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PubMed1995

Shoulder pain in a community-based rheumatology clinic.

The objective of this study was to assess the prevalence of different shoulder disorders likely to be experienced by a rheumatologist in a community-based rheumatology clinic. We assessed patients with shoulder pain presenting to a large general practice at a community-based rheumatology clinic. It was found that the more common conditions seen were rotator cuff lesions (65%), pericapsular soft tissue pain (11%), acromioclavicular joint pain (10%) and referred pain from cervical spine (5%). In conclusion this study has established the spectrum of shoulder disorders referred from general practice to a highly accessible community-based rheumatology clinic. The diagnostic processes to distinguish the different conditions rely chiefly on an accurate history and directed examination.

Adolescent↗
PubMed2001

Long-lasting orofacial pain--a study of 109 consecutive patients referred to a pain group.

The aim was to register and evaluate the orofacial pain condition, with special focus on the equalities/inequalities between the sexes, in consecutive patients referred to the pain group at the Centre for Oral Health Sciences in Malmö, Sweden. The 109 patients, 85 (78%) women and 24 (22%) men, were referred to the pain group during the years 1988 to 1993 and were clinically examined using a standardised procedure. Pain duration of one year or more was experienced by 83% of the patients. The pain onset was related to dental care or toothache by 56% of the patients. Temporomandibular disorders were the most common diagnoses (52%) and were more common among women than among men (p < 0.05). Multiple pain locations were frequently reported, range 1-47 locations, and the women had significantly (p < 0.05) more pain locations than the men. Equalities between the sexes were more frequent than inequalities among patients referred for long-lasting orofacial pain. It can be discussed whether the sex difference in the prevalence of pain of musculoskeletal origin emerges from biological differences or can be explained by different psychosocial circumstances.

Adult↗
PubMed2001

Pain as sign of recurrent disease in head and neck squamous cell carcinoma.

BACKGROUND: The role of pain in head and neck cancer is seldom addressed. This retrospective study examined in a group of 190 curatively treated patients to what extent pain complaints should be considered to be the first sign of recurrent disease. METHODS: The research population exists of 95 patients with a recurrent head and neck carcinoma and control group matched for age, gender, primary tumor, and duration of follow-up. RESULTS: Of the patients with proven recurrent disease, 70% reported pain complaints as the first symptom. In 35% of these cases, the complaints concerned referred pain, whereas in 65% localized pain complaints in the head and neck were registered. The median interval between reporting localized pain complaints and histologic confirmation of recurrence was 4 months. In the case of referred pain, this delay was 2.5 months. No statistically significant correlation between pain complaints and site of recurrence could be demonstrated. Only 2% of the control group reported pain complaints. CONCLUSIONS: This study confirms that each pain complaint after intentional curative treatment should be regarded as a warning sign. Recurrence of disease without preceding pain complaints (30%) emphasizes the importance of a thorough follow-up.

Adult↗
PubMed1982

[Iopamidol, a new non-ionic roentgen contrast medium. Results of angiographic studies in more than 300 patients, with special reference to pain reactions].

Iopamidol, a new non-ionic, monomeric contrast medium with low osmolality has been well established in our angiographic routine procedures according to the favourable results obtained in more than 300 controlled trials. The general tolerance (demonstrated by the rate of systemic adverse reactions) of the lower concentrated solution (300 mg iodine/ml) is a little bit better than that of the higher concentrated one (370 mg iodine/ml). We could demonstrate a significant difference between the two preparations regarding to local side effects such as pain and heat sensations. The results of 100 intraindividual double blind studies (only peripheral angiography) specially referring to local side effects showed the high significant decrease of pain and heat sensations after application of Iopamidol as compared to the results gained by the ionic Ioxitalamate and Ioglicinate. There was no remarkable difference between Iopamidol and Ioxaglate which is a dimeric but equally low osmolar substance. The role of osmolality in the generation of side effects is pointed out. In consequence the advantages of using contrast media of reduced osmolality particularly in peripheral angiography must be emphasized.

Angiography↗
PubMedDate not supplied

The injured shoulder. Primary care assessment.

