Pain
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This study examined the extent to which the psychological variables of depression, anxiety, and helplessness predicted the pain behavior and functional status of 64 rheumatoid arthritis (RA) patients beyond what could be predicted on the basis of demographic and medical status variables. Pain behavior was evaluated using a standardized observation method, and functional status was assessed using a modified Health Assessment Questionnaire (MHAQ) and rheumatologists' ratings. Regression analyses revealed that a modified rheumatoid activity index and/or disease duration were significant predictors of levels of guarding, rigidity, and total pain behavior. ⋯ Age, disease duration and depression also were independent predictors of functional status ratings. Thus, depression had a significant relationship with physician ratings of functional status but not with patient self-reports of disability. Psychological factors not examined in this study that might influence RA pain behavior and self-reports of functional status are discussed.
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Test-retest reliability of a pain drawing instrument was investigated. Pain drawings of chronic pain patients (n = 51) were scored for percentage of total body surface in pain and location of pain. ⋯ The effect on reliability of age, gender and time-interval differences was investigated. The utility of the pain drawing instrument as a measure of extent of pain and location of pain over time is discussed.
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In order to overcome the cross-cultural semantic barriers related to the literal translation of the McGill Pain Questionnaire (MPQ) in non-English speaking areas, an Italian Pain Questionnaire (IPQ) has been developed, based on the 3 factorial structures proposed by Melzack and Torgerson: sensory, affective and evaluative. A group of 30 normal subjects (15 doctors and 15 university students) was used to define 5 anchor words of the intensity verbal scale by means of a visual analogue scale, and a 5-point Present Pain Intensity (PPI) verbal scale was derived. For the semantic key, a first group of 80 subjects (30 university students and patients, respectively, and 20 doctors) was asked to sort out appropriate pain descriptors from 203 pain-related words with the help of clinical literature and Italian dictionaries. ⋯ The final pain vocabulary was formed from those words, which reflected a statistically significant intensity change (P less than 0.05) within each group. The IPQ comprises 42 pain descriptors, distributed into 3 major classes (sensory, affective and evaluative) and 16 subclasses. It represents the most parsimonious, meaningful and idiomatic set of Italian pain descriptors, providing quantitative information that can be treated statistically, yet preserving a close structural parallel with the MPQ.
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Randomized Controlled Trial Clinical Trial
Lack of analgesic effect of opioids on neuropathic and idiopathic forms of pain.
The aim of the present study has been to assess the responsiveness of various types of chronic pain to opioids given i.v. and tested against placebo in a double-blind, randomized fashion. Pain classified as primary nociceptive was effectively alleviated (P greater than 0.001) while neuropathic deafferentation pain was not significantly influenced by morphine or equivalent doses of other opioids. Also 'idiopathic' pain, defined as chronic pain with no or little demonstrable pathology, failed to respond. ⋯ It may also support the indication and choice of invasive stimulation procedures (spinal cord or brain). The results of the study illustrate the misconception of chronic pain as an entity and highlight the importance of recognizing different neurobiological mechanisms and differences in responsiveness to analgesic drugs as well as to non-pharmacological modes of treatment. The opioid test has thus become a valuable tool in pain analysis and helpful as a guide for further treatment.
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A peripheral mononeuropathy in rat that produces disorders of pain sensation like those seen in man.
A peripheral mononeuropathy was produced in adult rats by placing loosely constrictive ligatures around the common sciatic nerve. The postoperative behavior of these rats indicated that hyperalgesia, allodynia and, possibly, spontaneous pain (or dysesthesia) were produced. Hyperalgesic responses to noxious radiant heat were evident on the second postoperative day and lasted for over 2 months. ⋯ The affected hind paw was abnormally warm or cool in about one-third of the rats. About one-half of the rats developed grossly overgrown claws on the affected side. Experiments with this animal model may advance our understanding of the neural mechanisms of neuropathic pain disorders in humans.