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At least 1,027 records · Page 57Linked to original sources
PubMed1998

Vertebral axial decompression therapy for pain associated with herniated or degenerated discs or facet syndrome: an outcome study.

The outcomes of vertebral axial decompression (VAX-D) therapy for patients with low back pain from various causes are reported. Data was collected from twenty-two medical centers for patients who received VAX-D therapy for low back pain, which was sometimes accompanied by referred leg pain. Only patients who received at least ten sessions and had a diagnosis of herniated disc, degenerative disc, or facet syndrome, which were confirmed by diagnostic imaging, were included in this study; a total of 778 cases. The average time between the initial onset of symptoms and the beginning of this therapy was 40 months, and it was four months or more in 83% of the cases. The data contained the patients' quantitative assessments of their own pain, mobility, and ability to carry out the usual 'activities of daily living'. The treatment was successful in 71% of the 778 cases, when success was defined as a reduction in pain to 0 or 1, on a 0 to 5 scale. Improvements in mobility and activities of daily living correlated strongly with pain reduction. The causes of back pain and their relationship to this therapy are also discussed.

Glucose↗
PubMedDate not supplied

Sublingual buprenorphine is effective in the treatment of chronic pain syndrome.

Many patients with chronic pain have less than optimal therapeutic outcomes after prolonged treatment with opiate analgesics. Worsening of pain perception, functional capacity, and mood often result. Medical detoxification is often undertaken in this situation. Ninety-five consecutive patients (49 men and 46 women; age range, 26-84) with chronic noncancer pain (maldynia) were referred by local pain clinics for detoxification from long-term opiate analgesic (LTOA) therapy. All patients had failed treatment as manifest by increasing pain levels, worsening functional capacity, and, in 8%, the emergence of opiate addiction. Length of prior LTOA therapy ranged from 1.5 to 27 years (mean, 8.8 years). After a minimum of 12 hours of abstinence from all opiate analgesics, patients were given low doses of sublingual (SL) buprenorphine or buprenorphine/naloxone (Reckitt Benckiser). Maintenance dosing was individualized to treat chronic pain. Daily SL dose of buprenorphine ranged from 4 to 16 mg (mean, 8 mg) in divided doses. Mean duration of treatment is 8.8 months (range, 2.4-16.6 months). At clinic appointments, patients were assessed for pain reports, functional capacity, and mood inventory. Eighty-six percent of patients experienced moderate to substantial relief of pain accompanied by both improved mood and functioning. Patient and family satisfaction was robust. Only 6 patients discontinued therapy secondary to side effects and/or exacerbation of pain. In this open-label study, SL buprenorphine and buprenorphine/naloxone were well tolerated and safe and appeared to be effective in the treatment of chronic pain patients refractory to LTOA.

Administration, Sublingual↗
PubMed2006

Development and testing of a neuropathic pain screening questionnaire: ID Pain.

OBJECTIVE: To develop a patient-completed screening tool to help differentiate nociceptive and neuropathic pain. RESEARCH DESIGN AND METHODS: A multicenter study was performed for item reduction (initial 89-item questionnaire) and model building. Patients (N = 586) with non-headache chronic pain completed the questionnaire and were referred to pain specialists for diagnosis. Factor and regression analyses were used to derive a final, 6-item questionnaire--ID Pain. A second multicenter study evaluated reliability and validity. Patients (N = 308) treated by pain specialists completed ID Pain and validation measures. MAIN OUTCOME MEASURES: Sensitivity and specificity were assessed using receiver operating characteristic curves and the concordance c index. Reliability was assessed using a kappa statistic and intraclass correlation coefficient. RESULTS: Final 6 items were: did the pain feel: (1) like pins and needles? (2) hot/burning? (3) numb? (4) like electrical shocks? (5) is the pain made worse with the touch of clothing or bed sheets? (6) is the pain limited to your joints? "Yes" answers to questions 1-5 were scored as 1, while a "yes" answer to question 6 was scored as -1. "No" answers were scored as 0. Higher scores (-1 to 5) suggested a neuropathic component. The questionnaire accurately predicted diagnoses of neuropathic pain made by pain specialists. The concordance c indices in the studies were 0.73 and 0.69. The ICC was 0.742; the kappa statistic ranged from 0.742 to 0.527. CONCLUSIONS: ID Pain appeared to accurately indicate the presence of a neuropathic component of pain. As a brief, self-administered screening tool, it could be useful in primary care settings.

Adult↗
PubMed2002

Self-appraised problem solving and pain-relevant social support as predictors of the experience of chronic pain.

The purpose of this study was to examine the contributions of self-appraised problem-solving competence and pain-relevant social support to the prediction of pain, depression, and disability. The 234 chronic pain patients referred for participation in a comprehensive pain management program were administered self-report measures of pain, depression, disability, pain-relevant social support, and problem solving. Hierarchical multiple-regression analyses revealed that lower self-appraised problem-solving competence was related to increased pain, depression, and disability. Pain-relevant social support was directly related to pain and disability but indirectly related to depression. High levels of pain-relevant social support were found to buffer the relation between poorer self-appraised problem-solving competence and depressive symptoms. The results support the assessment of problem-solving skills in chronic pain patients and the investigation and utility of interventions aimed at increasing adaptive pain-relevant social support.

Adaptation, Psychological↗
PubMed1998

Optimal treatment of phantom limb pain in the elderly.

Phantom limb and stump pain is a common sequela of amputation. In geriatric patients with an amputated limb and multiple other illnesses, drug therapy may be problematic and invasive techniques may be risky. Interactions between pathophysiological mechanisms in the peripheral and central nervous systems may be responsible for the initiation and maintenance of chronic phantom limb and stump pain. These mechanisms include: (i) peripheral damage to nociceptive fibres and dorsal root ganglion cells, which acquire abnormal sensitivity to mechanical, thermal and chemical stimuli; (ii) the prolonged sensitisation of central nociceptive 'second order' neurons in the dorsal horn of the spinal cord, which become hyperexcitable and start responding to nonnoxious stimuli; and (iii) the degeneration of nociceptive neurons, which may trigger the anatomical sprouting of low threshold mechanosensitive terminals to form connections with central nociceptive neurons. This may subsequently induce functional synaptic reorganisation in the dorsal horn. The provision of a pain-free perioperative interval using regional anaesthetic techniques is likely to reduce the incidence of phantom limb pain. The therapy of manifest pain is difficult, and treatment should start as soon as possible to prevent chronic pain. In the acute state, the infusion of calcitonin and oral opioid analgesics have proven to be helpful, while established phantom limb pain may respond to antidepressants, anticonvulsants and drugs that mimic or enhance gamma-aminobutyric acid function. Pharmacological treatment should be combined with transcutaneous electrical nerve stimulation, sympathetic blockade and psychotherapy. In addition, new therapeutic strategies are now being tested; examples include capsaicin, new anticonvulsants and N-methyl-D-aspartate antagonists. Patients with severe pain should be referred to a pain specialist to ensure optimal and timely interventional pain management.

Amputation Stumps↗
PubMedDate not supplied

Living with chronic pain: the patient's perspective.

AIM: The aim of this study is to investigate patients' perceptions and experiences of chronic pain management before and after attending pain services. METHOD: A sample of 245 patients with chronic pain, who attended specialist pain services in 11 UK hospitals, were interviewed using a structured questionnaire. Patients' ages ranged between 23 and 86 years (median 51 years), and the duration of pain ranged between six months and 57 years (median five years). RESULTS: Patients reported that pain had had a profound effect on their lives, restricting daily living and leisure activities. 33 per cent (81) were classified as medically disabled. Patients' perceptions and attitudes to the management of chronic pain varied. Their main concern was that, although they wanted a specific diagnosis, they were often not given a reason for their chronic pain. CONCLUSION: Pain management requires a significant amount of input by health professionals. Patients wanted advice on the best techniques to help them cope with chronic pain. Most patients had previously tried many different pain treatments to obtain short-term pain relief. One third of patients had waited up to four months for their initial pain assessment at the pain service. Once referred to specialist pain services, patients were satisfied with their care. Almost half (47 per cent, 115) of the interviewees reported that their pain had improved. As chronic pain has a profound effect on patients' lives, it is important that early diagnosis, treatment and referral to appropriate specialists is given high priority. This study has raised the awareness and understanding of an important, but often misunderstood area.

Activities of Daily Living↗
PubMed1992

Trigger point therapy.

Trigger points (TP) are objectively demonstrable foci in muscles. They are painful on compression and trigger pain in a referred area. This area may be the only locus of complaint in humans. In dogs we cannot prove the existence of referred zones of pain. Therefore, we can only diagnose a TP-induced claudication if we cannot find bone, joint, or neurologic abnormalities, and we do find TP that disappear after treatment together with the original lameness. Several methods have been developed to demonstrate TP existence objectively. These are pressure algometry, pressure threshold measurements, magnetic resonance thermography, and histology. In humans, 71% of the TP described are acupuncture points. TP treatment consists of TP stimulation with non-invasive or invasive methods such as dry needling or injections. In the dog, ten TP are described in two categories of clinical patients. First, those with one or few TP reacting favorably on treatment (+/- 80% success in +/- 2-3 weeks). Second, those with many TPs reacting badly on treatment. Most probably the latter group are fibromyalgia patients.

Animals↗
PubMed1991

Nongynecologic somatic pathology in women with chronic pelvic pain and negative laparoscopy.

One hundred eighty-three women with chronic pelvic pain were referred to a multidisciplinary chronic pelvic pain clinic after negative laparoscopy. One hundred twenty-two of them completed a thorough medical and psychologic evaluation and were followed for a minimum of six months after completion of therapy. Occult somatic pathology was diagnosed in 57 women (47%), including 19 in whom coexistent psychopathology was diagnosed. Myofascial pain was the most common somatic diagnosis, followed by atypical cyclic pain (dysmenorrhea or mittelschmerz); gastroenterologic, urologic and infectious diseases; and pelvic vascular congestion. No plausible somatic etiology was apparent in the remaining 65 (53%) of the 122 referrals. Nongynecologic somatic pathology accounted for 34 (29%) and gynecologic pathology for 23 (19%) of the referrals, only 6 (5%) of whom ultimately required hysterectomy. Women with a somatic diagnosis were found to be significantly older than the remainder of the referral population. Long-term symptomatic improvement or resolution of pain was obtained in 43 (75%) of the 57 patients with somatic diagnoses. Coexistent psychopathology was found to correlate with a poorer long-term prognosis. Our findings underscore the importance of a multidisciplinary approach to evaluating and treating chronic pelvic pain in women and confirm that hysterectomy is indicated in this setting only rarely.

Adult↗
PubMed1991

[A case report of long-term post-thoracotomy pain management with intrapleural bupivacaine].

A 50-year old woman with right post-thoracotomy pain was referred to us for assistance with pain control. She required pentazocine 60-150 mg per day before our treatment. First, we treated her with intercostal nerve block or oral morphine sulfate. But the result was not satisfactory after five months. Then we tried intrapleural bupivacaine. An epidural catheter was inserted into the pleural space from eight intercostal space at the anterior axillary line and 10 ml of 0.5% bupivacaine was instilled. The treatment was effective for about 4-5 hours. We continued this method for 42 days with 10 ml of 0.25% or 0.5% bupivacaine once or twice a day. She felt so good from the intrapleural analgesia and could be discharged. There was no hypotension, respiratory depression, urinary retention except burning thoracic sensation. We think it is possible to use this intrapleural bupivacaine to treat a certain kind of unilateral chronic pain.

Bupivacaine↗
PubMed2002

[Cesarean section: current management of postoperative acute pain. Continuous and intermittent epidural analgesia with and without elastomeric infusion device].

OBJECTIVE: To compare the analgesia quality obtained in the management of the acute pain in 50 puerperae post-cesarean section using one of the two therapeutic modalities. The results were evaluated using descriptive and inferential statistics. MATERIAL AND METHOD: Controlled, systematized a clinical trial, carried out from January to June of 2001. REGIMES AND RESULTS: A) Continuous epidural analgesia. With fentanyl citrate plus bupivacaine using a low flow elastomerics infuser (Single day Baxter infuser) 85% referred mild pain in rest or activity; 3% or less in analogic scale visual (VAS) in the first 24 hours of postoperative. B) Intermittent epidural analgesia. With bupivacaine plus intravenous Ketorolaco; 59% of the cases referred mild pain, 32% moderate pain and 9% severe. CONCLUSION: Management of acute pain postcesarean section should be priority with continuous epidural analgesia using the infuser and concentrations of drugs referred in order to minimize the incidence and magnitude of acute postoperative pain.

Acute Disease↗
PubMed1999

An unusual cause of unilateral facial pain.

Cardiac pain that is referred to the face is a common symptom in patients with angina pectoris, but unilateral facial pain referred from a non-ischaemic cardiac source is rare. We report a case of unilateral facial pain that occurred in relation to a large pericardial effusion and which resolved on drainage of the effusion.

Aged↗
PubMedDate not supplied

[Transcatheter embolization of expansive masses of the sacrum].

The authors report their 4-year (1984-1988) experience with TCE in the treatment of primary sacral benign/malignant and vascular bone tumors, after similar preliminary studies on aneurysmal bone cysts. Eleven patients were treated, for a total of 21 procedures: in 85% of the eight cases of palliative embolization, multiple instrumental approaches were needed for late revascularization, up to four consecutive embolizations in the same patients. Severe complications were observed in 19% of the procedures, due to arterial catheterization and/or instrumental maneuvers, but in none of them was surgery required. Technical results--i.e. devascularization of the mass--were optimal/suboptimal in all cases at the end of multiple procedures in the same patient: in 7/8 patients treated for palliation, however, the treatment was repeated, the late venous DSA angiographic control showing recanalization of the great vessels surrounding the lesion and/or revascularization through collateral channels. The analysis of morphological and clinical results (with reference to pain relief, dimension of the mass, and calcification at CT follow up) showed a complete pain relief in 100% of the patients treated preoperatively for palliation. The dimension of the mass was reduced in 12.5% of the cases treated for palliation, and recalcification was demonstrated on CT in 12.5% of cases. In 25.5% the mass had increased in size and in 62.5% its dimensions were unchanged. Effective pain relief was always obtained in the cases treated preoperatively. Thus, in our experience TCE of expansive lesions of the sacral bone can be considered as an effective therapeutical choice, with special reference to pain relief, for use in all inoperable cases, and as a preoperative treatment to minimize blood loss at surgery. Still, embolization materials are not completely satisfying: many of them are expensive, difficult to use and cannot be trusted to permanently occlude the vessels, which forces to intervene more than once to obtain optimal clinicomorphological results. As for malignant lesions, chemo-embolization with cytostatic substances should be used to improve the efficacy of the method. However, even through such negative judgements can be expressed on TCE, both technical and clinical results have been, in our experience, quite satisfactory, which calls for optimization of the methodology.

Angiography↗
PubMed2006

Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values.

The nationwide multicenter trials of the German Research Network on Neuropathic Pain (DFNS) aim to characterize the somatosensory phenotype of patients with neuropathic pain. For this purpose, we have implemented a standardized quantitative sensory testing (QST) protocol giving a complete profile for one region within 30 min. To judge plus or minus signs in patients we have now established age- and gender-matched absolute and relative QST reference values from 180 healthy subjects, assessed bilaterally over face, hand and foot. We determined thermal detection and pain thresholds including a test for paradoxical heat sensations, mechanical detection thresholds to von Frey filaments and a 64 Hz tuning fork, mechanical pain thresholds to pinprick stimuli and blunt pressure, stimulus/response-functions for pinprick and dynamic mechanical allodynia, and pain summation (wind-up ratio). QST parameters were region specific and age dependent. Pain thresholds were significantly lower in women than men. Detection thresholds were generally independent of gender. Reference data were normalized to the specific group means and variances (region, age, gender) by calculating z-scores. Due to confidence limits close to the respective limits of the possible data range, heat hypoalgesia, cold hypoalgesia, and mechanical hyperesthesia can hardly be diagnosed. Nevertheless, these parameters can be used for group comparisons. Sensitivity is enhanced by side-to-side comparisons by a factor ranging from 1.1 to 2.5. Relative comparisons across body regions do not offer advantages over absolute reference values. Application of this standardized QST protocol in patients and human surrogate models will allow to infer underlying mechanisms from somatosensory phenotypes.

Adolescent↗
PubMed2005

What factors explain the number of physical therapy treatment sessions in patients referred with low back pain; a multilevel analysis.

