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Items 1 - 24 of 24 |
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alpha2-Adrenoceptor activation by clonidine enhances stimulation-evoked acetylcholine release from spinal cord tissue after nerve ligation in rats.
Obata H, Li X, Eisenach JC.
Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
BACKGROUND: Spinally administered clonidine produces analgesia via alpha2-adrenergic receptors. The analgesic potency of clonidine and its dependency on muscarinic acetylcholine receptors increase in rats after nerve injury. The authors hypothesized that these changes reflect greater acetylcholine release from the spinal cord by clonidine, either through direct or indirect effects. METHODS: Male Sprague-Dawley rats were divided into two groups: no surgery or left L5 and L6 spinal nerve ligation (SNL). All experiments were performed 3 weeks after SNL. Crude synaptosomes were prepared from the spinal enlargement and loaded with [H]choline. Samples were incubated with clonidine in the absence or presence of KCl depolarization. The authors also examined the effect of clonidine on KCl evoked acetylcholine release using perfusion of spinal cord slices, in which some spinal circuitry is maintained. RESULTS: In synaptosomes, clonidine alone induced minimal acetylcholine release, which was actually greater in tissue from normal rats than in tissue from SNL rats. In the presence of KCl depolarization, however, clonidine enhanced acetylcholine release in tissue from SNL rats but inhibited release in tissue from normal rats. Similarly, in spinal cord slices, clonidine enhanced KCl evoked acetylcholine release in tissue from SNL animals but inhibited such release in tissue from normal animals. The alpha2-adrenoceptor antagonist idazoxan inhibited the effects of clonidine in slices from SNL rats. CONCLUSION: These results suggest that clonidine enhances depolarization-induced acetylcholine release in neuropathic but not in normal spinal cord tissue. Interestingly, this enhanced acetylcholine release by clonidine occurs in a synaptosomal preparation, consistent with a direct effect on alpha2 adrenoceptors on cholinergic terminals. Enhanced release of acetylcholine by clonidine could contribute to increased analgesia of clonidine in neuropathic pain.
PMID: 15731607 [PubMed - indexed for MEDLINE]
 
Investigation of the potentiation of the analgesic effects of fentanyl by ketamine in humans: a double-blinded, randomised, placebo controlled, crossover study of experimental pain[ISRCTN83088383].
Tucker AP, Kim YI, Nadeson R, Goodchild CS.
Department of Anaesthesia and Perioperative Medicine, Monash Medical Centre, 246 Clayton Road, Melbourne, Victoria 3168, Australia. adam.tucker@med.monash.edu.au.
BACKGROUND: Despite preclinical evidence suggesting a synergistic interaction between ketamine and opioids promoting analgesia, several clinical trials have not identified dosing regimens capable of eliciting a benefit in the co-administration of ketamine with opioids. METHODS: Ten healthy volunteers participated in a double blinded, randomised, placebo controlled, crossover laboratory study in order to determine whether a low dose of ketamine potentiated the antinociceptive effect of fentanyl without causing an increase in sedative effects. A battery of tests was used to assess both nociception and sedation including electrical current, pressure, thermal stimuli, psychometric tests, and both subjective and objective scores of sedation. Target controlled infusions of the study drugs were used. Ketamine and fentanyl were administered alone and in combination in a double-blinded randomised crossover design. Saline was used as the control, and propofol was used to validate the tests of sedation. Cardiovascular and respiratory parameters were also assessed. RESULTS: The electrical current pain threshold dose response curve of fentanyl combined with ketamine was markedly steeper than the dose response curve of fentanyl alone. While a ketamine serum concentration of 30 ng/ml did not result in a change in electrical pain threshold when administered alone, when it was added to fentanyl, the combination resulted in greater increase in pain threshold than that of fentanyl administered alone. When nociception was assessed using heat and pressure stimuli, ketamine did not potentiate the anti-nociceptive effect of fentanyl. There was no difference between the sedative effect of fentanyl and fentanyl in combination with ketamine as assessed by both subjective and objective measures of sedation. Cardiovascular and respiratory parameters were unaffected by the study drugs at the doses given. CONCLUSION: A serum concentration of ketamine that did not alter indices of sedation potentiated the antinociceptive effect of fentanyl. This potentiation of antinociception occurred without an increase in sedation suggesting that low steady doses of ketamine (30-120 ng/ml) might be combined with mu opioid agonists to improve their analgesic effect in a clinical setting. (296 words).
PMID: 15804361 [PubMed - as supplied by publisher]
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Faces Scales for the Measurement of Postoperative Pain Intensity in Children Following Minor Surgery.
Chambers CT, Hardial J, Craig KD, Court C, Montgomery C.
