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Computerized assessment of pain drawing area: A pilot study  

PubMed Central

Aim: To investigate if pain area in patients with chronic pain could be measured by a computerized assessment on previously marked pain drawings on paper figures and to analyze the further application of the method. Methods: Seventy-two patients (54 women and 18 men) who were admitted to Umeå University Hospital during 2003 for assessment of chronic pain answered a set of questionnaires (pain intensity on the visual analog scale [VAS], disability on the Disability Rating Index [DRI], life satisfaction on the LiSat-11) and filled in pain drawings on paper figures of the human body. The pain drawings were later analyzed by using computerized assessment. Results: Women marked a greater pain area than men, but the difference was not significant (p =0.433). No significant difference was shown for the previous seven days between men and women on the VAS (p =0.914), DRI (p =0.493), or LiSat-11 (p =0.124). A statistically significant correlation was found between pain area and VAS for the previous seven days (r =0.250; p =0.046). Pain area was statistically significantly correlated to the DRI (r =0.336; p =0.014) and close to negatively correlated to the LiSat-11 (r =0.687; p =0.057). Conclusion: This pilot study shows that pain drawing area could be measured by a computerized assessment of pain drawings. The method points to the possibility of relating pain area with other instruments. In the present study, an association between the patientspain drawing area and pain intensity and between pain area and level of activity was shown.

Wenngren, Anna; Stalnacke, Britt-Marie



Pain-drawing does not predict the outcome of fusion surgery for chronic low-back pain: a report from the Swedish Lumbar Spine Study  

Microsoft Academic Search

Despite a widespread use of pain drawing in the selection of patients for surgical and non-surgical treatment, its value as a predictor of outcome is still not well documented. In a prospective multicentre randomised controlled trial of surgical and non-surgical treatment for chronic low-back pain (CLBP), two hypotheses were tested: (1) Pain drawing predicts outcome of treatment for CLBP, (2)

O. Hägg; P. Fritzell; R. Hedlund; H. Möller; L. Ekselius; A. Nordwall



Pain Maps from Facial Pain Patients Indicate a Broad Pain Geography  

Microsoft Academic Search

Two hundred consecutive female patients, who were referred to a university-based facial pain clinic, were asked to mark all painful sites on sketches showing the contours of a human body in the frontal and rear views. The drawings were analyzed with transparent templates containing 1875 (frontal view) and 1929 (rear view) square cells of equal size. The average patient scored

J. C. Türp; C. J. Kowalski; N. OLeary; C. S. Stohler



Fear of pain in orofacial pain patients  

Microsoft Academic Search

In the present study, we examined whether fear of pain, dental fear, general indices of psychological distress, and self-reported stress levels differed between 40 orofacial pain patients and 40 gender and age matched control general dental patients. We also explored how fear of pain, as measured by the Fear of Pain Questionnaire-III (J Behav Med 21 (1998) 389), relates to

Daniel W McNeil; Anthony R Au; Michael J Zvolensky; Deborah Rettig McKee; Iven J Klineberg; Christopher C. K Ho



Longitudinal Analysis of Clock Drawing in Alzheimer's Disease Patients  

Microsoft Academic Search

Longitudinal changes in the role of conceptual, spatial, and graphic processes in the drawing deficits of patients with Alzheimer's disease (AD) were assessed over a 2-year period. Both the drawing-to-command and copy conditions of the Clock Drawing Test were administered to 33 AD patients as part of three consecutive annual examinations. The drawings from each administration were evaluated for overall

Isabelle Rouleau; David P. Salmon; Nelson Butters



Patients' Perspectives on Pain  

PubMed Central

Nociceptive and neuropathic pain (NP) are common consequences following spinal cord injury (SCI), with large impact on sleep, mood, work, and quality of life. NP affects 40% to 50% of individuals with SCI and is sometimes considered the major problem following SCI. Current treatment recommendations for SCI-NP primarily focus on pharmacological strategies suggesting the use of anticonvulsant and antidepressant drugs, followed by tramadol and opioid medications. Unfortunately, these are only partly successful in relieving pain. Qualitative studies report that individuals with SCI-related long-lasting pain seek alternatives to medication due to the limited efficacy, unwanted side effects, and perceived risk of dependency. They spend time and money searching for additional treatments. Many have learned coping strategies on their own, including various forms of warmth, relaxation, massage, stretching, distraction, and physical activity. Studies indicate that many individuals with SCI are dissatisfied with their pain management and with the information given to them about their pain, and they want to know more about causes and strategies to manage pain. They express a desire to improve communication with their physicians and learn about reliable alternative sources for obtaining information about their pain and pain management. The discrepancy between treatment algorithms and patient expectations is significant. Clinicians will benefit from hearing the patient´s voice.

Norrbrink, Cecilia; Lofgren, Monika; Hunter, Judith P.; Ellis, Jaqueline



Assessing pain in patients.  


This article defines pain and discusses options for pain assessment. Both unidimensional and multidimensional pain assessment scales are considered and described. Nursing skills required to carry out pain assessment are identified and discussed. PMID:18376633

McLafferty, E; Farley, A


Breakthrough pain: characteristics and impact in patients with cancer pain  

Microsoft Academic Search

Few surveys have been performed to define the characteristics and impact of breakthrough pain in the cancer population. In this cross-sectional survey of inpatients with cancer, patients responded to a structured interview (the Breakthrough Pain Questionnaire) designed to characterize breakthrough pain, and also completed measures of pain and mood (Memorial Pain Assessment Card (MPAC)), pain-related interference in function (Brief Pain

Russell K Portenoy; David Payne; Paul Jacobsen



Myofascial pain in patients with postthoracotomy pain syndrome  

Microsoft Academic Search

Objective: Postthoracotomy pain syndrome is generally considered to be neuropathic pain due to intercostal nerve injury. However, nonneuropathic pain can also occur following thoracic surgery. We present a series of cases with postthoracotomy pain syndrome in which myofascial pain was thought to be a causative component of postthoracotomy pain syndrome.Case Report: Twenty-seven patients (17 men and 10 women) were treated

H. Moriwaki K Hamada; Katsuyuki Moriwaki; Kazuhisa Shiroyama; Hiroyuki Tanaka; Masashi Kawamoto; Osafumi Yuge



Pain Responses to Experimental Chewing in Myofascial Pain Patients  

Microsoft Academic Search

Although patients with myofascial pain of the masticatory muscles often report that chewing exacerbates their pain, this has never been verified experimentally. In this study, pain was assessed before and after chewing in 20 asymptomatic subjects and in 61 patients with muscle pain. First, self-reports of pain were obtained with a checklist and on five-point category scales (CAT) at the

T. T. T. Dao; J. P. Lund; G. J. Lavigne



Patient education in pain control  

Microsoft Academic Search

Patients' concerns about reporting pain and using analgesics have been cited as major contributors to the problem of inadequate pain management. The purpose of this paper is to describe a program of research in which we have focused on these patient concerns, or as we refer to them, \\

S. Ward; S. Hughes; H. Donovan; R. Serlin



Late-night hours draw busy patients.  


Planned Parenthood of Houston and southeast Texas is currently implementing a reproductive health care clinic with night-time hours. The clinic provides for the reproductive health care needs of college students with after-class jobs, women with two jobs or with night-shift employment, and all other women who do not have time to go to a daytime clinic. The clinic operates twice a month on Fridays and was initially open 10:30 p.m. - 7 a.m., but now it has changed its hours to 7:30 p.m. - 3:30 a.m. The clinic is staffed by one clinician and two clinic assistants, which attend to an average of 17-22 patients per night's schedule. Women who use the clinic keep their appointments better and do not have to wait so long for care. PMID:12322321



[Pain management in cancer patients].  


Cancer pain management is expected to become more important because of the growing number of cancer patients in the years to come. To improve cancer pain relief requires understanding and adequate application of the WHO three-step analgesic ladder. Selective cox-2 inhibitors have efficacy in decreasing side effects. Tramadol and a new type of transdermal fentanyl patch that provides 24-hour sustained release of fentanyl is commercially available to alleviate pain. New anti-seizure drugs such as Gabapentin and Pregabalin can be used for neuropathic pain and cancer pain as analgesic adjuvant drugs. They allow simple use than with palliative drugs so far. Palliation of cancer pain requires a multi-discipline approach for intensive management of symptoms. PMID:20948246

Tajima, Tsukasa; Nakaho, Toshimichi



Pain patterns and descriptions in patients with radicular pain: Does the pain necessarily follow a specific dermatome?  

PubMed Central

Background It is commonly stated that nerve root pain should be expected to follow a specific dermatome and that this information is useful to make the diagnosis of radiculopathy. There is little evidence in the literature that confirms or denies this statement. The purpose of this study is to describe and discuss the diagnostic utility of the distribution of pain in patients with cervical and lumbar radicular pain. Methods Pain drawings and descriptions were assessed in consecutive patients diagnosed with cervical or lumbar nerve root pain. These findings were compared with accepted dermatome maps to determine whether they tended to follow along the involved nerve root's dermatome. Results Two hundred twenty-six nerve roots in 169 patients were assessed. Overall, pain related to cervical nerve roots was non-dermatomal in over two-thirds (69.7%) of cases. In the lumbar spine, the pain was non-dermatomal in just under two-thirds (64.1%) of cases. The majority of nerve root levels involved non-dermatomal pain patterns except C4 (60.0% dermatomal) and S1 (64.9% dermatomal). The sensitivity (SE) and specificity (SP) for dermatomal pattern of pain are low for all nerve root levels with the exception of the C4 level (Se 0.60, Sp 0.72) and S1 level (Se 0.65, Sp 0.80), although in the case of the C4 level, the number of subjects was small (n = 5). Conclusion In most cases nerve root pain should not be expected to follow along a specific dermatome, and a dermatomal distribution of pain is not a useful historical factor in the diagnosis of radicular pain. The possible exception to this is the S1 nerve root, in which the pain does commonly follow the S1 dermatome.

Murphy, Donald R; Hurwitz, Eric L; Gerrard, Jonathan K; Clary, Ronald



Chronic neuropathic pain in veterinary patients.  


Neuropathic pain is pathophysiologically distinct from other types of chronic pain and is defined by the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain as "pain arising as a direct consequence of a lesion or disease affecting the somatosensory system." At least in humans, and perhaps in animals, neuropathic pain causes a much greater impairment in the patient's quality of life than is caused by other pain syndromes. And, unfortunately, this type of pain is generally quite difficult to accurately diagnose and even harder to effectively treat. A brief review of neuropathic pain and its treatment in veterinary patients is presented here. PMID:20188338

Grubb, Tamara



Myofascial Pain Syndrome in Chronic Back Pain Patients  

PubMed Central

Background Myofascial pain syndrome (MPS) is a regional musculoskeletal pain disorder that is caused by myofascial trigger points. The objective of this study was to determine the prevalence of MPS among chronic back pain patients, as well as to identify risk factors and the outcome of this disorder. Methods This was a prospective observational study involving 126 patients who attended the Pain Management Unit for chronic back pain between 1st January 2009 and 31st December 2009. Data examined included demographic features of patients, duration of back pain, muscle(s) involved, primary diagnosis, treatment modality and response to treatment. Results The prevalence of MPS among chronic back pain patients was 63.5% (n = 80). Secondary MPS was more common than primary MPS, making up 81.3% of the total MPS. There was an association between female gender and risk of developing MPS (?2 = 5.38, P = 0.02, O.R. = 2.4). Occupation, body mass index and duration of back pain were not significantly associated with MPS occurrence. Repeated measures analysis showed significant changes (P < 0.001) in Visual Analogue Score (VAS) and Modified Oswestry Disability Score (MODS) with standard management during three consecutive visits at six-month intervals. Conclusions MPS prevalence among chronic back pain patients was significantly high, with female gender being a significant risk factor. With proper diagnosis and expert management, MPS has a favourable outcome.

Nizar, Abd Jalil



Pain management outcomes for hospitalized Hispanic patients  

Microsoft Academic Search

The purposes of the study were to describe outcomes of pain management and predictors of patient satisfaction in a minority sample. By using a survey design, 3 instruments were used to collect data: (1) The American Pain Society's Patient Outcome Questionnaire-Modified, a 16-item self-report tool about pain and patient satisfaction; (2) a demographic form; and (3) the Pain Management Index.

Jeanette A. McNeill; Gwen D. Sherwood; Patricia L. Starck; Bea Nieto



Prevalence and Characteristics of Breakthrough Pain in Opioid-Treated Patients With Chronic Noncancer Pain  

Microsoft Academic Search

Breakthrough pain is well-characterized in cancer patients but not in patients with chronic noncancer pain. We recruited 228 patients with diverse types of chronic noncancer pain from 9 pain programs and administered a telephone questionnaire with a breakthrough pain assessment algorithm originally designed for cancer patients. All patients had controlled baseline pain, and 168 (74%) experienced severe to excruciating breakthrough

Russell K. Portenoy; Daniel S. Bennett; Richard Rauck; Steven Simon; Donald Taylor; Michael Brennan; Steven Shoemaker



23. Pain in patients with cancer.  


Pain in patients with cancer can be refractory to pharmacological treatment or intolerable side effects of pharmacological treatment may seriously disturb patients' quality of life. Specific interventional pain management techniques can be an effective alternative for those patients. The appropriate application of these interventional techniques provides better pain control, allows the reduction of analgesics and hence improves quality of life. Until recently, the majority of these techniques are considered to be a fourth consecutive step following the World Health Organization's pain treatment ladder. However, in cancer patients, earlier application of interventional pain management techniques can be recommended even before considering the use of strong opioids. Epidural and intrathecal medication administration allow the reduction of the daily oral or transdermal opioid dose, while maintaining or even improving the pain relief and reducing the side effects. Cervical cordotomy may be considered for patients suffering with unilateral pain at the level below the dermatome C5. This technique should only be applied in patients with a life expectancy of less than 1 year. Plexus coeliacus block or nervus splanchnicus block are recommended for the management of upper abdominal pain due to cancer. Pelvic pain due to cancer can be managed with plexus hypogastricus block and the saddle or lower end block may be a last resort for patients suffering with perineal pain. Back pain due to vertebral compression fractures with or without pathological tumor invasion may be managed with percutaneous vertebroplasty or kyphoplasty. All these interventional techniques should be a part of multidisciplinary patient program. PMID:21679293

Vissers, Kris C P; Besse, Kees; Wagemans, Michel; Zuurmond, Wouter; Giezeman, Maurice J M M; Lataster, Arno; Mekhail, Nagy; Burton, Allen W; van Kleef, Maarten; Huygen, Frank



Persistent pain in patients following scoliosis surgery.  


Chronic or persistent pain is increasingly recognised as a consequence of surgery in a number of different disciplines. The pain often exhibit qualities that differ from the acute post-operative pain and may represent changes in the central nervous system. There is lack of information regarding the incidence of persistent pain in patients following spinal surgery for scoliosis. This study aims to estimate the incidence of persistent pain following spinal surgery for scoliosis in a group of mainly adolescent patients. Questionnaires were distributed to consecutive patients attending the outpatient clinic of a hospital with specialist services in paediatric orthopaedics and spinal surgery. One hundred and five patients out of 122 eligible patients completed the survey. Fifty-two percent had ongoing pain upon hospital discharge either in the primary surgical site and/or in the iliac bone graft site. Approximately 10 and 7% of all patients had back and pelvic pain persisting beyond 12 months, respectively. A small proportion described elements of neuropathic pain. There was a trend suggesting that those who experienced more severe post-operative pain were more likely to develop persistent pain. These data are consistent with those reports that implicate surgery as the trigger for chronic pain. PMID:17410382

Wong, G T C; Yuen, V M Y; Chow, B F M; Irwin, M G



Surgical options for patients with shoulder pain  

Microsoft Academic Search

Shoulder pain is a common musculoskeletal complaint in the community, which can arise from diverse causes. Regardless of the cause, mild cases can often be effectively treated conservatively, with options including rest, physiotherapy, pain relief and glucocorticoid injections. If conservative strategies fail after a 3–6 month period then surgery might be considered. Generally, the proportion of patients with shoulder pain

Salma Chaudhury; Stephen E. Gwilym; Jane Moser; Andrew J. Carr



JAMA Patient Page: Acute Pain Treatment  


... your symptoms and the history of your illness, injury, or surgery. You may be asked to fill out a questionnaire to assess the intensity and location of your pain. The Wong-Baker FACES Pain Rating Scale (below) may help young patients rate pain intensity. ...


The dimensionality of pain: palliative care and chronic pain patients differ in their reports of pain intensity and pain interference.  


The accurate, precise, and consistent assessment of pain is of particular importance in palliative care. The European Palliative Care Research Collaborative is developing a computer-based pain assessment instrument and has been evaluating the content and dimensionality of existing pain questionnaires. The most important dimensions of pain are intensity and interference. However, since pain interference is a consequence of and largely reflects pain intensity, we postulated that it might either provide information to enhance the evaluation of intensity, or that an overall summary measure of pain severity could be constructed by combining the 2 dimensions. Cancer patients in palliative care (n=395) and chronic pain patients (n=168) completed questionnaires that included 23 pain items culled from existing questionnaires. Psychometric analyses confirmed the existence of 2 main dimensions, intensity and interference, and also guided identification of items that contributed most strongly to these dimensions. However, there was strong evidence that the relationship between the intensity and the interference items differs markedly in palliative care patients compared to chronic pain patients. As hypothesized, there was strong correlation between intensity and interference, lending support to the possibility that, for some purposes, these dimensions may be combined to provide a higher-level summary measure of patients' pain experience. We conclude that these dimensions should be kept distinct when assessing patients in general, although for a single type of patient (such as palliative care patients), it may be possible to regard intensity and interference as contributing to an overall measure of pain severity. PMID:21458921

Fayers, Peter M; Hjermstad, Marianne J; Klepstad, Pål; Loge, Jon Håvard; Caraceni, Augusto; Hanks, Geoffrey W; Borchgrevink, Petter; Kaasa, Stein



Pain catastrophizing and pain-related fear in osteoarthritis patients: relationships to pain and disability.  


This study examined the degree to which pain catastrophizing and pain-related fear explain pain, psychological disability, physical disability, and walking speed in patients with osteoarthritis (OA) of the knee. Participants in this study were 106 individuals diagnosed as having OA of at least one knee, who reported knee pain persisting for six months or longer. Results suggest that pain catastrophizing explained a significant proportion (all Ps < or = 0.05) of variance in measures of pain (partial r(2) [pr(2)] = 0.10), psychological disability (pr(2) = 0.20), physical disability (pr(2) = 0.11), and gait velocity at normal (pr(2) = 0.04), fast (pr(2) = 0.04), and intermediate speeds (pr(2) = 0.04). Pain-related fear explained a significant proportion of the variance in measures of psychological disability (pr(2) = 0.07) and walking at a fast speed (pr(2) = 0.05). Pain cognitions, particularly pain catastrophizing, appear to be important variables in understanding pain, disability, and walking at normal, fast, and intermediate speeds in knee OA patients. Clinicians interested in understanding variations in pain and disability in this population may benefit by expanding the focus of their inquiries beyond traditional medical and demographic variables to include an assessment of pain catastrophizing and pain-related fear. PMID:19041218

Somers, Tamara J; Keefe, Francis J; Pells, Jennifer J; Dixon, Kim E; Waters, Sandra J; Riordan, Paul A; Blumenthal, James A; McKee, Daphne C; LaCaille, Lara; Tucker, Jessica M; Schmitt, Daniel; Caldwell, David S; Kraus, Virginia B; Sims, Ershela L; Shelby, Rebecca A; Rice, John R



Managing pain in the dying patient.  


End-of-life care can be a challenge requiring the full range of a family physician's skills. Significant pain is common but is often undertreated despite available medications and technology. Starting with an appropriate assessment and following recommended guidelines on the use of analgesics, family physicians can achieve successful pain relief in nearly 90 percent of dying patients. Physicians must overcome their own fears about using narcotics and allay similar fears in patients, families and communities. Drugs such as corticosteroids, antidepressants and anticonvulsants can also help to alleviate pain. Anticonvulsants can be especially useful in relieving neuropathic pain. Side effects of pain medications should be anticipated and treated promptly, but good pain control should be maintained. The physical, psychologic, social and spiritual needs of dying patients are best managed with a team approach. Home visits can provide comfort and facilitate the doctor-patient relationship at the end of life. PMID:10695587

Whitecar, P S; Jonas, A P; Clasen, M E



[Pain assessment in patients with dementia].  


Recent literature demonstrates that pain in patients with dementia is often undertreated. This can partially be explained by a lack of training in the possibilities of assessing pain in patients with dementia. Subjective reports are the most valid approach for the assessment of the subjective experience of pain and should therefore be preferred over other methods. The assessment of the context, behavior, and physiological markers is advised if the patient is unable to provide a subjective report. Pain assessment scales are useful for documentation and monitoring. PMID:21932148

Bornemann-Cimenti, H; Wejbora, M; Michaeli, K; Kern-Pirsch, C; Sandner-Kiesling, A



Pain prevalence and pain relief in trauma patients in the Accident & Emergency department  

Microsoft Academic Search

BACKGROUND: Acute pain in the A&E department (ED) has been described as a problem, however insight into the problem for trauma patients is lacking. OBJECTIVE: This study describes the prevalence of pain, the pain intensity and the effect of conventional pain treatment in trauma patients in the ED. METHODS: In a prospective cohort study of 450 trauma patients, pain was

S. A. A. Berben; T. H. J. M. Meijs; R. T. M. van Dongen; A. B. van Vugt; L. C. M. Vloet; J. J. Mintjes-de Groot; T. van Achterberg



Assessment of neuropathic pain in cancer patients  

Microsoft Academic Search

Neuropathic pain is an increasingly common problem facing the cancer patient. Painful neuropathy can come from various sources\\u000a and significantly impact quality of life. The most commonly observed scenario is paraesthesia and dysesthesia as a result\\u000a of toxic effects of chemotherapies on the distal peripheral nerves. Neuropathic pain should be addressed ideally with the\\u000a help of a neuro-oncologist, and it

Deborah T. Blumenthal



Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey  

Microsoft Academic Search

Breakthrough pain (BKP) is a transitory flare of pain that occurs on a background of relatively well controlled baseline pain. Previous surveys have found that BKP is highly prevalent among patients with cancer pain and predicts more severe pain, pain-related distress and functional impairment, and relatively poor quality of life. An international group of investigators assembled by a task force

Augusto Caraceni; Cinzia Martini; Ernesto Zecca; Russell K Portenoy; M. A. Ashby; G. Hawson; K. A. Jackson; N. Lickiss; N. Muirden; M. Pisasale; D. Moulin; V. N. Schulz; M. A. Rico Pazo; J. A. Serrano; H. S. Andersen; H. T. Henriksen; I. Mejholm; P. M. Sjogren; T. Heiskanen; E. Kalso; P. Pere; R. Poyhia; E. Vuorinen; I. Tigerstedt; P. Ruismaki; M. Bertolino; F. Larue; J. Y. Ranchere; G. Hege-Scheuing; I. Bowdler; F. Helbing; E. Kostner; L. Radbruch; K. Kastrinaki; S. Shah; S. Vijayaram; K. S. Sharma; P. S. Devi; P. N. Jain; P. V. Ramamani; A. Beny; C. Brunelli; M. Maltoni; S. Mercadante; R. Plancarte; S. Schug; P. Engstrand; A. F. Ovalle; X. Wang; M. F. Alves; M. R. Abrunhosa; W. Z. Sun; L. Zhang; A. Gazizov; M. Vaisman; S. Rudoy; M. G. Sancho; P. Vila; J. Trelis; P. Chaudakshetrin; M. L. Koh; R. T. M. van Dongen; A. Vielvoye-Kerkmeer; M. V. Boswell; T. Elliott; E. Hargus; L. Lutz



[Postoperative pain management in elderly patient].  


Pain is a common occurrence for the hospitalized elderly, and may often be under recognized and inadequately managed. Insufficient pain management can lead to the sequelae of emotional distress and depression, delirium, anxiety, sleep disturbances, and physical disabilities, as well as increased health care costs. Effective pain management of the older adult begins with pain assessment using the proper tools. Morphine is the analgesic of choice for the older adult, and is appropriate for the postoperative period. It is important to maintain a therapeutic serum level of opioids to prevent inadequate management of the acute pain. Side effects of opioids include hypotension, nausea, mood disturbances, ileus, histamine production, and respiratory depression. The adage for pain treatment in the elderly is "start low and go slow". Paracetamol is commonly prescribed and may be the drug of choice for mild to moderate postoperative pain. Older adults may enjoy the benefits of Patient-Controlled Analgesia and Patient Controlled Epidural Analgesia in the postoperative period; however, thorough and ongoing teaching must occur to ensure understanding and compliance with the therapy. Treating post-procedure pain in the elderly patient requires an understanding of the normal changes associated with aging and the impact on medications, and multimodal analgesia can be the best approach. PMID:17595859

Neagu, St; Tudor, Cristina; Dinc?, V; Costea, R; Minc?, Dana Galieta


Opioid misuse in oncology pain patients.  


The problem of therapeutic opioid misuse largely affects patients who need opioids to treat chronic pain conditions. Opioid misuse is rarely an overt clinical problem during end of life or acute pain treatment. Misuse attaches a stigma to opioid use, and makes many patients and prescribers reluctant to use these uniquely effective drugs, even when misuse is unlikely. Cancer was once an explosive, typically terminal disease and became the prototype for end-of-life opioid pain treatment. However, cancer is no longer such an explosive disease, and many cancer sufferers can now expect to have a prolonged, even normal, lifespan. They may need pain treatment, but this treatment should not be modeled on palliative care paradigms. This article describes the underlying mechanisms of opioid dependence and its progression to addiction, and suggests a cautious approach to opioid treatment of chronic cancer pain that aims to minimize the problem of misuse. PMID:17686391

Ballantyne, Jane C



Pain Predictors in Selected Postoperative Patients.  

National Technical Information Service (NTIS)

This descriptive study described postoperative pain for 106 patients in a midwestern metropolitan hospital undergoing total hip arthroplasty (THA, n = 21), total knee arthroplasty (TKA, n = 44), or microlumbar discectomy (MLD, n = 41); and ascertained fac...

D. F. Degner



Pain and Its Treatment in Patients with Cancer in Korea  

Microsoft Academic Search

Substantial pain is experienced by a lot of patients with cancer, and undertreated pain significantly undermines their quality of life. Despite international and national guidelines on cancer pain management, the practical effectiveness of management is still problematic. We did a prospective cross-sectional survey on pain prevalence, pain intensity, its impact on daily activity, and adequacy of pain management in 823

Myung Soo Hyun; Jae Lyun Lee; Kyung Hee Lee; Ki Young Kwon; Hong Suk Song; Ok Bae Kim; Sang Kyun Sohn; Kyu Bo Lee; Hun Mo Rhu; Gun Wook Park; Dong Gun Shin; Jeong Lim Lee



Good patients cope with their pain: postoperative analgesia and nurses' perceptions of their patients' pain  

Microsoft Academic Search

Patients routinely receive less analgesia postoperatively than they need. Previous attempts to understand this have examined the nurses' attitudes to analgesia and their ability to assess accurately the intensity of their patients' pain. The present study examined three hypotheses derived from an alternative view that undermedication results from patients failing to disclose their difficulty in coping with pain because this

Peter Salmon; Anne Manyande



Pain intensity and severe pain in young immigrant patients with long-standing back pain  

PubMed Central

The aim of this study was to explore if self-rated pain intensity and severe pain differed significantly between immigrants from different regions, and if other socio-economic, or clinical, characteristics could predict severe pain. A total of 129 men and 217 women at a primary health centre in Stockholm, Sweden, 27–45 years, on long-term sick leave, were recruited in consecutive order and grouped into a Turkish (n = 122), Southern European (n = 52), Middle East (n = 69) and one Mixed (n = 173) group of immigrants. All were employed in service jobs. Somatic status, depression and level of psychosocial stressors, including pain anxiety, were established by standardized procedures. All reported long-standing disabling back pain. Patients rated intensity of pain “right now” on a 0–100 mm visual analogue scale (VAS) as a last part of the consultation with two doctors. Severe pain was defined as VAS 75–100. Median values (md) with inter-quartile ranges (IQR) were calculated for interval and ordinal data. Non-parametric statistics were used to calculate significant differences between groups. Crude and age-standardized odds ratios (OR) with 95% confidence intervals (95% CI) as rating severe pain were calculated by binary and forward conditional logistic regression. Men and women were analyzed separately. Women had more tender points, (P < 0.001), and reported pain anxiety more often (P < 0.01). Frequency of depression did not differ between the immigrant groups. The VAS-values varied, but not significantly, between the immigrant groups of men and women. Men had lower VAS values than women (md 50, IQR 36–69 vs. md 72, IQR 51–85), (P < 0.001). Women had a three-fold risk to rate severe pain (OR 2.9, 95% CI 1.8–4.7). By sex, no immigrant group had significantly elevated OR to rate severe pain. Being 40–45 year old doubled the OR as rating severe pain. Men with depression, or little education, had high risks as rating severe pain (age-standardized ORs 4.1; 95% CI 1.7–10.0 and 2.7; 95% CI 1.1–6.8, respectively), and so had depressed women (age-standardized OR 1.9; 95% CI 1.1–3.4). Women with pain anxiety had a doubled, not statistically significant, elevated risk (age-standardized OR 2.0, 95% CI 0.95–4.3). The groups did not differ significantly in pain intensity or severe pain. Severe pain was predicted by depressed mood and probably linked to gender, age and sick roles.

Taloyan, Marina



Drawings of the Opposite Sex: Continued Use of the Draw A Person Test and Young State Hospital Patients  

ERIC Educational Resources Information Center

Indicates that IQ ranking is the most significnat factor affecting Draw A Person test performance by male subjects. IQ rankings were not found to significantly influence drawings by females. (Author/DEP)

Dudley, Harold K.; And Others



Sleep disturbance in orofacial pain patients: pain-related or emotional distress?  


Associations between pain, depression, and sleep disturbance have been documented in several chronic pain patient samples. The current study assessed the prevalence and magnitude of sleep disturbance in a sample of 128 orofacial pain patients referred for clinical evaluation and tested linkages between sleep, depression, anxiety, and pain using cross-sectional and longitudinal data. Seventy-seven percent of the patients reported reduced sleep quantity since pain onset. In cross-sectional analyses, reduced sleep quantity was associated with depression and pain. Reduced sleep quality was associated with negative affect. Longitudinally, initial depression and pain predicted sleep at time two and initial pain predicted negative affect. Sleep did not predict pain. Results support the hypothesis that pain, rather than sleep disturbance, increases negative affect across time, whereas negative affect is more a cause of concurrent reduced sleep quality than is pain. The results highlight the importance of assessing for sleep disturbance in orofacial pain patients. PMID:11842861

Riley, J L; Benson, M B; Gremillion, H A; Myers, C D; Robinson, M E; Smith, C L; Waxenberg, L B



Enhanced dimensional complexity of the EEG during memory for personal pain in chronic pain patients  

Microsoft Academic Search

Associative connections between cortical cell assemblies representing pain-related memories should be stronger and more extensive in subjects with chronic pain. To test this hypothesis, the dimensional complexity of the electroencephalograph (EEG) was examined during the actual experience as well as during memory for pain. Nine chronic pain patients and nine matched healthy controls participated in the study. During acute pain

Werner Lutzenberger; Herta Flor; Niels Birbaumer



Life of pain, life of pleasure: pain from the patients' perspective--the evolution of the PAIN exhibit.  


This commentary describes a person's experience with chronic pain, how his beliefs and understanding of pain resolved, and how he developed coping mechanisms and a focus for his life after developing chronic pain. His realization of how art was the most effective way to describe his pain experience to others and the resulting development of the pain visual arts exhibit PAIN are described. Guidance for clinicians form the patient perspective is provided. PMID:16431832

Collen, Mark



Troponin I in Patients without Chest Pain  

Microsoft Academic Search

Background: Testing for troponin has important clinical value for patients who present with typical symptoms of acute coronary syndromes (ACS) such as chest pain (CP). Much less is known about the value of troponin testing for patients who present with other symptoms of ACS (anginal equivalent symptoms). Methods: The utilization and prognostic value of car- diac troponin I (cTnI) were

Detlef Ritter; Paul A. Lee; James F. Taylor; Leo Hsu; Jerome D. Cohen; Hyung D. Chung; Katherine S. Virgo


The Prevalence of Pain in Patients Attending Sarcoma Outpatient Clinics  

PubMed Central

The prevalence of pain in patients with sarcoma is not well documented. We investigated this in outpatients at a tertiary cancer referral centre, assessing the adequacy of pain control and for risk factors leading to higher prevalence and severity of pain. 149 patients were surveyed. Patients with pain within the previous 7 days completed pain assessment tools (BPI, S-LANSS, PMI). 53% of patients had pain within the previous 7 days, and 25% had significant pain. Of those with pain, 63% was inadequately controlled and neuropathic pain was identified in 36%. Age, gender, tumour type, and the type of cancer treatment were not significant predictors of the prevalence or severity of the pain. Based on our results, patients with sarcoma should be actively screened for pain and have regular reviews of their analgesic requirements.

Kuo, P. Y.; Yen, J. T. C.; Parker, G. M.; Chapman, S.; Kandikattu, S.; Sohanpal, I.; Barbachano, Y.; Williams, J. E.



The prevalence of pain in patients attending sarcoma outpatient clinics.  


The prevalence of pain in patients with sarcoma is not well documented. We investigated this in outpatients at a tertiary cancer referral centre, assessing the adequacy of pain control and for risk factors leading to higher prevalence and severity of pain. 149 patients were surveyed. Patients with pain within the previous 7 days completed pain assessment tools (BPI, S-LANSS, PMI). 53% of patients had pain within the previous 7 days, and 25% had significant pain. Of those with pain, 63% was inadequately controlled and neuropathic pain was identified in 36%. Age, gender, tumour type, and the type of cancer treatment were not significant predictors of the prevalence or severity of the pain. Based on our results, patients with sarcoma should be actively screened for pain and have regular reviews of their analgesic requirements. PMID:21647362

Kuo, P Y; Yen, J T C; Parker, G M; Chapman, S; Kandikattu, S; Sohanpal, I; Barbachano, Y; Williams, J E



Physical and emotional functioning of adult patients with chronic abdominal pain: Comparison with patients with chronic back pain  

Microsoft Academic Search

Adults with chronic abdominal pain remain a poorly defined population, despite the debilitation and depression associated with this therapeutically challenging condition. This study compared patients with chronic abdominal pain with an empirically well-known group of patients with chronic pain (back pain) to investigate similarities and differences in their physical and mental functioning. This retrospective, cross-sectional study included 136 patients with

Cynthia O. Townsend; Christopher D. Sletten; Barbara K. Bruce; Jeffrey D. Rome; Connie A. Luedtke; John E. Hodgson



Somatization symptoms in pediatric abdominal pain patients: Relation to chronicity of abdominal pain and parent somatization  

Microsoft Academic Search

Symptoms of somatization were investigated in pediatric patients with recurrent abdominal pain (RAP) and comparison groups of patients with organic etiology for abdominal pain and well patients. Somatization scores were higher in RAP patients than well patients at the clinic visit, and higher than in either well patients or organic patients at a 3- month followup. Higher somatization scores in

Lynn S. Walker; Judy Garber; John W. Greene



Characteristics of Methadone Maintenance Patients with Chronic Pain  

Microsoft Academic Search

Chronic pain patients who have limited access to opioids may be redirected to methadone maintenance centers for management of their pain. Unfortunately, little information exists on the incidence and characteristics of methadone maintenance patients with chronic pain. The aim of this study was to survey individuals at methadone maintenance centers in order to determine the prevalence of chronic pain and

Robert N. Jamison; Janice Kauffman; Nathaniel P. Katz



A survey of pain in patients with advanced cancer  

Microsoft Academic Search

One hundred eleven patients with advanced cancer and pain newly referred to a palliative care center completed the Brief Pain Inventory (BPI) weekly for up to 4 weeks. The aims were (a) to review the numbers and causes of pain, (b) to consider the usefulness of the BPI in the evaluation of pain in cancer patients, and (c) to determine

Robert Twycross; Jean Harcourt; Stephen Bergl



Effects of Anger Suppression on Pain Severity and Pain Behaviors Among Chronic Pain Patients: Evaluation of an Ironic Process Model  

Microsoft Academic Search

Objective: Evidence for links between anger inhibition or suppression and chronic pain severity is based mostly on studies with correlation designs. Following from ironic process theory, we proposed that attempts to suppress angry thoughts during provocation would increase subsequent pain intensity among chronic low back pain (CLBP) patients, and do so through paradoxically enhanced accessibility of anger. Design: CLBP patients

John W. Burns; Phillip Quartana; Wesley Gilliam; Erika Gray; Justin Matsuura; Carla Nappi; Brandy Wolfe; Kenneth Lofland



Pain Ratings, Psychological Functioning and Quantitative EEG in a Controlled Study of Chronic Back Pain Patients  

Microsoft Academic Search

ObjectivesSeveral recent studies report the presence of a specific EEG pattern named Thalamocortical Dysrhythmia (TCD) in patients with severe chronic neurogenic pain. This is of major interest since so far no neuroscientific indicator of chronic pain could be identified. We investigated whether a TCD-like pattern could be found in patients with moderate chronic back pain, and we compared patients with

Stefan Schmidt; José Raúl Naranjo; Christina Brenneisen; Julian Gundlach; Claudia Schultz; Holger Kaube; Thilo Hinterberger; Daniel Jeanmonod



Real-time assessment of pain behavior during clinical assessment of low back pain patients  

Microsoft Academic Search

The development of procedures for assessing factors that contribute to pain and disability is crucial for clinical and epidemiologic studies. The present paper describes a system for in vivo, real-time assessment of pain behaviors integrated with a standardized physical examination for low back pain patients. The principles for measuring five categories of pain behavior – guarding, touching\\/rubbing, words, sounds and

Kenneth M. Prkachin; Elizabeth Hughes; Izabela Schultz; Peter Joy; David Hunt



Pain Quality Predicts Lidocaine Analgesia among Patients with Suspected Neuropathic Pain  

PubMed Central

Objective Oral sodium channel blockers have shown mixed results in randomized controlled trials despite the known importance of sodium channels in generating pain. We hypothesized that differing baseline pain qualities (e.g. “stabbing” vs “dull”) might define specific subgroups responsive to intravenous (IV) lidocaine—a potent sodium channel blocker. Design A prospective cohort study of 71 patient with chronic pain suspected of being neuropathic were recruited between January 2003 and July 2007 and underwent lidocaine infusions at Stanford University Hospital in a single-blind nonrandomized fashion. Baseline sensory pain qualities were measured with the Short-Form McGill Pain Questionnaire (SF-MPQ). Pain intensity was measured with a visual analog scale (VAS). Results Factor analysis demonstrated two underlying pain quality factors among SF-MPQ sensory items: a heavy pain and a stabbing pain. Baseline heavy pain quality, but not stabbing quality predicted subsequent relief of pain intensity in response to lidocaine. In contrast, these factors did not predict divergent analgesic responses to placebo infusions. In response to each 1 mcg/mL increase in lidocaine plasma level, patients with high heavy pain quality drop their VAS 0.24 (95% CI 0.05–0.43) more points than those with low heavy pain quality (P < 0.013). Conclusions “Heavy” pain quality may indentify patients with enhanced lidocaine responsiveness. Pain quality may identify subgroups among patients with suspected neuropathic pain responsive to IV lidocaine. Further investigation is warranted to validate and extend these findings.

Carroll, Ian R.; Younger, Jared W.; Mackey, Sean C.



The relationship of depression and somatic focus to experimental and clinical pain in chronic pain patients  

Microsoft Academic Search

The present study examined Fields' proposal that depression increases the sensory experience of pain in part through greater somatic focus. Experimental and clinical pain measures were compared to self-report of depression and somatic focus in 60 chronic pain patients. Depression scores were unrelated to pain threshold or tolerance on the cold-pressor test. However, as hypothesized by Fields, path analytic models

Michael E. Geisser; Melodye E. Gaskin; Michael E. Robinson; Anthony F. Greene



Assessment and management of pain in haemophilia patients.  


Haemophilia patients experience acute pain during joint bleeds and chronic pain from haemophilic arthropathy. More than 50% of haemophilia patients have painful joints that cause disability and impair quality of life. Unfortunately, only a few clinical studies have investigated the non-pharmacological or pharmacological treatments for pain or the adverse effects of pain on the health and quality of life of children and adults with haemophilia. There are no detailed algorithms or guidelines for pain management in haemophilia patients, and treatment is largely empirical. Therefore, a standardized approach to the management of pain in haemophilia patients is needed. This approach should include a close relationship between pain specialists and the staffs at haemophilia treatment centres; validated instruments specific to haemophilia for assessing pain, quality of life and disability; and stepwise algorithms/protocols for treatment of chronic vs. acute pain and prophylactic vs early treatment. A pain treatment protocol should include a definition of the problem of pain and best practices for physicians. A call to action is needed to standardize treatment approaches to pain and to develop algorithms/protocols for the management of pain in haemophilia patients. This review will highlight the prevalence and devastating impact of pain in haemophilia patients, currently available treatment options and identify the unmet needs for pain management. PMID:21645179

Riley, R R; Witkop, M; Hellman, E; Akins, S



Pain in ambulatory AIDS patients. I: Pain characteristics and medical correlates  

Microsoft Academic Search

The characteristics and impact of pain were evaluated in a prospective cross-sectional survey of 438 ambulatory AIDS patients recruited from health care facilities in New York City. More than 60% of the patients reported ‘frequent or persistent pain’ during the 2 wks preceding the study. Patients with pain reported an average of 2.5 different pains. On the 0–10 numerical scale

William Breitbart; Margaret V McDonald; Barry Rosenfeld; Steven D Passik; David Hewitt; Howard Thaler; Russell K Portenoy



Intramuscular picenadol in patients with postoperative pain.  


1. The analgesic efficacy and safety of a single 50 mg intramuscular dose of rac-picenadol, a centrally acting agonist-antagonist opioid analgesic, were compared with pethidine (meperidine) 100 mg and placebo in 60 patients with moderate to severe postoperative pain using hourly pain intensity and relief measurements for up to 6 h following injection of the study medications. 2. Both picenadol and pethidine were statistically significantly (P < 0.05) more effective than placebo in reducing pain intensity and in increasing total relief. Patients receiving picenadol and pethidine had higher frequency of somnolence than patients receiving placebo. In addition, patients receiving picenadol 50 mg experienced a higher incidence of confusion (30%), speech disorders (30%), and tremors (25%) than the patients receiving either pethidine or placebo. 3. These results were compared with those of a similar study which investigated the effects of a 25 mg intramuscular dose of picenadol vs pethidine and placebo. This comparison suggests that 25 mg of picenadol is a more acceptable dosage since both 25 and 50 mg were effective dosages. PMID:12959314

Brunelle, R L; Goldstein, D J; George, R E; Zimmerman, D M



Can a patient educational book change behavior and reduce pain in chronic low back pain patients?  

Microsoft Academic Search

Background contextThis study was prompted by 1) the almost universal use of patient education as an initial or at least an ancillary step in the treatment of patients presenting with low back pain, 2) the relative dearth of studies evaluating the effectiveness of patient education and 3) the complete lack of support in the few existing studies for the efficacy

Brian E Udermann; Kevin F Spratt; Ronald G Donelson; John Mayer; James E Graves; John Tillotson



Pain Acceptance Moderates the Relation Between Pain and Negative Affect in Osteoarthritis and Fibromyalgia Patients  

PubMed Central

Background Chronic pain is often intractable despite advanced medical and psychotherapeutic treatments. Pain acceptance is emerging as a promising complement to control-based pain management strategies and a likely approach to maintaining quality of life for chronic pain patients. Purpose This theoretically-based analysis of an existing database examined the extent to which pain acceptance predicted weekly reports of positive affect (PA) and negative affect (NA), and the relations of pain severity to both PA and NA. Methods Participants were women, 35 with osteoarthritis and 75 with fibromylagia, who completed an initial assessment for demographics, pain catastrophizing, and pain acceptance, and 8?12 weekly assessments of pain severity, PA, and NA. Results Multilevel modeling analyses indicated that pain acceptance was related to higher levels of PA but was unrelated to NA. Furthermore, pain acceptance moderated the relation of NA and pain severity, such that expected increases in NA during pain exacerbations were buffered by higher levels of pain acceptance. Conclusions These findings suggest that pain patients with greater capacity to accept pain may be emotionally resilient in managing their condition.

Kratz, Anna L.; Davis, Mary C.; Zautra, Alex J.



I can't find it! Distorted body image and tactile dysfunction in patients with chronic back pain.  


The conscious sense of our body, or body image, is often taken for granted, but it is disrupted in many clinical states including complex regional pain syndrome and phantom limb pain. Is the same true for chronic back pain? Body image was assessed, via participant drawings, in six patients with chronic back pain and ten healthy controls. Tactile threshold and two-point discrimination threshold (TPD) were assessed in detail. All the patients, and none of the controls, showed disrupted body image of the back. Five patients were unable to clearly delineate the outline of their trunk and stated that they could not "find it". TPD was greatly increased in the same zone as the absence or disruption of body image, but was otherwise similar to controls. The disturbance of body image and decrease in tactile acuity coincided with the normal distribution of pain, although there was no allodynia and there was no relationship between resting pain level and TPD. Tactile threshold was unremarkable for patients and controls. These preliminary data indicate that body image is disrupted, and tactile acuity is decreased, in the area of usual pain, in patients with chronic back pain. This finding raises the possibility that training body image or tactile acuity may help patients in chronic spinal pain, as it has been shown to do in patients with complex regional pain syndrome or phantom limb pain. PMID:18786763

Moseley, G Lorimer



Thalamic Pain Syndrome (Central Post-Stroke Pain) in a patient presenting with right upper limb pain: a case report  

PubMed Central

In the elderly, pain of a widespread nature can often be debilitating. It is not uncommon to attribute this widespread pain to osteoarthritis within the spinal column structures and peripheral joints or to other musculoskeletal etiology. However, chiropractors should remain wary regarding pain experienced by the elderly, especially if pain is widespread and exhibits neuropathic features. Common features of neuropathic pain involve the presence of allodynia, hyperpathia and hyperalgesia. This characteristic widespread pain can sometimes be the sequelae of a central nervous system lesion such as a “Thalamic Pain Syndrome”, or “Central Post-Stroke Pain”, which are terms commonly used to describe pain that originates in the central nervous system. Following is the case of a 90-year-old patient presenting with widespread pain attributed to Thalamic Pain Syndrome or Central Post-Stroke Pain. Discussion of the characteristics of neuropathic pain and bedside testing techniques are presented to help the chiropractor identify a patient who may be presenting with Central Post-Stroke Pain.

