bluuebunny/crossref_metadata_2025 huggingface dataset:
Does failure hurt? The effects of failure feedback on pain report, pain tolerance and pain avoidance
Authors: van den Hout Johanna H.C. , Vlaeyen Johan W.S. , Peters Madelon L. , Engelhard Iris M. , van den Hout Marcel A.
Published: September 2002

In this study an experiment was conducted to examine whether failure experiences have an effect on pain report, pain tolerance and pain avoidance. Furthermore, it was investigated if negative affectivity (NA) affected the impact of failure feedback on pain report, either as a mediator, in the case of negative state affect, or as a moderator when NA as a personality trait was considered. Fifty‐four healthy female volunteers were included and randomly assigned to one of three conditions: (1) failure feedback; (2) success feedback; (3) neutral control task. After the manipulation, subjects were given a cold pressor task in order to obtain pain measures. Regarding the effects of failure feedback on pain report, it was found that, in comparison with success feedback, failure feedback led to increased pain report. With regard to pain tolerance, pain was tolerated for longer when preceded by success feedback than when preceded by failure feedback. Differences between failure and control conditions did not reach significance. With regard to pain avoidance, no differences between the conditions were found. The hypothesized mediating role of negative state affect was not found. Though in the hypothesized direction, no significant effect was found for NA‐trait moderating the influence of failure on pain. The discussion focuses on a number of research questions that remain to be answered, and the clinical relevance of the effects of failure and success experiences on pain report and pain tolerance.
Tramadol anti‐inflammatory activity is not related to a direct inhibitory action on prostaglandin endoperoxide synthases
Authors: Buccellati Carola , Sala Angelo , Ballerio Rossana , Bianchi Mauro
Published: September 2002

The analgesic drug tramadol has been shown to relieve pain in inflammatory conditions, to inhibit the development of experimental inflammation, and to reduce prostaglandin (PG)E2concentrations in the inflammatory exudate. In this study, we evaluated the putative activity of tramadol to suppress prostaglandin endoperoxide synthase‐1 (PGHS‐1), and prostaglandin endoperoxide synthase‐2 (PGHS‐2) activities in human whole blood in vitro. Platelet thromboxane (Tx)B2production and monocyte PGE2production in LPS‐ stimulated blood were measured in samples incubated with different concentrations (300 ng/ml, 3 μ g/ml, 30 μ g/ml) of tramadol or its enantiomers. Neither tramadol nor the enantiomers inhibited the formation of arachidonic acid metabolites. Our results indicate that the anti‐inflammatory effect of tramadol demonstrated in some models is not related to a direct inhibitory effect on the formation of prostanoids.
Computer‐controlled pneumatic pressure algometry—a new technique for quantitative sensory testing
Authors: Polianskis Romanas , Graven‐Nielsen Thomas , Arendt‐Nielsen Lars
Published: September 2002

Hand‐held pressure algometry usually assesses pressure‐pain detection thresholds and provides little information on pressure–pain stimulus–response function. In this article, a cuff pressure algometry for advanced pressure‐pain function evaluation is proposed.

The experimental set‐up consisted of a pneumatic tourniquet cuff, a computer‐controlled air compressor and an electronic visual analogue scale (VAS) for constant pain intensity rating. Twelve healthy volunteers were included in the study. In the first part, hand‐held algometry and cuff algometry were performed over the gastrocnemius muscle with constant compression rate. In the second part, the cuff algometry was performed with different compression rates to evaluate the influence of the compression rate on pain thresholds and other psychophysical data. Pressure‐pain detection threshold (PDT), pain tolerance threshold (PTT), pain intensity, PDT–PTT time and other psychophysical variables were evaluated.

Pressure‐pain detection thresholds recorded over the gastrocnemius muscle with a hand‐held and with a cuff algometer, were 482 ± 19 kPa and 26 ± 1.6 kPa, respectively. Pressure and pain intensities were correlated during cuff algometry. During increasing cuff compression, the subjective pain tolerance limit on VAS was 5.6 ± 0.95 cm. There was a direct correlation between the number of compressions, the compression rate and pain thresholds.

The cuff algometry technique is appropriate for pressure‐pain stimulus–response studies. Cuff algometry allowed quantification of psychophysical response to the change of stimulus configuration.
The management of chronic pain in Switzerland: A comparative survey of Swiss medical specialists treating chronic pain
Authors: Wilder‐Smith Oliver H.G. , Möhrle Jörg J. , Dolin Paul J. , Martin Nadine C.
Published: September 2002

Chronic pain management by Swiss specialist physicians with the primary hypothesis that pain clinic practitioners conform better to good practice (interdisciplinarity, diagnostic/therapeutic routines, quality control, education) than other specialists treating chronic pain was surveyed.

Management of all types of chronic pain by pain clinic practitioners and rheumatologists, oncologists or neurologists was compared via a mailed questionnaire survey (n=125/group).

