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Sample records for acute flank pain

  1. Flank pain

    Science.gov (United States)

    Pain - side; Side pain ... Flank pain can be a sign of a kidney problem. But, since many organs are in this area, other causes are possible. If you have flank pain and fever , chills, blood in the urine, or ...

  2. Unenhanced helical CT in the investigation of acute flank pain

    International Nuclear Information System (INIS)

    Colistro, Robert; Torreggiani, William C.; Lyburn, Iain D.; Harris, Alison C.; Al-Nakshabandi, Nizar A.; Nicolaou, Savvas; Munk, Peter L.

    2002-01-01

    Unenhanced helical CT has emerged as the imaging technique of choice for the investigation of patients presenting with acute flank pain and suspected nephroureteric stone disease. There are several signs identifiable on unenhanced CT that support a diagnosis of stone disease. However, there are many pitfalls, that may confound a correct diagnosis. Some of the common pitfalls, together with methods to avoid such occurrences, will be discussed. A review of some of the common alternative diagnoses that may mimic the symptoms of nephroureteric stone disease is illustrated. Colistro, R. et al (2002)

  3. Imaging modalities and therapy options in patients with acute flank pain

    International Nuclear Information System (INIS)

    Grosse, A.; Grosse, C.

    2014-01-01

    The objective of this article is the description of imaging techniques for the evaluation of patients with acute flank pain and suspicion of urolithiasis and the impact of these techniques in the therapy management of patients with calculi. (orig.) [de

  4. Unenhanced helical computed tomography in the evaluation of acute flank pain

    International Nuclear Information System (INIS)

    Ahmad, N.A.; Ather, M.H.; Rees, J.

    2003-01-01

    The purpose of this study was to determine the value of unenhanced helical computed tomography (UHCT) in the diagnosis of acute flank pain at our institution. Two hundred and thirty-three consecutive UHCT examinations, performed for suspected renal/ureteral colic between July 2000 and August 2001 were reviewed, along with pertinent medical records. Ureteral calculi were identified in 148 (64%) examinations, evidence of recent passage of calculi was found in 10 (4%) and no calculi were found in 75 (32%). Thirty-two of the conservatively managed patients were excluded for inadequate follow-up. In the remaining 201 patients, sensitivity of UHCT in diagnosing calculi was 99% and specificity was 98%, while the positive predictive value was 99% and negative positive predictive value was 98%. Overall, an alternative or additional diagnosis was established in 28 (12%) patients. Upon diagnosis of ureterolithiasis on UHCT, none of the patients required additional imaging studies for confirmation. UHCT is a highly sensitive imaging modality for the detection of urinary tract calculi and obstruction. (author)

  5. Imaging modalities and therapy options in patients with acute flank pain; Bildgebungsmodalitaeten und Therapieoptionen bei Patienten mit akutem Flankenschmerz

    Energy Technology Data Exchange (ETDEWEB)

    Grosse, A.; Grosse, C. [Universitaet Bern, Bern (Switzerland)

    2014-07-15

    The objective of this article is the description of imaging techniques for the evaluation of patients with acute flank pain and suspicion of urolithiasis and the impact of these techniques in the therapy management of patients with calculi. (orig.) [German] Ziel der Arbeit ist die Eroerterung der bildgebenden Verfahren zur Abklaerung von Patienten mit akutem Flankenschmerz und Verdacht auf Urolithiasis und die Rolle dieser Verfahren im Therapiemanagement von Steinpatienten. (orig.)

  6. Comparative analysis and interobserver variation of unenhanced computed tomography and intravenous urography in the diagnosis of acute flank pain.

    Science.gov (United States)

    Ben Nakhi, Abdelmohsen; Gupta, Renu; Al-Hunayan, Adel; Muttikkal, Thomas; Chavan, Venu; Mohammed, Ahmed; Ali, Yusuf

    2010-01-01

    The purpose of this study was to compare unenhanced computed tomography (UECT) to intravenous urography (IVU) for detecting urinary tract calculi, signs of obstruction and non-renal causes in the assessment of acute flank pain, and in their interobserver agreement. In this prospective study, carried out at a university hospital over a period of 1 year, 36 patients (27 males and 9 females) participated. Mean age was 44 +/- 15 years (range: 14-73 years). The patients presented with acute flank pain and underwent UECT and IVU. The images were blindly evaluated by 2 experienced radiologists and the two techniques compared using the two-tailed McNemar's test for matched pairs; p values IVU found them in only 8 (22.2%). The increased detection by UECT was due to its ability to detect smaller stones (IVU in determining calculus position, in detecting primary or secondary signs of obstruction and in identifying non-urinary causes of flank pain. The overall average of agreement, as indicated by kappa values, was 0.88 for UECT and 0.61 for IVU. UECT showed better detectability and interobserver agreement tan IVU, suggesting that UECT could replace IVU as the first imaging modality in the evaluation of acute renal colic. Copyright 2010 S. Karger AG, Basel.

  7. Prospective comparison of unenhanced spiral computed tomography and intravenous urogram in the evaluation of acute flank pain.

    Science.gov (United States)

    Miller, O F; Rineer, S K; Reichard, S R; Buckley, R G; Donovan, M S; Graham, I R; Goff, W B; Kane, C J

    1998-12-01

    To prospectively compare the diagnostic ability of unenhanced spiral computed tomography (NCCT) and intravenous urogram (IVU) in the evaluation of adults with acute flank pain. After giving informed consent, 106 adult patients with acute flank pain suspected of having urolithiasis underwent NCCT followed by IVU. Subsequent follow-up was scheduled within 72 hours in the Urology Clinic. Each NCCT was read by a single radiologist who was unaware of clinical history and IVU results. Each IVU was read by a different radiologist who was unaware of clinical history and NCCT results. Sensitivity, specificity, and positive and negative predictive values were determined for NCCT and IVU. The diagnosis of ureterolithiasis was defined as unequivocal evidence of urolithiasis on either NCCT or IVP. Seventy-five of 106 patients evaluated were diagnosed with ureterolithiasis. Clinical follow-up was available in 74 (98%) stone patients and in 31 (100%) of 31 non-stone patients. In 72 of the 75 patients diagnosed with ureteral calculi, the NCCT made the diagnosis. IVU made the diagnosis in 65 of the 75 patients. Of the 31 patients without ureterolithiasis, the NCCT was negative in all cases. IVU was negative in 29 of the 31 cases. Unenhanced spiral CT was 96% sensitive and 100% specific (P IVU was 87% sensitive and 94% specific (P IVU, using the log odds ratio and Fisher's exact test, NCCT was significantly better able to predict the presence of urolithiasis (P=0.015). NCCT accurately diagnoses ureterolithiasis in patients presenting with acute flank pain. NCCT is significantly better than IVU in determining the presence of urolithiasis.

  8. Right flank pain as the only symptom for acute pancreatitis in a ...

    African Journals Online (AJOL)

    Arun Kumar Agnihotri

    The initial abdominal ultrasonogram was normal and the patient was misdiagnosed as possible renal associated pain. The CECT scan done the following day showed acute pancreatitis with peripancreatic fat stranding, fluid upto the right perinephric space and thickening of pararenal fascia. Urinalysis and renal function.

  9. Comparison of effective radiation doses in patients undergoing unenhanced MDCT and excretory urography for acute flank pain

    Energy Technology Data Exchange (ETDEWEB)

    Eikefjord, E.N.; Thorsen, F.; Rorvik, J. [Haukeland University Hospital, Bergen (Norway). Dept. of Radiology

    2007-07-15

    Objective: The purpose of this study was to measure and compare the effective radiation dose in patients undergoing unenhanced MDCT and excretory urography for acute flank pain, and to explore technical and practical factors affecting the effective dose. Subjects and methods: One hundred nineteen patients with acute flank pain were included. All patients were examined using both MDCT and excretory urography. CT involved one acquisition from the upper kidney margin to the symphysis pubis. The only protocol variation was in the tube current (mAs), which was made according to patient body mass. The excretory urography protocol consisted of three images, with more when supplementary images were needed. Effective radiation doses were computer-simulated using dosimetry programs for CT and conventional radiography, based on Norwegian Radiological Protection Board dose data sets. Mean and SDs of measured patient doses were calculated and compared. Further analyses of dose variations in body mass categories (body mass index) were conducted, as were analyses concerning the number of images taken. Results: The mean effective doses were 7.7 mSv with MDCT and 3.63 mSv with excretory urography. The effective dose varied both in and between techniques but could be predicted. Radiation risk decreased significantly with increased patient weight. Conclusion: The average effective dose with MDCT was more than double that with excretory urography. However, the appropriate dose could be strongly predicted by the patient's body mass index and by procedure. An optimum low-dose protocol should be considered before initiating unenhanced MDCT for ureteral colic in order to minimize the radiation-induced cancer risk and to secure adequate image quality. (author)

  10. Investigation of acute flank pain: how do practices of U.K.and Irish urologists compare with those of transatlantic and continental European colleagues?

    Science.gov (United States)

    Otite, Ugo; Parkin, John; Waymont, Brian; Inglis, John A; Philp, Nigel H

    2005-10-01

    Noncontrast-enhanced spiral CT (NESCT) is more accurate and reliable than intravenous urography (IVU) in diagnosing the cause of acute flank pain. This study aimed to determine the impact of current literature on the choice of imaging modality used to investigate acute flank pain within the UK and the Republic of Ireland. A questionnaire regarding the preferred investigation for acute flank pain was sent to all consultant urologists registered as British Association of Urological Surgeons members. Of the 548 consultants from 210 institutions surveyed, 293 (54%) from 171 (81.4%) institutions returned their questionnaires. Intravenous urography is used in the majority of institutions (146; 85.4%) for investigating acute flank pain. Only 18 (10.5%) use NESCT, while 4.1% use ultrasonography. Among those using IVU as the investigation of choice, the main reason given was limited CT services (82.4%). Others included familiarity with IVU features (51.2%), limited availability of radiologists for out-of-hours reporting of CT (26%), more rapid procedure (20.8%), lower cost (20%), and lower radiation exposure (19.6%). Only 52.4% of consultants using IVU would prefer NESCT if both were equally available. Urography remains the commonest modality for the investigation of acute flank pain in the UK and Ireland primarily because of limited CT services and greater familiarity with the images. Given the opportunity, only half of consultant urologists would select NESCT in preference to IVU, suggesting that improving the availability of CT services alone may not lead to practice paralleling that of our transatlantic and continental European colleagues.

  11. Diagnosis of acute flank pain caused by ureteral stones: value of combined direct and indirect signs on IVU and unenhanced helical CT.

    Science.gov (United States)

    Wang, Li-Jen; Ng, Chip-Jin; Chen, Jih-Chang; Chiu, Te-Fa; Wong, Yon-Cheong

    2004-09-01

    The aim of this study was to assess the usefulness of combined direct and indirect signs on intravenous urography (IVU) and unenhanced helical computed tomography (UHCT) for the diagnosis of ureteral stones in emergency patients with acute flank pain. During an 8-month period, 82 emergency patients with acute flank pain undergoing IVU and UHCT with sufficient clinical follow-up formed the study group. The presence or absence of direct sign (visualization of ureteral stones) and indirect signs on IVU and UHCT was recorded. The diagnostic accuracy of each direct/indirect sign and their combination for the diagnosis of ureteral stones on IVU and UHCT were analyzed and compared. Of the 82 patients, 66 had ureteral stones, four had passed urinary stones prior to imaging and 12 had other diseases. The diagnostic accuracies of direct signs on IVU and UHCT for the diagnosis of ureteral stones were 79.3 and 98.8%, respectively, which was more accurate than that of any single indirect sign on IVU and UHCT. However, the diagnostic accuracy of ureteral stones by IVU increased to 90.2% when using diagnostic criteria requiring the presence of a direct sign or at least three indirect signs, and by UHCT, it increased to 100% when using diagnostic criteria requiring the presence of a direct sign with at least one indirect sign. Therefore, for emergency patients with acute flank pain, the use of the above combinations of direct/indirect signs is useful as the diagnostic criterion for ureteral stones.

  12. Diagnosis of acute flank pain caused by ureteral stones: value of combined direct and indirect signs on IVU and unenhanced helical CT

    International Nuclear Information System (INIS)

    Wang, Li-Jen; Wong, Yon-Cheong; Ng, Chip-Jin; Chen, Jih-Chang; Chiu, Te-Fa

    2004-01-01

    The aim of this study was to assess the usefulness of combined direct and indirect signs on intravenous urography (IVU) and unenhanced helical computed tomography (UHCT) for the diagnosis of ureteral stones in emergency patients with acute flank pain. During an 8-month period, 82 emergency patients with acute flank pain undergoing IVU and UHCT with sufficient clinical follow-up formed the study group. The presence or absence of direct sign (visualization of ureteral stones) and indirect signs on IVU and UHCT was recorded. The diagnostic accuracy of each direct/indirect sign and their combination for the diagnosis of ureteral stones on IVU and UHCT were analyzed and compared. Of the 82 patients, 66 had ureteral stones, four had passed urinary stones prior to imaging and 12 had other diseases. The diagnostic accuracies of direct signs on IVU and UHCT for the diagnosis of ureteral stones were 79.3 and 98.8%, respectively, which was more accurate than that of any single indirect sign on IVU and UHCT. However, the diagnostic accuracy of ureteral stones by IVU increased to 90.2% when using diagnostic criteria requiring the presence of a direct sign or at least three indirect signs, and by UHCT, it increased to 100% when using diagnostic criteria requiring the presence of a direct sign with at least one indirect sign. Therefore, for emergency patients with acute flank pain, the use of the above combinations of direct/indirect signs is useful as the diagnostic criterion for ureteral stones. (orig.)

  13. Computed tomography versus intravenous urography in diagnosis of acute flank pain from urolithiasis: a randomized study comparing imaging costs and radiation dose.

    Science.gov (United States)

    Thomson, J M; Glocer, J; Abbott, C; Maling, T M; Mark, S

    2001-08-01

    The equivalent sensitivity of non-contrast computed tomography (NCCT) and intravenous urography (IVU) in the diagnosis of suspected ureteric colic has been established. Approximately 50% of patients with suspected ureteric colic do not have a nephro-urological cause for pain. Because many such patients require further imaging studies, NCCT may obviate the need for these studies and, in so doing, be more cost effective and involve less overall radiation exposure. The present study compares the total imaging cost and radiation dose of NCCT versus IVU in the diagnosis of acute flank pain. Two hundred and twenty-four patients (157 men; mean age 45 years; age range 19-79 years) with suspected renal colic were randomized either to NCCT or IVU. The number of additional diagnostic imaging studies, cost (IVU A$136; CTU A$173), radiation exposure and imaging times were compared. Of 119 (53%) patients with renal obstruction, 105 had no nephro-urological causes of pain. For 21 (20%) of these patients an alternative diagnosis was made at the initial imaging, 10 of which were significant. Of 118 IVU patients, 28 (24%) required 32 additional imaging tests to reach a diagnosis, whereas seven of 106 (6%) NCCT patients required seven additional imaging studies. The average total diagnostic imaging cost for the NCCT group was A$181.94 and A$175.46 for the IVU group (P IVU) (P IVU) (P IVU, its advantages of faster diagnosis, the avoidance of additional diagnostic imaging tests and its ability to diagnose other causes makes it the study of choice for acute flank pain at Christchurch Hospital.

  14. Computed tomography versus intravenous urography in diagnosis of acute flank pain from urolithiasis: a randomized study comparing imaging costs and radiation dose

    International Nuclear Information System (INIS)

    Thomson, J.M.Z.; Maling, T.M.J.; Glocer, J.; Mark, S.; Abbott, C.

    2001-01-01

    The equivalent sensitivity of non-contrast computed tomography (NCCT) and intravenous urography (IVU) in the diagnosis of suspected ureteric colic has been established. Approximately 50% of patients with suspected ureteric colic do not have a nephro-urological cause for pain. Because many such patients require further imaging studies, NCCT may obviate the need for these studies and, in so doing, be more cost effective and involve less overall radiation exposure. The present study compares the total imaging cost and radiation dose of NCCT versus IVU in the diagnosis of acute flank pain. Two hundred and twenty-four patients (157 men; mean age 45 years; age range 19-79 years) with suspected renal colic were randomized either to NCCT or IVU. The number of additional diagnostic imaging studies, cost (IVU A$ 136; CTU A$ 173), radiation exposure and imaging times were compared. Of 119(53%) patients with renal obstruction, 105 had no nephro-urological causes of pain. For 21 (20%) of these patients an alternative diagnosis was made at the initial imaging, 10 of which were significant. Of 118 IVU patients, 28 (24%) required 32 additional imaging tests to reach a diagnosis, whereas seven of 106 (6%) NCCT patients required seven additional imaging studies. The average total diagnostic imaging cost for the NCCT group was A$181.94 and A$175.46 for the IVU group (P< 0.43). Mean radiation dose to diagnosis was 5.00 mSv (NCCT) versus 3.50 mSv (IVU) (P < 0.001). Mean imaging time was 30 min (NCCT) versus 75 min (IVU) (P < 0.001). Diagnostic imaging costs were remarkably similar. Although NCCT involves a higher radiation dose than IVU, its advantages of faster diagnosis, the avoidance of additional diagnostic imaging tests and its ability to diagnose other causes makes it the study of choice for acute flank pain at Christchurch Hospital. Copyright (2001) Blackwell Science Pty Ltd

  15. Unenhanced helical computed tomography vs intravenous urography in patients with acute flank pain: accuracy and economic impact in a randomized prospective trial.

    Science.gov (United States)

    Pfister, S A; Deckart, A; Laschke, S; Dellas, S; Otto, U; Buitrago, C; Roth, J; Wiesner, W; Bongartz, G; Gasser, T C

    2003-11-01

    Unenhanced helical computed tomography (UHCT) has evolved into a well-accepted alternative to intravenous urography (IVU) in patients with acute flank pain and suspected ureterolithiasis. The purpose of our randomized prospective study was to analyse the diagnostic accuracy of UHCT vs IVU in the normal clinical setting with special interest on economic impact, applied radiation dose and time savings in patient management. A total of 122 consecutive patients with acute flank pain suggestive of urolithiasis were randomized for UHCT ( n=59) or IVU ( n=63). Patient management (time, contrast media), costs and radiation dose were analysed. The films were independently interpreted by four radiologists, unaware of previous findings, clinical history and clinical outcome. Alternative diagnoses if present were assessed. Direct costs of UHCT and IVU are nearly identical (310/309 Euro). Indirect costs are much lower for UHCT because it saves examination time and when performed immediately initial abdominal plain film (KUB) and sonography are not necessary. Time delay between access to the emergency room and start of the imaging procedure was 32 h 7 min for UHCT and 36 h 55 min for IVU. The UHCT took an average in-room time of 23 min vs 1 h 21 min for IVU. Mild to moderate adverse reactions for contrast material were seen in 3 (5%) patients. The UHCT was safe, as no contrast material was needed. The mean applied radiation dose was 3.3 mSv for IVU and 6.5 mSv for UHCT. Alternative diagnoses were identified in 4 (7%) UHCT patients and 3 (5%) IVU patients. Sensitivity and specificity of UHCT and IVU was 94.1 and 94.2%, and 85.2 and 90.4%, respectively. In patients with suspected renal colic KUB and US may be the least expensive and most easily accessable modalities; however, if needed and available, UHCT can be considered a better alternative than IVU because it has a higher diagnostic accuracy and a better economic impact since it is more effective, faster, less expensive and

  16. Unenhanced helical computed tomography vs intravenous urography in patients with acute flank pain: accuracy and economic impact in a randomized prospective trial

    International Nuclear Information System (INIS)

    Pfister, S.A.; Deckart, A.; Laschke, S.; Gasser, T.C.; Dellas, S.; Otto, U.; Buitrago, C.; Wiesner, W.; Bongartz, G.; Roth, J.

    2003-01-01

    Unenhanced helical computed tomography (UHCT) has evolved into a well-accepted alternative to intravenous urography (IVU) in patients with acute flank pain and suspected ureterolithiasis. The purpose of our randomized prospective study was to analyse the diagnostic accuracy of UHCT vs IVU in the normal clinical setting with special interest on economic impact, applied radiation dose and time savings in patient management. A total of 122 consecutive patients with acute flank pain suggestive of urolithiasis were randomized for UHCT (n=59) or IVU (n=63). Patient management (time, contrast media), costs and radiation dose were analysed. The films were independently interpreted by four radiologists, unaware of previous findings, clinical history and clinical outcome. Alternative diagnoses if present were assessed. Direct costs of UHCT and IVU are nearly identical (310/309 Euro). Indirect costs are much lower for UHCT because it saves examination time and when performed immediately initial abdominal plain film (KUB) and sonography are not necessary. Time delay between access to the emergency room and start of the imaging procedure was 32 h 7 min for UHCT and 36 h 55 min for IVU. The UHCT took an average in-room time of 23 min vs 1 h 21 min for IVU. Mild to moderate adverse reactions for contrast material were seen in 3 (5%) patients. The UHCT was safe, as no contrast material was needed. The mean applied radiation dose was 3.3 mSv for IVU and 6.5 mSv for UHCT. Alternative diagnoses were identified in 4 (7%) UHCT patients and 3 (5%) IVU patients. Sensitivity and specificity of UHCT and IVU was 94.1 and 94.2%, and 85.2 and 90.4%, respectively. In patients with suspected renal colic KUB and US may be the least expensive and most easily accessable modalities; however, if needed and available, UHCT can be considered a better alternative than IVU because it has a higher diagnostic accuracy and a better economic impact since it is more effective, faster, less expensive and less

  17. Flank pain: is Intravenous Urogram necessary?

    Science.gov (United States)

    Teh, H S; Lin, M B; Khoo, T K

    2001-09-01

    To determine the diagnostic yield of Intravenous Urogram (IVU) and the values of plain radiograph of kidney, ureter and bladder (KUB) and urinalysis as screening tests, with the objective to improve the cost effectiveness, in the management of patients presenting with flank pain due to urinary lithiasis. All Intravenous Urogram (IVU) request forms and reports for the month of February 1998 were audited. The case notes, urinalysis, KUB and IVU films were traced and reviewed. There were 110 patients investigated, 61.8% (68) had normal IVU, 38.2% (42) had abnormal IVU. The sensitivity and specificity of KUB alone was 79.4% and 90%. The sensitivity using urinalysis alone was 90.9% and its specificity 33.8%. The sensitivity of combined KUB and urinalysis was 100% and its specificity 26%, with a negative predictive value of 100%. All the patients with both negative KUB and urinalysis in our study were found to have negative IVU. Our study shows that in patients with both negative KUB and urinalysis, the yield of IVU is very low and may not be necessary. This is important, as an IVU examination is not without risk. A combination of KUB with urinary analysis and careful evaluation of clinical symptoms will improve the cost-effectiveness of patient management.

  18. Case report: Right flank pain and fever | Stephany | Malawi Medical ...

    African Journals Online (AJOL)

    Case report: Right flank pain and fever. P Stephany, L Aaron, PA Buffet. Abstract. No Abstract. Malawi Medical Journal Vol.17(2) 2005: 54-55. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/mmj.v17i2.10881 · AJOL African Journals ...

  19. Analgesia for acute pain

    African Journals Online (AJOL)

    ailment known to man, and acute pain is an experience familiar to all. Pain is defined as an unpleasant sensation associated with ... of the pathways involved in pain perception, and how these pathways can be targeted with various modalities is required to obtain adequate analgesia. This article provides an overview of the ...

  20. Acute dental pain II

    DEFF Research Database (Denmark)

    Jonasson, Peter; Kirkevang, Lise-Lotte; Rosen, Annika

    2016-01-01

    information, and a systematic approach is necessary. This paper will focus on diagnosis and treatment of pulpitis, pulp necrosis and apical periodontitis, periodontal abscess and endodontic-periodontal lesions, pericoronitis and post-operative problems. When the patient seeks the dentist suffering from acute...... dental pain, they expect that the dentist starts treatment at once and that the treatment should provide pain relief. In this situation many patients are fragile, anxious and nervous. If the dentist is able to manage emergency treatment of acute dental pain this will build confidence and trust between......Acute dental pain most often occurs in relation to inflammatory conditions in the dental pulp or in the periradicular tissues surrounding a tooth, but it is not always easy to reach a diagnose and determine what treatment to perform. The anamnesis and the clinical examination provide valuable...

  1. MANAGEMENT OF ACUTE MUSCULOSKELETAL PAIN ...

    African Journals Online (AJOL)

    of multimodal and multi-agent approach to acute pain management for better patient care. ... injuries and surgical operations leave a huge burden .... Pain under treatment. There are multiple reasons for pain under treatment which include medical personnel lacking formal education on pain management; inadequate pain.

  2. “Isolated Spontaneous Renal Artery Thrombosis – A Rare Cause of Acute Flank Pain”

    Directory of Open Access Journals (Sweden)

    M. Raghavendran

    2016-11-01

    Full Text Available Many patients present with severe abdominal pain. Renal Artery Thrombosis (RAT is rare, serious and misdiagnosed. RAT has been well described in association with various disorders, but isolated spontaneously occurring RAT is rare and only 2 cases have been described as of date. We present a case of flank pain presenting to emergency for evaluation and discuss the clinical aspects and management. We would like to stress on the important role of serum LDH levels and CT scan in RAT. Early diagnosis may result in salvage of organ by minimally invasive techniques. Late diagnosis will almost always result in nephrectomy.

  3. The value of HASTE MR urography in the diagnosis of the chronic nephrogenic flank pain

    International Nuclear Information System (INIS)

    Werel, D.; Tarasow, E.; Dzienis, W.; Ustymowicz, A.; Orzechowska-Bobkiewicz, A.; Walecki, J.; Darewicz, B.

    2004-01-01

    To asses the usefulness of the projectional HASTE sequence in the diagnosis of chronic flank pain caused by obstructive uropathy in comparison with conventional urography. 28 patients with chronic flank pain and hydronephrosis on ultrasound underwent conventional urography and HASTE sequence of static MR urography. The methods were evaluated for image quality, presence, agree, level and cause of urinary tract dilatation. The image quality of the urinary tract on HASTE was good in 57.1% and satisfactory in 42.9%; in conventional urography - good in 28.6%, satisfactory in 42.8% and poor in 28.6%. HASTE demonstrated hydronephrosis and degree of hydronephrosis in all the cases and conventional urography in 25 (83.3%). HASTE identified correctly the site of obstruction in 29 cases (96.7%), and conventional urography in 21 cases (70%). The sensitivity of HASTE in diagnosis of the intrinsic and extrinsic causes of obstruction was 73.7% and 80%, accuracy 73.3% and that of conventional urography 68.4%, 40% and 56.7%, respectively. HASTE is a valuable method in the diagnostics of chronic obstructive uropathy. It allows to evaluate the degree of hydronephrosis, the level and in many cases the cause of obstruction. When the urinary tract is not visualized in conventional urography, static MR urography is especially useful. (author)

  4. Neck Pain and Acute Dysphagia.

    Science.gov (United States)

    Simões, João; Romão, José; Cunha, Anita; Paiva, Sofia; Miguéis, António

    2017-02-01

    The acute tendinitis of the longus colli muscle is an unusual diagnosis in the cases of acute dysphagia with cervical pain. Is a self-limiting condition caused by abnormal calcium hydroxyapatite deposition in the prevertebral space and can cause pharyngeal swelling with impaired swallow. It is absolutely critical to make the differential diagnosis with deep cervical infections in order to avoid invasive treatments.

  5. Acute pain management in children

    Directory of Open Access Journals (Sweden)

    Susan T Verghese

    2010-07-01

    Full Text Available Susan T Verghese, Raafat S HannallahThe George Washington University Medical Center, Division of Anesthesiology, Children’s National Medical Center, Washington, DC, USAAbstract: The greatest advance in pediatric pain medicine is the recognition that untreated pain is a significant cause of morbidity and even mortality after surgical trauma. Accurate assessment of pain in different age groups and the effective treatment of postoperative pain is constantly being refined; with newer drugs being used alone or in combination with other drugs continues to be explored. Several advances in developmental neurobiology and pharmacology, knowledge of new analgesics and newer applications of old analgesics in the last two decades have helped the pediatric anesthesiologist in managing pain in children more efficiently. The latter include administering opioids via the skin and nasal mucosa and their addition into the neuraxial local anesthetics. Systemic opioids, nonsteroidal anti-inflammatory agents and regional analgesics alone or combined with additives are currently used to provide effective postoperative analgesia. These modalities are best utilized when combined as a multimodal approach to treat acute pain in the perioperative setting. The development of receptor specific drugs that can produce pain relief without the untoward side effects of respiratory depression will hasten the recovery and discharge of children after surgery. This review focuses on the overview of acute pain management in children, with an emphasis on pharmacological and regional anesthesia in achieving this goal.Keywords: pediatric pain treatment, pain medication in children, pediatric regional anesthesia, pca and pcea in children, epidural additives

  6. Acute pain assessment

    LENUS (Irish Health Repository)

    Clear, Elaine

    2016-05-01

    The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” (IASP, 1997). This definition of pain emphasises that it is neither a sensory nor an emotional experience, but a combination of both. It is a subjective experience influenced by physical, psychological and environmental factors that is assessed from a biopsychosocial perspective. The gold standard in assessing pain however is always what the patient says it is.

  7. Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies

    Energy Technology Data Exchange (ETDEWEB)

    Marincek, B. [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland)

    2002-09-01

    Common causes of acute abdominal pain include appendicitis, cholecystitis, bowel obstruction, urinary colic, perforated peptic ulcer, pancreatitis, diverticulitis, and nonspecific, nonsurgical abdominal pain. The topographic classification of acute abdominal pain (pain in one of the four abdominal quadrants, diffuse abdominal pain, flank or epigastric pain) facilitates the choice of the imaging technique. The initial radiological evaluation often consists of plain abdominal radiography, despite significant diagnostic limitations. The traditional indications for plain films - bowel obstruction, pneumoperitoneum, and the search of ureteral calculi - are questioned by helical computed tomography (CT). Although ultrasonography (US) is in many centers the modality of choice for imaging the gallbladder and the pelvis in children and women of reproductive age, CT is considered to be one of the most valued tools for triaging patients with acute abdominal pain. CT is particularly beneficial in patients with marked obesity, unclear US findings, bowel obstruction, and multiple lesions. The introduction of multidetector row CT (MDCT) has further enhanced the utility of CT in imaging patients with acute abdominal pain. (orig.)

  8. Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies

    International Nuclear Information System (INIS)

    Marincek, B.

    2002-01-01

    Common causes of acute abdominal pain include appendicitis, cholecystitis, bowel obstruction, urinary colic, perforated peptic ulcer, pancreatitis, diverticulitis, and nonspecific, nonsurgical abdominal pain. The topographic classification of acute abdominal pain (pain in one of the four abdominal quadrants, diffuse abdominal pain, flank or epigastric pain) facilitates the choice of the imaging technique. The initial radiological evaluation often consists of plain abdominal radiography, despite significant diagnostic limitations. The traditional indications for plain films - bowel obstruction, pneumoperitoneum, and the search of ureteral calculi - are questioned by helical computed tomography (CT). Although ultrasonography (US) is in many centers the modality of choice for imaging the gallbladder and the pelvis in children and women of reproductive age, CT is considered to be one of the most valued tools for triaging patients with acute abdominal pain. CT is particularly beneficial in patients with marked obesity, unclear US findings, bowel obstruction, and multiple lesions. The introduction of multidetector row CT (MDCT) has further enhanced the utility of CT in imaging patients with acute abdominal pain. (orig.)

  9. Elderly patient with atypical leiomyoma of the bladder presenting as flank pain: A case report

    Directory of Open Access Journals (Sweden)

    Mojtaba Ameli

    2017-12-01

    Full Text Available Atypical leiomyoma is a rare tumor of the bladder whose correct diagnosis with imaging techniques and cystoscopy is difficult. This tumor is prevalent in females and more common in middle age. In the present study we report a rare case of atypical leiomyoma presenting as flank pain and history of recurrent urinary tract infections in an elderly female. Ultrasound (US showed that the wall of bladder was thickening and irregular, especially in the lower part of the bladder. US revealed hypoechoic solid mass with dimensions of 37 x 26 mm in the posterior bladder wall protruding into the bladder. Computed Tomography scan of the patient showed a mass with dimensions of 29 x 38 mm in the posterior wall of the bladder that infiltrated the mesenteric fat and also seemed to be invading the intestinal wall. According to the general condition and age of our patient, we removed all of the mass under spinal anesthesia by transurethral bladder resection (TURBT. Biopsy results showed atypical leiomyoma. About 6 months after the patient follow-up, no recurrence was observed and symptoms had completely resolved. According to the non-specificity of the imaging, of the age of presentation and of clinical manifestations of atypical leiomyoma differential diagnosis for bladder cancer it is recommended. Only with histopathologic findings, the diagnosis can be confirmed.

  10. Avaliação da concordância interobservador na análise da tomografia computadorizada sem contraste no diagnóstico da urolitíase em pacientes com cólica renal aguda Interobserver agreement on non-contrast computed tomography interpretation for diagnosis of urolithiasis in patients with acute flank pain

    Directory of Open Access Journals (Sweden)

    Luís Ronan Marquez Ferreira de Souza

    2006-10-01

    Full Text Available OBJETIVO: Avaliar a reprodutibilidade da tomografia computadorizada sem contraste na avaliação da litíase ureteral e os sinais secundários de obstrução do sistema coletor em pacientes com cólica renal aguda. MATERIAIS E MÉTODOS: Estudo prospectivo de 52 pacientes com diagnóstico clínico de cólica renal aguda submetidos a exame de tomografia computadorizada de abdome sem contraste. Os exames foram realizados com técnica helicoidal e posteriormente analisados por três observadores independentes, com a concordância interobservador avaliada pelo método estatístico kappa (kapa. Foram analisados os parâmetros: a presença, localização e mensuração dos cálculos ureterais; b dilatação do sistema coletor intra-renal; c heterogeneidade da gordura perirrenal; d dilatação ureteral; e edema da parede ureteral (sinal do halo. RESULTADOS: Foram encontrados 40 cálculos ureterais na tomografia computadorizada (77%. A concordância interobservador para a identificação do cálculo ureteral e da dilatação ureteral foi quase perfeita (kapa = 0,89 e kapa = 0,87, respectivamente, substancial para dilatação do sistema coletor intra-renal (kapa = 0,77 e moderada para heterogeneidade da gordura perirrenal e para edema da parede ureteral (kapa = 0,55 e kapa = 0,56, respectivamente. CONCLUSÃO: A tomografia computadorizada de abdome sem contraste apresenta elevada reprodutibilidade na avaliação da litíase ureteral e dos sinais secundários de obstrução do sistema coletor.OBJECTIVE: To evaluate the interobserver agreement on non-contrast computed tomography interpretation by a group of experienced abdominal radiologists, for the study of urolithiasis in patients presenting acute flank pain. MATERIALS AND METHODS: Prospective study of 52 patients submitted to non-contrast enhanced helical computed tomography. The images were subsequently analyzed by three independent observers, with the interobserver agreement assessed by means of the

  11. Acute pain transfusion reaction.

    Science.gov (United States)

    Hardwick, Jody; Osswald, Michael; Walker, Daniel

    2013-11-01

    A 34-year-old woman with a diagnosis of hemophagocytic lymphohistocytosis (HLH) received a double umbilical cord blood transplantation following a myeloablative chemotherapy preparative regimen with busulfan and cyclophosphamide. HLH is a rare, potentially fatal hematologic disorder characterized by the overactivation of histocytes and T lymphocytes, leading to organ infiltration and acute illness. On day 25 post-transplantation, the patient required a platelet transfusion for a platelet count of 6,000 per ml (normal range = 150,000-450,000 per ml). The patient's blood type prior to the cord blood transplantation was B positive and, although both umbilical cord blood donors were O positive, the patient was still B positive per blood bank testing on that day. Although the recipient of an allogenic stem cell transplantation will eventually become the blood type of the donor, the time for this process to occur varies for each person. That process must be monitored by the blood bank for the purpose of cross-matching blood products to decrease hemolysis as much as possible. The patient was premedicated with the facility's standard for platelet transfusions: acetaminophen 650 mg and diphenhydramine 25 mg about 30 minutes prior to the platelet transfusion.

  12. Acute pain service: past, present and future.

    Science.gov (United States)

    Tawfic, Qutaiba Amir; Faris, Ali S

    2015-01-01

    Post surgical pain is a continuing major medical challenge despite all the advances in understanding acute pain and the development of new modalities of pain management. Since 1985 when the first acute pain service (APS) was started, many organizations initiated APS protocols and guidelines and it became mandatory to have an APS in all major acute care centers. This review focuses on the stages of development of APS and the challenges of postoperative pain management to provide optimal analgesia. Further clinical studies are required to determine best medication regimen for post-operative pain management.

  13. Lamotrigine for acute and chronic pain

    Science.gov (United States)

    Wiffen, Philip J; Derry, Sheena; Moore, R Andrew

    2014-01-01

    Background This is an update of the original Cochrane review published in Issue 2, 2007. Some antiepileptic medicines have a place in the treatment of neuropathic pain (pain due to nerve damage). This updated review adds five new additional studies looking at evidence for Lamotrigine as an effective treatment for acute and chronic pain. Objectives To assess analgesic efficacy and adverse effects of the antiepileptic drug lamotrigine in acute and chronic pain. Search methods Randomised controlled trials (RCTs) of lamotrigine in acute, and chronic pain (including cancer pain) were identified from MEDLINE, EMBASE and CENTRAL up to January 2011. Additional studies were sought from the reference list of the retrieved papers. Selection criteria RCTs investigating the use of lamotrigine (any dose, by any route, and for any study duration) for the treatment of acute or chronic pain. Assessment of pain intensity or pain relief, or both, using validated scales. Participants were adults aged 18 and over. Only full journal publication articles were included. Data collection and analysis Dichotomous data (ideally for the outcome of at least 50% pain relief) were used to calculate relative risk with 95% confidence intervals. Meta-analysis was undertaken using a fixed-effect model. Numbers needed to treat to benefit (NNTs) were calculated as the reciprocal of the absolute risk reduction. For unwanted effects, the NNT becomes the number needed to harm (NNH) and was calculated. Main results Twelve included studies in 11 publications (1511 participants), all with chronic neuropathic pain: central post stroke pain (1), chemotherapy induced neuropathic pain (1), diabetic neuropathy (4), HIV related neuropathy (2), mixed neuropathic pain (2), spinal cord injury related pain (1), and trigeminal neuralgia (1); none investigated lamotrigine in acute pain. The update had five additional studies (1111 additional participants). Participants were aged between 26 and 77 years. Study duration

  14. [Emergency management of acute pain in oncology].

    Science.gov (United States)

    Pichard, Evelyne

    2003-12-15

    Acute pains requiring emergency management in oncology can be considered as physiopathological, somatic or visceral nociceptive pains. They are linked: to the tumour, indicating a modification of the tumoural evolution (necrosis, haemorrhage, fracture, acute obstruction of hollow organs or canals, occlusion, hydronephrosis); to the treatment: (inflammation of mucosal membranes, anusitis, post PL syndromes); and to invasive investigations. They are equally neuropathic, revealing an underlying threatened or confirmed medullary compression, or induced by neurotoxic chemotherapy. They are also analysed according to their mode of apparition: mechanical, arising as acute on chronic pain (the pre-fracture pain of metastases); insufficiency of the duration of therapeutic efficacity; an acute episode of neuropathic pain that is often lancing, unpredictable and inevitable. In all cases, it needs to be quantitatively and qualitatively analysed: evaluation, flavour of the symptoms; in order to choose one or a combination of adapted molecules, true antalgics or co-antalgics, antidepressants and anticonvulsants. To counteract this pain, medications with a short onset of action and a short half-life should be used to avoid side effects. These are administered in an intercurrent manner, initially starting at a low dose, modified daily according to the utilisation of supplementary doses. It is necessary to anticipate pain provoked by physical examinations or nursing care as much in the timing as the pharmacology, in using antalgics and/or anxiolytics with a short duration of action. Acutely emerging pains, whatever be their type, arising in the context of cancer and long-term pain are sensitising elements to all further pains, as they imprint in the memory, and are very negatively conditioned by the anguishing context of the illness.

  15. [Diagnostic imaging and acute abdominal pain].

    Science.gov (United States)

    Liljekvist, Mads Svane; Pommergaard, Hans-Christian; Burcharth, Jakob; Rosenberg, Jacob

    2015-01-19

    Acute abdominal pain is a common clinical condition. Clinical signs and symptoms can be difficult to interpret, and diagnostic imaging may help to identify intra-abdominal disease. Conventional X-ray, ultrasound (US) and computed tomography (CT) of the abdomen vary in usability between common surgical causes of acute abdominal pain. Overall, conventional X-ray cannot confidently diagnose or rule out disease. US and CT are equally trustworthy for most diseases. US with subsequent CT may enhance diagnostic precision. Magnetic resonance seems promising for future use in acute abdominal imaging.

  16. Acute Abdominal Pain in the Elderly

    Directory of Open Access Journals (Sweden)

    Ching-Chih Chang

    2007-06-01

    Full Text Available Abdominal pain is a common occurrence in the elderly patients and poses a difficult challenge for the emer-gency physician. Previous studies demonstrated that among the elderly patients presenting to the emergency department with abdominal pain, at least 50% were hospitalized and 30–40% eventually had surgery for the underlying condition. Reasons for the difficult diagnosis of acute abdomen in the elderly are multifactorial, and hence the diagnostic accuracy is lower and the mortality far higher in them than in the younger patients. High suspicion, widely differential diagnosis, and more aggressive use of imaging modalities are critical for these patients. In the geriatric population, biliary tract disease accounts for nearly 25% of cases of acute abdominal pain, followed by nonspecific pain, malignancy, bowel obstruction, complicated peptic ulcer disease, and incarcer-ated hernia. Acute appendicitis, pancreatitis, and diverticulitis are uncommon but important causes of acute abdomen in the elderly. Abdominal vascular diseases, including abdominal aortic aneurysm and mesenteric ischemia, are a rare but lethal condition in acute abdomen. Management of the elderly patients with acute abdomen should focus on keeping the vital signs, adequate hydration, and early administration of analgesics and antibiotics. Consultations with radiologists and surgeons are crucial in the management of difficult cases.

  17. [Acute pain in "Don Quixote"].

    Science.gov (United States)

    Fraile, J R; de Miguel, A; Yuste, A

    2003-01-01

    A descriptive analysis of references to pain symptoms in Don Quixote based on linguistic, literary, clinical, and mannerist features. Don Quixote was read and an entry was created for each description of an injury or illness (group I/I). A second group of entries was created for each medical commentary (group C). This information was complemented using a computer search for the roots of words referring to pain symptoms, with an asterisk placed after each root to locate all word forms used. Data entries with pain references were analyzed in group I/I by examining patient, location, characteristics, causes, associated disorders, remedies, caregivers, and recovery times and in group C by examining the full text. Ninety-one entries were made (64 in group I/I, 27 in group c). References to pain were found in 37 entries (29 in group I/I, 8 in group C). The most commonly used words came from the roots dol (the Spanish root for dolor, or pain, among other related words) (52) and moli (for forms related to Spanish idiomatic uses of molido, suggesting severe injury) (19). All pains were due to injuries. Forty-two occasions of injury (Don Quixote 14, Sancho 9, others 19) and 51 lesions (ribs 5, back 5, other 15, unspecified 26) were mentioned. Known remedies and caregivers of the period were described, but other invented ones were also present. Associated disorders were insomnia, anxiety, rage, melancholy, functional impotence and other sexual dysfunctions. Recovery times ranged from 0 to 8 days. Pain references are subject to literary considerations. The style is simple and the descriptions are credible for the period depicted but do not meet clinical standards. Issues of current interest are treated: pain threshold and sensitivity, social influences, the placebo effect, and affective disorders.

  18. Pregabalin in acute and chronic pain

    Directory of Open Access Journals (Sweden)

    Dalim Kumar Baidya

    2011-01-01

    Full Text Available Pregabalin is a gamma-amino-butyric acid analog shown to be effective in several models of neuropathic pain, incisional injury, and inflammatory injury. In this review, the role of pregabalin in acute postoperative pain and in chronic pain syndromes has been discussed. Multimodal perioperative analgesia with the use of gabapentinoids has become common. Based on available evidence from randomized controlled trials and meta-analysis, the perioperative administration of pregabalin reduces opioid consumption and opioid-related adverse effects in the first 24 h following surgery. Postoperative pain intensity is however not consistently reduced by pregabalin. Adverse effects like visual disturbance, sedation, dizziness, and headache are associated with higher doses. The advantage of the perioperative use of pregabalin is so far limited to laparoscopic, gynecological, and daycare surgeries which are not very painful. The role of the perioperative administration of pregabalin in preventing chronic pain following surgery, its efficacy in more painful surgeries and surgeries done under regional anesthesia, and the optimal dosage and duration of perioperative pregabalin need to be studied. The efficacy of pregabalin in chronic pain conditions like painful diabetic neuropathy, postherpetic neuralgia, central neuropathic pain, and fibromyalgia has been demonstrated.

  19. Radiological diagnostic in acute chest pain

    International Nuclear Information System (INIS)

    Kawel, Nadine; Bremerich, Jens

    2010-01-01

    Acute chest pain is one of the main symptoms leading to a consultation of the emergency department. Main task of the initial diagnostic is the confirmation or exclusion of a potentially life threatening cause. Conventional chest X-ray and computed tomography are the most significant techniques. Due to limited availability and long examination times magnetic resonance tomography rather plays a limited role in routine clinical workup. In the following paper we will systematically review the radiological diagnostic of the acute life threatening causes of chest pain. Imaging modalities, technical aspects and image interpretation will be discussed. (orig.)

  20. [Clinical investigation of the positioning accuracy of acute pulpitis pain].

    Science.gov (United States)

    Wang, Jin; Sun, Wei; Ji, Aiping

    2013-10-01

    This study aims to investigate the positioning accuracy of acute pulpitis pain and its possible factors. The clinical symptoms and physical signs of 3 432 cases of acute pulpitis were recorded and analyzed by using questionnaire forms, which included age, gender, tooth position, infection origin, pain history, time of acute attack, duration and nature of pain, pain frequency, referred pain areas, percussion examination, temperature pulp test, pulp bleeding, and positioning accuracy. Univariate analysis and multivariate stepwise regression analysis were used for data processing. Pain location was accurately identified by 39.1% of the patients with acute pulpitis. Referred pain could reduce the positioning accuracy of pain (P 0.05). Some cases of acute pulpitis pain can be located accurately. Referred pain and periodontium infection origin are related to the positioning accuracy of acute pulpitis pain. The exact cause of this correlation needs further study.

  1. Role of buprenorphine in acute postoperative pain

    Directory of Open Access Journals (Sweden)

    J. Alcázar-Castro

    2016-07-01

    Full Text Available Nowadays acute postoperative pain persists as a high prevalence symptom. The incidence, intensity and duration of postoperative pain vary considerably from one patient to another, from one surgery to another, from one hospital to another, and even from one country to another. It is important to learn about recent developments in central sensitisation, as it plays an important role in postoperative pain. Postoperative pain is mainly nociceptive somatic, in response to surgical damage. The surgical trauma and pain cause an endocrine response that increases the secretion of cortisol, catecholamines, and other stress hormones. Tachycardia, hypertension, decreased regional blood flow, impaired immune response, hyperglycaemia, lipolysis, and negative nitrogen balance also occur. All this plays an important role in morbidity and mortality in the postoperative period. Buprenorphine is a semi-synthetic opioid derived from thebaine. It has a binding affinity for the mu, kappa and delta receptors, and has a slow dissociation from these receptors. Because of its action on the mu and kappa receptors it can be used as an analgesic, as well as for maintenance therapy in patients with a history of drug abuse. This article will describe the characteristics of acute postoperative pain, the pharmacology of buprenorphine, and its interference in the management of postoperative pain.

  2. Acute pain management in burn patients

    DEFF Research Database (Denmark)

    Gamst-Jensen, Hejdi; Vedel, Pernille Nygaard; Lindberg-Larsen, Viktoria Oline

    2014-01-01

    OBJECTIVE: Burn patients suffer excruciating pain due to their injuries and procedures related to surgery, wound care, and mobilization. Acute Stress Disorder, Post-Traumatic Stress Disorder, chronic pain and depression are highly prevalent among survivors of severe burns. Evidence-based pain...... management addresses and alleviates these complications. The aim of our study was to compare clinical guidelines for pain management in burn patients in selected European and non-European countries. We included pediatric guidelines due to the high rate of children in burn units. METHOD: The study had...... a comparative retrospective design using combined methodology of instrument appraisal and thematic analysis. Three investigators appraised guidelines from burn units in Denmark (DK), Sweden (SE), New Zealand (NZ), and USA using the AGREE Instrument (Appraisal of Guidelines for Research & Evaluation), version II...

  3. Acute lymphangitis mimicking mechanical neck pain.

    Science.gov (United States)

    Boudreau, L A; Pinto, A

    2001-09-01

    To discuss acute lymphangitis as a potentially serious infection that can mimic mechanical musculoskeletal pain. A 27-year-old male plant worker had right-sided neck pain. Numerous lesions on the patient's scalp were observed, but were not considered to be related to the chief complaint. Conservative therapy was initiated to address what was thought to be mechanical neck pain. Shortly after the initial visit, it became evident that the source of the neck pain was infection because lymphangitis developed. Antibiotic therapy was initiated and complete resolution of the complaint occurred within 1 week. Primary contact practitioners should consider all aspects of the patient history and physical findings when formulating a diagnosis. This is especially important in the case of patients presenting with lymphangitis because mismanagement could have serious consequences. The importance of a good patient history and team approach to care is demonstrated by this case.

  4. The ACTTION–APS–AAPM Pain Taxonomy (AAAPT) Multidimensional Approach to Classifying Acute Pain Conditions

    Science.gov (United States)

    Kent, Michael L.; Tighe, Patrick J.; Belfer, Inna; Brennan, Timothy J.; Bruehl, Stephen; Brummett, Chad M.; Buckenmaier, Chester C.; Buvanendran, Asokumar; Cohen, Robert I.; Desjardins, Paul; Edwards, David; Fillingim, Roger; Gewandter, Jennifer; Gordon, Debra B.; Hurley, Robert W.; Kehlet, Henrik; Loeser, John D.; Mackey, Sean; McLean, Samuel A.; Polomano, Rosemary; Rahman, Siamak; Raja, Srinivasa; Rowbotham, Michael; Suresh, Santhanam; Schachtel, Bernard; Schreiber, Kristin; Schumacher, Mark; Stacey, Brett; Stanos, Steven; Todd, Knox; Turk, Dennis C.; Weisman, Steven J.; Wu, Christopher; Carr, Daniel B.; Dworkin, Robert H.; Terman, Gregory

    2017-01-01

    Objective. With the increasing societal awareness of the prevalence and impact of acute pain, there is a need to develop an acute pain classification system that both reflects contemporary mechanistic insights and helps guide future research and treatment. Existing classifications of acute pain conditions are limiting, with a predominant focus on the sensory experience (e.g., pain intensity) and pharmacologic consumption. Consequently, there is a need to more broadly characterize and classify the multidimensional experience of acute pain. Setting. Consensus report following expert panel involving the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), American Pain Society (APS), and American Academy of Pain Medicine (AAPM). Methods. As a complement to a taxonomy recently developed for chronic pain, the ACTTION public-private partnership with the US Food and Drug Administration, the APS, and the AAPM convened a consensus meeting of experts to develop an acute pain taxonomy using prevailing evidence. Key issues pertaining to the distinct nature of acute pain are presented followed by the agreed-upon taxonomy. The ACTTION-APS-AAPM Acute Pain Taxonomy will include the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms. Future efforts will consist of working groups utilizing this taxonomy to develop diagnostic criteria for a comprehensive set of acute pain conditions. Perspective. The ACTTION-APS-AAPM Acute Pain Taxonomy (AAAPT) is a multidimensional acute pain classification system designed to classify acute pain along the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms. Conclusions. Significant numbers of patients still suffer from significant acute pain

  5. The ACTTION-APS-AAPM Pain Taxonomy (AAAPT) Multidimensional Approach to Classifying Acute Pain Conditions.

    Science.gov (United States)

    Kent, Michael L; Tighe, Patrick J; Belfer, Inna; Brennan, Timothy J; Bruehl, Stephen; Brummett, Chad M; Buckenmaier, Chester C; Buvanendran, Asokumar; Cohen, Robert I; Desjardins, Paul; Edwards, David; Fillingim, Roger; Gewandter, Jennifer; Gordon, Debra B; Hurley, Robert W; Kehlet, Henrik; Loeser, John D; Mackey, Sean; McLean, Samuel A; Polomano, Rosemary; Rahman, Siamak; Raja, Srinivasa; Rowbotham, Michael; Suresh, Santhanam; Schachtel, Bernard; Schreiber, Kristin; Schumacher, Mark; Stacey, Brett; Stanos, Steven; Todd, Knox; Turk, Dennis C; Weisman, Steven J; Wu, Christopher; Carr, Daniel B; Dworkin, Robert H; Terman, Gregory

    2017-05-01

    With the increasing societal awareness of the prevalence and impact of acute pain, there is a need to develop an acute pain classification system that both reflects contemporary mechanistic insights and helps guide future research and treatment. Existing classifications of acute pain conditions are limiting, with a predominant focus on the sensory experience (eg, pain intensity) and pharmacologic consumption. Consequently, there is a need to more broadly characterize and classify the multidimensional experience of acute pain. Consensus report following expert panel involving the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), American Pain Society (APS), and American Academy of Pain Medicine (AAPM). As a complement to a taxonomy recently developed for chronic pain, the ACTTION public-private partnership with the US Food and Drug Administration, the APS, and the AAPM convened a consensus meeting of experts to develop an acute pain taxonomy using prevailing evidence. Key issues pertaining to the distinct nature of acute pain are presented followed by the agreed-upon taxonomy. The ACTTION-APS-AAPM Acute Pain Taxonomy will include the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms. Future efforts will consist of working groups utilizing this taxonomy to develop diagnostic criteria for a comprehensive set of acute pain conditions. The ACTTION-APS-AAPM Acute Pain Taxonomy (AAAPT) is a multidimensional acute pain classification system designed to classify acute pain along the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms. Significant numbers of patients still suffer from significant acute pain, despite the advent of modern multimodal analgesic strategies

  6. The ACTTION-APS-AAPM Pain Taxonomy (AAAPT) Multidimensional Approach to Classifying Acute Pain Conditions

    DEFF Research Database (Denmark)

    Kent, Michael L; Tighe, Patrick J; Belfer, Inna

    2017-01-01

    /functional consequences, and 5) putative pathophysiologic pain mechanisms. CONCLUSIONS: Significant numbers of patients still suffer from significant acute pain, despite the advent of modern multimodal analgesic strategies. Mismanaged acute pain has a broad societal impact as significant numbers of patients may progress...... to 30 days being common. The current understanding of acute pain mechanisms poorly differentiates between acute and chronic pain and is often insufficient to distinguish among many types of acute pain conditions. Given the usefulness of the AAPT multidimensional framework, the AAAPT undertook a similar...

  7. Emergency pulpotomy in relieving acute dental pain among Tanzanian patients

    Directory of Open Access Journals (Sweden)

    Simon Elison NM

    2006-01-01

    Full Text Available Abstract Background In Tanzania, oral health services are mostly in the form of dental extractions aimed at alleviating acute dental pain. Conservative methods of alleviating acute dental pain are virtually non-existent. Therefore, it was the aim of this study to determine treatment success of emergency pulpotomy in relieving acute dental pain. Methods Setting: School of Dentistry, Muhimbili National Hospital, Dar es Salaam, Tanzania. Study design: Longitudinal study. Participants: 180 patients who presented with dental pain due to acute irreversible pulpitis during the study period between July and August 2001. Treatment and evaluation: Patients were treated by emergency pulpotomy on permanent posterior teeth and were evaluated for pain after one, three and six week's post-treatment. Pain, if present, was categorised as either mild or acute. Results Of the patients with treated premolars, 25 (13.9% patients did not experience pain at all while 19 (10.6% experienced mild pain. None of the patients with treated premolars experienced acute pain. Among 136 patients with treated molars 56 (31% did not experience any pain, 76 (42.2% experienced mild pain and the other 4 (2.2% suffered acute pain. Conclusion The short term treatment success of emergency pulpotomy was high being 100% for premolars and 97.1% for molars, suggesting that it can be recommended as a measure to alleviate acute dental pain while other conservative treatment options are being considered.

  8. Acute abdominal pain: Advances in diagnosis and management

    NARCIS (Netherlands)

    Gans, S.L.

    2015-01-01

    The term acute abdominal pain refers to non-traumatic abdominal pain of rapid onset with duration of less than five days. Acute abdominal pain can be divided in urgent and non-urgent conditions. Urgent causes require treatment within 24 hours to prevent serious complications whereas for non-urgent

  9. Psychological Distress in Acute Low Back Pain

    DEFF Research Database (Denmark)

    Shaw, William S; Hartvigsen, Jan; Woiszwillo, Mary J

    2016-01-01

    OBJECTIVE: To characterize the measurement scales and levels of psychological distress reported among published studies of acute low back pain (LBP) in the scientific literature. DATA SOURCES: Peer-reviewed scientific literature found in 8 citation index search engines (CINAHL, Embase, MANTIS, Psyc......INFO, PubMed, Web of Science, AMED, and Academic Search Premier) for the period from January 1, 1966, to April 30, 2015, in English, Danish, Norwegian, and Swedish languages. STUDY SELECTION: Cross-sectional, case-control, cohort, or randomized controlled trials assessing psychological distress....... CONCLUSIONS: Based on the high consistency across studies using valid measures with a low to moderate risk of bias, there is strong evidence that psychological distress is elevated in acute LBP....

  10. Differential diagnosis of acute abdominal painacute intermittent porphyria

    Directory of Open Access Journals (Sweden)

    Mislav Klobučić

    2011-08-01

    Full Text Available Acute intermittent porphyria (AIP is a rare autosomal dominant disorder of heme biosynthesis in liver due to deficiency of porphobilinogen deaminase enzyme. Clinically, AIP is dominatedby a colicky type pain, which does not subside after taking usual analgesics. Additional frequent symptoms are vomiting, hypertension, peripheral neuropathy, seizures, depression, delirium and coma. This paper reported a case of a twenty-fi- ve-year-old female patient, who had undergone a period of six days between the first presentationto the medical department and the diagnosis confirmation. It has accentuated possible mistakes in symptomatic therapy administration as well as dangers of a delayed diagnosis.

  11. Acute pain management curriculum for emergency medicine residency programs.

    Science.gov (United States)

    Motov, Sergey M; Marshall, John P

    2011-10-01

    Pain is the most common reason people visit emergency departments (EDs); this implies that emergency physicians (EPs) should be experts in managing acute painful conditions. The current trend in the literature, however, demonstrates that EPs possess inadequate knowledge and lack formal training in acute pain management. The purpose of this article is to create a formal educational curriculum that would assist emergency medicine (EM) residents in proper assessment and treatment of acute pain, as well as in providing a solid theoretical and practical knowledge base for managing acute pain in the ED. The authors propose a series of lectures, case-oriented study groups, practical small group sessions, and class-specific didactics with the goal of enhancing the theoretical and practical knowledge of acute pain management in the ED. © 2011 by the Society for Academic Emergency Medicine.

  12. Evaluating the Association Between Acute and Chronic Pain After Surgery

    DEFF Research Database (Denmark)

    Gilron, Ian; Vandenkerkhof, Elizabeth; Katz, Joel

    2017-01-01

    AIM/OBJECTIVES/BACKGROUND: There is a need to predict chronic (Z3mo) postsurgical pain (CPSP). Acute (pain is a predictor, that is, more severe pain is associated with higher CPSP risk. However, reported associations vary widely. METHODS: Using a systematic search, we examined associations...... between 2 acute pain measures (pain at rest [PAR] and movement-evoked pain [MEP]) and CPSP outcomes (considering severity vs. any "nonzero" pain only) in 22 studies. RESULTS: Seven studies reported the relationship between CPSP and both PAR and MEP. Of these, 2/7 reported no association, 3/7 reported...... significant associations for both PAR and MEP, 1/7 reported an association for PAR only, and 1/7 reported an association for MEP only. Six of another 7 studies reporting only the association for MEP found a significant relationship. Three of the 5 studies that did not specify whether acute pain outcomes were...

  13. Different pain responses to chronic and acute pain in various ethnic/racial groups.

    Science.gov (United States)

    Rahavard, Behnoosh B; Candido, Kenneth D; Knezevic, Nebojsa Nick

    2017-09-01

    Our goal in this study was to review the similarities and differences among ethnic groups and their respective responses to acute and chronic clinically related and experimentally induced pain. In this review, the PUBMED and Google-Scholar databases were searched to analyze articles that have assessed the variations in both acute and chronic pain responses among different ethnic/racial groups. According to the results from 42 reviewed articles, significant differences exist among ethnic-racial groups for pain prevalence as well as responses to acute and chronic pain. Compared with Caucasians, other ethnic groups are more susceptible to acute pain responses to nociceptive stimulation and to the development of long-term chronic pain. These differences need to be addressed and assessed more extensively in the future in order to minimize the pain management disparities among various ethnic-racial groups and also to improve the relationship between pain management providers and their patients.

  14. Acute abdominal pain : considerations on diagnosis and management

    NARCIS (Netherlands)

    Toorenvliet, Boudewijn Ronald

    2011-01-01

    In this thesis several aspects on the diagnosing and management of patients with acute abdominal pain are investigated. 1; The efficacy and safety of standard outpatient re-evaluation for patients not admitted to the hospital after emergency department evaluation for acute abdominal pain. 2; The use

  15. Acute Non-Traumatic Abdominal Pain in Childhood at Kenyatta ...

    African Journals Online (AJOL)

    Background The assessment and diagnosis of acute abdominal pain in childhood is clinically challenging. The epidemiologic correlates differ for different paediatric age groups and settings. Objectives To determine the clinical spectrum of acute abdominal pain in childhood at a referral Kenyan public hospital. Design

  16. Management of Acute Musculoskeletal Pain: A Review | Muthuuri ...

    African Journals Online (AJOL)

    Objectives: Acute musculoskeletal insult (injury and surgery) is very common. It is also one of the commonest sources of acute pain. Unfortunately, this pain is also commonly undertreated. This is because of various factors that include poor understanding of the subject, fear of pharmacologic agents, there uses and ...

  17. Does Foot Massage Relieve Acute Postoperative Pain? A Literature Review

    Directory of Open Access Journals (Sweden)

    Chanif Chanif

    2013-01-01

    Full Text Available Purpose: This study aimed to examine the current state of knowledge regarding foot massageto determine if foot massage has an effect on relieving acute postoperative pain.Method: The following questions were used to guide this review: How does pain occur?What is the pain management modalities used in relieving acute postoperative pain? Does footmassage relieve acute postoperative pain? A comprehensive systematic search of publishedliterature and journal articles from Science Direct, CINAHL, PubMed, ProQuest and fromrelevant textbooks was conducted. The universal case entry website, Google-scholar was usedas well. The following keywords were used: foot massage, pain management, andpostoperative pain. Eight studies on foot massage and more than thirty related articles werereviewed.Result: Postoperative pain is caused by tissue damage that induces release of chemicalmediators from the surgical wound. The four processes of pain are transduction, transmission,perception and modulation. Pain medication is the goal standard for acute postoperative painrelief. In addition, foot massage is a modality that can be used in relieving acute postoperativepain. Massage stimulates large nerve fibers and dermatome layers which contain tactile andpressure receptors. The receptors subsequently transmit the nerve impulse to the centralnervous system. The gate control system in the dorsal horn is activated through the inhibitoryinterneuron, thus closing the gate. Subsequently, the brain does not receive the pain message.Eight reviewed studies demonstrated that foot massage relieves acute postoperative pain.However, there were some methodological limitations of these studies.Conclusion: It is recommended to examine the effect of foot massage on acute postoperativepain with high homogenous samples using various duration of massage and range of time forpain measurement at different settings.Key words: foot massage, pain management and postoperative pain.

  18. The ACTTION-APS-AAPM Pain Taxonomy (AAAPT) Multidimensional Approach to Classifying Acute Pain Conditions

    DEFF Research Database (Denmark)

    Kent, Michael L; Tighe, Patrick J; Belfer, Inna

    2017-01-01

    conditions are limiting, with a predominant focus on the sensory experience (eg, pain intensity) and pharmacologic consumption. Consequently, there is a need to more broadly characterize and classify the multidimensional experience of acute pain. SETTING: Consensus report following expert panel involving...... to suffer from chronic pain. An acute pain taxonomy provides a much-needed standardization of clinical diagnostic criteria, which benefits clinical care, research, education, and public policy. For the purposes of the present taxonomy, acute pain is considered to last up to seven days, with prolongation...

  19. Non-traumatic thoracic emergencies: acute chest pain: diagnostic strategies

    International Nuclear Information System (INIS)

    Bonomo, Lorenzo; Di Fabio, Francesca; Rita Larici, Anna; Merlino, Biagio; Luigia Storto, Maria

    2002-01-01

    Acute chest pain may represent the initial and/or accompanying symptom in a variety of disease processes that may occur in the cardiovascular system, respiratory system, gastrointestinal tract, or musculoskeletal system. Although clinical history, risk factors, and physical examination are important factors in establishing the etiology of symptoms in patients presenting with acute chest pain, imaging modalities are frequently utilized. Noncardiac causes of acute chest pain are reviewed in this paper with special reference to the most recently published literature and emphasis on acute aortic diseases. Imaging modalities with indication of appropriateness, optimal technique and practical keys for interpretation are discussed. (orig.)

  20. Benefit and harm of pregabalin in acute pain treatment

    DEFF Research Database (Denmark)

    Fabritius, M L; Strøm, C; Koyuncu, S

    2017-01-01

    Pregabalin has demonstrated anti-hyperalgesic properties and was introduced into acute pain treatment in 2001. Our aim was to evaluate the beneficial and harmful effects of pregabalin in postoperative pain management. We included randomized clinical trials investigating perioperative pregabalin....... Consequently, a routine use of pregabalin for postoperative pain treatment cannot be recommended....

  1. Respiratory symptoms and acute painful episodes in sickle cell disease.

    Science.gov (United States)

    Jacob, Eufemia; Sockrider, Marianna M; Dinu, Marlen; Acosta, Monica; Mueller, Brigitta U

    2010-01-01

    The authors examined the prevalence of respiratory symptoms and determined whether respiratory symptoms were associated with prevalence of chest pain and number of acute painful episodes in children and adolescents with sickle cell disease. Participants (N = 93; 44 females, 49 males; mean age 9.8 +/- 4.3 years) reported coughing in the morning (21.5%), at night (31.2%), and during exercise (30.1%). Wheezing occurred both when they had a cold or infection (29.0%) and when they did not have (23.7%) a cold or infection. Sleep was disturbed by wheezing in 20.4%. Among the 76 patients who were school-age (>5 years), 19.7% of patients missed more than 4 days of school because of respiratory symptoms. The majority of patients reported having acute painful episodes (82.8%), and most (66.7%) reported having chest pain during acute painful episodes in the previous 12 months. Participants with acute pain episodes greater than 3 during the previous 12 months had significantly higher reports of breathing difficulties (P = .01) and chest pain (P = .002). The high number of respiratory symptoms (cough and wheeze) among patients with sickle cell disease may trigger acute painful episodes. Early screening and recognition, ongoing monitoring, and proactive management of respiratory symptoms may minimize the number of acute painful episodes.

  2. Effect of corticosteroid therapy in acute pain edema caused by ...

    African Journals Online (AJOL)

    Purpose: To evaluate the curative effect of corticosteroids in the treatment of acute pain, local edema, and skin lesions caused by ... Conclusion: Treatment of herpes zoster with appropriate corticosteroid isodose application can effectively relieve ..... Glueocorticoid treatment in acute lung injury and acute respiratory distress ...

  3. Acute and chronic pain syndromes in multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Knudsen, L; Jensen, K

    1991-01-01

    A representative sample of 117 patients with definite multiple sclerosis (MS) was interviewed on pain syndromes. Chronic syndromes lasting more than one month included dysaestesthesia, low back pain, spasms, tonic seizures, tightening and painful sensations in the extremities. Acute syndromes...... with pain at the time of the examination increased with age and duration of disease. Patients with pain were significantly more often spastic and significantly more often sought alternative treatment forms. No difference was found for mean age, sex, physical impairment, duration of disease from onset of MS...... included neuralgia, L'Hermitte's sign and pain associated with optic neuritis. Thirty-five per cent were pain-free. Of the remaining patients had 45% pain at the time of the examination, 32% indicated pain among the most severe symptoms of MS and 23% had pain at the onset of MS. The number of patients...

  4. Acute and chronic pain syndromes in multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Knudsen, L; Jensen, K

    1991-01-01

    with pain at the time of the examination increased with age and duration of disease. Patients with pain were significantly more often spastic and significantly more often sought alternative treatment forms. No difference was found for mean age, sex, physical impairment, duration of disease from onset of MS......A representative sample of 117 patients with definite multiple sclerosis (MS) was interviewed on pain syndromes. Chronic syndromes lasting more than one month included dysaestesthesia, low back pain, spasms, tonic seizures, tightening and painful sensations in the extremities. Acute syndromes...... included neuralgia, L'Hermitte's sign and pain associated with optic neuritis. Thirty-five per cent were pain-free. Of the remaining patients had 45% pain at the time of the examination, 32% indicated pain among the most severe symptoms of MS and 23% had pain at the onset of MS. The number of patients...

  5. A review of dexketoprofen trometamol in acute pain.

    Science.gov (United States)

    Hanna, Magdi; Moon, Jee Y

    2018-03-23

    Dexketoprofen trometamol is a modified non-selective COX inhibitor with a rapid onset of action that is available as both oral and parenteral formulations. The aim of this narrative review was to assess the efficacy and tolerability/safety of dexketoprofen trometamol in acute pain states using the best available published scientific evidence (randomized controlled clinical trials and systematic reviews/meta-analyses). Literature retrieval was performed via Medline, Embase and the Cochrane Library (from inception up to March 2017) using combinations of the terms "randomized controlled trials", "dexketoprofen", "celecoxib", "etoricoxib", "parecoxib" and "acute pain". Single-dose dexketoprofen trometamol provides effective analgesia in the treatment of acute pain, such as postoperative pain (dental and non-dental surgery), renal colic, acute musculoskeletal disorders and dysmenorrhoea, and reduces opioid consumption in the postoperative setting. It has a rapid onset of action (within 30 minutes) and is well tolerated during short-term treatment. Direct comparisons with COX-2 inhibitors are lacking; however, the efficacy and tolerability of single-dose dexketoprofen trometamol appears to be consistent with that seen with celecoxib, etoricoxib and parecoxib in the acute pain setting. In conclusion, dexketoprofen trometamol appears to provide similar analgesic efficacy to COX-2 inhibitors when used to treat acute pain, has a rapid onset of action, is well tolerated, and has an opioid-sparing effect when used as part of a multimodal regimen in the acute pain setting.

