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Items 1 - 17 of 17 |
One page. |
Periodic autonomic dysfunction without pain in a patient with cluster headache.
Ashkenazi A, Silberstein SD.
Publication Types:
PMID: 15482367 [PubMed - in process]
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Early treatment of a migraine attack while pain is still mild increases the efficacy of sumatriptan.
Scholpp J, Schellenberg R, Moeckesch B, Banik N.
Medical Department, GlaxoSmithKline, Muenchen, Germany. Joachim.Scholpp@dgn.de
To investigate the hypothesis that early treatment of a migraine attack with sumatriptan, while pain is still mild, results in higher pain free rates in comparison to delayed treatment, when pain is at least moderate, we performed a prospective, controlled and open label study. Migraineurs with or without aura who fulfilled the diagnostic criteria recommended by the International Headache Society were enrolled in the study and randomly assigned to either 'early' or 'late' treatment with sumatriptan 100 mg tablets. In the early treatment group significantly more patients were pain free at all times measured during two hours after dosing than in the late treatment group. Furthermore, patients in the early treatment group became pain free significantly sooner after dosing than patients who delayed treatment. It is concluded that migraineurs, who are able to differentiate between a migraine attack and other forms of headache, benefit from early intervention with sumatriptan 100 mg tablets.
PMID: 15482353 [PubMed - in process]
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Benefits of treating highly disabled migraine patients with zolmitriptan while pain is mild.
Klapper J, Lucas C, Rosjo O, Charlesworth B; ZODIAC study group.
Colorado Neurology and Headache Center, Denver 80218, USA. jkheaddoc@aol.com
Clinical trials of migraine therapy often require treatment when migraine pain intensity is moderate or severe, but many physicians find this practice artificial and patients often prefer to treat while pain is mild. This randomized, placebo-controlled study assessed the efficacy of zolmitriptan 2.5 mg in treating migraine while pain is mild, in patients who typically experience migraine attacks that are initially mild, but progress to moderate or severe. The intent-to-treat population comprised 280 patients (138 zolmitriptan; 148 placebo), with mean MIDAS grades of 29.6 (zolmitriptan) and 27.6 (placebo). Zolmitriptan 2.5 mg provided a significantly higher pain-free rate at 2 h (43.4% vs. 18.4% placebo; P < 0.0001). Significantly fewer zolmitriptan patients reported progression of headache pain to moderate or severe intensity 2 h postdose (53.7% vs. 70.4% placebo; P < 0.01), or required further medication within 24 h (46.4% vs. 71.1% placebo; P < 0.0001). The efficacy of zolmitriptan was more pronounced in patients treating during the first 15 min following pain onset. Adverse events were reported in 31.2% of patients treated with zolmitriptan (vs. 11.3% for placebo), and the incidence was lower in patients who treated early after attack onset. Zolmitriptan provides high efficacy when treating migraine while pain is mild, with the clinical benefits being more pronounced when treating early after migraine onset.
PMID: 15482352 [PubMed - in process]
Comment on:
Point of view.
Farrar JT.
Publication Types:
PMID: 15322445 [PubMed - indexed for MEDLINE]
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Syringomyelia, neuropathic pain and Caesarean section.
Gredilla E, Palacio FJ, Perez-Ferrer A, Alonso E, Gimeno M, Gilsanz F.
Publication Types:
PMID: 15473626 [PubMed - indexed for MEDLINE]
Comment on:
Intrathecal ziconotide for chronic pain.
Bonicalzi V, Canavero S.
Publication Types:
PMID: 15479926 [PubMed - indexed for MEDLINE]
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Patient expectations of treatment for back pain: a systematic review of qualitative and quantitative studies.
Verbeek J, Sengers MJ, Riemens L, Haafkens J.
