Showing papers on "Pain medicine published in 2003"

Pulse oximetry: its invention, theory, and future.

Abstract: oximetry to establish a basis for improving pulse oximeter performance and for expanding application of the pulse spectrophotometry principle to other noninvasive measurements. Recently, the theory has been developed to a point where it has been proved effective for solving many problems. I will explain here this progress in theory development briefly. Although a complete explanation should involve strict mathematical proofs and detailed descriptions of experiments, including their methods and the interpretation of their results, I will omit these details here. In the final section, I will sketch a vision of pulse oximetry in the near future, not as wishful thinking but as a realizable goal.

Central sensitization in fibromyalgia and other musculoskeletal disorders

Abstract: Muscle hyperalgesia and referred pain play an important role in chronic musculoskeletal pain. New knowledge on the involved basic mechanisms and better methods to assess muscle pain in the clinic are needed to revise and optimize treatment regimens. Increased muscle sensitivity is manifested as pain evoked by a normally non-nociceptive stimulus (allodynia), increased pain intensity evoked by nociceptive stimuli (hyperalgesia), or increased referred pain areas with associated somatosensory changes. Some manifestations of sensitization, such as expanded referred muscle pain areas in patients with chronic musculoskeletal pain, can be explained from animal experiments showing extrasegmental spread of sensitization. An important part of the pain manifestations (eg, tenderness and referred pain) related to chronic musculoskeletal disorders may result from peripheral and central sensitization, which may play a role in the transition from acute to chronic pain.

Cognitive impairment in patients with chronic pain: the significance of stress.

Abstract: This review article examines the role of emotional distress and other aspects of suffering in the cognitive impairment that often is apparent in patients with chronic pain. Research suggests that pain-related negative emotions and stress potentially impact cognitive functioning independent of the effects of pain intensity. The anterior cingulate cortex is likely an integral component of the neural system that mediates the impact of pain-related distress on cognitive functions, such as the allocation of attentional resources. A maladaptive physiologic stress response is another plausible cause of cognitive impairment in patients with chronic pain, but a direct role for dysregulation of the hypothalamic-pituitary-adrenocortical axis has not been systematically investigated.

End-of-life decisions in intensive care units: attitudes of physicians in an Italian urban setting.

Abstract: Objective To assess the attitudes of physicians in Milan, Italy, intensive care units (ICUs) regarding end-of-life decisions.

Induction and assessment of muscle pain, referred pain, and muscular hyperalgesia.

Abstract: Muscle pain can be induced and assessed experimentally by a variety of methods. Ischemic and exercise-induced muscle pain are typical endogenous pain models; external stimulation with mechanical, electrical, and chemical modalities constitute the exogenous models. These models are a good basis to study the muscle sensitivity, muscle pain responses under normal and pathophysiologic conditions, and drug efficacy on specific muscle pain mechanisms. When evaluating muscle pain in clinical or experimental settings, it is important to assess parameters related to the pain intensity, pain quality, referred and local distribution, and the deep tissue sensitivity in local and referred areas. The experimental test paradigm must include different stimulation modalities (multimodal) to obtain sufficiently advanced and differentiated information about the human nociceptive system under normal and pathophysiologic conditions because the different stimuli activate different receptors, pathways, and mechanisms. This may be a useful approach in future mechanism-based classification and treatment of muscle pain. Similarly, the multimodal approach is important in clinical studies to provide evidence for which specific muscle pain modalities and mechanisms are affected and how they are modulated by pharmacologic approaches.

