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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of this research was to identify the factors which people with rheumatoid arthritis (RA) believed contributed to their fatigue. A second purpose was to examine the relationships among identified factors and the sensation of fatigue. One hundred people with RA were asked to identify verbally factors which they believed contributed to their fatigue. The three most frequently identified factors included RA disease activity, disturbed sleep and increased physical effort. These factors were operationalized and measured as joint pain using the Modified McGill Pain Inventory, fragmented sleep through overnight electroencephalographic (EEG) sleep studies, and reduced physical ability using walking time and grip strength measures. Fifteen of the original subjects with RA and 12 age and gender matched control subjects completed the second phase of the research. Five of the RA subjects were experiencing a disease flare while the remaining 10 were either in remission or their disease was midly active. Those subjects in flare had significantly (P less than 0.01) more joint pain, significantly (P less than 0.05) more fragmented sleep, and significantly reduced functional capacity as measured through walking time (P less than 0.05) and grip strength (P less than 0.05) when compared to non-flare and control subjects. Fatigue levels of the subjects in flare were positively correlated with joint pain (r = 0.62), fragmented sleep (r = 0.42) and grip strength of the right hand (r = 0.52) and left hand (r = 0.88). Fatigue levels of non-flare and control subjects were negatively correlated with the majority of measured variables.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Factors which contribute to fatigue associated with rheumatoid arthritis. 177 87

By reviewing the literature, this paper explores the nature and function of sleep. Most of the evidence for the functional theories of sleep has been obtained as a result of examining the effects of sleep deprivation, the physiological, emotional and behavioural effects of which are discussed. There is a discussion on how an awareness of the theoretical knowledge may help in the nursing care of patients with advanced cancer and other chronic diseases, as well as their carers. The physiological effects of stress, and the possible relationship to patients and their carers, leads the author to highlight the need for further research, and possible benefit of proactive intervention for the bereaved. The effects of poor nutrition and common symptoms such as pain and dyspnoea on sleep, and the iatrogenic causes of sleep disturbances, are discussed. The importance of individualized patient care is stressed. The conclusion is drawn that although researchers do not seem to have been able to prove conclusively any essential function of sleep, the nurse is in a unique position to facilitate and enable patients and their carers to cope during the waking hours, without the added stress that sleep disruption and deprivation bring.
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PMID:Why do we need sleep? Relating theory to nursing practice. 179 Dec 60

Sleep disturbances are common in cancer patients, but there are few specific data on their prevalence. Among other things, sleep problems may be a symptom of the cancer itself, part of a stress reaction to having cancer, a sequela to some other cancer symptom such as pain, or a side effect of cancer treatment. Insomnia is the more common sleep problem, although hypersomnia also occurs. Most insomnias are related either to pain or to psychophysiologic factors. Treatment should start with identification of a specific cause of sleeplessness; after that, behavioral interventions, medication, or psychotherapy may be helpful. When using medications, keep in mind possible complications, such as daytime sedation, tolerance, and rebound insomnia.
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PMID:Management of sleep problems in cancer patients. 183 74

Percutaneous efficacy and tolerability of a new topical indomethacin spray compared with a corresponding placebo product were evaluated in a double-blind, randomized crossover study in 30 patients with tendinitis, i.e. 28 patients with peri-arthritis of the shoulder and two with epicondylitis. Each patient was treated with 4% indomethacin spray or the corresponding placebo product three to five times daily for a period of 14 days and then received the other treatment for the same period of time. The indomethacin spray demonstrated a clear efficacy compared with the placebo based on both objective criteria (elevation, abduction and internal rotation) and subjective criteria (spontaneous pain, pain on movement, pressure-induced pain, functional disturbances and sleep disturbances). Tolerability was excellent: only two patients had minor local cutaneous irritation with the indomethacin spray, which did not require interruption of treatment. Treatment with indomethacin spray appeared to be effective in 80% and well-tolerated in 93% of the patients studied.
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PMID:Double-blind, randomized crossover study of the percutaneous efficacy and tolerability of a topical indomethacin spray versus placebo in the treatment of tendinitis. 186 49

There continues to be an emerging body of literature related to fibromyalgia and the related conditions chronic fatigue syndrome and myofascial pain. During the past year, the most notable contributions included a large multicenter study providing new diagnostic criteria for the classification of fibromyalgia and clinical studies describing the overlap of fibromyalgia, chronic fatigue syndrome, and myofascial pain. Pathophysiologic studies were often preliminary and uncontrolled but the focus of these studies on abnormal nociception, neurohormones, and muscle metabolism provides an exciting hypothesis to unify pain, fatigue, and sleep disturbances, the primary symptoms of fibromyalgia. Unfortunately, new therapeutic trials were neither innovative nor especially encouraging.
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PMID:Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. 206 4

