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Items 1 - 37 of 37 |
One page. |
Hyperbaric oxygen therapy and pain management in a child with continuous infraclavicular brachial plexus block.
Minville V, Chassery C, Kern D, Fourcade O, Dadure C.
Publication Types:
PMID: 15562104 [PubMed - indexed for MEDLINE]
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Pin-pricks and pins' tricks: a new method to reduce pin-prick pain of intramuscular and subcutaneous injections.
Romano CL, Cecca E.
Publication Types:
- Clinical Trial
- Letter
- Randomized Controlled Trial
PMID: 15562096 [PubMed - indexed for MEDLINE]
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Intrinsic spinal cord catheter placement: implications of new intractable pain in a patient with a spinal cord injury.
Huntoon MA, Hurdle MF, Marsh RW, Reeves RK.
Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA. huntoon.marc@mayo.edu
We present a case of new intractable flank pain after intrathecal infusion system placement in a 45-yr-old man with a history of a T12 spinal cord injury with dysesthetic leg pain. Pain after intrathecal infusion system placement was evaluated by magnetic resonance imaging and the catheter was found to be intraparenchymal. The patient was treated by cessation of infusion and surgical removal of the system. Before surgical removal, the pump was turned off and the patient's flank pain resolved. Increased vigilance is warranted when caring for paraplegic patients. When new pain persists, intrathecal medication tapering should be considered.
Publication Types:
PMID: 15562068 [PubMed - indexed for MEDLINE]
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The intravenous ketamine test: a predictive response tool for oral dextromethorphan treatment in neuropathic pain.
Cohen SP, Chang AS, Larkin T, Mao J.
Pain Management Center, 550 North Broadway, Suite 301, Baltimore, MD 21205, USA. scohen@jhmi.edu
IV infusion tests performed to predict subsequent response to oral analgesics are an increasingly popular method used to enhance medical care and conserve resources. Because no infusion test is completely accurate, the potential benefits of these tests must be weighed against the frustration and waste in resources encountered with false-positive results, and the failure to use a potentially beneficial treatment with false-negative results. In recent years, drugs that act antagonistically at N-methyl-d-aspartate receptors have been shown to be valuable adjuncts in the treatment of pain. To determine the predictive value of small-dose (0.1 mg/kg) IV ketamine on an oral dextromethorphan (DX) treatment regimen, we analyzed the analgesic response to these drugs in 25 patients at 2 tertiary care military treatment facilities, institutions at which DX is not readily accessible. When >/=50% response for both drugs was used as the outcome measure for success, the positive predictive value of the ketamine test was 64%, the negative predictive value 73%, and the observed agreement 68%. However, when >/=67% relief with ketamine was used as an outcome measure (as determined by a receiver operating characteristic curve), the positive predictive value was 90%, the negative predictive value 80%, and the observed agreement increased to 84%. Based on these results, we conclude that an IV ketamine test may be useful in predicting response to oral DX. More research is needed to determine the ideal candidates for such a test, and the optimal dose and cutoff value for the response to ketamine.
Publication Types:
PMID: 15562066 [PubMed - indexed for MEDLINE]
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A comparison of postoperative pain control in patients after right lobe donor hepatectomy and major hepatic resection for tumor.
Cywinski JB, Parker BM, Xu M, Irefin SA.
Department of General Anesthesiology / E31, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
After initiating a living donor liver transplant program at our institution, we observed that donor patients experienced significant postoperative pain despite the use of thoracic patient-controlled epidural analgesia (PCEA) infusion catheters. We retrospectively compared patients who underwent right lobe donor hepatectomy (RLDH, n = 15) with patients who had undergone major hepatic resection for tumor (MHRT, n = 15) to elucidate the cause for this observation. All patients had preoperative thoracic epidural catheters placed, and both groups had similar surgical exposure. Demographic information, intraoperative variables, intensity of postoperative pain by visual analog pain score (VAPS), side effects, total number of requested and delivered PCEA doses, and the total amount of bupivacaine (mg) and volume (mL) of PCEA solution administered through 48 h postoperatively were collected and analyzed. The RLDH group had a significantly longer surgical duration than did the MHRT group. The RLDH group patients had higher postoperative pain scores (P = 0.034), and were 2.76 (1.12-6.82, 95% CI) times more likely to have pain than those patients in the MHRT group. There was no significant difference between patient groups for the amount of bupivacaine and volume of PCEA solution administered. These observations may be explained, in part, by the longer duration of surgery in the RLDH group. The possible role of preemptive analgesia via PCEA infusion and better perioperative teaching of PCEA use are discussed; these may lead to improved early postoperative pain control in RLDH patients.
PMID: 15562065 [PubMed - indexed for MEDLINE]
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Pain on injection: a double-blind comparison of propofol with lidocaine pretreatment versus propofol formulated with long- and medium-chain triglycerides.
Schaub E, Kern C, Landau R.
Service d'Anesthesiologie, Hopitaux Universitaires de Geneve, Rue Micheli du Crest 24, 1211 Geneve 14, Switzerland.
The incidence of pain on injection of propofol has been reported to be 70%. A new propofol formulation with a 10% emulsion of long- and medium-chain triglycerides (LCT/MCT) is associated with less pain on injection. Our goal was to compare the effect of propofol-LCT/MCT on the incidence of pain versus propofol with lidocaine 40 mg IV pretreatment injected as a Bier's block. Two hundred healthy women scheduled for ambulatory gynecological procedures were allocated to 1 of 2 groups in a randomized double-blind fashion. Group LIDO received lidocaine 2% 2 mL injected with a tourniquet 1 min before propofol 1% 2 mg/kg IV; group LCT/MCT received NaCl 0.9% 2 mL with tourniquet 1 min before propofol-LCT/MCT 1% 2 mg/kg IV. Spontaneous verbal expressions of pain, movement of hand, frowning, and moaning during the injection were recorded. The incidence and severity of pain were assessed 30 min and 6 h after surgery. Recall of pain was considered with a visual analog scale (VAS) score >1, and pain was graded as VAS 0-10. More women reported spontaneous verbal expression of pain with propofol-LCT/MCT (47% versus 24%; P = 0.0014; relative risk 1.61 [95% confidence interval, 1.22-2.13]). Among women with a painful injection, there was no difference after surgery regarding the intensity of pain or recall of pain. In contrast to previous reports, we found that propofol-LCT/MCT resulted in a more frequent incidence of pain than propofol 1% with IV lidocaine pretreatment. This may be due to the diversity of pain definitions used in studies or to the lack of premedication in our study.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15562057 [PubMed - indexed for MEDLINE]
7: id: 15564971 Error occurred: Document retrieval error: document is empty
Comment on:
Frequent utilization of fluoroscopy is essential for precise needle placement in interventional pain procedure.
