PAIN MANAGEMENT

*Prepared by Kathy Kessel, Library Service \~ VAMC Northport, NY*

# 

## APRIL 2003

This bibliography on PAIN MANAGEMENT was prepared by Kathy Kessel,
Library Service, VAMC, Northport, NY, as part of a VA Library Network
(VALNET) effort to identify useful published information relating to
trends in health care. This bibliography will be updated monthly. Please
check with your Library Service if you are interested in this resource
or would like to identify other materials specific to your information
needs. Bibliographies prepared for this project are:

> **Chemical/Biological Terrorism**\
> Prepared by Halyna Korhun, Library Service, VAMC, Albany, NY.
>
> **Customer Focused Health Care And Delivery**\
> Prepared by Sandra Brayson, Library Service, VAMC, Portland, OR.
>
> **End Of Life Care**\
> Prepared by June Roullard, Library Service, VAMC, Togus, ME.
>
> **Hepatitis C**\
> Prepared by Barry Powell, Library Service, VAMC, Memphis TN.
>
> **High Performance Development Model (HPDM)**\
> Prepared by Joyce Zarrinnahad, Central Office Library, Washington, DC.
>
> **Patient Education**\
> Prepared by Liz Burns, Library, VAMC, Kansas City, MO.
>
> **Patient Safety\
> **Prepared by Farkhanda Sheikh, Library Service, VAMC, Perry Point,
> MD.
>
> **Post-Traumatic Stress Disorder\
> **Prepared by John Sandstrom, Central Office Library, Washington, DC .
>
> **Veterans Health Care**\
> Prepared by Susan Harker, VAMC, Library Service, Miami, FL .
>
> **Women\'s Health**\
> Prepared by Karen March, Library Service, VAMC, Fayetteville, NC.

Ackelman, B. H., and U. Lindgren. \"Validity and reliability of a
modified version of the neck disability index.\" *Journal of
Rehabilitation Medicine.* 34, no. 6(2002): 284-7 UI 12440803.

The Neck Disability Index was tested for validity and reliability.
Fifty-nine Swedish patients (28 men, 31 women) were included. Twenty
patients were in the acute phase after a neck sprain, 19 had chronic
neck pain and 20 had no neck pain but had other musculoskeletal
symptoms. On 5 occasions, the patients completed the Neck Disability
Index, the Disability Rating Index, the MOS 36-item short-form health
survey, 2 visual analogue scales, for pain and overall activity and some
complementary questions. Levels of sensitivity, test-retest reliability
and validity were acceptable. In order to increase specificity, we
modified the Neck Disability Index by clarifying that the items only
referred to the pain in the neck in 9 of 10 items. Thirty-eight patients
(16 men, 22 women) were included in a study of the modified version.
Twenty patients with acute neck sprain and 18 with other musculoskeletal
symptoms filled out the modified version of the Neck Disability Index,
which provided a more specific measure of disability due to neck pain.

Adams, H. A., et al. \"Postoperative pain management in orthopaedic
patients: no differences in pain score, but improved stress control by
epidural anaesthesia.\" *European Journal of Anaesthesiology.* 19, no.
9(2002): 658-65 UI 12243289.

BACKGROUND AND OBJECTIVE: To investigate the interactions of
postoperative pain and endocrine stress response, three groups of 21
patients each with total knee arthroplasty were compared in a
randomized, prospective design. For postoperative pain management, a
three-in-one block, an epidural catheter analgesia or an intravenous
patient-controlled analgesia was used. METHODS: After standardized
balanced anaesthesia, the pain intensity was measured by a visual
analogue scale (VAS). For detection of epinephrine, norepinephrine,
antidiuretic hormone, adrenocorticotropic hormone and cortisol in the
plasma, blood samples were taken at six time points before and up to 180
min after the start of pain therapy. In addition, systolic arterial
pressure, heart rate, partial arterial oxygen saturation, nausea,
vomiting and satisfaction of the patients were recorded. RESULTS: Within
15 min after the start of pain therapy, VAS in all groups was similarly
reduced from \>40 mm to a range \<10 mm (P \< 0.001). Initially, all
endocrine stress variables exceeded the normal range. Epidural
anaesthesia led to a significant decrease of epinephrine and
norepinephrine concentrations, while an increase was observed in the
group with patient-controlled analgesia, and the decrease in patients
with the three-in-one block was less than in patients receiving epidural
anaesthesia (P = 0.001). Differences in antidiuretic hormone,
adrenocorticotropic hormone and cortisol were less pronounced. Systolic
arterial pressure decreased significantly in all groups, particularly in
patients with epidural anaesthesia. Partial arterial oxygen saturation
and the incidence of nausea and vomiting were comparable. All patients
were satisfied with the methods used. CONCLUSIONS: All methods of pain
management led to sufficient analgesia, but they were not accompanied by
an adequate reduction in endocrine stress response. Thus, postoperative
pain is only a secondary stressor and sufficient analgesia with
subjective well-being does not prove a stress-free state. With regard to
the reduction of sympathoadrenergic stress response, epidural
anaesthesia is superior to the three-in-one block and patient-controlled
analgesia. Epidural anaesthesia is recommended particularly for
high-risk patients with hypertension, coronary heart disease and
diabetes mellitus. In these patients, the reduction of a \'hidden\'
endocrine stress response in addition to prevention of pain is of
special interest.

Adler, L., et al. \"A comparison of once-daily tramadol with normal
release tramadol in the treatment of pain in osteoarthritis.\" *Journal
of Rheumatology.* 29, no. 10(2002): 2196-9 UI 12375333.

OBJECTIVE: To compare the efficacy and tolerability of once daily (OD)
tramadol tablets with normal release tramadol capsules (50 mg) taken 3
or 4 times daily in a multicenter, double blind, double dummy parallel
study. METHODS: Patients with moderate to severe pain due to
osteoarthritis (OA) were recruited from general practice. Following a
titration period of a week, patients were assessed over one month for
the analgesic efficacy and tolerability of the test medications.
RESULTS: Both treatments were shown to be effective. There was no
difference between treatments and both produced good pain control as
shown by clinically relevant decreases from baseline pain scores, low
escape medication use, and sleep disturbance. The efficacy of the OD
tramadol over the 24 h dosing interval was confirmed by the low sleep
disturbance, absence of \"end of dose\" effects in morning pain scores,
and low escape medication use. Of the 279 patients recruited, 140
withdrew, mostly because of adverse events. The adverse event profiles
were typical of opioids and were similar for both treatments.
CONCLUSION: Tramadol OD was at least as effective and well tolerated as
normal release tramadol in the management of OA pain. However, OD
tramadol offers the advantage of a reduced dosing regimen, which is
especially valuable in the elderly population.

Agrawal, V., and M. Tharoor. \"Peribulbar anaesthesia for penetrating
keratoplasty. A case series.\" *Indian Journal of Ophthalmology.* 50,
no. 4(2002): 313-6 UI 12532497.

PURPOSE: To prospectively analyse the efficacy and safety of peribulbar
anaesthesia for penetrating keratoplasty through a noncomparative,
consecutive series. METHODS: One hundred twenty-four (91.1%) of 136
patients undergoing penetrating keratoplasty (PK) from January 1997 to
December 2001, were administered peribulbar anaesthesia. The anaesthetic
mixture consisted 5 ml of lignocaine, bupivacaine, and hyaluronidase (to
avoid evaluation bias) in the peribulbar space. A repeat injection of 3
ml was used if the primary injection was inadequate. Digital ocular
compression was done for 10-15 minutes after the first injection. Each
patient was analysed for degree of akinesia, subjective patient comfort,
analgesia, subjective surgeon comfort, and types of surgical conditions.
RESULTS: The age ranged from 19 to 86 years. Forty-nine of 124 patients
(39.5%) received PK only and remaining 75 patients (60.5%) received
additional procedures. A single injection was sufficient to achieve
adequate akinesia (grade II and III) in 114 (92%) patients and 120 (97%)
of patients were satisfied (graded pain as \< or = grade II). During
surgery, 6 (5%) phakic eyes developed episodes of positive intraocular
pressure and 5 eyes (4%) developed chemosis. There were no other local
or systemic adverse events. The surgeon level comfort was (grade II or
more) 98% (122 of 124). CONCLUSION: One-point, low volume, peribulbar
anaesthesia for penetrating keratoplasty is safe and efficacions.

Ahlgren, E. W., et al. \"Diagnosis of pain with a graduated spinal block
technique.\" *Jama.* 195, no. 10(1966): 813-6 UI 12608162.

The differential spinal examination has been used at Duke University
Medical Center for approximately 15 years in the evaluation of low-back
and lower extremity pain. This is a technique of using increasing
concentrations of procaine hydrochloride to block nerves of various
sizes and degrees of myelinization. With the ever increasing number of
compensation and liability cases, there is a corresponding need for this
type of diagnostic and prognostic test. It is an attempt to give the
physician an objective estimate of the pain. It must be stressed that
this is just another test for diagnostic and prognostic evaluation.
However, initial results seem to indicate that much weight can be placed
on the findings in an attempt to objectively categorize the pain as
being either organic or functional and whether it is medicated by
sensory or sympathetic pathways.

Ahn, S. H., et al. \"Gabapentin effect on neuropathic pain compared
among patients with spinal cord injury and different durations of
symptoms.\" *Spine.* 28, no. 4(2003): 341-6; discussion 346-7 UI
12590206.

STUDY DESIGN: This study evaluated the effect of gabapentin on
neuropathic pain in patients with spinal cord injury. OBJECTIVE: To
compare the effect of gabapentin on neuropathic pain refractory to
conventional analgesics in patients with spinal cord injury and
different durations of symptoms. SUMMARY OF BACKGROUND DATA: Neuropathic
pain in patients with spinal cord injury severely compromises their
quality of life. Gabapentin is a new antiepileptic drug that may
additionally have a role in the treatment of neuropathic pain. So far,
there has been little prospective research investigating the effect of
gabapentin on neuropathic pain in patients after spinal cord injury or
comparing gabapentin-treated patients with varying durations of symptoms
after spinal cord injury. METHODS: The study included 31 patients who
had experienced neuropathic pain associated with spinal cord injury or
cauda equina syndrome. These subjects were divided into two groups.
Group 1 (n = 13) was composed of patients whose duration of pain was
less than 6 months, and Group 2 (n = 18) comprised patients whose
symptoms of neuropathic pain had lasted more than 6 months. Although
these patients had been treated with conventional analgesics such as
antidepressants, anticonvulsants, membrane stabilizer, and neuroleptics,
they reported that their condition did not improve after a medication
trial of at least 2 weeks duration. In this study, conventional
analgesics were continued at a therapeutic level, and gabapentin was
administrated for an 18-day titration period followed by a 5-week
maintenance period at a dosage of 1800 mg/day or the maximum tolerable
dosage. The efficacy of gabapentin administration was gauged by a pain
score and a sleep interference score using a 100-mm visual analogue
scale (VAS) every 2 weeks. The scores of the two groups were compared
every 2 weeks over the course of the 8-week study. RESULTS: The mean
pain score and the mean sleep interference score for Group 1 decreased
more than that of Group 2 during the interval between 2 to 8 weeks (P \<
0.05). The mean pain score for Group 1 decreased from 7.3 +/- 0.5
initially to 3 +/- 0.6 after 8 weeks of treatment, whereas the
corresponding score for Group 2 decreased from 7.6 +/- 0.4 to 5.1 +/-
0.6 ( \< 0.05). The mean sleep interference score for Group 1 decreased
from 5.7 +/- 0.9 initially to 1.8 +/- 0.8 after 8 weeks of treatment,
whereas the corresponding score for Group 2 decreased from 5.9 +/- 0.8
to 4.2 +/- 0.7 (P \< 0.05). As compared with the onset of this study, a
decrease in pain score of 2 or more was reported at the completion of
this study for 11 patients (100%) in Group 1 and 10 (71%) of 14 patients
in Group 2. A decrease of 2 or more in sleep interference scores was
reported for 8 (89%) of 9 patients with sleep interference in Group 1
and for 8 (62%) of 13 patients with sleep interference in Group 2. Some
adverse effects such as somnolence were noted, but they were mild or
moderate in intensity. CONCLUSIONS: Gabapentin may be effective in
decreasing neuropathic pain refractory to conventional analgesics in
some patients with spinal cord injury whose duration of symptoms is less
than 6 months, although those with duration of symptoms longer than 6
months showed a significant decrease as well. The drug is unlikely to
cause serious adverse effects that limit its use in patients with spinal
cord injury.

Amici, E., et al. \"Usefulness of pharmacologic stress echocardiography
for the long-term prognostic assessment of patients with typical versus
atypical chest pain.\" *American Journal of Cardiology.* 91, no.
4(2003): 440-2 UI 12586260.

Anjum, S. N., M. Faisal, and M. S. Butt. \"Avascular necrosis with
complete resorption of the proximal humerus following undisplaced
three-part fracture.\" *Orthopedics.* 25, no. 11(2002): 1288-9 UI
12452349.

Anonymous. \"House calls. Compression fractures in my back have been
causing pain for about a month. Is there anything that can help?\"
*Johns Hopkins Medical Letter, Health After 50.* 14, no. 12(2003): 8 UI
12619613.

Anonymous. \"\[In acute coronary syndrome. Seize platelets with
pliers\].\" *MMW Fortschritte der Medizin.* 144, no. 45(2002): 61 UI
12534069.

Anonymous. \"New treatment for pain caused by bone cancer.\" *Mayo
Clinic Health Letter.* 21, no. 2(2003): 4 UI 12625278.

Arena, J. G. \"Chronic pain: psychological approaches for the front-line
clinician.\" *Journal of Clinical Psychology.* 58, no. 11(2002): 1385-96
UI 12412149.

Many of the techniques and skills the average front-line practitioner
possesses (such as intake, psychological testing, cognitive behavior
therapy, and relaxation therapy) can be readily and effectively applied
to a chronic-pain population. More specialized techniques for pain
reduction, such as biofeedback training, can be easily learned by the
generalist clinician with a minimum of additional training. In this
article, four general steps to assess and reduce chronic pain are
reviewed. Through careful use of the available research literature, and
by consulting with a colleague who has expertise in chronic pain, most
psychologists can straightforwardly begin to help individuals suffering
from chronic pain. Copyright 2002 Wiley Periodicals, Inc.

Arezzo, J. C. \"Possible mechanisms for the effects of botulinum toxin
on pain.\" *Clinical Journal of Pain.* 18, no. 6 Suppl(2002): S125-32 UI
12569959.

The therapeutic effects of botulinum toxin are principally, if not
exclusively, derived from an alteration in the release of acetylcholine
(ACh) at pre-synaptic neurons. The rationale for how these effects could
be beneficial in conditions characterized by excessive muscle
contraction is clear, but the hypotheses regarding botulinum
toxin-induced effects on pain are highly speculative. We explore five
possible mechanisms by which botulinum toxin could directly or
indirectly alter pain, including: 1) changes in the sensitivity and
response patterns of group III and IV muscle nociceptors, 2) diminished
activity in the gamma-motor neurons and consequent changes in muscle
spindle afferents, 3) alterations in cholinergic control of vascular and
autonomic functions, including neurogenic inflammation, 4) induced
neuroplastic changes in the processing of afferent somatosensory
activity at multiple levels of the neuroaxis, and 5) direct
non-cholinergic effects on pain afferents. \[References: 78\]

Argoff, C. E. \"A focused review on the use of botulinum toxins for
neuropathic pain.\" *Clinical Journal of Pain.* 18, no. 6 Suppl(2002):
S177-81 UI 12569966.

Understanding the pathophysiology of a pain syndrome is helpful in
selecting appropriate treatment strategies. Nociceptive pain is related
to damage to tissues due to thermal, chemical, mechanical, or other
types of irritants. Neuropathic pain results from injury to the
peripheral or central nervous system. Common examples of neuropathic
pain include postherpetic neuralgia, diabetic neuropathy, complex
regional pain syndrome, and pain associated with spinal cord injuries.
Nociceptive pain may have similar clinical characteristics to
neuropathic pain. It is also possible for acute nociceptive pain to
become neuropathic in nature, as with myofascial pain syndrome. A clear
benefit of botulinum toxin therapy for treatment of neuropathic pain
disorders is that it often relieves pain symptoms. Although the precise
mechanism of pain relief is not completely understood, the injection of
botulinum toxin may reduce various substances that sensitize
nociceptors. As a result, botulinum toxin types A and B are now being
actively studied in nociceptive and neuropathic pain disorders to better
define their roles as analgesics. \[References: 22\]

Armstrong, D. N. \"Multiple hemorrhoidal ligation: a prospective,
randomized trial evaluating a new technique.\" *Diseases of the Colon &
Rectum.* 46, no. 2(2003): 179-86 UI 12576891.

PURPOSE: A modified anoscope was developed, with lateral apertures at
the left lateral, right anterior, and right posterior quadrants, to
enable synchronous exposure and ligation of all three internal
hemorrhoids. Results were compared with those for conventional multiple
ligation. METHODS: Postligation pain, complications, and outcomes were
compared between synchronous ligation with the new anoscope (synchronous
group) and three-quadrant ligation with a conventional anoscope with
similar overall dimensions (conventional group). RESULTS: Twenty-five
patients were prospectively randomized to each group. Postligation pain
and analgesic requirements were recorded up to 28 days, and postligation
complications and outcomes were evaluated for a minimum of 6 months.
Narcotic requirements were lower in the synchronous group, but this
difference did not achieve statistical significance (P \> 0.05,
Student\'s t-test). Secondary hemorrhage occurred in 1 patient (4
percent) in the conventional group but resolved spontaneously. The
synchronous group experienced significantly less pain during the
ligation procedure and for 2 days afterward (P \< 0.01, Wilcoxon\'s
test). External hemorrhoidal thrombosis developed in 4 percent of the
synchronous group and 12 percent of conventionally treated patients, all
of whom responded to conservative treatment. Repeat ligation was
required less often in the synchronous group (16 percent) than with
conventional ligation (28 percent). Surgery (completion hemorrhoidectomy
for external thrombosis) was necessary in one patient (4 percent) in
each group. Anal stenosis developed in one patient in the synchronous
group. CONCLUSION: The new anoscope provides improved exposure of all
three internal hemorrhoids and permits optimal placement of the rubber
bands; this may account for the decreased postligation pain and lower
repeat ligation rates. Synchronous hemorrhoidal ligation is a less
painful method of multiple hemorrhoidal ligation and may improve
outcomes compared with conventional multiple ligation.

Arokoski, M. H., et al. \"Hip Muscle Strength and Muscle Cross Sectional
Area in Men with and without Hip Osteoarthritis.\" *Journal of
Rheumatology.* 29, no. 10(2002): 2187-95 UI 12375332.

OBJECTIVE: To study the hip muscle strength and cross sectional area
(CSA) in men with hip osteoarthritis (OA) compared to age and sex
matched healthy controls. METHODS: Based on the American College of
Rheumatology criteria regarding classification of hip OA, 27 men (aged
47-64 yrs) with unilateral or bilateral hip OA and 30 age matched
randomly selected healthy male controls were studied. The maximal
isometric hip abductor, adductor, flexor, and extensor strength (Nm) at
0 degree of hip flexion in the supine position was determined with a
dynamometer. The isokinetic hip flexion and extension strength (peak
torque, Nm) was determined using angular velocities of 60 degrees /s and
120 degrees /s. The subjective severity of hip pain was rated by visual
analog scale prior to the muscle strength test. CSA of the pelvic and
thigh muscles was measured from magnetic resonance images. RESULTS: The
reliability of intraclass correlation coefficients for repeated measures
of muscle strength varied from 0.70 to 0.94 in controls and from 0.84 to
0.98 in subjects with OA. Hip isometric adductor and abductor strength
was 25% and 31% lower (p \< 0.001) in OA subjects than in controls,
respectively. The hip isometric and isokinetic flexion strength was
18-22% lower (p \< 0.01) in OA subjects than in controls, but extension
strength did not differ between groups. In OA subjects, the hip flexion
and extension isometric and isokinetic strength values were 13-22% lower
(p \< 0.05) on the more deteriorated side compared to the better side.
CSA of the pelvic and thigh muscles did not differ between the groups.
However, in OA subjects, the CSA of the pelvic and thigh muscles was
6-13% less (p \< 0.05 to \< 0.001) on the more severely affected hip
compared to the better hip. CONCLUSION: Men with hip OA have
significantly lower abduction, adduction, and flexion muscle strength
than controls. The decrease of muscle size and hip pain may contribute
to the decrease of muscle strength in hip OA. Other possible underlying
causes of the muscle weakness need to be studied.

Arokoski, M. H., et al. \"Hip muscle strength and muscle cross sectional
area in men with and without hip osteoarthritis.\" *Journal of
Rheumatology.* 29, no. 10(2002): 2185-95 UI 12375331.

OBJECTIVE: To study the hip muscle strength and cross sectional area
(CSA) in men with hip osteoarthritis (OA) compared to age and sex
matched healthy controls. METHODS: Based on the American College of
Rheumatology criteria regarding classification of hip OA, 27 men (aged
47-64 yrs) with unilateral or bilateral hip OA and 30 age matched
randomly selected healthy male controls were studied. The maximal
isometric hip abductor, adductor, flexor, and extensor strength (Nm) at
0 degree of hip flexion in the supine position was determined with a
dynamometer. The isokinetic hip flexion and extension strength (peak
torque, Nm) was determined using angular velocities of 60 degrees /s and
120 degrees /s. The subjective severity of hip pain was rated by visual
analog scale prior to the muscle strength test. CSA of the pelvic and
thigh muscles was measured from magnetic resonance images. RESULTS: The
reliability of intraclass correlation coefficients for repeated measures
of muscle strength varied from 0.70 to 0.94 in controls and from 0.84 to
0.98 in subjects with OA. Hip isometric adductor and abductor strength
was 25% and 31% lower (p \< 0.001) in OA subjects than in controls,
respectively. The hip isometric and isokinetic flexion strength was
18-22% lower (p \< 0.01) in OA subjects than in controls, but extension
strength did not differ between groups. In OA subjects, the hip flexion
and extension isometric and isokinetic strength values were 13-22% lower
(p \< 0.05) on the more deteriorated side compared to the better side.
CSA of the pelvic and thigh muscles did not differ between the groups.
However, in OA subjects, the CSA of the pelvic and thigh muscles was
6-13% less (p \< 0.05 to \< 0.001) on the more severely affected hip
compared to the better hip. CONCLUSION: Men with hip OA have
significantly lower abduction, adduction, and flexion muscle strength
than controls. The decrease of muscle size and hip pain may contribute
to the decrease of muscle strength in hip OA. Other possible underlying
causes of the muscle weakness need to be studied.

Asahi, M., et al. \"Causative agent of vascular pain among
photodegradation products of dacarbazine.\" *Journal of Pharmacy &
Pharmacology.* 54, no. 8(2002): 1117-22 UI 12195827.

The photodegradation products of the anticancer drug, dacarbazine, cause
adverse reactions including local venous pain when injected
intravenously. In this study, we attempted to identify which of these
products is responsible. We synthesized or purchased five
photodegradation products of dacarbazine (dimethylamine,
5-diazoimidazole-4-carboxamide (Diazo-IC),
4-carbamoylimidazolium-5-olate,
5-carbamoyl-2-(4-carbamoylimidazol-5-ylazo)imidazolium-5-olate and
2-azahypoxanthine) and examined the pain reaction induced by their
intraperitoneal administration in mice using an abdominal stretching or
constriction assay. Only Diazo-IC clearly induced pain reaction in mice
in a dose-dependent manner, the other products caused no pain reaction.
The threshold concentration for pain reaction in mice was estimated to
be about 0.1 mg mL-1. While diclofenac sodium significantly reduced
acetic-acid-induced pain reaction in mice, it did not influence those
induced by Diazo-IC. This result suggests that the mechanism of
Diazo-IC-induced pain is different from that of acetic-acid-induced
inflammatory pain. Dacarbazine itself produced marked relaxation of rat
thoracic aorta strips in a concentration-dependent manner, but there was
no difference between the activity of dacarbazine and its photo-exposed
solution, so constriction or relaxation of blood vessels is unlikely to
be a factor in the pain reaction. In conclusion, Diazo-IC generated by
photodegradation of dacarbazine solution causes the side-effect of
venous pain. Dacarbazine solution that has turned pink should not be
used, because Diazo-IC is an intermediate in the formation of the
reddish product,
5-carbamoyl-2-(4-carbamoylimidazol-5-ylazo)imidazolium-5-olate. Drip
infusion preparations of dacarbazine should be shielded from light.

Beekwilder, J. P., et al. \"Kv1.1 channels of dorsal root ganglion
neurons are inhibited by n-butyl-p-aminobenzoate, a promising anesthetic
for the treatment of chronic pain.\" *Journal of Pharmacology &
Experimental Therapeutics.* 304, no. 2(2003): 531-8 UI 12538804.

In this study, we investigated the effects of the local anesthetic
n-butyl-p-aminobenzoate (BAB) on the delayed rectifier potassium current
of cultured dorsal root ganglion (DRG) neurons using the patch-clamp
technique. The majority of the K(+) current of small DRG neurons rapidly
activates and slowly inactivates at depolarized voltages. BAB inhibited
the whole-cell K(+) current of these neurons with an IC(50) value of 228
microM. Dendrotoxin K (DTX(K)), a specific inhibitor of Kv1.1, reduced
the DRG K(+) current at +20 mV by 34%, consistent with an important
contribution of channels incorporating the Kv1.1 subunit to the delayed
rectifier current. To further investigate the mechanism of BAB
inhibition, we examined its effect on Kv1.1 channels heterologously
expressed in mammalian tsA201 cells. BAB inhibits the Kv1.1 channels
with an IC(50) value of 238 microM, similar to what was observed for the
native DRG current. BAB accelerates the opening and closing of Kv1.1,
but does not alter the midpoint of steady-state activation. BAB seems to
inhibit Kv1.1 by stabilizing closed conformations of the channel.
Coexpression with the Kv beta 1 subunit induces rapid inactivation and
reduces the BAB sensitivity of Kv1.1. Comparison of the heterologously
expressed Kv1.1 and native DRG currents indicates that the Kv beta 1
subunit does not modulate the gating of the DTX(K)-sensitive Kv1.1
channels of DRG neurons. Inhibition of the delayed rectifier current of
these neurons may contribute to the long-duration anesthesia attained
during the epidural administration of BAB.

Belcher, P. R., et al. \"Are we negating the benefits of CABG by
forgetting secondary prevention?\" *Journal of Human Hypertension.* 16,
no. 10(2002): 691-7 UI 12420192.

The objective of the study was to examine medically managed secondary
prevention at one year after coronary artery bypass grafting (CABG). In
all, 214 consecutive patients undergoing isolated elective CABG seen
four weeks preoperatively and one year post-operatively. Preoperative
systolic blood pressure averaged 135+/-20 mmHg, which increased to
148+/-25 mmHg (P\<0.0001) as did diastolic pressure (81+/-12 to 87+/-13
mmHg; P\<0.0001). Anginal symptoms were reported by 45.1% (P\<0.0001)
although median severity scored lower (4.0 \[3.0-5.4\] vs 0 \[0-2.0\];
P\<0.0001). Breathlessness decreased from 93% to 64% (P\<0.0001) and was
scored less severely (4.0 \[2.0-5.0\] vs 2.0 \[0-4.0\]; P\<0.0001. In
all, 88% with postoperative angina reported dyspnoea against 44% of
those without (P\<0.0001). Calcium antagonist use was more common in
patients with angina (27.2% vs 5.1%; P\<0.0001), but not nitrates
(P=0.8695), diuretics (P=0.4218), digoxin (P=0.2565), beta-blockers
(P=0.0820), or ACE inhibitors (P=0.7256). Preoperatively 166 patients
(80.2%) took aspirin vs 69.2% afterwards (P=0.0131). Twelve patients
(6.5%) received warfarin after operation vs none preoperatively. Two
took digoxin (0.97%) preoperatively and 14 (7.7%) postoperatively
(P=0.001) for chronic atrial fibrillation. One of these took warfarin.
Long-acting nitrate use fell from 63.4% to 15.8% (P \<0.0001).
Short-acting nitrate use fell similarly (P\<0.0001). Preoperatively 37
patients (17.9%) took ACE inhibitors vs 44 postoperatively (24.2%); 39
had not received them before. Preoperatively 48 (23.2%) took diuretics
vs 30 (16.5%) postoperatively (P=0.127); 24 had not previously taken
diuretics. More patients took HMGCoA inhibitors postoperatively
(P=0.0068) and total cholesterol was significantly reduced with a
concomitant increase in HDL fraction. Smoking habit was virtually
unchanged from 17.8% to 15.1% (P=0.5023). In conclusion: angina was
common. Apart from statin prescribing, postoperative secondary
prevention measures were poorly applied, less widespread and less
effective than preoperatively. The implications are disturbing.

Bennett, W. F. \"Arthroscopic repair of anterosuperior
(supraspinatus/subscapularis) rotator cuff tears: a prospective cohort
with 2- to 4-year follow-up. Classification of biceps
subluxation/instability.\" *Arthroscopy.* 19, no. 1(2003): 21-33 UI
12522399.

PURPOSE: The purpose of this study was to evaluate the outcome of
patients who underwent arthroscopic repair of anterosuperior rotator
cuff tears. The null hypothesis, that there was no difference between
preoperative scores and postoperative scores, was tested statistically.
TYPE OF STUDY: A cohort study. METHODS: The preoperative and
postoperative status of patients with anterosuperior rotator cuff tears
was analyzed using the Constant score, American Shoulder and Elbow
Society Index (ASES Index), a visual analog pain scale (VAS), a single
question of percent function compared with the opposite unaffected
extremity, and a single question reflecting satisfaction, \"would you
undergo the surgery and the postoperative rehabilitation to achieve the
result you have today.\" There were also 2 groups compared: 1 that had a
\"tac\" used for repair of the subscapularis tendon, and the other that
used a \"tie\" technique for subscapularis repair. All supraspinatus
tendon tears were complete and were repaired using a soft-tissue
fixation device. RESULTS: There was a statistically significant
difference for all outcome measures except for the objective Constant
score of the tie group, P =.58. Follow-up was 2 to 4 years. There were
no differences based on sex or type of fixation device used for repair
of the subscapularis tendon. There were no reruptures, clinically.
CONCLUSIONS: The arthroscopic repair of anterosuperior rotator cuff
tears provides reliable expectation for improvement in function,
decreases in pain, decreases in clinical findings of biceps subluxation
and inflammation, improvement in shoulder scores, and the improvement of
clinical findings of subscapularis insufficiency.

Berlet, G. C., et al. \"A prospective trial of night splinting in the
treatment of recalcitrant plantar fasciitis: the Ankle Dorsiflexion
Dynasplint.\" *Orthopedics.* 25, no. 11(2002): 1273-5 UI 12452346.

Twelve patients were treated with the Ankle Dorsiflexion Dynasplint
(Dynasplint Systems Inc, Severna, Md) for recalcitrant plantar
fasciittis. Using a modified plantar fasciitis functional assessment
scale and a visual analog pain assessment scale for evaluation, 75% of
patients reported improvement ofsymptoms at 1-month follow-up. The
average percentage of weekly sleeping hours spent in the splint was 95%.
There was no tendency to deterioration of results by 6 months
postsplinting. The Ankle Dorsiflexion Dynasplint is effective in the
treatment of recalcitrant heel pain in a majority of patients. This
study supports its use for the treatment of recalcitrant plantar
fasciitis.

Bigal, M. E., C. A. Bordini, and J. G. Speciali. \"Intravenous dipyrone
for the acute treatment of episodic tension-type headache: a randomized,
placebo-controlled, double-blind study.\" *Brazilian Journal of Medical
& Biological Research.* 35, no. 10(2002): 1139-45 UI 12424485.

Acute headaches are responsible for a significant percentage of the case
load at primary care units and emergency rooms in Brazil. Dipyrone
(metamizol) is easily available in these settings, being the most
frequently used drug. We conducted a randomized, placebo-controlled,
double-blind study to assess the effect of dipyrone in the acute
treatment of episodic tension-type headache. Sixty patients were
randomized to receive placebo (intravenous injection of 10 ml saline) or
1 g dipyrone in 10 ml saline. We used seven parameters of analgesic
evaluation. The patients receiving dipyrone showed a statistically
significant improvement (P\<0.05) of pain compared to placebo up to 30
min after drug administration. The therapeutic gain was 30% in 30 min
and 40% in 60 min. The number of patients needed to be treated for at
least one to have benefit was 3.3 in 30 min and 2.2 in 60 min. There
were statistically significant reductions in the recurrence (dipyrone =
25%, placebo = 50%) and use of rescue medication (dipyrone = 20%,
placebo = 47.6%) for the dipyrone group. Intravenous dipyrone is an
effective drug for the relief of pain in tension-type headache and its
use is justified in the emergency room setting.

Birrell, F., et al. \"Predictors of hip joint replacement in new
attenders in primary care with hip pain.\" *British Journal of General
Practice.* 53, no. 486(2003): 26-30 UI 12564273.

BACKGROUND: Studies investigating the factors associated with need for
total hip replacement should ideally be based on prospective
investigation of new attenders in primary care. AIM: To determine the
incidence of listing for total hip replacement, and its predictors,
among attenders in primary care with a new episode of hip pain. DESIGN
OF STUDY: Prospective multicentre cohort study. SETTING: One hundred and
ninety-five patients (mean age = 63 years, 68% female) with new episode
of hip pain, attending primary care between November 1994 and October
1997. At the first visit, patients were evaluated for indices of pain
and disability, range of hip movement, and radiographic changes of
osteoarthritis. METHOD: General practitioner participants were recruited
from the membership of the Primary Care Rheumatology Society to recruit
all consecutive attenders with a new episode of hip pain. Annual
follow-up was carried out to determine which patients were being \'put
on a waiting list\' for total hip replacement. RESULTS: Seven per cent
of patients were put on a waiting list for total hip replacement within
12 months and 23% of patients within four years. At presentation, pain
duration, pain severity, (including the need to use a stick) and
restriction of internal rotation were the major clinical predictors of
being put on a waiting list. Radiographic predictors of osteoarthritis
performed similarly to the clinical measures. A simple scoring system
based on both radiographic severity and two of the clinical measures was
derived that identified groups at high likelihood of being put on a
waiting list (sensitivity = 76%) with a low false-positive rate
(specificity = 95%). CONCLUSION: New primary care attenders with pain
are frequently accepted for total hip replacement soon after their first
attendance\--a decision that can be predicted by simple clinical
measures.

Black, P., et al. \"A randomized, double-blind, placebo-controlled
comparison of the analgesic efficacy, onset of action, and tolerability
of ibuprofen arginate and ibuprofen in postoperative dental pain.\"
*Clinical Therapeutics.* 24, no. 7(2002): 1072-89 UI 12182253.

BACKGROUND: Because of its enhanced pharmacokinetic characteristics,
ibuprofen arginate might be expected to provide faster pain relief than
standard ibuprofen formulations in patients experiencing acute pain.
OBJECTIVE: This study assessed the analgesic efficacy, speed of onset,
and tolerability of ibuprofen arginate compared with a commercially
available form of ibuprofen in patients with postoperative dental pain.
METHODS: Patients were randomized to receive ibuprofen arginate 200 or
400 mg, ibuprofen 200 or 400 mg, or placebo in this multicenter,
double-blind, double-dummy, parallel-group trial. Patients were observed
for 6 hours after administration of a single dose of study medication. A
repeated-dose, open-label phase followed. Pain intensity and pain relief
were measured using traditional verbal descriptor scales; onset of
analgesia was assessed using 2 stopwatches to measure the time to
achievement of specific pain relief criteria. RESULTS: A total of 498
patients (219 men, 279 women; mean age, 21.5 years) participated in this
study. Baseline pain was moderate in 388 patients (78%) and severe in
110 patients (22%). Meaningful pain relief was reached after a median of
29 and 28 minutes with ibuprofen arginate 200 and 400 mg, respectively,
and after 52 and 44 minutes with ibuprofen 200 and 400 mg, respectively
(all, P \< 0.05). The percentages of patients who achieved meaningful
pain relief within the first hour after treatment were 77.6% and 83.7%
for ibuprofen arginate 200 and 400 mg, respectively, 61.0% and 63.0% for
ibuprofen 200 and 400 mg, respectively, and 39.8% for placebo. The
differences between ibuprofen arginate and ibuprofen were statistically
significant (both doses, P \< 0.05). Significantly greater numbers of
patients achieved meaningful pain relief with ibuprofen arginate 400 mg
compared with placebo from 20 minutes through 6 hours and with ibuprofen
arginate 200 mg from 30 minutes through 6 hours (P \< 0.05). Compared
with placebo, a greater number of patients achieved meaningful pain
relief with ibuprofen 400 mg from 45 minutes through 6 hours; with
ibuprofen 200 mg. the corresponding interval was from I through 6 hours.
After the first hour, pain reduction was similar for the similar doses
of the 2 ibuprofen preparations. Median remedication times with both
doses of ibuprofen arginate were similar to those with both doses of
ibuprofen, ranging from 4.0 to 5.2 hours. Adverse-event profiles were
similar between the 2 active medications. CONCLUSIONS: Ibuprofen
arginate was effective in this population of patients experiencing
moderate to severe pain after surgical extraction of \> or = 1 impacted
third molar, with 16 to 24 minutes\' faster time to meaningful pain
relief than with ibuprofen. The 2 formulations had similar tolerability
profiles.

