Ultimo Aggiornamento: Gennaio 2004

1: Anesth Analg. 2004 Jan;98(1):275-6.

Smaller dose of 0.5 mg/kg IV ketorolac is sufficient to provide pain relief in
children.

Hackmann T.

Publication Types:
Comment
LetterPMID: 14693649 [PubMed - in process]

2: Anesth Analg. 2004 Jan;98(1):274.

Assessment of pain during venous puncture using a visual analog scale and
problems associated with prolonged attachment of the lidocaine patch (PENLES).

Fujino Y, Nosaka S.

Publication Types:
LetterPMID: 14693648 [PubMed - in process]

3: Anesth Analg. 2004 Jan;98(1):178-84, table of contents.

Amiodarone decreases heat, cold, and mechanical hyperalgesia in a rat model of
neuropathic pain.

Datta S, Waghray T, Torres M, Glusman S.

Department of Anesthesiology and Pain Management, Cook County Hospital, Chicago,
Illinois, USA. sukdeb.datta@uc.edu

Lidocaine is effective in controlling ventricular dysrhythmia and neuropathic
pain. Amiodarone, like lidocaine, has sodium channel blocking properties. In the
present study we explore whether amiodarone has a similar effect as lidocaine on
the heat, cold, and mechanical hyperalgesia seen in the rat model of neuropathic
pain. Ten male Sprague-Dawley rats were anesthetized. Four loose ligatures were
placed on the sciatic nerve of the right hindpaw. A sham operation was performed
on the contralateral hindpaw (control). Heat hyperalgesia was determined by
comparing each paw withdrawal latency to heat stimulation (radiant heat source,
50 degrees C). Cold hyperalgesia was assessed with acetone application.
Mechanical hyperalgesia was determined by comparing the mechanical threshold in
the ligated and control hind paws using calibrated von Frey filaments.
Amiodarone was intraperitoneally administered at doses of 1, 5, 10, 20, 50, and
100 mg/kg after the development of hyperalgesia. The animals were tested for
hyperalgesia before and 1, 3, and 24 h after the administration of a single dose
of amiodarone. Intrathecal catheters were implanted in 5 new rats, and
amiodarone 5 mg/kg was injected. Testing for heat, mechanical, and cold
hyperalgesia was performed similarly in the intrathecal amiodarone
administration group. Amiodarone produces statistically significant decreases of
heat, cold, and mechanical hyperalgesia after intraperitoneal administration.
Results are statistically significant at 10 mg/kg (heat hyperalgesia), 20 mg/kg
(mechanical hyperalgesia), and 100 mg/kg (cold hyperalgesia) intraperitoneally.
Hyperalgesia returns 24 h after a dose. The intrathecal administration of
amiodarone produces a nonstatistically significant reduction of hyperalgesia.
Amiodarone seems to have a similar effect as lidocaine on the hyperalgesia seen
in the rat model of neuropathic pain. As the half-life of amiodarone is
significantly longer that that of lidocaine (mean, 53 days versus 90 min) in
humans, it may have the potential to provide a longer lasting (and perhaps more
effective) effect than lidocaine on neuropathic pain states. IMPLICATIONS:
Amiodarone was found to produce a statistically significant decrease in heat,
cold, and mechanical hyperalgesia in a rat model of neuropathic pain after
intraperitoneal injection. Considering its long half-life in humans, amiodarone
has the potential to provide long lasting pain relief in neuropathic pain
states.

PMID: 14693615 [PubMed - in process]

4: Anesth Analg. 2004 Jan;98(1):173-7, table of contents.

The sunburn pain model: the stability of primary and secondary hyperalgesia over
10 hours in a crossover setting.

Gustorff B, Anzenhofer S, Sycha T, Lehr S, Kress HG.

Department of Anesthesia and General Intensive Care Medicine (B), University of
Vienna, Wahringer-Gurtel 18-20, A-1090 Vienna, Austria.
burkhard.gustorff@univie.ac.at

It was our aim to study the within-day stability and between-day repeatability
of ultraviolet B (UVB) light-induced primary and secondary hyperalgesia over 10
h. Twenty hours after UVB irradiation of a skin spot (r = 2.5 cm) on the upper
leg of 8 healthy volunteers the areas of secondary hyperalgesia to pinprick and
pain tolerance thresholds to heat (HPTT) and electrical stimuli (5 and 250 Hz,
electrical pain tolerance thresholds [EPTT]) were assessed. Measurements were
repeated for 10 h at 2-h intervals and in 2 different sessions. Large areas of
secondary hyperalgesia to pin prick were observed (5995 mm(2); SD, 1645).
Primary hyperalgesia was evidenced by significant decreases of HPTT (mean
difference, 6.5 degrees C; 95% confidence interval, 6.1-6.8; P < 0.001) and EPTT
at 250 Hz (mean difference, 0.45 mA; 95% confidence interval, 0.13-0.78; P <
0.05) compared to normal skin. There was no trend within one session of either
primary (P = 0.14 for HPTT) or secondary hyperalgesia (P = 0.95) and no
difference between the two sessions (primary hyperalgesia, P = 0.28; secondary
hyperalgesia, P = 0.07). The sunburn pain model provides a long time course of
stable hyperalgesia with a high within-day stability and between-day
repeatability for primary and secondary hyperalgesia. IMPLICATIONS: The sunburn
pain model provides a long time course of stable hyperalgesia with a high
within-day stability and between-day repeatability for primary and secondary
hyperalgesia.

PMID: 14693614 [PubMed - in process]

5: Anesth Analg. 2004 Jan;98(1):159-65, table of contents.

Assessing analgesia in single and repeated administrations of propacetamol for
postoperative pain: comparison with morphine after dental surgery.

Van Aken H, Thys L, Veekman L, Buerkle H.

