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Development and early results of a new patellofemoral arthroplasty.
Ackroyd CE, Chir B.
Avon Orthopaedic Centre, Southmead General Hospital, Bristol, England. Ackroyd@tesco.net
A new patellofemoral arthroplasty is described, based on a previous design of total knee arthroplasty. The indications are for patients with specific isolated patellofemoral disease with advanced chondral or arthritic damage. The design and technique of insertion is detailed. Three hundred six patellofemoral arthroplasties have been done in 240 patients. The initial results show a high level of pain relief and improvement in function. Two-year followup is available for treatment of 124 knees and 5-year followup is available for treatment of 33 knees. There has been no deterioration in pain or function with followup to 5 years, and there were no late complications attributable to the arthroplasty. Disease progression in the tibiofemoral joint has occurred in 14 patients (16 knees, 5%) requiring revision in 10 of these patients (11 knees, 3.6%). Persistent anterior knee pain was recorded in 14 knees (4%). The short-term results using this new design were better than those of the prosthesis that we used previously, especially concerning malalignment and wear. It offers a reasonable alternative to total knee replacement in the small group of patients with isolated patellofemoral disease. LEVEL OF EVIDENCE: Therapeutic study, Level II (prospective cohort study). See the Guidelines for Authors for a complete description of levels of evidence.
Publication Types:
PMID: 15995414 [PubMed - indexed for MEDLINE]
Rapid switching between transdermal fentanyl and methadone in cancer patients.
Mercadante S, Ferrera P, Villari P, Casuccio A.
Anesthesia and Intensive Care Unit, La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy. terapiadeldolore@la-maddalena.it
PURPOSE: The aim of this study was to examine the clinical effects of switching from transdermal (TTS) fentanyl to methadone, or vice versa, in patients with a poor response to the previous opioid. PATIENTS AND METHODS: A prospective study was carried out on 31 patients who switched from TTS fentanyl to oral methadone, or vice versa, because of poor opioid response. A fixed conversion ratio of fentanyl to methadone of 1:20 was started and assisted by rescue doses of opioids, and then doses were changed according to clinical response. Pain and symptom intensity, expressed as distress score, were recorded before switching doses of the two opioids and after subsequent doses. The number of changes of the daily doses, time to achieve stabilization, and hospital stay were also recorded. RESULTS: Eighteen patients were switched from TTS fentanyl to methadone, and seven patients were switched from methadone to TTS fentanyl. A significant decrease in pain and symptom intensity, expressed as symptom distress score, was found within 24 hours after switching took place in both directions. Unsuccessful switching occurred in six patients, who were subsequently treated with an alternative therapy. CONCLUSION: A rapid switching using an initial fixed ratio of fentanyl to methadone of 1:20 is an effective method to improve the balance between analgesia and adverse effects in cancer patients with poor response to the previous opioid. No relationship between the final opioid dose and the dose of the previous opioid has been found.
Publication Types:
PMID: 16051965 [PubMed - indexed for MEDLINE]
Distorted body image in complex regional pain syndrome.
Moseley GL.
School of Physiotherapy, The University of Sydney, Sydney, Australia. lorimer.moseley@anat.ox.ac.uk
PMID: 16157921 [PubMed - in process]
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Dysynchiria: watching the mirror image of the unaffected limb elicits pain on the affected side.
Acerra NE, Moseley GL.
Division of Physiotherapy, The University of Queensland, Department of Physiotherapy, Royal Brisbane and Women's Hospital, Brisbane, Australia.
People with complex regional pain syndrome type 1 (CRPS1) watched a reflected image of their unaffected limb being touched and felt pain or paresthesia at the corresponding site on the affected limb. The authors suggest that allodynia and paresthesia can be mediated by the brain and that dysynchiria has implications for the understanding and management of CRPS1.
PMID: 16157911 [PubMed - in process]
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Does pain change the brain?
Birklein F, Rowbotham MC.
