ISSN:0749-8047    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectiveTo determine whether the tendency for chronic pain patients who receive Workers' Compensation to show a poorer response than non-compensated patients to pain treatment can be accounted for by mediating factors; to assess whether moderating factors can distinguish subgroups of Workers' Compensation recipients who react very poorly to treatment from compensated patients who respond well.DesignOutcome study based on archives.SettingMultidisciplinary pain treatment center.PatientsOf 214 patients, 158 had complete data.Outcome MeasureBlind ratings of narrative discharge summaries written by the Pain Treatment Center staff.ResultsA significant negative relationship between receiving Workers' Compensation and outcome was mediated by a pessimistic belief in the ability to return to former occupation. Moderator effects showed that Workers' Compensation recipients with high initial pain and a history of pain-related surgery fared worse than any other group. Moreover, Workers' Compensation recipients not characterized by high pain and a history of surgery responded as well as noncompensated patients.ConclusionsThe inadequate response to pain programs shown by Workers' Compensation recipients may be partly understood in terms of well-defined mediating factors, which may admit to amelioration via clinical intervention. Moreover, Workers' Compensation patients should not be considered high risks for failure by sole virtue of their compensation status. Multifactor assessment methods may be needed to identify that portion of compensation recipients who are actually at appreciable risk for treatment failure so that appropriate adjustments in treatment regimen may be made.

ISSN:0749-8047    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectiveIn clinical practice, patients with chronic pain frequently report problems with memory functioning. This issue, however, has received little attention in the scientific literature. The present study was designed to investigate this common problem and to stimulate research interest in this neglected and important area.DesignSelf-reported memory problems were investigated in two groups of chronic pain patients—patients with pain from acceleration-deceleration automobile accidents (n = 56) and patients with pain from various work accidents (n = 27)—and two control groups involving medical/dental (n = 24) and psychotherapy patients (n = 20).SettingPrivate practice, chronic pain, rehabilitation psychology services.ResultsOur findings suggest that memory complaints are higher in patients with chronic pain than in medical/dental or psychotherapy patients. No differences were found between chronic pain groups. On more general measures of memory complaint, differences between pain patients and controls were attributed to the severity of patients' depression. On a questionnaire designed to be more specific to memory complaint in chronic pain patients, differences in memory complaint between pain patients and controls were found, even after the effects due to depression were statistically removed. Although pain patients often attribute their memory problems to codeine use and/or psychoactive medications, there was no support for this in the present study.ConclusionsWithin the limitations of this study, these findings suggest that memory complaints may be related not only to depression but also to the presence of chronic pain. Further research in this area is needed.

ISSN:0749-8047    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectiveTo examine the accuracy of memory for pain in patients with chronic pain after injection of a local anesthetic and to investigate psychological factors hypothesized to coincide with distortion of memory.DesignConsecutive patients receiving nerve-block injections recorded pain before the block, during the effect of the block, ∼2 days after the block, and 2 weeks after the block. Memory for pain during the effect of the block was assessed 2 days and 2 weeks after the block for comparison with recorded pain ratings.SettingOutpatient, multidisciplinary pain-treatment center of a university medical center.PatientsForty-nine adult patients with chronic pain.InterventionsLocal nerve-block injections resulted in a significant, temporary reduction in pain, thus allowing patients to rate, and later recall, intensity of reduced pain.Outcome MeasuresSubjective ratings of pain intensity (numeric rating scale) were compared with recalled pain intensity. Demographic variables and psychological self-report measures were administered at evaluation.ResultsMemory distortions are commonplace and are more likely to involve recollection of higher pain levels than were reported at the time of the injection. Psychological self-report measures did not identify subjects who experienced distorted memory for pain relief.ConclusionsAn awareness of these distortions should lead health-care professionals to monitor and refer to patients' actual pain reports made during a treatment intervention rather than relying on patients' recall to gauge the efficacy of interventions. Memory distortions could influence avoidance behaviors implicated in the development of chronic pain by some theories.

ISSN:0749-8047    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectiveTo compare the utility of 0.0625% bupivacaine with fentanyl administered via patient-controlled epidural analgesia (PCEA) to a traditional continuous epidural infusion for pain of labor and delivery.Design and SubjectsForty-one women in established labor were randomized to receive either (a) 0.0625% bupivacaine with 2 μg/ml fentanyl via PCEA (demand dose = 3 ml, lockout interval = 6 min, background infusion = 6 ml/h, no 1 or 4 h limits) or (b) 0.125% bupivacaine with 2 ng/ml fentanyl via continuous epidural infusion (CEI) at 12 ml/h. Supplemental 0.25% bupivacaine (3 ml every 5 min, p.r.n., × 3) was administered for treatment of breakthrough pain upon patient request. The study protocol was double-blind and placebo-controlled.Outcome MeasuresVisual analogue pain scores, motor strength, pinprick level of sensory analgesia and bupivacaine use were assessed by an anesthesiologist unaware of the individual patient's randomization to a particular study group.ResultsThe cephalad extent of pinprick sensory analgesia was significantly lower during both the first (p < 0.03) and second (p < 0.03) stages of labor in patients receiving PCEA. However, visual analogue pain scores, intensity of motor blockade, and need for physician-administered supplemental bupivacaine were comparable in both groups. Patients receiving PCEA used 40% less bupivacaine per hour while achieving analgesia comparable to patients receiving CEI.ConclusionsThe results of this study show that 0.0625% bupivacaine with 2 μg/ml of fentanyl is an effective analgesic combination when used via PCEA.

