The Clinical journal of pain
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Comparative Study
Effect of high-frequency vibration on experimental pain threshold in young women when applied to areas of different size.
The purpose of this study was to compare the effects of high-frequency vibration when applied to two areas of different size. Subjects were 30 right-handed Caucasian women, aged 19-38 years, with a negative history of upper extremity dysfunction. The experimental cutaneous pain threshold was determined by stimulating the skin over the pisiform bone on the palmar surface of the hand. ⋯ Results of the mixed design analysis of variance performed on the mean pain thresholds indicate that there was no significant main effect for group (size of area vibrated), p greater than 0.05, or interaction effect between group by trial (size of area vibrated and time of pain threshold measurement), p greater than 0.05. There was a significant main effect for trial (time of pain threshold measurement), p less than 0.001. Pain threshold values were greatest for both groups during the period of vibration.
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Because of the difficulty in applying psychiatric diagnostic nomenclature to the problem of pain in the medical setting, medical and surgical inpatients referred for a psychiatric consultation with pain as a presenting complaint (N = 167) are compared with "nonpain" patients (N = 1,634). "Pain" patients were more often male (p less than 0.05), had additional presenting problems of coping with their illness (p less than 0.0001), drug misuse and abuse (p less than 0.0001), and terminal illness (p less than 0.0001); evidenced less severity of psychiatric impairment (p less than 0.05); received different treatment recommendations; and were more likely to be assigned less frequently employed DSM-III psychiatric diagnoses than those most commonly found in consultation populations. However, these diagnoses were nonspecific for the problem of pain and provided minimal information about the nature of the pain. Enhancements of the diagnostic classification systems that would better address the nature of the psychiatric disorders associated with pain are presented.
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Comparative Study
Why do people seek medical advice for back pain: a comparison of consulters and nonconsulters.
Respondents with back pain who had answered affirmatively to the question about back pain in a population study were divided into two groups depending on whether they had consulted or had not consulted a physician due to their back pain. There were 17 nonconsulters and 37 consulters. ⋯ Based on the results, we found that the nonconsulters differed from the consulters on many issues but had nevertheless rated their constant level of pain on two different occasions as being equally severe on a graphic rating scale (GRS). The groups differed as follows: The nonconsulters rated their work to be more stressful; had less frequently a spouse suffering or having suffered from chronic pain; had fewer abnormal pain drawings; woke up less frequently during the night; used sleeping pills less frequently; participated more often in sports; and had a higher frequency of repression on the MCT compared to a group of painless subjects.
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Work and injury related musculoskeletal pain is often complicated by psychological and medicolegal factors that obscure the validity of the pain presentation. Pressure algometry and stretching during thiopentone sodium (Pentothal) anesthesia was studied in 45 cases of musculoskeletal injury. ⋯ In unilateral pain cases, a right to left pressure threshold difference of 2.0 kg/cm2 predicted 94% of true organic pain cases and 100% of cases at a pressure threshold of 1.5 kg/cm2 if combined with stretching. Results of stretching painful areas correlated highly with pressure threshold assessments.
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Randomized Controlled Trial Clinical Trial
Trial of intravenous lidocaine on painful neuropathy in cancer patients.
In 10 cancer patients with cutaneous allodynia, intravenous lidocaine (5 mg/kg body weight) or 0.9% NaCl was given in a double blind, cross-over study to determine the analgesic effect. One patient had complete and one had partial pain relief with lidocaine infusion, whereas three patients experienced partial pain relief with placebo. Neither lidocaine nor placebo reduced pain intensity or consumption of analgesics significantly during the study period. Intravenous infusion of lidocaine cannot be recommended as routine pain treatment in cancer patients with cutaneous allodynia or pain, but further studies are needed to test the effect of lidocaine on different peripheral stimuli.