Two hundred and twenty‐nine (46%) of 500 mailed questionnaires were returned with similar group return rates. Eighty‐six percent of responders find chronic pain therapy very difficult/difficult; they estimate only 45% of these patients achieve good outcomes. Twenty‐three per cent of responders belong to an interdisciplinary pain centre, but 72% of chronic pain patients are treated by responders alone. Fifty‐nine percent never/only occasionally use therapeutic algorithms, 38% use formal pain diagnostic procedures, 20% have a pain quality control programme. Fifty‐one percent lack past pain education, 37% do not attend continuing pain education, 69% agree that pain education is their greatest need. Pain clinic practitioners are more interdisciplinary and use more pain diagnostics than other specialists. They are matched by oncologists in education and success in therapeutic escalation, and bettered by them in algorithm use.

Pain clinic practitioners and oncologists bring particular—differing—skills to chronic pain management compared to rheumatologists and neurologists. Chronic pain management diversity may result from differences in malignant and benign pain, and its generally being provided by the speciality treating the underlying cause. This survey identifies targets for improvement in areas fundamental to good chronic pain practice: interdisciplinarity, diagnostic/therapeutic tools, quality management and education.
von Frey hairs: new materials for a new design
Authors: Fruhstorfer Heinrich , Gross Wolfgang , Selbmann Otto
Published: September 2002

von Frey filaments are widely used in pain research. Conventionally, they are made of synthetic fibres. This plastic material is susceptible to changes in humidity and temperature, and such filaments do not keep their calibration. Filaments made of optical glass fibres are highly elastic and do not suffer these problems. Their optical properties can be used to make thin fibres more visible.
Worry and chronic pain patients: A description and analysis of individual differences
Authors: Eccleston Chris , Crombez Geert , Aldrich Sarah , Stannard Cathy
Published: September 2002

Patients with chronic pain often report negative and aversive rumination about pain and its consequences. Little is known about how and why patients with chronic pain worry. This study provides a description of worrying by chronic pain patients. Eighteen female and 16 male chronic pain patients reported, over a 7‐day period, their experience of pain‐related and non‐pain‐related worry. Results indicated that, in comparison with non‐pain related worry, worry about chronic pain is experienced as more difficult to dismiss, more distracting, more attention grabbing, more intrusive, more distressing and less pleasant. Further analyses suggest that these characteristics of worry about chronic pain do not arise from a general disposition to worry or from a general disposition to anxiety. Worry is, however, related to awareness of somatic sensations. These results are discussed within an attentional model in which worry functions to maintain vigilance to threat.
A comparison of the SF‐36 and Nottingham Health Profile in patients with chronic neuropathic pain
Authors: Meyer‐Rosberg Karin , Burckhardt Carol S , Huizar Karin , Kvarnström Ann , Nordfors Lars‐Olof , Kristofferson Ann
Published: September 2002

The aim of this study was to evaluate and compare the psychometric properties of two generic health‐related quality of life (HRQoL) instruments, the Short Form Health Survey (SF‐36) and the Nottingham Health Profile (NHP) in a group of patients with chronic peripheral neuropathic pain (PNP). The sample consisted of 126 adults (56 men and 70 women) with PNP following a lesion of a peripheral nerve, spinal nerve or nerve root or patients with post‐herpetic neuralgia. The battery of tests included visual analogue scales (VASs) for pain assessment and global rating of health and verbal rating scales of pain and other symptoms, as well as patient descriptors.

The SF‐36 had higher internal consistency reliability coefficients (α=0.79, range 0.70–0.90) than the NHP (α=0.68, range 0.49–0.79). Correlations between comparable dimensions of the two instruments were significant (range from −0.79 for the physical and mental dimensions to −0.29 for the social dimension) indicating a moderate degree of convergent validity. The study population had significantly worse scores on all dimensions of the two instruments when compared with the general population. Subjects with high VAS scores for pain on movement and those with low global health ratings had poorer scores on the both instruments. Overall, the SF‐36 performed somewhat better on psychometric testing than did the NHP. However, the NHP contains dimensions such as sleep and more pain items which might be of particular importance in the PNP population. Since the instruments are short, both could be retained for continued testing in outcome studies of this population.
Long‐term methadone treatment: effect on CD4+ lymphocyte counts and HIV‐1 plasma RNA level in patients with HIV infection
Authors: Quang‐Cantagrel Nathalie Do , Wallace Mark S. , Ashar Neil , Mathews Christopher
Published: September 2002

The objective was to examine the effect of methadone on CD4+ lymphocyte counts and viral load and to expect to document the safety of methadone maintenance in patients with human immune deficiency syndrome. This is a retrospective chart analysis comparing the trends in CD4+ count and viral load in two populations of 21 human immunodeficiency virus (HIV) infected patients, one on methadone maintenance and a methadone non‐using group. Each methadone user was matched with a control methadone non‐user that had a similar CD4+ at the beginning of the study. For the CD4+ count we compared the slope of regression for each couple of patients. In 15 patients we also collected the viral load, which was measured at 4–6 monthly intervals. The mean length of follow‐up was 811 days for the methadone group and 797 days in the control group. There was no statistical difference in the treatment received by the two groups of patients during the study. The slope of regression of CD4+ count showed a significantly steeper decline in the methadone‐using patients compared with the methadone non‐users (r= 0.487;p< 0.05). The evolution of the HIV‐1 RNA levels was the same during the follow‐up of mean 186 months in a few of the patients in each of the two groups. Long‐term methadone use was associated with a significantly faster decrease of CD4+ count in HIV‐1 affected patients compared with methadone non‐users. HIV‐1 RNA data were found in too few patients to enable any conclusions about the development of viral load in the two groups.
Evaluation of a randomized preventive behavioural medicine work site intervention for public health workers at risk for developing chronic pain
Authors: Dahl JoAnne C. , Nilsson Annika
Published: September 2002

