ISSN:0749-8047    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objective:To assess the perceived efficacy of pain clinics in the rehabilitation of injured workers among four groups of professionals.Design:A questionnaire was given to 351 subjects representing four professional groups: physicians, vocational rehabilitation counselors, staff at pain clinics, and employees of a workers compensation program. Subjects rated the effectiveness of pain clinics in eight specific functions, estimated the percentage of workers who return to work after pain clinic treatment, and indicated how soon after injury a worker should be referred to a pain clinic.Results:Pain clinic staff consistently gave the most favorable ratings and workers compensation employees the least favorable ones. There was good agreement across professional groups regarding the need for early referral of injured workers to pain clinics and the specific functions that pain clinics carry out relatively well. Clinics were ranked as most effective in reducing workers' use of opiates, and as least effective in reducing workers' pain. Return-to-work estimates varied significantly across professional groups. Within professional groups, subjects with high estimates gave more favorable overall ratings to pain clinics.Conclusions:The results provide a profile of the perceived effectiveness of pain clinics in various functions and highlight the importance of getting accurate information about return to work rates following pain clinic treatment. They suggest that workers are not referred to pain clinics early enough.

ISSN:0749-8047    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objectives:Because musculoskeletal pain is the second most frequent reason for seeking health care, the aims of this study were to determine the value of psychosocial variables in evaluating risk for developing chronic back pain problems and to develop a screening methodology to identify patients likely to have a poor prognosis.Study Design:A prospective study was conducted on consecutive patients with acute or subacute back pain, in which patients completed a screening questionnaire and were then followed up for 6 months to determine outcome. The primary outcome variable was accumulated sick leave.Methods:One hundred forty-two consecutive patients were asked to complete a questionnaire designed for this study. This questionnaire contained 24 items concerning psychosocial aspects of the problem. Six months later, patients were contacted to complete outcome questions about accumulated sick leave.Results:A total of 97% of the patients completed both questionnaires. Although patients, on average, improved greatly, 18% had 1-30 days and 20% had fewer than 30 days of sick leave during the follow-up period. Five variables were found to be the strongest predictors of sick leave outcome (fear-avoidance work beliefs, perceived improvement, problems with work function, stress, and previous sick leave), correctly classifying 73% of the patients as opposed to a chance rate of 33%. A total score was evaluated as a means of judging risk and found to be strongly related to outcome.Conclusion:Potent psychosocial risk factors associated with future sick absenteeism were identified. Because the total score was related to outcome, the instrument may have use in screening patients with acute or subacute spinal pain in clinical situations.

ISSN:0749-8047    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objective:Pain-relieving effects of lidocaine/bupivicaine local anesthetic (LA) and saline (S) block of sympathetic ganglia (stellate block, 4 patients; lumbar sympathetic block, 3 patients) were compared in 7 complex regional pain syndrome (CRPS) patients on a double-blind crossover basis to evaluate the diagnostic and therapeutic value of local anesthetic sympathetic blocks.Design:Patients rated their pain on a visual analog scale before and after blocks and were tested for mechanical allodynia one-half hour after blocks. Thereafter, they rated their pain intensity in diaries four times a day for 7 days. Each patient received two blocks, S and LA, and served as his own control.Results:Both S and LA injections of sympathetic ganglia produced large reductions in pain intensity in 6 of 7 patients 30 minutes after block. These large reductions were accompanied by the reversal of mechanical allodynia in both S and LA. The mean difference between initial peak reduction in pain intensity produced by saline (68.7%) and active local anesthetic (74.4%) did not approach statistical significance. In striking contrast, the mean duration of pain relief was reliably longer in the case of LA (3 days, 18 hours) as compared with S (19.9 hours), a difference that occurred in all 7 patients. In a larger sample of 41 CRPS patients, signs of sympathetic efferent blockade, including Horner's syndrome or skin surface temperature change, were not predictive of initial peak magnitude of pain relief from sympathetic blockade but were predictive of duration of pain reduction.Conclusion:The combination of these results provides evidence thatdurationof pain relief is affected by injection of local anesthetics into sympathetic ganglia. These results indicate thatbothmagnitude and duration of pain reduction should be closely monitored to provide optimal efficacy in procedures that use local anesthetics to treat CRPS.

ISSN:0749-8047    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objective:To determine whether homeopathicArnica30× can reduce muscle soreness following long-distance running more than a placebo.Design:Randomized, double-blind placebo-controlled trial.Setting:Long-distance runs taking place in the community.Subjects:A total of 519 runners anticipating delayed-onset muscles soreness after long-distance races.Interventions:A homeopathic medicine (Arnica30×) and an indistinguishable placebo.Outcome Measures:Subjects completed a visual analog scale and Likert scale of muscle soreness every morning and evening for the 5 days following their race. Race time was also recorded. The main outcome measure was mean 2-day visual analog scores.Results:Results were obtained from 400 subjects. Groups were well matched at baseline. Mean 2-day visual analog soreness scores forArnicaand placebo were 45.2 mm and 41.0 mm, respectively. The 95% confidence interval was between 8.81 mm in favor of placebo and 0.51 mm in favor ofArnica.No differences were found for Likert scores or race time.Conclusion:HomeopathicArnica30× is ineffective for muscle soreness following long-distance running.

ISSN:0749-8047    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objective:The efficacy of an integrated, psychological treatment program was tested in a controlled study involving 27 patients with chronic musculoskeletal pain (fibromyalgia).Design:The experimental treatment program consisted of instruction in various selfhelp techniques(e.g., cognitive behavioral strategies, relaxation, physical exercises) as well as information on chronic pain. Control groups were instructed only in autogenic training. Measures of pain, daily activities, general symptoms, and psychological functioning were assessed before and after treatment, as well as at 4 months after termination of therapy (follow-up).Results:At the end of treatment, 7 patients from the experimental group and 2 from the control group showed significant clinical improvement in 3 of 6 parameters (NS). At follow-up, the improvement was still present in 5 experimental cases but in none of the controls (p= 0.024). Successful patients had been sick for a shorter period of time and were less impaired by their condition.Conclusions:Psychological interventions in combination with physiotherapy can be effective in treating fibromyalgia patients, especially if applied early.

ISSN:0749-8047    

出版商:OVID    

年代:1998

数据来源: OVID