The Clinical journal of pain
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Clinical Trial
Prediction of outcome in whiplash-associated disorders using West Haven-Yale Multidimensional Pain Inventory.
To investigate the predictive capacity of the West Haven-Yale Multidimensional Pain Inventory (MPI) with regard to prolonged pain, using car occupants who had sustained a neck sprain in a traffic accident. ⋯ The MPI may be used at an early stage to identify patients who may develop chronic neck-pain after a traffic accident, at least in those who want a follow-up session after an initial visit to an accident and emergency department.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of multiple against single pain intensity measurements in complex regional pain syndrome type I: analysis of 54 patients.
To describe the comparison of multiple and single pain ratings in patients with complex regional pain syndrome type I (CRPS I). ⋯ In patients with CRPS I a single pain rating is an accurate predictor of the average pain measured by a multiple pain-rating test. Moreover, both assessments are accurate enough to determine changes in pain over time with an effective treatment.
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The pharmacological effects of the opioid analgesics are derived from their complex interactions with three opioid receptor types (mu, delta, and kappa; morphine is an agonist at the mu opioid receptor). These receptors are found in the periphery, at presynaptic and postsynaptic sites in the spinal cord dorsal horn, and in the brain stem, thalamus, and cortex, in what constitutes the ascending pain transmission system, as well as structures that comprise a descending inhibitory system that modulates pain at the level of the spinal cord. ⋯ A number of opioids are available for clinical use, including morphine, hydromorphone, levorphanol, oxymorphone, methadone, meperidine, oxycodone, and fentanyl, and their advantages and disadvantages for the management of pain are discussed. An understanding of the pharmacokinetic properties, as well as issues related to opioid rotation, tolerance, dependence, and addiction are essential aspects of the clinical pharmacology of opioids for pain.
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Comparative Study
The neck pain and disability scale: test-retest reliability and construct validity.
This research established test-retest reliability and construct validity for the Neck Pain and Disability Scale (NPAD). ⋯ The NPAD is a stable and responsive measure for patients with neck pain. The Neck Pain and Disability Scale factor scores are useful in identifying treatment effects on the specific dimensions involved in the pain experience.
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Comparative Study
Effects of intermediate- and long-term use of opioids on cognition in patients with chronic pain.
The authors review research on the intermediate- and long-term effects of taking opioid medication on cognitive functioning in patients with chronic cancer and noncancer pain. Opioids seem to be more likely to worsen cognitive performance during the first few days of use and during the first few hours after a given dose, particularly on timed performance in psychomotor tasks. ⋯ Relatively few differences have been found when cognitive performance in these patients is compared with their performance before taking opioids, or with the performance of a comparable pain population not taking opioids. Major unresolved questions remain regarding such important issues as effects of different types of opioids, dose effects, interactions with other medications, and subject variables.