Publication Types:
PMID: 16157896 [PubMed - in process]
A scale for rating the quality of psychological trials for pain.
Yates SL, Morley S, Eccleston C, de C Williams AC.
Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, 15 Hyde Terrace, Leeds LS2 9JT, UK.
This paper reports the development of a scale for assessing the quality of reports of randomised controlled trials for psychological treatments. The Delphi method was used in which a panel of 15-12 experts generated statements relating to treatment and design components of trials. After three rounds, statements with high consensus agreement were reviewed by a second expert panel and rewritten as a scale. Evidence to support the reliability and validity of the scale is reported. Three expert and five novice raters assessed sets of 31 and 25 published trials to establish scale reliability (ICC ranges from 0.91 to 0.41 for experts and novices, respectively) and item reliability (Kappa and inter-rater agreement). The total scale score discriminated between trials globally judged as good and poor by experts, and trial quality was shown to be a function of year of publication. Uses for the scale are suggested.
PMID: 16154704 [PubMed - in process]
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Spinal glial activation in a new rat model of bone cancer pain produced by prostate cancer cell inoculation of the tibia.
Zhang RX, Liu B, Wang L, Ren K, Qiao JT, Berman BM, Lao L.
Center For Integrative Medicine, School of Medicine, University of Maryland, 3rd Floor, James Kernan Hospital Mansion, 2200 Kernan Drive, Baltimore, MD 21207, USA.
Studies suggest that astrocytes and microglia in the spinal cord are involved in the development of persistent pain induced by tissue inflammation and nerve injury. However, the role of glial cells in bone cancer pain is not well understood. The present study evaluated the spinal glial activation in a novel rat model of bone cancer pain produced by injecting AT-3.1 prostate cancer cells into the unilateral tibia of male Copenhagen rats. The structural damage to the tibia was monitored by radiological analysis. The thermal hyperalgesia, mechanical hyperalgesia and allodynia, and spontaneous flinch were measured. The results showed that: (1) inoculation of prostate cancer cells, but not the vehicle Hank's solution, induced progressive bone destruction at the proximal epiphysis of the tibia from day 7-20 post inoculation; (2) the inoculation also induced progressive thermal hyperalgesia, mechanical hyperalgesia, mechanical allodynia, and spontaneous flinches; (3) astrocytes and microglia were significantly activated in the spinal cord ipsilateral to the cancer leg, characterized by enhanced immunostaining of both glial fibrillary acidic protein (GFAP, astrocyte marker) and OX-42 (microglial marker); (4) IL-1beta was up-regulated in the ipsilateral spinal cord, evidenced by an increase of IL-1beta immunostained astrocytes. These results demonstrate that injection of AT-3.1 prostate cancer cells into the tibia produces progressive hyperalgesia and allodynia associated with the progression of tibia destruction, indicating the successful establishment of a novel male rat model of bone cancer pain. Further, bone cancer activates spinal glial cells, which may release IL-1beta and other cytokines and contribute to hyperalgesia.
PMID: 16154703 [PubMed - as supplied by publisher]
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Isometric exercise has opposite effects on central pain mechanisms in fibromyalgia patients compared to normal controls.
Staud R, Robinson ME, Price DD.
Departments of Medicine, McKnight Brain Institute, University of Florida, Gainesville, FL 32610-0221, USA.
