Pain
-
Randomized Controlled Trial Clinical Trial
Trazodone hydrochloride in the treatment of dysesthetic pain in traumatic myelopathy: a randomized, double-blind, placebo-controlled study.
Dysesthetic pain following traumatic myelopathy is characterized by diffuse burning and tingling sensations distal to the level of spinal injury. The dysesthetic pain syndrome (DPS) can compromise performance of functional abilities and inhibit participation in rehabilitation programs. Recent laboratory evidence suggests that antidepressant medications with selective inhibition of serotonin reuptake in the brain may be associated with superior analgesic effect compared to such non-selective agents as amitriptyline. ⋯ However, significantly more patients randomized to trazodone complained of side effects and prematurely terminated their participation in the study. The results of this investigation are consistent with those of other earlier trials which indicate that such antidepressant medications as trazodone hydrochloride which selectively inhibit presynaptic reuptake of serotonin, may not be effective in the control of certain pain syndromes. These results do not preclude the possible utility of these agents in the treatment of other pain syndromes or at higher doses than previously studied.
-
For a normative study of chronic low back pain (CLBP), 702 consecutive admissions to a large multidisciplinary CLBP treatment program were assessed at admission, discharge, and 1-month follow-up, using a variety of psychological and functional performance instruments. Both univariate and multivariate approaches to appraising success are evaluated. ⋯ Composite indices of improvement demonstrated favorable outcomes for no less than four in every ten, and as high as nine in every ten participants. Because of the large sample size, relationships both within and across measurement domains can be assessed statistically: the separate sets of outcome measures, with the exception of psychological profiles, are generally independent of each other.
-
Pain expression in neonates instigated by heel-lance for blood sampling purposes was systematically described using measures of facial expression and cry and compared across sleep/waking states and sex. From gate-control theory it was hypothesized that pain behavior would vary with the ongoing functional state of the infant, rather than solely reflecting tissue insult. Awake-alert but inactive infants responded with the most facial activity, consistent with current views that infants in this state are most receptive to environmental stimulation. ⋯ Sex differences were apparent in speed of response, with boys showing shorter time to cry and to display facial action following heel-lance. The findings of facial action variation across sleep/waking state were interpreted as indicating that the biological and behavioral context of pain events affects behavioral expression, even at the earliest time developmentally, before the opportunity for learned response patterns occurs. Issues raised by the study include the importance of using measurement techniques which are independent of preconceived categories of affective response.
-
Different types of pain patients used visual analogue scales (VAS) to rate their level of pain sensation intensity (VAS sensory) and degree of unpleasantness (VAS affective) associated with pain experienced at its maximum, usual, and minimum intensity. Women used the same VAS to rate their labor pain during early, active, and transition phases of stage I and in pushing (stage II). ⋯ Affective VAS but not sensory VAS ratings of pain were considerably reduced when women in labor focused on the birth of the child as compared to when they focused on their pain. The results underscore the importance of utilizing separate measures of the sensory intensity versus the affective dimension of clinical pain and provide evidence that the affective dimension of different types of clinical pain is powerfully and differentially influenced by psychological contextual factors.