Pain
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Chronic low back pain (CLBP) patients with pain and symptomatology incongruent with physical pathology have been found to have a poorer outcome to medical treatment and rehabilitation, and to use health care resources excessively. To examine possible psychological and behavioral bases for this pattern, this investigation contrasted 40 CLBP patients who displayed non-organic physical signs, inappropriate symptoms, and/or anatomically incongruent pain drawings with 40 'control' CLBP patients without incongruent pain criteria. Multivariate analyses revealed that the incongruent CLBP group reported greater pain intensity and depression, received higher observer ratings of pain, displayed more ambulatory/postural pain behavior, and reported more dysfunctional cognitions during pain. ⋯ Incongruent CLBP patients still displayed more maladaptive and dysfunctional cognitions. These findings indicate that incongruent CLBP patients may be conceptualized as ineffective and overwhelmed in their attempts to cope and as more physically disabled as a result of their pain. The role of cognitive factors, reasons for failure of physically based interventions, and implications for patient management are discussed.
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The reflex sympathetic dystrophy syndrome (RSDS) consists of a triad of pain, edema and sympathetic dysfunction of an extremity following trauma, peripheral nerve injury or central nervous system disorder. Reflex sympathetic dystrophy syndrome is a difficult and costly pain syndrome to treat. One of the difficulties in evaluating treatment efficacy is the objectification and quantification of patient findings. ⋯ Skin temperature was not predictive of changes in joint pain score, AROM, limb volume or subjective pain measures. However, there was internal consistency between volumetric and AROM measures and joint pain indices. This protocol is recommended for use in therapeutic trials for the treatment of the RSDS.
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Epidural administration of opiates as a long-term treatment of cancer pain, even for out-patients, is now well established. Most reports describe intermittent injections given several times a day, which may have technical and personal disadvantages. ⋯ This report describes 16 patients who were treated with epidural opiates delivered by plastic infusion pumps. Pain relief was effective, the equipment was inexpensive and home treatment was easily accomplished.
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Recordings were made from dorsal horn neurones in the spinal cord and trigeminal nucleus caudalis of intact anaesthetized rats. These rats had been rendered polyarthritic by s.c. injection of Mycobacterium butyricum suspended in oil into the base of the tail. The experiments were carried out during the acute phase of the illness (3-4 weeks post inoculation) during which hyperalgesia occurred. ⋯ The activity of non-noxious neurones was never modified by any heterotopically applied stimuli. By contrast, all convergent neurones were inhibited by heterotopic stimuli, noxious (52 degrees C, pinch) or non-noxious (light and mild pressure), applied to inflamed areas. While the inhibition triggered by noxious stimuli was reminiscent of that observed in healthy rats, the inhibition triggered by non-noxious mechanical stimuli was related to the inflammatory state of the part of the body stimulated, the most sensitive areas being the hind paws.(ABSTRACT TRUNCATED AT 400 WORDS)
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A retrospective, multi-physician survey was carried out to examine the infusion concentrations of morphine delivered intrathecally by continuous infusion pumps placed to control pain. Replies from 19 physicians formed the basis for a population of 163 patients who received morphine by continuous infusion delivered by an Infusaid pump through a chronically implanted intrathecal catheter (N = 130 for pain of a metastatic origin; N = 3 for non-metastatic pain; N = 30 undefined). These patients received a total of 3443 patient weeks of infusion. ⋯ E. M.). Though the group morphine utilization rose, examination of the patient population which was infused for periods in excess of 3 months indicated that 48% showed less than a 2-fold increase in dose by 3 months.