The journal of pain : official journal of the American Pain Society
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The purpose of this investigation was to establish predictors of the dimensions of pain intensity and pain unpleasantness recalled at 1 week and 18 months after an invasive therapeutic procedure, root canal therapy (RCT). Pretreatment measures of mood state and RCT-related expectations of sensory and affective dimensions of pain by using a visual analog scale (VAS) format were obtained. ⋯ Regression analysis showed that after controlling for age, experienced pain intensity predicts 1-week memory of pain intensity (adjusted R(2) [equals].34, P [lt ].01), whereas patients[apos ] pretreatment affective state predicts the memory of pain intensity at 18 months (adjusted R(2) [equals].24, P [lt ].01) and the memory of pain unpleasantness at 1 week (adjusted R(2) [equals].40, P [lt ].01) and 18 months (adjusted R(2) [equals].62, P [lt ].01). These findings point to the contribution of preexisting affective state to the sensory and affective dimensions of pain recollection and illustrate the importance of anxiety management for minimizing patient[apos ]s long-term recollection of the aversiveness of outpatient medical and dental procedures.
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Comparative Study
The effect of race in older adults presenting for chronic pain management: a comparative study of black and white Americans.
In an aging society, chronic pain will increasingly have a significant impact on successful aging. Chronic pain may further differentially affect racial and ethnic minorities while diminishing their health and quality of life. This study addresses the potential differential effects of chronic pain cross-culturally in older Americans. ⋯ These results suggest that chronic pain adversely affects the quality of life and health status of black Americans to a greater extent than white Americans before initial presentation for treatment at a multidisciplinary pain center. This study of older Americans with chronic pain showed significant differences in pain and health status based on race. It further demonstrates a difference in the chronic pain experience based on race in older Americans.
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To be most useful, clinical trials of cancer pain treatments should use pain measures that are both reliable and valid. A great variety of measures are now available that may be used to assess cancer pain. However, there are not yet any clear guidelines for selecting one or more measures over the others. ⋯ Composite measures that combine ratings of pain intensity and pain interference into a single score appear to be both valid and reliable for describing patient populations, although their usefulness in clinical trials may be limited because they can obscure the contributions of intensity and interference to the total score. Proxy measures of cancer pain (pain ratings made by someone other than the patient) may be useful when patients are not able to provide pain ratings, but they should not be used as replacements for patient ratings when patient self-report measures are available. The discussion includes specific recommendations for selecting from among the available pain measures, as well as recommendations for future research into the assessment of cancer pain.
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Few data exist on the distribution of pharmaceutical costs for inpatient surgical procedures across different drug categories (eg, analgesia, anti-infectives). The goals of this study were to categorize pharmaceuticals administered to patients after joint replacement surgery and then to take the hospital's perspective and quantify the pharmacy cost of delivering postoperative analgesia to these patients. Two hundred ninety-eight patients undergoing unilateral hip replacement (n = 145), unilateral knee replacement (n = 121), or bilateral knee replacement (n = 32) were studied retrospectively. ⋯ Thus, analgesics accounted for approximately 31% of pharmacy costs. The pharmacy cost of delivering postoperative analgesia to patients undergoing joint replacement surgery represents 1% of the total costs of surgery. Almost two thirds of the analgesic costs were for opioids.
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Many treatment options are available for the management of cancer pain including drugs, local excision, radiation, brachytherapy, and nerve blocks. Percutaneous radiofrequency ablation has been used to treat painful neurologic and bone lesions and thus could potentially be used to treat cancer pain in other sites. Two superficial subcutaneous metastatic nodules were treated with percutaneous radiofrequency ablation. The patient received significant pain relief and improved quality of life.