WorldWideScience

Sample records for acute flank pain

  1. Flank pain

    Science.gov (United States)

    ... how to do these exercises at home. Nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy may be prescribed for flank pain caused by spinal arthritis. Antibiotics are used to treat most kidney infections. You ...

  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. An unusual manifestation of acute appendicitis with left flank pain

    Directory of Open Access Journals (Sweden)

    Roland Talanow, MD, PhD

    2008-08-01

    Full Text Available The author presents a case with an unusual presentation of early appendicitis. The patient presented initially with left sided flank pain. Workup for nephrolithiasis, including non-contrast CT of the abdomen and pelvis was negative for renal stones or hydronephrosis. After discharge, the patient presented one week later in the ED with right lower quadrant pain. Contrast enhanced CT of the abdomen revealed perforated appendicitis.

  4. 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

  5. The association between maternal hydronephrosis and acute flank pain during pregnancy: a prospective pilot-study.

    Science.gov (United States)

    Farr, Alex; Ott, Johannes; Kueronya, Verena; Margreiter, Markus; Javadli, Elchin; Einig, Sabrina; Husslein, Peter W; Bancher-Todesca, Dagmar

    2017-10-01

    Maternal hydronephrosis may cause flank pain during pregnancy. We aimed to investigate the association between maternal hydronephrosis and flank pain intensity. From 2014 to 2015, all consecutive women with singleton pregnancies, who presented at our tertiary center due to acute flank pain, were prospectively evaluated by renal ultrasonography and pain questionnaires. A visual analogue scale was used to assess pain intensity. The study had 90% power to detect a significant correlation between hydronephrosis and flank pain (Spearman's test). A total of 51 consecutive women with left-sided (13.7%), right-sided (64.7%) or bilateral (21.6%) pain were enrolled. The mean gestational age of these women, who presented due to their pain, was 27.5 ± 6.8 weeks at the time of consultation. The mean VAS score was 7.6 ± 2.2. In 43/51 (84.3%) women, hydronephrosis was found on renal sonograms. No correlation was found between the grade of hydronephrosis and pain intensity (p = 0.466; r= -0.28). Women delivered at a mean gestational age of 38.1 ± 2.4 weeks and their infants had a mean birthweight of 3138 ± 677 g. Hydronephrosis is a common finding among pregnant women with acute flank pain. The grade of hydronephrosis does not affect pain intensity. This study suggests normal pregnancy outcomes in these women.

  6. 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)

  7. 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.)

  8. Cost analysis of different protocols for imaging a patient with acute flank pain

    International Nuclear Information System (INIS)

    Grisi, G.; Stacul, F.; Cuttin, R.; Rimondini, A.; Meduri, S.; Dalla Palma, L.

    2000-01-01

    The aim of this study was to analyse the costs of different diagnostic approaches to patients with acute flank pain. Four different diagnostic approaches were considered: (a) spiral CT without contrast medium (CM); (b) plain film, ultrasonography (US) and intravenous urography (IVU) - the latter procedure is used in our department in cases still unsolved following the former investigations (28 % in our experience); (c) plain film, US and spiral CT without CM (as an alternative to IVU in 28 % of cases); and (d) IVU. The cost of each procedure in a university hospital was calculated, following analysis of the differential costs of each investigation (equipment, depreciation and maintenance costs, related materials and services, radiologists, radiographers, nurses) and their common costs (auxiliary personnel and indirect internal costs). Finally, we calculated the full cost of each procedure and applied it to the different diagnostic approaches. The full cost of each approach was: (a) spiral CT without CM = 74 Euro; (b) plain film, US and IVU (28 %) = 66.89 Euro; (c) plain film, US and spiral CT without CM (28 %) = 64.93 Euro; (d) IVU = 80.90 Euro. Intravenous urography alone or in unsolved cases is not to be considered because it provides higher costs and worse diagnostic results, whereas X-ray dose to patient is almost equal between IVU and spiral CT. Spiral CT integrated to plain film and US in unsolved cases could be preferred because of lower cost and dose to patient, though reaching a diagnostic conclusion may take longer than an immediate spiral CT. (orig.)

  9. 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.

  10. 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.)

  11. 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

  12. 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

  13. Amyloidosis of the renal pelvis presenting as flank pain

    Directory of Open Access Journals (Sweden)

    Rachel Shikhman, D.O.

    2018-02-01

    Full Text Available Amyloidosis is a rare disease defined by accumulation of extracellular amyloid systemically or within a specific organ. Localized amyloidosis of the genitourinary system is extremely rare, with the predominate location being the bladder. The imaging findings are often nonspecific and mimic urothelial carcinoma. We present a 49-year-old woman with a chief complaint of flank pain. A filling defect was discovered on radiological imaging. The defect was subsequently biopsied and proven to be a primary amyloidosis of the renal pelvis. We then review the radiological findings of amyloidosis of the genitourinary system.

  14. Pancreatic Tail Cancer with Sole Manifestation of Left Flank Pain: A Very Rare Presentation

    Directory of Open Access Journals (Sweden)

    Hsing-Lin Lin

    2008-06-01

    Full Text Available Pancreatic cancer is sometimes called a “silent disease” because it often causes no symptoms in the early stage. The symptoms can be quite vague and various depending on the location of cancer in the pancreas. The anatomic site distribution is 78% in the head of the pancreas, 11% in the body, and 11% in the tail. Pancreatic cancer is rarely detected in the early stage, and it is very uncommon to diagnose pancreatic tail cancer during an emergency department visit. The manifestation of pancreatic tail cancer as left flank pain is very rare and has seldom been identified in the literature. We present a case of pancreatic tail cancer with the sole manifestation of dull left flank pain. Having negative findings on an ultrasound study initially, this female patient was misdiagnosed as having possible acute gastritis, urolithiasis or muscle strain after she received gastroendoscopy and colonofiberscopy. Her symptoms persisted for several months and she visited our emergency department due to an acute exacerbation of a persistent dull pain in the left flank area. Radiographic evaluation with computed tomography was performed, and pancreatic tail tumor with multiple metastases was found unexpectedly. We review the literature and discuss this rare presentation of pancreatic tail cancer.

  15. Low back pain - acute

    Science.gov (United States)

    Backache; Low back pain; Lumbar pain; Pain - back; Acute back pain; Back pain - new; Back pain - short-term; Back strain - new ... lower back supports most of your body's weight. Low back pain is the number two reason that Americans see ...

  16. Concurrent Preoperative Presence of Hydronephrosis and Flank Pain Independently Predicts Worse Outcome of Upper Tract Urothelial Carcinoma.

    Science.gov (United States)

    Yeh, Hsin-Chih; Jan, Hau-Chern; Wu, Wen-Jeng; Li, Ching-Chia; Li, Wei-Ming; Ke, Hung-Lung; Huang, Shu-Pin; Liu, Chia-Chu; Lee, Yung-Chin; Yang, Sheau-Fang; Liang, Peir-In; Huang, Chun-Nung

    2015-01-01

    To investigate the impact of preoperative hydronephrosis and flank pain on prognosis of patients with upper tract urothelial carcinoma. In total, 472 patients with upper tract urothelial carcinoma managed by radical nephroureterectomy were included from Kaohsiung Medical University Hospital Healthcare System. Clinicopathological data were collected retrospectively for analysis. The significance of hydronephrosis, especially when combined with flank pain, and other relevant factors on overall and cancer-specific survival were evaluated. Of the 472 patients, 292 (62%) had preoperative hydronephrosis and 121 (26%) presented with flank pain. Preoperative hydronephrosis was significantly associated with age, hematuria, flank pain, tumor location, and pathological tumor stage. Concurrent presence of hydronephrosis and flank pain was a significant predictor of non-organ-confined disease (multivariate-adjusted hazard ratio = 2.10, P = 0.025). Kaplan-Meier analysis showed significantly poorer overall and cancer-specific survival in patients with preoperative hydronephrosis (P = 0.005 and P = 0.026, respectively) and in patients with flank pain (P hydronephrosis and flank pain independently predicted adverse outcome (hazard ratio = 1.98, P = 0.016 for overall survival and hazard ratio = 1.87, P = 0.036 for and cancer-specific survival, respectively) in multivariate Cox proportional hazards models. In addition, concurrent presence of hydronephrosis and flank pain was also significantly predictive of worse survival in patient with high grade or muscle-invasive disease. Notably, there was no difference in survival between patients with hydronephrosis but devoid of flank pain and those without hydronephrosis. Concurrent preoperative presence of hydronephrosis and flank pain predicted non-organ-confined status of upper tract urothelial carcinoma. When accompanied with flank pain, hydronephrosis represented an independent predictor for worse outcome in patients with upper tract

  17. [Acute anal pain].

    Science.gov (United States)

    Pittet, Olivier; Demartines, Nicolas; Hahnloser, Dieter

    2013-07-01

    Acute anal pain is a common proctological problem. A detailed history together with the clinical examination are crucial for the diagnosis. An acute perianal vein thrombosis can be successfully excised within the first 72 hours. Acute anal fissures are best treated conservatively using stool regulation and topical medications reducing the sphincter spasm. A chronic anal fissure needs surgery. Perianal abscesses can very often be incised and drained in local anesthesia. Proctalgia fugax and the levator ani syndrome are exclusion diagnoses and are treated symptomatically.

  18. Acute dental pain II

    DEFF Research Database (Denmark)

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

    2016-01-01

    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...

  19. MANAGEMENT OF ACUTE MUSCULOSKELETAL PAIN ...

    African Journals Online (AJOL)

    of multimodal and multi-agent approach to acute pain management for better patient care. Data Source:The material ..... in the management of pain and stiffness arising ..... include immediate, direct psychologic feedback to the motivated ...

  20. 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)

  1. Pain perception and modulation in acute and chronic pain states

    NARCIS (Netherlands)

    Oudejans, L.C.J.

    2016-01-01

    This thesis describes the evaluation of pain perception in acute and chronic pain patients and the strength of the endogenous pain modulation system in chronic pain patients. Additionally, pain phenotypes are determined in patients with chronic pain. The ability of patients with acute pain after

  2. Acute pain guidelines

    African Journals Online (AJOL)

    identified the fact that pain is badly managed in all parts of the world, but .... Physiological pain is the activation of nociceptors in response to a noxious ... postsynaptic neuron. ... The basic afferent pain pathway is outlined in Figure 2. 3.2 Neurotransmitters ..... “Crying” is characterised by an utterance of emotion accompanied.

  3. 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.

  4. Corticostriatal Regulation of Acute Pain

    Directory of Open Access Journals (Sweden)

    Erik Martinez

    2017-05-01

    Full Text Available The mechanisms for acute pain regulation in the brain are not well understood. The prefrontal cortex (PFC provides top-down control of emotional processes, and it projects to the nucleus accumbens (NAc. This corticostriatal projection forms an important regulatory pathway within the brain’s reward system. Recently, this projection has been suggested to control both sensory and affective phenotypes specifically associated with chronic pain. As this projection is also known to play a role in the transition from acute to chronic pain, we hypothesized that this corticostriatal circuit can also exert a modulatory function in the acute pain state. Here, we used optogenetics to specifically target the projection from the PFC to the NAc. We tested sensory pain behaviors with Hargreaves’ test and mechanical allodynia, and aversive pain behaviors with conditioned place preference (CPP test. We found that the activation of this corticostriatal circuit gave rise to bilateral relief from peripheral nociceptive inputs. Activation of this circuit also provided important control for the aversive response to transient noxious stimulations. Hence, our results support a novel role for corticostriatal circuitry in acute pain regulation.

  5. 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.

  6. Analgesia for acute pain

    African Journals Online (AJOL)

    order to facilitate recovery, prevent chronic pain and accomplish this with minimal ... standard drug or cocktail and a satisfactory patient response is based on targeting ... South African Family Practice 2016; 58(1):11-15 .... and cognitive therapy.

  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. 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

  10. [Ultrasonography in acute pelvic pain].

    Science.gov (United States)

    Kupesić, Sanja; Aksamija, Alenka; Vucić, Niksa; Tripalo, Ana; Kurjak, Asim

    2002-01-01

    Acute pelvic pain may be the manifestation of various gynecologic and non-gynecologic disorders from less alarming rupture of the follicular cyst to life threatening conditions such as rupture of ectopic pregnancy or perforation of inflamed appendix. In order to construct an algorithm for differential diagnosis we divide acute pelvic pain into gynecologic and non-gynecologic etiology, which is than subdivided into gastrointestinal and urinary causes. Appendicitis is the most common surgical emergency and should always be considered in differential diagnosis if appendix has not been removed. Apart of clinical examination and laboratory tests, an ultrasound examination is sensitive up to 90% and specific up to 95% if graded compression technique is used. Still it is user-depended and requires considerable experience in order to perform it reliably. Meckel's diverticulitis, acute terminal ileitis, mesenteric lymphadenitis and functional bowel disease are conditions that should be differentiated from other causes of low abdominal pain by clinical presentation, laboratory and imaging tests. Dilatation of renal pelvis and ureter are typical signs of obstructive uropathy and may be efficiently detected by ultrasound. Additional thinning of renal parenchyma suggests long-term obstructive uropathy. Ruptured ectopic pregnancy, salpingitis and hemorrhagic ovarian cysts are three most commonly diagnosed gynecologic conditions presenting as an acute abdomen. Degenerating leiomyomas and adnexal torsion occur less frequently. For better systematization, gynecologic causes of acute pelvic pain could be divided into conditions with negative pregnancy test and conditions with positive pregnancy test. Pelvic inflammatory disease may be ultrasonically presented with numerous signs such as thickening of the tubal wall, incomplete septa within the dilated tube, demonstration of hyperechoic mural nodules, free fluid in the "cul-de-sac" etc. Color Doppler ultrasound contributes to more

  11. Meeting Proceedings: Recommendations for Improved Acute Pain Services: Canadian Collaborative Acute Pain Initiative

    Directory of Open Access Journals (Sweden)

    David H Goldstein

    2004-01-01

    Full Text Available The Canadian Collaborative Acute Pain Initiative, established in 2002, is a voluntary, multidisciplinary consortium of acute pain health professionals from across Canada whose goal is to improve acute pain management through discussion and consensus. The group met in January 2002 to define strategic areas related to the treatment of acute pain. The areas identified were: the definition of pain; the epidemiology of pain; the concept of an 'ideal' acute pain management service; education; therapeutic options; symptom management; and research and safety. In November 2002, a second meeting was held to develop objectives and recommendations for the management of acute pain based on the defined areas. The outcome of these discussions is summarized in this paper.

  12. Acute and chronic lumbosacral pain: Topical problems

    Directory of Open Access Journals (Sweden)

    Ekaterina Vladimirovna Podchufarova

    2012-01-01

    Full Text Available The paper gives an account of approaches to treating patients with acute and chronic back pain in the context of evidence-based medicine and current clinical guidelines. In the vast majority, acute back pain is a benign self-limiting condition (nonspecific musculoskeletal pain and most patients need additional instrumental examinations. An active approach to treatment is considered to be optimal. It is expedient to apply a more differential approach involving the refinement of mechanisms for development of the pain syndrome and the elaboration of treatment strategy in relation to the leading pathophysiological mechanism when examining the patients with chronic back pain.

  13. Acute Procedural Pain in Children

    DEFF Research Database (Denmark)

    Kristensen, Helle Nygård; Lundbye-Christensen, Søren; Haslund-Thomsen, Helle

    2018-01-01

    INTRODUCTION: Hospitalized children often describe needle-related procedures as the worst pain possible and such procedures may be emotionally traumatic. The use of hospital clowns related to painful medical procedures in children may offer pain relief, but this has not been systematically...... evaluated. The objective of this study was to assess the effect of a therapeutic clown in comparison to standard care on the experience of pain for children receiving venipuncture. METHODS: A sample of 116 children aged 4-15 years consecutively admitted to the hospital was allocated to either......: Without the clown present, the mean pain score (2.7±2.8) was not significantly different between the two age groups. Children aged 7-15 years had lower pain scores when the clown was present compared to the control group (P=0.025). Children aged 4-6 years had higher pain scores with the clown present...

  14. [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.

  15. 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...... patients. The most highly recommended guidelines provided clear and accurate recommendations for the nursing and medical staff on pain management in burn patients. We recommend the use of a validated appraisal tool such as the AGREE instrument to provide more consistent and evidence-based care to burn...

  16. 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.)

  17. [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.

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

    African Journals Online (AJOL)

    inpatient system for debilitating events such as crises or acute pain. ... and pharmacological treatments documented in the patients' case files. ... this study. Therefore, our objective was to evaluate acute pain management in SCA children on ...

  19. Acute Postoperative Pain Therapy: Current State . Patient Experience

    OpenAIRE

    Lončarić-Katušin, Mirjana; Persoli-Gudelj, Marijana; Šimić-Korać, Nataša; Blažanin, Božidar; Žunić, Josip; Korać, Želimir

    2006-01-01

    In effective control of acute postoperative pain, it is essential to respect the principles of multimodal balanced analgesia, and to apply them within organized units for the management of acute postoperative pain (acute pain service). The aim of the study was to find out patient expectations and experience in the intensity of acute postoperative pain, and the efficiency of therapy they received. Between October 11, 2002 and December 14, 2002, 103 patients having undergone elective operative ...

  20. 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

  1. 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

  2. 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.

  3. 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

  4. 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.

  5. Legionella pneumonia presenting with bilateral flank pain, hyponatraemia and acute renal failure

    OpenAIRE

    Birkin, Celia; Biyani, Chandra Shekhar; Browning, Anthony J.

    2011-01-01

    Legionnaires’ disease (LD) is an often overlooked but a possible cause of sporadic community acquired pneumonia. High fever, cough and gastrointestinal symptoms are non-specific symptoms. Hyponatremia is more common in LD than pneumonia linked with other causes. A definitive diagnosis is usually confirmed by culture, urinary antigen testing for Legionella species. Macolide or quinolone antibiotic is the treatment of choice. We describe a case of Legionella pneumonia presenting with high fever...

  6. [Acute scrotal pain in childhood: legal pitfalls].

    Science.gov (United States)

    Bader, Pia; Hugemann, Christoph; Frohneberg, Detlef

    2017-12-01

    Acute scrotal pain in childhood is an emergency.Sudden scrotal pain may be caused by a variety of diseases. Therefore, it is important to carefully consider the specific medical history and possible differential diagnoses in each case for fast and decisive action (e. g. in case of testicular torsion). As minors lack the capacity for consent, it is absolutely necessary to obtain consent from their legal guardian. However, obtaining consent in the available time frame can cause organisational challenges in an acute emergency, which may lead to situations in the daily routine where a therapeutic decision needs to be taken (including surgery) without legal security based on consent by the guardian. In some cases, the child's consent also needs to be taken into account, depending on its age and development.For the physician and surgeon in charge, the legal evaluation of the case at hand and therewith the obtainment of legal security are of great significance. © Georg Thieme Verlag KG Stuttgart · New York.

  7. 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.

  8. 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

  9. 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

  10. 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.

  11. 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.)

  12. Acute psychosocial stress reduces pain modulation capabilities in healthy men.

    Science.gov (United States)

    Geva, Nirit; Pruessner, Jens; Defrin, Ruth

    2014-11-01

    Anecdotes on the ability of individuals to continue to function under stressful conditions despite injuries causing excruciating pain suggest that acute stress may induce analgesia. However, studies exploring the effect of acute experimental stress on pain perception show inconsistent results, possibly due to methodological differences. Our aim was to systematically study the effect of acute stress on pain perception using static and dynamic, state-of-the-art pain measurements. Participants were 29 healthy men who underwent the measurement of heat-pain threshold, heat-pain intolerance, temporal summation of pain, and conditioned pain modulation (CPM). Testing was conducted before and during exposure to the Montreal Imaging Stress Task (MIST), inducing acute psychosocial stress. Stress levels were evaluated using perceived ratings of stress and anxiety, autonomic variables, and salivary cortisol. The MIST induced a significant stress reaction. Although pain threshold and pain intolerance were unaffected by stress, an increase in temporal summation of pain and a decrease in CPM were observed. These changes were significantly more robust among individuals with stronger reaction to stress ("high responders"), with a significant correlation between the perception of stress and the performance in the pain measurements. We conclude that acute psychosocial stress seems not to affect the sensitivity to pain, however, it significantly reduces the ability to modulate pain in a dose-response manner. Considering the diverse effects of stress in this and other studies, it appears that the type of stress and the magnitude of its appraisal determine its interactions with the pain system. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  13. Acute pancreatitis during sickle cell vaso-occlusive painful crisis.

