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Items 1 - 38 of 38 |
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Single-dose, sustained-release epidural morphine in the management of postoperative pain after elective cesarean delivery: results of a multicenter randomized controlled study.
Carvalho B, Riley E, Cohen SE, Gambling D, Palmer C, Huffnagle HJ, Polley L, Muir H, Segal S, Lihou C, Manvelian G; DepoSur Study Group.
Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Dr., Stanford, CA 94305, USA. bcarvalho@stanford.edu
In this multicenter, randomized, controlled study, we compared the analgesic efficacy and safety profile of a new single-dose extended-release epidural morphine (EREM) formulation (DepoDur) with that of epidural morphine sulfate for the management of postoperative pain for up to 48 h after elective cesarean delivery. ASA physical status I or II parturients (n = 75) were anesthetized with a combined spinal/epidural technique. Parturients received intrathecal bupivacaine 12-15 mg and fentanyl 10 mug for spinal anesthesia and a single epidural injection of either 5 mg of standard (conventional preservative-free) morphine or 5, 10, or 15 mg of extended-release morphine after cord clamping for postoperative pain control. Single-dose EREM 10 and 15 mg groups significantly decreased total supplemental opioid medication use and improved functional ability scores for 48 h after surgery compared with those receiving 5 mg of standard morphine. Visual analog scale pain scores at rest and with activity at 24 to 48 h after dosing were significantly better in the 10- and 15-mg single-dose EREM groups versus the standard morphine group. There were no significant differences between the two 5 mg (single-dose EREM and standard morphine) groups. Single-dose EREM was well tolerated, and most adverse events were mild to moderate in severity. Single-dose EREM is a potentially beneficial epidural analgesic for the management of post-cesarean delivery pain and has particular advantages over standard morphine for the period from 24 to 48 h after surgery.
PMID: 15781537 [PubMed - in process]
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A comparison of Depodur, a novel, single-dose extended-release epidural morphine, with standard epidural morphine for pain relief after lower abdominal surgery.
Gambling D, Hughes T, Martin G, Horton W, Manvelian G.
Sharp Mary Birch Hospital for Women, Department of Anesthesiology (Second Floor), 3003 Health Center Dr., San Diego, CA 92123, USA. dgamb@san.rr.co
In this randomized, controlled, dose-ranging study, we evaluated the analgesic efficacy of a novel single-dose extended-release epidural morphine (Depodur) in patients undergoing lower abdominal surgery. Five-hundred-forty-one patients were randomly assigned to one of six epidural treatments administered approximately 30 min before surgery. The 6 treatments were 5 mg of standard epidural morphine sulfate (MS) (active comparator); 5 mg of single-dose extended-release epidural morphine (EREM) (dose control); and 10, 15, 20, and 25 mg of single-dose EREM. The main study objective was to assess the efficacy of single-dose EREM 10, 15, 20, or 25 mg versus single-dose EREM 5 mg for the management of postoperative pain. This was done by plotting a linear dose-response relationship to assess postoperative IV patient-controlled analgesia (PCA) fentanyl consumption for breakthrough pain for 48 h after surgery. Secondary safety and efficacy analyses compared the 10-, 15-, 20-, and 25-mg single-dose EREM groups with the 5-mg single-dose EREM group and compared each single-dose EREM group with 5 mg of MS. As shown by the dose-response relationship, there was a dose-related reduction in the use of postoperative IV fentanyl through 48 h (estimated slope, -22.2; P = 0.0002). Patients treated with 10, 20, and 25 mg of single-dose EREM used significantly less IV fentanyl (mean +/- sd: 995 +/- 987 microg, P = 0.0446; 972 +/- 982 microg, P = 0.0221; and 683 +/- 620 microg, P < 0.0001, respectively) through 48 h after surgery compared with the 5-mg single-dose EREM group (1218 +/- 894 microg). At 48 h postdose, significantly more single-dose EREM patients (13%) than MS patients (2%) had required no IV fentanyl (P < 0.01). Although all treatment groups had access to PCA fentanyl and there was more frequent PCA fentanyl use in the MS group, patients in the single-dose EREM 15, 20, and 25 mg groups reported significantly lower pain-intensity scores and greater satisfaction with their pain relief. Overall, single-dose EREM was well tolerated, with 97% of adverse events rated as mild to moderate. As expected, the adverse events reported were consistent with those of other epidural opioids (i.e., nausea, vomiting, pruritus, and hypotension). In conclusion, this controlled study demonstrated that single-dose EREM can provide up to 48 h of postoperative analgesia, but supplementation for breakthrough pain is still required in most patients. Within the context of this study, the side effect profile of single-dose EREM was acceptable and predictable.
PMID: 15781524 [PubMed - in process]
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The role of adrenergic and cholinergic transmission in volatile anesthetic-induced pain enhancement.
Rowley TJ, Daniel D, Flood P.
Department of Anesthesiology, Columbia University, 630 West 168th Street, NY, NY 10032, USA.
Volatile anesthetic drugs have a biphasic effect on pain transmission. At very small concentrations they enhance pain sensitivity whereas at larger subanesthetic concentrations they have an analgesic effect. Previous work has suggested that nicotinic inhibition could mediate the pronociceptive action of isoflurane. Furthermore, activation of nicotinic receptors facilitates the release of norepinephrine in the spinal cord. We hypothesize that nicotinic modulation of norepinephrine release in the spinal cord mediates isoflurane's pronociceptive action. We used hindpaw withdrawal latency as a measure of pain sensitivity after inhibition of adrenergic activity or treatment with nicotine in mice. Isoflurane's effect on pain is separable by concentration. The 50% effective concentration for pain enhancement is 0.16% isoflurane whereas the 50% effective concentration for the antinociceptive action of isoflurane is 0.8%. Depletion of systemic norepinephrine with the neurotoxin DSP-4 caused a reduction in baseline withdrawal latencies and prevented isoflurane pronociception. Baseline latency was also reduced by intrathecal yohimbine. After treatment with yohimbine, isoflurane had no additional pronociceptive effect. Nicotine administered through intracerebroventricular injection increased baseline latency but did not prevent isoflurane pronociception. Conversely, intrathecal applications of nicotine caused a slight reduction in baseline latency and prevented isoflurane's pronociceptive effect. We conclude that spinal noradrenergic transmission seems to be necessary for isoflurane pronociception to occur. Isoflurane may act by inhibiting tonically active nicotinic receptors that modulate the release of norepinephrine in the spinal cord.
