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Items 1 - 24 of 24 |
One page. |
[Ilioinguinal and iliohypogastric nerves block for postoperative analgesia after appendicectomy]
[Article in French]
Dareau S, Bassoul B, Gros T, Delire V, Eledjam JJ.
Publication Types:
PMID: 15324970 [PubMed - indexed for MEDLINE]
Chronic postoperative pain: the case of inguinal herniorrhaphy.
Aasvang E, Kehlet H.
Section of Surgical Pathophysiology, The Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark.
PMID: 15531621 [PubMed - as supplied by publisher]
Palliative radiation therapy for painful vertebral metastases.
Gupta T, Sarin R.
Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India.
No abstract.
PMID: 15534882 [PubMed - as supplied by publisher]
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The analgesic and sedative effects of intrathecal midazolam in perianal surgery.
Yegin A, Sanli S, Dosemeci L, Kayacan N, Akbas M, Karsli B.
Akdeniz University Medical Faculty, Department of Anaesthesiology, Antalya, Turkey. ayegin@superonline.com
BACKGROUND AND OBJECTIVE: Our purpose was to evaluate the analgesic and sedative effects of intrathecal midazolam when added to spinal bupivacaine in patients undergoing perianal surgery under spinal anaesthesia. METHODS: Forty-four patients were randomly allocated into two equal groups: Group I (B) received hyperbaric bupivacaine 0.5% 2 mL + saline 0.9% 1 mL in a total volume of 3 mL intrathecally; Group II (BM) received hyperbaric bupivacaine 0.5% 2 mL + 1 mL of 2mg preservative-free midazolam in a total volume of 3 mL intrathecally. In both groups, the onset and recovery times of sensory block, the degree and recovery times of motor block as well as the sedation and visual analogue pain scores were recorded, and statistically compared. RESULTS: In Group BM, the postoperative visual analogue pain scores were significantly lower at the first 4 h (P < 0.05), the average time until the first dose of additional analgesic requirement was significantly longer (P < 0.05), and sedation scales were significantly higher (P < 0.05), compared to Group B. There were no statistically significant differences in the onset and the full recovery times of sensory and motor blocks in the two groups. CONCLUSION: The use of intrathecal midazolam combined with intrathecal bupivacaine produces a more effective and longer analgesia with a mild sedative effect in perianal surgery.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15473622 [PubMed - indexed for MEDLINE]
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Is intraperitoneal levobupivacaine with epinephrine useful for analgesia following laparoscopic cholecystectomy? A randomized controlled trial.
Ng A, Swami A, Smith G, Robertson G, Lloyd DM.
Leicester Royal Infirmary, University Department of Anaesthesia, Critical Care and Pain Management, Leicester, UK. anae@le.ac.uk
BACKGROUND AND OBJECTIVE: A randomized controlled trial of patients undergoing laparoscopic cholecystectomy. To evaluate whether the instillation of levobupivacaine, with epinephrine, intraperitoneally, reduces morphine consumption; further, to consider the degree of abdominal and shoulder pain in the presence of local anaesthetic at the site of surgical incision. METHODS: Patients received a standardized procedure and were allocated randomly to receive either (a) 2.5 mg mL(-1) levobupivacaine 30 mL, with epinephrine 5 microg mL(-1), or (b) normal saline 30 mL, with epinephrine 5 microg mL(-1), to the bed of the gall bladder and above the liver, immediately before wound closure. RESULTS: Median (interquartile range) total abdominal pain during inspiration in the levobupivacaine group was significantly (P = 0.041) lower (71 (21-129) mm) than that in the placebo group (123 (71-179) mm). However, there was no significant difference between the two groups with respect to total abdominal pain at rest, right shoulder pain or the consumption of rescue morphine and rescue dihydrocodeine. There were no differences between the two groups with respect to the administration of cyclizine, total nausea and total sedation scores. In addition, the number of episodes of vomiting was not significantly different. CONCLUSIONS: Intraperitoneal administration of levobupivacaine with epinephrine is associated with modest analgesia following laparoscopic cholecystectomy.