Boker, A., L. Brownell, and N. Donen. \"The Amsterdam preoperative
anxiety and information scale provides a simple and reliable measure of
preoperative anxiety.\" *Canadian Journal of Anaesthesia.* 49, no.
8(2002): 792-8 UI 12374706.

PURPOSE: To compare three anxiety scales; the anxiety visual analogue
scale (VAS), the anxiety component of the Amsterdam preoperative anxiety
and information scale (APAIS), and the state portion of the Spielburger
state-trait anxiety inventory (STAI), for assessment of preoperative
anxiety levels in same day admission patients. METHODS: Patients
completed the three anxiety assessment scales both before and after
seeing the anesthesiologist preoperatively. The scales used were the
STAI, the six-question APAIS, and the VAS. APAIS was further subdivided
to assess anxiety about anesthesia (sum A), anxiety about surgery (sum
S) and a combined anxiety total (i.e., sum C = sum A + sum S). These
scales were compared to one another. Pearson\'s correlation (pair-wise
deletion) was used for validity testing. Cronbach\'s alpha analysis was
used to test internal validity of the various components of the APAIS
scale. A correlation co-efficient (r) \> or = 0.6 and P \< 0.05 were
considered significant. RESULTS: Four hundred and sixty three scale sets
were completed by 197 patients. There was significant and positive
correlation between VAS and STAI r = 0.64, P \< 0.001), VAS and APAIS r
= 0.6, P \< 0.001), sum C and STAI r = 0.63, P \< 0.001) and between VAS
and sum C r = 0.61, P \< 0.001). Sum C and STAI r value were consistent
with repeated administration. Cronbach\'s alpha-levels for the anxiety
components of the APAIS (sum C) and desire for information were 0.84 and
0.77 respectively. CONCLUSION: In addition to VAS, the anxiety component
of APAIS (sum C) is a promising new practical tool to assess
preoperative patient anxiety levels.

Borer, J. S., et al. \"Antianginal and antiischemic effects of
ivabradine, an I(f) inhibitor, in stable angina: a randomized,
double-blind, multicentered, placebo-controlled trial.\" *Circulation.*
107, no. 6(2003): 817-23 UI 12591750.

BACKGROUND: Heart rate reduction should benefit patients with chronic
stable angina by improving myocardial perfusion and reducing myocardial
oxygen demand. This study evaluated the antianginal and antiischemic
effects of ivabradine, a new heart rate-lowering agent that acts
specifically on the sinoatrial node. METHODS AND RESULTS: In a
double-blind, placebo-controlled trial, 360 patients with a \> or
=3-month history of chronic stable angina were randomly assigned to
receive ivabradine (2.5, 5, or 10 mg BID) or placebo for 2 weeks,
followed by an open-label 2- or 3-month extension on ivabradine (10 mg
BID) and a 1-week randomized withdrawal to ivabradine (10 mg BID) or
placebo. Primary efficacy criteria were changes in time to 1-mm
ST-segment depression and time to limiting angina during bicycle
exercise (exercise tolerance tests), performed at trough of drug
activity. In the per-protocol population (n=257), time to 1-mm
ST-segment depression increased in the 5 and 10 mg BID groups
(P\<0.005); time to limiting angina increased in the 10 mg BID group
(P\<0.05). Deterioration in all exercise tolerance test parameters
occurred in patients who received placebo during randomized withdrawal
(all P\<0.02) but not in those still receiving ivabradine. No rebound
phenomena were observed on treatment cessation. CONCLUSIONS: Ivabradine
produces dose-dependent improvements in exercise tolerance and time to
development of ischemia during exercise. These results suggest that
ivabradine, representing a novel class of antianginal drugs, is
effective and safe during 3 months of use; longer-term safety requires
additional assessment.

Braham, R., B. Dawson, and C. Goodman. \"The effect of glucosamine
supplementation on people experiencing regular knee pain.\" *British
Journal of Sports Medicine.* 37, no. 1(2003): 45-9; discussion 49 UI
12547742.

OBJECTIVE: The purpose of this study was to examine the effects of oral
glucosamine supplementation on the functional ability and degree of pain
felt by individuals who had regular knee pain, most likely due to
previous articular cartilage damage, and possibly osteoarthritis.
METHODS: Subjects were randomly supplemented with either glucosamine (G)
(n=24) or placebo (P) (lactose) (n=22) for 12 weeks at a dose of 2,000
mg per day. Over this period, four testing sessions were conducted, with
changes in knee pain and function assessed by clinical and functional
tests, (joint line palpation, a 3 metre \"duck walk\" and a repeated,
walking stair climb), two questionnaires (the Knee Injury and
Osteoarthritis Outcome Score (KOOS) and the Knee Pain Scale (KPS)) and
participant subjective evaluations. RESULTS: The clinical and functional
test scores improved with time (main effects: p\<0.05, p\<0.01) but
there were no significant differences between the two groups. The
questionnaire results also recorded a significant main effect for time
(p\<0.05), but the glucosamine group was found to have significantly
better KOOS quality of life scores at week eight and 12 (p\<0.05), and
lower KPS scores (p\<0.05) at week eight than the placebo group. On self
report evaluations of changes across the 12 week supplementation period,
88% (n=21) of the glucosamine group reported some degree of improvement
in their knee pain versus only 17% (n=3) in the placebo group.
CONCLUSIONS: These results suggest that glucosamine supplementation can
provide some degree of pain relief and improved function in persons who
experience regular knee pain, which may be caused by prior cartilage
injury and/or osteoarthritis. The trends in the results also suggest
that, at a dosage of 2,000 mg per day, the majority of improvements are
present after eight weeks.

Bresnihan, B. \"Preventing joint damage as the best measure of biologic
drug therapy.\" *Journal of Rheumatology - Supplement.* 65(2002): 39-43
UI 12236622.

Joint damage occurs progressively in patients with rheumatoid arthritis
(RA), leading to functional decline and disability. The proinflammatory
cytokines interleukin 1 (IL-1) and tumor necrosis factor-alpha
(TNF-alpha) are thought to play a key role in promoting cartilage and
bone erosion in the rheumatoid joint. In randomized clinical trials,
inhibitors of these cytokines significantly slowed the rate of
progressive joint damage as assessed by radiographic techniques. The
IL-1 receptor antagonist anakinra significantly reduced erosions, joint
space narrowing, and total joint damage when a modified Sharp score was
used to evaluate serial hand radiographs. The maximum benefit of
anakinra on joint space narrowing was achieved within the first 24 weeks
and was maintained during continued treatment, whereas the slowing of
erosions by anakinra increased with continued treatment beyond 24 weeks.
In terms of TNF-alpha inhibition, infliximab significantly reduced joint
damage in patients with long-standing RA, when used in combination with
methotrexate (MTX), whereas etanercept significantly reduced erosions
relative to MTX in patients with early stage disease. Comparisons among
the cytokine inhibitors are made problematic by differences in the
designs, patient populations, and outcome measures of these trials.
Nevertheless, these studies demonstrate that IL-1 or TNF-alpha
inhibition effectively suppresses the pathophysiological mechanisms
associated with cartilage degradation and bone erosion, resulting in a
slowing of further radiographic progression. \[References: 16\]

Briggs, E. \"The nursing management of pain in older people.\" *Nursing
Standard.* 17, no. 18(2003): 47-53; quiz 54-5 UI 12599983.

This article examines the complex skills nurses need to manage pain in
older people and the tools that can help quantify a subjective
experience. It also examines the pharmacological management of pain and
non-pharmacological approaches that can support analgesia and help
reduce pain. \[References: 39\]

Brocq, O., et al. \"Hip osteoarthritis: short-term efficacy and safety
of viscosupplementation by hylan G-F 20. An open-label study in 22
patients.\" *Joint, Bone, Spine: Revue du Rhumatisme.* 69, no. 4(2002):
388-91 UI 12184436.

We studied the short-term safety and efficacy of intraarticular hylan
G-F 20 (Synvisc) in patients with symptomatic hip osteoarthritis.
METHODS: In this open-label prospective study, patients who had hip
osteoarthritis with a visual analog pain scale score greaterthan 40/100
and a Lequesne index greater than 6 received one or two intra-articular
injections of hylan G-F 20 under fluoroscopic guidance. The patients
were evaluated once a month. A response was defined as a 50% decrease in
the Lequesne score after 1 month as compared to baseline. RESULTS:
Thirty injections were performed in 22 patients with a mean age of 54
years. The response rate was 50% (11/22) after the first injection. Five
of the 11 patients who failed to respond to the first injection received
a second injection on day 30; two had a response, yielding a cumulative
response rate of 13/22. In the six patients followed up for more than 6
months, the improvement was sustained. Short-term safety was
satisfactory, with a self-limited exacerbation of pain during the first
few days in three patients but no infections or other side effects.

Buchner, M., and D. Sabo. \"Ankle fusion attributable to posttraumatic
arthrosis: a long-term followup of 48 patients.\" *Clinical Orthopaedics
& Related Research.*, no. 406(2003): 155-64 UI 12579015.

The subjective, clinical, functional, and radiologic long-term results
of 48 patients after tibiotalar arthrodesis done for posttraumatic and
isolated arthrosis of the ankle are reported. After an average followup
of 9.3 years, good and very good results were achieved in 92% for
subjective parameters and in 73% for clinical and functional parameters
as reflected in the American Orthopaedic Foot and Ankle Society ankle
and hindfoot score. Fusion of the ankle in a position greater than 5
degrees plantar flexion was correlated with a worse late clinical
outcome monitored by the American Orthopaedic Foot and Ankle Society
ankle and hindfoot score. At the followup, average tarsal mobility in
the surgically treated foot was reduced to 54% of the contralateral side
and that loss of tarsal mobility led to a poorer clinical outcome.
However, a high incidence of subsequent arthrosis in the adjacent joints
of the foot seems not to be completely avoidable in the long-term. The
subtalar joint had moderate and severe arthrosis in 47% of patients.
Long-term outcome was worse in these patients compared with patients
with mild or without degenerative changes in this joint. The current
study justifies the value of ankle fusion as a surgical treatment option
in patients with end-stage arthrosis in the ankle, provided precise
intraoperative positioning of the arthrodesis and the importance of the
subtalar joint, are given due consideration.

Burton, R. I., R. M. Campolattaro, and P. J. Ronchetti. \"Volar plate
arthroplasty for osteoarthritis of the proximal interphalangeal joint: a
preliminary report.\" *Journal of Hand Surgery - American Volume.* 27,
no. 6(2002): 1065-72 UI 12457359.

Osteoarthritis of the hand, including involvement of the proximal
interphalangeal joint, is common in the aging population. The purpose of
this study is to provide a preliminary retrospective report on 12 volar
plate arthroplasties in 9 patients who had volar plate advancement
arthroplasty for osteoarthritis of the proximal interphalangeal joint.
The average age of the patients was 67.6 years. All of the patients\'
data were obtained from office notes and hand therapy assessment sheets.
The average time from surgery to follow-up evaluation was 36.5 months.
All patients had significant pain relief. Range of motion was
maintained; there was no significant difference between preoperative and
final arc of motion values. Preoperative pinch and grip strengths did
not differ significantly from the final values. Postoperative position
was similar to preoperative angulation, with recognized lateral
stability. Our results suggest that volar plate advancement arthroplasty
represents a good primary surgical therapeutic option for the
osteoarthritic proximal interphalangeal joint, providing pain relief
while preserving motion, strength, and stability.

Carasso, S., and W. Markiewicz. \"Medical treatment of patients with
stable angina pectoris referred for coronary angiography: failure of
treatment or failure to treat.\" *Clinical Cardiology.* 25, no. 9(2002):
436-41 UI 12269523.

BACKGROUND: Patients referred for elective coronary arteriography
because of stable angina pectoris frequently do not receive appropriate
medical therapy prior to arteriography. Persistence of symptoms due to
lack of appropriate therapy may influence the decision to catheterize
and the treatment chosen following catheterization. HYPOTHESIS: The
present study evaluates whether patients with stable angina pectoris
referred for cardiac catheterization received optimal therapy prior to
the procedure. We also evaluated whether medical therapy was optimized
as a result of the hospitalization for catheterization. METHODS: We
evaluated prospectively the adequacy of medical therapy in 333
consecutive patients undergoing elective coronary arteriography. Of
these, 160 had stable angina pectoris as their main problem and
constituted the study group. RESULTS: Mean duration of angina was 7.5
+/- 6.3 months. Canadian Cardiovascular Society angina grade 1 was
present in 20, grade 2 in 77, grade 3 or 4 in 63 patients. Arteriography
showed a \> or = 50% coronary stenosis in 141 of 160 patients. Aspirin
was used by 96%, and 86% received at least one drug aimed at relieving
anginal symptoms: beta blockers in 69%, calcium blockers in 30%, and
long-acting nitrates in 29%. Antianginal drugs and drugs aimed at
treating risk factors were usually taken at a low, subtherapeutic
dosage. Only 35 of 110 patients taking beta blockers had a resting heart
rate of \<60/min. Following catheterization, 88 of 141 patients with
coronary stenosis of \> or = 50% underwent percutanous intervention and
5 had urgent surgery. Optimization of treatment was advised in only 7 of
48 patients for whom medical therapy or elective surgery was
recommended. CONCLUSION: Patients with stable angina pectoris are
frequently referred for cardiac catheterization without making a serious
attempt to control their symptoms by medical therapy. Risk factors are
undertreated. With proper pharmacotherapy, many patients might have
become asymptomatic and have chosen not to undergo catheterization and
subsequent percutaneous interventions.

Carey, T. S., and J. M. Garrett. \"The relation of race to outcomes and
the use of health care services for acute low back pain.\" *Spine.* 28,
no. 4(2003): 390-4 UI 12590217.

STUDY DESIGN: Four strata of randomly selected health care providers in
North Carolina (primary care MDs, Doctors of Chiropractic, orthopedic
surgeons, and group model HMO primary care providers) enrolled 1633
consecutive patients with low back pain into a cohort study. OBJECTIVE:
To determine whether race had an independent effect on rate of recovery
from low back pain, and whether there was any racial disparity in the
treatments provided to patients with low back pain. SUMMARY OF
BACKGROUND DATA: Little research to date has examined the relation
between patient race and recovery from an episode of acute low back
pain. METHODS: Consecutive patients were enrolled in the provider\'s
office and contacted by telephone at baseline, at 2, 4, 8, 12, and 24
weeks, and at 22 months. RESULTS: Blacks (n = 238) at baseline had
higher pain scores on a 10-point scale (5.92 vs 5.25; P\< 0.01) and
worse functional disability (12.1 vs 11; P= 0.04), as assessed by the
23-point Roland-Morris scale, yet were considered by their health
provider as having less severe pain and less likely to have disc disease
than white patients (P \< 0.05 for all comparisons). Blacks had worse
functional disability at most follow-up interviews. Blacks were shown to
be less likely to receive radiographs (49% vs 40%) or advanced imaging
studies (10% vs 6%), even after controlling for income, education,
baseline severity of low back pain, and insurance status (P \< 0.05).
Doctors of Chiropractic had different practice approaches than MDs, and
there was an interaction with patient race. CONCLUSIONS: The relation of
patient race to outcomes from and care for low back pain is complex.
Blacks have slightly worse functional status than whites on presentation
and at follow-up assessment. Blacks receive less intense diagnostic and
treatment approaches from MDs, although the severity of their impairment
is at least as great.

Carli, G., et al. \"Reactivity to superficial and deep stimuli in
patients with chronic musculoskeletal pain.\" *Pain.* 100, no. 3(2002):
259-69 UI 12467997.

In this study, we evaluated pain sensitivity in patients with
fibromyalgia or other types of chronic, diffuse musculoskeletal pain to
establish whether fibromyalgia represents the end of a continuum of
dysfunction in the nociceptive system. One hundred and forty five
patients and 22 healthy subjects (HS) completed an epidemiological
questionnaire to provide information about fatigue, stiffness, sleep,
the intensity of pain (VAS 0-100) and its extent both at onset and at
present. Algometry was performed at all American College of Rheumatology
(ACR) tender points and at ten control points. Patients were divided
into five main groups: fibromyalgia (FS) patients, secondary-concomitant
fibromyalgia (SCFS) patients, patients with widespread pain (WP) but not
reaching the ACR criterion of 11 tender points, patients with diffuse
multiregional pain (MP) not reaching the ACR criteria (widespread pain,
tender point counts), and patients with multiregional pain associated
with at least 11 tender points (MPTE). von Frey monofilaments were used
to assess superficial punctate pressure pain thresholds. Heat and cold
pain thresholds were determined with a thermal stimulator. Ischemic pain
was assessed by the cold pressure test and the submaximal effort
tourniquet test. The scores for stiffness and present pain intensity
gradually increased concomitantly with the increase in tender point
count and pain extent. The pressure pain thresholds for positive tender
and positive control points were significantly lower in the SCFS, FS and
MPTE groups than in HS, MP and WP groups, the latter three groups
displaying similar values. In all groups, there were no differences in
pain thresholds between positive tender and positive control points. The
heat pain threshold and the pain threshold in the cold pressure test
were lower in the FS and SCFS groups than in HS. The cold pressure
tolerance was lower in patients with widespread pain than in HS. In the
von Frey test, all patient groups except MP had similar values, which
were significantly lower than in HS. Finally, all patient groups
displayed lower tourniquet tolerance than HS. In each psychophysical
test, patients with widespread pain and patients with multiregional pain
showed similar thresholds; however, the thresholds in the MP or MPTE
groups differed from those in the FS and SCFS groups. In the FS group,
pain thresholds and pain tolerance did not differ according to the
presence of ongoing pain at the stimulated site and were not correlated
to ongoing pain. The results indicate that dysfunction in the
nociceptive system is already present in patients with multiregional
pain with a low tender point count; it becomes more and more severe as
the positive tender point count and pain extent increase and it is
maximal in fibromyalgia patients.

Casarett, D., et al. \"Obtaining informed consent for cancer pain
research: do patients with advanced cancer and patients with chronic
pain have different concerns?\" *Journal of Pain & Symptom Management.*
24, no. 5(2002): 506-16 UI 12547050.

To explore the factors that patients with malignant and nonmalignant
pain consider when deciding whether to enroll in pain research studies,
determine whether their views are different, and determine whether
willingness to enroll in research is associated with pain severity,
semi-structured interviews were conducted with 80 patients (cancer pain:
n = 40; chronic nonmalignant pain: n = 40). The risks and potential
benefits that were important to patients with cancer were the same as
those that were important to patients with chronic pain. Willingness to
enroll in research was associated with pain severity (Spearman rho =
0.33; P = 0.041) in patients with chronic pain, but not in patients with
cancer pain. Patients with cancer pain do not have different concerns
than chronic pain patients do. Although chronic pain patients\'
willingness to enroll in research was related to pain severity and a
desire for better pain management, cancer patients\' willingness to
enroll was not.

Chang, P. F., L. Arendt-Nielsen, and A. C. Chen. \"Differential cerebral
responses to aversive auditory arousal versus muscle pain: specific EEG
patterns are associated with human pain processing.\" *Experimental
Brain Research.* 147, no. 3(2002): 387-93 UI 12428146.

The specificity of electroencephalogram (EEG) activity in relation to
processing of human pain needs further elucidation. This study was
designed to determine if nociceptive input and general arousal responses
to external stimulation exert different effects on EEG activity.
Continuous aversive auditory stimuli (90 dB for 2 min) and painful
injection of hypertonic saline (5.8%, 0.2 ml) into the left
brachioradialis muscle were administered to 12 male subjects during
separate sessions in a counterbalanced design. Intensity, arousal and
unpleasantness were assessed during the muscle pain and auditory
stimulation using a visual analogue scale and arousal-affective scales.
The EEG data (32 channels) was acquired before, during and after
application of painful and aversive auditory stimuli. Aversive auditory
stimulation and intramuscular injection of hypertonic saline induced
similar degrees of arousal and unpleasantness associated with a
similarity of intensity of sensation of pain and auditory sensation.
However, muscle pain induced a significant decrease of alpha-1 activity
(8-14 Hz) at T6, PC2, PC6, Pz, P4, O2 and POz sites compared to the
baseline, but aversive auditory stimulation did not produce any
significant changes in alpha-1 activity compared to baseline. The
alpha-1 EEG powers at P3, Pz, P4, PC1, PC2 and POz, and alpha-2 at Pz
and POz sites were significantly decreased during muscle pain when
compared with aversive noise stimulation. These results indicate that
specific EEG patterns are associated with human pain processing.

Chang, V. T., S. S. Hwang, and B. Kasimis. \"Longitudinal documentation
of cancer pain management outcomes: a pilot study at a VA medical
center.\" *Journal of Pain & Symptom Management.* 24, no. 5(2002):
494-505 UI 12547049.

We measured pain outcomes in a cohort of patients with cancer pain in a
general hematology/oncology setting at a Veterans Administration Medical
center (VA). The outcomes included pain relief, pain severity, changes
in pain severity, interference scores, symptom distress, quality of life
(QOL), and satisfaction. Seventy-four (74) consecutive patients with
worst cancer-related pain equal to or greater than 4/10 were recruited.
Cancer pain diagnoses were made and the cancer pain management
guidelines of the United States Agency for Health Care Policy and
Research were followed. Patients were followed weekly using the Brief
Pain Inventory (BPI), medication diary, satisfaction questionnaire,
visual analogue quality of life scale (VASQOL) and record of side
effects for 3 weeks. The Functional Assessment of Cancer Therapy
(FACT-G) and Memorial Symptom Assessment Scale Short Form (MSAS-SF) were
used at initial and final interviews. The mean initial worst pain
severity was 8.3 (range 4-10) and mean pain relief was 40% (range
0-100). By week 1, the majority of patients achieved pain relief of
\>/=80%, with a corresponding decrease in worst pain severity and pain
interference scores. Pain continued to decrease over three weeks. At
week 3, there was a significant improvement in the MSAS-SF psychological
symptom distress subscale (P = 0.02). The average number of
opioid-related side effects was 5 and remained steady over time. Most
patients felt \"quite a bit\" or \"very much\" satisfied at all weeks.
There was a significant improvement in VASQOL (P \< 0.005) and in FACTG
SUMQOL scores (P = 0.007). This experience demonstrates that cancer pain
management can result in measurable and significant changes in pain
relief, pain severity, pain interference scores, psychological symptom
distress, and QOL scores.

Charalambous, C., et al. \"Weight bearing following intra-articular
steroid injection of the knee: survey of current practice and review of
the available evidence.\" *Rheumatology International.* 22, no. 5(2002):
185-7 UI 12215863.

INTRODUCTION: Intra-articular steroid therapy is one of the most common
clinical procedures performed by rheumatologists. There is wide
variation in the postoperative instructions given to patients following
such injections. AIM: The aim of this study was to determine what advice
is given with regards to non-weight-bearing following steroid injections
of the knee by rheumatologists, orthopaedic surgeons, and general
practitioners (GPs). METHOD: A questionnaire examining advice on
non-weight-bearing following knee steroid injections was posted to 100
rheumatologists, 100 orthopaedic surgeons, and 50 GPs. RESULTS: A
significant proportion of respondents advised patients to avoid weight
bearing after injection (42.4%). Most of these advised patients to do so
for one (16.3%) or two (25.1%) days. As compared to 57.1% of general
practitioners and 2.8% of orthopaedic surgeons, 70.7% of rheumatologists
advised patients to avoid weight bearing (P \< 0.05). CONCLUSION: A
significant proportion of rheumatologists and general practitioners
performing steroid injections of the knee advise patients not to
weight-bear postinjection. Examination of the available literature fails
to reveal strong evidence to support such a practice, which has
potentially significant implications with regards to loss of working
days, costs of mobility aids, and patient inconvenience.

Cheah, P. Y., et al. \"Terazosin therapy for chronic prostatitis/chronic
pelvic pain syndrome: a randomized, placebo controlled
trial.\[comment\].\" *Journal of Urology.* 169, no. 2(2003): 592-6 UI
12544314.

PURPOSE: We evaluate terazosin therapy for chronic prostatitis/chronic
pelvic pain syndrome. MATERIALS AND METHODS: The study included 100, 20
to-50-year-old subjects who met the consensus criteria for chronic
prostatitis/chronic pelvic pain syndrome and had not received previous
alpha-blockers. Subjects were randomized to receive terazosin with dose
escalation from 1 to 5 mg. daily or placebo for 14 weeks. The primary
criterion for response was scoring 2 or less (\"delighted-to-mostly
satisfied\") on the National Institutes of Health Chronic Prostatitis
Symptom Index (NIH-CPSI) quality of life item. The secondary criterion
for response was greater than 50% reduction in NIH-CPSI pain score at 14
weeks. Other outcomes included total and NIH-CPSI domain scores,
International Prostate Symptom Score, peak urinary flow rate, post-void
residual urine and adverse effects. RESULTS: Using the primary criterion
24 of 43 evaluable subjects (56%) responded in the terazosin group
compared to 14 of 43 (36%) in the placebo group (p = 0.03). Using the
secondary criterion 26 of 43 subjects (60%) responded in the terazosin
group compared to 16 of 43 (37%) in the placebo group (p = 0.03). The
terazosin group had greater reductions (p \<0.05) in NIH-CPSI total
score, individual domain scores and International Prostate Symptom Score
than the placebo group. There was no difference in peak urinary flow
rate or post-void residual. In the terazosin group 18 patients (42%) had
side effects compared to 9 (21%) in the placebo group (p = 0.04).
CONCLUSIONS: Terazosin proved superior to placebo for patients with
chronic prostatitis/chronic pelvic pain syndrome who had not received
alpha-blockers previously.

Cheing, G. L., C. W. Hui-Chan, and K. M. Chan. \"Does four weeks of TENS
and/or isometric exercise produce cumulative reduction of osteoarthritic
knee pain?\" *Clinical Rehabilitation.* 16, no. 7(2002): 749-60 UI
12428824.

OBJECTIVE: To evaluate the cumulative effect of repeated transcutaneous
electrical nerve stimulation (TENS) on chronic osteoarthritic (OA) knee
pain over a four-week treatment period, comparing it to that of placebo
stimulation and exercise training given alone or in combination with
TENS. DESIGN: Sixty-two patients, aged 50-75, were stratified according
to age, gender and body mass ratio before being randomly assigned to
four groups. INTERVENTIONS: Patients received either (1) 60 minutes of
TENS, (2) 60 minutes of placebo stimulation, (3) isometric exercise
training, or (4) TENS and exercise (TENS & Ex) five days a week for four
weeks. MAIN OUTCOME MEASURES: Visual analogue scale (VAS) was used to
measure knee pain intensity before and after each treatment session over
a four-week period, and at the four-week follow-up session. RESULTS:
Repeated measures ANOVA showed a significant cumulative reduction in the
VAS scores across the four treatment sessions (session 1, 10, 20 and the
follow-up) in the TENS group (45.9% by session 20, p \< 0.001) and the
placebo group (43.3% by session 20, p = 0.034). However, linear
regression of the daily recordings of the VAS indicated that the slope
in the TENS group (slope = -2.415, r = 0.943) was similar to the
exercise group (slope = -2.625, r = 0.935), which were steeper than the
other two groups. Note that the reduction of OA knee pain was maintained
in the TENS group and the TENS & Ex group at the four-week follow-up
session, but not in the other two groups. CONCLUSIONS: The four
treatment protocols did not show significant between-group difference
over the study period. It was interesting to note that isometric
exercise training of the quadriceps alone also reduced knee pain towards
the end of the treatment period.

Chen, K. W., and J. J. Marbach. \"External qigong therapy for chronic
orofacial pain.\" *Journal of Alternative & Complementary Medicine.* 8,
no. 5(2002): 532-4 UI 12470431.

Chen, M. L. \"Pain and hope in patients with cancer: a role for
cognition.\" *Cancer Nursing.* 26, no. 1(2003): 61-7 UI 12556714.

The importance of hope in determining the adjustment of patients with
cancer to their illness has been recognized. Stressful events such as
pain and disease metastasis may have an impact on patients\' hope
levels. This study had three purposes: 1) to examine the effect of
disease status on hope levels among patients with cancer who have pain;
(2) to compare the level of hope between patients with cancer who have
pain and those do not; and (3) to determine which dimensions of pain are
associated with hope. Patients (n = 226) with various cancer diagnoses
completed the Herth Hope Index. Disease status was measured by one
objective indicator (disease stage) and one subjective indicator
(perceived treatment effect). The Perceived Meanings of Cancer Pain
Inventory was used to measure the cognitive dimension of pain, whereas
pain intensity and relief were used to represent the sensory dimension
of pain. The patients\' disease stage did not affect their level of
hope, but their perception of treatment effect was associated with this
factor. No difference in level of hope was found between patients with
pain and those without pain. For those with pain, the cognitive
dimension of pain (meaning ascribed to pain) was significantly
correlated with hope, whereas sensory dimensions (pain intensity and
relief) showed no such correlation. The study results support the role
of cognition in promoting the psychological well-being of patients with
cancer.

Chow, E., et al. \"International consensus on palliative radiotherapy
endpoints for future clinical trials in bone metastases.\" *Radiotherapy
& Oncology.* 64, no. 3(2002): 275-80 UI 12242115.

PURPOSE: To reach a consensus on a set of optimal endpoint measurements
for future external beam radiotherapy trials in bone metastases.METHODS:
An International Bone Metastases Consensus Working Party invited
principal investigators and individuals with a recognized interest in
bone metastases to participate in the two surveys and a panel meeting on
their preference of choice of optimal endpoints.RESULTS: Consensus has
been reached on the following: (a) eligibility criteria for future
trials; (b) pain and analgesic assessments; (c) radiation techniques;
(d) follow-up and timing of assessments; (e) parameters at follow-up;
(f) endpoints; (g) re-irradiation; and (h) statistical
analysis.CONCLUSIONS: Based on the available literature and the clinical
experience of the working party members, an acceptable set of endpoints
has been agreed upon for future clinical trials to promote consistency
in reporting. It is intended that the consensus will be re-examined
every 5 years. Areas of further research were identified.

Chrubasik, S., et al. \"A randomized double-blind pilot study comparing
Doloteffin and Vioxx in the treatment of low back pain.\"
*Rheumatology.* 42, no. 1(2003): 141-8 UI 12509627.

OBJECTIVE: This randomized, double-dummy, double-blind pilot study of
acutely exacerbated low back pain was aimed to inform a definitive
comparison between Doloteffin, a proprietary extract of Harpagophytum,
and rofecoxib, a selective inhibitor of cyclo-oxygenase-2 (COX-2).
METHODS: Forty-four patients (phyto-anti-inflammatory drug-PAID-group)
received a daily dose of Doloteffin containing, inter alia, 60 mg of
harpagoside for 6 weeks and 44 (non-steroidal anti-inflammatory
drug-NSAID-group) received 12.5 mg/day of rofecoxib. All were allowed
rescue medication of up to 400 mg/day of tramadol. Several outcome
measures were examined at various intervals to obtain estimates of
effect size and variability that might be used to decide the most
suitable principal outcome measure and corresponding numbers required
for a definitive study. RESULTS: Forty-three PAID and 36 NSAID patients
completed the study. Ten PAID and 5 NSAID patients reported no pain
without rescue medication for at least 5 days of the 6th week of
treatment. Eighteen PAID and 12 NSAID patients had more than a 50%
reduction in the week\'s average of their pain scores between the 1st
and 6th weeks. The mean percentage decrease from baseline in the pain
component of the Arhus Index was 23 (S.D. 52) in PAID and 26 (S.D. 43)
in NSAID. The corresponding measures for the overall Arhus Index were 11
(31) and 16 (24) and, for the Health Assessment Questionnaire, 7 (8) and
6 (7). Tramadol was used by 21 PAID patients and 13 NSAID patients.
Fourteen patients in each group experienced 39 adverse effects, of which
28 (13 in PAID) were judged to some degree attributable to the study
medications. CONCLUSION: Though no significant intergroup differences
were demonstrable, large numbers will be needed to show equivalence.

Clough, T. M., et al. \"The use of a local anesthetic foot block in
patients undergoing outpatient bony forefoot surgery: a prospective
randomized controlled trial.\" *Journal of Foot & Ankle Surgery.* 42,
no. 1(2003): 24-9 UI 12567364.

Foot blocks are known to prolong postoperative pain relief.
Consequently, their use has been extended to patients having outpatient
surgery, despite little evidence to show improved patient satisfaction.
Indeed, patients having outpatient surgery actually may be less
satisfied because they will first experience pain at home on the first
postoperative night, which may be more severe than anticipated. In this
prospective, randomized, blinded study, 42 patients having unilateral
outpatient bony forefoot surgery were assigned randomly to either having
the surgery under general anesthesia alone or under general anesthesia
with supplementary foot block (0.5% bupivicaine). All patients were
assessed at home by telephone interview on the first and second
postoperative day. There was a significantly longer time to first
perceived pain in the foot block group compared with the control group,
but no difference in the number of postoperative analgesic tablets
consumed, no difference in pain score on the first night, first
postoperative or second postoperative day, or any difference in the
overall patient satisfaction scores at 2 days. The authors conclude that
a local foot block, although prolonging the time to first perceived
pain, does not improve patient satisfaction and is not detrimental when
used as analgesia in the outpatient setting.

Crombez, G., et al. \"Exposure to physical movements in low back pain
patients: restricted effects of generalization.\" *Health Psychology.*
21, no. 6(2002): 573-8 UI 12433009.

Whether the effects of exposure to 1 movement generalize to another
dissimilar movement was investigated in 37 patients with low back pain
(15 men, 22 women). Two movements were executed twice: bending forward
while standing and lifting 1 leg while lying down. During each trial,
baseline pain, expected pain, and experienced pain were recorded.
Similar ratings for perceived harm were obtained. Analyses revealed an
initial over prediction of pain, but after exposure the overprediction
was readily corrected. This exposure effect did not generalize toward
another dissimilar movement. These results were only characteristic for
patients with catastrophic thinking about pain. Low pain catastrophizers
did not overpredict pain. There were no effects of exposure on perceived
harm. Exposure may profitably be conceived of as the learning of
exceptions to a general rule.

Dai, M. S., et al. \"Abdominal wall rhabdomyolysis mimicking
peritonitis: a diagnostic pitfall of acute abdomen.\" *Southern Medical
Journal.* 96, no. 1(2003): 105-6 UI 12602736.

Danhauer, S. C., et al. \"Impact of criteria-based diagnosis of burning
mouth syndrome on treatment outcome.\" *Journal of Orofacial Pain.* 16,
no. 4(2002): 305-11 UI 12455431.

AIMS: Burning mouth syndrome (BMS) primarily affects postmenopausal
women and is often difficult to treat successfully. Treatment outcomes
have been problematic because of failure to distinguish between patients
with BMS and patients presenting with oral burning (OB) resulting from
other clinical abnormalities. The purpose of this study was to determine
characteristics that might uniquely identify BMS patients from patients
with OB and to determine whether proper classification influences
treatment outcome. METHODS: The clinical sample consisted of 69 patients
(83% female) with an average age of 62 years, pain duration of 2.45
years, and visual analog scale pain rating of 49 mm (rated from 0 to 100
mm). All patients underwent a clinical exam and completed the
Multidimensional Pain Inventory and Symptom Checklist 90-Revised.
RESULTS: There were no differences between the BMS and OB groups with
respect to age, pain duration, pain intensity, life interference, and
levels of psychologic distress. Patients with OB demonstrated more
clinical abnormalities than BMS patients. Hyposalivation and greater use
of prescription medications, most notably hormone replacement therapy,
were more common in the OB group compared with the BMS group. When
treatment was provided that corrected an identifiable abnormality,
significantly more OB than BMS patients reported greater than 50% relief
from baseline pain rating. CONCLUSION: These data indicate that while
BMS and OB groups may initially present with similar clinical and
psychosocial features, they are distinguishable with careful diagnosis
that often enables successful management of symptoms for each group.

Davies, A. P. \"Rating systems for total knee replacement.\" *Knee.* 9,
no. 4(2002): 261-6 UI 12424032.

The objective assessment of outcome of surgical procedures is assuming
increasing significance as the culture of audit and revalidation
advances. There is a clear need for surgeons in all fields, but
especially in Orthopaedics, to be familiar with the available scoring
systems and their relative strengths and weaknesses. It is clear from a
recent survey of BASK members\' practice that there is little consensus
about which system to use (addendum). This review presents a summary of
the scoring systems available for the assessment of patients undergoing
total knee replacement. These scores are described in detail and their
relative merits discussed. None of the systems reviewed is perfect but
those developed most recently do appear to offer advantages over older
systems. Overall, the Western Ontario and McMaster University
Osteoarthritis Index, Short Form 36 and Oxford Knee Score have undergone
the most thorough assessment of reliability and validity and are
therefore appropriate for the assessment of outcome after total knee
replacement. \[References: 20\]

DeAngelis, N. A., and B. D. Busconi. \"Assessment and differential
diagnosis of the painful hip.\" *Clinical Orthopaedics & Related
Research.*, no. 406(2003): 11-8 UI 12578995.

