Pain
-
Randomized Controlled Trial Clinical Trial
Is TENS purely a placebo effect? A controlled study on chronic low back pain.
Although high-frequency low-intensity transcutaneous electric nerve stimulation (TENS) has been extensively used to relieve low back pain, experimental studies of its effectiveness have yielded contradictory findings mainly due to methodological problems in pain evaluation and placebo control. In the present study, separate visual analog scales (VAS) were used to measure the sensory-discriminative and motivational-affective components of low back pain. Forty-two subjects were randomly assigned to 1 of 3 groups: TENS, placebo-TENS, and no treatment (control). ⋯ This additive effect was not found for placebo-TENS. When evaluated at home, pain intensity was significantly reduced more by TENS than placebo-TENS 1 week after the end of treatment, but not 3 months and 6 months later. At home evaluation of pain unpleasantness in the TENS group was never different from the placebo-TENS group.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Randomized Controlled Trial Clinical Trial
The relationship between children's coping styles and psychological interventions for cold pressor pain.
This study examined the hypothesis that matching pain management interventions to children's preferred coping methods would increase pain tolerance and decrease self-reported pain during the cold pressor pain paradigm. Children aged 8-10 years were classified as 'attenders' (focusing on the stimulus) or 'distractors' (focusing away from the stimulus) based upon their spontaneous coping responses during a baseline exposure to the cold pressor. Children were then randomly assigned to 1 of 3 intervention conditions (sensory focusing, imagery, or no intervention) and completed the cold pressor procedure again 2 weeks later. ⋯ Although pain ratings tended to be lower for distractors using imagery, the significant interaction resulted from an increase in ratings for the distractors using sensory focusing (i.e., a 'mismatched' intervention). Results suggest that, for distractors, interventions that are consistent with natural coping methods are most effective in enhancing abilities to cope with pain, while a mismatched intervention reduces coping abilities. The findings also suggest further study regarding how to provide effective pain intervention with attenders, since neither intervention enhanced coping in this group.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of hydromorphone continuous subcutaneous infusion and basal rate subcutaneous infusion plus PCA in cancer pain: a pilot study.
In this pilot randomized, double-blind, cross-over study, the effectiveness and safety of hydromorphone administration by continuous subcutaneous (s.c.) infusion (mode A) and by continuous basal rate s.c. infusion + PCA (mode B) were compared in 8 cancer patients. Patients experimented with each infusion mode during 48 h. Statistical analysis was performed on data collected in 7 patients during 36 h from 22:00 h on day 1 to 10:00 h on day 3 and from 22:00 h on day 3 to 10:00 h on day 5. ⋯ Only 2 patients chose mode B at the end of the study, but it was interesting to note that those 2 patients were the youngest of the group. This study demonstrated the effectiveness and safety of both modes of hydromorphone administration. The data suggest that it may be possible to identify particular cancer patients which can really benefit from an association of a basal rate infusion and PCA for opiate administration.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Morphine injected around the stellate ganglion does not modulate the sympathetic nervous system nor does it provide pain relief.
Six patients with a presumptive diagnosis of upper limb reflex sympathetic dystrophy and 1 patient with anaesthesia dolorosa had pain and sympathetic activity assessed before and after injection of bupivacaine and morphine around the stellate ganglion. Sympathetic modulation was assessed by measuring the effect of each injection on the inspiratory gasping response (IGR), a measure of central arousal, the sympathetic skin response (SSR), a measure of peripheral sudomotor activity and the plethsymographic wave (PW), a measure of peripheral vasomotor activity. There were 5 women and 2 men with a mean age of 49 years (range: 41-66 years). ⋯ Bupivacaine did provide short-term pain relief in 4 out of 7 patients. Morphine did not produce any demonstrable effect on the sympathetic nervous system nor did it provide pain relief for any patient. Thus these data do not support injection of morphine around the stellate ganglion as it neither modulated sympathetic activity nor provided pain relief.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Efficacy of cognitive therapy for chronic low back pain.
The effects of outpatient group cognitive therapy, relaxation training, and cognitive therapy in combination with relaxation training on chronic low back pain and associated physical and psychosocial disability were evaluated and compared. One-hundred and two mildly disabled chronic low back pain patients were assigned randomly to a waiting-list (WL) control condition and the 3 treatments. ⋯ Depressive symptoms and disability improved significantly in all conditions (including the waiting list) from pretreatment to post-treatment, with no statistically significant differences among treatments. At both follow-ups, all 3 treatment groups remained significantly improved from pretreatment, with no statistically significant differences between treatments.