Aerobic exercise has been shown to activate endogenous opioid and adrenergic systems and attenuate experimental pain in normal control subjects (NC). In contrast, fibromyalgia (FM) subjects' experimental pain ratings increase after aerobic exercise, suggestive of abnormal pain modulation. In order to determine whether central or peripheral mechanisms are predominantly involved in the abnormal pain modulation of FM patients, the effects of handgrip exercise on thermal (cutaneous) and mechanical (somatic) experimental pain was tested in local as well as remote body areas of FM and NC subjects. Supra-threshold thermal pain ratings and pressure pain thresholds over both forearms were obtained before and during 90 s of sustained 30% maximal voluntary contraction (MVC). This isometric exercise resulted in substantially decreased thermal pain ratings and increased mechanical thresholds in local as well as remote body areas in NC. Opposite effects were detected in FM patients. Thus, sustained local muscular contraction induced widespread pain inhibitory effects in NC. In contrast, the widespread hyperalgesic effects of exercise on FM patients clearly indicate altered central pain mechanisms. However, whether these exercise effects of FM patients result from abnormal descending inhibition or excessive activation of muscle nociceptive afferents needs to be addressed in future studies.
PMID: 16154700 [PubMed - as supplied by publisher]
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Functional imaging of pain and analgesia-A valid diagnostic tool?
Borsook D, Becerra L.
Brain Imaging Centre, Department of Psychiatry, P.A.I.N. Group, McLean Hospital, Belmont, MA and Harvard Medical School, Boston, MA 02478, USA.
PMID: 16154699 [PubMed - in process]
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Different profiles of buprenorphine-induced analgesia and antihyperalgesia in a human pain model.
Koppert W, Ihmsen H, Korber N, Wehrfritz A, Sittl R, Schmelz M, Schuttler J.
Department of Anaesthesiology, University Hospital Erlangen, Krankenhausstrasse 12, D-91054 Erlangen, Germany.
Different mechanisms were proposed for opioid-induced analgesia and antihyperalgesia, which might result in different pharmacodynamics. To address this issue, the time course of analgesic and antihyperalgesic effects of intravenous (i.v.) and sublingual (s.l.) buprenorphine was assessed in an experimental human pain model. Fifteen volunteers were enrolled in this randomized, double-blind, and placebo controlled cross-over study. The magnitude of pain and the area of secondary hyperalgesia following transcutaneous stimulation were repetitively assessed before and up to 150min after administration of (1) 0.15mg buprenorphine i.v. and placebo pill s.l., (2) 0.2mg buprenorphine s.l. and saline 0.9% i.v. or (3) saline 0.9% i.v. and placebo pill s.l. as a control. The sessions were separated by 2 week wash-out periods. For both applications of buprenorphine the antihyperalgesic effects were more pronounced as compared to the analgesic effects (66+/-9 vs. 26+/-5% and 43+/-10 vs. 10+/-6%, for i.v. and s.l. application, respectively). This contrasts the pattern for the intravenous administration of pure mu-receptor agonists in the same model in which the antihyperalgesic effects are weaker. The apparent bioavailability of buprenorphine s.l. as compared to buprenorphine i.v. was 58% with a 15.8min later onset of antinociceptive effects. The half-life of buprenorphine-induced analgesic and antihyperalgesic effects were 171 and 288min, respectively. In contrast to pure mu-receptor agonists, buprenorphine exerts a lasting antihyperalgesic effect in our model. It will be of major clinical interest whether this difference will translate into improved treatment of pain states dominated by central sensitization.
PMID: 16154698 [PubMed - as supplied by publisher]
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Anti-allodynic efficacy of the chi-conopeptide, Xen2174, in rats with neuropathic pain.
Nielsen CK, Lewis RJ, Alewood D, Drinkwater R, Palant E, Patterson M, Yaksh TL, McCumber D, Smith MT.
School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia.