Huang J.
Publication Types:
PMID: 15564967 [PubMed - indexed for MEDLINE]
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Intranasal nicotine for postoperative pain treatment.
Flood P, Daniel D.
Department of Anesthesiology, Columbia University, New York, New York, USA. pdf3@columbia.edu
BACKGROUND: Despite pharmacological treatment, 70-80% of patients report moderate to severe pain after surgery. Because nicotine has been reported to have analgesic properties in animal and human volunteer studies, the authors assessed the analgesic efficacy of a single 3 mg dose of nicotine nasal spray administered before emergence from general anesthesia. METHODS: The authors conducted a randomized, double blind, placebo controlled trial of 20 healthy women (mean age 45 (SD 8) yr) who were to undergo uterine surgery through a low transverse incision. After the conclusion of surgery but before emergence from general anesthesia, the anesthesiologist administered either nicotine nasal spray or a placebo. Numerical analog pain score and morphine utilization and hemodynamic values were measured for 24 h. RESULTS: The patients treated with nicotine reported lower pain scores during the first hour after surgery (peak numerical analog score, 7.6 (SD 1.4) versus 5.3 (SD 1.6); P < 0.001) and used half the amount of morphine as the control group (12 (SD 6) versus 6 (SD 5) mg; P < 0.05). Patients who received nicotine still reported less pain than those in the control group 24 h after surgery (1.5 (SD 0.5) versus 4.9 (SD 1.4); P < 0.01). Systolic blood pressure was lower in the group that received nicotine (105 (SD 3) versus 122 (SD 3); P < 0.001), but there was no difference in diastolic blood pressure or heart rate. CONCLUSIONS: Treatment with a single dose of nicotine immediately before emergence from anesthesia was associated with significantly lower reported pain scores during the first day after surgery. The decreased pain was associated with a reduction in morphine utilization and the analgesic effect of nicotine was not associated with hypertension or tachycardia.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15564950 [PubMed - indexed for MEDLINE]
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Effect of pain and audiovisual stimulation on the depression of acute hypoxic ventilatory response by low-dose halothane in humans.
Pandit JJ, Moreau B, Donoghue S, Robbins PA.
Nuffield Department of Anaesthetics, John Radcliffe Hospital, University Laboratory of Physiology, Oxford, United Kingdom. jaideep.pandit@physiol.ox.ac.uk
BACKGROUND: The effects of different low-dose volatile agents in blunting the acute hypoxic ventilatory response (AHVR) are variable. Arousal (due to audiovisual stimulation) may prevent isoflurane-induced blunting of AHVR. The purpose of this study was to assess whether this was also the case for halothane. The authors also assessed the effects of pain on the interaction of halothane and AHVR. METHODS: Step decreases in end-tidal partial pressure of oxygen using dynamic end-tidal forcing were performed from normoxia to hypoxia (50 mmHg) in 10 healthy volunteers, with end-tidal partial pressure of carbon dioxide held 1-2 mmHg above normal, in six protocols: (1) control conditions (darkened, quiet room, eyes closed) without halothane and (2) with 0.1 minimum alveolar concentration (MAC) halothane; (3) audiovisual stimulation (bright room, loud television) without halothane and (4) with 0.1 MAC halothane; (5) pain (electrical stimulation of skin over the tibia to produce a visual analog pain score of 5-6 out of 10) without halothane and (6) with 0.1 MAC halothane. The Bispectral Index of the electroencephalogram was also monitored. RESULTS: Halothane did not affect normoxic minute ventilation in any arousal state but significantly reduced the magnitude of AHVR by 50% regardless of the background arousal state (P < 0.001). Bispectral Index values were reduced by halothane only in the absence of arousal (P < 0.003). Both pain and audiovisual stimulation modestly increased normoxic minute ventilation (P < 0.002) and AHVR (P < 0.003). CONCLUSIONS: Audiovisual stimulation does not prevent the blunting of AHVR by low-dose halothane. This result with halothane differs from previous results with isoflurane. Therefore, different anesthetics interact in different ways with arousal states. This finding raises the possibility that different anesthetics might differentially affect the hypoxic chemoreflex loop or that they might act in the brain at sites separate from the chemoreflex loop, differently to influence the wakefulness drive to ventilation.
PMID: 15564949 [PubMed - indexed for MEDLINE]
 
Non-steroidal anti-inflammatory drugs, including cyclo-oxygenase-2 inhibitors, in osteoarthritic knee pain: meta-analysis of randomised placebo controlled trials.
Bjordal JM, Ljunggren AE, Klovning A, Slordal L.
Department of Public Health and Primary Health Care, University of Bergen, 5018 Bergen, Norway. jmb@hib.no
OBJECTIVE: To estimate the analgesic efficacy of non-steroidal anti-inflammatory drugs (NSAIDs), including selective cyclo-oxygenase-2 inhibitors (coxibs), in patients with osteoarthritis of the knee. DESIGN: Systematic review and meta-analysis of randomised placebo controlled trials. STUDIES REVIEWED: 23 trials including 10 845 patients, median age of 62.5 years. 7807 patients received adequate doses of NSAIDs and 3038 received placebo. The mean weighted baseline pain score was 64.2 mm on 100 mm visual analogue scale (VAS), and average duration of symptoms was 8.2 years. MAIN OUTCOME MEASURE: Change in overall intensity of pain. RESULTS: Methodological quality of trials was acceptable, but 13 trials excluded patients before randomisation if they did not respond to NSAIDs. One trial provided long term data for pain that showed no significant effect of NSAIDs compared with placebo at one to four years. The pooled difference for pain on visual analogue scale in all included trials was 10.1 mm (95% confidence interval 7.4 to 12.8) or 15.6% better than placebo after 2-13 weeks. The results were heterogeneous, and the effect size for pain reduction was 0.32 (0.24 to 0.39) in a random effects model. In 10 trials that did not exclude non-responders to NSAID treatment the results were homogeneous, with an effect size for pain reduction of 0.23 (0.15 to 0.31). CONCLUSION: NSAIDs can reduce short term pain in osteoarthritis of the knee slightly better than placebo, but the current analysis does not support long term use of NSAIDs for this condition. As serious adverse effects are associated with oral NSAIDs, only limited use can be recommended.
