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Items 1 - 30 of 30 |
One page. |
Adrenal hemorrhage mimicking an acute abdomen.
Landen S, Delugeau V.
Department of Surgery, St Elisabeth Hospital, Brussels, Belgium.
Publication Types:
PMID: 15765354 [PubMed - indexed for MEDLINE]
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Late postpartum eclampsia as an obstetric complication seen in the ED.
Graeber B, Vanderwal T, Stiller RJ, Werdmann MJ.
Yale University School of Medicine, New Haven, CT 06510, USA.
Preeclampsia is a complication of pregnancy associated with hypertension and proteinuria. Preeclampsia may be associated with grand mal seizures and is termed eclampsia. Historically, eclampsia occurring more than 48 hours after delivery, known as late postpartum eclampsia, was thought to be uncommon; however, recent evidence suggests that its incidence is increasing. In addition, the presentation of late postpartum preeclampsia-eclampsia may differ from that occurring during the pregnancy. This contributes to difficulty in diagnosing late postpartum preeclampsia-eclampsia in an emergency department setting. We report 2 cases of late postpartum eclampsia presenting 8 days after delivery, which highlight the unique features of this disorder and discuss some of the difficulties in managing these patients. Greater awareness and knowledge of this disorder by ED physicians should improve outcomes in these potentially life-threatening cases.
Publication Types:
PMID: 15765338 [PubMed - indexed for MEDLINE]
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A randomized, double-blind study comparing morphine with fentanyl in prehospital analgesia.
Galinski M, Dolveck F, Borron SW, Tual L, Van Laer V, Lardeur JY, Lapostolle F, Adnet F.
Samu 93-Department of Anesthesiology and Intensive Care, Avicenne Hospital, Bobigny, France. michel.galinski@avc.ap-hop-paris.fr
STUDY OBJECTIVE: The aim of this study was to compare, by a randomized double-blind method, morphine (M) and fentanyl (F) in a prehospital setting. METHODS: Consecutive patients with severe, acute pain defined as a visual analog scale score (VASS) of 60/100 or higher were included. The M group received an initial intravenous M injection of 0.1 mg/kg then of 3 mg every 5 minutes. The F group received an initial intravenous F injection of 1 microg/kg then of 30 microg every 5 minutes. The goal of analgesia was a VASS of 30/100 or lower. The end point was the VASS measured 30 minutes after initial administration (VAS [T30]). RESULTS: There were 26 patients included in the M group and 28 in the F group. Initial VASS(T0) and VASS(T30), mean (95% CI), were 83 (78-88) and 40 (28-52) in the M group and 77 (72-82) and 35 (27-43) in the F group (P=NS). Sixty-two percent of patients in the M group described analgesia as excellent or good vs 76% of those in the F group who did (P=NS). There were no differences in the incidence of side effects in the 2 groups. CONCLUSION: This study demonstrates that M and F were comparable in treating severe, acute pain in a prehospital setting during the first 30 minutes in spontaneous breathing patients.
Publication Types:
- Clinical Trial
- Multicenter Study
- Randomized Controlled Trial
PMID: 15765326 [PubMed - indexed for MEDLINE]
Summary for patients in:
Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain.
Hayden JA, van Tulder MW, Tomlinson G.
Institute for Work & Health and University of Toronto, Toronto, Ontario, Canada. jhayden@iwh.on.ca
BACKGROUND: Exercise therapy encompasses a heterogeneous group of interventions. There continues to be uncertainty about the most effective exercise approach in chronic low back pain. PURPOSE: To identify particular exercise intervention characteristics that decrease pain and improve function in adults with nonspecific chronic low back pain. DATA SOURCES: MEDLINE, EMBASE, PsychInfo, CINAHL, and Cochrane Library databases to October 2004 and citation searches and bibliographic reviews of previous systematic reviews. STUDY SELECTION: Randomized, controlled trials evaluating exercise therapy in populations with chronic (>12 weeks duration) low back pain. DATA EXTRACTION: Two reviewers independently extracted data on exercise intervention characteristics: program design (individually designed or standard program), delivery type (independent home exercises, group, or individual supervision), dose or intensity (hours of intervention time), and inclusion of additional conservative interventions. DATA SYNTHESIS: 43 trials of 72 exercise treatment and 31 comparison groups were included. Bayesian multivariable random-effects meta-regression found improved pain scores for individually designed programs (5.4 points [95% credible interval (CrI), 1.3 to 9.5 points]), supervised home exercise (6.1 points [CrI, -0.2 to 12.4 points]), group (4.8 points [CrI, 0.2 to 9.4 points]), and individually supervised programs (5.9 points [CrI, 2.1 to 9.8 points]) compared with home exercises only. High-dose exercise programs fared better than low-dose exercise programs (1.8 points [CrI, -2.1 to 5.5 points]). Interventions that included additional conservative care were better (5.1 points [CrI, 1.8 to 8.4 points]). A model including these most effective intervention characteristics would be expected to demonstrate important improvement in pain (18.1 points [CrI, 11.1 to 25.0 points] compared with no treatment and 13.0 points [CrI, 6.0 to 19.9 points] compared with other conservative treatment) and small improvement in function (5.5 points [CrI, 0.5 to 10.5 points] compared with no treatment and 2.7 points [CrI, -1.7 to 7.1 points] compared with other conservative treatment). Stretching and strengthening demonstrated the largest improvement over comparisons. LIMITATIONS: Limitations of the literature, including low-quality studies with heterogeneous outcome measures and inconsistent and poor reporting; publication bias. CONCLUSIONS: Exercise therapy that consists of individually designed programs, including stretching or strengthening, and is delivered with supervision may improve pain and function in chronic nonspecific low back pain. Strategies should be used to encourage adherence. Future studies should test this multivariable model and further assess specific patient-level characteristics and exercise types.
