Pain
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Individual differences in human pain responsivity were characterized by the 1 degree C cold-pressor test. Behaviorally, a pain-tolerant group (PT = 29 Ss) tolerated the entire 3-min test (means = 180 +/- 0 sec), while a pain-sensitive group (PS = 13 Ss) averaged only 50.31 +/- 20.81 sec of the cold-pressor test (t = 16.75, P less than 0.0001), replicating our earlier studies. ⋯ However, the PS subjects showed significantly higher delta power, but not beta power, than the PT subjects. We conclude that heightened delta activity may reflect the stress component of human pain responsivity, and that beta activity reflects the vigilance scanning of pain processes.
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Fifty-six consecutive patients with pain due to cancer were admitted to a prospective study designed to test a clinical staging system for cancer pain. The system classifies patients in stage 1 (good prognosis) to stage 3 (poor prognosis) according to the mechanism of pain, characteristics of pain, previous narcotic exposure, cognitive function, psychological distress, tolerance and past history of drug addiction or alcoholism. During day 1 patients were staged after being seen by one of the investigators. ⋯ Eighteen of 22 patients in stage 1 achieved good pain control (82%) vs. 2/22 patients in stage 3 (10%; P less than 0.01). Sensitivity, specificity and negative predictive value of the system were 0.75, 0.86 and 0.80, respectively. We conclude that this is a simple and reliable system for clinical staging that can be used for clinical research and management of patients with cancer pain.
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The present study examined catastrophizing in rheumatoid arthritis (RA) patients. Subjects were 223 RA patients who were participants in a longitudinal study. Each patient completed the Catastrophizing scale of the Coping Strategies Questionnaire (CSQ) on 2 occasions separated by 6 months (time 1, time 2). ⋯ Predictive findings regarding catastrophizing while modest were obtained after controlling for initial scores on the dependent variables, demographic variables (age, sex, socioeconomic status), duration of pain, and disability support status. Taken together, these findings suggest that catastrophizing is a maladaptive coping strategy in RA patients. Further research is needed to determine whether cognitive-behavioral interventions designed to decrease catastrophizing can reduce pain and improve the physical and psychological functioning of RA patients.
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Randomized Controlled Trial Clinical Trial
Codeine 20 mg increases pain relief from ibuprofen 400 mg after third molar surgery. A repeat-dosing comparison of ibuprofen and an ibuprofen-codeine combination.
A combination of 20 mg codeine base and ibuprofen 400 mg was compared with ibuprofen 400 mg in a randomised double-blind cross-over study of multiple doses in 25 patients after 2-stage bilateral third molar removal. The combination produced significantly greater pain relief and doubled the hours of minimum pain intensity and maximal relief on the day of surgery. ⋯ There was no significant increase in side-effect incidence with the combination. The 30% increase in analgesic effect may be of clinical benefit, and this trial design, cross-over with multiple dosing in out-patients, may be a sensitive test for analgesics, potentially more predictive of side-effect problems than single-dose studies.
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Long-term outcomes for 300 chronic back pain patients were assessed retrospectively by a telephone follow-up 4-6 years after the patients were evaluated by a multi-disciplinary rehabilitative program. A Perception of Disability scale, developed to rate subjective disability, was used along with objective measures of functioning. On objective measures, 56% of patients reported themselves working or work ready, 58% no longer received compensation, 62% were taking no prescription medications and 65% had no or brief medical treatment since evaluations. ⋯ There was a strong relationship between perceived disability and objective circumstances with 63% of the patients unable to work and 61% still on disability payments reporting their disability as increasing. Of the 48 patients reporting back surgery at some point after evaluation only 17% perceived themselves as improved while 58% considered themselves worse. These results are discussed in the context of the development of pain focussed lifestyles.