Pain
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The streptozocin-induced diabetic rat has been put forward as a model of chronic pain with signs of hyperalgesia and allodynia that may reflect signs observed in diabetic humans. The aim of this work was to assess, in streptozocin-induced diabetic rats, the pharmacological activity to several analgesic drugs known to be effective (clomipramine, amitriptyline, desipramine, clonidine, lidocaine), ineffective (aspirin), or with a doubtful effectiveness (morphine) in human painful diabetic neuropathy. The animals were submitted to a mechanical pain test (paw pressure) and the ability of the drugs to reverse diabetes-induced hyperalgesia was tested. ⋯ Lidocaine (1-9 mg/kg, i.v.) had prolonged efficacy on mechanical hyperalgesia. Aspirin (100 mg/kg, i.v.) was without effect and morphine (0.5-4 mg/kg, i.v.) induced a dose-dependent antinociceptive effect but at doses twice as high as those used in normal rats. These results demonstrate the high pharmacological predictivity of this model of painful diabetes and suggest that in this pathological condition, among the drugs acting on monoaminergic transmission, noradrenergic drugs seem the most active.
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Randomized Controlled Trial Comparative Study Clinical Trial
Patient-controlled epidural analgesia in obstetric anaesthetic practice.
A randomised single-blind controlled study was made of 60 patients to evaluate the effectiveness of epidural patient-controlled analgesia (PCA) device for obstetric management compared with a continuous infusion system. In both cases 0.125% plain bupivacaine was used. It was found that epidural PCA is at least as effective as an infusion system in producing analgesia and has the advantages of increased satisfaction and reduction of local anaesthetic requirement. Whether there are also advantages resulting from less obstetric intervention at delivery has not been proven.
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The need to document cost-benefit of comprehensive work rehabilitation services represents a critical requirement for its long-term viability as a treatment option for injured workers. One approach to improving cost-benefit is to identify patients who experience difficulty completing a rigorous goal-oriented treatment approach. This study examined a set of psychological, pain, perceived work environment, and patient expectation measures in order to determine whether such factors were associated with failure to complete rehabilitation. ⋯ In addition, this group was significantly younger and had been out of work longer. The groups did not differ on gender, marital status, ICD-9 diagnoses or perceived work environment. These findings indicate that patients displaying the pattern of low return to work expectations, heightened perceived disability, pain and somatic focus experience compliance problems in an intensive work rehabilitation program.(ABSTRACT TRUNCATED AT 250 WORDS)
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We investigated the relationship between somatic and psychological symptoms and pain reported during a clinical examination for 220 patients with chronic temporomandibular disorder (TMD) pain. The clinical examination involved palpation of the muscles of the face and neck, as well as intraoral sites and non-TMD-related placebo sites. A distinction was drawn between somatization--the tendency to report numerous somatic symptoms--and psychological distress manifested by report of numerous affective and cognitive symptoms. ⋯ Heightened somatization and high-intensity pain were strong predictors of widely dispersed muscle palpation pain during the clinical examination. High-somatization patients were 3 times more likely than low-somatization subjects to report having a painful placebo site. Pain dispersion was more closely linked to report of number of somatic symptoms than to report of affective and cognitive symptoms of psychological distress.
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Percutaneous radiofrequency lumbar facet denervation has been in use as a treatment for intractable, mechanical low back pain for over 2 decades. A number of case series have been reported with high rates of success in selected patients; however, there has been limited objective outcome assessment, long-term follow-up, and analysis of prognostic factors. We have reviewed our experience with diagnostic lumbar facet blocks and percutaneous radiofrequency denervation at a mean follow-up interval of 3.2 years. ⋯ There was no difference, however, between the long-term results of bilateral denervation for bilateral or axial pain and those of unilateral denervation for unilateral pain. There was no significant difference in the rate of response between the 56 patients who had undergone prior lumbosacral spine surgery and the 26 who had not. There were no complications from the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)