Publication Types:
PMID: 15867410 [PubMed - indexed for MEDLINE]
Summary for patients in:
Meta-analysis: exercise therapy for nonspecific low back pain.
Hayden JA, van Tulder MW, Malmivaara AV, Koes BW.
Institute for Work & Health and University of Toronto, Toronto, Ontario, Canada. jhayden@iwh.on.ca
BACKGROUND: Exercise therapy is widely used as an intervention in low back pain. OBJECTIVE: To evaluate the effectiveness of exercise therapy in adult nonspecific acute, subacute, and chronic low back pain versus no treatment and other conservative treatments. DATA SOURCES: MEDLINE, EMBASE, PsychInfo, CINAHL, and Cochrane Library databases to October 2004; citation searches and bibliographic reviews of previous systematic reviews. STUDY SELECTION: Randomized, controlled trials evaluating exercise therapy for adult nonspecific low back pain and measuring pain, function, return to work or absenteeism, and global improvement outcomes. DATA EXTRACTION: Two reviewers independently selected studies and extracted data on study characteristics, quality, and outcomes at short-, intermediate-, and long-term follow-up. DATA SYNTHESIS: 61 randomized, controlled trials (6390 participants) met inclusion criteria: acute (11 trials), subacute (6 trials), and chronic (43 trials) low back pain (1 trial was unclear). Evidence suggests that exercise therapy is effective in chronic back pain relative to comparisons at all follow-up periods. Pooled mean improvement (of 100 points) was 7.3 points (95% CI, 3.7 to 10.9 points) for pain and 2.5 points (CI, 1.0 to 3.9 points) for function at earliest follow-up. In studies investigating patients (people seeking care for back pain), mean improvement was 13.3 points (CI, 5.5 to 21.1 points) for pain and 6.9 points (CI, 2.2 to 11.7 points) for function, compared with studies where some participants had been recruited from a general population (for example, with advertisements). Some evidence suggests effectiveness of a graded-activity exercise program in subacute low back pain in occupational settings, although the evidence for other types of exercise therapy in other populations is inconsistent. In acute low back pain, exercise therapy and other programs were equally effective (pain, 0.03 point [CI, -1.3 to 1.4 points]). LIMITATIONS: Limitations of the literature, including low-quality studies with heterogeneous outcome measures inconsistent and poor reporting, and possibility of publication bias. CONCLUSIONS: Exercise therapy seems to be slightly effective at decreasing pain and improving function in adults with chronic low back pain, particularly in health care populations. In subacute low back pain populations, some evidence suggests that a graded-activity program improves absenteeism outcomes, although evidence for other types of exercise is unclear. In acute low back pain populations, exercise therapy is as effective as either no treatment or other conservative treatments.
Publication Types:
PMID: 15867409 [PubMed - indexed for MEDLINE]
Original report in:
Summaries for patients. Best types of exercise for low back pain.
[No authors listed]
Publication Types:
- Patient Education Handout
PMID: 15867403 [PubMed - indexed for MEDLINE]
Original report in:
Summaries for patients. Exercise for low back pain.
[No authors listed]
Publication Types:
- Patient Education Handout
PMID: 15867402 [PubMed - indexed for MEDLINE]
Pool players' headache.
Lim EC, Ong BK, Wilder-Smith EP.
Division of Neurology, National University Hospital, Singapore 119074. mdcelch@nus.edu.sg
Publication Types:
PMID: 15773830 [PubMed - indexed for MEDLINE]
Leg Pain in a 39-year-old Man.
Hosalkar HS, Nussen-Lee S, Torbert JT, Dolinskas CA, Donthineni-Rao R, Lackman RD.
From the *Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA; the daggerDepartment of Pathology and double daggerDepartment of Radiology, Pennsylvania Hospital, Philadelphia, PA; and the section signDepartment of Orthopaedic Surgery, University of California Davis, Sacramento, CA.
PMID: 15864066 [PubMed - as supplied by publisher]
No release of interstitial glutamate in experimental human model of muscle pain.
Ashina M, Jorgensen M, Stallknecht B, Mork H, Bendtsen L, Pedersen JF, Olesen J, Jensen R.
Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, DK-2600 Glostrup, Copenhagen, Denmark.
Glutamate may be released from muscle nociceptors and thereby contribute to mechanisms underlying acute and chronic muscle pain. In vivo concentration of glutamate during muscle pain has not previously been studied in either animals or humans. In the present study, we aimed to study the in vivo concentration of glutamate before, during and after acute pain of trapezius muscle in humans using the microdialysis technique. In addition, we examined the nutritive skeletal muscle blood flow and the interstitial concentrations of lactate, glucose, glycerol, pyruvate and urea. Experimental pain and tenderness were induced by intramuscular infusion of a chemical mixture consisting of bradykinin, prostaglandin E(2), histamine and serotonin. One EMG-needle and one microdialysis catheter were inserted into non-dominant and dominant trapezius muscles on a standard anatomical point in 19 healthy subjects. Dialysates were collected at rest, during infusion and 60 and 120 min after stop of infusion. Local tenderness was recorded at baseline and at the end of experiment. Local pain was recorded during infusion. The infusion of chemical mixture was more painful than infusion of placebo (p<0.05) and resulted in significantly higher local tenderness score than placebo (p=0.007). There was no difference in change in interstitial concentrations of glutamate, lactate, glucose, glycerol, pyruvate and urea from baseline to infusion and post-infusion periods between chemical mixture and placebo (p>0.05). Muscle blood flow increased significantly over time in response to infusion of chemical mixture and placebo (p=0.001). However, we found no difference in changes in muscle blood flow between chemical mixture and placebo (p>0.05). In conclusion, the present study demonstrates no signs of increased release of glutamate from myofascial nociceptors during and after acute experimentally induced muscle pain and tenderness.
PMID: 15862483 [PubMed - in process]
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Differences in unpleasantness induced by experimental pressure pain between patients with fibromyalgia and healthy controls.
Petzke F, Harris RE, Williams DA, Clauw DJ, Gracely RH.
Department of Anesthesiology of the University of Cologne, Germany.
Pain possesses both sensory and affective dimensions, which are highly correlated yet distinct. Comparison of these dimensions within experimental pain settings has resulted in the construct of relative unpleasantness. Relative unpleasantness is defined as the amount of affective unpleasantness elicited for a given sensory magnitude. The aim of this study was to determine the relationship between affective and sensory components of evoked pain in subjects with fibromyalgia (FM) and healthy controls. Here we show that patients with FM unexpectedly display less relative unpleasantness than healthy controls in response to random noxious pressure stimuli. Relative unpleasantness was not correlated with distress, anxiety, or depression, which were pronounced in the FM group. Clinical pain in patients with FM was perceived to be more unpleasant than the evoked pain stimuli. These results are consistent with the concept that chronic pain may reduce the relative unpleasantness of evoked pain sensations.
PMID: 15862482 [PubMed - in process]
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Altered processing of pain-related information in patients with fibromyalgia.
Montoya P, Pauli P, Batra A, Wiedemann G.
Department of Psychology and Research Institute on Health Sciences, University of the Balearic Islands, Cra. de Valldemossa, km 7.5, E-07122 Palma, Spain.
Pressure pain thresholds (PPTs) and event-related potentials (ERPs) elicited by emotional words were analyzed in 12 patients with fibromyalgia (FM) and 12 matched healthy subjects. PPTs were assessed at the middle finger of both hands, before and after the experiment. Overall, FM patients and healthy subjects did not differ in PPT. Nevertheless, FM patients as compared with healthy controls were characterized by a significant enhancement of pain sensitivity from the beginning to the end of the experiment indicating a long lasting sensitization due to repeated stimulation. ERPs were recorded during a language decision task where subjects had to react to unpleasant pain-related and emotionally neutral words depending on syntactic or orthographic cues. An emotional category effect was observed on N400 and P300 components of the ERP, indicating that unpleasant words elicited more positive amplitudes than neutral words. A significant group effect was observed on P200 amplitudes, showing reduced amplitudes in FM patients as compared to healthy controls. Furthermore, unpleasant pain-related compared to neutral words triggered significantly enhanced late positive slow waves in healthy controls, while a comparable effect was not found in FM patients. The ERP and PPT data suggest that FM patients are characterized by an altered cognitive processing of pain-related information and by an abnormal adaptation to mechanical pain stimuli, respectively.
PMID: 15862479 [PubMed - in process]
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Memories of parental rearing and perceived self-image in groups of chronic pain patients.
Nordin H, Eisemann M, Richter J.
Division of Psychiatry, Central Hospital of Rogaland, Norway.
