Pain
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Clinical Trial
Anger management style, hostility and spouse responses: gender differences in predictors of adjustment among chronic pain patients.
This study examined whether relationships between anger management style (anger suppression; anger expression) and adjustment variables for patients with chronic pain depend on patient hostility, and/or depend on a patient's gender. A 'spouse response model' was also evaluated to test whether patient expression of hostile anger is linked to infrequent positive and frequent negative responses from spouses, and hence to poor adjustment. ⋯ Among men, support was also found for a spouse response model: pain severity and activity interference for High Anger Expressors was partly accounted for by negative spouse responses. Results suggest that discriminations among patients may be made based on anger management style in interaction with level of hostile attitude and the patient's gender, and that these distinctions may have implications for understanding mechanisms of pain and disability, and for designing appropriate treatment.
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The second exteroceptive suppression of masseter muscle activity (ES2) and tenderness in pericranial muscles were evaluated in 112 young adults who met IHS criteria in the following diagnostic classifications: 31 chronic tension headache, 31 episodic tension headache, 33 migraine without aura and 17 migraine with aura. An additional 31 subjects served as controls. Pericranial muscle tenderness better distinguished diagnostic subgroups and better distinguished recurrent headache sufferers from controls than did masseter ES2. ⋯ All chronic tension headache sufferers exhibited muscle tenderness in at least one of the pericranial muscles evaluated, while tenderness was exhibited by 52% of controls. The association between pericranial muscle tenderness and chronic tension headache was independent of the intensity, frequency, or chronicity of headaches. Our findings raise the possibility that pericranial muscle tenderness is present early in the development of tension headache, while ES2 suppression only emerges later in the evolution of the disorder.
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We asked 78 chronic low back pain patients to report on their usual pain intensity, and on the lifestyle changes caused by their pain, on a horizontally-oriented visual analogue scale (VAS). Also, the usual and the current pain intensities were examined on a vertical VAS. Statistical analysis showed normal distribution of data in the measurement of usual pain on the horizontal VAS, but no homogeneous distribution on the vertical VAS. ⋯ Also, there was no reduction of the failure rate by giving additional oral explanations in the use of the scale to the patient. Owing to a negative influence in distribution of rates and an increase in the failure rate, complex questions should be avoided. A short written introduction to the scale is sufficient, and oral explanations are not essential.
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This study determines the effects of dexamethasone versus co-administered dexamethasone and diclofenac, on carrageenan-evoked spinal c-Fos expression and peripheral oedema in the freely moving rat. Drugs were administered intravenously 25 min before intraplantar injection of carrageenan (6 mg/150 microliters of saline). Three hours later the number of spinal c-Fos-LI neurones and peripheral oedema were assessed. ⋯ The attenuation by co-administered dexamethasone and diclofenac, of both c-Fos expression and the peripheral oedema, was significantly greater than the effect of dexamethasone alone (P < 0.001 for both) and diclofenac alone (P < 0.001 for both). Our study illustrates enhanced attenuating effects of co-administered dexamethasone and diclofenac on both inflammatory oedema and the associated spinal expression of c-Fos, an indicator of nociceptive transmission at the spinal level. The apparent interactions between the mechanisms of action of NSAIDs and steroids suggest that co-therapy may produce beneficial inflammatory and pain relief in the absence of excessive side effects.
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Many aspects of bilateral presentation or recurrence of reflex sympathetic dystrophy (RSD) are unknown. For this reason 1183 consecutive patients with RSD were analyzed. In 10 patients RSD started in symmetrical limbs. ⋯ Reflex sympathetic dystrophy may recur in the same or in another limb, although only in a minority of patients. Recurrences occur especially in younger patients and in the symmetrical limb. Diagnosis of a recurrence is difficult, for often the recurrence is spontaneous and presents with few signs and symptoms.