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Comment on:
Acupuncture for low back pain.
Shekelle P.
Publication Types:
PMID: 16263896 [PubMed - in process]
Effects of glucocorticoid receptor antagonists on allodynia and hyperalgesia in mouse model of neuropathic pain.
Takasaki I, Kurihara T, Saegusa H, Zong S, Tanabe T.
Department of Pharmacology and Neurobiology, Graduate School of Medicine, Tokyo Medical and Dental University, Bunkyo-ku, Japan.
Injury to the spinal nerves of mice induces mechanical allodynia and thermal hyperalgesia. In the injured spinal cord, the expression of glucocorticoid receptor mRNA was increased, whereas it was decreased in N-type Ca(2+)-channel-deficient mice, in which neuropathic pain is eliminated. Intrathecal and intraperitoneal injection of the glucocorticoid receptor antagonist RU486 produced antinociceptive effects, whereas intracerebroventricular injection was without effect. The more selective antagonist dexamethasone 21-mesylate suppressed both mechanical allodynia and thermal hyperalgesia. These results suggest that spinal glucocorticoid receptors play an important role in neuropathic pain, and that controlling the activity of glucocorticoid receptors may be of great importance in the treatment of neuropathic pain.
PMID: 16256102 [PubMed - in process]
Single-level lumbar fusion in chronic discogenic low-back pain: psychological and emotional status as a predictor of outcome measured using the 36-item Short Form.
Derby R, Lettice JJ, Kula TA, Lee SH, Seo KS, Kim BJ.
Spinal Diagnostics and Treatment Center, Daly City, USA.
OBJECT: The authors examined the effect of psychological and emotional status on the outcome in patients with suspected chronic discogenic low-back pain (LBP) who have undergone lumbar fusion. METHODS: The authors retrospectively analyzed the medical records, including the results of the 36-item Short Form (SF-36), of 57 consecutive patients (mean age 42.7 years) who underwent single-level lumbar reconstructive surgery between 1994 and 2000. The SF-36 physical component summary (PCS) and mental component summary (MCS) domains were evaluated. Data were sorted into the following categories: excellent, good, fair, same, and worse. Scores greater than 40 for MCS and PCS were defined as "normal" according to US general population data provided by the Medical Outcomes Trust. Of 57 patients, 47 completed postoperative SF-36 surveys at 1 year and 36 completed the 2-year follow-up surveys. Analysis showed that preoperative MCS scores exhibited a significant, direct correlation with PCS score improvements at 1 (r = 0.584, p = 0.000) and 2 (r = 0.623, p = 0.000) years after surgery. In patients in whom preoperative MCS scores reflected normal status, outcomes were excellent or good in 60% at 1-year (18 of 30 cases) and 2-year (15 of 25 cases) follow-up intervals. Patients in whom MCS scores represented abnormal status had less satisfactory outcomes, with excellent or good outcome in only two (18.2%) of all patients at the 2-year follow-up study. CONCLUSIONS: Analysis of the data suggests that psychological and emotional distress may negatively affect postoperative outcome in patients with chronic discogenic LBP. The SF-36 may be easily and effectively used to measure both preoperative psychosocial distress and postoperative outcome.
PMID: 16266065 [PubMed - indexed for MEDLINE]
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Pain severity in diabetic peripheral neuropathy is associated with patient functioning, symptom levels of anxiety and depression, and sleep.
Gore M, Brandenburg NA, Dukes E, Hoffman DL, Tai KS, Stacey B.
Avalon Health Solutions, Inc., Philadelphia, Pennsylvania 19102, USA.
