Pain
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The analgesic efficacy of 5% of EMLA cream (5 or 10 g) when applied for 24 h periods was evaluated in 5 female and 7 male patients (mean age 69 years, range 50-85 years) with refractory post-herpetic neuralgia (PHN). Mean visual analogue pain intensity scores for all patients were significantly improved 6 h after application (P less than 0.05). In a subgroup of patients with facial PHN receiving EMLA cream, 5 g (n = 4), there were significant improvements in pain intensity scores at 6 h (P less than 0.05). 8 h (P less than 0.01) and 10 h (P less than 0.01) after application. Plasma lignocaine and plasma prilocaine concentrations were well below potentially toxic levels in all patients after application.
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Both experimental and clinical studies have shown that psychological manipulations, such as hypnosis, behavioral modification and cognitive-behavioral therapy, can reduce reports of pain. Although these are complex procedures, one important variable common to each is direction of attention. We have previously demonstrated in both humans and monkeys a method for monitoring and manipulating attention toward or away from a painful stimulus and have shown that changes in the direction of attention alter the ability to discriminate noxious heat stimuli. ⋯ These data confirm that both the speed and accuracy of detecting changes in noxious heat stimuli are decreased when the subject attends to another stimulus modality. In addition, they show that direction of attention affects the perceived intensity and unpleasantness of painful stimuli in a similar manner. Our previous findings of attention-related modulation of nociceptive neuronal activity in the medullary dorsal horn suggest that these attention-dependent changes in sensory-discriminative and affective components of pain are mediated at early stages of sensory processing.
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Recent studies have suggested that spouses of chronic pain patients are at risk for emotional and marital maladjustment. This study explored the role of patient and spouse gender in mediating the effects of chronic pain on the spouse's adjustment. Eight-three chronic low back pain patients and their spouses completed measures of physical and psychosocial disability, pain behaviors, marital satisfaction, and depression. ⋯ In female but not male patient couples, spouses reported significantly less depression than did patients. Significant relationships were more frequently observed between spouse-rated patient dysfunction and spouse's depression and marital adjustment in male patient couples. The results suggest a stronger relationship for female than for male spouses between the spouse's perception of patient dysfunction and the spouse's emotional and marital adjustment.
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This study dealt with the validity and correlates of facial expressions of pain. Twenty-four patients seeking treatment for gleno-humeral joint pain and 12 controls underwent a standardized physiotherapy assessment protocol involving active and passive arm movements, and experimental pain induced by pressure. Subjects rated pain intensity on each trial using categorical, sensory and affective scales. ⋯ Greater physical disability was associated with more intense pain actions on active, but not passive, tests. The results support the validity and generality of facial measures of pain, show that they yield graded sensitive information and suggest that they encode information about the psychosocial context of pain problems. Theoretical implications of these findings are discussed.
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An observation method for assessing chronic pain in back pain and rheumatoid arthritis has been developed during the last decade in the U. S. A. ⋯ Correlations between pain behavior and other measures of pain, e.g., intensity ratings, medication intake, and spinal mobility, were statistically significant but somewhat lower than expected. The results indicate that the behavioral observation method provides reliable and valid information about non-chronic back pain among Swedish females. However, some modifications in the standardized sequence of maneuvers and the definitions of pain behaviors may be necessary to improve the utility of the method in this population.