Amizon in the treatment of nervous system involvement in herpes zoster

The authors submit results of treatment of patients having suffered from postherpetic pain syndrome (herpetic ganglionitis of the cervical, thoracic, lumbosacral localization, postherpetic intercostal neuralgia, ganglionitis of the trigeminal nerve). In viral diseases, amizone has marked analgetic, antiinflammatory, and immunomodulating effects. The drug is well tolerated by patients, is not associated with side effects under prescribed doses (0.25-0.75 as one dose on a three- or four-times daily schedule during the course of treatment lasting three or four weeks). The drug preparation in question is less effective in the treatment of chronic recurring post-therapeutic intercostal neuralgias, radiculalgia.     

Successful hormonal treatment of pulmonary parenchymal endometriosis

OBJECTIVE: Tobacco use and other behavioral factors are associated with chronic back pain. Anecdotes suggest excess caffeine use may also be associated with chronic back pain. We compared caffeine consumption by chronic back pain patients with caffeine consumption by controls. DESIGN: Retrospective case-control study. SETTING: A multispecialty outpatient facility. PATIENTS: Sixty new, consecutive patients with chronic back pain compared to 60 new, consecutive patients without chronic back pain. INTERVENTION: Patients were prospectively asked to complete an intake questionnaire. MAIN OUTCOME MEASURE: Daily caffeine consumption was estimated by analyzing the intake questionnaire. Differences between groups were analyzed by both normal and nonparametric statistics. RESULTS: Consumption of caffeine by patients with chronic back pain averaged 392.4 mg/day. Controls consumed 149.8 mg/ day, a significant difference (p = .0001). Men consumed 86% more caffeine per day than women (p = .02). Age and caffeine consumption showed little correlation (r = .126). CONCLUSIONS: Patients with chronic back pain consume over twice as much caffeine as patients without chronic back pain. Confounding variables and possible mechanisms associating caffeine with chronic back pain are discussed.     

The problem of acute pain in postoperative period]

The problem of postoperative pain remains actual despite the existence of a variety of pharmaceutical and nonpharmaceutical methods of anesthesia. Acute postoperative pain is an essential component of the surgical stress syndrome. Opioid analgetics (Buprenorfin, Nubain, Tramal, Promedol, Morphine) take the leading position among other types of analgetics. Present-day individual approach to administration of analgetics is still imperfect. The use of a standard dose of analgetics appears to be inadequate in a number of patients. The increase of opioids dose may lead to adverse reactions. In view of this it is valid to use nonsteroid antinflammatory medicines (Ketorolac). The choice of a proper dose of an analgetic is critically important in achieving adequate anesthesia. Patient-controlled analgesia (PCA) or "analgesia on demand" is an alternative to administration of analgetics. The major advantage of PCA is the opportunity to achieve the rate of analgesia, according to individual demand of a patient. Besides, PCA allows to reach the desired effect much faster and to maintain the stable plasma level of an analgetic. 2-year experience of the PCA use in more than 200 patients of the National Research Centre for Surgery ICU has been analysed. The authors advocate use of PCA in clinical practice.     

Screening for addiction in patients with chronic pain and "problematic" substance use: evaluation of a pilot assessment tool

Assessing for the presence of addiction in the chronic pain patient receiving chronic opioid analgesia is a challenging clinical task. This paper presents a recently developed screening tool for addictive disease in chronic pain patients, and pilot efficacy data describing its ability to do so. In a small sample of patients (n = 52) referred from a multidisciplinary pain center for "problematic" medication use, responses to the screening questionnaire were compared between patients who met combined diagnostic criteria for a substance use disorder and those who did not, as assessed by a trained addiction medicine specialist. Responses of addicted patients significantly differed from those of nonaddicted patients on multiple screening items, with the two groups easily differentiated by total questionnaire score. Further, three key screening indicators were identified as excellent predictors for the presence of addictive disease in this sample of chronic pain patients.     

