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Arm Pain (arm + pain)
Selected AbstractsThe impact of psychological factors on placebo responses in a randomized controlled trial comparing sham device to dummy pillJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2009Suzanne M. Bertisch MD MPH Abstract Objectives, To explore to what extent psychological factors such as expectation, depression, anxiety and belief in alternative medicine impact placebo response and differential responses to separate placebo interventions. Methods, We analysed data from a randomized controlled trial designed to compare the clinical response of two distinct placebo treatments (sham acupuncture device and placebo pill) in 119 participants with persistent distal upper arm pain due to repetitive stress injury. We used a multivariable linear regression model to identify potential correlates of self-reported upper extremity pain at the end of treatment in both placebo arms of the study combined. We also performed stratified analyses by placebo treatment. Results, We did not find any of the psychological factors of interest to be associated with pain at the end of treatment in our combined analysis. We found higher baseline pain score and pain for longer than 1 year's duration to be significantly associated with higher pain scores at the end of treatment for the placebo treatments combined. In stratified analyses, for the sham acupuncture group, we found higher baseline depression score, higher baseline pain score and younger age to be independently correlated with higher pain score at the end of treatment. For the placebo pill group, only baseline pain was significantly correlated to pain score at the end of treatment. Conclusion, In this trial, neither expectancy nor psychological states were associated with response to placebo, with the exception of baseline depression score for the sham acupuncture arm. [source] Persistent Pain After Breast Cancer SurgeryPAIN MEDICINE, Issue 7 2007B Lau Purpose of the study:, To identify strengths and weaknesses in current studies with a view to carrying out a major multi-center study in Australia. Methods:, The literature was reviewed using standard Medline and Ovid methods. Bibliography of well known key recent papers were used to identify further papers. Results:, Studies evaluating persistent pain after breast cancer surgery have been small and few were prospective controlled studies with adequate power. Like Jung et al[1] we found that the literature was inconsistent in defining chronic pain and differentiating the breast cancer surgery pain syndromes. Marked variations in prior studies are due to differences in: study size (n = 22 to 282 patients), methodology, diagnostic criteria, pain assessment instruments, and distribution of demographic and clinical characteristics in the samples studied. Unfortunately the largest study to date, the ALMANAC Trial (n = 1031) which compared sentinel node biopsy vs "standard axillary dissection" evaluated arm and shoulder function and quality of life, but not pain[2]. From the current literature, it appears that neuropathic breast and arm pain are most common. Widely varying prevalence estimates of different neuropathic pain syndromes have been reported: phantom breast pain (3,44%); intercostobrachial neuralgia (ICBN) (16,39%); ICBN in breast conserving surgery (14,61%); and "neuroma pain" (23,49%). The most established risk factors for surgically related neuropathic pain syndromes are intraoperative nerve trauma, severe acute postoperative pain, and high use of postoperative analgesics[1]. Psychosocial distress is reported to be a risk factor and a consequence of chronic pain[1]. Conclusions:, Well-designed large multi-center studies are required to identify prevalences of various pain types, associated risk factors and treatment success for pain after breast cancer surgery. Such a study is in progress through the collaboration of our group with the Sentinel Node vs Axillary Clearance (SNAC) Study of 1000 women following breast surgery, conducted by the Royal Australian College of Surgeons (RACS). [source] DICHOTOMY OF CORTICAL PAIN PROCESSINGPAIN MEDICINE, Issue 2 2002Article first published online: 4 JUL 200 Jahangir Maleki, Rollin M. Gallagher, Pain Medicine and Rehabilitation Center, MCP/Hahnemann School of Medicine Introduction: Functional MRI and PET studies of cortical pain processing indicate segregated pain pathways above the thalamus. Although experimental pain may result in multiple areas of altered cortical activity, it is postulated that thalamic pain fibers known as the lateral system, projecting to sensory cortex, serve to localize pain, whereas medial pathways projecting to limbic cortex, process affective aspects of pain. Case Study: A 27 y/o female, with left upper extremity pain and severe allodynia from Complex Regional Pain Syndrome, Type I (CRPS I / RSD), after receiving intra-pleural bupivacaine blocks developed an ipsilateral focal-onset secondary generalized tonic clonic seizure. This was followed by one hour of post-ictal confusion. Simultaneously she developed a dense left-sided motor and sensory deficit (Todd's palsy) with a motor deficit resolving in one day whereas a sensory deficit lasted 2 days. Throughout the duration of the sensory deficit she denied any left arm pain, although she continued to report the same intensity of pain, but now localized to her epigastric region. Interestingly, despite the lack of sensory perception on the left side, palpation of her left arm resulted in increased epigastric pain and suffering. Discussion: This case indicates a bifurcation of the pain pathway between the thalamus and cortex. Due to focal seizure activity, the sensory cortex (i.e. lateral system) was transiently rendered dysfunctional, during which time the continued presence of pain and allodynia without appropriate localization likely resulted from pain conduction, from the thalamus to functional limbic structures such as Cingulum (i.e. via the medial fibre system). Conclusion: This case report strongly supports the hypothesis of medial and lateral pain