ISSN:0749-8047    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:This is the first review of chronic pain (CP) malingering/disease simulation research. The purpose of this review was to determine the prevalence of malingering within CP patients (CPPs), whether evidence exists that malingering can be detected within CPPs, and to suggest some avenues of research for this topic.Design:A computer and manual literature search produced 328 references related to malingering, disease simulation, dissimulation, symptom magnification syndrome, and submaximal effort. Of these, 68 related to one of these topics and to pain. The references were reviewed in detail, sorted into 12 topic areas, and placed into tabular form. These 12 topic areas addressed the following: existence of malingering within the CP setting; dissimulation, identification simulated (faked) facial expressions of pain; identification of malingering by questionnaire; identification of malingered sensory impairment; identification of malingered loss of hand grip strength; identification of submaximal effort by isometric strength testing; identification of submaximal or malingered effort by isokinetic strength testing; identification of submaximal or malingered effort by the method of coefficient of variation; self-deception; symptom magnification syndrome; and miscellaneous malingering identification studies. Each report, in each topic area, was rated for scientific quality according to guidelines developed by the Agency for Health Care, Policy and Research (AHCPR) for rating the level of evidence presented in the reviewed study. The AHCPR guidelines were then used to rate the strength and consistency of the research evidence in each topic area based on the type of evidence the reports represented. All review conclusions were based on the results of these ratings.Setting:Any medical setting reporting on either malingering or disease simulation, or dissimulation, or submaximal effort and pain.Patients:Normal volunteers, CPPs, or any group asked to produce a submaximal or malingered effort or a malingered test profile.Results:The reviewed studies indicated that malingering and dissimulation do occur within the CP setting. Malingering may be present in 1.25-10.4% of CPPs. However, because of poor study quality, these prevalence percentages are not reliable. The study evidence also indicated that malingering cannot be reliably identified by facial expression testing, questionnaire, sensory testing, or clinical examination. There was no acceptable scientific information on symptom magnification syndrome. Hand grip testing using the Jamar dynamometer and other types of isometric strength testing did not reliably discriminate between a submaximal/malingering effort and a maximal/best effort. However, isokinetic strength testing appeared to have potential for discriminating between maximal and submaximal effort and between best and malingered efforts. Repetitive testing with the coefficient of variation was not a reliable method for discriminating a real/best effort from a malingered effort.Conclusions:Current data on the prevalence of malingering within CPPs is not consistent, and no conclusions can be drawn from these data. As yet, there is no reliable method for detecting malingering within CPPs, although isokinetic testing shows promise. Claims by professionals that such a determination can be made should be viewed with caution.

ISSN:0749-8047    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:To determine whether elderly individuals with chronic pain as a result of osteoarthritis of the hip and/or knee would report adaptations to their activities, or occupational adaptations, as a coping response to pain and, if so, to describe these adaptations and their relation to chronic pain, functional difficulty, depression, social support, and life satisfaction.Design:Thirty elderly individuals completed rating scales and a structured questionnaire designed to measure occupational adaptation and the importance of activity.Setting:Participants were community-dwelling elderly individuals and were interviewed in their homes or in a research office setting.Patients:Consecutive orthopedic surgeon, family physician, or Arthritis Society patients, whose names were provided with the patient's consent, to the researcher.Results:Individuals reported two approaches to occupational adaptation: they changed how they performed personal activities of daily living that they rated as most important and they stopped performing a number of avocational activities that they rated as less important. Statistically significant correlations were found among occupational adaptation, pain, depression, and difficulty with functioning. These variables were inversely related to life satisfaction.Conclusions:This sample of elderly individuals with chronic pain described occupational adaptations, or adaptations to "doing," as a means of coping with their chronic pain. There appeared to be a relation among pain, functional difficulty, depression, social support, and occupational adaptation. Additional research to increase the understanding of occupational adaptation as a means of coping with chronic pain is warranted.

