bluuebunny/crossref_metadata_2025 huggingface dataset:
The spatial organization of central sensitization of hind limb flexor reflexes in the decerebrated, spinalized rabbit
Authors: Clarke R.W. , Harris J.
Published: September 2002

This study was designed to investigate the relationship between the location of a noxious stimulus and the magnitude and duration of the plastic effects induced by that stimulus in withdrawal reflexes acting about the knee and the ankle, in rabbits. Reflexes were evoked in the nerves to the anterior tibial and semitendinosus flexor muscles by electrical stimulation at the toes. Repetitive, high intensity electrical stimulation of nerve trunks (sural, medial gastrocnemius, superficial peroneal, tibial, 100 pulses, 20 V, 1 ms at 0.5 Hz) was generally found to be a poor method for inducing central sensitization in these flexor reflexes. ‘Natural'; noxious stimulation induced more reliable enhancement of both reflexes. Mechanical (clamp) or chemical (mustard oil) stimulation of the heel induced prolonged (median duration >30 min) increases in reflexes to both muscles. Mechanical (clamp and superficial pinch) or chemical (mustard oil) stimulation of the toes, and injection of bradykinin into the gastrocnemius muscles or into the soft tissues of the sole of the foot, also led to enhancement of both reflexes, with the median duration of potentiation between 7 and 30 min. The effects obtained from deep tissue stimulation were generally weaker than those obtained after stimulation of superficial structures. These data show that there were no major differences in the effects obtained from the heel vs the toes, or between the two reflexes. It appears that the spatial organization of the spinal mechanisms underlying central sensitization of flexor withdrawal reflexes is rather more crudely drawn than that pertaining to the reflexes themselves. Furthermore, the data indicate that in the present preparation, afferents from deep tissues are no more effective in generating central sensitization than those from superficial structures.
Cross‐validation of the SCL‐27: a short psychometric screening instrument for chronic pain patients
Authors: Hardt J. , Gerbershagen H.U.
Published: September 2002

We constructed a short multidimensional screening instrument for chronic pain patients based on the items contained in the Symptom Check List‐90‐Revised (SCL‐90‐R). The proposed dimensional structure of the SCL‐90‐R was recently shown to be irreproducible in chronic pain patients. As a consequence, the use of the Global Severity Index (GSI) was recommended, although it did not capture all information contained in the many items of the SCL‐90‐R. Based on an exploratory factor analysis, a six‐dimensional structure using 27 items from the SCL‐90‐R was explored utilizing the data of 2780 chronic pain patients. A short form was prospectively tested on 581 patients in the same setting. Criteria for item selection were high convergent and low discriminant correlations. The assessment of the dimensions was kept short, but a minimum of four items were retained. A questionnaire yielding the dimensions (I) depressive symptoms, (II) dysthymic symptoms, (III) vegetative symptoms, (IV) agoraphobic symptoms, (V) symptoms of social phobia, and (VI) symptoms of mistrust was obtained. Additionally, the GSI of the SCL‐90‐R could be estimated precisely (r =0.96). The SCL‐27 can be used for screening psychopathology in chronic pain patients. The scoring algorithm of the SCL‐27 can be used for the 90‐item form as well.
Pregabalin in patients with postoperative dental pain
Authors: Hill C.M. , Balkenohl M. , Thomas D.W. , Walker R. , Mathé H. , Murray G.
Published: September 2002

Pregabalin is an analogue of the inhibitory neurotransmitter gamma‐aminobutyric acid. In preclinical models, it has shown activity as an analgesic agent. A randomized, double‐blind, placebo‐controlled, parallel‐group trial was undertaken to compare pregabalin to placebo and 400 mg of ibuprofen using a dental pain model. Study medication was administered postoperatively to patients who had undergone elective surgery to remove one or two third molars, at least one of which was mandibular and fully or partially impacted in bone. The study was conducted in the UK at a single centre and evaluated pregabalin at doses of 50 and 300 mg. Primary efficacy parameters included pain relief (PR), pain intensity difference (PID), pain relief intensity difference (PRID), time to onset of analgesia, and duration of analgesia. The patient';s global impression of the study medication was used as a secondary efficacy parameter. Efficacy data were evaluated for the intent‐to‐treat (ITT) population, defined as all randomized patients who took study medication. Results showed that there were statistically significant differences in PR, PID, and PRID between the 300‐mg pregabalin group and placebo. In addition, the 300‐mg pregabalin group had a significantly longer duration of analgesia than the ibuprofen group and had the highest score on the patient global impression of study medication. Adverse events were reported more frequently in the pregabalin 300‐mg group.

