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Comment on:
Age and routine invasive management of acute coronary syndromes.
Masoodi NA.
Publication Types:
PMID: 15611499 [PubMed - indexed for MEDLINE]
Summary for patients in:
Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial.
Berman BM, Lao L, Langenberg P, Lee WL, Gilpin AM, Hochberg MC.
University of Maryland School of Medicine, Baltimore, Maryland 21207, USA.
BACKGROUND: Evidence on the efficacy of acupuncture for reducing the pain and dysfunction of osteoarthritis is equivocal. OBJECTIVE: To determine whether acupuncture provides greater pain relief and improved function compared with sham acupuncture or education in patients with osteoarthritis of the knee. DESIGN: Randomized, controlled trial. SETTING: Two outpatient clinics (an integrative medicine facility and a rheumatology facility) located in academic teaching hospitals and 1 clinical trials facility. PATIENTS: 570 patients with osteoarthritis of the knee (mean age [+/-SD], 65.5 +/- 8.4 years). INTERVENTION: 23 true acupuncture sessions over 26 weeks. Controls received 6 two-hour sessions over 12 weeks or 23 sham acupuncture sessions over 26 weeks. MEASUREMENTS: Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at 8 and 26 weeks. Secondary outcomes were patient global assessment, 6-minute walk distance, and physical health scores of the 36-Item Short-Form Health Survey (SF-36). RESULTS: Participants in the true acupuncture group experienced greater improvement in WOMAC function scores than the sham acupuncture group at 8 weeks (mean difference, -2.9 [95% CI, -5.0 to -0.8]; P = 0.01) but not in WOMAC pain score (mean difference, -0.5 [CI, -1.2 to 0.2]; P = 0.18) or the patient global assessment (mean difference, 0.16 [CI, -0.02 to 0.34]; P > 0.2). At 26 weeks, the true acupuncture group experienced significantly greater improvement than the sham group in the WOMAC function score (mean difference, -2.5 [CI, -4.7 to -0.4]; P = 0.01), WOMAC pain score (mean difference, -0.87 [CI, -1.58 to -0.16];P = 0.003), and patient global assessment (mean difference, 0.26 [CI, 0.07 to 0.45]; P = 0.02). LIMITATIONS: At 26 weeks, 43% of the participants in the education group and 25% in each of the true and sham acupuncture groups were not available for analysis. CONCLUSIONS: Acupuncture seems to provide improvement in function and pain relief as an adjunctive therapy for osteoarthritis of the knee when compared with credible sham acupuncture and education control groups.
Publication Types:
- Clinical Trial
- Multicenter Study
- Randomized Controlled Trial
PMID: 15611487 [PubMed - indexed for MEDLINE]
Original report in:
Summaries for patients. Acupuncture for treating knee osteoarthritis.
[No authors listed]
Publication Types:
- Patient Education Handout
PMID: 15611482 [PubMed - indexed for MEDLINE]
Comment on:
Placebos in medicine: placebo use is well known, placebo effect is not.
Barfod TS.
Publication Types:
PMID: 15626818 [PubMed - indexed for MEDLINE]
Comment on:
Placebos in medicine: medical paradoxes need disentangling.
Di Blasi Z, Reilly D.
Publication Types:
PMID: 15626817 [PubMed - indexed for MEDLINE]
Comment on:
Placebos in medicine: is placebo analgesia always in the mind?
Au-Yeung PK.
Publication Types:
PMID: 15626816 [PubMed - indexed for MEDLINE]
In memory of Professor Virgilio Gallai.
Sarchielli P.
Publication Types:
- Biography
- Historical Article
Personal Name as Subject:
PMID: 15482369 [PubMed - indexed for MEDLINE]
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Gabapentin-responsive idiopathic stabbing headache.
Franca MC Jr, Costa AL, Maciel JA Jr.
Headache Clinic, Department of Neurology, Faculty of Medical Sciences, Campinas State University (UNICAMP), Sao Paulo, Brazil.
Idiopathic stabbing headache (ISH) is defined as the occurrence of short-lasting, painful jabs, restricted to the ophthalmic division of the trigeminal nerve. It is closely related to other forms of headache (such as migraine and tension-type headache) and has been reported among all age groups, including children and adolescents. As pathogenic mechanisms of the disease remain unclear, management decisions are empirical and limited to few options. Classically, indomethacin has been considered the first option, but therapeutic failure occurs in up to 35% of cases. In this setting, we report four patients with young-onset indomethacin-resistant ISH which had good responses to gabapentin and discuss the use of this drug in the presenting situation.
Publication Types:
PMID: 15482364 [PubMed - indexed for MEDLINE]
Efficacy and safety of acetaminophen versus ibuprofen for treating children's pain or fever: a meta-analysis.