Our goal was to evaluate pain severity, pain-related interference with function, sleep impairment, symptom levels of anxiety and depression, and quality of life among patients with painful diabetic peripheral neuropathy (DPN). Participants in a burden of illness survey (n = 255) completed the modified Brief Pain Inventory-DPN (BPI-DPN), MOS Sleep Scale, Hospital Anxiety and Depression Scale (HADS), Short Form Health Survey-12v2 (SF-12v2), and the EuroQoL (EQ-5D). Patients were 61 +/- 12.8 years old (51.4% female), had diabetes for 12 +/- 10.3 years and painful DPN for 6.4 +/- 6.4 years. Average and Worst Pain scores (BPI-DPN, 0-10 scales) were 5.0 +/- 2.5 and 5.6 +/- 2.8. Pain substantially interfered (>or=4 on 0-10 scales) with walking ability, normal work, sleep, enjoyment of life, mood, and general activity. Moderate to severe symptom levels of anxiety and depression (HADS-A and HADS-D scores >or=11 on 0-21 scales) occurred in 35% and 28% of patients, respectively. Patients reported greater sleep problems compared with the general U.S. population and significant impairment in both physical and mental functioning (SF-12v2) compared with subjects with diabetes. The mean EQ-5D utility score was 0.5 +/- 0.3. Greater pain levels in DPN (mild to moderate to severe) corresponded with higher symptom levels of anxiety and depression, more sleep problems, and lower utility ratings and physical and mental functioning, (all Ps < 0.01). Painful DPN is associated with decrements in many aspects of patients' lives: physical and emotional functioning, affective symptoms, and sleep problems. The negative impact is higher in patients with greater pain severity.
PMID: 16256902 [PubMed - in process]
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Topical morphine in the treatment of painful ulcers.
Porzio G, Aielli F, Verna L, Cannita K, Marchetti P, Ficorella C.
Publication Types:
PMID: 16256893 [PubMed - in process]
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Incidence of chronic pain in patients with end-stage renal disease on dialysis.
Mercadante S, Ferrantelli A, Tortorici C, Lo Cascio A, Lo Cicero M, Cutaia I, Parrino I, Casuccio A.
Publication Types:
PMID: 16256892 [PubMed - in process]
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Drug crime is a source of abused pain medications in the United States.
Joranson DE, Gilson AM.
Publication Types:
PMID: 16256890 [PubMed - in process]
Channelling treatment for neuropathic pain.
Hayward P.
Publication Types:
PMID: 16265790 [PubMed - indexed for MEDLINE]
Salivary cortisol and mood and pain profiles during skin-to-skin care for an unselected group of mothers and infants in neonatal intensive care.
Morelius E, Theodorsson E, Nelson N.
Division of Pediatrics, Department of Molecular and Clinical Medicine, University Hospital, SE-581 85 Linkoping, Sweden. evalotte.morelius@lio.se
OBJECTIVES: Mother-infant separation after birth is a well-known source of stress. Parents and preterm infants in neonatal intensive care are separated immediately after birth. Skin-to-skin care is 1 possible method to reduce the separation-dependent stress. The aim of the present study was to investigate how skin-to-skin care influences stress for the mother and the infant in neonatal intensive care. METHODS: Seventeen mother-infant pairs were included at their first and fourth skin-to-skin care. The infants were 25 to 33 weeks' gestational age, with birth weights ranging from 495 to 2590 g. In mothers, salivary cortisol, heart rate, mood scale, and stress measured on a visual analog scale (VAS) were analyzed. In infants, salivary cortisol and heart rate were analyzed, and because pain is one facet of stress, 2 different pain scales were used. RESULTS: In mothers, the skin-to-skin care decreased salivary cortisol (32%), heart rate (7%), and VAS (89%), whereas mood increased (6%). Before the fourth skin-to-skin care, mothers rated less stress on VAS, and salivary cortisol and heart rate improved faster. The infants' cortisol either increased or decreased. Their heart rates and pain scores decreased during skin-to-skin care. CONCLUSIONS: Our results lend additional support to the value of skin-to-skin care in neonatal intensive care. Variable stress responses in preterm infants favor the need for individualized care. The mothers' need for support seem to be more pronounced in the first skin-to-skin session as our results show a higher degree of stress as compared with later skin-to-skin care.
PMID: 16263996 [PubMed - in process]
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Continuous, intra-articular infusion of bupivacaine after total-knee arthroplasty may lead to potentially toxic serum levels of local anesthetic.
Hoeft MA, Rathmell JP, Dayton MR, Lee P, Howe JG, Incavo SJ, Lawlis JF.
Publication Types:
PMID: 16032602 [PubMed - indexed for MEDLINE]
Comment on:
Continuous sciatic nerve block and total-knee arthroplasty.
Sciard D, Lam N, Hussain M.
Publication Types:
PMID: 16032598 [PubMed - indexed for MEDLINE]
Comment on:
Sciatic nerve block for total-knee replacement: is it really necessary in all patients?
Levesque S, Delbos A.