Coronel Institute for Work, Environment and Health, Amsterdam, The Netherlands. j.h.verbeek@amc.uva.nl
STUDY DESIGN: A systematic review of qualitative and quantitative studies. OBJECTIVES: To summarize evidence from studies among patients with low back pain on their expectations and satisfaction with treatment as part of practice guideline development. SUMMARY OF BACKGROUND DATA: Patients are often dissatisfied with treatment for acute or chronic back pain. METHODS: We searched the literature for studies on patient expectations and satisfaction with treatment for low back pain. Treatment aspects related to expectations or satisfaction were identified in qualitative studies. Percentages of dissatisfied patients were calculated from quantitative studies. RESULTS: Twelve qualitative and eight quantitative studies were found. Qualitative studies revealed the following aspects that patient expectation from treatment for back pain or with which they are dissatisfied. Patients want a clear diagnosis of the cause of their pain, information and instructions, pain relief, and a physical examination. Next, expectations are that there are more diagnostic tests, other therapy or referrals to specialists, and sickness certification. They expect confirmation from the healthcare provider that their pain is real. Like other patients, they want a confidence-based association that includes understanding, listening, respect, and being included in decision-making. The results from qualitative studies are confirmed by quantitative studies. CONCLUSIONS: Patients have explicit expectations on diagnosis, instructions, and interpersonal management. New strategies need to be developed in order to meet patients' expectations better. Practice guidelines should pay more attention to the best way of discussing the causes and diagnosis with the patient and should involve them in the decision-making process.
PMID: 15480147 [PubMed - in process]
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The pain disability questionnaire: a new psychometrically sound measure for chronic musculoskeletal disorders.
Anagnostis C, Gatchel RJ, Mayer TG.
PRIDE Research Foundation, Dallas, TX 75235, USA.
STUDY DESIGN: The Pain Disability Questionnaire (PDQ) is a psychometric evaluation study of a new measure of functional status. OBJECTIVE: To evaluate the psychometric properties of the PDQ and compare its validity and responsiveness to traditional measures of functional status, such as the Oswestry, Million (MVAS), and SF-36 instruments. SUMMARY OF BACKGROUND DATA: Measuring clinical outcomes is an essential element of any musculoskeletal treatment. The PDQ was developed for this purpose. It yields a total functional disability score ranging from 0 to 150. The focus, much like other health inventories, is primarily on disability and function. However, unlike most other measures, this instrument is designed for the full array of chronic disabling musculoskeletal disorders (CDMDs), rather than low back pain alone. Further, psychosocial variables, which recent studies have shown to play an integral role in the development and maintenance of chronic pain disability, formed an important core of the PDQ. METHODS: Four groups were used in this psychometric evaluation: an asymptomatic normative population (NP; n = 50), an acute musculoskeletal disorder population (AMD; n = 52), a chronic disabled musculoskeletal disorder population (CDMD; n = 230), and a heterogeneous pain population (HP; n = 114). The NP and AMD groups served as comparison samples for the CDMD and HP groups. Analyses of PDQ reliability, validity, and responsiveness were conducted. RESULTS: Test-retest reliability coefficients (ranging from 0.94 to 0.98) and a Cronbach's alpha coefficient of 0.96 for the PDQ were found to be of excellent quality. The responsiveness of the PDQ, as measured by Cohen's effect size statistic, ranged from 0.85 to 1.07, better than the Oswestry, MVAS, and SF-36. A high level of face validity was observed for the PDQ, as the CDMD population exhibited significantly higher pretreatment PDQ scores than a group of patients suffering from acute injuries. The construct-related validity of the PDQ was also found to be of excellent quality, as it correlated well to both the MVAS (0.65-0.81) and Oswestry (0.55-0.80). The PDQ consistently demonstrated stronger correlation coefficients to a wide variety of physical and psychosocial measures of human function, such as the SF-36, Beck Depression Inventory, Hamilton-D, State-Trait Anxiety Scale, and Pain Intensity VAS, than either the Oswestry or MVAS. A factor analysis of the PDQ revealed two factors: a Functional Status Component (FSC) and a Psychosocial Component (PC). Analyses proved each of these two components to be valid in assessing their theorized constructs. CONCLUSIONS: The present study represents a comprehensive psychometric evaluation of a new functional status measure for musculoskeletal conditions in general, and a CDMD population in particular. The psychometric properties of the PDQ are excellent, demonstrating strong reliability, responsiveness, and validity, relative to many other existing measures of functional status. The many weaknesses cited for some of the existing measures were taken into account in designing this instrument. Consequently, the characteristics commonly noted as weaknesses for these other measures (such as a restriction to only the low back pain population, and inconsistent responsiveness) can be cited as strengths of the PDQ. Its generalizability and utility for assessing orthopedic treatment progress and functional outcomes must now be evaluated in broader settings.
PMID: 15480144 [PubMed - in process]
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A randomized clinical trial of manipulative therapy and interferential therapy for acute low back pain.
Hurley DA, McDonough SM, Dempster M, Moore AP, Baxter GD.
