The Clinical journal of pain
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We report the case of a woman with presumed cancer pain treated with escalating doses of opiates despite no evident improvement in her pain and several deleterious side effects. ⋯ This case report illustrates some of the hazards of opioid therapy in the management of patients with chronic pain. Our patient's opiate therapy was expensive, gave her undesirable side effects, and did not reduce her pain complaints or improve her function. In the treatment of chronic pain, of noncancerous or cancerous origin, a) systemic opioids may not be effective in reducing pain complaints in every patient, b) treatment efficacy evaluation should always include functional endpoints, and c) nonefficacious treatments should not be continued indefinitely.
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Thirty-six subjects participated in an 18-month follow-up of a secondary prevention program for back pain of recent onset. The follow-up assessment included most of the same instruments used in the original study. In addition, interviews were conducted to ascertain help and hindrance factors for maintaining improvements during the follow-up period. ⋯ A cost-benefit analysis indicated substantial economic savings when follow-up sick-listing data were compared with estimates based on an increasing trend for pain-related absenteeism found during the baseline period. Hindrance factors reported by subjects were related to personal time-management and workplace factors, especially psychosocial aspects of the work environment. It was concluded that the secondary prevention program was effective and that future maintenance programs should focus more on personal time-management and workplace factors.
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Items and selected subscales of Scale 3 (Hysteria) of the MMPI were examined to pinpoint personality or emotional factors predictive of back injury reports in an industrial setting. Data were derived from a previous prospective-design study of back pain in volunteer hourly wage employees of an aircraft manufacturing company. After physical examination and completion of questionnaires pertaining to demographic, psychosocial (including the MMPI), and workplace factors, workers were followed for an average of 3 years. ⋯ Three Harris-Lingoes subscales showed significant relationships to the criterion. Hy-3: Lassitude/Malaise; Hy-1: Denial of Social Anxiety; and, marginally, Hy-2: Need for Affection, significantly contributed to prediction effectiveness. Results and implications for the understanding of factors predicting back injury reports and for the medical evaluation of pain and the concept of pain are discussed.
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Randomized Controlled Trial Clinical Trial
Persistent low-back pain is real. However, diagnostic spinal injections are not helpful in its evaluation.
We endeavored to assess the short-term effects of intrathecal fentanyl and lidocaine in chronic-pain patients by ascertaining whether the opioid fentanyl, by virtue of its lack of sensory and motor paralysis, conferred any diagnostic advantages over lidocaine, a local anesthetic whose effects include sensory and motor paralysis. Neuraxial administration of fentanyl has been touted as an improved diagnostic tool to distinguish between peripheral and central pain, because the absence of sensory and motor effects may avert the patient's presumption of the onset of analgesia based on these cues. Twenty-two patients with persistent low-back pain, whose investigations had determined that they were not surgical candidates, were studied using a counter-balanced, placebo-controlled, and double-blinded crossover design. ⋯ There were no significant differences in the baseline median-pain scores among injection types. The baseline and best cerebrospinal fluid-pain scores were significantly different, suggesting a placebo effect. The best pain scores for fentanyl and lidocaine were superior to their own baseline levels and to the best cerebrospinal fluid scores.(ABSTRACT TRUNCATED AT 250 WORDS)