Effects of brief pain education on hospitalized cancer patients with moderate to severe pain

Abstract: The purpose of this randomized controlled study was to assess the effects of a structured pain education program on the pain experience of hospitalized cancer patients. Eligible cancer pain patients were randomly assigned to either an experimental group (receiving pain education 10–15 min per day for 5 days, n=15) or a standard care control group (n=15). The effects of the intervention on six pain-related variables were evaluated using three instruments. Pain intensity, pain interference with daily life, negative beliefs about opioids, beliefs about endurance of pain, pain catastrophizing (an individual’s tendency to focus on and exaggerate the threat value of painful stimuli and negatively evaluate his or her own ability to deal with pain), and sense of control over pain were evaluated by the Brief Pain Inventory—Short Form Taiwanese version (BPI-T), Pain and Opioid Analgesic Beliefs Scale—Cancer (POABS-CA), and the Catastrophizing subscale and the sense of control over pain measure from the Coping Strategies Questionnaire (CSQ). The results indicated that, after completing treatment, patients who had received structured pain education had significantly less pain intensity on average, negative pain beliefs regarding opioids, pain endurance beliefs, and pain catastrophizing than patients in the control group. In addition, patients in the pain education group showed a significant increase in their sense of control over pain. These preliminary results strongly suggest that structured pain education can effectively improve the pain experience of hospitalized cancer patients and should be further implemented clinically.

Practical pain management

Abstract: FoundationsAnatomy of PainThe Neurobiology of PainThe Psychology PainTaxomony and Classification of Pain DiagnosticsFocused Evaluation of the Pain PatientMedical ElectrodiagnosticsPsychological Evaluation and Assessment of PainDiagnostic and Therapeutic Injections Therapeutic ModalitiesManipulative Therapy in the Management of PainRehabilitation Therapies in Pain and Disability ManagementNeuroaxial Opioid TherapyNeurostimulation TechniquesNeurosurgical Options for the Management of Intractable PainCognitive Behavioral Therapies and BeyondAlternative TherapiesOpioid Analgesics Pharmacologic InterventionBehavioral Issues and Controversies in Opioid AnalgesiaNon-Opioid and Adjuvant AnalgesicsPharamacological Management of Chronic PainAnticonvulsants and Muscle RelaxantsPediatric and Geriatric Medications ConsiderationsOpiate, Hypnosedative, Alcohol and Nicotine Detoxification ProtocolsPharmacological Management of Pain in the Terminally IllMigraine And The Primary Headaches The Treatment of Selected Pain DisordersOrofacial Pain - Differential diagnosis and TreatmentDifferential Diagnosis and Management of Cervical Spine PainDifferential Diagnosis and Treatment of Low Back PainSpinal Disc DiseaseNeuropathic Pain in Peripheral NeuropathiesNeuropraxic InjuriesGynecologic PainConcepts in Male Genito Urinary PainComplex Regional Pain SyndromePhantom Pain: What it is and What to doPost-Herpetic NeuralgiaChronic Joint and Connective Tissue PainEvaluation And Management Of Non-Articular Rheumatic Pain Disorders: Fibromyalgia SyndromeMyofascial Pain: Evaluation and Treatment StrategiesThe Somatizing Disorders Diagnostic and Treatment Approaches for Pain Medicine Cancer PainCancer Pain ManagementManagement of Cancer Pain Utilizing Radiation TherapyCancer Pain: Psychological Management Pain and Medicolegal IssuesJpain the the Social Security Disability System: The Validation of PainPain in Workers Compensation and Personal Injury LawThe Pain Physician's Role in Legal ProceedingsCompliance for Pain PhysiciansEvaluating and Rating of Physical ImpairmentEvaluation and Rating of Psychological Impairment and Disability Selected TopicsPain Management in Primary Care Medical PracticePain in Infants and ChildrenOffice and Hospital Pain ConsultationsOutpatient Rehabilitation Programs For Patients With Chronic PainHospital Based Inpatient Treatment ProgramsProviding Pain Management Services Under The Managed Care Paradig

Using a personal digital assistant enhances gathering of patient data on an acute pain management service: a pilot study

Abstract: Purpose Handheld computer technology provides a unique opportunity for health care professionals to access real time or near real time patient information and evidence-based resources at the point-of-care. The purpose of this study was to assess one physician’s experience using acute pain assessment software on a personal digital assistant (PDA) to assess patients on an acute pain management service (APMS).

