Pain
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Causes of pain were analysed in 200 patients referred to a specialized cancer pain clinic. Pain caused by tumour growth was found in 158 patients, pain secondary to cancer or its treatment in 116 patients and pain unrelated to cancer in 33 patients. ⋯ The patients presented with a multitude of different combinations of causes of pain, the majority having at least two separate causes. Since pain treatment in cancer patients should be determined by its aetiology, a detailed analysis of the pain condition in each patient should form the basis for a rational therapy.
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Eight normal male volunteers performed 4 repeated sustained voluntary isometric protrusive jaw muscle contractions of 25, 50, 75 and 100% of maximum effort. Each contraction was sustained until maximum pain tolerance was reached, and all 4 contractions were completed within a single 120-min experimental period. ⋯ None of these measurements showed any significant post-experimental changes. Contrary to common clinical belief, these results suggest that in healthy male subjects, significant jaw pain and tenderness following repeated sustained isometric protrusion efforts are difficult to induce.
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Randomized Controlled Trial Clinical Trial
Efficacy of desipramine in painful diabetic neuropathy: a placebo-controlled trial.
Although amitriptyline relieves pain in many patients with painful diabetic neuropathy, side effects often preclude effective treatment. Desipramine has the least anticholinergic and sedative effects of the first generation tricyclic antidepressants. We compared a 6 week course of desipramine (mean dose, 201 mg/day) to active placebo in 20 patients with painful diabetic neuropathy in a double-blind crossover trial. ⋯ Pain relief tended to be greater in depressed patients, but relief was also observed in patients who did not show an antidepressant effect. We conclude that desipramine relieves pain in many patients with painful diabetic neuropathy, offering an alternative for patients unable to tolerate amitriptyline. Blockade of norepinephrine reuptake, an action shared by desipramine, amitriptyline, and other antidepressants proven effective in neuropathic pain, may mediate this analgesic effect.
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Randomized Controlled Trial Clinical Trial
CSF and blood pharmacokinetics of hydromorphone and morphine following lumbar epidural administration.
Sixteen consenting patients scheduled for elective thoracotomy were enrolled into a randomized trial of epidural morphine and hydromorphone. Each patient had a lumbar epidural catheter placed preoperatively for the purpose of post-thoracotomy analgesia. Shortly before the end of the operative procedure each patient received 5 mg of morphine and 0.75 mg of hydromorphone via the epidural catheter. ⋯ The mean peak CSF opioid concentrations of 1581 ng/ml for morphine and 309 ng/ml for hydromorphone occurred 60 min after epidural administration. The blood and CSF pharmacokinetic profiles for morphine and hydromorphone are presented. These profiles are similar for the two drugs after lumbar epidural administration.
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The clinical relevance of strategies to cope with pain was assessed by means of the Coping Strategy Questionnaire (CSQ). This was presented to a sample of 53 low back pain patients in The Netherlands, who had agreed to participate in a treatment outcome study of a group program consisting of education about pain and a training in relaxation and imaginative pain coping strategies. ⋯ However, at the 6-month follow-up, only pain reduction appeared to be significantly related to pretreatment-follow-up changes on CSQ scores for Perceived Control. It is concluded that a judgment about one's capability to control pain may be as important as the specific pain coping strategies used.