Goldman RD.
Department of Pediatrics, University of Toronto, Toronto, Canada.
PMID: 15644842 [PubMed - in process]
MRI of idiopathic lumbosacral plexopathy.
Ishii K, Tamaoka A, Shoji S.
Department of Neurology, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan. kazishii@md.tsukuba.ac.jp
Publication Types:
PMID: 15277659 [PubMed - indexed for MEDLINE]
Circumstances surrounding the deaths of hospitalized children: opportunities for pediatric palliative care.
Carter BS, Howenstein M, Gilmer MJ, Throop P, France D, Whitlock JA.
Vanderbilt Children's Hospital, Vanderbilt University School of Medicine, TN, USA. brian.carter@vanderbilt.edu
OBJECTIVES: Little is known regarding the assessment and treatment of symptoms during end-of-life (EOL) care for children. This study was conducted to describe the circumstances surrounding the deaths of hospitalized terminally ill children, especially pain and symptom management by the multidisciplinary pediatric care team. DESIGN: Patients in the neonatal intensive care unit, pediatric critical care unit, or general pediatric units of Vanderbilt Children's Hospital who were hospitalized at the time of death, between July 1, 2000, and June 30, 2001, were identified. Children eligible for the survey had received inpatient EOL care at the hospital for at least 24 hours before death. A retrospective medical record review was completed to describe documentation of care for these children and their families during the last 72 hours of life. RESULTS: Records of children who had received inpatient EOL care were identified (n = 105). A majority (87%) of children were in an intensive care setting at the time of death. Most deaths occurred in the pediatric critical care unit (56%), followed by the neonatal intensive care unit (31%). Pain medication was received by 90% of the children in the last 72 hours of life, and 55% received additional comfort care measures. The presence of symptoms other than pain was infrequently documented. CONCLUSIONS: The duration of hospitalization for most children dying in this inpatient setting was sufficient for provision of interdisciplinary pediatric palliative care. Management of pain and other symptoms was accomplished for many children. The documentation of pain and symptom assessment and management can be improved but requires new tools.
PMID: 15342898 [PubMed - indexed for MEDLINE]
Controlling pain by influencing neurogenic pathways.
Puehler W, Stein C.
Department of Anesthesiology and Critical Care Medicine, Charite-Universitatsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
Neurogenic inflammation and ensuing pain can be modulated by inhibiting the function of primary afferent neurons. The best studied mechanism to accomplish such inhibition is the opioid system. Under inflammatory conditions, the anterograde axonal transport of opioid receptors from dorsal root ganglia toward the peripheral sensory nerve endings is augmented. The increased number of opioid receptors (among other mechanisms) leads to improved analgesic effects of exogenously administered ligands (eg, morphine) and of endogenous leukocyte-derived opioid peptides (eg, beta-endorphin). A current concept proposes that during inflammatory processes endogenous opioid peptides can be secreted from immunocytes, occupy peripheral opioid receptors on sensory nerve endings, and produce analgesia by inhibiting the excitability of these nerves or the release of proinflammatory neuropeptides. This article focuses on the role of peripheral opioid receptors in pain control and on novel pharmaceutical concepts for the treatment of patients who suffer from rheumatoid arthritis and other inflammatory pain.
PMID: 15639058 [PubMed - in process]
Re: Niemisto L, Kalso E, Malmivaara A, et al. Radiofrequency denervation for neck and back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 2003;28:1877-88.
Curatolo M, Reiz S.
Publication Types:
PMID: 15644768 [PubMed - in process]
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Backpacks, back pain, sagittal spinal curves and trunk alignment in adolescents: a logistic and multinomial logistic analysis.
Korovessis P, Koureas G, Zacharatos S, Papazisis Z.
Orthopaedic Department, Spine Unit, General Hospital Agios Andreas Patras, Greece. korovess@otenet.gr
STUDY DESIGN: Cross-sectional study using logistic and multinomial logistic analysis. OBJECTIVES: To investigate the influence of backpack carrying on spinal profile shoulder and trunk. SUMMARY OF BACKGROUND DATA: No similar investigations. METHODS: A randomly selected sample of 1263 students aged 12-18 years were asked for dorsal (DP) and low back pain (LBP) during the school period and holidays. Debrunner's Kyphometer and Scoliometer were used to measure craniocervical angle (CCA), thoracic kyphosis, lumbar lordosis, and shoulder shift (BL). Upper trunk shift from plumbline were recorded. RESULTS: Girls suffer from DP more often and of much more intensity pain than boys in school period and in holidays. Backpack carrying decreased CCA and changed shoulder and upper trunk shift. Asymmetrically backpack carrying increased DP and LBP. BL-shift increased DP. DP and LBP increased with coronal trunk shift. Sagittal trunk shift increased LBP. Asymmetrically carrying of backpacks increased back pain and shoulder shift in holidays. Coronal trunk shift while carrying backpacks asymmetrically increased back pain in holidays. Asymmetric backpack carrying is associated with high intensity pain. Frontal trunk shift is associated with high intensity pain. CONCLUSION: Backpack carrying, particularly asymmetrically, results in shift of upper trunk and shoulder and cervical lordosis, which furthermore seem to increase back pain in school period and holidays. Symmetric backpack carrying is recommended.
