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Dextromethorphan-associated epidural patient-controlled analgesia provides better pain- and analgesics-sparing effects than dextromethorphan-associated intravenous patient-controlled analgesia after bone-malignancy resection: a randomized, placebo-controlled, double-blinded study.
Weinbroum AA, Bender B, Nirkin A, Chazan S, Meller I, Kollender Y.
Postanesthesia Care Unit, the Acute Pain Service, and. the National Orthopedic Oncology Unit, Tel Aviv Sourasky Medical Center and the Sackler Faculty Medicine, Tel Aviv University, Tel Aviv, Israel.
Pain after bone malignancy surgery is intense and requires large amounts of analgesics. The augmented antinociceptive effects of dextromethorphan (DM), a N-methyl-D-aspartate receptor antagonist, were demonstrated previously. We assessed the use of postoperative patient-controlled epidural analgesia (PCEA) or IV patient-controlled analgesia (PCA) in patients undergoing surgery for bone malignancy under standardized combined general and epidural anesthesia with or without DM. Patients (n = 120) were randomly allocated to receive PCEA (ropivacaine 3.2 mg plus fentanyl 8 micro g/dose) or IV-PCA (morphine 2 mg/dose) postoperatively, starting at subjective visual analog scale pain intensity >/==" BORDER="0">4 of 10 for up to 96 h. Placebo or DM 90 mg orally (30 patients/group/set) was given in a double-blinded manner before surgery and for 2 days afterwards. Diclofenac 75 mg IM was available as a rescue drug. DM patients used PCA and rated their pain >50% less than their placebo counterparts in each set, especially during the first 2 postoperative days (P < 0.01). Hourly and overall maximal pain intensity among PCEA patients was approximately 50% less than in the IV-PCA set (P < 0.01). Diclofenac was used 42% less (P < 0.01) by the PCA-DM patients compared with their placebo counterparts. Seven PCEA-DM and 11 IV-PCA-DM individuals reported having side effects compared with 44 in the PCEA-placebo and the IV-PCA-placebo groups (P < 0.01). Time to first ambulation was similar with both analgesia techniques but shorter among the DM-treated patients compared with the placebo recipients (1.5 +/- 0.8 versus 2.1 +/- 1.1 days, P = 0.02). Thus, DM afforded better pain control and reduced the demand for analgesics, augmented the PCEA effect versus IV-PCA, and was associated with minimal untoward effects in each analgesia set. DM patients ambulated earlier than placebo recipients. IMPLICATIONS: Patients undergoing bone-malignancy surgery under combined general and epidural anesthesia received randomly patient-controlled epidural analgesia (PCEA) or IV patient-controlled analgesia (PCA) postoperatively and dextromethorphan (DM) 90 mg or placebo double-blindly for 3 days (n = 30/group/set). The DM effect was recorded with minimal untoward effects: it afforded better pain control and reduced the demand for analgesics compared with the placebo, especially when associated with PCEA. DM patients ambulated earlier than placebo recipients.
PMID: 14980926 [PubMed - in process]
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Cost drivers in patient-controlled epidural analgesia for postoperative pain management after major surgery.
Schuster M, Gottschalk A, Freitag M, Standl T.
Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
In this retrospective study, we determined efficiency, treatment length, and resource use for postoperative pain management with patient-controlled epidural analgesia (PCEA) in 350 consecutive patients undergoing major abdominal, thoracic, gynecological, or orthopedic surgery. Average pain scores on a visual analog scale were 16 +/- 23 and 9 +/- 16 (visual analog scale range, 0 to 100) on postoperative Days 1 and 3, respectively, and were similar among groups. The treatment length was 4.9 +/- 2.2 days in general surgical, 5.2 +/- 3.1 days in gynecological, and 4.5 +/- 2.8 days in orthopedic patients. The total volumes of the mixture of local anesthetic and opioid received epidurally were 707 +/- 507 mL, 770 +/- 576 mL, and 593 +/- 456 mL in the general surgical, gynecological, and orthopedic groups, respectively. The average total costs for all groups for the full treatment course with PCEA were 447 +/- 218 per case (1 equals approximately US$1). Fifty-one percent of these costs were staff costs, 20% were costs for the applied drugs, 15% were costs for PCEA pumps and pump material, and 13% were costs for the initial catheter insertion. In the light of these costs and the availability of less costly alternatives, measurements for cost containment by using PCEA are recommended. Because treatment length is the main cost driver both for drug and staff costs, close monitoring of treatment length and a predefined migration path to alternative techniques after PCEA should be considered. IMPLICATIONS: Patient-controlled epidural analgesia is increasingly used as first-line treatment for postoperative pain management. In this study, costs and cost drivers are analyzed for the first time for this new technique, based on 350 cases of pain therapy after major surgery in a university hospital.