Publication Types:
PMID: 15561731 [PubMed - indexed for MEDLINE]
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United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care.
UK BEAM Trial Team.
OBJECTIVE: To estimate the effect of adding exercise classes, spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise to "best care" in general practice for patients consulting with back pain. [See figure]. DESIGN: Pragmatic randomised trial with factorial design. SETTING: 181 general practices in Medical Research Council General Practice Research Framework; 63 community settings around 14 centres across the United Kingdom. PARTICIPANTS: 1334 patients consulting their general practices about low back pain. MAIN OUTCOME MEASURES: Scores on the Roland Morris disability questionnaire at three and 12 months, adjusted for centre and baseline scores. RESULTS: All groups improved over time. Exercise improved mean disability questionnaire scores at three months by 1.4 (95% confidence interval 0.6 to 2.1) more than "best care." For manipulation the additional improvement was 1.6 (0.8 to 2.3) at three months and 1.0 (0.2 to 1.8) at 12 months. For manipulation followed by exercise the additional improvement was 1.9 (1.2 to 2.6) at three months and 1.3 (0.5 to 2.1) at 12 months. No significant differences in outcome occurred between manipulation in NHS premises and in private premises. No serious adverse events occurred. CONCLUSIONS: Relative to "best care" in general practice, manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months; and exercise achieved a small benefit at three months but not 12 months.
Publication Types:
- Clinical Trial
- Multicenter Study
- Randomized Controlled Trial
PMID: 15556955 [PubMed - indexed for MEDLINE]
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United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care.
UK BEAM Trial Team.
OBJECTIVE: To assess the cost effectiveness of adding spinal manipulation, exercise classes, or manipulation followed by exercise ("combined treatment") to "best care" in general practice for patients consulting with low back pain. DESIGN: Stochastic cost utility analysis alongside pragmatic randomised trial with factorial design. SETTING: 181 general practices and 63 community settings for physical treatments around 14 centres across the United Kingdom. PARTICIPANTS: 1287 (96%) of 1334 trial participants. MAIN OUTCOME MEASURES: Healthcare costs, quality adjusted life years (QALYs), and cost per QALY over 12 months. RESULTS: Over one year, mean treatment costs relative to "best care" were 195 pounds sterling (360 dollars; 279 euros; 95% credibility interval 85 pounds sterling to 308 pounds sterling) for manipulation, 140 pounds sterling (3 pounds sterling to 278 pounds sterling) for exercise, and 125 pounds sterling (21 pounds sterling to 228 pounds sterling) for combined treatment. All three active treatments increased participants' average QALYs compared with best care alone. Each extra QALY that combined treatment yielded relative to best care cost 3800 pounds sterling; in economic terms it had an "incremental cost effectiveness ratio" of 3800 pounds sterling. Manipulation alone had a ratio of 8700 pounds sterling relative to combined treatment. If the NHS was prepared to pay at least 10,000 pounds sterling for each extra QALY (lower than previous recommendations in the United Kingdom), manipulation alone would probably be the best strategy. If manipulation was not available, exercise would have an incremental cost effectiveness ratio of 8300 pounds sterling relative to best care. CONCLUSIONS: Spinal manipulation is a cost effective addition to "best care" for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise.
Publication Types:
- Clinical Trial
- Multicenter Study
- Randomized Controlled Trial
PMID: 15556954 [PubMed - indexed for MEDLINE]
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A 32-year-old man with knee pain.
Adams JE, Lopez-Ben R, Meyer RD, Siegal GP.
Department of Resident in Pathology, The University of Alabama School of Medicine 35233, USA.
Publication Types:
- Case Reports
- Clinical Conference
PMID: 15552168 [PubMed - indexed for MEDLINE]
Diffuse bone pain in a young woman.
Cheng CJ, Chu P, Huang GS, Lin SH.
Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical College, National Defense University, Taipei, Taiwan.
Publication Types:
PMID: 15555672 [PubMed - indexed for MEDLINE]
An fMRI study of cortical representation of mechanical allodynia in patients with neuropathic pain.
Peyron R, Schneider F, Faillenot I, Convers P, Barral FG, Garcia-Larrea L, Laurent B.
Departement de Neurologie, Hopital de Bellevue, Bd Pasteur, 42055 Saint-Etienne, France. Roland.Peyron@univ-st-etienne.fr
OBJECTIVE: To investigate cerebral activity associated with allodynia in patients with neuropathic pain. METHODS: The brain responses of 27 patients with peripheral (5), spinal (3), brainstem (4), thalamic (5), lenticular (5), or cortical (5) lesions were studied with fMRI as innocuous mechanical stimuli were addressed to either the allodynic territory or the homologous contralateral region. RESULTS: When applied to the normal side, brush and cold rubbing stimuli did not evoke pain and activated a somatosensory "control" network including contralateral primary (SI) and secondary (SII) somatosensory cortices and insular regions. The same stimuli became severely painful when applied to the allodynic side and activated regions in the contralateral hemisphere that mirrored the "control" network, with, however, lesser activation of the SII and insular cortices. Increased activation volumes were found in contralateral SI and primary motor cortex (MI). Whereas ipsilateral responses appeared very small and restricted after control stimuli, they represented the most salient effect of allodynia and were observed mainly in the ipsilateral parietal operculum (SII), SI, and insula. Allodynic stimuli also recruited additional responses in motor/premotor areas (MI, supplementary motor area), in regions involved in spatial attention (posterior parietal cortices), and in regions linking attention and motor control (mid-anterior cingulate cortex). CONCLUSION: On a background of deafferentation in the hemisphere contralateral to stimuli, enhanced or additional responses to innocuous stimuli in the ipsilateral hemisphere may contribute to the shift of perception from innocuous toward painful and ill-defined sensations.
PMID: 15557499 [PubMed - in process]
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Comment on: Familial aggregation of depression in fibromyalgia: a community-based test of alternative hypotheses, Raphael et al., Pain 110 (2004) 449-460.
Arnold LM, Hudson JI.
Department of Psychiatry, University of Cincinnati, University Medical Arts Building, 222 Piedmont Avenue Suite 8200, Cincinnati, OH 45219, USAE-mail address: lesley.arnold@uc.edu.
Publication Types:
PMID: 15561398 [PubMed - in process]
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Spinal cord stimulation in a patient with persistent oesophageal pain.
