Showing papers in "The Clinical Journal of Pain in 1995"
2,666 citations
TL;DR: The reliability of comparative blocks of the medial branches of the cervical dorsal rami in the diagnosis of cervical zygapophysial joint pain was evaluated to find that, when diagnostic certainty is critical, such as in a medicolegal context or when surgical intervention is contemplated, placebo-controlled blocks are recommended.
Abstract: Background:The development of target-specific local anesthetic blocks has enabled pain physicians to explore the anatomical source of chronic spinal pain. However, such blocks rely on subjective responses and may be subject to the placebo effect. Comparative local anesthetic blocks have been advocat
276 citations
TL;DR: This study validated a measure entitled the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) for assessing the attitudes and beliefs of health care providers about functional expectation for chronic low back pain patients and suggested that HC-PAirS can be used to measure health care provider' attitudes and belief about the degree to which chronic lowBack pain justifies impairments and disability.
Abstract: :Objective: This study validated a measure entitled the Health Care Providers' Pain and Impairment Relatinship Scale (HC- PAIRS) for assessing the attitudes and beliefs of health care providers about functional expectation for chronic low back pain patients. HC-PAIRS was developed by modifyi
158 citations
TL;DR: The findings suggest that memory complaints are higher in patients with chronic pain than in medical/dental or psychotherapy patients and not only to depression but also to the presence of chronic pain.
Abstract: ObjectiveIn clinical practice, patients with chronic pain frequently report problems with memory functioning. This issue, however, has received little attention in the scientific literature. The present study was designed to investigate this common problem and to stimulate research interest in this
123 citations
TL;DR: In the population and with the technique of insertion and care reported here, the use of externalized tunneled intrathecal catheters has not been associated with higher rates of complications and therefore should not be used for durations of intratheCal pain treatment of > 1 week.
Abstract: ObjectiveTo test the concept that externalized tunneled intrathecal catheters lead to a high risk of complications, such as meninigitis and epidural abscess, and therefore should not be used for durations of intrathecal pain treatment of > 1 week.DesignProspective, cohort, nonrandomized, con
113 citations
TL;DR: Correlations showed that patients with greater social desirability response bias reported less depression and anxiety but higher levels of pain severity, suggesting that social desIRability response biases should be considered in both research and clinical assessments of chronic pain patients.
Abstract: Objective: To examine the relationship between social desirability and self- report in data collected from chronic pain patients. Setting: A multidisciplinary pain management center located in a major university medical center. Patients: Two hundred persons presenting with chronic pain, including low back, head/neck, and extremity pain. Measures: Marlowe-Crowne Social Desirability Scale, Beck Depression Inventory—Short Form, Spielberger Trait Anxiety Inventory, Psychosomatic Symptom Checklist, McGill Pain Questionnaire, Pain Disability Index, Quality of Life Scale, Pain Drawing. Results and Conclusions: Correlations showed that patients with greater social desirability response bias reported less depression and anxiety but higher levels of pain severity. When depression effects were controlled in a regression analysis, social desirability correlated positively with self-reported disability. These results show systematic response patterns associated with social desirability, suggesting that social desirability response biases should be considered in both research and clinical assessments of chronic pain patients.
111 citations
TL;DR: The results of the reviewed studies support the potential importance of the “secondary gain” concept to understanding illness behavior and underscore a need for future research in this area.
Abstract: The “secondary gain” concept originated in the psychoanalytic literature, where it was never vigorously examined. The purpose of this review is to determine if there are scientific studies that have explored the validity of this concept.DesignA computer and manual literature review yielded 166 refer
95 citations
79 citations
TL;DR: Epidurography might confirm epidural filling defects for contrast dye in the patients with epidural fibrosis, and a more direct visualization of the resulting functional changes after adhesiolysis as with epiduroscopy might be useful.
Abstract: ObjectivePain treatment in the chronic failed back surgery patient remains problematic. Defining the pathogenesis of the pain could be helpful in treatment. The assumption that epidural fibrosis and adhesions might play an important role in the origin of the pain is verified.DesignWe investigated 34
78 citations
TL;DR: The data suggest that interventions which involve coping-skills training or self-control management of pain may be affected by an abuse history via reduced perceptions of efficacy, resourcefulness, and beliefs that external variables are responsible for pain.
