ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundUntil recently, very little has been written regarding chronic pain as a secondary problem in persons who already have a physical disability, despite the potential for pain to increase the negative impact of what may already be a very disabling condition. The purpose of this review is to summarize what is currently known concerning the nature and scope of chronic pain as a secondary condition to disability, specifically spinal cord injury, acquired amputations, cerebral palsy, multiple sclerosis, neuromuscular disease, and postpolio syndrome.MethodWhat is known concerning the frequency, severity, impact, and treatment of pain in these specific conditions is reviewed, as are the factors that contribute to, or are associated with, adjustment to chronic pain in these disability groups. The authors conclude with several research questions that emerge from this knowledge, the answers to which will contribute to the long-term goal of the reduction of pain and suffering in persons with disabilities.ConclusionsThe existing literature clearly documents that many persons with disabilities experience chronic pain. Many questions remain unanswered regarding the scope, severity, and treatment of chronic pain in these groups.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivesFirst, to identify what physical performance differences existed between a group of disabled individuals with chronic pain and a control group of pain-free individuals with comparable disabilities; and second, to test a psychosocial model designed to evaluate which psychosocial constructs were predictive of performance in disabled individuals with chronic pain.DesignCase-comparison study.SettingAmbulatory university laboratory.ParticipantsA community sample of 62 individuals with lower limb amputations or paraplegia, 31 with chronic pain and 31 pain-free.InterventionStandardized lifting and wheel-turning tasks.Main Outcome MeasuresStatic strength, endurance, lifting speed, lateral and anterior–posterior sway, and multidimensional psychosocial measures.ResultsDisabled individuals with chronic pain had decreased endurance for both the lifting (p<0.001) and the wheel-turning (p<0.05) tasks. A psychosocial model of physical performance also was evaluated. Using confirmatory factor analysis, 31 measures were used to validate 8 theoretical constructs: emotional functioning, pain intensity, pain cognitions, physical functioning, social functioning, task-specific self-efficacy, performance outcome, and performance style. Regression analyses indicated that more than 90% of the variance in performance was predicted by psychosocial factors, with self-efficacy, perceived emotional and physical functioning, pain intensity, and pain cognitions showing the highest associations.ConclusionsChronic pain was found to significantly reduce the performance in individuals with lower limb amputations and paraplegia. A strong association was found between performance and psychosocial factors in disabled individuals with chronic pain. These findings extend the existing literature by validating that psychosocial models of chronic pain can be applied to the disabled population, with results similar to those of other chronic pain samples.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo develop and establish the psychometric properties of a pain treatment willingness scale and identify factors associated with willingness to try specific pain treatments for spinal cord injury (SCI)-related pain.DesignAs part of a larger study, a questionnaire was designed to assess willingness to use various pain medications and other types of pain treatments. This questionnaire, which included measures of pain severity, pain interference, mood, hope, and current use of pain treatments, was completed by persons with SCI recruited through the mail or in person.SubjectsOne hundred fifteen persons completed the questionnaire (35% response rate). Seventy-two percent of the participants were men, mean age was 49.1 years, and average time elapsed since injury was 8 years.ResultsFactor analysis indicated two factors—willingness to use opioids and willingness to use nonpharmacological treatment (i.e., physical therapy, relaxation methods and stress management, and alternative medicine). Internal consistency and convergent and divergent validity were established. Persons experiencing SCI-related pain were more willing to use pain treatments than those without current pain, and those who were currently using opioids reported greater willingness to use that treatment. Persons who reported SCI-related pain were more willing to use nonpharmacological treatments than opioid medications. Finally, participants demonstrated different degrees of willingness to use an opioid medication based on its name (i.e., “narcotic,” “codeine,” “morphine,” “methadone”).ConclusionsWillingness to use a specific pain treatment may be a key factor mediating the behavior of using that specific treatment. Assessment of patient attitudes toward various treatments options, particularly regarding opioid medications, is warranted to optimize treatment adherence. Once the factors that determine these attitudes are identified, interventions to increase willingness to use nonpharmacological or opioid treatments can be designed and evaluated.