of healthy subjects reduced pain induced by 5-HT and abolished allodynia/hyperalgesia. The aim of this study was to investigate whether GRA can influence pain and allodynia/hyperalgesia of the masseter muscle in patients with fibromyalgia. Eighteen female patients who met the criteria of fibromyalgia according to the American College of Rheumatology participated in the study. They were examined regarding pain intensity and pressure pain threshold (PPT) over the masseter muscle. One milliliter of GRA (1mg/ml) was injected into the masseter muscle on one side and 1ml of isotonic saline on the other side in a randomized and double-blind manner. After the injections, the pain intensity and PPT were recorded during 30min. The pain intensity increased after injection of saline and to a lower degree after injection of GRA. The PPT increased after injection of GRA, while no such change was observed after saline. The difference between GRA and saline was, however, not significant. Eight of the patients responded to the GRA injection by an increase of PPT during the experimental period that differed from saline. They also showed a tendency to a lower increase of pain intensity after injection of GRA when compared to saline. In conclusion, the results of this study do not prove that injection of the 5-HT(3)-antagonist GRA into the masseter muscle influences local pain and allodynia/hyperalgesia in patients with fibromyalgia.
PMID: 12583870, UI: 22472574
Pain 2003 Feb;101(3):267-74
Department of Psychology, University of North Carolina at Chapel Hill, NC 27599, Chapel Hill, USA
Under some conditions, vibration delivered to the skin can reduce pain (vibratory analgesia). Previous studies of this phenomenon in a clinical context have been somewhat variable in terms of stimulus control, and have not examined the way in which the spatial distribution of pain is affected. In the present study, we used rigorously controlled conditions to examine vibratory analgesia in participants (N=17) with painful temporomandibular disorders (TMD). Results of 20- and 100-Hz vibration were compared with data from a no-vibration control condition. The results document for the first time that vibratory analgesia occurs in TMD chronic pain conditions. We measured its time course using continuous visual analog scale (VAS) recording, and its spatial aspects by asking subjects to indicate painful regions on standardized drawings. VAS ratings and drawings both showed that pain is reduced by 100-Hz, but not by 20-Hz, vibration. The effectiveness of the high-frequency vibration cannot be attributed to a mechanism involving Pacinian corpuscles, since these receptors are lacking in the skin of the orofacial region. Spatial analyses revealed that ipsilateral and contralateral effects of vibration were statistically equivalent, suggesting that vibratory analgesia relies at least in part on central nervous system processes rather than local mechanisms.
PMID: 12583869, UI: 22472573
Pain 2003 Feb;101(3):259-66
Department of Physiotherapy Studies, McKay Building, Keele University, University Park, Staffordshire, ST5 5BG, England, UK
AIMS OF INVESTIGATION: To quantify the magnitude of putative gender differences in experimental pressure pain threshold (PPT), and to establish the relevance of repeated measurements to any such differences. METHODS: Two separate studies were undertaken. A pressure algometer was used in both studies to assess PPT in the first dorsal interosseous muscle. Force was increased at a rate of 5N /s. In study 1, two measurements were taken from 240 healthy volunteers (120 males, 120 females; mean age 25 years) giving a power for statistical analysis of beta=0.80 at alpha=0.01. In study two, 30 subjects (15 males, 15 females mean age 28 years) were randomly selected from study one. Fourteen repeated PPT measurements were recorded at seven, 10min intervals. Mean PPT data for gender groups, from both studies, were analysed using analysis of covariance with repeated measures, and age as the covariate. RESULTS: The mean PPT for each of the two measurements in study one showed a difference between gender of 12.2N (f=30.5N, m=42.7N) and 12.8N (f=29.5N, m=42.3N), respectively, representing a difference of 28% with females exhibiting a lower threshold. In study two, the mean difference calculated from 14 PPT repeated measurements over a 1h period was comparable to that in study one at 12.3N (range 10.4-14.4N) again females exhibited the lower threshold. The differences in mean PPT values between gender were found to be significant in both study one, at (P<0.0005, F=37.8, df=1) and study two (P=0.01, F=7.6, df=1). No significant differences were found in either study with repeated measurement (P=0.892 and P=0.280), or on the interaction of gender and repeated measurement after controlling for age (P=0.36 and P=0.62). CONCLUSION: Healthy females exhibited significantly lower mean PPTs in the first dorsal interosseous muscle than males, which was maintained for fourteen repeated measures within a 1h period. This difference is likely to be above clinically relevant levels of change, and it has clear implications for the use of different gender subjects in laboratory based experimental designs utilising PPT as an outcome measure.
