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Unilateral diagnostic infiltration of lumbar L3 nerve root resulting in an inadvertent discogram: the importance of fluoroscopic guidance in interventional pain therapy.
Haspeslagh S, Van Zundert J, Puylaert M, Heylen R, van Kleef M, Vissers K.
Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Campus A. Dumont, Ghent, Belgium.
PMID: 15087643 [PubMed - in process]
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Repeated dosing with oral allosteric modulator of adenosine A1 receptor produces tolerance in rats with neuropathic pain.
Li X, Bantel C, Conklin D, Childers SR, Eisenach JC.
Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA. xli@wfubmc.edu
BACKGROUND: The positive allosteric adenosine receptor modulator, T62 (2-amino-3-(4-chlorobenzoyl)-5,6,7,8-tetrahydrobenzothiophene), has been shown to reduce mechanical allodynia in a rat model of neuropathic pain. However, whether chronic oral T62 retains efficacy in this pain model has not been examined. Therefore, the authors studied antiallodynic effects of chronic oral T62 in spinal nerved-ligated rats, as well as motor and sedative behavioral effects. METHODS: Oral T62, 100 mg/kg, or oral oil was applied daily to spinal nerve-ligated rats for 4 weeks, with rat weights examined daily. Sedation, placing and ambulation scores, and withdrawal threshold were observed for 3 h daily for the first 2 weeks and then once a week. At the end of observation, the animals were killed, and the spinal tissues were collected for radioligand binding. In addition, withdrawal thresholds were also observed in rats with 5 days of treatment with 50 mg/kg oral T62. Furthermore, the effects of intrathecal adenosine on rats with oral T62 or oil treatment were compared. RESULTS: Chronic oral T62, at 100 mg/kg, initially returned the withdrawal threshold to mechanical testing to preinjury levels, with minor or no sedative or motor effects. Tolerance was observed, with a 60% loss of most possible effects in antiallodynia within 5 days of daily administration. Similarly, tolerance also occurred with chronic oral T62 at 50 mg/kg but did not alter the effect of intrathecal adenosine. Furthermore, 4 weeks of exposure to 100 mg/kg T62 resulted in a small reduction in spinal cord A1 receptor number. CONCLUSION: The results imply that chronically administered A1 adenosine modulators lose efficacy over time, partly as a result of receptor down-regulation.
PMID: 15087633 [PubMed - in process]
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Dissociable brain activation responses to 5-Hz electrical pain stimulation: a high-field functional magnetic resonance imaging study.
Alkire MT, White NS, Hsieh R, Haier RJ.
Department of Anesthesiology, University of California, Irvine, Orange, 92868, USA. malkire@uci.edu
BACKGROUND: To elucidate neural correlates associated with processing of tonic aching pain, the authors used high-field (3-T) functional magnetic resonance imaging with a blocked parametric study design and characterized regional brain responses to electrical stimulation according to stimulus intensity-response functions. METHODS: Pain was induced in six male volunteers using a 5-Hz electrical stimulus applied to the right index finger. Scanning sequences involved different levels of stimulation corresponding to tingling sensation (P1), mild pain (P2), or high pain (P3). Common effects across subjects were sought using a conjunction analyses approach, as implemented in statistical parametric mapping (SPM-99). RESULTS: The contralateral posterior/mid insula and contralateral primary somatosensory cortex were most associated with encoding stimulus intensity because they showed a positive linear relation between blood oxygenation level-dependent signal responses and increasing stimulation intensity (P1 < P2 < P3). The contralateral secondary somatosensory cortex demonstrated a response function most consistent with a role in pain intensity encoding because it had no significant response during the innocuous condition (P1) but proportionally increased activity with increasingly painful stimulus intensities (0 < P2 < P3). Finally, a portion of the anterior cingulate cortex (area 24) and supplementary motor area 6 demonstrated a high pain-specific response (P3). CONCLUSIONS: The use of response function modeling, conjunction analysis, and high-field imaging reveals dissociable regional responses to a tonic aching electrical pain. Most specifically, the primary somatosensory cortex and insula seem to encode stimulus intensity information, whereas the secondary somatosensory cortex encodes pain intensity information. The cingulate findings are consistent with its proposed role in processing affective-motivational aspects of pain.
PMID: 15087631 [PubMed - in process]
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Antiallodynic effects of systemic and intrathecal morphine in the spared nerve injury model of neuropathic pain in rats.
Zhao C, Tall JM, Meyer RA, Raja SN.
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
BACKGROUND: The efficacy of opioids for neuropathic pain remains controversial. The effects of morphine on pain behavior were investigated in two animal models of neuropathic pain: the spared nerve injury (SNI) model and the spinal nerve ligation (SNL) model. METHODS: Nerve injuries were created in rats either by tight ligation and section of the left tibial and common peroneal nerves (SNI) or by unilateral ligation of L5 and L6 spinal nerves (SNL). Paw withdrawal threshold to mechanical stimuli was measured using the up-down method in the hairy and glabrous skin territories of the sural nerve for SNI rats or in the mid-plantar paw of SNL rats. RESULTS: Before SNI, the median paw withdrawal thresholds in hairy and glabrous skin were similar (26 g [25%, 75% quartiles: 26, 26 g]). The paw withdrawal threshold decreased after SNI in both hairy and glabrous skin (P < 0.001). Thirty days after the SNI, the threshold in hairy skin (0.3 g) was significantly lower than in glabrous skin (1.9 g; P < 0.001). In blinded experiments, both subcutaneous and intrathecal morphine (0.1-10 microg) dose-dependently attenuated mechanical allodynia induced by SNI measured in the hairy skin, an effect that was naloxone reversible. The ED50 for the intrathecal morphine was 0.52 microg (95% confidence interval, 0.31-0.90 microg). Morphine (1 microg intrathecal) attenuated SNI-induced mechanical allodynia in glabrous skin with potency similar to that in hairy skin. In SNL rats, morphine (30 microg intrathecal) almost completely reversed the SNL-induced mechanical allodynia. CONCLUSIONS: (1) SNI-induced mechanical allodynia is characterized by a lower paw withdrawal threshold in hairy versus glabrous skin; (2) systemic and intrathecal morphine reverse SNI-induced mechanical allodynia in a dose-dependent fashion; and (3) intrathecal morphine also reverses SNL-induced mechanical allodynia. These results suggest that intrathecal opioids are likely to be effective in the treatment of neuropathic pain.
PMID: 15087626 [PubMed - in process]
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Did experimenter bias conceal the efficacy of spinal opioids in previous studies with the spinal nerve ligation model of neuropathic pain?
Eisenach JC, Lindner MD.
Publication Types:
PMID: 15087608 [PubMed - in process]
Chest pain after travel to the tropics.
Elzi L, Decker M, Battegay M, Rutishauser J, Blum J.
Division of Infectious Diseases University Hospital Basel CH-4002 Basel, Switzerland. Elzil@uhbs.ch
PMID: 15081653 [PubMed - in process]
Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 12-2004. A 38-year-old woman with acute onset of pain in the chest.
O'Gara PT, Greenfield AJ, Afridi NA, Houser SL.
Cardiovascular Division, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, USA.
Publication Types:
- Case Reports
- Clinical Conference
PMID: 15084700 [PubMed - indexed for MEDLINE]
Pilot tolerability and effectiveness study of levetiracetam for postherpetic neuralgia.