  6. Deciphering neuronal population codes for acute thermal pain

    Science.gov (United States)

    Chen, Zhe; Zhang, Qiaosheng; Phuong Sieu Tong, Ai; Manders, Toby R.; Wang, Jing

    2017-06-01

    Objective. Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Current pain research mostly focuses on molecular and synaptic changes at the spinal and peripheral levels. However, a complete understanding of pain mechanisms requires the physiological study of the neocortex. Our goal is to apply a neural decoding approach to read out the onset of acute thermal pain signals, which can be used for brain-machine interface. Approach. We used micro wire arrays to record ensemble neuronal activities from the primary somatosensory cortex (S1) and anterior cingulate cortex (ACC) in freely behaving rats. We further investigated neural codes for acute thermal pain at both single-cell and population levels. To detect the onset of acute thermal pain signals, we developed a novel latent state-space framework to decipher the sorted or unsorted S1 and ACC ensemble spike activities, which reveal information about the onset of pain signals. Main results. The state space analysis allows us to uncover a latent state process that drives the observed ensemble spike activity, and to further detect the ‘neuronal threshold’ for acute thermal pain on a single-trial basis. Our method achieved good detection performance in sensitivity and specificity. In addition, our results suggested that an optimal strategy for detecting the onset of acute thermal pain signals may be based on combined evidence from S1 and ACC population codes. Significance. Our study is the first to detect the onset of acute pain signals based on neuronal ensemble spike activity. It is important from a mechanistic viewpoint as it relates to the significance of S1 and ACC activities in the regulation of the acute pain onset.

  7. Acute pain management in general practice: Steps to effective pain ...

    African Journals Online (AJOL)

    Pain is one of the most common complaints that general practitioners encounter in everyday practice. The swift and effective management of pain is a medical mandate, not only to fulfil an ethical obligation to the patient, but also to prevent long-term complications, such as chronic pain. General practitioners are often ...

  8. The effect of acute pain on risky and intertemporal choice.

    Science.gov (United States)

    Koppel, Lina; Andersson, David; Morrison, India; Posadzy, Kinga; Västfjäll, Daniel; Tinghög, Gustav

    2017-01-01

    Pain is a highly salient and attention-demanding experience that motivates people to act. We investigated the effect of pain on decision making by delivering acute thermal pain to participants' forearm while they made risky and intertemporal choices involving money. Participants (n = 107) were more risk seeking under pain than in a no-pain control condition when decisions involved gains but not when they involved equivalent losses. Pain also resulted in greater preference for immediate (smaller) over future (larger) monetary rewards. We interpret these results as a motivation to offset the aversive, pain-induced state, where monetary rewards become more appealing under pain than under no pain and when delivered sooner rather than later. Our findings add to the long-standing debate regarding the role of intuition and reflection in decision making.

  9. Pain management in the emergency chain: the use and effectiveness of pain management in patients with acute musculoskeletal pain

    NARCIS (Netherlands)

    Pierik, J.G.; IJzerman, M.J.; Gaakeer, M.I.; Berben, S.A.; Eenennaam, F.L. van; Vugt, A.B. van; Doggen, C.J.

    2015-01-01

    OBJECTIVE: While acute musculoskeletal pain is a frequent complaint in emergency care, its management is often neglected, placing patients at risk for insufficient pain relief. Our aim is to investigate how often pain management is provided in the prehospital phase and emergency department (ED) and

  10. A nurse-initiated pain protocol in the ED improves pain treatment in patients with acute musculoskeletal pain

    NARCIS (Netherlands)

    Pierik, Jorien; Berben, Sivera A.; IJzerman, Maarten Joost; Gaakeer, Menno I.; Eenennaam, Fred L.; van Vugt, Arie B.; Doggen, Catharina Jacoba Maria

    2016-01-01

    While acute musculoskeletal pain is a frequent complaint, its management is often neglected. An implementation of a nurse-initiated pain protocol based on the algorithm of a Dutch pain management guideline in the emergency department might improve this. A pre–post intervention study was performed as

  11. A nurse-initiated pain protocol in the ED improves pain treatment in patients with acute musculoskeletal pain

    NARCIS (Netherlands)

    Pierik, J.G.; Berben, S.A.A.; IJzerman, M.J.; Gaakeer, M.I.; Eenennaam, F.L. van; Vugt, A.B. van; Doggen, C.J.

    2016-01-01

    While acute musculoskeletal pain is a frequent complaint, its management is often neglected. An implementation of a nurse-initiated pain protocol based on the algorithm of a Dutch pain management guideline in the emergency department might improve this. A pre-post intervention study was performed as

  12. Pain Management in the Emergency Chain: The Use and Effectiveness of Pain Management in Patients With Acute Musculoskeletal Pain

    NARCIS (Netherlands)

    Pierik, Jorien; IJzerman, Maarten Joost; Gaakeer, Menno I.; Berben, Sivera A.; Eenennaam, Fred L.; van Vugt, Arie B.; Doggen, Catharina Jacoba Maria

    2015-01-01

    Objective While acute musculoskeletal pain is a frequent complaint in emergency care, its management is often neglected, placing patients at risk for insufficient pain relief. Our aim is to investigate how often pain management is provided in the prehospital phase and emergency department (ED) and

  13. Clinical study of acute and chronic pain after temporal craniotomy

    Directory of Open Access Journals (Sweden)

    WANG Cheng-wei

    2013-10-01

    Full Text Available Objective To investigate the correlation of chronic pain after surgery and acute pain within 48 h after temporal craniotomy. Methods One hundred and seventy-six patients who underwent surgery through temporal approach were divided into 3 groups and treated with morphine 30 mg (Group M, N = 57, tramadol 1000 mg (Group T, N = 60 and morphine 20 mg + flurbiprofen 200 mg (Group F, N = 59 by patient-controlled intravenous analgesia (PCIA. Postoperative acute pain (resting and movement was evaluated by Visual Analogue Scale (VAS at 4, 16, 24 and 48 h respectively. Chronic pain was measured by Short-Form McGill Pain Questionnaire (SF-MPQ 3 months after surgery. The characteristics of acute and chronic pain, the relationship between them and analgesic effect of 3 kinds of analgesic drugs were analyzed. Results The differences of observed indicators including gender, age, weight and operating time, which might affect the degree of postoperative pain between before and after surgery were not statistically significant (P > 0.05. VAS scores at different time points within 48 h after surgery in each group decreased gradually. The VAS scores in group T (2.91 ± 1.64 was significantly higher than group M (2.19 ± 1.68 and group F (1.71 ± 1.17, P 0.05. The overall incidence rate of chronic pain was 71.02% (125/176, with moderate and severe pain in 15.91% (28/176. Chronic pain and acute postoperative pain severity were positively correlated (resting: rs = 0.171, P = 0.012; movement: rs = 0.190, P = 0.006. The difference of the acute pain (VAS corresponding to SF-MPQ Ⅱ score > 0 and SF-MPQ Ⅱ score = 0 was statistically significant (P < 0.05. Conclusion The postoperative chronic pain following temporal craniotomy is related to acute pain within 48 h after operation. Effective treatment of early postoperative acute pain may reduce the incidence of chronic pain.

  14. Biodanza Reduces Acute Pain Severity in Women with Fibromyalgia.

    Science.gov (United States)

    Segura-Jiménez, Víctor; Gatto-Cardia, Claudia M; Martins-Pereira, Clélia M; Delgado-Fernández, Manuel; Aparicio, Virginia A; Carbonell-Baeza, Ana

    2017-10-01

    Biodanza is a useful therapy for the fibromyalgia management; however, there is no evidence of its effectiveness on acute pain. The objectives of the present study were: to determine the changes of a 3-month Biodanza program on acute pain severity (before vs. after session) and cumulative pain severity in women with fibromyalgia; and to check the associations of acute pain severity reduction with presession pain severity, body fat percentage, and satisfaction with the session. This was a 3-month low-moderate intensity (rate of perceived exertion around 12, based on a 6-20 point scale) Biodanza intervention study (1 session/week). Twenty-seven women with fibromyalgia (54.2 ± 6.2 years) participated. Pain severity was assessed before and after each single session with a visual analog scale. There were immediate changes in all sessions (p = .001-.028), except in the first, second, and fourth sessions. An overall 16% decrease of acute pain severity before and after each session was noted (mean presession pain vs. postsession pain, 5.8 ± 2.1 vs. 4.9 ± 2.4; respectively). There was an independent association of pain severity reduction (presession-postsession) with presession pain severity (unstandardized coefficient B = .21 ± .05; standardized coefficient β = .25; p pain severity (p pain severity (p = .007; 95% CI = .02, .12) along the 3-month intervention. No significant cumulative effect in presession pain severity was identified (p > .05). In conclusion, Biodanza is an alternative therapy that reduced acute pain severity in women with fibromyalgia. The intervention also yielded cumulative pain severity reduction, which were higher in those women with fibromyalgia presenting higher presession pain severity and lower body fat percentage. The satisfaction with the session was also a key factor positively associated with pain reduction. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights

  15. [Quality assurance in acute pain therapy : Development of software for the acute pain service].

    Science.gov (United States)

    Czaplik, M; Joppich, R; Rossaint, R

    2010-08-01

    A detailed documentation system is essential for an effectively working acute pain service. Patient-related documentation aids the physician with check lists and algorithms and may thus further improve clinical practice. As adequate software was missing, we developed a database that was first adapted to the in-house conditions, but can also be adjusted to other surroundings. By integrating "one-click documentation" and new codes for clinical observations, a user-friendly software was created that notably improved the quality of documentation. In the first test period more than 30,000 ward rounds were collected, and a considerably improved documentation quality could be achieved.

  16. Acute and chronic pain syndromes in multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Knudsen, L; Jensen, K

    1991-01-01

    A representative sample of 117 patients with definite multiple sclerosis (MS) was interviewed on pain syndromes. Chronic syndromes lasting more than one month included dysaestesthesia, low back pain, spasms, tonic seizures, tightening and painful sensations in the extremities. Acute syndromes...... with pain at the time of the examination increased with age and duration of disease. Patients with pain were significantly more often spastic and significantly more often sought alternative treatment forms. No difference was found for mean age, sex, physical impairment, duration of disease from onset of MS...

  17. Pentazocine Pain Relief in Adult Patients With Acute Abdominal ...

    African Journals Online (AJOL)

    jen

    Results: Twenty patients in the PZ group and 9 patients in the control group had a VAS score drop. >12mm. ... investigate the safety of early administration of pentazocine in adult patients with acute abdominal pain. ... significant pain relief compared to a placebo, and whether pentazocine administration to patients with.

  18. Silent ischemia and severity of pain in acute myocardial infarction

    DEFF Research Database (Denmark)

    Nielsen, F E; Nielsen, S L; Knudsen, F

    1991-01-01

    An overall low tendency to complain of pain, due to a low perception of pain, has been suggested in the pathogenesis of silent ischemia, independent of the extent of the diseased coronaries and a history of previous acute myocardial infarction. This hypothesis has been tested indirectly...

  19. Acute and chronic pain management in fibromyalgia: updates on pharmacotherapy.

    Science.gov (United States)

    Hsu, Eric S

    2011-11-01

    Fibromyalgia (FM) is a mysterious pain syndrome with progressive and widespread pain, explicit areas of tender points, stiffness, sleep disturbance, fatigue, and psychological distress without any obvious disease. FM is commonly perceived as a condition of central pain and sensory augmentation. There are documented functional abnormalities in pain and sensory processing in FM. Central sensitization and lack of descending analgesic activity are the 2 leading mechanisms that have been demonstrated by advance in both basic and clinical research. The pathogenesis of FM may also be attributed to the genetic polymorphisms involving serotoninergic, dopaminergic, and catecholaminergic systems. Any psychiatric disorders and psychosocial influences in FM may also affect the severity of pain. The various external stimuli or trigger such as infection, trauma, and stress may all contribute to proceed to presentation of FM. The recent launches of 3 US Food and Drug Administration-approved pharmacotherapy for FM namely pregabalin, duloxetine, and milnacipran have certainly raised the profile of optimal chronic pain management. However, appropriate evaluation and efficacious management of acute pain has not been as well publicized as chronic pain in FM. Acute pain or flare up caused by any trauma or surgery certainly may present a real challenge for patients with FM and their health care providers. Pre-emptive analgesia and pro-active treatment may offer the momentum for acute pain control based on model of central sensitization and pain in FM. This review article on FM appraises the modern practice of multimodal therapy focus on both acute and chronic pain management. Meanwhile, the evolving nonpharmacological approach is summarized and stressed as an essential component of integrated care in FM.

  20. Acute Pain Medicine in the United States: A Status Report

    Science.gov (United States)

    Tighe, Patrick; Buckenmaier, Chester C.; Boezaart, Andre P.; Carr, Daniel B.; Clark, Laura L.; Herring, Andrew A.; Kent, Michael; Mackey, Sean; Mariano, Edward R.; Polomano, Rosemary C.; Reisfield, Gary M.

    2015-01-01

    Background Consensus indicates that a comprehensive, multimodal, holistic approach is foundational to the practice of acute pain medicine (APM), but lack of uniform, evidence-based clinical pathways leads to undesirable variability throughout U. S. healthcare systems. Acute pain studies are inconsistently synthesized to guide educational programs. Advanced practice techniques involving regional anesthesia assume the presence of a physician-led, multidisciplinary acute pain service, which is often unavailable or inconsistently applied. This heterogeneity of educational and organizational standards may result in unnecessary patient pain and escalation of healthcare costs. Methods A multidisciplinary panel was nominated through the Acute Pain Medicine Shared Interest Group (APMSIG) of the American Academy of Pain Medicine (AAPM). The panel met in Chicago, Illinois, in July 2014, to identify gaps and set priorities in APM research and education. Results The panel identified 3 areas of critical need: 1) an open-source acute pain data registry and clinical support tool to inform clinical decision making and resource allocation and to enhance research efforts; 2) a strong professional APM identity as an accredited subspecialty; and 3) educational goals targeted toward third-party payers, hospital administrators, and other key stakeholders to convey the importance of APM. Conclusion This report is the first step in a 3-year initiative aimed at creating conditions and incentives for the optimal provision of APM services to facilitate and enhance the quality of patient recovery after surgery, illness, or trauma. The ultimate goal is to reduce the conversion of acute pain to the debilitating disease of chronic pain. PMID:26535424

  1. IDIOPATHIC OMENTAL INFARCTION : A RARE CAUSE OF ACUTE PAIN ABDOMEN

    Directory of Open Access Journals (Sweden)

    Narendra Nath

    2015-02-01

    Full Text Available Omental torsion leading on to omental infarction is an unusual cause of acute abdominal pain in adults. Often the condition mimics common causes of acute abdomen like acute cholecystitis, acute appendicitis or acute pancreatitis. A review of literature reveals that this enigmatic condition has been managed both non - operatively and by surgery in the past. We report the case of a 46 - year - old man who presented with a 4 - day history of severe right - sided abdominal pain mimicking acute cholecystitis. Abdominal CT scan revealed a right upper quadrant mass with a whirl - like appearance, suspicious for omental infarction. He was started on conservative management with analgesics and antibiotics. He improved symptomatically and was discharged

  2. Assessment of acute pain in trauma

    DEFF Research Database (Denmark)

    Hebsgaard, Stine; Mannering, Anne; Zwisler, Stine T

    2016-01-01

    .003). CONCLUSIONS: Effect was only documented in one patient after administering opioids in a patient with trauma population, where approximately 17 percent of patients experienced severe pain. Severe pain was correlated to male gender, respiratory intervention, opioid administration, and the diagnosis unspecified......OBJECTIVE: To elucidate pain treatment with analgesics in a prehospital trauma population. DESIGN: Retrospective database study. SETTING: Prehospital data from the anesthesiologist-manned Mobile Emergency Care Unit (MECU) in Odense, Denmark, were extracted and subjected to analysis. PATIENTS...... MEASURES: Evaluation of the application of the pain scale Numeric Rating Scale (NRS). Furthermore, the authors performed a characterization of the patients with mild pain and severe pain according to specific parameters such as pharmacological interventions, opioid consumption, intubation, and others...

  3. Pain-related psychological correlates of pediatric acute post-surgical pain

    Directory of Open Access Journals (Sweden)

    Pagé MG

    2012-11-01

    Full Text Available M Gabrielle Pagé,1 Jennifer Stinson,2,3 Fiona Campbell,2,4 Lisa Isaac,2,4 Joel Katz1,4,51Department of Psychology, Faculty of Health, York University, 2Department of Anesthesia and Pain Medicine, Hospital for Sick Children, 3Lawrence S Bloomberg Faculty of Nursing, University of Toronto, 4Department of Anesthesia, Faculty of Medicine, University of Toronto, 5Department of Psychology, Hospital for Sick Children, Toronto, ON, CanadaBackground: Post-surgical pain is prevalent in children, yet is significantly understudied. The goals of this study were to examine gender differences in pain outcomes and pain-related psychological constructs postoperatively and to identify pain-related psychological correlates of acute post-surgical pain (APSP and predictors of functional disability 2 weeks after hospital discharge.Methods: Eighty-three children aged 8–18 (mean 13.8 ± 2.4 years who underwent major orthopedic or general surgery completed pain and pain-related psychological measures 48–72 hours and 2 weeks after surgery.Results: Girls reported higher levels of acute postoperative anxiety and pain unpleasantness compared with boys. In addition, pain anxiety was significantly associated with APSP intensity and functional disability 2 weeks after discharge, whereas pain catastrophizing was associated with APSP unpleasantness.Conclusion: These results highlight the important role played by pain-related psychological factors in the experience of pediatric APSP by children and adolescents.Keywords: acute post-surgical pain, children, adolescents, pain anxiety, pain catastrophizing

  4. Acupuncture Anesthesia and Analgesia for Clinical Acute Pain in Japan

    Directory of Open Access Journals (Sweden)

    Reina Taguchi

    2008-01-01

    Full Text Available Acupuncture anesthesia has been practiced in China since about 1960. In Japan, Hyodo reported 30 cases of acupuncture anesthesia in 1972. However, from around 1980, the direction of acupuncture investigations turned from anesthesia to analgesia. Acupuncture analgesia is presently considered a way to activate the body's endogenous analgesic system. Recently, with the rise of acupuncture as one of the most well known CAM therapies, acupuncture or moxibustion treatment has been reported for both acute and chronic pain. Even so, few clinical reports and original articles have been reported in Japan. This review illustrates how acupuncture is being used in Japan for acute pain such as surgical operations, post- operative pain (POP, neuropathic pain, pain associated with teeth extractions and after the extraction of impacted wisdom teeth.

  5. Pain management in adult acute sickle cell pain crisis: a view point ...

    African Journals Online (AJOL)

    Pain management in adult acute sickle cell pain crisis: a view point. E Udezue, E Herrera, E Herrera. Abstract. No Abstract. West African Journal of Medicine Vol. 26 (3) 2007 pp. 179-182. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

  6. Quick identification of acute chest pain patients study (QICS

    Directory of Open Access Journals (Sweden)

    van der Horst Iwan CC

    2009-06-01

    Full Text Available Abstract Background Patients with acute chest pain are often referred to the emergency ward and extensively investigated. Investigations are costly and could induce unnecessary complications, especially with invasive diagnostics. Nevertheless, chest pain patients have high mortalities. Fast identification of high-risk patients is crucial. Therefore several strategies have been developed including specific symptoms, signs, laboratory measurements, and imaging. Methods/Design The Quick Identification of acute Chest pain Study (QICS will investigate whether a combined use of specific symptoms and signs, electrocardiography, routine and new laboratory measures, adjunctive imaging including electron beam (EBT computed tomography (CT and contrast multislice CT (MSCT will have a high diagnostic yield for patients with acute chest pain. All patients will be investigated according a standardized protocol in the Emergency Department. Serum and plasma will be frozen for future analysis for a wide range of biomarkers at a later time point. The primary endpoint is the safe recognition of low-risk chest pain patients directly at presentation. Secondary endpoint is the identification of a wide range of sensitive predictive clinical markers, chemical biomarkers and radiological markers in acute chest pain patients. Chemical biomarkers will be compared to quantitative CT measurements of coronary atherosclerosis as a surrogate endpoint. Chemical biomarkers will also be compared in head to head comparison and for their additional value. Discussion This will be a very extensive investigation of a wide range of risk predictors in acute chest pain patients. New reliable fast and cheap diagnostic algorithm resulting from the test results might improve chest pain patients' prognosis, and reduce unnecessary costs and diagnostic complications.

  7. Circulating Lipids and Acute Pain Sensitization: An Exploratory Analysis.

    Science.gov (United States)

    Starkweather, Angela; Julian, Thomas; Ramesh, Divya; Heineman, Amy; Sturgill, Jamie; Dorsey, Susan G; Lyon, Debra E; Wijesinghe, Dayanjan Shanaka

    In individuals with low back pain, higher lipid levels have been documented and were associated with increased risk for chronic low back pain. The purpose of this research was to identify plasma lipids that discriminate participants with acute low back pain with or without pain sensitization as measured by quantitative sensory testing. This exploratory study was conducted as part of a larger parent randomized controlled trial. A cluster analysis of 30 participants with acute low back pain revealed two clusters: one with signs of peripheral and central sensitivity to mechanical and thermal stimuli and the other with an absence of peripheral and central sensitivity. Lipid levels were extracted from plasma and measured using mass spectroscopy. Triacylglycerol 50:2 was significantly higher in participants with peripheral and central sensitization compared to the nonsensitized cluster. The nonsensitized cluster had significantly higher levels of phosphoglyceride 34:2, plasmenyl phosphocholine 38:1, and phosphatidic acid 28:1 compared to participants with peripheral and central sensitization. Linear discriminant function analysis was conducted using the four statistically significant lipids to test their predictive power to classify those in the sensitization and no-sensitization clusters; the four lipids accurately predicted cluster classification 58% of the time (R = .58, -2 log likelihood = 14.59). The results of this exploratory study suggest a unique lipidomic signature in plasma of patients with acute low back pain based on the presence or absence of pain sensitization. Future work to replicate these preliminary findings is underway.

  8. The Transition of Acute Postoperative Pain to Chronic Pain: An Integrative Overview of Research on Mechanisms.

    Science.gov (United States)

    Chapman, C Richard; Vierck, Charles J

    2017-04-01

    The nature of the transition from acute to chronic pain still eludes explanation, but chronic pain resulting from surgery provides a natural experiment that invites clinical epidemiological investigation and basic scientific inquiry into the mechanisms of this transition. The primary purpose of this article is to review current knowledge and hypotheses on the transition from acute to persistent postsurgical pain, summarizing literature on clinical epidemiological studies of persistent postsurgical pain development, as well as basic neurophysiological studies targeting mechanisms in the periphery, spinal cord, and brain. The second purpose of this article is to integrate theory, information, and causal reasoning in these areas. Conceptual mapping reveals 5 classes of hypotheses pertaining to pain. These propose that chronic pain results from: 1) persistent noxious signaling in the periphery; 2) enduring maladaptive neuroplastic changes at the spinal dorsal horn and/or higher central nervous system structures reflecting a multiplicity of factors, including peripherally released neurotrophic factors and interactions between neurons and microglia; 3) compromised inhibitory modulation of noxious signaling in medullary-spinal pathways; 4) descending facilitatory modulation; and 5) maladaptive brain remodeling in function, structure, and connectivity. The third purpose of this article is to identify barriers to progress and review opportunities for advancing the field. This review reveals a need for a concerted, strategic effort toward integrating clinical epidemiology, basic science research, and current theory about pain mechanisms to hasten progress toward understanding, managing, and preventing persistent postsurgical pain. The development of chronic pain after surgery is a major clinical problem that provides an opportunity to study the transition from acute to chronic pain at epidemiologic and basic science levels. Strategic, coordinated, multidisciplinary research

  9. Pain and dyspepsia after elective and acute cholecystectomy

    DEFF Research Database (Denmark)

    Middelfart, H V; Kristensen, J U; Laursen, C N

    1998-01-01

    and dyspepsia 5-10 years after cholecystectomy in 345 (222 women, 123 men) patients cholecystectomized for acute cholecystitis and in a control group of 296 (213 women, 83 men) patients cholecystectomized for uncomplicated symptomatic gallbladder stones. RESULTS: Of 641 questionnaires, 534 (83%) were completed....... Complaints of abdominal pain and dyspepsia were found with similar frequencies in the acute cholecystitis and gallstone groups. Women had abdominal pain more often than men (42% versus 29%) (P = 0.01). Although more than one-third complained of abdominal pain after cholecystectomy, 93% had improved or were...... cured. CONCLUSION: The outcome after cholecystectomy seems to be independent of the underlying gallbladder disease (acute cholecystitis or elective operations for gallstones)....

  10. Acute pain induces insulin resistance in humans

    DEFF Research Database (Denmark)

    Greisen, J.; Juhl, C.B.; Grøfte, Thorbjørn

    2001-01-01

    Background: Painful trauma results in a disturbed metabolic state with impaired insulin sensitivity, which is related to the magnitude of the trauma. The authors explored whether pain per se influences hepatic and extrahepatic actions of insulin. Methods: Ten healthy male volunteers underwent two...... randomly sequenced hyperinsulinemic–euglycemic (insulin infusion rate, 0.6 mU · kg-1 · min-1 for 180 min) clamp studies 4 weeks apart. Self-controlled painful electrical stimulation was applied to the abdominal skin for 30 min, to a pain intensity of 8 on a visual analog scale of 0–10, just before...... the clamp procedure (study P). In the other study, no pain was inflicted (study C). Results: Pain reduced whole-body insulin-stimulated glucose uptake from 6.37 ± 1.87 mg · kg-1 · min-1 (mean ± SD) in study C to 4.97 ± 1.38 mg · kg-1 · min-1 in study P (P

  11. Support Vector Machine Diagnosis of Acute Abdominal Pain

    Science.gov (United States)

    Björnsdotter, Malin; Nalin, Kajsa; Hansson, Lars-Erik; Malmgren, Helge

    This study explores the feasibility of a decision-support system for patients seeking care for acute abdominal pain, and, specifically the diagnosis of acute diverticulitis. We used a linear support vector machine (SVM) to separate diverticulitis from all other reported cases of abdominal pain and from the important differential diagnosis non-specific abdominal pain (NSAP). On a database containing 3337 patients, the SVM obtained results comparable to those of the doctors in separating diverticulitis or NSAP from the remaining diseases. The distinction between diverticulitis and NSAP was, however, substantially improved by the SVM. For this patient group, the doctors achieved a sensitivity of 0.714 and a specificity of 0.963. When adjusted to the physicians' results, the SVM sensitivity/specificity was higher at 0.714/0.985 and 0.786/0.963 respectively. Age was found as the most important discriminative variable, closely followed by C-reactive protein level and lower left side pain.

  12. Assay sensitivity of pain intensity versus pain relief in acute pain clinical trials: ACTTION systematic review and meta-analysis.

    Science.gov (United States)

    Singla, Neil; Hunsinger, Matthew; Chang, Phoebe D; McDermott, Michael P; Chowdhry, Amit K; Desjardins, Paul J; Turk, Dennis C; Dworkin, Robert H

    2015-08-01

    The magnitude of the effect size of an analgesic intervention can be influenced by several factors, including research design. A key design component is the choice of the primary endpoint. The purpose of this meta-analysis was to compare the assay sensitivity of 2 efficacy paradigms: pain intensity (calculated using summed pain intensity difference [SPID]) and pain relief (calculated using total pain relief [TOTPAR]). A systematic review of the literature was performed to identify acute pain studies that calculated both SPIDs and TOTPARs within the same study. Studies were included in this review if they were randomized, double-blind, placebo-controlled investigations involving medications for postsurgical acute pain and if enough data were provided to calculate TOTPAR and SPID standardized effect sizes. Based on a meta-analysis of 45 studies, the mean standardized effect size for TOTPAR (1.13) was .11 higher than that for SPID (1.02; P = .01). Mixed-effects meta-regression analyses found no significant associations between the TOTPAR - SPID difference in standardized effect size and trial design characteristics. Results from this review suggest that for acute pain studies, utilizing TOTPAR to assess pain relief may be more sensitive to treatment effects than utilizing SPID to assess pain intensity. The results of this meta-analysis suggest that TOTPAR may be more sensitive to treatment effects than SPIDs are in analgesic trials examining acute pain. We found that standardized effect sizes were higher for TOTPAR compared to SPIDs. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.

  13. Acute Abdomen in a Patient with Cancer Pain on Oxycodone

    Directory of Open Access Journals (Sweden)

    Naomi Kishine

    2011-01-01

    Full Text Available Opioids are a mainstay of treatment for moderate to severe cancer pain. At present, oxycodone has fewer adverse effects compared to morphine and is widely used for cancer pain therapy. The adverse effects of oxycodone are similar to morphine and include constipation, nausea, and sedation. However, acute abdominal pain is rarely seen. Here, we describe a cancer patient presenting with acute abdomen with stercoral diarrhea. A 54-year-old man with squamous cell carcinoma of the external auditory canal had been taking oxycodone for pain relief. The patient had taken oxycodone for several months and had never complained of either diarrhea or constipation. After an increase in the dosage of oxycodone, he complained of abdominal distension and constipation. After being administered a laxative, he complained of diarrhea and severe abdominal pain. He visited the emergency department and was diagnosed with acute colonic obstruction caused by severe constipation. He self-medicated with oxycodone at dosages of up to 180 mg/day, and this abrupt increase of oxycodone caused stercoral diarrhea. Finally, total blockage of stool developed, resulting in acute abdomen.

  14. Embolized prostatic brachytherapy seeds mimicking acute chest pain syndromes

    Directory of Open Access Journals (Sweden)

    Nirmal Guragai

    2017-01-01

    Full Text Available A 59-year-old male with a history of nonobstructive coronary artery disease, diabetes mellitus, hypertension, and prostate cancer presented to the hospital with 1-day history of pleuritic chest pain. Initial workup for acute coronary event was unremarkable. Chest X-ray revealed multiple small radial densities which were linear and hyperdense, consistent with embolization of metallic seeds to the pulmonary circulation. The patient was noted to have had radioactive metallic seeds implanted for prostate cancer 6 months ago. Diagnosis of pulmonary embolization of prostatic seeds is challenging as they frequently present with chest pain mimicking acute coronary syndromes.

  15. Pressure Pain Threshold as a Predictor of Acute Postoperative Pain Following Total Joint Arthroplasty.

    Science.gov (United States)

    Haghverdian, Brandon A; Wright, David J; Schwarzkopf, Ran

    2016-10-26

    Acute pain in the postoperative period after total joint arthroplasty (TJA) has a significant effect on early rehabilitation, hospital length of stay, and the development of chronic pain. Consequently, efforts have been made to predict the occurrence of postoperative pain using preoperative and intraoperative factors. In this study, we tested the usefulness of preoperative pressure pain threshold (PPT) values in the prediction of three outcomes for patients who underwent TJA: visual analog scale pain scores, hospital length of stay, and opioid consumption. Using a digital pressure algometer, we measured the preoperative PPT in 41 patients expected to undergo TJA at three different body sites: the first web space of the hand, the operative joint, and the contralateral joint. We correlated each PPT separately with postoperative visual analog scale pain scores, hospital length of stay, and opioid consumption. No significant correlation was found between preoperative PPT and the three postoperative outcomes. This finding held true when patients were subdivided by surgery type (total knee arthroplasty vs. total hip arthroplasty). There was no significant difference in PPT between the three body testing sites. This study failed to prove the usefulness of PPT in the prediction of acute postoperative pain, pain medication consumption, and length of stay. The pressure algometer has previously found a place in the assessment of pain in a variety of clinical settings, but its utility has not yet been demonstrated in patients undergoing TJA.

  16. Single dose oral tenoxicam for acute postoperative pain in adults.

    Science.gov (United States)

    Moore, Owen A; McIntyre, Mairead; Moore, R Andrew; Derry, Sheena; McQuay, Henry J

    2009-07-08

    Tenoxicam is a non-steroidal anti-inflammatory drug (NSAID) licensed for use in rheumatic disease and other musculoskeletal disorders in the UK, and is widely available in other countries worldwide. This review sought to evaluate the efficacy and safety of oral tenoxicam in acute postoperative pain, using clinical studies of patients with established pain, and with outcomes measured primarily over 6 hours using standard methods. This type of study has been used for many decades to establish that drugs have analgesic properties. To assess the efficacy of single dose oral tenoxicam in acute postoperative pain, and any associated adverse events. We searched The Cochrane Library (Issue 1, 2009), MEDLINE (March 2009); EMBASE via Ovid (March 2009); the Oxford Pain Relief Database. Randomised, double-blind, placebo-controlled clinical trials of oral tenoxicam for relief of acute postoperative pain in adults. Two review authors independently assessed trial quality and extracted data. The area under the "pain relief versus time" curve was used to derive the proportion of participants with tenoxicam experiencing least 50% pain relief over 4 to 6 hours, using validated equations. The number needed to treat to benefit (NNT) was calculated using 95% confidence intervals (CI). The proportion of participants using rescue analgesia over a specified time period, and time to use of rescue analgesia, were sought as additional measures of efficacy. Information on adverse events and withdrawals was also collected. Not one of sixteen studies identified by the searches and examined in detail studied oral tenoxicam in patients with established postoperative pain and therefore no results are available. In the absence of evidence of efficacy for oral tenoxicam in acute postoperative pain, its use in this indication is not justified at present. Because trials clearly demonstrating analgesic efficacy in the most basic of acute pain studies is lacking, use in other indications should be

  17. Psychometric properties of the Brazilian version of the Pain Catastrophizing Scale for acute low back pain

    Directory of Open Access Journals (Sweden)

    Renata Antunes Lopes

    2015-05-01

    Full Text Available Measurement instruments of pain catastrophizing for middle-aged and elderly individuals are needed to understand its impact on low back pain. The goals were to cross-culturally adapt the Pain Catastrophizing Scale, assess the construct validity through Rasch analysis, and verify reliability and convergent validity of pain catastrophizing with psychosocial factors. 131 individuals aged 55 years and older with acute low back pain were interviewed . The intra-rater reliability was Kp = 0.80 and interrater Kp = 0.75. The Rasch analysis found adequate reliability coefficients (0.95 for items and 0.90 for individuals . The separation index for the elderly was 2.95 and 4.59 items. Of the 13 items, one did not fit the model, which was justified in the sample evaluated. The pain catastrophizing correlated with most psychosocial factors. The instrument proved to be clinically useful. Subsequent studies should carry out the same analysis in different populations.

  18. Approach to chest pain and acute myocardial infarction

    African Journals Online (AJOL)

    March 2016, Vol. 106, No. 3. Chest pain is a common cause for attendance at emer gency and primary care consultation rooms. The life time prevalence accounts for 20 ..... Pancreatitis. Cholecystitis. Cholangitis. Biliary colic. Peptic ulcer disease. Pulmonary. Acute pulmonary embolism. Pulmonary hypertension. Pneumonia.

  19. Quality of primary care guidelines for acute low back pain.

    NARCIS (Netherlands)

    van Tulder, Maurits W.; Tuut, Mariska; Pennick, Victoria; Bombardier, Claire; Assendelft, Willem J J

    2004-01-01

    STUDY DESIGN: Systematic review of clinical guidelines. OBJECTIVES: To assess the methodologic quality of existing guidelines for the management of acute low back pain. SUMMARY OF BACKGROUND DATA: Guidelines are playing an increasingly important role in evidence-based practice. After publication of

  20. Common Questions About the Evaluation of Acute Pelvic Pain.

    Science.gov (United States)

    Bhavsar, Amit K; Gelner, Elizabeth J; Shorma, Toni

    2016-01-01

    Acute pelvic pain is defined as lower abdominal or pelvic pain of less than three months' duration. It is a common presentation in primary care. Evaluation can be challenging because of a broad differential diagnosis and because many associated signs and symptoms are nonspecific. The most common diagnoses in reproductive-aged women with acute pelvic pain are idiopathic pelvic pain, pelvic inflammatory disease, acute appendicitis, ovarian cysts, ectopic pregnancy, and endometriosis. Among postmenopausal women, cancer must be considered. Findings from the history and physical examination can point to likely diagnoses, and laboratory testing and imaging can help confirm. Women of reproductive age should take a pregnancy test. In early pregnancy, transvaginal ultrasonography and beta human chorionic gonadotropin levels can help identify ectopic pregnancy and spontaneous abortion. For nonpregnant women, ultrasonography or computed tomography is indicated, depending on the possible diagnosis (e.g., ultrasonography is preferred when ovarian pathology is suspected). If ultrasonography results are nondiagnostic, magnetic resonance imaging can be helpful in pregnant women when acute appendicitis is suspected. If magnetic resonance imaging is unavailable, computed tomography may be indicated.

  1. Effect of corticosteroid therapy in acute pain edema caused by ...

    African Journals Online (AJOL)

    Purpose: To evaluate the curative effect of corticosteroids in the treatment of acute pain, local edema, and skin lesions caused by herpes zoster, and to develop some pertinent therapeutic guidelines. Methods: A total of 48 cases of patients diagnosed with herpes zoster from 2010 to 2011 in the dermatology clinic of Shan ...

  2. Diagnosis in acute abdominal pain and ongoing abdominal sepsis

    NARCIS (Netherlands)

    Kiewiet, J.J.S.

    2016-01-01

    Acute abdominal pain is a common reason for presentation at the emergency department. To establish a timely and adequate diagnosis, doctors use the pattern of complaints and physical examination as the basis for the evaluation of a patient. In this thesis we conducted a study that showed that

  3. Diagnosis of Acute Abdominal Pain in Older Patients | Lyon | South ...

    African Journals Online (AJOL)

    Acute abdominal pain is a common presenting complaint in older patients. Presentation may differ from that of the younger patient and is often complicated by coexistent disease, delays in presentation, and physical and social barriers. The physical examination can be misleadingly benign, even with catastrophic conditions ...

  4. Gait Kinematics in Individuals with Acute and Chronic Patellofemoral Pain.

    Science.gov (United States)

    Fox, Aaron; Ferber, Reed; Saunders, Natalie; Osis, Sean; Bonacci, Jason

    2018-03-01

    This study aimed to identify the discriminating kinematic gait characteristics between individuals with acute and chronic patellofemoral pain (PFP) and healthy controls. Ninety-eight runners with PFP (39 male, 59 female) and 98 healthy control runners (38 male, 60 female) ran on a treadmill at a self-selected speed while three-dimensional lower limb kinematic data were collected. Runners with PFP were split into acute (n = 25) and chronic (n = 73) subgroups on the basis of whether they had been experiencing pain for less or greater than 3 months, respectively. Principal component analysis and linear discriminant analysis were used to determine the combination of kinematic gait characteristics that optimally separated individuals with acute PFP and chronic PFP and healthy controls. Compared with controls, both the acute and chronic PFP subgroups exhibited greater knee flexion across stance and greater ankle dorsiflexion during early stance. The acute PFP subgroup demonstrated greater transverse plane hip motion across stance compared with healthy controls. In contrast, the chronic PFP subgroup demonstrated greater frontal plane hip motion, greater knee abduction, and reduced ankle eversion/greater ankle inversion across stance when compared with healthy controls. This study identified characteristics that discriminated between individuals with acute and chronic PFP when compared with healthy controls. Certain discriminating characteristics were shared between both the acute and chronic subgroups when compared with healthy controls, whereas others were specific to the duration of PFP.

  5. Managing acute abdominal pain in pediatric patients: current perspectives

    Directory of Open Access Journals (Sweden)

    Hijaz NM

    2017-06-01

    Full Text Available Nadia M Hijaz, Craig A Friesen Division of Gastroenterology, Hepatology, and Nutrition, Children’s Mercy Kansas City, Kansas City, MO, USA Abstract: Acute abdominal pain in pediatric patients has been a challenge for providers because of the nonspecific nature of symptoms and difficulty in the assessment and physical examination in children. Although most children with acute abdominal pain have self-limited benign conditions, pain may be a manifestation of an urgent surgical or medical condition where the biggest challenge is making a timely diagnosis so that appropriate treatment can be initiated without any diagnostic delays that increase morbidity. This is weighed against the need to decrease radiation exposure and avoid unnecessary operations. Across all age groups, there are numerous conditions that present with abdominal pain ranging from a very simple viral illness to a life-threatening surgical condition. It is proposed that the history, physical examination, laboratory tests, and imaging studies should initially be directed at differentiating surgical versus nonsurgical conditions both categorized as urgent versus nonurgent. The features of the history including patient’s age, physical examination focused toward serious conditions, and appropriate tests are highlighted in the context of making these differentiations. Initial testing and management is also discussed with an emphasis on making use of surgeon and radiologist consultation and the need for adequate follow-up and reevaluation of the patient. Keywords: acute abdominal pain, surgical abdomen, ultrasound

  6. Usefulness of the Pain Tracking Technique in Acute Mechanical Low Back Pain

    Directory of Open Access Journals (Sweden)

    Tania Bravo Acosta

    2015-01-01

    Full Text Available Objective. To evaluate the usefulness of the pain tracking technique in acute mechanical low back pain. Method. We performed an experimental prospective (longitudinal explanatory study between January 2011 and September 2012. The sample was randomly divided into two groups. Patients were assessed at the start and end of the treatment using the visual analogue scale and the Waddell test. Treatment consisted in applying the pain tracking technique to the study group and interferential current therapy to the control group. At the end of treatment, cryotherapy was applied for 10 minutes. The Wilcoxon signed-rank test and the Mann Whitney test were used. They were performed with a predetermined significance level of p≤0.05. Results. Pain was triggered by prolonged static posture and intense physical labor and intensified through trunk movements and when sitting and standing. The greatest relief was reported in lateral decubitus position and in William’s position. The majority of the patients had contracture. Pain and disability were modified with the rehabilitation treatment in both groups. Conclusions. Both the pain tracking and interferential current techniques combined with cryotherapy are useful treatments for acute mechanical low back pain. The onset of analgesia is faster when using the pain tracking technique.

  7. Usefulness of the Pain Tracking Technique in Acute Mechanical Low Back Pain

    Science.gov (United States)

    Bravo Acosta, Tania; Martín Cordero, Jorge E.; Hernández Tápanes, Solangel; Pedroso Morales, Isis; Fernández Cuesta, José Ignacio; Leyva Serrano, Maritza

    2015-01-01

    Objective. To evaluate the usefulness of the pain tracking technique in acute mechanical low back pain. Method. We performed an experimental prospective (longitudinal) explanatory study between January 2011 and September 2012. The sample was randomly divided into two groups. Patients were assessed at the start and end of the treatment using the visual analogue scale and the Waddell test. Treatment consisted in applying the pain tracking technique to the study group and interferential current therapy to the control group. At the end of treatment, cryotherapy was applied for 10 minutes. The Wilcoxon signed-rank test and the Mann Whitney test were used. They were performed with a predetermined significance level of p ≤ 0.05. Results. Pain was triggered by prolonged static posture and intense physical labor and intensified through trunk movements and when sitting and standing. The greatest relief was reported in lateral decubitus position and in William's position. The majority of the patients had contracture. Pain and disability were modified with the rehabilitation treatment in both groups. Conclusions. Both the pain tracking and interferential current techniques combined with cryotherapy are useful treatments for acute mechanical low back pain. The onset of analgesia is faster when using the pain tracking technique. PMID:26240758

  8. Recurrent acute low back pain secondary to lumbar epidural calcification

    Energy Technology Data Exchange (ETDEWEB)

    Ziade, M.; Zufferey, P.; So, A.K.L. [Centre Hospitalier Vaudois, Service de Rhumatologie, Lausanne (Switzerland)

    2007-06-15

    Epidural calcification is a rare cause of back pain, and spontaneous epidural calcification has not been reported previously. We describe a patient with acute low back pain and signs of lumbar nerve root compression due to epidural calcification, as demonstrated by CT-scan and MRI. Radiological signs of spondylodiscitis led to a search for an infectious cause, which was negative, and her symptoms responded rapidly to NSAID treatment alone. Her symptoms recurred 18 months later, and further imaging studies again revealed epidural calcification, but with a changed distribution. Her symptoms were relieved once more by NSAID treatment alone. We propose that epidural calcification secondary to aseptic spondylodiscitis is the main cause of acute back pain in this patient. A possible mechanism may be the pro-inflammatory effects of calcium pyrophosphate or hydroxyapatite crystal deposition within the epidural space. (orig.)

  9. Quality of primary care guidelines for acute low back pain

    DEFF Research Database (Denmark)

    van Tulder, Maurits W.; Tuut, Mariska; Pennick, Victoria

    2004-01-01

    STUDY DESIGN: Systematic review of clinical guidelines. OBJECTIVES: To assess the methodologic quality of existing guidelines for the management of acute low back pain. SUMMARY OF BACKGROUND DATA: Guidelines are playing an increasingly important role in evidence-based practice. After publication...... of the Quebec Task Force in Canada in 1987 and the Agency for Health Care Policy and Research guidelines in the United States in 1994, guidelines for acute low back pain were developed in many other countries. However, little is known about the methodologic quality of these guidelines. METHODS: Guidelines were...... selected by electronically searching MEDLINE and the Internet and through personal communication with experts in the field of low back pain research in primary care. The methodologic quality of the guidelines was assessed by two authors independently using the AGREE instrument. RESULTS: A total of 17...

  10. Acute abdominal pain and constipation due to lead poisoning.

    Science.gov (United States)

    Mongolu, S; Sharp, P

    2013-01-01

    Although uncommon, lead poisoning should be considered as a differential diagnosis in cases of unexplained acute abdominal pain in both adults and children. We present the case of a 35-year-old Asian male who presented with abdominal pain and constipation secondary to lead poisoning. Initially, the source of lead exposure was not apparent; this was later found to be due to ingestion of an Ayurvedic herbal medicine for the treatment of infertility. Lead poisoning due to the ingestion of Ayurvedic remedies is well described. We discuss the diagnosis, pathophysiology and treatment of lead poisoning. This case illustrates one of the rarer medical causes of acute abdominal pain and emphasizes the need to take a thorough history (including specific questioning regarding the use of over-the-counter and traditional/ herbal remedies) in cases of suspected poisoning or drug toxicity.

  11. Dissociating anticipation from perception: Acute pain activates default mode network.

    Science.gov (United States)

    Ter Minassian, Aram; Ricalens, Emmanuel; Humbert, Stanislas; Duc, Flavie; Aubé, Christophe; Beydon, Laurent

    2013-09-01

    Few studies have explored the effect of acute pain on attentional networks and on the default mode network. Moreover, these studies convey conflicting results, seemingly caused by design. To reassess this issue, we studied 20 healthy subjects with functional magnetic resonance imaging while delivering painful electric shocks. The design was purposely constructed to separate rest, anticipation, and pain perception. We found that default mode network activity in response to pain was biphasic. It deactivated during anticipation when the dorsal attentional network was activated. During pain perception, the default mode network was activated, as were attentional networks. The left posterior fusiform gyrus showed the same dynamics as the default mode network, and its activity was negatively correlated to the subject's pain intensity rating. The associative pregenual anterior cingulate cortex seemed to play a key role in these coactivations. These results concur with data from the literature showing that enhanced pain perception results in greater default mode network activity and that the anticorrelation between the default mode network and the dorsal attentional network disappears in chronic pain patients. Copyright © 2012 Wiley Periodicals, Inc., a Wiley company.

  12. A Rare Cause of Acute Abdominal Pain: Primary Appendagitis Epiploica

    Directory of Open Access Journals (Sweden)

    Tarkan Ergun

    2014-03-01

    Primary appendagitis epiploica – one of the causes of acute abdominal pain – is a self-limited rare benign inflammatory condition involving the colonic epiploic appendages. Their therapy is conservative and clinically mimics other conditions requiring surgery such as acute diverticulitis or appendicitis. However, being a quite rare condition is the reason they are usually neglected by both the surgeon and the radiologist. However the computed tomography (CT findings are rather characteristic and pathognomonic. Thus, to consider CT as the diagnostic modality of choice is extremely important in order to diagnose the condition and to avoid unnecessary surgical interventions.             This is a paper reporting an acute abdominal pain case of primary appendicitis epiploica diagnosed using computed tomography. 

  13. Acute painful neuropathy in thallium poisoning.

    Science.gov (United States)

    Kuo, H-C; Huang, C-C; Tsai, Y-T; Chu, C-C; Hsieh, S-T; Chu, N-S

    2005-07-26

    Dysesthesia, allodynia, distal muscle weakness, and sensory impairment were noted in two patients with acute thallium intoxication. Two months later, nerve conduction studies showed an axonal degeneration. Sural nerve biopsy disclosed a decreased fiber density in the large myelinated fibers. Quantitative sensory testing also revealed an impairment of pinprick, temperature, and touch sensations. Cutaneous nerve biopsy confirmed a loss of epidermal nerves indicating an involvement of the small sensory nerves.

  14. Pentazocine pain relief in adult patients with acute abdominal ain: A ...

    African Journals Online (AJOL)

    Background: Reported studies in the African population, on early pain relief in patients with acute abdominal pain are few. The objective of the study was to evaluate the effect of pentazocine (PZ) on pain relief, diagnostic accuracy and treatment decisions in patients with acute abdominal pain. Methods: This was a ...

  15. Computer mouse use predicts acute pain but not prolonged or chronic pain in the neck and shoulder

    DEFF Research Database (Denmark)

    Gerster, Mette; Grimstrup, S; Lassen, C F

    2008-01-01

    BACKGROUND: Computer use may have an adverse effect on musculoskeletal outcomes. This study assessed the risk of neck and shoulder pain associated with objectively recorded professional computer use. METHODS: A computer programme was used to collect data on mouse and keyboard usage and weekly...... reports of neck and shoulder pain among 2146 technical assistants. Questionnaires were also completed at baseline and at 12 months. The three outcome measures were: (1) acute pain (measured as weekly pain); (2) prolonged pain (no or minor pain in the neck and shoulder region over four consecutive weeks...... followed by three consecutive weeks with a high pain score); and (3) chronic pain (reported pain or discomfort lasting more than 30 days and "quite a lot of trouble" during the past 12 months). RESULTS: Risk for acute neck pain and shoulder pain increased linearly by 4% and 10%, respectively, for each...

  16. Right psoas abscess following right flank trauma: a case report ...

    African Journals Online (AJOL)

    This is a case of 15 year old boy who presented with three weeks history of right flank pain, two weeks history of fever and five days history of inability to walk well. There was history of right flank trauma a week before the onset of right flank pain. He had earlier presented in two different hospitals before he was brought to our ...

  17. An acute pain service improves postoperative pain management for children undergoing selective dorsal rhizotomy.

    Science.gov (United States)

    Frigon, Chantal; Loetwiriyakul, Witthaya; Ranger, Manon; Otis, Annik

    2009-12-01

    A continuous epidural infusion of morphine is the pain treatment modality for children undergoing selective dorsal rhizotomy (SDR) in our institution. The aim of the study was to evaluate the impact of having an organized acute pain service (APS) on postoperative pain management of these children. We conducted a retrospective cohort study using anesthetic records and the APS database to compare the postoperative pain management of children undergoing SDR before and after the introduction of the APS at the Montreal Children's Hospital in April 2001. Ninety-two consecutive children who had their surgery between January 1997 and July 2006 were included. We collected data regarding postoperative pain, opioid-induced side effects, complications (sedation, desaturations improvements in general postoperative care and in length of stay, our study did show that having an organized APS allowed to significantly decrease the incidence of postoperative oxygen desaturation and to decrease the hospital length of stay by 1 day.

  18. Diagnostic imaging of acute abdominal pain in adults.

    Science.gov (United States)

    Cartwright, Sarah L; Knudson, Mark P

    2015-04-01

    Acute abdominal pain is a common presentation in the outpatient setting and can represent conditions ranging from benign to life-threatening. If the patient history, physical examination, and laboratory testing do not identify an underlying cause of pain and if serious pathology remains a clinical concern, diagnostic imaging is indicated. The American College of Radiology has developed clinical guidelines, the Appropriateness Criteria, based on the location of abdominal pain to help physicians choose the most appropriate imaging study. Ultrasonography is the initial imaging test of choice for patients presenting with right upper quadrant pain. Computed tomography (CT) is recommended for evaluating right or left lower quadrant pain. Conventional radiography has limited diagnostic value in the assessment of most patients with abdominal pain. The widespread use of CT raises concerns about patient exposure to ionizing radiation. Strategies to reduce exposure are currently being studied, such as using ultrasonography as an initial study for suspected appendicitis before obtaining CT and using low-dose CT rather than standard-dose CT. Magnetic resonance imaging is another emerging technique for the evaluation of abdominal pain that avoids ionizing radiation.

  19. Systematic review of dexketoprofen in acute and chronic pain.

    Science.gov (United States)

    Moore, R Andrew; Barden, Jodie

    2008-10-31

    Dexketoprofen, an NSAID used in the management of acute and chronic pains, is licensed in several countries but has not previously been the subjected of a systematic review. We used published and unpublished information from randomised clinical trials (RCTs) of dexketoprofen in painful conditions to assess evidence on efficacy and harm. PubMed and Cochrane Central were searched for RCTs of dexketoprofen for pain of any aetiology. Reference lists of retrieved articles and reviews were also searched. Menarini Group produced copies of published and unpublished studies (clinical trial reports). Data were abstracted into a standard form. For studies reporting results of single dose administration, the number of patients with at least 50% pain relief was derived and used to calculate the relative benefit (RB) and number-needed-to-treat (NNT) for one patient to achieve at least 50% pain relief compared with placebo. Thirty-five trials were found in acute pain and chronic pain; 6,380 patients were included, 3,381 receiving dexketoprofen. Information from 16 trials (almost half the total patients) was obtained from clinical trial reports from previously unpublished trials or abstracts. Almost all of the trials were of short duration in acute conditions or recent onset pain.All 12 randomised trials that compared dexketoprofen (any dose) with placebo found dexketoprofen to be statistically superior. Five trials in postoperative pain yielded NNTs for 12.5 mg dexketoprofen of 3.5 (2.7 to 4.9), 25 mg dexketoprofen of 3.0 (2.4 to 3.9), and 50 mg dexketoprofen of 2.1 (1.5 to 3.5). In 29/30 active comparator trials, dexketoprofen at the dose used was at least equivalent in efficacy to comparator drugs. Adverse event withdrawal rates were low in postoperative pain and somewhat higher in trials of longer duration; no serious adverse events were reported. Dexketoprofen was at least as effective as other NSAIDs and paracetamol/opioid combinations. While adverse event withdrawal was not

  20. Trajectories of acute low back pain: a latent class growth analysis.

    Science.gov (United States)

    Downie, Aron S; Hancock, Mark J; Rzewuska, Magdalena; Williams, Christopher M; Lin, Chung-Wei Christine; Maher, Christopher G

    2016-01-01

    Characterising the clinical course of back pain by mean pain scores over time may not adequately reflect the complexity of the clinical course of acute low back pain. We analysed pain scores over 12 weeks for 1585 patients with acute low back pain presenting to primary care to identify distinct pain trajectory groups and baseline patient characteristics associated with membership of each cluster. This was a secondary analysis of the PACE trial that evaluated paracetamol for acute low back pain. Latent class growth analysis determined a 5 cluster model, which comprised 567 (35.8%) patients who recovered by week 2 (cluster 1, rapid pain recovery); 543 (34.3%) patients who recovered by week 12 (cluster 2, pain recovery by week 12); 222 (14.0%) patients whose pain reduced but did not recover (cluster 3, incomplete pain recovery); 167 (10.5%) patients whose pain initially decreased but then increased by week 12 (cluster 4, fluctuating pain); and 86 (5.4%) patients who experienced high-level pain for the whole 12 weeks (cluster 5, persistent high pain). Patients with longer pain duration were more likely to experience delayed recovery or nonrecovery. Belief in greater risk of persistence was associated with nonrecovery, but not delayed recovery. Higher pain intensity, longer duration, and workers' compensation were associated with persistent high pain, whereas older age and increased number of episodes were associated with fluctuating pain. Identification of discrete pain trajectory groups offers the potential to better manage acute low back pain.

  1. Oxycodone Ingestion Patterns in Acute Fracture Pain With Digital Pills.

    Science.gov (United States)

    Chai, Peter R; Carreiro, Stephanie; Innes, Brendan J; Chapman, Brittany; Schreiber, Kristin L; Edwards, Robert R; Carrico, Adam W; Boyer, Edward W

    2017-12-01

    Opioid analgesics are commonly prescribed on an as-needed (PRN) basis for acute painful conditions. Uncertainty of how patients actually take PRN opioids, coupled with a desire to completely cover pain, leads to variable and overly generous opioid prescribing practices, resulting in a surplus of opioids. This opioid surplus becomes a source for diversion and nonmedical opioid use. Understanding patterns of actual opioid ingestion after acute painful conditions can help clinicians counsel patients on safe opioid use, and allow timely recognition and intervention when escalating opioid self-dosing occurs, to prevent tolerance and addiction. We used a novel oxycodone digital pill system (ingestible biosensor within a standard gelatin capsule combined with 5-mg oxycodone) that when ingested, is activated by the chloride ion gradient in the stomach thereby emitting a radiofrequency signal captured by a wearable reader. The reader relays ingestion data to a cloud-based server that displays ingestion events to the study team. We deployed the oxycodone digital pill among opioid-naive individuals discharged from the emergency department with acute fracture pain. Participants were trained on digital pill operation and discharged with twenty-one 5-mg oxycodone digital pills. They were instructed to take digital pills PRN for pain on discharge. We conducted a brief interview 7 days after study enrollment, at which point participants returned the digital pill system. We identified oxycodone ingestion events in real time by data from the digital pill system and performed pill counts at the return visit to validate digital pill reporting of medication ingestion. In this study, 26 individuals were approached; 16 enrolled with 15 completing the study. Participants ingested a median of 6 (3-9.5) oxycodone digital pills over the course of 7 days, with 82% of the oxycodone dose ingested in the first 3 days. In individuals who required operative repair, 86% (N = 6) continued to ingest

  2. Multimodal Preincisional Premedication to Prevent Acute Pain After Cholecystectomy

    Directory of Open Access Journals (Sweden)

    Dawood Aghamohammadi

    2012-09-01

    Full Text Available Introduction: Postoperative pain as an important medical concern is usually treated by opioids which also are of various inevitable side effects. The aim of this study was to assess the efficacy of multimodal preincisional premedication on preventing post-cholecystectomy acute pain. Methods: In a randomized clinical trial, sixty patients undergoing open cholecystectomy were randomized into two groups. Before anesthesia induction, Diclofenac suppository (100 mg and oral Clonidine (0.2 mg were administered in the first group. Immediately before operation, patients received Ketamine (1 mg/kg IV while the control group received placebo. The site of incision was infiltrated by the surgeon with 20 mL Bupivacaine 0.25% in both groups. Anesthesia induction and maintenance were similar in both groups. The severity of pain was recorded 2, 4, 6, 12, 24 and 48 hours after operation according to Visual Analogue Scale. Results: The severity of pain at two defined stages (6 and 12 hours later was significantly less in the intervention group than the control group (P<0.005. The average pain severity score was less than the control group (P<0.005. Conclusion: In our study, the administration of Clonidine, Diclofenac and Ketamine and bupivacaine infiltration to the site of incision, altogether was associated with a significant decrease in pain score and opioid requirement after cholecystectomy in comparison to bupivacaine infiltration to the site of incision.

  3. Disseminated lymphoma presenting as acute thigh pain and renal failure.

    LENUS (Irish Health Repository)

    Brown, Catherine

    2009-01-01

    A 66-year-old diabetic man presented with severe right thigh swelling and pain together with acute renal failure. At autopsy, this was found to be due to disseminated high grade B cell lymphoma invading the psoas muscle and multiple organs, including the kidneys. The unique presentation of this case emphasizes the need for increased awareness of the variety of ways in which lymphoma can manifest itself.

  4. Acute jejunogastric intussusception: a rare cause of abdominal pain.

    Science.gov (United States)

    O'Dell, K B; Gordon, R S; Victory, C

    1992-05-01

    We report the case of a 61-year-old man with a history of a Bilroth II procedure who presented to the emergency department after 12 hours of severe epigastric pain and one episode of coffee-ground emesis. Computed tomography and esophagogastroduodenoscopy revealed intussuscepted jejunum through a gastrojejunostomy that required emergency operative reduction. This case illustrates the rare complication of acute jejunogastric intussusception more than 20 years after a Bilroth II procedure.

  5. Topical NSAIDs for acute pain: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Derry Sheena

    2004-05-01

    Full Text Available Abstract Background A previous systematic review reported that topical NSAIDs were effective in relieving pain in acute conditions like sprains and strains, with differences between individual drugs for efficacy. More trials, a better understanding of trial quality and bias, and a reclassification of certain drugs necessitate a new review. Methods Studies were identified by searching electronic databases and writing to manufacturers. We selected randomised double blind trials comparing topical NSAID with either placebo or another active treatment in adults with acute pain, and extracted dichotomous information approximating to a 50% reduction in pain at one week, together with details of adverse events and withdrawals. Relative benefit and number-needed-to-treat (NNT, and relative risk and number-needed-to-harm (NNH were calculated, with sensitivity analyses where appropriate to investigate differences between individual drugs and aspects of trial design. Results Twenty-six double blind placebo controlled trials had information from 2,853 patients for evaluation of efficacy. Topical NSAID was significantly better than placebo in 19 of the 26 trials, with a pooled relative benefit of 1.6 (95% confidence interval 1.4 to 1.7, and NNT of 3.8 (95% confidence interval 3.4 to 4.4 compared with placebo for the outcome of half pain relief at seven days. Results were not affected by outcome reported, or condition treated, but smaller trials yielded a larger estimate of efficacy. Indirect comparisons of individual topical NSAIDs showed that ketoprofen was significantly better than all other topical NSAIDs, while indomethacin was barely distinguished from placebo. Three trials, with 433 patients, compared topical with oral NSAID (two trials compared the same drug, one compared different drugs and found no difference in efficacy. Local adverse events, systemic adverse events, or withdrawals due to an adverse event were rare, and no different between topical

  6. Assessment of quality of care in acute postoperative pain management

    Directory of Open Access Journals (Sweden)

    Milutinović Dragana

    2009-01-01

    Full Text Available Background/Aim. Managing of acute postoperative pain should be of great interest for all hospital institutions, as one of the key components of patients satisfaction, which indicates quality, as well as the outcome of treatment. The aim of this study was to assess the quality of nursing care in managing acute postoperative pain and to establish factors which influence patients assessment of the same. Method. The investigation was conducted on the sample of 135 patients hospitalized in surgical clinics of the Clinical Centre of Vojvodina in Novi Sad in the form of cross-sectional study, by interviewing patients during the second postoperative day and collecting sociodemographic variables, type of surgical procedure and applied analgesic therapy which were taken from their medical documentation. The modified questionnaire of the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP was used as the instrument of the investigation. The data were processed with suitable mathematical statistics methods such as multivariate analyses of variance (MANOVA, discriminative and other parametric procedures and methods. Roy's test, Pearson's coefficient contingency (χ, multiple correlation coefficient (R were conducted amongst other invariant procedures. Results. The mean score for the individual items of SCQIPP questionnaire was between 2.0 and 4.7 (scale range 1-5 and the percentage of patients answers 'strongly agree' ranged from 4.4 to 77%. The smallest number of positive answers were given by the patients for the item 'In order to assess pain intensity, some of the staff asked me at least once in the morning, in the afternoon and in the evening to show the number from 0-10'. Most of the patients (57% evaluated severe pain during the previous 24 hours, as moderate pain, which represents significantly greater number of patients which complain of severe pain and mild pain (p < 0.001. The analysis of patients evaluation (MANOVA p

  7. Pregabalin Effect on Acute and Chronic Pain after Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Aik Bouzia

    2017-01-01

    Full Text Available Introduction. Pain after cardiac surgery affects long-term patient wellness. This study investigated the effect of preoperative pregabalin on acute and chronic pain after elective cardiac surgery with median sternotomy. Methods. Prospective double blind study. 93 cardiac surgery patients were randomly assigned into three groups: Group 1 received placebo, Group 2 received oral pregabalin 75 mg, and Group 3 received oral pregabalin 150 mg. Data were collected 8 hours, 24 hours, and 3 months postoperatively. Results. Patients receiving pregabalin required fewer morphine boluses (10 in controls versus 6 in Group 1 versus 4 in Group 2, p=0.000 and had lower pain scores at 8 hours (4 versus 3 versus 3, p=0.001 and 3 months (3 versus 2 versus 2, p=0.000 and lower morphine consumption at 8 hours (14 versus 13 versus 12 mg, p=0.000 and 24 hours (19.5 versus 16 versus 15 mg, p=0.000. Percentage of patients with sleep disturbances or requiring analgesics was lower in the pregabalin group and even lower with higher pregabalin dose (16/31 versus 5/31 versus 3/31, p=0.000, and 26/31 versus 16/31 versus 10/31, p=0.000, resp. 3 months after surgery. Conclusion. Preoperative oral pregabalin 75 or 150 mg reduces postoperative morphine requirements and acute and chronic pain after cardiac surgery.

  8. Acute patellofemoral pain: aggravating activities, clinical examination, MRI and ultrasound findings

    DEFF Research Database (Denmark)

    Brushoj, C.; Holmich, P.; Nielsen, M.B.

    2008-01-01

    Objective: To investigate acute anterior knee pain caused by overuse in terms of pain location, aggravating activities, findings on clinical examination and ultrasound/MRI examination. To determine if acute anterior knee pain caused by overuse should be classified as a subgroup of patellofemoral...... pain syndrome (PFPS). Methods: In a observational study design 30 army recruits with anterior knee pain (mean duration of pain 4 weeks) were examined using the PFPS pain severity scale (PSS), knee pain diagrams, standardised clinical examination, ultrasound and MRI examinations. Results: On PSS typical....../ultrasound. Conclusions: Acute anterior knee pain should be regarded as a subgroup of PFPS as both symptoms and clinical examination suggests this. The clinical examination with disseminated pain in all synovial covered structures is consistent with ideas of the importance of synovium in the genesis of pain...

  9. Severity of acute pain after breast surgery is associated with the likelihood of subsequently developing persistent pain.

    LENUS (Irish Health Repository)

    Hickey, Oonagh T

    2010-09-01

    Persistent postsurgical pain (PPSP) after surgery for breast cancer has a prevalence of 20% to 52%. Neuroplastic changes may play a role in the aetiology of this pain. The principal objective of this study was to examine the relationship between acute pain after surgery for breast cancer and the likelihood of subsequently developing PPSP.

  10. Acute patellofemoral pain: aggravating activities, clinical examination, MRI and ultrasound findings

    DEFF Research Database (Denmark)

    Brushoj, C.; Holmich, P.; Nielsen, M.B.

    2008-01-01

    knee loading activities were the most painful, while sitting with knee bend for prolonged time caused surprisingly little pain. Pain was most commonly perceived in the peripatellar area (25 patients (83%)). The most common site of pain on clinical examination was the peripatellar area (25 patients (83......Objective: To investigate acute anterior knee pain caused by overuse in terms of pain location, aggravating activities, findings on clinical examination and ultrasound/MRI examination. To determine if acute anterior knee pain caused by overuse should be classified as a subgroup of patellofemoral...... pain syndrome (PFPS). Methods: In a observational study design 30 army recruits with anterior knee pain (mean duration of pain 4 weeks) were examined using the PFPS pain severity scale (PSS), knee pain diagrams, standardised clinical examination, ultrasound and MRI examinations. Results: On PSS typical...

  11. Diagnostic profiles of acute abdominal pain with multinomial logistic regression

    Directory of Open Access Journals (Sweden)

    Ohmann, Christian

    2007-07-01

    Full Text Available Purpose: Application of multinomial logistic regression for diagnostic support of acute abdominal pain, a diagnostic problem with many differential diagnoses. Methods: The analysis is based on a prospective data base with 2280 patients with acute abdominal pain, characterized by 87 variables from history and clinical examination and 12 differential diagnoses. Associations between single variables from history and clinical examination and the final diagnoses were investigated with multinomial logistic regression. Results: Exemplarily, the results are presented for the variable rigidity. A statistical significant association was observed for generalized rigidity and the diagnoses appendicitis, bowel obstruction, pancreatitis, perforated ulcer, multiple and other diagnoses and for localized rigidity and appendicitis, diverticulitis, biliary disease and perforated ulcer. Diagnostic profiles were generated by summarizing the statistical significant associations. As an example the diagnostic profile of acute appendicitis is presented. Conclusions: Compared to alternative approaches (e.g. independent Bayes, loglinear model there are advantages for multinomial logistic regression to support complex differential diagnostic problems, provided potential traps are avoided (e.g. α-error, interpretation of odds ratio.

  12. Hypnosis for Acute Procedural Pain: A Critical Review.

    Science.gov (United States)

    Kendrick, Cassie; Sliwinski, Jim; Yu, Yimin; Johnson, Aimee; Fisher, William; Kekecs, Zoltán; Elkins, Gary

    2016-01-01

    Clinical evidence for the effectiveness of hypnosis in the treatment of acute procedural pain was critically evaluated based on reports from randomized controlled clinical trials (RCTs). Results from the 29 RCTs meeting inclusion criteria suggest that hypnosis decreases pain compared to standard care and attention control groups and that it is at least as effective as comparable adjunct psychological or behavioral therapies. In addition, applying hypnosis in multiple sessions prior to the day of the procedure produced the highest percentage of significant results. Hypnosis was most effective in minor surgical procedures. However, interpretations are limited by considerable risk of bias. Further studies using minimally effective control conditions and systematic control of intervention dose and timing are required to strengthen conclusions.

  13. HYPNOSIS FOR ACUTE PROCEDURAL PAIN: A Critical Review

    Science.gov (United States)

    Kendrick, Cassie; Sliwinski, Jim; Yu, Yimin; Johnson, Aimee; Fisher, William; Kekecs, Zoltán; Elkins, Gary

    2015-01-01

    Clinical evidence for the effectiveness of hypnosis in the treatment of acute, procedural pain was critically evaluated based on reports from randomized controlled clinical trials (RCTs). Results from the 29 RCTs meeting inclusion criteria suggest that hypnosis decreases pain compared to standard care and attention control groups and that it is at least as effective as comparable adjunct psychological or behavioral therapies. In addition, applying hypnosis in multiple sessions prior to the day of the procedure produced the highest percentage of significant results. Hypnosis was most effective in minor surgical procedures. However, interpretations are limited by considerable risk of bias. Further studies using minimally effective control conditions and systematic control of intervention dose and timing are required to strengthen conclusions. PMID:26599994

  14. Varicella Zoster Infection: A Rare Cause of Abdominal Pain Mimicking Acute Abdomen

    OpenAIRE

    Olmez, Deniz; Boz, Alper; Erkan, Nazif

    2009-01-01

    Varicella zoster is an acute viral infection that results from reactivation of a latent varicella zoster virus. It usually occurs in adult population and immune compromised patients. It rarely occurs in healthy children. Here we present a 14 years old male with varicella zoster that had abdominal pain mimicking acute abdomen to alert others who are consulted for the differentiation of acute abdomen and others who may be consulted for pain management. Keywords Varicella zoster; Abdominal pain

  15. Effect of Probiotic Administration on Acute Inflammatory Pain

    Directory of Open Access Journals (Sweden)

    Shadnoush

    2016-11-01

    Full Text Available Background Acute inflammatory pain causes by direct stimulation of nociceptors and release of inflammatory mediators and cytokines. Probiotics are capable to modulate the immune system, down regulate the inflammatory mediators, and increase regulatory and anti-inflammatory cytokines. Objectives The aim of this study was to examine the effect of oral administration of probiotics on behavioral, cellular and molecular aspects of acute inflammatory pain in male rats. Methods Adult male Wistar rats (200 - 220 g were selected and randomly divided into 7 experimental groups (CFA, CFA control, CFA + vehicle (distilled water, CFA + 3 doses of probiotics, CFA + indomethacin and each group was divided into 3 subgroups based on different time points (days 0, 3, and 7 (n = 6 rats, each group. Complete Freund’s adjuvant (CFA-induced arthritis (AA was caused by a single subcutaneous injection of CFA into the rats’ left hind paw on day 0. Different doses of probiotics (1/250, 1/500 and 1/1000 (109 CFU/g was administered daily (gavage after the CFA injection. Blood samples were taken from the vessel retro-orbital corners of rat’s eyes. After behavioral and inflammatory tests, the lumbar segments of rat’s spinal cord (L1 - L5 were removed. Hyperalgesia, edema, serum TNF-α and IL-1β levels and NF-κB expression were assessed on days 0, 3, and 7 of the study. Results The results of this study showed the role of effective dose of probiotics (1/500 in reducing edema (P = 0.0009, hyperalgesia (P = 0.0002, serum levels of TNF-α (P = 0.0004 and IL-1β (P = 0.0004 and NF-κB expression (P = 0.0007 during the acute phase of inflammatory pain caused by CFA. Conclusions It seems that an effective dose of probiotics due to its direct effects on inhibition of intracellular signaling pathways and pro-inflammatory cytokines can alleviate inflammatory symptoms and pain in the acute phase.

