The Clinical journal of pain
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To determine the current status for the association of chronic pain and depression and to review the evidence for whether depression is an antecedent or consequence of chronic pain (CP). ⋯ Depression is more common in chronic pain patients (CPPs) than in healthy controls as a consequence of the presence of CP. At pain onset, predisposition to depression (the scar hypothesis) may increase the likelihood for the development of depression in some CPPS. Because of difficulties in measuring depression in the presence of CP, the reviewed studies should be interpreted with caution.
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The Coping Strategies Questionnaire (CSQ), a rationally constructed pain coping assessment instrument, was conceived to measure the extent to which patients used six different cognitive coping strategies and two behavioral coping strategies. A number of studies have factor analyzed the original scales but have not found a reliable factor structure. Recent studies by Turtle et al. and Swartzman et al. have obtained a five-factor solution performing exploratory factor analysis on the individual items. Robinson and associates from the University of Florida performed an item level exploratory factor analysis on a much larger sample (n = 965) and found a six-factor solution that was relatively supportive of the original rationally derived scales. The purpose of the present investigation was to perform a confirmatory factor analysis using the LISREL structural equation modeling program to compare these three different factor structures. ⋯ The results indicated that the Florida six-factor model was a better fit to the sample data than either of the five-factor models. Creation of the Coping Strategy Questionnaire Revised (CSQ-R), which retains 27 of the original items, is suggested.
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Clinical Trial
Prescription opiate abuse in chronic pain patients: clinical criteria, incidence, and predictors.
Opiates are commonly used to treat patients with chronic nonmalignant pain. There is much controversy over the definition, incidence, and risk factors of prescription opiate abuse in chronic pain treatment. The present study, done at the Seattle VA Medical Center, was designed to create opiate abuse criteria, test inter-rater reliability of the criteria, apply the criteria to a group of chronic pain patients, and correlate the risk of opiate abuse with the results of alcohol and drug testing. ⋯ Prescription opiate abuse criteria for use in patients with chronic nonmalignant pain were designed. The criteria had good reliability and can be applied during normal clinic interactions. The percentage of chronic opiate users who become opiate abusers in pain treatment is within the range reported by others. Past opiate or alcohol abuse or psychosocial testing on clinic admission failed to predict who would become an opiate abuser. The criteria can be used to identify patients who will subsequently require more intensive treatment or intervention or can be used as an outcome to measure to test the effectiveness of treatment strategies.
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Randomized Controlled Trial Clinical Trial
Iontophoretic administration of 2% lidocaine HCl and 1:100,000 epinephrine in humans.
The primary objective was to evaluate the clinical safety and effectiveness of the iontophoretic administration of lidocaine HCl 2% and epinephrine 1:100,000 to induce local dermal anesthesia before intravenous (i.v.) cannulation. ⋯ Iontophoresis of lidocaine 2% with 1:100,000 epinephrine for short delivery times does not lead to delivery of clinically important systemic levels of lidocaine in healthy adults. Iontophoresis of lidocaine 2% with 1:100,000 epinephrine provides adequate skin anesthesia for placement of peripheral small-gauge i.v. catheters.
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Comparative Study Clinical Trial Controlled Clinical Trial
Pain in 4- to 6-year-old children receiving intramuscular injections: a comparison of the Faces Pain Scale with other self-report and behavioral measures.
The main objective was to compare the utility of the Faces Pain Scale (Bieri et al., 1990) with three alternative self-report measures of pain intensity in children, as well as with pain ratings based on observations of the child's behavior. ⋯ The Faces Pain Scale was simple to use, readily understood by the children, and showed a realistic distribution of scores with respect to the type of pain being measured. With the exception of verbal reactions (which were not meaningfully related to self-report), observer ratings based on detailed coding of the child's behavior correlated only poorly to moderately well with self-report scores (r = .39 to r = .58). Similarly, although confident in their judgments, the nurses' ratings showed only moderate agreement with those of the children. In estimating the child's pain, all observers appeared to appropriately weigh changes in the child's facial behavior, which showed evidence of being the most sensitive behavioral index to the intensity of short sharp (needle) pain in 4 to 6 years olds.