Ice massage and transcutaneous electrical stimulation: comparison of treatment for low-back pain.

It has recently been shown that ice massage of the web between the thumb and index finger produces significantly greater relief of dental pain than a placebo control procedure. These results indicate that ice massage may be comparable to transcutaneous electrical stimulation (TES) and acupuncture, and may be mediated by similar neural mechanisms. The purpose of this study was to examine the relative effectiveness of ice massage and TES for the relief of low-back pain. Patients suffering chronic low-back pain were treated with both ice massage and TES. The order of treatments was balanced, and changes in the intensity of pain were measured with the McGill Pain Questionnaire (MPQ). The results show that both methods are equally effective: based on the Pain Rating Index of the MPQ, 67-69% of patients obtained pain relief greater than 33% with each method. The results indicate that ice massage is an effective therapeutic tool, and appears to be more effective than TES for some patients. It may also serve as an additional sensory-modulation method to alternate with TES to overcome adaptation effects. Evidence that cold signals are transmitted to the spinal cord exclusively by A-delta fibers and not by C fibers suggests that ice massage provides a potential method for differentiating among the multiple feedback systems that mediate analgesia produced by different forms of intense sensory input.

Randomized controlled trial of a community-based psychoeducation program for the self-management of chronic pain.

Although chronic pain is a frequent cause of suffering and disability and is costly to society, there continues to be limited access to specialty pain clinic services. Hence, there is a need for cost-effective, accessible interventions that will help people find ways to better manage this difficult problem. This randomized controlled trial examined the effect of a low-cost, community-based, nurse-delivered, group psychoeducation program entitled the Chronic Pain Self-Management Program (CPSMP). It has a standard protocol that was modified from the successful Arthritis Self-Management Program (ASMP). One hundred and ten individuals with mixed idiopathic chronic pain conditions were enrolled in the study (75% female; mean age 40 years; mean chronicity 6 years) and were randomly assigned to one of two conditions: the 12-h (CPSMP) intervention group, or the 3-month wait-list control group. Self-report measures of pain-related and other quality of life variables as well as two hypothesized mediating variables were collected pre-treatment and 3 months later by assessors blind to group allocation. One hundred and two subjects completed the study. Results of intention-to-treat analysis indicated that the treatment group made significant short-term improvements in pain, dependency, vitality, aspects of role functioning, life satisfaction and in self-efficacy and resourcefulness as compared to the wait-list control group. Because it has a standard protocol, this intervention has the potential to be reliably delivered at low cost in varied urban and rural community settings and hence be more widely accessible to a greater number of people suffering from chronic pain than is currently the case with more specialized pain clinic services. Based on the results of this study, further research evaluating the long-term impact and potential cost savings to the individual and to the health care system is warranted.

A survey of pain in hospitalized patients aged 4-14 years.

One hundred fifty randomly selected hospitalized children between the ages of 4-14 were interviewed to assess their pain experience in the hospital. Follow-up information was obtained through parent interviews 3 weeks, 3 months, and 6 months later. On enrollment, more than 87% of children reported having had pain within 24 h and, of those, 19% reported their usual pain intensity as in the severe range. Thirty-eight percent of children had received analgesic medication during the preceding 24 h. Children who had undergone surgery were three to four times more likely to have received narcotic analgesic than nonsurgical patients, although similar proportions in both groups reported moderate to severe pain intensity. In spite of these reports of significant pain by a substantial number of children during hospitalization, at the 3-week follow-up check, by parent report, 68% were pain free. The parents of those with pain were contacted at 3 and 6 months postenrollment, and 96% of children were no longer experiencing pain. Five children reported pain at all contact points; three of these were suffering chronic diseases and the other two had suffered major trauma from motor-vehicle accidents.

Tryptophan-morphine interactions and postoperative pain.

Patients undergoing abdominal surgery were infused with saline or the 5-hydroxytryptamine (5-HT) precursor tryptophan starting in the operating room and continuing for three hours in the recovery room. There was a nonsignificant trend for patients who received tryptophan to have higher pain scores. In the saline-treated patients, plasma tryptophan was below the range for normal healthy subjects, and there was a strong positive relationship between plasma tryptophan and morphine requirements. These data, taken together with animal data obtained using the formalin pain test, suggest that a 5-HT system in the brain can antagonize the dissociative state produced by morphine, which helps patients to tolerate pain. When plasma tryptophan falls below normal levels, brain 5-HT falls and morphine requirements are reduced. While tryptophan may potentiate spinal 5-HT function to decrease nociceptive afference in some circumstances, there may be clinical conditions in which the use of tryptophan is contraindicated.

Primary care and primary health care for an integrated system.