    Science.gov (United States)

    Ahmed, Shahid; Siddiqui, Anita K; Siddiqui, Rina K; Kimpo, Miriam; Russo, Linda; Mattana, Joseph

    2003-07-01

    Sickle cell disease is characterized by chronic hemolytic anemia and vaso-occlusive painful crisis. The vascular occlusion in sickle cell disease is a complex process and accounts for the majority of the clinical manifestations of the disease. Abdominal pain is an important component of vaso-occlusive painful crisis and may mimic diseases such as acute appendicitis and cholecystitis. Acute pancreatitis is rarely included as a cause of abdominal pain in patients with sickle cell disease. When it occurs it may result form biliary obstruction, but in other instances it might be a consequence of microvessel occlusion causing ischemia. In this series we describe four cases of acute pancreatitis in patients with sickle cell disease apparently due to microvascular occlusion and ischemic injury to the pancreas. All patients responded to conservative management. Acute pancreatitis should be considered in the differential diagnosis of abdominal pain in patients with sickle cell disease. Copyright 2003 Wiley-Liss, Inc.

  14. [The etiological aspects of acute abdominal pain in children].

    Science.gov (United States)

    Dinu, C A; Moraru, D

    2011-01-01

    The study of the etiological aspects of acute abdominal pain in children, in order to perceive the clinical-etiological correlations and the disorders distribution related to age, gender and the origin of the patients. The criteria for including patients were age (between 0 and 18 years) and the presence of acute abdominal pain before or during the consultation with the physician. The research on acute abdominal pain in children was performed on the level of the Surgery and Pediatrics II clinical departments of the "Sf. Ioan" Children's Emergency Clinical Hospital in Galati, between 01.01.2009 - 01.01.2011. The clinical study performed on the patients registered in the studied groups focused on the identification, the evaluation of the symptoms of acute abdominal pain in children, diagnosing and treating it. The criteria for excluding patients were an age older than 18 years or the absence of acute abdominal pain as a symptom before or during the examination. The statistical analysis used the descriptive and analytical methods. The data was centralized and statistically processed in M.S.EXCEL and S.P.S.S. databases. The patients with acute abdominal pain represent a percentage of 92.9% (2358 cases) of the total number of patients who suffer from abdominal pain (N=2537). The highest frequency of cases is represented by acute appendicitis (1056 cases - 44.8%). In the 5-18 years age group, acute appendicitis, mesenteric lymphadenitis, ovarian follicular cysts, acute pyelenophritis and salpingitis are predominant. In the 0-4 years age group gastroenteritis, acute pharyngitis, reactive hepatitis and lower digestive bleeding are predominant. In females, acute appendicitis, gastroenteritis, gastroduodenitis and cystitis are predominant, whereas in males, peritonitis, sepsis through E. coli, the contusion of the abdominal wall and acute pharyngitis are predominant.

  15. 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.

  16. 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.

  17. 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

    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...

  18. 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

  19. 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

  20. 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

  1. Recent advances in acute pain management: understanding the mechanisms of acute pain, the prescription of opioids, and the role of multimodal pain therapy [version 1; referees: 3 approved

    Directory of Open Access Journals (Sweden)

    Richa Wardhan

    2017-11-01

    Full Text Available In this review, we discuss advances in acute pain management, including the recent report of the joint American Pain Society and American Academy of Pain Medicine task force on the classification of acute pain, the role of psychosocial factors, multimodal pain management, new non-opioid therapy, and the effect of the “opioid epidemic”. In this regard, we propose that a fundamental principle in acute pain management is identifying patients who are most at risk and providing an “opioid free anesthesia and postoperative analgesia”. This can be achieved by using a multimodal approach that includes regional anesthesia and minimizing the dose and the duration of opioid prescription. This allows prescribing medications that work through different mechanisms. We shall also look at the recent pharmacologic and treatment advances made in acute pain and regional anesthesia.

  2. 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.

  3. Approach to chest pain and acute myocardial infarction | Pandie ...

    African Journals Online (AJOL)

    Approach to chest pain and acute myocardial infarction. ... Patient history, physical examination, 12-lead electrocardiogram (ECG) and cardiac biomarkers ... Essential adjunctive therapies include antiplatelet therapy (aspirin, P2Y12 inhibitors), ...

  4. 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...

  5. 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

    electrical temporal summation, and low socioeconomic status 7 predict chronic post-traumatic pain occurrence. Pressure-pain threshold- conditioned...psychological state of the patients b. Acute head pain, higher electrical temporal summation, and low socioeconomic status predict chronic post-traumatic...and neck pain patients Award Number: W81XWH-15-1-0603 PI: David Yarnitsky Org: Technion – Israel Institute of Technology Award Amount: $1,499,904

  6. A recovery room-based acute pain service.

    Science.gov (United States)

    Leykin, Y; Pellis, T; Ambrosio, C; Zanette, G; Malisano, A; Rapotec, A; Casati, A

    2007-04-01

    Despite routine postoperative pain management improves recovery and reduces postoperative morbidity and overall costs, and the availability of a large armamentarium of analgesic techniques and drugs, a significant portion of patients do not receive adequate postoperative pain control. We describe a recovery room (RR) based acute pain service model. Guidelines on postoperative pain and therapeutic protocols were instituted in January 1999. The analgesic endpoint was a visual analogic scale (VAS) below 4 for all surgical patients for the first 48-72 h. The RR, run by one anesthesiologist and 2 nurses and one assistant, acted as a coordination centre. Discharge from the RR was subject to achieving effective analgesia. Nurses of each ward monitored VAS along with vital signs, administered rescue doses if necessary, and reported to the RR nurse when needed. RR nurses monitored the patient at least twice daily and reported to the anesthesiologist. We have distributed an anonymous questionnaire, within surgical wards, to both surgeons and nurses to evaluate their perception of pain management and of this acute pain service (APS) model. VAS was maintained significantly process confirmed the desire of all professional figures to be informed and involved in acute pain management as part of a coordinated and systematic approach to the surgical patient. A RR-based APS can effectively act as coordinating centre for acute pain treatment without adjunctive personnel.

  7. Benign acute childhood myositis: an unusual cause of calf pain

    Energy Technology Data Exchange (ETDEWEB)

    Panghaal, Vikash; Levin, Terry L. [Montefiore Medical Center, Department of Radiology, Bronx, NY (United States); Ortiz-Romero, Sara [Albert Einstein College of Medicine, Bronx, NY (United States); Lovinsky, Stephanie [Montefiore Medical Center, Department of Pediatrics, Bronx, NY (United States)

    2008-06-15

    We present a 17-year-old boy with benign acute childhood myositis (BACM) who presented with acute onset of right calf pain, swelling, and difficulty walking. The MR findings are reviewed. MR may be useful in diagnosing BACM and in differentiating it from other causes of myositis. (orig.)

  8. Benign acute childhood myositis: an unusual cause of calf pain

    International Nuclear Information System (INIS)

    Panghaal, Vikash; Levin, Terry L.; Ortiz-Romero, Sara; Lovinsky, Stephanie

    2008-01-01

    We present a 17-year-old boy with benign acute childhood myositis (BACM) who presented with acute onset of right calf pain, swelling, and difficulty walking. The MR findings are reviewed. MR may be useful in diagnosing BACM and in differentiating it from other causes of myositis. (orig.)

  9. Time perspective as a predictor of acute postsurgical pain and coping with pain following abdominal surgery.

    Science.gov (United States)

    Sobol-Kwapinska, M; Plotek, W; Bąbel, P; Cybulski, M; Kluzik, A; Krystianc, J; Mandecki, M

    2017-04-01

    The aim of this study was to predict acute postsurgical pain and coping with pain following surgery based on preoperative time perspectives. Time perspective is a basic dimension of psychological time. It is a tendency to focus on a particular time area: the past, the present and the future. Seventy-six patients completed measures of time perspective and pain 24 h before abdominal surgery. During the 3 days after surgery, measures of pain and coping with pain were completed. We performed hierarchical regression analyses to identify predictors of acute postsurgical pain and how patients cope with it. These analyses suggested that a preoperative past-negative time perspective can be a predictor of postoperative pain level and catastrophizing after surgery. The findings of our study indicate the importance of time perspective, especially the past perspective, in dealing with postoperative pain. Our research indicates that a preoperative past-negative time perspective is a significant predictor of acute postsurgical pain intensity and the strongest predictor of pain catastrophizing. © 2016 European Pain Federation - EFIC®.

  10. 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

  11. Triathletes Lose Their Advantageous Pain Modulation under Acute Psychosocial Stress.

    Science.gov (United States)

    Geva, Nirit; Pruessner, Jens; Defrin, Ruth

    2017-02-01

    Triathletes, who constantly engage in intensely stressful sport, were recently found to exhibit greater pain tolerance and more efficient pain inhibition capabilities than nonathletes. However, pain inhibition correlated negatively with retrospective reports of mental stress during training and competition. The aim of the current study was to test pain inhibition capabilities of triathletes under acute, controlled psychological stress manipulation. Participants were 25 triathletes and ironman triathletes who underwent the measurement of pain threshold, pain intolerance, tonic suprathreshold pain, and conditioned pain modulation before and during exposure to the Montreal Imaging Stress Task (MIST). Perceived ratings of stress and anxiety, autonomic variables, and salivary cortisol levels were obtained as indices of stress. The MIST induced a significant stress reaction manifested in the subjective and objective indices. Overall, a significant reduction in pain threshold and in conditioned pain modulation efficacy was observed after the MIST, which reached the baseline levels observed previously in nonathletes. Paradoxically, the magnitude of this stress-induced hyperalgesia (SIH) correlated negatively with the magnitude of the stress response; low-stress responders exhibited greater SIH than high-stress responders. The results suggest that under acute psychological stress, triathletes not only react with SIH and a reduction in pain modulation but also lose their advantageous pain modulation over nonathletes. The stronger the stress response recorded, the weaker the SIH. It appears that triathletes are not resilient to stress, responding with an increase in the sensitivity to pain as well as a decrease in pain inhibition. The possible effects of athletes' baseline pain profile and stress reactivity on SIH are discussed.

  12. 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

    BACKGROUND: Chlorzoxazone is a muscle relaxant administered for musculoskeletal pain, and as an analgesic adjunct for post-operative pain. Chlorzoxazone for low back pain is currently not advised due to the lack of placebo-controlled trials. We explored the effect of chlorzoxazone on acute pain...... 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.......5 mg). Primary outcome was pain during mobilization (visual analogue scale) 2 h after the intervention. Secondary outcomes were pain at rest, opioid consumption, nausea, vomiting, sedation and dizziness. RESULTS: For pain during mobilization 2 h after intervention, there was no significant difference...

  13. Assessment of acute pain in trauma

    DEFF Research Database (Denmark)

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

    2016-01-01

    were treated with opioid analgesics or S-ketamine, while no pharmacological intervention was documented in 30 cases. Eight of the 138 cases with severe pain needed endotracheal intubation, whereas nine cases in the patients with mild or no pain needed endotracheal intubation; odds ratio (OR) 4.3 (p = 0......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...

  14. 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

  15. Person-centred pain management for the patient with acute abdominal pain

    DEFF Research Database (Denmark)

    Avallin, Therese; Muntlin Athlin, Åsa; Sorensen, Erik Elgaard

    2018-01-01

    AIMS: To explore and describe the impact of the organizational culture on and the patient-practitioner patterns of actions that contribute to or detract from successful pain management for the patient with acute abdominal pain across the acute care pathway. BACKGROUND: Although pain management...... is a recognised human right, unmanaged pain continues to cause suffering and prolong hospital care. Unanswered questions about how to successfully manage pain relate to both organizational culture and individual practitioners' performance. DESIGN: Focused ethnography, applying the Developmental Research Sequence...... and the Fundamentals of Care framework. METHODS: Participant observation and informal interviews (92 hours) were performed at one emergency department and two surgical wards at a University Hospital during April - November 2015. Data includes 261 interactions between patients, aged ≥18 years seeking care for acute...

  16. Ketamine in the treatment of acute pain.

    Science.gov (United States)

    Brinck, Elina; Kontinen, Vesa

    2017-01-01

    Ketamine is an old anesthetic agent that relieves pain by reducing central sensitization in the central nervous system. This is advantageous for patients suffering from severe pain prior to surgery or are using a strong opioid. The S enantiomer of ketamine used for anesthesia is more powerful than racemic ketamine. The ideal dose of ketamine for pain relief is not yet known, and its adverse effects on the central nervous system, including hallucinations, sedation, and diplopia have limited its use in pain management. The significance of these effects at low doses is probably less than expected, particularly if benzodiazepines or an alpha-2 agonist, such as dexmedetomidine, are administered in addition to ketamine.

  17. 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.

  18. Single dose oral flurbiprofen for acute postoperative pain in adults

    Science.gov (United States)

    Sultan, Asquad; McQuay, Henry J; Moore, R Andrew; Derry, Sheena

    2014-01-01

    Background Flurbiprofen is a non-selective non-steroidal anti-inflammatory drug (NSAID), related to ibuprofen and naproxen, used to treat acute and chronic painful conditions. There is no systematic review of its use in acute postoperative pain. Objectives To assess efficacy, duration of action, and associated adverse events of single dose oral flurbiprofen in acute postoperative pain in adults. Search methods We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to January 2009. Selection criteria Randomised, double blind, placebo-controlled trials of single dose orally administered flurbiprofen in adults with moderate to severe acute postoperative pain. Data collection and analysis 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 (RR) 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 were collected. Main results Eleven studies compared flurbiprofen (699 participants) with placebo (362 participants) in studies lasting 6 to 12 hours. Studies were of adequate reporting quality, and most participants had pain following dental extractions. The dose of flurbiprofen used was 25 mg to 100 mg, with most information for 50 mg and 100 mg. The NNT for at least 50% pain relief over 4 to 6 hours for flurbiprofen 50 mg compared with placebo (692 participants) was 2.7 (2.3 to 3.3) and for 100 mg (416 participants) it was 2.5 (2.0 to 3.1). With flurbiprofen 50 mg and 100 mg 65% to 70% of participants experienced at least 50% pain relief, compared with 25% to 30% with placebo. Rescue medication was used by 25

  19. 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

  20. 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.

  1. 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.

  2. [Transfer managment of postoperative acute pain therapy to outpatient aftercare].

    Science.gov (United States)

    Tank, C; Lefering, R; Althaus, A; Simanski, C; Neugebauer, E

    2014-10-01

    The significance of postoperative pain management for patients in the hospital is well known and has been a focus of research for several years. The ambulatory care after hospital discharge, however, is not well investigated. A prospective observational study was therefore conducted to study the transfer management from in-hospital patients to ambulatory care. A patient questionnaire was developed and patients were asked to fill it out at different time points after the operation: during the time in the hospital, then at 2 weeks and 6 months after hospital discharge. In addition, the responsible family doctor was approached and interviewed. The main focus of the questionnaire was the measurement of post-surgical pain (numeric rating scale NRS), patient satisfaction (Cologne patient questionnaire), and quality of life (SF 12). Of a total of 128 patients 72.9% described moderate to severe pain after the orthopaedic operations in the hospital. 90.8% of the patients had pain directly after discharge from the hospital; in 67.4% of the cases pain was ≥3 and in 23.4% of the cases pain was ≥6. Six months after discharge pain was significant in 29.4% of the patients, 60.8% of the patients were satisfied with the transfer to the home setting. 16% were not satisfied at all and 23.2% were neutral. Important factors for dissatisfaction with the transfer management were, according to stepwise logistic regeression analysis, sex (female patients), young age, a poor bodily constitution at the hospital and thereafter, and the pain management in the hospital and after discharge. The study shows the significance of the acute pain therapy not only during the hospital stay but also after discharge. There are very few data on pain therapy after discharge from the hospital. Based on the significance of the chronification of acute pain it is of the utmost importance to close this gap. © Georg Thieme Verlag KG Stuttgart · New York.

  3. 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.

  4. Co-morbid pain and opioid addiction: long term effect of opioid maintenance on acute pain.

    Science.gov (United States)

    Wachholtz, Amy; Gonzalez, Gerardo

    2014-12-01

    Medication assisted treatment for opioid dependence alters the pain experience. This study will evaluate changes pain sensitivity and tolerance with opioid treatments; and duration of this effect after treatment cessation. 120 Individuals with chronic pain were recruited in 4 groups (N = 30): 1-methadone for opioid addiction; 2-buprenorphine for opioid addiction; 3-history of opioid maintenance treatment for opioid addiction but with prolonged abstinence (M = 121 weeks; SD = 23.3); and 4-opioid naïve controls. Participants completed a psychological assessment and a cold water task including, time to first pain (sensitivity) and time to stopping the pain task (tolerance). Data analysis used survival analyses. A Kaplan-Meier-Cox survival analysis showed group differences for both pain sensitivity (log rank = 15.50; p opioid maintenance resulted in differing pain sensitivity compared to opioid naïve (p's opioid maintenance compared to active methadone patients (p opioid naïve control group participants (p's opioid abstinence increased (R = .37; p opioid maintenance, there appears to be long-term differences in pain sensitivity that do not resolve with discontinuation of opioid maintenance. Although pain sensitivity does not change, pain tolerance does improve after opioid maintenance cessation. Implications for treating co-morbid opioid addiction and pain (acute and chronic) are discussed. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. Factors associated with acute postoperative pain following breast reconstruction

    Directory of Open Access Journals (Sweden)

    Anita R. Kulkarni

    2017-03-01

    Conclusions: This study identifies patients at risk for severe acute postoperative pain following breast reconstruction. These findings will allow plastic surgeons to better tailor postoperative care to improve patient comfort, reduce clinical morbidity, and enhance patient satisfaction with their surgical outcome.

  6. 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

  7. 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 ...

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

    African Journals Online (AJOL)

    jen

    on pain relief, diagnostic accuracy and treatment decisions in patients with acute ... With level of power at 80% and a 5% significance level, a ... 72 hours` duration and were judged by the attending physician to require surgical consultation. .... Clinically Important Differences Between Pre Injection, Post Injection and Final ...

  9. 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 ...

  10. 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

  11. 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.)

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

    International Nuclear Information System (INIS)

    Ziade, M.; Zufferey, P.; So, A.K.L.

    2007-01-01

    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.)

  13. 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.

  14. Transcutaneous electrical nerve stimulation: nonparallel antinociceptive effects on chronic clinical pain and acute experimental pain.

    Science.gov (United States)

    Cheing, G L; Hui-Chan, C W

    1999-03-01

    To investigate to what extent a single 60-minute session of transcutaneous electrical nerve stimulation (TENS) would modify chronic clinical pain, acute experimental pain, and the flexion reflex evoked in chronic low back pain patients. Thirty young subjects with chronic low back pain were randomly allocated to two groups, receiving either TENS or placebo stimulation to the lumbosacral region for 60 minutes. The flexion reflex was elicited by an electrical stimulation applied to the subject's right sole and recorded electromyographically from the biceps femoris and the tibialis anterior muscles. Subjective sensation of low back pain and the electrically induced pain were measured by two separate visual analog scales, termed VAS(LBP) and VAS(FR), respectively. Data obtained before, during, and 60 minutes after TENS and placebo stimulations were analyzed using repeated measures ANOVA. The VAS(LBP) score was significantly reduced to 63.1% of the prestimulation value after TENS (pTENS protocol had different degrees of antinociceptive influence on chronic and acute pain in chronic low back pain patients.

  15. 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. 

  16. CPDX (Chest Pain Diagnostic Program) - A Decision Support System for the Management of Acute Chest Pain (User’s Manual)

    Science.gov (United States)

    1988-02-25

    pain: appendicitis; renal colic; perforated duodenal ulcer ; acute cholecystitis; small bowel obstruction; and non-specific abdominal pain, This...psychoneurotic disorder; g) epigastric lesions (cholelithiasis, peptic ulcer , etc.). Musculoskeletal pain and costochrondritis denote muscle, rib, or cartilage...hyperventilation syndrome; f) psychoneurotic disorder; g) epigastric lesions (cholelithiasis, peptic ulcer , etc.). Musculoskeletal pain and the

  17. 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

  18. 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 ...

  19. 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.

  20. 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

  1. 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.