Abstract: OBJECTIVE: We investigated the association of physical/sexual abuse to pain description, coping, psychological distress, and health-care utilization in a heterogeneous sample of chronic pain patients. DESIGN: A cross-sectional, retrospective design was used. Patients were categorized as abused (n = 22) or nonabused (n = 58) based on responses to a valid and reliable sexual/physical abuse questionnaire. MAIN OUTCOME MEASURES: Pain description (Visual Analog Scale measures of pain intensity and frequency, and the McGill Pain Questionnaire); coping ability and attributional style (Functional Interference Estimate, Self-Control Schedule, Pain Locus of Control Scale); psychological distress (SCL-90-R Global Severity Index); and a Health-care utilization measure. RESULTS AND CONCLUSIONS: No differences between abused and nonabused groups were found for the pain description or functional interference variables. Compared to the nonabused group, the abused group had significantly lower Self-Control Schedule scores, higher Pain Locus of Control Scale Chance Factor scores, and higher SCL-90-R Global Severity Index scores and was more likely to use the emergency room for pain symptoms. These results replicate the findings of previous studies of the effects of abuse in more specific pain samples and underscore the importance of assessment of abuse in patients with chronic pain. The data suggest that interventions which involve coping-skills training or self-control management of pain may be affected by an abuse history via reduced perceptions of efficacy, resourcefulness, and beliefs that external variables are responsible for pain. Language: en
75 citations
TL;DR: Pretreatment to 3-month follow-up changes in beliefs and coping are associated modestly with TMD patient improvement after conservative dental treatment with and without a brief cognitive-behavioral intervention.
Abstract: :Objective:This study examined the applicability of the cognitive-behavioral model for temporomandibular disorders (TMD) by determining whether changes in TMD patient pain-related beliefs and coping over the course of treatment related to improvement in symptoms and disability and whether pa
TL;DR: There was a significantly better short-term and long-term pain relief in patients with a clearly localized pain that was confined to one or two thoracic segmental levels, compared to patients with more than two segmentsal levels involved in the pain syndrome.
Abstract: :Object: To evalate the effectiveness of a radiofrequency lesion adjacent to the dorsal root ganglion (RF-DRG) On a consecutive group of patients presemtomg wotj chronic thoracic pain.Design: Retrps[ectove stid by a disinterested third party.Setting: Clinical outcome study.Patients: Forty- t
TL;DR: The results indicate that the CSQ is a reliable measure for the study of pain-coping strategies used in this population, and one that relates to differences reported in the experience of pain.
Abstract: ObjectiveThe first goal of the study was to determine the internal reliability of the Coping Strategies Questionnaire (CSQ) in young adults. The second goal was to examine the relation of the CSQ to reported pain levels. The third goal was to investigate the relationship between the CSQ and concomit
TL;DR: Insight is provided into the cues parents use to assess pain in their children and serves as a foundation for future studies on parents' assessment of children's pain.
Abstract: Objective: Very little is known about the cues parents use to assess pain in their children. This study has described the cues (verbal and nonverbal) parents reported using to determine how their children felt following surgery. Design and Subjects: The subjects were 176 parents of children undergoing short-stay or day surgery. Using pain diaries, parents were asked to provide written responses to the question Did your child give you any clues on how they were feeling? for the day of surgery and 2 days after their children's surgery. Parents also provided ratings of their children's pain five times per day using a visual analogue scale. Setting: The study was conducted at a tertiary care children's hospital. Results and Conclusions: Parents frequently cited using verbal report and appetite as cues to how their children were feeling. A variety of other cue types were also reported by parents, including activity level, sleep quality, visible/ audible discomfort, and physiological observations. Cue types were not significantly related to the child's gender, and only one cue type was significantly related to the child's age (appetite was used more often for older children than younger children). The presence or absence of illness behavior cues (e.g., protective behavior, visible/audible discomfort) as well as disruptions to normal behavior pattern cues (e.g., sleep, level of activity) was related, in the expected direction, to the pain intensity ratings. This study provides insights into the cues parents use to assess pain in their children and serves as a foundation for future studies on parents' assessment of children's pain.
TL;DR: ZSDS items describing symptoms which could be a consequence of the pain problem (e.g., sleep problems) are clearly related more to pain severity than other indicators of depression—e.G., feelings of hopelessness.
