Pain
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Comparative Study
Severity and specificity of neglect-like symptoms in patients with complex regional pain syndrome (CRPS) compared to chronic limb pain of other origins.
In the literature, the neglect-like syndrome is described as an additional phenomenon of CRPS. The perception of the affected limb as strange, disordered and not belonging to the body is typical of and characterises this syndrome. Since this phenomenon has never been studied in other pain conditions, we assessed occurrence and extent of neglect-like symptoms in patients with CRPS of the upper and lower limb (n = 123) and in a control group with chronic limb pain of other origins (n = 117). ⋯ The only difference between these two localisations concerning the neglect-like syndrome was the symptom of 'involuntary movements', which occurs significantly more often in affected legs. In conclusion, we recommend to evaluate neglect-like symptoms and to use them as an additional criterion in the diagnosis of CRPS. High scores of > or = 5 confirm the diagnosis of CRPS, whereas lower scores must not be used for disease classification.
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Randomized Controlled Trial Comparative Study Clinical Trial
Physical therapy and active exercises--an adequate treatment for prevention of late whiplash syndrome? Randomized controlled trial in 200 patients.
The aim of this study was to compare the effect of a physical therapy regimen including active exercises with the current standard treatment on reduction of pain 6 weeks and 6 months after whiplash injury caused by motor vehicle collision. Two hundred patients were enrolled in a prospective randomized controlled trial. In the standard group, treatment consisted of immobilization with a soft collar over 7 days. ⋯ However, after 6 weeks, mean pain intensity was significantly (p=0.002) lower in the physical therapy group (1.49+/-2.26 versus 2.7+/-2.78). Similarly, after 6 months, significantly (p<0.001) less pain was reported in the physical therapy group (1.17+/-2.13) than the standard treatment group (2.33+/-2.56). We conclude that a physical therapy regimen which includes active exercises is superior in reducing pain 6 weeks and 6 months after whiplash injury compared to the current standard treatment with a soft collar.
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Randomized Controlled Trial Comparative Study
Assessment of persistent pain or distress and adequacy of analgesia in preterm ventilated infants.
Indicators of persistent pain in preterm neonates are poorly defined. In the setting of a double blind, placebo-controlled trial investigating morphine use in ventilated preterm infants (NEOPAIN Trial) we aimed to identify factors that may be useful in assessing persistent pain. Twenty-two babies (morphine 12; placebo 10) were assessed for comfort, pain or distress and clinical staff described the factors they had considered. ⋯ Observation of a good response to handling, good synchrony with ventilation, a "settled" baby, normal blood pressure and heart rate were poor discriminators. Hypotension and poor respiratory drive were noted exclusively in babies receiving morphine infusions. Facial expressions of pain, high activity levels, poor response to routine care, and poor ventilator synchrony were associated with placebo versus morphine therapy, and may be considered useful markers for persistent pain in preterm infants.
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Randomized Controlled Trial Comparative Study Clinical Trial
Chronic pain and sensory changes after augmentation mammoplasty: long term effects of preincisional administration of methylprednisolone.
We studied the prevalence of chronic pain and long term sensory changes after cosmetic augmentation mammoplasty and the effects of a single i.v. preoperative dose of methylprednisolone 125 mg (n=74), parecoxib 40 mg (n=71), or placebo (n=74). A questionnaire was mailed 6 weeks and 1 year after surgery. Response rate after 1 year was 80%. ⋯ We conclude that persistent pain and sensory changes are common after augmentation mammoplasty, and that patients having pain at 6 weeks most likely will have pain also at 1 year. Acute postoperative pain, hyperesthesia at 6 weeks, and the presence of hyperesthesia increased the odds for pain at 1 year. Preoperative methylprednisolone resulted in significantly less hyperesthesia compared with both parecoxib and placebo, but did not significantly reduce the prevalence of persistent spontaneous or evoked pain.