Pregabalin appears to have significant analgesic properties in the third molar extraction model. Further research is needed to confirm these findings.
Sensory changes during the ovulatory phase of the menstrual cycle in healthy women
Authors: Bajaj Priti , Arendt‐Nielsen Lars , Bajaj Prem , Madsen Hans
Published: September 2002

This study compared the pain sensitivity in healthy women at the abdomen and lower back (presumed referral areas of menstrual pain), thigh and arm (control areas), in the menstrual, ovulatory, luteal and premenstrual phases of confirmed ovulatory cycles, with that of males. The pressure pain threshold (PPT) and pinch pain threshold (PiPT) was determined by an electronic pressure algometer, heat pain threshold (HPT) by a contact thermode and tactile threshold (TT) with von Frey hairs. The abdominal PPT was significantly lower in females in all menstrual phases as compared to the control sites ( p<0.0007). The abdominal and lower back HPT was significantly lower in females in all menstrual phases compared with control areas, and to the sites in males ( p<0.002). The TT was significantly reduced in females compared with males ( p< 0.013). There was no difference in the PiPT between females and males. In males, the HPT, PPT and TT were not different within any site. During the ovulatory phase, the HPT was significantly reduced at the abdomen and the PPT at the back compared with the menstrual, luteal and premenstrual phases (p<0.0002). There were no within‐menstrual phase variations in the PiPT and TT at any site, or for the HPT and PPT at the control areas. The reduced thresholds in menstruating women may be due to the presence of latent uterine algogenic stimuli, and the increased levels of oestrogen and leuteinizing hormone at ovulation may enhance nociception by acting both at the peripheral and central level, resulting in the hypersensitivity changes at the abdomen and lower back areas. Copyright 2001 European Federation of Chapters of the International Association for the Study of PainCopyright 2001 European Federation of Chapters of the International As̋Ér the Study of Pain
Improving the quality of pain treatment by a tailored pain education programme for cancer patients in chronic pain
Authors: de Wit Rianne , van Dam Frits , Loonstra Simone , Zandbelt Linda , van Buuren Anneke , van der Heijden Karin , Leenhouts Gerleen , Duivenvoorden Hugo , Abu‐Saad Huda Huijer
Published: September 2002

Educational interventions, aiming to increase patients' knowledge and attitude regarding pain, can affect pain treatment. The purpose of this study was to evaluate the effects of a Pain Education Programme (PEP), on adequacy of pain treatment, and to describe characteristics predicting change in adequacy. The PEP consists of a multi‐method approach in which patients are educated about the basic principles regarding pain, instructed how to report pain in a pain diary, how to communicate about pain, and how to contact healthcare providers. The effects of the PEP were evaluated taking into consideration the lack of well‐established outcome measures to evaluate adequacy of pain treatment, the lack of long‐term follow‐up, and the influence of missing data.

A prospective, randomized study was utilized in which 313 chronic cancer patients were followed‐up until 8 weeks postdischarge. Adequacy of pain treatment was evaluated by means of the Amsterdam Pain Management Index (APMI), consisting of an integrated score of patients' Present Pain Intensity, Average Pain Intensity, and Worst Pain Intensity, corrected for patients' Tolerable Present Pain, with the analgesics used by the patient.

At pretest, 60% of the patients in the hospital were treated inadequately for their pain. Postdischarge, the control group patients were significantly more inadequately treated at 2 weeks after discharge (56%vs 41%), at 4 weeks after discharge (62%vs 42%) and at 8 weeks after discharge (57%vs 51%) than the intervention group patients. While the level of inadequacy in the control groups remained relatively stable at all assessment points, a slight increase in the percentage of patients being treated inadequately was found in the intervention group patients over time. A beneficial effect of the PEP was found for patients both with and without district nursing. Variables predicting an improvement in adequacy of pain treatment consisted of the PEP, the APMI score at baseline, patients' level of physical functioning, patients' level of social functioning, the extent of adherence to pain medication, patients' pain knowledge, and the amount of analgesics used.

These findings suggest that quality of pain treatment in cancer patients with chronic pain can be enhanced by educating patients about pain and improving active participation in their own pain treatment. The benefit from the PEP, however, decreases slightly over time, pointing at a need for ongoing education.
Opioids in non‐cancer pain: a life‐time sentence?
Authors: Dellemijn Paul L.I.
Published: September 2002

There is continuing reluctance to prescribe strong opioids for the management of chronic non‐cancer pain due to concerns about side‐effects, physical tolerance, withdrawal and addiction. Randomized controlled trials have now provided evidence for the efficacy of opioids against both nociceptive and neuropathic pain. However, there is considerable variability in response rates, possibly depending on the type of pain, the type of opioid and its route of administration, the time to follow‐up, compliance and the development of tolerance.

Five patients were selected with nociceptive or neuropathic pain in whom other pharmacological or physical therapies had failed to provide satisfactory pain relief. They received transdermal fentanyl (starting dose 25 μg/h) for at least 6 weeks. Transdermal fentanyl dosage was titrated upwards as required. Transdermal fentanyl provided adequate pain relief in patients with nociceptive pain (diabetic ulcer, osteoporotic vertebral fracture, ankylosing spondylitis) or neuropathic pain with a nociceptive component (radicular pain due to disc protrusion, herpetic neuralgia). The duration of treatment ranged from 6 weeks to 6 months for four cases. In the case of ankylosing spondylitis, treatment was carried out for 2 years, stopped and then restarted successfully. There were no withdrawal effects or addictive behaviour on treatment cessation, regardless of duration of the treatment. In conclusion, strong opioids may provide prolonged effective pain relief in selected patients with nociceptive and neuropathic non‐cancer pain. Transdermal fentanyl treatment can often be temporary and can easily be stopped following adequate pain relief without withdrawal effects or any evidence of addictive behaviour.
Factorial validity of the short‐form McGill pain questionnaire (SF‐MPQ)
Authors: Wright Kristi D. , Asmundson Gordon J.G. , McCreary Donald R.
Published: September 2002