From the *Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; daggerCentre for Community Child Health Research, BC Research Institute for Children's & Women's Health, Vancouver, British Columbia, Canada; double daggerDepartment of Psychology, University of British Columbia, Vancouver, British Columbia, Canada; section signDepartments of Nursing and Anesthesiology, Pain Management, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada; and parallelDepartment of Anesthesiology, University of British Columbia and British Columbia's Children's Hospital, Vancouver, British Columbia, Canada.
OBJECTIVES:: Faces scales are commonly used to obtain self-reports of pain intensity from children. Previous research using hypothetical vignettes and pain following venepuncture has found differences in children's pain ratings as a function of the type of faces scale used. The purpose of the present study was to determine whether scales beginning with a smiling rather than neutral "no pain" face would produce higher ratings in the assessment of postoperative pain intensity in children and to compare ratings using different faces scales to those reported with an additional independent measure of pain intensity. METHODS:: Participants were 78 children between the ages of 5 and 13 years undergoing surgery, one of their parents, and their postoperative care nurse. Following surgery, children were asked to provide a rating of their current pain intensity using a set of 5 successively administered faces scales and the Colored Analog Scale (CAS). Parents and nurses provided independent ratings using the same measures. RESULTS:: Results showed that parents and nurses rated significantly more pain when using scales with a smiling rather than a neutral "no pain" face. This pattern was not as clear for the children's ratings, although their highest ratings were provided when using a smiling "no pain" faces scale. Children's and nurses' ratings on the CAS were generally more similar to their ratings using scales with neutral "no pain" faces, whereas parents' CAS ratings tended to fall in between ratings provided on the smiling and neutral "no pain" faces scales. Scale preference, age and sex differences in pain ratings, and child-parent-nurse agreement in pain ratings are also examined. DISCUSSION:: Children's and parents' ratings of postoperative pain intensity are influenced by the presence of a smiling "no pain" face at the beginning of faces scales, with such scales producing significantly higher ratings than scales with neutral "no pain" faces. Ratings on the independent CAS measure were more comparable to those provided on faces scales with neutral "no pain" faces. Nurses are also susceptible to the influencing effect of a smiling face at the beginning of a faces scale.
PMID: 15818080 [PubMed - as supplied by publisher]
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Physicians' Assessments Versus Measured Symptoms of Complex Regional Pain Syndrome Type 1: Presence and Severity.
Perez RS, Burm PE, Zuurmond WW, Bezemer PD, Brink HE, de Lange JJ.
From the *Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands; daggerDepartment of Surgery, Nijmegen Medical Center St. Radboud, Nijmegen; and double daggerDepartment of Clinical Epidemiology and Biostatistics, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
OBJECTIVE:: To assess the validity of physician's judgements of symptoms associated with Complex Regional Pain Syndrome Type 1. METHODS:: The validity of physicians' judgments was assessed using measurements with regard to presence and severity of pain, temperature and volume asymmetry, and reduction in active range of motion in 66 Complex Regional Pain Syndrome Type 1 outpatients. Measurements were performed using Visual Analog Scales and McGill (number of words chosen total) for pain, infrared thermography for temperature differences, water displacement volumeters for volume differences, and hand-held goniometers for active range of motion. Physicians were blind to the outcomes of the measurements. RESULTS:: In general, physicians were capable of determining presence or absence of measured symptoms and indicate the direction of the symptom asymmetry. Establishing presence of temperature and volume asymmetries was, however, inadequate. Poor to moderate correspondence was found for the severity of individual symptoms between physicians' judgments and measurements. For the total number of assessments, correlation coefficients ranged from 0.39 for Volume to 0.68 for Pain. In general, lower correlations and percentages of association for Volume and Temperature were found. Monitoring changes between consecutive patient assessments showed poor correspondence between both assessment methods, with correlation coefficients ranging from 0.25 for Volume to 0.37 for Pain. CONCLUSIONS:: We conclude that establishing the presence of Complex Regional Pain Syndrome Type 1 symptoms, except for temperature and volume asymmetries, and monitoring of disease progression based on these symptoms can be performed by clinical judgment. The severity of the individual symptoms evaluated in this study should be measured with reliable and valid measurement instruments.
PMID: 15818079 [PubMed - as supplied by publisher]
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Pain Report and Pain-Related Evoked Potentials Operantly Conditioned.
Lousberg R, Vuurman E, Lamers T, Van Breukelen G, Jongen E, Rijnen H, Maessen C, Hermens H.
From the *Roessingh Research and Development, Enschede, The Netherlands; daggerDepartment of Psychiatry & Neuropsychology, Academical Hospital Maastricht, Maastricht, The Netherlands; double daggerDepartment of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands; and section signDepartment of Psychology, Maastricht University, Maastricht, The Netherlands.
