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Background and Objectives: Patient preferences play an important role when choosing between different treatment options and may have an influence on outcome. We performed a study to investigate (1) to what extent patients make use of the offer to receive acupuncture as a pretreatment for gastroscopy, (2) whether this is perceived as being as effective as sedation, and (3) whether characteristics and outcomes differ between patients giving consent to random allocation and patients choosing their pretreatment., Design: Partially randomized patient preference trial. Patients who gave consent to randomization were allocated randomly while patients who had a preference received the treatment of their choice., Patients: One hundred and six (106) inpatients of a district hospital in southern Germany undergoing gastroscopy for diagnostic purposes., Interventions: Pretreatment with a sedative (midazolam) or acupuncture., Main Outcome Measure: Patient's overall assessment on a visual analogue scale (VAS)., Results: Twenty-eight (28) patients (26%) agreed to be randomized, 21 (20%) chose acupuncture, 51 (47%) midazolam, and 8 (7%) did not want pretreatment. Patients receiving midazolam rated the examination as slightly less troublesome than those receiving acupuncture. Oxygen saturation, blood pressure, and heart rate were significantly lower in patients receiving midazolam. Characteristics and outcomes of randomized and nonrandomized patients did not differ significantly., Conclusions: Because of the low number of patients giving consent to random allocation conclusions on effectiveness are difficult to draw. The partially randomized patient preference design is recommended for use in future trials of acupuncture for gastroscopy. Such trials should be performed in an outpatient setting.

Purpose: The purpose of this study was to compare morphine with ketamine to morphine alone in a double-blind investigation of postsurgical pain control., Methods: Forty-two ASA 1 and 2 patients undergoing elective microdiscectomy were administered either 1 mg.ml-1 of morphine (n = 20) or 1 mg.ml-1 of both morphine and ketamine (n = 22) via iv patient controlled analgesia (IVPCA). Pain relief and side effects were assessed at 24 hr after surgery., Results: The mean (SD) visual analogue scale (VAS) pain rating of 2.3 (1.67) for patients receiving morphine with ketamine was lower (P < 0.001) than the VAS scores of patients receiving only morphine 4.5 (1.54). Patients receiving morphine and ketamine also had less difficulty with side effects, reporting less nausea (P < 0.05), pruritus (P < 0.001), and urinary retention (P < 0.05). Although dysphoria is reported to be a common side effect of ketamine, complaints of dysphoria were rare in both groups, with only one subject (5%) in the morphine with ketamine group and three (15%) subjects receiving morphine alone reporting this side effect., Conclusion: IVPCA ketamine in combination with morphine provides superior postsurgical pain relief at lower dosage and with fewer side effects than morphine alone.

The Multidimensional Pain Inventory (MPI) and the MMPI have been used widely to assess chronic pain patients. This study examined the relationship between patient profile classifications generated by the MPI and psychopathology as measured by the MMPI. MPI Dysfunctional and Interpersonally Distressed means were significantly different than the MPI Adaptive Coper means on scales 4, 6, 7, and 8 of the MMPI. The Dysfunctional and Adapative Coper means were also significantly different on MMPI scale 2. MMPI profiles for 79% classified as Dysfunctional and 62% classified as Interpersonally Distressed displayed psychopathology as defined by significant two-point scale elevations. Only 23% of those classified as Adaptive Copers had significant two-point MMPI scale elevations.

The submaximum effort tourniquet technique (SETT) is becoming more widely used as part of the clinical assessment of chronic pain patients despite little information about the scaling of this technique. Ratio scaling procedures resulted in a linear function, presumed to underlie clinical application of the SETT, for only 11% of the subjects. Therefore, current clinical use of the tourniquet ratio score should be questioned. Normals also obtained significantly more negatively accelerated power functions than pain patients with no difference in tolerances. Differences in these growth curves are discussed with reference to the concept of pain endurance. Continued needs for standardized pain evaluation techniques suggest that this type of psychophysical scaling procedure may improve the precision of some clinical pain assessments.

Cardiac Adjustment Scale (CAS) scores for 74 cardiac patients between 31 and 64 years of age who completed a comprehensive cardiac rehabilitation program were examined to determine whether they could predict return to work, judged adjustment to cardiac disability, and participation in the rehabilitation program. CAS scores proved to be unrelated to either vocational status or program involvement. Low CAS scores were associated with maladjustment, but higher scores were associated equally with good and poor adjustment. The results suggested that the CAS alone was of little value in increasing the accuracy of prediction of psychological or vocational adjustment with the population studied.