ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectivesInsomnia and depression are common problems for people with chronic pain, and previous research has found that each is correlated with measures of pain and disability. The goal of this study was to examine the combined impact of major depression and insomnia on individuals with chronic pain.MethodsThe participants were patients with chronic musculoskeletal pain who underwent evaluation at an interdisciplinary treatment center. On the basis of semistructured interviews, participants were classified in three groups depending on whether they: (1) met criteria for major depression with insomnia (n = 38); (2) had insomnia without major depression (n = 58); or (3) had neither insomnia nor major depression (n = 47). The groups were then compared on self-report measures that included the McGill Pain Questionnaire, the Beck Depression Inventory, and the Multidimensional Pain Inventory.ResultsParticipants with major depression and insomnia reported the most difficulty on measures of affective distress, life control, interference, and pain severity, although the insomniac patients without major depression also had elevated scores on some measures. In regression analyses, insomnia severity ratings did not contribute uniquely to the prediction of psychosocial problems when depression was controlled, but they did contribute to the prediction of pain severity.ConclusionsThese results suggest that patients with chronic pain and concurrent major depression and insomnia report the highest levels of pain-related impairment, but insomnia in the absence of major depression is also associated with increased pain and distress.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectivesThe objective was to examine the evidence to determine the optimal management of phantom limb pain in the preoperative and postoperative phase of amputations.MethodsTrials were identified by a systematic search of MEDLINE, review articles, and references of relevant trials from the period 1966–1999, including only English-language articles. Included trials involved a control group, any intervention, and reported phantom pain as an outcome.ResultsTwelve trials were identified, including 375 patients whose follow-ups ranged in duration from 1 week to 2 years. Only three randomized, controlled studies with parallel groups and three randomized crossover trials were identified. Eight trials examined treatment of acute phantom pain, including epidural treatments (three trials), regional nerve blocks (three trials), treatment with calcitonin (one trial), and transcutaneous electrical nerve stimulation (one trial). Three trials demonstrated a positive impact of the intervention on phantom limb pain, but the remainder demonstrated no difference between the intervention and control groups. Four trials examined late postoperative interventions, including transcutaneous electrical nerve stimulation (two trials) and the use of Farabloc (a metal threaded sock) and ketamine (one trial each). With regard to late postoperative interventions, three of the four trials showed modest short-term reduction of phantom limb pain. There was no relation between the quality of the trial and a positive result of the intervention.ConclusionsAlthough up to 70% of patients have phantom limb pain after amputation, there is little evidence from randomized trials to guide clinicians with treatment. Evidence on preemptive epidurals, early regional nerve blocks, and mechanical vibratory stimulation provides inconsistent support for these treatments. There is currently a gap between research and practice in the area of phantom limb pain.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveThe objective was to present new visual sensorimotor findings in a patient with complex regional pain syndrome type I, formerly known as reflex sympathetic dystrophy.DesignClinical measurements were compared for the following visual sensorimotor tasks before and after 10 minutes of near visual stimulation: accommodation, vergence, and reading eye movements.PatientThe patient was a 19-year-old female university student with complex regional pain syndrome type I.ResultsAll visual sensorimotor findings worsened dramatically after performance of the brief near visual task. In addition, the patient experienced severe dizziness, nausea, dull eye ache, and general fatigue, which persisted for 30 to 45 minutes following each test period.ConclusionsThe patient manifested signs and symptoms of complex regional pain syndrome type I per the prior neurologic diagnosis, as well as the newly diagnosed accommodative infacility, accommodative insufficiency, convergence insufficiency, and deficits of saccades and pursuits, which were severely debilitating. The findings neither support nor refute the conventional notion of abnormal sympathetic mediation as a mechanism of fatigue and pain. However, the diagnoses of accommodative infacility and insufficiency suggest abnormal parasympathetic activation. Further investigation is needed to characterize the array of visual dysfunctions in a large sample of such patients, which may help elucidate the precise underlying neurologic causes of the sensorimotor deficits in these patients.