ISSN:0749-8047    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThis study was designed to investigate whether Complex Regional Pain Syndrome type I (CRPS I) could be linked to any previous infection.PatientsFifty-two patients with CRPS I of one extremity were screened for the presence of antibodies against mostly neurotropic microorganisms.ResultsOf these 52 patients, none had antibodies againstTreponema pallidum, Borrelia burgdorferi,or HTLV-1. Only four patients were positive forCampylobacter jejuni.For cytomegalovirus, Epstein-Barr virus, herpes simplex virus, andToxoplasma gondii,seroprevalences were similar to control values. The total seroprevalence of Parvovirus B19 in our CRPS population was 77%, which was significantly higher than in an independent Dutch population group (59%). Seroprevalence in lower extremity CRPS I (94%) was significantly higher than in upper extremity CRPS I patients (68%). In this study all patients were seropositive for varicella zoster virus (VZV) antibodies, but a high prevalence of VZV antibodies is similar to its prevalence in a normal population (>90%).ConclusionsIn this study we found a significantly higher seroprevalence of Parvovirus B19 in CRPS I and this is most striking in lower extremity CRPS I patients. Further serologic research in other geographic areas is needed to provide additional information about a potential role of Parvovirus B19 or other microorganisms in the etiopathogenesis of CRPS I.

ISSN:0749-8047    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe objective of this study was to explore the relation between the application of a mixture of lidocaine/prilocaine cream (eutectic mixture of local anesthetics [EMLA]) before intravenous cannula insertion and perceived pain in the pediatric patient.DesignDouble-blind placebo-controlled trial.SettingA general inpatient pediatric ward.PatientsWe examined 26 male and 31 female patients between the ages of 4 and 12 years who required intravenous cannula insertion. Intravenous insertion was performed on 57 patients, with 29 patients in the placebo group (mean age, 8.1 years) and 28 in the EMLA group (mean age, 8.0 years).InterventionsApplication of either EMLA cream or placebo 45 minutes before intravenous cannulation.Outcome MeasuresPain was scored by the patients using a 0-to 10-cm visual analogue scale combined with a Faces pain scale as well as visual observation by a nurse. Adverse side effects were recorded in a separate table.ResultsData collected and the differences between the placebo and treated groups were tested using a Mann-WhitneyUtest. Those children in the EMLA group (mean pain score, 1.25) experienced less pain than those in the placebo group (mean, 8.39). There was no statistical significance between age, sex, and race.ConclusionsThe authors conclude that a topical preparation of lidocaine/prilocaine significantly reduces children's pain during intravenous cannula insertion when applied to an intact dermal layer of the skin and that this effect occurs within 45 minutes.

ISSN:0749-8047    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe study examined symptom-specific muscle hyperreactivity in patients with chronic pain with upper limb cumulative trauma disorder (CTD).DesignFour tasks were presented in counterbalanced order and included neutral, general stressor, personal stressor, and pain stressor tasks. Ratings of stressfulness and recordings of skin conductance level confirmed the effectiveness of the experimental manipulations in inducing stress experiences for all subject groups.SettingThe study was conducted in a university research center.PatientsThirty patients with CTD were matched as closely as possible for age and gender to control groups of chronic low back pain, arthritis, and pain-free subjects.Outcome MeasuresSurface electromyograph recordings were taken from the frontalis, forearm flexors, trapezius, and lower back during baseline and tasks.ResultsThe study found no evidence of greater muscle tension increases or extended duration of return to baseline for the CTD or low back pain patients at any of the muscle sites for any of the tasks in comparison to control groups.ConclusionsThe results indicate that symptom-specific psychophysiological responses may be limited to certain subgroups rather than being characteristic of chronic musculoskeletal pain patients in general.

