Pain
-
Postmastectomy pain (PMP), a distinctive postsurgical neuropathic pain syndrome, has been thought to be consequence of 4-6% of surgical procedures for cancer of the breast, but remains understudied and poorly documented. In this cross-sectional descriptive study, a convenience sample of 95 women who had undergone breast cancer surgery was recruited from 16 ambulatory care sites. Prevalence, characteristics, and impact of the PMP syndrome were investigated using a medical record review, a patient information questionnaire, a cancer pain questionnaire and the McGill Pain Questionnaire. ⋯ Women experiencing the syndrome reported chronic, stable pain of long duration that began shortly after surgery. They described paroxysms of lancinating pain against a background of burning, aching, tight constriction in the axilla, medial upper arm, and/or chest that significantly interfered with the performance of daily occupational and domestic activities. Data suggest that these women were undertreated and generally obtained poor pain relief from their symptoms.
-
Randomized Controlled Trial Clinical Trial
Chronic pain and depression: role of perceived impact and perceived control in different age cohorts.
Chronic pain adversely affects individuals' physical as well as emotional well-being. A cognitive-behavioral model has been proposed to explain the role of cognitive appraisal variables in mediating the development of emotional distress following pain of long duration. There is little evidence linking the prevalence of depression in chronic pain patients to life stage, but there are suggestions in the literature that the link between medical illness and depression may be stronger in elderly patients. ⋯ Consistent with the cognitive-behavioral model, the younger patients demonstrated a low and non-significant correlation between pain severity and depression (r = 0.01). Conversely, a strong direct association was observed in the older patients between these variables (r = 0.51). These results suggest that the relationship between pain and depression varies substantially depending upon age cohort.
-
Some children and adolescents with sickle cell disease experience frequent painful episodes. To gain information about the natural history of the pain and its impact on sleep and school attendance, we developed a home-based diary system. Eighteen children and adolescents completed 4756 diary days, with an average compliance of 75%. ⋯ Of the pain-associated absenteeisms, two-thirds occurred when pain was managed at home, and one-third when patients were hospitalized. The average consecutive number of school days missed was 2.7. These findings have implications for developmentally critical activities.
-
This study sought to identify distinct subgroups of chronic pain patients based on responses to the Symptom Checklist 90-revised (SCL-90R), a measure of psychological distress. Two scoring methods were used: the standard scoring that accompanies the manual, and a scoring method based upon factor scores obtained in an earlier study using low back pain patients. Two separate cluster analyses assigned patients into 2 groups: one based on standard scores and one based on factor scores. ⋯ Depending upon group membership, patients significantly differed on measures of qualitative pain and quantitative pain report, depressive symptoms, medication usage, and pain-related behaviors. This study supports the use of SCL-90R factor scoring with pain patients as greater differentiation between clusters was found for pain report and pain-related behavior when this method was used. Guidelines for clinical application of SCL-90R cluster groups is provided.
-
Randomized Controlled Trial Comparative Study Clinical Trial
The hypoalgesic effect of imipramine in different human experimental pain models.
In a randomized, placebo-controlled, double-blind, cross-over study, the hypoalgesic effect of a single oral dose of 100 mg imipramine was investigated in 12 healthy volunteers. Test procedures performed before, 3, 6, and 9 h after medication included determination of (1) pain detection and tolerance thresholds to heat and pressure; (2) the thresholds of quadriceps femoris muscle withdrawal reflex to single and repeated electric stimulation of the sural nerve; (3) amplitude of the reflex evoked by 1.5 times the premedication reflex threshold; and (4) continuous pain rating during the cold pressor test. Imipramine significantly increased pain tolerance thresholds to heat (P = 0.03) and pressure (P = 0.01), and both the psychophysical pain tolerance threshold and the reflex threshold to single electric stimulation (P = 0.02 and P = 0.03, respectively). ⋯ Pain detection thresholds to heat and pressure, the amplitude of the reflex to single suprathreshold stimulation, and pain ratings during the cold pressor test were unaltered by imipramine. It is concluded that imipramine has a differential hypoalgesic effect on different human experimental pain tests. This provides new possibilities of assessing the differential effect of different tricyclic antidepressants on different pain modalities and intensities.