氯胺酮阿是穴注射配合放松训练减缓肺癌晚期疼痛

目的：观察阿是穴小剂量氯胺酮注射配合放松训练对肺癌晚期疼痛的缓解作用，为临床筛选减轻肺癌晚期患者疼痛方法提供依据。方法：34肺癌晚期患者按住院治疗的先后顺序分为观察组23例，对照组Ⅱ例。观察组给予氯胺酮(小剂量)阿是穴穴位注射配合放松训练法，对照组采用传统的肌肉注射哌替啶或吗啡法。两组均于治疗前后采用Jane scott目测疼痛分数测量法进行疼痛分数测量并进行统计分析。结果：治疗后观察组疼痛分数值(21．8&;#177;14．8)分与治疗前(55．0&;#177;16．5)分比较(t=7．2，P&;lt;0．01)。治疗后对照组疼痛分数值(40．6&;#177;22．5)与治疗前(59．6&;#177;19．5)比较(t=2．1，P&;lt;0．05)差异有显著性意义。治疗后两组比较(t=2．9，P&;lt;0．01)差异有非常显著性意义。两组治疗后疼痛缓解率分别为(63．8&;#177;21．8)％，(27．7&;#177;19．6)％，两者比较(t=4．7,P&;lt;0．01)。结论：小剂量氯胺酮阿是穴注射配合放松训练是缓解肺癌疼痛的一种有效方法。     

晚期肺癌疼痛对患者认知功能的影响

目的:研究晚期肺癌患者疼痛对认识功能的影响,寻找其规律性。方法:57例晚期肺癌患者(UICC-TNM分期Ⅲb～Ⅳ期)入院后1周内分别接受了疼痛主诉分级法(VRS法)和中国韦氏成人智测量表(WAIS-RC)评估,并与正常人常模数据比较。结果:57例晚期肺癌患者(肺癌组)VRS法评分为1～4分,平均2.15～0.37分,在WAIS-RC智测成绩比较中,肺癌组的知识(17.9±3.6)、领悟(18.1±4.4)、算术(6.7±2.1)、相似性(16.2±5.1)、数字广度(9.2±2.7)、词汇(54.5±18.4)、数字符号(36.3±13.5)、填图(10.4±2.2)、木块图(29.7±12.9)、图形排列(18.5±3.7)和图形拼凑(20.6±4.5)等分测验均明显低于正常人常模数据(t=2.137～3.319,P<0.01～0.05)。按疼痛程度分组后,疼痛程度重组(VRS≥2.15分,23例)的知识、算术、数字广度、数字符号、填图、木块图、图形排列和图形拼凑等分量表评分均明显低于疼痛程度轻组(<2.15分,34例)(t=2.155～3.324,P<0.01～0.05)。结论:晚期肺癌疼痛对认知功能有明显影响,随着疼痛程度的加深这种损害程度也加重。     

康复治疗缓解晚期癌症患者疼痛症状及对生活质量的影响

目的:观察综合性康复治疗配合肿瘤科常规治疗对晚期癌痛患者的疼痛强度和生活质量的影响。方法:纳入2001-03/2004-12郑州大学第一附属医院肿瘤科住院晚期癌症患者152例,男96,女56例,35～72岁,平均(48±14.7)岁。按随机抽签法分为观察组73例和对照组79例。两组患者均给予肿瘤科常规治疗,患者生命体征稳定。对照组采用WHO推荐世界疼痛学会所提出的“癌性疼痛三级阶梯治疗方案”;观察组联合综合性康复治疗(运动疗法、物理治疗、放松及暗示训练、心理治疗)。按照WHO推荐视觉模拟评分方法评估,采用0～10数字进行镇痛强度分级,完全无痛为0分,难以忍受疼痛为10分;镇痛疗效评定:6～10分为镇痛无效,3～5分为镇痛有效,0～2分为镇痛效果佳;生活质量评估参考国内1990年制定的肿瘤患者生存质量评分草案,由患者对康复治疗或药物治疗镇痛前后的食欲、睡眠、日常生活、精神状态、情绪、与人交往、生活乐趣等进行自我评估(以0～10分表示,0分为无干扰,10分为极度干扰。)。观察两组治疗1个月前后的疼痛强度、生活质量评分的变化和不同治疗的不良反应。结果:参与观察的住院晚期癌症患者152例全部进入结果分析。①治疗后,观察组和对照组患者疼痛评分均明显低于治疗前(2.70±1.91,8.90±1.73,t=3.657,P<0.01;4.60±1.83,9.20±1.50,t=2.132,P<0.05),且观察组显著低于对照组(t=2.631,P<0.01)。②治疗后,观察组患者食欲、睡眠、日常生活、精神状态、情绪、与人交往、生活乐趣评分均明显低于对照组(4.67±1.23,5.86±0.45;4.62±0.73,5.45±1.31;4.92±0.50,5.01±0.67;4.81±0.61,5.70±1.02;4.64±1.26,5.40±0.52;4.61±0.63,5.61±0.47;4.84±1.59,5.50±0.38;t=2.652,2.731,2.807,2.931,2.841,2.874,2.933,P<0.01)。③康复观察组没有明显的不良事件和副反应。三阶梯组有明显的不良反应,如恶心、呕吐、皮肤瘙痒、尿潴留、便秘和呼吸抑制等。结论:综合性康复治疗配合肿瘤科常规治疗,具有较好的有效性、安全性,且不良反应少,能改善晚期癌痛患者的食欲、睡眠、日常生活、精神状态、情绪、与人交往、生活乐趣等生活质量指标。     

