Pain
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The role of epidural morphine in chronic cancer pain treatment is unresolved. In a population of 1205 cancer patients, the aggressive use of systemic opiates limited the trial of epidural analgesia to 16 cases. ⋯ Complications occurred in 11 of the 16 cases of epidural analgesia and included dislodged or broken catheters, pain on injection, hyperesthesia from epidural morphine and bleeding or infection related to the epidural catheter. Epidural morphine is indicated only in selected cancer pain patients and, although bupivacaine extends the efficacy of epidural analgesia, these methods are accompanied by problems and limitations.
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Randomized Controlled Trial Comparative Study Clinical Trial
The analgesic action of dexmedetomidine--a novel alpha 2-adrenoceptor agonist--in healthy volunteers.
The analgesic efficacy of dexmedetomidine (DEX)--a novel alpha 2-adrenoceptor agonist--was studied in man. Single intravenous doses of fentanyl (FEN; 2 micrograms/kg), DEX (0.25, 0.50 and 1.0 micrograms/kg) and placebo were administered to 5 healthy male volunteers in a double-blind, crossover study in randomized order. The analgesic effect of the different treatments was measured by determining the time course of pain threshold with dental dolorimetry and by quantitating subjective pain induced by a standard ischemic pain stimulus on the upper arm using a visual analogue scale (VAS). ⋯ FEN and DEX both had analgesic effects on ischemic pain, which was seen as a statistically significant decrease in subjective VAS ratings. FEN appeared to be more effective than DEX; the difference was not, however, statistically significant. Neither of the drugs affected the pain threshold measurements.
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Comparative Study
A comparison of cognitive measures in low back pain: statistical structure and clinical validity at initial assessment.
Four cognitive measures--MHLC, PLC, CSQ and PRSS/PRCS--were directly compared in 120 U. K. patients with chronic low back pain. 80% of the individual items in the PLC and 86% in the CSQ had satisfactory test-retest reliability, as had most of the scales of the CSQ and the PLC PC scale. The items and the scales of the MHLC and the PRSS/PRCS had lower reliability. ⋯ There was also a relationship among cognitive measures and both disability and work loss which persisted even after controlling for severity of pain and depressive symptoms. The present results suggest that the concept of catastrophising has greatest potential for understanding current low back symptoms and that the CSQ may be the most useful measure of this. Other work, however, suggests that the PLC may also be of value in following change and predicting response to treatment.
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Clinical Trial Controlled Clinical Trial
The effects of auricular transcutaneous electrical nerve stimulation (TENS) on experimental pain threshold and autonomic function in healthy subjects.
The present study examines the effects of auricular transcutaneous electrical nerve stimulation (TENS) on electrical pain threshold measured at the ipsilateral wrist and autonomic functions including skin temperature, blood pressure and pulse rate in 24 healthy subjects. TENS was administered as low frequency trains of pulses delivered at a 'strong but comfortable' intensity to 1 of 3 auricular points to be examined: (i) autonomic effects (autonomic point), (ii) pain threshold effects (wrist point), and (iii) placebo effects at an unrelated point (face point). A fourth untreated group was designated as a situation control. ⋯ However, pain threshold was found to increase by over 50% of its pretreatment baseline in 4 subjects and by 30% in 6 subjects. This rise was not dependent upon the site of auricular TENS. The possible mechanisms of such changes are discussed.