Jackson M, Simpson KH.
Pain Management Service, Ashley Wing, St James's University Hospital, Leeds LS15 4NE, UK.
This study describes a man with a long history of oesophageal pain that led to inability to swallow food and drink. Over a period of 8 years, he had multiple oesophageal operations that were unsuccessful. He presented, to the pain management team, with persistent oesophageal pain and required jejunostomy tube feeding to maintain nutrition. Conservative pain management strategies failed. Spinal cord stimulation (SCS) was suggested, and after counseling, an electrode was placed in the high thoracic region. Stimulation covered the area of the chest pain. He achieved immediate reduced pain on swallowing water. A permanent system was implanted. In this case, SCS resulted in a significant improvement in pain on swallowing liquids. The patient can now also eat certain foods occasionally and enjoy the social aspect of eating; this was impossible previously. He feels that SCS has been worthwhile. The authors discuss the rationale for this treatment. The decision was based on the use of SCS for refractory angina, and the idea that the neural mechanisms that generate both these pain states may be similar.
PMID: 15561397 [PubMed - in process]
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Social networks and pain interference with daily activities in middle and old age.
Peat G, Thomas E, Handy J, Croft P.
Primary Care Sciences Research Centre, Keele University, Keele, Stoke-on-Trent, Staffordshire ST5 5BG, UK.
Social networks have emerged as important in the development and progression of disability in aging cohorts. We have previously reported that pain that interferes with daily activities is common and increases incrementally from middle age into later life. The current study has investigated whether pain interference in this age group is related to social network characteristics. 5215 community-dwelling adults aged 50 years and over participating in the North Staffordshire Osteoarthritis Project (NorStOP) and identified as currently experiencing pain formed the sample for the present analysis. Questions on pain-related interference and the number and frequency of contact with children, close relatives, close friends, and confidant were included in the baseline postal questionnaire. The number and frequency of contact for most social ties declined with age. Being widowed (Age-adjusted OR: 1.30; 95%CI: 1.10, 1.54), the absence of close friends (2.07; 1.64, 2.63), and the absence of close relatives for women (2.24; 1.66, 3.04) were associated with increased likelihood of pain interference with daily activities. The absence of children was linked to lower levels of pain interference (0.76; 0.64, 0.91). The associations with close friends and children were reduced but remained significant after adjusting for sociodemographic factors. The association with close friends became non-significant after adjusting for depression suggesting this may form part of the pathway linking close friends networks and pain interference. Pain-related interference shows similar associations with social networks as all-cause disability and may benefit similarly from a public health perspective.
PMID: 15561396 [PubMed - in process]
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Opioids in chronic non-cancer pain: systematic review of efficacy and safety.
Kalso E, Edwards JE, Moore RA, McQuay HJ.
Pain Clinic, Department of Anaesthesia and Intensive Care Medicine, Helsinki University Central Hospital, P.O. Box 340, FIN 00029 HUS, Finland.
Opioids are used increasingly for chronic non-cancer pain. Controversy exists about their effectiveness and safety with long-term use. We analysed available randomised, placebo-controlled trials of WHO step 3 opioids for efficacy and safety in chronic non-cancer pain. The Oxford Pain Relief Database (1950-1994) and Medline, EMBASE and the Cochrane Library were searched until September 2003. Inclusion criteria were randomised comparisons of WHO step 3 opioids with placebo in chronic non-cancer pain. Double-blind studies reporting on pain intensity outcomes using validated pain scales were included. Fifteen randomised placebo-controlled trials were included. Four investigations with 120 patients studied intravenous opioid testing. Eleven studies (1025 patients) compared oral opioids with placebo for four days to eight weeks. Six of the 15 included trials had an open label follow-up of 6-24 months. The mean decrease in pain intensity in most studies was at least 30% with opioids and was comparable in neuropathic and musculoskeletal pain. About 80% of patients experienced at least one adverse event, with constipation (41%), nausea (32%) and somnolence (29%) being most common. Only 44% of 388 patients on open label treatments were still on opioids after therapy for between 7 and 24 months. The short-term efficacy of opioids was good in both neuropathic and musculoskeletal pain conditions. However, only a minority of patients in these studies went on to long-term management with opioids. The small number of selected patients and the short follow-ups do not allow conclusions concerning problems such as tolerance and addiction.
PMID: 15561393 [PubMed - in process]
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Fear-avoidance beliefs and distress in relation to disability in acute and chronic low back pain.
Grotle M, Vollestad NK, Veierod MB, Brox JI.
Section for Health Science, University of Oslo, P.O. Box 1153 Blindern, N-0316 Oslo, Norway.
Patients with chronic low back pain (LBP) frequently demonstrate high scores for fear-avoidance beliefs and distress. We need better knowledge about fear-avoidance beliefs and distress in early stages of LBP. The objectives of this study were to compare the level of fear-avoidance beliefs and distress in patients with acute LBP to patients with chronic LBP, and to assess the relationship of fear-avoidance beliefs and distress to disability in acute and chronic LBP. Two different back pain groups including 123 patients with acute and 233 patients with chronic LBP were studied. Main outcome measures were Oswestry Disability Index and work loss. The scores for fear-avoidance beliefs and distress in patients with acute LBP were significantly lower than among patients with chronic LBP. The results of the multivariate regression analyses, adjusting for sociodemographic, pain and clinical variables, demonstrated that whereas fear-avoidance beliefs for physical activity and distress were significantly associated with the Oswestry Disability Index, fear-avoidance beliefs for work and distress were significantly associated with work loss. The associations showed the same pattern in acute and chronic LBP. In addition, several of the pain and clinical variables were significantly associated with the Oswestry Disability Index and fingertip-floor distance was associated with work loss. In conclusion, fear-avoidance beliefs and distress influence pain-related disability both in early acute and long-term chronic LBP. The results replicate previous reports on the association between pain experience, fear-avoidance beliefs, distress, and disability in chronic LBP, and extend the findings to patients at an early stage of acute LBP.
PMID: 15561390 [PubMed - in process]
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Electronic diary assessment of pain-related fear, attention to pain, and pain intensity in chronic low back pain patients.
Roelofs J, Peters ML, Patijn J, Schouten EG, Vlaeyen JW.