PMID: 14980925 [PubMed - in process]
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Pretreatment with thiopental for prevention of pain associated with propofol injection.
Agarwal A, Ansari MF, Gupta D, Pandey R, Raza M, Singh PK, Shiopriye, Dhiraj S, Singh U.
Departments of Anesthesia and Biostatistics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Propofol causes pain on IV injection in 28%-90% of patients. A number of techniques have been tried to minimize propofol-induced pain, with variable results. We compared the efficacy of pretreatment with thiopental 0.25 mg/kg and 0.5 mg/kg and lidocaine 40 mg after venous occlusion for prevention of propofol-induced pain. One-hundred-twenty-four adult patients, ASA physical status I-II, undergoing elective surgery were randomly assigned into 4 groups of 31 each. Group I received normal saline, group II received lidocaine 2% (40 mg), and groups III and IV received thiopental 0.25 mg/kg and 0.5 mg/kg, respectively. All pretreatment drugs were made in 2 mL and were accompanied by manual venous occlusion for 1 min. Propofol was administered after release of venous occlusion. Pain was assessed with a four-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain at the time of propofol injection. Twenty-four patients (77%) complained of pain in the group pretreated with normal saline as compared with 12 (39%), 10 (32%), and 1 (3%) in the groups pretreated with lidocaine 40 mg, thiopental 0.25 mg/kg, and thiopental 0.5 mg/kg, respectively (P < 0.05). Thiopental 0.5 mg/kg was the most effective treatment. We therefore suggest routine pretreatment with thiopental 0.5 mg/kg along with venous occlusion for 1 min for prevention of pain associated with propofol injection. IMPLICATIONS: Pain associated with IV injection of propofol is seen in 28%-90% patients. Pretreatment with thiopental 0.25 mg/kg and 0.5 mg/kg after manual venous occlusion for 1 min effectively attenuated pain associated with propofol injection. Thiopental 0.5 mg/kg was the most effective in prevention of propofol pain and can be used routinely.
PMID: 14980919 [PubMed - in process]
Chronobiology and anesthesia.
Chassard D, Bruguerolle B.
Department of Anesthesiology, Hotel-Dieu Hospital, Lyon, France. dominique.chassard@chu-lyon.fr
Publication Types:
PMID: 14739819 [PubMed - indexed for MEDLINE]
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Infraclavicular perineural local anesthetic infusion: a comparison of three dosing regimens for postoperative analgesia.
Ilfeld BM, Morey TE, Enneking FK.
Department of Anesthesiology, P. O. Box 100254, 1600 Archer Road, Gainesville, Florida 32610-0254, USA. bilfeld@ufl.edu
BACKGROUND: In this randomized, double-blind study, the authors investigated the efficacy of continuous and patient-controlled ropivacaine infusions via an infraclavicular perineural catheter in ambulatory patients undergoing moderately painful orthopedic surgery at or distal to the elbow. METHODS: Preoperatively, patients (n = 30) received an infraclavicular perineural catheter and nerve block. Postoperatively, patients were discharged home with both oral analgesics and a portable infusion pump delivering 0.2% ropivacaine (500-ml reservoir) in one of three dosing regimens: the basal group (12 ml/h basal, 0.05-ml patient-controlled bolus dose), the basal-bolus group (8 ml/h basal, 4 ml bolus), or the bolus group (0.3 ml/h basal, 9.9 ml bolus). Investigators and patients were blinded to random group assignment. RESULTS: The basal group (n = 10) required more oral analgesics than the basal-bolus group (P = 0.002) and had a shorter median infusion duration than the other two groups (P < 0.001 for both). The bolus group had the longest median infusion duration (P < 0.001 for both) but experienced an increase in breakthrough pain incidence (P = 0.004) and intensity (P = 0.04 vs. basal-bolus group) as well as sleep disturbances (P < 0.001 for both) compared with the other groups. Overall satisfaction was greatest in the basal-bolus group (9.7 +/- 0.5 vs. 7.9 +/- 1.7 and 8.1 +/- 1.5; P < 0.05 for both). CONCLUSIONS: After moderately painful orthopedic surgery at or distal to the elbow, 0.2% ropivacaine delivered as a continuous infusion combined with patient-controlled bolus doses via an infraclavicular perineural catheter optimizes analgesia while minimizing oral analgesic use compared with basal- or bolus-only dosing regimens.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 14739817 [PubMed - indexed for MEDLINE]
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Epidural neostigmine produces analgesia but also sedation in women after cesarean delivery.
