摘要:

ObjectiveTo investigate the degree of pain reduction in patients with complex regional pain syndrome type 1 (CRPS 1) that can be defined as “successful.”DesignAll patients rated their pain on a visual analog scale (VAS; 0–10) before treatment and on three occasions after treatment, at 6 months, 1 year, and 2 years. Patients also rated a Global Perceived Effect (GPE) for their pain relief at the same time periods. The GPE items were classified as “successful” or “unsuccessful.” The mean absolute and relative pain reduction (using the VAS) was calculated for both “successful” and “unsuccessful” GPE classifications for each time period. Sensitivity and specificity analyses were performed.PatientsSixty-one patients with CRPS 1.ResultsThe patients defined a relative pain reduction of 58% (SD, 23.4) or more as “successful,” whereas in “successful” and “unsuccessful” patient groups the pain was reduced significantly on the VAS. Furthermore, sensitivity and specificity analyses showed that a cut-off point of 50% relative pain reduction and a 3-cm absolute pain reduction on the VAS have the highest likelihood that patients will report their treatment “successful” on the GPE.ConclusionsRelative pain reduction of 50% or more and an absolute pain reduction of at least 3 cm on the VAS are accurate in predicting a successful pain reduction after a given treatment.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Physicians and other healthcare professionals may often be faced with the need to change opioids during the course of a patient's opioid analgesic care due to a number of clinical reasons. The act of converting opioid analgesics, for many physicians, nurses, and pharmacists, who do not receive adequate training, remains a challenging and often uncomfortable aspect of pain treatment. Part of the challenge clinicians face is secondary to the relatively weak literature evidence base that exists to support the equianalgesic ratios provided in textbooks, journals, and other medical resources. Another aspect involves the lack of a widely recognized treatment algorithm or guideline to assist clinicians with opioid conversion. The final decision on which opioid dose to prescribe must involve a thorough clinical assessment to minimize the risk of prescribing inappropriate opioid doses over or under the patient's actual need. The purpose of this paper is to provide the clinician with an approach for dealing with the conversion between opioid analgesics that is standardized, yet allows for individualized results to meet unique patient needs. We present a 5-step process as a guide for clinicians faced with the need to change a patient's opioid regimen. This approach may help to build a comfort level when dealing with the clinical challenges of converting from one opioid to another.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundPoor pain management persists in health care. Although common practice errors in pain management have been identified and standards and guidelines for pain management have been published, improvement has been modest. With the goal of rapid improvement in pain management, a joint Collaborative (Veterans Health Administration and Institute for Healthcare Improvement) was conducted from May 2000 to January 2001.ObjectiveTo improve delivery of pain management to VHA patients and to compare team process and patient report data on key goals from selected study units.MethodsCharts were reviewed for outcome and process measures. Measures included changes in percentage of patients with (1) moderate to severe pain, (2) documentation of a pain assessment, (3) documentation of a pain care plan, and (4) documentation that the patient received pain education.ResultsSeventy teams from 22 Veteran's Integrated Service Networks throughout the U.S. participated. Moderate or severe pain on study units dropped from 24% to 17%; pain assessment increased from 75% to 85%; pain care plans for patients with at least mild pain increased from 58% to 78%; and number of patients provided with pain educational materials increased from 35% to 62%.DiscussionSignificant progress toward the target goals was reported during the Collaborative period. This improvement needs to be viewed in the context of a VHA system-wide effort to improve pain management. Data suggest that a program of team formation, goal identification, testing and adaptation of recommended system changes, sharing and feedback of process and outcome information can produce significant change in pain management in a major health care organization.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Ongoing efforts to develop mechanisms-based assessment and treatment of chronic pain have been hindered by the lack of assessment tools differentially sensitive to various phenomena underlying different mechanisms of pain. This study describes the development of an assessment instrument intended to measure neuropathic pain based on qualities of pain as they are inferred from pain descriptors. Subjects were 528 chronic pain patients from several clinics. Of these, 149 had strictly neuropathic pain, while 233 had non-neuropathic pain. Subjects completed a 32 item preliminary questionnaire, which asked them to rate their usual pain on multiple descriptors, as well as the degree to which their pain differed in response to various internal and external factors. This preliminary questionnaire was submitted to factor analysis, and this yielded 6 factors. Representatives of each of these factors were combined with additional items that demonstrated significant differences between neuropathic and non-neuropathic pain groups, to yield a 12 item Neuropathic Pain Questionnaire (NPQ). These items were able to differentiate neuropathic pain patients from non-neuropathic pain patients in a holdout sample with 66.6% sensitivity and 74.4% specificity. The newly developed instrument, NPQ, may be used for the initial screening of neuropathic pain patients. It also has the ability to provide a quantitative measure for the descriptors important in the diagnosis and assessment of neuropathic pain. Consequently, it can be used for monitoring of neuropathic pain treatments and as an outcome measure.

