摘要:

ObjectiveChronic pain is prevalent in many Western countries. Its prevalence in a non-Caucasian population is not known. The authors performed this study to measure the prevalence of chronic pain in the Hong Kong Chinese adult population, as well as the pattern of pain and the demographic characteristics, the impact on social and work function, and the help-seeking behavior of those with pain.DesignCross-sectional survey using telephone interview with a structured questionnaire. Chronic pain was defined as pain persisting for more than 3 months.SubjectsA random sample of over 1,000 persons out of the entire Chinese adult population of Hong Kong.ResultsOne thousand fifty-one adults were interviewed. One hundred thirteen (10.8% [95% C.I.: 8.9%–12.7%]) had chronic pain. The median number of pains was two. Of those with chronic pain, 38.3% reported their work was affected, and 19.8% had taken a median of 5 days' sick leave in the past year; 70.8% said the pain had interfered with their daily life, 88.5% had tried self-treatment, and 74.3% had sought medical advice. Only 35.7% considered the treatment definitely helpful. Two risk factors were identified: the female gender (O.R. 1.5, 95% C.I. 1.0–2.3) and age greater than 60 (O.R. 2.2, 95% C.I. 1.3–3.6).ConclusionsThe study showed that the prevalence of chronic pain in Hong Kong adults was approximately 10.8%. Work and daily life are significantly affected and there is considerable demand on the health care system. Despite the ethnic difference, the prevalence, pattern, and demographic characteristics of chronic pain in Hong Kong are very similar to those seen in Western countries.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundPhantom limb pain is an intriguing pain syndrome that may result from damage to peripheral nerve tissue but could also involve central amplifying congeners.N-methyl-d-aspartate (NMDA)-receptor antagonists were recently shown to alleviate neuropathic pain in both animal and human models. Dextromethorphan is a noncompetitive NMDA-receptor antagonist.Study DesignOral dextromethorphan (120–180 mg daily) was administered to three selected cancer patients during a 3-week study and an additional 1 month of treatment with the dosage subjectively judged to be best.ResultsOral dextromethorphan effectively reduced postamputation phantom limb pain, bestowing improvement in feeling and minimizing sedation in comparison with the pretreatment or placebo conditions, with no side effects. Pain recurred in one patient 1 month after treatment was stopped.ConclusionsFurther clinical trials are warranted to determine the optimal dosage and identify which patients with phantom pain would benefit the most from this therapeutic approach.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveThis study examined the relation between level of educational achievement (LOE) and the clinical morbidity associated with chronic pain.SettingA multidisciplinary pain rehabilitation program located within a university hospital.PatientsTwo hundred ninety-nine consecutive patients with chronic spinal pain, average age 39.6 years (SD = 10.7) and with an average duration of pain of 41.9 months (SD = 51.6).Outcome MeasuresAge, duration of pain, sex, and compensation and litigation status were controlled for in the statistical analysis because each was found to be significantly associated with LOE. Pain intensity was assessed by the McGill Pain Questionnaire. Affective distress was assessed by the Global Severity Index from the Brief Symptom Inventory. Severity of depressive symptoms was derived from scores from the Center for Epidemiological Studies—Depression Scale. Pain beliefs and pain coping strategies were assessed by the Survey of Pain Attitudes and the Coping Strategies Questionnaire, respectively. Finally, self-report of pain-related disability was assessed by the Pain Disability Index.Results and ConclusionsAfter controlling for relevant covariates, LOE was unrelated to pain intensity, severity of depressive symptoms, or affective distress, but was inversely related to self-reported disability. Persons with lower LOEs possessed a greater belief that pain is a “signal of harm,” unrelated to emotional experience, disabling and uncontrollable. They also endorsed more passive and maladaptive coping strategies, including a tendency to catastrophize about their pain. Path analysis indicated that, after controlling for the influence of both the belief that pain is a “signal of harm” and catastrophizing on the association between LOE and disability, this relation loses statistical significance. These results suggest that pain-related cognitions mediate the relation between LOE and pain disability and that persons with lower LOEs are more likely to develop maladaptive pain beliefs and coping strategies.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundSeveral controlled clinical trials have demonstrated the efficacy and safety of the lidocaine patch 5% (LP) for the treatment of postherpetic neuralgia (PHN).ObjectiveTo assess the effects of the LP on distinct neuropathic pain qualities common to all neuropathic pain conditions, the authors analyzed data from one of the vehicle-controlled trials in which the Neuropathic Pain Scale (NPS), the only assessment tool specifically designed to measure the distinct components of neuropathic pain, was administered.Methods and ResultsTo improve the sensitivity of the NPS to treatment effects, only patients who, at the time of enrollment in the study, reported moderate-to-severe pain on the NPS (as defined by a score ≥4/10 reported for at least 6 of the 10 individual NPS items) were included in the analysis. Thus, 96 patients were included in this analysis. After a 3-week, vehicle-controlled study, LP improved all assessed pain qualities to a greater extent than the placebo patch, as measured by the NPS 10, a sum score including all 10 NPS item scores (p= 0.043), and an NPS 8 score, which included scores for all 8 pain descriptors, excluding “unpleasantness” and “global intensity” (p= 0.042). Separate analysis of all 8 items believed not to reflect allodynia (NPS NA; excluding “skin sensitivity” and “surface pain”) also demonstrated superiority (p= 0.022), as did analysis of the subitems that are believed not to be primarily related to peripheral pathophysiological events (the “NPS 4”: “sharp,” “hot,” “dull,” and “deep” pains;p= 0.013).ConclusionsThis study demonstrates that LP reduces the intensity of all common neuropathic pain qualities and thus may be of potential benefit for nonallodynic neuropathic pain states. Furthermore, these findings suggest that peripheral mechanisms may play a role in the pathophysiological development of pain qualities that heretofore have been assumed not to involve peripheral mechanisms, such as “dull,” “deep,” “sharp,” and “burning” pains.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectivesThe aim of the present study was to evaluate the contribution of individual spa therapies administered during a period of 3 weeks on measures of well being and pain in a sample of patients with chronic back pain.DesignOne hundred fifty-three patients with chronic back pain undergoing inpatient spa therapy in Bad Tatzmannsdorf, Austria, participated in the study. According to the prescription of their spa physician, patients underwent two or more of the following treatments: mud packs, carbon dioxide baths, massages, exercise therapies, spinal traction, and electrotherapy. The outcome measures were general pain, back pain, negative mood, and health satisfaction. Regression analyses were conducted to predict the 4 outcome measures at the end of spa therapy and at 6 weeks' follow-up for all therapies applied. The pretreatment outcome measure, age, and sex were controlled for by entering them into the analysis.ResultsPatients showed significant improvements in all 4 outcome measures. The prediction of improvement was generally small: only 1% to 11% of the change of the outcome measures could be explained by the type and number of therapies received. On a short-term basis, mud packs and exercise were found to be associated with a greater improvement in mood, whereas a greater frequency of massage therapy and carbon dioxide baths was associated with a smaller improvement in health satisfaction. On a long-term basis, exercise therapy and spinal traction were associated with a greater reduction in back pain.ConclusionsThe results indicate that, in addition to the individual therapies, other factors relating to spa therapy as a whole must contribute to overall treatment outcome. In addition, the results support the efficacy of exercise therapy for chronic back pain.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

