ISSN:0749-8047    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The prediction of return to the workplace after Multidisciplinary Pain Center (MPC) treatment has become a major research area. To delineate the variables that predict this outcome, the authors reviewed 164 multidisciplinary outcome studies. Of these, 79 addressed work as an outcome variable. Twenty-six studies attempted to identify patient variables predicting return to the workplace. These latter studies were critically inspected for eight methodological criteria: pain location, follow-up time interval, response percentage and follow-up method, return to work subcategorization, vocational movement, univariate vs. multivariate statistics, multicolinearity and variance, and statistical treatment of dropouts. In addition, other disability studies besides those in the chronic pain area were reviewed for return to the workplace predictor variables. Of these 26 studies, only a few appeared to satisfy the criteria examined. In addition, many studies were in conflict with one another on whether a variable was predictive. The review of the nonchronic pain/disability prediction literature yielded a large number of potential predictors that related to the work area. It is unclear which variables or set of variables predict return to the workplace after MPC treatment. Chronic pain studies may be neglecting the work area as an important source of return to the workplace predictor variables.

ISSN:0749-8047    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo examine gender-related differences in pain and cardiovascular responses to forearm ischemia.DesignForearm ischemia was produced by the submaximal effort tourniquet procedure. Participants performed 2 min of dynamic hand exercise at 30% maximum grip strength. Forearm ischemia was maintained until the report of ischemic pain tolerance or until 20 min elapsed. Arterial blood pressure, heart rate, and verbal reports of ischemic pain were assessed at 2 min intervals.SubjectsThirty four male and 33 female participants of similar age.ResultsThe times to ischemic pain onset and ischemic pain tolerance were similar for both male and female participants. However, during the ischemic period, females reported ischemic pain to be more intense and of greater unpleasantness than male participants. The relative changes in arterial blood pressure and heart rate during the exercise and occlusion period were equivalent for both male and female participants. In contrast, arterial blood pressure responses during the postexercise ischemic period were gender-dependent. Arm ischemia evoked pressor responses in male participants and either a decrease or no change in arterial pressure in female participants. Changes in arterial pressure during the postexercise ischemic period were significantly and positively correlated with verbal measures of ischemic pain for male subjects but not for female subjects.ConclusionsThe data demonstrated that gender influences both the sensory and the cardiovascular responses to a tonic noxious stressor.

ISSN:0749-8047    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectivesWe designed a clinical study to determine: a) the safety and efficacy of patient-controlled analgesia (PCA) therapy in children and adolescents undergoing major-operations, b) if the use of a concurrent opioid infusion improved the efficacy of conventional PCA therapy, and c) if nurse control of the PCA device was a useful alternative in the intensive care unit (ICU) setting.DesignSubjects were randomly assigned to receive morphine sulfate for postoperative pain relief via intermittent PCA boluses on demand or PCA plus a continuous infusion (PCA + CI). Children (n = 12) who were unable to use the PCA device because of inadequate developmental level or upper extremity weakness were assigned to a nurse-controlled analgesia (NCA) group.SettingIn the ICU of a university-based pediatric teaching hospital.PatientsFifty-four children and adolescents underwent elective scoliosis surgery.InterventionsThe PCA devices were connected to the patient's i.v. catheter immediately after surgery. Morphine sulfate was administered on demand by either the patient or an ICU nurse for pain relief during the first 72 h after the operation.Main Outcome MeasuresPain scores were recorded simultaneously by both the nurse and the patient using standardized visual analog scales. Opioid analgesic usage, side effects, and therapeutic interventions were recorded by the ICU nurse.ResultsThere were no differences between the PCA and PCA + CI groups with regard to morphine use, pain relief, side effects, or patient satisfaction. Nurses consistently underestimated their patient's level of pain, and children in the NCA groups received less morphine per kilogram than those who self-administered their own analgesic medication.ConclusionsBoth PCA and NCA were safe and efficient methods of analgesic administration in the pediatric ICU setting. However, use of a concurrent opioid infusion with PCA therapy did not provide any clinically significant advantages over intermittent bolus doses of the analgesic medication after scoliosis surgery. For patients unable to use a conventional PCA device, NCA is an acceptable alternative for the management of acute pain in the ICU setting.