Tuling, Jeffrey R; Tunks, Eldon



Biobehavioral measures for pain in the pediatric patient.  


Pain is a complex biobehavioral phenomenon. The quantification of pain involves the incorporation of many factors, including physiologic, behavioral, and psychologic factors. Recognition of pain relies heavily on the expression of the patient as well as the interpretation of the caregiver. There are many studies published on biobehavioral pain assessment tools, such as neuroimaging, neuromuscular, biomarker, and behavioral pain assessment scales. These tools present a clinical challenge to appropriately assess and manage pain in the noncommunicative pediatric patients, such as infants, preverbal toddlers, and intubated and/or unconscious or cognitively impaired patients. Pain is a combination of physiologic, behavioral, and psychologic interactions. Any tool that incorporates the measurement of only one of those domains is inherently incomplete in the assessment of pain. Therefore, the purpose of this literature review was to provide a comprehensive overview of these biobehavioral pain assessment tools used in pain assessment in the noncommunicative pediatric population. PMID:22929603

Arif-Rahu, Mamoona; Fisher, Deborah; Matsuda, Yui



Patient Pain in Primary Care: Factors That Influence Physician Diagnosis  

PubMed Central

BACKGROUND The accurate recognition of patient pain is a crucial, but sometimes difficult, task in medical care. This study explored factors related to the physician’s diagnosis of pain in primary care patients. METHODS New adult patients were prospectively randomized to care by primary care providers at a university medical center clinic. Study participants were interviewed prior to the initial visit, and their level of self-reported pain was measured with the Visual Analog Pain Scale and the Medical Outcomes Study Short Form-36. The medical encounter was videotaped in its entirety and later analyzed using the Davis Observation Code to characterize physician practice style. Patient satisfaction was measured immediately after the visit. A review of the medical record was used to assess physician recognition of patient pain. RESULTS For all patients (N = 509), as the amount of pain increased, the percentage of patients having pain diagnosed by the physician also increased. Female patients reported a greater amount of pain than male patients. When women were in severe pain, they were more likely than men to have their pain accurately recognized by their physician. The correct diagnosis of pain was not significantly related to patient satisfaction. Physician practice styles emphasizing technically oriented activities and health behavior discussions were strongly predictive of the physician diagnosing patient pain. CONCLUSIONS The diagnosis of pain is influenced by the severity of patient pain, patient gender, and physician practice style. If the routine use of pain assessment tools is found to be effective in improving physician recognition and treatment of patientspain, then application of these tools in patient care settings should be encouraged.

Bertakis, Klea D.; Azari, Rahman; Callahan, Edward J.



Pain in hemodialysis patients: prevalence, cause, severity, and management  

Microsoft Academic Search

Background: There is growing evidence that dialysis patients have a high burden of symptoms, including pain. However, the prevalence, cause, severity, and management of pain in dialysis patients have not been described. Methods: This prospective cohort study of 205 Canadian hemodialysis (HD) patients describes the prevalence, cause, severity, and management of pain in this population. A chart review for demographic

Sara N Davison



Neuropathic pain in AIDS patients prior to antiretroviral therapy  

Microsoft Academic Search

The human immunodeficiency virus (HIV) has a predilection for nerve tissue; therefore, the peripheral nerves, spinal cord and brain are frequently affected in patients with HIV\\/AIDS, resulting in a high prevalence of neuropathic pain. Neuropathic pain is defined by the International Association for the Study of Pain (IASP) as '… pain initiated or caused by a primary lesion or dysfunction

S A Hitchcock; H P Meyer; E Gwyther



Duloxetine vs. placebo in patients with painful diabetic neuropathy  

Microsoft Academic Search

The aim of this study was to examine the efficacy and safety of duloxetine, a balanced and potent dual reuptake inhibitor of serotonin and norepinephrine, in the management of diabetic peripheral neuropathic pain. Serotonin and norepinephrine are thought to inhibit pain via descending pain pathways. In a 12-week, multicenter, double-blind study, 457 patients experiencing pain due to polyneuropathy caused by

David J. Goldstein; Yili Lu; Michael J. Detke; Thomas C. Lee; Smriti Iyengar



Dysfunctional pain modulation in somatoform pain disorder patients  

Microsoft Academic Search

To date, pain perception is thought to be a creative process of modulation carried out by an interplay of pro- and anti-nociceptive\\u000a mechanisms. Recent research demonstrates that pain experience constitutes the result of top–down processes represented in\\u000a cortical descending pain modulation. Cortical, mainly medial and frontal areas, as well as subcortical structures such as\\u000a the brain stem, medulla and thalamus

Klug StefanieAnderer; Anderer Peter; Saletu-Zyhlarz Gerda; Freidl Marion; Saletu Bernd; Prause Wolfgang; Aigner Martin



Diagnosing patients with longstanding shoulder joint pain  

PubMed Central

Methods: Eighty six patients with longstanding shoulder joint pain were "blindly" examined by two trained doctors using several clinical tests. In all patients an ultrasonographic examination was performed, and in 42 (49%) an arthroscopy. Results: Tests for impingement showed poor to moderate agreement. Tenderness of muscles, muscle weakness, and tests for labral lesion also showed poor agreement. Pain during muscle contraction showed moderate agreement. The agreement of clinical diagnoses was poor and the accuracy was low in comparison with arthroscopy. Ultrasonography was accurate in full thickness supraspinatus tendon tears, but inaccurate for partial tears and labral lesions. Conclusions: Most clinical tests showed poor agreement. Clinical and ultrasonographic diagnoses had low accuracy in comparison with arthroscopy.

Norregaard, J; Krogsgaard, M; Lorenzen, T; Jensen, E



Assessing Patient Pain Scores in the Emergency Department  

PubMed Central

Background: Pain management in the Emergency Department is challenging. Do we need to ask patients specifically about their pain scores, or does our observational scoring suffice? The objective of this study was to determine the inter-rater differences in pain scores between patients and emergency healthcare (EHC) providers. Pain scores upon discharge or prior to ward admission were also determined. Methods: A prospective study was conducted in which patients independently rated their pain scores at primary triage; EHC providers (triagers and doctors) separately rated the patientspain scores, based on their observations. Results: The mean patient pain score on arrival was 6.8 ± 1.6, whereas those estimated by doctors and triagers were 5.6±1.8 and 4.3±1.9, respectively. There were significant differences among patients, triagers and doctors (P< 0.001). There were five conditions (soft tissue injury, headache, abdominal pain, fracture and abscess/cellulites) that were significantly different in pain scores between patients and EHC providers (P<0.005). The mean pain score of patients upon discharge or admission to the ward was 3.3 ± 1.9. Conclusions: There were significant differences in mean patient pain scores on arrival, compared to those of doctors and triagers. Thus, asking for pain scores is a very important step towards comprehensive pain management in emergency medicine.

Baharuddin, Kamarul Aryffin; Mohamad, Nasir; Nik Abdul Rahman, Nik Hisamuddin; Ahmad, Rashidi; Nik Him, Nik Ahmad Shaiffudin



The association of pain with aerobic fitness in patients with chronic low back pain  

Microsoft Academic Search

Wittink H, Hoskins Michel T, Sukiennik A, Gascon C, Rogers W. The association of pain with aerobic fitness in patients with chronic low back pain. Arch Phys Med Rehabil 2002;83:1467-71. Objective: To investigate the association of aerobic fitness ([Vdot ]O2max) with pain intensity as reported by a sample of patients with chronic low back pain (LBP). Design: Cross-sectional with partial

Harriët Wittink; Theresa Hoskins Michel; Andrew Sukiennik; Celeste Gascon; William Rogers



Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain  

Microsoft Academic Search

Temporomandibular disorders (TMD) represent a group of chronic painful conditions involving the muscles of mastication and the temporomandibular joint. We determined whether patients with painful TMD are more sensitive to noxious stimuli than age-matched control subjects. Fifty-two TMD patients (16 with muscle pain and 36 with combined muscle and joint pain) and 23 age-matched and gender-matched volunteers participated. Forearm thermal

William Maixner; Roger Fillingim; Donna Booker; Asgeir Sigurdsson



The effects of self-pain management on the intensity of pain and pain management methods in arthritic patients.  


The aims of this study were to investigate the effects of pain management education on the intensity of pain and frequency of utilization of pain management methods in two groups of patients with arthritis of different pathogenesis and clinical features, and to compare whether a significant difference existed between the two groups. The study was carried out between September 2007 and June 2008 on 30 female patients with gonarthrosis and 30 female patients with rheumatoid arthritis (RA) followed at the rheumatology outpatient clinic of a university hospital. Data on sociodemographic characteristics and those related with the illness were collected using a special survey. Each patient was given information about the features, causes, and treatment of the arthritis and how to cope with pain, emphasizing the importance of pain management methods. The intensity of pain and efficacy of pain management methods were assessed using the McGill Pain Questionnaire and the Pain Management Inventory at baseline and the second and sixth weeks after the education. The SPSS (v15.0) statistical package was used for statistical analysis. After education, significant improvements in pain intensity scores compared with baseline scores were observed in both groups (p < .05), and there was no significant difference between the RA and gonarthrosis groups. Among the various pain management methods, the education program led to significantly more utilization of massaging the painful area, exercising, and using complementary methods to control stress in both groups of patients, and there was no significant difference between the groups. In conclusion, the pain management education given in this study alleviated the intensity of pain and significantly increased the use of some pain management methods in both gonarthrosis and RA cases. PMID:23972864

Parlar, Serap; Fadiloglu, Cicek; Argon, Gulumser; Tokem, Yasemin; Keser, Gokhan



Pain and its treatment in hospitalized patients with metastatic cancer  

Microsoft Academic Search

GoalsThe aim of this prospective study was to assess the quality of pain management hospitalized cancer patients.Patients and methodsIn a quantitative and qualitative evaluation from six oncology centers in Italy, all consecutive cancer patients complaining of pain and hospitalized during the same 2 weeks were requested to fill in a McGill pain questionnaire (MPQ), a present pain intensity scale (PPI),

Stefano Cascinu; Paolo Giordani; Romina Agostinelli; Giampietro Gasparini; Sandro Barni; Giordano D. Beretta; Franca Pulita; Laura Iacorossi; Domenico Gattuso; Marzia Mare; Stefania Munaò; Roberto Labianca; Renata Todeschini; Roberta Camisa; Riccardo Cellerino; Giuseppina Catalano



Perioperative pain control in pediatric patients undergoing orthopaedic surgery.  


Management of perioperative pain is critical in the pediatric patient undergoing orthopaedic surgery. A variety of modalities can be used to manage pain and optimize recovery and patient satisfaction, including nonopioid and opioid analgesia; local anesthetic injection; and regional analgesia such as intrathecal morphine, epidural therapy, and peripheral nerve blocks. Acute pain management can be tailored based on the needs of the patient, the surgical site, and the anticipated level of postoperative pain. A preoperative discussion of the plan for perioperative pain control with the patient, his or her parents, and the anesthesiologist can help manage expectations and maximize patient satisfaction. PMID:23203935

Nowicki, Philip D; Vanderhave, Kelly L; Gibbons, Kathleen; Haydar, Bishr; Seeley, Mark; Kozlow, Kenneth; Bhoopal, Kiran; Gauger, Virginia T



Improving Cancer Pain Management Through Patient and Family Education  

Microsoft Academic Search

The purpose of this study was to determine if continued access to information following a baseline pain education program would increase knowledge and positive beliefs about cancer pain management, thus resulting in improved pain control during a 6-month follow-up period. Patients with cancer-related pain and their primary caregivers received a brief pain education program, and were then randomized into one

Nancy Wells; Joseph T Hepworth; Barbara A Murphy; Debra Wujcik; Rolanda Johnson



Do depression and pain intensity interfere with physical activity in daily life in patients with Chronic Low Back Pain?  

Microsoft Academic Search

Patients with chronic pain may have difficulties estimating their own physical activity level in daily life. Pain-related factors such as depression and pain intensity may affect a patients’ ability to estimate their own daily life activity level. This study evaluates whether patients with Chronic Low Back Pain (CLBP) who are more depressed and\\/or report more pain indeed have a lower

Ivan P. J. Huijnen; Jeanine A. Verbunt; Madelon L. Peters; Philippe Delespaul; Hanne P. J. Kindermans; Jeffrey Roelofs; Marielle Goossens; Henk A. M. Seelen



Memories of pain after burn injury--the patient's experience.  


Pain after burns is a major clinical problem and researchers continue to report that burn pain remains undertreated. Adequate pain management could contribute to the prevention of posttraumatic stress disorder and can give a growing sense of patients' self-confidence and strength. Freedom from pain might be unrealistic, but the objective should be to reduce pain as much as possible. The purpose of this study was to describe burn patients' experiences and memories of pain during burn care and to acquire a deeper understanding of how patients cope with the experience. The study method was qualitative and interviews were conducted with 12 adult burn patients (eight men and four women) 6 to 12 months postburn (mean = 7 months). The mean burn size for the group was 10.6% mean of TBSA and the mean stay in hospital was 16 days. The interviews were analyzed using Kvales' method for structuring analysis. The patients' experiences and memories of pain during the trajectory of care were clearly described by the informants during the interviews. Four themes were identified for pain: becoming aware of pain, allowing oneself to feel pain, different pain experiences, and fragile body surface. Four themes were identified for coping: pragmatic coping, allowing someone to care for you, carrying the pain, and perspectives on the trauma. Both good and bad memories were recorded during the care trajectory, and it is evident that the patient has to carry the pain experience by themselves to a large extent. PMID:20182364

Tengvall, Oili; Wickman, Marie; Wengström, Yvonne


Emergency pulpotomy in relieving acute dental pain among Tanzanian patients  

PubMed Central

Background In Tanzania, oral health services are mostly in the form of dental extractions aimed at alleviating acute dental pain. Conservative methods of alleviating acute dental pain are virtually non-existent. Therefore, it was the aim of this study to determine treatment success of emergency pulpotomy in relieving acute dental pain. Methods Setting: School of Dentistry, Muhimbili National Hospital, Dar es Salaam, Tanzania. Study design: Longitudinal study. Participants: 180 patients who presented with dental pain due to acute irreversible pulpitis during the study period between July and August 2001. Treatment and evaluation: Patients were treated by emergency pulpotomy on permanent posterior teeth and were evaluated for pain after one, three and six week's post-treatment. Pain, if present, was categorised as either mild or acute. Results Of the patients with treated premolars, 25 (13.9%) patients did not experience pain at all while 19 (10.6%) experienced mild pain. None of the patients with treated premolars experienced acute pain. Among 136 patients with treated molars 56 (31%) did not experience any pain, 76 (42.2%) experienced mild pain and the other 4 (2.2%) suffered acute pain. Conclusion The short term treatment success of emergency pulpotomy was high being 100% for premolars and 97.1% for molars, suggesting that it can be recommended as a measure to alleviate acute dental pain while other conservative treatment options are being considered.

Nyerere, Joachim W; Matee, Mecky I; Simon, Elison NM



Changes in Lateral Abdominal Muscle Thickness During an Abdominal Drawing-In Maneuver in Individuals With and Without Low Back Pain  

Microsoft Academic Search

The purpose of this study was to compare lateral abdominal muscle thickness changes in individuals with and without low back pain (LBP) during an abdominal drawing-in maneuver (ADIM) using ultrasound imaging. Twenty individuals (13 females and 7 males, average age 40.1 ± 13.4) with stabilization classification LBP and 19 controls (10 females and 9 males, average age 30.3 ± 8.7)

James R. Beazell; Terry L. Grindstaff; Joseph M. Hart; Eric M. Magrum; Martha Cullaty; Francis H. Shen



Persistent EEG overactivation in the cortical pain matrix of neurogenic pain patients  

Microsoft Academic Search

Functional brain imaging of pain over the last years has provided insight into a distributed anatomical matrix involved in pain processing which includes multiple cortical areas. EEG\\/MEG-based imaging studies have mostly relied on settings of evoked nociception. We report here the spontaneous presence of enhanced activations in the pain matrix of the patient group on the basis of continuous EEG

Jair Stern; Daniel Jeanmonod; Johannes Sarnthein



A Psychometric Evaluation of the Pain Response Preference Questionnaire in a Chronic Pain Patient Sample  

Microsoft Academic Search

Objective: The Pain Response Preference Questionnaire (PRPQ) assesses preferences regarding pain-related social support. The initial factor analytic study of the PRPQ conducted with a nonclinical sample identified scales labeled Solicitude, Management, Suppression, and Encouragement. The first aim of the current study was to evaluate whether these scales would be appropriate for use with chronic pain patients. The construct validity of

Lachlan A. McWilliams; Bruce D. Dick; Kristen Bailey; Michelle J. Verrier; John Kowal



JAMA Patient Page: Steroid Injections to Treat Back Pain  


JAMA PATIENT PAGE Steroid Injections to Treat Back Pain Example of epidural steroid injection for back pain SIDE VIEW (CROSS SECTION) Needle inserted using fluoroscopic guidance Steroid Epidural space Dura (membrane covering spinal cord and ...


Scrambler Therapy for Patients with Cancer Pain - Case Series -  

PubMed Central

More than 80% of cancer patients experience cancer pain. Among them, more than 50% experience moderate to severe pain. To control cancer pain, a variety of methods have been used, including medications and nerve blocks. In some patients, however, it is impossible to perform nerve blocks due to caner metastasis into the epidural space, while in other patients, opioid dose escalation is impossible due to opioid side effects; thus, cancer pain management is difficult. Scrambler therapy is a novel approach for pain control that uses EKG-like pads, which are applied above and below the site of pain. Scrambler therapy synthesizes 16 different types of nerve action potentials that provide "non-pain" information via cutaneous nerves. The advantages of this treatment are that it is non-invasive and safe and has no significant side effects. In this case series, we report the treatment results of using scrambler therapy in three cancer patients with intractable pain.

Park, Hong Sik; Sin, Woo Kyung; Kim, Hye Young; Park, Soo Young; Kim, Yong Chul; Lee, Sang Chul



Scrambler therapy for patients with cancer pain - case series -.  


More than 80% of cancer patients experience cancer pain. Among them, more than 50% experience moderate to severe pain. To control cancer pain, a variety of methods have been used, including medications and nerve blocks. In some patients, however, it is impossible to perform nerve blocks due to caner metastasis into the epidural space, while in other patients, opioid dose escalation is impossible due to opioid side effects; thus, cancer pain management is difficult. Scrambler therapy is a novel approach for pain control that uses EKG-like pads, which are applied above and below the site of pain. Scrambler therapy synthesizes 16 different types of nerve action potentials that provide "non-pain" information via cutaneous nerves. The advantages of this treatment are that it is non-invasive and safe and has no significant side effects. In this case series, we report the treatment results of using scrambler therapy in three cancer patients with intractable pain. PMID:23342211

Park, Hong Sik; Sin, Woo Kyung; Kim, Hye Young; Moon, Jee Youn; Park, Soo Young; Kim, Yong Chul; Lee, Sang Chul



Pain in Patients with Chronic Idiopathic Axonal Polyneuropathy  

Microsoft Academic Search

Background\\/Aims: Pain in patients with chronic idiopathic axonal polyneuropathy (CIAP) has never been studied in detail. The aim of the study was to investigate the pain experienced by patients with CIAP, and to determine whether pain is associated with health-related quality of life (HRQoL). Methods: The McGill Pain Questionnaire (MPQ) and the RAND-36 were used in a cross-sectional study. Results:

Peter G. Erdmann; Frank R. van Genderen; Laurien L. Teunissen; Nicolette C. Notermans; Eline Lindeman; Albert J. M. van Wijck; Nico L. U. van Meeteren



Imaging pain: a potent means for investigating pain mechanisms in patients  

PubMed Central

Summary Chronic pain is a state of physical suffering strongly associated with feelings of anxiety, depression and despair. Disease pathophysiology, psychological state, and social milieu can influence chronic pain, but can be difficult to diagnose based solely on clinical presentation. Here, we review brain neuroimaging research that is shaping our understanding of pain mechanisms, and consider how such knowledge might lead to useful diagnostic tools for the management of persistent pain in individual patients.

Lee, M. C.; Tracey, I.



Management of shoulder pain in patients with stroke  

PubMed Central

Shoulder pain affects from 16% to 72% of patients after a cerebrovascular accident. Hemiplegic shoulder pain causes considerable distress and reduced activity and can markedly hinder rehabilitation. The aetiology of hemiplegic shoulder pain is probably multifactorial. The ideal management of hemiplegic stroke pain is prevention. For prophylaxis to be effective, it must begin immediately after the stroke. Awareness of potential injuries to the shoulder joint reduces the frequency of shoulder pain after stroke. The multidisciplinary team, patients, and carers should be provided with instructions on how to avoid injuries to the affected limb. Foam supports or shoulder strapping may be used to prevent shoulder pain. Overarm slings should be avoided. Treatment of shoulder pain after stroke should start with simple analgesics. If shoulder pain persists, treatment should include high intensity transcutaneous electrical nerve stimulation or functional electrical stimulation. Intra-articular steroid injections may be used in resistant cases.???Keywords: shoulder pain; stroke

Walsh, K



Pain beliefs and perceived physical disability of patients with chronic low back pain  

Microsoft Academic Search

Cognitive–behavioural therapy and maintenance of exercise have emerged as major tools in the treatment of patients with chronic low back pain. Patients' beliefs about their problem may influence their uptake of and responses to particular treatment modalities. In particular, we hypothesised that patients' beliefs about the cause and treatment of pain may mediate changes in physical disability following participation in

David Andrew Walsh; Jenny Clare Radcliffe



Abdominal pain in patients with acquired immune deficiency syndrome.  

PubMed Central

The patient with acquired immune deficiency syndrome (AIDS) and abdominal pain presents the surgeon with a difficult challenge. The pain may be due to an opportunistic infection, ileus, organomegaly, or a true surgical emergency. The hospital records of 235 patients with AIDS were reviewed. Of the 29 patients with abdominal pain, 12 had infectious diarrhea, eight were diagnosed as having ileus or organomegaly, and nine had miscellaneous causes for their pain. Only five patients underwent laparotomy. Two patients were operated on for pain associated with bleeding (Meckel's diverticulum and intestinal Kaposi's sarcoma); one had a perforated duodenal ulcer and one had severe ileitis. One patient was electively operated on for Burkitt's lymphoma. Laparotomy for abdominal pain is not usually necessary in patients with AIDS. Specific recommendations for evaluation and management of these patients are offered. Images FIG. 1. FIG. 2. FIG. 3. FIG. 4.

Barone, J E; Gingold, B S; Arvanitis, M L; Nealon, T F



Efficacy of Duloxetine in Patients with Chronic Pain Conditions  

PubMed Central

The primary objective of this study is to review the efficacy of duloxetine in treating chronic pain using the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) recommendations for clinical significance across chronic pain states. These include pain intensity, patient ratings of overall improvement, physical functioning, and mental functioning. This review comprised the side-by-side analyses of 12 double-blind, placebo-controlled trials of duloxetine in patients with chronic pain (diabetic peripheral neuropathic pain, fibromyalgia, chronic pain due to osteoarthritis, and chronic low back pain). Patients received duloxetine (60 to 120 mg/day) or placebo. Average pain reduction was assessed over 3 months as the primary efficacy outcome. Other measures used were physical function and Patient Global Impression of Improvement. In 10 of the 12 studies, statistically significant greater pain reduction was observed for duloxetine- compared with placebo-treated patients. The response rates based on average pain reduction, improvement of physical function, and global impression were comparable across all 4 chronic pain states. Compared with patients on placebo, significantly more patients treated with duloxetine reported a moderately important pain reduction (?30% reduction) in 9 of the 12 studies, a minimally important improvement in physical function in 8 of the 12 studies, and a moderately important to substantial improvement in Patient Global Impression of Improvement rating in 11 of the 12 studies. The analyses reported here show that duloxetine is efficacious in treating chronic pain as demonstrated by significant improvement in pain intensity, physical functioning, and patient ratings of overall improvement.

Skljarevski, Vladimir; Zhang, Shuyu; Iyengar, Smriti; D'Souza, Deborah; Alaka, Karla; Chappell, Amy; Wernicke, Joachim



Pain management among medical in-patients in Blantyre, Malawi  

PubMed Central

Background Pain is a leading symptom which influences patients to seek medical attention. The management of pain among patients attending in-patient care in southern African countries has been little described. Information regarding the prevalence of pain and the quality of its management may be useful in guiding clinical decisions, training of health workers and health care quality improvements. Methods A hospital-based audit was conducted to estimate the prevalence of pain and examine the quality of its management among patients admitted to adult medical wards at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi in 2004. Data were abstracted from ward charts of consecutive patients' who had been either been discharged or had died within a specified period. Characteristics of interest included; socio-demographic data, presence or absence of pain at admission, characterization or description of pain when present, and drug treatment given. Data were analyzed to obtain frequencies and proportions of the characteristics and assess the prevalence of pain and quality of care. Results A total of 121 patients' case notes were reviewed and the prevalence of pain was recorded for 91 (75.2%) of the patients. Clinicians had recorded pertinent information regarding pain management with the following frequency: pain severity or intensity 5/91 (5.5%), alleviating factors 5 (5.5%), pain radiation 7 (7.7%), exacerbating factors in 9 (9.9%) and periodicity in 43 (47.3%) of the cases. Males with pain were more than 3 times more likely to receive analgesic as compared to females, p < 0.01. Paracetamol was the commonest analgesic prescribed. Conclusion Inadequate management of pain among patients attending medical wards at QECH was found. There is need for prospective studies to further characterize pain management and identify pain management gaps in Malawi. Interviews of clinicians and documentation of observations within clinical practice are likely to be of value.

Muula, Adamson S; Misiri, Humphreys E



Neuropathic pain and use of PainDETECT in patients with fibromyalgia: a cohort study  

PubMed Central

Backround Fibromyalgia has a plethorae of symptoms, which can be confusing and even misleading. Accurate evaluation is necessary when patients with fibromyalgia are treated. Different types of instruments are available for the clinicians to supplement evaluation. Our objective was to study the applicability of the PainDETECT instrument to screen neuropathic pain in patients with fibromyalgia. Methods 158 patients with primary fibromyalgia underwent a neurological examination including bedside sensory testing. They also fulfilled four questionnaires: PainDETECT, Beck depression inventory IA (BDI IA), Fibromyalgia Impact Questionnaire (FIQ) and a self-made questionnaire regarding present pain and pain relieving methods of the patients. The results of the clinical evaluation and questionnaires were then compared. Results Clinically verified neuropathic pain was diagnosed in 53/158 [34% (95% Cl: 26 to 41)] patients. The ROC curve achieved a maximum Youden´s index at score of 17 when sensitivity was 0.79 (95% Cl: 0.66 to 0.89) and specificity 0.53 (95% Cl: 0.43 to 0.63). The PainDETECT total score (OR: 1.14 95% Cl: 1.06 to 1.22), FM as the worst current pain (OR: 0.31; 95% 0.16 to 0.62), body mass index (BMI) (OR: 1.05; 95% Cl: 1.00 to 1.11) and the intensity of current pain (OR: 1.20; 95% Cl: 1.01 to 1.41) were significantly associated with the presence of neuropathic pain in univariate analyses. Conclusion This study highlights the importance of thorough clinical examination. The Neuropathic pain screening tool PainDETECT is not as useful in patients with fibromyalgia as in patients with uncompromised central pain control.



Background pain in burn patients: routine measurement and recording of pain intensity in a burn unit.  


It goes without saying that pain following a burn must be treated but it is not so evident to measure and document the intensity of pain and the efficacy of treatment. Since 1994 the authors have routinely measured background pain, that is, at rest, along with temperature and pulse rate. For analysis and quality assessment a relational database programme is used in the ward. In this paper the authors' experience is reported from a consecutive series of 98 patients with burn injuries who assessed the intensity of pain on a visual analogue scale. There were great intra- and inter-individual variations in pain intensity. Highest values were found during the first week of treatment when female patients experienced pain more intensively than male. For other time periods there was no statistical significant difference between the sexes. Pain intensity and severity of burn was not related except during the second week when patients with major burns had a tendency to express more pain than moderate burns. Measurement of background pain along with other routine registrations is easy and not time-consuming. Patients needing intensified pain treatment can be identified. For research and quality assessment a computerized patient register is of great help. PMID:9725686

Jonsson, C E; Holmsten, A; Dahlström, L; Jonsson, K



Changes after Multidisciplinary Pain Treatment in Patient Pain Beliefs and Coping Are Associated with Concurrent Changes in Patient Functioning  

PubMed Central

Little is known about how patient functioning changes after completion of multidisciplinary pain programs, and what factors are associated with such changes when they occur; for example, whether improvement or deterioration in functioning corresponds to changes in patient beliefs and coping during this period. The objective of this study was to examine the extent to which changes in patient pain and functioning were associated with changes in beliefs and coping after multidisciplinary pain treatment. Patients with chronic pain (N = 141) completed outcome (pain, functioning) and process (beliefs, catastrophizing, coping) measures at the end of multidisciplinary pain treatment and 12 months posttreatment. On average, patients reported similar levels of pain at both times, but showed a small worsening in disability and depression outcomes between posttreatment and follow-up, which were associated significantly with concurrent changes in the process measures. In particular, increased belief in oneself as disabled by pain, catastrophizing, and increased use of resting, guarding and asking for assistance in response to pain were linked with increased disability and depression. Decreased perceived control over pain was also consistently associated with worsening of these outcomes. The results highlight the potential importance of specific pain-related beliefs and coping responses in long-term patient pain and adjustment. Research is needed to determine whether booster interventions after the end of intensive multidisciplinary treatment that target these beliefs and coping responses improve long-term outcomes.

Jensen, Mark P.; Turner, Judith A.; Romano, Joan M.



Daily Interpersonal Events in Pain Patients  

PubMed Central

Action theory proposes that individuals actively shape and then respond to their environments, highlighting the role of stable person characteristics in the development and maintenance of life’s interpersonal difficulties. In this study, we adopted the action perspective in our examination of the daily lives of chronic pain patients with rheumatoid arthritis. Our evaluation of patients’ daily diary reports indicated that individuals played a more prominent role in shaping their positive versus their negative social worlds. The contribution of symptoms of ill health and demographic characteristics, as well as personality attributes were also examined as stable factors that predicted exposure to and appraisal of events. In addition to between-person measures, day to day variations in illness symptoms also played a key role in predicting their social experinces. Together, these findings suggest that stable person characteristics and within-person fluctuations in ill health are each tied to daily interpersonal experiences for those in chronic pain. More broadly, they point to the value of capturing the experiences of individuals intensively over time, an approach that can help to elaborate the contributions of both stable factors and circumstance in shaping our social contexts.

Davis, Mary C.; Affleck, Glenn; Zautra, Alex J.; Tennen, Howard



Peripheral and electrocortical responses to painful and non-painful stimulation in chronic pain patients, tension headache patients and healthy controls  

Microsoft Academic Search

Sixteen chronic back pain (CBP) patients, 16 tension headache (THA) patients and 16 healthy controls (HC) were exposed to four series of ten electric stimuli at perception threshold, pain threshold and 10% below pain tolerance. The EEG was recorded from three sites, in addition, the EMG from the m. frontalis and m. erector spinae, heart rate and skin conductance were

Herta Flor; Martin Diers; Niels Birbaumer



Post-operative painPatients' pain experience following oral mucosal biopsy under local anaesthesia  

Microsoft Academic Search

Objective To examine the incidence and severity of post-operative pain and use of analgesics following biopsy of oral mucosal lesions.Design A patient survey using a self-completed pain diary.Subjects and Methods Seventy-six patients attending an oral medicine clinic for investigation of oral mucosal disease recorded overall and worst pain experiences and analgesic usage over 7 post-operative days following biopsy using visual

H P O Kearns; P-J Lamey; B E McCartan



Presleep Cognitions in Patients with Insomnia Secondary to Chronic Pain  

Microsoft Academic Search

This study had two primary objectives: (1) characterize the content of presleep cognitions of chronic pain patients and (2) evaluate the association between presleep cognitions and sleep disturbance. Thirty-one outpatients with benign chronic pain completed the Beck Depression Inventory, pain and sleep diaries and participated in an in vivo, presleep thought sampling procedure for 1 week in their homes. The

M. T. Smith; M. L. Perlis; T. P. Carmody; M. S. Smith; D. E. Giles



Pain insensitivity in the relatives of schizophrenia patients  

Microsoft Academic Search

The psychiatric literature contains anecdotal reports of diminished pain sensitivity in schizophrenia that date back to Kraepelin. Yet, the phenomenon of pain insensitivity in schizophrenia remains largely unstudied. For example, it is not clear if pain insensitivity is a consequence of the illness or if it is also present in the well relatives of schizophrenia patients. To explore this issue,

Jill M Hooley; Margarita L Delgado



The Colour of Pain: Can Patients Use Colour to Describe Osteoarthritis Pain?  


OBJECTIVE: The aim of the present study was to explore patients' views on the acceptability and feasibility of using colour to describe osteoarthritis (OA) pain, and whether colour could be used to communicate pain to healthcare professionals. METHODS: Six group interviews were conducted with 17 patients with knee OA. Discussion topics included first impressions about using colour to describe pain, whether participants could associate their pain with colour, how colours related to changes to intensity and different pain qualities, and whether they could envisage using colour to describe pain to healthcare professionals. RESULTS: The group interviews indicated that, although the idea of using colour was generally acceptable, it did not suit all participants as a way of describing their pain. The majority of participants chose red to describe high-intensity pain; the reasons given were because red symbolized inflammation, fire, anger and the stop signal in a traffic light system. Colours used to describe the absence of pain were chosen because of their association with positive emotional feelings, such as purity, calmness and happiness. A range of colours was chosen to represent changes in pain intensity. Aching pain was consistently identified as being associated with colours such as grey or black, whereas sharp pain was described using a wider selection of colours. The majority of participants thought that they would be able to use colour to describe their pain to healthcare professionals, although issues around the interpretability and standardization of colour were raised. CONCLUSIONS: For some patients, using colour to describe their pain experience may be a useful tool to improve doctor-patient communication. Copyright © 2013 John Wiley & Sons, Ltd. PMID:23495128

Wylde, Vikki; Wells, Victoria; Dixon, Samantha; Gooberman-Hill, Rachael



[Pain analysis is vital in rheumatic diseases. The pain is often the patient's worst problem].  


The article consists of a synthesis of a rheumatic pain symposium held at the annual meeting of the Swedish Medical Association in 1996. Various aspects of pain in rheumatic diseases were discussed, such as physiological, neurohumoral and neurogenic mechanisms, sensory stimulation treatment, differentiation of mechanical and inflammatory pain, quality enhancement by improved cooperation between primary and tertiary care facilities, pharmacological treatment with (centrally and peripherally acting) opioids, selective cyclo-oxygenase inhibitors, and NMDA (N-methyl-D-aspartate) receptor antagonists. The aim of the symposium, with its focus on the manifest pain problem, was to improve our knowledge and skill in the understanding and treatment of this large patient category. For patients with rheumatic disorders exacerbated by pain problems, as for other patients, a pain diagnosis is of fundamental importance. This can be achieved by analysis of the social, psychological, physiological and medical factors contributing to the cause and degree of pain and to pain behaviour, and of the extent to which the pain may be nociceptive (i.e., inflammatory, mechanical, or ischaemic in origin), neurogenic or idiopathic. Pain analysis should be followed by individualised treatment focused on the patient's most crucial problems, thus enhancing the prospect of optimal treatment outcome. PMID:9542822

Nisell, R; Arnér, S; Ekblom, A; Hansson, P; Lundeberg, T; Németh, G; Petersson, I



Mood spectrum in patients with different painful temporomandibular disorders.  


The purpose of this study was to investigate for difference in the prevalence of mood disorders between patients with different painful temporomandibular disorders (TMD). After a sample size necessary for the study was calculated, 60 patients with a painful TMD were selected and divided into the following groups: myofascial pain (n=20), temporomandibular joint (TMJ) pain (n=18), combined myofascial and TMJ pain (n=22). Two distinct comparison groups were selected: subjects with a nonpainful TMD (n=25) and TMD-free subjects (n=29). All participants filled out a self-report validated instrument (MOODS-SR) to evaluate psychopathological symptoms related to mood disturbances. A one-way analysis of variance (ANOVA) with Bonferroni's post hoc test for multiple comparisons was performed to investigate for significant differences among the groups. The three groups of patients with painful TMD scored significantly higher than comparison groups in all MOODS-SR domains investigating depression, but no difference was shown between subjects with myofascial pain and those with TMJ pain. No significant differences among the groups emerged for the presence of manic symptoms, indicating that depressive disorders associated with TMD are not an expression of a more complex manic depressive illness. The study concluded that the presence of depressive symptoms in TMD patients seems to be related to the presence of a painful condition and seems to be unrelated to the location of pain. Furthermore, depressive disturbances in painful TMD patients affect the whole spectrum of depressive psychopathology. PMID:15293779

Manfredini, Daniele; di Poggio, Adolfo Bandettini; Romagnoli, Mario; Dell'Osso, Liliana; Bosco, Mario



Subgrouping Patients With Low Back Pain  

PubMed Central

Context: Low back pain (LBP) is a prevalent condition imposing a large socioeconomic burden. Despite intensive research aimed at the efficacy of various therapies for patients with LBP, most evidence has failed to identify a superior treatment approach. One proposed solution to this dilemma is to identify subgroups of patients with LBP and match them with targeted therapies. Among the subgrouping approaches, the system of treatment-based classification (TBC) is promoted as a means of increasing the effectiveness of conservative interventions for patients with LBP. Evidence acquisition: MEDLINE and PubMed databases were searched from 1985 through 2010, along with the references of selected articles. Results: TBC uses a standardized approach to categorize patients into 1 of 4 subgroups: spinal manipulation, stabilization exercise, end-range loading exercise, and traction. Although the TBC subgroups are in various stages of development, recent research lends support to the effectiveness of this approach. Conclusions: While additional research is required to better elucidate this method, the TBC approach enhances clinical decision making, as evidenced by the improved clinical outcomes experienced by patients with LBP.

Hebert, Jeffrey J.; Koppenhaver, Shane L.; Walker, Bruce F.



Pain Relief and Functional Recovery in Patients with Complex Regional Pain Syndrome after Motor Cortex Stimulation  

Microsoft Academic Search

In addition to pain and neurovegetative symptoms, patients with severe forms of complex regional pain syndrome (CRPS) develop a broad range of symptoms, including sensory disturbances, motor impairment and dystonic posturing. While most patients respond to medical therapy, some are considered refractory and become surgical candidates. To date, the most commonly used surgical procedure for CRPS has been spinal cord

Erich Talamoni Fonoff; Clement Hamani; Daniel Ciampi de Andrade; Lin Tchia Yeng; Marco Antonio Marcolin; Manoel Jacobsen Teixeira



Tactile, thermal and pain sensibility in burned patients with and without chronic pain and paresthesia problems  

Microsoft Academic Search

Abnormal return of cutaneous sensibility is common after burn injuries and many patients complain of painful and\\/or paresthetic sensations in their healed wounds. However, little is known about the exact nature and severity of these problems. The present study was designed to provide a quantitative evaluation of the cutaneous sensibility in burned patients. Tactile, thermal and pain thresholds were measured

Annie Malenfant; Robert Forget; Rhonda Amself; Jacques Papillon; Jean-Yves Frigon; Manon Choinièrea



[Diagnostic subgroups and psychosocial characteristics in chronic non-malignant pain patients referred to an out-patient pain center].  


The purpose of this study is to describe an out-patient Pain Center population on the basis of IASP Classification of Chronic Pain. Furthermore, the study investigates the relationship between diagnostic subgroups of chronic non-malignant pain patients and psychosocial parameters. The average age of the patients was 42 and the mean age at the onset of pain was 34.2. In the present study about x of all the patients had severe pain with a duration of 48 months (median value), patients with dysfunctional pain, one of three diagnostic subgroups, had a significantly longer pain duration (80 months). Nearly (1/3) of all patients are not able to work regularly and 85 % felt impaired in their daily work activities. Nearly (1/3) of the patients without any somatic pathological findings had at least one invasive intervention, just like the patients in the other diagnostic subgroups, and the need-controlled pain medication reached its highest level in this group (45 %). Only 19 % of the 323 patients investigated had nociceptive-neuropathic pain complaint, whereas 53 % were suffering from dysfunctional, and 28 % had a somatoform pain disorder. So, in patients suffering from chronic pain, simultaneous somatic and psychic or psychosomatic diagnostics are indispensable due to the relevance of psychic and psychosocial factors to pain genesis, modulation and persistence. For patients in each of the described subgroups additional psychological factors such as attitudes, beliefs, self-efficacy, fear-avoidance beliefs and motivational factors always have a significant influence on the persistence of chronic pain syndromes. So, as a rule, to make a reliable diagnosis and to give a profound prognosis for the course of treatment, a close interdisciplinary cooperation is required. PMID:12355344

Nickel, Ralf; Egle, Ulrich T; Schwab, Rainer


Patient empowerment and choice in chronic pain management.  


Service provision and access to pain services vary considerably in the UK, with only a small percentage of people with chronic pain accessing specialist services. Government policy supports giving patients more choice and control over their care. Empowerment involves ensuring patients have the knowledge, skills, attitudes and self-awareness to improve the quality of their lives. As most healthcare professionals provide care to people with chronic pain at some point, it is their responsibility to prepare patients to make informed decisions about their treatment. Empowering patients to self-manage their chronic pain can lead to improved person-centred outcomes. PMID:21560709

Barrie, Janette


Thalamic EEG recordings in patients with chronic pain  

Microsoft Academic Search

Thalamic EEG recordings were made in 10 patients; the therapeutic goal of the implantation was the electrical stimulation treatment for pain. The patients' ages ranged from 37 to 72 years; seven patients had thalamic pain (Dejerine-Roussy syndrome), two had chronic spinal arachnoiditis and one had facial anaesthesia dolorosa.

G. Gficer; E. Niedermeyer; D. M. Long



Painful crises in sickle cell disease--patients' perspectives  

Microsoft Academic Search

One hundred and two patients returned structured questionnaires sent to clinics for sickle cell disease in the United Kingdom in order to gain greater insight into the patients' perception of painful crises. Most patients who suffer pain crises experience a prodromal stage that should be investigated further to find out if prophylaxis is possible. Cold, exertion, and tiredness were the

N. Murray; A. May



MDCT in Early Triage of Patients with Acute Chest Pain  

Microsoft Academic Search

OBJECTIVE. Current risk stratification of patients with acute chest pain but normal initial cardiac enzymes and nondiagnostic ECG is inefficient. We sought to determine whether con- trast-enhanced MDCT-based detection of stenosis is feasible and improves early and accurate triage of patients with acute chest pain. SUBJECTS AND METHODS. We studied 40 patients (53% men; mean age, 57 ± 13 years)

Udo Hoffmann; Antonio J. Pena; Fabian Moselewski; Maros Ferencik; Suhny Abbara; Ricardo C. Cury; Claudia U. Chae; John T. Nagurney


Acupuncture in Patients With Chronic Low Back Pain  

Microsoft Academic Search

Background: Acupuncture is widely used by patients with low back pain, although its effectiveness is un- clear. We investigated the efficacy of acupuncture com- pared with minimal acupuncture and with no acupunc- ture in patients with chronic low back pain. Methods: Patients were randomized to treatment with acupuncture, minimal acupuncture (superficial needling at nonacupuncture points), or a waiting list control.

A Randomized Controlled Trial; Benno Brinkhaus; Claudia M. Witt; Susanne Jena; Klaus Linde; Andrea Streng; Stefan Wagenpfeil; Dominik Irnich; Heinz-Ulrich Walther; Dieter Melchart; Stefan N. Willich



Oral and maxillofacial surgery in patients with chronic orofacial pain  

Microsoft Academic Search

Purpose: In this investigation, we evaluated a population of patients with chronic orofacial pain who sought treatment at a pain center in an academic institution. These patients were evaluated with respect to 1) the frequency and types of previous oral and maxillofacial surgery procedures, 2) the frequency of previous significant misdiagnoses, and 3) the number of patients who subsequently required

Howard A. Israel; John Desmond Ward; Brenda Horrell; Steven J. Scrivani



Associations between Pain and Current Smoking Status among Cancer Patients  

PubMed Central

There is growing empirical and clinical interest in purported associations between smoking and the aggravation of cancer symptoms and treatment side effects, such as pain. Both pain and smoking are highly prevalent among persons with cancer, and there is recent evidence to suggest that cancer patients who continue to smoke despite their diagnosis experience greater pain than nonsmokers. Accordingly, the main goal of this cross-sectional study was to examine associations between multiple levels of smoking status and several pain-related outcomes among a sample of 224 cancer patients about to begin chemotherapy. Patients completed self-report measures of pain severity, pain-related distress, and pain-related interference, as well as a demographics questionnaire. Results indicated that persons who continued to smoke despite being diagnosed with cancer reported more severe pain than never smokers, F (2, 215) = 3.47, p < .05. Current smokers also reported greater interference from pain than either former or never smokers, F (2, 215) = 5.61, p < .01. Among former smokers, an inverse relation between pain severity and the number of years since quitting smoking was observed, r (104) = ?.26, p < .01. These data suggest that continued smoking despite a cancer diagnosis is associated with greater pain severity and interference from pain; however, future research is warranted to determine the directionality of this relationship.