Department of Medical, Clinical and Experimental Psychology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
The present study investigated the relationships between pain-related fear, attention to pain, and pain intensity in daily life in patients with chronic low back pain. An experience sampling methodology was used in which electronic diary data were collected by means of palmtop computers from 40 chronic low back pain patients who were followed for one week. Attention to pain was hypothesized to mediate the relation between pain-related fear and pain intensity. Further, pain-related fear as a trait characteristic was expected to moderate the relation between attention to pain and pain intensity. Multi-level analysis was used for all analyses. Although the tested mediation models yielded statistically significant mediation effects, the sizes of these effects were relatively small and clinically irrelevant. Instead, results suggested that pain-related fear and attention to pain independently predicted pain intensity. No evidence for moderation of the relation between attention to pain and pain intensity by pain-related fear as a trait characteristic was found. Implications of the results from this study are discussed and suggestions for future research are provided.
PMID: 15561389 [PubMed - in process]
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In vivo recruitment by painful stimuli of AMPA receptor subunits to the plasma membrane of spinal cord neurons.
Galan A, Laird JM, Cervero F.
Anesthesia Research Unit, McGill University, Montreal, Que., Canada; Department of Pharmacology and Therapeutics, McGill University, Montreal, Que., Canada.
The persistent increase in pain sensitivity observed after injury, known as hyperalgesia, depends on synaptic plasticity in the pain pathway, particularly in the spinal cord. Several potential mechanisms have been proposed, including post-synaptic exocytosis of the AMPA subclass of glutamate receptors (AMPA-R), which is known to play a critical role in synaptic plasticity in the hippocampus. AMPA-R trafficking has been described in spinal neurons in culture but it is unknown if it can also occur in spinal neurons in vivo, or if it can be induced by natural painful stimulation. Here we have induced referred mechanical hyperalgesia in vivo by intracolonic instillation of capsaicin in mice and have observed a recruitment of GluR1 AMPA-R subunits to neuronal plasma membranes in the lumbar spinal cord. Intracolonic capsaicin induced a rapid (10min) increase in GluR1, but not GluR2/3 in the synaptosomal membrane fraction which lasted at least 3h and a decrease in GluR1 subunit in the cytosolic fraction. Capsaicin treatment also provoked CaMKII activation and pre-treatment with a specific CaMKII inhibitor prevented the GluR1 trafficking. Brefeldin-A, an antibiotic that inhibits exocytosis of proteins, not only prevented GluR1 trafficking to the membrane but also inhibited referred hyperalgesia in capsaicin-treated mice. Our results show that delivery of GluR1 AMPA receptor subunits to the cell membrane through a CaMKII activity-dependent exocytotic regulated pathway contributes to the development of hyperalgesia after a painful stimulus. We conclude that AMPA-R trafficking contributes to the synaptic strengthening induced in the pain pathway by natural stimulation.
PMID: 15561387 [PubMed - in process]
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The association between pain and disability.
Turner JA, Franklin G, Heagerty PJ, Wu R, Egan K, Fulton-Kehoe D, Gluck JV, Wickizer TM.
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St., Room BB1517a Box 356560, Seattle, WA 98195-6560, USA; Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA.
A clearer understanding of how pain intensity relates to disability could have important implications for pain treatment goals and definitions of treatment success. The objectives of this study were to determine the optimal pain intensity rating (0-10 scale) cutpoints for discriminating disability levels among individuals with work-related carpal tunnel syndrome (CTS) and low back (LB) injuries, whether these cutpoints differed for these conditions and for different disability measures, and whether the relationship between pain intensity and disability was linear in each injury group. Approximately 3 weeks after filing work injury claims, 2183 workers (1059 CTS; 1124 LB) who still had pain completed pain and disability measures. In the LB group, pain intensity rating categories of 1-4, 5-6, and 7-10 optimally discriminated disability levels for all four disability measures examined. In the CTS group, no pain intensity rating categorization scheme proved superior across all disability measures. For all disability measures examined, the relationship between pain intensity and disability level was linear in the CTS group, but nonlinear in the LB group. Among study participants with work-related back injuries, when pain level was 1-4, a decrease in pain of more than 1-point corresponded to clinically meaningful improvement in functioning, but when pain was rated as 5-10, a 2-point decrease was necessary for clinically meaningful improvement in functioning. The findings indicate that classifying numerical pain ratings into categories corresponding to levels of disability may be useful in establishing treatment goals, but that classification schemes must be validated separately for different pain conditions.
PMID: 15561386 [PubMed - as supplied by publisher]
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Efficacy of two cannabis based medicinal extracts for relief of central neuropathic pain from brachial plexus avulsion: results of a randomised controlled trial.
Berman JS, Symonds C, Birch R.
Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
The objective was to investigate the effectiveness of cannabis-based medicines for treatment of chronic pain associated with brachial plexus root avulsion. This condition is an excellent human model of central neuropathic pain as it represents an unusually homogenous group in terms of anatomical location of injury, pain descriptions and patient demographics. Forty-eight patients with at least one avulsed root and baseline pain score of four or more on an 11-point ordinate scale participated in a randomised, double-blind, placebo-controlled, three period crossover study. All patients had intractable symptoms regardless of current analgesic therapy. Patients entered a baseline period of 2 weeks, followed by three, 2-week treatment periods during each of which they received one of three oromucosal spray preparations. These were placebo and two whole plant extracts of Cannabis sativa L.: GW-1000-02 (Sativex((R))), containing Delta(9)tetrahydrocannabinol (THC):cannabidiol (CBD) in an approximate 1:1 ratio and GW-2000-02, containing primarily THC. The primary outcome measure was the mean pain severity score during the last 7 days of treatment. Secondary outcome measures included pain related quality of life assessments. The primary outcome measure failed to fall by the two points defined in our hypothesis. However, both this measure and measures of sleep showed statistically significant improvements. The study medications were generally well tolerated with the majority of adverse events, including intoxication type reactions, being mild to moderate in severity and resolving spontaneously. Studies of longer duration in neuropathic pain are required to confirm a clinically relevant, improvement in the treatment of this condition.
PMID: 15561385 [PubMed - in process]
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Randomised trial of long term effect of acupuncture for shoulder pain.
Guerra de Hoyos JA, Martin Mdel C, Leon EB, Lopez MV, Lopez TM, Morilla FA, Moreno MJ.
Andalusia Public Health Service, C/La Maria 26, DP 41008 Sevilla, Spain.