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveMany juveniles with chronic pain of no known organic cause recover. Because adolescents whose pain persists may have chronic pain as adults, a subsample of 42 adolescents from a prevalence study in which continuation of their pain was observed throughout the study period was investigated quantitatively and qualitatively. All mothers (n = 42) completed a questionnaire on the impact of the adolescent's pain on the family. The authors tested the hypothesis that pain parameters, pain-related quality of life, and impact of pain on the family would deteriorate over time.DesignThree-year follow-up questionnaires, diaries, and interviews were used.SettingThe study was conducted in the general population in the Rotterdam area.ParticipantsAdolescents (aged 12–18 years) who indicated chronic pain in our previous prevalence study and in a diary and questionnaire each year of the 3-year follow-up were included in the study.ResultsThe most prevalent pains were limb pain and headache. The pain intensity was mild (33 mm on a visual analog scale), very frequent (72% of all diary entries), and associated with relatively poor functional status and poor psychological and somatic functioning. The pain parameters, pain-related quality of life, and impact of pain on the family (i.e., restrictions in social life and problems in dealing with the stress of the adolescent's pain) remained surprisingly stable across the assessments. The interviews showed that pain had become part of the daily life of several adolescents, who structured their activities and sleeping hours to prevent aggravation of pain. In particular, adolescents with headache reported problems with cognitive activities, whereas those with limb pain and back pain reported problems with physical activities.ConclusionsFor adolescents with persistent pain with no known organic cause, intensity and frequency of pain, quality of life, and impact of pain on the family did not change. Generally, they seemed to cope quite well with their pain. In view of these results, further studies should involve follow-up of adolescents with persistent pain into adulthood to establish the determinants of their pain and to find out whether they maintain their adaptive ways of living with their pain.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundThere are no reports in the literature about patients with painfully restricted temporomandibular joints concerning the reliability of unidimensional and multidimensional pain scales on the basis of a generalizability and decision study. Generalizability and decision studies are designed to aid in reasoned decision-making and therefore are complementary to classic psychometric analyses, in which correlation coefficients express the reliability of a measurement design. The smallest detectable difference as an outcome of the decision study is the smallest statistically significant change that can be detected.PatientsTwenty-five consecutive patients (5 males and 20 females) with painfully restricted mandibular function participated in the current study.DesignRepeated measurements of three levels of unidimensional experienced pain (average, minimal, and maximal pain before the week of assessment; n = 200) and the multidimensional pain rating index of the MPQ (n = 100) were used. The measurement sessions were supervised by two observers on two separate measurement days, 1 week apart, with each measurement repeated twice.ResultsInconsistency in measurement results analyzed in terms of absolute error variance (i.e., the measurement facets plus all the interactions) represented at least 24% of total variance. The smallest detectable difference of visual analog scales varied from 43 to 15 mm, depending on the amount of repetitions, whereas for the pain rating index it varied from 22.7 to 14.4 units.ConclusionsFor statistically and clinically successful treatment of patients with painfully restricted temporomandibular joints, clinicians must overcome at least the smallest detectable difference and 38% of the initial average pain level.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo determine the long-term efficacy of gabapentin as a treatment of pain after spinal cord injury.DesignAll patients with traumatic-onset spinal cord injury treated with gabapentin were identified and followed up using a longitudinal observational design with two contact points (6 and 36 months after the trial) using a semi-structured interview. The first follow-up interview attempted to capture all 31 patients placed on therapeutic trial. The second follow-up interview attempted to capture those reporting a favorable response (n = 14) to the therapeutic trial at the first follow-up.ResultsOf the 27 patients contacted at the first follow-up (87% response rate), 6 (22%) discontinued the trial secondary to intolerable side effects; therefore, the pain analgesic effects of gabapentin in these patients could not be determined. Of the remaining 21 patients, 14 (67%) reported a favorable response (i.e., a 2 or greater point reduction on a 0–10 pain-rating scale). The second follow-up interview captured 11 (79% response rate) of the 14 patients reporting a favorable response at the first interview, and 91% (10 of 11 patients) continued to report that gabapentin was an effective analgesic. There was no evidence to suggest dosing difficulties due to tolerance over the 3-year period. Sedation, dizziness, and forgetfulness were the most common side effects.ConclusionsGabapentin may be an effective treatment of pain after spinal cord injury among those able to tolerate initial and long-term side effects.