Ditre, Joseph W.; Gonzalez, Brian D.; Simmons, Vani N.; Faul, Leigh Anne; Brandon, Thomas H.; Jacobsen, Paul B.



Spatial Summation of Mechanically Evoked Muscle Pain and Painful Aftersensations in Normal Subjects and Fibromyalgia Patients  

PubMed Central

Impulse frequency and number of recruited central neurons are relevant for pain encoding and temporal as well as spatial summation of pain (SSP). Whereas SSP of heat-induced pain is well characterized, mechanical SSP (MSSP) has been less studied. MSSP may be relevant for chronic pain conditions like fibromyalgia (FM) and play an important role in the pathogenesis of this chronic pain syndrome. Our study was designed to determine MSSP in twelve normal controls (NC) and eleven FM subjects. MSSP testing consisted of 5sec supratheshold pressure-pain stimulations of forearm muscles by up to three identical probes (separated by 4cm or 8cm). The stimulated areas ranged between 0.79cm2 and 2.37cm2. The subjects rated the pain intensity of mechanical stimuli as well as pain aftersensations. Although MSSP increased monotonically in NC and FM subjects, pressure pain and pressure pain aftersensations were greater in FM subjects and highly associated with clinical pain intensity (r2= .44 to .64), suggesting that spatial and temporal summation factors may contribute to overall clinical pain. However, despite higher experimental pain ratings, the magnitude of MSSP was not statistically different between NC and FM subjects. Furthermore, muscle stimuli elicited more MSSP when separated by 8cm than 4cm and this finding was not different between NC and FM subjects. Thus, mechanisms of MSSP were similar for both FM and NC subjects. The important role of MSSP for pain encoding suggests that decreasing pain in some muscle areas by local anesthetics or other means, may improve overall clinical pain of FM patients.

Staud, Roland; Koo, Euna; Robinson, Michael E.; Price, Donald D.



Factors affecting self-efficacy and pain intensity in patients with chronic musculoskeletal pain seen in a specialist rheumatology pain clinic  

Microsoft Academic Search

Objective. Chronic musculoskeletal pain is a very common and costly health problem. Patients presenting to rheumatology clinics with chronic pain can be difficult to manage. We studied 354 patients referred to a rheumatology chronic pain clinic over 5 yrs to identify factors affecting their self-efficacy and intensity of pain. Methods. We collected data for each patient, covering demographic and psychosocial

A. Rahman; E. Reed; M. Underwood; M. E. Shipley; R. Z. Omar



Prediction of postoperative pain after percutaneous nephrolithotomy: can preoperative experimental pain assessment identify patients at risk?  


Postoperative pain remains a significant problem and the individual variance in postoperative pain is not fully understood. In recent years, there has been focus on identifying risk factors predicting patients with high postoperative pain intensity or consumption of analgesics, which may facilitate an improvement in rehabilitation. This study evaluates the relationship between preoperative experimental pain assessment and postoperative pain and opioid consumption. Forty-four patients with uni- or bilateral kidney stone disease scheduled for percutaneous nephrolithotomy were included. The preoperative pain thresholds were measured using electrical (single and 5 repeated) and pressure pain stimulation over the flank bilaterally (stone-side = operation side and control-side = non-operation side). Postoperative pain scores were recorded on a numerical rating scale and analgesic consumption was registered. The responses to repeated electrical stimuli (temporal summation) were preoperatively increased on the stone-side compared to the control-side (P = 0.016). Preoperative electrical pain thresholds from the control-side correlated inversely with postoperative opioid consumption (single stimuli: ? = -0.43, P < 0.01; repeated stimuli: ? = -0.45, P < 0.005). This correlation was more pronounced for the 22 patients with unilateral renal calculi (single stimuli: ? = -0.54, P < 0.02; repeated stimuli: ? = -0.58, P < 0.01). There were no other correlations between the preoperative sensory tests and postoperative pain or opioid consumption. This study showed a correlation between the preoperative electrical pain thresholds on the control-side and postoperative opioid consumption after percutaneous nephrolithotomy. Preoperative measurement of the electrical pain thresholds may, therefore, be useful as a screening tool to identify patients at high risk of postoperative pain. PMID:23503880

Pedersen, Katja Venborg; Olesen, Anne Estrup; Osther, Palle Jørn Sloth; Arendt-Nielsen, Lars; Drewes, Asbjørn Mohr



Investigating patient characteristics on pain assessment using virtual human technology.  


Pain assessment and treatment is challenging and can be influenced by patient demographic characteristics. Few research studies have been able to specifically examine these influences experimentally. The present study investigated the effects of patients' sex, race, age, and pain expression on healthcare students' assessment of pain and pain-related sequelae using virtual human (VH) technology. A lens model design was employed, which is an analogue method for capturing how individuals use environmental information to make judgments. In this study, decision-making policies were captured at the nomothetic and idiographic level. Participants included 107 healthcare students who viewed 32 VH patients that differed in sex, race, age, and pain expression in an online study. Participants provided ratings on a 100-point scale on the VH pain intensity, pain unpleasantness, negative mood, coping, and need for medical treatment. Nomothetic analyses revealed that female, African-American, older, and high pain expression VH were rated higher than male, Caucasian, younger, and low pain expression VH, respectively, on most of the five ratings. Idiographic analyses revealed detailed findings for individuals' decision-making policies. VH technology and the lens model design were shown to be highly effective in examining individuals' decision-making policies. Pain assessment often varied among individuals based on patient demographic and facial expression cues. This study could serve as a model for future investigations of pain assessment and treatment in healthcare students and providers. PMID:20435492

Stutts, Lauren A; Hirsh, Adam T; George, Steven Z; Robinson, Michael E



Comparison of patients with orofacial pain of different diagnostic categories.  


The authors compared the pain intensity and difficulty experienced in performing activities of daily living (ADL) among 237 patients with orofacial pain. The patients underwent comprehensive examinations and recorded their subjective symptoms on a form (five items for pain intensity and six for ADL-related difficulty). On the basis of the primary diagnosis, the patients were divided into the temporomandibular joint dysfunction (TMJ), myofascial pain (MP), neuropathic pain (NP), and fibromyalgia (FM) groups. The intensity of pain in the jaw/face, tightness in the jaw/face, pain in the neck, and toothache significantly differed among the groups (p < 0.01, Kruskal-Wallis test). Compared to other patients, the FM and NP groups reported greater pain intensity, whereas those in the TMJ group reported lesser pain intensity. The ADL-related difficulty was not significantly different among the groups. Thus, compared to pain due to joint-related disorders, myalgic and neuropathic pain seem to be of higher intensity. PMID:21661588

Karibe, Hiroyuki; Goddard, Greg; McNeill, Charles; Shih, Sandy Thai



Nitric oxide and pro-inflammatory cytokines correlate with pain intensity in chronic pain patients  

Microsoft Academic Search

.\\u000a Objective:  Inflammatory cytokines as well as nitric oxide (NO) play a key role in the pathogenesis of persistent and exaggerated pain\\u000a states. To document this, we investigated whether a range of cytokines and NO were detectable in the plasma of chronic pain\\u000a patients and whether cytokine and NO levels correlated with pain severity.\\u000a \\u000a \\u000a \\u000a Methods:  Plasma samples of 94 chronic pain patients

A. Koch; K. Zacharowski; O. Boehm; M. Stevens; P. Lipfert; H. J. von Giesen; A. Wolf; R. Freynhagen



Pain perception in recovered bulimia nervosa patients  

Microsoft Academic Search

Objective: Decreased pain sensitivity is found in individuals who are ill with bulimia nervosa (BN). The purpose of this study is to determine whether altered pain perception persists after recovery from bulimia nervosa (RBN). Methods: Eleven women who were recovered from BN for more than 1 year were compared with 15 healthy volunteer women. The participants received two pain evaluations—thermal

Daniel Stein; Walter H. Kaye; Hisato Matsunaga; Daniel Myers; Israel Orbach; Dov Har-Even; Guido Frank; Rhadika Rao



Difference in pain relief after trigger point injections in myofascial pain patients with and without fibromyalgia  

Microsoft Academic Search

Objective: To compare responses to trigger point (TrP) injection between patients having both myofascial pain syndrome (MPS) caused by active TrPs and fibromyalgia syndrome (FMS) and patients with MPS due to TrPs but without FMS.Design: Prospective design blinded measurement, before-after trial.Setting: A pain control medical clinic.Patients: Group 1: MPS + FMS; Group 2: MPS only. All patients (9 in each

Chang-Zern Hong; Tse-Chieh Hsueh



Paramedic assessment of pain in the cognitively impaired adult patient  

PubMed Central

Background Paramedics are often a first point of contact for people experiencing pain in the community. Wherever possible the patient's self report of pain should be sought to guide the assessment and management of this complaint. Communication difficulty or disability such as cognitive impairment associated with dementia may limit the patient's ability to report their pain experience, and this has the potential to affect the quality of care. The primary objective of this study was to systematically locate evidence relating to the use of pain assessment tools that have been validated for use with cognitively impaired adults and to identify those that have been recommended for use by paramedics. Methods A systematic search of health databases for evidence relating to the use of pain assessment tools that have been validated for use with cognitively impaired adults was undertaken using specific search criteria. An extended search included position statements and clinical practice guidelines developed by health agencies to identify evidence-based recommendations regarding pain assessment in older adults. Results Two systematic reviews met study inclusion criteria. Weaknesses in tools evaluated by these studies limited their application in assessing pain in the population of interest. Only one tool was designed to assess pain in acute care settings. No tools were located that are designed for paramedic use. Conclusion The reviews of pain assessment tools found that the majority were developed to assess chronic pain in aged care, hospital or hospice settings. An analysis of the characteristics of these pain assessment tools identified attributes that may limit their use in paramedic practice. One tool - the Abbey Pain Scale - may have application in paramedic assessment of pain, but clinical evaluation is required to validate this tool in the paramedic practice setting. Further research is recommended to evaluate the Abbey Pain Scale and to evaluate the effectiveness of paramedic pain management practice in older adults to ensure that the care of all patients is unaffected by age or disability.

Lord, Bill



Emergency Department Disposition of Patients Presenting with Chest Pain  

Microsoft Academic Search

\\u000a The disposition of patients with chest pain, concerning for acute coronary syndrome, presenting to the emergency department,\\u000a is a challenge for emergency physicians. The creation of chest pain observation units had added another option, other than\\u000a discharge or admission, for further evaluation of patients with chest pain. The key to rapid and safe evaluation and treatment\\u000a is risk stratification. Most

Kelly Owen; Deborah B. Diercks


Characterization of Breakthrough Pain by Hospice Patients and Their Caregivers  

Microsoft Academic Search

This study sought to characterize the nature of breakthrough pain experienced by 22 hospice patients and to assess the perceptions of their respective caregivers. Questionnaires were administered by trained hospice nurses to determine key elements of episodic pains in this home-based terminally ill population. Eighty-six percent of the patients surveyed experienced breakthrough pain, with an average of 2.9 episodes per

Perry G Fine; Michael A Busch



[Pain analysis is vital in rheumatic diseases. Pain often causes much worry to patients].  


The article consists of a synthesis of a rheumatic pain symposium held at the annual meeting of the Swedish Medical Association in 1996. Various aspects of pain in rheumatic diseases were discussed, such as physiological, neurohumoral and neurogenic mechanisms, sensory stimulation treatment, differentiation of mechanical and inflammatory pain, quality enhancement by improved co-operation between primary and tertiary care facilities, pharmacological treatment with (centrally and peripherally acting) opioids, selective cyclo-oxygenase inhibitors, and NMDA (N-methyl-D-aspartate) receptor antagonists. For patients with rheumatic disorders exacerbated by pain problems, as for other patients, a pain diagnosis is of fundamental importance. This can be achieved by analysis of the social, psychological, physiological and medical factors contributing to the cause and degree of pain and to pain behaviour, and of the extent to which the pain may be nociceptive (i.e., inflammatory, mechanical, or ischaemic in origin), neurogenic or idiopathic. Pain analysis should be followed by individualised treatment focused on the patient's most crucial problems, thus enhancing the prospect of optimal treatment outcome. PMID:9617167

Nisell, R; Arnér, S; Ekblom, A; Hansson, P; Lundeberg, T; Németh, G; Petersson, I



Motivation for behavior change in patients with chest pain  

Microsoft Academic Search

Purpose – To assess the effect of diagnostic testing for coronary artery disease (CAD) on motivation for change, and on lifestyle change for patients with chest pain. Design\\/methodology\\/approach – This observational study followed patients with chest pain suggestive of CAD for three years. Constructs of autonomous and controlled motivation for lifestyle change, autonomous orientation, and autonomy support from self-determination theory

Geoffrey C. Williams; Marylène Gagné; Alvin I. Mushlin; Edward L. Deci



[Anaesthesia and pain therapy: perioperative management of patients with complex regional pain syndrome].  


The complex regional pain syndrome (CRPS) is indeed a very complex pain situation. The treatment of CRPS is challenging. Patients with an acute CRPS or a CRPS in the past, who have to undergo surgery, provide a special situation. Recommendations for the management of such patients will be described in the article. High degree of evidence exists for high doses of vitamin C to prevent the development of a CRPS in trauma patients. PMID:23235899

Pouskoulas, Christos Dimitrios; Aeschbach, Armin; Ruppen, Wilhelm



Use of a Behavioural Pain Scale to assess pain in ventilated, unconscious and\\/or sedated patients  

Microsoft Academic Search

Current empirical evidence supports claims that pain in sedated. unconscious Intensive Care Unit (ICU) patients is underrated and under-treated. Given the severity of ICU patients' illness pain management, whilst important, may not be considered a priority and therefore Can be easily overlooked. The aim of this study was to validate the Behavioural Pain SCale (BPS) for the assessment of pain

Jeanne Young; Joanne Siffleet; Suzanne Nikoletti; Thérèse Shaw



Responsiveness and minimal clinically important difference for pain and disability instruments in low back pain patients  

PubMed Central

Background The choice of an evaluative instrument has been hampered by the lack of head-to-head comparisons of responsiveness and the minimal clinically important difference (MCID) in subpopulations of low back pain (LBP). The objective of this study was to concurrently compare responsiveness and MCID for commonly used pain scales and functional instruments in four subpopulations of LBP patients. Methods The Danish versions of the Oswestry Disability Index (ODI), the 23-item Roland Morris Disability Questionnaire (RMQ), the physical function and bodily pain subscales of the SF36, the Low Back Pain Rating Scale (LBPRS) and a numerical rating scale for pain (0–10) were completed by 191 patients from the primary and secondary sectors of the Danish health care system. Clinical change was estimated using a 7-point transition question and a numeric rating scale for importance. Responsiveness was operationalised using standardardised response mean (SRM), area under the receiver operating characteristic curve (ROC), and cut-point analysis. Subpopulation analyses were carried out on primary and secondary sector patients with LBP only or leg pain +/- LBP. Results RMQ was the most responsive instrument in primary and secondary sector patients with LBP only (SRM = 0.5–1.4; ROC = 0.75–0.94) whereas ODI and RMQ showed almost similar responsiveness in primary and secondary sector patients with leg pain (ODI: SRM = 0.4–0.9; ROC = 0.76–0.89; RMQ: SRM = 0.3–0.9; ROC = 0.72–0.88). In improved patients, the RMQ was more responsive in primary and secondary sector patients and LBP only patients (SRM = 1.3–1.7) while the RMQ and ODI were equally responsive in leg pain patients (SRM = 1.3 and 1.2 respectively). All pain measures demonstrated almost equal responsiveness. The MCID increased with increasing baseline score in primary sector and LBP only patients but was only marginally affected by patient entry point and pain location. The MCID of the percentage change score remained constant for the ODI (51%) and RMQ (38%) specifically and differed in the subpopulations. Conclusion RMQ is suitable for measuring change in LBP only patients and both ODI and RMQ are suitable for leg pain patients irrespectively of patient entry point. The MCID is baseline score dependent but only in certain subpopulations. Relative change measured using the ODI and RMQ was not affected by baseline score when patients quantified an important improvement.

Lauridsen, Henrik H; Hartvigsen, Jan; Manniche, Claus; Korsholm, Lars; Grunnet-Nilsson, Niels



The Effects of Music Therapy on Pain in Patients with Neuropathic Pain.  


The aim of this study was to investigate the effect of relaxing music on pain intensity in patients with neuropathic pain. A quasi-experimental study, repeated measures design was used. Thirty patients, aged 18-70 years, with neuropathic pain and hospitalized in an Algology clinic were identified as a convenience sample. Participants received 60 minutes of music therapy. Classical Turkish music was played to patients using a media player (MP3) and headphones. Participants had pain scores taken immediately before the intervention and at the 30th and 60th minutes of the intervention. Data were collected over a 6-month period in 2012. The patients' mean pain intensity scores were reduced by music, and that decrease was progressive over the 30th and 60th minutes of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of music therapy in the routine care of patients with neuropathic pain could provide nurses with an effective practice for reducing patients' pain intensity. PMID:23375348

Korhan, Esra Ak?n; Uyar, Meltem; Eyigör, Can; Hakverdio?lu Yönt, Gülendam; Celik, Serkan; Khorsh?d, Leyla



Neuropathic pain in patients with osteoarthritis of hip joint  

Microsoft Academic Search

Objectives  The aim of the present study was to evaluate the relationship between neuropathic pain and pain deriving from osteoarthritis\\u000a of the hip joint, using painDETECT, a self-report questionnaire.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Patients with osteoarthritis of the hip joint referred to the Department of Orthopaedic Surgery at Chiba University Hospital\\u000a were eligible for participation in the study. All the patients completed painDETECT and visual

Tomonori Shigemura; Seiji Ohtori; Shunji Kishida; Junichi Nakamura; Munenori Takeshita; Makoto Takazawa; Yoshitada Harada; Kazuhisa Takahashi


Pain intensity and severe pain in young immigrant patients with long-standing back pain  

Microsoft Academic Search

The aim of this study was to explore if self-rated pain intensity and severe pain differed significantly between immigrants\\u000a from different regions, and if other socio-economic, or clinical, characteristics could predict severe pain. A total of 129\\u000a men and 217 women at a primary health centre in Stockholm, Sweden, 27–45 years, on long-term sick leave, were recruited in\\u000a consecutive order and

Monica Löfvander; Marina Taloyan



Undertreatment of pain in the prehospital setting: a comparison between trauma patients and patients with chest pain.  


The aim of this study was to evaluate pain treatment with morphine administered by emergency medical service personnel (EMSP) to patients with chest pain and patients with pain in extremities because of trauma. This is a retrospective chart review of 2021 patients with chest pain and 887 patients with trauma. Pain was assessed using a 0-10 Numerical Rating Scale, and measured at the beginning and at the end of the ambulance care period. Trauma patients experienced more pain both at the start and at the end of the treatment than patients with chest pain [median 8 (interquartile ranges (IQR 6-9)) vs. 6 (IQR 4-7) and 4 (IQR 2-6) vs. 2 (IQR 0-4), P<0.001], but were treated with similar doses as in patients with chest pain [median 7.5 (IQR 5-10) and 5 (IQR 2.5-7.5), P=0.09]. Inadequate analgesia was frequently observed for both patient groups. The protocol was not fully utilized, suggesting that education in pharmacology and follow-up of the EMSP is required. PMID:23242076

Bakkelund, Karin E; Sundland, Erlend; Moen, Siv; Vangberg, Gunnar; Mellesmo, Sindre; Klepstad, Pål



Exploring the information needs of patients with unexplained chest pain  

PubMed Central

Background Unexplained chest pain is a common condition. Despite negative findings, a large number of these patients will continue to suffer from chest pain after being investigated at cardiac outpatient clinics. Unexplained chest pain covers many possible complaints, and diagnosing a single cause for a patient’s pain is often described as difficult, as there are a number of possible factors that can contribute to the condition. For health professionals to meet patients’ expectations, they must know more about the information needs of patients with unexplained chest pain. The aim of this study was to describe information needs among patients with unexplained chest pain and how those needs were met by health professionals during medical consultations. Methods A qualitative design was used. Data were collected by means of seven individual interviews with four women and three men, aged 21–62 years. The interviews were analyzed by qualitative content analysis. Results The results are described in two subthemes, ie, “experiencing lack of focus on individual problems” and “experiencing unanswered questions”. These were further abstracted under the main theme “experiencing unmet information needs”. Conclusion Existing models of consultations should be complemented to include a person-centered approach to meeting patients’ beliefs, perceptions, and expressions of feelings related to experiencing unexplained chest pain. This is in line with a biopsychosocial model with active patient participation, shared decision-making, and a multidisciplinary approach. Such an approach is directly within the domain of nursing, and aims to take into account patient experience.

R?ysland, Ingrid ?lfarnes; Dysvik, Elin; Furnes, Bodil; Friberg, Febe



Painful prosthesis: approaching the patient with persistent pain following total hip and knee arthroplasty  

PubMed Central

Summary Background Symptomatic severe osteoarthritis and hip osteoporotic fractures are the main conditions requiring total hip arthroplasty (THA), whereas total knee arthroplasty (TKA) is mainly performed for pain, disability or deformity due to osteoarthritis. After surgery, some patients suffer from “painful prosthesis”, which currently represents a clinical problem. Methods A systematic review of scientific literature has been performed. A panel of experts has examined the issue of persistent pain following total hip or knee arthroplasty, in order to characterize etiopathological mechanisms and define how to cope with this condition. Results Four major categories (non infective, septic, other and idiopathic causes) have been identified as possible origin of persistent pain after total joint arthroplasty (TJA). Time to surgery, pain level and function impairment before surgical intervention, mechanical stress following prosthesis implant, osseointegration deficiency, and post-traumatic or allergic inflammatory response are all factors playing an important role in causing persistent pain after joint arthroplasty. Diagnosis of persistent pain should be made in case of post-operative pain (self-reported as VAS ?3) persisting for at least 4 months after surgery, or new onset of pain (VAS ?3) after the first 4 months, lasting ?2 months. Acute pain reported as VAS score ?7 in patients who underwent TJA should be always immediately investigated. Conclusions The cause of pain needs always to be indentified and removed whenever possible. Implant revision is indicated only when septic or aseptic loosening is diagnosed. Current evidence has shown that peri-and/or post-operative administration of bisphosphonates may have a role in pain management and periprosthetic bone loss prevention.

Piscitelli, Prisco; Iolascon, Giovanni; Innocenti, Massimo; Civinini, Roberto; Rubinacci, Alessandro; Muratore, Maurizio; D'Arienzo, Michele; Leali, Paolo Tranquilli; Carossino, Anna Maria; Brandi, Maria Luisa



Pain, Executive Functioning, and Affect in Patients with Rheumatoid Arthritis  

PubMed Central

Objectives Rheumatoid arthritis (RA) is a chronic inflammatory disease resulting in substantial pain. The physical and emotional effects of RA are well known, but little attention has been given to the potential cognitive effects of RA pain, although intact executive functioning in patients with chronic illness is crucial for the successful completion of many daily activities. We examined the relationship between pain and executive functioning in patients with RA, and also considered the influence of positive and negative affect in the relationship between pain and executive functioning. Methods A sample of 157 adults with RA completed measures of pain and positive and negative affect and were tested for working memory and selective attention using the Letter Number Sequencing subtest from the WAIS-III and the Stroop Color Word Test tests, respectively. Results: Consistent with prior research, pain was inversely related to executive functioning, with higher pain levels associated with poorer performance on executive functioning tasks. This relationship was not moderated or mediated by negative affect; however, positive affect moderated the relationship between pain and executive functioning. For patients high in positive affect there was a significant inverse relationship between pain and executive functioning, whereas there was no such relationship for patients low in positive affect. Discussion These findings are discussed in the context of cognitive research on the effects of positive affect on executive functioning as well as functional neuroanatomical research suggesting neurocognitive mechanisms for such moderation.

Abeare, Christopher A.; Cohen, Jay L.; Axelrod, Bradley N.; Leisen, James C.C.; Mosley-Williams, Angelia; Lumley, Mark A.



Opioid use behaviors, mental health and pain-Development of a typology of chronic pain patients*  

PubMed Central

Background The intersection of pain, addiction and mental health has not been adequately described. We describe the roles of these three conditions in a chronic pain patient population using opioid analgesics. Aims were to improve our understanding of this population as well as to explore ways of identifying different types of patients. Methods We conducted a retrospective cohort study in a large integrated group medical practice in Washington State with persons using opioids chronically (n=704). Patient classes were derived with latent class analysis using factors representing DSM-IV opioid abuse and dependence, opioid misuse, pain, anxiety and depression. Regression analyses explored the utility of automated and interview data to distinguish the empirically-derived patient groups. Results Three classes were identified: a Typical group, the substantial majority that had persistent, moderate mental health and pain symptoms; an Addictive Behaviors group with elevated mental health symptoms and opioid problems, but pain similar to the Typical class; and a Pain Dysfunction class with significantly higher pain interference as well as elevated mental health and opioid problems. Prescribed average daily dose of opioids was three times higher for those in the two atypical groups and was strongly associated with class membership after adjusting for other variables. Conclusion We describe three distinct types of patient classes as well as data elements that could help identify the two atypical types. Further research is needed to confirm these findings and determine the utility of this approach in other clinical settings.

Banta-Green, Caleb J.; Merrill, Joseph O.; Doyle, Suzanne R.; Boudreau, Denise M.; Calsyn, Donald A.



Patient satisfaction and pain severity as outcomes in pain management: A longitudinal view of one setting's experience  

Microsoft Academic Search

Longitudinal data from quality assurance studies of pain. outcomes (pain severity and patient satisfaction) were critically examined to explore the reasons that patients are satisfied with their care even when they are in pain. Data were acquired from three sources: self-report surveys of patients during inpatient admission or ambulatory clinic visit (N = 306), telephone interviews of patients after discharge

Sandra E. Ward; Debra B. Gordon



Patients with chronic pain and abnormal pituitary function require investigation.  


Misuse of opioids is associated with abnormalities of pituitary function. Patients with chronic pain frequently complain of fatigue and undergo endocrine testing. To test whether oral opioid treatment causes abnormal pituitary function we prospectively assessed pituitary function in 37 patients with chronic pain who were receiving either oral opioid analgesia or non-opioid analgesia. Oral opioid treatment was not associated with abnormal pituitary function although a few patients had abnormal results mainly related to obesity. Our results suggest that patients with chronic pain who have abnormal endocrine results should have a complete assessment, since abnormal test results cannot be attributed to their analgesia. PMID:12842375

Merza, Z; Edwards, N; Walters, S J; Newell-Price, J; Ross, R J M



The Impact of Pain on Patient and Physician  

PubMed Central

A patient's pain has lost its status as an expression of personal suffering and is seen by both physician and patient as a strictly physical attribute. Because of this, their communication may become oblique and subversive, effectively destroying a therapeutic relationship. The patient's failure to recover causes the physician to suffer unease and begin assuming pain-reducing postures of anger, indifference and assertiveness. The physician, to avoid this scenario, must acknowledge the existential component of the patient's pain, the reality of his own discomfort, and be open enough to give personal suffering a place in the relationship.

Longhurst, Mark F.



Cutaneous thermal thresholds in patients with painful burning feet.  

PubMed Central

Small nerve fibre sensory function was assessed by psychophysical estimates of cutaneous thermal thresholds in 30 patients who presented with the symptoms of painful burning feet. Thresholds were abnormal in 12 and normal in 18 patients although symptoms in the two groups were very similar. Various hypotheses for the mechanism of pain in small fibre neuropathy have been proposed previously and these are discussed, but the cause of symptoms in patients with normal thresholds, is unknown. The possibility exists that these patients have a neuropathic disorder which affects only those unmyelinated fibres involved with pain.

Smith, S J; Ali, Z; Fowler, C J



Effect of Massage on Pain Management for Thoracic Surgery Patients  

PubMed Central

Background: Integrative therapies such as massage have gained support as interventions that improve the overall patient experience during hospitalization. Thoracic surgery patients undergo long procedures and commonly have postoperative back, neck, and shoulder pain. Purpose: Given the promising effects of massage therapy for alleviation of pain, we studied the effectiveness and feasibility of massage therapy delivered in the postoperative thoracic surgery setting. Methods: Patients who received massage in the postoperative setting had pain scores evaluated pre and post massage on a rating scale of 0 to 10 (0 = no pain, 10 = worst possible pain). Results: In total, 160 patients completed the pilot study and received massage therapy that was individualized. Patients receiving massage therapy had significantly decreased pain scores after massage (p ? .001), and patients’ comments were very favorable. Patients and staff were highly satisfied with having massage therapy available, and no major barriers to implementing massage therapy were identified. Conclusions: Massage therapy may be an important additional pain management component of the healing experience for patients after thoracic surgery.

Dion, Liza; Rodgers, Nancy; Cutshall, Susanne M.; Cordes, Mary Ellen; Bauer, Brent; Cassivi, Stephen D.; Cha, Stephen



Ketamine reduces muscle pain, temporal summation, and referred pain in fibromyalgia patients  

Microsoft Academic Search

Central mechanisms related to referred muscle pain and temporal summation of muscular nociceptive activity are facilitated in fibromyalgia syndrome (FMS) patients. The present study assessed the effects of an NMDA-antagonist (ketamine) on these central mechanisms. FMS patients received either i.v. placebo or ketamine (0.3 mg\\/kg, Ketalar®) given over 30 min on two separate occasions. Habitual pain intensity was assessed on

Thomas Graven-Nielsen; Sally Aspegren Kendall; Karl G. Henriksson; Mats Bengtsson; Jan Sörensen; Anders Johnson; Björn Gerdle; Lars Arendt-Nielsen



Pain and quality of life in Turkish cancer patients.  


This study was designed to examine the relationship between patients' pain severity and their self-reported quality of life, to evaluate factors that may affect pain and quality of life, and to assess patients' opinions and practices on the use of analgesics. The study was conducted with 260 cancer patients. Data were collected using a Quality of Life Scale and Visual Analog Scale questionnaire. It was found that mean scores of pain, all subdomains of quality of life, and overall mean scores of patients were at a moderate level, the lowest score in the subdomains of quality of life was in the psychological subdomain and the highest was in the spiritual subdomain. It was also found that as severity of pain experienced by patients increased, their general activities, mood, activeness, sleep, and nutrition were negatively affected. As severity of pain experienced by patients increased, their quality of life worsened. Patients were observed to have insufficient knowledge and a poor understanding with respect to the use of analgesics. In conclusion, it is very important for nurses to assess factors that can complicate pain management and to establish an effective pain control. PMID:23480371

Ovayolu, Nimet; Ovayolu, Ozlem; Serçe, Sibel; Tuna, Döndü; Pirbudak Çöçelli, Lütfiye; Sevinç, Alper



Evaluating Patients with Chronic Pain and their Families  

PubMed Central

Inclusion of family members in the assessment of patients with chronic pain can improve outcomes. Family functioning can be assessed in four basic areas: boundaries, power, communication, and intimacy. Early recognition of maladaptive patterns in the family allows the family physician to consider a variety of interventions ranging from educating the spouse to referring the family for therapy or multidisciplinary pain management.

Margolis, Ronald B.; Merkel, William T.; Tait, Raymond C.; Richardson, William



Highly anxious dental patients report more pain during dental injections  

Microsoft Academic Search

Objectives In the present study, the relationship between anxiety and pain was investigated using a clinically relevant sample and stimulus.Methods A sample of highly anxious dental patients (n = 23) and a sample of 'normal' subjects (n = 57) were compared with respect to the duration and intensity of pain while receiving a dental anaesthetic injection.Results As expected, highly anxious

P. C. Makkes; A. J. van Wijk



Patients' vs nurses' assessments of postoperative pain and anxiety during patient- or nurse-controlled analgesia  

Microsoft Academic Search

We have compared patients' and nurses' assessments of postoperative pain and anxiety after different analgesic treatments. Sixty orthopaedic patients were allocated randomly to receive i.v. piritramide (either nurse-controlled or patient-controlled) or subarachnoid bupivacaine (nurse-controlled or patient-controlled). Patients and nurses assessed pain and anxiety using a visual analogue scale (VAS; 1-100 mm). Pain and anxiety ratings of patients and nurses were

I. Rundshagen; K. Schnabel; T. Standl



Neuropathic orofacial pain patients in need of dental care.  


Dental pain is a common complaint among the general population. Most pain is a result of traumatic injury or bacterial infection in pulpal and periapical tissues, and dental practitioners are successful at diagnosing these conditions and providing prompt relief. However, in some cases, patients continue to complain of persistent pain, which may be categorized as neuropathic. These people may avoid or neglect routine dental treatment or interventions to prevent precipitation, perpetuation or exacerbation of their pain condition, and practitioners may have to modify their procedures when managing the dental needs of this unique population. PMID:22985895

Klasser, Gary D; Gremillion, Henry A



Neuropathic Pain in Patients with Upper-Extremity Nerve Injury  

PubMed Central

ABSTRACT Purpose: The purpose of this review was to present an analysis of the literature of the outcome studies reported in patients following traumatic upper-extremity (UE) nerve injuries (excluding amputation), to assess the presence of an association between neuropathic pain and outcome in patients following traumatic UE nerve injuries, and to provide recommendations for inclusion of more comprehensive outcome measures by clinicians who treat these patients. Summary of Key Points: A Medline and CINAHL literature search retrieved 48 articles. This review identified very few studies of patients with peripheral nerve injury that reported neuropathic pain. When pain was reported, visual analogue or numeric rating scales were most frequently used; standardized questionnaires measuring pain or psychosocial function were rarely administered. Recent evidence shows substantial long-term disability and pain in patients following peripheral nerve injury. Recommendation: To better understand neuropathic pain in patients following peripheral nerve injury, future outcome studies should include valid, reliable measures of physical impairment, pain, disability, health-related quality of life, and psychosocial functioning.

Katz, Joel



Alternative Treatments of Breakthrough Pain in Patients Receiving Spinal Analgesics for Cancer Pain  

Microsoft Academic Search

Patients who experience a poor response to different systemic opioid trials (oral and intravenous) are candidates for spinal treatment. Breakthrough pain occurring in this group of patients is challenging for physicians. This phenomenon has never been described in this context and the treatment is quite difficult, as patients already demonstrated a poor response to systemic opioids. We report a preliminary

Sebastiano Mercadante; Edoardo Arcuri; Patrizia Ferrera; Patrizia Villari; Salvatore Mangione



Somatic focus/awareness: Relationship to negative affect and pain in chronic pain patients  

PubMed Central

Somatic focus refers to the tendency to notice and report physical symptoms, and has been investigated in relation to chronically painful conditions. This study investigated the relationship between somatic focus, as measured by the Pennebaker Inventory of Limbic Languidness (PILL), negative affect and pain. A secondary purpose of the present study was to examine sex differences in these relationships. Participants included 280 chronic pain patients (69.6% females, 88.9% Caucasian), who completed a battery of self-report measures on somatic focus, pain, negative affect, coping, and dysfunction. Results for the overall sample revealed that the PILL shares considerable variance with measures of negative affect, particularly with the physiological components of anxiety and depression. When the results were analyzed separately for male and female patients, it was found that several components of negative affect and cognitive factors play a stronger role in predicting somatic focus among men compared to women. Additional analyses then examined whether somatic focus was predictive of male and female patientspain reports. Results indicated that somatic focus explained a small, but unique amount of variance in female patientspain reports, which differed from the relationship observed among male patients.

O'Brien, Erin M.; Atchison, James W.; Gremillion, Henry A.; Waxenberg, Lori B.; Robinson, Michael E.



Somatic focus/awareness: Relationship to negative affect and pain in chronic pain patients.  


Somatic focus refers to the tendency to notice and report physical symptoms, and has been investigated in relation to chronically painful conditions. This study investigated the relationship between somatic focus, as measured by the Pennebaker Inventory of Limbic Languidness (PILL), negative affect and pain. A secondary purpose of the present study was to examine sex differences in these relationships. Participants included 280 chronic pain patients (69.6% females, 88.9% Caucasian), who completed a battery of self-report measures on somatic focus, pain, negative affect, coping, and dysfunction. Results for the overall sample revealed that the PILL shares considerable variance with measures of negative affect, particularly with the physiological components of anxiety and depression. When the results were analyzed separately for male and female patients, it was found that several components of negative affect and cognitive factors play a stronger role in predicting somatic focus among men compared to women. Additional analyses then examined whether somatic focus was predictive of male and female patients' pain reports. Results indicated that somatic focus explained a small, but unique amount of variance in female patients' pain reports, which differed from the relationship observed among male patients. PMID:17524684

O'Brien, Erin M; Atchison, James W; Gremillion, Henry A; Waxenberg, Lori B; Robinson, Michael E




PubMed Central

Purpose The incidence of painful bone metastases increases with longer survival times. While External Beam Radiation Therapy (EBRT) is an effective palliative treatment, it often requires several days from the start of treatment to produce a measurable reduction in pain scores and a qualitative amelioration of patient pain levels. Meanwhile, the use of analgesics remains the best approach early on in the treatment course. We investigated the role of Radiation Therapists as key personnel for collecting daily pain scores to supplement assessments by physician and oncology nursing staff and manage pain more effectively, during radiation treatment. Methods and Materials Daily pain scores were obtained by the radiation therapists for 89 patients undertaking a total of 124 courses of EBRT for bone metastases and compared to pre-treatment pain score. The majority of patients (71%) were treated to 30 (20–37.5) Gy in 10 (8–15) fractions. Results A total of 119 treatment courses (96%) were completed. Pain Scores declined rapidly to 37.5%, 50% and 75% of the pretreatment levels by Days 2, 4, and 10 respectively. Pain was improved in 91 % of patients with only 4% of worse pain at the end of treatment. Improved pain scores were maintained in 83% of patients at 1 month follow up, but in 35% of them the pain was worse than at the end of treatment. Conclusions Collection of daily pain scores by radiation therapists was associated with an effective reduction in pain scores early on during EBRT of painful osseous metastases.

Andrade, Regiane S.; Proctor, Julian W.; Slack, Robert; Marlowe, Ursula; Ashby, Karlotta R.; Schenken, Larry I



Cancer patient and caregiver experiences: communication and pain management issues  

Microsoft Academic Search

This study examined facilitators and barriers to effective patient and caregiver communication with providers with emphasis on communication related to cancer pain management. Focus groups and personal interviews were conducted with cancer patients and family caregivers of patients. Communication experiences of subjects as well as suggestions for ways to improve the communication process were elicited. Twenty-two cancer patients and 16

Carole Kimberlin; David Brushwood; William Allen; Ellyn Radson; Debbie Wilson



Psychological Symptoms in Patients with Injury-Related Chronic Pain  

PubMed Central

Background. Chronic injury-related pain could be influenced by psychological symptoms such as depression, anxiety, and stress that also affect daily life. Methods. Patients with chronic pain caused by an injury (n = 86) aged 18–65 years referred to the Pain Rehabilitation Clinic at the Umeå University Hospital answered a set of questionnaires to assess pain intensity, depression, anxiety, posttraumatic stress, sleep disturbance, and fatigue. Results. A significantly higher proportion of women (47.5%) reported depression (Hospital Anxiety and Depression Scale (HAD)) than men (22.2%). In all patients anxiety (HAD) was reported by 39.5% and moderate/severe posttraumatic stress (Impact of Event Scale) by 30.2%. A majority reported sleep disturbance (84.9%) and fatigue (90.7%). Significant relationships were found between posttraumatic stress and depression and anxiety. Conclusion. These findings indicate the importance of assessing and treating psychological symptoms associated with chronic pain as the result of trauma.

Stalnacke, Britt-Marie



Quick identification of acute chest pain patients study (QICS)  

PubMed Central

Background Patients with acute chest pain are often referred to the emergency ward and extensively investigated. Investigations are costly and could induce unnecessary complications, especially with invasive diagnostics. Nevertheless, chest pain patients have high mortalities. Fast identification of high-risk patients is crucial. Therefore several strategies have been developed including specific symptoms, signs, laboratory measurements, and imaging. Methods/Design The Quick Identification of acute Chest pain Study (QICS) will investigate whether a combined use of specific symptoms and signs, electrocardiography, routine and new laboratory measures, adjunctive imaging including electron beam (EBT) computed tomography (CT) and contrast multislice CT (MSCT) will have a high diagnostic yield for patients with acute chest pain. All patients will be investigated according a standardized protocol in the Emergency Department. Serum and plasma will be frozen for future analysis for a wide range of biomarkers at a later time point. The primary endpoint is the safe recognition of low-risk chest pain patients directly at presentation. Secondary endpoint is the identification of a wide range of sensitive predictive clinical markers, chemical biomarkers and radiological markers in acute chest pain patients. Chemical biomarkers will be compared to quantitative CT measurements of coronary atherosclerosis as a surrogate endpoint. Chemical biomarkers will also be compared in head to head comparison and for their additional value. Discussion This will be a very extensive investigation of a wide range of risk predictors in acute chest pain patients. New reliable fast and cheap diagnostic algorithm resulting from the test results might improve chest pain patients' prognosis, and reduce unnecessary costs and diagnostic complications.

Willemsen, Hendrik M; de Jong, Gonda; Tio, Rene A; Nieuwland, Wybe; Kema, Ido P; van der Horst, Iwan CC; Oudkerk, Mattijs; Zijlstra, Felix



Pain 5 years after instrumented and non-instrumented posterolateral lumbar spinal fusion  

Microsoft Academic Search

Pain drawings have been used in spine surgery for diagnostic use and psychological evaluation of fusion candidates; they have rarely been used to evaluate pain status after spinal fusion. This study is a 5-year follow-up on a randomised clinical trial assigning patients to posterolateral spinal fusion with or without pedicle screw instrumentation. Patients were mailed a pain drawing and questionnaires

Thomas Andersen; Finn B. Christensen; Ebbe S. Hansen; Cody Bünger



Brain processing of pain in patients with unresponsive wakefulness syndrome  

PubMed Central

By definition, patients with unresponsive wakefulness syndrome (UWS) do not experience pain, but it is still not completely understood how far their brain can process noxious stimuli. The few positron emission tomography studies that have examined pain processing did not yield a clear and consistent result. We performed an functional magnetic resonance imaging scan in 30 UWS patients of nontraumatic etiology and 15 age- and sex-matched healthy control participants (HC). In a block design, noxious electrical stimuli were presented at the patients' left index finger, alternating with a resting baseline condition. Sixteen of the UWS patients (53%) showed neural activation in at least one subsystem of the pain-processing network. More specifically, 15 UWS patients (50%) showed responses in the sensory-discriminative pain network, 30% in the affective pain network. The data indicate that some patients completely fulfilling the clinical UWS criteria have the neural substrates of noxious stimulation processing, which resemble that in control individuals. We therefore suppose that at least some of these patients can experience pain.

Markl, Alexandra; Yu, Tao; Vogel, Dominik; Muller, Friedemann; Kotchoubey, Boris; Lang, Simone



Hip pain in active patients: what you may be missing.  


When a patient who's physically active complains of hip pain, don't be too quick to label it a "hip pointer" that requires time and rest to heal. Consider this more nuanced-and effective-approach. PMID:23313991

Frank, Rachel M; Slabaugh, Mark A; Grumet, Robert C; Bush-Joseph, Charles A; Virkus, Walter W; Nho, Shane J



Can a pharmacological pain analysis in patients with chronic low back pain predict the outcome of lumbar fusion? Preliminary report  

Microsoft Academic Search

Chronic low back pain patients chosen for lumbar fusion surgery were entered into a prospective study with the aim of evaluating whether pre-operative pharmacological pain classification correlated with the outcome of surgical treatment. Twenty consectutive patients (mean age 39 years, range 29–50 years) with a mean pain duration of 4.6 years (range 1–8 years) participated. The patients' pain, disability and

J. Sörensen; S. Aaro; M. Bengtsson; S. Kalman; T. Reigo; H. Tropp



Neurocognitive Performance and Emotional Status in Chronic Pain Patients  

Microsoft Academic Search

The following study examined the association between neurocognitive performance and emotional status in chronic pain patients. Seventy-three chronic pain patients recruited consecutively from services in a general medical hospital completed a battery of 10 neurocognitive measures and the Symptom Checklist-90-Revised (SCL-90-R; a gross measure of emotional distress). Cluster analytic procedures were used to identify a three-cluster group solution based on

Tony Iezzi; Yvonne Archibald; Peter Barnett; Ann Klinck; Melanie Duckworth



Exercise Testing and Training in Patients with (Chronic) Pain  

Microsoft Academic Search

A vast body of literature supports the idea that exercise training is an important modality in the treatment and rehabilitation\\u000a of the chronic pain patient. Exercise testing and prescription should therefore be incorporated in the therapeutic armamentarium\\u000a of health care professionals working with chronic pain patients. In this chapter we present the scientific basis of the positive\\u000a effects regular exercise

Harriët Wittink; Tim Takken


Repeated thermal therapy improves outcomes in patients with chronic pain  

Microsoft Academic Search

The purpose of this study is to clarify the effects of repeated thermal therapy in patients with chronic pain. Forty-six chronic pain patients were assigned to group A (multidisciplinary treatment, n=24) or group B (combination of multidisciplinary treatment and repeated thermal therapy, n=22). Thermal therapy was performed with 60 °C far-infrared ray dry sauna for 15 min and was then

Akinori Masuda; Masato Hattanmaru; Chuwa Tei



Psychotherapeutic issues encountered in the psychotherapy of chronic pain patients  

Microsoft Academic Search

The clinical art of applying scientific knowledge to a patient’s circumstances of suffering is especially challenging when\\u000a practicing psychotherapy with people who are experiencing chronic pain. Health psychology has made substantial contributions\\u000a by showing that psychosocial factors are essential in explaining the phenomenon of pain and, particularly, its chronic progression\\u000a to debilitating degrees. In addition, clinical health psychology has developed

Timothy R. Tumlin; Steven Kvaal



Topical review: orofacial pain in dementia patients. A diagnostic challenge.  