OBJECTIVE:: The purpose of the present study was to answer the question whether pain report can be increased and decreased by operant conditioning. We predicted that the conditioned pain effects would remain significant after correction for social desirability and fantasy proneness. Furthermore, we tried to show that the neurophysiologic basis of verbal pain report, defined by pain (event)-related potentials, was affected by the conditioning procedure. Specifically, it was expected that the central recording site N150-P260 pain (event)-related potentials peak-to-peak amplitude would show the largest effect. METHODS:: There were 4 groups: an up-conditioning group, a down-conditioning group, an at-random conditioning, and no-feedback control group. Healthy patients received 45 calibrated pain stimuli of equal physical intensity and were asked to rate the pain intensity they experienced. Up-conditioning was established by rewarding the subject if pain report increased compared with the previous trial. Down-conditioning of pain report was achieved by rewarding a decrease in the pain score. RESULTS:: Results of the subjective pain reports clearly indicated that both forms of conditioning succeeded. Up-conditioning resulted in the highest pain scores and down-conditioning in the lowest scores with the two control groups in between them. Controlling for level of social desirability and fantasy proneness did not negatively influence these results. The N150-P260 pain (event)-related potentials peak-to-peak central recording site component also showed the predicted effect and reached statistical significance. DISCUSSION:: We concluded that the subjective report of pain as well as a specific pain-related potentials component can be operantly conditioned.
PMID: 15818078 [PubMed - as supplied by publisher]
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Chronic Pain and Posttraumatic Stress Symptoms in Litigating Motor Vehicle Accident Victims.
Duckworth MP, Iezzi T.
From the *University of Nevada, Reno, NV; and daggerLondon Health Sciences Center, London, Ontario, Canada.
OBJECTIVE:: There has been little research examining chronic pain and posttraumatic stress symptoms in persons injured in motor vehicle accidents. The purpose of this study was to evaluate differences in physical injury and impairment, psychological distress, and pain coping strategies in litigating chronic pain patients low and high in motor vehicle accident-related posttraumatic stress symptoms. DESIGN:: A total of 160 consecutive chronic pain patients referred for psychological-legal assessment underwent semistructured interview and testing. The testing battery included the Minnesota Multiphasic Personality Inventory-2, the Multidimensional Pain Inventory, the Sickness Impact Profile, and the Coping Strategies Questionnaire. Using the sample-specific median split of 18 posttraumatic stress symptoms on the Minnesota Multiphasic Personality Inventory-2 Posttraumatic Stress Disorder scale, chronic pain patients were categorized as evidencing low or high levels of posttraumatic stress symptoms. RESULTS:: The findings indicate that participants evidencing high posttraumatic stress symptoms had more physical impairment, psychological distress, and maladaptive pain coping strategies and were more likely to be treated with antidepressants, other medications, and psychological management than participants evidencing low posttraumatic stress symptoms. A discriminant function analysis was performed using the full combination of physical injury and impairment, psychological distress, and pain coping variables in the prediction of posttraumatic stress symptom-defined group membership. The resulting discriminant function accounted for 61% of the between-group variance and correctly classified 92% of participants who were low in posttraumatic stress symptoms and 88% of participants who were high in posttraumatic stress symptoms. CONCLUSIONS:: Chronic pain and posttraumatic stress symptoms in litigating motor vehicle accident victims are associated with increased physical and psychological morbidity.
PMID: 15818077 [PubMed - as supplied by publisher]
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Pain-Related Factors Contributing to Muscle Inhibition in Patients With Chronic Low Back Pain: An Experimental Investigation Based on Superimposed Electrical Stimulation.
Verbunt JA, Seelen HA, Vlaeyen JW, Bousema EJ, van der Heijden GJ, Heuts PH, Knottnerus JA.
From the *Rehabilitation Foundation Limburg, Hoensbroek The Netherlands; daggerInstitute for Rehabilitation Research, Hoensbroek, The Netherlands; double daggerDepartment of Medical, Clinical, and Experimental Psychology, Maastricht University, Maastricht, The Netherlands; section signJulius Center for Health Sciences and Primary Care, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands; and parallelNetherlands School of Primary Care Research, Maastricht University, Maastricht, The Netherlands.
