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Items 1 - 19 of 19 |
One page. |
ABC of burns. Psychosocial aspects of burn injuries.
Wiechman SA, Patterson DR.
Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, USA.
Publication Types:
PMID: 15310609 [PubMed - indexed for MEDLINE]
Comment in:
Rehabilitation after burn injury.
Edgar D, Brereton M.
Upper Limb Rehabilitation Unit, Royal Perth Hospital, Perth, Australia.
Publication Types:
PMID: 15297346 [PubMed - indexed for MEDLINE]
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Efficacy of topical non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis: meta-analysis of randomised controlled trials.
Lin J, Zhang W, Jones A, Doherty M.
Academic Rheumatology, University of Nottingham, City Hospital, Nottingham NG5 1PB.
OBJECTIVE: To assess the efficacy of topical non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of osteoarthritis. DATA SOURCES: Medline, Embase, Scientific Citation Index, CINAHL, Cochrane Library, and abstracts from conferences. REVIEW METHODS: Inclusion criterion was randomised controlled trials comparing topical NSAIDs with placebo or oral NSAIDs in osteoarthritis. Effect size was calculated for pain, function, and stiffness. Rate ratio was calculated for dichotomous data such as clinical response rate and adverse event rate. Number needed to treat to obtain the clinical response was estimated. Quality of trial was assessed, and sensitivity analyses were undertaken. RESULTS: Topical NSAIDs were superior to placebo in relieving pain due to osteoarthritis only in the first two weeks of treatment. Effect sizes for weeks 1 and 2 were 0.41 (95% confidence interval, 0.16 to 0.66) and 0.40 (0.15 to 0.65), respectively. No benefit was observed over placebo in weeks 3 and 4. A similar pattern was observed for function, stiffness, and clinical response rate ratio and number needed to treat. Topical NSAIDs were inferior to oral NSAIDs in the first week of treatment and associated with more local side effects such as rash, itch, or burning (rate ratio 5.29, 1.14 to 24.51). CONCLUSION: Randomised controlled trials of short duration only (less than four weeks) have assessed the efficacy of topical NSAIDs in osteoarthritis. After two weeks there was no evidence of efficacy superior to placebo. No trial data support the long term use of topical NSAIDs in osteoarthritis.
Publication Types:
PMID: 15286056 [PubMed - indexed for MEDLINE]
The older orthopaedic patient: general considerations.
Potter JF.
Section of Geriatrics and Gerontology, University of Nebraska Medical Center, 981320 Nebraska Medical Center, Omaha, NE 68198, USA. jpotter@unmc.edu
People older than 65 years are more likely to need elective and emergent orthopaedic surgery compared with younger persons. They also experience significant benefits. Although age-related changes increase the risk of perioperative complications, understanding those changes allows prevention or at least early recognition and treatment when problems arise. Because of comorbidities, older persons take more medications that need to be managed in the perioperative period. Care could be simplified if patients were to bring their medications to the preoperative evaluation. Central nervous system sensitivity to certain pain medications (meperidine and propoxyphene) means that these drugs are best avoided as good alternatives exist (morphine and oxycodone). Adverse reactions to drugs are an important cause of acute confusion (delirium) that often complicates orthopaedic care. Early mobilization after surgery, avoiding certain drugs, avoiding restraints (including Foley catheters), attending to hydration, promoting normal sleep, compensating for sensory disorders, and stimulating daytime activities can prevent delirium. Patients with dementia are more likely to have delirium develop and, like many older people, will present special challenges in communication and decision making. Including family members in discussions may be helpful in ensuring truly informed consent.
Publication Types:
PMID: 15292786 [PubMed - indexed for MEDLINE]
Analgesic effect of TT-232, a heptapeptide somatostatin analogue, in acute pain models of the rat and the mouse and in streptozotocin-induced diabetic mechanical allodynia.
Szolcsanyi J, Bolcskei K, Szabo A, Pinter E, Petho G, Elekes K, Borzsei R, Almasi R, Szuts T, Keri G, Helyes Z.
Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Pecs, H-7643, Pecs, Szigeti u. 12, Hungary; Neuropharmacological Research Group of the Hungarian Academy of Sciences, H-7643, Pecs, Szigeti u. 12, Hungary.
Somatostatin released from capsaicin-sensitive sensory nerves exerts systemic anti-inflammatory and antinociceptive actions. TT-232 is a stable, peripherally acting heptapeptide (D-Phe-Cys-Tyr-D-Trp-Lys-Cys-Thr-NH(2)) somatostatin analogue with highest binding affinity for somatostatin sst(4) receptors. It has been shown to inhibit acute and chronic inflammatory responses and sensory neuropeptide release from capsaicin-sensitive nociceptors. In the present study the antinociceptive effects of TT-232 were analysed using both acute and chronic models of nociception. Formalin-induced pain behaviour, noxious heat threshold and streptozotocin-induced diabetic neuropathic mechanical allodynia were examined in rats and phenylquinone-evoked abdominal constrictions were tested in mice. TT-232 (80 microg/kg i.p.) inhibited both early (0-5 min) and late phases (25-45 min) of formalin-induced nociception as revealed by determination of the composite pain score. The minimum effective dose to elevate the noxious heat threshold and diminish the heat threshold drop (heat allodynia) evoked by resiniferatoxin (0.05 nmol intraplantarly) was 20 and 10 microg/kg i.p., respectively, as measured by an increasing-temperature hot plate. TT-232 (10-200 microg/kg s.c.) significantly inhibited phenylquinone-evoked writhing movements in mice, but within this dose range no clear dose-response correlation was found. Five weeks after streptozotocin administration (50 mg/kg i.v.) the diabetes-induced decrease in the mechanonociceptive threshold was inhibited by 10-100 microg/kg i.p. TT-232. These findings show that TT-232 potently inhibits acute chemical somatic/visceral and thermal nociception and diminishes chronic mechanical allodynia associated with diabetic neuropathy, thereby it could open new perspectives in the treatment of various pain syndromes.
PMID: 15363982 [PubMed - in process]
Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 29-2004. A 75-year-old woman with acute onset of chest pain followed by fever.
Karchmer AW, Torchiana DF, Chae CU, Afridi NA, Houser SL.
Division of Infectious Diseases, Beth Israel Deaconess Medical Center. Boston, USA.
Publication Types:
- Case Reports
- Clinical Conference
PMID: 15371582 [PubMed - indexed for MEDLINE]
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The prevalence of pain in multiple sclerosis: a multicenter cross-sectional study.
Solaro C, Brichetto G, Amato MP, Cocco E, Colombo B, D'Aleo G, Gasperini C, Ghezzi A, Martinelli V, Milanese C, Patti F, Trojano M, Verdun E, Mancardi GL; PaIMS Study Group.
Department of Neurology, P.A. Micone Hospital, Genova, Italy. csolaro@libero.it
In a multicenter cross-sectional study, the authors assessed pain in patients with multiple sclerosis (MS) using a symptom-oriented approach. Out of 2,077 questionnaires, we used 1,672 for data analysis. Pain and frequencies included trigeminal neuralgia 2%, Lhermitte's sign 9%, dysesthetic pain 18.1%, back pain 16.4%, and painful tonic spasms 11%. Comparison between different groups showed significant differences for age, Expanded Disability Status Scale, disease duration, and disease course, but not for sex. This study underlines the relevance of pain in the clinical history of MS.
PMID: 15365151 [PubMed - in process]
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Topiramate vs placebo in painful diabetic neuropathy: analgesic and metabolic effects.
Raskin P, Donofrio PD, Rosenthal NR, Hewitt DJ, Jordan DM, Xiang J, Vinik AI; CAPSS-141 Study Group.