Hip pain is a common problem seen by orthopaedic surgeons. The current
authors provide an approach to the patient with hip pain, including
important information to be gained from the history and physical
examination and relevant radiographic studies and laboratory tests. A
differential diagnosis for patients presenting with the complaint of hip
pain and indications for hip arthroscopy are provided. \[References:
21\]

Deaton, C., and W. S. Weintraub. \"Outcome measurement: evaluating
evidence for managing patients with acute coronary syndromes.\" *Journal
of Cardiovascular Nursing.* 16, no. 4(2002): 71-4 UI 12597264.

Evidence-based practice has been proposed as a means to improve the
quality of care and decrease unwarranted variability in practice, but
evaluating clinical trial data as evidence for practice is made more
difficult because practice changes rapidly. This article reviews current
clinical trial data on the management of patients with acute coronary
syndromes, but the same principles can be used when evaluating
alternative medicines. Current evidence supports risk stratification,
early treatment with glycoprotein IIb/IIIa inhibitors, and an early
invasive strategy in patients who are at intermediate to high risk. In
addition, cholesterol-lowering statins should be initiated early in the
patient\'s hospitalization. \[References: 8\]

Difazio, M., and B. Jabbari. \"A focused review of the use of botulinum
toxins for low back pain.\" *Clinical Journal of Pain.* 18, no. 6
Suppl(2002): S155-62 UI 12569963.

Chronic low back pain is the second most common illness reported by
patients in the United States and accounts for substantial morbidity and
health-care resource utilization. Many back and spine stressors can
contribute to tissue injury, resulting in acute or chronic pain. In
response to injury, biochemical processes that cause inflammation and
nerve sensitization increase pain levels and contribute to a cycle of
reactivity that further heightens patients\' sensitivity to pain
stimuli. Treatment of back pain depends on its severity, duration, and
underlying cause. Traditional therapeutic options include exercise, oral
anti-inflammatory or analgesic medication, antidepressants, physical
therapy and, in severe cases, surgery. Unfortunately, dissatisfaction
with treatment of back pain is common. Oral medications may not
completely alleviate symptoms, and opioid analgesics must be used with
caution because of their addictive properties. Surgery does not always
produce relief and, in some cases, may even exacerbate the problem.
Botulinum toxin, which has already been shown to alleviate pain
associated with cervical dystonia and other conditions characterized by
muscle spasticity, is now being studied for the treatment of back pain.
Preliminary evaluations have shown that this treatment is safe and has
the advantage of providing local relief directly to the site of injury
or pain, without causing systemic side effects. Initial data from small
trials also suggest that botulinum toxin is effective, alleviating back
pain in selected patients. On the basis of these promising results,
additional study in larger trials is warranted. \[References: 46\]

Drosos, G. I., et al. \"Intra-articular morphine and postoperative
analgesia after knee arthroscopy.\" *Knee.* 9, no. 4(2002): 335-40 UI
12424044.

The aim of this study was to evaluate the postoperative analgesic effect
of intra-articular administration of a low- and a high-dose morphine
solution after knee arthroscopy. Thirty patients who underwent
diagnostic arthroscopy or arthroscopic meniscectomy were allocated in
three groups. At the end of the arthroscopic procedure patients in Group
A received intra-articularly 20 ml normal saline (N/S), Group B received
5 mg morphine in 20 ml N/S and Group C received 15 mg morphine in 20 ml
N/S. The postoperative pain was assessed using a visual analogue scale
for 24 h, while all the patients stayed at hospital. Side effects from
the central action of opioids were not detected. Although the pain
scores in the group of low-dose morphine were lower than in the control
group, we failed to detect any significant differences in pain scores
among the three groups. There was evidence that a high-dose can cause
hyperalgesia.

Dukat, M., et al. \"(-)6-n-Propylnicotine antagonizes the
antinociceptive effects of (-)nicotine.\" *Bioorganic & Medicinal
Chemistry Letters.* 12, no. 20(2002): 3005-7 UI 12270194.

Several 6-alkyl analogues of nicotine were examined in radioligand
binding and in vivo functional assays. Although (-)6-ethylnicotine (3)
binds with high affinity at nACh receptors (Ki=5.6 nM) and produces
nicotine-like actions, its n-propyl homologue (-)4 (Ki=22 nM) failed to
produce such effects. In fact, (-)4 antagonized the antinociceptive
effects of (-)nicotine in the tail-flick assay in mice, but not the
spontaneous activity or discriminative stimulus effects of (-)nicotine.
Compound (-)4 appears to selectively antagonize only one of the three
effects examined and is an interesting cholinergic agent for subsequent
investigation.

Duker, P. C., et al. \"Effects of single and repeated shock on perceived
pain and startle response in healthy volunteers.\" *Research in
Developmental Disabilities.* 23, no. 4(2002): 285-92 UI 12365852.

Contingent shock (CS) has been used in a number of studies to suppress
health-threatening self-injurious behavior of individuals with mental
retardation and autism. As sustained suppression is an issue of concern,
research into procedural variables of CS is needed. In this study,
clinical evidence was used to infer a variable that might be of
relevance for the application of clinical contingent shock, that is, to
assess the effect of single versus repeated shock at a specific location
on the body. With pain intensity and startle response as dependent
variables, shocks were administered to 48 healthy volunteers. Electric
shocks were identical to those that used in clinical practice. The
second shock in succession to the same location of the body produced
higher pain intensity ratings than the first shock and that the third
shock in succession to the same location of the body produced higher
pain intensity ratings than the second shock in succession. Startle
responses, however, failed to be affected in this direction. The latter
result is consistent with a previous study. Our data suggest that
repeated shock to the same location is likely to be more effective to
establish suppression than repeated shock to different locations.

Edwards, J. E., et al. \"Single dose dipyrone for acute renal colic
pain.\" *Cochrane Database of Systematic Reviews.*, no. 4(2002):
CD003867 UI 12519613.

BACKGROUND: Renal colic pain is extremely painful and requires immediate
treatment with strong analgesics. Dipyrone is the most popular
non-opioid first line analgesic in many countries but in others it has
been banned (e.g. USA, UK) because of its association with blood
dyscrasias such as agranulocytosis. Since dipyrone is used in many
countries (e.g. Brazil, Spain) there is a need to determine the benefits
and harms of its use to treat renal colic pain. OBJECTIVES: To assess
quantitatively the analgesic efficacy and adverse effects of single-dose
dipyrone in adults with moderate to severe renal colic pain. SEARCH
STRATEGY: Published reports were identified from electronic databases
(MEDLINE, EMBASE, the Cochrane Library, LILACS) and additional studies
were identified from the reference lists of retrieved reports. Date of
the most recent search: January 2000. SELECTION CRITERIA: Inclusion
criteria were: full journal publication; RCT with a double-blind design;
adult patients with baseline renal colic pain of moderate or severe
intensity; treatment arms which included dipyrone (oral, intramuscular
or intravenous administration) and a control; single dose data. DATA
COLLECTION AND ANALYSIS: Summed pain intensity and pain relief data were
extracted and converted into dichotomous information to yield the number
of patients with at least 50% pain relief over 15-30 minutes, 1-2 hours
and six hours. The proportion of patients with at least 50% pain relief
was calculated. Single dose adverse effect data were collected. MAIN
RESULTS: Eleven studies with 1053 patients (550 on dipyrone) met the
inclusion criteria. Unfortunately, few data were available for analysis;
most analyses were based on the results of single, small trials and
statistical pooling of the results was inappropriate. Efficacy estimates
were calculated as the weighted mean percent of patients achieving at
least 50% pain relief with the range of values from trials contributing
to the analysis. However, these estimates were not robust. Commonly
reported adverse effects with intravenous dipyrone were dry mouth and
somnolence, and one study reported pain at the injection site.
Insufficient information was available for safety analyses to be
conducted. REVIEWER\'S CONCLUSIONS: Limited available data indicated
that single dose dipyrone was of similar efficacy to other analgesics
used in renal colic pain, although intramuscular dipyrone was less
effective than diclofenac 75 mg. Combining dipyrone with antispasmolytic
agents did not appear to improve its efficacy. Intravenous dipyrone was
more effective than intramuscular dipyrone. Dry mouth and somnolence
were commonly reported with intravenous dipyrone. None of the studies
reported agranulocytosis. \[References: 46\]

Eisenberg, E., and C. Brecker. \"Lumbar spinal cord stimulation for
cervical-originated central pain: a case report.\" *Pain.* 100, no.
3(2002): 299-301 UI 12468001.

This case presents a patient with neuropathic pain in a lower extremity,
which appeared subsequent to the removal of a C1 meningioma and which
was successfully treated by lower thoracic spinal cord stimulation.

Ekberg, E., and M. Nilner. \"A 6- and 12-month follow-up of appliance
therapy in TMD patients: a follow-up of a controlled trial.\"
*International Journal of Prosthodontics.* 15, no. 6(2002): 564-70 UI
12475163.

PURPOSE: This study compared the long-term effects of treatment with a
stabilization appliance and treatment with a control appliance in
patients with temporomandibular disorders (TMD). MATERIALS AND METHODS:
In a controlled trial, 60 TMD patients with temporomandibular joint
(TMJ) pain were evaluated after 10 weeks of treatment with either a
stabilization appliance or a control appliance. At the 10-week
follow-up, the 60 patients were assigned to one of three groups
according to their demand for treatment. Group T, the treatment group,
comprised 30 patients treated with a stabilization appliance; group C,
the control group, comprised nine patients treated with a control
appliance; and group M, the mixed treatment group, comprised 21 patients
treated with first a control appliance and then a stabilization
appliance. Signs and symptoms were evaluated in all three groups at 6-
and 12-month follow-ups. RESULTS: At the 6- and 12-month follow-ups, a
significant reduction in TMJ pain as measured on a visual analogue scale
was found in all three groups, and a significant decrease in signs and
symptoms was found in groups T and M. CONCLUSION: After 6 and 12 months
of use, the stabilization appliance was found to still be effective in
the alleviation of signs and symptoms in patients with TMD. Many
patients in group C changed to a stabilization appliance at the 1 0-week
follow-up, which significantly reduced the number of patients in this
group. Most patients reported positive change in overall subjective
symptoms in this trial. The stabilization appliance can therefore be
recommended for patients with TMD.

Endres, S. M. \"More on IDET.\" *Wmj.* 101, no. 8(2002): 4-5 UI
12557605.

Ernst, M. E., S. S. Iyer, and W. R. Doucette. \"Drug-related problems
and quality of life in arthritis and low back pain sufferers.\" *Value
in Health.* 6, no. 1(2003): 51-8 UI 12535238.

OBJECTIVE: The objective of this study was to determine the relationship
between drug-related problems (DRPs) and health-related quality-of-life
(HRQoL) in ambulatory, community-dwelling patients with musculoskeletal
disorders. METHODS: A 12-month, prospective, observational study was
conducted in 12 independent community pharmacies in eastern Iowa.
Ambulatory patients with self-reported diagnoses of osteoarthritis,
rheumatoid arthritis, or low back pain were invited to participate.
During quarterly visits to the pharmacy, patients used touch-screen
computers to fill out the Short Form-36 (SF-36) general health survey.
Using the results of these point-of-service health status assessments,
community pharmacists interviewed patients to assess for DRPs. To
examine the influences of different DRP characteristics on HRQoL and
controlling for potential confounders, both univariate and multivariate
analyses were performed using the change in physical component summary
(PCS) score and mental component summary (MCS) score of the SF-36 from
baseline to 12 months as the dependent variables. In each regression,
the independent variables were those significant variables from the
univariate analyses, as well as the types of DRPs and their outcomes.
RESULTS: A total of 461 patients were enrolled in the study. Through 12
months, 926 cumulative DRPs were identified. Overall regression models
were significant for the PCS and MCS scores, respectively. Two types of
DRPs showed significant negative associations with change in PCS: wrong
drug and needs additional drug therapy. One type of DRP showed
significant negative association with change in MCS: needs additional
drug therapy. Resolution or improvement in DRPs showed a significant
positive correlation with change in MCS but not PCS. CONCLUSIONS: Two
DRPs, needs additional drug therapy and wrong drug, are associated with
reduced self-reported physical health in arthritis and low back pain,
while the DRP needs additional drug therapy is also associated with
reduced self-reported mental health. Resolution of DRPs is associated
with improvement in mental health in this cohort.

Evans, A. J., et al. \"Vertebral compression fractures: pain reduction
and improvement in functional mobility after percutaneous
polymethylmethacrylate vertebroplasty retrospective report of 245
cases.\" *Radiology.* 226, no. 2(2003): 366-72 UI 12563127.

PURPOSE: To describe the immediate outcome of a large cohort of patients
who underwent percutaneous polymethylmethacrylate (PMMA) vertebroplasty
for treatment of one or more vertebral fractures. MATERIALS AND METHODS:
This retrospective cohort study included seven university-based and
private hospitals in the United States. Of 488 consecutive patients
(mean age, 76 years) who underwent percutaneous PMMA vertebroplasty
between 1996 and 1999, 245 were successfully interviewed retrospectively
after vertebroplasty (median time, 7 months). Through telephone
interview, patients completed our self-developed questionnaire designed
to measure pain (10-point scale), ambulation (five-point scale), and
ability to perform activities of daily living (ADL) (five-point scale)
before and after vertebroplasty. Differences in reported pain,
ambulation, and ability to perform ADL before and after vertebroplasty
were evaluated with paired t tests. Differences in proportions were
compared with the McNemar test. Subgroup analyses were performed to
assess the consistency of differences in pre- and postprocedural pain
and functional status by patient age, number of fractures, time from
fracture to vertebroplasty, and time from vertebroplasty to
questionnaire completion. RESULTS: On a 10-point scale, mean pain
decreased from 8.9 before vertebroplasty to 3.4 afterward (P \<.001).
Seventy-two percent of patients had substantially impaired ambulation
before vertebroplasty compared with 28% afterward (P \<.001). Ability to
perform ADL was also significantly improved following vertebroplasty (P
\<.001). Twelve patients (4.9%) experienced symptomatic complications
(none major or life threatening). CONCLUSION: Treatment of vertebral
fractures with percutaneous PMMA vertebroplasty appears to be safe and
results in substantial immediate pain reduction and improved functional
status. A randomized controlled trial appears warranted to assess the
efficacy and safety of vertebroplasty.

Evers, A. W., et al. \"Tailored cognitive-behavioral therapy in early
rheumatoid arthritis for patients at risk: a randomized controlled
trial.\" *Pain.* 100, no. 1-2(2002): 141-53 UI 12435467.

Recent developments in chronic pain research suggest that effectiveness
of cognitive-behavioral therapy (CBT) may be optimized when applying
early, customized treatments to patients at risk. For this purpose, a
randomized, controlled trial with tailor-made treatment modules was
conducted among patients with relatively early rheumatoid arthritis (RA
disease duration of \<8 years), who had been screened for psychosocial
risk profiles. All participants received standard medical care from a
rheumatologist and rheumatology nurse consultant. Patients in the CBT
condition additionally received an individual CBT treatment with two out
of four possible treatment modules. Choice of treatment modules was
determined on the basis of patient priorities, which resulted in most
frequent application of the fatigue module, followed by the negative
mood, social relationships and pain and functional disability modules.
Analyses of completers and of intention-to-treat revealed beneficial
effects of CBT on physical, psychological and social functioning.
Specifically, fatigue and depression were significantly reduced at
post-treatment and at the 6-month follow-up in the CBT condition in
comparison to the control condition, while perceived support increased
at follow-up assessment. In addition, helplessness decreased at
post-treatment and follow-up assessment, active coping with stress
increased at post-treatment, and compliance with medication increased at
follow-up assessment in the CBT condition in comparison to the control
condition. Results indicate the effectiveness of tailor-made CBT for
patients at risk in relatively early RA, and supply preliminary support
for the idea that customizing treatments to patient characteristics may
be a way to optimize CBT effectiveness in RA patients.

Fagan, D. J., W. Martin, and A. Smith. \"A randomized, double-blind
trial of pre-emptive local anesthesia in day-case knee arthroscopy.\"
*Arthroscopy.* 19, no. 1(2003): 50-3 UI 12522402.

PURPOSE: The study goal was to assess the efficacy of pre-emptive
analgesia in a clinical setting. TYPE OF STUDY: A block randomized,
double-blind design was used. METHODS: Subjects were 40 patients
undergoing day-case arthroscopy of the knee. The trial group received a
prophylactic injection of bupivacaine with adrenaline. After surgery, a
placebo injection was given. The postsurgical injection group received
identical injections in reverse order. There was no difference in the
mean dose of propofol used to maintain general anesthesia between
groups: 15 mg/kg/h (standard deviation \[SD\] = 2.85) trial versus 14.6
mg/kg/h (SD = 1.96) postsurgical injection (95% confidence interval
\[CI\] = -1.14 to 1.94). RESULTS: Although no statistically significant
difference was observed in postoperative pain scores at 15, 30, or 60
minutes, there was a trend for the trial group to require less analgesia
in recovery (chi2 = 9.74; P =.1). CONCLUSIONS: Prophylactic local
anesthesia confers no statistically significant reduction in pain scores
or perioperative general anesthetic requirements as compared with
postoperative administration. The pre-emptive effect in clinical
practice may be less dramatic than that observed in more controlled
animal models. Further studies are required to investigate the magnitude
of the pre-emptive effect in clinical practice.

Ferreira, M. L., et al. \"Does spinal manipulative therapy help people
with chronic low back pain?\" *Australian Journal of Physiotherapy.* 48,
no. 4(2002): 277-84 UI 12443522.

A systematic review of randomised clinical trials was conducted to
assess the effect of spinal manipulative therapy on clinically relevant
outcomes in patients with chronic low back pain. Databases searched
included EMBASE, CINAHL, MEDLINE and PEDro. Methodological assessment of
the trials was performed using the PEDro scale. Where there was
sufficient homogeneity, a meta-analysis was conducted. Nine trials of
mostly moderate quality were included in the review. Two trials were
pooled comparing spinal manipulative therapy and placebo treatment, and
two other trials were pooled comparing spinal manipulative therapy and
non-steroidal anti-inflammatory drugs (NSAIDs). Spinal manipulative
therapy reduced pain by 7mm on a 100mm visual analogue scale (95% CI 1
to 14) at one month follow-up when compared with placebo treatment, and
by 14mm (95% CI -11 to 40) when compared with NSAIDs. Spinal
manipulative therapy reduced disability by 6 points (95% CI 1 to 12) on
a 100-point disability questionnaire when compared with NSAIDs. It is
concluded that spinal manipulation does not produce clinically
worthwhile decreases in pain compared with sham treatment, and does not
produce clinically worthwhile reductions in disability compared with
NSAIDs for patients with chronic low back pain. It is not clear whether
spinal manipulation is more effective than NSAIDs in reducing pain of
patients with chronic low back pain. \[References: 33\]

Ferreira, P. H., et al. \"Effect of applying different \"levels of
evidence\" criteria on conclusions of Cochrane reviews of interventions
for low back pain.\" *Journal of Clinical Epidemiology.* 55, no.
11(2002): 1126-9 UI 12507677.

The objective of this study was to examine the consistency of
conclusions of Cochrane systematic reviews when different criteria are
used to determine levels of evidence. We reanalyzed the data in six
Cochrane reviews of conservative treatment of low back pain by applying
three additional sets of \"levels of evidence\" criteria. Overall
agreement between the conclusions attained with the different levels of
evidence criteria was only \"fair\" (multirater kappa coefficient 0.33;
95% CI 0.28 to 0.38). For example, the four sets of levels of evidence
criteria produced four conclusions on the efficacy of back school:
\"strong evidence that back schools are effective,\" \"weak evidence,\"
\"limited evidence,\" and \"no evidence.\" Pairwise agreement between
the four pooling systems ranged from slight to substantial (kappas
ranging from 0.10 to 0.80). Different rules for determining levels of
evidence in systematic reviews produce markedly different conclusions on
treatment efficacy. Crown

Finnerup, N. B., H. Gottrup, and T. S. Jensen. \"Anticonvulsants in
central pain.\" *Expert Opinion on Pharmacotherapy.* 3, no. 10(2002):
1411-20 UI 12387687.

Treatment of central neuropathic pain (CP) following lesions of the CNS
is a great challenge to the clinician. Preclinical and clinical studies
indicate that neuronal hyperexcitability in damaged areas of the central
nervous system plays a major role in the development of CP.
Anticonvulsants are thought to act by increasing gamma-aminobutyric
acid-mediated inhibition, decreasing abnormal neuronal hyperexcitability
by modulating sodium and calcium channels or by inhibiting excitatory
amino acid actions. The resulting inhibition of excess neuronal activity
is thought to be the basis for the use of anticonvulsants in epilepsy as
well as neuropathic pain. Both first-generation anticonvulsant drugs
(e.g., phenytoin, benzodiazepines, valproate and carbamazepine) and
second-generation anticonvulsant drugs (e.g., lamotrigine, gabapentin
and topiramate) are used in CP conditions. However, few randomised
controlled trials on the treatment of this condition have been
published. Present suggestions for anticonvulsant treatment of CP are
lamotrigine as the first choice, followed by gabapentin or
carbamazepine/oxcarbazepine. These compounds are considered as effective
as the antidepressant amitriptyline. \[References: 107\]

Fishbain, D. A. \"Analgesic effects of antidepressants.\[comment\].\"
*Journal of Clinical Psychiatry.* 64, no. 1(2003): 96; author reply 96-7
UI 12590632.

Foster, M. R. \"Piriformis syndrome.\" *Orthopedics.* 25, no. 8(2002):
821-5 UI 12195908.

Seven patients underwent release of the piriformis from the femur.
Patients with residual symptoms after conservative treatment had
dramatic relief of sciatica and 70% resumed customary work after
surgery. Minimum follow-up was 31 months (average: 51 months). Early
diagnosis can avoid prolonging ineffective empiric treatment and
disability with satisfactory results achieved in most patients by
conservative treatment and relief of sciatica in selected surgical
cases.

Freund, B. J., and M. Schwartz. \"Use of botulinum toxin in chronic
whiplash-associated disorder.\" *Clinical Journal of Pain.* 18, no. 6
Suppl(2002): S163-8 UI 12569964.

Whiplash-associated disorders (WADs) occur as a result of trauma and are
often due to motor vehicle accidents and sports injuries. Cervical
injury is attributed to rapid extension followed by neck flexion. The
exact pathophysiology of WAD is uncertain but probably involves some
degree of aberrant muscle spasms and may produce a wide range of
symptoms. Initial treatment of pain associated with whiplash usually
includes oral medications, such as muscle relaxants and nonsteroidal
anti-inflammatory drugs. However, these agents are limited by potential
systemic adverse effects. Some patients with chronic WAD may benefit
from radiofrequency neurotomy. A new approach to treatment is the use of
botulinum toxin, which acts to reduce muscle spasms. Type A toxin
(Botox) has been studied in small trials of patients with WAD and has
generally been found to relieve pain and improve range of motion. In
addition, recent preliminary data from a small trial showed that type B
toxin (Myobloc) produced almost immediate pain relief for most patients
with post-whiplash headache. Although botulinum toxin has not been
evaluated in large long-term trials, these initial data are promising
and suggest a role for this agent in the treatment of WAD. Additional
study is needed to identify the subset of patients with WAD who are most
likely to respond to treatment with botulinum toxin.

Fujita, T., et al. \"The effect of active absorbable algal calcium (AAA
Ca) with collagen and other matrix components on back and joint pain and
skin impedance.\" *Journal of Bone & Mineral Metabolism.* 20, no.
5(2002): 298-302 UI 12203036.

The effect of active absorbable algal calcium (AAA Ca) with collagen and
other matrix components on aging-associated skin changes and backache
and joint pain was tested in a case-controlled study of 40 test subjects
and 40 age-matched control subjects (mean age, 65 years) complaining of
backache and knee joint pain due to osteoarthritis, spondylosis
deformans, and/or osteoporosis. Supplementation with 900 mg calcium
(given as AAA Ca) and 3.5 g collagen and other matrix components,
including glucosamine, daily for 4 months resulted in a marked
alleviation of subjective pain, assessed by the face scale. A fall of
skin impedance in response to exercise loads, such as standing up,
walking, squatting, and climbing up and down stairs, reported as an
objective manifestion of pain, was also alleviated. The basal skin
impedance, which increases with age, was significantly reduced in
response to the Ca-collagen-matrix supplementation, suggesting a change
of skin properties similar to rejuvenation, along with subjective
smoothening and moistening of the skin. Urinary excretion of N-terminal
crosslinking telopeptide of type I collagen (NTx) was decreased in the
Ca-collagen-matrix supplementation group, but not in the control group.
In addition to calcium suppression of parathyroid hormone, preventing
bone resorption, collagen, acting on the intestinal lymphatic system,
may protect collagen from degradation through the inhibition of
cytokine-induced release of metalloproteinases, including collagenase.

Furman, M. I., et al. \"Quantification of abciximab-induced platelet
inhibition is assay dependent: a comparative study in patients
undergoing percutaneous coronary intervention.\" *American Heart
Journal.* 145, no. 2(2003): e6 UI 12595861.

BACKGROUND: The best method for measuring the degree of platelet
inhibition with glycoprotein (GP) IIb-IIIa antagonists during
percutaneous coronary intervention (PCI) and the optimal degree of
periprocedural inhibition is uncertain. Low molecular weight heparins
have been reported to cause less platelet activation than unfractionated
heparin. Therefore, compared with unfractionated heparin (UHF), a low
molecular weight heparin could enhance measured platelet inhibition. In
this study, we compared 3 methods of measuring platelet inhibition and
investigated the effects of half doses of abciximab in combination with
either UFH or the low molecular weight heparin dalteparin in patients
undergoing PCI with planned abciximab administration. METHODS:
Abciximab-induced platelet inhibition was measured serially by means of
3 assays: 1) GP IIb-IIIa receptor occupancy, 2) binding of the activated
GP IIb-IIIa-specific monoclonal antibody PAC1, and 3) agglutination of
platelets with fibrinogen-coated beads (RPFA). Forty patients were
randomly allocated to receive either UFH (70 U/kg) or dalteparin (60
IU/kg), followed by a half dose of abciximab (0.125 mg/kg) administered
twice at 10-minute intervals. Assays were obtained 10 minutes after each
half dose of abciximab and 8 to 10 and 24 hours after abciximab
administration. RESULTS: No differences between UFH and dalteparin were
observed. At each time-point measured, the mean percent platelet
inhibition as determined by means of the receptor occupancy assay and
PAC1 binding assay was less than the degree of inhibition determined by
means of the RPFA. CONCLUSIONS: The results of targeted levels of
platelet inhibition cannot be extrapolated between different clinical
trials of GP IIb-IIIa antagonists unless the same assay is used.
Dalteparin, compared with UFH, does not enhance platelet inhibition or
receptor occupancy by abciximab, as demonstrated by means of 3 separate
assays.

Furuhashi-Yonaha, A., et al. \"Short- and long-term efficacy of oral
ketamine in eight chronic-pain patients.\" *Canadian Journal of
Anaesthesia.* 49, no. 8(2002): 886-7 UI 12374726.

Gao, C., et al. \"Sensory and biomechanical responses to ramp-controlled
distension of the human duodenum.\" *American Journal of Physiology -
Gastrointestinal & Liver Physiology.* 284, no. 3(2003): G461-71 UI
12431908.

The aim of this study was to develop a new method for investigation of
the relationship among the mechanical stimulus, the biomechanical
properties, and the visceral perception evoked by volume/ramp-controlled
distension in the human duodenum in vivo. An impedance planimetric probe
for balloon distension was placed in the third part of the duodenum in
seven healthy volunteers. Distension of the duodenum was done at
infusion rates of 10, 25, and 50 ml/min. The pump was reversed when
level 7 was reached on a visual analog scale ranging from 0 to 10.
Distensions were done with and without the administration of the
antimuscarinic drug butylscopolamine. The total circumferential tension
(T(total)) and the passive circumferential tension (T(passive)) were
determined from the distension tests without and with the administration
of butylscopolamine, respectively. T(total) and T(passive) showed an
exponential behavior as a function of strain (a measure of deformation).
The active circumferential tension (T(active)) was computed as
T(total)-T(passive) and showed a bell-shaped behavior as a function of
strain. At low distension intensities, the intensity of sensation at 10
ml/min was significantly higher than that obtained at 25 and 50 ml/min.
The coefficient of variation at the pain threshold for circumferential
strain (average 4.34) was closer to zero compared with those for volume
(8.72), pressure (31.22), and circumferential tension (31.55). This
suggests that the mechanoreceptors in the gastrointestinal wall depend
primarily on circumferential strain. The stimulus-response functions
provided evidence for the existence of low- and high-threshold
mechanoreceptors in the human duodenum. Furthermore, the data suggest
that high-threshold receptors are nonadapting.

Gardell, L. R., et al. \"Dynorphin-independent spinal cannabinoid
antinociception.\" *Pain.* 100, no. 3(2002): 243-8 UI 12467995.

Spinal antinociception produced by delta 9-tetrahydro-cannabinol
(Delta(9)-THC) and other cannabinoid agonists has been suggested to be
mediated by the release of dynorphin acting at the kappa opioid
receptor. Alternatively, as cannabinoid receptors are distributed
appropriately in the pain transmission pathway, cannabinoid agonists
might act directly at the spinal level to inhibit nociception, without
requiring dynorphin release. Here, these possibilities were explored
using mice with a deletion of the gene encoding prodynorphin.
Antinociceptive dose-response curves were constructed for spinal
Delta(9)-THC and WIN 55,212-2 in prodynorphin knock-out mice and in
wild-type littermates. WIN 55,212-2 and Delta(9)-THC were equipotent in
the wild-type and prodynorphin knock-out mice. Spinal pretreatment with
a kappa opioid receptor antagonist, nor-binaltorphimine (nor-BNI), did
not alter the dose-response curves for either WIN 55,212-2 or
Delta(9)-THC in prodynorphin knock-out and wild-type mice. However, the
same dose of nor-BNI used blocked U50,488H-induced antinociception in
both wild-type and prodynorphin knock-out mice, confirming kappa opioid
receptor activity. Pretreatment with SR141716A, a cannabinoid receptor
antagonist blocked the antinociceptive actions of both WIN 55,212-2 and
Delta(9)-THC. These data support the conclusion that antinociception
produced by spinal cannabinoids are likely to be mediated directly
through activation of cannabinoid receptors without the requirement for
dynorphin release or activation of kappa opioid receptors.

Gardner, A. W. \"Sex differences in claudication pain in subjects with
peripheral arterial disease.\" *Medicine & Science in Sports &
Exercise.* 34, no. 11(2002): 1695-8 UI 12439070.

PURPOSES: To compare the claudication distances between men and women
patients with peripheral arterial disease (PAD), and to determine
whether sex differences in claudication pain persisted after controlling
for potential confounders such as demographic, functional, and
physiological measures. METHODS: A total of 488 men and 72 women
functionally limited by intermittent claudication were evaluated.
Patients were characterized on PAD-specific measures consisting of
ankle/brachial index (ABI) and treadmill claudication distances,
physical function measures consisting of ambulatory function, monitored
physical activity, balance, and strength, and demographic measures
obtained during a medical history. RESULTS: Initial claudication
distance (ICD) was 33% shorter ( = 0.024) in women than in men (126 +/-
22 vs 189 +/- 13 m; mean +/- SEM), and absolute claudication distance
(ACD) was 23% shorter ( = 0.022) in women (313 +/- 43 vs 407 +/- 18 m).
These differences were present despite similar ( = 0.440) ABI values
between women (0.63 +/- 0.02) and men (0.62 +/- 0.01). Peak oxygen
uptake ( = 0.043) and self-perceived stair climbing ability ( = 0.020)
were different between men and women, and were independently related to
ICD (multiple R = 0.57, \< 0.001) and to ACD (multiple R = 0.71, \<
0.001). The sex differences in ICD ( = 0.524) and ACD ( = 0.722) were no
longer present after controlling for peak oxygen uptake and
self-perceived stair climbing ability. CONCLUSION: Shorter treadmill
claudication distances in women with PAD were explained by their lower
cardiopulmonary fitness and poorer self-perceived ability to climb
stairs than compared with men. Therefore, women with intermittent
claudication represent a subgroup of PAD patients who should receive
high priority for exercise rehabilitation to improve physical function.

Gaughen, J. R., Jr., et al. \"The therapeutic benefit of repeat
percutaneous vertebroplasty at previously treated vertebral levels.\"
*Ajnr: American Journal of Neuroradiology.* 23, no. 10(2002): 1657-61 UI
12427618.

BACKGROUND AND PURPOSE: Recurrent pain after vertebroplasty is
relatively common, usually representing a new fracture at a different
vertebral level. In a small cohort described herein, clinical and
imaging findings indicated that recurrent pain arose from abnormality of
the previously treated level. Our purpose was to demonstrate that repeat
percutaneous vertebroplasty performed within the same fractured vertebra
can offer therapeutic benefit for patients with recurrent pain after
initial treatment. METHODS: We conducted a retrospective review of
consecutive vertebroplasty procedures performed at our institution to
define a patient population that underwent repeat vertebroplasty for
recurrent pain at previously treated vertebral levels. We identified six
such patients over an 8-year period, and clinical outcomes were assessed
through quantitative measurements of pre- and postoperative levels of
pain and mobility. RESULTS: Initial vertebroplasty resulted in
substantial improvement in pain in all six patients. Patients developed
recurrent pain between 8 days and 167 days after initial vertebroplasty.
After repeat vertebroplasty, five of the six patients reported a
reduction of at least 3 points in their rating of pain, with a mean
reduction of 6.5 points and a mean postoperative pain level of 3.5
points (11-point scale). Four of six patients reported impaired mobility
before repeat vertebroplasty, and all four demonstrated a postoperative
improvement in mobility. Mean increase in mobility was 1.50 points, and
the mean postoperative mobility impairment was 0.25 points (5-point
scale). CONCLUSION: The clinical outcomes of the patients within this
case series suggest that repeat percutaneous vertebroplasty performed at
previously treated vertebral levels for recurrent pain offer therapeutic
benefit.

Gaumond, I., P. Arsenault, and S. Marchand. \"The role of sex hormones
on formalin-induced nociceptive responses.\" *Brain Research.* 958, no.
1(2002): 139-45 UI 12468038.

Many chronic pain conditions are more frequent in women than in men.
This observation suggests that there is a potential role of sex hormones
on pain perception. In the present study, we measured nociceptive
responses to the formalin test in normal and gonadectomized male and
female rats. The nociceptive responses to formalin injection were
divided in four phases: acute (phase I), interphase and late phases
(phases II and III). Four groups of rats were tested: (a) males (n =
15), (b) females (n = 16), (c) ovariectomized females (OVX) (n = 15) and
(d) castrated males (CAST) (n = 15). Females presented significantly
more nociceptive responses than males during phase I, interphase and
phase II (P \< 0.01). They also presented significantly more nociceptive
responses than OVX females during the interphase (P \< 0.05). CAST males
presented significantly more nociceptive responses during the phases I
(P \< 0.01), II (P \< 0.01) and III (P \< 0.05) than the male rats.
Finally, the responses of CAST males and OVX females were virtually
identical, suggesting that the differences recorded between males and
females in the formalin test were related to an activational effect of
the sex hormones rather than an organizational effect. In conclusion,
these results permit the support of the role of sex hormones on the
modulation of pain perception. Interestingly, male and female sex
hormones seem to act specifically on the different phases of the
formalin test, suggesting some specific roles for sex hormones in
different pain conditions. Copyright 2002 Elsevier Science B.V.

Glende, M., et al. \"Extended analysis of a double-blind,
placebo-controlled, 15-week study with otilonium bromide in irritable
bowel syndrome.\" *European Journal of Gastroenterology & Hepatology.*
14, no. 12(2002): 1331-8 UI 12468954.

BACKGROUND/OBJECTIVE: In order to follow the most recent developments
and recommendations in trial methodology for drug evaluation in patients
with irritable bowel syndrome, we performed an extended analysis of a
large clinical trial from a previously published study of otilonium
bromide, using an assessment that integrates the key symptoms of
irritable bowel syndrome. MATERIALS AND METHODS: A large-scale clinical
trial with a double-blind, placebo-controlled, parallel-group study
design was conducted in 378 patients, treated for 15 weeks with the
recommended standard dose of 40 mg otilonium bromide or placebo three
times daily. The study was based on the collection of 12 single efficacy
endpoints. The new efficacy assessment was based on the data reported by
the patients. Rather than demonstrating score differences between the
treatment groups of the study, we carried out an assessment that
integrates the most frequent symptoms reported (pain frequency and
intensity, presence of meteorism and distension) by the patient.
RESULTS: The rate of response to treatment within 2-4 months (the
primary efficacy outcome measure) was significantly higher in the
otilonium bromide group (36.9%) than in the placebo group (22.5%; P =
0.007). In each month of treatment, the rate of monthly response was
higher in the otilonium bromide group as compared to the placebo group
(P \< 0.05). The total monthly and weekly responses to the single
endpoints (intensity and frequency of pain and discomfort,
meteorism/abdominal distension, severity of diarrhoea or constipation
and mucus in the stool) were significantly more frequent in the group
treated with otilonium bromide than in the placebo-treated group, with
differences ranging from 10% to 20%. The subgroup analysis of the
intestinal habits endpoint indicates that patients with diarrhoea have
an additional benefit. CONCLUSION: The present re-evaluation of a
previously published study confirms that otilonium bromide is more
effective than placebo for the treatment of irritable bowel syndrome,
being very efficient in relieving pain and discomfort.