OBJECTIVE:: To evaluate muscle strength, as a component of physical deconditioning, and central activation ratio, representing the performance level during testing, in patients with chronic low back pain as compared to healthy controls, and to evaluate the contribution of cognitive-behavioral and pain-related factors to the central activation ration of patients with chronic low back pain. METHODS:: Twenty-five patients with chronic low back pain and 25 age and gender-matched controls participated. Muscle strength, that is, peak torque of the quadriceps muscle, was measured on a Cybex dynamometer. During peak torque, the quadriceps muscle was percutaneously stimulated using superimposed electrical stimulation, generating an additional twitch torque in case of submaximal performance. The central activation ratio was calculated as peak torque/(peak torque + additional twitch torque). To evaluate cognitive-behavioral and pain-related factors influencing the central activation ratio, measures of fear of injury, pain catastrophizing, psychologic distress, and pain intensity were used. Differences between groups were tested using either T tests or Mann-Whitney U tests. Associations were tested by partial correlation coefficients controlling for gender. RESULTS:: The male:female ratio was 15:10. Mean age and chronic low back pain duration were 42.7 (+/-9.5) and 9.9 (+/-8.3) years, respectively. Mean muscle torque (per kg lean body mass) in patients (1.95 Nm/kg +/-0.8) was less than in controls (3.16 Nm/kg +/-0.7) (P < 0.01). Median central activation ratio was lower in patients (P < 0.05). Patients experiencing increased psychologic distress and patients with a higher current pain level showed a lower central activation ratio (P < 0.05). CONCLUSIONS:: When interpreting decreased muscle strength in terms of physical deconditioning in patients with chronic low back pain, submaximal performance has to be taken into account. The results suggest that patients with chronic low back pain who report increased psychologic distress and a higher level of current pain tend to show increased inhibition of muscle activity, leading to submaximal performance.
PMID: 15818075 [PubMed - as supplied by publisher]
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Self-Report and Pain Behavior Among Patients With Chronic Pain.
McCahon S, Strong J, Sharry R, Cramond T.
From the Department of Occupational Therapy, University of Queensland, Brisbane, Queensland, Australia; daggerRoyal Brisbane Hospital, Brisbane, Queensland, Australia; and double daggerMultidisciplinary Pain Centre, Royal Brisbane Hospital, Brisbane, Queensland, Australia.
OBJECTIVES:: To determine the relationship between pain behaviors and self-report of pain and disability in patients with chronic pain. METHODS:: Thirty-nine patients (59% women), aged 19 to 79 years, admitted to a Multidisciplinary Pain Center with chronic noncancer pain, were assessed on the following: 1) pain intensity using a 0 to 10 Numerical Graphic Rating Scale; 2) the Pain Disability Index; 3) the Pain Self-Efficacy Questionnaire; 4) a 10-minute videotaped session involving sitting, standing, walking, and reclining, after which pain behaviors were coded using a standardized observational protocol. RESULTS:: Interrelationships among pain intensity, pain disability, self-efficacy, and pain behavior were tested using the Pearson product-moment correlations. Significant relationships were found between pain behavior frequencies and self-reported pain intensity (r = 0.29, P < 0.05), self-reported pain disability (r = 0.54, P < 0.0005), and reported self-efficacy (r = -0.42, P < 0.005). Multiple regression analyses were performed to further investigate these interrelationships. Only the Pain Disability Index score was found to make a significant unique contribution (semipartial correlation of 15%, P < 0.008) to the prediction of total pain behavior score. DISCUSSION:: Findings suggest that pain behavior observation is a valid and reliable assessment tool for use with a heterogeneous chronic pain population. Significant associations were found between pain behaviors and self-report measures of pain intensity, pain disability, and self-efficacy; pain intensity scores displayed a weak relationship; and pain disability scores the strongest relationship with pain behavior. Viewed with previous research, the results of this study indicate the value of a multimodal, cognitive-behavioral approach to assessing patients with chronic pain.
PMID: 15818074 [PubMed - as supplied by publisher]
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Working Through the Pain: A Controlled Study of the Impact of Persistent Pain on Performing a Computer Task.
Harman K, Ruyak P.
From the *School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada, and the daggerDepartment of Psychology, Dalhousie University, Halifax, Nova Scotia, Canada.
OBJECTIVES:: A large percentage of employees experience persistent pain while at work. This situation can become costly to employers with large amounts of lost production-time, absenteeism, and long-term disability. The link or transition between working through (ignoring) pain and disabling pain is unknown. This paper presents the results of a controlled study examining the impact of persistent pain on performance in a working population. Benefits of early detection are discussed. METHODS:: This was a controlled, repeated measures study using 3 types of measures: questionnaires (pain, pain anxiety, daily memory, and attention mistakes); actigraphic monitoring to assure the absence of sleep deprivation; and the Performance Assessment Battery, a computer-based series of tests. Participants were studied during 3 time periods (9:00 AM, 3:00 PM, and 9:00 PM). RESULTS:: Forty participants (20 pain, 20 controls) were studied. For all tasks, pain participants were slower than controls with significant findings on 2 tasks and less accurate with significant differences on 1 task. DISCUSSION:: Unlike other studies that either induced pain or used persons with complex pain conditions, this study used participants with a low level of pain intensity and had a majority still engaged in full-time employment. Our results found that people with persistent low-level pain demonstrate a reduction in performance compared with controls. Our study revealed that using a sensitive tool to detect minor performance deficits could indicate pain interference. The early detection of pain interference would provide an opportunity for prevention programs to have a pre-emptive effect on work-related musculoskeletal disorders.
