Pain
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The aim of this paper is to study the quality of verbal description and its diagnostic value in neuropathic pain. The verbal description of pain as assessed by a French adjective list questionnaire (QDSA) is compared between a group of 100 patients with neuropathic pain and a mixed group of 97 chronic benign and cancer non-neuropathic pain patients. Seventeen descriptors of the 61 QDSA descriptors have a significant intergroup frequency difference. ⋯ Seven descriptors from the discriminant analysis function correctly assign 77% of neuropathic pain patients and 81% of the non-neuropathic pain patients. In a second neuropathic pain group of 32 patients, the discriminant function coefficient permits correct diagnostic categorization in 66% of the cases. Implications for clinical practice and trials are discussed.
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From research reports published over the last 20 years, it appears that moderate to severe uncontrolled pain may be the norm for hospitalized patients despite recent advances in the management of pain. Research on the extent of under-management of pain and the factors associated with it is examined and summarized in this paper. ⋯ A clinical decision making model is also reviewed and it is suggested that this model could be applied to pain management problems. Further, it is suggested that this model may be very useful in developing educational interventions to improve health practitioners' clinical skills in pain management.
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In the cancer population, the term breakthrough pain typically refers to a transitory flare of pain in the setting of chronic pain managed with opioid drugs. The prevalence and characteristics of this phenomenon have not been defined, and its impact on patient care is unknown. We developed operational definitions for breakthrough pain and its major characteristics, and applied these in a prospective survey of patients with cancer pain. ⋯ Pain was related to the tumor in 42 (82%), the effects of therapy in 7 (14%), and neither in 2 (4%). Diverse interventions were employed to manage these pains, with variable efficacy. These data clarify the spectrum of breakthrough pains and indicate their importance in cancer pain management.
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An electrophysiological study was carried out in anesthetized rats to characterize the properties of single neurons in trigeminal (V) subnucleus caudalis. Each neuron was functionally classified in terms of its cutaneous mechanoreceptive field properties as low-threshold mechanoreceptive (LTM), wide dynamic range (WDR) or nociceptive-specific (NS), and its responsiveness was also tested to electrical stimulation of hypoglossal (XII) nerve muscle afferents. Some neurons were also tested with noxious stimulation of the tail or forepaw for the presence of diffuse noxious inhibitory controls (DNIC) of evoked responses. ⋯ In contrast to the LTM neurons, but consistent with our previous data in cats, many of the nociceptive neurons also received convergent excitatory inputs from XII muscle afferents, and the stimulus-response functions of the WDR neurons indicated that they were capable of coding the intensity of A and C fiber craniofacial muscle afferent inputs as well as those from cutaneous afferents. The study has also documented for the first time that muscle afferent-evoked responses as well as those evoked by cutaneous afferent inputs to nociceptive neurons are subject to DNIC. These findings indicate that subnucleus caudalis plays an important role in the transmission of superficial and deep nociceptive information from the craniofacial region of the rat, and also reveal that responses of the nociceptive neurons evoked by deep as well as superficial afferent inputs can be powerfully modulated by other nociceptive influences originating from widespread parts of the body.
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Randomized Controlled Trial Clinical Trial
Parturition pain treated by intracutaneous injections of sterile water.
Forty-five pregnant women in the first stage of labour presenting with lower back pain were randomized into 2 groups. One group received intracutaneous injections of sterile water in the lumbosacral region, while the other group was given corresponding subcutaneous injections of isotonic saline, regarded as a placebo treatment. ⋯ However, the requirement of pethidine (meperidine) was similar in the 2 groups. The analgesic method presented was found to be an effective treatment against lower back pain during the first stage of labour and it is speculated that the mode of action resembles acupuncture.