Pain
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Randomized Controlled Trial Clinical Trial
Neuropsychological effects of methylphenidate in patients receiving a continuous infusion of narcotics for cancer pain.
Twenty consecutive patients with cancer pain receiving a continuous subcutaneous infusion of narcotics were admitted to a double-blind, crossover trial designed to assess the effects of methylphenidate on neuropsychological functions. After a baseline assessment, patients were randomized to receive methylphenidate orally at 08.00 h for 2 consecutive days or placebo. During day 3, a crossover took place and patients received the alternate treatment for 2 more days. ⋯ After completion of the trial, methylphenidate was chosen blindly by the patient and investigator in 13 and 14 cases, placebo in 3 and 2 cases, a "no choice" in 3 and 3 cases, respectively (P less than 0.01). Our results suggest that methylphenidate is capable of improving cognitive function in patients receiving high doses of opiates subcutaneously. More research is necessary in order to determine the duration of cognitive improvement after each dose of methylphenidate as well as the best type and dose of amphetamine.
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Randomized Controlled Trial Clinical Trial
Hypnosis or cognitive behavioral training for the reduction of pain and nausea during cancer treatment: a controlled clinical trial.
Few controlled clinical trials have tested the efficacy of psychological techniques for reducing cancer pain or post-chemotherapy nausea and emesis. In this study, 67 bone marrow transplant patients with hematological malignancies were randomly assigned to one of four groups prior to beginning transplantation conditioning: (1) hypnosis training (HYP); (2) cognitive behavioral coping skills training (CB); (3) therapist contact control (TC); or (4) treatment as usual (TAU; no treatment control). Patients completed measures of physical functioning (Sickness Impact Profile; SIP) and psychological functioning (Brief Symptom Inventory; BSI), which were used as covariates in the analyses. ⋯ Risk, SIP, and BSI pre-transplant were found to be effective predictors of inpatient physical symptoms. Nausea, emesis and opioid use did not differ significantly between the treatment groups. The cognitive behavioral intervention, as applied in this study, was not effective in reducing the symptoms measured.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intrathecal midazolam for the treatment of chronic mechanical low back pain: a controlled comparison with epidural steroid in a pilot study.
This paper describes a prospective, double blind, randomised and dummy-controlled trial in 28 patients with chronic mechanical low back pain presenting to the York Pain Clinic. The therapeutic effects of epidural methyl prednisolone (80 mg) were compared with intrathecal midazolam (2 mg). All the patients had pain for a considerable length of time (range: 1-35 years) and all had received previous treatments which had failed. ⋯ However, although the improvement in the two groups was similar, all the patients treated with steroid were either taking more or the same amount of self-administered analgesic medication after their treatment, whereas between one-third and one-half of the midazolam-treated patients took less medication during the 2 month follow-up period. We conclude that intrathecal midazolam is an effective treatment for chronic mechanical low back pain. The mechanism responsible for this effect is discussed.
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Randomized Controlled Trial Clinical Trial
Calcitonin in phantom limb pain: a double-blind study.
Salmon calcitonin (s-CT) has been shown to be a valuable analgesic in phantom limb pain (PLP) in several case reports. To evaluate these findings a double-blind crossover comparison of s-CT treatment versus placebo was initiated. Twenty-one out of 161 patients who had undergone major amputations and developed severe PLP 0-7 days after surgery were included in the study. ⋯ One year later 8 out of the 13 surviving patients (62%) still had more than 75% PLP relief. After 2 years PLP exceeded 3 on NAS in 5 individuals (42%), and the remaining 12 patients presented the same PLP as after 1 year. In conclusion, s-CT is a valuable treatment for PLP in the early postoperative period.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of intermittent bolus with continuous infusion of epidural morphine in the treatment of severe cancer pain.
Twenty-eight patients with severe pain due to cancer, who could no longer obtain acceptable pain relief from optimised doses of oral opioids, were entered into a study which compared pain relief, satisfaction with pain therapy and estimates of neuropsychological functioning during treatment with spinally administered (i.e., epidural and intrathecal) morphine as either repeated bolus doses or as a continuous infusion. These measures of efficacy and side effects were repeated every 2 weeks until either the patient died (82% of patients), withdrew from the study or were no longer able to complete the tests due to deterioration of their condition. The mean (range) duration of treatment was 169 (6-537) days for those patients receiving continuous infusion and 140 (28-378) days for those patients receiving repeated bolus doses. ⋯ There was a significantly greater degree of dose escalation in patients receiving continuous infusion compared to patients receiving repeated bolus doses. For 6 patients in the infusion group the catheter was sited in the intrathecal space, as the dose requirements by the epidural route exceeded the delivery capacity of the pump. For 4 patients in the bolus group the catheter was similarly sited, due to pain on injection and leakage/blockage.(ABSTRACT TRUNCATED AT 250 WORDS)