摘要:

ObjectiveThe objective was to evaluate whether the Multidimensional Pain Inventory (MPI) is effective for predicting response to interdisciplinary treatment in a heterogeneous group of patients with chronic pain. Changes in patients' profiles to a predominantly adaptive coping status after treatment also were assessed.DesignA prospective study was conducted of patients with an array of pain conditions. A standard evaluation battery, including measures of self-reported pain and disability, psychosocial functioning, helpfulness of the program, and medication use, was used for all patients before and after treatment. The MPI status of patients was evaluated and differential response to treatment was assessed.MethodsSixty-five consecutive patients with chronic pain were evaluated before and immediately after participation in an interdisciplinary pain treatment program. This heterogeneous pain-condition cohort was also differentiated on the basis of the MPI to evaluate potential differential response to treatment.ResultsResults revealed significant improvement among these patients with chronic pain when a comprehensive interdisciplinary pain-management program was administered. This improvement was seen across the variety of outcomes evaluated, including narcotic medication use. Most important, the MPI subgroup classification did not significantly predict the degree of positive treatment outcome; all subgroups improved.ConclusionsAlthough there were major differences in psychosocial functioning before treatment, the MPI was not found to significantly predict response to interdisciplinary treatment in a heterogeneous group of patients with chronic pain. Thus, a comprehensive interdisciplinary treatment program may achieve its full effectiveness across a wide array of pain/disability-related outcome variables, regardless of initial MPI profile categorization.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveSexual dysfunction and low testosterone levels have been observed previously in males with chronic noncancer pain treated with intrathecal opioids. To investigate the hypothesis that intrathecal opioids suppress the hypothalamic-pituitary-gonadal axis, a prospective nonrandomized investigation of the function of this axis was undertaken.DesignTen males with chronic noncancer pain were evaluated for clinical and biochemical evidence of hypogonadism at baseline and during the first twelve weeks of intrathecal opioid therapy.ResultsIntrathecal opioid administration resulted in a significant (p<0.0001) reduction in serum testosterone, from 7.7 ± 1.1 (mean ± SEM) nmol/L at baseline to 2.0 ± 0.7, 2.8 ± 0.5, and 4.0 ± 0.9 nmol/L at 1, 4, and 12 weeks, respectively. This was associated with a reduction in libido and potency. Luteinizing hormone and follicle-stimulating hormone levels remained within reference ranges, indicating central rather than peripheral suppression.ConclusionsAdministration of intrathecal opioids may result in hypogonadotrophic hypogonadism. As part of the consent for therapy process, patients should be informed about this effect and its management. With long-term intrathecal opioid administration, the hypothalamic-pituitary-gonadal axis should be monitored. Where indicated, testosterone replacement should be undertaken to improve sexual function and prevent the potential metabolic effects of hypogonadism, in particular, osteoporosis.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveThe aim of the study was to compare the therapeutic effect of the superficial and in-depth insertion of acupuncture needles in the treatment of patients with chronic lumbar myofascial pain.DesignA prospective randomized double-blind study of superficial and deep acupuncture was conducted.SettingThe study was conducted in the Pain Service Unit of the University of Padova.PatientsThe study comprised 42 patients with lumbar myofascial pain who were divided into two equal groups (A and B).InterventionIn group A, the needle was introduced in the skin at a depth of 2 mm, whereas in group B the needle was placed deeply into muscular tissue. The treatment was planned for a cycle of eight sessions.Outcome MeasuresThe intensity of pain was evaluated with the McGill Pain Questionnaire before and after treatment and at the 3-month follow-up examination.ResultsAlthough at the end of the treatment there was no evidence of significant statistical differences between the two different groups, pain reduction was greater in the group treated with deep acupuncture. A statistical difference existed between the two groups at the 3-month follow up, with a better result in the deeply stimulated group.ConclusionsClinical results show that deep stimulation has a better analgesic effect when compared with superficial stimulation.