Gur, A., et al. \"Effects of low power laser and low dose amitriptyline
therapy on clinical symptoms and quality of life in fibromyalgia: a
single-blind, placebo-controlled trial.\" *Rheumatology International.*
22, no. 5(2002): 188-93 UI 12215864.

The purpose of this study was to examine the effectiveness of low power
laser (LPL) and low-dose amitriptyline therapy and to investigate
effects of these therapy modalities on clinical symptoms and quality of
life (QOL) in patients with fibromyalgia (FM). Seventy-five patients
with FM were randomly allocated to active gallium-arsenide (Ga-As) laser
(25 patients), placebo laser (25 patients), and amitriptyline therapy
(25 patients). All groups were evaluated for the improvement in pain,
number of tender points, skin fold tenderness, morning stiffness, sleep
disturbance, muscular spasm, and fatigue. Depression was evaluated by a
psychiatrist according to the Hamilton Depression Rate Scale and DSM IV
criteria. Quality of life of the FM patients was assessed according to
the Fibromyalgia Impact Questionnaire (FIQ). In the laser group,
patients were treated for 3 min at each tender point daily for 2 weeks,
except weekends, at each point with approximately 2 J/cm(2) using a
Ga-As laser. The same unit was used for the placebo treatment, for which
no laser beam was emitted. Patients in the amitriptyline group took 10
mg daily at bedtime throughout the 8 weeks. Significant improvements
were indicated in all clinical parameters in the laser group (P = 0.001)
and significant improvements were indicated in all clinical parameters
except fatigue in the amitriptyline group (P = 0.000), whereas
significant improvements were indicated in pain (P = 0.000), tender
point number (P = 0.001), muscle spasm (P = 0.000), morning stiffness (P
= 0.002), and FIQ score (P = 0.042) in the placebo group. A significant
difference was observed in clinical parameters such as pain intensity (P
= 0.000) and fatigue (P = 0.000) in favor of the laser group over the
other groups, and a significant difference was observed in morning
stiffness (P = 0.001), FIQ (P = 0.003), and depression score (P = 0.000)
after therapy. A significant difference was observed in morning
stiffness (P = 0.001), FIQ (P = 0.003), and depression (P = 0.000) in
the amitriptyline group compared to the placebo group after therapy.
Additionally, a significant difference was observed in depression score
(P = 0.000) in the amitriptyline group in comparison to the laser group
after therapy. Our study suggests that both amitriptyline and laser
therapies are effective on clinical symptoms and QOL in fibromyalgia and
that Ga-As laser therapy is a safe and effective treatment in cases with
FM. Additionally, the present study suggests that the Ga-As laser
therapy can be used as a monotherapy or as a supplementary treatment to
other therapeutic procedures in FM.

Hartmannsgruber, M. W., et al. \"A method for overcoming the ceiling
effect of bounded pain scales.\" *Journal of Clinical Monitoring &
Computing.* 15, no. 7-8(1999): 455-9 UI 12578043.

OBJECTIVE: The Verbal Numerical Scale (VNS) for rating pain is bounded
between 0 (= no pain) and 10 (= worst pain imaginable). We hypothesized
that the limitations inherent to this boundary when rating extremely
painful stimuli may be identified by integrating the VNS with an
unbounded score such as magnitude estimation of relative change.
METHODS: Volunteers received stimuli of increasing current via cutaneous
electrodes until they rated \>5 on the VNS scale. This stimulus, termed
S, was arbitrarily assigned a magnitude estimate of 100%. Then, stimuli
of varying currents were delivered; two were 10 mA and 20 mA higher than
S (S(+10) and S(+20)), two were 1/2 of the current for the S stimulus
(S(1/2)), and one was at the original current (Srepeat). The pain
elicited by each stimulus was scored in proportion to the S stimulus.
The extrapolated VNS score (VNSext) was determined by multiplying this
magnitude estimate (%) by the VNS score for S. MAIN RESULTS: Seventy
percent of the stimuli with higher intensity than S generated a VNSext
score above 10. The mean magnitude estimations for S(+10) and S(+20)
were 186% and 242%: they generated mean (median) VNSext values of 12.4
and 16.2, respectively (p = 0.019 for the difference between them by
Wilcoxon signed rank test). CONCLUSIONS: The combined use of VNS and
magnitude estimation confirmed that the ceiling of the bounded pain
scale may significantly limit a patient\'s ability to describe a new
pain stimulus. VNSext may provide a means of overcoming this limitation.

Heidenreich, A., P. Olbert, and U. H. Engelmann. \"Management of chronic
testalgia by microsurgical testicular denervation.\" *European Urology.*
41, no. 4(2002): 392-7 UI 12074809.

OBJECTIVES: Chronic testicular pain (CTP) is defined as uni- or
bilateral, intermittent or continuous testicular discomfort of at least
3 months duration that interferes with the patient\'s daily activities
and prompts him to seek medical advice is a rather common urological
manifestation of chronic pain syndrome. Diagnosis and treatment of CTP
has been a difficult and often unrewarding clinical situation. Success
rates of conservative and surgical measures including epididymectomy and
orchiectomy rarely exceed 55-73% and 10-40%, respectively. We report our
experience on microsurgical testicular denervation as therapeutic option
in CTP. PATIENTS AND METHODS: Following an extensive preoperative
work-up (urine/semen cultures, transrectal ultrasound, testicular
sonography, pain and orthopedic consultation) not revealing any
pathologic abnormalities and a positive response to spermatic cord
block, 35 patients underwent microsurgical testicular denervation. In
brief, spermatic cord was dissected, vas deferens, cremasteric muscle
and testicular vessels were separated. After identification of the
testicular artery by application of vasodilatating agents using
magnifying loops or the operating microscope, all structures besides the
testicular artery, vas deferens and 1-2 lymphatic vessels were
coagulated and transsected using bipolar diathermy. RESULTS: After a
mean follow-up of 31.5 months 34/35 (96%) patients are completely
pain-free; no intra- or postoperative complications were encountered. No
case of testicular atrophy or hydrocele formation was observed during
postoperative follow-up. CONCLUSIONS: Microsurgical testicular
denervation results in reliable and reproducible excellent therapeutic
success rates of 96% and should be integrated in the management of CTP
at an early stage. High success rates require adequate and meticulous
diagnostic work-up of the patients by spermatic cord block using saline
as placebo and different local anaesthetics as an initial therapeutic
armentarium predicting postoperative outcome.

Hemingway, A. E., L. Herrington, and A. L. Blower. \"Changes in muscle
strength and pain in response to surgical repair of posterior abdominal
wall disruption followed by rehabilitation.\" *British Journal of Sports
Medicine.* 37, no. 1(2003): 54-8 UI 12547744.

BACKGROUND: Posterior abdominal wall deficiency (PAWD) is a tear in the
external oblique aponeurosis or the conjoint tendon causing a posterior
wall defect at the medial end of the inguinal canal. It is often known
as sportsman\'s hernia and is believed to be caused by repetitive
stress. OBJECTIVE: To assess lower limb and abdominal muscle strength of
patients with PAWD before intervention compared with matched controls;
to evaluate any changes following surgical repair and rehabilitation.
METHODS: Sixteen subjects were assessed using a questionnaire,
isokinetic testing of the lower limb strength, and pressure biofeedback
testing of the abdominals. After surgery and a six week rehabilitation
programme, the subjects were re-evaluated. A control group were assessed
using the same procedure. RESULTS: Quadriceps and hamstrings strength
was not affected by this condition. A deficit hip muscle strength was
found on the affected limb before surgery, which was significant for the
hip flexors (p = 0.05). Before surgery, 87% of the patients compared
with 20% of the controls failed the abdominal obliques test. Both the
injured and non-injured sides had improved significantly in strength
after surgery and rehabilitation. The strength of the abdominal obliques
showed the most significant improvement over the course of the
rehabilitation programme. CONCLUSIONS: Lower limb muscle strength may
have been reduced as the result of disuse atrophy or pain inhibition.
Abdominal oblique strength was deficient in the injured patients and
this compromises rotational control of the pelvis. More sensitive
investigations (such as electromyography) are needed to assess the link
between abdominal oblique function and groin injury.

Henderson, M. M. \"A 67-year-old man with increasing severe lower back
pain since the night before.\" *Journal of Emergency Nursing.* 29, no.
1(2003): 9-11 UI 12556822.

Henderson, S. O., S. Swadron, and E. Newton. \"Comparison of intravenous
ketorolac and meperidine in the treatment of biliary colic.\" *Journal
of Emergency Medicine.* 23, no. 3(2002): 237-41 UI 12426013.

To compare the analgesic efficacy and tolerability of intravenous (IV)
ketorolac tromethamine with IV meperidine in the treatment of biliary
colic, a prospective, randomized, double blind study was carried out
upon a convenience sample of patients at a large inner city facility.
Patients between the ages of 18 and 65 years of age with a history and
physical examination consistent with biliary colic were enrolled over a
2-year period. Patients were randomly assigned to receive ketorolac 30
mg IV or meperidine 50 mg IV. Pain was quantified using a 4-point verbal
rating system (VRS) as well as a visual analog scale (VAS). Patients
were queried about their pain at times 0, 12 h, 1 h, and 2 h after
administration of the study medication. Adverse effects were also
recorded. A total of 324 patients completed the study protocol with 175
patients receiving ketorolac and 149 receiving meperidine. Patient
demographics were similar for both groups with mean age for the
ketorolac group of 36.1 years and for the meperidine group of 34.6
years. Both groups were predominantly Latino and over 80% of patients in
both groups were female. No significant difference in pain control was
found between ketorolac and meperidine in either the VAS or VRS for any
time interval studied. The mean change in the VAS at time 2 h was 6.2 cm
+/- 3.6 cm for the ketorolac group, compared with 6.7 cm +/- 3.6 cm for
the meperidine group (p = 0.25). Although no significant difference was
found in overall drug tolerability, patients receiving meperidine
reported higher incidences of nausea and of dizziness than those
receiving ketorolac (p = 0.009 and 0.003, respectively). Ketorolac
tromethamine is a well-tolerated, effective medication in the treatment
of acute biliary colic. It showed similar efficacy to meperidine with a
decreased number of adverse effects. Copyright 2002 Elsevier Science
Inc.

Heuft-Dorenbosch, L., et al. \"Assessment of enthesitis in ankylosing
spondylitis.\" *Annals of the Rheumatic Diseases.* 62, no. 2(2003):
127-32 UI 12525381.

OBJECTIVE: To assess, firstly, the validity of the enthesis index
published by Mander (Mander enthesis index (MEI)) and, secondly, to
investigate whether it is possible to define a new enthesis index that
is less time consuming to perform with at least similar or better
properties. METHODS: Data from the OASIS cohort, an international,
longitudinal, observational study on outcome in ankylosing spondylitis,
were used. In this study, measures of disease activity, including the
Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the MEI,
were assessed regularly in 217 patients. With the MEI, for each
measurement period independently, a process of data reduction was
performed to identify the entheses most commonly reported as painful by
the patients. A more concise enthesis index was constructed with aid of
the entheses found in this way. Correlations with measures of disease
activity were used to test the validity of several entheses indices.
RESULTS: Reduction of the number of entheses from 66 to 13 and omitting
grading of the intensity of pain resulted in an index which was named
the \"Maastricht Ankylosing Spondylitis Enthesitis Score\" (MASES). The
MASES (range 0-13) has much greater feasibility than the MEI (range
0-90). However, up to 21% of patients with a score \>0 on the MEI were
not identified by a score on the MASES \>0. Only 2.1% of the patients
with an original enthesis score \>0 had an original score on the MEI \>3
(range 0-90) and it can be questioned whether a low score on the MEI
index represents clinically important enthesitis. The Spearman
correlation coefficient between the MASES score and the MEI was 0.90 and
between the MASES and the BASDAI was 0.53 compared with a correlation of
0.59 between the MEI and the BASDAI. CONCLUSIONS: MASES seems to be a
good alternative to the MEI with much better feasibility.

Hilbert, J. E., G. A. Sforzo, and T. Swensen. \"The effects of massage
on delayed onset muscle soreness.\" *British Journal of Sports
Medicine.* 37, no. 1(2003): 72-5 UI 12547748.

OBJECTIVES: The purpose of this study was to investigate the
physiological and psychological effects of massage on delayed onset
muscle soreness (DOMS). METHODS: Eighteen volunteers were randomly
assigned to either a massage or control group. DOMS was induced with six
sets of eight maximal eccentric contractions of the right hamstring,
which were followed 2 h later by 20 min of massage or sham massage
(control). Peak torque and mood were assessed at 2, 6, 24, and 48 h
postexercise. Range of motion (ROM) and intensity and unpleasantness of
soreness were assessed at 6, 24, and 48 h postexercise. Neutrophil count
was assessed at 6 and 24 h postexercise. RESULTS: A two factor ANOVA
(treatment v time) with repeated measures on the second factor showed no
significant treatment differences for peak torque, ROM, neutrophils,
unpleasantness of soreness, and mood (p \> 0.05). The intensity of
soreness, however, was significantly lower in the massage group relative
to the control group at 48 h postexercise (p \< 0.05). CONCLUSIONS:
Massage administered 2 h after exercise induced muscle injury did not
improve hamstring function but did reduce the intensity of soreness 48 h
after muscle insult.

Hodges, S. D., S. C. Humphreys, and J. C. Eck. \"Effect of spirituality
on successful recovery from spinal surgery.\" *Southern Medical
Journal.* 95, no. 12(2002): 1381-4 UI 12597302.

BACKGROUND: Many patients believe prayer helps them recover from health
problems. Benefits of spirituality on other illnesses and surgical
procedures have been reported. It is unknown whether patients with
strong spiritual beliefs have a greater propensity for successful
recovery from spinal surgery. METHODS: In this study, 188 patients
having spinal surgery completed the visual analog pain scale (VAS) and
the Oswestry functional capacity questionnaire (OSW) before and after
operation, and the scores were used to assess surgical outcome. Degree
of spirituality was assessed using the INSPIRIT survey. RESULTS: Paired
t test revealed significant improvements in both the VAS and OSW outcome
measures. Linear regression analysis revealed no correlation between
change in either VAS or OSW. CONCLUSIONS: These results suggest that
recovery from spinal surgery may be more dependent on proper patient
selection and surgical technique than on patient spiritual beliefs.

Hoekstra, J. W., et al. \"Improving the care of patients with
non-ST-elevation acute coronary syndromes in the emergency department:
the CRUSADE initiative.\" *Academic Emergency Medicine.* 9, no.
11(2002): 1146-55 UI 12414463.

Although acute coronary syndromes (ACS) represent a well-recognized
source of morbidity and mortality for patients with cardiovascular
disease, evidence-based therapies shown to improve outcomes for ACS are
frequently underused in appropriate patients, especially in the
emergency department (ED). Despite dissemination of expert
recommendations from the American College of Cardiology/American Heart
Association (ACC/AHA) and ED-focused recapitulation of them in the
emergency medicine literature, significant barriers continue to limit
the adoption of guidelines in clinical practice and appear to hinder the
use of beneficial therapies and interventions in the ED. Unique and
creative approaches are therefore needed to stimulate better adherence
to practice guidelines and improve the quality of care for patients with
non-ST-elevation myocardial infarction (NSTE) ACS. The CRUSADE (Can
Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse
Outcomes with Early Implementation of the ACC/AHA Guidelines) quality
improvement and educational initiative provides an innovative and
multifaceted approach to the education of emergency physicians and
cardiologists in the care of patients with NSTE ACS. The CRUSADE
initiative is a multidisciplinary cooperative effort involving over 400
EDs and medical centers. It includes an ACS registry designed to
characterize demographic patterns and risk stratification results in
patients who meet diagnostic criteria for high-risk NSTE ACS. It also
measures the use of ED treatment modalities including aspirin, heparin,
beta-blockers, and platelet inhibitors as recommended in the ACC/AHA
guidelines. The results of a given institution\'s treatment patterns
will be reported back to the practitioners, with comparisons with
national norms. These reports can be used as quality improvement tools
to improve care at participating institutions. Beyond a static registry,
these reports are coupled with educational efforts by the CRUSADE
steering committee, scientific publications of risk stratification
practice and success, as well as ED patterns of care, and tailored
educational interventions, to reinforce compliance with the ACC/AHA
guidelines. This initiative represents a truly innovative approach to
improving care for ACS patients in the ED as well as on the cardiology
service. This article describes the CRUSADE initiative and its
implications for the practicing emergency physician. It is the intent of
CRUSADE to improve patient care in the ED by tracking and encouraging
compliance with evidence-based guidelines for the evaluation and
management of NSTE ACS.

Honderick, T., et al. \"A prospective, randomized, controlled trial of
benzodiazepines and nitroglycerine or nitroglycerine alone in the
treatment of cocaine-associated acute coronary syndromes.\" *American
Journal of Emergency Medicine.* 21, no. 1(2003): 39-42 UI 12563578.

The purpose of the present study was to compare the use of lorazepam
plus nitroglycerine (NTG) versus NTG alone in the reduction of cocaine
induced chest pain in the emergency department. The secondary objective
of the study was to help determine the safety of lorazepam in the
treatment of cocaine- associated chest pain. The study was a
prospective, randomized, single-blinded, controlled trial conducted at
an university-affiliated urban emergency department (ED). All patients
who presented with cocaine-associated chest pain were enrolled.
Exclusion criteria included age greater than 45 years, documented
coronary artery disease, chest pain of more than 72 hours duration, or
pretreatment with nitroglycerin. Patients were given either sublingual
nitroglycerine (SL NTG) (Group 1) or SL NTG plus 1 mg of lorazepam
intravenously (Group 2) every 5 minutes for a total of 2 doses. Chest
pain was recorded on an ordinal scale of 0 to 10 at baseline, and then
at 5 minutes after each dose. Adverse reactions to medication were also
recorded. Twenty-seven patients met the inclusion criteria and were
enrolled in the study. The average age of these subjects was 34.1 years,
and 67% were men. The NTG-only group consisted of 15 patients and the
NTG-plus-lorazepam group consisted of 12 patients. Baseline mean
chest-pain scores were 6.87 in Group 1 and 6.54 in Group 2, with no
differences between groups. Five minutes after initial treatment, mean
scores for the two groups were 5.2 and 3.9, respectively, with a
difference in means of 1.24 (95% confidence interval \[CI\] -0.8-3.8).
Five minutes after the second treatment, the mean scores were 4.6 and
1.5, respectively, with a difference in means of 3.1 (95% CI 1.2-5).
Kruskal-Wallis testing showed a significant difference in pain relief
between the two study groups (P =.003), with greater pain relief noted
at 5 and 10 minutes in the NTG-plus-lorazepam group (P =.02 and P =.005,
respectively). All patients in the study were admitted to the hospital,
but no patient in either group had an acute myocardial infarction or
cardiac complications in the ED. No adverse side effects were noted for
either group. The early use of lorazepam with NTG was more efficacious
than NTG alone, and appears to be safe in relieving cocaine-associated
chest pain. Copyright 2003, Elsevier Science (USA). All rights
reserved.)

Hournbuckle, W. \"Patient education on pain management.\" *Prairie
Rose.* 71, no. 4(2002): 26-9; quiz 30 UI 12567849.

Howard, P. A. \"New treatment guidelines for unstable
angina/non-ST-segment elevation myocardial infartion.\" *Annals of
Pharmacotherapy.* 36, no. 11(2002): 1800-4 UI 12432893.

Hubbard, R. C., et al. \"Parecoxib sodium has opioid-sparing effects in
patients undergoing total knee arthroplasty under spinal anaesthesia.\"
*BJA: British Journal of Anaesthesia.* 90, no. 2(2003): 166-72 UI
12538372.

BACKGROUND: This multicentre, double-blind, placebo-controlled study
compared the opioid-sparing effectiveness and clinical safety of
parecoxib sodium over 48 h, in 195 postoperative patients after routine
total knee replacement surgery. METHODS: Elective total primary knee
arthroplasty was performed under spinal anaesthesia, with a single dose
of spinal bupivacaine 10-20 mg, and intraoperative sedation with
midazolam 0.5-1.0 mg i.v., or propofol \<6 mg kg(-1)h(-1). Patients were
randomized to receive either parecoxib sodium 20 mg twice daily (bd)
i.v. (n=65), parecoxib sodium 40 mg bd i.v. (n=67), or placebo (n=63) at
the completion of surgery, and after 12, 24, and 36 h. Morphine (1-2 mg)
was taken by patient-controlled analgesia or by bolus doses after 30
min. RESULTS: Patients receiving parecoxib sodium 20 mg bd and 40 mg bd
consumed 15.6% and 27.8% less morphine at 24 h than patients taking
placebo (both P\<0.05). Both doses of parecoxib sodium administered with
morphine provided significantly greater pain relief than morphine alone
from 6 h (P\<0.05). A global evaluation of study medication demonstrated
a greater level of satisfaction among patients taking parecoxib sodium
than those taking placebo. Parecoxib sodium administered in combination
with morphine was well tolerated. However, a reduction in opioid-type
side-effects was not demonstrated in the parecoxib sodium groups.
CONCLUSION: Parecoxib sodium provides opioid-sparing analgesic effects
in postoperative patients.

Idvall, E., et al. \"Patient and nurse assessment of quality of care in
postoperative pain management.\" *Quality & Safety in Health Care.* 11,
no. 4(2002): 327-34 UI 12468692.

OBJECTIVE: To describe and compare patient and nurse assessments of the
quality of care in postoperative pain management, to investigate
differences between subgroups of patients, and to compare patient
assessments in different departments. DESIGN: Patient and nurse
questionnaires. SETTING: Five surgical wards in general surgery,
orthopaedics, and gynaecology in a central county hospital in Sweden.
SAMPLE: Two hundred and nine inpatients and 64 registered nurses. The
response rates were 96% for the patients and 99% for the nurses; there
were 196 paired patient-nurse assessments. METHOD: The Strategic and
Clinical Quality Indicators in Postoperative Pain Management patient
questionnaire was used which comprises 14 items in four subscales
(communication, action, trust, and environment). The items were scored
on a 5 point scale with higher values indicating a higher quality of
care. Five complementary questions on levels of pain intensity and
overall satisfaction with pain relief were scored on an 11 point scale.
Twelve of the 14 items in the patient questionnaire and two of the
complementary questions were adjusted for use in the nurse
questionnaire. RESULTS: The patients\' mean (SD) score on the total
scale (scale range 14-70) was 58.6 (8.9) and the nurses\' mean (SD)
score (scale range 12-60) was 48.1 (6.2). The percentage of patients who
scored 1 or 2 for an individual item (disagreement) ranged from 0.5% to
52.0%, while for nurses the percentage ranged from 0.0% to 34.8%. Forty
two patients (24%) reported more pain than they expected; these patients
assessed the quality of care lower. There were differences between
patient and nurse assessments concerning the environment subscale, the
question on overall satisfaction, and patients\' experience of worst
possible pain intensity. CONCLUSION: The results provided valuable
baseline data and identified important areas for quality improvement in
postoperative pain management.

Im, E. O., and W. Chee. \"Decision support computer program for cancer
pain management.\" *CIN: Computers, Informatics, Nursing.* 21, no.
1(2003): 12-21 UI 12544150.

The purpose of the study was to develop an initial version of computer
software that could assist nurses\' decision making about cancer pain
reported by women from diverse cultural groups. This cross-sectional
study included two phases: (1) data collection and (2) development of
computer software. Data were collected using an Internet survey and
e-mail group discussions of 19 faculty members from 10 countries who
were self-identified experts in oncology nursing. The data were analyzed
using descriptive statistics and content analysis. The findings
indicated ethnic, gender, geographic, and age differences in cancer pain
descriptions. Based on the collected data, a decision support computer
program for cancer pain management, including (1) a knowledge base
generation module, (2) a decision-making module, and (3) a
self-adaptation module, was developed. Based on the study findings,
suggestions for future research and practice related to cancer pain and
expert systems were proposed.

Immer, F. F., et al. \"Pain treatment with a COX-2 inhibitor after
coronary artery bypass operation: a randomized trial.\" *Annals of
Thoracic Surgery.* 75, no. 2(2003): 490-5 UI 12607659.

BACKGROUND: Adequate analgesic medication is mandatory after cardiac
operations. Cyclooxygenase-2 inhibitors represent a new therapeutic
option, acting primarily on the response to inflammation. METHODS: We
compared a cyclooxygenase-2 inhibitor (etodolac) with two traditional
drugs: a nonselective cyclooxygenase inhibitor (diclofenac) and a weak
opioid (tramadol) on postoperative pain and renal function in patients
undergoing coronary artery bypass operations. Sixty consecutive patients
were randomized into three groups: (1) group A patients who received
tramadol; (2) group B patients who received diclofenac; and (3) group C
patients who received etodolac. For measurement of analgesic effect, the
visual analogue scale was assessed up to postoperative day 4.
Creatinine-clearance was determined before and at the end of study
medication, and serum creatinine and urea were monitored daily for renal
effects. Study medication was given on postoperative days 2 and 3. Side
effects and additional pain medication were recorded. RESULTS: The
visual analogue scale was lower in group C (p \< 0.05) from
postoperative days 2 to 4 and in group B (p \< 0.05) from postoperative
days 3 to 4 compared with group A. Amount of additional pain medication
and incidence of side effects were significantly less in group C
compared with group A. We observed a short-lasting elevation of serum
creatinine and urea in groups B and C compared with group A (p \< 0.05).
CONCLUSIONS: At the doses analyzed, etodolac and diclofenac produced
better postoperative pain relief with less side-effects than tramadol. A
short-lasting impairment of renal function was found in patients treated
with etodolac and diclofenac.

Innocenti, M., G. Moscatelli, and S. Lopez. \"Efficacy of gelclair in
reducing pain in palliative care patients with oral lesions: preliminary
findings from an open pilot study.\" *Journal of Pain & Symptom
Management.* 24, no. 5(2002): 456-7 UI 12547044.

Izzedine, H., et al. \"Pharmacokinetics of tramadol in a hemodialysis
patient.\" *Nephron.* 92, no. 3(2002): 755-6 UI 12372979.

Jellish, W. S., et al. \"The effect of spinal bupivacaine in combination
with either epidural clonidine and/or 0.5% bupivacaine administered at
the incision site on postoperative outcome in patients undergoing lumbar
laminectomy.\" *Anesthesia & Analgesia.* 96, no. 3(2003): 874-80, table
of contents UI 12598277.

Spinal anesthesia has numerous advantages over general anesthesia for
patients undergoing lumbar laminectomy and microdisk surgery. In this
study, we evaluated the addition of epidural clonidine and/or
bupivacaine, injected at the incision site, on postoperative outcome
variables in patients undergoing lower spine procedures using spinal
anesthesia. One hundred twenty patients having lumbar spine surgery
received bupivacaine spinal anesthesia supplemented by 150 microg of
epidural clonidine with or without incisional bupivacaine, epidural
placebo plus incisional bupivacaine, or placebo with incisional saline.
Demographic data, intraoperative hemodynamics, blood loss, pain, nausea,
urinary retention, hospital discharge, and other variables were compared
by using either analysis of variance or chi(2) analysis. Demographics
were similar. IV fluids, blood loss, incidence of intraoperative
bradycardia, and hypotension were not different among groups.
Postanesthesia care unit pain scores were lower and demand for
analgesics was less in patients who received both the clonidine and
subcutaneous bupivacaine. Patients who received epidural clonidine also
had improved postoperative hemodynamics. Hospital discharge, urinary
retention, and other variables were not different. We conclude that
epidural clonidine as a supplement to spinal anesthesia produced no
perioperative complications and improved postoperative pain and
hemodynamic stability in patients undergoing lower spine procedures.
IMPLICATIONS: Spinal anesthesia with supplemental epidural clonidine in
combination with incision site subcutaneous bupivacaine was evaluated
both intra- and postoperatively and compared with spinal anesthesia
alone for lower lumbar spine procedures. Both epidural clonidine and
subcutaneous incisional bupivacaine, added to spinal anesthesia for
lumbar spine surgery, improves pain relief and reduces the need for
postoperative opioids with their associated side effects.

Jonas, J. B., M. Jager, and T. M. Hemmerling. \"Anesthesia through a
novel retrobulbar catheter provides perioperative pain control for 24 h
after pars plana vitrectomy.\" *European Journal of Ophthalmology.* 12,
no. 6(2002): 512-7 UI 12516533.

PURPOSE: The purpose of this study was to assess the retrobulbar
catheter technique for perioperative pain control in pars plana
vitrectomy. METHODS: One hundred consecutive pars plana vitrectomies
(duration 20-220 minutes) in 88 patients (age range 37-88 years) were
performed by the same surgeon under retrobulbar anesthesia using a
commercially available retrobulbar needle. Initially, 7 ml of
mepivacaine 2% were injected, a 28-gauge flexible catheter was
introduced into the retrobulbar space and the needle was withdrawn. The
catheter was removed 24 h after surgery. Intraoperatively and
postoperatively, the patients were asked to rate pain using a numerical
scale from 0 to 10. When pain was more than grade 3, 2 ml of a local
anesthetic were re-injected through the catheter. RESULTS: A first
re-injection was given intraoperative/y 53.0 +/- 34.6 minutes after the
start of surgery during 35/100 procedures, and second and third
injections were needed during 12 /100 and 4/100 procedures,
respectively. The first postoperative re-injection was given 3.9 +/- 1.5
hours after the start of surgery in 54 procedures, and second and third
injections were carried out in 35/100 and 10/100 procedures
respectively. CONCLUSIONS: The results suggest that a temporary
indwelling retrobulbar catheter allows long-lasting titratable local
anesthesia during pars plana vitrectomy and titratable postoperative
analgesia.

Kacar, F., et al. \"A limited form of Churg-Strauss syndrome presenting
as acute abdominal catastrophe.\" *Virchows Archiv.* 441, no. 6(2002):
632-4 UI 12587603.

Kairaluoma, M., K. Nuorva, and I. Kellokumpu. \"Day-case stapled
(circular) vs. diathermy hemorrhoidectomy: a randomized, controlled
trial evaluating surgical and functional outcome.\" *Diseases of the
Colon & Rectum.* 46, no. 1(2003): 93-9 UI 12544528.

PURPOSE: Stapled hemorrhoidectomy may be associated with less pain and
faster recovery than conventional hemorrhoidectomy for prolapsing
hemorrhoids. Therefore, the outcome of stapled hemorrhoidectomy was
compared with that of diathermy hemorrhoidectomy in a randomized,
controlled trial. METHODS: Sixty patients with third-degree hemorrhoids
were randomly assigned to stapled hemorrhoidectomy (n = 30) or to
diathermy hemorrhoidectomy in a day-case setting. Visual analog scale
was used for postoperative pain scoring. Surgical and functional outcome
was assessed at six weeks and one year after surgery. RESULTS: Operation
time was a median of 21 (range, 11-59) minutes in the stapled group. 22
(range, 14-40) minutes in the diathermy group. Day-case surgery was
successful in 24 patients (80 percent) in the stapled group vs. 29
patients (97 percent) in the diathermy group. Average pain in the
stapled group was significantly lower than in the diathermy group
(median, 1.8 (0.1-4.8) vs. 4.3 (1.4-6.2), 95 percent confidence interval
difference medians, 1.15-3.85, P = 0.0002, Mann-Whitney U test) as was
the average pain expected by the patients (median -2.7 (-0.15-0.8) vs.
0.006 (-4.05-0.5) respectively, 95 percent confidence interval
difference medians, 0.5-3.55, P = 0.0018, Mann-Whitney U test).
Postoperative morbidity and time off work were not significantly
different between the diathermy and stapled groups. Seven treatment
failures in the stapled group and one in the diathermy group
necessitated other treatments at a later date. Patient satisfaction
scores in the stapled and diathermy group were similar. Symptoms
attributed to difficult rectal evacuation decreased significantly after
surgery. CONCLUSIONS: Stapled hemorrhoidectomy is a significantly less
painful operation than diathermy hemorrhoidectomy, but does not seem to
offer significant advantages in terms of hospital stay or symptom
control in the long term. Hemorrhoidectomy may improve symptoms of
difficult rectal evacuation.

Kalus, J. S., and C. M. White. \"Amlodipine versus Angiotensin-receptor
blockers for nonhypertension indications.\" *Annals of Pharmacotherapy.*
36, no. 11(2002): 1759-66 UI 12398574.

OBJECTIVE: To review the efficacy and safety data of amlodipine and the
angiotensin-receptor blockers (ARBs), focusing on heart failure, angina,
percutaneous coronary intervention (PCI), and renal protection. DATA
SOURCE: A MEDLINE search (1966-December 2001) was completed using
amlodipine, angiotensin-receptor antagonist, losartan, valsartan,
candesartan, and telmisartan as key words. English-language articles
were identified and included. STUDY SELECTION AND DATA EXTRACTION: All
identified articles were evaluated. Articles representative of the
subject matter of our review were included. DATA SYNTHESIS: Amlodipine
and the ARBs lower blood pressure to a similar extent. Amlodipine is an
effective antianginal agent, whereas ARBs are not. However, amlodipine
is not effective in the treatment of heart failure; ARBs may be useful
in this setting. ARBs are also effective in preserving renal function
and may provide some protection from restenosis in patients who have had
a PCI. The ARBs may also be useful in preventing both diabetic and
nondiabetic nephropathy. CONCLUSIONS: Concomitant disease states should
be considered when choosing between an ARB and amlodipine for the
management of hypertension. \[References: 47\]

Kamal, K., A. Zini, and K. Jarvi. \"Testicular block using
intra-testicular lidocaine: a new anaesthetic technique for percutaneous
testis biopsy.\" *Canadian Journal of Urology.* 9, no. 3(2002): 1568-70;
discussion 1571 UI 12121584.

PURPOSE: We describe a simple technique to deliver local anaesthetic for
percutaneous testis biopsies. MATERIALS AND METHODS: With the testis
held firmly, a 25 gage needle is used to inject lidocaine, without
epinephrine, into the skin and dartos superficial to the testis, then
the needle is advanced through the tunica albuginea and 0.5 mL to 1.0 mL
of lidocaine is injected directly into the testis. The testis becomes
slightly more turgid with the injection. A percutaneous biopsy is then
immediately performed. RESULTS: Intra-testicular lidocaine, (without
need of a cord block or any sedation) was used on a total of 45
consecutive patients having percutaneous testicular biopsies. Procedure
time was short (averages less than 5 minutes) and anaesthesia was
profound. There was no change in the number of seminiferous tubules for
evaluation compared to biopsies on men using a cord block. Only 1/45 men
had a post-procedure testicular hematoma (this resolved in 4 weeks).
CONCLUSIONS: Intra-testicular lidocaine appears to be a simple, rapid
and safe method to provide anaesthesia for a percutaneous testis biopsy.

Kampe, S., et al. \"Epidural combination of ropivacaine with sufentanil
for postoperative analgesia after total knee replacement: a pilot
study.\" *European Journal of Anaesthesiology.* 19, no. 9(2002): 666-71
UI 12243290.

BACKGROUND AND OBJECTIVE: We assessed the analgesic efficacy of
postoperative epidural infusions of ropivacaine 0.1 and 0.2% combined
with sufentanil 1 microg mL(-1) in a prospective, randomized,
double-blinded study. METHODS: Twenty-two ASA I-III patients undergoing
elective total-knee replacement were included. Lumbar epidural blockade
using ropivacaine 0.75% was combined with either propofol sedation or
general anaesthesia for surgery. After surgery, the epidural infusion
was commenced. Eleven patients in each group received either an epidural
infusion of ropivacaine 0.1% with 1 microg mL(-1) sufentanil (Group 1)
or ropivacaine 0.2% with 1 microg mL(-1) sufentanil (Group 2) at a rate
of 5-9 mL h(-1). All patients had access to intravenous pirinatrimide
(piritramide) via a patient-controlled analgesia (PCA) device. RESULTS:
Motor block was negligible for the study duration in both groups. There
was no significant difference with the 100 mm visual analogue scale
(VAS) scores, with the consumption of rescue analgesia or with patient
satisfaction. Patients in Group 1 experienced significantly less nausea
(P \< 0.05) than those in Group 2. Both treatment regimens provided
effective postoperative analgesia with only a minimal use of
supplemental opioid PCA. CONCLUSIONS: We recommend the use of
ropivacaine 0.1% with 1 microg mL(-1) sufentanil for postoperative
analgesia after total knee replacement as it provides efficient pain
relief with no motor block of the lower limbs. In addition, compared
with 0.2% ropivacaine with sufentanil, the mixture reduces local
anaesthetic consumption without compromise in patient satisfaction or
VAS scores. Patients even experience less nausea.

