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Items 1 - 31 of 31 |
One page. |
A patient with Glanzmann's thrombasthenia for emergent abdominal surgery.
Uzunlar HI, Eroglu A, Senel AC, Bostan H, Erciyes N.
Department of Anesthesiology and Reanimation, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey. uzunlar@gmx.com.tr
Glanzmann's thrombasthenia is a rare autosomal recessive disease characterized by potentially major mucocutaneous complications and nose bleeds. It is considered hazardous for these surgical patients to conceive, with a high risk of urgent surgery. The treatment of bleeding or prevention of hemorrhage for surgery or invasive procedures is based on platelet transfusion. However, platelet transfusions may be responsible for the development of alloimmunization, with a high risk of future platelet refractoriness. We report a surgical case of Glanzmann's thrombasthenia complicated by nasopharyngeal bleeding and managed with platelet transfusions, recombinant activated factor VII, and postoperative airway management in the intensive care unit.
Publication Types:
PMID: 15385386 [PubMed - indexed for MEDLINE]
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Small-dose intrathecal clonidine and isobaric bupivacaine for orthopedic surgery: a dose-response study.
Strebel S, Gurzeler JA, Schneider MC, Aeschbach A, Kindler CH.
Department of Anesthesia, University Clinics, Kantonsspital, Basel, Switzerland.
We examined the dose-response relationship of intrathecal clonidine at small doses (<or=150 microg) with respect to prolonging bupivacaine spinal anesthesia. We aimed for establishing doses of intrathecal clonidine that would produce clinically relevant prolongation of spinal anesthesia and pain relief without significant side effects. Eighty orthopedic patients were randomly assigned to intrathecally receive isobaric 0.5% bupivacaine, 18 mg, plus saline (Group 1), clonidine 37.5 microg (Group 2), clonidine 75 microg (Group 3), and clonidine 150 microg (Group 4). Duration of the sensory block (regression below level L1) was increased in patients receiving intrathecal clonidine: 288 +/- 62 min (Group 1, control), 311 +/- 101 min in Group 2 (+8%), 325 +/- 69 min in Group 3 (+13%), and 337 +/- 78 min in Group 4 (+17%) (estimated parameter for dose 0.23 [95% confidence interval -0.05-0.50]). Duration of pain relief from intrathecal clonidine administration until the first request for supplemental analgesia was significantly prolonged: 295 +/- 80 min (Group 1, control), 343 +/- 75 min in Group 2 (+16%), 381 +/- 117 min in Group 3 (+29%), and 445 +/- 136 min in Group 4 (+51%) (estimated parameter for dose 1.02 [95% confidence interval 0.59-1.45]). Relative hemodynamic stability was maintained and there were no between-group differences in the sedation score. We conclude that small doses of intrathecal clonidine (<or=150 microg) significantly prolong the anesthetic and analgesic effects of bupivacaine in a dose-dependent manner and that 150 microg of clonidine seems to be the preferred dose, in terms of effect versus unwarranted side effects, when prolongation of spinal anesthesia is desired.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15385382 [PubMed - indexed for MEDLINE]
-
Large-dose intrathecal sufentanil prevents the hormonal stress response during major abdominal surgery: a comparison with intravenous sufentanil in a prospective randomized trial.
Borgdorff PJ, Ionescu TI, Houweling PL, Knape JT.
Department of Anaesthesiology, Diakonessenhuis Hospital, Utrecht, The Netherlands. pborgdorff@diakhuis.nl
We studied the effect of large-dose intrathecal sufentanil (ITS) for major abdominal surgery on the hormonal stress response. Forty patients were randomly allocated to receive either IV sufentanil (IVS) or 150 microg of ITS as part of general anesthesia. In the IVS group, adrenocorticotropic hormone (ACTH) and cortisol concentrations were larger than baseline and the ITS group, 60 min after incision and at skin closure. Plasma concentrations of cortisol and ACTH were not different from baseline in the ITS group during surgery. Six hours after skin closure, cortisol concentrations were larger than baseline in both groups. Twenty-four and 48 h after skin closure, ACTH and cortisol values were similar between groups. Norepinephrine concentrations increased after surgery in both groups. Blood glucose levels increased in both groups during and after surgery. Pain scores and morphine consumption during the first 48 h after surgery were lower in the ITS group. The data show that large-dose ITS prevents the intraoperative hormonal stress response in comparison with balanced anesthesia. We speculate that this is due to the highly specific binding of sufentanil to spinal and supraspinal receptors. This technique improves postoperative analgesia when compared with balanced anesthesia.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15385360 [PubMed - indexed for MEDLINE]
-
A randomized controlled comparison of electro-acupoint stimulation or ondansetron versus placebo for the prevention of postoperative nausea and vomiting.
Gan TJ, Jiao KR, Zenn M, Georgiade G.