OBJECTIVES: The aim of this study was to analyze the relationships between perceived parental rearing styles as determining factors of self-image in chronic pain patients, and to test the hypothesis of two different groups inherent to the pain sample. METHODS: In this study, 152 patients with chronic pain participated. The sample was divided into two groups by means of hierarchical cluster analysis on the Minnesota multiphasic personality inventory, version 2. Cluster 1 comprised 116 individuals (44 men and 72 women) with a "conversion V" MMPI-2 profile, and cluster 2 comprised 21 individuals (5 men and 16 women) with a "general elevated" MMPI-2 profile. The patients were investigated by means of the structural analysis of social behavior (SASB), the Giessen test (GT), the locus of control scale (LOC) and the EMBU questionnaire (My memories of parental upbringing). RESULTS: The results show significant associations between memories of parental rearing and self-image as adults and are in line with results from previous studies describing two psychologically different groups inherent to chronic pain patients. CONCLUSIONS: The significant differences between healthy controls, pain patients and between clusters of pain patients on parental rearing scales, and the significant relationship between memories of parental rearing and self-image provide therapists with a special approach to the treatment of chronic pain patients in accordance to social cognitive theories and the psychodynamic theoretical construct of introjection as an early process in the development of self-images.
PMID: 15862477 [PubMed - in process]
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Health related quality of life and quantitative pain measurement in females with chronic non-malignant pain.
Laursen BS, Bajaj P, Olesen AS, Delmar C, Arendt-Nielsen L.
Clinical Nursing Research Unit, Aalborg Hospital Stengade 10, 3, 9000 Aalborg, Denmark; Center for Sensory-Motor Interaction, Laboratory for Experimental Pain Research, Aalborg University, Fredrik Bajers Vej 7 D3, 9220 Aalborg, Denmark.
The aim of the present study was to assess, compare, and correlate the pain response to an experimental pain stimulus (hyperalgesia to pressure pain threshold (PPT) measured from different body sites), the pain intensity (VAS) of the habitual pain, and quality of life parameters (SF-36) in groups of females with chronic non-malignant pain syndromes. Forty female pain patients with fibromyalgia/whiplash (n=10), endometriosis (n=10), low back pain (n=10), or rheumatoid arthritis (n=10), as well as 41 age-matched healthy female controls participated in the study. The fibromyalgia/whiplash patients scored significantly higher (p<0.04) VAS ratings (median rating=7.0) than the endometriosis (6.0), low back pain (6.0), and rheumatoid arthritis (3.5) patients. All fours patient groups had significantly lower PPTs at all sites as compared with controls. The fibromyalgia/whiplash patients experienced the highest influence of pain on their overall health status, particularly vitality, social function, emotional problems, and mental health. A significant negative correlation was found between VAS rating and quality of life (p<0.04). Significant correlation (p<0.05) was found between pressure hyperalgesia measured at lowest PPT sites and the impairment of SF-36 physical function as well as mental health parameters. This study demonstrates significant generalised pressure hyperalgesia in four groups of chronic pain patients, correlations between degree of pressure hyperalgesia and impairment of some quality of life parameters, and increased pain intensity of the ongoing pain is associated with decreased quality of life.
PMID: 15862476 [PubMed - in process]
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The causal status of pain catastrophizing: an experimental test with healthy participants.
Severeijns R, van den Hout MA, Vlaeyen JW.
Department of Medical Psychology, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
In the current study we report findings on the effects of experimentally induced catastrophizing about pain on expected pain, experienced pain and escape/avoidance behavior during a cold pressor task in a sample of healthy participants. It was hypothesized that increasing the level of catastrophizing would result in a higher level of expected pain, a higher level of experienced pain, and a shorter duration of ice-water immersion. Also, it was hypothesized that these relations might be stronger for participants who already catastrophized about pain prior to the experiment. The results demonstrated that despite the successful attempt to induce catastrophizing, this neither significantly affected expected pain, experienced pain, and duration of ice-water immersion, nor were these relations moderated by the pre-experimental level of catastrophizing. Although the level of catastrophizing was successfully manipulated, more similar experiments are necessary in order to give a more definite answer on the possible causal status of pain catastrophizing.
PMID: 15862475 [PubMed - in process]
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COMT (Val158Met) polymorphism is not associated to neuropathic pain in a Spanish population.
Armero P, Muriel C, Santos J, Sanchez-Montero FJ, Rodriguez RE, Gonzalez-Sarmiento R.
Unidad de Medicina Molecular, Departamento de Medicina, Universidad de Salamanca, Avda. de Alfonso X el Sabio s/n, 37007 Salamanca, Spain; Instituto de Neurociencias de Castilla y Leon, Universidad de Salamanca, Spain.
It is well known that the response to painful stimuli varies between individuals and this could be consequence of individual differences to pain sensitivity that may be related to genetic factors. Catechol-O-methyltransferase (COMT) is one of the enzymes that metabolize catecholamine neurotransmitters. Differences in the activity of COMT influence the functions of these neurotransmitters. A single nucleotide polymorphism (Val158Met) of COMT leads to a three to four fold reduction in the activity of the enzyme and has been associated to modifications in the response to a pain stressor. Neuropathic pain is a progressive nervous system disease due to an alteration of the peripheral or central nervous system. To elucidate the possible role of COMT polymorphism in the susceptibility to neuropathic pain, we have performed a case-control study in a Spanish population. Analysis of the (Val158Met) COMT polymorphism was performed by PCR amplification and DNA digestion with restriction enzymes. Our study concludes that functional Val158Met polymorphism of COMT gene is not associated to increased susceptibility to neuropathic pain.