Abstract: Objective:To analyze how the cognitive, affective, and somatic-vegetative symptoms of depression included in the modified Zung Self-Rating Depression Scale (ZSDS) relate to pain severity.Subjects:Three groups of subjects were compared. The “no pain” group (n = 64) reported no musculoskeletal symptom
TL;DR: Continuous epidural blockade for patients with acute zoster can shorten the duration of treatment and may reduce the incidence of postherpetic neuralgia.
Abstract: Objective:The purpose of this study was to investigate the effects of continuous epidural blockade on acute zoster-associated pain, compared with intermittent epidural blocks.Design:The design was a retrospective, nonrandomized study.Setting:The study was conducted at a university hospital in Japan
TL;DR: The inadequate response to pain programs shown by Workers' Compensation recipients may be partly understood in terms of well-defined mediating factors, which may admit to amelioration via clinical intervention.
Abstract: Objective: To determine whether the tendency for chronic pain patients who receive Workers' Compensation to show a poorer response than noncompensated patients to pain treatment can be accounted for by mediating factors; to assess whether moderating factors can distinguish subgroups of Workers' Compensation recipients who react very poorly to treatment from compensated patients who respond well. Design: Outcome study based on archives. Setting: Multidisciplinary pain treatment center. Patients: Of 214 patients, 158 had complete data. Outcome Measure: Blind ratings of narrative discharge summaries written by the Pain Treatment Center staff. Results: A significant negative relationship between receiving Workers' Compensation and outcome was mediated by a pessimistic belief in the ability to return to former occupation. Moderator effects showed that Workers' Compensation recipients with high initial pain and a history of pain-related surgery fared worse than any other group. Moreover, Workers' Compensation recipients not characterized by high pain and a history of surgery responded as well as noncompensated patients. Conclusions: The inadequate response to pain programs shown by Workers' Compensation recipients may be partly understood in terms of well-defined mediating factors, which may admit to amelioration via clinical intervention. Moreover, Workers' Compensation patients should not be considered high risks for failure by sole virtue of their compensation status. Multifactor assessment methods may be needed to identify that portion of compensation recipients who are actually at appreciable risk for treatment failure so that appropriate adjustments in treatment regimen may be made.
TL;DR: Patients with left-sided pain had higher MMPI scores for hysteria and hypochondriasis and also had higher scores on the physical dimension of the SIP, consistent with the hypothesis that unilateral stimulation activates the contralateral cerebral hemisphere and arouses the emotions associated with that hemisphere.
Abstract: Objective: To test the neuropsychological hypothesis that left-sided pain will have more adverse consequences than right-sided pain by virtue of activation of the depressogenic right hemisphere. Design: A retrospective analysis comparing data of chronic pain patients with left-sided pain to patients with right-sided pain. Patients: All of the right-handed patients (n = 85) presenting with unilateral shoulder, arm, and hand pain and suspected of having Thoracic Outlet syndrome (TOS) were assessed as potential candidates for surgery at the Toronto Western Hospital Pain Investigation Unit over a 5-year period. Outcome Measures: Minnesota Multiphasic Personality Inventory (MMPI), SIP (Sickness Impact Profile). Results: Contrary to the intuitive expectation that right-sided pain would be more disruptive in right-handed subjects, patients with left-sided pain had higher MMPI scores for hysteria and hypochondriasis and also had higher scores on the physical dimension of the SIP. Conclusion: Differences between the groups could not be accounted for by different etiologies because the proportions and causes of left- and right-sided pain were comparable. The results are consistent with the hypothesis that unilateral stimulation activates the contralateral cerebral hemisphere and arouses the emotions associated with that hemisphere.
TL;DR: The results of this study show that 0.0625% bupivacaine with 2 μg/ml of fentanyl is an effective analgesic combination when used via PCEA.