The objective of the study is to compare the efficacy of electro-acupuncture with placebo-acupuncture for the treatment of shoulder pain. This study comprised of a prospective, randomized, placebo controlled trial, with independent evaluator set in a Public primary care clinic in Spain. The participants are patients aged from 25 to 83 years with shoulder pain. Patients were randomly allocated to two treatments over eight weeks, with electro-acupuncture or skin non-penetrating placebo-acupuncture, both able to take diclofenac if needed for intense pain. Primary outcome measure was the difference between groups in pain intensity (visual analogue scale-VAS). Secondary outcomes were differences between groups in pain intensity measured by Lattinen index, in range of motion (goniometer), functional ability (SPADI), quality of life (COOP-WONCA charts), NSAIDS intake, credibility (Borkoveck and Nau scale) and global satisfaction (10 points analogue scale). Assessments were performed before, during and three and six months after treatment. At six month follow-up after treatment the acupuncture group showed a significantly greater improvement in pain intensity compared with the control group [VAS mean difference 2.0 (95% CI 1.2-2.9)]. The acupuncture group had consistently better results in every secondary outcome measure than the control group. Acupuncture is an effective long-term treatment for patients with shoulder pain (from soft tissues lesions) in a primary care setting.
PMID: 15561384 [PubMed - in process]
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Acceptance of the unpleasant reality of chronic pain: effects upon attention to pain and engagement with daily activities.
Viane I, Crombez G, Eccleston C, Devulder J, De Corte W.
Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, B-9000 Ghent, Belgium; Research Institute for Psychology and Health, University of Bath, Bath, UK.
This paper investigates whether acceptance was related to less attention to pain, and to more engagement with daily activities. The results of two studies are reported. In a first cross-sectional study, 501 chronic pain patients completed self-report instruments on pain severity, attention to pain and acceptance. In a second diary study, 62 patients with chronic pain reported pain intensity, attention to pain and characteristics of goal-directed behaviour 8 times a day using an experience sampling method. Acceptance was measured using a self-report instrument. It was found that acceptance was related to less attention to pain (study 1 and study 2), more engagement with daily activities, a higher motivation to complete activities and a better efficacy to perform daily activities (study 2). Results are discussed in terms of how a positive life despite pain may be preserved by a flexible adjustment of personal goals to current limitations and adversities.
PMID: 15561383 [PubMed - in process]
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Laboratory pain perception and clinical pain in post-menopausal women and age-matched men with osteoarthritis: relationship to pain coping and hormonal status.
France CR, Keefe FJ, Emery CF, Affleck G, France JL, Waters S, Caldwell DS, Stainbrook D, Hackshaw KV, Edwards C.
Department of Psychology, Ohio University, 245 Porter Hall, Athens, OH 45701, USA.
The present study examined relationships between pain coping, hormone replacement therapy, and laboratory and clinical pain reports in post-menopausal women and age-matched men with osteoarthritis. Assessment of nociceptive flexion reflex threshold was followed by an assessment of electrocutaneous pain threshold and tolerance. Participants rated their arthritis pain using the Arthritis Impact Measurement Scales. To assess pain coping, participants completed measures of emotion-focused coping, problem-focused coping, and pain catastrophizing. Results indicated that women were more likely than men to report using emotion-focused pain strategies, and that emotion-focused coping was associated with more arthritic pain and lower electrocutaneous pain tolerance. Correlations between coping measures and pain reports revealed that catastrophizing was associated with greater arthritis pain and lower pain threshold and tolerance levels. However, catastrophizing was not related to nociceptive flexion reflex threshold, suggesting that the observed relationship between catastrophizing and subjective pain does not rely on elevated nociceptive input. A comparison of men (n=58), post-menopausal women receiving hormone replacement therapy (n=32), and post-menopausal women not receiving hormone replacement therapy (n=42) revealed no significant group differences in arthritis pain, electrocutaneous pain threshold or tolerance, or nociceptive flexion reflex threshold. Thus, older adults with osteoarthritis do not exhibit the pattern of sex differences in response to experimental pain procedures observed in prior studies, possibly due to the development of disease-related changes in pain coping strategies. Accordingly, individual differences in clinical and experimental pain may be better predicted by pain coping than by sex or hormonal differences.
PMID: 15561382 [PubMed - in process]
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The annual incidence and course of neck pain in the general population: a population-based cohort study.
Cote P, Cassidy JD, Carroll LJ, Kristman V.
Institute for Work and Health, 481 University Avenue, Suite 800, Toronto, Ont., Canada M5G 2E9; Department of Public Health Sciences, University of Toronto, Toronto, Ont., Canada.
Although neck pain is a common source of disability, little is known about its incidence and course. We conducted a population-based cohort study of 1100 randomly selected Saskatchewan adults to determine the annual incidence of neck pain and describe its course. Subjects were initially surveyed by mail in September 1995 and followed-up 6 and 12 months later. The age and gender standardized annual incidence of neck pain is 14.6% (95% confidence interval: 11.3, 17.9). Each year, 0.6% (95% confidence interval: 0.0-1.1) of the population develops disabling neck pain. The annual rate of resolution of neck pain is 36.6% (95% confidence interval: 32.7, 40.5) and another 32.7% (95% confidence interval: 25.5, 39.9) report improvement. Among subjects with prevalent neck pain at baseline, 37.3% (95% confidence interval: 33.4, 41.2) report persistent problems and 9.9% (95% confidence interval: 7.4, 12.5) experience an aggravation during follow-up. Finally, 22.8% (95% confidence interval: 16.4, 29.3) of those with prevalent neck pain at baseline report a recurrent episode. Women are more likely than men to develop neck pain (incidence rate ratio=1.67, 95% confidence interval 1.08-2.60); more likely to suffer from persistent neck problems (incidence rate ratio=1.19, 95% confidence interval 1.03-1.38) and less likely to experience resolution (incidence rate ratio=0.75, 95% confidence interval 0.63-0.88). Neck pain is a disabling condition with a course marked by periods of remission and exacerbation. Contrary to prior belief, most individuals with neck pain do not experience complete resolution of their symptoms and disability.
PMID: 15561381 [PubMed - in process]
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Development and validation of the pain treatment satisfaction scale (ptss): a patient satisfaction questionnaire for use in patients with chronic or acute pain.
Evans CJ, Trudeau E, Mertzanis P, Marquis P, Pena BM, Wong J, Mayne T.
Mapi Values, Boston, MA, USA; Lyon, France.