Department of Anesthesiology and Intensive Care Medicine, University Hospital,
University of Munster, Albert-Schweitzer-Strasse 33, D-48149 Munster, Germany.
hva@anit.uni-muenster.de

We conducted this double-blinded, randomized study to assess the analgesic
effect of repeated administrations of paracetamol, administered as propacetamol,
an injectable prodrug formulation of paracetamol, and to compare this with the
analgesic effects of morphine. Patients experiencing moderate to severe pain
after elective surgical removal of bone-impacted third-molar teeth under general
anesthesia were randomly assigned to receive IV propacetamol 2 g (n = 31), IM
morphine 10 mg (n = 30), or placebo (n = 34). Five hours later, the treatments
were readministered at half of the previous dosages. Standard measures of
analgesia were collected repeatedly for 10 h. Propacetamol and morphine were
significantly more effective than placebo in all primary measures of analgesia
over 5 h after the first administration and globally over 10 h (first and second
administrations). After the first dose, 21 of the 34 patients in the placebo
group required rescue medication, compared with 6 of the 31 in the propacetamol
group (P < 0.0009) and 4 of the 30 in the morphine group (P < 0.0001). No
statistically or clinically significant differences were found between
propacetamol and morphine for any sum or peak measures of analgesia. No serious
adverse events were reported; adverse events were significantly less frequent in
the propacetamol group than in the morphine group (P < 0.027). Propacetamol
administered IV in repeated doses (2 g followed by 1 g) has a significant
analgesic effect that is indistinguishable from that of morphine administered IM
(10 mg followed by 5 mg) after dental surgery, with better tolerability.
IMPLICATIONS: After moderately painful surgical procedures, IV paracetamol,
administered as propacetamol, may be an asset in the control of acute
postoperative pain.

PMID: 14693612 [PubMed - in process]

6: Anesth Analg. 2004 Jan;98(1):135-40, table of contents.

Preoperative rofecoxib oral suspension as an analgesic adjunct after lower
abdominal surgery: the effects on effort-dependent pain and pulmonary function.

Sinatra RS, Shen QJ, Halaszynski T, Luther MA, Shaheen Y.

Department of Anesthesiology, Yale University School of Medicine, TMP-3, 333
Cedar Street, New Haven, CT 06520-8051, USA. raymond.sinatra@yale.edu

Rofecoxib is a selective cyclooxygenase-2 inhibitor that reduces pain and
inflammation without inhibiting platelet function. We examined its effects on
effort-dependent pain, postoperative morphine requirements, and pulmonary
function in 48 patients recovering from open abdominal surgery. Spirometric
measurement of forced expiratory volume(1) and vital capacity (FVC) were
assessed preoperatively. One hour before the induction of a standardized general
anesthetic, patients were given either placebo oral suspension (Group A), or
rofecoxib oral suspension (25 mg [Group B] or 50 mg [Group C]) in a
double-blinded manner. Postoperative pain control was provided with IV morphine
in the postanesthesia care unit and IV-patient-controlled analgesia morphine on
the patient care unit. Morphine dose, pain intensity at rest, and pain after
respiratory effort (postoperative spirometry) were assessed at 12 and 24 h after
study drug administration. The patient-controlled analgesia morphine dose at 24
h was reduced 44% in Group B (30.3 +/- 17.5 mg) and 59% in Group C (22.1 +/-
16.5 mg) versus Group A (53.7 +/- 31.1 mg); P < 0.01 (A versus B). At 12 h, pain
scores at rest and after spirometry were lower in Groups B and C than in A (P <
0.05). At 24 h, resting pain scores were lowest in Group C (P < 0.05).
Twelve-hour FVC was best preserved in Group C (P < 0.03). There were no
inter-group differences in adverse effects or perioperative blood loss.
Rofecoxib oral suspension provided a morphine-sparing effect, as well as
improvements in pain control and 12-h FVC in patients recovering from open
abdominal surgery. IMPLICATIONS: Rofecoxib belongs to class of analgesics known
as cyclooxygenase-2 inhibitors that reduce pain and inflammation with less risk
of bleeding than standard nonsteroidal antiinflammatory drugs. We found that
patients treated with rofecoxib 25 or 50 mg before open abdominal surgery
required less IV morphine during the first day of recovery. Despite reductions
in morphine requirements, rofecoxib-treated patients reported lower pain
intensity scores at rest and after a vigorous cough. In the 50-mg group,
improvements in pain control correlated with greater preservation of baseline
cough effectiveness (vital capacity) at 12 h. These findings may offer clinical
advantages in patients with preexisting pulmonary disease.

PMID: 14693607 [PubMed - in process]

7: Anesthesiology. 2004 Jan;100(1):165-9.

Approach to painful disorders by serefeddin sabuncuoglu in the fifteenth century
ottoman period.

Ganidagli S, Cengiz M, Aksoy S, Verit A.

Assistant Professor, Department of Anesthesiology and Reanimation, dagger
Associate Professor, Department of Medical Ethics and History of Medicine,
double dagger Assistant Professor, Department of Urology.

PMID: 14695738 [PubMed - in process]

8: Anesthesiology. 2004 Jan;100(1):149-57.

Mobilization of Opioid-containing Polymorphonuclear Cells by Hematopoietic
Growth Factors and Influence on Inflammatory Pain.

Brack A, Rittner HL, Machelska H, Beschmann K, Sitte N, Schafer M, Stein C.

Instructor, dagger Research Associate, double dagger Medical Student, section
sign Professor, parallel Professor and Chairman.

