ISSN:0749-8047    

出版商:OVID    

年代:1990

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1990

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Assessment and treatment responses were compared in 17 subjects with chronic low back pain assessed as showing at least one clear consciously produced inconsistency in statements and/or behaviors during their participation in an interdisciplinary treatment program and 143 subjects assessed as showing no such inconsistency. Numerous statistically significant differences emerged: Inconsistent subjects were more likely to have pending litigation and to be assessed by staff as showing a higher degree of focus on pain and more dramatized complaints, lower levels of medical findings and attention and interest in treatment, and poor compliance with treatment and assessment procedures. In addition, these subjects reported lower levels of physical activity and generally more inconsistent or negative responses to lumbar sympathetic injections with fewer expected changes in physical sensations. Though not definitive, these results suggested a syndrome of characteristics among such subjects which are similar to those proposed as likely characterizing malingerers. The need for a particularly careful validation of self-report data in patients showing many of these characteristics was emphasized.

ISSN:0749-8047    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Chronic pain can be described as a syndrome or process of decompensation not unlike any other chronic disease or illness. As such, chronic pain patients are often difficult to work with because of the pervasive personal, social, emotional, and physical impact of the syndrome on their lives and the lives of their families. The pain curve was developed to be used as an educational instrument to assist patients in understanding the disease process, confronting denial, and self-diagnosing their illness. This curve now in use at our institution describes both the progression and the recovery of the illness. The pain curve is used as an educational tool to aid patients in addressing important recovery issues such as denial and the disease process, the progression of symptoms in a chronic illness, medication and alcohol use and abuse in the management of chronic pain, the impact on and from the family and the importance of peer support.

ISSN:0749-8047    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A postal survey aimed at studying the prevalence of chronic pain and the need for care because of pain was carried out in a representative sample of a Swedish population. A random sample of the study population has been interviewed and assessed clinically to determine whether a questionnaire method gives the same results as clinical assessment. The agreement between estimates based on the questionnaire and those based on the clinical assessments varied depending on the questions used. By creating questions more independent of language habits and values, it was shown that it is possible to get better agreement between different descriptions. The best agreement was shown when answers to questions regarding different dimensions of pain were combined in a model for selecting individuals with more serious pain problems.

ISSN:0749-8047    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The therapeutic habits of general practitioners are an important clue when drug therapy is considered, because they are treating the most frequent complaints. When pain problems are considered, it would be valuable to determine the characteristics of the pain consultations and their therapeutic attempts to solve these complaints. The present study was designed to elucidate the characteristics of pain diagnoses and treatment approaches at primary-care level in Spain. A total of 299 patients were evaluated, considering pain location, diagnostic syndrome, previous therapies, and treatments selected by the 13 participating physicians. Limb and back pain were the most frequent pain complaints. A third of the patients had received previous treatment and 36% were self-medicating, mainly with aspirin or paracetamol. Physicians prescribed diclofenac at full doses, but aspirin and paracetamol were used at subtherapeutic dosages. The study showed that (a) rheumatic pain was the most frequent at primary-care level, (b) a high level of self-medication was determined, therefore recommending a careful drug history. and (c) misconceptions about analgesic drugs may partially explain the therapeutic failure in some patients. Educational programs in rheumatic pain and analgesic therapy for general practitioners are strongly recommended.

ISSN:0749-8047    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Forty patients (ASA status I-III) recovering from major orthopedic or gynecological operations were investigated to evaluate analgesic efficacy and threshold concentrations of tramadol and its main metabolite O-demethyltramadol (M1) in serum during the early postoperative period, using patient-controlled analgesia (PCA) by means of the Abbott Lifecare Infuser. Following an individualized intravenous loading dose of 97.5 |Mp 42.3 mg (mean, SD), tramadol demand doses were 20 mg with a limit of 500 mg within 4 h: the lockout time was set to 5 min. The duration of PCA was 20.5 |Mp 4.8 h. During this time 8.0 |Mp 5.0 demands per patient were recorded, resulting in an average tramadol consumption of 257.5 |Mp 102.8 mg (including loading dose). Analgesia was mostly judged good to excellent. Side effects were only of minor intensity and never gave rise to concern. There were no statistically significant differences between the types of surgery. Tramadol proved to be about 1/6 to 1/10 as potent an analgesic as morphine when both intensity and duration of effect were considered. Minimum effective tramadol serum concentration (MEC) varied greatly and could be best described by a log-normal distribution (range 20.2–986.3 ng/ml, median 287.7 ng/ml). Intraindividual MEC variability was lower than intersubject variability (38.2 vs 59.1%). Median M1 concentrations were 36.2 ng/ml.

ISSN:0749-8047    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The purpose of this study was to compare the pain-alleviating effect of classical acupuncture with superficial needle insertion in 82 patients suffering from lateral epicondylalgia. Sessions were 20 min long, two to three times weekly with 10 treatments in all. Five acupuncture points were treated: LI 10, 11, 12, Lu 5, and SJ 5. After 10 treatments significant differences were observed between the groups favoring the classical acupuncture technique in relation to subjective and objective outcome. No such differences could be observed at the follow-ups after 3 months and 1 year. This study showed that classical “deep” acupuncture is superior to superficial needle insertion in the short-term symptomatic treatment of lateral epicondylalgia, but not at 3− and 12-month follow-up.

ISSN:0749-8047    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A reliable, safe approach to achieving unilateral anesthesia in multiple contiguous thoracic dermatomes would be of great benefit to anesthesiologists in the acute and chronic pain setting. The multidermatomal intercostal technique is one such approach, although the anatomical mechanism of this nerve block is a matter of debate. At our pain clinic, we have used another technique, a modification of the paravertebral block, to achieve multiple segments of unilateral sensory blockade. We have used this technique, which we call the paravertebral-peridural block, for over 20 years in the treatment of various pain problems. In retrospective analysis of the 384 blocks performed from 1982 to 1986, there was one pneumothorax (0.26%). one thecal puncture (0.26%), and two accidental intrathecal injections (0.52%). Eighteen blocks (4.6%) resulted in transient hypotension. There were no permanent sequelae. Ninety-three percent of blocks were evaluated as—or—in quality. Bilateral sensory blockade was documented in five patients (1.3%). In order to clarify the mechanism of bilateral blockade resulting from a unilateral technique. we injected four fresh cadavers with colored latex solution using the paravertebral-peridural approach. This revealed spread of the latex across the midline prevertebrally to the contralateral paravertebral space. We conclude that the paravertebral-peridural thoracic block is a reliable, safe technique for achieving unilateral anesthesia over multiple dermatomes with a single injection.

ISSN:0749-8047    

出版商:OVID    

年代:1990

数据来源: OVID