Long-term effects of continuous intrathecal opioid treatment in chronic pain of nonmalignant etiology

In the present retrospective investigation, the long-term effects of continuous intrathecal opioid therapy via implantable infusion pump systems were examined in 120 patients with chronic, nonmalignant pain syndromes. The follow-up period was 6 months to 5.7 years (mean 3.4 years +/- 1.3 standard error of the mean). Deafferentation pain and neuropathic pain showed the best long-term results, with 68% and 62% pain reduction (visual analog scale), respectively. The mean morphine dosage initially administered was 2.7 mg/day (range 0.3-12 mg/day); after an average of 3.4 years, it was 4.7 mg/day (range 0.3-12 mg/day). In a long-term observation of 28 patients who received intrathecal morphine for longer than 4 years. 18 patients (64.3%) had a constant dosage history and 10 patients (35.7%) showed an increase in morphine dosage to more than 6 mg/day 1 year after dosage determination. In seven cases, a tolerance developed: in four patients the tolerance was controlled by means of "drug holidays"; but in three patients it was necessary to remove the pump systems. Explantation of the pump system occurred in 22 additional cases for other reasons. Throughout the follow-up period, 74.2% of the patients profited from the intrathecal opiate therapy: the average pain reduction after 6 months was 67.4% and, as of the last follow-up examination, it was 58.1%. Ninety-two percent of the patients were satisfied with the therapy and 81% reported an improvement in their quality of life. The authors' 6-year experience with administration of intrathecal opioid medications for nonmalignant pain should encourage the use of this method in carefully selected patients.     

Effects of on-demand versus fixed-interval schedules in the treatment of chronic pain with analgesic compounds.

The effects of fixed-interval and on-demand administration of analgesic medication in chronic pain patients were compared in a cross-over design. It was hypothesized that each analgesic schedule would have a different effect on subjective pain experience, mood experience, and physical activity. A fixed-interval analgesic schedule was found more effective than an on-demand analgesic schedule in reducing subjective pain and elevating mood. No differences were found between the two conditions on measures of physical activity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal stress and pain behaviors in patients with chronic pain.

Evaluated the role of interpersonal stress in eliciting pain behavior. 34 male patients with chronic back pain and their wives participated in a randomized between-groups study examining the effects of 2 interactional conditions (i.e., maritally focused stress interview and neutral talking control task) on subsequent persistence in a physically demanding task and with self-reports of pain. Results show that a greater proportion of patients in the stress interview group terminated the physical activity task prematurely, compared with controls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic effectiveness of untrained volunteers with chronic patients.

20 chronic psychotic patients were divided into a treatment (N = 13) and control (N = 7) group. The groups were matched for age, education, sex, length of hospitalization, and diagnosis. Treatment group Ss had 1 of 13 nonprofessional therapists assigned to them for 1 session a wk. 7 therapists were given an optimistic picture of their chances of helping the patient and the remaining 6 were given a pessimistic guarded outlook. After 5 mo., it was found that the treatment group showed significantly more improvement in their interactions with the aides, and in both the quantity and quality of their social behavior (less verbal hostility, better sense of humor, and less withdrawn). 5 treatment-group Ss were discharged from the hospital while none of the control group left. The initial outlook of the therapists made no difference. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acceptance and values-based action in chronic pain: A study of treatment effectiveness and process.

Developing approaches within cognitive behavioral therapy are increasingly process-oriented and based on a functional and contextual framework that differs from the focus of earlier work. The present study investigated the effectiveness of acceptance and commitment therapy (S. C. Hayes, K. Strosahl, & K. G. Wilson, 1999) in the treatment of chronic pain and also examined 2 processes from this model, acceptance and values-based action. Participants included 171 completers of an interdisciplinary treatment program, 66.7% of whom completed a 3-month follow-up assessment as well. Results indicated significant improvements for pain, depression, pain-related anxiety, disability, medical visits, work status, and physical performance. Effect size statistics were uniformly medium or larger. According to reliable change analyses, 75.4% of patients demonstrated improvement in at least one key domain. Both acceptance of pain and values-based action improved, and increases in these processes were associated with improvements in the primary outcome domains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of long-term intrathecal morphine in the management of chronic nonmalignant pain

OBJECTIVE: To examine in a prospective manner the long-term safety and efficacy of chronic intrathecal morphine in patients with severe, nonmalignant pain refractory to less invasive modalities. METHODS: Forty patients with severe, chronic nonmalignant pain poorly managed by systemic medications were identified as candidates for intraspinal trial of morphine. Thirty participants reported successful pain relief during trial and were implanted with an intraspinal delivery system. Standardized measures of pain and functional status were assessed before treatment was begun and at defined intervals during the subsequent 24 months. Intrathecal opioid use and pharmacological and device-related complications were also monitored. RESULTS: The participants had a mean age of 58 +/- 13 years and a mean pain duration of 8 +/- 9 years. Fifty-three percent of the study participants were women. Pain type was characterized as mixed neuropathic-nociceptive (15 of 30 patients, 50%), peripheral neuropathic (10 of 30 patients, 33%), deafferentation (4 of 30 patients, 13%), or nociceptive (1 of 30 patients, 3%). Forty-seven percent of the patients were diagnosed with failed back surgery syndrome. Significant improvement over baseline levels of visual analog scale pain was measured at each follow-up examination after implant. Overall, 50% (11 of 22 patients) of the population reported at least a 25% reduction in visual analog scale pain after 24 months of treatment. In addition, the McGill Pain Questionnaire, visual analog scale measures of functional improvement and pain coping, and several subscales of the Chronic Illness Problem Inventory showed improvement throughout the follow-up period. Pharmacological side effects were managed medically by morphine dose reduction, addition of bupivacaine, or replacement of morphine with hydromorphone. Device-related complications requiring repeat operations were experienced by 20% of the patients. CONCLUSION: Continuous intrathecal morphine can be a safe, effective therapy for the management of severe, nonmalignant pain among a carefully selected patient population and can result in long-term improvement in several areas of daily function.     

有氧运动对治疗慢性下背痛的疗效

目的:探索有氧运动对治疗慢性下背痛疗效的影响.方法:选择社区医疗服务中心40例病史3个月以上的下背痛患者,采用电脑随机方法将受试者分为两组:一组为实验组,进行有氧训练;另一组为对照组,不接受任何训练计划.对照组和实验组分别在干预介入前与介入后进行下背痛失能程度量表和疼痛评分(Visual Analogue Scale,VAS).结果:治疗12周后,发现实验组在治疗后欧式下背痛失能程度显著小于对照组,且VAS评分结果显著优于对照组.结论:有氧运动可以改善慢性下腰痛患者的疼痛程度及改善其失能状况.     

A prospective analysis of acceptance of pain and values-based action in patients with chronic pain.

Objective: Acceptance of pain and values-based action appear important in the emotional, physical, and social functioning of individuals with chronic pain. The purpose of the current study was to prospectively investigate these combined processes. Method: 115 patients attending an assessment and treatment course for chronic pain in the U.K. completed a standard set of measures on two occasions separated by an average of 18.5 weeks. Results: Correlation analyses showed that acceptance of pain and values-based action measured at Time 1 were significantly correlated with pain, pain-related distress, pain-related anxiety and avoidance, depression, depression-related interference with functioning, and physical and psychosocial disability measured at Time 2. Multiple regression analyses, in which pain and relevant patient background variables were controlled, showed that the combined acceptance and values measures accounted for between 6.5% and 27.0% of variance in six key measures of patient functioning later in time. Conclusion: These results support the importance of acceptance and values-related processes in relation to chronic pain. These results also encourage continued applications of a functional contextual model of psychopathology, the model underlying Acceptance and Commitment Therapy and related approaches such as Contextual Cognitive-Behavioral Therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychophysiologic treatment of chronic lower back pain.

Research concerning the mechanisms and efficacy of psychophysiological treatments for chronic low back pain is reviewed. Despite methodological shortcomings, the literature supports the efficacy of a number of psychophysiological treatments. The mechanism of successful treatment is poorly understood. New models of pathophysiology of muscle pain are presented, and it is hoped that they will clarify treatment issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sociodemographic predictors of treatment outcome in chronic non-malignant pain patients. Do patients receiving or applying for disability pension benefit from multidisciplinary pain treatment?

