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Functional recovery of a patient with complex regional pain syndrome in an inpatient pain rehabilitation program : a case report

Feldman DD; Vitale KC; Gusmorino P; Snow B; Shen H; Jimenez A; Moroz A; Knotkova H
ORIGINAL:0006479
ISSN: 1939-5914
CID: 90956

Clinically significant placebo analgesic response in a pilot trial of botulinum B in patients with hand pain and carpal tunnel syndrome

Breuer, Brenda; Sperber, Kevin; Wallenstein, Sylvan; Kiprovski, Kiril; Calapa, Angela; Snow, Barry; Pappagallo, Marco
OBJECTIVE: We conducted a pilot trial to assess the effect of botulinum toxin B on palmar pain and discomfort in carpal tunnel syndrome (CTS) patients. Design. Randomized, double-blind, placebo-controlled. PATIENTS: Twenty ambulatory CTS patients. Intervention. Botulinum toxin B or placebo injections into three hypothenar muscles anatomically linked or attached to the carpal tunnel and its tentorium, that is, the Opponens Digiti Minimi and Flexor Digiti Minimi, located with electromyography (EMG), and the Palmaris Brevis Muscle, anatomically located without EMG. SETTING: New York City hospital. OUTCOME MEASURES: Outcomes were measured with numeric ratings, with higher scores indicating worse outcomes. Daily, subjects recorded their 0-10 numeric ratings of overall pain levels and pain-related sleep disturbances. During weekly telephone calls, they reported their 0-10 ratings for overall pain, pain-related sleep disturbance, and CTS-related tingling during the night and day as experienced over the preceding 24 hours. For each of four clinic visits, we averaged each subject's ratings of nine quality of life indicators from the West Haven-Yale Multidimensional Pain Inventory (WHYMPI), each measured on a 0-6 numeric scale. RESULTS: Over the 13-week trial, compared to baseline scores, the following outcomes predominantly showed decreases of statistical significance (P < or = 0.050) or borderline significance (0.050 < P < or = 0.10) for weeks 2 through 8: overall pain per daily diary entries and per weekly telephone reports, and pain-related sleep disturbance in the placebo group per phone report and in the botulinum toxin B group per diary report. CTS painful night tingling and day tingling, as well as the average scores of the WHYMPI quality of life indicators, showed improvements with statistical or borderline significance for almost each follow-up week. Between-group analyses, however, demonstrated that at each follow-up week, there was no statistically significant difference between the two study groups regarding changes from baseline in any study outcome. CONCLUSION: Botulinum toxin B is not dramatically superior to placebo for the relief of CTS symptoms. Possible explanations of the improvements in each study group are explored
PMID: 16533192
ISSN: 1526-2375
CID: 95715

Non-pharmacologic techniques for acute pain management

Chapter by: Snow BR; Gusmorino P
in: Pain management and regional anesthesia in trauma by Bernstein RL; Rosenberg AD; Grande CM [Eds]
London : WB Saunders, 2000
pp. 253-261
ISBN: 0702022853
CID: 3857

Hospitalization of the chronic pain patient

Chapter by: Snow BR; Gusmorino P; Pinter I
in: A practical approach to pain management by Lefkowitz M; Lebovits AH [Eds]
Boston : Little, Brown, 1996
pp. 165-170
ISBN: 0316519588
CID: 3856

Behavioral medicine and cancer: a clinician's guide

Chapter by: Snow BR; Gusmorino P; Pinter I
in: Musculoskeletal oncology by Lewis MM [Eds]
Philadelphia : WB Saunders, 1992
pp. 449-463
ISBN: 0721657710
CID: 3855

Multidisciplinary treatment for a chronic pain patient returning to work: a case report [Case Report]

Snow BR; Gusmorino P; Pinter I
PMID: 2175668
ISSN: 0883-9344
CID: 61875

Behavioral medicine and the geriatric orthopaedic inpatient: assessment and treatment

Chapter by: Gusmorino P; Snow BR; Pinter I
in: Comprehensive care of orthopaedic injuries in the elderly by Zuckerman JD [Eds]
Baltimore : Urban & Schwarzenberg, 1990
pp. 595-605
ISBN: 080672241x
CID: 3853

Chronic pain and the geriatric patient: assessment and treatment

Chapter by: Snow BR; Gusmorino P; Pinter I
in: Comprehensive care of orthopaedic injuries in the elderly by Zuckerman JD [Eds]
Baltimore : Urban & Schwarzenberg, 1990
pp. 607-618
ISBN: 080672241x
CID: 3854

Factors for predicting premature termination from a multidisciplinary inpatient chronic pain program

King SA; Snow BR
Forty-eight chronic pain patients who were discharged from or left the 21-day inpatient component of a multidisciplinary pain program prior to completion were compared with a randomly selected matched group of program patients who stayed the entire 21 days. The purpose of the study was to determine if pre-admission factors are useful in predicting whether a chronic pain patient will complete an inpatient pain program. The results of pre-admission MMPI, POMS, MPQ, and information obtained from a questionnaire specially created for the program were studied. On the tests, the non-completers admitted to less psychopathology than those who did complete the program. The non-completers also had a higher number of pain-related surgeries and were more likely to be college graduates; limited social support from their families and lower MMPI premature termination scale scores were also found. Implications of these findings for the management of chronic pain patients are discussed
PMID: 2616179
ISSN: 0304-3959
CID: 61876

Post-traumatic stress disorder among American Legionnaires in relation to combat experience in Vietnam: associated and contributing factors

Snow BR; Stellman JM; Stellman SD; Sommer JF Jr
The relationship between combat stress, DSM-III-defined post-traumatic stress disorder (PTSD), and a variety of behavioral factors was examined in a large nonclinical population. A total of 2858 randomly selected American Legion members who had served in Southeast Asia completed a questionnaire which elicited information on military service, personal health, and a variety of mental health outcomes. The data confirm the utility of the PTSD diagnosis as a distinct clinical entity. The frequency of PTSD and the extent of symptoms developed varied with the severity of criteria used for determining the extent of traumatic exposure. The PTSD rate ranged from 1.8 to 15.0% of the total sample, depending on whether 'exposure' to combat was defined relatively narrowly or broadly. A distinct linear dose-response relationship between combat stress and a quantitative measure of PTSD intensity was observed. The frequency of PTSD diagnosis was not affected by the presence of either physical or mental health problems which predated military service. A strong, stable relationship was found between combat stress and PTSD intensity for cohorts with differing intervals since the experience of combat trauma, which persisted up to 20 years after discharge from the military. The data thus support a broader approach to defining traumatic events which recognizes individual differences in response to combat, as well as the existence of other behavioral outcomes as residual effects of combat. Implications of these findings and the importance of treating veterans with varying presentations of PTSD are discussed
PMID: 3181093
ISSN: 0013-9351
CID: 61877