Rowbotham MC, Manville NS, Ren J.
UCSF Pain Clinical Research Center, Department of Neurology, School of Medicine, University of California San Francisco, CA 94115, USA. mcrwind@itsa.ucsf.edu
Publication Types:
PMID: 14504347 [PubMed - indexed for MEDLINE]
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Melatonin as treatment for idiopathic stabbing headache.
Rozen TD.
Michigan Head-Pain and Neurological Institute, Ann Arbor, MI 48104, USA. tdrozmigraine@yahoo.com
Publication Types:
PMID: 14504346 [PubMed - indexed for MEDLINE]
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Response to Letters to the Editor regarding White et al., "The placebo needle, is it a valid and convincing placebo for use in acupuncture trials? A randomised, single-blind, cross-over pilot trial" (Pain 106(3):401-409).
White P, Lewith G, Hopwood V, Prescott P.
Complementary Research Unit, Mail Point OPH, Royal South Hants Hospital, Brintons Terrace, Southampton, UK.
Publication Types:
PMID: 15082145 [PubMed - in process]
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Letter to the editor regarding White et al., "The placebo needle, is it a valid and convincing placebo for use in acupuncture trials? A randomised, single-blind, cross-over pilot trial" (Pain 106: 401-409).
Ernst E.
Complementary Medicine, University of Exeter, 25 Victoria Park Road, Exeter EX2 4NT, UK.
Publication Types:
PMID: 15082144 [PubMed - in process]
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Spinal cord lesion after long-term intrathecal clonidine and bupivacaine treatment for the management of intractable pain.
Perren F, Buchser E, Chedel D, Hirt L, Maeder P, Vingerhoets F.
CHUV, Neurology Department, 1011 Lausanne, Switzerland.
Long-term intrathecal drug administration using implanted pumps is increasingly used in the treatment of chronic refractory pain [, Neurosurgery 44 (1999) 289;, Best Pract Res Clin Anaesthesiol 16 (2002) 619;, Neurology 59 (2002) S18]. Extensive clinical experience over the last 15 years suggests that in selected cases the technique is safe, although infections, system malfunction and drug-related complications have been reported. In most cases, drug-related spinal cord injuries have resulted from the compression of a spinal inflammatory mass or abcess rather than from a direct neurotoxic effect. We report on a case of toxic spinal cord lesion occurring after more than 3 years of uneventful continuous infusion of a mixture of bupivacaine and clonidine.
PMID: 15082141 [PubMed - in process]
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Panic disorder and pain in a national sample of persons living with HIV.
Tsao JC, Dobalian A, Naliboff BD.
Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, 10940 Wilshire Blvd, Suite 1450, Los Angeles, CA 90024, USA.
Research to date has focused on depression and co-existing pain in HIV with relatively little attention devoted to the study of anxiety disorders and concurrent pain. We therefore examined the relationships among panic disorder, posttraumatic stress disorder (PTSD), major depression and pain in a US national sample of persons with HIV, controlling for key sociodemographic and clinical variables, including HIV disease status. The study sample comprised 1489 HIV+ individuals (representing 219?667 persons). In multivariate analyses, panic disorder showed a strong association with pain ( [Formula: see text] 99% confidence interval [CI]=-21.33 to -10.08; [Formula: see text] ), which was significantly greater than PTSD [Formula: see text] but only marginally greater than major depression [Formula: see text] Longitudinal analyses of the three psychological disorders revealed that increasing pain from baseline to follow-up (an approximately 6-month period) was associated with panic disorder only (relative risk ratio=2.18, 99% CI=1.02-4.69; [Formula: see text] ), after controlling for baseline pain scores, baseline HIV disease status and change in disease stage across time. We discuss specific mechanisms by which clinical anxiety and chronic pain may be mutually maintained in HIV+ individuals. Our findings suggest that panic disorder, as well as PTSD and major depression are associated with greater pain in HIV patients.
PMID: 15082139 [PubMed - in process]
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Ethosuximide reverses paclitaxel- and vincristine-induced painful peripheral neuropathy.
Flatters SJ, Bennett GJ.
Anaesthesia Research Unit, McIntyre Building, Room 1213, McGill University, 3655 Promenade Sir William Osler, Montreal, Qc, Canada H3G 1Y6.
Paclitaxel (Taxol(R)) is one of the most effective and frequently used chemotherapeutics for the treatment of solid tumours. However, paclitaxel produces peripheral neurotoxicity with patients reporting sensory abnormalities and neuropathic pain during and often persisting after paclitaxel therapy. The mechanisms underlying this dose-limiting side effect are currently unknown and there are no validated drugs for its prevention or control. Male Sprague-Dawley rats received four intraperitoneal (i.p.) injections on alternate days of 2 mg/kg paclitaxel. Behavioural assessment using von Frey filaments and acetone showed that such paclitaxel treatment induced a pronounced mechanical and cold allodynia/hyperalgesia. Thus these studies aim to test potential analgesics on established paclitaxel-induced pain. Paclitaxel-induced pain appears to be relatively resistant to opioid therapy i.p. 4 mg/kg morphine was ineffective and i.p. 8 mg/kg morphine only elicited up to a 50% reversal of mechanical allodynia/hyperalgesia. Interestingly, a maximally tolerated dose (i.p. 0.2 mg/kg) of the potent NMDA receptor antagonist MK-801 produced no significant reversal of the mechanical allodynia/hyperalgesia suggesting that NMDA receptors have little role in paclitaxel-induced pain. Ethosuximide (i.p. 450 mg/kg) an anti-epileptic and relatively selective T-type calcium channel blocker elicited a near complete reversal of mechanical allodynia/hyperalgesia. Repetitive dosing with ethosuximide (i.p. 100 or 300 mg/kg daily for 3 days) showed a dose-related consistent reversal of mechanical allodynia/hyperalgesia with no evidence of tolerance. Ethosuximide (i.p. 300 mg/kg) also reversed paclitaxel-induced cold allodynia and vincristine-induced mechanical allodynia/hyperalgesia. These data suggest that T-type calcium channels may play a role in chemotherapy-induced neuropathy and moreover identify ethosuximide as a new potential treatment for chemotherapy-induced pain.
PMID: 15082137 [PubMed - in process]
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Decreasing sympathetic sprouting in pathologic sensory ganglia: a new mechanism for treating neuropathic pain using lidocaine.
Zhang JM, Li H, Munir MA.
Department of Anesthesiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., #515, Little Rock, AR 72205, USA.
Lidocaine brings relief to those suffering from certain neuropathic pain syndromes in humans and in animal models. Evidence suggests that some neuropathic pain behaviors are closely associated with extensive sprouting of noradrenergic sympathetic fibers in the dorsal root ganglia (DRG). Using immunohistochemistry, we examined lidocaine's effects on abnormal sprouting of sympathetic fibers in two animal models: rats with unilateral spinal nerve ligation (SNL) and rats with complete sciatic nerve transection (CSNT). For the first time, we have demonstrated that systemic lidocaine beginning at the time of surgery via an implanted osmotic pump remarkably reduces sympathetic sprouting (2-3 fold) (e.g. the density of sympathetic fibers and the number of DRG neurons surrounded by sympathetic fibers) in axotomized DRGs in SNL rats. The effects of systemic lidocaine lasted more than 7 days after the termination of lidocaine administration. Similar results were obtained after topical application of lidocaine to the nerve trunk to block abnormal discharges originating in the neuroma in CSNT rats. Results strongly suggest that sympathetic sprouting in pathologic DRG may be associated with abnormal spontaneous activity originating in the DRG or the injured axons (e.g. neuroma). This finding provides new insight into the mechanisms underlying sympathetic sprouting and increases our current understanding of the prolonged therapeutic effects of lidocaine on neuropathic pain syndromes.