  2. Validation of the Diagnostic Score for Acute Lower Abdominal Pain in Women of Reproductive Age

    OpenAIRE

    Jearwattanakanok, Kijja; Yamada, Sirikan; Suntornlimsiri, Watcharin; Smuthtai, Waratsuda; Patumanond, Jayanton

    2014-01-01

    Background. The differential diagnoses of acute appendicitis obstetrics, and gynecological conditions (OB-GYNc) or nonspecific abdominal pain in young adult females with lower abdominal pain are clinically challenging. The present study aimed to validate the recently developed clinical score for the diagnosis of acute lower abdominal pain in female of reproductive age. Method. Medical records of reproductive age women (15–50 years) who were admitted for acute lower abdominal pain were collec...

  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. 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

  5. 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......, Peto's odds ratio was 2.9 (1.2, 6.8; TSA adjusted confidence interval: 0.1, 97.1). Based on trials with low risk of bias, pregabalin may have a minimal opioid-sparing effect, but the risk of SAEs seems increased. However, the GRADE-rated evaluations showed only moderate to very low quality of evidence....... Consequently, a routine use of pregabalin for postoperative pain treatment cannot be recommended....

  6. 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.

  7. [Managment of acute low back pain without trauma - an algorithm].

    Science.gov (United States)

    Melcher, Carolin; Wegener, Bernd; Jansson, Volkmar; Mutschler, Wolf; Kanz, Karl-Georg; Birkenmaier, Christof

    2018-05-14

    Low back pain is a common problem for primary care providers, outpatient clinics and A&E departments. The predominant symptoms are those of so-called "unspecific back pain", but serious pathologies can be concealed by the clinical signs. Especially less experienced colleagues have problems in treating these patients, as - despite the multitude of recommendations and guidelines - there is no generally accepted algorithm. After a literature search (Medline/Cochrane), 158 articles were selected from 15,000 papers and classified according to their level of evidence. These were attuned to the clinical guidelines of the orthopaedic and pain-physician associations in Europe, North America and overseas and the experience of specialists at LMU Munich, in order to achieve consistency with literature recommendations, as well as feasibility in everyday clinical work and optimised with practical relevance. An algorithm was formed to provide the crucial differential diagnosis of lumbar back pain according to its clinical relevance and to provide a plan of action offering reasonable diagnostic and therapeutic steps. As a consequence of distinct binary decisions, low back patients should be treated at any given time according to the guidelines, with emergencies detected, unnecessary diagnostic testing and interventions averted and reasonable treatment initiated pursuant to the underlying pathology. In the context of the available evidence, a clinical algorithm has been developed that translates the complex diagnostic testing of acute low back pain into a transparent, structured and systematic guideline. Georg Thieme Verlag KG Stuttgart · New York.

  8. Approach to chest pain and acute myocardial infarction.

    Science.gov (United States)

    Pandie, S; Hellenberg, D; Hellig, F; Ntsekhe, M

    2016-03-01

    Patient history, physical examination, 12-lead electrocardiogram (ECG) and cardiac biomarkers are key components of an effective chest pain assessment. The first priority is excluding serious chest pain syndromes, namely acute coronary syndromes (ACSs), aortic dissection, pulmonary embolism, cardiac tamponade and tension pneumothorax. On history, the mnemonic SOCRATES (Site Onset Character Radiation Association Time Exacerbating/relieving factor and Severity) helps differentiate cardiac from non-cardiac pain. On examination, evaluation of vital signs, evidence of murmurs, rubs, heart failure, tension pneumothoraces and chest infections are important. A 12-lead ECG should be interpreted within 10 minutes of first medical contact, specifically to identify ST elevation myocardial infarction (STEMI). High-sensitivity troponins improve the rapid rule-out of myocardial infarction (MI) and confirmation of non-ST elevation MI (NSTEMI). ACS (STEMI and NSTEMI/unstable anginapectoris (UAP)) result from acute destabilisation of coronary atheroma with resultant complete (STEMI) or subtotal (NSTEMI/UAP) thrombotic coronary occlusion. The management of STEMI patients includes providing urgent reperfusion: primary percutaneous coronary intervention(PPCI) if available, deliverable within 60 - 120 minutes, and fibrinolysis if PPCI is not available. Essential adjunctive therapies include antiplatelet therapy (aspirin, P2Y12 inhibitors), anticoagulation (heparin or low-molecular-weight heparin) and cardiac monitoring.

  9. Enhanced presurgical pain temporal summation response predicts post-thoracotomy pain intensity during the acute postoperative phase.

    Science.gov (United States)

    Weissman-Fogel, Irit; Granovsky, Yelena; Crispel, Yonathan; Ben-Nun, Alon; Best, Lael Anson; Yarnitsky, David; Granot, Michal

    2009-06-01

    Recent evidence points to an association between experimental pain measures obtained preoperatively and acute postoperative pain (POP). We hypothesized that pain temporal summation (TS) might be an additional predictor for POP insofar as it represents the neuroplastic changes that occur in the central nervous system following surgery. Therefore, a wide range of psychophysical tests (TS to heat and mechanical repetitive stimuli, pain threshold, and suprathreshold pain estimation) and personality tests (pain catastrophizing and anxiety levels) were administered prior to thoracotomy in 84 patients. POP ratings were evaluated on the 2nd and 5th days after surgery at rest (spontaneous pain) and in response to activity (provoked pain). Linear regression models revealed that among all assessed variables, enhanced TS and higher pain scores for mechanical stimulation were significantly associated with greater provoked POP intensity (overall r2 = 0.225, P = .008). Patients who did not demonstrate TS to both modalities reported lower scores of provoked POP as compared with patients who demonstrated TS in response to at least 1 modality (F = 4.59 P = .013). Despite the moderate association between pain catastrophizing and rest POP, none of the variables predicted the spontaneous POP intensity. These findings suggest that individual susceptibility toward a greater summation response may characterize patients who are potentially vulnerable to augmented POP. This study proposed the role of pain temporal summation assessed preoperatively as a significant psychophysical predictor for acute postoperative pain intensity. The individual profile of enhanced pain summation is associated with the greater likelihood of higher postoperative pain scores.

  10. 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

  11. 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.

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

    DEFF Research Database (Denmark)

    Lundorf, Luise Jessen; Nedergaard, H. K.; Møller, Ann Merete

    2016-01-01

    422 participants in our analysis. Thirteen studies are awaiting classification. For the comparison dexmedetomidine versus placebo (six studies, 402 participants), most studies found a reduction in 'rescue' opioid consumption in the first 24 hours after surgery, together with in general no clinically...... elective abdominal surgery. A potential bias was a considerable quantity of unobtainable data from studies with mixed surgery. To detect and investigate patient-important outcomes, larger studies with longer periods of follow-up are needed.......Background 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...

  13. 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

  14. [Caffeine as adjuvant analgeticum for treating acute pain].

    Science.gov (United States)

    Nikolajsen, Lone; Haroutiunian, Simon

    2013-10-14

    Based on 19 studies (7,238 participants) a Cochrane review concludes that the addition of caffeine to an analgesic drug provides superior analgesia compared with the analgesic drug alone. The benefit is small, with a number needed to treat of approx. 16. The use of analgesics containing caffeine is associated with an increased risk of the development of physical dependence, overuse headache, and withdrawal symptoms upon abrupt discontinuation. Combination analgesics with caffeine should only be used temporarily and exclusively for the treatment of acute pain conditions.

  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. 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

    Riluzole modulates several transmitter systems which may be involved in nociception. Antinociceptive effects have been shown in animal studies, but there are no human data. Therefore, we have examined the acute analgesic effect of riluzole in a human model of inflammatory pain induced by a thermal...... 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...

  17. 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)

  18. Acute chest pain in a patient with a non-strangulated hiatal hernia

    Directory of Open Access Journals (Sweden)

    Alexander John Scumpia

    2015-10-01

    Full Text Available Acute chest pain resulting in spontaneous idiopathic hemomediastinum is a rare, potentially life-threatening occurrence. Acute chest pain is a common chief complaint of patients, accounting for 2.4%–6.0% of adult emergency room visits. The clinician's differential diagnoses for acute chest pain rarely include complications of hiatal hernias. An 83-year-old male presented with acute chest pain and was emergently diagnosed with hemomediastinum secondary to spontaneous gastric mesenteric vessel rupture due to a non-strangulated hiatal hernia after physical exertion.

  19. 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.

  20. Gender, age and ethnicity influence on pain levels and analgesic use in the acute whiplash injury.

    Science.gov (United States)

    Koren, L; Peled, E; Trogan, R; Norman, D; Berkovich, Y; Israelit, S

    2015-06-01

    Initial pain level in the acute whiplash injury is the most consistent predictor of transformation to a chronic pain syndrome. The risk factors for those early pain levels were, to our knowledge, scarcely evaluate to this date. We set to evaluate whether gender, age or ethnicity comprise a risk factor for those initial pain levels. Further, gender, age and ethnicity have been shown to be bias factors in pain management. We investigated if gender, age or ethnicity are bias factor in pain management in the face of a standardized pain treatment protocol in the acute whiplash injury. We reviewed 2,538 patients with acute whiplash injury that were treated at our emergency department (ED). Gender, age and ethnicity were investigated as risk factors for elevated visual analog scale (VAS) scores. Those factors were also investigated as bias in pain medication administration in the face of a standardized analgesic protocol. Women had significantly higher VAS scores (p = 0.009). Age and ethnicity did not influence pain levels. There was no influence of gender or age on pain medication administration. The Jewish patients (the majority in Israel) were administered fewer pain medication (p whiplash injury. Age and ethnicity have less impact on those pain levels. A pain management protocol might reduce bias in pain management in the acute whiplash injury in the ED. The Jewish population tends to be less receptive to pain medication administration.

  1. Systemic classification for a new diagnostic approach to acute abdominal pain in children.

    Science.gov (United States)

    Kim, Ji Hoi; Kang, Hyun Sik; Han, Kyung Hee; Kim, Seung Hyo; Shin, Kyung-Sue; Lee, Mu Suk; Jeong, In Ho; Kim, Young Sil; Kang, Ki-Soo

    2014-12-01

    With previous methods based on only age and location, there are many difficulties in identifying the etiology of acute abdominal pain in children. We sought to develop a new systematic classification of acute abdominal pain and to give some helps to physicians encountering difficulties in diagnoses. From March 2005 to May 2010, clinical data were collected retrospectively from 442 children hospitalized due to acute abdominal pain with no apparent underlying disease. According to the final diagnoses, diseases that caused acute abdominal pain were classified into nine groups. The nine groups were group I "catastrophic surgical abdomen" (7 patients, 1.6%), group II "acute appendicitis and mesenteric lymphadenitis" (56 patients, 12.7%), group III "intestinal obstruction" (57 patients, 12.9%), group IV "viral and bacterial acute gastroenteritis" (90 patients, 20.4%), group V "peptic ulcer and gastroduodenitis" (66 patients, 14.9%), group VI "hepatobiliary and pancreatic disease" (14 patients, 3.2%), group VII "febrile viral illness and extraintestinal infection" (69 patients, 15.6%), group VIII "functional gastrointestinal disorder (acute manifestation)" (20 patients, 4.5%), and group IX "unclassified acute abdominal pain" (63 patients, 14.3%). Four patients were enrolled in two disease groups each. Patients were distributed unevenly across the nine groups of acute abdominal pain. In particular, the "unclassified abdominal pain" only group was not uncommon. Considering a systemic classification for acute abdominal pain may be helpful in the diagnostic approach in children.

  2. [Inpatient acute pain management in German hospitals: results from the national survey "Akutschmerzzensus 2012"].

    Science.gov (United States)

    Erlenwein, J; Stamer, U; Koschwitz, R; Koppert, W; Quintel, M; Meißner, W; Petzke, F

    2014-04-01

    In 2007, the German national guidelines on "Treatment of acute perioperative and post-traumatic pain" were published. The aim of this study was to describe current structure and process data for acute pain management in German hospitals and to compare how the guidelines and other initiatives such as benchmarking or certification changed the healthcare landscape in the last decade. All directors of German departments of anesthesiology according to the DGAI ("Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin", German Society for Anesthesiology and Intensive Care) were mailed a standardized questionnaire on structures and processes of acute pain management in their hospitals. A total of 403 completed questionnaires (46 %) could be evaluated. Of hospitals, 81 % had an acute pain service (ASD), whereby only 45 % met defined quality criteria. Written standards for acute pain management were available in 97 % of the hospitals on surgical wards and 51 % on nonsurgical wards. In 96 %, perioperative pain was regularly recorded (generally pain at rest and/or movement, pain-related functional impairment in 16 % only). Beside these routine measurements, only 38 % of hospitals monitored pain for effectiveness after acute medications. Often interdisciplinary working groups and/or pain managers are established for hospital-wide control. As specific therapy, the patient-controlled analgesia and epidural analgesia are largely prevalent (> 90 % of all hospitals). In the last decade, intravenous and oral opioid administration of opioids (including slow release preparations) has become established in acute pain management. The survey was representative by evaluating 20 % of all German hospitals. The organizational requirements for appropriate pain management recommended by the German guidelines for acute pain recommended have been established in the hospital sector in recent years. However, the organizational enforcement for acute pain management in

  3. Impulsive choice and psychological pain in acutely suicidal depressed patients.

    Science.gov (United States)

    Cáceda, Ricardo; Durand, Dante; Cortes, Edmi; Prendes-Alvarez, Stefania; Moskovciak, Tori; Harvey, Philip D; Nemeroff, Charles B

    2014-01-01

    Despite identification of several risk factors, suicide prediction and prevention is still a clinical challenge. Suicide can be seen as a consequence of poor decision making triggered by overwhelming psychological pain. We examined the relationship of choice impulsivity and psychological pain in depressed patients with acute suicidality. Impulsive choice (delay discounting), psychological pain, and clinical characteristics were assessed in four groups of adults (N = 20-22): a) depressed patients within 72 hours after a suicide attempt, b) depressed patients with active suicidal ideation, c) nonsuicidal depressed patients, and d) healthy controls. Impulsive choice was higher in the suicide attempt (0.114 [0.027]) and ideation (0.099 [0.020]) groups compared with nonsuicidal depressed (0.079 [0.020]) and healthy (0.066 [0.019]) individuals (F(3,79) = 3.06, p = .042). Psychological pain data showed a similar profile (F(3,78) = 43.48, p suicide attempt, 54.3 (2.2) for suicide ideation, 37.0 (3.2) for nonsuicidal depressed, and 13.7 (0.5) for healthy groups. Within the suicide attempt group, persisting suicidal ideation was associated with more severe depression (36.6 [2.9] versus 21.5 [3.1], p = .007) and choice impulsivity (0.134 [0.03] versus 0.078 [0.04], p = .015). Both measures normalized within a week: depression (29.9 [2.6] versus 14.4 [3.0], p = .006) and choice impulsivity (0.114 [0.026] versus 0.066 [0.032], p = .019). Transient impulsive choice abnormalities are found in a subset of those who attempt suicide. Both, suicidal ideation and behavior were associated with choice impulsivity and intense psychological pain.

  4. Ketamine Use for Successful Resolution of Post-ERCP Acute Pancreatitis Abdominal Pain

    Directory of Open Access Journals (Sweden)

    Suneel M. Agerwala

    2017-01-01

    Full Text Available We report a case in which a patient with intractable pain secondary to post-endoscopic retrograde cholangiopancreatography (ERCP acute pancreatitis is successfully treated with a subanesthetic ketamine infusion. Shortly after ERCP, the patient reported severe stabbing epigastric pain. She exhibited voluntary guarding and tenderness without distension. Amylase and lipase levels were elevated. Pain persisted for hours despite hydromorphone PCA, hydromorphone boluses, fentanyl boluses, and postprocedure anxiolytics. Pain management was consulted and a ketamine infusion was trialed, leading to a dramatic reduction in pain. This case suggests that ketamine may be a promising option in treating intractable pain associated with ERCP acute pancreatitis.

  5. Diagnosis and treatment of acute low back pain.

    Science.gov (United States)

    Casazza, Brian A

    2012-02-15

    Acute low back pain is one of the most common reasons for adults to see a family physician. Although most patients recover quickly with minimal treatment, proper evaluation is imperative to identify rare cases of serious underlying pathology. Certain red flags should prompt aggressive treatment or referral to a spine specialist, whereas others are less concerning. Serious red flags include significant trauma related to age (i.e., injury related to a fall from a height or motor vehicle crash in a young patient, or from a minor fall or heavy lifting in a patient with osteoporosis or possible osteoporosis), major or progressive motor or sensory deficit, new-onset bowel or bladder incontinence or urinary retention, loss of anal sphincter tone, saddle anesthesia, history of cancer metastatic to bone, and suspected spinal infection. Without clinical signs of serious pathology, diagnostic imaging and laboratory testing often are not required. Although there are numerous treatments for nonspecific acute low back pain, most have little evidence of benefit. Patient education and medications such as nonsteroidal anti-inflammatory drugs, acetaminophen, and muscle relaxants are beneficial. Bed rest should be avoided if possible. Exercises directed by a physical therapist, such as the McKenzie method and spine stabilization exercises, may decrease recurrent pain and need for health care services. Spinal manipulation and chiropractic techniques are no more effective than established medical treatments, and adding them to established treatments does not improve outcomes. No substantial benefit has been shown with oral steroids, acupuncture, massage, traction, lumbar supports, or regular exercise programs.

  6. [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

  7. Prognosis of acute low back pain: design of a prospective inception cohort study

    Directory of Open Access Journals (Sweden)

    York John

    2006-06-01

    Full Text Available Abstract Background Clinical guidelines generally portray acute low back pain as a benign and self-limiting condition. However, evidence about the clinical course of acute low back pain is contradictory and the risk of subsequently developing chronic low back pain remains uncertain. There are few high quality prognosis studies and none that have measured pain, disability and return to work over a 12 month period. This study aims to provide the first estimates of the one year prognosis of acute low back pain (pain of less than 2 weeks duration in patients consulting primary care practitioners. A secondary aim is to identify factors that are associated with the prognosis of low back pain. Methods/Design The study is a prospective inception cohort study. Consecutive patients consulting general medical practitioners, physiotherapists and chiropractors in the Sydney metropolitan region will complete a baseline questionnaire regarding their back pain. Subsequently these patients will be followed up by telephone 6 weeks, 3 months and 12 months after the initial consultation. Patients will be considered to have recovered from the episode of back pain if they have no pain and no limitation of activity, and have returned to pre-injury work status. Life tables will be generated to determine the one year prognosis of acute low back pain. Prognostic factors will be assessed using Cox regression. Discussion This study will provide the first estimates of the one year prognosis of acute low back pain in a representative sample of primary care patients.

  8. Does weather affect daily pain intensity levels in patients with acute low back pain? A prospective cohort study.

    Science.gov (United States)

    Duong, Vicky; Maher, Chris G; Steffens, Daniel; Li, Qiang; Hancock, Mark J

    2016-05-01

    The aim of this study was to investigate the influence of various weather parameters on pain intensity levels in patients with acute low back pain (LBP). We performed a secondary analysis using data from the PACE trial that evaluated paracetamol (acetaminophen) in the treatment of acute LBP. Data on 1604 patients with LBP were included in the analysis. Weather parameters (precipitation, temperature, relative humidity, and air pressure) were obtained from the Australian Bureau of Meteorology. Pain intensity was assessed daily on a 0-10 numerical pain rating scale over a 2-week period. A generalised estimating equation analysis was used to examine the relationship between daily pain intensity levels and weather in three different time epochs (current day, previous day, and change between previous and current days). A second model was adjusted for important back pain prognostic factors. The analysis did not show any association between weather and pain intensity levels in patients with acute LBP in each of the time epochs. There was no change in strength of association after the model was adjusted for prognostic factors. Contrary to common belief, the results demonstrated that the weather parameters of precipitation, temperature, relative humidity, and air pressure did not influence the intensity of pain reported by patients during an episode of acute LBP.

  9. 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。

  10. Overview review: Comparative efficacy of oral ibuprofen and paracetamol (acetaminophen) across acute and chronic pain conditions.