Kaya FN, Sahin S, Owen MD, Eisenach JC.
Departments of Anesthesiology, Uludag University, Bursa, Turkey.
BACKGROUND: Intrathecal neostigmine produces analgesia but also nausea, limiting its utility. In contrast, epidural administration of neostigmine has been suggested to produce postoperative analgesia without nausea in nonpregnant patients. The purpose of this study was to examine the dose range for efficacy and side effects of epidural neostigmine in women at cesarean delivery receiving combined spinal-epidural anesthesia. METHODS: After institutional approval and informed consent, 80 patients for elective cesarean delivery were given combined spinal-epidural anesthesia with 8 mg hyperbaric bupivacaine plus 10 microg fentanyl. Patients were randomized to receive either saline or 75, 150, or 300 microg neostigmine (n = 20 per group) in 10 ml saline after cord clamping. Pain, morphine consumption, and side effects were monitored for 24 h. RESULTS: Global pain assessment for the first 24 h was reduced from 5.4 +/- 0.2 in the saline group to 3.0-3.5 +/- 0.3 in the neostigmine groups, dose independently. Correspondingly, global satisfaction with neostigmine was also improved (P < 0.05). Nausea and morphine consumption were similar among groups. Intraoperative shivering and sedation were increased in the 300-microg neostigmine group only (P < 0.05), and postoperative sedation was increased by neostigmine in a dose-independent fashion (P < 0.05). CONCLUSIONS: Epidural neostigmine produced modest analgesia in women after cesarean delivery. In contrast with previous reports, which focused primarily on nausea, these data suggest that epidural neostigmine can also produce mild sedation for several hours. These data suggest a limited role for single bolus-administration epidural neostigmine for analgesia after cesarean delivery. They also support future study of epidural neostigmine for obstetric analgesia.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 14739815 [PubMed - indexed for MEDLINE]
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An investigation to dissociate the analgesic and anesthetic properties of ketamine using functional magnetic resonance imaging.
Rogers R, Wise RG, Painter DJ, Longe SE, Tracey I.
Nuffield Department of Anesthetics, John Radcliffe Hospital, Oxford, Oxfordshire, OX3 9DU, United Kingdom. rogers@fmrib.ox.ac.uk
BACKGROUND: Anatomic sites within the brain, which activate in response to noxious stimuli, can be identified with the use of functional magnetic resonance imaging. The aim of this study was to determine whether the analgesic effects of ketamine could be imaged. METHODS: Ketamine was administered to eight healthy volunteers with use of a target-controlled infusion to three predicted plasma concentrations: 0 (saline), 50 (subanalgesic), and 200 ng/ml (analgesic, subanesthetic). Volunteers received noxious thermal stimuli and auditory stimuli and performed a motor task within a 3-T human brain imaging magnet. Activation of brain regions in response to noxious and auditory stimuli and during the motor task was compared with behavioral measures. RESULTS: The analgesic subanesthetic dose of ketamine significantly reduced the pain scores, and this matched a decrease in activity within brain regions that activate in response to noxious stimuli, in particular, the insular cortex and thalamus. A different pattern of activation was observed in response to an auditory task. In comparison, smaller behavioral and imaging changes were found for the motor paradigm. The lower dose of ketamine gave similar but smaller nonsignificant effects. CONCLUSION: The analgesic effect can be measured within a more global effect of ketamine as shown by auditory and motor tasks, and the analgesia produced by ketamine occurs with a smaller degree of cortical processing in pain-related regions.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 14739803 [PubMed - indexed for MEDLINE]
Prediction of the distance from skin to epidural space for low-thoracic epidural catheter insertion by computed tomography.
Kao MC, Tsai SK, Chang WK, Liu HT, Hsieh YC, Hu JS, Mok MS.
Department of Anesthesiology, Veterans General Hospital-Taipei, School of Medicine,National Yang-Ming University, Taipei, Taiwan.