Because of the substantial increase of sick listing, reports of work disabilities and early retirement due to the musculoskeletal chronic pain, prevention studies at the work site are greatly needed. The purpose of the present study was to investigate the effects of a cognitive behavioural work site intervention on a group of public health workers judged to be at risk for developing chronic pain. Following baseline measurements, a group of 29 practical nurses with daily pain symptoms working at services for the elderly were randomized into two conditions: an active treatment based on cognitive behaviour therapy and a passive treatment based on traditional symptom alleviation. The two treatment conditions, provided by a registered nurse and a physical therapist, took place 30 min a week each once a week, on an individual basis for 4 weeks at the work site during work time. Results at 4 and 8 weeks and at 6, 12 and 24 month follow‐ups showed improvements for those individuals receiving the active treatment with regard to the reduction of use of pain‐killers, perception of one's self as being sick and the fear‐avoidance response to work‐related activities. A preliminary conclusion was that this short‐term work site programme for the prevention of chronic pain for individuals at risk may be a promising development in the treatment of pain.
Validation of a pain evaluation scale for patients with severe cerebral palsy
Authors: Collignon Patrick , Giusiano Bernard
Published: September 2002

Polyhandicapped children are extremely limited by severe mental retardation, motor deficiency, perception disability and expression troubles. So pain is very difficult to assess in these patients. We have developed a specific scale for rapid evaluation of pain based on the observation of their behaviour. A first questionnaire listing 22 items was elaborated by physicians and nurses on the basis of their clinical experience. The first part of our study was designed to select the most pertinent items in order to define a final scale for simple and reliable everyday use. The second part of our study was designed to demonstrate the construct validity and the psychometric qualities and to determine the threshold of decision of the 10‐item final scale. This tool seems to be sensitive and reliable enough to assess pain in severely cerebrally palsied children and young adults.
Clonidine for treatment of postoperative pain: a dose‐finding study
Authors: Marinangeli Franco , Ciccozzi Alessandra , Donatelli Francesco , Di Pietro Alcide , Iovinelli Giorgio , Rawal Narinder , Paladini Antonella , Varrassi Giustino
Published: September 2002

The aim of this double‐blind randomized study was to evaluate the optimal intravenous dose of Clonidine administrated during the peri‐operative period, after lumbar hemilaminectomy for herniated disk repair. The ‘optimal intravenous dose’ was defined as that providing minimal analgesic request, stable haemodynamic profile and a minimal sedation score during 12 h after extubation. Eighty adult patients, ASA physical status I–II, undergoing lumbar hemilaminectomy for herniated disk (L4‐L5, L5‐S1) were included in the study. All the patients were randomly assigned to one of four study groups (A, B, C, D), 20 patients each. The same standardized general anaesthesia was performed for each group. Thirty minutes before the end of surgery, group A, B and C patients received three different loading doses of intravenous Clonidine (5 μg/kg, 3 μg/kg, 2 μg/kg respectively), followed by the same infusion of intravenous Clonidine (0.3 μg/kg per hour). Group D patients received a bolus dose and a continuous infusion of NaCl 0.9%. In the recovery unit, postoperative pain was treated by a patient‐controlled analgesia device, containing morphine. Pain relief was evaluated by the total morphine requirement during the postoperative period. Systolic blood pressure (SBP), heart rate and sedation were also noted during the first 12 h postoperatively. Intravenous Clonidine decreased morphine requirements in a dose‐dependent manner. Group A, B, C and D patients requested 5 ± 2, 11 ± 3, 19 ± 4 and 29 ± 8 doses of morphine respectively. Clonidine also affected SBP in a dose‐related manner. Group A, B and C patients had an SBP decrease respectively of 26 ± 3%, 7 ± 4% and 2 ± 2% compared with basic values while, at the same time, in group D patients no SBP variation was registered. In conclusion, this study demonstrates that, when sedation and analgesic effect of Clonidine is required, 3 μg/kg bolus dose followed by a continuous infusion of 0.3 μg/kg per hour has to be considered the optimal intravenous dose. The higher dose of intravenous Clonidine (5 μg/kg) produced better analgesia but the degree of hypotension and sedation was more severe and longer lasting; it required ephedrine administration and careful monitoring of the patient. On the other hand, the bolus of intravenous Clonidine 2 μg/kg (group C) was less effective in terms of pain relief but with similar side‐effects to the 3 μg/kg dosage (group B). © 2002 European Federation of Chapters of the International Association for the Study of Pain
Preliminary validation of a German version of pain stages of change questionnaire
Authors: Maurischat Carsten , Härter Martin , Auclair Petra , Kerns Robert D. , Bengel Jürgen
Published: September 2002