PMID: 15082136 [PubMed - in process]
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Evidence that CB-1 and CB-2 cannabinoid receptors mediate antinociception in neuropathic pain in the rat.
Scott DA, Wright CE, Angus JA.
The Department of Pharmacology, University of Melbourne, Melbourne, Vic. 3010, Australia.
The roles of the two cannabinoid receptor subtypes, CB-1 and CB-2, have not been clarified in cannabinoid-mediated analgesia. We investigated the efficacy of the non-selective cannabinoid receptor agonist CP55,940 in the modulation of responses in the rat to both acute pain (tail flick) and neuropathic pain (tactile allodynia following chronic L5/6 spinal nerve ligation). Responses were also assessed in the presence of the CB-1 antagonist SR141716A (SR1) and the CB-2 antagonist SR144528 (SR2). CP55,940 attenuated tactile allodynia (ED(50) 0.04 mg/kg i.t. (95% CI 0.032-0.044 mg/kg), 0.12 mg/kg i.p. (95% CI 0.10-0.15 mg/kg)) and induced thermal antinociception (ED(50) tail flick 0.07 mg/kg i.t. (95% CI 0.05-0.10 mg/kg), 0.17 mg/kg i.p. (95% CI 0.11-0.26 mg/kg)). SR1 0.5 mg/kg i.t. attenuated the antinociceptive effect of CP55,940 in both modalities. However, SR1 1.0 mg/kg i.p. decreased tail flick latency but had no effect on tactile allodynia antinociception. In contrast, SR2 1.0 mg/kg i.p. significantly decreased the effect of i.p. CP55,940 on both tail flick antinociception and tactile allodynia [Formula: see text] The combination of SR1 and SR2 (i.p.) had an additive effect in decreasing the antinociception induced by CP55,940 on tail flick responses [Formula: see text] These results suggest a role for CB-2 receptor-mediated antinociception in both acute and neuropathic pain in addition to centrally located CB-1 mechanisms.
PMID: 15082134 [PubMed - in process]
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Sex differences in temporal summation of pain and aftersensations following repetitive noxious mechanical stimulation.
Sarlani E, Grace EG, Reynolds MA, Greenspan JD.
University of Maryland Dental School, Baltimore, MD, USA.
Several studies demonstrate that women are more sensitive to experimental pain than men. In addition, women exhibit greater temporal summation of heat and mechanically evoked pain. Since temporal summation of pain is centrally mediated, its greater expression in women suggests a central nociceptive hyperexcitability relative to men. The purpose of this study was to pursue this theory, by further assessing sex differences in (1) temporal summation of mechanically evoked pain, and (2) aftersensations following repetitive noxious stimulation. Sixteen series of 10 repetitive, mildly noxious, mechanical stimuli were applied to the fingers of 25 women and 25 age-matched men. The subjects rated the pain intensity and unpleasantness caused by the first, fifth and tenth stimulus in the series, as well as their aftersensations 15 s and 1 min following the end of stimulation. Data were analyzed by three-way repeated-measures analysis of variance. Pain and unpleasantness ratings increased with repetition of stimulation [Formula: see text] Temporal summation of pain intensity and unpleasantness ratings were more pronounced in women than men [Formula: see text] In addition, significant temporal summation occurred only with 2 s interstimulus interval for men [Formula: see text] but with 2 and 5 s interstimulus interval for women [Formula: see text] Moreover, women provided greater ratings for the intensity and the unpleasantness of aftersensations [Formula: see text] and reported painful aftersensations at greater frequency [Formula: see text] Greater temporal summation of pain and aftersensations in women suggests that their central processing of nociceptive input may be more easily upregulated into pathological hyperexcitability, possibly accounting for the higher prevalence of various chronic pain conditions among women.
PMID: 15082133 [PubMed - in process]
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Stability of patient adaptation classifications on the multidimensional pain inventory.
Broderick JE, Junghaenel DU, Turk DC.
Department of Psychiatry and Behavioral Science, Putnam Hall, Stony Brook University, Stony Brook, NY 11794-8790, USA.
This study examined the adaptational classification stability of the multidimensional pain inventory (MPI) in two samples of female fibromyalgia syndrome patients. Retest resulted in one-third of patients being assigned to a different classification. Twenty patients had four repeated MPI assessments over a 10-month period; 85% of them changed classification at least once. Prediction of classification stability using demographic variables and measures of pain, depression, anxiety, impression management, and self-deception was unsuccessful. Examination of the MPI Variable Response Scale and an index of the goodness of fit of the cluster for each patient did not yield sufficient predictive power. The implication of this study is that for a sizable number of chronic pain patients, MPI classifications may not be stable, trait-like characterizations. As such, caution must be applied when treatment is tailored to MPI clusters and when classification change is used as an outcome measure.
PMID: 15082130 [PubMed - in process]
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Impact of preoperative education on pain outcomes after coronary artery bypass graft surgery.
Watt-Watson J, Stevens B, Katz J, Costello J, Reid GJ, David T.
Faculty of Nursing and Centre for the Study of Pain, University of Toronto, 50 St George Street, Toronto, Ont., Canada M5S 3H4.
Cardiovascular diseases cause more disability and economic loss in industrialized nations than any other group of diseases. In previous work [Nurs Res 49 (2000a) 1], most coronary artery bypass graft patients (CABG, [Formula: see text] ) reported unrelieved pain and received inadequate analgesics. This study proposed to evaluate a preadmission education intervention to reduce pain and related activity interference after CABG surgery. Patients [Formula: see text] were randomly assigned to (a) standard care or (b) standard care+pain booklet group. Data were examined at the preadmission clinic and across days 1-5 after surgery. Outcomes were pain-related interference (BPI-I), pain (MPQ-SF), analgesics (chart), concerns about taking analgesics (BQ-SF), and satisfaction (American Pain Society-POQ). The impact of sex was explored related to primary and secondary outcomes. The intervention group did not have better overall pain management although they had some reduction in pain-related interference in activities ( [Formula: see text] [Formula: see text] ) and fewer concerns about taking analgesics ( [Formula: see text] [Formula: see text] ) on day 5. Despite moderate 24-h pain intensity across 5 days, patients in both groups received inadequate analgesics (i.e. 33% prescribed dose). Women reported more pain and pain-related interference in activities than men. The booklet was rated as helpful, particularly by women. In conclusion, the intervention did not result in a clinically significant improvement in pain management outcomes. In future, an intervention that considers sex-specific needs and also involves educating the health professionals caring for these patients may influence these results.
PMID: 15082128 [PubMed - in process]
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The anatomical pattern and determinants of pain in the neck and upper limbs: an epidemiologic study.
Walker-Bone K, Reading I, Coggon D, Cooper C, Palmer KT.