Clifton and Betsy Robinson Chair in Biomedical Research, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-8858, USA. Philip.Raskin@UTSouthwestern.edu
BACKGROUND: Using identical methods, three simultaneous placebo-controlled trials of topiramate for painful diabetic neuropathy (PDN) did not reach significance. This independent yet concurrent placebo-controlled trial used different methods to assess topiramate efficacy and tolerability in PDN. METHODS: This 12-week, multicenter, randomized, double-blind trial included 323 subjects with PDN and pain visual analog (PVA) score of at least 40 on a scale from 0 (no pain) to 100 (worst possible pain). Topiramate (n = 214) or placebo (n = 109) was titrated to 400 mg daily or maximum tolerated dose. Short-acting rescue analgesics were permitted only during the first 6 weeks. RESULTS: Baseline characteristics were comparable between groups except for mean body weight (topiramate, 101.4 kg; placebo, 95.7 kg; p = 0.028). Twelve weeks of topiramate treatment reduced PVA scale score (from 68.0 to 46.2 mm) more effectively than placebo (from 69.1 to 54.0 mm; p = 0.038). Fifty percent of topiramate-treated subjects and 34% of placebo-treated subjects responded to treatment, defined as >30% reduction in PVA scale score (p = 0.004). Topiramate monotherapy also reduced worst pain intensity (p = 0.003 vs placebo) and sleep disruption (p = 0.020 vs placebo). Diarrhea, loss of appetite, and somnolence were the most commonly reported adverse events in the topiramate group. Topiramate reduced body weight (-2.6 vs +0.2 kg for placebo; p < 0.001) without disrupting glycemic control. CONCLUSIONS: Topiramate monotherapy reduced pain and body weight more effectively than placebo in patients with painful diabetic neuropathy.
PMID: 15365138 [PubMed - in process]
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The anticipation of pain modulates spatial attention: evidence for pain-specificity in high-pain catastrophizers.
Van Damme S, Crombez G, Eccleston C.
Department of Experimental, Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium.
Recent studies have suggested that the anticipation of pain may modulate spatial attention. However, it is possible that this modulation reflects a general effect of anticipating somatosensory stimulation, without being pain-specific. In the present study, we therefore compared the effect of the anticipation of somatosensory stimulation on spatial attention between two groups, using conditioned signals in a spatial cueing paradigm. In the pain group, signals predicted painful electrocutaneous stimulation, whereas in the control group, signals predicted non-painful vibrotactile stimulation. Tests between both groups showed that attentional engagement was equally facilitated by the anticipation of somatosensory stimulation in both groups. Interestingly, disengagement of attention was more retarded by the anticipation of pain than by the anticipation of non-painful vibrotactile stimulation in participants high in catastrophic thinking about pain. Theoretical and clinical implications of these findings are discussed.
PMID: 15363884 [PubMed - in process]
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Abnormal contralateral pain responses from an intradermal injection of phenylephrine in a subset of patients with complex regional pain syndrome (CRPS).
Mailis-Gagnon A, Bennett GJ.
Comprehensive Pain Program, Krembil Neuroscience Center, Toronto Western Institute, Toronto Western Hospital and University of Toronto Center for the Study of Pain, 4F811, 399 Bathurst Street, Toronto, Ont., Canada M5T 2S8.
We have examined the effect of an intradermal injection of phenylephrine (1mg/0.1ml), an alpha-1-adrenoceptor agonist in normal subjects, and patients with sympathetically-independent (SIP) and sympathetically-maintained pain (SMP). Normal subjects and SIP patients experienced only brief stinging pain, while subsets of both sympathectomized and non-sympathectomized SMP patients (6/9 and 4/8, respectively) experienced an additional abnormal pain response accompanied by mechano-allodynia around the injection site. Both the normal and abnormal pain response after intradermal phenylephrine are similar to those observed with intradermal norepinephrine. In contrast to previous reports in the literature, we found that three sympathectomized SMP patients (who, however, had failed to experience pain relief after surgical sympathectomy despite very good relief after sympathetic blocks) also experienced abnormal pain and mechano-allodynia when phenylephrine was injected to a limb contralateral to the symptomatic sympathectomized extremity. Abnormal pain response evoked by norepinephrine or phenylephrine injection in the ipsilateral symptomatic limb of SMP patients may be due to injury-evoked nociceptor responsiveness to catecholamines. However, such a response in contralateral asymptomatic limbs suggests an additional factor that more likely than not is of central origin and may or may not be related to sympathectomy and its success or failure to treat pain.
