摘要:

“Surely, the more you carry on your studies and research the more you come to recognize that suffering is a mystery which is inseparably joined to the human condition. Even though every morally legitimate effort must be made to relieve and eliminate physical pain, nonetheless we are acutely aware that suffering in a wider sense will always accompany man as he travels through this world. Indeed it can be the means of his salvation. (1)”

ISSN:0749-8047    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective: This review tries to consolidate the literature on changes in serotonin and the importance of these changes for understanding headache pathogenesis and determining treatment. A model is presented that integrates previous serotonin studies and offers an explanation for apparent contradictions in the literature.Data Sources: Fifty-four journal articles that described a relationship between serotonin and headache in animal and human models were identified through Medline search and bibliography and reviewed. Alterations in serotonin, headache, and clinical situations influencing headache activity were examined.Data Synthesis: Abnormalities in blood vessels have traditionally been implicated in the pathogenesis of migraine headaches, and excessive muscle contraction in tension-type headaches. Interestingly, both vascular and muscular changes occur in both migraine and tension-type headache. Recently, biochemical changes have been demonstrated in both types of headaches. These biochemical changes are postulated to precede and possibly cause the subsequent changes in blood vessels and muscle tone, known to occur in chronic headaches. Serotonin has been the most widely studied neurochemical in relation to headaches. Apparently contradictory results have been shown, such as increasing serotonin levels both increasing and decreasing headaches.Conclusions: Serotonin plays an important role in the pathogenesis of headaches. Changes in serotonin may precede the vascular and muscular changes of migraine and tension-type headaches. The influence of serotonin on headaches explains a number of clinical situations that affect headache activity and the variety of classes of effective headache medications.

ISSN:0749-8047    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective: The pain physician is often asked to establish the medical impairment of the chronic pain patient (CPP) and from that determination ascertain the work capacity of the CPP. Functional capacity (FC) testing has recently been introduced as a more objective and accurate way of facilitating the determination of work capacity. However, there are conceptual problems with the measurement of FC. These will be reviewed and the relationship of FC to residual functional capacity (RFC) will be determined. Finally, a method for measuring RFC in a job-specific manner will be suggested.Data Sources: The literature in reference to the measurement of medical impairment, FC, and RFC was reviewed.Study Selection: Studies appropriate to the objective of this review were selected for inclusion.Conclusions: The FC and RFC are poorly defined. Lack of definition has interfered with design of appropriate test batteries specific to work capacity. To circumvent this problem a job-specific RFC measurement method is suggested. This method is based on theDictionary of Occupational Titles.

ISSN:0749-8047    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective: To establish basic epidemiological data on chronic pain (duration >3 months) in a defined population. Relationships between age, gender, and social class were tested.Design: A survey of pain symptoms, including location, intensity, duration, and functional capacity, was conducted by means of a mail questionnaire.Setting: General populations in two Swedish primary health care districts. Medical care was provided in a state health system.Subjects: A random sample (from the population register) of 15% of the population aged 25–74 (n = 1,806). The response rate was 90%.Outcome Measures: Descriptive epidemiologic data in relation to objectives of the study.Results: Without sex differences, 55% (95% confidence interval, 53–58%) of the population had perceived persistent pain for 3 months and 49% for 6 months. Among individuals with chronic pain, 90% localized their pain to the musculoskeletal system to a variable extent. Women experienced more multiple localizations of pain and had pain in the neck, shoulder, arm, and thigh to a greater extent than men. Prevalence of pain increased by age up to 50–59 years for both genders and then slowly decreased. The neck-shoulder area was the most common site of pain (30.2%), followed by the lower back (23.2%). Even in the youngest age groups more than one of four reported chronic pain. Blue-collar workers and employers (including farmers) reported chronic pain to a greater extent than other groups. In 13% of the population, manifest pain problems were associated with reduced functional capacity.Conclusion: Chronic pain symptoms are common but unevenly distributed in a general population. The results may influence planning and consultation in primary health care as well as warranting selective prevention activities.

