Articles: pain.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Double-blind, multiple-dose comparison of buprenorphine and morphine in postoperative pain of children.
In a randomized double-blind study of 57 children (aged 6 months-6 yr), pain following lateral thoracotomy was relieved with repeated i.v. doses of morphine 100 or 50 micrograms kg-1, or buprenorphine 3.0 or 1.5 micrograms kg-1. The same drug and dosage were continued and cardioventilatory indices, pain intensity and sedation measured for an observation period of 24 h. The sums of the pain intensity differences were equal in all groups. ⋯ The total consumption of both morphine and buprenorphine was less when the smaller bolus doses were used. Two patients developed a degree of ventilatory depression following repeated doses of buprenorphine. Buprenorphine was equal to morphine as a postoperative analgesic.
-
A clinical study was undertaken to formulate better criteria for accurate diagnosis of the lumbar facet syndrome and for predicting treatment response to facet joint injection. Twenty-two consecutive patients with a clinical diagnosis of lumbar facet syndrome, made by conventional diagnostic criteria, who were then treated with facet joint injection, were reviewed for their treatment responses. New diagnostic criteria were formulated based on a scoring system derived from the values observed in this review study. ⋯ A score of 60 points or more indicates a very high probability of satisfactory response to facet joint injection (100% prolonged response in this study). When only the conventional criteria were used, the overall results of prolonged relief of pain after facet joint injection was 50%. A "scorecard" system is proposed that may give a higher degree of diagnostic accuracy and predictability of successful response to facet joint injection.
-
Chronic low back pain (CLBP) patients with pain and symptomatology incongruent with physical pathology have been found to have a poorer outcome to medical treatment and rehabilitation, and to use health care resources excessively. To examine possible psychological and behavioral bases for this pattern, this investigation contrasted 40 CLBP patients who displayed non-organic physical signs, inappropriate symptoms, and/or anatomically incongruent pain drawings with 40 'control' CLBP patients without incongruent pain criteria. Multivariate analyses revealed that the incongruent CLBP group reported greater pain intensity and depression, received higher observer ratings of pain, displayed more ambulatory/postural pain behavior, and reported more dysfunctional cognitions during pain. ⋯ Incongruent CLBP patients still displayed more maladaptive and dysfunctional cognitions. These findings indicate that incongruent CLBP patients may be conceptualized as ineffective and overwhelmed in their attempts to cope and as more physically disabled as a result of their pain. The role of cognitive factors, reasons for failure of physically based interventions, and implications for patient management are discussed.
-
A method to measure cutaneous hyperalgesia to thermal stimulation in unrestrained animals is described. The testing paradigm uses an automated detection of the behavioral end-point; repeated testing does not contribute to the development of the observed hyperalgesia. ⋯ Both the thermal method and the Randall-Selitto mechanical method detected dose-related hyperalgesia and its blockade by either morphine or indomethacin. However, the thermal method showed greater bioassay sensitivity and allowed for the measurement of other behavioral parameters in addition to the nociceptive threshold.