Shoulder problems are the second most common orthopedic complaint in primary care medicine. The range of motion, ligamentous and muscular support, and central location of the shoulder are key factors for the successful performance of persons at work or on the playing field. These special attributes also contribute to injury and to difficulty in assessing the painful shoulder. An understanding of the pertinent anatomic structures, the differential diagnosis of shoulder pain (intrinsic and referred pains), and a systematic approach to the evaluation including a complete history and physical examination are necessary in this assessment. Adequate examination consists of inspection, muscle strength and range-of-motion testing, palpation, and neurologic testing of the shoulder, neck, and elbow followed by special tests to detect impingement, instability, or tendinosis. This basic assessment is augmented by the proper use of radiographs, arthrography, computed tomography, ultrasonography, and magnetic resonance imaging. An adequate database and proper assessment of the injured shoulder allow the primary care physician to make a pathoanatomic diagnosis and formulate an appropriate treatment plan and make appropriate use of orthopedic consultants.

Acute Disease↗
PubMed2006

Correlates of knee pain in older adults: Tasmanian Older Adult Cohort Study.

OBJECTIVE: To describe the association between chondral defects, bone marrow lesions, knee and hip radiographic osteoarthritis (OA), and knee pain. METHODS: Knee pain was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index. T1- and T2-weighted fat saturation magnetic resonance imaging was performed on the right knee to assess chondral defects and subchondral bone marrow lesions. Radiography was performed on the right knee and hip and scored for radiographic OA. Body mass index (BMI) and knee extension strength were measured. RESULTS: A total of 500 randomly selected men and women participated. The prevalence of knee pain was 48%. In multivariable analysis, prevalent knee pain was significantly associated with medial tibial chondral defects (odds ratio [OR] 2.32, 95% confidence interval [95% CI] 1.02-5.28 for grade 3 versus grade 2 or less; OR 4.93, 95% CI 1.07-22.7 for grade 4 versus grade 2 or less), bone marrow lesions (OR 1.44, 95% CI 1.04-2.00 per compartment), and hip joint space narrowing (OR 1.36, 95% CI 1.07-1.73 per unit), as well as greater BMI and lower knee extension strength. It was not significantly associated with radiographic knee OA. These variables were also associated with more severe knee pain. In addition, there was a dose response association between knee pain and number of sites having grade 3 or 4 chondral defects (OR 1.39, 95% CI 1.12-1.73 per site), with all subjects having knee pain if all compartments of the knee had these defects. CONCLUSION: Knee pain in older adults is independently associated with both full and non-full-thickness medial tibial chondral defects, bone marrow lesions, greater BMI, and lower knee extension strength, but is not associated with radiographic knee OA. The association between radiographic hip OA and knee pain indicates that referred pain from the hip needs to be considered in unexplained knee pain.

Bone Marrow Diseases↗
PubMed2006

Outcome of transcutaneous electrical nerve stimulation in chronic pain: short-term results of a double-blind, randomised, placebo-controlled trial.

The aim of this study was to test the efficacy of shortterm transcutaneous electrical nerve stimulation (TENS) treatment in chronic pain with respect to pain intensity and patients' satisfaction with treatment results. We therefore performed a randomised controlled trial comparing TENS and sham TENS. Patients, researchers and therapists were blinded for treatment allocation. One hundred and sixty-three patients with chronic pain referred to the Pain Centre entered the study. Conventional TENS and sham TENS were applied in the segments of pain, for a period of ten days. Outcome measures were pain intensity (visual analogue scale) and patients' satisfaction with treatment result (yes or no). The proportions of patients satisfied with treatment result differed significantly for TENS compared to sham TENS (58 and 42.7% respectively, chi(2)=3.8, p=0.05). However, no differences in pain intensity were found for patients treated with TENS or sham TENS. Only for patients satisfied with treatment results pain intensity gradually decrease equally both for TENS and sham TENS with repeated treatment application.

Adult↗
PubMed2003

Effect of firmness of mattress on chronic non-specific low-back pain: randomised, double-blind, controlled, multicentre trial.

