ISSN:0749-8047    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Objective:To examine possible deficiencies in endogenous pain modulating mechanisms in fibromyalgia patients compared with matched pain-free control subjects.Design/Subjects/Methodology:Pain reduction was investigated in 25 female patients with fibromyalgia and 26 age-matched healthy women using the diffuse noxious inhibitory controls (DNIC) paradigm. Tonic thermal stimuli at painful and nonpainful intensities, tailored to individual heat pain thresholds, were employed to induce pain inhibition. The anticipated effect was assessed by measuring the electrical pain threshold and detection threshold, using a double staircase method. Only nontender control points were stimulated (thermode on the foot, electrodes on the inner forearm).Results:The patients with fibromyalgia had significantly lower heat pain thresholds than the healthy subjects, but similar electrical detection and pain thresholds. The repeatedly applied electrical stimuli resulted in a degree of perceptual adaptation that was similar between the two groups. However, concurrent tonic thermal stimuli, at both painful and nonpainful levels, significantly increased the electrical pain threshold in the healthy subjects but not in the fibromyalgia patients. The electrical detection threshold was not affected in either group.Conclusions:Pain modulation, produced by a concurrent tonic stimulus in healthy persons, was not seen in the fibromyalgia group. The patients either had deficient pain modulation or were unable to tolerate a tonic stimulus intense enough to engage a modulatory process. It remains to be established whether the pain reduction found in the healthy subjects was the conventional DNIC effect, another effect (e.g., distraction), or a combination of both.

ISSN:0749-8047    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Objective:To explore the influence of age on the empirical classification of patients with chronic pain.Design:Cluster analyses of two cohorts defined by age.Setting:Two outpatient pain management clinics for young and older people.Sample:The sample consisted of 340 patients between the ages of 17 and 93 years, who were consecutively assessed on admission to the multidisciplinary pain clinics. The subjects were allocated to two groups according to age; either 17 to 65 years or 66 years and older.Measurements:Clustering was carried out using standardised scores from measures of pain (McGill Pain Questionnaire), depression (Zung or Geriatric Depression Scales), and impact of pain (Sickness Impact Profile adapted for pain).Results:Previous classifications of younger adults were replicated in the clusters of: "Good Pain Control," "Positive Adaption to Pain," and "Chronic Pain Syndrome." A fourth cluster, "High Impact," was identified in the older group and subsequently replicated in the combined sample. This group consisted of subjects with high levels of impact of pain and depression and low levels of pain.Conclusion:Age differences are present in the clinical presentation of chronic pain patients. Some older patients with chronic pain present with a unique constellation of clinical symptoms, and the classic patient profile of high pain, high impact, and high mood disturbance (i.e., Chronic Pain Syndrome) identified in younger to middle-aged adults does not occur as frequently in older patients. A number of explanations are presented to account for these differences, including comorbidity as well as other medical, psychological, and social factors.

ISSN:0749-8047    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Objective:Because back pain patients often relapse within months of treatment, the effects of two types of support groups as a complement to usual medical treatment was investigated on long-term outcome.Design:Regular treatment was compared with an "educational" support group and a professional support group before and 1 year after intervention in a randomized controlled trial.Patients:A total of 76 women and 27 men, average age of 50 years and with an accumulated sick leave for musculoskeletal pain of 2-24 weeks during the past year, were randomly assigned to the three groups.Outcome Measures:Sick leave records were obtained from the National Insurance Authority. A battery of standardized instruments was employed, which featured the Sickness Impact Profile, the Coping Strategies Questionnaire, the Multidimensional Pain Inventory, the Pain and Impairment Relationship Scale, the Pain and Discomfort Scale, the Pain Beliefs and Perceptions Inventory, and the Outcome Evaluation Questionnaire.Results:The Educational Support Group demonstrated greater attendance than did the Professional Support Group. However, long-term outcome was not significantly different between any of the groups for sick leave, coping, function, or experienced pain. Both support groups, relative to the Regular Treatment Group, made greater improvements on the Sickness Impact Profile.Conclusion:This study provides little evidence that support groups, as a complement to regular treatment, enhance long-term outcome for subacute musculoskeletal pain problems. Specific treatment techniques, matched to the patient's needs, stringently taught, and delivered in a more compact form, may be necessary for enhancing outcome.