Xen2174 is a structural analogue of Mr1A, a chi-conopeptide recently isolated from the venom of the marine cone snail, Conus marmoreus. Although both chi-conopeptides are highly selective inhibitors of the norepinephrine transporter (NET), Xen2174 has superior chemical stability relative to Mr1A. It is well-known that tricyclic antidepressants (TCAs) are also potent NET inhibitors, but their poor selectivity relative to other monoamine transporters and various G-protein-coupled receptors, results in dose-limiting side-effects in vivo. As TCAs and the alpha(2)-adrenoceptor agonist, clonidine, have established efficacy for the relief of neuropathic pain, this study examined whether intrathecal (i.t.) Xen2174 alleviated mechanical allodynia in rats with either a chronic constriction injury of the sciatic nerve (CCI-rats) or an L5/L6 spinal-nerve injury. The anti-allodynic responses of i.t. Mr1A and i.t. morphine were also investigated in CCI-rats. Paw withdrawal thresholds were assessed using calibrated von Frey filaments. Bolus doses of i.t. Xen2174 produced dose-dependent relief of mechanical allodynia in CCI-rats and in spinal nerve-ligated rats. Dose-dependent anti-allodynic effects were also produced by i.t. bolus doses of Mr1A and morphine in CCI-rats, but a pronounced 'ceiling' effect was observed for i.t. morphine. The side-effect profiles were mild for both chi-conopeptides with an absence of sedation. Confirming the noradrenergic mechanism of action, i.t. co-administration of yohimbine (100nmol) with Xen2174 (10nmol) abolished Xen2174s anti-allodynic actions. Xen2174 appears to be a promising candidate for development as a novel therapeutic for i.t. administration to patients with persistent neuropathic pain.
PMID: 16154696 [PubMed - as supplied by publisher]
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A prospective clinical analysis of pain behavior and self-injurious behavior.
Symons FJ, Danov SE.
Department of Educational Psychology, University of Minnesota, 206 Burton Hall, 178 Pillsbury Dr, Minneapolis, MN 55455, USA.
It is a widely assumed but rarely tested proposition that the experience and expression of pain is altered among individuals with self-injurious behavior and disabilities. As a preliminary test of this proposition, the purpose of this case study was to apply a validated pain measure to examine ratings of pain behavior in relation to ratings of self-injurious behavior (SIB). A prospective correlational design was used with maternal ratings completed three times/day for 9 days using two item independent rating scales specific to pain and SIB. The participant was a 6-year-old boy with severe SIB secondary to midbrain tumor (pilocytic astrocytoma) resection and post-operative sequelae. Measures were taken in the child's home. Pain behavior was measured using the Non-Communicating Children's Pain Checklist Revised (NCCPC-R). Self-injury was measured using the Self-Injury Trauma Scale (SITS). Time intervals associated with elevated ratings of SIB were associated with elevated pain ratings. There was a significant difference (P<0.05) for pain ratings between time intervals with and without self-injury. It is suggested that additional empirical work is needed to clarify the relation between pain and self-injury to improve assessment and treatment outcomes.
PMID: 16154695 [PubMed - in process]
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Tension-type headache as the unique pain experience of a patient with congenital insensitivity to pain.
Danziger N, Willer JC.
Departement de Neurophysiologie Clinique, Centre Hospitalo-Universitaire, Pitie-Salpetriere, Paris, France; Consultation de la Douleur, Centre Hospitalo-Universitaire, Pitie-Salpetriere, Paris, France; INSERM U713, Centre Hospitalo-Universitaire, Pitie-Salpetriere, Paris, France.
Congenital insensitivity to pain (CIP) is a rare clinical syndrome characterized by dramatic impairment of pain perception since birth and is generally caused by a hereditary sensory and autonomic neuropathy (HSAN) with loss of the small-calibre, nociceptive nerve fibres. We report the case of a 32-year-old woman with CIP and a presumptive diagnosis of HSAN type V, who experienced physical pain for the first and unique time in her life shortly after the sudden loss of her brother. This patient had sustained innumerable painless injuries during childhood, including bone fractures and severe burns. The only pain she ever felt consisted in an intense headache, which took place in a context of strong emotional overload and anxiety, 3 weeks after her younger brother died suddenly in a car accident. The description of this inaugural episode of headache fulfilled the diagnostic criteria of episodic tension-type headache. This case strongly suggests that the transcription of the grief of bereavement into physical pain may sometimes occur independently of the peripheral mechanisms of nociception and despite the lack of previous pain experience. In the light of recent experimental data showing that the same neural mechanisms that regulate physical pain may also control the expression of separation distress and the feeling of social exclusion, this unique case helps to better understand why some patients may feel physically hurt after the loss of someone they love.