The purpose of this study was to develop and validate a measure of patient satisfaction for patients receiving treatment for either acute or chronic pain: the Pain Treatment Satisfaction Scale (PTSS). Development of the initial questionnaire included a comprehensive literature review and interviews with patients, physicians and nurses in the United States, Italy and France. After initial items were created, psychometric validation was run on responses from 111 acute pain and 89 chronic pain patients in the United States. Analyses included principal components factor analysis tests of reliability, clinical validity and confounding. The hypothesized structure of the questionnaire was supported by statistical analyses, and seven overlapping or inconsistent items were removed. The multi-item domains of the final PTSS included 39 items grouped in five dimensions: information (5 items); medical care (8 items); impact of current pain medication (8 items); satisfaction with pain medication which included the two subscales medication characteristics (3 items) and efficacy (3 items); and side effects (12 items). Internal consistency reliability coefficients were good (ranging from 0.83 to 0.92). The test-retest reliability coefficients (ranging from 0.67 to 0.81) were good for all dimensions except medication characteristics (0.55). All dimensions except medical care discriminated well according to pain severity. The satisfaction with efficacy dimension, hypothesized to change in the acute pain population, indicated good preliminary responsiveness properties (effect size 0.37; P<0.001). The PTSS is a valid, comprehensive instrument to assess satisfaction with treatment of pain based on independent modules that have demonstrated satisfactory psychometric performance.
PMID: 15561380 [PubMed - in process]
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Gender is a confounding factor in pain trials: women report more pain than men after arthroscopic surgery.
Rosseland LA, Stubhaug A.
Department of Anaesthesia, Rikshospitalet University Hospital, N-0027, Oslo, Norway.
A gender difference in the incidence of acute pain may be a confounder in analgesic trials. We have tested the hypothesis that the incidence of acute pain after knee arthroscopic procedures is greater in women than men. We performed three RCTs on intra-articular analgesics in which no postoperative analgesia was given until the need for such treatment was documented by scoring moderate-to-severe pain on a verbal rating scale (VRS 0-4; n=219), and a 0-100mm visual analogue pain scale (VAS) within 2h postoperatively. All trials were performed with an intra-articular catheter technique. The design allowed us to study the natural course of pain after arthroscopic surgery until analgesia was required. Women reported more pain of at least moderate intensity than men (84 vs 57%; P<0.0001), indicating that being female is a risk factor for early postoperative pain (RR 1.47, 95% confidence interval from 1.23 to 1.74). The VAS score corresponding to moderate and severe pain is similar in men and women. Only short acting anaesthetics were given in order to minimise carry-over effects. Since previous trials on arthroscopic analgesics neither measured baseline pain nor stratified for gender, a difference between treatment groups could result from an uneven distribution regarding these factors. Our findings have major implications for the interpretation of previously published trials on intra-articular analgesia.
PMID: 15561379 [PubMed - in process]
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Pavlovian conditioning of muscular responses in chronic pain patients: central and peripheral correlates.
Schneider C, Palomba D, Flor H.
Department of Neuropsychology, University of Heidelberg, Central Institute of Mental Health, J 5, D-68159 Mannheim, Germany.
A differential conditioning design using an aversive slide as conditioned stimulus (CS(+)) that was followed by an intracutaneous electric stimulus to the left index finger as unconditioned stimulus (US) and a pleasant slide that was not followed by shock (CS(-)) were used to test the hypothesis of enhanced aversive conditioning of muscular responses in chronic back pain patients (CBP). Heart rate, skin conductance levels, and integrated surface electromyograms (EMG) from the left and right m. flexor digitorum, the right m. trapezius, and bilaterally from the m. orbicularis oculi were recorded. The electroencephalogram (EEG) was measured from nine electrode positions. The CBP patients showed an enhanced muscular response of the left forearm (where the US was applied) to the CS(+) already in the preconditioning phase. During acquisition both the left forearm and the right trapezius of the patients but not the controls displayed enhanced muscular responding to the CS(+). During extinction the CBP patients' muscular responses to both CS(+) and CS(-) were elevated. The contingent negative variation of the EEG differentiated between CS(+) and CS(-) in the healthy controls but not the chronic pain patients. These data confirm the hypothesis of enhanced muscular responding in chronic pain patients and suggest a dissociation of muscular and central processes during aversive conditioning in the patients that might contribute to the chronicity problem.
PMID: 15561378 [PubMed - in process]
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Control of inflammatory pain by chemokine-mediated recruitment of opioid-containing polymorphonuclear cells.
Brack A, Rittner HL, Machelska H, Leder K, Mousa SA, Schafer M, Stein C.
Klinik fur Anaesthesiologie und operative Intensivmedizin, Charite-Universitatsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, D-12200 Berlin, Germany.
Opioid-containing leukocytes can counteract inflammatory hyperalgesia. Under stress or after local injection of corticotropin releasing factor (CRF), opioid peptides are released from leukocytes, bind to opioid receptors on peripheral sensory neurons and mediate antinociception. Since polymorphonuclear cells (PMN) are the predominant opioid-containing leukocyte subpopulation in early inflammation, we hypothesized that PMN and their recruitment by chemokines are important for peripheral opioid-mediated antinociception at this stage. Rats were intraplantarly injected with complete Freund's adjuvant (CFA). Using flow cytometry, immunohistochemistry, and ELISA, leukocyte subpopulations, chemokine receptor (CXCR2) expression on opioid-containing leukocytes and the CXCR2 ligands keratinocyte-derived chemokine (KC), macrophage inflammatory protein-2 (MIP-2) and cytokine-induced neutrophil chemoattractant-2 (CINC-2) were quantified. Paw pressure threshold (PPT) was determined before and after intraplantar and subcutaneous injection of CRF with or without naloxone. PMN depletion was achieved by intravenous injection of an antiserum. Chemokines were blocked by intraplantar injection of anti-MIP-2 and/or anti-KC antiserum. We found that at 2h post CFA (i) intraplantar but not subcutaneous injection of CRF produced dose-dependent and naloxone-reversible antinociception (P<0.05, ANOVA). (ii) Opioid-containing leukocytes in the paw and CRF-induced antinociception were reduced after PMN depletion (P<0.05, t-test). (iii) Opioid-containing leukocytes mostly expressed CXCR2. MIP-2 and KC, but not CINC-2 were detectable in inflamed but not in noninflamed tissue (P<0.05, ANOVA). (iv) Combined but not single blockade of MIP-2 and KC reduced the number of opioid-containing leukocytes and peripheral opioid-mediated antinociception (P<0.05, t-test; P>0.05, ANOVA). In summary, in early inflammation peripheral opioid-mediated antinociception is critically dependent on PMN and their recruitment by CXCR2 chemokines.
