Pain
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Randomized Controlled Trial Clinical Trial
Correlates of depression in chronic pain patients: a comprehensive examination.
This study examined the relations between depression and demographic, pain-related, and work-related variables in 254 chronic pain patients. Regression analyses were conducted, initially by category (i.e., demographic, pain-related, and work-related), and finally a comprehensive regression analysis was performed, containing the significant independent variables from each category. Among the demographic variables, education level and marital status were related to depression, and an interaction between age and gender was associated with depression, with younger women and older men reporting more depression. ⋯ Among the work-related variables, unemployment was associated with depression, and there was an interaction between work status and litigation status, with working and litigating being associated with depression and not working and not litigating being associated with depression. In the comprehensive analysis, work status, education level, and marital status accounted for a significant amount of the variance in depression scores. These findings, together with future research directions, are discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Responsiveness of functional status in low back pain: a comparison of different instruments.
This study compares the responsiveness of three instruments of functional status: two disease-specific questionnaires (Oswestry and Roland Disability Questionnaires), and a patient-specific method (severity of the main complaint). We compared changes over time of functional status instruments with pain rated on a visual analog scale. Two strategies for evaluating the responsiveness in terms of sensitivity to change and specificity to change were used: effect size statistics and receiver-operating characteristic method. ⋯ The sensitivity to change of the rating of Oswestry Questionnaire was lower than that of the other instruments. The main complaint was not very specific to change. The two strategies for evaluating the responsiveness were very useful and appeared to complement each other.
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Randomized Controlled Trial Clinical Trial
Lidocaine patch: double-blind controlled study of a new treatment method for post-herpetic neuralgia.
Post-herpetic neuralgia (PHN) is a common and often intractable neuropathic pain syndrome predominantly affecting the elderly. Topical local anesthetics have shown promise in both uncontrolled and controlled studies. Thirty-five subjects with established PHN affecting the torso or extremities completed a four-session, random order, double-blind, vehicle-controlled study of the analgesic effects of topically applied 5% lidocaine in the form of a non-woven polyethylene adhesive patch. ⋯ The highest blood lidocaine level measured was 0.1 micrograms/ml, indicating minimal systemic absorption of lidocaine. Patch application was without systemic side effect and well tolerated when applied on allodynic skin for 12 h. This study demonstrates that topical 5% lidocaine in patch form is easy to use and relieves post-herpetic neuralgia.
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Randomized Controlled Trial Clinical Trial
Specificity of diagnostic nerve blocks: a prospective, randomized study of sciatica due to lumbosacral spine disease.
Temporary nerve blocks using local anesthetic are employed extensively in the evaluation of pain problems, particularly lumbosacral spine disease. Their specificity and sensitivity in localizing anatomic sources of pain have never been studied formally, however, and so their diagnostic and prognostic value is questionable. There have been anecdotal reports of relief of pain by temporary blocks directed to areas of pain referral, as opposed to areas of documented underlying pathology; but there has been no study to define the frequency or magnitude of this effect. ⋯ Our findings indicate a limited role for uncontrolled local anesthetic blocks in the diagnostic evaluation of sciatica and referred pain syndromes in general. Negative blocks or a pattern of responses may have some predictive value, but isolated, positive blocks are non-specific. This lack of specificity may, however, be advantageous in therapeutic applications.
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The objectives of this study were to identify the characteristics of children who required regional anesthesia for pain associated with terminal malignancy and to identify the safety, tolerability and effectiveness of regional anesthesia as an analgesic modality in terminal pediatric malignancy. A retrospective examination was made of the medical records of children who died of malignancy following treatment at the Dana-Farber Cancer Institute and Children's Hospital, Boston, Massachusetts and who required either epidural or subarachnoid infusions, or neurolytic blockade for pain management (June, 1986--April, 1994) during the terminal phase of their illness. Eleven patients were identified, with a duration of epidural or subarachnoid infusions ranging from 3 days to 7 weeks. ⋯ Analgesia was judged to be satisfactory in all cases after regional anesthesia was instituted and remained satisfactory in all cases throughout the treatment course. Complications associated with regional anesthesia included dural puncture headache and mild respiratory depression. Five patients were nursed at home with either epidural or subarachnoid infusions.