Articles: pain-measurement.
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Scand. J. Rheumatol. · Jan 1996
Randomized Controlled Trial Clinical TrialQuantitative and qualitative assessments of pain in children with juvenile chronic arthritis based on the Norwegian version of the Pediatric Pain Questionnaire.
Quantitative and qualitative aspects of pain were studied using a standardized questionnaire (the Varni/Thompson Pediatric Pain Questionnaire--PPQ). Fifty-seven of 64 consecutive in- and out-patients (6-18 yrs) with juvenile chronic arthritis (pauciart. n = 27, polyart. n = 30) and 52 parents participated. The patients were examined by the same rheumatologist and randomly interviewed by either a disabled or a non-disabled person. ⋯ Forty-two percent of the patients thought it valuable to be interviewed by a disabled physician. The Norwegian Varni/Thompson PPQ is easy to administer to children down to six years and makes it possible to compare results internationally. Lack of agreement on the assessment of pain by a child and his/her parent indicates the need to interview both parties.
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J Pain Symptom Manage · Jan 1996
Comparative Study Clinical TrialPostoperative pain in children: comparison between ratings of children and nurses.
Frequently, decisions about analgesic treatment of postoperative pain in children are based on judgments made by nurses. Several studies from North America indicate that nurses underestimate the amount of pain experienced by children. Additional investigations are required to evaluate the extent to which this problem affects children in other countries and societies that have various health-care systems. ⋯ The nurses tended to overestimate the effect of analgesics. Although the correlations between the children's and the nurses' pain scores were statistically significant (r = 0.35-0.43, P < 0.001), the findings indicate that the nurses are not good at interpreting the patients' pain. These results from Danish children and nurses are similar to studies in other populations.
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Research demonstrates that many nurses lack knowledge about pain assessment, the differences between acute and chronic pain, and the use of pain rating scales. In this article, the authors describe an instrument for evaluating chronic pain, the purpose of which is to assess systematically the various dimensions of chronic pain and its impact on quality of life. ⋯ Using this tool can provide an accurate multidimensional assessment of clients' chronic pain experiences. The article also discusses recommendations for other applications of the tool.
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Comparative Study
An isobolographic analysis of the effects of N-methyl-D-aspartate and NK1 tachykinin receptor antagonists on inflammatory hyperalgesia in the rat.
1. The interaction between N-methyl-D-aspartate (NMDA) and NK1 tachykinin receptors was analyzed isobolographically in rats with inflammatory hyperalgesia induced by intraplantar injection of complete Freund's adjuvant-saline emulsion (CFA, 100 micrograms Mycobacterium tuberculosis). 2. Thermal hyperalgesia of the inflamed paw, determined by paw withdrawal response to a heat stimulus, was dose-dependently attenuated by intrathecal administration of an NMDA receptor antagonist, dextrorphan (2.5-40 micrograms, ED50 = 7.2 micrograms), and two NK1 tachykinin receptor antagonists, WIN 51,708 (0.01-200 micrograms, ED50 = 10.4 micrograms) or CP-96,345 (5-200 micrograms, ED50 = 82.1 micrograms). ⋯ Isobolographic analysis revealed that the ED50s obtained from the three combination ratios were not significantly different from those that were expected from a simple additive effect. 4. Thus, an additive interaction was demonstrated between NMDA and NK1 tachykinin receptor systems at the spinal level. These results suggest that both NMDA and NK1 tachykinin receptors are activated in response to peripheral inflammation, but that they may contribute independently to development of hyperalgesia.
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Br J Clin Pharmacol · Jan 1996
Randomized Controlled Trial Clinical TrialContribution of monoaminergic modulation to the analgesic effect of tramadol.
1. In humans, the central analgesic effect of tramadol 100 mg orally is only partially reversed by the opioid antagonist naloxone (0.8 mg intravenously). As suggested by in vitro and animal data tramadol analgesia may thus result from an action on opioid as well as monoaminergic pathways. ⋯ Peak analgesic effect was observed at 3.7 h (RIII + 39.6 +/- 3.9% and PINS 50.1 +/- s.e.mean 5%) and the analgesia lasted about 6 h. 4. Yohimbine significantly reversed the analgesic effects of tramadol for 2.8 h with a maximum decrease of 97 +/- 4% (RIII) and 67 +/- 12% (PINS), whereas the addition of naloxone abolished tramadol effects throughout the study period with a decrease of 90 +/- 6% (RIII) and 79 +/- 9% (PINS), P < 0.05). 5. Yohimbine alone did not significantly reduce pain thresholds. 6. alpha 2-Adrenoceptor antagonism reverses tramadol effects, thus pointing to the significant role of monoaminergic modulation and the synergy with opioid agonism in tramadol antinociception after a single oral dose.