ISSN:0749-8047    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo evaluate the cardiorespiratory endurance (CRE) and physical activity level of patients with chronic pain compared with healthy subjects.Design and SubjectsCross-sectional study, with a consecutive sample of 55 patients with chronic pain (20 men, 35 women). Comparison of CRE and physical activity indices obtained in patients with data available in the literature for age-matched healthy subjects.SettingA multidisciplinary pain center in a city of more than 1,000,000 inhabitants.Outcome MeasuresA physical working capacity index (PWC65%/kg) and physical activity level scores and subscores obtained with two questionnaires (the Baecke and the Five-City Project questionnaires).ResultsThe physiological gender difference in CRE indices that characterizes healthy subjects was not observed in patients with chronic pain. When compared with values previously obtained in controls, male patients presented with a very significant 34% reduction in PWC65%/kg. The 17% reduction found in women hardly reached significance level. The Baecke total physical activity score was significantly higher in female than in male patients, a finding not observed in healthy controls. There was no significant difference between male and female patients in the Five-City Project total physical activity score expressed in kilocalories per day per kilogram (i.e., normalized for body weight), although data from the literature show that healthy men present with a significantly higher level of physical activity compared with healthy women.ConclusionsData on CRE and the physical activity level of patients with chronic pain obtained in this study show that chronic pain may have a greater impact on male than female patients. Sociocultural factors are probably at the origin of this phenomenon.

ISSN:0749-8047    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveDescription of the specific physical and psychological problems associated with sexual activity in patients with chronic pain.DesignSelf-completion questionnaire on extent and nature of sexual difficulties related to pain; data on psychological and physical function in respondents; personal and medical data for respondents and nonrespondents.PatientsThree hundred twenty-seven patients with chronic pain in inpatient and outpatient pain programs; 237 (72%) completed the questionnaire.MeasuresExtent of general and specific sexual problems; anxiety and depression (Hospital Anxiety and Depression Scale [HAD]); pain self-efficacy; pain-related disability (Sickness Impact Profile); drug use.ResultsRespondents were younger and had less depressed mood than nonrespondents, but there were no other major differences. Seventy-three percent of respondents had pain-related difficulty with sexual activity; most had several, in various combinations of problems with arousal, position, exacerbating pain, low confidence, performance worries, and relationship problems. All except position difficulties were associated with less frequent sexual activity. There were few differences between men and women, and only weak relations emerged between specific problems and mood and disability.ConclusionsThere is a high prevalence of sexual difficulties in patients with chronic pain attending treatment, nearly double that of a general UK survey. These difficulties are not simply related to mood or disability. The range of problems and patients' expressed preferences for help suggest that multidisciplinary intervention is required.

ISSN:0749-8047    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Physicians and patients alike find it easy to divide pain into mental pain and physical pain. But close examination of this distinction shows that it fails on clinical and philosophical grounds. The body is not a passive conduit for information about tissue damage. Nociception is modified and analyzed throughout the nervous system. The mind is not a central theater where pain is finally apprehended. Pain perception cannot be understood as the private observation of a pain sensation. Pain must have mental (e.g., aversion) and physical (e.g., location) elements if it is to qualify as pain. We understand our pain as well as the pain of others in terms of socially categorized pain behavior. Pain thus originates, not in mind or body, but between minds and bodies. The dualism of mental and physical pain cannot be overcome if the biological individual is considered in isolation. Mental and physical pain can only be reconciled if their common interpersonal roots are understood. This interpersonal view of pain can help clarify some clinical and moral dilemmas in the care of patients with pain.

