Pain
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Randomized Controlled Trial Multicenter Study Clinical Trial
Pain and analgesic response after third molar extraction and other postsurgical pain.
There is uncertainty over whether the patient group in which acute pain studies are conducted (pain model) has any influence on the estimate of analgesic efficacy. Data from four recently updated systematic reviews of aspirin 600/650 mg, paracetamol 600/650 mg, paracetamol 1000 mg and ibuprofen 400 mg were used to investigate the influence of pain model. Area under the pain relief versus time curve equivalent to at least 50% maximum pain relief over 6 h was used as the outcome measure. ⋯ The event rate with placebo was systematically statistically lower for dental than postsurgical pain for all four treatments. Event rates with analgesics, RB and NNT were infrequently different between the pain models. Systematic difference in the estimate of analgesic efficacy between dental and postsurgical pain models remains unproven, and, on balance, no major difference is likely.
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Randomized Controlled Trial Comparative Study Clinical Trial
Addition of ultralow dose naloxone to postoperative morphine PCA: unchanged analgesia and opioid requirement but decreased incidence of opioid side effects.
Ultralow doses of naloxone (0.001-0.1 microg/kg) produce analgesia in animal models. However, no clinical study has evaluated the combination of ultralow dose naloxone and morphine using patient-controlled analgesia (PCA). This randomized, double blind controlled study sought to determine if the combination of ultralow dose naloxone and morphine in PCA solutions affects opioid requirements, analgesia, and side effects. ⋯ The morphine+naloxone group had a lower incidence of nausea and pruritus than the morphine group (P=0.01 for both symptoms). However, the incidence of vomiting, time to tolerate fluids, sedation, and urinary retention were similar between groups (all P values >0.1). The combination of ultralow dose naloxone and morphine in PCA does not affect analgesia or opioid requirements, but it decreases the incidence of nausea and pruritus.
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Comparative Study
Oral health attitudes and communication with laypersons about orofacial pain among middle-aged and older adults.
Communication patterns with persons outside the health care system during a pain episode are poorly understood, yet can have a significant influence on patient behavior. This study examined associations between attitudes and beliefs about oral disease and dental care and talking about orofacial pain with laypersons and health care professionals. The subjects were 724 participants in the Florida Dental Care Study, a longitudinal study of oral health among community-dwelling adults. ⋯ Our data are consistent with the hypothesis that lay consultation during a pain episode may substitute for formal care for persons with less positive views of the health care system. Intensity ratings and temporal characteristics of pain were also important determinants of these pain-related communication patterns. These findings emphasize the importance of understanding the communication between persons with pain and non-health care professionals, and how these attitudes and communication preferences relate to the management of pain.
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Comparative Study
Phantom phenomena in mastectomized patients and their relation to chronic and acute pre-mastectomy pain.
Chronic and acute pre-mastectomy pain as well as prevalence and characteristics of phantom phenomena following mastectomy were investigated by interview in a sample of 39 women who had undergone unilateral breast amputation. Twenty of 39 participants reported phantom sensations in the breast. Nine of the participants with phantom sensations experienced phantom pain and 11 non-painful phantom sensations. ⋯ This difference may be explained by the absence of kinesthesis and the small representation of the human breast. Seven of the 39 participants experienced chronic and six acute breast pain prior to the amputation. The amount of chronic pre-mastectomy breast pain weighted by the amount of involved tissue was significantly higher among participants with non-painful phantom sensations, compared to women with painful phantoms and those without phantom phenomena.
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Comparative Study
Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia.
Patients with chronic pain after whiplash injury and fibromyalgia patients display exaggerated pain after sensory stimulation. Because evident tissue damage is usually lacking, this exaggerated pain perception could be explained by hyperexcitability of the central nervous system. The nociceptive withdrawal reflex (a spinal reflex) may be used to study the excitability state of spinal cord neurons. ⋯ We provide evidence for spinal cord hyperexcitability in patients with chronic pain after whiplash injury and in fibromyalgia patients. This can cause exaggerated pain following low intensity nociceptive or innocuous peripheral stimulation. Spinal hypersensitivity may explain, at least in part, pain in the absence of detectable tissue damage.