A respiration trial was conducted in 14 adult sows to investigate the energetic effects of a high carbohydrate and a high fat diet over a period of 21 weeks. The basal ration was mainly based on barley and soybean meal and covered 60% of the maintenance requirement for energy. The addition of starch (50% wheat starch, 50% maize starch) or fats (25% lard, 25% soybean oil, 50% olive oil) was 173 kJ/kgW0.75. All rations were calculated with reference to the initial weight of the sows and remained constant throughout the experiment. The animals were fed twice daily. Feces and urine were collected during the first and last part of the experiment over six days each. Forty eight hour measurements of the gas exchange were recorded five times in the course of the trial. Energy balances were calculated using an indirect calorimetry technique (RQ method) as well as the carbon nitrogen balance technique. All components of the energy balance (feces energy, urine energy, metabolizable energy, energy retention) showed no significant difference between the two treatments. The heat production of the animals was 413 +/- 31 with the starch diet and 412 +/- 36 kJ/kg W0.75 when the fat diet was fed. The mean weekly body weights of both treatment groups coincided in all phases of the experiment. Calculation of nutrient oxidation performed for diets and for animal metabolism revealed that only the carbohydrate balance was achieved, whereas the fat balance showed unrealistic results. The sensitivity of the nutrient balance method to measurement errors of the gas exchange has been discussed. The current results indicate that an equal supply of starch or fat energy acts identically in the long-term on body weight regulation and energy balance when overfeeding is not present.     

Correlates of improvement in multidisciplinary treatment of chronic pain.

Although multidisciplinary pain programs have been demonstrated to be effective, the processes of improvement have yet to be clarified. Cognitive-behavioral models posit that improvement is due, in part, to changes in patient pain beliefs and coping strategies. To test the relationships between treatment outcome and changes in beliefs and coping strategies, 94 chronic pain patients (aged 21–64 yrs) completed measures of physical and psychological functioning, health care utilization, pain beliefs, and use of pain coping strategies at admission and 3 to 6 mo after inpatient pain treatment. Improved functioning and decreased health care use were associated with changes in both beliefs and cognitive coping strategies. However, changes in some coping strategies, such as exercise and use of rest, were not associated with improvement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Signal detection and threshold measures for chronic back pain patients, chronic illness patients, and cohort controls to radiant heat stimuli.

15 chronic low back pain patients, 11 chronic respiratory patients, and 11 nonpatient controls (mean ages 47–56 yrs) were studied using a standard radiant heat signal detection methodology. Following determination by ascending limits of each S's stimulus detection and faint pain thresholds, 26 randomized trials at each of 5 stimulus levels were administered. Ss rated each stimulus on a 6-point subjective rating scale ranging from no pain to severe pain. Results indicate that the back pain Ss and respiratory Ss had higher radiant heat pain thresholds than the controls, and the back pain Ss had a discrimination deficit for mildly painful stimuli. Results fit the predictions of an adaptation model of pain perception in chronic pain patients as opposed to a hypochondriasis model. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dropout from treatment for chronic low-back pain.

Chronic low-back pain is a common clinical complaint, and patient dropout can be a major complication to treatment. The authors examined the variables predicting dropout from a 12-week outpatient clinical trial on the treatment of chronic low-back pain. Findings underscore the importance of carefully evaluating the patient's pain severity, attitudes about pain symptoms, and expectations and goals for treatment. Attempts should be made to correct misconceptions and unrealistic expectations regarding the nature of the pain condition, treatment options, likely outcomes, the role of self-regulation training, and family support. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Global marital satisfaction versus marital adjustment: An empirical comparison of three measures.

Two measures of marital satisfaction, the Quality of Marriage Index (R. Norton; see record 1983-27053-001) and the Relationship Satisfaction Questionnaire (D. D. Burns and S. L. Sayers, 1992) were compared to a measure of marital adjustment, the Dyadic Adjustment Scale (G. B. Spanier; see record 1977-00122-001). The measures showed excellent convergent validity (high correlations among each other and with other measures of marital functioning) and discriminant validity (low or nonsignificant correlations with psychopathology subscales). However, spouses' ratings of frequency of disagreements differed significantly from their ratings of satisfaction in the same areas. Formulas for converting scores among the measures are given, and the measures were found to have modest classification powers. The relative advantages and disadvantages of adjustment and satisfaction measures are discussed, and recommendations are made for when to use each type of measure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in pain perception after treatment for chronic pain

Pain threshold, sensitivity, response bias and ability to discriminate were measured before and after treatment for 15 improved and 15 unimproved chronic pain patients diagnosed as having myofascial pain dysfunction (MPD) syndrome, There were no differences between the groups before treatment. After treatment, the improved group showed an increase in pain threshold, sensitivity and ability to discriminate between different levels of painful stimulation and a decrease in response bias to report pain. The unimproved group showed no changes.