This study describes the development of the German questionnaire FF‐STABS (Freiburg Questionnaire‐Stages of Chronic Pain Management), which documents the willingness of chronic pain patients to use cognitive‐behavioural methods for pain management independently. The newly constructed assessment instrument, modified from a similar instrument developed by Kerns and his colleagues, was administered to a heterogeneous sample of 118 chronic pain patients. Item and factor analysis support the identification of four reliable scales: precontemplation, preparation, action and maintenance. All scales evidenced sufficient indices of reliability and discriminant validity. Deviations from the original American version and suggestions for future refinements in the new measure are discussed. © 2002 European Federation of Chapters of the International Association for the Study of Pain
Special aspects of cancer pain management in a Chinese general hospital
Authors: Yu Shiying , Wang Xin Shelley , Cheng Yuan , Yang Jinxiang , Cleeland Charles S.
Published: September 2002

China is still faced with a challenge in cancer pain management. The purposes of this study are to assess the current status of cancer pain management, and physicians' attitudes in China towards cancer pain management. The survey was done in a Chinese general hospital; 427 physicians and 387 cancer pain patients participated. The survey consisted of questionnaires to evaluate cancer pain management and physicians' knowledge of, and attitudes towards, cancer pain management. A total of 43% of patients with cancer pain and 51% with bone pain felt that they had been inadequately treated. The physicians rated the main reason for not using opioid drugs as the strong and difficult to control side‐effects. The four main barriers to optimal management of cancer pain were: inadequate pain assessment; excessive state regulation of the prescribing of opioids; inadequate staff knowledge of pain management; and lack of access to powerful analgesics. To conclude: In China, there are some special aspects of cancer pain management, including physicians' concern about using opioid drugs, fear of being unable to manage adverse effects of opioids, and inadequately treated bone pain.
Evolution of a rational use of opioids in chronic pain
Authors: O'Callaghan James P.
Published: September 2002

Since the isolation of morphine from opium by Serturner in 1806, morphine, which Osler referred to! as ‘God's own medicine’, has remained the analgesic of choice for the treatment of severe pain despite its known addictive potential and the attempts to replace it with synthetic or semi‐synthetic medications. Its early use was based on clinical experience alone until the identification of the opioid receptors and endogenous opioids 25 years ago. Advances in pharmacology and pharmacokinetics and the development of precision equipment to quantify the parent drugs and their metabolites in plasma have provided a better understanding of the mechanisms of action as well as adverse effects. Clinicians can now select the drug and route of administration to suit the patient's needs. The objective of care now is for clinical observation to be reinforced by randomized controlled trials and evidence‐based medicine, but controlled clinical trials are lacking for the use of opioids in chronic pain.
Pain in patients with HIV infection: issues for the new millennium
Authors: Glare Paul A.
Published: September 2002

Pain is a common problem in people infected with the human immunodeficiency virus (HIV), particularly when they develop the acquired immune deficiency syndrome (AIDS). Until recently AIDS was a progressive fatal illness with a short prognosis, so the assessment and treatment of AIDS‐related pain was logically based on the approach taken for the management of cancer pain. The cancer pain paradigm may no longer be appropriate for pain in patients with HIV infection, however, because the natural history of HIV disease has been transformed into a chronic illness by highly active anti‐retroviral therapy (HAART), available since the late 1990s. In resource‐poor countries of the Asia Pacific region where access to HAART is limited, the cancer pain paradigm may still be relevant. In this paper, the clinical characteristics of pain in HIV disease are described, along with current approaches to assessment and treatment. These are compared and contrasted with the characteristics, assessment and treatment of cancer pain. Data are presented which emphasize these similarities and differences, and highlight the need for a multidisciplinary, comprehensive approach to managing pain in HIV disease, now a chronic illness. There is a great need for more research on HIV‐related pain in the HAART era.
The development of national guidelines for pain control: synopsis and commentary
Authors: Carr Daniel B.
Published: September 2002

This synopsis outlines factors that prompted development of national clinical practice guidelines for the management of pain and presents the essential content of major pain control guidelines. Also described is the concurrent growth of the evidence‐based pain management movement worldwide in the decade since initial US federal guidelines on acute and cancer pain were developed, and products of this global movement. The latter include systematic reviews and meta‐analyses about treatments for pain, their assemblage in resources such as the Cochrane Collaboration, and (in the US) the embedding of pain assessment and management within quality assurance requirements for hospital accreditation. This survey will highlight recent research that evidence‐based guidelines alone are insufficient to overcome established attitudes, practices and myths that hinder pain assessment and management. Hypotheses for the inadequacy of scientific evidenceper seto overcome clinicians' attitudes and practices will be advanced, along with suggestions as to how those in the ‘pain treatment community’ may help to tip the balance.
Australian management strategies for oral opioid use in non‐malignant pain
Authors: Goucke C. Roger
Published: September 2002

