Pain
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Randomized Controlled Trial Clinical Trial
Does intravenous methadone provide longer lasting analgesia than intravenous morphine? A randomized, double-blind study.
A prospective, randomized, double-blind trial was designed to compare the duration of analgesia produced by intravenous morphine and methadone. Patients with intractable cancer-related pain were studied for 5-6 days. One-eighth of the patient's daily opiate requirement was supplied as an i.v. infusion of either morphine or methadone over a period of 15 min. when initiated by the patient using a patient-controlled analgesia device. ⋯ All patients had adequate analgesia as determined by at least a 50% difference in pain intensity at peak relief. The duration of pain relief when repeated intravenous doses of these analgesics were given was similar throughout the entire study period although morphine and methadone have different serum half-lives (3 vs. 25 h). Parenteral methadone does not offer a clinically significant increase in the duration of analgesia in patients with severe pain secondary to cancer.
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Eighteen patients with the post-mastectomy pain syndrome (PMPS) form the basis of this study. PMPS probably occurs in a minority of women after mastectomy. The onset of persistent pain usually occurred immediately or very shortly after the operation. ⋯ Twelve of 14 patients completing treatment with topical 0.025% capsaicin showed improvement after 4 weeks and 8 (57%) were judged to be good or excellent responses. Six months after the trial's completion 50% of those followed continued to have good pain relief. This therapy should now be subjected to a randomized, double-blind, placebo-controlled trial.
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The nociceptive thresholds to mechanical and thermal stimuli in patients with chronic tension-type headache were compared. Palpation of pericranial tenderness was performed in 50 patients and a total tenderness score (TTS) was calculated. Palpation was repeated, and pressure pain thresholds (PPTs) were determined with a pressure algometer in the temporal and occipital regions. ⋯ A correlation was found between PPT and the corresponding cold pain thresholds, but no correlation could be demonstrated between TTS and thermal pain thresholds. In conclusion, headache patients had decreased pain perception thresholds. Chronic tension-type headache might be a result of dysmodulation of nociceptive impulses, but it is likely that sensitized nociceptors also play a role.
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Case Reports
Post-axillary dissection pain in breast cancer due to a lesion of the intercostobrachial nerve.
Seven patients with breast carcinoma and post-axillary dissection pain are described. They complained about pain in the axilla, inner side of the upper arm and/or shoulder. All had undergone a partial or radical breast amputation including an axillary lymph node dissection. ⋯ The pain was not associated with lymphedema and only one patient had undergone radiotherapy to the axillary and supraclavicular area. Post-axillary dissection pain is probably a more appropriate name than the usual post-mastectomy pain for this syndrome. During the dissection, the intercostobrachial nerve is often lesioned, which may give rise to neuropathic pain of that nerve.
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The purpose of this study was to examine the differential role of fear, anxiety, alexithymia, family factors and coping in cancer pain. Twenty-seven patients with pain related to cancer, 26 patients with chronic non-cancer pain, 26 patients with chronic illness but no pain (hypertensives) and 24 healthy controls completed a set of questionnaires during an initial interview and recorded severity and duration of pain, pain interference with activities, thoughts, behaviors and physiological responses associated with fear of pain, and coping strategies using a diary once daily for 7 days. In general, cancer patients reported lower pain levels than patients with chronic non-cancer pain. ⋯ The perceived family environment of the cancer pain patient did not differ significantly from the 3 other groups. These results do not support anecdotal impressions that the level of reported pain and fear of pain is significantly greater in cancer pain in contrast to non-cancer pain. The results do indicate the importance of emotional expressivity in the modulation of cancer pain where the ability to assess and express emotions was associated with reduced pain.