Pain
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We investigated the relationship between somatic and psychological symptoms and pain reported during a clinical examination for 220 patients with chronic temporomandibular disorder (TMD) pain. The clinical examination involved palpation of the muscles of the face and neck, as well as intraoral sites and non-TMD-related placebo sites. A distinction was drawn between somatization--the tendency to report numerous somatic symptoms--and psychological distress manifested by report of numerous affective and cognitive symptoms. ⋯ Heightened somatization and high-intensity pain were strong predictors of widely dispersed muscle palpation pain during the clinical examination. High-somatization patients were 3 times more likely than low-somatization subjects to report having a painful placebo site. Pain dispersion was more closely linked to report of number of somatic symptoms than to report of affective and cognitive symptoms of psychological distress.
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It is being increasingly recognized that the solution to the problem of inadequate postoperative pain relief lies not so much in development of new techniques but in development of a formal organization for better use of existing techniques. Acute Pain Services (APS) are being increasingly established to provide good quality postoperative analgesia. In the United States such 24-h services usually consist of anesthesiologists, residents, specially trained nurses and pharmacists. ⋯ Regular recording of each patient's pain intensity by VAS every 3 h and recording of treatment efficacy on a bedside vital-sign chart are the cornerstones of this model. A VAS greater than 3 is promptly treated. Surgeon and ward nurse participation are crucial in this organization.(ABSTRACT TRUNCATED AT 250 WORDS)
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Percutaneous radiofrequency lumbar facet denervation has been in use as a treatment for intractable, mechanical low back pain for over 2 decades. A number of case series have been reported with high rates of success in selected patients; however, there has been limited objective outcome assessment, long-term follow-up, and analysis of prognostic factors. We have reviewed our experience with diagnostic lumbar facet blocks and percutaneous radiofrequency denervation at a mean follow-up interval of 3.2 years. ⋯ There was no difference, however, between the long-term results of bilateral denervation for bilateral or axial pain and those of unilateral denervation for unilateral pain. There was no significant difference in the rate of response between the 56 patients who had undergone prior lumbosacral spine surgery and the 26 who had not. There were no complications from the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
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A questionnaire study was performed in order to clarify knowledge and practice of cancer pain treatment in Norway: a 10% random sample of Norwegian physicians received a questionnaire. Of 800 correctly addressed questionnaires, 549 were returned and 306 were analyzed after exclusion of those doctors who never treated cancer patients. Their knowledge of the principles and methods of cancer pain treatment were evaluated with 8 multiple-choice and 13 open questions. ⋯ Two hundred seventy-four (97%) of the physicians said they experienced problems when treating cancer pain, ranging from inefficient pain relief (52%) to side effects of opioid analgesics (32%), most often sedation, in combination with nausea and constipation. Only 13% of the physicians had a correct understanding of opioid drug dependence. As many as 72% of Norwegian physicians thought their education in cancer pain treatment was insufficient.
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Although a number of self-report indices that measure intensity and psychosocial components of the pain experience are available, these measures do not assess the range of cognitive, behavioral, and physiological reactions frequently associated with pain. This paper describes the initial determination of the psychometric properties of the Biobehavioral Pain Profile (BPP) developed to measure these reactions. The BPP is a 41-item self-report scale tested in a sample of 617 subjects with chronic recurrent pain, chronic non-malignant pain or chronic malignant pain. ⋯ Test-retest reliability for the scales ranged from 0.57 to 0.73. Low correlations among the BPP and general indices of fear, depression, anxiety, body consciousness and social desirability are reported. The BPP appears to provide a unique composite assessment of self-report of behavioral, physiological, and cognitive reactions to pain experienced by individuals with a wide range of pain problems.