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA. gan00001@mc.duke.edu
In this study we evaluated the efficacy of electro-acupoint stimulation, ondansetron versus placebo for the prevention of postoperative nausea and vomiting (PONV). Patients undergoing major breast surgery under general anesthesia were randomized into active electro-acupoint stimulation (A), ondansetron 4 mg IV (O), or sham control (placement of electrodes without electro-acupoint stimulation; placebo [P]). The anesthetic regimen was standardized. The incidence of nausea, vomiting, rescue antiemetic use, pain, and patient satisfaction with management of PONV were assessed at 0, 30, 60, 90, 120 min, and at 24 h. The complete response (no nausea, vomiting, or use of rescue antiemetic) was significantly more frequent in the active treatment groups compared with placebo both at 2 h (A/O/P = 77%/64%/42%, respectively; P = 0.01) and 24 h postoperatively (A/O/P = 73%/52%/38%, respectively; P = 0.006). The need for rescue antiemetic was less in the treatment groups (A/O/P = 19%/28%/54%; P = 0.04). Specifically, the incidence and severity of nausea were significantly less in the A group compared with the other groups, and in the O group compared with the P group (A/O/P = 19%/40%/79%, respectively). The A group experienced less pain in the postanesthesia care unit, compared with the O and P groups. Patients in the treatment groups were more satisfied with their management of PONV compared with placebo. When used for the prevention of PONV, electro-acupoint stimulation or ondansetron was more effective than placebo with greater degree of patient satisfaction, but electro-acupoint stimulation seems to be more effective in controlling nausea, compared with ondansetron. Stimulation at P6 also has analgesic effects.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15385352 [PubMed - indexed for MEDLINE]
Popliteal sciatic perineural local anesthetic infusion: a comparison of three dosing regimens for postoperative analgesia.
Ilfeld BM, Thannikary LJ, Morey TE, Vander Griend RA, Enneking FK.
Department of Anesthesiology, University of Florida, 1600 SW Archer Road, Gainesville, FL 32610-0254, USA. bilfeld@ufl.edu
BACKGROUND: This randomized, double-blind study investigated the efficacy of continuous and patient-controlled ropivacaine infusion via a popliteal sciatic perineural catheter in ambulatory patients undergoing moderately painful orthopedic surgery of the foot or ankle. METHODS: Preoperatively, patients (n = 30) received a posterior popliteal sciatic perineural catheter and nerve block. Postoperatively, patients were discharged home with a portable infusion pump delivering 0.2% ropivacaine (500 ml) in one of three dosing regimens: the basal group (12-ml/h basal rate, 0.05-ml patient-controlled bolus dose), the basal-bolus group (8-ml/h basal rate, 4-ml bolus dose), or the bolus group (0.3-ml/h basal rate, 9.9-ml bolus dose). RESULTS: The bolus group experienced an increase in baseline pain, breakthrough pain incidence and intensity, and sleep disturbances compared with the other two groups (P < 0.05 for all comparisons). Compared with the basal-bolus group, the basal group experienced an increase in these outcome measures only after local anesthetic reservoir exhaustion, which occurred earlier than in the other two groups (P < 0.05 for all comparisons). Satisfaction scores did not differ among the three groups. CONCLUSIONS: This study demonstrates that when providing analgesia with 0.2% ropivacaine via a popliteal sciatic perineural catheter after moderately painful surgery of the foot or ankle, a continuous infusion is required to optimize infusion benefits. Furthermore, adding patient-controlled bolus doses allows for a lower continuous basal rate and decreased local anesthetic consumption and thereby increases the duration of infusion benefits when in an ambulatory environment with a limited local anesthetic reservoir.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15448531 [PubMed - indexed for MEDLINE]
Comment in:
Ciprofloxacin or tamsulosin in men with chronic prostatitis/chronic pelvic pain syndrome: a randomized, double-blind trial.
Alexander RB, Propert KJ, Schaeffer AJ, Landis JR, Nickel JC, O'Leary MP, Pontari MA, McNaughton-Collins M, Shoskes DA, Comiter CV, Datta NS, Fowler JE Jr, Nadler RB, Zeitlin SI, Knauss JS, Wang Y, Kusek JW, Nyberg LM Jr, Litwin MS; Chronic Prostatitis Collaborative Research Network.
Veterans Affairs Maryland Health Care System and University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. ralexander@smail.umaryland.edu
BACKGROUND: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men is principally defined by pain in the pelvic region lasting more than 3 months. No cause of the disease has been established, and therapies are empirical and mostly untested. Antimicrobial agents and alpha-adrenergic receptor blockers are frequently used. OBJECTIVE: To determine whether 6-week therapy with ciprofloxacin or tamsulosin is more effective than placebo at improving symptoms in men with refractory, long-standing CP/CPPS. DESIGN: Randomized, double-blind trial with a 2 x 2 factorial design comparing 6 weeks of therapy with ciprofloxacin, tamsulosin, both drugs, or placebo. SETTING: Urology outpatient clinics at 10 tertiary care medical centers in North America. PATIENTS: Patients were identified from referral-based practices of urologists. One hundred ninety-six men with a National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score of at least 15 and a mean of 6.2 years of symptoms were enrolled. Patients had received substantial previous treatment. MEASUREMENTS: The authors evaluated NIH-CPSI total score and subscores, patient-reported global response assessment, a generic measure of quality of life, and adverse events. Interventions: Ciprofloxacin, 500 mg twice daily; tamsulosin, 0.4 mg once daily; a combination of the 2 drugs; or placebo. RESULTS: The NIH-CPSI total score decreased modestly in all treatment groups. No statistically significant difference in the primary outcome was seen for ciprofloxacin versus no ciprofloxacin (P = 0.15) or tamsulosin versus no tamsulosin (P > 0.2). Treatments also did not differ significantly for any of the secondary outcomes. LIMITATIONS: Treatment lasting longer than 6 weeks was not tested. Patients who had received less pretreatment may have responded differently. CONCLUSION: Ciprofloxacin and tamsulosin did not substantially reduce symptoms in men with long-standing CP/CPPS who had at least moderate symptoms.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15492337 [PubMed - indexed for MEDLINE]
Comment on:
Summaries for patients. Treating men with chronic prostatitis/chronic pelvic pain syndrome.
