摘要:

Objective:The purpose of this study was to investigate the relation between cervical discographic pain responses and radiographic images.Design:Records were reviewed for a series of patients who had undergone cervical discography.Setting:All patients were being treated at a spine specialty clinic.Patients:A total of 269 discs were studied in 161 discographic procedures in patients with neck, shoulder, or arm pain. All patients underwent other diagnostic procedures before discography, including magnetic resonance imaging, computed tomography (CT), and CT/myelography.Interventions:During the injection of contrast in each disc evaluated, the patient was asked if any pain was felt, and if so, was it similar or dissimilar to the pain typically experienced.Outcome Measures:Results were determined by analyzing the pain responses during disc injection with respect to imaged pathology seen on the axial CT discographic image of the disc. Results were further analyzed based on patient age.Results:There was a significant relation between the radiographic image of the disc and the results of clinical pain provocation (p< 0.01; χ2). Among the 35 discs appearing as normal, clinical pain was provoked in only 14.3%. Among the 234 discs appearing as abnormal, clinical pain was provoked in 77.8%. The mean age of the patients with painless radiographically abnormal discs was significantly greater than that of the patients in the other subgroups of the study population.Conclusions:There was good agreement between the radiographic appearance of the disc and the pain provocation results. Discs that were painless but disrupted were found among older patients. Among such patients, discography may be particularly helpful in differentiating clinically significant abnormalities from those associated with aging.

ISSN:0749-8047    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:The purpose of this study was to assess the analgesic potential of sustained-release (SR) bupropion for neuropathic pain.Design:Open-label treatment design.Setting:Outpatient pain clinic, University of Arizona Health Sciences Center, Tucson, Arizona.Patients:Twenty-two patients with a diagnosis of neuropathic pain.Interventions:Patients with neuropathic pain received 1 week of 150 mg SR bupropion once daily followed by 7 weeks of 150 mg SR bupropion twice daily.Outcome Measures:Treatment effects were assessed by daily ratings of pain intensity, posttreatment global ratings of pain relief, depression scores (Hamilton Depression Scale), and daily ratings of side effects.Results:Fifteen patients (68%) reported that their pain relief was improved or much improved with bupropion. The mean average pain score at week 1 was 6.7, which decreased at the end of week 8 to 5.3 (pairedttest,t[df= 21]3.327;p= 0.003) in all patients studied and to 3.8 (pairedttest,t[df= 14]3.754;p= 0.002) in the patients who improved. Pain relief was statistically significant at week 5 (pairedttest,t[df= 21]3.816;p= 0.001) and continued throughout weeks 6, 7, and 8. Most patients were not depressed, and analgesia was observed to occur without change in depression ratings in most patients who responded. Side effects were rated as mild and consisted primarily of insomnia (8 patients), tremor (3 patients), and gastrointestinal upset (2 patients). These symptoms had a tendency to recede with continuation of therapy.Conclusions:This uncontrolled pilot study suggests that bupropion may be an effective and tolerated treatment for some patients with neuropathic pain. Blockade of norepinephrine reuptake may mediate this effect. The role of dopamine reuptake blockade is uncertain. A larger randomized, double-blind, placebo-controlled study is currently underway to confirm these preliminary results.

ISSN:0749-8047    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:A randomized, double-blind, controlled study was designed to evaluate the effect of presurgical local infiltration of bupivacaine in the surgical field on postsurgical wound pain relief and analgesic requirements in 28 healthy patients scheduled for laparoscopic gynecologic examinations.Interventions:After induction of general anesthesia by routine methods, the patients were randomly divided into two groups. In the bupivacaine (B) group (n = 15), patients were injected with 5 ml of 0.25% bupivacaine at each incisional area (four sites, total of 20 ml) approximately 15 minutes before skin incision. In the control (C) group (n= 13), the surgical field was injected with an equal volume of physiologic saline solution (four sites, total of 20 ml).Outcome Measures:Postsurgical wound pain at rest was evaluated by a 10-cm visual analog pain scale at 1, 10, 24, and 72 hours and 1 month after surgery. The patients were interviewed via telephone 1 month after hospital discharge for reevaluation of resting pain.Results:The results indicated that the incidence of postsurgical wound pain for up to 10 hours after surgery in group B was significantly lower (p< 0.05) than in group C. Pain intensity ranged from mild to moderate (2-5 cm). In addition, the mean visual analog pain scale pain intensity was significantly less for group B (0.31 ± 0.85 cm) than for group C (2.62 ± 2.06 cm) for up to 10 hours after surgery (p< 0.05). The number of patients who requested analgesics and complained of sleep disturbances was significantly higher in group C (p< 0.05). The mean cumulative dose of diclofenac sodium at 24 hours was significantly (p< 0.05) lower in group B (6.67 ± 17.6 mg) than in group C (30.8 ± 25.3 mg). Prolonged postsurgical wound pain persisting 1 month after surgery was observed in one patient in group C.Conclusions:It is concluded that presurgical infiltration of 0.25% bupivacaine in the surgical field is a useful method for decreasing postsurgical wound pain for up to 10 hours and analgesic consumption for up to 24 hours after laparoscopic gynecologic examination.

ISSN:0749-8047    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:The goal of this study was to use computed tomographic (CT) scanning to localize clinically guided sacroiliac (SI) joint injections and identify other structures affected by this procedure.Design:A prospective, double-blind, correlational outcome study design was used. Injection of 39 SI joints with a mixture of bupivacaine (0.25%), methylprednisolone (40 mg), and iohexol (Omnipaque; 180 mg/dl) using a clinically guided technique, (i.e., no image guidance) was performed. Patients had CT scans obtained both immediately after needle placement and after contrast injection. Neither the patients nor their clinicians were aware of the CT findings at the time of injection.Setting:Academic multidisciplinary pain center.Patients:Patients with SI disease by clinical criteria.Results:Intra-articular injection was accomplished in 8 of 37 (22%) patients. Injected material was identified within 1 cm of the joint 68% of the time. Epidural (spinal canal) injected material was seen 24% of the time.Conclusions:The low rate of intra-articular injection seen with this clinically-guided technique suggests restraint in its use for injection therapy. Some image guidance (e.g., fluoroscopy, CT) is probably necessary to reliably inject the SI joint. Perhaps in clinical settings, where image guidance is not readily available, a clinically-guided technique could initially be tried in patients at low risk for complications from such injections. This study also provides an anatomic explanation for the occasional weakness observed after SI joint injection.

ISSN:0749-8047    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:The goals of this study were to examine agreement and estimate differences in sensitivity between pain assessment scales.Design:Multiple simultaneous pain assessments by patients in acute pain after oral surgery were used to compare a four-category verbal rating scale (VRS-4) and an 11-point numeric rating scale (NRS-11) with a 100-mm visual analog scale (VAS). The sensitivity of the scales (i.e., their ability [power] to detect differences between treatments) was compared in a simulation model by sampling from true pairs of observations using varying treatment differences of predetermined size.Results:There was considerable variability in VAS scores within each VRS-4 or NRS-11 category both between patients and for repeated measures from the same patient. Simulation experiments showed that the VAS was systematically more powerful than the VRS-4 in all simulations performed. The sensitivity of the VAS and NRS-11 was approximately equal.Conclusions:In this acute pain model, the VRS-4 was less sensitive than the VAS. The simulation results demonstrated similar sensitivity of the NRS-11 and VAS when comparing acute postoperative pain intensity. The choice between the VAS and NRS-11 can thus be based on subjective preferences.

ISSN:0749-8047    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:This study examined factors related to reduced fecundity among women with myofascial face pain (MFP) arising from hypotheses concerning the role of neurohormonal factors in MFP and associated conditions.Design:Fecundity rates among 162 MFP cases and 173 demographically equivalent acquaintance female controls were compared.Outcome Measures:Fecundity indicators and factors underlying differential fecundity rates were investigated.Results:It was determined that female cases with MFP had significantly fewer children and were more likely to have never been pregnant. Although women with MFP were more likely than controls to indicate that volitional factors related to their health discouraged them from any or additional pregnancies, these factors did not account for lower rates of fecundity. MFP cases also did not differ from controls on self-reported indicators of infertility. Moreover, we show that reduced fecundity was restricted to the subgroup of MFP cases who reported a history of fibromyalgia.Conclusions:Reduced fecundity in women with MFP is restricted to those who self-report a history of fibromyalgia. Possible mechanisms for reduced fecundity in fibromyalgia are discussed. These findings highlight the need to screen for widespread pain among women with regional myofascial pain syndromes.

ISSN:0749-8047    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:The goal of this study was to examine whether body activity such as postural, trunk, and limb movements may be potential pain cues in preterm infants.Design:Convenience sample.Setting:Level III neonatal intensive care unit (NICU).Patients:Extremely low birth weight (≤1,000 g) preterm infants (n = 64) undergoing routine NICU medical care.Outcome Measures:Procedures likely to differ in evoking distress (i.e., endotracheal suctioning, chest physical therapy, diaper change, or nasogastric feed) were observed. Behaviors were recorded at bedside using the Neonatal Individualized Developmental Care and Assessment Program system.Results:Changes in heart rate and sleep/waking state were related to the procedures, supporting the assumption of differing relative disruption to the infant. Arching, squirming, startles, and twitching were not observed significantly more during procedures than at baseline. After controlling for background variables, finger splay and leg extension were significantly related to ongoing procedures. Facial brow raising was a function of the number of invasive procedures in the past 24 hours; thus, it may be a useful cue of sensitization.Conclusions:Some extensor movements seemed to be distress signals, whereas tremors, startles, and twitches were not related to discomfort during the observation period. These behaviors may differ qualitatively during longer lasting tissue invasive events. The results of this study indicate the need for more in-depth study of patterns of motor activity in preterm infants over longer observation periods to evaluate potential signs of stress and pain in babies undergoing NICU medical care.