Chronic non‐cancer pain is a complex biopsychosocial phenomenon; as such it is unlikely that any one treatment modality will achieve relief. There is increasing availability of oral opioid preparations and an associated increased level of prescribing; consequently in 1997 the Australian Pain Society drew up some management strategies for their use. This paper reviews the principles of those strategies, stressing that oral opioids should not be used in isolation nor used to treat ‘distress’ often associated with chronic pain. The place of a trial of opioid and informed consent are discussed.
Usefulness of the evidence‐based medicine‐supported cancer pain management guideline
Authors: Hiraga Kazuaki , Nozaki‐Taguchi Natsuko
Published: September 2002

The Japanese guidelines for the clinical practice of cancer pain management supported by evidence‐based medicine were established by the Japanese Society for Palliative Medicine in 1999 [as their Evidence‐based Medicine‐supported Cancer Pain Management Guideline. To evaluate usefulness of the Guideline for the management of cancer pain, the same questionnaires were addressed to nurses and physicians of enrolled institutions twice. The first survey was conducted before the distribution of the Guideline in July, 1999 and the second was done after the distribution in January, 2000. Usefulness of the Guideline was examined by comparing the results of two surveys. Cancer patients were divided into two groups depending on their stages (conservative or terminal).

Morbidity of pain in cancer patients at each stage having some analgesics did not change at each survey period. (2) At the first survey the rate of pain relief in each stage of cancer patients was essentially unchanged from a previous result obtained in 1998. The rate of pain relief shown in the second survey tended to be higher than that shown in the first in both groups of patients. The rate of pain relief with per os morphine was shown to be significantly higher in the second survey than in the first for each group of patients at conservative or terminal stage. The rate of pain relief of patients staying in the ward where the guidance for dosing of morphine had been carried out was 37.5% at the first survey versus 47.9% at the second. The answers from physicians to questions about treatment of cancer pain remained unchanged between the first and the second survey.

The usefulness of the Guideline for cancer pain management is partly confirmed by these results. The significance of the Guideline will be totally discussed by comparing its effects on nurses, pharmacists and physicians.
Nociceptive behaviour induced by dental application of irritants to rat incisors: A new model for tooth inflammatory pain
Authors: Chidiac José‐Johann , Rifai Khaldoun , Hawwa Nadim N. , Massaad Cynthia A. , Jurjus Abdo R. , Jabbur Suhayl J. , Saadé Nayef E.
Published: September 2002

Animal models simulating acute human pulpitis are still lacking. The rat incisors present a particular situation where most of their innervation is considered to be unmyelinated and concentrated mainly in the tooth pulp. This study reports on a new model for dental pain induced by inflammatory agents applied to the tooth pulps of incisors. In different groups of rats, artificial crowns were fixed on the lower incisors, after cutting 1–2 mm of their distal extremities. A volume of 7–10 μl of solutions of saline, capsaicin (1–10 mg/ml) or formalin (2.5% or 5%) was injected in the crown cavity, and the nociceptive behaviour was quantitated following a devised scoring method of four scales. Intradental application of capsaicin produced nociceptive scores in the form of one plateau for 1–2 h depending on the concentration used. Similar results were obtained with intradental application of formalin 2.5%. The one plateau of nociceptive scores obtained with formalin contrasts with the biphasic aspect of nociceptive behaviour described with the intradermal formalin test. This discrepancy could be attributed to a difference in the types of afferent fibres involved in each situation. Pretreatment with morphine (2 mg/kg) attenuated, in a naloxone‐reversible manner, the nociceptive behaviour observed following intradental application of capsaicin. Pretreatment with meloxicam (a cyclo‐oxygenase‐2 inhibitor) exerted a less pronounced attenuation of the nociceptive scores when compared with morphine. These results provide evidence for the validity of the described model for the simulation of tooth pulp inflammatory pain in awake animals. © 2002 European Federation of Chapters of the International Association for the Study of Pain
Anticonvulsants: aspects of their mechanisms of action
Authors: Söderpalm Bo
Published: September 2002

An ideal anticonvulsant drag would prevent or inhibit excessive pathological neuronal discharge without interfering with physiological neuronal activity and without producing untoward effects. Such an ideal compound is not yet available. However, during the last few years several new anticonvulsants have appeared (e.g. vigabatrine, gabapentin, topiramate, lamotrigine, tiagabine, felbamate and oxcarbazepine) which may challenge the older, more established substances (i.e. phenytoin, benzodiazepines, phenobarbital, valproate, carbamazepine and ethosuximide). Interestingly, several of the old and new anticonvulsants are beneficial in the treatment of various psychiatric conditions (most notably mood disorders) as well as neuropathic pain. The reason these various drags are effective in the treatment of such disparate clinical conditions is unknown. The answer may be that the neuronal dysfunctions underlying these conditions are similar in a mechanistic sense, but are manifested in different neurons/locations of the nervous system, or that the drags possess several mechanisms of action that contribute in different ways to the favourable effect depending on the condition studied. Even though all these drags inhibit excessive neuronal activity, this acute effect appears to be produced by several mechanisms, which fall into three major categories: (1) blockade of voltage‐gated sodium channels; (2) indirect or direct enhancement of inhibitory γ‐aminobutyric acid [GABAergic] neurotransmission; or (3) inhibition of excitatory glutamatergic neurotransmission. Moreover, several of these drags fall into more than one category, and it is often unclear which category is responsible for a given effect of a drag. It is plausible that some of the beneficial effects observed in the clinic can be explained by the secondary neural depressant mechanisms of action of these substances, whereas other benefits may be due to long‐term neuro‐plastic effects, which may either be common or different across the various conditions treated. © 2002 European Federation of Chapters of the International Association for the Study of Pain
Neuropathic pain: evidence matters
Authors: McQuay Henry J.
Published: September 2002

‘He slept less and less; they gave him opium and began to inject morphine. But this did not relieve him. The dull pain he experienced in the half asleep condition at first only relieved him as a change, but then it became as bad, or even more agonizing, than the open pain.’