SUMMARY: BACKGROUND Leukocytes can control inflammatory pain by secretion of
opioid peptides, stimulated by cold-water swimming or local injection of
corticotropin-releasing factor, and subsequent activation of opioid receptors on
peripheral sensory neurons. This study investigated whether mobilization of
polymorphonuclear cells (PMN) by granulocyte colony-stimulating factor (G-CSF)
and stem cell factor (SCF) enhances immigration of opioid-containing PMN and
peripheral opioid analgesia in rats with Freund complete adjuvant-induced hind
paw inflammation.METHODS In circulating PMN of rats treated with G-CSF+SCF and
sham-treated rats, opioid peptide content was measured by radioimmunoassay.
Expression of adhesion molecules (CD62L, CD49d, CD18), in vitro migration in the
Boyden chamber, and infiltrating leukocytes were analyzed by flow cytometry.
Chemokine messenger RNA transcription was quantified by LightCycler polymerase
chain reaction. Paw pressure threshold was measured at baseline, after
cold-water swimming, and after injection of corticotropin-releasing
factor.RESULTS G-CSF+SCF treatment increased circulating PMN (11-fold, P <
0.05). Mobilized PMN had decreased content of beta-endorphin but not of
Met-enkephalin per cell, down-regulation of CD62L, up-regulation of CD49d (but
no change in CD18), and reduced migration toward higher chemokine concentrations
(all P < 0.05). In the paw, one of four chemokine messenger RNAs was
significantly expressed during the first 2 h of inflammation (P < 0.05),
immigration of PMN and opioid-containing cells was slightly increased (1.5-fold,
P < 0.05), and baseline paw pressure threshold, as well as paw pressure
threshold increases induced by corticotropin-releasing factor and cold-water
swimming, were unchanged (P > 0.05).CONCLUSIONS G-CSF+SCF mobilized circulating
opioid-containing PMN but had a minor influence on cell migration and peripheral
analgesia, probably because of the low expression of chemokines in the inflamed
paw and one of the decreased beta-endorphin content in PMN.

PMID: 14695736 [PubMed - in process]

9: Anesthesiology. 2004 Jan;100(1):134-141.

Effects of Perioperative Oral Amantadine on Postoperative Pain and Morphine
Consumption in Patients after Radical Prostatectomy: Results of a Preliminary
Study.

Snijdelaar DG, Koren G, Katz J.

Clinical Research Fellow, Acute Pain Research Unit, Department of Anesthesia and
Pain Management, Toronto General Hospital. Current position: Consultant in
Anesthesiology and Pain Medicine, Department of Anesthesiology/Pain Centre,
University Medical Centre, Nijmegen, The Netherlands. dagger Professor,
Departments of Pediatrics, Pharmacology, Pharmacy, Medicine and Medical
Genetics, University of Toronto, Toronto, Ontario, Canada, and Division of
Clinical Pharmacology/Toxicology, Hospital For Sick Children, Toronto, Ontario,
Canada. double dagger Director, Acute Pain Research Unit, Department of
Anesthesia and Pain Management, Toronto General Hospital and Mount Sinai
Hospital, Toronto, Ontario, Canada. Professor, Departments of Anesthesia and
Public Health Sciences, University of Toronto. Professor and Canada Research
Chair, Department of Psychology and School of Kinesiology and Health Science,
York University, Toronto, Ontario, Canada.

SUMMARY: BACKGROUND Amantadine is known to be a noncompetitive
N-methyl-d-aspartate receptor antagonist and may be useful in preventing
postoperative central sensitization, acute opioid tolerance, and opioid-induced
hyperalgesia, thereby decreasing pain and analgesic requirements. The aim of
this pilot study was to evaluate the effects of perioperative oral amantadine on
postoperative pain and analgesic consumption.METHODS Twenty-four patients
scheduled to undergo radical prostatectomy were given oral amantadine before and
after surgery in a randomized, double-blind, placebo-controlled manner. After
surgery, patients received intravenous patient-controlled analgesia with
morphine for 48 h. Wound pain intensity, sensitivity to mechanical pressure
around the surgical wound, and incidence of bladder spasm pain were assessed.
Blood samples were drawn for analysis of amantadine, morphine, and the morphine
metabolites. Adverse effects and patient satisfaction were assessed.RESULTS The
cumulative morphine consumption was significantly lower in the amantadine group
at all time points (except at 48 h), amounting to a 32% reduction over the 48-h
period. Forty-eight hours after surgery, visual analog pain scores to pressure
applied near the wound were significantly lower in the amantadine group than in
the placebo group. In addition, the number of patients reporting bladder spasm
pain was significantly lower in the amantadine group. Plasma concentration of
morphine-3-glucuronide was significantly lower at the end of surgery in the
amantadine group. Pharmacokinetic analyses showed that the plasma clearance of
morphine at 22-24 h after surgery was also significantly lower in the amantadine
group.CONCLUSION The results suggest that perioperative oral amantadine reduces
postoperative opioid consumption by pharmacokinetic mechanisms, although
additional pharmacodynamic interactions may also be involved.

PMID: 14695734 [PubMed - as supplied by publisher]

10: Anesthesiology. 2004 Jan;100(1):115-9.

Prediction of postoperative pain by preoperative nociceptive responses to heat
stimulation.

Werner MU, Duun P, Kehlet H.

Director of Acute Pain Service, Department of Anesthesiology, dagger Assistant
Professor, Department of Orthopedic Surgery, double dagger Professor, Department
of Surgical Gastroenterology.

SUMMARY: BACKGROUND Despite major advances in the understanding of the
neurobiologic mechanisms of pain, the wide variation in acute pain experience
has not been well explained. Therefore, the authors investigated the potential
of a preoperatively induced heat injury to predict subsequent postoperative pain
ratings in patients undergoing knee surgery.METHODS Twenty patients were
studied. The burn injury was induced 6 days before surgery with a contact
thermode (12.5 cm2, 47 degrees C for 7 min). The sensory testing, before and 1 h
after the injury, included pain score during induction of the burn, secondary
hyperalgesia area, thermal and mechanical pain perception, and pain thresholds.
Postoperative analgesia consisted of ibuprofen and acetaminophen. Pain ratings
(visual analog scale) at rest and during limb movement were followed for 10 days
after surgery.RESULTS The burn injury was associated with development of
significant hyperalgesia. There was a significant correlation between
preoperative pain ratings during the burn injury and early (0-2 days, area under
the curve) and late (3-10 days, area under the curve) postoperative dynamic pain
ratings during limb movement.CONCLUSION The results of this study suggest that
the pain response to a preoperative heat injury may be useful in research in
predicting the intensity of postoperative pain. These findings may have
important implications to identify patients at risk for development of chronic
pain and to stratify individuals for investigations of new analgesics.

