ISSN:0749-8047    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Objective:This study reports the results of reliability and validity analyses on the Multiperspective Multidimensional Pain Assessment Protocol (MMPAP). When pain becomes chronic it intertwines with the many dimensions of a patient's life, increasing the complexity of the patient's perception of the pain and, subsequently, the prescribed treatment. Both the patient's perspective and the physician's perspective are crucial in the assessment of these multiple dimensions, creating a fundamental need for a valid and reliable, multiperspective, multidimensional pain assessment tool.Design:A randomized regional sample of outpatients complaining of chronic pain. Each MMPAP consisted of physical examinations by two physicians and the participant's subjective self-report. Primary criterion standards were the Multidimensional Pain Instrument and the McGill Pain Questionnaire.Setting:Ambulatory referral centers, both public and private.Participants:A population-based random sample of 651 outpatients claiming chronic pain. Thirty-six patients who were originally recruited refused participation, and four patients did not complete the entire assessment.Interventions:No interventions were continued or initiated by the research team.Main outcome measures:As this was a validation of the instruments used, no patient outcomes were influenced or assessed. The MMPAP is a recently developed pain assessment protocol, which uses both subjective information and objective medical evidence.Results:The MMPAP proved to be a reliable and valid tool that may assist in the assessment of chronic pain when two physicians independently assess the patient and this information is combined with the patient's self-reported pain perceptions. Test-retest and interrater reliability analyses confirmed that the data collected with the MMPAP were repeatable. A combination of concurrent comparisons with previously validated instruments, construct corroboration with factor analysis, and internal consistency analyses ascertained the validity of the MMPAP.Conclusions:The introduction of this standardized protocol will assist in standardizing assessments of patients with chronic pain. The MMPAP has potential as a diagnostic tool, a measure of treatment effectiveness, and a tool to compare various pain treatment center outcomes.

ISSN:0749-8047    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Objective:The results of cross-sectional and prospective studies suggest that the disease conviction scale of the Illness Behavior Questionnaire (IBQ) provides important information about chronic pain. To examine further the characteristics and correlates of this scale, the relationships between disease conviction and average pain intensity and interference of pain with daily activities were examined in a sample of chronic pain patients.Design:The disease conviction scale and measures of hypochondriasis, psychological distress, pain intensity, and pain interference were administered to a sample of 127 chronic pain patients.Results:The results suggested that pain intensity and interference were more strongly associated with disease conviction than with measures of psychological distress and hypochondriasis. In an analysis in which the relationships between the individual items of the disease conviction scale and pain intensity and interference were examined, disease conviction scale items that reflect consequences of pain and illness were significantly associated with both pain intensity and pain interference, whereas items that reflect disease conviction were in general not associated with either pain intensity or interference.Conclusions:These results suggest that items included in the disease conviction scale that reflect consequences of pain and illness, rather than disease conviction, may have contributed to the relationships that have been reported between disease conviction and other aspects of the chronic pain experience.

ISSN:0749-8047    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Objective:The present study employed causal modeling to examine the impact of somatic and cognitive symptoms of depression on the functioning of patients with chronic pain.Design:Path analyses were conducted to determine whether pain level is directly related to the psychosocial and physical dimensions of functional status or whether this relationship is mediated by depression.Setting:Subjects were recruited from a facial pain clinic at the University of Florida, an outpatient clinic associated with a tertiary-care health center.Patients:Subjects were 70 patients with chronic pain, 53 of whom had primary facial pain.Main outcome measures:All subjects completed a packet of self-report questionnaires, including the Beck Depression Inventory, McGill Pain Questionnaire, and Sickness Impact Profile.Results:Results of path analyses indicated that both somatic and cognitive symptoms of depression significantly correlate with psychosocial functioning even after controlling for the effects of pain level, trait anxiety, and trait anger. Somatic symptoms of depression were significantly correlated with physical functioning after pain level, anxiety and anger were controlled.Conclusions:This study indicates that depression is directly related to both the physical and the psychosocial functioning of facial pain patients, while self-reported level of pain is not. A better understanding of the impact of depression on chronic pain and the relationship of these two disorders could lead to improved assessment and treatment of chronic pain disorders.