School of Physiotherapy, University College Dublin, Mater Misericordiae Hospital, Dublin, Republic of Ireland. deirdre.hurleyosing@ucd.ie
STUDY DESIGN: A multicenter assessor-blinded randomized clinical trial was conducted. OBJECTIVES: To investigate the difference in effectiveness of manipulative therapy and interferential therapy for patients with acute low back pain when used as sole treatments and in combination. SUMMARY OF BACKGROUND DATA: Both manipulative therapy and interferential therapy are commonly used treatments for low back pain. Evidence for the effectiveness of manipulative therapy is available only for the short-term. There is limited evidence for interferential therapy, and no study has investigated the effectiveness of manipulative therapy combined with interferential therapy. METHODS: Consenting subjects (n = 240) recruited following referral by physicians to physiotherapy departments in the (government-funded) National Health Service in Northern Ireland were randomly assigned to receive a copy of the Back Book and either manipulative therapy (MT; n = 80), interferential therapy (IFT; n = 80), or a combination of manipulative therapy and interferential therapy (CT; n = 80). The primary outcome was a change in functional disability on the Roland Morris Disability Questionnaire. Follow-up questionnaires were posted at discharge and at 6 and 12 months. RESULTS: The groups were balanced at baseline for low back pain and demographic characteristics. At discharge all interventions significantly reduced functional disability (Roland Morris scale, MT: -4.53; 95% CI, -5.7 to -3.3 vs. IFT: -3.56; 95% CI, -4.8 to -2.4 vs. CT: -4.65; 95% CI, -5.8 to -3.5; P = 0.38) and pain (McGill questionnaire, MT: -5.12; 95% CI, -7.7 to -2.5 vs. IFT: -5.87; 95% CI, -8.5 to -3.3 vs. CT: -6.64; 95% CI, -9.2 to -4.1; P = 0.72) and increased quality of life (SF-36 Role-Physical, MT: 28.6; 95% CI, 18.3 to 38.9 vs. IFT: 31.4; 95% CI, 21.2 to 41.5 vs. CT: 30; 95% CI, 19.9 to 40; P = 0.93) to the same degree and maintained these improvements at 6 and 12 months. No significant differences were found between groups for reported LBP recurrence, work absenteeism, medication consumption, exercise participation, or healthcare use at 12 months (P > 0.05). CONCLUSIONS: For acute low back pain, there was no difference between the effects of a combined manipulative therapy and interferential therapy package and either manipulative therapy or interferential therapy alone.
PMID: 15480130 [PubMed - in process]
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Back pain and health policy research: the what, why, how, who, and when.
Wyatt M, Underwood MR, Scheel IB, Cassidy JD, Nagel P.
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. mwyatt@ozemail.com.au
STUDY DESIGN: A background literature, supported by discussion and outcomes on the subject of Health Policy and Back Pain, from the Fifth International Forum on Low Back Pain Research in Primary Care, in Montreal in May 2002. SUMMARY OF BACKGROUND DATA: A multitude of randomized controlled trials and systematic reviews have been completed in the field of back pain research. There has been limited health policy research in the field of back pain but a greater amount of health policy research in other medical fields. METHODS: The focus of the workshop was on the contribution health policy could make in the area of back pain, the methodologies that are appropriate to research in back pain, and the barriers to back pain health policy research. The workshop was supported by the workshop coordinators' literature review. RESULTS: There was consensus about the lack of improved outcomes from randomized controlled trials and individual treatments and general agreement on the importance supporting current research initiatives with health policy research. That policy-makers were developing policy in this area was agreed, and study methodology to support evidence based policy development was explored. CONCLUSIONS: Health policy research is a relatively underdeveloped area of research in back pain. Back pain as a public health problem may be supported by a broader research approach and a collaborative association with policy-makers in this area.
PMID: 15480125 [PubMed - in process]
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Importance of the back-café concept to rehabilitation after lumbar spinal fusion: a randomized clinical study with a 2-year follow-up.
Christensen FB, Laurberg I, Bunger CE.
