bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of topical anaesthesia methods for venous cannulation in adults
Authors: Biro P. , Meier T. , Cummins A.S.
Published: February 2004

A prospective, randomized clinical trial was performed in order to assess the efficacy and side‐effects of commonly used topical anaesthesia methods in adults receiving peripheral venous cannulation. The study was double‐blinded to the degree that the methodologies allowed. One hundred and fifty healthy adults undergoing elective surgery were allocated at random to five groups: EMLA® cream, ethyl chloride spray, intracutaneous infiltration with 2% lidocaine, placebo cream and no treatment. Venipuncture was performed with a 18G cannula on the dorsal side of the hand. Puncture pain and pain caused by the topical treatment itself were measured using a visual analogue scale (VAS, range: 0–100 mm). Haemodynamic response, difficulties in performing the puncture and side‐effects were recorded. All analgesic techniques were well tolerated. Haemodynamic response and degree of puncture difficulty showed no differences among the groups. Puncture pain (median mrnVAS) following infiltration (1.0) and EMLA® (10.0) was significantly lower than no treatment (30.0) or placebo (30.0). The benefit of local infiltration was altered by injection pain (11.5). Spray did not significantly lower puncture pain (26.5) and, in addition, was associated with discomfort (10.5). In adults, EMLA® cream significantly reduces puncture pain and represents an acceptable alternate method for topical anaesthesia in venous cannulation. Local lidocaine infiltration is impaired by applicational pain, whereas spraying the puncture site with ethyl chloride has no analgesic benefit.
Methadone in cancer pain
Authors: Mercadante S.
Published: February 2004

Methadone is often considered as a second‐choice drug alternative to morphine in cancer pain treatment. A lack of information regarding methadone's pharmacokinetic/pharmacodynamic relationships has contributed to limitation in its use in analgesic treatments. However, it has been recently re‐evaluated in light of better knowledge of its pharmacological characteristics and wider experience. Concern about the safety of methadone therapy arising because of its long and unpredictable half‐life should not deter clinicians from its appropriate use. Methadone is a very useful drug in cancer pain because of its low cost, lack of known metabolites, high oral bioavailability, rapid onset and time to peak analgesic effect, and the long duration of activity which allows for longer intervals between doses. Moreover, methadone has been demonstrated to have a high receptor reserve and to exert some NMDA receptor antagonist effect. A shift from one opioid to methadone is recommended when the side‐effect/analgesic balance is unfavourable, as symmetrical patterns of cross‐tolerance of opioid agonists have been demonstrated. Different approaches, including the oral PCA, have been proposed to circumvent problems related to its pharmacokinetic properties.
Startle intensification during painful heat
Authors: Crombez G. , Baeyens F. , Vansteenwegen D. , Eelen P.
Published: February 2004

Applying affective‐motivational theories of emotions to pain presupposes that the immediate emotional reaction to pain can be conceptualized as an action disposition or an urge to escape. According to these emotion theories, an aversive emotional state should potentiate low‐level reflexes with a matching affective tone. In line with this view, this study investigated whether the startle reflex, measured as the EMG peak amplitude of the eyeblink to a white noise burst, was intensified during painful heat. Twenty‐four healthy volunteers were exposed twice to four heat stimuli (43, 45, 47 and 49°C; 5 s duration). As predicted, an intensification of the startle reflex to the noise burst was observed during the high‐intensity stimuli (47 and 49°C) in comparison with the low‐intensity stimuli (43 and 45°C). The startle modulation was effective within a limited temporal window. Five seconds after heat offset, the startle intensification had disappeared.
GABA‐receptor control of the amplitude and duration of the neuronal responses to formalin in the rat spinal cord
Authors: Green G.M. , Dickenson A.
Published: February 2004

The GABAergic inhibitory system in the dorsal horn of the spinal cord has been implicated in the modulation of pain, including the control of nociceptive transmission during inflammation. This electrophysiological study examined the effects of the GABAA and GABAB receptor antagonists, bicuculline and CGP35348, on the magnitude and duration of the formalin response. The responses of spinal nociceptive dorsal horn neurones to subcutaneous injection of formalin into the hindpaw in the anaesthetized rat were recorded. Both phases of the formalin response were monitored, and the antagonists were administered either simultaneously with formalin or 50 min after injection of formalin.

Bicuculline (50 μg), the GABAA antagonist, administered simultaneously with formalin significantly increased the magnitude of the overall response, especially the second phase, and also abolished the silent interphase period. In addition, 50 min after injection of formalin, bicuculline increased the duration of the second phase in a dose‐dependent manner. CGP35348 (250 μg), the GABAB antagonist, administered 50 min after injection of formalin also increased the duration of the second phase significantly, but had no effect on the magnitude of the response or the silent interphase when administered simultaneously with formalin.

