Comparison of the effect of video glasses and nitrous oxide analgesia on the perceived intensity of pain and unpleasantness evoked by dental scaling.

The aim of this study was to evaluate whether distraction induced by video glasses had an effect on the perceived intensity of pain and unpleasantness during dental scaling compared with the effect of nitrous oxide (N(2)O) analgesia. The pain stimulus was dental scaling (removal of dental calculus) with an ultrasonic scaler. As a standardised, non-dental painful stimulus, Von Frey filaments were used. A total of 26 patients with superficial chronic periodontitis were enrolled in this randomised, controlled clinical study. The effect of video glasses was compared with N(2)O in one session and the effect of video glasses versus a control situation in another. The patients rated the intensity of pain and unpleasantness evoked by dental scaling and Von Frey filament stimulation on 100-mm visual analogue scales (VAS). For dental scaling, there was no effect of video glasses on the perceived pain (p=0.85) or unpleasantness (p=0.73) nor of N(2)O (p=0.69 and p=0.51, respectively) compared with the control situation. Similarly, no significant difference was found between VAS scores in the video glasses and N(2)O session (p=0.48, p=0.58). A significant effect of video glasses and N(2)O(p<0.008) was found on the perceived pain intensity produced by Von Frey filament stimulation compared with the control situation, but no significant difference was seen between these methods (p=0.07). Post-treatment interviews of the patients revealed that 81% of the patients in the video and 65% in the N(2)O session stated that the method had some beneficial effect on their overall experience of the treatment situation. In conclusion, administration of video glasses or N(2)O did not affect the perceived intensity of pain and unpleasantness evoked by dental scaling.     

虚拟现实技术在肝胆胰外科术后患者疼痛控制的应用效果研究

目的 观察虚拟现实技术在肝胆胰外科术后患者疼痛控制中的效果.方法 将102例患者按患者自身意愿分为对照组51例及观察组51例.对照组采用传统疼痛控制管理,观察组采用虚拟现实技术进行疼痛控制管理,比较两组患者在首次换药、拆线及拔管过程的关注度评分,操作前后疼痛评分,操作前及操作中平均动脉压、心率的变化,以及术后恢复一般指...     

The treatment of phantom limb pain using immersive virtual reality: three case studies

Purpose. This paper describes the design and implementation of a case study based investigation using immersive virtual reality as a treatment for phantom limb pain.

Method. Three participants who experienced phantom limb pain (two with an upper-limb amputation, and one with a lower-limb amputation) took part in between 2 and 5 immersive virtual reality (IVR) sessions over a 3-week period. The movements of participants' anatomical limbs were transposed into the movements of a virtual limb, presented in the phenomenal space of their phantom limb.

Results. Preliminary qualitative findings are reported here to assess proof of principle for this IVR equipment. All participants reported the transferal of sensations into the muscles and joints of the phantom limb, and all participants reported a decrease in phantom pain during at least one of the sessions.

Conclusion. The authors suggest the need for further research using control trials.     

The treatment of phantom limb pain using immersive virtual reality: Three case studies

Purpose. This paper describes the design and implementation of a case study based investigation using immersive virtual reality as a treatment for phantom limb pain.

Method. Three participants who experienced phantom limb pain (two with an upper-limb amputation, and one with a lower-limb amputation) took part in between 2 and 5 immersive virtual reality (IVR) sessions over a 3-week period. The movements of participants' anatomical limbs were transposed into the movements of a virtual limb, presented in the phenomenal space of their phantom limb.

Results. Preliminary qualitative findings are reported here to assess proof of principle for this IVR equipment. All participants reported the transferal of sensations into the muscles and joints of the phantom limb, and all participants reported a decrease in phantom pain during at least one of the sessions.

Conclusion. The authors suggest the need for further research using control trials.     

Nociceptive behaviour induced by dental application of irritants to rat incisors: a new model for tooth inflammatory pain.

Animal models simulating acute human pulpitis are still lacking. The rat incisors present a particular situation where most of their innervation is considered to be unmyelinated and concentrated mainly in the tooth pulp. This study reports on a new model for dental pain induced by inflammatory agents applied to the tooth pulps of incisors. In different groups of rats, artificial crowns were fixed on the lower incisors, after cutting 1-2mm of their distal extremities. A volume of 7-10 microl of solutions of saline, capsaicin (1-10mg/ml) or formalin (2.5% or 5%) was injected in the crown cavity, and the nociceptive behaviour was quantitated following a devised scoring method of four scales. Intradental application of capsaicin produced nociceptive scores in the form of one plateau for 1-2h depending on the concentration used. Similar results were obtained with intradental application of formalin 2.5%. The one plateau of nociceptive scores obtained with formalin contrasts with the biphasic aspect of nociceptive behaviour described with the intradermal formalin test. This discrepancy could be attributed to a difference in the types of afferent fibres involved in each situation. Pretreatment with morphine (2 mg/kg) attenuated, in a naloxone-reversible manner, the nociceptive behaviour observed following intradental application of capsaicin. Pretreatment with meloxicam (a cyclo-oxygenase-2 inhibitor) exerted a less pronounced attenuation of the nociceptive scores when compared with morphine. These results provide evidence for the validity of the described model for the simulation of tooth pulp inflammatory pain in awake animals.     