[No authors listed]
Publication Types:
- Comment
- Patient Education Handout
PMID: 15492335 [PubMed - indexed for MEDLINE]
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Primary care management of chronic stable angina and asymptomatic suspected or known coronary artery disease: a clinical practice guideline from the American College of Physicians.
Snow V, Barry P, Fihn SD, Gibbons RJ, Owens DK, Williams SV, Mottur-Pilson C, Weiss KB; American College of Physicians; American College of Cardiology Chronic Stable Angina Panel.
American College of Physicians and University of Pennsylvania, Philadelphia, Pennsylvania 19106, USA. vincenza@mail.acponline.org
In 1999, the American College of Physicians (ACP), then the American College of Physicians-American Society of Internal Medicine, and the American College of Cardiology/American Heart Association (ACC/AHA) developed joint guidelines on the management of patients with chronic stable angina. The ACC/AHA then published an updated guideline in 2002, which ACP recognized as a scientifically valid review of the evidence and background paper. This ACP guideline summarizes the recommendations of the 2002 ACC/AHA updated guideline and underscores the recommendations most likely to be important to physicians seeing patients in the primary care setting. This guideline is the second of 2 that provide guidance on the management of patients with chronic stable angina. This document covers treatment and follow-up of symptomatic patients who have not had an acute myocardial infarction or revascularization procedure in the previous 6 months. Sections addressing asymptomatic patients are also included. Asymptomatic refers to patients with known or suspected coronary disease based on a history or electrocardiographic evidence of previous myocardial infarction, coronary angiography, or abnormal results on noninvasive tests. A previous guideline covered diagnosis and risk stratification for symptomatic patients who have not had an acute myocardial infarction or revascularization procedure in the previous 6 months and asymptomatic patients with known or suspected coronary disease based on a history or electrocardiographic evidence of previous myocardial infarction, coronary angiography, or abnormal results on noninvasive tests.
Publication Types:
- Guideline
- Practice Guideline
PMID: 15466774 [PubMed - indexed for MEDLINE]
Delayed retroperitoneal haematoma after failed lumbar plexus block.
Aveline C, Bonnet F.
Departement d'Anesthesie-Reanimation, Polyclinique Sevigne, 3 rue du Chene Germain, F-35510 Cesson-Sevigne, France. caveline@club-internet.fr
A 72-yr-old patient was to undergo a left lumbar plexus block by the posterior approach to achieve postoperative analgesia after hip replacement. The block failed after three unsuccessful attempts to identify nerve structures and a fascia iliaca compartment block was performed. Postoperatively the patient received enoxaparin and then phenylindanedione for thromboprophylaxis. She was re-admitted 2 weeks after surgery because of a lower limb motor deficit and a left retroperitoneal haematoma requiring blood transfusion. Clinicians need to be aware of this potential complication of lumbar plexus block in patients receiving thrombphylaxis.
Publication Types:
PMID: 15321930 [PubMed - indexed for MEDLINE]
Characterization of N-methyl-d-aspartate receptor subunits responsible for postoperative pain.
Nishimura W, Muratani T, Tatsumi S, Sakimura K, Mishina M, Minami T, Ito S.
Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
N-methyl-d-aspartate (NMDA) receptors have been suggested to be critical for the development of central sensitization, which may amplify postoperative pain. NMDA receptors are formed by GluRzeta (NR1) with any one of four GluRvarepsilon1-4 (NR2A-D) subunits. To clarify the involvement of NMDA receptors in postoperative pain, we examined the effect of the GluRvarepsilon2-selective antagonist (1S,2S)-1-(4-hydroxyphenyl)-2-(4-hydroxy-4-phenyl piperidino)-1-propanol (CP-101,606) on postoperative pain caused by plantar incision. We also applied the postoperative pain model to GluRvarepsilon1 and GluRvarepsilon4 knockout mice. CP-101,606 administered intrathecally 30 min prior to incision significantly increased mechanical withdrawal thresholds 2 h and 1-3 days after surgery and reduced postoperative pain dose-dependently. Neither GluRvarepsilon1 nor GluRvarepsilon4 knockout mice showed a difference in withdrawal thresholds as compared with wild-type mice. Pretreatment with CP-101,606 did not produce an additive analgesic effect in the mice. These results demonstrate that GluRvarepsilon2-containing NMDA receptors are involved in postoperative pain and that CP-101,606 may be effective in reducing it.
PMID: 15496298 [PubMed - in process]
Comment in:
Oral antiplatelet therapy in cerebrovascular disease, coronary artery disease, and peripheral arterial disease.
Tran H, Anand SS.
Thromboembolism Unit, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
CONTEXT: Atherothrombosis is a pathophysiologic process that results in clinical ischemic events affecting the cerebral, coronary, and peripheral arterial circulation. Antiplatelet agents, used alone or in combination, are effective in preventing recurrent vascular events among individuals with established vascular disease. OBJECTIVE: To summarize the current state of evidence regarding oral antiplatelet treatment in patients with cerebrovascular disease, coronary artery disease (CAD), and peripheral arterial disease. EVIDENCE ACQUISITION: Using the key terms acute coronary syndrome, atherothrombosis, ischemic stroke, myocardial infarction, MI, peripheral arterial disease, TIA, transient ischemic attack, unstable angina,aspirin,ticlopidine,dipyridamole, and clopidogrel, we searched the MEDLINE database as well as the trial register of the Cochrane Groups to identify studies published from 1960 to August 2004. We manually searched journals and abstract booklets; scrutinized reference lists of trials and review articles; and reviewed meta-analyses, scientific statements, and guidelines from official societies. EVIDENCE SYNTHESIS: Appropriate oral first-line antiplatelet therapy is aspirin for individuals with ST-segment elevation myocardial infarction; aspirin or clopidogrel for those with TIA or stroke, chronic stable angina, or peripheral arterial disease; and aspirin combined with clopidogrel for those with non-ST-segment elevation acute coronary syndrome. Aspirin combined with dipyridamole is a possible alternative for patients who experience a first episode of TIA or stroke in the absence of clinically apparent CAD. Although ticlopidine has been shown to be of benefit in various vascular conditions, its adverse-effect profile has limited its use. CONCLUSIONS: Aspirin, ticlopidine, clopidogrel, aspirin combined with clopidogrel, and aspirin combined with dipyridamole are effective in preventing recurrent vascular events among various subgroups of patients with vascular disease. Current clinical trial evidence favors the use of aspirin or clopidogrel as first-line agents for the majority of patients with vascular disease. Clinical trials evaluating combination antiplatelet therapies will direct future practice.
