The Clinical journal of pain
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Comparative Study
Why do people seek medical advice for back pain: a comparison of consulters and nonconsulters.
Respondents with back pain who had answered affirmatively to the question about back pain in a population study were divided into two groups depending on whether they had consulted or had not consulted a physician due to their back pain. There were 17 nonconsulters and 37 consulters. ⋯ Based on the results, we found that the nonconsulters differed from the consulters on many issues but had nevertheless rated their constant level of pain on two different occasions as being equally severe on a graphic rating scale (GRS). The groups differed as follows: The nonconsulters rated their work to be more stressful; had less frequently a spouse suffering or having suffered from chronic pain; had fewer abnormal pain drawings; woke up less frequently during the night; used sleeping pills less frequently; participated more often in sports; and had a higher frequency of repression on the MCT compared to a group of painless subjects.
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Data from the charts of 40 patients in whom a continuous epidural infusion of fentanyl had been used to effect postoperative pain relief were retrospectively reviewed. Of these patients, 39 out of 40 (97.5%) reported adequate analgesia at an average fentanyl infusion rate of 1.3 micrograms/kg/h. ⋯ The overall incidence of side effects was low, and, in particular, respiratory depression was not noted. In our experience, this analgesia technique is safe, effective, and could be readily introduced into most community hospital settings.
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Randomized Controlled Trial Clinical Trial
Trial of intravenous lidocaine on painful neuropathy in cancer patients.
In 10 cancer patients with cutaneous allodynia, intravenous lidocaine (5 mg/kg body weight) or 0.9% NaCl was given in a double blind, cross-over study to determine the analgesic effect. One patient had complete and one had partial pain relief with lidocaine infusion, whereas three patients experienced partial pain relief with placebo. Neither lidocaine nor placebo reduced pain intensity or consumption of analgesics significantly during the study period. Intravenous infusion of lidocaine cannot be recommended as routine pain treatment in cancer patients with cutaneous allodynia or pain, but further studies are needed to test the effect of lidocaine on different peripheral stimuli.
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Randomized Controlled Trial Clinical Trial
A controlled trial of the treatment of migraine by acupuncture.
A randomised controlled trial comparing true and sham acupuncture was conducted on 30 patients suffering from chronic migraine. Diary measures of headache and medication intake were recorded throughout the study, and measures of headache quality, anxiety, and pain behaviour were taken. ⋯ True acupuncture was significantly more effective than the control procedure in reducing the pain of migraine headache. Posttreatment reductions in pain scores and medication of 43 and 38%, respectively, were recorded in the true acupuncture group and were maintained at 4-month and 1-year follow-up.
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Because of the difficulty in applying psychiatric diagnostic nomenclature to the problem of pain in the medical setting, medical and surgical inpatients referred for a psychiatric consultation with pain as a presenting complaint (N = 167) are compared with "nonpain" patients (N = 1,634). "Pain" patients were more often male (p less than 0.05), had additional presenting problems of coping with their illness (p less than 0.0001), drug misuse and abuse (p less than 0.0001), and terminal illness (p less than 0.0001); evidenced less severity of psychiatric impairment (p less than 0.05); received different treatment recommendations; and were more likely to be assigned less frequently employed DSM-III psychiatric diagnoses than those most commonly found in consultation populations. However, these diagnoses were nonspecific for the problem of pain and provided minimal information about the nature of the pain. Enhancements of the diagnostic classification systems that would better address the nature of the psychiatric disorders associated with pain are presented.