Publication Types:
PMID: 15473621 [PubMed - indexed for MEDLINE]
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Remifentanil provides better protection against noxious stimuli during cardiac surgery than alfentanil.
Heijmans JH, Maessen JG, Roekaerts PM.
University Hospital Maastricht, Department of Anaesthesiology, Maastricht, The Netherlands.
BACKGROUND AND OBJECTIVE: We hypothesized that remifentanil-propofol cardiac anaesthesia, plus administration of pirinitramide (piritramide) upon cessation of the remifentanil infusion, would be associated with a shorter time to tracheal extubation than alfentanil-propofol anaesthesia, without the occurrence of major haemodynamic instability. METHODS: Haemodynamic stability and recovery characteristics of two remifentanil infusion regimens (0.5 microg kg(-1)min(-1); 0.25 microg kg(-1)min(-1)) were therefore compared with an alfentanil infusion regimen (1 microg kg(-1)min(-1)), in combination with target-controlled infusion of propofol, in a randomized blinded trial in 75 coronary artery surgery patients. RESULTS: Pirinitramide provided good postoperative analgesia without prolonging extubation times: median extubation time in minutes after stopping the opioid-sedative drugs was 300 in the higher-dose remifentanil group and 270 in the lower-dose remifentanil group and alfentanil group (P = 0.606). Significant time-by-treatment interactions were seen for systolic arterial pressure (P = 0.015), mean arterial pressure (P = 0.009) and diastolic arterial pressure (P = 0.006). No significant interaction (P = 0.489) and no constant treatment effect were seen for heart rate (P = 0.288). Time effects were highly significant (P < 0.0001) for all haemodynamic variables. Heart rate remained stable in all groups. In the higher-dose remifentanil group, blood pressure was significantly different and lower during surgery and in this group less bolus doses of the opioid-sedative drugs (P = 0.015) had to be given. CONCLUSION: The higher-dose remifentanil infusion provided superior suppression of haemodynamic responses to noxious stimuli with better haemodynamic stability.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15473615 [PubMed - indexed for MEDLINE]
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Modification of attentional biases in chronic pain patients: a preliminary study.
Dehghani M, Sharpe L, Nicholas MK.
Department of Psychology, Clinical Psychology Unit F12, School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia.
Research suggests that chronic pain patients demonstrate cognitive biases towards pain-related information and that such biases predict patient functioning. This study examined the degree to which a successful cognitive-behavioural program was able to reduce the observed attentional bias towards sensory pain words. Forty-two patients with chronic pain conditions for more than three months were recruited prior to commencing a cognitive-behavioural pain management program. Participants were assessed before the program, after the program and at one-month follow-up. Results confirmed that chronic pain patients exhibited biased attention towards sensory pain-related words at pre-treatment. These biases were still evident at post-treatment, but were no longer statistically significant at follow-up. Multiple regression analyses indicated that the changes in attentional bias towards sensory words between post-treatment and follow-up were predicted by pre- to post-treatment changes in fear of movement (Tampa Scale for Kinesiophobia) but not other relevant variables, such fear of pain or anxiety sensitivity. These results demonstrate that successful cognitive-behavioural treatments can reduce selective attention, thought to be indicative of hypervigilance towards pain. Moreover, these biases appear to be changed by reducing the fear associated with movement. Theoretically, these results provide support for the fear of (re)injury model of pain. Clinically, this study supports the contention that fear of (re)injury and movement is an appropriate target of pain management and that reducing these fears causes patients to attend less to pain-related stimuli.
PMID: 15531227 [PubMed - in process]
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The role of the pain-evoked negative difference potential in dual-task response conflict.
Dowman R.
Department of Psychology, Clarkson University, Potsdam, NY 13699-5825, USA.