Helicobacter pylori infection in patients with chronic pancreatitis and duodenal ulcer

BACKGROUND: The prevalence of duodenal ulcer is high in patients with chronic pancreatitis. Patients with simple duodenal ulcer without chronic pancreatitis are mostly Helicobacter pylori-infected, and the prevalence of IgG seropositivity is > 95%. The prevalence of H. pylori infection in patients with chronic pancreatitis is not known. METHODS: IgG antibodies against H. pylori were measured in a cross-sectional survey of consecutive patients who had their exocrine pancreas function examined with a Lundh meal test in the period 1988-95 and in a control group of patients with simple duodenal ulcer. RESULTS: Twenty-seven per cent of the patients with chronic pancreatitis had duodenal ulcer during the observation period. The prevalence of IgG antibodies against H. pylori was 22% in patients with chronic pancreatitis without duodenal ulcer as compared with 27% with non-organic abdominal pain. The prevalence of IgG antibodies against H. pylori was 60% in patients with chronic pancreatitis complicated by duodenal ulcer as compared with 86% in controls with simple duodenal ulcer. CONCLUSIONS: H. pylori infection contributes but may not be the only cause of duodenal ulcer in patients with chronic pancreatitis.     

Tramadol (Tramal) in the treatment of rheumatic diseases-- comparative study

In order to evaluate the efficacy of centrally acting analgesics. In treating rheumatic diseases, tramadol hydrochloride (Tramal Grunental) has been administered to a group of 68 patients (36 women and 32 men), who received 100 mg twice a day during a 10-day treatment. The testing comprised 14 female patients with rheumatoid arthritis, 20 patients (7 women and 13 men) with degenerative (OA) hip and knee diseases and 34 patients (15 women and 19 men) affected by the vertebrogen painful syndrome of lumbar spine. The control group comprised 12 patients (9 women and 3 men) with rheumatoid arthritis using non-steroidal antiinflammatory drugs only, 22 patients (12 women and 10 men) with the OA of the hip and knee, using paracetamol only, and 30 patients (15 women and 15 men) affected by the vertebrogen painful syndrome of lumbar spine, also using paracetamol only. The visual analogue scale has been used in following the pain relief assessments during the therapy. It has thus been observed that the intensity of pain has not been significantly relieved with the acute rheumatic diseases (p > 0.05) in the control group either; that the significant pain relief has occurred with the degenerative (OA) rheumatic diseases (p < 0.05) but not in the control group; while the best analgetic effect of tramadol has been proved on the patients affected by the vertebrogen painful syndrome of lumbar spine (p < 0.01) but was not significant in the control group. During the therapeutic treatment 13 patients (19%), mostly the elderly, experienced side effects, manifested as nausea and the dry mouth.     

Changes in crystallinity by sterilization and processing of ultrahigh molecular polyethylene used in endoprosthetics]

Research in animals shows that the levels of neuropathic pain expression is genetically associated with a characteristic response profile to sensory stimuli. The aim of the present investigation was to examine if pressure algometry can identify a specific pain sensitivity profile in patients with complex regional pain syndrome, Type I (reflex sympathetic dystrophy), and to distinguish complex regional pain syndromes from other chronic pain dysfunction syndromes. Pressure pain threshold and pain tolerance measured at the sternum in 17 patients with complex regional pain syndrome, Type I (reflex sympathetic dystrophy), were compared with values obtained in 13 patients suffering from other chronic pain dysfunction syndromes and in a control group of 24 pain-free volunteers. The pressure algometer consisted of a force displacement transducer with a 0.25 cm2 tip connected to a recorder. The rate of force application was 1 kg/0.25 cm2/s. The difference between threshold and tolerance was defined as the pain sensitivity range. Young patients with complex regional pain syndrome (<40 yr) demonstrated a significantly higher mean pain sensitivity range compared with young subjects who had chronic pain or who were pain-free. Mean threshold and tolerance values were significantly lower in patients with complex regional pain syndrome (2.7+/-1.0 kg (mean +/- standard deviation) and 5.4+/-2.0 kg, respectively) and in patients suffering from other chronic pain syndromes (2.6+/-1.1 and 4.6+/-1.7 kg) than in healthy subjects (5.4+/-2.3 and 8.4+/-2.6 kg). Women in the chronic pain group exhibited a significantly lower pressure pain threshold than all other subgroups. Regardless of group, women exhibited lower pressure pain tolerance than men. In conclusion, the study contained herein shows a specific pain sensitivity profile to experimental stimuli behavior in young patients with complex regional pain syndrome expressed by a large pressure pain sensitivity range, at a location away from the painful area. However, one single pressure pain measurement over the sternum is insufficient for differentiation of patients with complex regional pain syndrome from those with chronic pain because of intersubject variation.     

