Pain
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Results from laboratory and naturalistic studies have demonstrated decreased subjective pain ratings in hypertensives and individuals at risk for hypertension. Based on previous evidence that the nociceptive withdrawal reflex may provide an objective index of pain threshold in humans, the present study examined the intensity of sural nerve stimulation required to elicit nociceptive withdrawal in offspring of hypertensives and normotensives. Participants included 60 men and 56 women who were normotensive, 18-23 years of age, and predominately Caucasian. ⋯ Second, offspring of hypertensives endured significantly more intense stimulation before reporting pain. Third, both parental history of hypertension and resting systolic blood pressure were significant independent predictors of stimulation intensity at nociceptive withdrawal reflex and subjective pain thresholds. These results confirm and extend previous observations of an association between risk for hypertension and hypoalgesia, and suggest that hypoalgesia should be examined as a potential predictor of progressive blood pressure increases in individuals at risk for hypertension.
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Randomized Controlled Trial Clinical Trial Controlled Clinical Trial
Opiate and H1 antagonist effects on histamine induced pruritus and alloknesis.
Itching is a well known side-effect of opiate therapy. To gain insight into the possible contribution of opiate receptors to itching we compared the antipruritic effect of naltrexone (Nemexin), an opiate antagonist, to an H1-receptor antagonist and to placebo. In a double blind cross-over study on 15 healthy volunteers, 25 mg naltrexone or placebo was orally given 60 min prior to a histamine stimulus. ⋯ Both naltrexone and cetirizine significantly diminished histamine induced itching. In contrast to placebo and cetirizine, naltrexone abolished alloknesis completely in four of 15 volunteers and in the others alloknesis was greatly reduced after naltrexone. Since vascular reactions to histamine are of peripheral origin, whereas alloknesis depends on central nervous mechanisms, our findings suggest a pronounced centrally mediated action of naltrexone on histamine induced pruritus.
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Comparative Study Clinical Trial Controlled Clinical Trial
Pain coping strategies that predict patients' and spouses' ratings of patients' self-efficacy.
This study examined the relationship of pain coping strategies to osteoarthritis patients' ratings of self-efficacy and to spouses' ratings of the patients' self-efficacy. Subjects, 130 individuals having osteoarthritis of the knees and persistent knee pain, completed a pain coping strategies measure (the Coping Strategies Questionnaire), a measure of self-efficacy (the Arthritis Self-Efficacy Scale), and a measure of pain (the McGill Pain Questionnaire). Two sets of regression analyses were conducted, one examining the degree to which pain coping strategies predicted patients' self-efficacy ratings, and the other examining the degree to which coping strategies predicted spouses' ratings of the patients' self-efficacy. ⋯ The findings regarding coping strategies were particularly interesting in that they were obtained even after controlling for pain intensity and demographic variables. The pain coping strategies identified are potentially important targets for cognitive-behavioral assessment and treatment efforts. Interventions designed to increase the use of adaptive pain coping strategies and decrease the use of maladaptive pain coping strategies could enhance self-efficacy, reduce pain, and improve the physical and psychological functioning of individuals having osteoarthritis.
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Efforts to examine the process and risk of developing chronic back pain have relied generally upon retrospective study of individuals with already established pain. In an alternative approach to understanding the clinical course and evolution of low back disorders, a cohort of 76 men experiencing their first episode of back pain was assessed prospectively at 2, 6 and 12 months following pain onset. Standard measures of pain (Descriptor Differential Scale: DDS), disability (Sickness Impact Profile: SIP), and distress (Beck Depression Inventory: BDI) were employed to classify the sample into five groups: Resolved, Pain Only, Disability/Distress Only, Pain and Mild Disability/Distress, and Clinical Range. ⋯ Comparison of those classified as 'improvers' with those who did not improve from 2 to 12 months showed similar findings. The clinical course of first onset back pain may be prolonged for many patients, and involves a continuum of related disability and distress. Individuals at risk for marked symptoms 1 year after an initial episode of back pain can be identified early, and prompt treatment might reduce the risk of pain chronicity.
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This case report describes the successful alleviation of the pain of pancreatic carcinoma with intravenous phentolamine mesylate. A 2 day infusion gave relief for 26 days on the first occasion and for 12 weeks after the second infusion. The possible mode of action is discussed.