Although widely used, there have been few investigations of the factorial validity of the short‐form McGill Pain Questionnaire (SF‐MPQ; Melzack, 1987). Confirmatory factor analysis was performed on item responses to the SF‐MPQ obtained from 188 patients with chronic back pain. Consistent with the original structure proposed by Melzack (1987), results indicated that the SF‐MPQ is best represented by a two‐factor solution. However, these findings are contrary to results obtained by Burckhardt and Bjelle (1994) who, using their Swedish version of the SF‐MPQ, obtained a three‐factor solution. Potential explanations for the disparity between the results of the two studies are explored and recommendations for continuing clinical and research applications are offered.
The assessment of radiating low back pain by thermal sensory testing
Authors: Mosek Amnon , Yarnitsky David , Korczyn Amos D. , Niv David
Published: September 2002

Low back pain radiating into the legs is a common pain syndrome. However, neurological examination, imaging and electromyographic studies are of limited value for prognosis or therapy. The origin of the pain remains unknown. The aim was to evaluate the potential of thermal sensory testing to serve as a diagnostic tool in 24 patients who had low back pain radiating down the S1 dermatome, compared with 26 pain‐free controls. The method of limits was used to detect the thresholds of warm sensation, cold sensation, warm pain and cold pain at the L4, L5 and S1 dermatomes of the symptomatic and the non‐symptomatic legs. Thresholds on the asymptomatic leg were similar to values obtained in controls. We found a significantly higher threshold for cold sensation in the S1 dermatome of the symptomatic leg of the patients compared with the controls (p< 0.005). In addition, patients who had abnormal neurological examination (50%) had higher thresholds for cold sensation or cold pain in the three dermatomes tested at the symptomatic leg compared with the non‐symptomatic leg. No differences in the thresholds of warm sensation or warm pain were detected. We propose that these findings indicate selective damage to the Aδ fibres which are involved in transmission of cold sensation and pain, presumably by root compression. We found no evidence of involvement of C fibres, which transmit warm sensation and pain. Thermal testing should be considered among the testing modalities that are capable of demonstrating objective findings in patients with radiating low back pain.
Outcome of intrathecal opioids in chronic non‐cancer pain
Authors: Roberts Lindy J. , Finch Phillip M. , Goucke C. Roger , Price Leanne M.
Published: September 2002

Eighty‐eight patients (58 women and 30 men; mean age 53.4 years) with chronic non‐cancer pain present on average for 9.8 years were evaluated following treatment with intrathecal opioids for an average duration of 36.2 months. Outcome measures were global pain relief, physical activity levels, medication consumption, work status, intrathecal opioid side‐effects, proportion of patients who ceased therapy and patient satisfaction. The most common diagnosis in this group was lumbar spinal or radicular pain after failed spinal surgery (n= 55, 63%). At the time of follow‐up, mean pain relief was 60% with 74% of patients (36 of 49) reporting increased activity levels. Oral medication intake was significantly reduced (Medication Quantification Scale Score prior to implantation 31.0±2.6 and at follow‐up 12.7±1.4;n= 48;p< 0.0001). These gains were not accompanied by a change in work status (43 of 50 working age patients not working at follow‐up). There were frequent reports of opioid side‐effects, including sexual dysfunction and menstrual disturbance. Technical complications occurred with the drug administration device, most often catheter related, requiring at least one further surgical procedure in 32 patients (40%). Patient satisfaction with intrathecal opioids was high, with 45 of 51 (88%) reporting satisfaction. Mean intrathecal morphine dose increased from 9.95±1.49 mg/day (mean±SEM) at 6 months to 15.26±2.52 mg/day 36 months after initiation of therapy. Drug administration systems were permanently removed in five patients (6%). Intrathecal opioid therapy appears to have a place in the management of chronic non‐cancer pain. Therapy does not seem to be significantly inhibited by the development of tolerance.
Contributions of pain‐related adjustment and perceptions of control to coping strategy use among cervical sprain patients
Authors: LaChapelle Diane L. , Hadjistavropoulos Heather D. , McCreary Donald R. , Asmundson Gordon J.G.
Published: September 2002

Coping is a cyclical process in which an individual evaluates stressful events, chooses and implements coping strategies, re‐evaluates the outcome of the coping effort and modifies the strategy if necessary. The intent of the present study was to evaluate the extent to which pain‐related adjustment (i.e. pain severity, pain interference, negative affect) and perceptions of control are associated with the implementation of particular coping strategies. Participants were 136 patients assessed at an interdisciplinary pain clinic for cervical sprain injuries. As part of a routine assessment, participants completed a questionnaire package regarding background, pain severity, pain interference, negative affect, perceived control and use of particular coping strategies. Results of hierarchical multiple regression analyses revealed that pain interference, after controlling for all other variables, was associated with greater use of less physically demanding strategies (i.e. resting, guarding, asking for assistance, seeking social support and coping self‐statements). Negative affect, on the other hand, after controlling for other variables, was associated with reduced use of task persistence. Finally, perceived control, independent of other variables, was associated with greater use of cognitive and social coping strategies (i.e. asking for assistance, seeking social support and coping self‐statements). The results of the study shed light on the complex relationship between use of particular coping strategies and situational variables of pain‐related adjustment and perceived control. Implications for clinicians who assist patients via implementation or modification of particular coping techniques are discussed.
Differential effectiveness of psychological interventions for reducing osteoarthritis pain: a comparison of Erickson hypnosis and Jacobson relaxation
Authors: Gay Marie‐Claire , Philippot Pierre , Luminet Olivier
Published: September 2002