MRC Environmental Epidemiology Unit, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
Little is known about the distribution and determinants of pain at multiple sites in the neck and upper limb. To investigate the prevalence, pattern, and clustering of such pains and the association of extensive involvement with putative risk factors, we mailed a questionnaire to a community sample of 9696 working-aged adults. Age-sex specific prevalence rates for pain were estimated and the frequency of bilateral involvement, pairwise overlap at different sites, and extent to which reports clustered within individuals were explored. Associations of multi-site involvement with age, gender, psychological health, smoking, and employment status were assessed by logistic regression. Among 6038 responders, 2657 reported at least a day of neck or upper limb pain in the past 7 days, including 1843 whose symptoms rendered normal activities difficult or impossible. Pain was frequently bilateral or in the dominant arm. Significant associations were seen for pain at anatomically adjacent sites. Pain affecting every site considered (neck, shoulders, elbows, wrists/hands) was far more common than might be expected if each site were statistically independent (observed/expected ratio 8750). Being female, unemployed, a blue-collar worker, or a smoker were independent risk factors for such extensive pain, but the strongest association was with psychological ill-health (odds ratio for worst vs. best third of the SF-36 low vitality score, 30.3, 95% CI 7.1-129.0). Neck and upper limb pain commonly cluster, and frequently display symmetry and adjacent patterns of involvement. Extensive neck and upper limb pain is far more strongly associated with poor mental vitality than localised pain.
PMID: 15082125 [PubMed - in process]
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Pregabalin reduces pain and improves sleep and mood disturbances in patients with post-herpetic neuralgia: results of a randomised, placebo-controlled clinical trial.
Sabatowski R, Galvez R, Cherry DA, Jacquot F, Vincent E, Maisonobe P, Versavel M, The 1008-045 Study Group.
Department of Anaesthesiology, University of Cologne, Cologne, Germany.
This study was designed to assess the efficacy and safety of pregabalin-a novel alpha(2)-delta ligand with analgesic, anxiolytic, and anticonvulsant activity-for treating neuropathic pain in patients with post-herpetic neuralgia (PHN). Two hundred and thirty-eight patients were randomised into this multicentre, doubleblind, placebo-controlled trial to receive 150 [Formula: see text] 300 mg/day [Formula: see text] pregabalin, or placebo [Formula: see text] for 8 weeks. Among the exclusion criteria was failure to respond to previous treatment for PHN with gabapentin at doses >/=1200 mg/day. Endpoint mean pain scores were significantly reduced in patients receiving 150 or 300 mg/day pregabalin compared with placebo. Efficacy was observed as early as week 1 and was maintained throughout the study. Significantly more patients in both pregabalin groups (150 mg, 26%; 300 mg, 28%) were responders (>/=50% decrease in mean pain score from baseline to endpoint) than in the placebo group (10%). Additionally, by week 1 and for the study's duration, 150 and 300 mg/day pregabalin significantly reduced weekly mean sleep interference scores. More pregabalin-treated patients than placebo-treated patients reported that they were 'much improved' or 'very much improved'. Health-related quality-of-life (HRQoL) measurements using the SF-36 Health Survey demonstrated improvement in the mental health domain for both pregabalin dosages, and bodily pain and vitality domains were improved in the 300 mg/day group. The most frequent adverse events were dizziness, somnolence, peripheral oedema, headache, and dry mouth. Pregabalin efficaciously treated the neuropathic pain of PHN. Additionally, pregabalin was associated with decreased sleep interference and significant improvements in HRQoL measures.
PMID: 15082123 [PubMed - as supplied by publisher]
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The meaning of pain influences its experienced intensity.
Arntz A, Claassens L.
Department of Medical, Clinical and Experimental Psychology, Maastricht University, P.O. Box 616, NL 6200 MD Maastricht, The Netherlands.
This experiment tested whether meaning influences the experience of pain. Thirty-one healthy students participated in a study on evaluations of various stimuli placed against the neck. By suggesting that a very cold metal bar was either hot or cold, the potentially tissue-damaging property of the stimulus was experimentally manipulated. A manipulation check revealed that participants believed the experimenter's information, as they rated the bar as more hot in the corresponding condition than in the other condition. Confirming the hypothesis that tissue-damaging meaning influences the experience of pain, participants who were told that the bar was hot rated it as more painful than participants who were told that it was cold. Damage interpretations mediated the effect of information on pain intensity scores, which supported the theory that tissue-damage is a crucial aspect of meaning to influence the subjective intensity of pain.
PMID: 15082122 [PubMed - in process]
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Possible association of interleukin 1 gene locus polymorphisms with low back pain.
Solovieva S, Leino-Arjas P, Saarela J, Luoma K, Raininko R, Riihimaki H.
Department of Epidemiology and Biostatistics, Finnish Institute of Occupational Health, Topeliuksenkatu 41aA, Helsinki 00250, Finland.
Based on a hypothesis that interleukin 1 (IL-1) activity is associated with low back pain (LBP), we investigated relationships between previously described functional IL-1 gene polymorphisms and LBP. The subjects were a subgroup of a Finnish study cohort. The IL-1alpha(C(889)-T), IL-1beta(C(3954)-T) and IL-1 receptor antagonist (IL-1RN)(G(1812)-A, G(1887)-C and T(11100)-C) polymorphisms were genotyped in 131 middle-aged men from three occupational groups (machine drivers, carpenters and office workers). A questionnaire inquired about individual and lifestyle characteristics and the occurrence of LBP, the number of days with pain and days with limitation of daily activities because of pain, and pain intensity, during the past 12 months. Lumbar disc degeneration was determined with magnetic resonance imaging. Carriers of the IL-1RNA(1812) allele had an increased risk of LBP (OR 2.5, 95% CI 1.0-6.0) and carriers of this allele in combination with the IL-1alphaT(889) or IL-1betaT(3954) allele had a higher risk of and more days with LBP than non-carriers. Pain intensity was associated with the simultaneous carriage of the IL-1alphaT(889) and IL-1RNA(1812) alleles (OR 3.7, 95% CI 1.2-11.9). Multiple regression analyses allowing for occupation and disc degeneration showed that carriage of the IL-1RNA(1812) allele was associated with the occurrence of pain, the number of days with pain and days with limitations of daily activities. Carriage of the IL-1betaT(3954) allele was associated with the number of days with pain. The results suggest a possible contribution of the IL-1 gene locus polymorphisms to the pathogenesis of LBP. The possibility of chance findings cannot be excluded due to the small sample size.
PMID: 15082121 [PubMed - in process]
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Acceptance and change in the context of chronic pain.
McCracken LM, Carson JW, Eccleston C, Keefe FJ.
Pain Management Unit, Royal National Hospital for Rheumatic Diseases and The University of Bath, Bath BA1 1RL, UK.
PMID: 15082120 [PubMed - in process]
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Assessing pain candidate gene studies.
Max MB.
Pain and Neurosensory Mechanisms Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
Publication Types:
PMID: 15082119 [PubMed - in process]
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Local application of the cannabinoid receptor agonist, WIN 55,212-2, to spinal trigeminal nucleus caudalis differentially affects nociceptive and non-nociceptive neurons.
Papanastassiou AM, Fields HL, Meng ID.
Department of Neurology, University of California, San Francisco, CA 94143-0114, USA.