Complex regional pain syndrome: a review of evidence-supported treatment options.

Abstract: Complex regional pain syndrome consists of pain and other symptoms that are unexpectedly severe or protracted after an injury. In type II complex regional pain syndrome, major nerve injury, often with motor involvement, is the cause; in complex regional pain syndrome I, the culprit is a more occult lesion, often a lesser injury that predominantly affects unmyelinated axons. In florid form, disturbances of vasoregulation (eg, edema) and abnormalities of other innervated tissues (skin, muscle, bone) can appear. Because of these various symptoms and the difficulty in identifying causative lesions, complex regional pain syndrome is difficult to treat or cure. Complex regional pain syndrome has not been systematically investigated; there are few controlled treatment trials for established complex regional pain syndrome. This article reviews the existing studies (even if preliminary) to direct clinicians toward the best options. Treatments for other neuropathic pain syndromes that may be efficacious for complex regional pain syndrome also are discussed. Some common treatments (eg, local anesthetic blockade of sympathetic ganglia) are not supported by the aggregate of published studies and should be used less frequently. Other treatments with encouraging published results (eg, neural stimulators) are not used often enough. We hope to encourage clinicians to rely more on evidence-supported treatments for complex regional pain syndrome.

Addiction, Physical Dependence, and Tolerance

Abstract: Pain is among the most common complaints for which people seek medical care; yet pain is also among the most undertreated patient complaints. Reasons for this include reluctance by clinicians to prescribe and support the use of opioids, often due to a fear of addiction. To address this issue, three major health professional organizations that deal with the treatment of pain and addiction, the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine, formed the Liaison Committee on Pain and Addiction (LCPA). The first mission of the LCPA was to formulate precise definitions of the terms addiction, physical dependence, and tolerance. This report explains these definitions and discusses how they apply to clinical practice.

The effect of craniotomy location on postoperative pain and nausea

Abstract: Purpose. At least one retrospective study has suggested that the need for postoperative control of pain and nausea depends on the location of the cranial surgery. This prospective study was performed to examine the hypothesis that patients who have had infratentorial craniotomy experience more severe pain and more frequent nausea than those with supratentorial procedures. Methods. We compared postoperative outcomes in 28 patients with infratentorial craniotomy, 53 with supratentorial craniotomy, and 47 with complex spinal cord surgery (the control group). Anesthesia was standardized for all three groups and the concentration of isoflurane was titrated to keep mean arterial pressure within 30% of preoperative values. Severity of pain and frequency of nausea and vomiting were recorded for 24 h after surgery. Pain was assessed with a verbal pain score scale of 0–10, with 10 being the worst pain imaginable. Data were collected for 24 h postoperatively. Results. Because nausea and pain diminish drastically 2 h after surgery, pairwise differences were assessed at each point within the first 2 h. Within 30 min of extubation, median pain scores in the supratentorial and spine groups rose to 2 and in the infratentorial group to 5. The statistical differences between groups were not significant (P > 0.06) by logistic regression. Also, the incidence of nausea was not significantly different (57% supratentorial, 57% spine, 67% infratentorial; P = 0.62) by Dunn’s procedure. Conclusion. There were no significant differences in the severity of pain or the frequency of nausea based on the craniotomy site.

Diagnose und Therapie myofaszialer Triggerpunkte

Abstract: Fragestellung Myofasziale Triggerpunkte (MTrPs) sind druckempfindliche Stellen im Skelettmuskel, die im Verlauf von palpierbaren verspannten Muskelfaserbundeln (taut bands) liegen. In der Arbeit werden die Entstehung, Diagnose und Therapie diskutiert.

[Theories and models of chronicity: on the way to a broader definition of chronic back pain].