ISSN:0749-8047    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:To evaluate the analgesic efficacy of calcitonin suppositories (200 IU) in comparison with bed rest and paracetamol tablets, as a rescue analgesic.Design:A prospective, double-blind, randomized, placebo-controlled, clinical trial.Patients:Forty patients (8 men and 32 postmenopausal women), who had recently (within the last 5 days) suffered a nontraumatic osteoporotic vertebral fracture.Setting and Interventions:All patients were admitted to the hospital, divided randomly into two groups and received either one calcitonin or placebo suppository once a day, respectively, for 28 days. All patients were allowed to take paracetamol tablets (500 mg), with a maximum dose of six tablets daily.Outcome Measures:Spinal pain evaluation was performed at the beginning of the study (before the initiation of treatment) and then daily until the end of the study (day 28) using the Huskinsson's visual analog scale (VAS) and a painmeter device, by direct pressure on the fractured vertebra. Pain was evaluated with the patients attempting or performing four different locomotor functions, e.g., bed rest, sitting, standing, and walking functions. Biochemical urine and plasma measurements were carried out before the initiation of treatment and on days 14 and 28.Results:All calcitonin-treated patients experienced an overall statistically significant (allpvalues < 0.001) decrease of spinal pain as assessed by the VAS and the painmeter device. Pain relief allowed for early mobilization and the gradual restoration of the locomotive functions in the calcitonin-treated group. Placebo-treated patients remained in bed for almost the whole of the observation period. At the end of the study (28th day), fasting osteocalcin, hydroxyproline/creatinine, and calcium/creatinine ratio values were statistically significantly (allpvalues < 0.001), lower in the calcitonin-treated than in the placebo-treated patients. In the placebo group these values showed a gradual increase. In the calcitonin-treated group side effects mainly included dizziness and enteric irritation caused by the suppositories. Enteric irritation was also present in the placebo-treated group.Conclusions:Salmon calcitonin suppositories (200 IU daily) caused a dramatic decrease in spinal pain in patients with recent osteoporotic vertebral fractures and influenced the early mobilization and the gradual restoration of their locomotor functions.

ISSN:0749-8047    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:The Multidimensional Pain Inventory (MPI) has been used widely to assess the psychosocial adaptation in chronic pain patients. The MPI can also be used to classify patients into one of three primary subgroups. However, studies have reported that anywhere from 3% to 30% of patients are unclassifiable, mostly attributable to an excessive number of missing responses to questions. The purpose of this study was to examine the reasons for the large number of missing responses and subsequently to reduce the number of patients who cannot be classified within one of the three primary MPI subgroups.Design:Two versions of the MPI were evaluated on two samples of patients (N= 147; andN= 143) with persistent pain being evaluated by the Workers Compensation Board of British Columbia, Canada. One version used the published MPI instructions and the second modified the instructions to clarify the meaning of the term "significant other." In addition, patients were required to designate a significant other who would serve as the anchor for all responses related to a significant other.Results:Approximately 18% of patients could not be classified within one of the three primary profiles and were determined to be unanalyzable using the MPI standard classification procedure. Most patients who could not be classified had excessive missing data to those questions asking about support received from "significant other." Almost all of these patients with missing data were unmarried and living alone. Modifying the instructions of the MPI to specify the meaning of the term "significant other" resulted in an almost threefold (6.3% vs. 18%) reduction in the percentage of patients whose responses could not be analyzed and consequently classified into one of the three primary MPI subgroups. The revised instructions did not lead to any difference in the actual distribution of patients assigned to one of the three profiles. Thus, using the modified instruction did not alter the proportion of patients assigned to one of the three primary groups.Conclusion:Modification of the MPI instructions clarifying the definition of a significant other can greatly reduce the number of patients who are classifiable within one of the three primary MPI profiles. Thus, the modified instructions of the MPI (hence the MPI-M) have a significant advantage over the original version. The mean scores on the individual scales of the MPI and the MPI-M are comparable. Moreover, the results demonstrate that the proportion of the previously unanalyzable patients classified within one of the three primary subgroups is comparable to the original proportion of patients assigned to each of the primary subgroups. Thus, it may not be necessary to reestablish the norm scores based on the modified instructions. Future studies and clinicians who wish to use the MPI for the purpose of classifying patients on the basis of psychosocial and behavioral factors should make use of the MPI-M that incorporates the clarification of the meaning of "significant other."

