Pain
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Randomized Controlled Trial Comparative Study Clinical Trial
Intrathecal midazolam for the treatment of chronic mechanical low back pain: a controlled comparison with epidural steroid in a pilot study.
This paper describes a prospective, double blind, randomised and dummy-controlled trial in 28 patients with chronic mechanical low back pain presenting to the York Pain Clinic. The therapeutic effects of epidural methyl prednisolone (80 mg) were compared with intrathecal midazolam (2 mg). All the patients had pain for a considerable length of time (range: 1-35 years) and all had received previous treatments which had failed. ⋯ However, although the improvement in the two groups was similar, all the patients treated with steroid were either taking more or the same amount of self-administered analgesic medication after their treatment, whereas between one-third and one-half of the midazolam-treated patients took less medication during the 2 month follow-up period. We conclude that intrathecal midazolam is an effective treatment for chronic mechanical low back pain. The mechanism responsible for this effect is discussed.
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The purpose of this study was to determine the factors that are associated with child, parent, and nurse ratings of acute pediatric pain and distress during venipuncture. The behavior of eighty-five pediatric cancer patients during venipuncture was recorded by trained raters, and their observations were compared with ratings of pain and distress obtained from parents, pediatric patients, and pediatric nurses. Regression analyses indicated that ratings made by the child, parent, and nurse reflect different perspectives. Nurses' ratings were based upon overt distress, parents' ratings reflected their subjective perception of the child's pain, and the child's self-report was associated with the child's chronologic age.
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Clinical Trial Controlled Clinical Trial
Early and late effects of prolonged topical capsaicin on cutaneous sensibility and neurogenic vasodilatation in humans.
Cutaneous sensibility and neurogenic vasodilatation (flare) were measured before, during and after long-term topical application of capsaicin in humans. Each subject applied a vehicle cream containing 0.075% capsaicin (Axsain, GalenPharma Inc.) to a 4 cm2 area of skin on one volar forearm and vehicle alone to an identical treatment area on the other forearm, according to a double-blind procedure. Each substance was applied 4 times/day for 6 weeks. ⋯ These studies demonstrate that prolonged application of capsaicin at low concentration selectively diminishes sensations of heat pain and neurogenic vasodilatation, presumably via desensitization of heat-sensitive nociceptors. It is also shown that the decrease in heat pain is temporary and is maintained with repeated capsaicin application. There appears to be a therapeutic role for capsaicin in cutaneous painful syndromes mediated, at least in part, by activity of heat-sensitive nociceptors.
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We report the case of a patient who developed myoclonus and hyperalgesia following administration of high-dose subarachnoid morphine. This complication occurred with 40-80 mg/day continuous infusion. The pathophysiology of these side effects is discussed.
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A growing number of investigators have used models of stress and coping to help explain the differences in adjustment found among persons who experience chronic pain. This article reviews the empirical research which has examined the relationships among beliefs, coping, and adjustment to chronic pain. Although preliminary, some consistent findings are beginning to emerge. ⋯ Although coping strategies appear to be associated with adjustment in chronic pain patients, methodological problems limit conclusions regarding the strength and nature of this association. Our recommendations for future research include the development of coping and belief measures which: (1) do not confound different dimensions (e.g., coping, beliefs, and adjustment) in the same measure; (2) assess specific (rather than composite) constructs; (3) are psychometrically sound; and (4) assess behavioral coping strategies more objectively. We also recommend a greater use of experimental research designs to examine causal relationships among appraisals, coping, and adjustment.