Pain
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Randomized Controlled Trial Comparative Study Clinical Trial
Patient-controlled epidural analgesia in obstetric anaesthetic practice.
A randomised single-blind controlled study was made of 60 patients to evaluate the effectiveness of epidural patient-controlled analgesia (PCA) device for obstetric management compared with a continuous infusion system. In both cases 0.125% plain bupivacaine was used. It was found that epidural PCA is at least as effective as an infusion system in producing analgesia and has the advantages of increased satisfaction and reduction of local anaesthetic requirement. Whether there are also advantages resulting from less obstetric intervention at delivery has not been proven.
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Review Historical Article
The role of psychological factors in chronic pain. I. A half century of study.
This review examines a half century of thought about the role of psychological factors in chronic pain. Changing views are discussed, and representative examples of pain research based on psychoanalytic, behavioural, cognitive, and psychophysiological theories are presented and evaluated. ⋯ Studies reviewed show that an earlier concept, based on simple formulations of psychological causation, has been replaced by more comprehensive explanations comprising both physical and psychological influences. Further methodological and conceptual problems are discussed in the second paper of this 2-part review.
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Percutaneous radiofrequency lumbar facet denervation has been in use as a treatment for intractable, mechanical low back pain for over 2 decades. A number of case series have been reported with high rates of success in selected patients; however, there has been limited objective outcome assessment, long-term follow-up, and analysis of prognostic factors. We have reviewed our experience with diagnostic lumbar facet blocks and percutaneous radiofrequency denervation at a mean follow-up interval of 3.2 years. ⋯ There was no difference, however, between the long-term results of bilateral denervation for bilateral or axial pain and those of unilateral denervation for unilateral pain. There was no significant difference in the rate of response between the 56 patients who had undergone prior lumbosacral spine surgery and the 26 who had not. There were no complications from the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
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A questionnaire study was performed in order to clarify knowledge and practice of cancer pain treatment in Norway: a 10% random sample of Norwegian physicians received a questionnaire. Of 800 correctly addressed questionnaires, 549 were returned and 306 were analyzed after exclusion of those doctors who never treated cancer patients. Their knowledge of the principles and methods of cancer pain treatment were evaluated with 8 multiple-choice and 13 open questions. ⋯ Two hundred seventy-four (97%) of the physicians said they experienced problems when treating cancer pain, ranging from inefficient pain relief (52%) to side effects of opioid analgesics (32%), most often sedation, in combination with nausea and constipation. Only 13% of the physicians had a correct understanding of opioid drug dependence. As many as 72% of Norwegian physicians thought their education in cancer pain treatment was insufficient.
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Although a number of self-report indices that measure intensity and psychosocial components of the pain experience are available, these measures do not assess the range of cognitive, behavioral, and physiological reactions frequently associated with pain. This paper describes the initial determination of the psychometric properties of the Biobehavioral Pain Profile (BPP) developed to measure these reactions. The BPP is a 41-item self-report scale tested in a sample of 617 subjects with chronic recurrent pain, chronic non-malignant pain or chronic malignant pain. ⋯ Test-retest reliability for the scales ranged from 0.57 to 0.73. Low correlations among the BPP and general indices of fear, depression, anxiety, body consciousness and social desirability are reported. The BPP appears to provide a unique composite assessment of self-report of behavioral, physiological, and cognitive reactions to pain experienced by individuals with a wide range of pain problems.