PMID: 15644765 [PubMed - in process]
-
Predicting timely recovery and recurrence following multidisciplinary rehabilitation in patients with compensated low back pain.
Gross DP, Battie MC.
Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada. dgross@ualberta.ca
STUDY DESIGN: Historical cohort study. OBJECTIVES: We investigated factors predictive of timely and sustained recovery following multidisciplinary rehabilitation in Workers' Compensation claimants with low back pain. SUMMARY OF BACKGROUND DATA: It is still unknown which factors predict better outcomes among back pain patients enrolled in intensive rehabilitation programs. Previously, few consistent predictors have been reported. METHODS: We created and tested predictive models using data from clinical and administrative databases of the Alberta Workers' Compensation Board. Predictive models were built on a cohort of subjects admitted for multidisciplinary rehabilitation in 1999 and tested on subjects admitted in 2000. Cox regression was used to evaluate days to time-loss benefit suspension and days to claim closure following admission for rehabilitation. Logistic regression was used to evaluate risk of future recurrence as judged through time-loss benefit resumption, claim reopening, or new back-related claims filing. RESULTS: Prediction models were variable between exploratory and confirmatory stages, and few variables were found to predict consistently. The number of preadmission healthcare visits was the most robust predictor of all recovery outcomes. Recurrence rates were 18% in 1999 and 22% in 2000. A higher number of preadmission healthcare visits and more previous back-related claims were associated with higher risk of recurrence. CONCLUSIONS: The number of preadmission healthcare visits was the most robust prognostic indicator with more healthcare visits related to delayed recovery and higher risk of recurrence. Recurrence rates following successful functional restoration were consistent with the episodic and recurrent nature of low back pain.
PMID: 15644763 [PubMed - in process]
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Small effect of genetic factors on neck pain in old age: a study of 2,108 Danish twins 70 years of age and older.
Hartvigsen J, Pedersen HC, Frederiksen H, Christensen K.
Nordic Institute of Chiropractic and Clinical Biomechanics, Odense C, Denmark. j.hartvigsen@nikkb.dk
STUDY DESIGN: Classic twin study. OBJECTIVES: To determine the heritability of neck pain in persons 70 years of age and older. SUMMARY OF BACKGROUND DATA: Previous studies have shown a moderate effect of genetic factors on back pain in the elderly. Genetic influence on neck pain in old age is unknown. METHODS: Data on the 1-month prevalence of neck pain from twin pairs participating in the population based Longitudinal Study of Aging Danish Twins formed the basis of this analysis. To assess twin similarity, probandwise concordance rates, odds ratios, and tetrachoric correlations were calculated and compared for monozygotic and dizygotic twins. Further, heritability estimates were calculated using bivariate probit estimation. RESULTS: A total of 2,108 twin individuals, including 1,054 complete twin pairs, answered the question related to neck pain at intake into the Longitudinal Study of Aging Danish Twins study. Low and nonsignificant probandwise concordance rates, odds ratios, and tetrachoric correlations were found for both men and women in monozygotic and dizygotic twin pairs, indicating small or negligible genetic effects. Heritability estimates adjusted for age and significant environmental risk factors (rheumatoid arthritis, osteoarthritis, disc prolapse, and coronary heart disease) showed no significant additive genetic, dominant genetic, or common environmental effects. CONCLUSION: Genetic factors do not play an important role in the liability to neck pain in persons 70 years of age or older.
PMID: 15644757 [PubMed - in process]
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Nerve growth factor content in dorsal root ganglion as related to changes in pain behavior in a rat model of experimental lumbar disc herniation.
Onda A, Murata Y, Rydevik B, Larsson K, Kikuchi S, Olmarker K.
Department of Orthopaedics, Sahlgrenska University Hospital, Goteborg University, Gothenburg, Sweden.