  16. Effects of gabapentin in acute inflammatory pain in humans

    DEFF Research Database (Denmark)

    Werner, M U; Perkins, F M; Holte, Kathrine

    2001-01-01

    BACKGROUND AND OBJECTIVES: The aim of the study was to examine the analgesic effects of the anticonvulsant, gabapentin, in a validated model of acute inflammatory pain. METHODS: Twenty-two volunteers were investigated in a double-blind, randomized, placebo-controlled cross-over study. Gabapentin 1...... stimuli (visual analog scale [VAS]), assessments of thermal and mechanical detection thresholds, and areas of secondary hyperalgesia. Side effects drowsiness and postural instability were assessed by subjective ratings (VAS). RESULTS: The burn injury induced significant primary and secondary hyperalgesia...

  17. The effect of chlorzoxazone on acute pain after spine surgery

    DEFF Research Database (Denmark)

    Nielsen, R V; Fomsgaard, J S; Siegel, M H

    2016-01-01

    after spine surgery. METHODS: One hundred and ten patients were randomly assigned to 500 mg oral chlorzoxazone or placebo in this blinded study of patients having spine surgery under general anaesthesia. In the 4 h trial period analgesia consisted of IV patient-controlled analgesia (morphine bolus 2...... morphine use 0-4 h: median 10 (7-21) vs. 13 (5-19) mg in the chlorzoxazone and placebo groups, respectively, P = 0.82. We found no significant difference in adverse effects. CONCLUSION: No analgesic effect of single-dose chlorzoxazone was demonstrated in patients with acute pain after spine surgery. Based...

  18. Perioperative dexmedetomidine for acute pain after abdominal surgery in adults.

    Science.gov (United States)

    Jessen Lundorf, Luise; Korvenius Nedergaard, Helene; Møller, Ann Merete

    2016-02-18

    Acute postoperative pain is still an issue in patients undergoing abdominal surgery. Postoperative pain and side effects of analgesic treatment, in particular those of opioids, need to be minimized. Opioid-sparing analgesics, possibly including dexmedetomidine, seem a promising avenue by which to improve postoperative outcomes. Our primary aim was to determine the analgesic efficacy and opioid-sparing effect of perioperative dexmedetomidine for acute pain after abdominal surgery in adults.Secondary aims were to establish effects of dexmedetomidine on postoperative nausea and vomiting (PONV), gastrointestinal function and mobilization, together with the side effect profile of dexmedetomidine. We searched the following databases: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Institute for Scientific Information (ISI), Web of Science and Cumulative Index to Nursing and Allied Health Literature (CINAHL), and reference lists of articles to May 2014. We searched the Science Citation Index, ClinicalTrials.gov and Current Controlled Trials, and we contacted pharmaceutical companies to identify unpublished and ongoing studies. We applied no language restrictions. We reran the search in May 2015 and found nine studies of interest. We will deal with the studies of interest when we update the review. We included randomized, controlled trials of perioperative dexmedetomidine versus placebo or other drug during abdominal surgery in adults. Trials included one of the following outcomes: amount of 'rescue' opioid, postoperative pain, time to 'rescue' analgesia, participants requiring 'rescue' analgesia, postoperative sedation, PONV, time to first passage of flatus and stool or time to first out-of-bed mobilization. Two review authors independently screened the titles and abstracts for eligibility. We retrieved full trial reports if necessary, and we extracted relevant data from the included studies using a data collection form and assessed risk of bias. We

  19. Preoperative dexamethasone reduces acute but not sustained pain after lumbar disk surgery

    DEFF Research Database (Denmark)

    Nielsen, Rikke V; Siegel, Hanna; Fomsgaard, Jonna S

    2015-01-01

    with morphine. Primary outcome was pain during mobilization (visual analog scale) 2 to 24 hours postoperatively. Secondary outcomes were acute pain at rest, morphine consumption, nausea, vomiting, ondansetron consumption, sedation, and quality of sleep. Patients were followed up by written questionnaire 3......Glucocorticoids have attracted increasing attention as adjuvants in the treatment of acute postoperative pain. Furthermore, anecdotal reports may support glucocorticoids for preventing sustained postoperative pain. We explored preoperative dexamethasone combined with paracetamol and ibuprofen...

  20. Differential diagnosis of pelvic pain in women: acute and chronic forms

    International Nuclear Information System (INIS)

    Speiser, P. . paul.speiser@univie.ac.at

    2001-01-01

    Acute and chronic forms of pelvic pain are symptoms of various gynaecological entities with a difficult clinical differential diagnosis. Acute pains are generally intensive attacks with a sudden onset, rapid progression, and normally short duration. Chronic pelvic pain is a continuous non-cyclic condition. Transvaginal sonography is an efficient tool to document morphologic abnormalities. Other imaging modalities, especially magnetic resonance imaging (MRI) and computed tomography (CT) are valuable to differentiate gynaecological from other abdominal causes pain. (author)

  1. Laparoscopy and ultrasound examination in women with acute pelvic pain

    DEFF Research Database (Denmark)

    Mikkelsen, A L; Felding, C

    1990-01-01

    The results of preoperative pelvic examination and eventual ultrasound examination were correlated with the laparoscopic findings in 316 women with acute pelvic pain. The predictive values of normal and abnormal findings at pelvic examination were 46.9 and 82.1%, respectively. 42.1% of the women...... had ultrasound examination performed. This investigation showed to be helpful especially in patients with normal findings at pelvic examination. If ultrasonic findings were abnormal the results at laparoscopy were also abnormal in 90%. On the contrary, normal findings at ultrasound examination did...... not exclude abnormal pelvic findings. The predictive value of normal results at ultrasound examination was 50.0%. This discrepancy between ultrasonic and pelvic findings can be explained by the size of the pelvic masses. Ultrasound examination is a valuable tool in the evaluation of patients with acute pelvic...

  2. Acute pain services in India: A long and challenging journey ahead

    Directory of Open Access Journals (Sweden)

    Samina Khaliloddin Khatib

    2016-01-01

    Full Text Available Acute post-operative pain and other forms of pain are widely undertreated globally including the Indian hospitals. As a result a large proportion of patients suffer from moderate to severe forms of pain. Undertreated pain can have many negative consequences such as pulmonary complications, acute myocardial ischemic events, delayed wound healing, prolonged hospital stay, etc. In spite of this acute pain continues to be negelected. The solution to poorly managed pain is not just developing newer and sophisticated techniques. But the solution lies in developing a dedicated, round-the-clock service called as acute pain service. This concept has gained world wide acceptance in last two decades and a majority of countries are developing such pain services in the hospitals. Unfortunately in India the field of acute pain medicine is still in its infancy. A very few hospitals have full fledged Acute Pain Services. In this review article we have tried to throw light on the hurdles in developing Acute Pain Services in our country. Also we have suggested a few possible solutions.

  3. Tension Hydrocele: An Unusual Cause of Acute Scrotal Pain.

    Science.gov (United States)

    Dagrosa, Lawrence M; McMenaman, Kathryn S; Pais, Vernon M

    2015-08-01

    The etiology of acute scrotal pain can vary from a benign process such as mild trauma, appendicular torsion, or epididymo-orchitis to an emergent process such as an incarcerated inguinal hernia, testicular torsion, or rupture. Furthermore, testicular insult often results in a reactive hydrocele that can both cloud the diagnosis and impair the physical examination. Traditionally, the acute scrotum was managed with immediate exploration, but emergency physicians and urologists have increasingly used Doppler ultrasonography to assess vascular flow, aide in the diagnosis, and ultimately guide triage of those patients who require urgent intervention. We describe the case of a 15-year-old boy who presented with 2 days of increasing testicular pain and swelling, confirmed to have a large hydrocele with compromised testicular perfusion, and was managed by emergent operative drainage and repair of a "tension hydrocele" with immediate return of testicular perfusion. To our knowledge, this is the first report of tension hydrocele causing intratesticular vascular compromise in a pediatric patient.

  4. [Acute pain therapy in German hospitals as competitive factor. Do competition, ownership and case severity influence the practice of acute pain therapy?].

    Science.gov (United States)

    Erlenwein, J; Hinz, J; Meißner, W; Stamer, U; Bauer, M; Petzke, F

    2015-07-01

    Due to the implementation of the diagnosis-related groups (DRG) system, the competitive pressure on German hospitals increased. In this context it has been shown that acute pain management offers economic benefits for hospitals. The aim of this study was to analyze the impact of the competitive situation, the ownership and the economic resources required on structures and processes for acute pain management. A standardized questionnaire on structures and processes of acute pain management was mailed to the 885 directors of German departments of anesthesiology listed as members of the German Society of Anesthesiology and Intensive Care Medicine (DGAI, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin). For most hospitals a strong regional competition existed; however, this parameter affected neither the implementation of structures nor the recommended treatment processes for pain therapy. In contrast, a clear preference for hospitals in private ownership to use the benchmarking tool QUIPS (quality improvement in postoperative pain therapy) was found. These hospitals also presented information on coping with the management of pain in the corporate clinic mission statement more often and published information about the quality of acute pain management in the quality reports more frequently. No differences were found between hospitals with different forms of ownership in the implementation of acute pain services, quality circles, expert standard pain management and the implementation of recommended processes. Hospitals with a higher case mix index (CMI) had a certified acute pain management more often. The corporate mission statement of these hospitals also contained information on how to cope with pain, presentation of the quality of pain management in the quality report, implementation of quality circles and the implementation of the expert standard pain management more frequently. There were no differences in the frequency of using the benchmarking

  5. Managing the acute painful episode in sickle cell disease

    Directory of Open Access Journals (Sweden)

    B. Kaya

    2011-12-01

    Full Text Available Sickle cell pain is a complex but frequently experienced symptom. Acute painful events in children can be managed effectively in the community with appropriate support and education. If hospital management is required, rapid access to a consistent, reliable and safe analgesic pathway is recommended to ensure a good standard of care. Use of oral opiates in addition to short acting easily administrable forms of analgesia and strict adherence to protocoled monitoring will enable the acute event to be well managed and the negative pain experience minimised. An important part of the outpatient evaluation is determining the impact pain events are having on the child’s quality of life. Addressing psycho-social aspects, defining and modifying precipitating factors, if any are identified, and having a holistic approach to pain management is helpful. Education and use of self-management techniques can also be productive. Use of sickle modifying interventions such as hydroxycarbamide therapy or transfusion therapy can have a significant impact on reducing the severity and frequency of the acute pain event. 镰状细胞疼痛是一种复杂的常发症。 通过适当的支助和教育,儿童急性疼痛症可以得到有效抑制。 如果需要在医院进行护理,患者应尽快寻求持续可靠且安全的止痛方式,确保良好的护理。 除采取作用短、管理方便的止痛治疗和遵守监测协议之外,患者还需口服鸦片剂,这样,急性症状可以得到良好的抑制,还可尽量减轻疼痛感。 诊断门诊病人一个重要的部分就是确定疼痛症对患儿生活质量产生的影响。 问询生理社会方面问题,确定和修改诱发因子(如有),并整体分析可行的疼痛护理方法。 教育和使用个人护理法也很有效果。 采用镰状细胞修改干预法,例如羟基尿素疗法或输液疗法,对减轻急性疼痛症和减少发作频率有着显著效果。

  6. MANIPULATIVE THERAPY AND CLINICAL PREDICTION CRITERIA IN TREATMENT OF ACUTE NONSPECIFIC LOW BACK PAIN

    NARCIS (Netherlands)

    Hallegraeff, H. J. M.; de Greef, Mathieu; Winters, Jan C.; Lucas, Cees

    Manipulative therapy as part of a multidimensional approach may be more effective than standard physical therapy in treating Acute Nonspecific Low Back Pain. 64 participants, 29 women and 35 men, with Acute Nonspecific Low Back Pain and a mean age of 40 yr. (SD = 9.6) were randomly assigned to two

  7. Can preoperative electrical nociceptive stimulation predict acute pain after groin herniotomy?

    DEFF Research Database (Denmark)

    Aasvang, Eske Kvanner; Hansen, J.B.; Kehlet, H.

    2008-01-01

    Preoperative identification of patients at risk for high-intensity postoperative pain may be used to predict patients at risk for development of a persistent pain state and allocate patients to more intensive specific pain therapy. Preoperative pain threshold to electrocutaneus stimulation has...... recently been shown to correlate to acute postoperative pain after cesarean section, but the findings have not been confirmed in larger studies or other procedures. Preoperative electrical pain detection threshold and pain tolerance were assessed in patients undergoing a primary unilateral groin hernia...... repair. The correlation between the pain data for electrical stimulation was compared with the postoperative pain during the first week in 165 patients, whereof 3 were excluded. Preoperative electrical pain detection threshold and electrical pain tolerance threshold did not correlate to postoperative...

  8. Fascia iliaca compartment blockade for acute pain control in hip fracture patients

    DEFF Research Database (Denmark)

    Foss, Nicolai B; Kristensen, Billy B; Bundgaard, Morten

    2007-01-01

    Hip fracture patients are in severe pain upon arrival at the emergency department. Pain treatment is traditionally based on systemic opioids. No study has examined the effect of fascia iliaca compartment blockade (FICB) in acute hip fracture pain management within a double-blind, randomized setup....

  9. Population pharmacokinetics of oral diclofenac for acute pain in children.

    Science.gov (United States)

    Standing, Joseph F; Howard, Richard F; Johnson, Atholl; Savage, Imogen; Wong, Ian C K

    2008-12-01

    To develop a population pharmacokinetic model for a new diclofenac suspension (50 mg 5 ml(-1)) in adult volunteers and paediatric patients, and recommend a dose for acute pain in children. Blood samples were drawn at the start and end of surgery, and on removal of the venous cannula from 70 children (aged 1 to 12 years, weight 9 to 37 kg) who received a preoperative oral 1 mg kg(-1) dose; these were pooled with rich (14 post-dose samples) data from 30 adult volunteers. Population pharmacokinetic modelling was undertaken with NONMEM. The optimum adult dose of diclofenac for acute pain is 50 mg. Simulation from the final model was performed to predict a paediatric dose to achieve a similar AUC to 50 mg in adults. A total of 558 serum diclofenac concentrations from 100 subjects was used in the pooled analysis. A single disposition compartment model with first order elimination and dual absorption compartments was used. The estimates of CL/F and V(D)/F were 53.98 l h(-1) 70 kg(-1) and 4.84 l 70 kg(-1) respectively. Allometric size models appeared to predict adequately changes in CL and V(D) with age. Of the simulated doses investigated, 1 mg kg(-1) gave paediatric AUC((0,12 h)) to adult 50 mg AUC((0,12 h)) ratios of 1.00, 1.08 and 1.18 for ages 1-3, 4-6 and 7-12 years respectively. This study has shown 1 mg kg(-1) diclofenac to produce similar exposure in children aged 1 to 12 years as 50 mg in adults, and is acceptable for clinical practice; patients are unlikely to obtain further benefit from higher doses.

  10. [Delegation of medical activities in acute pain therapy].

    Science.gov (United States)

    Erlenwein, J; Moroder, A; Biermann, E; Petzke, F; Ehlers, A P F; Bitter, H; Pogatzki-Zahn, E

    2018-01-01

    Acute pain management is an interprofessional and interdisciplinary task and requires a good and trustful cooperation between stakeholders. Despite provisions in Germany according to which medical treatment can only be rendered by a formally qualified physician ("Arztvorbehalt"), a physician does not have to carry out every medical activity in person. Under certain conditions, some medical activities can be delegated to medical auxiliary personnel but they need to be (1) instructed, (2) supervised and (3) checked by the physician himself; however, medical history, diagnostic assessment and evaluation, indications, therapy planning (e.g. selection, dosage), therapeutic decisions (e. g. modification or termination of therapy) and obtaining informed consent cannot be delegated. With respect to drug therapy, monitoring of the therapy remains the personal responsibility of the physician, while the actual application of medication can be delegated. From a legal perspective, the current practice needs to be stressed about what is within the mandatory requirements and what is not when medical activities are delegated to non-medical staff. The use of standards of care improves treatment quality but like any medical treatment it must be based on the physician's individual assessment and indications for each patient and requires personal contact between physician and patient. Delegation on the ward and in acute pain therapy requires the authorization of the delegator to give instructions in the respective setting. The transfer of non-delegable duties to non-medical personnel is regarded as medical malpractice.

  11. [Postoperative pain management. Aims and organization of a strategy for postoperative acute pain therapy].

    Science.gov (United States)

    Nolli, M; Nicosia, F

    2000-09-01

    The Health Services, not only the Italian one, is under pressure because of request for improving treatment quality and the financial need for reorganization and cost-saving. It's required a rationalization of intervention, together with a careful choice of the best and cheapest techniques and the demonstration of their efficacy. The anaesthesia service activity, in a period of cost rationalization and funds restriction should be aimed to appropriate outcome measures corrected by both patient's risk factors and surgical-anaesthesiological case-mix. The development of a complete strategy for surgical pain management might run into two phases. The first phase, internal and mono-specialistic, should develop like the creation of an Acute Pain Team. The main processes are: focusing the problem (charge of the care), training, information, teaching methodology (timing, methods, drugs, techniques, etc.) and the audit (before and after changes). The main aims are the evaluation of the level of analgesia and pain relief or patient's satisfaction which are partial endpoints useful to demonstrate the improvement and the efficacy of the new pain management strategies. The second phase, multidisciplinary, is directed toward the creation of a Postoperative Evaluation Team. The main objective is to set up a collaborative clinical group able to identify the criteria for quality, efficacy and safety. The major purpose is the evaluation of major outcome measures: surgical outcome, morbidity, mortality and length of hospitalization. The improvement in the quality of postoperative pain treatment goes through a better organization and a progressive increase of the already available therapy. The achievement of the result and the quality projects depend on the interaction among staff members with different behaviours and settings. Internal teaching and training, continuous education for doctors and nurses, and external information, marketing and improvement of attractive capability of

  12. An unusual cause of acute abdominal pain in dengue fever.

    Science.gov (United States)

    Waseem, Tariq; Latif, Hina; Shabbir, Bilquis

    2014-07-01

    Dengue fever is an acute febrile viral disease caused by the bite of Aedes aegypti mosquito. It is a major health problem especially in tropical and subtropical areas including South East Asia and Pakistan. In the past few years, dengue fever has been endemic in Northern Punjab. Physicians managing dengue fever come across varied and uncommon complications of dengue fever. We report a case of dengue fever that developed severe right upper quadrant abdominal pain and induration after extreme retching and vomiting for 2 days. A rectus sheath hematoma was confirmed on noncontrast computed tomography (CT). Rectus sheath hematoma as a complication of dengue fever has rarely been reported before and never from this part of the world. Rectus sheath hematoma is an uncommon and often clinically misdiagnosed cause of abdominal pain. It is the result of bleeding into the rectus sheath from damage to the superior or inferior epigastric artery or their branches or from a direct tear of the rectus muscle. It can mimic almost any abdominal condition (See Fig.) (See Table).

  13. Altered fMRI resting-state connectivity in individuals with fibromyalgia on acute pain stimulation.

    Science.gov (United States)

    Ichesco, E; Puiu, T; Hampson, J P; Kairys, A E; Clauw, D J; Harte, S E; Peltier, S J; Harris, R E; Schmidt-Wilcke, T

    2016-08-01

    Fibromyalgia is a chronic widespread pain condition, with patients commonly reporting other symptoms such as sleep difficulties, memory complaints and fatigue. The use of magnetic resonance imaging (MRI) in fibromyalgia has allowed for the detection of neural abnormalities, with alterations in brain activation elicited by experimental pain and alterations in resting state connectivity related to clinical pain. In this study, we sought to monitor state changes in resting brain connectivity following experimental pressure pain in fibromyalgia patients and healthy controls. Twelve fibromyalgia patients and 15 healthy controls were studied by applying discrete pressure stimuli to the thumbnail bed during MRI. Resting-state functional MRI scanning was performed before and immediately following experimental pressure pain. We investigated changes in functional connectivity to the thalamus and the insular cortex. Acute pressure pain increased insula connectivity to the anterior cingulate and the hippocampus. Additionally, we observed increased thalamic connectivity to the precuneus/posterior cingulate cortex, a known part of the default mode network, in patients but not in controls. This connectivity was correlated with changes in clinical pain. These data reporting changes in resting-state brain activity following a noxious stimulus suggest that the acute painful stimuli may contribute to the alteration of the neural signature of chronic pain. WHAT DOES THIS STUDY/ADD?: In this study acute pain application shows an echo in functional connectivity and clinical pain changes in chronic pain. © 2016 European Pain Federation - EFIC®

  14. Discriminative ability of reflex receptive fields to distinguish patients with acute and chronic low back pain.

    Science.gov (United States)

    Müller, Monika; Biurrun Manresa, José A; Treichel, Fabienne; Agten, Christoph A; Heini, Paul; Andersen, Ole K; Curatolo, Michele; Jüni, Peter

    2016-12-01

    Low back pain has a life time prevalence of 70% to 85%. Approximately 10% to 20% of all patients experience recurrent episodes or develop chronic low back pain. Sociodemographic, clinical, and psychological characteristics explain the transition from acute to chronic low back pain only to a limited extent. Altered central pain processing may be a contributing mechanism. The measurement of reflex receptive fields (RRF) is a novel method to assess altered central pain processing. The RRF area denotes the area of the foot sole from which spinal nociceptive reflexes can be elicited. It was shown to be enlarged in patients with acute and chronic low back pain compared with pain-free individuals. The aim of the study was to explore the discriminative ability of the RRF to distinguish patients with acute and chronic low back pain with the hypothesis that enlarged RRF are associated with chronic low back pain. We included 214 patients with either acute or chronic low back pain and compared RRF between groups in both univariable and multivariable analyses adjusted for different sociodemographic and clinical characteristics possibly associated with the transition to chronic pain. We found a mean difference between patients with acute and chronic low back pain of -0.01 (95% confidence interval [CI], -0.06 to 0.04) in the crude, -0.02 (95% CI, -0.08 to 0.04) in the age and sex adjusted, and -0.02 (95% CI, -0.09 to 0.05) in the fully adjusted model. Our results suggest that the enlargement of RRF area may not be associated with the transition from acute to chronic low back pain.

  15. Preoperative Pain, Symptoms, and Psychological Factors related to Higher Acute Pain Trajectories during Hospitalization for Total Knee Arthroplasty.

    Directory of Open Access Journals (Sweden)

    Maren Falch Lindberg

    Full Text Available Unrelieved postoperative pain after total knee arthroplasty (TKA is a significant problem. This longitudinal study investigated how preoperative pain intensity, as well as a comprehensive list of preoperative and perioperative factors, influenced the severity of acute average and worst pain after TKA.Prior to surgery, 203 patients completed a demographic questionnaire, Lee Fatigue Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, and Brief Illness Perception Questionnaire. Brief Pain Inventory was completed prior to surgery as well as through postoperative days (POD 0 to 4. Clinical data were extracted from medical records.Several factors were associated with higher levels of preoperative and postoperative pain. Lower preoperative average and worst pain intensity scores were associated with increases in average and worst postoperative pain from POD1 to POD4. A higher number of comorbidities, higher C-reactive protein values, and higher pain interference with function were associated with higher preoperative levels of average pain. Older age, higher fatigue levels, and higher scores on identity and emotional responses to osteoarthritis (OA were associated with higher preoperative levels of worst pain. Lower perceived consequences of OA were associated with higher pain from POD1 to POD4. Males and patients with lower preoperative scores for average pain had higher worst pain following surgery.Patients at higher risk for more severe postoperative pain can be identified through an assessment of pain and other risk factors identified in this study. Future research needs to test the efficacy of interventions that modify patients' perceptions of living with OA and pain intensity before surgery on short and long term postoperative outcomes.

  16. Preoperative Pain, Symptoms, and Psychological Factors related to Higher Acute Pain Trajectories during Hospitalization for Total Knee Arthroplasty

    Science.gov (United States)

    Lindberg, Maren Falch; Miaskowski, Christine; Rustøen, Tone; Rosseland, Leiv Arne; Paul, Steven M.

    2016-01-01

    Objectives Unrelieved postoperative pain after total knee arthroplasty (TKA) is a significant problem. This longitudinal study investigated how preoperative pain intensity, as well as a comprehensive list of preoperative and perioperative factors, influenced the severity of acute average and worst pain after TKA. Methods Prior to surgery, 203 patients completed a demographic questionnaire, Lee Fatigue Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, and Brief Illness Perception Questionnaire. Brief Pain Inventory was completed prior to surgery as well as through postoperative days (POD) 0 to 4. Clinical data were extracted from medical records. Results Several factors were associated with higher levels of preoperative and postoperative pain. Lower preoperative average and worst pain intensity scores were associated with increases in average and worst postoperative pain from POD1 to POD4. A higher number of comorbidities, higher C-reactive protein values, and higher pain interference with function were associated with higher preoperative levels of average pain. Older age, higher fatigue levels, and higher scores on identity and emotional responses to osteoarthritis (OA) were associated with higher preoperative levels of worst pain. Lower perceived consequences of OA were associated with higher pain from POD1 to POD4. Males and patients with lower preoperative scores for average pain had higher worst pain following surgery. Discussion Patients at higher risk for more severe postoperative pain can be identified through an assessment of pain and other risk factors identified in this study. Future research needs to test the efficacy of interventions that modify patients’ perceptions of living with OA and pain intensity before surgery on short and long term postoperative outcomes. PMID:27583551

  17. Experiences of patients with acute abdominal pain in the ED or acute surgical ward --a qualitative comparative study

    DEFF Research Database (Denmark)

    Schultz, Helen; Qvist, Niels; Backer Mogensen, Christian

    2013-01-01

    with the patients took place after surgical assessment. In all, patients experienced long waiting times. The study shows a need to define the roles of the professionals in units receiving patients with acute abdominal pain in order to fulfil the medical as well as the experienced needs of the acute patient....

  18. DoD-NCCAM/NIH workshop on acupuncture for treatment of acute pain.

    Science.gov (United States)

    Edwards, Emmeline; Belard, Jean Louis; Glowa, John; Khalsa, Partap; Weber, Wendy; Huntley, Kristen

    2013-03-01

    The Department of Defense (DoD) and the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) cosponsored a workshop that explored the possible benefits of acupuncture treatment for acute pain. One goal of the workshop was to establish a roadmap to building an evidence base on that would indicate whether acupuncture is helpful for treating active-duty military personnel experiencing acute pain. The workshop highlighted brief presentations on the most current research on acupuncture and acute pain mechanisms. The impact of various modifiers (stress, genetics, population, phenotypes, etc.) on acute pain pathways and response to acupuncture treatment was discussed. Additional presentations focused on common neural mechanisms, an overview of real-world experience with using acupuncture to treat traumatic acute pain, and best tools and methods specific for acupuncture studies. Three breakout groups addressed the gaps, opportunities, and barriers to acupuncture use for acute pain in military and trauma settings. Different models of effectiveness research and optimal research designs for conducting trials in acute traumatic pain were also discussed.

  19. DoD–NCCAM/NIH Workshop on Acupuncture for Treatment of Acute Pain

    Science.gov (United States)

    Belard, Jean Louis; Glowa, John; Khalsa, Partap; Weber, Wendy; Huntley, Kristen

    2013-01-01

    Abstract The Department of Defense (DoD) and the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) cosponsored a workshop that explored the possible benefits of acupuncture treatment for acute pain. One goal of the workshop was to establish a roadmap to building an evidence base on that would indicate whether acupuncture is helpful for treating active-duty military personnel experiencing acute pain. The workshop highlighted brief presentations on the most current research on acupuncture and acute pain mechanisms. The impact of various modifiers (stress, genetics, population, phenotypes, etc.) on acute pain pathways and response to acupuncture treatment was discussed. Additional presentations focused on common neural mechanisms, an overview of real-world experience with using acupuncture to treat traumatic acute pain, and best tools and methods specific for acupuncture studies. Three breakout groups addressed the gaps, opportunities, and barriers to acupuncture use for acute pain in military and trauma settings. Different models of effectiveness research and optimal research designs for conducting trials in acute traumatic pain were also discussed. PMID:23020611

  20. Rapid Response Team activation for pediatric patients on the acute pain service.

    Science.gov (United States)

    Teets, Maxwell; Tumin, Dmitry; Walia, Hina; Stevens, Jenna; Wrona, Sharon; Martin, David; Bhalla, Tarun; Tobias, Joseph D

    2017-11-01

    Untreated pain or overly aggressive pain management may lead to adverse physiologic consequences and activation of the hospital's Rapid Response Team. This study is a quality improvement initiative that attempts to identify patient demographics and patterns associated with Rapid Response Team consultations for patients on the acute pain service. A retrospective review of all patients on the acute pain service from February 2011 until June 2015 was cross-referenced with inpatients requiring consultation from the Rapid Response Team. Two independent practitioners reviewed electronic medical records to determine which events were likely associated with pain management interventions. Over a 4-year period, 4872 patients were admitted to the acute pain service of whom 135 unique patients required Rapid Response Team consults. There were 159 unique Rapid Response Team activations among 6538 unique acute pain service consults. A subset of 27 pain management-related Rapid Response Team consultations was identified. The largest percentage of patients on the acute pain service were adolescents aged 12-17 (36%). Compared to this age group, the odds of Rapid Response Team activation were higher among infants Rapid Response Team consultations may help to identify patients at risk for clinical decompensation. © 2017 John Wiley & Sons Ltd.

  1. Acute pain from the perspective of minor trauma patients treated at the emergency unit

    Directory of Open Access Journals (Sweden)

    Andrea Regina Martin

    Full Text Available OBJECTIVE: To study the factors that influence the perception of acute pain and the consequences of this experience in patients suffering from mild trauma. METHOD: Descriptive qualitative study conducted in an emergency service in southern Brazil. Data was collected in October 2013, through semi-structured interviews with 29 individuals who reported pain after physical trauma, regardless of the triggering factor. To process the data, we used a Content Analysis technique, subject modality. RESULTS: Two categories emerged: Factors that influence the perception of pain resulting from trauma and, Consequences of acute pain due to trauma. The acute pain sensation was influenced by biological, emotional, spiritual and socio-cultural factors and induced biological and emotional consequences for individuals. CONCLUSION: The health professionals need to consider the factors that influence soreness and its consequences for the proper assessment and management of pain resulting from trauma.

  2. Challenge of improving postoperative pain management: case studies of three acute pain services in the UK National Health Service.

    Science.gov (United States)

    Powell, A E; Davies, H T O; Bannister, J; Macrae, W A

    2009-06-01

    Previous national survey research has shown significant deficits in routine postoperative pain management in the UK. This study used an organizational change perspective to explore in detail the organizational challenges faced by three acute pain services in improving postoperative pain management. Case studies were conducted comprising documentary review and semi-structured interviews (71) with anaesthetists, surgeons, nurses, other health professionals, and managers working in and around three broadly typical acute pain services. Although the precise details differed to some degree, the three acute pain services all faced the same broad range of inter-related challenges identified in the organizational change literature (i.e. structural, political, cultural, educational, emotional, and physical/technological challenges). The services were largely isolated from wider organizational objectives and activities and struggled to engage other health professionals in improving postoperative pain management against a background of limited resources, turbulent organizational change, and inter- and intra-professional politics. Despite considerable efforts they struggled to address these challenges effectively. The literature on organizational change and quality improvement in health care suggests that it is only by addressing the multiple challenges in a comprehensive way across all levels of the organization and health-care system that sustained improvements in patient care can be secured. This helps to explain why the hard work and commitment of acute pain services over the years have not always resulted in significant improvements in routine postoperative pain management for all surgical patients. Using this literature and adopting a whole-organization quality improvement approach tailored to local circumstances may produce a step-change in the quality of routine postoperative pain management.

  3. A survey to assess the educational-level interference on self-evaluation of acute pain.

    Science.gov (United States)

    Labronici, Pedro José; Pires, Robinson Esteves Santos; Bastos Filho, Ricardo Pinheiro dos Santos; Pires-e-Albuquerque, Rodrigo Sattamini; Palma, Idemar Monteiro de; Giordano, Vincenzo; Franco, José Sérgio

    2015-08-01

    The present study aimed to evaluate whether patient education level interferes in the percentage of pain relief or increase using visual analogue scale (VAS) and subjective pain perception. Ninety-five patients presenting acute shoulder pain due to enthesitis were evaluated. They were asked to quantify the pain using VAS before steroid articular infiltration. One week later, patients reevaluated the pain using VAS and orally stated the percentage of perceived pain increase or relief. The information gathered was then compared among three patient educational levels (elementary, high school, and university). Percentages of improvement stated orally and utilizing VAS presented no statistically significant differences among the three educational status levels (p = 0.804). Patient educational status caused no impact in the results of acute pain self-assessment with VAS and oral evaluation.

  4. The prognosis of acute and persistent low-back pain: a meta-analysis

    Science.gov (United States)

    Menezes Costa, Luciola da C.; Maher, Christopher G.; Hancock, Mark J.; McAuley, James H.; Herbert, Robert D.; Costa, Leonardo O.P.

    2012-01-01

    Background: Although low-back pain is a highly prevalent condition, its clinical course remains uncertain. Our main objective was to systematically review the literature on the clinical course of pain and disability in patients with acute and persistent low-back pain. Our secondary objective was to investigate whether pain and disability have similar courses. Methods: We performed a meta-analysis of inception cohort studies. We identified eligible studies by searching MEDLINE, Embase and CINAHL. We included prospective studies that enrolled an episode-inception cohort of patients with acute or persistent low-back pain and that measured pain, disability or recovery. Two independent reviewers extracted data and assessed methodologic quality. We used mixed models to determine pooled estimates of pain and disability over time. Results: Data from 33 discrete cohorts (11 166 participants) were included in the review. The variance-weighted mean pain score (out of a maximum score of 100) was 52 (95% CI 48–57) at baseline, 23 (95% CI 21–25) at 6 weeks, 12 (95% CI 9–15) at 26 weeks and 6 (95% CI 3–10) at 52 weeks after the onset of pain for cohorts with acute pain. Among cohorts with persistent pain, the variance-weighted mean pain score (out of 100) was 51 (95% CI 44–59) at baseline, 33 (95% CI 29–38) at 6 weeks, 26 (95% CI 20–33) at 26 weeks and 23 (95% CI 16–30) at 52 weeks after the onset of pain. The course of disability outcomes was similar to the time course of pain outcomes in the acute pain cohorts, but the pain outcomes were slightly worse than disability outcomes in the persistent pain cohorts. Interpretation: Patients who presented with acute or persistent low-back pain improved markedly in the first six weeks. After that time improvement slowed. Low to moderate levels of pain and disability were still present at one year, especially in the cohorts with persistent pain. PMID:22586331

  5. Acute chest pain: a purely clinical problem or a question for radiology

    International Nuclear Information System (INIS)

    Loewe, C.

    2008-01-01

    Acute chest pain represents a very common clinical occurrence and at the same time poses a severe diagnostic dilemma. It can be due to an acute life-threatening event such as acute cardiac infarct, or a relatively harmless condition of pain and illness (e.g. vertebrogenic pain) under the main symptom category of acute chest pain. This often unclear symptomatic, behind which there can always be a life-threatening disease leads to an exaggerated grouping of patients into emergency cases and to an increased number of inpatients for observation. The diagnosis of acute coronary syndrome with no initial ECG changes typical for ischemia is especially problematic. The availability of modern multidetector computed tomography is becoming increasingly more important for radiologists in the diagnosis and clarification of acute chest pain. In this article the clinical difficulties and radiology options for the diagnosis of patients with acute chest pain will be presented and possible future algorithms for diagnosis will be discussed. (orig.) [de

  6. Knowledge translation: An interprofessional approach to integrating a pain consult team within an acute care unit.

    Science.gov (United States)

    Feldman, Kira; Berall, Anna; Karuza, Jurgis; Senderovich, Helen; Perri, Giulia-Anna; Grossman, Daphna

    2016-11-01

    Management of pain in the frail elderly presents many challenges in both assessment and treatment, due to the presence of multiple co-morbidities, polypharmacy, and cognitive impairment. At Baycrest Health Sciences, a geriatric care centre, pain in its acute care unit had been managed through consultations with the pain team on a case-by-case basis. In an intervention informed by knowledge translation (KT), the pain specialists integrated within the social network of the acute care team for 6 months to disseminate their expertise. A survey was administered to staff on the unit before and after the intervention of the pain team to understand staff perceptions of pain management. Pre- and post-comparisons of the survey responses were analysed by using t-tests. This study provided some evidence for the success of this interprofessional education initiative through changes in staff confidence with respect to pain management. It also showed that embedding the pain team into the acute care team supported the KT process as an effective method of interprofessional team building. Incorporating the pain team into the acute care unit to provide training and ongoing decision support was a feasible strategy for KT and could be replicated in other clinical settings.

  7. Torsion of abdominal appendages presenting with acute abdominal pain

    International Nuclear Information System (INIS)

    Al-Jaberi, Tareq M.; Gharabeih, Kamal I.; Yaghan, Rami J.

    2000-01-01

    Diseases of abnormal appendages are rare causes of abdominal pain in all age groups. Nine patients with torsion and infraction of abdominal appendages were retrospectively reviewed. Four patients had torsion and infarction of the appendices epiploicae, four patients had torsion and infarction of the falciform ligament. The patient with falciform ligament disease represents the first reported case of primary torsion and infarction of the falciform ligament, and the patient with the transverse colon epiplocia represents the first reported case of vibration-induced appendix epiplocia torsion and infarction. The patient with the falciform ligament disease presented with a tender upper abdominal mass and the remaining patients were operated upon with the preoperative diagnosis of acute appendicitis. The presence of normal appendix with free serosanguinous fluid in the peritoneal cavity should raise the possibility of a disease and calls for further evaluation of the intra-abdominal organs. If the diagnosis is suspected preoperatively, CT scan and ultrasound may lead to a correct diagnosis and possibly conservative management. Laparoscopy is playing an increasing diagnostic and therapeutic role in such situations. (author)

  8. The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis

    NARCIS (Netherlands)

    Ong, Cliff K.-S.; Lirk, Philipp; Seymour, Robin A.; Jenkins, Brian J.

    2005-01-01

    Whether preemptive analgesic interventions are more effective than conventional regimens in managing acute postoperative pain remains controversial. We systematically searched for randomized controlled trials that specifically compared preoperative analgesic interventions with similar postoperative

  9. Content validation of the nursing diagnosis acute pain in the Czech Republic and Slovakia.

    Science.gov (United States)

    Zeleníková, Renáta; Žiaková, Katarína; Čáp, Juraj; Jarošová, Darja

    2014-10-01

    The main purpose of the study was to validate the defining characteristics of the nursing diagnosis acute pain in the Czech Republic and Slovakia. This is a descriptive study. The validation process involved was based on Fehring's diagnostic content validity model. Four defining characteristics were classified as major by Slovak nurses and eight defining characteristics were classified as major by Czech nurses. Validation of the nursing diagnosis acute pain in the Czech and Slovak sociocultural context has shown that nurses prioritize characteristics that are behavioral in nature as well as patients' verbal reports of pain. Verbal reports of pain and behavioral indicators are important for arriving at the nursing diagnosis acute pain. © 2014 NANDA International, Inc.

  10. Sustainability of Evidence-Based Acute Pain Management Practices for Hospitalized Older Adults.

    Science.gov (United States)

    Shuman, Clayton J; Xie, Xian-Jin; Herr, Keela A; Titler, Marita G

    2017-11-01

    Little is known regarding sustainability of evidence-based practices (EBPs) following implementation. This article reports sustainability of evidence-based acute pain management practices in hospitalized older adults following testing of a multifaceted Translating Research Into Practice (TRIP) implementation intervention. A cluster randomized trial with follow-up period was conducted in 12 Midwest U.S. hospitals (six experimental, six comparison). Use of evidence-based acute pain management practices and mean pain intensity were analyzed using generalized estimating equations across two time points (following implementation and 18 months later) to determine sustainability of TRIP intervention effects. Summative Index scores and six of seven practices were sustained. Experimental and comparison group differences for mean pain intensity over 72 hours following admission were sustained. Results revealed most evidence-based acute pain management practices were sustained for 18 months following implementation. Further work is needed to identify factors affecting sustainability of EBPs to guide development and testing of sustainability strategies.

  11. Exploring acute-to-chronic neuropathic pain in rats after contusion spinal cord injury.

    Science.gov (United States)

    Gaudet, Andrew D; Ayala, Monica T; Schleicher, Wolfgang E; Smith, Elana J; Bateman, Emily M; Maier, Steven F; Watkins, Linda R

    2017-09-01

    Spinal cord injury (SCI) causes chronic pain in 65% of individuals. Unfortunately, current pain management is inadequate for many SCI patients. Rodent models could help identify how SCI pain develops, explore new treatment strategies, and reveal whether acute post-SCI morphine worsens chronic pain. However, few studies explore or compare SCI-elicited neuropathic pain in rats. Here, we sought to determine how different clinically relevant contusion SCIs in male and female rats affect neuropathic pain, and whether acute morphine worsens later chronic SCI pain. First, female rats received sham surgery, or 150kDyn or 200kDyn midline T9 contusion SCI. These rats displayed modest mechanical allodynia and long-lasting thermal hyperalgesia. Next, a 150kDyn (1s dwell) midline contusion SCI was performed in male and female rats. Interestingly, males, but not females showed SCI-elicited mechanical allodynia; rats of both sexes had thermal hyperalgesia. In this model, acute morphine treatment had no significant effect on chronic neuropathic pain symptoms. Unilateral SCIs can also elicit neuropathic pain that could be exacerbated by morphine, so male rats received unilateral T13 contusion SCI (100kDyn). These rats exhibited significant, transient mechanical allodynia, but not thermal hyperalgesia. Acute morphine did not exacerbate chronic pain. Our data show that specific rat contusion SCI models cause neuropathic pain. Further, chronic neuropathic pain elicited by these contusion SCIs was not amplified by our course of early post-trauma morphine. Using clinically relevant rat models of SCI could help identify novel pain management strategies. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Hyperalgesia in a human model of acute inflammatory pain: a methodological study

    DEFF Research Database (Denmark)

    Pedersen, J L; Kehlet, H

    1998-01-01

    sensitive to heat pain on their left side (P ... measurements themselves evoked hyperalgesia to heat and mechanical stimuli on the arm, but only to mechanical stimuli on the legs. including secondary hyperalgesia. Hyperalgesia evoked by the measurements was significantly less intense than that induced by injury. Habituation to the painful stimuli...... was demonstrated by significantly higher pain thresholds and lower pain responses on the second and third day of the study. The burn model is a sensitive psychophysical model of acute inflammatory pain, when cross-over designs and within-day comparisons are used, and the model is suitable for double-blind, placebo...

  13. [Case of acute pain of herpes zoster with preceding immobility of the shoulder].

    Science.gov (United States)

    Takekawa, Kimiko

    2012-07-01

    A 62-year-old-man treated for nephrotic syndrome with steroid developed acute pain of herpes zoster after immobility of the shoulder. Steroids might have suppressed the first symptoms of pain. But immobility probably appeared as VZV infection developing to spinal ventral root. Suprascapular nerve block was effective for severe pain of the right arm. Sympathetic nerve contained in suprascapular nerve might have been blocked. Sympathetically maintained pain may occur when primary afferent neurons are excited by inflammation due to VZV infection. Pain was abolished 17 weeks after the onset of rash using blocks three times and amitriptyrin and valproic acid. Immobility was resolved seven months after the onset of rash.

  14. DoD–NCCAM/NIH Workshop on Acupuncture for Treatment of Acute Pain

    OpenAIRE

    Edwards, Emmeline; Belard, Jean Louis; Glowa, John; Khalsa, Partap; Weber, Wendy; Huntley, Kristen

    2013-01-01

    The Department of Defense (DoD) and the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) cosponsored a workshop that explored the possible benefits of acupuncture treatment for acute pain. One goal of the workshop was to establish a roadmap to building an evidence base on that would indicate whether acupuncture is helpful for treating active-duty military personnel experiencing acute pain.

  15. Acute low back pain is marked by variability: An internet-based pilot study

    Directory of Open Access Journals (Sweden)

    Katz Jeffrey N

    2011-10-01

    Full Text Available Abstract Background Pain variability in acute LBP has received limited study. The objectives of this pilot study were to characterize fluctuations in pain during acute LBP, to determine whether self-reported 'flares' of pain represent discrete periods of increased pain intensity, and to examine whether the frequency of flares was associated with back-related disability outcomes. Methods We conducted a cohort study of acute LBP patients utilizing frequent serial assessments and Internet-based data collection. Adults with acute LBP (lasting ≤3 months completed questionnaires at the time of seeking care, and at both 3-day and 1-week intervals, for 6 weeks. Back pain was measured using a numerical pain rating scale (NPRS, and disability was measured using the Oswestry Disability Index (ODI. A pain flare was defined as 'a period of increased pain lasting at least 2 hours, when your pain intensity is distinctly worse than it has been recently'. We used mixed-effects linear regression to model longitudinal changes in pain intensity, and multivariate linear regression to model associations between flare frequency and disability outcomes. Results 42 of 47 participants (89% reported pain flares, and the average number of discrete flare periods per patient was 3.5 over 6 weeks of follow-up. More than half of flares were less than 4 hours in duration, and about 75% of flares were less than one day in duration. A model with a quadratic trend for time best characterized improvements in pain. Pain decreased rapidly during the first 14 days after seeking care, and leveled off after about 28 days. Patients who reported a pain flare experienced an almost 3-point greater current NPRS than those not reporting a flare (mean difference [SD] 2.70 [0.11]; p ß [SE} 0.28 (0.08; p = 0.002. Conclusions Acute LBP is characterized by variability. Patients with acute LBP report multiple distinct flares of pain, which correspond to discrete increases in pain intensity. A

  16. Auricular acupuncture in the treatment of acute pain syndromes: A pilot study.

    Science.gov (United States)

    Goertz, Christine M H; Niemtzow, Richard; Burns, Stephen M; Fritts, Matthew J; Crawford, Cindy C; Jonas, Wayne B

    2006-10-01

    This pilot study used a randomized controlled clinical trial design to compare the effects of standard emergency medical care to auricular acupuncture plus standard emergency medical care in patients with acute pain syndromes. Eighty-seven active duty military personnel and their dependents with a diagnosis of acute pain completed the study, which was conducted in the emergency room (ER) at Malcolm Grow Medical Center, Andrews Air Force Base, Maryland. The primary outcome measure was change in pain level from baseline, as measured by the Numerical Rating Scale. Participants in the acupuncture group experienced a 23% reduction in pain before leaving the ER, while average pain levels in participants in the standard medical care group remained basically unchanged. (p pain 24 hours following treatment in the ER. More research is needed to elucidate treatment effects and to determine mechanisms.

  17. Characteristics of acute pain attacks in patients with irritable bowel syndrome meeting Rome III criteria

    DEFF Research Database (Denmark)

    Hellström, P.M.; Saito, Y.A.; Bytzer, P.

    2011-01-01

    the survey were women with a mean age of 41 years and time since IBS diagnosis of 5 years. The median pain attack frequency was 5.4 attacks per month and was significantly higher in the IBS with diarrhea (IBS-D, 6.4 per month) group vs. the IBS with constipation (4.4 per month) and the IBS with mixed pattern......Objectives: An international multicenter, prospective, non-interventional, 2-month study characterized acute pain attacks in patients with irritable bowel syndrome (IBS). Methods: Adult patients meeting the Rome III IBS diagnostic criteria with a history of 3 pain attacks per month participated...... in a survey that captured daily and episodic information regarding IBS symptoms and pain attacks for 2 months. Acute pain attacks were defined as a sudden onset or increase in the intensity of IBS abdominal pain with a minimum intensity of 4 (0-10 scale). Results: The majority (84%) of the 158 patients taking...

  18. Acute pain management in children with sickle cell anaemia during ...

    African Journals Online (AJOL)

    ) begins with accurate and thorough pain assessment. However, little or no evidence of this practice exists among SCA patients in developing countries. Objectives. To evaluate pain management in children with SCA during emergency ...

  19. Improving the management of post-operative acute pain: Priorities for change

    NARCIS (Netherlands)

    Meissner, W. (Winfried); F. Coluzzi (Flaminia); Fletcher, D. (Dominique); F.J.P.M. Huygen (Frank); B. Morlion (Bart); Neugebauer, E. (Edmund); Pérez, A.M. (Antonio Montes); J. Pergolizzi (Joseph)

    2015-01-01

    textabstractPoor management of post-operative acute pain can contribute to medical complications including pneumonia, deep vein thrombosis, infection and delayed healing, as well as the development of chronic pain. It is therefore important that all patients undergoing surgery should receive

  20. Acute non-specific low back pain in primary care

    African Journals Online (AJOL)

    disability and absenteeism from work. Routine imaging is not required when making a diagnosis of non-specific or simple low back pain. A comprehensive history and physical examination usually suffice. This contrasts with back pain associated with radiculopathy or spinal stenosis, or back pain associated with serious ...

  1. Consensus statement on the anticipation and prevention of acute postoperative pain: multidisciplinary RADAR approach.

    Science.gov (United States)

    Vickers, A; Bali, S; Baxter, A; Bruce, G; England, J; Heafield, R; Langford, R; Makin, R; Power, I; Trim, J

    2009-10-01

    There has been considerable investment in efforts to improve postoperative pain management, including the introduction of acute pain teams. There have also been a number of guidelines published on postoperative pain management and there is widespread agreement on how pain should be practically managed. Despite these advances, there is no apparent improvement in the number of patients experiencing moderately severe or extreme pain after surgery. This highlights significant scope for improvement in acute postoperative pain management. In January 2009, a multidisciplinary UK expert panel met to define and agree a practical framework to encourage implementation of the numerous guidelines and fundamentals of pain management at a local level. The panel recognised that to do this, there was a need to organise the information and guidelines into a simplified, accessible and easy-to-implement system based on their practical clinical experience. Given the volume of literature in this area, the Chair recommended that key international guidelines from professional bodies should be distributed and then reviewed during the meeting to form the basis of the framework. Consensus was reached by unanimous agreement of all ten participants. This report provides a framework for the key themes, including consensus recommendations based upon practical experience agreed during the meeting, with the aim of consolidating the key guidelines to provide a fundamental framework which is simple to teach and implement in all areas. Key priorities that emerged were: Responsibility, Anticipation, Discussion, Assessment and Response. This formed the basis of RADAR, a novel framework to help pain specialists educate the wider care team on understanding and prioritising the management of acute pain. Acute postoperative pain can be more effectively managed if it is prioritised and anticipated by a well-informed care team who are educated with regard to appropriate analgesic options and understand what

  2. Children’s pain and distress while undergoing an acute radiographic examination

    International Nuclear Information System (INIS)

    Björkman, B.; Nilsson, S.; Sigstedt, B.; Enskär, K.

    2012-01-01

    Pain has been highlighted as a main concern for children in conjunction with an acute radiographic examination. The aim of this study was to further investigate children’s pain and distress while undergoing an acute radiographic examination. The study comprised 29 participants with an age range of 5–15 years who were injured and submitted to an acute radiographic examination of the upper or lower extremity when the question at issue was fracture. The Coloured Analogue Scale (CAS) and the Facial Affective Scale (FAS) were used as self-reporting scales to measure the children’s pain and distress. The Face, Legs, Activity, Cry and Consolability Behavioural scale (FLACC) was used as an observation tool to assess behaviours associated with pain in children. Descriptive statistics were used when analysing the scores, and the results showed that children experience pain and distress in conjunction with a radiographic examination after an injury. Spearman’s correlation was used to compare variables, and significant correlations were obtained between the self-reported pain and the observed pain behaviour. Fischer’s Exact test was used to compare groups, and when using the cut-off 3.0 on the self-reporting scale no significant correlation was found concerning the pain reported by children diagnosed with and without a fracture. No significant correlations were found concerning the self-reported distress and pain either, regardless of whether it was a first-time visit and whether a parent was near during the examination.

  3. Biliary scintigraphy in children with sickle cell anemia and acute abdominal pain

    International Nuclear Information System (INIS)

    D'Alonzo, W.A. Jr.; Heyman, S.

    1985-01-01

    The patterns of radionuclide hepatobiliary scans in nine children with sickle cell disease and acute right upper quadrant abdominal pain were reviewed. The most common pattern observed was delayed gall bladder visualization, consistent with chronic cholecystitis. The value of hepatobiliary imaging in distinguishing acute cholecystitis from crisis is presented. (orig.)

  4. Gender differences in acute and chronic pain in the emergency department: results of the 2014 Academic Emergency Medicine consensus conference pain section.

    Science.gov (United States)

    Musey, Paul I; Linnstaedt, Sarah D; Platts-Mills, Timothy F; Miner, James R; Bortsov, Andrey V; Safdar, Basmah; Bijur, Polly; Rosenau, Alex; Tsze, Daniel S; Chang, Andrew K; Dorai, Suprina; Engel, Kirsten G; Feldman, James A; Fusaro, Angela M; Lee, David C; Rosenberg, Mark; Keefe, Francis J; Peak, David A; Nam, Catherine S; Patel, Roma G; Fillingim, Roger B; McLean, Samuel A

    2014-12-01

    Pain is a leading public health problem in the United States, with an annual economic burden of more than $630 billion, and is one of the most common reasons that individuals seek emergency department (ED) care. There is a paucity of data regarding sex differences in the assessment and treatment of acute and chronic pain conditions in the ED. The Academic Emergency Medicine consensus conference convened in Dallas, Texas, in May 2014 to develop a research agenda to address this issue among others related to sex differences in the ED. Prior to the conference, experts and stakeholders from emergency medicine and the pain research field reviewed the current literature and identified eight candidate priority areas. At the conference, these eight areas were reviewed and all eight were ratified using a nominal group technique to build consensus. These priority areas were: 1) gender differences in the pharmacological and nonpharmacological interventions for pain, including differences in opioid tolerance, side effects, or misuse; 2) gender differences in pain severity perceptions, clinically meaningful differences in acute pain, and pain treatment preferences; 3) gender differences in pain outcomes of ED patients across the life span; 4) gender differences in the relationship between acute pain and acute psychological responses; 5) the influence of physician-patient gender differences and characteristics on the assessment and treatment of pain; 6) gender differences in the influence of acute stress and chronic stress on acute pain responses; 7) gender differences in biological mechanisms and molecular pathways mediating acute pain in ED populations; and 8) gender differences in biological mechanisms and molecular pathways mediating chronic pain development after trauma, stress, or acute illness exposure. These areas represent priority areas for future scientific inquiry, and gaining understanding in these will be essential to improving our understanding of sex and gender

  5. The effect of streptokinase on chest pain in acute myocardial infarction

    DEFF Research Database (Denmark)

    Christensen, J H; Sørensen, H T; Rasmussen, S E

    1991-01-01

    Treatment with intravenous streptokinase is known to restore blood flow to the ischaemic myocardium in patients with acute myocardial infarction. However, little is known about its effect on chest pain. In a retrospective cohort study, 76 patients treated with streptokinase were compared to 76......, the median duration (3.5 h) of pain was reduced significantly in patients treated with streptokinase compared to patients not treated (24 h). We conclude that intravenous streptokinase given in the acute phase of myocardial infarction is effective in reducing the duration of cardiac chest pain....

  6. State of the Art Management of Acute Vaso-occlusive Pain in Sickle Cell Disease.

    Science.gov (United States)

    Puri, Latika; Nottage, Kerri A; Hankins, Jane S; Anghelescu, Doralina L

    2018-02-01

    Acute vaso-occlusive crisis (VOC) is a hallmark of sickle cell disease (SCD). Multiple complex pathophysiological processes can result in pain during a VOC. Despite significant improvements in the understanding and management of SCD, little progress has been made in the management of pain in SCD, although new treatments are being explored. Opioids and non-steroidal anti-inflammatory drugs (NSAIDs) remain the mainstay of treatment of VOC pain, but new classes of drugs are being tested to prevent and treat acute pain. Advancements in the understanding of the pathophysiology of SCD and pain and the pharmacogenomics of opioids have yet to be effectively utilized in the management of VOC. Opioid tolerance and opioid-induced hyperalgesia are significant problems associated with the long-term use of opioids, and better strategies for chronic pain therapy are needed. This report reviews the mechanisms of pain associated with acute VOC, describes the current management of VOC, and describes some of the new therapies under evaluation for the management of acute VOC in SCD.

  7. Etiology of acute scrotal pain in children and adolescent patients ...

    African Journals Online (AJOL)

    Purpose Acute scrotum is an emergency condition requiring rapid intervention. The aim of this study was to evaluate the clinical and epidemiological specifications of acute scrotum. Patients and methods This retrospective study was carried out on patients less than 21 years admitted with a diagnosis of acute scrotum in the ...

  8. Evidence for acute central sensitization to prolonged experimental pain in posttraumatic stress disorder.

    Science.gov (United States)

    Moeller-Bertram, Tobias; Strigo, Irina A; Simmons, Alan N; Schilling, Jan M; Patel, Piyush; Baker, Dewleen G

    2014-05-01

    Post-traumatic stress disorder (PTSD) and pain have a well-documented high comorbidity; however, the underlying mechanisms of this comorbidity are currently poorly understood. The aim of this psychophysical study was to investigate the behavioral response to a prolonged suprathreshold pain stimulus in subjects with combat-related PTSD and combat controls (CC) for clinical evidence of central sensitization. Ten male subjects with current PTSD related to combat and 11 CC male subjects underwent baseline quantitative sensory testing (QST), temporal pain summation, and psychological profiling followed by an intramuscular injection of capsaicin into the quadriceps muscle. There was no significant between-group difference for the initial maximal pain response or an initial pain reduction for the first 15 minutes postinjection on QST or pain ratings. However, we observed significantly higher scores in the PTSD group for the second 15 minutes postinjection on both pain intensity and pain unpleasantness ratings. Assessment of temporal summation to repetitive pressure stimuli showed significantly higher subjective pain in the PTSD group. These findings are consistent with a significantly higher degree of acute central sensitization in individuals with PTSD. Increased acute central sensitization may underlie increased vulnerability for developing pain-related conditions following combat trauma. Wiley Periodicals, Inc.

  9. A randomised sham controlled trial of vertebroplasty for painful acute osteoporotic vertebral fractures (VERTOS IV

    Directory of Open Access Journals (Sweden)

    Juttmann Job R

    2011-04-01

    Full Text Available Abstract Background The standard care in patients with a painful osteoporotic vertebral compression fracture (VCF is conservative therapy. Percutaneous vertebroplasty (PV, a minimally invasive technique, is a new treatment option. Recent randomized controlled trials (RCT provide conflicting results: two sham-controlled studies showed no benefit of PV while an unmasked but controlled RCT (VERTOS II found effective pain relief at acceptable costs. The objective of this study is to compare pain relief after PV with a sham intervention in selected patients with an acute osteoporotic VCF using the same strict inclusion criteria as in VERTOS II. Secondary outcome measures are back pain related disability and quality of life. Methods The VERTOS IV study is a prospective, multicenter RCT with pain relief as primary endpoint. Patients with a painful osteoporotic VCF with bone edema on MR imaging, local back pain for 6 weeks or less, osteopenia and aged 50 years or older, after obtaining informed consent, are included and randomized for PV or a sham intervention. In total 180 patients will be enrolled. Follow-up is at regular intervals during a 1-year period with a standard Visual Analogue Scale (VAS score for pain and pain medication. Necessary additional therapies and complications are recorded. Discussion The VERTOS IV study is a methodologically sound RCT designed to assess pain relief after PV compared to a sham intervention in patients with an acute osteoporotic VCF selected on strict inclusion criteria. Trial registration This study is registered at ClinicalTrials.gov., NCT01200277.

  10. [ACUTE PAIN MANAGEMENT IN PATIENT ON OPIOID SUBSTITUTION THERAPY WITH METHADONE OR BUPRENORPHINE].

    Science.gov (United States)

    Adam, V Nesek; Matolić, M; Stojčić, E Grizelj; Mršić, V; Rašić, Ž

    2016-09-01

    The result of the increase in drug abuse is a growing number of patients receiving methadone or buprenorphine substitution therapy. Physicians are increasingly confronted with patients on substitution therapy at the time when they are developing acute pain conditions or when they need surgery. Although pain has sensory qualities, it is a very personal and complex experience. The intensity and duration of pain are influenced by numerous factors. Poorly controlled pain leads to unnecessary suffering of the patients with the possibility of permanent changes in behavior and reduced quality of life. Efficacious pain treatment is considered a basic right of every patient. Because of the complex mechanisms of the emergence and transmission of pain and the emotional components that are involved in the experience of pain, appropriate pain relief in patients on substitution therapy is a major challenge for both the physicians and the patients. The article gives an overview of issues related to the treatment of acute pain and perioperative treatment in patients on substitution therapy with methadone and buprenorphine. The article highlights the wrong common misconception about pain treatment in these patients, which also are the most common cause of their inadequate treatment.

  11. Acute pain control and accelerated postoperative surgical recovery

    DEFF Research Database (Denmark)

    Kehlet, H

    1999-01-01

    Postoperative pain relief continues to demand our awareness, and surgeons should be fully aware of the potential physiologic benefits of effective dynamic pain relief regimens and the great potential to improve postoperative outcome if such analgesia is used for rehabilitation. To achieve advanta...... to recent knowledge within surgical pathophysiology. Such efforts must be expected to lead to improved quality of care for patients, with less pain and reduced morbidity leading to cost efficiency....

  12. Expectations about recovery from acute non-specific low back pain predict absence from usual work due to chronic low back pain : a systematic review

    NARCIS (Netherlands)

    Hallegraeff, J.M.; Krijnen, W.P.; van der Schans, C.P.; de Greef, M.H.G.

    2012-01-01

    Question: Do negative expectations in patients after the onset of acute low back pain increase the odds of absence from usual work due to progression to chronic low back pain? Design: Systematic review with meta-analysis of prospective inception cohort studies. Participants: Adults with acute or

  13. Acute Psychosocial Stress and Emotion Regulation Skills Modulate Empathic Reactions to Pain in Others

    Directory of Open Access Journals (Sweden)

    Gabriele eBuruck

    2014-05-01

    Full Text Available Psychosocial stress affects resources for adequate coping with environmental demands. A crucial question in this context is the extent to which acute psychosocial stressors impact empathy and emotion regulation. In the present study, 120 participants were randomly assigned to a control group vs. a group confronted with the Trier Social Stress Test, an established paradigm for the induction of acute psychosocial stress. Empathy for pain as a specific subgroup of empathy was assessed via pain intensity ratings during a pain-picture task. Self-reported emotion regulation skills were measured as predictors using an established questionnaire. Stressed individuals scored significantly lower on the appraisal of pain pictures. A regression model was chosen to find variables that further predict the pain ratings. These findings implicate that acute psychosocial stress might impair empathic processes to observed pain in another person and the ability to accept one’s emotion additionally predicts the empathic reaction. Furthermore, the ability to tolerate negative emotions modulated the relation between stress and pain judgments, and thus influenced core cognitive-affective functions relevant for coping with environmental challenges. In conclusion, our study emphasizes the necessity of reducing negative emotions in terms of empathic distress when confronted with pain of another person under psychosocial stress, in order to be able to retain pro-social behavior.

  14. Quality Assessment of Acute Inpatient Pain Management in an Academic Health Center.

    Science.gov (United States)

    Lin, Richard J; Reid, M Carrington; Chused, Amy E; Evans, Arthur T

    2016-02-01

    The quality of acute inpatient pain management remains suboptimal and poorly understood. In this retrospective study, we analyze acute pain management practice in a large academic health center using several quality indicators. Not surprisingly, despite high rate of pain assessment, many patients still have frequent, prolonged, and unrelieved severe pain episodes. Upon examination of naloxone administration, we identify potential inappropriate opioid prescription practices such as the use of wrong opioids in hepatic and renal failure and simultaneous use of multiple short-acting opioids. Most importantly, we find that chronic opioid users appear to suffer the most in terms of undertreatment of pain as well as opioid overdose, highlighting the urgent need to target this underserved population of patients. © The Author(s) 2014.

  15. Intranasal fentanyl in the treatment of acute pain--a systematic review

    DEFF Research Database (Denmark)

    Hansen, M S; Mathiesen, O; Trautner, S

    2012-01-01

    . No significant analgesic differences between IN fentanyl and intravenous (IV) fentanyl were demonstrated in treatment of acute and post-operative pain. Significant analgesic effect of IN fentanyl was demonstrated in the treatment of breakthrough pain in cancer patients. In the paediatric population, results...... demonstrated some analgesic effect of IN fentanyl following myringotomy, no analgesic effect following voiding cystourethrography, and finally, no significant analgesic difference after long bone fractures, in burns patients, and in post-operative pain relief when compared to IV morphine, oral morphine, or IV...... fentanyl, respectively. Significant analgesic effect of IN fentanyl was demonstrated in the treatment of breakthrough pain in cancer patients. However, the significant deficiencies in trials investigating acute and post-operative pain, and the paediatric population makes firm recommendations impossible....

  16. Posttraumatic Stress in Children After Injury: The Role of Acute Pain and Opioid Medication Use.

    Science.gov (United States)

    Hildenbrand, Aimee K; Kassam-Adams, Nancy; Barakat, Lamia P; Kohser, Kristen L; Ciesla, Jeffrey A; Delahanty, Douglas L; Fein, Joel A; Ragsdale, Lindsay B; Marsac, Meghan L

    2018-01-16

    After injury, many children experience posttraumatic stress symptoms (PTSS) that negatively impact recovery. Acute pain and PTSS share neurobiological pathways, and acute dosage of morphine has been linked to reduced PTSS in naturalistic studies. However, the complex interactions between pain, morphine and other opioid use, and PTSS have yet to be investigated in robust pediatric samples.This prospective, longitudinal study examined relationships between acute pain, opioid medications, and PTSS after pediatric injury. Ninety-six children aged 8 to 13 years (mean = 10.60, SD = 1.71), hospitalized for unintentional injury, completed assessments at baseline (T1) and 12 weeks (T2) later. Pain ratings and opioid administration data were obtained via chart review. Structural equation modeling revealed that worst pain endorsed during hospitalization was positively associated with concurrent and later PTSS when controlling for evidence-based risk factors (ie, age, sex, prior trauma history, traumatic appraisals of injury event, heart rate). Neither opioid medications overall nor morphine specifically (milligram/kilogram/day) administered during hospitalization mediated the relationship between pain and T2 PTSS. Pain during hospitalization may increase susceptibility for persistent PTSS above and beyond the influence of other empirical risk factors. Findings suggest that pain assessment may be a useful addition to pediatric PTSS screening tools and highlight the need for additional research on pharmacological secondary prevention approaches. Given that inadequate pain control and persistent PTSS each hinder recovery and long-term functioning, better understanding of interactions between acute pain and PTSS after injury is essential for improving screening, prevention, and early intervention efforts.

  17. Nurse-based monitoring and management of breakthrough pain in an acute pain relief and palliative care unit.

    Science.gov (United States)

    Mercadante, Sebastiano; Prestia, Giovanna; Casuccio, Alessandra

    2016-10-01

    To assess the nurses' performance in assessing, treating, and documenting breakthrough pain (BTP) in a palliative care unit where traditionally there is continuous training. The study was performed in an acute palliative care unit. Once a week, a research nurse examined the documentation regarding all the episodes of BTP registered in a specific pain chart, designed by the institutional nurse board, as part of the routine nurse activity. The charts of 50 consecutive eligible patients (32 M/18 F), were analysed. The mean number of episodes/patient was 3.3 (SD 1.61; range 1-7). 166 episodes occurred. The main BTP pain intensity was 7.06 (SD 0.82). In 7 episodes, pain intensity was not evaluated at T0. The pain intensity after 15 minutes after BTP medication was 3.01 (SD1.19). In 28 episodes, pain intensity was not evaluated at T15. The change in pain intensity was highly significant (P nurse diary. Training in a research environment allows a good nurse capability in evaluating and treating BTP, and above all, providing documentation for each BTP episode. The theoretical work and recommendations around BTP need to be translated into day-to-day clinical practice.

  18. Introducing a patient-controlled analgesia-based acute pain ...

    African Journals Online (AJOL)

    I. Harmer M. PostOperative pain relief - time to take our heads om of the sand) Anaeschesia 1991; 46: 167-168. 2. Royal College ofSurgeons of England and College ofAnaesthetists. Commission on the provision of surgical services. Report of the. Working Parry on Pain after Surgery, 1990. 3. Carrwrighr PD, Helfinger RG, ...

  19. Imperforate Hymen - a rare cause of acute abdominal pain and ...

    African Journals Online (AJOL)

    Imperforate hymen is a rare condition that presents with amenorrhea, cyclical abdominal pains and urine retention among pubertal girls. A 14 year old girl with imperforate hymen underwent hymenotomy for hematocolpometra, having presented with abdominal pains and tenesmus. Key words: Imperforate hymen, ...

  20. State Versus Trait: Validating State Assessment of Child and Parental Catastrophic Thinking About Children's Acute Pain.

    Science.gov (United States)

    Durand, Hannah; Birnie, Kathryn A; Noel, Melanie; Vervoort, Tine; Goubert, Liesbet; Boerner, Katelynn E; Chambers, Christine T; Caes, Line

    2017-04-01

    Pain catastrophizing has emerged as one of the most robust predictors of child pain outcomes. Although assessments of state (ie, situation-specific) pain catastrophizing in children and parents are often used, their psychometric properties are unknown. This study aimed to assess factor structure, reliability, and predictive validity of state versions of Pain Catastrophizing Scales for children and parents relative to corresponding trait versions for child and parental pain-related outcomes. Data were pooled from 8 experimental pain studies in which child and/or parent state catastrophizing (measured immediately before application of a pain stimulus) and trait catastrophizing were assessed in community-based samples of children aged 8 to 18 years (N = 689) and their parents (N = 888) in Dutch or English. Exploratory factor analyses were conducted to examine the underlying factor structure of the state versions of the Pain Catastrophizing Scale for parents/children, revealing a single factor solution that explained 55.53% of the variance for children and 49.72% for parents. Hierarchical linear regression analyses were used to examine relative influence of state versus trait catastrophizing on child and parent pain-related outcomes. Child and parent state catastrophizing were significantly associated with child pain intensity, child state anxiety and parental distress. State catastrophizing scores showed stronger associations than trait scores for most outcomes. This article presents the psychometric properties of state pain catastrophizing measures for children and parents. Findings underscore the importance of assessing state pain catastrophizing about acute pain experiences in parents and children, and provide a basis for robust and valid measurement of state pain catastrophizing about child pain. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

  1. Electroacupuncture Alleviates Pain Responses and Inflammation in a Rat Model of Acute Gout Arthritis

    Directory of Open Access Journals (Sweden)

    Wenxin Chai

    2018-01-01

    Full Text Available Acute gout arthritis is one of the most painful inflammatory conditions. Treatments for gout pain are limited to colchicine, nonsteroidal anti-inflammatory drugs, and corticosteroids, which oftentimes result in severe adverse effects. Electroacupuncture (EA has been proved to be effective in relieving many inflammatory pain conditions with few side effects. Here, we aim to investigate the therapeutic potentials of EA on pain and inflammation of a rat model of acute gout arthritis and underlying mechanisms. We found that 2/100 Hz EA produced the most robust analgesic effect on mechanical hyperalgesia of acute gout arthritis rat model compared with 2 and 100 Hz. EA produced similar analgesic effect compared with indomethacin. 2/100 Hz EA also significantly alleviates the ongoing pain behavior, thermal hyperalgesia, and ankle edema. Locally applied μ and κ-opioid receptor antagonists but not adenosine A1 receptor antagonist significantly abolished the analgesic effect of EA. Locally applied μ and κ-opioid receptor agonists produced significant antiallodynia on acute gout arthritis rats, mimicking EA. Furthermore, 2/100 Hz EA upregulated β-endorphin expression in inflamed ankle skin tissue. Our results demonstrated, for the first time, that EA can be used for relieving acute gout arthritis with effect dependent on peripheral opioid system and comparable with the one obtained with indomethacin.

  2. CHOLECYSTITIS AS A CAUSE OF ABDOMINAL PAIN IN PATIENTS WITH ACUTE VIRAL HEPATITIS A AND B

    Directory of Open Access Journals (Sweden)

    Miodrag Radunović

    2012-03-01

    Full Text Available Acute cholecystitis is an inflammation of the gallbladder wall, usually caused by gallstones in the cystic duct, which causes attacks of severe pain. At least 95% of the population with acute inflammation of the gallbladder have gallstones. Acute viral hepatitis is the liver inflammation accompanied by nausea, faintness, vomiting, pain below the right rib arch, jaundice. The presence of acute cholecystitis intensifies the existing symptoms. The aim of the paper was to show the incidence of the gallbladder inflammation in patients with acute hepatitis A or B. This retrospective-prospective study involved 110 patients treated for viral hepatitis A or B and had severe abdominal pain during hospitalization. The selected sample involved more male examinees - 63 (62% compared to female ones - 47 (38%. The most frequent age of examinees was 30-50 years, 82 (83%, and cholecystitis during hepatitis was also most common in the age group 30-50 years, 28 (73% patients. Cholecystitis was more common in patients with acute hepatitis B - 21 (55% examinees than in patients with acute hepatitis A - 17 (45% examinees. Ultrasound examination, performed in 24 (63% examinees showed gallstones in inflamed gallbladder, while 14 (37% examinees had the inflammation of the gallbladder without gallstones. The most common cause of severe abdominal pain in patients with acute liver infection caused by HAV and HBV infection was the gallbladder, 38 (34.5% patients. Cholecystitis was more common in patients with acute hepatitis B, 21 (55% examinees, than in those with an acute hepatitis A, 17 (45% examinees.

  3. Acute Thrombo-embolic Renal Infarction

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    Haijiang Zhou

    2016-07-01

    Full Text Available A 65-year-old woman was admitted for acute onset of right lower abdominal pain. She was taking anticoagulant medication regularly for rheumatic valvular disease and atrial fibrillation. Physical examination revealed no obvious abdominal or flank tenderness. Right thrombo-embolic renal infarction was diagnosed after performing computed tomography angiography (CTA.

  4. Adaptations in responsiveness of brainstem pain-modulating neurons in acute compared with chronic inflammation.

    Science.gov (United States)

    Cleary, Daniel R; Heinricher, Mary M

    2013-06-01

    Despite similar behavioral hypersensitivity, acute and chronic pain have distinct neural bases. We used intraplantar injection of complete Freund's adjuvant to directly compare activity of pain-modulating neurons in the rostral ventromedial medulla (RVM) in acute vs chronic inflammation. Heat-evoked and von Frey-evoked withdrawal reflexes and corresponding RVM neuronal activity were recorded in lightly anesthetized animals either during the first hour after complete Freund's adjuvant injection (acute) or 3 to 10 days later (chronic). Thermal and modest mechanical hyperalgesia during acute inflammation were associated with increases in the spontaneous activity of pain-facilitating ON-cells and suppression of pain-inhibiting OFF-cells. Acute hyperalgesia was reversed by RVM block, showing that the increased activity of RVM ON-cells is necessary for acute behavioral hypersensitivity. In chronic inflammation, thermal hyperalgesia had resolved but mechanical hyperalgesia had become pronounced. The spontaneous discharges of ON- and OFF-cells were not different from those in control subjects, but the mechanical response thresholds for both cell classes were reduced into the innocuous range. RVM block in the chronic condition worsened mechanical hyperalgesia. These studies identify distinct contributions of RVM ON- and OFF-cells to acute and chronic inflammatory hyperalgesia. During early immune-mediated inflammation, ON-cell spontaneous activity promotes hyperalgesia. After inflammation is established, the antinociceptive influence of OFF-cells is dominant, yet the lowered threshold for the OFF-cell pause allows behavioral responses to stimuli that would normally be considered innocuous. The efficacy of OFF-cells in counteracting sensitization of ascending transmission pathways could therefore be an important determining factor in development of chronic inflammatory pain. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All

  5. Involvement of the melanocortin-1 receptor in acute pain and pain of inflammatory but not neuropathic origin.

    Directory of Open Access Journals (Sweden)

    Ada Delaney

    2010-09-01

    Full Text Available Response to painful stimuli is susceptible to genetic variation. Numerous loci have been identified which contribute to this variation, one of which, MC1R, is better known as a gene involved in mammalian hair colour. MC1R is a G protein-coupled receptor expressed in melanocytes and elsewhere and mice lacking MC1R have yellow hair, whilst humans with variant MC1R protein have red hair. Previous work has found differences in acute pain perception, and response to analgesia in mice and humans with mutations or variants in MC1R.We have tested responses to noxious and non-noxious stimuli in mutant mice which lack MC1R, or which overexpress an endogenous antagonist of the receptor, as well as controls. We have also examined the response of these mice to inflammatory pain, assessing the hyperalgesia and allodynia associated with persistent inflammation, and their response to neuropathic pain. Finally we tested by a paired preference paradigm their aversion to oral administration of capsaicin, which activates the noxious heat receptor TRPV1. Female mice lacking MC1R showed increased tolerance to noxious heat and no alteration in their response to non-noxious mechanical stimuli. MC1R mutant females, and females overexpressing the endogenous MC1R antagonist, agouti signalling protein, had a reduced formalin-induced inflammatory pain response, and a delayed development of inflammation-induced hyperalgesia and allodynia. In addition they had a decreased aversion to capsaicin at moderate concentrations. Male mutant mice showed no difference from their respective controls. Mice of either sex did not show any effect of mutant genotype on neuropathic pain.We demonstrate a sex-specific role for MC1R in acute noxious thermal responses and pain of inflammatory origin.

  6. Relationship between post-extraction pain and acute pulpitis: a randomised trial using third molars.

    Science.gov (United States)

    Zhang, Wei; Dai, Yong-Bo; Wan, Peng-Cheng; Xu, Dong-Dong; Guo, Yi; Li, Zhi

    2016-12-01

    The aim of the present study was to examine the relationship between post-extraction pain and acute pulpitis in third molars. This study was a randomised controlled trial. Sixty patients requiring removal of a single maxillary third molar with acute pulpitis were included and randomly divided into two groups: group A (n = 30); and group B (n = 30). In group A, third molars were directly extracted, and group B received endodontic therapy (pulp chamber opening and drainage) and underwent extraction 24 hours later, aiming to eliminate the acute inflammation. Another 30 patients requiring removal of a single maxillary third molar and with the same inclusion criteria but without caries or acute pulpitis were recruited into group C, in which the maxillary third molars were also directly extracted. The level of postoperative pain reported each day among the three groups was statistically evaluated. On the first, second and third days after surgery, there was a statistically significant difference between group A and group B and between group A and group C, but there was no statistically significant difference between group B and group C. The results of the present study indicate that there is more pain when third molars with acute pulpitis are directly removed compared with the pain level of the removal of third molars without acute pulpitis. © 2016 FDI World Dental Federation.

  7. Ketamine for acute neuropathic pain in patients with spinal cord injury.

    Science.gov (United States)

    Kim, Kyongsong; Mishina, Masahiro; Kokubo, Rinko; Nakajima, Takao; Morimoto, Daijiro; Isu, Toyohiko; Kobayashi, Shiro; Teramoto, Akira

    2013-06-01

    Ketamine, an N-methyl-d-aspartic acid (NMDA) receptor antagonist, may be useful for treating neuropathic pain, which is often difficult to control. We report a prospective study of 13 patients with acute neuropathic pain due to spinal cord injury (SCI) treated with ketamine. All underwent a test challenge with 5mg ketamine. Patients with satisfactory responses were then treated intravenously and subsequently perorally with ketamine. Pre- and post-treatment pain was recorded on a visual analogue scale. All 13 patients responded positively to the ketamine test challenge and underwent continued ketamine administration. At the cessation of treatment and alter at final follow up, pain was decreased by 74.7% and 96.8%, respectively. The average administration period was 17.2 days; it was longer (59 days) in one patient treated in the subacute phase. All patients suffered allodynia-type pain and experienced 30% or less of their original pain intensity upon test challenge. Side effects were noted in five patients, although their severity did not require treatment cessation. In patients with SCI, ketamine reduced allodynia. Particularly good results were obtained in patients treated in the acute phase and these patients did not experience post-treatment symptom recurrence. Our results suggest that in patients with SCI, ketamine is useful for treating neuropathic pain in the acute phase. Copyright © 2012 Elsevier Ltd. All rights reserved.

  8. SDF1-CXCR4 Signaling Contributes to the Transition from Acute to Chronic Pain State.

    Science.gov (United States)

    Yang, Fei; Sun, Wei; Luo, Wen-Jun; Yang, Yan; Yang, Fan; Wang, Xiao-Liang; Chen, Jun

    2017-05-01

    Emerging evidence has demonstrated the involvement of stromal cell-derived factor 1 (SDF1, also known as CXCL12)-CXCR4 signaling in a variety of pain state. However, the underlying mechanisms of SDF1-CXCR4 signaling leading to the maintenance of chronic pain states are poorly understood. In the present study, we sought to explore the role of SDF1-CXCR4 signaling in the forming of neuroplasticity by applying a model of the transition from acute to chronic pain state, named as hyperalgesic priming. Utilizing intraplantar bee venom (BV) injection, we successfully established hyperalgesic priming state and found that peripheral treating with AMD3100, a CXCR4 antagonist, or knocking down CXCR4 by intraganglionar CXCR4 small interfering RNA (siRNA) injection could prevent BV-induced primary mechanical hyperalgesia and hyperalgesic priming. Moreover, we showed that single intraplantar active SDF1 protein injection is sufficient to induce acute mechanical hyperalgesia and hyperalgesic priming through CXC4. Intraplantar coinjection of ERK inhibitor, U0126, and PI3K inhibitor, LY294002, as well as two protein translation inhibitors, temsirolimus and cordycepin, prevented the development of SDF1-induced acute mechanical hyperalgesia and hyperalgesic priming. Finally, on the models of complete Freund's adjuvant (CFA)-induced chronic inflammatory pain and spared nerve injury (SNI)-induced chronic neuropathic pain, we observed that knock-down of CXCR4 could both prevent the development and reverse the maintenance of chronic pain state. In conclusion, our present data suggested that through regulating ERK and PI3K-AKT pathways-mediated protein translation SDF1-CXCR4 signaling mediates the transition from acute pain to chronic pain state and finally contributes to the development and maintenance of chronic pain.

  9. Opioid exit plan: A pharmacist's role in managing acute postoperative pain.

    Science.gov (United States)

    Genord, Cheryl; Frost, Timothy; Eid, Deeb

    The benefits of a pharmacist's involvement in medication reconciliation and discharge counseling are well documented in the literature as improving patient outcomes. In contrast, no studies have focused on the initiation of a pharmacist-led opioid exit plan (OEP) for acute postoperative pain management. This paper summarizes a pharmacist-led OEP practice model and the potential role that pharmacists and student pharmacists can have at the point of admission, during postoperative recovery, and on discharge in acute pain management patients. The pain management team at St. Joseph Mercy Hospital in Ann Arbor, MI, has developed and implemented a pharmacist-led OEP to better manage acute postoperative pain in neurosurgery and orthopedic and colorectal surgery in an effort to ensure appropriate patient and provider education and understanding of pain management. OEP is a tool with the potential to expand the role of pharmacists in managing acute pain in postoperative patients at the point of admission, during the postoperative inpatient stay, and on discharge. Its benefits include medication reconciliation review and prescription drug-monitoring program search before admission, interdisciplinary rounds with the medical team to provide optimal inpatient postoperative pain management, clinical assessment of outpatient prescriptions with opioid discharge counseling, and medication evaluation of prescribed pain regimen and opioid discontinuation status at the post-discharge follow-up appointment. A hospital pain management team operating a pharmacist-led OEP can be key to guiding the appropriate prescribing practice of opioids and assisting with transitions of care on discharge. Further outcomes-based evaluations of the practice model are planned and encouraged to validate and improve the pharmacist-led OEP practice. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  10. CLINICAL ASPECTS OF ACUTE POST-OPERATIVE PAIN MANAGEMENT & ITS ASSESSMENT

    Directory of Open Access Journals (Sweden)

    R.S.R Murthy

    2010-06-01

    Full Text Available Management of postoperative pain relieve suffering and leads to earlier mobilization, shortened hospital stay, reduced hospital costs, and increased patient satisfaction. An effective postoperative management is not a standardized regime rather is tailored to the needs of the individual patient, taking into account medical, psychological, and physical condition; age; level of fear or anxiety; surgical procedure; personal preference; and response to therapeutic agents given. The major goal in the management of postoperative pain is to minimize the dose of medications to lessen side effects & provide adequate analgesia. Postoperative pain is still under managed due to obstacles in implementation of Acute Pain Services due to insufficient education, fear of complications associated with available analgesic drugs, poor pain assessment and inadequate staff. This review reflects the clinical aspects of postoperative pain & its assessment & management with an emphasis on research for new analgesic molecules & delivery system.

  11. Clinical aspects of acute post-operative pain management & its assessment

    Directory of Open Access Journals (Sweden)

    Anuj Gupta

    2010-01-01

    Full Text Available Management of postoperative pain relieve suffering and leads to earlier mobilization, shortened hospital stay, reduced hospital costs, and increased patient satisfaction. An effective postoperative management is not a standardized regime rather is tailored to the needs of the individual patient, taking into account medical, psychological, and physical condition; age; level of fear or anxiety; surgical procedure; personal preference; and response to therapeutic agents given. The major goal in the management of postoperative pain is to minimize the dose of medications to lessen side effects & provide adequate analgesia. Postoperative pain is still under managed due to obstacles in implementation of Acute Pain Services due to insufficient education, fear of complications associated with available analgesic drugs, poor pain assessment and inadequate staff. This review reflects the clinical aspects of postoperative pain & its assessment & management with an emphasis on research for new analgesic molecules & delivery system.

  12. Management of acute pain in the postoperative setting

    DEFF Research Database (Denmark)

    Meissner, Winfried; Huygen, Frank Jpm; Neugebauer, Edmund A M

    2018-01-01

    Despite the introduction of evidence-based recommendations for postoperative pain management (POPM), the consensus is that pain control remains suboptimal. Barriers to achieving patient-satisfactory analgesia include deficient knowledge regarding POPM among staff, lack of instructions, insufficient....../unsuccessful. In the hospital sector the development and implementation of QIs is complex. The nature of POPM requires a highly-trained, multidisciplinary team and it is at this level where major improvements can be made. Greater involvement of patients regarding pain management is also seen as a priority area for improving...

  13. Management of acute pain in the postoperative setting

    DEFF Research Database (Denmark)

    Meissner, Winfried; Huygen, Frank Jpm; Neugebauer, Edmund A M

    2017-01-01

    Despite the introduction of evidence-based recommendations for postoperative pain management (POPM), the consensus is that pain control remains suboptimal. Barriers to achieving patient-satisfactory analgesia include deficient knowledge regarding POPM among staff, lack of instructions, insufficient....../unsuccessful. In the hospital sector the development and implementation of QIs is complex. The nature of POPM requires a highly-trained, multidisciplinary team and it is at this level where major improvements can be made. Greater involvement of patients regarding pain management is also seen as a priority area for improving...

  14. Peripheral analgesic effects of ketamine in acute inflammatory pain

    DEFF Research Database (Denmark)

    Pedersen, J L; Galle, T S; Kehlet, H

    1998-01-01

    BACKGROUND. This study examined the analgesic effect of local ketamine infiltration, compared with placebo and systemic ketamine, in a human model of inflammatory pain. METHODS: Inflammatory pain was induced by a burn (at 47 degrees C for 7 min; wound size, 2.5 x 5 cm) on the calf in 15 volunteers.......02). Secondary hyperalgesia and suprathreshold pain responses to heat and mechanical stimuli were not significantly affected by local ketamine. No difference between local ketamine and placebo could be detected 1 h and 2 h after the burn. CONCLUSIONS: Ketamine infiltration had brief local analgesic effects...

  15. Objective assessment of induced acute pain in neonatology with the Newborn Infant Parasympathetic Evaluation index.

    Science.gov (United States)

    Cremillieux, C; Makhlouf, A; Pichot, V; Trombert, B; Patural, H

    2018-01-25

    Objective tools are needed to improve pain assessment in newborns. The aim of this study was to assess the correlation between the Newborn Infant Parasympathetic Evaluation (NIPE) index and two pain scales during a painful procedure in premature infants. Each baby born at least at 26 weeks of gestational age (GA) undergoing a planned painful procedure in the Neonatal Intensive Care Unit (NICU) was eligible. NIPE index, heart rate variability (HRV) indices and Neonatal Acute Pain scale (DAN) were recorded across three periods: the first at rest 5 min before the painful procedure (T1), the second during it (T2) and the third 3 min after the end of it (T3). The Premature Infant Pain Profile-Revised (PIPP-R) pain scale was recorded at T2. Sixty-four recordings were performed in 29 preterm infants (mean GA = 29.9 ± 4.2 weeks). Twenty-eight tachograms were coupled to NIPE for analysis. We did not find a correlation between the NIPE index and DAN and PIPP-R at the pain time T2. Between T1 and T2, heart rate was higher (159 ± 16 vs. 169 ± 12, p < 0.001). Considering the linear HRV indices, we did not observe a modification in parasympathetic or sympathetic activity, while for the nonlinear HRV indices (H exponent, Approximate and conditional Entropy), a significant change towards a loss of physiological chaotic cardiac behaviour was detected. The NIPE index seems to be not reliable to assess acute pain in the preterm infant, but other HRV indices could be explored as additional tools next to pain scales in NICUs. The NIPE monitor was developed for objective pain assessment in neonates based on HFnu variations, but it does not seem reliable enough for assessing acute pain in real time in preterm neonates. Pain assessment in preterm babies still relies on pain scales. © 2018 European Pain Federation - EFIC®.

  16. Evaluating acute pain intensity relief: challenges when using an 11-point numerical rating scale.

    Science.gov (United States)

    Chauny, Jean-Marc; Paquet, Jean; Lavigne, Gilles; Marquis, Martin; Daoust, Raoul

    2016-02-01

    Percentage of pain intensity difference (PercentPID) is a recognized way of evaluating pain relief with an 11-point numerical rating scale (NRS) but is not without flaws. A new metric, the slope of relative pain intensity difference (SlopePID), which consists in dividing PercentPID by the time between 2 pain measurements, is proposed. This study aims to validate SlopePID with 3 measures of subjective pain relief: a 5-category relief scale (not, a little, moderate, very, complete), a 2-category relief question ("I'm relieved," "I'm not relieved"), and a single-item question, "Wanting other medication to treat pain?" (Yes/No). This prospective cohort study included 361 patients in the emergency department who had an initial acute pain NRS > 3 and a pain intensity assessment within 90 minutes after analgesic administration. Mean age was 50.2 years (SD = 19.3) and 59% were women. Area under the curves of receiver operating characteristic curves analyses revealed similar discriminative power for PercentPID (0.83; 95% confidence interval [CI], 0.79-0.88) and SlopePID (0.82; 95% CI, 0.77-0.86). Considering the "very" category from the 5-category relief scale as a substantial relief, the average cutoff for substantial relief was a decrease of 64% (95% CI, 59-69) for PercentPID and of 49% per hour (95% CI, 44-54) for SlopePID. However, when a cutoff criterion of 50% was used as a measure of pain relief for an individual patient, PercentPID underestimated pain-relieved patients by 12.1% (P pain intensity at baseline was an odd number compared with an even number (32.9% vs 45.0%, respectively). SlopePID should be used instead of PercentPID as a metric to evaluate acute pain relief on a 0 to 10 NRS.

  17. Lidocaine 5% Patch for Treatment of Acute Pain After Robotic Cardiac Surgery and Prevention of Persistent Incisional Pain: A Randomized, Placebo-Controlled, Double-Blind Trial.

    Science.gov (United States)

    Vrooman, Bruce; Kapural, Leonardo; Sarwar, Sheryar; Mascha, Edward J; Mihaljevic, Tomislav; Gillinov, Marc; Qavi, Shahbaz; Sessler, Daniel I

    2015-08-01

    To test the hypotheses that lidocaine 5% patches decrease the severity of acute pain and incidence of persistent incisional pain after robotic cardiac valve surgery. A randomized, placebo-controlled, double-blind trial. Tertiary care academic medical center. Patients having robotic cardiac valve surgery. Patients having robotic cardiac valve surgery were randomly assigned to 5% lidocaine patches or identical-appearing placebo patches. Patches were applied around each incision 12 hours/day until pain resolved, or for 6 months. Supplemental opioid was provided by patient-controlled analgesia or orally. Pain was initially evaluated with a Visual Analog Scale, and subsequently by telephone with a Verbal Response Scale and the Pain Disability Index (our primary outcome) after 1 week, 1 month, 3 months, and 6 months. Global Perceived Effect, a measure of patient satisfaction, was simultaneously recorded. Repeated-measures analysis of variance and generalized estimating equations were our primary statistical tools. Acute pain scores and opioid use were low, as was the incidence of persistent pain. Lidocaine 5% patches did not influence any measure of acute or persistent incisional pain. Estimated difference (95% CI) in mean Pain Disability Index for Lidocaine patch minus placebo was -2.5 (95% CI -7.1, 2.1), P = 0.28. Lidocaine 5% patches did not reduce acute or persistent pain in patients having robotic thoracic surgery, though pain scores were low in both treatment groups. Clinicians should choose alternative analgesic approaches in these patients. Wiley Periodicals, Inc.

  18. Effects of gabapentin in acute inflammatory pain in humans

    DEFF Research Database (Denmark)

    Werner, M U; Perkins, F M; Holte, Kathrine

    2001-01-01

    ,200 mg or placebo was given on 2 separate study days. Three hours after drug administration, a first-degree burn injury was produced on the medial aspect of the nondominant calf (12.5 cm(2), 47 degrees C for 7 minutes). Quantitative sensory testing (QST) included pain ratings to thermal and mechanical...... stimuli (visual analog scale [VAS]), assessments of thermal and mechanical detection thresholds, and areas of secondary hyperalgesia. Side effects drowsiness and postural instability were assessed by subjective ratings (VAS). RESULTS: The burn injury induced significant primary and secondary hyperalgesia...... (P burn area (P =.04) and reduced secondary hyperalgesia, but the reduction was not significant (P =.06). Heat pain thresholds, pain during the burn, and mechanical pain in the area of secondary hyperalgesia were...

  19. A descriptive study of pressure pain threshold at 2 standardized sites in people with acute or subacute neck pain.

    Science.gov (United States)

    Walton, David M; Macdermid, Joy C; Nielson, Warren; Teasell, Robert W; Nailer, Tamara; Maheu, Phillippe

    2011-09-01

    Cross-sectional convenience sample. To describe the distribution of scores for pressure pain threshold (PPT) at 2 standardized testing sites in people with neck pain of less than 90 days' duration: the angle of the upper trapezius and the belly of the tibialis anterior. A secondary objective was to identify important influences on PPT. PPT may be a valuable assessment and prognostic indicator for people with neck pain. However, to facilitate interpretation of scores, knowledge of means and variance for the target population, as well as factors that might influence scores, is needed. Participants were recruited from community-based physiotherapy clinics and underwent PPT testing using a digital algometer and standardized protocol. Descriptive statistics (mean, standard deviations, quartiles, skewness, and kurtosis) were calculated for the 2 sites. Simple bivariate tests of association were conducted to explore potential moderators. A positively skewed distribution was described for the 2 standardized sites. Significant moderators were sex (male higher than female), age (r = 0.22), and self-reported pain intensity (r = -0.24). Neither litigation status nor most symptomatic/least symptomatic side influenced PPT. This manuscript presents information regarding the expected scores for PPT testing in people with acute or subacute neck pain. Clinicians can compare the results of individual patients against these population values, and researchers can incorporate the significant confounders of age, sex, and self-reported pain intensity into future research designs.

  20. Ultrasonography of adnexal causes of acute pelvic pain in pre-menopausal non-pregnant women

    Directory of Open Access Journals (Sweden)

    Carolyn S. Dupuis

    2015-10-01

    Full Text Available Acute-onset pelvic pain is an extremely common symptom in premenopausal women presenting to the emergency department. After excluding pregnancy in reproductive-age women, ultrasonography plays a major role in the prompt and accurate diagnosis of adnexal causes of acute pelvic pain, such as hemorrhagic ovarian cysts, endometriosis, ovarian torsion, and tubo-ovarian abscess. Its availability, relatively low cost, and lack of ionizing radiation make ultrasonography an ideal imaging modality in women of reproductive age. The primary goal of imaging in these patients is to distinguish between adnexal causes of acute pelvic pain that may be managed conservatively or medically, and those requiring emergency/urgent surgical or percutaneous intervention.

  1. A rare cause of acute abdominal pain: Herlyn-Werner-Wunderlich syndrome.

    Science.gov (United States)

    Aydin, Ramazan; Ozdemir, Ayse Zehra; Ozturk, Bahadir; Bilgici, Meltem Ceyhan; Tosun, Migraci

    2014-01-01

    Herlyn-Werner-Wunderlich (HWW) syndrome is a rare müllerian duct anomaly with uterus didelphys, unilateral obstructed hemivagina, and ipsilateral renal agenesis. Patients with this syndrome generally present after menarche with pelvic pain and mass and, rarely, primary infertility in later years. Strong suspicion and knowledge of this syndrome are mandatory for an accurate diagnosis. A 14-year-old female patient presented with acute retention of urine and abdominopelvic pain. Her condition was diagnosed with the use ultrasonography and magnetic resonance imaging as a case of HWW syndrome. She was treated with vaginal hemiseptal resection. The HWW syndrome should be considered among the differential diagnoses in girls with renal anomalies presenting with pelvic mass, symptoms of acute abdominal pain, and acute urinary retention.

  2. Medic - Abdominal Pain: A Decision Support Program for the Management of Acute Abdominal Pain. (User’s Manual)

    Science.gov (United States)

    1989-10-11

    Diagnosis Entry Page Your Gynecological Diagnosis APPENDICITIS NON-SPECIFIC ABDOMINAL PAIN PELVIC INFLAMMATORY DISEASE URINARY TRACT INFECTION OVARIAN...presence of diverticular disease does not preclude development of acute appendicitis concxitantly. The initial medical treatment is the same as for...for those patients whose symptoms are non-specific and resolve spontaneously without a diagnosis being made. Peptic ulcer disease (FUD) is included in

  3. Attitudes toward the use of animals in chronic versus acute pain research: results of a web-based forum.

    Science.gov (United States)

    Ormandy, Elisabeth H; Griffin, Gilly

    2016-09-01

    When asked about the use of animals in biomedical research, people often state that the research is only acceptable if pain and distress are minimised. However, pain is caused when the aim is to study pain itself, resulting in unalleviated pain for many of the animals involved. Consequently, the use of animals in pain research is often considered contentious. To date, no research has explored people's views toward different types of animal-based pain research (e.g. chronic or acute pain). This study used a web-based survey to explore people's willingness to support the use of mice in chronic versus acute pain research. The majority of the participants opposed the use of mice for either chronic (68.3%) or acute (63.1%) pain research. There was no difference in the levels of support or opposition for chronic versus acute pain research. Unsupportive participants justified their opposition by focusing on the perceived lack of scientific merit, or the existence of non-animal alternatives. Supporters emphasised the potential benefits that could arise, with some stating that the benefits outweigh the costs. The majority of the participants were opposed to pain research involving mice, regardless of the nature and duration of the pain inflicted, or the perceived benefit of the research. A better understanding of public views toward animal use in pain research may provide a stronger foundation for the development of policy governing the use of animals in research where animals are likely to experience unalleviated pain. 2016 FRAME.

  4. Secret Underlying Unexplained Abdominal Pain, Neurological Symptoms and Intermittent Hypertension: Acute Intermittent Porphyria

    Directory of Open Access Journals (Sweden)

    Komac Andac

    2017-06-01

    Full Text Available A 21-year-old female patient with abdominal pain, vomiting and constipation was admitted to the hospital with the possible diagnosis of diabetic ketoacidosis. Due to increased abdominal pain and constipation the patient underwent a surgery with the diagnosis of ileus. However, no pathological findings were found in the abdominal organs apart from serous fluid in the abdominal cavity. The patient became hypertensive, tachycardic and had an episode of seizures postoperatively. Neurological manifestations with unexplained abdominal pain indicated a diagnosis of acute intermittent porphyria (AIP. Acute intermittent porphyria diagnosis is based on elevated urinary δ-aminolevulinic acid (ALA and porphobilinogen (PBG levels as well as hydroxymethylbilane synthase (HMBS IVS13-2 A>G heterozygous mutation. Familial Mediterranean Fever (FMF gene mutations were not confirmed. Porphyria should be considered in the differential diagnosis of patients with recurrent abdominal pain, neurological symptoms and lack of FMF gene polymorphism.

  5. Tapentadol immediate release: a new treatment option for acute pain management

    Directory of Open Access Journals (Sweden)

    Marc Afilalo

    2010-02-01

    Full Text Available Marc Afilalo1, Jens-Ulrich Stegmann2, David Upmalis31Sir Mortimer B. Davis Jewish General Hospital, Montréal, Canada; 2Global Drug Safety, Grünenthal GmbH, Aachen, Germany; 3Johnson & Johnson Pharmaceutical Research and Development, L.L.C., Raritan, New Jersey, USAAbstract: The undertreatment of acute pain is common in many health care settings. Insufficient management of acute pain may lead to poor patient outcomes and potentially life-threatening complications. Opioids provide relief of moderate to severe acute pain; however, therapy with pure µ-opioid agonists is often limited by the prevalence of side effects, particularly opioid-induced nausea and vomiting. Tapentadol is a novel, centrally acting analgesic with 2 mechanisms of action, µ-opioid receptor agonism and norepinephrine reuptake inhibition. The analgesic effects of tapentadol are independent of metabolic activation and tapentadol has no active metabolites; therefore, in theory, tapentadol may be associated with a low potential for interindividual efficacy variations and drug–drug interactions. Previous phase 3 trials in patients with various types of moderate to severe acute pain have shown that tapentadol immediate release (IR; 50 to 100 mg every 4 to 6 hours provides analgesia comparable to that provided by the pure µ-opioid agonist comparator, oxycodone HCl IR (10 or 15 mg every 4 to 6 hours, with a lower incidence of nausea, vomiting, and constipation. Findings suggest tapentadol may represent an improved treatment option for acute pain.Keywords: tapentadol IR, acute pain, opioid, gastrointestinal tolerability

  6. Single dose oral piroxicam for acute postoperative pain

    Science.gov (United States)

    Moore, R Andrew; Edwards, Jayne; Loke, Yoon; Derry, Sheena; McQuay, Henry J

    2014-01-01

    Background This is an updated version of the original Cochrane review published in Issue 2, 2000. Piroxicam is a non-steroidal anti-inflammatory drug (NSAID) with analgesic properties, and is used mainly for treating rheumatic disorders. Some drugs have been directly compared against each other within a trial setting to determine their relative efficacies, whereas other have not. It is possible, however, to compare analgesics indirectly by examining the effectiveness of each drug against placebo when used in similar clinical situations. Objectives To determine the analgesic efficacy and adverse effects of single-dose piroxicam compared with placebo in moderate to severe postoperative pain. To compare the effects of piroxicam with other analgesics. Search methods Published studies were identified from systematic searching of MEDLINE, Biological Abstracts, EMBASE, CENTRAL and the Oxford Pain Relief Database in December 2007. Additional studies were identified from the reference lists of retrieved reports. Selection criteria The following inclusion criteria were used: full journal publication, randomised placebo controlled trial, double-blind design, adult participants, postoperative pain of moderate to severe intensity at the baseline assessment, postoperative administration of oral or intramuscular piroxicam. Data collection and analysis Summed pain intensity and pain relief data were extracted and converted into dichotomous information to yield the number of participants obtaining at least 50% pain relief. This was used to calculate estimates of relative benefit and number-needed-to-treat-to-benefit (NNT) for one participant to obtain at least 50% pain relief. Information was collected on adverse effects and estimates of relative risk and number-needed-to-treat-to-harm (NNH) were calculated. Main results In this update no further studies were found. The original search identified three studies (141 participants) which compared oral piroxicam 20 mg with placebo and

  7. Chronic pain associated with the Chikungunya Fever: long lasting burden of an acute illness

    Directory of Open Access Journals (Sweden)

    Dallel Radhouane

    2010-02-01

    Full Text Available Abstract Background Chikungunya virus (CHIKV is responsible for major epidemics worldwide. Autochthonous cases were recently reported in several European countries. Acute infection is thought to be monophasic. However reports on chronic pain related to CHIKV infection have been made. In particular, the fact that many of these patients do not respond well to usual analgesics suggests that the nature of chronic pain may be not only nociceptive but also neuropathic. Neuropathic pain syndromes require specific treatment and the identification of neuropathic characteristics (NC in a pain syndrome is a major step towards pain control. Methods We carried out a cross-sectional study at the end of the major two-wave outbreak lasting 17 months in Réunion Island. We assessed pain in 106 patients seeking general practitioners with confirmed infection with the CHIK virus, and evaluated its impact on quality of life (QoL. Results The mean intensity of pain on the visual-analogical scale (VAS was 5.8 ± 2.1, and its mean duration was 89 ± 2 days. Fifty-six patients fulfilled the definition of chronic pain. Pain had NC in 18.9% according to the DN4 questionnaire. Conversely, about two thirds (65% of patients with NC had chronic pain. The average pain intensity was similar between patients with or without NC (6.0 ± 1.7 vs 6.1 ± 2.0. However, the total score of the Short Form-McGill Pain Questionnaire (SF-MPQ(15.5 ± 5.2 vs 11.6 ± 5.2; p Conclusions There exists a specific chronic pain condition associated to CHIKV. Pain with NC seems to be associated with more aggressive clinical picture, more intense impact in QoL and more challenging pharmacological treatment.

  8. Abdominal pain and syndrome of inappropriate antidiuretic hormone secretion as clinical presentation of acute intermittent porphyria.

    Science.gov (United States)

    Valle Feijóo, M L; Bermúdez Sanjurjo, J R; González Vázquez, L; Rey Martínez, M; de la Fuente Aguado, J

    2015-01-01

    Acute intermittent porphyria (AIP) is a rare condition characterized by abdominal pain and a wide range of nonspecific symptoms. We report the case of a woman with abdominal pain and syndrome of inappropriate antidiuretic hormone secretion (SIADH) as clinical presentation of AIP. The diagnosis was achieved through the etiologic study of the SIADH. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  9. Incident reporting by acute pain service at a tertiary care university hospital

    OpenAIRE

    Aliya Ahmed; Muhammad Yasir

    2015-01-01

    Background and Aims: Provision of effective and safe postoperative pain management is the principal responsibility of acute pain services (APSs). Continuous quality assurance is essential for high-quality patient care. We initiated anonymous reporting of critical incidents by APS to ensure continuous quality improvement and here present prospectively collected data on the reported incidents. Our objective was to analyze the frequency and nature of incidents and to see if any harm was caused t...

  10. Adaptations in responsiveness of brainstem pain-modulating neurons in acute compared to chronic inflammation

    Science.gov (United States)

    Cleary, Daniel R.; Heinricher, Mary M.

    2013-01-01

    Despite similar behavioral hypersensitivity, acute and chronic pain have distinct neural bases. Here we used intraplantar injection of Complete Freund’s Adjuvant (CFA) to directly compare activity of pain-modulating neurons in the rostral ventromedial medulla (RVM) in acute versus chronic inflammation. Heat- and von Frey-evoked withdrawal reflexes and corresponding RVM neuronal activity were recorded in lightly anesthetized animals either during the first hour after CFA injection (acute) or 3–10 days later (chronic). Thermal and modest mechanical hyperalgesia during acute inflammation were associated with increases in the spontaneous activity of pain-facilitating ON-cells and suppression of pain-inhibiting OFF-cells. Acute hyperalgesia was reversed by RVM block, showing that the increased activity of RVM ON-cells is necessary for acute behavioral hypersensitivity. In chronic inflammation, thermal hyperalgesia had resolved, but mechanical hyperalgesia had become pronounced. The spontaneous discharges of ON- and OFF-cells were not different from controls, but the mechanical response thresholds for both cell classes were reduced into the innocuous range. RVM block in the chronic condition worsened mechanical hyperalgesia. These studies identify distinct contributions of RVM ON- and OFF-cells to acute and chronic inflammatory hyperalgesia. During early immune-mediated inflammation, ON-cell spontaneous activity promotes hyperalgesia. After inflammation is established, the anti-nociceptive influence of OFF-cells is dominant, yet the lowered threshold for the OFF-cell pause allows behavioral responses to stimuli that would normally be considered innocuous. The efficacy of OFF-cells in counteracting sensitization of ascending transmission pathways could therefore be an important determining factor in development of chronic inflammatory pain. PMID:23588008

  11. Role of the Cannabinoid System in Pain Control and Therapeutic Implications for the Management of Acute and Chronic Pain Episodes

    Science.gov (United States)

    Manzanares, J; Julian, MD; Carrascosa, A

    2006-01-01

    Cannabis extracts and synthetic cannabinoids are still widely considered illegal substances. Preclinical and clinical studies have suggested that they may result useful to treat diverse diseases, including those related with acute or chronic pain. The discovery of cannabinoid receptors, their endogenous ligands, and the machinery for the synthesis, transport, and degradation of these retrograde messengers, has equipped us with neurochemical tools for novel drug design. Agonist-activated cannabinoid receptors, modulate nociceptive thresholds, inhibit release of pro-inflammatory molecules, and display synergistic effects with other systems that influence analgesia, especially the endogenous opioid system. Cannabinoid receptor agonists have shown therapeutic value against inflammatory and neuropathic pains, conditions that are often refractory to therapy. Although the psychoactive effects of these substances have limited clinical progress to study cannabinoid actions in pain mechanisms, preclinical research is progressing rapidly. For example, CB1mediated suppression of mast cell activation responses, CB2-mediated indirect stimulation of opioid receptors located in primary afferent pathways, and the discovery of inhibitors for either the transporters or the enzymes degrading endocannabinoids, are recent findings that suggest new therapeutic approaches to avoid central nervous system side effects. In this review, we will examine promising indications of cannabinoid receptor agonists to alleviate acute and chronic pain episodes. Recently, Cannabis sativa extracts, containing known doses of tetrahydrocannabinol and cannabidiol, have granted approval in Canada for the relief of neuropathic pain in multiple sclerosis. Further double-blind placebo-controlled clinical trials are needed to evaluate the potential therapeutic effectiveness of various cannabinoid agonists-based medications for controlling different types of pain. PMID:18615144

  12. Unusual cause of acute abdominal pain in a postmenopausal woman: adnexal torsion

    Directory of Open Access Journals (Sweden)

    Alper Biler

    2016-03-01

    Full Text Available Adnexal torsion is an infrequent but significant cause of acute lower abdominal pain in women. While adnexal torsion is generally considered in premenopausal women presenting with acute abdominal pain and a pelvic mass, it is a rare cause of acute abdominal pain during postmenopausal period. The diagnosis of adnexal torsion is often challenging due to nonspesific clinical, laboratory and physical examination findings. Causes of adnexal torsion is also different in premenopausal and postmenopausal women. While a simple functional cyst is often the cause of torsion in premenopausal women, it is more rarely the cause in postmenopausal women. Adnexal torsion is a surgical emergency. The surgery of adnexal torsion is performed either via conventional exploratory laparotomy or laparoscopic surgery. Adnexal torsion in postmenopausal women should be considered not only in the setting of sudden onset pain, but also in long-term abdominal discomfort. In this article, we presented a case with adnexal torsion that rarely cause acute abdominal pain in postmenopausal women. [Cukurova Med J 2016; 41(1.000: 167-170

  13. Acute neck pain caused by pseudogout attack of calcified cervical yellow ligament: a case report.

    Science.gov (United States)

    Kobayashi, Takashi; Miyakoshi, Naohisa; Abe, Toshiki; Abe, Eiji; Kikuchi, Kazuma; Noguchi, Hideaki; Konno, Norikazu; Shimada, Yoichi

    2016-05-30

    Calcification of the yellow ligament sometimes compresses the spinal cord and can induce myelopathy. Usually, the calcification does not induce acute neck pain. We report a case of a patient with acute neck pain caused by calcium pyrophosphate dihydrate in a calcified cervical yellow ligament. A 70-year-old Japanese woman presented with acute neck pain. She had a moderately high fever (37.5 °C), and her neck pain was so severe that she could not move her neck in any direction. Computed tomography showed a high-density area between the C5 and C6 laminae suspicious for calcification of the yellow ligament. Magnetic resonance imaging showed intermediate-signal intensity on T1-weighted imaging and high-signal intensity on T2-weighted imaging surrounding a low-signal region on both T1- and T2-weighted imaging with cord compression. There was a turbid, yellow fluid collection in the yellow ligament at the time of operation. Histologically, calcium pyrophosphate dihydrate crystals were found in the fluid, and she was diagnosed as having a pseudogout attack of the yellow ligament. Pseudogout attack of the cervical yellow ligament is rare, but this clinical entity should be added to the differential diagnosis of acute neck pain, especially when calcification of the yellow ligament exists.

  14. Measuring Psychosocial Variables in Patients With (Sub) Acute Low Back Pain Complaints, at Risk for Chronicity A Validation Study of the Acute Low Back Pain Screening Questionnaire-Dutch Language Version

    NARCIS (Netherlands)

    Heneweer, Hans; van Woudenberg, Nienke J.; van Genderen, Frank; Vanhees, Luc; Wittink, Harriet

    2010-01-01

    Study Design. A validation study of the Acute Low Back Pain Screening Questionnaire Dutch Language Version (ALBPSQ-DLV). Objective. To determine internal consistency, construct and convergent validity of the ALBPSQ-DLV in a population of patients with (sub) acute low back pain (LBP) referred to

  15. Plain abdominal radiography in acute abdominal pain; past, present, and future

    Directory of Open Access Journals (Sweden)

    Gans SL

    2012-06-01

    Full Text Available Sarah L Gans,1 Jaap Stoker,2 Marja A Boermeester11Department of Surgery, 2Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsAbstract: Several studies have demonstrated that a diagnosis based solely on a patient’s medical history, physical examination, and laboratory tests is not reliable enough, despite the fact that these aspects are essential parts of the workup of a patient presenting with acute abdominal pain. Traditionally, imaging workup starts with abdominal radiography. However, numerous studies have demonstrated low sensitivity and accuracy for plain abdominal radiography in the evaluation of acute abdominal pain as well as various specific diseases such as perforated viscus, bowel obstruction, ingested foreign body, and ureteral stones. Computed tomography, and in particular computed tomography after negative ultrasonography, provides a better workup than plain abdominal radiography alone. The benefits of computed tomography lie in decision-making for management, planning of a surgical strategy, and possibly even avoidance of negative laparotomies. Based on abundant available evidence, major advances in diagnostic imaging, and changes in the management of certain diseases, we can conclude that there is no place for plain abdominal radiography in the workup of adult patients with acute abdominal pain presenting in the emergency department in current practice.Keywords: abdominal x-ray, acute abdomen, acute abdominal pain, emergency department, diagnostic imaging, abdominal radiography

  16. Cost-effectiveness of medical and chiropractic care for acute and chronic low back pain.

    Science.gov (United States)

    Haas, Mitchell; Sharma, Rajiv; Stano, Miron

    2005-10-01

    To identify relative provider costs, clinical outcomes, and patient satisfaction for the treatment of low back pain (LBP). This was a practice-based, nonrandomized, comparative study of patients self-referring to 60 doctors of chiropractic and 111 medical doctors in 51 chiropractic and 14 general practice community clinics over a 2-year period. Patients were included if they were at least 18 years old, ambulatory, and had low back pain of mechanical origin (n = 2780). Outcomes were (standardized) office costs, office costs plus referral costs for office-based care and advanced imaging, pain, functional disability, patient satisfaction, physical health, and mental health evaluated at 3 and 12 months after the start of care. Multiple regression analysis was used to correct for baseline differences between provider types. Chiropractic office costs were higher for both acute and chronic patients (P .20). Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction (P pain and disability improvement were found for chronic patients only. Chiropractic care appeared relatively cost-effective for the treatment of chronic LBP. Chiropractic and medical care performed comparably for acute patients. Practice-based clinical outcomes were consistent with systematic reviews of spinal manipulation efficacy: manipulation-based therapy is at least as good as and, in some cases, better than other therapeusis. This evidence can guide physicians, payers, and policy makers in evaluating chiropractic as a treatment option for low back pain.

  17. Topical lidocaine patch 5% for acute postoperative pain control.

    LENUS (Irish Health Repository)

    Gilhooly, D

    2011-02-01

    A 39-year-old para 3 woman presented for elective caesarean section (lower segment caesarean section (LSCS)) for breech presentation. The patient had a strong history of atopy and anaphylaxis to paracetamol, codeine, penicillin and latex. The patient was asthmatic, triggered by aspirin. Epidural anaesthesia was unsuccessful and LSCS was carried out under spinal anaesthesia. Postoperatively the patient was unwilling to take analgesic medication due to fear of an allergic reaction. Three 5% lidocaine patches were applied to the wound for postoperative analgesia. This reduced the patient\\'s visual analogue scale pain score from 10\\/10 to 5\\/10 at rest and 10\\/10 to 7\\/10 with movement. Transcutaneous electrical nerve stimulation was added and this improved associated back pain, reducing the pain further to 2\\/10. This is the first description of lignocaine patch 5% for postoperative LSCS pain. It is suggested that this method of delivery of local anaesthetic, which is easy to apply and has minimal side effects, should be considered not as a sole agent but as part of a multimodal technique to address postoperative LSCS pain.

  18. No evidence of real progress in treatment of acute pain, 1993–2012: scientometric analysis

    Directory of Open Access Journals (Sweden)

    Correll DJ

    2014-04-01

    Full Text Available Darin J Correll, Kamen V Vlassakov, Igor Kissin Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA Abstract: Over the past 2 decades, many new techniques and drugs for the treatment of acute pain have achieved widespread use. The main aim of this study was to assess the progress in their implementation using scientometric analysis. The following scientometric indices were used: 1 popularity index, representing the share of articles on a specific technique (or a drug relative to all articles in the field of acute pain; 2 index of change, representing the degree of growth in publications on a topic compared to the previous period; and 3 index of expectations, representing the ratio of the number of articles on a topic in the top 20 journals relative to the number of articles in all (>5,000 biomedical journals covered by PubMed. Publications on specific topics (ten techniques and 21 drugs were assessed during four time periods (1993–1997, 1998–2002, 2003–2007, and 2008–2012. In addition, to determine whether the status of routine acute pain management has improved over the past 20 years, we analyzed surveys designed to be representative of the national population that reflected direct responses of patients reporting pain scores. By the 2008–2012 period, popularity index had reached a substantial level (≥5% only with techniques or drugs that were introduced 30–50 years ago or more (epidural analgesia, patient-controlled analgesia, nerve blocks, epidural analgesia for labor or delivery, bupivacaine, and acetaminophen. In 2008–2012, promising (although modest changes of index of change and index of expectations were found only with dexamethasone. Six national surveys conducted for the past 20 years demonstrated an unacceptably high percentage of patients experiencing moderate or severe pain with not even a trend toward outcome improvement. Thus

  19. Oral Oxycodone for Acute Postoperative Pain: A Review of Clinical Trials.

    Science.gov (United States)

    Cheung, Chi Wai; Ching Wong, Stanley Sau; Qiu, Qiu; Wang, Xianyu

    2017-02-01

    Opioids are the mainstay of pain management for acute postsurgical pain. Oral oxycodone is an opioid that can provide effective acute postoperative pain relief. To evaluate the use of oral oxycodone for acute postoperative pain management. This is a narrative review based on published articles searched in PubMed and Medline from 2003 to 2015 on oral oxycodone for acute postoperative pain management. Clinical trials related to the use of oral oxycodone for acute postoperative pain management were searched via PubMed and Medline from 2003 to 2015. The search terms used were "oral strong opioids," "postsurgical," "postoperative," "post-surgical," and "post-operative." Treatment interventions were compared for analgesic efficacy, rescue medication use, side effects, recovery, length of hospital stay, and patient satisfaction. There were 26 clinical trials included in the review. Oral oxycodone showed superior postoperative analgesic efficacy compared with placebo in patients undergoing laparoscopic cholecystectomy, abdominal or pelvic surgery, bunionectomy, breast surgery, and spine surgery. When compared with intravenous opioids, oral oxycodone provided better or comparable pain relief following knee arthroplasty, spine surgery, caesarean section, laparoscopic colorectal surgery, and cardiac surgery. One study of dental postsurgery pain reported inferior pain control with oral oxycodone versus rofecoxib. (withdrawn from the US market due to cardiac safety concerns). In many studies, the demand for rescue analgesia and total opioid consumption were reduced in the oxycodone treatment arm. Patients receiving oral oxycodone experienced fewer opioid-related side effects than those on other opioids, and had a similar occurrence of postoperative nausea and vomiting as patients on placebo. Furthermore, oral oxycodone did not prolong hospital stay and was associated with lower drug costs compared with epidural and intravenous analgesics. Oxycodone administered as part of a

  20. Can Recurrence After an Acute Episode of Low Back Pain Be Predicted?

    Science.gov (United States)

    Machado, Gustavo C; Maher, Chris G; Ferreira, Paulo H; Latimer, Jane; Koes, Bart W; Steffens, Daniel; Ferreira, Manuela L

    2017-09-01

    Although recurrence is common after an acute episode of low back pain, estimates of recurrence rates vary widely and predictors of recurrence remain largely unknown. The purposes of the study were to determine the 1-year incidence of recurrence in participants who recovered from an acute episode of low back pain and to identify predictors of recurrence. The design was an inception cohort study nested in a case-crossover study. For 12 months, 832 of the 999 participants who initially presented to primary care within the first 7 days of an episode of low back pain were followed. Of these participants, 469 recovered (1 month pain free) from the index episode within 6 weeks and were included in this study. Recurrence was defined as a new episode lasting more than 1 day, or as an episode of care seeking. Putative predictors were assessed at baseline and chosen a priori. Multivariable regression analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI). The 1-year incidence of recurrence of low back pain was 33%, and the 1-year incidence of recurrence of low back pain with care seeking was 18%. Participants reporting more than 2 previous episodes of low back pain had increased odds of future recurrences (OR = 3.18, CI = 2.11-4.78). This factor was also associated with recurrent episodes that led to care seeking (OR = 2.87, CI = 1.73-4.78). No other factors were associated with recurrences. There are limitations inherent in reliance on recall. After an acute episode of low back pain, one-third of patients will experience a recurrent episode, and approximately half of those will seek care. Experiencing more than 2 previous episodes of low back pain triples the odds of a recurrence within 1 year.

  1. Single-dose oral naproxen for acute postoperative pain: a quantitative systematic review

    Directory of Open Access Journals (Sweden)

    Moore R Andrew

    2003-09-01

    Full Text Available Abstract Background Naproxen and naproxen sodium are non-steroidal anti-inflammatory drugs used in a variety of painful conditions, including the treatment of postoperative pain. This review aims to assess the efficacy, safety and duration of action of a single oral dose of naproxen/naproxen sodium for moderate to severe acute postoperative pain in adults, compared with placebo. Methods The Cochrane Library (issue 4 2002, EMBASE, PubMed, MEDLINE and an in-house database were searched for randomised, double blind, placebo controlled trials of a single dose of orally administered naproxen or naproxen sodium in adults with acute postoperative pain. Pain relief or pain intensity data were extracted and converted into dichotomous information to give the number of patients with at least 50% pain relief over 4 to 6 hours. Relative benefit and number-needed-to-treat were then calculated. The percentage of patients with any adverse event, number-needed-to-harm, and time to remedication were also calculated. Results Ten trials with 996 patients in met the inclusion criteria. Six trials compared naproxen sodium 550 mg (252 patients with placebo (248 patients; the NNT for at least 50% pain relief over six hours was 2.6 (95% confidence interval 2.2 to 3.2. There was no significant difference between the number of patients experiencing any adverse event on treatment compared with placebo. Weighted mean time to remedication was 7.6 hours for naproxen sodium 550 mg (206 patients and 2.6 hours for placebo (205 patients. Four other trials used lower doses. Conclusion A single oral dose of naproxen sodium 550 mg is an effective analgesic in the treatment of acute postoperative pain. A low incidence of adverse events was found, although these were not reported consistently.

  2. Effect of sympathetic nerve block on acute inflammatory pain and hyperalgesia

    DEFF Research Database (Denmark)

    Pedersen, J L; Rung, G W; Kehlet, H

    1997-01-01

    . The duration and quality of blocks were evaluated by the sympatogalvanic skin response and skin temperature. Bilateral heat injuries were produced on the medial surfaces of the calves with a 50 x 25 mm thermode (47 degrees C, 7 min) 45 min after the blocks. Pain intensity induced by heat, pain thresholds....... METHODS: The study was made as a randomized, single blinded investigation, in which the volunteers served as their own controls. A lumbar sympathetic nerve block and a contralateral placebo block were performed in 24 persons by injecting 10 ml bupivacaine (0.5%) and 10 ml saline, respectively...... acute inflammatory pain or hyperalgesia after a heat injury in human skin....

  3. Pain Relief for Acute Urolithiasis: The Case for Non-Steroidal Anti-Inflammatory Drugs.

    Science.gov (United States)

    Steinberg, Peter L; Chang, Steven L

    2016-07-01

    Pain from renal colic is often severe and incapacitating. Many patients require emergent hospitalization and aggressive analgesia to relieve such discomfort. For many years, the optimal analgesic strategy has been sought to manage such severe pain. One of the mainstays of therapy for acute renal colic is with non-steroidal anti-inflammatory drugs (NSAIDs). This paper reviews the mechanism by which NSAIDs allow pain relief in renal colic, the evidence for their use in this condition, and the use of NSAIDs combined with other agents in renal colic.

  4. Manipulative therapy and/or NSAIDs for acute low back pain: design of a randomized controlled trial [ACTRN012605000036617

    Directory of Open Access Journals (Sweden)

    Day Richard O

    2005-11-01

    Full Text Available Abstract Background Acute low back pain is a common condition resulting in pain and disability. Current national and international guidelines advocate general practitioner care including advice and paracetamol (4 g daily in otherwise well adults as the first line of care for people with acute low back pain. Non-steroidal anti-inflammatory drugs (NSAIDs and spinal manipulative therapy (SMT are advocated in many guidelines as second line management options for patients with acute low back pain who are not recovering. No studies have explored the role of NSAIDs and/or SMT in addition to first line management for acute low back pain. The primary aim of this study is to investigate if NSAIDs and/or SMT in addition to general practitioner advice and paracetamol results in shorter recovery times for patients with acute low back pain. The secondary aims of the study are to evaluate whether the addition of SMT and/or NSAIDs influences pain, disability and global perceived effect at 1, 2, 4 and 12 weeks after onset of therapy for patients with significant acute low back pain. Methods/design This paper presents the rationale and design of a randomised controlled trial examining the addition of NSAIDs and/or SMT in 240 people who present to their general practitioner with significant acute low back pain.

  5. OC05 - Tokenism or true partnership - parental involvement in a child's acute pain care.

    Science.gov (United States)

    Vasey, Jackie; Smith, Joanna; Kirshbaum, Marilynne; Chirema, Kathleen

    2016-05-09

    Theme: Parenting/parenthood. Family-centred care (FCC) is widely acknowledged as underpinning children's nursing. Delivering FCC requires nurses to advocate for family involvement, particularly in areas where evidence suggest the child's needs are not being met, such as pain care. To explore parental involvement in their child's acute pain care. A qualitative ethnographical approach was adopted, with non-participant observation and follow-up interviews. The framework approach underpinned data analysis. Partnership between nurses and parents is not overtly evident in relation to pain care. Involvement is often 'unspoken', indicating that neither the nurse nor parent are clear about the extent to which parents can, or are, involved in care. Parents want greater involvement in their child's pain care and often initiate involvement by advocating for their child, with or without support from nurses. The 'Pillars of Partnership in Pain Care' model offers an alternative approach to involving parents.

  6. Can improvised somatic dance reduce acute pain for young people in hospital?

    Science.gov (United States)

    Dowler, Lisa

    2016-11-08

    Aim This study explores the effects of improvised somatic dance (ISD) on children and young people experiencing acute pain following orthopaedic or cardiac surgery, or post-acquired brain injury. Methods The study involved 25 children and young people and adopted a mixed methods approach. This included a descriptive qualitative approach to help the participants and witnesses verbalise their experience of ISD, and pain scores were assessed before and after ISD using validated pain assessment tools. Data were analysed using descriptive statistical analysis. Findings A total of 92% of participants experienced a reduction in pain, with 80% experiencing a >50% reduction. There was an improved sense of well-being for all. Conclusion Although not a replacement for pharmacological treatments, a multidimensional, child-centred and inclusive approach with ISD can be a useful complementary, non-pharmacological method of pain management in children and young people.

  7. Chiropractic care of acute low back pain and incidental spina bifida occulta: a case report.

    Science.gov (United States)

    Cofano, Gregory P; Anderson, Benjamin C; Stumpff, Eric R

    2014-12-01

    The purpose of this case report is to describe chiropractic care of an adolescent with acute low back pain and incidental finding of spina bifida occulta managed with high-velocity low-amplitude manipulation. A 10-year-old boy was referred for chiropractic care by his pediatrician for the management of low back pain after a fall 3 days prior. Examination and medical records revealed the patient also had spina bifida occulta at the level of L5. High-velocity low-amplitude treatment for lower back pain showed resolution of patient's pain after 6 visits. No adverse effects were reported. An adolescent patient with lower back pain and incidental finding of spina bifida occulta improved with a course of care that included with high-velocity low-amplitude manipulation therapy.

  8. Managing patients with acute and chronic non-specific neck pain

    DEFF Research Database (Denmark)

    Brockhusen, Simon Sidenius; Bussières, André; French, Simon David

    2017-01-01

    Background: Non-specific neck pain represents a quarter of all chiropractic patient visits in Denmark. Evidence informed practice can help ensure providers use best available treatment, speed up patient recovery rate and reduce healthcare utilization. It is generally believed that Danish...... chiropractors treat according to best practice, but we do not know if this is true for management of neck-pain. The objective of this study was to investigate how Danish chiropractors treat patients with acute and chronic non-specific neck pain and determine if management is compliant with recent Canadian...... and chronic non-specific neck pain cases; and 3) provide demographic data. Treatment modalities ranked as "used often" were considered in further analysis and compared to the Canadian Guideline recommendations for neck pain. Chi-squared test was used to investigate differences between treatment and guideline...

  9. A concise rehabilitation protocol for sub-acute and chronic non-specific neck pain.

    Science.gov (United States)

    Noormohammadpour, Pardis; Tayyebi, Fereshte; Mansournia, Mohammad Ali; Sharafi, Elham; Kordi, Ramin

    2017-07-01

    There is increasing evidence in support of multidisciplinary approaches for management of chronic neck pain. Although presence of different team members is one of the strengths of these approaches, it can limit the access to these treatments. The main objective of this study is designing and investigating the efficacy of a concise rehabilitation program. Thirty-nine patients with sub-acute and chronic non-specific neck pain underwent an 8-week rehabilitation program. Baseline and 8 weeks' follow-up data regarding neck pain (visual analog scale, neck disability index and quality of life) were compared using paired T test. After eight weeks of study, pain and disability significantly decreased: -3.8 of 10 (95% CI: -4.6 to -3.0) (p-value < 0.001) for pain and -18.4 of 100 (95% CI: -23.7 to -13.2) (p-value < 0.001) for disability. Also, all SF-36 domain scales improved significantly. By using this concise rehabilitation approach, pain, disability, and quality of life improved significantly in patients with sub-acute and chronic non-specific neck pain. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Patient Nonadherence to Guideline-Recommended Care in Acute Low Back Pain.

    Science.gov (United States)

    Bier, Jasper D; Kamper, Steven J; Verhagen, Arianne P; Maher, Christopher G; Williams, Christopher M

    2017-12-01

    To describe the magnitude of patient-reported nonadherence with guideline-recommended care for acute low back pain. Secondary analysis of data from participants enrolled in the Paracetamol for Acute Low Back Pain study trial, a randomized controlled trial evaluating the effectiveness of paracetamol for acute low back pain. Primary care, general practitioner. Data from participants with acute low back pain (N=1643). Guideline-recommended care, including reassurance, simple analgesia, and the advice to stay active and avoid bed rest. Also, advice against additional treatments and referral for imaging. Proportion of nonadherence with guideline-recommended care. Nonadherence was defined as (1) failure to consume the advised paracetamol dose, or (2) receipt of additional health care, tests, or medication during the trial treatment period (4wk). Multivariable logistic regression analysis was performed to determine the factors associated with nonadherence. In the first week of treatment, 39.7% of participants were classified as nonadherent. Over the 4-week treatment period, 70.0% were nonadherent, and 57.5% did not complete the advised paracetamol regimen. Higher perceived risk of persistent pain, lower level of disability, and not claiming workers' compensation were associated with nonadherence, with odds ratios ranging from .46 to 1.05. Adherence to guideline-recommended care for acute low back pain was poor. Most participants do not complete the advised paracetamol regimen. Higher perceived risk of persistence of complaints, lower baseline disability, and participants not claiming workers' compensation were independently associated with nonadherence. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  11. Controlling Acute Post-operative Pain in Iranian Children with using of Music Therapy

    Directory of Open Access Journals (Sweden)

    Mojtaba Miladinia

    2016-05-01

    Full Text Available Background: Despite the development of pediatric post-operative pain management and use of analgesic/narcotic drugs, post-operative pain remains as a common problem. Some studies suggested, the most effective approach to controlling immediate post-operative pain may include a combination of drug agents and non-drug methods. The aim of this study was to investigate the effect of music therapy on the acute post-operative pain in Iranian children.  Materials and Methods: A quasi-experimental, repeated measure design was used. In this study, 63 children were placed in the music and control groups. In the music group, pain intensity was measured before start intervention (baseline. Then, this group listened to two non-speech music for 20 minutes. Then, pain intensity was measured with numeric rating scale, immediately after intervention, 1 hour, 3 hours and 6 hours after intervention, respectively. Also, in the control group, pain intensity was measured in times similar to music group. Results: The mean of pain intensity did not significantly different between the 2 groups at baseline (P>0.05. The results of repeated measure ANOVA showed that, trend of pain intensity between 2 groups was significant (P

  12. Does adherence to treatment mediate the relationship between patients' treatment outcome expectancies and the outcomes of pain intensity and recovery from acute low back pain?

    Science.gov (United States)

    Haanstra, Tsjitske M; Kamper, Steven J; Williams, Christopher M; Spriensma, Alette S; Lin, Chung-Wei Christine; Maher, Christopher G; de Vet, Henrica C W; Ostelo, Raymond W J G

    2015-08-01

    It is believed that patients' expectancies about the effectiveness of treatment influence their treatment outcomes, but the working mechanism is rarely studied in patients with low back pain. Theoretical models suggest that adherence to treatment may be an important pathway. The aim of this study was to assess the mediating role of adherence to treatment in the relationship between expectancies and the outcomes of recovery and pain intensity in patients with acute low back pain. This study used data from a randomized placebo-controlled trial of paracetamol for acute low back pain. Expectancies were measured with the Credibility Expectancy Questionnaire. Adherence was measured with a medication diary. Pain intensity was recorded daily in a diary on a 0 to 10 pain scale, and recovery was defined as the first of 7 consecutive days scoring 0 or 1 on a 6-point pain scale. Cox regression (dependent variable: recovery) and linear mixed-model analyses (dependent variable: daily pain intensity scores) were performed. The "difference in coefficients" approach was used to establish mediation. A total of 1573 participants were included in current analyses. There was a small but highly significant relationship between expectancies and outcomes; 3.3% of the relationship between expectancies and recovery and 14.2% of the relationship between expectancies and pain intensity were mediated by adherence to treatment. This study does not convincingly support the theory that adherence is a key pathway in the relationship between treatment outcome expectancies and recovery and pain intensity in this acute low back pain population.

  13. Acute pain treatment on postoperative and medical non-surgical wards [Akutschmerztherapie auf operativen und konservativen Stationen

    Directory of Open Access Journals (Sweden)

    Korczak, Dieter

    2013-05-01

    Full Text Available [english] The effectiveness of acute pain treatment in hospitals is examined. An efficient therapy of acute pain is efficient and cost-effective. Although every patient is entitled for the relief of pain, many hospitals do not treat acute pain in an optimal manner.[german] Es wird die Effektivität der Akutschmerztherapie in Krankenhäusern untersucht. Eine effiziente Behandlung akuter Schmerzen ist wirksam und spart Kosten. Obwohl jeder Patient Anspruch auf Linderung seiner Schmerzen hat, behandeln viele Krankenhäuser akute Schmerzen noch nicht optimal.

  14. Volcano Flank Terraces on Mars

    Science.gov (United States)

    Byrne, P. K.; van Wyk de Vries, B.; Murray, J. B.; Troll, V. R.

    2008-12-01

    Flank terraces are bulge-like structures that occur on the slopes of at least nine large shield volcanoes on Mars, and three on Earth. Terraces have a convex-upward, convex-outward morphology, with an imbricate "fish scale" stacking pattern in plan. They occur at all elevations, are scale-invariant structures, and have similar proportions to thrust faults on Earth. Suggested mechanisms of formation include elastic self-loading, lithospheric flexure, magma chamber tumescence, flank relaxation, and shallow gravitational slumping. Terrace geometries predicted by most of these mechanisms do not agree with our observations, however. Only lithospheric flexure can fully account for terrace geometry on Mars and Earth, and so is the most likely candidate mechanism for flank terrace formation. To verify this hypothesis, we conducted scaled analogue modelling experiments, and investigated the structures formed during flexure. Cones of a sand-gypsum mix were placed upon a deep layer of silicone gel, to simulate volcanic loads upon viscoelastic Martian crust. Key parameters were varied across our experimental program. In all cases convex topographic structures developed on the cones' flanks, arranged in an imbricate, overlapping plan-view pattern. These structures closely resemble flank terraces observed on Mars, and our results provide for a basic kinematic model of terrace formation. Analogue volcanoes experienced a decrease in upper surface area whilst volume was conserved; the contractional surface strain was accommodated by outward verging, circumferentially striking thrusts. The morphology of experimental structures suggests an orientation of the principal stress axes of σ1 = radial, σ2 = concentric, and σ3 = vertical. Elsewhere (J. B. Murray et al., this volume) we detail the relationship between flank terraces and other structures such as pit craters and gräben, using Ascraeus Mons as a case study. We suggest that terraces may influence the distribution and location

  15. Acute pain management in children with sickle cell anaemia during ...

    African Journals Online (AJOL)

    are triggered by various environmental and psychological states, such as high altitudes, extreme temperatures, infection, dehydration, stress and fatigue.[8] Painful episodes experienced by children with SCA often interfere with intellectual activities, such as attending school and completing homework, social activities such ...

  16. Sufentanil sublingual tablet 30mcg for moderate-to-severe acute pain in the emergency department.

    Science.gov (United States)

    Miner, James R; Rafique, Zubaid; Minkowitz, Harold S; DiDonato, Karen P; Palmer, Pamela P

    2017-10-31

    Pharmacological properties of the sufentanil sublingual tablet 30mcg (SST 30mcg) could offer potential analgesic advantages in settings requiring noninvasive, acute pain management. The feasibility of using SST 30mcg for moderate-to-severe pain management in the emergency department (ED) was evaluated. This open-label, multicenter feasibility study included patients aged ≥18years who presented to the ED with moderate-to-severe pain (≥4 on the numeric rating scale of pain intensity (NRS); opioid-tolerant patients were excluded. Patients received a single SST 30-mcg dose (single-dose cohort) or, upon request, ≤3 additional doses ≥60min apart (multiple-dose cohort) and were evaluated over 1 or 2h. Effectiveness was assessed by patient-reported pain scores (11-point NRS; 5-point pain relief scale). Safety and tolerability were also assessed. Overall, 76 patients enrolled into the single-dose (n=40) and multiple-dose (n=36) cohorts. In the first hour (combined cohorts), mean pain intensity was significantly lower 15-min post-dosing (P<0.001; clinically meaningful within 30-minutes post-dosing) and continued to decrease during the first hour (P<0.001 for each 15-minute interval). Mean pain intensity (multiple-dose cohort) decreased from 7.6 at baseline to 4.5 at 1h and to 4.6 at 2h (P<0.001 for both); mean pain relief increased from baseline to 1.9 at 1h (P<0.001) and to 2.0 at 2h (P<0.001). Most (79%) patients had no adverse events (AEs), and there were no severe AEs. SST 30mcg was feasible for managing moderate-to-severe acute pain in an ED setting. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  17. Low cost continuous femoral nerve block for relief of acute severe cancer related pain due to pathological fracture femur

    Directory of Open Access Journals (Sweden)

    Rachel Cherian Koshy

    2010-01-01

    Full Text Available Pathological fractures in cancer patient cause severe pain that is difficult to control pharmacologically. Even with good pain relief at rest, breakthrough and incident pain can be unmanageable. Continuous regional nerve blocks have a definite role in controlling such intractable pain. We describe two such cases where severe pain was adequately relieved in the acute phase. Continuous femoral nerve block was used as an efficient, cheap and safe method of pain relief for two of our patients with pathological fracture femur. This method was proved to be quite efficient in decreasing the fracture-related pain and improving the level of well being.

