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Items 1 - 12 of 12 |
One page. |
Mesenteric vein thrombosis: abdominal pain in a thrombophile.
Padgett RG, Salik RM.
Publication Types:
PMID: 15520948 [PubMed - indexed for MEDLINE]
Treatments for back pain: can we get past trivial effects?
Deyo RA.
Publication Types:
PMID: 15611493 [PubMed - in process]
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A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study.
Childs JD, Fritz JM, Flynn TW, Irrgang JJ, Johnson KK, Majkowski GR, Delitto A.
Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas, USA. childsjd@sbcglobal.net
BACKGROUND: Conflicting evidence exists about the effectiveness of spinal manipulation. OBJECTIVE: To validate a manipulation clinical prediction rule. DESIGN: Multicenter randomized, controlled trial. SETTING: Physical therapy clinics. PATIENTS: 131 consecutive patients with low back pain, 18 to 60 years of age, who were referred to physical therapy. INTERVENTION: Patients were randomly assigned to receive manipulation plus exercise or exercise alone by a physical therapist for 4 weeks. MEASUREMENTS: Patients were examined according to the clinical prediction rule criteria (symptom duration, symptom location, fear-avoidance beliefs, lumbar mobility, and hip rotation range of motion). Disability and pain at 1 and 4 weeks and 6 months were assessed. RESULTS: Outcome from spinal manipulation depends on a patient's status on the prediction rule. Treatment effects are greatest for the subgroup of patients who were positive on the rule (at least 4 of 5 criteria met); health care utilization among this subgroup was decreased at 6 months. Compared with patients who were negative on the rule and received exercise, the odds of a successful outcome among patients who were positive on the rule and received manipulation were 60.8 (95% CI, 5.2 to 704.7). The odds were 2.4 (CI, 0.83 to 6.9) among patients who were negative on the rule and received manipulation and 1.0 (CI, 0.28 to 3.6) among patients who were positive on the rule and received exercise. A patient who was positive on the rule and received manipulation has a 92% chance of a successful outcome, with an associated number needed to treat for benefit at 4 weeks of 1.9 (CI, 1.4 to 3.5). LIMITATIONS: The response rate for the 6-month follow-up resulted in inadequate power to detect statistically significant differences for some comparisons. CONCLUSIONS: The spinal manipulation clinical prediction rule can be used to improve decision making for patients with low back pain.
PMID: 15611489 [PubMed - in process]
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Acupuncture versus placebo for the treatment of chronic mechanical neck pain: a randomized, controlled trial.
White P, Lewith G, Prescott P, Conway J.
Complementary Medicine Research Unit, Mail Primary Medical Care, University of Southampton, Aldermoor Health Centre, Southampton, United Kingdom. pjw1@soton.ac.uk
BACKGROUND: Despite substantial increases in its popularity and use, the efficacy of acupuncture for chronic mechanical neck pain remains unproved. OBJECTIVE: To compare acupuncture and placebo for neck pain. DESIGN: A randomized, single-blind, placebo-controlled, parallel-arm trial with 1-year follow-up. SETTING: The outpatient departments of 2 major hospitals in the United Kingdom, 1999 to 2001. PATIENTS: 135 patients 18 to 80 years of age who had chronic mechanical neck pain. Eleven patients withdrew from treatment, and 124 completed the primary end point. MEASUREMENTS: The primary outcome was pain 1 week after treatment, according to a visual analogue scale. Secondary outcomes were pain at other time points, score on the Neck Disability Index and the Short Form-36, and use of analgesic medications. INTERVENTIONS: Patients were randomly assigned to receive, over 4 weeks, 8 treatments with acupuncture or with mock transcutaneous electrical stimulation of acupuncture points using a decommissioned electroacupuncture stimulation unit. RESULTS: Both groups improved statistically from baseline, and acupuncture and placebo had similar credibility. For the primary outcome (weeks 1 to 5), a statistically significant difference in visual analogue scale score in favor of acupuncture (6.3 mm [95% CI, 1.4 to 11.3 mm]; P = 0.01) was observed between the 2 study groups, after adjustment for baseline pain and other covariates. However, this difference was not clinically significant because it demonstrated only a 12% (CI, 3% to 21%) difference between acupuncture and placebo. Secondary outcomes showed a similar pattern. LIMITATIONS: All treatments were provided by 1 practitioner. Although the control was credible, it did not mimic the process of needling. A nonintervention group was not present to control for regression to the mean. CONCLUSIONS: Acupuncture reduced neck pain and produced a statistically, but not clinically, significant effect compared with placebo. The beneficial effects of acupuncture for pain may be due to both nonspecific and specific effects.