PMID: 14695732 [PubMed - in process]

11: Anesthesiology. 2004 Jan;100(1):98-105.

Chronic Pain Management: American Society of Anesthesiologists Closed Claims
Project.

Fitzgibbon DR, Posner KL, Domino KB, Caplan RA, Lee LA, Cheney FW.

Associate Professor, section sign Clinical Professor, parallel Assistant
Professor, # Professor and Chair, Department of Anesthesiology; dagger Research
Associate Professor, Departments of Anesthesiology and Anthropology (adjunct),
double dagger Professor, Departments of Anesthesiology and Neurological Surgery
(adjunct).

SUMMARY: BACKGROUND The practice of chronic pain management has grown steadily
in recent years. The purpose of this study was to identify and describe issues
and trends in liability related to chronic pain management by
anesthesiologists.METHODS Data from 5,475 claims in the American Society of
Anesthesiologists Closed Claims Project database between 1970 and 1999 were
reviewed to compare liability related to chronic pain management with that
related to surgical and obstetric (surgical/obstetric) anesthesia. Acute pain
management claims were excluded from analysis. Outcomes and liability
characteristics between 284 pain management claims and 5,125 surgical/obstetric
claims were compared.RESULTS Claims related to chronic pain management increased
over time (P < 0.01) and accounted for 10% of all claims in the 1990s.
Compensatory payment amounts were lower in chronic pain management claims than
in surgical/obstetric anesthesia claims from 1970 to 1989 (P < 0.05), but during
the 1990s, there was no difference in size of payments. Nerve injury and
pneumothorax were the most common outcomes in invasive pain management claims.
Epidural steroid injections accounted for 40% of all chronic pain management
claims. Serious injuries, involving brain damage or death, occurred with
epidural steroid injections with local anesthetics and/or opioids and with
maintenance of implantable devices.CONCLUSIONS Frequency and payments of claims
associated with chronic pain management by anesthesiologists increased in the
1990s. Brain damage and death were associated with epidural steroid injection
only when opioids or local anesthetics were included. Anesthesiologists involved
in home care of patients with implanted devices such as morphine pumps and
epidural injections or patient-controlled analgesia should be aware of potential
complications that may have severe outcomes.

PMID: 14695730 [PubMed - as supplied by publisher]

12: Anesthesiology. 2004 Jan;100(1):2-4.

The case for pediatric drug development in clinical pain research.

Wood M.

Publication Types:
EditorialPMID: 14695715 [PubMed - in process]

13: Ann Intern Med. 2003 Dec 16;139(12):1036-7.

Comment on:
Ann Intern Med. 2003 Dec 16;139(12):979-86.Nitroglycerin: should we still ask?

Gibbons RJ.

Publication Types:
Comment
EditorialPMID: 14678924 [PubMed - indexed for MEDLINE]

14: Cephalalgia. 2004 Jan;24(1):52-53.

Non-lateralized pain in a case of chronic paroxysmal hemicrania?

Mulder L, Spierings E.

Departments of Neurology, Ikazia Hospital, Rotterdam, the Netherlands and
Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts,
U.S.A.

Mulder LJMM & Spierings ELH. Non-lateralized pain in a case of chronic
paroxysmal hemicrania? Cephalalgia 2004; 24:52-53. London. ISSN 0333-1024 We
describe a man with chronic paroxysmal hemicrania, who remained free of
headaches on indomethacin, 25 mg once or twice daily. However, in this case, in
contrast to typical cases of paroxysmal hemicrania, the pain of the headaches
was nonlateralized and was located in the centre of the forehead. The headaches
were not associated with local autonomic symptoms or signs involving the eyes or
nose. Initially, the pain of the headaches lasted for seconds only and was
brought on by coughing.

PMID: 14687013 [PubMed - as supplied by publisher]

15: Cephalalgia. 2004 Jan;24(1):44-51.

Suppression of pain and the R2 component of the blink reflex during optokinetic
stimulation.

Drummond P.

School of Psychology, Murdoch University, Western Australia.

Drummond PD. Suppression of pain and the R2 component of the blink reflex during
optokinetic stimulation. Cephalalgia 2004; 24:44-51. London. ISSN 033-1024 The
effect of exposure to a rotating optokinetic drum on the electrically evoked
blink reflex was investigated in 20 healthy volunteers. Pain ratings and the
area under the curve of the R2 component of the blink reflex to innocuous and
nociceptive trigeminal stimulation decreased substantially during and after
optokinetic stimulation. At low shock intensities, R2 decreased most during
optokinetic stimulation in subjects who did not develop symptoms of motion
sickness. In contrast, during the recovery period after optokinetic stimulation,
suppression of R2 to moderate and intense stimuli was greatest in the most
nauseated subjects. These findings suggest that a mechanism that suppresses
symptoms of motion sickness during sensory conflict also inhibits activity in
wide dynamic range neurones in the trigeminal nucleus caudalis. Nausea in the
absence of sensory conflict may inhibit R2 to intense electrical stimulation by
provoking diffuse noxious inhibitory controls.

PMID: 14687012 [PubMed - as supplied by publisher]

16: Cephalalgia. 2003 Nov;23(9):901-6.

Association between ACE inhibitors use and headache caused by nitrates among
hypertensive patients: results from the Italian group of pharmacoepidemiology in
the elderly (GIFA).

Onder G, Pahor M, Gambassi G, Federici A, Savo A, Carbonin P, Bernabei R; GIFA
Study.