The possible role of the generators of the sural nerve pain-evoked negative difference potential (NDP), the anterior cingulate cortex and supplementary somatosensory area, in monitoring response conflict was investigated in 19 healthy adults. Each trial consisted of a visual arrow stimulus and a painful electrical stimulus applied to the sural nerve. The subjects determined whether their left or right sural nerve had been stimulated and whether the arrow was pointing to the left or to the right. The sural nerve pain detection task reaction times and response errors were greater in the incongruent condition, where the arrow pointed to the side opposite of that receiving the sural nerve pain, than in the congruent condition, where the arrow pointed to the same side as that receiving the sural nerve pain. Response conflict was greatest, therefore, in the incongruent condition. There were no differences in NDP amplitude across the congruent and incongruent conditions. These results argue against the hypothesis that the NDP generators are involved in monitoring response conflict.
PMID: 15531225 [PubMed - in process]
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Prevalence and characteristics of chronic pain in the general Norwegian population.
Rustoen T, Wahl AK, Hanestad BR, Lerdal A, Paul S, Miaskowski C.
Faculty of Nursing, Oslo University College, P.O. Box 4, St. Olavs Place , 0130 Oslo, Norway.
Background. Population-based studies suggest that prevalence of chronic pain is increasing. The purpose of this study was to determine the prevalence of chronic pain in a sample drawn from the general Norwegian population. In addition, the characteristics of chronic pain, as well as differences in demographic characteristics and health-related variables between persons with and without chronic pain were evaluated. Methods. A total of 4000 Norwegian citizens, were randomly drawn from the National Register, by Statistics Norway and were mailed a questionnaire. Results. The response rate was 48.5%. The majority of the sample was female (51%), married (59%), and working for pay (69%) with a mean age of 45.2 years. The prevalence of chronic pain in the total sample was 24.4%, and 65% of the participants with chronic pain indicated that they had experienced chronic pain for over 5 years. The cause of the pain was not specified by 57% of the participants in chronic pain, and 31% reported no pain treatments. Women, older individuals, persons with less education, and those who were pensioned, reported chronic pain more frequently. The results of a logistic regression analysis indicate that the variables that provide unique contributions to predicting pain group memberships were: gender, education, being frequently ill, or having a chronic illness. Conclusions. These findings suggest that chronic pain is a significant problem in the general Norwegian population, and that gender, education, being frequently ill, or having a chronic illness are important variables in predicting pain group membership.
PMID: 15531224 [PubMed - in process]
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Effects of the combined continuous administration of morphine and the high-efficacy 5-HT(1A) agonist, F 13640 in a rat model of trigeminal neuropathic pain.
Deseure KR, Adriaensen HF, Colpaert FC.
Laboratory of Anesthesiology, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium.
F 13640 is a recently discovered high-efficacy 5-HT(1A) receptor agonist that has demonstrated robust anti-allodynic efficacy in a rat model of trigeminal neuropathic pain upon acute and continuous administration. In this model, continuous morphine infusion (5 mg/day) was shown to be effective during the first week of its administration but became almost completely ineffective by the end of the second week; F 13640's effectiveness (0.63 mg/day) remained unchanged during two weeks. Here, we examined the effects of combining F 13640 infusion with that of morphine. During the first week, the combination of the two agents produced a magnitude of effect that was similar to that of morphine when given alone and larger than that of F 13640 alone. During the second week, the combination produced an effect that was similar to that of F 13640 alone, and more effective than that of morphine alone. The latter data suggest that the 5-HT(1A) agonist, F 13640, inhibits the development of tolerance to morphine in this model. However, it is also possible that little, if any, interaction occurred between the different mechanisms initiated by opioid and 5-HT(1A) receptor activation, and that the anti-allodynic effect that remained by the end of the two-week treatment period is due solely to 5-HT(1A) receptor activation. The stable effects of F 13640 during the second week of treatment surpassed those of morphine and were not improved by the addition of morphine to F 13640.
PMID: 15531223 [PubMed - in process]
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Efficacy of coeliac plexus and splanchnic nerve blockades in body and tail located pancreatic cancer pain.
Suleyman Ozyalcin N, Talu GK, Camlica H, Erdine S.
Department of Algology, Istanbul Medical Faculty, Istanbul University, Capa Klinikleri, 34390 Istanbul, Turkey.
