Pain
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Randomized Controlled Trial Clinical Trial
Nimodipine-enhanced opiate analgesia in cancer patients requiring morphine dose escalation: a double-blind, placebo-controlled study.
The ability of nimodipine, a dihydropyridine calcium antagonist, to reduce the daily dose of oral morphine in cancer patients who had developed dose escalation, was tested in 54 patients under randomized, double-blind, placebo-controlled conditions. We selected patients that required at least two successive increments of morphine to maintain pain relief. A possible pharmacokinetic interaction between nimodipine and morphine was also studied in 14 patients by assaying steady-state serum levels of morphine and its 3- and 6-glucuronides. ⋯ One week after introducing nimodipine or placebo, while the dose of morphine remained similar to that of the pre-test week, the serum levels of morphine and its glucuronides were not modified significantly. We conclude that the introduction of nimodipine in patients chronically treated with morphine may be a safe alternative to reduce the daily requirements of the opioid. It is suggested that interference with Ca2+-related events may attenuate the development and/or expression of tolerance to morphine in a clinically relevant way.
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Randomized Controlled Trial Clinical Trial
Same incidence of adverse drug events after codeine administration irrespective of the genetically determined differences in morphine formation.
The analgesic effect and adverse events of the weak opioid codeine is assumed to be mediated by its metabolite morphine. The cytochrome P-450 enzyme CYP2D6 catalysing the formation of morphine exhibits a genetic polymorphism. Two distinct phenotypes, the extensive (EMs) and poor metabolisers (PMs), are present in the population. ⋯ In contrast to the analgesic effect, frequency and intensity of the adverse events did not present significant differences between the two phenotypes. These findings have implications for the clinical use of codeine. Since side effects occurred in both EM and PM subjects, the use of codeine as an analgesic will expose 7% to 10% of patients who are PMs to the side effects of the drug without providing any beneficial analgesic effects.
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The purpose of this study was to examine the utility of the pain map as a pain assessment tool in frail nursing home residents. The study was conducted in two phases. In Phase 1, nursing home staff's knowledge of the locations of resident pain complaints was examined. ⋯ Pain extensity also demonstrated modest predictive validity with self-rated health, but not with depression or functional impairment. The advantage of knowing where residents hurt is that this allows staff to target their assessment and thus determine the functional implications of residents' pain. It appears that pain maps add a useful dimension to pain assessment in residents of long term care facilities.
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Clinical Trial
Multimodal cognitive-behavioural treatment for workers with chronic spinal pain: a matched cohort study with an 18-month follow-up.
An outpatient multimodal cognitive-behavioural treatment program (MMCBT) for chronic spinal pain was evaluated during an 18-month follow-up period. The treatment included a 1-day course for the patients' work supervisors. The aim of the study was to evaluate the long-term effect of the treatment program as well as the effect of a work supervisor-training program on the patients' return to work. ⋯ There is not sufficient statistical support to accept the assumption of MMCBT being superior in reducing sick-leave, either with or without the education of supervisors. Even when supervisors changed their behaviour as reported by the patient, no significant effect was found on patients' return to work. In conclusion, the MMCBT do not seem to be effective in reducing sick-leave compared to no treatment, but the MMCBT program is superior in decreasing pain intensity, enhancing self-reported behavioural changes in personal life and improving pain coping ability at work.
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A new measure of coping, the Pain Coping Questionnaire (PCQ), is presented and validated in two studies of children and adolescents. Factor analyses of data from healthy children and adolescents supported eight hypothesized subscales (information seeking, problem solving, seeking social support, positive self-statements, behavioral distraction, cognitive distraction, externalizing, internalizing/catastrophizing) and three higher-order scales (approach, problem-focused avoidance, emotion-focused avoidance). The subscales and higher-order scales were internally consistent. ⋯ The PCQ is a promising instrument for assessing children's pain coping strategies. The items are simple and relatively few, making it useful for assessing coping across a wide age range. It can be administered to children as young as 8 years of age in approximately 15 min.