PMID: 15818073 [PubMed - as supplied by publisher]
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Functional capacity evaluation as a performance measure: evidence for a new approach for clients with chronic back pain.
Gibson L, Strong J, Wallace A.
From the Department of Occupational Therapy, School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
OBJECTIVES:: To report the research and development of a new approach to Functional Capacity Evaluation, the Gibson Approach to Functional Capacity Evaluation (GAPP FCE) for chronic back pain clients. METHODS:: Four studies, including pilot and feasibility testing, expert review, and preliminary interrater reliability examination, are described here. Participants included 7 healthy young adults and 19 rehabilitation clients with back pain who underwent assessment using the GAPP FCE. Thirteen therapists were trained in the approach and were silently observed administering the Functional Capacity Evaluations by at least 1 other trained therapists or the first investigator or both. An expert review using 5 expert occupational therapists was also conducted. RESULTS:: Study 1, the pilot with healthy individuals, indicated that the GAPP FCE was a feasible approach with good utility. Study 2, a pilot using 2 trained therapists assessing 5 back pain clients, supported the clinical feasibility of the approach. The expert review in Study 3 found support for GAPP FCE. Study 4, a trial of the approach with 14 rehabilitation clients, found support for the interrater reliability of recommendations for return to work based on performance in the GAPP FCE. DISCUSSION:: The evidence thus far available supports the GAPP FCE as an approach that provides a sound method for evaluating the performance of the physical demands of work with clients with chronic back pain. The tool has been shown to have good face and content validity, to meet acceptable test standards, and to have reasonable interrater reliability. Further research is occurring to look at a larger interrater reliability study, to further examine content validity, and to examine predictive validity.
PMID: 15818072 [PubMed - in process]
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The Differential Influence of Pain and Fatigue on Physical Performance and Health Status in Ambulatory Patients With Human Immunodeficiency Virus.
Simmonds MJ, Novy D, Sandoval R.
From the *School of Health Professions and Rehabilitation Sciences, University of Southampton, Southhampton, United Kingdom; daggerDepartment of Anesthesiology, University of Texas Health Science Center at Houston, Houston, TX; and double daggerDepartment of Physical Therapy, Harris County Hospital District, Thomas Street Clinic, Houston, TX.
OBJECTIVES:: The purposes of this study were to: 1) characterize physical performance in individuals with human immunodeficiency virus; and 2) examine group differences by pain and fatigue on a multivariate profile of disease, physical, and psychologic symptoms. METHODS:: One hundred outpatients, 78 men and 22 women (mean age 40.70 +/- 7.49 years) participated. Patients completed a battery of physical performance tests in which the time taken or the distance reached or walked was measured. Self-report questionnaires included measures of pain (0-10 numerical rating scale), fatigue (Brief Fatigue Inventory), and perceived health status (Medical Outcomes Survey-HIV scale). RESULTS:: Physical performance was compromised in a task specific manner. Patients took twice as long as healthy individuals on a belt-tie and 4 times as long on a sit-to-stand task and in 6 minutes walked 75% of the distance covered by healthy individuals. Fifty percent of patients (n = 50) had pain at the time of testing (mean 6.3 +/- 2.4), and 98% had fatigue (mean 5.4 +/- 2.3). Multivariate analysis of variance showed pain had a greater influence on performance than fatigue. Pain, distance walked in 6 minutes, and unloaded forward reach accounted for 26% of the variability in quality of life (r = 0.51, P </= 0.0001). DISCUSSION:: Pain has a substantial impact on physical performance and quality of life among ambulatory human immunodeficiency virus patients. Fatigue also impacts physical performance. Compromised ability to perform certain physical tasks affects quality of life. Further investigation of the roles of these relevant variables should be investigated in path analyses.
PMID: 15818071 [PubMed - as supplied by publisher]
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Functional capacity testing in patients with chronic pain.
Wittink H.
From the Department of Physical Therapy, VU Medisch Centrum, Amsterdam, The Netherlands.
PMID: 15818070 [PubMed - in process]
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Analgesic effects of topical methadone: a report of four cases.
Gallagher RE, Arndt DR, Hunt KL.
Division of Palliative Care and Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada. romayne@interchange.ubc.ca
Topical morphine has been used on open wounds for pain management, but has a variable duration of action not suitable for palliative dressing changes. The objective of this study is to find an opioid and delivery method that would provide long-lasting pain relief between dressing changes. Methadone powder (100 mg) was mixed in Stomahesive powder (10 g) and sprinkled on the open wound once daily at the time of dressing change. Four cases are presented with varying results using the methadone/Stomahesive mixture. Exudative wounds with exposed tissue work best, whereas dry wounds with eschar show less response. Topical methadone powder can be effective for pain relief in open, exudative wounds with little eschar. Further research questions are raised.