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectivesTo study pain characteristics and peripheral nerve involvement in patients with painful diabetic and nondiabetic polyneuropathy in comparison with patients with nonpainful polyneuropathy.Patients and MethodsFifty-five patients with polyneuropathy (37 with painful polyneuropathy, of whom 19 had diabetes and 18 had no diabetes; and 18 with painless polyneuropathy of different etiologies) were examined clinically using quantitative sensory tests and neurophysiology. Pain intensity and characteristics were analyzed by daily ratings on a 10-step verbal scale and by a questionnaire.ResultsMost patients experienced pain of more than one character. There was no clear difference in character or duration of pain between patients with and without diabetes. The mean value of the daily rating of pain intensity showed that pain was more severe in the evenings than in the mornings and that diabetic patients reported worse pain than nondiabetic patients.Thirty-two of the 37 patients with pain had paresthesias and/or dysesthesias, whereas only 7 of 18 patients without pain had paresthesias. Pain was always located in the feet, and, in most patients, also in the lower part of the legs. Some patients also experienced pain in the hands.Tactile sensibility, measured by quantitative tests, was more affected in both diabetic and nondiabetic patients with painful polyneuropathy compared with patients without pain (p= 0.02). Temperature, pain, and vibratory sensibility were equally affected in all patient groups. Nerve conduction velocity, amplitudes, and distal latency were equally affected in the pain group as compared with the control group, indicating that both thin and thick nerve afferents are affected in patients with painful as well as nonpainful polyneuropathy and that etiology has no clear impact on nerve involvement.ConclusionsNeuropathy pain was always located in the feet and more severe in diabetic patients compared with patients with neuropathy pain of other etiologies. The authors also found evidence for a greater tactile sensibility involvement in patients with neuropathy pain, irrespective of etiology, whereas other quantitative sensibility and neurography parameters were equally affected in all patient groups.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectivesThe case here presented adequately reflects the difficulties involved in the treatment of pain in patients where the neuropathic component of pain predominates, and shows the different therapeutic steps that may be taken—from surgery and radiotherapy, to the administration of different drugs via the spinal route, to, finally, the presently little-used option of a direct intraventricular access.ConclusionsSpinal tumors are infrequent, but pose great difficulties for the management and control of the pain they cause. The utility of the spinal route as an early approach for the provision of adequate analgesia seems clear. However, it also appears to lose efficacy with time, and dose incrementing and/or the addition of drugs that enhance the analgesic action of morphine are not always effective. In such selected cases, the intraventricular route may constitute a useful alternative, allowing improved symptoms control with lower morphine doses, and the use of the system previously implanted for intrathecal spinal infusion.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveMeralgia parestheticais a syndrome of pain or dysesthesia or both in the anterolateral thigh, caused by entrapment of the lateral femoral cutaneous nerve at the anterior superior iliac spine. The aim of this report is to emphasize that meralgia paresthetica can be confused with low-back pain.PatientA 21-year-old man was admitted to hospital because of low-back and thigh pain. He had a history of low-back pain. Physical examination and radiologic studies for low-back pain and radiculopathy showed no pathologic findings. It was suspected that the most likely cause was lateral femoral cutaneous neuropathy, caused by the wide military belt he continuously wore tightly around his waist.InterventionsThe nerve was blocked with 10 ml of bupivacaine 0.25%, which provided immediate pain relief. A nonsteroidal anti-inflammatory drug was administered orally.ResultsAfter 15 days of bed rest and 45 days without the belt, he was completely symptom-free.ConclusionsIt is important to be rigorous in investigating the etiology of low-back pain. Meralgia paresthetica can mimic low-back pain because of the similarity of the symptoms. It can be treated by conservative or ablative therapeutic interventions; however, conservative methods should be considered primarily.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID