Pain
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Four patients completed a 10-session out-patient pain management programme which included didactic information, relaxation training and cognitive-behavioural techniques. At the beginning and completion of the programme a number of measures were taken, including symptom inventories and a repertory grid designed to tap the patients' self-concepts and attitudes towards illness. These two sets of before and after measures were compared. ⋯ Analysis of the raw data suggested that emotional factors were considered more relevant to physical illness at the completion of the programme. It would seem, therefore, that the main impact of our programme was on the patients' attitudes towards illness rather than on symptoms. Since attitudes may partly determine subsequent illness behaviour, it is encouraging to note changes here which suggest that our patients have adopted a more healthy view of physical illness.
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Patients who receive worker's compensation or are awaiting litigation after an accident have long been regarded as neurotics or malingerers who are exaggerating their pain for financial gain. However, there is a growing body of evidence that patients who receive worker's compensation are no different from patients who do not. In particular, a recent study found no differences between compensation and non-compensation patients based on pain scores obtained with the McGill Pain Questionnaire (MPQ). ⋯ Compensation patients, contrary to traditional opinion, appear not to differ from people who do not receive compensation. Accidents which produce injury and pain should be considered as potentially psychologically traumatic as well as conducive to the development of subtle physiological changes such as trigger points. Patients on compensation or awaiting litigation deserve the same concern and compassion as all other patients who suffer chronic pain.
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Comparative Study
Urinary function during epidural analgesia with methadone and morphine in post-cesarean section patients.
Urinary function was assessed in 120 women after cesarean section under epidural anesthesia. Postoperative analgesia was obtained by means of epidurally administered methadone (40 patients) or morphine (40 patients). In the remaining 40 women, no narcotic drugs were given and postoperative pain was treated with intramuscular or oral non-opiate analgesics and sedatives. ⋯ The mean time interval between the end of surgery and first voiding following methadone analgesia was shorter (336 +/- 27 min) than after morphine (582 +/- 18 min) or after non-opiate (448 +/- 28 min) analgesic drugs. Difficulty in micturition and the need for bladder catheterization were also decreased in the group with epidural methadone (2.5%) in comparison with the groups receiving morphine (57.5%) or non-opiate analgesic medicaments (12.5%). The use of epidural methadone for postoperative pain relief is advocated, both in view of its analgesic potency and of the low incidence of urinary disturbances.
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The supraspinal inhibitory control of lumbar spinal dorsal horn neurones was investigated in N2O-anaesthetized cats by reversibly blocking conduction in the spinal cord. Dorsal horn neurones selected for this study had convergent input from myelinated (A-) and unmyelinated (C-) fibres in the posterior tibial and/or superficial peroneal nerves of the hind limb. Virtually all of them could also be excited by noxious heating of the skin of the footpad region and by low intensity mechanical stimulation of the foot. ⋯ The decrease in the threshold to skin heating ranged up to 4.5 degrees C; the mean decrease was 2 degrees C. It is confirmed that in anaesthetized cats, nociceptive spinal neurones are subject to a tonically active descending inhibition, which is interrupted by local spinal cooling. The effect of the spinal block on the SRF of the neurones suggests that this tonic inhibition is similar to that produced by electrical stimulation in the lateral reticular formation of the brain-stem.
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A comprehensive functional evaluation designed for patients with chronic low back pain (CLBP) is described. The evaluation includes measures from 4 domains of the CLBP syndrome; physical abilities, level of activity, psychological adjustment and pain perception. New measures for standardized assessment of physical abilities and employment of body mechanics are introduced. ⋯ Results indicate important deficits in physical abilities and psychological adjustment for the CLBP group compared to the controls. Factor analysis of the evaluation measures yielded a general conditioning factor and a general psychological adjustment factor but complicated factor structures for report of pain and time in activities. Further analysis demonstrated a strong relationship between objective disability and psychological and psychosocial adjustment but little relationship between level of pain and other disability measures.