Publication Types:
PMID: 15494585 [PubMed - indexed for MEDLINE]
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Overt versus covert treatment for pain, anxiety, and Parkinson's disease.
Colloca L, Lopiano L, Lanotte M, Benedetti F.
University of Turin Medical School, Turin, Italy.
The recent introduction of covert administration of treatment to biomedical research has produced some interesting results, with many clinical and ethical implications. Concealed treatment has been used in people with nervous system conditions including pain, anxiety, and Parkinson's disease. The main finding is that when the patient is completely unaware that a treatment is being given, the treatment is less effective than when it is given overtly in accordance with routine medical practice. The difference between open and hidden administrations is thought to represent the placebo component of the treatment, even though no placebo has been given. The decreased effectiveness of hidden treatments indicates that knowledge about a treatment affects outcome and highlights the importance of the patient-provider interaction. In addition, by use of covert administration, the efficacy of some treatments can be assessed without the use of a placebo and associated ethical issues.
Publication Types:
PMID: 15488461 [PubMed - indexed for MEDLINE]
-
Catastrophizing, coping and validation for chronic pain: a comment on.
Macdonald MR.
Department of Psychiatry, University of Western Ontario, 110-339 Wellington Road South, London, Ont., Canada N6C5Z9Tel.: +1-519-660-8139; fax: +1-519-660-8149.
Publication Types:
PMID: 15494204 [PubMed - in process]
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Do medical factors predict disability in older adults with persistent low back pain?
Weiner DK, Rudy TE, Kim YS, Golla S.
Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Pain Evaluation and Treatment Institute, University of Pittsburgh, Pittsburgh, PA, USA.
Persistent low back pain (LBP) is one of the most common and challenging persistent pain conditions in older adults. Medical comorbidity also is common in these individuals, but its impact on disability has not been examined. The purpose of this study was, using a cross-sectional design, to examine the functional impact of pain-related and general medical comorbidity on 100 community dwelling older adults (mean age 74.3) with persistent mechanical LBP. Subjects received a structured history and physical examination, lumbosacral spine X-rays, and standardized tests of physical function. Pain-related variables included intensity, duration, extent, and lumbar motion-induced pain. General medical variables included age, comorbidity, number of medications, depressive symptoms, back range of motion, body mass index, and severity of radiographic pathology. Function/disability measures included self-reported disability, gait speed, and mean number of static lifts and amount of work performed during a dynamic lifting task. Structural equation modeling was used to evaluate the influence of pain and medical variables on function/disability. The overall regression model indicated pain and medical variables were significantly associated with function/disability measures (R(2)=0.45, P<0.01). Individual regression coefficients, however, indicated that only pain duration (r=-0.36, P<0.05) and pain severity (r=0.37, P<0.001) were significantly associated with function/disability. Despite the prevalence of medical co-morbidities in older PLBP subjects, they appear to be of limited utility in understanding level of disability. These findings also underscore the need to optimize pain treatment in independent older adults to optimize physical function and delay the onset of dependent living status.
PMID: 15494203 [PubMed - as supplied by publisher]
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Sedative music reduces anxiety and pain during chair rest after open-heart surgery.
Voss JA, Good M, Yates B, Baun MM, Thompson A, Hertzog M.
College of Nursing, South Dakota State University, 1011 11th Street, Rapid City, SD 57701, USA.
Open-heart surgery patients report anxiety and pain with chair rest despite opioid analgesic use. The effectiveness of non-pharmacological complementary methods (sedative music and scheduled rest) in reducing anxiety and pain during chair rest was tested using a three-group pretest-posttest experimental design with 61 adult postoperative open-heart surgery patients. Patients were randomly assigned to receive 30min of sedative music (N=19), scheduled rest (N=21), or treatment as usual (N=21) during chair rest. Anxiety, pain sensation, and pain distress were measured with visual analogue scales at chair rest initiation and 30min later. Repeated measures MANOVA indicated significant group differences in anxiety, pain sensation, and pain distress from pretest to posttest, P<0.001. Univariate repeated measures ANOVA (P</=0.001) and post hoc dependent t-tests indicated that in the sedative music and scheduled rest groups, anxiety, pain sensation, and pain distress all decreased significantly, P<0.001-0.015; while in the treatment as usual group, no significant differences occurred. Further, independent t-tests indicated significantly less posttest anxiety, pain sensation, and pain distress in the sedative music group than in the scheduled rest or treatment as usual groups (P<0.001-0.006). Thus, in this randomized control trial, sedative music was more effective than scheduled rest and treatment as usual in decreasing anxiety and pain in open-heart surgery patients during first time chair rest. Patients should be encouraged to use sedative music as an adjuvant to medication during chair rest.