PMID: 15363882 [PubMed - in process]
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Controlled trial of Internet-based treatment with telephone support for chronic back pain.
Buhrman M, Faltenhag S, Strom L, Andersson G.
Department of Psychology, Uppsala University, Box 12 25, SE-751 42 Uppsala, Sweden.
The purpose of this study was to investigate the effects of an Internet-based cognitive-behavioral intervention with telephone support for chronic back pain. Participants who met the criteria for chronic back pain (N=56) were randomly assigned to either an Internet-based cognitive behavioral self-help treatment or to a waiting-list control condition. The study period lasted 8 weeks and consisted of 1 week of self-monitoring prior to the intervention, 6 weeks of intervention, and 1 week of post-intervention assessment. Treatment consisted of education, cognitive skill acquisition, behavioral rehearsal, generalization and maintenance. The dropout rate was 9% (N=5). Results showed statistically significant improvements in catastrophizing, control over pain and ability to decrease pain. Some improvement was found in both the control group and the treatment group. A follow-up of 3 months after treatment termination was completed in 92% (N=47) of the participants who completed the treatment intervention. Follow-up results showed that some improvement was maintained. Findings indicate that Internet-based self-help with telephone support, based on established psychological treatment methods, holds promise as an effective approach for treating disability in association with pain.
PMID: 15363881 [PubMed - in process]
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Spatial summation of heat pain within and across dermatomes in fibromyalgia patients and pain-free subjects.
Staud R, Vierck CJ, Robinson ME, Price DD.
Department of Medicine, McKnight Brain Institute, University of Florida, College of Medicine, 1600 SW Archer Road, P.O. Box 100221, Gainesville, FL 32610-0221, USA.
The mechanisms of spatial summation of pain (SSP) include pain coding dependent on impulse frequency and the number of recruited central neurons. However, SSP may also be influenced by pain inhibitory mechanisms, such as diffuse noxious inhibitory controls. Abnormal interactions between pain inhibitory mechanisms and SSP may be relevant for chronic pain conditions such as fibromyalgia (FM) and may help explain why widespread pain is characteristic for this chronic pain syndrome. The present study was designed to determine the difference of thermal SSP in the upper extremities between FM and normal control (NC) subjects, particularly within and across dermatomes of the hand. Fourteen NC and 19 FM subjects were enrolled in this study. SSP testing sessions involved immersion of each individual fingertip as well as stepwise immersion of the fingers, hands, and forearms in a hot water bath (46 degrees C) for 5s and 20s. In addition, immersion of several fingertips across dermatome C(7)-C(8) was compared to progressive immersion of the index finger (dermatome C(7)). These experiments demonstrated significant spatial summation of heat-induced pain in both FM and NC subjects. SSP was most extensive within the fingers, and became negligible as the stimulus area increased above the hand. Furthermore, SSP was more pronounced within one dermatome such as that of the index finger than across several dermatomes of the hand. These results were similar for both FM and NC subjects. Thus, mechanisms of SSP, including possible inhibitory factors that limit this relevant pain mechanism, appear to be similar for both FM and NC subjects.
PMID: 15363878 [PubMed - in process]
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Catastrophizing as a mediator of sex differences in pain: differential effects for daily pain versus laboratory-induced pain.
Edwards RR, Haythornthwaite JA, Sullivan MJ, Fillingim RB.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 1-101, Baltimore, MD 21287, USA.
