Pain
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The purpose of this study was to examine the differential role of fear, anxiety, alexithymia, family factors and coping in cancer pain. Twenty-seven patients with pain related to cancer, 26 patients with chronic non-cancer pain, 26 patients with chronic illness but no pain (hypertensives) and 24 healthy controls completed a set of questionnaires during an initial interview and recorded severity and duration of pain, pain interference with activities, thoughts, behaviors and physiological responses associated with fear of pain, and coping strategies using a diary once daily for 7 days. In general, cancer patients reported lower pain levels than patients with chronic non-cancer pain. ⋯ The perceived family environment of the cancer pain patient did not differ significantly from the 3 other groups. These results do not support anecdotal impressions that the level of reported pain and fear of pain is significantly greater in cancer pain in contrast to non-cancer pain. The results do indicate the importance of emotional expressivity in the modulation of cancer pain where the ability to assess and express emotions was associated with reduced pain.
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The McGill Pain Questionnaire has previously been shown to be useful in the differential diagnosis of painful conditions and has also been used to assess the efficacy of therapeutic intervention. We have applied this simple test to 42 patients with painful diabetic neuropathy and 49 control subjects with painful legs or feet of varying aetiologies. ⋯ Each questionnaire was given a single score as a result of the analysis, and this score correctly classified a total of 91% to either the neuropathic or control groups, and when applied prospectively to a further 25 ungrouped questionnaires a useful probability of their belonging to a diagnostic group was obtained. Use of the questionnaire might be a useful aid to the differential diagnosis of the painful diabetic leg.
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Following our earlier research, we further investigated a model that conceptualizes placebo phenomena as the result of conditioning and attempted to extend and replicate the finding that placebo responses can be conditioned in human subjects. Two groups of 10 subjects were told that they were receiving an analgesic which was in fact a placebo. During the conditioning, placebo administration was surreptitiously paired with an increase in the painful stimulus for half of the subjects and with a decrease for the other half. ⋯ A second type of experimental pain was also used to determine stimulus generalization. The results confirmed a previous finding that placebo responses can be conditioned in human subjects. The implications for clinical practice of a learning model of placebo behavior are discussed.
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This project sought to determine measurement effects, topographic variability, and reliability of pressure pain thresholds (PPT) as an index of normal tenderness in the masseter and temporalis muscles of non-patient subjects. PPTs were measured using the ascending method of limits in 10 subjects. The PPT over 5 trials at each of 5 temporalis sites and 10 masseter sites was measured in 1 experiment. ⋯ The mean of the first 2 trials at each site appeared to give a better estimate of the PPT than the data from either the first trial or second trial alone from that site. In a second experiment, the PPT was measured in 2 trials at each of 4 sites over 5 sessions. The between-session PPT across multiple sessions was reliable and without differences.
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Randomized Controlled Trial Clinical Trial
Comparison of one technique of patient-controlled postoperative analgesia with intramuscular meperidine.
We have compared analgesic requirements, perceived pain, and self-assessment of 'health locus of control' for 72 h in 88 subjects after cholecystectomy, randomized to either a standard technique of self-administration of meperidine (patient-controlled analgesia, PCA) or to intramuscular injections on demand (i.m.). Multivariate analysis revealed no statistical differences between group scores for pain (over any 24 h period) and only minor differences in total meperidine administered. ⋯ Assessment of 'health locus of control' did not show any marked changes. Analysis of patient questionnaires suggests more enthusiasm for patient-controlled analgesia, but in this study, it was difficult to clearly demonstrate any significant advantage for pain management or amount of opiate administered.