PMID: 15781512 [PubMed - in process]
A safer and more effective intervention for radiculopathic pain.
Rathmell J, Aprill C, Bogduk N.
* University of Vermont, Burlington, Vermont. james.rathmell@vtmednet.org.
PMID: 15791129 [PubMed - in process]
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A safer and more effective intervention for radiculopathic pain.
Willis ML, Martin DC.
* Medical College of Georgia, Augusta, Georgia. damartin@mail.mcg.edu.
PMID: 15791126 [PubMed - in process]
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Efficacy and Safety of Single and Repeated Administration of 1 Gram Intravenous Acetaminophen Injection (Paracetamol) for Pain Management after Major Orthopedic Surgery.
Sinatra RS, Jahr JS, Reynolds LW, Viscusi ER, Groudine SB, Payen-Champenois C.
* Professor of Anesthesiology, Department of Anesthesiology, Yale University School of Medicine. dagger Professor of Anesthesiology, David Geffen School of Medicine, UCLA. Charles R. Drew University of Medicine and Science. double dagger Associate Professor of Anesthesiology, Loma Linda University School of Medicine. section sign Associate Professor of Anesthesiology, Jefferson Medical College of Thomas Jefferson University. parallel Associate Professor of Anesthesiology, Albany Medical College. # Project Leader, Medical Department, Bristol-Myers Squibb Company.
BACKGROUND:: Intravenous acetaminophen injection (paracetamol) is marketed in Europe for the management of acute pain. A repeated-dose, randomized, double-blind, placebo-controlled, three-parallel group study was performed to evaluate the analgesic efficacy and safety of intravenous acetaminophen as compared with its prodrug (propacetamol) and placebo. Propacetamol has been available in many European countries for more than 20 yr. METHODS:: After orthopedic surgery, patients reporting moderate to severe pain received either 1 g intravenous acetaminophen, 2 g propacetamol, or placebo at 6-h intervals over 24 h. Patients were allowed "rescue" intravenous patient-controlled analgesia morphine. Pain intensity, pain relief, and morphine use were measured at selected intervals. Safety was monitored through adverse event reporting, clinical examination, and laboratory testing. RESULTS:: One hundred fifty-one patients (intravenous acetaminophen: 49; propacetamol: 50; placebo: 52) received at least one dose of study medication. The intravenous acetaminophen and propacetamol groups differed significantly from the placebo group regarding pain relief from 15 min to 6 h (P < 0.05) and median time to morphine rescue (intravenous acetaminophen: 3 h; propacetamol: 2.6 h; placebo: 0.8 h). Intravenous acetaminophen and propacetamol significantly reduced morphine consumption over the 24-h period: The total morphine doses received over 24 h were 38.3 +/- 35.1 mg for intravenous acetaminophen, 40.8 +/- 30.2 mg for propacetamol, and 57. 4 +/- 52.3 mg for placebo, corresponding to decreases of -33% (19 mg) and -29% (17 mg) for intravenous acetaminophen and propacetamol, respectively. Drug-related adverse events were reported in 8.2%, 50% (most of them local), and 17.3% of patients treated with intravenous acetaminophen, propacetamol, and placebo, respectively. CONCLUSION:: Intravenous acetaminophen, 1 g, administered over a 24-h period in patients with moderate to severe pain after orthopedic surgery provided rapid and effective analgesia and was well tolerated.
PMID: 15791113 [PubMed - as supplied by publisher]
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Randomized, Double-blind Study of the Analgesic Efficacy of Morphine-6-Glucuronide versus Morphine Sulfate for Postoperative Pain in Major Surgery.
Hanna MH, Elliott KM, Fung M.
* Director, dagger Research Coordinator, double dagger Analytical Chemist.
BACKGROUND:: Morphine-6-glucuronide (M6G) has promising preclinical characteristics and encouraging pharmacokinetic features for acute nociceptive pain. Early studies have produced a good safety profile when compared to morphine sulfate, although in surrogate pain models studies, a mixed picture emerged. A study to evaluate the efficacy and safety profile in a clinical setting was designed. METHODS:: The authors conducted a double-blind, randomized, dose-finding study of patients scheduled to undergo major joint replacement. One hundred patients of both sexes were included, with 50 patients in each group. A loading dose of 10 mg of study medication was given intravenously at induction of anesthesia, and two further doses were allowed during surgery if required. Bolus doses via a patient-controlled analgesia system were given subcutaneously at 2 mg/dose and set at a 10-min lockout. Assessments of pain intensity and relief were recorded during the 24-h period. RESULTS:: There were no statistically significant differences between the treatments for 24-h mean pain intensity. However, pain intensity was significantly higher in the M6G group than in the morphine group at 30 min and 1 h. There was no statistical difference in 24-h mean pain relief or retrospective pain scores at any time point during the 24-h period. The severity of sedation was significantly greater in the morphine group than in the M6G group at 30 min, 1 h, 2 h, and 24 h. Respiratory depression was greater in the morphine group than in the M6G group, and more patients in the morphine group withdrew from the study because of respiratory depression. CONCLUSIONS:: Overall, M6G has an analgesic effect similar to that of morphine over the first 24 h postoperatively. However, M6G may be slower onset initially than morphine; therefore, a larger initial dose may be required.
PMID: 15791112 [PubMed - as supplied by publisher]
Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single blind controlled trial.
Elden H, Ladfors L, Olsen MF, Ostgaard HC, Hagberg H.