Sex differences in the experience of pain have been widely reported, with females generally reporting more frequent clinical pain and demonstrating greater pain sensitivity. However, the mechanisms underpinning such differences, while subject to intense speculation, are not well-characterized. Catastrophizing is a cognitive and affective process that relates strongly to enhanced reports of pain and that varies as a function of sex. It is thus a prime candidate to explain sex differences; indeed, several prior studies offer evidence that controlling for catastrophizing eliminates the gap between men and women in reported pain. We recruited 198 healthy young adults (115 female) who took part in laboratory studies of pain responses, including thermal pain, cold pain, and ischemic pain, and who also completed questionnaires assessing catastrophizing, mood, and day-to-day painful symptoms (e.g. headache, backache). Women reported greater levels of catastrophizing, more recent painful symptoms, and demonstrated lower pain thresholds and tolerances for noxious heat and cold relative to men. Mediational analyses suggested that after controlling for negative mood, catastrophizing mediated the sex difference in recent daily pain but did not mediate the much larger sex differences in pain threshold and tolerance. These findings highlight the role of catastrophizing in shaping pain responses, as well as illuminating potentially important differences between experimental pain assessment and the clinical experience of pain.
PMID: 15363877 [PubMed - in process]
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Oral ibandronate improves bone pain and preserves quality of life in patients with skeletal metastases due to breast cancer.
Body JJ, Diel IJ, Bell R, Pecherstorfer M, Lichinitser MR, Lazarev AF, Tripathy D, Bergstrom B.
Institut Jules Bordet, Universite Libre de Bruxelles, 1 Rue Heger-Bordet, 1000 Brussels, Belgium.
The objective of this study is to assess the effect of oral ibandronate on bone pain and quality of life in women with metastatic bone disease from breast cancer. In two double-blind, placebo-controlled studies, 564 patients were randomised to receive oral ibandronate, 50mg once daily, or placebo for up to 96 weeks. Throughout the studies, we assessed bone pain (on a 5-point scale from 0=none to 4=intolerable), analgesic use (7-point scale) and quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 [EORTC QLQ-C30], 100-point scale). Oral ibandronate significantly reduced and maintained bone-pain scores below baseline throughout the 96-week study period (at endpoint, -0.1 vs +0.2, P=0.001 vs placebo). Analgesic use increased in both groups; however, the increase was significantly less in the ibandronate group (0.60 vs 0.85, P=0.019). Although quality of life deteriorated during the study, the decrease in quality of life was significantly lower with ibandronate therapy (-8.3 vs -26.8, P=0.032). Drug-related adverse events were generally minor and as expected with oral bisphosphonates. Oral ibandronate had beneficial effects on bone pain and quality of life and was well tolerated. These results suggest that this treatment is of considerable clinical value as a co-analgesic to patients with painful bone metastases.
PMID: 15363874 [PubMed - in process]
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Dietary fat and protein interact in suppressing neuropathic pain-related disorders following a partial sciatic ligation injury in rats.
Perez J, Ware MA, Chevalier S, Gougeon R, Bennett GJ, Shir Y.
Anesthesia Research Unit, McGill University Health Centre, Montreal, Que., Canada; Department of Anesthesia, Pain Centre, McGill University Health Centre, Montreal, Que., Canada.
Chronic neuropathic sensory disorders (CNSD) of rats receiving a partial sciatic nerve ligation injury (the PSL model) are suppressed by dietary soy protein. Although previously shown to modify nociceptive behavior in acute pain models, dietary fat has never been tested for its putative analgesic properties in chronic pain states. Here we tested the role of dietary fat, protein and fat/protein interactions in the development of tactile allodynia and heat hyperalgesia in PSL-injured rats. Male Wistar rats were fed nine different diets, comprising of three proteins (soy, casein and albumin) and three fats (corn, soy and canola) for a week preceding PSL injury and for 2 weeks thereafter. Rats' responses to tactile and noxious heat stimuli were tested before surgery and 3, 7 and 14 days afterwards. Tactile and heat sensory abnormalities following PSL injury were significantly different among the nine dietary groups. Consumption of corn and soy fats suppressed the levels of tactile and heat allodynia and hyperalgesia, whereas consumption of soy and casein proteins was associated with lower levels of heat hyperalgesia but not tactile allodynia. A significant fat/protein interaction was found for the heat but not tactile stimuli. We conclude that dietary fat is a significant independent predictor of levels of neuropathic sensory disorders in rats and that this effect is accentuated by dietary protein. The mechanisms by which fat suppresses neuropathic disorders have yet to be determined.
