ISSN:0749-8047    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:This study evaluated the effects of a group learning program on patients with chronic musculoskeletal pain and high absenteeism and investigates what characterizes those patients who may benefit from such a program. The learning program was based on personal construct theory. The theory included the following: (1) participation in an educational program is related to a favorable outcome across the outcome measures (pain, pain coping, management of daily life, absenteeism, and use of health care), (2) patients with high agency orientation (i.e., inner-directed) cope with their pain and manage daily life in a better manner than do patients with low agency orientation (i.e., outer-directed), and (3) patients with high personal control, measured in terms of agency orientation, in terms of health locus of control, or in both terms, will benefit more from the educational program than will patients with low personal control.Design:The study was a randomized controlled study.Patients:One hundred and sixteen patients with chronic musculoskeletal pain and high absenteeism answered a questionnaire before and after the intervention program. The intervention group (n = 61) consisted of nine subgroups geographically spread through the eastern part of Norway and met for four hours every 2 weeks from February 1997 to October 1997. A total of 12 meetings were held.Results:The intervention group reported a significantly higher score for the variable "management of everyday life" (p<0.005) and for the variable "health care consumption" (p<0.001) than did the control group. Patients with high agency orientation benefited more from the program with regard to pain reduction and improved pain coping than did those patients with low agency orientation (p<0.05). Patients with high agency orientation also reported less absenteeism than did those patients with low agency orientation (p<0.05).

ISSN:0749-8047    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:To determine the sleep quality and quality of life for individuals with degenerative spinal disease or failed back surgery syndrome.Design:Cross-sectional survey design utilizing standardized instruments. Data were analyzed with use of hierarchical stepwise multiple regression analyses.Patients:One hundred sixty-seven individuals with degenerative spinal disease or postlaminectomy syndrome who presented to a tertiary care outpatient patient pain center.Outcome Measures:The Center for Epidemiological Studies Depression Index measured depressive symptomatology. A modified Pittsburgh Sleep Quality Index (PSQI) measured sleep quality. The arithmetic average of least and usual VAS ratings of pain measured everyday pain. A visual analog scale rating of highest pain during the past 2 weeks measured highest pain. The Epworth Sleepiness Scale measured daytime sleepiness. The Medical Outcome Study-Short Form-Health Survey (SF-36) measured the mental health and general health components of quality of life.Results:Higher overall sleep quality and lower sleep latency primarily were related to higher ratings of physical functioning and shorter duration of pain. Ratings of the highest pain, but not everyday pain, were independent predictors of overall sleep quality and sleep latency. Daytime sleepiness was associated with younger age and depressed mood. Pain was not associated independently with daytime sleepiness. The quality of life related to mental functioning was associated positively with depressed mood and with the interaction of pain and depressed mood. None of the variables in the model (i.e., pain intensity, sleep quality, depression, and demographic variables) predicted quality of life related to overall general health.Conclusions:These data suggest that physical functioning, duration of pain, and age may be more important than pain intensity and depressed mood in contributing to decreased overall sleep quality and sleep latency. The contribution of physical functioning was particularly strong and should be included in subsequent studies of sleep, pain, and mood. The SF-36 should be compared to pain-specific quality-of-life measures to further evaluate the usefulness of this instrument with outpatients with chronic nonmalignant pain conditions.

ISSN:0749-8047    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:To determine the part played by drag on the pectoral girdle muscles of women in the production of pain in these muscles from breast weight being carried at the shoulders through the brassiere straps.Design:When patients presented with pain in the pectoral girdle musculature, breast weight was recorded. The sites of pain and tenderness were also recorded because tenderness in the trapezius has been shown to correlate well with muscle ischemia. The patient was then asked if she would be willing to remove breast weight from the shoulders for two weeks, as a trial, to see whether pain was relieved. The Studentttest was used to determine whether breast weight was significant in producing symptoms and signs in the pectoral girdle musculature and, if so, where these sites were located.Setting:Private surgical practice with patients initiating the consultation randomly.Intervention:Removal of breast weight from the shoulders for a period of 2 weeks. The choice of method was left to the patient. Most chose brassiere removal; only one patient chose a strapless brassiere.Results:Presence or absence of muscle pain after the trial period. Long-term outcome was presence or absence of muscle pain and tenderness. Seventy-nine percent of patients decided to remove breast weight from the shoulder permanently because it rendered them symptom free.

ISSN:0749-8047    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:To compare pain relief in metastatic pancreatic cancer patients between neurolytic celiac plexus block (NCPB) and epidural 5% butamben suspension (EBS), a material-based delivery system of a local anesthetic that produces a long-lasting differential nerve block.Design:Open-label patient-selected parallel groups.Setting:Urban tertiary care medical center.Patients:Twenty-four adult patients with metastatic pancreatic cancer experiencing pain uncontrolled by systemic opioids who were referred to a multidisciplinary pain clinic for interventional therapy.Interventions:Antecrural NCPB-block with ethanol and epidural 5% butamben suspension injections.Measures:Subjective global pain relief assessments on a 0-100% scale were made weekly for 4 weeks and then monthly. Change in opioid use postintervention.Results:Eight patients had a single NCPB and three patients had two NCPB. Four of the former and two of the latter had successful pain relief defined to be a more than 75% reduction in pain when compared with pretreatment maintained for more than 4 weeks or until death (if less than 4 weeks). Thirteen patients received EBS in divided doses. Eleven patients received a cumulative EBS dose of 5 grams, one patient received a cumulative EBS dose of 2.5 grams, and one patient received a cumulative EBS dose of 8.75 grams. Nine of the eleven patients and each of the other two patients had successful pain relief. The overall incidence (85% EBS vs. 55% NCPB), the duration of successful pain relief, and the percent reduction in opioid use did not differ between the two groups. There were no serious complications.Conclusion:EBS appears to be a safe and effective alternative to NCPB in the treatment of pancreatic cancer pain.