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveThe objective was to investigate, in two community samples of people with spinal cord injuries, the frequency of use of different pain treatments and the perceived helpfulness of these treatments.Design and SettingA postal survey was conducted in the community.ParticipantsThe participants were 471 persons aged 18 years or older who had spinal cord injuries and pain. There were 2 separate samples (n = 308 and n = 163).Outcome MeasuresThe pain treatments used, the helpfulness of these treatments, and the Chronic Pain Grade questionnaire answers were assessed.ResultsRespondents reported multiple pain treatments (range of 0–14 and median of 4 in sample 1; range of 0–16 and median of 4 in sample 2). The most commonly reported treatments were oral medications and physical therapy. Medication types most commonly reported were nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids. The treatments rated as most helpful were opioid medications, physical therapy, and diazepam therapy, and those rated as least helpful were spinal cord stimulation, counseling or psychotherapy, administration of acetaminophen, and administration of amitriptyline. Alternative treatments reported as most helpful were massage therapy and use of marijuana. Acupuncture was tried by many but was rated as only moderately helpful.ConclusionsThis survey of two large samples of community-dwelling individuals with spinal cord injury–related chronic pain indicates that multiple pain treatments are tried but only a few are rated as more than somewhat helpful. Furthermore, the treatments that are most commonly reported are not always those that are rated as most helpful. The findings point to a number of potentially fruitful directions for future research.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveThe objective was to assess the associations between changes in pain and grip strength and manual tests among patients with chronic tennis elbow.DesignMeasurements for 45 consecutive patients with unilateral tennis elbow were made before and after an exercise intervention.SettingThe setting was a physiatric outpatient clinic.PatientsThe patients were 45 persons with chronic unilateral tennis elbow: 32 women and 13 men. The mean age was 44 (31–54) years; mean duration of symptoms was 35 (10–66) weeks.Outcome MeasuresManual tests, pressure pain thresholds at three cubital points, a pain questionnaire, a pain drawing, and grip strength measurements were assessed.ResultsGrip strength became normal during the treatment. Pressure pain thresholds reached 66% of that of the healthy arm. Lowered pain thresholds and changes in pain thresholds of the lateral epicondyle were strongly associated with the findings in the manual tests. Mills test and resisted wrist extension tests were associated with perceived pain, and resisted wrist extension tests also were associated with decreased grip strength. Pain on palpation was associated with lowered pain thresholds at the lateral epicondylus and with perceived pain under physical load. After the treatment, for 13 patients all 4 manual tests were still positive; for 17 patients, 3 were still positive; and for 5 patients, all were negative. Positive clinical tests were associated with lowered pain thresholds, decreased grip strength, and high perceived pain scores.ConclusionsPain thresholds at the lateral epicondyles are strongly associated with pain on palpation and with a positive Mills test. Resisted wrist extension test results reflect decreased grip strength. Impaired function of the hand is associated with the number of positive clinical tests. Pain threshold evaluation is a simple, easy, inexpensive method that provides useful additional quantitative data on pain and disability among patients with chronic tennis elbow.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveAbnormalities of central sensory processing may play a role in the pathogenesis of chronic pain. TheChiari I malformationis a congenital hindbrain anomaly characterized by protrusion of the cerebellar tonsils into the upper cervical canal, with variable effects on the lower brain stem and cervical cord. The purpose of this study was to compare sensory function and pain among patients with chronic pain who had these disorders incidentally diagnosed, to assess the effect on pain in these patients in comparison with those without central nervous system disease.DesignRetrospective study in which pain, mood, and sensory function in 32 patients with chronic pain who had mild Chiari I malformation were compared with that in 53 patients with chronic pain who had moderate to severe compression of the cervical spinal cord and 52 patients with chronic pain who had no apparent central nervous system disorder. Data had been collected previously as part of standard clinical assessments, including clinical neurological examinations, quantitative sensory testing, pain drawings, and psychometric testing with the Symptom Checklist 90.PatientsAll subjects were patients of a hospital-based pain management practice who had been accepted for treatment over a 5-year period.ResultsBoth the Chiari I and cervical compression groups had long tract signs evident on clinical neurological examination. Quantitative sensory testing indicated elevations in the trigeminal territory among patients with Chiari I malformation and on the neck, hands, and feet in both the Chiari I and cervical compression groups. The extent of pain and mood disturbance was greatest in the Chiari I group and least in the group with no central nervous system disorder. Complex regional pain syndrome, fibromyalgia, and temporal mandibular joint disorder were more common among the Chiari I malformation group than among the other groups.ConclusionsQuantitative sensory analysis indicates sensory dysfunction associated with Chiari I malformation and cervical cord compression. The pattern of sensory abnormality is consistent with medullary dysfunction among the patients with Chiari I malformation and cervical cord dysfunction among cord compression patients. There were differences in the types and extent of pain and the associated disorders of mood observed among the cohorts defined above. These differences may be partly due to the presence and location of central sensory dysfunction.