Palliative treatment, pain therapy and quality of life (QOL) are very important in pancreatic cancer patients. We evaluated the pain relieving efficacy, side effects and effects on QOL of neurolytic coeliac plexus blockade (NCPB) and splanchnic nerves neurolytic blockade (SNB) in body and tail located pancreatic cancer. The study protocol was approved by the local ethics committee. Patients were randomly divided into two groups. Coeliac group; GC, [Formula: see text] were treated with coeliac plexus blockade, whereas the patients in splanchnic group; GS, [Formula: see text] were treated with bilateral splanchnic nerve blockade. The VAS values, opioid consumption and QOL (Patient satisfaction scale=PSS, performance status scale=PS) were evaluated prior to the procedure and at 2 weeks intervals after the procedure with the survival rates. The demographic features were found to be similar. The VAS differences (difference of every control's value with baseline value) in GS were significantly higher than the VAS differences in GC on every control meaning that VAS values in GS decreased more than the VAS values in GC. GS patients were found to decrease the opioid consumption significantly more than GC till the 6th control. GS patients had significant improvement in PS values at the first control. The mean survival rate was found to be significantly lower in GC. Two patients had severe pain during injection in GC and 5 patients had intractable diarrhoea in GC. Comparing the ease, pain relieving efficacy, QOL-effects of the methods, splanchnic nerve blocks may be an alternative to coeliac plexus blockade in patients with advanced body and tail located pancreatic cancer.
PMID: 15531222 [PubMed - as supplied by publisher]
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Plasma endothelin-1 levels in patients with complex regional pain syndrome.
Eisenberg E, Erlich T, Zinder O, Lichinsky S, Diamond E, Pud D, Davar G.
Pain Relief Unit, Rambam Medical Center, Technion - Israel Institute of Technology, P.O.B. 9602, Haifa 31096, Israel.
The clinical characteristics of complex regional pain syndrome (CRPS) - spontaneous and stimulus-evoked pain, autonomic abnormalities, motor dysfunction, and trophic changes in the affected limb - are well known. However, its pathogenesis is unclear, and the diagnosis is often delayed, in part due to lack of objective laboratory tests. Endothelin-1 (ET-1) is a potent vasoconstrictor that has recently been shown to produce pain, allodynia, edema, and muscle weakness, as well as to exert a direct excitatory effect on nociceptive afferents. Furthermore, new evidence indicates that ET-1 is involved in various cancer- and non-cancer-related painful conditions. The aim of the present explorative study was to determine the ET-1 plasma levels in patients with CRPS in an attempt to identify a `laboratory marker' for CRPS and to search for evidence suggesting that ET-1 may be involved in the pathogenesis of CRPS. ET-1 plasma levels were determined in 20 severely affected CRPS patients, in eight patients with non-CRPS chronic painful conditions, and in 10 healthy volunteers. The results showed that there were no significant differences in ET-1 plasma levels between the three groups. We conclude that the plasma level of ET-1 cannot be regarded as a `marker' for CRPS. Yet, the possibility that ET-1 is involved in the pathophysiology of CRPS has not been excluded and deserves further investigation.
PMID: 15531221 [PubMed - as supplied by publisher]
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Cognitive bias in back pain patients attending osteopathy: testing the enmeshment model in reference to future thinking.
Read J, Pincus T.
AL2 Ward, Maudsley Hospital, Denmark Hill, London SE5 8AZ, UK.
Background: Depressive symptoms are common in chronic pain. Previous research has found differences in information-processing biases in depressed pain patients and depressed people without pain. The schema enmeshment model of pain (SEMP) has been proposed to explain chronic pain patients' information-processing biases. Negative future thinking is common in depression but has not been explored in relation to chronic pain and information-processing models. Objectives: The study aimed to test the SEMP with reference to future thinking. Methods: An information-processing paradigm compared endorsement and recall bias between depressed and non-depressed chronic low back pain patients and control participants. Twenty-five depressed and 35 non-depressed chronic low back pain patients and 25 control participants (student osteopaths) were recruited from an osteopathy practice. Participants were asked to endorse positive and negative ill-health, depression-related, and neutral (control) adjectives, encoded in reference to either current or future time-frame. Incidental recall of the adjectives was then tested. Results: While the expected hypothesis of a recall bias by depressed pain patients towards ill-health stimuli in the current condition was confirmed, the recall bias was not present in the future condition. Additionally, patterns of endorsement and recall bias differed. Discussion: Results extend understanding of future thinking in chronic pain within the context of the SEMP.
