Pain
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In a cross-sectional epidemiological study of headache disorders information on precipitating factors, age at onset, influence of menstruation and pregnancy and use of oral contraceptives was collected. The presence of migraine and tension-type headache was ascertained by a clinical interview and examination using the operational diagnostic criteria of the International Headache Society. The prevalence of migraine and tension-type headache was also analysed in relation to variables of lifestyle: physical activity, smoking, consumption of coffee, alcohol intake and sleep pattern. ⋯ Smoking, coffee and alcohol consumption showed no significant associations with the headache disorders. Sleep pattern was significantly associated with migraine and tension-type headache in both univariate and multivariate analyses. In conclusion, migraine and tension-type headache seem to be different with regard to a number of endogenous and exogenous factors.
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Randomized Controlled Trial Comparative Study Clinical Trial
Morphine injected around the stellate ganglion does not modulate the sympathetic nervous system nor does it provide pain relief.
Six patients with a presumptive diagnosis of upper limb reflex sympathetic dystrophy and 1 patient with anaesthesia dolorosa had pain and sympathetic activity assessed before and after injection of bupivacaine and morphine around the stellate ganglion. Sympathetic modulation was assessed by measuring the effect of each injection on the inspiratory gasping response (IGR), a measure of central arousal, the sympathetic skin response (SSR), a measure of peripheral sudomotor activity and the plethsymographic wave (PW), a measure of peripheral vasomotor activity. There were 5 women and 2 men with a mean age of 49 years (range: 41-66 years). ⋯ Bupivacaine did provide short-term pain relief in 4 out of 7 patients. Morphine did not produce any demonstrable effect on the sympathetic nervous system nor did it provide pain relief for any patient. Thus these data do not support injection of morphine around the stellate ganglion as it neither modulated sympathetic activity nor provided pain relief.
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To help clarify the nature of coping activities in chronic pain, this study compared how depressed (n = 37) and non-depressed (n = 40) chronic low back pain (CLBP) patients attempted to cope with pain-specific and general non-pain life stressors, relative to matched healthy control subjects (n = 40). We hypothesized that depressed mood, rather than pain alone, would account for differences in coping activities between groups. Specifically, we expected that depressed CLBP patients would report a greater proportion of passive and avoidant coping responses and less active problem solving coping attempts than non-depressed patients and controls. ⋯ Additionally, subjects across groups tended to report more passive-avoidant coping in response to the specific back pain stressor (i.e., exacerbation of back pain during activity) than to other life stressors. Finally, the magnitude of reported differences in coping attempts across groups varied as a function of the type of stressor (i.e., specific back pain stressor vs. general stressful life events), particularly with regard to a disinclination to seek social support in response to the back pain exacerbation. We conclude that: (1) chronic back pain patients may employ different coping activities when attempting to manage pain exacerbations than when confronting more general life stressors, and (2) an increased rate of passive-avoidant coping responses (relative to matched health controls) is associated with the combination of CLBP and concurrent depressed mood, rather than with CLBP alone.(ABSTRACT TRUNCATED AT 250 WORDS)
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This study examines the incidence of sexual and physical abuse and its relationship to selected pain description and psychological variables in a sample of 36 chronic pelvic pain patients. Abuse was measured on a 6-item reliable scale, and abused and non-abused respondents were compared on 4 categories of variables expected to be related to the effects of abuse (pain description, functional impact of pain, other's response to pain, and psychosocial impact of pain). Results indicated that 19 of 36 patients reported prior abuse. ⋯ No differences between the abused and non-abused groups were noted on demographic, pain description, or the functional interference variables. On the psychological variables, however, the abused group reported less perceived life control, greater punishing responses to pain, and higher levels of somatization and global distress than the non-abused group. These results indicate a high incidence of sexual abuse in patients with chronic pelvic pain and suggest that abused and non-abused patients differ on psychological but not pain description or self-reported functional interference variables.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of hydromorphone continuous subcutaneous infusion and basal rate subcutaneous infusion plus PCA in cancer pain: a pilot study.
In this pilot randomized, double-blind, cross-over study, the effectiveness and safety of hydromorphone administration by continuous subcutaneous (s.c.) infusion (mode A) and by continuous basal rate s.c. infusion + PCA (mode B) were compared in 8 cancer patients. Patients experimented with each infusion mode during 48 h. Statistical analysis was performed on data collected in 7 patients during 36 h from 22:00 h on day 1 to 10:00 h on day 3 and from 22:00 h on day 3 to 10:00 h on day 5. ⋯ Only 2 patients chose mode B at the end of the study, but it was interesting to note that those 2 patients were the youngest of the group. This study demonstrated the effectiveness and safety of both modes of hydromorphone administration. The data suggest that it may be possible to identify particular cancer patients which can really benefit from an association of a basal rate infusion and PCA for opiate administration.