Publication Types:
PMID: 16032596 [PubMed - indexed for MEDLINE]
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Management of postoperative analgesia in elderly patients.
Aubrun F.
Departement d'anesthesie reanimation Chirurgicale, Universite Pierre et Marie Curie, Paris, France. frederic.aubrun@psl.ap-hop-paris.fr
Publication Types:
PMID: 16032589 [PubMed - indexed for MEDLINE]
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Plasma concentrations and analgesic effects of ropivacaine 3.75 mg/ml during long-term extrapleural analgesia after thoracotomy.
Meyer M, Siauw PT, Scholz G, Frey DJ.
Clinic of Anesthesiology and Surgical Intensive Care Medicine, Ibbenburen, Germany. m.meyer@klinikum-libbenbueren.de
BACKGROUND AND OBJECTIVES: Fourteen patients received long-term extrapleural analgesia with ropivacaine for postoperative pain relief after posterolateral thoracotomy. We determined plasma concentrations of ropivacaine as well as pain scores and opioid consumption to assess the analgesic effect. METHODS: In this prospective study, an extrapleural catheter was placed with its tip near the third rib before chest closure. The extrapleural block started with 10 mL of 7.5 mg/mL of ropivacaine followed 30 minutes later by an infusion of 3.75 mg/mL of ropivacaine at a fixed rate of 0.1 mL/kg/h for 71.5 hours. RESULTS: Mean total and free ropivacaine concentrations increased until day 1, reached similar values on day 2, and subsequently decreased. In 13 patients, free drug levels did not exceed 0.14 mg/L. Coincidence of above-average total ropivacaine concentrations up to 4.8 mg/L and low plasma binding resulted in free drug concentrations up to 0.31 mg/L in 1 patient. An impaired ropivacaine plasma binding was observed in 2 patients after major surgical blood loss, in 3 patients in a state of a moderate postoperative acidosis, and in 1 patient after intravenous administration of clindamycin. All free ropivacaine concentrations measured were below the toxic threshold, and we observed no clinical signs of ropivacaine-related toxicity. The magnitude of pain scores and the opioid consumption pointed out a sufficient postoperative analgesia. CONCLUSIONS: A dose of 0.375 mg/kg/h of ropivacaine can safely be administered for long-term extrapleural analgesia after thoracotomy.
PMID: 16032588 [PubMed - indexed for MEDLINE]
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Systemic meloxicam reduces tactile allodynia development after L5 single spinal nerve injury in rats.
Takahashi M, Kawaguchi M, Shimada K, Nakashima T, Furuya H.
Department of Anesthesiology, Nara Medical University, Japan. masakun@nmu-gw.naramed-u.ac.jp
BACKGROUND: Although recent evidence suggests that cyclooxygenase-2 (COX-2) may contribute to the development and management of neuropathic pain, the efficacy of COX-2 inhibitor against neuropathic pain is still unclear. In this study, we investigated the effects of the systemic administration of the selective COX-2 inhibitor meloxicam at an early stage after nerve injury on the development of tactile allodynia in L5 single spinal-nerve injury in rats. METHODS: Twenty-four young male Sprague-Dawley rats received L5 single spinal-nerve injury. Nerve-injured rats (6 per group) received repeated intraperitoneal administrations of meloxicam (1, 2, or 4 mg/kg) or vehicle 0, 12, 24, and 36 hours after nerve injury. Tactile allodynia was quantified for 4 weeks by use of von Frey filaments. RESULTS: In animals given 2 mg/kg and 4 mg/kg, hind-paw withdrawal thresholds 4 weeks after nerve injury were significantly higher compared with those of the vehicle-treated animals. The area under the time-effect curve from preinjury to 4 weeks after nerve injury values were significantly higher in animals treated with 4 mg/kg of meloxicam compared with animals treated with vehicle. CONCLUSION: Systemic administration of 2 mg/kg and 4 mg/kg of meloxicam at an early stage after nerve injury attenuated the development of tactile allodynia. These results suggest that COX-2 may be at least in part involved in the development of tactile allodynia in an L5 single spinal-nerve injury model.
PMID: 16032587 [PubMed - indexed for MEDLINE]
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Morphologic analysis of bipolar radiofrequency lesions: implications for treatment of the sacroiliac joint.
Pino CA, Hoeft MA, Hofsess C, Rathmell JP.