Tolstoy The Death of Ivan Ilyitch

It comes as a surprise to many pharmacologists that not all pains are relieved by opioids. Those who work in chronic pain are unfortunately only too aware of the problems that such pains can cause. One of the hallmarks of neuropathic pain is poor or incomplete relief with opioids. As with so many things in medicine, there is nothing novel in this realization, as the Tolstoy quotation shows. © 2002 European Federation of Chapters of the International Association for the Study of Pain
Using facial expressions to assess musculoskeletal pain in older persons
Authors: Hadjistavropoulos Thomas , La Chapelle Diane L. , Hadjistavropoulos Heather D. , Green Sheryl , Asmundson Gordon J. G.
Published: September 2002

Past research examined measures of pain among seniors who were experiencing movement‐related exacerbations of musculoskeletal pain and obtained clear support for the utility of the behavioural coding of pain‐related body movements (e.g., bracing, guarding). Support for the utility of the Facial Action Coding System (FACS), which involves the objective coding of facial reactions, was not as strong. The findings concerning FACS could have been an artifact of the methodology that was used. Specifically, the duratio of the facial reactions was not taken into account and the patients suffered from a variety of painful conditions. Thus, the physical activities involved in the study could have been painful for some patients but not for others. The present study corrected these methodological concerns by accounting for the duration of facial reactions and ensuring that all patients suffered from the same painful condition. Participants were 82 post‐surgical (knee replacement) inpatients. Cognitive status was assessed using the Modified Mini Mental Status Examination. Under physiotherapist's supervision, the patients performed structured activities (i.e., reclining, standing, knee bends). Facial reactions were coded using FACS. Facial reactions varied as a function of the degree to which the various activities were strenuous. The results support the utility of FACS in the assessment of musculoskeletal pain among seniors undergoing rehabilitation following knee surgery. © 2002 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Science Ltd. All rights reserved.
Are childhood adversities relevant in patients with chronic low back pain?
Authors: Nickel R. , Egle U. T. , Hardt J.
Published: September 2002

Previous studies have found a high number of childhood adversities in patients with chronic low back pain, particularly in patients reporting persisting problems after back surgery. Our aim was to reproduce these results.

Within the framework of a comprehensive diagnostic assessment and psychometric evaluation, 109 inpatients who had been treated for low back pain were examined in the orthopedics department of a German university hospital. Five risk factors investigated by Schofferman and his staff (Schofferman et al., 1993) were re‐assessed in all of our patients using a structured biographical interview. The German chronic low back pain group was also compared with an age‐and gender‐matched control group of 109 non‐chronic pain patients with respect to these childhood adversities and additional ones.

Only approximately 11% of the German chronic low back pain sample demonstrated three or more risk factors, compared with more than 50% in Schofferman's sample, and 47.7% showed none of the five risk factors, compared to only 11% in the Schofferman sample. Moreover, no significant differences in distribution either in terms of the individual risk factors or their cumulative frequency were found in the German chronic low back pain group compared with an age and gender‐matched control group without chronic pain.

Childhood adversities do not occur frequently in a non‐selected group of patients with chronic low back pain. Earlier results showing an increased likelihood of the occurrence of psychosocial risk factors could not be confirmed. As a consequence, further psychic or psychosomatic diagnostics of patients with chronic low back pain are needed to define diagnostic subgroups. © 2002 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Science Ltd. All rights reserved.
Comparison of QT dispersion during atrial fibrillation and sinus rhythm in the same patients, at normal and prolonged ventricular repolarization
Authors: Houltz B. , Darpö B. , Swedberg K. , Blomström P. , Crijns H.J.G.M. , Jensen S.M. , Svernhage E. , Edvardsson N.
Published: September 2002

Aims

Drug-induced increase in QT dispersion has been associated with increased risk of ventricular proarrhythmia. The aim of the present study was to compare QT dispersion during atrial fibrillation and sinus rhythm in the same patients at normal and prolonged ventricular repolarization.

Methods and Results

Sixty-one patients who had had chronic atrial fibrillation for 8±14 months received a 6 h infusion of the Ikr-blocker almokalant, the first 90 min of which are used for this analysis. The following day, after conversion to sinus rhythm, by almokalant (n=19) or direct current cardioversion (n=42), an identical 90 min infusion was administered. Prior to infusion, there was no difference in precordial QT dispersion between atrial fibrillation and sinus rhythm (29±12 vs 36±17 ms, P=ns). During infusion, at prolonged repolarization, the increase in QT dispersion was greater during sinus rhythm than during atrial fibrillation (58±49 vs 30±15 ms,P =0·0011, after 30 min infusion). No correlation was found between QT dispersion and the QT or RR interval.

