Edited by Catherine D. DeAngelis, MD, MPH
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.
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.
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.
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.
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.
"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."
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
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.
Meldrum reviews highlights of the history of pain management, focusing
on developments in the 20th century and treatment of chronic and cancer pain.
Advances in the management of cancer pain.
For your patients: Information about pain management.
This Week in JAMA. JAMA. 2003;290(18):2371. doi:10.1001/jama.290.18.2371