ISSN:0749-8047    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Objectives:To determine the relationship between depression scores and (1) anginal indices during exercise including time to onset of angina, duration of angina, and severity of angina and (2) β-endorphin at rest and in response to exercise.Design:Prospective clinical trial.Setting:Tertiary-care university hospital.Patients:Fifty-eight patients with documented coronary artery disease and exercise-induced ischemia.Outcome measures:Anginal indices during exercise (time to onset of angina, duration of angina, severity of angina); hemodynamic measures (systolic blood pressure, heart rate, rate pressure product) at rest, at onset of angina and at peak exercise; and plasma β-endorphin levels at rest and immediately after exercise.Results:Twenty-two of 58 patients had typical angina and electrocardiographic changes indicating myocardial ischemia during exercise. There was a positive correlation between depression scores and duration of angina and a negative correlation between depression scores and time to onset of angina. Among patients with angina during exercise, systolic blood pressure increased to a greater extent in patients with high depression scores. Patients with high depression scores had higher resting β-endorphin levels.Conclusions:Patients with depressed mood had greater perception of anginal pain than nondepressed patients, which cannot be explained by differences in the severity of ischemia. Possible mechanisms include an alteration in β-endorphin regulation or differences in baroreceptor stimulation.

ISSN:0749-8047    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Objective:To discuss the numerous psychological barriers to optimum pain relief in infants, children, and adolescents.Data Sources:The professional and scientific literature on pediatric pain was accessed by means of Psychlit and Medline searches. Our clinical experience with patients was also used.Data syntheses:The potential barriers to optimum management were discussed in terms of cognitive and emotional developmental barriers, perceived lack of control, children's knowledge and attitudes, and characteristics of children.Conclusions:The psychological barriers to optimum pain relief are significant and attention to these barriers could lead to better pain management.

ISSN:0749-8047    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Case Report:Thoracic epidural morphine was administered to five patients who underwent radical resection and reconstructive surgery for oral malignant tumors.Methods and Results:In case 1, an epidural catheter was inserted at the T3-T4 interspace, and 4 mg morphine was administered through the catheter ≈5 h before the end of surgery. Forty-five minutes after the end of surgery, a total of 10 mg morphine was continuously infused over a 2-day period using a balloon infusion system. The patient did not complain of pain, and no other analgesics were necessary. There were no serious side effects throughout the treatment of postoperative pain. Good control of pain was obtained by this method in four similar cases.Conclusion:Thoracic epidural morphine was effective in the relief of post-operative pain following oral surgery in five cases.

ISSN:0749-8047    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Objective:Peripheral nerve pathology commonly results in symptoms that suggest a diagnosis of complex regional pain syndrome (CRPS) type I (RSD). We briefly review common symptoms of peripheral nerve pathology (referred pain, hyperpathia, and autonomic changes) and present three illustrative cases of peripheral nerve injury misdiagnosed and treated as RSD. The nonspecificity of current taxonomy regarding CRPS as it relates to the three cases is emphasized.Design:The study is case series.Setting:All three of the cases were diagnosed and treated for their painful symptoms at a university hospital clinic that provides multispecialty evaluations for painful conditions.Patients:The three patients all had work-related injuries resulting in pain, hyperpathia, and autonomic changes in one of their upper extremities. Their injuries were representative of common peripheral nerve lesions, one being a neuroma, one an irritative lesion, and one an entrapment.Results and Conclusions:The clinical entity of CRPS quite apparently encompasses symptomatology caused by peripheral nerve entrapment, irritative lesions, and neuroma. As such, its use as a diagnostic end point may overlook these treatable conditions. As illustrated in these cases, peripheral nerve pathology may prove a diagnostic challenge and alternative techniques of investigation other than electrophysiologic studies are often helpful.

ISSN:0749-8047    

出版商:OVID    

年代:1996

数据来源: OVID