Pain
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Randomized Controlled Trial Comparative Study Clinical Trial
Impact of preoperative education on pain outcomes after coronary artery bypass graft surgery.
Cardiovascular diseases cause more disability and economic loss in industrialized nations than any other group of diseases. In previous work [Nurs Res 49 (2000a) 1], most coronary artery bypass graft patients (CABG, N=225 ) reported unrelieved pain and received inadequate analgesics. This study proposed to evaluate a preadmission education intervention to reduce pain and related activity interference after CABG surgery. ⋯ The booklet was rated as helpful, particularly by women. In conclusion, the intervention did not result in a clinically significant improvement in pain management outcomes. In future, an intervention that considers sex-specific needs and also involves educating the health professionals caring for these patients may influence these results.
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Randomized Controlled Trial Comparative Study Clinical Trial
Pregabalin reduces pain and improves sleep and mood disturbances in patients with post-herpetic neuralgia: results of a randomised, placebo-controlled clinical trial.
This study was designed to assess the efficacy and safety of pregabalin-a novel alpha(2)-delta ligand with analgesic, anxiolytic, and anticonvulsant activity-for treating neuropathic pain in patients with post-herpetic neuralgia (PHN). Two hundred and thirty-eight patients were randomised into this multicentre, doubleblind, placebo-controlled trial to receive 150 (n=81), 300 mg/day (n=76) pregabalin, or placebo (n=81) for 8 weeks. Among the exclusion criteria was failure to respond to previous treatment for PHN with gabapentin at doses > or =1200 mg/day. ⋯ The most frequent adverse events were dizziness, somnolence, peripheral oedema, headache, and dry mouth. Pregabalin efficaciously treated the neuropathic pain of PHN. Additionally, pregabalin was associated with decreased sleep interference and significant improvements in HRQoL measures.
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Comparative Study
Stability of patient adaptation classifications on the multidimensional pain inventory.
This study examined the adaptational classification stability of the multidimensional pain inventory (MPI) in two samples of female fibromyalgia syndrome patients. Retest resulted in one-third of patients being assigned to a different classification. Twenty patients had four repeated MPI assessments over a 10-month period; 85% of them changed classification at least once. ⋯ Examination of the MPI Variable Response Scale and an index of the goodness of fit of the cluster for each patient did not yield sufficient predictive power. The implication of this study is that for a sizable number of chronic pain patients, MPI classifications may not be stable, trait-like characterizations. As such, caution must be applied when treatment is tailored to MPI clusters and when classification change is used as an outcome measure.
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Comparative Study
Decreasing sympathetic sprouting in pathologic sensory ganglia: a new mechanism for treating neuropathic pain using lidocaine.
Lidocaine brings relief to those suffering from certain neuropathic pain syndromes in humans and in animal models. Evidence suggests that some neuropathic pain behaviors are closely associated with extensive sprouting of noradrenergic sympathetic fibers in the dorsal root ganglia (DRG). Using immunohistochemistry, we examined lidocaine's effects on abnormal sprouting of sympathetic fibers in two animal models: rats with unilateral spinal nerve ligation (SNL) and rats with complete sciatic nerve transection (CSNT). ⋯ Similar results were obtained after topical application of lidocaine to the nerve trunk to block abnormal discharges originating in the neuroma in CSNT rats. Results strongly suggest that sympathetic sprouting in pathologic DRG may be associated with abnormal spontaneous activity originating in the DRG or the injured axons (e.g. neuroma). This finding provides new insight into the mechanisms underlying sympathetic sprouting and increases our current understanding of the prolonged therapeutic effects of lidocaine on neuropathic pain syndromes.
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Comparative Study
Stimulus-dependent specificity for annexin 1 inhibition of the inflammatory nociceptive response: the involvement of the receptor for formylated peptides.
In this study we investigated how the peptides derived from the glucocorticoid-inducible protein annexin 1 are able to alter the nociceptive threshold of mice. The effects of the annexin1 fragment 2-26 (Anxa1(2-26)) on nociceptive threshold were studied using both chemical (formalin test) and thermal (hot plate and tail flick test) nociceptive stimuli on mice. Subcutaneous administration of Anxa1(2-26) into the dorsal surface of the mouse's hind paw was able to selectively reduce formalin-induced nociceptive behavior in the last phase of the test. ⋯ We found that the formyl peptide receptor agonist formyl-MLF (fMLF) induced anti-nociceptive effects in the formalin test both after the peripheral and central administration. The formyl peptide receptor antagonist N-t-butoxycarbonyl-MLP did not alter the response to formalin, but it was able to block the anti-nociceptive effects of Anxa1(2-26,) Anxa1(2-12) and fMLF after peripheral or central administration. These results indicate that exogenously administered Anxa1 can peripherally and centrally inhibit the nociceptive transmission associated with inflammatory processes through a mechanism that involves formyl peptide receptors.