Centro Medicina dell'Invecchiamento, Universita Cattolica del Sacro Cuore, Rome,
Italy. graziano_onder@rm.unicatt.it

Treatment with ACE inhibitors has shown to be effective in the prophylaxis of
migraine attacks. The aim of this study was to explore whether among
hospitalized hypertensive patients use of ACE inhibitors may reduce the risk of
headache caused by nitrates. To this end, we used the GIFA database, that
includes patients admitted to academic medical centres throughout Italy. We
studied 1537 patients (mean age 75 +/- 10 years) receiving treatment with
nitrates during a hospital stay and diagnosed with hypertension. Headaches that
had a probable or definite causal relation with nitrates use based on the
Naranjo algorithm were considered for this analysis. Of the total enrolled
sample, 762 patients (50%) used ACE inhibitors during hospital stay. Headache
caused by nitrates was recorded in 12/762 (1.6%) ACE inhibitor users and in
24/775 (3.2%) other participants (P = 0.049). After adjusting for potential
confounders, ACE inhibitors use was associated with a significantly lower risk
of headache (OR 0.43; 95% Confidence Intervals: 0.20-0.90). This result was
confirmed if ACE inhibitors use was compared with use of other antihypertensive
agents (OR 0.44; 95% CI 0.20-0.95). In conclusion, this study suggests that
among hypertensive subjects use of ACE inhibitors is associated with a reduced
risk of headache caused by nitrates.

PMID: 14616932 [PubMed - indexed for MEDLINE]

17: Cephalalgia. 2003 Nov;23(9):854-9.

Comment in:
Cephalalgia. 2003 Nov;23(9):853.Bathing headache: a variant of idiopathic thunderclap headache.

Liao YC, Fuh JL, Lirng JF, Lu SR, Wu ZA, Wang SJ.

The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.

Bathing headache is rarely described in literature. We report four middle-aged
Taiwanese women who developed severe throbbing headache with maximum intensity
of onset during bathing. Diffuse cerebral vasospasm was demonstrated in one of
them. All their headaches resolved spontaneously (n = 1) or after nimodipine
treatment (n = 3). Except for one patient with vasospasm in whom reversible
posterior leukoencephalopathy and an asymptomatic cerebellar infarction
developed, the others recovered without any complications. The clinical profile
of bathing headache points to idiopathic thunderclap headache. It may not be as
benign as previously reported. Nimodipine might be effective in treatment of
this special headache syndrome.

Publication Types:
Case ReportsPMID: 14616926 [PubMed - indexed for MEDLINE]

18: J Clin Oncol. 2004 Jan 1;22(1):185-92.

Methadone versus morphine as a first-line strong opioid for cancer pain: a
randomized, double-blind study.

Bruera E, Palmer JL, Bosnjak S, Rico MA, Moyano J, Sweeney C, Strasser F, Willey
J, Bertolino M, Mathias C, Spruyt O, Fisch MJ.

Department of Palliative Care & Rehabilitation Medicine (Unit 0008), the
University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX
77030-0049, USA. Ebruera@mail.mdanderson.org

PURPOSE: To compare the effectiveness and side effects of methadone and morphine
as first-line treatment with opioids for cancer pain. PATIENTS AND METHODS:
Patients in international palliative care clinics with pain requiring initiation
of strong opioids were randomly assigned to receive methadone (7.5 mg orally
every 12 hours and 5 mg every 4 hours as needed) or morphine (15 mg sustained
release every 12 hours and 5 mg every 4 hours as needed). The study duration was
4 weeks. RESULTS: A total of 103 patients were randomly assigned to treatment
(49 in the methadone group and 54 in the morphine group). The groups had similar
baseline scores for pain, sedation, nausea, confusion, and constipation.
Patients receiving methadone had more opioid-related drop-outs (11 of 49; 22%)
than those receiving morphine (three of 54; 6%; P =.019). The opioid escalation
index at days 14 and 28 was similar between the two groups. More than three
fourths of patients in each group reported a 20% or more reduction in pain
intensity by day 8. The proportion of patients with a 20% or more improvement in
pain at 4 weeks in the methadone group was 0.49 (95% CI, 0.34 to 0.64) and was
similar in the morphine group (0.56; 95% CI, 0.41 to 0.70). The rates of
patient-reported global benefit were nearly identical to the pain response rates
and did not differ between the treatment groups. CONCLUSION: Methadone did not
produce superior analgesic efficiency or overall tolerability at 4 weeks
compared with morphine as a first-line strong opioid for the treatment of cancer
pain.

PMID: 14701781 [PubMed - in process]

19: J Pain Symptom Manage. 2003 Nov;26(5):1055-61.

Hypogonadism and sexual dysfunction in male cancer survivors receiving chronic
opioid therapy.

Rajagopal A, Vassilopoulou-Sellin R, Palmer JL, Kaur G, Bruera E.

Department of Anesthesiology, University of Texas M. D. Anderson Cancer Center,
Houston, Texas 77030, USA.

The purpose of this study was to determine the prevalence of central
hypogonadism and sexual dysfunction in male cancer survivors exposed to chronic
high-dose oral opioid therapy. We studied 20 male patients with cancer-related
chronic pain who were disease-free for at least one year. All patients consumed
at least 200 mg-equivalent of morphine on a daily basis for at least one year.
Participants completed the Sexual Desire Inventory questionnaire and serum
levels of testosterone, follicle-stimulating hormone (FSH), and luteinizing
hormone (LH) were assessed. Serum testosterone levels were reduced in these
patients. The median value was 140 ng/dL (normal 241-827). There was no
compensatory increase in FSH and LH. The median FSH level was 3.5 mIU/mL (normal
1.4-18.1). The median LH level was 2.1 mIU/mL (normal 1.5-9.3). The mean dyadic
sexual desire score was 23.9+/-15.7 (normal value, 42.8+/-8.9). The mean
solitary sexual desire score was 1.3+/-1.9 (normal value, 10.6+/-1.9). Our data
suggest that chronic exposure to high-dose oral opioid therapy may result in
marked central hypogonadism and sexual dysfunction. Given the increasing use of
long-term opioid therapy for chronic pain syndromes, further investigation into
these findings is warranted.