PMID: 15531220 [PubMed - in process]
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Health care utilisation among individuals reporting long-term pain: an epidemiological study based on Danish National Health Surveys.
Eriksen J, Sjogren P, Ekholm O, Rasmussen NK.
Multidisciplinary Pain Centre, H:S Rigshospitalet, Dept. 7612, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
Individuals reporting long-term pain in the 1994 and 2000 Danish Health and Morbidity Surveys, which included random samples of 6000 and 16,684 persons respectively, were investigated concerning their use of the health care systems. A considerably higher use was observed in the pain population in the primary as well as the secondary health care sector, compared with a no pain control group. In 1994, individuals reporting long-term pain had on average 12.8 contacts per year to the primary health care sector compared with 7.3 for the control group. Use of secondary health care sector as estimated by hospital admission frequency and number of in-hospital days was not only significantly higher for the pain group but showed also an increasing tendency during the periods investigated (1991-1997). Women used the health care system significantly more than men, whereas age did not seem to influence. In conclusion, individuals reporting long-term/chronic pain have a significantly higher use of the health care system than individuals without long-term/chronic pain complaints. Reasons may be ascribed to within-patient factors, factors within the health care system (insufficient knowledge on chronic pain resulting in the seeking after a somatic diagnosis, and difficulties in recognizing the endpoint of reasonable treatment attempts), and societal factors (legislation on disability and compensation).
PMID: 15531219 [PubMed - in process]
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Factor structure and psychometric properties of the Pain Anxiety Symptoms Scale-20 in a community physiotherapy clinic sample.
Coons MJ, Hadjistavropoulos HD, Asmundson GJ.
Department of Psychology, University of Waterloo, Waterloo, Ont., Canada.
The PASS-20 was developed to assess pain-related anxiety among a variety of pain populations. This measure was constructed by extracting 20 items from its 40-item parent measure (PASS). Initial studies of the PASS-20 suggest that the psychometric properties have been preserved. The purpose of the present study extended this research and explored the factor structure of the PASS-20, and its reliability and validity in a sample of pain patients receiving treatment in a community physiotherapy clinic. Patients with current pain [Formula: see text] were asked to complete a battery of self-report measures related to the experience of pain on two separate occasions (3-month interval). Results of principal components analyses suggested that a 4-factor solution representing fear of pain, escape-avoidance, physiological symptoms, and cognitive symptoms of anxiety provided the best fit to these data. Results also showed that the total and subscale scores of the PASS-20 have good reliability (internal consistency, test-retest) and validity (construct) correlating greater with other conceptually similar measures than distinct constructs. These results suggest that this measure has good utility for both clinical and research applications. Directions for future evaluation are also discussed.
PMID: 15531218 [PubMed - in process]
Utilization of early invasive management strategies for high-risk patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative.
Bhatt DL, Roe MT, Peterson ED, Li Y, Chen AY, Harrington RA, Greenbaum AB, Berger PB, Cannon CP, Cohen DJ, Gibson CM, Saucedo JF, Kleiman NS, Hochman JS, Boden WE, Brindis RG, Peacock WF, Smith SC Jr, Pollack CV Jr, Gibler WB, Ohman EM; CRUSADE Investigators.