These results show that GABAA‐ and GABAB‐receptor‐mediated inhibitions are involved in controlling the duration of the second phase of the formalin response, and that GABAA‐receptor‐mediated inhibition also contributes to the manifestation of the silent interphase period and the magnitude of the second phase. Thus, GABA neurones are critical in determining the level and duration of nociceptive information transmitted through the spinal cord during inflammation.
Intrathecal catheterization alone induces neuroimmune activation in the rat
Authors: DeLeo J.A. , Colburn R.W. , Rickman A.J. , Yeager M.P.
Published: February 2004

Intrathecal (i.t.) catheterization in the rat has been used extensively for drug delivery in various experimental paradigms. These indwelling i.t. catheters have been associated with inflammatory processes and tissue reactions external to the spinal cord in numerous clinical and animal studies. The purpose of this study was to determine whether i.t. catheter placement produced glial activation and changes in specific cytokine expression, i.e. neuroimmune activation, within the spinal cord which might cause altered sensory processing. Rats underwent i.t. catheterization or sham surgery and were killed at 3 or 14 days postsurgery (n ≥ 3 per group). Spinal cord segments were taken at the cervical level, tip of the catheter and distal to the catheter (thoracic levels). Immunohistochemistry was used to examine spinal localization of the cytokines, interleukin (IL)‐6, IL‐10 and glial activation (OX‐42 for microglia and anti‐glial fibrillary acidic protein for astrocytes). At 3 and 14 days after i.t. catheterization, there was an elevation in OX‐42 and GFAP expression as compared to control (n=; 3) and sham surgery (n=4) groups. IL‐10‐like immunoreactivity was significantly increased in both the dorsal and ventral horns 14 days after i.t. placement as compared to the sham and normal groups. Conversely, IL‐6‐like immunoreactivity was not significantly different from sham or normal groups. These cytokine findings are discussed in the context of a differential role of specific cytokines in the potential generation of pain states or in the production of analgesia. This study demonstrated that i.t. catheterization induces robust neuroimmune activation that manifests as increases in glial markers and specific cytokine expression. This method should be controlled for, or alternate methods used for, drug delivery in nociceptive animal models that require spinally administered agents.
Busy with pain: Disorganization in subjective time in experimental pain
Authors: Hellström C. , Carlsson S.G.
Published: February 2004

The cold pressor test was used to investigate perception of time and change of mood in subjects experiencing pain. Using a within‐group design, 15 subjects were tested in a pain vs no‐pain condition. Subjects were requested to fill in the mood adjective checklist (MACL) concerning the mood factors of activity, calmness and pleasantness, and were interviewed about their perceptions before and immediately after each condition. The results indicated that subjects in the pain condition estimated retrospective time passage as significantly shorter, indicating a disorganization of temporal orientation (the relative dominance of past, present and future in a person's thought). In addition, results indicated that many of the subjects in the pain condition, although underestimating time, experienced time as long‐lasting. The main finding concerning mood was that the activity level was increased, and calmness and pleasantness were significantly reduced in the pain condition. The main conclusion is that pain per se changes the perception of duration of time intervals and temporal orientation within the same individual.
Lesions of the caudal ventrolateral medulla block the hypertension‐induced inhibition of noxious‐evoked c‐fos expression in the rat spinal cord
Authors: Tavares I. , Almeida A. , Albino‐Teixeira A. , Lima D.
Published: February 2004

The effect of lesioning the lateral portion of the caudal ventrolateral medullary reticular formation (VLMIat) on the noxious‐evoked expression of the c‐fos proto‐oncogene in spinal neurons, was studied in short‐term hypertensive rats. Occlusion of the renal artery for 96 h in unlesioned animals induced a 52% increase in blood pressure (BP) and a 66% decrease in the number of Fos‐immunoreactive (Fos‐IR) spinal cells following noxious cutaneous stimulation, as compared to values in normotensive controls. Lesioning the VLMIat in hypertensive rats by unilateral quinolinic acid (QA) injection (0.3 μl of a 180 nmol/μl solution) 24 h before noxious stimulation, prevented the Fos‐IR cell decrease. In normotensive rats, lesioning the VLMIat produced no changes in c‐fos expression. To investigate the role played by the VLMIat in cardiovascular control, BP and heart rate (HR) were measured during local injections of QA or glutamate (0.5 μl of a 100 nmol/μl solution) to normotensive animals. Injections of QA produced an immediate rise in BP and HR which reached maximal values (18 and 14% increase, respectively) 5 min after the administration onset, then returning gradually to baseline levels. Glutamate injections resulted in an immediate decrease of the same values, which reached 29 and 39%, respectively, 4 min after the beginning of injection, after which they decreased to baseline levels.

These results suggest that VLMIat neurons inhibit nociceptive spinal neurons in response to rises in blood pressure, while exerting negative control of cardiovascular parameters. It is suggested that the VLMIat is involved in the genesis of hypoalgesia during hypertension.
Sensory manifestations in experimental and work‐related chronic neck‐shoulder pain
Authors: Madeleine P. , Lundager B. , Voigt M. , Arendt‐Nielsen L.
Published: February 2004

Little is known about the mechanisms leading to chronic neck‐shoulder musculo‐skeletal disorders. The aim of the present study was to investigate and compare the sensory manifestations of experimental or chronic neck‐shoulder pain under controlled, low load, repetitive work.

Experimental and clinical experiments were carried out. In Experiment 1, experimental muscle pain was induced in healthy subjects by intramuscular injection of hypertonic saline in the trapezius (n=10) and infraspinatus (n=10) muscles. Experiment 2 was performed on 18 workers with (n= 12) and without (n= 6) chronic neck‐shoulder pain. Sensory assessments were performed before and/or after a session of controlled, low load, repetitive work. The pain intensity was assessed by a visual analogue scale. The pain quality and location(s) were monitored together with pressure‐pain thresholds.