  18. A qualitative study of the barriers to prehospital management of acute pain in children.

    Science.gov (United States)

    Murphy, Adrian; Barrett, Michael; Cronin, John; McCoy, Siobhan; Larkin, Philip; Brenner, Maria; Wakai, Abel; O'Sullivan, Ronan

    2014-06-01

    Effective pain management in the prehospital setting is gaining momentum as a potential key performance indicator by many emergency medical service systems, but historically has been shown to be inadequate, particularly in the paediatric population. This study aimed to identify the barriers, as perceived by a national cohort of advanced paramedics (APs), to achieving optimal prehospital management of acute pain in children. A qualitative approach was employed to capture data through two focus group interviews. Sixteen APs were invited to participate in this study. Both focus groups were audio recorded, transcribed and analysed using Attride-Stirling's framework for thematic network analysis. The global theme 'Understanding Barriers to the Prehospital Management of Acute Pain in Children' emerged from three organising themes as follows: AP education and training; current clinical practice guidelines for paediatric pain management; realities of prehospital practice. Limited exposure to children in the prehospital setting, difficulty assessing pain intensity in small children, and challenges in administering oral or inhaled analgesic agents to distressed and uncooperative children were highlighted by participants. Short transfer times to the emergency department, and a 'medical' cause of pain were also implicated as examples of when children are less likely to receive analgesia from practitioners. The pathway to improving care must include an emphasis on improvements in practitioner education and training, offering alternatives to assessing pain in preverbal children, exploring the intranasal route of drug delivery in managing acute severe pain, and robustly developed evidence-based guidelines that are practitioner friendly and patient-focused. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  19. Trunk muscle co-ordination during gait: relationship between muscle function and acute low back pain.

    Science.gov (United States)

    Anders, Christoph; Scholle, Hans-Christoph; Wagner, Heiko; Puta, Christian; Grassme, Roland; Petrovitch, Alexander

    2005-12-01

    Low back pain costs billions of Euros annually in all industrialized countries. Often radiological diagnosis fails to give evidence of the pathogenesis of low back pain. Although psychophysiological characteristics have an influence, it seems that insufficient muscular spinal stabilization may play the major role in the development of low back pain. Assessment of trunk muscle stabilization activity during everyday activities is rare. Therefore, in this study healthy persons were investigated during walking on a treadmill at a speed of 4 km/h. Women (n = 16) with no history of back pain were investigated before and after a static loading situation of the spine, i.e. while wearing a waistcoat. After this loading situation four women developed pain (pain subjects). Surface EMG (SEMG) was taken from five trunk muscles of both sides. Grand averaged amplitude curves over stride, amplitude normalized curves and variation between all included strides were calculated for all muscles and subjects, respectively. The normal range of all calculated parameters was defined within the span between the 5th and the 95th percentiles of all pain free subjects. Data were evaluated according to deviations from the normal range. Already before the load situation, pain subjects showed considerable deviations from the normal range, mainly of their abdominal muscles. There was no relationship between magnitude of deviation and pain intensity, but perceived exertion was highest in those subjects who showed the most symptoms in terms of number of muscles being identified as considerably deviating from the normal range. No specific "dysfunction pattern" could be identified, which argues for highly individual mechanisms instead of a single target muscle. The results suggest cumulative effects of different disturbance levels resulting in acute back pain. Since deviations could be identified already before the pain occurred, disturbed muscle function seems to be a risk factor for developing back

  20. An experimental investigation of the role of perceived justice in acute pain.

    Science.gov (United States)

    McParland, J; Knussen, C; Lawrie, J; Brodie, E

    2013-03-01

    Emerging research suggests that perceiving injustice can compound the suffering of chronic pain, while perceiving justice serves as a positive psychological resource in this context. However, little more is currently known about the function of justice beliefs, particularly in the context of acute pain. The present study undertook this investigation, using cold pressor methodology to investigate whether trusting in the fairness of the world would help someone to cope with short-term pain. Sixty-five men and 65 women completed measures of personal and general just world beliefs and state anxiety before pain induction and measures of the intensity and quality of pain, in addition to state anxiety following pain induction. The personal and general beliefs in a just world were negatively correlated with pre-task anxiety but not with measures of pain induction (threshold, tolerance and sensitivity) or measures of post-task pain. Gender had a moderating role, whereby men with a stronger general just world belief reported lower post-task state anxiety and men who had a stronger personal just world belief reported lower pain intensity. However, unexpectedly, women with a stronger personal just world belief reported higher pain intensity. The observed gender differences may be attributed to gender variations in cognitive appraisals of the task. Overall, while perceived injustice may be undesirable and a potential target for intervention, perceived justice is not necessarily a desired cognition in pain. Research is needed to replicate and extend this emerging research. © 2012 European Federation of International Association for the Study of Pain Chapters.

  1. [Administration of lysine acetylsalicylate and meperidine in acute postoperative pain].

    Science.gov (United States)

    Miralles, F S; Cárceles, M D; Micol, J A; Hernández-Palazón, J; Delpino, A L; Guillamón, L

    1992-01-01

    Postoperative analgesia is insufficiently done due, among others, to the undesirable effects of analgesic agents. The aim of this study was to analyze the effects of the simultaneous administration of opiates (meperidine) and AINES (lysine acetylsalicylate, ASL). We studied 160 patients during the immediate postoperative phase. All of them underwent programmed surgery with the same general anesthetic technique. Patients were allocated into 8 groups of treatment: A) ASL 900 mg and 1.800 mg/8 h, B) ASL 900 mg and 3.600 mg/8 h, C) ASL 900 mg and meperidine 100 mg/8 h, D) ASL 900 mg and 1.800 mg/8 h together with meperidine 100 mg/8 h, E) meperidine 50 mg and ASL 1.800 mg/8 h, F) meperidine 50 mg and ASL 3.600 mg/8 h, G) meperidine 50 mg and 100 mg/8 h, and H) meperidine 50 mg and 100 mg/8 h together with ASL 1.800 mg/8 h. The effects of analgesic agents were evaluated on the basis of patient's appreciation of the degree of pain and relief and on the basis of an observer who did not know the therapeutic regime administered. Results were compared according to the analysis of variance in a graded factorial design. A p value less than 0.05 was considered significant. The degree of pain was significantly lower in groups C, D, G and H (specially in G and H) than in the remaining groups, but there were no significant differences between them. The lowest pain relief was observed in groups A, B, E and F. The highest attenuation of pain was achieved in groups G and H. The highest attenuation of pain was achieved in groups G and H. The observer considered that the two latter groups were those with the highest pain relief, followed by groups C and D. The remaining patients failed to show appreciable improvement. Nausea and vomiting only occurred in some patients after administration of a bolus of meperidine. There were no other secondary effects. The best degree of postoperative analgesia is achieved after administration of continuous infusion of meperidine 100 mg/8 h

  2. Plain abdominal radiography in acute abdominal pain; past, present, and future

    NARCIS (Netherlands)

    Gans, Sarah L.; Stoker, Jaap; Boermeester, Marja A.

    2012-01-01

    Several studies have demonstrated that a diagnosis based solely on a patient's medical history, physical examination, and laboratory tests is not reliable enough, despite the fact that these aspects are essential parts of the workup of a patient presenting with acute abdominal pain. Traditionally,

  3. Elderly patient with acute, left lower abdominal pain: perforated jejunal diverticulitis (2010:7b)

    International Nuclear Information System (INIS)

    Franca, Manuela; Certo, Manuela; Varzim, Pedro; Silva, Donzilia; Peixoto, Carlos

    2010-01-01

    An elderly patient with acute, left, lower abdominal pain is described, for whom the diagnosis of perforated jejunal diverticulitis was established by computed tomography (CT). The presence of a jejunal segmental inflammatory process, with or without abscess or perforation, in the setting of jejunal diverticulosis, is very suggestive of jejunal diverticulitis. (orig.)

  4. Elderly patient with acute, left lower abdominal pain: perforated jejunal diverticulitis (2010:7b)

    Energy Technology Data Exchange (ETDEWEB)

    Franca, Manuela; Certo, Manuela; Varzim, Pedro [Centro Hospitalar do Porto, Radiology Department, Porto (Portugal); Silva, Donzilia [Centro Hospitalar do Porto, Surgery Department, Porto (Portugal); Peixoto, Carlos [Centro Hospitalar do Porto, Pathology Department, Porto (Portugal)

    2010-10-15

    An elderly patient with acute, left, lower abdominal pain is described, for whom the diagnosis of perforated jejunal diverticulitis was established by computed tomography (CT). The presence of a jejunal segmental inflammatory process, with or without abscess or perforation, in the setting of jejunal diverticulosis, is very suggestive of jejunal diverticulitis. (orig.)

  5. Introducing a patient-controlled analgesia-based acute pain relief ...

    African Journals Online (AJOL)

    The 10 months after the introduction of the first acute pain relief service (APRS) in southern Africa is described. Seven hundred patients were treated with morphine by means of patient-controlled analgesia (PCA), administered to patients after major surgery or extensive burns via the intravenous (IV) or subcutaneous (SC) ...

  6. Soluble Urokinase Plasminogen Activator Receptor for Risk Prediction in Patients Admitted with Acute Chest Pain

    DEFF Research Database (Denmark)

    Lyngbæk, Stig; Andersson, Charlotte; Marott, Jacob L

    2013-01-01

    Plasma concentrations of soluble urokinase plasminogen activator receptor (suPAR) predict mortality in several clinical settings, but the long-term prognostic importance of suPAR in chest pain patients admitted on suspicion of non-ST-segment elevation acute coronary syndrome (NSTEACS) is uncertain....

  7. Acute calcific tendinitis of the gluteus medius: an uncommon source for back, buttock, and thigh pain.

    Science.gov (United States)

    Paik, Nam Chull

    2014-06-01

    This study was conducted to describe the imaging features and clinical manifestations in acute calcific tendinitis (CaT) of the gluteus medius muscle (GMe). A retrospective analysis was conducted, aimed at six patients with acute calcific tendinitis of the gluteus medius muscle (CaT-GMe), who were seen between January 2011 and December 2012. Clinical presentations, radiologic data (radiography, CT, and MRI), and laboratory reports were all subject to review. All patients presented with pain and decreased range of motion (ROM) at the hip. Two of the six patients experienced pain in the anterolateral thigh and groin, with antalgic gait (anterior group). The other four complained of low back, buttock, and posterolateral thigh pain, accompanied by difficulty in standing and antalgic gait (posterior group). Edema within the GMe or effusion surrounding the muscle was regularly identified on MRIs. Calcific deposits were conspicuous in the gluteus medius tendon attachments to the lateral (anterior group) and superoposterior (posterior group) facets of the greater trochanter on radiography, CT, or MRI. Complete resolution of symptoms was uniformly achieved in 5-10 days with conservative management. Acute CaT-GMe should be considered in any patient suffering lateral hip pain (with either groin or low back pain) and ROM limitation. Images of the hip characteristically show edema of the gluteus medius and calcifications lateral or superior to the greater trochanter. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Diagnostic strategies for acute abdominal pain: The OPTIMA study

    NARCIS (Netherlands)

    Laméris, W.

    2010-01-01

    In het kader van de OPTIMA-studie deed Wytze Laméris onderzoek naar de diagnostiek bij acute buikpijn op de spoedeisende hulp. Hij keek onder meer naar de toegevoegde waarde van beeldvormend onderzoek, zoals thoraxfoto's, CT-scans van de buik en echo. Het blijkt dat een echo in eerste instantie

  9. The simple query "Do you want more pain medication?" is not a reliable way to assess acute pain relief in patients in the emergency department.

    Science.gov (United States)

    Chauny, Jean-Marc; Marquis, Martin; Paquet, Jean; Lavigne, Gilles; Cournoyer, Alexis; Manzini, Christiane; Daoust, Raoul

    2018-01-01

    The management of acute pain constitutes an essential skill of emergency department (ED) physicians. However, the accurate assessment of pain intensity and relief represents a clinically challenging undertaking. Some studies have proposed to define effective pain relief as the patient's refusal for additional analgesic administration. The aim of this study was to verify whether such a refusal is effectively indicative of pain relief. This prospective cohort study included ED patients who received single or multiple doses of pain medication for an acute pain problem. Patients were evaluated for pain relief using one Likert scale and two dichotomous questions: Is your pain relieved? and Do you want more analgesics? Non-relieved patients were further analysed using a checklist as to the reasons behind their refusal for supplemental pain medication. We have recruited 378 adult patients with a mean age of 50.3 years (±19.1); 60% were women and had an initial mean pain level of 7.3 (±2.0) out of 10. We observed that 68 out of 244 patients who were adequately relieved from pain asked for more analgesics (28%), whereas 51 out of 134 patients who were not relieved from pain refused supplemental drugs (38%). Reasons for refusal included wanting to avoid side effects, feeling sufficiently relieved, and disliking the medication's effects. Over a third of ED patients in acute pain were not relieved but refused supplemental pain medication. Patients have reported legitimate reasons to decline further analgesics, and this refusal cannot be used as an indication of pain relief.

  10. Development and preliminary validation of the Neonatal Infant Acute Pain Assessment Scale (NIAPAS).

    Science.gov (United States)

    Pölkki, Tarja; Korhonen, Anne; Axelin, Anna; Saarela, Timo; Laukkala, Helena

    2014-12-01

    Several pain scales are available for neonates, but, unfortunately they are only rarely used in clinical practice. To help with the current situation of unrecognized and under-treated pain in neonatal intensive care units (NICUs), we developed an assessment tool in close collaboration with clinical staff. To develop a multidimensional scale, NIAPAS (the Neonatal Infant Acute Pain Assessment Scale), that is sensitive to the needs of infants in neonatal intensive care units, and to test the validity, reliability, feasibility and clinical utility of the scale for this population. Instrument development and psychometric analysis. Pain assessments (n=180) were made of 34 neonates born between 23 and 42 weeks gestational age who were undergoing 60 painful procedures (heel lance 77%, tracheal suctioning 23%) in the NICU. Using bedside video recordings, each neonate was observed through three phases of the procedure: 1 min before the procedure, during the procedure (lasting from 0.6 to 11.2 min, mean 2.6), and 1 min after the procedure. In addition, an expert panel (n=5) and nurses (n=26) participated in the validation of the scale. A pool of 8 pain indicators (5 behavioral and 3 physiological indicators), including the gestational age of neonates as a contextual factor, was identified based on the nurses' expertise in neonatal intensive care. Scores on the NIAPAS changed significantly across the phases (pNeonatal Infant Pain Score) were high (0.751-0.873). The study also demonstrated high coefficients for inter-rater (r=0.991-0.997) and intra-rater reliability (r=0.992-1.00), with an internal consistency of 0.723. The content validity was very good (Mean I-CVI 1.00), as evaluated by the expert group. The nurses agreed that the scale was easy to administer and that it helped decision-making in the pain management of infants. The NIAPAS was shown to be a valid and reliable scale for assessing acute pain in preterm and full-term infants in the NICU. It allows nurses to

  11. TREATMENT FOR ACUTE NONSPECIFIC BACK PAIN IN OUTPATIENT PRACTICE

    Directory of Open Access Journals (Sweden)

    O N Gerasimova

    2009-01-01

    to 1,14± 0,95 visual analogue scores, the routine activity reached the baseline level as had been before pain occurrence; the duration of the disease being less than 2 weeks (mean 11 days. Adverse reactions caused by therapy were observed in sporadic cases; these were mild and transient. Case histories of 2 patients in whom movalis therapy was effective when the use of other nonsteroidal anti-inflammatory drugs failed are presented.

  12. Evaluation and management of acute abdominal pain in the emergency department

    Directory of Open Access Journals (Sweden)

    Macaluso CR

    2012-09-01

    Full Text Available Christopher R Macaluso, Robert M McNamaraDepartment of Emergency Medicine, Temple University School of Medicine, Philadelphia, PA, USAAbstract: Evaluation of the emergency department patient with acute abdominal pain is sometimes difficult. Various factors can obscure the presentation, delaying or preventing the correct diagnosis, with subsequent adverse patient outcomes. Clinicians must consider multiple diagnoses, especially those life-threatening conditions that require timely intervention to limit morbidity and mortality. This article will review general information on abdominal pain and discuss the clinical approach by review of the history and the physical examination. Additionally, this article will discuss the approach to unstable patients with abdominal pain.Keywords: acute abdomen, emergency medicine, peritonitis

  13. Psychosocial differences in high risk versus low risk acute low-back pain patients.

    Science.gov (United States)

    Pulliam, C B; Gatchel, R J; Gardea, M A

    2001-03-01

    The current study built upon previous research that predicted with 90.7% accuracy which patients presenting with acute low-back pain go on to develop chronic disability problems. Fifty-seven patients were classified as high risk (HR) or low risk (LR) according to a predictive algorithm, and were evaluated with a variety of psychosocial measures. Overall, HR patients had more Axis I pathology than LR patients, and used poorer coping styles. Logistic regression analyses identified variables that differentiated, with 80% accuracy, between the HR and LR patients. The results highlight the importance of identifying patients who are at risk for developing chronic pain following acute injury so that prophylactic intervention can be offered before chronic pain disability status becomes entrenched.

  14. Bowel perforation by crumpled paper in a patient presenting with acute abdominal pain

    International Nuclear Information System (INIS)

    Bakhshaeekia, Alireza; Hosseini, Seyed M.V; Razmi, Tannaz; Shamsaeefar, Alireza

    2009-01-01

    Many of the abdominal foreign bodies are due to accidental ingestion. Our objective in this case report is to emphasize the importance of the enquiry about the foreign body in the differential diagnosis of acute abdominal pain. According to our knowledge, this is the first report of bowel perforation caused by paper ingestion. A 14-year-old boy with abdominal pain underwent exploratory laparotomy and was found to have abdominal pus and ileal perforation. A crumpled paper was found at the site of perforation. Postoperative enquiry revealed that the patient had ingested 10 crumpled papers. We highlight that recording the history is an important aspect in the management of patients with acute abdominal pain and that foreign bodies should be included in its differential diagnosis. (author)

  15. Sufentanil sublingual formulation for the treatment of acute, moderate to severe postoperative pain in adult patients.

    Science.gov (United States)

    Porela-Tiihonen, Susanna; Kokki, Merja; Kokki, Hannu

    2017-02-01

    Sufentanil is a highly selective µ-opioid agonist commonly used by intravenous and intrathecal routes for acute pain. Sublingual sufentanil formulation for patient controlled analgesia (PCA) uses an innovative administration device that suspends a 15 µg nanotablet with a fixed lockout interval. The system is a non-invasive, less burdensome method of opioid delivery compared to intravenous and intrathecal routes. Sublingual nanotablet PCA transmucosal bioavailability is 59% and the meaningful analgesic onset time is 60 minutes. Areas covered: This paper focuses on the effectiveness, safety and feasibility of sufentanil PCA sublingual formulation for the management of postoperative pain. The paper is based on PubMed searches and the European Medicine Agency assessment report. Expert commentary: Under-treatment of acute pain is a substantial clinical problem. The initial experiences with the sublingual delivery system are encouraging. Sufentanil sublingual nanotablets intended for PCA device use are approved in Europe, and approval is pending in the United States.

  16. Endurance Tests Ability to predict Chronicity in First Episode Acute Low Back Pain Patients

    Directory of Open Access Journals (Sweden)

    Ali Asghar Norasteh

    2008-01-01

    Full Text Available Objective: Despite evaluation of spinal muscle endurance was done in chronic low back pain, this has not been studied in first episode acute low back pain. The purpose of present study was comparatively evaluating patients with first-episode low back pain and healthy subjects to predict disability and chronicity after six weeks with spinal muscle endurance tests. Materials & Methods: Through an analytical, cross sectional and case – control study in the first stage of research Eliot’s spinal endurance tests were used to evaluate endurance. Disability and pain were used to assess recovery. The study was conducted in two groups of patients (n=32 and normal subjects (n=51 using non-randomized simple sampling. In the second stage, a longitudinal prospective study was done. Studied variables were compared in recovered and non recovered patients after six weeks. Data were analyzed by using Kolmogorof – Smirnoff test, independent T test and Chi-Square. Results: The results of independent t tests showed lower muscular endurance in patients compared to normal individuals (P<0.0001. Also the results of independent t-tests showed lower flexor endurance in unrecovered patients (P<0.04. Conclusion: It seems low back pain patients can contract decreased endurance in the first episode and no need to repeat episodes. Results show may be endurance tests could differentiate acute low back pain patients with high risk to chronicity and disability.

  17. Meperidine (pethidine versus morphine in acute pain management of opioid-dependent patients

    Directory of Open Access Journals (Sweden)

    Solhi H

    2016-08-01

    Full Text Available Hassan Solhi,1 Hossein Sanaei-Zadeh,2 Sadra Solhi,1 Mohammad Ali Azizi Nadian,1 Morteza Gharibi,3 Bahman Sadeghi Sedeh4 1Department of Internal Medicine, Arak University of Medical Sciences, Arak, 2Emergency Room, Division of Medical Toxicology, Hazrat Ali-Asghar (p Hospital, Shiraz University of Medical Sciences, Shiraz, 3Department of Emergency Medicine, Arak University of Medical Sciences, 4Department of Social Medicine, Arak University of Medical Sciences, Arak, Iran Abstract: The present study aimed to evaluate the effectiveness of morphine and meperidine (pethidine as pain relief in opioid-dependent patients with acute pain. A total of 122 opioid-dependent patients with acute pain were included in the study. Their pain severity was assessed, using visual analog scale (VAS scores ranging from 0 to 10. The patients randomly received intravenous morphine (up to 0.15 mg/kg or meperidine (up to 1.5 mg/kg for pain control by patient control analgesia (PCA pump. The clinical opioid withdrawal scale (COWS was employed for the assessment of withdrawal symptoms. The pain relief and the emergence of withdrawal symptoms were measured at 15, 30, and 60 minutes after drug administration. The patients who received morphine reported a better pain control compared to those who received meperidine (mean ± standard deviation [SD] VAS scores 4.11±1.90 vs 5.85±2.08 at the end of the study; P<0.001. On the other hand, the patients who received meperidine indicated prominent withdrawal symptoms (mean ± SD COWS scores 4.80±2.18 vs. 1.98±0.82 at the end of the study; P<0.001. Our findings revealed that morphine can be recommended in acute pain management of opioid-dependent patients. In addition, emergency physicians should ask their patients about any drug dependence before selecting the appropriate drug for their acute pain management. Keywords: pain management, meperidine, morphine, opioid dependency, withdrawal symptoms

  18. Dor aguda no joelho do paciente idoso Acute knee pain in elderly patients

    Directory of Open Access Journals (Sweden)

    Gilberto Luís Camanho

    2008-09-01

    Full Text Available A dor aguda no joelho de pacientes idosos é freqüente, sendo caracterizada por seu aparecimento súbito, sem causa aparente, com exame radiográfico dentro dos padrões da normalidade, na maioria dos casos. A etiologia da dor aguda no joelho é decorrente de insuficiência das estruturas, e seu quadro clínico difere completamente daquele determinado pela osteoartrose, sendo sempre unilateral e ocorre na grande maioria em pacientes do sexo feminino, após a quinta década de vida, e na região medial do joelho (local de maior carga. Com o propósito de analisar as possíveis etiologias para a dor aguda do joelho de pacientes acima de 60 anos de idade, suas características e tratamento, os autores discutem as etiologias relacionadas à dor aguda: lesão meniscal, fratura por fadiga e osteonecrose idiopática.Acute knee pain in elderly patients is not uncommon, and is characterized by a sudden onset, no apparent cause, and by normal radiographic findings in most cases. The etiology of acute knee pain is the result of insufficient structures, and clinical symptoms are totally different from the symptoms seen in osteoarthrosis. This acute pain in the knee is always unilateral and in the medial region of the knee joint (site with the heaviest load, predominantly in females after the fifth decade of live. In order to consider the possible etiologies for acute knee joint pain in patients older than 60 years, its characteristics and treatment, the authors discuss etiologies related to acute pain: lesion of the meniscus, stress fracture, and idiopathic osteonecrosis.

  19. Ultrasound imaging for tailored treatment of patients with acute shoulder pain.

    Science.gov (United States)

    Ottenheijm, Ramon P G; Cals, Jochen W L; Weijers, René; Vanderdood, Kurt; de Bie, Rob A; Dinant, Geert-Jan

    2015-01-01

    The objective of this study was to assess the frequencies of ultrasound findings in patients with acute rotator cuff disorders in family medicine. In a prospective observational study, 129 patients aged 18 to 65 years with acute shoulder pain in whom the family physician suspected rotator cuff disease underwent ultrasound imaging. Rotator cuff disease was present in 81% of the patients, and 50% of them had multiple disorders. Calcific tendonitis was the most frequently diagnosed specific disorder. An age of 40 years or older was most strongly related to rotator cuff disease. Ultrasound imaging enables family physicians to rationalize treatment in nearly all patients who are aged 40 years and older with acute shoulder pain. © 2015 Annals of Family Medicine, Inc.

  20. A clinical trial comparing Lanconone® with ibuprofen for rapid relief in acute joint pain.

    Science.gov (United States)

    Girandola, Robert N; Srivastava, Shalini; Loullis, Costas C

    2016-04-06

    To study the effect of Lanconone® (1000 mg) on acute pain on exertion as compared to the standard of care, Ibuprofen (400 mg). The study recruited 72 subjects diagnosed with mild to moderate knee joint pain on exertion. Subjects with Pain Visual Analogue Scale of more than 40 mm were included. Uphill walking was provided as the stressor using Naughton's protocol on a treadmill. The subjects walked for 10 minutes continuously followed by a rest period and baseline pain score for index knee joint was recorded. Subjects were administered a single dose of Lanconone® (1000 mg)/Ibuprofen (400 mg). Thereafter the same stressor was provided at 0.5, 1, 2, 3, 4, and 6 hours, subsequently, pain scores were recorded on a visual analogue scale. Double stopwatch method was used to evaluate the onset of pain relief and time taken to meaningful pain relief. Both Lanconone® and Ibuprofen showed the first perceived pain relief at 65.31 ± 35.57 mins as compared to 60.82 ± 32.56 mins respectively. The mean time taken to experience meaningful pain relief in Lanconone® group was 196.59 ± 70.85 mins compared to 167.13 ± 71.41 mins amongst Ibuprofen group. The meaningful pain relief continued for 6 hours. The current study successfully demonstrated rapid pain-relieving potential of Lanconone® which was comparable to Ibuprofen. No adverse event related to the interventions was reported in the study. Clinical trials.gov NCT02417506 . 21 January 2015.

  1. [Multimodal distraction to relieve pain in children undergoing acute medical procedures].

    Science.gov (United States)

    Miller, Kate; Rodger, Sylvia; Bucolo, Sam; Wang, Xue-Qing; Kimble, Roy M

    2009-10-01

    Non-pharmacological approaches to pain management have been used by therapists for decades to reduce the anxiety and pain experienced by children during burn care procedures. With a greater understanding of pain and the principles behind what causes a child to be distracted, combined with access to state of the art technology, we have developed an easy to use, hand held multimodal distraction device (MMD). MMD is an interactive device that prepares the child for a procedure and uses developmentally appropriate distraction stories and games during the procedures to alleviate anxiety and pain. This paper summarizes the results of three randomized control trials. The trials aimed to understand the effectiveness of MMD as a distraction and preparation tool in reducing anxiety and pain in children undergoing burns and non-burns medical procedures compared to pure pharmacological approaches Standard Distraction (SD) and off the shelf video games (VG). Three separate prospective randomized control trials involving 182 children having 354 dressing changes were conducted in the burns and orthopedic departments at Royal Children's Hospital, Brisbane, Australia, to address the above aims. Pain and anxiety scores were completed for the child, caregiver and nursing staff according to the Modified Faces, Legs, Activity, Cry and Consolability Scale, Faces Pain Scale-Revised, Visual Analogue Scale and Wong-Baker Faces Pain Rating Scale. Procedural length was recorded. MMD as a preparation and distraction tool were shown to have a significant impact on child, parent and nursing staff reported anxiety and pain during procedures compared to standard care and video games (P < 0.01). The MMD had a positive effect on clinical time and was shown to sustain its impact on pain and time with further dressing changes. MMD is more effective in reducing the pain and anxiety experienced by children in acute medical procedures as compared with SD and VG. MMD is continuing to be trialed and is

  2. Investigation of inflammatory markers in horses with acute abdominal pain

    DEFF Research Database (Denmark)

    Pihl, Tina Holberg; Kjelgaard-Hansen, Mads; Andersen, Pia Haubro

    Background The use of acute phase proteins as objective markers of underlying pathology may facilitate the decision-making regarding diagnosis, treatment and estimation of prognosis of colic horses in a referral hospital. Evaluation of acute phase proteins in both serum and peritoneal fluid...... 19 healthy control horses. SAA and haptoglobin were measured in both serum and PF. Colic cases were classified according to diagnosis, treatment and outcome based on the clinical records. Protein concentrations were compared between groups with student´s t-test and ANOVA. Results Colic horses had...... and haptoglobin can be measured in equine peritoneal fluid similar to measurements in serum. The peritoneal fluid concentrations are more indicative of diagnosis, treatment necessary and outcome than the serum concentrations. Potential relevance Evaluation of SAA and haptoglobin in serum and peritoneal fluid...

  3. Effect of riluzole on acute pain and hyperalgesia in humans

    DEFF Research Database (Denmark)

    Hammer, N A; Lillesø, J; Pedersen, J L

    1999-01-01

    injury on the distal leg (47 degrees C, 7 min, 12.5 cm2) in 20 healthy volunteers. Hyperalgesia to mechanical and heat stimuli were examined by von Frey hairs and thermodes. We used a randomized, double-blind, placebo-controlled design, and subjects received riluzole 100 mg or placebo for 2 days...... with a 14-day interval. The burns produced significant hyperalgesia, but riluzole had no acute analgesic effects in normal or hyperalgesic skin....

  4. Clinical, nociceptive and psychological profiling to predict acute pain after total knee arthroplasty

    DEFF Research Database (Denmark)

    Luna, I E; Kehlet, H; Petersen, M A

    2017-01-01

    ). The prediction of acute post-TKA pain was assessed by univariate analysis, logistic regressions and ROC curves. RESULTS: Reduced PPT on the arm and increased PCS were predictive variables for moderate/severe post-TKA pain 24 h after surgery (P = 0.007 and P = 0.026, respectively, R-squared 0.21) in the logistic...... regression model. Odds ratios were 0.67 for a 50 kPa increased PPT and 1.36 for a 5 point increase in PCS. A predictive model with cut-off values of PPT ≤ 245 kPa and PCS≥ 8 point had a sensitivity of 71.4 and a specificity of 62.5. CONCLUSION: Pre-operative widespread pressure pain hypersensitivity and pain...

  5. Direct Radiofrequency Application Improves Pain and Gait in Collagenase-Induced Acute Achilles Tendon Injury

    Directory of Open Access Journals (Sweden)

    Yun-Pu Tsai

    2013-01-01

    Full Text Available Radiofrequency (RF is often used as a supplementary and alternative method to alleviate pain for chronic tendinopathy. Whether or how it would work for acute tendon injury is not addressed in the literatures. Through detailed pain and gait monitoring, we hypothesized that collagenase-induce acute tendinopathy model may be able to answer these questions. Gait parameters, including time, distance, and range of motion, were recorded and analyzed using a walking track equipped with a video-based system. Expression of substance P (SP, calcitonin gene related peptide (CGRP, and galanin were used as pain markers. Beta-III tubulin and Masson trichrome staining were used as to evaluate nerve sprouting, matrix tension, and degeneration in the tendon. Of fourteen analyzed parameters, RF significantly improved stance phase, step length, preswing, and intermediary toe-spread of gait. Improved gait related to the expression of substance P, CGRP, and reduced nerve fiber sprouting and matrix tension, but not galanin. The study indicates that direct RF application may be a valuable approach to improve gait and pain in acute tendon injury. Altered gait parameters may be used as references to evaluate therapeutic outcomes of RF or other treatment plan for tendinopathy.

  6. Acute Hypoglycemia Induces Painful Neuropathy and the Treatment of Coenzyme Q10

    Directory of Open Access Journals (Sweden)

    Yan Ping Zhang

    2016-01-01

    Full Text Available Diabetic neuropathic pain is reduced with tight glycemic control. However, strict control increases the risk of hypoglycemic episodes, which are themselves linked to painful neuropathy. This study explored the effects of hypoglycemia-related painful neuropathy. Pretreatment with coenzyme Q10 (CoQ10 was performed to explore the preventive effect of CoQ10 on hypoglycemia-related acute neuropathic pain. Two strains of mice were used and 1 unit/kg of insulin was given to induce hypoglycemia. Mechanical sensitivity of hindpaw withdrawal thresholds was measured using von Frey filaments. Blood glucose levels were clamped at normal levels by joint insulin and glucose injection to test whether insulin itself induced hypersensitivity. Results suggest that the increased mechanical sensitivity after insulin injection is related to decreased blood glucose levels. When blood glucose levels remained at a normal level by the linked administration of insulin and glucose, mice demonstrated no significant change in mechanical sensitivity. Pretreatment with CoQ10 prevented neuropathic pain and the expression of the stress factor c-Fos. These results support the concept that pain in the diabetic scenario can be the result of hypoglycemia and not insulin itself. Additionally, pretreatment with CoQ10 may be a potent preventive method for the development of neuropathic pain.

  7. A Survey of Acute Pain Service Structure and Function in United States Hospitals

    Directory of Open Access Journals (Sweden)

    Dawood Nasir

    2011-01-01

    Full Text Available Although the number of U.S. hospitals offering an acute pain service (APS is increasing, the typical structure remains unknown. This survey was undertaken to describe the structure and function of the APS in U.S. hospitals only. We contacted 200 non-teaching and 101 teaching U.S. hospitals. The person in charge of postoperative pain management completed and returned the survey. Seventy-four percent of responding hospitals had an organized APS. An APS was significantly more formally organized in academic/teaching hospitals when compared to non-teaching hospitals. Pain assessments included “pain at rest” (97%, “pain on activity” (63%, and reassessment after pain therapy intervention (88.8%. Responding hospitals utilized postoperative pain protocols significantly more commonly in teaching hospitals when compared to non-teaching and VA hospitals. Intravenous patient controlled analgesia (IV-PCA was managed most commonly by surgeons (75%, while epidural analgesia and peripheral nerve block infusions were exclusively managed by anesthesiologists. For improved analgesia, 62% allowed RNs to adjust the IV-PCA settings within set parameters, 43% allowed RN adjustment of epidural infusion rates, and 21% allowed RN adjustment of peripheral nerve catheter local anesthetic infusion rates.

  8. Effects of Acute Alcohol Intoxication on Empathic Neural Responses for Pain

    Directory of Open Access Journals (Sweden)

    Yang Hu

    2018-01-01

    Full Text Available The questions whether and how empathy for pain can be modulated by acute alcohol intoxication in the non-dependent population remain unanswered. To address these questions, a double-blind, placebo-controlled, within-subject study design was adopted in this study, in which healthy social drinkers were asked to complete a pain-judgment task using pictures depicting others' body parts in painful or non-painful situations during fMRI scanning, either under the influence of alcohol intoxication or placebo conditions. Empathic neural activity for pain was reduced by alcohol intoxication only in the dorsal anterior cingulate cortex (dACC. More interestingly, we observed that empathic neural activity for pain in the right anterior insula (rAI was significantly correlated with trait empathy only after alcohol intoxication, along with impaired functional connectivity between the rAI and the fronto-parietal attention network. Our results reveal that alcohol intoxication not only inhibits empathic neural responses for pain but also leads to trait empathy inflation, possibly via impaired top-down attentional control. These findings help to explain the neural mechanism underlying alcohol-related social problems.

  9. [Intra-abdominal pressure as a surgery predictor in patients with acute abdominal pain].

    Science.gov (United States)

    Campos-Muñoz, Manuel Alejandro; Villarreal-Ríos, Enrique; Chimal-Torres, Mariano; Pozas-Medina, Josué Atila

    2016-01-01

    Intra-abdominal pressure is the pressure's state of balance within the abdominal cavity when a patient is at rest. This pressure may vary during mechanical ventilation or spontaneous breathing. The objective was to establish the intra-abdominal pressure as a surgery predictor in patients with acute abdominal pain. From April to December, 2013, it was carried out a nested case-control study on patients with acute abdominal pain in the emergency room of a second level hospital. Thirty-seven patients fit the inclusion criteria; they all underwent surgery with a previous measurement of the intra-abdominal pressure. Based on the results of the anatomopathological study, we divided the patients into two groups: those with evidence of acute abdominal inflammatory process (n=28) (case group), and patients without evidence of acute abdominal inflammatory process (n=9) (control group). In the case group, 100 % of patients shown high intra-abdominal pressure with a p=0.01 (OR=5 [95 % CI=2.578-9.699]. In the case group, the mean intra-abdominal pressure was 11.46, and in the control group 9.2 (p=0.183). Abdominal pain requiring surgical intervention is directly related to intra-abdominal pressure>5 mmHg.

  10. Acute abdominal and pelvic pain in pregnancy: MR imaging as a valuable adjunct to ultrasound?

    Science.gov (United States)

    Masselli, Gabriele; Brunelli, Roberto; Casciani, Emanuele; Polettini, Elisabetta; Bertini, Luca; Laghi, Francesca; Anceschi, Maurizio; Gualdi, Gianfranco

    2011-10-01

    To investigate the usefulness of magnetic resonance imaging (MRI) in the evaluation of pregnant women with acute abdominal and pelvic pain after sonographically (US) indeterminate findings. Forty pregnant patients with acute abdominal and/or pelvic pain, in whom ultrasound was indeterminate, were included in this study. Multiplanar MR images of the abdomen and pelvis were obtained and independently reviewed by two radiologists with discrepancies were resolved by consensus. Correlation of prospective clinical MR interpretations with surgical and obstetric records and clinical follow-up showed correct identification of disease entities in all 40/40 patients. The following disease processes were correctly identified using MRI in 21/40 patients: appendicitis (n = 5), ileal volvulus (n = 1), common bile duct lithiasis (n = 2), pubic chondrosarcoma (n = 1), uterine dehiscence (n = 1), placental hematoma (n = 3), iliac venous thrombosis (n = 2), ulcerative colitis (n = 1), acute pancreatitis (n = 1), hydronephrosis (n = 1), ovarian dermoid (n = 1), and ovarian torsion (n = 2). 19 of the 40 patients had normal findings on MR examinations and unremarkable follow-up. Interobserver agreement for lesion detection was excellent (0.95 k). Magnetic resonance imaging (MRI) is an accurate investigation in detecting the cause of acute abdominal and pelvic pain during pregnancy and should be considered after US indeterminate findings.

  11. [Appendicitis versus non-specific acute abdominal pain: Paediatric Appendicitis Score evaluation].

    Science.gov (United States)

    Prada Arias, Marcos; Salgado Barreira, Angel; Montero Sánchez, Margarita; Fernández Eire, Pilar; García Saavedra, Silvia; Gómez Veiras, Javier; Fernández Lorenzo, José Ramón

    2018-01-01

    Non-specific acute abdominal pain is the most common process requiring differential diagnosis with appendicitis in clinical practice. The aim of this study was to assess the Paediatric Appendicitis Score in differentiating between these two entities. All patients admitted due to suspicion of appendicitis were prospectively evaluated in our hospital over a two-year period. Cases of non-specific acute abdominal pain and appendicitis were enrolled in the study. Several variables were collected, including Score variables and C-reactive protein levels. Descriptive, univariate and multivariate analyses and diagnostic accuracy studies (ROC curves) were performed. A total of 275 patients were studied, in which there were 143 cases of non-specific acute abdominal pain and 132 cases of appendicitis. Temperature and right iliac fossa tenderness on palpation were the variables without statistically significant differences, and with no discrimination power between groups. Pain on coughing, hopping, and/or percussion tenderness in the right lower quadrant was the variable with greater association with appendicitis. The Score correctly stratified the patients into risk groups. Substitution of temperature for C-reactive protein in the Score increased diagnostic accuracy, although with no statistically significant differences. The Paediatric Appendicitis Score helps in differential diagnosis between appendicitis and non-specific acute abdominal pain. It would be advisable to replace the temperature in the Score, since it has no discrimination power between these groups. C-reactive protein at a cut-off value of 25.5mg/L value could be used instead. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Acute chest pain in a top soccer player due to thoracic disc herniation.

    Science.gov (United States)

    Baranto, Adad; Börjesson, Mats; Danielsson, Barbro; Hellström, Mikael; Swärd, Leif

    2009-05-01

    Case report. An unusual and previously not reported case of upper thoracic disc herniation combined with acute chest pain, is presented. Disc herniation in the thoracic spine is rare. There are only a few cases of thoracic disc herniation in top athletes presented in the literature. The clinical presentation of a thoracic disc herniation can vary widely depending on its location and morphologic characteristics. Clinically, the acute symptoms may be severe. A 24-year-old soccer player with acute left-sided chest pain that started in the middle of a soccer game has been followed clinically and with MRI examinations for 3 years. MRI of the thoracic spine showed a left-sided paramedial disc herniation at T2-T3 level and the right-sided paramedial disc herniation at T3-T4 level. The player was prescribed initial rest and subsequent physical rehabilitation. He had no further symptoms during rehabilitation to full training, and could resume play and remained symptom free for the rest of the season.The following season, the player experienced a similar sudden thoracic pain episode during training. This time the chest pain was right-sided. A new MRI of the thoracic spine showed unchanged findings. The initial rehabilitation was similar to the one used in the first episode. After 15 months with no symptoms during normal life the player was allowed to increase the intensity of training gradually and after 2 years the patient played soccer at elite level again. However, 3 years later the symptoms relapsed and the player ended his career after another rehabilitation period. In conclusion, it is important to consider thoracic disc herniation as acute chest pain in athletes and that the long-term prognosis of this entity is not always good.

  13. Dexketoprofen-induced antinociception in animal models of acute pain: synergy with morphine and paracetamol.

    Science.gov (United States)

    Miranda, Hugo F; Puig, Margarita M; Dursteler, Christian; Prieto, Juan Carlos; Pinardi, Gianni

    2007-02-01

    The antinociceptive activity of dexketoprofen was studied in mice using the acetic acid writhing test (acute tonic pain), the tail flick test (acute phasic pain) and the formalin assay (inflammatory pain). Isobolographic analysis was used to study the antinociceptive interactions between morphine and paracetamol co-administered with dexketoprofen. In the writhing test, the intraperitoneal administration of dexketoprofen or ketoprofen resulted in parallel dose-response curves with equal efficacy, but higher relative potency for dexketoprofen. In the tail flick test, the curves were parallel with similar efficacy and potency. The administration of morphine or paracetamol in both tests resulted in dose-response curves not parallel with that of dexketoprofen, which showed a potency between morphine and paracetamol. In the formalin assay, the antinociceptive activity of morphine during phase I was 122, 295 and 1695 times higher than dexketoprofen, ketoprofen and paracetamol, respectively. Isobolographic analysis demonstrated that the combination of sub-analgesic doses of dexketoprofen with morphine or with paracetamol was strongly synergic in all three tests. Synergistic drug combinations should improve effective pharmacological treatment of pain, minimizing drug specific adverse effects. These findings are undoubtedly worthy of additional controlled clinical trials in severe pain syndromes.

  14. Predictors of outcome in neck pain patients undergoing chiropractic care: comparison of acute and chronic patients

    Directory of Open Access Journals (Sweden)

    Peterson Cynthia

    2012-08-01

    Full Text Available Abstract Background Neck pain is a common complaint in patients presenting for chiropractic treatment. The few studies on predictors for improvement in patients while undergoing treatment identify duration of symptoms, neck stiffness and number of previous episodes as the strong predictor variables. The purpose of this study is to continue the research for predictors of a positive outcome in neck pain patients undergoing chiropractic treatment. Methods Acute ( 3 months (n = 255 neck pain patients with no chiropractic or manual therapy in the prior 3 months were included. Patients completed the numerical pain rating scale (NRS and Bournemouth questionnaire (BQ at baseline prior to treatment. At 1 week, 1 month and 3 months after start of treatment the NRS and BQ were completed along with the Patient Global Impression of Change (PGIC scale. Demographic information was provided by the clinician. Improvement at each of the follow up points was categorized using the PGIC. Multivariate regression analyses were done to determine significant independent predictors of improvement. Results Baseline mean neck pain and total disability scores were significantly (p  Conclusions The most consistent predictor of clinically relevant improvement at both 1 and 3 months after the start of chiropractic treatment for both acute and chronic patients is if they report improvement early in the course of treatment. The co-existence of either radiculopathy or dizziness however do not imply poorer prognosis in these patients.

  15. Pain management of acute appendicitis in Canadian pediatric emergency departments.

    Science.gov (United States)

    Robb, Andrea L; Ali, Samina; Poonai, Naveen; Thompson, Graham C

    2017-11-01

    Children with suspected appendicitis are at risk for suboptimal pain management. We sought to describe pain management patterns for suspected appendicitis across Canadian pediatric emergency departments (PEDs). A retrospective medical record review was undertaken at 12 Canadian PEDs. Children ages 3 to 17 years who were admitted to the hospital in February or October 2010 with suspected appendicitis were included. Patients were excluded if partially assessed or treated at another hospital. Data were abstracted using a study-specific, standardized electronic data extraction tool. The primary outcome was the proportion of children who received analgesia while in the emergency department (ED). Secondary outcomes included the proportion of children receiving intravenous (IV) morphine and the timing of analgesic provision. A total of 619 health records were abstracted; mean (SD) patient age was 11.4 (3.5) years. Sixty-one percent (381/616) of patients received analgesia in the ED; 42.8% (264/616) received IV morphine. Other analgesic agents provided included oral acetaminophen (23.5% [145/616]) and oral ibuprofen (5.8% [36/616]). The median (IQR) initial dose of IV morphine was 0.06 (0.04, 0.09) mg/kg. The median (IQR) time from triage to the initial dose of analgesia was 196 (101, 309.5) minutes. Forty-three percent (117/269) of children receiving analgesia received the initial dose following surgical consultation; 43.7% (121/277) received their first analgesic after abdominal ultrasound was performed. Suboptimal and delayed analgesia remains a significant issue for children with suspected appendicitis in Canadian PEDs. This suggests a role for multidimensional knowledge translation interventions and care protocols to improve timely access to analgesia.

  16. Long-Term Clinical Impact of Coronary CT Angiography in Patients With Recent Acute-Onset Chest Pain

    DEFF Research Database (Denmark)

    Linde, Jesper J; Hove, Jens D; Sørgaard, Mathias

    2015-01-01

    . BACKGROUND: The prognostic implications of a coronary CTA-guided treatment strategy have not been compared in a randomized fashion to standard care in patients referred for acute-onset chest pain. METHODS: Patients with acute chest pain but normal electrocardiograms and troponin values were randomized......) in the standard care group (p = 0.04; HR: 0.36 [95% CI: 0.16 to 0.95]). Differences in cardiac death and MI (8 vs. 2) were insignificant (p = 0.06). CONCLUSIONS: A coronary CTA-guided treatment strategy appears to improve clinical outcome in patients with recent acute-onset chest pain and normal...

  17. [Implementation of a web based software for documentation and control of quality of an acute pain service].

    Science.gov (United States)

    Pawlik, Michael T; Abel, Reinhard; Abt, Gregor; Kieninger, Martin; Graf, Bernhard Martin; Taeger, Kai; Ittner, Karl Peter

    2009-07-01

    Providing an acute pain service means accumulation of a large amount of data. The alleviation of data collection, improvement of data quality and data analysis plays a pivotal role. The electronic medical record (EMR) is gaining more and more importance in this context and is continuously spreading in clinical practice. Up to now only a few commercial softwares are available that specifically fit to the needs of an acute pain service. Here we report the development and implementation of such a program (Schmerzvisite, Medlinq, Hamburg, Germany) in the acute pain service of a University Hospital.

  18. Why does Acute Postwhiplash Injury Pain Transform into Chronic Pain Multimodal Assessment of Risk Factors and Predictors of Pain Chronification

    Science.gov (United States)

    2016-10-19

    Haifa, Israel. 4d. Consultation regarding the psychological data is done by the team at Griffith University, Australia . 4. KEY RESEARCH...our study, HRPO submissions and communications , pain application development, purchases, FITBIR accounts, preparing all study documentations...coordinator / Study nurse Researcher Identifier: Nearest person month worked: 1 Contribution to Project: Hen identifies potential patients in

  19. TREATMENT OF ACUTE INFLAMMATORY DISEASES ACCOMPANIED BY THROAT IRRITATION AND PAIN

    Directory of Open Access Journals (Sweden)

    M. I. Petrovskaya

    2013-01-01

    Full Text Available Pathogenetically, prescription of local action drugs containing a wide spectrum antiseptic is reasonable for the upper respiratory tract diseases accompanied by throat irritation and pain. It should be noted that such drugs are very popular among parents; however, most of these drugs may have a range of side effects, which considerably complicate their use in children. That is why the right choice of local action drugs for the acute inflammatory diseases accompanied by throat irritation and pain is a guarantee of treatment efficacy and high compliance. This article examines pharmacological qualities of an antiseptic-containing local action drug permitted to use in children over 4 years of age.

  20. Towards remote assessment and screening of acute abdominal pain using only a smartphone with native accelerometers

    OpenAIRE

    Myers, David R.; Weiss, Alexander; Rollins, Margo R.; Lam, Wilbur A.

    2017-01-01

    Smartphone-based telehealth holds the promise of shifting healthcare from the clinic to the home, but the inability for clinicians to conduct remote palpation, or touching, a key component of the physical exam, remains a major limitation. This is exemplified in the assessment of acute abdominal pain, in which a physician’s palpation determines if a patient’s pain is life-threatening requiring emergency intervention/surgery or due to some less-urgent cause. In a step towards virtual physical e...

  1. Acute lower abdominal pain caused by adnexal torsion in a ten-year-old girl

    DEFF Research Database (Denmark)

    Steinthorsdottir, Kristin Julia; Hansen, Lars Folmer; Bisgaard, Thue

    2014-01-01

    A ten-year-old girl presented with four days of lower abdominal pain. A diagnostic laparoscopy on the suspicion of acute appendicitis revealed left-sided adnexal torsion. The cyanotic ovary was detorsed and recovered. At three-month follow-up there were no clinical or ultrasonic signs of pathology....... The clinical presentation of adnexal torsion is unspecific and mimics several differential diagnosis. Adnexal torsion is a rare condition, especially in pre-pubertal girls. However, it must still be kept in mind when evaluating girls regardless of age with lower abdominal pain....

  2. An elderly man with acute anterior neck pain and odynophagia after a meal

    Directory of Open Access Journals (Sweden)

    Irfan Mohamad

    2013-12-01

    Full Text Available The upper aerodigestive tract, specifically the cricopharyngeal area, is the most common site of foreign body impaction. Anatomically, this area is the first constriction of the oesophagus. Fish bones, one of the most common foreign bodies encountered in the throat, tend to get stuck in this area. The movement of this sharp-edged foreign body upon swallowing will induce odynophagia and an acute onset of neck pain. We report a case of a healthy elderly man who complained of sudden anterior neck pain and odynophagia after eating yellowtail scad fish.

  3. Unusual Cause of Acute Scrotal Pain-Inflammatory Noncommunicating Hydrocele: A Pediatric Case Report

    Science.gov (United States)

    Moritoki, Yoshinobu; Kato, Taiki; Hayashi, Yutaro

    2018-01-01

    The etiology of scrotal pain is clinically classified in terms of the necessity for emergency surgery. Lately, color Doppler ultrasonography has reduced unnecessary surgeries, but there are still some cases that require immediate exploration because of an uncertain diagnosis. Here, we describe the case of a 14-month-old boy, who could not deliver his complaint accurately, presenting with a grumpy mood and a red swollen scrotum. Emergency surgery revealed that the cause was intense inflammation of the hydrocele wall, which typically does not cause acute scrotum. We also reviewed rare etiologies of scrotal pain for general physicians to develop the differential diagnosis. PMID:29560001

  4. [The influence of the menstrual cycle on acute and persistent pain after laparoscopic cholecystectomy].

    Science.gov (United States)

    Sari, Sinem; Kozanhan, Betul; Egilmez, Ayse Ilksen; Soyder, Aykut; Aydin, Osman Nuri; Galimberti, Fabrizio; Sessler, Daniel; Turan, Alparslan

    2018-01-16

    Fluctuations of female sex hormones during menstrual cycle influence pain perception. Endogenous pain inhibition is impaired in follicular phase of menstrual cycle. We tested the primary hypothesis that the women having surgery during their follicular phase have more acute pain and require higher opioids than those in the luteal phase, and secondarily we tested that women who have surgery during their follicular phase have more incisional pain at 3 month postoperatively. 127 adult females having laparoscopic cholecystectomy were randomized to have surgery during the luteal or follicular phase of their menstrual cycle. Standardized anesthesia and pain management regimen was given to all patients. Pain and analgesic consumption were evaluated in post-anesthesia care unit and every 4h in the first 24h. Adverse effects were questioned every 4h. Time to oral intake and ambulation were recorded. Post-surgical pain, hospital anxiety, depression scale, SF-12 questionnaire were evaluated at 1 and 3 month visits. There was no difference in acute pain scores and analgesic consumption through the 24h period, Visual Analog Scale at 24h was 1.5±1.5cm for follicular group 1.4±1.7cm for luteal group (p=0.57). Persistent postoperative pain was significantly more common one and at three month, with an incidence was 33% and 32% in the patients at follicular phase versus 16% and 12% at luteal phase, respectively. The Visual Analog Scale at one and at three month was 1.6±0.7cm and 1.8±0.8cm for follicular group and 2.7±1.3cm and 2.9±1.7cm in the luteal group (p=0.02), respectively. There were no significant differences between the groups with respect to anxiety and depression, SF-12 scores at either time. Nausea was more common in follicular-phase group (p=0.01) and oral feeding time was shorter in follicular phase (5.9±0.9h) than in luteal phase (6.8±1.9h, p=0.02). Although persistent postoperative pain was significantly more common one and three months after surgery the

  5. Benztropine for the relief of acute non-traumatic neck pain (wry neck): a randomised trial.

    Science.gov (United States)

    Asha, Stephen Edward; Kerr, Andrew; Jones, Keryn; McAlpine, Ann

    2015-08-01

    The aim of this study was to determine the effect of intra-muscular benztropine on pain and range of motion in patients presenting to the emergency department with acute, non-traumatic neck pain (wry neck). In this two-centre randomised, double-blind, placebo-controlled, parallel-group superiority trial, participants were allocated to receive 2 mg intramuscular benztropine or normal saline. Participants were aged 16-65 years, no history of neck disorders and no use of medication that cause dystonia. Randomisation was computer generated, with allocation concealment by opaque sequentially numbered sealed envelopes. Pain scores and neck range of motion were measured immediately before drug administration, and 30 min after. Pain scores, range of motion and adverse effects were compared between the groups. No funding was received. The trial was registered. Thirty participants were enrolled, 15 randomised to placebo and 15 to benztropine. Pain scores at 30 min were lower in those allocated to benztropine, but the difference was neither statistically nor clinically significant (0.6 points, 95% CI -0.8 to 1.8, p=0.40). The range of motion of the cervical spine was greater in those receiving benztropine, but the differences were very small and not statistically significant. Adverse events were more common in those receiving benztropine. Benztropine was ineffective for reducing pain or improving range of motion of the cervical spine in patients suffering from acute, non-traumatic neck pain, but frequently caused anticholinergic side effects. However, as the CI for the primary outcome included the minimum difference considered clinically significant, an important effect of benztropine cannot be ruled out. ANZCTR#12612000354886. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  6. Why Does Acute Postwhiplash Injury Pain Transform into Chronic Pain Multimodal Assessment of Risk Factors and Predictors of Pain Chronification

    Science.gov (United States)

    2017-10-01

    Psychophysical, neurophysiological, psychological , imaging and genetic data are being collected within 72 hours. Patients are being followed up for one year. 2...at University of Haifa, Israel. 4d. Consultation regarding the psychological data is done by the team at Griffith University, Australia. 4...below. A first paper out of this study is in the final stages of writing. It analyses the baseline QST, demographic and pain-related psychological

  7. Acute abdominal pain presenting as a rare appendiceal duplication: a case report

    Directory of Open Access Journals (Sweden)

    Mahmood Ali

    2012-03-01

    Full Text Available Abstract Introduction Appendiceal duplication is a rare anomaly that can manifest as right lower quadrant pain. There are several variations described for this condition. We recommend aggressive operative management should this anatomical variation present in the presence of acute appendicitis. Case presentation We report the case of a 15-year-old African American girl who presented to our hospital with right lower quadrant pain and was subsequently found to have appendiceal duplication. Conclusion There are two categorical systems that have described and stratified appendiceal duplication. Both classification systems have been outlined and referenced in this case report. A computed tomography scan has been included to provide a visual aid to help identify true vermiform appendiceal duplication. The presence of this anatomical abnormality is not a reason for surgical intervention; however, should this be found in the setting of acute appendicitis, aggressive resection of both appendices is mandatory.

  8. Acute neck pain caused by arthritis of atlanto-axial joint

    International Nuclear Information System (INIS)

    Kobayashi, Takashi; Ishikawa, Yoshinori; Abe, Eiji; Konno, Norikazu; Noguchi, Hideaki

    2009-01-01

    We reviewed 27 cases in which the patient complained of acute neck pain. We had performed arthrocentesis of the atlanto-axial joint in every case. An aspirate was obtained in 16 of the cases, and calcium pryophosphate dihydrate (CPPD) crystals were demonstrated in 10 of them. The patients' scores on the visual analogue scale decreased 30 minutes after aspiration of the crystals (p<0.001). CT demonstrated calcification of the transverse ligament in 22 cases, calcification anterior to the body of C2 in 2 cases, and no calcification in 3 cases. The results in these patients suggest that acute neck pain in some elderly patients is related to arthritis of the atlanto-axial joint. (author)

  9. Conceptual and operational definitions of the components of the nursing diagnosis Acute Pain (00132).

    Science.gov (United States)

    Correia, Marisa Dibbern Lopes; Duran, Erika Christiane Marocco

    2017-12-21

    to develop the operational and conceptual definitions of the defining characteristics and related factors of the nursing diagnosis Acute Pain (00132) for nonverbal critically ill patients. integrative literature review in the databases/libraries: Medical Literature Analysis and Retrieval System Online (MEDLINE via Pubmed), Cochrane Library, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Latin American & Caribbean Health Sciences Literature (LILACS). 799 results were found in the literature, of which 80 studies were selected for full text reading and 16 were used in the elaboration of definitions for the 17 defining characteristics and three related factors of the nursing diagnosis. The gray literature, ie, thesis, dissertations, books, guidelines and dictionary was also explored to ensure the robustness needed to clarify the topics not covered by the studies. the definitions aim to facilitate the identification of the nursing diagnosis for nonverbal critically ill patients and to support future teaching and research on the nursing diagnosis of Acute Pain (00132).

  10. Prevalence of acute neuropathic pain after cancer surgery: A prospective study

    Directory of Open Access Journals (Sweden)

    P N Jain

    2014-01-01

    Full Text Available Background and Aims: Acute neuropathic pain (ANP is an under-recognised and under-diagnosed condition and often difficult to treat. If left untreated, it may further transform into persistent post-operative chronic pain leading to a disability. Aims: This prospective study was undertaken on 300 patients to identify the prevalence of ANP in the post-operative period by using a neuropathic pain detection questionnaire tool. Methods: This is an open-label study in which patients with six different types of cancer surgeries (Thoracic, gastro-intestinal, gynae/urology, bone/soft-tissue, head and neck and breast subgroups-50 each were included for painDETECT questionnaire tool on the 2 nd and 7 th day surgery. Results: This study found a 10% point prevalence of ANP. Analysis showed that 25 patients had ′possible′ ANP, the maximum from urological cancer surgery (6 followed by thoracic surgery (5. Five patients were found to have ′positive′ ANP including 2 groin node dissection, 2 hemipelvectomy and 1 oesophagectomy. Conclusion: Significant relationship between severity of post-operative pain was found with the occurrence of ANP in the post-operative period requiring a special attention to neuropathic pain assessment. Larger studies are required with longer follow-up to identify accurately the true prevalence and causative factors of ANP after surgery.

  11. Acute Pain and Depressive Symptoms: Independent Predictors of Insomnia Symptoms among Adults with Sickle Cell Disease.

    Science.gov (United States)

    Moscou-Jackson, Gyasi; Allen, Jerilyn; Kozachik, Sharon; Smith, Michael T; Budhathoki, Chakra; Haywood, Carlton

    2016-02-01

    No studies to date have systematically investigated insomnia symptoms among adults with sickle cell disease (SCD). The purpose of this study was to (1) describe the prevalence of insomnia symptoms and (2) identify biopsychosocial predictors in community-dwelling adults with SCD. Cross-sectional analysis of baseline data from 263 African American adults with SCD (aged 18 years or older). Measures included the Insomnia Severity Index (ISI), Center for Epidemiologic Studies in Depression scale, Urban Life Stress Scale, Brief Pain Inventory, and a chronic pain item. SCD genotype was extracted from the medical record. A slight majority (55%) of the sample reported clinically significant insomnia symptomatology (ISI ≥ 10), which suggests that insomnia symptoms are prevalent among community-dwelling African American adults with SCD. While insomnia symptoms were associated with a number of biopsychosocial characteristics, depressive symptoms and acute pain were the only independent predictors. Given the high number of participants reporting clinically significant insomnia symptoms, nurses should screen for insomnia symptoms and explore interventions to promote better sleep among adults with SCD, with an emphasis on recommending treatment for pain and depression. In addition, current pain and depression interventions in this population could add insomnia measures and assess the effect of the intervention on insomnia symptomatology as a secondary outcome. Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  12. Short-term changes in neck pain, widespread pressure pain sensitivity, and cervical range of motion after the application of trigger point dry needling in patients with acute mechanical neck pain: a randomized clinical trial.

    Science.gov (United States)

    Mejuto-Vázquez, María J; Salom-Moreno, Jaime; Ortega-Santiago, Ricardo; Truyols-Domínguez, Sebastián; Fernández-de-Las-Peñas, César

    2014-04-01

    Randomized clinical trial. To determine the effects of trigger point dry needling (TrPDN) on neck pain, widespread pressure pain sensitivity, and cervical range of motion in patients with acute mechanical neck pain and active trigger points in the upper trapezius muscle. TrPDN seems to be effective for decreasing pain in individuals with upper-quadrant pain syndromes. Potential effects of TrPDN for decreasing pain and sensitization in individuals with acute mechanical neck pain are needed. Methods Seventeen patients (53% female) were randomly assigned to 1 of 2 groups: a single session of TrPDN or no intervention (waiting list). Pressure pain thresholds over the C5-6 zygapophyseal joint, second metacarpal, and tibialis anterior muscle; neck pain intensity; and cervical spine range-of-motion data were collected at baseline (pretreatment) and 10 minutes and 1 week after the intervention by an assessor blinded to the treatment allocation of the patient. Mixed-model analyses of variance were used to examine the effects of treatment on each outcome variable. Patients treated with 1 session of TrPDN experienced greater decreases in neck pain, greater increases in pressure pain threshold, and higher increases in cervical range of motion than those who did not receive an intervention at both 10 minutes and 1 week after the intervention (Pneck pain intensity and widespread pressure pain sensitivity, and also increase active cervical range of motion, in patients with acute mechanical neck pain. Changes in pain, pressure pain threshold, and cervical range of motion surpassed their respective minimal detectable change values, supporting clinically relevant treatment effects. Level of Evidence Therapy, level 1b-.

  13. Assessment of patient satisfaction with acute pain management service: Monitoring quality of care in clinical setting

    OpenAIRE

    Farooq, Fizzah; Khan, Robyna; Ahmed, Aliya

    2016-01-01

    Background and Aims: Assessment of patient satisfaction is an important tool for monitoring the quality of care in hospitals. The aim of this survey was to develop a reliable tool to assess patient satisfaction with acute pain management service (APMS) and identify variables affecting this so that care can be improved. Methods: A questionnaire was developed and administered to  patients after being discharged from APMS care by an unbiased person. Data collected from record included patient de...

  14. Primary segmental omental infarction as a rare cause of acute abdominal pain in childhood

    Directory of Open Access Journals (Sweden)

    N.F. Tepeneu

    2018-01-01

    Full Text Available Introduction: Primary omental infarction (POI has a low incidence worldwide, with most cases occurring in adults. This condition is rarely considered in the differential diagnosis of acute abdominal pain in childhood. Material and methods: We present 2 cases of omental infarction in an obese 8-year-old boy and a 5-year-old boy who presented with acute abdominal pain in the right abdomen. Both patients were initially treated with intravenous fluids and analgesics with no improvement. Abdominal ultrasound of the first patient showed free intraperitoneal fluid, meteorism and distended bowel loops. The appendix was not visualized. With a presumptive clinical diagnosis of appendicitis the child underwent laparotomy.On entering the peritoneal cavity an omental infarction was seen and a portion of the omentum was resected. Appendectomy was performed.The second patient presented with acute abdominal pain in the right upper quadrant, which started 2 days before. There was a history of possible abdominal trauma about 3 weeks earlier. The patient had repeated ultrasound examinations and a CT scan of the abdomen which showed a omental infarction. He underwent laparoscopy and resection of the omental infarction, as well as incidental appendectomy. Results: The postoperative period was uneventful. The first patient was discharged on day 3, the second patient on day 4 after surgery. Histology showed a normal vermiform appendix and an omental infarction in both cases. Conclusion and discussion: Since the omental infarction as etiology of acute abdominal pain is uncommon in children, we emphasize the importance of accurate diagnosis and appropriate treatment of omental infarction. Keywords: Primary segmental omental infarction (POI, Appendicitis, Childhood

  15. Oral valdecoxib and injected parecoxib for acute postoperative pain: a quantitative systematic review

    Directory of Open Access Journals (Sweden)

    McQuay Henry J

    2003-07-01

    Full Text Available Abstract Background Clinical trials suggest that cyclo-oxygenase-2 specific inhibitors (coxibs are an effective treatment for acute postoperative pain. The aims of this systematic review were to examine the evidence for oral valdecoxib and injected parecoxib, and quantify efficacy and adverse effects. Methods Information from randomized, double-blind studies in acute postoperative pain was sought. The area under the pain relief versus time curve over four to six hours was dichotomized using validated equations to derive the proportion of patients with treatment and placebo with at least 50% pain relief over four to six hours and calculate the number-needed-to-treat (NNT. Information on duration of analgesia and adverse events was also collected. Results The NNT for one patient to experience at least 50% relief over six hours following a single oral dose of valdecoxib 20 mg and 40 mg was 1.7 (1.4 to 2.0 and 1.6 (1.4 to 1.8 respectively. The NNT for one patient to have at least 50% relief over four to six hours with parecoxib 20 mg IV and 40 mg IV was 3.0 (2.3 to 4.1 and 2.3 (2.0 to 2.6 respectively. Mean time to remedication (weighted by trial size was >24 hours with valdecoxib 40 mg, 8.7 hours with parecoxib 40 mg IV and 1.7 to 1.8 hours with placebo. There were no statistical differences between treatment and placebo for any adverse effect. Conclusion Both oral valdecoxib and injected parecoxib are effective treatments for acute postoperative pain.

  16. Acute aquatic treadmill exercise improves gait and pain in people with knee osteoarthritis.

    Science.gov (United States)

    Roper, Jaimie A; Bressel, Eadric; Tillman, Mark D

    2013-03-01

    To examine the acute effects of aquatic and land treadmill exercise on gait kinematics as well as the level of disease-specific and movement-related pain for individuals with osteoarthritis. Quasi-experimental crossover design. Biomechanics laboratory. Participants (N=14; age, 43-64y) diagnosed with osteoarthritis at the knee (n=12), osteoarthritis at the knee and ankle (n=1), or osteoarthritis at the knee and hip (n=1). Participants performed 3 exercise sessions separated by at least 24 hours in 1 week for each mode of exercise (aquatic treadmill and land treadmill). Gait kinematics and pain were measured before and after each intervention. The angular velocity gain score during stance for left knee extension was improved by 38% after aquatic treadmill exercise (P=.004). Similarly, during swing, the gain scores for angular velocity were also greater for left knee internal rotation and extension by 65% and 20%, respectively (P=.004, P=.008, respectively). During stance, the joint angle gain score for left hip flexion was 7.23% greater after land exercise (P=.007). During swing, the angular velocity gain score for right hip extension was significantly greater for aquatic exercise by 28% (P=.01). Only the joint angle gain score for left ankle abduction during stance was significantly higher after land exercise (4.72%, P=.003). No other joint angle gain scores for either stance or swing were significantly different for either condition (P=.06-.96). Perceived pain was 100% greater after land than aquatic treadmill exercise (P=.02). Step rate and step length were not different between conditions (P=.31-.92). An acute training period on an aquatic treadmill positively influenced joint angular velocity and arthritis-related joint pain. Acute aquatic treadmill exercise may be useful as a conservative treatment to improve angular speed of the lower-extremity joints and pain related to osteoarthritis. Copyright © 2013 American Congress of Rehabilitation Medicine. Published

  17. Relationship of depression in participants with nonspecific acute or subacute low back pain and no-pain by age distribution

    Directory of Open Access Journals (Sweden)

    Calvo-Lobo C

    2017-01-01

    Full Text Available Cesar Calvo-Lobo,1 Juan Manuel Vilar Fernández,2 Ricardo Becerro-de-Bengoa-Vallejo,3 Marta Elena Losa-Iglesias,4 David Rodríguez-Sanz,5 Patricia Palomo López,6 Daniel López López7 1Physical Therapy Department, Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid; 2Modeling, Optimization and Statistical Inference Research Group, Universidade da Coruña, A Coruña; 3School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid; 4Faculty of Health Sciences, Universidad Rey Juan Carlos, Madrid; 5Physical Therapy & Health Sciences Research Group, Facultad de Ciencias de la Salud, el Ejercicio y el Deporte, Universidad Europea de Madrid, Madrid; 6University Center of Plasencia, Universidad de Extremadura, Badajoz; 7Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, A Coruña, Spain Background and purpose: Nonspecific low back pain (LBP is the most prevalent musculoskeletal condition in various age ranges and is associated with depression. The aim of this study was to determine the Beck Depression Inventory (BDI scores in participants with nonspecific LBP and no-pain by age distribution.Methods: A case–control study was carried out following the Strengthening the Reporting of Observational Studies in Epidemiology criteria. A sample of 332 participants, divided into the following age categories: 19–24 (n=11, 25–39 (n=66, 40–64 (n=90, 65–79 (n=124, and ≥80 (n=41 years was recruited from domiciliary visits and an outpatient clinic. The BDI scores were self-reported in participants with nonspecific acute or subacute (≤3 months LBP (n=166 and no-pain (n=166.Results: The BDI scores, mean ± standard deviation, showed statistically significant differences (p<0.001 between participants with nonspecific acute or

  18. Inter-observer agreement for abdominal CT in unselected patients with acute abdominal pain

    Energy Technology Data Exchange (ETDEWEB)

    Randen, Adrienne van [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); Academic Medical Center, Amsterdam (Netherlands); Lameris, Wytze [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); Nio, C.Y.; Spijkerboer, Anje M.; Meier, Mark A.; Tutein Nolthenius, Charlotte; Smithuis, Frank; Stoker, Jaap [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); Bossuyt, Patrick M. [University of Amsterdam, Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Center, Amsterdam (Netherlands); Boermeester, Marja A. [University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands)

    2009-06-15

    The level of inter-observer agreement of abdominal computed tomography (CT) in unselected patients presenting with acute abdominal pain at the Emergency Department (ED) was evaluated. Two hundred consecutive patients with acute abdominal pain were prospectively included. Multi-slice CT was performed in all patients with intravenous contrast medium only. Three radiologists independently read all CT examinations. They recorded specific radiological features and a final diagnosis on a case record form. We calculated the proportion of agreement and kappa values, for overall, urgent and frequently occurring diagnoses. The mean age of the evaluated patients was 46 years (range 19-94), of which 54% were women. Overall agreement on diagnoses was good, with a median kappa of 0.66. Kappa values for specific urgent diagnoses were excellent, with median kappa values of 0.84, 0.90 and 0.81, for appendicitis, diverticulitis and bowel obstruction, respectively. Abdominal CT has good inter-observer agreement in unselected patients with acute abdominal pain at the ED, with excellent agreement for specific urgent diagnoses as diverticulitis and appendicitis. (orig.)