Cleveland Clinic Foundation, Department of Cardiovascular Medicine/Desk F25, Cleveland, Ohio 44195, USA. bhattd@ccf.org
CONTEXT: The American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the management of non-ST-segment elevation acute coronary syndromes (NSTE ACS) recommend early invasive management for high-risk patients, given the benefits with this approach demonstrated in randomized clinical trials. OBJECTIVES: To determine the use and predictors of early invasive management strategies (cardiac catheterization <48 hours following presentation) in high-risk patients with NSTE ACS and to examine the association of early invasive management with mortality. DESIGN, SETTING, AND PATIENTS: The CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) Quality Improvement Initiative evaluated care patterns and outcomes for 17,926 high-risk NSTE ACS patients (positive cardiac markers and/or ischemic electrocardiographic changes) based on ACC/AHA guidelines recommendations at 248 US hospitals with catheterization and revascularization facilities between March 2000 and September 2002. MAIN OUTCOME MEASURES: Use of early invasive management within 48 hours of presentation, predictors of early invasive management, and in-hospital mortality. Results Of the 17,926 patients analyzed, 8037 (44.8%) underwent early cardiac catheterization less than 48 hours following presentation. Predictors of early invasive management included cardiology care, younger age, lack of prior or current congestive heart failure, lack of renal insufficiency, ischemic electrocardiographic changes, positive cardiac markers, white race, and male sex. Patients treated with early invasive management were more likely to be treated with medications and interventions recommended by the ACC/AHA guidelines and had a lower risk of in-hospital mortality after adjusting for differences in clinical characteristics and after comparing propensity-matched pairs (2.5% vs 3.7%, P<.001). Conclusions An early invasive management strategy is not utilized in the majority of high-risk patients with NSTE ACS. This strategy appears to be reserved for patients without significant comorbidities and those cared for by cardiologists and is associated with a lower risk of in-hospital mortality.
PMID: 15523070 [PubMed - indexed for MEDLINE]
Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 34-2004. A 45-year-old man with recurrent pain in the right flank and hematuria.
Dahl DM, Mueller PR, Young RH.
Department of Urology, Massachusetts General Hospital, USA
Publication Types:
- Case Reports
- Clinical Conference
PMID: 15537909 [PubMed - in process]
Autoimmune etiology of complex regional pain syndrome (M. Sudeck).
Blaes F, Schmitz K, Tschernatsch M, Kaps M, Krasenbrink I, Hempelmann G, Brau ME.
Department of Neurology, Justus-Liebig-University, Am Steg 14, 35385 Giessen, Germany. franz.blaes@neuro.med.uni-giessen.de
Sera of 12 patients with complex regional pain syndrome (CRPS) were tested for the occurrence of autoantibodies against nervous system structures. Immunohistochemistry revealed autoantibodies against autonomic nervous system structures in 5 of 12 (41.6%) of the patients. Western blot analysis showed neuronal reactivity in 11 of 12 (91.6%) patients. The authors hypothesize that CRPS can result from an autoimmune process against the sympathetic nervous system.
PMID: 15534271 [PubMed - in process]
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Post-surgical neuralgia.
Eisenberg E.
Pain Relief Unit, Rambam Medical Center, Haifa Pain Research Group, The Technion, Israel Institute of Technology, P.O. Box 9602, Haifa 31096, Israel. e_eisenberg@rambam.health.gov.il
Publication Types:
PMID: 15327802 [PubMed - indexed for MEDLINE]
The effect of previous low back surgery on general health status: results from the National Spine Network initial visit survey of patients with low back pain.
Hee HT, Whitecloud TS 3rd, Myers L.
Tulane University Medical Center, New Orleans, LA, USA. hwantak@hotmail.com
STUDY DESIGN: A cross-sectional study on 18,325 patients with back pain enrolled at first visit in the National Spine Network (NSN) database from January 1998 to April 2000. OBJECTIVES: To examine whether patients who had previous low back surgeries had poorer general health status than patients with no surgery. SUMMARY OF BACKGROUND DATA: Several studies have described the role of psychological abnormalities in patients with chronic low back pain. Some of these patients have had previous spinal surgeries performed. No study has examined the effects of previous low back surgery on the general health status. METHODS: The Short Form Health Survey 36 was administered to the initial visit NSN patients. Of the 18,325 patients enrolled, 3,632 had previous low back surgeries. RESULTS: Patients who had previous lumbar surgeries fared significantly poorly in all 10 scores of the SF-36 health survey, even after adjustment for confounding factors. Among these patients, decompression achieved significantly higher scores for General Health, Role-Physical, and Mental Component Summary scales. Patients who had decompression as their most recent surgery had higher scores for General Health, Role-Physical, Role-Emotional, and Mental Component Summary scales, when compared to those who had other surgeries. Patients who had instrumentation as their most recent surgery had higher scores for Bodily Pain and Physical Component Summary scores. There is a positive correlation between time since last surgery and the SF-36 outcomes. CONCLUSIONS: Previous back surgery is associated with significantly worse general health status than those without surgery. Among patients who had previous surgeries, decompression seems to exert better effects on SF-36 health status. There is a positive correlation between time since last surgery and the SF-36 outcomes, although the SF-36 scores are significantly lower than those without previous surgery.