Moderate‐to‐strong deep pain intensity was experienced in the experimental and clinical part of the working session (six patients out of 12). The verbal descriptors used to describe the experimental or chronic pain qualities were partially similar, i.e. first of all verbal descriptors from the sensory class. The patterns of local and referred pain characteristics were similar (around the shoulder girdle), but it is difficult to evoke pain in extensive areas with hypertonic saline. Patients exhibited hypersensitivity or tenderness to pressure stimuli in both sides of the upper body, i.e. in the trapezius, supraspinatus, infraspinatus and pectoralis major muscles (p<0.05). This hypersensitivity was only seen at the referred pain site in the healthy volunteers exposed to infraspinatus experimental muscle pain.

In conclusion, the present study demonstrated similar sensory manifestations in the experimental and clinical neck‐shoulder pain experiments. The presented experimental model can most likely be used to investigate the underlying pain mechanisms involved in work‐related chronic musculoskeletal pain.
Oral ibuprofen and diclofenac in post‐operative pain: A quantitative systematic review
Authors: Collins Sally L. , Moore R. Andrew , McQuay Henry J. , Wiffen Philip J.
Published: February 2004

Surveys show consistently that pain is not treated well. Improvement depends on knowing which treatments are the most effective. We used systematic review to compare the relative efficacy of two common analgesics, ibuprofen and diclofenac, in post‐operative pain.

Studies were identified by searching MEDLINE (1966 to Dec 1996), EMBASE (1980 to Jan 1997), the Cochrane Library (Aug 1996), Biological Abstracts (Jan 1985 to Dec 1996) and the Oxford Pain Relief Database (1950 to 1994). We sought randomised, controlled, single‐dose comparisons of oral ibuprofen or diclofenac against placebo. Summed pain relief or pain intensity difference over 4–6 h was extracted and converted into dishotomous information yielding the number of patients with at least 50% pain relief. This was then used to calculate the relative benefit and the number‐needed‐to‐treat for one patient to achieve at least 50% pain relief.

Thirty‐four reports compared ibuprofen and placebo (3591 patients), six compared diclofenac with placebo (840 patients), and there were two direct comparisons of diclofenac 50 mg and ibuprofen 400 mg (130 patients). In post‐operative pain, the numbers‐needed‐to‐treat for ibuprofen 200 mg were 3.3 (95% confidence interval 2.8–4.0) compared with placebo, for ibuprofen 400 mg 2.7 (2.5–3.0), for ibuprofen 600 mg 2.4 (1.9–3.3), for diclofenac 50 mg 2.3 (2.0–2.7) and for diclofenac 100 mg 1.8 (1.5–2.1). Direct comparisons of diclofenac 50 mg with ibuprofen 400 mg showed no significant difference between the two.

Both drugs worked well. Choosing between them is an issue of dose, safety and cost.
Systemic local‐anaesthetic‐type drugs in chronic pain: A systematic review
Authors: Kalso E. , Tramèr M.R. , McQuay H.J. , Moore R.A.
Published: February 2004

Basic research indicates that systemic local‐anaesthetic‐type drugs that block sodium channels are effective in pain due to nerve damage. These drugs were first used as analgesics in the 1950s and they are still commonly used to try to relieve neuropathic pain and incident pain caused by cancer. As they are potentially toxic, these drugs should not be used without proven effectiveness. For these reasons, a systematic review of randomized controlled trials of systemically administered local‐anaesthetic‐type drugs in chronic pain was performed. Main outcomes were pain relief or pain intensity difference and adverse effects. Twenty‐one reports were found, and four publications were excluded. In the remaining 17 studies (450 patients), 10 used intravenous lignocaine, two used intranasal lignocaine, four used oral mexiletine and one used oral tocainide.

The best documented effective dose of intravenous lignocaine was 5 mg/kg, and when infused over 30 min it was well tolerated. Intravenous lignocaine was effective in all four studies in non‐cancer‐related neuropathic pain. In migraine, lignocaine produced an inconsistent effect. Lignocaine was without effect in all three studies in cancer‐related pain.

Oral mexiletine showed some efficacy in all three studies in pain due to peripheral nerve damage, but lacked effect in the only study in central pain. Only minor dose‐related adverse effects were reported in the 85 patients given mexiletine 225–750 mg.

Local‐anaesthetic‐type drugs are effective in pain due to nerve damage, but there is little or no evidence to support their use in cancer‐related pain.
Effects of an opioid antagonist on pain intensity and withdrawal reflexes during induction of hypnotic analgesia in high‐ and low‐hypnotizable volunteers
Authors: Zachariae R. , Andersen O.K. , Bjerring P. , Jørgensen M.M. , Arendt‐Nielsen L.
Published: February 2004

