European journal of pain : EJP
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Randomized Controlled Trial Comparative Study
Comparison of articaine and lidocaine for infiltration anaesthesia in patients undergoing bone marrow aspiration and biopsy.
Infiltration anaesthesia with articaine, a local anaesthetic able to penetrate bone, may relieve procedural pain better than lidocaine in bone marrow aspiration and biopsy. This randomised, double-blind study comprised 150 patients with suspected or known haematologic disease. Either articaine 20mg/ml (50 patients), articaine 40mg/ml (49 patients) or lidocaine 20mg/ml (51 patients), all with adrenaline 5mug/ml, was infiltrated in volume of 6ml (sternal manubrium), 8ml (sternal body) or 10ml (iliac crest) 2min before puncture. ⋯ No parameter differed significantly between the groups. In conclusion, the quality of infiltration anaesthesia for bone marrow punctures and aspiration with articaine and lidocaine was similarly poor. Several patients experienced strong pain which correlated with the degree of anxiety.
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Randomized Controlled Trial
Laser-evoked potentials as a tool for assessing the efficacy of antinociceptive drugs.
Laser-evoked potentials (LEPs) are brain responses to laser radiant heat pulses and reflect the activation of Adelta nociceptors. LEPs are to date the reference standard technique for studying nociceptive pathway function in patients with neuropathic pain. ⋯ The opioid antagonist naloxone partially reversed the tramadol-induced LEP amplitude decrease. We conclude that LEPs may be reliably used in clinical practice and research for assessing the efficacy of antinociceptive drugs.
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Randomized Controlled Trial
What factors influence the measurement properties of the Roland-Morris disability questionnaire?
Although the Roland disability questionnaire (RDQ) is a commonly used questionnaire for patients with low back pain (LBP), several important issues remain understudied. The purposes of this study were to investigate the impact that several parameters (length of test-retest interval, interpretation of the global perceived effect (GPE) scores, methods to estimate standard error of measurement (SEM), intervention and baseline scores) have on various measurement properties, such as agreement (Limits of Agreement (LOA), SEM(agreement)), responsiveness (area under the ROC curve, sensitivity, specificity) and interpretability (optimal cut-off point, Minimal Detectable Change), of the RDQ. RDQ was administered four times to 212 patients with chronic non-specific LBP (first consultation (T-1), eligibility check (T0), randomization/start of treatment (T1) and end of treatment (T2)). ⋯ Results revealed that agreement parameters decreased with increasing time interval between test-retest. They confirmed the influence of the interpretation of the GPE as well as of the method to calculate the SEM on the magnitude of the Minimal Detectable Change and ROC parameters. Baseline RDQ scores and the way to cluster patients with regard to baseline scores influenced mainly the optimal cut-off point and responsiveness parameters; intervention did not affect the magnitude of the Minimal Detectable Change.
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Randomized Controlled Trial
Brush-evoked allodynia predicts outcome of spinal cord stimulation in complex regional pain syndrome type 1.
Spinal cord stimulation (SCS) has proven to be an effective however an invasive and relatively expensive treatment of chronic Complex Regional Pain Syndrome type 1(CRPS-1). Furthermore, in one third of CRPS-1 patients, SCS treatment fails to give significant pain relief and 32-38% of treated patients experience complications. The aim of the current study was to develop effective prognostic factors for prediction of successful outcome of SCS. ⋯ Brush-evoked allodynia may be a significant negative prognostic factor of SCS treatment outcome after 1 year in chronic CRPS-1.
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Chronic pain is often associated with comorbidities such as anxiety and depression, resulting in a low health-related quality of life. The mechanisms underlying this association are not clear, but a disturbance in the pain control systems from the brain stem has been suggested. Thirty neuropathic pain (NP) patients, 28 patients with fibromyalgia (FM), and 26 pain-free age- and gender-matched controls were included and examined with respect to mental distress (self-rated Symptom Checklist-92), depression (doctor-rated Hamilton Depression Scale and self-rated Major Depression Inventory), and anxiety (doctor-rated Hamilton Anxiety Scale and self-rated Anxiety Inventory). ⋯ However, these scores are low compared to other studies on mental distress in chronic pain patients. Only few chronic pain patients meet the diagnostic criteria for depression (NP 3.3%, FM 7.1%), and associations between pain and mental symptoms were only found in the FM group despite similar pain intensities. The findings suggest that different mechanisms are responsible for the development of mood disorders in the two patient groups.