PMID: 15534419 [PubMed - in process]
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The core outcomes for neck pain: validation of a new outcome measure.
White P, Lewith G, Prescott P.
Complementary Medicine Research Unit, University of Southampton, Aldermoor Health Centre, Southhampton, United Kingdom. P.J.White@soton.ac.uk
STUDY DESIGN: Patients enrolled in a randomized controlled trial were asked to complete various questionnaires, which were then compared to establish validity for a new neck pain questionnaire. OBJECTIVES: To validate a new and brief outcome measure for use with patients with mechanical neck pain. SUMMARY OF BACKGROUND DATA: Neck pain is a very common problem and one that clinicians will be required to treat with some regularity. In today's climate of evidence-based practice and the need to quantify and justify clinical intervention, a quick and easy method to evaluate progress is required. Such a measure has already been produced for those experiencing back pain, but as yet, there is no such measure for neck pain and this needs to be addressed. METHODS: The back pain measure was adapted to enable its use with patients with neck pain. Repeatability was assessed by using a 1-week test/retest on 104 patients who were enrolled in a neck pain trial. Validity was assessed by comparing the new questionnaire against other already well validated measures (i.e., the Neck Disability Index and a Visual Analogue Scale for pain) with 133 patients. RESULTS: The test/retest showed excellent repeatability with high intraclass correlations and P < 0.001 for each question tested. The Core Neck Pain Questionnaire also showed good validity, giving close agreement to the other comparison measures. CONCLUSION: The short Core Neck Pain Questionnaire has been demonstrated to be repeatable and valid as a brief outcome measure for use with patients with mechanical neck pain.
PMID: 15534418 [PubMed - in process]
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Quality of primary care guidelines for acute low back pain.
van Tulder MW, Tuut M, Pennick V, Bombardier C, Assendelft WJ.
Institute for Research in Extramural Medicine (EMGO), VU University Medical Center, Amsterdam, The Netherlands. mw.van_tulder.emgo@med.vu.nl
STUDY DESIGN: Systematic review of clinical guidelines. OBJECTIVES: To assess the methodologic quality of existing guidelines for the management of acute low back pain. SUMMARY OF BACKGROUND DATA: Guidelines are playing an increasingly important role in evidence-based practice. After publication of the Quebec Task Force in Canada in 1987 and the Agency for Health Care Policy and Research guidelines in the United States in 1994, guidelines for acute low back pain were developed in many other countries. However, little is known about the methodologic quality of these guidelines. METHODS: Guidelines were selected by electronically searching MEDLINE and the Internet and through personal communication with experts in the field of low back pain research in primary care. The methodologic quality of the guidelines was assessed by two authors independently using the AGREE instrument. RESULTS: A total of 17 guidelines were included. Overall, the quality of reporting of guidelines was disappointing. Most guidelines clearly described the aim of the guideline and its target population, and most guideline development committees were multiprofessional. However, many other methodologic flaws were identified. More than half of the guidelines did not take patients' preferences into account, did not perform a pilot test among target users, did not clearly describe the methods of study identification and selection, did not include an external review, did not provide a procedure for updating, were not supported with tools for application, did not consider potential organizational barriers and cost implications, did not provide criteria for monitoring and audit, did not include recommendations for implementation strategies, and did not adequately record editorial independence and conflict of interest of the members. The diagnostic and therapeutic recommendations of the guidelines were largely similar. CONCLUSIONS: The quality and transparency of the development process and the consistency in the reporting of primary care guidelines for low back pain need to be improved.