The aim of this investigation was to study the effect of suggestions of hypnotic analgesia on spinal pain transmission and processing. Pain intensity and amplitude of nociceptive withdrawal reflexes to electrical stimuli were measured in 10 high‐ and 10 low‐hypnotizable subjects during two sessions taking place at least 24 h apart under five conditions of. (1) pre‐hypnosis; (2) neutral hypnotic relaxation; (3) suggestions of hypnotic analgesia; (4) suggestions of hypnotic analgesia after injections of either naloxone (1 ml, 1 mg/ml) or saline (1 ml) under double‐blinded conditions; and (5) post‐hypnosis. The conditions of naloxone or saline were allocated at random to either Day 1 or Day 2 in a double‐blinded fashion. Results showed significant reductions of pain intensity during hypnotic analgesia, and a significant reduction in nociceptive reflexes during hypnotic analgesia on Day 1 in the highly hypnotizable group. No differences were found for low‐hypnotizable subjects. The results support previous findings that pain intensity as well as the nociceptive reflex can be modulated by suggestions of hypnotic analgesia. While no effect of naloxone on pain intensity was found during hypnotic analgesia, naloxone significantly reversed the suppressive effect of suggestions of hypnotic analgesia on reflexes in high‐hypnotizable subjects. Subsequent analysis showed that the effect of naloxone was associated with the intensity of the stimulus needed to elicit a reflex, and was unrelated to hypnotic susceptibility when controlling for stimulus intensity. These results suggest that the effect of naloxone was related to the greater stimulus intensities needed to elicit a reflex in the high‐hypnotizable group, rather than to hypnosis or hypnotic susceptibility in itself. It is unclear why greater stimulus intensities were needed in high‐hypnotizable subjects and further studies are needed.
Pain, coping and psychological well‐being in late life
Authors: Lohmann R. , Heuft G. , Schneider G. , Kruse A.
Published: February 2004

In the present article, the relationships between pain, coping, functional capacity and psychological well‐being are examined in a population of older patients (≥ 60 years; n = 202) treated for a variety of somatic complaints in a university‐affiliated hospital. Results indicate that moderate to extreme pain is common in older patients and often occurs in several body regions simultaneously. Extreme pain in one or more body regions is associated with reduced daily functional capacity, lower values for life satisfaction and self‐evaluated competence, and more negative attitudes towards the present and future. Results of a hierarchical cluster analysis reveal interindividual differences in coping approaches among older patients suffering from extreme pain; they also emphasize the importance of cognitive strategies and life‐review coping. Relevance for clinical practice with older pain patients is discussed.
Transdermal fentanyl for pain control in adults with chronic cancer pain
Authors: Kongsgaard U.E. , Poulain P.
Published: February 2004

The transdermal therapeutic system (TTS) for fentanyl is a drug‐delivery system for use in patients with chronic pain who require an opioid analgesic. A multicentre, randomized, double‐blind, placebo‐controlled study was performed to evaluate the efficacy and safety of TTS‐fentanyl as an analgesic for chronic cancer pain. One hundred and thirty‐eight patients entered a 15‐day dose‐titration period, followed by a 9‐day double‐blind period (95 patients) with TTS‐fentanyl or placebo. Fifty‐five patients entered a follow‐up period of indefinite duration. For the majority of patients, TTS‐fentanyl 50–75 μg/h provided effective analgesia. Due to an unexpectedly high placebo response, it was not possible to show fentanyl to be statistically superior to placebo at the 5% significance level. Nine patients treated with fentanyl and 13 treated with placebo were withdrawn from the study during the double‐blind therapy because of insufficient efficacy (not significant), while 66% of fentanyl‐treated patients experienced effective pain control compared with 48% of placebo‐treated patients (p = 0.071). During the course of the double‐blind therapy, the mean dose of rescue morphine increased slightly more in the placebo group than in the fentanyl group. At the end of the double‐blind phase, the investigators rated trial medication as being ‘good'; or ‘excellent'; in 30 patients in the fentanyl group and 23 in the placebo group. TTS‐fentanyl appeared to be well tolerated, with a low incidence of constipation, somnolence and nausea.

Due to an unexpectedly high placebo response it was not possible to demonstrate fentanyl to be statistically superior to placebo. This may reflect the practical difficulties of performing clinical trials in cancer patients with great inter‐individual variability.
Where does it hurt? Describing the body locations of chronic pain
Authors: Davies H.T.O. , Crombie I.K. , Macrae W.A.
Published: February 2004

Chronic pain patients have complex problems. Due to this, much research effort has been expended on the classification of pain patients and the classification of pain problems. A mainstay of most pain classification systems is the use of the physical location of the pain. Yet describing the location of the patient's pain is not straightforward. Many patients have pain at multiple sites and thus simple statements such as ‘patients with low back pain'; have considerable ambiguity. Does the statement refer to patients with pain just in the lower back or those with low back pain who may also have pain elsewhere (e.g. pain down the leg)? If patients do have pain elsewhere, at what other body sites and what are the implications of this?

This paper presents data on the body location of pain for a large sample of 5279 patients seen with chronic pain in Scotland and the north of England. It shows that one‐third of patients have pain in multiple locations, and that using a single body site to classify patients leads to groups with large overlaps. Thus, 38% of patients reported pain in the ‘lower bacK+spine'; and 34% reported pain in the ‘buttock, leg, foot’ — but there was considerable overlap between these groups. Nineteen percent of patients reported pain in both of these body areas, and one‐third of these patients also had pain in at least one further body area. Furthermore, a systematic look at patients with diverse physical pain locations but a single site in common shows large demographic differences.

Common pain groupings help to reduce the confusion; 13 pain site descriptions were able to account for 82% of all patients. The remaining 18% of patients had pain in a combination of body sites which they shared with fewer than 1% of other patients. Thus, pain patients are widely heterogeneous and complex.