Performance and nonperformance strategies for coping with acute pain: The role of perceived self-efficacy,expected outcomes,and attention

We compared several strategies for coping with acute induced pain, and examined self-efficacy perceptions, outcome expectations, and attention to pain as cognitive mediators of pain tolerance. The coping strategy of central interest was an overt performance task selected to be highly distracting. Sixty-four subjects were randomly assigned to either overt performance distraction, verbal—imaginal distraction, relaxation, or no strategy. Before and after strategy training, subjects completed measures of cold-pressor pain tolerance, subjective pain, perceived self-efficacy, anticipated painful outcomes, and attention to pain. The performance strategy enhanced pain tolerance much more than did the verbal—imaginal or relaxation strategies. Self-efficacy perceptions accurately predicted individual differences in tolerance even when anticipated pain, subjective pain, or attention to pain were held constant. With self-efficacy held constant, attention predicted tolerance but anticipated pain did not. The findings suggest that self-efficacy perceptions and attention deployment both influence individuals' pain-coping ability.This research was supported by United States Public Health Service grants 5R29MH42385 and S07RR07173.     

Improving the quality of pain treatment by a tailored pain education programme for cancer patients in chronic pain.

Educational interventions, aiming to increase patients' knowledge and attitude regarding pain, can affect pain treatment. The purpose of this study was to evaluate the effects of a Pain Education Programme (PEP), on adequacy of pain treatment, and to describe characteristics predicting change in adequacy. The PEP consists of a multi-method approach in which patients are educated about the basic principles regarding pain, instructed how to report pain in a pain diary, how to communicate about pain, and how to contact healthcare providers. The effects of the PEP were evaluated taking into consideration the lack of well-established outcome measures to evaluate adequacy of pain treatment, the lack of long-term follow-up, and the influence of missing data.A prospective, randomized study was utilized in which 313 chronic cancer patients were followed-up until 8 weeks postdischarge. Adequacy of pain treatment was evaluated by means of the Amsterdam Pain Management Index (APMI), consisting of an integrated score of patients' Present Pain Intensity, Average Pain Intensity, and Worst Pain Intensity, corrected for patients' Tolerable Present Pain, with the analgesics used by the patient. At pretest, 60% of the patients in the hospital were treated inadequately for their pain. Postdischarge, the control group patients were significantly more inadequately treated at 2 weeks after discharge (56% vs 41%), at 4 weeks after discharge (62% vs 42%) and at 8 weeks after discharge (57% vs 51%) than the intervention group patients. While the level of inadequacy in the control groups remained relatively stable at all assessment points, a slight increase in the percentage of patients being treated inadequately was found in the intervention group patients over time. A beneficial effect of the PEP was found for patients both with and without district nursing. Variables predicting an improvement in adequacy of pain treatment consisted of the PEP, the APMI score at baseline, patients' level of physical functioning, patients' level of social functioning, the extent of adherence to pain medication, patients' pain knowledge, and the amount of analgesics used.These findings suggest that quality of pain treatment in cancer patients with chronic pain can be enhanced by educating patients about pain and improving active participation in their own pain treatment. The benefit from the PEP, however, decreases slightly over time, pointing at a need for ongoing education.     

风湿病引起胸痛、腹痛的鉴别诊断及处理

风湿性疾病可导致患者出现胸痛、腹痛的症状,很多患者病情隐匿,诊断困难,而部分患者的病情凶险,甚至出现生命危险。因此,当患者出现胸痛腹痛时,应注意风湿病的存在,本文旨在总结风湿病引起胸痛腹痛的临床特点,及时做好鉴别诊断,改善患者预后。     

口腔科患儿牙科畏惧症的临床处理

目的：探讨口腔科4～11岁儿童患者牙科畏惧症的临床处理。方法：选取2010年8月-2011年2月收治的明显不配合治疗的4～11岁患儿80例,随机分为干预组和对照组,每组40例。干预组在常规治疗的基础上再进行心理行为干预,对照组只是单纯地进行常规治疗,最后用牙科焦虑量表来评定临床效果。结果：两组治疗前的牙科焦虑评分差异无统计学意义（P〉0．05）,而治疗后的干预组牙科焦虑评分较对照组显著下降,两组比较差异有显著性（P〈0．01）。结论：现代儿童口腔临床医学中,医师首先应具备儿童心理学知识,并在操作中尽量避免失误,从而减轻患儿的心理负担,缓解患儿的心理不良情绪,以达到临床治疗的目的。