Cannabinoid receptor agonists produce analgesia for pains of non-cranial origin. However, their effectiveness for craniofacial pains is currently unclear. In the present study, the cannabinoid CB1/CB2 receptor agonist, WIN 55,212-2 (WIN), was bath applied to the brainstem while activity of spinal trigeminal nucleus caudalis (Vc) neurons evoked by transcutaneous electrical stimulation was recorded in isoflurane anesthetized rats. Neurons were characterized using mechanical and electrical stimulation of the face, and were classified as either low-threshold mechanoreceptive (LTM) or wide dynamic range (WDR). LTM neurons responded to light brushing of the receptive field and received only Abeta primary afferent fiber input. WDR neurons showed a graded response to mechanical stimulation, responding maximally to noxious stimuli, and demonstrated both A- and C-fiber evoked activity. In addition, WDR neurons displayed longer latency, C-fiber mediated post-discharge (PDC) activity after repetitive stimulation. Local bath application of 2.0 mg/ml WIN significantly reduced PDC activity (3+/-1% control, P<0.01), C-fiber evoked activity (58+/-9% control, P<0.01), and Abeta evoked activity (57+/-10% control, P<0.01) in WDR neurons. In contrast, LTM Abeta-fiber evoked activity increased after local administration of WIN (204+/-52% control, P<0.01). SR141716A, a CB1 receptor antagonist, prevented the effects of WIN on WDR PDC and LTM Abeta evoked activity. These results indicate that cannabinoid receptor agonists may be effective agents for craniofacial pain. Furthermore, the particular sensitivity of PDC activity, a measure of neuronal hyperexcitability, to cannabinoid receptor agonists may be relevant to the treatment of persistent craniofacial pain.
PMID: 14736589 [PubMed - indexed for MEDLINE]
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Interventions to prevent postherpetic neuralgia: cutaneous and percutaneous techniques.
Opstelten W, van Wijck AJ, Stolker RJ.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85060, 3500 AB, Utrecht, The Netherlands. w.opstelten@med.uu.nl
Publication Types:
PMID: 14736581 [PubMed - indexed for MEDLINE]
Comment on:
Biomarkers for pain.
Kalso E.
Publication Types:
PMID: 14736580 [PubMed - indexed for MEDLINE]
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Physiotherapists' pain beliefs and their influence on the management of patients with chronic low back pain.
Daykin AR, Richardson B.
Centre for Primary Health Care Studies, Warwick Medical School, University of Warwick, Coventry, UK. Anne.Daykin@warwick.ac.uk
PURPOSE: Little is known about physiotherapists' pain beliefs and whether they influence behavior within therapeutic encounters with patients. This qualitative study explored physiotherapists' pain beliefs with the purpose of highlighting the nature of their beliefs and the role they played within their management of chronic low back pain. METHODS: Six physiotherapists were purposefully sampled along with 12 of their patients with chronic low back pain (two patients each). A qualitative exploration of physiotherapists' pain beliefs within the context of a clinical situation was carried out using semistructured interviews and observations at designated stages throughout therapeutic encounters with their patients. The data were prepared and analyzed according to a grounded theory approach. RESULTS: The themes that emerged from the data indicated that the pain beliefs of physiotherapists in this study were determined by a number of perspectives including their beliefs regarding the development of craft knowledge needed to manage chronic low back pain, beliefs regarding the clinical characteristics of patients with chronic low back pain they considered to be "good" to treat and the challenge of patients who were "difficult" to treat, and pain beliefs within the therapeutic encounter. A tentative theory was developed which proposed that the physiotherapists' biomedically oriented pain beliefs influenced their clinical reasoning processes including the explanations given to the patients. CONCLUSIONS: The findings suggest that in order to maximize the rehabilitation potential of patients with chronic low back pain, physiotherapists need to be aware that their pain beliefs may influence their management of these patients.
PMID: 15087802 [PubMed - in process]
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The IDET procedure for chronic discogenic low back pain.
Davis TT, Delamarter RB, Sra P, Goldstein TB.
Spine Institute at Saint John's Health Center, Santa Monica, CA 90404, USA. tdavis@espineinstitute.com
STUDY DESIGN: Retrospective study with independent evaluation of patient outcomes approximately 1 year post-intradiscal electrothermal therapy (IDET). OBJECTIVE.: To assess functional status, symptoms, and subsequent treatments of patients treated with IDET. SUMMARY OF BACKGROUND DATA: IDET was introduced as a procedure for discogenic pain. Several studies reported improvement in >70% of patients. METHODS: Seventeen physicians referred 60 patients. Each patient had a positive discogram and had been treated with IDET. Patients were contacted approximately 1 year post-IDET, answered a telephone interview, and completed a self-administered questionnaire. Overall patient satisfaction, pain, functional and work status, analgesic usage, and subsequent treatments were noted. Kaplan-Meier survival curve was generated to predict the percentage that would undergo lumbar surgery after IDET. RESULTS: Average age was 40 years (range 25-64 years) with 66% males and 34% females. Of the 44 patients who responded, 6 patients had a lumbar surgery within 1 year. Their outcomes were excluded from descriptive analysis; 97% continued to have back pain, 11 (29%) reported more pain post versus pre-IDET, 15 (39%) had less pain, and 11 (29%) reported no change; 11 (29%) reported using more pain medication post-IDET, 10 (26%) used the same, 12 (32%) used less, and 5 (13%) used none; 19 (50%) were dissatisfied with IDET, 14 (37%) were satisfied, and 5 (13%) were undecided; 20 (53%) would have the procedure again, 12 (31%) would not, and 6 (16%) were unsure. Most patients wore a brace >6 hours/day after surgery (duration 1-15 months). Sixteen (42%) were employed full-time pre-IDET and 11 (29%) were employed full-time post-IDET. CONCLUSION: At 1-year post-IDET, half of patients were dissatisfied with their outcome. The percentage of patients on disability remained constant. The estimated proportion of patients undergoing fusion was predicted to be 15% at 1 year and 30% at 2 years.
PMID: 15087797 [PubMed - in process]
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Gabapentin is a first line drug for the treatment of neuropathic pain in spinal cord injury.
Levendoglu F, Ogun CO, Ozerbil O, Ogun TC, Ugurlu H.
Department of Physical Medicine and Rehabilitation, Selcuk University, Meram School of Medicine, Konya, Turkey.
STUDY DESIGN: Prospective, randomized, double blind, placebo-controlled, crossover clinical trial. OBJECTIVES: To determine the efficacy of gabapentin in the treatment of neuropathic pain related to spinal cord injury. SUMMARY OF BACKGROUND DATA: Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the nervous system. Neuropathic pain associated with spinal cord injury is quite refractory, and current treatments are not effective. Gabapentin, an anticonvulsant, has become the first choice in the treatment of neuropathic pain. The place of gabapentin in the treatment of spinal cord injury-related neuropathic pain was questioned in only a few recent reports; however, they are retrospectively designed, nonstandardized, and uncontrolled studies, or involve a very small series of patients using less than optimum doses. METHODS: A total of 18-week study period included a 4-week medication/placebo titration period. This was followed by a 4-week stable dosing period when the patients continued to receive maximum tolerated doses, a 2-week washout period, then a crossover of 4 weeks of medication/placebo titration, and another 4 weeks of stable dosing period. Twenty paraplegic patients (female/male: 7/13) with complete spinal cord injury at the thoracic and lumbar level, aged between 20 and 65 years, with neuropathic pain for more than 6 months were recruited for the study. RESULTS: All patients completed the study. Gabapentin reduced the intensity as well as the frequency of pain, relieved all neuropathic pain descriptors except the itchy, sensitive, dull, and cold types, and improved the quality of life (P < 0.05). CONCLUSIONS: Gabapentin can be added to the list of first-line medications for the treatment of chronic neuropathic pain in spinal cord injury patients. It is a promising new agent and offers advantages over currently available treatments.
