Pain
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In a prospective study 58 patients undergoing limb amputation were interviewed the day before operation about their pre-amputation limb pain and 8 days, 6 months and 2 years after limb loss about their stump and phantom limb pain. All but one patient had experienced pain in the limb prior to amputation. Pre-amputation limb pain lasted less than 1 month in 25% of patients and more than 1 month in the remaining 75% of patients. ⋯ Both the localization and character of phantom pain changed within the first half year; no further change occurred later in the course. The incidence of stump pain 8 days, 6 months and 2 years after limb loss was 57, 22 and 21%, respectively. It is suggested that preoperative limb pain plays a role in phantom pain immediately after amputation, but probably not in late persistent phantom pain.
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Visual analogue scales (VAS) of different lengths (5, 10, 15 and 20 cm) and with different end-phrases (troublesome, miserable, intense, unbearable and worst pain imaginable) were used to record pain in 50 male and 50 female patients with pulpitis or pericoronitis. All 100 patients successfully completed the questionnaire. High correlation was found between the scores on all the scales. ⋯ The scale with the end-phrase 'worst pain imaginable' was found to be the best choice for comparing present pain or worst pain between different groups. Using this scale no significant difference was found between the scores of males and females or between those of patients with pulpitis and pericoronitis. This study suggests the use of 10 cm visual analogue scales with the end-phrase 'worst pain imaginable' as being the most suitable for measuring dental pain.
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Sixty-two patients with intractable pain secondary to cancer of the pelvic organs were managed with intrathecal injections of morphine. Forty-six patients experienced pain relief from an initial test dose that ranged from 0.5 to 2.0 mg. In order to provide long-term pain relief, these 46 patients were further treated with repeated single injections (14 patients), external catheter (28 patients), or implanted pump (4 patients). ⋯ When side effects developed, they were generally itching, sphincter disorder and somnolence. No serious respiratory depression was noted. Intrathecal morphine offers a hopeful alternative to systemic narcotics or ablative neurosurgical procedures in the management of terminal cancer pain.
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Two patients with severe thalamic pain and one patient with causalgia from the shoulder-hand syndrome are described whose pain was markedly improved or abolished by anticholinesterase drugs. Both short-acting parenteral and oral anticholinesterase preparations were employed. Anticholinesterase drugs are a new and potentially valuable approach to the treatment of chronic pain.
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This study compared 47 patients with chronic low back pain who were involved in personal injury litigation with 33 patients not seeking compensation who were also complaining of low back pain. Pain was assessed using a visual analogue scale and the adjectival check-list of the McGill Pain Questionnaire. Psychological state was assessed using the Zung Depression Scale, the State-Trait Anxiety Inventory, the Eysenck Personality Inventory and the Hostility and Direction of Hostility Questionnaire. ⋯ There was no difference between the two groups on ratings of pain severity or pain description, and no difference on measures of psychological disturbance. Both groups had significant elevations of mean depression, neuroticism, state anxiety and trait anxiety scores when compared with the normal population. It was concluded that there is no support for the claim that personal injury litigants describe their pain as more severe than do non-litigants, and that both groups show similar levels of psychological disturbance.