BACKGROUND: It may be clinically useful to predict the depth of the epidural space. METHODS: To investigate the accuracy of preoperative abdominal computed tomography (CT) in prediction of the distance for low-thoracic epidural insertion, a single group observational study was conducted in 30 male patients undergoing elective major abdominal surgery requiring epidural analgesia for postoperative pain relief. Using the paramedian approach, low-thoracic epidural insertion at T10-11 interspace was performed with a standardized procedure to obtain an actual insertion length (AIL). According to the principles of trigonometry, an estimated insertion length (EIL) was calculated as 1.26 times the distance from skin to epidural space measured from the preoperative abdominal CT. RESULTS: The mean (SD) EIL and AIL were 5.5 (0.7) and 5.1 (0.6) cm, respectively, with a significant correlation (r=0.899, P<0.01). The EIL tended to have a higher value than the AIL (0.4 (0.3) cm). There were significant correlations of both EIL and AIL with weight (P<0.01), BMI (P<0.01), and body fat percentage (P<0.01), but not with height (P>0.05). CONCLUSIONS: We conclude that the preoperative abdominal CT is helpful in prediction of the distance for low-thoracic epidural insertion using the paramedian approach.
Publication Types:
PMID: 14722181 [PubMed - indexed for MEDLINE]
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Caudal bupivacaine supplemented with caudal or intravenous clonidine in children undergoing hypospadias repair: a double-blind study.
Hansen TG, Henneberg SW, Walther-Larsen S, Lund J, Hansen M.
Department of Anaesthesia and Intensive Care, Odense University Hospital, DK-5000 Odense C, Denmark. tomghansen@dadlnet.dk
BACKGROUND: Clonidine is used increasingly in paediatric anaesthetic practice to prolong the duration of action of caudal block with a local anaesthetic agent. Which route of administration of clonidine is the most beneficial remains unknown. We compared the effects of caudal and i.v. clonidine on postoperative analgesia produced by caudal bupivacaine after hypospadias repair. METHODS: Forty-six children (ASA I or II) aged 24-104 months received standardized premedication with midazolam, a general anaesthetic and a caudal block with bupivacaine 0.25%, 0.5 ml kg(-1). The children were randomized in a double-blind fashion to two groups: the i.v. group received clonidine 2 micro g kg(-1) i.v. and simultaneously the same volume of saline caudally. The caudal group received clonidine 2 micro g kg(-1) caudally and a similar volume of saline i.v. After surgery, all children received acetaminophen 20 mg kg(-1) rectally or orally 6-hourly and were given a patient-controlled or nurse-controlled analgesia (PCA/NCA) pump with i.v. morphine (bolus of 25 micro g kg(-1) and an 8-min lockout period with no background infusion). Monitoring of scores for pain, sedation, motor block, and postoperative nausea and vomiting was performed by nurses blinded to the study allocations. Time to first activation of the PCA/NCA pump and 0-24 h and 24-48 h morphine consumption were also recorded. RESULTS: Forty-four children completed the study. Age, weight and duration of anaesthesia and surgery were similar in the two groups. The median (range) time to first activation of the PCA/NCA pump was similar in the two groups: 425 (150-1440) min in the i.v. group and 450 (130-1440) min in the caudal group. The number of children not requiring postoperative morphine was four and seven respectively. Morphine consumption during 0-24 h and 24-48 h was similar between groups. CONCLUSIONS: The analgesic effect of clonidine 2 micro g kg(-1) as an adjunct to caudal block with bupivacaine 0.25%, 0.5 ml kg(-1) is similar whether administered i.v. or caudally.
Publication Types:
- Clinical Trial
- Multicenter Study
- Randomized Controlled Trial
PMID: 14722172 [PubMed - indexed for MEDLINE]
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Developmental pharmacokinetics of morphine and its metabolites in neonates, infants and young children.
Bouwmeester NJ, Anderson BJ, Tibboel D, Holford NH.
Department of Anaesthesiology and Paediatric Surgery, Sophia Children's Hospital, University Hospital Rotterdam, Dr Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands.