ISSN:0749-8047    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveThis study examined the hypothesis that among chronic pain patients lacking participation in activities, perceived pain-relevant spousal support would act to compensate for a low level of social reinforcement and provide a buffer against depression.DesignHierarchical regression analyses were conducted to examine the relative and cumulative effects of support and activity, and their interactions, in the prediction of depression severity.SettingThe study setting was a training and research oriented Veterans Administration Medical Center.PatientsParticipants were 105 married, male chronic pain patients evaluated for a comprehensive pain management program.Main Outcome MeasureDepression severity was measured by the Beck Depression Inventory.ResultsThree categories of activity, and perceived interference of pain accounted for significant proportions of the variance in depression severity scores beyond that accounted for by age and pain severity. Support was not predictive of depression. Interactions between interference and support, and between two of the specific activities and support added significantly to the prediction of depression.ConclusionsResults are consistent with a buffering model of social support in which perceived spousal support among chronic pain patients appears to moderate the potentially deleterious effects of a low level of activity.

ISSN:0749-8047    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo assess the overall efficiency of an outpatient behavioral rehabilitation program for excess disability and chronic pain and to describe the program staff, treatment components and outcomes in sufficient detail to facilitate comparison with similar programs.DesignEight-year follow-up study of patients referred and treated.SettingOutpatient primary care and multispecialty group medical practice.Patients354 of 421 unselected patients referred for the behavioral management of excess disability, who completed the treatment program and participated in follow-up.Interventions15–20 sessions of physical and occupational therapy, 5–10 sessions of biofeedback, and one or two family sessions all based upon behavioral techniques described by Fordyce and by Roberts.Main Outcome MeasuresQuestionnaires, including analog scales, administered before treatment and at 1, 6, 12, and 24 months posttreatment.ResultsPatients (n= 67) who dropped out did not differ systematically from those who participated (n= 354). The treatment program resulted in a marked and enduring reduction of pain, and a statistically and clinically significant improvement in patients' ability to function at work and in the home. Patients overwhelmingly endorsed the program.ConclusionsA brief, inexpensive, outpatient behavioral rehabilitation program for chronic pain and excess disability can achieve a clinically significant and lasting reduction of pain and improvement in function at work and at home.

ISSN:0749-8047    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo determine whether chronic pain patients' beliefs and attributions about pain control are amenable to change in a short-term inpatient multidisciplinary pain management program.DesignNon-randomized consecutive sample with prospective, before–after treatment.SettingPain-management, tertiary care center in a major U.S. city.PatientsAll adult patients (n = 50) who were treated in an inpatient multidisciplinary pain management center were contrasted with those of a control group of 46 adult patients who were treated in an outpatient pain center.Outcome MeasuresPain Locus of Control Scale, the Pain Beliefs and Perceptions Inventory, subjective pain intensity, and medication usage were measured before and after treatment.ResultsStatistically significant posttreatment changes were found for the treatment group, but not the control group. Patients who completed the inpatient pain management program reported significant decreases in subjective pain intensity despite discontinuation of narcotic analgesics. Patients in the treatment group showed an increased sense of personal control over their pain and substantial decreases in attributions of pain control to powerful others and chance. Patients in the treatment group also showed a significant reduction in their endorsement of the belief that their pain was a mysterious phenomenon.ConclusionChronic non-terminal pain patients' beliefs about pain and attributions of pain control are amenable to change in a short-term inpatient multidisciplinary pain management program. These results suggest that an intensive multidisciplinary program involving psychotherapy might be more effective in treating chronic pain patients similar to those in this study than outpatient treatment without psychotherapy.

ISSN:0749-8047    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1993

数据来源: OVID