DesignThe authors reviewed the available pediatric pain literature and selected those studies that reported quantitative information on the reliability and validity of, and the optimal cutoff points for, the visual analog scale (VAS) when used as an observational pediatric pain tool.ResultsAvailable psychometric findings concerning the observational VAS (VASobs) are limited. The estimated interrater reliability of the VASobsfrom 9 studies ranged from 0.36 to 0.91. The correlation between self-report and the VASobswas variable and ranged 0.23 to 0.83 in 6 studies. The concurrent validity of the VASobsand other pain instruments ranged from 0.42 to 0.86.ConclusionsFurther psychometric testing needs to be conducted on intraobserver reliability, responsiveness, and optimal cutoff points. Future research may guide the choice between VASobsand the numerous behavioral pain instruments.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveThe aim of this prospective, controlled study was to evaluate the risk factors for postoperative emesis in patients undergoing gynecologic surgery and receiving patient-controlled analgesia for three days.MethodsSix hundred twenty-five gynecologic patients with an American Society of Anesthesiologists physical status of I to III undergoing lower-abdominal surgeries were enrolled. A standard, general anesthetic technique was used. Postoperative pain was treated by a patient-controlled analgesia device with bolus intravenous doses of 1 mg morphine. For 3 days after surgery patients were assessed for occurrence of emesis, sedation, and pain intensity when at rest and during movement.ResultsThe incidence of emesis was 26% on postoperative day 1, 13% on day 2, and 4% on day 3. On all 3 days, patients' pain scores when at rest and when coughing were higher for those with emesis than for those without. During the first 2 postoperative days the patients with and those without emesis consumed similar amounts of morphine daily, but on the third day the patients with emesis consumed significantly more morphine than did those without emesis (p<0.05). Further logistic regression analysis showed that incident pain was the main risk factor for postoperative emesis on all 3 days.ConclusionsThe results suggested that postoperative pain was an associative risk factor to increase the incidence of emesis in these female patients.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveLittle is known of the effectiveness of nonpharmacological interventions for fibromyalgia syndrome (FMS). The authors therefore carried out a systematic review from 1980 to May 2000 of randomized controlled trials (RCTs) of nonpharmacological interventions for FMS.MethodA search of computerized databases was supplemented by hand searching of bibliographies of key publications. The methodological quality of studies included in the review was evaluated independently by two researchers according to a set of formal criteria. Discrepancies in scoring were resolved through discussion.ResultsThe review yielded 25 RCTs, and the main categories of interventions tested in the studies were exercise therapy, educational intervention, relaxation therapy, cognitive–behavioral therapy, acupuncture, and forms of hydrotherapy. Methodological quality of studies was fairly low (mean score = 49.5/100). Most studies had small samples (mediannfor individual treatment groups after randomization = 20), and the mean power of the studies to detect a medium effect (d≥ 0.5) was 0.36. Sixteen studies had blinded outcome assessment, but patients were blinded in only 6 studies. The median longest follow-up was 16 weeks. Statistically significant between-group differences on at least one outcome variable were reported in 17 of the 24 studies.ConclusionsThe varying combinations of interventions studied in the RCTs and the wide range of outcome measures used make it hard to form conclusions across studies. Strong evidence did not emerge in respect to any single intervention, though preliminary support of moderate strength existed for aerobic exercise. There is a need for larger, more methodologically rigorous RCTs in this area.

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

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID