Pain
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Randomized Controlled Trial Clinical Trial
High dose alfentanil pre-empts pain after abdominal hysterectomy.
This study tested the hypothesis that high dose systemic alfentanil administered before and during abdominal hysterectomy would pre-empt post-operative pain to a greater extent than administration of either low dose alfentanil or no alfentanil perioperatively. Patients (ASA 1 or 2) were randomly assigned to group 1 (n = 15), no opioid; group 2 (n = 15), low dose alfentanil; or group 3 (n = 15), high dose alfentanil. Anaesthesia was induced in group 1 with midazolam and thiopentone and was maintained with isoflurane and 70% N2O in O2. ⋯ A 6-month follow-up did not reveal any significant differences among the three groups. It is concluded that intra-operative high dose alfentanil anaesthetic pre-empts post-operative pain after abdominal hysterectomy, but the effects are small and of short duration. Surgical procedures carried out under general anaesthesia using standard (and even high) doses of opioids intraoperatively provide suboptimal protection from the injury barrage brought about by incision and subsequent noxious surgical events.
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Randomized Controlled Trial Clinical Trial
The initial effects of a cervical spine manipulative physiotherapy treatment on the pain and dysfunction of lateral epicondylalgia.
Manipulative therapy is frequently used in the management of musculoskeletal pain. A frequently reported clinical feature of this treatment is the immediacy with which it appears to initiate improvement in pain and function. A randomised, double blind, placebo controlled, repeated measures design was employed to study the initial effects of a cervical spine treatment technique in a group of 15 patients with lateral epicondylalgia. ⋯ Differences between the pre-post measures were used as indicators of change in subject's symptom profiles. The treatment condition produced significant improvement in pressure pain threshold, pain-free grip strength, neurodynamics and pain scores relative to placebo and control conditions (P < 0.05). In summary, this study demonstrates that manipulative therapy is capable of eliciting a rapid hypoalgesic effect.
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Randomized Controlled Trial Clinical Trial
Assessing the stages of pain processing: a multivariate analytical approach.
A four-stage model of pain processing was proposed, consisting of pain sensation intensity, pain unpleasantness (stage 1 affect), suffering (stage 2 affect), and pain behavior. We studied 506 chronic pain patients (230 male and 276 female) using a multivariate statistical technique (LISREL) in order to demonstrate the structural relationship among multiple indicators of pain processing; and to characterize these stages in terms of their interactions. A strong relationship was revealed between the majority of the underlying indicators of each pain processing stage. ⋯ A confirmatory LISREL analysis was conducted with an additional sample of 502 chronic pain patients. In this replication analysis the structural equation model consisted of pain intensity, unpleasantness (stage 1 affect), emotional suffering (stage 2 affect), and pain behavior. This study extends the validation of these pain dimensions, as well as the validity of the measure(s) of each separate stage.
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Randomized Controlled Trial Clinical Trial
Lack of effect of transcutaneous electrical nerve stimulation upon experimentally induced delayed onset muscle soreness in humans.
The aim of the current study, for which ethical approval was obtained, was to assess the hypoalgesic efficacy of transcutaneous electrical nerve stimulation (TENS) upon acute stage (72 h) experimentally induced delayed onset muscle soreness (DOMS). TENS naive subjects (n = 48; 24 male and 24 female) were recruited, screened for relevant pathology and randomly allocated to one of four experimental groups: control, placebo, low TENS (200 microseconds; 4 Hz) or high TENS group (200 microseconds; 110 Hz). DOMS was induced in a standardised fashion in the non-dominant elbow flexors of all subjects by repeated eccentric exercise. ⋯ Measurements were taken before and after treatment under controlled double blinded conditions. Analysis of results using repeated measures analysis of variance (ANOVA) and post hoc tests showed some inconsistent isolated effects of high TENS (110 Hz) compared to the other conditions upon resting angle and flexion scores; no significant effects were found for any of the other variables. These results provide no convincing evidence for any measurable hypoalgesic effects of TENS upon DOMS-associated pain at the stimulation parameters used here.
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural and subcutaneous morphine in the management of cancer pain: a double-blind cross-over study.
Ten patients who suffered from severe cancer-related pain participated in a randomised, double-blind and cross-over study to compare the effectiveness and acceptability of epidural and subcutaneous administration of morphine. The patients titrated themselves pain-free in 48 h using a patient controlled analgesia system. ⋯ The two modes of morphine administration turned out to be comparable in terms of both effectiveness and acceptability. Both treatments provided better pain relief with less adverse effects compared with the prestudy oral morphine treatment.