Cognitive-behavioral classifications of chronic pain: replication and extension of empirically derived patient profiles

Many attempts have been made to classify patients with chronic pain in order to make sense of a very complex problem and to direct patients towards appropriate treatments for their condition. Unfortunately, these efforts have not been empirically based and have demonstrated limited clinical use. Predominant emphasis has been placed on either biomedical or psychopathological elements of the chronic pain experience with little integration of cognitive-behavioral factors. Turk and Rudy (1988) introduced an empirically derived pain patient taxonomy based on analyses of the Multidimensional Pain Inventory (MPI). The primary purpose of the present study was to replicate this classification system by using different measures for similar constructs in different groups of chronic pain patients. Items designed to measure 4 constructs (activity interference, emotional distress, pain intensity, and perceived support) were collected from 1594 pain patients evaluated at two separate pain treatment facilities. Confirmatory factor analytic results indicated high reliability of the items in measuring these 4 constructs. Replicated clustering techniques demonstrated the robustness of 3 patient profiles across the patient samples. The 3 clusters corresponded remarkably well to the groups initially labeled by Turk and Rudy (1988) as Dysfunctional, Interpersonally Distressed and Adaptive Copers. External validation of the classification system supported replication of the 3 groups and offered further interpretational clarity to the patient profiles. Strong evidence was found for a taxonomy of 3 chronic pain patient groups. Implication for predicting treatment outcome and for future research are discussed.     

Sleep complaints in chronic postconcussion syndrome

This study was designed to identify the incidence of sleep complaints in 39 patients with chronic postconcussion syndrome compared to those of a control group of 27 patients with orthopedic injuries. Patients with orthopedic injuries were selected as a comparison group to control for the effects of traumatic injury or chronic pain. There were no differences in age, sex distribution, or time from injury between the patient groups. Type and frequency of sleep disturbances in a mean two-year postinjury period were evaluated. Patients with chronic postconcussion syndrome reported more difficulty in initiating and maintaining sleep at night and greater difficulty with sleepiness during the day.     

Chronic morphine reduces pain-related disability in a rodent model of chronic, inflammatory pain.

Chronic pain is disabling, and the adverse effects of morphine are also disabling. The best way to assess the beneficial effects relative to the potential adverse effects of chronic morphine may be through the use of quantitative measures of functional disability in people and animals experiencing pain. If chronic morphine alleviates chronic pain and its beneficial analgesic effects outweigh whatever adverse effects it may produce, then it should reduce pain-related disability. Rats with adjuvant-induced arthritis were implanted with subcutaneous morphine pellets. Continuous morphine reduced pain-related disability in tasks motivated by food reward or shock avoidance throughout the 35 days of continuous administration—first, in tests that primarily assessed the function of the less severely affected forelimbs, and later, as the inflammation subsided, in tests more dependent on the function of the more severely affected hind limbs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The psychological profiles of patients with whiplash-associated headache

Headache often compounds chronic neck pain following whiplash injury. To better understand post-traumatic headache, the SCL-90-R symptom checklist was used to determine the psychological profiles of patients with whiplash-associated headache and of patients with whiplash-associated neck pain without headache. The psychological profiles of these patients were compared with previously published SCL-90-R profiles of patients with post-traumatic and nontraumatic headache, and of the normal population. Patients with whiplash-associated headache were not significantly different from those with other forms of post-traumatic headache or with whiplash-associated neck pain without headache. However, when patients with whiplash-associated headache and patients with nontraumatic headache were compared to normal data, significant differences emerged. Patients with nontraumatic headache exhibited higher scores on all subscales, whereas patients with whiplash-associated headache differed from the normal sample only on somatization, obsessive-compulsive, depression and hostility subscales, and the global severity index. These differences imply that patients with whiplash-associated headache suffer psychological distress secondary to chronic pain and not from tension headache and generalized psychological distress.     

Empirical-Bayes and semi-Bayes approaches to occupational and environmental hazard surveillance

Depression, a complex psychobiological syndrome, has been found to be prevalent among individuals with chronic pain problems. It has been repeatedly recommended that chronic pain patients be routinely screened for depression. Many self-report questionnaires have been used to screen for depression although few have addressed potential limitations of using a self-report questionnaire to identify depressed chronic pain patients. Among the most serious problems is an over-diagnosis since typical neurovegetative symptoms of depression often resemble patients' medical/physical conditions. Some have suggested that the physical items should be replaced and others have suggested that a higher cut-off criteria for diagnosing depression should be used. In this study, the validity of the Center for Epidemiological Studies-Depression (CES-D) scale was examined to determine (a) its sensitivity, specificity, and positive, and negative predictive value with chronic pain patients, (b) the biasing effect of somatic items, and (c) the optimal cut-off score for diagnosing depression. The results support the predictive validity of the CES-D and suggest that a cut-off score of 19 should be used for diagnosing depression in chronic pain patients rather than the standard cut-off point of 16. Interestingly, the removal of the somatic items did not enhance the effectiveness of the CES-D. The discriminatory ability of somatic items with the total assessment of depression is discussed.     