This article presents a comprehensive review of the literature on the diagnosis of pain in the orofacial region of patients suffering from a cognitive impairment or a dementia. This review was based on a literature search yielding 74 papers, most of which dealt with the assessment of pain in general in nonverbal individuals, for which several observational tools were developed. Unfortunately, none of these tools have been designed for the specific assessment of orofacial or dental pain. Thus, none of them can be recommended for use in the dental setting. There is hardly any information available in the literature on how to assess orofacial and/or dental pain in patients with a cognitive impairment or a dementia. Given the expected increase in the incidence of dementia over the upcoming decades, it is of the utmost importance that dentists can use well-tested tools that can help them in the diagnosis of orofacial and dental pain in this vulnerable patient population. Such tools should incorporate specific orofacial/dental pain indicators, such as the patient holding/rubbing the painful orofacial area, limiting his/her mandibular movements, modifying his/her oral behavior, and being uncooperative/resistant to oral care. PMID:21359232

Lobbezoo, Frank; Weijenberg, Roxane A F; Scherder, Erik J A



Changes in lateral abdominal muscle thickness during an abdominal drawing-in maneuver in individuals with and without low back pain.  


The purpose of this study was to compare lateral abdominal muscle thickness changes in individuals with and without low back pain (LBP) during an abdominal drawing-in maneuver (ADIM) using ultrasound imaging. Twenty individuals (13 females and 7 males, average age 40.1 ± 13.4) with stabilization classification LBP and 19 controls (10 females and 9 males, average age 30.3 ± 8.7) participated in this study. Bilateral measurements were made using ultrasound imaging to determine changes in thickness of the transversus abdominus (TrA) and external and internal oblique (EO+IO) muscles during an ADIM. There were no significant differences in relaxed muscle thickness values or contraction ratios for the TrA or EO+IO between groups or side. Individuals with stabilization classification LBP demonstrated no difference in lateral abdominal muscle thickness during an ADIM when compared with controls without LBP when using a pressure biofeedback device to monitor stability. PMID:21988269

Beazell, James R; Grindstaff, Terry L; Hart, Joseph M; Magrum, Eric M; Cullaty, Martha; Shen, Francis H



Drawing research  

Microsoft Academic Search

To understand research as new to architectural design is to ignore the history of the architect. Research—as the drawing forth of ideas—has been fundamental to the practice of the architect since the Italian Renaissance. The term ‘design’ comes from the Italian disegno, meaning drawing, suggesting both the drawing of a line on paper and the drawing forth of an idea.

Jonathan Hill



Pain coping strategies that predict patients' and spouses' ratings of patients' self-efficacy  

Microsoft Academic Search

This study examined the relationship of pain coping strategies to osteoarthritis patients' ratings of self-efficacy and to spouses' ratings of the patients' self-efficacy. Subjects, 130 individuals having osteoarthritis of the knees and persistent knee pain, completed a pain coping strategies measure (the Coping Strategies Questionnaire), a measure of self-efficacy (the Arthritis Self-Efficacy Scale), and a measure of pain (the McGill

Francis J Keefe; Susmita Kashikar-Zuck; Elwood Robinson; Al Salley; Pat Beaupre; David Caldwell; Donald Baucom; Jennifer Haythornthwaite



Acupuncture for chronic pain: individual patient data meta-analysis  

PubMed Central

Background Although acupuncture is widely used for chronic pain, there remains considerable controversy as to its value. We aimed to determine the effect size of acupuncture for four chronic pain conditions: back and neck pain, osteoarthritis, chronic headache, and shoulder pain. Methods We conducted a systematic review to identify randomized trials of acupuncture for chronic pain where allocation concealment was determined unambiguously to be adequate. Individual patient data meta-analyses were conducted using data from 29 of 31 eligible trials, with a total of 17,922 patients analyzed. Results In the primary analysis including all eligible trials, acupuncture was superior to both sham and no acupuncture control for each pain condition (all p<0.001). After exclusion of an outlying set of trials that strongly favored acupuncture, the effect sizes were similar across pain conditions. Patients receiving acupuncture had less pain, with scores 0.23 (95% C.I. 0.13, 0.33), 0.16 (95% C.I. 0.07, 0.25) and 0.15 (95% C.I. 0.07, 0.24) standard deviations lower than sham controls for back and neck pain, osteoarthritis, and chronic headache respectively; the effect sizes in comparison to no acupuncture controls were 0.55 (95% C.I. 0.51, 0.58), 0.57 (95% C.I. 0.50, 0.64) and 0.42 (95% C.I. 0.37, 0.46). These results were robust to a variety of sensitivity analyses, including those related to publication bias. Conclusions Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.

Vickers, Andrew J.; Cronin, Angel M.; Maschino, Alexandra C.; Lewith, George; MacPherson, Hugh; Victor, Norbert; Foster, Nadine E.; Sherman, Karen J.; Witt, Claudia M.; Linde, Klaus



Vulnerability in Clinical Research with Patients in Pain  

PubMed Central

Some have characterized patients living with intractable pain as a vulnerable population in both clinical and research settings. Labeling the population as vulnerable, however, does not provide clarity regarding the potential risks that they face when they participate in research. Instead, research vulnerability for patients in pain is a function of an interaction between their pain conditions and elements of the research enterprise. Therefore, the identification of potential risks requires consideration not only of characteristics of patients with chronic pain, but also consideration of features of researchers, the quality of institutional oversight, and the medical/social environment within which the research is conducted. This paper provides an analysis of those risks and provides some suggestions as to how the risks might be better managed.

Tait, Raymond C.



Linear and nonlinear analyses of EEG dynamics during non-painful somatosensory processing in chronic pain patients  

Microsoft Academic Search

The aim of our study was to characterize brain dynamics of affective modulation of somatosensory processing in chronic pain. We hypothesized that chronic pain patients will show abnormal EEG activity under negative mood conditions compared to healthy controls. Nineteen patients with chronic pain and 21 healthy subjects participated in the experiment. Multiscale entropy, fractal dimension, event-related potentials, and fast Fourier

Carolina Sitges; Xavier Bornas; Jordi Llabrés; Miquel Noguera; Pedro Montoya



The diagnostic workup of patients with neuropathic pain.  


Determining the causes of neuropathic pain is more than an epistemological exercise. At its essence, it is a quest to delineate mechanisms of dysfunction through which treatment strategies can be created that are effective in reducing, ameliorating, or eliminating symptomatology. To date, predictors of which patients will develop neuropathic pain or who will respond to specific therapies are lacking, and present therapies have been developed mainly through trial and error. Our current inability to make therapeutically meaningful decisions based on ancillary test data is illustrated by the following: In a study specifically designed to assess the response of patients with painful distal sensory neuropathies to the 5% lidocaine patch, no relationship between treatment response and distal leg skin biopsy, QST, or sensory nerve conduction study results could be established. From a mechanistic perspective, the hypothesis that the lidocaine patch would be most effective in patients with relatively intact epidermal innervation, whose neuropathic pain is presumed attributable to "irritable nociceptors," and least effective in patients with few surviving epidermal nociceptors, presumably with "deafferentation pain," was unproven. The possible explanations are multiple and outside the scope of this review. However, these findings, coupled with the disparity in C-fiber subtype involvement in diabetic small-fiber neuropathy, and the recently reported inability of enzyme replacement therapy in Fabry disease to influence intraepidermal innervation density, while having mixed effects on cold and warm QST thresholds, and beneficial effects on sudomotor findings, when therapeutic benefit was demonstrated, lead one to conclude that the specificity of ancillary testing in neuropathic pain is inadequate at present, and reinforce the aforementioned caveats about inferential conclusions from indirect data. The diagnosis of neuropathic pain mechanisms is in its nascent stages and ancillary testing remains "subordinate," "subsidiary," and "auxiliary" as defined in Webster's Third New International Dictionary. As a consequence of these difficulties, the recent approach by Bennett and his colleagues may have merit. They have hypothesized (and provide data in support) that chronic pain can be more or less neuropathic on a spectrum between "likely," "possible," and "unlikely," based on patient responses on validated neuropathic pain symptom scales, when compared with specialist pain physician certainty of the presence of neuropathic pain on a 100-mm visual analog scale. The symptoms most associated with neuropathic pain were dysesthesias, evoked pain, paroxysmal pain, thermal pain, autonomic complaints, and descriptions of the pain as being sharp, hot, or cold, with high sensitivity. Higher scores for these symptoms correlated with greater clinician certainty of the presence of neuropathic pain mechanisms. Considering each individual patient's chronic pain as being somewhere on a continuum between "purely nociceptive" and "purely neuropathic" may have diagnostic and therapeutic relevance by enhancing specificity, but this requires clinical confirmation. Thus, symptom assessment remains indispensable in the evaluation of neuropathic pain, ancillary testing notwithstanding PMID:17164102

Horowitz, Steven H



Is Postoperative Pain a Self-Fulfilling Prophecy? Expectancy Effects on Postoperative Pain and Patient-Controlled Analgesia Use Among Adolescent Surgical Patients  

Microsoft Academic Search

Objective To explore relationships among anxiety, anticipated pain, coping styles, postoperative pain, and patient-controlled analgesia (PCA) use among adolescent surgical patients and their parents. Methods Sixty-five 12- to 18-year-old surgical patients undergoing surgery with postoperative PCA pain management were included. Before surgery, adolescents and parents reported anxiety and expected levels of postoperative pain. Pain catastrophizing and coping style were assessed

Deirdre E. Logan; John B. Rose



Symptoms and signs in patients with suspected neuropathic pain  

Microsoft Academic Search

The study sought to determine if symptoms and signs cluster differentially in groups of patients with increasing evidence of neuropathic pain (NP). We prospectively looked at symptoms and signs in 214 patients with suspected chronic NP of moderate to severe intensity. According to a set of clinical criteria the patients were a priori classified as having the so-called ‘Definite NP’

Peter Vestergaard Rasmussen; Søren Hein Sindrup; Troels Staehelin Jensen; Flemming Winther Bach



A prospective audit of postoperative pain control in pediatric patients.  


Pain is a subjective experience that is affected by physical, emotional, and psychological factors, and reliable assessment of pain can be a challenge in the pediatric population. A quality improvement project was conducted at one Canadian health care facility to examine the effectiveness of the postoperative pain management strategy for children admitted to the postanesthesia care unit (PACU). Effective control of postoperative pain involves several preventive strategies that include preoperative analgesia, appropriate use of intraoperative analgesic techniques, and identification of children at risk for significant postoperative pain. Successful implementation of these techniques requires a multidisciplinary team approach involving the patient, the PACU nurses, the anesthesia care provider, and other surgical team members. PMID:19801005

Trudeau, Jacqueline D; Lamb, Elizabeth; Gowans, Margot; Lauder, Gillian



Differences in Pain, Psychological Symptoms, and Gender Distribution Among Patients with Left vs. Right-Sided Chronic Spinal Pain  

PubMed Central

Objective To determine pain levels, function, and psychological symptoms in relation to predominant sidedness of pain (right or left) and gender in patients being treated for chronic spinal pain. Design Prospective cohort study Patients Patients with chronic neck or low back pain undergoing a nerve block procedure in a speciality pain medicine clinic Interventions/Outcomes Patients completed the Hospital Anxiety and Depression Scale and the Brief Pain Inventory just prior to the procedure. Pain history and demographic variables were collected from a chart review. Chi-square, Pearson correlations, and multivariate statistics were used to characterize the relationships between side of pain, gender, pain levels, pain interference, and psychological symptoms. Results Among 519 subjects, men with left-sided pain (n=98) were found to have significantly greater depression and anxiety symptoms and worse pain-related quality of life (p<.01), despite having similar pain levels as men with right-sided pain (n=91) or women with left or right-sided pain (n=289). In men, psychological symptoms had a significantly greater correlation with pain levels than in women (p<.01). Conclusion In this sample, men with left-sided spinal pain report worse quality of life and more psychological symptoms than women. These data provide clinical evidence corroborating basic neuroscience findings indicating that the right cerebral hemisphere is preferentially involved in the processing of pain and negative affect. These data suggest that men appear more right hemisphere dominant in pain and affect processing. These findings have implications for multidisciplinary assessment and treatment planning in men.

Wasan, Ajay D.; Anderson, Nina K.; Giddon, Donald B.



Lack of pressure pain modulation by heterotopic noxious conditioning stimulation in patients with painful osteoarthritis before, but not following, surgical pain relief  

Microsoft Academic Search

To investigate the influence of chronic nociceptive pain on endogenous pain modulation, the effect of heterotopic noxious conditioning stimulation (HNCS) on perception of various somatosensory modalities was assessed in 15 patients with painful osteoarthritis of the hip. Thirteen patients were re-assessed when pain-free 6–14 months following surgery. Sex- and age matched healthy subjects assessed at similar time intervals served as

Eva Kosek; Gunnar Ordeberg



Measurement structure of the Pain Self-Efficacy Questionnaire in a sample of Chinese patients with chronic pain  

Microsoft Academic Search

Objective: To examine the factorial structure of the Chinese translation of the Pain Self-Efficacy Questionnaire in a sample of Chinese patients with chronic pain.Setting: Outpatient physiotherapy department in a local hospital and a local rehabilitation clinic.Participants: One hundred and twenty patients with chronic pain in physiotherapy treatment.Methods: Each participant was asked to complete the Chinese version of the Pain Self-Efficacy

Sinfia KS Vong; Gladys LY Cheing; Chetwyn CH Chan; Fong Chan; Arran SL Leung



Pain assessment strategies in patients with musculoskeletal conditions.  


Valid and reliable assessment of pain is fundamental for both clinical trials and effective pain management. The nature of pain makes objective measurement impossible. Chronic musculoskeletal pain assessment and its impact on physical, emotional and social functions require multidimensional qualitative tools and healthrelated quality of life instruments. The recommendations concerning outcome measurements for pain trials are useful for making routine assessments that should include an evaluation of pain, fatigue, disturbed sleep, physical functioning, emotional functioning, patient global ratings of satisfaction, and quality of life. Despite the growing availability of instruments and theoretical publications related to measuring the various aspects of chronic pain, there is still little agreement and no unified approach has been devised. There is, therefore, still a considerable need for the development of a core set of measurement tools and response criteria, as well as for the development and refinement of the related instruments, standardized assessor training, the cross-cultural adaptation of health status questionnaires, electronic data capture, and the introduction of valid, reliable and responsive standardized quantitative measurement procedures into routine clinical care. This article reviews a selection of the instruments used to assess chronic musculoskeletal pain, including validated newly developed and well-established screening instruments, and discusses their advantages and limitations. PMID:23024966

Salaffi, F; Ciapetti, A; Carotti, M



Spinal cord stimulation for treatment of pain in a patient with post thoracotomy pain syndrome.  


Post Thoracotomy Pain Syndrome (PTPS) is defined as pain that occurs or persists in the area of the thoracotomy incision for at least 2 months following the initial procedure.  The true incidence of PTPS is hard to define as literature reports a wide range of occurrence from 5% to 90%.  Thoracotomy is associated with a high risk of severe chronic postoperative pain.  Presenting symptoms include both neuropathic pain in the area of the incision, as well as myofascial pain commonly in the ipsilateral scapula and shoulder.  Pain management can be challenging in these patients.  Multiple treatments have been described including conservative treatments with oral nonsteroidal anti-inflammatory drugs (NSAIDs); topically applied, peripherally acting drugs; neuromodulating agents; physical therapy; transcutaneous electrical nerve stimulation as well as more invasive treatments including intercostal nerve blocks, trigger point steroid injections, epidural steroid injections, radiofrequency nerve ablation, cryoablation, and one case report of spinal cord stimulation.  Unfortunately, a portion of these patients will have persistent pain in spite of multiple treatment modalities, and in some cases will experience worsening of pain. This case report describes the novel utility and complete resolution of symptoms with spinal cord stimulation (SCS) in treatment of a patient with persistent PTPS. In the operating room, a percutaneous octet electrode lead was placed using sterile technique under fluoroscopic guidance and loss-of-resistance technique.  The octet electrode lead was subsequently advanced with the aid of fluoroscopy to the level of the T3 superior endplate just right of midline.  The patient's pain distribution was captured optimally with stimulation at this level.  With the assistance of a neurosurgeon, the lead was anchored, tunneled, and connected to a generator, which was implanted over the right iliac crest.  The patient tolerated the procedure well with no complications. We report the successful use of SCS as well as complete resolution of symptoms at 4 months follow-up, in a patient with persistent PTPS, which was resistant to other modalities. In conclusion, studies designed to evaluate the effectiveness of SCS for PTPS may be warranted. PMID:21927048

Graybill, Jordan; Conermann, Till; Kabazie, Abraham J; Chandy, Sunil


The Kinetic Family Drawing with Donor and Nondonor Siblings of Pediatric Bone Marrow Transplant Patients.  

ERIC Educational Resources Information Center

|Utilizes the Kinetic Family Drawings-Revised (KFD-R) to measure siblings' (N=44) feelings and attitudes toward bone marrow transplants. Data from drawings and discussions with siblings underscore that not all children are affected by stress in the same way. How a particular child responds depends on factors such as life history, personality,…

Packman, Wendy L.; Crittenden, Mary R.; Fischer, Jodie B. Rieger; Cowan, Morton J.; Long, Janet K.; Gruenert, Carol; Schaeffer, Evonne; Bongar, Bruce



Observational study of prehospital delays in patients with chest pain  

PubMed Central

Method: A prospective observational study of prehospital times and events was undertaken on a target population of patients presenting with acute chest pain attributable to an acute coronary syndrome over a three month period. Results: Patients who decided to call the ambulance service were compared with patients who contacted any other service. Most patients who contact non-ambulance services are seen by general practitioners. The prehospital system time for 121 patients who chose to call the ambulance service first was significantly shorter than for 96 patients who chose to call another service (median 57 min v 107 min; p<0.001). Of the 42 patients thrombolysed in the emergency department, those who chose to call the ambulance service had significantly shorter prehospital system times (number 21 v 21; median 44 v 69 min; p<0.001). Overall time from pain onset to initiation of thrombolysis was significantly longer in the group of patients who called a non-ambulance service first (median 130 min v 248 min; p=0.005). Conclusions: Patient with acute ischaemic chest pain who call their general practice instead of the ambulance service are likely to have delayed thrombolysis. This is likely to result in increased mortality. The most beneficial current approach is for general practices to divert all patients with possible ischaemic chest pain onset within 12 hours direct to the ambulance service.

Hitchcock, T; Rossouw, F; McCoubrie, D; Meek, S



Prevalence and Characteristics of Breakthrough Pain in Cancer Patients Admitted to a Hospice  

Microsoft Academic Search

A prospective survey was undertaken to determine the prevalence and characteristics of breakthrough pain in cancer patients admitted to a hospice. Of 414 consecutive admissions, 33 patients were confused or too unwell to take part and 136 were pain-free. The remaining 245 reported 404 pains (range 1–5 per patient); of these patients, 218 (89%) had breakthrough pain and identified 361

Giovambattista Zeppetella; Catherine A O'Doherty; Silke Collins



Influence of depression symptoms on serum tumor necrosis factor-? of patients with chronic low back pain  

PubMed Central

Introduction Patients with chronic low back pain (cLBP) have high rates of comorbid psychiatric disorders, mainly depression. Recent evidence suggests that depressive symptoms and pain, as interacting factors, have an effect on the circulating levels of inflammatory markers relevant to coronary artery disease. Our previous work showed a higher serum level of an inflammatory marker tumour necrosis factor-alpha (TNF?) in patients with cLBP, which did not correlate with intensity of low back pain alone. In the present study we investigated the cross-sectional associations of depressive symptoms, low back pain and their interaction with circulating levels of TNF?. Methods Each group of 29 patients with cLBP alone or with both cLBP and depression was age-matched and sex-matched with 29 healthy controls. All subjects underwent a blood draw for the assessment of serum TNF? and completed a standardised questionnaire regarding medication, depression scores according to the German version of Centre for Epidemiological Studies Depression Scale (CES-D), pain intensity from a visual analogue scale, and back function using the Roland and Morris questionnaire. The correlations between TNF? level and these clinical parameters were analysed. Results There were no differences in TNF? level between cLBP patients with and without depression. Both cLBP patients with (median = 2.51 pg/ml, P = 0.002) and without (median = 2.58 pg/ml, P = 0.004) depression showed significantly higher TNF? serum levels than healthy controls (median = 0 pg/ml). The pain intensity reported by both patient groups was similar, while the patients with depression had higher CES-D scores (P < 0.001) and worse back function (P < 0.001). The variance analysis showed that the interaction between TNF? level and pain intensity, CES-D scores, sex, body mass index and medication was statistically significant. Conclusions Depression as a comorbidity to cLBP did not influence the serum TNF? level. It seems that TNF? somehow acts as a mediator in both cLBP and depression, involving similar mechanisms that will be interesting to follow in further studies.



Selective attention towards painful faces among chronic pain patients: evidence from a modified version of the dot-probe.  


Evidence that patients with chronic pain selectively attend to pain-related stimuli presented in modified Stroop and dot-probe paradigms is mixed. The pain-related stimuli used in these studies have been primarily verbal in nature (i.e., words depicting themes of pain). The purpose of the present study was to determine whether patients with chronic pain, relative to healthy controls, show selective attention for pictures depicting painful faces. To do so, 170 patients with chronic pain and 40 age- and education-matched healthy control participants were tested using a dot-probe task in which painful, happy, and neutral facial expressions were presented. Selective attention was denoted using the mean reaction time and the bias index. Results indicated that, while both groups shifted attention away from happy faces (and towards neutral faces), only the control group shifted attention away from painful faces. Additional analyses were conducted on chronic pain participants after dividing them into groups on the basis of fear of pain/(re)injury. The results of these analyses revealed that while chronic pain patients with high and low levels of fear both shifted attention away from happy faces, those with low fear shifted attention away from painful faces, whereas those with high fear shifted attention towards painful faces. These results suggest that patients with chronic pain selectively attend to facial expressions of pain and, importantly, that the tendency to shift attention towards such stimuli is positively influenced by high fear of pain/(re)injury. Implications of the findings and future research directions are discussed. PMID:19201094

Khatibi, Ali; Dehghani, Mohsen; Sharpe, Louise; Asmundson, Gordon J G; Pouretemad, Hamidreza



Repeatability of gait analysis for measuring knee osteoarthritis pain in patients with severe chronic pain.  


Gait measures are receiving increased attention in the evaluation of patients with knee osteoarthritis (OA). Yet, there remains a need to assess variability of gait analysis in patients with knee osteoarthritis over time and how pain affects variation in these gait parameters. The purpose of this study was to determine if important gait parameters, such as the knee adduction moment, knee flexion moment, peak vertical ground reaction force, and speed, were repeatable in patients with mild-to-moderate knee OA over a trial period of 12 weeks. Six patients were enrolled in this cross-over study design after meeting strict inclusion criteria. Gait tests were conducted three times at 4 week intervals and once after the placebo arm of a randomized treatment sequence; each gait test followed a 2-week period of receiving a placebo for a pain modifying drug. Repeatability for each gait variable was found using intraclass correlation coefficients (ICC) with a two-way random model. This study found that the knee adduction moment was repeatable throughout the four gait tests. However, normalized peak vertical ground reaction force and knee flexion moment were not as repeatable, varying with pain. This suggests that these gait outcomes could offer a more objective way to measure a patient's level of pain. PMID:23508626

Asay, Jessica L; Boyer, Katherine A; Andriacchi, Thomas P



Rapid musculoskeletal ultrasound for painful episodes in adult haemophilia patients.  


Little objective information exists about musculoskeletal bleeding patterns in haemophilic arthropathy. Bleeding is assumed to be the cause of painful joints or muscles. Clotting factor treatment is provided empirically, but often does not alleviate pain. We hypothesized that perception of pain aetiology is unreliable, and introduced point-of-care high-resolution musculoskeletal ultrasound (MSKUS) to differentiate intra-articular bleeds vs. joint inflammation, and intra-muscle bleeds vs. other regional pain syndromes. To assess painful musculoskeletal episodes in adult haemophiliacs, we used rapid MSKUS, employing grey scale and power Doppler examination. Forty episodes in 30 adult haemophiliacs were evaluated. Thirty three of the 40 episodes were patient-reported as 'bleeding', five as 'arthritis-type' pain and two as 'undecided'. Of the 33 bleeding reports, only 12 were confirmed by MSKUS; the other episodes revealed other pathology. In contrast, three of five perceived arthritis flares were reclassified as bleeds. Similarly, physician assessment was incorrect in 18 of 40 instances. Swelling and warmth were present in approximately half of confirmed bleeding and non-bleeding episodes, and therefore not useful clinically. Few of the painful episodes were symptom controlled at the time of MSKUS. Management changed based on objective imaging findings in >70% of episodes, which resulted in symptom improvement >60% of the time. Significant discrepancies exist between MSKUS findings and patient/physician-perceived pain classification as bleeding or other musculoskeletal symptoms. Current practice of prescribing clotting factor or conservative measures based on pain perception seems inadequate and suggests that point-of-care imaging should be included into modern haemophilia care. PMID:23672827

Ceponis, A; Wong-Sefidan, I; Glass, C S; von Drygalski, A



Drawing Dinos  

NSDL National Science Digital Library

This OLogy activity shows kids how paleo-artists are able to transform dinosaur bones into dynamic drawings. After walking them through the five-step process, the activity challenges kids to create their own drawings from dinosaur skeletons.


Personality profiles and subjective perception of pain in head pain patients.  


Little or no information is available regarding the effect of the personality characteristics of headache sufferers on the quality of pain perception. The aim of this study is to investigate, in head pain sufferers, the relationship between the personality profile, assessed by the MMPI, and the different dimensions of pain (sensory, affective and evaluative), as assessed by the MPQ. Three hundred and seventeen patients with Migraine and/or tension-type headache (episodic or chronic) and myogenic facial pain were included. The Italian versions of the MMPI-2 and MPQ were administered, and the pain level was measured by the VAS. Cluster analysis based on the clinical scales of MMPI identified four personality profiles closely corresponding to the MMPI profiles obtained by the previous researchers: "depressive" (Dep.), "emotionally overwhelmed" (Emot.), "conversive" (Conv.) and "Coper". Differences in MPQ scales between personality profiles were investigated by means of a general linear model (GLM), adjusting for sex, age and pain level and type. Results of GLM analysis showed that the affective dimension was significantly higher in cluster Emot. than in Dep. (p=0.027), Conv. (p=0.002) and Coper (p=0.003). Total PRI was significantly higher in Emot. than in Conv. (p=0.010). The findings of the present study suggest that a specific personality profile (Emot.), characterized by a heavy emotional burden, may increase the affective dimension of pain with respect to a depressive profile (Dep.), a conversive profile (Conv.) or a normal profile (Coper), independent of sex, age and pain level and type. PMID:19394764

Mongini, Franco; Rota, Eugenia; Evangelista, Andrea; Ciccone, Giovannino; Milani, Chantal; Ugolini, Alessandro; Ferrero, Luca; Mongini, Tullia; Rosato, Rosalba



Postconcussion Symptoms in Patients with Injury-Related Chronic Pain  

PubMed Central

Background. Postconcussion symptoms (PCSs)—such as fatigue, headache, irritability, dizziness, and impaired memory—are commonly reported in patients who have mild traumatic brain injuries (MTBIs). Evaluation of PCS after MTBI is proposed to have a diagnostic value although it is unclear whether PCS are specific to MTBI. After whiplash injuries, patients most often complain of headaches and neck pain; the other PCS are not as closely evaluated. In patients with chronic pain because of other injuries, the presence of PCS is unclear. This study aimed to describe the frequency of PCS in patients with injury-related pain and to examine the relationships between PCS, pain, and psychological factors. Methods. This study collected data using questionnaires addressing PCS (Rivermead Postconcussion Questionnaire, RPQ), pain intensity (Visual Analogue Scale), depression, anxiety (Hospital, Anxiety, and Depression Scale), and posttraumatic stress (Impact of Event Scale). Results. Fatigue (90.7%), sleep disturbance (84.9%), headache (73.5%), poor concentration (88.2%), and poor memory (67.1%) were some of the most commonly reported PCS. Significant relationships were found between PCS and posttraumatic stress, depression, and anxiety. Conclusion. To optimize treatment, it is important to assess each patient's PCS, the mechanism of injury, and factors such as posttraumatic stress and depression.

Stalnacke, Britt Marie



Tolerance of Pain by Cancer Patients in Hyperthermia Treatment  

Microsoft Academic Search

Hyperthermia-the artificial inducement of abnormally high blood temperature-is designed to cause tumor tissue to retain heat and has additive or synergistic effects with radiation and chemotherapy. Because of the clinically administered high temperature, cancer patients often experience pain and discomfort. In the study described in this article, 30 cancer patients undergoing hyperthermia treatment as part of their overall cancer care

Ronald H. Rozensky; Laurie Feldman Honor; Steve M. Tovian; Gordon Herz; Margaret Holland




PubMed Central

Fifty cases of chronic non-specific abdominal pain were studied prospectively. All patients were subjected to a detailed clinical examination and investigations related to gastrointestinal system. A full psychiatric assessment was done with application of Goldberg's 60 item's General Health Questionnaire. Thirty four (68%) patients had psychiatric symptoms, of whom twenty six (52%) had a definite psychiatric illness while the remaining eight patients had organic illness. Sixteen patients (32%) had a pure organic illness. Dysthymic disorder constituted the main (22%) psychiatric illness.

Kachhwaha, S.S.; Chadda, V.S.; Singhwal, A.K.; Bhardwaj, P.



Cancer patient supportive care and pain management. Special listing  

SciTech Connect

This Special Listing of Current Cancer Research Projects is a publication of the International Cancer Research Data Bank (ICRDB) Program of the National Cancer Institute. Each Listing contains descriptions of ongoing projects in one selected cancer research area. The research areas include: Infectious disease in cancer patients; Immunological aspects of supportive care of cancer patients; Nutritional evaluation and support of cancer patients; Pain management of cancer patients.

Not Available



Characteristics of highly impaired children with severe chronic pain: a 5-year retrospective study on 2249 pediatric pain patients  

PubMed Central

Background Prevalence of pain as a recurrent symptom in children is known to be high, but little is known about children with high impairment from chronic pain seeking specialized treatment. The purpose of this study was the precise description of children with high impairment from chronic pain referred to the German Paediatric Pain Centre over a 5-year period. Methods Demographic variables, pain characteristics and psychometric measures were assessed at the first evaluation. Subgroup analysis for sex, age and pain location was conducted and multivariate logistic regression applied to identify parameters associated with extremely high impairment. Results The retrospective study consisted of 2249 children assessed at the first evaluation. Tension type headache (48%), migraine (43%) and functional abdominal pain (11%) were the most common diagnoses with a high rate of co-occurrence; 18% had some form of musculoskeletal pain disease. Irrespective of pain location, chronic pain disorder with somatic and psychological factors was diagnosed frequently (43%). 55% of the children suffered from more than one distinct pain diagnosis. Clinically significant depression and general anxiety scores were expressed by 24% and 19% of the patients, respectively. Girls over the age of 13 were more likely to seek tertiary treatment compared to boys. Nearly half of children suffered from daily or constant pain with a mean pain value of 6/10. Extremely high pain-related impairment, operationalized as a comprehensive measure of pain duration, frequency, intensity, pain-related school absence and disability, was associated with older age, multiple locations of pain, increased depression and prior hospital stays. 43% of the children taking analgesics had no indication for pharmacological treatment. Conclusion Children with chronic pain are a diagnostic and therapeutic challenge as they often have two or more different pain diagnoses, are prone to misuse of analgesics and are severely impaired. They are at increased risk for developmental stagnation. Adequate treatment and referral are essential to interrupt progression of the chronic pain process into adulthood.



Depression and quality of life in cancer patients with and without pain: the role of pain beliefs  

Microsoft Academic Search

BACKGROUND: Pain is said to be one of the most feared and distressing symptoms of cancer and one that disrupts all aspects of life. The purposes of this study were: 1) to compare depression and quality of life among Iranian cancer patients with and without pain; and 2) to determine the relationships between pain beliefs and depression and quality of

Azadeh Tavoli; Ali Montazeri; Rasool Roshan; Zahra Tavoli; Mahdiyeh Melyani



Factors That Influence Patient Advocacy by Pain Management Nurses: Results of the American Society for Pain Management Nursing Survey  

Microsoft Academic Search

What is the meaning of advocacy, and how does it relate to the nurse who wants patients to experience optimum pain management? This question and the lack of empirical data provided the stimulus for the American Society for Pain Management Nursing (ASPMN) Research Committee to explore ASPMN members' beliefs, knowledge, and skills regarding pain management advocacy activities. The specific aim

Laurie Jowers Ware; Patricia Bruckenthal; Gail C. Davis; Susan K. O'Conner-Von



A Prospective Analysis of Acceptance of Pain and Values-Based Action in Patients With Chronic Pain  

Microsoft Academic Search

Objective: Acceptance of pain and values-based action appear important in the emotional, physical, and social functioning of individuals with chronic pain. The purpose of the current study was to prospectively investigate these combined processes. Method: 115 patients attending an assessment and treatment course for chronic pain in the U.K. completed a standard set of measures on two occasions separated by

Lance M. McCracken; Kevin E. Vowles



Do patients with chronic pain selectively attend to pain-related information?: preliminary evidence for the mediating role of fear  

Microsoft Academic Search

Preliminary evidence from a study using a modified Stroop paradigm suggests that individuals with chronic pain selectively attend to pain-related information. The current study was conducted in an attempt to replicate and extend this finding. Nineteen patients with chronic pain stemming from musculoskeletal injury and 22 healthy control subjects participated. All participants completed a computerised task designed to evaluate attentional

Gordon J. G Asmundson; Jenora L Kuperos; G Ron Norton



Cerebral responses to pain in patients suffering acute post-dental extraction pain measured by positron emission tomography (PET)  

Microsoft Academic Search

Previous studies with normal volunteers have demonstrated distributed cortical responses to experimental heat pain within a network of structures. The network includes the insula, anterior cingulate, prefrontal, inferior parietal and somatosensory cortices. Patients suffering from chronic nociceptive pain following rheumatoid arthritis (RA) have shown damped central responses to experimental heat pain applied to the back of the right hand. In

Stuart W. G. Derbyshire; Anthony K. P. Jones; Mary Collins; Charlotte Feinmann; Malcolm Harris



Correlations of Radiographic Findings in Patients with Low Back Pain  

PubMed Central

Background: Low back pain can cause severe debilitating pain that may lead to loss of productivity. The pain is usually non-specific and imaging request protocols varies. However, physicians may order lumbo-sacral x-ray in the initial radiologic assessment of the patient. This study aims to determine the frequency of occurrence of radiographic findings in patients reporting low back pain including the presence of osteophytes, spondylolisthesis and degenerative disc diseases and determine the relationship with patients’ features including age, sex, marital status, level of education, body mass index and other radiographic findings. Method: Patients who presented at our department for radiographic assessment of the lumbo-sacral spine were voluntarily recruited. Their radiographs were reviewed and questionnaire administered. Height and weight were measured. The radiographic findings were documented and data analysis using Chi square with significant level set at p < 0.05. Result: Lumbo-sacral x-rays of 337 patients were reviewed with more females than males, ratio 1:1.4. Osteophytes were demonstrable in 73.6%; spondylolisthesis, 13.4%; and disc degeneration, 28.2%. Disc degeneration correlated with age, educational status, osteophytosis, osteopenia and spondylolisthesis. Osteophytosis correlated with age, BMI and educational level. While spondylolisthesis correlated with educational level and sex. Conclusion: Osteophytosis was the commonest finding in patients presenting with LBP. Disc degeneration shows a strong association with osteophytosis and spondylolisthesis and it is reported to herald these changes. Radiography still shows some correlations between the findings in LBP and patients’ characteristics.

Igbinedion, B. O. E; Akhigbe, A.



Doloplus-2 pain assessment: an effective tool in patients over 85 years with advanced dementia and persistent pain.  


Persistent pain in the elderly with dementia is neglected and effective pain diagnostic tools still lack. The aim of the study was to re-assess pain after 1 year in a group of elderly with dementia, resident in a Nursing Home. Doloplus-2 scale was adopted to detect pain and to evaluate its adequacy to address analgesia. Thirty-six out of 90 residents were affected by moderate-severe dementia and 23 patients with persistent pain were enrolled in the study. The results showed a significant reduction of Doloplus-2 score in the observational period (p <0.001) and of its mean score below the pain threshold (p <0.0001). This case analysis confirmed the clinical utility of Doloplus-2 to detect pain in patients with very advanced age and with severe dementia. The tool also confirmed its handiness and clinical applicability by nurses in order to support a systematic pain assessment in long term care. PMID:23455747

Monacelli, F; Vasile Nurse, A; Odetti, P; Traverso, N



The approach to patients with possible cardiac chest pain.  


Chest pain is a common reason for presentation in hospital emergency departments and general practice. Some patients presenting with chest pain to emergency departments and, to a lesser extent, general practice will be found to have a life-threatening cause, but most will not. The challenge is to identify those who do in a safe, timely and cost-effective manner. An acute coronary syndrome cannot be excluded on clinical grounds alone. In patients with ongoing symptoms of chest pain, without an obvious other cause, ST-segment-elevation myocardial infarction should be excluded with a 12-lead electrocardiogram at the first available opportunity. Significant recent advances in the clinical approach to patients with acute chest pain, including better understanding of risk stratification, increasingly sensitive cardiac biomarkers and new non-invasive tests for coronary disease, can help clinicians minimise the risk of unexpected short-term adverse cardiac events. An approach that integrates these advances is needed to deliver the best outcomes for patients with chest pain. All hospital emergency departments should adopt such a strategic approach, and general practitioners should be aware of when and how to access these facilities. PMID:23829259

Parsonage, William A; Cullen, Louise; Younger, John F



Slowed EEG rhythmicity in patients with chronic pancreatitis: evidence of abnormal cerebral pain processing?  

Microsoft Academic Search

BACKGROUND AND AIM: Intractable pain usually dominates the clinical presentation of chronic pancreatitis (CP). Slowing of electroencephalogram (EEG) rhythmicity has been associated with abnormal cortical pain processing in other chronic pain disorders. The aim of this study was to investigate the spectral distribution of EEG rhythmicity in patients with CP. PATIENTS AND METHODS: Thirty-one patients with painful CP (mean age

S. S. Olesen; T. M. Hansen; C. Graversen; K. Steimle; O. H. G. Wilder-Smith; A. M. Drewes



Neuropathic and nociceptive pain in head and neck cancer patients receiving radiation therapy  

Microsoft Academic Search

BACKGROUND: Pain is common in head and neck cancer (HNC) patients and may be attributed to the malignancy and\\/or cancer treatment. Pain mechanisms and patient report of pain in HNC are expected to include both nociceptive and neuropathic components. The purpose of this study was to assess the trajectory of orofacial and other pain during and following treatment, using patient

Joel B Epstein; Diana J Wilkie; Dena J Fischer; Young-Ok Kim; Dana Villines



Comparison of different pain scoring systems in critically ill patients in a general ICU  

Microsoft Academic Search

BACKGROUND: Pain in critically ill patients in the intensive care unit (ICU) is common. However, pain assessment in critically ill patients often is complicated because these patients are unable to communicate effectively. Therefore, we designed a study (a) to determine the inter-rater reliability of the Numerical Rating Scale (NRS) and the Behavioral Pain Scale (BPS), (b) to compare pain scores

Sabine JGM Ahlers; Laura van Gulik; Aletta M van der Veen; Hendricus PA van Dongen; Peter Bruins; Svetlana V Belitser; Anthonius de Boer; Dick Tibboel; Catherijne AJ Knibbe



The Effects of Repeated Thermal Therapy for Patients with Chronic Pain  

Microsoft Academic Search

Background: It has been reported that local thermal therapy with a hot pack or paraffin relieves pain. We hypothesized that systemic warming may decrease pain and improve the outcomes in patients with chronic pain. The purpose of this study was to clarify the effects of systemic thermal therapy in patients with chronic pain. Methods: Group A (n = 24) patients

Akinori Masuda; Yasuyuki Koga; Masato Hattanmaru; Shinichi Minagoe; Chuwa Tei



Validation of a screener and opioid assessment measure for patients with chronic pain  

Microsoft Academic Search

There has been a need for a brief assessment tool for providers who treat chronic pain patients to determine potential risk of abuse when prescribed opioids for pain. The purpose of this study was to develop and begin the validation of a self-administered screening tool (Screener and Opioid Assessment for Patients with Pain, SOAPP) for chronic pain patients considered for

Stephen F. Butler; Simon H. Budman; Kathrine Fernandez; Robert N. Jamison



Children's drawings.  


Children's drawings have been used in clinical interviews to provide direction for recollection and memory of events. Drawings encourage the retrieval of experience in the motoric, visual, and auditory recall. The drawing itself gives an expression of motor sensory discharge; the objects in the drawing help with the perceptual cues that are remembered; the cognitive dimensions are represented in the organization, interpersonal patterns, and verbal discussion of the picture. The premise of this paper is that children's drawings are useful as an associative tool for assessing and accessing traumatic memories. PMID:8435780

Burgess, A W; Hartman, C R


Determinants of vocational disability in patients with low back pain.  


Eighty-seven unemployed subjects with low back pain were recruited from an orthopedic back pain clinic and were given a battery of physical and psychologic tests. Subjects were contacted six months later to determine their current compensation status and whether they had returned to work. Age, length of time out of work, how much they had lifted in their previous job, the number of weeks they had been compensated, current activity levels, leg pain, and various psychologic factors significantly differentiated those who worked from those who did not. Physical examination findings and testing of the ability to lift were not significantly related to return to work. It is suggested that demographic, job-related, and psychologic factors should be emphasized, rather than only physical capacity, in the evaluation of vocational potential and the assessment of disability in patients with low back pain. PMID:2527487

Milhous, R L; Haugh, L D; Frymoyer, J W; Ruess, J M; Gallagher, R M; Wilder, D G; Callas, P W



Pain epidemiology and health related quality of life in chronic non-malignant pain patients referred to a Danish multidisciplinary pain center  

Microsoft Academic Search

This paper presents the results of a detailed study of the pain epidemiology and health related quality of life (HRQL) in 150 chronic non-malignant pain patients consecutively referred to a Danish multidisciplinary pain center. Mean pain severity was 71.6 (SD=18.5) on the VAS scale. Forty-two percent reported poor quality of sleep. HRQL was evaluated with the Medical Outcome Study-Short Form

Niels Becker; Annemarie Bondegaard Thomsen; Alf Kornelius Olsen; Per Sjøgren; Per Bech; Jørgen Eriksen



Randomized controlled pilot study: pain intensity and pressure pain thresholds in patients with neck and low back pain before and after traditional East Asian "gua sha" therapy.  


Gua Sha is a traditional East Asian healing technique where the body surface is "press-stroked" with a smooth-edged instrument to raise therapeutic petechiae that last 2-5 days. The technique is traditionally used in the treatment of both acute and chronic neck and back pain. This study aimed to measure the effects of Gua Sha therapy on the pain ratings and pressure pain thresholds of patients with chronic neck pain (CNP) and chronic low back pain (CLBP). A total of 40 patients with either CNP or CLBP (mean age 49.23 ± 10.96 years) were randomized to either a treatment group (TG) or a waiting list control group (WLC). At baseline assessment (T1), all patients rated their pain on a 10 cm visual analog scale (VAS). Patients' pressure pain thresholds (PPT) at a site of maximal pain (pain-maximum) and an adjacent (pain-adjacent) site were also established. The treatment group then received a single Gua Sha treatment. Post-intervention measurements were taken for both groups at T2, seven days after baseline assessment (T1), using the same VAS and PPT measurements in precisely the same locations as at T1. Final analysis were conducted with 21 patients with CNP and 18 patients with CLBP. The study groups were equally distributed with regard to randomization. Patients in both the CNP and the CLBP treatment groups reported pain reduction (p < 0.05) and improved health status from their one Gua Sha treatment, as compared to the waiting list group. Pain sensitivity improved in the TG in CNP, but not in CLBP patients, possibly due to higher pressure sensitivity in the neck area. No adverse events were reported. These results suggest that Gua Sha may be an effective treatment for patients with chronic neck and low back pain. Further study of Gua Sha is warranted. PMID:22928824

Lauche, Romy; Wübbeling, Klaus; Lüdtke, Rainer; Cramer, Holger; Choi, Kyung-Eun; Rampp, Thomas; Michalsen, Andreas; Langhorst, Jost; Dobos, Gustav J



Do main caregivers selectively attend to pain-related stimuli in the same way that patients do?  

Microsoft Academic Search

Despite increasing interest in the attentional biases of pain patients towards pain-related stimuli, there have been no investigations of whether the main caregivers of chronic pain patients also selectively attend to pain-related information. We compared the attentional biases to painful or happy faces of 120 chronic pain patients, 118 caregivers, and 50 controls. Analyses found that both patients and caregivers

Somayeh Mohammadi; Mohsen Dehghani; Louise Sharpe; Mahmoud Heidari; Maryam Sedaghat; Ali Khatibi


Persistent pain in postmastectomy patients: comparison of psychophysical, medical, surgical, and psychosocial characteristics between patients with and without pain.  