The present study investigates the effectiveness of Erikson hypnosis and Jacobson relaxation for the reduction of osteoarthritis pain. Participants reporting pain from hip or knee osteoarthritis were randomly assigned to one of the following conditions: (a) hypnosis (i.e. standardized eight‐session hypnosis treatment); (b) relaxation (i.e. standardized eight sessions of Jacobson's relaxation treatment); (c) control (i.e. waiting list). Overall, results show that the two experimental groups had a lower level of subjective pain than the control group and that the level of subjective pain decreased with time. An interaction effect between group treatment and time measurement was also observed in which beneficial effects of treatment appeared more rapidly for the hypnosis group. Results also show that hypnosis and relaxation are effective in reducing the amount of analgesic medication taken by participants. Finally, the present results suggest that individual differences in imagery moderate the effect of the psychological treatment at the 6 month follow‐up but not at previous times of measurement (i.e. after 4 weeks of treatment, after 8 weeks of treatment and at the 3 month follow‐up). The results are interpreted in terms of psychological processes underlying hypnosis, and their implications for the psychological treatment of pain are discussed. © 2002 European Federation of Chapters of the Association for the Study of Pain
Neurolytic blockade of the obturator nerve for intractable spasticity of adductor thigh muscles
Authors: Viel Eric J. , Perennou Dominique , Ripari Jacques , Pélissier Jacques , Eledjam Jean J.
Published: September 2002

Neurolytic blockade is one of the therapeutic possibilities to treat spasticity of various muscles. In patients with spasticity of the adductor thigh muscles, a percutaneous approach to the obturator nerve is often difficult. We describe a new approach to the obturator nerve and we examine its feasibility. The second objective was to assess the efficacy of obturator neurolysis for the management of adductor thigh muscle pain and spasticity associated with hemiplegia or paraplegia. Nerve blocks were performed via a combined approach using fluoroscopy and nerve stimulation to identify the obturator nerve. Neurolysis was performed by injection of 65% ethanol. We performed 27 blocks in 23 patients. Technical evaluation was achieved in terms of number of attempted needle insertions, time to accurate location of the nerve and success rate. The efficacy of the block was assessed using four scores: degree of alleviation of muscle spasm and triple flexion of the lower limb, improvement of gait and facilitation of hygienic care. Success rate of the technique was 100% with a time to accurate nerve location of 130 ± 35 s. Compared with scores measured immediately before the block, all studied parameters were significantly improved. Efficiency was significant on adductor muscle spasticity (p < 0.001 at 1 day and p < 0.01 at 60 and 120 months). Triple flexion was also significantly improved (p < 0.05 from 1 to 120 days), as well as gait (p < 0.02) and hygiene (p < 0.01) scores. No complications occurred. The combined approach of the obturator nerve represents a new technique which proved to be accurate, fast, simple, highly successful and reproducible. Obturator neurolysis was confirmed as an efficient and cost‐effective technique to reduce adductor muscle spasm and related pain and to improve gait and hygienic care in patients with neurological sequelae of stroke, head trauma or any lesion of the motor neurone. © 2002 European Federation of Chapters of the International Association for the Study of Pain.
Approaching cancer pain relief
Authors: Lickiss J. Norelle
Published: September 2002

Pain is defined as an unpleasant experience—it is subjective and achieving pain relief is achieving a change in the patient's experience. There needs to be an adequate concept of a human person (an ecological model will be discussed) and a logical process for approaching pain relief in an individual patient (e.g. the plan used in the Sydney Institute of Palliative Medicine).

Communication with the patient is critical to get a grasp of him or her as a person, their environment, personal experience and cultural background. Then encourage him or her to tell the story of the cancer saga as they perceive it, listening carefully for the matters which may have given rise to acute distress (for example, delay in diagnosis) and how they adjusted to this. The individual is conveying a great deal about him or herself as they tell their story. Next the story of the treatment and their experience of it, and then the response of their tumour to it—then the story of their pain: when it began, its characteristics, how it evolved, what factors worsen the pain, what relieves it, etc.

This is followed by careful clinical examination to clarify what could be the most likely mechanism(s) responsible for the noxious stimulus. Some investigation (e.g. X‐ray) may be justified to assist clarification—but not before making a clinical diagnosis (best guess) and commencing treatment with drugs or other logical measures with some local action—depending on the most probable mechanism. Paracetamol/non‐steroidal anti‐inflammatory drugs (NSAIDs) etc may be logical.

Threshold factors should be attended to—comfort, concern always, or anxiolytic or antidepressant drugs if the patient is pathologically anxious or depressed.

The opioid drugs—with morphine still as the gold standard—should be appropriately used. This involves careful calibration of dose (below sedative level) normally with an immediate‐release, preparation—and, in the case of morphine, specific counselling concerning ‘myths’ to ventilate fears of dying, fears of addiction, fear of tolerance etc. It is irresponsible to use an opioid without assessing the prior state of the bowel (? loaded) or without prescribing a laxative.