ISSN:0749-8047    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe appropriate and optimal use of analgesics is essential for the adequate management of postoperative pain. Concern that use of opioid analgesics contributes to the development of addiction is a barrier to effective pain relief. The purpose of this study was to determine the prevalence of fear of addiction in postoperative patients in relation to surgical outcomes and staff participation in an educational program.DesignTwo treatment levels (program vs. control) and three data collection periods (before program, immediately after the program, and 6 months after the program).SettingSix community hospitals with 100–500-bed capacities in a southeastern state.PatientsSeven hundred eighty-seven patients who had undergone orthopedic or laparotomy procedures.InterventionsStaff at three of the six hospitals received an educational program to promote implementation of Agency for Health Care Policy and Research acute pain management guidelines.Outcome MeasuresPatient report of preoperative and postoperative fear of addiction, satisfaction with pain treatment, communication with clinicians, and pain intensity.ResultsOnly 10.8% of the sample reported preoperative or postoperative fear of addiction. Staff participation in the educational program was found to decrease fear of addiction in this sample. Fear of addiction was also related to surgery type, with disc surgery patients more likely to report fear of addiction as compared with patients undergoing other types of surgery. Fear of addiction was not related to other outcomes in this sample.ConclusionsFear of addiction is not prevalent among postoperative patients, yet clinician education can further decrease the proportion of surgical patients who fear of addiction to pain medication.

ISSN:0749-8047    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe aim of the current study was to examine the relation between catastrophizing and pain intensity, pain-related disability, and psychological distress in a group of patients with chronic pain, controlling for the level of physical impairment. Furthermore, it was examined whether these relations are the same for three subgroups of chronic pain patients: those with chronic low back pain, those with chronic musculoskeletal pain other than low back pain, and those with miscellaneous chronic pain complaints, low back pain and musculoskeletal pain excluded.DesignCorrelational, cross-sectional.Patients and SettingParticipants in this study were 211 consecutive referrals presenting to a university hospital pain management and research center, all of whom had a chronic pain problem.ResultsOverall, chronic pain patients who catastrophize reported more pain intensity, felt more disabled by their pain problem, and experienced more psychological distress. Regression analyses revealed that catastrophizing was a potent predictor of pain intensity, disability, and psychological distress, even when controlled for physical impairment. No fundamental differences between the three subgroups were found in this respect. Finally, it was demonstrated that there was no relation between physical impairment and catastrophizing.ConclusionsIt was concluded that for different subgroups of chronic pain patients, catastrophizing plays a crucial role in the chronic pain experience, significantly contributing to the variance of pain intensity, pain-related disability, and psychological distress. These relations are not confounded by the level of physical impairment. Some clinical implications of the results are discussed. Finally, the authors concluded that these results support the validity of a cognitive–behavioral conceptualization of chronic pain–related disability.

ISSN:0749-8047    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe objectives of this study were to use a self-report pain scale to examine child pain treatment thresholds after major surgery (i.e., the level of pain they are comfortable with before requiring analgesia), as well as to examine agreement between mother-, nurse-, and child-rated pain treatment thresholds.MethodsTwenty-five children aged 6 to 16 years were interviewed for 3 consecutive days after major surgery. Subjects used the Faces Pain Scale to rate their current pain, worst postoperative pain, and pain level at which they would like to receive analgesia (the pain treatment threshold). Parents and nurses also estimated the child pain treatment thresholds.ResultsFor day 1, mean pain was 1.86 of a maximum of 6, mean worst pain was 4.16, and mean pain treatment threshold was 2.28. For day 2, these values were 1.90, 4.10, and 2.54, and for day 3 they were 1.62, 4.56, and 1.85, respectively. Mean scores for all 3 days were as follows: pain, 1.79; worst pain, 4.15; and pain treatment threshold, 2.33. Although mother–nurse ratings were correlated (0.471), mother–child and nurse–child ratings were not significantly correlated. Using the pain treatment threshold as the criterion, 36% of our subjects were undermedicated after the first day of surgery.ConclusionPain treatment thresholds seem to be lower in children after major as compared with minor surgery. Parents and nurses are not accurate in rating child pain treatment thresholds. Parents tended to overestimate their child's pain treatment threshold, whereas nurses were less consistent in their scoring.

ISSN:0749-8047    

出版商:OVID    

年代:2001

数据来源: OVID