Persistent postmastectomy pain (PPMP) is a major individual and public health problem. Increasingly, psychosocial factors such as anxiety and catastrophizing are being revealed as crucial contributors to individual differences in pain processing and outcomes. Furthermore, differences in patients' responses to standardized quantitative sensory testing (QST) may aid in the discernment of who is at risk for acute and chronic pain after surgery. However, characterization of the variables that differentiate those with PPMP from those whose acute postoperative pain resolves is currently incomplete. The purpose of this study was to investigate important surgical, treatment-related, demographic, psychophysical, and psychosocial factors associated with PPMP by comparing PPMP cases with PPMP-free controls. Pain was assessed using the breast cancer pain questionnaire to determine the presence and extent of PPMP. Psychosocial and demographic information were gathered via phone interview, and women underwent a QST session. Consistent with most prior research, surgical and disease-related variables did not differ significantly between cases and controls. Furthermore, treatment with radiation, chemotherapy, or hormone therapy was also not more common among those with PPMP. In contrast, women with PPMP did show elevated levels of distress-related psychosocial factors such as anxiety, depression, catastrophizing, and somatization. Finally, QST in nonsurgical body areas revealed increased sensitivity to mechanical stimulation among PPMP cases, while thermal pain responses were not different between the groups. These findings suggest that an individual's psychophysical and psychosocial profile may be more strongly related to PPMP than their surgical treatment. PMID:23290256

Schreiber, Kristin L; Martel, Marc O; Shnol, Helen; Shaffer, John R; Greco, Carol; Viray, Nicole; Taylor, Lauren N; McLaughlin, Meghan; Brufsky, Adam; Ahrendt, Gretchen; Bovbjerg, Dana; Edwards, Robert R; Belfer, Inna



The Effects of Depression and Smoking on Pain Severity and Opioid Use in Patients with Chronic Pain  

PubMed Central

Depression and smoking are common comorbid conditions among adults with chronic pain. The aim of this study was to determine the independent effects of depression on clinical pain and opioid use among patients with chronic pain according to smoking status. A retrospective design was used to assess baseline levels of depression, clinical pain, opioid dose (calculated as morphine equivalents), and smoking status in a consecutive series of patients admitted to a 3-week outpatient pain treatment program from September 2003 through February 2007. Depression was assessed using the Centers for Epidemiologic Studies-Depression scale, and clinical pain was assessed using the pain severity subscale of the Multidimensional Pain Inventory. The study cohort (N = 1241) included 313 current smokers, 294 former smokers, and 634 never smokers. Baseline depression (P = 0.001) and clinical pain (P = 0.001) were greater among current smokers compared to former and never smokers, and the daily morphine equivalent dose was greater among smokers compared to never smokers (P = 0.005). In multivariate linear regression analyses, baseline pain severity was independently associated with greater levels of depression, but not with smoking status. However, status as a current smoker was independently associated with greater opioid use (by 27 mg/day), independent of depression scores. The relationship between depression, smoking status, opioid use, and chronic pain is complex, and both depression and smoking status may be potentially important considerations in the treatment of patients with chronic pain who utilize opioids.

Hooten, W. Michael; Shi, Yu; Gazelka, Halena M.; Warner, David O.



Assessment and management of breakthrough pain in cancer patients: Current approaches and emerging research  

Microsoft Academic Search

Cancer pain is highly prevalent and often severe. Fortunately, most cancer pain can be readily managed, with up to 90% of\\u000a patients responding well to standard interventions. However, breakthrough cancer pain—brief flares of severe pain superimposed\\u000a on baseline pain—is common, difficult to manage, and often negatively impacts patients’ quality of life. Breakthrough cancer\\u000a pain is traditionally managed with oral, immediaterelease

Neil A. Hagen; Patricia Biondo; Carla Stiles



Temporal Summation of Heat Pain in Temporomandibular Disorder Patients  

PubMed Central

Aims One possible mechanism underlying myofascial temporomandibular disorders (TMD) is altered central nervous system processing of painful stimuli. The current study aimed to compare TMD cases to controls on two measures of central processing, i.e., temporal summation of heat pain and decay of subsequent aftersensations, following thermal stimulation in both a trigeminal and extratrigeminal area. Methods Using a “wind-up” (WU) protocol, 19 female TMD patients and 17 controls were exposed to 15 heat stimuli at a rate of 0.3 Hz. Numeric pain ratings were elicited after the 1st, 5th, 10th and 15th stimulus presentation and every 15 seconds after final presentation (aftersensations), for up to 2 minutes. In separate trials, the thermode was placed on the thenar eminence of the hand and the skin overlying the masseter muscle. Results Groups did not differ with respect to the slope of WU when stimulated at either anatomic site, although asymptote occurred sooner for TMD patients than controls. In analysis of aftersensations, a significant group x site x time interaction was detected, in which TMD patients experienced more prolonged painful aftersensations than controls when stimulated on the skin overlying the masseter muscles. Conclusions These results are consistent with the presence of enhanced central sensitivity in TMD and suggest that this sensitivity may be largely confined to the region of clinical pain. This contrasts with conditions such as fibromyalgia, where central sensitivity appears to be widespread.

Raphael, Karen G.; Janal, Malvin N.; Ananthan, Sowmya; Cook, Dane B.; Staud, Roland



Chronic wound and postamputation claudication pain in a diabetic patient.  


Underlying ischaemic disease should be excluded in patients with delayed wound healing. Contrast angiography is a useful imaging method for assessing the specific cause of wound chronicity and may also be helpful in assessing the aetiology of unexplained pain symptoms. Angioplasty provides a practical alternative to more invasive techniques in addressing peripheral ischaemia. Our patient suffered claudication-type pain in his thigh and a non-healing stump wound following below-knee amputation. Magnetic resonance angiography confirmed the presence of arterial stenoses and an angioplasty was successfully performed to improve patency of the profunda femoris vessel. Following the operation, the claudication pain symptoms were significantly reduced and the stump wound went on to heal. PMID:24112482

Warner, B E; Richards, A J; Biswas, M; Chick, C; Lewis, P; Harding, K G



Patient Satisfaction with private Physiotherapy for musculoskeletal Pain  

PubMed Central

Background Despite emphasis on patient centred healthcare, healthcare professionals have been slow to use validated measurements of patient satisfaction in physiotherapy practice. The aim of this cross sectional survey was to measure patient satisfaction with private physiotherapy in Ireland, for patients with musculoskeletal pain, using a previously validated survey instrument. Methods A multidimensional patient satisfaction questionnaire 'PTOPS', which assesses patient satisfaction with outpatient physiotherapy treatment, was translated from American English to European English, and relevant demographic and global satisfaction items were included. This was then circulated to patients with musculoskeletal pain (n = 240) for anonymous completion and return to the research team. Data were analysed using the Statistical Package for the Social Sciences (SPSS, v.12). Results In total 55% (n = 131/240) of questionnaires were returned. Just over half of the respondents were male (53.4%, n = 70), with a mean age (SD) of 37.7 years (12.4), and had previous experience of physiotherapy (65.6%, n = 86). The most common site of musculoskeletal pain was spinal (51.5% n = 66). The mean (SD) number of treatments was 8.3 (8.3), at a mean total cost (SD) of €350.2 (€322.8). The 'PTOPS' questionnaire categorised and scored satisfaction items under four domains, Enhancer, Detractor, Location and Cost. The mean score (SD), optimum score, and scoring range for each domain were: 'Enhancer' 41.2 (3.8), 50, 10–50; 'Detractor' 19.4 (4.4), 10, 10–50; 'Location' 28.0 (4.1), 35, 7–35; 'Cost' 18.9 (2.8), 7, 7–35. "Overall satisfaction with physiotherapy experience" was scored on a five-point scale "excellent to poor", with a modal response of "Very Good" (42%; n = 55). Conclusion This study measured patient satisfaction with private physiotherapy treatment for musculoskeletal pain in Ireland using a previously validated outcome measure and provides a template for future studies of this increasingly important topic. Results demonstrated high levels of satisfaction with all components of physiotherapy treatment, except cost, and provided valuable patient feedback regarding their physiotherapy treatment for musculoskeletal pain. Results can be used by physiotherapists to improve future patient experiences with a view to improving patient attendance and compliance with physiotherapy treatment protocols for patients with musculoskeletal pain.

Casserley-Feeney, Sarah N; Phelan, Martin; Duffy, Fionnuala; Roush, Susan; Cairns, Melinda C; Hurley, Deirdre A



When race matters: disagreement in pain perception between patients and their physicians in primary care.  

PubMed Central

Patients and physicians often disagree in their assessment of pain intensity. This study explores the impact of patient factors on underestimation of pain intensity in chronic noncancer pain. We surveyed patients and their physicians in 12 primary care centers. To measure pain intensity, patients completed an 11-point numeric rating scale for which pain scores range from 0 (no pain) to 10 (unbearable pain). Physicians rated patients' pain on the same scale. We defined disagreement of pain intensity as underestimation or overestimation by 22 points. Of 601 patients approached, 463 (77%) completed the survey. The majority of participants were black (39%) or white (47%), 67% were female, and the mean age was 53 years. Physicians underestimated pain intensity relative to their patients 39% of the time. Forty-six percent agreed with their patients' pain perception, and 15% of physicians overestimated their patients' pain levels by > or =2 points. In both the bivariate and multivariable models, black race was a significant variable associated with underestimation of pain by physicians (p < 0.05; OR = 1.92; 95% CI: 1.31-2.81). This study finds that physicians are twice as likely to underestimate pain in blacks patients compared to all other ethnicities combined. A qualitative study exploring why physicians rate blacks patients' pain low is warranted.

Staton, Lisa J.; Panda, Mukta; Chen, Ian; Genao, Inginia; Kurz, James; Pasanen, Mark; Mechaber, Alex J.; Menon, Madhusudan; O'Rorke, Jane; Wood, JoAnn; Rosenberg, Eric; Faeslis, Charles; Carey, Tim; Calleson, Diane; Cykert, Sam



Evaluating care of patients reporting pain in fundholding practices.  

PubMed Central

OBJECTIVE--To compare quality of care between 1990 and 1992 in patients with self diagnosed joint pain. DESIGN--Questionnaire and record based study. SUBJECTS--Patients identified at consecutive consultations during two weeks in 1990, 1991, and 1992. SETTING--Six practice groups in pilot fundholding scheme in Scotland. MAIN OUTCOME MEASURES--Length of consultation; numbers referred or investigated or prescribed drugs; responses to questions about enablement and satisfaction. RESULTS--About 15% of patients consulted with joint pain each year. 25% (316) of them had social problems in 1990 and 37% (370) in 1992; about a fifth wanted to discuss their social problems. Social problems were associated with a raised general health questionnaire score. The mean length of consultation for patients with pain was 7.6 min in 1990 and 7.7 min in 1992. Patients wishing to discuss social problems received longer consultations (8.5 min 1990; 10.4 min 1992); but other patients with social problems received shorter consultations (7.4 min; 7.2 min). The level of prescribing was stable but the proportion of patients having investigations or attending hospital fell significantly from 1990 to 1992 (31% to 24%; 31% to 13% respectively). Fewer patients responded "much better" to six questions about enablement in 1992 than in 1990. Enablement was better after longer than shorter consultations for patients with social problems. CONCLUSIONS--Quality of care for patients with pain has been broadly maintained in terms of consultation times. The effects of lower rates of investigation and referral need to be investigated further.

Howie, J. G.; Heaney, D. J.; Maxwell, M.



Internet-Based Survey Evaluating Use of Pain Medications and Attitudes of Radiation Oncology Patients Toward Pain Intervention  

SciTech Connect

Purpose: Pain is a common symptom among cancer patients, yet many patients do not receive adequate pain management. Few data exist quantifying analgesic use by radiation oncology patients. This study evaluated the causes of pain in cancer patients and investigated the reasons patients fail to receive optimal analgesic therapy. Methods and Materials: An institutional review board-approved, Internet-based questionnaire assessing analgesic use and pain control was posted on the OncoLink (available at ( Website. Between November 2005 and April 2006, 243 patients responded. They were predominantly women (73%), white (71%), and educated beyond high school (67%) and had breast (38%), lung (6%), or ovarian (6%) cancer. This analysis evaluated the 106 patients (44%) who underwent radiotherapy. Results: Of the 106 patients, 58% reported pain from their cancer treatment, and 46% reported pain directly from their cancer. The pain was chronic in 51% and intermittent in 33%. Most (80%) did not use medication to manage their pain. Analgesic use was significantly less in patients with greater education levels (11% vs. 36%, p = 0.002), with a trend toward lower use by whites (16% vs. 32%, p 0.082) and women (17% vs. 29%, p = 0.178). The reasons for not taking analgesics included healthcare provider not recommending medication (87%), fear of addiction or dependence (79%), and inability to pay (79%). Participants experiencing pain, but not taking analgesics, pursued alternative therapies for relief. Conclusions: Many radiation oncology patients experience pain from their disease and cancer treatment. Most study participants did not use analgesics because of concerns of addiction, cost, or failure of the radiation oncologist to recommend medication. Healthcare providers should have open discussions with their patients regarding pain symptoms and treatment.

Simone, Charles B. [Department of Radiation Oncology, Hospital of University of Pennsylvania, Philadelphia, PA (United States); Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (United States)], E-mail:; Vapiwala, Neha; Hampshire, Margaret K.; Metz, James M. [Department of Radiation Oncology, Hospital of University of Pennsylvania, Philadelphia, PA (United States)



Clinimetric evaluations of patients with chronic widespread pain.  


Assessing chronic widespread pain (CWP) and its impact on physical, emotional and social function requires multidimensional qualitative and health-related quality of life (HRQL) instruments. The recommendations of the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) concerning outcome measurements for pain trials are useful for making routine assessments, the most significant of which include pain, fatigue, disturbed sleep, physical functioning, emotional functioning, patient global ratings of satisfaction and HRQL. However, despite the growing spread of instruments and theoretical publications devoted to measuring the various aspects of chronic pain, there is little widespread agreement, and no unified approach has yet been devised. There is therefore still considerable scope for the development of consensus around a core set of measures and response criteria, as well as for the development and refinement of the related instruments, standardised assessor training, the cross-cultural adaptation of health status questionnaires, electronic data capture and the introduction of valid, reliable and responsive standardised quantitative measurements into routine clinical care. Clinicians need to be aware of the psychometric properties of the instruments used, including their levels of imprecision and minimum clinically important differences (those indicating a meaningful change in clinical status). This article reviews a selection of the instruments used to assess CWP patients, including validated newly developed and well-established screening instruments, and discusses their advantages and limitations. PMID:22094200

Salaffi, Fausto; Sarzi-Puttini, Piercarlo; Ciapetti, Alessandro; Atzeni, Fabiola



Predicting pain and disability in patients with hand fractures: Comparing pain anxiety, anxiety sensitivity and pain catastrophizing  

Microsoft Academic Search

There is a range of anxiety-related constructs associated with pain and pain-related disability. Those most often examined are pain catastrophizing, pain anxiety and anxiety sensitivity. All three are conceptualized to be important in the development and maintenance of chronic pain, and are included within fear avoidance models. Surprisingly these constructs are not routinely examined together, and when they are, have

Edmund Keogh; James Thomas; Grey Giddins; Christopher Eccleston



[Female patient with hematemesis and upper abdominal pain].  


A 42-year-old female patient presented with acute pain of the upper abdomen, postprandial vomiting and hematemesis. An operation for gastric banding had been carried out 1 month prior to presentation. The abdominal X-ray and radioscopy revealed a posterior slippage of the gastric fundus following the gastric banding operation. PMID:21512762

Simon, M; Borberg, T; Jungbluth, T; Kovács, A; Barkhausen, J; Hunold, P



Neurodegenerative Properties of Chronic Pain: Cognitive Decline in Patients with Chronic Pancreatitis  

Microsoft Academic Search

Chronic pain has been associated with impaired cognitive function. We examined cognitive performance in patients with severe chronic pancreatitis pain. We explored the following factors for their contribution to observed cognitive deficits: pain duration, comorbidity (depression, sleep disturbance), use of opioids, and premorbid alcohol abuse. The cognitive profiles of 16 patients with severe pain due to chronic pancreatitis were determined

Marijtje L. A. Jongsma; Simone A. E. Postma; Pierre Souren; Martijn Arns; Evian Gordon; Kris Vissers; Oliver Wilder-Smith; Clementina M. van Rijn; Harry van Goor



Altered rectal sensory response induced by balloon distention in patients with functional abdominal pain syndrome  

Microsoft Academic Search

BACKGROUND: Functional abdominal pain syndrome (FAPS) has chronic unexplained abdominal pain and is similar to the psychiatric diagnosis of somatoform pain disorder. A patient with irritable bowel syndrome (IBS) also has chronic unexplained abdominal pain, and rectal hypersensitivity is observed in a majority of the patients. However, no reports have evaluated the visceral sensory function of FAPS precisely. We aimed

Tsukasa Nozu; Miwako Kudaira



Processing of pain- and body-related verbal material in chronic pain patients: central and peripheral correlates  

Microsoft Academic Search

The processing of pain-related, body-related and neutral words was assessed in chronic pain patients and matched healthy controls. During and after word presentation at perception threshold, electromyographic activity (EMG), heart rate, skin conductance level and electroencephalographic (EEG) data from 11 electrode sites were recorded. Startle responses were measured to suprathreshold word stimuli. Although the patients did not recognize more pain-related

Herta Flor; Bärbel Knost; Niels Birbaumer



The use of a new overlay mattress in patients with chronic pain: impact on sleep and self-reported pain  

Microsoft Academic Search

Objective: To evaluate the use of an air flotation mattress overlay in patients with chronic pain.Design: Four-week prospective AB design.Setting: The mattress overlay was used in a community setting.Subjects: Adult patients attending an outpatients clinic in a department of rheumatology, with chronic pain plus sleep problems, or pain sufficient to disturb sleep.Interventions: An inexpensive low-pressure inflatable mattress overlay (ReposeTM), which

P Price; S Rees-Mathews; N Tebble; J Camilleri



Managing pain in high-risk patients within a patient-centered medical home.  


Chronic pain remains a major healthcare problem despite noteworthy advancements in diagnostics, pharmacotherapy, and invasive and non-invasive interventions. The prevalence of chronic pain in the United States is staggering and continues to grow, and the personal and societal costs are not inconsequential. The etiology of pain is complex, and individuals suffering from chronic pain tend to have significant medical and psychiatric comorbidities such as depression, anxiety, and in some cases, substance use disorders. There is great concern regarding the burgeoning rate of prescription opioid misuse/abuse both for non-medical use and in pain patients receiving chronic opioid therapy. While there is ongoing debate about the "true" incidence of opioid abuse in the pain population, clearly, patients afflicted with both pain and substance use disorder are particularity challenging. The majority of patients with chronic pain including those with co-occurring substance use disorders are managed in the primary care setting. Primary care practitioners have scant time, resources and training to effectively assess, treat and monitor these complicated cases. A number of evidence- and expert consensus-based treatment guidelines on opioid therapy and risk mitigation have been developed but they have been underutilized in both specialty and primary care clinics. This article will discuss the utilization of new technologies and delivery systems for risk stratification, intervention and monitoring of patients with pain receiving opioid. PMID:24073097

Cheatle, Martin D; Klocek, John W; McLellan, A Thomas



A Study of the Diagnostic Drawing Series with Eating Disordered Patients.  

ERIC Educational Resources Information Center

|Examined possible existence of structural and content elements in Diagnostic Drawing Series (DDS) significant to eating-disordered population. Findings from 81 women with eating-disorders revealed that profile of eating disordered subjects did not vary from control group profile except for groundline and falling apart trees. (Author/NB)|

Kessler, Kathie



The Human Figure Drawing with Donor and Nondonor Siblings of Pediatric Bone Marrow Transplant Patients.  

ERIC Educational Resources Information Center

|There is little research on the psychological impact of bone marrow transplantation (BMT) on family members. This study uses the Human Figure Drawing (HFD) to measure siblings' emotional distress toward BMT. Among the siblings, feelings of isolation, anger, depression, anxiety, and low self-esteem emerged as major themes. Findings indicate the…

Packman, Wendy L.; Beck, Vanessa L.; VanZutphen, Kelly H.; Long, Janet K.; Spengler, Gisele



Similarity between complexity on Role Construct Repertory Technique and articulation on Draw-A-Person test for patients and non-patients.  


In an investigation of the underlying unity of the articulation of human figure drawings and personal construct complexity, moderate correlations were found, but in opposite directions, for inpatient and non-patient groups. For inpatients, greater construct complexity was associated with less sophisticated drawings. For non-patients, greater construct complexity was correlated with more sophisticated human figures. Mean and range differences in complexity and articulation scores between the two groups suggested that the higher complexity scores of the patient group indicated a loss of construct coordination, rather than greater articulation and organization of self and interpersonal experience. PMID:1012903

Phillips, W M; Phillips, A M



The experience and expression of pain in Alzheimer patients  

Microsoft Academic Search

Objectives: to establish whether there is a sub-group of patients suffering from senile dementia, Alzheimer-type (SDAT), who have ceased to undergo normal experience of pain. Methods: two single case studies are briefly described and a small-scale national survey by questionnaire is reported. Results: combining the original two cases with those garnered from the survey yielded 49 cases of SDAT patients




Avoidance and Confrontation of Painful, Back-Straining Movements in Chronic Back Pain Patients  

Microsoft Academic Search

Avoidance of painful activities has been proposed to be an important n'sk factor for the initiation and maintenance of chronic low back suffering, whereas exposure to these activities has been suggested to be beneficial for recovery. In a cross-sectional study, the differences between chronic patients with avoidant and confrontational styles were investigated using self-report measures and a behavioral test. Participants

Geert Crombez; Leen Vervaet; Roland Lysens; Frank Baeyens; Paul Eelen



Pain Expectancies, Pain, and Functional Self-Efficacy Expectancies as Determinants of Disability in Patients With Chronic Low Back Disorders  

Microsoft Academic Search

This study tested the relative predictive power of self-efficacy expectations of physical capabilities (functional self-efficacy [FSE]), expectations of pain, and expectations of reinjury on physical function in chronic back patients. Before behavioral assessment of function, 85 patients rated their abilities to perform essential job tasks (FSE) and the likelihood that their performances would be accompanied by pain and reinjury. Partial

Jeffrey M. Lackner; Ann Marie Carosella; Michael Feuerstein



Assessment of pain in patients with juvenile rheumatoid arthritis: relation between pain intensity and degree of joint inflammation.  

PubMed Central

The relation between pain and joint inflammation in patients with juvenile rheumatoid arthritis has not previously been systematically evaluated. Eighteen patients with juvenile rheumatoid arthritis completed paediatric pain questionnaires and the joints affected were examined by thermography. Although significant correlations were shown between parent and doctor pain intensity ratings and joint temperature, correlations of patient pain intensity ratings and joint temperature were only significant in younger children. The degree of joint inflammation is only one factor of several contributing to the amount of subjective pain experienced by children with juvenile rheumatoid arthritis, indicating the need for a comprehensive assessment of the relatively independent variables of inflammation and pain in children with juvenile rheumatoid arthritis.

Ilowite, N T; Walco, G A; Pochaczevsky, R



Continuous Quality Improvement for Patients with Back Pain  

PubMed Central

Recent evidence has changed traditional approaches to low back pain, suggesting minimal bed rest, highly selective imaging, and early return to normal activities. However, there are wide geographical variations in care, and substantial gaps between practice and evidence. This project sought to merge scientific evidence about back pain and knowledge about behavior change to help organizations improve care for back pain. Participating insurance plans, HMOs, and group practices focused on problems they themselves identified. The year-long program included quarterly meetings, coaching for rapid cycles of change, a menu of potential interventions, and recommendations for monitoring outcomes. Participants interacted through meetings, e-mail, and conference calls. Of the 22 participating organizations, 6 (27%) made major progress. Typical changes were reduced imaging, bed rest, and work loss, and increased patient education and satisfaction. Specific examples were a 30% decrease in plain x-rays, a 100% increase in use of patient education materials, and an 81% drop in prescribed bed rest. Despite the complexity of care for back pain, rapid improvements appear feasible. Several organizations had major improvements, and most experienced at least modest improvements. Key elements of successful programs included focus on a small number of clinical goals, frequent measurement of outcomes among small samples of patients, vigilance in maintaining gains; involvement of office staffs as well as physicians, and changes in standard protocols for imaging, physical therapy, and referral.

Deyo, Richard A; Schall, Marie; Berwick, Donald M; Nolan, Tom; Carver, Penny



Religiosity, depression and pain in patients with breast cancer.  


There is a growing body of evidence that religiosity can buffer depression and support the healing process. Our objective was to assess the relationship between religiosity, depression and pain in patients with breast cancer. Participants in our study were 115 breast cancer female patients recruited from a radiotherapy unit of a cancer teaching hospital, surveyed during the course of 6 months. The assessment used the Santa Clara Strength of Religious Faith Questionnaire as the measure of religiosity, and the subjects were categorized into low-, moderate- and high-religiosity groups according to its score. Depression was measured with the Center for Epidemiologic Studies Depression Scale, a 20-item self-report scale. The score of >or=16 indicated clinically relevant depression. A visual analogue scale was used for the assessment of pain. High religiosity was associated with a significantly lower prevalence of depression (chi(2)=6.635; df=2; P=.036), but religiosity was not related to the intensity of pain perception. Higher religiosity was associated with older age, lower education, unemployment and more children. Depression was associated with a higher pain level (U=1027.5; P=.004). The type of operation and tumor stage were not associated with categories of depression or religiosity, but mastectomized patients who belonged to the high-religiosity group were significantly less depressed (chi(2)=9.552; df=2; P=.008). PMID:15993256

Aukst-Margeti?, Branka; Jakovljevi?, Miro; Margeti?, Branimir; Bis?an, Mirjana; Samija, Mirko


Osteopathic manipulative medicine considerations in patients with chronic pain.  


Osteopathic manipulative medicine (OMM) incorporates diagnostic and therapeutic strategies that address body unity, homeostatic mechanisms, and structure-function interrelationships. In regard to pain, osteopathic physicians take thorough histories guided by palpatory examination to determine the quality, duration, and origin of this condition, how it uniquely affects the individual, and whether segmental, reflex, or triggered pain phenomena coexist. Osteopathic manipulative medicine expands differential diagnoses by considering somatic dysfunction and treatment options by integrating specific aspects of complementary care into state-of-the-art pain management practices. Prescriptions formulated through an OMM algorithm integrate each osteopathic tenet with biopsychosocial and patient education models and medication, rehabilitation, and manual medicine techniques proportionate to individual needs. PMID:16249364

Kuchera, Michael L



Acute Pain Management for Patients Receiving Maintenance Methadone or Buprenorphine Therapy  

PubMed Central

More patients with opioid addiction are receiving opioid agonist therapy (OAT) with methadone and buprenorphine. As a result, physicians will more frequently encounter patients receiving OAT who develop acutely painful conditions, requiring effective treatment strategies. Undertreatment of acute pain is suboptimal medical treatment, and patients receiving long-term OAT are at particular risk. This paper acknowledges the complex interplay among addictive disease, OAT, and acute pain management and describes 4 common misconceptions resulting in suboptimal treatment of acute pain. Clinical recommendations for providing analgesia for patients with acute pain who are receiving OAT are presented. Although challenging, acute pain in patients receiving this type of therapy can effectively be managed.

Alford, Daniel P.; Compton, Peggy; Samet, Jeffrey H.



Triage decisions for emergency department patients with chest pain  

Microsoft Academic Search

OBJECTIVE: To determine whether physicians’ risk attitudes correlate with their triage decisions for emergency department patients with\\u000a acute chest pain.\\u000a \\u000a \\u000a DESIGN: Cohort.\\u000a \\u000a \\u000a \\u000a \\u000a SETTING: The emergency department of a university teaching hospital.\\u000a \\u000a \\u000a \\u000a \\u000a PATIENTS: Patients presenting to the emergency department with a chief complaint of acute chest pain.\\u000a \\u000a \\u000a \\u000a \\u000a PHYSICIANS: All physicians who were primarily responsible for the emergency department triage of at

Steven D. Pearson; Lee Goldman; E. John Orav; Edward Guadagnoli; Tomas B. Garcia; Paula A. Johnson; Thomas H. Lee



The relationship between sleep-wake disturbance and pain in cancer patients admitted to hospice home care  

Microsoft Academic Search

There is evidence of a relationship between sleep-wake disturbances and pain variables in cancer patients. It is hypothesized that pain affects all aspects of sleep patterns. Pain has been known to affect sleep disturbances; however there are different facets of sleep-disturbances and pain that can be evaluated. These variables include pain distress, pain intensity, pain at its worst, relief from

Marjorie Acierno



Thoracic spine compression fracture in a patient with back pain.  


A 55-year-old man was referred to physical therapy because of constant mid-back pain of 1 month's duration. Because of the strong suspicion for a fracture, thoracic spine anterior-posterior and lateral radiographs were ordered, which revealed compression deformities of the T6, T8, T9, and T12 vertebral bodies. An interventional radiologist ordered magnetic resonance imaging and believed the patient was a candidate for vertebroplasty, a technique in which medical grade cement is injected into a painful fractured vertebral body in an effort to stabilize the fracture. At 1 week following his vertebroplasty the patient was pain free. Further medical evaluation indicated that the patient had underlying osteoporosis, and treatment was initiated. At 1 and 2 years after vertebroplasty, the patient reported being symptom free. However, a history of osteoporosis and multiple compression fractures led to further medical evaluation 2 years after vertebroplasty and the patient was eventually diagnosed with multiple myeloma for which treated was initiated. PMID:18434669

Ross, Michael D; Elliott, Ryan L



Abdominal muscle contraction thickness and function after specific and general exercises: A randomized controlled trial in chronic low back pain patients  

Microsoft Academic Search

The aim of this study was to assess changes in deep abdominal muscle function after 8 weeks of exercise in chronic low back pain patients. Patients (n = 109) were randomized to specific ultrasound guided, sling or general exercises. Contraction thickness ratio in transversus abdominis (TrA), obliquus internus (OI) and externus (OE), and TrA lateral slide were assessed during the abdominal drawing-in

Ottar Vasseljen; Anne Margrethe Fladmark



Inadequate pain relief in ambulatory patients with human immunodeficiency virus disease in Port Harcourt  

PubMed Central

Objectives To estimate the prevalence of pain in ambulatory patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in Port Harcourt and to determine the type, site, severity, and adequacy of the treatment of pain in these patients. Materials and methods A cross-sectional survey was carried out at two antiretroviral therapy centers in Port Harcourt, Nigeria. A data sheet, the brief pain inventory, and the short form of the McGill pain questionnaire were used and 157 patients in various stages of HIV/AIDS participated in the study. Results About 83.7% (129/157) of the ambulatory patients with HIV/AIDS complained of pains. Of the patients who reported pain 61.24% (79/129) reported nociceptive pain while 38.76% (50/129) reported neuropathic pain. Chest pain was the most frequent site of pain followed by headache. About 82% (106/129) of those who complained of pain received some form of analgesic, but only 23.58% (25/106) of these obtained adequate pain relief. The majority of the participants had significant impairment of their quality of life due to the severity of their pain. Conclusion Pain associated with significant impairment of quality of life is common in ambulatory patients with HIV/AIDS in Port Harcourt. Whereas the majority of the patients used various pain relief methods, analgesia was inadequate.

Ebirim, Longinus Ndubuisi; Otokwala, Job Gogo



Fear-Avoidance Beliefs and Temporal Summation of Evoked Thermal Pain Influence Self-Report of Disability in Patients With Chronic Low Back Pain  

Microsoft Academic Search

\\u000a Introduction: Quantitative sensory testing has demonstrated a promising link between experimentally determined pain sensitivity and clinical pain. However, previous studies of quantitative sensory testing have not routinely considered the important influence of psychological factors on clinical pain. This study investigated whether measures of thermal pain sensitivity (temporal summation, first pulse response, and tolerance) contributed to clinical pain reports for patients

Steven Z. George; Virgil T. Wittmer; Roger B. Fillingim; Michael E. Robinson



Consistent and Breakthrough Pain in Diverse Advanced Cancer Patients: A Longitudinal Examination  

Microsoft Academic Search

Although cancer pain, both consistent and breakthrough pain ([BTP]; pain flares interrupting well-controlled baseline pain), is common among cancer patients, its prevalence, characteristics, etiology, and impact on health-related quality of life (HRQOL) are poorly understood. This longitudinal study examined the experience and treatment of cancer-related pain over six months, including an evaluation of ethnic differences. Patients with Stage III or

Carmen R. Green; Laura Montague; Tamera A. Hart-Johnson



Laboratory diagnosis of patients with acute chest pain.  


The enzyme activities of creatine kinase (CK), its isoenzyme MB (CK-MB) and of lactate dehydrogenase isoenzyme 1 (LD-1) have been used for years in diagnosing patients with chest pain in order to differentiate patients with acute myocardial infarction (AMI) from non-AMI patients. These methods are easy to perform as automated analyses, but they are not specific for cardiac muscle damage. During the early 90's the situation changed. First creatine kinase MB mass (CK-MB mass) replaced the measurement of CK-MB activity. Subsequently cardiac-specific proteins troponin T (cTnT) and troponin I (cTnI) appeared on the scene, displacing LD-1 analysis. However, troponin concentrations in blood increase only from four to six hours after onset of chest pain. Therefore a rapid marker such as myoglobin, fatty acid binding protein or glycogen phosphorylase BB could be used in early diagnosis of AMI. On the other hand, CK-MB isoforms alone may also be useful in rapid diagnosis of cardiac muscle damage. Myoglobin, CK-MB mass, cTnT and cTnI are nowadays widely used in diagnosing patients with acute chest pain. Myoglobin is not cardiac-specific and therefore requires supplementation with some other analyses such as troponins to support the myoglobin value. Troponins are very highly cardiac-specific. Only the sera of some patients with severe renal failure, which requires hemodialysis, have elevated cTnT and/or cTnI without there being any evidence of cardiac damage. On the other hand, the latest studies have shown that elevated troponin levels in sera of hemodialysis patients point to an increased risk of future cardiac events in a similar manner to the elevated troponin values in sera of patients with unstable angina pectoris. In addition, the bedside tests for cTnT and cTnI alone or together with myoglobin and CK-MB mass can be used instead of quantitative analyses in the diagnosis of patients with chest pain. These rapid tests are easy to perform and they do not require expensive instrumentation. For routine clinical laboratory practice we suggest that in diagnosis of patients with chest pain, myoglobin and CK-MB mass measurements should be performed whenever they are requested (24 h/day) and cTnT or cTnI on admission to the hospital and then 4-6 and 12 hours later. PMID:10905753

Penttilä, I; Penttilä, K; Rantanen, T



Dimensions of “unidimensional” ratings of pain and emotions in patients with chronic musculoskeletal pain  

Microsoft Academic Search

The use of unidimensional scales to measure pain intensity has been criticised because of the multidimensional nature of pain. We conducted multiple linear regression analyses to determine which dimensions of pain – sensory versus affective – predicted scores on unidimensional scales measuring pain intensity and emotions in 109 Italian women suffering from chronic, non-malignant musculoskeletal pain. We then compared the

Alexa Huber; Anna Lisa Suman; Carmela Anna Rendo; Giovanni Biasi; Roberto Marcolongo; Giancarlo Carli



Guidelines for the management of breakthrough pain in patients with cancer.  


The moral imperative to adequately manage pain is being increasingly recognized worldwide. A comprehensive pain management approach that addresses the various presentations of pain in patients with cancer is required, including appropriate management of breakthrough pain. Breakthrough pain commonly occurs in patients with advanced cancer and is disabling to the individual and burdensome to society, yet it is often inadequately managed. Because pain is heterogeneous, the best management of an individual's pain, including breakthrough pain in cancer, requires a thorough assessment to tailor the treatment strategies. Recently developed guidelines support this approach and recommend treating breakthrough pain using rapid- or short-acting opioids with pharmacodynamics that mirror the rapid onset and short duration of the presenting pain. This approach should be part of a comprehensive strategy to treat pain within the context of the primary disease trajectory, offering continuity of care and access to specialized palliative care when appropriate. PMID:23520183

Caraceni, Augusto; Davies, Andrew; Poulain, Philippe; Cortés-Funes, Hernán; Panchal, Sunil J; Fanelli, Guido



Somatosensory Profiles but Not Numbers of Somatosensory Abnormalities of Neuropathic Pain Patients Correspond with Neuropathic Pain Grading  

PubMed Central

Due to the lack of a specific diagnostic tool for neuropathic pain, a grading system to categorize pain as ‘definite’, ‘probable’, ‘possible’ and ‘unlikely’ neuropathic was proposed. Somatosensory abnormalities are common in neuropathic pain and it has been suggested that a greater number of abnormalities would be present in patients with ‘probable’ and ‘definite’ grades. To test this hypothesis, we investigated the presence of somatosensory abnormalities by means of Quantitative Sensory Testing (QST) in patients with a clinical diagnosis of neuropathic pain and correlated the number of sensory abnormalities and sensory profiles to the different grades. Of patients who were clinically diagnosed with neuropathic pain, only 60% were graded as ‘definite’ or ‘probable’, while 40% were graded as ‘possible’ or ‘unlikely’ neuropathic pain. Apparently, there is a mismatch between a clinical neuropathic pain diagnosis and neuropathic pain grading. Contrary to the expectation, patients with ‘probable’ and ‘definite’ grades did not have a greater number of abnormalities. Instead, similar numbers of somatosensory abnormalities were identified for each grade. The profiles of sensory signs in ‘definite’ and ‘probable’ neuropathic pain were not significantly different, but different from the ‘unlikely’ grade. This latter difference could be attributed to differences in the prevalence of patients with a mixture of sensory gain and loss and with sensory loss only. The grading system allows a separation of neuropathic and non-neuropathic pain based on profiles but not on the total number of sensory abnormalities. Our findings indicate that patient selection based on grading of neuropathic pain may provide advantages in selecting homogenous groups for clinical research.

Konopka, Karl-Heinz; Harbers, Marten; Houghton, Andrea; Kortekaas, Rudie; van Vliet, Andre; Timmerman, Wia; den Boer, Johan A.; Struys, Michel M. R. F.; van Wijhe, Marten



Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes  

Microsoft Academic Search

Background: The European Pain in Cancer survey sought to increase understanding of cancer-related pain and treatment across Europe. Patients and methods: Patients with all stages of cancer participated in a two-phase telephone survey conducted in 11 European countries and Israel in 2006-2007. The survey screened for patients experiencing pain at least weekly, then randomly selected adult patients with pain of

H. Breivik; N. Cherny; B. Collett; F. de Conno; M. Filbet; A. J. Foubert; R. Cohen; L. Dow



Reflex receptive fields are enlarged in patients with musculoskeletal low back and neck pain.  


Pain hypersensitivity has been consistently detected in chronic pain conditions, but the underlying mechanisms are difficult to investigate in humans and thus poorly understood. Patients with endometriosis pain display enlarged reflex receptive fields (RRF), providing a new perspective in the identification of possible mechanisms behind hypersensitivity states in humans. The primary hypothesis of this study was that RRF are enlarged in patients with musculoskeletal pain. Secondary study end points were subjective pain thresholds and nociceptive withdrawal reflex (NWR) thresholds after single and repeated (temporal summation) electrical stimulation. Forty chronic neck pain patients, 40 chronic low back pain patients, and 24 acute low back pain patients were tested. Electrical stimuli were applied to 10 sites on the sole of the foot to quantify the RRF, defined as the area of the foot from where a reflex was evoked. For the secondary end points, electrical stimuli were applied to the cutaneous innervation area of the sural nerve. All patient groups presented enlarged RRF areas compared to pain-free volunteers (P<.001). Moreover, they also displayed lower NWR and pain thresholds to single and repeated electrical stimulation (P<.001). These results demonstrate that musculoskeletal pain conditions are characterized by enlarged RRF, lowered NWR and pain thresholds, and facilitated temporal summation, most likely caused by widespread spinal hyperexcitability. This study contributes to a better understanding of the mechanisms underlying these pain conditions, and it supports the use of the RRF and NWR as objective biomarkers for pain hypersensitivity in clinical and experimental pain research. PMID:23707309

Biurrun Manresa, José A; Neziri, Alban Y; Curatolo, Michele; Arendt-Nielsen, Lars; Andersen, Ole K



Adult Patients’ Postoperative Pain Descriptions and Responses to the Short-Form McGill Pain Questionnaire  

Microsoft Academic Search

This study examined the clinical usefulness of the Short-Form McGill Pain Questionnaire (SF-MPQ). Thirty postoperative patients were asked to describe their postoperative pain and were then administered the SF-MPQ. Eighteen (60%) used exact SF-MPQ sensory or affective words or synonyms to describe their postoperative pain during the interview. These results provide further evidence of the clinical relevance of the SF-MPQ

Deborah Dillon McDonald; Constance Spagnola Weiskopf



Clock drawing test: is it useful for dementia screening in patients having Parkinson disease with and without depression?  


Despite the wide use of clock drawing tests (CDTs) for screening cognitive impairment, their use in patients having Parkinson disease (PD) with dementia has not been systematically investigated until date. In this cross-sectional study, neurological and neuropsychiatric statuses of 1449 outpatients having PD with and without dementia were comprehensively assessed. The CDT revealed cognitive impairment in 42.7% of the 1383 patients whose drawings were available. Overall, CDT sensitivity and specificity were 70.7% and 68.9%, respectively. The positive and negative predictive values were 48.0% and 85.3%, respectively. In patients with depression, CDT specificity dropped significantly to 55.8% (71.3% in nondepressed patients, P < .001). Classification performance was not impacted by motor symptoms. The estimated classification performances and predictive values correspond to those reported previously for non-PD populations. Our results indicate that CDT is a suitable screening instrument in patients with PD, but test results from patients with depression warrant careful consideration. PMID:23720572

Riedel, Oliver; Klotsche, Jens; Förstl, Hans; Wittchen, Hans-Ulrich



GPS Drawing  

NSDL National Science Digital Library

This website on GPS Drawing was created by Jeremy Wood and features his artwork and a few other GPS artists. The drawings posted in the Gallery "are of journeys captured using GPS receivers" and "were created by treating travel like a geodetic pencil or a cartographic crayon." He has created images of animals and objects through travels by foot, boat, bicycle and plane. The project is also meant to provide "a platform for creativity and innovation with GPS software and technology." One section describes the software used to make the drawings, but also notes that it is currently not available to the public. The Projects section includes various GPS animations, documentation of exhibitions, and workshops conducted in galleries, museums, and schools, as well as computer and cardboard models that make the drawings three dimensional.


Drawing Board  

NSDL National Science Digital Library

The Drawing Board consists of a marking pen that remains stationary and a platform that swings beneath the pen, acting as a pendulum. As the platform swings, the pen marks a sheet of paper that is fastened to the platform, generating beautiful repetitive patterns. These colorful designs contain hidden lessons in physics. This resource includes instructions for making a large-scale Drawing Board as well.

Exploratorium, The



Long-term pain relief during spinal cord stimulation. The effect of patient selection  

Microsoft Academic Search

We reviewed our experience with spinal cord stimulation (SCS) in treating 116 patients with pain in one or both legs. All these patients were selected for an initial week of trial stimulation by the criteria: pain due to a known benign organic cause, failure of conventional pain control methods and absence of major personality disorders. Selected patients included 78 with

E. Van de Kelft; C. Porte




Microsoft Academic Search

OBJECTIVE: This study examined medical resource consumption by patients with chronic and breakthrough pain (BTP) who were using transdermally-delivered fentanyl for the management of chronic pain. Patients were participants in a broader survey designed to collect clini- cal and economic information regarding their pain. METHODS: Surveys were administered to cancer and non-cancer patients with chronic and BTP to assess medical

Les L. Noe; P Peeples



Cognitive-Somatic Anxiety Response Patterning in Chronic Pain Patients and Nonpatients.  

ERIC Educational Resources Information Center

Examined group differences in self-reporting anxiety for one hundred chronic pain patients, an equal number of college students, and two smaller comparison samples. Pain patients, relative to nonpatients, acknowledged dramatically fewer total signs of anxiety. Also, pain patients endorsed significantly more somatic than cognitive indicators of…

DeGood, Douglas E.; And Others



Isometric exercise has opposite effects on central pain mechanisms in fibromyalgia patients compared to normal controls  

Microsoft Academic Search

Aerobic exercise has been shown to activate endogenous opioid and adrenergic systems and attenuate experimental pain in normal control subjects (NC). In contrast, fibromyalgia (FM) subjects' experimental pain ratings increase after aerobic exercise, suggestive of abnormal pain modulation. In order to determine whether central or peripheral mechanisms are predominantly involved in the abnormal pain modulation of FM patients, the effects

Roland Staud; Michael E. Robinson; Donald D. Price



Assessing Pain in Dementia Patients with Comorbid Delirium and\\/or Depression  

Microsoft Academic Search

Pain in older adults with severe limitations in ability to communicate is often assessed with observational methods. However, many of the behaviors that are used to assess pain often overlap with behavioral manifestations of delirium and depression. Such overlap can make the assessment of pain in patients with comorbid delirium and\\/or depression especially challenging. In this study, we assessed pain

Thomas Hadjistavropoulos; Philippe Voyer; Donald Sharpe; René Verreault; Michèle Aubin



Initial pharmacokinetic, safety and efficacy evaluation of nasal morphine gluconate for breakthrough pain in cancer patients  

Microsoft Academic Search

Patients with controlled background pain associated with cancer frequently also experience episodes of moderate to severe intensity breakthrough pain. Opioid pharmacotherapy, particularly with oral morphine, remains the cornerstone for the management of cancer pain. Nasal administration of opioids provides a mechanism for more rapid drug absorption and more rapid onset of pain relief compared with oral dosing. This non-randomized, open-label,

Dermot Fitzgibbon; Donna Morgan; Deanna Dockter; Chris Barry; Evan D. Kharasch



Pain, coping strategies, and quality of life in Arab American cancer patients  

Microsoft Academic Search

Cancer pain remains inadequately treated worldwide in up to 91% of patients. Challenges to daily activities due to cancer pain may produce maladaptation that significantly affects quality of life. Enhancing behavioral and cognitive coping are important strategies in providing holistic care for optimum pain management, potentially leading to better quality of life. Assessment of cancer pain lacks a comprehensive framework

Nijmeh Mohammad Hussein Al-Atiyyat



Is Pain Intensity Really That Important to Assess in Chronic Pain Patients? A Study Based on the Swedish Quality Registry for Pain Rehabilitation (SQRP)  

PubMed Central

Background Incorporating the patient's view on care and treatment has become increasingly important for health care. Patients describe the variety of consequences of their chronic pain conditions as significant pain intensity, depression, and anxiety. We hypothesised that intensities of common symptoms in chronic pain conditions carry important information that can be used to identify clinically relevant subgroups. This study has three aims: 1) to determine the importance of different symptoms with respect to participation and ill-health; 2) to identify subgroups based on data concerning important symptoms; and 3) to determine the secondary consequences for the identified subgroups with respect to participation and health factors. Methods and Subjects This study is based on a cohort of patients referred to a multidisciplinary pain centre at a university hospital (n?=?4645, participation rate 88%) in Sweden. The patients answered a number of questionnaires concerning symptoms, participation, and health aspects as a part of the Swedish Quality Registry for Pain Rehabilitation (SQRP). Results Common symptoms (such as pain intensity, depression, and anxiety) in patients with chronic pain showed great variability across subjects and 60% of the cohort had normal values with respect to depressive and anxiety symptoms. Pain intensity more than psychological symptoms showed stronger relationships with participation and health. It was possible to identify subgroups based on pain intensity, depression, and anxiety. With respect to participation and health, high depressive symptomatology had greater negative consequences than high anxiety. Conclusions Common symptoms (such as pain intensity and depressive and anxiety symptoms) in chronic pain conditions carry important information that can be used to identify clinically relevant subgroups.