When neuropathic pain does not respond to a correctly calibrated opioid, it may be necessary to add certain antidepressants, anticonvulsants, gabapentin, steroid etc.

A system must be set in place for evaluation of pain relief: relief is usually possible.
Cancer pain management in children
Authors: Collins John J.
Published: September 2002

The World Health Organization document Cancer Pain Relief and Palliative Care in Children (WHO, 1998) advocates the global application of the principles of pain management and palliative care for children with cancer. The principles of pain management include the application of the WHO analgesic ladder, appropriate opioid dose escalation, the use of adjuvant analgesics, and the use of non‐pharmacological methods of pain control. These principles of pain management should be incorporated into the treatment protocols of all children with cancer, acknowledging that treatment options may be limited for some children.
The development of use of oral morphine within the last 10 years in Japan
Authors: Takeda Fumikazu
Published: September 2002

Japan's national cancer relief programme was initiated with a field‐test of the WHO guidelines for cancer pain management in 1982. It revealed in an excellent result that 87% of 156 cancer patients could be completely relieved of their persistent pain, but this result were ignored by most Japanese health professionals, because of their lack of interest in cancer pain relief. The WHO guidelines were published in 1986 and made quite an impact on those health professionals in Japan. In 1987, a special research team appointed by the Ministry of Health and Welfare of Japan (MOHW) initiated discussion on the philosophy of palliative care in Japan. According to the recommendations made by this research team, the MOHW established a new policy on palliative care, edited manuals on palliative care for terminally ill cancer patients which included guidelines on cancer pain management, and revised narcotics control measures by 1992 in order to much improve the accessibility of opioid analgesics to cancer patients who need them for effective pain relief. The annual consumption of morphine for medical purposes was only 65 kg in 1986 in Japan, but it rose to 973 kg in 1999. Currently, morphine is mostly given by mouth and two‐thirds of morphine preparations consumed are MS Contin Tablets. However, the current morphine consumption per capita in Japan is still less than one‐sixth of the consumption in the United States.

In order to achieve further improvement, educational effort should be much emphasized. In the 1990s, approximately 70% of medical and nursing schools in Japan have initiated their educational curriculum for cancer pain relief and palliative care. There have been government‐sponsored, medical, nursing and pharmaceutical societies‐sponsored seminar courses on appropriate morphine use in cancer pain management, palliative care and opioid availability, all of which have increasingly strengthened postgraduate education.
Opioid use in chronic pain management in the Philippines
Authors: Javier Francis O. , Magpantay Lyde A. , Espinosa E.L. , Harder S.M. , Unite M.A.
Published: September 2002

The aim of this investigation was to determine current opioid use in the Philippines and the reasons why its use is very low. We surveyed 314 doctors in Metro Manila to determine their specialty, possession of narcotics license, and knowledge of opioid use beyond the terminal stage.

We found that the majority of respondents possess a narcotics licence. All of them see pain patients in their practice. They agree that opioids should not be reserved for the terminally ill; 235 have prescribed opioids for non‐cancer pain. A small minority believes that use of opioids for non‐cancer pain can lead to addiction. Opioids that were most easily recalled were morphine, meperidine and nalbuphine. The survey contradicts the national data for opioid use. With an INCB (International Narcotics Control Board) allocation of 87 kilograms annually, less than 15 kilograms are consumed every year. Fentanyl has a 7 gram usage versus a 100 gram INCB allocation.

We conclude that actual opioid use in the Philippines is minimal. However, the correlation between survey results and actual usage indicates a strong awareness of the usefulness of opioids but hesitancy in opioid prescription.
Opioid formulations: tailoring to the needs in chronic pain
Authors: Reder Robert F.
Published: September 2002

Opioids are one of the standard therapies used in the management of chronic pain. They were first widely adopted for the treatment of chronic pain associated with cancer and are now considered important in the alleviation of non‐cancer and neuropathic pain. Around‐the‐clock (ATC) medication has been found to be an effective approach in treating chronic pain. Guidelines issued by the American Pain Society (1999) note that in most cases the preferred route of administering opioids is oral, because of convenience, flexibility, and relative steadiness of the opioid concentrations in the blood. The advantages of ATC therapy and oral medication are some of the reasons for the development of controlled‐release, oral formulations of opioids (e.g. morphine, oxycodone, hydromorphone, and hydrocodone). The reduced dosing frequency makes the oral medication more convenient for patients, making it easier for them to comply with the dosing regimen. ATC therapeutic coverage and the possible increased compliance afforded by controlled‐release formulations can make opioids even more effective in managing chronic pain.
Advancement of opioid analgesia with controlled‐release oxycodone
Authors: Levy Michael H.
Published: September 2002