Perinatal Center, Department of Obstetrics and Gynecology, Institute for the Health of Women and Children, Sahlgrenska Academy, East Hospital, 41685 Gothenburg, Sweden. helen.elden@vgregion.se
OBJECTIVES: To compare the efficacy of standard treatment, standard treatment plus acupuncture, and standard treatment plus stabilising exercises for pelvic girdle pain during pregnancy. DESIGN: Randomised single blind controlled trial. Settings East Hospital, Gothenburg, and 27 maternity care centres in Sweden. PARTICIPANTS: 386 pregnant women with pelvic girdle pain. INTERVENTIONS: Treatment for six weeks with standard treatment (n = 130), standard treatment plus acupuncture (n = 125), or standard treatment plus stabilising exercises (n = 131). MAIN OUTCOME MEASURES: Primary outcome measure was pain (visual analogue scale); secondary outcome measure was assessment of severity of pelvic girdle pain by an independent examiner before and after treatment. RESULTS: After treatment the stabilising exercise group had less pain than the standard group in the morning (median difference = 9, 95% confidence interval 1.7 to 12.8; P = 0.0312) and in the evening (13, 2.7 to 17.5; P = 0.0245). The acupuncture group, in turn, had less pain in the evening than the stabilising exercise group (-14, -18.1 to -3.3; P = 0.0130). Furthermore, the acupuncture group had less pain than the standard treatment group in the morning (12, 5.9 to 17.3; P < 0.001) and in the evening (27, 13.3 to 29.5; P < 0.001). Attenuation of pelvic girdle pain as assessed by the independent examiner was greatest in the acupuncture group. CONCLUSION: Acupuncture and stabilising exercises constitute efficient complements to standard treatment for the management of pelvic girdle pain during pregnancy. Acupuncture was superior to stabilising exercises in this study.
PMID: 15778231 [PubMed - in process]
Formalin-induced pain is reduced in sigma(1) receptor knockout mice.
Cendan CM, Pujalte JM, Portillo-Salido E, Montoliu L, Baeyens JM.
Department of Pharmacology and Institute of Neurosciences, School of Medicine, University of Granada, Avenida de Madrid 12, 18012 Granada, Spain.
The role of sigma(1) receptors in non-acute pain has not been explored. In this study we show that both phases of formalin-induced pain were reduced by approximately 55% in sigma(1) receptor knockout mice in comparison to wild-type animals. These results suggest that the tonic pain induced by formalin is altered in mice lacking sigma(1) receptors, and highlight the potential usefulness of further studies of the role of sigma(1) receptors in models of non-acute pain.
PMID: 15777781 [PubMed - in process]
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Buprenorphine: Considerations for Pain Management.
Johnson RE, Fudala PJ, Payne R.
Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit (R.E.J.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Psychiatry (P.J.F.) and Behavioral Health Service (P.J.F.), University of Pennsylvania School of Medicine, VA Medical Center, Philadelphia, Pennsylvania; and Department of Neurology (R.P.), Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
New effective analgesics are needed for the treatment of pain. Buprenorphine, a partial mu-opioid agonist which has been in clinical use for over 25 years, has been found to be amenable to new formulation technology based on its physiochemical and pharmacological profile. Buprenorphine is marketed as parenteral, sublingual, and transdermal formulations. Unlike full mu-opioid agonists, at higher doses, buprenorphine's physiological and subjective effects, including euphoria, reach a plateau. This ceiling may limit the abuse potential and may result in a wider safety margin. Buprenorphine has been used for the treatment of acute and chronic pain, as a supplement to anesthesia, and for behavioral and psychiatric disorders including treatment for opioid addiction. Prolonged use of buprenorphine can result in physical dependence. However, withdrawal symptoms appear to be mild to moderate in intensity compared with those of full mu agonists. Overdoses have primarily involved buprenorphine taken in combination with other central nervous system depressants.
PMID: 15781180 [PubMed - as supplied by publisher]
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Patient-Related Barriers to Pain Management: The Icelandic Barriers Questionnaire II.
Gunnarsdottir S, Serlin RC, Ward S.
School of Nursing (S.G., S.W.) and Department of Educational Psychology (R.C.S.), University of Wisconsin Madison, Madison, Wisconsin, USA; and Landspitali-University Hospital (S.G.), Reykjavik, Iceland.
The Barriers Questionnaire-II (BQ-II) is used to evaluate eight attitudinal barriers to cancer pain management. The purpose of this study was to evaluate the psychometric properties of the Icelandic BQ-II (IBQ-II). Icelandic adults (n=244) completed the IBQ-II, the Brief-Pain-Inventory, and demographic questions. Half the responders were male (52%), and 42.8% had pain on the day of data collection. Participants had a mean (SD) age of 34.73 (11.78) years and education of 15.08 (3.69) years. Factor analysis of the IBQ-II supported three factors. The alpha was 0.90. The mean (SD) IBQ-II total score was 2.32 (0.78), on a scale of 0 to 5, with higher scores indicating stronger barriers. IBQ-II total scores were inversely related to education (r=-0.21; P < 0.01), and positively related to least pain (r=0.24; P < 0.05), average pain (r=0.23; P < 0.05), and pain interference with life activities (r=0.22; P < 0.05) for those who had pain. There is support for reliability, validity, and feasibility of the IBQ-II.
PMID: 15781178 [PubMed - in process]
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Partner-Guided Cancer Pain Management at the End of Life: A Preliminary Study.
Keefe FJ, Ahles TA, Sutton L, Dalton J, Baucom D, Pope MS, Knowles V, McKinstry E, Furstenberg C, Syrjala K, Waters SJ, McKee D, McBride C, Rumble M, Scipio C.
Duke University Medical Center (F.J.K., L.S., M.S.P., V.K., S.J.W., D.M., C.M., M.R., C.S.), Durham, North Carolina; Dartmouth Hitchcock Medical Center (T.A.A., E.M., C.F.), Lebanon, New Hampshire; University of North Carolina at Chapel Hill (J.D., D.B.), Chapel Hill, North Carolina; and University of Washington (K.S.), Seattle, Washington, USA.
