Pain
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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.
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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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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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The pain tolerance latencies of 10 chronic pain patients were evaluated by heat beam dolorimetry (stimulus intensity 15.33 mW.cm-2.sec-1) prior to and following administration of morphine by intrathecal (n = 5) or intravenous (n = 5) routes. Patients not undergoing opiate withdrawal evinced increased baseline pain tolerance latencies prior to drug administration compared with normal volunteers. Two patients undergoing the opiate withdrawal syndrome at the time of test experienced reduced pain tolerance latencies compared with normal volunteers, most probably corresponding to the hyperesthesia symptom of the syndrome. ⋯ A dissociation was noted therefore between the self-reported relief of endogenous pain and dolorimetrically measured cutaneous analgesia following intrathecal morphine administration. Linear regression correlation analysis characterized this phenomenon as a positive correlation between cutaneous pain tolerance and pain relief self-report following intravenous morphine infusion and a negative correlation following intrathecal administration. We propose that the phenomenon may be due to intrathecal morphine acting via two separate compartments: one spinal and one supraspinal.(ABSTRACT TRUNCATED AT 250 WORDS)