PMID: 15862471 [PubMed - in process]
Comment in:
Medical end-of-life decisions in neonates and infants in Flanders.
Provoost V, Cools F, Mortier F, Bilsen J, Ramet J, Vandenplas Y, Deliens L; Neonatal Intensive Care Consortium.
Vrije Universiteit Brussel, End-of-Life Care Research Group, Brussels, Belgium.
BACKGROUND: Paediatricians are increasingly confronted with end-of-life decisions in critically ill neonates and infants. Little is known about the frequency and characteristics of end-of-life decisions in this population, nor about the relation with clinical and patients' characteristics. METHODS: A death-certificate study was done for all deaths of neonates and infants in the whole of Flanders over a 12 month period (August, 1999, to July, 2000). We sent an anonymous questionnaire by mail to the attending physician for each of the 292 children who died under the age of 1 year. Information on patients was obtained from national registers. An attitude study was done for all physicians who attended at least one death during the study period. FINDINGS: 253 (87%) of the 292 questionnaires were returned, and 121 (69%) of the 175 physicians involved completed the attitude questions. An end-of-life decision was possible in 194 (77%; 95% CI 70.4-82.4) of the 253 deaths studied, and such a decision was made in 143 cases (57%; 48.9-64.0). Lethal drugs were administered in 15 cases among 117 early neonatal deaths and in two cases among 77 later deaths (13%vs 3%; p=0.018). The attitude study showed that 95 (79%; 70.1-85.5) of the 121 physicians thought that their professional duty sometimes includes the prevention of unnecessary suffering by hastening death and 69 (58%; 48.1-66.5) of 120 supported legalisation of life termination in some cases. INTERPRETATION: Death of neonates and infants is commonly preceded by an end-of-life decision. The type of decision varied substantially according to the age of the child. Most physicians favour legalisation of the use of lethal drugs in some cases.
PMID: 15823381 [PubMed - indexed for MEDLINE]
Comment on:
Control of suffering on the slippery slope of care.
Feudtner C.
Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. feudtner@email.chop.edu
Publication Types:
PMID: 15823363 [PubMed - indexed for MEDLINE]
Clinical practice. Persistent low back pain.
Carragee EJ.
Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, Calif 94305, USA. carragee@stanford.edu
Publication Types:
PMID: 15872204 [PubMed - indexed for MEDLINE]
Comment in:
Antibiotic treatment of Chlamydia pneumoniae after acute coronary syndrome.
Cannon CP, Braunwald E, McCabe CH, Grayston JT, Muhlestein B, Giugliano RP, Cairns R, Skene AM; Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 Investigators.
Thrombolysis in Myocardial Infarction Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA. cpcannon@partners.org
BACKGROUND: Chlamydia pneumoniae has been found within atherosclerotic plaques, and elevated titers of antibody to this organism have been linked to a higher risk of coronary events. Pilot studies have suggested that antibiotic treatment may reduce the risk of cardiovascular events. METHODS: We enrolled 4162 patients who had been hospitalized for an acute coronary syndrome within the preceding 10 days and evaluated the efficacy of long-term treatment with gatifloxacin, a bactericidal antibiotic known to be effective against C. pneumoniae, in a double-blind, randomized, placebo-controlled trial. Subjects received 400 mg of gatifloxacin daily during an initial 2-week course of therapy that began 2 weeks after randomization, followed by a 10-day course every month for the duration of the trial (mean duration, 2 years), or placebo. The primary end point was a composite of death from all causes, myocardial infarction, documented unstable angina requiring rehospitalization, revascularization (performed at least 30 days after randomization), and stroke. RESULTS: A Kaplan-Meier analysis revealed that the rates of primary-end-point events at two years were 23.7 percent in the gatifloxacin group and 25.1 percent in the placebo group (hazard ratio, 0.95; 95 percent confidence interval, 0.84 to 1.08; P=0.41). No benefit was seen in any of the prespecified secondary end points or in any of the prespecified subgroups, including patients with elevated titers to C. pneumoniae or C-reactive protein. CONCLUSIONS: Despite long-term treatment with a bactericidal antibiotic effective against C. pneumoniae, no reduction in the rate of cardiovascular events was observed. Copyright 2005 Massachusetts Medical Society.
Publication Types:
- Clinical Trial
- Multicenter Study
- Randomized Controlled Trial
PMID: 15843667 [PubMed - indexed for MEDLINE]
Mirror-like spread of chronic pain.
Forss N, Kirveskari E, Gockel M.
From the Brain Research Unit (Drs. Forss and Kirveskari), Low Temperature Laboratory, Helsinki University of Technology; Department of Clinical Neurosciences (Dr. Forss) and Division of Clinical Neurophysiology (Dr. Kirveskari), Helsinki University Central Hospital; Orthopaedic Hospital and Rehabilitation Unit of the Invalid Foundation (Dr. Gockel), Helsinki, Finland.