PMID: 15087796 [PubMed - in process]
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Quality improvement in an outpatient department for subacute low back pain patients: prospective surveillance by outcome and performance measures in a health technology assessment perspective.
Johansen B, Mainz J, Sabroe S, Manniche C, Leboeuf-Yde C.
Medical Research Unit in the County of Ringkoebing, Ringkoebing, Denmark. bendt@post4.tele.dk
STUDY DESIGN.: Prospective cohort study. OBJECTIVES: To develop clinical indicators and standards in an outpatients' department for sub acute low back pain patients. SUMMARY OF BACKGROUND DATA: A systematic quantitative surveillance to assess quality of care was implemented using outcome and performance measures. These measures were developed within the framework of Health Technology Assessment, which comprises the areas of healthcare technology, patient, organization, and economy. METHODS: A multidisciplinary project group defined 1) clinical indicators in terms of outcome and performance measures and 2) the corresponding standards using the available evidence from literature. Observed outcomes were compared with the standards. Associations between process and outcome measures were investigated. RESULTS: A total of 300 patients were included consecutively. In relation to technology, the standards for the field of application were fulfilled (e.g., not too many patients were x-rayed). With respect to effectiveness, the observed rate of patients reaching a 50% cutoff point of improvement of pain and function did not fulfill the standards. In relation to patient aspects, the standards of, for example, proper understanding of patient education and satisfaction, were fulfilled. In relation to organization, nearly one third of the patients were referred later to the department than the recommended 24 weeks. This refer variable showed an association to a reduced chance of scoring "better" or "much better" in "patients global assessment." The chance was reduced by 50% if patients were referred later than 12 weeks after onset of pain. In relation to economy, the cost of gaining a quality adjusted life-year by a course in the department was considerably lower than by comparison with total hip arthroplasty. CONCLUSIONS: Surveillance by clinical indicators in relation to the four areas of health technology assessment provides quantitative information that is meaningful for various stakeholders on important aspects of the quality of care (including consumers), provides a basis for quality improvement, and provides data for analysis of possible important relationships between structure, process, and outcome.
PMID: 15082998 [PubMed - indexed for MEDLINE]
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The prognostic value of functional capacity evaluation in patients with chronic low back pain: part 2: sustained recovery.
Gross DP, Battie MC.
Faculty of Rehabilitation Medicine, University Of Alberta, Edmonton, Alberta, Canada. dgross@ualberta.ca
STUDY DESIGN: Historical cohort study. OBJECTIVES: We investigated the ability of the Isernhagen Work Systems' Functional Capacity Evaluation to predict sustained recovery. SUMMARY OF BACKGROUND DATA: Functional Capacity Evaluation is commonly used to determine readiness or ability for safe return to work following musculoskeletal injury, implying a low risk of future recurrence or "reinjury." However, this theoretical construct has not yet been tested. METHODS: Workers' compensation claimants who underwent Functional Capacity Evaluation following low back injury and subsequently demonstrated recovery in the form of suspension of total temporary disability benefits or claim closure were studied. The number of failed tasks and performance on the floor-to-waist lift task in the protocol were used as indicators of Functional Capacity Evaluation performance. Indicators of sustained recovery included whether or not total temporary disability benefits restarted, the claim was reopened, or a new back claim was filed. Logistic regression was used to determine the prognostic effect of Functional Capacity Evaluation alone and after controlling for suspected confounding variables. RESULTS: Overall, 46 of 226 patients (20%) experienced a recurrent back-related event within the year following Functional Capacity Evaluation. Opposite to the initial hypothesis, a lower number of failed Functional Capacity Evaluation tasks was consistently associated with higher risk of recurrence after controlling for potential confounding variables. Performance on the floor-to-waist lift task was not related to future recurrence. CONCLUSIONS: Contrary to Functional Capacity Evaluation theory, better Functional Capacity Evaluation performance as indicated by a lower number of failed tasks was associated with higher risk of recurrence. The validity of Functional Capacity Evaluation's purported ability to identify claimants who are "safe" to return to work is suspect.
Publication Types:
PMID: 15082997 [PubMed - indexed for MEDLINE]
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The prognostic value of functional capacity evaluation in patients with chronic low back pain: part 1: timely return to work.
Gross DP, Battie MC, Cassidy JD.
Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada. dgross@ualberta.ca
STUDY DESIGN: Historical cohort study. OBJECTIVES: We examined the validity of the Isernhagen Work Systems' Evaluation in predicting timely return to work. SUMMARY OF BACKGROUND DATA: Functional Capacity Evaluations are used commonly to determine readiness for return to work, yet little is known of their validity. METHODS: Workers' compensation claimants undergoing Functional Capacity Evaluations following work-related low back injury were studied. Two cohorts were formed, one on which exploratory analyses were conducted and a second for confirmation. Evaluation indicators were the number of tasks in the protocol rated as failed and performance during the floor-to-waist lift task. The primary outcome investigated was time receiving total temporary disability benefits (as a surrogate of return to work) and a secondary outcome was time until claim closure in the year following Evaluation. Cox proportional-hazards regression was used to determine the prognostic effect of Evaluation crudely and after controlling for potential confounders. RESULTS: Few patients (4%) were found to pass all Evaluation tasks, yet most experienced total temporary disability suspension and claim closure within 1 year following Functional Capacity Evaluations. Better Evaluation performance was related to faster time to suspension of total temporary disability benefits and claim closure after controlling confounding factors, but explained little of the variation in these outcomes (approximately 10%). Performance on the floor-to-waist lift was as predictive as the number of failed tasks in the entire Functional Capacity Evaluations protocol. CONCLUSIONS: Better performance on Evaluation was weakly associated with faster recovery; however, the amount of variation explained was small. One task in the Evaluation was as predictive as the entire protocol.
Publication Types:
PMID: 15082996 [PubMed - indexed for MEDLINE]
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Reliability and validity of the back performance scale: observing activity limitation in patients with back pain.
Magnussen L, Strand LI, Lygren H.
