Pain
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Pain responsiveness was investigated experimentally as a function of age and childbirth pain experience. Sensitivity to cold pressor-induced pain was assessed through threshold, tolerance, and visual analog pain ratings. It was hypothesized that childbirth pain experience would mostly modify experimental pain judgment, in accordance with the adaptation-levels model. ⋯ Thus, painful childbirth experience is sufficient to raise cold pressor pain threshold. This finding has never before been reported in the pain literature. It is consistent with anecdotal reports from parous women who, when providing cold pressor pain judgments, say that "nothing compares to labor pain."
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The effects of the major morphine metabolites, morphine-3-glucuronide and morphine-6-glucuronide, on nociception were assessed by the tail-flick, hot-plate and writhing tests in the rat. Morphine-3-glucuronide (M3G) 1.1 x 10(-9) mol (0.5 micrograms) or saline was injected intracerebroventricularly (i.c.v.) or intrathecally (i.t.) followed by a second injection of 2.0 x 10(-10) mol (0.1 microgram) or 2.0 x 10(-11) mol (0.01 microgram) morphine-6-glucuronide (M6G) 10 min later. Administration of M3G (i.c.v.) significantly attenuated the antinociceptive effects of M6G in the hot-plate test. ⋯ In animals receiving M3G there was a prevention or attenuation of the M6G induced depression of respiratory frequency, tidal volume and minute ventilation compared to control groups receiving M6G in combination with saline. These results show that M3G may functionally antagonize the central antinociceptive effects as well as the ventilatory depression induced by M6G. Interestingly, M3G was more potent in antagonizing the M6G-induced analgesia after i.t. administration than that after i.c.v. administration, which may suggest that the spinal cord is more sensitive to the non-opioid excitatory effects of M3G than supraspinal structures.
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Randomized Controlled Trial Clinical Trial
Neuropsychological effects of methylphenidate in patients receiving a continuous infusion of narcotics for cancer pain.
Twenty consecutive patients with cancer pain receiving a continuous subcutaneous infusion of narcotics were admitted to a double-blind, crossover trial designed to assess the effects of methylphenidate on neuropsychological functions. After a baseline assessment, patients were randomized to receive methylphenidate orally at 08.00 h for 2 consecutive days or placebo. During day 3, a crossover took place and patients received the alternate treatment for 2 more days. ⋯ After completion of the trial, methylphenidate was chosen blindly by the patient and investigator in 13 and 14 cases, placebo in 3 and 2 cases, a "no choice" in 3 and 3 cases, respectively (P less than 0.01). Our results suggest that methylphenidate is capable of improving cognitive function in patients receiving high doses of opiates subcutaneously. More research is necessary in order to determine the duration of cognitive improvement after each dose of methylphenidate as well as the best type and dose of amphetamine.
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Randomized Controlled Trial Clinical Trial
Hypnosis or cognitive behavioral training for the reduction of pain and nausea during cancer treatment: a controlled clinical trial.
Few controlled clinical trials have tested the efficacy of psychological techniques for reducing cancer pain or post-chemotherapy nausea and emesis. In this study, 67 bone marrow transplant patients with hematological malignancies were randomly assigned to one of four groups prior to beginning transplantation conditioning: (1) hypnosis training (HYP); (2) cognitive behavioral coping skills training (CB); (3) therapist contact control (TC); or (4) treatment as usual (TAU; no treatment control). Patients completed measures of physical functioning (Sickness Impact Profile; SIP) and psychological functioning (Brief Symptom Inventory; BSI), which were used as covariates in the analyses. ⋯ Risk, SIP, and BSI pre-transplant were found to be effective predictors of inpatient physical symptoms. Nausea, emesis and opioid use did not differ significantly between the treatment groups. The cognitive behavioral intervention, as applied in this study, was not effective in reducing the symptoms measured.
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This study compared the psychometric properties of two scales designed to measure attitudes towards and beliefs about pain. The Survey of Pain Attitudes (Revised) SOPA(R) (Jensen and Karoly 1987) and the Pain Beliefs and Perceptions Inventory (PBPI) (Williams and Thorn 1989) were examined in terms of internal consistency, discriminant validity, factor structure, construct validity and sensitivity to age and gender effects. ⋯ Further work is suggested for the PBPI, as the reported factor structure was not replicated. Discussion centered around the possible reasons for this finding, with issues such as the possible orientation of different treatment facilities, the possible differences in attitudes between patients with different types of pain, and the possible influence of length of years in pain or the receipt of workers compensation payments being considered.