  19. Dual-source computed tomography in patients with acute chest pain: feasibility and image quality

    Energy Technology Data Exchange (ETDEWEB)

    Schertler, Thomas; Scheffel, Hans; Frauenfelder, Thomas; Desbiolles, Lotus; Leschka, Sebastian; Stolzmann, Paul; Marincek, Borut; Alkadhi, Hatem [University Hospital Zurich, Department of Medical Radiology, Institute of Diagnostic Radiology, Zurich (Switzerland); Seifert, Burkhardt [University of Zurich, Department of Biostatistics, Zurich (Switzerland); Flohr, Thomas G. [Computed Tomography CTE PA, Siemens Medical Solutions, Forchheim (Germany)

    2007-12-15

    The aim of this study was to determine the feasibility and image quality of dual-source computed tomography angiography (DSCTA) in patients with acute chest pain for the assessment of the lung, thoracic aorta, and for pulmonary and coronary arteries. Sixty consecutive patients (32 female, 28 male, mean age 58.1{+-}16.3 years) with acute chest pain underwent contrast-enhanced electrocardiography-gated DSCTA without prior beta-blocker administration. Vessel attenuation of different thoracic vascular territories was measured, and image quality was semi-quantitatively analyzed by two independent readers. Image quality of the thoracic aorta was diagnostic in all 60 patients, image quality of pulmonary arteries was diagnostic in 59, and image quality of coronary arteries was diagnostic in 58 patients. Pairwise intraindividual comparisons of attenuation values were small and ranged between 1{+-}6 HU comparing right and left coronary artery and 56{+-}9 HU comparing the pulmonary trunk and left ventricle. Mean attenuation was 291{+-}65 HU in the ascending aorta, 334{+-}93 HU in the pulmonary trunk, and 285{+-}66 HU and 268{+-}67 HU in the right and left coronary artery, respectively. DSCTA is feasible and provides diagnostic image quality of the thoracic aorta, pulmonary and coronary arteries in patients with acute chest pain. (orig.)

  20. Effect of peripheral morphine in a human model of acute inflammatory pain

    DEFF Research Database (Denmark)

    Lillesø, J; Hammer, N A; Pedersen, J L

    2000-01-01

    Several studies have demonstrated the presence of opioid inducible receptors on peripheral nerves and peripheral antinociceptive effects of opioids. However, the effects of peripheral opioid administration in man are controversial. Our study used a randomized, double-blind, placebo-controlled, th......Several studies have demonstrated the presence of opioid inducible receptors on peripheral nerves and peripheral antinociceptive effects of opioids. However, the effects of peripheral opioid administration in man are controversial. Our study used a randomized, double-blind, placebo......-controlled, three-way crossover design in a human model of acute inflammatory pain (heat injury). We studied 18 healthy volunteers who each received morphine locally (2 mg), morphine systemically (2 mg), or placebo on three separate study days. The subjects received morphine infiltration subcutaneously (s.c.). 1 h......, but local morphine infiltration neither reduced pain during the burn, nor primary or secondary hyperalgesia to mechanical and heat stimuli after the burn. In conclusion, peripherally applied morphine had no acute antinociceptive effects in this human model of acute inflammatory pain....

  1. Inter-observer agreement for abdominal CT in unselected patients with acute abdominal pain

    International Nuclear Information System (INIS)

    Randen, Adrienne van; Lameris, Wytze; Nio, C.Y.; Spijkerboer, Anje M.; Meier, Mark A.; Tutein Nolthenius, Charlotte; Smithuis, Frank; Stoker, Jaap; Bossuyt, Patrick M.; Boermeester, Marja A.

    2009-01-01

    The level of inter-observer agreement of abdominal computed tomography (CT) in unselected patients presenting with acute abdominal pain at the Emergency Department (ED) was evaluated. Two hundred consecutive patients with acute abdominal pain were prospectively included. Multi-slice CT was performed in all patients with intravenous contrast medium only. Three radiologists independently read all CT examinations. They recorded specific radiological features and a final diagnosis on a case record form. We calculated the proportion of agreement and kappa values, for overall, urgent and frequently occurring diagnoses. The mean age of the evaluated patients was 46 years (range 19-94), of which 54% were women. Overall agreement on diagnoses was good, with a median kappa of 0.66. Kappa values for specific urgent diagnoses were excellent, with median kappa values of 0.84, 0.90 and 0.81, for appendicitis, diverticulitis and bowel obstruction, respectively. Abdominal CT has good inter-observer agreement in unselected patients with acute abdominal pain at the ED, with excellent agreement for specific urgent diagnoses as diverticulitis and appendicitis. (orig.)

  2. Acute pain management efficiency improves with point-of-care handheld electronic billing system.

    Science.gov (United States)

    Fahy, Brenda G

    2009-02-01

    Technology advances continue to impact patient care and physician workflow. To enable more efficient performance of billing activities, a point-of-care (POC) handheld computer technology replaced a paper-based system on an acute pain management service. Using a handheld personal digital assistant (PDA) and software from MDeverywhere (MDe, MDeverywhere, Long Island, NY), we performed a 1-yr prospective observational study of an anesthesiology acute pain management service billings and collections. Seventeen anesthesiologists providing billable acute pain services were trained and entered their charges on a PDA. Twelve months of data, just before electronic implementation (pre-elec), were compared to a 12-m period after implementation (post-elec). The total charges were 4883 for 890 patients pre-elec and 5368 for 1128 patients post-elec. With adoption of handheld billing, the charge lag days decreased from 29.3 to 7.0 (P billing using PDAs to replace a paper-based billing system improved the collection rate and decreased the number of charge lag days with a positive return on investment. The handheld PDA billing system provided POC support for physicians during their daily clinical (e.g., patient locations, rounding lists) and billing activities, improving workflow.

  3. Clinical Scoring for Diagnosis of Acute Lower Abdominal Pain in Female of Reproductive Age

    Directory of Open Access Journals (Sweden)

    Kijja Jearwattanakanok

    2013-01-01

    Full Text Available Background. Obstetrics and gynecological conditions (OB-GYNc are difficult to be differentiated from appendicitis in young adult females presenting with acute lower abdominal pain. Timely and correct diagnosis is clinically challenging. Method. A retrospective data analysis was performed on 542 female patients who were admitted to a tertiary care hospital with a chief complaint of acute lower abdominal pain. Diagnostic indicators of appendicitis and OB-GYNc were identified by stepwise multivariable polytomous logistic regression. Diagnostic performances of the scores were tested. Result. The developed clinical score is comprised of (1 guarding or rebound tenderness, (2 pregnancy, (3 sites of abdominal tenderness, (4 leukocytosis, (5 peripheral neutrophils ≥75%, and (6 presence of diarrhea. For diagnosis of appendicitis, the area under the ROC curve was 0.8696, and the sensitivity and specificity were 89.25% and 70.00%. For OB-GYNc, the corresponding values were 0.8450, 66.67%, and 94.85%, respectively. Conclusion. The clinical scoring system can differentiate the diagnosis of acute lower abdominal pain in young adult females. Time spent for diagnosis at the emergency room may be shortened, and the patients would be admitted to the appropriate departments in less time.

  4. Dual-source computed tomography in patients with acute chest pain: feasibility and image quality

    International Nuclear Information System (INIS)

    Schertler, Thomas; Scheffel, Hans; Frauenfelder, Thomas; Desbiolles, Lotus; Leschka, Sebastian; Stolzmann, Paul; Marincek, Borut; Alkadhi, Hatem; Seifert, Burkhardt; Flohr, Thomas G.

    2007-01-01

    The aim of this study was to determine the feasibility and image quality of dual-source computed tomography angiography (DSCTA) in patients with acute chest pain for the assessment of the lung, thoracic aorta, and for pulmonary and coronary arteries. Sixty consecutive patients (32 female, 28 male, mean age 58.1±16.3 years) with acute chest pain underwent contrast-enhanced electrocardiography-gated DSCTA without prior beta-blocker administration. Vessel attenuation of different thoracic vascular territories was measured, and image quality was semi-quantitatively analyzed by two independent readers. Image quality of the thoracic aorta was diagnostic in all 60 patients, image quality of pulmonary arteries was diagnostic in 59, and image quality of coronary arteries was diagnostic in 58 patients. Pairwise intraindividual comparisons of attenuation values were small and ranged between 1±6 HU comparing right and left coronary artery and 56±9 HU comparing the pulmonary trunk and left ventricle. Mean attenuation was 291±65 HU in the ascending aorta, 334±93 HU in the pulmonary trunk, and 285±66 HU and 268±67 HU in the right and left coronary artery, respectively. DSCTA is feasible and provides diagnostic image quality of the thoracic aorta, pulmonary and coronary arteries in patients with acute chest pain. (orig.)

  5. Brief review: Adoption of electronic medical records to enhance acute pain management.

    Science.gov (United States)

    Goldstein, David H; Phelan, Rachel; Wilson, Rosemary; Ross-White, Amanda; VanDenKerkhof, Elizabeth G; Penning, John P; Jaeger, Melanie

    2014-02-01

    The purpose of this paper is to examine physician barriers to adopting electronic medical records (EMRs) as well as anesthesiologists' experiences with the EMRs used by the acute pain management service at two tertiary care centres in Canada. We first review the recent literature to determine if physician barriers to adoption are changing given the exponential growth of information technology and the evolving healthcare environment. We next report on institutional experience from two academic health sciences centres regarding the challenges they encountered over the past ten years in developing and implementing an electronic medical record system for acute pain management. The key identified barriers to adoption of EMRs are financial, technological, and time constraints. These barriers are identical to those reported in a systematic review performed prior to 2009 and remain significant factors challenging implementation. These challenges were encountered during our institution's process of adopting EMRs specific to acute pain management. In addition, our findings emphasize the importance of physician participation in the development and implementation stages of EMRs in order to incorporate their feedback and ensure the EMR system is in keeping with their workflow. Use of EMRs will inevitably become the standard of care; however, many barriers persist to impede their implementation and adoption. These challenges to implementation can be facilitated by a corporate strategy for change that acknowledges the barriers and provides the resources for implementation. Adoption will facilitate benefits in communication, patient management, research, and improved patient safety.

  6. Kinin B1 receptors contributes to acute pain following minor surgery in humans

    Directory of Open Access Journals (Sweden)

    Brahim Jaime S

    2010-02-01

    Full Text Available Abstract Background Kinins play an important role in regulation of pain and hyperalgesia after tissue injury and inflammation by activating two types of G-protein-coupled receptors, the kinin B1 and B2 receptors. It is generally accepted that the B2 receptor is constitutively expressed, whereas the B1 receptor is induced in response to inflammation. However, little is known about the regulatory effects of kinin receptors on the onset of acute inflammation and inflammatory pain in humans. The present study investigated the changes in gene expression of kinin receptors and the levels of their endogenous ligands at an early time point following tissue injury and their relation to clinical pain, as well as the effect of COX-inhibition on their expression levels. Results Tissue injury resulted in a significant up-regulation in the gene expression of B1 and B2 receptors at 3 hours post-surgery, the onset of acute inflammatory pain. Interestingly, the up-regulation in the gene expression of B1 and B2 receptors was positively correlated to pain intensity only after ketorolac treatment, signifying an interaction between prostaglandins and kinins in the inflammatory pain process. Further, the gene expression of both B1 and B2 receptors were correlated. Following tissue injury, B1 ligands des-Arg9-BK and des-Arg10-KD were significantly lower at the third hour compared to the first 2 hours in both the placebo and the ketorolac treatment groups but did not differ significantly between groups. Tissue injury also resulted in the down-regulation of TRPV1 gene expression at 3 hours post-surgery with no significant effect by ketorolac treatment. Interestingly, the change in gene expression of TRPV1 was correlated to the change in gene expression of B1 receptor but not B2 receptor. Conclusions These results provide evidence at the transcriptional level in a clinical model of tissue injury that up-regulation of kinin receptors are involved in the development of the

  7. Single dose oral ketoprofen and dexketoprofen for acute postoperative pain in adults.

    Science.gov (United States)

    Barden, Jodie; Derry, Sheena; McQuay, Henry J; Moore, R Andrew

    2009-10-07

    Ketoprofen is a non-selective non-steroidal anti-inflammatory drug (NSAID) used to treat acute and chronic painful conditions. Dexketoprofen is the (S)-enantiomer, which is believed to confer analgesia. Theoretically dexketoprofen is expected to provide equivalent analgesia to ketoprofen at half the dose, with a consequent reduction in gastrointestinal adverse events. To assess efficacy, duration of action, and associated adverse events of single dose oral ketoprofen and dexketoprofen in acute postoperative pain in adults. We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to August 2009. Randomised, double blind, placebo-controlled trials of single dose orally administered ketoprofen and dexketoprofen in adults with moderate to severe acute postoperative pain. Two review authors independently assessed trial quality and extracted data. Pain relief or pain intensity data were extracted and converted into the dichotomous outcome of number of participants with at least 50% pain relief over 4 to 6 hours, from which relative risk and number-needed-to-treat-to-benefit (NNT) were calculated. Numbers of participants using rescue medication over specified time periods, and time to use of rescue medication, were sought as additional measures of efficacy. Information on adverse events and withdrawals was collected. Fourteen studies compared ketoprofen (968 participants) at mainly 25 mg and 50 mg with placebo (520 participants). Seven studies compared dexketoprofen (681 participants) at mainly 10 mg to 25 mg with placebo (289 participants). Studies were of adequate reporting quality, and participants had pain following dental, orthopaedic, obstetric, gynaecological and general surgery. There was considerable clinical heterogeneity between studies in dental and other types of surgery, particularly bunionectomy, which limited analysis.Ketoprofen at doses between 12.5 mg and 100 mg produced NNTs for at least 50% pain relief over 4 to 6

  8. [Acute painful crisis in a female Nigerian patient with sickle cell disease].

    Science.gov (United States)

    Nin, Sayaka; Seki, Masanori; Maie, Koichiro; Kuroda, Akihiro; Miyamoto, Kana; Ogawa, Shinichi; Ito, Yufu; Kurita, Naoki; Yokoyama, Yasuhisa; Sakata Yanagimoto, Mamiko; Obara, Naoshi; Hasegawa, Yuichi; Ogino, Yasuko; Ito, Takayoshi; Chiba, Shigeru

    2015-01-01

    We report a 38-year-old Nigerian woman with sickle cell disease. Sickle cell disease had been diagnosed when she experienced her first sickle cell crisis episode at age 8 years. Thereafter, she had infrequent minor episodes. She visited a hospital presenting with fever, anemia, jaundice, and systemic pain, and was then transferred to our hospital. Together with rehydration and red blood cell transfusion, analgesics and antibiotics were prescribed, and produced gradual improvement of all symptoms and signs. The patient was discharged on day 9 of hospitalization. Sickle cell crisis is an acute painful episode caused by occlusion of arterioles. The degree of pain and accompanying symptoms, as well as the frequencies of crises, are variable. Moreover, one third of individuals with sickle cell disease never experience a crisis. As our society becomes increasingly globalized, the probabilities of encountering sickle cell disease patients will be higher.

  9. TRPA1 channels mediate acute neurogenic inflammation and pain produced by bacterial endotoxins

    Science.gov (United States)

    Meseguer, Victor; Alpizar, Yeranddy A.; Luis, Enoch; Tajada, Sendoa; Denlinger, Bristol; Fajardo, Otto; Manenschijn, Jan-Albert; Fernández-Peña, Carlos; Talavera, Arturo; Kichko, Tatiana; Navia, Belén; Sánchez, Alicia; Señarís, Rosa; Reeh, Peter; Pérez-García, María Teresa; López-López, José Ramón; Voets, Thomas; Belmonte, Carlos; Talavera, Karel; Viana, Félix

    2014-01-01

    Gram-negative bacterial infections are accompanied by inflammation and somatic or visceral pain. These symptoms are generally attributed to sensitization of nociceptors by inflammatory mediators released by immune cells. Nociceptor sensitization during inflammation occurs through activation of the Toll-like receptor 4 (TLR4) signalling pathway by lipopolysaccharide (LPS), a toxic by-product of bacterial lysis. Here we show that LPS exerts fast, membrane delimited, excitatory actions via TRPA1, a transient receptor potential cation channel that is critical for transducing environmental irritant stimuli into nociceptor activity. Moreover, we find that pain and acute vascular reactions, including neurogenic inflammation (CGRP release) caused by LPS are primarily dependent on TRPA1 channel activation in nociceptive sensory neurons, and develop independently of TLR4 activation. The identification of TRPA1 as a molecular determinant of direct LPS effects on nociceptors offers new insights into the pathogenesis of pain and neurovascular responses during bacterial infections and opens novel avenues for their treatment.

  10. Coronary Computed Tomography Angiography in the Assessment of Acute Chest Pain in the Emergency Room

    International Nuclear Information System (INIS)

    Prazeres, Carlos Eduardo Elias dos; Cury, Roberto Caldeira; Carneiro, Adriano Camargo de Castro; Rochitte, Carlos Eduardo

    2013-01-01

    The coronary computed tomography angiography has recently emerged as an accurate diagnostic tool in the evaluation of coronary artery disease, providing diagnostic and prognostic data that correlate directly with the data provided by invasive coronary angiography. The association of recent technological developments has allowed improved temporal resolution and better spatial coverage of the cardiac volume with significant reduction in radiation dose, and with the crucial need for more effective protocols of risk stratification of patients with chest pain in the emergency room, recent evaluation of the computed tomography coronary angiography has been performed in the setting of acute chest pain, as about two thirds of invasive coronary angiographies show no significantly obstructive coronary artery disease. In daily practice, without the use of more efficient technologies, such as coronary angiography by computed tomography, safe and efficient stratification of patients with acute chest pain remains a challenge to the medical team in the emergency room. Recently, several studies, including three randomized trials, showed favorable results with the use of this technology in the emergency department for patients with low to intermediate likelihood of coronary artery disease. In this review, we show data resulting from coronary angiography by computed tomography in risk stratification of patients with chest pain in the emergency room, its diagnostic value, prognosis and cost-effectiveness and a critical analysis of recently published multicenter studies

  11. Prognostic Factors for Persistent Leg-Pain in Patients Hospitalized With Acute Sciatica.

    Science.gov (United States)

    Fjeld, Olaf; Grotle, Margreth; Siewers, Vibeke; Pedersen, Linda M; Nilsen, Kristian Bernhard; Zwart, John-Anker

    2017-03-01

    Prospective cohort study. To identify potential prognostic factors for persistent leg-pain at 12 months among patients hospitalized with acute severe sciatica. The long-term outcome for patients admitted to hospital with sciatica is generally unfavorable. Results concerning prognostic factors for persistent sciatica are limited and conflicting. A total of 210 patients acutely admitted to hospital for either surgical or nonsurgical treatment of sciatica were consecutively recruited and received a thorough clinical and radiographic examination in addition to responding to a comprehensive questionnaire. Follow-up assessments were done at 6 weeks, 6 months, and 12 months. Potential prognostic factors were measured at baseline and at 6 weeks. The impact of these factors on leg-pain was analyzed by multiple linear regression modeling. A total of 151 patients completed the entire study, 93 receiving nonrandomized surgical treatment. The final multivariate models showed that the following factors were significantly associated with leg-pain at 12 months: high psychosocial risk according to the Örebro Musculosceletal Pain Questionnaire (unstandardized beta coefficient 1.55, 95% confidence interval [CI] 0.72-2.38, P sciatica. 2.

  12. Assessment of patient satisfaction with acute pain management service: Monitoring quality of care in clinical setting

    Directory of Open Access Journals (Sweden)

    Fizzah Farooq

    2016-01-01

    Full Text Available Background and Aims: Assessment of patient satisfaction is an important tool for monitoring the quality of care in hospitals. The aim of this survey was to develop a reliable tool to assess patient satisfaction with acute pain management service (APMS and identify variables affecting this so that care can be improved. Methods: A questionnaire was developed and administered to  patients after being discharged from APMS care by an unbiased person. Data collected from record included patient demographics, surgical procedure, analgesic modality, co-analgesics and dynamic and static pain scores. Questions included pain expected and pain experienced, APMS response time, quality of pain relief with treatment, professionalism of APMS team, overall experience of pain relief and choosing/suggesting same modality for themselves/family/friends again. Five-point Likert scale was used for most of the options. Statistical analysis was done using SPSS 19. Results: Frequency and percentages were computed for qualitative observation and presented on pie chart and histogram. Seventy-one per cent patients expected severe pain while 43% actually experienced it. About 79.4% would choose same analgesia modality in future for self/family/friends. Ninety-nine per cent found APMS staff courteous and professional. About 89% rated their experience of pain management as excellent to very good. Conclusion: The survey of patients′ satisfaction to monitor the quality of care provided by APMS provided positive inputs on its role. This also helps to identify areas requiring improvement in care and as a tool to gauge the quality of care.

  13. Assessment of patient satisfaction with acute pain management service: Monitoring quality of care in clinical setting

    Science.gov (United States)

    Farooq, Fizzah; Khan, Robyna; Ahmed, Aliya

    2016-01-01

    Background and Aims: Assessment of patient satisfaction is an important tool for monitoring the quality of care in hospitals. The aim of this survey was to develop a reliable tool to assess patient satisfaction with acute pain management service (APMS) and identify variables affecting this so that care can be improved. Methods: A questionnaire was developed and administered to patients after being discharged from APMS care by an unbiased person. Data collected from record included patient demographics, surgical procedure, analgesic modality, co-analgesics and dynamic and static pain scores. Questions included pain expected and pain experienced, APMS response time, quality of pain relief with treatment, professionalism of APMS team, overall experience of pain relief and choosing/suggesting same modality for themselves/family/friends again. Five-point Likert scale was used for most of the options. Statistical analysis was done using SPSS 19. Results: Frequency and percentages were computed for qualitative observation and presented on pie chart and histogram. Seventy-one per cent patients expected severe pain while 43% actually experienced it. About 79.4% would choose same analgesia modality in future for self/family/friends. Ninety-nine per cent found APMS staff courteous and professional. About 89% rated their experience of pain management as excellent to very good. Conclusion: The survey of patients’ satisfaction to monitor the quality of care provided by APMS provided positive inputs on its role. This also helps to identify areas requiring improvement in care and as a tool to gauge the quality of care. PMID:27141107

  14. Accuracy of gestalt perception of acute chest pain in predicting coronary artery disease.

    Science.gov (United States)

    das Virgens, Cláudio Marcelo Bittencourt; Lemos, Laudenor; Noya-Rabelo, Márcia; Carvalhal, Manuela Campelo; Cerqueira Junior, Antônio Maurício Dos Santos; Lopes, Fernanda Oliveira de Andrade; de Sá, Nicole Cruz; Suerdieck, Jéssica Gonzalez; de Souza, Thiago Menezes Barbosa; Correia, Vitor Calixto de Almeida; Sodré, Gabriella Sant'Ana; da Silva, André Barcelos; Alexandre, Felipe Kalil Beirão; Ferreira, Felipe Rodrigues Marques; Correia, Luís Cláudio Lemos

    2017-03-26

    To test accuracy and reproducibility of gestalt to predict obstructive coronary artery disease (CAD) in patients with acute chest pain. We studied individuals who were consecutively admitted to our Chest Pain Unit. At admission, investigators performed a standardized interview and recorded 14 chest pain features. Based on these features, a cardiologist who was blind to other clinical characteristics made unstructured judgment of CAD probability, both numerically and categorically. As the reference standard for testing the accuracy of gestalt, angiography was required to rule-in CAD, while either angiography or non-invasive test could be used to rule-out. In order to assess reproducibility, a second cardiologist did the same procedure. In a sample of 330 patients, the prevalence of obstructive CAD was 48%. Gestalt's numerical probability was associated with CAD, but the area under the curve of 0.61 (95%CI: 0.55-0.67) indicated low level of accuracy. Accordingly, categorical definition of typical chest pain had a sensitivity of 48% (95%CI: 40%-55%) and specificity of 66% (95%CI: 59%-73%), yielding a negligible positive likelihood ratio of 1.4 (95%CI: 0.65-2.0) and negative likelihood ratio of 0.79 (95%CI: 0.62-1.02). Agreement between the two cardiologists was poor in the numerical classification (95% limits of agreement = -71% to 51%) and categorical definition of typical pain (Kappa = 0.29; 95%CI: 0.21-0.37). Clinical judgment based on a combination of chest pain features is neither accurate nor reproducible in predicting obstructive CAD in the acute setting.

  15. Single-dose rofecoxib for acute postoperative pain in adults: a quantitative systematic review

    Directory of Open Access Journals (Sweden)

    McQuay Henry J

    2002-06-01

    Full Text Available Abstract Background Rofecoxib is a cyclo-oxygenase 2 selective inhibitor. This systematic review of rofecoxib in acute pain examined studies in adults of analgesic efficacy over six hours, the amount and quality of the evidence on extended duration of analgesia, and the quality and quantity of evidence on adverse events. Methods Cochrane Library (issue 4, 2001, Biological Abstracts (March 2002, MEDLINE (March 2002 and PubMed (March 2002 were searched using rofecoxib as a free text term. The area under the pain relief versus time curve was dichotomized using validated equations to derive the proportion of patients on rofecoxib 50 mg or placebo with at least 50% pain relief over six hours. This was used to calculate the number needed to treat for at least 50% pain relief over six hours for rofecoxib compared with placebo. Information on duration of analgesia and adverse events was also collected. Results Five included trials investigated 1,118 patients, of whom 211 received placebo and 464 received rofecoxib 50 mg. The NNT for rofecoxib 50 mg was 2.3 (95% confidence interval 2.0 to 2.6. The weighted mean remedication time was 1.9 hours for placebo (126 patients, 7.4 hours for ibuprofen 400 mg (97 patients and 13.6 hours for rofecoxib 50 mg (322 patients. Conclusion Rofecoxib at 2–4 times the standard daily dose for chronic pain is an effective single dose oral analgesic in acute pain. Limitations in trial reporting constrain conclusions about longer duration of analgesia and adverse event profile.

  16. Single dose oral ibuprofen plus caffeine for acute postoperative pain in adults.

    Science.gov (United States)

    Derry, Sheena; Wiffen, Philip J; Moore, R Andrew

    2015-07-14

    There is good evidence that combining two different analgesics in fixed doses in a single tablet can provide better pain relief in acute pain and headache than either drug alone, and that the drug-specific benefits are essentially additive. This appears to be broadly true in postoperative pain and migraine headache across a range of different drug combinations, and when tested in the same and different trials. Adding caffeine to analgesics also increases the number of people obtaining good pain relief. Combinations of ibuprofen and caffeine are available without prescription in some parts of the world. To assess the analgesic efficacy and adverse effects of a single oral dose of ibuprofen plus caffeine for moderate to severe postoperative pain, using methods that permit comparison with other analgesics evaluated in standardised trials using almost identical methods and outcomes. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Oxford Pain Relief Database, two clinical trial registries, and the reference lists of articles. The date of the most recent search was 1 February 2015. Randomised, double-blind, placebo- or active-controlled clinical trials of single dose oral ibuprofen plus caffeine for acute postoperative pain in adults. Two review authors independently considered trials for inclusion in the review, assessed risk of bias, and extracted data. We used the area under the pain relief versus time curve to derive the proportion of participants with at least 50% pain relief over six hours prescribed either ibuprofen plus caffeine or placebo. We calculated the risk ratio (RR) and number needed to treat to benefit (NNT). We used information on the use of rescue medication to calculate the proportion of participants requiring rescue medication and the weighted mean of the median time to use. We also collected information on adverse effects. We identified five randomised, double-blind studies with 1501 participants, but

  17. The Use of Intravenous Lidocaine for the Management of Acute Pain Secondary to Traumatic Ankle Injury: A Case Report.

    Science.gov (United States)

    Sin, Billy; Gritsenko, Diana; Tam, Grace; Koop, Kimberly; Mok, Eva

    2018-02-01

    Sports-related injuries are a frequent cause of visits to the emergency department (ED) across the United States. A majority of these injuries affect the lower extremities with the ankle as the most frequently reported site. Most sports-related injuries are not severe enough to require inpatient hospitalization; however, they often lead to acute distress and pain which require prompt treatment with analgesics. Approximately 22% of patients who presented to the ED required pharmacotherapy for acute pain management. Opioids have been traditionally used for the management of severe acute pain in the ED; however, there are growing concerns for opioid overuse and misuse. As a result, there is growing controversy regarding the appropriate selection of analgesic agents, optimal dosing, and need for outpatient therapy which has contributed to changes in prescribing patterns of opioids in the ED. Lidocaine, a class 1b antiarrhythmic, has been utilized as an analgesic agent. Its use has been documented for the management of intractable chronic pain caused by cancer, stroke, neuropathies, or nephrolithiasis. However, literature describing the use of intravenous lidocaine for the management of acute pain secondary to trauma is limited to a single case series. This case report describes the use of intravenous lidocaine in a 17-year-old male who presented to the ED in acute distress secondary to ankle dislocation and fracture. This report serves to describe additional clinical experience with intravenous lidocaine for the management of acute pain secondary to ankle fracture in the emergency department.

  18. Influence of Catastrophizing and Personality Traits on Recalled Ratings of Acute Pain Experience in Healthy Young Adults.

    Science.gov (United States)

    Pallegama, Ranjith Wasantha; Ariyasinghe, Sajjiv; Perera, Eranthi Dinoka; Treede, Rolf-Detlef

    2017-01-01

    To investigate whether pain catastrophizing and personality traits bias recalled ratings of acute pain in an experimental tonic pain model. Fifty-six undergraduates (14 males) recruited from the University of Peradeniya (mean age 21.7 ± 0.8 SD years). Participants completed the Pain Catastrophizing Scale and the Eysenck Personality Questionnaire. They were subjected to two cold pressor tests (dominant and non-dominant hands) and pain threshold, maximum pain intensity, and pain tolerance were recorded. One-week later, the maximum pain intensities of both hands were recalled and percentage distortions in recalling were calculated. Based on a 180 s cutoff, two participants were considered pain-insensitive during the test and were excluded from the analysis. The maximum pain intensity was recalled with a moderate accuracy (Intraclass Correlation Coefficients = 0.68 for dominant and 0.59 for non-dominant hands). Hierarchical multiple regression analyses revealed that maximum pain intensity ( P  memory for painful events in healthy subjects was reasonably accurate over a period of 1 week. Pain catastrophizing biased pain recall, whereas among personality traits only neuroticism exhibited a weak positive association with the recalled ratings.

  19. The in vitro mechanisms and in vivo efficacy of intravenous lidocaine on the neuroinflammatory response in acute and chronic pain

    NARCIS (Netherlands)

    Wal, S.E.I. van der; Heuvel, S.A.S. van den; Radema, S.A.; Berkum, B.F. van; Vaneker, M.; Steegers, M.A.H.; Scheffer, G.J.; Vissers, K.C.P.

    2016-01-01

    INTRODUCTION: The neuroinflammatory response plays a key role in several pain syndromes. Intravenous (iv) lidocaine is beneficial in acute and chronic pain. This review delineates the current literature concerning in vitro mechanisms and in vivo efficacy of iv lidocaine on the neuroinflammatory

  20. Pain and Anxiety in Rural Acute Coronary Syndrome Patients Awaiting Diagnostic Cardiac Catheterization.

    Science.gov (United States)

    O'Keefe-McCarthy, Sheila; McGillion, Michael; Clarke, Sean P; McFetridge-Durdle, Judith

    2015-01-01

    In rural areas of Canada, people with acute coronary syndromes (ACS) can wait up to 32 hours for transfer for diagnostic cardiac catheterization (CATH). While awaiting CATH, it is critical that pain and anxiety management be optimal to preserve myocardial muscle and minimize the risk of further deterioration. The aim of this study was to examine the relationship between clinical management, cardiac pain intensity, and state anxiety for rural ACS patients awaiting diagnostic CATH. In a prospective, descriptive-correlational repeated-measures design involving 121 ACS rural patients, we examined the associations of analgesic and nitroglycerin administration with cardiac pain intensity (numeric rating scale) and state anxiety (Spielberger State Anxiety Inventory) and also nurses' pain knowledge and attitudes (Toronto Pain Management Inventory-ACS Version and Knowledge and Attitudes Survey Regarding Pain) using linear mixed models. The mean age of patients was 67.6 ± 13, 50% were men, and 60% had unstable angina and the remainder had non-ST-elevated myocardial infarction. During follow-up, cardiac pain intensity scores remained in the mild range from 1.1 ± 2.2 to 2.4 ± 2.7. State anxiety ranged from 44.0 ± 7.2 to 46.2 ± 6.6. Cumulative analgesic dose was associated with a reduction in cardiac pain by 1.0 points (numeric rating scale, 0-10) (t108 = -2.5; SE, -0.25; confidence interval, -0.45 to -0.06; P = .013). Analgesic administration was not associated with state anxiety. Over the course of follow-up, ACS patients reported consistently high anxiety scores. Whereas cardiac pain declines in most patients in the early hours after admission, many patients experience a persistent anxious state up to 8 hours later, which suggest that development and testing of protocols for anxiety reduction may be needed. More urgently, the development and examination of a treatment intervention, early on in the ACS trajectory, are warranted that targets pain and anxiety for those for

  1. Acute caffeine ingestion enhances performance and dampens muscle pain following resistance exercise to failure.

    Science.gov (United States)

    Duncan, M J; Oxford, S W

    2012-06-01

    This double-blind, within-subjects experiment examined the effects of acute caffeine ingestion on perceptions of muscle pain following a bout of high-intensity, upper-body resistance exercise to failure. Moderately trained males (N.=18) ingested a dose of caffeine (5 mg · kg-1) or placebo in a randomised and counterbalanced order and 1 hour later completed bench press exercise to failure at an intensity of 60% 1 repetition maximum. Repetitions completed was taken as a measure of performance, peak heart rate was determined via heart rate telemetry during the exercise bout, rating of perceived exertion (RPE) and upper body muscle pain was recorded immediately upon failure of the exercise task and peak blood lactate concentration was determined post-exercise. Caffeine resulted in improved repetitions to failure (t [17]=3.119, P=0.006), greater peak blood lactate (t [17] =5.080, P=0.0001) and lower RPE (t 17=-3.431, P=0.003) compared to placebo. Muscle pain perception was also significantly lower in the caffeine condition compared to placebo (t [17]=-2.567, P=0.04). These results support prior studies using aerobic based exercise modes in suggesting that caffeine ingestion can dampen exercise-induced muscle pain. Specifically, caffeine ingestion enhances muscular strength performance and reduces upper body muscle pain perception immediately following a bout of high-intensity resistance exercise to failure.

  2. Preoperative intravenous glucocorticoids can decrease acute pain and postoperative nausea and vomiting after total hip arthroplasty

    Science.gov (United States)

    Yang, Qing; Zhang, Zhi; Xin, Wenqi; Li, Aixiang

    2017-01-01

    Abstract Background: A systematic review and meta-analysis of published randomized controlled trials (RCTs) were performed to assess the efficacy and safety of preoperative intravenous glucocorticoids versus controls for the prevention of postoperative acute pain and postoperative nausea and vomiting (PONV) after primary total hip arthroplasty (THA). Methods: A computer literature search of electronic databases, including PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, China National Knowledge Infrastructure (CNKI), and China Wanfang database, was conducted to identify the relevant RCTs comparing preoperative intravenous glucocorticoids versus placebos for reducing acute pain and PONV in THA patients. The primary outcomes included the use of the visual analog scale (VAS) with rest or mobilization at 6, 24, 48, and 72 hours and the occurrence of PONV. The secondary outcome was total morphine consumption. We calculated the risk ratio (RR) with a 95% confidence interval (95% CI) for dichotomous outcomes, and the weighted mean difference (WMD) with a 95% CI for continuous outcomes. Results: Pooled data from 7 RCTs (411 THAs) favored preoperative intravenous glucocorticoids against acute pain intensity at 4, 24, and 48 hours (P  .05). Subsequently, preoperative intravenous glucocorticoids provided a total morphine-sparing effect of 9.36 mg (WMD = −9.36, 95% CI = −12.33 to −6.38, P = .000). In addition, preoperative intravenous glucocorticoids were associated with a significant reduction of the occurrence of PONV (RR = 0.41, 95% CI = 0.30–0.57, P = .000). Conclusion: Intravenous glucocorticoids can decrease early pain intensity and PONV after THA. However, the low number of studies and variation in dosing regimens limits the evidence for its use. Thus, more high-quality RCTs are still needed to identify the optimal drug and the safety of intravenous glucocorticoids. PMID:29381983

  3. The effect of Tc99m Sestamibi scans during acute chest pain on clinical management

    International Nuclear Information System (INIS)

    Baldey, A.; Cameron, P.; Grigg, L.; Knott, J.; Better, N.

    1998-01-01

    Full text: The aim of this study is to assess whether the increased sensitivity and specificity of Tc99m sestamibi scans, during acute chest pain, will lead to alteration in clinical management and potential cost saving in an Australian population. Consecutive patients who presented with acute chest pain were injected 800 MBq of Tc99m sestamibi during pain (Hot MlBI) and SPECT imaging performed 1-6 hours later. The population was those only with a 'intermediate risk' of myocardial ischaemia The patients included in patients, those in the Emergency Department, and those with a previous history of cardiac disease. 25% of patients required a second, pain free study the following day to differentiate acute ischaemia from prior infarction. A question sheet was filled out by the requesting physician prior to the study indicating the likelihood of cardiac disease and the proposed management if no 'Hot MIBI' scan was available. The treatment that the patient subsequently received was ascertained from the patient's medical record. Of the 28 patients, a prediction whether to or not to proceed to coronary angiography was made in 13 patients prior to the MIBI study being performed. Of the 13, 5 would have had coronary angiography performed. and in all 5, the decision to proceed to coronary angiography was averted by the 'Hot MIBI'. Of note, 3 patients were admitted purely because of an abnormal 'Hot MIBI'. The 'Hot MIBI' was able to reduce coronary care admissions by 83% reduce all admissions by 17%, and avert coronary angiography in 38% of patients. In this intermediate risk category patient, this translates to not only admissions saved but potential cost saving

  4. Monitoring acute equine visceral pain with the Equine Utrecht University Scale for Composite Pain Assessment (EQUUS-COMPASS) and the Equine Utrecht University Scale for Facial Assessment of Pain (EQUUS-FAP) : A scale-construction study

    NARCIS (Netherlands)

    van Loon, Johannes P A M; Van Dierendonck, Machteld C

    2015-01-01

    Although recognition of equine pain has been studied extensively over the past decades there is still need for improvement in objective identification of pain in horses with acute colic. This study describes scale construction and clinical applicability of the Equine Utrecht University Scale for

  5. Pain over speed bumps in diagnosis of acute appendicitis: diagnostic accuracy study.

    Science.gov (United States)

    Ashdown, Helen F; D'Souza, Nigel; Karim, Diallah; Stevens, Richard J; Huang, Andrew; Harnden, Anthony

    2012-12-14

    To assess the diagnostic accuracy of pain on travelling over speed bumps for the diagnosis of acute appendicitis. Prospective questionnaire based diagnostic accuracy study. Secondary care surgical assessment unit at a district general hospital in the UK. 101 patients aged 17-76 years referred to the on-call surgical team for assessment of possible appendicitis. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios for pain over speed bumps in diagnosing appendicitis, with histological diagnosis of appendicitis as the reference standard. The analysis included 64 participants who had travelled over speed bumps on their journey to hospital. Of these, 34 had a confirmed histological diagnosis of appendicitis, 33 of whom reported increased pain over speed bumps. The sensitivity was 97% (95% confidence interval 85% to 100%), and the specificity was 30% (15% to 49%). The positive predictive value was 61% (47% to 74%), and the negative predictive value was 90% (56% to 100%). The likelihood ratios were 1.4 (1.1 to 1.8) for a positive test result and 0.1 (0.0 to 0.7) for a negative result. Speed bumps had a better sensitivity and negative likelihood ratio than did other clinical features assessed, including migration of pain and rebound tenderness. Presence of pain while travelling over speed bumps was associated with an increased likelihood of acute appendicitis. As a diagnostic variable, it compared favourably with other features commonly used in clinical assessment. Asking about speed bumps may contribute to clinical assessment and could be useful in telephone assessment of patients.

  6. Diazepam Is No Better Than Placebo When Added to Naproxen for Acute Low Back Pain.

    Science.gov (United States)

    Friedman, Benjamin W; Irizarry, Eddie; Solorzano, Clemencia; Khankel, Nauman; Zapata, Jennifer; Zias, Eleftheria; Gallagher, E John

    2017-08-01

    Low back pain causes more than 2.5 million visits to US emergency departments (EDs) annually. Low back pain patients are often treated with nonsteroidal anti-inflammatory drugs and benzodiazepines. The former is an evidence-based intervention, whereas the efficacy of the latter has not been established. We compare pain and functional outcomes 1 week and 3 months after ED discharge among patients randomized to a 1-week course of naproxen+diazepam versus naproxen+placebo. This was a randomized, double-blind, comparative efficacy clinical trial conducted in an urban health care system. Patients presenting with acute, nontraumatic, nonradicular low back pain of no more than a duration of 2 weeks were eligible for enrollment immediately before discharge from an ED if they had a score greater than 5 on the Roland-Morris Disability Questionnaire, a validated 24-item inventory of functional impairment caused by low back pain. Higher scores on the questionnaire indicate greater functional disability. The primary outcome in the trial was improvement in the score between ED discharge and 1 week later. Secondary outcomes included pain intensity 1 week and 3 months after ED discharge, as measured on a 4-point descriptive scale (severe, moderate, mild, and none). All patients were given 20 tablets of naproxen 500 mg, to be taken twice a day as needed for low back pain. Additionally, patients were randomized to receive either 28 tablets of diazepam 5 mg or identical placebo, to be received as 1 or 2 tablets every 12 hours as needed for low back pain. All patients received a standardized 10-minute low back pain educational session before discharge. Using a between-group mean difference of 5 Roland-Morris Disability Questionnaire points, a previously validated threshold for clinical significance, we calculated the need for at least 100 patients with primary outcome data. Enrollment began in June 2015 and continued for 9 months. Five hundred forty-five patients were screened for

  7. Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain

    Science.gov (United States)

    Paige, Neil M.; Miake-Lye, Isomi M.; Booth, Marika Suttorp; Beroes, Jessica M.; Mardian, Aram S.; Dougherty, Paul; Branson, Richard; Tang, Baron; Morton, Sally C.

    2017-01-01

    Importance Acute low back pain is common and spinal manipulative therapy (SMT) is a treatment option. Randomized clinical trials (RCTs) and meta-analyses have reported different conclusions about the effectiveness of SMT. Objective To systematically review studies of the effectiveness and harms of SMT for acute (≤6 weeks) low back pain. Data Sources Search of MEDLINE, Cochrane Database of Systematic Reviews, EMBASE, and Current Nursing and Allied Health Literature from January 1, 2011, through February 6, 2017, as well as identified systematic reviews and RCTs, for RCTs of adults with low back pain treated in ambulatory settings with SMT compared with sham or alternative treatments, and that measured pain or function outcomes for up to 6 weeks. Observational studies were included to assess harms. Data Extraction and Synthesis Data extraction was done in duplicate. Study quality was assessed using the Cochrane Back and Neck (CBN) Risk of Bias tool. This tool has 11 items in the following domains: randomization, concealment, baseline differences, blinding (patient), blinding (care provider [care provider is a specific quality metric used by the CBN Risk of Bias tool]), blinding (outcome), co-interventions, compliance, dropouts, timing, and intention to treat. Prior research has shown the CBN Risk of Bias tool identifies studies at an increased risk of bias using a threshold of 5 or 6 as a summary score. The evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Main Outcomes and Measures Pain (measured by either the 100-mm visual analog scale, 11-point numeric rating scale, or other numeric pain scale), function (measured by the 24-point Roland Morris Disability Questionnaire or Oswestry Disability Index [range, 0-100]), or any harms measured within 6 weeks. Findings Of 26 eligible RCTs identified, 15 RCTs (1711 patients) provided moderate-quality evidence that SMT has a statistically significant

  8. Dopamine and pain sensitivity: neither sulpiride nor acute phenylalanine and tyrosine depletion have effects on thermal pain sensations in healthy volunteers.

    Science.gov (United States)

    Becker, Susanne; Ceko, Marta; Louis-Foster, Mytsumi; Elfassy, Nathaniel M; Leyton, Marco; Shir, Yoram; Schweinhardt, Petra

    2013-01-01

    Based on animal studies and some indirect clinical evidence, dopamine has been suggested to have anti-nociceptive effects. Here, we investigated directly the effects of increased and decreased availability of extracellular dopamine on pain perception in healthy volunteers. In Study 1, participants ingested, in separate sessions, a placebo and a low dose of the centrally acting D2-receptor antagonist sulpiride, intended to increase synaptic dopamine via predominant pre-synaptic blockade. No effects were seen on thermal pain thresholds, tolerance, or temporal summation. Study 2 used the acute phenylalanine and tyrosine depletion (APTD) method to transiently decrease dopamine availability. In one session participants ingested a mixture that depletes the dopamine amino acid precursors, phenylalanine and tyrosine. In the other session they ingested a nutritionally balanced control mixture. APTD led to a small mood-lowering response following aversive thermal stimulation, but had no effects on the perception of cold, warm, or pain stimuli. In both studies the experimental manipulation of dopaminergic neurotransmission was successful as indicated by manipulation checks. The results contradict proposals that dopamine has direct anti-nociceptive effects in acute experimental pain. Based on dopamine's well-known role in reward processing, we hypothesize that also in the context of pain, dopamine acts on stimulus salience and might play a role in the initiation of avoidance behavior rather than having direct antinociceptive effects in acute experimental pain.

  9. Ibuprofen plus paracetamol versus ibuprofen in acute low back pain: a randomized open label multicenter clinical study.

    Science.gov (United States)

    Ostojic, Predrag; Radunovic, Goran; Lazovic, Milica; Tomanovic-Vujadinovic, Sanja

    2017-01-01

    to estimate whether combination of ibuprofen and paracetamol is more effective than ibuprofen in monotherapy, in the treatment of acute low back pain. 80 adult patients with acute low back pain were randomized into two subgroups. In the first subgroup, 40 patients were treated with ibuprofen 400mg three times a day (TID), whilst patients in the second subgroup (n=40) were treated with a fixed-dose combination tablet of ibuprofen 200mg plus paracetamol 325mg TID, for three consecutive days. Patients were followed for another 7 days. Efficacy and tolerability of both treatment options was assessed. A statistically significant decrease in pain intensity, assessed using a visual analogue scale (pibuprofen monotherapy reported minor gastric intolerability. compared to ibuprofen monotherapy, combination of ibuprofen and paracetamol may provide faster and longer analgesia in patients with acute low back pain, with equally favorable effect on mobility and functional ability and similar tolerability.

  10. Effects of ultrasound-guided stellate ganglion block on acute pain after arthroscopic shoulder surgery.

    Science.gov (United States)

    Choi, Eun Mi; Kim, Eun Mi; Chung, Mi Hwa; Park, Jong Hee; Lee, Hyo Keun; Choi, Young Rong; Lee, Mihyeon

    2015-01-01

    Apart from a few case reports, the effectiveness of stellate ganglion block (SGB) as a monotherapy in acute nociceptive pain has not been determined. We aimed to assess the effects of SGB on postoperative pain after arthroscopic shoulder surgery. Randomized, blind, controlled, clinical trial University Hospital outpatient Forty-six patients undergoing arthroscopic shoulder surgery were assigned randomly to 2 groups: group S included patients who underwent SGB prior to surgery and group C did not. In group S, subfascial ultrasound-guided SGB was conducted with 4 mL of 0.375% levobupivacaine. For the first postoperative 48 hours, postoperative visual analog scale (VAS) and analgesic requirements were compared. The results of 40 patients were included in the study. There was no difference between groups with regards to analgesics requirement for the first postoperative 48 hours and no difference in VAS score (P > 0.05). Small number of patients in study. Preoperative ultrasound-guided SGB did not reduce postoperative acute pain in arthroscopic shoulder surgery.

  11. ACR Appropriateness Criteria® Acute Pelvic Pain in the Reproductive Age Group.

    Science.gov (United States)

    Bhosale, Priyadarshani R; Javitt, Marcia C; Atri, Mostafa; Harris, Robert D; Kang, Stella K; Meyer, Benjamin J; Pandharipande, Pari V; Reinhold, Caroline; Salazar, Gloria M; Shipp, Thomas D; Simpson, Lynn; Sussman, Betsy L; Uyeda, Jennifer; Wall, Darci J; Zelop, Carolyn M; Glanc, Phyllis

    2016-06-01

    Acute pelvic pain in premenopausal women frequently poses a diagnostic dilemma. These patients may exhibit nonspecific signs and symptoms such as nausea, vomiting and leukocytosis. The cause of pelvic pain includes a myriad of diagnostic possibilities such as obstetric, gynecologic, urologic, gastrointestinal, and vascular etiologies. The choice of the imaging modality is usually determined by a suspected clinical differential diagnosis. Thus the patient should undergo careful evaluation and the suspected differential diagnosis should be narrowed before an optimal imaging modality is chosen. Transvaginal and transabdominal pelvic sonography is the modality of choice, to assess for pelvic pain, when an obstetric or gynecologic etiology is suspected and computed tomography is often more useful when gastrointestinal or genitourinary pathology is thought to be more likely. Magnetic resonance imaging, when available in the acute setting, is favored over computed tomography for assessing pregnant patients for nongynecologic etiologies owing to its lack of ionizing radiation.The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

  12. Towards remote assessment and screening of acute abdominal pain using only a smartphone with native accelerometers.

    Science.gov (United States)

    Myers, David R; Weiss, Alexander; Rollins, Margo R; Lam, Wilbur A

    2017-10-06

    Smartphone-based telehealth holds the promise of shifting healthcare from the clinic to the home, but the inability for clinicians to conduct remote palpation, or touching, a key component of the physical exam, remains a major limitation. This is exemplified in the assessment of acute abdominal pain, in which a physician's palpation determines if a patient's pain is life-threatening requiring emergency intervention/surgery or due to some less-urgent cause. In a step towards virtual physical examinations, we developed and report for the first time a "touch-capable" mHealth technology that enables a patient's own hands to serve as remote surrogates for the physician's in the screening of acute abdominal pain. Leveraging only a smartphone with its native accelerometers, our system guides a patient through an exact probing motion that precisely matches the palpation motion set by the physician. An integrated feedback algorithm, with 95% sensitivity and specificity, enabled 81% of tested patients to match a physician abdominal palpation curve with <20% error after 6 attempts. Overall, this work addresses a key issue in telehealth that will vastly improve its capabilities and adoption worldwide.

  13. Disability in older adults with acute low back pain: the study Back Complaints in the Elderly - (Brazil).

    Science.gov (United States)

    Aguiar, Alessandra Regina Silva Araujo; Ribeiro-Samora, Giane Amorim; Pereira, Leani Souza Maximo; Godinho, Larissa Birro; Assis, Marcella Guimarães

    The increase in the older adult and oldest old population in Brazil is growing. This phenomenon may be accompanied by an increase in musculoskeletal symptoms such as low back pain. This condition is usually associated with disability. To verify the association between pain intensity and disability in older adults with acute low back pain and assess whether these variables differ depending on the age group and marital status. This is a cross-sectional study conducted with 532 older adults with acute low back pain episodes. Pain intensity was assessed through the Numeric Pain Scale and disability through the Late Life Function and Disability Instrument, which shows two dimensions: "frequency" and "limitation" in performing activities. The association between pain and disability was analyzed. For the interaction effect between age groups and marital status, we found that the oldest old living with a partner performed activities of the personal domain less often compared to the oldest old living alone. The oldest old group living with a partner had a lower frequency of performing activities, but did not report feeling limited. The association of pain with disability was minimal (rholow back pain was influenced by the interaction between age groups and marital status and is not associated with pain intensity. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

  14. Randomized Clinical Trial of Intraosseous Methylprednisolone Injection for Acute Pulpitis Pain.

    Science.gov (United States)

    Bane, Khaly; Charpentier, Emmanuel; Bronnec, François; Descroix, Vianney; Gaye-N'diaye, Fatou; Kane, Abdoul Wahabe; Toledo, Rafael; Machtou, Pierre; Azérad, Jean

    2016-01-01

    The present study reports the results of a randomized clinical trial comparing local intraosseous methylprednisolone injection and emergency pulpotomy in the management of acute pulpitis on efficacy, safety, and efficiency end points. After providing prior informed written consent, 94 patients consulting for acute irreversible pulpitis pain at university-affiliated teaching hospital dental clinics in Dakar, Senegal were randomly assigned to either the methylprednisolone treatment group (n = 47) or the pulpotomy treatment group (n = 47). Patients were followed up at 1 week and assessed 6 months later to evaluate the therapeutic outcome of their treatment. At day 7 the patients in the methylprednisolone group reported less intense spontaneous and percussion pain in the day 0-day 7 period than the patients in the pulpotomy group. Methylprednisolone treatment took approximately 7 minutes (4.6-9.3) less to accomplish than pulpotomy (or about half the time). No difference in the therapeutic outcome was found between the 2 treatment groups at 6 months (all credible intervals span 0). This study establishes that methylprednisolone injection for acute pulpitis is relieved by a minimally invasive pharmacologic approach more effectively than by the reference pulpotomy and conserves scarce dental resources (ie, endodontic equipment and supplies, dental surgeon's time). Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  15. The acute benefits and risks of passive stretching to the point of pain.

    Science.gov (United States)

    Muanjai, Pornpimol; Jones, David A; Mickevicius, Mantas; Satkunskiene, Danguole; Snieckus, Audrius; Skurvydas, Albertas; Kamandulis, Sigitas

    2017-06-01

    This study evaluated the acute effects of two different stretch intensities on muscle damage and extensibility. Twenty-two physically active women (age 20 ± 1.0 years) were divided into two matched groups and undertook eight sets of 30-s passive hamstring stretching. One group stretched to the point of discomfort (POD) and the other to the point of pain (POP). Hamstring passive torque, sit and reach (S&R), straight leg raise (SLR), and markers of muscle damage were measured before, immediately after stretching and 24 h later. S&R acutely increased and was still increased at 24 h with median (interquartile range) of 2.0 cm (0.5-3.75 cm) and 2.0 cm (0.25-3.0 cm) for POP and POD (p muscle tenderness occurred at 24 h in both groups and there was a very small increase in thigh circumference in both groups which persisted at 24 h in POP. Plasma CK activity was not raised at 24 h. Stretching to the point of pain had no acute advantages over stretching to the discomfort point. Both forms of stretching resulted in very mild muscle tenderness but with no evidence of muscle damage. The increased ROM was not associated with changes in passive stiffness of the muscle but most likely resulted from increased tolerance of the discomfort.

  16. Heterotopic gastric mucosa associated with abdominal abscess formation, hypotension, and acute abdominal pain in a puppy.

    Science.gov (United States)

    Tobleman, Bridget N; Sinnott, Virginia B

    2014-01-01

    To describe the presence of heterotopic gastric mucosa forming an abscess associated with acute abdominal pain and shock in a puppy. A 7-month-old male intact Shih-Tzu was presented to the emergency service for evaluation of a 12-hour history of vomiting and lethargy progressing to weakness. On presentation, the puppy was obtunded and hypotensive. Radiographs revealed an ill-defined mid-ventral abdominal mass. Ultrasound revealed an echogenic, fluid-filled mass associated with the jejunum. The puppy had an exploratory celiotomy and a 2 × 4 cm oval fluid-filled soft tissue mass was found to be intimately associated, but not communicating with, a section of the mid-jejunum. The mass and associated jejunum were removed via enterectomy. Histopathology of the resected mass revealed heterotopic gastric mucosa; bacterial culture of the fluid contained in the mass revealed heavy growth of Escherichia coli. The puppy recovered from surgery, was discharged from the hospital, and has had no further complications from this episode. Heterotopic gastric mucosa is commonly found incidentally on necropsy. When it has been associated with acute gastrointestinal signs, mechanical intestinal obstruction with or without perforation was noted. To the authors' knowledge, this is the first reported case of heterotopic gastric mucosa leading to abscess formation and acute abdominal pain in the dog. © Veterinary Emergency and Critical Care Society 2014.

  17. Acupuncture for acute postoperative pain after back surgery: a systematic review and meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Cho, Young-Hun; Kim, Chang-Kyu; Heo, Kwang-Ho; Lee, Myeong Soo; Ha, In-Hyuk; Son, Dong Wuk; Choi, Byung Kwan; Song, Geun-Sung; Shin, Byung-Cheul

    2015-03-01

    Acupuncture is commonly used as a complimentary treatment for pain management. However, there has been no systematic review summarizing the current evidence concerning the effectiveness of acupuncture for acute postoperative pain after back surgery. This systematic review aimed at evaluating the effectiveness of acupuncture treatment for acute postoperative pain (≤1 week) after back surgery. We searched 15 electronic databases without language restrictions. Two reviewers independently assessed studies for eligibility and extracted data, outcomes, and risk of bias. Random effect meta-analyses and subgroup analyses were performed. Five trials, including 3 of high quality, met our inclusion criteria. The meta-analysis showed positive results for acupuncture treatment of pain after surgery in terms of the visual analogue scale (VAS) for pain intensity 24 hours after surgery, when compared to sham acupuncture (standard mean difference -0.67 (-1.04 to -0.31), P = 0.0003), whereas the other meta-analysis did not show a positive effect of acupuncture on 24-hour opiate demands when compared to sham acupuncture (standard mean difference -0.23 (-0.58 to 0.13), P = 0.21). Our systematic review finds encouraging but limited evidence for the effectiveness of acupuncture treatment for acute postoperative pain after back surgery. Further rigorously designed clinical trials are required. © 2014 The Authors. Pain Practice published by Wiley periodicals, Inc. on behalf of World Institute of Pain.

  18. [Effectiveness of an individualised physiotherapy program versus group therapy on neck pain and disability in patients with acute and subacute mechanical neck pain].

    Science.gov (United States)

    Antúnez Sánchez, Leonardo Gregorio; de la Casa Almeida, María; Rebollo Roldán, Jesús; Ramírez Manzano, Antonio; Martín Valero, Rocío; Suárez Serrano, Carmen

    To compare the efficacy in reducing neck pain and disability in an individualised physiotherapy treatment with group treatment in acute and subacute mechanical neck pain. Randomised clinical trial. Health Area of University Hospital Virgen del Rocío, Seville, Spain. A total of 90 patients diagnosed with mechanical neck pain of up to one month onset, distributed randomly into two groups: (i)individualised treatment; (ii)group treatment. The treatment consisted of 15 sessions of about 60minutes for both groups. Individual treatment consisted of 15minutes of infrared heat therapy, 17minutes of massage, and analytical passive stretching of the trapezius muscles and angle of the scapula. The group treatment consisted of a program of active mobilisation, isometric contractions, self-stretching, and postural recommendations. Pain was measured at the beginning and end of treatment pain using a Visual Analogue Scale (VAS) and an algometer applied on the trapezius muscles and angle of the scapula, and neck disability using the Neck Disability Index. Both treatments were statistically significant (P<.001) in improving all variables. Statistically significant differences (P<.001) were found for all of them in favour of individualised treatment compared to group treatment. Patients with acute or subacute mechanical neck pain experienced an improvement in pain and neck disability after receiving either of the physiotherapy treatments used in our study, with the individual treatment being more effective than collective. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  19. The role of intercostal nerve preservation in acute pain control after thoracotomy

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    Marco Aurélio Marchetti-Filho

    2014-04-01

    Full Text Available OBJECTIVE: To evaluate whether the acute pain experienced during in-hospital recovery from thoracotomy can be effectively reduced by the use of intraoperative measures (dissection of the neurovascular bundle prior to the positioning of the Finochietto retractor and preservation of the intercostal nerve during closure. METHODS: We selected 40 patients who were candidates for elective thoracotomy in the Thoracic Surgery Department of the Federal University of São Paulo/Paulista School of Medicine, in the city of São Paulo, Brazil. The patients were randomized into two groups: conventional thoracotomy (CT, n = 20 and neurovascular bundle preservation (NBP, n = 20. All of the patients underwent thoracic epidural anesthesia and muscle-sparing thoracotomy. Pain intensity was assessed with a visual analog scale on postoperative days 1, 3, and 5, as well as by monitoring patient requests for/consumption of analgesics. RESULTS: On postoperative day 5, the self-reported pain intensity was significantly lower in the NBP group than in the CT group (visual analog scale score, 1.50 vs. 3.29; p = 0.04. No significant differences were found between the groups regarding the number of requests for/consumption of analgesics. CONCLUSIONS: In patients undergoing thoracotomy, protecting the neurovascular bundle prior to positioning the retractor and preserving the intercostal nerve during closure can minimize pain during in-hospital recovery.

  20. Presumptive intraperitoneal envenomation resulting in hemoperitoneum and acute abdominal pain in a dog.

    Science.gov (United States)

    Istvan, Stephanie A; Walker, Julie M; Hansen, Bernard D; Hanel, Rita M; Marks, Steven L

    2015-01-01

    To describe the clinical features, diagnostic findings, treatment, and outcome of a dog with acute abdominal pain and hemoperitoneum secondary to a presumptive intraperitoneal (IP) snakebite. A 10-month-old castrated male mixed-breed dog was evaluated for suspected snake envenomation. The dog presented recumbent and tachycardic with signs of severe abdominal pain. Two cutaneous puncture wounds and hemoperitoneum were discovered during evaluation. Ultrasonographic examination revealed communication of the wounds with the peritoneal cavity. The dog was treated with supportive care, parenteral analgesia, packed red blood cell and fresh frozen plasma transfusions, crotalid antivenom, and placement of an IP catheter to provide local analgesia. The dog recovered fully and was discharged 5 days after initial presentation. To our knowledge, this is the first report of IP envenomation accompanied by hemorrhage treated with continuous IP analgesia in the veterinary literature. © Veterinary Emergency and Critical Care Society 2015.

  1. A review of sufentanil and the sufentanil sublingual tablet system for acute moderate to severe pain.

    Science.gov (United States)

    Minkowitz, Harold S

    2015-01-01

    The sufentanil sublingual tablet system (SSTS) is a novel patient-controlled analgesia (PCA) system that is pending approval from the US FDA for the management of moderate to severe acute pain in hospitalized patients. SSTS offers a noninvasive alternative to intravenous (iv.) PCA and optimized on-demand analgesia with the rapid onset and titratibility of sublingual sufentanil. Phase III clinical trials have demonstrated that SSTS has greater efficacy for the treatment of pain during the 72-h postoperative period after open abdominal and major orthopedic (total knee or total hip arthroplasty) surgery compared with iv. PCA with morphine sulfate (MS) or a placebo system. Safety assessments indicate that adverse events are typical for postoperative patients taking opioid analgesics. While the frequency of adverse events is comparable between patients using SSTS and iv. PCA MS, the incidence of oxygen desaturation is lower in those using SSTS.

  2. Yellow flag scores in a compensable New Zealand cohort suffering acute low back pain

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    Karen Grimmer-Somers

    2008-12-01

    Full Text Available Karen Grimmer-Somers1, Mathew Prior1, Jim Robertson21Centre for Allied Health Evidence, University of South Australia, City East Campus, North Tce, Adelaide, South Australia, Australia; 2New Zealand Accident Compensation Corporation, Auckland, New ZealandBackground: Despite its high prevalence, most acute low back pain (ALBP is nonspecific, self-limiting with no definable pathology. Recurrence is prevalent, as is resultant chronicity. Psychosocial factors (yellow flags comprising depression and anxiety, negative pain beliefs, job dissatisfaction are associated with the development of chronic LBP.Methods: A national insurer (Accident Compensation Corporation, New Zealand [NZ], in conjunction with a NZ primary health organization, piloted a strategy for more effective management of patients with ALBP, by following the NZ ALBP Guideline. The guidelines recommend the use of a psychosocial screening instrument (Yellow Flags Screening Instrument, a derivative of Örebro Musculoskeletal Pain Questionnaire. This instrument was recommended for administration on the second visit to a general medical practitioner (GP. This paper tests whether published cut-points of yellow flag scores to predict LBP claims length and costs were valid in this cohort.Results: Data was available for 902 claimants appropriately enrolled into the pilot. 25% claimants consulted the GP once only, and thus were not requested to provide a yellow flag score. Yellow flag scores were provided by 48% claimants who consumed two or more GP services. Approximately 60% LBP presentations resolved within five GP visits. Yellow flag scores were significantly and positively associated with treatment costs and service use, although the association was nonlinear. Claimants with moderate yellow flag scores were similarly likely to incur lengthy claims as claimants with at-risk scores.Discussion: Capturing data on psychosocial factors for compensable patients with ALBP has merit in predicting

  3. Effect of painless diabetic neuropathy on pressure pain hypersensitivity (hyperalgesia after acute foot trauma

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    Tobias Wienemann

    2014-11-01

    Full Text Available Introduction and objective: Acute injury transiently lowers local mechanical pain thresholds at a limb. To elucidate the impact of painless (diabetic neuropathy on this post-traumatic hyperalgesia, pressure pain perception thresholds after a skeletal foot trauma were studied in consecutive persons without and with neuropathy (i.e. history of foot ulcer or Charcot arthropathy. Design and methods: A case–control study was done on 25 unselected clinical routine patients with acute unilateral foot trauma (cases: elective bone surgery; controls: sprain, toe fracture. Cases were 12 patients (11 diabetic subjects with severe painless neuropathy and chronic foot pathology. Controls were 13 non-neuropathic persons. Over 1 week after the trauma, cutaneous pressure pain perception threshold (CPPPT and deep pressure pain perception threshold (DPPPT were measured repeatedly, adjacent to the injury and at the opposite foot (pinprick stimulators, Algometer II®. Results: In the control group, post-traumatic DPPPT (but not CPPPT at the injured foot was reduced by about 15–25%. In the case group, pre- and post-operative CPPPT and DPPPT were supranormal. Although DPPPT fell post-operatively by about 15–20%, it remained always higher than the post-traumatic DPPPT in the control group: over musculus abductor hallucis 615 kPa (kilopascal versus 422 kPa, and over metatarsophalangeal joint 518 kPa versus 375 kPa (medians; case vs. control group; CPPPT did not decrease post-operatively. Conclusion: Physiological nociception and post-traumatic hyperalgesia to pressure are diminished at the foot with severe painless (diabetic neuropathy. A degree of post-traumatic hypersensitivity required to ‘pull away’ from any one, even innocuous, mechanical impact in order to avoid additional damage is, therefore, lacking.

  4. Effect of painless diabetic neuropathy on pressure pain hypersensitivity (hyperalgesia) after acute foot trauma.

    Science.gov (United States)

    Wienemann, Tobias; Chantelau, Ernst A; Koller, Armin

    2014-01-01

    Acute injury transiently lowers local mechanical pain thresholds at a limb. To elucidate the impact of painless (diabetic) neuropathy on this post-traumatic hyperalgesia, pressure pain perception thresholds after a skeletal foot trauma were studied in consecutive persons without and with neuropathy (i.e. history of foot ulcer or Charcot arthropathy). A case-control study was done on 25 unselected clinical routine patients with acute unilateral foot trauma (cases: elective bone surgery; controls: sprain, toe fracture). Cases were 12 patients (11 diabetic subjects) with severe painless neuropathy and chronic foot pathology. Controls were 13 non-neuropathic persons. Over 1 week after the trauma, cutaneous pressure pain perception threshold (CPPPT) and deep pressure pain perception threshold (DPPPT) were measured repeatedly, adjacent to the injury and at the opposite foot (pinprick stimulators, Algometer II(®)). In the control group, post-traumatic DPPPT (but not CPPPT) at the injured foot was reduced by about 15-25%. In the case group, pre- and post-operative CPPPT and DPPPT were supranormal. Although DPPPT fell post-operatively by about 15-20%, it remained always higher than the post-traumatic DPPPT in the control group: over musculus abductor hallucis 615 kPa (kilopascal) versus 422 kPa, and over metatarsophalangeal joint 518 kPa versus 375 kPa (medians; case vs. control group); CPPPT did not decrease post-operatively. Physiological nociception and post-traumatic hyperalgesia to pressure are diminished at the foot with severe painless (diabetic) neuropathy. A degree of post-traumatic hypersensitivity required to 'pull away' from any one, even innocuous, mechanical impact in order to avoid additional damage is, therefore, lacking.

  5. Mesotherapy versus Systemic Therapy in the Treatment of Acute Low Back Pain: A Randomized Trial

    Directory of Open Access Journals (Sweden)

    Cosimo Costantino

    2011-01-01

    Full Text Available Pharmacological therapy of back pain with analgesics and anti-inflammatory drugs is frequently associated with adverse effects, particularly in the elderly. Aim of this study was to compare mesotherapic versus conventional systemic administration of nonsteroidal anti-inflammatory drugs (NSAIDs and corticosteroids in patients with acute low back pain. Eighty-four patients were randomized to receive anti-inflammatory therapy according to the following protocols: (a mesotherapy group received the 1st and 4th day 2% lidocaine (1 mL + ketoprofen 160 mg (1 mL + methylprednisolone 40 mg (1 mL, then on 7th, 10th, and 13th day, 2% lidocaine (1 mL + ketoprofen 160 mg (1 mL + methylprednisolone 20 mg (1 mL (b conventional therapy group received ketoprofen 80 mg × 2/die and esomeprazole 20 mg/die orally for 12 days, methylprednisolone 40 mg/die intramuscularly for 4 days, followed by methylprednisolone 20 mg/die for 3 days, and thereafter, methylprednisolone 20 mg/die at alternate days. Pain intensity and functional disability were assessed at baseline (T0, at the end of treatment (T1, and 6 months thereafter (T2 by using visual analogic scale (VAS and Roland-Morris disability questionnaire (RMDQ. In both groups, VAS and RMDQ values were significantly reduced at the end of drug treatment and after 6 months, in comparison with baseline. No significant differences were found between the two groups. This suggests that mesotherapy may be a valid alternative to conventional therapy in the treatment of acute low back pain with corticosteroids and NSAIDs.

  6. Kaempferol, a dietary flavonoid, ameliorates acute inflammatory and nociceptive symptoms in gastritis, pancreatitis, and abdominal pain.

    Science.gov (United States)

    Kim, Shi Hyoung; Park, Jae Gwang; Sung, Gi-Ho; Yang, Sungjae; Yang, Woo Seok; Kim, Eunji; Kim, Jun Ho; Ha, Van Thai; Kim, Han Gyung; Yi, Young-Su; Kim, Ji Hye; Baek, Kwang-Soo; Sung, Nak Yoon; Lee, Mi-nam; Kim, Jong-Hoon; Cho, Jae Youl

    2015-07-01

    Kaempferol (KF) is the most abundant polyphenol in tea, fruits, vegetables, and beans. However, little is known about its in vivo anti-inflammatory efficacy and mechanisms of action. To study these, several acute mouse inflammatory and nociceptive models, including gastritis, pancreatitis, and abdominal pain were employed. Kaempferol was shown to attenuate the expansion of inflammatory lesions seen in ethanol (EtOH)/HCl- and aspirin-induced gastritis, LPS/caerulein (CA) triggered pancreatitis, and acetic acid-induced writhing. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  7. Incidence and characteristics of acute referred orofacial pain caused by a posterior single tooth pulpitis in an Iranian population.