穴位注射小剂量氯胺酮治疗癌性疼痛

目的:探索小剂量氯胺酮穴位注射治疗晚期癌性疼痛的效果。方法:选择60例晚期癌性疼痛患者,分成3组:A组(穴位-氯胺酮)、B组(皮下氯胺酮)和C组(穴位生理盐水),分组进行治疗并观察其疗效。结果:A组镇痛有效率为100%,优良率达85%,B组镇痛效果的优良率为40%,C组镇痛效果的优良率为25%,3组镇痛效果比较差异有显著性意义,A组镇痛效果优于B,C组(χ2=15.6,P<0.01)。在止痛起效时间和维持时间上A组明显优于B组和C组(χ2=21.6667,19.3939,P<0.01)。结论:小剂量氯胺酮穴位注射镇痛法,简便、安全、有效,有明显的临床使用价值。     

多奈哌齐治疗血管性痴呆的对照研究

目的:观察多奈哌齐对轻、中度血管性痴呆(vasculardementia,VD)患者认知功能、生活能力和个性的改善作用。方法:64例轻、中度VD患者,分为小剂量组和大剂量组,分别给予多奈派齐5mg,口服,1次/d,10mg,口服,1次/d,治疗90d。在治疗前和治疗90d后,使用简易精神状态检查表(MMSE)和Blessed行为量表进行疗效评价,比较治疗前后MMSE,Blessed行为量表变化,并比较不同剂量对MMSE和Blessed行为影响。结果:治疗前后比较两组各指标除日常习惯外,生活能力、个性及MMSE评分均有改善,差异有非常显著性和显著性意义(P<0.01或0.05),治疗90d后非认知方面评分:小剂量组:生活能力(2.00±0.46)分、日常习惯(12.13±2.01)分及个性改变(4.43±0.97)分,大剂量组:生活能力(1.73±0.45)分、日常习惯(11.47±2.52)分及个性改变(4.17±1.09)分,两组比较差异有显著性意义(t=0.03,0.26,0.32,P<0.05);MMSE评分:小剂量组为(19.70±1.88)分,大剂量组为(21.57±2.50)分,经t检验差异有非常显著性意义(t=-3.27,P<0.01)。结论:多奈派齐对轻中度血管性痴呆的认知能力、生活能力和个性有一定的改善,且大剂量组疗效优于小剂量组。     

穴位注射改善脑梗死后遗症患者日常生活活动能力

目的观察穴位注射疗法对提高脑梗死偏瘫患者ADL及运动功能恢复的作用。方法将106例患者按住院先后顺序号随机分为观察组(n=66)和对照组(n=40)。前者采用穴位注射士的宁合剂方法,后者采用持续静脉点滴活血化瘀通络类药物法。两组治疗疗程为10d,均分别治疗4个疗程。50d后对两组肌力,肢体运动功能评分(motorassessmentscale,MAS)和ADL分值进行比较。结果观察组MAS均分为(41.667±6.828)分,对照组MAS均分为(23.150±9.150)分,两组比较差异有非常显著性意义(t=11.877,P<0.001)。观察组Barthel指数平均为84.788±18.222,对照组平均为39.650±14.781,两组比较差异有非常显著性意义(t=13.265,P<0.001)。观察组完全至较少帮助完成ADL占总例数的92.23%,对照组占42.5%。两组比较差异有非常显著性意义(χ2=48.645,P<0.001)。结论穴位注射疗法可促使脑梗死患者的运动能力较快恢复,有效提高ADL水平。     