STUDY DESIGN: The time courses of nerve growth factor content and pain-related behavior were examined using experimental disc herniation models. OBJECTIVES: To investigate a relationship between nerve growth factor level and pain behavior. SUMMARY OF BACKGROUND DATA: An induction of nerve growth factor in the periphery is regarded as a major contributor of inflammatory hyperalgesia and neuropathic pain. However, it has not been clarified quantitatively whether disc herniation induces changes in nerve growth factor levels in the dorsal root ganglion in relation to pain-related behavior. METHODS: A total of 140 rats were used in this study. The animals had their left L4 nerve roots and associated dorsal root ganglion exposed and were equally divided into 4 groups: L4-L5 disc puncture, displacement of L4 nerve roots/dorsal root ganglion, the combination of disc puncture and displacement, and sham exposure. The content of nerve growth factor in the affected dorsal root ganglion was assessed by enzyme-linked immunosorbent assay as well as pain behavior during a postoperative 21-day period. RESULTS: Disc puncture resulted in nerve growth factor induction at postoperative day 3, but not apparent behavioral changes. Mechanical displacement induced nerve growth factor at postoperative day 1 and mechanical allodynia at postoperative day 3, respectively (P < 0.05). In the combination model, there were more pronounced changes in nerve growth factor induction and both mechanical and thermal threshold during 7 days after surgery (P < 0.05). CONCLUSIONS: These data suggest the possibilities that elevated nerve growth factor level is partly involved in pain behavior and further the combined model mimicking the clinical situation, which causes the marked neuronal responses, is helpful to advance the understanding of the mechanisms underlying sciatica due to lumbar disc herniation.
PMID: 15644754 [PubMed - in process]
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Scrotal pain as the presenting symptom of lumbar disc herniation: a report of 2 cases.
Wouda EJ, Leenstra S, Vanneste JA.
Department of Neurology, St. Lucas Andreas Hospital, Amsterdam, The Netherlands. e.wouda@SLAZ.nl
STUDY DESIGN: Case description. OBJECTIVE: To describe a treatable cause of scrotal pain associated with lumbar disc herniation SUMMARY OF BACKGROUND DATA: Scrotal pain due to intraspinal compression of a sacral nerve root caused by lumbar disc herniation is probably very rare, as the literature contains only sporadic single case descriptions. METHODS: Two patients with isolated scrotal pain were analyzed. In both patients, a lumbar disc herniation was found. Lumbar discectomy was performed in both patients. RESULTS: Complete and persisting relief of the scrotal pain was obtained after lumbar discectomy. CONCLUSIONS: Despite the absence of other symptoms or signs suggestive of nerve root involvement, lumbar disc herniation with intraspinal compression of a sacral nerve root seemed the most probable cause of the scrotal pain.
PMID: 15644747 [PubMed - in process]
Randomized double-blind, double-dummy crossover clinical trial of oral tramadol versus rectal tramadol administration in opioid-naive cancer patients with pain.
Mercadante S, Arcuri E, Fusco F, Tirelli W, Villari P, Bussolino C, Campa T, De Conno F, Ripamonti C.
Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Via San Lorenzo 312, 90146, Palermo, Italy, terapiadeldolore@la-maddalena.it.
Tramadol is commonly used as second step drug of the analgesic ladder. In circumstances where the oral route is unavailable, rectal administration of opioids might be a simple alternative. The aim of this study was to compare the analgesic activity and tolerability of tramadol by oral and rectal administration in a double-blind, double-dummy crossover trial. The study included 60 cancer patients with cancer pain no longer responsive to non-opioid drugs. Each patient initially received oral tramadol 50 mg (drops), followed by tramadol sustained release 100 mg orally, and placebo rectally, or tramadol 100 mg rectally and placebo orally, twice a day, in a randomized sequence, on each of 3 days. Patients were allowed to take 50 mg of oral tramadol by drops as needed (four doses per day, to a maximum of 400 mg/day, including the basal dose given by the oral or rectal route). Pain intensity and relief and symptom scores were recorded every day and at the end of each phase of the crossover. The mean age of the patients was 66.1 years (SD 13.5 years); 36 were female, and 44 completed both periods. Patients dropped out due to adverse effects (15 patients) and refusal (1 patient). No differences in the use of rescue dose of oral tramadol were observed between the groups. No differences in pain intensity and relief scores, or in other symptoms between the two treatments were observed. No differences in treatment efficacy as judged by the clinician (P=0.73), in patient compliance (P=0.35), or in patient satisfaction regarding treatment (P<0.35) were found. No differences in adverse effects were found between the two treatments (25.5%, 13 patients, and 20.4%, 11 patients, with oral and rectal treatment, respectively). The proportion of preferences favored oral administration for both physicians (P=0.0002) and patients (P=0.002). Rectal administration of tramadol appears a reliable, noninvasive alternative method of pain control for patients no longer responsive to non-opioid analgesics, unable to take oral tramadol.
PMID: 15645186 [PubMed - as supplied by publisher]
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