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Biomedical subjects

J D Mann

Publications and source records attributed to J D Mann.

At least 19 recordsLinked to original sources
PubMed2000

Methadone in the treatment of chronic nonmalignant pain: a 2-year follow-up.

OBJECTIVE: To examine the longitudinal use of methadone in a pain clinic. DESIGN: Follow-up study of 40 patients initially treated with methadone and re-evaluated 2 years later, comparing those maintained on methadone with those who were switched to other opioids. SETTING: Pain clinic at a university hospital. RESULTS: The 14 patients (35%) who stayed on methadone for the duration of the study, had higher employment rates (P <.05) and higher functional ratings (P <.02) than those on other opioids. Side effects were the most common reason (33.4%) for discontinuation of methadone. Dose escalation occurred in 11 of 14 patients (78.6%). CONCLUSIONS: Chronic pain patients may be safely and effectively treated with methadone. Those not responding or tolerating methadone may be benefited by treatment with other opioids.

Journal Article↗
PubMed1998

Successful treatment of headache related to intravenous immunoglobulin with antimigraine medications.

In order to investigate headache related to intravenous immunoglobulin, we studied a 36-year-old woman with a history of migraine receiving weekly intravenous immunoglobulin for refractory myasthenia gravis who experienced severe headaches with each treatment. Neurological examination, CT scan of the head, and a lumber puncture after the first headache were normal. Significant therapeutic response was based upon 50% reduction in pain and associated features. Headache features included throbbing pain which worsened with head movement and was associated with severe photophobia and nausea. Sumatriptan, 6 mg subcutaneous, reduced headache significantly with resolution of associated complaints. Treatment prior to intravenous immunoglobulin with dihydroergotamine mesylate resulted in development of only a mild dull ache without further development of severe head pain. Dihydroergotamine mesylate was also abortive in the few instances when the headache worsened. Headaches associated with intravenous immunoglobulin may have features of migraine and may be successfully prevented and/or treated with 5-HT1D receptor agonists.

Adult↗
PubMed1998

Pain management issues: the cost of medications in rural settings.

Cost of analgesic and adjuvant medications used by rural patients with cancer cared for by 29 nurses participating in an in-depth education program were evaluated before and after the program. Across all time periods, the median daily cost was $5.16 across all medications. Average daily cost and maximum and median cost of all medications were $5.36, $74.38 and $3.58, respectively. Average daily cost did not change over time. Average pain intensity did not change over time and was not related to prescribing patterns or daily costs. While professional education was demonstrated to produce change in prescribing practices, further research is needed to evaluate patterns of medication administration and effectiveness patterns using reliable outcome measures other than self report of pain intensity.

Adult↗
PubMed1996

Changing the relationship among nurses' knowledge, self-reported behavior, and documented behavior in pain management: does education make a difference?

An educational program designed to change knowledge in order to change pain management practices and patient outcomes was offered to nurses who provide day-to-day care to patients with cancer in communities in a predominantly rural state. A quasi-experimental time-series design was used to measure the effectiveness of the program in changing nurse knowledge, attitude and behavior, and to evaluate the relationships between the outcomes. Data were collected from nurses (N = 29) and patient charts before (N = 209) and after (N = 163) the program. Nurses' knowledge increased, but the change was not statistically significant; the mean percent of correct answers on the three subtests were different and differences persisted throughout the study. Nurses believed that patients should be "pain free." Documentation of behaviors, for example, practice activities, occurred infrequently and showed little change until 6 months after the program. Increase in documentation of pain-intensity ratings, pain location, number of sites of pain, presence of confusion, anxious or depressed mood, sleep, nausea and vomiting, constipation, and general activity were noted. Documentation of the use of a propoxyphene-containing analgesic decreased; increase in the use of hydromorphone methadone and transdermal fentanyl was noted. Analysis of the relationships between correct responses to nurse knowledge questions and documentation of behavior provided interesting, statistically insignificant results that need to be reexamined in future research. Future programs should emphasize analgesic dosing and calculation of equianalgesic doses. Current practices in chart documentation may provide incomplete information regarding change in practice behaviors; more detailed documentation of pain management practices is needed. Nurses who participated in the program anecdotally reported feelings of increased credibility and effectiveness. Although change in behavior is slow to occur, education does make a difference.

Adult↗
PubMed1995

Managing cancer pain: content and scope of an educational program for nurses who work in predominantly rural areas.

A great deal of effort is being expended at national, state and local levels to improve cancer pain management in the United States. The fact that cancer patients continue to experience "unrelieved pain" is of concern to professional caregivers and families, as well as to the patients themselves. This article describes the content and scope of an educational program for nurses who work in predominantly rural areas. Content of the program and the evaluation process are described in detail in order to provide other caregivers with a model that could be implemented in similar settings.

Chronic Disease↗
PubMed1995

Relationship of learned resourcefulness to measures of pain description, psychopathology and health behavior in a sample of chronic pain patients.

OBJECTIVE: We investigated the association between the coping style of learned resourcefulness and the variables of pain description, pain locus of control, psychological distress, and health-care utilization. DESIGN: A cross-sectional, retrospective, correlational design was used. PATIENTS AND SETTING: The sample was comprised of 87 outpatients from a university-based, multidisciplinary pain clinic. MAIN OUTCOME MEASURES: Self-Control Schedule, pain intensity, McGill Pain Questionnaire, Pain Locus of Control Scale, SCL-90-R, Health-Care Utilization Questionnaire. RESULTS AND CONCLUSIONS: Results indicated that chronic pain patients obtained comparable resourcefulness ratings to normal subjects but there were wide individual differences. Consistent with theoretical predictions, resourcefulness was found to be associated with better psychological adjustment and less impulsive health-care measures. Results suggest that assessment of learned resourcefulness may be useful in predicting behavioral outcome in clinical settings with chronic pain patients.

Adaptation, Psychological↗
PubMed1995

Relationship of sexual and physical abuse to pain description, coping, psychological distress, and health-care utilization in a chronic pain sample.

OBJECTIVE: We investigated the association of physical/sexual abuse to pain description, coping, psychological distress, and health-care utilization in a heterogeneous sample of chronic pain patients. DESIGN: A cross-sectional, retrospective design was used. Patients were categorized as abused (n = 22) or nonabused (n = 58) based on responses to a valid and reliable sexual/physical abuse questionnaire. MAIN OUTCOME MEASURES: Pain description (Visual Analog Scale measures of pain intensity and frequency, and the McGill Pain Questionnaire); coping ability and attributional style (Functional Interference Estimate, Self-Control Schedule, Pain Locus of Control Scale); psychological distress (SCL-90-R Global Severity Index); and a Health-care utilization measure. RESULTS AND CONCLUSIONS: No differences between abused and nonabused groups were found for the pain description or functional interference variables. Compared to the nonabused group, the abused group had significantly lower Self-Control Schedule scores, higher Pain Locus of Control Scale Chance Factor scores, and higher SCL-90-R Global Severity Index scores and was more likely to use the emergency room for pain symptoms. These results replicate the findings of previous studies of the effects of abuse in more specific pain samples and underscore the importance of assessment of abuse in patients with chronic pain. The data suggest that interventions which involve coping-skills training or self-control management of pain may be affected by an abuse history via reduced perceptions of efficacy, resourcefulness, and beliefs that external variables are responsible for pain.

Adaptation, Psychological↗
PubMed1993

Psychometric characteristics of a brief measure of pain-related functional impairment.

This study presents reliability and validity data from two samples (pain clinic vs medical clinic) on a five-item self-report scale, termed the Functional Interference Estimate (FIE), designed to measure functional impairment associated with chronic pain. Results from the pain clinic sample demonstrated that the FIE is internally consistent and has satisfactory levels of test-retest reliability, item-total score correlations, and convergent validity. Results from the medical clinic sample demonstrated that the FIE discriminated between medical clinic patients without pain and both medical clinic patients with pain and pain clinic patients. The data support the use of the FIE as one of several available assessment methods for evaluation of pain-related functional impairment.

Activities of Daily Living↗
PubMed1993

Pain locus of control scores in chronic pain patients and medical clinic patients with and without pain.

OBJECTIVE: We investigated the association between treatment setting and pain control attributions as assessed by the Pain Locus of Control Scale (PLOC). DESIGN: Nonrandomized consecutive samples. PATIENTS AND SETTING: The patient groups included an outpatient pain clinic sample of chronic pain patients (n = 48), a group of medical clinic outpatients with chronic pain (n = 28), and a group of medical clinic outpatients without current pain (n = 22). Medical clinic patients without current pain were asked to reply to the PLOC items in terms of their usual response when experiencing pain. RESULTS AND CONCLUSIONS: Results indicated that pain clinic patients were the least likely of the three groups to report predictable control of their pain as reflected by their significantly lower "powerful other" and higher "chance" dimension scores. Medical clinic patients without pain reported greater personal control of pain than the other two groups as evidenced by their higher "internality" dimension score and lower "chance" dimension score. Results indicate that pain control appraisals differ among patients with chronic pain and illness as a function of the treatment setting and suggest that differences in cognitive appraisal can affect treatment efficacy.

Adaptation, Psychological↗
PubMed1993

Extrarenal Wilms' tumor. Unusual presentation in the lumbosacral region.

True extrarenal Wilms' tumor is a rare malignant neoplasm most frequently presenting in the retroperitoneal or inguinal regions. We report an unusual subcutaneous lumbosacral (LS) region extrarenal Wilms' tumor without associated teratomatous tumor elements or associated neural tube defect in a 2 1/2-year-old girl. Pathologic review revealed features of true extrarenal Wilms' tumor, and the patient remains in complete remission following surgery and combination chemotherapy. This report illustrates the importance of early surgical intervention and pathologic examination of similar soft tissue masses in children.

Dactinomycin↗
PubMed1992

Octanoic acid produces accumulation of monoamine acidic metabolites in the brain: interaction with organic anion transport at the choroid plexus.

Effects of octanoic acid on monoamines and their acidic metabolites in the rat brain were analyzed by HPLC. Octanoic acid (1,000 mg/kg i.p.) elevated homovanillic acid levels by 54% in the caudate and 338% in the hypothalamus but increased 5-hydroxyindoleacetic acid (5-HIAA) levels in both the caudate and the hypothalamus by approximately 50% compared with the control. A lower dose of octanoic acid (500 mg/kg) increased 5-HIAA levels by 29% in the caudate and 20% in the hypothalamus. However, it did not produce any changes in the concentration of homovanillic acid in either the caudate or the hypothalamus. Treatment with octanoic acid also failed to change the level of dopamine, serotonin, and 3,4-dihydroxyphenylacetic acid in the caudate and the hypothalamus. The role of carrier-mediated transport in the clearance of 5-HIAA from the rabbit CSF was also evaluated in vivo by ventriculocisternal perfusion. Steady-state clearance of 5-HIAA from CSF exceeded that of inulin and was reduced in the presence of octanoic acid. Because this transport system in the choroid plexus is normally responsible for the excretion of the serotonin metabolite from the brain to the plasma, accumulation of endogenously produced organic acids in the brain, secondary to reduced clearance by the choroid plexus, could be a contributing factor in the development of encephalopathy in children with medium-chain acyl-CoA dehydrogenase deficiency who have elevated levels of octanoic acid systematically.

Acids↗
PubMed1991

Relationship between perceived self-control of pain, pain description and functioning.

Recent research has shown an association between preferred coping style and pain report. The present study explores in a sample of 51 patients with chronic pain of myofascial origin the relationship between a dispositional measure of coping, the internality dimension of the Pain Locus of Control Scale (PLOC), and ratings of pain intensity, frequency, and pain-related behavioral functioning. Patients above the median on the internality dimension of the PLOC reported their pain as less intense and frequent than those below the median. No differences were noted on the behavioral functioning measures. Results are consistent with previous studies and indicate an association between ability to control pain and variations in magnitude and periodicity of pain. The clinical implication of the data is that strategies which provide reduction in pain intensity and frequency might be expected to result in increased perception of personal control of pain.

Adaptation, Psychological↗
PubMed1991

Relationship of pain drawing scores to ratings of pain description and function.

We examined the relationship between pain distribution and measures of self-reported behavioral functioning, pain intensity, frequency, and quality in 51 patients with chronic pain. Results indicate that patients with more distributed pain report their pain as more disruptive to important areas of functioning and also report their pain as more intense and frequent. These results corroborate previous findings and suggest that pain distribution may be used as a useful clinical marker of disability status in chronic pain patients.

Adult↗
PubMed1985

A nonlinear least-squares method for determining cerebrospinal fluid formation and absorption kinetics in pseudotumor cerebri.

Data from 14 patients with benign intracranial hypertension (pseudotumor cerebri) have been analyzed using a nonlinear least-squares regression model which was developed and programmed from in-hospital microcomputer use. The method of analysis permits rapid estimation of cerebrospinal fluid (CSF) formation and absorption rates as functions of pressure in individual patients using data from constant-rate infusion manometrics. The analysis predicts that prednisone therapy in pseudotumor cerebri reduces resting CSF pressure by increasing CSF absorption at all intracranial pressures studied, and decreasing CSF formation at high pressures. This result is in accordance with evidence suggesting that impaired CSF absorption plays a major role in the pathogenesis of increased intracranial pressure in pseudotumor cerebri.

Absorption↗
PubMed1983

Effect of increasing carbon chain length on organic acid transport by the choroid plexus: a potential factor in Reye's syndrome.

Transport of the anionic herbicide 2,4-dichlorophenoxyacetic acid by choroid plexus is inhibited significantly by several short and medium chain acids. For both monocarboxylic and dicarboxylic homologs, inhibition clearly increases with chain length. It appears that organic acid compounds of longer chain length, higher brain uptake index, and highest inhibition of choroid plexus transport would be the ones producing the most significant increases in intracranial pressure in metabolic encephalopathy such as Reye's syndrome.

2,4-Dichlorophenoxyacetic Acid↗
PubMed1983

Assessment of cerebrospinal fluid compliance and outflow resistance: analysis of steady-state response to sinusoidal input.

Cerebrospinal fluid dynamics have been studied in the past by analyses of responses to bolus, constant rate or constant pressure inputs. In this study, we present a method for analyzing CSF pressure responses to sinusoidal variation in the infusion rate. Infusion of artificial CSF into the cisterna magna of adult rats was modulated sinusoidally between 0 and 30 microliter/min. The resulting sinusoidal variation in intracranial pressure was recorded on a strip chart recorder simultaneously with the infusion rate signal. The two signals were analyzed for peak-to-peak variation, mean value, and phase shift for input frequencies in the range of 0.0015 to 0.01 HZ (0.00942 to 0.0628 radians/sec). The system was analyzed at each mean infusion rate as a parallel resistance and compliance with a first order linear model. The resistance to CSF outflow was determined as the change in mean steady-state pressure divided by the change in mean infusion rate. The compliance was then obtained from the frequency dependent phase shift between input and output using the first-order linear model. Resistance values were lower for higher average infusion rates consistent with our previous work, while compliance remained constant over the measured pressure range.

Animals↗