Pain
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Research on the assessment and management of pain in infants and children has increased dramatically, with the consequence that a wide variety of behavioral, physiological, and psychological methods are now available for measuring pediatric pain. Although the criteria for a pain measure for children are identical to those required for any measuring instrument, special problems exist in pediatric pain measurement because the influence of developmental factors, previous pain experience, and parental attitudes on children's perceptions and expressions of pain is not known. This article reviews the recent advances in the measurement of pain in children, with special emphasis on the methods that satisfy the criteria for reliability and validity, the methods that can be used to assess multiple dimensions of pain, and the methods that may be appropriate for assessing all types of acute, recurrent, and chronic pediatric pain.
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A retrospective, multi-physician survey was carried out to examine the infusion concentrations of morphine delivered intrathecally by continuous infusion pumps placed to control pain. Replies from 19 physicians formed the basis for a population of 163 patients who received morphine by continuous infusion delivered by an Infusaid pump through a chronically implanted intrathecal catheter (N = 130 for pain of a metastatic origin; N = 3 for non-metastatic pain; N = 30 undefined). These patients received a total of 3443 patient weeks of infusion. ⋯ E. M.). Though the group morphine utilization rose, examination of the patient population which was infused for periods in excess of 3 months indicated that 48% showed less than a 2-fold increase in dose by 3 months.
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Twenty-one chronic low back pain (CLBP) patients and 20 control subjects participated in 8 successive cold pressor tests (CPT). The hypotheses were that: (1) CLBP patients would demonstrate poorer acute pain tolerance and report higher acute pain, and (2) CLBP patients would become sensitized during 8 successive CPT trials, while control subjects would habituate, resulting in increasing differences in test behavior between both groups. ⋯ These findings lead one to conclude that the deviant acute pain behavior of CLBP patient may be regarded either as a consequence of CLBP or as an important risk factor in the development of CLBP. Patients with relatively high CLBP levels performed poorly on the CPT as compared with patients with relatively low CLBP levels.
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Review Clinical Trial
Epidural blood patch in the treatment of post-lumbar puncture headache.
Post-lumbar puncture headache is a common complication of dural puncture. Treatment of severe cases with an epidural 'blood patch'--injection of 10-20 ml autologous blood into the epidural space at the site of the dural puncture--is an effective and safe method with few and generally mild complications. The method has been used by anesthesiologists for many years with good results, but only rarely by radiologists, neurologists and other specialists who often perform lumbar punctures. The technique of 'blood patching,' its indications, effects, and complications and the epidural blood patch as post-lumbar puncture headache prophylaxis are discussed.
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A short form of the McGill Pain Questionnaire (SF-MPQ) has been developed. The main component of the SF-MPQ consists of 15 descriptors (11 sensory; 4 affective) which are rated on an intensity scale as 0 = none, 1 = mild, 2 = moderate or 3 = severe. Three pain scores are derived from the sum of the intensity rank values of the words chosen for sensory, affective and total descriptors. ⋯ The correlations were consistently high and significant. The SF-MPQ was also shown to be sufficiently sensitive to demonstrate differences due to treatment at statistical levels comparable to those obtained with the standard form. The SF-MPQ shows promise as a useful tool in situations in which the standard MPQ takes too long to administer, yet qualitative information is desired and the PPI and VAS are inadequate.