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveThe objective was to evaluate somatosensory thresholds to a multimodality stimulation regimen applied both within and outside areas of referred menstrual pain in dysmenorrheic women, over four phases of confirmed ovulatory cycles, and to compare them with thresholds in nondysmenorrheic women during menstruation.DesignTwenty dysmenorrheic women with menstrual pain scoring 5.45 ± 0.39 cm (mean ± standard error of mean) on a visual analog scale (10 cm) participated. Fifteen nondysmenorrheic women with a menstrual pain score of 0.4 ± 0.2 cm participated as controls. Ovulation was confirmed by an enzyme-multiplied immunoassay technique. Menstrual pain was described with the McGill Pain Questionnaire. Areas within menstrual pain referral were two abdominal sites and the midline of the low back, and the arm and thigh were the control areas. The pressure pain threshold (PPT) and pinch pain threshold were determined by a hand-held electronic pressure algometer, the heat pain threshold (HPT) by a contact thermode, and the tactile threshold with von Frey hairs.ResultsIn dysmenorrheic women the McGill Pain Questionnaire showed a larger sensory and affective component of pain than the evaluative and miscellaneous groups. The HPT and PPT were lower in the menstrual phase than in the ovulatory, luteal, and premenstrual phases, both within and outside areas of referred menstrual pain (p<0.01), with a more pronounced decrease at the referral pain areas. The pinch pain threshold was lower in the menstrual phase than in the ovulatory phase (p<0.02), and the tactile threshold did not differ significantly across the menstrual phases or within any site. Dysmenorrheic women had a lower HPT at the control sites and a lower PPT at the abdomen, back, and control sites, than in those of nondysmenorrheic women in the menstrual phase.ConclusionsThe results show reduced somatosensory pain thresholds during menstruation to heat and pressure stimulation, both within and outside areas of referred menstrual pain in dysmenorrheic women. Dysmenorrheic women showed a lower HPT at the control sites and a lower PPT at all the sites than those for nondysmenorrheic women in the menstrual phase. The altered somatosensory thresholds may be dependent on a spinal mechanism of central hyperexcitability, induced by recurrent moderate to severe menstrual pain.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo investigate integrative thermal perception in a patient with multiple sclerosis.DesignQuantitative thermosensory testing was used to evaluate pain and other sensations produced by heat, cold, and the thermal grill pain illusion.PatientThe authors report on a 43-year-old patient with central pain manifest most strongly in her left arm and hand, contralateral to an upper cervical spinothalamic lesion due to multiple sclerosis.Outcome Measures and ResultsQuantitative thermosensory testing showed that the patient had heat hypalgesia (no pain with stimuli of 45–50°C) and cold allodynia (pain with innocuous cool temperatures, 25–10°C). Whereas healthy subjects rated 20° and 40°C as nonpainful, but the thermal grill (intermixed 20 and 40°C stimuli) as painful, the patient rated the thermal grill as less painful than 20°C.ConclusionsThe absence of thermal grill-evoked pain is consistent with the hypothesis that in some cases of central pain the loss of the thermosensory pathway results in disruption of the normal cold inhibition of burning pain.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveThe authors sought to determine the usefulness of long-term continuous trigeminal nerve block with local anesthetics using an indwelling catheter in a patient with trigeminal neuralgia.DesignThe study design included pain control in a patient with trigeminal neuralgia until the time of neurosurgical operation.SettingThe study was conducted in the Dental Hospital of Tokyo Medical and Dental University.PatientThe patient was a 78-year-old woman with trigeminal neuralgia in the right maxillary region. Her pain could not be controlled by carbamazepine and was unbearable.InterventionThe authors estimated the patient's pain intensity, quality, and locality using a visual analog scale to determine the effectiveness of continuous nerve block.Outcome MeasuresVisual analog scores were measured during treatment. The treatment term was divided into three periods according to the difference of the catheter location and injection protocol (premandibular nerve block, infuser injection, and patient-controlled analgesia [PCA] pump injection). The authors also examined the patient's general condition and blood concentration of drugs.ResultsThe visual analog values were 44.8 ± 3.6, 26.7 ± 3.5, and 11.9 ± 3.1 mm in each period, respectively. The value in the PCA pump infusion period was significantly lower than that in the other periods. No side effects of the local anesthetics were observed on the patient's systemic condition.ConclusionsThe authors controlled trigeminal neuralgia pain by blocking the mandibular nerve with local anesthetics administered through an indwelling catheter. Because the continuous nerve block with local anesthetics is reversible and only mildly toxic, this method is beneficial for pain control in patients with trigeminal neuralgia scheduled to undergo microvascular decompression.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID