摘要:

ObjectiveAn overview is presented of neuropathic pain syndromes, their characteristic symptoms and signs, and recent approaches to identifying their pathophysiologic mechanisms.DesignThe results of recent clinical studies of neuropathic pain are reviewed. Chronic neuropathic pain syndromes are emphasized because these long-lasting and often disabling conditions present a much greater challenge for the clinician than acute pain. Peripheral neuropathic syndromes have received greater attention in the research literature than central pain, and studies of syndromes such as postherpetic neuralgia and painful diabetic neuropathy provide the basis for current knowledge of neuropathic pain.ConclusionsPrecise estimates of the prevalence of neuropathic pain are not available, but chronic neuropathic pain may be much more common than has generally been appreciated and its prevalence can be expected to increase in the future. There is considerable agreement that both peripheral and central processes contribute to many chronic neuropathic pain syndromes, and that these different mechanisms may explain the qualitatively different symptoms and signs that patients experience. The limitations of existing treatments for neuropathic pain and the inability to provide relief for many patients has stimulated ongoing studies that examine different approaches to preventing neuropathic pain.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveThis article reviews the prevalence, risk factors, natural history, and impact on quality of life of painful diabetic neuropathy (PDN) and postherpetic neuralgia (PHN).DiscussionDiabetes mellitus afflicts more than 14 million persons in the U.S. An estimated 20% to 24% of these persons experience PDN. Data on risk factors for PDN are limited, but duration of diabetes mellitus and poor glycemic control are probably important factors. Painful diabetic neuropathy may interfere with general activity, mood, mobility, work, social relations, sleep, leisure activities, and enjoyment of life. Herpes zoster strikes an estimated 800,000 persons each year in the U.S., most of whom are elderly or immunosuppressed. Using pain at 3 months after rash onset as a definition of PHN, between 25% and 50% of adults older than 50 years develop PHN, depending on early antiviral therapy for herpes zoster. Increasing age, greater pain and rash severity, greater degree of sensory impairment, and psychological distress are risk factors for PHN. Postherpetic neuralgia may cause fatigue, insomnia, depression, anxiety, interference with social roles and leisure activity, and impaired basic and instrumental activities of daily living.ConclusionsBoth conditions are common complications of their underlying disorders and can profoundly diminish the quality of life of affected persons.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveChronic pain is a prevalent and costly problem. This review addresses the question of the clinical effectiveness and cost-effectiveness of the most common treatments for patients with chronic pain.Data SourcesRepresentative published studies that evaluate the clinical effectiveness of pharmacological treatments, conservative (standard) care, surgery, spinal cord stimulators, implantable drug delivery systems (IDDSs), and pain rehabilitation programs (PRPs) are examined and compared. The cost-effectiveness of these treatment approaches is also considered.Data SynthesisOutcome criteria including pain reduction, medication use, health care consumption, functional activities, and closure of disability compensation cases are examined. In addition to clinical effectiveness, the cost-effectiveness of PRPs, conservative care, surgery, spinal cord stimulators, and IDDSs are compared using costs to return a treated patient to work to illustrate the relative expenses for each of these treatments.ConclusionsThere are limitations to the success of all the available treatments. The author urges caution in interpreting the results, particularly in comparisons between treatments and across studies, because there are broad differences in the pain syndromes and inclusion criteria used, the drug dosages, comparability of treatments, the definition of “chronic” used, the outcome criteria selected to determine success, and societal differences. None of the currently available treatments eliminates pain for the majority of patients. Pain rehabilitation programs provide comparable reduction in pain to alternative pain treatment modalities, but with significantly better outcomes for medication use, health care utilization, functional activities, return to work, closure of disability claims, and with substantially fewer iatrogenic consequences and adverse events. Surgery, spinal cord stimulators, and IDDSs appear to have substantial benefits on some outcome criteria for carefully selected patients. These modalities are, however, expensive. Pain rehabilitation programs are significantly more cost effective than implantation of spinal cord stimulators, IDDSs, conservative care, and surgery, even for selected patients. Research is needed to identify which patients are most likely to benefit from the available treatments and to study combinations of the available treatments since none of them appear capable of eliminating pain or significantly improving functional outcomes for all treated.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundPharmacoeconomic analysis is increasingly being used to assist decision makers in getting the biggest “bang for the buck” within cost-constrained health care budgets. The tools and techniques of this science, however, have scarcely been applied to neuropathic pain.ObjectiveTo describe the basic principles of pharmacoeconomic analysis and set forth a preliminary pharmacoeconomic model of neuropathic pain.Key FindingsApplying the tools and techniques of pharmacoeconomic analysis to neuropathic pain yields several insights. First, because pain treatment predominantly benefits quality of life, the results of a pharmacoeconomic analysis of neuropathic pain treatment should be expressed in terms of the cost per quality-adjusted life-year (QALY)-gained metric. Second, because pain can fluctuate, a state-transition modeling approach should be used in constructing the pharmacoeconomic model to account for changes in pain status over time, particularly as relates to the effects of treatment. Finally, assessment of typical practice patterns in neuropathic pain suggests that the pharmacoeconomic model should account for multiple rounds of treatment (i.e., first-line therapy, second-line therapy, and so on), primary care to specialty care referral patterns, and differences in costs and outcomes between primary care physicians and pain specialists.ConclusionsPharmacoeconomic analysis of neuropathic pain treatments can play an influential role in formulary committee deliberations, treatment algorithms, and decision making in the clinical setting. By describing the fundamental concepts and key challenges in this field, it is hoped that this article will represent a useful first step toward a pharmacoeconomic model of neuropathic pain.