Publication Types:
PMID: 15722814 [PubMed - indexed for MEDLINE]
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The effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia: a randomized controlled trial.
Lemstra M, Olszynski WP.
College of Medicine, University of Saskatchewan, Saskatoon, Canada.
OBJECTIVES: To assess the effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia in comparison to standard medical care. METHODS: Seventy-nine men and women were randomly assigned to one of two groups. The intervention group consisted of a rheumatologist and physical therapist intake and discharge, 18 group supervised exercise therapy sessions, 2 group pain and stress management lectures, 1 group education lecture, 1 group dietary lecture, and 2 massage therapy sessions. The control group consisted of standard medical care with the patients' family physician. Outcome measures included self-perceived health status, pain-related disability, average pain intensity, depressed mood, days in pain, hours in pain, prescription and nonprescription medication usage, and work status. Outcomes were measured at the end of the 6-week intervention and at 15-month follow-up. RESULTS: Thirty-five out of 43 patients from the intervention group and 36 out of 36 patients from the control group completed the study. There were no statistically significant differences between the 2 groups prior to intervention. Intention-to-treat analysis revealed that the intervention group, in comparison to the control group, experienced statistically significant changes at intervention completion in self-perceived health status, average pain intensity, pain related disability, depressed mood, days in pain, and hours in pain, but no significant differences in nonprescription drug use, prescription drug use, or work status. At 15 months, all health outcomes retained their significance except health status. Nonprescription and prescription drug use demonstrated significant reductions at 15 months. Binary logistic regression indicated that long-term changes in Pain Disability Index were influenced by long-term exercise adherence and income status. CONCLUSIONS: Positive health-related outcomes in this mostly unresponsive condition can be obtained with a low-cost, group multidisciplinary intervention in a community-based, nonclinical setting.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15722810 [PubMed - indexed for MEDLINE]
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Right Knee Pain in a 13-Year-Old Boy.
Zimmerman SL, Moroz LA, Guttenberg ME, Dormans JP.
From the *Hospital of the University of Pennsylvania, Philadelphia, PA; daggerDivision of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA; double daggerPathology Department, The Children's Hospital of Philadelphia, Philadelphia, PA.
PMID: 15805969 [PubMed - as supplied by publisher]
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A Hand Mass That Became Painful 13 Years after Onset.
Hirata H, Kusuzaki K, Fukutome K, Maeda M, Uchida A.
From the *Department of Orthopaedic Surgery and daggerDepartment of Radiology, Mie University, Tsu City, Japan; and the double daggerDepartment of Pathology, Matsuzaka Chuo Hospital, Japan.
PMID: 15805967 [PubMed - as supplied by publisher]
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Tourniquets May Increase Postoperative Swelling and Pain after Internal Fixation of Ankle Fractures.
Konrad G, Markmiller M, Lenich A, Mayr E, Ruter A.
From the *Universitatsklinikum Freiburg, Klinik fur Traumatologie, Freiburg; the daggerKlinikum Augsburg, III Chirurgische Klinik, Augsburg; and the double daggerKlinikum der Universitat Regensburg, Abteilung fur Unfallchirurgie, Regensburg, Germany.
Tourniquets frequently are used in orthopaedic surgery to provide a bloodless field. There is still controversy among authors regarding the benefits and potential risks of using a tourniquet. The objective of this prospective randomized study was to quantify the effect of tourniquet use on postoperative swelling, pain, and range of motion after open reduction and internal fixation of ankle fractures. Fifty-four patients with closed ankle fractures were treated surgically; 26 patients were operated on using a thigh tourniquet (Group A), and 28 patients had surgery without the use of a tourniquet (Group B). The groups of patients were similar for age, gender, fracture types, and operative procedures. There was no difference in operation time. Using a tourniquet during open reduction and internal fixation of ankle fractures did increase postoperative swelling and postoperative pain at Day 5 and at Week 6 after surgery. We found a trend for a better range of motion in the ankle until the 6-week followup in the nontourniquet group compared with the group in which the tourniquet was inflated. According to these results we do not recommend using a tourniquet for osteosynthesis of ankle fractures.Level of Evidence: Therapeutic study, Level I-1 (randomized controlled trial). See the Guidelines for Authors for a complete description of levels of evidence.
PMID: 15805957 [PubMed - as supplied by publisher]
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Ketamine pretreatment with venous occlusion attenuates pain on injection with propofol.
Batra YK, Al Qattan AR, Marzouk HM, Smilka M, Agzamov A.
Publication Types:
PMID: 15816578 [PubMed - in process]
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Comparison of ephedrine and ketamine in prevention of injection pain and hypotension due to propofol induction.
Ozkocak I, Altunkaya H, Ozer Y, Ayoglu H, Demirel CB, Cicek E.