Patients report pain in more complex patterns than can easily be captured by a single body‐site code. Further, large demographic differences between patients with different painful sites, even when they have at least one pain site in common, suggests that grouping patients based on a single site descriptor may be inappropriate. These findings have important implications for chronic pain description and classification.
Differential effects of morphine on pain and temperature perception in human volunteers
Authors: Morin Chantal , Duncan Gary H. , Lavigne Gilles , Boily Jean‐Guy , Bushnell M. Catherine
Published: February 2004

Electrophysiological and behavioral evidence suggests that morphine may have a differential effect on nociceptive and thermal pathways. In this study, we explored the perceptual consequences of these differential actions by examining the effect of a low morphine dose (0.08 mg/kg) on pain and temperature sensations arising from cutaneous thermal stimuli. In a double‐blind placebo‐controled study, we compared the perceived temperature intensity and perceived pain intensity and unpleasantness of noxious and innocuous heat and cold applied to the face of human subjects, with and without low doses of systemic morphine. The results showed that morphine modified pain‐related sensations. In contrast, perceived thermal intensity of both noxious and innocuous heat or cold stimuli was unchanged by low‐dose morphine administration. These findings suggest that low doses of morphine have a differential effect on pain and temperature sensations arising from the same stimulus, and thus that these sensations could be subserved by different neuronal populations.
Patient‐controlled extradural analgesia after caesarean section: a comparison between tramadol, sufentanil and a mixture of both
Authors: Vercauteren M.P. , Mertens E. , Schols G. , Van Mol I. , Adriaensen H.A.
Published: February 2004

In a double‐blind randomised study into post‐operative pain relief by extradural PCA, 66 Caesarean section patients were divided in to three groups to receive either sufentanil (2 μ/ml), tramadol (10 mg/ml) or a mixture of both. After a loading dose of 10 ml, patients were allowed to ask for additional boluses of 2.5 ml, respecting a lock‐out time of 10 min and a 1‐h limit of 10 ml. Every 6 h, VAS pain scores, consumption of drugs, number of demands and side‐effects were registered.

At 6 h, pain was significantly less in the combination group compared to patients receiving tramadol alone. The 24‐h dose requirements for sufentanil and tramadol when used alone were 123.5±10.3 μg and 652±42 mg, respectively. Combining both drugs decreased the consumption and number of demands for tramadol only (22%, p<0.05 vs 18% for sufentanil, NS). In the tramadol groups, more failures and significantly more side‐effects, mainly nausea and vomiting, were noticed.

It may be concluded that the extradural use of tramadol is less beneficial than previously reported. Due to disturbing side‐effects, relatively high dose requirements (even after the addition of a lipophilic opioid) and somewhat inferior analgesic quality, its extradural administration for postoperative pain relief cannot be recommended.
Subjective future as a mediating factor in the relation between pain, pain‐related distress and depression
Authors: Hellström Christina , Jansson Bengt , Carlsson Sven G.
Published: February 2004

The coincidence of chronic pain, psychological distress and depression has been well documented in several studies. However, there is still debate about the type of causality linking these factors and whether psychological distress and depression precede or are a consequence of pain. This study contributes to this debate through an analysis of the latent structure behind these complex concepts. To test the hypothesis that subjective future (i.e. how the pain patient perceives the future) has an impact on pain, data were analysed from 660 chronic pain patients who were tested with The Multidimensional Pain Inventory (MPI), The Symptom Distress Checklist (SCL‐90) and a Future Scale, which was constructed from items of the Sense of coherence‐scale. By use of path analysis and structural equation modeling (S.E.M.) four latent constructs were tested: Pain, Interference, Distress and Subjective future. The results indicated that Subjective future has a strong impact on Distress, is a mediating variable, which contributes to conceptually explaining and practically nullifying the relationship between Pain and Distress, and finally that Pain is a concept, that changes with increasing duration.
Connective tissue massage in the treatment of fibromyalgia
Authors: Brattberg Gunilla
Published: February 2004

The aim of this study was to investigate the effect of connective tissue massage in the treatment of individuals with fibromyalgia. The results of this random study of 48 individuals diagnosed with fibromyalgia (23 in the treatment group and 25 in the reference group) show that a series of 15 treatments with connective tissue massage conveys a pain relieving effect of 37%, reduces depression and the use of analgesics, and positively effects quality of life. The treatment effects appeared gradually during the 10‐week treatment period. Three months after the treatment period about 30% of the pain relieving effect was gone, and 6 months after the treatment period pain was back to about 90% of the basic value. As long as there is a lack of effective medical treatment for individuals with fibromyalgia, they ought to be offered treatments with connective tissue massage. However, further studies are needed in the mechanisms behind the treatment effects.
A psychometric evaluation of the Swedish version of the Multidimensional Pain Inventory (MPI‐S): a gender differentiated evaluation
Authors: Bergström K. Gunnar , Jensen Irene B. , Linton Steven J. , Nygren Åke L.
Published: February 2004