BACKGROUND: Descriptions of the pharmacokinetics and metabolism of morphine and its metabolites in young children are scant. Previous studies have not differentiated the effects of size from those related to age during infancy. METHODS: Postoperative children 0-3 yr old were given an intravenous loading dose of morphine hydrochloride (100 micro g kg(-1) in 2 min) followed by either an intravenous morphine infusion of 10 micro g h(-1) kg(-1) (n=92) or 3-hourly intravenous morphine boluses of 30 micro g kg(-1) (n=92). Additional morphine (5 micro g kg(-1)) every 10 min was given if the visual analogue (VAS, 0-10) pain score was >/=4. Arterial blood (1.4 ml) was sampled within 5 min of the loading dose and at 6, 12 and 24 h for morphine, morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G). The disposition of morphine and formation clearances of morphine base to its glucuronide metabolites and their elimination clearances were estimated using non-linear mixed effects models. RESULTS: The analysis used 1856 concentration observations from 184 subjects. Population parameter estimates and their variability (%) for a one-compartment, first-order elimination model were as follows: volume of distribution 136 (59.3) litres, formation clearance to M3G 64.3 (58.8) litres h(-1), formation clearance to M6G 3.63 (82.2) litres h(-1), morphine clearance by other routes 3.12 litres h(-1) per 70 kg, elimination clearance of M3G 17.4 (43.0) litres h(-1), elimination clearance of M6G 5.8 (73.8) litres h(-1). All parameters are standardized to a 70 kg person using allometric 3/4 power models and reflect fully mature adult values. The volume of distribution increased exponentially with a maturation half-life of 26 days from 83 litres per 70 kg at birth; formation clearance to M3G and M6G increased with a maturation half-life of 88.3 days from 10.8 and 0.61 litres h(-1) per 70 kg respectively at birth. Metabolite formation decreased with increased serum bilirubin concentration. Metabolite clearance increased with age (maturation half-life 129 days), and appeared to be similar to that described for glomerular filtration rate maturation in infants. CONCLUSION: M3G is the predominant metabolite of morphine in young children and total body morphine clearance is 80% that of adult values by 6 months. A mean steady-state serum concentration of 10 ng ml(-1) can be achieved in children after non-cardiac surgery in an intensive care unit with a morphine hydrochloride infusion of 5 micro g h(-1) kg(-1) at birth (term neonates), 8.5 micro g h(-1) kg(-1) at 1 month, 13.5 micro g h(-1) kg(-1) at 3 months and 18 micro g h(-1) kg(-1) at 1 year and 16 micro g h(-1) kg(-1) for 1- to 3-yr-old children.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 14722170 [PubMed - indexed for MEDLINE]
SUNCT syndrome: the first German case series.
Schwaag S, Frese A, Husstedt IW, Evers S.
Publication Types:
PMID: 12780772 [PubMed - indexed for MEDLINE]
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Caffeine-induced headache in children and adolescents.
Hering-Hanit R, Gadoth N.
Department of Neurology, Meir General Hospital, Sapir Medical Centre, Kfar Saba, Israel. hering@post.tau.ac.il
Caffeine is the most widely used behaviourally active substance. Excessive caffeine consumption, mostly in the form of coffee and tea, is a well-recognized cause of headache or migraine, and withdrawal can cause headache. Nevertheless, caffeine abuse headache is not listed as a separate category in the International Headache Society classification, 1988. We report our experience with children and adolescents with daily or near-daily headache and excessive consumption of caffeine in the form of cola drinks. Over a period of 5 years we have encountered, in a tertiary headache clinic in a general hospital, 36 children and adolescents (17 girls and 19 boys) with daily or near-daily headache related to excessive caffeine intake in the form of cola drinks. The mean age of the subjects was 9.2 years (range 6-18) and mean headache duration was 1.8 years (range 0.6-5). All were heavy cola drinks consumers; at least 1.5 L of cola drinks per day (192.88 mg of caffeine daily), and an average of 11 (range 10.5-21) L of cola drinks a week, which amounts to 1414.5 mg of caffeine (range 1350.1-2700.3). Patients were encouraged to achieve gradual withdrawal from cola drinks, which led to complete cessation of all headaches in 33 subjects, whereas one boy and two adolescent girls continued to suffer from migraine without aura not frequent enough to justify prophylactic medication. Children and adolescents with high daily caffeine consumption in the form of cola drinks may suffer from caffeine-induced daily headache. Gradual withdrawal can be achieved without withdrawal headache and with complete disappearance of the induced chronic daily headache.
PMID: 12780761 [PubMed - indexed for MEDLINE]
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Factors independently associated with increased risk of pain development after ophthalmic surgery.
Henzler D, Kramer R, Steinhorst UH, Piepenbrock S, Rossaint R, Kuhlen R.
Medizinische Hochschule Hannover, Department of Anaesthesiology I, Hannover, Germany. dhenzler@ukaachen.de
BACKGROUND AND OBJECTIVE: Little has been documented about the development of pain after ophthalmic surgery. This study was designed to assess the incidence and severity of postoperative pain following ophthalmic surgery, and to identify key factors independently associated with development of such pain. METHODS: In a prospective, observational cohort study, 500 patients undergoing elective ophthalmic surgery were examined by assessing numerical analogue scales and analgesic requirements. RESULTS: Depending on anatomical location of surgery, operations could be classified into creating 'more severe' or 'less severe pain'. Patients undergoing posterior segment, corneal and muscle surgery exhibited the highest numerical analogue scale scores (risk ratio 4.5, 95% CI 3.01-6.79, P < 0.0001). Anterior segment surgery, which per se did not create much pain, resulted in significantly more pain when performed under general anaesthesia compared to regional anaesthesia (risk ratio 6.52, 95% CI 2.33-18.2, P < 0.0001). No other factors independently associated with an increased risk of developing serious postoperative pain could be identified. CONCLUSIONS: Patients undergoing certain ophthalmic operations, especially if performed under general anaesthesia, are more likely to experience serious postoperative pain.
PMID: 14977340 [PubMed - in process]
Effect of a cognitive behavioral intervention on reducing symptom severity during chemotherapy.
Given C, Given B, Rahbar M, Jeon S, McCorkle R, Cimprich B, Galecki A, Kozachik S, Brady A, Fisher-Malloy MJ, Courtney K, Bowie E.
Department of Family Practice, College of Human Medicine, Michigan State University, B108 Clinical Center, East Lansing, MI 48824, USA. givenc@msu.edu
PURPOSE: To describe a randomized trial of a cognitive behavioral intervention on reducing symptom severity among patients diagnosed with solid tumors and undergoing a first course of chemotherapy and to determine whether the intervention had an additive or interactive effect on symptom severity in the presence of supportive care medications. PATIENTS AND METHODS: Patients (N = 237) were accrued from comprehensive and community cancer centers, interviewed, and randomly assigned to either the experimental intervention (n = 118) or conventional care (n = 119). A symptom severity index, based on summed severity scores across 15 symptoms, was the primary outcome. Each patient's site of cancer, stage at diagnosis, chemotherapy protocols, and use of supportive medications were learned from medical records. RESULTS: Groups were equivalent at baseline, and attrition by characteristics by group was not different. The proportion of patients not receiving chemotherapy at 10 and 20 weeks did not differ by group. At the 10- and 20-week observations, there was a significant interaction between the experimental group and baseline symptom severity. Patients in the experimental group who entered the trial with higher symptom severity reported significantly lower severity at 10 and 20 weeks. Controlling for chemotherapy treatment status at follow-up and supportive care medications did not alter the effect of the experimental intervention. CONCLUSION: Compared with conventional care alone, the experimental intervention was effective among patients who entered the trial with higher levels of symptom severity. Age, sex, site or stage of cancer, and supportive medications did not modify the effect of this cognitive behavioral intervention on symptom severity.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 14752074 [PubMed - indexed for MEDLINE]
Comment on:
"Cooling-off" vs immediate revascularization for patients with acute coronary syndromes.
Goodman S.
Publication Types:
PMID: 14871906 [PubMed - indexed for MEDLINE]
Comment on:
Opioid therapy for chronic pain.
Klein MJ.
Publication Types:
PMID: 14978839 [PubMed - indexed for MEDLINE]
Comment on:
Opioid therapy for chronic pain.
Gajraj N.
Publication Types:
PMID: 14978838 [PubMed - indexed for MEDLINE]
Comment on:
Opioid therapy for chronic pain.
Hermos JA.
Publication Types:
PMID: 14978837 [PubMed - indexed for MEDLINE]
Comment in:
Spinal-fusion surgery - the case for restraint.
Deyo RA, Nachemson A, Mirza SK.
Department of Medicine, Center for Cost and Outcomes Research, University of Washington, Seattle, USA.
PMID: 14960750 [PubMed - indexed for MEDLINE]
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Clinical practice. Acute renal colic from ureteral calculus.
Teichman JM.