PMID: 15363873 [PubMed - in process]
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Can one predict the likely specific orofacial pain syndrome from a self-completed questionnaire?
Macfarlane TV, Blinkhorn AS, Craven R, Zakrzewska JM, Atkin P, Escudier MP, Amy Rooney C, Aggarwal V, Macfarlane GJ.
University Dental Hospital of Manchester, Higher Cambridge Street, Manchester M15 6FH, UK.
To estimate the prevalence of orofacial pain (OFP) by specific diagnostic subgroups in the general population. Cross-sectional population study. General medical practice in South East Cheshire, UK. Participants of baseline investigation who completed the full postal questionnaire (1510, adjusted study participation rate 81%). Clinical examination was attended by 126 (43%) of all the participants who reported OFP in the questionnaire. These individuals were classified as musculoligamentous/soft tissue type, dentoalveolar or neurological/vascular. OFP duration, location, descriptors and statements on OFP were predictors of classification group. The estimated prevalence in the general population of musculoligamentous/soft tissue type of OFP was 7%, dentoalveolar 7% and neurological/vascular 6%. This study has derived a statistical model to classify participants with OFP into three broad groups (musculoligamentous/soft tissue, dentoalveolar and neurological/vascular) based on questionnaire information about OFP (OFP chronicity, location and verbal descriptors of pain). It is potentially useful in large population studies of OFP, where a clinical examination is not possible, however, further validation of its performance in large populations are necessary.
PMID: 15363870 [PubMed - in process]
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Self-efficacy, fear avoidance, and pain intensity as predictors of disability in subacute and chronic musculoskeletal pain patients in primary health care.
Denison E, Asenlof P, Lindberg P.
Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala Science Park, Uppsala Se-751 83, Sweden.
This study examined the relations between disability, as measured by the Pain Disability Index (PDI) and self-efficacy, fear avoidance variables (kinesiophobia and catastrophizing), and pain intensity, using a prospective design. Two primary health care samples (n(1)=210; n(2)=161) of patients with subacute, chronic or recurring musculoskeletal pain completed sets of questionnaires at the beginning of a physiotherapy treatment period. Multiple hierarchial regression analyses showed that self-efficacy explained a considerably larger proportion of the variance in disability scores than the fear avoidance variables in the first sample. This finding was replicated in the second sample. Pain intensity explained a small, but significant proportion of the variance in disability scores in one sample only. Gender, age, and pain duration were not related to disability. These findings suggest that self-efficacy beliefs are more important determinants of disability than fear avoidance beliefs in primary health care patients with musculoskeletal pain. The findings also suggest that pain-related beliefs, such as self-efficacy and fear avoidance, in turn, are more important determinants of disability than pain intensity and pain duration in these patients.
PMID: 15363867 [PubMed - in process]
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Do we need a communal coping model of pain catastrophizing? An alternative explanation.
Severeijns R, Vlaeyen JW, Van Den Hout MA.
Department of Medical Psychology, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
PMID: 15363864 [PubMed - in process]
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Headache management for the pain specialist.
Ashkenazi A, Silberstein SD.
Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. avi.ashkenazi@mail.tju.edu
Headache is a common symptom caused by a wide variety of diseases. Primary headaches include migraine, cluster headache, tension-type headache, and other less common diseases. It is important to differentiate these headaches from secondary headaches caused by vascular, neoplastic, infectious, metabolic, or toxic disorders. Most primary headaches have a genetic basis, with environmental factors acting as triggers. Recent advances in basic research resulted in the development of more specific and effective therapies. Medication-overuse headache is a very common cause of chronic daily headache. Detoxification from the offending drug is essential for headache improvement. Cervicogenic headache is common and needs to be diagnosed correctly since it may require specific therapy. Nerve blocks are useful for some patients with primary, as well as secondary, headaches.
PMID: 15372392 [PubMed - in process]
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