ISSN:0749-8047    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:To test the following hypotheses: there is a correlation between spread of epidural analgesia as assessed postoperatively by pinprick/cold test and postoperative pain intensity; block of pinprick/cold sensation is associated with absence of postoperative pain.Design:Correlation analysis on prospectively collected data.Setting:University hospital.Patients:One hundred patients undergoing major surgery. Consecutive sample.Interventions:Patients received an epidural infusion of bupivacaine 1 mg/ml, fentanyl 2 μg/ml, and epinephrine 2 μg/ml for at least 48 hours postoperatively. The infusion rate was adjusted according to pain intensity, occurrence of hypotension, or motor block.Outcome Measures:Assessments were made on three time points: 20-24 hours, 32-36 hours, and 42-48 hours after extubation. Assessments included pinprick and cold sensitivity from C2 to S5, pain intensity (visual analogue scale, VAS) at rest, after cough, and after mobilization. Data were analyzed by multiple regression.Results:VAS significantly decreased with increasing spread (number of dermatomes for which hyposensitivity to pinprick or cold was observed). Spread could explain only 2-5% of the variability of VAS. Absence of both pinprick and cold sensation at all dermatomes corresponding to the surgical wound was frequently associated with pain. A high proportion of patients manifesting an upper level of block above T5 had pain after abdominal surgery.Conclusions:Spread and efficacy of epidural analgesia as assessed by pinprick and cold stimulation correlate poorly with postoperative pain. These methods are of limited value both as clinical indicators of the efficacy of postoperative pain control and for investigating the effect of epidural drugs and techniques.

ISSN:0749-8047    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:The goal was to study the utility of nonverbal facial expressions as a research tool for assessing pain in persons with intellectual disabilities. Biases and stereotypes related to age, gender, physical attractiveness, and intellectual disability that may influence the ability of observers to evaluate pain reactions were also examined.Design:Facial reactions to an intramuscular injection of 40 adults (mean age = 49.6 years) with an intellectual disability were videotaped and objectively examined using the Facial Action Coding System. Self-reported pain ratings were obtained using a Colored Visual Analogue Scale for pain. Pain reactions were also rated by untrained observers.Results:A significant proportion of participants (35%) was unable to provide valid self-report. The intensity of objectively coded facial activity as well as observer-rated pain intensity showed significant increases from baseline to injection segments. Observers' pain ratings were primarily determined by the intensity of facial activity and were not significantly affected by stereotypes based on perceived level of intellectual disability, gender, age, or physical attractiveness.Conclusions:The findings support the validity of both objectively coded and observer-rated facial expressions of pain as research tools in treatment outcome studies involving persons with intellectual disabilities. Self-report has substantial limitations for the assessment of pain in this population.

ISSN:0749-8047    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:Although the West Haven-Yale Multidimensional Pain Inventory (MPI) is frequently used in clinical evaluation and research with chronic pain patients, few studies have reported item-level factor analyses. After performing such an analysis, Bernstein et al. (Spine1995;20:956-63) reported lack of independence between the solicitous and distracting response scales in section II as well as the activities away from home and social activities scales in section III. They suggested that the combination of these scales would improve the internal structure of the MPI. The purpose of this study was to perform a confirmatory factor analysis testing whether the MPI would be improved by the consolidation of these scales. In addition, a third, empirical model was generated for comparison with the West Haven-Yale and Bernstein models.Design:This study used exploratory and confirmatory factor analysis on two independent samples of chronic pain patients (n= 472 andn= 346) to test hypotheses regarding the factor structure of the MPI.Results and Conclusion:Principal axis factor analysis resulted in an empirical model that suggested that the primary psychometric problem of the MPI was lack of item-factor discrimination for several items. When the three models were tested using confirmatory factor analysis, improvement in model fit occurred when cross loading items were excluded. Nevertheless, the goodness of fit of original factor structure was adequate, suggesting it would be premature to suggest changes in this instrument.

ISSN:0749-8047    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:To investigate the impact of gender and a set of pain characteristics on the threat or challenge appraisal of pain and the impact of these appraisals on the coping strategies used to manage the pain.Design:This study used a community telephone survey to examine these relationships for a troublesome pain experienced by respondents in the 2 weeks preceding the interview.Study Respondents:The sampling frame consisted of 1,430 households randomly selected from the Halifax-Dartmouth-Bedford community. Of the 390 respondents with a troublesome pain in the 2 weeks preceding the interview, 309 respondents agreed to participate (79% response rate).Results:Women tended to report more pain located in the head and more somatic problems. They reported significantly more intense pain. For women and men, the most important impact on threat appraisal of pain was overall interference of pain and emotional upset due to pain. These two variables accounted for 48% of the variance in threat appraisal for women and 37% of the variance for men. There was no gender difference in emotional upset due to pain or in the impact of emotional upset on threat appraisal. There was no gender difference in challenge appraisal. Threat appraisal was associated with increased catastrophizing whereas challenge appraisal was associated with positive self-statements. Women reported significantly more problem solving, social support, positive self-statements, and palliative behaviors than did men.Conclusions:Interference of pain has a greater impact on threat appraisal of pain for women. Increasing threat appraisal is associated with health care utilization for women, but women's more frequent use of several coping strategies is unrelated to their appraisal of pain. Appraisal of pain may have important implications on coping and overall well-being of women and men.

