Pain
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Comparative Study
The development and testing of the depression, anxiety, and positive outlook scale (DAPOS).
Measurement of depression and other mood states in pain patients has been criticised in recent years on the grounds that most questionnaires were not developed in pain populations and suffer from criterion contamination by somatic items. In addition, there is no accepted measurement for positive emotions which are more than the absence of depression. The aim of this study was to develop a reliable and brief tool to assess mood in pain patients. ⋯ The structure was calibrated and tested using confirmatory factor analysis on both samples. Finally, a subset of patients carried out a sorting task to test for face validity. The DAPOS performed well, indicating that it is a reliable measure of the three mood states with good initial evidence of validity in these samples.
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Case Reports Comparative Study
Spinal cord lesion after long-term intrathecal clonidine and bupivacaine treatment for the management of intractable pain.
Long-term intrathecal drug administration using implanted pumps is increasingly used in the treatment of chronic refractory pain [Anderson and Burchiel 1999, Neurosurgery 44 (1999) 289; Krames 2002, Best Pract Res Clin Anaesthesiol 16 (2002) 619; Wallace 2002, Neurology 59 (2002) S18]. Extensive clinical experience over the last 15 years suggests that in selected cases the technique is safe, although infections, system malfunction and drug-related complications have been reported. In most cases, drug-related spinal cord injuries have resulted from the compression of a spinal inflammatory mass or abcess rather than from a direct neurotoxic effect. We report on a case of toxic spinal cord lesion occurring after more than 3 years of uneventful continuous infusion of a mixture of bupivacaine and clonidine.
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Comparative Study
Sex differences in temporal summation of pain and aftersensations following repetitive noxious mechanical stimulation.
Several studies demonstrate that women are more sensitive to experimental pain than men. In addition, women exhibit greater temporal summation of heat and mechanically evoked pain. Since temporal summation of pain is centrally mediated, its greater expression in women suggests a central nociceptive hyperexcitability relative to men. ⋯ Temporal summation of pain intensity and unpleasantness ratings were more pronounced in women than men (P<0.0001). In addition, significant temporal summation occurred only with 2 s interstimulus interval for men (P<0.0005) but with 2 and 5 s interstimulus interval for women (P<0.0001). Moreover, women provided greater ratings for the intensity and the unpleasantness of aftersensations (P<0.0005) and reported painful aftersensations at greater frequency (P<0.05) Greater temporal summation of pain and aftersensations in women suggests that their central processing of nociceptive input may be more easily upregulated into pathological hyperexcitability, possibly accounting for the higher prevalence of various chronic pain conditions among women.
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Comparative Study
Lessons learned from a multiple-dose post-operative analgesic trial.
Patients undergoing major surgery often require several days of post-operative analgesic management. However, little data are available on the course of post-operative pain during this period. Such data would be extremely helpful in planning treatment, formulating pain management guidelines, and determining how to construct multiple-dose post-operative analgesic clinical trials. ⋯ Only 9% of patients reported experiencing moderate-to-severe pain approximately 2 weeks later, at the end of the study. Describing pain as mild, moderate, or severe could be a simple, meaningful clinical trial outcome measure. Because most patients experience only mild pain 6 days after surgery, long-term clinical trials of post-operative pain control may be more efficient and cost-effective if they focus on the subset of patients with persistent moderate or severe pain.
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This experiment tested whether meaning influences the experience of pain. Thirty-one healthy students participated in a study on evaluations of various stimuli placed against the neck. ⋯ Confirming the hypothesis that tissue-damaging meaning influences the experience of pain, participants who were told that the bar was hot rated it as more painful than participants who were told that it was cold. Damage interpretations mediated the effect of information on pain intensity scores, which supported the theory that tissue-damage is a crucial aspect of meaning to influence the subjective intensity of pain.