ISSN:0749-8047    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:The objective of this study was to determine if intractable pain from erythromelalgia could be successfully treated with intrathecal hydromorphone and clonidine.Design:A single case of pain from erythromelalgia refractory to multiple treatment modalities was examined and treated.Setting:The setting is an outpatient pain clinic at a major university teaching hospital.Patient:Our patient is an 82-year-old woman with hypertension and peripheral vascular disease.Intervention:Intrathecal opioid and an α2-agonist were administered.Outcome Measures:Outcome was determined by means of patient self-report during office follow-up visits.Results and Conclusions:Administration of intrathecal opioid and an α2-agonist can be effective in the treatment of the pain of erythromelalgia and offers an alternative pain treatment modality for patients with unremitting pain refractory to more conservative therapy.

ISSN:0749-8047    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objectives:One aim of this study was to evaluate the relation of scores on the Multidimensional Affect and Pain Survey (MAPS) that was administered before surgery to postoperative morphine consumption and patient-controlled analgesia. A second aim of the study was to compare the ability of MAPS administered postsurgery with the commonly used Numerical Pain Rating Scale to predict patient-controlled analgesia behavior.Design:The MAPS questionnaire measures pain, suffering, and well-being. It was administered to patients 1 day before and 1 day after left hemicolectomy for colon cancer. The relations of the two scores to postoperative pain control were determined.Patients:Thirty-four patients in the surgical ward of a general hospital admitted for colorectal cancer surgery participated in this study.Results:High preoperative MAPS scores on sensory and emotional words predicted postoperative morphine dosage, dose presses, and lockout presses. Greater morphine consumption was correlated positively with high presurgery MAPS scores in four of the eight "Suffering" subclusters (Depressed Mood, Anger, Anxiety, and Fear). High presurgery MAPS scores in 13 of the 17 "Sensory Qualities" subclusters (e.g., Bothersome, Intense Pain, Pain Extent, Incisive Pressure, Traction/Abrasion) were correlated positively with lockout presses. Neither the postsurgery MAPS nor the postsurgery Numerical Pain Rating Scale predicted patient-controlled analgesia behavior.Conclusion:The emotional states and attitudes of the patients to ward pain before surgery are important factors in determining patient-controlled analgesia pressing behavior and postoperative demand for analgesics.

ISSN:0749-8047    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:The purpose of this review is to examine the accumulating evidence indicating that lamotrigine is effective in the treatment of neuropathic pain.Method:A review of the available literature.Results:Neuropathic pain is a debilitating series of conditions that are often poorly controlled. The molecular action of lamotrigine in terms of its effects in preclinical models of pain and hyperalgesia are considered along with the accumulating evidence suggesting that lamotrigine may be effective in the clinical management of neuropathic pain.Conclusion:A review of the literature suggests that lamotrigine may be effective in the management of neuropathic pain.

ISSN:0749-8047    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:Six patients with severe neuropathic pain caused by a Pancoast tumor were treated with the continuous administration of local anesthetics. These patients had not responded to any other treatment, including nonsteroidal anti-inflammatory drugs, opioids, dexamethasone, tricyclic antidepressants, anticonvulsants, ketamine, and transcutaneous electric nerve stimulation.Interventions:An axillary catheter was placed in the brachial plexus using a posterior approach that has not been described previously. A continuous infusion system of local anesthetics was delivered via a catheter. In two patients, the main purpose was to evaluate the technical possibilities and implications of this new approach. In all patients, the visual analogue scale score was evaluated until the patient died. In four additional patients, the quality of life and performance skills were recorded.Results:In all patients, there was a significant reduction in the visual analog scale score, and there was an increase in performance skills and quality of life in four patients. No side effects occurred from this technique or from the continuous administration of local anesthetics.Conclusions:We conclude that neuropathic pain may be treated by local anesthetics administered through an axillary catheter placed in the brachial plexus. This technique is reversible and is preferable to destructive procedures such as cordotomy.

ISSN:0749-8047    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Twenty-seven clinical trials that evaluated the efficacy of acupuncture in the treatment of primary headaches (migraine headache, tension-type headache, and mixed forms) were reviewed. In the majority of the trials (23 of the 27 trials), it was concluded that acupuncture offers benefits in the treatment of headaches. Conversely, the evaluation of physical forms of treatment, including acupuncture, has special difficulties, and certain parameters in the study design need consideration. Acupuncture methods need individualization, a carefully selected placebo ("minimal acupuncture" seems to be best), and the crossover design must have adequate time between the two treatment periods. Clinical trials that evaluate acupuncture frequently are characterized by several inadequacies (including some from these evaluating headaches), but it seems that additional clinical research is necessary to confirm its efficacy and to clarify its indications.

ISSN:0749-8047    

出版商:OVID    

年代:2000

数据来源: OVID