Department of Anesthesiology, University of Vermont College of Medicine, Burlington, 05401, USA.
BACKGROUND AND OBJECTIVES: Sacroiliac (SI) joint dysfunction is an important cause of mechanical low-back pain. Bipolar radiofrequency ablation has been proposed as a long-lasting treatment for pain in patients with SI dysfunction who report temporary pain relief with local-anesthetic injection into the joint. No data are available to guide the technical aspects of bipolar radiofrequency lesion creation. This study documents the optimal spacing of cannulae and time required to produce bipolar lesions by use of radiofrequency technology. METHODS: Two radiofrequency cannulae were secured in a parallel position 2, 4, 6, 8, and 10 mm apart and submerged in egg white for lesion production in a medium that would allow visualization of the size and shape of the lesions as they were created. Temperatures of the probes were raised from 40 degrees C to 90 degrees C at a constant rate and were held at 90 degrees C for 190 seconds. The progress of lesion formation was photographed every 10 seconds, and the resultant surface area of the lesions was measured from the digital images. RESULTS: Contiguous strip lesions were produced when the cannulae were spaced 6 mm or less apart; unipolar lesions around each cannula resulted if they were spaced more than 6 mm apart. Ninety percent of the final lesion area was reached by 120 seconds, and the final lesion size was reached by 150 seconds, regardless of spacing. CONCLUSIONS: Bipolar radiofrequency treatment creates continuous "strip" lesions proportional in size to the distance between the probes when the distance between cannulae is 6 mm or less. Spacing the cannulae 4 to 6 mm apart and treating at 90 degrees C for 120 to 150 seconds maximizes the surface area of the lesion.
PMID: 16032584 [PubMed - indexed for MEDLINE]
A randomized, double-blind, controlled trial: intradiscal electrothermal therapy versus placebo for the treatment of chronic discogenic low back pain.
Freeman BJ, Fraser RD, Cain CM, Hall DJ, Chapple DC.
Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia. brian.freeman@qmc.nhs.uk
STUDY DESIGN: A prospective, randomized, double-blind, placebo-controlled trial of intradiscal electrothermal therapy (IDET) for the treatment of chronic discogenic low back pain (CDLBP). OBJECTIVES: To test the safety and efficacy of IDET compared with a sham treatment (placebo). SUMMARY OF BACKGROUND DATA: In North America alone, more than 40,000 intradiscal catheters have been used to treat CDLBP. The evidence for efficacy of IDET is weak coming from retrospective and prospective cohort studies providing only Class II and Class III evidence. There is one study published with Class I evidence. This demonstrates statistically significant improvements following IDET; however, the clinical significance of these improvements is questionable. METHODS: Patients with CDLBP who failed to improve following conservative therapy were considered for this study. Inclusion criteria included the presence of one- or two-level symptomatic disc degeneration with posterior or posterolateral anular tears as determined by provocative computed tomography (CT) discography. Patients were excluded if there was greater than 50% loss of disc height or previous spinal surgery. Fifty-seven patients were randomized with a 2:1 ratio: 38 to IDET and 19 to sham procedure (placebo). In all cases, the IDET catheter was positioned to cover at least 75% of the annular tear as defined by the CT discography. An independent technician connected the catheter to the generator and then either delivered electrothermal energy (active group) or did not (sham group). Surgeon, patient, and independent outcome assessor were all blinded to the treatment. All patients followed a standard postprocedural rehabilitation program. Independent statistical analysis was performed. OUTCOME MEASURES: Low Back Outcome Score (LBOS), Oswestry Disability Index (ODI), Short Form 36 questionnaire (SF-36), Zung Depression Index (ZDI), and Modified Somatic Perceptions Questionnaire (MSPQ) were measured at baseline and 6 months. Successful outcome was defined as: no neurologic deficit, improvement in LBOS of greater then 7 points, and improvement in SF-36 subsets (physical function and bodily pain) of greater than 1 standard deviation. RESULTS: Baseline demographic data, initial LBOS, ODI, SF-36, ZDI, and MSPQ were similar for both groups. No neurologic deficits occurred. No subject in either arm showed improvement of greater than 7 points in LBOS or greater than 1 standard deviation in the specified domains of the SF-36. Mean ODI was 41.42 at baseline and 39.77 at 6 months for the IDET group, compared with 40.74 at baseline and 41.58 at 6 months for the placebo group. There was no significant change in ZDI or MSPQ scores for either group. CONCLUSIONS: The IDET procedure appeared safe with no permanent complications. No subject in either arm met criteria for successful outcome. Further detailed analyses showed no significant change in outcome measures in either group at 6 months. This study demonstrates no significant benefit from IDET over placebo.