BACKGROUND: It is well-known that the number of physical therapy treatment sessions varies over treatment episodes. Information is lacking, however, on the source and explanation of the variation. The purposes of the current study are: 1) to determine how the variance in the number of physical therapy treatment sessions in patients with non-specific low back pain (LBP) in the Netherlands is distributed over patient level, therapist level and practice level; and 2) to determine the factors that explain the variance. METHODS: Data were used from a national registration network on physical therapy. Our database contained information on 1,733 patients referred with LBP, treated by 97 therapists working in 41 practices. The variation in the number of treatment sessions was investigated by means of multilevel regression analyses. RESULTS: Eighty-eight per cent of the variation in the number of treatment sessions for patients with LBP is located at patient level and seven per cent is located at practice level. It was possible to explain thirteen per cent of all variance. The duration of the complaint, prior therapy, and the patients' age and gender in particular are related to the number of physical therapy treatment sessions. CONCLUSION: Our results suggest that the number of physical therapy treatment sessions in patients with LBP mainly depends on patient characteristics. More variation needs to be explained, however, to improve the transparency of care. Future research should examine the contribution of psychosocial factors, baseline disability, and the ability to learn motor behavior as possible factors in the variation in treatment sessions.

Adult↗
PubMed2000

Pre-emptive analgesia in rats with artificial ureteric calculosis. Effects on visceral pain behavior in the post-operative period.

'Pre-emptive' analgesia is a controversial issue in both the clinical and experimental literature on pain. This paper investigates the effect of chronic (4 days) administration of morphine or ketoprofen initiated pre- or post-operatively on behavioral indicators of visceral pain and referred hyperalgesia in an animal model of artificial ureteric calculosis. In the morphine experiment, female Sprague-Dawley rats were treated i.p. with saline or morphine sulphate (2.5 or 5 mg/kg/day) starting either 45 min before or 45 min after surgery (pentobarbital anesthesia) for stone implantation in the left ureter, until the 4th day after intervention. Behavioral crises of ureteric pain were recorded (video-tape) in all rats over 4 days post-operatively. Number, duration and complexity of crises of stone-rats were significantly and dose-dependently reduced by administration of morphine with respect to saline in an identical manner for the pre- and post-operative treatment. In the ketoprofen experiment, rats were given saline or ketoprofen (15 mg/kg/day, in 3 i.p. injections per day) starting either pre- or post-operatively with the same paradigm as for the morphine study. Vocalization thresholds to electrical stimulation of the left oblique musculature were measured daily for 3 days pre- and 4 days post-operatively. Muscle hyperalgesia (post-operative decrease in threshold with respect to pre-stone implantation) was significantly reduced in extent and duration in ketoprofen with respect to saline-injected animals but no difference was found between the pre- and post-operative treatment. It is concluded that pre-emptive administration of morphine or ketoprofen has no advantage in reducing behavioral indicators of visceral pain and referred hyperalgesia in this animal model.

Analgesia↗
PubMed2004

Inter-tester reliability of a new diagnostic classification system for patients with non-specific low back pain.

Most patients referred to physiotherapy with low back pain are without a precise medical diagnosis. Identification of subgroups of non-specific low back pain patients may improve clinical outcomes and research efficiency. A pathoanatomic classification system has been developed, classifying patients with non-specific low back pain into 12 different syndromes and three subcategories based on history and physical examination. The purpose of this study was to estimate the inter-tester reliability of clinical tests used as criteria for classifying patients. Ninety patients with chronic low back pain were each examined by two physiotherapists. A total of four physiotherapists conducted the assessments. Examination findings were recorded independently by the two examiners. Percentage of agreement and kappa coefficients were calculated for each category. The overall rate of agreement was 72% and the kappa coefficient was 0.62 for the mutually exclusive syndromes in the classification system. Agreement rates for each of the syndromes ranged from 74% to 100% and kappa coefficients ranged from 0.44 to 1.00. The findings suggest the inter-tester reliability of the system is acceptable. The relatively modest level of total agreement (39%) for the system as a whole might indicate that the utility of the system for general screening purposes is limited, compared with the utility in identification of particular syndromes. Due to low prevalence of positive findings in some of the syndromes, future work should focus on testing reliability on a larger sample of patients, and testing of validity and feasibility of the system.

Adult↗