    Science.gov (United States)

    Hashemipour, Maryam Alsadat; Borna, Roya

    2014-02-01

    This study was designed to evaluate incidence and characteristics of acute referred orofacial pain caused by a posterior single tooth pulpitis in an Iranian population. In this cross-sectional study, 3,150 patients (1,400 males and 1,750 females) with pain in the orofacial region were evaluated via clinical and radiographic examination to determine their pain source. Patients completed a standardized clinical questionnaire consisting of a numerical rating scale for pain intensity and chose verbal descriptors from short form McGill questionnaire to describe the quality of their pain. Visual analog scale (VAS) was used to score pain intensity. In addition, patients indicated sites to which pain referred by drawing on an illustration of the head and neck. Data were analyzed using chi-square, fisher exact, and Mann-Whitney tests. Two thousand and hundred twenty patients (67/3%) reported pain in sites that diagnostically differed from the pain source. According to statistical analysis, sex (P = 0.02), intensity of pain (0.04), and quality (P = 0.001) of pain influenced its referral nature, while age of patients and kind of stimulus had no considerable effect on pain referral (P > 0.05). The results of the present study show the prevalence of referred pain in the head, face, and neck region is moderately high. Therefore, in patients with orofacial pain, it is essential to carefully examination before carrying out treatment that could be inappropriate. © 2013 The Authors Pain Practice © 2013 World Institute of Pain.

  8. The Effect of Massage on Acute Postoperative Pain in Critically and Acutely Ill Adults Post-thoracic Surgery: Systematic Review and Meta-analysis of Randomized Controlled Trials.

    Science.gov (United States)

    Boitor, Madalina; Gélinas, Céline; Richard-Lalonde, Melissa; Thombs, Brett D

    Critical care practice guidelines identify a lack of clear evidence on the effectiveness of massage for pain control. To assess the effect of massage on acute pain in critically and acutely ill adults post-thoracic surgery. Medline, Embase, CINAHL, PsychInfo, Web of Science, Scopus and Cochrane Library databases were searched. Eligible studies were randomized controlled trials (RCTs) evaluating the effect of massage compared to attention control/sham massage or standard care alone on acute pain intensity post-thoracic surgery. Twelve RCTs were included. Of these, nine evaluated massage in addition to standard analgesia, including 2 that compared massage to attention control/sham massage in the intensive care unit (ICU), 6 that compared massage to standard analgesia alone early post-ICU discharge, and 1 that compared massage to both attention control and standard care in the ICU. Patients receiving massage with analgesia reported less pain (0-10 scale) compared to attention control/sham massage (3 RCTs; N = 462; mean difference -0.80, 95% confidence interval [CI] -1.25 to -0.35; p Massage, in addition to pharmacological analgesia, reduces acute post-cardiac surgery pain intensity. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Acute Hypotension and Chest Pain as The Presentation of a Post-Myocardial Infarction Acute Pericarditis (Dressler’s Syndrome

    Directory of Open Access Journals (Sweden)

    Alfredo De Giorgi

    2016-01-01

    Full Text Available We report a case of a 53-year old man admitted because of fever (38.5°C and atypical chest pain. He also complained of epigastric pain spread to left hypochondrium and exacerbated by breathing. In his past medical history, Hodgkin’s lymphoma, gastric MALToma (oncologic follow-up only, hypothyroidism, and hypertension are recorded. Fifteen days prior actual hospital admission, the patient underwent angioplasty with stenting due to a ST elevation myocardial infarction. Moreover, he was enrolled in the experimental clinical double-blind trial GEMINI-ACS [1], designed to compare the safety of rivaroxaban vs aspirin in addition to either clopidogrel or ticagrelor. Thus, his complete therapy included also ticagrelor, bisoprolol, perindopril, levothyroxine, pantoprazole, and atorvastatin. At the time of admission chest X-ray showed bilateral pleural effusion. Blood chemistry panel showed moderate anemia, increase of inflammatory indexes, in particular fibrinogen 1057 mg/dl (normal range 150-400 mg/dl, C-reactive-protein 17.6 mg/dl (normal range <0.5 mg/dl, serum ferritin 650 ng/ml (normal range 11-306 ng/ml, while serum pro-calcitonin was normal. Electrocardiography and cardiac troponin I were not suggestive of further heart ischemic damage. Two days later, the patient showed hypotension, exacerbation of chest pain, as well as a rapid drop hemoglobin values. A thoracicabdominal CT (figure 1 was performed, showing peri-hepatic and pericardial effusions associated with hyper-reflectivity of pericardial leaflets. After a precautionary discontinuation of the experimental drugs, acetylsalicylic acid and clopidogrel were only given, together with antibiotics, diuretics and steroids. Clinical conditions slowly improved, blood pressure levels raised, together with hemoglobin values, and inflammatory parameters decreased. The patient was discharged in good clinical conditions, with the conclusive discharge diagnosis of Dressler syndrome (DS related to

  10. Using the Horse Grimace Scale (HGS) to Assess Pain Associated with Acute Laminitis in Horses (Equus caballus).

    Science.gov (United States)

    Dalla Costa, Emanuela; Stucke, Diana; Dai, Francesca; Minero, Michela; Leach, Matthew C; Lebelt, Dirk

    2016-08-03

    Acute laminitis is a common equine disease characterized by intense foot pain, both acutely and chronically. The Obel grading system is the most widely accepted method for describing the severity of laminitis by equine practitioners, however this method requires movement (walk and trot) of the horse, causing further intense pain. The recently developed Horse Grimace Scale (HGS), a facial-expression-based pain coding system, may offer a more effective means of assessing the pain associated with acute laminitis. The aims of this study were: to investigate whether HGS can be usefully applied to assess pain associated with acute laminitis in horses at rest, and to examine if scoring HGS using videos produced similar results as those obtained from still images. Ten horses, referred as acute laminitis cases with no prior treatment, were included in the study. Each horse was assessed using the Obel and HGS (from images and videos) scales: at the admission (before any treatment) and at seven days after the initial evaluation and treatment. The results of this study suggest that HGS is a potentially effective method to assess pain associated with acute laminitis in horses at rest, as horses showing high HGS scores also exhibited higher Obel scores and veterinarians classified them in a more severe painful state. Furthermore, the inter-observer reliability of the HGS total score was good for both still images and video evaluation. There was no significant difference in HGS total scores between the still images and videos, suggesting that there is a possibility of applying the HGS in clinical practice, by observing the horse for a short time. However, further validation studies are needed prior to applying the HGS in a clinical setting.

  11. Chiropractic Treatment vs Self-Management in Patients With Acute Chest Pain: A Randomized Controlled Trial of Patients Without Acute Coronary Syndrome

    DEFF Research Database (Denmark)

    Stochkendahl, Mette J; Christensen, Henrik W; Vach, Werner

    2012-01-01

    rating scale) and self-perceived change in pain (7-point ordinal scale). RESULTS: Both groups experienced decreases in pain, self-perceived positive changes, and increases in Medical Outcomes Study Short Form 36-Item Health Survey scores. Observed between-group significant differences were in favor...... minimal intervention in patients without acute coronary syndrome but with musculoskeletal chest pain. Results suggest that chiropractic treatment might be useful; but further research in relation to patient selection, standardization of interventions, and identification of potentially active ingredients...

  12. Back Pain

    Science.gov (United States)

    ... Accessed May 29, 2015. Adult acute and subacute low back pain. Bloomington, Minn.: Institute for Clinical Systems Improvement. http://www.icsi.org/low_back_pain/adult_low_back_pain__8.html. Accessed June ...

  13. The effect of Kinesio taping application for acute non-specific low back pain: a randomized controlled clinical trial.

    Science.gov (United States)

    Kelle, Bayram; Güzel, Rengin; Sakallı, Hakan

    2016-10-01

    To investigate the effect of Kinesio taping application in acute non-specific low back pain. A randomized controlled clinical trial. Physical Medicine and Rehabilitation Clinic. A total of 109 patients with acute low back pain were randomized into either Kinesio taping (n = 54) or control (n = 55) groups. The intervention group was treated with information and reassurance plus Kinesio taping, while the control group received merely information and reassurance. All participants were allowed to use as-needed doses of paracetamol. Kinesio tape was applied to the most painful area of the low back for a total of 12 days. Worst pain and disability were assessed at baseline, after the 12-day intervention, and at four weeks follow-up. During the first 12 days, participants filled in a pain diary consisting of a numeric rating scale and recorded the number of paracetamol tablets consumed daily. Disability was assessed with the Oswestry Disability Index. After 12 days of intervention, pain intensity and the Oswestry Disability Index improved significantly in both groups; the improvements were significantly superior in the Kinesio taping group (p = 0.003, p = 0.011). The Kinesio taping group reached pain control earlier (sixth day vs. 12th day) and consumed less paracetamol. At the fourth week, although pain intensity was significantly more reduced in the Kinesio taping group (p = 0.015), there were no differences with regard to disability. Kinesio taping provided significant improvements in pain and disability; thus, it can be used as a complementary method in acute non-specific low back pain. © The Author(s) 2015.

  14. Conceptual and operational definitions of the components of the nursing diagnosis Acute Pain (00132)

    Science.gov (United States)

    Correia, Marisa Dibbern Lopes; Duran, Erika Christiane Marocco

    2017-01-01

    ABSTRACT Objective: to develop the operational and conceptual definitions of the defining characteristics and related factors of the nursing diagnosis Acute Pain (00132) for nonverbal critically ill patients. Method: integrative literature review in the databases/libraries: Medical Literature Analysis and Retrieval System Online (MEDLINE via Pubmed), Cochrane Library, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Latin American & Caribbean Health Sciences Literature (LILACS). Results: 799 results were found in the literature, of which 80 studies were selected for full text reading and 16 were used in the elaboration of definitions for the 17 defining characteristics and three related factors of the nursing diagnosis. The gray literature, ie, thesis, dissertations, books, guidelines and dictionary was also explored to ensure the robustness needed to clarify the topics not covered by the studies. Conclusion: the definitions aim to facilitate the identification of the nursing diagnosis for nonverbal critically ill patients and to support future teaching and research on the nursing diagnosis of Acute Pain (00132). PMID:29267544

  15. Profile of extended-release oxycodone/acetaminophen for acute pain

    Directory of Open Access Journals (Sweden)

    Bekhit MH

    2015-10-01

    Full Text Available Mary Hanna Bekhit1–51David Geffen School of Medicine, 2Ronald Reagan UCLA Medical Center, 3UCLA Ambulatory Surgery Center, 4UCLA Wasserman Eye Institute, 5UCLA Martin Luther King Community Hospital, University of California Los Angeles, Los Angeles, CA, USA Abstract: This article provides a historical and pharmacological overview of a new opioid analgesic that boasts an extended-release (ER formulation designed to provide both immediate and prolonged analgesia for up to 12 hours in patients who are experiencing acute pain. This novel medication, ER oxycodone/acetaminophen, competes with current US Food and Drug Administration (FDA-approved opioid formulations available on the market in that it offers two benefits concurrently: a prolonged duration of action, and multimodal analgesia through a combination of an opioid (oxycodone with a nonopioid component. Current FDA-approved combination analgesics, such as Percocet (oxycodone/acetaminophen, are available solely in immediate-release (IR formulations. Keywords: opioid, analgesic, xartemis, acute postsurgical pain, substance abuse, acetaminophen, extended release 

  16. Conceptual and operational definitions of the components of the nursing diagnosis Acute Pain (00132

    Directory of Open Access Journals (Sweden)

    Marisa Dibbern Lopes Correia

    2017-12-01

    Full Text Available ABSTRACT Objective: to develop the operational and conceptual definitions of the defining characteristics and related factors of the nursing diagnosis Acute Pain (00132 for nonverbal critically ill patients. Method: integrative literature review in the databases/libraries: Medical Literature Analysis and Retrieval System Online (MEDLINE via Pubmed, Cochrane Library, The Cumulative Index to Nursing and Allied Health Literature (CINAHL and Latin American & Caribbean Health Sciences Literature (LILACS. Results: 799 results were found in the literature, of which 80 studies were selected for full text reading and 16 were used in the elaboration of definitions for the 17 defining characteristics and three related factors of the nursing diagnosis. The gray literature, ie, thesis, dissertations, books, guidelines and dictionary was also explored to ensure the robustness needed to clarify the topics not covered by the studies. Conclusion: the definitions aim to facilitate the identification of the nursing diagnosis for nonverbal critically ill patients and to support future teaching and research on the nursing diagnosis of Acute Pain (00132.

  17. Single dose oral ketoprofen or dexketoprofen for acute postoperative pain in adults.

    Science.gov (United States)

    Gaskell, Helen; Derry, Sheena; Wiffen, Philip J; Moore, R Andrew

    2017-05-25

    This review is an update of "Single dose oral ketoprofen and dexketoprofen for acute postoperative pain in adults" last updated in Issue 4, 2009. Ketoprofen is a non-selective nonsteroidal anti-inflammatory drug (NSAID) used to treat acute and chronic painful conditions. Dexketoprofen is the (S)-enantiomer, which is believed to confer analgesia. Theoretically dexketoprofen is expected to provide equivalent analgesia to ketoprofen at half the dose, with a consequent reduction in gastrointestinal adverse events. This review is one of a series on oral analgesics for acute postoperative pain. Individual reviews have been brought together in two overviews to provide information about the relative efficacy and harm of the different interventions. To assess the efficacy and safety of single dose oral ketoprofen and oral dexketoprofen compared with placebo for acute postoperative pain, using methods that permit comparison with other analgesics evaluated in the same way, and criteria of efficacy recommended by an in-depth study at the individual patient level. For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase from 2009 to 28 March 2017. We also searched the reference lists of retrieved studies and reviews, and two online clinical trial registries. Randomised, double-blind, placebo-controlled trials of single dose orally administered ketoprofen or dexketoprofen in adults with moderate to severe acute postoperative pain. Two review authors independently considered studies for inclusion in the review, examined issues of study quality and potential bias, and extracted data. For dichotomous outcomes, we calculated risk ratio (RR) and number needed to treat for an additional beneficial outcome (NNT) or harmful outcome (NNH) with 95% confidence intervals (CI) for ketoprofen and dexketoprofen, compared with placebo, where there were sufficient data. We collected information on the number of participants with at least 50

  18. Biophysical parameters of erythrocyte membranes and mechanisms of interaction with non-opioid analgesics under acute pain syndrome

    Directory of Open Access Journals (Sweden)

    Yu. I. Gubskyi

    2014-06-01

    Full Text Available Methods of fluorescent probing, spectrophotometry and microcalorimetry were applied to investigate the alterations in biophysical parameters of erythrocytes membranes, and specifically microviscosity, surface charge, molecular organization of lipid bilayer and lipid-protein interactions under conditions of acute pain syndrome produced by experimental chemical lesion. The distinctive features of non-opiod analgesics interactions and binding to the erythrocytes membranes of rats subjected to acute nociceptive pain accompanied with oxidative stress development were investigated. The abilities of analgesics under research, and namely paracetamol, aspirin, phenazone, ketorolac, pyrodazole, ketoprofenum, natrium mefenaminate, indometacin, nimesulide to make up physico-chemical complexes with lipoperoxidation modified erythrocytes surface and protein-lipid bilayer showed marked changes. The significance of oxidative damage of biophase under conditions of acute pain syndrome for analgesics effective pharmacodynamics and pharmacokinetics realization is under consideration.

  19. Laparoscopy for the management of acute lower abdominal pain in women of childbearing age.

    Science.gov (United States)

    Gaitán, Hernando G; Reveiz, Ludovic; Farquhar, Cindy; Elias, Vanessa M

    2014-05-22

    This is an updated version of the original review, published in Issue 1, 2011, of The Cochrane Library. Acute lower abdominal pain is common, and making a diagnosis is particularly challenging in premenopausal women, as ovulation and menstruation symptoms overlap with symptoms of appendicitis, early pregnancy complications and pelvic infection. A management strategy involving early laparoscopy could potentially provide a more accurate diagnosis, earlier treatment and reduced risk of complications. To evaluate the effectiveness and harms of laparoscopy for the management of acute lower abdominal pain in women of childbearing age. The Menstrual Disorders and Subfertility Group (MDSG) Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, PsycINFO, LILACS and CINAHL were searched (October 2013). The International Clinical Trials Registry Platform (ICTRP) was also searched. No new studies were included in this updated version. Randomised controlled trials (RCTs) that included women of childbearing age who presented with acute lower abdominal pain, non-specific lower abdominal pain or suspected appendicitis were included. Trials were included if they evaluated laparoscopy with open appendicectomy, or laparoscopy with a wait and see strategy. Study selection was carried out by two review authors independently. Data from studies that met the inclusion criteria were independently extracted by two review authors and the risk of bias assessed. We used standard methodological procedures as expected by The Cochrane Collaboration. A summary of findings table was prepared using GRADE criteria. A total of 12 studies including 1020 participants were incorporated into the review. These studies had low to moderate risk of bias, mainly because allocation concealment or methods of sequence generation were not adequately reported. In addition, it was not clear whether follow-up was similar for the treatment groups

  20. Emergency assessment of patients with acute abdominal pain using low-dose CT with iterative reconstruction: a comparative study.

    Science.gov (United States)

    Poletti, Pierre-Alexandre; Becker, Minerva; Becker, Christoph D; Halfon Poletti, Alice; Rutschmann, Olivier T; Zaidi, Habib; Perneger, Thomas; Platon, Alexandra

    2017-08-01

    To determine if radiation dose delivered by contrast-enhanced CT (CECT) for acute abdominal pain can be reduced to the dose administered in abdominal radiography (<2.5 mSv) using low-dose CT (LDCT) with iterative reconstruction algorithms. One hundred and fifty-one consecutive patients requiring CECT for acute abdominal pain were included, and their body mass index (BMI) was calculated. CECT was immediately followed by LDCT. LDCT series was processed using 1) 40% iterative reconstruction algorithm blended with filtered back projection (LDCT-IR-FBP) and 2) model-based iterative reconstruction algorithm (LDCT-MBIR). LDCT-IR-FBP and LDCT-MBIR images were reviewed independently by two board-certified radiologists (Raters 1 and 2). Abdominal pathology was revealed on CECT in 120 (79%) patients. In those with BMI <30, accuracies for correct diagnosis by Rater 1 with LDCT-IR-FBP and LDCT-MBIR, when compared to CECT, were 95.4% (104/109) and 99% (108/109), respectively, and 92.7% (101/109) and 100% (109/109) for Rater 2. In patients with BMI ≥30, accuracies with LDCT-IR-FBP and LDCT-MBIR were 88.1% (37/42) and 90.5% (38/42) for Rater 1 and 78.6% (33/42) and 92.9% (39/42) for Rater 2. The radiation dose delivered by CT to non-obese patients with acute abdominal pain can be safely reduced to levels close to standard radiography using LDCT-MBIR. • LDCT-MBIR (<2.5 mSv) can be used to assess acute abdominal pain. • LDCT-MBIR (<2.5 mSv) cannot safely assess acute abdominal pain in obese patients. • LDCT-IR-FBP (<2.5 mSv) cannot safely assess patients with acute abdominal pain.

  1. Acute neck pain in the ED: Consider longus colli calcific tendinitis vs meningitis.

    Science.gov (United States)

    Patel, Tyag K; Weis, James C

    2017-06-01

    Presented here is a rare cause of severe neck pain - acute longus colli calcific tendinitis - in a 54year old man who presented to the emergency department. The neck pain is due to inflammation caused by calcium hydroxyapatite crystal deposition in the tendons on the longus colli muscles. This is non-infectious. The gold standard for diagnosis is a CT neck which best shows the calcifications in the anterior vertebral column of C1-C4, where the tendons of these muscles insert bilaterally. Longus colli calcific tendinitis is not life-threatening and patients will make a full recovery after treatment with NSAIDs. However, this condition is often confused with life-threatening conditions such as infection (meningitis or retropharyngeal abscess), intracranial hemorrhage, trauma, herniation of cervical discs, or malignancy (Estimable et al. (2015) [1]). Symptoms associated with calcific tendinitis of the longus colli muscle are non-specific and include mild fever, moderate-severe headache, neck pain, and drastically reduced range of motion of the neck. More specific symptoms are the presence of dysphagia and odynophagia. Lab findings usually are significant for mild leukocytosis, and elevated ESR and CRP. Awareness of this condition by E.D. physicians can avoid unnecessary invasive interventions, increased costs, and delays that result from incorrect diagnosis and treatment. This is a unique case in which a patient who was afebrile with a normal ESR was worked up for meningitis and an intracranial process, and also empirically treated for meningitis before finally being diagnosed with acute calcific tendinitis of the longus colli muscle in the E.D. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Diagnostic accuracy of surgeons and trainees in assessment of patients with acute abdominal pain.

    Science.gov (United States)

    2016-09-01

    Diagnostic accuracy in the assessment of patients with acute abdominal pain in the emergency ward is not adequate. It has been argued that this is because the investigations are carried out predominantly by a trainee. Resource utilization could be lowered if surgeons had a higher initial diagnostic accuracy. Patients with acute abdominal pain were included in a prospective cohort study. A surgical trainee and a surgeon made independent assessments in the emergency department, recording the clinical diagnosis and proposed diagnostic investigations. A reference standard diagnosis was established by an expert panel, and the proportion of correct diagnoses was calculated. Diagnostic accuracy was expressed in terms of sensitivity, specificity, positive predictive value and negative predictive value. Interobserver agreement for the diagnosis and elements of history-taking and physical examination were expressed by means of Cohen's κ. Certainty of diagnosis was recorded using a visual analogue scale. A trainee and a surgeon independently assessed 126 patients. Trainees made a correct diagnosis in 44·4 per cent of patients and surgeons in 42·9 per cent (P = 0·839). Surgeons, however, recorded a higher level of diagnostic certainty. Diagnostic accuracy was comparable in distinguishing urgent from non-urgent diagnoses, and for the most common diseases. Interobserver agreement for the clinical diagnosis varied from fair to moderate (κ = 0·28-0·57). The diagnostic accuracy of the initial clinical assessment is not improved when a surgeon rather than a surgical trainee assesses a patient with abdominal pain in the emergency department. © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.

  3. Addressing challenges of clinical trials in acute pain: The Pain Management of Vaso-occlusive Crisis in Children and Young Adults with Sickle Cell Disease Study.

    Science.gov (United States)

    Nottage, Kerri A; Hankins, Jane S; Faughnan, Lane G; James, Dustin M; Richardson, Julie; Christensen, Robbin; Kang, Guolian; Smeltzer, Matthew; Cancio, Maria I; Wang, Winfred C; Anghelescu, Doralina L

    2016-08-01

    Neuropathic pain is a known component of vaso-occlusive pain in sickle cell disease; however, drugs targeting neuropathic pain have not been studied in this population. Trials of acute pain are complicated by the need to obtain consent, to randomize participants expeditiously while optimally treating pain. We describe the challenges in designing and implementing the Pain Management of Vaso-occlusive Crisis in Children and Young Adults with Sickle Cell Disease Study (NCT01954927), a phase II, randomized, double-blind, placebo-controlled trial to determine the effect of gabapentin for vaso-occlusive crisis. In the Pain Management of Vaso-occlusive Crisis in Children and Young Adults with Sickle Cell Disease Study, we aim to assess the analgesic effect of gabapentin during vaso-occlusive crisis. Difficulties we identified included avoiding delay of notification of study staff of potential participants which we resolved by automated notification. Concern for rapid randomization and drug dispensation was addressed through careful planning with an investigational pharmacy and a single liquid formulation. We considered obtaining consent during well-visits to avoid the time constraints with acute presentations, but the large number of patients and limited duration that consent is valid made this impractical. In all, 79% of caregivers/children approached have agreed to participate. The trial is currently active, and enrollment is at 45.8% of that targeted (76 of 166) and expected to continue for two more years. Maintaining staff availability after-hours remains problematic, with 8% of screened patients missed for lack of available staff. Lessons learned in designing a trial to expedite procedures in the acute pain setting include (1) building study evaluations upon a standard-of-care backbone; (2) implementing a simple study design to facilitate consent and data capture; (3) assuring ample, well-trained study staff; and (4) utilizing technology to automate procedures

  4. Determinants of inappropriate acute pain management in old people unable to communicate verbally in the emergency department.

    Science.gov (United States)

    Allione, Attilio; Pivetta, Emanuele; Pizzolato, Elisa; Lorenzati, Bartolomeo; Pomero, Fulvio; Barutta, Letizia; Lauria, Giuseppe; Tartaglino, Bruno

    2017-12-01

    Poor pain management is relevant among individuals unable to communicate verbally (UCV). Analgesia may be due to three determinants: patients' status, physician's characteristics and pain etiology. Our aim is to investigate the association between prescription of ED pain treatment and these determinants. An observational prospective study including UCV patients was conducted. Severity of pain was evaluated by ALGOPLUS Scale and a score P ≥ 2 out of 5 on the pain scale was retained as the threshold for the presence of acute pain in elderly UCV patients. Our data showed that only 31,9% of UCV patients received a pharmacological treatment. The presence of the caregiver would influence the rate of therapy administration [OR 6,19 (95% CI 2,6-14,75)]. The presence of leg pain [OR 0,32 (95% CI 0,12-0,86)] and head pain [OR 0,29 (95% CI 0,10-0,84)] were less likely associated to receive analgesia. Pain related to trauma [OR 4.82 (95% CI 1.17 to 19.78)] and youngest physicians [OR 1.08 (95% CI 1.001 to 1.18)] were variables associated with the administration of drugs opiates. Older UCV patients presenting to the ED with pain are at high risk of inadequate analgesia. Providers should always suspect presence of pain and an increasing need for behavioural pain evaluation is necessary for a complete assessment. Presence of a caregiver influences a more appropriate pain management in these patients. Staff training on pain management could result in better assessment, treatment, and interaction with caregivers.

  5. Application of Low Frequency and Medium Frequency Currents in the Management of Acute and Chronic Pain-A Narrative Review

    OpenAIRE

    Samuel, Stephen Rajan; Maiya, G Arun

    2015-01-01

    Trancutaneous electrical nerve stimulation (TENS) and interferential therapy (IFT) have been a regular line of treatment for various types of acute and chronic pain. This review aims to compile the latest literature in pain management using these modalities which use low-frequency and medium-frequency currents. The Cochrane Library, Scopus, PubMed, MEDLINE, and CINAHL were searched and studies were examined from their inception till October 2013. After title and abstract screening the relevan...

  6. Effects of Acute Administration of Adipokinetic Hormone on Depression, Anxiety, Pain, Locomotion and Memory in Mice.

    Science.gov (United States)

    Mutlu, Oguz; Ulak, Guner; Akar, Furuzan; Erden, Faruk; Celikyurt, Ipek Komsuoglu; Bektas, Emine; Tanyeri, Pelin; Kaya, Havva

    2017-04-30

    The neurosecretory cells in the corpus cardiacum of insects synthesize a set of hormones that are called adipokinetic, hypertrehalosemic or hyperprolinemic depending on the insect in question. They are the Adipokinetic Hormone/Red Pigment-Concentrating Hormone (AKH/RPCH) family of peptides. The present study investigated the effects of acute administration of Locusta Migratoria (Locmi-AKHII) and Anax Imperator (Anaim-AKH) on depression, anxiety, pain (analgesy), locomotion and memory in mice in forced swimming (FST), elevated plus maze (EPM), hot plate, locomotor activity and passive avoidance tests. Both Locmi-AKH-II (4 mg/kg) and Anaim-AKH (0.25 and 0.50 mg/kg) decreased immobility time (in sec, s) in the FST test. Anaim-AKH (0.5 and 1 mg/kg) increased the percentage of time spent in open arms/total time spent and the percentage of the number of open arm/total arm entries in the EPM test. Anaim-AKH (1 and 2 mg/kg) significantly increased latency (s) (initial time passed) for mice to lick their hind paws or jumping in the hot plate test. Anaim-AKH (4 mg/kg) significantly decreased the total distance (cm) moved, or the speed (cm/s) of movement of the animals in the locomotor activity test. Neither Locmi-AKH-II nor Anaim-AKH altered the retention latency (s) in the passive avoidance test. Both Locmi-AKH-II and Anaim-AKH exerted antidepressant effects, while only Anaim-AKH had anxiolytic and analgesic effects when administered acutely. Anaim-AKH diminished locomotion at higher doses while Locmi-AKH-II had no such effects. Neither Locmi-AKH-II nor Anaim-AKH disturbed learning and memory when acutely administered. Data of our studies suggest clinical potentials of AKH to be used in depression, anxiety and pain without disturbing memory.

  7. Diagnostic Role of Hyperechoic Fatty Tissue at Ultrasonography in Women with Acute Pelvic Pain

    Energy Technology Data Exchange (ETDEWEB)

    Park, Seong Jin; Yi, Boem Ha; Lee, Hae Kyung; Hong, Hyun Sook [Soonchunhyang University Hospital, Bucheon (Korea, Republic of); Kim, Hyun Cheol [Kyung Hee University East-West Neo-medicine Hospital, Seoul (Korea, Republic of)

    2009-12-15

    The aim of this study was to determine whether hyperechoic fatty tissue (HFT) at transabdominal and transvaginal ultrasonography in women with acute pelvic pain has a diagnostic role. We studied 201 women (mean age, 32 years) with acute pelvic and lower abdominal pain; we performed ultrasonography (US) in all them. Of the 201, 94 with gynecological problems were included., They were divided into two groups: with pelvic inflammatory disease (PID: n = 45) and without PID (n = 49). We evaluated the presence and distribution of HFT and its role in differential diagnosis between PID and non-PID groups. We found, using US, HFT in 36/45 (80%) patients with PID by US. Of the 36, single-center HFT was observed in 12/36 (33.3%) patients and multicentric HFT was detected in 24/36 (66.7%). HFT was present adjacent to inflammatory foci, tuboovarian abscesses or inflamed salpinx in 30 women: HFT was present outside the pelvic cavity in 24. Among the latter 24, HFT was present only in the lower abdomen, and not in the pelvic cavity in 6. In the non-PID group, HFT was found in the lower abdomen and pelvic cavity in 7 women. Four of the seven were misdiagnosed with PID. One of seven women with a hemorrhagic corpus luteal cyst rupture with underlying PID and two with ectopic pregnancy with HFT were correctly diagnosed. The presence of HFT may be a reliable US finding for the diagnosis of PID. HFT distinguishes PID from other acute gynecological problems

  8. The role of gaseous neurotransmitters in the antinociceptive effects of morphine during acute thermal pain.

    Science.gov (United States)

    Gou, Gemma; Leánez, Sergi; Pol, Olga

    2014-08-15

    Treatment with a carbon monoxide-releasing molecule (tricarbonyldichlororuthenium(II) dimer, CORM-2) or a classical inducible heme oxygenase (HO-1) inducer (cobalt protoporphyrin IX, CoPP) enhanced the antinociceptive effects of morphine during chronic pain but the role played by these compounds in acute thermal nociception was not evaluated. The effects of CORM-2 and CoPP treatments on the local antinociceptive actions of morphine and their interactions with nitric oxide during acute pain were evaluated by using wild type (WT), neuronal (nNOS-KO) or inducible (iNOS-KO) nitric oxide synthase knockout mice and assessing their thermal nociception to a hot stimulus with the hot plate test. Our results showed that the absence of nNOS or iNOS genes did not alter licking and jumping responses nor the antinociceptive effects produced by morphine indicating that the local thermal inhibitory effects produced by this drug in the absence of inflammation or injury are not mediated by the nitric oxide pathway triggered by nNOS or iNOS enzymes. Moreover, while the systemic administration of CORM-2 or CoPP inhibited licking and jumping latencies in all genotypes, these treatments only enhanced the local inhibition of jumping latencies produced by morphine in WT and nNOS-KO mice which effects were reversed by the peripheral administration of an HO-1 inhibitor. These data indicate that the co-administration of morphine with CORM-2 or CoPP produced remarkable local antinociceptive effects in WT and nNOS-KO mice and reveal that a significant interaction between carbon monoxide and nitric oxide systems occurs on the local antinociceptive effects produced by morphine during acute thermal nociception. Copyright © 2014 Elsevier B.V. All rights reserved.

  9. Experiences of acute pain in children who present to a healthcare facility for treatment: a systematic review of qualitative evidence.

    Science.gov (United States)

    Pope, Nicole; Tallon, Mary; McConigley, Ruth; Leslie, Gavin; Wilson, Sally

    2017-06-01

    Pain is a universal and complex phenomenon that is personal, subjective and specific. Despite growing knowledge in pediatric pain, management of children's pain remains sub-optimal and is linked to negative behavioral and physiological consequences later in life. As there is no synthesis of these studies, it was timely to undertake a systematic review. To identify, evaluate and synthesize the existing qualitative evidence on children's experiences of acute pain, including pain management, within a healthcare facility. Children aged four to 18 years (inclusive) attending a healthcare facility who experienced acute pain associated with any injury, medical condition or treatment. Children's experiences and perceptions of their acute pain, pain management and expectations of others in managing their pain. Studies on children's experiences of pain in the postoperative context were excluded as a systematic review exploring this phenomenon had previously been published. Studies reporting on children's experiences of chronic pain were also excluded. Any healthcare facility including general practitioners' surgeries, hospitals, emergency departments and outpatient clinics. Qualitative studies including phenomenology, grounded theory, ethnography, action research and feminist research designs. Using a three-step search strategy, databases were searched in December 2015 to identify both published and unpublished articles from 2000 to 2015. Studies published in languages other than English were excluded. All studies that met the inclusion criteria were assessed by at least two independent reviewers for methodological quality using a standardized critical appraisal tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). Data were extracted from the papers included in the review using standardized data extraction tool from JBI-QARI. Findings were pooled using JBI-QARI. Findings were rated according to their level of credibility and

  10. Acute Renal Failure with Severe Loin Pain and Patchy Renal Vasoconstriction in a Patient without Hypouricemia, Provoked by Epileptic Seizure.

    Science.gov (United States)

    Maekawa, Michitaka; Imaizumi, Takahiro; Yamakawa, Taishi; Ito, Yasuhiko

    2017-01-01

    A 26-year-old Japanese man without hypouricemia and with 3 previous episodes of seizures concurrent with acute kidney injury (AKI) was admitted due to an epileptic seizure, lower back pain and AKI. His creatinine kinase levels were slightly elevated. Patchy renal ischemia on contrast-enhanced computed tomography and persistent residual contrast medium was observed, consistent with acute renal failure with severe loin pain and patchy renal ischemia after anaerobic exercise (ALPE). Diffusion-weighted imaging (DWI) demonstrated signal changes in the corresponding area. ALPE should be considered a cause of AKI following seizures. We recommend DWI as an alternative diagnostic modality.

  11. A rare cause of acute abdominal pain in children: Isolated tubal torsion; a case series

    Directory of Open Access Journals (Sweden)

    Yasemin Dere Gunal

    2017-06-01

    Full Text Available Isolated tubal torsion -a rare cause of acute abdomen in children-is usually difficult to diagnose because of non-specific findings. Surgical salphingectomy is required in delayed diagnosis in most cases. Three sexual inactive adolescents diagnosed in isolated tubal torsion (ITT were discussed for its diagnostic features and surgical management. Laboratory tests and radiological studies including ultrasonography (US, color doppler ultrasound were performed in all patients after evaluation for acute lower abdominal pain in emergency department and they underwent surgical intervention with laparotomy (n:2 and laparoscopy (n:1. One of the patients in this study had salpingectomy. Detorsion of the fallopian tube and cyst excision were performed in the remaining two patients who also had paratubal cysts. There was no recurrence in these patients during the follow-up for 3 and 2 years. The isolated tubal torsion should be kept in mind and early surgical management is essential in order to preserve fallopian tube because of its importance in fertility. Keywords: Fallopian tube, Torsion, Paratubal cyst, Adolescent, Acute abdomen

  12. Single fixed-dose oral dexketoprofen plus tramadol for acute postoperative pain in adults.

    Science.gov (United States)

    Derry, Sheena; Cooper, Tess E; Phillips, Tudor

    2016-09-22

    Combining two different analgesics in fixed doses in a single tablet can provide better pain relief than either drug alone in acute pain. This appears to be broadly true across a range of different drug combinations, in postoperative pain and migraine headache. A new combination of dexketoprofen (a nonsteroidal anti-inflammatory drug) plus tramadol (an opioid) has been tested in acute postoperative pain conditions. It is not yet licensed for use. This review is one of a series on oral analgesics for acute postoperative pain. Individual reviews have been brought together in two overviews to provide information about the relative efficacy and harm of the different interventions. To assess the analgesic efficacy and adverse effects of a single fixed-dose of oral dexketoprofen plus tramadol, compared with placebo, for moderate to severe postoperative pain in adults, using methods that permit comparison with other analgesics evaluated in standardised trials using almost identical methods and outcomes. A secondary objective was to compare the combination with the individual analgesics alone. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) via CRSO, MEDLINE via Ovid, and Embase via Ovid from inception to 31 May 2016. We also searched the reference lists of retrieved studies and reviews, and two online clinical trial registries. Randomised, double-blind trials of oral dexketoprofen plus tramadol administered as a single oral dose, for the relief of acute postoperative pain in adults, and compared to placebo. Two review authors independently considered trials for inclusion in the review, examined issues of study quality and potential bias, and extracted data. For dichotomous outcomes, we calculated risk ratio (RR) and number needed to treat for an additional beneficial outcome (NNT) for dexketoprofen plus tramadol, compared with placebo with 95% confidence intervals (CI). We collected information on the number of participants with at least 50% of

  13. Incident reporting by acute pain service at a tertiary care university hospital

    Science.gov (United States)

    Ahmed, Aliya; Yasir, Muhammad

    2015-01-01

    Background and Aims: Provision of effective and safe postoperative pain management is the principal responsibility of acute pain services (APSs). Continuous quality assurance is essential for high-quality patient care. We initiated anonymous reporting of critical incidents by APS to ensure continuous quality improvement and here present prospectively collected data on the reported incidents. Our objective was to analyze the frequency and nature of incidents and to see if any harm was caused to patients. Material and Methods: Data were collected from January 1, 2012 to September 30, 2013. An incident related to pain management was defined as An incident that occurs in a patient receiving pain management supervised by APS, and causes or has the potential to cause harm or affects patient safety. A form was filled including incident type, personnel involved, any harm caused, and steps taken to rectify it. Frequencies and percentages were computed for categorical variables. Results: A total of 2042 patients were seen and 442 (21.64%) incidents reported during the study period, including documentation errors (136/31%), noncompliance with protocols (113/25.56%), wrong combination of drugs (56/12.66%), premature discontinuation (74/16.72%), prolonged delays in change of syringes (27/6.10%), loss to follow-up (19/4.29%), administration of contraindicated drugs (9/2.03%), catheter pull-outs (6/1.35%), and faulty equipment (2/0.45%). Steps were taken to rectify the errors accordingly. No harm was caused to any patient. Conclusion: Reporting of untoward incidents and their regular analysis by APS is recommended to ensure high-quality patient care and to provide guidance in making teaching strategies and guidelines to improve patient safety. PMID:26702208

  14. Comparison of Neonatal Pain, Agitation, and Sedation Scale with Premature Infant Pain Profile for the assessment of acute prolonged pain in neonates on assisted ventilation: A prospective observational study

    Directory of Open Access Journals (Sweden)

    Saumil Ashvin Desai

    2017-01-01

    Full Text Available Aim: This study aimed to compare Neonatal Pain, Agitation, and Sedation Scale (N-PASS with Premature Infant Pain Profile (PIPP for the assessment of acute prolonged pain in ventilated neonates. Methods: This study was conducted in two phases. In phase 1 of the study, we assessed whether neonates on assisted ventilation experienced acute prolonged pain. In phase 2, the aim was to compare N-PASS with PIPP for the assessment of acute prolonged pain in neonates on assisted ventilation.. Design: This is a prospective observational study. Study Setting and Duration: This study was conducted at a tertiary care neonatal intensive care unit for 6 months. Inclusion Criteria: Neonates on assisted ventilation for >48 h were selected for this study. Exclusion Criteria: Neonates with lethal congenital anomalies and severe encephalopathy were excluded from the study. N-PASS and PIPP tools were used to assess acute prolonged pain in ventilated neonates. Taking PIPP as gold standard and N-PASS as a new test, the correlation coefficient was calculated. The sensitivity, specificity, positive predictive value, and negative predictive value were also computed. The time taken to administer the tools was also computed. Results: The average PIPP score for ventilated neonates was 8.33. The correlation coefficient of N-PASS when compared to PIPP was 0.62. The average time taken to apply the N-PASS scale was 4.42 min as compared to 8.20 min for PIPP scale. In term neonates, the sensitivity, specificity, positive predictive value, and negative predictive value of N-PASS were 75%, 100%, 100%, and 60%, respectively. The corresponding values in preterm neonates were lesser. Conclusions: The study proves that neonates on assisted ventilation experience acute prolonged pain. N-PASS is clinically reliable and valid to assess acute prolonged pain in ventilated term neonates. The N-PASS is quicker than PIPP in assessing acute prolonged pain in ventilated neonates. Future

  15. Pediatricians' attitudes in management of acute otitis media and ear pain in Turkey.

    Science.gov (United States)

    Büyükcam, Ayşe; Kara, Ateş; Bedir, Tuğba; Gülhan, Belgin; Özdemir, Halil; Sütçü, Murat; Düzgöl, Mine; Arslan, Aslı; Tekin, Tuna; Çelebi, Solmaz; Kukul, Musa Gürel; Bayhan, Gülsüm İclal; Köşker, Muhammet; Karbuz, Adem; Çelik, Melda; Kocabay Sütçü, Zümrüt; Metin, Özge; Karakaşlılar, Sebahat; Dağlı, Abdullah; Kara, Soner Sertan; Albayrak, Eda; Kanık, Saliha; Tezer, Hasan; Parlakay, Aslınur; Çiftci, Ergin; Somer, Ayper; Devrim, İlker; Kurugöl, Zafer; Dinleyici, Ener Çağrı; Atla, Pınar

    2018-04-01

    Acute otitis media (AOM) is predominantly a disease of childhood and one of the common reasons for prescribing antibiotics. Ear pain is the main symptom of AOM, with the result that parents frequently seek immediate medical assistance for their children. Antibiotic therapy for AOM does not provide symptomatic relief in the first 24 hours, and analgesics are commonly recommended for relieving the pain associated with AOM. The aims of the present study were to assess pediatricians' attitudes toward AOM and ear pain management in Turkey. This multicenter descriptive questionnaire study was conducted in 20 centers from different geographic locations in Turkey, with 977 pediatricians, between June 2015 and December 2016. The questionnaire comprised 20 questions focusing on the pediatricians' sociodemographic variables, experiences, and treatment related to AOM and ear pain. Of the pediatricians, 58.2% were residents, 36.5% were specialists, and 4.3% were lecturers. Most participants were working in a university hospital (54.8%) or education and research hospital (32.2%). In general daily practice, the AOM diagnosis rates were between 6% and 20% in outpatient clinics, and 52.3% of the participants stated the patients complained about ear pain in pediatric clinics. The watchful waiting (WW) rate, as opposed to immediate antibiotic treatment, was 39.8% for all the pediatricians. The pediatric residents used the WW strategy less than the specialists and lecturers did (p = 0.004). The rates of the WW strategy were higher in outpatient clinics where AOM was commonly diagnosed (p pediatricians had experiences of the parents' usage of a variety of herbal and folk remedies, such as breast milk or olive oil, for their children's ear pain. Amoxicillin clavulanate was the most frequently prescribed antibiotic for AOM. WW was approved by the pediatricians, and having more AOM patients was a significant factor in the physicians' choice of WW; nevertheless, the WW rate was poor

  16. Acupuncture in acute herpes zoster pain therapy (ACUZoster – design and protocol of a randomised controlled trial

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    Pfab Florian

    2009-08-01

    Full Text Available Abstract Background Acute herpes zoster is a prevalent condition. One of its major symptoms is pain, which can highly influence patient's quality of life. Pain therapy is limited. Acupuncture is supposed to soften neuropathic pain conditions and might therefore act as a therapeutic alternative. Objective of the present study is to investigate whether a 4 week semi-standardised acupuncture is non-inferior to sham laser acupuncture and the anticonvulsive drug gabapentine in the treatment of pain associated with herpes zoster. Methods/Design Three-armed, randomised, placebo-controlled trial with a total follow-up time of 6 months. Up to estimated 336 patients (interim analyses with acute herpes zoster pain (VAS > 30 mm will be randomised to one of three groups (a semi-standardised acupuncture (168 patients; (b gabapentine with individualised dosage between 900–3600 mg/d (84 patients; (c sham laser acupuncture. Intervention takes place over 4 weeks, all patients will receive analgesic therapy (non-opioid analgesics: metamizol or paracetamol and opioids: tramadol or morphine. Therapy phase includes 4 weeks in which group (a and (c consist of 12 sessions per patient, (b visits depend on patients needs. Main outcome measure is to assess the alteration of pain intensity before and 1 week after treatment sessions (visual analogue scale VAS 0–100 mm. Secondary outcome measure are: alteration of pain intensity and frequency of pain attacks; alteration of different aspects of pain evaluated by standardised pain questionnaires (NPI, PDI, SES; effects on quality of life (SF 36; analgesic demand; alteration of sensoric perception by systematic quantitative sensory testing (QST; incidence of postherpetic neuralgia; side effects and cost effectiveness. Credibility of treatments will be assessed. Discussion This study is the first large-scale randomised placebo controlled trial to evaluate the efficacy of acupuncture compared to gabapentine and sham treatment

  17. Psychometric Properties of the German Version of the Pain Vigilance and Awareness Questionnaire (PVAQ) in Pain-Free Samples and Samples with Acute and Chronic Pain

    NARCIS (Netherlands)

    Kunz, M.; Capito, E. S.; Horn-Hofmann, C.; Baum, C.; Scheel, J.; Karmann, A. J.; Priebe, J. A.; Lautenbacher, S.

    The way individuals attend to pain is known to have a considerable impact on the experience and chronification of pain. One method to assess the habitual "attention to pain" is the Pain Vigilance and Awareness Questionnaire (PVAQ). With the present study, we aimed to test the psychometric properties

  18. Prospective comparison of changes in lumbar spine MRI findings over time between individuals with acute low back pain and controls

    DEFF Research Database (Denmark)

    Panagopoulos, J.; Magnussen, J. S.; Hush, J.

    2017-01-01

    BACKGROUND AND PURPOSE: The clinical importance of lumbar MR imaging findings is unclear. This study was an exploratory investigation of whether lumbar spine MR imaging findings change more commonly during a 12-week period in individuals with acute low back pain compared with pain-free controls...... difference. For all other MR imaging findings, the proportions of subjects and controls in whom MR imaging findings were reported to change during 12 weeks were similar. CONCLUSIONS: Changes in MR imaging findings were observed in a similar proportion of the low back pain and control groups, except....... MATERIALS AND METHODS: Twenty individuals with recent-onset low back pain and 10 pain-free controls were recruited into an exploratory prospective cohort study. All participants had a lumbar spine MR imaging at baseline and repeat MR imaging scans at 1, 2, 6, and 12 weeks. The proportion of individuals who...

  19. The analgesic effect of electroacupuncture on acute thermal pain perception-a central neural correlate study with fMRI

    Directory of Open Access Journals (Sweden)

    Leung Albert

    2011-06-01

    Full Text Available Abstract Background Electrical acupuncture (EA has been utilized in acute pain management. However, the neuronal mechanisms that lead to the analgesic effect are still not well defined. The current study assessed the intensity [optimal EA (OI-EA vs. minimal EA (MI-EA] effect of non-noxious EA on supraspinal regions related to noxious heat pain (HP stimulation utilizing an EA treatment protocol for acute pain and functional magnetic resonance imaging (fMRI with correlation in behavioral changes. Subjects underwent five fMRI scanning paradigms: one with heat pain (HP, two with OI-EA and MI-EA, and two with OI-EA and HP, and MI-EA and HP. Results While HP resulted in activations (excitatory effect in supraspinal areas known for pain processing and perception, EA paradigms primarily resulted in deactivations (suppressive effect in most of these corresponding areas. In addition, OI-EA resulted in a more robust supraspinal sedative effect in comparison to MI-EA. As a result, OI-EA is more effective than MI-EA in suppressing the excitatory effect of HP in supraspinal areas related to both pain processing and perception. Conclusion Intensities of EA plays an important role in modulating central pain perception.

  20. Do People Eat the Pain Away? The Effects of Acute Physical Pain on Subsequent Consumption of Sweet-Tasting Food.

    Directory of Open Access Journals (Sweden)

    Kathleen E Darbor

    Full Text Available Sweet tasting foods have been found to have an analgesic effect. Therefore people might consume more sweet-tasting food when they feel pain. In Study 1, participants were randomly assigned to a pain or non-pain condition and their consumption of cheesecake was measured. Participants ate more cheesecake (a sweet-tasting food following a painful experience than a non-painful one. In Study 2, participants were randomly assigned to a painful experience or a resource depleting experience (i.e., squeezing a handgrip and then were asked to taste test two foods, one sweet and one not sweet. Participants ate more sweet-tasting food following a painful experience than a non-painful or a resource-depleting experience. These differences were not present for consumption of non-sweet food. Further, habitual self-control predicted consumption of sweet-tasting food when in pain, with those lower in self-control particularly likely to eat more. Results suggest that people do eat more sweet-tasting food when they feel pain, particularly if they are not in the habit of controlling their impulses. These findings have implications for health given rising rates of obesity and pain-related diagnoses.

  1. Do People Eat the Pain Away? The Effects of Acute Physical Pain on Subsequent Consumption of Sweet-Tasting Food.

    Science.gov (United States)

    Darbor, Kathleen E; Lench, Heather C; Carter-Sowell, Adrienne R

    2016-01-01

    Sweet tasting foods have been found to have an analgesic effect. Therefore people might consume more sweet-tasting food when they feel pain. In Study 1, participants were randomly assigned to a pain or non-pain condition and their consumption of cheesecake was measured. Participants ate more cheesecake (a sweet-tasting food) following a painful experience than a non-painful one. In Study 2, participants were randomly assigned to a painful experience or a resource depleting experience (i.e., squeezing a handgrip) and then were asked to taste test two foods, one sweet and one not sweet. Participants ate more sweet-tasting food following a painful experience than a non-painful or a resource-depleting experience. These differences were not present for consumption of non-sweet food. Further, habitual self-control predicted consumption of sweet-tasting food when in pain, with those lower in self-control particularly likely to eat more. Results suggest that people do eat more sweet-tasting food when they feel pain, particularly if they are not in the habit of controlling their impulses. These findings have implications for health given rising rates of obesity and pain-related diagnoses.

  2. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... Surveys Resource Guide to Chronic Pain Treatments The Art of Pain Management Partners for Understanding Pain Pain ... The physician and the patient are accustomed to deal with acute pain and both naturally expect that ...

  3. Diagnostic values of chest pain history, ECG, troponin and clinical gestalt in patients with chest pain and potential acute coronary syndrome assessed in the emergency department.

    Science.gov (United States)

    Mokhtari, Arash; Dryver, Eric; Söderholm, Martin; Ekelund, Ulf

    2015-01-01

    In the assessment of chest pain patients with suspected acute coronary syndrome (ACS) in the emergency department (ED), physicians rely on global diagnostic impressions ('gestalt'). The aim of this study was to determine the diagnostic value of the ED physician's overall assessment of ACS likelihood, and the values of the main diagnostic modalities underlying this assessment, namely the chest pain history, the ECG and the initial troponin result. 1,151 consecutive ED chest pain patients were prospectively included. The ED physician's interpretation of the chest pain history, the ECG, and the global likelihood of ACS were recorded on special forms. The discharge diagnoses were retrieved from the medical records. A chart review was carried out to determine whether patients with a non-ACS diagnosis at the index visit had ACS or suffered cardiac death within 30 days. The gestalt was better than its components both at ruling in ("Obvious ACS", LR 29) and at ruling out ("No Suspicion of ACS", LR 0.01) ACS. In the "Strong suspicion of ACS" group, 60% of the patients did not have ACS. A positive TnT (LR 24.9) and an ischemic ECG (LR 8.3) were strong predictors of ACS and seemed superior to pain history for ruling in ACS. In patients with a normal TnT and non-ischemic ECG, chest pain history typical of AMI was not a significant predictor of AMI (LR 1.9) while pain history typical of unstable angina (UA) was a moderate predictor of UA (LR 4.7). Clinical gestalt was better than its components both at ruling in and at ruling out ACS, but overestimated the likelihood of ACS when cases were assessed as strong suspicion of ACS. Among the components of the gestalt, TnT and ECG were superior to the chest pain history for ruling in ACS, while pain history was superior for ruling out ACS.

  4. Management of people with acute low-back pain: a survey of Australian chiropractors

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    Walker Bruce F

    2011-12-01

    Full Text Available Abstract Introduction Chiropractors commonly provide care to people with acute low-back pain (LBP. The aim of this survey was to determine how chiropractors intend to support and manage people with acute LBP and if this management is in accordance with two recommendations from an Australian evidence-based acute LBP guideline. The two recommendations were directed at minimising the use of plain x-ray and encouraging the patient to stay active. Methods This is a cross sectional survey of chiropractors in Australia. This paper is part of the ALIGN study in which a targeted implementation strategy was developed to improve the management of acute LBP in a chiropractic setting. This implementation strategy was subsequently tested in a cluster randomised controlled trial. In this survey phase of the ALIGN study we approached a random sample of 880 chiropractors in three States of Australia. The mailed questionnaire consisted of five patient vignettes designed to represent people who would typically present to chiropractors with acute LBP. Four vignettes represented people who, according to the guideline, would not require a plain lumbar x-ray, and one vignette represented a person with a suspected vertebral fracture. Respondents were asked, for each vignette, to indicate which investigation(s they would order, and which intervention(s they would recommend or undertake. Results Of the 880 chiropractors approached, 137 were deemed ineligible to participate, mostly because they were not currently practising, or mail was returned to sender. We received completed questionnaires from 274 chiropractors (response rate of 37%. Male chiropractors made up 66% of respondents, 75% practised in an urban location and their mean number of years in practice was 15. Across the four vignettes where an x-ray was not indicated 68% (95% Confidence Intervals (CI: 64%, 71% of chiropractors responded that they would order or take an x-ray. In addition 51% (95%CI: 47%, 56

  5. Acute Abdominal Pain Secondary to Retroperitoneal Bleeding From a Giant Adrenal Lipoma With Review of Literature

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    Reyaz M. Singaporewalla

    2009-07-01

    Full Text Available Adrenal lipomas are rare, non-functioning benign tumours, which are primarily detected during autopsy or imaging, as asymptomatic incidentalomas. Occasionally, they can present with abdominal pain due to their large size. Imaging studies help to determine the origin, volume, composition of the lesion and presence of bleeding. Histopathology, however, is necessary to differentiate an adrenal lipoma from other fatty tumours such as myelolipoma, angiomyolipomas, teratomas and liposarcomas. We report a case of spontaneous bleeding from a giant adrenal lipoma that presented as an acute abdomen, and was initially mistaken on imaging for the more common myelolipoma. The literature is reviewed to discuss the clinical, pathological and radiological features, and the optimum therapeutic management.

  6. Acute neck pain due to tendonitis of the longus colli: CT and MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Artenian, D.J.; Lipman, J.K.; Scidmore, G.K.; Brant-Zawadzki, M.

    1989-05-01

    Calcific retropharyngeal tendonitis is an under-recognized cause of acute cervical pain produced by inflammation of the longus colli muscle. Although the clinical presentation may mimic more serious disorders, the diagnosis can be established radiographically by identification of prevertebral soft tissue calcification and swelling. Six patients with typical signs and symptoms of retropharyngeal tendonitis are presented. All were evaluated with plain films, four with CT and one with MRI. The pathognomonic finding of amorphous calcification anterior to C1-2 with associated asymmetric soft tissue swelling was clearly demonstrated by CT. Diffuse swelling of the longus colli muscle was shown as prominent high signal in the prevertebral region by T2 weighted MRI.

  7. Acute neck pain due to tendonitis of the longus colli: CT and MRI findings

    International Nuclear Information System (INIS)

    Artenian, D.J.; Lipman, J.K.; Scidmore, G.K.; Brant-Zawadzki, M.

    1989-01-01

    Calcific retropharyngeal tendonitis is an under-recognized cause of acute cervical pain produced by inflammation of the longus colli muscle. Although the clinical presentation may mimic more serious disorders, the diagnosis can be established radiographically by identification of prevertebral soft tissue calcification and swelling. Six patients with typical signs and symptoms of retropharyngeal tendonitis are presented. All were evaluated with plain films, four with CT and one with MRI. The pathognomonic finding of amorphous calcification anterior to C1-2 with associated asymmetric soft tissue swelling was clearly demonstrated by CT. Diffuse swelling of the longus colli muscle was shown as prominent high signal in the prevertebral region by T2 weighted MRI. (orig.)

  8. A randomized clinical trial of chiropractic treatment and self-management in patients with acute musculoskeletal chest pain

    DEFF Research Database (Denmark)

    Stochkendahl, Mette J; Christensen, Henrik W; Vach, Werner

    2012-01-01

    We have previously reported short-term follow-up from a pragmatic randomized clinical trial comparing 2 treatments for acute musculoskeletal chest pain: (1) chiropractic treatment and (2) self-management. Results indicated a positive effect in favor of the chiropractic treatment after 4 and 12...

  9. Filariasis presenting as acute abdominal pain: The role of imaging and image-guided intervention in diagnosis

    Directory of Open Access Journals (Sweden)

    Natasha N. Metha, MD

    2015-01-01

    Full Text Available Filariasis is an endemic infection seen in tropical and subtropical regions of the world that presents with lymphatic dysfunction in the form of lymphocoele, hydrocoele, chyluria, or groin lymphadenovarix. We report a case of filariasis with the unusual presentation of acute abdominal pain in which radiographic imaging modalities played a crucial role in diagnosis.

  10. Filariasis presenting as acute abdominal pain: The role of imaging and image-guided intervention in diagnosis.

    Science.gov (United States)

    Metha, Natasha N; Dalavi, Vashali S; Mehta, Nikit P

    2015-01-01

    Filariasis is an endemic infection seen in tropical and subtropical regions of the world that presents with lymphatic dysfunction in the form of lymphocoele, hydrocoele, chyluria, or groin lymphadenovarix. We report a case of filariasis with the unusual presentation of acute abdominal pain in which radiographic imaging modalities played a crucial role in diagnosis.

  11. Filariasis presenting as acute abdominal pain: The role of imaging and image-guided intervention in diagnosis

    OpenAIRE

    Metha, Natasha N.; Dalavi, Vashali S.; Mehta, Nikit P.

    2016-01-01

    Filariasis is an endemic infection seen in tropical and subtropical regions of the world that presents with lymphatic dysfunction in the form of lymphocoele, hydrocoele, chyluria, or groin lymphadenovarix. We report a case of filariasis with the unusual presentation of acute abdominal pain in which radiographic imaging modalities played a crucial role in diagnosis.

  12. Standardized activities of daily living in presence of sub-acute low-back pain: A pilot study

    NARCIS (Netherlands)

    Svendsen, Jacob H.; Svarrer, Heine; Laessoe, Uffe; Vollenbroek-Hutten, Miriam Marie Rosé; Madeleine, Pascal

    2013-01-01

    The aim of this pilot study was to investigate how sub-acute low-back pain (LBP) patients differed with respect to control in movements and muscle activation during standardized tasks representing daily living activities, and explore relationships between cognition and measured motor performance.

  13. Nanoparticles of Zinc Oxide Reduces Acute Somatic Pain in Adult Female Wistar Rats

    Directory of Open Access Journals (Sweden)

    Mahnaz Kesmati

    2014-06-01

    Full Text Available Background: With appearance of nano particles as an important component in modern medicine, and considering to new properties of these components, study of their effects on human health is essential. Since zinc components influences mechanisms of nociception, the aim of this study was to evaluate the effect of nano zinc oxide as a new source of zinc and important components in pharmaceutical and hygienic cosmetic production on nociception in adult female rats. Materials and Methods: Female rats were divided into groups: control (receiving saline 0.9% and receiving nano ZnO (0.5, 1, and 5 mg/kg. Hot plate and tail flick tests as models of somatic acute pain were used for evaluation of the pain. The mean of latency time in paw licking and tail withdrawal respectively recorded as nociception indexes in each test for every animal. The animal numbers in each group was seven. Results: In tail flick test, nano ZnO (0.5, 1 mg/kg and in the hot plate test in dose of 0.5 mg/kg, induces significant analgesia (p<0.05 and with increasing of dose reduced its analgesic effect. Conclusion: It seems nano ZnO inhibit the nociception mechanisms and these analgesic properties are more efficient in the low doses. Probably by increasing dose of nano particles aggregation phenomenon prevent of anti-nociception effects of nano ZnO.

  14. Current perspectives of acute pain treatment Perspectivas actuales de tratamiento del paciente con dolor agudo

    Directory of Open Access Journals (Sweden)

    Tiberio Alvarez Echeverri

    1993-03-01

    Full Text Available

    In the last years opioids have become of great importance in the relief of postoperative and other forms of acute pain. Reasons for this trend have been the availability of agonist opioids like phentanyl. sulphentanyl and alphentanyl and the results of research on the physlology. The pharmacology and the chemistry of drug receptors and neurotransmitters. The studies on chemicals other than opioids that contribute to pain relief when administered through different ways. specially the spinal. Have also influenced such a trend.

    En los últimos años los opiáceos han adquirido gran importancia en el alivio del dolor agudo especialmente del tipo postoperatorio. Una de las razones ha sido la disponibilidad de morfínicos agonistas como el fentanil, el sufentanil y el alfentanil; otra es la investigación de la fisiología, la farmacología y la química de los receptores y los neurotransmisores como de sustancias diferentes a los opláceos, aplicadas por diferentes vías en especial la espinal, que coadyuvan al alivio del dolor.

  15. [Medico-legal features of early discharge in acute myocardial infarction and chest pain].

    Science.gov (United States)

    Montisci, M; Ruscazio, M; Snenghi, R; Nalin, S; Montisci, R; Iliceto, S; Ferrara, S D

    2001-06-01

    The authors' aim is to outline some of the main medico-legal problems in cardiology, especially those regarding the premature hospital discharge of patients with undefined chest pain and/or with acute myocardial infarction. After a brief overview on the etiology and clinical definition of chest pain and myocardial infarction, premature hospital discharge is defined and the incidental medico-legal risks that physicians operating in such situations are exposed to are pointed out. Next, the profiles regarding both the positive and negative views of professional medical responsibility are described. In the negative frame, the authors outline the most frequent civil and penal aspects of the unpremeditated responsibility. Then the physician's error, in both qualitative (generic or specific guilt) and quantitative (degree) terms, is considered; particularly, negligence, imprudence and inexperience, as qualitatively accepted meanings of generic guilt, are dealt with by adopting illustrative cases settled in the light of the right legal interpretation. The phases of the diagnostic or prognostic error are evaluated, and clinical protocols, as a reference parameter for the identification of error, are considered. Lastly, the problem of causality, essential condition for the judgment about the professional responsibility, and the problem of the patient's consent, including an evaluation of the legal capability or incapability about the declaration of consent, are examined closely.

  16. Impact of a dedicated infusion clinic for acute management of adults with sickle cell pain crisis.

    Science.gov (United States)

    Lanzkron, Sophie; Carroll, C Patrick; Hill, Peter; David, Mandy; Paul, Nicklaine; Haywood, Carlton

    2015-05-01

    Most adults with sickle cell disease (SCD) receive care for their acute painful episodes in an emergency department (ED) setting. The purpose of this article is to describe the impact of opening a dedicated treatment center for adults with SCD [Sickle Cell Infusion Clinic (SCIC)] on patient outcomes and on hospital discharges for SCD. Descriptive data including demographics, time to first dose of narcotic, and pain scores were collected on patients presenting to the SCIC and ED. Maryland hospital discharge data were obtained from the Maryland Health Services Cost Review Commission. Analyses were conducted using T tests, χ(2) tests, and simple generalized estimating equation regression models accounting for the clustered nature of observations, as appropriate. There were 3,874 visits to the SCIC by 361 unique patients; 85% of those visits resulted in the patient being sent home. During the same time period, there were 3,408 visits to the ED by 558 unique patients with SCD. The overall admission rate from the ED for these patients was 35.9% but decreased significantly over the time period with a rate of 20% in December 2011. There was a significant decrease in readmissions over time for the entire Baltimore Metro area with the likelihood of readmission decreasing by 7% over time. The SCIC model provides adults with SCD access to high quality care that decreases the need for hospital admission. Further research needs to be done to evaluate the cost effectiveness of this model. © 2015 Wiley Periodicals, Inc.

  17. Effect of matricaria recutita on acute pain in the presence and absence of sex hormones

    Directory of Open Access Journals (Sweden)

    Mahnaz Kesmati

    2007-08-01

    Full Text Available

    BACKGROUND: Chamomile is a beneficial herbal drug that is used as an anti-inflammatory, sedative and anti-allergic agent. The mechanism of action of matricaria recutita (MR, a specious of chamomile, in nociception in male and female animals is not fully understood. In this study, the sedative effect of a species of chamomile, MR, on acute pain was investigated in both male and female adult mice in the presence and absence of sex hormones.
    METHODS: Male and female NMRI mice weighing 28 ± 3 grams were used. Animals of each sex were divided into intact and gonadectomized groups. Intact group received saline or MR extract (10, 30, 50 mg/kg, intraperitoneally. Gonadectomized group contained two subgroups: a group that received saline or MR hydro alcoholic extract (50 mg/kg, I.P., and b group that received sex hormones (testosterone in male mice and estradiol benzoate and progesterone in female mice, both with and without MR extract (50mg/kg, IP. The analgesia times in all groups were evaluated by hot plate test.
    RESULTS: MR increased analgesia time both in intact and gonadectomized male and female mice, but had no effect in the presence of pharmacological doses of testosterone (2 mg/kg, subcutaneous in male mice, and estradiol benzoate (0.1 mg/kg, SC and progesterone (0.5 mg/kg, SC in female mice.
    CONCLUSIONS: It seems that MR can induce a pain-relieving effect with and without physiological doses of sex hormones in male and female mice, but sex hormones probably interact with its analgesic effect in their pharmacological doses.
    KEY WORDS: Matricaria recutita, pain, testosterone, estradiol benzoate, progesterone, hot plate.

  18. Effect of Diclofenac with B Vitamins on the Treatment of Acute Pain Originated by Lower-Limb Fracture and Surgery

    Directory of Open Access Journals (Sweden)

    Héctor A. Ponce-Monter

    2012-01-01

    Full Text Available The aim of this study was to compare the efficacy of diclofenac, for the treatment of acute pain originated by lower-limb fracture and surgery, with that of diclofenac plus B vitamins. This was a single-center, prospective, randomized, and double-blinded clinical trial. Patients with lower-limb closed fractures rated their pain on a 10 cm visual analog scale (VAS. Patients were then randomized to receive diclofenac or diclofenac plus B vitamins (thiamine, pyridoxine, and cyanocobalamin intramuscularly twice daily. Patient evaluations of pain intensity were recorded throughout two periods: twenty-four hours presurgery and twenty-four hours postsurgical. One hundred twenty-two patients completed the study. The subjects' assessments of limb pain on the VAS showed a significant reduction from baseline values regardless of the treatment group. Diclofenac plus B vitamins combination was more effective to reduce the pain than diclofenac alone. The results showed that the addition of B vitamins to diclofenac increased its analgesic effect. The novelty of this paper consists in that diclofenac and diclofenac plus B vitamins were useful for treatment of acute pain originated by lower-limb fracture and surgery.

  19. Use of Therapeutic Neuroscience Education to address psychosocial factors associated with acute low back pain: a case report.

    Science.gov (United States)

    Zimney, Kory; Louw, Adriaan; Puentedura, Emilio J

    2014-04-01

    Acute low back pain (LBP) from injuries is prevalent in the work place. It has been shown that patients with psychosocial factors often progress with persistent pain and lead to significant workers compensation costs. Therapeutic Neuroscience Education (TNE) has been shown to be beneficial in changing a patient's cognition regarding their pain state, which may result in decrease fear, anxiety and catastrophization. A 19-year-old female who developed LBP from a work injury was the patient for this case report. A physical examination, Numeric Pain Rating Scale (NRPS), Oswestry Disability Index (ODI), Fear-Avoidance Beliefs Questionnaire (FABQ), Keele STarT Back Screening Tool (Keele SBST) and Acute Low Back Pain Screening (ALBPS) Questionnaires were assessed during initial physical therapy visit and discharge. Treatment consisted of use of TNE, manual therapy and exercises. She attended five total visits over a 2-week period prior to full discharge. During the initial visit the patient reported NRPS = 3/10, ODI = 36%, FABQ-PA = 23, FABQ-W = 30, Keele SBST = 4/9, ALBPS = 101. At discharge the patient reported a 0 on all outcome questionnaires with ability to return to full work and no pain complaints.

  20. Nursing Education Interventions for Managing Acute Pain in Hospital Settings: A Systematic Review of Clinical Outcomes and Teaching Methods.

    Science.gov (United States)

    Drake, Gareth; de C Williams, Amanda C

    2017-02-01

    The objective of this review was to examine the effects of nursing education interventions on clinical outcomes for acute pain management in hospital settings, relating interventions to health care behavior change theory. Three databases were searched for nursing education interventions from 2002 to 2015 in acute hospital settings with clinical outcomes reported. Methodological quality was rated as strong, moderate, or weak using the Effective Public Health Practice Project Quality Assessment Tool for quantitative studies. The 12 eligible studies used varied didactic and interactive teaching methods. Several studies had weaknesses attributable to selection biases, uncontrolled confounders, and lack of blinding of outcome assessors. No studies made reference to behavior change theory in their design. Eight of the 12 studies investigated nursing documentation of pain assessment as the main outcome, with the majority reporting positive effects of education interventions on nursing pain assessment. Of the remaining studies, two reported mixed findings on patient self-report of pain scores as the key measure, one reported improvements in patient satisfaction with pain management after a nursing intervention, and one study found an increase in nurses' delivery of a relaxation treatment following an intervention. Improvements in design and evaluation of nursing education interventions are suggested, drawing on behavior change theory and emphasizing the relational, contextual, and emotionally demanding nature of nursing pain management in hospital settings. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

  1. Single-Blind Randomized Controlled Trial of Poly-Herbal Formula Sahatsatara for Acute Low Back Pain: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Thiyapha Verayachankul

    2016-01-01

    Full Text Available Objective: To evaluate the efficacy and safety of poly-herbal formula Sahatsatara (SHT in pain reduction in acute low back pain (LBP patients. Methods: Twenty-nine patients aged 18-65 years with a history of moderate to severe acute LBP ≤3-day (score ≥4 on a 0-10 numeric rating scale [NRS] were enrolled and randomized to receive an ibuprofen (400 mg after meals three times daily or SHT (1,350 mg before meals three times daily for 7 days. The non-inferiority trial margin was set at ±10 percentage points. The outcomes were measured on pain intensity on the 0-10 NRS, disability on the Thai version of the Oswestry disability index [ODI], total analgesic consumption, patient satisfaction, and safety. Results: Fourteen patients and 15 patients were randomly allocated to ibuprofen and SHT groups, respectively. The mean difference in pain intensity and disability between the two groups at day 7 adjusted according to baseline was within ±1 for pain (-0.3; 95% CI, -1.48 to 0.96 and ±10% (-4.9%; 95% CI, -14.86% to 5.02% for the NRS and ODI scores, respectively. One patient in the SHT group and 5 in the ibuprofen group had gastrointestinal irritation, but the difference was not statistically significant. Conclusion: SHT was not inferior to ibuprofen in pain relieving and disability in patients with acute LBP. The result suggests a role for SHT as an alternative analgesic in acute LBP. (Thai Clinical Trials Registry number 20141027001

  2. CT and MR imaging in patients with localized acute abdominal pain

    International Nuclear Information System (INIS)

    Prassopoulos, P.