Abstract: OBJECTIVE To compare the utility of 0.0625% bupivacaine with fentanyl administered via patient-controlled epidural analgesia (PCEA) to a traditional continuous epidural infusion for pain of labor and delivery. DESIGN AND SUBJECTS Forty-one women in established labor were randomized to receive either (a) 0.0625% bupivacaine with 2 micrograms/ml fentanyl via PCEA (demand dose = 3 ml, lockout interval = 6 min, background infusion = 6 ml/h, no 1 or 4 h limits) or (b) 0.125% bupivacaine with 2 micrograms/ml fentanyl via continuous epidural infusion (CEI) at 12 ml/h. Supplemental 0.25% bupivacaine (3 ml every 5 min, p.r.n., x 3) was administered for treatment of breakthrough pain upon patient request. The study protocol was double-blind and placebo-controlled. OUTCOME MEASURES Visual analogue pain scores, motor strength, pinprick level of sensory analgesia and bupivacaine use were assessed by an anesthesiologist unaware of the individual patient's randomization to a particular study group. RESULTS The cephalad extent of pinprick sensory analgesia was significantly lower during both the first (p < 0.03) and second (p < 0.03) stages of labor in patients receiving PCEA. However, visual analogue pain scores, intensity of motor blockade, and need for physician-administered supplemental bupivacaine were comparable in both groups. Patients receiving PCEA used 40% less bupivacaine per hour while achieving analgesia comparable to patients receiving CEI. CONCLUSIONS The results of this study show that 0.0625% bupivacaine with 2 micrograms/ml of fentanyl is an effective analgesic combination when used via PCEA.
TL;DR: The findings indicate that dietary caffeine consumption is not related to the global experience of pain and disability in patients with chronic low back pain, although high caffeine use may be embedded in a context of other unhealthy life-style behaviors.
Abstract: Objective: Although caffeine apparently plays a role in the modulation of pain perception in a variety of acute pain states, little is known about its effects on the experience of chronic pain. This exploratory study examined the relationship between dietary caffeine consumption and the symptoms reported by patients with chronic low back pain. Design and Patients: A retrospective chart review was conducted of 131 patients with chronic low back pain (64 men and 67 women; mean age = 42.1 years; mean duration of pain = 6.1 years) referred to a multidisciplinary pain clinic over a 2-year period. Patients were classified as low (less than 100 mg; n = 34), moderate (100-400 mg; n = 68) or high (more than 400 mg; n = 29) caffeine users based on their self-reports of daily coffee, tea, and cola consumption. Results: There were no significant differences among the low, medium, and high caffeine consumer groups on any self-report measure of pain severity, affective distress, anxiety-related symptoms, or sleeping behavior. High caffeine users were more likely to be tobacco smokers than low caffeine users (79% and 27%, respectively, p < 0.001). Conclusions: Our findings indicate that dietary caffeine consumption is not related to the global experience of pain and disability in patients with chronic low back pain, although high caffeine use may be embedded in a context of other unhealthy life-style behaviors.
TL;DR: Cutaneous nociceptive C-fibers do not signal dynamic mechanical allodynia, and this symptom may hypothetically be due to secondary changes in the central nervous system processing that might strengthen the synaptic ties between AB-fiberers and central nocICEptive pathways, or due to peripheral multiplication of primary afferent low threshold mechanoreceptor input.
Abstract: OBJECTIVE In neuropathic pain states, dynamic mechanical allodynia is mediated by large diameter A beta-fibers. We test whether ongoing peripheral C-nociceptor input is necessary to maintain central changes hypothetically responsible for A beta-mediated allodynia. CASE REPORT A patient with long-standing diabetes mellitus demonstrated generalized signs of painless diabetic small fiber polyneuropathy. Following mechanical trauma, the patient additionally developed a typical neuropathic pain syndrome at the arm. Despite substantial impairment of cutaneous small fiber function, he complained of severe dynamic mechanical allodynia confined to a forearm skin area. METHODS AND RESULTS Marstock test revealed a considerably increased cold perception threshold within the allodynic area and on the contralateral side. The patient could not perceive any warm sensation on either side. Histamine iontophoresis was not followed by any itch or pain sensations within the allodynic area or contralaterally. Nociceptive C-fiber axon reflex reactions were substantially impaired within the allodynic skin or contralaterally. Standard neurophysiological testing and quantitative vibrametry showed only mild impairment of large diameter sensory and motor fiber function at the arms. Cardiovascular reflex tests showed almost no heart rate variation indicating impairment of vagal small fiber function. CONCLUSIONS (a) Cutaneous nociceptive C-fibers do not signal dynamic mechanical allodynia. This symptom may hypothetically be due to secondary changes in the central nervous system processing that might strengthen the synaptic ties between A beta-fibers and central nociceptive pathways, or due to peripheral multiplication of primary afferent low threshold mechanoreceptor input. (b) Ongoing nociceptive C-fiber input is not necessary to maintain either hypothetical mechanism. (c) Hypothetical secondary central hyperexcitability might work autonomously without any nociceptive C-fiber input for a long time or even indefinitely in some neuropathic patients.