Bromley Milton, Maria; Borsbo, Bjorn; Rovner, Graciela; Lundgren-Nilsson, Asa; Stibrant-Sunnerhagen, Katharina; Gerdle, Bjorn



The role of pain anxiety, coping, and pain self-efficacy in rheumatoid arthritis patient functioning  

Microsoft Academic Search

Anxiety about pain is increasingly recognized as one factor contributing to increased pain perception and pain behavior [McCracken, L. M., Faber S. D., & Janeck A. S. (1998) Pain-related anxiety predicts nonspecific physical complaints in persons with chronic pain. Behavior Research and Therapy, 36, 621–630; McCracken L., & Gross R. (1995). The pain anxiety symptoms scale (PASS) and the assessment

Carolyn Strahl; Ronald A Kleinknecht; Dale L Dinnel



Components of Mindfulness in Patients with Chronic Pain  

Microsoft Academic Search

Methods of mindfulness are gaining increasing popularity within the behavioral and cognitive therapies and appear helpful\\u000a for a range of clinical problems. The purpose of this study was to examine cognitive and behavioral processes underlying mindfulness.\\u000a One hundred fifty patients seeking treatment for chronic pain completed a battery of questionnaires, including the 15-item\\u000a Mindful Attention Awareness Scale (MAAS; Brown and

Lance M. McCracken; Miles Thompson



Dual Pathology in a Patient with Right Lower Quadrant Pain  

PubMed Central

Meckel diverticula are remnants of the omphalomesenteric duct. They have 2% incidence in the general population, are usually asymptomatic, and tend to be diagnosed incidentally. The generally held principle had been that asymptomatic cases do not require resection, as exemplified by a 2008 systematic review of over 200 studies. However, a recent series reported an increased risk of malignancies, and recommended mandatory resection. We present a case of Meckel diverticulitis with concurrent infiltrative appendiceal carcinoid in a patient with right lower quadrant pain.

Deutsch, Gary B.; Sathyanarayana, Sandeep Anantha; Nicastro, Jeffrey; Molmenti, Ernesto; Coppa, Gene; Rubach, Eugene; Friedman, Barak



Impact of Pain and Palliative Care Services on Patients  

PubMed Central

Background: Palliative care has become an emerging need of the day as the existing health-care facilities play only a limited role in the care of the chronically ill in the society. Patients with terminal illness in most cases spend their lives in the community among their family and neighbors, so there is the need for a multi disciplinary team for their constant care. Volunteers are primary care givers who originate normally from the same locality with local knowledge and good public contact through which they can make significant contributions in a team work by bridging the gap between the patient community and outside world. Aim: The present study has been undertaken to analyze the impact of palliative care services on patients by considering 51 variables. Materials and Methods: The respondents of the study include 50 pain and palliative care patients selected at random from 15 palliative care units functioning in Ernakulam district. The analysis was made by using statistical techniques viz. weighted average method, Chi-square test, Friedman repeated measures analysis of variance on ranks and percentages. Results: The study revealed that the major benefit of palliative care to the patients is the reduction of pain to a considerable extent, which was unbearable for them earlier. Second, the hope of patients could be maintained or strengthened through palliative care treatment. Conclusion: It is understood that the services of the doctors and nurses are to be improved further by making available their services to all the palliative care patients in a uniform manner.

Santha, S



Static Balance in Patients With Patellofemoral Pain Syndrome  

PubMed Central

Background: The relationship between one-leg static standing balance (OLSSB) and patellofemoral pain syndrome (PFPS) is unknown. Hypothesis: OLSSB decreases in patients with PFPS. Design: Prospective case series. Methods: Fifty-two women with unilateral PFPS were enrolled in this study. OLSSB was evaluated with a stabilometer. Q angle was measured with a lengthened-arm universal goniometer. Lower extremity alignment was analyzed with full-length standing anteroposterior teleroentgenograms. Quadriceps and hamstring strength was measured on an isokinetic dynamometer. Results: There were significant differences in OLSSB, Q angle, and strength of quadriceps and hamstring between the symptomatic and asymptomatic sides. There was a correlation between the strength of the quadriceps and hamstring and OLSSB, while there was no correlation between OLSSB and the severity of pain, lower extremity alignment, and Q angle on the symptomatic side. Conclusions: OLSSB and quadriceps and hamstring strength decreased and Q angle increased on the symptomatic side in PFPS patients. A relationship between OLSSB and pain, Q angle, and lower extremity alignment was not detected, while there was a correlation between the strength of the quadriceps and hamstring and OLSSB. Clinical Relevance: A quadriceps and hamstring strengthening may be beneficial to improve OLSSB in patients with PFPS.

Citaker, Seyit; Kaya, Defne; Yuksel, Inci; Yosmaoglu, Baran; Nyland, John; Atay, Ozgur Ahmet; Doral, Mahmut Nedim



Intrathecal neurolytic block in a patient with refractory cancer pain.  


We report the successful treatment of refractory cancer pain by bilateral intrathecal neurolysis using phenol-glycerol. A 60-year-old man had recurrent sigmoid cancer and metastases to the lumbar (L4-5) and sacral bones. He complained of refractory pain in the lower back and lower extremities despite high-dose opioid treatment based on the WHO ladder. On admission to our hospital, he received continuous intravenous infusion of morphine (7,000 mg/day) with ketamine (300 mg/day) and lidocaine (700 mg/day). Intravenous midazolam was required to treat extreme anxiety. Because of inadequate pain relief and severe drowsiness, intrathecal phenol-glycerol neurolytic block was performed twice at the L2/3 intervertebral space. His analgesia was greatly improved and high-dose intravenous opioid was retitrated and ceased. He remained comfortable and lucid at home for 2 months, until 2 days before his death at hospital. Intrathecal neurolytic block may be appropriate for some patients suffering from refractory pain that is resistant to conventional opioid analgesic treatment. PMID:21479833

Watanabe, Akihiko; Yamakage, Michiaki



Discounting pain in the absence of medical evidence is explained by negative evaluation of the patient.  


This study investigated the effect on observer responses of the presence/absence of information about medical evidence for pain and psychosocial influences on the patient's pain experience. Additionally, the moderating role of the patient's pain expressions and the mediating role of the observer's belief in deception and evaluation of the patient was examined. Sixty-two participants were presented with videos of 4 patients, each accompanied by a vignette describing the presence or absence of both medical evidence for the pain and psychosocial influences on the patient's pain. Participants estimated patients' pain and rated their own sympathy and inclination to help; they re-estimated patients' pain when the patient's self-report of pain was provided. Finally, participants evaluated each patient as positive or negative and the likelihood that the patient was feigning pain. Participants gave lower ratings on pain, sympathy, and help when medical evidence was absent. Further, in the presence of psychosocial influences, participants took patients' self-reported pain less into account. Next, only for patients expressing high-intensity pain, information about both medical evidence and psychosocial influences was taken into account. Finally, the observer's evaluation of the patient and his/her belief in deception fully, respectively partially, explained the effect of medical evidence. The results indicate that discounting pain in the absence of medical evidence may involve negative evaluation of the patient. Further, the patient's pain expression is a moderating variable, and psychosocial influences negatively impact the degree to which patients' self-reports are taken into account. The results indicate that contextual information impacts observer responses to pain. PMID:23391696

De Ruddere, Lies; Goubert, Liesbet; Stevens, Michaël; de C Williams, Amanda C; Crombez, Geert



The Accuracy of the DSM-IV Pain Disorder and the ICD10 Persistent Somatoform Pain Disorder in Chronic Pain Patients  

Microsoft Academic Search

  Objectives. In this investigation we studied the relationships between different psychological relevant subgroups and the presence of different psychosomatic symptoms in a sample of chronic pain patients, testing the accuracy of the DSM- and ICD classification systems.Results. We found no evidence for a “pure” pain syndrome according to the DSM- and ICD systems. On the contrary, we found highly significant

Håkan Nordin; Martin Eisemann; Jörg Richter



Can attitudes of stoicism and cautiousness explain observed age-related variation in levels of self-rated pain, mood disturbance and functional interference in chronic pain patients?  

Microsoft Academic Search

The aims of the present study were (a) to examine the relationship between age, attitudes and self-reported pain and suffering in a sample of chronic pain patients and (b) to determine the extent to which attitudes of stoicism and cautiousness might mediate between age and chronic pain experience. Psychometric measures were administered to 338 chronic pain patients. The results indicate

Hua-Hie Yong



The relationship between symptoms of post-traumatic stress disorder and pain, affective disturbance and disability among patients with accident and non-accident related pain  

Microsoft Academic Search

Recent studies have reported a high prevalence of symptoms of post-traumatic stress disorder (PTSD) among individuals with chronic pain. Studies suggest that persons with pain and PTSD also display higher levels of affective disturbance. In the present study we examined self-reports of pain, affective disturbance, and disability among pain patients with and without symptoms of PTSD. Patients without PTSD symptoms

Michael E. Geisser; Randy S. Roth; Jan E. Bachman; Thomas A. Eckert



Assessing pain in non-intubated critically ill patients unable to self report: an adaptation of the Behavioral Pain Scale  

Microsoft Academic Search

Purpose  To validate an adaptation of the Behavioral Pain Scale (BPS) for its use in non-intubated intensive care unit (ICU) patients\\u000a unable to self-report their pain because of the occurrence of delirium. The “vocalization” domain was inserted to construct\\u000a the BPS-non intubated (BPS-NI) scale, ranging from 3 (no pain) to 12 (most pain).\\u000a \\u000a \\u000a \\u000a Design  Prospective psychometric study in a medical-surgical ICU.\\u000a \\u000a \\u000a \\u000a Methods  The

Gérald Chanques; Jean-François Payen; Grégoire Mercier; Sylvie de Lattre; Eric Viel; Boris Jung; Moussa Cissé; Jean-Yves Lefrant; Samir Jaber



Cancer pain management at home (I): do older patients experience less effective management than younger patients?  

Microsoft Academic Search

Goals of work  We wanted to examine whether older cancer patients living at home experienced poorer pain management than younger patients,\\u000a and if so, what were the potential explanations for this.\\u000a \\u000a \\u000a \\u000a Materials and methods  We interviewed 90 new referrals to community palliative care services who were aged 75 years and above or aged 60 years and\\u000a below. We asked about pain intensity, pain relief

Michael I. Bennett; S. José Closs; John Chatwin



[Treatment of chronic lumbosacral pain by transcutaneous electrical stimulation in laminectomized patients: preliminary results (author's transl)].  


The authors have tried transcutaneous electrical stimulation for the treatment of chronic lumbosacral pain in 27 patients already treated by laminectomy without benefit. Six patients experienced a 55% mean reduction of pain; another six had a 35% reduction; and the remaining 15 a 16% reduction of pain severity. From these results and a review of published data the authors conclude that the method is of limited value in alleviating chronic lumbosacral pain in laminectomized patients. PMID:162276

Bianchi, G P; Leonardi, G; Marelli, B



Ketamine treatment for intractable pain in a patient with severe refractory complex regional pain syndrome: a case report.  


In this case report, we describe the effect of ketamine infusion in a case of severe refractory complex regional pain syndrome I (CRPS I). The patient was initially diagnosed with CRPS I in her right upper extremity. Over the next 6 years, CRPS was consecutively diagnosed in her thoracic region, left upper extremity, and both lower extremities. The severity of her pain, combined with the extensive areas afflicted by CRPS, caused traumatic emotional problems for this patient. Conventional treatments, including anticonvulsants, bisphosphonates, oral steroids and opioids, topical creams, dorsal column spinal cord stimulation, spinal morphine infusion, sympathetic ganglion block, and sympathectomy, failed to provide long-term relief from pain. An N-methyl-d-aspartate (NMDA) antagonist inhibitor, ketamine, was recently suggested to be effective at resolving intractable pain. The patient was then given several infusions of intravenous ketamine. After the third infusion, the edema, discoloration, and temperature of the affected areas normalized. The patient became completely pain-free. At one-year of follow-up, the patient reported that she has not experienced any pain since the last ketamine infusion. Treatment with intravenous ketamine appeared to be effective in completely resolving intractable pain caused by severe refractory CRPS I. Future research on this treatment is needed. PMID:18523505

Shirani, Peyman; Salamone, Alicia R; Schulz, Paul E; Edmondson, Everton A


Self-management practices among primary care patients with musculoskeletal pain and depression.  


The objective of this study was to assess the effect of clinical depression on pain self-management practices. We employed a cross-sectional analysis of baseline data from the Stepped Care for Affective disorders and Musculoskeletal Pain (SCAMP) study. Participants included 250 patients with pain and comorbid depression and 250 patients with pain only and were enrolled from urban university and VA primary care clinics. Musculoskeletal pain was defined as low back, hip or knee pain present >or=3 months and with at least a moderate, Brief Pain Inventory severity score >or=5. Depression was defined as a PHQ-9 score >or=10. We used multiple logistic and Poisson regression to assess the relationship between individual and combined effects of depression and pain severity on two core pain self-management skills: exercise duration and cognitive strategies. Depressed patients exercised less per week than did nondepressed patients but showed a trend towards more frequent use of cognitive strategies. On multivariable analysis, depression severity substantially decreased the use of exercise as a pain self-management strategy. In contrast, depression and pain severity interacted to increase the use of cognitive strategies. Depression and pain severity have differential effects on self-management practices. Understanding the differences between preferential strategies of pain patients with and without depression may be useful in tailoring pain self-management programs. PMID:18553130

Damush, Teresa M; Wu, Jingwei; Bair, Matthew J; Sutherland, Jason M; Kroenke, Kurt



Is pain the price of empathy? The perception of others' pain in patients with congenital insensitivity to pain  

Microsoft Academic Search

Empathy is a complex form of psychological inference that enables us to understand the personal experience of another person through cognitive\\/evaluative and affective processes. Recent findings suggest that empathy for pain may involve a 'mirror-matching' simulation of the affective and sensory features of others' pain. Despite such evidence for a shared representation of self and other pain at the neural

Nicolas Danziger; Kenneth M. Prkachin; Jean-Claude Willer



Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain: evidence for altered temporal summation of pain  

Microsoft Academic Search

Temporomandibular disorders (TMD) represent a group of chronic painful conditions involving the muscles of mastication and the temporomandibular joint. Several studies have reported that TMD is associated with enhanced sensitivity to experimental pain. Twenty-three TMD subjects and 24 pain-free matched control subjects participated in a set of studies which were designed to evaluate whether the temporal integrative aspects of thermal

William Maixner; Roger Fillingim; Asgeir Sigurdsson; Shelley Kincaid; Stefanie Silva



Escitalopram is Associated with Reductions in Pain Severity and Pain Interference in Opioid Dependent Patients with Depressive Symptoms  

PubMed Central

Pain is common among opioid dependent patients, yet pharmacologic strategies are limited. The aim of this study was to explore whether escitalopram, a selective serotonin reuptake inhibitor, was associated with reductions in pain. The study used longitudinal data from a randomized, controlled trial that evaluated the effects of escitalopram on treatment retention in patients with depressive symptoms who were initiating buprenorphine/naloxone for treatment of opioid dependence. Participants were randomized to take escitalopram 10mg or placebo daily. Changes in pain severity, pain interference and depression were assessed at 1, 2 and 3 months visits using the Visual Analog Scale, Brief Pain Inventory and the Beck Depression Inventory II, respectively. Fixed-effects estimator for panel regression models were used to assess the effects of intervention on changes in outcomes over time. Additional models were estimated to explore whether the intervention effect was mediated by within-person changes in depression. In this sample of 147 adults, we found that participants randomized to escitalopram had significantly larger reductions on both pain severity (b = ?14.34, t = ?2.66, p < .01) and pain interference (b = ?1.20, t = ?2.23, p < .05) between baseline and follow-up. After adjusting for within-subject changes in depression, the estimated effects of escitalopram on pain severity and pain interference were virtually identical to the unadjusted effects. In summary, this study of opioid-dependent patients with depressive symptoms found that treatment with escitalopram was associated with clinically meaningful reductions in pain severity and pain interference during the first three months of therapy.

Tsui, Judith I.; Herman, Debra S.; Kettavong, Malyna; Anderson, Bradley J.; Stein, Michael D.



Trunk muscle activation in low-back pain patients, an analysis of the literature  

Microsoft Academic Search

This paper provides an analysis of the literature on trunk muscle recruitment in low-back pain patients. Two models proposed in the literature, the pain–spasm–pain model and the pain adaptation model, yield conflicting predictions on how low- back pain would affect trunk muscle recruitment in various activities. The two models are outlined and evidence for the two from neurophsysiological studies is

Jaap H. van Dieën; Luc P. J. Selen; Jacek Cholewicki



Suicidal ideation, plans, and attempts in chronic pain patients: factors associated with increased risk  

Microsoft Academic Search

This study describes suicidal behavior in a cross-sectional sample of chronic pain patients and evaluates factors associated with increased risk for suicidal ideation. One hundred-fifty-three adults with nonmalignant pain (42% back pain) who were consecutively referred to a tertiary care pain center completed a Structured Clinical Interview for Suicide History, the McGill Pain Questionnaire, and the Beck Depression Inventory. Nineteen-percent

Michael T. Smith; Robert R. Edwards; Richard C. Robinson; Robert H. Dworkin



Beyond Patient Reported Pain: Perfusion Magnetic Resonance Imaging Demonstrates Reproducible Cerebral Representation of Ongoing Post-Surgical Pain  

PubMed Central

Development of treatments for acute and chronic pain conditions remains a challenge, with an unmet need for improved sensitivity and reproducibility in measuring pain in patients. Here we used pulsed-continuous arterial spin-labelling [pCASL], a relatively novel perfusion magnetic-resonance imaging technique, in conjunction with a commonly-used post-surgical model, to measure changes in regional cerebral blood flow [rCBF] associated with the experience of being in ongoing pain. We demonstrate repeatable, reproducible assessment of ongoing pain that is independent of patient self-report. In a cross-over trial design, 16 participants requiring bilateral removal of lower-jaw third molars underwent pain-free pre-surgical pCASL scans. Following extraction of either left or right tooth, repeat scans were acquired during post-operative ongoing pain. When pain-free following surgical recovery, the pre/post-surgical scanning procedure was repeated for the remaining tooth. Voxelwise statistical comparison of pre and post-surgical scans was performed to reveal rCBF changes representing ongoing pain. In addition, rCBF values in predefined pain and control brain regions were obtained. rCBF increases (5–10%) representing post-surgical ongoing pain were identified bilaterally in a network including primary and secondary somatosensory, insula and cingulate cortices, thalamus, amygdala, hippocampus, midbrain and brainstem (including trigeminal ganglion and principal-sensory nucleus), but not in a control region in visual cortex. rCBF changes were reproducible, with no rCBF differences identified across scans within-session or between post-surgical pain sessions. This is the first report of the cerebral representation of ongoing post-surgical pain without the need for exogenous tracers. Regions of rCBF increases are plausibly associated with pain and the technique is reproducible, providing an attractive proposition for testing interventions for on-going pain that do not rely solely on patient self-report. Our findings have the potential to improve our understanding of the cerebral representation of persistent painful conditions, leading to improved identification of specific patient sub-types and implementation of mechanism-based treatments.

Howard, Matthew A.; Krause, Kristina; Khawaja, Nadine; Massat, Nathalie; Zelaya, Fernando; Schumann, Gunter; Huggins, John P.; Vennart, William; Williams, Steven C. R.; Renton, Tara F.



Relationships between changes in pain severity and other patient-reported outcomes: an analysis in patients with posttraumatic peripheral neuropathic pain  

PubMed Central

Background The objective of this study is to use the pain numeric rating scale (NRS) to evaluate associations between change in pain severity and changes in sleep, function, and mood assessed via patient-reported outcomes (PROs) in patients with posttraumatic pain. Methods This is a secondary analysis of a clinical trial evaluating pregabalin in patients with posttraumatic peripheral neuropathic pain (N = 254). Regression models were used to determine associations between changes in pain (0-10 NRS) as the predictor and scores on the following PRO measures as the outcome: Pain Interference Index; Hospital Anxiety and Depression Scale anxiety and depression subscales; Medical Outcomes Study-Sleep Scale 9-item Sleep Problems Index and Sleep Disturbance subscale; and Daily Sleep Interference Scale (0-10 NRS). Results Change in pain severity showed clear, direct relationships with changes in function, anxiety, depression, and sleep PROs, all of which were statistically significant (P <.001). Results from subgroup analyses (?30% or ?50% pain responders, pregabalin or placebo treatment, age ? 51 years or > 51 years) tended to be consistent with results from the overall sample. Conclusions Overall, a direct relationship exists between pain and various aspects of patient's well-being and functioning, which can provide a quantitative assessment of how improvements in pain may be expected to relate to other patient outcomes. ( Identifier number NCT00292188; EudraCT #2005-003048-78).



Pain control in ambulatory cancer patients--can we do better?  


To evaluate the degree of pain control among ambulatory cancer patients visiting the outpatient clinics of three oncology centers in south Israel, these patients were interviewed using the Brief Pain Inventory translated into Hebrew (BPI-Heb). Patients suffering from pain at least three times a week or reporting taking daily analgesics during the last two weeks were enrolled. Non-Hebrew speakers and patients too frail or ill were excluded. The study population included 218 subjects. Substantial pain was experienced by 77%, the majority was not adequately treated (81%), and 75% were undermedicated. The daily living activities of the majority of patients (64%) were moderately to severely impacted. Pain control was not associated with any of the sociodemographic or previous treatment profile variables, or by physicians' pain assessment. The physicians' and the patients' ratings of the extent to which pain interfered with the patients' activities fully agreed (+/-2) in fewer than half of the patients. Physicians estimated more severe pain levels, but underestimated its impact on everyday life. These data indicate that better pain control for ambulatory cancer patients is needed and that more information about patients' pain and its impact should be solicited. Further training of care providers is needed to improve the relief from cancer pain and the quality of life of patients. PMID:12906956

Shvartzman, Pesach; Friger, Michael; Shani, Adi; Barak, Frida; Yoram, Cohen; Singer, Yoram



Discussing sexual concerns with chronic low back pain patients: barriers and patients' expectations.  


This study aims to explore patient's concerns when discussing sexual problems caused by chronic low back pain with their healthcare provider. It also aims to identify factors influencing and limiting such communication. A cross-sectional analysis of 100 consenting chronic low back pain sexually active patients was carried out. Patients answered questions on their disease characteristics and sex life. They also mentioned prohibitions of discussing sex with their healthcare provider and their expectations of such discussion. Factors influencing patient's experiences were analyzed. Median of chronic low back pain duration was 36 (24-72)?months and back pain intensity using visual analogical scale (0-100 mm) was 50?±?10.7 mm. Eighty-one percent of our patients complained of sexual problems, 66 % have never discussed the subject with their healthcare provider. Barriers which prevent discussion on sex include the taboo character of the topic, inappropriateness of visit conditions, and patient disinterest in sex. Ninety-three percent of patients expressed the need of sexual problems' management in chronic low back pain consulting. Seventy-four percent expected information and advice from their healthcare provider about recommended intercourse positions so as to avoid pain. Thirty-three percent of patients wanted their partner to be involved in the discussion and 81 % preferred talking with a healthcare provider of the same gender. Ability to communicate on the topic was associated with the decrease of patient sexual satisfaction and limited by patient illiteracy. Our study evidences that sex discussion between patient and healthcare provider is restricted by several barriers and that patients expect more involvement from their healthcare provider on the subject. Illiteracy and level of sexual satisfaction seem to be the strongest factors influencing this communication. PMID:23743660

Bahouq, H; Allali, F; Rkain, H; Hajjaj-Hassouni, N



Lymphocyte Subsets and the Role of Th1\\/Th2 Balance in Stressed Chronic Pain Patients  

Microsoft Academic Search

Background: The complex regional pain syndrome (CRPS) and fibromyalgia (FM) are chronic pain syndromes occurring in highly stressed individuals. Despite the known connection between the nervous system and immune cells, information on distribution of lymphocyte subsets under stress and pain conditions is limited. Methods: We performed a comparative study in 15 patients with CRPS type I, 22 patients with FM

Ines Kaufmann; Christoph Eisner; Peter Richter; Volker Huge; Antje Beyer; Alexander Chouker; Gustav Schelling; Manfred Thiel



[Treatment and rehabilitation of patients with pain syndrome in surgical clinic].  


Though the progress of modern medicine in understanding the mechanisms of pain and its treatment is significant, the problem of organizing help to the patients with pain syndrome is still actual and undecided. The issue highlights the general types of pain among surgical patients, as well as the integrative approach to the treatment and rehabilitation. PMID:23612343

Samo?lova, N V; Zagorul'ko, O I; Gnezdilov, A V; Medvedeva, L A



Congruence in family dyadic perceptions of pain controllability between older adult cancer patients and family caregivers  

Microsoft Academic Search

Several studies have shown that perception of control over pain contributes to higher levels of well being and thus, is highly valued by both patients and their family caregivers (Anderson, 1998; Wells, 1994) trying to manage cancer pain in the home. However, there have been no studies that have investigated how congruence in perceptions of control over pain between patients

Cheryl K Riley-Doucet



Race, age, and gender influences among clusters of african american and white patients with chronic pain  

Microsoft Academic Search

Racial and ethnic minorities, older people, and women are differentially affected by chronic pain. This study aimed to identify the experiences of adult African Americans and whites with chronic pain while identifying patient clusters on the basis of clinical characteristics as well as race, age, and gender influences within and between clusters. Three clusters of patients with chronic pain were

Carmen R Green; S. Khady Ndao-Brumblay; Andrew M Nagrant; Tamara A Baker; Edward Rothman



Etiology of Chronic Low Back Pain in Patients Having Undergone Lumbar Fusion  

Microsoft Academic Search

ObjectiveTo estimate the prevalence of lumbar internal disc disruption, zygapohyseal joint pain, sacroiliac joint pain, and soft tissue irritation by fusion hardware in post-fusion low back pain patients compared with non-fused patients utilizing diagnostic spinal procedures.

Michael J. DePalma; Jessica M. Ketchum; Thomas R. Saullo



Evidence-based practice part 3: Acute pain management of the perianesthesia patient  

Microsoft Academic Search

Evidence exists that pain is inadequately controlled in most patients. This is caused, in part, by the fact that doctors and nurses have based clinical practice on myths and misconceptions about pain medications, rather than by using evidence-based research. Evidence also exists that when pain is adequately controlled, there is greater patient satisfaction with care. The purpose of Part 3

Sharon Summers



Supplementation with alkaline minerals reduces symptoms in patients with chronic low back pain  

Microsoft Academic Search

The cause of low back pain is heterogeneous, it has been hypothesised that a latent chronic acidosis might contribute to these symptoms. It was tested whether a supplementation with alkaline minerals would influence symptoms in patients with low back pain symptoms. In an open prospective study 82 patients with chronic low back pain received daily 30 g of a lactose

Jürgen Vormann; Michael Worlitschek; Thomas Goedecke; Burton Silver



Magnetic resonance imaging findings of internal derangement and effusion in patients with unilateral temporomandibular joint pain  

Microsoft Academic Search

Objectives: The purpose of this study was to investigate the relationship between the presence of temporomandibular joint (TMJ) pain and the magnetic resonance (MR) imaging findings of internal derangement (ID) and effusion. Study Design: The study was comprised of 41 consecutive patients with TMJ pain. Criteria for including a patient were report of unilateral pain near the TMJ, with the

Ansgar Rudisch; Katharina Innerhofer; Stefan Bertram; Rüdiger Emshoff



Symptoms and visceral perception in patients with pain-predominant irritable bowel syndrome  

Microsoft Academic Search

OBJECTIVE:Abdominal pain is thought to be a hallmark of the irritable bowel syndrome (IBS), although currently used symptom criteria do not differentiate between abdominal pain and discomfort. By focusing on viscerosensory symptoms, we sought to determine: 1) which type of symptoms are most commonly reported by IBS patients, and 2) whether patients who report pain as their most bothersome symptom

Tony Lembo; Bruce Naliboff; Julie Munakata; Steve Fullerton; Lynn Saba; Scott Tung; Max Schmulson; Emeran A Mayer



Xerostomia and salivary flow in patients with orofacial pain compared with controls  

Microsoft Academic Search

ObjectivesPain in the orofacial region is frequently reported by patients in dental and medical offices. Facial pain, headache, masticatory abnormalities and other complaints often become chronic and may be associated with local disturbances, such as xerostomia and teeth abnormalities. The objective of this study was to investigate salivary flow and xerostomia in patients with orofacial pain.

Luciana A. da Silva; Manoel J. Teixeira; Jose T. T. de Siqueira; Silvia R. D. T. de Siqueira



Attentional Strategy Moderates Effects of Pain Catastrophizing on Symptom-Specific Physiological Responses in Chronic Low Back Pain Patients  

Microsoft Academic Search

In the present study, we examined whether experimentally-manipulated attentional strategies moderated relations between pain\\u000a catastrophizing and symptom-specific physiological responses to a cold-pressor task among sixty-eight chronic low back patients.\\u000a Patients completed measures of pain catastrophizing and depression, and were randomly assigned to sensory focus, distraction\\u000a or suppression conditions during a cold pressor. Lumbar paraspinal and trapezius EMG, and cardiovascular responses

Phillip J. Quartana; John W. Burns; Kenneth R. Lofland



Fentanyl Buccal Tablet for Relief of Breakthrough Pain in Opioid-Tolerant Patients With Cancer-Related Chronic Pain  

Microsoft Academic Search

Fentanyl buccal tablet (FBT) is a new opioid formulation pro- viding rapid-onset analgesia for the treatment of breakthrough pain (BTP). This study evaluated FBT for BTP in opioid-tolerant patients with chronic cancer pain. The study had a randomized, double-blind, placebo- controlled design and was conducted at 30 outpatient treatment centers in the United States. Following open-label titration, patients were ran-

Neal E. Slatkin; Fang Xie; John Messina; Thalia J. Segal



Effects of a continuing education program on nurses' practices of cancer pain assessment and their acceptance of patients' pain reports  

Microsoft Academic Search

A hospital-based quasi-experimental (pretest and post-test) study was conducted in Kaohsiung Veteran General Hospital, Taiwan. This study was to evaluate a continuing education program (CEP) on nurses' practices of cancer pain assessment and their acceptance of patients' pain reports with respect to four types of misconceptions. A questionnaire was sent to on-duty nurses or head nurses with patient care responsibilities

Luo-Ping Ger; Ching-Ying Chang; Shung-Tai Ho; Ming-Chien Lee; Hsien-Hsien Chiang; Co-Shi Chao; Kwok-Hung Lai; Jui-Mei Huang; Shih-Chun Wang



Pain Management in the Cirrhotic Patient: The Clinical Challenge  

PubMed Central

Pain management in patients with cirrhosis is a difficult clinical challenge for health care professionals, and few prospective studies have offered an evidence-based approach. In patients with end-stage liver disease, adverse events from analgesics are frequent, potentially fatal, and often avoidable. Severe complications from analgesia in these patients include hepatic encephalopathy, hepatorenal syndrome, and gastrointestinal bleeding, which can result in substantial morbidity and even death. In general, acetaminophen at reduced dosing is a safe option. In patients with cirrhosis, nonsteroidal anti-inflammatory drugs should be avoided to avert renal failure, and opiates should be avoided or used sparingly, with low and infrequent dosing, to prevent encephalopathy. For this review, we searched the available literature using PubMed and MEDLINE with no limits.

Chandok, Natasha; Watt, Kymberly D. S.



Drawing Amish.  

ERIC Educational Resources Information Center

|Explores how the universal stages of graphic language development manifest themselves in children living in the Amish community and how the uniqueness of this subculture is reflected in their drawings. Explains that Amish children focus on an agrarian environment and use copying as a means to finding an accepted place in the community. (CMK)|

Strauch-Nelson, Wendy



Drawing Conclusions  

NSDL National Science Digital Library

Drawing conclusions involves comparing initial ideas with new evidence and then deciding whether the ideas fit or need to be changed. It is the key to the investigation, where mental and practical activity comes together. This is how scientists approach i

Klentschy, Michael P.



The Patient–Provider Relationship in Chronic Pain Care: Providers' Perspectives  

Microsoft Academic Search

BackgroundPain is the most commonly reported symptom in primary care and is a leading cause of disability. Primary care providers (PCPs) face numerous challenges in caring for patients with chronic pain including communication and relational difficulties.

Marianne S. Matthias; Amy L. Parpart; Kathryn A. Nyland; Monica A. Huffman; Dawana L. Stubbs; Christy Sargent; Matthew J. Bair



Are physicians' ratings of pain affected by patients' physical attractiveness?  

Microsoft Academic Search

The degree to which physical attractiveness and nonverbal expressions of pain influence physicians' perceptions of pain was investigated. Photographs of eight female university students were represented in four experimental conditions created by the manipulation of cosmetics, hairstyles, and facial expressions: (a) attractive-no pain, (b) attractive-pain, (c) unattractive-no pain, and (d) unattractive-pain. Each photograph was accompanied by a brief description of

Heather D. Hadjistavropoulos; Michael A. Ross; Carl L. Von Baeyer



Sex Differences in Experimental and Clinical Pain Sensitivity for Patients with Shoulder Pain  

PubMed Central

Previous research demonstrates that men and women differ in the way that they perceive and process pain. Much of this work has been done in healthy adults with a lack of consensus in clinical pain populations. The purpose of this study was to investigate how men and women with shoulder pain differ in their experience of experimental and clinical pain and whether psychological processes differentially affect these responses. Fifty nine consecutive subjects (24 women, 35 men) seeking operative treatment for shoulder pain were enrolled in this study. Subjects completed self report questionnaires to assess clinical pain, catastrophizing, anxiety and depression and underwent a series of experimental pain tests consisting of pressure pain, thermal pain (threshold and tolerance), and thermal temporal summation. Results indicated that women experienced greater clinical pain and enhanced sensitivity to pressure pain. Age did not affect the observed sex differences. There were no sex differences in psychological association with experimental and clinical pain in this cohort. The relationship between clinical and experimental pressure pain was stronger in women as compared to men. These findings offer insight into the interactions between biological and psychosocial influences of pain and how these interactions vary by sex.

Kindler, Lindsay L.; Valencia, Carolina; Fillingim, Roger B.; George, Steven Z.



Do patients with fibromyalgia show abnormal neural responses to the observation of pain in others?  


Chronic widespread pain is a hallmark of fibromyalgia (FM). Previous neuroimaging studies have reported that the pain neuro-matrix in patients with FM showed augmented activation in response to actual pain. However, the effect of observing pain in others among patients with FM remains poorly understood. Both healthy female control subjects (n=24) and female patients with FM (n=23) underwent functional magnetic resonance imaging while observing a series of color pictures depicting others' hands and feet being injured, and a matched set of control pictures that did not show any painful events. Compared with healthy subjects, patients with FM showed a smaller neural response to pain-related versus neutral stimuli in several neural regions, including the thalamus, anterior cingulate cortex, dorsolateral prefrontal cortex, pre- and post-central gyrus, and supplementary motor area. In contrast to augmented pain processing in response to actual experimental pain, patients with FM did not show an enhanced pain response but generally showed lesser activation in cortical regions known to play a role in processing of pain. These hemodynamic alterations observed in patients with FM suggest that patients with chronic pain may empathize less with others in pain, possibly in order to lessen arousal and aversive self-oriented emotions. PMID:23419861

Lee, Seung Jae; Song, Hui-Jin; Decety, Jean; Seo, Jeehye; Kim, Seong-Ho; Kim, Sang-Hyon; Nam, Eon Jeong; Kim, Seong-Kyu; Han, Seung Woo; Lee, Hui Joong; Do, Younghae; Chang, Yongmin



Assessing Pain in Nonresponsive Hospice Patients: Development and Preliminary Testing of the Multidimensional Objective Pain Assessment Tool (MOPAT)  

PubMed Central

Abstract Background Accurate assessment in hospice patients who cannot communicate their pain is almost impossible, increasing their risk for unrecognized and inadequately managed pain. Objective The purpose of this article is to describe a series of small-scale projects aimed at developing and refining an instrument to assess acute pain in noncommunicative hospice patients. Methods Project 1 was a clinical project in which focus groups with hospice nurses yielded an adaptation of an existing pain assessment measure that was named the Multidimensional Objective Pain Assessment Tool (MOPAT) and had behavioral and physiological subscales. Projects 2 and 3 tested the MOPAT in 30 cognitively impaired/nonresponsive hospice inpatients and 28 alert and oriented hospice inpatients, with study nurses and hospice nurses rating pain with the MOPAT before and after a pain-relieving intervention and rating its clinical usefulness. Projects 3 and 4 analyzed the reliability, validity, and clinical utility of the MOPAT. Results Overall internal consistency reliability of the MOPAT was demonstrated with Cronbach's ? coefficients of 0.79 before and 0.84 after the pain-relieving intervention. The behavioral and physiological subscale scores changed significantly (p?pain medication, demonstrating sensitivity to changes in pain. Principal components factor analysis revealed two factors matching the subscales and accounting for 66% of the variance. Nearly all the hospice nurses found the MOPAT helpful, easy to use and understand, and conducive to use in daily practice. Conclusion The MOPAT has preliminary evidence of reliability, validity, and clinical utility. Full-scale psychometric testing in hospice and acute care hospital patients is currently underway.

Reifsnyder, JoAnne; Soeken, Karen; Kaiser, Karen S.; Yeager, Katherine A.



Treatment of myofascial trigger points in patients with chronic shoulder pain: a randomized, controlled trial  

Microsoft Academic Search

BACKGROUND: Shoulder pain is a common musculoskeletal problem that is often chronic or recurrent. Myofascial trigger points (MTrPs) cause shoulder pain and are prevalent in patients with shoulder pain. However, few studies have focused on MTrP therapy. The aim of this study was to assess the effectiveness of multimodal treatment of MTrPs in patients with chronic shoulder pain. METHODS: A

Carel Bron; Arthur de Gast; Jan Dommerholt; Boudewijn Stegenga; Michel Wensing; Rob AB Oostendorp



Impact of litigation on quality of life outcomes in patients with chronic low back pain  

Microsoft Academic Search

Low back pain progresses to chronic low back pain (CLBP) in 5–10 per cent of patients. A Multi-disciplinary Pain Management\\u000a Programme was tested in 20 patients (m=4, f=16). This regime involved psychological and behaviour modification strategies,\\u000a combined with intensive exercise. Treatment outcome in terms of impairment was assessed by lumbar flexibility, trunk muscle\\u000a endurance and pain. The disability assessed was

C. Blake; M. Garrett



Increased use of safety-seeking behaviors in chronic back pain patients with high health anxiety  

Microsoft Academic Search

Many patients with chronic pain also exhibit elevated levels of health anxiety. This study examined the effect of health anxiety on the use of safety-seeking behaviors (SSBs) in pain-provoking situations. Participants were 20 chronic back pain patients with high health anxiety (Group H), 20 with low health anxiety (Group L) and 20 pain-free controls (Group C). Two physical tasks were

Nicole K. Y. Tang; Paul M. Salkovskis; Elena Poplavskaya; Kelly J. Wright; Magdi Hanna; Joan Hester



Attention focus, trait anxiety and pain perception in patients undergoing colposcopy.  


Few studies have compared the relative efficacy of attention-focus strategies in reducing clinical pain. Colposcopy, a medical diagnostic examination performed to identify premalignant cervical cell changes, elicits both anxiety and pain in patients, while allowing little or no behavioural control over the event. Employing a multi-group experimental design, the present study sought to investigate how different types of attention-focus strategies impacted upon pain perception, state anxiety and affect, in a sample of 123 colposcopy patients. Patients were randomly assigned to one of three groups: sensory focusing, active distraction and undirected control. Psychometric measures of pre-colposcopy pain expectancy and dispositional trait anxiety were also taken, in order to assess whether these factors further contributed to outcomes. Overall, when controlling for pain expectancy and trait anxiety, self-reported pain intensity, sensory pain and affective pain did not differ across groups. Further, there were no significant between-group differences in colposcopy-related state anxiety or affect. However, pre-colposcopy psychometric measures were found to be predictive of a range of outcomes. Pre-colposcopy pain expectancy, but not trait anxiety, was found to be positively related to colposcopy-related pain. It was further demonstrated that heightened state anxiety following colposcopy was due to experienced pain and pain unpleasantness, rather than to aspects of the pre-colposcopy prediction of pain. The results have implications for management of acute clinical pain. PMID:22337343

Kola, S; Walsh, J C; Hughes, B M; Howard, S



Does patient perception of pain control affect patient satisfaction across surgical units in a tertiary teaching hospital?  


In this study, the relationship between patients' perceptions of pain control during hospitalization and their overall satisfaction with care was examined. Satisfaction data were collected from the federally mandated Hospital Consumer Assessment of Healthcare Providers and Systems survey for 4349 adult patients admitted to any surgical unit over an 18-month period. Patients' perceptions of pain control and staff's efforts to control pain were associated with their overall satisfaction scores. These perceptions varied widely among services and nursing units. Interestingly, patient satisfaction was more strongly correlated with the perception that caregivers did everything they could to control pain than with pain actually being well controlled. The odds of a patient being satisfied were 4.86 times greater if pain was controlled and 9.92 times greater if the staff performance was appropriate. Hospitals may improve their patients' satisfaction by focusing on improving the culture of pain management. PMID:22345130

Hanna, Marie N; González-Fernández, Marlís; Barrett, Ashlea D; Williams, Kayode A; Pronovost, Peter



A survey of pain-related hospitalizations, emergency department visits, and physician office visits reported by cancer patients with and without history of breakthrough pain  

Microsoft Academic Search

Pain is a common problem for cancer patients and can result in substantial medical costs, but little is known about the characteristics of pain that may predict these costs. This study applied telephone survey methodology to investigate the relationship between breakthrough pain (BTP) and the use of medical resources in a cancer population with pain. A nonrandom sample of 1,000

Barry V. Fortner; Theodore A. Okon; Russell K. Portenoy



Is physical functioning influenced by activity-related pain prediction and fear of movement in patients with subacute low back pain?  

Microsoft Academic Search

In patients with low back pain (LBP), physical functioning may be negatively influenced by both expectations on pain and pain-related fear. It is unclear whether these factors influence both physical functioning in the laboratory as well as in daily life. The aim of this study was to test if a combination of persistent overprediction of pain and fear of movement

Ivan P. J. Huijnen; Jeanine A. Verbunt; Madelon L. Peters; Henk A. M. Seelen



Barriers to pain management in a community sample of Chinese American patients with cancer.  


Barriers to cancer pain management can contribute to the undertreatment of cancer pain. No studies have documented barriers to cancer pain management in Chinese American patients. The purposes of this study in a community sample of Chinese Americans were to: describe their perceived barriers to cancer pain management; examine the relationships between these barriers and patients' ratings of pain intensity, pain interference with function, mood disturbances, education, and acculturation level; and determine which factors predicted barriers to cancer pain management. Fifty Chinese Americans with cancer pain completed the following instruments: Brief Pain Inventory (BPI), Karnofsky Performance Status (KPS) Scale, Barriers Questionnaire (BQ), Hospital Anxiety and Depression Scale (HADS), Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA), and a demographic questionnaire. The mean total BQ score was in the moderate range. The individual barriers with the highest scores were: tolerance to pain medicine; time intervals used for dosage of pain medicine; disease progression; and addiction. Significant correlations were found between the tolerance subscale and least pain (r=0.380) and the religious fatalism subscale and average pain (r=0.282). These two subscales were positively correlated with anxiety and depression levels: (tolerance: r=0.282, r=0.284, respectively; religious fatalism: r=0.358, r=0.353, respectively). The tolerance subscale was positively correlated with pain interference (r=0.374). Approximately 21% of the variance in the total BQ score was explained by patients' education level, acculturation score, level of depression, and adequacy of pain treatment. Chinese American cancer patients need to be assessed for pain and perceived barriers to cancer pain management to optimize pain management. PMID:19004613

Edrington, Janet; Sun, Angela; Wong, Candice; Dodd, Marylin; Padilla, Geraldine; Paul, Steven; Miaskowski, Christine



Characteristics of chronic ischemic pain in patients with peripheral arterial disease.  


