Pain
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Randomized Controlled Trial
The effect of local anaesthetic on age-related capsaicin-induced mechanical hyperalgesia--a randomised, controlled study.
Adults over 65 years exhibit a prolonged punctate hyperalgesia induced by topical application of capsaicin. The aim of this study was to investigate the role of peripheral afferent input in the slowed resolution of punctate hyperalgesia in older people. Twenty young (25.7+/-4.8 years) and 19 old (74.9+/-4.4 years) healthy adults were recruited, and subjects in each age group were randomly assigned to receive either EMLA cream (a local anaesthetic) (n=10 in each age group) or Sorbolene treatment (n=9 in the older group, n=10 in the young group) after the development of punctate hyperalgesia. ⋯ Stoicism and cautiousness measured with Pain Attitude Questionnaire were negatively correlated with highest pain rating in the young, but not in the older groups. We suggest that the prolonged punctate hyperalgesia in older adults is possibly sustained by central mechanisms, indicating age differences in central plasticity following acute injury. The relationship between such age-related changes and the chronicity of pain in older adults should be further explored.
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Randomized Controlled Trial
A randomized trial of a tailored barriers intervention for Cancer Information Service (CIS) callers in pain.
Cancer pain management can be improved by overcoming patients' attitudinal barriers to reporting pain and using analgesics. A simple cost-effective barriers intervention designed to reach a large number of persons with cancer has not yet been tested. Such an intervention should be tested against barriers' assessment-alone, as well as no-treatment control. ⋯ At follow-up the TBI group had significantly lower attitudinal barriers scores compared to assessment-alone and control, but the groups did not differ on the pain outcome variables. TBI and assessment-alone had similar cost effectiveness. The TBI needs to be strengthened to achieve reductions in pain severity.
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Randomized Controlled Trial
Placebo analgesia induced by social observational learning.
Although it has long been known that psychosocial factors play a crucial role in placebo responses, no attempt has been made to understand if social observation shapes the placebo analgesic effect. To address this question, we compared placebo analgesia induced through social observation (Group 1) with first-hand experience via a typical conditioning procedure (Group 2) and verbal suggestion alone (Group 3). In Group 1, subjects underwent painful stimuli and placebo treatment after they had observed a demonstrator (actually a simulator) showing analgesic effect when the painful stimuli were paired to a green light. ⋯ We found that observing the beneficial effects in the demonstrator induced substantial placebo analgesic responses, which were positively correlated with empathy scores. Moreover, observational social learning produced placebo responses that were similar to those induced by directly experiencing the benefit through the conditioning procedure, whereas verbal suggestions alone produced significantly smaller effects. These findings show that placebo analgesia is finely tuned by social observation and suggest that different forms of learning take part in the placebo phenomenon.
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The Multidimensional Pain Inventory (MPI) is one of the most widely used instruments to assess patients' coping with chronic pain. It provides a psychosocial classification system that categorizes patients into three coping styles: Adaptive, Dysfunctional, and Interpersonally Distressed. To date, comprehensive information about the validity of the MPI taxonomy obtained from informants other than the patient has been unavailable. ⋯ Results revealed that partner- and provider-reported MPI ratings corresponded with the self-report patient profiles. The profiles of patients showing classification stability rather than switching of cluster assignment between the two MPI assessments had the highest correspondence with proxy ratings. These results extend prior validity research on the MPI and demonstrate that differential psychological adaptational styles to chronic pain can be reliably recognized by partners and healthcare providers.
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Morphine is widely used to treat moderate to severe postoperative pain. The goal of this study was to characterize the pharmacodynamics of morphine-induced analgesia during intravenous morphine titration in the immediate postoperative period and to evaluate sedation occurrence according to morphine dose in this setting. Two hundred and twenty-eight patients undergoing major orthopedic surgery were included. ⋯ Logistic regression showed that a morphine dose of 20 mg was associated with a high likelihood of sedation occurrence. Our study supported the possibility of modeling the time course of a complex response in the absence of pharmacokinetic data. The current data should lead to a more rational management of the immediate postoperative pain.