This preliminary study tested the efficacy of a partner-guided cancer pain management protocol for patients who are at the end of life. Seventy-eight advanced cancer patients meeting criteria for hospice eligibility and their partners were randomly assigned to a partner-guided pain management training intervention, or usual care control condition. The partner-guided pain management training protocol was a three-session intervention conducted in patients' homes that integrated educational information about cancer pain with systematic training of patients and partners in cognitive and behavioral pain coping skills. Data analyses revealed that the partner-guided pain management protocol produced significant increases in partners' ratings of their self-efficacy for helping the patient control pain and self-efficacy for controlling other symptoms. Partners receiving this training also showed a trend to report improvements in their levels of caregiver strain. Overall, the results of this preliminary study suggest that a partner-guided pain management protocol may have benefits in the context of cancer pain at the end of life. Given the significance of pain at the end of life, future research in this area appears warranted.
PMID: 15781177 [PubMed - as supplied by publisher]
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Pain and its relation to depressive symptoms in frail older people living in the community: an observational study.
Landi F, Onder G, Cesari M, Russo A, Barillaro C, Bernabei R; on behalf of the SILVERNET-HC Study Group.
Istituto di Medicina Interna e Geriatria (F.L., G.O., M.C. A.R., C.B., R.B.), Universita Cattolica del Sacro Cuore, Rome, Italy; and Sticht Center on Aging (G.O., M.C.), Wake Forest University-Baptist Medical Center, Winston-Salem, North Carolina, USA.
The association of pain and depression represents an important health problem that is correlated with high rates of disability, morbidity, greater consumption of health care resources, and socioeconomic difficulties. Understanding the interaction between pain and depression is an important issue in light of the fact that physicians frequently fail to accurately assess and diagnose pain symptoms, and that elderly patients suffering from pain are particularly likely to receive inaccurate treatments. The aim of the present study was to describe the prevalence of pain and to investigate the association between pain and depressive symptoms in a representative sample of frail elderly people living in the community (n=5,372). The results show that more than 15% and 40% of elderly patients experienced pain less than daily and daily, respectively. The average score on the depression scale was significantly lower in patients without pain (2.5 +/- 2.5) than patients with less than daily and daily pain (3.2 +/- 2.5 and 3.6 +/- 2.5, respectively) (P < 0.001). Without substantial differences between men and women, the rate of each depressive symptom was significantly and progressively higher among patients suffering less than daily and daily pain compared to those without pain. In conclusion, this study provides evidence from a large sample of frail elderly people that individuals suffering pain present an elevated risk to experience depressive symptoms. Treatment models that put together the assessment and the treatment of both pain and depression are indispensable for better outcomes.
PMID: 15781176 [PubMed - in process]
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A Multicenter Study of the Revised Edmonton Staging System for Classifying Cancer Pain in Advanced Cancer Patients.
Fainsinger RL, Nekolaichuk CL, Lawlor PG, Neumann CM, Hanson J, Vigano A.
Division of Palliative Care Medicine (R.L.F., P.G.L., C.M.N.), Department of Oncology, University of Alberta, Edmonton, Alberta; Alberta Cancer Board Palliative Care Research Initiative (C.L.N.), Edmonton, Alberta; Division of Population Health and Information (J.H.), Cross Cancer Institute, Edmonton, Alberta; and Division of Palliative Care Medicine (A.V.), Department of Oncology, and Department of Medicine (A.V.), McGill University, Montreal, Quebec, Canada.
The comparative analysis of analgesic interventions for cancer pain is greatly compromised by the lack of well-validated and clinically acceptable tools, which allow a composite classification of pain and patient population characteristics. Although the Edmonton Staging System (ESS) for cancer pain was developed for this purpose, clinical and research utility has been limited due to problems associated with the assessment of some items, especially in relation to definitions and terminology. To overcome these limitations, we designed a revised ESS (rESS) and conducted a multicenter study to determine its inter-rater reliability and predictive value. In revising the rESS, we hypothesized that patients with less problematic pain features would require a shorter time to achieve stable pain control, require less complicated analgesic regimens, be more responsive to opioid therapy, and use lower opioid doses. The rESS items include mechanism of pain, presence or absence of incidental pain, presence or absence of psychological distress and addictive behavior, and level of cognitive function. Patients with cancer pain who were consecutively admitted to two different hospice centers, an acute care consultation service in a teaching hospital or a tertiary palliative care unit in a second teaching hospital were evaluated for study entry. Two independent palliative care specialists completed the rESS where possible within 24 hours of each other. Patients' pain ratings and opioid consumption were recorded daily until the study endpoint (i.e. achievement of stable pain control, discharge or death). Seven hundred and forty-six patients were eligible for study entry and of these, 619 (83%) had a pain syndrome. Inter-rater reliability estimates ranged from 0.67 (pain mechanism) to 0.95 (presence of addiction). In the univariate Cox regression analysis, younger patients (< 60), as well as patients with neuropathic pain, incidental pain, psychological distress, or co-morbid psychological distress and addiction, required a significantly longer time to achieve stable pain control (P < 0.05). In the multivariate Cox regression analysis, only age (< 60), neuropathic pain and incidental pain were significantly associated with time to reach stable pain control (P </= 0.05). Patients with neuropathic or incidental pain used significantly more modalities to achieve stable pain control (P < 0.01). Patients with neuropathic pain, incidental pain, as well as the presence of psychological distress or addiction, required a higher final mean morphine equivalent daily dose (MEDD) (P < 0.001). A comparison of the rESS with the ESS demonstrated the ineffectiveness of the ESS prognostic staging system for predicting achievement of stable pain control. These findings confirm the study hypothesis, suggesting that the rESS appears to have good predictive value and a moderate to high inter-rater reliability. We suggest the rESS should prove to be a useful tool in clinical practice, and in the comparison of cancer pain populations in research studies.
