Pain
-
Comparative Study
Familial aggregation of depression in fibromyalgia: a community-based test of alternate hypotheses.
Numerous studies report that fibromyalgia (FM), a syndrome characterized by widespread pain and generalized tender points, is comorbid with major depressive disorder (MDD). The current study tests two alternate explanations for their comorbidity using a family study methodology. The first is that FM is a depression spectrum disorder. ⋯ Results indicated that rates of MDD in the relatives of probands with FM but without personal histories of MDD were virtually identical to rates of MDD in relatives of probands with MDD themselves. This outcome is consistent with the hypothesis that FM is a depression spectrum disorder, in which FM and MDD are characterized by shared, familially mediated risk factors. The implications of these findings for a stress-vulnerability model of FM are discussed.
-
Little is known about the extent to which individuals vary versus remain stable in their pain-related catastrophizing, or to which catastrophizing is associated with pain and related problems on a daily basis. We used daily electronic interviews to examine the: (1) reliability and validity of a brief daily catastrophizing measure; (2) stability of catastrophizing; (3) patient characteristics associated with catastrophizing; (4) associations between catastrophizing and concurrent and subsequent outcomes (pain, activity interference, jaw use limitations, and negative mood), between and within patients; and (5) associations between pain and subsequent catastrophizing. One hundred patients with chronic temporomandibular disorder pain completed electronic interviews three times a day for 2 weeks [mean (SD) number of interviews=46 (15)]. ⋯ Daily catastrophizing was associated significantly with concurrent outcomes, between- and within-subjects (P < 0.001); however, associations with same-day subsequent outcomes were greatly attenuated after adjusting for prior outcome levels. Similarly, daily pain was associated significantly with subsequent catastrophizing, but this association was no longer statistically significant after adjusting for prior catastrophizing. The data indicate that catastrophizing is stable over short periods of time in the absence of substantial change in pain, and that within patients, times of greater catastrophizing are associated with worse pain, disability, and mood.
-
Randomized Controlled Trial Comparative Study Clinical Trial
A randomized clinical trial of the effectiveness of a scheduled oral analgesic dosing regimen for the management of postoperative pain in children following tonsillectomy.
The purpose of this study was to determine whether around-the-clock (i.e. ATC) dosing of acetaminophen with codeine, with or without nurse coaching, compared to standard care with as needed (i.e. PRN) dosing: reduced children's reports of pain intensity with and without swallowing; increased pain relief, and increased analgesic consumption. ⋯ No significant differences were found in the amount of nausea and vomiting among the three groups. Scheduled dosing of acetaminophen with codeine did not provide adequate pain relief for children following tonsillectomy. Nurse coaching does not increase parent's adherence with an ATC dosing schedule.
-
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Relative analgesic potency of fentanyl and sufentanil during intermediate-term infusions in patients after long-term opioid treatment for chronic pain.
Sufentanil, a potent mu-opioid agonist, historically has not been been given systemically to treat chronic pain. An implantable, fixed-rate osmotic pump that delivers sufentanil subcutaneously is being developed for this purpose. In that transdermal fentanyl may be a useful intermediary to estimate the appropriate sufentanil dose before implant, accurate information is needed about the relative analgesic potency of sufentanil and fentanyl during continuous infusion. ⋯ For the remaining 41 patients, target concentrations associated with adequate analgesia were achieved for both sufentanil and fentanyl. The median value for the equianalgesic concentration ratio (steady-state fentanyl infusion to steady-state sufentanil infusion) was 7.5; mean potency ratio was 7.44 (95% confidence interval 6.8-8.2). During titrated, intermediate-term infusions in patients previously treated with opioids for chronic pain, sufentanil is approximately 7.5 times as potent as fentanyl.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Imagery reduces children's post-operative pain.
This un-blinded experimental study investigated the effectiveness of imagery, in addition to routine analgesics, in reducing tonsillectomy and/or adenoidectomy pain and anxiety after ambulatory surgery (AS) and at home. Seventy-three children, aged 7-12, were recruited from five AS settings. Thirty-six children randomly assigned to the treatment group watched a professionally developed videotape on the use of imagery and then listened to a 30-min audio tape of imagery approximately 1 week prior to surgery (T1). ⋯ When controlling for trait anxiety, a two-way RM MANCOVA indicated no significant group differences in combined opioid and non-opioid use between the groups, or between times. Appropriately trained health care providers should use imagery to reduce post-operative pain following tonsillectomy and/or adenoidectomy in AS. Teaching parents about adequate home administration of analgesics may increase the effectiveness of imagery at home.