Zonguldak Karaelmas University School of Medicine, Department of Anaesthesiology and Reanimation, Zonguldak, Turkey. uzim@ttnet.net.tr
BACKGROUND AND OBJECTIVE: This prospective, double-blind, randomized, placebo-controlled study compares the effects of ephedrine and ketamine on injection pain, and hypotension from propofol. METHODS: After obtaining the approval of the Ethics Committee, 75 patients (ASA I-II) scheduled for elective operations with general anaesthesia were divided into three groups. Saline 2 mL (Group S, n = 25), ketamine 0.5 mg kg(-1) (Group K, n = 25) or ephedrine 70 microg kg(-1) (Group E, n = 25) were administered over 5 s after tourniquet application. After releasing the tourniquet, propofol 2 mg kg(-1) was injected in 30 s. Pain was evaluated on a numerical scale (0-10) where 0 represented no pain and 10 the most severe pain possible. Systolic, diastolic blood pressures and heart rates were recorded preoperatively, 1 min after propofol injection, before intubation and 1, 2 and 3 min after intubation in all patients. RESULTS: The incidences of pain in Groups S, E and K were similar (84%, 80% and 72%, respectively). The mean pain score in Group K (2.1, SD 3.1) was significantly lower than those of Groups S and E (4.9, SD 2.6 and 4.6, SD, 3.3, respectively) (P < 0.05). The systolic and diastolic blood pressure values in Group K (120 +/- 27 mmHg) and Group E (123 +/- 21 mmHg) before intubation were significantly higher than that of Group S (104 +/- 25 mmHg) (P < 0.05). There was no significant difference between the mean heart rate values of the groups. CONCLUSIONS: Low dose ketamine or ephedrine pretreatment may prevent hypotension due to propofol induction. Despite the reduction in injection pain intensity after ketamine, the study drugs were found to be ineffective in lowering the injection pain incidence.
PMID: 15816573 [PubMed - in process]
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Postoperative magnesium sulphate infusion reduces analgesic requirements in spinal anaesthesia.
Apan A, Buyukkocak U, Ozcan S, Sari E, Basar H.
Kirikkale University Faculty of Medicine, Department of Anaesthesiology, Kirikkale, Turkey. alpaslanapan@doctor.com
BACKGROUND AND OBJECTIVES: Magnesium sulphate infusion during general anaesthesia reduces anaesthetic consumption and analgesic requirements. The aim of this study was to assess the effects of postoperative magnesium infusion on duration of block, sedation and analgesic consumption after spinal anaesthesia. METHODS: Fifty ASA I-II patients were included in the randomized double blind study. Spinal anaesthesia was performed at L3-4 or L4-5 interspace with 12.5 mg 0.5% heavy bupivacaine, using a 25 G Quincke needle. Patients received a 5 mg kg(-1) bolus of magnesium sulphate followed by a 500 mg h(-1) infusion or saline in the same volumes for 24 h. Time to first pain, analgesic request, return of motor function, visual analogue pain and sedation scores were evaluated every 4 h during the 24 h postoperative period. The t- and U-tests were used for statistical analyses. Data were expressed as mean +/- SD, with P < 0.05 being considered significant. RESULTS: Vital signs were stable during spinal anaesthesia and postoperative period. When compared to the control group, time to analgesic need was increased and total analgesic consumption was reduced in the magnesium group (meperidine consumption 60.0 +/- 73.1 mg control group, 31.8 +/- 30.7 mg magnesium group, P = 0.02). CONCLUSIONS: Magnesium sulphate infusion may be used as an adjunct for reducing analgesic consumption after spinal anaesthesia.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15678729 [PubMed - indexed for MEDLINE]
Procedural pain in neonates: the new millennium.
McClain BC, Kain ZN.
Center for the Advancement of Perioperative Health and the Department of Anesthesiology, Yale University School of Medicine New Haven, CT 06510, USA.
Publication Types:
PMID: 15805387 [PubMed - in process]
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The role of endogenous opioids in mediating pain reduction by orally administered glucose among newborns.
Gradin M, Schollin J.