BACKGROUND: A firm mattress is commonly believed to be beneficial for low-back pain, although evidence supporting this recommendation is lacking. We assessed the effect of different firmnesses of mattresses on the clinical course of patients with chronic non-specific low-back pain. METHODS: In a randomised, double-blind, controlled, multicentre trial, we assessed 313 adults who had chronic non-specific low-back pain, but no referred pain, who complained of backache while lying in bed and on rising. Mattress firmness is rated on a scale developed by the European Committee for Standardisation. The H(s) scale starts at 1.0 (firmest) and stops at 10.0 (softest). We randomly assigned participants firm mattresses (H(s)=2.3) or medium-firm mattresses (H(s)=5.6). We did clinical assessments at baseline and at 90 days. Primary endpoints were improvements in pain while lying in bed, pain on rising, and disability. FINDINGS: At 90 days, patients with medium-firm mattresses had better outcomes for pain in bed (odds ratio 2.36 [95% CI 1.13-4.93]), pain on rising (1.93 [0.97-3.86]), and disability (2.10 [1.24-3.56]) than did patients with firm mattresses. Throughout the study period, patients with medium-firm mattresses also had less daytime low-back pain (p=0.059), pain while lying in bed (p=0.064), and pain on rising (p=0.008) than did patients with firm mattresses. INTERPRETATION: A mattress of medium firmness improves pain and disability among patients with chronic non-specific low-back pain.

Adult↗
PubMed1997

Are there fundamental differences in the peripheral mechanisms of visceral and somatic pain?

There are some conspicuous differences between the sensibilities of cutaneous and visceral tissues: (1) Direct trauma, which readily produces pain when applied to the skin, is mostly without effect in healthy visceral tissue. (2) Pain that arises from visceral tissues is initially often poorly localised and diffuse. (3) With time, visceral pains are often referred to more superficial structures. (4) The site of referred pain may also show hyperalgesia. (5) In disease states, the afflicted viscera may also become hyperalgesic. In this target article, I consider to what extent differences in the physiology, anatomy, and chemistry of peripheral processing systems explain these different sensibilities. In almost every aspect, there are subtle differences in the properties of the processing mechanisms for cutaneous and visceral information. These may arise because of distinct developmental cues operating in the two domains. Many of the differences between visceral and cutaneous afferents are quantitative rather than qualitative. The quantitative differences, for example in the density of afferent innervation, can be large. The quantitative differences in the numbers of afferents alone may be a sufficient explanation for some aspects of the differential sensibility, for example, the poor localisation of sensation and the apparent insensitivity to focal yet tissue-damaging stimuli. In addition, the few clear qualitative differences apparent in the innervations of the two tissue types may be of special importance. That the encoding of visceral nociceptive events may occur by an intensity mechanism rather than a specificity mechanism could be the key difference in viscerosensory and somatosensory processing.

Humans↗
PubMed2006

Hypoalgesia to experimental visceral and somatic stimulation in painful chronic pancreatitis.

OBJECTIVES: To gain more information of the pain mechanisms in chronic pancreatitis we applied standardized experimental pain stimulation of the duodenum, oesophagus and the skin in 12 healthy controls and 13 patients with chronic pancreatitis and typical pain attacks. METHODS: Using endoscopy a guide wire was positioned into the horizontal part of the duodenum, and a probe with a distal balloon was introduced over the guide wire. Mechanical stimuli were given as tonic (38 ml/min) or phasic (increasing volume steps of 5 ml delivered for 60 s) distensions of the balloon. After stimulation of the duodenum, the distal oesophagus was stimulated with the same protocol. Finally, the skin was stimulated with 'single and repeated burst' electrical stimuli reflecting activation of peripheral and central pain mechanisms. RESULTS: The stimuli reliably evoked both painful and non-painful local and referred sensations. The patients had hyposensitivity to both tonic and phasic mechanical stimuli of the duodenum and the oesophagus (P=0.001). Hypoalgesia was also observed to single and repeated electrical skin stimuli in the patients, most evident for repeated stimuli (P=0.001). The evoked referred pain did not differ between the groups, but the patients used on average more words from the McGill Pain Questionnaire to describe the pain evoked in the duodenum (P=0.02). CONCLUSIONS: Generalized hypoalgesia to experimental visceral and somatic stimulations was found in chronic pancreatitis. The findings suggest that the activation and modulation of central mechanisms is fundamental in pancreatic pain, and future studies should address the effect of analgesics with central effects in the treatment of these patients.

Abdominal Pain↗
PubMed2001

Switching from morphine to methadone to improve analgesia and tolerability in cancer patients: a prospective study.

PURPOSE: To evaluate the clinical benefits of switching from morphine to oral methadone in patients who experience poor analgesia or adverse effects from morphine. PATIENTS AND METHODS: Fifty-two consecutive cancer patients receiving oral morphine but with uncontrolled pain and/or moderate to severe opioid adverse effects were switched to oral methadone administered every 8 hours using different dose ratios. Intensity of pain and adverse effects were assessed daily, and the symptom distress score (DS) was calculated before and after switching. RESULTS: Data were analyzed for 50 patients. Switching was considered effective in 80% of the patients; results were achieved in an average of 3.65 days. In the 10 patients who switched to methadone because of uncontrolled pain, a significant reduction in pain intensity (P <.005) and an average of a 33% increase in methadone doses necessary (P <.01) were found after an average of 3.5 days. DS significantly decreased from an average of 8.4 to 4.5 (P <.0005). In the 32 patients switching because of uncontrolled pain and morphine-related adverse effects, significant improvement was found in pain intensity (P <.0005), nausea and vomiting (P <.03), constipation (P <.001), and drowsiness (P <.01), but a significant increase in the methadone dose of an average of 20% (P <.004) was required. CONCLUSION: In most patients with cancer pain referred for poor pain control and/or adverse effects, switching to oral methadone is a valid therapeutic option. In the clinical setting of poor pain control, higher doses of methadone are necessary with respect to the equianalgesic calculated dose ratios previously published.

Administration, Oral↗
PubMed2006

The effect of intravenous ketorolac on capsaicin-induced deep tissue hyperalgesia.

Preclinical and clinical studies have emphasized that persistent small afferent input will induce a state of central facilitation that can be attenuated by systemically administered nonsteroidal antiinflammatory drugs. However, these studies have been performed using cutaneous models of hyperalgesia. In this study we evaluated the effects of IV ketorolac on an experimental model of deep tissue hyperalgesia using IM capsaicin. We used a double-blind, placebo-controlled, crossover design. Ten subjects received 60 mg of ketorolac or placebo in 2 sessions separated by 1 wk. Capsaicin (100 microg in 10 microL) was then injected into the flexor carpi ulnaris muscle of the left forearm. After injection, spontaneous pain scores, pressure pain scores, gripping pain, pain distribution, and pain quality were recorded at 0, 5, 10, 15, 20, and 25 min. Cutaneous allodynia and dysesthesia were then mapped and thermal and mechanical thresholds were measured. The IM injection of capsaicin resulted in a reliable report of pain, hyperalgesia, and referred pain. Ketorolac had no effect on spontaneous pain, elicited pain, pain distribution, or secondary hyperalgesia induced by capsaicin. The findings of this study support the feasibility of further pharmacological studies using the IM capsaicin pain model.

Adult↗
PubMed2003

Neuropathic pain in patients with cancer.

We provide a detailed description of painful neural lesions in hospitalized patients with cancer. A total of 187 consecutive patients with cancer and pain, referred to the pain service of a cancer hospital, were evaluated within 24 hours by two neurologists and followed until discharge or death. Based on history, pain descriptors, physical examination, and radiological and electrophysiological studies, the pain was categorized as neuropathic in 103 patients. The most frequent sites of neurological injury were nerve roots, spinal cord and cauda equina, brachial and lumbosacral plexus, and peripheral nerves. There were no patients with pain caused by injury to the brain. In 93 of these patients, the pain was caused by ongoing neural injury, while, in 10 patients, the neural injury was old and stable. Within these two groups of patients with neuropathic pain, analgesic treatments differed. Prospective studies may determine if categorizing painful neurological injuries in cancer patients based on inferred pathophysiology is useful when deciding among different treatment options.

Adolescent↗
PubMed1989

[Management and treatment of patients with atypical facial pain].

The term "atypical facial pain" refers to a pain disease and should not be used for pain of peripheral origin. As a rule atypical facial pain is induced by a peripheral tissue trauma not necessarily associated with nerve lesions. The intensity of pain does not correlate with the measurable magnitude of the trauma. If treatment is possible, it will be the more successful the earlier it is started. Therapy comprises transcutaneous electric nerve stimulation, sympathetic nerve block, drug therapy and psychotherapy.

Adult↗