| 1. |
- Kvarnström, Ann, 1956-
(författare)
-
Neuropathic Pain; Quality of Life, Sensory Assessments and Pharmacological Treatments
- 2003
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Neuropathic pain of central and peripheral origin presents a substantial clinical problem as it is often resistant to pharmacological treatment.The health related quality of life of 126 patients with peripheral neuropathic pain was studied, to provide a cross sectional description from this point of view. Two generic health-related quality of life instruments; the SF-36 and the Nottingham Health Profile were used together with pain assessments, global rating of health and verbal rating scales of pain and other symptoms, as well as patient descriptors.The analgesic effect of ketamine, lidocaine and morphine were assessed in a double blind, placebo-controlled, randomized study design. Three groups of patients were studied: patients with peripheral neuropathic pain of traumatic origin, patients with central post-stroke pain and patients with neuropathic pain after spinal cord injury. Somatosensory function was examined to see if this could predict response to treatment and to investigate if the drugs caused changes in thermal or mechanical sensibility.The results shows that the intense pain, limited efficacy and tolerability of available treatments, the low overall rating of health, reduced work status and troublesome symptoms constitute a substantial impact on the quality of life for patients with peripheral neuropathic pain.The NMDA-antagonist ketamine yielded substantial pain relief to patients with peripheral neuropathic pain and patients with neuropathic pain after spinal cord injury. However, the reported side effects limit the clinical usefulness of the treatment. Lidocaine did not give significant pain relief to the patients in the three studied groups. Morphine may represent a therapeutic alternative for some patients with central post-stroke pain, although only a small group of this category of patients responded with analgesia.Assessment of baseline somatosensory functions could not be used to identify responders to treatment with either drug, nor did ketamine, lidocaine or morphine cause any changes in thermal or mechanical sensibility.
|
|
| 2. |
- Kvarnström, Ann, et al.
(författare)
-
The analgesic effect of intravenous ketamine and lidocaine on pain after spinal cord injury
- 2004
-
Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 48:4, s. 498-506
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Pain following spinal cord injury (SCI) is a therapeutic challenge. Only a few treatments have been assessed in randomized, controlled trials. The primary objective of the present study was to examine the analgesic effect of ketamine and lidocaine in a group of patients with neuropathic pain below the level of spinal cord injury. We also wanted to assess sensory abnormalities to see if this could help us to identify responders and if treatments resulted in changes of sensibility.Methods: Ten patients with spinal cord injury and neuropathic pain below the level of injury were included. The analgesic effect of ketamine 0.4 mg kg−1 and lidocaine 2.5 mg kg−1 was investigated. Saline was used as placebo. The drugs were infused over 40 min. A randomized, double-blind, three-period, three-treatment, cross-over design was used. Systemic plasma concentrations of ketamine and lidocaine were assessed. Pain rating was performed using a visual analogue scale (VAS). Sensory function was assessed with a combination of traditional sensory tests and quantitative measurement of temperature thresholds.Results: Response to treatment, defined as 50% reduction in VAS-score during infusion, was recorded in 5/10 in the ketamine, 1/10 in the lidocaine and 0/10 in the placebo groups. Neither ketamine nor lidocaine changed temperature thresholds or assessments of mechanical; dynamic and static sensibility. Nor could these sensory assessments predict response to treatment in this setting. Lidocaine and particularly ketamine were associated with frequent side-effects.Conclusion: Ketamine but not lidocaine showed a significant analgesic effect in patients with neuropathic pain after spinal cord injury. The pain relief was not associated with altered temperature thresholds or other changes of sensory function.
|
|
| 3. |
|
|
| 4. |
- Meyerson, J., et al.
(författare)
-
The incidence of chronic post-sternotomy pain after cardiac surgery : a prospective study
- 2001
-
Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 45:8, s. 940-944
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Post-sternotomy pain is sometimes a sequela of cardiac surgery. The incidence, characteristics and clinical course of post-sternotomy pain are not well known. The aim of our study was to determine the incidence of chronic post-sternotomy pain in patients undergoing sternotomy for cardiac surgery in general and according to the specific surgical procedure. METHOD: In a prospective manner, a group of 349 consecutive patients were evaluated for chronic post-sternotomy pain one year after surgery. The patients were asked in a postal questionnaire to describe and score any persistent pain following the surgical procedure. The patients were classified into 3 sub-groups according to surgical procedure. The first group consisted of patients operated for coronary artery by-pass grafting (CABG) including internal thoracic artery grafting (ITAG). The second group included patients operated with CABG without ITAG and the third group of patients with valve replacement without CABG. RESULT: A total of 318 patients (91%) answered the questionnaire of whom 90 (28%) reported chest discomfort different from what they experienced before surgery. The scoring on the visual analogue scale (VAS, 0-100 mm) showed that 41 patients (13%) reported maximum pain intensity > or =30 mm (moderate pain), and 14 of these patients (4%) scored > or =54 mm (severe pain). There was no statistically significant difference in pain incidence and pain intensity when comparing the patients subjected to different surgical procedures. CONCLUSIONS: This prospective study shows that the overall incidence of non-cardiac pain after sternotomy for cardiac surgery is high (28%). Most patients experience a modest pain intensity but some (1%) report severe pain, never being lower than 54 mm on VAS. The study also indicates that the incidence of pain after sternotomy is not only associated with harvest of the ITA and additional aetiological factors must be sought.
|
|