PMID: 16261111 [PubMed - in process]
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A prospective randomized study of preemptive analgesia for postoperative pain in the patients undergoing posterior lumbar interbody fusion: continuous subcutaneous morphine, continuous epidural morphine, and diclofenac sodium.
Yukawa Y, Kato F, Ito K, Terashima T, Horie Y.
Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan. yukawa.ort@chubuh.rofuku.go.jp
STUDY DESIGN: A prospective randomized clinical trial in preemptive analgesia for postoperative pain was conducted. OBJECTIVE: To compare the efficacy of three preemptive analgesics combined with local anesthesia: continuous subcutaneous morphine (SC), continuous epidural morphine (ED), and diclofenac sodium (DS). SUMMARY OF BACKGROUND DATA: Systemic opioids are known to be effective methods of postoperative pain control. The use of epidural morphine for postoperative analgesia has been a standard treatment in spinal surgery. Only a few studies in the literature have investigated the efficacy of preemptive analgesia using morphine. This is the first prospective randomized clinical trial to assess both subcutaneous and epidural continuous administration of opioids for preemptive analgesia. METHODS: For this study, 73 patients were assigned randomly to one of three treatment groups: SC, ED, or DS. All patients underwent posterior lumbar interbody fusion with instrumentation. Pain management was assessed using the visual analogue scale (VAS). Usage of supplemental analgesics, the time to first request of them, and side effects were also investigated. RESULTS: Twenty-two patients were randomized to SC, 23 to ED, and 27 to DS. No baseline variable differences among the three groups were seen. The results showed no significant difference in analgesic effects among those three preemptive analgesics. Only immediately after surgery (at 0 hours), the VAS of the DS group was lowest among three groups. But the DS group took more supplemental analgesic drugs until 72 hours, and the time to first request of this group was shorter than that of the other two groups. High rates of minor side effects were seen in both the ED and DS groups. SC gave moderate analgesic effects as well as the other two groups with few adverse effects. CONCLUSIONS: DS provided a favorable effect immediately after surgery, but the effective time was short and the patient needed more supplemental drugs after that. ED did not give the expected effect, with comparatively high rates of side effects. Continuous epidural anesthesia did not seem to be suitable for preemptive analgesia. Continuous subcutaneous morphine brought some analgesic effects with a low rate of complications. It can be an attractive method for postoperative analgesia with technical ease.
PMID: 16261108 [PubMed - in process]
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Adjacent segment degeneration at T1-T2 presenting as chest pain: case report.
Freccero D, Donovan DJ.
Department of Surgery, Tripler Army Medical Center, Honolulu, HI 96859-5000, USA. dfreccero@aol.com
STUDY DESIGN: A case report of a T1-T2 herniated disc adjacent to a cervical spine fusion. OBJECTIVE: To describe the clinical presentation and treatment of a symptomatic T1-T2 disc herniation adjacent to an anterior cervical spine arthrodesis. SUMMARY OF BACKGROUND DATA: Symptomatic adjacent segment disease after cervical spine arthrodesis occurs most commonly in the lower cervical spine motion segments and has not been previously reported at T1-T2. METHODS: A 51-year-old female patient presented 4 years after three-level anterior cervical discectomy and fusion involving the C5-T1 levels. She complained of chronic chest pain and had undergone extensive medical evaluation before presentation. Magnetic resonance imaging revealed a left-sided T1-T2 herniated disc compressing the T1 nerve root. She underwent T1-T2 anterior discectomy and fusion. RESULTS: The patient's symptoms resolved completely. CONCLUSION: Adjacent-segment degeneration after cervical spine fusion may rarely occur even at T1-T2, and the unusual symptoms of a T1 radiculopathy may obscure the diagnosis. The combination of sharp anterior paramedian chest pain and numbness or weakness of the hand should prompt consideration of the diagnosis when cardiac ischemia or other more serious conditions have been ruled out.
PMID: 16261104 [PubMed - in process]
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