Department of Public Health and Primary Health Care, Section of Physiotherapy Science, Faculty of Medicine, University of Bergen, Bergen, Norway. Liv.Magnussen@psybp.uib.no
STUDY DESIGN: A single group design to examine reliability and validity of the Back Performance Scale. OBJECTIVES: To examine intertester reliability, test-retest reliability, and concurrent validity of the Back Performance Scale. SUMMARY OF BACKGROUND DATA: The Back Performance Scale is a condition-specific performance measure of activity limitation in patients with back pain. It includes five tests of daily activities requiring mobility of the trunk: sock test, pick-up test, roll-up test, fingertip-to-floor test, and lift test. Discriminative ability and responsiveness to important change have previously been demonstrated. METHODS: A total of 41 patients with back pain participated in the study. Two physiotherapists examined test performances concurrently, but independently. The patients filled in three questionnaires, two reflecting perceived disability (Der Funktionsfragenbogen Hannover, Roland-Morris Disability Questionnaire) as well as one for fear avoidance of daily activities and work (Fear Avoidance Belief Questionnaire). One physiotherapist retested the patients after 2 to 3 days. RESULTS: Intertester agreement of the Back Performance Scale sum score was very high (intraclass correlation coefficient 2.1): 0.996. Within-patient standard deviation (sw) on the 16-point Back Performance Scale was very low: 0.25. Test-retest reliability was high (intraclass correlation coefficient = 0.91, sw = 1.3). Intertester agreement of the separate tests was also very high, ranging from kappa= 0.90-1.00. Test-retest reliability was moderate to high (kappa= 0.55-0.83). A high correlation was demonstrated between the Back Performance Scale and the Der Funktionsfragenbogen Hannover: Spearman rho (rho) = 0.825, P < 0.01. Correlation between the Back Performance Scale and Roland-Morris Disability Questionnaire was moderate: rho = 0.454, P < 0.01. No correlation was demonstrated between the Back Performance Scale and the Fear Avoidance Belief Questionnaire. CONCLUSION: The Back Performance Scale appears to be a reliable and valid outcome measure of activity limitation.
Publication Types:
PMID: 15082994 [PubMed - indexed for MEDLINE]
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Genetic and environmental contributions to back pain in old age: a study of 2,108 danish twins aged 70 and older.
Hartvigsen J, Christensen K, Frederiksen H, Pedersen HC.
Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. j.hartvigsen@nikkb.dk
STUDY DESIGN: Self-reported 1-month prevalence of back pain in older twins assessed at intake in a population-based longitudinal survey. OBJECTIVES: To determine the relative contribution of genetic and environmental factors to back pain in old age. SUMMARY OF BACKGROUND DATA: To date, genetic contributions to back pain in old age have not been assessed, to the authors' best knowledge. METHODS: Interview data given at entry into a nationwide cohort-sequential population-based survey of Danish twins aged 70 years and older in 1995, 1997, 1999, and 2001 form the basis of this analysis. Analysis of twin similarity was estimated using probandwise concordance rates, odds ratios, and tetrachoric correlations for back pain. Heritability (proportion of the population variance attributable to genetic variation) was estimated by bivariate probit estimation and adjusted for known significant environmental factors. Odds ratios for known environmental effects were estimated after controlling for age, sex, and genetic effects. RESULTS: Modest and nonsignificant differences between monozygotic and dizygotic twin pairs were found for probandwise concordance rates, odds ratios, and tet-rachoric correlations for both men and women. In the bivariate probit estimation, a current or previous diagnosis of osteoporosis, degenerative joint disease, or lumbar disc prolapse was found to significantly affect the risk of back pain. Additive genetic effects explained approximately one fourth of the liability to report back pain in men and none of the occurrence in women. Individual environmental effects were found to explain roughly 75% of the occurrence of back pain in men and 100% in women. CONCLUSIONS: Additive genetic effects are modest contributors to back pain in older men but not in women. A current or previous medical diagnosis of osteoporosis, degenerative joint disease, or lumbar disc prolapse is-strongly associated with back pain, also when genetic factors are controlled for. Because of inherent methodologic issues, this estimate of the genetic influence on back pain in old age is probably conservative.
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PMID: 15082992 [PubMed - indexed for MEDLINE]
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Patterns and trends in opioid use among individuals with back pain in the United States.
Luo X, Pietrobon R, Hey L.
Center for Clinical Effectiveness, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA. luo00003@mc.duke.edu
STUDY DESIGN: Secondary analysis of Medical Expenditure Panel Survey from 1996 to 1999. OBJECTIVE: To examine patterns in opioid use in 1996, 1997, 1998, and 1999 among individuals with back pain in the United States and to investigate trends in the use of overall and individual opioid category. SUMMARY OF BACKGROUND DATA: To the authors' best knowledge, no study has examined at a national level the patterns and trends in opioid use among individuals with back pain in the United States. METHODS: Individuals with back pain were stratified by sociodemographic characteristics and geographic regions. Rates of overall opioid use were compared among different strata by the use of simple and multivariate logistic regression models. To investigate trends in opioid use, use rates of the overall and individual opioid category in each year were calculated and compared. RESULTS: From 1996 to 1999, wide variations in overall opioid use were consistently observed among individuals with different educational levels, family income, and health insurance status. Regional variation in opioid use was also observed for most of the 4 years. After adjustment for covariates, health insurance status and geographic regions were consistent predictors of opioid use from 1997 to 1999. Trend analysis indicated that the rates of overall opioid use increased slightly across the 4-year span. Among individual opioid categories, the use of oxycodone or hydrocodone increased, whereas the use of propoxyphene decreased. CONCLUSIONS: The variation in overall opioid use among individuals with back pain with different sociodemographic characteristics and from different geographic regions suggested an opportunity to improve opioid prescribing patterns. The increase in the use of hydrocodone and oxycodone indicated a need to better assess the efficacy and safety associated with these drugs among individuals with back pain.
PMID: 15082989 [PubMed - indexed for MEDLINE]
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Responsiveness of pain, disability, and physical impairment outcomes in patients with low back pain.
Pengel LH, Refshauge KM, Maher CG.
School of Physiotherapy, University of Sydney, Lidcombe, NSW, Australia. l.pengel@gprf.mrc.ac.uk
STUDY DESIGN: Cohort study. OBJECTIVE: To conduct a head-to-head comparison of the responsiveness of pain, disability, and physical impairment measures in patients with low back pain. SUMMARY OF BACKGROUND DATA: Pain, disability, and physical impairment measures are routinely measured in clinical practice and clinical research. However, to date, a head-to-head comparison has not been performed. METHODS: A numerical pain scale (0-10), the 24-item and 2 modified 18-item versions of the Roland Morris questionnaire, the patient specific functional scale, and physical impairment measures were completed by 155 patients with low back pain at baseline and then again after 6 weeks together with an 11-point global perceived effect scale. Responsiveness was evaluated by using effect sizes and t tests, correlating the change scores for each outcome with the global perceived effect score and by calculating the Guyatt responsiveness index. RESULTS: The most responsive outcome proved to be the patient specific functional scale (effect size = 1.6), followed by the numerical pain scale (effect size = 1.3) and 24-item Roland Morris questionnaire (effect size = 0.8). The responsiveness of the two 18-item Roland Morris versions was equal to the 24-item version. However, the physical impairment measures were not very responsive (effect size 0.1-0.6). The ranking of the responsiveness indices was consistent across all statistical analyses. CONCLUSIONS: Physical impairments are routinely measured in clinical practice and clinical research, but the lower responsiveness indicates that this approach is not optimal. Our findings suggest that more emphasis should be placed on change in pain and disability scores than on change in physical impairments.
Publication Types:
PMID: 15082988 [PubMed - indexed for MEDLINE]
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Long-term outcomes in multidisciplinary treatment of chronic low back pain: results of a 13-year follow-up.
Patrick LE, Altmaier EM, Found EM.