conducting fibers branching at the level of thalamus with medial sub-serving the emotional aspects of pain by projection to limbic cortex, whereas lateral fibres project to sensory cortex, primarily serving a localizing function. [source] The Development of the Negative Pain Thoughts QuestionnairePAIN PRACTICE, Issue 5 2008Ana-Maria Vranceanu PhD ,,Abstract Background: Cognitive processes play a pivotal role in the perception of pain intensity, pain-related disability, and response to medical treatments including surgeries. While various measures of dysfunctional pain coping exist in the literature, there is no instrument available to examine such negative cognitions in relation to perceptions of medical treatment in pain patients presenting to a surgical orthopedics practice. Aims: The purpose of this article is to report on the development and preliminary testing of the Negative Pain Thoughts Questionnaire (NPTQ). Methods: The NPTQ is an 11-item questionnaire assessing cognitions about pain and its treatment in patients presenting to orthopedics surgical practices. It was administered to 2 samples of patients with hand and arm pain seeking medical treatment in a hospital surgical practice. Patients in the second sample also completed a measure of depression and one of disability of hand, arm, and shoulder. Results: The NPTQ was found to be internally consistent, and unidimensional. The NPTQ total score was found to have a moderate to high positive correlation with perceived hand, arm, and shoulder disability, and a moderate positive correlation with depression. In multivariate analyses, high scores on the NPTQ significantly predicted high perceived hand, arm, and shoulder disability, even after controlling for depression. Conclusion: This short and easily administered measure of negative pain thoughts could potentially help surgeons identify at risk patients, and facilitate referrals to cognitive behavioral therapy. This, in turn, may prevent unnecessary surgeries, may decrease healthcare costs, and prevent transition toward costly chronic pain syndrome.,, [source] The Elder Patient with Suspected Acute Coronary Syndromes in the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 8 2007Jin H. Han MD ObjectivesTo describe the evaluation and outcomes of elder patients with suspected acute coronary syndromes (ACS) presenting to the emergency department (ED). MethodsThis was a post hoc analysis of the Internet Tracking Registry for Acute Coronary Syndromes (i,trACS) registry, which had 17,713 ED visits for suspected ACS. First visits from the United States with nonmissing patient demographics, 12-lead electrocardiogram results, and clinical history were included in the analysis. Those who used cocaine or amphetamines or left the ED against medical advice were excluded. Elder was defined as age 75 years or older. ACS was defined by 30-day revascularization, Diagnosis-related Group codes, or death within 30 days with positive cardiac biomarkers at index hospitalization. Multivariable logistic regression analyses were performed to determine the association between being elder and 1) 30-day all-cause mortality, 2) ACS, 3) diagnostic tests ordered, and 4) disposition. Multivariable logistic regression was also performed to determine which clinical variables were associated with ACS in elder and nonelder patients. ResultsA total of 10,126 patients with suspected ACS presenting to the ED were analyzed. For patients presenting to the ED, being elder was independently associated with ACS and all-cause 30-day mortality, with adjusted odds ratios of 1.8 (95% confidence interval [CI] = 1.5 to 2.2) and 2.6 (95% CI = 1.6 to 4.3), respectively. Elder patients were more likely to be admitted to the hospital (adjusted odds ratio, 2.2; 95% CI = 1.8 to 2.6), but there were no differences in the rates of cardiac catheterization and noninvasive stress cardiac imaging. Different clinical variables were associated with ACS in elder and nonelder patients. Chest pain as chief complaint, typical chest pain, and previous history of coronary artery disease were significantly associated with ACS in nonelder patients but were not associated with ACS in elder patients. Male gender and left arm pain were associated with ACS in both elder and nonelder patients. ConclusionsElder patients who present to the ED with suspected ACS represent a population at high risk for ACS and 30-day mortality. Elders are more likely to be admitted to the hospital, but despite an increased risk for adverse events, they have similar odds of receiving a diagnostic test, such as stress cardiac imaging or cardiac catheterization, compared with nonelder patients. Different clinical variables are associated with ACS, and clinical prediction rules utilizing presenting symptoms should consider the effect modification of age. [source] Neck pain and disability: A cross-sectional survey of the demographic and clinical characteristics of neck pain seen in a rheumatology clinicINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2 2005A.O. Frank Summary This hospital-based cross-sectional cohort study examines the clinical and demographic features of neck pain, disability (using the Northwick Park neck pain questionnaire) and relationships to handicap in employment. Of 173 consecutive referrals to a rheumatology clinic with neck pain, 70% had neck/arm pain without neurological involvement, 13% other conditions, 11% nerve involvement and 5% other spinal pain. 141 patients (mean age 50 years) had mechanical or degenerative neck pain, of which 13% was probably work-related and 13% was trauma-related. 44 had taken sickness absence for an average of 30 weeks. Comorbidities were frequent (lumbar pain 51%). Those in work were significantly less disabled than those not working (p = 0.001) and those off sick (p < 0.01). Those reporting sleep disturbance, tearfulness and crying were significantly more disabled (p = 0.0001) than those who did not. Neck pain in secondary care is complicated by physical and emotional comorbidities. Comprehensive management requires a biopsychosocial model of care. [source] | ||||||||||