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:

ObjectivesThe aim of this study was to compare the analgesic effects and pharmacokinetics of epidural versus intravenous administration of low doses of ketamine.Methods45 patients scheduled for selective gastrectomy were randomly assigned into 3 groups: 0.5mg/kg ketamine administered epidurally (Kepi group), 0.5 mg/kg ketamine administered intravenously (Kiv group), or 10ml normal saline administered epidurally (Ctr group). Analgesic effects were evaluated using Visual Analog Scale (VAS) pain scores at rest, time to first request for analgesic (TFA), and subsequent morphine consumption. The plasma concentration of ketamine was measured with high performance liquid chromatography (HPLC) in the Kepi and Kiv groups. The elimination half-life of ketamine was calculated.ResultsPatients in the Kepi group had significantly lower VAS pain scores, longer TFA, and lower morphine consumption than patients in the Kiv or Ctr groups. Compared with intravenous administration, epidural administration of ketamine resulted in higher plasma concentrations from 90 minutes to 48 hours after injection, and much longer elimination half-life of ketamine, but a lower maximum plasma concentration of ketamine.ConclusionThe results suggest that epidural administration of a low dose of ketamine provides more effective analgesic effects as seen post-operatively than intravenous administration. The prolonged half-life and high plasma sustained concentration of epidural ketamine might account for the difference in analgesic effects.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveThe involvement of ongoing peripheral activity in the generation of nociceptive input in neuropathic pain suggests that topical drug delivery may be useful as a treatment strategy. This is a pilot study providing initial information regarding the use of novel topical preparations containing amitriptyline (AMI), ketamine (KET), and a combination of both in the treatment of neuropathic pain.MethodsThe study design included a 2 day randomized, double blind, placebo controlled, 4 way cross-over trial of all treatments, followed by an open label treatment phase using the combination cream for 7 days. Twenty volunteers with chronic neuropathic pain were randomly assigned to treatment order and applied 5 mls of each topical treatment (1% AMI, 0.5% KET, combination AMI 1%/KET 0.5%, and placebo) for 2 days. Measures of pain at the end of each block included the short form McGill Pain Questionnaire (MPQ) and visual analog scales (VAS) for present pain intensity and pain relief. Eleven subjects who judged subjective improvement from any treatment in the initial trial entered the open-label trial and used the combination cream for 7 days. Pain levels were recorded daily using the same measures. Blood levels for amitriptyline and ketamine were performed at 7 days to determine whether systemic absorption had occurred.ResultsThere was no statistically significant difference from placebo after 2 days for any treatment during the double blind component of the trial. In the 11 subjects who used the combination cream, there was a statistically significant effect, with subjects reporting significantly greater analgesia by days 3 to 7 according to measures of pain and pain relief. Blood levels revealed that there was no significant systemic absorption of amitriptyline or ketamine. Only 2 subjects experienced side effects; these were minor and did not lead to discontinuation of the cream.ConclusionThis pilot study demonstrated a lack of effect for all treatments in the 2 day double blind placebo controlled trial, followed by analgesia in an open label trial in a subgroup of subjects who chose to use the combination cream for 7 days. Blood analysis revealed no significant systemic absorption of either agent after 7 days of treatment, and creams were well tolerated. A larger scale randomized trial over a longer interval is warranted to examine further effects observed in the open label trial.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivesPain assessment can be a challenging task for parents, who increasingly provide the care for their children after surgery. This research provides evidence of the construct validity of the Parents' Postoperative Pain Measure (PPPM), a 15-item behavioral scale.MethodsStudy 1 examined the ability of scores on the PPPM to discriminate between pain and anxiety in a sample of 75 children (30 girls) between the ages of 7 and 12 years undergoing day surgery. Study 2 examined the sensitivity of scores on the PPPM to analgesic intervention among a sample of 28 children (7 girls) between the ages of 7 and 12 years undergoing day surgery.ResultsIn Study 1, scores on the PPPM closely followed the pattern of children's self-reported pain intensity and not state-related anxiety. Results from Study 2 showed that scores on the PPPM, like children's self-reported pain intensity ratings, were sensitive to analgesic intervention.DiscussionThe results of these studies provide further support for the construct validity of the PPPM and confirm that the measure is a valid pain assessment tool for use by parents at home following children's surgeries.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID