ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objectives:Clinical, epidemiological, and laboratory‐based studies have all suggested that female sex and elevated anxiety are associated with greater experience of pain. However, several recent reports have also indicated that sex may moderate the relationship between anxiety and responses to noxious stimuli, with anxiety more strongly related to pain among males. The present study examined whether anxiety differentially impacts outcomes for pain treatment among males and females.Methods:Seventy‐four chronic pain patients (34 males, 40 females) completed the Pain Anxiety Symptoms Scale and several other psychologic measures before undergoing a variety of treatment procedures including epidural steroids, trigger point injections, and participation in brief, cognitive‐behaviorally oriented psychoeducational groups. Patients provided pre‐ and post‐treatment ratings of pain for all interventions.Results:Consistent with findings from previous investigations, the present study noted stronger relationships between baseline anxiety and pre‐treatment pain severity among males relative to females. In addition, while lower levels of baseline anxiety were related to greater treatment‐associated pain reduction among females, the reverse pattern emerged for males. These relationships persisted even after controlling for other psychologic factors such as depression, coping style, and hypervigilance.Discussion:These findings suggest differential relationships between anxiety and pain relief as a function of sex. While we are unable to identify a mechanism for this effect, higher anxiety may have predicted more pain relief among males and less pain relief among females due to sex differences in coping strategies or placebo effects.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objectives:Spousal responses have been related to clinical variables in patients with chronic pain. For example, solicitous responses from spouses have been associated with greater levels of pain and disability among patients with chronic pain. However, few investigators have determined whether spousal solicitousness produces different effects in women versus men with chronic pain. The present study examined pain reports, medication use, psychosocial factors, functional measures, and pain tolerance in patients with chronic pain.Methods:Subjects included 114 female and 213 male chronic pain patients, who described their spouses as either high or low in solicitousness on the Multidimensional Pain Inventory. Measures of pain severity, affective distress, physical function, medication use, and pain tolerance were examined in women and men with high versus low scores on spousal solicitousness.Results:Among males only, high spousal solicitousness was associated with greater numerical ratings of pain and greater self‐reported disability compared with patients with low solicitous spouses. Among females only, the high spousal solicitousness patients showed lower pain tolerance, greater pain‐related interference, poorer performance on functional tasks (eg, timed walking, lifting, and carrying tasks), and greater use of opioid medications. In both women and men, spousal solicitousness was associated with higher scores on the MPI pain severity scale.Discussion:These results extend previous findings demonstrating a relationship between spousal responses and patients' adjustment to pain; however, the pattern of these effects appears to be moderated by the sex of the patient. Implications for assessment and treatment of chronic pain are discussed.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Abstract:Sex‐correlated differences in pain perception and behavior have been reported in several studies. Where such differences are found, they are most often in the direction of girls and women reporting more pain than is reported by boys and men. Although biologic, psychologic, and sociocultural factors act interdependently to influence pain responding, most efforts to explain sex‐correlated differences in pain have focused on first‐order biologic differences between the sexes. The current paper discusses empirical and theoretical literature addressing gender role socialization, cognitive factors, and affective factors associated with sex‐correlated differences in pain. We affirm that there is convincing evidence that such psychosocial factors must be taken into account in research on sex‐correlated differences in pain. We contend that the use of the dichotomous variable sex as a proxy for presumed biologic aspects of being female or male may obscure the contribution to sex‐correlated differences that could be ascribed to the ways in which women and men are socialized with respect to pain perception and pain reporting.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objectives:Evidence has accumulated that men and women show different responses to noxious stimuli, with women exhibiting greater sensitivity to pain than men. Data concerning sex differences in Cortisol response patterns have revealed inconsistent results so far. The purpose of the present study was to examine sex differences in subjective pain and Cortisol response to a noxious stressor.Methods:Seventy‐six subjects (39 male and 37 female) were investigated by a modification of the cold pressor test that consisted of intermittent immersion of the hand into ice water (plunge test, PT). The PT was conducted twice, in consecutive trials, to guarantee a sufficient exposure to the noxious stressor for eliciting Cortisol responses. In each trial, tolerance time and pain ratings visual analog scale (VAS) were assessed. Seven saliva samples (c1‐c7) were collected to determine Cortisol levels at baseline (c1‐c2), directly before (c3) and 20 minutes after noxious stress (c4), and during recovery period (c5‐c7).Results:We found no significant sex differences in tolerance time in trial 1, but highly significant differences in tolerance time in trial 2, with higher tolerance times in men. No significant sex differences were found for the VAS ratings of pain intensity and unpleasantness in the 2 trials. In contrast, a significantly larger Cortisol increase in men was observed compared with women. Analysis of covariance revealed that this result could not be attributed to sex differences in Cortisol level at baseline and in tolerance time.Discussion:The present study demonstrates that men show a larger Cortisol response to a noxious stressor than women that is not attributable to sex differences in subjective pain. The conclusion of a causal relation between larger Cortisol responses and higher pain tolerance thresholds in men is tempting but yet speculative.