ISSN:0749-8047    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:Considerable research indicates that both high levels of anxiety and female sex are associated with increased sensitivity to experimental pain and greater experience of clinical pain. In general, however, previous research has not investigated the joint effects of sex and anxiety on pain responses. A single previous laboratory-based study indicated that anxiety was inversely related to pain thresholds among men but not among women. The present study examined the relation between pain-related anxiety and adjustment to chronic pain in a sex-dependent manner.Design and Setting:A total of 215 (114 women, 101 men) chronic pain patients referred to a multidisciplinary treatment center completed questionnaires assessing anxiety and adjustment to chronic pain.Results:Results generally supported the previous laboratory-based finding indicating that an inverse relation between anxiety and adjustment to chronic pain was present only among male patients. Although male patients with high pain-related anxiety reported greater pain severity, greater interference of pain, and lower levels of daily activity than male patients with low anxiety, this effect was not present among female patients. Moreover, the effects of pain-related anxiety on adjustment to chronic pain were not attributable to either hypervigilance or use of passive coping strategies. Potential explanations and implications for the present findings are discussed.

ISSN:0749-8047    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:Prior research examining the utility of nonverbal measures of pain in persons with cognitive impairments has focused on acute procedurally-induced phasic pain (i.e., venipuncture and needle injections). The goal of the current project was to examine the utility of both self-report and nonverbal measures of pain in frail elders experiencing exacerbations of chronic musculoskeletal pain. These were assumed to be more representative of the day-to-day pain experience of elderly patients.Design:Participants were 58 frail elders, 29 of whom had been found to have significant cognitive impairments. All were filmed as they undertook a series of structured activities (e.g., walking and reclining), and pain was assessed using self-report. Trained coders identified the incidence of pain-related behaviors using the videotapes. The various pain measures (i.e., self-report and nonverbal indices) were compared across both patient groups and the several activities.Results:Consistent with our hypotheses, more pain was identified (using both self-report and nonverbal measures) when patients engaged in more physically demanding activities. Facial reactions varied as a function of patient cognitive status, with those participants who were cognitively impaired more responsive. Of the various nonverbal indices that we examined, guarded behavior appeared to be especially sensitive. The various pain indices were only modestly correlated with one another.Conclusions:This study supports the validity of self-report and behavioral measures of pain in frail elders with and without cognitive impairments. Each of the measures used contributed different information to pain assessment, suggesting that investigations of pain in elders with cognitive impairments should employ varying types of pain assessment tools.

ISSN:0749-8047    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:The goal of this study was to assess clinical consensus regarding whether myofascial pain syndrome (MPS) is a legitimate and distinct diagnosis as well as the signs and symptoms characterizing MPS.Design:A standardized mailed survey with return postage provided.Subjects:A total of 1,663 American Pain Society members in medically related disciplines listed in the 1996/1997 directory.Outcome Measures:A standardized survey assessing clinical opinion regarding whether MPS is a legitimate diagnosis, whether MPS is a clinical entity distinct from fibromyalgia, and the signs and symptoms believed to be "essential to," "associated with," or "irrelevant to" to the diagnosis of MPS.Results:Of the 403 surveys returned, 88.5% respondents reported that MPS was a legitimate diagnosis, with 81% describing MPS as distinct from fibromyalgia. The only signs and symptoms described as essential to the diagnosis of MPS by greater than 50% of the sample were regional location, presence of trigger points, and a normal neurologic examination. Regarding the signs and symptoms considered to be essential or associated with MPS, more than 80% of respondents agreed on regional location, trigger points, normal neurologic examination, reduced pain with local anesthetic or "spray and stretch," taut bands, tender points, palpable nodules, muscle ropiness, decreased range of motion, pain exacerbated by stress, and regional pain described as "dull," "achy," or "deep." Sensory or reflex abnormalities, scar tissue, and most test results were considered to be irrelevant to the diagnosis of MPS by a large proportion of the respondents.Conclusions:There was general agreement across specialties that MPS is a legitimate diagnosis distinct from fibromyalgia. There was a high level of agreement regarding the signs and symptoms essential or associated with a diagnosis of MPS. Differences across specialties are discussed. This survey provides a first step toward the development of consensus-based diagnostic criteria for MPS, which can then be validated empirically.

ISSN:0749-8047    

出版商:OVID    

年代:2000

数据来源: OVID