PMID: 15534397 [PubMed - in process]
Effectiveness and safety of oral extended-release oxymorphone for the treatment of cancer pain: a pilot study.
Sloan P, Slatkin N, Ahdieh H.
University of Kentucky Medical Center, 800 Rose St., Suite N212, KY 40536, Lexington, USA.
GOALS OF WORK. Inadequate analgesia and/or unmanageable adverse events frequently result in the need to rotate patients with cancer pain to a different opioid. The availability of a novel oral extended-release (ER) formulation of oxymorphone provides clinicians with another treatment option. In this study, we assessed the analgesic effectiveness and safety of the new oral ER formulation of oxymorphone following treatment with controlled-release (CR) morphine sulfate or oxycodone. PATIENTS AND METHODS. Adults with moderate to severe cancer pain were stabilized for >/=3 days on morphine CR or oxycodone CR, and then treated for 7 days at their stabilized dose. Drug selection was based upon patients' previous use or investigator preference. Patients were then crossed over for 7 days of treatment at an estimated equianalgesic dosage of oxymorphone ER. Pain was assessed using a visual analog scale, and adverse events were recorded. MAIN RESULTS. A total of 86 patients entered open-label treatment. Of 34 patients assigned to morphine CR and 52 assigned to oxycodone CR, 21 (61.8%) and 42 (80.8%) completed stabilization and began treatment with oxymorphone ER, respectively; 59 of 63 (93.7%) completed treatment with oxymorphone. There were no significant differences in daily pain intensity scores between oxymorphone ER and comparators (paired t -test). Rescue medication use, expressed as the percent of the daily dose of scheduled opioid, was greater during morphine CR treatment than after crossover to oxymorphone ER (25.2% vs 13.3%; P <0.05, Wilcoxon's test). The tolerability/safety profiles (e.g., nausea, drowsiness, somnolence) were similar for all opioids. CONCLUSIONS. Cancer patients stabilized on morphine CR or oxycodone CR were safely and rapidly converted to a lower milligram dose of oxymorphone ER that provided adequate pain relief with comparable tolerability. These results justify additional trials with oxymorphone ER.
PMID: 15538638 [PubMed - as supplied by publisher]
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Differences in physician-reported practice in palliative sedation therapy.
Morita T.
Seirei Hospice, Seirei Mikatabara Hospital, 3453 Mikatabara-cho, Hamamatsu, Shizuoka 433-8558, Japan. seireihc@jt6.so-net.ne.jp
BACKGROUND: Although palliative sedation therapy is often required in terminally ill cancer patients, little is known about actual practice. The aims of this study were to clarify the physician-reported sedation practices and the factors influencing the sedation rates. METHODS: A questionnaire was sent to 105 representative physicians of all certified palliative care units in Japan. A total of 81 responses were analyzed (effective response rate, 80%). RESULTS: The prevalence of continuous-deep sedation for physical symptoms was <10% in 33 institutions (41%), 10-50% in 43 institutions (53%), and >50% in 5 institutions (6.2%). The prevalence of continuous-deep sedation for psychoexistential suffering was 0% in 52 institutions (64%), 0.5-5% in 26 institutions (32%) and more than 10% in 3 institutions (3.6%). Continuous-deep sedation was more frequently performed by physicians who did not believe clear consciousness was necessary for a good death, who did not believe that sedation often shortened patient life, who worked with nurses specializing in cancer/palliative care, who judged the symptoms as refractory without actual trials of treatments, who performed continuous sedation first rather than intermittent sedation, and who used phenobarbitones frequently. CONCLUSIONS: Physician-reported practice in palliative sedation therapy varied widely among institutions. The differences were mainly associated with the physicians' philosophy about a good death, physicians' belief about the effects of sedation on patient survival, and physicians' medical practice. Discussion should be focused on these divergent areas, and clear clinical guidelines are urgently needed to provide valid end-of-life care.
PMID: 14991486 [PubMed - indexed for MEDLINE]
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