Pain
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of tenoxicam and bromazepan in the treatment of fibromyalgia: a randomized, double-blind, placebo-controlled trial.
Fibromyalgia is a painful syndrome of non-articular origin, predominantly involving muscles, and the commonest cause of chronic widespread musculoskeletal pain. The diversity of therapeutic programs for patients with fibromyalgia reflects both the lack of a known pathophysiology for this disorder and the low efficacy of the current therapies. We studied the efficacy of tenoxicam and bromazepan in the treatment of patients with fibromyalgia. ⋯ At the end of the trial, 17%, 10%, 12%, and 29% of the P, T, B, and TB patients, respectively, had clinical improvement. A statistically significant difference was found only between the T and TB groups. Our data indicate that treatment with tenoxicam + bromazepan can be effective for some patients with fibromyalgia, but the differences with the placebo group were neither clinically nor statistically significant.
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Randomized Controlled Trial Clinical Trial
Sufentanil does not preempt pain after abdominal hysterectomy.
We compared the effect of intravenous (i.v.) sufentanil on postoperative pain and analgesic requirements, when given before or after abdominal hysterectomy. Patients were assigned in a random blind manner to receive 1 microgram/kg of sufentanil 5 min before induction of anaesthesia (group A, n = 18) or after ligation of the round ligaments of the uterus (group B, n = 21). General anaesthesia was induced with midazolam, thiopental and vecuronium and maintained with isoflurane and N2O in oxygen. ⋯ Pain was assessed with VAS and a verbal rating scale (VRS: 1 = no pain and 6 = intolerable pain) immediately before the first analgesic administration and 4, 8, 12, and 24 h postoperatively. VAS or VRS scores did not differ between the two groups at any time: neither did propoxyphene, paracetamol, and pethidine requirements. These results suggest that preinjury i.v. sufentanil is not more beneficial for postoperative pain control than the postinjury administration.
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Randomized Controlled Trial Clinical Trial
Lidocaine patch: double-blind controlled study of a new treatment method for post-herpetic neuralgia.
Post-herpetic neuralgia (PHN) is a common and often intractable neuropathic pain syndrome predominantly affecting the elderly. Topical local anesthetics have shown promise in both uncontrolled and controlled studies. Thirty-five subjects with established PHN affecting the torso or extremities completed a four-session, random order, double-blind, vehicle-controlled study of the analgesic effects of topically applied 5% lidocaine in the form of a non-woven polyethylene adhesive patch. ⋯ The highest blood lidocaine level measured was 0.1 micrograms/ml, indicating minimal systemic absorption of lidocaine. Patch application was without systemic side effect and well tolerated when applied on allodynic skin for 12 h. This study demonstrates that topical 5% lidocaine in patch form is easy to use and relieves post-herpetic neuralgia.
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Randomized Controlled Trial Clinical Trial
Specificity of diagnostic nerve blocks: a prospective, randomized study of sciatica due to lumbosacral spine disease.
Temporary nerve blocks using local anesthetic are employed extensively in the evaluation of pain problems, particularly lumbosacral spine disease. Their specificity and sensitivity in localizing anatomic sources of pain have never been studied formally, however, and so their diagnostic and prognostic value is questionable. There have been anecdotal reports of relief of pain by temporary blocks directed to areas of pain referral, as opposed to areas of documented underlying pathology; but there has been no study to define the frequency or magnitude of this effect. ⋯ Our findings indicate a limited role for uncontrolled local anesthetic blocks in the diagnostic evaluation of sciatica and referred pain syndromes in general. Negative blocks or a pattern of responses may have some predictive value, but isolated, positive blocks are non-specific. This lack of specificity may, however, be advantageous in therapeutic applications.
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Randomized Controlled Trial Comparative Study Clinical Trial
Responsiveness of functional status in low back pain: a comparison of different instruments.
This study compares the responsiveness of three instruments of functional status: two disease-specific questionnaires (Oswestry and Roland Disability Questionnaires), and a patient-specific method (severity of the main complaint). We compared changes over time of functional status instruments with pain rated on a visual analog scale. Two strategies for evaluating the responsiveness in terms of sensitivity to change and specificity to change were used: effect size statistics and receiver-operating characteristic method. ⋯ The sensitivity to change of the rating of Oswestry Questionnaire was lower than that of the other instruments. The main complaint was not very specific to change. The two strategies for evaluating the responsiveness were very useful and appeared to complement each other.