ISSN:0749-8047    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective: To study the occurrence of chronic pain in relation to different sociodemographic factors.Design and patients: The study cohort included all 1,360 new patients who, between July 1, 1988, and June 30, 1991, were referred to the multidisciplinary Pain Clinic at Malmö General Hospital, Malmö, Sweden, because of chronic, nonmalignant pain. The patients were characterized by age, sex, type of pain (nociceptive, neurogenic, psychogenic), place of residence, and ethnic background.Setting: The referred sample was from the municipality of Malmö, a city with 240,000 inhabitants in an industrialized area served by one hospital.Results: The age and sex standardized number of patients referred per 10,000 inhabitants and year varied among the different city areas from 0.35 to 1.63. High-rate areas had, in comparison to the city average, a higher migration rate, a higher proportion of single households with children, a higher percentage of people in need of social security benefits, a higher unemployment rate, and a greater percentage of people with foreign background. The age and sex distribution differed greatly among the three pain categories. Nociceptive pain was the most common category, with a striking overrepresentation of young women.Conclusion: Our results support the view that the occurrence of pain in an urban population is related to a number of sociodemographic factors. Further studies should be performed to evaluate how these factors influence incidence, medical-seeking behavior, clinical course, and rules for referral.

ISSN:0749-8047    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective: To determine the intercorrelation between subjective disability, as assessed with the Pain Disability Index (PDI) and the Oswestry Disability Questionnaire (ODQ) and their correlation with visual analogue scale (VAS) pain intensity ratings.Design and Subjects: Questionnaires were administered to 94 patients with chronic low back pain with or without radiation into the legs of at least 3 months' duration.Setting: Tertiary care center.Results: High correlations were noted between the ODQ and PDI (r= 0.83) and PDI factor 1 (r= 0.84), a subscale of the PDI. Lower correlations were noted between pain intensity (VAS) scores and the ODQ (r= 0.62) and the PDI (r= 0.69). A weaker correlation (r= 0.41) was noted between the ODQ and PDI factor 2. Intraclass correlation coefficients (ICC) for test-retest reliability in 20 patients (time interval 1 week) were for the ODQ ICC = 0.83, PDI ICC = 0.91, PDI percentage score ICC = 0.91, PDI factor 1 ICC = 0.87, and PDI factor 2 ICC = 0.73, respectively.Conclusions: The present results suggest that either the PDI or the percentage score PDI and also the even shorter-to-administer PDI factor 1 may be useful and reliable tests for the assessment of subjective disability in low back pain patients. As noted by the moderate intercorrelations with pain intensity scores, both the PDI and the ODQ address a broader concept of disability than that directly related to pain intensity.

ISSN:0749-8047    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective: This study examined pain and impairment beliefs [measured with the Pain and Impairment Relationship Scale, (PAIRS)] of chronic low back pain patients during rehabilitation and hypothesized that pain beliefs would be stronger in drop-out subjects, decrease during treatment, and after treatment correlate strongly with disability measures.Design: Prospective cohort.Setting: Outpatient, functionally oriented rehabilitation program for chronic low back pain.Patients: 72 consecutive chronic low back pain referral patients disabled from working because of pain.Involvement: Interdisciplinary rehabilitation with a focus on intensive physical reconditioning was employed.Outcome Measures: Program completion versus drop-out groups and pretreatment and posttreatment pain, disability, depression, and PAIRS scores were compared.Results: Thirty patients dropped out and 42 subjects completed treatment. The PAIRS scores at evaluation were similar for both groups. The PAIRS scores improved significantly during treatment (p < 0.001). Posttreatment PAIRS scores correlated highly with disability measures (r= 0.79, p < 0.001).Conclusion: Pain beliefs are of minimal value for predicting treatment compliance, but may be altered during functionally oriented treatment of chronic low back pain. Posttreatment disability closely mirrored attitudes and belief-associated pain and impairment.