PMID: 14585556 [PubMed - indexed for MEDLINE]

20: J Pain Symptom Manage. 2003 Nov;26(5):975-89.

Validation of a modified Rotterdam Symptom Checklist for use with cancer
patients in the United States.

Stein KD, Denniston M, Baker F, Dent M, Hann DM, Bushhouse S, West M.

American Cancer Society Behavioral Research Center, Atlanta, Georgia 30329-4251,
USA.

The Rotterdam Symptom Checklist (RSCL) is a well-known instrument for the
assessment of symptom-related distress among cancer patients. Despite its broad
application, the utility of the RSCL with patients of some cancers is hindered
by the omission of several important physical symptoms and methodological
limitations of previous validation studies. The aims of the present study were
to modify the RSCL through the addition of several physical symptoms and to
subsequently validate the modified version of the Rotterdam Symptom Checklist
(RSCL-M) with a heterogeneous sample of cancer patients from the United States.
A total of 1,005 male and female cancer patients from two midwestern states
completed the RSCL-M and several other self-report instruments. Results
indicated that the RSCL-M is a reliable and valid instrument for use with cancer
patients in the United States and is sensitive to differences in physical
distress across groups expected to have distinct symptom-related distress
profiles.

Publication Types:
Clinical Trial
Validation StudiesPMID: 14585549 [PubMed - indexed for MEDLINE]

21: JAMA. 2003 Dec 17;290(23):3129-32.

Sexual activity in patients with angina.

DeBusk RF.

Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif
94304, USA. debusk@stanford.edu

PMID: 14679276 [PubMed - indexed for MEDLINE]

22: Neurology. 2003 Dec 23;61(12):1707-15.

Patterns of cortical reorganization in complex regional pain syndrome.

Maihofner C, Handwerker HO, Neundorfer B, Birklein F.

Departments of Neurology (Drs. Maihofner and Neundorfer) and Physiology and
Experimental Pathophysiology (Drs. Maihofner and Handwerker), University of
Erlangen-Nuremberg, Erlangen.

OBJECTIVE: To use magnetoencephalography to assess possible cortical
reorganization in the primary somatosensory cortex (S1) of patients with complex
regional pain syndrome (CRPS). BACKGROUND: Patterns of pain and sensory symptoms
in CRPS may indicate plastic changes of the CNS. METHODS: Magnetic source
imaging was used to explore changes in the cortical representation of digits (D)
1 and 5 in relation to the lower lip on the unaffected and affected CRPS side in
12 patients. RESULTS: The authors found a significant shrinkage of the extension
of the cortical hand representation for the CRPS affected side. The center of
the hand was shifted toward the cortical representation of the lip. The cortical
reorganization correlated with the amount of CRPS pain (r = 0.792), as measured
by the McGill questionnaire, and the extent of mechanical hyperalgesia (r =
0.860). Using multiple regression analysis, the best predictor for the plastic
changes was found to be mechanical hyperalgesia. Additionally, S1 sources
following tactile stimulation were significantly increased on the CRPS side
compared to the unaffected limb. CONCLUSIONS: This study showed reorganization
of the S1 cortex contralateral to the CRPS affected side. The reorganization
appeared to be linked to complaints of neuropathic pain.

PMID: 14694034 [PubMed - in process]

23: Pediatrics. 2004 Jan;113(1 Pt 1):54-8.

Influence of Helicobacter pylori eradication on gastroesophageal reflux symptoms
and epigastric pain in children and adolescents.

Levine A, Milo T, Broide E, Wine E, Dalal I, Boaz M, Avni Y, Shirin H.

Pediatric Gastroenterology Unit, Edith Wolfson Medical Center, Holon, Israel.
a-levine@inter.net.il

OBJECTIVE: Conflicting reports have noted a possible association linking
eradication of Helicobacter pylori with aggravation of gastroesophageal reflux
(GER) disease. We prospectively evaluated the effect of eradication of H pylori
on GER symptoms and epigastric pain and the association among these 3 parameters
in a pediatric cohort. METHODS: Patients who were referred for gastroscopy were
evaluated for frequency, severity, and nocturnal presence of symptoms related to
GER as well as epigastric pain. Patients who were positive for H pylori received
triple antibiotic therapy. The patients were followed for at least 6 months
after therapy. Patients with successful eradication had symptoms compared with
their pre-eradication state and were compared with a cohort of patients without
H pylori or those with persistent H pylori. RESULTS: Of 119 children and
adolescents who were recruited, 95 patients completed the study, with a mean
follow-up of 11.2 months. The distribution of outcomes for each GER symptom
(better, worse, unchanged) was similar before and after eradication and did not
depend on prior H pylori status. Among patients with GER and epigastric pain,
improvement in epigastric pain was significantly correlated with the improvement
in GER symptoms but not with eradication of H pylori. CONCLUSIONS: Eradication
of H pylori is not associated with increased symptoms of GER in children and
adolescents. Improvement in epigastric pain in children is significantly
correlated with the improvement in GER symptoms but not with eradication of H
pylori.

PMID: 14702447 [PubMed - in process]

24: Spine. 2004 Jan 1;29(1):87-93.

Performance problems of patients with chronic low-back pain and the measurement
of patient-centered outcome.

Andrew Walsh D, Jane Kelly S, Sebastian Johnson P, Rajkumar S, Bennetts K.

Back Pain Unit, Sears Centre, King's Mill Hospital, Notts, United Kingdom and
dagger Academic Rheumatology, University of Nottingham, City Hospital,
Nottingham, United Kingdom.