PMID: 15781173 [PubMed - as supplied by publisher]
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Pregabalin for painful neuropathy.
Jaaskelainen SK.
Department of Clinical Neurophysiology and Pain Clinic at the Department of Anaesthesiology and Intensive Care, Turku University Hospital, Turku, Finland.
Publication Types:
PMID: 15778098 [PubMed - in process]
Case records of the Massachusetts General Hospital. Case 8-2005. A 10-year-old boy with pain in the right thigh.
Gebhardt MC, Rosenthal DI, Arnell PM.
Department of Orthopedics, Beth Israel Deaconess Medical Center, Boston, USA.
Publication Types:
- Case Reports
- Clinical Conference
PMID: 15784666 [PubMed - indexed for MEDLINE]
C2 myelitis presenting with neuralgiform occipital pain.
Boes CJ.
Department of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA. boes.christopher@mayo.edu
PMID: 15781842 [PubMed - in process]
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Cognitive modulation of pain-related brain responses. Comments on Seminowicz et al. (Pain 2004;112:48-58).
Legrain V, Plaghki L, Garcia-Larrea L.
Fonds National de la Recherche Scientifique (FNRS), Brussels, Belgium; Unite de Neurosciences Cognitives (NESC), Faculte de Psychologie et des Sciences de l'Education, Universite catholique de Louvain (UCL), Louvain-la-Neuve, Belgium; Centre de Lutte contre la Douleur, Cliniques universitaires Saint-Luc, Brussels, Belgium; INSERM E342 (Central Integration of Pain), Hopital neurologique and Universite Claude Bernard, Lyon, France.
Publication Types:
PMID: 15777883 [PubMed - as supplied by publisher]
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PAIN: comment in reply to Dr David Knapp's Letter Pain relief: a universal right.
Cousins MJ, Brennan F, Carr DB.
Pain Management Research Institute, Royal North Shore Hospital and University of Sydney, St. Leonards, Sydney, 2065 NSW, Australia.
Publication Types:
PMID: 15777881 [PubMed - in process]
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Assessment of pain in laboratory animals: a comment on Mogil and Crager (2004).
Vierck CJ, Mauderli AP, Wiley RG.
Department of Neuroscience, McKnight Brain Institute, University of Florida College of Medicine, 100 Newell Drive, Gainesville, FL 326510-0244, USA.
Publication Types:
PMID: 15777880 [PubMed - in process]
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Response to Letter regarding "Impaired self-perception of the hand in complex regional pain syndrome"
Forderreuther S, Krause P, Straube A.
Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany.
Publication Types:
PMID: 15777879 [PubMed - as supplied by publisher]
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Comment on "Pain relief: a universal right" by Cousins, Brennan and Carr. PAIN Vol 112/1-2, pp. 1-4.
Knapp DS.
Arthritis Pain Center, Turner Family Easter Seals Unit, 2410 Patterson St., Ste. 106, Nashville, TN 37203, USA.
Publication Types:
PMID: 15777878 [PubMed - in process]
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Impaired self-perception of the hand in complex regional pain syndrome (CRPS) [S. Forderreuther, U. Sailer, A. Straube, Pain 2004; 110:756-761].
McCabe CS, Shenker N, Lewis J, Blake DR.
The Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath BA1 1RL, UK; The Department of Pharmacy and Pharmacology, University of Bath, Bath BA1 1RL, UK.
Publication Types:
PMID: 15777877 [PubMed - in process]
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Spinal administration of MK-801 and NBQX demonstrates NMDA-independent dorsal horn sensitization in incisional pain.
Zahn PK, Pogatzki-Zahn EM, Brennan TJ.
Department of Anesthesia, University of Muenster, Germany.
Surgery commonly causes pain and neural plasticity that are unique compared to other persistent pain problems. To more precisely study central sensitization and plasticity, we examined the role of ionotropic EAA receptors in dorsal horn neuron sensitization early after incision. Sensitization, in the form of increased background activity, increased mechanosensitivity or pinch receptive field expansion, was induced by plantar incision 1h later in 30 neurons. (+)-5-Methyl-10,11-dihydro-5H-dibenzo(a,d)cyclohepten-5,10-imine (MK-801) or 1mM 1,2,3,4-tetrahydro-6-nitro-2,3-dioxo[f]quinoxaline-7-sulfonamide (NBQX) was administered through a microdialysis fiber to block NMDA and nonNMDA EAA receptors, respectively. Dorsal horn neuron sensitization was reexamined 1h later. Spinal administration of NBQX blocked AMPA-induced excitation but did not affect excitation by NMDA. NBQX decreased background activity in the neurons that developed sustained increased activity after incision. The median decrease caused by NBQX was from 2.3 to 0.0imp/s. Spinal administration of 5mM MK-801 blocked NMDA-induced excitation but did not affect excitation by AMPA. The median change (from 2.6 to 1.1imp/s) in background activity increased by incision was not significantly affected by MK-801. The responses to mechanical stimuli were enhanced after incision in wide dynamic range (WDR) neurons. NBQX eliminated these responses but MK-801 had no effect. The pinch receptive field (RF) expansion into uninjured areas of the paw and hindquarters occurred after incision. Only 1 of 13 neurons exhibited RF expansion after spinal NBQX administration; 9 of 12 neurons had RF expansion remaining after MK-801. Thus, nonNMDA receptors are critical and NMDA-independent factors influence the increased responsiveness of dorsal horn neurons that occur early after incision.
PMID: 15777875 [PubMed - in process]
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Do health care providers' attitudes towards back pain predict their treatment recommendations? Differential predictive validity of implicit and explicit attitude measures.
Houben RM, Gijsen A, Peterson J, de Jong PJ, Vlaeyen JW.
Department of Medical, Clinical and Experimental Psychology, Research Institute Experimental Psychopathology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
The current study aimed to measure the differential predictive value of implicit and explicit attitude measures on treatment behaviour of health care providers. Thirty-six physiotherapy students completed a measure of explicit treatment attitude (Pain Attitudes And Beliefs Scale For Physiotherapists-PABS-PT) and a measure of implicit treatment attitude (Extrinsic Affective Simon Task-EAST). Furthermore, they gave treatment recommendations for a patient simulating back pain on three video scenes. The implicit and explicit measures of attitudes were only weakly related to each other. However, both were differentially related to treatment recommendations. The implications of the differential predictive value of implicit and explicit attitude measures for treatment behaviour are discussed.
PMID: 15777874 [PubMed - in process]
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Sensory function and quality of life in patients with multiple sclerosis and pain.
Svendsen KB, Jensen TS, Hansen HJ, Bach FW.
Danish Pain Research Center, Building 1 A, University Hospital of Aarhus, Noerrebrogade 44, DK-8000 Aarhus C, Denmark.
Central neuropathic pain is well known in multiple sclerosis (MS), but the underlying mechanisms are unclear. In the present study we studied sensory function in MS patients with pain, MS patients without pain and healthy subjects in order to clarify the role of sensory abnormalities in pain. Fifty MS patients with pain were randomly recruited from a previous epidemiological MS study in Aarhus County, Denmark. Age and gender stratified MS patients without pain (N=50) and healthy subjects (N=50) served as controls. Patients with pain underwent a structured pain interview. Sensory function was examined by bedside and quantitative sensory testing. Quality of life was assessed using the health-related quality of life questionnaire, SF-36. Patients with pain had lower pressure pain threshold than pain-free patients (260kPa vs. 322 (median), P=0.02) otherwise quantitative sensory testing was similar. Pain patients more frequently had cold allodynia (9/50 vs. 0/50, P=0.003) and abnormal temporal summation (10/48 vs. 3/49, P=0.03). Fifty-eight percent had central pain. Central pain patients did not differ from musculoskeletal pain patients in quantitative sensory testing, but allodynia was more common in MS patients with central pain. Pain patients scored lower in all dimensions of SF-36 compared with pain-free patients and healthy subjects. The results suggest that pain in MS is central in more than half of the patients and is associated with mechanical or thermal hyperalgesia.
PMID: 15777872 [PubMed - in process]
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Does neonatal surgery lead to increased pain sensitivity in later childhood?
Peters JW, Schouw R, Anand KJ, van Dijk M, Duivenvoorden HJ, Tibboel D.
Department of Pediatric Surgery, Erasmus MC-Sophia, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands.
Does pain or tissue damage in early life lead to hyperalgesia persisting into childhood? We performed a cross-sectional study in 164 infants to investigate whether major surgery within the first 3 months of life increases pain sensitivity to subsequent surgery and to elucidate whether subsequent surgery in the same dermatome or in a different dermatome leads to differences in pain sensitivity. All infants received standard intraoperative and postoperative pain management, with rescue analgesia guided by a treatment algorithm. Differences in pain sensitivity during surgery were assessed by the intraoperative fentanyl intake and by (nor)epinephrine plasma concentrations. Differences in postoperative pain sensitivity were assessed by the observational pain measures COMFORT and VAS, and by morphine intake and (nor)epinephrine plasma concentrations. Infants previously operated upon in the same dermatome needed more intraoperative fentanyl, had higher COMFORT and VAS scores, had greater (nor)epinephrine plasma concentrations, and needed also more morphine than did infants with no prior surgery. In contrast, infants who previously underwent surgery in another dermatome had only significant higher postoperative analgesic requirements and norepinephrine plasma concentrations in comparison with infants with no prior surgery. These preliminary differences may indicate the occurrence of spinal and supraspinal changes following neonatal surgery. We conclude that the long-term consequences of surgery in early infancy are greater in areas of prior tissue damage and that these effects may portend limited clinical but important neurobiological differences.
PMID: 15777869 [PubMed - in process]
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Disruption of the P2X(7) purinoceptor gene abolishes chronic inflammatory and neuropathic pain.
Chessell IP, Hatcher JP, Bountra C, Michel AD, Hughes JP, Green P, Egerton J, Murfin M, Richardson J, Peck WL, Grahames CB, Casula MA, Yiangou Y, Birch R, Anand P, Buell GN.
Pain Research, N&GI CEDD, GlaxoSmithKline, Third Avenue, Harlow, Essex CM19 5AW, UK.
The P2X(7) purinoceptor is a ligand-gated cation channel, expressed predominantly by cells of immune origin, with a unique phenotype which includes release of biologically active inflammatory cytokine, interleukin (IL)-1beta following activation, and unique ion channel biophysics observed only in this receptor family. Here we demonstrate that in mice lacking this receptor, inflammatory (in an adjuvant-induced model) and neuropathic (in a partial nerve ligation model) hypersensitivity is completely absent to both mechanical and thermal stimuli, whilst normal nociceptive processing is preserved. The knockout animals were unimpaired in their ability to produce mRNA for pro-IL-1beta, and cytometric analysis of paw and systemic cytokines from knockout and wild-type animals following adjuvant insult suggests a selective effect of the gene deletion on release of IL-1beta and IL-10, with systemic reductions in adjuvant-induced increases in IL-6 and MCP-1. In addition, we show that this receptor is upregulated in human dorsal root ganglia and injured nerves obtained from chronic neuropathic pain patients. We hypothesise that the P2X(7) receptor, via regulation of mature IL-1beta production, plays a common upstream transductional role in the development of pain of neuropathic and inflammatory origin. Drugs which block this target may have the potential to deliver broad-spectrum analgesia.
PMID: 15777864 [PubMed - in process]
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Cigarette smoking, stress-induced analgesia and pain perception in men and women.
Girdler SS, Maixner W, Naftel HA, Stewart PW, Moretz RL, Light KC.
Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7175, Medical Research Bldg A, Chapel Hill, NC 27599-7175, USA.
