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Query: UMLS:C0184567 (acute pain)
 3,962 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The effect of the presence of either chronic or acute clinical pain on pain threshold and on the nociceptive flexion reflex (RIII) threshold was studied. The experimental pain sensation and the flexion reflex were evoked by trains of short electrical pulses. It was hypothesized that both kinds of clinical pain would be able to induce 'diffuse noxious inhibitory controls' (DNIC) and thereby raise the 2 experimental thresholds. Patients with chronic low back pain, patients with postoperative pain from oral surgery, and pain-free subjects were tested in 3 conditions: during baseline, after i.v. administration of a placebo, and after i.v. administration of naloxone. In comparison with 2 pain-free control groups, the 2 pain groups had a significantly higher pain threshold in all conditions. However, the RIII threshold was not significantly elevated in chronic or acute pain patients compared to controls. Naloxone had no effect on the RIII or pain threshold in any of the groups. It is concluded that the increased pain threshold which is frequently found in chronic pain patients, and which could be confirmed in the present study, does not result from a DNIC effect. The adaptation level theory offers an alternative explanation. Also, the acute postoperative pain in this study did not seem to induce DNIC. Because other forms of acute pain have been found to be effective in activating DNIC, future research should establish which pains are and which pains are not effective.
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PMID:Chronic back pain, acute postoperative pain and the activation of diffuse noxious inhibitory controls (DNIC). 140 14

Although ethnic identity has been found to have an important influence on experimental and acute pain intensity and response, little work has been directed to understanding how ethnicity affects the chronic pain experience. We report the results of a quantitative study of 372 chronic pain patients, in six ethnic groups, who were under treatment at a multidisciplinary pain management center in New England. The study used questionnaires and standardized instruments for assessing pain intensity to determine whether ethnic background was significantly related to interethnic or intraethnic group variation in pain intensity and response when other significant medical, sociodemographic, and psychological variables were controlled. In this study population, the most frequent statistically significant intergroup differences in pain intensity and in behavioral, psychological, and attitudinal responses to pain are related to differences in ethnic identity and psychological coping style according to locus of control. In addition, in this population, ethnic identity is a predictor of locus-of-control coping style. The major statistically significant intragroup differences in pain intensity and response are related to differences in generation, degree of heritage consistency, and locus-of-control style. We suggest that treatment programs for multiethnic populations should include a thorough cultural assessment and that providers need to be aware of the potential effect of ethnic background on chronic pain patients' communications, concerns, and coping styles related to the chronic pain experience.
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PMID:Ethnic variations in the chronic pain experience. 145 17

Little is known about the evolution of chronic pain in primary care. Forty five patients with a four week history of musculoskeletal pain were assessed and followed up over 26 weeks by a research nurse using a structured interview and formal assessment instruments. Patients aged 18 to 65 years were recruited on presentation at two semirural Cheshire general practices and subsequently interviewed on a domiciliary visit. Twenty patients (44%) continued to have pain at 26 weeks and these patients were considered to have chronic pain. Nineteen patients had no pain after 12 weeks and a further six had no pain after 26 weeks; these patients together formed the group with acute pain. Comparing the two groups at entry into the study (pain of four weeks' duration) demonstrated significantly higher visual analogue scale scores for intensity of pain (P < 0.01) and a higher incidence of depression (P < 0.01) in the group which subsequently developed chronic pain. In this group, the presence of depression at 12 weeks was associated with higher visual analogue scale scores (P < 0.05) but at 26 weeks scores were similar in depressed and non-depressed patients. The correlation between visual analogue scale score for intensity of pain and the use of passive coping strategies to cope with pain appeared more strongly positive with duration of pain (P < 0.05 at 26 weeks). It is suggested that high pain intensity scores, the presence of depression, and the increasing use of passive coping strategies may be identifiable associations with the development of chronic pain. Areas for further research are identified.
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PMID:The evolution of chronic pain among patients with musculoskeletal problems: a pilot study in primary care. 147 92

This chapter has reviewed research on psychological and social factors associated with the onset and progression of low back pain. From this review it can be concluded that psychosocial traits appear to be important contributors to the course of pain and disability though methodologically well-designed longitudinal studies are rare. For this reason it is difficult to assess the relative importance of, for example, psychological distress compared with work stress. Furthermore, the mechanisms by which specific variables effect back pain remain unknown. The answer, no doubt, lies in longitudinal studies which employ multicausal models. It has been noted the psychosocial treatments which have proven effective for chronic pain populations are rarely assessed with acute pain patients. Some problems are the inaccessibility of acute back pain sufferers to psychologists, the difficulty of isolating the effect of one component of a multidisciplinary programme and the lack of uniform practice of psychosocial techniques. None the less, programmes which include psychosocial interventions appear to have superior results to those which do not. Since these techniques are often simple and inexpensive to include they should be incorporated into all treatment programmes where the potential for chronic pain syndrome exists. Gaps and flaws in current research methodologies have been identified and suggestions for future investigations have been proposed. In addition we have attempted to provide some practical guidelines for health care professionals to help them identify salient psychosocial issues which may effect the course of their patient's treatment. Recommendations for assessment and referral are also provided.
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PMID:Psychosocial issues in the prevention of chronic low back pain--a literature review. 147 96

