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This Week in JAMA
November 12, 2003

This Week in JAMA

JAMA. 2003;290(18):2371. doi:10.1001/jama.290.18.2371
PAIN MANAGEMENT

Edited by Catherine D. DeAngelis, MD, MPH

Control of Postoperative Pain

Surgical trauma induces cyclooxygenase 2 (COX-2)–mediated synthesis of prostaglandins, which sensitize peripheral nociceptors and mediate central neural sensitization. Buvanendran and colleaguesArticle conducted a randomized trial among patients undergoing primary total knee arthroplasty to assess the effect of rofecoxib, a selective COX-2 inhibitor, on postoperative outcomes. Postsurgical opioid consumption and pain scores were significantly reduced and joint range of motion was significantly increased in the group that received preoperative rofecoxib followed by continued postoperative administration compared with the group that received placebo. In a meta-analysis of randomized trials comparing postoperative epidural analgesia with parenteral opioids, Block and colleaguesArticle found that epidural analgesia provided significantly better postoperative pain control than did parenteral opioids.

Continuous Morphine Infusion in Preterm Newborns

Consensus statements have suggested using continuous opioid infusions for preterm neonates receiving mechanical ventilation despite only limited evidence to support their use. In this randomized trial among preterm newborns who received ventilatory support, Simons and colleagues found that pain responses in the group that received continuous intravenous morphine infusions were not significantly different than those in the placebo group. The incidence of intraventricular hemorrhage was lower in the continuous morphine infusion group than in the placebo group, but the rate of poor neurologic outcome was not significantly different.

Enhanced Depression Care in Adults With Arthritis

Depression is a risk factor for poor health outcomes among patients with arthritis. To determine whether enhancing care for depression improves pain and functional outcomes in older adults with both depression and arthritis, Lin and colleagues conducted a subgroup analysis of data from participants in the Improving Mood-Promoting Access to Collaborative Treatment study, a multicenter randomized trial among older adults with depression, who reported coexisting arthritis at baseline. More than half of the study participants reported a coexisting diagnosis or treatment for arthritis at baseline. Arthritis-related pain and functional outcomes, depression symptoms, general health status, and quality of life were significantly improved at 12 months among patients who received antidepressant medication and/or brief psychotherapy compared with patients who received usual care.

Chronic Pain and Poor Self-rated Health

Mäntyselkä and colleagues conducted a questionnaire survey of a population-based sample of individuals aged 15 to 74 years in Finland to evaluate the association between chronic pain and self-rated health. About one third of respondents reported any chronic pain, and 14.3% reported daily chronic pain. The prevalence of moderate self-rated health was 26.6% and of poor health, 7.6%. Chronic pain was independently associated with low self-rated health. The magnitude of this association increased with increasing frequency of pain and worsening of self-rated health.

Lost Productive Time, Costs Due to Pain in US Workers

Few data are available on the amount and cost of productive time lost due to pain in the US workforce. Based on an analysis of data from the American Productivity Audit, a telephone survey of working adults, Stewart and colleagues estimated that 13% of the total workforce experienced a loss in productive time during a 2-week period due to a common pain condition. Total lost productive time attributed to common pain conditions among active workers cost approximately $61.2 billion per year. Most of the lost productive time was explained by health-related reduced performance while at work rather than by work absence.

A Piece of My Mind

"I'm new at this and I don't know what to do. I don't understand why the pain has to be so bad. Can't they give her something?" From "Grams."

Medical News & Perspectives

New research is illuminating the connections between physical and emotional pain, including the finding that some brain regions that are important in the response to physical pain respond similarly to certain kinds of emotional distress.

Pain Management in Children

Howard discusses current pain management practices in children, recent advances in the understanding of pain in early life and its long-term consequences, and directions for future research.

History of Pain Management

Meldrum reviews highlights of the history of pain management, focusing on developments in the 20th century and treatment of chronic and cancer pain.

CLINICIAN'S CORNER

Advances in the management of cancer pain.

JAMA Patient Page

For your patients: Information about pain management.

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