Pain
-
Randomized Controlled Trial Comparative Study Clinical Trial
The analgesic action of dexmedetomidine--a novel alpha 2-adrenoceptor agonist--in healthy volunteers.
The analgesic efficacy of dexmedetomidine (DEX)--a novel alpha 2-adrenoceptor agonist--was studied in man. Single intravenous doses of fentanyl (FEN; 2 micrograms/kg), DEX (0.25, 0.50 and 1.0 micrograms/kg) and placebo were administered to 5 healthy male volunteers in a double-blind, crossover study in randomized order. The analgesic effect of the different treatments was measured by determining the time course of pain threshold with dental dolorimetry and by quantitating subjective pain induced by a standard ischemic pain stimulus on the upper arm using a visual analogue scale (VAS). ⋯ FEN and DEX both had analgesic effects on ischemic pain, which was seen as a statistically significant decrease in subjective VAS ratings. FEN appeared to be more effective than DEX; the difference was not, however, statistically significant. Neither of the drugs affected the pain threshold measurements.
-
The role of epidural morphine in chronic cancer pain treatment is unresolved. In a population of 1205 cancer patients, the aggressive use of systemic opiates limited the trial of epidural analgesia to 16 cases. ⋯ Complications occurred in 11 of the 16 cases of epidural analgesia and included dislodged or broken catheters, pain on injection, hyperesthesia from epidural morphine and bleeding or infection related to the epidural catheter. Epidural morphine is indicated only in selected cancer pain patients and, although bupivacaine extends the efficacy of epidural analgesia, these methods are accompanied by problems and limitations.
-
Comparative Study
Stress-related electromyographic responses in patients with chronic temporomandibular pain.
Surface electromyographic (EMG) recordings from the right and left masseter and the left biceps muscle during stress and non-stress imagery were obtained from patients with temporomandibular myofascial pain and dysfunction syndrome (MPDS), temporomandibular joint disorder (TMJD), chronic low back pain (CBP) and healthy controls (HC). Both the MPDS and the TMJD groups displayed significantly more masseter EMG reactivity to the stressful imagery than the CBP and HC groups. ⋯ The MPDS patients indicated more life stress and gave higher aversiveness ratings during the experiment. These findings are discussed with respect to the validity of the TMJD and MPDS distinction.
-
Patients' beliefs about chronic pain, such as how long it will last and whether it is a mysterious experience, have been shown to be related to compliance with treatment programs. The present study examined whether these pain beliefs related to a specific component of pain management, namely the frequency of use and the perceived effectiveness of cognitive and behavioral coping strategies. One hundred twenty chronic pain patients were administered the Pain Beliefs and Perceptions inventory (PBAPI) and the Coping Strategies questionnaire (CSQ). ⋯ Multivariate analysis of variance was used to detect whether the use of cognitive-behavioral pain coping strategies differed in patients in the 3 pain beliefs subgroups. The results indicated that patients belonging to the group characterized by the belief that pain was enduring and mysterious were less likely to use cognitive coping strategies (e.g., reinterpretation of pain sensation), more likely to catastrophize, and less likely to rate their coping strategies as effective in controlling and decreasing pain than patients believing their pain to be understandable and of short duration. The implications of these results for understanding the patient's choice of and compliance with treatment and coping efforts is discussed.
-
One hundred and fifty-six patients with moderate to severe postherpetic neuralgia (PHN) were followed for up to 11 years. Nearly half of all patients were doing well at the final assessment (median 2 years) and more than half of these were on no therapy at this time. ⋯ More of these patients were noted to be using some form of treatment at follow up. A group of patients seemed to follow a progressive course and were refractory to all treatments used in this study.