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The current study investigated the utility of the Back Pain Classification Scale with chronic, intractable low back pain and headache patients. Subjects consisted of 50 chronic low back pain and 50 chronic headache patients referred to a university based Pain Center for evaluation. Data indicated that subjects were a representative sample of severely intractable chronic pain patients typically referred for Pain Center evaluation and treatment. Each was administered the Back Pain Classification Scale as part of a thorough physical and psychological/behavioral evaluation. All subjects were classified by blind review of medical records into one of two categories: (1) presence of psychopathologically based pain complaint with little or no pathophysiological findings and (2) presence of pathophysiologically based pain complaints with little or no psychopathological findings. Subjects were also independently classified from blind review of their scores on the Back Pain Classification Scale into one of these two categories. Findings revealed that the Back Pain Classification Scale accurately predicted the actual classification of 80% of the low back pain patients (i.e., 30% above baseline prediction rate) and only 60% of the chronic headache patients (i.e., only equal to the baseline prediction rate). Furthermore, the scale was found to be most accurate in predicting low back pain patients with primary psychopathologically based pain. It was concluded that the Back Pain Classification Scale was an empirically valid instrument to use with chronic low back pain patients, but not with chronic headache patients. This lack of utility with chronic headache patients was also viewed as support for the construct validity of the scale. Wider use of the scale with chronic low back pain patients was suggested.
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PMID:Cross-validation of the Back Pain Classification Scale with chronic, intractable pain patients. 316 34

Orbital venous vasculitis has been suggested to cause characteristic periorbital pain in patients with pathologic changes in their orbital phlebograms. The orbital pain is characterized by being unilateral, not shifting side, boring and pressing, but not throbbing, increasing on eye strain, exposure to cold, or weather changes, and resistant to analgesics. It is ameliorated by steroids. Fifty patients with symptoms of orbital venous vasculitis were investigated for other symptoms that could be related to the vasculitis. When the 32 female patients were compared with a randomly selected age- and sex-matched control group, there was a significant increase of symptoms of chronic fatigue, cold feet, gut problems such as constipation and/or diarrhea, arthralgia, memory impairment, rotatory vertigo, spontaneous ecchymoses (all, p less than 0.0001), back pain (p less than 0.012), and thrombophlebitis (p less than 0.022) in the patient group. These symptoms, although commonly occurring, seem in these patients to be related to the vasculitis. Blood tests of the fifty patients showed signs of inflammation which did not disagree with the hypothesis of an immunologic cause of the orbital venous vasculitis.
Cephalalgia 1988 Dec
PMID:Systemic symptoms associated with orbital venous vasculitis. 321 27

The care of burns to the head, face, and neck remains a challenge to the clinician. From 1978 to 1986, halo traction was used as an immobilizing device and as a protective frame for 31 patients with burns to the head (n = 8), face (n = 24), and neck (n = 28). The patients ranged in age from 8 months to 80 years (mean = 16 years) and had second- and third-degree burns covering a total body surface area of 8% to 75% (mean = 28%). The halo was used for an average of eight days (range one to 19 days) and served to immobilize and protect areas of fresh skin grafts, as well as to elevate and protect scalp donor sites (n = 10). Traction was initially used in patients who were confused and uncooperative, and in patients whose burns involved the neck to provide extension for prophylaxis against contractures. Treatment side effects included intermittent headache and backache, the latter occurring especially in the patients subjected to hyperextension. Eight patients (26%) complained of discomfort, which was reduced with adequate analgesia, sedation, and emotional support. The halo had to be removed from one patient after one day because of a loose pin, and in another patient after eight days because of the development of cellulitis at a pin site. Halo immobilization was used successfully to minimize graft loss in 30 of 31 patients.
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PMID:Halo immobilization in the treatment of burns to the head, face, and neck. 328 35

A double-blind, placebo-controlled crossover trial was undertaken to determine the efficacy of meclofenamate sodium in the treatment of menorrhagia. Twenty-nine patients who had a baseline menstrual blood loss greater than 60 ml received 2 months' each of meclofenamate sodium, 100 mg by mouth, three times a day, or a placebo. The mean menstrual blood loss was reduced from 141.6 +/- 15.9 ml at baseline to 69.0 +/- 6.3 ml during treatment cycles but remained increased during placebo cycles (135.6 +/- 11.3 ml). The symptoms of dysmenorrhea, backache, and headache were significantly reduced only during active drug periods. The number of days of flow and pads or tampons used was also reduced during drug cycles but not during placebo cycles. Overall, 26 of the 29 patients evaluated had a reduction in menstrual blood loss with the use of meclofenamate sodium. It appears that many women with unexplained menorrhagia may benefit from this treatment.
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PMID:Treatment of menorrhagia with meclofenamate sodium. 331 21

Antidepressant drugs have been used successfully in the treatment of chronic pain syndromes. Clinical trials have supported the use of these drugs for pain and the depression that often accompanies pain syndromes. Although the exact mechanisms of action have not been clearly elucidated, it has been suggested that these agents have analgesic properties independent of their antidepressant effect on mood and behavior. Pain patients without concomitant depression experienced pain relief with antidepressant therapy; these patients represent the most convincing evidence that antidepressant drugs have a direct analgesic effect. Studies presented in this paper support the clinical efficacy of antidepressant medications in the treatment of patients suffering from headaches (migraine, tension, and mixed types), diabetic neuropathy, arthritis, and facial pain. These data also suggest that antidepressant drugs may be effective in the treatment of postherpetic neuralgia, back pain, and pain from mixed etiologies; however, data for these pain syndromes are less clear, and, thus, further testing is required.
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PMID:The future for antidepressants: treatment of pain. 332 Nov 36

A survey concerning common pain conditions and psychological distress was carried out among a probability sample of the adult enrollees of a large health maintenance organization in Seattle. The prevalence of pain in the prior six months was 41% for back pain; 26% for headache; 17% for abdominal pain; 12% for chest pain; and 12% for facial pain. Headache, abdominal and facial pain were less prevalent among older persons and more prevalent among females. We examined the temporal dimensions of these pain conditions, as well as intensity, treatment seeking, and activity limitation. The pain conditions were typically long standing, recurrent, of mild to moderate intensity, and usually did not limit activities. However, depending on the pain condition, 9-40% reported one or more days in the prior six months when they were unable to carry out their usual activities due to the pain problem. On average, persons with a pain condition had higher levels of anxiety, depression, and non-pain somatic symptoms as measured by the scales of the Symptom Checklist (SCL); poorer self-rating of health status; and more family stress compared to persons without a pain condition. Of these alternative measures of distress, the SCL somatization scale had the strongest independent association with pain. The increments in measures of anxiety, depression, and family stress with the presence of pain were greatest among persons with higher levels of non-pain somatic symptoms.
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PMID:An epidemiologic comparison of pain complaints. 336 55

Voluntary abortions in day hospitals fulfill the need for shorter hospital stays and minimal interference with patient activities; on the other hand, it makes it more difficult to evaluate the possible complications of anesthesia. 1820 patients who received general anesthesia for voluntary abortion were given a questionnaire before they were discharged; items queried included drowsiness, headache, dizziness, nausea or vomiting, sore throat or mouth, abdominal cramps, pain at IV site, backache or muscular cramps, inability to perform daily activities. Only 465 patients returned the questionnaire. The most frequent complaint was sleepiness or drowsiness (19.8%), headache (7.1%), dizziness (15.1%), nausea or vomiting (8.2%), abdominal cramps (24.7%), and backache (16.7%). There seems to be less nausea or vomiting with the use of pentothal rather than alothane. Ketamine was never used on its own. The findings seen to suggest that the simplest combinations of drugs result in fewer and less severe complications than the use of several drugs.
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PMID:[Minor sequelae of ambulatory anesthesia]. 345 85

In a health and morbidity screening among 500 carpet weaving children and 450 children attending school selected at random in a rural field practice area the age group studied was from 6 to 16. Each child was thoroughly interviewed and examined for any deviation from health. The height and weight were taken by standard procedures and clinical assessment of morbidity and nutritional status was also observed. The results showed that the heights and weights of schoolchildren were greater than those of the carpet weaving children in both boys and girls. Clinically, 56% of the schoolchildren as against 41.6% of carpet weaving children had no nutritional defects. The main complaints in the carpet weaving children were in order of descent, headache, blurring of vision, backache, abdominal pain, limb pains, and respiratory tract infection. Both groups of children were later followed up for six months from September 1981 to March 1982. The incidence of subjective and objective deviations from health were higher in the carpet weaving than in the schoolchildren and the first ten major complaints in the carpet weaving children were respiratory tract infection, headache, backache, pain in the abdomen, injuries (major and minor), joint pains, diarrhoea and dysentery, fever of unknown origin, dermatitis, and chilblains.
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PMID:Health status of school age children employed in carpet weaving in Ganderbal Block. 349 Aug 78

The use of iopamidol and iohexol for lumbar myelography is compared in this study. Fifty-eight patients were examined, the contrast media being allocated on a randomised double-blind basis. Radiographic quality was good with both media. Headache and an increase of back pain were the most frequent symptoms, though the incidence of side-effects was slightly but significantly greater with iohexol. We conclude from our study that while the radiographic quality is comparable, iopamidol seems to be slightly better tolerated.
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PMID:A comparison of iohexol and iopamidol for lumbar myelography. 353 Jun 2

A prospective study of health service utilization carried out in the Correctional Services of Canada (CSC), Pacific Region, is reported. Health service encounters occurring at the six Regional Institutions with on-site health care centers between May 29th and June 28th, 1984 were surveyed using a health clinic encounter form. There were 7,449 encounters during the study period. The mean rate of encounters was 5.2 per inmate. Seventy-two percent of these encounters occurred at wickets, and 28% occurred at clinics. Physician visits occurred at a mean estimated annual rate of 6.7 visits per year. This is 2.4 times higher than the mean annual physician visit rate for non-institutionalized men in Canada. The reason for visits was new illness (57%), chronic illness (31%), injuries (5%), psychosocial problems (2%), and administrative (5%). The encounter rate per 100 inmates varied from 19.7 to 1,203.6 across the institutions studied. Overall 89% of all visits were seen by health service nurses, while 11% were seen by physicians. Using ICHPPC-2 Defined, the ten most common complaints presented to the health service were headache, sore throat, stomach complaint, other respiratory complaint, tension headache, limb pain, other/not codable, medical examination, back pain and upper respiratory tract infection. These ten complaints accounted for 4896 (59%) of the total complaints recorded. The majority of visits took less than five minutes, were most often treated with medication, and did not require scheduled follow-up. The 50 most frequent visitors, those making 25 or more visits during the study period, while only 3.5% of the study population, accounted for 25% of all encounters.
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PMID:Prison health services: a utilization study. 358 36


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