A need to consider possible gender differences in pain research has been recognized by researchers during the last decades. As part of a psychometric evaluation of the Swedish version of the Multidimensional Pain Inventory (MPI‐S), we performed gender‐differentiated analyses of the internal consistency, validity and sensitivity to change of the MPI‐S in a sample of 235 individuals (129 females, 106 males) suffering from long‐term non‐specific pain from the lower back and/or neck region. The construct validation and sensitivity analyses were performed by using validated self‐report measures and direct observational assessment techniques as external constructs. For sections 1 and 2 of the MPI‐S, the results support the internal consistency (alpha coefficients ranged from 0.74 to 0.85 for females and 0.62 to 0.89 for males) and construct validity across gender. The General Activity (GA) scale of section 3 of the MPI‐S displayed acceptable internal consistency across gender (alpha = 0.79 for females, 0.80 for males) but not a satisfactory construct validity. Furthermore, the results yielded some support for the sensitivity to change of the Pain Severity (PS), Interference (1), Life Control (LC) and Affective Distress (AD) scales (from section 1) across gender. Unfortunately, the GA scale did not display a satisfactory sensitivity either for females or males. Altogether, the results showed a similar pattern across gender, although some divergences were detected, such as the substantially weaker negative correlation between perceived supportive behaviour from significant others and punishing responses for males compared to females. In conclusion, we recommend the use of sections 1 and 2 of the MPI‐S as a psychometrically evaluated and comprehensive instrument in the assessment of individuals suffering from chronic non‐specific low back pain or neck pain.
Annual review of research
Authors: Johnstone Richard
Published: February 2004

The present review refers to studies published in 2002 in leading research journals. It focuses in particular on learning, teaching and policy in respect of second, modern foreign or additional languages. The comments offered about particular studies are not intended to summarise them (for that, it is best to refer to the actual abstracts which the present journal publishes). What is on offer is a personal selection made because some aspect of a particular article seemed to be of particular interest or to reflect an important trend, and I have attempted to link such elements together to form a narrative. Compared with previous years, two important themes seemed to gather particular momentum in 2002: first, the role of ‘frequency’ in acquisition; and second, the impact of complex and contradictory global factors on everyday pedagogical practice, thinking and attitudes. As in previous years reference is made to the abstracts. Thus, Tarone (2002: 03-158) refers to an article by Tarone published in 2002 and reflected in the 2003 series of this journal as abstract 158. In previous years I have discussed ICT (information and communications technology) in a separate section of its own but this has now been integrated into other sections, reflecting a process of ‘normalisation’.
A DIFFERENTIAL PATTERN OF AUTOBIOGRAPHICAL MEMORY RETRIEVAL IN SOCIAL PHOBIC AND NONANXIOUS INDIVIDUALS
Authors: Wenzel Amy , Werner Megan M. , Cochran Cassandra K. , Holt Craig S.
Published: February 2004

The present study examined characteristics of autobiographical memories retrieved by individuals with social phobia (n=15) and nonanxious individuals (n=17). Participants were presented with social threat, positive, and neutral cue words and instructed to retrieve the first specific personal memory that came to mind. Memories were coded for retrieval latency, overgenerality (vs. specificity), and affective tone. Nonanxious individuals, rather than social phobic individuals, demonstrated a bias toward the retrieval of specific negative memories when cued by social threat words. Significant omnibus results were attenuated when self-reported depression was included as a covariate in analyses. These results suggest that memories cued by social threat words are particularly salient for nonanxious individuals but not for individuals with social phobia and that depressive symptoms must be accounted for in studies examining cognitive biases toward threat.
COMPARISON OF TWO TREATMENTS FOR CHILDREN WITH SEVERELY DISRUPTIVE BEHAVIOURS: A FOUR-YEAR FOLLOW-UP
Authors: Hutchings Judy , Lane Eleanor , Kelly Joanne
Published: February 2004

A 4-year follow-up compared the long-term effects of two treatments for severely conduct disorder children referred to a Child and Adolescent Mental Health Service (CAMHS). Forty-two families received either the standard CAMHS treatment or a more intensive intervention. The intensive treatment involved a unit-based component for parents to practise new child management strategies. At the 6-month follow-up the intensive treatment group showed significant improvements on all measures of child behaviour and maternal mental health and improvements remained significant at the 4-year follow-up. By contrast, initial improvements for the standard treatment group, which were significant on only two measures, were not significant at the 4-year follow-up. The results suggest that the intensive treatment was advantageous in bringing about long-term improvements for these families. They also add to the growing evidence that interventions involving the rehearsal of child management strategies have better outcomes than those using more didactic methods of parent training.
COMPUTERIZED COGNITIVE BEHAVIOUR THERAPY: A SYSTEMATIC REVIEW
Authors: Kaltenthaler Eva , Parry Glenys , Beverley Catherine
Published: February 2004