The article by Rosser and Kasperski, "Organizing Primary Care for an Integrated System," provides an important stimulus for examining issues surrounding healthcare reform in Canada. As the "Guidelines for Commentary" of HealthcarePapers indicate, healthy debate can foster "constructive change. " The Canadian Nurses Association welcomes the opportunity to engage in such a debate and it is within this spirit that we offer a number of challenges, both at a theoretical/conceptual as well as a factual level, to the ideas presented by Rosser and Kasperski. Although there are a number of points in the article that warrant attention, this commentary will address only a selected few.

Identification of predictor variables of a postpartum emotional reaction.

Clinical observations and research suggest that postpartum emotional reactions (PEREA) are a widespread phenomenon. Prenatal identification of women who are at risk is essential if health professionals are to intervene and prevent long-term problems for the mother and her family. Health status, previous psychiatric history, locus of control, psychosocial assets, and life change events, as well as maternal adaptation to pregnancy and motherhood were examined in this study as possible predictor variables of a postpartum emotional reaction. Twenty-seven expectant women were assessed once prenatally and twice in the postpartum period. The data revealed that 59% of the participants, both primiparas and multiparas, experienced an increase in negative affect at some stage of the pregnancy and/or within 4 to 6 weeks postpartum. There were no significant differences between those who developed a PEREA and those who did not on the following variables: planned versus unplanned pregnancy, desired versus undesired pregnancy, attendance at prenatal class, and feeding plans. There was a significant association (p less than .01) between breastfeeding and the occurrence of a PEREA at 4 to 6 weeks postpartum among the primiparas. The study demonstrated that there was no single cause but several factors that, if present in combination, were predictive of an emotional reaction postpartum. Locus of control and existing emotional reactions, especially prenatal depression, were the most important predictor variables. The individual's ability to adapt to day-to-day life was influenced by the presence or absence of a combination of factors. These included preexisting emotional reactions, perceived locus of control, health status, and/or stress.(ABSTRACT TRUNCATED AT 250 WORDS)

Professional and executive women: health and lifestyle characteristics.

Selected health characteristics of professional and executive women, and relationships among physical fitness, physical activity, and health characteristics in this group were examined. The health characteristics examined included stress, Type A patterns of behavior, substance use (alcohol, tranquilizers, and smoking), nutrition, health practices, safety, and relaxation. A convenience sample of 104 executive/professional women between the ages of 30 and 59 years, who were working full time, were administered the Canadian Standardized Test of Fitness (Step-Test) to measure cardiovascular fitness, the Framingham Type A Questionnaire, the Personal Life-style Questionnaire, the Physical Activity Questionnaire, and a visual analog scale to measure stress. The results suggest that executive women are significantly more fit than Canadian norms and that they tend to consume more alcohol and to smoke less. Demographically, they are more likely to be unmarried, childless, and have higher incomes than other Canadian women. Fitness levels are only associated (inversely) with smoking habits. Of interest are the high Type A scores, which are almost twice that of the Framingham norms. The possible consequences and implications of these findings are discussed.

Reduction of postoperative morbidity following patient-controlled morphine.

The present study examined the impact of two methods of pain management on recovery in 38 women undergoing hysterectomy. One group received IV morphine in the recovery room and IM morphine on the ward on a PRN basis (PRN group). In the other group, a loading dose of morphine 8 mg IV was given when the patient first complained of pain and patient-controlled IV morphine (PCA) was initiated and continued for 48 h (PCA group). Both groups received similar amounts of morphine overall, differently distributed over time. The PCA patients received 8 mg.h-1 in the recovery room (approximately 2.5 hrs) and less thereafter. The PRN patients received approximately 2 mg.h-1 for the entire 48-hr period. Pain control was better throughout convalescence and less variable across time with PCA management. Minute ventilation also recovered faster and by day four was 25 per cent above the preoperative baseline in the PCA group. In addition, oral temperature became normal one day earlier, ambulation recovered more rapidly and patients were discharged from hospital earlier. The data suggest that early treatment with relatively high, self-titrated morphine doses may alter the course of the metabolic response to surgery.

Predictors of the development of chronic pain.

The purpose of this secondary analysis was to explore the role of potential risk factors in predicting the development of chronic pain. Linear discriminant function analysis was used to derive a prediction equation that maximized the differences between a group of hospitalized patients experiencing acute pain who developed chronic pain (n = 171) and a group whose pain resolved (n = 200). Patients who developed chronic pain reported a higher pain intensity, higher anxiety and distress, less certainty that their pain would resolve, longer hospitalization, less independence in ambulation, a diagnosis of trauma, and less need for surgery. Recognition of these factors could lead to early identification of those individuals with acute pain who are at risk for developing chronic pain.