Chronic ischemic pain is a leading cause of pain in the lower extremities. A neuropathic component in ischemic pain has been shown. Neuropathic pain questionnaires are established as a common tool in pain research. The aim of this study was to analyze the clinical nature and the character of chronic ischemic pain in peripheral arterial disease (PAD). One hundred and two patients suffering from symptomatic PAD (Fontaine stages II-IV) were surveyed using validated pain questionnaires (VAS, NPSI, S-LANSS, PDI, SF-MPQ). Pain related disability was 22.7+/-1.7 (mean+/-SEM) in patients with intermittent claudication (CI) and 34.0+/-2.3 in patients with critical limb ischemia (CLI). Neuropathic pain questionnaires revealed distinctly higher scores for CLI than for CI: The S-LANSS indicated pain of predominantly neuropathic origin in patients with CLI (17.2+/-0.8) compared to CI (6.7+/-0.8; p<0.001). Global NPSI scores were 34.1+/-3.1 for CLI and 6.6+/-1.1 for CI (p<0.001). S-LANSS and NPSI correlated well (Spearman's rho=0.779; p<0.001). The SF-MPQ revealed that patients with CLI scored significantly higher for pain descriptors stabbing, hot-burning, tender and cruel-punishing compared to those with CI. The results suggest that the character of ischemic pain changes from nociceptive pain in patients with CI to predominantly neuropathic pain in patients with CLI. A neuropathic pain component seems to be a serious aspect in CLI, while it is not in CI. Questionnaires might be a helpful tool to investigate and diagnose ischemic pain. PMID:18472216

Rüger, Linda J; Irnich, Dominik; Abahji, Thomas N; Crispin, Alexander; Hoffmann, Ulrich; Lang, Philip M



Pain assessment and management in patients after abdominal surgery from PACU to the postoperative unit.  


The aim of this exploratory study was to determine the effectiveness of pain relief for surgical patients (N = 52) in transition from the PACU to the postoperative unit. The study also explored whether there was an association between a verbal numeric pain score (0 to 10) on discharge from the PACU and the duration of time until analgesia was administered in the postoperative unit. Information was obtained about pain management, time of discharge, and patient pain scores on discharge from the PACU, as well as pain scores and the time of first analgesic administered in the postoperative unit. Most patients were discharged from the PACU with a pain score in the mild range (0 to 4), indicating reasonable pain relief. An association existed between the pain score on discharge from the PACU and the duration of time to the first analgesic dose administered on the postoperative unit. PMID:19647660

Wilding, Jane R; Manias, Elizabeth; McCoy, Diarmuid G L



Perceived success and failure of intrathecal infusion pump implantation in chronic pain patients.  


Objectives.? Over the past few years, there has been an increased reliance on the intrathecal delivery of drugs for patients suffering from intractable pain. We sought to demonstrate the effectiveness of the intrathecal pain pump by examining self-reported pre- and postimplantation pain levels. Methods.? Eighty-four patients who had elected to implant a Medtronic SynchroMed 1 or 2 system in order to control their pain were asked to complete a survey. The survey consisted of pain ratings before implantation, pain ratings postimplantation, medications used before and after implantation, and patient satisfaction with the procedure. Results.? Perceived success rate for implantation is 68%, when measured by the ability to reduce reliance on oral medication. When measured by willingness to undergo the procedure again, the success rate is 86%. Conclusions.? Overall, the implantation of an intrathecal pain pump is an effective way for most people to manage their intractable pain and reduce reliance on oral medications. PMID:22151041

Corrado, Philip; Alperson, Burton; Wright, Michelle



Cancer patient and staff ratings of caring behaviors: relationship to level of pain intensity.  


This study explored differences in the perceived importance of nursing caring behaviors between patients with cancer pain and oncology nurses and to explore the relationship between level of pain intensity and the importance of various nursing caring behaviors. The study included 50 matched cancer patient-staff pairs from oncology inpatient units of 3 hospitals in northern Taiwan. The Brief Pain Inventory-Chinese version (BPI-C) and the Caring Assessment Report Evaluation Q-sort (CARE-Q) were used for data collection. Results revealed that cancer pain patients ranked "being accessible," "monitors and follows through," and "anticipates" as being the most important nursing caring behaviors; the nursing staff ranked "being accessible," "explains and facilitates," and "monitors and follows through" as being the most important behaviors. No correlations were found between cancer pain patients and staff rankings of the perceived importance of various caring behaviors. The self-reported level of pain intensity by patients was significantly positively correlated with the patient rating of the "anticipates" behavior. Patient self-reported level of pain interference was significantly positively correlated with the "monitors and follows through" behavior and significantly negatively correlated with the "explains and facilitates" behavior. Staff perception of both a patient's level of pain intensity and pain interference was significantly positively correlated with staff rating of the "being accessible" behavior. Results demonstrated that greater patient-staff communication is needed for staff to more accurately provide caring interventions to make patients with cancer pain feel cared for. PMID:16192823

Chang, Yuanmay; Lin, Ya-Ping; Chang, Hsiu-Ju; Lin, Chia-Chin


Functional Abdominal Pain Patient Subtypes in Childhood Predict Functional Gastrointestinal Disorders with Chronic Pain and Psychiatric Comorbidities in Adolescence and Adulthood  

PubMed Central

Although pediatric functional abdominal pain (FAP) has been linked to abdominal pain later in life, childhood predictors of long-term outcomes have not been identified. This study evaluated whether distinct FAP profiles based on patterns of pain and adaptation in childhood could be identified and whether these profiles predicted differences in clinical outcomes and central sensitization (wind-up) on average 9 years later. In 843 pediatric FAP patients, cluster analysis was used to identify subgroups at initial FAP evaluation based on profiles of pain severity, gastrointestinal (GI) and non-GI symptoms, pain threat appraisal, pain coping efficacy, catastrophizing, negative affect, and activity impairment. Three profiles were identified: High Pain Dysfunctional, High Pain Adaptive, and Low Pain Adaptive. Logistic regression analyses controlling for age and sex showed that, compared to pediatric patients with the Low Pain Adaptive profile, those with the High Pain Dysfunctional profile were significantly more likely at long-term follow-up to meet criteria for pain-related functional gastrointestinal disorder (FGID) (OR: 3.45; CI: 1.95–6.11), FGID with comorbid non-abdominal chronic pain (OR: 2.6; CI:1.45–4.66), and FGID with comorbid anxiety or depressive psychiatric disorder (OR: 2.84; CI: 1.35–6.00). Pediatric patients with the High Pain Adaptive profile had baseline pain severity comparable to the High Pain Dysfunctional profile, but had outcomes as favorable as the Low Pain Adaptive profile. In laboratory pain testing at follow-up, High Pain Dysfunctional patients exhibited significantly greater thermal wind-up than Low Pain Adaptive patients, suggesting that a subgroup of FAP patients has outcomes consistent with widespread effects of heightened central sensitization.

Walker, Lynn S.; Sherman, Amanda L.; Bruehl, Stephen; Garber, Judy; Smith, Craig A.



Background pain in burn patients: routine measurement and recording of pain intensity in a burn unit  

Microsoft Academic Search

It goes without saying that pain following a burn must be treated but it is not so evident to measure and document the intensity of pain and the efficacy of treatment. Since 1994 the authors have routinely measured background pain, that is, at rest, along with temperature and pulse rate. For analysis and quality assessment a relational database programme is

C.-E. Jonsson; A. Holmsten; L. Dahlström; K. Jonsson



Cocontraction of Ankle Dorsiflexors and Transversus Abdominis Function in Patients With Low Back Pain  

PubMed Central

Context The abdominal draw-in maneuver (ADIM) with cocontraction has been shown to be a more effective method of activating the transversus abdominis (TrA) in healthy adults than the ADIM alone. Whether such an augmented core stabilization exercise is effective in managing low back pain (LBP) remains uncertain. Objective To determine the effect of 2 weeks of ADIM and cocontraction training on abdominal muscle thickness and activation timing and to monitor pain and function in patients with LBP. Design Case-control study. Setting Local orthopaedic clinic and research laboratory. Patients or Other Participants Twenty patients with mechanical LBP (age = 27.20 ± 6.46 years, height = 166.25 ± 8.70 cm, mass = 58.10 ± 11.81 kg) and 20 healthy, age-matched people (age = 24.25 ± 1.59 years, height = 168.00 ± 8.89 cm, mass = 60.65 ± 11.99 kg) volunteered for the study. Intervention(s) Both the LBP and control groups received ten 30-minute sessions of ADIM and cocontraction training of the tibialis anterior (TA) and rectus femoris (RF) muscles over a 2-week period. Main Outcome Measure(s) A separate, mixed-model analysis of variance was computed for the thicknesses of the TrA, internal oblique (IO), and external oblique muscles. The differences in mean and peak electromyographic (EMG) amplitudes, onset time, and latency were compared between the groups. The visual analog pain scale, Pain Disability Index, and LBP rating scale were used to assess pain in the LBP group before and after the intervention. Results We found an interaction between the LBP and control groups and a main effect from pretest to posttest for only TrA muscle thickness change (F1,38 = 6.57, P = .01). Reductions in all pain measures were observed after training (P < .05). Group differences in peak and mean EMG amplitudes and onset time values for TrA/IO and TA were achieved (P < .05). The RF peak (t38 = ?3.12, P = .003) and mean (t38 = ?4.12, P = .001) EMG amplitudes were different, but no group difference was observed in RF onset time (t38 = 1.63, P = .11) or the cocontracted TrA/IO peak (t38 = ?1.90, P = .07) and mean (t38 = ?1.81, P = .08). The test-retest reliability for the muscle thickness measure revealed excellent correlations (intraclass correlation coefficient range, 0.95–0.99). Conclusions We are the first to demonstrate that a cocontraction of the ankle dorsiflexors with ADIM training might result in a thickness change in the TrA muscle and associated pain management in patients with chronic LBP.

Chon, Seung-Chul; You, Joshua H.; Saliba, Susan A.




Microsoft Academic Search

Objective: To investigate whether the International Classifi - cation of Functioning Disability and Health (ICF) Core Sets for low back pain encompass the key functional problems of patients. Design: Cross-sectional evaluation of patient-centred pro- blems with low back pain. Subjects: A total of 402 patients living in the UK recruited into a randomized clinical trial. Methods: Patients with acute or

Ricky Mullis; Julie Barber; Martyn Lewis; Elaine Hay



Pain management in cardiac surgery patients: Comparison between standard therapy and patient-controlled analgesia regimen  

Microsoft Academic Search

Objective: To compare standard nurse-based pain therapy with a patient-controlled analgesia (PCA) regimen.Design: Prospective, randomized study.Setting: Single-institutional, clinical investigation in an urban, university-affiliated hospital.Participants: Sixty patients undergoing elective first-time cardiac surgery were included.Interventions: In 30 patients, a standard analgesic regimen was used, and in 30 patients, a PCA regimen was used. The perioperative and postoperative management was similar for all

Joachim Boldt; Eef Thaler; Andreas Lehmann; Michael Papsdorf; Frank Isgro



The prevalence of pain at pressure areas and pressure ulcers in hospitalised patients  

PubMed Central

Background Patients with pressure ulcers (PUs) report that pain is their most distressing symptom, but there are few PU pain prevalence studies. We sought to estimate the prevalence of unattributed pressure area related pain (UPAR pain) which was defined as pain, soreness or discomfort reported by patients, on an “at risk” or PU skin site, reported at a patient level. Methods We undertook pain prevalence surveys in 2 large UK teaching hospital NHS Trusts (6 hospitals) and a district general hospital NHS Trust (3 hospitals) during their routine annual PU prevalence audits. The hospitals provide secondary and tertiary care beds in acute and elective surgery, trauma and orthopaedics, burns, medicine, elderly medicine, oncology and rehabilitation. Anonymised individual patient data were recorded by the ward nurse and PU prevalence team. The analysis of this prevalence survey included data summaries; no inferential statistical testing was planned or undertaken. Percentages were calculated using the total number of patients from the relevant population as the denominator (i.e. including all patients with missing data for that variable). Results A total of 3,397 patients in 9 acute hospitals were included in routine PU prevalence audits and, of these, 2010 (59.2%) patients participated in the pain prevalence study. UPAR pain prevalence was 16.3% (327/2010). 1769 patients had no PUs and of these 223 patients reported UPAR pain, a prevalence of 12.6%. Of the 241 people with pressure ulcers, 104 patients reported pain, a UPAR pain prevalence of 43.2% (104/241). Conclusion One in six people in acute hospitals experience UPAR pain on ‘at risk’ or PU skin sites; one in every 8 people without PUs and, more than 2 out of every five people with PUs. The results provide a clear indication that all patients should be asked if they have pain at pressure areas even when they do not have a PU.



Tension-type headache as the unique pain experience of a patient with congenital insensitivity to pain.  


Congenital insensitivity to pain (CIP) is a rare clinical syndrome characterized by dramatic impairment of pain perception since birth and is generally caused by a hereditary sensory and autonomic neuropathy (HSAN) with loss of the small-calibre, nociceptive nerve fibres. We report the case of a 32-year-old woman with CIP and a presumptive diagnosis of HSAN type V, who experienced physical pain for the first and unique time in her life shortly after the sudden loss of her brother. This patient had sustained innumerable painless injuries during childhood, including bone fractures and severe burns. The only pain she ever felt consisted in an intense headache, which took place in a context of strong emotional overload and anxiety, 3 weeks after her younger brother died suddenly in a car accident. The description of this inaugural episode of headache fulfilled the diagnostic criteria of episodic tension-type headache. This case strongly suggests that the transcription of the grief of bereavement into physical pain may sometimes occur independently of the peripheral mechanisms of nociception and despite the lack of previous pain experience. In the light of recent experimental data showing that the same neural mechanisms that regulate physical pain may also control the expression of separation distress and the feeling of social exclusion, this unique case helps to better understand why some patients may feel physically hurt after the loss of someone they love. PMID:16154693

Danziger, N; Willer, J-C



[Long term effect of spinal cord stimulation in a patient with complex regional pain syndrome and phantom pain syndrome type 1 after amputation].  


The development of stump and phantom pain after limb amputation in patients with complex regional pain syndrome (CRPS) is very frequent. Stump pain is typically recurred CRPS and the possibilities for effective pharmacological pain relief are often limited. Spinal cord stimulation (SCS) has a well-documented pain relieving effect in patients with CRPS. This case story summarises the long term effect of SCS in a patient with CRPS after two amputations of the right leg. Pharmacological pain therapies as well as Guanethidine blockade were found to be ineffective. PMID:18252182

Enggaard, Thomas Peter; Scherer, Christian; Nikolajsen, Lone; Andersen, Claus



Pain patterns and descriptions in patients with radicular pain: Does the pain necessarily follow a specific dermatome?  

Microsoft Academic Search

BACKGROUND: It is commonly stated that nerve root pain should be expected to follow a specific dermatome and that this information is useful to make the diagnosis of radiculopathy. There is little evidence in the literature that confirms or denies this statement. The purpose of this study is to describe and discuss the diagnostic utility of the distribution of pain

Donald R Murphy; Eric L Hurwitz; Jonathan K Gerrard; Ronald Clary



Prevalence and aetiology of neuropathic pain in cancer patients: a systematic review.  


Pain in cancer patients remains common and is often associated with insufficient prescribing of targeted analgesia. An explanation for undertreatment could be the failure to identify neuropathic pain mechanisms, which require additional prescribing strategies. We wanted to identify the prevalence of neuropathic mechanisms in patients with cancer pain to highlight the need for detailed assessment and to support the development of an international classification system for cancer pain. We searched for studies that included adult and teenage patients (age above 12 years), with active cancer and who reported pain, and in which a clinical assessment of their pain had been made. We found 22 eligible studies that reported on 13,683 patients. Clinical assessment methods varied, and only 14 studies reported confirmatory testing for either sensory abnormality or diagnostic lesion to corroborate a diagnosis of neuropathic pain. We calculated that the prevalence of patients with neuropathic pain (95% confidence interval) varied from a conservative estimate of 19% (9.4% to 28.4%) to a liberal estimate of 39.1% (28.9% to 49.5%) when patients with mixed pain were included. The prevalence of pain with a neuropathic mechanism (95% confidence interval) ranged from a conservative estimate of 18.7% (15.3% to 22.1%) to a liberal estimate of 21.4% (15.2% to 27.6%) of all recorded cancer pains. The proportion of pain caused by cancer treatment was higher in neuropathic pain compared with all types of cancer pain. A standardised approach or taxonomy used for assessing neuropathic pain in patients with cancer is needed to improve treatment outcomes. PMID:22115921

Bennett, Michael I; Rayment, Clare; Hjermstad, Marianne; Aass, Nina; Caraceni, Augusto; Kaasa, Stein



The evolution of chronic pain among patients with musculoskeletal problems: a pilot study in primary care.  

PubMed Central

Little is known about the evolution of chronic pain in primary care. Forty five patients with a four week history of musculoskeletal pain were assessed and followed up over 26 weeks by a research nurse using a structured interview and formal assessment instruments. Patients aged 18 to 65 years were recruited on presentation at two semirural Cheshire general practices and subsequently interviewed on a domiciliary visit. Twenty patients (44%) continued to have pain at 26 weeks and these patients were considered to have chronic pain. Nineteen patients had no pain after 12 weeks and a further six had no pain after 26 weeks; these patients together formed the group with acute pain. Comparing the two groups at entry into the study (pain of four weeks' duration) demonstrated significantly higher visual analogue scale scores for intensity of pain (P < 0.01) and a higher incidence of depression (P < 0.01) in the group which subsequently developed chronic pain. In this group, the presence of depression at 12 weeks was associated with higher visual analogue scale scores (P < 0.05) but at 26 weeks scores were similar in depressed and non-depressed patients. The correlation between visual analogue scale score for intensity of pain and the use of passive coping strategies to cope with pain appeared more strongly positive with duration of pain (P < 0.05 at 26 weeks). It is suggested that high pain intensity scores, the presence of depression, and the increasing use of passive coping strategies may be identifiable associations with the development of chronic pain. Areas for further research are identified.

Potter, R G; Jones, J M



[Acute pain management in paediatrics and geriatrics - pain assessment: which scale for which patient?].  


In the perioperative period acute pain is measured by one-dimensional scales concentrating on pain intensity. As part of a quality assurance procedure pain assessment is to be exercised during periods of rest and activity. Pain is a subjective experience. That is why self-report is the golden standard of pain assessment. Only in case self-report is not available due to mental development or to cognitive restraints, it has to be replaced by behavioural observation. Established scales are the visual analogue scale (VAS), the verbal rating scale (VRS), and the numerical rating scale (NRS) with a preference for the NRS. Scales that measure pain in children are the Faces-Pain-Scale and behavioural observation scales. The assessment of non verbal adults also has to rely on behavioural observation. PMID:21560099

Basler, Heinz-Dieter



Neuropathic pain, depressive symptoms, and C-reactive protein in sciatica patients.  


There is evidence that neuropathic pain component in low back pain (LBP) patients is associated with higher ratings of comorbidities such as depression and anxiety disorders. In line with current findings, the purpose of this clinical study is to examine a hypothesis regarding a relationship of neuropathic pain component, depression, and other psychopathological symptoms in a specific group of LBP patients with sciatica pain. With respect to findings that depression is related to inflammatory changes, and inflammatory mediators may play a role in neuropathic pain generation, we have assessed also serum C-reactive protein (CRP). Results of the present study show that increased neuropathic pain component in sciatica patients is associated with elevated levels of depression, anxiety, alexithymia, and serum CRP levels. In conclusion, results of this study indicate that CRP levels in sciatica patients are closely associated with neuropathic pain. PMID:23126320

Uher, Tomas; Bob, Petr



Fentanyl buccal tablet for relief of breakthrough pain in opioid-tolerant patients with cancer-related chronic pain.  


Fentanyl buccal tablet (FBT) is a new opioid formulation providing rapid-onset analgesia for the treatment of breakthrough pain (BTP). This study evaluated FBT for BTP in opioid-tolerant patients with chronic cancer pain. The study had a randomized, double-blind, placebo-controlled design and was conducted at 30 outpatient treatment centers in the United States. Following open-label titration, patients were randomly assigned to 1 of 18 double-blind dose sequences (7 FBT tablets, 3 placebo) to treat 10 BTP episodes. Pain intensity was measured on an 11-point scale (0 = no pain; 10 = worst pain). The primary efficacy measure was the sum of pain intensity differences (PIDs) for the first 60 minutes (SPID60); secondary efficacy measures included PIDs and pain relief (PR) measured from 5 minutes through 2 hours. Adverse events (AEs) were recorded. Of 129 patients enrolled, 87 entered the double-blind phase. SPID60 significantly favored FBT versus placebo (mean +/- SE, 9.7 +/- 0.63 vs 4.9 +/- 0.50; P < 0.0001). Secondary measures also favored FBT: PIDs and PR showed significant differences versus placebo at 10 minutes (0.9 vs 0.5; 0.815 vs 0.606, respectively, P < 0.0001) and all subsequent time points (P < 0.0001). AEs were typical of opioids (eg, nausea, dizziness, fatigue). In conclusion, in this study of opioid-tolerant patients with chronic cancer pain and BTP, FBT was efficacious, well tolerated, demonstrated rapid onset of analgesia (within 10 minutes), and had a sustained effect. PMID:17708123

Slatkin, Neal E; Xie, Fang; Messina, John; Segal, Thalia J


One-year trend in pain and disability relief recall in acute and chronic ambulatory low back pain patients  

Microsoft Academic Search

Clinicians use patients' recall of pain and disability relief as indicators of therapeutic effectiveness. Recall can change over time, however, and is influenced by factors other than true relief, including current health status. We have determined the trend in the relative contribution of current pain\\/disability and actual relief (current-baseline score) to relief recall over the course of 1 year. Self-referred

Mitchell Haas; Joanne Nyiendo; Mikel Aickin



The additional effect of orthotic devices on exercise therapy for patients with patellofemoral pain syndrome: a systematic review.  


The aim of the study is to determine "the additional effect of... function" for patellofemoral pain syndrome (PFPS). The additional effect of orthotic devices over exercise therapy on pain and function. A systematic literature search was conducted in MEDLINE, CINAHL, EMBASE, Cochrane and PEDro. Randomised controlled trials and controlled clinical trials of patients diagnosed with PFPS evaluating a clinically relevant outcome were included. Treatment had to include exercise therapy combined with orthotics, compared with an identical exercise programme with or without sham orthotics. Data were summarised using a best evidence synthesis. Eight trials fulfilled the inclusion criteria, of which three had a low risk of bias. There is moderate evidence for no additive effectiveness of knee braces to exercise therapy on pain (effect sizes (ES) varied from -0.14 to 0.04) and conflicting evidence on function (ES -0.33). There is moderate evidence for no difference between knee braces and exercise therapy versus placebo knee braces and exercise therapy on pain and function (ES -0.1-0.10). More studies of high methodological quality are needed to draw definitive conclusions. PMID:21402565

Swart, Nynke M; van Linschoten, Robbart; Bierma-Zeinstra, Sita M A; van Middelkoop, Marienke



Inhibition in expressing pain: a qualitative study among Dutch surgical breast cancer patients  

Microsoft Academic Search

In this qualitative study, 26 white Dutch women were interviewed who had recently undergone breast cancer surgery. The interviews indicated that during their hospital stay many of them had hardly expressed their postoperative pain and had rarely asked for pain medication. Patients' conceptions of postoperative pain and analgesics, their insecurity and lack of assertiveness, and some suboptimal interactions with nurses

Anneke L. Francke; Iris Theeuwen



Deficient modulation of pain by a positive emotional context in fibromyalgia patients.  


This study aimed to investigate the modulating effects of emotional context on pain perception in 16 patients with fibromyalgia syndrome (FMS) and 16 healthy control (HC) subjects. An infrared laser was used to apply individually adapted painful stimuli to the dorsum of the left hand. The emotional background of the painful stimuli was modulated by concurrent presentations of negative, neutral, and positive picture stimuli selected from the International Affective Picture System. As control conditions, painful stimuli and the pictures were also presented by themselves. During each of the 5 laser-picture trials, subjects received 10 painful stimuli and were asked to rate the average intensity and unpleasantness of the experienced pain. Functional magnetic resonance images were obtained, using a T2(?) sensitive echo planar sequence. HC subjects showed a linear increase in pain intensity and unpleasantness ratings when painful stimuli were presented during positive, neutral, and negative pictures. In contrast, FMS patients showed a quadratic trend for pain intensity ratings indicating a lack of pain reduction by the positive pictures. In addition, the FMS patients showed less activation in secondary somatosensory cortex, insula, orbitofrontal cortex, and anterior cingulate cortex during the positive picture pain trials. Our results suggest that fibromyalgia patients are less efficient in modulating pain by positive affect and may benefit less from appetitive events than healthy control subjects. PMID:23752177

Kamping, Sandra; Bomba, Isabelle C; Kanske, Philipp; Diesch, Eugen; Flor, Herta



Patients' and professionals' understandings of the causes of chronic pain: Blame, responsibility and identity protection  

Microsoft Academic Search

A social constructionist analysis of how sense is made of the causes of chronic pain is reported. It is recognised that there is a multiplicity of stories available in any culture from which understanding can be reached. Q-factor analysis is used within a critical framework as Q-methodology. Sixty chronic pain patients and pain professionals completed the sorting procedure. Four factors

Chris Eccleston; Amanda C. De C. Williams; Wendy Stainton Rogers



Epidemiology of complex regional pain syndrome: a retrospective chart review of 134 patients  

Microsoft Academic Search

Complex regional pain syndrome (CRPS) remains a poorly understood chronic pain disorder. Little data has been published assessing the epidemiology of CRPS (and reflex sympathetic dystrophy, RSD). This study assessed epidemiological variables in 134 CRPS patients evaluated at a tertiary chronic pain clinic in the US, including demographic, health care utilization and legal\\/workman's compensation measures. In addition, the frequency of

Ginger Allen; Bradley S. Galer; Lauren Schwartz



White Cancer Patients' Perception of Gender and Ethnic Differences in Pain Experience  

PubMed Central

Not considering cancer patients’ own views and experience with pain, especially gender and ethnic differences in their cancer pain experience, was reported to be a major contributor to the miscommunication that frequently results in inadequate cancer pain management. The purpose of this study was to explore white cancer patients’ perception of gender and ethnic differences in pain experience through an online forum. This was a descriptive qualitative study among 29 white cancer patients based on a feminist approach. Nine topics related to cancer pain experience were used. The data were analyzed using thematic analysis: 5 themes were identified. First, the participants perceived that pain accompanies cancer throughout the diagnosis and treatment process. Second, the specific characteristics of the participants’ individual culture and its view of pain and cancer could result in different cancer pain experience even among white cancer patients. Third, the participants complained that women’s pain was not taken seriously by health care providers. Fourth, the participants reported highly individualized pain experience with emotional pain. Finally, the participants wanted to have a control of their own pain management process. Based on the findings, implications for nursing research and practice are proposed.

Im, Eun-Ok



Trigger point acupuncture treatment of chronic low back pain in elderly patients – a blinded RCT  

Microsoft Academic Search

Objective There is some evidence for the efficacy of acupuncture in chronic low back pain, but it remains unclear which acupuncture modes are most effective. Our objective was to evaluate the effects of two different modes of trigger point acupuncture on pain and quality of life in chronic low back pain patients compared to standard acupuncture treatment.Methods Thirty five consecutive

Kazunori Itoh; Yasukazu Katsumi; Hiroshi Kitakoji



Chronic pain in old and young patients: differences appear less important than similarities.  


Two studies compared physical and psychosocial characteristics of elderly and younger chronic pain patients. No age differences were found during intake for the number of physical coping strategies. Elderly patients named fewer cognitive strategies. No age differences were detected in the percentage of patients offered treatment, who agreed to enter treatment, or who completed treatment. Although older patients more frequently had abnormal physical findings, there were no significant differences on measures of self-reported activity, pain severity, life interference, emotional or worry reactions in response to pain. Both age groups had comparable scores on measures of social support and perceptions of how others react to their pain. The present research suggests that there are relatively few factors distinguishing pain patients based on age. Moreover, age should not be a significant factor to consider when offering patients multidisciplinary treatment for chronic pain that focuses on psychological as well as physical modalities. PMID:2313050

Sorkin, B A; Rudy, T E; Hanlon, R B; Turk, D C; Stieg, R L



The influence of pain distribution on walking velocity and horizontal ground reaction forces in patients with low back pain.  


Objective. The primary purpose of this paper was to evaluate the influence of pain distribution on gait characteristics in subjects with low back problems (LBP) during walking at preferred and fastest speeds. Design. Cross-sectional, observational study. Setting. Gait analysis laboratory in a health professions university. Participants. A convenience age- and gender-matched sample of 20 subjects with back pain only (BPO), 20 with referred leg pain due to back problems (LGP), and 20 pain-free individuals (CON). Methods and Measures. Subjects completed standardized self-reports on pain and disability and were videotaped as they walked at their preferred and fastest speeds along a walkway embedded with a force plate. Temporal and spatial gait characteristics were measured at the midsection of the walkway, and peak medial, lateral, anterior, and posterior components of horizontal ground reaction forces (hGRFs) were measured during the stance phase. Results. Patients with leg pain had higher levels of pain intensity and affect compared to those with back pain only (t = 4.91, P < .001 and t = 5.80, P < 0.001, resp.) and walking had an analgesic effect in the BPO group. Gait velocity was highest in the control group followed by the BPO and LGP group and differed between groups at both walking speeds (F(2.57) = 13.62, P < .001 and F(2.57) = 9.09, P < .001, for preferred and fastest speed condition, resp.). When normalized against gait velocity, the LGP group generated significantly less lateral force at the fastest walking speed (P = .005) and significantly less posterior force at both walking speeds (P ? .01) compared to the control group. Conclusions. Pain intensity and distribution differentially influence gait velocity and hGRFs during gait. Those with referred leg pain tend to utilize significantly altered gait strategies that are more apparent at faster walking speeds. PMID:22550576

Simmonds, Maureen J; Lee, C Ellen; Etnyre, Bruce R; Morris, G Stephen



Patient-reported outcomes: descriptors of nociceptive and neuropathic pain and barriers to effective pain management in adult outpatients with sickle cell disease.  


Despite frequent episodes of severe recurrent pain in sickle cell disease (SCD), sensory pain in outpatient adults with SCD lacks sufficient characterization. Furthermore, pivotal barriers may interfere with these patients' adherence to prescribed analgesic therapies but have not been studied systematically. We describe sensory pain characteristics, barriers, and analgesic use reported by adults with SCD during routine clinic visits. Patients (N = 145; 67% female, 94% African American) completed measures on a pen-tablet computer. Patients reported an average of 3.6 +/- 2.3 pain sites; mean current pain intensity (3.3 +/- 3.2), least (3.0 +/- 2.7) and worst (4.9 +/- 3.5) pain intensity in 24 hours on a 0 to 10 scale, multiple neuropathic (4.5 +/- 3.4, 8.3% selected none) and nociceptive (6.8 +/- 4.0) pain descriptors, and continuous pain pattern (59%). Their mean pain barriers score was 2.2 +/- 0.9, and 33% were dissatisfied with their pain levels. Only 14% reported taking at least 1 adjuvant drug, 82% were taking nonopioids, 85% step 2 opioids, and 65% step 3 opioids. Patients reported using, on average, 4.9 +/- 2.7 analgesics. Their pain barriers scores were similar to or greater than people with cancer. Importantly, their pain may be both nociceptive and neuropathic, contrary to common expectations that SCD pain is only nociceptive. Few patients, however, took drugs effective for neuropathic pain. PMID:20158132

Wilkie, Diana J; Molokie, Robert; Boyd-Seal, Debra; Suarez, Marie L; Kim, Young Ok; Zong, Shiping; Wittert, Harriet; Zhao, Zhongsheng; Saunthararajah, Yogen; Wang, Zaijie J



Cancer Breakthrough Pain in the Presence of Cancer-Related Chronic Pain: Fact versus Perceptions of HealthCare Providers and Patients  

Microsoft Academic Search

Cancer breakthrough pain is a flare in pain that “breaks through” well-controlled persistent cancer pain. Although the condition is highly prevalent, the concept of cancer breakthrough pain is not well understood and is therefore underdiagnosed and undertreated. The purpose of this review is to examine the roles the health-care practitioner and patient\\/family caregiver play in the undertreatment of breakthrough pain.

Michelle I. Rhiner; Charles F. von Gunten



Creation of a Novel Recuperative Pain Medicine Service to Optimize Postoperative Analgesia and Enhance Patient Satisfaction  

Microsoft Academic Search

Many patients have difficulty with pain control after transition from patient-controlled analgesia modalities to oral analgesics.\\u000a The creation of a Recuperative Pain Medicine (RPM) service was intended to bridge this gap in pain management at the Hospital\\u000a for Special Surgery. Specific goals were to improve patient and staff satisfaction with management of postoperative oral analgesics\\u000a by improving clinical care, administrative

Brian D. Philips; Spencer S. Liu; Barbara Wukovits; Friedrich Boettner; Seth Waldman; Gregory Liguori; Stephanie Goldberg; Lisa Goldstein; Joanne Melia; Marion Hare; Laura Jasphey; Sharyn Tondel



Outcomes of Follow-Up Visits to Chronic Nonmalignant Pain Patients  

Microsoft Academic Search

Follow-up visits by clinical nurse specialists are beneficial for patients with various chronic conditions. It is unknown whether patients with chronic nonmalignant pain can achieve similar benefit. The aim of this study was to assess outcomes of follow-up visits by clinical nurse specialists to chronic nonmalignant pain patients regarding health-related quality of life (HRQoL), pain, opioid treatment, quality of sleep,

Liv M. H. Frich; Jan Sorensen; Susanne Jacobsen; Bente Fohlmann; Jette Højsted


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

Microsoft Academic Search

GoalsUndertreatment 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.Patients and methodsFocus groups were conducted among hospice and home-health-care nurses (two groups; n=22) and patients (six

Elizabeth Randall-David; Judy Wright; Deborah S. Porterfield; Glenn Lesser



Prevalence of pain in public hospital: correlation between patients and caregivers  

Microsoft Academic Search

The prevalence of patients suffering pain in hospital is high. This situation is censured during congresses on the study\\u000a and treatment of pain, which highlight how little consideration the problem is given. Our study, which measured exactly how\\u000a far pain is underestimated and inappropriately treated, took place as part of the project “Towards a Pain-Free Hospital” in\\u000a San Bortolo Hospital,

Leonardo Trentin; Marco Visentin; Roberto de Marco; Elisabetta Zandolin



Pain management in the emergency department and its relationship to patient satisfaction  

PubMed Central

Background: Pain is the most common reason due to which patients come to the emergency department (ED). Aim: The purpose of this study was to measure the correlation, if any, between pain reduction and the level of satisfaction in patients who presented to the ED with pain as their chief complaint. Materials and Methods: This study used a randomly selected group of patients who presented to the ED with pain of 4 or more on the Visual Analogue Pain Scale (VAS) as their chief complaint to a level one adult and pediatric trauma center. Instruments that were used in this study were the VAS, Brief Pain Inventory (BPI), and the Medical Interview Satisfaction Scale (MISS). They were administered to patients by research fellows in the treatment rooms. Statistical analysis included frequencies, descriptive, and linear regression. This study was approved by the Internal Review Board. Results: A total of 159 patients were enrolled in the study. All patients were given some type of treatment for their pain upon arrival to the ED. A logistic regression showed a significant relationship to reduction in pain by 40% or more and customer service questions. Conclusions: A reduction in perceived pain levels does directly relate to several indicators of customer service. Patients who experienced pain relief during their stay in the ED had significant increases in distress relief, rapport with their doctor, and intent to comply with given instructions.

Downey, La Vonne A; Zun, Leslie S



Analyzing physician\\/patient chronic pain communication through primary goals, secondary goals, stages of change and processes of change  

Microsoft Academic Search

Primary care office visits regarding chronic pain seldom lead to pain management strategies that improve health outcomes. A cycle of blame between physicians and patients often ensues: patients blame physicians for not taking away their pain and physicians blame patients for not taking a more active role in their pain management. Very little research has been conducted in the U.S.

Jennifer Susan Kramer



Pain in Underserved Community-Dwelling Chinese American Cancer Patients: Demographic and Medical Correlates  

PubMed Central

Background. Little is known about cancer pain in Chinese Americans. The objective of this study was to describe the epidemiology of pain in this population. This information is needed to identify and address unmet clinical needs for culturally relevant interventions targeting pain and its consequences. Methods. A consecutive sample of underserved ethnic Chinese patients in a large community-based oncology practice was screened for persistent or frequent pain. Those patients with pain completed translated instruments assessing demographics, linguistic acculturation, disease-related characteristics, and pain-related characteristics. Results. Of 312 patients screened, 178 (57.1%) reported frequent or persistent pain, 175 were eligible, and 170 participated. Most participants (85.9%) were born in China and 84.7% overall spoke Cantonese only. The most common cancers were gastrointestinal (28.2%), lung (21.8%), breast (20.6%), head and neck (12.9%), and genitourinary (4.7%); 43.5% had metastatic disease. The mean worst pain severity on a 0–10 numeric scale was 4.7 (standard deviation, 2.4), with 28.2% of patients rating their worst pain at ?7 of 10. Although 37.6% used opioids and 47.1% used nonopioids, 45.8% reported “little” or “no” pain relief from medications. Complementary or alternative medicine therapies for cancer pain were used by 35.8%. In multiple regression analyses, worst pain was positively associated with acculturation to the English language and opioid therapy, and pain-related distress was positively associated with opioid therapy. Conclusion. Pain is prevalent among community-dwelling, ethnic Chinese American cancer patients. Additional studies are needed to confirm these results and investigate the finding that higher linguistic acculturation is associated with reports of more intense pain.

Lam, Kin; Homel, Peter; Chen, Jack; Chang, Victor T.; Zhou, Juanyi; Chan, Selina; Lam, Wan Ling; Portenoy, Russell



[Psychological evaluation of patients by state-trait anxiety inventory in pain clinic].  


In 84 outpatients who visited our pain clinic, we evaluated their anxiety before the first examination, using State-Trait Anxiety Inventory. State anxiety scores were high in all the patients regardless of their underlying disease. Trait anxiety scores in patients with chronic pain such as postherpetic neuralgia or cervic-shoulder-hand syndrome were higher than in patients with facial nerve palsy, sudden hearing loss or herpetic pain. This study indicates that psychosomatic management is mandatory for patients with chronic pain. PMID:7815700

Fukuda, H; Kasuda, H; Nakaigawa, Y; Nemoto, K; Shimizu, R



Conversing rate from morphine to continuous infusion of fentanyl in patients suffering cancer pain  

Microsoft Academic Search

Objective  To investigate the proper conversing rate from morphine to continuous infusion of fentanyl in patients suffering cancer pain.\\u000a \\u000a \\u000a \\u000a Methods  A retrospective study was carried on in 20 patients with cancer pain in Shizuoka Cancer Center from Sep. 2002 to Nov. 2003.\\u000a Pain intensity, adverse reactions, and satisfaction index of patients were evaluated.\\u000a \\u000a \\u000a \\u000a Results  The pain intensity was stable in 17 patients indicating

Wen-ping Wang; Da-yong An



Impact of a public campaign on pre-hospital delay in patients reporting chest pain  

Microsoft Academic Search

OBJECTIVE: To decrease pre-hospital delay in patients with chest pain. DESIGN: Population based, prospective observational study. SETTING: A province of Switzerland with 380000 inhabitants. SUBJECTS: All 1337 patients who presented with chest pain to the emergency department of the Hôpital Cantonal Universitaire of Geneva during the 12 months of a multimedia public campaign, and the 1140 patients who came with

J. M. Gaspoz; P. F. Unger; P. Urban; J. C. Chevrolet; W. Rutishauser; C. Lovis; L. Goldman; C. Héliot; L. Séchaud; S. Mischler; F. A. Waldvogel



Validation of a Behavioral Pain Scale in Critically Ill, Sedated, and Mechanically Ventilated Patients  

Microsoft Academic Search

Assessing pain in critically ill patients, particularly in nonverbal patients, is a great challenge. In this study, we validated a behavioral pain scale (BPS) in critically ill, sedated, and mechanically ventilated patients. The BPS score was the sum of 3 subscales that have a range score of 1-4: facial expression, upper limb movements, and compliance with mechanical ventilation. Two as-

Amine Ali Zeggwagh; Khalid Abidi; Redouane Abouqal



Enhanced temporal summation of second pain and its central modulation in fibromyalgia patients  

Microsoft Academic Search

We have previously shown that fibromyalgia (FMS) patients have enhanced temporal summation (windup) and prolonged decay of heat-induced second pain in comparison to control subjects, consistent with central sensitization. It has been hypothesized that sensory abnormalities of FMS patients are related to deficient pain modulatory mechanisms. Therefore, we conducted several analyses to further characterize enhanced windup in FMS patients and

Donald D. Price; Roland Staud; Michael E. Robinson; Andre P. Mauderli; Richard Cannon; Charles J. Vierck



Gabapentin in painful HIV-related neuropathy: a report of 19 patients, preliminary observations.  


The objective of this study was to assess the efficacy and safety of Gabapentin as the sole analgesic in patients with HIV-related painful neuropathy. Nineteen patients with HIV-related painful neuropathy were administered Gabapentin. Efficacy was evaluated with two 100-mm Visual Analogue Scales (VAS) (0: no symptom; 100: worst symptom), rating pain and interference of pain with sleep, performed at baseline and monthly intervals. Main Pain VAS score decreased from a baseline of 55.7 +/- 19.1 mm to a final 14.7 +/- 18.6 mm (ANOVA P = 0.0001) and mean Sleep Interference VAS score decreased from a baseline of 60.4 +/- 31.9 mm to a final 15.5 +/- 27.7 mm (ANOVA P = 0.0001). Gabapentin provided significant pain relief in our patients with HIV-associated painful sensory neuropathy. PMID:11509084

La Spina, I; Porazzi, D; Maggiolo, F; Bottura, P; Suter, F



Patients with persistent pain after breast cancer surgery show both delayed and enhanced cortical stimulus processing  

PubMed Central

Background Women who undergo breast cancer surgery have a high risk of developing persistent pain. We investigated brain processing of painful stimuli using electroencephalograms (EEG) to identify event-related potentials (ERPs) in patients with persistent pain after breast cancer treatment. Methods Nineteen patients (eight women with persistent pain, eleven without persistent pain), who were surgically treated more than 1 year previously for breast cancer (mastectomy, lumpectomy, and axillary lymph node dissection) and/or had chemoradiotherapy, were recruited and compared with eleven healthy female volunteers. A block of 20 painful electrical stimuli was applied to the calf, somatopically remote from the initially injured or painful area. Simultaneously an EEG was recorded, and a visual analog scale (VAS) pain rating obtained. Results In comparison with healthy volunteers, breast cancer treatment without persistent pain is associated with accelerated stimulus processing (reduced P260 latency) and shows a tendency to be less intense (lower P260 amplitude). In comparison to patients without persistent pain, persistent pain after breast cancer treatment is associated with stimulus processing that is both delayed (ie, increased latency of the ERP positivity between 250–310 ms [P260]), and enhanced (ie, enhanced P260 amplitude). Conclusion These results show that treatment and persistent pain have opposite effects on cortical responsiveness.

van den Broeke, Emanuel N; de Vries, Marjan; van Goor, Harry; Vissers, Kris CP; van Rijn, Clementina M; Wilder-Smith, Oliver HG



Effects of Coaching Patients with Lung Cancer to Report Cancer Pain  

PubMed Central

We examined effects of sensory self-monitoring and reporting Coaching on pain-related variables in patients with lung cancer. Randomly assigned to Coached or Not-Coached groups, 215 patients had their interactions with their providers audiotaped and completed study measures pre and post intervention. Of the 151 patients who completed the 4-week study, those Coached were more likely than those Not-Coached to give their providers unsolicited sensory pain information and to mention it before their providers asked for it. The mean number of pain parameters discussed during the audiotaped clinic visit was statistically larger at study-end for the Coached group. Scores for analgesic adequacy, all pain indices except one, anxiety, depression, and catastrophizing coping were not significantly different. Although Coaching increased the amount of pain data communicated to providers by patients with lung cancer, the magnitude was small and did not lead to improved adequacy of analgesics prescribed for each patient's pain level.

Wilkie, Diana J.; Werley, Harriet H.; Berry, Donna L.; Cain, Kevin C.; Huang, Hsiu-Ying; Mekwa, Julia; Lewis, Frances Marcus; Gallucci, Betty; Lin, Yu-Chuan; Chen, Angela Chia-Chen; Ko, Nai-Ying



Microneurographic findings of relevance to pain in patients with erythromelalgia and patients with diabetic neuropathy.  


Mechanisms responsible for neuropathic pain are still unclear. By using microneurography we have been able to record from single C-nociceptive and sympathetic fibers in patients and attempted to uncover possible abnormal functional properties of these fibers of relevance for pain. In two previously published studies conducted on patients with erythromelalgia and patients with diabetic neuropathy, some of the major findings were: (1) spontaneous activity in nociceptive fibers, (2) sensitization of mechano-insensitive C-fibers, and (3) an altered distribution of C-afferent nerve fibers with a reversal of the proportion of the two main subtypes of C-nociceptive fibers, indicating a loss of function of polymodal nociceptors. Although some degree of spontaneous activity and sensitization also was found in patients without pain, these mechanisms may still be of importance for the development and maintenance of neuropathic pain. A change in the distribution of C-nociceptive fibers in the skin as shown in the patients with diabetic neuropathy may help to reveal mechanisms responsible for small-fiber dysfunction. PMID:19481586

Orstavik, Kristin; Jørum, Ellen



Relationship of depression and catastrophizing to pain, disability, and medication adherence in patients with HIV-associated sensory neuropathy  

Microsoft Academic Search

Few studies have examined how patients with chronic HIV infection cope with pain and how pain relates to medication adherence. Pain coping strategies such as catastrophizing are often associated with increased pain and disability and may also influence adherence to medications. The goal of our study is to assess the relationship of catastrophizing and depression to pain, disability, and medication

Brendan P. Lucey; David B. Clifford; Jason Creighton; Robert R. Edwards; Justin C. McArthur; Jennifer Haythornthwaite



Marital and Family Issues in Patients with Chronic Pain  

Microsoft Academic Search

This paper attempts to review the relevant literature pertaining to the family issues in chronic pain. To begin with, a rationale is developed for adopting a family approach to the understanding of physical and psychosomatic disorders. Pain literature is examined to demonstrate the significance of family factors in the etiology, perpetuation and treatment of chronic pain. Overall research in this

Ranjan Roy



A Prospective Audit of Postoperative Pain Control in Pediatric Patients  

Microsoft Academic Search

Pain is a subjective experience that is affected by physical, emotional, and psychological factors, and reliable assessment of pain can be a challenge in the pediatric population.A quality improvement project was conducted at one Canadian health care facility to examine the effectiveness of the postoperative pain management strategy for children admitted to the postanesthesia care unit (PACU).Effective control of postoperative

Jacqueline D. Trudeau; Elizabeth Lamb; Margot Gowans; Gillian Lauder



Suppression of anger and subsequent pain intensity and behavior among chronic low back pain patients: the role of symptom-specific physiological reactivity  

Microsoft Academic Search

Suppression of anger may be linked to heightened pain report and pain behavior during a subsequent painful event among chronic\\u000a low back patients, but it is not clear whether these effects are partly accounted for by increased physiological reactivity\\u000a during suppression. Chronic low back pain patients (N = 58) were assigned to Suppression or No Suppression conditions for a “cooperative” computer maze

John W. BurnsPhillip; Phillip J. Quartana; Wesley Gilliam; Justin Matsuura; Carla Nappi; Brandy Wolfe


Cordotomy for treatment of cancer-related pain: patient selection and intervention timing.  