ISSN:0749-8047    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:The Coping with Health, Injuries, and Problems (CHIP) Scale is a self-report instrument that is designed for diverse patient populations to provide measures of emotion-focused (e.g., emotional preoccupation) and task-oriented (e.g., palliative, instrumental, distraction) responses to injury. The present investigation assessed the factor structure, reliability, and validity of the measure in patients (n= 203) with chronic musculoskeletal pain.Method:Patients were administered questionnaires, including the CHIP Scale, and measures of pain coping strategies, adjustment, and personality.Results:The factor structure, with one exception, was replicable, and the subscale reliabilities were acceptable. The subscales related in predictable ways to other similar questionnaires, to pain adjustment, and to personality.Conclusion:Overall, the CHIP Scale is both reliable and valid in assessing responses to chronic pain. Researchers and clinicians who want to use a psychometrically sound measure of response to illness that is applicable across diverse patient populations are encouraged to consider this measure.

ISSN:0749-8047    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:The purpose of this study is to investigate the management of chronic pain in a large health maintenance organization using cognitive-behavioral techniques and a blinded control group.Design:Subjects were randomized into two groups. All participants completed a self-administered baseline questionnaire and were mailed a self-administered 6-month follow-up questionnaire.Setting:This study examines chronic pain management in a large, established health maintenance organization.Patients:Patients were members of a health maintenance organization, had pain for at least 6 months, and had failed all known treatment regimens.Interventions:The treatment group participated in a 16-hour, 8-week class teaching cognitive-behavioral techniques, the relaxation response, meditation, and stress management. The minimal treatment group received a home-study manual.Outcome Measures:Behavioral outcomes, function, and pain severity and also patient satisfaction were measured.Results:Both the treatment and minimal treatment groups exhibited improvement in pain severity, negative mood, pain affect, and pain interference with the patient's life.Conclusion:Gains were achieved in pain severity, negative mood, pain affect, self-control, and pain interference with the patient's life. Other behavioral variables and activity did not improve. Except in self-control, pain affect, and distracting responses from their significant others, the blinded minimal treatment group demonstrated similar findings. Patient satisfaction with treatment strongly favored the treatment group with over 78% of the treatment participants satisfied with the care provided.

ISSN:0749-8047    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:This trial was performed to evaluate the efficacy of an adjunctive cognitive-behavioral treatment compared with rheumatological treatment alone in unselected rheumatoid arthritis outpatients.Design:A prospective randomized control design was used. Change in medication during treatment was controlled by matching therapy- and control-group subjects according to this change in medication, sex, age, duration of disease, and functional class.Setting:A rheumatological outpatient clinic, University of Goettingen, Germany.Patients:Fifty-five consecutive outpatients with a diagnosis of rheumatoid arthritis (age 52.7 years, 74.5% female, duration of disease 9.4 years) finished the study.Interventions:Subjects received routine care by the rheumatologists and routine medical treatment. Cognitive-behavioral treatment subjects (n= 19) received adjunctive standardized cognitive-behavioral group treatment with 12 weekly sessions.Outcome Measures:Outcome measures included disease activity variables, pain variables (pain intensity, affective pain), psychological symptoms, and coping.Results:Subjects mostly demonstrated an increasing disease activity during treatment; change in medication during treatment was necessary in some patients. In the cognitive-behavioral treatment group the course of rheumatoid arthritis seemed less progressive than in the control group. The core effects of cognitive-behavioral treatment pertain more to improved coping, emotional stabilization, and reduced impairment than to reduced pain intensity. Passive, emotion-focused coping, helplessness, depression, anxiety, affective pain, and fluctuation of pain are reduced, "Acceptance of Illness" is improved.Conclusions:Cognitive-behavioral therapy has proven an effective adjunct to standard treatment of rheumatoid arthritis outpatients. These effects were shown in an unselected sample with increasing disease activity and with comparable changes in medication during treatment. We recommend cognitive-behavioral treatment as an desirable adjunct to standard medical treatment of rheumatoid arthritis.

ISSN:0749-8047    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Case Report:Nine patients with Complex Regional Pain Syndrome types I and/or II (CRPS), previously known as reflex sympathetic dystrophy (RSD) and causalgia, respectively, were selected for treatment with a continuous four to eight week subcutaneous infusion of 10% lidocaine.Results and Conclusions:Five patients completed the infusion treatment. The treatment significantly alleviated much of the pain and other symptomatology (i.e., dysesthesia, allodynia, hyperpathia, color and temperature changes, decreased range of motion of involved extremities, changes in hair and nail growth, etc.) commonly observed for CRPS/RSD patients. Upon discontinuation of the continuous subcutaneous infusion, patients appear to maintain the pain relief obtained. Periodic maintenance infusions may be needed.

ISSN:0749-8047    

出版商:OVID    

年代:1999

数据来源: OVID