ISSN:0749-8047    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:The Premature Infant Pain Profile (PIPP) is a 7-indicator composite measure developed to assess acute pain in preterm and term neonates. It has been validated in studies using synchronized videotaping of infants undergoing procedures. The purpose of this study was to establish (a) construct validity of the PIPP and (b) inter- and intrarater reliability of the PIPP prospectively in the clinical environment.Design:A randomized, crossover design was used.Setting:The study was conducted in a Level III outborn neonatal intensive care unit.Participants:A convenience sample of 43 neonates, stratified by gestational age, was studied.Interventions:Each infant experienced three separate, randomly ordered events: baseline, a painful event, and a nonpain event. Infants were videotaped and scored at the bedside using the PIPP by the nurse caring for the infant and the clinical nurse specialist who had expertise in infant pain. The videotapes were later reviewed by two additional experts; one in real time and one using a second-to-second stop frame technique.Results:Repeated-measures analysis of the main effects and interactions yielded a statistically significant main effect for event (pain, nonpain, baseline), thus differentiating pain from nonpain and baseline events (F= 48,p= 0.0001) and establishing construct validity. Interrater reliability analysis of individual event scores of the PIPP yielded reliability coefficients of 0.93-0.96. Intrarater reliability coefficients analysis for individual events were equally high at 0.94-0.98.Conclusions:This study demonstrates that the PIPP is a pain measure with good construct validity and excellent inter- and intrarater reliability for the assessment of procedural pain of preterm and term infants in clinical settings.

ISSN:0749-8047    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:To gather information about healthcare providers' beliefs regarding pain and its treatment in children with cognitive impairment.Design:A survey consisting of two acute pain vignettes (a child undergoing surgery and a child undergoing an outpatient medical procedure) was completed by 440 nurses and 146 physicians at Arkansas Children's Hospital. Respondents completed one of four different surveys that systematically varied the child's level of cognitive impairment (none, mild, moderate, severe) in both vignettes. Questions addressed expected pain, pain assessment methods, pharmacologic regimens, and nonpharmacologic interventions.Results:In general, provider discipline and level of cognitive impairment did not significantly influence responses about pain experience and treatment. Potent analgesia, regularly scheduled dosing, and nonpainful administration were selected most frequently. Self-report of pain, patient-controlled analgesia, and behavioral interventions requiring higher cognitive skills were selected less frequently for children with more severe cognitive impairment.Conclusions:The presence of cognitive impairment appeared to influence provider decisions regarding the appropriateness of specific pain assessment and treatment methods requiring skills on the part of the child. Overall, healthcare provider views regarding analgesia and sedation were similar for all children, regardless of impairment. Whether these beliefs are consistent with clinical practice is yet to be documented.

ISSN:0749-8047    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background:This study was a retrospective examination of adolescents' use of non-pharmacologic methods to manage menstrual discomfort.Methods:A convenience sample of 289 female adolescents (mean age = 16.28 years, SD = 1.00) recruited from a public high school completed a questionnaire designed for this study.Results:Ninety-eight percent of these adolescents reported using at least one non-pharmacologic method (e.g., heat, distraction) to manage menstrual discomfort. The mean perceived effectiveness of most of these methods was reported by adolescents to be below 40% (range = 3-74%).Conclusion:It is possible that some methods are used because they have a physiologic impact on pain (e.g. heat), whereas others (e.g., distraction) provide a sense of comfort and control. Further research is necessary to examine the determinants of why and when certain management strategies are used by adolescents.

ISSN:0749-8047    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:To increase awareness of the possibility of severe respiratory depression when oral opioids are used in patients with gastrointestinal motility disorders.Setting:A major county hospital affiliated with a university.Patient:A patient with severe pain from diabetic muscle necrosis with a history of gastroparesis.Interventions:Attempted pain control with oral and transdermal opioids.Results and Conclusions:Pain control in our patient was attempted using potent oral opioids on two occasions. However, this patient suffered severe respiratory depression after each attempt. Transdermal delivery of fentanyl eventually provided satisfactory pain relief without side effects. We conclude that patients with gastrointestinal motility disorders may be at high risk for side effects of oral opioids due to altered absorption kinetics. Suggestions are made for alternative strategies for opiate delivery in patients with gastrointestinal motility disorders.

ISSN:0749-8047    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1999

数据来源: OVID