    2006-01-01

    Full text: Acute abdominal pain (AAP) is one of the most common causes for admissions to emergency departments. Clinical presentation, physical and laboratory examinations are often inconclusive and, therefore, imaging evaluation is required. Ultrasonography is efficient in the evaluation of gallbladder and gynecologic conditions and it is considered the first-line examination in many centres. Plain radiography and barium studies are often falsely normal or non-specific, especially in the most common conditions related with rightsided AAP and their use has significantly decreased. CT is a rapid and accurate imaging modality in the diagnosis of common (appendicitis, acute cholecystitis, biliary obstruction, duodenal ulcer perforation) or uncommon (mesenteric adenitis, liver abscess, cholangitis etc) conditions associated with right-sided AAP. CT may demonstrate a number of either specific or sensitive imaging findings for the confident diagnosis of diseases manifested with AAP. Moreover, CT has the advantage to suggest alternative diagnoses, if the suspected clinical diagnosis is unconfirmed. Different examination protocols and different strategies for the application of oral-rectal-intravenous contrast agents have been proposed to balance diagnostic accuracy to time effectiveness and radiation dose. MRI is suggested for AAP related to biliary abnormalities or to gynecologic diseases and it may be used as a complementary examination in pregnant patients. Imaging evaluation is an indispensable part in the diagnostic work up of most patients with AAP. CT has gained widespread acceptance, as offering more accurate and confident diagnosis and its use has changed management of the patients in 28-60% of the cases

  3. Hydroxyurea and acute painful crises in sickle cell anemia: effects on hospital length of stay and opioid utilization during hospitalization, outpatient acute care contacts, and at home.

    Science.gov (United States)

    Ballas, Samir K; Bauserman, Robert L; McCarthy, William F; Castro, Oswaldo L; Smith, Wally R; Waclawiw, Myron A

    2010-12-01

    Exploratory findings from the randomized, double-blind, placebo-controlled, multicenter study of hydroxyurea (MSH) in sickle cell anemia (SS). Recurrent acute painful crises may be mild, moderate, or severe in nature and often require treatment at home, in acute care facilities as outpatients, and in the hospital with oral and/or parenteral opioids. The objectives of this study were to determine the effects of hydroxyurea (HU) on length of stay (LOS) in hospital and opioid utilization during hospitalization, outpatient acute care contacts, and at home. Data from patient diaries, follow-up visit forms, and medical contact forms for the 299 patients enrolled in the MSH were analyzed. Types and dosages of at home, acute care, and in-hospital analgesic usage were explored descriptively. At-home analgesics were used on 40% of diary days and 80% of two-week follow-up periods, with oxycodone and codeine the most frequently used. Responders to HU used analgesics on fewer days. During hospitalization, 96% were treated with parenteral opioids, with meperidine the most frequently used; oxycodone was the most commonly used oral medication. The average LOS for responders to HU was about two days less than for other groups, and their cumulative time hospitalized during the trial was significantly less than for nonresponders or placebo groups (P<0.022). They also had the lowest doses of parenteral opioids during acute care crises (P=0.015). Beneficial effects of HU include shortening the duration of hospitalization because of acute painful episodes and reducing the net amount of opioid utilization. Copyright © 2010 U.S. Cancer Pain Relief Committee. All rights reserved.

  4. The short-term effectiveness of balance taping on acute nonspecific low-back pain: A case report.

    Science.gov (United States)

    Lee, Jung-Hoon

    2017-12-01

    Low back pain has a significant socioeconomic impact. Repetitive lifting, with combined twisting and flexion motions of the lumbar spine, increases the risk for low-back pain and injury to the supporting tissues. A 60-year-old male who presented with acute low-back pain, with a pain intensity of 6/10 on the visual analog scale (VAS) and an Oswestry disability index (ODI) score of 70%. The range of motion (ROM) of the lumbar spine on initial examination, relative to the normal peak ROM, was as follows: extension, 12°/30°; flexion, 15°/80°; left rotation, 15°/45°; and right rotation, 25°/45°. He was diagnosed as acute nonspecific low-back pain sustained with repetitive lifting, combining motions of flexion and twisting. The balance taping was applied for 16 h/day, on average, for 3 consecutive days was used as the primary treatment to manage the patient's low-back pain. The application of balance taping increased the range of motion of the lumbar spine as follows: flexion, from 15° to 77°; extension, from 12° to 27°; right rotation, from 25° to 45°; and left rotation, from 15° to 45°. The ODI score decreased from 70% to 0%, and the VAS score from 6/10 to 0. We propose that balance taping using kinesiology tape could serve as a complementary approach to other treatments for the treatment of acute nonspecific low-back pain. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  5. Sensory Disturbances, but Not Motor Disturbances, Induced by Sensorimotor Conflicts Are Increased in the Presence of Acute Pain

    Science.gov (United States)

    Brun, Clémentine; Gagné, Martin; McCabe, Candida S.; Mercier, Catherine

    2017-01-01

    Incongruence between our motor intention and the sensory feedback of the action (sensorimotor conflict) induces abnormalities in sensory perception in various chronic pain populations, and to a lesser extent in pain-free individuals. The aim of this study was to simultaneously investigate sensory and motor disturbances evoked by sensorimotor conflicts, as well as to assess how they are influenced by the presence of acute pain. It was hypothesized that both sensory and motor disturbances would be increased in presence of pain, which would suggest that pain makes body representations less robust. Thirty healthy participants realized cyclic asymmetric movements of flexion-extension with both upper limbs in a robotized system combined to a 2D virtual environment. The virtual environment provided a visual feedback (VF) about movements that was either congruent or incongruent, while the robotized system precisely measured motor performance (characterized by bilateral amplitude asymmetry and medio-lateral drift). Changes in sensory perception were assessed with a questionnaire after each trial. The effect of pain (induced with capsaicin) was compared to three control conditions (no somatosensory stimulation, tactile distraction and proprioceptive masking). Results showed that while both sensory and motor disturbances were induced by sensorimotor conflicts, only sensory disturbances were enhanced during pain condition comparatively to the three control conditions. This increase did not statistically differ across VF conditions (congruent or incongruent). Interestingly however, the types of sensations evoked by the conflict in the presence of pain (changes in intensity of pain or discomfort, changes in temperature or impression of a missing limb) were different than those evoked by the conflict alone (loss of control, peculiarity and the perception of having an extra limb). Finally, results showed no relationship between the amount of motor and sensory disturbances evoked

  6. Sensory Disturbances, but Not Motor Disturbances, Induced by Sensorimotor Conflicts Are Increased in the Presence of Acute Pain

    Directory of Open Access Journals (Sweden)

    Clémentine Brun

    2017-07-01

    Full Text Available Incongruence between our motor intention and the sensory feedback of the action (sensorimotor conflict induces abnormalities in sensory perception in various chronic pain populations, and to a lesser extent in pain-free individuals. The aim of this study was to simultaneously investigate sensory and motor disturbances evoked by sensorimotor conflicts, as well as to assess how they are influenced by the presence of acute pain. It was hypothesized that both sensory and motor disturbances would be increased in presence of pain, which would suggest that pain makes body representations less robust. Thirty healthy participants realized cyclic asymmetric movements of flexion-extension with both upper limbs in a robotized system combined to a 2D virtual environment. The virtual environment provided a visual feedback (VF about movements that was either congruent or incongruent, while the robotized system precisely measured motor performance (characterized by bilateral amplitude asymmetry and medio-lateral drift. Changes in sensory perception were assessed with a questionnaire after each trial. The effect of pain (induced with capsaicin was compared to three control conditions (no somatosensory stimulation, tactile distraction and proprioceptive masking. Results showed that while both sensory and motor disturbances were induced by sensorimotor conflicts, only sensory disturbances were enhanced during pain condition comparatively to the three control conditions. This increase did not statistically differ across VF conditions (congruent or incongruent. Interestingly however, the types of sensations evoked by the conflict in the presence of pain (changes in intensity of pain or discomfort, changes in temperature or impression of a missing limb were different than those evoked by the conflict alone (loss of control, peculiarity and the perception of having an extra limb. Finally, results showed no relationship between the amount of motor and sensory

  7. A Computer Assisted Program for the Management of Acute Dental Pain. User’s Manual

    Science.gov (United States)

    1989-07-28

    Acute apical abscess Fractured maxilla Acute apical periodontitis Fractured facial bones Acute herpteic gingivostomatitis Irreversible pulpitis Acute...lnfection/Cellulitis • Periodontal Abscess • Reversible Pulpitis - • Irreversible Pulpitis • Acute Apical Abscess ■ Acute Apical Periodontitis...Hemorrhagic Hyperplastic Infraorbital Rim Intercanthal Distance Irreversible Pulpitis Keratotic Lobulated Localized Definition >Abscess Esc - Quit

  8. Impaired trunk muscle function in sub-acute neck pain: etiologic in the subsequent development of low back pain?

    Science.gov (United States)

    Moseley, G Lorimer

    2004-08-01

    Low back pain (LBP) and neck pain are associated with dysfunction of the trunk and neck muscles, respectively, and may involve common or similar mechanisms. In both cases, dysfunction may compromise spinal control. Anecdotally, neck pain patients commonly develop LBP. This study investigated the possibility that trunk muscle function is compromised in neck pain patients and that compromised trunk muscle function is associated with increased risk of LBP. Fifty-four neck pain patients and 52 controls were assessed on an abdominal drawing-in task (ADIT) and on self-report tests. Performance on the ADIT was able to detect neck pain patients with 85% sensitivity and 73% specificity. Catastrophizing and McGill pain questionnaire (affective) scores were higher in patients with an abnormal task response than in patients with an uncertain or normal response, although the self-report data did not predict task performance. Fifty subjects from each group were contactable by telephone at 2 years. They were asked whether they had experienced persistent or recurrent LBP since the assessment. Subjects (patients and controls) who obtained an abnormal response on the ADIT were 3 to 6 times more likely to develop persistent or recurrent LBP than those who obtained an uncertain or normal response. ADIT performance was the main predictor of development of LBP in patients. The results suggest that reduced voluntary trunk muscle control in neck pain patients is associated with an increased risk of developing LBP.

  9. Tapentadol immediate release versus oxycodone immediate release for treatment of acute low back pain.

    Science.gov (United States)

    Biondi, David; Xiang, Jim; Benson, Carmela; Etropolski, Mila; Moskovitz, Bruce; Rauschkolb, Christine

    2013-01-01

    Tapentadol has demonstrated analgesic efficacy across a range of pain conditions. In a head-to-head study of up to 10 days in duration, the analgesic efficacy and tolerability of tapentadol immediate release (IR) versus oxycodone IR using a flexible dosing regimen were compared in patients with acute low back pain (LBP) and associated radicular leg pain. Randomized (1: 1), double-blind, parallel-group study (NCT00986180). Independent Ethics Committee/Institutional Review Board approval of the protocol was obtained. Ninety US outpatient treatment centers. Patients with moderate to severe, acute LBP received tapentadol IR (50, 75, or 100 mg) or oxycodone HCl IR (5, 10, or 15 mg) every 4 to 6 hours as needed for pain for up to 10 days. Patients reported current pain intensity twice daily (11-point numerical rating scale). The primary efficacy endpoint was the sum of pain intensity differences (SPID) over 120 hours for LBP. Tapentadol IR was considered non-inferior to oxycodone IR if the upper bound of the 95% confidence interval (CI) for the least-squares mean (LSM) difference in SPID120 was less than 120. Secondary efficacy endpoints included 2-, 3-, and 10-day SPID for LBP; 2-, 3-, 5-, and 10-day SPID for index leg pain; 30% and 50% responder rates; patient and clinician global impressions of change; and patient satisfaction. The safety population included 645 patients, and the modified intent-to-treat population included 585 patients. In the tapentadol IR and oxycodone IR groups, respectively, 86.3% (277/321) and 82.7% (268/324) of patients completed the study. The most common reason for study withdrawal in both treatment groups was adverse events (tapentadol IR, 6.5% [21/321]; oxycodone IR, 7.1% [23/324]). The LSM (standard error) SPID120 for LBP was 264.6 (11.43) for tapentadol IR (n = 287) and 264.0 (11.22) for oxycodone IR (n = 298). The 95% CI for the LSM difference was -32.1 to 30.9; therefore, tapentadol IR was non-inferior to oxycodone IR for relief of LBP

  10. Low power laser in the treatment of the acute low back pain

    Directory of Open Access Journals (Sweden)

    Mandić Milan

    2011-01-01

    Full Text Available Beckground/Aim. Acute low back pain (ALBP is one of the most frequent painful conditions in the human population. The objective of the paper was to compare the efficacy of the low power laser (LPL in the pain and the muscular spasm reduction with conservative methods of physical medicine. Method. The prospective cohort study was done. The study involved 70 patients, both men and women, from 25 to 64 years of age with the diagnosis of ALBP. Two groups were formed. There were 40 patients in the first group and they were treated with the LPL with frequency of 73 Hz. The second group was the control one and it consisted of 30 patients who were treated with conservative methods of physical medicine (electrotherapy: diadynamic currents CP ± 3 and CP ± 3, interferent currents - 90 Hz for 15 min; electrophoresis with novocaine. The ALBP were diagnosed by clinical examination and by the nuclear magnetic resonance imaging (NMRI. The low power laser - Gallium Arsenide (GaAs was used. The laser sonde consisted of 4 laser diodes, each powered of 15 mW, wavelength 904 nm and with frequency 73Hz. The total period of time for each treatment was 10 minutes and the total dose per treatment was 15 J. The intensity of acute low back pain was assessed by Roland´s scale. The degree of the spasm was assessed in the relaxed position and during movements. Results. The average score in the first group before the onset of rehabilitation was 3.3 ± 1.1 (Me = 3.0, and in the control group was 3.43 ± 0.89 (Me = 3.0. After five treatments in patients who were treated with LPL the average score in Roland´s scale was decreased (1.12 ± 1.3, Me = 2.0 and in the control group there were no changes. After 10 treatments with the LPL the analgesic effect was obtained in 82.5% of patients from the first group and in 20% of patients in the control group. The analgesic effect in patients of the first group was obtained after 7.5 ± 2.1 treatments and in the second group after 17

  11. Efficacy of Short-Term Spinal Cord Stimulation in Acute/Subacute Zoster-Related Pain: A Retrospective Study.

    Science.gov (United States)

    Dong, Dao-Song; Yu, Xue; Wan, Cheng-Fu; Liu, Yan; Zhao, Lin; Xi, Qi; Cui, Wen-Yao; Wang, Qiu-Shi; Song, Tao

    2017-07-01

    Postherpetic neuralgia (PHN) is a refractory condition that impairs the patient's quality of life (QoL), it develops secondary to herpes zoster infection. Therefore, it's important to prevent the transition of acute/subacute zoster-related pain to PHN. Despite of numerous studies, the optimal intervention that reduces PHN incidence is still unknown. We evaluate the efficacy of short-term spinal cord stimulation (stSCS) in patients with refractory acute/subacute zoster-related pain. Retrospective study. Tertiary referral center/teaching hospital. A total of 46 patients who presented with acute/subacute zoster-related pain, and had previously failed conventional therapies, underwent stSCS treatment. Visual analog scale (VAS), Short Form Health Survey 12 items (SF-12), and analgesic consumptions were recorded before stSCS, post-stSCS, 2 weeks, and 1, 3, 6, 9, and 12 months after stimulation. The VAS scores at post-stSCS, 2 weeks, and 1, 3, 6, 9, and 12 months after stSCS treatment were significantly decreased compared with the baseline score (P < 0.001). Thirty-two patients (69.6%, 32/46) achieved the minimal clinically important difference (MCID), including 18 patients (39.1%, 18/46) who achieved complete pain relief (VASless than orequal to2). During the follow-up period, the efficacy of stSCS didn't decrease and VAS scores were declining. Similarly, SF-12 scores and analgesic consumptions improved after stSCS treatment. The efficacy of stSCS did not differ significantly among patients with different durations of acute/subacute zoster-related pain starting from the onset of rash. No serious adverse effects were observed in the entire follow-up period. This study was not a randomized prospective controlled study. We did not compare the outcomes with patients presenting with mild or moderate pain, and did not compare the efficacy of stSCS treatment with conventional therapies. stSCS is a safe, effective, and less invasive analgesic method for patients with refractory

  12. Prognostic factors for short-term improvement in acute and persistent musculoskeletal pain consulters in primary care

    Directory of Open Access Journals (Sweden)

    Bolton Jennifer E

    2011-11-01

    Full Text Available Abstract Background Given the costs associated with the management of musculoskeletal pain in primary care, predicting the course of these conditions remains a research priority. Much of the research into prognostic indicators however considers musculoskeletal conditions in terms of single pain sites whereas in reality, many patients present with pain in more than one site. The aim of this study was to identify prognostic factors for early improvement in primary care consulters with acute and persistent musculoskeletal conditions across a range of pain sites. Methods Consecutive patients with a new episode of musculoskeletal pain completed self-report questionnaires at baseline, and then again at the 4/5th treatment visit, and if they were still consulting, at the 10th visit. The outcome was defined as patient self-report improvement sufficient to make a meaningful difference. Independent predictors of outcome were identified using multivariate regression analyses. Results Acute (th visit. Several variables at baseline were associated with improvement at the 4/5th visit, but the predictive models were weak and unable to discriminate between patients who were improved and those who were not. In contrast, it was possible to elicit a predictive model for improvement later on at the 10th visit, but only in patients with persistent pain. Being employed, reporting a decline in work fear-avoidance behaviour at the 4/5th visit, and being better by the 4/5th visit, were all independently associated with improvement. This model accounted for 34.3% (p Conclusions We were unable to identify baseline characteristics that predicted early outcome in musculoskeletal pain patients. However, early self-reported improvement and decline in work fear-avoidance behaviour as predictors of later improvement highlighted the importance of speedy recovery in persistent musculoskeletal pain consulters. Our findings reinforce the elusive nature of baseline predictors, and

  13. Acupuncture for the treatment of severe acute pain in Herpes Zoster: results of a nested, open-label, randomized trial in the VZV Pain Study

    Directory of Open Access Journals (Sweden)

    Placido Giuseppina

    2011-06-01

    Full Text Available Abstract Background Data on the potential efficacy of acupuncture (AC in controlling intense or very intense pain in patients with Herpes Zoster (HZ has not been so far adequately assessed in comparison with standard pharmacological treatment (ST by a controlled trial design. Methods Within the VZV Pescara study, pain was assessed in HZ patients on a Visual Analogue Scale (VAS and by the McGill Pain Questionnaire (MPQ both at the beginning and at the end of treatment. Response rates, mean changes in pain intensity, differences in total pain burden with an area-under-the-curve (AUC method over a 1-year follow-up and differences in the incidence of Post-Herpetic Neuralgia (PHN were evaluated. Results One hundred and two patients were randomized to receive either AC (n = 52 or ST (n = 50 for 4 weeks. Groups were comparable regarding age, sex, pain intensity at presentation and missed antiviral prescription. Both interventions were largely effective. No significant differences were observed in response rates (81.6% vs 89.2%, p = 0.8, mean reduction of VAS (4.1 +/- 2.3 vs 4.9 +/- 1.9, p = 0.12 and MPQ scores (1.3 +/- 0.9 vs 1.3 +/- 0.9, p = 0.9, incidence of PHN after 3 months (48.4% vs 46.8%, p = 0.5, and mean AUC during follow-up (199 +/- 136 vs 173 +/- 141, p = 0.4. No serious treatment-related adverse event was observed in both groups. Conclusions This controlled and randomized trial provides the first evidence of a potential role of AC for the treatment of acute herpetic pain. Trial registration ChiCTR-TRC-10001146.

  14. Topical diclofenac epolamine patch 1.3% for treatment of acute pain caused by soft tissue injury.

    Science.gov (United States)

    McCarberg, B H; Argoff, C E

    2010-10-01

    Acute pain caused by musculoskeletal disorders is very common and has a significant negative impact on quality-of-life and societal costs. Many types of acute pain have been managed with traditional oral non-steroidal anti-inflammatory drugs (NSAIDs) and selective cyclooxygenase-2 inhibitors (coxibs). Data from prospective, randomised controlled clinical trials and postmarketing surveillance indicate that use of oral traditional NSAIDs and coxibs is associated with an elevated risk of developing gastrointestinal, renovascular and/or cardiovascular adverse events (AEs). Increasing awareness of the AEs associated with NSAID therapy, including coxibs, has led many physicians and patients to reconsider use of these drugs and look for alternative treatment options. Treatment with NSAIDs via the topical route of administration has been shown to provide clinically effective analgesia at the site of application while minimising systemic absorption. The anti-inflammatory and analgesic potency of the traditional oral NSAID diclofenac, along with its physicochemical properties, makes it well suited for topical delivery. Several topical formulations of diclofenac have been developed. A topical patch containing diclofenac epolamine 1.3% (DETP, FLECTOR(®) Patch), approved for use in Europe in 1993, has recently been approved for use in the United States and is indicated for the treatment of acute pain caused by minor strains, sprains and contusions. In this article, we review the available clinical trial data for this product in the treatment of pain caused by soft tissue injury. © 2010 Blackwell Publishing Ltd.

  15. Effect of acute and chronic administration of caffeine on pain-like behaviors in rats with partial sciatic nerve injury.

    Science.gov (United States)

    Wu, Wei-Ping; Hao, Jing-Xia; Fredholm, Bertil B; Wiesenfeld-Hallin, Zsuzsanna; Xu, Xiao-Jun

    2006-07-10

    Caffeine, used in many pain medications as an adjuvant analgesic, is an adenosine A1 and A2A receptor antagonist. Here we examined the effects of acute or chronic caffeine administration in rats after partial sciatic nerve injury. The hindpaw response to mechanical or cold stimulation was assessed following photochemically induced sciatic nerve injury which leads to hypersensitivity to these stimuli. Caffeine was administered i.p. acutely or in the drinking water chronically. The mechanical and cold hypersensitivity of sciatic nerve-injured rats was dose-dependently alleviated by acute systemic administration of caffeine (10-80 mg/kg). The effect of caffeine was, however, associated with side effects including locomotor stimulation or depression. Chronic oral administration (average daily doses 27.5 mg/kg/day or 61.5 mg/kg/day for 2 weeks) of caffeine starting at the time of nerve injury did not significantly affect the development of pain-like behaviors. Thus, acute, but not long term, caffeine intake reduced neuropathic pain state in nerve-injured rats, but only at very high doses. The potential hyperalgesic effect of chronic A1 adenosine receptor blockade may have been compensated for by an antinociceptive effect of caffeine through antagonism of A2A receptors and tolerance development.

  16. Variation among Primary Care Physicians in the Use of Imaging for Older Patients with Acute Low Back Pain.

    Science.gov (United States)

    Tan, Alai; Zhou, Jie; Kuo, Yong-Fang; Goodwin, James S

    2016-02-01

    Diagnostic imaging is not recommended in the evaluation and management of non-specific acute low back pain. To estimate the variation among primary care providers (PCPs) in the use of diagnostic imaging for older patients with non-specific acute low back pain. Retrospective cohort study using 100 % Texas Medicare claims data. We identified 145,320 patients aged 66 years and older with non-specific acute low back pain during the period January 1, 2007, through November 30, 2011, cared for by 3297 PCPs. We tracked whether each patient received lumbar imaging (radiography, computed tomography [CT], or magnetic resonance imaging [MRI]) within 4 weeks of the initial visit. Multilevel logistic regression models were used to estimate physician-level variation in imaging use. Among patients, 27.2 % received radiography and 11.1 % received CT or MRI within 4 weeks of the initial visit for low back pain. PCPs varied substantially in the use of imaging. The average rate of radiography within 4 weeks was 53.9 % for PCPs in the highest decile, compared to 6.1 % for PCPs in the lowest decile. The average rates of CT/MRI within 4 weeks were 18.5 % vs. 3.2 % for PCPs in the highest and lowest deciles, respectively. The specific physician seen by a patient accounted for 25 % of the variability in whether imaging was performed, while only 0.44 % of the variance was due to measured patient characteristics and 1.4 % to known physician characteristics. Use of imaging by individual physicians was stable over time. PCPs vary substantially in the use of imaging for non-specific acute low back pain. Provider-level measures can be employed to provide feedback to physicians in an effort to modify imaging use.

  17. PACE - The first placebo controlled trial of paracetamol for acute low back pain: design of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Day Richard O

    2010-07-01

    Full Text Available Abstract Background Clinical practice guidelines recommend that the initial treatment of acute low back pain (LBP should consist of advice to stay active and regular simple analgesics such as paracetamol 4 g daily. Despite this recommendation in all international LBP guidelines there are no placebo controlled trials assessing the efficacy of paracetamol for LBP at any dose or dose regimen. This study aims to determine whether 4 g of paracetamol daily (in divided doses results in a more rapid recovery from acute LBP than placebo. A secondary aim is to determine if ingesting paracetamol in a time-contingent manner is more effective than paracetamol taken when required (PRN for recovery from acute LBP. Methods/Design The study is a randomised double dummy placebo controlled trial. 1650 care seeking people with significant acute LBP will be recruited. All participants will receive advice to stay active and will be randomised to 1 of 3 treatment groups: time-contingent paracetamol dose regimen (plus placebo PRN paracetamol, PRN paracetamol (plus placebo time-contingent paracetamol or a double placebo study arm. The primary outcome will be time (days to recovery from pain recorded in a daily pain diary. Other outcomes will be pain intensity, disability, function, global perceived effect and sleep quality, captured at baseline and at weeks 1, 2, 4 and 12 by an assessor blind to treatment allocation. An economic analysis will be conducted to determine the cost-effectiveness of treatment from the health sector and societal perspectives. Discussion The successful completion of the trial will provide the first high quality evidence on the effectiveness of the use of paracetamol, a guideline endorsed treatment for acute LBP. Trail registration ACTRN12609000966291.

  18. Xanthogranulomatous pyelonephritis presenting as acute pleuritic chest pain: a case report.

    Science.gov (United States)

    Chow, Justin; Kabani, Rameez; Lithgow, Kirstie; Sarna, Magdalena A

    2017-04-12

    Xanthogranulomatous pyelonephritis is a rare and serious manifestation of chronic kidney inflammation that can be life-threatening if not recognized and treated appropriately, often with antibiotics and surgery. Affected patients are most commonly females in their fifth or sixth decade of life with a background of obstructive uropathy, nephrolithiasis, or recurrent urinary tract infections who present with vague nonspecific symptoms. A 43-year-old woman of Russian ethnicity with a history of nephrolithiasis presented to our emergency department with new left-sided pleuritic chest pain amid a 6-week history of constitutional symptoms including fevers, night sweats, and 7 kg of weight loss. Workup for acute coronary syndrome and pulmonary embolism in our emergency department was negative. Given that she was clinically unwell, she was admitted to internal medicine to expedite workup for the cause of her symptoms. A broad differential diagnosis for various infectious, inflammatory/autoimmune, and neoplastic processes was considered. Based on classic radiographic and histopathologic findings, she was ultimately diagnosed with xanthogranulomatous pyelonephritis of her left kidney, which was a direct consequence of chronic inflammation. This inflammation exhibited spread to local tissues and across her left hemidiaphragm, resulting in a unilateral pleural effusion which explained her chest discomfort. She was treated with antibiotics administered intravenously and urgent total nephrectomy with a good functional outcome. Our case illustrates an uncommon but clinically important do-not-miss diagnosis that underlies a common clinical presentation of pleuritic chest pain. The case underscores the importance of maintaining a broad differential diagnosis and organized approach when treating patients with undifferentiated clinical presentations.

  19. Postoperative pain

    DEFF Research Database (Denmark)

    Kehlet, H; Dahl, J B

    1993-01-01

    Treatment of postoperative pain has not received sufficient attention by the surgical profession. Recent developments concerned with acute pain physiology and improved techniques for postoperative pain relief should result in more satisfactory treatment of postoperative pain. Such pain relief may...... also modify various aspects of the surgical stress response, and nociceptive blockade by regional anesthetic techniques has been demonstrated to improve various parameters of postoperative outcome. It is therefore stressed that effective control of postoperative pain, combined with a high degree...

  20. Pain-to-hospital times, cardiovascular risk factors, and early intrahospital mortality in patients with acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Brković E

    2015-02-01

    Full Text Available Eliana Brković,1 Katarina Novak,2,3 Livia Puljak3 1Department of Psychiatry, 2Department of Internal Medicine, Division of Cardiology, 3Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia Background: The aim of the study was to analyze the most recent trends in myocardial infarction (MI care, the number of patients treated for MI and their outcomes, cardiovascular disease risk factors, and pain-to-hospital times in MI patients. Subjects and methods: For 778 patients treated for acute MI at the Coronary Care Unit (CCU of University Hospital Split, Croatia the following data were acquired: outcome during hospitalization (survived, deceased, cardiovascular risk factors (hypertension, diabetes, dyslipidemia, previous MI, smoking, and pain-to-CCU time. Results: Among 778 patients treated for acute MI, there were 291 (37% women and 487 (63% men. Forty-five patients (6% died during hospitalization, mostly due to cardiogenic shock. An association was found between early intrahospital mortality and the following risk factors: age >70 years, female sex, previous MI, and smoking. Median pain-to-call time was 2 hours, and median time from the onset of pain to arrival into the CCU was 4 hours. There were 59 (7.6% patients admitted to the CCU within recommended 90 minutes. Diabetic comorbidity was not associated with early death or with longer time from pain to emergency calls. Conclusion: Some of the risk factors associated with adverse outcomes in MI are modifiable. Prehospital delay of 4 hours observed in patients who suffered an MI is too long, and more effort should be devoted to investments in health care and education of the general public regarding chest pain symptoms. Keywords: prehospital delay, ischemic heart disease

  1. Nicoboxil/nonivamide cream effectively and safely reduces acute nonspecific low back pain – a randomized, placebo-controlled trial

    Directory of Open Access Journals (Sweden)

    Blahova Z

    2016-12-01

    Full Text Available Zuzana Blahova,1 Janina Claudia Holm,1 Thomas Weiser,2 Erika Richter,2 Matthias Trampisch,2 Elena Akarachkova3 1Boehringer Ingelheim RCV GmbH & Co KG, Vienna, Austria; 2Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim am Rhein, Germany; 3I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation Background/objective: Low back pain affects many patients and has a high socioeconomic impact. Topical capsaicinoids have been used for decades to treat musculoskeletal pain. This study investigated the effects of the fixed dose combination (FDC of nonivamide (a capsaicinoid and nicoboxil (a nicotinic acid ester cream in the treatment of acute nonspecific low back pain.Materials and methods: This phase III randomized, double-blind, placebo-controlled, multinational, multi-center trial investigated efficacy, safety, and tolerability of topical nicoboxil 1.08%/nonivamide 0.17% (Finalgon® cream in treatment of acute nonspecific low back pain with the endpoints: pain intensity (PI difference between pre-dose baseline and 8 hours after first application and the end of treatment, mobility score, and efficacy score.Results: Patients (n=138, 21–65 years of age, were treated for up to 4 days with FDC or placebo cream. Mean baseline PI was 6.8 on a 0–10 point numerical rating scale. After 8 hours, pain was more reduced with the FDC than with placebo (adjusted means: 2.824 vs. 0.975 points; p<0.0001. On the last treatment day, mean pain reduction by the FDC was stronger than with placebo (adjusted means: 5.132 vs. 2.174 points; p<0.0001. Mobility on Day 1 was in favor of the FDC when compared to placebo (odds ratio [95% confidence interval {CI}]: 7.200 [3.609, 14.363], p<0.0001. At the end of treatment, patients treated with the FDC rated efficacy significantly higher than placebo (odds ratio [95% CI]: 11.370 [5.342, 24.199], p<0.0001. Both treatments were tolerated well. No serious adverse events were reported.Conclusion: Nicoboxil

  2. Efficacy of an Acute Pain Titration Protocol Driven by Patient Response to a Simple Query: Do You Want More Pain Medication?

    Science.gov (United States)

    Chang, Andrew K; Bijur, Polly E; Holden, Lynne; Gallagher, E John

    2016-05-01

    We assess the efficacy of a simple pain titration protocol of 1-mg increments of intravenous hydromorphone, given at fixed intervals, driven solely by patient response to a yes/no question. This was a prospective interventional cohort study of nonelderly adults with acute severe pain defined as requiring intravenous opioids in the judgment of the attending emergency physician. All patients received 1 mg intravenous hydromorphone and 30 minutes later were asked, "Do you want more pain medication?" Patients responding yes received an additional 1 mg of intravenous hydromorphone and were asked the same question 30 minutes after receiving it. Those responding no did not receive additional opioid and were asked the question again 30 minutes later. Each patient was queried 4 times. The primary endpoint was the proportion of patients achieving satisfactory pain control, defined as declining additional pain medication on 1 or more occasions. Of 215 patients enrolled, there were 8 protocol violations, leaving 207 patients with analyzable data; 205 of 207 patients (99%; 95% confidence interval 97% to 100%) achieved satisfactory analgesia at 1 or more points during the study. Nine patients desaturated below 95% on room air, 2 had respiratory rates less than 10 breaths/min, and 2 had pulse rates less than 50 beats/min. No adverse events were associated with amount of hydromorphone received. A pain protocol, based on titration of 1 mg intravenous hydromorphone, driven solely by patient response to a simple standardized question repeated at intervals, resulted in achievement of satisfactory analgesia on at least 1 occasion in 99% of patients. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  3. Muscle pain

    African Journals Online (AJOL)

    Key Summary Points. • Muscle pain, known as myalgia, can be in one targeted area or across many muscles, occurring with overexertion or overuse of these muscles. • Pain can be classified as acute or chronic pain and further categorized as nociceptive or neuropathic. • Causes of muscle pain include stress, physical ...

  4. A case of pancreatic arteriovenous malformation identified by investigating the cause of upper abdominal pain associated with acute pancreatitis.

    Science.gov (United States)

    Sato, Kohei; Monden, Kazuteru; Ueki, Toru; Tatsukawa, Masashi; Sadamori, Hiroshi; Sakaguchi, Kousaku; Takakura, Norihisa

    2016-07-01

    A man in his 60s with epigastric pain was diagnosed with acute pancreatitis and subsequently recovered following conservative treatment. However, because of repeated upper abdominal pain and the formation of a pancreatic pseudocyst, he was transferred to our institution for evaluation. Dynamic computed tomography (CT) scanning confirmed abnormal vessels in the tail of the pancreas and early venous return to the splenic vein in the early arterial phase. Abdominal angiography revealed a racemose vascular network in the tail of the pancreas, confirming the presence of an arteriovenous malformation (AVM) in this region. This AVM was thought to be the cause of the acute pancreatitis, so a distal pancreatectomy was performed. The patient's postoperative course was uneventful, and there has been no recurrence at the 7-month postoperative follow-up. Surgical resection has a low recurrence rate and good outcome;thus, if a pancreatic AVM appears difficult to treat with conservative medical therapy, surgical resection appears to be the definitive treatment.

  5. The roles of acute and chronic pain in regression of sensory analgesia during continuous epidural bupivacaine infusion

    DEFF Research Database (Denmark)

    Mogensen, T; Scott, N B; Lund, Claus

    1988-01-01

    The purpose of this study was to investigate whether regression of sensory analgesia during constant epidural bupivacaine infusion was different in postoperative patients with acute pain than in patients with chronic nonsurgical pain. Sensory levels of analgesia (to pinprick) and pain (on a five......-point scale) were assessed hourly for 16 hours during continuous epidural infusion of 0.5% plain bupivacaine (8 ml/hr) in 12 patients with chronic nonsurgical pain and in 30 patients after major abdominal surgery performed under combined bupivacaine and halothane--N2O general anesthesia. No opiates were given....... If sensory analgesia decreased more than five segments from the initial level or if the pain score reached 2 (moderate pain), the patient was removed from the study. Initial levels of sensory analgesia after loading doses of 21.8 +/- 0.5 and 19.3 +/- 0.8 ml bupivacaine 0.5% were similar (T3.8 +/- 0.3 and T3...

  6. Brain Network Response to Acupuncture Stimuli in Experimental Acute Low Back Pain: An fMRI Study

    Directory of Open Access Journals (Sweden)

    Yu Shi

    2015-01-01

    Full Text Available Most neuroimaging studies have demonstrated that acupuncture can significantly modulate brain activation patterns in healthy subjects, while only a few studies have examined clinical pain. In the current study, we combined an experimental acute low back pain (ALBP model and functional magnetic resonance imaging (fMRI to explore the neural mechanisms of acupuncture analgesia. All ALBP subjects first underwent two resting state fMRI scans at baseline and during a painful episode and then underwent two additional fMRI scans, once during acupuncture stimulation (ACUP and once during tactile stimulation (SHAM pseudorandomly, at the BL40 acupoint. Our results showed that, compared with the baseline, the pain state had higher regional homogeneity (ReHo values in the pain matrix, limbic system, and default mode network (DMN and lower ReHo values in frontal gyrus and temporal gyrus; compared with the OFF status, ACUP yielded broad deactivation in subjects, including nearly all of the limbic system, pain status, and DMN, and also evoked numerous activations in the attentional and somatosensory systems; compared with SHAM, we found that ACUP induced more deactivations and fewer activations in the subjects. Multiple brain networks play crucial roles in acupuncture analgesia, suggesting that ACUP exceeds a somatosensory-guided mind-body therapy for ALBP.

  7. Safety and efficacy of different systemic treatment modalities for acute pain of herpes zoster: A pilot study

    Directory of Open Access Journals (Sweden)

    Sanjiv Choudhary

    2018-01-01

    Full Text Available Background: Herpes zoster is a viral infection of skin caused by Varicella Zoster virus. The most important symptom for which the patient seeks medical advice is pain, which is perceived before the development of rash and lasts even after its resolution. The pain during the first 30 days after onset of herpes zoster is known as acute herpetic neuralgia. The aim of this study was to compare the efficacy and side-effects of different systemic treatment modalities for acute herpes zoster neuralgia. Materials and Methods: This was a randomized, single-blind, parallel control study. Forty-five patients of herpes zoster within 72 hours of onset were enrolled after considering various inclusion and exclusion criteria over a duration of 1 year. Pain severity was assessed after sequential distribution and allotment of patients in three groups using verbal rating scale (VRS. Patients in Group A (control group, were treated with Tab.valacyclovir (1 g tds × 7 days, Group B–Tab.valacyclovir (1 g tds × 7 days + Cap. Pregabalin (75 mg bd × 1 month, and Group C –Tab.valacyclovir (1 g tds × 7 days +Cap. Pregabalin (75 mg bd × 1 month + Tab.methylprednisolone (0.64 mg/kg body weight in two divided doses × 7 days. Patients were followed up at 1, 4, 6 weeks. Complete resolution of acute pain and side-effects were noted. Results: At the end of 4 weeks, reduction in acute pain was statistically significant (P < 0.05 in all the three groups individually compared to the baseline value. At the end of 6 weeks, percentage of patients with persistence of pain was more in Group A and B compared to Group C, which was statistically significant (P = 0.0001. In group A, postherpetic neuralgia was observed in more patients compared to group B and C. No significant side-effects were observed in any group except vomiting, somnolence, and dizziness. Limitations: Sample size of this study was limited. Further studies with large sample size are required to further validate

  8. A new score for the diagnosis of acute coronary syndrome in acute chest pain with non-diagnostic ECG and normal troponin.

    Science.gov (United States)

    Boubaker, Hamdi; Grissa, Mohamed Habib; Beltaief, Kaouther; Amor, Mohamed Haj; Mdimagh, Zouhaier; Boukhris, Amor; Ben Amor, Mehdi; Dridi, Zohra; Letaief, Mondher; Bouida, Wahid; Boukef, Riadh; Najjar, Fadhel; Nouira, Semir

    2015-10-01

    Acute coronary syndrome (ACS) represents a difficult diagnostic challenge in patients with undifferentiated chest pain. There is a need for a valid clinical score to improve diagnostic accuracy. To compare the performance of a model combining the Thrombolysis in Myocardial Infarction (TIMI) score and a score describing chest pain (ACS diagnostic score: ACSD score) with that of both scores alone in the diagnosis of ACS in ED patients with chest pain associated with a non-diagnostic ECG and normal troponin. In this observational cohort study, we enrolled 809 patients admitted to a chest pain unit with normal ECG and normal troponin. They were prospectively evaluated in order to calculate TIMI score, chest pain characteristics score and ACSD score. Diagnosis of ACS was the primary outcome and defined on the basis of 2 cardiologists after reviewing the patient medical records and follow-up data. Mortality and major cardiovascular events were followed for 1 month for patients discharged directly from ED. Discriminative power of scores was evaluated by the area under the ROC curve. ACS was confirmed in 90 patients (11.1%). The area under the ROC curve for ACSD score was 0.85 (95% CI 0.80 to 0.90) compared with 0.74 (95% CI 0.67 to 0.81) for TIMI and 0.79 (95% CI 0.74 to 0.84) for chest pain characteristics score. A threshold value of 9 appeared to optimise sensitivity (92%) and negative predictive value (99%) without excessively compromising specificity (62%) and positive predictive value (23%). The ACSD score showed a good discrimination performance and an excellent negative predictive value which allows safely ruling out ACS in ED patients with undifferentiated chest pain. Our findings should be validated in a larger multicentre study. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  9. [Usefulness of copeptin in discarding non-ST elevation acute myocardial infarction in patients with acute chest pain and negative first troponin I].

    Science.gov (United States)

    Esteban-Torrella, P; García de Guadiana-Romualdo, L; Consuegra-Sánchez, L; Dau-Villarreal, D; Melgarejo-Moreno, A; Albaladejo-Otón, M D; Villegas-García, M

    2015-11-01

    To evaluate the usefulness of copeptin as a rapid and reliable marker for discarding non-ST elevation acute myocardial infarction (NSTEMI) in patients attended in an Emergency Care Department due to acute chest pain with a normal or non-diagnostic electrocardiogram and a negative first troponin I result. A prospective observational study was carried out. The Emergency Care Department of a university hospital. The study comprised a total of 97 patients attended in the Emergency Care Department due to chest pain suggestive of acute coronary syndrome with an evolution of under 12h, a non-diagnostic electrocardiogram and a negative first troponin I result. None. Patient demographic data and baseline characteristics, copeptin upon admission, troponin I upon admission and after 6h, and final diagnosis. The final diagnosis was NSTEMI in 14 patients (14.4%) -no significant differences in copeptin concentration being observed between the 2 groups, though a tendency towards higher values was recorded in the NSTEMI group (median: 24.6pmol/l [interquartile range: 42.0] vs. 12.0pmol/l [16.1]; P=.06). The AUC ROC for copeptin upon admission was 0.657 (95%CI: 0.504-0.810), with a negative predictive value of 92% for a cutoff point of 14pmol/l. Copeptin determination upon admission to the Emergency Care Department in patients with chest pain for ≤12h, suggestive of acute coronary syndrome, with a non-diagnostic electrocardiogram and a negative first troponin I determination does not allow rapid and reliable exclusion of the presence of NSTEMI. Serial troponin I measurements are needed in this respect. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  10. [Nocioceptive pain, neuropathic pain and pain memory].

    Science.gov (United States)

    Montero-Homs, Jordi

    2009-01-01

    Pain is a cognitive evaluation. Its appearance in the new functional image systems is promising. Nocioceptive pain, usually acute or persistent, is useful to prevent animals from getting injured. Chronic pain is disease per se: It is due to a sensitisation phenomena and pain memory with an important relationship with emotions. Neuropathic pain is a neurological symptom due to a somatosensorial system dysfunction. In this case, axonal ectopic generation of impulses and synaptic hyperexcitability occurs. In persistent cases, sensitisation phenomenon and memory of pain appear together with neuropathic pain. Pain treatment should be physiopathologicaly orientated. Pain units, specialized in analgesic treatment and some invasive techniques, are usually competent in the treatment of nocioceptive pain. Neuropathic pain should have a neurologic diagnosis and treatment. But neurologist need to be more and more interested in the chronic pain related with memory and sensitisation: better knowledge of the cerebral mechanisms in this phenomenon can add to this pathology in our field.

  11. Ice burn: protecting the flank during renal cryotherapy.

    Science.gov (United States)

    Young, Jennifer L; Sountoulides, Petros; Kolla, Surendra B; Pick, Donald L; Kaufmann, Oskar B; Huynh, Victor B; Kaplan, Adam G; Ortiz, Cervando; Louie, Michael K; Andrade, Lorena A; Osann, Kathryn E; McDougall, Elspeth M; Clayman, Ralph V

    2010-08-01

    Cryoablation is a viable minimally invasive strategy for the treatment of small renal masses. One of the most common postoperative complaints is pain or paresthesia at the cryoprobe insertion site. The use of a 14-gauge angiocatheter to insulate the flank during renal cryotherapy was investigated. Six Yorkshire swine underwent laparoscopy-guided percutaneous cryoablation of the upper and lower poles of both kidneys with a 1.47 mm (17 gauge) cryoneedle. Treatment consisted of a double 10-minute freeze separated by a 5-minute active thaw. Trials were randomized to placement of the cryoneedle directly through the flank or through a 14-gauge angiocatheter as an insulating sheath. Temperatures were recorded adjacent to the cryoneedle at two depths in the flank with a Multi-Point Thermal Sensor. Twelve trials were completed each with a bare and sheathed cryoneedle. The coldest temperature observed was -26 degrees C for the bare cryoneedle and -21 degrees C for the sheathed cryoneedle. At the outer sensor, there was a 4.1 degrees C increase in mean temperature for freeze 1, and 6.2 degrees C increase in mean temperature for freeze 2 with sheath use. At the inner sensor, there was a 3.0 degrees C increase in mean temperature for freeze 1, and 9.4 degrees C increase in mean temperature for freeze 2 with sheath use. There was a trend toward statistical significance of sheath insulation at the outer (p = 0.07) and inner (p = 0.08) temperature sensors. A 14-gauge angiocatheter may provide some insulation and thereby might help protect against "ice burn" during renal cryotherapy.

  12. The utility of ultrasonography in the the diagnostics and monitoring of treatment of acute abdominal pain in children with neoplasms

    International Nuclear Information System (INIS)

    Zaleska-Dorobisz, U.; Jankowski, B.; Maciaszek, A.; Moron, K.

    2005-01-01

    The aim of this study was to estimate the results of the diagnostic imaging modalities, especially ultrasonography (US) in children during the oncological therapy with the acute abdominal symptoms. Acute abdominal symptoms in children with neoplasms causing a very difficult clinical and diagnostic problems and can occur in any stage of disease. The high-resolution ultrasound has a very important role in diagnosis in all patients with acute abdominal pain and with neoplasms. The authors consider that the US should be the first imaging method in the differential diagnosis of the abdominal changes in children with neutropenia and oncological disease. Proper diagnosis should be established only with clinical information. We analyzed 249 ultrasounds examinations of the abdominal cavity in 144 girls and 105 boys aged from 1 to 18 years (mean age 10, 3 years). The more important indication for the US exam in 133 cases was acute abdominal symptoms. We took exams during pre- and postoperative chemotherapy, radiotherapy and after the hematopoietic stem cell transplantation. All the patients were under routine hematological control. Based on the clinical symptoms and the laboratory tests we analysed two groups of children with oncological disease and acute abdomen: I group - 111 children with neutropenia, II group - 22 children without neutropenia. In the patients who underwent operation procedure the final diagnosis was established on histopathology. In the other cases diagnosis was based on clinical, laboratory and radiological exams, especially ultrasonography. We analyzed clinical picture of disease, the results of therapy and the US changes in examined patients using statistic parameters as: sensitivity, specificity and efficiency. In the group of 133 children with acute abdominal symptoms the most (92- 69,1%) patients suffer from ALL (acute lymphoblastic leukaemia) and 16(12%) - from AML (acute lymphoblastic leukaemia), Ewing sarcoma-3(2,2%), osteosarcoma - 3(2,2%), NHL

  13. A randomized, controlled trial of routine early abdominal computed tomography in patients presenting with non-specific acute abdominal pain

    International Nuclear Information System (INIS)

    Sala, E.; Watson, C.J.E.; Beadsmoore, C.; Groot-Wassink, T.; Fanshawe, T.R.; Smith, J.C.; Bradley, A.; Palmer, C.R.; Shaw, A.; Dixon, A.K.

    2007-01-01

    Aim: To compare the effect of an initial early computed tomography (CT) examination versus standard practice (SP) on the length of hospital stay, diagnostic accuracy, and mortality of adults presenting with acute abdominal pain. Materials and methods: Two hundred and five adults presenting with acute abdominal pain were randomized to undergo an early CT examination or current SP, which comprised supine abdominal and erect chest radiography. One hundred and ninety-eight patients (99 in each arm) were included in the analysis. The primary endpoint was the duration of inpatient stay; secondary endpoints were diagnostic certainty and mortality. Results: There was no significant difference in the length of hospital stay between the two arms (p = 0.20). At randomization 36% (35 of 96) of CT patients and 49% (48 of 98) of SP patients were correctly diagnosed; 24 h after randomization the correct diagnosis had been established in 84% of CT patients and 73% of SP patients. This refinement in diagnostic certainty was significantly better in the CT group (p < 0.001). There was no difference in mortality between the two trial arms (p = 0.31). Conclusion: Early abdominal CT in patients with acute abdominal pain improves diagnostic certainty, but does not reduce the length of hospital stay and 6 month mortality

  14. Application of low frequency and medium frequency currents in the management of acute and chronic pain-a narrative review.

    Science.gov (United States)

    Samuel, Stephen Rajan; Maiya, G Arun

    2015-01-01

    Trancutaneous electrical nerve stimulation (TENS) and interferential therapy (IFT) have been a regular line of treatment for various types of acute and chronic pain. This review aims to compile the latest literature in pain management using these modalities which use low-frequency and medium-frequency currents. The Cochrane Library, Scopus, PubMed, MEDLINE, and CINAHL were searched and studies were examined from their inception till October 2013. After title and abstract screening the relevant studies were included for this review. We found through this review that even though TENS and IFT are used in management of pain, there is limited amount of high quality research available in this area. Most of the studies lack methodological quality and have a low sample size.

  15. Application of low frequency and medium frequency currents in the management of acute and chronic pain-A narrative review

    Directory of Open Access Journals (Sweden)

    Stephen Rajan Samuel

    2015-01-01

    Full Text Available Trancutaneous electrical nerve stimulation (TENS and interferential therapy (IFT have been a regular line of treatment for various types of acute and chronic pain. This review aims to compile the latest literature in pain management using these modalities which use low-frequency and medium-frequency currents. The Cochrane Library, Scopus, PubMed, MEDLINE, and CINAHL were searched and studies were examined from their inception till October 2013. After title and abstract screening the relevant studies were included for this review. We found through this review that even though TENS and IFT are used in management of pain, there is limited amount of high quality research available in this area. Most of the studies lack methodological quality and have a low sample size.

  16. Application of Low Frequency and Medium Frequency Currents in the Management of Acute and Chronic Pain-A Narrative Review

    Science.gov (United States)

    Samuel, Stephen Rajan; Maiya, G Arun

    2015-01-01

    Trancutaneous electrical nerve stimulation (TENS) and interferential therapy (IFT) have been a regular line of treatment for various types of acute and chronic pain. This review aims to compile the latest literature in pain management using these modalities which use low-frequency and medium-frequency currents. The Cochrane Library, Scopus, PubMed, MEDLINE, and CINAHL were searched and studies were examined from their inception till October 2013. After title and abstract screening the relevant studies were included for this review. We found through this review that even though TENS and IFT are used in management of pain, there is limited amount of high quality research available in this area. Most of the studies lack methodological quality and have a low sample size. PMID:25709199

  17. Diagnostic performance of contrast-enhanced MR for acute appendicitis and alternative causes of abdominal pain in children

    Energy Technology Data Exchange (ETDEWEB)

    Koning, Jeffrey L. [University of California San Diego, Department of Radiology, San Diego, CA (United States); Naheedy, John H.; Kruk, Peter G. [University of California San Diego, Department of Radiology, San Diego, CA (United States); Rady Children' s Hospital, Department of Radiology, San Diego, CA (United States)

    2014-08-15

    Unenhanced MRI has emerged as a useful tool for diagnosing pediatric acute appendicitis. The use of contrast-enhanced MRI for diagnosing pediatric appendicitis has not been documented. The purpose of this study is to examine the diagnostic performance of contrast-enhanced MRI for acute appendicitis and alternative entities in the pediatric population presenting with acute abdominal pain. A retrospective review was conducted of 364 consecutive pediatric patients undergoing contrast-enhanced MRI for the evaluation of possible appendicitis at a single institution between November 2012 and September 2013. There were 132 cases of pathologically confirmed appendicitis out of 364 pediatric patients (36.3%) included in the study. Overall sensitivity and specificity were 96.2% (95% CI [91.4-98.4%]) and 95.7% (95% CI [92.3-97.6%]), respectively. Positive predictive value and negative predictive value were 92.7% (95% CI [86.6-96.3%]) and 97.8% (95% CI [94.7-99.1%]), respectively. The appendix was visualized in 243 cases (66.8%). Imaging confirmed alternative diagnoses in 75 patients, including most commonly colitis, enteritis or terminal ileitis (n = 25, 6.9%), adnexal cysts (n = 25, 6.9%) and mesenteric adenitis (n = 7, 1.9%). Contrast-enhanced MRI is capable of accurately diagnosing acute appendicitis while detecting many alternative entities of abdominal pain, and it allows good visualization of the appendix. Further evaluation is needed to determine whether contrast-enhanced MRI provides an advantage over non-enhanced MRI for imaging evaluation of acute abdominal pain in the pediatric population. (orig.)

  18. Rapidly progressing, fatal and acute promyelocytic leukaemia that initially manifested as a painful third molar: a case report

    Directory of Open Access Journals (Sweden)

    Suárez-Cuenca Juan A

    2009-11-01

    Full Text Available Abstract Introduction Acute promyelocytic leukaemia, an uncommon and devastating subtype of leukaemia, is highly prevalent in Latin American populations. The disease may be detected by a dentist since oral signs are often the initial manifestation. However, despite several cases describing oral manifestations of acute promyelocytic leukaemia and genetic analysis, reports of acute promyelocytic leukaemia in Hispanic populations are scarce. The identification of third molar pain as an initial clinical manifestation is also uncommon. This is the first known case involving these particular features. Case presentation A 24-year-old Latin American man without relevant antecedents consulted a dentist for pain in his third molar. After two dental extractions, the patient experienced increased pain, poor healing, jaw enlargement and bleeding. A physical examination later revealed that the patient had pallor, jaw enlargement, ecchymoses and gingival haemorrhage. Laboratory findings showed pancytopaenia, delayed coagulation times, hypoalbuminaemia and elevated lactate dehydrogenase. Splenomegaly was detected on ultrasonography. Peripheral blood and bone marrow analyses revealed a hypercellular infiltrate of atypical promyelocytic cells. Cytogenetic analysis showing genetic translocation t(15;17 further confirmed acute promyelocytic leukaemia. Despite early chemotherapy, the patient died within one week due to intracranial bleeding secondary to disseminated intravascular coagulation. Conclusion The description of this unusual presentation of acute promyelocytic leukaemia, the diagnostic difficulties and the fatal outcome are particularly directed toward dental surgery practitioners to emphasise the importance of clinical assessment and preoperative evaluation as a minimal clinically-oriented routine. This case may also be of particular interest to haematologists, since the patient's cytogenetic analysis, clinical course and therapeutic response are well

  19. Efficacy of Hand Behind Back Mobilization With Movement for Acute Shoulder Pain and Movement Impairment: A Randomized Controlled Trial.

    Science.gov (United States)

    Satpute, Kiran H; Bhandari, Prashant; Hall, Toby

    2015-06-01

    The aim of this study was to investigate the effects of hand-behind-back (HBB) Mulligan mobilization with movement (MWM) techniques on acute shoulder pain, impairment, and disability. This double-blind, randomized, controlled trial recruited 44 patients with acute shoulder pain and movement impairment presenting to an Indian general hospital. Participants were allocated to receive either MWM and exercise/hot pack (n = 22) or exercise/hot pack alone (n = 22). The average duration of symptoms was 4.1 and 4.7 weeks in the exercise and MWM groups, respectively. The primary outcome was HBB range of motion (ROM). Secondary variables were shoulder internal rotation ROM, pain intensity score, and shoulder disability identified by the shoulder pain and disability index. All variables were evaluated by a blinded assessor before and immediately after 9 treatment sessions over 3 weeks. Paired t tests revealed that both groups demonstrated statistically significant improvements (P hot packs alone. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

  20. A pilot feasibility study of massage to reduce pain in people with spinal cord injury during acute rehabilitation.

    Science.gov (United States)

    Chase, T; Jha, A; Brooks, C A; Allshouse, A

    2013-11-01

    To determine the feasibility of conducting a randomized controlled trial of massage therapy for patients with a new spinal cord injury (SCI) during acute inpatient rehabilitation. A pilot single-center, randomized, single-blind, cross-over clinical trial. Free-standing, not-for-profit, comprehensive rehabilitation center specializing in SCI rehabilitation. Forty adults ages 18 years and older undergoing acute rehabilitation following an SCI reporting any type of pain. Rehabilitation nurses trained to give broad compression massage (BCM) and a control light contact touch (LCT) treatments. Participants were randomized to receive either BCM or LCT first, in six 20-min treatment sessions over 2 weeks, with a 1-week washout between the 2-week treatment periods. Primary outcomes were changes in pain intensity and in fatigue, measured daily. Secondary outcomes included depressive symptoms measured by the Patient Health Questionnaire-9 (PHQ-9) and an assessment of pain medication usage. Pain intensity was higher at baseline and reduced more in the LCT-first group compared with the BCM-first group in period 1 (P=0.014), although this pattern was not found in period 2 (P=0.58). LCT and BCM groups did not significantly differ on any secondary measures except PHQ-9. This study demonstrates the feasibility of using rehabilitation nurses to provide tactile therapy to patients with an SCI and suggests a model for controlled clinical trials examining the efficacy of massage therapies. Although efficacy was difficult to assess, BCM was safe and well tolerated.

  1. [Correlation between dental pulp demyelination degree and pain visual analogue scale scores data under acute and chronic pulpitis].

    Science.gov (United States)

    Korsantiia, N B; Davarashvili, X T; Gogiashvili, L E; Mamaladze, M T; Tsagareli, Z G; Melikadze, E B

    2013-05-01

    The aim of study is the analysis of pulp nerve fibers demyelination degree and its relationship with Visual Analogue Scale (VAS) score that may be measured as objective criteria. Material and methods of study. Step I: electron micrografs of dental pulp simples with special interest of myelin structural changes detected in 3 scores system, obtained from 80 patients, displays in 4 groups: 1) acute and 2) chronic pulpitis without and with accompined systemic deseases, 20 patients in each group. Dental care was realized in Kutaisi N1 Dental clinic. Step II - self-reported VAS used for describing dental pain. All data were performed by SPSS 10,0 version statistics including Spearmen-rank and Mann-Whitny coefficients for examine the validity between pulp demyelination degree and pain intensity in verbal, numbered and box scales. Researched Data were shown that damaged myelin as focal decomposition of membranes and Schwann cells hyperthrophia correspond with acute dental pain intensity as Spearman index reported in VAS numbered Scales, myelin and axoplasm degeneration as part of chronic gangrenous pulpitis disorders are in direct correlation with VAS in verbal, numbered and behavioral Rating Scales. In fact, all morphological and subjective data, including psychomotoric assessment of dental painin pulpitis may be used in dental practice for evaluation of pain syndrome considered personal story.

  2. Persuasive technology in teaching acute pain assessment in nursing: Results in learning based on pre and post-testing.

    Science.gov (United States)

    Alvarez, Ana Graziela; Dal Sasso, Grace T Marcon; Iyengar, M Sriram

    2017-03-01

    Thousands of patients seek health services every day with complaints of pain. However, adequate pain assessment is still flawed, a fact that is partly related to gaps in professional learning on this topic. Innovative strategies such as the use of a virtual learning object mediated by persuasive technology in the learning of undergraduate nursing students can help to fill these gaps and to provide different ways of learning to learn. To evaluate the results in learning among undergraduate nursing students about assessment of acute pain in adults and newborns, before and after an online educational intervention. This is a quasi-experimental, non-equivalent study using pre-and post-testing. Federal University of Santa Catarina, Brazil. 75 undergraduate nursing students. Our study was conducted in three steps (pre-test, education intervention, post-test). Data were collected from November 2013 to February 2014. The educational intervention was performed using online access to virtual learning object about acute pain assessment, which students accessed on their mobile devices. A significant difference was seen in student learning (ppersuasive technology such as small mobile devices as mediators of online educational interventions broadens learning spaces in an innovative, flexible, motivational, and promising manner. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Acute traumatic tear of gluteus medius and minimus tendons in a patient without antecedant peritrochanteric hip pain.

    Science.gov (United States)

    Stanton, Michael C; Maloney, Michael D; Dehaven, Kenneth E; Giordano, Brian D

    2012-06-01

    Morphologic similarities between the abductor mechanisms of the hip and shoulder have given rise to the term rotator cuff tear of the hip. Although the true incidence of gluteus medius and minimus tears in the general population is unknown, the association between these tears and recalcitrant lateral hip pain has been described as greater trochanteric pain syndrome. Historically, tears of the gluteus medius and minimus have been thought to be attritional, and associated with chronic peritrochanteric pain, found incidentally during fracture fixation or hip arthroplasty, or with failure of abductor repair following arthroplasty utilizing the anterolateral approach. The literature supports favorable clinical outcomes with operative repair utilizing either endoscopic or open techniques. To our knowledge, there has never been a reported case of an acute traumatic tear of the gluteus medius and minimus that occurred without antecedant peritrochanteric hip pain. In this case, the patient was treated with acute open repair of the gluteus medius and minimus tendons within 3 weeks of injury and excellent clinical results were obtained at 6-month follow-up. Of note, the patient was notified and gave consent for his case to be used in publication.

  4. Massage and modality effects on treatment of sub-acute and chronic non specific low back pain

    Directory of Open Access Journals (Sweden)

    Fatemeh Panahi

    2011-11-01

    Full Text Available Background: Low back pain (LBP is the second most common medical complaint. It’s estimated that about 70-85% of the population will suffer at least one episode of LBP during their life. The aim of present study was to compare the effects of massage and modality in patient with sub-acute and chronic non-specific LBPMethods: In this clinical trial study 30 women (MeanAge: 33.96±10.93 with sub-acute and chronic non-specific LBP (Mean pain-duration:9.68±3.38 were included in the study and randomized into two equal groups; massage and modality. Patients in both group underwent 10 sessions treatment period. Pain (numerical-pain-scale,NRS, functional disability index (oswestry-disability-index,ODI and lumbar-flexion(modified-schober-testwere recorded before and immediately after treatment period. Data was analyzed using paired t-test and independent sample t-test.Results: Significant improvement showed in both groups separately in pain-intensity, disability level, and flexion after treatment (P<0.001. Statically significant improvement was seen in massage group in comparison to modality group for NRS & ODI after treatment (PNRS=0.015, PODI=0.013. There was a not significant change in point of lumber flexion between two groupsConclusion: The results showed that both massage and modality had beneficial effects on the improvement of pain, functional disability and lumbar flexion in patients with non-specific LBP. It seems that massage is better than modality for non-specific LBP in a short period of time.

  5. Medic - Chest Pain: A Decision Support Program for the Management of Acute Chest Pain (User’s Manual)

    Science.gov (United States)

    1989-10-05

    their complaint. f) Patients with disorders that present with epigastric pain such as gastritis , peptic ulcer, pancreatitis, and cholelithiasis may...of bacterial pneumonia. 3. TREUMENT OF PNEICNIA The treatment of pneumonia consists of bed rest, hydration, adequate nutrition , an antipyretic, an

  6. A self-administered method of acute pressure block of sciatic nerves for short-term relief of dental pain: a randomized study.

    Science.gov (United States)

    Wang, Xiaolin; Zhao, Wanghong; Wang, Ye; Hu, Jiao; Chen, Qiu; Yu, Juncai; Wu, Bin; Huang, Rong; Gao, Jie; He, Jiman

    2014-08-01

    While stimulation of the peripheral nerves increases the pain threshold, chronic pressure stimulation of the sciatic nerve is associated with sciatica. We recently found that acute pressure block of the sciatic nerve inhibits pain. Therefore, we propose that, the pain pathology-causing pressure is chronic, not acute. Here, we report a novel self-administered method: acute pressure block of the sciatic nerves is applied by the patients themselves for short-term relief of pain from dental diseases. This was a randomized, single-blind study. Hospital patients. Patients aged 16-60 years with acute pulpitis, acute apical periodontitis, or pericoronitis of the third molar of the mandible experiencing pain ≥3 on the 11-point numerical pain rating scale. Three-minute pressure to sciatic nerves was applied by using the hands (hand pressure method) or by having the patients squat to force the thigh and shin as tightly as possible on the sandwiched sciatic nerve bundles (self-administered method). The primary efficacy variable was the mean difference in pain scores from the baseline. One hundred seventy-two dental patients were randomized. The self-administered method produced significant relief from pain associated with dental diseases (P ≤ 0.001). The analgesic effect of the self-administered method was similar to that of the hand pressure method. The self-administered method is easy to learn and can be applied at any time for pain relief. We believe that patients will benefit from this method. © 2014 The Authors. Pain Medicine published by Wiley Periodicals, Inc. on behalf of American Academy of Pain Medicine.

  7. Comparison of lumbo-pelvic kinematics during trunk forward bending and backward return between patients with acute low back pain and asymptomatic controls.

    Science.gov (United States)

    Shojaei, Iman; Salt, Elizabeth G; Hooker, Quenten; Van Dillen, Linda R; Bazrgari, Babak

    2017-01-01

    Prior studies have reported differences in lumbo-pelvic kinematics during a trunk forward bending and backward return task between individuals with and without chronic low back pain; yet, the literature on lumbo-pelvic kinematics of patients with acute low back pain is scant. Therefore, the purpose of this study was set to investigate lumbo-pelvic kinematics in this cohort. A case-control study was conducted to investigate the differences in pelvic and thoracic rotation along with lumbar flexion as well as their first and second time derivatives between females with and without acute low back pain. Participants in each group completed one experimental session wherein they performed trunk forward bending and backward return at self-selected and fast paces. Compared to controls, individuals with acute low back pain had larger pelvic range of rotations and smaller lumbar range of flexions. Patients with acute low back pain also adopted a slower pace compared to asymptomatic controls which was reflected in smaller maximum values for angular velocity, deceleration and acceleration of lumbar flexion. Irrespective of participant group, smaller pelvic range of rotation and larger lumbar range of flexion were observed in younger vs. older participants. Reduced lumbar range of flexion and slower task pace, observed in patients with acute low back pain, may be the result of a neuromuscular adaptation to reduce the forces and deformation in the lower back tissues and avoid pain aggravation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. The use of dry needling for a subject with acute onset of neck pain: a case report.

    Science.gov (United States)

    Pavkovich, Ron

    2015-02-01

    Neck pain is a common complaint treated by the physical therapist. Trigger points (TrPs) have been studied as a source of neuromusculoskeletal pain, though the ability of clinicians to accurately locate a TrP is not well supported. Dry needling (DN) is an intervention utilized by physical therapists where a monofilament needle is inserted into soft tissue in order to reduce pain thereby facilitating return to prior level of function. The purpose of this case report is to report the outcomes of DN as a primary treatment intervention for acute, non-specific cervical region pain. The subject was an active 64-year-old female who self- referred for cervical pain following lifting heavy boxes while moving into a new home. She had a history of multi-level cervical fusion and recurrent cervical pain that physical therapy helped to control over the past few years. Physical examination supported a diagnosis of acute cervical region strain. Objective findings included decreased cervical active range of motion (AROM) and upper extremity strength, as well as, reproduction of pain symptoms upon palpation indicating the likelihood of TrPs in the right upper trapezius, levator scapula, supraspinatus, and infraspinatus musculature. She was treated using DN to the aforementioned muscles for two sessions, and no other interventions were performed in order to determine the effectiveness of DN as a primary intervention strategy without other interventions masking the effects of DN. Clinically meaningful improvements were noted in pain and disability, as measured by the Neck Disability Index and Quadruple Visual Analog Scale. Physical examination denoted minimal to no change in cervical AROM (likely associated with multi-level fusion), except for right lateral flexion, and no change in shoulder flexion/ abduction MMT. The patient was able to return to daily and work activities without further functional limitations caused by pain. This case report shows promising outcomes for the use of

  9. Antinociceptive effect of Zanthoxylum rhoifolium Lam. (Rutaceae) in models of acute pain in rodents.

    Science.gov (United States)

    Pereira, S S; Lopes, L S; Marques, R B; Figueiredo, K A; Costa, D A; Chaves, M H; Almeida, F R C

    2010-05-27

    Zanthoxylum rhoifolium Lam. (Rutaceae) is locally known as "mamica de cadela", and its bark is popularly used for toothache and earache. The objective of this study was to investigate the antinociceptive effect of the ethanolic extract from this species' stem bark (EtOH), its fractions of partition (hexane-HEX, ethyl acetate-AcOEt, aqueous-AQ) and lupeol (a triterpene obtained from HEX) in models of acute pain. Male and female Swiss mice (25-35 g, n=6-12 animals/group) were used to assess acute toxicity and nociception (Animal Ethics Committee/UFPI, No. 09/2008). Acute toxicity was studied up to 2 g/kg p.o. of EtOH. In the formalin test (2%, 20 microL/paw), the licking time of the stimulated paw was quantified during the first 5 min (first phase) and at 15-30 min (second phase), 1h after oral treatment with EtOH, HEX, AcOEt or saline, and 30 min after use of morphine-MOR (5 mg/kg i.p.). The same response evoked by capsaicin (2 microg/20 microL/paw) was quantified during 5 min, after administration of EtOH, HEX, AcOEt, AQ, saline and MOR. The licking time of the paw that was stimulated with glutamate (10 micromol/20 microL) was measured (15 min) after treatment with EtOH, HEX, AcOEt, AQ, lupeol, saline or MK801 (0.03 mg/kg, i.p.). Mice were submitted to the rota-rod task and open-field test in order to assess any non-specific muscle-relaxant or sedative effects of EtOH (250 mg/kg p.o.) and HEX (500 mg/kg p.o.). The animals did not exhibit any acute toxicity to EtOH (up to 2 g/kg p.o.), so it was not possible to calculate the LD50. EtOH, HEX and AcOEt (62.5-250 mg/kg) produced a significant antinociceptive effect in the formalin and capsaicin tests. However, AQ was ineffective. EtOH, HEX, AcOEt and lupeol reduced the glutamate-evoked nociceptive response, but AQ had no effect. EtOH and HEX did not alter the locomotion of animals in the open-field or rota-rod tests, which suggest a lack of a central depressant effect. The results confirm the popular use of Zanthoxylum

  10. Hypnosis in the treatment of acute pain in the emergency department setting.

    OpenAIRE

    Deltito, J. A.

    1984-01-01

    Emergency ward physicians are presented daily with patients in pain. Provisions of safe, quick pain cont