ISSN:0749-8047    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Objective:Increasing attention has been given to the assessment of patient satisfaction as a way to monitor quality of care in hospital settings. Postoperative patient satisfaction has been thought to be related to level of pain intensity, expectations of outcome, perceived concern by the staff, and helpfulness of treatments. The aim of this study is to develop a simple, reliable measure to assess pain and satisfaction in postsurgical patients and to examine factors related to patient satisfaction.Design:A satisfaction questionnaire was developed for this study and administered to 119 patients who had undergone a major orthopedic surgical procedure. The majority of the patients were diagnosed with osteoarthritis and reported moderate to severe preoperative pain. The 13-item measure was found to be reliable (test-retestr= .86; interexaminerr= .98), valid (exploratory factor analyses; intercorrelations), and easy to administer.Results:Results showed that the majority of the patients were satisfied with their care (91%), postoperative pain intensity (94%), and the way they were treated by the physicians and nurses (98%). Patients with low postoperative pain ratings who perceived that the physicians and nurses showed concern with how much pain they were feeling reported greatest satisfaction with their care (p < .001). In general, lower postoperative pain ratings were the best predictors of satisfaction and helpfulness of treatment. Preoperative pain status, expected level of postoperative pain, and time waiting for pain medication after a request was made were not significantly correlated with ratings of postoperative pain or satisfaction.Conclusions:These results highlight the important influence of adequate treatment of postoperative pain and perceived concern by the hospital staff on patient satisfaction.

ISSN:0749-8047    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Objective:To identify the pretreatment characteristics and progress in treatment and outcomes of chronic pain patients, with and without concomitant traumatic brain injury (TBI).Design and Patients:Retrospective cohort study of 12 consecutive patients in a chronic pain treatment program who were discovered to have previously untreated brain injury and a cohort of 12 chronic pain patients from the same program matched for age and sex who did not have brain injury.Setting:Interdisciplinary university-based outpatient rehabilitation medicine clinic.Main Outcome Measures:Length of time in treatment and vocational outcomes.Results:A surprising number of patients referred for treatment of chronic pain were found to have history and symptoms indicative of previously untreated or undiagnosed mild traumatic brain injury (n = 21 of 65). Of these, 12 received therapy for both their brain injury and chronic pain. The 12 treated, dual diagnosed patients did not differ in terms of education, employment status, or marital status from the chronic pain patients. Those with TBI were more likely to have sustained an automobile injury and less likely to have a work-related injury. On admission, 25% of each group were working, and at discharge, that proportion reached 75% for each group. Those with TBI required significantly longer treatment (459 consecutive days) from intake to discharge compared with the control group (295 days).Conclusion:Patients who exhibit memory or concentration problems, who express confusion about their diagnosis, who were injured in an automobile accident, or who complain of pain in the head, neck, or arms should be questioned about the possibility of concurrent TBI. Most of these patients can achieve successful employment outcomes, however, the TBI group may require a longer treatment time.

ISSN:0749-8047    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Objective:The objective was to assess the analgesic, antihyperesthesic, and antiallodynic properties of SNX-111 in neuropathic pain.Design:We describe a patient with refractory, severe deafferentation pain successfully treated with SNX-111 in an open-label, baseline-controlled Phase I/II trial.Setting:The patient was hospitalized for treatment and observation.Patient:The patient was a 43-year-old man with intractable deafferentation pain of 23 years' duration secondary to brachial plexus avulsion.Intervention:SNX-111, the first neuron-specific, N-type, voltage-sensitive calcium channel blocker developed for clinical use, was administered by continuous, constant-rate, intrathecal infusion via an indwelling cervical catheter.Outcome Measures:The primary outcome measures were the Visual Analog Scales of Pain Intensity (VASPI) and Pain Relief (VASPR).Results:The patient experienced complete pain relief (VASPI = 0.0 cm and VASPR = 10.0 cm) with elimination of hyperesthesia and allodynia.Conclusions:SNX-111, administered intrathecally by continuous, constant-rate infusion, produced dose-dependent pain relief in a 43-year-old male patient with a 23-year history of intractable deafferentation and phantom limb pain secondary to brachial plexus avulsion and subsequent amputation. Dizziness, blurred vision, and lateral-gaze nystagmus were dose-dependent side effects that resolved with decreasing dose levels. Complete pain relief was achieved in this patient without side effects after dose adjustment. We conclude that SNX-111 is a potent analgesic, antihyperesthesic, and antiallodynic agent. Controlled studies of SNX-111 in patients with malignant and nonmalignant pain syndromes are warranted and are under way.

ISSN:0749-8047    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Case Report:Three cases of intractable pain arising from widespread metastatic cancer with poor response to opioids were treated with MRI-guided cingulotomy.Results and Conclusions:In most cases, MRI-guided cingulotomy was associated with significant pain relief and reduced opioid use. To provide insight into the role of MRI-guided cingulotomy in oncologic pain refractory to more conservative measures, the relative risks and benefits of cingulotomy are discussed, along with the course of one patient who experienced postoperative cognitive impairment. This report also describes the relevant neurosurgical and pharmacotherapeutic issues associated with management of pain in patients with widespread metastatic disease.

ISSN:0749-8047    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1997

数据来源: OVID