This study examined gender differences in smoking-related analgesia and stress-induced analgesia (SIA), as a function of pain modality. Forty men (20 smokers, 20 nonsmokers) and 37 women (17 smokers) were tested twice for pain sensitivity to tourniquet ischemia, thermal heat, and cold pressor tests; once following mental stress and once following rest control, counterbalancing order. Cardiovascular and neuroendocrine responses to mental stress were also examined. While expected gender differences in pain sensitivity were observed, women smokers had greater threshold and tolerance times to ischemic pain than women nonsmokers (P<0.05) when pain testing followed rest. Male smokers had greater threshold and tolerance to cold pressor pain than male nonsmokers (P<0.05) after both rest and stress. Only women showed evidence for SIA, since women nonsmokers demonstrated greater ischemic pain threshold and tolerance following mental stress versus rest (P<0.05), and all women reported lower thermal heat pain unpleasantness after stress versus rest (P=0.05). Only nonsmokers showed expected inverse relationships between sympathetic and hypothalamic-pituitary-adrenal (HPA) axis reactivity measures and sensitivity to pain. Smokers showed evidence for blunted HPA-axis function at rest and stress. These results indicate that analgesia related to both being a smoker and stress is influenced by gender and pain modality. The reduced pain perception in smokers and absence of relationships between endogenous pain regulatory mechanisms and pain sensitivity may reflect a maladaptive response to chronic smoking.
PMID: 15777863 [PubMed - in process]
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Socio-economic differences in the prevalence of acute, chronic and disabling chronic pain among ageing employees.
Saastamoinen P, Leino-Arjas P, Laaksonen M, Lahelma E.
Department of Public Health, 00014 University of Helsinki, Helsinki, Finland.
Pain is a strong predictor of reduced work ability and well-being, but there is little information on the prevalence of and socio-economic differences in acute, chronic and disabling chronic pain among employees. A questionnaire survey conducted in 2000-2002 among employees aged 40, 45, 50, 55 and 60 of the City of Helsinki (N=8970, response rate 67%) included socio-demographic and socio-economic factors and measures of current pain, pain duration and pain-related disability. Pain was acute when lasting a maximum of 3 months and chronic when persisting for more than 3 months. Disabling chronic pain was determined using the disability subscale of Von Korff's Chronic Pain Grade questionnaire. Acute pain was reported by 15% of women, chronic pain by 29% and disabling chronic pain by 7%. The corresponding figures for men were 12, 24 and 5%. Chronic and disabling chronic pain were more common in older age groups among both genders. Among women, those with secondary or basic education were more likely to report chronic or disabling chronic pain than those with higher education, and semi-professionals, routine non-manual employees and manual workers were more likely to report disabling chronic pain than managers. Among men, separated/divorced or widowed men were more likely to report acute pain than married men, and manual workers were more likely to report chronic pain than managers. Chronic pain was relatively common in this population, and those with older age, lower education and occupational class appear to be at excess risk for chronic pain, especially for disabling chronic pain.
PMID: 15777862 [PubMed - in process]
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The anterior cingulate cortex contains distinct areas dissociating external from self-administered painful stimulation: a parametric fMRI study.
Mohr C, Binkofski F, Erdmann C, Buchel C, Helmchen C.
Neuroimage Nord (NIN), Department of Neurology, University of Lubeck, Ratzeburger Allee 160, 23538 Lubeck, Germany.
The anterior cingulate cortex (ACC) has a pivotal role in human pain processing by integrating sensory, executive, attentional, emotional, and motivational components of pain. Cognitive modulation of pain-related ACC activation has been shown by hypnosis, illusion and anticipation. The expectation of a potentially noxious stimulus may not only differ as to when but also how the stimulus is applied. These combined properties led to our hypothesis that ACC is capable of distinguishing external from self-administered noxious tactile stimulation. Thermal contact stimuli with noxious and non-noxious temperatures were self-administered or externally applied at the resting right hand in a randomized order. Two additional conditions without any stimulus-eliciting movements served as control conditions to account for the certainty and uncertainty of the impending stimulus. Calculating the differences in the activation pattern between self-administered and externally generated stimuli revealed three distinct areas of activation that graded with perceived stimulus intensity: (i) in the posterior ACC with a linear increase during external but hardly any modulation for the self-administered stimulation, (ii) in the midcingulate cortex with activation patterns independent of the mode of application and (iii) in the perigenual ACC with increasing activation during self-administered but decreasing activation during externally applied stimulation. These data support the functional segregation of the human ACC: the posterior ACC may be involved in the prediction of the sensory consequences of pain-related action, the midcingulate cortex in pain intensity coding and the perigenual ACC is related to the onset uncertainty of the impending stimuli.
PMID: 15777860 [PubMed - in process]
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Development and pharmacological characterization of a rat model of osteoarthritis pain.
Pomonis JD, Boulet JM, Gottshall SL, Phillips S, Sellers R, Bunton T, Walker K.
Discovery Research, Purdue Pharma, L.P., 6 Cedarbrook Drive, Cranbury, NJ 08512, USA.
Osteoarthritis (OA) is an age-related joint disease characterized by degeneration of articular cartilage and is associated with chronic pain. Although several experimental models of OA have been employed to investigate the underlying etiologies of the disease, there has been relatively little investigation into development of animal models of OA to study the pain associated with the condition. In the present study, we investigated OA induced by injection of either iodoacetate or papain into the knee joint of rats, and assessed the joint degeneration with radiographic analyses and measured pain behavior using hind limb weight bearing. We found that injection of iodoacetate, but not papain, resulted in a chronic joint degeneration as measured by decreased bone mineral content and bone mineral density, necrosis of articular cartilage and osteophyte formation. These pathological changes were associated with pain that manifested as time- and concentration-dependent alterations in hind limb weight bearing. These alterations in hind limb weight bearing were reversed with morphine, but were not significantly affected by acute administration of either indomethacin or celecoxib. However, administration of 30mg/kg celecoxib twice daily for 10 days resulted in a significant restoration of hind limb weight bearing. We conclude that the iodoacetate model of OA is a relevant animal model to study pain associated with OA, and can be used to test potential therapeutic agents.