Abstract: Chronic back pain is one of the most common and costly disorders An overview shows that chronicity has various definitions, of which purely temporal ones predominate Back pain is said to be "chronic" if it lasts for a variable number of weeks or months Our attempt to refine such definitions is based on three previous works: Loeser's multidimensional pain model, the oncological TNM model and the International Classification of Functioning, Disability and Health of WHO (ICF) We suggest an unidirectional process of pain in the back to a complex pain syndrome including other types of pain, various bodily complaints and cognitive as well as emotional impairments, and propose an empirically testable research model

Pain, nausea, vomiting and ocular complications delay discharge following ambulatory microdiscectomy.

Abstract: Nowadays, microsurgical discectomy is being performed as an outpatient procedure. A retrospective chart review was done to document factors that delayed discharge or led to unanticipated admission. After Institutional Review Board approval, the hospital medical records of 106 patients who underwent microsurgical discectomy on an ambulatory basis were reviewed. All patients were operated upon by a single surgeon at the Toronto Western Hospital. Perioperative data were collected on specifically designed data sheets. All anesthetic and surgical factors that affected discharge were noted. Of the 106 patients reviewed, only six required unanticipated admission. Two patients were admitted due to nausea and vomiting, one due to severe pain, one due to urinary retention and two were surgical causes (durai tear). Eight patients had delayed discharge. Anesthesia causes were severe nausea, severe pain, low oxygen saturation, sore throat and dry eyes. Two patients had surgical causes. The incidence of postoperative nausea was 61% and postoperative vomiting was 9.4%. Eighty patients (75.4%) complained of pain in the postanesthesia care unit. Of these, 33.9% had visual analogue pain scale scores more than 6. Ambulatory lumbar microdiscectomy can be carried out as an ambulatory procedure with an acceptably low unanticipated admission rate (5.7%). The percentage of patients with severe nausea (16%) and pain (33.9%) is high. Adequate perioperative pain management and effective control of nausea and vomiting may further improve the patients’ experience after anesthesia for ambulatory microdiscectomy.

SARS safety and science.

Abstract: 1315a 43rd Interscience Conference Antimicrobial Agents and Chemotherapy, September

Barriers to cancer pain management: home-health and hospice nurses and patients.

Abstract: Undertreatment of cancer pain remains a major health-care problem. We utilized focus groups of hospice and home-health nurses and patients to elucidate factors contributing to inadequate pain management and to generate solutions for closing the gap between the current reality and optimal pain management. Focus groups were conducted among hospice and home-health-care nurses (two groups; n=22) and patients (six groups; n=54) using a standardized question guide. Audiotapes were transcribed and analyzed using NUD*IST software. Themes discovered among patients and nurses were analyzed for similarities and differences. Of 22 participants in the two home-health and hospice nurses focus groups, all were white women, the average age was 43 (range 29–64) years, and the average number of years in nursing was 21 (range 8–47) years. Of 54 participants in the six cancer patient focus groups, 80% were women, the average age was 54 (range 25–76) years, and 76% were white. Fifty-four percent of patients reported a history of pain associated with their cancer, and almost 30% had pain that they rated as 8 or higher on the pain scale. Barriers to adequate pain management fell into four categories: fears; attitudes, beliefs, and values; patient and provider behaviors; and structural barriers. Patients and nurses reported similar barriers to pain management; however, patients identified more barriers related to provider behavior and structure of the health care system. This study identified several barriers to cancer pain control not previously identified in the literature. Strategies to improve cancer pain control are suggested.

Pain and its treatment in hospitalized patients with metastatic cancer

Abstract: Goals The aim of this prospective study was to assess the quality of pain management hospitalized cancer patients.