Northwest Occupational Medicine Center, Portland, OR 97223, USA. lpatrick@nwomc.com
STUDY DESIGN: Patients completing a multidisciplinary pain treatment were contacted to obtain 13-year follow-up information on pain, mood, employment, and general health. OBJECTIVES: Study objectives were to determine if post-treatment improvements were maintained over a lengthy follow-up period and to compare patients' general health to norms of comparably aged persons. SUMMARY OF BACKGROUND DATA: Although many studies have demonstrated the short-term effectiveness of multidisciplinary pain treatment programs for chronic low back pain, few studies have documented that these treatment gains are maintained over time. Only two studies have reported patient outcomes on a long-term basis (10+ years). Those studies have documented that patient gains during treatment are generally maintained during follow-up. METHODS: An attempt was made to contact all patients completing an inpatient chronic back pain rehabilitation program at the University of Iowa's Spine Diagnostic and Treatment Center. Of the 45 participants, 28 were located and 26 agreed to participate in a telephone interview. Analyses of pretreatment and posttreatment data revealed these follow-up participants did not differ from the larger study sample. RESULTS: Patients maintained their treatment gains in all areas (pain intensity and interference, negative mood). Additionally, patients showed levels of general health comparable to similarly aged peers with the exceptions of pain (more pain) and physical functioning (lower functioning, more pain interference). More than half the sample was employed; of those not employed, few reported this was due to pain. CONCLUSIONS: The data lend support to the long-term effectiveness of multidisciplinary treatment programs for chronic low back pain.
PMID: 15082983 [PubMed - indexed for MEDLINE]
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The use of intradiscal steroid therapy for lumbar spinal discogenic pain: a randomized controlled trial.
Khot A, Bowditch M, Powell J, Sharp D.
Department of Trauma and Orthopaedics, Ipswich Hospital, Ipswich, UK.
STUDY DESIGN: A prospective randomized study of the therapeutic effect of intradiscal steroid injection compared to a saline placebo. OBJECTIVES: To determine whether intradiscal steroid injection influences the clinical outcome at 1 year in patients with chronic low back pain of discogenic origin. SUMMARY OF BACKGROUND DATA: Steroids have been used empirically in the treatment of back pain. They have been used in the epidural space and around nerve roots and have been used as an alternative to chymopapain within the disc. Previous studies have, however, shown variable results. METHODS: A total of 120 patients with chronic low back pain of discogenic origin were enrolled in the study. At discography, if they had concordant pain, they were randomized to injection of normal saline or methylprednisolone into the disc space. These patients were prospectively followed up for 12 months, and they were asked to report pain according to a visual analogue score and their Oswestry Disability Index was recorded. The primary outcome measure was determined as a percentage change in disability, and the results were analyzed using independent samples t test. The secondary outcome measure was a change in the pain score, and this was analyzed using the Mann-Whitney U test. RESULTS: There was no significant difference in the primary outcome between the two groups (P = 0.71). The steroid group had a mean change of 2.28 (SE 2.49) in percentage disability, while the saline group had a mean change of 3.42 (SE 1.79). With respect to the change in pain score, there was no significant difference between the two groups (P = 0.72). Those patients who had saline injection had a median change in pain score of 0 (interquartile range -1 to 1), whereas those given steroid treatment had a median change in pain score of 0 (interquartile range -0.25 to 1). CONCLUSIONS: This study demonstrates that intradiscal steroid injections do not improve the clinical outcome in patients with discogenic back pain compared with placebo.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15082979 [PubMed - indexed for MEDLINE]
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Cervical epidural abscess after epidural steroid injection.
Huang RC, Shapiro GS, Lim M, Sandhu HS, Lutz GE, Herzog RJ.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA. huangr@hss.edu
STUDY DESIGN: This is a case report of a cervical epidural abscess presenting with neurologic deficits after cervical epidural steroid injection. OBJECTIVE: To describe the presentation, diagnosis, treatment, and outcome of a rare complication of cervical epidural steroid injection. SUMMARY OF BACKGROUND DATA: Cervical epidural steroid injections are a commonly used modality in the treatment of cervical spine disease. Serious complications from the procedure are rare. There is only one previously reported case of cervical epidural abscess after cervical epidural injection in the literature. MATERIALS AND METHODS: A case of cervical epidural abscess after epidural steroid injection is presented and the relevant literature is reviewed. RESULTS: The patient had partial recovery of neurologic function within the first 24 hours after decompressive laminectomy, irrigation, and debridement. There were no perioperative complications. Intraoperative cultures permitted positive identification of the infecting organism and appropriate antibiotic selection. At 7-month follow-up, there was no recurrence of infection and the patient had recovered baseline neurologic function and neck pain status. CONCLUSIONS: Cervical epidural abscess is a rare but potentially devastating complication after epidural steroid injection. Neurologic compromise may occur. Timely diagnosis and appropriate treatment may result in good clinical outcomes.
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PMID: 14699291 [PubMed - indexed for MEDLINE]
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Rapid improvement of paraplegia caused by epidural involvements of Burkitt's lymphoma with chemotherapy.
Matsubara H, Watanabe K, Sakai H, Chang H, Fujino H, Higashi Y, Kobayashi M, Adachi S, Seto S, Nakahata T.
Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan. hrmatsub@kuhp.kyoto-u.ac.jp
STUDY DESIGN: Case report. OBJECTIVE: The authors present a case of atypical Burkitt's lymphoma with multiple epidural involvements. SUMMARY OF BACKGROUND DATA: Spinal cord compression in children is an emergency that requires urgent attention to minimize neurologic dysfunction. Although it is not life-threatening in most patients, cord compression can cause severe neurologic morbidity. MATERIALS AND METHODS: Because the patient showed rapid neurologic deterioration, we started chemotherapy and high-dose steroids without laminectomy or radiotherapy immediately after a tumor biopsy from the left mandible. RESULT: The combined therapies were very effective and his neurologic symptoms improved immediately. The epidural involved masses disappeared in imaging studies after the first course of chemotherapy including methylprednisolone (20 mg/kg per day for 3 consecutive days and gradually tapered off over 2 weeks), vincristine (1.5 mg/m2 per day), cyclophosphamide (2 g/m2 per day for 2 days) and pirarubicin (40 mg/m2 per day). After completing seven courses of chemotherapy, the patient is now fully ambulant. CONCLUSION: Considering the severe late effects of laminectomy and radiotherapy, chemotherapy should be considered as a first choice of treatment for spinal cord compression caused by malignant lymphoma.
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PMID: 14699290 [PubMed - indexed for MEDLINE]
Comment on:
Manual therapy and exercise therapy in patients with chronic low back pain: a randomized, controlled trial with 1-year follow-up.
Mooney V.
Publication Types:
PMID: 14699287 [PubMed - indexed for MEDLINE]
Dialogues on complex analgesic strategies for difficult pain syndromes.
Mercadante S, Villari P, Ferrera P.
Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Via S.Lorenzo 312, 90146, Palermo, Italy.
Although the use of oral analgesics for the control of cancer pain has been demonstrated to be successful in most patients, some patients will fail to respond to pharmacological therapy or will suffer unacceptable adverse effects. Experience is accumulating that when adverse effects prevail with oral opioid administration, the analgesic response may be improved by changing the drug and/or the route of administration. Switching to an alternative opioid may further improve the balance between analgesia and adverse effects Despite optimal systemic opioid treatment, in some complicated circumstances it is necessary to find different solutions, including the neuraxial administration of multiple drugs with different characteristics, which are difficult to manage. Three case reports illustrate how complex could be the analgesic approach using multiple analgesic regimens and different routes of administration to effectively manage complex pain syndromes commonly defined as unresponsive.
PMID: 15083354 [PubMed - as supplied by publisher]
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