    Science.gov (United States)

    Moore, R A; Derry, S; Wiffen, P J; Straube, S; Aldington, D J

    2015-10-01

    Ibuprofen and paracetamol have long been used as analgesics in a range of acute, intermittent and chronic pain conditions. Paracetamol is often the first line analgesic recommended, without consensus about which is the better analgesic. An overview review of systematic reviews and meta-analyses directly compares ibuprofen and paracetamol at standard doses in particular painful conditions, or uses indirect comparisons against placebo. Electronic searches for systematic reviews were sought published since 1995 using outcomes approximating to ≥50% pain intensity reduction. Painful conditions were acute post-operative pain, dysmenorrhoea, tension-type headache (TTH), migraine, osteoarthritis and rheumatoid arthritis, back pain, cancer and paediatric pain. There was no systematic assessment of harm. Sixteen systematic reviews and four individual patient data meta-analyses were included. Ibuprofen was consistently superior to paracetamol at conventional doses in a range of painful conditions. Two direct comparisons favoured ibuprofen (acute pain, osteoarthritis). Three of four indirect comparisons favoured ibuprofen (acute pain, migraine, osteoarthritis); one showed no difference (TTH), although there were methodological problems. In five pain conditions (dysmenorrhoea, paediatric pain, cancer pain, back pain and rheumatoid arthritis), there were limited data on paracetamol and ibuprofen. At standard doses in different painful conditions, ibuprofen was usually superior producing more patients with the degree of pain relief that patients feel worthwhile. Neither of the drugs will be effective for everyone, and both are needed. This overview questions the practice of routinely using paracetamol as a first line analgesic because there is no good evidence for efficacy of paracetamol in many pain conditions. © 2014 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFICC®.

  11. Re-Appraising the Role of Sonography in Pediatric Acute Abdominal Pain

    OpenAIRE

    Lin, Wei-Ching; Lin, Chien-Heng

    2013-01-01

    Objective Most pediatric emergency department (ED) visits are due to acute abdominal pain. Sonography is a reliable technique for differential diagnosis. The objective of this study was to re-appraise the role of sonography in evaluating acute abdominal pain in children. Methods Retrospective chart review of children aged

  12. Clinical diagnostic accuracy of acute colonic diverticulitis in patients admitted with acute abdominal pain, a receiver operating characteristic curve analysis.

    Science.gov (United States)

    Jamal Talabani, A; Endreseth, B H; Lydersen, S; Edna, T-H

    2017-01-01

    The study investigated the capability of clinical findings, temperature, C-reactive protein (CRP), and white blood cell (WBC) count to discern patients with acute colonic diverticulitis from all other patients admitted with acute abdominal pain. The probability of acute diverticulitis was assessed by the examining doctor, using a scale from 0 (zero probability) to 10 (100 % probability). Receiver operating characteristic (ROC) curves were used to assess the clinical diagnostic accuracy of acute colonic diverticulitis in patients admitted with acute abdominal pain. Of 833 patients admitted with acute abdominal pain, 95 had acute colonic diverticulitis. ROC curve analysis gave an area under the ROC curve (AUC) of 0.95 (CI 0.92 to 0.97) for ages patients. Separate analysis showed an AUC = 0.83 (CI 0.80 to 0.86) of CRP alone. White blood cell count and temperature were almost useless to discriminate acute colonic diverticulitis from other types of acute abdominal pain, AUC = 0.59 (CI 0.53 to 0.65) for white blood cell count and AUC = 0.57 (0.50 to 0.63) for temperature, respectively. This prospective study demonstrates that standard clinical evaluation by non-specialist doctors based on history, physical examination, and initial blood tests on admission provides a high degree of diagnostic precision in patients with acute colonic diverticulitis.

  13. 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

    BACKGROUND: Sympathetic nerve blocks relieve pain in certain chronic pain states, but the role of the sympathetic pathways in acute pain is unclear. Thus the authors wanted to determine whether a sympathetic block could reduce acute pain and hyperalgesia after a heat injury in healthy volunteers....... 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...... between sympathetic block and placebo for pain or mechanical allodynia during injury, or pain thresholds, pain responses to heat, or areas of secondary hyperalgesia after the injury. The comparisons were done for the period when the block was effective. CONCLUSION: Sympathetic nerve block did not change...

  14. Magnetic resonance imaging in children with acute hip pain

    Energy Technology Data Exchange (ETDEWEB)

    Ranner, G.; Ebner, F.; Fotter, R.; Justich, E. (Graz Univ. (Austria). Radiologische Klinik); Linhart, W. (Graz Univ. (Austria). Kinderklinik)

    1989-11-01

    45 children presenting with acute hip pain were prospectively evaluated with conventional radiography, radioisotope bone scan, and magnetic resonance imaging (MRI). The final diagnoses were transient synovitis (n=17), septic arthritis (n=2), Legg-Calve-Perthes disease (LCPD, n=13), epiphyseal dysplasia (n=2), other conditions (n=4), and normal findings (n=7). In the work-up MRI provided more morphologic information than other techniques and enlarged the diagnostic possibilities. It was the only imaging technique able to give an early indication of bone marrow involvement in systemic diseases. For the early diagnosis of LCPD, MRI was as sensitive as isotope bone scan and more precise than conventional radiography. In the follow-up of LCPD patients MRI was not able to indicate the start of revascularisation of the necrotic area, which bone scans showed reliably in six patients: But MRI provided excellent evaluation of the position, form and size of the femoral head and the surrounding soft tissues. (orig.).

  15. 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....

  16. 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

    BACKGROUND: Pre-operative identification of high-pain responders for acute pain after total knee arthroplasty (TKA) could lead to targeted analgesic trials and individualized analgesic strategies to improve recovery and potentially reduce the risk of persistent post-surgical pain. The aim...

  17. 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.

  18. [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.

  19. [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

  20. Psychological interventions for acute pain after open heart surgery.

    Science.gov (United States)

    Ziehm, Susanne; Rosendahl, Jenny; Barth, Jürgen; Strauss, Bernhard M; Mehnert, Anja; Koranyi, Susan

    2017-07-12

    This is an update of a Cochrane review previously published in 2014. Acute postoperative pain is one of the most disturbing complaints in open heart surgery, and is associated with a risk of negative consequences. Several trials investigated the effects of psychological interventions to reduce acute postoperative pain and improve the course of physical and psychological recovery of participants undergoing open heart surgery. To compare the efficacy of psychological interventions as an adjunct to standard care versus standard care alone or standard care plus attention control in adults undergoing open heart surgery for pain, pain medication, psychological distress, mobility, and time to extubation. For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science, and PsycINFO for eligible studies up to February 2017. We used the 'related articles' and 'cited by' options of eligible studies to identify additional relevant studies. We checked lists of references of relevant articles and previous reviews. We searched the ProQuest Dissertations and Theses Full Text Database, ClinicalTrials and the WHO International Clinical Trials Registry Platform to identify any unpublished material or ongoing trials. We also contacted the authors of primary studies to identify any unpublished material. In addition, we wrote to all leading heart centres in Germany, Switzerland, and Austria to check whether they were aware of any ongoing trials. Randomised controlled trials comparing psychological interventions as an adjunct to standard care versus standard care alone or standard care plus attention in adults undergoing open heart surgery. Two review authors (SZ and SK) independently assessed trials for eligibility, estimated the risk of bias and extracted all data. We calculated effect sizes for each comparison (Hedges' g) and meta-analysed data using a random-effects model. We assessed the evidence using GRADE and created

  1. The reliability of measuring pain distribution and location using body pain diagrams in patients with acute whiplash-associated disorders.

    Science.gov (United States)

    Southerst, Danielle; Stupar, Maja; Côté, Pierre; Mior, Silvano; Stern, Paula

    2013-09-01

    The objective of this study was to measure the interexaminer reliability of scoring pain distribution using paper and electronic body pain diagrams in patients with acute whiplash-associated disorder and to assess the intermethod reliability of measuring pain distribution and location using paper and electronic diagrams. We conducted an interexaminer reliability study on 80 participants recruited from a randomized controlled trial on the conservative management of acute grade I/II whiplash-associated disorder. Participants were assessed for inclusion/exclusion criteria by an experienced clinician. As part of the baseline assessment, participants independently completed paper and electronic pain diagrams. Diagrams were scored independently by 2 examiners using the body region method. Interexaminer and intermethod reliability was computed using intraclass correlation coefficients (ICCs) for pain distribution and κ coefficient for pain location. We used Bland-Altman plots to compute limits of agreement. The interexaminer reliability was ICC = 0.925 for paper and ICC = 0.997 for the electronic body pain diagram. The intermethod reliability for measuring pain distribution ranged from ICC = 0.63 to ICC = 0.93. For pain location, the intermethod reliability varied from κ = 0.23 (posterior neck) to κ = 0.90 (right side of the face). We found good to excellent interexaminer reliability for scoring 2 versions of the body pain diagram. Pain distribution and pain location were reliably and consistently measured on body pain diagrams using paper and electronic methods; therefore, clinicians and researchers may choose either medium when using body pain diagrams. Copyright © 2013 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

  2. High frequency migraine is associated with lower acute pain sensitivity and abnormal insula activity related to migraine pain intensity, attack frequency, and pain catastrophizing

    Directory of Open Access Journals (Sweden)

    Vani A Mathur

    2016-09-01

    Full Text Available Migraine is a pain disorder associated with abnormal brain structure and function, yet the effect of migraine on acute pain processing remains unclear. It also remains unclear whether altered pain-related brain responses and related structural changes are associated with clinical migraine characteristics. Using fMRI and three levels of thermal stimuli (non-painful, mildly painful, and moderately painful, we compared whole-brain activity between 14 migraine patients and 14 matched controls. Although, there were no significant differences in pain thresholds and pre-scan pain ratings to mildly painful thermal stimuli, patients had aberrant suprathreshold nociceptive processing. Compared to controls, patients had reduced activity in pain modulatory regions including left dorsolateral prefrontal, posterior parietal, and middle temporal cortices and, at a lower-threshold, greater activation in the right mid-insula to moderate pain versus mild pain. We also found that pain-related activity in the insula was associated with clinical variables in patients, including associations between: bilateral anterior insula and pain catastrophizing (PCS; bilateral anterior insula and contralateral posterior insula and migraine pain intensity; and bilateral posterior insula and migraine frequency at a lower-threshold. PCS and migraine pain intensity were also negatively associated with activity in midline regions including posterior cingulate and medial prefrontal cortices. Diffusion tensor imaging revealed a negative correlation between fractional anisotropy (a measure of white matter integrity; FA and migraine duration in the right mid-insula and a positive correlation between left mid-insula FA and PCS. In sum, while patients showed lower sensitivity to acute noxious stimuli, the neuroimaging findings suggest enhanced nociceptive processing and significantly disrupted modulatory networks, particularly involving the insula cortex, associated with indices of

  3. 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.

  4. 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...... 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...... pain (rho = -0.13, P = .09, and rho = -1.2, P = .4, respectively. PERSPECTIVE: Although preoperative electrical nociceptive stimulation may predict patients at risk of high-intensity acute pain after other surgical procedures, this was not the case in groin hernia repair patients receiving concomitant...

  5. Timing and gender determine if acute pain impairs working memory performance.

    Science.gov (United States)

    Hood, Anna; Pulvers, Kim; Spady, Thomas J

    2013-11-01

    The effects of pain on memory are complex, and little is known about the vulnerability of working memory (WM) performance when individuals complete a WM test while concurrently experiencing pain. Here, we subjected 78 healthy nonsmoking participants to either acute pain or a control condition while we administered a WM test. In this context, we also tested WM 20 minutes after pain in order to determine if timing of pain affected WM performance, and assessed objective and subjective measures of pain. We hypothesized that pain would impair WM performance during pain. Further, women's WM performance would be impaired more than men. Importantly, there was an interaction between gender and condition, with women exposed to pain experiencing impairments during but not after the cold pressor task. Our data imply that timing and gender are critically important in whether acute pain is costly to WM performance. Our findings have interesting clinical, professional, and educational implications, and understanding the influence of pain could help to improve the interpretation of WM tests in these diverse settings. Results of this study support the growing body of work that attests to the detrimental effect of pain on WM performance. Further, this study provides new evidence that concurrently experiencing cold pressor pain impairs WM in regularly menstruating women and women taking a contraceptive. Copyright © 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.

  6. 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 Team consultations may help to identify patients at risk for clinical decompensation. © 2017 John Wiley & Sons Ltd.

  7. 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.

  8. 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.

  9. 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......%)), but other synovial covered structures including the fat pad of Hoffa (12 patients (40%)), the medial plica and the joint line (12 patients (40%)) were also involved. Only eight patients (27%) experienced pain on the patellofemoral compression test. Only discrete changes was detected on MRI...

  10. 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.

  11. Patient clusters in acute, work-related back pain based on patterns of disability risk factors.

    Science.gov (United States)

    Shaw, William S; Pransky, Glenn; Patterson, William; Linton, Steven J; Winters, Thomas

    2007-02-01

    To identify subgroups of patients with work-related back pain based on disability risk factors. Patients with work-related back pain (N = 528) completed a 16-item questionnaire of potential disability risk factors before their initial medical evaluation. Outcomes of pain, functional limitation, and work disability were assessed 1 and 3 months later. A K-Means cluster analysis of 5 disability risk factors (pain, depressed mood, fear avoidant beliefs, work inflexibility, and poor expectations for recovery) resulted in 4 sub-groups: low risk (n = 182); emotional distress (n = 103); severe pain/fear avoidant (n = 102); and concerns about job accommodation (n = 141). Pain and disability outcomes at follow-up were superior in the low-risk group and poorest in the severe pain/fear avoidant group. Patients with acute back pain can be discriminated into subgroups depending on whether disability is related to pain beliefs, emotional distress, or workplace concerns.

  12. Supporting Parents' Pain Care Involvement With Their Children With Acute Lymphoblastic Leukemia: A Qualitative Interpretive Description.

    Science.gov (United States)

    Bettle, Amanda; Latimer, Margot; Fernandez, Conrad; Hughes, Jean

    Children with acute lymphoblastic leukemia experience pain from the disease, treatment, and procedures. Parents can be effective in managing their child's pain, but little is systematically known about how they do this. Appreciative inquiry was used to frame the study within a strengths-based lens and interpretive descriptive methods were used to describe pain sources, parents' pain care role, and key structures supporting parents pain care involvement. Eight paediatric oncology clinic nurses and 10 parents participated. Six key themes per group were identified. Parent themes included establishing therapeutic relationships, relearning how to care for my child, overcoming challenges and recognizing pain, learning parent specific strategies, empowering to take active pain care role, and maintaining relationships. Nurse themes included establishing therapeutic relationships, preparing parents to care for their child, facilitating pain assessment, teaching parents best pain care, empowering parents, and maintaining relationships. These findings can be used to guide clinical practice and future research.

  13. Pain and Satisfaction With Pain Management Among Older Patients During the Transition From Acute to Skilled Nursing Care.

    Science.gov (United States)

    Simmons, Sandra F; Schnelle, John F; Saraf, Avantika A; Simon Coelho, Chris; Jacobsen, J Mary Lou; Kripalani, Sunil; Bell, Susan; Mixon, Amanda; Vasilevskis, Eduard E

    2016-12-01

    Approximately 20% of hospitalized Medicare beneficiaries are discharged from the hospital to skilled nursing facilities (SNFs); and up to 23% of SNF patients return to the hospital within 30 days of hospital discharge, with pain as one of the most common symptoms precipitating hospital readmission. We sought to examine the prevalence of moderate to severe pain at hospital discharge to SNF, the incidence of new moderate to severe pain (relative to prehospitalization), and satisfaction with pain management among older acute care patients discharged to SNF. Structured patient interviews were conducted with 188 Medicare beneficiaries discharged to 23 area SNFs from an academic medical center. Pain level (0-10) and satisfaction with pain management were assessed upon hospital admission, discharge, and within 1 week after transition to SNF. There was a high prevalence of moderate to severe pain at each time point including prehospital (51%), hospital discharge (38%), and following SNF admission (53%). Twenty-eight percent of participants reported new moderate to severe pain at hospital discharge, whereas 44% reported new moderate to severe pain following SNF admission. Most participants reported being "satisfied" with their pain treatment, even in the context of moderate to severe pain. Moderate to severe pain is a common problem among hospitalized older adults discharged to SNF and continues during their SNF stay. Pain assessment and management should involve a specific, planned process between hospital and SNF clinicians at the point of care transition, even if patients express "satisfaction" with current pain management. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  14. 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

  15. 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)

  16. 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.

  17. 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.

  18. 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.

  19. [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.

  20. Development of Novel Local Analgesics for Management of Acute Tissue Injury Pain

    Science.gov (United States)

    2017-09-01

    Project Manager Boston Biomedical Innovation Center 215 First Street, Suite 500; Cambridge, MA 02142 857-307-2441 | rblackman1@partners.org | b...AWARD NUMBER: W81XWH-15-1-0480 TITLE: Development of Novel Local Analgesics for Management of Acute Tissue Injury Pain PRINCIPAL...31/2017 4. TITLE AND SUBTITLE Development of Novel Local Analgesics for Management of Acute Tissue Injury Pain 5a. CONTRACT NUMBER Tissue Injury

  1. Time to significant pain reduction following DETP application vs placebo for acute soft tissue injuries.

    Science.gov (United States)

    Yanchick, J; Magelli, M; Bodie, J; Sjogren, J; Rovati, S

    2010-08-01

    Nonsteroidal anti-inflammatory drugs (NSAIDs) provide fast and effective acute pain relief, but systemic administration has increased risk for some adverse reactions. The diclofenac epolamine 1.3% topical patch (DETP) is a topical NSAID with demonstrated safety and efficacy in treatment of acute pain from minor soft tissue injuries. Significant pain reduction has been observed in clinical trials within several hours following DETP application, suggesting rapid pain relief; however, this has not been extensively studied for topical NSAIDs in general. This retrospective post-hoc analysis examined time to onset of significant pain reduction after DETP application compared to a placebo patch for patients with mild-to-moderate acute ankle sprain, evaluating the primary efficacy endpoint from two nearly identical studies. Data from two double-blind, randomized, parallel-group, placebo-controlled studies (N = 274) of safety and efficacy of the DETP applied once daily for 7 days for acute ankle sprain were evaluated post-hoc using statistical modeling to estimate time to onset of significant pain reduction following DETP application. Pain on active movement on a 100 mm Visual Analog Scale (VAS) recorded in patient diaries; physician- and patient-assessed tolerability; and adverse events. DETP treatment resulted in significant pain reduction within approximately 3 hours compared to placebo. Within-treatment post-hoc analysis based on a statistical model suggested significant pain reduction occurred as early as 1.27 hours for the DETP group. The study may have been limited by the retrospective nature of the analyses. In both studies, the DETP was well tolerated with few adverse events, limited primarily to application site skin reactions. The DETP is an effective treatment for acute minor soft tissue injury, providing pain relief as rapidly as 1.27 hours post-treatment. Statistical modeling may be useful in estimating time to onset of pain relief for comparison of topical

  2. 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

  3. 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

  4. Ketamine Use for Successful Resolution of Post-ERCP Acute Pancreatitis Abdominal Pain

    OpenAIRE

    Agerwala, Suneel M.; Sundarapandiyan, Divya; Weber, Garret

    2017-01-01

    We report a case in which a patient with intractable pain secondary to post-endoscopic retrograde cholangiopancreatography (ERCP) acute pancreatitis is successfully treated with a subanesthetic ketamine infusion. Shortly after ERCP, the patient reported severe stabbing epigastric pain. She exhibited voluntary guarding and tenderness without distension. Amylase and lipase levels were elevated. Pain persisted for hours despite hydromorphone PCA, hydromorphone boluses, fentanyl boluses, and post...

  5. 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

  6. 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.

  7. Transcutaneous electrical nerve stimulation reduces acute low back pain during emergency transport.

    Science.gov (United States)

    Bertalanffy, Alexander; Kober, Alexander; Bertalanffy, Petra; Gustorff, Burkhard; Gore, Odette; Adel, Sharam; Hoerauf, Klaus

    2005-07-01

    Patients with acute low back pain may require emergency transport because of pain and immobilization. Transcutaneous electrical nerve stimulation (TENS) is a nonpharmaceutical therapy for patients with low back pain. To evaluate the efficacy of paramedic-administered TENS in patients with acute low back pain during emergency transport. This was a prospective, randomized study involving 74 patients transported to hospital. The patients were randomly assigned to two groups: group 1 (n = 36) was treated with true TENS, while group 2 (n = 36) was treated with sham TENS. The authors recorded pain and anxiety as the main outcome variables using a visual analog scale (VAS). The authors recorded a significant (p pain reduction (mean +/- standard deviation) during transport in group 1 (79.2 +/- 6.5 mm VAS to 48.9 +/- 8.2 mm VAS), whereas pain scores remained unchanged in group 2 (75.9 +/- 16.4 mm VAS and 77.1 +/- 11.2 mm VAS). Similarly, the scores for anxiety were significantly reduced (p TENS was found to be effective and rapid in reducing pain during emergency transport of patients with acute low back pain and should be considered due to its ease of use and lack of side effects in the study population.

