RESUMEN
BACKGROUND: Postoperative pain may lead to delayed mobilization, persisting pain, and psychosocial distress. There are no simple and reliable techniques for prediction of postoperative pain. This study was designed to evaluate if pain induced by venous cannulation or propofol injection can be used to predict postoperative pain. METHODS: This prospective study included 180 patients scheduled for laparoscopic cholecystectomy. Pain intensity associated with peripheral venous cannulation and administration of propofol preoperatively and pain intensity, and use of opioid postoperatively was recorded. RESULTS: Patients scoring cannulation-induced pain intensity > 2.0 VAS units were given postoperative opioid more often (65% vs. 36%; P < 0.001), earlier (12 min vs. 90 min; P < 0.001), and in higher doses (4.8 mg vs. 0 mg; P < 0.001), and also reported higher levels of postoperative pain intensity (5.8 vs. 2.9 VAS units; P < 0.001). There were also significant (P < 0.01) correlations with postoperative pain intensity (rs = 0.24), time to opioid administration (rs = -0.26), and total dose of opioid (rs = 0.25). Propofol-induced pain intensity correlated significantly (P < 0.05) with postoperative pain intensity (rs = 0.19). CONCLUSION: Pain intensity associated with venous cannulation and propofol infusion can easily be evaluated at bedside before surgery without specific equipment or training. Patients scoring > 2.0 VAS units on venous cannulation were found to have 3.4 times higher risk of postoperative pain after laparoscopic cholecystectomy. Low pain intensity associated with venous cannulation and propofol infusion indicate lower risk of postoperative pain.
Asunto(s)
Anestésicos Intravenosos/administración & dosificación , Cateterismo Periférico/efectos adversos , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Propofol/administración & dosificación , Adulto , Anciano , Anestésicos Intravenosos/efectos adversos , Colecistectomía Laparoscópica , Femenino , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Propofol/efectos adversos , Estudios ProspectivosRESUMEN
The purposes of the present study were to describe physical and psychological characteristics of 55 chronic pain patients with predominantly nociceptive neck and shoulder complaints, and to explore relationships between physical assessment methods, self-reported pain and psychological distress. The physical measures included cervical and shoulder mobility and muscle tenderness. The Pain Severity and Interference subscales from the Multidimensional Pain Inventory (MPI), Becks Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI-Y), and a pain drawing assessed self-reports of pain and psychological distress. The number of tender points (TP score) correlated significantly with pain severity, (p < 0.01) Interference (p < 0.05), pain drawing score (p < 0.05), BDI (p < 0.05) and state anxiety (p < 0.05). No significant correlation was seen between TP score and age, pain duration or trait anxiety. The results suggest that there are relationships between observers' ratings of muscle tenderness (TP score) and self-reports of pain severity, interference of pain and psychological distress in patients with chronic cervico-brachial pain.
Asunto(s)
Dolor de Cuello , Dolor de Hombro , Estrés Psicológico , Adulto , Anciano , Ansiedad , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor de Cuello/psicología , Dimensión del Dolor , Dolor de Hombro/psicologíaRESUMEN
This study focuses on the influence of trait anxiety and mood variables on changes in tooth pain threshold following two similar methods of somatic afferent stimulation, one familiar (manual acupuncture) and one unfamiliar (low-frequency transcutaneous electrical nerve stimulation [low-TENS]). Twenty-one acupuncture responders, treated for long-lasting orofacial muscular pain but naive to low-TENS, were selected for the study. In an experimental session, acupuncture and low-TENS were randomly given during two periods separated by a rest interval. Tooth pain thresholds (PT) were measured before and after stimulation with a computerized electrical pulp tester. Trait anxiety and depression were assessed with psychometric forms before the experimental session in all patients, whereas momentary mood was assessed in 10 randomly selected patients with visual analogue scales during and after the two types of stimulation. Following acupuncture, the group average PT increased significantly, whereas no significant change was observed following low-TENS. Higher scores on trait anxiety correlated significantly with a low PT increase following low-TENS, and higher ratings of stress correlated significantly with a low PT increase following acupuncture. This indicates that the magnitude of analgesia induced by these methods may be modified by psychologic factors like anxiety and stress.
Asunto(s)
Dolor Facial/psicología , Umbral del Dolor/psicología , Síndrome de la Disfunción de Articulación Temporomandibular/psicología , Terapia por Acupuntura , Ansiedad/fisiopatología , Dolor Facial/fisiopatología , Humanos , Psicometría , Análisis de Regresión , Estadísticas no Paramétricas , Estrés Psicológico/fisiopatología , Síndrome de la Disfunción de Articulación Temporomandibular/fisiopatología , Estimulación Eléctrica Transcutánea del NervioRESUMEN
Twelve outpatients, all women, who fulfilled the criteria for both fibromyalgia and chronic fatigue syndrome were rated on 15 items of the Comprehensive Psychopathological Rating Scale (CPRS-15). These items were chosen to constitute a proper neurasthenic subscale. Blood laboratory levels were generally normal. The most obvious finding was that, in all the patients, the homocysteine (HCY) levels were increased in the cerebrospinal fluid (CSF). There was a significant positive correlation between CSF-HCY levels and fatiguability, and the levels of CSF-B12 correlated significantly with the item of fatiguability and with CPRS-15. The correlations between vitamin B12 and clinical variables of the CPRS-scale in this study indicate that low CSF-B12 values are of clinical importance. Vitamin B12 deficiency causes a deficient remethylation of HCY and is therefore probably contributing to the increased homocysteine levels found in our patient group. We conclude that increased homocysteine levels in the central nervous system characterize patients fulfilling the criteria for both fibromyalgia and chronic fatigue syndrome.
Asunto(s)
Síndrome de Fatiga Crónica/líquido cefalorraquídeo , Fibromialgia/líquido cefalorraquídeo , Homocisteína/líquido cefalorraquídeo , Adulto , Cistationina/líquido cefalorraquídeo , Síndrome de Fatiga Crónica/complicaciones , Femenino , Fibromialgia/complicaciones , Humanos , Metionina/líquido cefalorraquídeo , Persona de Mediana Edad , Modelos Biológicos , Vitamina B 12/líquido cefalorraquídeoRESUMEN
Changes in skin temperature and haemodynamics were studied during experimentally administered electro-acupuncture before and after a 4-week period of electro-acupuncture (EA) treatments. Subjective pain intensity was evaluated using a pain questionnaire. Twelve patients with long-lasting nociceptive pain were included. Before clinical treatment, skin temperature tended to decrease after 30 minutes' stimulation. In contrast, a significant increase was seen after the clinical treatment. No significant changes were seen for blood pressure, heart rate or pain intensity before and after the clinical treatment. The data indicate that an increased skin vasoconstrictor sympathetic activity may be responsible for the decreased skin temperature during the electro-acupuncture in the initial test sessions, whereas an inhibition of skin sympathetic activity and/or a release of vasodilatory substances may be responsible for the increase in temperature after completed clinical treatment. Despite a small number of subjects and correction for multiple inference, the difference in temperature effects before and up to 3 months after acupuncture treatment was significant.
Asunto(s)
Electroacupuntura , Manejo del Dolor , Dolor/fisiopatología , Temperatura Cutánea , Adulto , Enfermedad Crónica , Femenino , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Dimensión del DolorRESUMEN
The effects of one 5-HT1A serotonin agonist (8-OH-DPAT) and of two alpha 2 noradrenaline agonists (tizanidine and B-HT 933) were tested on the transmission between group II muscle afferents and spinal neurons in the sacral segments of the spinal cord in the cat. These agonists have previously been found to depress transmission from group II muscle afferents either in the dorsal horn or in the intermediate zone of midlumbar segments, and this study addressed the question of whether their actions in the sacral segments are similarly selective. The drugs were applied ionophoretically and their effects were tested on field potentials evoked from group II muscle afferents. As judged by changes in the amplitude of the early components of these field potentials, the transmission is effectively depressed by the serotonin agonist (to 56 +/- 26% after 2 min of ionophoresis of 8-OH-DPAT) but not by the noradrenaline agonists (to 97 +/- 12% after 6 min of ionophoresis of B-HT 933 and to 95 +/- 17% after 6 min of ionophoresis of tizanidine). These data suggest that transmission from group II muscle spindle afferents in the sacral segments is under control of serotonin releasing neurons, as in the dorsal horn of midlumbar segments, but leave open the question of the similarities or differences in the mechanisms (pre- and/or postsynaptic) of this control.