Pain
-
An important issue that has yet to be resolved in pain measurement literature concerns the number of levels needed to assess self-reported pain intensity. An examination of treatment outcome literature shows a large variation in the number of levels used, from as few as 4 (e.g., 4-point Verbal Rating scales (VRS)) to as many as 101 (e.g., 101-point Numerical Rating scales (NRS)). The purpose of this study was to provide an empirically derived guideline for determining the number of levels needed. ⋯ The results indicated that little information is lost if 101-point scales are coded as 11- or 21-point scales. Moreover, examination of the actual responses to the 101-point measure showed that almost all patients treated it as a 21-point scale by providing responses in multiples of 5 or 10, while a substantial number of patients treated it as an 11-point scale, providing responses in multiples of 10 only. The results suggest that 10- and 21-point scales provide sufficient levels of discrimination, in general, for chronic pain patients to describe pain intensity.
-
Comparative Study
On the absence of correlation between responses to noxious heat, cold, electrical and ischemic stimulation.
Is a person's response to one noxious stimulus similar to his/her responses to other noxious stimuli? This long-investigated topic in pain research has provided inconclusive results. In the present study, 2 samples were studied: one using 60 healthy volunteers and the other using 29 patients with coronary artery disease. Results showed near-zero correlations between measures of heat, cold, ischemic, and electrical laboratory pains, as well as between these laboratory pains and an idiopathic pain, the latency to exercise-induced angina in the patients. ⋯ Reliability analyses indicated retest correlations on the order of 0.60 for these measures, indicating that the lack of correlation between modalities was not due to unreliability within a measure. These studies fail to demonstrate alternate-forms reliability among these tests, and also fail to support the notion that a person can be characterized as generally stoical or generally complaining to any painful stimulus. In practice, this implies that a battery of tests should generally be used to assess pain sensitivity and also that assessments of one pain modality are not generally useful for making inferences about another.
-
The presence of a trigger point is essential to the myofascial pain syndrome. This study centres on identifying clearer criteria for the presence of trigger points in the quadratus lumborum and gluteus medius muscle by investigating the occurrence and inter-rater reliability of trigger point symptoms. Using the symptoms and signs as described by Simons' 1990 definition and two other former sets of criteria, 61 non-specific low back pain patients and 63 controls were examined in general practice by 5 observers, working in pairs. ⋯ This is not the case with trigger points defined by Simons' 1990 criteria. Concerning reliability there is also a significant difference between the two different criteria sets. This study suggests that the clinical usefulness of trigger points is increased when localized tenderness and the presence of either jump sign or patient's recognition of his pain complaint are used as criteria for the presence of trigger points in the M. quadratus lumborum and the M. gluteus medius.
-
Clinical Trial
Percutaneous cervical cordotomy and subarachnoid phenol block using fluoroscopy in pain control of costopleural syndrome.
We examined the efficacy of percutaneous cervical cordotomy (PCC) and subarachnoid phenol block using fluoroscopy (SAPB-F) for control of chest and/or back pain from costopleural syndrome. The efficacy of each block was evaluated by changes in pain score (PS), analgesic dose and performance status 1 week after the block, as well as by the complications. Between 1980 and 1986, PCC was performed in 10 patients. ⋯ There were no complications and no changes in performance status. From this study we concluded that PCC is an effective method of pain control for costopleural syndrome, but a risk of serious complications is involved. SAPB-F is an effective and safe method and should be the first choice of nociceptive pathway block.
-
The treatment of pain in the patient with cancer necessitates careful assessment and definition of factors contributing to the pain complaint. We describe 3 cases of patients who had cancer, complained of pain, and were inappropriately treated with escalating doses of opioids. Opioid analgesic medications are commonly used in the management of pain in patients with cancer. Failure to respond to this treatment, the development of increasing pain, and the report of new side effects should prompt reassessment of opioid use.