Ibuprofen ( Motrin ) 400 mg is effective in women, and women are well represented in trials.

BACKGROUND: A recent article in the New Scientist argued that women were under-represented in clinical trials which, until now, had masked the finding that Ibuprofen ( Motrin ) 400 mg was ineffective in women. METHODS: Meta-analysis of randomised, double-blind placebo-controlled trials of Ibuprofen ( Motrin ) 400 mg in acute pain, and use of individual patient information were planned to test the hypothesis that Ibuprofen ( Motrin ) is ineffective in women. For each trial the proportion of women participating, the number of patients with at least 50% pain relief and the overall event rate for Ibuprofen ( Motrin ) 400 mg and placebo was calculated. For each patient percentage pain relief was calculated, and the numbers of women and men achieving at least 50% pain relief used to calculate number-needed-to-treat (NNT) for Ibuprofen ( Motrin ) 400 mg compared to placebo. RESULTS: Thirty-seven included trials had 3,577 patients, 67% of whom were women. The proportion with at least 50% pain relief was unaffected by how many women were included. In an analysis of 678 individual patients the proportion of women and men with at least 50% pain relief was the same, NNT 3.4 (2.6 to 4.6) and 2.5 (2.0 to 3.3) respectively. CONCLUSION: There is no clinically meaningful difference in the efficacy of Ibuprofen ( Motrin ) 400 mg between men and women experiencing moderate to severe postoperative pain and women were well represented.

Psychosocial factors influencing personal control in pain relief.

A questionnaire was administered to 100 women (50 primigravidae, 50 multigravidae) to investigate the influence of psychosocial factors on personal control in pain relief. Personal control was measured using a 36-item scale based on the concept of 'Rule'. The women were asked to rate each rule on a 7-point Likert scale. Measures of psychosocial factors included assessment of the women's expectations of labour pain, maternal confidence, pain intensity, antenatal training and partner support. Demographic variables including parity were also recorded. The questionnaires were completed prior to and within 48 h following the women's delivery (whilst they were inpatients on the postnatal ward).Two variables, antenatal training and pain intensity, emerged as predictors of personal control in pain relief following stepwise multiple regression analysis. These findings have implications for clinical practice particularly in the area of antenatal care and planning care during labour.

The interpretation of pain relief and sensory changes following sympathetic blockade.

A comparative study of the effects of sympathetic blockade by stellate ganglion block (SGB) and intravenous phentolamine infusion (PhI) was carried out in 24 patients with presumed sympathetically maintained pain of an upper extremity. A total of 15 SGBs and 16 PhIs were performed, with seven patients undergoing both procedures. All patients developed a Horner's syndrome with SGB and nasal stuffiness and cardiovascular changes with PhI. Similar pain relief was obtained with SGB and PhI in six of the seven who underwent both procedures. Pre-procedure patient characteristics including age, sex, duration of pain, historical and physical examination features suggestive of the reflex sympathetic dystrophy syndrome, and sensory disturbances such as allodynia and hyperpathia did not predict pain relief from either procedure. Changes in skin temperature following the sympatholytic procedure did not correlate with pain relief. For PhI, pain relief correlated with the magnitude of decrease in systolic blood pressure. After SGB, changes in quantitative thermal sensory testing (QST) suggestive of a partial deficit in thermal sensation correlated with pain relief. In 20 normal controls, water bath immersion to cool the hand passively by 7 degrees C and warm the hand passively by 4 degrees C had small and selective effects on thermal QST thresholds, but did not produce a general impairment in thermal sensation. In conclusion, the diagnosis of sympathetically maintained pain based on the history and physical examination alone cannot be made with confidence and therefore a sympatholytic procedure is necessary. When SGB produces pain relief but PhI does not, systemic absorption of local anaesthetic and/or sensory blockade by spread to somatic nerves may be the reason. Thus, PhI appears to be a less sensitive but more specific test than SGB. These two procedures provide complementary information and both may be needed to establish the diagnosis of sympathetically maintained pain.

Microvascular decompression for trigeminal neuralgia in patients with multiple sclerosis.

AIMS: To assess whether microvascular decompression (MVD) is a safe and efficacious treatment for patients with trigeminal neuralgia (TGN) and multiple sclerosis (MS). METHODS: Case records were reviewed of all patients with TGN and MS who underwent posterior fossa exploration with a view to MVD between 1993 and 2001. In all patients, magnetic resonance tomoangiography (MRTA) demonstrated vascular compression. RESULTS: Nine patients were included in the study. Seven patients underwent MVD alone; in 2 patients a partial sensory rhizotomy of the trigeminal nerve was added to the decompression. All patients had excellent initial pain relief. Recurrence of neuralgia was noted in 5 patients after MVD and in 1 of the 2 patients after partial sensory rhizotomy. Long-term pain relief was obtained in 1 patient who underwent a redo MVD after postoperative MRTA scans demonstrated recurrent vascular compression of the root entry zone (REZ). Thus only 4 out of 9 patients maintained pain relief. In addition, 3 patients experienced transient worsening of their MS. CONCLUSIONS: Although MVD provides good initial pain relief, the recurrence rate is much higher than that obtained in 'idiopathic' TGN. Although all procedures for the treatment of TGN are worse than those for idiopathic TGN, it is concluded that because of the high recurrence rate together with the morbidity associated with the procedure MVD should not be offered to patients with TGN and MS. Copyright 2003 S. Karger AG, Basel