PMID: 15494201 [PubMed - in process]
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An evaluation of sex differences in psychological and physiological responses to experimentally-induced pain: a path analytic description.
Dixon KE, Thorn BE, Ward LC.
Pain Prevention and Treatment Research Program, Department of Psychiatry, Duke University Medical Center, 725 Broad St., Durham, NC 27705, USA.
A cold pressor task (CPT) was used with 203 college students (112 women and 91 men) in a study of sex differences in pain response. Physiological measures were taken before and after pain induction, and sex-differentiating personality traits were assessed with the Personal Attributes Questionnaire (PAQ). The Pain Catastrophizing Scale (PCS) was given with standard instructions prior to the CPT, and it was re-administered after the CPT with modified instructions to assess catastrophic thinking during the CPT. Hypotheses were formulated into an explanatory model that was evaluated by path analysis. Pain induction elevated blood pressures and cortisol levels for both sexes, but systolic blood pressure reactivity and cortisol response were greater in men, even with sex differences in CPT tolerance times controlled statistically. Post-CPT PCS scores were positively related to pain ratings and negatively related to tolerance, but baseline PCS scores did not predict tolerance or pain ratings. Pre-PCS scores were not well correlated with post-PCS scores (r=0.46) and underestimated post-PCS scores, particularly for women. The Sex difference on the post-CPT PCS was largely attributable to the PAQ personality trait of Emotional Vulnerability. The differential results obtained from assessing catastrophizing before and after the CPT emphasized the importance of specifying the context in which catastrophizing is assessed (both timing and instructions). Theoretical considerations in the construct of catastrophizing are also highlighted, including, but not limited to, the confounding of variables such as pain intensity and unpleasantness.
PMID: 15494200 [PubMed - in process]
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Gender differences in patient-spouse interactions: a sequential analysis of behavioral interactions in patients having osteoarthritic knee pain.
Smith SJ, Keefe FJ, Caldwell DS, Romano J, Baucom D.
Ohio University, Athens, OH, USA.
Theory and research suggest that spousal responses to displays of pain behavior can vary markedly. To our knowledge, observational research on spousal responses to pain behavior has been carried out only in chronic low back pain patients, but not in other populations. In this study systematic observations were conducted of interactions occurring between 50 married osteoarthritis patients (25 male and 25 female) and their respective spouses. Observations were conducted as the patient and spouse performed three common household tasks: sweeping the floor, folding laundry, and carrying small, artificial logs from one side of the room to the other. Contrary to prior research on chronic low back pain this study found that in osteoarthritis patients spouse facilitative behavior preceded and followed patient pain behavior significantly more often than did spouse solicitous behavior. A gender difference in spousal responding to pain behavior also was observed in that wives were significantly more likely to show facilitative behavior preceding and following patient pain behavior than were husbands. The implications of these findings for future research and clinical interventions focused on patient-spouse interactions are discussed.
PMID: 15494199 [PubMed - in process]
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Involvement of the histaminergic system in the nociceptin-induced pain-related behaviors in the mouse spinal cord.
Sakurada S, Watanabe H, Mizoguchi H, Yonezawa A, Orito T, Katsuyama S, Kuramasu A, Sakurada C, Yanai K, Sakurada T.
Department of Physiology and Anatomy, Tohoku Pharmaceutical University, 4-4-1 Komatsushima, Aoba-ku, Sendai 981-8558, Japan.
Intrathecal (i.t.) injection of nociceptin elicited a behavioral response mainly consisting of biting and licking, which were eliminated by the i.t. co-administration of opioid receptor-like-1 (ORL-1) receptor antagonists. The behavioral response induced by nociceptin was characteristically similar to that by i.t.-administered histamine, and was attenuated by i.t. co-administration of the H(1) receptor antagonists, but not by the H(2) receptor antagonists, whereas the H(3) receptor antagonist promoted the nociceptin-induced behavior. H(1) receptor knockout (H(1)R-KO) mice did not show the nociceptin-induced nociceptive behavior, which was observed in wild-type mice. Pretreatment with a histamine antiserum or a histidine decarboxylase inhibitor resulted in a significant reduction of the response to nociceptin. The previous studies showed that NK(1) receptor antagonists and a novel substance P (SP)-specific antagonist given i.t. could reduce the behavioral response to nociceptin and histamine. On the other hand, the nociceptive response induced by nociceptin, but not histamine, was completely attenuated by the i.t. co-administration of agonists for GABA(A) and GABA(B) receptors. In contrast, the antagonists for GABA(A) and GABA(B) receptors injected i.t. showed same nociceptive response with nociceptin and histamine, and their nociceptive responses were significantly blocked by the i.t. co-administration of the H(1) receptor antagonists, but not H(2) receptor antagonists or ORL-1 receptor antagonists. The present results suggest that the activation of the ORL-1 receptor by nociceptin may induce the disinhibition of histaminergic neuron and enhance the release of histamine, which subsequently acts on the H(1) receptor located on the SP-containing neurons to produce the spinal cord-mediated nociceptive response.
PMID: 15494198 [PubMed - in process]
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Chronic orofacial pain among Korean elders: prevalence, and impact using the graded chronic pain scale.
Chung JW, Kim JH, Kim HD, Kho HS, Kim YK, Chung SC.
Department of Oral Medicine and Oral Diagnosis, College of Dentistry, Dental Research Institute, Seoul National University, 28-22 Yunkeun-Dong, Chongro-Ku, Seoul 110-749, South Korea.