Depression, anxiety disorders and phobias are common mental health problems associated with considerable occupational and interpersonal impairment. Although there is substantial evidence to support the use of cognitive behaviour therapy (CBT) in the treatment of these disorders, access is limited. Computerized cognitive behaviour therapy (CCBT) is one of a variety of aids to self-management that offer patients the potential benefits of CBT with less therapist involvement than therapist led CBT (TCBT). In this systematic review of the efficacy of CCBT, 16 studies were identified. Of these 11 were RCTS and the remaining 5 were pilot or cohort studies. The quality of studies ranged from poor to moderate (although the criteria used precluded the highest rating). In the studies comparing CCBT with TCBT, five studies showed CCBT have equivalent outcomes to TCBT. One study of depressed inpatients found TCBT to be significantly more effective than CCBT. Four studies found CCBT to be more effective than treatment as usual (TAU). Two studies found CCBT to be no more effective than TAU. Two studies compared CCBT with bibliotherapy. Of these, one study found CCBT to be as effective as bibliotherapy and one found bibliotherapy to be significantly more effective than CCBT on some outcome measures. Although the results of this review are not conclusive, CCBT is potentially useful in the treatment of anxiety disorders, depression and phobias. From the results of this review, we make three recommendations to improve the quality of research in this field, and suggest four areas requiring further research.
IF THE EVIDENCE IS SO GOOD – WHY DOESN'T ANYONE USE THEM? A NATIONAL SURVEY OF THE USE OF COMPUTERIZED COGNITIVE BEHAVIOUR THERAPY
Authors: Whitfield Graeme , Williams Chris
Published: February 2004

Computerized Self-help (CSH) has recently been the subject of a NICE (National Institute of Clinical Excellence) review. This increase in interest is also reflected in the increase in advertising for CSH programmes. We report a national survey of a random sample of 500 therapists accredited with the British Association for Behavioural and Cognitive Psychotherapies, which is the lead organization for CBT in the UK. A total of 329 therapists responded (65.8%). A surprisingly small number of CBT therapists were using CSH (12 or 2.4%) and only 5 or 1% were using it as an alternative to patient-therapist contact. Despite this, over 90% of the responding therapists had not ruled out using CSH in the future, but the majority of these would use it to supplement rather than as an alternative to individual face-to-face therapy. The need to know more about computerized self-help and the need for training in therapy using this modality were seen as the main factors that would have to change to allow the therapists to use CSH. Knowledge of and ability to use computers did not appear to be an important factor as most therapists in this sample used computers on a regular basis. Most therapists were not aware of evidence of the effectiveness of CSH but the minority who did feel able to express views stated that CSH would be less effective than individual face-to-face therapy and result in less client satisfaction.
COGNITIVE-BEHAVIOUR THERAPY FOR INPATIENTS WITH PSYCHOSIS AND ANGER PROBLEMS WITHIN A LOW SECURE ENVIRONMENT
Authors: Haddock Gillian , Lowens Ian , Brosnan Nicola , Barrowclough Christine , Novaco Raymond W.
Published: February 2004

There is a growing body of evidence that cognitive-behaviour therapy is an effective treatment in chronic psychosis for reducing the severity and distress associated with hallucinations and delusions. However, no work has been published that has applied cognitive-behaviour therapy (CBT) with inpatients within secure environments who may have co-existing problems with psychosis and aggression. This paper describes how CBT for psychosis has been integrated with a CBT approach for treating anger for this group of patients. Three case studies of inpatients on a low secure, high dependency facility are described with whom this approach was used. The paper highlights the unique problems of interventions with these types of clients, and describes how CBT can be applied within these environments.
COMBINED GROUP COGNITIVE-BEHAVIOUR THERAPY AND HYPNOTHERAPY IN THE MANAGEMENT OF THE IRRITABLE BOWEL SYNDROME: THE FEASIBILITY OF CLINICAL PROVISION
Authors: Taylor Elizabeth E. , Read Nicholas W. , Hills Helen M.
Published: February 2004

Conventional medical treatment is often ineffective in the management of Irritable Bowel Syndrome (IBS). Although controlled trials of psychotherapy and hypnotherapy have been shown to be effective, psychological interventions are not widely available. The aim of this study was to assess the feasibility of the clinical provision of combined group cognitive-behaviour therapy (CBT) and hypnotherapy delivered by 13 therapists using a standardized protocol. Attempts were also made to disseminate the programme by patient graduates. A session-by-session instruction manual was compiled and the protocol was tested in a pilot group. Thereafter a total of 158 patients in 23 different groups took part in the 16-session intervention. Attrition rate was very low. Significant improvements in both gastrointestinal and psychosocial symptoms were observed following the intervention. The results suggest that professionally led group psychotherapy and hypnotherapy is a feasible option for the treatment of sufferers of IBS and increased efforts should be made in the training and supervision of user facilitators.
THE USE OF TIME BASE LAG SEQUENTIAL ANALYSIS TO LOOK AT THE RELATIONSHIP BETWEEN ENVIRONMENTAL EVENTS AND CHALLENGING BEHAVIOUR IN PEOPLE WITH LEARNING DISABILITIES
Authors: Whitaker Simon , Walker Tammi , McNally Carolyn
Published: February 2004

Although low frequency challenging behaviour (that which occurs less than once a day) is common, very little research has been done into its analysis or treatment. It is suggested that the methods of analysing high frequency challenging behaviour, such as experimental functional analysis, will not be applicable with low frequency challenging behaviour. The use of correctional analysis of case records is considered as a method for generating hypotheses as to why a client is showing low frequency challenging behaviour. It is noted that using simple correlations is a method that can provide only limited information as to the relationship between a challenging behaviour and other events. A method that can reveal more about the temporal relationship between environmental events and challenging behaviour is time base lag sequential analysis. Three case studies are presented in which time base lag sequential analysis was used to analyse the relationship between challenging behaviour and possible causal factors.
SHORT TERM DURABILITY OF A COGNITIVE BEHAVIOURAL INTERVENTION IN PSYCHOSIS: EFFECTS FROM A PILOT STUDY
Authors: Hall Pauline L. , Tarrier Nicholas
Published: February 2004

