The Clinical journal of pain
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A postal survey aimed at studying the prevalence of chronic pain and the need for care because of pain was carried out in a representative sample of a Swedish population. A random sample of the study population has been interviewed and assessed clinically to determine whether a questionnaire method gives the same results as clinical assessment. ⋯ By creating questions more independent of language habits and values, it was shown that it is possible to get better agreement between different descriptions. The best agreement was shown when answers to questions regarding different dimensions of pain were combined in a model for selecting individuals with more serious pain problems.
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The causes, diagnostic features, and therapy of chronic spinal arachnoiditis are reviewed. Two unexpected results from attempted epidural injections (one of lignocaine and clonidine, and one of lignocaine, clonidine, and morphine) in patients with this condition are described. The anatomical abnormalities of the epidural and subarachnoid spaces in such patients and the consequent unpredictable and potentially dangerous results that may follow drug injection into these spaces are discussed.
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Case Reports
Headache in acromegaly: dramatic improvement with the somatostatin analogue SMS 201-995.
Two acromegalic patients with severe headache, persisting after pituitary adenomectomy followed by radiotherapy in one, were treated with the somatostatin analogue SMS 201-995. Both had been resistant to conventional headache therapy and experienced dramatic and rapid relief after the first injection of the analogue. This result persisted with long-term treatment of the drug. Although the mechanism of action of SMS 201-995 in pain remains unclear, the rapid and efficacious analgesic effect of this compound may be one more indication for its use in pituitary tumors associated with cephalalgias.
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Assessment and treatment responses were compared in 17 subjects with chronic low back pain assessed as showing at least one clear consciously produced inconsistency in statements and/or behaviors during their participation in an interdisciplinary treatment program and 143 subjects assessed as showing no such inconsistency. Numerous statistically significant differences emerged: Inconsistent subjects were more likely to have pending litigation and to be assessed by staff as showing a higher degree of focus on pain and more dramatized complaints, lower levels of medical findings and attention and interest in treatment, and poor compliance with treatment and assessment procedures. ⋯ Though not definitive, these results suggested a syndrome of characteristics among such subjects which are similar to those proposed as likely characterizing malingerers. The need for a particularly careful validation of self-report data in patients showing many of these characteristics was emphasized.