Pain
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Randomized Controlled Trial Comparative Study Clinical Trial
Influence of timing on the analgesic effect of intravenous ketorolac after orthopedic surgery.
This study evaluated the pre-emptive analgesic effect of intravenous (i.v.) ketorolac (KET) for total hip replacement (THR). Sixty patients who underwent surgery for THR under general anesthesia were randomly allocated to 3 groups. Two i.v. injections were administered: one before induction and one after surgery. ⋯ Upon arrival in the RR, VAS scores taken at rest and at movement were lower for the PRE group than for the CONT and POST groups. Otherwise, VAS scores were similar in all 3 groups. The cumulative dose of morphine in the PRE group was lower than that for the CONT and POST groups from 0 to 6 h.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
Sensory abnormalities in consecutive, unselected patients with central post-stroke pain.
This study examined the sensory abnormalities in an unselected, consecutive group of patients with central post-stroke pain (CPSP) surviving more than 1 year after stroke. The sensory examination included clinical examination and quantitative measures with detection and pain thresholds to heat and cold stimuli, argon laser, von Frey hair and determination of stimulus-response function in the 10-45 degrees C range. Sensory examination was in 11 identified CPSP patients (5 female, 6 male; aged 43-80 years) carried out in the painful area using the contralateral homologue area as reference. ⋯ A cold allodynia in the 10-45 degrees C range was present in the painful area in 6 (56%) of the patients. The results support the theory that damage to the spino-thalamo-cortical pathway is a necessary condition in CPSP. It is proposed that the spontaneous pain in CPSP is linked to hyperexitability or spontaneous discharges in thalamic or cortical neurons that have lost part of their normal input.
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Randomized Controlled Trial Clinical Trial
A double-blind investigation of the hypoalgesic effects of transcutaneous electrical nerve stimulation upon experimentally induced ischaemic pain.
The hypoalgesic effect of transcutaneous electrical nerve stimulation (TENS) at 2 different frequencies was assessed under double-blind conditions using a standardised form of the submaximum effort tourniquet technique. For the purpose of pain induction, 32 healthy naive female subjects attended on 2 occasions, the first during which baseline data were obtained and the second during which the women were randomly allocated to 1 of 4 groups: Control, Placebo, TENS-1 (110 Hz) or TENS-2 (4 Hz). In the treatment groups, 2 hydrogel electrodes were positioned over Erb's point and lateral to C6 and C7 vertebral spines. ⋯ Analysis of VAS scores showed significant differences between groups (ANOVA, P = 0.02), with the TENS-2 group showing a greater hypoalgesic effect than the other groups. One-factor ANOVA showed no significant differences in MPQ scores between groups. The results of this study have provided evidence of the hypoalgesic effects of TENS upon experimental ischaemic pain which were found to be frequency specific with the lower frequency used here (4 Hz) demonstrating the only significant effect.
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Randomized Controlled Trial Clinical Trial
Analgesic efficacy and safety of single-dose intramuscular ketorolac for postoperative pain management in children following tonsillectomy.
The efficacy of ketorolac, a non-steroidal anti-inflammatory drug, in the management of moderate to severe pain in adults, has led us to conduct a trial of this analgesic in children following tonsillectomy. Children were randomized to receive intramuscular (i.m.) ketorolac (1 mg/kg, EXP group, n = 45) or saline (CTL group, n = 42) at the completion of surgery. Intravenous (i.v.) fentanyl (0.5 micrograms/kg/dose) was administered in repeated doses postoperatively. ⋯ In the first hour postoperatively, the CHEOPS demonstrated significant decreases in pain intensity scores in response to opioids, in both groups. In the PACU, children were unable to provide a self-report of pain intensity potentially due to a variety of factors (e.g., emergence delirium, agitation, excitement, sedation, and/or pain). However, during the remainder of the postoperative stay, the photographic scale of the Oucher was a more valid measure of pain intensity than the CHEOPS.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
Chronic pain and depression: role of perceived impact and perceived control in different age cohorts.
Chronic pain adversely affects individuals' physical as well as emotional well-being. A cognitive-behavioral model has been proposed to explain the role of cognitive appraisal variables in mediating the development of emotional distress following pain of long duration. There is little evidence linking the prevalence of depression in chronic pain patients to life stage, but there are suggestions in the literature that the link between medical illness and depression may be stronger in elderly patients. ⋯ Consistent with the cognitive-behavioral model, the younger patients demonstrated a low and non-significant correlation between pain severity and depression (r = 0.01). Conversely, a strong direct association was observed in the older patients between these variables (r = 0.51). These results suggest that the relationship between pain and depression varies substantially depending upon age cohort.