Pain
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Case Reports
Post-axillary dissection pain in breast cancer due to a lesion of the intercostobrachial nerve.
Seven patients with breast carcinoma and post-axillary dissection pain are described. They complained about pain in the axilla, inner side of the upper arm and/or shoulder. All had undergone a partial or radical breast amputation including an axillary lymph node dissection. ⋯ The pain was not associated with lymphedema and only one patient had undergone radiotherapy to the axillary and supraclavicular area. Post-axillary dissection pain is probably a more appropriate name than the usual post-mastectomy pain for this syndrome. During the dissection, the intercostobrachial nerve is often lesioned, which may give rise to neuropathic pain of that nerve.
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The purpose of this study was to examine the differential role of fear, anxiety, alexithymia, family factors and coping in cancer pain. Twenty-seven patients with pain related to cancer, 26 patients with chronic non-cancer pain, 26 patients with chronic illness but no pain (hypertensives) and 24 healthy controls completed a set of questionnaires during an initial interview and recorded severity and duration of pain, pain interference with activities, thoughts, behaviors and physiological responses associated with fear of pain, and coping strategies using a diary once daily for 7 days. In general, cancer patients reported lower pain levels than patients with chronic non-cancer pain. ⋯ The perceived family environment of the cancer pain patient did not differ significantly from the 3 other groups. These results do not support anecdotal impressions that the level of reported pain and fear of pain is significantly greater in cancer pain in contrast to non-cancer pain. The results do indicate the importance of emotional expressivity in the modulation of cancer pain where the ability to assess and express emotions was associated with reduced pain.
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The semantic structure and the underlying dimensions of 176 common Dutch words used to describe various kinds of pain were studied. Seventy-seven subjects rated the intensity of the pain described by each of these words; another 53 subjects sorted the words with regard to their similarity in meaning. A unidimensional solution adequately represented the intensity ratings. ⋯ Regression analysis showed intensity to be the main criterion for similarity within the affective/evaluative group, whereas intensity was not related to the similarities among the sensory words. Cluster analysis, using the distances in the 3-dimensional HOMALS space, yielded 32 clusters of words among which the subscales of both the original McGill Pain Questionnaire (MPQ) and the Dutch version by Vanderiet et al. could easily be identified. Since the present results were obtained in a different country and by completely different methods of data collection (i.e., similarity sortings without a priori categories), they strongly indicate the cross-cultural and cross-methodological generality of the structure of pain descriptions.
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The McGill Pain Questionnaire has previously been shown to be useful in the differential diagnosis of painful conditions and has also been used to assess the efficacy of therapeutic intervention. We have applied this simple test to 42 patients with painful diabetic neuropathy and 49 control subjects with painful legs or feet of varying aetiologies. ⋯ Each questionnaire was given a single score as a result of the analysis, and this score correctly classified a total of 91% to either the neuropathic or control groups, and when applied prospectively to a further 25 ungrouped questionnaires a useful probability of their belonging to a diagnostic group was obtained. Use of the questionnaire might be a useful aid to the differential diagnosis of the painful diabetic leg.
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Following our earlier research, we further investigated a model that conceptualizes placebo phenomena as the result of conditioning and attempted to extend and replicate the finding that placebo responses can be conditioned in human subjects. Two groups of 10 subjects were told that they were receiving an analgesic which was in fact a placebo. During the conditioning, placebo administration was surreptitiously paired with an increase in the painful stimulus for half of the subjects and with a decrease for the other half. ⋯ A second type of experimental pain was also used to determine stimulus generalization. The results confirmed a previous finding that placebo responses can be conditioned in human subjects. The implications for clinical practice of a learning model of placebo behavior are discussed.