Optimal pharmacologic management of pain requires selection of the appropriate analgesic drug, prescription of the appropriate dose, administration of the analgesic by the appropriate route, scheduling of the appropriate dosing interval, prevention of persistent pain and relief of breakthrough pain, aggressive titration of the dose of the analgesic, prevention, anticipation, and management of analgesic side‐effects, use of appropriate co‐analgesic drugs, and consideration of sequential trials of opioid analgesics. Controlled‐release oxycodone (CRO) has the characteristics of an ‘ideal’ opioid analgesic drug: short half‐life, long duration of action, predictable pharmacokinetics, absence of clinically active metabolites, rapid onset of action, easy titration, no ceiling dose, minimal adverse effects, and minimal associated stigma. CRO has been shown to be effective in the control of pain caused by cancer, osteoarthritis, post‐herpetic neuralgia, major surgery, and degenerative spine disease.
Treatment of complex regional pain syndrome type I
Authors: Forouzanfar Tymour , Köke Albere J. A. , van Kleef Maarten , Weber Wilhelm E. J.
Published: September 2002

Reflex sympathetic dystrophy (RSD), also known as complex regional pain syndrome type I (CRPS I), is a disabling neuropathic pain syndrome. Controversy exists about the effectiveness of therapeutic interventions for the management of RSD/CRPS I. In order to ascertain appropriate therapies we conducted a review of existing randomized controlled trials of therapies for this disabling disease. Eligible trials were identified from the Cochrane, Pubmed, Embase and MEDLINE databases from 1966 through June 2000, from references in retrieved reports and from references in review articles. Twenty‐six studies concerning treatment modalities were identified. Eighteen studies were randomized placebo‐controlled trials and eight studies were randomized active‐controlled trials. Three independent investigators reviewed articles for inclusion criteria using a 15‐item checklist. Seventeen of the trials were of high quality according to the 15‐item criteria. There was limited evidence for the effectiveness of these interventions because of the heterogeneity of treatment modalities. The search for trials concerning prevention of RSD/CRPS I resulted in two eligible studies. Both were of high quality and dealt with different interventions. There is limited evidence for their preventive effect. © 2002 European Federation of Chapters of the International Association for the Study of Pain
Systemic morphine selectively depresses a thalamic link of widespread nociceptive inputs in the rat
Authors: Monconduit Lénaïc , Bourgeais Laurence , Bernard Jean‐François , Villanueva Luis
Published: September 2002

The lateral part of the ventromedial thalamus (VMl) relays nociceptive inputs from the whole body surface to the dorsolateral frontal cortex. The aim of the present study was to investigate the effects of systemic morphine on nociceptive activity evoked in VMl neurones either by thermal (48 °C) or by supramaximal percutaneous electrical stimuli. The noxious thermal evoked responses were depressed by 10.8 ± 10.1%, 48.3 ± 23.0% and 67.3 ± 10.1%, 5 min after i.v. injections of 1.0, 1.73 and 3.0 mg/kg of morphine, respectively. Moreover, strong depressive effects on the Aδ‐and C‐fibre responses were already present 5 min after the injection. The responses were significantly reduced by 7.2 ± 5.9%, 32.5 ± 11.1% and 37.2 ± 11.8% for Aδ fibres after i.v. injections of 1.0, 1.73 and 3.0 mg/kg of morphine, respectively. The corresponding values for C‐fibre evoked responses were 16.3 ± 16.2%, 57.0 ± 12.0% and 69.0 ± 8.2%. The dose of morphine that reduced VMl neuronal nociceptive responses by 50% (1.73 mg/kg) was around 3.5 times lower than that necessary to inhibit the responses of its spinal or medullary relays under similar experimental conditions. These results, added to the data of the literature, suggest that supraspinal effects of morphine are primarily mediated at the thalamic level. It is tempting to speculate that morphine‐induced reductions of attentional or psychomotor responses related to pain may be mediated by its action on VMl. © 2002 European Federation of Chapters of the International Association for the Study of Pain
Pain behaviour in young immigrants having chronic pain: an exploratory study in primary care
Authors: Löfvander Monica B. , Furhoff Anna‐Karin
Published: September 2002

Pain behaviour can hamper rehabilitation. The aim of this study was to explore the phenomenon of pain behaviour in an unselected group of immigrant patients on >6 weeks of sick leave before and after a transcultural treatment programme in primary care. Anxiety about pain and pain behaviour—i.e. ≥1.5 points on the University of Alabama in Birmingham (UAB) scale with scores of 0–10—were noted before and after treatment. The sex‐adjusted odds ratios (OR) for pain behaviour, before and after the treatment, were calculated using logistic regression with 95% confidence intervals (95% CIs). Forty‐nine men and 102 women having a mean age of 38 years participated. Their mean sick leave was 46 weeks. All reported psychosocial stress, one‐quarter were depressed and social functioning was generally low. The pain was mostly caused by muscular insertion lesions (entesopathies). The frequency of pain behaviour and anxiety about pain declined after treatment (from 68% to 54% and from 76% to 50% respectively). Duration of full‐time sick leave and among men also decreasing social functioning were correlated with the UAB score. Those who reported persistent anxiety about pain, or men who were depressed, had higher scores. Only persons on full‐time sick leave >1 year had a significant OR for pain behaviour before treatment (OR 3.23; 95% CI 1.17‐8.85, adjusted for sex). After treatment, only persons reporting persistent anxiety about pain showed a significant OR for pain behaviour (OR 3.05; 95% CI 1.49‐6.23, adjusted for sex). In conclusion, pain behaviour was common in this group of immigrant patients ≤45 years of age on long‐term sick leave. Anxiety about pain and full‐time sick leave for more than 1 year significantly predicted pain behaviour. © 2002 European Federation of Chapters of the International Association for the Study of Pain
Somatosensory perception in a remote pain‐free area and function of diffuse noxious inhibitory controls (DNIC) in patients suffering from long‐term trapezius myalgia
Authors: Leffler Ann‐Sofie , Hansson Per , Kosek Eva
Published: September 2002