Assessing cardiac preload or fluid responsiveness? It depends on the question we want to answer

Abstract: between these extreme values [4]. Therefore, for physiological reasons, we cannot accurately predict fluid responsiveness simply by assessing cardiac preload. Does it mean that assessing cardiac preload is useless? No, because assessing preload is useful in answering another clinical question: “Does our fluid challenge effectively increase cardiac preload?” The increase in ventricular end-diastolic volumes (i.e. in preload) as a result of fluid therapy depends on the partitioning of the fluid into different cardiovascular compartments organized in series. In this regard, when venous capacitance is increased or ventricular compliance is decreased, fluid infusion will increase intravascular blood volume, but not necessarily cardiac preload [5]. Thus, a patient can be a non-responder to a fluid challenge because preload does not increase or because his heart is operating on the flat portion of the Frank-Starling curve. In the first case, giving more fluid may be useful to increase cardiac preload and hence output significantly, while in the second case only an inotrope may improve cardiac output. Thus, assessment of cardiac preload as well as fluid responsiveness are useful for the clinician, but definitely not to answer the same question. References

A model of acute symptom control unit: Pain Relief and Palliative Care Unit of La Maddalena Cancer Center

Abstract: Palliative care in Italy was provided solely on a home care basis until a couple of years ago. In recent years different realities have been created according to personal experience, quite apart from new resources provided by the National Health System. The first Pain Relief and Palliative Care Unit in Sicily, the largest region in Italy, was established in March 1999. Most members of the regular staff of this Unit have a background in anesthesiology. Activity in the Unit has grown progressively, with 460 admissions in the last year. The characteristics of the first 1,000 patients admitted, the principal protocols for diagnostic and therapeutic procedures, such as those for hitherto intractable pain, nutrition and hydration, interventional procedures for symptom control, and emerging problems, a project called "Island with no pain," and activities in the fields of formation and research are described.

Postoperative pain and analgesic responses are similar in male and female Sprague-Dawley rats.

Abstract: Purpose Controversy exists concerning the influence of gender on pain sensitivity and response to analgesics both in animal and human studies. The present study compares postoperative pain scores in male and female rats and how they respond to analgesic interventions.

Pharmacotherapy of neuropathic low back pain.

Abstract: Neuropathic low back pain is examined from a structural standpoint, distinguishing processes that start from chronic inflammation and mechanical compromise and cross into the realm of neuropathy with primary neurogenic pathophysiology. The disease of chronic pain is discussed, examining peripheral and central changes in neuroanatomy, neurophysiology, and neuromolecular dynamics. The limitations of inadequate random controlled trials regarding long-term pharmacologic interventions are contrasted with excellent work in the basic science of chronic pain. Complex rational pharmacologic strategies for structural pathology, central pain processes, sites of medication action, and differing routes of administration are delineated.

Multidimensional subgroups in migraine: differential treatment outcome to a pain medicine program.

Abstract: objective. The present study compared two different approaches for deriving patient profiles on their ability to predict treatment outcome to a pain medicine program for migraine headache. design/methods. Using visual analog scale measures of pain intensity and functional limitations and the Beck Depression Inventory (BDI), as a measure of depression, 235 migraine patients were classified into statistical clusters. The same patients were also classified using the Multidimensional Pain Inventory (MPI) algorithm into three subgroups: Adaptive copers (AC), characterized by lower reported levels of pain intensity, life interference, and distress, as well as higher levels of perceived life control; interpersonally distressed (ID), characterized by more intermediate levels of pain, distress, and interference, with a predominant perception of inadequate support and punishing responses from significant others; and dysfunctional (Dys), characterized by high levels of pain severity, life interference, and distress and low levels of perceived life control and activity. results. The results of the K-cluster analysis yielded a three-cluster solution: The low impact cluster, was characterized by low pain, low functional limitations and low depression and showed significant reductions in pre-to-posttreatment pain; the moderate impact cluster displayed higher levels of pain and functional limitations and low depression and showed only slight pre-to-posttreatment pain reduction; and the high impact cluster displayed the highest levels of pain, functional limitations, and depression and showed significant increases in pre-to-posttreatment pain. Unlike the K-clustered groups, MPI subgroups failed to differentially predict treatment outcome. When the K-clustered groups were crosstabulated with the MPI subgroups, the predictive validity of the MPI subgroups was enhanced. conclusion. This study questions the validity of the MPI subgroup classification algorithm. The results indicate that the K-clustering approach is more useful than the MPI in deriving meaningful patient clusters that differentially predict treatment outcome in a migraine population.