ISSN:0749-8047    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Objective:To review the published literature on the use of spinal opioids in the treatment of chronic pain due to nonmalignant diseases.Design:Literature review.Results:Ten studies describing 146 patients have been located and reviewed. The data are insufficient to permit formal analysis.Conclusion:The proper role of intraspinal opioids in the treatment of chronic pain not due to cancer cannot be determined from the existing literature. Intraspinal opioids should be considered an experimental procedure for chronic pains not due to cancer until better data can be obtained; all patients who receive such therapy should be part of a clinical protocol whose results are published. The development of standardized clinical trial methodology and case reporting protocols would facilitate this process.

ISSN:0749-8047    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Objective:To assess the evidence for pharmacological, behavioural, and interpersonal influences on quality of pain management in sickle cell disease.Data Sources:English-language reports from the research literature up to 1995, identified using Medline, Psychlit, and the Bath Information Data Service.Study Selection:Studies are reviewed that (a) reported quantitative clinical outcomes for particular analgesic methods used to treat painful episodes or (b) provide data on patient factors, interpersonal treatment factors, or levels of drug dependence in relation to pain management in sickle cell disease.Data Synthesis:Findings vary on the effectiveness of longer-acting opiates, patient-controlled or continuously infused analgesia, and behavioural analgesic techniques, with better results for trials where interpersonal aspects of pain management were also addressed. Risks for poorer pain management are greatest for patients in adverse social circumstances, who are more severely affected by painful episodes and who are poorly adjusted and have less effective personal strategies for coping with pain, but the limited evidence on drug dependence indicates very low levels by comparison with risk and exposure factors.Conclusions:Analgesic methods and approaches should continue to be developed and evaluated, but conflicting perceptions between patients and staff about pain that is reported and analgesia that is required probably contribute most to poor pain management in sickle cell disease. Promising areas for future research include the assessment of patients' everyday pain coping styles and patterns of drug use in relation to their hospital experiences of pain management, and the evaluation of psychological interventions to improve patients' styles and strategies for coping with pain.

ISSN:0749-8047    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Objective:A cross-sectional study on patients with chronic low back pain to compare relationships between subjective disability and pain intensity, pain duration, pain location, and work-related factors.Design and Subjects:One hundred and seven outpatients with low back pain, with or without radiation to the legs, of at least 3 months' duration, were administered a comprehensive back patient questionnaire. The questionnaire included the Pain Disability Index (PDI) for the assessment of overall perceived disability and assessments of pain intensity, duration, and location and two pretested short-form work questionnaires. None of the patients had undergone a back operation.Setting:Tertiary care center.Results:There was evidence of significant interrelationships between the PDI and pain intensity (low back pain, r = 0.53, p < 0.001; leg pain, r = 0.32, p < 0.01; and buttock pain, r = 0.36, p < 0.01), pain location (significantly higher scores with distal pain radiation), and work-related factors (a work load sum score of r = 0.31, p < 0.01; significantly higher scores in patients on sick leave).Conclusions:The results suggest that subjective disability in patients with chronic low back pain overlaps with both pain and work-related factors. The observations support the multidimensionality of low back disability.

ISSN:0749-8047    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Objective:Previous reviewers of the literature on transcutaneous electrical nerve stimulation (TENS) outcome have concluded the following: (a) there are few long-term TENS follow-up studies, and (b) fewer studies have addressed the effect of long-term TENS use on outcome variables other than pain (e.g., function).Design/Setting/Participants/Outcome Measures:From a population of 2,003 chronic pain patients (CPPs) who bought a TENS device for pain management, 506 patients were randomly selected and interviewed by telephone long enough after purchase to allow at least 6 months of TENS use. The interview process used a structured “skip” questionnaire designed to assess the CPPs' perceptions regarding the effectiveness of TENS for a variety of outcome variables. Of the 506 CPPs interviewed, 376 (74.3%) had used their TENS device for 6 months or longer and were defined aslong-term users. The responses of this group of CPPs to the telephone questionnaire were then subjected to statistical analysis.Results:Pairedt-tests, correlated z-tests, SS Wilks, and chi-square tests demonstrated statistically significant change or improvement (p < 0.05) that paralleled the introduction of TENS use in the following outcome variables: less pain interference with work, home, and social activities; increased activity level and pain management; decreased use of other therapies (e.g., physical therapy, occupational therapy, chiropractic); decreased use of narcotics, tranquilizers, muscle relaxants, nonsteroidal anti-inflammatory drugs and steroids.Conclusions:The results suggest that TENS is associated with improvement on multiple outcome variables in addition to pain relief for CPPs who are long-term users. Also, for some CPPs, long-term TENS use continues to be effective.