The aims of this study were to investigate the prevalence of orofacial pain symptoms in the Korean elderly population, and to evaluate factors associated with orofacial pain and graded chronic pain. Of 4342 Korean elders from the cohort of Korean National Interview Survey of Oral Health Status in 2000, telephone interviews were conducted on a stratified random sample of 1032 people aged 55 years or older. Prevalence of five orofacial pain symptoms (jaw joint pain, face pain, toothache, oral sores, and burning mouth) in the past 6 months along with questions from the graded chronic pain scale were assessed by telephone using a structured questionnaire. The results suggested that the 6-month prevalence of joint pain (15.5%), face pain (9.3%), toothache (26.8%), oral sores (26.2%), and burning mouth (14.2%) in Korean elders were higher than in studies on Caucasian populations. Painful oral sores and burning mouth had higher prevalence for females than for males. Subjects with joint pain, burning mouth or toothache pain were more likely to report high levels of a pain-related disability compared with subjects not reporting those symptoms. There were no age group differences in pain intensity, but the older age group reported a higher number of disability days because of their pain. Chronic orofacial pain is a substantial health problem in the elderly population.
PMID: 15494197 [PubMed - in process]
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The effects of experimenter characteristics on pain reports in women and men.
Kallai I, Barke A, Voss U.
Institut fur Psychologie, J.W. Goethe-Universitat, Mertonstrasse 17, 60054 Frankfurt/Main, Germany.
The present study investigated the effects of two attributes of the experimenter (gender and professional status) on the report and tolerance of pain in male and female subjects. 160 non-psychology students (80 male and 80 female, aged 17-59 years) participated in a cold-pressor task. Subjects were assigned to one of 8 groups: male (M) and female (F) experimenters tested male (m) and female (f) students. In each combination (Mm, Mf, Fm, Ff), the cold-pressor task was conducted by either one of two faculty members (high professional) or one of two students (low professional). Subjects were asked to immerse their non-dominant hand as long as possible in cold water (-1 degrees C). Dependent variables were pain threshold, pain tolerance, and pain intensity. Results indicated a significant main effect for professional status of the experimenter on pain tolerance. Subjects tolerated pain longer when they were tested by a professional experimenter. Further, a significant interaction of experimenter gender and subject gender on pain tolerance indicated that subjects also tolerated pain longer when they were tested by an experimenter of the opposite sex. Additionally, a significant main effect for experimenter gender showed higher pain intensities for subjects tested by female experimenters. The observation that pain responsivity is influenced by the professional status of the experimenter might have implications for the study of pain in general and should be addressed in more detail in future experiments.
PMID: 15494194 [PubMed - as supplied by publisher]
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Chronic post-ischemia pain (CPIP): a novel animal model of complex regional pain syndrome-Type I (CRPS-I; reflex sympathetic dystrophy) produced by prolonged hindpaw ischemia and reperfusion in the rat.
Coderre TJ, Xanthos DN, Francis L, Bennett GJ.
Department of Anesthesia, Anesthesia Research Unit, McGill University, Room 1203, McIntyre Bldg, 3655 Drummond St., Montreal, Que., Canada H3G 1Y6; Department of Neurology and Neurosurgery, McGill University, Montreal, Que., Canada; Department of Psychology, McGill University, Montreal, Que., Canada; Centre for Research on Pain, McGill University, Montreal, Que., Canada; McGill University Health Centre Research Institute, Montreal, Que., Canada.
A neuropathic-like pain syndrome was produced in rats following prolonged hindpaw ischemia and reperfusion, creating an animal model of complex regional pain syndrome-Type I (CRPS-I; reflex sympathetic dystrophy) that we call chronic post-ischemia pain (CPIP). The method involves placing a tourniquet (a tight fitting O-ring) on one hindlimb of an anesthetized rat just proximal to the ankle joint for 3h, and removing it to allow reperfusion prior to termination of the anesthesia. Rats exhibit hyperemia and edema/plasma extravasation of the ischemic hindpaw for a period of 2-4h after reperfusion. Hyperalgesia to noxious mechanical stimulation (pin prick) and cold (acetone exposure), as well as mechanical allodynia to innocuous mechanical stimulation (von Frey hairs), are evident in the affected hindpaw as early as 8h after reperfusion, and extend for at least 4 weeks in approximately 70% of the rats. The rats also exhibit spontaneous pain behaviors (hindpaw shaking, licking and favoring), and spread of hyperalgesia/allodynia to the uninjured contralateral hindpaw. Light-microscopic examination of the tibial nerve taken from the region just proximal to the tourniquet reveals no signs of nerve damage. Consistent with the hypothesis that the generation of free radicals may be partly responsible for CRPS-I and CPIP, two free radical scavengers, N-acetyl-l-cysteine (NAC) and 4-hydroxy-2,2,6,6-tetramethylpiperydine-1-oxyl (Tempol), were able to reduce signs of mechanical allodynia in this model.
PMID: 15494189 [PubMed - as supplied by publisher]
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Pain related behaviour in two models of osteoarthritis in the rat knee.
Fernihough J, Gentry C, Malcangio M, Fox A, Rediske J, Pellas T, Kidd B, Bevan S, Winter J.
Novartis Institute for Medical Sciences, 5 Gower Place, London WCE 6BS, UK.
