The Clinical journal of pain
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Comparative Study
Effect of high-frequency vibration on experimental pain threshold in young women when applied to areas of different size.
The purpose of this study was to compare the effects of high-frequency vibration when applied to two areas of different size. Subjects were 30 right-handed Caucasian women, aged 19-38 years, with a negative history of upper extremity dysfunction. The experimental cutaneous pain threshold was determined by stimulating the skin over the pisiform bone on the palmar surface of the hand. ⋯ Results of the mixed design analysis of variance performed on the mean pain thresholds indicate that there was no significant main effect for group (size of area vibrated), p greater than 0.05, or interaction effect between group by trial (size of area vibrated and time of pain threshold measurement), p greater than 0.05. There was a significant main effect for trial (time of pain threshold measurement), p less than 0.001. Pain threshold values were greatest for both groups during the period of vibration.
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Data from the charts of 40 patients in whom a continuous epidural infusion of fentanyl had been used to effect postoperative pain relief were retrospectively reviewed. Of these patients, 39 out of 40 (97.5%) reported adequate analgesia at an average fentanyl infusion rate of 1.3 micrograms/kg/h. ⋯ The overall incidence of side effects was low, and, in particular, respiratory depression was not noted. In our experience, this analgesia technique is safe, effective, and could be readily introduced into most community hospital settings.
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Because of the difficulty in applying psychiatric diagnostic nomenclature to the problem of pain in the medical setting, medical and surgical inpatients referred for a psychiatric consultation with pain as a presenting complaint (N = 167) are compared with "nonpain" patients (N = 1,634). "Pain" patients were more often male (p less than 0.05), had additional presenting problems of coping with their illness (p less than 0.0001), drug misuse and abuse (p less than 0.0001), and terminal illness (p less than 0.0001); evidenced less severity of psychiatric impairment (p less than 0.05); received different treatment recommendations; and were more likely to be assigned less frequently employed DSM-III psychiatric diagnoses than those most commonly found in consultation populations. However, these diagnoses were nonspecific for the problem of pain and provided minimal information about the nature of the pain. Enhancements of the diagnostic classification systems that would better address the nature of the psychiatric disorders associated with pain are presented.
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Work and injury related musculoskeletal pain is often complicated by psychological and medicolegal factors that obscure the validity of the pain presentation. Pressure algometry and stretching during thiopentone sodium (Pentothal) anesthesia was studied in 45 cases of musculoskeletal injury. ⋯ In unilateral pain cases, a right to left pressure threshold difference of 2.0 kg/cm2 predicted 94% of true organic pain cases and 100% of cases at a pressure threshold of 1.5 kg/cm2 if combined with stretching. Results of stretching painful areas correlated highly with pressure threshold assessments.