The Clinical journal of pain
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Randomized Controlled Trial Comparative Study Clinical Trial
0.0625% bupivacaine with 0.0002% fentanyl via patient-controlled epidural analgesia for pain of labor and delivery.
To compare the utility of 0.0625% bupivacaine with fentanyl administered via patient-controlled epidural analgesia (PCEA) to a traditional continuous epidural infusion for pain of labor and delivery. ⋯ The results of this study show that 0.0625% bupivacaine with 2 micrograms/ml of fentanyl is an effective analgesic combination when used via PCEA.
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Clinical Trial
Relevance of epidurography and epidural adhesiolysis in chronic failed back surgery patients.
Pain treatment in the chronic failed back surgery patient remains problematic. Defining the pathogenesis of the pain could be helpful in treatment. The assumption that epidural fibrosis and adhesions might play an important role in the origin of the pain is verified. ⋯ Epidurography might confirm epidural filling defects for contrast dye in the patients with epidural fibrosis. A better contrast dye spread, assuming scar lysis, does not guarantee a sustained pain relief. A more direct visualization of the resulting functional changes after adhesiolysis as with epiduroscopy might be useful.
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The first goal of the study was to determine the internal reliability of the Coping Strategies Questionnaire (CSQ) in young adults. The second goal was to examine the relation of the CSQ to reported pain levels. The third goal was to investigate the relationship between the CSQ and concomitant pain problems. The fourth goal was to compare young adults and different chronic pain samples in terms of the frequency of coping strategy use and perceived effectiveness of coping strategies. ⋯ The results indicate that the CSQ is a reliable measure for the study of pain-coping strategies used in this population, and one that relates to differences reported in the experience of pain.
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The study assessed the predictive ability of the standardized Multiperspective Multidimensional Pain Assessment Protocol (MMPAP). An assessment tool that predicts return to work with chronic pain patients is needed, as increasing numbers of disability applications are adjudicated in the courts. ⋯ The MMPAP accurately predicts future employment of disability applicants claiming chronic pain. The introduction of this standardized protocol will assist in standardizing disability determination for claimants with chronic pain.
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Clinical Trial
Complications of intrathecal opioids and bupivacaine in the treatment of "refractory" cancer pain.
To test the concept that externalized tunneled intrathecal catheters lead to a high risk of complications, such as meningitis and epidural abscess, and therefore should not be used for durations of intrathecal pain treatment of > 1 week. ⋯ In our population and with the technique of insertion and care reported here, the use of externalized tunneled intrathecal catheters has not been associated with higher rates of complications when compared with earlier reported rates of externalized epidural catheters and internalized (both epidural and intrathecal) catheters connected to subcutaneously implanted ports, reservoirs, and pumps. The opinion that the use of externalized tunneled intrathecal catheters should be restricted only to patients who need pain treatment for < 1 week (because of the potential risk of infection, particularly meningitis and epidural abscess) is unfounded.