Pain
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In this study we estimated the costs of back pain to society in The Netherlands in 1991 to be 1.7% of the GNP. The results also show that musculoskeletal diseases are the fifth most expensive disease category regarding hospital care, and the most expensive regarding work absenteeism and disablement. One-third of the hospital care costs and one-half of the costs of absenteeism and disablement due to musculoskeletal disease were due to back pain. ⋯ The mean costs per case of absenteeism and disablement due to back pain were US$4622 and US$9493, respectively. The indirect costs constituted 93% of the total costs of back pain, the direct medical costs contributed only 7%. It is therefore concluded that back pain is not only a major medical problem but also a major economical problem.
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Randomized Controlled Trial Comparative Study Clinical Trial
The influence of lockout intervals and drug selection on patient-controlled analgesia following gynecological surgery.
This study systematically compared 2 opioids, morphine (MOR) and fentanyl (FEN), and 2 lockout intervals, long (L) and short (S) in patients utilizing patient-controlled analgesia (PCA). Seventy-eight women undergoing gynecological surgery were randomly assigned to 1 of 4 groups: MOR-S (7 min), MOR-L (11 min), FEN-S (5 min), FEN-L (8 min). PCA measures obtained during the first 24 h after surgery included: number of demands/h, number of completed deliveries/h, dose/h, and demand/delivery ratio. ⋯ Results indicated that pain relief was equivalent with minimal side effects for both opioids. The selection of opioid, however, influenced the pattern of PCA use, with an improved demand/delivery ratio initially for FEN. The lockout intervals chosen for this study did not influence pain or anxiety levels.
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Randomized Controlled Trial Comparative Study Clinical Trial
Lack of analgesic effect of 50 and 100 mg oral tramadol after orthopaedic surgery: a randomized, double-blind, placebo and standard active drug comparison.
Tramadol hydrochloride is a synthetic mu-opioid agonist with additional monoaminergic activity. Tramadol's analgesic effect has been equated with that of pethidine, with a more favourable side-effect profile. Tramadol has been the most-selling prescription analgesic in Germany for several years, and it is now available in many other European countries, but still there is a lack of adequately controlled clinical studies of its analgesic properties. ⋯ The active drug control, paracetamol+codeine, was significantly superior to placebo for all efficacy variable (P = 0.0002-0.004), confirming good assay sensitivity. Paracetamol+codeine was also significantly superior to both 50 mg tramadol (P = 0.002-0.03) and 100 mg tramadol (P = 0.002-0.02). There was no difference between placebo and 50 and 100 mg tramadol for any of the efficacy variables.(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports Randomized Controlled Trial Clinical Trial
Ketamine as an adjunct to morphine in the treatment of pain.
A double-blind multidose trial of the addition of ketamine (0-40 mg, i.m., 8 times per day) to intramuscular morphine therapy was undertaken in a 61-year-old man with chronic back pain related to osteoporosis who had received inadequate pain relief from anterior interbody fusion, dorsal column stimulation and morphine alone. The patient reported only mild side effects. ⋯ In addition, the amount of morphine used by the patient was significantly reduced as the ketamine dose increased. This patient experienced substantial benefit from the addition of ketamine to intramuscular morphine therapy.
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The McGill Pain Questionnaire (MPQ) (Melzack 1975) is an important assessment tool for multidimensional pain measurement in both clinical practice and research. Despite widespread acceptance, empirical analyses have not consistently verified the 3 a-priori factors that guided the subclass construction of the Pain Rating Index (PRI) of the MPQ. This study compared the a-priori model with 2 qualitatively different factor models in 191 patients with oral mucositis pain at 3 days and 10 days following bone marrow transplantation. ⋯ Although the factor analyses indicated an unambiguous ranking of PRI models according to statistical criteria, these theoretical results generalize poorly to simple scores formed by direct addition of the PRI subclasses. Summary scores can only approximate the unobserved factors and cannot retain the fine discriminations revealed by the theoretical factors. Psychometric considerations suggest that a single PRI total score will yield better practical measurement than any scoring rules based on multiple factors.