Spine Section, Department of Orthopedic Surgery, University Hospital of Aarhus, Denmark. fbc@dadlnet.dk
STUDY DESIGN: A prospective, randomized, clinical study with a 2-year follow-up. OBJECTIVES: To analyze the effect of three different rehabilitation strategies for lumbar spinal fusion patients. SUMMARY OF BACKGROUND DATA: Fifteen percent to 40% of lumbar spinal fusion patients are not expected to improve significantly over a 2-year period. Optimization of present forms of rehabilitation could possibly further improve the outcome. MATERIALS AND METHODS: Between 1996 and 1999, 90 patients who had undergone lumbar spinal fusion were 3 months after surgery randomized to one of three different rehabilitation groups. Video group participants watched a video of exercises for training and were subsequently and only once provided instruction regarding their use. The back-cafe group was provided the same program as the video group, but as a supplement met with a back-cafe with other fusion-operated patients three times over an 8-week period. The training group was provided physical therapy training twice weekly for 8 weeks. Functional outcome was evaluated at 6, 12, and 24 months after surgery by use of the low back pain rating scale and a questionnaire covering daily functions, work status, and a patient's contact with the primary sector. RESULTS: By 2-year follow-up, the back-cafe and video groups had less pain compared with the training group (P < 0.03). The back-cafe group was better at performing daily functions such as carrying bags of market items (P < 0.01), getting up from a chair (P < 0.01), and ascending staircases (P < 0.01) compared with the video and training groups. More in the back-cafe group resumed working after surgery compared with the two other groups (P < 0.04). The video group had significantly more contacts with general practitioners, physical therapists, and so on compared with the back-cafe and training groups (P < 0.001). CONCLUSION: The patients in the back-cafe group were significantly better at accomplishing a succession of daily tasks compared with the video and training groups 2 years after lumbar spinal fusion. At the 2-year follow-up the training group had a significant pain problem compared with the video and back-cafe groups. The video group had significantly more treatment demands outside the hospital system. This study demonstrates the relevance of the inclusion of coping schemes and questions the role of intensive exercises in a rehabilitation program for spinal fusion patients.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 14652472 [PubMed - indexed for MEDLINE]
Comment on:
Re: Hurwitz EL, Morgenstern H, Harber P, et al. A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA low back pain study. Spine 2002; 27:2193-204.
Conijn FJ.
Publication Types:
PMID: 14595169 [PubMed - indexed for MEDLINE]
Successful use of ketamine for intractable cancer pain.
Lossignol DA, Obiols-Portis M, Body JJ.
Institut Jules Bordet, Clinique des Soins Supportifs et des Soins Palliatifs, Service de medecine interne, Universite Libre de Bruxelles, 1 Rue Heger Bordet, 1000, Brussels, Belgium.
GOALS AND WORK. Despite medical awareness, intractable pain is a serious problem in cancer and occurs in up to 2% of advanced cancer patients. However, few data are available concerning the optimal treatment of such patients. The emergence of intractable pain may notably be due to the activation of N-methyl-D-aspartate (NMDA) receptors located in the central nervous system. NMDA antagonists might thus be an interesting approach in such pain syndromes. PATIENTS AND METHODS. Twelve patients with intractable cancer pain received a test dose of 5-10 mg of ketamine, a strong NMDA antagonist, in order to determine their response and tolerance to the drug. Continuous intravenous infusions of ketamine associated with morphine were then administered. MAIN RESULTS. The acute test dose was successful in all cases (VAS <3/10 after 5 min). The prolonged use of ketamine allowed us to reduce the total daily dose of morphine required (range: 200-1,200 mg) by 50% and allowed eight patients to go home with a portable pump with morphine and ketamine during a relatively long period of time (range: 7-350 days, median: 58 days). Side effects were moderate (dizziness) and they were limited to the test phase. CONCLUSION. Our data suggest the importance of NMDA receptors in the genesis of chronic cancer pain and indicate that NMDA antagonists should be further studied for the management of cancer pain and, in particular, intractable pain.
PMID: 15480820 [PubMed - as supplied by publisher]
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Pain evaluation and management: a survey of Italian radiotherapists.
Porzio G, Valenti M, Aielli F, Verna L, Narducci F, Valeriani M, Ricevuto E, Ficorella C, Marchetti P, Tombolini V.
Supportive Care and Rehabilitation Unit, Medical Oncology Department, University of L'Aquila, L'Aquila, Italy.