  8. The evaluation of cervical spinal angle in patients with acute and chronic neck pain.

    Science.gov (United States)

    Aşkin, Ayhan; Bayram, Korhan Barış; Demirdal, Ümit Seçil; Atar, Emel; Arifoğlu Karaman, Çiğdem; Güvendi, Ece; Tosun, Aliye

    2017-06-12

    Clinicians associate the changes in cervical lordosis with neck pain, but there is no clear consensus on this. We aimed to investigate the relationships of cervical angles, neck pain, disability, and the psychological status of the patients with acute and chronic neck pain. A total of 110 patients with neck pain were included in this study. Demographic and clinical characteristics of the patients were recorded. The lordosis angle was determined by the posterior tangent method. A visual analog scale (VAS), the Neck Disability Index (NDI), and the Hospital Anxiety and Depression (HAD) scale were administered to all patients. The mean cervical lordosis angle was 23.10 ± 8.07 degrees. A statistically negative correlation was detected between cervical angle and duration of disease (P cervical angle of the acute neck pain group was higher than that of the chronic pain group (P pain groups with respect to VAS, NDI, and HAD scores (P > 0.05). We found that the cervical angle was significantly lower in chronic neck pain patients when compared to acute patients, and patients with higher pain scores had more severe disability and that disability increased with the duration of disease.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1985-09-01

    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.

  10. 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.)

  11. 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

  12. 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

    The Danish health care system is currently establishing emergency departments (EDs) with an observation unit nationwide. The aim of the study was to investigate patients with acute abdominal pain and their experiences upon arrival and stay in an acute surgical ward (ASW) versus an ED with an obse......The Danish health care system is currently establishing emergency departments (EDs) with an observation unit nationwide. The aim of the study was to investigate patients with acute abdominal pain and their experiences upon arrival and stay in an acute surgical ward (ASW) versus an ED...... was that the ED included a multidisciplinary team with nurses, who mainly had interactions with the patients before surgical assessment. In all, it resulted in fragmentation of care and a patient experience of repetition. In ASW, focus was on assessment by a senior physician, only, and the nurses' interaction...... 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....

  13. A Systematic Review of Early Prognostic Factors for Persistent Pain Following Acute Orthopedic Trauma

    Directory of Open Access Journals (Sweden)

    Fiona J Clay

    2012-01-01

    Full Text Available Persistent or chronic pain is prevalent in many developed countries, with estimates ranging from 10% to higher than 50%, and is a major economic burden to individuals and societies. However, the variation in pain outcomes after acute orthopedic trauma and treatment confronts treating physicians with uncertainty in providing prognostic advice regarding long-term recovery. Although several previous reviews have addressed the determinants of chronic pain outcomes secondary to acute trauma, they have primarily focused on specific injury samples and, furthermore, lack consistency with respect to the important prognostic factors, which limits the generalizability of findings. This review, however, aimed specifically to identify the early prognostic factors associated with variation in persistent pain outcomes following acute orthopedic trauma presenting with a spectrum of pathologies.

  14. 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 ...

  15. 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.

  16. Reduced acute nociception and chronic pain in Shank2 ?/? mice

    OpenAIRE

    Ko, Hyoung-Gon; Oh, Seog-Bae; Zhuo, Min; Kaang, Bong-Kiun

    2016-01-01

    Autism spectrum disorder is a debilitating mental illness and social issue. Autism spectrum disorder patients suffer from social isolation, cognitive deficits, compulsive behavior, and sensory deficits, including hyposensitivity to pain. However, recent studies argued that autism spectrum disorder patients show physiological pain response and, in some cases, even extremely intense pain response to harmless stimulation. Recently, Shank gene family was reported as one of the genetic risk factor...

  17. 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....

  18. 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

  19. 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.

  20. 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.

  1. Pregabalin reduces acute inflammatory and persistent pain associated with nerve injury and cancer in rat models of orofacial pain.

    Science.gov (United States)

    Hummig, Wagner; Kopruszinski, Caroline Machado; Chichorro, Juliana Geremias

    2014-01-01

    To assess the analgesic effect of pregabalin in orofacial models of acute inflammatory pain and of persistent pain associated with nerve injury and cancer, and so determine its effectiveness in controlling orofacial pains having different underlying mechanisms. Orofacial capsaicin and formalin tests were employed in male Wistar rats to assess the influence of pregabalin (or vehicle) pretreatment in acute pain models, and the results from these experiments were analyzed by one-way analysis of variance (ANOVA) followed by Newman Keuls post-hoc test. Pregabalin (or vehicle) treatment was also tested on the facial heat hyperalgesia that was evaluated in rats receiving injection of the inflammatory irritant carrageenan into the upper lip, as well as after constriction of the infraorbital nerve (a model of trigeminal neuropathic pain), or after inoculation of tumor cells into the facial vibrissal pad; two-way repeated measures ANOVA followed by Newman-Keuls post-hoc test was used to analyze data from these experiments. Facial grooming induced by capsaicin was abolished by pretreatment with pregabalin at 10 and 30 mg/kg. However, pregabalin failed to modify the first phase of the formalin response, but reduced the second phase at both doses (10 and 30 mg/kg). In addition, treatment of rats with pregabalin reduced the heat hyperalgesia induced by carrageenan, as well as by nerve injury and facial cancer. Pregabalin produced a marked antinociceptive effect in rat models of facial inflammatory pain as well as in facial neuropathic and cancer pain models, suggesting that it may represent an important agent for the clinical control of orofacial pain.

  2. 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, ...

  3. Ketamine's second life : Treatment of acute and chronic pain

    NARCIS (Netherlands)

    Sigtermans, Marnix Johannes

    2010-01-01

    Chronic pain is a widespread condition in the general population. For this reason, chronic pain management has received increased attention in recent years, both in clinical practice and in scientifi c research. This thesis describes a series of experiments which studied the effi cacy and safety

  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......, depressive score and score of delayed verbal memory....

  5. Pharmacist's role in dispensing opioids for acute and chronic pain.

    Science.gov (United States)

    Marlowe, Karen F; Geiler, Richard

    2012-10-01

    Pain continues to be a serious health care concern in the United States. Patients with chronic pain experience the impact of the disease throughout their lives including their social interactions, family relationships, and in many cases economic productivity. Multiple surveys have found that many pharmacists hold misconceptions regarding opioids, pain disease states, and their understandings of current regulations. Multiple barriers affect the ability of pharmacists to deliver care to patients' prescribed opioid therapy. Inadequate communication between health care professionals and patients is one of the hurdles, which prevents quality care. Increased communication between health care providers including access to health information is one step, which is crucial to improving provision of pharmacotherapy. Finally, the quality of educational opportunities relative to opioids and pain management specifically for pharmacists needs to be increased, and consideration needs to be given for making appropriate pain management education mandatory.

  6. Cocaine abuse that presents with acute scrotal pain and mimics testicular torsion

    Directory of Open Access Journals (Sweden)

    José Tadeu Nunes Tamanini

    Full Text Available ABSTRACT Report case (s relevant aspects: Man, 27 years old, complaining of acute testicular pain by 2 hours in the remaining left testicle. Denies fever, lower urinary tract symptoms such as dysuria, urinary frequency, concommitant or prior urethral discharge to the painful condition. He underwent right orchiectomy 13 years ago by testicular torsion. He is a chronic user of cocaine for 15 years and during the last three days the drug use was continuous and intense. Proposed premise substantiating case (s description: Initial diagnostic hypothesis: Syndromic: Acute Scrotum Syndrome (SEA Main Etiologic (testicular torsion Secondary Etiologic (acute orchiepididymitis Briefly delineates what might it add? Lines of research That Could be Addressed: In this challenging clinical case we presented an alternative and new etiologic diangosis for the acute scrotum which the main etiologic factor remains testicular torsion. This new diangosis is acute testicular ischemia as a complication of cocaine abuse.

  7. 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.

  8. 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.

  9. Effectiveness of Tai-Chi for decreasing acute pain in fibromyalgia patients.

    Science.gov (United States)

    Segura-Jiménez, V; Romero-Zurita, A; Carbonell-Baeza, A; Aparicio, V A; Ruiz, J R; Delgado-Fernández, M

    2014-05-01

    Tai-Chi has shown benefits in physical and psychological outcomes in diverse populations. We aimed to determine the changes elicited by a Tai-Chi program (12 and 24 weeks) in acute pain (before vs. after session) in fibromyalgia patients. We also assessed the cumulative changes in pain brought about by a Tai-Chi program. Thirty-six patients (29 women) with fibromyalgia participated in a low-moderate intensity Tai-Chi program for 12 weeks (3 sessions/week). Twenty-eight patients (27 women) continued the program for an additional 12 weeks (i. e., 24 weeks). We assessed pain by means of a Visual Analogue Scale (VAS) before and after each single session (i. e., 72 sessions). We observed significant immediate changes (P-values from 0.037 to 0.0001) with an approximately 12% mean decrease of acute pain in the comparison of VAS-values before and after each session (72 sessions in total), with the exception of 4 sessions. We observed significant changes in cumulative pain pre-session (95% CI=-0.019; -0.014; PTai-Chi program for 12 weeks (3 times/week) decreased levels of acute pain in fibromyalgia patients. A longer period is necessary (e. g. 24 weeks) for observing cumulative changes in pain. © Georg Thieme Verlag KG Stuttgart · New York.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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®.

  17. 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.

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

    African Journals Online (AJOL)

    and skin lesions caused by herpes zoster, and to develop some pertinent therapeutic guidelines. Methods: A total of 48 ... antiviral, pain-relieving and nerve nutrition. They were ... nerve dysfunction as well as Ramsay-Hunt syndrome (facial.

  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. Inflammation and Rupture of a Congenital Pericardial Cyst Manifesting Itself as an Acute Chest Pain Syndrome.

    Science.gov (United States)

    Aertker, Robert A; Cheong, Benjamin Y C; Lufschanowski, Roberto

    2016-12-01

    We present the case of a 63-year-old woman with a remote history of supraventricular tachycardia and hyperlipidemia, who presented with recurrent episodes of acute-onset chest pain. An electrocardiogram showed no evidence of acute coronary syndrome. A chest radiograph revealed a prominent right-sided heart border. A suspected congenital pericardial cyst was identified on a computed tomographic chest scan, and stranding was noted around the cyst. The patient was treated with nonsteroidal anti-inflammatory drugs, and the pain initially abated. Another flare-up was treated similarly. Cardiac magnetic resonance imaging was then performed after symptoms had resolved, and no evidence of the cyst was seen. The suspected cause of the patient's chest pain was acute inflammation of a congenital pericardial cyst with subsequent rupture and resolution of symptoms.

  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. Clinical Presentation of Acute Gastroenteritis in Children With Functional Abdominal Pain Disorders.

    Science.gov (United States)

    Saps, Miguel; Mintjens, Stijn; Pusatcioglu, Cenk K; Cohen, Daniel M; Sternberg, Petra

    2017-08-01

    Visceral hypersensitivity and abnormal coping are common in children with functional abdominal pain disorders (FAPDs). Thus, it would be expected that children with visceral hypersensitivity would report more pain if their gut is acutely inflamed. The aim of the study was to compare clinical symptoms and somatization of children with and without FAPDs at time of an episode of acute gastroenteritis. Seventy children with acute gastroenteritis and their parents completed the Rome III Diagnostic Questionnaire for Pediatric Functional GI Disorders and the Children's Somatization Inventory. Twenty-one percent of children were diagnosed with an FAPD. Children with FAPDs showed significantly more nongastrointestinal somatic symptoms than children without FAPDs. There were no significant differences in abdominal pain, nausea, vomiting, or school absenteeism between both groups at time of consultation.

  3. 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.

  4. What is the impact of acute and chronic orofacial pain on quality of life?

    Science.gov (United States)

    Shueb, S S; Nixdorf, D R; John, M T; Alonso, B Fonseca; Durham, J

    2015-10-01

    Orofacial pain (OFP) is thought to substantially reduce oral health-related quality of life (OHRQoL). Little has been reported about the impact of acute dental pain and persistent (chronic) orofacial pain conditions, other than temporomandibular disorders (TMD), on OHRQoL. The aim of this study was to examine and compare OHRQoL impairment among four OFP conditions: TMD, acute dental pain (ADP), trigeminal neuralgia (TN) and persistent dentoalveolar pain disorder (PDAP). OHRQoL was measured using the OHIP-49 in a convenience sample of subjects with four OFP conditions (TMD (n=41), ADP (n=41), TN (n=21), PDAP (n=22) and a pain-free control group (n=21)). The mean OHIP-49 summary score described the level of impact and inferential and descriptive statistics were used to examine any differences inter-condition. The mean of the OHIP-14 and 5 were also measured by extracting the corresponding items from the OHIP-49. All pain conditions presented with statistically significant (Porofacial pain conditions are likely not to be substantial. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Research design considerations for single-dose analgesic clinical trials in acute pain

    DEFF Research Database (Denmark)

    Cooper, Stephen A; Desjardins, Paul J; Turk, Dennis C

    2016-01-01

    This article summarizes the results of a meeting convened by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) on key considerations and best practices governing the design of acute pain clinical trials. We discuss the role of early phase clinical trials......, including pharmacokinetic-pharmacodynamic (PK-PD) trials, and the value of including both placebo and active standards of comparison in acute pain trials. This article focuses on single-dose and short-duration trials with emphasis on the perioperative and study design factors that influence assay...... sensitivity. Recommendations are presented on assessment measures, study designs, and operational factors. Although most of the methodological advances have come from studies of postoperative pain after dental impaction, bunionectomy, and other surgeries, the design considerations discussed are applicable...

  6. 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

    Due to its non-invasive mode of administration, intranasal (IN) application of drugs may be a valuable alternative to non-invasive pain management. With characteristics that appear to be ideal for IN application, IN fentanyl may have a place in the out-of-hospital treatment and the paediatric...... population. The objective of this systematic review was to evaluate the current evidence of IN fentanyl in the treatment of acute pain. Reports of randomized controlled trials (RCTs) of IN fentanyl in treatment of pain were systematically sought using the PubMed database, Embase, Google scholar, Cochrane...... database, and Cumulative Index to Nursing and Allied Health Literature. Reports were considered for inclusion if they were double-blinded randomized controlled trials (RCTs) of IN fentanyl in the treatment of acute pain. Thirty-two RCTs were identified, and 16 were included in the final analysis...

  7. Transcutaneous electrical neurostimulation in musculoskeletal pain of acute spinal cord injuries.

    Science.gov (United States)

    Richardson, R R; Meyer, P R; Cerullo, L J

    1980-01-01

    Cervical, thoracic, thoracolumbar, and lumbar fractures associated with physiologic complete or incomplete spinal cord injuries frequently have severe soft-tissue injury as well as severe pain associated with the site or area of injury. Transcutaneous electrical neurostimulation has proved effective in the treatment of various causes of severe acute and chronic intractable pains. We applied this modality to a group of 20 patients who had acute spinal cord injuries and pain associated with severe, extensive soft-tissue injury. Its advantages include ease of application, lack of major complications, increased intestinal peristalsis, and avoidance of narcotic analgesic medications. It also produced significant (greater than 50%) pain relief in 75% of patients treated by transcutaneous electrical neurostimulation.

  8. 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

  9. Patient Perception of Acute Pain Management: Data from Three Tertiary Care Hospitals

    Directory of Open Access Journals (Sweden)

    Elsy Ramia

    2017-01-01

    Full Text Available Introduction. The primary objectives of this study were to assess patients’ description of their acute pain intensity; patients’ attitude towards their pain management during hospitalization; and their overall satisfaction with pain treatment. Methodology. A cross-sectional questionnaire-based study was conducted between October 2014 and March 2015 in three medical centers in Lebanon. All participants’ responses were reported using descriptive statistics. The association between categorical variables was evaluated using Pearson χ2 test or Fisher’s exact test where the expected cell count was < 5. Results. A total of 119 women on the maternity services and 177 patients on the orthopedic services were surveyed. Around 50% of obstetric and 37% of orthopedic patients reported pain to be severe at its highest intensity. In maternity and orthopedic patients, respectively, unfavorable practices included pain not being assessed prior to pain medication administration (19.3% and 30.5%, having to wait for ≥30 minutes before getting the pain medication (14.2% and 11.3%, and pain score not being documented on medical chart (95% and 93.2%. Surprisingly, 94.1% of the maternity and 89.2% of orthopedic patients were satisfied to strongly satisfied with their pain management. Conclusion. Pre- and postoperative pain remain a prevalent problem that requires a consensus and joint efforts for improvement.

  10. Acute pain in an emergency clinic: latency of onset and descriptor patterns related to different injuries.

    Science.gov (United States)

    Melzack, R; Wall, P D; Ty, T C

    1982-09-01

    Features of acute pain were examined in patients at an emergency clinic. Patients who had severe, life-threatening injuries or who were agitated, drunk, or 'in shock' were excluded from the study. Of 138 patients who were alert, rational and coherent, 51 (37%) stated that they did not feel pain at the time of injury. The majority of these patients reported onset of pain within an hour of injury, although the delays were as long as 9 h or more in some patients. The predominant emotions of the patients were embarrassment at appearing careless or worry about loss of wages. None expressed any pleasure or indicated any prospect of gain as a result of the injury. The occurrence of delays in pain onset was related to the nature of the injury. Of 46 patients whose injuries were limited to skin (lacerations, cuts, abrasions, burns), 53% had a pain-free period. Of 86 patients with deep-tissue injuries (fractures, sprains, bruises, amputation of a finger, stabs and crushes), only 28% had a pain-free period. The McGill Pain Questionnaire was administered to patients who felt pain immediately after injury or after a delay, and revealed a normal distribution of sensory scores but very low affective scores compared to patients with chronic pain. The results indicate that the relationship between injury and pain is highly variable and complex.

  11. Efficacy of Acute Pain Control Protocol in Triage Department on Analgesics Administration Time and Patients' Satisfaction

    Directory of Open Access Journals (Sweden)

    Seyedhossein Seyyedhoseini Davaraani

    2014-07-01

    Full Text Available Objective: Current study was conducted to develop a pain control protocol by Morphine Sulfate (MS Suppository in triage ward with the main primary outcomes of first analgesic administration time, patients' satisfaction and also the changes in pain intensity. Methods: In this randomized clinical trial, 318 consecutive patients attending to an academic tertiary health care center in Tehran, Iran in 2011 and 2012 were enrolled. The patients were randomly assigned to receive either routine pain control by emergency medicine residents in emergency department (n=132 or pain control protocol in triage level by nurses (n=186. Those with pain in control group were treated with conventional pain control program and those in intervention group with pain intensities higher than four were treated with suppository stat 10 mg dose of MS administered by nurses in triage ward. Results: The mean change in pain intensity was significantly (P<0.0001 higher in intervention group (4.2 versus 0.2 and the first analgesic administration time was significantly different between groups (P<0.05 being less in the intervention group (43.1 versus 4.6. Also the patients' satisfaction was significantly higher in the intervention group (P<0.0001. No drug adverse effects were seen. Conclusions: Totally, according to the obtained results, it may be concluded that acute pain control protocol in triage department by suppository of MS would result in reduced analgesics administration time and higher patients' satisfaction.   Keywords: Analgesia; Emergency Department; Pain Control

  12. 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.

  13. Validation of the diagnostic score for acute lower abdominal pain in women of reproductive age.

    Science.gov (United States)

    Jearwattanakanok, Kijja; Yamada, Sirikan; Suntornlimsiri, Watcharin; Smuthtai, Waratsuda; Patumanond, Jayanton

    2014-01-01

    Background. The differential diagnoses of acute appendicitis obstetrics, and gynecological conditions (OB-GYNc) or nonspecific abdominal pain in young adult females with lower abdominal pain are clinically challenging. The present study aimed to validate the recently developed clinical score for the diagnosis of acute lower abdominal pain in female of reproductive age. Method. Medical records of reproductive age women (15-50 years) who were admitted for acute lower abdominal pain were collected. Validation data were obtained from patients admitted during a different period from the development data. Result. There were 302 patients in the validation cohort. For appendicitis, the score had a sensitivity of 91.9%, a specificity of 79.0%, and a positive likelihood ratio of 4.39. The sensitivity, specificity, and positive likelihood ratio in diagnosis of OB-GYNc were 73.0%, 91.6%, and 8.73, respectively. The areas under the receiver operating curves (ROC), the positive likelihood ratios, for appendicitis and OB-GYNc in the validation data were not significantly different from the development data, implying similar performances. Conclusion. The clinical score developed for the diagnosis of acute lower abdominal pain in female of reproductive age may be applied to guide differential diagnoses in these patients.