超激光照射对带状疱疹患者疼痛评分的影响

为观察超激光照射对带状疱疹疼痛患者视觉模拟评分法(VAS)评分影响。选43例带状疱疹患者超激光治疗,与同期紫外线照射患者比较,治疗前后使用VAS评估疼痛程度。超激光组与紫外线组治疗前VAS评分为(7.89±2.36),(7.91±2.42)分,治疗后为(3.31±0.25),(3.59±0.29)分,超激光组治疗后VAS评分显著低于紫外线组(t=2.077,P均<0.05)。提示超激光和紫外线光治疗带状疱疹均有效,前者缓解疼痛作用超过后者。     

晚期肺癌患者疼痛表现与社会支持的相关性

目的:探讨晚期肺癌患者疼痛表现与社会支持的相关性,寻求可能的干预方法。方法:63例晚期肺癌患者入院后1周内分别接受了疼痛主诉分级法(CVRS)和领悟社会支持量表(PSSS)的评估。结果:全部患者疼痛主诉分级中,0级4例(6%),1级38例(60%),2级19例(30%),3级2例(3%)。在家庭支持评分比较中,疼痛程度轻患者(评分0～1级,42例)的4个条目的所有评分均明显高于疼痛程度重组(评分2～3级,21例)(t=2.138～3.325,P<0.01～0.05)。在朋友支持评分比较中,疼痛程度轻组“朋友能真正帮助我”和“我有能与我分享快乐和忧伤的朋友”等条目得分(6.43±1.56和6.57±1.23)明显高于程度重组(4.98±0.97和4.54±0.88)(t=2.175和2.809,P<0.05和0.01)。在他人支持评分比较中,疼痛程度轻组“当我需要帮助时就有人在旁”、“有人能安慰我”和“在我的生活中有人关心我的情绪”等条目评分(7.36±1.63,8.24±2.05,8.77±2.32)明显高于程度重组(5.96±1.05,6.48±1.58,6.96±1.86)(t=2.189～2.454,P均<0.05)。结论:晚期肺癌患者的疼痛表现与社会支持评分密切相关。     

加味四妙勇安汤并电针治疗改善脑卒中患者的运动功能

目的:探讨加味四妙勇安汤配合电针治疗脑卒中后遗症运动功能恢复的作用。方法:将观察病例抽签随机分成观察组和对照组,观察组用加味四妙勇安汤配合电针治疗,对照组用补阳还五汤治疗,采用Fugl-Meyer法评定患者的功能,ADL评价采用功能独立性评定(FIM),进行统计分析。结果:Fugl-Meyer积分:观察组治疗前(135.25±23.22)分,治疗后(180.31±19.56)分,对照组治疗前(137.22±25.31)分,治疗后(164.33±21.43)分,治疗前两组无差异,治疗后观察组明显优于对照组(P<0.01)。FIM积分:观察组治疗前(36.25±21.36)分,治疗后(85.42±18.23)分,对照组治疗前(38.35±20.21)分,治疗后(61.32±17.65)分,治疗前两组无差异,治疗后观察组明显优于对照组(P<0.01)。观察组功能评定明显优于对照组(P<0.01)。结论:加味四妙勇安汤配合电针能更好的改善脑卒中后遗症患者的功能。     

热凝与无水乙醇注射治疗三叉神经痛的效果比较

目的观察热凝治疗三叉神经痛的疗效及副作用,并与无水乙醇治疗的效果相比较。方法选择30例三叉神经痛患者,经药物控制无效者。分为两组,每组15例。A组,在三叉神经的神经干走行处注射无水乙醇0.3mL。B组,在三叉神经的神经干走行处用RCG-3F(美国产)进行射频热凝治疗70,75,80,85℃各1次,90s/次。术后1周观察患者疼痛缓解程度(VAS法),随访其疼痛缓解时间、面部麻木感恢复时间。结果术后1周B组患者疼痛缓解程度(0.2±0.1)分,A组(1.5±0.6)分,与A组比差异有非常显著性意义(t=7.056,P<0.01),B组患者疼痛缓解时间(7.8±0.5)个月,A组(5.3±0.8)个月,与A组比差异有显著性意义(t=2.328,P<0.05),B组患者面部麻木感恢复时间(2.5±0.3)个月,明显快于A组(5.8±0.9)个月,与A组比差异有非常显著性意义(t=3.782,P<0.01)。结论热凝治疗三叉神经痛明显优于无水乙醇注射法。     