PMID: 15561377 [PubMed - in process]
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Discogenic pain.
Hurri H, Karppinen J.
The Orthopaedic Hospital and Rehabilitation Centre, ORTON, Tenholantie 10, 00280 Helsinki, Finland.
PMID: 15561376 [PubMed - in process]
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The occurrence of anular tears and their relation to lifetime back pain history: a cadaveric study using barium sulfate discography.
Videman T, Nurminen M.
University of Alberta, Edmonton, Alberta, Canada. tapio.videman@ualberta.ca
STUDY DESIGN: The occurrence of anular tears and general disc degeneration of the lumbar spine was studied in relation to the lifetime frequency of back pain. SUMMARY OF BACKGROUND DATA: Although anular tears and ruptures are common targets for diagnostic and therapeutic approaches, the relationship between disc findings and back pain has been weak or nonexistent. METHODS: The data comprised barium sulfate discograms of lumbar spine levels from 157 male cadavers. The extent of "anular tears" and "general disc degeneration" based on posterior-anterior and side views were evaluated separately using a 4-point scale. Lifetime history of back pain occurrence and work were obtained from the families of 86 cadavers. To assess whether the risk of back pain changed with the severity of findings or the level of disc, we applied trend tests and proportional-odds logistic models for occurrence data. RESULTS: In early adulthood, the risk of anular tears was 0.6 to 0.7, whereas at retirement age, tears were practically unavoidable. The risk of full anular tears with barium sulfate leaking ("leaking" tear) was estimated to be 0.10 and 0.35 among the men in the age groups of 20 to 49 and 50 to 59 years, respectively. The risk of "leaking" tears was greatest at the L5-S1 levels. There were less severe degenerative findings associated with sedentary occupation but no differences between driving and physically light and heavy occupations. Overall, the risk of any anular tears and any general degeneration as defined was similar. The frequency of back pain had a highly significant relation to the occurrence of tears (model-based P = 0.0009). With a "leaking" tear, the model-based estimate of the risk of frequent lifetime back pain was 0.42, with an "outer" tear the risk was 0.20, and with no tears or "inner" tears the risk was 0.10 (the observed prevalence was 0). The effect of occupational loading was of borderline significance (P = 0.045). CONCLUSION: Anular degeneration of the lumbar discs appear earlier and are more clearly related to back pain than previously thought, most probably due to the better sensitivity of the BaSO4 discography method to detect tears.
PMID: 15564915 [PubMed - in process]
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Does it matter which exercise? A randomized control trial of exercise for low back pain.
Long A, Donelson R, Fung T.
Bonavista Physical Therapy, Calgary, Alberta, Canada. longma@telusplanet.net
STUDY DESIGN: Multicentered randomized controlled trial. OBJECTIVES: To determine if previously validated low back pain (LBP) subgroups respond differently to contrasting exercise prescriptions. SUMMARY OF BACKGROUND DATA: The role of "patient-specific" exercises in managing LBP is controversial. METHODS: A total of 312 acute, subacute, and chronic patients, including LBP-only and sciatica, underwent a standardized mechanical assessment classifying them by their pain response, specifically eliciting either a "directional preference" (DP) (i.e., an immediate, lasting improvement in pain from performing either repeated lumbar flexion, extension, or sideglide/rotation tests), or no DP. Only DP subjects were randomized to: 1) directional exercises "matching" their preferred direction (DP), 2) exercises directionally "opposite" their DP, or 3) "nondirectional" exercises. Outcome measures included pain intensity, location, disability, medication use, degree of recovery, depression, and work interference. RESULTS: A DP was elicited in 74% (230) of subjects. One third of both the opposite and non-directionally treated subjects withdrew within 2 weeks because of no improvement or worsening (no matched subject withdrew). Significantly greater improvements occurred in matched subjects compared with both other treatment groups in every outcome (P values <0.001), including a threefold decrease in medication use. CONCLUSIONS: Consistent with prior evidence, a standardized mechanical assessment identified a large subgroup of LBP patients with a DP. Regardless of subjects' direction of preference, the response to contrasting exercise prescriptions was significantly different: exercises matching subjects' DP significantly and rapidly decreased pain and medication use and improved in all other outcomes. If repeatable, such subgroup validation has important implications for LBP management.
PMID: 15564907 [PubMed - in process]
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Prescription of nonsteroidal anti-inflammatory drugs and muscle relaxants for back pain in the United States.
Luo X, Pietrobon R, Curtis LH, Hey LA.
Center for Clinical Effectiveness, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710, USA. luo00003@mc.duke.edu
STUDY DESIGN: Secondary analysis of the 2000 Medical Expenditure Panel Survey (MEPS). OBJECTIVE.: To examine national prescription patterns of nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants among individuals with back pain in the United States. SUMMARY OF BACKGROUND DATA: There is a lack of information on national prescription patterns of NSAIDs and muscle relaxants among individuals with back pain in the United States. METHODS: Traditional NSAIDs, cyclooxygenase-2-specific (COX-2) inhibitors, and muscle relaxants were investigated. Individuals with back pain were stratified by socio-demographic characteristics and geographic regions. For each medication category, overall prescribing frequency was compared across different strata and individual drug prescription was analyzed. RESULTS: Traditional NSAIDs, COX-2 inhibitors, and muscle relaxants, respectively, accounted for 16.3%, 10%, and 18.5% of total prescriptions for back pain in 2000. Among individual drugs, ibuprofen and naproxen accounted for most of the prescriptions for traditional NSAIDs (60%), whereas two thirds of the prescriptions for muscle relaxants were attributable to cyclobenzaprine, carisoprodol, and methocarbamol. Prescription of COX-2 inhibitors or muscle relaxants demonstrated wide variations across different regions. Several individual characteristics including age, race, and educational level were associated with the prescription of some of the medications. CONCLUSIONS: Neither traditional NSAIDs, nor COX-2 inhibitors, nor muscle relaxants dominated prescriptions for back pain. However, a small number of individual drugs were attributable to most of the prescriptions for traditional NSAIDs or muscle relaxants. The prescription of some of the medications demonstrated wide variations across different regions or different racial and educational groups. More studies are needed to understand the source of the variations and what constitutes optimal prescribing.
PMID: 15564901 [PubMed - in process]
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