  14. 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

  15. 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.

  16. 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.

  17. 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

  18. The effects of massage therapy on pain management in the acute care setting.

    Science.gov (United States)

    Adams, Rose; White, Barb; Beckett, Cynthia

    2010-03-17

    Pain management remains a critical issue for hospitals and is receiving the attention of hospital accreditation organizations. The acute care setting of the hospital provides an excellent opportunity for the integration of massage therapy for pain management into the team-centered approach of patient care. This preliminary study evaluated the effect of the use of massage therapy on inpatient pain levels in the acute care setting. The study was conducted at Flagstaff Medical Center in Flagstaff, Arizona-a nonprofit community hospital serving a large rural area of northern Arizona. A convenience sample was used to identify research participants. Pain levels before and after massage therapy were recorded using a 0 - 10 visual analog scale. Quantitative and qualitative methods were used for analysis of this descriptive study. Hospital inpatients (n = 53) from medical, surgical, and obstetrics units participated in the current research by each receiving one or more massage therapy sessions averaging 30 minutes each. The number of sessions received depended on the length of the hospital stay. Before massage, the mean pain level recorded by the patients was 5.18 [standard deviation (SD): 2.01]. After massage, the mean pain level was 2.33 (SD: 2.10). The observed reduction in pain was statistically significant: paired samples t(52) = 12.43, r = .67, d = 1.38, p massage therapy into the acute care setting creates overall positive results in the patient's ability to deal with the challenging physical and psychological aspects of their health condition. The study demonstrated not only significant reduction in pain levels, but also the interrelatedness of pain, relaxation, sleep, emotions, recovery, and finally, the healing process.

  19. 43 Management of acute low back pain in the ED: a systematic review.

    Science.gov (United States)

    Ashbrook, Jane; Rodgdakis, Nikos; Goodwin, Peter; Yeowell, Gill; Callaghan, Michael

    2017-12-01

    There is no consensus on the management of low back pain in the ED and evidence suggests that these patients are likely to receive unwarranted imaging and inappropriate opioid prescription.The purpose of this study is to review the available literature pertaining to the clinical management of acute low back pain in the ED. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines were observed during this review.Trials were included if the population studied were adults with acute low back pain in an emergency setting. All diagnostic tests and therapeutic interventions were evaluated.Methodological quality and risk of bias was appraised using the Downs and Black checklist. 19 articles were identified including 1896 patients that were sub-grouped according to management.In the pharmacological subgroup corticosteroids were effective in patients with radicular pain, NSAIDs were as effective as other medication with less adverse events, Phenyramidol was not superior to placebo, promethazine and morhpine combined was not more effective than morphine alone and ketamine was no more effective than morphine but had a worse adverse effect profile.In the emergency transport group TENS and active warming both showed effects in reducing pain, anxiety and heart rate.In the physical therapy management group less pain and greater satisfaction were reported.In the adjunct interventions group showed a trend towards pain reduction in the use of heat/ice packs and short term pain relief in acupuncture and auricular acupuncture. More high quality trials are needed to determine an evidence-based management protocol for the treatment of acute low back pain in the ED. © 2017, 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.

  20. Increased neural responses to empathy for pain might explain how acute stress increases prosociality

    OpenAIRE

    Tomova, L.; Majdand?i?, J.; Hummer, A.; Windischberger, C.; Heinrichs, M.; Lamm, C.

    2016-01-01

    Abstract Recent behavioral investigations suggest that acute stress can increase prosocial behavior. Here, we investigated whether increased empathy represents a potential mechanism for this finding. Using functional magnetic resonance imaging, we assessed the effects of acute stress on neural responses related to automatic and regulatory components of empathy for pain as well as subsequent prosocial behavior. Stress increased activation in brain areas associated with the automatic sharing of...

  1. 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...... on 3 separate days with 7-day intervals. They received either (1) subcutaneous infiltration with ketamine in the burn area (local treatment) and contralateral placebo injections, or (2) subcutaneous ketamine contralateral to the burn (systemic treatment) and placebo in the burn area, or (3) placebo...... hyperalgesia. Local ketamine infiltration reduced pain during the burn injury compared with systemic treatment and placebo (P ketamine treatment compared with placebo immediately after injection (P

  2. Acute Responses of Strength and Running Mechanics to Increasing and Decreasing Pain in Patients With Patellofemoral Pain

    Science.gov (United States)

    Bazett-Jones, David M.; Huddleston, Wendy; Cobb, Stephen; O'Connor, Kristian; Earl-Boehm, Jennifer E.

    2017-01-01

    -extension (pretest: −2.31 ± 0.46) and hip-abduction (pretest: −2.02 ± 0.35) moments decreased after both the TENS (extension: −2.15 ± 0.48 Nm/kg, P = .015; abduction: −1.91 ± 0.33 Nm/kg, P = .015) and RSLS (extension: −2.18 ± 0.52 Nm/kg, P = .003; abduction: −1.87 ± 0.36 Nm/kg, P = .039) protocols. Conclusions:  This study presents a novel and effective method of increasing pain in persons with PFP. Functionally increased pain after RSLS coincides with reduced hip-extensor muscle strength and decreased plantar-flexion angle during running. The TENS treatment decreased pain during running in those with PFP but failed to influence strength. Hip moments were reduced by both protocols, which may demonstrate that acute increases or decreases in pain cause runners to change their mechanics. PMID:28388232

  3. 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.

  4. 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

  5. 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.

  6. 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.

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

    African Journals Online (AJOL)

    Treatment of non-specific low back pain typically results in a significant improvement ... and the potential benefits and risks associated with drug treatment, have been ... South African Family Practice 2014; 56(6):10-14. Open Access article ...

  8. Management of acute pain in the postoperative setting

    DEFF Research Database (Denmark)

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

    2018-01-01

    /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...

  9. Management of acute pain in the postoperative setting

    DEFF Research Database (Denmark)

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

    2017-01-01

    /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...

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

    African Journals Online (AJOL)

    say: 'The treatment of pain after surgery in British hos- pitals has been ... Senior registrars are assigned to share the service load. This enables .... The physiotherapists are active supporrers ofthe. APRS. ... of the registrars fall ill or take leave. Consultant .... raises the importance ofpain prevention in the minds of all clinical ...

  11. 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...

  12. Race and acute abdominal pain in a pediatric emergency department.

    Science.gov (United States)

    Caperell, Kerry; Pitetti, Raymond; Cross, Keith P

    2013-06-01

    To investigate the demographic and clinical factors of children who present to the pediatric emergency department (ED) with abdominal pain and their outcomes. A review of the electronic medical record of patients 1 to 18 years old, who presented to the Children's Hospital of Pittsburgh ED with a complaint of abdominal pain over the course of 2 years, was conducted. Demographic and clinical characteristics, as well as visit outcomes, were reviewed. Subjects were grouped by age, race, and gender. Results of evaluation, treatment, and clinical outcomes were compared between groups by using multivariate analysis and recursive partitioning. There were 9424 patient visits during the study period that met inclusion and exclusion criteria. Female gender comprised 61% of African American children compared with 52% of white children. Insurance was characterized as private for 75% of white and 37% of African American children. A diagnosis of appendicitis was present in 1.9% of African American children and 5.1% of white children. Older children were more likely to be admitted and have an operation associated with their ED visit. Appendicitis was uncommon in younger children. Constipation was commonly diagnosed. Multivariate analysis by diagnosis as well as recursive partitioning analysis did not reflect any racial differences in evaluation, treatment, or outcome. Constipation is the most common diagnosis in children presenting with abdominal pain. Our data demonstrate that no racial differences exist in the evaluation, treatment, and disposition of children with abdominal pain.

  13. Epidemiology and incidence of acute and chronic Post-Surgical pain.

    Science.gov (United States)

    Sansone, Pasquale; Pace, Maria Caterina; Passavanti, Maria Beatrice; Pota, Vincenzo; Colella, Umberto; Aurilio, Caterina

    2015-01-01

    Post Surgical Pain (PSP) treatment represents a significant aspect of management of surgical patients. Incidence of severe PSP, with significant functional deficit is estimated at 5-10%. Most studies include a limited number of patients and this is a factor which affects power of results. Aims of our prospective observational study was to evaluate the incidence and characteristics of acute and chronic PSP in patients undergoing surgery at the university hospital of second university of naples. After Ethics Committee approval and written informed consent, the PSP acute on first day (at least 6 hours after surgery) through the International Pain Outcomes questionnaire was rated. Subsequently, patients were followed-up at 6 and 12 months; data collection took place by e-mail or phone and the Brief Pain Inventory and the DN4 were administered. We enrolled 235 patients, 219 performed the follow-up to 6months, 195 even that to 12 The incidence of CPSP at 6 months was of 45.2% for mild pain, 15.9% for moderate pain and of 2.7% for severe pain while the incidence of CPSP at 12 months was 35.9%, 11.8% and 2.5% respectively for the pain mild, moderate and severe. Neuropathic pain occurred in 40.3% of patients who CPSP moderate at 12 months compared with 31.9% of the patients interviewed at 6 months. Incidence and characteristics of PSP varied, often considerably, depending on the type of surgery, gender, age of the patient and the presence of PSP severe in the 24 hours following surgery. The incidence of CPSP 12 months after surgery must be improved in the next future. Preoperative pain and the percentage of time with severe pain during the first 24 hours after surgery seem to be CPSP predictors.

  14. 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.

  15. 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.

  16. 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.)

  17. 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) ...

  18. 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...

  19. 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

  20. 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.

  1. 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.

  2. Acute pain in children and adults with sickle cell disease: management in the absence of evidence-based guidelines.

    Science.gov (United States)

    Field, Joshua J; Knight-Perry, Jessica E; Debaun, Michael R

    2009-05-01

    Acute, vaso-occlusive pain is the most characteristic complication of sickle cell disease (SCD). Although there has been rigorous work examining the pathogenesis of vaso-occlusion, fewer studies have focused on approaches to the clinical management of acute pain. In this review, we will examine the epidemiology and management strategies of acute pain events and we will identify limitations in the best available studies. Most acute pain events in adults with SCD are managed at home without physician contact. Prior descriptions of the natural history of pain episodes from the Cooperative Study of Sickle Cell Disease relied on physician contact, limiting the generalizability of these findings to current practice. Patient-controlled analgesia has replaced on-demand therapy to become the standard for management of severe pain events in children and adults with SCD requiring hospital admission. Unfortunately, most clinical practice guidelines for the management of acute pain are not based on randomized clinical trials. As a result, our practice of pain management is primarily limited to expert opinion and inferences from observational studies. Additional clinical trials in management of acute pain in children and adults with SCD are critical for the development of evidence-based guidelines.

  3. 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

  4. 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

    on acute and sustained pain after lumbar disk surgery. In this blinded study, 160 patients undergoing lumbar disk surgery were randomly assigned to 16 mg IV dexamethasone or placebo. All patients received perioperative paracetamol and ibuprofen, and postoperative IV patient-controlled analgesia...... months postoperatively. Acute pain during mobilization (weighted average area under the curve, 2-24 hours) was significantly reduced in the dexamethasone group: 33 (22) mm vs placebo 43 (18) mm, (95% confidence interval [CI] 3-16) P = 0.005. Vomiting 0 to 24 hours postoperatively was reduced....../paralysis of the legs in the dexamethasone and placebo groups, respectively, 3 months postoperatively (P = 0.20). In conclusion, preoperative dexamethasone significantly reduced pain during mobilization and vomiting, after lumbar disk surgery. No significant effects were observed 3 months postoperatively....

  5. 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)

  6. Acute Low Back Pain? Do Not Blame the Weather-A Case-Crossover Study.

    Science.gov (United States)

    Beilken, Keira; Hancock, Mark J; Maher, Chris G; Li, Qiang; Steffens, Daniel

    2017-06-01

    To investigate the influence of various weather parameters on the risk of developing a low back pain (LBP) episode. Case-crossover study. Primary care clinics in Sydney, Australia. 981 participants with a new episode of acute LBP. Weather parameters were obtained from the Australian Bureau of Meteorology. Odds ratios (OR) and 95% confidence intervals (95% CI) were derived comparing two exposure variables in the case window-(1) the average of the weather variable for the day prior to pain onset and (2) the change in the weather variable from 2 days prior to 1 day prior to pain onset-with exposures in two control windows (1 week and 1 month before the case window). The weather parameters of precipitation, humidity, wind speed, wind gust, wind direction, and air pressure were not associated with the onset of acute LBP. For one of the four analyses, higher temperature slightly increased the odds of pain onset. Common weather parameters that had been previously linked to musculoskeletal pain, such as precipitation, humidity, wind speed, wind gust, wind direction, and air pressure, do not increase the risk of onset for LBP. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  7. Spinal epidural neurostimulation for treatment of acute and chronic intractable pain: initial and long term results.

    Science.gov (United States)

    Richardson, R R; Siqueira, E B; Cerullo, L J

    1979-09-01

    Spinal epidural neurostimulation, which evolved from dorsal column stimulation, has been found to be effective in the treatment of acute and chronic intractable pain. Urban and Hashold have shown that it is a safe, simplified alternative to dorsal column stimulation, especially because laminectomy is not required if the electrodes are inserted percutaneously. Percutaneous epidural neurostimulation is also advantageous because there can be a diagnostic trial period before permanent internalization and implantation. This diagnostic and therapeutic modality has been used in 36 patients during the past 3 years at Northwestern Memorial Hospital. Eleven of these patients had acute intractable pain, which was defined as pain of less than 1 year in duration. Initial postimplantation results from the 36 patients indicate that spinal epidural neurostimulation is most effective in treating the intractable pain of diabetes, arachnoiditis, and post-traumatic and postamputation neuroma. Long term follow-up, varying from 1 year to 3 years postimplantation in the 20 initially responding patients, indicates that the neurostimulation continues to provide significant pain relief (50% or greater) in a majority of the patients who experienced initial significant pain relief.

  8. 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

  9. Reported provision of analgesia to patients with acute abdominal pain in Canadian paediatric emergency departments.

    Science.gov (United States)

    Poonai, Naveen; Cowie, Allyson; Davidson, Chloe; Benidir, Andréanne; Thompson, Graham C; Boisclair, Philippe; Harman, Stuart; Miller, Michael; Butter, Andreana; Lim, Rod; Ali, Samina

    2016-09-01

    Evidence exists that analgesics are underutilized, delayed, and insufficiently dosed for emergency department (ED) patients with acute abdominal pain. For physicians practicing in a Canadian paediatric ED setting, we (1) explored theoretical practice variation in the provision of analgesia to children with acute abdominal pain; (2) identified reasons for withholding analgesia; and (3) evaluated the relationship between providing analgesia and surgical consultation. Physician members of Paediatric Emergency Research Canada (PERC) were prospectively surveyed and presented with three scenarios of undifferentiated acute abdominal pain to assess management. A modified Dillman's Tailored Design method was used to distribute the survey from June to July 2014. Overall response rate was 74.5% (149/200); 51.7% of respondents were female and mean age was 44 (SD 8.4) years. The reported rates of providing analgesia for case scenarios representative of renal colic, appendicitis, and intussusception, were 100%, 92.1%, and 83.4%, respectively, while rates of providing intravenous opioids were 85.2%, 58.6%, and 12.4%, respectively. In all 60 responses where the respondent indicated they would obtain a surgical consultation, analgesia would be provided. In the 35 responses where analgesia would be withheld, 21 (60%) believed pain was not severe enough, while 5 (14.3%) indicated it would obscure a surgical condition. Pediatric emergency physicians self-reported rates of providing analgesia for acute abdominal pain scenarios were higher than previously reported, and appeared unrelated to request for surgical consultation. However, an unwillingness to provide opioid analgesia, belief that analgesia can obscure a surgical condition, and failure to take self-reported pain at face value remain, suggesting that the need exists for further knowledge translation efforts.

  10. 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.

  11. 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.

  12. [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 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 continuing to show

  13. Pharmacist's impact on acute pain management during trauma resuscitation.

    Science.gov (United States)

    Montgomery, Kayla; Hall, A Brad; Keriazes, Georgia

    2015-01-01

    The timely administration of analgesics is crucial to the comprehensive management of trauma patients. When an emergency department (ED) pharmacist participates in trauma resuscitation, the pharmacist acts as a medication resource for trauma team members and facilitates the timely administration of analgesics. This study measured the impact of a pharmacist on time to first analgesic dose administered during trauma resuscitation. All adult (>18 years) patients who presented to this level II trauma center via activation of the trauma response system between January 1, 2009, and May 31, 2013, were screened for eligibility. For inclusion, patients must have received intravenous fentanyl, morphine, or hydromorphone in the trauma bay. The time to medication administration was defined as the elapsed time from ED arrival to administration of first analgesic. There were 1328 trauma response system activations during the study period; of which 340 patients were included. The most common analgesic administered was fentanyl (62% in both groups). When a pharmacist was participating, the mean time to first analgesic administered was decreased (17 vs 21 minutes; P = .03). Among the 78% of patients with documented pain scores, the overall mean reduction in pain scores from ED arrival to ED discharge was similar between the 2 groups. There was a 2.4 point reduction with a pharmacist versus 2.7 without a pharmacist, using a 0 to 10 numeric pain rating scale. The participation of a clinical pharmacist during trauma resuscitation significantly decreased the time to first analgesic administration in trauma patients. The results of this study supplement the literature supporting the integration of clinical ED pharmacists on trauma teams.

  14. BET 2: Low-dose ketamine for acute pain in the ED.

    Science.gov (United States)

    Duncan, Colby; Riley, Brad

    2016-12-01

    A short cut review was carried out to establish whether low-dose ketamine is better than morphine at safely and effectively reducing pain scores in ED patients with acute pain who do not respond to conventional therapies. One hundred and thirty-two papers were found using the reported searches, of these three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that the evidence is limited, but that ketamine can be an effective alternative or adjunct to intravenous opioid pain medications and in some instances may provide more effective pain relief when compared with opioids. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  15. 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

    was mainly reserved for chronic patients. Danish chiropractors' compliance with guidelines for neck-pain patients was low, but is neither worse nor better than what is seen for other complaints or health disciplines. Our findings suggest a need for active knowledge translation strategies and robust......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...

  16. Are there gender differences in coping with neck pain following acute whiplash trauma?

    DEFF Research Database (Denmark)

    Carstensen, T B W; Frostholm, Lisbeth; Oernboel, E

    2012-01-01

    BACKGROUND: Little is known about gender differences in coping after whiplash, and to date possible interaction of gender and coping on recovery has not been investigated. AIMS: To examine if gender differences in coping are associated with long-lasting neck pain after acute whiplash. METHODS...... they completed the Coping Strategies Questionnaire, and after 12months a VAS scale on neck pain intensity. RESULTS: The odds for long-lasting neck pain were more than twice as high for women than for men (OR=2.17 (95% CI: 1.40; 3.37). However, no gender difference in coping and no interaction between gender.......10 (95% CI: 1.05; 1.13) for each point on these scales. CONCLUSIONS: No interaction between coping and gender on neck pain was found, thus different coping strategies 3months post-collision did not explain the different prognosis observed in men and women. Clinically relevant influence...

  17. Parental risk factors for the development of pediatric acute and chronic postsurgical pain: a longitudinal study

    Directory of Open Access Journals (Sweden)

    Pagé MG

    2013-09-01

    Full Text Available M Gabrielle Pagé,1 Fiona Campbell,2,3 Lisa Isaac,2,3 Jennifer Stinson,2,4 Joel Katz1,3,5 1Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada; 2Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON, Canada; 3Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; 4Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada; 5Department of Psychology, Hospital for Sick Children, Toronto, ON, Canada Background: The goal of this longitudinal study was to examine the associations among psychological factors and pain reports of children and their parents over the 12 month period after pediatric surgery. Materials and methods: Included in the study were 83 children aged 8–18 years undergoing major surgery. In each case, the child and one of their parents completed measures of pain intensity and unpleasantness, psychological function, and functional disability at 48–72 hours, 2 weeks (child only, 6 months, and 12 months after surgery. Results: The strength of the correlation coefficients between the psychological measures of the parent and their child increased significantly over time. There was a fair level of agreement between parent ratings of child acute and chronic pain (6 months after surgery and the child's actual ratings. Parent and child pain anxiety scores 48–72 hours after surgery interacted significantly to predict pain intensity, pain unpleasantness, and functional disability levels 2 weeks after discharge from hospital. Parent pain catastrophizing scores 48–72 hours after surgery predicted child pain intensity reports 12 months later. Conclusion: These results raise the possibility that as time from surgery increases, parents exert greater and greater influence over the pain response of their children, so that by 12 months postsurgery mark, parent pain catastrophizing (measured in the days after surgery is the

  18. Lead Poisoning Can Be Easily Misdiagnosed as Acute Porphyria and Nonspecific Abdominal Pain

    Directory of Open Access Journals (Sweden)

    Ming-Ta Tsai

    2017-01-01

    Full Text Available Lead poisoning (LP is less commonly encountered in emergency departments (ED. However, lead exposure still occurs, and new sources of poisoning have emerged. LP often goes unrecognized due to a low index of suspicion and nonspecific symptoms. We present a case of a 48-year-old man who had recurring abdominal pain with anemia that was misdiagnosed. His condition was initially diagnosed as nonspecific abdominal pain and acute porphyria. Acute porphyria-like symptoms with a positive urine porphyrin test result led to the misdiagnosis; testing for heme precursors in urine is the key to the differential diagnosis between LP and acute porphyria. The final definitive diagnosis of lead toxicity was confirmed based on high blood lead levels after detailed medical history taking. The lead poisoning was caused by traditional Chinese herbal pills. The abdominal pain disappeared after a course of chelating treatment. The triad for the diagnosis of lead poisoning should be a history of medicine intake, anemia with basophilic stippling, and recurrent abdominal pain.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. Increased energy expenditure and glucose oxidation during acute nontraumatic skin pain in humans.

    Science.gov (United States)

    Holland-Fischer, Peter; Greisen, Jacob; Grøfte, Thorbjørn; Jensen, Troels S; Hansen, Peter O; Vilstrup, Hendrik

    2009-04-01

    Tissue injury is accompanied by pain and results in increased energy expenditure, which may promote catabolism. The extent to which pain contributes to this sequence of events is not known. In a cross-over design, 10 healthy volunteers were examined on three occasions; first, during self-controlled nontraumatic electrical painful stimulus to the abdominal skin, maintaining an intensity of 8 on the visual analogue scale (0-10). Next, the electrical stimulus was reproduced during local analgesia and, finally, there was a control session without stimulus. Indirect calorimetry and blood and urine sampling was done in order to calculate energy expenditure and substrate utilization. During pain stimulus, energy expenditure increased acutely and reversibly by 62% (95% confidence interval, 43-83), which was abolished by local analgesia. Energy expenditure paralleled both heart rate and blood catecholamine levels. The energy expenditure increase was fuelled by all energy sources, with the largest increase in glucose utilization. The pain-related increase in energy expenditure was possibly mediated by adrenergic activity and was probably to a large extent due to increased muscle tone. These effects may be enhanced by cortical events related to the pain. The increase in glucose consumption favours catabolism. Our findings emphasize the clinical importance of pain management.

  4. Person-centred pain management for the patient with acute abdominal pain: an ethnography informed by the Fundamentals of Care framework.

    Science.gov (United States)

    Avallin, Therese; Muntlin Athlin, Åsa; Sorensen, Erik Elgaard; Kitson, Alison; Björck, Martin; Jangland, Eva

    2018-06-12

    To explore and describe the impact of the organizational culture on and the patient-practitioner patterns of actions that contribute to or detract from successful pain management for the patient with acute abdominal pain across the acute care pathway. Although pain management is a recognised human right, unmanaged pain continues to cause suffering and prolong hospital care. Unanswered questions about how to successfully manage pain relate to both organizational culture and individual practitioners' performance. Focused ethnography, applying the Developmental Research Sequence and the Fundamentals of Care framework. Participant observation and informal interviews (92 hours) were performed at one emergency department and two surgical wards at a University Hospital during April - November 2015. Data includes 261 interactions between patients, aged ≥18 years seeking care for acute abdominal pain at the emergency department and admitted to a surgical ward (N = 31; aged 20-90 years; 14 men, 17 women; 9 with communicative disabilities) and healthcare practitioners (N =198). The observations revealed an organizational culture with considerable impact on how well pain was managed. Well managed pain presupposed the patient and practitioners to connect in a holistic pain management including a trustful relationship, communication to share knowledge and individualized analgesics. Person-centred pain management requires an organization where patients and practitioners share their knowledge of pain and pain management as true partners. Leaders and practitioners should make small behavioural changes to enable the crucial positive experience of pain management. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  5. 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.

  6. Frutalin reduces acute and neuropathic nociceptive behaviours in rodent models of orofacial pain.

    Science.gov (United States)

    Damasceno, Marina B M V; de Melo Júnior, José de Maria A; Santos, Sacha Aubrey A R; Melo, Luana T M; Leite, Laura Hévila I; Vieira-Neto, Antonio E; Moreira, Renato de A; Monteiro-Moreira, Ana Cristina de O; Campos, Adriana R

    2016-08-25

    Orofacial pain is a highly prevalent clinical condition, yet difficult to control effectively with available drugs. Much attention is currently focused on the anti-inflammatory and antinociceptive properties of lectins. The purpose of this study was to evaluate the antinociceptive effect of frutalin (FTL) using rodent models of inflammatory and neuropathic orofacial pain. Acute pain was induced by formalin, glutamate or capsaicin (orofacial model) and hypertonic saline (corneal model). In one experiment, animals were pretreated with l-NAME and naloxone to investigate the mechanism of antinociception. The involvement of the lectin domain in the antinociceptive effect of FTL was verified by allowing the lectin to bind to its specific ligand. In another experiment, animals pretreated with FTL or saline were submitted to the temporomandibular joint formalin test. In yet another, animals were submitted to infraorbital nerve transection to induce chronic pain, followed by induction of thermal hypersensitivity using acetone. Motor activity was evaluated with the rotarod test. A molecular docking was performed using the TRPV1 channel. Pretreatment with FTL significantly reduced nociceptive behaviour associated with acute and neuropathic pain, especially at 0.5 mg/kg. Antinociception was effectively inhibited by l-NAME and d-galactose. In line with in vivo experiments, docking studies indicated that FTL may interact with TRPV1. Our results confirm the potential pharmacological relevance of FTL as an inhibitor of orofacial nociception in acute and chronic pain mediated by TRPA1, TRPV1 and TRPM8 receptor. Copyright © 2016. Published by Elsevier Ireland Ltd.

  7. [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.

  8. 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.

  9. 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.

  10. The use of subdissociative-dose ketamine for acute pain in the emergency department.

    Science.gov (United States)

    Sin, Billy; Ternas, Theologia; Motov, Sergey M

    2015-03-01

    Ketamine is a well-known anesthetic with its use trailing back to the 1960s. It has antagonistic effects at the N-methyl-d-aspartate receptor. There is emerging literature to suggest the use of subdissociative-dose ketamine (SDDK) for pain reduction. This evidence-based review evaluates the evidence regarding the use of SDDK for acute pain control in the emergency department (ED). The MEDLINE and EMBASE databases were searched. Randomized controlled trials (RCTs) that described or evaluated the use of SDDK for acute pain in the ED were included. Literature was excluded if it was not published in English. Duplicate articles, unpublished reports, abstracts, and review articles were also excluded. Quality assessment and evaluation of literature were evaluated based on the GRADE criteria. The primary outcome of interest in this review was the difference in pain score from baseline to cutoff time as specified in the studies. Secondary outcome measures were the incidence of adverse events and reduction in the amount of adjuvant opioids consumed by patients who received SDDK. Four RCTs met the inclusion criteria, which enrolled a total of 428 patients. Three adult trials and one pediatric trial were identified. The level of evidence for the individual trials ranged from low to moderate. A significant reduction in pain scores was only found in two of the four trials. One trial found a significant reduction in mean pain scores when ketamine was compared to morphine (p ketamine over placebo (0.14 mg/kg, 95% confidence interval [CI] = 0.13 to 0.16 mg/kg vs. 0.2 mg/kg, 95% CI = 0.18 to 0.22 mg/kg; p pain control in the ED. © 2015 by the Society for Academic Emergency Medicine.

  11. [Quality management in acute pain therapy: results from a survey of certified hospitals].

    Science.gov (United States)

    Böhmer, A B; Poels, M; Simanski, C; Trojan, S; Messer, K; Wirtz, M D; Neugebauer, E A M; Wappler, F; Joppich, R

    2012-08-01

    Systems for and methods of quality management are increasingly being implemented in public health services. The aim of our study was to analyze the current state of the integrated quality management concept "quality management acute pain therapy" of the TÜV Rheinland® (TÜV) after a 5-year project period. General characteristics of the participating hospitals, number of departments certified by the TÜV and implementation of structures and processes according to the TÜV guidelines were evaluated by a mail questionnaire. Furthermore, positive and negative aspects concerning the effects of certification were evaluated by the hospitals' representatives of certification. A total of 36 questionnaires were returned. Since 2006 the number of certified hospitals (2011: n = 48) and surgical departments (2011: n = 202) has increased continuously. The number of certified medical departments is low (2011: n = 39); however, in the last 3 years, it has increased by about 200-300% annually. Standard operative procedures for pain therapy and measurement of pain intensity at regular intervals were implemented in all certified clinics (100%). Although 41% take part in the benchmarking project QUIPS (Quality Improvement in Postoperative Pain Therapy), 24% do not systematically check the quality of the outcome of pain management. Acceptance of the new pain therapy concepts among nursing staff was rated positively (ratio positive:negative 16:1); however, acceptance among physicians was rated negatively (1:15). Certification by the TÜV leads to sustainable implementation of quality management principles. Future efforts should focus on better integration of physicians in acute pain therapy and the development of an integrated tool to measure patients' outcome.

  12. The Effect of Foot Reflexology on Acute Pain in Infants: A Randomized Controlled Trial.

    Science.gov (United States)

    Koç, Tuba; Gözen, Duygu

    2015-10-01

    This study was a randomized controlled trial designed to evaluate the effect of foot reflexology applied on infants on acute pain that may arise after vaccine injection. The sample consisted of 1- to 12-month-old infants registered in a family health center in Istanbul, Turkey, for healthcare follow-up. A total of 60 infants who met the criteria of the sample group were included in the study; 30 infants constituted the reflexology group and the other 30 constituted the control group. Although questionnaire forms were used to determine the descriptive characteristics of infant-mother pairs, the Face, Legs, Activity, Cry, Consolability (FLACC) Pain Assessment Scale was used to evaluate pain level. Infants in the reflexology group received reflexology treatment for an average of 20-30 minutes before vaccination, depending on the physical size of the infant's foot. Pain, heart rate, oxygen saturation levels, and crying periods of infants in the reflexology and control groups were evaluated before and after vaccination. The FLACC pain score was observed to be statistically similar between groups. After reflexology was applied to infants in the reflexology group before vaccination, it was determined that the pain score was reduced to .50 ± 1.14. In the examination performed after vaccination, FLACC pain score was found to be 5.47 ± 2.11 in the reflexology group and 9.63 ± .85 in the control group. A statistically significant difference was observed between the mean FLACC pain scores of infants in the reflexology and control groups (p = .000). The infants in the reflexology group also had lower heart rates, higher oxygen saturation, and shorter crying periods than the infants in the control group (p Reflexology before vaccine reduced the pain level experienced after vaccination. Future research needs to explore different interventional practices. © 2015 Sigma Theta Tau International.

  13. 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.

  14. 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)

  15. Acute chest pain after bench press exercise in a healthy young adult.

    Science.gov (United States)

    Smereck, Janet A; Papafilippaki, Argyro; Sudarshan, Sawali

    2016-01-01

    Bench press exercise, which involves repetitive lifting of weights to full arm extension while lying supine on a narrow bench, has been associated with complications ranging in acuity from simple pectoral muscle strain, to aortic and coronary artery dissection. A 39-year-old man, physically fit and previously asymptomatic, presented with acute chest pain following bench press exercise. Diagnostic evaluation led to the discovery of critical multivessel coronary occlusive disease, and subsequently, highly elevated levels of lipoprotein (a). Judicious use of ancillary testing may identify the presence of "high-risk" conditions in a seemingly "low-risk" patient. Emergency department evaluation of the young adult with acute chest pain must take into consideration an extended spectrum of potential etiologies, so as to best guide appropriate management.

  16. Red herring: Acute back pain after combined spinal epidural for labor analgesia

    Directory of Open Access Journals (Sweden)

    Yoong Chuan Tay

    2018-04-01

    Full Text Available Symphysis pubis diastases complicate 1:300 to 1:30,000 pregnancies. Peripartum pain in chronological sequence with labor epidural analgesia often attracts instinctive causation and distress. Predisposing risk factors include macrosomia, short second stage of labor, forceps use, multiparity, small pelvis, intense uterine contractions, previous pelvic ring pathology and trauma. A gestational diabetic primigravid parturient presents with acute post-partum back pain after an uneventful analgesic labor epidural. Her pain distributed over the right paravertebral L5-S1 region without radiculopathy, worsened with positional change and accompanied by urinary incontinence, precluding child care. Spine imaging incidentally revealed a 38 mm symphysis pubis diastasis. A pelvic binder by orthopaedics aided physiotherapy and ambulation. Pubic diastases are usually conservatively managed, unless separation exceeds 5 cm when early surgery may improve functional outcomes. Although symptoms may recur in subsequent pregnancies, it does not preclude vaginal delivery. Early recognition and prompt management aim to reduce parturient morbidity and promote resumption of activity. Keywords: Symphysis pubis diasthesis, Pubic symphysis diasthesis, Post-epidural pain, Labor epidural pain, Post-partum pain

  17. Intradermal therapy (mesotherapy) for the treatment of acute pain in carpal tunnel syndrome: a preliminary study.

    Science.gov (United States)

    Conforti, Giorgio; Capone, Loredana; Corra, Stefano

    2014-01-01

    The carpal tunnel syndrome (CTS) is the most common cause of severe hand pain. In this study we treated acute pain in CTS patients by means of local intradermal injections of anti-inflammatory drugs (mesotherapy). In twenty-five patients (forty-five hands), CTS diagnosis was confirmed by clinical and neurophysiological examination prior to mesotherapy. A mixture containing lidocaine 10 mg, ketoprophen lysine-acetylsalycilate 80 mg, xantinol nicotinate 100 mg, cyanocobalamine 1,000 mcg plus injectable water was used. Sites of injection were three parallel lines above the transverse carpal ligament and two v-shaped lines, one at the base of the thenar eminence, and the other at the base of the hypothenar eminence. The day after the treatment, all but four patients reported a significant reduction in pain and paresthesias. After 12 months, 17 patients had a complete pain relief, eight patients reported recurrence of pain and sensory symptoms and four out of them underwent surgical treatment. With the obvious limits of a small-size open-label study, our results suggest that mesotherapy can temporary relieve pain and paresthesias in most CTS patients and in some cases its effect seems to be long-lasting. Further controlled studies are needed to confirm our preliminary findings and to compare mesotherapy to conventional approaches for the treatment of CTS.

  18. 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.

  19. 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

  20. 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

  1. 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

  2. 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

  3. 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.)

  4. 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....

  5. 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.)

  6. 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.

  7. 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.)

  8. 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.

  9. 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.)

  10. Acute severe neck pain and dysphagia following cervical maneuver: diagnostic approach.

    Science.gov (United States)

    Trendel, D; Bonfort, G; Lapierre-Combes, M; Salf, E; Barberot, J-P

    2014-04-01

    Overlooking an etiologic hypothesis in acute neck pain with dysphagia may lead to misdiagnosis. A 51-year-old man who had received cervical manipulation came to the emergency unit with evolutive acute neck pain, cervical spine stiffness and odynophagia, without fever or other signs of identified pathology. Cervical X-ray and CT angiography of the supra-aortic vessels ruled out traumatic etiology (fracture or arterial dissection) and revealed an accessory bone, orienting diagnosis toward retropharyngeal abscess, which was, however, belied by endoscopy performed under general anesthesia. A second CT scan with contrast injection and tissue phase ruled out infection, revealing a retropharyngeal calcification inducing retropharyngeal edema. Evolution under analgesics was favorable within 13 days. Given a clinical triad associating acute neck pain, cervical spine stiffness and odynophagia, traumatic or infectious etiology was initially suspected. Cervical CT diagnosed calcific tendinitis of the longus colli, revealing a pathognomic retropharyngeal calcification. Secondary to hydroxyapatite deposits anterior to the odontoid process of the axis, this is a rare form of tendinopathy, usually showing favorable evolution in 10-15 days under analgesic and anti-inflammatory treatment. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

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

    Energy Technology Data Exchange (ETDEWEB)

    Prazeres, Carlos Eduardo Elias dos; Cury, Roberto Caldeira; Carneiro, Adriano Camargo de Castro [Hospital do Coração - HCor, Associação do Sanatório Sírio, São Paulo, SP (Brazil); Rochitte, Carlos Eduardo, E-mail: rochitte@cardiol.br [Hospital do Coração - HCor, Associação do Sanatório Sírio, São Paulo, SP (Brazil); Instituto do Coração - InCor - HCFMUSP, São Paulo, SP (Brazil)

    2013-12-15

    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.

  13. 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

  14. 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.

  15. Efficacy of naturopathic extracts in the management of ear pain associated with acute otitis media.

    Science.gov (United States)

    Sarrell, E M; Mandelberg, A; Cohen, H A

    2001-07-01

    To determine the efficacy and tolerance of Otikon Otic Solution (Healthy-On Ltd, Petach-Tikva, Israel), a naturopathic herbal extract (containing Allium sativum, Verbascum thapsus, Calendula flores, and Hypericum perforatum in olive oil), compared with Anaesthetic (Vitamed Pharmaceutical Ltd, Benyamina, Israel) ear drops (containing ametocaine and phenazone in glycerin) in the management of ear pain associated with acute otitis media (AOM). Children between the ages of 6 and 18 years who experienced ear pain (otalgia) and who were diagnosed with eardrum problems associated with AOM were randomly assigned to be treated with Otikon or Anaesthetic ear drops, which were instilled into the external canal(s) of the affected ear(s). Ear pain was assessed using 2 visual analog scales: a linear scale and a color scale. Pain assessment took place throughout the course of 3 days. The mean score of pain reduction was used to measure outcome. Primary pediatric community ambulatory centers. One hundred three children aged 6 to 18 years who were diagnosed with otalgia associated with AOM. Each of the 2 treatment groups were comparable on the basis of age, sex, laterality of AOM, and the effectiveness of ameliorating symptoms of otalgia. The 2 groups were also comparable to each other in the initial ear pain score and in the scores at each application of Otikon or Anaesthetic drops. There was a statistically significant improvement in ear pain score throughout the course of the study period (P =.007). Otikon, an ear drop formulation of naturopathic origin, is as effective as Anaesthetic ear drops and was proven appropriate for the management of AOM-associated ear pain.

  16. 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.

  17. 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

    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......OBJECTIVE: The musculoskeletal system is a common but often overlooked cause of chest pain. The purpose of the present study is to evaluate the relative effectiveness of 2 treatment approaches for acute musculoskeletal chest pain: (1) chiropractic treatment that included spinal manipulation and (2......) self-management as an example of minimal intervention. METHODS: In a nonblinded, randomized, controlled trial set at an emergency cardiology department and 4 outpatient chiropractic clinics, 115 consecutive patients with acute chest pain and no clear medical diagnosis at initial presentation were...

  18. 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 (Ppain 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-.

  19. Acute chest pain: The role of MR imaging and MR angiography

    Energy Technology Data Exchange (ETDEWEB)

    Hunold, Peter, E-mail: peter.hunold@uk-sh.de [Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck (Germany); Bischoff, Peter, E-mail: peter.bischoff@uk-sh.de [Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck (Germany); Barkhausen, Jörg, E-mail: joerg.barkhausen@uk-sh.de [Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck (Germany); Vogt, Florian M., E-mail: florian.vogt@uk-sh.de [Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck (Germany)

    2012-12-15

    MR imaging (MRI) and MR angiography (MRA) have gained a high level of diagnostic accuracy in cardiovascular disease. MRI in cardiac disease has been established as the non-invasive standard of reference in many pathologies. However, in acute chest pain the situation is somewhat special since many of the patients presenting in the emergency department suffer from potentially life-threatening disease including acute coronary syndrome, pulmonary embolism, and acute aortic syndrome. Those patients need a fast and definitive evaluation under continuous monitoring of vital parameters. Due to those requirements MRI seems to be less suitable compared to X-ray coronary angiography and multislice computed tomography angiography (CTA). However, MRI allows for a comprehensive assessment of all clinically stable patients providing unique information on the cardiovascular system including ischemia, inflammation and function. Furthermore, MRI and MRA are considered the method of choice in patients with contraindications to CTA and for regular follow-up in known aortic disease. This review addresses specific features of MRI and MRA for different cardiovascular conditions presenting with acute chest pain.