From past pain to future pain through the pain of others: Information about other people's pain ratings can alleviate our subsequent pain

Background

Previous studies have shown that pain memories have a profound impact on subsequent pain experiences. This study investigated whether pain ratings derived from other people can modify an individual's memory of past pain. This study also examined whether pain memory modified by others' pain ratings determines subsequent pain experiences.

Methods

Participants were divided into two groups: an experimental group and a control group. Participants in both groups were exposed to pain stimulation; then, they recalled its intensity twice over a period of time; after a break, they were again exposed to pain stimulation of the same intensity. The final sample consisted of 53 participants. The only difference between the experimental group and the control group was that in the former the pain ratings of other alleged participants were presented between the two consecutive pain recalls. These ratings suggested that other people experienced the same pain as less intense.

Results

The pain ratings derived from other people did not alter the pain memory; nevertheless, they affected an individual's next pain experience even for a certain period of time after their presentation. This type of pain-related information shaped participants' subsequent pain experiences regardless of their empathy, conformity, and susceptibility to social influence.

Conclusions

Information on pain derived from other people not only shapes the response to a novel stimulation but also substantially modifies the subsequent experience of that stimulation.

Significance

The study demonstrates the importance of social information on pain and provides evidence that this type of information substantially modifies the subsequent experience of the same pain. These results suggest that social information on pain can be used to alleviate pain associated with recurring medical procedures and thus increase patients' willingness to continue treatment.     

Electronic momentary assessment in chronic pain II: pain and psychological pain responses as predictors of pain disability

OBJECTIVES AND METHODS: More than 7,100 electronic diaries from 80 patients with chronic pain (mean: 89.3, range 30-115) entered multilevel analyses to establish the statistical prediction of disability by pain intensity and by psychological functioning (fear avoidance, cognitive, and spousal pain responses). We also tested the differences between pre-chronic, recently chronic, and persistently chronic pain in the prediction of disability (impaired physical and mental capacity, pain interference with activities, immobility due to pain). RESULTS: Pain intensity explained 8% to 19% of the disability variance. Beyond this psychological functioning explained 7% to 16%: particularly fear-avoidance and cognitive pain responses predicted chronic pain disorder disability; spousal responses predicted immobility better than other aspects of disability. Immobility due to actual pain occurred infrequently. When it did, however, it was better predicted by avoidance behavior in the patient and by spousal discouragement of movement than by actual pain intensity. The prediction of immobility due to pain by, respectively, avoidance behavior and catastrophizing was better in chronic pain (>6 months) and that of physical impairment by catastrophizing better in persistently chronic pain (>12 months) than in pain of shorter duration. DISCUSSION: The psychological prediction of chronic pain disorder disability was determined beyond that accounted for by pain intensity. Nonetheless, psychological functioning explained substantial variance in chronic pain disorder disability. The psychological prediction of immobility and physical impairment was stronger with longer pain duration. Patient characteristics and momentary states of disability-and in particular of immobility-should be carefully distinguished and accounted for in chronic pain disorder.     

Neuraxial pain relief for intractable cancer pain

Most patients with cancer pain achieve good analgesia using traditional analgesics and adjuvant medications; however, an important minority of patients (2% to 5%) suffers from severe and refractory cancer pain. For these individuals, spinal analgesics (intrathecal or epidural) provide significant hope for pain relief over months or years of treatment to help improve quality of life. Spinal analgesics have been suggested as the fourth step in the World Health Organization guidelines in the management of cancer pain, and thus the pain physician should be familiar with principles of use. Most patients achieve pain relief using spinal analgesics, with a minimum of complications that are easily managed at home. A variety of opioids, local anesthetics, clonidine, ketamine, and other analgesics are available for the spinal route of administration and should be titrated to clinical effect or intolerable side effect. This article discusses the appropriate selection of patients for spinal analgesics, reviews current recommended infusion systems and current spinal analgesics, discusses possible complications, and includes practical suggestions for patient management.