Pain practice : the official journal of World Institute of Pain
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The cold pressor task (CPT) was originally developed as a clinically indicative cardiovascular test, and quantifies vascular response and pulse excitability when a subject's hand is immersed into ice water. Since the test procedure results in a gradually increasing cold pain, the CPT has been widely used as a nociceptive stimulus in experimental studies on adults and children. ⋯ Consistent with previous findings, regression analysis reveals that age is significantly associated with pain tolerance. The CPT procedure shows excellent 2 week test-retest stability to assess pain threshold and pain tolerance within a student population.
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Chronic pain conditions are highly prevalent, with somatoform pain disorder accounting for a large proportion. However, the psychological forms of treatment currently used achieve only small to medium effect sizes. This retrospective study investigated the effectiveness of a 5-week multimodal pain program for patients with somatoform pain disorder. ⋯ The lowest effect sizes were found for improvement of pain-related disabilities (PDI: d = 0.42) and sensory items of the Pain Perception Scale (SES-S: d = 0.50). Despite high chronification of pain condition, with average pain duration of greater than 8 years, the multimodal treatment program showed medium to large effect sizes on the outcome of patients with somatoform pain disorder. Compared with previous data with small to moderate effect sizes, a multimodal program seems to be more effective than other interventions to address somatoform pain disorder.
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A subcostal transversus abdominis plane (TAP) phenol injection was performed on a patient with refractory cancer pain due a metastatic involvement of the abdominal wall. A diagnostic block with local anesthetic was performed under ultrasound guidance (USG), resulting in a decrease of 80% and 100% in dynamic and static visual analog scale (VAS) for pain, respectively, for 20 hours. ⋯ TAP blocks offer an interesting tool for either diagnosis or therapeutic purpose in chronic pain management. USG provides an optimal approach to soft-tissue lesions where fluoroscopy techniques are not useful.
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Neuropathic pain is a serious chronic condition strongly affecting quality of life, which can be relieved but cannot be cured. Apart from symptomatic management, treatment should focus on the underlying disorder. The estimated prevalence is at least 1% to 5% of the general population. ⋯ Ancillary investigations may include EMG and computerized tomography/magnetic resonance imaging scans, depending on the localization of the suspected lesion. A limited number of agents, primarily directed at symptom control, are currently approved for use in neuropathic pain. A mechanism-based approach to pharmacological intervention supports the use of polypharmacy in neuropathic pain.
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Comparative Study Observational Study
The Comparison of Two Analgesic Regimes after Ambulatory Surgery: An Observational Study.
Over the past 15 years, the number of ambulatory surgical procedures worldwide has increased continuously. Studies show that 30% to 40% of the patients experience moderate-to-severe pain in the first 48 hours. The objective of this observational study is to compare the percentage of moderate-to-severe pain, side effects, and the use of escape medication of two different analgesic regimes after ambulatory surgery. ⋯ A total of 375 patients participated in the study, of which 99 in the tramadol group and 138 in the combination tablet tramadol/paracetamol group. The percentage of patients with moderate-to-severe postoperative pain was 25% to 40%. In both the groups, an equal percentage of patients experienced moderate-to-severe postoperative pain. Both analgesic regimes have a comparable analgesic effectiveness with each with its own specific advantages and disadvantages. On the first day after surgery, patients with the tramadol/paracetamol regime experienced more side effects (drowsiness and nausea) were less therapy compliant, but needed a smaller amount of escape medication than the patients from the tramadol group.