Temporomandibular joint (TMJ) disorders have been collectively grouped as myofascial pain-dysfunction syndrome (MPDS) or temporomandibular joint dysfunction syndrome (TMJDS). In the past, these terms have been used synonomously to describe a set of clinical signs and symptoms that include pain in the TMJ and muscles of mastication, limited or deviant opening of the mandible, and/or joint sounds. The present study segregated two major subgroups subsumed within this diagnostic classification and assigned them to a myogenic facial pain (MFP) group and a TMJ internal derangement (TMJID) group. Previous studies may have included both of these disorders as MPDS/TMJDS. While some signs and symptoms are similar, the primary differentiation is based on meniscus displacement present with TMJID patients and pain distribution patterns between the two groups. While MFP/TMJID patients comprise the majority of the facial pain population, a third major group of patients is encountered, being classified under the diagnostic appellation of atypical facial pain (AFP). Patients with AFP usually complain of vague and wandering pain in the maxilla or mandible; however, no identifiable source of infection or organic disease can be uncovered. One hundred fifty patients seeking consultation and care for facial pain met the criteria for inclusion into one of three clinical groups. The groups were compared for age, sex, duration of symptoms, bruxism and/or clenching habits, and disturbed sleep patterns. Differences in surface electromyographic levels from the facial and cervical muscles were also examined. Minnesota Multiphasic Personality Inventory (MMPI) scores from 95 subjects were compared with self-report measures of depression and anxiety. It was concluded that subcategorization of myofascial pain dysfunction patients into a MFP and TMJID group is justified on the basis of psychometric differences, clenching habits, masseter EMG levels, and male:female ratio. Furthermore, psychopathological factors are more significant among MFP and AFP subjects than TMJID patients.
Clin J Pain 1990 Mar
PMID:Comparison of clinical characteristics in myogenic, TMJ internal derangement and atypical facial pain patients. 213 94

One hundred and seventeen outpatients (87 females and 30 males; mean age 53.5 +/- 13.2 years) encompassing the 1987 American Rheumatism Association criteria for rheumatoid arthritis were admitted into a multicentre open study. All patients were evaluated at baseline and after two months of therapy with etodolac (400 or 600 mg/die per os). Clinical evaluation was performed by using the following indicators: viso-analogic scale of global pain; index of pain on active movements; index for sleep disturbances, and duration of morning stiffness. The erythrocyte sedimentation rate was chosen for the laboratory evaluation of the activity of the disease. One hundred patients received 400 mg/die, while only 17 patients received 600 mg/die; 115 patients undertook the evaluation after treatment, whereas two patients were considered "lost to follow-up". One hundred and five patients completed the study while ten patients withdrew (seven because of inefficacy and three because of intolerance of the gastrointestinal tract). Only nine patients presented side-effects, among these: five were judged etodolac-related, whereas four were not. A complete resolution of all these side-effects was achieved in all cases. Significant improvements were registered for all the four clinical variables. At the end of the study 56.5% of patients expressed a preference for etodolac, 16.5% for one of the non-steroidal anti-inflammatory drugs previously taken and 27% did not answer or were not able to express any definite preference. Strict concordance was found between the degree of clinical improvement achieved and the preferences expressed. The laboratory parameters did not reveal any variation at the end of the study in comparison with baseline values.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effectiveness and safety of etodolac in treatment of rheumatoid arthritis: a multicentre two-months' open study. 215 75

The painful arm often presents a diagnostic challenge. The cause is often obvious, especially with regional pain syndromes including the carpal tunnel and the tennis elbows. However, pain reference syndromes can be confusing and it is advisable to first examine the cervical spine because it is a common and often overlooked cause of arm pain or paraesthesia. It is common for arm pain to cause sleep disturbances and in such cases it is worth considering cervical causes, carpal tunnel syndrome and the thoracic outlet syndromes. The working rule is: patients with thoracic outlet syndrome cannot fall asleep; a carpal tunnel lesion wakes the patient in the middle of the night; and cervical spondylosis wakes the patient with pain and stiffness that persists well into the day.
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PMID:The painful arm. 203 23

Fibromyalgia is a chronic rheumatologic disorder. The primary symptoms include musculoskeletal pain and aching, disturbed sleep, fatigue, morning stiffness, and local tenderness. It is frequently misdiagnosed, despite being a fairly common, chronic disorder in most primary care clinics. Failure to make this diagnosis often leads to unnecessary medical and surgical treatment. The treatment of fibromyalgia syndrome is multifaceted. Goals include reassurance, education about pain management and modification, and symptom reduction. Exercise may be beneficial. Amitriptyline is effective in reducing certain symptoms of fibromyalgia, such as pain and lack of restful sleep. Narcotics, steroids, and nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided.
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PMID:Fibromyalgia syndrome. 235 77

The morbidity after temporomandibular joint arthrography was studied as the amount of pain, use of pain medicine, and disturbed sleep and was compared with the morbidity after removal of lower third molars. The morbidity was substantially higher after surgery than after arthrography. It was concluded that the morbidity after arthrography can be kept at a low level and that it should not restrict the indications for this examination.
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PMID:Morbidity after temporomandibular joint arthrography is lower than after removal of lower third molars. 237 Oct 47


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