TL;DR: An awareness of these distortions should lead health-care professionals to monitor and refer to patients' actual pain reports made during a treatment intervention rather than relying on patients' recall to gauge the efficacy of interventions.
Abstract: OBJECTIVE To examine the accuracy of memory for pain in patients with chronic pain after injection of a local anesthetic and to investigate psychological factors hypothesized to coincide with distortion of memory. DESIGN Consecutive patients receiving nerve-block injections recorded pain before the block, during the effect of the block, approximately 2 days after the block, and 2 weeks after the block. Memory for pain during the effect of the block was assessed 2 days and 2 weeks after the block for comparison with recorded pain ratings. SETTING Outpatient, multidisciplinary pain-treatment center of a university medical center. PATIENTS Forty-nine adult patients with chronic pain. INTERVENTIONS Local nerve-block injections resulted in a significant, temporary reduction in pain, thus allowing patients to rate, and later recall, intensity of reduced pain. OUTCOME MEASURES Subjective ratings of pain intensity (numeric rating scale) were compared with recalled pain intensity. Demographic variables and psychological self-report measures were administered at evaluation. RESULTS Memory distortions are commonplace and are more likely to involve recollection of higher pain levels than were reported at the time of the injection. Psychological self-report measures did not identify subjects who experienced distorted memory for pain relief. CONCLUSIONS An awareness of these distortions should lead health-care professionals to monitor and refer to patients' actual pain reports made during a treatment intervention rather than relying on patients' recall to gauge the efficacy of interventions. Memory distortions could influence avoidance behaviors implicated in the development of chronic pain by some theories.
TL;DR: There may be a relationship between some preinjury job perceptions and intent to return to the preinjured type of work in some groups of CPPs.
Abstract: OBJECTIVES: (1) To demonstrate a relationship between intent to return to preinjury job and preinjury job perceptions about that job; and (2) to demonstrate that worker compensation chronic pain patients (WC CPPs) would be more likely than non-worker compensation chronic pain patients (NWC CPPs) not to intend to return to a preinjury type of job because of preinjury job perceptions. STUDY DESIGN: The relationship between preinjury job perceptions and intent to return to the preinjury job was investigated and compared between worker compensation (WC) and nonworker compensation (NWC) chronic pain patients (CPPs). Within the WC and NWC groups CPPs not intending to return to their preinjury type of work were compared to those CPPs intending to return on preinjury job perception. BACKGROUND DATA: Compensation status, being a WC CPPs or being a non-WC CPPs, has been claimed to be predictive or not predictive of return to work post pain treatment. These studies have, however, ignored the preinjury job stress perception variable as an area of research. METHODS: WC CPPs were age- and sex-matched to NWC CPPs and statistically compared on their responses to rating scale and yes/no questionnaires for intent to return to work and perceived preinjury job stress. In a second analysis, both the WC and NWC groups were divided according to their intent to return to work and statistically compared on their responses to these questionnaires. RESULTS: Both male and female WC CPPs were less likely than their counterparts to intend to return to their preinjury job. Both WC and NWC were found to complain of preinjury job complaints, and these complaints were found to differ between WC and NWC CPPs. An association between intent not to return to work and the perceptions of preinjury job dissatisfaction and job dislike was found for male and female WC CPPs and for male and female NWC CPPs. CONCLUSIONS: There may be a relationship between some preinjury job perceptions and intent to return to the preinjury type of work in some groups of CPPs. However, a specific relationship between WC status, intent not to return to the preinjury type of work, and preinjury job perceptions in comparison to NWC CPPs could not be demonstrated. Language: en
Journal Article•
TL;DR: How DSM-IV deals with pain is discussed, with a specific focus on the new diagnostic category of Pain Disorder.
Abstract: The American Psychiatric Association recently published the fourth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Although earlier editions included pain-related diagnosis, inherent problems in their construction limited their applicability. This article discusses how DSM-IV deals with pain, with a specific focus on the new diagnostic category of Pain Disorder.
Journal Article•
TL;DR: The MMPAP accurately predicts future employment of disability applicants claiming chronic pain and the introduction of this standardized protocol will assist in standardizing disability determination for claimants with chronic pain.