Abstract-- The spread of chronic pain from its initial site of presentation is common, but the mechanisms of the spread are unknown. Here the authors present neurophysiologic evidence of altered interhemispheric conduction in a patient with a mirror-like spread of complex regional pain syndrome symptoms.
PMID: 15872154 [PubMed - as supplied by publisher]
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The outcome of pain related undergraduate teaching in Finnish medical faculties.
Poyhia R, Niemi-Murola L, Kalso E.
Department of Anaesthesia and Intensive Care Medicine, Helsinki University Central Hospital, P.O. Box 340, FIN-00029 HUS Helsinki, Finland.
Little is known about how other than cancer pain related issues are represented in medical education. A standardised questionnaire was mailed to all medical students who graduated from the five Finnish medical schools in 2001. A total of 387 students received the questionnaire and 41% responded. The students had to evaluate the quantity and the quality of pain teaching. The availability and the participation in the advanced courses or research in pain medicine were asked. The students reported how the IASP curriculum on pain had been covered during the studies. Two clinical cases were presented for diagnosis and treatment. In addition to integrated pain teaching, specific pain education was received by 27% of the students. The departments of anaesthesiology were reported as the major deliverers of teaching of pain. The overall ratings of the pain-related teaching of the faculties varied from 3.4 to 4.6 on a scale of 10. Anatomy, biochemistry, physiology and pharmacology of pain were covered well. The definitions of pain, pain research, sociological issues, paediatric, geriatric and mentally retarded patients' pain were taught most poorly. Only 34% of the students had been offered advanced studies and 15% had been offered research projects in pain medicine. The lack of teaching about the concept of a multidisciplinary pain clinic was recognised by almost all students. The clinical problems were excellently solved. In conclusion, the IASP curriculum is well covered in the present programmes in the Finnish medical faculties. However, the quality and the methods of teaching still need improvement.
PMID: 15876496 [PubMed - in process]
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Human surrogate models of neuropathic pain.
Klein T, Magerl W, Rolke R, Treede RD.
Institute of Physiology and Pathophysiology, Johannes Gutenberg University, Saarstrasse 21, D-55099 Mainz, Germany.
PMID: 15876495 [PubMed - in process]
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Age effects on pain thresholds, temporal summation and spatial summation of heat and pressure pain.
Lautenbacher S, Kunz M, Strate P, Nielsen J, Arendt-Nielsen L.
Physiological Psychology, Otto-Friedrich University Bamberg, Markuspl. 3, D-96045 Bamberg, Germany.
Experimental data on age-related changes in pain perception have so far been contradictory. It has appeared that the type of pain induction method is critical in this context, with sensitivity to heat pain being decreased whereas sensitivity to pressure pain may be even enhanced in the elderly. Furthermore, it has been shown that temporal summation of heat pain is more pronounced in the elderly but it has remained unclear whether age differences in temporal summation are also evident when using other pain induction methods. No studies on age-related changes in spatial summation of pain have so far been conducted. The aim of the present study was to provide a comprehensive survey on age-related changes in pain perception, i.e. in somatosensory thresholds (warmth, cold, vibration), pain thresholds (heat, pressure) and spatial and temporal summation of heat and pressure pain. We investigated 20 young (mean age 27.1 years) and 20 elderly (mean age 71.6 years) subjects. Our results confirmed and extended previous findings by showing that somatosensory thresholds for non-noxious stimuli increase with age whereas pressure pain thresholds decrease and heat pain thresholds show no age-related changes. Apart from an enhanced temporal summation of heat pain, pain summation was not found to be critically affected by age. The results of the present study provide evidence for stimulus-specific changes in pain perception in the elderly, with deep tissue (muscle) nociception being affected differently by age than superficial tissue (skin) nociception. Summation mechanisms contribute only moderately to age changes in pain perception.
PMID: 15876494 [PubMed - in process]
Visual diagnosis: a 15-year-old female who has cough, rash, and painful swallow.
Bullen LK, Zenel JA.
Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, USA.
PMID: 15863628 [PubMed - in process]
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Prevalence of low back pain in a developing urban setting.
Gilgil E, Kacar C, Butun B, Tuncer T, Urhan S, Yildirim C, Sunbuloglu G, Arikan V, Tekeoglu I, Oksuz MC, Dundar U.
Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Akdeniz University Faculty of Medicine, Antalya, Turkey. erdalgilgil@akdeniz.edu.tr
STUDY DESIGN: A cross-sectional survey was conducted using face-to-face interviews. OBJECTIVES: To estimate the prevalence of low back pain (LBP) in an urban population of Turkey and to determine the factors associated with occurrence of LBP. SUMMARY OF BACKGROUND DATA: Little information exists in the literature regarding the epidemiology of LBP in developing countries. A few data from previous studies suggest that the prevalence of LBP is rather lower in developing countries compared with developed countries. METHODS: A total of 100 clusters of households (3,215 residents aged 16 years or older) in municipality area of Antalya was selected by systematic sampling. Of these, 3,173 study participants agreed to interview. The response rate was 98.7%. RESULTS: The crude lifetime, 12-month, and point prevalences of LBP were 46.6% (95% confidence interval [CI], 44.9-48.3), 35.9% (95% CI, 34.2-37.6), and 20.1% (95% CI, 18.7-21.5), respectively. In logistic regression analysis, age of 36 years or older, female sex, multiparity, being a housewife, being from East Turkey, and smoking showed independent associations with having current LBP. Being religious, heavy smoking, and age 26 to 45 years were associated with having restricted activity related to LBP. CONCLUSIONS: In comparison with other developing countries, point prevalence of LBP is higher in Turkey and approximates to prevalence estimates of LBP in developed countries. Smoking may be associated with both occurrence and severity of LBP. Although piety is not associated with having LBP, religious people are more likely to have restricted activity related to LBP.
PMID: 15864165 [PubMed - in process]
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Analgesic usage for low back pain: impact on health care costs and service use.
Vogt MT, Kwoh CK, Cope DK, Osial TA, Culyba M, Starz TW.
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. vogtm@upmc.edu
STUDY DESIGN: Cross-sectional analysis of analgesic use by patients with low back pain (LBP). OBJECTIVES: To describe patterns of analgesic use and their cost implications for the use of other care services among individuals with LBP enrolled in a health insurance plan during 2001. It was hypothesized that the use of analgesics would be most frequent among patients with LBP with neurologic findings. SUMMARY OF BACKGROUND DATA: National guidelines have recommended analgesics as the primary pharmacologic treatment of LBP. The choice of specific analgesics has major cost and service use implications. METHODS: The University of Pittsburgh Health System includes 18 affiliated hospitals, more than 5000 physicians, and a commercial health plan with 255,958 members in 2001. This study uses the System Health Plan's insurance claims database to identify members who had services provided for one of 66 International Classification of Diseases, Version 9, Clinical Modification codes that identify mechanical LBP (n = 17,148). RESULTS: In 2001, 7631 (43.5%) members with claims for LBP services had no analgesic pharmacy claims. The other 9517 (55.5%) had analgesics claims costing a total of $1.4 million; 68% of claimants were prescribed an opioid and 58% nonselective nonsteroidal antiinflammatory drugs (NSAID). The costs of opioids, NSAID, and cyclooxygenase-2 selective NSAID for patients with LBP represented 48%, 24%, and 28%, respectively, of total health plan expenditures for all uses of these drugs, including cancer. Opioid use was associated with the high volume usage of LBP care services. Patients with LBP with and without neurologic involvement and those with acquired lumbar spine structural disorders had similar patterns of analgesic use: those with congenital structural disorders were less likely to use analgesics; and those with psychogenic pain and LBP related to orthopedic devices were more likely to use opioids. CONCLUSIONS: With this health plan, a high proportion of patients with LBP had claims for opioids during 2001. The use of opioids by patients with LBP represents a major cost for the health plan, and is associated with specific patient characteristics and their use of other LBP services.
PMID: 15864162 [PubMed - in process]
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The relationship of anticipated pain and fear avoidance beliefs to outcome in patients with chronic low back pain who are not receiving workers' compensation.
Al-Obaidi SM, Beattie P, Al-Zoabi B, Al-Wekeel S.
Department of Physical Therapy, Kuwait University, Faculty of Allied Health Sciences and Nursing, Sulaibikhat, Kuwait.
STUDY DESIGN: A prospective, interventional case series design. OBJECTIVES: To determine the degree to which preintervention measures of anticipated pain and fear avoidance beliefs predict outcome after intervention for patients with delayed recovery from low back pain (LBP) for which they are not receiving workers' compensation. SUMMARY OF BACKGROUND DATA: Anticipated pain and fear avoidance beliefs have been suggested as important factors for the classification and treatment of patients with LBP. However, the degree to which they are associated with outcome after intervention is uncertain. METHODS: There were 42 subjects with activity limiting LBP for more than 2 months enrolled in an exercise based, physical therapy program. A multidimensional test battery was completed before and after a 10-week program of lumbar extensor muscle strengthening. Correlational analyses, independent t tests, and validity indexes were used to determine relationships of preintervention measures of anticipated pain and the fear avoidance beliefs to clinically meaningful improvements in the Roland-Morris score. Intention-to-treat strategies were used to account for study dropouts. RESULTS: A total of 36 subjects completed the 10-week intervention. The lack of clinically meaningful outcome, as determined by a failure-to-report a minimum of 16% decrease in the Roland-Morris score, was associated with high preintervention scores on the physical activity subscale of the Fear Avoidance Beliefs Questionnaire (FABQP). Subjects with a preintervention score > or =29 on the FABQP had a likelihood ratio of 3.78 (95% confidence interval [CI] 2.4-5.16) for an increased probability of negative outcome after initial testing when compared to those subjects with low (<20) scores. The sensitivity and specificity of low scores to predict clinically meaningful outcomes compared to those with high scores were moderate (sensitivity = 0.87 and specificity 0.77); however, the likelihood ratio was inconclusive. Anticipated pain was significantly correlated with but was higher than the reported pain during activity both before and after intervention but not predictive of outcome. CONCLUSIONS: In a sample of people from a Middle Eastern culture undergoing exercise intervention for LBP for which they are not receiving workers' compensation, the preintervention physical activity subscale of the FABQ is predictive of negative outcome when the observed scores are > or =29. Despite significant improvements in all variables after intervention, anticipated pain remained significantly higher than reported pain during physical performance testing but did not predict outcome.