ISSN:0749-8047    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Objective:We investigated the prevalence of a history of sexual abuse among patients with long-term musculoskeletal pain. Psychological factors associated with abuse and pain were also studied.Design:First, the prevalence of abuse was determined based on self-report on a valid and reliable abuse questionnaire. Subsequently, a cross-sectional method, in which patients were categorized as abused or non-abused, was employed and responses to a battery of questionnaires compared.Patients:Seventy-five consecutive patients undergoing assessment for chronic musculoskeletal pain participated.Outcome Measures:These included Beck's Depression Inventory, the Coping Strategies Questionnaire, the Multidimensional Pain Inventory, the Uppsala Type A Behavior Questionnaire, the Pain and Impairment Rating Scale, as well as ratings of pain intensity.Results:Thirty-eight percent of the women and 10% of the men reported some form of sexual abuse, usually during adulthood. A majority (77%) had disclosed the abuse to someone, but >85% did not believe that the abuse negatively affected their pain or sex lives. Abused women, relative to non-abused ones, had poorer scores on 27 of the 29 assessment variables. Abused female patients had significantly higher levels of depression, stress from daily hassles, affective distress, and more frequent negative responses from spouses, in addition to having lower levels of social activities, life control and effective coping for pain than did the nonabused female patients.Conclusion:These data extend the relationship between sexual abuse and pain to a Swedish population suffering from musculoskeletal complaints. Our findings suggest that intervention in the pain treatment setting may need to address further the problems of effective coping strategies and depression.

ISSN:0749-8047    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Objective:To look for anatomical and histochemical signs of interaction between sensory and sympathetic nerves in the hyperalgesic skin of patients with complex regional pain syndrome.Subjects:Skin samples were obtained from eight patients whose condition developed after a suspected or confirmed peripheral nerve injury, and from nine patients with features of reflex sympathetic dystrophy (RSD) following a soft-tissue injury. A skin sample was also obtained from 18 control subjects of similar age and sex distribution to patients.Design:In patients, skin samples were taken from an area of static mechanical hyperalgesia and from an equivalent site in the contralateral limb. In controls, skin samples were obtained from the dorsum of one hand or foot.Histochemical Markers:We used neuron-specific enolase for all classes of nerve fiber; tyrosine hydroxylase for noradrenergic fibers; vasoactive intestinal peptide for sympathetic sudomotor fibers; tyrosine hydroxylase co-existing with neuropeptide Y for sympathetic vasoconstrictor fibers; and calcitonin gene-related peptide with substance P or somatostatin for peptide-containing unmyelinated sensory fibers.Results:In patients, the distribution of markers was similar in skin taken from an area of mechanical hyperalgesia and skin taken from an equivalent site contralaterally, and was unrelated to clinical features of RSD. The distribution of markers did not differ between patients and controls. Nerve tangles immunoreactive to neuron-specific enolase, but not to other markers, were detected in samples taken from four patients and two controls. The nerve tangles were present bilaterally in two patients, and only on the affected side in two other patients. The clinical condition was more fully developed in the four patients whose skin samples contained nerve tangles than in most other patients.Conclusions:A major difference in distribution or change in histochemical content of cutaneous autonomic or nociceptor fibers is unlikely to underly static mechanical hyperalgesia following a soft-tissue or peripheral nerve injury. The relevance of cutaneous nerve tangles for the pathophysiology of RSD is uncertain.

ISSN:0749-8047    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Objective:To examine the social barriers that lead to less than optimal management of pain in children.Design:Recognizing the vulnerabilities of infants and children and their dependence on caring adults, a model of pain communication is proposed. The model examines (a) the pain experiences of children, including social determinants; (b) developmental variations in the capacity to encode the severity and qualities of pain as expressive behavior; (c) adult skills and deficiencies in decoding pain; and (d) the actions of adults predicated on the meaning and significance attached to children's actions. Limitations in care were examined.Data sources:The current research and professional literature were accessed through searches of the Psyclit and Medline databases for relevant investigations on the basis of our working knowledge of the literature.Conclusion:Numerous deterrents to optimal care are identified in the domains of commonplace beliefs about the nature of pain in infants and children: failure to recognize the impact of socialization in familial and cultural modes of experience and expression; needs for age-specific assessment instruments; the limited capacity to use available evidence concerning pain; the need to employ clinicians, parents, and other adults more effectively in delivering care; and structural problems in the health care system.

ISSN:0749-8047    

出版商:OVID    

年代:1996

数据来源: OVID