Abstract: OBJECTIVE The study assessed the predictive ability of the standardized Multiperspective Multidimensional Pain Assessment Protocol (MMPAP). An assessment tool that predicts return to work with chronic pain patients is needed, as increasing numbers of disability applications are adjudicated in the courts. DESIGN National randomized validation sample of disability applicants. Each MMPAP consisted of physical examinations by two physiatrists and the participant's subjective assessment. Criterion standards were Multidimensional Pain Inventory and McGill Pain Questionnaire. There was phone follow-up 6 months postdecision. SETTING Six clinical sites were ambulatory referral centers, both public and private. PARTICIPANTS Population-based random national sample of 710 Social Security disability applicants claiming chronic pain related to their disability, stratified by national Social Security Administration (SSA) applicant demographics. Seventy-eight were lost to follow-up, and 688 initially refused. INTERVENTIONS No interventions were continued or initiated by the research team between assessment and follow-up. MAIN OUTCOME MEASURES Claimant employment status 6 months after disability decision was primary outcome, change in pain intensity, and change in employment situation. RESULTS The MMPAP predicted with 90% accuracy employment status of SSA disability applicants with chronic pain 6 months postdecision when assessed at application by two physicians trained in Physical Medicine and Rehabilitation (physiatry). Accuracy of employment situation change was 93%, and pain intensity change was 65%. Self-report measures, physical examination results, psychological status, functional limitations, and physician's subjective appraisal predict future employment. CONCLUSIONS The MMPAP accurately predicts future employment of disability applicants claiming chronic pain. The introduction of this standardized protocol will assist in standardizing disability determination for claimants with chronic pain.
TL;DR: Preliminary evidence suggested that felbamate was effective in relieving trigeminal neuralgia, and stabilization of neuronal membrane depolarization was the most likely mechanism of action.
Abstract: Objective The analgesic efficacy of the novel anticonvulsant felbamate was evaluated in trigeminal neuralgia. Patients and setting This trial was offered in a tertiary referral center to three outpatients with severe pain who had exhausted other medical options, yet did not wish to undergo surgery. Interventions Felbamate was prescribed as the sole analgesic for approximately 1 month. Outcome measures A visual analogue scale was utilized. Results Felbamate potently diminished the severe pain of trigeminal neuralgia and was well tolerated. The drug was withdrawn because of subsequent reports elsewhere of aplastic anemia and hepatic failure associated with it when used for epilepsy. Conclusions Preliminary evidence suggested that felbamate was effective in relieving trigeminal neuralgia. Stabilization of neuronal membrane depolarization was the most likely mechanism of action. However, significant potential risks preclude further use of felbamate in the management of nonmalignant pain. Principles that have proven useful in screening for new anticonvulsant drugs might be relevant to the development of methods by which to search for new analgesic drugs.
TL;DR: Ketorolac appears not to be as effective as fentanyl in treating early postoperative pain, and the parenteral use of ket orolac was more effective during the later postoperative period in providing longer lasting analgesia.
Abstract: Objective: The purpose of this study was to compare the efficacy and safety of i.v. ketorolac and fentanyl for moderate to severe postoperative pain in patients undergoing elective surgery in an ambulatory surgery unit. Design: A double-blind randomized trial. Setting: An ambulatory surgery unit in a university-affiliated hospital. Patients: Sixty-nine patients undergoing elective laparoscopy, inguinal hernia repair, or knee arthroscopy were enrolled. Intervention: Patients were randomly assigned to receive intravenous ketoroLac 30 mg (n = 38) or fentanyl 50 μg (n = 31) for moderate to severe postoperative pain. Outcome Measures: Pain, assessed using a 100-mm visual analog scale and a 5-point verbal pain scale; adverse effects, as well as vital signs were recorded every 15 min for 150 min or until discharge from the postanesthesia care unit, 6 and 24 h after discharge. Results: Pain reduction on both visual analog and verbal scales was significantly greater with fentanyl than ketorolac at 15 min. In addition, the proportion of patients requiring remedication at the 15-min time point was significantly greater in the ketorolac group. However, there were no significant differences between fentanyl and ketorolac between 30 and 150 min after surgery. Notably, pain reduction was significantly greater with ketorolac on the verbal scale at the 6 h measurement. Conclusions: Ketorolac appears not to be as effective as fentanyl in treating early postoperative pain. Although fentanyl still appears to be the drug of choice in the early postoperative period, the parenteral use of ketorolac was more effective during the later postoperative period in providing longer lasting analgesia.