Low self-esteem in psychosis is common and has been found to be significantly related to a number of clinical variables and to symptom severity. This report describes the follow-up evaluation of a simple time-limited cognitive behavioural intervention aimed to improve feelings of low self-worth in the treatment of psychotic symptoms. A previous small scale pilot project found encouraging results for the efficacy of the novel intervention following its delivery and at 3-month follow-up. This report examines the benefits of the technique at 12 months following delivery of the intervention. These preliminary results suggest that the intervention may promote improved levels of self-esteem, psychotic symptomatology and social functioning over the longer term. Implications for practice and future research are discussed.
A COGNITIVE BEHAVIOUR THERAPY GROUP FOR PATIENTS WITH CHRONIC FATIGUE SYNDROME: A PRELIMINARY INVESTIGATION
Authors: Wittkowski Anja , Toye Karla , Richards Helen L.
Published: February 2004

A number of studies suggest that individual cognitive-behavioural therapy (CBT) is beneficial to patients suffering from Chronic Fatigue Syndrome (CFS). This study investigated the effectiveness of group CBT in reducing fatigue and distress in five outpatients with a diagnosis of CFS throughout therapy and at 3-month follow-up. The nature of the group, treatment outcomes and benefits of this approach are outlined. Group CBT was acceptable to participants and led to improvements in fatigue as well as cognitive functioning.
MOTIVATIONAL INTERVIEWING WITH INJURED ADOLESCENTS IN THE EMERGENCY DEPARTMENT: IN-SESSION PREDICTORS OF CHANGE
Authors: Dunn Chris , Droesch RoseAnne M. , Johnston Brian D. , Rivara Frederick P.
Published: February 2004

This paper reports the process outcomes of a randomized trial of a one-session Motivational Interviewing (MI) intervention conducted with youth (12–20 years) in a hospital emergency department (ED) while undergoing medical care for an injury. The interventions targeted six behaviors placing youths at high risk for injury. Those youth whose counselors perceived their readiness to increase between the start and end of the MI session were 4.5 times more likely to have improved their use of seat belts 6 months later compared with youth who were not perceived to have increased in readiness during the session.
Pearson syndrome and the role of deletion dimers and duplications in the mtDNA
Authors: Jacobs L. J. A. M. , Jongbloed R. J. E. , Wijburg F. A. , de Klerk J. B. C. , Geraedts J. P. M. , Nijland J. G. , Scholte H. R. , de Coo I. F. M. , Smeets H. J. M.
Published: February 2004

Summary: Pearson syndrome is an often fatal multisystem disease associated with mitochondrial DNA rearrangements. Here we report a patient with a novel mtDNA deletion of 3.4 kb ranging from nucleotides 6097 to 9541 in combination with deletion dimers. The mutation percentage in different tissues (blood, muscle and liver) varied between 64% and 95%. After a remission period of about a year, the patient suddenly died at the age of 3 years owing to a severe lactic acidosis. A second patient with a previously reported deletion of 8 kb and a milder phenotype was found to have mitochondrial duplications and died at the age of 10 years. From these data and data from previous reports, we hypothesize that duplications might be beneficial in the clinical course of the disease and in life expectancy.
Homozygous acute intermittent porphyria in a 7‐year‐old boy with massive excretions of porphyrins and porphyrin precursors
Authors: Hessels J. , Voortman G. , van der Wagen A. , van der Elzen C. , Scheffer H. , Zuijderhoudt F. M. J.
Published: February 2004

Summary: A 7‐year‐old boy demonstrating hepatosplenomegaly, mild anaemia, mild mental retardation, yellow‐brown teeth and dark red urine had excessively elevated levels of urinary δ‐aminolevulinic acid, porphobilinogen and uroporphyrin. Furthermore hepta‐, hexa‐, penta‐ and copro(I)porphyrins were highly increased in urine. This pattern of porphyrin precursor and metabolite excretion is characteristic of acute intermittent porphyria. The decreased copro(III)/copro(I+III) ratio, normally not found in acute intermittent porphyria, is discussed. The porphobilinogen deaminase activity in red cells was decreased to 2–4%. Mutation analysis revealed a novel homozygous L81P mutation in exon 6 of the porphobilinogen deaminase gene. The father and mother, shown to be gene carriers of the same mutation, are asymptomatic and have normal urinary porphyrin precursor and metabolite excretion.
Reversion of hypertrophic cardiomyopathy in a patient with deficiency of the mitochondrial copper binding protein Sco2: Is there a potential effect of copper?
Authors: Freisinger P. , Horvath R. , Macmillan C. , Peters J. , Jaksch M.
Published: February 2004

Summary:Mutations in Sco2, a protein involved in copper trafficking to the terminal enzyme of the respiratory chain, cytochromecoxidase, results in infantile hypertrophic cardioencephalomyopathy. We have recently shown that copper‐histidine (Cu‐his) supplementation of Sco2‐deficient myoblasts rescues COX activityin vitro. Here, we report a patient withSCO2 mutations and with resolution of severe hypertrophic cardiomyopathy. Weighing up the evidence, the most likely explanation for the improved cardiac function in this patient was the subcutaneous application of Cu‐his.