SUMMARY: STUDY DESIGN In a prospective interventional study, problems with
performance were evaluated in 101 consecutive patients with chronic low-back
pain for more than 12 months, before and after participation in an
outpatient-based multidisciplinary pain management program in Mansfield, United
Kingdom.OBJECTIVES To describe problems identified as most important by patients
with chronic low-back pain and to evaluate the Canadian Occupational Performance
Measure (COPM) as a tool for measuring problem-specific outcomes.SUMMARY OF
BACKGROUND DATA Patients with chronic low-back pain report difficulties with a
variety of activities. The COPM permits the identification and measurement of
problems of particular concern to the patient.MATERIALS AND METHODS COPM,
likert-modified Roland and Morris Disability Questionnaire, Pain Self-Efficacy
Questionnaire, and 5-minute walk test were administered at baseline, immediately
after, and 9 months after intervention. Differences and statistical interactions
were determined by nonparametric tests.RESULTS Participants identified 60
different types of problem activity, 45 of which were identified by nine or
fewer participants. Decreased walking tolerance was the most frequently
identified problem (56% of participants). Improvements were observed in all
outcomes following intervention. Approximately one third of participants
reported improvements two or more COPM units in overall performance and
satisfaction with their performance at 9 months. Higher reported performance and
satisfaction were associated with greater self-efficacy. Increased reported
walking performance was associated with increased observed 5-minute walk
distance (R = 0.35, P = 0.02).CONCLUSIONS Patients with chronic low-back pain
report problems with diverse activities. The COPM provides a patient-centered
outcome measure that displays good external validity and responsiveness to
change when addressing the individual's goals.

PMID: 14699282 [PubMed - in process]

25: Spine. 2004 Jan 1;29(1):79-86.

Estimates and patterns of direct health care expenditures among individuals with
back pain in the United States.

Luo X, Pietrobon R, X Sun S, Liu GG, Hey L.

Center for Clinical Effectiveness and dagger Division of Orthopedic Surgery,
Department of Surgery, Duke University Medical Center, Durham, North Carolina;
and.

SUMMARY: STUDY DESIGN Secondary analysis of the 1998 Medical Expenditure Panel
Survey.OBJECTIVE To estimate total health care expenditures incurred by
individuals with back pain in the United States, calculate the incremental
expenditures attributable to back pain among these individuals, and describe
health care expenditure patterns of individuals with back pain.SUMMARY OF
BACKGROUND DATA There is a lack of updated information on health care
expenditures and expenditure patterns for individuals with back pain in the
United States.METHODS This study used data from the 1998 Medical Expenditure
Panel Survey, a national survey on health care utilization and expenditures.
Total health care expenditures and per-capita expenditures among individuals
with back pain were calculated. Multivariate regression models were used to
estimate the incremental expenditures attributable to back pain. The expenditure
patterns were examined by stratifying individuals with back pain by
sociodemographic characteristics and medical diagnosis, and calculating
per-capita expenditures for each stratum.RESULTS In 1998, total health care
expenditures incurred by individuals with back pain in the United States reached
$90.7 billion and total incremental expenditures attributable to back pain among
these persons were approximately $26.3 billion. On average, individuals with
back pain incurred health care expenditures about 60% higher than individuals
without back pain ($3,498 vs. $2,178). Among back pain individuals, at least 75%
of service expenditures were attributed to those with top 25% expenditure, and
per-capita expenditures were generally higher for those who were older, female,
white, medically insured, or suffered from disc disorders.CONCLUSIONS Health
care expenditures for back pain in the United States in 1998 were substantial.
The expenditures demonstrated wide variations among individuals with different
clinical, demographic, and socioeconomic characteristics.

PMID: 14699281 [PubMed - in process]

26: Spine. 2004 Jan 1;29(1):70-7.

Predictors of back pain in a general population cohort.

Kopec JA, Sayre EC, Esdaile JM.

Departments of Health Care and Epidemiology and double dagger Arthritis Research
Centre of Canada, Vancouver, British Columbia, Canada.

SUMMARY: STUDY DESIGN The study used longitudinal data from the first and second
cycles (1994-1995 and 1996-1997) of the Canadian National Population Health
Survey.OBJECTIVE Our objective was to derive prediction models for back pain in
the general male and female household populations.SUMMARY OF BACKGROUND DATA
Little is known about the predictors of back pain in the general population.
Most previous studies focused on specific occupational groups and used a
cross-sectional or case-control design.METHODS The study cohort consisted of all
respondents aged 18+ years who reported no back problems in the 1994-1995
National Population Health Survey cycle (N = 11,063). Potential predictors of
chronic back pain were classified into nine groups and entered into stepwise
logistic regression models. Bootstrap methods were used to derive the final
models and assess their predictive power.RESULTS The overall incidence of back
pain was 44.7 per 1,000 person-years and was higher in women (47.0 per 1,000
person-years) compared with men (42.2 per 1,000 person-years). In men,
significant predictors of back pain were age (peak effect in 45-64 years),
height, self-rated health, usual pattern of activity (especially heavy work),
yard work or gardening (negative association), and general chronic stress. In
women, significant factors were self-reported restrictions in activity, being
diagnosed with arthritis, personal stress, and history of psychological trauma
in childhood or adolescence.CONCLUSIONS Overall health and psychosocial factors
are important predictors of back pain in both men and women. Other risk factors
differ between the two sexes.

PMID: 14699279 [PubMed - in process]

27: Spine. 2004 Jan 1;29(1):33-40.

Cervical range of motion associations with subclinical neck pain.

Lee H, Nicholson LL, Adams RD.