Chronic pain, the pain which persists or appears after the initial lesions are healed, has recently been recognized as a medical entity called the "chronic pain syndrome". This condition may be differentiated from acute pain on the basis of biological finality, pathogenic mechanisms, autonomic reactions, affective and behavioural components but most of all of the therapeutic goals. It is important to remind that the experience of pain is the result of at least three interactive neuro-psychological determinants viz. the sensory-discriminative, the affective-motivational and the cognitive-evaluative systems. For this reason, when pain becomes treatment resistant, it is important to complete the usual diagnostic approach by an evaluation of pain as a phenomenon and to abandon a strictly "peripheral" model. Such evaluation is necessarily interdisciplinary.
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PMID:[Evaluation of a chronic pain syndrome]. 148 67

In several diseases chronic pain is associated with long-lasting pathophysiological responses which differ strongly from those observed in acute situations. When persisting, acute pain often results in physical and psychological stress which may in turn aggravate the initial pathological state. In the present work we examined the secretory patterns of pituitary hormones related to acute stress (growth hormone (GH), prolactin (PRL) and beta-endorphin (beta-END)) in rats during the phase of Freund adjuvant-induced arthritis (AIA, a model used for chronic pain studies) when chronic pain is maximum (14 and 21 days, postinoculation (PI)). Using radio-immunoassay hormones were measured in plasma samples taken every 30 min for 7 h in free-moving rats 14 and 21 days after Freund adjuvant or vehicle injection and in control animals. The total amount of GH secretion was higher at 14 and 21 days PI in AIA rats as compared to vehicle-treated and control animals, and the pulsatility of GH secretory pattern was not modified by AIA. PRL and beta-END secretion were not significantly different in arthritic rats as compared to controls. These results show that GH, PRL and beta-END responses induced by acute stress are not observed during the AIA phase when chronic pain is maximum. Thus, in our experimental conditions, beta-END and PRL do not seem to be good plasma markers of chronic pain.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Chronic pain induces a paradoxical increase in growth hormone secretion without affecting other hormones related to acute stress in the rat. 159 79

Vertebral compression fractures (VCFs) may be defined radiographically or as a clinical event. The prevalence of these fractures in women aged 50 and over has been estimated at 26% when defined as a reduction in vertebral height greater than 15%. Retrospective reviews of case records have shown a clinical detection rate of VCF in white women of 153/100,000 person years. Of these clinically detected VCFs, 84% were associated with pain. VCF may be defined as a clinical event characterised by loss of height and acute pain. The pain of acute fracture usually lasts 4 to 6 weeks with intense pain at the site of fracture. Chronic pain may also occur in patients with multiple compression fractures, height loss and low bone density but is probably due to structural changes or osteoarthritis. Radiographic VCF may not be symptomatic. The greater the deformity, the greater the likelihood of pain and disability. As height is lost, patients experience discomfort from the rib cage pressing downward on the pelvis. Patients develop a thoracic kyphosis, a lumbar lordosis, and a protuberant abdomen with prominent horizontal skinfold creases. The reduced thoracic space may result in decreased exercise tolerance and reduced abdominal space may give rise to early satiety and weight loss. Sleep disorders may also occur. Patients lose self esteem. Self care may become difficult. They are often depressed. They become fearful of further fracture. They have distorted body image and poor health perception. Patients with one vertebral fracture are at increased risk of peripheral fracture and further vertebral fracture. The aims of acute management are to reduce symptoms and mobilise the patient as quickly as possible.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The clinical consequences of vertebral compression fracture. 162 11

There are two components to the perception of pain; the 'sensory' and the 'reactive'. Psychological factors control the latter. Pain research is rapidly advancing: the discovery of endorphins and opioid receptors, the appreciation of the psychological component of pain and the multidisciplinary approach to chronic pain are major advances. Pain can be classified as acute or chronic. Acute pain is easy to diagnose, the cause of pain obvious and the treatment logical, chronic pain has a greater psychological component, is difficult to diagnose and treatment is often empirical. Methods of pain control include drugs, injection techniques, electro stimulation, non invasive therapies, denervation procedures and palliative procedures. A multidisciplinary approach and a combination of methods is necessary to treat chronic pain. Spinal opioids, radiofrequency thermocoagulation, intrapleural bupivacaine, cryoanalgesia and patient controlled analgesia are recent advances in pain control. However, most pain can be controlled adequately with simple methods; what is essential is the interest and commitment of the physician towards achieving optimum therapeutics.
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PMID:Pain control. 167 99

From 1. 1. 1976 to 30. 6. 1987, a total of 25,611 prescriptions for narcotics were obtained from pharmacies by 4131 persons living in a town of 250,000 inhabitants in the Federal Republic of Germany. 2412 patients (58.4%) had been prescribed narcotics on only one occasion, 3178 patients (76.9%) over a limited period of six months, presumably for acute pain. Only 520 patients (12.6%) received, over a period of at least six months, five or more narcotic prescriptions per six months. Reasons for the latter prescriptions were malignant tumours in 273 (6.6%) and chronic pain due to benign diseases in 144 (3.5%). In 21 patients (0.5%) the narcotic dosage had risen over two years, presumably because of the development of tolerance. 19 patients had been on narcotics for at least eight years, without their doctor diagnosing addiction. The data suggest that, in prescribing narcotics for patients with incurable disease, the risk of addiction should play no role.
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PMID:[Long-term use of narcotics in pain therapy]. 169 88

This paper reports a qualitative review of the literature on memory for pain. Most research has focused on the accuracy of memory for pain intensity. There is some evidence that recall is moderately accurate but this conclusion is tentative because of significant methodological problems. There is also some evidence that recall of acute pain is more accurate than recall of chronic pain and we make some suggestions as to why this difference might occur. We conclude that further research on memory for pain should be informed by reference to methodological practices developed in cognitive psychology and embedded within an appropriate theoretical framework.
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PMID:Memory for pain: a review. 169 54


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