ISSN:0749-8047    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectiveThe purpose of this study was to compare the efficacy and safety of i.v. ketorolac and fentanyl for moderate to severe postoperative pain in patients undergoing elective surgery in an ambulatory surgery unit.DesignA double-blind randomized trial.SettingAn ambulatory surgery unit in a university-affiliated hospital.PatientsSixty-nine patients undergoing elective laparoscopy, inguinal hernia repair, or knee arthroscopy were enrolled.InterventionPatients were randomly assigned to receive intravenous ketorolac 30 mg (n = 38) or fentanyl 50 fig (n = 31) for moderate to severe postoperative pain.Outcome MeasuresPain, assessed using a 100-mm visual analog scale and a 5-point verbal pain scale; adverse effects, as well as vital signs were recorded every 15 min for 150 min or until discharge from the postanesthesia care unit, 6 and 24 h after discharge.ResultsPain reduction on both visual analog and verbal scales was significantly greater with fentanyl than ketorolac at 15 min. In addition, the proportion of patients requiring remedication at the 15-min time point was significantly greater in the ketorolac group. However, there were no significant differences between fentanyl and ketorolac between 30 and 150 min after surgery. Notably, pain reduction was significantly greater with ketorolac on the verbal scale at the 6 h measurement.ConclusionsKetorolac appears not to be as effective as fentanyl in treating early postoperative pain. Although fentanyl still appears to be the drug of choice in the early postoperative period, the parenteral use of ketorolac was more effective during the later postoperative period in providing longer lasting analgesia.

ISSN:0749-8047    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectiveThis trial aimed to study moclobemide, a reversible, Type-A selective monoamine oxidase inhibitor, in patients with chronic neuropathic pain.DesignPain clinic patients suitable for antidepressant therapy were treated for 2 months in an open label, uncontrolled trial with moclobemide 150–600 mg/day.Outcome measuresVisual analog scores of pain and affective symptoms, a side-effect checklist, and clinical global impressions of efficacy and tolerability.ResultsThe trial was terminated after assessment of seven patients; partial analgesic activity was discernible only in one, and beneficial mood effects notable in two others. Significant adverse effects, particularly insomnia and GI disturbance, were reported by the majority of patients.ConclusionMoclobemide appears to have limited efficacy in the treatment of neuropathic pain.

ISSN:0749-8047    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectiveThe analgesic efficacy of the novel anticonvulsant felbamate was evaluated in trigeminal neuralgia.Patients and SettingThis trial was offered in a tertiary referral center to three outpatients with severe pain who had exhausted other medical options, yet did not wish to undergo surgery.InterventionsFelbamate was prescribed as the sole analgesic for approximately 1 month.Outcome MeasuresA visual analogue scale was utilized.ResultsFelbamate potently diminished the severe pain of trigeminal neuralgia and was well tolerated. The drug was withdrawn because of subsequent reports elsewhere of aplastic anemia and hepatic failure associated with it when used for epilepsy.ConclusionsPreliminary evidence suggested that felbamate was effective in relieving trigeminal neuralgia. Stabilization of neuronal membrane depolarization was the most likely mechanism of action. However, significant potential risks preclude further use of felbamate in the management of nonmalignant pain. Principles that have proven useful in screening for new anticonvulsant drugs might be relevant to the development of methods by which to search for new analgesic drugs.

ISSN:0749-8047    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Case ReportA 3-year-old boy with neuroblastoma complained of severe pain in the left lower extremity. Pharmacologic management had previously been attempted, but severe pain continued, and further upward titration was complicated by sedative effects.Methods and ResultsBecause the focus of treatment had become the controlling of pain, a lumbosacral subarachnoid neurolytic block was performed under general anesthesia. One-time neurolysis was more acceptable to the family than a procedure like epidural analgesia, that requires greater management. Contrast medium was used to monitor the spread of the neurolytic. An epidural catheter was inserted during the neurolytic block procedure for possible future use. The short-term results were good—pain reports and opioid doses decreased greatly, although with increased incontinence. The boy had new abdominal distention and pain 5 days after neurolysis. Opioid doses and sedatives were increased. He died 3 days later.

ISSN:0749-8047    

出版商:OVID    

年代:1995

数据来源: OVID