PMID: 15611488 [PubMed - in process]
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Summaries for patients. Identifying patients with low back pain who are likely to benefit from spinal manipulation.
[No authors listed]
PMID: 15611484 [PubMed - in process]
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Summaries for patients. Acupuncture for treatment of chronic neck pain.
[No authors listed]
PMID: 15611483 [PubMed - in process]
The Sick Dürer--a Renaissance prototype pain map.
Schott GD.
National Hospital for Neurology and Neurosurgery, London WC1N 3BG. geoffrey.schott@uclh.org
Publication Types:
PMID: 15604197 [PubMed - indexed for MEDLINE]
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Randomised controlled trial of magnetic bracelets for relieving pain in osteoarthritis of the hip and knee.
Harlow T, Greaves C, White A, Brown L, Hart A, Ernst E.
College Surgery, Cullompton, Devon EX15 1TG. timharlow@eclipse.co.uk
OBJECTIVE: To determine the effectiveness of commercially available magnetic bracelets for pain control in osteoarthritis of the hip and knee. DESIGN: Randomised, placebo controlled trial with three parallel groups. SETTING: Five rural general practices. PARTICIPANTS: 194 men and women aged 45-80 years with osteoarthritis of the hip or knee. INTERVENTION: Wearing a standard strength static bipolar magnetic bracelet, a weak magnetic bracelet, or a non-magnetic (dummy) bracelet for 12 weeks. MAIN OUTCOME MEASURES: Change in the Western Ontario and McMaster Universities osteoarthritis lower limb pain scale (WOMAC A) after 12 weeks, with the primary comparison between the standard and dummy groups. Secondary outcomes included changes in WOMAC B and C scales and a visual analogue scale for pain. RESULTS: Mean pain scores were reduced more in the standard magnet group than in the dummy group (mean difference 1.3 points, 95% confidence interval 0.05 to 2.55). Self reported blinding status did not affect the results. The scores for secondary outcome measures were consistent with the WOMAC A scores. CONCLUSION: Pain from osteoarthritis of the hip and knee decreases when wearing magnetic bracelets. It is uncertain whether this response is due to specific or non-specific (placebo) effects.
Publication Types:
- Clinical Trial
- Multicenter Study
- Randomized Controlled Trial
PMID: 15604181 [PubMed - indexed for MEDLINE]
Anaesthesia for laparoscopic urological surgery.
Conacher ID, Soomro NA, Rix D.
Freeman Hospitals Trust, Newcastle upon Tyne, UK. i.d.conacher@btinternet.com
Laparoscopy for urological surgery is a relatively recent surgical innovation. Some centres have substantial experience of single operations, but very few have experience with a comprehensive range. Our programme began with nephrectomy and pyeloplasty, and has expanded to provide for a living related kidney donor programme and for other procedures usually conducted open. Recently, it has included prostate and bladder cancer surgery. The learning curve and implications for anaesthesia are described on the basis of the experience of one anaesthetist with 124 patients. Perioperative care issues, in common with other abdominal laparoscopic procedures, relate to operating positions, the consequences of carbon dioxide under pressure in the abdomen and postoperative analgesia. There is only a small requirement for regional anaesthesia supplementation and invasive analgesia. The corporate laparoscopic cholecystectomy experience was used as the foundation for anaesthesia and to delineate specific organ system issues and any interventions. Significant differences were found in the spectrum of the urological patient population and comorbidity, notably renal function or dysfunction, and complications.