Division of Urology, University of British Columbia, Section of Urology, St. Paul's Hospital, Vancouver, Canada.
Publication Types:
PMID: 14960744 [PubMed - indexed for MEDLINE]
Comment on:
Spinal-fusion surgery -- advances and concerns.
Lipson SJ.
Department of Orthopedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, and Harvard Vanguard Medical Associates, Boston, MA, USA.
Publication Types:
PMID: 14960739 [PubMed - indexed for MEDLINE]
Analgesic use: A predictor of chronic pain in medication overuse headache: The Head-HUNT Study.
Sheftell FD, Tepper SJ, Rapoport AM.
Stamford, CT. Trondheim, Norway.
PMID: 14981203 [PubMed - in process]
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Vertebral osteonecrosis related to intradiscal electrothermal therapy: a case report.
Scholl BM, Theiss SM, Lopez-Ben R, Kraft M.
Division of Orthopaedic Surgery, University of Alabama at Birmingham, 35294, USA.
STUDY DESIGN: A case of a patient in whom vertebral osteonecrosis developed after intradiscal electrothermal therapy is reported. OBJECTIVE: To illustrate a potential complication of intradiscal electrothermal therapy and potential strategies to avoid it. SUMMARY OF BACKGROUND DATA: Thermal energy delivered in a controlled fashion directly to the annular wall and disc nucleus has been developed as an alternative to surgical methods for treating internal disc disruption. Although 2-year follow-up data are available, few complications and no vertebral body injury have been reported. METHODS: After intradiscal electrothermal therapy, a patient exhibited MRI changes consistent with osteonecrosis in the adjacent vertebral body. The clinical and radiologic findings are presented, along with a review of the pertinent literature. RESULTS: The magnetic resonance images, the temporal relation of intradiscal therapy, and the patient's clinical symptoms are consistent with focal osteonecrosis of the vertebral body. CONCLUSIONS: This case study highlights a potential complication of intradiscal electrothermal therapy. Catheter placement may expose cortical and cancellous bone to temperatures well within the range reported to induce necrosis. In addition, focal disruption of the endplate may prove to be a relative contraindication for intradiscal electrothermal therapy.
Publication Types:
PMID: 12942018 [PubMed - indexed for MEDLINE]
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Back to work: predictors of return to work among patients with back disorders certified as sick: a two-year follow-up study.
Reiso H, Nygard JF, Jorgensen GS, Holanger R, Soldal D, Bruusgaard D.
Department of General Practice and Community Medicine, the Section for Occupational Health and Social Insurance Medicine, University of Oslo, Norway. harald.reiso@ samfunnsmed.uio.no
STUDY DESIGN: A 2-year follow-up study of patients with back disorders certified as sick. OBJECTIVES: To identify predictors of return to work. SUMMARY OF BACKGROUND DATA: Back disorders are common health problems and the most important disorders associated with absence from work in the welfare states. Predictors of future absence may be of help in allocating rehabilitation efforts to such patients. Possible predictors include demographic and medical factors, the patients' functional status, and former absence. METHODS: For this study, 190 patients certified as sick who attended a back disorder outpatient clinic from September 1997 to December 1998 answered a questionnaire. Demographic data, medical factors, self-assessed function, and absence data were recorded. Return to work, defined as returning to work for at least 60 consecutive calendar days, was used in Cox regression analyses. RESULTS: According to multiple Cox regression analyses, age of 40 to 49 years (HR, 0.52; 95% confidence interval [95%CI], 0.29-0.94), high pain intensity (HR, 0.30; 95%CI, 0.17-0.55), low self-assessed work ability (HR, 0.43; 95%CI, 0.25-0.73), and a self-predicted absence status of not returning to work (HR, 0.31; 95%CI, 0.17-0.54) predicted longer time until return to work. Back disorders with radiation predicted shorter time until return to work (HR, 2.08; 95%CI, 1.37-3.16). The COOP/WONCA chart's physical fitness, daily activities, overall health, and change in health were associated with time until return to work in univariate analyses only, as was the duration of the sickness certification episodes from start to inclusion and the degree of sickness certification at inclusion. CONCLUSIONS: Information about the age of the patients, diagnoses, pain intensity, self-assessed work ability, and self-predicted absence status may be used as predictors of time until return to work in patients with back disorders certified as sick who attend a back disorder outpatient clinic.
PMID: 12838108 [PubMed - indexed for MEDLINE]
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