In patients with localized musculoskeletal pain, spread of pain and tenderness outside the primarily painful area and sometimes even generalization of pain have been reported, the latter possibly indicating a dysfunction of endogenous pain modulatory systems. The purpose of the study was to use patients with long‐term trapezius myalgia as a model to investigate the possible influence of a localized muscle pain on somatosensory processing in a remote pain‐free area and the effect of heterotopic noxious conditioning stimulation (HNCS) on ‘diffuse noxious inhibitory controls’ (DNIC) related mechanisms. Altered somatosensory processing may indicate subclinical derangement of endogenous modulatory systems. Ten patients with long‐term (≥1 year) trapezius myalgia and 10 age‐and sex‐matched healthy controls participated. Pressure pain sensitivity, low threshold mechanoreceptive function and thermal sensitivity, including thermal pain, were assessed at the right thigh before, during and following HNCS. Pain was induced in the forearm by the tourniquet test. At rest allodynia to pressure was found at the thigh in conjunction with hypoaesthesia to cold (p< 0.03 andp< 0.01 respectively), in patients compared with controls. During HNCS, the sensitivity to pressure pain and supra‐threshold heat pain decreased in patients and controls alike (p< 0.02 andp< 0.04 respectively) and returned to baseline following HNCS. In conclusion, in a remote non‐painful area allodynia to pressure and hypoaesthesia to cold were found in conjunction with preserved function of DNIC‐related mechanisms. Whether altered central somatosensory processing at rest may indicate a predisposition for further spread of pain is at present unclear. © 2002 European Federation of Chapters of the International Association for the Study of Pain
Somatosensory perception and function of diffuse noxious inhibitory controls (DNIC) in patients suffering from rheumatoid arthritis
Authors: Leffler Ann‐Sofie , Kosek Eva , Lerndal Thomas , Nordmark Birgitta , Hansson Per
Published: September 2002

The purpose was to investigate the influence of ongoing pain from an inflammatory nociceptive pain with two different disease durations on somatosensory functions and the effect of heterotopic noxious conditioning stimulation (HNCS) on ‘diffuse noxious inhibitory controls’ (DNIC) related mechanisms. Eleven patients with rheumatoid arthritis of a short duration (< 1 year) (RAI), and 10 patients with rheumatoid arthritis of longer duration (>5 years) (RA5) as well as 21 age‐and sex‐matched healthy controls participated. Pressure pain sensitivity, low threshold mechanoreceptive function and thermal sensitivity, including thermal pain, were assessed over a painful and inflamed joint as well as in a pain‐free area, i.e. the right thigh before HNCS (cold‐pressor test) and repeated at the thigh only during and following HNCS. In RAI and RA5 allodynia to pressure was seen over the joint (p< 0.02 andp< 0.001 respectively) in conjunction with hypoaesthesia to light touch (p< 0.02) and hyperaesthesia to innocuous cold (p< 0.05) in RA5. At the thigh, allodynia to pressure was found in RA5 (p< 0.002). During HNCS, the sensitivity to pressure pain decreased in patients and controls alike (p< 0.001). In conclusion, over an inflamed joint allodynia to pressure was found in both RA groups, with additional sensory abnormalities in RA5. In a non‐painful area, allodynia to pressure was found in RA5, suggesting altered central processing of somatosensory functions in RA5 patients. The response to HNCS was similar in both RA groups and controls, indicating preserved function of DNIC‐related mechanisms. © 2002 European Federation of Chapters of the International Association for the Study of Pain
Acute pain management after surgery or in the emergency room in Switzerland: a comparative survey of Swiss anaesthesiologists and surgeons
Authors: Wilder‐Smith Oliver H. G. , Möhrle Jörg J. , Martin Nadine C.
Published: September 2002

The treatment of acute pain remains unsatisfactory despite advances in pain research and the publication of numerous guidelines. The aim of this study was to survey postoperative and emergency room acute pain treatment in Switzerland, particularly regarding compliance with practice guidelines on therapeutic responsibility, treatment algorithms, pain documentation, quality control and education.

A representative sample of anaesthesiologists and surgeons (general and orthopaedic) was selected from all Swiss hospitals with regular surgical activity and sent a 256 point questionnaire on acute pain management.

Five hundred and seventy five doctors were contacted in 98 hospitals, 44% of doctors (covering 89% of hospitals) returned fully completed questionnaires. Half the respondents work in a hospital with an acute pain service. For postoperative pain management, only 10% of prescription is by algorithm, less than a third of respondents regularly determine pain scores, only 15% perform any statistical analysis of pain management, less than one third regularly meet to discuss management problems, and half claim not to have received—or be receiving—formal (i.e. structured/accredited) pain education. The situation is even less satisfactory for emergency room analgesia. Respondents accept the contribution of postoperative and emergency room analgesia to reduced costs and improved medical outcomes. Asked to highlight their major concerns in acute pain management, lack of education and inadequate organisation are listed in first and second positions.

This survey suggests that compliance with published practice guidelines for acute pain management can be improved, and highlights the need for continuing organisational and educational development in acute analgesia, particularly for the emergency room. © 2002 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Science Ltd. All rights reserved.
The auditory event related potentials in episodic and chronic pain sufferers
Authors: De Mirci Serpil , Savas Serpil
Published: September 2002

To examine the cognitive processing differences in chronic and episodic pain sufferers, auditory event‐related potentials (P300 or P3) were recorded in two consecutive trials from 23 chronic lower back pain patients, 22 episodic tension‐type headache sufferers, and from 23 age‐and sex‐matched healthy persons. P3 latency and amplitude showed no difference between groups at first trial. Considering P3 latency habituation, healthy controls and episodic tension‐type headache sufferers showed a significant change of P3 latency whereas lower back pain sufferers failed. Comparing the amount of habituation lower back pain sufferers stood clearly apart from healthy controls. Although there was a remarkable increase of P3 latency in episodic tension‐type headache sufferers, the amount of habituation was not statistically different than it was in lower back pain sufferers. Significant P3 amplitude habituation was observed only in healthy controls. Actually, episodic tension‐type headache sufferers also showed some degree of habituation, which was not statistically remarkable. The amount of amplitude habituation was not different between groups. No correlation was observed between P3 habituation and age, disease duration and symptom severity. These results may point to a disturbed attentional processing in chronic pain sufferers. Our findings suggest that in spite of a similar cortical information processing, the neurocognitive networks related with decision making and memory processing seem to work differently in chronic pain sufferers from those in episodic pain sufferers in repeating tasks. Taking into consideration the reported P3 habituation abnormalities in chronic migraine patients we can say that not the location of pain but rather its temporal pattern may have a role in disturbed attentional processing. © 2002 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Science Ltd. All rights reserved.
Detection of inter-atrial conduction defects with unfiltered signal-averaged P-wave ECG in patients with lone atrial fibrillation
Authors: Platonov P.G. , Carlson J. , Ingemansson M.P. , Roijer A. , Hansson A. , Chireikin L.V. , Olsson S.B.
Published: September 2002

Aims

To demonstrate a possible inter-atrial conduction delay in patients with lone paroxysmal atrial fibrillation (PAF) using ‘unfiltered’ signal-averaged P-wave ECG (PSAECG) and compare these results with those obtained with conventional filter settings.

Methods and Results

Twenty one patients with lone PAF and 20 healthy volunteers (control group) were enrolled in the study. An orthogonal lead surface ECG was high-pass filtered at 0·8 Hz, averaged with template matching, and combined into a spatial magnitude (‘unfiltered’ technique). Results were compared with conventionally filtered (40–300 Hz) PSAECG. The filtered technique revealed no differences in P-wave duration between the two groups (121±12 vs 128±15 ms, control and PAF groups respectively, ns). Double-peaked P-wave spatial magnitudes (interpeak distance >30 ms) were revealed in 11 of 21 PAF patients but only in two of 18 controls (P<0·01). The nadir in the spatial magnitude was located significantly later in the PAF group (114±13 vs 103±9 ms,P <0·01).

Conclusion

‘Unfiltered’ PSAECG revealed significant differences in orthogonal P-wave morphology in patients with lone PAF, indicating the possibility of an inter-atrial conduction delay, while conventional P-wave duration analysis failed to discriminate between the two groups.
Rectal Prolapse of an Ileocaecal Neoplasm Associated with Intussusception in a Cat
Authors: Demetriou J L , Welsh E M
Published: September 2002

Intussusception associated with lymphoma of the ileocaecocolic junction was diagnosed in a 12-year-old female domestic short-haired cat that presented with a 3-week history of diarrhoea and a protruding anal mass. Surgical exploration revealed an ileocolonic intussusception proximal to the mass at the ileocaecal junction which was excised. A diagnosis of ileocaecocolic lymphosarcoma was made and euthanasia was later performed. This is an unusual case of an ileocaecal junction tumour that manifested as a rectal prolapse associated with intussusception in a cat.
Intestinal Obstruction by Trichobezoars in Five Cats
Authors: Barrs V R , Beatty J A , Tisdall P L C , Hunt G B , Gunew M , Nicoll R G , Malik R
Published: September 2002

Between 1997 and 1999, five domestic crossbred cats (four long haired, one short haired) presented with a palpable abdominal mass and were shown to have small intestinal trichobezoars at laparotomy or necropsy. Hair balls were associated with partial or complete intestinal obstruction and were situated in the proximal jejunum to distal ileum. In four cats obstructions were simple, while the remaining cat had a strangulating obstruction. Three of the cats were 10 years or older, and two were less than 4 years. In the three older cats abdominal neoplasia was suspected and investigations were delayed or declined in two of these cats because of a perceived poor prognosis. Predisposing factors identified in this series of cats included a long-hair coat, flea allergy dermatitis, inflammatory bowel disease and ingestion of non-digestible plant material. This report shows that the ingestion of hair is not always innocuous and that intestinal trichobezoars should be considered in the differential diagnoses of intestinal obstruction and intra-abdominal mass lesions, particularly in long-haired cats.