PMID: 15864158 [PubMed - in process]
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Fulcrum assisted soft stabilization system: a new concept in the surgical treatment of degenerative low back pain.
Sengupta DK, Mulholland RC.
Department of Orthopaedics, Spine Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756-0001, USA. dilip.k.sengupta@hitchcock.org
STUDY DESIGN: An experimental study on cadaver spine and spine model for biomechanical evaluation of a novel dynamic stabilization device. OBJECTIVES: First, to test the hypothesis that in dynamic stabilization of a lumbar spine using pedicle screws and ligament, addition of a fulcrum in front of the ligament can unload the disc. Second, to determine the relationship between the length and stiffness of the fulcrum and the ligament on disc unloading, lordosis and motion preservation. SUMMARY OF BACKGROUND DATA: Activity related low back pain may be attributable to abnormal disc loading or abnormal movement. Spinal fusion addresses both the mechanisms, but it has limitations. Soft stabilization with Graf ligament restricts abnormal movement but increases the disc pressure. The Dynesys system uses a plastic cylinder around the ligament to prevent overloading the disc, but it restricts extension and loses lordosis. METHODS: A novel dynamic stabilization system (fulcrum assisted soft stabilization or FASS) was developed in which a flexible fulcrum was placed in front of a ligament between the pedicle screws. It was hypothesized that the fulcrum should transform the compressive force of a ligament behind into a distraction force in front and unload the disc. Three spine models were developed using wooden blocks for vertebral bodies and neoprene rubber of different hardness for disc. Their load-deformation character was tested and compared with that of the cadaver spine in a spine tester. The spine model with the closest load-deformation property to cadaver spine was then tested for the effect of a FASS system, consisting of high density polythene rod as fulcrums and rubber "O" rings as ligaments. The disc pressure in the spine models were recorded with strain gauge in the center. RESULTS: Application of ligaments alone across the pedicle screws increased the disc pressure, produced a lordosis, and reduced the range of motion. Application of fulcrums reduced the disc pressure and maintained the lordosis. Increasing the fulcrum length resulted in progressive unloading of the disc but increased stiffness of the motion segment. As the fulcrum length approximated the height of the motion segment, the lordosis was lost, and the disc was completely unloaded. Decreasing the lateral bending stiffness of the fulcrum had minimal effect on disc unloading and motion-segment stiffness. CONCLUSION: The novel FASS system can unload the disc, control the range of motion, and maintain lordosis. These parameters may be controlled with a suitable combination of ligament and fulcrum system. The study provides an indication toward the desirable biomechanical properties of the fulcrum and ligament for future development of a clinically applicable prototype.
PMID: 15864153 [PubMed - in process]
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Long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic low back pain.
Friedrich M, Gittler G, Arendasy M, Friedrich KM.
Department of Orthopedic Pain Management, Orthopedic Hospital Speising, Vienna, Austria. martin.friedrich@oss.at
STUDY DESIGN: A prospective clinical randomized controlled trial. OBJECTIVES: To determine the long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic and recurrent low back pain (LBP). SUMMARY OF BACKGROUND DATA: There is agreement on the importance of exercise during the course of chronic LBP. However, it is well known that long-term adherence with exercises is particularly low. METHODS: A total of 93 patients with LBP were randomly assigned to the control group (standard exercise program) or the motivational group (combined exercise and motivational program). Follow-up assessments were performed at 3.5 weeks, 4 months, 12 months, and 5 years. Main outcome measures were disability scores, pain intensity, and working ability. In addition to classic statistics, the sophisticated linear partial credit model was used to test the effects of treatment on disability scores. RESULTS: In both groups, significant improvements in the disability scores were found at all points of follow-up assessment, however, the cumulative effect of the treatment in the motivational group was more than twice as much as in the control group. This result is in accordance with the increasing divergence in pain intensity between groups between 12 months and 5 years after intervention. A significant, positive long-term effect at the 5-year reassessment in working ability was only seen in the motivational group. All statistically significant results were confirmed by intention-to-treat analyses. CONCLUSIONS: Regarding long-term efficacy, the combined exercise and motivation program was superior to the standard exercise program. Five years after the supervised combined exercise and motivational program, patients had significant improvements in disability, pain intensity, and working ability.
PMID: 15864148 [PubMed - in process]
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