Pain
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The present report describes a nation-wide survey on the incidence, the indications and the efficacy of spinal cord stimulation (SCS), as assessed by the Belgian health authorities. The direct motive for this survey was the rapidly growing expenditures resulting from the increasing use of SCS. Between 1983 and 1992, nearly 700 SCS devices were implanted for a population of less than 10 million inhabitants. ⋯ In a third study, the impact of psychiatric screening on patient selection was evaluated. Of the 100 candidates, 36 were withheld from implantation with a SCS device because of psychiatric contra-indications. Patients who had received a positive psychiatric advice showed a significantly better therapeutic outcome than patients for whom the psychiatrist had made reservations.
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Randomized Controlled Trial Comparative Study Clinical Trial
Low-dose intra-articular morphine analgesia in day case knee arthroscopy: a randomized double-blinded prospective study.
The aim of this study was to demonstrate the effect of intra-articular morphine following knee arthroscopy performed in infiltration analgesia. Fifty-two healthy patients were randomized to receive either 1 mg of morphine or placebo. The pain was assessed 2, 4, 8 and 24 h after the procedure by (1) a VAS scale and (2) the amount of acetaminophen consumed. ⋯ Stratifying data in therapeutic versus diagnostic arthroscopy indicated additional effect of morphine in patients undergoing therapy (P < 0.1), an aspect supporting the hypothesis of peripherally administered morphine as a potential suppressor of the substance P-mediated cytokine cascade and the peripheral leukocyte activity. Intra-articular morphine (1 mg) after knee arthroscopy offers efficient analgesia lasting more than 24 h. The method is devoid of side effects and deserves wider recognition.
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Randomized Controlled Trial Clinical Trial
The cold pressor test in children: methodological aspects and the analgesic effect of intraoral sucrose.
To determine whether intraoral sucrose has analgesic-like effects in pre-pubertal children and to explore the utility of an ethical and viable laboratory test of nociceptive stimulation in this age group, 8-11-year-olds (n = 42) underwent the cold pressor test (CPT) at 10 degrees C on each of 2 successive days, while holding either 24% sucrose or water in their months. Outcome measures used were threshold (time at which the arm first started to hurt), tolerance (when children removed their arms because they could not stand it any more) and visual analogue scale (VAS) ratings of the intensity of sensation. To ensure validity of the data obtained in this age group, some responses were rejected according to established decision rules and blind to group assignment. ⋯ Inability to perform adequately on the VAS also occurred, but was not related to age. Holding sucrose in the mouth was associated with a significant 35% prolongation of the children's threshold times relative to water, but there was no detectable effect on tolerance and intensity ratings. It is concluded that the analgesic properties of intraoral sucrose, seen previously in human newborns and rat pups, may also be present in pre-pubertal children.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales.
Numerical rating scales and mechanical visual analogue scales (M-VAS) were compared for their capacity to provide ratio scale measures of experimental pain. Separate estimates of experimental pain sensation intensity and pain unpleasantness were obtained by each method, as were estimates of clinical pain. Orofacial pain patients made numerical scale and VAS ratings in response to noxious thermal stimuli (45-51 degrees C) applied for 5 sec to the forearm by a contact thermode. ⋯ Both M-VAS and numerical rating scales produced reliably different stimulus response functions for pain sensation intensity as compared to pain unpleasantness and both provided consistent measures of experimental and clinical pain intensity. Finally, both mechanical and pencil-and-paper VAS produced very similar stimulus-response functions. The ratio scale properties of M-VAS combined with its ease of administration and scoring in clinical settings offer the possibility of a simple yet powerful pain measurement technology in both research and health care settings.
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Recent studies have suggested that morphine-3-glucuronide (M3G) may antagonize the analgesic effects of morphine and morphine-6-glucuronide (M6G). To investigate this hypothesis, steady-state concentrations of morphine, M6G and M3G in serum and cerebrospinal fluid (CSF) were measured in 11 patients receiving chronic morphine therapy (9 orally and 2 subcutaneously) for treatment of cancer-related pain. All patients appeared to have morphine-resistant pain and had elected to proceed to intrathecal bupivacaine or percutaneous cordotomy. ⋯ The median molar ratios for CSF/serum distribution of morphine, M6G and M3G were 1.23, 0.12 and 0.14, respectively. Thus, despite their relatively poor ability to penetrate into the CSF, the high serum concentrations of M6G and M3G resulted in substantial concentrations of these metabolites in the CSF. Nevertheless, M3G/M6G ratios in our morphine-resistant patients were similar to published values in patients with well-controlled pain, suggesting that the hypothesis that M3G plays a major role in morphine-resistance is not correct.