PAIN�
The efficacy of ketorolac, a non-steroidal anti-inflammatory drug, in the management of moderate to severe pain in adults, has led us to conduct a trial of this analgesic in children following tonsillectomy. Children were randomized to receive intramuscular (i.m.) ketorolac (1 mg/kg, EXP group, n = 45) or saline (CTL group, n = 42) at the completion of surgery. Intravenous (i.v.) fentanyl (0.5 μg/kg/dose)...
The hypoalgesic effect of transcutaneous electrical nerve stimulation (TENS) at 2 different frequencies was assessed under double-blind conditions using a standardised form of the submaximum effort tourniquet technique. For the purpose of pain induction, 32 healthy naive female subjects attended on 2 occasions, the first during which baseline data were obtained and the second during which the women...
Adenosine, an endogenous antinociceptive compound acting in the central nervous system, was infused intravenously (50-70 μg/kg/min) to 2 patients with peripheral neuropathic pain. In 1 subject, spontaneous pain was alleviated, and tactile allodynia was essentially relieved during 40 min of infusion. Allodynia to warmth and touch were abolished in the other subject. In addition, hyperalgesia to...
Postmastectomy pain (PMP), a distinctive postsurgical neuropathic pain syndrome, has been thought to be a consequence of 4-6% of surgical procedures for cancer of the breast, but remains understudied and poorly documented. In this cross-sectional descriptive study, a convenience sample of 95 women who had undergone breast cancer surgery was recruited from 16 ambulatory care sites. Prevalence, characteristics,...
This study sought to identify distinct subgroups of chronic pain patients based on responses to the Symptom Checklist 90-revised (SCL-90R), a measure of psychological distress. Two scoring methods were used: the standard scoring that accompanies the manual, and a scoring method based upon factor scores obtained in an earlier study using low back pain patients. Two separate cluster analyses assigned...
Terminally ill patients suffering from intractable cancer pain are treated in our hospital on an outpatient basis with a percutaneous intrathecal (i.t.) catheter and a portable pump delivering morphine continuously. In a patient showing an increased demand of morphine the dose was raised from 1.5 to 2 mg/h, but pain intensity did not decrease. Subsequently a 1.5 ml dose of 5% lidocaine was administered;...
Intradermal injection of the capsaicin analogue, NE-21610 (Procter and Gamble), inactivates nociceptors but not low-threshold mechanoreceptors in monkey. The present study examined the effects of cutaneous NE-21610 on heat and mechanical sensation in normal human volunteers. In the first series of experiments, subjects received intradermal (i.d.) injections (30 μl) of the vehicle alone or with the...
Some children and adolescents with sickle cell disease experience frequent painful episodes. To gain information about the natural history of the pain and its impact on sleep and school attendance, we developed a home-based diary system. Eighteen children and adolescents completed 4756 diary days, with an average compliance of 75%. Pain was reported on 30% of days and was managed at home nine-tenths...
The effect of continuous subcutaneous (s.c.) infusion of ketamine on nerve injury pain was examined in patients with post-herpetic neuralgia. Five patients that reported pain relief after acute intravenous injection of ketamine were included in this open prospective study. Ketamine was administered continuously in increasing doses using a portable infusion pump (CADD-PLUS, Pharmacia), and the treatment...
We examined the analgesic effect of racemic ketamine and its 2 enantiomers in 16 female patients (age: 20-29 years) suffering acute pain after oral surgery and in 7 female patients (age: 42-79 years) suffering chronic neuropathic orofacial pain. All 3 forms of ketamine consistently relieved postoperative pain, (S)-ketamine being 4 times more potent than (R)-ketamine. The analgesic effect was maximal...
This study examined the sensory abnormalities in an unselected, consecutive group of patients with central post-stroke pain (CPSP) surviving more than 1 year after stroke. The sensory examination included clinical examination and quantitative measures with detection and pain thresholds to heat and cold stimuli, argon laser, von Frey hair and determination of stimulus-response function in the 10-45°C...
Patients with chronic pain frequently report that changes in the weather influence their pain. This study investigated differences in the perceived influence of weather on pain among 558 chronic pain patients living in 4 cities (San Diego, California; Nashville, Tennessee; Worcester, Massachusetts; and Boston, Massachusetts) in the United States. Local climatologic data for each city were obtained...
The Beck Depression Inventory (BDI) is widely used to document the prevalence of depression in sufferers of chronic pain and in research designs about this population. Williams and Richardson (1993) initially posed the question, What does the BDI measure in chronic pain? . Results from their study found 3 independent constructs, which differed somewhat from those obtained in analyses with other...
This study compared the antinociceptive properties of systemic administration of selective, non-peptidergic antagonists at neurokinin (NK 1 and NK 2 ) receptors to those of other classes of antinociceptive agent. (All doses are in mg/kg.) In mice, the NK 1 antagonist, CP 99,994, preferentially (inhibitory dose 5 0 (ID 5 0 ) = 4.4) inhibited the late...
The present study examined antinociception produced by systemic administration of caffeine in the rat hot-plate (HP) and formalin tests and addressed several aspects of the mechanism of action of caffeine. Locomotor activity was monitored throughout. Caffeine produced a dose-related antinociception the HP (50-100 mg/kg) and formalin tests (12.5-75 mg/kg). When observed during the formalin test,...
Prolonged and severe diarrhoea after alcohol celiac plexus block is a rare, but life-threatening, complication if not recognized. This type of diarrhoea may be considered an autonomic neuropathy due to sympathetic denervation. A 65-year-old pancreatic cancer patient developed serious diarrhoea after celiac plexus block which was unresponsive to traditional treatment such as loperamide, dyphenoxylate...
This paper reports on the development of a measure of significant-others' reports of the frequency of their solicitous, distracting and negative responses to chronic pain patients demonstrations of pain. This significant-other version is based on analogous scales that comprise part of the West Haven-Yale Multidimensional Pain Inventory (WHYMPI). The 3 pain-relevant response scales were demonstrated...
The patient with a history of current opioid consumption presenting in the acute postoperative setting presents a challenge for pain management. Standard treatment dosages and strategies are often ineffective in providing pain relief. This retrospective case-control study reviews 4 years' experience of the Acute Pain Service (APS) at our institution providing care for 202 chronic pain and opioid-consuming...