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveThe predelivery of intravenous alfentanil (a &mgr; opioid agonist) and ketamine (anN-methyl d-aspartate antagonist) has recently been shown to decrease the secondary hyperalgesia induced by intradermal capsaicin. The focus of this study was to determine the effects of the postdelivery of intravenous alfentanil and ketamine on intradermal capsaicin–induced secondary hyperalgesia.DesignDouble-blind, placebo-controlled, randomized, crossover study. Five minutes after an intradermal capsaicin injection, alfentanil and ketamine infusions were administered for a target plasma concentration of 75 ng/ml for alfentanil and 150 ng/ml for ketamine or placebo equivalent using a computer-controlled infusion pump and maintained for the remainder of the study. The investigator recorded the magnitude of the pain score at the time of injection and at 5-minute intervals. Fifteen minutes after the intradermal capsaicin injection, the region of secondary hyperalgesia and flare response was determined.ResultsAlfentanil and ketamine plasma levels targeted after injection of intradermal capsaicin had no significant effect on pain scores, flare response, or secondary hyperalgesia.ConclusionsConsistent with animal studies on preemptive analgesia, this study demonstrates that alfentanil and ketamine have a differential effect when delivered before and after a painful stimulus. Because of the differential effect seen, future studies on the pharmacology of human experimental pain should evaluate both predrug and postdrug delivery.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectivesTo report preliminary data relevant to the effects of an exercise and toileting intervention on pain among incontinent nursing home (NH) residents.DesignA randomized controlled intervention trial.Setting and ParticipantsFifty-one incontinent residents in one skilled NH.InterventionThe intervention was implemented by research staff for a total of 4 times a day (every 2 hours), 5 days a week, for 32 weeks. Residents were provided with incontinence care and assistance to either walk or, if nonambulatory, wheel their chairs, and to repeat sit-to-stand movements.MeasurementsPain was measured in two ways at baseline and again at 32 weeks: (1) a count of the number of verbal expressions and pain behaviors during a standardized physical performance assessment; and (2) a modified Geriatric Pain Measure administered in a one-on-one interview format.ResultsThere were significant differences between intervention and control groups on all physical performance measures over time, with the intervention group remaining stable and the control group showing a significant decline in sit-to-stand, walking, and wheelchair propulsion endurance. Both groups showed mild to moderate pain at baseline according to each of the two pain measures, while there were no significant changes in pain reports between groups over time based on either measure. There was, however, a trend for pain to increase in the intervention group.ConclusionsNo significant changes in pain reports were attributable to exercise despite significant improvements in physical performance. In fact, there was a tendency for pain reports to increase with exercise. These preliminary findings suggest that exercise alone may be ineffective for pain management among incontinent NH residents. Care providers should consider that exercise to improve physical function may increase pain symptoms, requiring preemptive analgesia, other pain control strategies, or modified exercise techniques for this frail segment of the NH population.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo test whether muscle pain intensity caused by different intensities of unaccustomed eccentric exercise was moderately and negatively associated with resting blood pressure, and whether women reported higher pain ratings compared with men in response to such exercise.Design and SubjectsThe repeated measures design involved random assignment of 42 young adults (21 women, 7 per condition) to complete elbow extension exercises with a weight that was 80%, 100%, or 120% of their maximal voluntary concentric strength. Total work was equated by manipulating the number of repetitions performed in the 80% (n = 45), 100% (n = 36), and 120% (n = 30) condition groups.SettingA clinical laboratory in a large university in the southeastern U.S.Outcome MeasuresPain intensity ratings averaged over 3 days and resting blood pressure measurements averaged over 6 days.ResultsFor both sexes there was a dose–response relation between the relative intensity of the unaccustomed eccentric exercise and mean pain intensity ratings. Mean pain intensity was not significantly related to systolic or diastolic blood pressure. There was no significant sex difference in pain intensity, although men's ratings, in contrast to expectations, tended to be higher than the women's ratings.ConclusionsThe negative findings, contrary to those predicted from previous experiments in which other types of noxious stimuli have been used, suggest that sex and blood pressure associations with pain intensity are stimulus dependent.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveThe aim of this study was to examine childhood traumatic experiences and dissociative characteristics in women with chronic headache and low back pain.SettingThe patients were evaluated in the multidisciplinary pain clinic of a university hospital.SubjectsThis study included 73 patients: 41 with chronic headache and 32 with chronic low back pain.Outcome MeasuresAll the patients were assessed with use of a semistructured questionnaire, the Dissociative Experiences Scale (DES), the Somatoform Dissociation Questionnaire (SDQ), and the Childhood Abuse and Neglect Questionnaire.Results and ConclusionsThere were no significant differences between the headache and low back pain groups in terms of prevalence of history of neglect; abuse; or sexual, physical, and emotional abuse separately. In addition, no significant differences were found between the groups with respect to the Dissociative Experiences Scale scores. However, analysis of the SDQ scores showed that the neglect rate in the two groups differed significantly. According to our findings, the neglect rate was higher in the headache group, thus warranting further research to investigate the sensitivity of the SDQ for neglect.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID