Expectations Of Pain Relief Research Articles

Microsurgical DREZotomy for pain of spinal cord and Cauda equina injury origin: clinical characteristics of pain and implications for surgery in a series of 26 patients.

The result of the DREZotomy procedure used for the treatment of chronic intractable neuropathic pain caused by injuries at the T9-L4 spine level in 26 patients has been reported. For the purpose of identifying the most favorable pain pattern for DREZ surgery we retrospectively analyzed the effectiveness of surgical treatment on different forms of pain in the follow-up period of 13-50 months, 37 months on average. All pain forms were classified according to subjective sensory pain expression including the rhythm and topography of the pain. Three groups of pain were formed according to subjective sensory equivalents: pain of thermal quality (burning, boiling, baking, warm etc.), pain of mechanical-nonthermal quality (shooting, cutting, stabbing, sharp, incisive, cramping, constriction, distraction, throbbing etc.). The third group was the combination of the previous two. Success in pain relief has been defined as a 50% or greater reduction in pain after surgery such that pain no longer interferes with patient activities of daily living and sleeping pattern and no longer requires routine analgesic pain medication. Our results revealed that the pain of mechanical-nonthermal nature and intermittent rhythm, confined to segmental topography was the most responsive to the DREZ surgical treatment so that 90% patients suffering from this pain pattern experienced a good long-term pain relief (70% had complete long term pain relief). Neuropathic pain of thermal quality with the diffuse infralesional distribution and steady rhythm was the most resistant to the DREZ surgical treatment: neither patient had long-term relief of this pain pattern. In the group of patients suffering from pain consisting of combined mechanical and thermal sensory components with confined pain territory, 75% experienced a good long-term pain relief (50% had complete long-term pain relief). Immediate pain relief was obtained in 88% of patients and was long lasting in 69% of the total series. Our results pointed to confined territory, intermittent rhythm and mechanical nature of the pain as the most relevant predictors of the expected pain relief achieved by the DREZ surgery.

Blinding effectiveness and association of pretreatment expectations with pain improvement in a double-blind randomized controlled trial

Patient, provider, and clinical investigator expectations concerning treatments are believed to play important roles in patient response. This study examined the association of patient and research nurse/physician pretreatment expectations of pain relief with actual pain relief, the accuracy of patient and research nurse guesses about patient medication assignment, and changes in research nurse and patient pain relief expectations over the course of a randomized double-blind trial of amitriptyline versus an active placebo for patients with chronic pain and spinal cord injuries (SCI). Patient expectations of pain relief with amitriptyline were associated significantly with actual pain decrease for patients in the amitriptyline, but not placebo, condition. Research nurse/physician expectations did not predict patient pain relief. Both patients and the research nurse were able to guess patient medication assignment at a rate significantly greater than chance. The research nurse's, but not the patients’, expectations of pain relief with amitriptyline decreased significantly over the course of the study. These findings have implications for future randomized controlled trials. Fully double-blind conditions are very difficult to achieve, and it is informative to assess patient and research clinician expectations and guesses regarding medication assignment.

Correlation of Correction Angle with Pain at First Metatarsophalangeal Joint in the Treatment of Hallux Valgus

Purpose : We evaluated the correlation between correction angle and pain of the first metatarsophalangeal joint in the treatment of hallux valgus. Materials and Methods : The 28 cases (20 patients) with moderate to severe hallux valgus deformity and pain of the first metatarsophalangeal joint who underwent the distal soft tissue procedure and proximal metatarsal closing wedge osteotomy, were divided into two groups, Group I: no pain of the first metatarsophalangeal joint after surgery, and Group II: with persisting pain. We analyzed the correction angle and pain of the first metatarsophalangeal joint in each group, preoperatively and at the last follow-up. All of the patients were women and their mean age was 58 years old. The average follow-up time was 18months. Results : At the last follow-up, the 21 feet (75%) were free of pain of the first metatarsophalangeal joint. In 7 feet (25%) pain persisted. In group I, sufficient deformity correction was obtained, but in group II, the deformity was corrected insufficiently. A high correlation was observed between correction angle and pain relief. Conclusion : A high correlation was obtained between correction angle and pain of the first metatarsophalangeal joint in the treatment of hallux valgus deformity. Therefore, in view of the patient’s expectation of pain relief, meticulous attention should be paid to the correction of hallux valgus deformity.

Hispanic and non-hispanic white patient pain management expectations

This study compares emergency department (ED) pain management expectations in Hispanic versus non-Hispanic white patients with painful conditions. A prospective convenience sample of patients was enrolled at a university ED. Patient expectations of pain relief were recorded on a 100-mm visual analogue scale (VAS). Surveys from 58 Hispanics and 408 non-Hispanic whites were completed and used for data analysis. Sample size was adequate to detect a minimum difference in pain relief of 13 mm. Both groups had similar chief complaints and degree of pain at presentation. Their demographics differed in age and language spoken. Mean expectations for pain relief were not significantly different (76mm [95% confidence interval (CI) 70-82] and 72mm [95% CI 70-74]) between Hispanics and non-Hispanic whites, respectively. Mean expectations of a reasonable time to wait for pain medications were also not significantly different (31 minutes [95% CI 28-33] and 33 minutes [95% CI 26-48]) between Hispanics and non-Hispanic whites, respectively.

Hospice care and patients' pain: communication between patients, relatives, nurses and doctors.

This article describes a study that sought to assess how patients, relatives, doctors and nurses in a palliative care unit viewed pain and pain management, and how standards and expectations for pain relief can be raised by upholding statements of care and agreed partnership values. The results showed that research-based pain management enables the provision of pain control that is acceptable to patients, relatives, doctors and nurses. By valuing patient-centred care, where assessment tools assist communication and information sharing, a partnership of care is established in which patient and professional autonomy are recognized and respected, international recommendations for pain relief are practised and professional codes of conduct upheld. Good pain management requires accurate assessment that is best achieved by open and honest discussion in a supportive environment. Hospices provide specialist symptom control aimed at improving quality of life for patients with advanced disease. They are not only an ideal setting to provide evidence for practice, but also a learning environment for specialist understanding of symptom control and a resource base for other professionals.

The temperament and character inventory (TCI) in patients with substance use disorders: Comparative study with community subjects

Numerous studies of experimental and clinical pain show that placebo treatments reduce reported pain and that expectancies play a key role in their effectiveness. However, very little is known about the neurobiological mechanisms of either placebo analgesia or the generation of expectancy that enables it. To address this issue, I used functional magnetic resonance imaging to quantify placebo-induced changes in pain-processing brain regions during the experience of pain. Results show placebo-induced decreases in contralateral thalamus, anterior insula, and anterior cingulate, and increases in prefrontal brain regions that may maintain expectations for pain relief. These findings are discussed in light of several proposed neuropsychological mechanisms of placebo analgesia: altered appraisal of threat, diversion of attention, and activation of descending opioid systems for spinal control. These results suggest that placebo treatment alters the appraisal process, reducing the subjective distress caused by pain.

The prognostic importance of patient pre-operative expectations of surgery for lumbar spinal stenosis

The influence of psychosocial variables in the outcome of surgery for lumbar spinal stenosis (LSS) has not been evaluated. We studied 257 patients with LSS pre-operatively and at 6 months to: (a) relate patient expectations of surgery to baseline function and pain; and (b) determine how patient expectations and pre-operative function interact to predict post-operative outcomes. Results: On average, patients experienced substantial pain relief, improved function and satisfaction. Patients with many pre-operative expectations, particularly patients with low baseline function, reported more improvement in post-operative function than patients with few expectations. More ambitious expectations for physical function were also associated with improved function and satisfaction at 6 months. Conversely, having more numerous pain relief expectations was associated with more pain and less satisfaction with pain relief. Conclusion: Patient expectations influence recovery from surgery at 6 months. To improve outcomes and satisfaction, clinicians should discuss expectations with patients pre-operatively.

Quantifying meaningful changes in pain.

One hundred and thirty-eight nurses were asked to indicate the smallest meaningful reduction in pain from each of four hypothetical pain intensities: 100, 75, 50 and 25, on 100 mm visual analogue scales. The median values for the smallest meaningful reductions in pain were 31, 24, 18 and 10 mm, respectively, representing reductions in pain intensity of 31%, 32%, 36% and 40%, respectively. These tests were repeated in 110 patients before and after they had a lower third molar extraction under general anaesthesia. The patients' expectations of pain relief, pre- and postoperatively, were very similar to those observed in the nurses. For each of the four hypothetical pain intensities the median values for meaningful reductions in pain became greater following surgery. The pre-operative median reductions from the hypothetical pains 100, 75, 50 and 25 mm were 26, 20, 15 and 11 mm (26%, 27%, 29% and 44%), respectively. The corresponding postoperative reductions were 31, 24, 19 and 12 mm (31%, 32%, 38% and 48%). To achieve a meaningful reduction in pain postoperatively in 50% of patients it is necessary to reduce pain as represented by the visual analogue scale, by between 31 and 48%, depending on its initial intensity.

Where are the causes of placebo analgesia?: A behavioral experiential analysis

Environmental conditions that foster a placebo analgesic effect include prior exposure to an effective analgesic treatment and contextual cues associated with such treatment. This evidence for the role of classical conditioning in placebo analgesia suggests the potential use of animal models for studying this phenomenon and the possibility of understanding it at the level of neural mechanisms. In addition, cognitive dimensions, such as desire for and expectation of pain relief, can potentially extend explanations of how placebo analgesia occurs. Importantly, these experiential factors are measurable and could be incorporated into analyses of human placebo analgesia. Measures of experiential factors that may directly cause placebo analgesia, multiple measures of the different dimensions of pain, and adequate controls for the natural history could permit a refined analysis of the nature and mechanisms of placebo analgesia. Measurement of the critical experiential factors that cause placebo responses may have far-reaching implications for the evaluation of placebo effects in human clinical studies.

Low expectations of pain relief encourage persistence of poor standards

EDITOR,--M Harmer and colleagues report the slow pace of development and lack of funding for acute pain services in Britain since a report on postoperative pain by the Royal College of Surgeons of England and the College of Anaesthetists.2 Their paper makes for depressing though familiar reading for those working to secure universally applied humanitarian standards of postoperative analgesic care for surgical patients. Like …

Maternal expectations and experiences of labour pain — options of 1091 Finnish parturients

A prospective survey of 1091 Finnish parturients was conducted in order to ascertain mothers' expectations for labour pain relief, to measure the actual pain during all three stages of labour and to question their satisfaction and the adequacy of pain relief on the third day following delivery. Antenatal expectations for pain relief were surveyed. Mothers were questioned on pain levels in the delivery room and 3 days after giving birth. Pain levels were ascertained using a visual pain score method. Antenatally, 90% of all parturients anticipated a need for pain relief during labour. In the delivery room over 80% of all parturients described their pain as very severe to intolerable, only 4% of the multiparous had low pain scores (0-2). After pain treatment 50% of multiparous women still had pain scores from 8 to 10, which reflects a lack of effective pain relief. Dissatisfaction with the childbirth experience was very low, and was associated with instrumental deliveries, but not with the usage of analgesia. 51% of all parturients complained of inadequate pain relief during childbirth, which, in multiparous women, was significantly associated with the second stage of labour.

Identification of patient, medical and nursing staff attitudes to postoperative opioid analgesia: stage 1 of a longitudinal study of postoperative analgesia

Sixty-one successive patients undergoing routine cholecystectomy together with all the registered nursing staff and junior doctors working on the surgical wards in a major teaching hospital were studied by means of questionnaires. These were designed to identify beliefs and attitudes to postoperative analgesia in the hospital. The survey revealed that there is a continuing prevalence among medical and nursing staff of attitudes and practices likely to contribute to poor postoperative analgesia. Patients had low expectations of pain relief and displayed reluctance to request analgesia. Injections were generally effective when given, but dosing intervals were often too long for good analgesia. With this knowledge it has been possible to devise strategies to counteract those attitudes leading to poor analgesia and these have formed the basis of a new Acute Pain Service. It is intended to repeat this survey at 3 yearly intervals in order to monitor progress.

Patients have low expectations of pain relief following surgery

Patients have low expectations of pain relief following surgery

Perceptions of pain relief after surgery.

To assess patients' satisfaction with postoperative pain relief. A descriptive and questionnaire study of patients' experience. Two surgical and two gynaecological wards. 50 Patients admitted to hospital for cholecystectomy and 51 admitted for hysterectomy. Visual analogue scales with no divisions were completed by the patients immediately after each dose of postoperative analgesia was administered throughout their stay in hospital. A questionnaire completed on the fifth postoperative day recorded patients' recollections of their experience. Opinions were also sought from medical and nursing staff. During the first 24 hours after surgery recorded pain levels were 60% of the maximum and were not influenced by age, sex, or the type of operation performed. The median interval between the return of pain and a further injection of analgesic was 2 hours (interquartile range 1 to 3.5 hours). Expectations of pain relief were low, and for 70% of the patients the pain was at least as bad as they had expected. Only half of the medical and nursing staff questioned thought that postoperative analgesia should relieve pain completely; drugs were prescribed and administered with too little attention to the patient's response and too much concern about adverse effects and opioid dependence. The results suggest that the standard of postoperative pain relief is poor because of inadequate education of patients in what to expect (and demand), and of medical and nursing staff in how to prescribe and administer analgesia with reference to individual drug response.

Total knee arthroplasty in chronic hemophilic arthropathy.

Nine total knee arthroplasties were performed in seven patients with either Hemophilia A (factor VIII deficiency) or Hemophilia B (factor IX deficiency) and followed for an average of 52 months. A total condylar prosthesis was used in eight virgin knees and a stemmed variable axis prosthesis was used in one revision case. All knees demonstrated the severe joint destruction and cartilage erosion characteristic of chronic hemophilic arthropathy. The average age at operation was 32 years. All patients were evaluated using the knee disability assessment of The Hospital for Special Surgery. All knees were postoperatively rated as either excellent or good. Pain, function, and range of motion were markedly improved. Postoperative radiographic alignment averaged 4 degrees of valgus with half of the virgin knees demonstrating 1 mm or less of non-progressive tibial radiolucency without clinical loosening. The only complication was hemarthrosis from 37 to 59 months postoperatively. This was thought to be secondary to trauma to residual synovium. Total knee arthroplasty in the hemophiliac is a viable alternative to conventional methods of treatment for chronic arthropathy and expectations for pain relief and functional gain can be high.

Acupuncture treatment: a perspective.

Acupuncture, dating back some 4,000 )'ears, is a major method of treatment for more than one-third of the world's populationJ Although associated with China, acupuncture is practiced in Japan, Africa, India, Indonesia and other parts of the Asian world for diagnosis and treatment of body disorders as well as pain control. 2 In the West, its use was first recognized by Sir William Osler in 1892, who proposed that threeto four-inch needles inserted into lumbar muscles and left in place for 5 to 10 minutes were an effective treatment for lumbago; 3 Osier also noted that applying constant electrical current to these needles was sometimes beneficial for the patient. 3 Despite this lengthy histor); western physicians view the therapeutic effects of acupuncture with skepticism. 4 Response differences between Oriental and Occidental cultures may be related to patient selection, duration of pain, psychological readiness and expectations for pain relief of the individual selected for this therapy. In hospitals throughout the People's Republic of Ctfina, scientific and traditional medicine coexist. 5 Often acupuncture is prescribed early in the treatment of painful conditions. To benefit from this procedure, the patient must be emotionally stable, physically receptive and psychologically prepared. In low back pain patients for example, surgical intervention is often considered only if acupuncture fails to provide pain relief. In the West, acupuncture treatment is usually prescribed after medical and surgical fail to control pain. Used in this manner, Addison 6 places acupuncture with other vogue therapies that work only 15% to 20% of the

Expectations and outcome of total hip replacement.

The preoperative function, expectations of pain relief and expectations of improvement in activities of daily living were compared with the results nine months after total hip replacement in 145 patients with osteoarthrosis or rheumatoid arthritis. patients improved functionally and their expectations generally were met. They were most satisfied with improvements in pain relief and mobility but 28% still expressed disappointment because specific expectations were not fulfilled. The expectations of doctors were higher than those of occupational therapists.