PMID: 12583868, UI: 22472572
Pain 2003 Feb;101(3):229-235
Department of Neurology, The National Hospital, University of Oslo, 0027, Oslo, Norway
[Record supplied by publisher]
Cold allodynia and hyperalgesia are frequent clinical findings in patients with neuropathic pain. While there have been several clinical studies showing the involvement of central sensitization mechanisms and N-methyl-D-aspartate (NMDA) receptor activation in mechanical allodynia/hyperalgesia and ongoing pain, the mechanisms of thermal allodynia and hyperalgesia have received less attention. The aim of the present study was to examine the effect of the NMDA-receptor antagonist ketamine on thermal allodynia/hyperalgesia, ongoing pain and mechanical allodynia/hyperalgesia in patients with neuropathic pain (11 patients with post-traumatic neuralgia and one patient with post-herpetic neuralgia). All the patients were known to suffer from severe cold allodynia (cold pain detection threshold (CPDT): 23.8 degrees C, median value). The &mgr;-opioid agonist alfentanil was used as an active control. The study design was double-blind and placebo-controlled and the drugs were administered i.v. (bolus dose and infusion). CPDT in the asymptomatic contralateral area was found to be significantly decreased (cold allodynia) compared to CPDT in site- and age-matched normal controls. Heat pain detection thresholds were found to be normal and no consistent heat hyperalgesia occurred. Alfentanil significantly reduced cold allodynia (by increasing CPDT) in symptomatic area (P=0.0076). Ketamine did not significantly increase the threshold. Significant and marked reductions of hyperalgesia to cold (visual analogue score at threshold value) were seen following both alfentanil (4.5 before, 1.4 after, median value) and ketamine (6.8 before, 0.4 after, median value). Alfentanil and ketamine also significantly reduced ongoing pain and mechanical hyperalgesia. It is concluded that NMDA-receptor mediated central sensitization is involved in cold hyperalgesia, but since CPDT remained unaltered, it is likely that other mechanisms are present.
PMID: 12583865
Pain 2003 Feb;101(3):221-7
Department of Clinical Oral Physiology, Dental School, Aarhus University, DK-8000, Aarhus C, Denmark
The present study examined the effect of peripheral administration of the excitatory amino acid (EAA) glutamate on the intensity of perceived pain and pressure pain thresholds (PPTs) in healthy young women (n=17) and men (n=18). Two injections separated by 25min of 0.2ml, 1.0M glutamate into the masseter muscle produced significantly higher scores of pain on 0-10cm visual analogue scales (VAS) in women than in men (analysis of variance, ANOVA: P<0.001). There was no significant difference between the VAS scores for the first and the second injections in either men or women. The PPTs determined in the masseter muscle were significantly reduced following the first injection and further significantly reduced after the second injection (ANOVA: P<0.001). Furthermore, the PPTs were reduced to a similar extent in both women and men (maximum 44-56%), suggesting that gender did not influence the process of sensitization. There were no significant difference in VAS scores or PPTs between women taking oral contraceptives (n=9) and those who did not (n=8) (ANOVAs: P=0.709, P=0.153). It is concluded that the VAS scores produced by intramuscular administration of 1.0M glutamate may reflect a gender-dependent activation of nociceptive pathways which, in part, may be mediated through peripheral EAA receptors. The reduction of PPTs in the masseter muscle following administration of glutamate in a concentration of 1.0M may reflect allodynia to mechanical stimuli. This process of sensitization was not gender-dependent. The present results suggest that injection of 1.0M glutamate into the masseter muscle may provide a useful experimental method to test sensitization and efficacy of peripheral EAA receptor antagonists in human subjects.
PMID: 12583864, UI: 22472568
Pain 2003 Feb;101(3):213-9
Washington University School of Medicine, St. Louis, MO, USA
PMID: 12583863, UI: 22472567