PMID: 16154693 [PubMed - as supplied by publisher]
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The association between negative affect and opioid analgesia in patients with discogenic low back pain.
Wasan AD, Davar G, Jamison R.
Brigham and Women's Hospital/Harvard Medical School, Departments of Anesthesiology, Perioperative and Pain Medicine; and Psychiatry, Pain Mangement Center, 850 Boylston Street, Chestnut Hill, MA 02467, USA.
Comprised mainly of depression, anxiety, and high neuroticism, psychopathology diminishes the effectiveness of many chronic pain treatments. But, it is not known if it is associated with diminished opioid analgesia in patients with chronic, noncancer pain. We tested the hypothesis that psychopathology diminishes opioid analgesia in patients with discogenic low back pain in 60 patients not on opioids in a double blind, placebo controlled, random crossover designed trial. Patients were stratified into three groups of psychological symptom severity (LOW, MOD, and HIGH), based on composite scores on depression, anxiety for pain, and neuroticism scales. Subjects were given intravenous morphine (4-6mg dosed by ideal body weight) and placebo in random order on separate visits, and completed serial pain ratings over three hours at each session. With 20 subjects per group, there were nonsignificant differences between groups in the distribution of age, gender, baseline pain (avg. 6.1/10), radicular pain, and morphine dose (5.0mg). For morphine analgesia, using a total pain relief calculation (TOTPAR), the LOW group had 65.1% TOTPAR vs. 41.0% in the HIGH group, P=.026. For placebo analgesia the LOW group had 7.7% TOTPAR vs. 23.5% in the HIGH group, P=.03. A morphine minus placebo analgesia calculation revealed 59.2% TOTPAR in the LOW group vs. 21.7% in the HIGH group, P=.0001. High levels of psychopathology are associated with diminished opioid analgesia in patients with discogenic low back pain. These results have implications for the prescription of oral opioids to patients with chronic low back pain and psychopathology.
PMID: 16154274 [PubMed - in process]
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Brief cognitive-behavioral therapy for temporomandibular disorder pain: Effects on daily electronic outcome and process measures.
Turner JA, Mancl L, Aaron LA.
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 356560, Seattle, WA 98195, USA; Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA.
We used patient daily electronic ratings of outcome (activity interference, pain intensity, jaw use limitations, negative mood) and process (pain-related beliefs, catastrophizing, and coping) variables to evaluate a brief cognitive-behavioral (CB) treatment for chronic temporomandibular disorder (TMD) pain. TMD clinic patients (N=158) were assigned randomly to four biweekly sessions of either CB pain management training (PMT) or an education/attention control condition [self-care management (SCM)] and were asked to complete electronic interviews three times daily for the 8-week treatment. We analyzed diary data from 126 participants who completed >50% of requested interviews for >6 weeks. Multilevel regression analyses indicated no statistically significant difference between the study groups in rate of within-subject change over time on the daily outcome measures, but consistently greater within-subject improvement in the PMT group on the daily process measures. Significantly (P<0.05) greater proportions of PMT than of SCM patients showed clinically important (>50%) improvement from weeks 1 to 8 in daily activity interference and jaw use limitations. This study is novel in its application of electronic diary methods for assessing outcome and process variables in a chronic pain treatment trial, and supports the feasibility and utility of such methods. The brief CB treatment was efficacious in decreasing catastrophizing and increasing perceived control over pain, and in improving activity interference and jaw use limitations for a subgroup of patients. Longer-term follow-ups are ongoing to determine if there is an impact on outcomes over time.
PMID: 16153777 [PubMed - in process]
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The measurement of postoperative pain: A comparison of intensity scales in younger and older surgical patients.