PMID: 15777859 [PubMed - in process]
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Effects of deliberate control on verbal and facial expressions of pain.
Prkachin KM.
Department of Psychology, University of Northern British Columbia, 3333 University Way, Prince George, BC, Canada V2N 4Z9.
The 'facial feedback hypothesis' suggests that inhibiting or exaggerating pain displays produces parallel effects on subjective experience. Research on the regulation of emotional expressions suggests that the act of self-regulation may be detectable in the properties of facial behavior. Both issues were examined in this study. Healthy young volunteers were videotaped while they were exposed to electric shocks varying in intensity. Participants in the Augment group were instructed to exaggerate their facial reactions to the shocks. Participants in the Attenuate group were instructed to inhibit their reactions. Controls simply responded to the shocks. All groups rated the pain of each shock on numeric, sensory and affective scales. In subsequent phases, judges rated the intensity of pain displays for all participants, and facial reactions were measured with the Facial Action Coding System. Results provided no support for the facial feedback hypothesis. Judges' ratings of participants' pain indicated that the augment instructions produced distinct alterations in pain expression. The control and inhibit groups showed linear increases in pain expression with increasing pain intensity, which did not differ significantly. Fine-grained analysis of participants' facial behavior provided evidence that pain augmentation was accompanied by topographic changes in pain expression. Parallels with existing studies, methodological issues and practical implications of the findings are discussed.
PMID: 15777858 [PubMed - in process]
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Auricular acupuncture for pain relief after total hip arthroplasty - a randomized controlled study.
Usichenko TI, Dinse M, Hermsen M, Witstruck T, Pavlovic D, Lehmann Ch.
Department of Anesthesiology and Intensive Care Medicine, Ernst Moritz Arndt University of Greifswald, Friedrich Loeffler Str. 23b, 17487 Greifswald, Germany.
Auricular acupuncture (AA) is known to be effective in treatment of various pain conditions, but still there have been no randomized controlled studies of AA for treatment of acute postoperative pain. Therefore we tested whether AA of specific points is superior to sham acupuncture for complementary analgesia after total hip arthroplasty in a patient-anesthesiologist-evaluator-analyst blinded study. The patients were randomly allocated to receive true AA (lung, shenmen, thalamus and hip points) or sham procedure (4 non-acupuncture points on the auricular helix). Permanent press AA needles were retained in situ 3 days after surgery. Postoperative pain was treated with intravenous piritramide (opioid receptor agonist with analgesic potency of 0.7 compared with morphine) using a patient-controlled analgesia (PCA) pump. The time to the first analgesic request, the amount of postoperative piritramide via PCA and pain intensity on a 100-mm visual analogue scale (VAS-100) were used to evaluate postoperative analgesia. Intraoperative anesthetic requirement, incidence of analgesia-related side effects, inflammation parameters and success of patients' blinding were also recorded. Fifty-four patients (29 AA and 25 controls) completed the study. Piritramide requirement during 36h after surgery in AA group was lower than in control: 37+/-18 vs. 54+/-21mg; mean+/-SD; P=0.004. Pain intensity on VAS-100 and incidence of analgesia-related side effects were similar in both groups. The differences between the groups as regard patients' opinions concerning success of blinding were not significant. Findings from our study demonstrate that AA could be used to reduce postoperative analgesic requirement.
PMID: 15777857 [PubMed - in process]
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Quantitative assessment of experimental pain perception: multiple domains of clinical relevance.
Edwards RR, Sarlani E, Wesselmann U, Fillingim RB.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 1-101, Baltimore, MD 21287, USA.
PMID: 15777856 [PubMed - in process]
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The burning case of neuropathic pain wording.
Marchettini P.
Scientific Institute, Hospital San Raffaele, Pain Medicine Center, via Stamira D'Ancona 20, 20127 Milano, Italy.
Publication Types:
PMID: 15777855 [PubMed - in process]
Gaps and junctions between clinical experience and theoretical framework in the use of opioids.
Kloke M.
Publication Types:
PMID: 15480811 [PubMed - indexed for MEDLINE]
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Concerns of family members of patients receiving palliative sedation therapy.
Morita T, Ikenaga M, Adachi I, Narabayashi I, Kizawa Y, Honke Y, Kohara H, Mukaiyama T, Akechi T, Kurihara Y, Uchitomi Y; Japan Pain, Rehabilitation, Palliative Medicine, and Psycho-Oncology (J-PRPP) Study Group.
Palliative Care Team and Seirei Hospice, Seirei Mikatabara Hospital, 3453 Mikatabara-cho, 433-8558 Hamamatsu, Shizuoka, Japan. seireihc@jt6.so-net.ne.jp
PURPOSE: Symptomatic sedation is often required in terminally ill cancer patients and could cause significant distress to their families. The aim of this study was to gather vivid family descriptions about their experiences in palliative sedation therapy. METHODS: This report is an additional analysis of a multicenter questionnaire survey. We performed content analysis on 48 statements described by 185 bereaved family members of patients who received palliative sedation therapy. RESULTS: Family members reported guilt, helplessness, and physical and emotional exhaustion when patients received palliative sedation therapy. They were concerned about whether sedated patients experienced distress, wished to know that the maximum efforts had been made, wished to prepare for patient death, wished to tell important things to patients before sedation, wished to understand patients' suffering, and wanted medical professionals to treat patients with dignity. CONCLUSIONS: To alleviate family distress, clinicians should understand families' emotional distress, ensure that unconscious patients feel no distress, reassure family members that the symptoms are truly refractory despite maximum efforts for symptom relief, give information and coordinate the situation to enable families to prepare for patient death and to tell important things to patients before sedation, help families to share patients' suffering, and treat patients the same as when they remained conscious.
Publication Types:
PMID: 15372223 [PubMed - indexed for MEDLINE]
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