Pain
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We present a systematic review of prospective cohort studies. Our aim was to assess prognostic factors associated with functional recovery of patients with whiplash injuries. The failure of some patients to recover following whiplash injury has been linked to a number of prognostic factors. ⋯ High initial pain intensity is an important predictor for delayed functional recovery for patients with whiplash injury. Often mentioned factors like age, gender and compensation do not seem to be of prognostic value. Scientific information about prognostic factors can guide physicians or other care providers to direct treatment and to probably prevent chronicity.
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Comparative Study
Long term effects of oral sustained release morphine on neuropsychological performance in patients with chronic non-cancer pain.
Morphine is increasingly used in patients with chronic non-cancer pain, but a major concern associated with chronic use relates to possible cognitive side-effects. The aim of this long-term prospective study was to evaluate the cognitive impact of oral sustained release morphine in patients with non-cancer pain. A battery of neuropsychological tests to explore attention, psychomotor speed and memory was administered. ⋯ Morphine induced persisting effects on pain, and to a lesser extent on quality of life and mood. The visual analog scale score for side-effects increased at 12 months and essentially consisted of gastrointestinal disorders. This study demonstrates that 12 months treatment with oral morphine does not disrupt cognitive functioning in patients with chronic non-cancer pain and instead results in moderate improvement of some aspects of cognitive functioning, as a consequence of the pain relief and concomitant improvement of well-being and mood.
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Comparative Study
Functional self-efficacy and pain-related disability among older veterans with chronic pain in a primary care setting.
We examined the relationship between functional self-efficacy and pain-related disability in a sample of older veterans with chronic pain. A total of 1045 veterans aged 65 years or older who received primary care at the VA Connecticut Healthcare System in West Haven, CT, were assessed for the presence of chronic pain (i.e. pain due to a non-cancer cause for >/=3 consecutive months in the past 12 months); 303 (26%) screened positive; and 245 (81%) participated. Using a ten-item functional self-efficacy questionnaire (scale: 0-40), participants were categorized into three functional self-efficacy groups: low, score
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Untreated complex regional pain syndrome (CRPS) may progress from acute stages with increased hair and nail growth in the affected limb to chronic stages with atrophy of the skin, muscles and bones. The aim of this study was to investigate whether tissue hypoxia could be one mechanism responsible for this late CRPS symptoms. Nineteen patients with CRPS and two control groups (healthy control subjects, surgery patients with edema) participated in this study. ⋯ Our results indicate skin hypoxia in CRPS. Impairment of nutritive blood flow in the affected limb may be one factor contributing to atrophy and ulceration in chronic CRPS. The investigation of patients after surgery revealed that edema could not be the only reason for hypoxia.