Many neurosurgical interventions for the management of cancer-related pain have been tried, but their role in today's advanced supportive and palliative care is not well described. The authors discuss the current knowledge gaps that prevent successful integration of neurosurgical interventions and patients with cancer-related pain. Two patients underwent percutaneous CT-guided cordotomy for refractory cancer-related pain: one patient had melanoma and the other had ovarian carcinoma. Both patients seemed to have unilateral, somatic, nociceptive cancer-related pain. Cordotomy was effective for only 1 patient. Percutaneous CT-guided cordotomy is a low-risk intervention that can benefit carefully selected patients with cancer-related pain. There is a clear need for prospective controlled studies to evaluate the effectiveness of cordotomy for patients receiving optimal medical treatment. A multidisciplinary study design could help to identify factors correlated with a positive outcome. PMID:23991819

Viswanathan, Ashwin; Bruera, Eduardo



Percutaneous thoracic intervertebral disc nucleoplasty: technical notes from 3 patients with painful thoracic disc herniations.  


Symptomatic thoracic disc herniation is an uncommon condition and early surgical approaches were associated with significant morbidity and even mortality. We are the first to describe the technique of percutaneous thoracic nucleoplasty in three patients with severe radicular pain due to thoracic disc herniation. Two of the patients experienced more than 75% pain relief and one patient experienced more than 50% pain relief. Post-procedural pain relief was maintained up to an average of 10 months after nucleoplasty. One patient with preoperative neurological signs improved postoperatively. There were no reported complications in all three patients. In view of the reduced morbidity and shorter operating time, thoracic intervertebral disc nucleoplasty can be considered in patients with pain due to thoracic disc herniation, with no calcification of the herniated disc, and in patients who may be otherwise be unfit for conventional surgery. PMID:21386942

Chua, Nicholas H L; Gültuna, Ismail; Riezebos, Patricia; Beems, Tjemme; Vissers, Kris C



Percutaneous Thoracic Intervertebral Disc Nucleoplasty: Technical Notes from 3 Patients with Painful Thoracic Disc Herniations  

PubMed Central

Symptomatic thoracic disc herniation is an uncommon condition and early surgical approaches were associated with significant morbidity and even mortality. We are the first to describe the technique of percutaneous thoracic nucleoplasty in three patients with severe radicular pain due to thoracic disc herniation. Two of the patients experienced more than 75% pain relief and one patient experienced more than 50% pain relief. Post-procedural pain relief was maintained up to an average of 10 months after nucleoplasty. One patient with preoperative neurological signs improved postoperatively. There were no reported complications in all three patients. In view of the reduced morbidity and shorter operating time, thoracic intervertebral disc nucleoplasty can be considered in patients with pain due to thoracic disc herniation, with no calcification of the herniated disc, and in patients who may be otherwise be unfit for conventional surgery.

Gultuna, Ismail; Riezebos, Patricia; Beems, Tjemme; Vissers, Kris C.



Allopathic, complementary, and alternative medical treatment utilization for pain among methadone-maintained patients: An exploratory study1  

PubMed Central

We surveyed 150 methadone maintenance treatment program (MMTP) patients about pain, pain treatment utilization, perceived efficacy of prior pain treatment, and interest in pursuing pain treatment at the MMTP. Respondents with chronic severe pain (CSP) (i.e., pain lasting at least 6 months with moderate to severe pain intensity or significant pain interference) and “some pain” (i.e., pain reported in the previous week but not CSP) endorsed similar rates of past-week and lifetime allopathic or standard medical (with the exception of lifetime medical use of non-opiate medication) and complementary and alternative medicine (CAM) utilization for pain reduction. Prior pain treatments were perceived to be less effective by CSP than SP patients but both groups had equivalent high rates of interest in pain treatment associated with the MMTP. These findings may have implications for resource and program planning in MMT programs.

Barry, Declan T.; Beitel, Mark; Cutter, Christopher J.; Garnet, Brian; Joshi, Dipa; Schottenfeld, Richard S.; Rounsaville, Bruce J.



Investigation of neuropathic pain in treated leprosy patients in Ethiopia: a cross-sectional study.  


Pain can be a significant problem for treated leprosy patients. It can be nociceptive due to tissue inflammation occurring during episodes of immune mediated reactions, or neuropathic due to leprosy affecting the somatosensory system. There are sparse epidemiological data on the prevalence and impact of neuropathic pain in treated leprosy patients. Tools for assessing neuropathic pain have not been validated in leprosy. We have examined nature of pain in a cross-sectional study to determine the prevalence of neuropathic pain (NP) in 80 recently treated leprosy patients in Ethiopia. Pain and depression were evaluated using the General Health Questionnaire (GHQ-12) and the Brief Pain Inventory (BPI) questionnaire. The Douleur Neuropathique en 4 Questions (DN4) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) were used as screening tools for NP. Pain of any type was experienced by 60% of the patients. Pure nociceptive pain was experienced by 43%, pure NP by 11%, and mixed pain by 6%. Of the 14 patients who had NP either alone or in combination with nociceptive pain, 12 had high GHQ-12 scores, indicating possible depression. The DN4 had sensitivity and specificity of 100% and 45%, whereas the LANSS had 85% and 42%, respectively. This is the first study to differentiate nociceptive from NP in leprosy patients. The prevalence of NP is high in recently treated Ethiopian leprosy patients. We have validated the use of DN4 in leprosy and it is easier to use than LANSS. Depression is a common co-morbidity in patients with NP. The high prevalence and morbidity of NP in treated leprosy patients warrant clinical trials to assess the efficacy of pain therapies for leprosy-associated NP. PMID:22727538

Haroun, Omer M O; Hietaharju, Aki; Bizuneh, Elizabeth; Tesfaye, Fasil; Brandsma, J Wim; Haanpää, Maija; Rice, Andrew S C; Lockwood, Diana N J



Improving Physician-Patient Communication About Cancer Pain With a Tailored Education-Coaching Intervention  

PubMed Central

Objective This study examined the effect of a theoretically grounded, tailored education-coaching intervention to help patients more effectively discuss their pain-related questions, concerns, and preferences with physicians. Methods Grounded in social-cognitive and communication theory, a tailored education coaching (TEC) intervention was developed to help patients learn pain management and communication skills. In a RCT, 148 cancer patients agreed to have their consultations audio-recorded and were assigned to the intervention or a control group. The recordings were used to code for patients’ questions, acts of assertiveness, and expressed concerns and to rate the quality of physicians’ communication. Results Patients in the TEC group discussed their pain concerns more than did patients in the control group. More active patients also had more baseline pain and interacted with physicians using participatory decision-making. Ratings of physicians’ information about pain were higher when patients talked more about their pain concerns. Conclusions The study demonstrates the efficacy of a theoretically grounded, coaching intervention to help cancer patients talk about pain control. Practice implications Coaching interventions can be effective resources for helping cancer patients communicate about their pain concerns if they are theoretically grounded, can be integrated within clinical routines, and lead to improve health outcomes.

Street, Richard L.; Slee, Christina; Kalauokalani, Donna K; Dean, Dionne Evans; Tancredi, Daniel J; Kravitz, Richard L.



Altered intestinal permeability in patients with primary fibromyalgia and in patients with complex regional pain syndrome  

Microsoft Academic Search

Objectives. The pain intensity of patients with FM has recently been reported to be correlated with the degree of small intestinal bacterial overgrowth (SIBO). SIBO is often associated with an increased intestinal permeability (IP). Increased IP, if shown in FM, may have pathogenetic relevance because it leads to the exposure of immune cells to luminal antigens and consequent immune modulation.

A. Goebel; S. Buhner; R. Schedel; H. Lochs; G. Sprotte



Gastric electrical stimulation for abdominal pain in patients with symptoms of gastroparesis.  


Abdominal pain physiology may be better understood studying electrophysiology, histology, and symptom scores in patients with the symptoms of gastroparesis (Gp) treated with gastric electrical stimulation (GES). Ninety-five Gp patients' symptoms were recorded at baseline and during temporary and permanent GES. Gastric-emptying times and cutaneous, mucosal, and serosal electrogastrograms were obtained. S100-stained, full-thickness gastric biopsies were compared with autopsy controls. Sixty-eight patients reported severe pain at baseline. Severe pain patients' mean pain scores decreased with temporary GES from 3.62 to 1.29 (P < 0.001) and nonsevere pain from 1.26 to 0.67 (P = 0.01). With permanent GES, severe mean pain scores fell to 2.30 (P < 0.001); nonsevere pain changed to 1.60 (P = 0.221). Mean follow-up was 275 days. Mean cutaneous, mucosal, and serosal frequencies and frequency-to-amplitude ratios were markedly higher than literature controls. For patients with Gp overall and subdivided by etiology and severity of pain, S-100 neuronal fibers were significantly reduced in both muscularis propria layers. GES improved severe pain associated with symptoms of Gp. This severe pain is associated with abnormal electrogastrographic activity and loss of S100 neuronal fibers in the stomach's inner and outer muscularis propria and, therefore, could be the result of gastric neuropathy. PMID:23635579

Lahr, Christopher J; Griffith, James; Subramony, Charu; Halley, Lindsey; Adams, Kristen; Paine, Elizabeth R; Schmieg, Robert; Islam, Saleem; Salameh, Jay; Spree, Danielle; Kothari, Truptesh; Kedar, Archana; Nikitina, Yana; Abell, Thomas



Nursing responses to transcultural encounters: what nurses draw on when faced with a patient from another culture.  


Objective: We explored nurses' experiences when they encounter patients from cultures other than their own and their perception of what helps them deliver culturally competent care.Methods: Registered nurses from all shifts and units at Kaiser Permanente Santa Clara Medical Center were invited to complete a questionnaire. Within the time frame allowed, 111 nurses participated by returning completed questionnaires.A descriptive survey was conducted using a questionnaire that contained multiple-choice, fill-in-the-blank, and open-ended items.Results: A large majority of respondents reported that they drew on prior experience, including experience with friends and family, and through their education and training, and more than half also included travel experience and information obtained through the Internet and news media. They also expressed a desire for more training and continuing education, exposure to more diverse cultures, and availability of more interpreters. When respondents were asked to enumerate the cultures from which their patients have come, their answers were very specific, revealing that these nurses understood culture as going beyond ethnicity to include religious groups, sexual orientation, and social class (eg, homeless).Discussion: Our research confirmed our hypothesis that nurses are drawing heavily on prior experience, including family experiences and experiences with friends and coworkers from different cultures. Our findings also suggest that schools of nursing are providing valuable preparation for working with diverse populations. Our research was limited to one geographic area and by our purposeful exclusion of a demographic questionnaire. We recommend that this study be extended into other geographic areas. Our study also shows that nurses are drawing on their experiences in caring for patients from other cultures; therefore, we recommend that health care institutions consider exposing not only nurses but also other health care professionals to different cultures by creating activities that involve community projects in diverse communities, offering classes or seminars on different cultures and having an active cultural education program that would reach out to nurses. The experiences provided by such activities and programs would help nurses become more sensitive to the differences between cultures and not immediately judge patients or make assumptions about them. PMID:20740086

Cang-Wong, Celeste; Murphy, Susan O; Adelman, Toby



Hypnotherapy in management of pain and reexperiencing of trauma in burn patients.  


This study examined the effects of hypnosis on both pain and reexperiencing of trauma in burn patients. Forty-four patients hospitalized for burn care were randomly assigned to either hypnotherapy or a control group. Direct and indirect hypnotic suggestions were used to reduce pain and reexperiencing of trauma. All patients received routine burn care. Pain reports were quantified by using a self-report numeric rating scale ranging from 0 to 5. The number of recalled vivid, troubling events of the trauma in 24-hour intervals was used for rating the reexperiencing of trauma. The hypnotherapy group showed significantly lower pain ratings than the control group and reported a significant reduction in pain from baseline. There was a significant reduction in trauma reexperience scores in the hypnotherapy group but not the control group. The findings support the efficacy of hypnotherapy in the management of both pain and reexperiencing of trauma in burn patients. PMID:18307128

Shakibaei, Fereshteh; Harandi, Ali Amini; Gholamrezaei, Ali; Samoei, Raheleh; Salehi, Pejman



Alexithymia partly predicts pain, poor health and social difficulties in patients with temporomandibular disorders.  


Temporomandibular disorders (TMD) are functional diseases of the masticatory system; their symptoms are clicking, difficulty opening the mouth wide, ear pain, facial pain and headaches. The relationships among distress, emotional factors and TMD are well known. It was shown that patients with TMD have little awareness of their inner states and emotions, and it was found that those reporting oro-facial pain presented higher alexithymia than did asymptomatic people. Other authors confirmed that alexithymia was higher in the painful TMD group than controls. This study was aimed to evaluate whether alexithymia and its components can be considered as predisposing factors for pain severity, poor health and greater social difficulties in patients with TMD. One hundred thirty-three patients received a diagnosis of TMD and completed the 20-item Toronto Alexithymia Scale. Multiple stepwise regressions showed that alexithymia and age explained 10% of the pain and 31% of poor health and also that alexithymia explained 7% of social difficulty. A direct comparison of patients with TMD based on alexithymia revealed a higher presence of pain in alexithymic patients with TMD than in those characterised by moderate or no alexithymia. In conclusion, alexithymia partly predicts pain, poor health and social difficulties in patients with TMD. Furthermore, alexithymic patients have more pain than those with moderate or low alexithymia. PMID:23869944

Mingarelli, A; Casagrande, M; Di Pirchio, R; Nizzi, S; Parisi, C; Loy, B C; Solano, L; Rampello, A; Di Paolo, C



Effects of written anger expression in chronic pain patients: making meaning from pain.  


Based on prior research demonstrating benefits of emotional disclosure for chronically ill individuals and evidence that anger is particularly problematic in chronic pain sufferers, outpatients from a chronic pain center (N=102) were randomly assigned to express their anger constructively or to write about their goals non-emotionally in a letter-writing format on two occasions. Letters were coded for degree of expressed anger and meaning-making (speculation and insight into conditions that precipitated anger). Over a 9 week period, participants in the anger-expression group (n=51) experienced greater improvement in control over pain and depressed mood, and marginally greater improvement in pain severity than the control group (n=51). Degree of expressed anger uniquely accounted for intervention effects and meaning-making mediated effects on depressed mood. These findings suggest that expressing anger may be helpful for chronic pain sufferers, particularly if it leads to meaning-making. PMID:18320302

Graham, Jennifer E; Lobel, Marci; Glass, Peter; Lokshina, Irina



Depression, Pain, and Pain Behavior  

Microsoft Academic Search

This study examined the degree to which depression predicted pain and pain behavior. The Beck Depression Inventory (BDI) was administered to 207 low back pain patients. Observations of pain behaviors during physical examination, ratings of pain, and measures of activity level and medication intake were taken on each patient. Regression analyses revealed that depression and physical findings were the most

Francis J. Keefe; Robert H. Wilkins; Wesley A. Cook; James E. Crisson; Lawrence H. Muhlbaier



Localized Pressure Pain Sensitivity is Associated With Lower Activation of the Semispinalis Cervicis Muscle in Patients With Chronic Neck Pain.  


OBJECTIVE:: To investigate the relation between localized pressure pain sensitivity and the amplitude and specificity of semispinalis cervicis muscle activity in patients with chronic neck pain. MATERIALS AND METHODS:: Pressure pain detection thresholds (PPDTs) were measured over the C2-C3 and C5-C6 cervical zygapophyseal joints in 10 women with chronic neck pain and 9 healthy age-matched and sex-matched controls. Intramuscular electromyography (EMG) was acquired from the semispinalis cervicis at the levels of C2 and C5 during isometric circular contractions in the horizontal plane at 15 and 30 N, with continuous change in force direction in the range 0 to 360 degrees. The average rectified value and directional specificity of semispinalis cervicis muscle activity were computed and regression analyses were performed between measures of EMG and PPDT. RESULTS:: Patients showed significantly lower PPDT compared with controls (P<0.01). Patients also displayed lower EMG amplitude of the semispinalis cervicis at both spinal levels during the circular contractions (average across spinal levels, mean±SD: 129.01±58.99 and 126.83±58.78 µV for the 15- and 30-N contractions, respectively) compared with controls (158.69±66.27 and 187.64±87.82 µV; P<0.05). Furthermore, the directional specificity of semispinalis cervicis muscle was lower for the patients during the circular contractions (P<0.05). The PPDT (C2 and C5 pooled) was positively correlated to both, directional specificity (R=0.22, P<0.05) and amplitude (R=0.15, P<0.05) of the EMG. DISCUSSION:: In contrast to asymptomatic individuals, the semispinalis cervicis muscle displays reduced and less-defined EMG activity during a multidirectional isometric contraction in patients with chronic neck pain. The altered behavior of the semispinalis cervicis is weakly associated to pressure pain sensitivity. PMID:23370070

Schomacher, Jochen; Boudreau, Shellie A; Petzke, Frank; Falla, Deborah



The effectiveness of a 6-week Pilates programme on outcome measures in a population of chronic neck pain patients: a pilot study.  


Neck pain is becoming increasingly more common and multiple interventions have been advocated in its management. The literature supports the use of a variety of exercises including specific low load endurance exercises, scapular muscle retraining and neck and upper limb strengthening. Pilates is one form of exercise that is developing in popularity. This pilot uncontrolled study investigates whether a 6-week matwork based Pilates programme can change outcome measures in a group of chronic neck pain patients. Thirteen subjects were assessed on self-report tests; neck disability index (NDI), patient specific functional scale (PSFS), numerical rating pain scale (NRPS) and one objective measure; the abdominal drawing in test (ADIT). A statistically significant improvement was obtained in the disability outcomes (NDI and PSFS) at both 6 and 12 weeks. The NRPS also demonstrated statistical improvement at 12 weeks but not at 6. The minimal clinically important difference (MCID) is the score that reflects a change that is meaningful for the patient and this was achieved at 12-weeks for the NDI (>5 points), PSFS (>3 points) and NRPS (>2 points). Only 2 subjects reached normal levels in the ADIT at 12-weeks. The results of this pilot study suggest that Pilates has a role to play in reducing pain and disability in neck pain patients. PMID:23768285

Mallin, Germaine; Murphy, Susan



Pain management in patients with inflammatory bowel disease: insights for the clinician.  


Abdominal pain is a common symptom in patients with inflammatory bowel disease (IBD) and has a profound negative impact on patients' lives. There are growing data suggesting that pain is variably related to the degree of active inflammation. Given the multifactorial etiologies underlying the pain, the treatment of abdominal pain in the IBD population is best accomplished by individualized plans. This review covers four clinically relevant categories of abdominal pain in patients with IBD, namely, inflammation, surgical complications, bacterial overgrowth, and neurobiological processes and how pain management can be addressed in each of these cases. The role of genetic factors, psychological factors, and psychosocial stress in pain perception and treatment will also be addressed. Lastly, psychosocial, pharmacological, and procedural pain management techniques will be discussed. An extensive review of the existing literature reveals a paucity of data regarding pain management specific to IBD. In addition, there is growing consensus suggesting a spectrum between IBD and irritable bowel syndrome (IBS) symptoms. Thus, this review for adult and pediatric clinicians also incorporates the literature for the treatment of functional abdominal pain and the clinical consensus from IBD and IBS experts on pharmacological, behavioral, and procedural methods to treat abdominal pain in this population. PMID:22973418

Srinath, Arvind Iyengar; Walter, Chelsea; Newara, Melissa C; Szigethy, Eva M



Pain management in patients with inflammatory bowel disease: insights for the clinician  

PubMed Central

Abdominal pain is a common symptom in patients with inflammatory bowel disease (IBD) and has a profound negative impact on patients’ lives. There are growing data suggesting that pain is variably related to the degree of active inflammation. Given the multifactorial etiologies underlying the pain, the treatment of abdominal pain in the IBD population is best accomplished by individualized plans. This review covers four clinically relevant categories of abdominal pain in patients with IBD, namely, inflammation, surgical complications, bacterial overgrowth, and neurobiological processes and how pain management can be addressed in each of these cases. The role of genetic factors, psychological factors, and psychosocial stress in pain perception and treatment will also be addressed. Lastly, psychosocial, pharmacological, and procedural pain management techniques will be discussed. An extensive review of the existing literature reveals a paucity of data regarding pain management specific to IBD. In addition, there is growing consensus suggesting a spectrum between IBD and irritable bowel syndrome (IBS) symptoms. Thus, this review for adult and pediatric clinicians also incorporates the literature for the treatment of functional abdominal pain and the clinical consensus from IBD and IBS experts on pharmacological, behavioral, and procedural methods to treat abdominal pain in this population.

Srinath, Arvind Iyengar; Walter, Chelsea; Newara, Melissa C.



Management Strategies for Patients with Low-Risk Chest Pain in the Emergency Department  

Microsoft Academic Search

Opinion statement  There is abundant evidence to guide the management of chest pain patients with a confirmed or reasonably suspected diagnosis\\u000a of acute coronary syndrome (ACS). But when it comes to the low-risk chest pain patient in the emergency department, there\\u000a is limited evidence to support one approach over another. As a result, the evaluation of low-risk chest pain represents a

Maame Yaa A. B. Yiadom; Joshua M. Kosowsky



Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain  

Microsoft Academic Search

CONTEXT: Although chest pain is widely considered a key symptom in the diagnosis of myocardial infarction (MI), not all patients with MI present with chest pain. The extent to which this phenomenon occurs is largely unknown.\\u000aOBJECTIVES: To determine the frequency with which patients with MI present without chest pain and to examine their subsequent management and outcome.\\u000aDESIGN: Prospective

John G. Canto; Michael G. Shlipak; William J. Rogers; Judith A. Malmgren; Paul D. Frederick; Costas T. Lambrew; Joseph P. Ornato; Hal V. Barron; Catarina I. Kiefe



An Observational Study of Oncology Patients' Utilization of Breakthrough Pain Medication  

Microsoft Academic Search

The aim of this study was to determine utilization of breakthrough pain medication among a community-dwelling group of oncology patients. The subjects were recruited from patients attending the oncology outpatient department and oncology day unit. The protocol involved completion of a study-specific proforma: the information collected included demographic information (i.e., age, gender), cancer diagnosis, background cancer pain management, breakthrough pain

Andrew N. Davies; Joanna Vriens; Alison Kennett; Michelle McTaggart



Comparative study of ibuprofen lysine and acetaminophen in patients with postoperative dental pain  

Microsoft Academic Search

This single-dose, double-blind, parallel-group, single-site study compared ibuprofen lysine 400 mg with acetaminophen 1000 mg and placebo in 240 patients with moderate-to-severe postoperative dental pain. The relative onset of analgesic response, overall analgesic efficacy, duration of effect, and safety were assessed over a 6-hour postdose period. Analgesic efficacy was assessed by patient self-rating of pain intensity, pain relief, time to

Donald R. Mehlisch; R. Dean Jasper; Polly Brown; Scott H. Korn; Kathleen McCarroll; Amanda A. Murakami



Pain and distress among elderly intensive care unit patients: Comparison of patients' experiences and nurses' assessments  

Microsoft Academic Search

OBJECTIVE: To investigate elderly intensive care unit (ICU) patients' experiences of pain and distress, as well as interventions aimed at reducing these conditions, and to compare these experiences with the way nurses and assistant nurses, respectively, assess their patients' responses related to these issues.DESIGN: Descriptive, correlational, comparative.SETTING: Two medical-surgical ICUs at county hospitals in two medium-sized cities in Sweden.SUBJECTS: Fifty-one

Marie Louise Hall-Lord; Gerry Larsson; Bertil Steen



Effects of naltrexone on electrocutaneous pain in patients with hypertension compared to normotensive individuals.  


An opioid mechanism may help explain hypertensive hypoalgesia. A double-blind placebo-controlled design compared the effects of opioid blockade (naltrexone) and placebo on electrocutaneous pain threshold, pain tolerance, and retrospective McGill Pain Questionnaire ratings in 35 unmedicated patients with essential hypertension and 28 normotensive individuals. The hypertensives experienced less pain than normotensives during the assessment of their pain tolerance; however, this manifestation of hypertensive hypoalgesia was not moderated by naltrexone. These findings fail to support the hypothesis that essential hypertension is characterised by relative opioid insensitivity. PMID:18031920

Ring, Christopher; France, Christopher R; al'Absi, Mustafa; Edwards, Louisa; McIntyre, David; Carroll, Douglas; Martin, Una



Dysfunctional pain inhibition in patients with chronic whiplash-associated disorders: an experimental study.  


Inefficient endogenous pain inhibition, in particular impaired conditioned pain modulation (CPM), may disturb central pain processing in patients with chronic whiplash-associated disorders (WAD). Previous studies revealed that abnormal central pain processing is responsible for a wide range of symptoms in patients with chronic WAD. Hence, the present study aimed at examining the functioning of descending pain inhibitory pathways, and in particular CPM, in patients with chronic WAD. Thirty-five patients with chronic WAD and 31 healthy controls were subjected to an experiment evaluating CPM. CPM was induced by an inflated occlusion cuff and evaluated by comparing temporal summation (TS) of pressure pain prior to and during cuff inflation. Temporal summation was provoked by means of 10 consecutive pressure pulses at upper and lower limb location. Pain intensity of first, fifth, and 10th pressure pulse was rated. During heterotopic noxious conditioning stimulation, TS of pressure pain was significantly depleted among healthy controls. In contrast, TS was quite similar prior to and during cuff inflation in chronic WAD, providing evidence for dysfunctional CPM in patients with chronic WAD. The present study demonstrates a lack of endogenous pain inhibitory pathways, and in particularly CPM, in patients with chronic WAD, and hence provides additional evidence for the presence of central sensitization in chronic WAD. PMID:22983264

Daenen, Liesbeth; Nijs, Jo; Roussel, Nathalie; Wouters, Kristien; Van Loo, Michel; Cras, Patrick



Impact of temporomandibular joint pain on activities of daily living in patients with rheumatoid arthritis.  


The aim of this study was to investigate the impact of temporomandibular joint (TMJ) pain on daily living in patients with rheumatoid arthritis (RA) involving the TMJ. Nineteen patients (17 F, 2 M) with a median (IQR) age of 44 (23) years were included. A scale for the influence of TMJ pain/discomfort on the activities of daily living was used. TMJ resting pain and pain upon maximum mouth opening according to a visual analog scale as well as pressure pain threshold and tenderness to digital palpation of the TMJ were assessed. Blood samples were collected to measure the level of acute phase proteins. Activities of daily living were influenced in all patients at different levels. The impact on daily living by TMJ pain/discomfort was greatest on the performance of physical exercises and jaw movements, while it was smallest on the performance of hobbies and eating. Pain during maximum mouth opening and tenderness to digital palpation were correlated to difficulties with several activities such as to yawn and open the mouth wide, while pressure pain threshold was correlated with difficulties during eating, which confirms that the pain was located in the TMJ. In conclusion, this study indicates that pain/discomfort from the TMJ in patients with RA has a significant negative impact on activities of daily living. PMID:14763779

Voog, Ulle; Alstergren, Per; Leibur, Edvitar; Kallikorm, Riina; Kopp, Sigvard



Facial expression and pain in the critically ill non-communicative patient: State of science review  

PubMed Central

Summary The aim of this review is to analyse the evidence related to the relationship between facial expression and pain assessment tools in the critically ill non-communicative patients. Pain assessment is a significant challenge in critically ill adults, especially those who are unable to communicate their pain level. During critical illness, many factors alter verbal communication with patients including tracheal intubation, reduced level of consciousness and administration of sedation and analgesia. The first step in providing adequate pain relief is using a systematic, consistent assessment and documentation of pain. However, no single tool is universally accepted for use in these patients. A common component of behavioural pain tools is evaluation of facial behaviours. Although use of facial expression is an important behavioural measure of pain intensity, there are inconsistencies in defining descriptors of facial behaviour. Therefore, it is important to understand facial expression in non-communicative critically ill patients experiencing pain to assist in the development of concise descriptors to enhance pain evaluation and management. This paper will provide a comprehensive review of the current state of science in the study of facial expression and its application in pain assessment tools.

Arif-Rahu, Mamoona; Grap, Mary Jo



Course and prognosis of older back pain patients in general practice: a prospective cohort study.  


The aim of the current study was to determine the course of back pain in older patients and identify prognostic factors for non-recovery at 3 months' follow-up. We conducted a prospective cohort study (the BACE study) of patients aged >55 years visiting a general practitioner (GP) with a new episode of back pain in the Netherlands. The course of back pain was described in terms of self-perceived recovery, pain severity, disability, pain medication, and GP visits at 6 weeks' and 3 months' follow-up. Prognostic factors for non-recovery at 3 months' follow-up were derived from the baseline questionnaire and physical examination. Variables with a prognostic value were identified with multivariable logistic regression analysis (method backward), and an area under the receiver operating curve (AUC) was calculated for the prognostic model. A total of 675 back pain patients (mean age 66.4 (SD 7.6) years) participated in the BACE cohort study. At 6 weeks' follow-up 64% of the patients reported non-recovery from back pain. At 3 months' follow-up 61% still reported non-recovery, but only 26% of these patients had revisited the GP. Longer duration of the back pain, severity of back pain, history of back pain, absence of radiating pain in the leg below the knee, number of comorbidities, patients' expectation of non-recovery, and a longer duration of the timed 'Up and Go' test were significantly associated with non-recovery in a multiple regression model (AUC 0.79). This information can help GPs identify older back pain patients at risk for non-recovery. PMID:23597679

Scheele, Jantine; Enthoven, Wendy T M; Bierma-Zeinstra, Sita M A; Peul, Wilco C; van Tulder, Maurits W; Bohnen, Arthur M; Berger, Marjolein Y; Koes, Bart W; Luijsterburg, Pim A J



Pain measurement as part of primary healthcare of adult patients with sickle cell disease  

PubMed Central

Objective The aim of this exploratory, cross-sectional study was to evaluate pain in sickle cell disease patients and aspects related to primary healthcare. Methods Data were obtained through home interviews. The assessment instruments (body diagram, Numerical Pain Scale, McGill Pain Questionnaire) collected information on the underlying disease and on pain. Data were analyzed using the Statistical Package for Social Sciences program for Windows. Associations between the subgroups of sickle cell disease patients (hemoglobin SS, hemoglobin SC, sickle ?-thalassemia and others) and pain were analyzed using contingency tables and non-parametric tests of association (classic chi-square, Fisher's and Kruskal-Wallis) with a level of 5% (p-value < 0.05) being set for the rejection of the null hypothesis. Results Forty-seven over 18-year-old patients with sickle cell disease were evaluated. Most were black (78.7%) and female (59.6%) and the mean age was 30.1 years. The average number of bouts of pain annually was 7.02; pain was predominantly reported by individuals with sickle cell anemia (hemoglobin SS). The intensity of pain (Numeric Pain Scale) was 5.5 and the quantitative index (McGill) was 35.9. This study also shows that patients presented a high frequency of moderately painful crises in their own homes. Conclusion According to these facts, it is essential that pain related to sickle cell disease is properly identified, quantified, characterized and treated at the three levels of healthcare. In primary healthcare, accurate measurement of pain combined with better care may decrease acute painful episodes and consequently minimize tissue damage, thus improving the patient's overall health.

Signorelli, Andreza Aparecida Felix; Ribeiro, Sonia Beatriz Felix; Moraes-Souza, Helio; de Oliveira, Lucas Felix; Ribeiro, Joao Batista; da Silva, Sheron Hellen; de Oliveira, Daniel Fachinelli Felix; Ribeiro, Matheus Fernando Felix



Measurement of sacroiliac joint stiffness in peripartum pelvic pain patients with Doppler imaging of vibrations (DIV)  

Microsoft Academic Search

Objectives. The research question of the present study was: are sacroiliac joint stiffness levels of peripartum pelvic pain patients different from those of healthy subjects?Study design. A cross-sectional comparative sacroiliac joint stiffness analysis of peripartum pelvic pain patients with healthy subjects. In previous studies we introduced a new technique, Doppler imaging of vibrations (DIV), to assess sacroiliac joint stiffness using

H. Muzaffer Buyruk; Hendrik J. Stam; Christian J. Snijders; Johan S. Laméris; Wim P. J. Holland; Theo H. Stijnen



Overcoming the Influence of Chronic Pain on Older Patients' Difficulty with Recommended Self-Management Activities  

ERIC Educational Resources Information Center

Purpose: Many older patients with common chronic conditions also experience chronic pain. We examined how chronic pain affects patients' difficulty with recommended self-management activities and the potential intervening role of self-efficacy (the level of confidence in one's own ability to perform a specific task). Design and Methods: We…

Krein, Sarah L.; Heisler, Michele; Piette, John D.; Butchart, Amy; Kerr, Eve A.



Functional assessment of pediatric pain patients: Psychometric properties of the Functional Disability Inventory  

Microsoft Academic Search

The Functional Disability Inventory (FDI; Walker LS, Greene JW. The functional disability inventory: measuring a neglected dimension of child health status. J Pediatr Psychol 1991;16:39–58) assesses activity limitations in children and adolescents with a variety of pediatric conditions. This study evaluated the psychometric properties of the FDI in pediatric pain patients. Participants included 596 patients with chronic abdominal pain, ages

Robyn Lewis Claar; Lynn S. Walker



Pain Reports by Older Hospice Cancer Patients and Family Caregivers: The Role of Cognitive Functioning  

Microsoft Academic Search

Purpose: Prior research in nursing homes has shown that cognitive impairment may reduce self-reported pain, but this relation has not been systematically explored among hospice patients. The assessment and treatment of pain is a primary goal of hospice care, and both disease pro- cesses and the use of opioid analgesics may lead to cog- nitive impairment among hospice patients. However,

Rebecca S. Allen; William E. Haley; Brent J. Small; Susan C. McMillan



Multicenter Study of Pain and Its Management in Patients with Advanced Cancer in Korea  

Microsoft Academic Search

The aim of this study was to evaluate the prevalence, severity, and management of pain in Korean patients with advanced cancer, and to identify the predictors of inadequate management of cancer pain in Korea. From 8 university hospitals, 655 patients with advanced cancer were surveyed. Information concerning analgesics prescribed was acquired from the medical records by the investigator. Physicians, nurses

Young Ho Yun; Dae Seog Heo; In Goo Lee; Hyun Sik Jeong; Hyo Jin Kim; Si-Young Kim; Yeul Hong Kim; You Ja Ro; Sung Soo Yoon; Ki Hyeong Lee; Bong Yul Huh



Predictors of opioid misuse in patients with chronic pain: a prospective cohort study  

Microsoft Academic Search

BACKGROUND: Opioid misuse can complicate chronic pain management, and the non-medical use of opioids is a growing public health problem. The incidence and risk factors for opioid misuse in patients with chronic pain, however, have not been well characterized. We conducted a prospective cohort study to determine the one-year incidence and predictors of opioid misuse among patients enrolled in a

Timothy J Ives; Paul R Chelminski; Catherine A Hammett-Stabler; Robert M Malone; J Stephen Perhac; Nicholas M Potisek; Betsy Bryant Shilliday; Darren A DeWalt; Michael P Pignone



Cognitive-Behavioral Classifications of Chronic Pain in Patients with Multiple Sclerosis  

ERIC Educational Resources Information Center

The aim of this study was to replicate, in patients with multiple sclerosis (MS), the three-cluster cognitive-behavioral classification proposed by Turk and Rudy. Sixty-two patients attending a tertiary MS rehabilitation center completed the Pain Impact Rating questionnaire measuring activity interference, pain intensity, social support, and…

Khan, Fary; Pallant, Julie F.; Amatya, Bhasker; Young, Kevin; Gibson, Steven



Cognitive-Behavioral Classifications of Chronic Pain in Patients with Multiple Sclerosis  

ERIC Educational Resources Information Center

|The aim of this study was to replicate, in patients with multiple sclerosis (MS), the three-cluster cognitive-behavioral classification proposed by Turk and Rudy. Sixty-two patients attending a tertiary MS rehabilitation center completed the Pain Impact Rating questionnaire measuring activity interference, pain intensity, social support, and…

Khan, Fary; Pallant, Julie F.; Amatya, Bhasker; Young, Kevin; Gibson, Steven



Overcoming the Influence of Chronic Pain on Older Patients' Difficulty with Recommended Self-Management Activities  

ERIC Educational Resources Information Center

|Purpose: Many older patients with common chronic conditions also experience chronic pain. We examined how chronic pain affects patients' difficulty with recommended self-management activities and the potential intervening role of self-efficacy (the level of confidence in one's own ability to perform a specific task). Design and Methods: We…

Krein, Sarah L.; Heisler, Michele; Piette, John D.; Butchart, Amy; Kerr, Eve A.



Safety and Effectiveness of Intravenous Morphine for Episodic Breakthrough Pain in Patients Receiving Transdermal Buprenorphine  

Microsoft Academic Search

Supplemental dosing of an opioid is the main treatment suggested to manage breakthrough pain in cancer patients. The intravenous route has been proven to be safe and effective, providing rapid analgesia in patients receiving oral morphine. Transdermal buprenorphine (TTS-BUP) is increasingly used in cancer pain management, but this drug has been labeled as a difficult drug to use in combination

Sebastiano Mercadante; Patrizia Villari; Patrizia Ferrera; Giampiero Porzio; Federica Aielli; Lucilla Verna; Alessandra Casuccio



Pain Control in Augmentation Mammaplasty Using Indwelling Catheters in 687 Consecutive Patients: Data Analysis  

Microsoft Academic Search

Background: Postoperative pain following augmentation mammaplasty can cause significant disability. In the authors' previously published prospective study of 644 consecutive augmentation mammaplasty patients, it was shown that the use of indwelling catheters for the postoperative instillation of bupivacaine is both safe and effective in postoperative pain management. Objective: This study analyzes a large population of augmentation mammaplasty patients to not

Peter T. Pacik; Craig E. Nelson; Catherine Werner



Painful Hashimoto's Thyroiditis as an Indication for Thyroidectomy: Clinical Characteristics and Outcome in Seven Patients  

Microsoft Academic Search

Patients with chronic lymphocytic thyroiditis, or Hashimoto's thyroiditis (HT), usually present with goiter, hypothyroidism, or both. Thyroid pain and tenderness are rare and suggest an alternative diagnosis of subacute granulomatous thyroiditis or other forms of thyroiditis. We report seven patients with painful HT who had temporary or no relief from L-thyroxine replacement or steroid treatment and required surgical in- tervention



Pressure pain thresholds of tender point sites in patients with fibromyalgia and in healthy controls  

Microsoft Academic Search

Pressure pain threshold (PPT) is defined as the minimum force applied which induces pain. This measure has proven to be commonly useful in evaluating tenderness symptom. Our aim was to study the intra-examiner reproducibility of PPT measurement, define cutoffs in normal groups, and compare these results with patients with fibromyalgia (FM). Fifty healthy females, 50 healthy males, and 20 patients

Didier Maquet; Jean-Louis Croisier; Christophe Demoulin; Jean-Michel Crielaard



Prior History of Back Pain in Patients with Compensable and Non-Compensable Injuries.  

ERIC Educational Resources Information Center

|Data were collected retrospectively from insurance information forms and histories of 111 patients (ages 14-84) referred to physical therapy for evaluation of back and/or neck pain. Analysis indicated that patients with compensable (work-related or motor vehicle accident) injuries infrequently acknowledged prior episodes of back or neck pain.…

Pellecchia, Geraldine L.



A prospective study of ED pain management practices and the patient's perspective  

Microsoft Academic Search

Objective: This study was conducted to describe the prevalence of pain in the emergency department and to identify factors that may contribute to its treatment. Methods: Interviews were conducted with 203 patients who entered the emergency department during the study period. Patients were interviewed regarding various aspects of their pain. Medical records were reviewed to determine what treatments were provided.

Paula Tanabe; MaryBeth Buschmann



Psychometric properties of the Brief Pain Inventory among patients with osteoarthritis undergoing total hip replacement surgery  

Microsoft Academic Search

BACKGROUND: Pain is a cardinal symptom of osteoarthritis (OA) of the hip and important for deciding when to operate. This study assessed the internal consistency reliability, validity and responsiveness of the Brief Pain Inventory (BPI) among patients with OA undergoing total hip replacement (THR). METHODS: We prospectively included 250 of 356 patients who were accepted to the waiting list for

Heidi Kapstad; Berit Rokne; Knut Stavem



Quantitative sensory testing of neuropathic pain patients: potential mechanistic and therapeutic implications.  


Quantitative sensory testing (QST) is a widely accepted tool to investigate somatosensory changes in pain patients. Many different protocols have been developed in clinical pain research within recent years. In this review, we provide an overview of QST and tested neuroanatomical pathways, including peripheral and central structures. Based on research studies using animal and human surrogate models of neuropathic pain, possible underlying mechanisms of chronic pain are discussed. Clinically, QST may be useful for 1) the identification of subgroups of patients with different underlying pain mechanisms; 2) prediction of therapeutic outcomes; and 3) quantification of therapeutic interventions in pain therapy. Combined with sensory mapping, QST may provide useful information on the site of neural damage and on mechanisms of positive and negative somatosensory abnormalities. The use of QST in individual patients for diagnostic purposes leading to individualized therapy is an interesting concept, but needs further validation. PMID:22535540

Pfau, Doreen B; Geber, Christian; Birklein, Frank; Treede, Rolf-Detlef



A Systematic Review of Health Care Interventions for Pain in Patients With Advanced Cancer.  


Purpose: Poorly controlled pain is common in advanced cancer. The objective of this article was to synthesize the evidence on the effectiveness of pain-focused interventions in this population. METHODS: We searched MEDLINE, CINAHL, PsycINFO, Cochrane, and DARE from 2000 through December 2011. We included prospective, controlled health care intervention studies in advanced cancer populations, focusing on pain. RESULTS: Nineteen studies met the inclusion criteria; most focused on nurse-led patient-centered interventions. In all, 9 (47%) of the 19 studies found a significant effect on pain. The most common intervention type was patient/caregiver education, in 17 (89%) of 19 studies, 7 of which demonstrated a significant decrease in pain. Conclusions: We found moderate strength of evidence that pain in advanced cancer can be improved using health care interventions, particularly nurse-led patient-centered interventions. PMID:23408371

Martinez, Kathryn A; Aslakson, Rebecca A; Wilson, Renee F; Apostol, Colleen C; Fawole, Oluwakemi A; Lau, Brandyn D; Vollenweider, Daniela; Bass, Eric B; Dy, Sydney M



Comparison of the history obtained by patient-completed questionnaires with doctors’ standard notes for patients with acute abdominal pain  

Microsoft Academic Search

Background:Studies have shown that proformas improve the information recorded by junior doctors when they clerk patients with acute abdominal pain. This increases their diagnostic accuracy, but doctors are reluctant to use them. Patient-completed questionnaires are being used in elective surgery, but can they be used for patients with acute abdominal pain?Objective:To evaluate the history obtained by patient-completed questionnaires in patients

B Saravanan; R Muhammad; R Geach; L R Jenkinson



The relationship of gender to pain, pain behavior, and disability in osteoarthritis patients: the role of catastrophizing  

Microsoft Academic Search

One hundred and sixty-eight patients with osteoarthritis (OA) of the knees participated in this study. Of the participants, 72 were men and 96 were women. All participants completed the Arthritis Impact Measurement Scales (AIMS), underwent a 10 min standardized observation session to assess their pain behavior, and completed the Catastrophizing Scale of the Coping Strategies Questionnaire (CSQ) and the Depression

Francis J Keefe; John C Lefebvre; Jennifer R Egert; Glenn Affleck; Michael J Sullivan; David S Caldwell



BRIEF REPORT: Patient-Physician Agreement as a Predictor of Outcomes in Patients with Back Pain  

PubMed Central

Objective To determine whether a patient-physician agreement instrument predicts important health outcomes. Design Three hundred eighty patients with back pain were enrolled in a comparison of rapid magnetic resonance imaging with standard x-rays. One month later, patients rated agreement with their physician in the following areas: diagnosis, diagnostic plan, and treatment plan. Outcomes included patient satisfaction with care at 1 and 12 months and functional and health status at 12 months. Setting Urban academic and community primary care and specialty clinics. Measurements and Main Results Higher agreement at 1 month (using a composite sum of scores on the 3 agreement questions) was correlated in univariate analysis with higher patient satisfaction at 1 month (R=.637, P<.001). In multivariate analysis, controlling for 1-month satisfaction and other potential confounders, higher agreement independently predicted better 12-month patient satisfaction (?=0.188, P=.003), mental health (?=1.080, P<.001), social function (?=1.124, P=.001), and vitality (?=1.190, P<.001). Conclusion Agreement between physicians and patients regarding diagnosis, diagnostic plan, and treatment plan is associated with higher patient satisfaction and better health status outcomes in patients with back pain. Additional research is required to clarify the relationship between physician communication skills, agreement, and patien