Department of Pediatrics, Orebro University Hospital, S-701 85 Orebro, Sweden. maria.gradin@orebroll.se
OBJECTIVE: It has been demonstrated clearly that sweet-tasting solutions given before a painful intervention can reduce pain among newborns. There is no fully accepted explanation for this effect, but activation of endogenous opioids has been suggested as a possible mechanism. The aim of this study was to obtain deeper knowledge of the underlying mechanism by investigating whether administration of an opioid antagonist would reduce the effect of orally administered glucose at heel stick among term newborns. DESIGN: A randomized, placebo-controlled, double-blind trial with a validated, neonatal, pain-rating scale. PARTICIPANTS: The trial included 30 term newborns undergoing heel stick, who were assigned randomly to 1 of 2 groups, ie, group I, with naloxone hydrochloride (opioid antagonist) 0.01 mg/kg administered intravenously before oral administration of 1 mL of 30% glucose, or group II, with a corresponding amount of placebo (saline solution) administered intravenously before oral administration of glucose. OUTCOME MEASURES: Pain-related behavior during blood sampling was measured with the Premature Infants Pain Profile. Crying time and heart rate were also recorded. RESULTS: The 2 groups did not differ significantly in Premature Infant Pain Profile scores during heel stick. The median crying time during the first 3 minutes was 14 seconds (range: 0-174 seconds) for the naloxone group and 105 seconds (range: 0-175 seconds) for the placebo group. There was no significant difference in heart rate between the 2 groups. CONCLUSION: Administration of an opioid antagonist did not decrease the analgesic effect of orally administered glucose given before blood sampling.
PMID: 15805377 [PubMed - in process]
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Rapid, needle-free delivery of lidocaine for reducing the pain of venipuncture among pediatric subjects.
Migdal M, Chudzynska-Pomianowska E, Vause E, Henry E, Lazar J.
Clinical Pharmacology Unit and Department of Anesthesiology and Intensive Care, Children's Memorial Health Institute, Warsaw, Poland.
OBJECTIVES: The purpose of this study was to determine the optimal configuration of an investigational, single-use, needle-free, drug system (ALGRX 3268) that delivers powdered lidocaine into the epidermis for the rapid production of local anesthesia among pediatric subjects undergoing venipuncture. METHODS: Children 3 to 18 years of age were randomly allocated to receive 1 of 3 treatments, ie, (1) placebo, (2) a system configured to deliver 0.25 mg of lidocaine, or (3) a system configured to deliver 0.5 mg of lidocaine, at the antecubital fossa 2 to 3 minutes before venipuncture. Three age groups were included, ie, 3 to 7 years, 8 to 12 years, and 13 to 18 years. Two sets of pain rating scales were used, the Faces Pain Scale-Revised for the youngest age stratum and a visual analog scale for the oldest age stratum. Children in the middle age stratum used both scales. RESULTS: One-hundred forty-four subjects completed the study. For all ages combined, there was a statistically significant and clinically meaningful reduction in pain scores for subjects who received 0.5 mg of lidocaine, compared with placebo. The reduction in pain after 0.25 mg of lidocaine did not achieve statistical significance. CONCLUSIONS: Both active configurations were safe and well tolerated by pediatric subjects undergoing venipuncture at the antecubital fossa. ALGRX 3268 at 0.5 mg, administered 2 to 3 minutes before venipuncture, produced significantly lower pain scores, compared with placebo.
PMID: 15805340 [PubMed - in process]
MR-based stereotactic mesencephalic tractotomy.
Fountas KN, Lane FJ, Jenkins PD, Smith JR.
Department of Neurosurgery, Medical College of Georgia, Augusta, Ga., USA. knfountasmd@excite.com
INTRODUCTION: Medically refractory pain related to cancer is a major indication for pain surgery. Stereotactic mesencephalic tractotomy (SMT) constitutes a widely accepted procedure in treating unilateral head and neck cancer pain. MATERIAL AND METHOD: We report a case of a MRI-based right-sided SMT for treating intractable craniofacial pain, in a 38-year-old patient, related to a previously resected adenocystic carcinoma of the parotid gland. The patient had undergone an implantation of an intrathecal morphine/clonidine pump and subsequent radiofrequency cingulotomy with only temporary improvement. Prior to SMT the patient developed left-sided chest wall pain, secondary to metastasis, in addition to her left-sided facial, dysesthetic pain. The MRI-based SMT was performed with the assistance of a side-extruding monopolar electrode (Leibinger GmbH, Freiburg, Germany) for intraoperative, topographic mapping of the spinothalamic tract. Two lesions were made at 8 and 5 mm off the midline on the right side at the level of the superior colliculus at 70 degrees C for 90 s with a 2 x 4 mm radiofrequency bipolar electrode (Leibinger GmbH). RESULTS: The patient developed intraoperatively left-sided facial, bodily and extremity thermoanalgesia. She had an unremarkable postoperative course. No early proprioceptive or gaze deficits were noted. Her facial and truncal pain was well controlled with intrathecal morphine and clonidine at the preoperative dosology for 17 months. Left-sided upper extremity dysesthesia developed 15 months after the procedure. The patient expired 18 months after this procedure due to an extensive metastatic disease. CONCLUSIONS: The use of high-resolution MRI (MPRAGE) and side-extruding electrode represent technical maneuvers that could decrease the morbidity and further improve the long-term outcome of SMT in treating patients with chronic, medically refractory cancer pain, who have a likely survival time in the order of 1 year +/- 6 months.
Publication Types:
PMID: 15637444 [PubMed - indexed for MEDLINE]
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