Gagliese L, Weizblit N, Ellis W, Chan VW.
School of Kinesiology and Health Science, York University, Toronto, Ont., Canada; Department of Anaesthesia and Pain Management, University Health Network, Toronto General Hospital, Toronto, Canada; Department of Anaesthesia, University of Toronto, Toronto, Ont., Canada; Department of Psychiatry, University of Toronto, Toronto, Ont., Canada.
The psychometric properties of pain intensity scales for the assessment of postoperative pain across the adult lifespan have not been reported. The objective of this study was to compare the feasibility and validity of the Numeric Rating Scale (NRS), Verbal Descriptor Scale (VDS), and Visual Analog Scale (horizontal (VAS-H) and vertical (VAS-V) line orientation) for the assessment of pain intensity in younger and older surgical patients. At 24h following surgery, 504 patients, who were receiving i.v. morphine via patient-controlled analgesia, completed the pain intensity measures and the McGill Pain Questionnaire (MPQ) in a randomized order. They were asked which scale was easiest to complete, the most accurate measure, and which they would most prefer to complete in the future, as an index of face validity. The amount of opioid self-administered was recorded. Age differences in postoperative pain intensity were not found. However, elderly patients obtained lower MPQ scores and self-administered less morphine than younger people. Psychometric analyses suggested that the NRS was the preferred pain intensity scale. It had low error rates, and higher face, convergent, divergent and criterion validity than the other scales. Most importantly, its properties were not age-related. The VDS also had a favourable profile with low error rates and good face, convergent and criterion validity. Finally, difficulties with VAS use among the elderly were identified, including high rates of unscorable data and low face validity. Its use with elderly postoperative patients should be discouraged.
PMID: 16153776 [PubMed - as supplied by publisher]
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Neurophysiologic and quantitative sensory testing in the diagnosis of trigeminal neuropathy and neuropathic pain.
Jaaskelainen SK, Teerijoki-Oksa T, Forssell H.
Department of Clinical Neurophysiology, Turku University Hospital, P.O Box 52, FIN-20521 Turku, Finland.
This study investigated the utility of neurophysiologic examination and thermal quantitative sensory testing (QST) in the diagnosis of trigeminal neuropathy and neuropathic pain. Fifty-eight patients (14 men), 34 with sensory deficit within the inferior alveolar nerve (IAN) and 24 within the lingual nerve (LN) distribution, were included. Twenty-six patients (45%) reported neuropathic pain. Patients underwent blink reflex (BR) test and thermal QST; sensory neurography was done to the IAN patients. Results of clinical sensory testing were available from the charts of 48 patients revealing abnormal findings in 77% of the IAN and in 94% of the LN patients. The BR test was abnormal in 41%, neurography in 96%, and QST in 91% of the IAN patients. In the LN group, BR was abnormal in 33%, and QST in 100% of the patients tested. Neurophysiologic tests and QST verified the subjective sensory alteration in all but 2 IAN patients, both with old injuries, and 4 LN patients who did not undergo QST. When abnormal, thermal QST showed elevation of warm and cold detection thresholds (hypo/anesthesia), hypoalgesia was less marked, and heat allodynia was only occasionally present. Contralateral thermal hypoesthesia after unilateral injury was found in 14 patients. It was associated with the occurrence of neuropathic pain (P=0.016). Axonal Abeta afferent damage was less severe in the IAN patients with pain than in those without pain (P=0.012). Neurophysiologic tests and thermal QST provide sensitive tools for accurate diagnosis of trigeminal neuropathy and study of pathophysiological features characteristic to human neuropathic pain.
PMID: 16153774 [PubMed - in process]
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Surgical relief of causalgia with an artificial nerve guide tube: Successful surgical treatment of causalgia (Complex Regional Pain Syndrome Type II) by in situ tissue engineering with a polyglycolic acid-collagen tube.
Inada Y, Morimoto S, Moroi K, Endo K, Nakamura T.