GOALS. The objective of this study was to assess the knowledge possessed and the attitudes held by Italian radiotherapists regarding evaluation and treatment of pain. METHODS. One hundred and twenty-six radiotherapists completed a 16-item questionnaire that was specifically designed to investigate three main topics: the attention paid to pain, the use of analgesics, and pain in children. Chi-square or Fisher's exact text was employed to evaluate differences based on position (staff/resident), age (<35/ >35 years old), availability of consultants in pain therapy and/or palliative care, colleagues with main interest in palliative care among their own staff, and region of residence (north/center/south of Italy). RESULTS. Overall percentage of correct answers was 76.6% (range 34.9-94.4%). Correct answers by groups of items were: attention paid to pain 77.3%, use of analgesics 81.5%, and pain in children 63.7%. CONCLUSION. Results of the survey demonstrate that knowledge and attitudes of Italian radiotherapists towards the approach to and treatment of pain can be considered satisfactory.
PMID: 15480818 [PubMed - as supplied by publisher]
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Pain intensity assessment by bedside nurses and palliative care consultants: a retrospective study.
Bruera E, Willey JS, Ewert-Flannagan PA, Cline MK, Kaur G, Shen L, Zhang T, Palmer JL.
Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., 77030, Houston, TX, USA.
OBJECTIVE. To evaluate the specificity, sensitivity, and accuracy of pain intensity assessments (0-10) conducted by registered nurses (RN) and clinical nurse assistants (CAN) as compared to those conducted by the palliative care consultant (PCC). PATIENTS AND METHODS. We performed a retrospective review of charts of patients who had received palliative care consult between April 2002 and August 2002. Data on patient demographic, date of palliative care consult, and date and intensity of pain assessment were collected. A numerical rating scale from 0 (no pain) to 10 (worst pain) was used to assess pain intensity. The data were included for analysis if the pain intensity assessment was performed during the same shift by all three care providers (RN, CNA, and PCC). RESULTS. Forty-one charts were found to include a complete pain assessment performed by the RN, CNA, and PCC. The agreement of pain intensity between the PCC and both the RN and CNA was poor. For a diagnosis of moderate-to-severe pain, the RN's intensity assessment had a specificity of 90% but a sensitivity of 45%, and the CNA's intensity assessment had a specificity of 100% but a sensitivity of only 30%. The Spearman correlation coefficient between the intensity assessments performed by the PCC and the RN was 0.56 ( p=0.00) and between those by the PCC and the CNA 0.22 ( p=0.15). CONCLUSION. Lack of agreement between pain intensity assessments performed by the PCC and bedside nurse suggests possible inconsistencies in the way the assessments were performed. Better education on how to perform standard pain intensity assessment is needed.
PMID: 15480817 [PubMed - as supplied by publisher]
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Treatment of cancer-related pain with transdermal buprenorphine: a report of three cases.
Schriek P.
Twachtmannshof 4, 29229, Celle, Germany.
Three patients suffering from pain arising from renal and metastasing prostate and breast cancer were successfully treated with transdermal buprenorphine. The three cases demonstrate that transdermal buprenorphine is an easy-to-use and effective therapeutic option for the treatment of advanced cancer pain, that it can also be used in opioid rotation as an alternative after formerly applied steps II or III opioids have failed and that long-term treatment without dose escalation or compromise in tolerability is possible.
PMID: 15480815 [PubMed - as supplied by publisher]
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Stories from doctors of patients with pain. A qualitative research on the physicians' perspective.
Vegni E, Mauri E, Moja EA.
Chair Department of Medical Psychology, School of Medicine, University of Milan, Milan, Italy.
GOAL OF WORK. .The aim of this study was to explore the physicians' internal representation of the doctor-patient relationship in the dramatic field of the patient with pain. METHODS. Using an open narrative format, 151 physicians were asked to "Tell us about an episode during your professional experience in which you found yourself in difficulty whilst confronting a patient who was in pain". The narrations were examined in accordance with a clinical-interpretive method. MAIN RESULTS. Three "perspectives of observation" were identified, namely: the biological perspective, the professional perspective, and the personal perspective. The biological perspective is about the biological model and the "depersonalization" of pain. In the professional perspective, the narrative concerns the patient as a "person" and the reattribution of the pain to the suffering person. The personal perspective is about the emotional-relational explosion within the meeting between the doctor as human being and the patient as human being. Most of the narrations did not strictly connect to one or another of the perspectives, but each story seemed a journey without peace back and forth among the perspectives. CONCLUSIONS. The professional perspective seemed to be the only place in which physicians could "stop", a space not extreme in which they seemed to express the need for education about the management of the professional relationship with the other person.
PMID: 15480810 [PubMed - as supplied by publisher]
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