Pain
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Words related to pain were collected by asking 59 students and 18 patients to create a list by free association. Each subject was then given a dictionary-derived Finnish version of the McGill Pain Questionnaire (MPQ) with the words arranged in alphabetical order and was asked to place his own words among the dictionary-derive words which appeared most appropriate. Simultaneously, each word was allocated on a visual analogue scale (VAS) in order of increasing intensity. ⋯ Those words were chosen for the pain vocabulary which reflected a statistically significant intensity change and were most often to be found in the word-list. The same method is applicable irrespective of language. Words are replaceable by numerical values so that follow-up and renewed investigations become statistically comparable.
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The cross-modality matching methods of Stevens [16] have been used by Gracely and his colleagues [4-6] to provide numerical values for "verbal pain descriptors." These numerical values, it is claimed, provide reliable, objective and valid ratio-level measurement of the sensory and affective dimensions of pain. Each of these claims is critically examined.
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The principal dimensions of the pain experience of 102 patients with chronic low back pain were studied and components of the pain experience were compared to pre-treatment measures of emotional disturbance. Responses on the McGill Pain Questionnaire (MPQ) were factor analyzed revealing dimensions of the pain experience that seemed to represent sensory, affective, and evaluative aspects. ⋯ The evaluation descriptive dimension was highly related to the overall intensity of the pain experience. Only the affective dimension was related to emotional disturbance separately from the effects of intensity alone.
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Conventional transcutaneous electrical nerve stimulation was applied to 114 patients diagnosed as having peripheral neuropathy (N = 18), peripheral nerve injury (N = 21), radiculopathy (N = 36) and musculoskeletal disorders (N = 39) to determine optimal electrode placements and stimulation parameters for pain relief. Treatment outcomes were assessed primarily through evaluation of the present pain intensity (PPI) rating scale, Immediate improvements in PPI scores occurred in patients in all these diagnostic categories. ⋯ In certain instances (subjects with radiculopathy or peripheral nerve injury) a positive relationship existed between higher intensity stimulation and amelioration of pain. Greater pain relief was reported among patients with minimal previous medical or surgical treatment in every diagnostic group.
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Somatosensory evoked potentials (EPs) to stimuli ranging from barely perceptible to painful were recorded in 153 normal adults. Reliability of amplitude and amplitude/intensity slopes were demonstrated in 29 individuals tested twice, two or more weeks apart. In randomized, double-blind placebo controlled trials, both aspirin and morphine significantly diminished N120 component at high stimulus intensities. Age, sex and pharmacological effects paralleled those found with psychophysical techniques in part I of this study.