ISSN:0749-8047    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective: This study attempts to clarify the relationship between depression and the cognitions of chronic pain patients. It was hypothesized that the ambiguity and desirability of self-rated traits would significantly predict level of depression.Design: The study incorporated a correlational design in which subjects rated a number of traits as they pertained to themselves and completed questionnaires on negative affect and pain.Setting: Subjects were recruited from a Spine Program and the Orthopaedic Clinic, at a tertiary care facility at the University of Florida.Subjects: Fifty-eight chronic pain patients, two thirds of whom had primary back pain, were recruited for the study.Outcome Measure(s): All subjects completed a Beck Depression Inventory and McGill Pain Questionnaire, and rated themselves on 28 traits characterized by the dimensions of desirability and ambiguity.Results: A hierarchical regression analysis indicated that the subjects' self-ratings on ambiguous negative traits significantly predicted level of depression.Conclusions: Patients with chronic pain are more likely to acknowledge undesirable traits in themselves when they have higher levels of depression when the pain level was controlled. These findings may have important implications for the cognitive-behavioral treatment of chronic pain patients.

ISSN:0749-8047    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective: Psychophysical assessments of orofacial sensory function were performed in order to investigate neurophysiological aspects of the burning mouth syndrome (BMS).Design: Sensory and pain thresholds to brief argon laser stimulation were determined on six test regions, which included the tip of tongue, the lower lip mucosa and skin, the buccal mucosa, the anterior hard palate, and the dorsum of the hand.Setting: The experimental examination was performed at the Pain Clinic Unit at the Royal Dental College.Patients: Twenty-three elderly denture-wearing patients diagnosed as suffering from BMS were studied, and a control group included 23 age-, sex-, and denture-matched subjects. The obtained thresholds were compared between groups.Results: Sensory thresholds were significantly higher and ratios between pain and sensory thresholds significantly lower in patients with BMS on all the tested regions. Pain thresholds were significantly elevated on the lower lip skin, the anterior hard palate, and the hand in patients with BMS. At sensory threshold level, a faint pinprick perception was often reported by patients with BMS contrary to a perception of warmth described by control subjects. The intraregional variations in sensory and pain thresholds on the hard palate, the lower lip mucosa, and on the skin were similar in both groups, but differences occurred in sensory thresholds on the tongue in patients with BMS.Conclusions: The presence of abnormal prepain perceptions and disturbances in the perception of nonnociceptive and nociceptive thermal stimuli applied on both pain-affected and normal regions suggest a perceptual deficit unrelated to specific pathophysiological mechanisms in BMS. However, it appears that a psychological explanation of BMS should be used cautiously, as the present results suggest alterations in sensory function.

ISSN:0749-8047    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective: To evaluate the effects of different frequencies of auricular (ear-to-ear) sine-wave transcutaneous electrical nerve stimulation (TENS), administered at subliminal intensity, on trigeminal nerve sensitivity.Design: In a double-blind protocol, healthy volunteer subjects were administered one of three different frequencies of active TENS (5, 100, or 2,000 Hz) or placebo TENS (no current was passed) for 30 min.Setting: Department of Psychology, City University of New York.Subjects: 72 healthy undergraduate volunteers with no preexisting pain problems (16 men and 56 women), from the Department of Psychology, City University of New York.Outcome measure: Pretreatment to posttreatment changes were measured in sensation threshold for a 250-Hz electrical stimulus applied transcutaneously to an area 1 cm anterior to the tragus of the ear (mandibular division of the trigeminal nerve).Results: Analysis of variance indicated no group differences in baseline trigeminal sensation threshold, but there were significant group differences in pretreatment to posttreatment changes in sensation threshold (p < 0.001). A postiori analysis showed significant increases in trigeminal sensation threshold after active TENS as compared to placebo TENS (p < 0.05), with 5− and 100-Hz TENS producing significantly greater hypesthesia than 2,000-Hz TENS (p < 0.05).Conclusions: Sine-wave auricular TENS produces frequency-dependent trigeminal hypesthesia that is not a placebo effect.

ISSN:0749-8047    

出版商:OVID    

年代:1993

数据来源: OVID