Conclusion

QT dispersion during atrial fibrillation does not differ from QT dispersion during sinus rhythm during normal repolarization, while measurement of QT dispersion during prolonged repolarization, induced by an Ikr-blocker, yielded larger values during sinus rhythm than during atrial fibrillation.
How to map and ablate atrial scar macroreentrant tachycardia of the right atrium
Authors: Cosio F. G. , Pastor A. , Núñez A. , Montero M. A.
Published: September 2002

A special form of macroreentrant atrial tachycardia (MRAT), due to reentrant activation around surgical scars, can occur in patients after cardiac surgery. Scar MRAT occurs usually after correction of congenital defects, such as atrial or ventricular septal defects, and especially after Mustard, Senning or Fontan procedures, but it can occur also after myxoma, valvular or coronary bypass surgery.

The simplest form of scar MRAT is reentry around a lateral right atrial surgical scar. A basic mapping array with multiple simultaneous recordings from the anterior and septal right atrium is very useful to make the electrophysiological diagnosis. A line of double electrograms can be mapped in the centre of the circuit and a fragmented electrogram usually marks the pivoting point between the inferior end of the scar and the inferior vena cava (IVC). Extension of the scar toward the closest fixed obstacle, usually the IVC, by means of radiofrequency ablation, can interrupt the tachycardia and make it non-inducible. Typical atrial flutter usually coexists with scar MRAT and flutter isthmus ablation is probably indicated in all cases.

In patients having undergone baffle atrial surgery it can be impossible to map the whole circuit and entrainment-mapping is helpful to localize critical isthmuses in the circuit. After the Fontan operation the right atrium can be severely dilated and scarred, and multiple, complex reentry circuits can be found. Left atrial MRAT based on large areas of scar has been described, but there is still too little experience with these to propose general rules for diagnosis and management.
Fine-Needle Aspirate Cytology Suggesting Hepatic Lipidosis in Four Cats with Infiltrative Hepatic Disease
Authors: Willard M D , Weeks B R , Johnson M
Published: September 2002

Four cats are reported in which cytology smears obtained by ultrasound-guided fine needle aspiration of the liver were interpreted as indicative of hepatic lipidosis. However, histopathology of hepatic tissue samples obtained with Tru-Cut®-like needles or wedge biopsy revealed that the cats had inflammatory or neoplastic hepatic disease causing their clinical signs. Fine needle aspiration and cytology may not detect infiltrative lesions, particularly those that are nodular, multifocal, or localised around the portal regions. Fine needle aspirate cytology is a useful diagnostic procedure with many advantages, but care must be taken to avoid diagnosing hepatic lipidosis as the cause of illness when an infiltrative lesion is responsible.
Peripheral Vestibular Disease Associated with Cryptococcosis in Three Cats
Authors: Beatty J A , Barrs V R , Swinney G R , Martin P A , Malik R
Published: September 2002

Peripheral vestibular disease referable to otitis media/interna was the main reason for presentation in three cats with cryptococcosis. In two cats, Cryptococcus neoformans var neoformans was isolated from the tympanic bulla. In the remaining cat, otitis media/interna was considered to be secondary to occlusion of the auditory tube by a nasopharyngeal granuloma associated with a C neoformans var gattii infection. This report emphasises the importance of maintaining an index of suspicion for a fungal aetiology in cats with signs of otitis media/interna, particularly in countries with a high prevalence of cryptococcosis. The presence of C neoformans may be overlooked with potentially fatal consequences where only standard methods for bacterial isolation are used to examine samples obtained from the middle ear.
Bartonella spp Antibodies and DNA in Aqueous Humour of Cats
Authors: Lappin M R , Kordick D L , Breitschwerdt E B
Published: September 2002

Bartonella spp antibodies were measured in the serum and aqueous humour of cats with and without uveitis and polymerase chain reaction (PCR) for Bartonella spp DNA was performed on aqueous humour from most of the cats. Serum and aqueous humour were assayed from 49 client-owned cats with uveitis, 49 healthy shelter cats, and nine cats experimentally inoculated with either B henselae or B clarridgeiae, 454 days after inoculation. An aqueous antibody coefficient (C value) was calculated for cats positive for Bartonella spp antibodies in the aqueous humour. Ocular production of Bartonella spp IgG (C value >1) was detected in seven of 49 cats with uveitis, none of 49 healthy shelter cats, and four of nine experimentally inoculated cats. The organism was detected by PCR in the aqueous humour of three of 24 cats with uveitis, one of 49 healthy shelter cats, and four of nine experimentally inoculated cats. Bartonella spp infect the eyes of some cats following natural exposure or experimental inoculation and may cause uveitis in some cats.
Calcium Oxalate Stones in Feline Littermates
Authors: Byrne K M , Bynum K , Robinette L , Brownlee L
Published: September 2002