Pretherapy dental decisions in patients with head and neck cancer. A proposed model for dental decision support

OBJECTIVE: Sensory and motor abnormalities are common among patients with complex regional pain syndrome (CRPS). The purpose of the present study was to define and characterize these abnormalities and to develop a hypothesis regarding the area of the central nervous system from which they derive. DESIGN: Data were acquired from study subjects using clinical examination and quantitative assessment of neurological function. Subjects were divided into four groups. CRPS patients were differentiated into two groups based on the presence or absence of sensory deficit on the face to clinical examination. The other two groups were composed of patients with other chronic pain syndromes and normal individuals without chronic pain or disability. Clinical and quantitative data were compared between groups. PATIENTS: One hundred forty-five CRPS patients, 69 patients with other pain conditions, and 26 normal individuals were studied. RESULTS: A high incidence of trigeminal hypoesthesia was observed in CRPS patients. CRPS patients with trigeminal hypoesthesia manifested bilateral deficits of sensory function, with a predominant hemilateral pattern. These patients also manifested bilateral motor weakness with a more prominent hemiparetic pattern. Both sensory and motor deficits were greatest ipsilateral to the painful side of the body. These features differed significantly from those of CRPS patients lacking clinical trigeminal deficit, other pain patients, and normals. A lower cranial nerve abnormality (sternocleidomastoid weakness) and a myelopathic feature (Hoffman's reflex) were more common in CRPS patients with trigeminal hypoesthesia. CONCLUSIONS: Nearly half of CRPS patients had abnormalities of spinothalamic, trigeminothalamic, and corticospinal function that may represent dysfunction of the medulla. One-third of the remaining CRPS patients had neuroimaging evidence of spinal cord or brain pathology. The majority of CRPS patients in this study have measurable abnormalities of the sensory and motor systems or neuroimaging evidence of spinal cord or brain dysfunction.     

Magnetic resonance of the encephalon in 17 patients with ocular Beh?et''s disease

OBJECTIVE: To evaluate the relationships between patient and physician pretreatment expectations of pain relief and subsequent pain relief reported by chronic pain patients immediately after treatment. DESIGN: Prospective study of consecutive patients undergoing a procedure in a pain clinic for treatment of chronic pain. Patients rated their current pain level and their expectation of pain relief immediately prior to undergoing a procedure (e.g., intravenous drug infusion, nerve block) for the treatment of chronic pain. Simultaneously and independently, the treating physician completed a similar questionnaire. At completion of the procedure, patients rated their current pain level and degree of pain relief. SETTING: University of Washington Multidisciplinary Pain Center procedure suite. PATIENTS: Forty-six consecutive chronic pain patients. INTERVENTION: Intravenous drug infusions and nerve blocks. OUTCOME MEASURES: Current pain and pain relief ratings. RESULTS: Patients' pain relief expectation ratings were not correlated significantly with their postprocedure pain relief ratings or pre-post procedure changes in pain ratings. However, a statistically significant correlation was found between physician expectations of pain relief and patient pain relief ratings and patient pre-post procedure changes in pain. CONCLUSIONS: The results of this study suggest that physicians are better predictors than are patients of patients responses to these procedures and/or that physicians may somehow subtly communicate their expectations to patients during the procedure, and these expectations then influence patient response. Patient pretreatment expectations may not always play a significant role in nonspecific treatment effects.     

The MMPI and chronic pain: A cross-cultural view.