Publication Types:
PMID: 15377587 [PubMed - indexed for MEDLINE]
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Painful stimulation of the temple induces nausea, headache and extracranial vasodilation in migraine sufferers.
Drummond PD, Granston A.
School of Psychology, Murdoch University, Western Australia. p.drummond@murdoch.edu.au
To determine whether painful stimulation of the temple would induce nausea, ice was applied to the temple for 30 s, three times at 4-min intervals in 23 migraine sufferers and 22 age- and sex-matched controls. On one occasion, the ice was applied in the presence of residual motion sickness induced by optokinetic stimulation. On another occasion, the ice application was not preceded by optokinetic stimulation (the baseline condition). In the baseline condition, nausea had developed in migraine sufferers but not controls by the third application of ice. In the presence of residual motion sickness, each painful stimulus intensified nausea and headache in migraine sufferers whereas symptoms were minimal in controls. Changes in frontotemporal pulse amplitude were monitored with photoelectric pulse transducers. The extracranial blood vessels dilated in migraine sufferers but not controls before the first application of ice in the baseline condition, presumably due to anticipatory anxiety. In contrast, the ice application did not provoke extracranial vasodilation in either group after optokinetic stimulation. The findings show that susceptibility to nausea and stress-induced extracranial vascular hyper-reactivity are associated with the migraine predisposition. They also suggest that head pain might intensify gastrointestinal disturbances during attacks of migraine.
PMID: 15606565 [PubMed - in process]
Pain education for underserved minority cancer patients: a randomized controlled trial.
Anderson KO, Mendoza TR, Payne R, Valero V, Palos GR, Nazario A, Richman SP, Hurley J, Gning I, Lynch GR, Kalish D, Cleeland CS.
Department of Symptom Research, The University of Texas M.D. Anderson Cancer Center, 1100 Holcombe Blvd, Box 221, Houston, TX 77030, USA. koanderso@mdanderson.org
PURPOSE: Previous studies found that African American and Hispanic cancer patients are at risk for undertreatment of pain. We evaluated the efficacy of a pain education intervention for underserved minority patients. PATIENTS AND METHODS: Ninety-seven underserved African American and Hispanic outpatients with cancer-related pain were enrolled onto a randomized clinical trial of pain management education. The patients in the education group received a culture-specific video and booklet on pain management. The control group received a video and booklet on nutrition. A research nurse met with each patient to review the materials. We measured changes in pain intensity and pain-related interference 2 to 10 weeks after the intervention, as well as changes in quality of life, perceived pain control, functional status, analgesics, and physician pain assessments. RESULTS: Physicians underestimated baseline pain intensity and provided inadequate analgesics for more than 50% of the sample. Although the ratings for pain intensity and pain interference decreased over time for both groups, there was no statistically significant difference between groups. Pain education did not affect quality of life, perceived pain control, or functional status. African American patients in the education but not the control group reported a significant decrease in pain worst ratings from baseline to first follow-up (P < .01), although this decrease was not maintained at subsequent assessments. CONCLUSION: Brief education had limited impact on pain outcomes for underserved minority patients, suggesting that more intensive education for patients and interventions for physicians are needed.
PMID: 15611506 [PubMed - in process]
Comment in:
Patterns of cannabis use among patients with multiple sclerosis.
Clark AJ, Ware MA, Yazer E, Murray TJ, Lynch ME.
Dalhousie University, Halifax, Nova Scotia, Canada.
To estimate the patterns and prevalence of cannabis use among patients with multiple sclerosis (MS), 220 patients were surveyed in Halifax, Nova Scotia. Seventy-two subjects (36%) reported ever having used cannabis for any purpose; 29 respondents (14%) reported continuing use of cannabis for symptom treatment. Medical cannabis use was associated with male gender, tobacco use, and recreational cannabis use. The symptoms reported by medical cannabis users to be most effectively relieved were stress, sleep, mood, stiffness/spasm, and pain.
PMID: 15184623 [PubMed - indexed for MEDLINE]
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