Two feline littermates were diagnosed with calcium oxalate uroliths. Both had been maintained on a commercially available dry diet with reduced magnesium and urine acidifying properties. One female littermate was diagnosed by visualising the stones by radiographs while the second littermate, also female, became blocked when one of the uroliths lodged in the urethra. Two other, unrelated cats in the household, of similar age and raised under the same conditions, did not develop calcium oxalate uroliths.
Feline Non-Ocular Melanoma: A Retrospective Study of 23 Cases (1991–1999)
Authors: Luna L D , Higginbotham M L , Henry C J , Turnquist S E , Moore A S , Graham J C
Published: September 2002

Non-ocular melanoma is considered to be a rare neoplasm in cats; however, more than 150 cases have been reported in the literature since 1961. The objective of this study was to characterise this tumour better by evaluating case outcome and survival data for cats with melanoma and to compare clinical and histopathological findings with those of previous reports. Twenty-three feline non-ocular melanomas were identified, the most common locations being the nose, digit and pinna. Cats with digital melanomas had survival rates similar to their canine counterparts. Histological assignation of benignity, malignancy or junctional activity was not found to be an accurate predictor of clinical behaviour. Melanoma should be considered as a differential diagnosis for cats presenting with pigmented or non-pigmented masses and histopathology is essential for definitive diagnosis, as other tumours may clinically appear quite similar. Regular follow-up examinations are recommended indefinitely for benign or malignant feline melanomas.
A Study of the Efficacy of Topical and Systemic Therapy for the Treatment of Feline Microsporum Canis Infection
Authors: Sparkes A H , Robinson A , MacKay A D , Shau S E
Published: September 2002

Microsporum canis infection was induced in 21 healthy SPF-derived cats. Once infection was established (4 weeks after inoculation) the cats were divided into three equal groups housed in separate rooms and monitored for 16 weeks. During this time, group A cats received oral griseofulvin at approximately 50 mg/kg daily and were shampooed twice weekly with a product containing chlorhexidine and miconazole. Group B cats were treated with griseofulvin alone, and group C cats served as untreated controls. The cats were examined on a weekly basis and the severity of lesions was scored semi-quantitatively. In addition, hair samples were collected from each cat on a weekly basis by the MacKenzie brush technique and by the sticky-tape method. A semi-quantitative scoring system was also used for the assessment of fungal ( M canis) growth. Generally, significant differences in clinical scores were not seen between the groups although at weeks 3, 4 and 11 there was a significant difference ( P≤0.015) with cats in group A having significantly lower median scores than those in group C. Median times to clinical resolution (return of clinical scores to zero) in groups A, B and C were at treatment weeks 2, 9 and 12, respectively ( P>0.05). Median times for mycological resolution (persistently negative culture results) for groups A, B and C were at treatment weeks 2, 9 and 12, respectively, for the MacKenzie brush technique and at weeks 4, 8 and 12 for the sticky-tape technique. For both these results, the groups differed significantly ( P≤0.001) and in both instances group A had significantly more rapid resolution than groups B or C. Median culture scores were significantly different between the three groups using one or both of the sampling techniques at week 2 through to week 12 of treatment with median scores for either group A alone, or groups A and B being significantly lower than group C ( P≤0.026). These results showed a benefit from the addition of twice-weekly chlorhexidine-miconazole shampooing to systemic griseofulvin therapy alone in the treatment of M canis infected cats.
Intervertebral Disc Extrusion in Six Cats
Authors: Knipe MF , Vernau KM , Hornof WJ , LeCouteur RA
Published: September 2002

Existing reports concerning intervertebral disc disease (IVDD) have focused almost exclusively on dogs, although a small number of individual case reports of IVDD of cats has been published. The medical records of six cats with IVDD were reviewed. Radiographic studies confirmed narrowed intervertebral disc spaces, mineralised intervertebral discs, and one or more extradural compressive lesions of the spinal cord in each cat. All disc extrusions were located in the thoracolumbar region. Surgical decompression of the spinal cord was achieved in all cats by means of hemilaminectomy and removal of compressive extradural material confirmed to be degenerative disc material. Good to excellent neurological recovery was noted in five of the six cats included in this report. Based on this review, it appears that IVDD of cats has many similarities to IVDD of dogs, and that healthy cats with acute intervertebral disc extrusion(s) respond favourably to surgical decompression of the spinal cord.
Detection of Feline Leukaemia Virus in Blood and Bone Marrow of Cats with Varying Suspicion of Latent Infection
Authors: Herring ES , Troy GC , Toth TE , Forrester SD , Weigt LA , Herring IP
Published: September 2002

The purpose of this study was to determine if polymerase chain reaction (PCR) could be used to detect FeLV proviral DNA in bone marrow samples of cats with varying suspicion of latent infection. Blood and bone marrow samples from 50 cats and bone marrow from one fetus were collected, including 16 cats with diseases suspected to be FeLV-associated. Serum enzyme-linked immunosorbent assay (ELISA), blood and bone marrow immunofluorescent antibody test (IFA), and blood and bone marrow PCR were performed on each cat, and IFA and PCR on bone marrow of the fetus. Forty-one cats were FeLV negative. Five cats and one fetus were persistently infected with FeLV. Four cats had discordant test results. No cats were positive on bone marrow PCR only. It appears persistent or latent FeLV infection is not always present in conditions classically associated with FeLV.