Department of Orthopaedic Surgery, Inada Hospital, Nara, Japan; Department of Bioartificial Organs, Institute for Frontier Medical Sciences, Kyoto University, 53 Kawahara-cho, Sakyo-Ku Kyoto 606-8507, Japan.
Two patients with causalgia associated with allodynia and finger contracture were treated surgically with a bioresorbable nerve guide tube made from polygycolic acid and collagen: the injured segment of the digital nerve was resected and the resulting gap (25 and 36mm) was bridged with the tube. In both cases, a neuroma was found on the injured nerve and many sprouting branches were. After reconstruction, the causalgia and allodynia disappeared and movement of the fingers recovered during the following 6 months. Functional recovery was objectively identified for 1 year and 9 months. Both patients regained full use of their finger and were free of discomfort for up to 24 and 18 months, respectively. Since the first description of causalgia in 1864, there has been no definitive treatment for this intractable burning pain. Our experience shows that at least some types of causalgia can be resolved successfully by surgery.
PMID: 16153773 [PubMed - in process]
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A prognostic approach to defining chronic pain.
Von Korff M, Miglioretti DL.
Group Health Cooperative of Puget Sound, Center for Health Studies, 1730 Minor Avenue, Suite 1600, Seattle WA, 98101, USA.
This paper develops a prognostic approach to defining chronic back pain. Possible and probable chronic back pain were defined, respectively, by a 50% and an 80% (or greater) probability of future clinically significant back pain. We assessed whether an empirically derived chronic pain classification satisfied these validating criteria among 1213 primary care back pain patients assessed at baseline and at 1, 2 and 5 year follow-ups. From multiple measures of back pain intensity and dysfunction, Latent Transition Regression Analysis empirically identified four pain severity latent classes: no pain; mild pain; moderate pain and limitation; and severe, limiting pain. From one observation point to the next, patients were most likely to remain in the same pain severity class, but chronic pain was better characterized as a dynamic state than a static trait. Among persons with severe, limiting pain, prognostic variables (depression, diffuse pain, pain persistence) improved prediction of future severe, limiting pain. A risk score developed from pain severity and prognostic measures identified risk levels corresponding to 50 and 80% probability thresholds for predicting future clinically significant back pain. At baseline and 1 year, 6.1 and 4.4% of study patients met or exceeded the 80% risk threshold for probable chronic back pain. An additional 20.3% at baseline and 12.5% at 1 year met or exceeded the 50% risk threshold for possible chronic back pain. Defining chronic pain prospectively, by risk thresholds for future clinically significant pain, provides an empirically grounded approach to chronic pain assessment.
PMID: 16153772 [PubMed - in process]
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Ambivalence over emotional expression in patients with gastrointestinal cancer and their caregivers: Associations with patient pain and quality of life.
Porter LS, Keefe FJ, Lipkus I, Hurwitz H.
Duke University Medical Center, Box 90399, Durham, NC 27708, USA.
This study examined the role of patient and caregiver ambivalence over emotional expression (AEE) in pain and quality of life (QOL) in a sample of 78 patients with gastrointestinal (GI) cancer. Measures of ambivalence over emotional expression as well as ratings of patient pain and pain behavior were collected from patients and caregivers. Measures of pain catastrophizing, perceptions of social support, and QOL were obtained from patients. Data analyses revealed that patients high in AEE engaged in more catastrophizing and reported higher levels of pain behaviors and poorer QOL. In addition, patients whose caregivers were high in AEE engaged in more catastrophizing, had higher levels of pain and pain behavior, and reported lower emotional well-being. Patient catastrophizing mediated the effects of both patient and caregiver AEE on some patient outcomes. Taken together, these findings suggest that emotional regulation in both patients and their caregivers may be an important factor in understanding cancer patients' experience of and coping with symptoms such as pain.
PMID: 16153771 [PubMed - in process]
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