Karaca, S., and E. O. Unlusoy. \"Accidental injection of intravenous
bupivacaine.\" *European Journal of Anaesthesiology.* 19, no. 8(2002):
616-7 UI 12200956.

Karibe, H., G. Goddard, and R. W. Gear. \"Sex differences in masticatory
muscle pain after chewing.\" *Journal of Dental Research.* 82, no.
2(2003): 112-6 UI 12562883.

Neither the etiology of muscle-related temporomandibular disorders (TMD)
nor the reason for the disproportionate number of women suffering from
these disorders is well-established. We tested the hypothesis that
physiologically relevant exercise (i.e., chewing bubble gum for 6 min)
increases masticatory muscle pain in patients, but not in asymptomatic
control subjects, and that female patients experience a significantly
greater increase than males. Chewing increased pain in both female and
male patients and, unexpectedly, also in female control subjects. One
hour after chewing, the pain remained above pre-test levels for female
patients but not for the other groups. Thus, sex differences in
chewing-induced pain were found in control subjects but not as
hypothesized in patients. Because chewing-induced masticatory muscle
pain was significantly greater in female control subjects than in males,
and persisted longer in female patients than in males, these results
suggest greater susceptibility in women.

Karmakar, M. K., et al. \"Continuous thoracic paravertebral infusion of
bupivacaine for pain management in patients with multiple fractured
ribs.\" *Chest.* 123, no. 2(2003): 424-31 UI 12576361.

STUDY OBJECTIVE: To evaluate the efficacy of a continuous thoracic
paravertebral infusion of bupivacaine for pain management in patients
with unilateral multiple fractured ribs (MFR). DESIGN: Prospective
nonrandomized case series. SETTING: Multidisciplinary tertiary hospital.
PATIENTS: Fifteen patients with unilateral MFR. INTERVENTIONS: Insertion
of a catheter into the thoracic paravertebral space. We administered an
initial injection of 0.3 mL/kg (1.5 mg/kg) bupivacaine 0.5% with
1:200,000 epinephrine followed 30 min later by an infusion of
bupivacaine 0.25% at 0.1 to 0.2 mL/kg/h for 4 days. Measurements and
results: The following parameters were measured during the initial
assessment before thoracic paravertebral block (TPVB), 30 min after the
initial injection, and during follow-up on day 1 and day 4 after
commencing the infusion of bupivacaine: visual analog pain score at rest
and during coughing; respiratory rate; arterial oxygen saturation
(SaO(2)); bedside spirometry (ie, FVC, FEV(1), FEV(1)/FVC ratio, and
peak expiratory flow rate \[PEFR\]); arterial blood gas measurements;
and O(2) index (ie, PaO(2)/fraction of inspired oxygen ratio). There
were significant improvements in pain scores (at rest, p = 0.002; during
coughing, p = 0.001), respiratory rate (p \< 0.0001), FVC (p = 0.007),
PEFR (p = 0.01), SaO(2) (p = 0.04), and O(2) index (p = 0.01) 30 min
after the initial injection, which were sustained for the 4 days that
the thoracic paravertebral infusion was in use (p \< 0.05). PaCO(2) did
not change significantly after the initial injection, but on day 4 it
was significantly lower than the post-TPVB value (p = 0.04). One patient
had an inadvertent epidural injection, and another developed transient
ipsilateral Horner syndrome with sensory changes in the arm. No patient
exhibited clinical signs of inadvertent intravascular injection or local
anesthetic toxicity. CONCLUSION: Our results confirmed that continuous
thoracic paravertebral infusion of bupivacaine is a simple and effective
method of providing continuous pain relief in patients with unilateral
MFR. It also produced a sustained improvement in respiratory parameters
and oxygenation.

Kawamata, M., et al. \"Experimental incision-induced pain in human skin:
effects of systemic lidocaine on flare formation and hyperalgesia.\"
*Pain.* 100, no. 1-2(2002): 77-89 UI 12435461.

In order to try to gain a better understanding of the mechanisms of
post-operative pain, this study was designed to psychophysically
determine physiological and pharmacological characteristics of
experimental pain induced by a 4-mm-long incision through the skin,
fascia and muscle in the volar forearm of humans. In experiment 1, the
subjects (n=8) were administered lidocaine systemically (a bolus
injection of 2mg/kg for a period of 5 min followed by an intravenous
infusion of 2mg/kg/h for another 40 min), and then the incision was
made. In experiment 2, cumulative doses of lidocaine (0.5-2mg/kg) were
systemically injected in the subjects (n=8) 30 min after the incision
had been made, when primary and secondary hyperalgesia had fully
developed. Spontaneous pain was assessed using the visual analog scale
(VAS). Primary hyperalgesia was defined as mechanical pain thresholds to
von Frey hair stimuli (from 7 to 151 mN) in the injured area. The area
of secondary hyperalgesia to punctate mechanical stimuli was assessed
using a rigid von Frey hair (151 mN). Flare formation was assessed in
the first experiment using a laser doppler imager (LDI).Pain perception
was maximal when the incision was made and then rapidly disappeared
within 30 min after the incision had been made. Primary hyperalgesia was
apparent at 15 min after the incision had been made and remained for 2
days. The incision resulted in a relatively large area of flare
formation immediately after the incision had been made. The area of
flare began to shrink within 15 min and was limited to a small area
around the injured area at 30 min after incision. Secondary hyperalgesia
was apparent at 30 min after incision and persisted for 3h after
incision and then gradually disappeared over the next 3h. In experiment
1, pre-traumatic treatment with systemic lidocaine suppressed primary
hyperalgesia only during the first 1h after the incision had been made.
The lidocaine suppressed the development of flare formation without
affecting the pain rating when the incision was made. The development of
secondary hyperalgesia continued to be suppressed after completion of
the lidocaine infusion.In experiment 2, post-traumatic treatment with
lidocaine temporarily suppressed primary as well as secondary
hyperalgesia that had fully developed; however, the primary and
secondary hyperalgesia again became apparent after completion of the
lidocaine administration.These findings suggest that pre-traumatic
treatment with lidocaine reduces the excessive inputs from the injured
peripheral nerves, thus suppressing development of flare formation and
secondary hyperalgesia through peripheral and central mechanisms,
respectively. Pre-traumatic treatment with lidocaine would temporarily
stabilize the sensitized nerves in the injured area, but the nerves
would be sensitized after completion of the administration.
Post-traumatic treatment with lidocaine reduced primary and secondary
hyperalgesia that had fully developed. However, the finding that the
suppressive effect of lidocaine on secondary hyperalgesia was temporary
suggests that the development and maintenance of secondary hyperalgesia
are caused by different mechanisms.

Kawamata, Y. T., et al. \"A comparison of hyperbaric 1% and 3% solutions
of small-dose lidocaine in spinal anesthesia.\" *Anesthesia &
Analgesia.* 96, no. 3(2003): 881-4, table of contents UI 12598278.

We examined whether the concentration of hyperbaric lidocaine affected
the regression of motor block when the dose of lidocaine was kept
constant at 30 mg. We also examined the spread, duration, and regression
of sensory block. Sixty-five patients (ASA physical status I or II),
scheduled for elective perineum or lower limb surgery, were enrolled in
this study. Patients received spinal anesthesia with 1 mL of 3%
lidocaine or 3 mL of 1% lidocaine. Adequate level of block was obtained
for surgery in 63 of 65 patients. Whereas the administration of 3 mL of
hyperbaric 1% lidocaine solution produced a level of sensory block
similar to that produced by the administration of 1 mL of hyperbaric 3%
lidocaine solution in spinal anesthesia, the administration of 3 mL of
hyperbaric 1% lidocaine solution resulted in shorter times to full motor
recovery and to urination and produced less motor block compared with 1
mL of hyperbaric 3% lidocaine solution. Two patients receiving 1%
lidocaine and four patients receiving 3% lidocaine required IV ephedrine
because of hypotension. Our results showed the clinical advantages of
hyperbaric 1% lidocaine spinal anesthesia compared with hyperbaric 3%
lidocaine spinal anesthesia for surgery of short duration. IMPLICATIONS:
When the dose of lidocaine was kept constant at 30 mg, hyperbaric 1%
lidocaine solution resulted in shorter times for recovery from motor
block and to urination than did hyperbaric 3% lidocaine solution. Levels
of sensory block were similar. Therefore, the more dilute lidocaine for
spinal anesthesia may be suitable for day-care surgery and short
duration surgery.

Kay, G., et al. \"The role of ketorolac tromethamine in a clinical care
pathway for men undergoing radical retropubic prostatectomy.\" *Urologic
Nursing.* 22, no. 6(2002): 392-3, 396-7, 426 UI 12593230.

The use of ketorolac in managing postoperative pain after a variety of
surgical procedures has potential advantages over the use of narcotic
analgesics alone. The purpose of this study was to determine whether the
addition of ketorolac influenced the time to resumption of a full diet,
hospital discharge, and postoperative complication rates, compared to a
group of patients receiving only narcotic analgesics whose postoperative
management was otherwise similar. The group receiving ketorolac had an
earlier return to full diet than those receiving narcotics alone.
Similarly, the median length of hospital stay was shorter in the
ketorolac group then the group treated with narcotics alone. The
inclusion of ketorolac in the postoperative pain management of patients
after radical retropubic prostatectomy appears to be a safe and
effective strategy.

Khaitan, E., S. Scholz, and W. O. Richards. \"Laparoscopic adhesiolysis
and placement of Seprafilm: a new technique and novel approach to
patients with intractable abdominal pain.\" *Journal of Laparoendoscopic
& Advanced Surgical Techniques. Part A.* 12, no. 4(2002): 241-7 UI
12269490.

Patients who suffer from chronic abdominal pain as a result of
postoperative adhesion formation are challenging to treat. Many surgeons
argue that operative treatment of these patients exacerbates symptoms
because of the continued adhesion formation following each procedure.
Seprafilm (Genzyme, Tucker, GA, USA), a bioresorbable membrane of sodium
hyaluronate and carboxymethylcellulose, and laparoscopic surgery have
both been shown to significantly decrease postoperative adhesion
formation. Although the utility of laparoscopy is controversial in the
treatment of these patients, the combination of laparoscopy and
Seprafilm can provide excellent relief in this difficult patient
population. We report a new technique, laparoscopic adhesiolysis and
Seprafilm placement, for patients with intractable abdominal pain
secondary to adhesions.

King, B. \"Pain at first dressing change after toenail avulsion: the
experience of nurses, patients and an observer: 1.\" *Journal of Wound
Care.* 12, no. 1(2003): 5-10 UI 12572229.

OBJECTIVE: Ingrowing toenails are often treated surgically by nail
avulsion, with paraffin tulle gauze applied to the toenail bed
afterwards. In one large city\'s primary care trusts, community nurses
reported that patients felt pain when the gauze was removed
postoperatively. This study looked at patients\' general pain
experience, and their pain during the first dressing change after
toenail avulsion. Patients\' perceptions of their pain were
investigated, along with nurses\' experience of redressing toenail beds,
their technique and their interaction with patients, especially in
relation to pain prevention. METHOD: First an extensive literature
review was conducted. Then a collective instrumental case study design
was used. This allowed triangulation of data sources using patient and
nurse interviews, and non-participant observation, from six cases
recruited from the city\'s primary care trusts. Data were subjected to
thematic content analysis, with two main categories identified. These
were \'setting up of expectations\' and \'a painful experience: but for
whom?\' RESULTS AND CONCLUSION: This study provides a unique description
of the type of pain patients experience. It raises serious issues about
the adequacy of nurses\' management of pain, including assessment,
documentation and advice on pain-relief strategies. It supports
discontinuing the use of paraffin tulle gauze as the postoperative
dressing, and raises ethical issues about changing treatments and lack
of communication with secondary care. Finally, it identifies a gap in
knowledge of the most suitable dressing product to apply immediately
after surgery. A randomised controlled trial is needed to clarify these
preliminary findings.

Kirsner, R. \"New approaches to a timeless dilemma.\" *Ostomy Wound
Management.* 49, no. 1(2003): 12-4 UI 12532028.

Klepstad, P., et al. \"The Norwegian brief pain inventory questionnaire:
translation and validation in cancer pain patients.\" *Journal of Pain &
Symptom Management.* 24, no. 5(2002): 517-25 UI 12547051.

The European Association of Palliative Care recommends the Brief Pain
Inventory questionnaire (BPI) as a pain assessment tool in clinical
studies. After translation into Norwegian, we administered the BPI to
300 hospitalized cancer patients. Cronbach\'s alphas were computed to
assess reliability, and factor analysis was utilized to ascertain
construct validity. The BPI interference and pain severity scales were
validated against items on pain intensity and pain influence on daily
function in the European Organization for Research and Therapy of Cancer
(EORTC) QLQ-C30 questionnaire. In total, 235 patients (78%) were able to
complete the BPI questionnaire, but 82 (35%) of these questionnaires had
one or more missing items. Cronbach\'s alphas were 0.87 for the pain
severity and 0.92 for the interference scales. A factor analysis
identified three factors; pain intensity, interference with physical
function, and interference with psychological functions/sleep. These
three factors explained 82% of the variance. The correlation between BPI
pain severity index and the EORTC QLQ-C30 item on pain intensity was
0.70 (P \< 0.001). The correlation between BPI interference index and
the EORTC QLQ-C30 item on pain influence on daily living was 0.62 (P \<
0.001). We conclude that BPI has satisfactory psychometric properties,
but is not completed by a significant proportion of patients. Further
research is needed to establish pain assessment tools for patients
unable to answer a comprehensive pain questionnaire, to establish
routines for analysis of missing values, and to investigate if pain
interference items also reflect disease-related impairment.

Kogan, A., et al. \"Evaluation of chest pain in the ED: factors
affecting triage decisions.\" *American Journal of Emergency Medicine.*
21, no. 1(2003): 68-70 UI 12563585.

The emergency physician\'s (EP) fast and correct diagnosis of patients
with chest pain is crucial for preventing inappropriate discharge and
dire consequences. To determine which factors affect admission decisions
in the ED, we studied epidemiologic characteristics of both discharged
and admitted patients, and the percentage of discharged patients who
returned to the ED with acute myocardial infarction. The study included
185 patients seen in the ED because of chest pain between July 1 and 31,
1997 (every third day not included). Ninety patients were admitted:
36.7% were admitted for \"observation of chest pain\" and 63.3% met the
criteria for active coronary heart disease. A form was used to collect
personal data, medical history, risk factors, clinical examination,
electrocardiogram interpretation, laboratory data, and admittance
decision. EPs\' diagnosis of cardiac chest pain demonstrated a
sensitivity of 93.4%, a specificity of 73.4%, and a positive predictive
value of 63.3%. Sensitivity for diagnosing acute myocardial infarct was
100%, with no erroneous discharges. The EP\'s ability to integrate the
medical history information, including risk factors and pain
characteristics, had a marked influence on the admittance decision.
Efforts to reduce missed diagnoses are warranted. Copyright 2003,
Elsevier Science (USA). All rights reserved.)

Korttila, K. \"Concluding remarks. C0X-2-selective inhibition: a new
advance in pain management.\" *European Journal of Anaesthesiology -
Supplement.* 25(2002): 21-3 UI 12596801.

Korttila, K. \"COX-2-selective inhibition: a new advance in pain
management. Chairman\'s introduction.\" *European Journal of
Anaesthesiology - Supplement.* 25(2002): 1-2 UI 12449671.

Kunjur, J., P. A. Brennan, and V. Ilankovan. \"The use of triamcinolone
in thyrohyoid syndrome.\" *British Journal of Oral & Maxillofacial
Surgery.* 40, no. 5(2002): 450-1 UI 12379199.

Kuster, G. M., et al. \"Comparison of presentation, perception, and
six-month outcome between women and men \> or =75 years of age with
angina pectoris.\" *American Journal of Cardiology.* 91, no. 4(2003):
436-9 UI 12586259.

Kvale, P. A., et al. \"Lung cancer. Palliative care.\" *Chest.* 123, no.
1 Suppl(2003): 284S-311S UI 12527586.

The majority of patients who acquire lung cancer will have troublesome
symptoms at some time during the course of their disease. Some of the
symptoms are common to many types of cancers, while others are more
often encountered with lung cancer than other primary sites. The most
common symptoms are pain, dyspnea, and cough. This document will address
the management of these symptoms, and it will also address the
palliation of specific problems that are commonly seen in lung cancer:
metastases to the brain, spinal cord, and bones; hemoptysis;
tracheoesophageal fistula; and obstruction of the superior vena cava.
\[References: 216\]

Kyriakides, Z. S., et al. \"Usefulness of endothelin(A) receptor
antagonists for the prevention of in-stent restenosis in patients with
stable angina pectoris or silent myocardial ischemia.\" *American
Journal of Cardiology.* 91, no. 4(2003): 476-9 UI 12586272.

Lalak, N. J., et al. \"The Dornier Compact Delta lithotripter: the first
150 ureteral calculi.\" *Journal of Endourology.* 16, no. 9(2002): 645-8
UI 12490016.

BACKGROUND AND PURPOSE: Shockwave lithotripsy (SWL) is the least
invasive treatment for ureteral calculi and is the best accepted by
patients and clinicians. This prospective study was performed to
evaluate the results of SWL for all ureteral calculi. PATIENTS AND
METHODS: Between April 1999 and May 2000, there were 150 SWL treatments
for ureteral calculi at our center. All patients who completed treatment
(24 females, 126 males with an average age of 54 +/- 14 years) were
entered in the study and were assessed at 1 and 3 months with a plain
film of the kidneys, ureters, and bladder and an ultrasound scan or
intravenous urogram if clinically indicated. The outcome has been
analyzed according to stone size, location (lower ureter \[LU\],
midureter \[MU\], and upper ureter \[UU\], number of treatments per
stone, number of shocks per stone, and stone-free rate (SFR). The
analgesia requirements during each treatment and complications have also
been analyzed. RESULTS: The SFR in the UU was 77% at 1 month and 85% at
3 months. The SFR in the MU was 74% at both 1 and 3 months. The SFR in
the LU was 65% at 1 month and 74% at 3 months. Overall, the SFR for all
calculi was 72% at 1 month and 79% at 3 months. Ureteroscopic extraction
was necessary in 19% of the patients and conservative management for the
remaining asymptomatic fragments, which were 2 mm or smaller. All of
these asymptomatic fragments were seen to have passed spontaneously on
follow-up imaging studies. Ureteral stents were not placed routinely
prior to SWL, but there were 32 calculi (21%) for which stents had been
placed prior to SWL: 29 (19%) in the UU, 3 (2%) in the MU, and 0 in LU.
There was no difference in the SFR or ureteroscopy rate in UU calculi
treated with or without stents and no difference in the number of
treatments needed to achieve these SFRs. The efficiency quotient for the
UU was 55%, 45% for the MU, and 45% for the LU. Oral analgesia was given
routinely; however, additional intravenous analgesia was necessary in
24% of treatments. No serious complications were seen. CONCLUSIONS: The
Dornier Compact Delta lithotripter provides an effective noninvasive
treatment for ureteral calculi that is achieved with minimal anesthesia
and a low complication rate. Placement of ureteral stents prior to SWL
does not enhance the SFR or obviate intervention if SWL fails. We
recommend a low threshold for ureteroscopic treatment if significant
progress is not made in fragmenting the stone with SWL.

Lane, P., et al. \"A pain assessment tool for people with advanced
Alzheimer\'s and other progressive dementias.\" *Home Healthcare Nurse.*
21, no. 1(2003): 32-7 UI 12544460.

Appropriate pain management can only be achieved through accurate pain
assessment that is individualized, ongoing, and well documented.
Assessment tools must focus on the patient as the authority on pain\'s
existence and severity; however, self-reports are not feasible when
patients lose their ability to verbally communicate. This article
describes a scientifically proven pain assessment tool that can be used
for patients with advanced dementia and Alzheimer\'s Disease.

Laprade, J. A., and E. G. Culham. \"A self-administered pain severity
scale for patellofemoral pain syndrome.\" *Clinical Rehabilitation.* 16,
no. 7(2002): 780-8 UI 12428827.

OBJECTIVE: To develop a scale for estimating the severity of
patellofemoral pain syndrome (PFPS) and to determine its reliability and
validity. DESIGN: The PFPS Severity Scale (PSS) was developed following
a literature search, input from clinicians, and pilot testing in people
with PFPS. The final version of the instrument encompasses 10 statements
regarding PFPS pain in a visual analogue format. Reliability and
validity of the new scale were determined in a PFPS population. SETTING:
All testing was performed at the Canadian Forces Base Kingston,
Physiotherapy Department. SUBJECTS: Twenty-nine military subjects (7
female) between the ages of 20 and 48 (32 years +/- 8.9) with subjective
and objective findings consistent with PFPS were recruited. Twenty-four
of the participants (6 female, 31.8 years +/- 9.4) participated in the
reliability phase of the study. METHODS: Reliability of the PSS was
determined by comparing the scores obtained on two test days (24 hours
apart). Convergent validity of the PSS was determined by comparing data
from the PSS with two established knee scales: the WOMAC (Western
Ontario and McMaster Universities) Osteoarthritis Index and the Hughston
Foundation subjective knee scale. RESULTS: Test-retest reliability was
excellent (Spearman\'s rho = 0.95, p \< 0.0001). The correlations
between the PSS and the WOMAC and Hughston scales were strong (rho =
0.72 and 0.83, p \< 0.001 respectively). CONCLUSIONS: The PSS is
reliable and has demonstrated convergent validity making it a useful
tool for monitoring rehabilitative or surgical outcomes in clients with
PFPS.

Lapsley, J. N. \"The clergy as advocates for the severely demented.\"
*The Journal of Pastoral Care & Counseling: JPCC.* 56, no. 4(2002):
317-25 UI 12564392.

The author sets forth the argument that pastoral caregivers ought to
consider expanding their traditional role of ministering to dementia
patients by pressing the issue of whether appropriate medication might
significantly lessen the suffering of these persons. After discussing
and documenting the current understanding regarding the nature of pain,
the author outlines several advocacy, ethical, and procedural issues
that could be included in providing pastoral care to this population, at
the same time not miminizing more traditional faith-based activities.

Larsen, K., F. Weidick, and C. Leboeuf-Yde. \"Can passive prone
extensions of the back prevent back problems? A randomized, controlled
intervention trial of 314 military conscripts.\" *Spine.* 27, no.
24(2002): 2747-52 UI 12486341.

SUMMARY OF BACKGROUND DATA: Back schools may be effective in treating
back problems, but there is conflicting evidence of the effect on
prevention. OBJECTIVES: To investigate if passive prone extensions of
the back can prevent back problems. STUDY DESIGN: Prospective,
randomized controlled intervention trial. METHODS: In total, 314 male
conscripts were randomized into two groups. After randomization, 65
conscripts dropped out for administrative reasons, leaving 249
conscripts to participate fully in the study. Data were collected
through questionnaires at the start of military duty and after 10
months. All conscripts in the intervention group had one 40-minute
theoretical lesson on back problems and ergonomics and had to perform
passive prone extensions of the back daily during the rest of their
military duty. The control group had no intervention. Outcome variables
were as follows: 1) number of persons with self-reported back problems
during the last 3 weeks; 2) number of persons with self-reported back
problems during the last year; and 3) number of persons who reported
having consulted the regiment medical physician with back problems
during their military service. RESULTS: In an intention-to-treat
analysis, significantly fewer persons in the intervention group versus
those in the control group reported back problems during the last year
(33% versus 51%), and the number needed to prevent was 6. Significantly
fewer persons in the intervention group versus those in the control
group consulted the regiment infirmary (9% versus 25%), and the number
needed to prevent was 6. CONCLUSION: It may be possible to reduce the
prevalence rate of back problems and the use of health care services
during military service, at a low cost, using passive prone extensions
of the back motivated by a back school approach, including the theory of
the disc as a pain generator and ergonomic instructions.

Lenderink, T., et al. \"Elevated troponin T and C-reactive protein
predict impaired outcome for 4 years in patients with refractory
unstable angina, and troponin T predicts benefit of treatment with
abciximab in combination with PTCA.\[comment\].\" *European Heart
Journal.* 24, no. 1(2003): 77-85 UI 12559939.

AIMS: Treatment with the glycoprotein IIb/IIIa receptor antagonist
abciximab before and during coronary intervention in refractory unstable
angina improves early outcome. We collected 4-year follow-up data to
assess whether this benefit is sustained. Additionally, we investigated
the predictive value of baseline troponin T and CRP for long-term
cardiovascular events. METHODS AND RESULTS: Of 1265 patients enrolled in
the CAPTURE trial follow-up was available in 94% of the patients alive
after 6 months (median 48 months). Survival was similar in both groups.
Both elevated troponin T and CRP were associated with impaired outcome,
independently of other established risk factors, but with a different
time course. Elevated troponin was associated with increased procedure
related risk, and elevated CRP with increased risk for subsequent
events. Lower rates of the composite end-point of death or myocardial
infarction with abciximab vs. placebo were sustained during long-term
follow up: 15.7% vs 17.2% at 4 years (P=ns), particularly in patients
with elevated troponin T: 16.9% with abciximab vs 28.4% with placebo:
P=0.015. Elevated CRP was not associated with specific benefit of
abciximab. CONCLUSION: Troponin T as a marker of thrombosis and CRP as a
marker of inflammation are independent predictors of impaired outcome at
4 years follow-up. The initial benefit from abciximab with regard to
death and myocardial infarction was preserved at 4 years. No specific
benefit with abciximab was observed for patients with elevated CRP,
suggesting that a chronic inflammatory process is not affected by
abciximab. In contrast the benefit of treatment in patients with
elevated troponin T implies that the acute thrombotic process in
refractory unstable angina is treated effectively.

Lew, M. F. \"Review of the FDA-approved uses of botulinum toxins,
including data suggesting efficacy in pain reduction.\" *Clinical
Journal of Pain.* 18, no. 6 Suppl(2002): S142-6 UI 12569961.

Botulinum toxin has dramatically improved the treatment of a variety of
neurologic disorders. Two botulinum toxin preparations are commercially
available in the United States: type A (Botox) and type B (Myobloc).
Current indications approved by the United States Food and Drug
Administration include cervical dystonia, strabismus, blepharospasm,
hemifacial spasm, and glabellar wrinkles for Botox, and cervical
dystonia for Myobloc. Botulinum toxin inhibits release of acetylcholine
from the neuromuscular junction, resulting in a localized paralysis when
minute doses are injected. This mechanism enables botulinum toxin to
alleviate symptoms of focal dystonias (which are characterized by
excessive muscle contraction), and it may also, along with other
theoretical mechanisms, be responsible for pain relief. Studies
conducted in patients with cervical dystonia have shown that botulinum
toxin effectively reduces pain associated with this disorder, suggesting
that this agent may be effective in alleviating other painful syndromes.
\[References: 37\]

Li, S. F., and P. W. Greenwald. \"How distracting is distracting pain?\"
*American Journal of Emergency Medicine.* 21, no. 1(2003): 43-4 UI
12563579.

The study was to determine the effect of preexisting pain on the
perception of a painful stimulus. We conducted a cross-section study at
an urban ED using convenience sampling. Adult patients who had a 20-g IV
catheter placed as part of their ED care were eligible for the study.
Patients were excluded for the following reasons: more than one IV
attempt, altered mental status, visual impairment, intoxication, or a
physical abnormality at the IV site. Patients were asked to indicate on
a 10-cm visual analog scale (VAS) the amount of pain they had at
baseline immediately before IV placement. They were then asked to
indicate on a separate VAS the amount of pain caused by the IV
placement. Correlation between baseline pain and pain of the IV was
assessed using Pearson\'s rho. One hundred patients were enrolled in the
study. The pain of IV placement did not differ significantly by gender,
race, who placed the IV, or the location of the IV. The correlation
between baseline pain and pain of the IV placement was poor (rho =.14,
confidence interval:-.06-.33). The response to a standardized painful
stimulus among ED patients does not correlate highly with the severity
of preexisting pain. Copyright 2003, Elsevier Science (USA). All rights
reserved.)

Link, T. M., et al. \"Osteoarthritis: MR imaging findings in different
stages of disease and correlation with clinical findings.\" *Radiology.*
226, no. 2(2003): 373-81 UI 12563128.

PURPOSE: To determine whether knee pain, stiffness, and limited function
in patients with different stages of osteoarthritis correlate with the
degree of disease assessed on magnetic resonance (MR) images and
radiographs. MATERIALS AND METHODS: Radiographs in 50 patients with
varying degrees of osteoarthritis of the knee were assessed by using the
the Western Ontario and McMaster University (WOMAC) osteoarthritis index
and the Kellgren-Lawrence (KL) scale. MR images were obtained and
analyzed by two readers for cartilage lesions, bone marrow edema
pattern, and ligamentous and meniscal lesions. RESULTS: Thirteen of 16
knees with a KL score of 4 showed full-thickness cartilage lesions and
bone marrow edema pattern. Cruciate ligament tears were found in five of
12 knees with a KL score of 3 and in nine of 16 knees with a KL score of
4. While the KL score correlated significantly (P \<.05) with the grade
of cartilage lesions, and a substantially higher percentage of lesions
with higher KL scores were found on MR images, the correlations between
MR imaging findings and KL score versus clinical findings were not
significant (P \>.05). Significant differences between WOMAC scores were
found only for the grades of cartilage lesions (P \<.05). CONCLUSION:
Cartilage lesions, bone marrow edema pattern, and meniscal and
ligamentous lesions were frequently demonstrated on MR images in
patients with advanced osteoarthritis. Clinical findings showed no
significant correlations with KL score and extent of findings at MR
imaging.

Lippert, J. A., and J. K. McGraw. \"Spine interventions.\" *Seminars in
Roentgenology.* 37, no. 4(2002): 266-81 UI 12455125.

Luginbuhl, M., et al. \"Modulation of remifentanil-induced analgesia,
hyperalgesia, and tolerance by small-dose ketamine in humans.\"
*Anesthesia & Analgesia.* 96, no. 3(2003): 726-32, table of contents UI
12598253.

Adding a small dose of ketamine to opioids may increase the analgesic
effect and prevent opioid-induced hyperalgesia and acute tolerance to
opioids. In this randomized, double-blinded, placebo-controlled
crossover study, we investigated the effect of remifentanil combined
with small concentrations of ketamine on different experimental pain
models. Pain detection thresholds to single and repeated IM electrical
stimulation and to repeated transcutaneous electrical stimulation,
pressure pain tolerance threshold, and sedative, respiratory, and
cardiovascular side effects were assessed in 14 healthy volunteers.
Saline, remifentanil alone, and remifentanil combined with ketamine at
target plasma concentrations of 50 or 100 ng/mL were administered in
four study sessions. The ketamine infusion was started after baseline
testing at a constant target concentration. Remifentanil was started
after testing with ketamine alone at an initial target concentration of
1 ng/mL and then increased to 2 ng/mL and decreased to 1 ng/mL. The last
test series were started 10 min after discontinuation of remifentanil.
Acute remifentanil-induced hyperalgesia and tolerance were detected only
by the pressure pain test and were not suppressed by ketamine.
Remifentanil alone induced significant analgesia with all pain tests.
Ketamine further increased the remifentanil effect only on IM electrical
pain. Remifentanil at a 2 ng/mL target concentration induced a slight
respiratory depression that was antagonized by ketamine. We conclude
that ketamine effects on opioid analgesia are pain-modality specific.
IMPLICATIONS: Coadministration of ketamine and morphine for pain relief
is still controversial. Our experimental pain study with volunteers
showed that ketamine enhances opioid analgesia without increasing
sedation and reduces respiratory depression. Opioid-induced hyperalgesia
and tolerance were not affected by ketamine and depended on the type of
nociceptive stimulus. This may explain the conflicting results on opioid
tolerance in previous studies.

Lutz, C., G. E. Lutz, and P. M. Cooke. \"Treatment of chronic lumbar
diskogenic pain with intradiskal electrothermal therapy: a prospective
outcome study.\" *Archives of Physical Medicine & Rehabilitation.* 84,
no. 1(2003): 23-8 UI 12589616.

OBJECTIVE: To determine the clinical efficacy of intradiskal
electrothermal annuloplasty in treating patients with chronic constant
lumbar diskogenic pain who have not responded to at least 6 months of
aggressive nonoperative care. DESIGN: Prospective case series. SETTING:
Academic-affiliated private physiatry practice. PARTICIPANTS:
Thirty-three patients with chronic constant lumbar diskogenic pain of
more than 6 months in duration diagnosed with history and physical
examination, with concordant pain on provocative pressure-controlled
lumbar diskography, and with symptomatic annular tears and/or
protrusions less than 5mm, who did not respond to aggressive
nonoperative care. INTERVENTION: Intradiskal electrothermal
annuloplasty. MAIN OUTCOME MEASURES: Visual analog scale (VAS) pain
scores for the back and for the lower extremity, the Roland-Morris
Disability Questionnaire (RMDQ), and the North American Spine Society
Patient Satisfaction Index. RESULTS: A total of 33 patients, with mean
age of 40 years and a mean duration of symptoms of 46 months, were
observed with a mean follow-up of 15 months. Relief of pain and
improvement in physical function were associated with a mean change in
the VAS score of 3.9 (P\<.001), a mean change in the lower-extremity VAS
score of 3.7 (P\<.001), and a mean change in the RMDQ of 7.3 (P\<.001).
For patient satisfaction, 75.7% reported that they would undergo the
same procedure for the same outcome. Complete pain relief was achieved
in 24% of the patients, and partial pain relief in 46% of the patients.
CONCLUSIONS: Intradiskal electrothermal annuloplasty offers a safe,
minimally invasive treatment option for carefully selected patients with
chronic lumbar diskogenic pain who have not responded to aggressive
nonoperative care. Copyright 2003 by the American Congress of
Rehabilitation Medicine and the American Academy of Physical Medicine
and Rehabilitation

Mader, R. \"Clinical manifestations of diffuse idiopathic skeletal
hyperostosis of the cervical spine.\" *Seminars in Arthritis &
Rheumatism.* 32, no. 2(2002): 130-5 UI 12430101.

OBJECTIVES: To describe the clinical manifestations and the
complications of cervical spine (C-spine) involvement in diffuse
idiopathic skeletal hyperostosis (DISH). METHODS: Two patients, who
presented with dysphagia resulting from large anterior osteophytes of
the C-spine, were diagnosed as having DISH. A Medline search from 1964
to present, using the terms \"diffuse idiopathic skeletal hyperostosis\"
and \"cervical spine,\" identified several clinical manifestations
associated with DISH. RESULTS: Two groups of conditions associated with
DISH were found. 1. Spontaneous complications such as: dysphagia, being
the commonest, dyspnea, stridor, myelopathy associated with ossification
of the posterior longitudinal ligament (OPLL) or with atlanto-axial
pseudoarthrosis or subluxation. Other rare events were aspiration
pneumonia, sleep apnea and thoracic outlet syndrome. 2. Provoked
complications such as endoscopic and intubation difficulties and
fractures of the C-spine with frequent transverse shift of the fractured
segment and resultant myelopathy. CONCLUSIONS: C-spine involvement in
DISH is a recognized cause of various clinical manifestations involving
the pharynx, larynx and the esophagus. Prior knowledge of the existence
of cervical DISH should alert the clinicians for possible complications,
at times severe, during invasive procedures in the neck region and as a
consequence of trauma. Copyright 2002, Elsevier Science (USA). All
rights reserved.

Maihofner, C., et al. \"Temporo-spatial analysis of cortical activation
by phasic innocuous and noxious cold stimuli\--a magnetoencephalographic
study.\" *Pain.* 100, no. 3(2002): 281-90 UI 12467999.

Clinical findings and recent non-invasive functional imaging studies
pinpoint the insular cortex as the crucial brain area involved in cold
sensation. By contrast, the role of primary (SI) and secondary (SII)
somatosensory cortices in central processing of cold is controversial.
So far, temporal activation patterns of cortical areas involved in cold
processing have not been examined. Using magnetoencephalography, we
studied, in seven healthy subjects, the temporo-spatial dynamics of
brain processes evoked by innocuous and noxious cold stimulation as
compared to tactile stimuli. For this purpose, a newly designed and
magnetically silent cold-stimulator was employed. In separate runs, cold
and painful cold stimuli were delivered to the dorsum of the right hand.
Tactile afferents were stimulated by pneumatic tactile
stimulation.Following innocuous cold stimulation (DeltaT=5+/-0.3 degrees
C in 50+/-2ms), magnetic source imaging revealed an exclusive activation
of the contra- and ipsilateral posterior insular cortex. The mean peak
latencies were 194.3+/-38.1 and 241.0+/-31.7ms for the response in the
ipsi- and contralateral insular cortex, respectively. Based on the
measurement of onset latencies, the estimated conduction velocity of
peripheral nerve fibres mediating cold fell in the range of
Adelta-fibres (7.4+/-0.8 m/s). Noxious cold stimulation (DeltaT=35+/-5
degrees C in 70+/-12ms) initially activated the contra- and ipsilateral
insular cortices in the same latency ranges as innocuous cold stimuli.
Additionally, we found an activation of the contra- and ipsilateral SII
areas (peak latencies 304+/-22.7 and 310.1+/-19.4ms, respectively) and a
variable activation of the cingulate cortex. Notably, neither cold- nor
painful cold stimulation produced an activation of SI. By contrast, the
evoked cortical responses following tactile stimulation could be located
to the contralateral SI cortex and bilateral SII. In conclusion, this
study strongly corroborates the posterior insular cortex as the primary
somatosensory area for cortical processing of cold sensation.
Furthermore, it supports the role of SII and the cingulate cortex in
mediating freeze-pain. Therefore, these results suggest different
processing of cold, freeze-pain and touch in the human brain.

Manfredi, P. L., et al. \"Pain assessment in elderly patients with
severe dementia.\" *Journal of Pain & Symptom Management.* 25, no.
1(2003): 48-52 UI 12565188.

The purpose of this study was to assess the reliability and validity of
facial expressions as pain indicators in patients with severe dementia.
Based on interviews with patients who could report pain, we defined
characteristics of decubitus ulcers associated with reports of pain
during dressing changes. We then evaluated 9 patients who had ulcers
with these characteristics but were unable to communicate verbally
because of severe dementia. We videotaped their facial expressions
before and during their decubitus ulcer dressing change. We showed the
videotape segments, in random order, to 8 medical students and 10
nurses. The 18 viewers were asked to infer the presence or absence of
pain based on their observations of the patients\' facial expressions
and vocalizations. The dressing change of decubitus ulcers extending
beyond the subcutaneous tissue, covering an area of at least 9 cm(2),
and with a moist surface, was always reported as painful by study
patients able to report (95% confidence interval of 69-100%). The
intraclass correlation coefficient for the answers of the 18 viewers
evaluating each videotape segment for the presence of pain was 0.64.
Sensitivity, specificity, and positive and negative predictive values of
viewers\' ratings of facial expressions and vocalizations as a measure
of the presence of pain were: 0.70, 0.83, 0.90, and 0.81. The intraclass
correlation coefficient for the answers rating pain intensity was only
0.10, indicating only slight agreement beyond chance. Assuming dressing
changes of ulcers reported as painful by communicative patients are also
painful in non-verbal severely demented patients, clinician observations
of facial expressions and vocalizations are accurate means for assessing
the presence of pain, but not its intensity, in patients unable to
communicate verbally because of advanced dementia.

Mao, J. \"Opioid-induced abnormal pain sensitivity: implications in
clinical opioid therapy.\" *Pain.* 100, no. 3(2002): 213-7 UI 12467992.

Matsumoto, A. K., et al. \"A randomized, controlled, clinical trial of
etoricoxib in the treatment of rheumatoid arthritis.\[comment\].\"
*Journal of Rheumatology.* 29, no. 8(2002): 1623-30 UI 12180720.

OBJECTIVE: To evaluate the efficacy and tolerability of the highly
selective cyclooxygenase-2 (COX-2) inhibitor etoricoxib for the
treatment of rheumatoid arthritis (RA). METHODS: A double blind,
randomized, placebo and active comparator controlled, 12 week study
conducted at 88 US sites. Eligible patients were chronic nonsteroidal
antiinflammatory drug (NSAID) users with clinical worsening of RA upon
withdrawal of prestudy NSAID. Patients received either placebo,
etoricoxib 90 mg once daily, or naproxen 500 mg twice daily (2:2:1
allocation ratio). Primary efficacy measures: patient and investigator
global assessments of disease activity and direct assessment of
arthritis by counts of tender and swollen joints. Key secondary
measures: patient global assessment of pain, the Stanford Health
Assessment Questionnaire, and the percentage of patients both completing
the study and meeting the ACR20 criteria. Tolerability was assessed by
tabulation of adverse events and routine laboratory evaluations.
RESULTS: In all, 816 patients were randomized (placebo = 323, etoricoxib
= 323, naproxen = 170), and 448 completed 12 weeks of treatment (placebo
= 122, etoricoxib = 230, naproxen = 96). Compared with patients
receiving placebo, patients receiving etoricoxib and naproxen showed
significant improvements in all efficacy endpoints (p \< 0.01). Compared
with patients receiving naproxen, patients receiving etoricoxib
demonstrated significant improvements (p \< 0.05) on all primary
endpoints and most other endpoints including ACR20 criteria. The
percentage of patients who achieved an ACR20 response and who completed
the study was 21%, 53%, and 39% in the placebo, etoricoxib and naproxen
groups, respectively. Etoricoxib and naproxen were both generally well
tolerated. CONCLUSION: In this study, etoricoxib 90 mg once daily was
more effective than either placebo or naproxen 500 mg twice daily for
treating patients with RA over 12 weeks. Etoricoxib 90 mg was generally
well tolerated in patients with RA.

McCleane, G. J. \"A phase 1 study of the cholecystokinin (CCK) B
antagonist L-365,260 in human subjects taking morphine for intractable
non-cancer pain.\" *Neuroscience Letters.* 332, no. 3(2002): 210-2 UI
12399016.

To investigate the safety and tolerability of L-365,260 in human
subjects taking morphine for intractable pain. An open label study of
nine adult subjects. Two doses of L-365,260 were administered to all
subjects separated by a 4 h interval (three received 10 mg, three 30 mg
and three 60 mg). Haemodynamic and respiratory variables were recorded
from immediately prior to first drug administration to T + 600 min. In
addition, continuous electrocardiogram (ECG) monitoring and serial 12
lead ECGs were recorded along with pain and side effect measurements. No
major side effects were observed. L-365,260 was well tolerated. No
abnormalities in blood pressure, heart rate, respiratory rate or ECG
measurements were recorded. Minor side effects were observed. L-365,260
can be safely administered at the doses investigated to human subjects
receiving morphine for intractable pain. Copyright 2002 Elsevier Science
Ireland Ltd.

McConnell, J. \"The physical therapist\'s approach to patellofemoral
disorders.\" *Clinics in Sports Medicine.* 21, no. 3(2002): 363-87 UI
12365233.

Management of patellofemoral pain is no longer a conundrum if the
therapist can determine the underlying causative factors and address
those factors in treatment. It is imperative that the patient\'s
symptoms are significantly reduced. This often is achieved by taping the
patella, which not only decreases the pain but also promotes an earlier
activation of the VMO and increases quadriceps torque. Management needs
to include specific VMO training, gluteal-control work, stretching tight
lateral structures, and appropriate advice regarding the foot, whether
it is orthotics, training, or taping. \[References: 60\]

McNamara, M. E., et al. \"The effects of back massage before diagnostic
cardiac catheterization.\" *Alternative Therapies in Health & Medicine.*
9, no. 1(2003): 50-7 UI 12564351.

CONTEXT: Admission to the hospital for a diagnostic cardiac
catheterization can be perceived as a threat to one\'s health status.
Autonomic nervous system arousal, particularly the sympathetic division,
can elicit negative physiological and psychological human responses as a
reaction to this threat. OBJECTIVE: The purpose of this study was to
measure the effects of a 20-minute back massage on the physiological and
psychological human responses of patients admitted for a diagnostic
cardiac catheterization. DESIGN: A randomized clinical trial design was
used. Data were compared in a repeated measures design before massage
(T1), immediately following the back massage or standard care (T2), and
10 minutes later (T3). SETTING: A large urban academic medical center.
PARTICIPANTS: Forty-six subjects admitted from home for a diagnostic
cardiac catheterization. MAIN OUTCOME MEASURES: Heart rate, heart rate
variability, blood pressure, respiration, peripheral skin temperature,
pain perception, and psychological state. INTERVENTION: A 20-minute back
massage. RESULTS: There was a significant difference between subject
effect for group, with a reduction in systolic blood pressure in the
treatment group (F = 8.6, P \< .05). In addition, main effects were
noted for time for diastolic blood pressure (F = 5.44; P \< .006),
respiration (F = 10.6; P \< .005), total Profile of Mood States score (F
= 5.9; P \< .001) and pain perception (F = 4.09; P \< .04) in both
groups. CONCLUSIONS: A 20-minute back massage appeared to reduce
systolic blood pressure in patients awaiting a diagnostic cardiac
catheterization, while preparatory time in the cardiac catheterization
laboratory appeared to reduce diastolic blood pressure, respiration,
perceived psychological distress, and pain.

Melegati, G., et al. \"The influence of local steroid injections, body
weight and the length of symptoms in the treatment of painful
subcalcaneal spurs with extracorporeal shock wave therapy.\" *Clinical
Rehabilitation.* 16, no. 7(2002): 789-94 UI 12428828.

OBJECTIVE: To evaluate the effectiveness of extracorporeal shock wave
therapy (ESWT) for the treatment of painful subcalcaneal spurs and
evaluate whether local steroid injections, body weight and the length of
symptoms can affect the clinical results. DESIGN: Subjects were selected
through clinical examination and heel radiograms according to diagnosis
of painful subcalcaneal spurs. SUBJECTS: Sixty-four subjects were
divided into two groups of treatment depending on their past history of
previous local steroid injections. INTERVENTIONS: Each subject received
a three-session ESWT (performed weekly). A rehabilitative programme was
instituted, consisting of self-assisted plantar fascia and plantar
flexors stretching exercises. MAIN OUTCOME MEASURES: The Mayo Clinical
Scoring System (MCSS) was utilized to evaluate each subject before the
treatment and at two- and ten-month follow-ups. In addition, standard
radiograms were done both before the treatment and at the ten-month
follow-up. RESULTS: Patients with no past treatment using steroids did
not show any statistically significant improvement of the MCSS at the
two-month follow-up. The statistical significance was obtained at the
ten-month follow-up. Patients with past treatment using steroids did not
show any statistically significant improvement of the MCSS at either
follow-up. At the radiogram check, none of the subjects showed any
modification of the heel spurs. CONCLUSIONS: According to the results of
the present study ESWT should be considered as an effective treatment
for painful subcalcaneal spurs. Previous local steroid injections may
negatively affect the result of ESWT.

Mildh, L. H., A. Piilonen, and O. A. Kirvela. \"Supplemental oxygen is
not required in trauma patients treated with IV opiates.\" *American
Journal of Emergency Medicine.* 21, no. 1(2003): 35-8 UI 12563577.

The risk of respiratory depression can prevent the proper use of opioids
in trauma patients and lead to use of supplemental oxygen. However, high
FiO(2) might contribute to atelectasis formation and consequently to
relative hypoxia. Supplemental oxygen also can cause a risk of fire. In
a randomized, controlled study we evaluated the need and effects of
supplemental oxygen in 13 patients with extremity trauma who were
treated pain-free with an intravenous opioid, oxycodone (dose range
6.75-13.6 mg). After opioid injection, 7 patients received 40%
supplemental oxygen and 6 were breathing room air. Pulse oxygen
saturation (SpO(2)), arterial blood gases, and hemodynamic parameters
were monitored for 30 minutes. Atelectasis formation was evaluated with
a computed tomography scan. No hypoxia, hypoventilation, or significant
atelectasis formation was detected in any of the patients. Accordingly,
routinely given supplemental oxygen was not considered necessary in
these patients because no complications were seen. Copyright 2003,
Elsevier Science (USA). All rights reserved.)

Miura, H., et al. \"Morphine for the management of pain in lung
cancer.\" *Nippon Rinsho - Japanese Journal of Clinical Medicine.* 60,
no. Suppl 5(2002): 676-80 UI 12101762.

Moore, J., S. Ziebland, and S. Kennedy. \"\"People sometimes react funny
if they\'re not told enough\": women\'s views about the risks of
diagnostic laparoscopy.\" *Health Expectations.* 5, no. 4(2002): 302-9
UI 12460219.

OBJECTIVES: To explore women\'s views about the risks and benefits of
diagnostic laparoscopy in the investigation of chronic pelvic pain,
including how much information it is thought appropriate to give about
three specific risks: death, major complications and the chance that the
procedure would have an inconclusive result. DESIGN: A qualitative
analysis of semi-structured, audio-taped interviews with 20 women about
their experiences of undergoing a diagnostic laparoscopy in a day
surgery unit. Interviews were conducted 3-6 months after the procedure.
RESULTS: All the women who were interviewed were aware that diagnostic
laparoscopy carried risks, including the small risk of death associated
with general anaesthesia. One-third of respondents said that they had
initially been reluctant to discuss the risks of the procedure in
general terms. However, when specific examples of complications and
risks were introduced all but one of the respondents reported that they
would have liked to discuss these at the time that the decision to have
the operation was made. Women maintained that the information was needed
to make an informed decision about whether to have the operation, to
help them understand and cope should things go wrong and in order to
make appropriate plans to cover contingencies. Most were surprised to
hear that the procedure is frequently inconclusive and thought that this
information should be made clear to women contemplating a laparoscopy.
CONCLUSIONS: Women undergoing diagnostic laparoscopy for the
investigation of chronic pelvic pain wish to be given full and accurate
information about complication rates such as bowel perforation, what to
expect during their recovery, and the chances of finding a cause for
their pain. Although they may not want to dwell on the risk of death,
they do need to be informed about the specific risks associated with the
procedure in order to make a balanced decision.

Moseley, L. \"Combined physiotherapy and education is efficacious for
chronic low back pain.\" *Australian Journal of Physiotherapy.* 48, no.
4(2002): 297-302 UI 12443524.

Manual therapy, exercise and education target distinct aspects of
chronic low back pain and probably have distinct effects. This study
aimed to determine the efficacy of a combined physiotherapy treatment
that comprised all of these strategies. By concealed randomisation, 57
chronic low back pain patients were allocated to either the four-week
physiotherapy program or management as directed by their general
practitioners. The dependent variables of interest were pain and
disability. Assessors were blind to treatment group. Outcome data from
49 subjects (86%) showed a significant treatment effect. The
physiotherapy program reduced pain and disability by a mean of 1.5/10
points on a numerical rating scale (95% CI 0.7 to 2.3) and 3.9 points on
the 18-point Roland Morris Disability Questionnaire (95% CI 2 to 5.8),
respectively. The number needed to treat in order to gain a clinically
meaningful change was 3 (95% CI 3 to 8) for pain, and 2 (95% CI 2 to 5)
for disability. A treatment effect was maintained at one-year follow-up.
The findings support the efficacy of combined physiotherapy treatment in
producing symptomatic and functional change in moderately disabled
chronic low back pain patients.

Murphy, B., N. Dawson, and R. J. Irwin. \"Intramuscular sensation in
conscious human subjects: a qualitative and quantitative study utilizing
signal detection theory methodology.\" *Somatosensory & Motor Research.*
19, no. 3(2002): 181-90 UI 12396574.

To investigate whether human subjects could consciously perceive
different levels of intramuscular sensation, EMG needle electrodes were
inserted into the forearm extensor musculature. Qualitative descriptions
of the types of sensations evoked at various current intensities were
recorded. A series of preliminary experiments was performed in order to
determine the optimum waveform, current intensity, duration and
separation between adjacent current pairs that could reliably be
discriminated by conscious human subjects. The methodology of signal
detection theory was utilized to obtain the discrimination measure, d\'
(d prime). Values of d\' were obtained for sequential blocks of trials
consisting of randomly delivered blocks of 50 \"strong\" and 50 \"weak\"
stimuli. The ability to discriminate both noxious and non-noxious
stimuli was determined using d\'. It was demonstrated that human
subjects are able to qualitatively describe non-nociceptive sensations
elicited by low levels of intramuscular stimulation. Subjects were able
to reliably discriminate pairs of electrical stimuli separated in
intensity by 0.4 dB over four sequential blocks of trials on the same
day and on different days. This work demonstrates that signal detection
theory methods can reliably measure sensory discrimination in skeletal
muscle, for both noxious and non-noxious levels of electrical
stimulation. A protocol is proposed for appropriate future use of this
methodology to investigate alterations in muscle sensation following
experimental interventions.

Nagelvoort, R. W., M. Kon, and A. H. Schuurman. \"Proximal row
carpectomy: a worthwhile salvage procedure.\" *Scandinavian Journal of
Plastic & Reconstructive Surgery & Hand Surgery.* 36, no. 5(2002):
289-99 UI 12477088.

After proximal row carpectomy 11 patients were evaluated in the six
ensuing years for pain relief, satisfaction, ranges of movement, grip
and precision grip strength, and radiographic picture. The median
follow-up period was 3.1 years (range 4 months to 6 years). They were
operated on for scaphoid non-union with radiocarpal arthritis, late
stage Kienbock\'s disease, chronic scapholunate dissociation and
scapholunate advanced collapse wrist deformity. The mean disabilities of
the arm, shoulder and hand (DASH) scoring list, which indicates the
patient\'s degree of disability 28% (range 2%-64%) of maximum disability
for the function and symptom score. Flexion, extension, and radial and
ulnar deviation of the wrist improved to 47% (range 21%-76%), 67% (range
41%-81%), 39% (range 25%-55%), and 81% (range 44%-90%) of the opposite
wrist. Mean grip strength, 70% (range 22%-117%) of the opposite site,
while the three precision grips improved between 72% and 79%. A review
of previous studies of proximal row carpectomy showed results comparable
with those of our study. Compared with other treatments, it is a
dependable, relatively-simple procedure that gives reliable relief of
pain, preserves functional ranges of movement and grip strength, and
allows most patients to return to work.

Naslund, J., et al. \"Sensory stimulation (acupuncture) for the
treatment of idiopathic anterior knee pain.\" *Journal of Rehabilitation
Medicine.* 34, no. 5(2002): 231-8 UI 12392239.

A randomized controlled study was conducted to evaluate the effect of
acupuncture treatment in idiopathic anterior knee pain, a pain syndrome
without known aetiology. Fifty-eight patients, clinically and
radiologically examined, were randomly assigned to either deep or
minimal superficial acupuncture treatment. The patients were treated
twice weekly for a total of 15 treatments. The main outcome measurements
were one leg vertical jump, functional score, daily VAS recording and
skin temperature. Fifty-seven patients completed the study. Pain
measurements on VAS decreased significantly within both groups; in the
deep acupuncture group from 25 before treatments to 10 afterwards, and
in the superficial (placebo) acupuncture group from 30 to 10. There was
no significant difference between the groups. The improvement on the VAS
recordings remained significant even after 3 and 6 months. Even though
the pain decreased after sensory stimulation, neither the ability to
jump on one leg, the functional score nor the skin temperature changed.
This study shows that patients with idiopathic anterior knee pain
benefit from both electroacupuncture treatment and subcutaneous
needling. The pain-relieving effect remains for at least 6 months.
Central pain inhibition, caused by either afferent stimulation or by
non-specific therapeutic (placebo) effects, is a plausible explanation
behind the treatment effects.

Newberg, A. H., and J. S. Newman. \"Imaging the painful hip.\" *Clinical
Orthopaedics & Related Research.*, no. 406(2003): 19-28 UI 12578996.

With the advent of magnetic resonance imaging and, subsequently,
magnetic resonance arthrography, the imaging algorithm for hip pain has
evolved considerably. Magnetic resonance imaging has supplanted bone
scintigraphy as the first line imaging test after conventional
radiographs in the setting of suspected occult fracture, transient
marrow edema, and osteonecrosis. Computed tomography scanning and
magnetic resonance imaging are invaluable for the evaluation of
monarticular arthropathies such as pigmented villonodular synovitis and
synovial osteochondromatosis. By combining conventional magnetic
resonance imaging with capsular distention afforded by arthrography,
magnetic resonance arthrography has become the imaging examination of
choice for disorders of the acetabular labrum and for the evaluation of
articular cartilage at the hip. \[References: 18\]

Nicassio, P. M., et al. \"The contribution of pain, reported sleep
quality, and depressive symptoms to fatigue in fibromyalgia.\" *Pain.*
100, no. 3(2002): 271-9 UI 12467998.

The major objective of this research was to evaluate the predictors of
fatigue in patients with fibromyalgia (FM), using cross-sectional and
daily assessment methodologies. In the cross-sectional phase of the
research involving a sample of 105 FM patients, greater depression and
lower sleep quality were concurrently associated with higher fatigue.
While pain was correlated with fatigue, it did not independently
contribute to fatigue in the regression equation. For a subset of
patients from the cross-sectional sample (n=63) who participated in a
week of prospective daily assessment of their pain, sleep quality, and
fatigue, multiple regression analysis of aggregated (averaged) daily
scores revealed that previous day\'s pain and sleep quality predicted
next day\'s fatigue. Depression from the cross-sectional phase was not
related to aggregated daily fatigue scores. A path analytic framework
was tested with disaggregated (removing between subjects variability)
data in which pain was predicted to contribute to lower sleep quality
which, in turn, was predicted to lead to greater fatigue. The results
revealed that poor sleep quality fully accounted for the positive
relationship between pain and fatigue, thus substantiating the
mediational role of sleep quality. The findings are indicative of a
dysfunctional, cyclical pattern of heightened pain and non-restful sleep
underlying the experience of fatigue in FM.

Olsson, A. G., et al. \"Are early clinical effects of cholesterol
lowering mediated through effects on inflammation?\" *Acta Physiologica
Scandinavica.* 176, no. 2(2002): 147-50 UI 12354174.

In a randomized, double-blind trial in 3086 patients with unstable
angina pectoris or non-Q wave myocardial infarction we investigated if
80 mg of atorvastatin daily could improve outcome of cardiovascular
events during a short period of time (16 weeks) compared with placebo.
Baseline LDL cholesterol was 3.2 mmol L-1 (124 mg dL-1) and decreased by
40% to 1.9 mmol L-1 (72 mg dL-1) during atorvastatin treatment. The
primary endpoint, which was a composite of death, non-fatal acute
myocardial infarction, cardiac arrest with resuscitation or recurrent
symptomatic myocardial ischaemia with objective evidence and requiring
emergency rehospitalization occurred in 228 patients (14.8%) in the
atorvastatin group and 269 patients (17.4%) in the placebo group. The
relative risk was 0.84 and 95% confidence interval was 0.70-1.00 (P =
0.048). Thus for patients with acute coronary syndromes, lipid-lowering
therapy with high dose atorvastatin reduces recurrent ischaemic events
in the short-term. A possible mechanism behind this rapid clinical
effect induced by statin treatment is on inflammatory processes. Recent
studies strongly suggest that acute T-cell activation is involved in the
pathogenesis of unstable angina. In another study we investigated
whether circulating T cells showed signs of activation in patients with
stable angina pectoris (SA). Systemic venous blood samples were taken
from 38 men with SA and 42 healthy controls. The T-cell receptor
expression was assessed by three-colour flow cytometry using monoclonal
antibodies against CD3,CD4, CD8, CD25 and human leucocyte antigen
(HLA)-DR. Soluble interleukin-2 receptor (sIL-2R) was measured as the
circulating form in serum. Levels of circulating CD3+ and CD4+ T cells
tended to be higher in patients compared with controls. Patients were
also shown to have a significant increase in CD4+ T cells expressing the
activation markers CD25 (P \< 0.05) and HLA-DR (P \< 0.01). Furthermore,
serum levels of sIL-2R were significantly higher (P \< 0.001) in
patients than in controls. We also observed that the T-cell response was
more pronounced in patients without simvastatin treatment (n = 18)
compared with simvastatin-treated patients (n = 20). In conclusion, our
findings indicate that a continuous immune system activation takes place
in patients with chronic angina pectoris, predominantly involving
proliferation of CD4+ T cells. Statin treatment seems to be able to
decrease this inflammatory response.

Pace, K. T., et al. \"Health-related quality of life after laparoscopic
and open nephrectomy.\" *Surgical Endoscopy.* 17, no. 1(2003): 143-52 UI
12399838.

BACKGROUND: Postoperative recovery often is assessed with parameters
(pain and return to work) susceptible to bias. This study sought
objectively to compare postoperative health-related quality of life
(HRQL) after laparoscopic and open nephrectomy with the Postoperative
Recovery (PRS) (a validated questionnaire designed to assess pain),
activities of daily living (ADL), and HRQL in postoperative patients.
METHODS: Patients undergoing contemporaneous laparoscopic and open
nephrectomy received the PRS pre- and postoperatively. The results were
analyzed with analysis of covariance (ANCOV) and survival analysis.
RESULTS: The 33 open nephrectomy and 38 laparoscopic patients in this
study were comparable in age, gender, body mass index (BMI) and
employment. Laparoscopic operative time was longer (p = 0.015), and the
hospital stay was shorter (p\<0.001). Laparoscopic patients had higher
HRQL scores from postoperative days 3 to 365 (p\<0.001), and they
returned to preoperative HRQL faster (p\<0.001). CONCLUSIONS: An
objective HRQL instrument confirms that laparoscopic nephrectomy
patients recover faster and with a higher HRQL than open surgery
patients. The PRS can be modified for use after other abdominal
procedures, and may prove useful for comparisons of other minimally
invasive surgical techniques.

Pacula, R. L., et al. \"State medical marijuana laws: understanding the
laws and their limitations.\" *Journal of Public Health Policy.* 23, no.
4(2002): 413-39 UI 12532682.

Significant attention has been given to the debate regarding allowances
for medical marijuana use since the 1996 California and Arizona ballot
initiatives. State medical marijuana allowances, however, have existed
since the mid-1970s. Much of the current debate stems from confusion
about the various ways states approach the issue. In this paper, we
present original legal research on current state medical marijuana laws
identifying four different ways states statutorily enable the medical
use of marijuana. We discuss the tension these approaches have with
federal law as well as their implications regarding real access for
patients. In addition, we present information on how a small number of
states are trying to deal with the issue of access within the context of
their medical marijuana laws, and discuss the implication of various
supply approaches on the enforcement of other state marijuana laws.

Papadopoulos, E. C., et al. \"Total knee arthroplasty following prior
distal femoral fracture.\" *Knee.* 9, no. 4(2002): 267-74 UI 12424033.

BACKGROUND: Femoral fracture may predispose the knee to the development
of post-traumatic arthritis by either a direct intra-articular injury or
residual limb malalignment. Malunion, intra-articular osseous defects,
limb malalignment, retained internal fixation devices, and compromised
surrounding soft tissues may in turn affect the outcome of total knee
arthroplasty (TKA) in these patients. The aim of our study was to
evaluate the result of TKA in patients with previous distal femoral
fracture. METHODS: The results of 48 cemented condylar total knee
arthroplasties, performed between 1980 to 1998, in 47 patients with a
previous distal femoral fracture were reviewed. There were 37 females
and 10 males with an average age of 65 years (range, 19-84 years).
Follow-up averaged 6.2 years (range, 2-16 years). No patients were lost
to follow-up. RESULTS: At the time of arthroplasty a femoral fracture
non-union was present in three knees, all of which were treated with a
long stem cemented femoral component and bone grafting. Malunion,
defined as angulation greater than 10 degrees in the coronal plain or
greater than 15 degrees in the sagittal plain, was present in 21 knees.
Of these, six underwent distal femoral osteotomy during TKA. In the
remaining 15 patients, with a malunion, the deformity was addressed by
alterations in the orientation and location of bone resection. Other
procedures were commonly needed at the time of arthroplasty and
included: lateral retinacular release (22 knees), extensor mechanism
realignment (eight knees), and collateral ligament reconstruction (two
knees). The mean pre-operative Knee Society Scores were 40 (range, 0-80)
for pain and 48 (range, 0-100) for function and improved significantly
to a mean of 84 (range, 37-99) and 66 (range, 0-100) points,
respectively, at the latest follow-up (P\<0.001). The knee arc of motion
improved from a pre-operative mean of 83-99 degrees at the latest
follow-up (P\<0.004). Post-operative manipulation under anesthesia for
poor motion was carried out in four knees. Two knees had aseptic
loosening that required subsequent revisions. Three knees developed deep
infection which was treated with debridement and retention of components
in one knee, arthrodesis in another, and eventual amputation in one
knee. CONCLUSIONS: Significant improvement in function and relief of
pain is seen in the vast majority of patients with previous distal
femoral fractures undergoing subsequent TKA. However, these patients are
at increased risk for restricted motion and perioperative complications
following TKA. Special efforts to preserve the vascularity of the skin
and subcutaneous tissues, restore limb alignment, ensure correct
component positioning, and achieve soft tissue balance may help minimize
the problems identified in this study.

Pasero, C., and M. McCaffery. \"The patient\'s report of pain.\" *AJN,
American Journal of Nursing.* 101, no. 12(2001): 73-4 UI 12585068.

Pasero, C., and M. McCaffery. \"Tramadol.\" *AJN, American Journal of
Nursing.* 103, no. 2(2003): 71, 73 UI 12582344.

Pepine, C. J., et al. \"Comparison of effects of nisoldipine-extended
release and amlodipine in patients with systemic hypertension and
chronic stable angina pectoris.\" *American Journal of Cardiology.* 91,
no. 3(2003): 274-9 UI 12565082.

The efficacy and safety of nisoldipine-extended release (ER) and
amlodipine were compared in a 6-week multicenter, randomized,
double-blind, double-dummy, parallel group, titration-to-effect trial in
patients with stage 1 to 2 systemic hypertension (90 to 109 mm Hg
diastolic blood pressure \[BP\]) and chronic stable angina pectoris.
After a 3-week placebo run-in period, patients (n = 120) were randomly
assigned to active treatment with either nisoldipine-ER (20 to 40 mg) or
amlodipine (5 to 10 mg) once daily, titrated as necessary after 2 weeks
to achieve diastolic BP \<90 mm Hg. After 6 weeks, the mean reduction in
systolic/diastolic BP from baseline was 15/13 mm Hg with nisoldipine-ER
and 13/11 mm Hg with amlodipine (p = NS/p = NS). Both drugs resulted in
similar BP responder rates (diastolic BP \<90 mm Hg in 87% of patients
who received nisoldipine-ER and 78% of patients on amlodipine, p = NS)
and anti-ischemic responder rates (increasing exercise time \>20% in 20%
and 27%, respectively \[p = NS\], and increasing exercise time \>60
seconds in 32% and 29% of patients, respectively \[p = NS\]. Also, after
6 weeks of active therapy, there was a similar mean increase in total
exercise duration (23 seconds in the nisoldipine-ER group and 21 seconds
in the amlodipine group, p = NS). Neither drug increased heart rate and
both decreased frequency of anginal episodes. Adverse events were
infrequent, and typically were vasodilator-related effects (including
headache and peripheral edema) that occurred with somewhat higher
incidence in the nisoldipine-ER group. Thus, nisoldipine-ER and
amlodipine provided comparable antihypertensive and anti-ischemic
efficacy, and both were generally well tolerated.

Persson, J., et al. \"Ultrasound nucleolysis: an in vitro study.\"
*Ultrasound in Medicine & Biology.* 28, no. 9(2002): 1189-97 UI
12401390.

Thermal intradiscal therapy for chronic low back pain, using a catheter
inserted into the intervertebral disc, is becoming more popular in the
treatment of low back pain. The aim of this study was to investigate the
possibility of heating the nucleus pulposus of the intervertebral disc
with high-intensity focused ultrasound (US) or HIFU. Two specific
situations were considered, invasive transducers that would be in
contact with the annulus fibrosus of the disc, and noninvasive
transducers that could be used externally. Theoretical simulations were
performed to find the optimal parameters of US transducers and then
experimental studies were done using transducers made to these
specifications. These experiments confirmed that it was possible to heat
the discs with HIFU. Two orthogonal transducers resulted in a superior
temperature distribution than using just one transducer. It is,
therefore, feasible to consider thermal treatment of the nucleus
pulposus of the disc using noninvasive US. Copyright 2002 World
Federation for Ultrasound in Medicine & Biology

Peters, F. P., et al. \"Reversible migratory osteoporosis in renal
oncocytoma mimicking renal cell carcinoma with bone metastases.\"
*Netherlands Journal of Medicine.* 60, no. 10(2002): 411-3 UI 12607593.

We report a case in which initially the wrong diagnosis of renal cell
carcinoma with bone metastases was made. Nephrectomy and bone biopsy led
to the right diagnosis of oncocytoma with transient osteoporosis. This
report stresses the importance of pathological investigation and points
to oncocytoma in the differential diagnosis of solid renal masses. In
addition, the possible relationship between this tumour and migratory
osteoporosis, which disappeared after surgery, is described.

Pfisterer, M., et al. \"Outcome of elderly patients with chronic
symptomatic coronary artery disease with an invasive vs optimized
medical treatment strategy: one-year results of the randomized TIME
trial.\[comment\].\" *Jama.* 289, no. 9(2003): 1117-23 UI 12622581.

CONTEXT: The risk-benefit ratio of invasive vs medical management of
elderly patients with symptomatic chronic coronary artery disease (CAD)
is unclear. The Trial of Invasive versus Medical therapy in Elderly
patients (TIME) recently showed early benefits in quality of life from
invasive therapy in patients aged 75 years or older, although with a
certain excess in mortality. OBJECTIVE: To assess the long-term value of
invasive vs medical management of chronic CAD in elderly adults in terms
of quality of life and prevention of major adverse cardiac events.
DESIGN: One-year follow-up analysis of TIME, a prospective randomized
trial with enrollment between February 1996 and November 2000. SETTING
AND PARTICIPANTS: A total of 282 patients with Canadian Cardiac Society
class 2 or higher angina despite treatment with 2 or more anti-anginal
drugs who survived for the first 6 months after enrollment in TIME (mean
age, 80 years \[range, 75-91 years\]; 42% women), enrolled at 14 centers
in Switzerland. INTERVENTIONS: Participants were randomly assigned to
undergo coronary angiography followed by revascularization (if feasible)
(n = 140 surviving 6 months) or to receive optimized medical therapy (n
= 142 surviving 6 months). MAIN OUTCOME MEASURES: Quality of life,
assessed by standardized questionnaire; major adverse cardiac events
(death, nonfatal myocardial infarction, or hospitalization for acute
coronary syndrome) after 1 year. RESULTS: After 1 year, improvements in
angina and quality of life persisted for both therapies compared with
baseline, but the early difference favoring invasive therapy
disappeared. Among invasive therapy patients, later hospitalization with
revascularization was much less likely (10% vs 46%; hazard ratio \[HR\],
0.19; 95% confidence interval \[CI\], 0.11-0.32; P\<.001). However,
1-year mortality (11.1% for invasive; 8.1% for medical; HR, 1.51; 95%
CI, 0.72-3.16; P =.28) and death or nonfatal myocardial infarction rates
(17.0% for invasive; 19.6% for medical; HR, 0.90; 95% CI, 0.53-1.53; P
=.71) were not significantly different. Overall major adverse cardiac
event rates were higher for medical patients after 6 months (49.3% vs
19.0% for invasive; P\<.001), a difference which increased to 64.2% vs
25.5% after 12 months (P\<.001). CONCLUSIONS: In contrast with
differences in early results, 1-year outcomes in elderly patients with
chronic angina are similar with regard to symptoms, quality of life, and
death or nonfatal infarction with invasive vs optimized medical
strategies based on this intention-to-treat analysis. The invasive
approach carries an early intervention risk, while medical management
poses an almost 50% chance of later hospitalization and
revascularization.

Pham, T., et al. \"Supraspinal antinociceptive effects of mu and delta
agonists involve modulation of adenosine uptake.\" *Anesthesiology.* 98,
no. 2(2003): 459-64 UI 12552206.

BACKGROUND: The modulation of extracellular adenosine concentration by
opioids provides evidence that the antinociceptive effects of these
compounds involve endogenous adenosine. The aim of this study was to
determine whether there is a relation between the inhibition of brain
synaptosome adenosine uptake by opioid agonists and the analgesic
effects of these compounds. METHODS: The authors used the hot plate and
tail-pinch tests to evaluate in mice (C57BL/6 females; weight, 25-30 g)
the effects of caffeine, a nonspecific adenosine receptor antagonist, on
the antinociceptive effect induced by the intracerebroventricular
administration of oxymorphone as a mu agonist, SNC80 as a delta agonist,
or U69593 as a kappa agonist. They also investigated the effect of these
opioid receptor agonists on the uptake of adenosine by whole brain
synaptosomes. RESULTS: Caffeine decreased the analgesic effects induced
by oxymorphone or SNC80 but not those induced by U69593. Oxymorphone and
SNC80 inhibited adenosine uptake by brain cells, but U69593 did not.
CONCLUSION: The antinociceptive effects obtained with mu or delta (but
not kappa) agonists administered supraspinally were indicative of the
involvement of modulation of adenosine uptake.

Polianskis, R., T. Graven-Nielsen, and L. Arendt-Nielsen. \"Spatial and
temporal aspects of deep tissue pain assessed by cuff algometry.\"
*Pain.* 100, no. 1-2(2002): 19-26 UI 12435455.

This study assessed spatial and temporal aspects of pressure pain during
increasing and constant compressions using a cuff algometer and during
adaptive compressions using a closed-loop feedback system for
maintaining stable pain. Experimental setup consisted of a pneumatic
tourniquet cuff, a computer-controlled air compressor, and a 10-cm
electronic visual analogue scale (VAS). The first experiment assessed
spatial summation for cuff pain by recording the pressure-pain
stimulus-response (SR) function during increasing compressions with
single and double cuffs. The second experiment assessed temporal profile
of cuff pain during constant compression for 10 min beginning at pain
intensities of 2, 4, and 6 cm on the VAS. The third experiment assessed
temporal pressure profile when pain was maintained for 10 min by a
close-loop system within target zones of +/-0.5 cm VAS at pain
intensities of 2, 4, and 6 cm on the VAS.Doubling the tissue volume
under the cuff shifted the SR function to the left, demonstrating
spatial summation. The constant cuff pressure evoked typical biphasic
response consisting of an overshoot in pain intensity, followed by
decreasing pain, or adaptation. The pain intensity was significantly
correlated to the time of constant stimulation, showing time-dependency
of pain encoding. Both overshoot magnitude and adaptation rate were
dependent on the starting pain intensity. The pain decrease rate was
lowest for a pain intensity of 2 cm on the VAS. The overshoot magnitude
was lowest for a pain intensity of 6 cm on the VAS. Both the overshoot
and the adaptation were maximal for a pain intensity of 4 cm on the VAS.
The oscillating pressure generated by closed-loop system led to constant
rather than adapting pain at intensities of 2, 4, and 6 cm on the
VAS.The cuff algometer is highly configurable tool for assessment of
pain sensitivity by pressure-pain and time-pain functions. The presented
models are useful additions to a researcher\'s armamentarium for further
pharmacological and clinical studies on deep tissue pain and related
mechanisms.

Putzke, J. D., et al. \"Interference due to pain following spinal cord
injury: important predictors and impact on quality of life.\" *Pain.*
100, no. 3(2002): 231-42 UI 12467994.

Two studies were designed to examine important predictors of pain
following spinal cord injury (SCI), and the impact of pain on
self-reported quality of life (QOL). Pain was defined as \"interference
in day-to-day activities secondary to pain\". In order to determine risk
factors associated with the development of pain interference, Study 1
examined the predictive validity of multiple demographic, medical, and
QOL variables at year 1 post-SCI to self-reported pain interference 2
years post-injury. Results showed that middle age (30-59-year-olds),
lower self-reported mental health, and pain interference at 1 year
post-SCI were the most important unique predictors of pain interference
2 years post-SCI. In Study 2, participants were separated into four
groups; (1) those pain-free at years 1 and 2, (2) those pain-free at
year 1 and in pain at year 2, (3) those in pain at year 1 and pain-free
at year 2, and (4) those in pain at years 1 and 2. Results showed that
only those experiencing a change in pain interference status reported a
change in QOL. More specifically, those developing pain interference
(group 2) from year 1 to year 2 reported decreased life satisfaction,
physical health, and mental health, whereas, those with resolving pain
interference from year 1 to year 2 reported an increase in these same
domains. Unexpectedly, change in pain interference status was unrelated
to change in self-reported handicap. Implications and future directions
are discussed.

Ragab, A. A., M. A. Fye, and H. H. Bohlman. \"Surgery of the lumbar
spine for spinal stenosis in 118 patients 70 years of age or older.\"
*Spine.* 28, no. 4(2003): 348-53 UI 12590208.

STUDY DESIGN: A consecutive case retrospective chart review and an
outcome satisfaction questionnaire were used in this study. OBJECTIVE:
To provide a surgical reference for surgeons and elderly patients who
may have concerns regarding the safety and outcome of lumbar spine
surgery in their age population. SUMMARY OF BACKGROUND DATA: Elderly
patients scheduled for spine surgery have a major concern about the
safety and outcome of the procedure in light of their advanced age. A
review of the literature demonstrated conflicting results regarding the
outcome of lumbar spine surgery for spinal stenosis in the elderly.
METHODS: A retrospective review evaluated 118 consecutive patients ages
70 to 101 years who were managed surgically for lumbar spinal stenosis.
This patient population was analyzed for the operative procedure,
postoperative morbidity and mortality, and long-term clinical outcome
and satisfaction. All 118 patients had at least a 2-year follow-up
evaluation, and 21 of these patients were older than 80 years. Clinical
parameters were compiled and analyzed on the basis of chart review.
RESULTS: Overall morbidity occurred in 24 patients (20%). During the
study period, the average length of hospitalization declined an average
of 2 days. Of the 118 patients, 109 expressed satisfaction with the
operation and resumed daily activities, whereas 9 had fair or poor
results. CONCLUSIONS: Advanced age did not increase the morbidity
associated with this operation because the results reported in this
study are comparable with those from other studies of a younger
population, nor did advanced age decrease patient satisfaction or return
to activities.

Renfrey, S., C. Downton, and J. Featherstone. \"The painful reality.\"
*Nature Reviews. Drug Discovery.* 2, no. 3(2003): 175-6 UI 12619637.

Rey, E., et al. \"Long-term outcome of patients with non-cardiac chest
pain.\" *Revista Espanola de Enfermedades Digestivas.* 94, no. 1(2002):
25-33 UI 12073666.

OBJECTIVE: To assess long-term outcome for patients with chest pain in
our environment, to estimate direct resource use, and to evaluate the
influence of patient views regarding pain origin on outcome. PATIENTS
AND METHODS: All patients referred to our Department between 1994 and
1998 to undergo pH-metry as a result of chest pain were identified.
Those detected were subjected to a structured direct interview on the
telephone. RESULTS: 104 patients with a follow-up period (since
pH-metry) of 3.76 years were evaluated. Thirty nine percent of patients
were free from pain (37.5%), and one had died from a seemingly unrelated
cause (1%), whereas the rest still suffered from pain. The mean number
of visits per patient during the last year was 2.83 to their general
practitioner, 1.04 to an specialist, and 0.99 to an Emergency Unit;
hospitalisations were 0.26, and ICU admissions 0.09. Patients who
trusted medical diagnoses showed better outcomes than those who did not
trust or understand them, in association with lower resource use,
particularly Emergency Unit use. CONCLUSION: Patients with chest pain
had a favourable life prognosis, but 60% still suffer from pain after
nearly 4 years of follow-up, which entails a relevant use of health-care
resources. Trust in medical diagnosis seemingly influences outcome, and
the use of diagnostic procedures to determine pain origin is thus likely
beneficial for patient.

Riley, J. L., 3rd, G. H. Gilbert, and M. W. Heft. \"Race/ethnic
differences in health care use for orofacial pain among older adults.\"
*Pain.* 100, no. 1-2(2002): 119-30 UI 12435465.

The purpose of this study was to describe race/ethnic differences in the
use of formal health care services for painful oral symptoms by older
adults. We also considered the sex of the respondent rather than
assuming that males and females within a specific racial group would use
health care services similarly. To our knowledge, these specific
utilization patterns have never been reported before in the pain
literature.Telephone interviews were conducted on a stratified random
sample of 1,636 community dwelling older (65+) north Floridians. A total
of 5,860 households were contacted and screened, with 75.3%
participating to the point where their eligibility for the study could
be determined.Overall race/ethnic differences in patterns of health care
use for orofacial pain were not found. However, when we stratified
race/ethnicity by sex, Black females (37.6%) were the least likely to
have visited a health care provider, followed by non-Hispanic White
females (47.2%), non-Hispanic White males (49.3%), and Black males
(62.7%). Point estimates of odds ratio, adjusting for financial
differences, indicate that more non-Hispanic White males (OR=1.79) and
Black males (OR=2.74) visited a health care provider than Black
females.Our results also suggest that for older Black adults, financial
constraints have a more significant impact on decisions about health
care for orofacial pain than they do for non-Hispanic Whites. For
non-Hispanic White respondents, characteristics of the pain symptoms
were significant determinates of health care use for their painful oral
symptoms. Pain at its worst was a positive predictor for four of the
five analyses (jaw joint pain, painful oral sores, temperature
sensitivity, and toothache pain). The duration variable (years with
pain) was a negative predictor of health care use. This is consistent
with the conclusion that individuals seek care early in the course of
the symptom, i.e. an active care seeking phase, make emotional or
physical adjustments, and then resign themselves to the symptoms.

Riley, J. L., 3rd, et al. \"Racial/ethnic differences in the experience
of chronic pain.\[comment\].\" *Pain.* 100, no. 3(2002): 291-8 UI
12468000.

The purpose of this study was to examine racial/ethnic-related
differences in a four-stage model of the processing of chronic pain. The
subjects were 1557 chronic pain patients (White=1084, African
American=473) evaluated at a pain management clinic at a large
southeastern university medical center. Using an analysis of covariance
controlling for pain duration and education, African American patients
reported significantly higher levels of pain unpleasantness, emotional
response to pain, and pain behavior, but not pain intensity than Whites.
Differences were largest for the unpleasantness and emotion measures,
particularly depression and fear. The groups differed by approximately
1.0 visual analogue scale unit, a magnitude that may be clinically
significant. Racial/ethnic differences in the linear relationship
between stages were also tested using structural equation modeling and
LISREL-8. The results indicate differences in linear associations
between pain measures with African Americans showing a stronger link
between emotions and pain behavior than Whites.

Ringe, J. D., et al. \"Transdermal fentanyl for the treatment of back
pain caused by vertebral osteoporosis.\" *Rheumatology International.*
22, no. 5(2002): 199-203 UI 12215866.

Pain relief for patients with osteoporosis is important to maintain
mobility and facilitate physical therapy. Transdermal fentanyl may be
useful but has not been studied systematically. Patients with at least
one osteoporotic vertebral fracture requiring strong opioids were
enrolled and received transdermal fentanyl. Treatment history, pain,
ease of physical therapy, and quality of life were recorded at baseline
and after 4 weeks. Of 64 patients enrolled, 49 completed the study; 12
withdrew because of adverse events, most commonly nausea, vomiting, or
dizziness. Pain at rest and on movement decreased significantly from
baseline to final assessment (mean scores 7.84 and 8.55, respectively,
at baseline, falling to 3.56 and 4.50 after 4 weeks). Quality of life
improved significantly, and 61% of patients were satisfied with the
treatment. Ability to undergo physical therapy improved significantly.
Transdermal fentanyl is useful for the treatment of severe back pain
caused by osteoporosis.

Rowbotham, D. J. \"COX-2-selective inhibitors: clinical relevance in
surgical and acute pain.\" *European Journal of Anaesthesiology -
Supplement.* 25(2002): 11-20 UI 12449673.

Rupp, H., A. Zarain-Herzberg, and B. Maisch. \"The use of partial fatty
acid oxidation inhibitors for metabolic therapy of angina pectoris and
heart failure.\" *Herz.* 27, no. 7(2002): 621-36 UI 12439634.

BACKGROUND: Partial fatty acid oxidation inhibitors have raised great
interest since they are expected to counteract a dysregulated gene
expression of hypertrophied cardiocytes. Some of these compounds have
been developed for treating non-insulin-dependent diabetes mellitus and
stable angina pectoris. A shift from fatty acid oxidation to glucose
oxidation leads to a reduced gluconeogenesis and improved economy of
cardiac work. An increased glucose oxidation can be achieved with the
following enzyme inhibitors: etomoxir, oxfenicine, methyl palmoxirate,
S-15176, metoprolol, amiodarone, perhexiline (carnitine
palmitoyltransferase-1); aminocarnitine, perhexiline (carnitine
palmitoyltransferase-2); hydrazonopropionic acid
(carnitine-acylcarnitine translocase); MET-88 (gamma-butyrobetaine
hydroxylase); 4-bromocrotonic acid, trimetazidine, possibly ranolazine
(thiolases); hypoglycin (butyryl-CoA dehydrogenase); dichloroacetate
(pyruvate dehydrogenase kinase). CLINICAL TRIALS with trimetazidine and
ranolazine showed that this shift in substrate oxidation has an
antianginal action. Etomoxir and MET-88 improved the function of
overloaded hearts by increasing the density of the Ca(2+) pump of
sarcoplasmic reticulum (SERCA2). The promoters of SERCA2 and
alpha-myosin heavy-chain exhibit sequences which are expected to respond
to transcription factors responsive to glucose metabolites and/or
peroxisome proliferator-responsive element (PPAR) agonists. Further
progress in elucidating novel compounds which upregulate SERCA2
expression is closely linked to the characterization of regulatory
sequences of the SERCA2 promoter. \[References: 158\]

Salmore, R. \"Development of a new pain scale: Colorado Behavioral
Numerical Pain Scale for sedated adult patients undergoing
gastrointestinal procedures.\" *Gastroenterology Nursing.* 25, no.
6(2002): 257-62 UI 12488689.

A limited number of studies have addressed pain assessment among sedated
patients undergoing a gastrointestinal examination. The Colorado
Behavioral Numerical Pain Scale is a quick, simple tool that can provide
an estimation of the patient\'s comfort level while sedated. Multiple
studies completed in intensive care unit and postanesthesia care unit
settings provide ample evidence of the accuracy of behavioral pain
scales ratings. In developing the Colorado Behavioral Numerical Pain
Scale, experienced endoscopy nurses provided suggestions and
modifications of descriptive words for behavioral assessment of pain
selected from the relevant literature. Three nurses simultaneously rated
pain using the scale for 30 procedures. Interrater reliability was high
with 82% of observations in total agreement and 17% having one of the
three persons disagreeing on the rating. Nurses from four hospitals and
one ambulatory facility also evaluated the Colorado Behavioral Numerical
Pain Scale tool. In this evaluation, 98% of the 52 respondents agreed
that the words described what they observed during a gastrointestinal
examination and 94% felt it was a better descriptor of pain than a
patient self-report numerical scale. Assessment of pain for the sedated
patient undergoing gastrointestinal procedures is often difficult due to
the patient\'s inability to report pain levels. The sedated patient
undergoing painful procedures depends on the nurse to interpret physical
signs to quantify his or her distress. The Acute Pain Management
Guidelines (AHCPR, 1992) promotes the use of both physiological and
behavioral responses to pain for assessment when self-report is absent.
While an individual\'s self-report of pain intensity and distress is the
most accurate assessment measurement, the validity of a sedated
patient\'s elicited response about pain is questionable. It is the
nurse, through observation, who attempts to assess the sedated
individual\'s pain levels.

Sandhu, F. A., et al. \"Occipitocervical fusion for rheumatoid arthritis
using the inside-outside stabilization technique.\" *Spine.* 28, no.
4(2003): 414-9 UI 12590220.

STUDY DESIGN: A retrospective study investigating the clinical outcome
of the inside-outside cranial bolt technique for occipitocervical
stabilization used to manage rheumatoid arthritis was conducted.
OBJECTIVE: To evaluate the safety and efficacy of the inside-outside
technique for occipitocervical stabilization used to manage rheumatoid
patients. SUMMARY OF BACKGROUND DATA: Achieving occipital cervical
fusion for patients with rheumatoid arthritis is a complex and
challenging problem. Complications related to placement of occipital
screws have been reported. METHODS: Occipitocervical stabilization was
used for atlantoaxial subluxation or basilar invagination in 21 patients
with rheumatoid arthritis. The patients were assessed for pre- and
postoperative neurologic status (Ranawat classification), neck pain,
fusion and alignment, hardware complications, and continued posterior
cranial settling. All the patients underwent stabilization using
inside-outside occipital screws. The technique involves bilateral
fixation of cervical plates to the occiput using inside-outside screws,
and to the cervical spine using pars screws at C2 or lateral mass screws
at subaxial levels. Bone grafting was accomplished with autologous rib
or iliac crest graft. RESULTS: During the study, 14 women and 7 men with
rheumatoid arthritis underwent occipitocervical stabilization and
fusion. The average age of the patients was 65 years, and the mean
follow-up period was 25.5 months. There were no surgical complications.
Neck pain was reduced from an average Ranawat pain score of 2.40 to 0.4
(P \< 0.0001). The Ranawat neurologic grade improved in 62% of the
patients with preoperative neurologic deficit. Further cranial settling
was not observed in any patient. There were no complications from
implants and no incidence of instrumentation failure. CONCLUSIONS: The
\"inside-outside\" technique is safe and effective for stabilizing the
occipitocervical junction in rheumatoid patients. It is associated with
significant reduction of neck pain, improved neurologic status, and
maintenance of alignment and stability.

Santiveri, X., et al. \"Anaesthetic and postoperative analgesic effects
of spinal clonidine as an additive to prilocaine in the transurethral
resection of urinary bladder tumours.\" *European Journal of
Anaesthesiology.* 19, no. 8(2002): 589-93 UI 12200949.

BACKGROUND AND OBJECTIVE: The alpha 2-adrenoceptor agonist clonidine has
potent central antinociceptive properties. The study was designed to
investigate the effects of the combined subarachnoid administration of
clonidine and prilocaine on spinal block and postoperative analgesia for
the transurethral resection of tumours in the urinary bladder. METHODS:
The controlled, prospective, double-blind study enrolled 40 patients
scheduled for elective transurethral resection of bladder tumours under
spinal anaesthesia with prilocaine. Patients were randomly assigned to
receive an intrathecal injection of prilocaine 75 mg alone (control
group) or in combination with clonidine 75 micrograms. We assessed
haemodynamic changes (non-invasive arterial pressure, heart rate), pulse
oximetry, the upper level of block, the onset and duration of sensory
and motor block, postoperative analgesia and any adverse effects.
RESULTS: There were no statistically significant differences in
demographic data, heart rate, onset time or the levels of sensory or
motor block. Analgesia lasted significantly longer in the clonidine
group (498.4 +/- 226.9 versus 187.2 +/- 103.1 min; P \< 0.05). The
duration of motor block was longer in the clonidine group (165.5 +/-
30.6 min) than in the control group (139.7 +/- 40.4 min; P \< 0.05) and
the duration of sensory block was also longer in the clonidine group
(157.3 +/- 24.5 min) than in the control group (137.2 +/- 31.2 min; P \<
0.05). Fewer patients in the recovery room needed metamizol (dipyrone)
in the clonidine group (5%) than in the control group (50%). Arterial
pressure decreased significantly in the clonidine group 75-135 min after
the block. CONCLUSIONS: The addition of clonidine 75 micrograms to
prilocaine 75 mg for subarachnoid anaesthesia increased the duration of
sensory and motor block and reduced the need for additional
postoperative analgesics by providing excellent analgesia for about 8 h
during recovery from transurethral resection of bladder tumours.

Schaeffer, A. J. \"Editorial: Emerging concepts in the management of
prostatitis/chronic pelvic pain syndrome.\[comment\].\" *Journal of
Urology.* 169, no. 2(2003): 597-8 UI 12544315.

Schull, M. J., et al. \"Emergency department overcrowding and ambulance
transport delays for patients with chest pain.\" *CMAJ Canadian Medical
Association Journal.* 168, no. 3(2003): 277-83 UI 12566332.

OBJECTIVE: Emergency department overcrowding sometimes results in
diversion of ambulances to other locations. We sought to determine the
resulting prehospital delays for cardiac patients. METHODS: Data on
consecutive patients with chest pain who were transported to Toronto
hospitals by ambulance were obtained for a 4-month period in 1997 and a
4-month period in 1999, which represented periods of low and high
emergency department overcrowding respectively. Multivariate analyses
were used to model 90th percentile system response (initiation of 9-1-1
call to arrival on scene), on-scene (arrival on scene to departure from
scene) and transport (departure from scene to arrival at hospital)
intervals. Predictor variables were study period (1997 or 1999), day of
the week, time of day, geographic location of the patient, dispatch
priority, case severity, return priority and number of other patients
with chest pain transported within 2 hours of the index transport.
RESULTS: A total of 3609 patients (mean age 66.3 years, 50.3% female)
who met the study criteria were transported by ambulance during the 2
study periods. There were no significant differences in patient
characteristics between the 2 periods, despite the fact that more
patients were transported during the second period (p \< 0.001). The
90th percentile system response interval increased by 11.3% from the
first to the second period (9.7 v. 10.8 min, p \< 0.001), whereas the
on-scene interval decreased by 8.2% (28.0 v. 25.7 min, p \< 0.001). The
longest delay was in the transport interval, which increased by 28.4%
from 1997 to 1999 (13.4 v. 17.2 min, p \< 0.001). In multivariate
analyses, the study period (1997 v. 1999) remained a significant
predictor of longer transport interval (p \< 0.001) and total
prehospital interval (p = 0.004). INTERPRETATION: An increase in
overcrowding in emergency departments was associated with a substantial
increase in the system response interval and the ambulance transport
interval for patients with chest pain.

Seeber, P. W., and V. J. Staschiak. \"Diagnosis and treatment of ankle
pain with the use of arthroscopy.\" *Clinics in Podiatric Medicine &
Surgery.* 19, no. 4(2002): 509-17, vi UI 12471858.

One of the most common pathologies associated with chronic ankle pain is
anterolateral ankle impingement secondary to an inversion ankle sprain.
An average of one ankle sprain per 10,000 people occur every day. After
an ankle sprain 10% to 50% of patients have some form of chronic ankle
pain, which the authors consider to be pain that lasts over three
months. The use of ankle arthroscopy allows us to directly inspect all
of the intra-articular structures at a magnified view without the need
for multiple arthrotomies. \[References: 5\]

Setler, P. E. \"Therapeutic use of botulinum toxins: background and
history.\" *Clinical Journal of Pain.* 18, no. 6 Suppl(2002): S119-24 UI
12569958.

The seven botulinum neurotoxin serotypes share less than 50% sequence
homology and are immunologically distinct. The neurotoxins inhibit
release of the neurotransmitter acetylcholine from the axon terminals of
motor neurons, preganglionic sympathetic and parasympathetic neurons,
and postganglionic parasympathetic nerves by a multi-step mechanism that
differs slightly, but significantly, for each serotype. The inhibition
is long lasting but temporary. The resulting muscle paralysis has
provided the basis for therapeutic use of botulinum toxin types A and B
in a variety of focal dystonias. The safety of the botulinum toxins,
when administered focally, has permitted their widespread use in a
number of other painful conditions. \[References: 55\]

Shapiro, G. S., G. Taira, and O. Boachie-Adjei. \"Results of surgical
treatment of adult idiopathic scoliosis with low back pain and spinal
stenosis: a study of long-term clinical radiographic outcomes.\"
*Spine.* 28, no. 4(2003): 358-63 UI 12590210.

STUDY DESIGN: A case series of adults with surgical treatment for adult
idiopathic thoracolumbar and/or lumbar scoliosis, low back pain, and
spinal stenosis was studied. OBJECTIVE: To assess pain relief, curve
correction, and complications after combined procedures consisting of
decompression, spine fusion, and stabilization. SUMMARY OF BACKGROUND
DATA: Only one publication has focused specifically at this group, and
this was before the advent of modern segmental instrumentation. This is
the first report of long-term follow-up evaluation in such a patient
population. METHODS: This study included 16 patients who underwent
elective anterior and posterior surgical reconstruction for adult
idiopathic thoracolumbar and/or lumbar scoliosis, spinal stenosis, and
low back pain with a minimum follow-up period of 2 years. Radiographic
findings, clinical results, and long-term outcome data were obtained
using the Modified Scoliosis Research Society outcome instrument and the
Oswestry Disability Back Pain Questionnaire. RESULTS: Restoration of
coronal and sagittal balance, or improvement thereof, was achieved in
all the patients with balance problems. There was significant
improvement in all outcome domains. Overall, 94% of the patients were
satisfied with the surgery. Ten major complications occurred in 10
patients, 8 of whom required additional surgery. There were two minor
complications. CONCLUSIONS: Combined symptoms of back pain and spinal
stenosis require complex reconstructive surgery in adults with
idiopathic thoracolumbar and/or lumbar scoliosis. Significant pain
relief, functional restoration, and satisfaction can be achieved and
maintained over the long term in the properly selected patient.

Shenoy, M. M., R. Sengupta, and A. Khanna. \"Atrial pacing stress
echocardiography: an alternative diagnostic test for chest pain in the
elderly.\" *American Journal of Geriatric Cardiology.* 11, no. 6(2002):
404-9 UI 12417847.

The authors utilized rapid right atrial pacing and handgrip exercise to
provoke myocardial ischemia in 20 participants (age \>65 years) who, for
reasons of disability, were not candidates for exercise and
pharmacologic stress testing. Echocardiographic left ventricular
ejection fraction and left ventricular wall motions were obtained during
pacing at baseline and at maximal pacing rates and were compared with
coronary angiography. Using the failure of left ventricular ejection
fraction to increase with pacing as an indicator of myocardial ischemia,
the test yielded a sensitivity of 75%, specificity of 100%, positive
predictive value of 100%, and negative predictive value of 71%. When a
pacing-induced decrease of wall-motion index was taken as an ischemia
indicator, the sensitivity was 63%, specificity 100%, positive
predictive value 100%, and negative predictive value 80%. Rapid atrial
pacing echocardiography is a safe test. It may be considered in a select
group of elderly patients as an alternative to exercise or pharmacologic
tests before resorting to coronary angiography. Copyright 2002 CVRR,
Inc.

Sheridan, P. J., and D. C. Crossman. \"Critical review of unstable
angina and non-ST elevation myocardial infarction.\" *Postgraduate
Medical Journal.* 78, no. 926(2002): 717-26 UI 12509688.

Within the coronary vasculature the progression of a stable
atherosclerotic plaque into a vulnerable and ultimately unstable lesion
leads to a cascade of events culminating in the clinical presentation of
unstable angina or acute myocardial infarction. In recent years studies
have provided new insights in to the pathology and natural history,
stimulating advances in diagnosis, treatment, and management. The review
discusses the progress made including the role of inflammation, cardiac
biomarkers, antiplatelet therapy, and percutaneous intervention. Current
issues of debate and future directions are also addressed. \[References:
86\]

Shiina, K., et al. \"Diagnosis of effort angina pectoris at rest by
first derivative electrocardiography.\" *Journal of Cardiology.* 40, no.
5(2002): 199-206 UI 12463094.

OBJECTIVES: First derivative electrocardiography (FDECG) records the
slope of the wave of the standard 12-lead electrocardiography (ECG) and
enables quantification of ECG-T wave symmetry. This study investigated
the usefulness of FDECG to diagnose effort angina pectoris in patients
with chest pain. METHODS: All 62 patients who visited our hospital with
exertional chest pain underwent FDECG at rest, and exercise
electrocardiography or stress thallium scintigraphy. Patients with
possible ischemic change underwent coronary angiography, and those with
significant coronary artery stenosis (\> or = 75% reduction) were
classified as the angina pectoris group (23 subjects). The other
patients (without ischemic change or without significant coronary artery
stenosis) formed the non-angina pectoris group (39 subjects). The FDECG
is a simple differential wave with two peaks. The first peak of the
FDECG-T wave designated as the T1 wave and the second peak as the T2
wave. The heights (the T1 and T2 wave amplitude) and the T2/T1 ratio (T2
wave heights/T1 wave heights) were calculated in the two groups.
RESULTS: The T2/T1 ratios in leads I, V3, V4, V5 and V6 were
significantly (I, V3, V4: p \< 0.01, V5: p \< 0.0001, V6: p \< 0.001)
decreased in the angina pectoris group. Using the criterion of a T2/T1
ratio at the V5 lead of less than 1.30, FDECG could detect effort angina
pectoris patients with 65% in sensitivity, 74% specificity and 71%
accuracy. CONCLUSIONS: ECG-T waves in the angina pectoris group were
symmetrical. T2/T1 ratio of the FDECG-T wave is a useful index to
diagnose effort angina pectoris at rest.

Shimokawa, H., et al. \"Anti-anginal effect of fasudil, a Rho-kinase
inhibitor, in patients with stable effort angina: a multicenter study.\"
*Journal of Cardiovascular Pharmacology.* 40, no. 5(2002): 751-61 UI
12409984.

Rho-kinase plays an important role in calcium sensitization for vascular
smooth muscle (VSMC) contraction and may be involved in the
inappropriate coronary vasoconstriction during exercise-induced
myocardial ischemia. In this multicenter phase II study, the
anti-anginal effect of fasudil, which is metabolized to a specific
Rho-kinase inhibitor hydroxyfasudil after oral administration, was
examined in patients with stable effort angina. In the phase IIa trial,
after a 2-week washout period of anti-anginal drugs, 45 patients
received increasing doses of fasudil (5, 10, and 20 mg TID for every 2
weeks). The fasudil treatment significantly prolonged the maximum
exercise time and the time to the onset of 1-mm ST segment depression on
treadmill exercise test (both p \< 0.01), whereas blood pressure and
heart rate during exercise were unchanged before and after the
treatment. Higher doses of fasudil (20 and 40 mg TID) were subsequently
tested in 22 patients in the same manner with similar positive results.
In the phase IIb trial, after a 2-week washout period of anti-anginal
drugs, 125 patients were assigned, in a double-blind manner, to a 4-week
oral treatment with a different dose of fasudil (5, 10, 20, or 40 mg
TID) and treadmill exercise test was performed before and after the
treatment. Again, both maximum exercise time and time to the onset of
1-mm ST segment depression were prolonged in all groups. A significant
dose-response relation was noted across the treatment groups for the
exercise tolerance index that was determined by the combined effect of
exercise time and ST segment depression (p = 0.006). Fasudil was well
tolerated in both trials without any serious adverse reactions. These
results suggest the efficacy and adequate safety profile of fasudil, the
first drug in a novel class of vasodilators, for the treatment of stable
effort angina.

Singh, R. M., and S. L. Wyant. \"Pain management content in curricula of
U.S. schools of pharmacy.\" *Journal of the American Pharmaceutical
Association.* 43, no. 1(2003): 34-40 UI 12585749.

OBJECTIVES: To identify individuals in schools of pharmacy in the United
States who are responsible for covering the topic of pain management in
courses for doctor of pharmacy students and to describe how and at what
depth pain management is covered in pharmacy school curricula. DESIGN:
One-time qualitative assessment. SETTING: Schools of pharmacy in the
United States. PARTICIPANTS Twenty-eight faculty members with the rank
of professor, associate professor, or assistant professor who had been
employed in their current positions for at least 2 years and who were
directly involved in preparing and teaching didactic courses that
address pain management. INTERVENTION: In-depth telephone interviews.
MAIN OUTCOME MEASURES: Qualitative responses to open-ended interview
questions. RESULTS: While pain management was included in the curricula
of all 28 schools of pharmacy, it was generally covered in a fragmented
way, usually as part of presentations on diseases with pain as a
prominent feature (e.g., cancer pain addressed during oncology lectures)
or as part of discussions of analgesics. Only two schools offered
stand-alone courses in pain management, and both of those courses were
electives that were taken by an average of 15 students per year.
Three-fourths of respondents believed that pain was being given too
little emphasis in their schools\' curricula. Palliative care and the
use of medications in the treatment of cancer pain was not presented in
a standardized manner, and respondents were unsure of how the subject
was covered in pharmacy law classes. Instruction about the diagnosis of
pain, patient assessment, and physical examination was reported as
\"minimal\" by most respondents. Respondents perceived a need for a
single, complete reference and teaching resource that would address the
entire spectrum of pain management as it applies to pharmacy.
CONCLUSION: The topic of pain management is poorly presented and
inadequately developed in the curricula of many U.S. schools of
pharmacy.

Slatkin, N. E., and M. Rhiner. \"Phenol saddle blocks for intractable
pain at end of life: report of four cases and literature review.\"
*American Journal of Hospice & Palliative Care.* 20, no. 1(2003): 62-6
UI 12568439.

Four cancer patients with prior bladder diversions had phenol neurolytic
saddle blocks performed for intractable pelvi-sacral pain. All patients
had advanced disease, the focus of their treatment being palliative.
Treatment limiting side effects precluded further upward titration of
systemic analgesic therapies. Pain control improved after intrathecal
neurolysis and allowed a greater than 60 percent reduction in systemic
opiate dosage. No significant block-related adverse effects were
encountered. The value and technical aspects of intrathecal saddle
blocks in end-of-life pain management is discussed. \[References: 16\]

Smith, H. S., J. Audette, and M. A. Royal. \"Botulinum toxin in pain
management of soft tissue syndromes.\" *Clinical Journal of Pain.* 18,
no. 6 Suppl(2002): S147-54 UI 12569962.

Botulinum toxin is approved for the treatment of muscle overactivity
associated with several disorders, such as dystonias. However, control
of muscle spasm often results in pain relief as well. Effective relief
of pain associated with myofascial pain syndrome provides a model for
the use of botulinum toxin to relieve pain associated with other types
of soft-tissue syndromes, such as fibromyalgia. Although the mechanisms
that trigger the pain in these syndromes vary, recent data suggest that
a central neuroplastic mechanism may contribute to many complex pain
syndromes. Botulinum toxin therapy may be particularly useful in
soft-tissue syndromes that are refractory to traditional treatment with
physical therapy, electrical muscle stimulation, and other approaches.
Although not used as first-line therapy for pain relief, botulinum toxin
may decrease pain long enough for patients to resume more conservative
therapy. A primary benefit of treatment with botulinum toxin is its long
duration of action. Several studies have demonstrated the efficacy of
botulinum toxin types A and B in treating several neuropathic pain
disorders. Proper patient selection, injection technique, and dosing are
critical to obtaining the best outcomes in managing pain with botulinum
toxin. Additional study is needed to better characterize its use for the
treatment of pain. \[References: 82\]

Smith, P. F. \"Cannabinoids in the treatment of pain and spasticity in
multiple sclerosis.\" *Current Opinion in Investigational Drugs.* 3, no.
6(2002): 859-64 UI 12137404.

There is a large amount of evidence to support the view that the
psychoactive ingredient in cannabis, delta9-tetrahydrocannabinol
(delta9-THC), and cannabinoids in general, can reduce muscle spasticity
and pain under some circumstances. Cannabinoid (CB1) receptors in the
CNS appear to mediate both of these effects and endogenous cannabinoids
may fulfil these functions to some extent under normal circumstances.
However, in the context of multiple sclerosis (MS), it is still
questionable whether cannabinoids are superior to existing, conventional
medicationsfor the treatment of spasticity and pain. In the case of
spasticity, there are too few controlled clinical trials to draw any
reliable conclusion at this stage. In the case of pain, most of the
available trials suggest that cannabinoids are not superior to existing
treatments; however, few trials have examined chronic pain syndromes
that are relevant to MS. Whether or not cannabinoids do have therapeutic
potential in the treatment of MS, a further issue will be whether
synthetic cannabinoids should be used in preference to cannabis itself.
Smoking cannabis is associated with significant risks of lung cancer and
other respiratory dysfunction. Furthermore, delta9-THC, as a
broad-spectrum cannabinoid receptor agonist, will activate both CB1 and
CB2 receptors. Synthetic cannabinoids, which target specific cannabinoid
receptor subtypes in specific parts of the CNS, are likely to be of more
therapeutic use than delta9-THC itself. If rapid absorption is
necessary, such synthetic drugs could be delivered via aerosol
formulations. \[References: 78\]

Solca, M. \"Acute pain management: unmet needs and new advances in pain
management.\" *European Journal of Anaesthesiology - Supplement.*
25(2002): 3-10 UI 12449672.

Sot, U., et al. \"Intrathecal bradykinin administration: opposite
effects on nociceptive transmission.\" *Pharmacology.* 66, no. 2(2002):
76-80 UI 12207114.

Injected intrathecally, bradykinin (BK) produced either hyperalgesia
(0.15 microg) or antinociception (6.0 microg) in rats when thermal
noxious stimuli were used. Similarly, des-Arg(9)-BK at the lower dose
(0.15 microg) decreased, whereas at the higher dose (6.0 microg) it
increased the threshold to thermal noxious stimuli; however, these
effects were less pronounced than those of BK. The antinociception
induced by BK was abolished by HOE 140, a B(2) receptor antagonist,
injected intrathecally at a dose of 1.3 ng and was markedly attenuated
by des-Arg(10)-HOE 140, a B(1) receptor antagonist (1.15 ng i.t.). The
results obtained in this study showed that\--depending on the dose
used\--BK and des-Arg(9)-BK could produce pro- as well as
antinociceptive actions. Both B(2) and B(1) receptors are involved in
the action of intrathecally applied BK. Copyright 2002 S. Karger AG,
Basel

Soyer, J., et al. \"The relationship between clinical outcomes and the
amount of arthroscopic acromial resection.\" *Arthroscopy.* 19, no.
1(2003): 34-9 UI 12522400.

PURPOSE: In 47 consecutive patients who had a shoulder impingement
syndrome treated by arthroscopic subacromial decompression, we compared
the functional outcome with the amount of the acromion resection. TYPE
OF STUDY: Prospective study. METHODS: The inclusion criteria for patient
selection was a chronic impingement syndrome unresolved by conservative
treatment with an intact rotator cuff or with an irreparable rupture of
the rotator cuff. The assessment was performed with the scoring system
of Constant preoperatively and postoperatively. Quantitative
measurements of the acromion resection were made by comparing
preoperative and postoperative anteroposterior radiographic views,
standardized under fluoroscopic control in order to become reproducible
and comparable. There were 39 patients (41 shoulders) available for
follow-up at 37 months. RESULTS: The condition of the shoulder,
concerning pain, motion and activities, was improved at the time of
follow-up, the mean gain of the total functional score was 29
points/100. Age, side, activity, duration of pain before procedure and
cuff statement had no influence on preoperative and postoperative
Constant\'s score. The difference between preoperative and postoperative
measurements of anterior acromion protuberance was significant. There
was no correlation between the amount of the acromion resection and the
improvement of Constant\'s score (P =.84). CONCLUSIONS: The origin of
impingement syndrome is multi-factorial, and efficiency of arthroscopic
decompression may not be only due to the amount of acromion resection.
From these results and a literature review, this study analyzes several
morphologic factors, which could explain the good results of
arthroscopic subacromial decompression in impingement syndrome.

St Clair, E. W. \"Tides of inflammation: impact of biologics.\" *Journal
of Rheumatology - Supplement.* 65(2002): 22-6 UI 12236618.

Increased knowledge about the mechanisms of joint inflammation and
damage has profoundly shaped the development of new therapies for
rheumatoid arthritis (RA). The first stop on this remarkable
bench-to-bedside journey has been the biologics targeting tumor necrosis
factor-alpha (TNF-alpha) and interleukin 1 (IL-1). These engineered
adaptations of naturally occurring molecules function to neutralize the
biological activity of proinflammatory cytokines overproduced in the
joints of patients with RA. The successful translation of this approach
into the clinic has had a substantial effect on the care of patients
with RA. \[References: 12\]

Stawowy, M., et al. \"Somatosensory changes in the referred pain area
following acute inflammation of the appendix.\" *European Journal of
Gastroenterology & Hepatology.* 14, no. 10(2002): 1079-84 UI 12362098.

BACKGROUND AND AIMS: Abdominal pain provoked by acute gastrointestinal
disease may increase the sensitivity in the referred somatic pain area.
The aim of this study was to examine sensory changes in the referred
pain area during acute appendicitis. SUBJECTS: Twenty patients with
clinical symptoms of appendicitis were included; 16 of these had
appendicitis confirmed at operation. Ten healthy volunteers served as
controls. METHODS: In patients with symptoms of appendicitis, somatic
sensitivity was assessed using different stimuli presented in the area
of referred pain and in a comparable non-painful area at the
contralateral site of the abdomen. In healthy control subjects, the same
stimuli were presented to McBurney\'s point and at a similar area on the
left abdomen. The rating to pinprick was determined using a Von Frey
hair. The rating to thermal stimuli was tested by warm and cold metal
rollers. A constant current stimulator was used to measure the sensation
and pain-detection threshold to single and repeated electrical stimuli.
The pressure pain threshold was determined by an electronic pressure
algometer. RESULTS: Patients (n = 16) with verified appendicitis showed
increased ratings to pinprick (50%, P \< 0.05) and thermal stimuli (56%,
P \< 0.05) in the referred pain area. There was a reduction in pain
thresholds to single electrical (4.3 v. 8.4 mA, P = 0.001), repeated
electrical (3.5 v. 4.6 mA, P = 0.005) and pressure (89 v. 243 kPa, P \<
0.001) stimuli in the referred pain area versus the control area. In the
control group, no difference was observed between the two areas. The
pain thresholds for electrical and pressure stimuli were lower in the
referred pain area in patients compared with the same area in controls
(P \< 0.001). CONCLUSION: Somatosensory hyperalgesia to experimental
stimuli was observed in acute appendicitis. We believe that
viscerosomatic convergence mechanisms and central nervous system
hyperexcitability explain these findings.

Sueda, S., et al. \"Limitations of medical therapy in patients with pure
coronary spastic angina.\" *Chest.* 123, no. 2(2003): 380-6 UI 12576355.

OBJECTIVES: To assess the efficacy of medication for the treatment of
pure coronary spastic angina, 71 consecutive patients with this
diagnosis who had undergone coronary arteriography in a hospital with a
follow-up of at least 2 years were studied. Methods and results: All 71
patients without significant organic stenosis were treated with
long-acting calcium antagonists. The disappearance of chest pain attacks
while receiving medical therapy was observed in 27 patients (38%),
whereas the remaining 44 patients (62%) had chest pain attacks. Of
special interest, 30 patients had more than one attack per month
irrespective of the administration of calcium antagonists or isosorbide
dinitrate. Medical treatment showed a good response in female patients
(63% vs 31%, respectively; p \< 0.05) and those with ST-segment
elevation during selective spasm provocation tests (63% vs 30%,
respectively; p \< 0.05). In contrast, patients with a longer history of
chest pain attacks before hospital admission and those with diffuse
spasms (77% vs 34%, respectively; p \< 0.01) had poor responses to
medical treatment. In this study, neither sudden death nor acute
myocardial infarction was observed during the follow-up periods.
CONCLUSION: The limitations of medical therapy, including the
administration of long-acting calcium antagonists, were observed in 30
of 71 patients (42%) with pure coronary spastic angina. Medical
treatment was effective in only 38% of patients with pure coronary
spastic angina in Japan.

Suter, P. B. \"Employment and litigation: improved by work, assisted by
verdict.\" *Pain.* 100, no. 3(2002): 249-57 UI 12467996.

Previous research exploring the relationship between litigation status
and the symptoms of the plaintiff has been inconsistent and limited by
methodological difficulties. This longitudinal study addressed many of
the methodological shortcomings of previous research and examined the
relationship between litigation status, employment, depression, pain and
disability over the duration of the compensation process. Two hundred
chronic back pain participants were selected from patients who attended
an initial assessment interview at a pain centre. According to their
litigation and employment status these patients were divided into four
groups, namely a non-litigating non-working group, a non-litigating
working group, a litigating non-working group and a litigating working
group. All participants completed three questionnaires, one at intake,
one at a minimum of 2 years later (for litigants during the litigation
process), with the final questionnaire completed at a minimum of 15
months thereafter (for litigants after they had settled their claim).
Questionnaires contained measures of pain (Visual Analogue Scale, Short
Form McGill Pain Questionnaire), depression (Zung Self-Rating Depression
Scale), and disability (Oswestry Disability Questionnaire). Overall
participants who were working scored lower on all the measures than did
participants who were not working. On the other hand participants who
were litigating scored higher on all the measures than did participants
who were not litigating. There was a significant time effect on all
measures but this was qualified on some measures by the interactions of
time with litigation status and work status. The present research
further demonstrated that both litigation and employment were
significant factors influencing recovery from injury.

Sutherland, S., and D. C. Matthews. \"Emergency management of acute
apical periodontitis in the permanent dentition: a systematic review of
the literature.\" *Journal \[Computer File\]/Canadian Dental
Association.* 69, no. 3(2003): 160 UI 12622880.

OBJECTIVE: To perform a systematic literature review and meta-analysis
on the effectiveness of interventions used in the emergency management
of acute apical periodontitis in the permanent dentition. METHODS:
Electronic databases were searched from their inception to 2001. These
searches, combined with manual searching, yielded 1,097 citations, of
which 92 were relevant. Independent application of inclusion criteria by
2 teams of reviewers yielded 15 eligible randomized controlled trials.
Data on population, interventions, outcomes (pain relief or change in
intensity of pain as reported by patients or clinicians) and
methodological quality were determined by independent duplicate review.
Disagreements were resolved by consensus. RESULTS: Meta-analysis showed
that pre-emptive analgesics (nonsteroidal anti-inflammatory drugs
\[NSAIDs\]) in conjunction with pulpectomy provided a significant
benefit (weighted mean difference -11.70, 95% confidence interval -22.84
to -0.56). Three interventions did not show significant benefit:
systemic antibiotics, intracanal treatment with a steroid-antibiotic
combination, and trephination through attached gingiva. CONCLUSIONS: In
the management of pain associated with acute apical periodontitis, there
is strong evidence to support the use of systemic NSAIDs in conjunction
with nonsurgical endodontics. The use of antibiotics is not recommended.
\[References: 45\]

Svensson, C. I., et al. \"Systemic and spinal analgesic activity of a
delta-opioid-selective lanthionine enkephalin analog.\" *Journal of
Pharmacology & Experimental Therapeutics.* 304, no. 2(2003): 827-32 UI
12538839.

A lanthionine enkephalin derivative,
Tyr-c\[D-Val(L)-Gly-Phe-D-Ala(L)\]-OH (DV(L)(2)DA(L)(5)LanEnk), where
Val(L) and Ala(L) denote the lanthionine amino acid ends linked via a
monosulfide bridge to form the lanthionine structure, was synthesized.
It was found to possess selectivity for and potency at the delta versus
mu opioid receptor as defined by binding studies and by its respective
activity on the mouse vas deferens compared with the guinea pig ileum.
The agent produced a potent analgesia after intrathecal and
intraperitoneal delivery with ED(50) values being, respectively, 0.19
mucrog and 0.49 mg/kg. The effects of the agent were reversed by the
delta-selective antagonist naltrindole. These analgesic actions occurred
at doses that had no effect upon general behavior or motor function.
These results suggest a potent delta-preferring agent suitable for
development as a systemic delta opioid analgesic.

Takahashi, Y. \"Variability and assessment of subjective symptoms in
painful neuropathy.\" *Nippon Rinsho - Japanese Journal of Clinical
Medicine.* 60, no. Suppl 10(2002): 235-9 UI 12430234.

Takenaka-Hamaya, C., Y. Hamaya, and S. Dohi. \"Epidural morphine
injection after combined spinal and epidural anaesthesia.\" *European
Journal of Anaesthesiology.* 19, no. 9(2002): 672-6 UI 12243291.

BACKGROUND AND OBJECTIVE: Although combined spinal and epidural
anaesthesia is efficient and easy to perform, the technique can be a
double-edged sword having the potential risk that an increased flux of
drugs across the meninges through the hole made in it may lead to severe
adverse effects. The aim was to compare the incidence of adverse events
when an epidural injection of morphine was given after combined spinal
and epidural anaesthesia or after epidural anaesthesia. METHODS: Fifteen
patients had an epidural catheter inserted at the L2-3 interspace, and
then a spinal block administered via the L3-4 interspace. Another 15
patients only had an epidural catheter inserted. After the onset of
spinal or epidural anaesthesia had been confirmed, morphine 2 mg was
injected into the epidural space, and a continuous epidural infusion of
morphine was started. At the end of the operation and at 4, 8 and 12 h
after the administration of epidural morphine and on the next day, the
following variables were examined: blood pressure, heart rate,
respiratory rate, arterial blood-gas analysis, visual analogue scale
pain scores, nausea/vomiting scores, and pruritus scores. RESULTS: In
the study population, the epidural injection of morphine was not
associated with a significantly higher incidence of adverse events when
given after spinal anaesthesia than after epidural anaesthesia.
CONCLUSIONS: The adverse effects associated with epidural morphine given
after spinal anaesthesia did not increase significantly when a 27-G
Whitacre needle was used. Thus, the morphine flux through the meningeal
hole into the cerebrospinal fluid was trivial.

Tashiro, S., et al. \"Gout tophus in the bipartite patella.\"
*Orthopedics.* 25, no. 11(2002): 1295-6 UI 12452351.

Tfelt-Hansen, P., K. McCarroll, and C. Lines. \"Sum of Pain Intensity
Differences (SPID) in migraine trials. A comment based on four
rizatriptan trials.\" *Cephalalgia.* 22, no. 8(2002): 664-6 UI 12383062.

Sum of Pain Intensity Difference (SPID) is an outcome measure that
summarizes treatment response over a clinically relevant period. SPID is
widely reported in clinical trials of analgesics but has been little
used in migraine trials. We compared SPID over 2 h with the standard
migraine outcome measures of pain-free at 2 h and headache relief at 2 h
using data from four published clinical trials of rizatriptan in
migraine patients. In assessing treatment response (rizatriptan and
sumatriptan versus placebo, rizatriptan versus sumatriptan,
within-treatment dose effects), SPID usually yielded similar results to
the more easily understood pain-free measure.

Theroux, P. \"Unstable angina and non-Q-wave myocardial infarction.
Treatment beyond aspirin and heparin.\" *Cardiologia.* 44 Suppl 1, no.
Pt 2(1999): 799 UI 12497824.

Thomas, S. H., et al. \"Effects of morphine analgesia on diagnostic
accuracy in Emergency Department patients with abdominal pain: a
prospective, randomized trial.\" *Journal of the American College of
Surgeons.* 196, no. 1(2003): 18-31 UI 12517545.

BACKGROUND: Because of concerns about masking important physical
findings, there is controversy surrounding whether it is safe to provide
analgesia to patients with undifferentiated abdominal pain. The purpose
of this study was to address the effects of analgesia on the physical
examination and diagnostic accuracy for patients with abdominal pain.
STUDY DESIGN: The study was a prospective, double-blind clinical trial
in which adult Emergency Department (ED) patients with undifferentiated
abdominal pain were randomized to receive placebo (control group, n =
36) or morphine sulphate (MS group, n = 38). Diagnostic and physical
examination assessments were recorded before and after a 60-minute
period during which study medication was titrated. Diagnostic accuracy
and physical examination changes were compared between groups using
univariate statistical analyses. RESULTS: There were no differences
between control and MS groups with respect to changes in physical or
diagnostic accuracy. The overall likelihood of change in severity of
tenderness was similar in MS (37.7%) as compared with control (35.3%)
patients (risk ratio \[RR\] 1.07, 95% confidence interval \[CI\]
0.64-1.78). MS patients were no more likely than controls to have a
change in pain location (34.0% versus 41.2%, RR 0.82, 95% CI 0.50-1.36).
Diagnostic accuracy did not differ between MS and control groups (64.2%
versus 66.7%, RR 0.96, 95% CI 0.73-1.27). There were no differences
between groups with respect to likelihood of any change occurring in the
diagnostic list (37.7% versus 31.4%, RR 1.20, 95% CI 0.71-2.05).
Correlation with clinical course and final diagnosis revealed no
instance of masking of physical examination findings. CONCLUSIONS:
Results of this study support a practice of early provision of analgesia
to patients with undifferentiated abdominal pain. Copyright 2003 by the
American College of Surgeons

Thompson, A. R., and J. B. Ray. \"The importance of opioid tolerance: a
therapeutic paradox.\" *Journal of the American College of Surgeons.*
196, no. 2(2003): 321-4 UI 12595060.

Thornhill, T. S. \"Painful total knee arthroplasty.\" *Orthopedics.* 25,
no. 9(2002): 965-7 UI 12269431.

Tong, D., et al. \"Prospective study on incidence and functional impact
of transient neurologic symptoms associated with 1% versus 5% hyperbaric
lidocaine in short urologic procedures.\" *Anesthesiology.* 98, no.
2(2003): 485-94 UI 12552209.

BACKGROUND: The objectives of this study were to compare the incidence,
onset, duration and pain scores of transient neurologic symptoms (TNS)
with 1% versus 5% hyperbaric lidocaine in spinal anesthesia for short
urological procedures in a large prospective study. This study would
also evaluate patient satisfaction, and impact of TNS on functional
recovery to assess the clinical significance of TNS. METHODS: This was a
multicenter, double-blind, randomized controlled trial. Four hundred
fifty-three patients undergoing short transurethral procedures were
randomized to receive 1% or 5% hyperbaric lidocaine. Eighty milligrams
of 1% or 5% hyperbaric lidocaine was administered. During the first 3
days after surgery, the presence of TNS, its intensity and duration, and
patient functional level were recorded. An intention-to-treat analysis
was used. RESULTS: There was no difference in the incidence of TNS (21%
vs. 18%) between 1% versus 5% lidocaine. Patients with TNS had
significantly higher pain scores (5.3 +/- 3 vs. 2.3 +/- 3) than patients
without TNS during the first 24 h. This difference in pain scores
persisted until 72 h postoperatively. There was a significant difference
in the daily activities functional scores (2.2 +/- 1 vs. 1.4 +/- 0.8) of
TNS non-TNS patients during the first 24 h postoperatively. CONCLUSIONS:
There was no difference in the incidence of TNS between the 1% versus 5%
spinal lidocaine groups. Pain scores were higher in patients with TNS
than those who did not have TNS. During the first 48 h postop, a small
proportion of patients who had TNS experienced functional impairment of
walking, sitting, and sleeping.

Tumia, N., et al. \"Aberdeen Colles\' fracture brace as a treatment for
Colles\' fracture. A multicentre, prospective, randomised, controlled
trial.\" *Journal of Bone & Joint Surgery - British Volume.* 85, no.
1(2003): 78-82 UI 12585582.

We carried out a randomised, prospective, multicentre clinical trial of
the treatment of Colles\' fractures. A total of 339 patients was placed
into two groups, those with minimally displaced fractures not requiring
manipulation (151 patients) and those with displaced fractures which
needed manipulation (188 patients). Treatment was by either a
conventional Colles\' plaster cast (a control group) or with a
prefabricated functional brace (the Aberdeen Colles\' fracture brace).
Similar results were obtained in both groups with regard to the
reduction and to pain scores but the brace provided better grip strength
in the early stages of treatment. This was statistically significant
after five weeks for both manipulated and non-manipulated fractures. At
the tenth day the results were statistically significant only in
manipulated fractures. There was no significant difference in the
functional outcome between the two treatment groups. However, younger
patients and those with less initial displacement had better functional
results.

Turk, D. C., E. S. Monarch, and A. D. Williams. \"Cancer patients in
pain: considerations for assessing the whole person.\" *Hematology -
Oncology Clinics of North America.* 16, no. 3(2002): 511-25 UI 12170565.

Pain is a subjective perception that is influenced by psychosocial and
behavioral factors and physical pathology. In cancer, the source of the
pain may be the disease itself, the treatment, or co-occurring pain
syndromes. Often, cancer is a progressive disease, and pain may be
marked by exacerbations, additional treatment, and remissions. Thus,
pain assessment must become part of routine care. Ratings of pain should
be performed on a regular basis, just as vital signs are taken on a
regular basis. Unlike the other vital signs, however, pain can only be
assessed by the patients\' verbal and nonverbal behavior. Therefore, it
is necessary to actively involve the patient in the assessment process.
In deciding what to assess about the pain and how, the clinician needs
to balance the purposes of the evaluation with the patient\'s capacity.
During initial assessment it may be possible to include a more
comprehensive evaluation of the patient and his or her pain. Relatively
brief measures may be used on a routine ongoing basis. When a new type
of pain or exacerbation of pain is identified, additional attention
beyond pain severity and location may be appropriate. For the very ill
patient, it may be possible only to ask a few questions and to observe
his or her behavior. In some circumstances, such as when patients are
unwilling or unable to report on their pain, it is useful to gather
information from caretakers. At a minimum, the severity, location, and
pattern of pain and patients\' functional activity and mood should be
assessed. Timely, appropriate, and thorough assessment and treatment of
cancer patients experiencing pain should reduce their suffering and
improve the quality of their lives. \[References: 43\]

Vielhaber, A., and R. K. Portenoy. \"Advances in cancer pain
management.\" *Hematology - Oncology Clinics of North America.* 16, no.
3(2002): 527-41 UI 12170566.

Although most patients with cancer pain can attain a favorable balance
between analgesia and side effects with a conventional approach to
opioid therapy, a substantial minority cannot. For these patients, an
important subgroup of whom have neuropathic pain, alternative
therapeutic strategies are needed. With a detailed assessment,
clinicians should be able to choose among the large and diverse group of
options available and implement an approach, or combination of
approaches, that have a high probability of improving analgesic
outcomes. \[References: 92\]

Walker, K., et al. \"Disease modifying and anti-nociceptive effects of
the bisphosphonate, zoledronic acid in a model of bone cancer pain.\"
*Pain.* 100, no. 3(2002): 219-29 UI 12467993.

Inoculation of syngeneic MRMT-1 mammary tumour cells into one tibia of
female rats produced tumour growth within the bone associated with a
reduction in bone mineral density (BMD) and bone mineral content (BMC),
severe radiological signs of bone destruction, together with the
development of behavioural mechanical allodynia and hyperalgesia.
Histological and radiological examination showed that chronic treatment
with the bisphosphonate, zoledronic acid (30 microg/kg, s.c.), for 19
days significantly inhibited tumour proliferation and preserved the
cortical and trabecular bone structure. In addition, BMD and BMC were
preserved and a dramatic reduction of tartrate resistant acid
phosphatase-positive polykaryocytes (osteoclasts) was observed. In
behavioural tests, chronic treatment with zoledronic acid but not the
significantly less effective bisphosphonate, pamidronate, or the
selective COX-2 inhibitor, celebrex, attenuated mechanical allodynia and
hyperalgesia in the affected hind paw. Zoledronic acid also attenuated
mechanical hyperalgesia associated with chronic peripheral neuropathy
and inflammation in the rat. In contrast, pamidronate or clodronate did
not have any anti-hyperalgesic effect on mechanical hyperalgesia in the
neuropathic and inflammatory pain models. We conclude that zoledronic
acid, in addition to, or independent from, its anti-metastatic and bone
preserving therapeutic effects, is an anti-nociceptive agent in a rat
model of metastatic cancer pain. This unique property of zoledronic acid
amongst the bisphosphonate class of compounds could make this drug a
preferred choice for the treatment of painful bone metastases in the
clinic.

Wang, W. T., et al. \"Effectiveness of physical therapy for patients
with neck pain: an individualized approach using a clinical
decision-making algorithm.\" *American Journal of Physical Medicine &
Rehabilitation.* 82, no. 3(2003): 203-18; quiz 219-21 UI 12595773.

OBJECTIVE: The purpose of this study was to determine the effectiveness
of an individualized physical therapy intervention in treating neck pain
based on a clinical reasoning algorithm. Treatment effectiveness was
examined by assessing changes in impairment, physical performance, and
disability in response to intervention. DESIGN: One treatment group of
30 patients with neck pain completed physical therapy treatment. The
control group of convenience was formed by a cohort group of 27 subjects
who also had neck pain but did not receive treatment for various
reasons. There were no significant differences between groups in
demographic data and the initial test scores of the outcome measures. A
quasi-experimental, nonequivalent, pretest-posttest control group design
was used. A physical therapist rendered an eclectic intervention to the
treatment group based on a clinical decision-making algorithm. Treatment
outcome measures included the following five dependent variables:
cervical range of motion, numeric pain rating, timed weighted overhead
endurance, the supine capital flexion endurance test, and the Patient
Specific Functional Scale. Both the treatment and control groups
completed the initial and follow-up examinations, with an average
duration of 4 wk between tests. RESULTS: Five mixed analyses of variance
with follow-up tests showed a significant difference for all outcome
measures in the treatment group compared with the control group. After
an average 4 wk of physical therapy intervention, patients in the
treatment group demonstrated statistically significant increases of
cervical range of motion, decrease of pain, increases of physical
performance measures, and decreases in the level of disability. The
control group showed no differences in all five outcome variables
between the initial and follow-up test scores. CONCLUSIONS: This study
delineated algorithm-based clinical reasoning strategies for evaluating
and treating patients with cervical pain. The algorithm can help
clinicians classify patients with cervical pain into clinical patterns
and provides pattern-specific guidelines for physical therapy
interventions. An organized and specific physical therapy program was
effective in improving the status of patients with neck pain.

Weber, A., et al. \"Sciatic nerve block and the improvement of femoral
nerve block analgesia after total knee replacement.\" *European Journal
of Anaesthesiology.* 19, no. 11(2002): 834-6 UI 12442936.

Weinbroum, A. A. \"A single small dose of postoperative ketamine
provides rapid and sustained improvement in morphine analgesia in the
presence of morphine-resistant pain.\" *Anesthesia & Analgesia.* 96, no.
3(2003): 789-95, table of contents UI 12598264.

It is a common clinical observation that postoperative pain may be
resistant to morphine. The analgesic potentials of ketamine have also
been well documented. In this study, we evaluated the effects of
postoperative coadministration of small doses of ketamine and morphine
on pain intensity, SpO(2), and subjectively rated variables in surgical
patients who underwent standardized general anesthesia and complained of
pain (\> or =6 of 10 on a visual analog scale \[VAS\]) despite \>0.1
mg/kg of i.v. morphine administration within 30 min. Patients randomly
received up to three boluses of 30 microg/kg of morphine plus saline
(MS; n = 114) or 15 microg/kg of morphine plus 250 microg/kg of ketamine
(MK; n = 131) within 10 min in a double-blinded manner. The MS group\'s
pain VAS scores were 5.5 +/- 1.18 and 3.8 +/- 0.9 after 10 and 120 min,
respectively, after 2.52 +/- 0.56 injections, versus the MK group\'s VAS
scores of 2.94 +/- 1.28 and 1.47 +/- 0.65, respectively (P \< 0.001),
after 1.35 +/- 0.56 injections (P \< 0.001). The 10-min level of
wakefulness (1-10 VAS) in the MS group was significantly (P \< 0.001)
less (6.1 +/- 1.5) than the MK group\'s (8.37 +/- 1.19). SpO(2)
decreased by 0.26% in the MS group but increased by 1.71% in the MK
patients at the 10-min time point (P \< 0.001). Thirty MS versus nine MK
patients (P \< 0.001) experienced nausea/vomiting; nine MK patients
sustained a 2-min light-headed sensation, and one patient had a weird
dream after the second drug injection. IMPLICATIONS: A small-dose
ketamine and morphine regimen interrupted severe postoperative pain that
was not relieved previously by morphine. Ketamine reduced morphine
consumption and provided rapid and sustained improvement in morphine
analgesia and in subjective feelings of well-being, without unacceptable
side effects.

Wentz, J. D. \"Understanding neuropathic pain.\" *Nursing.* 33, no.
1(2003): 22 UI 12555754.

Wilson, S. G., et al. \"The heritability of antinociception: common
pharmacogenetic mediation of five neurochemically distinct analgesics.\"
*Journal of Pharmacology & Experimental Therapeutics.* 304, no. 2(2003):
547-59 UI 12538806.

The heritability of nociception and antinociception has been well
established in the mouse. The pharmacogenetics of morphine analgesia are
fairly well characterized, but far less is known about other analgesics.
The purpose of this work was to begin the systematic genetic study of
non-mu-opioid analgesics. We tested mice of 12 inbred mouse strains for
baseline nociceptive sensitivity (49 degrees C tail-withdrawal assay)
and subsequent antinociceptive sensitivity to systemic administration of
(trans)-3,4-dichloro-N-methyl-N-\[2-(1-pyrrolidinyl)-cyclohexyl\]benzeneacetamide
methane-sulfonate hydrate (U50,488; 10-150 mg/kg), a kappa-opioid
receptor agonist;
(R)-(+)-\[2,3-dihydro-5-methyl-3-(4-morpholinylmethyl)pyrroloand 2 over
black square\]; \[1 and 2 over black
square\],2,3-de\]-1,4-benzoxazin-6-yl\]-1-naphthalenylmethanone
(WIN55,212-2; 0.5-480 mg/kg), a synthetic cannabinoid receptor agonist;
epibatidine (7.5-150 microg/kg), a nicotinic receptor agonist; clonidine
(0.1-5 mg/kg), an alpha(2)-adrenergic receptor agonist; and, for
purposes of comparison, the prototypic mu-opioid receptor agonist,
morphine (5-200 mg/kg). Robust interstrain variability was observed in
nociceptive sensitivity and in the antinociceptive effects of each of
the drugs, with extreme-responding strains exhibiting antinociceptive
potencies differing up to 37-fold. Unexpectedly, we observed
moderate-to-high genetic correlations of strain sensitivities to the
five drugs (r = 0.39-0.77). We also found moderate-to-high correlations
between baseline nociceptive sensitivity and subsequent analgesic
response to each drug (r = 0.33-0.68). The generalizability of these
findings was established in follow-up experiments investigating morphine
and clonidine inhibition of formalin test nociception. Despite the fact
that each drug activates a unique receptor, our results suggest that the
potency of each drug is affected by a common set of genes. However, the
genes in question may affect antinociception indirectly, via a primary
action on baseline nociceptive sensitivity.

Yamamoto, T., et al. \"Off-pump coronary artery bypass grafting in a
patient with liver cirrhosis.\" *Japanese Journal of Thoracic &
Cardiovascular Surgery.* 50, no. 12(2002): 526-9 UI 12561096.

We report a case of unstable angina pectoris and alcohol-related
Child-Pugh class B cirrhosis. The patient was a 60-year-old man who was
admitted to hospital with chest pain. He had previously been diagnosed
to have Child B cirrhosis due to alcoholic liver dysfunction at 58 years
of age. He also had experienced ruptured esophageal varices, moderate
ascites, and hyperammonemia. We performed percutaneous catheter
intervention; however, he developed re-stenosis in the right coronary
artery, and progression in the disease in other coronary arteries. We
then performed coronary artery bypass grafting on the beating heart
without cardiopulmonary bypass. He was discharged on the 13th
postoperative day without any complications. This case demonstrated that
off-pump coronary artery bypass grafting was safe for such a patient.

Yamashita, S., et al. \"Lidocaine toxicity during frequent viscous
lidocaine use for painful tongue ulcer.\" *Journal of Pain & Symptom
Management.* 24, no. 5(2002): 543-5 UI 12547053.

Oral viscous lidocaine is useful for the treatment of symptoms induced
by oral inflamed mucosa, such as radiation- or chemotherapy-induced
mucositis. The toxic reactions associated with an accidental overdose
have been reported in pediatric cases. We report a case of lidocaine
toxicity in a 22-year-old man during frequent viscous lidocaine use for
severe painful tongue ulcer. The toxic symptoms developed when the
amount of oral viscous lidocaine exceeded 240 ml per day. The serum
lidocaine concentration associated with this use was 6.7 microg/ml. The
toxic symptoms continued in spite of the serum lidocaine concentration
below the toxic level after the start of a diluted preparation, which
contained a half-dose lidocaine. It is speculated that lidocaine
metabolites might have contributed to the toxic symptoms. Clinicians
should consider the risk of lidocaine toxicity in cases of frequent
viscous lidocaine use, and determine the serum concentrations of
lidocaine and its metabolites.

Yoburn, B. C., et al. \"Role of G(i)alpha2-protein in opioid tolerance
and mu-opioid receptor downregulation in vivo.\" *Synapse.* 47, no.
2(2003): 109-16 UI 12454948.

Although opioid receptors are G-protein coupled, the role that specific
G-protein subunits play in the development of opioid tolerance and the
regulation of opioid receptor number is not well understood. In the
present study, we used a G((i)alpha2) antisense oligodeoxynucleotide
(ODN) to examine the contribution of G((i)alpha2) proteins to mu-opioid
tolerance and receptor downregulation in the mouse. Mice were injected
intracerebroventricularly (ICV) and into the spinal intrathecal space
(IT) for 4-5 consecutive days (30 microg/site/day), with an antisense
ODN or a mismatch ODN directed at mRNA for the G((i)alpha2) subunit of
G-proteins. Controls were treated with dH(2)O. On the second day of ODN
treatment continuous subcutaneous (SC) infusion of etorphine (200
microg/kg/day) or morphine (40 mg/kg/day + 25 mg pellet) was begun.
Control mice were implanted with inert placebo pellets. Three days
later, pumps and pellets were removed and mice were tested for morphine
analgesia or mu-opioid receptor density was determined in whole brain.
Etorphine produced significant tolerance (ED(50) shift = approximately
11-fold) and downregulation of mu-opioid receptors (approximately 25%).
Morphine treatment produced significant tolerance (ED(50) shift
approximately 9-fold), but no mu-opioid receptor downregulation.
Antisense treatment reduced G((i)alpha2) protein levels in striatum and
spinal cord by approximately 25%. G((i)alpha2) antisense reduced the
acute potency of morphine. G((i)alpha2) antisense blocked the
development of tolerance to morphine treatment and reduced the
development of tolerance to etorphine treatment. Antisense did not have
any effect on etorphine-induced mu-opioid receptor downregulation. In
another experiment, 7-day treatment with morphine or etorphine similarly
increased G((i)alpha2) mRNA and protein abundance in spinal cord.
Overall, these results support an important role for
G((i)alpha2)-protein in the acute effects of opioids and opioid
tolerance. However, G((i)alpha2) is not required for agonist-induced
mu-opioid receptor density regulation in vivo. Copyright 2002
Wiley-Liss, Inc.

Yokoyama, M., et al. \"Total spinal anesthesia provides transient relief
of intractable pain.\" *Canadian Journal of Anaesthesia.* 49, no.
8(2002): 810-3 UI 12374709.

PURPOSE: Intentional total spinal anesthesia (TSA) has been used for
intractable pain treatment. However, the long-term effect of pain-relief
is controversial. We investigate the short- and long-term effects of
pain-relief by TSA. METHODS: Twelve patients with intractable pain
participated in a crossover study. All participants received two
different treatments in random order at a 30-day interval: i.v. infusion
with 300 mg of lidocaine (i.v.-Lido), and TSA with 20 mL of 1.5%
lidocaine (TSA-Lido). Pain level at rest was scored with the visual
analogue scale (VAS: 0-100), and blood pressure and heart rate were
measured before and at two hours, 24 hr, seven days, and 30 days after
treatment. Plasma lidocaine concentrations were measured at 0.5, one,
and two hours. RESULTS: Heart rate and mean arterial pressure during or
after TSA-Lido were similar to those before TSA-Lido. Plasma lidocaine
concentrations were similar between the two treatments. No significant
difference in any value occurred in the i.v.-Lido treatment. VAS were
similar before both treatments (87 +/- 6 for TSA-Lido; 86 +/- 7 for
i.v.-Lido). After TSA-Lido, VAS decreased significantly until day seven
(two hours, 17 +/- 22, P \< 0.01; 24 hr, 43 +/- 20, P \< 0.01; seven
days, 66 +/- 16, P \< 0.01). However, VAS returned to the pre-block
values 30 days after TSA-Lido. CONCLUSION: Intractable pain was
decreased significantly for several days after TSA, but pain-relief was
not sustained.

Yusuf, S., et al. \"Early and late effects of clopidogrel in patients
with acute coronary syndromes.\[comment\].\" *Circulation.* 107, no.
7(2003): 966-72 UI 12600908.

BACKGROUND: The risk of ischemic events is high, both early and late
after acute coronary syndromes (ACS). We examine the benefits and risks
associated with the use of adding clopidogrel to aspirin within the
first 30 days and later (31 days to 12 months) in 12 562 patients with
ACS. METHODS AND RESULTS: A total of 12 562 ACS patients were randomized
to receive clopidogrel (300 mg initially followed by 75 mg/d) or placebo
for 3 to 12 months. The proportion of patients experiencing
cardiovascular death, myocardial infarction, or strokes (primary
outcome) at 30 days was 5.4% in the placebo group and 4.3% in the active
group (relative risk 0.79, 95% CI 0.67 to 0.92). Beyond 30 days, the
corresponding rates were 6.3% versus 5.2% (relative risk 0.82, 95% CI
0.70 to 0.95). There was no significant excess in life-threatening
bleeds in each period (0.97% versus 1.28%, relative risk 1.32, 95% CI
0.95 to 1.84 for 0 to 30 days; 0.83% versus 0.91%, relative risk 1.09,
95% CI 0.75 to 1.59 for 31 days to 12 months). Further subdivision of
the early data indicates benefits within 24 hours with consistently
lower rates of the primary outcome in combination with refractory or
severe ischemia. CONCLUSIONS: Clopidogrel reduces the risk of ischemic
vascular events, with the benefits emerging within 24 hours of
initiation of treatment and continuing throughout the 12 months (mean 9
months) of the study.

Yvanes-Thomas, M., et al. \"Validity of the French-language version of
the Quebec back pain disability scale in low back pain patients in
France.\" *Joint, Bone, Spine: Revue du Rhumatisme.* 69, no. 4(2002):
397-405 UI 12184438.

OBJECTIVES: The primary objectives were to evaluate the acceptability in
France of the Quebec Back Pain Disability Scale (QBPDS) in its original
French-language version and to study its correlational validity against
indicators of impairment, pain, disability, psychological status, and
perceived health status. MATERIAL AND METHODS: Thirty-two patients with
chronic low back pain were recruited at the rheumatology outpatient
clinic of a French hospital. A physical examination was performed for
determination of an impairment score, and scales were completed for pain
(visual analog scale and Saint-Antoine Questionnaire), disability (QBPDS
and Dallas Scale \[DS\]), perceived health status (Nottingham Health
Profile, NHP), and psychological status (Hospital Anxiety and Depression
Scale, HADS). RESULTS: Acceptability, internal consistency, and content
validity of the QBPDS were satisfactory. Investigation of correlational
validity showed good agreement with the DPQ (r = 0.755) and NHP (r =
0.739) and fair agreement with the impairment score (r = 0.449), the VAS
pain score (r = 0.448), and the HADS score (r = 0.473). The QBPDS showed
good discriminating power. Validity of the QBPDS was confirmed.
DISCUSSION: Our results confirm the good measurement properties of the
original French-language version of the QBPDS in French hospital-clinic
patients with chronic low back pain. Comparison of the QBPDS and DPQ in
this study shows that the QBPDS is better for evaluating disability,
whereas the DPQ evaluates the overall, functional, psychological, and
social impact of low back pain.

Zimmermann, P. G. \"Triaging lower abdominal pain.\" *Rn.* 65, no.
12(2002): 52-7; quiz 58 UI 12567831.

Zinn, C. \"Doctors told to use positive language in managing pain.\"
*Bmj.* 326, no. 7384(2003): 301 UI 12574030.