SUMMARY: STUDY DESIGN Cross-sectional study.OBJECTIVE To investigate
associations between subclinical neck pain/discomfort, and range of motion and
physical dimensions of the cervicothoracic spine.SUMMARY OF BACKGROUND DATA
Despite the high prevalence of neck problems, few studies are available
indicating any physical associations with the development of neck pain, or
information regarding early signs of pathology from neck pain for subjects not
in treatment.METHODS Forty healthy volunteers, between 19 and 42 years of age
(mean age 28 years), were recruited. The dimensions of the cervicothoracic spine
measured were as follows: spinal posture, active cervical range of motion, and
segment length of the neck. All measurements were taken twice from each subject
by different testers, on the same occasion. Cervical muscle endurance was
measured by a modified Biering-Sorensen Test. Finally, subjects were questioned
about any recurrent neck pain/discomfort.RESULTS Fourteen subjects reported
experiencing low-level neck pain/discomfort on a recurrent basis. Neck muscle
endurance time (F1,38 = 6.75, P = 0.01) and left rotation end-of-range (F1,38 =
4.56, P = 0.04) were found to be significantly lower for subjects with neck
pain. Extension end-of-range showed a group-specific change at retest,
increasing for subjects without pain, but decreasing for those with neck pain
(F1,38 = 4.67, P = 0.04). This same group had a greater range of retraction than
the asymptomatic group (F1,38 = 4.56, P = 0.04). Subjects overall, irrespective
of pain classification, demonstrated greater left rotation than right rotation
(F1,38 = 4.34, P = 0.04) and also showed reduced side flexion on the left (F1,38
= 5.10, P = 0.03) and right (F1,38 = 5.27, P = 0.03) with repeated
measurement.CONCLUSIONS Between-groups differences were observed as lower neck
muscle endurance time, reduced left rotation, relatively reduced extension at
second test, but greater range of retraction, when the subclinical and normal
groups were compared. These data suggest that there are early range changes
associated with the development of neck pain.

PMID: 14699273 [PubMed - in process]

28: Spine. 2004 Jan 1;29(1):9-16.

Prolotherapy injections, saline injections, and exercises for chronic low-back
pain: a randomized trial.

Yelland MJ, Glasziou PP, Bogduk N, Schluter PJ, McKernon M.

Centre for General Practice and School of Population Health, University of
Queensland, Brisbane, Australia and.

SUMMARY: OBJECTIVES To assess the efficacy of a prolotherapy injection and
exercise protocol in the treatment of chronic nonspecific low back pain.DESIGN
Randomized controlled trial with two-by-two factorial design, triple-blinded for
injection status, and single-blinded for exercise status.SETTING General
practice.PARTICIPANTS One hundred ten participants with nonspecific low-back
pain of average 14 years duration were randomized to have repeated prolotherapy
(20% glucose/0.2% lignocaine) or normal saline injections into tender
lumbo-pelvic ligaments and randomized to perform either flexion/extension
exercises or normal activity over 6 months.MAIN OUTCOME MEASURES Pain intensity
(VAS) and disability scores (Roland-Morris) at 2.5, 4, 6, 12, and 24
months.RESULTS Follow-up was achieved in 96% at 12 months and 80% at 2 years.
Ligament injections, with exercises and with normal activity, resulted in
significant and sustained reductions in pain and disability throughout the
trial, but no attributable effect was found for prolotherapy injections over
saline injections or for exercises over normal activity. At 12 months, the
proportions achieving more than 50% reduction in pain from baseline by injection
group were glucose-lignocaine: 0.46 versus saline: 0.36. By activity group these
proportions were exercise: 0.41 versus normal activity: 0.39. Corresponding
proportions for >50% reduction in disability were glucose-lignocaine: 0.42
versus saline 0.36 and exercise: 0.36 versus normal activity: 0.38. There were
no between group differences in any of the above measures.CONCLUSIONS In chronic
nonspecific low-back pain, significant and sustained reductions in pain and
disability occur with ligament injections, irrespective of the solution injected
or the concurrent use of exercises.

PMID: 14699269 [PubMed - in process]

29: Spine. 2004 Jan 1;29(1):3-8.

Trunk Muscle Strength, Cross-sectional Area, and Density in Patients With
Chronic Low Back Pain Randomized to Lumbar Fusion or Cognitive Intervention and
Exercises.

Keller A, Brox JI, Gunderson R, Holm I, Friis A, Reikeras O.

Department of Physical Medicine and Rehabilitation, Ullevaal University
Hospital; and the Departments of.

SUMMARY: STUDY DESIGN A randomized study.OBJECTIVES To compare muscle strength,
cross-sectional area, and density of the back muscles in two categories of
patients with chronic low back pain, randomized to either lumbar fusion or
cognitive intervention and exercises.SUMMARY OF BACKGROUND DATA In two clinical
trials, patients with chronic low back pain plus disc degeneration and
postlaminectomy syndrome, respectively, were randomized to either lumbar fusion
or cognitive intervention and exercises. We have previously reported that
results for the primary outcome were similar at the 1-year follow-up
examination.METHODS As the treatment alternatives and test procedures were
identical, the two trials were merged into one. A total of 124 patients 25 to 60
years of age were included. Muscle strength, measured by isokinetic test device
and by the Biering-Sorensen Test, was measured in 112 patients, and the
cross-sectional area and density of the back muscles were measured in 61
patients at the inclusion and at the 1-year follow-up examination.RESULTS The
exercise group performed significantly better in muscle strength than did the
lumbar fusion group, with the mean difference at 184 Nm (95% confidence
interval, 64-303 Nm; P = 0.003) and for the Biering-Sorensen Test 21 seconds
(95% confidence interval, 6-36 seconds; P = 0.006). The density at L3-L4
decreased in the lumbar fusion group but remained unchanged in the exercise
group. The mean difference was 5.3 HU (95% confidence interval, 1.1-9.5 HU; P =
0.01). The cross-sectional area was unchanged in both groups.CONCLUSIONS
Patients with chronic low back pain who followed cognitive intervention and
exercise programs improved significantly in muscle strength compared with
patients who underwent lumbar fusion. In the lumbar fusion group, density
decreased significantly at L3-L4 compared with the exercise group.

PMID: 14699268 [PubMed - in process]