Pain
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Clinical Trial Controlled Clinical Trial
Effects of transcutaneous electrical nerve stimulation on myofascial pain and trigger point sensitivity.
The effects of transcutaneous electrical nerve stimulation (TENS) on myofascial pain and trigger point sensitivity were assessed. Four modes of TENS and a no-stimulation control were compared in a double-blind design. ⋯ No significant alteration in myofascial trigger point sensitivity, assessed with the pressure algometer, was found between the groups. The results suggest that high frequency, high intensity TENS is effective in reducing myofascial pain, and that these pain reductions do not reflect changes in local trigger point sensitivity.
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Randomized Controlled Trial Clinical Trial
Codeine 20 mg increases pain relief from ibuprofen 400 mg after third molar surgery. A repeat-dosing comparison of ibuprofen and an ibuprofen-codeine combination.
A combination of 20 mg codeine base and ibuprofen 400 mg was compared with ibuprofen 400 mg in a randomised double-blind cross-over study of multiple doses in 25 patients after 2-stage bilateral third molar removal. The combination produced significantly greater pain relief and doubled the hours of minimum pain intensity and maximal relief on the day of surgery. ⋯ There was no significant increase in side-effect incidence with the combination. The 30% increase in analgesic effect may be of clinical benefit, and this trial design, cross-over with multiple dosing in out-patients, may be a sensitive test for analgesics, potentially more predictive of side-effect problems than single-dose studies.
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Comparative Study
The dimensions of pain: a multidimensional scaling comparison of cancer patients and healthy volunteers.
This paper presents a new approach to the measurement and understanding of clinical pain. A multidimensional scaling (MDS) procedure was used to analyze pairwise similarity judgments made to 9 pain descriptors by 24 cancer pain patients and 24 healthy volunteers. The question was whether the dimensions of the global pain space differed between the 2 groups. ⋯ The subject weight space revealed that the Pain Intensity dimension was the most important dimension for the patients, while Emotional Quality was more salient for the volunteers. Wide differences were found in the salience of the various dimensions to different individuals; this information may prove useful for tailoring patient treatment. The study demonstrates that MDS procedures such as INDSCAL, in which the subjects (rather than the researcher) determine the number and characteristics of the global pain dimensions, will improve our understanding and treatment of pain.
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Case Reports
An unusual case of causalgia. Relevance to recent hypothesis on mechanism of causalgia.
Intravenous regional sympathetic block with guanethidine caused only limited improvement in a patient with longstanding causalgia. Lumbar sympathetic block with phenol also had little direct effect on the pain but completely abolished associated allodynia and vasomotor signs. ⋯ This improvement persisted even after 8 months when there was some return of the previous allodynia and vasomotor signs (to involve a smaller area than previously). The case would appear to have implications for a recently proposed hypothesis concerning the mechanism of pain in causalgia.
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The use of strategies for coping with chronic pain was assessed by means of the Coping Strategy Questionnaire (CSQ) in a Dutch sample of 108 chronic low back pain (LBP) patients referred for behavioral treatment. The 3 factors of the CSQ were related to measurements of behavioral and emotional adjustment to LBP above and beyond the effects of demographic and medical status variables. Especially patients high on the factor Helplessness reported higher levels of pain, functional impairment, anxiety, depression and psychoneuroticism, while patients high on the factor Perceived Control reported lower levels of pain, functional impairment and also manifested a higher level of uptime. The causal role of coping strategies in adjustment to pain, the selectivity of focusing on LBP patients selected through referral and implications for pain management are discussed.