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivesFirst, to define the clinical characteristics of nonpainful sensations (NP) that commonly appear after spinal cord injury (SCI); and second, to compare the clinical characteristics of NP and chronic pain (CP) after SCI.MethodsTwo sets of questions concerning CP and NP were mailed to 330 subjects. Responses from 197 persons experiencing CP as well as NP were analyzed.ResultsThe most common locations for CP and NP were back and lower extremities. Although the number of areas in which the subjects perceived CP and NP to be located was significantly correlated, a factor analysis showed separate groupings of areas with CP and NP, respectively. Self-reported allodynia or hyperesthesia in the lower extremities, however, was significantly associated with CP in the same areas. The number of descriptive adjectives used for CP and NP was also significantly correlated, as was the perceived intensity of CP versus NP. Additionally, significant correlations were found in onset and temporal pattern of CP and NP. Similarly to CP, NP interfered with sleep, work, and other daily activities, and the patterns of interference due to CP and NP were significantly correlated.DiscussionWhile many aspects of the clinical picture of CP and NP are similar after SCI, the CP and spontaneous NP are not necessarily located in the same areas. Although the observed similarities between CP and NP may be based on pathophysiologic mechanisms, the significant relations between the interference patterns suggest that psychosocial mechanisms related to coping are also involved.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundChronic pain was believed to be a recognized but infrequent complication after inguinal hernia repair. Evidence suggests that patients with chronic pain place a considerable burden on health services. However, few scientific data on chronic pain after this common elective operation are available.ObjectivesTo review the frequency of chronic pain and to discuss etiological theories and current treatment options for patients with chronic post herniorrhaphy pain.Materials and MethodsAll studies of postoperative pain after inguinal hernia repair with a minimum follow-up period of 3 months, published between 1987 and 2000, were critically reviewed.Results and DiscussionThe frequency of chronic pain after inguinal hernia repair was found to be as high as 54%, much more than previously reported. Quality of life of these patients is affected. Chronic pain is reported less often after laparoscopic and mesh repairs. Recurrent hernia repair, preoperative pain, day case surgery, delayed onset of symptoms, and high pain scores in the first week after surgery, however, were identified to be risk factors for the development of chronic pain. Definition of chronic pain was not explicit in the majority of the reviewed studies. Accurate evaluation of the frequency of chronic pain will require standardization of definition and methods of assessment. Prospective studies are required to define the role of risk factors identified in this review.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundNonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to enhance opioid analgesia in the acute pain service. The question, however, of whether NSAIDs produce a similar extent of potentiation among different types of pain, has not been thoroughly investigated.Materials and MethodsA randomized, placebo-controlled, double-blind study was performed to characterize the analgesic effect of tenoxicam, a long-acting NSAID, on resting wound pain, evoked wound pain, and uterine cramping pain after cesarean section. Saline (n = 48) or 20 mg tenoxicam (n = 45) was intravenously injected immediately after clamping the umbilical cord. All patients were instructed to obtain maximal postoperative analgesia by intravenous patient-controlled morphine.ResultsTenoxicam profoundly reduced the intensity of uterine cramping pain (3.6 [2.0–5.6] versus 5.5 [3.4–6.6];p< 0.01) but had no additional effect on wound pain at rest, with movement, changing position, sitting, and walking. Intraoperative injection of 20 mg tenoxicam decreased the demand ratio for patient-controlled analgesia (PCA) and 24-hour morphine consumption by approximately 30%.ConclusionsThe data show that tenoxicam potentiates opioid analgesic effect on the somatic and visceral types of pain to different extents, and they suggest that intraoperative injection of 20 mg tenoxicam is sufficient to enhance intravenous PCA morphine on uterine cramping pain for the first 24 hours after cesarean section.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo outline the modes of action of topiramate and to examine the theoretical reasons as to why topiramate may alleviate neuropathic pain. Results of animal and human studies in the use of topiramate for treating pain are reviewed, together with case studies describing situations where topiramate was effective when other treatments have failed.ConclusionsTopiramate acts on neuronal transmission in at least five ways: by modulating voltage-gated sodium ion channels, potentiating &ggr;-aminobutyric acid inhibition, blocking excitatory glutamate neurotransmission, modulating voltage-gated calcium ion channels, and by inhibiting carbonic anhydrase. This review suggests that there are good theoretical reasons for a trial of topiramate in patients with neuropathic pain where conventional medical treatments have failed. Although not currently licensed for treating pain, topiramate should be considered before invasive methods of pain relief are contemplated. Most of the side effects of topiramate are dose dependent, but by starting medication with a low dose (≤25 mg/d) that is gradually titrated upward, tolerance is much more easily achieved.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundComplex regional pain syndrome type I(CRPS I [formerly called reflex sympathetic dystrophy]) is a syndrome with pain and signs of autonomic dysfunction after trauma or immobilization; the pathophysiologic mechanisms of CRPS I, however, remain unknown.DesignThe authors present a case of CRPS I associated with amyotrophic lateral sclerosis. Along with the motor paresis due to amyotrophic lateral sclerosis, pain, swelling, and signs of autonomic disturbance occurred.ConclusionsThis case supports the hypothesis that immobilization is one of the major contributing factors for CRPS I.

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