Osteoarthritis (OA) is a major healthcare burden, with increasing incidence. Pain is the predominant clinical feature, yet therapy is ineffective for many patients. While there are considerable insights into the mechanisms underlying tissue remodelling, there is poor understanding of the link between disease pathology and pain. This is in part owing to the lack of animal models that combine both osteoarthritic tissue remodelling and pain. Here, we provide an analysis of pain related behaviours in two models of OA in the rat: partial medial meniscectomy and iodoacetate injection. Histological studies demonstrated that in both models, progressive osteoarthritic joint pathology developed over the course of the next 28 days. In the ipsilateral hind limb in both models, changes in the percentage bodyweight borne were small, whereas marked mechanical hyperalgesia and tactile allodynia were seen. The responses in the iodoacetate treated animals were generally more robust, and these animals were tested for pharmacological reversal of pain related behaviour. Morphine was able to attenuate hyperalgesia 3, 14 and 28 days after OA induction, and reversed allodynia at days 14 and 28, providing evidence that this behaviour was pain related. Diclofenac and paracetamol were effective 3 days after arthritic induction only, coinciding with a measurable swelling of the knee. Gabapentin varied in its ability to reverse both hyperalgesia and allodynia. The iodoacetate model provides a basis for studies on the mechanisms of pain in OA, and for development of novel therapeutic analgesics.
PMID: 15494188 [PubMed - in process]
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Validation of a screener and opioid assessment measure for patients with chronic pain.
Butler SF, Budman SH, Fernandez K, Jamison RN.
Inflexxion, Inc., 320 Needham street, Suite 100, Newton, MA 02464-1594, USA.
There has been a need for a brief assessment tool for providers who treat chronic pain patients to determine potential risk of abuse when prescribed opioids for pain. The purpose of this study was to develop and begin the validation of a self-administered screening tool (Screener and Opioid Assessment for Patients with Pain, SOAPP) for chronic pain patients considered for long-term opioid therapy. A consensus of 26 pain and addiction experts was obtained on important characteristics of chronic pain patients that predict future medication misuse using concept mapping. A 24-item SOAPP (version 1.0) was developed based on this consensus and was administered to 175 patients who were taking opioids for chronic pain. After 6 months, 95 of these patients were re-evaluated. Validation of the SOAPP was conducted by identifying those patients exhibiting aberrant drug-related behavior as determined by any of the following: a positive score on the Prescription Drug Use Questionnaire (PDUQ) interview, positive urine toxicology screen, and/or ratings by staff as to whether patients had a serious drug problem. Of the original 24 items, 14 SOAPP items appeared to predict subsequent aberrant behaviors. Coefficient alpha for these 14 items was acceptable for a short scale (0.74). Receiver operating characteristics curve analysis yielded an area under the curve of 0.881 (P<0.001), suggesting adequate sensitivity and specificity for a screening device. These reliability and predictive validity results suggest that the SOAPP is a promising step toward screening risk potential for substance misuse among persons with chronic pain.
PMID: 15494186 [PubMed - in process]
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Cognitive modulation of pain-related brain responses depends on behavioral strategy.
Seminowicz DA, Mikulis DJ, Davis KD.
Toronto Western Research Institute, Toronto Western Hospital, University Health Network, MP14-306, 399 Bathurst Street, Toronto, Ont., Canada M5T 2S8; Institute of Medical Science, University of Toronto, Toronto, Ont., Canada.
Interactions of pain and cognition have been studied in humans and animals previously, but the relationship between such behavioral interactions and brain activity is unknown. We aimed to show using functional MRI (fMRI) how a cognitively demanding task (Stroop) modulates pain-related brain activations and conversely, how pain modulates attention-related activity. Reaction time data indicated two types of pain responders: subjects in the A group had a faster Stroop reaction time when pain was concomitant to the attention task, while those in the P group had a slower Stroop performance during painful stimulation. fMRI data obtained during Stroop performance with and without noxious stimulation were subjected to region of interest analyses. We first tested whether brain activity during painful median nerve stimulation was modulated by cognitive load. We next tested whether brain activity during the high conflict cognitive task was modulated by pain. Pain-related activity in three regions, primary (S1), and secondary (S2) somatosensory cortices, and anterior insula, was attenuated by cognitive engagement, but this effect was specific to the A group. Pain-related activations in the caudal and rostral anterior cingulate cortex (ACC) and ventroposterior thalamus were not modulated by cognitive load. None of the areas showing attention-related responses, including bilateral dorsolateral prefrontal and posterior parietal cortices, were modulated by pain. These findings suggest that cortical regions associated with pain can be modulated by cognitive strategies. Furthermore, the distinction of behavioral subgroups may relate to cognitive coping strategies taken by patients with chronic pain.
PMID: 15494184 [PubMed - in process]
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Perception and modulation of pain in waking and hypnosis: functional significance of phase-ordered gamma oscillations.
De Pascalis V, Cacace I, Massicolle F.
Department of Psychology, University of Rome, 'La Sapienza', 5, Piazzale Aldo Moro, Via dei Marsi 78, 00185 Rome, Italy.
Somatosensory event-related phase-ordered gamma oscillations (40-Hz) to electric painful standard stimuli under an odd-ball paradigm were analyzed in 13 high, 13 medium, and 12 low hypnotizable subjects during waking, hypnosis, and post-hypnosis conditions. During these conditions, subjects received a suggestion of Focused Analgesia to produce an obstructive hallucination of stimulus perception; a No-Analgesia treatment served as a control. After hypnosis, a post-hypnotic suggestion was given to draw waking subjects into a deep hypnosis with opened eyes. High hypnotizables, compared to medium and low ones, experienced significant pain and distress reductions for Focused Analgesia during hypnosis and, to a greater extent, during post-hypnosis condition. Correlational analysis of EEG sweeps of each individual revealed brief intervals of phase ordering of gamma patterns, preceding and following stimulus onset, lasting approximately six periods. High and medium hypnotizable subjects showed significant reductions in phase-ordered gamma patterns for Focused Analgesia during hypnosis and post-hypnosis conditions; this effect was found, however, more pronounced in high hypnotizable subjects. Phase-ordered gamma scores over central scalp site predicted subject pain ratings across Waking-Pain and Waking-Analgesia conditions, while phase-ordered gamma scores over frontal scalp site predicted pain ratings during post-hypnosis analgesia condition. During waking conditions, this relationship was present in high, low and medium hypnotizable subjects and was independent of stimulus intensity measures. This relationship was unchanged by hypnosis induction in the low hypnotizable subjects, but not present in the high and medium ones during hypnosis, suggesting that hypnosis interferes with phase-ordered gamma and pain relationship.
PMID: 15494182 [PubMed - as supplied by publisher]
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What should we be measuring in behavioral studies of chronic pain in animals?
Mogil JS, Crager SE.
Department of Psychology and Centre for Research on Pain, McGill University, 1205 Dr Penfield Ave., Montreal, Que., Canada H3A 1B1.
PMID: 15494180 [PubMed - in process]
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Understanding pain management by examining the social context in which pain is reported.
Weisse CS.
Psychology Department, Director of Health Professions Program, Union College, 807 Union St, Schenectady, NY 12308, USA.
Publication Types:
PMID: 15494179 [PubMed - in process]
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Pain relief: a universal human right.
Cousins MJ, Brennan F, Carr DB.
Pain Management Research Institute, Royal North Shore Hospital and University of Sydney, St Leonards, Sydney, 2065 NSW, Australia.
Publication Types:
PMID: 15494176 [PubMed - in process]
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Re: Molde Hagen E, Grasdal A, Eriksen HR. Does Early intervention with a light mobilization program reduce long-term sick leave for low back pain: a 3-year follow-up study. Spine 2003;28:2309-16.
Mooney V.
Publication Types:
PMID: 15480152 [PubMed - in process]
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Sedation with ketamine during intradiscal electrothermal therapy.
Cohen SP, Larkin T.
Pain Management Centers, Department of Anesthesiology, and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. spc5_2000@yahoo.com
STUDY DESIGN: A technical report. OBJECTIVES: To present a new and improved method to sedate patients during intradiscal electrothermal therapy (IDET). SUMMARY OF BACKGROUND DATA: The current standard of practice is to sedate patients with short-acting benzodiazepines and opioids during the coagulation phase of intradiscal electrothermal therapy. There are few data on the subject, but it is estimated that between 5% and 20% of IDET procedures are either aborted early or switched to a lower heating temperature because patients cannot tolerate the optimal, recommended heating protocol. A priori, one must assume these patients are more likely to fail their treatment than those who are able to tolerate complete heating. METHODS: The authors treated 9 patients receiving intradiscal electrothermal therapy who were unable to tolerate the latter portion of their heating protocol secondary to axial low back pain despite high doses of opioids, with low dose ketamine. This paper outlines our experience with "rescue" doses of ketamine, along with the rationale and guidelines for its use. RESULTS: After receiving ketamine, all patients were able to complete the full intradiscal electrothermal therapy heating protocol. The rescue dosages of ketamine ranged from 15 to 55 mg. The dosages of midazolam used to prevent the psychomimetic effects of ketamine ranged from 3 to 7 mg. Oxygen saturation and hemodynamic parameters did not change significantly after ketamine was administered, and all patients remained responsive throughout the procedure. There were no adverse effects or complications reported. CONCLUSIONS: When used judiciously to treat axial back pain during intradiscal electrothermal therapy heating, ketamine is a safe and effective rescue medication.
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PMID: 15247585 [PubMed - indexed for MEDLINE]
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A Cochrane review of manipulation and mobilization for mechanical neck disorders.
Gross AR, Hoving JL, Haines TA, Goldsmith CH, Kay T, Aker P, Bronfort G; Cervical Overview Group.
McMaster University, Faculty of Health Sciences, School of Rehabilitation Sciences, Institute of Applied Health Sciences, Hamilton, Ontario, Canada. grossa@mcmaster.ca
STUDY DESIGN AND OBJECTIVES: Our systematic review of randomized trials assessed whether manipulation and mobilization relieve pain or improve function/disability, patient satisfaction, and global perceived effect in adults with mechanical neck disorders. SUMMARY OF BACKGROUND DATA: Neck disorders are common, disabling, and costly. METHODS: Computerized bibliographic databases were searched up to March 2002. Two independent reviewers conducted study selection, data abstraction, and methodologic quality assessment. Relative risk and standardized mean differences were calculated. In the absence of heterogeneity, pooled effect measures were calculated using a random effects model. RESULTS: Of the 33 selected trials, 42% were high quality trials. Single or multiple (3-11) sessions of manipulation or mobilization showed no benefit in pain relief when assessed against placebo, control groups, or other treatments for acute/subacute/chronic mechanical neck disorders with or without headache. There was strong evidence of benefit favoring multimodal care (mobilization and/or manipulation plus exercise) over a waiting list control for pain reduction [pooled standardized mean differences -0.85 (95% CI: -1.20 to -0.50)], improvement in function [pooled SMD -0.57 (95% CI: -0.94 to -0.21)] and global perceived effect [standardized mean differences -2.73 (95% CI: -3.30 to -2.16)] for subacute/chronic mechanical neck disorders with or without headache. CONCLUSIONS: Mobilization and/or manipulation when used with exercise are beneficial for persistent mechanical neck disorders with or without headache. Done alone, manipulation and/or mobilization were not beneficial; when compared to one another, neither was superior. There was insufficient evidence available to draw conclusions for neck disorder with radicular findings. Factorial design would help determine the active agent(s) within a treatment mix.
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PMID: 15247576 [PubMed - indexed for MEDLINE]
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