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objective:To analyze the different analgesic response to intraarticular morphine and bupivacaine in different types of arthroscopic surgery.Design:Prospective, randomized and double‐blinded. Fifty‐three consecutive patients undergoing an arthroscopic knee procedure under general anesthesia. They were studied separately in 2 groups (types of surgery): (1) “Low inflammatory surgery”: diagnostic arthroscopy, partial meniscectomy; and (2) “High inflammatory surgery”: ACL (anterior cruciate ligament) reconstruction, lateral release, patellar shaving and plicae removal. At the end of the procedure, patients were randomized to receive 25 mL of bupivacaine 0.25% with epinephrine (1/200,000), 5 mg of morphine, or saline (placebo) into the knee joint. Postoperative pain was determined through the visual analog scale (VAS). Supplemental analgesia (ketorolac) was administered via intravenous patient‐controlled analgesia (IV PCA). Pain and requirements of analgesia were compared between bupivacaine, morphine, and placebo in each group of surgery.Results:When considering only the “Low inflammatory” group of patients, those who received bupivacaine showed a lower postoperative pain score at 4 and 8 hours (P< 0.05). When considering only the “High inflammatory” group, the patients who received morphine showed a lower postoperative pain score at 24 hours and less requirements of ketorolac (P< 0.05).Conclusions:The analgesic effect of morphine and bupivacaine is different depending on the type of arthroscopic surgery. Intraarticular bupivacaine is effective in surgeries with a low inflammatory response. For surgeries with a higher inflammatory response, morphine has a better analgesic effect. Postoperative intraarticular analgesic therapy should be indicated according to the performed arthroscopic procedure.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objectives:To determine if psychosocial factors, as suggested by the demographic variables of widowhood and living alone, are associated with pain, particularly severe pain, in a representative sample of independent older people.Design:One thousand older people (65+) randomly selected from independent residents living in a major city were surveyed about their health status (Health Status of Older People Study). Demographic characteristics, including age, gender, education, income, living alone, widowhood, and childlessness, were analyzed by logistic regression for their association with pain report of differing severity. Path analysis was used to confirm the association with pain severity and further define the role of mood disturbance in mediating this relationship.Results:The prevalence of any pain report for the preceding 12 months was 56.3%. This was reduced when using more restrictive criteria, such that moderate‐to‐severe pain “at worst” and “at present” was found in 48.7% and 4.1% of the sample, respectively. After adjusting for type 1 error rate, the status of living alone was primarily associated with moderate‐to‐severe pain at worst, and being a widow(er) was associated with moderate‐to‐severe pain at present. The latter association had an estimated odds ratio greater than 3 and was characterized by more recent bereavement. Using path analysis, the model that severe pain was secondary to mood disturbance of widowhood, particularly recent bereavement, was tested and confirmed. The model explained 17% of the variance of pain severity in widow(er)s.Conclusion:The mood disturbance related to spousal bereavement aggravates pain in older people. This lends support to the biopsychosocial model of pain.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background:There isclinicalexperimental evidence that extracranial arterial vasodilation, extracranial neurogenic inflammation, and decreased inhibition of central pain transmission are involved in the pathogenesis of the migraine headache. The migraine aura is likely caused by a neurophysiologic phenomenon akin to Leão's cortical spreading depression, a wave of short‐lasting neuronal excitation that travels over the cerebral cortex, followed by prolonged depression of cortical neuronal activity.Method:A concept of the pathogenesis of the migraine attack is presented, in which the relation of the mechanism of the migraine aura and that of the migraine headache is considered parallel rather than sequential in nature.Conclusions:The process driving the pathogenesis of the migraine attack and susceptible to the migraine trigger factors may be located in the brain stem.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objectives:This study sought to determine what functional and affective outcomes had the most predictive value for overall satisfaction and improvement in patients seeking chiropractic treatment of low back pain.Method:Baseline questionnaires were completed by 965 patients seeking chiropractic help for low back pain, with blinded follow‐up at 6 weeks. Patients were asked about effects on pain, anxiety, normal activity, work, depression, lifestyle, satisfaction, and overall improvement. Stepwise multiple regression analyses were used to evaluate the contribution of change scores to overall improvement and satisfaction. A 2‐stage block regression was conducted to find out what additional factors besides overall improvement predicted patient satisfaction.Results:There were weak to moderate, but highly significant, relationships between the change scores and both improvement and satisfaction. However, most of the variance (57%) in the latter was explained by overall improvement and a very small amount (0.5%) by improvements in activity, leaving nearly 43% unexplained by any of the variables. Pain, work, and ability to control pain together predicted 27% of the variance in overall improvement. No other variables predicted this, leaving 73% of the variance unexplained.Discussion:Pragmatic rather than affective variables played some part in predicting satisfaction through global improvement in these patients. This should help to inform future interpretation of clinical trials of chiropractic treatments for back pain. However, the nature of the “unknown” components needs further investigation. There are initial indications in the literature that information giving, and the reconfiguration of patients' perceptions of the problem, may contribute to patient satisfaction generally. Further work is needed to confirm this and to establish where such interventions can also contribute to overall improvement.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID