Pain
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In recent years, multidisciplinary pain programs were seen to successfully treat patients by basing treatment on a combination of physical exercise and psychological interventions. However, in spite of their effectiveness, it still remains to be clarified exactly which features of these programs were responsible for patient improvement. Cognitive-behavioral models posit that improvement is due, in part, to changes in patient coping strategies. ⋯ Other objective parameters, such as medical history, physical impairment and general physical variables were seen to have little predictive value in determining a return to work. The results suggest that the primary target point for further investigation is the analysis of the patients' beliefs about their pain. Our results indicate that future research must be attentive to the complex interactions between environmental factors and the coping demands posed by the specific nature of pain problems.
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Previous studies of intrathecal ketamine use in humans have documented the clinical effects of its administration without reference to local central nervous system (CNS) toxicity (Reich and Silvay, 1989). Although several post-mortem studies in small groups of rabbits, monkeys, and baboons have largely shown no significant CNS damage after intrathecal ketamine use, a study in rats reported vacuolation of dorsal root ganglia (Ahuja, 1983). We report post-mortem CNS histopathological changes of subpial spinal cord vacuolation in a terminally ill cancer patient who received continuous infusion intrathecal ketamine at a rate of 5 mg/day for a duration of 3 weeks.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Controlled-release oxycodone and morphine in cancer related pain.
Controlled-release (CR) formulations of oxycodone and morphine were compared in 45 patients with chronic cancer pain. The study was started with an open-label, randomised titration phase to achieve stable pain control for at least 48 h, followed by a double-blind, randomised, crossover phase in two periods, 3-6 days each. To blind the study using available tablet strengths, the dose ratio of oxycodone to morphine was set at 2:3. ⋯ If the results of the two periods were combined, the patients consumed significantly more escape doses and the mean pain intensities were significantly greater with CR oxycodone. The total opioid consumption ratio of oxycodone to morphine was 2:3 when oxycodone was administered first, and 3:4 when oxycodone was administered after morphine. The total incidence of adverse experiences reported by the patients was similar, but significantly more vomiting occurred with morphine, whereas constipation was more common with oxycodone.
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A 1-year follow-up study of 1756 third- and fifth-grade schoolchildren was conducted with a structured pain questionnaire to assess the prevalence and persistence of self-reported musculoskeletal pain symptoms and disability caused by pain. At follow-up, 1626 (92.7%) children participated in the study. Pain at least once a week persisted in 270 (52.4%) of the 564 children who reported musculoskeletal pain at least once a week in at least one part of the body at baseline. ⋯ Disability was more severe in children with pain symptoms in more than one area. This study showed that about half of the preadolescents complaining of musculoskeletal pain at least once a week at baseline had persistent pain symptoms at follow-up. The prognosis of widespread pain in preadolescents was almost the same as the previous findings in adults.
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The aim of the present study was to investigate the prevalence of physical and sexual abuse in the general population as well as to investigate the link between abuse and pain. From a pool of randomly selected people 35-45-years-old, three groups were selected based on their reports of their musculoskeletal pain. These were the No Pain Group (n = 449), the Mild Pain Group (n = 229), and the Pronounced Pain Group (n = 271). ⋯ For females only, there was a clear link between self-reported abuse and pain as physical abuse increased the risk of pronounced pain by five-fold and sexual abuse increased this risk by four-fold. These data provide the prevalence of self-reported abuse in a 'normal' population base and moreover demonstrate an important link between self-reported abuse and pain for women. The findings show that self-reported abuse may be an important predictor for chronic pain and provide support for the idea that abuse may indirectly or directly be implicated in the chronification of pain.