The MMPI scores were studied for 430 male and 180 female Australian chronic pain patients. Analysis revealed mean MMPI profiles (i.e., elevated Hypochondriasis, Hysteria, and Depression clinical scales) and 3 cluster-analytically derived profile types that corresponded closely to findings in the literature on US chronic pain patients. Further, at least some of the behavioral correlates associated with MMPI performance among US pain patients were also found for the Australian pain patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug-induced gingival hyperplasia and its management--a literature review

The purpose of our study was to find out whether patient-controlled epidural administration (PCEA) of a mixture containing a low-dose local anaesthetic, opioid and alpha 2-agonist provides as good or better postoperative analgesia as continuous epidural administration of the same analgetic solution. METHODS: 30 patients (ASA I-III), scheduled for major abdominal surgery, were randomly divided into 2 groups. 90 minutes after induction of general anaesthesia all patients received a continuous epidural infusion of 5 ml/h of the analgetic solution (50 micrograms sufentanil + 150 micrograms clonidine in 50 ml 0.125% bupivacaine) until the end of surgery. Immediately postoperatively the patients of group A received a continuous infusion of the study solution (5-8 ml/h), the patients of group B received a baseline continuous epidural infusion (3 ml/h), additionally they could self-administer 5 ml boli via a PCEA device. Measurements included the total dose of infused drug solution, pain at rest and on exercise by a visual analogue scale, cardiorespiratory data and side effects within the first 24 hours postoperatively. A standardised interview on analgesia and side effects was held 2 days after surgery. RESULTS: The PCEA group demanded less epidural analgesics (gr. B: 112 +/- 33 ml vs. gr. A: 135 +/- 20 ml) p < 0.01). Both continuous epidural infusion and patient-controlled administration provided very good analgesia at rest (gr. A: VAS 0.4 +/- 0.4 and gr. B: VAS 0.4 +/- 0.5) (n.s.). On exercise continuous epidural infusion of analgesics resulted in significantly lower pain scores (gr. A: 1.9 +/- 1.1) than patient-controlled application (gr. B: 3.4 +/- 1.1) (p < 0.01). We did not notice severe side effects such as respiratory depression or drop of heart rate or blood pressure. CONCLUSION: In patients at rest both continuous and patient-controlled epidural administration of analgesics provides excellent analgesia after major abdominal surgery. Contrariwise, patients on exercise who could use a PCA-device experienced more pain compared to those with a continuous epidural infusion technique. On the other hand the patients of the PCA-group consumed less epidural analgesics. We did not notice any severe side effects such as respiratory depression or cardiovascular instability during the study.     

Chronic gastrointestinal symptoms in hemodialysis patients

INTRODUCTION: Gastrointestinal disorders occur frequently in dialysis patients. Few data are available on the prevalence of symptoms originating from the gastrointestinal tract in this group of patients. Our aim was to obtain data on the prevalence of chronic gastrointestinal symptoms in patients undergoing hemodialysis. METHODS: All 109 patients of our dialysis unit were given a questionnaire to complete which was previously validated and designed to measure the occurrence of gastrointestinal, and some general symptoms during the preceding year. 105 subjects responded (96% response rate). RESULTS: 79% of dialysis patients had at least one of the following chronic gastrointestinal symptoms: Esophageal symptoms were reported in 21% abdominal pain in 28% and dyspeptic symptoms in 48%. The irritable bowel syndrome was diagnosed in 12 patients (11%), 40% had chronic constipation and 24% had chronic diarrhoea. Colonic pain was described in 20% of patients. Frequent general symptoms (such as weakness, headaches, insomnia and fatigue) were described in up to 51%, and patients were severely bothered by symptoms in up to 33% of cases. CONCLUSION: Although patients on hemodialysis generally report a good quality of life, the prevalence of gastrointestinal symptoms and of general symptoms is high and many dialysis patients consider these symptoms to cause major impairment of daily life.     

Complicated ulcer; prevention and therapy of upper gastrointestinal bleeding; indications for antacid therapy

Antacids reduce gastric acidity by neutralization, diminish peptic activity by increasing luminal pH above that optimal for proteolysis and provide thereby the rational for their use in ulcer disease. In clinical trials antacids fastened ulcer healing in patients with duodenal ulcer but not with gastric ulcer when compared to placebo. Furthermore, the prophylactic use of antacid medication can significantly reduce the frequency of acute bleeding when gastric content is titrated to a pH greater 3.5 on an hourly basis. Cimetidine does not adequately protect seriously ill patients from acute upper gastrointestinal tract bleeding. Antacids are better for this purpose. So far the efficacy of an antacid therapy has not been proven in controlled trials in patients with chronic ulcer disease, in patients with recurring ulcers following gastric surgery and in patients bleeding from acute or chronic gastroduodenal lesions.