  20. Flank tectonics of Martian volcanoes

    International Nuclear Information System (INIS)

    Thomas, P.J.; Squyres, S.W.; Carr, M.H.

    1990-01-01

    On the flanks of Olympus Mons is a series of terraces, concentrically distributed around the caldera. Their morphology and location suggest that they could be thrust faults caused by compressional failure of the cone. In an attempt to understand the mechanism of faulting and the possible influences of the interior structure of Olympus Mons, the authors have constructed a numerical model for elastic stresses within a Martian volcano. In the absence of internal pressurization, the middle slopes of the cone are subjected to compressional stress, appropriate to the formation of thrust faults. These stresses for Olympus Mons are ∼250 MPa. If a vacant magma chamber is contained within the cone, the region of maximum compressional stress is extended toward the base of the cone. If the magma chamber is pressurized, extensional stresses occur at the summit and on the upper slopes of the cone. For a filled but unpressurized magma chamber, the observed positions of the faults agree well with the calculated region of high compressional stress. Three other volcanoes on Mars, Ascraeus Mons, Arsia Mons, and Pavonis Mons, possess similar terraces. Extending the analysis to other Martian volcanoes, they find that only these three and Olympus Mons have flank stresses that exceed the compressional failure strength of basalt, lending support to the view that the terraces on all four are thrust faults

  1. 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

  2. The impact of anxiety and catastrophizing on interleukin-6 responses to acute painful stress

    Directory of Open Access Journals (Sweden)

    Lazaridou A

    2018-03-01

    Full Text Available Asimina Lazaridou,1 Marc O Martel,1 Christine M Cahalan,1 Marise C Cornelius,1 Olivia Franceschelli,1 Claudia M Campbell,2 Jennifer A Haythornthwaite,2 Michael Smith,2 Joseph Riley,3 Robert R Edwards1 1Department of Anesthesiology, Harvard Medical School, Brigham & Women’s Hospital, Boston, MA, USA; 2Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; 3Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA Objective: To examine the influence of anxiety and pain-related catastrophizing on the time course of acute interleukin-6 (IL-6 responses to standardized noxious stimulation among patients with chronic pain.Methods: Data were collected from 48 participants in the following demographically matched groups: patients with chronic pain (n=36 and healthy controls (n=12. Participants underwent a series of Quantitative Sensory Testing (QST procedures assessing responses to mechanical and thermal stimuli during two separate visits, in a randomized order. One visit consisted of standard, moderately painful QST procedures, while the other visit involved nonpainful analogs to these testing procedures. Blood samples were taken at baseline, and then for up to 2 hours after QST in order to study the time course of IL-6 responses.Results: Results of multilevel analyses revealed that IL-6 responses increased across assessment time points in both visits (p<0.001. While patients with chronic pain and healthy controls did not differ in the magnitude of IL-6 responses, psychological factors influenced IL-6 trajectories only in the chronic pain group. Among patients, increases in catastrophizing over the course of the QST session were associated with elevated IL-6 responses only during the painful QST session (p<0.05. When controlling for anxiety, results indicated that the main multilevel model among patients remained significant

  3. A novel and effective acupuncture modality as a complementary therapy to acute pain relief in inpatients with rib fractures

    OpenAIRE

    Hsin-Yi Ho; Chao-Wei Chen; Ming-Chieh Li; Yu-Pao Hsu; Shih-Ching Kang; Erh-Hao Liu; Ko-Hung Lee

    2014-01-01

    Background: Pain control has been emphasized as a priority for both practitioners and inpatients with rib fractures, since analgesia could only offer limited relief from severe pain. A prospective and randomized controlled trial was conducted to analyze the efficacy and efficiency of acupuncture in acute pain relief for inpatients with rib fractures. Methods: A total of 58 inpatients were recruited and allocated to two groups, receiving identical doses of conventional oral analgesics as we...

  4. Psychosocial predictors in the transition from acute to chronic pain: a systematic review.

    Science.gov (United States)

    Hruschak, Valerie; Cochran, Gerald

    2018-02-28

    Chronic non-cancer pain (CNCP) is a major health problem which psychosocial factors have significant implications in. There is a gap in regards to evidence for the prevention of chronicity specifically addressing psychological and social domains. Four databases were searched with terms related to "psychosocial", "acute pain", and "chronic pain". A total of 1,389 studies were identified in which titles, abstracts, and full texts were assessed for inclusion criteria. A data template was used to capture pertinent details, and overall themes and patterns were organized according to type of pain examined and psychosocial variables measured. Of the 18 articles that met inclusion criteria, fifteen (83%) of the articles reported an association between psychosocial factors and chronicity. A total of 5 of the studies (29%) demonstrated that depression was a possible predictor and 6 (35%) of the studies found fear-avoidance to be associated with chronicity. This review provides evidence that psychosocial factors are associated with chronicity within CNCP. These results suggest a need for targeting psychosocial predictors in prevention and early intervention through clinical guidelines and a national strategy to support a cultural change in pain care.

  5. [Sacroiliac joint dysfunction presented with acute low back pain: three case reports].

    Science.gov (United States)

    Hamauchi, Shuji; Morimoto, Daijiro; Isu, Toyohiko; Sugawara, Atsushi; Kim, Kyongsong; Shimoda, Yusuke; Motegi, Hiroaki; Matsumoto, Ryoji; Isobe, Masanori

    2010-07-01

    Sacroiliac joint (SIJ) can cause low back pain when its joint capsule and ligamentous tissue are damaged. We report our experience in treating three SIJ dysfunction patients presenting with acute low back pain (a 38 year-old male, a 24 year-old male, and a 32 year-old female). SIJ dysfunction was diagnosed using the one-finger test, the modified Newton test, and SIJ injection. In all three patients, lumbar MRI demonstrated slightly degenerated lumbar lesions (lumbar canal stenosis, lumbar disc hernia). Two patients had paresthesia or pain in the leg and all three patients showed iliac muscle tenderness in the groin, which was thought to be a referred symptom because of improvement after SIJ injection. The two male patients returned to work and the problems have not recurred. Although our female patient resumed daily life as a housewife, her condition recurred at intervals of 2-3 months and she required regular SIJ injections. The prevalence of SIJ dysfunction of low back pain is about 10%, so it should be considered as a differential diagnosis when treating low back pain and designing treatment for lumbar spinal disorders.

  6. Lumiracoxib for acute postoperative dental pain: a systematic review of randomized clinical trials

    Directory of Open Access Journals (Sweden)

    Ricardo Carvalho Lopes Silva

    Full Text Available CONTEXT AND OBJECTIVE: Lumiracoxib is an anti-inflammatory drug that has been used to treat acute dental pain, mainly in postsurgical settings, in which the greatest levels of pain and discomfort are experienced during the first 24 hours. This study aimed to assess the efficacy and safety of lumiracoxib for treating acute postsurgical dental pain. DESIGN AND SETTING: Systematic review developed at the Brazilian Cochrane Centre, Universidade Federal de São Paulo. METHODS: An electronic search was conducted in the PubMed, Cochrane Library, Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde, SciELO (Scientific Electronic Library Online and Embase databases. A manual search was also performed. Only randomized controlled trials were included, and these were selected and assessed by two researchers with regard to the risk of bias. RESULTS: Three clinical trials with 921 participants were included. Lumiracoxib 400 mg produced onset of analgesia in a shorter time than shown by lumiracoxib 100 mg, celecoxib 200 mg and ibuprofen 400 mg. There was no difference between lumiracoxib 400 mg and rofecoxib 50 mg. In two studies, the mean time taken to attain onset of analgesia for the placebo was not estimated because the number of participants who reached onset was too small. CONCLUSION: There is evidence with a moderate risk of bias that recommends the use of lumiracoxib for acute postoperative dental pain. However, the adverse effects are not completely known. Given that lumiracoxib is currently available in only three countries, further studies are likely to be rare and discouraged.

  7. 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

  8. Assessment of post-operative pain management among acutely and electively admitted patients - a Swedish ward perspective.

    Science.gov (United States)

    Magidy, Mahnaz; Warrén-Stomberg, Margareta; Bjerså, Kristofer

    2016-04-01

    Swedish health care is regulated to involve the patient in every intervention process. In the area of post-operative pain, it is therefore important to evaluate patient experience of the quality of pain management. Previous research has focused on mapping this area but not on comparing experiences between acutely and electively admitted patients. Hence, the aim of this study was to investigate the experiences of post-operative pain management quality among acutely and electively admitted patients at a Swedish surgical department performing soft-tissue surgery. A survey study design was used as a method based on a multidimensional instrument to assess post-operative pain management: Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP). Consecutive patients at all wards of a university hospital's surgical department were included. Data collection was performed at hospital discharge. In total, 160 patients participated, of whom 40 patients were acutely admitted. A significant difference between acutely and electively admitted patients was observed in the SCQIPP area of environment, whereas acute patients rated the post-operative pain management quality lower compared with those who were electively admitted. There may be a need for improvement in the areas of post-operative pain management in Sweden, both specifically and generally. There may also be a difference in the experience of post-operative pain quality between acutely and electively admitted patients in this study, specifically in the area of environment. In addition, low levels of the perceived quality of post-operative pain management among the patients were consistent, but satisfaction with analgesic treatment was rated as good. © 2015 John Wiley & Sons, Ltd.

  9. Predicting Severity of Acute Pain After Cesarean Delivery: A Narrative Review.

    Science.gov (United States)

    Gamez, Brock H; Habib, Ashraf S

    2018-05-01

    Cesarean delivery is one of the most common surgical procedures in the United States, with over 1.3 million performed annually. One-fifth of women who undergo cesarean delivery will experience severe pain in the acute postoperative period, increasing their risk of developing chronic pain and postpartum depression, and negatively impacting breastfeeding and newborn care. A growing body of research has investigated tools to predict which patients will experience more severe pain and have increased analgesic consumption after cesarean delivery. These include quantitative sensory testing, assessment of wound hyperalgesia, response to local anesthetic infiltration, and preoperative psychometric evaluations such as validated psychological questionnaires and simple screening tools. For this review, we searched MEDLINE, the Cochrane database, and Google Scholar to identify articles that evaluated the utility of various tools to predict severe pain and/or opioid consumption in the first 48 hours after cesarean delivery. Thirteen articles were included in the final review: 5 utilizing quantitative sensory testing, including patient responses to pressure, electrical, and thermal stimuli; 1 utilizing hyperalgesia testing; 1 using response to local anesthetic wound infiltration; 4 utilizing preoperative psychometric evaluations including the State-Trait Anxiety Inventory, the Pain Catastrophizing Scale, the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale, and simple questionnaires; and 2 utilizing a combination of quantitative sensory tests and psychometric evaluations. A number of modalities demonstrated statistically significant correlations with pain outcomes after cesarean delivery, but most correlations were weak to modest, and many modalities might not be clinically feasible. Response to local anesthetic infiltration and a tool using 3 simple questions enquiring about anxiety and anticipated pain and analgesic needs show potential for clinical

  10. 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

  11. Oral health and orofacial pain in people with dementia admitted to acute hospital wards: observational cohort study.

    Science.gov (United States)

    van de Rijt, Liza J M; Weijenberg, Roxane A F; Feast, Alexandra R; Vickerstaff, Victoria; Lobbezoo, Frank; Sampson, Elizabeth L

    2018-05-23

    Orofacial pain in people with dementia is difficult to detect, and often under-treated. Our aim was to investigate the prevalence of orofacial pain in people with dementia in acute hospitals in the UK. Secondary aims were to examine oral health status and explore associations between orofacial pain and oral health factors. This cross-sectional observational study was carried out in two UK hospitals. Using the Orofacial Pain Scale in Non-Verbal Individuals (OPS-NVI) to identify orofacial pain, 101 participants with dementia, admitted to acute medical wards, were observed for at least 3 min during rest and chewing. Verbal participants were then asked about presence of orofacial pain, using self-report pain scales. Finally, a brief oral assessment was performed. Orofacial pain, assessed with the OPS-NVI, was present in 11.9% (95% C.I. 5.9, 18.8) of participants at rest and 21.9% (95% C.I. 14.6, 31.3) whilst chewing. Participants who were no longer able to self-report pain were significantly more likely to experience orofacial pain. Oral health in both dentate and edentate participants was poor. Brush frequency, indication of chewing quality, consistency of the food, presence of extra-oral abnormalities, person who performed mouth care, and oral hygiene in dentate participants were significant predictors for the presence of orofacial pain. Improving oral care in acute hospital patients with dementia, particularly those who cannot self-report pain, may significantly reduce pain and suffering in this population.

  12. 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.

  13. Prolonged nerve block by microencapsulated bupivacaine prevents acute postoperative pain in rats.

    Science.gov (United States)

    Ohri, Rachit; Blaskovich, Phillip; Wang, Jeffrey Chi-Fei; Pham, Lan; Nichols, Gary; Hildebrand, William; Costa, Daniel; Scarborough, Nelson; Herman, Clifford; Strichartz, Gary

    2012-01-01

    To minimize acute postoperative pain, a new formulation of slowly released bupivacaine was developed. Bupivacaine was microencapsulated at 60% (wt/wt) in poly-lactide-co-glycolide polymers and characterized for physicochemical properties and bupivacaine release kinetics. This formulation was injected around the rat sciatic nerve to produce an antinociceptive effect to toe pinch. Mechanical hyperalgesia following lateral plantar paw incision in rats was assessed for 7 to 14 days when the bupivacaine slow-release formulation was placed at the ipsilateral sciatic nerve and compared with the hyperalgesia that developed with various controls. Bupivacaine was released in vitro at a relatively constant rate over a period of ≈ 72 to 96 hours. Complete antinociception, shown as no response to toe pinch, lasted for 23 ± 7 hours, with a half-recovery time of 42 ± 8 hours after sciatic nerve injection of 0.4 mL of the microspheres delivering 34 mg of bupivacaine. Solutions of 0.5% (wt/vol) bupivacaine-HCl (0.1 mL) produced complete antinociception for less than 2 hours and recovery half-times of 2 hours. Postincisional mechanical hyperalgesia, shown by increased withdrawal responses to von Frey filaments, was absent for 24 hours and was lower than control for 96 hours, when the sciatic nerve was blocked by bupivacaine microspheres, whereas the 0.5% bupivacaine solution reduced postincisional pain for only 4 hours. Corresponding to its far greater functional blocking time, the microsphere-bupivacaine formulation was able to significantly reduce postoperative pain below control levels for up to 4 days. These findings of several days of postoperative pain relief, for an injectable formulation containing a single active agent, present an improved and potentially promising therapy to prevent acute pain after surgery.

  14. [Spontaneous bile duct perforation: a rare cause of acute abdominal pain during childhood].

    Science.gov (United States)

    Ozdemir, Tunç; Akgül, Ahsen Karagözlü; Arpaz, Yağmur; Arikan, Ahmet

    2008-07-01

    Spontaneous perforation of the bile duct (SPBD) is a rare cause of acute abdominal pain during childhood. Pancreatico-biliary malfunction has been postulated to contribute to its etiology. Factors related to diagnosis and treatment and difference from the other common causes of acute abdominal pain are emphasized. Five patients (3 boys, 2 girls, mean age 4.6) were admitted with peritonitis and operated with initial diagnosis of perforated appendicitis. During laparotomy, SPBD was detected. Presentation, laboratory findings and operative technique of the patients were evaluated retrospectively. Common complaints were abdominal pain and bilious vomiting. Abdominal distention was present in all patients. Leukocytosis and mild hyperbilirubinemia were detected in 5, elevated serum transaminase levels in 4, hyperglycemia in 1 and constipation in 1 patient(s). Abdominal ultrasonography showed a large amount of free fluid. During laparotomy, sterile bile peritonitis was detected initially. After exploration, SPBD was seen. T-tube drainage of the bile duct was carried out. Patients were discharged after removal of the T-tubes. Pancreatico-biliary malfunction was detected in 4 of 5 patients. In patients with generalized peritonitis, elevated transaminase levels and hyperbilirubinemia, SPBD must be considered. Even though the T-tube drainage is the treatment of choice, Roux-en-Y hepatico-portoenterostomy may be mandatory in certain patients.

  15. 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 work addresses a key issue in telehealth that will vastly improve its capabilities and adoption worldwide.

  16. 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.

  17. Comprehensive cardiovascular ECG-gated MDCT as a standard diagnostic tool in patients with acute chest pain

    International Nuclear Information System (INIS)

    Runza, G.; La Grutta, L.; Alaimo, V.; Evola, S.; Lo Re, F.; Bartolotta, T.V.; Cademartiri, F.; Midiri, M.

    2007-01-01

    Acute myocardial infarction, pulmonary embolism, and aortic dissection are diseases associated with acute chest pain and may lead to severe morbidity and mortality. These diseases may not be trivial to diagnose in the settings of emergency room. ECG-gated multi-detector computed tomography (MDCT), already established for the assessment of pulmonary embolism and aortic dissection, provides reliable information regarding the triage of patients with acute coronary syndrome in the emergency room. MDCT recently appeared to be logistically feasible and a promising comprehensive method for the evaluation of cardiac and non-cardiac chest pain in emergency department patients. The possibility to scan the entire thorax visualizing the thoracic aorta, the pulmonary arteries, and the coronary arteries could provide a new approach to the triage of acute chest pain. The inherent advantage of MDCT with cardiac state-of-the-art capabilities is the rapid investigation of the main sources of acute chest pain with a high negative predictive value. Recent studies also reports an advantage in terms of costs. With current evidence, the selection of patients with acute chest pain candidates to MDCT should remain restricted to avoid unjustified risk of ionizing radiation

  18. Comprehensive cardiovascular ECG-gated MDCT as a standard diagnostic tool in patients with acute chest pain

    Energy Technology Data Exchange (ETDEWEB)

    Runza, G. [Department of Radiology, University of Palermo (Italy)], E-mail: grunza@sirm.org; La Grutta, L.; Alaimo, V. [Department of Radiology, University of Palermo (Italy); Evola, S. [Department of Cardiology, University of Palermo (Italy); Lo Re, F.; Bartolotta, T.V. [Department of Radiology, University of Palermo (Italy); Cademartiri, F. [Department of Radiology and Cardiology, Erasmus Medical Center, Rotterdam (Netherlands); Department of Radiology and Cardiology, Cardiovascular CT Unit, University Hospital, Parma (Italy); Midiri, M. [Department of Radiology, University of Palermo (Italy)

    2007-10-15

    Acute myocardial infarction, pulmonary embolism, and aortic dissection are diseases associated with acute chest pain and may lead to severe morbidity and mortality. These diseases may not be trivial to diagnose in the settings of emergency room. ECG-gated multi-detector computed tomography (MDCT), already established for the assessment of pulmonary embolism and aortic dissection, provides reliable information regarding the triage of patients with acute coronary syndrome in the emergency room. MDCT recently appeared to be logistically feasible and a promising comprehensive method for the evaluation of cardiac and non-cardiac chest pain in emergency department patients. The possibility to scan the entire thorax visualizing the thoracic aorta, the pulmonary arteries, and the coronary arteries could provide a new approach to the triage of acute chest pain. The inherent advantage of MDCT with cardiac state-of-the-art capabilities is the rapid investigation of the main sources of acute chest pain with a high negative predictive value. Recent studies also reports an advantage in terms of costs. With current evidence, the selection of patients with acute chest pain candidates to MDCT should remain restricted to avoid unjustified risk of ionizing radiation.

  19. 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.

  20. 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.

  1. 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.

  2. Increased neural responses to empathy for pain might explain how acute stress increases prosociality.

    Science.gov (United States)

    Tomova, L; Majdandžic, J; Hummer, A; Windischberger, C; Heinrichs, M; Lamm, C

    2017-03-01

    Recent behavioral investigations suggest that acute stress can increase prosocial behavior. Here, we investigated whether increased empathy represents a potential mechanism for this finding. Using functional magnetic resonance imaging, we assessed the effects of acute stress on neural responses related to automatic and regulatory components of empathy for pain as well as subsequent prosocial behavior. Stress increased activation in brain areas associated with the automatic sharing of others' pain, such as the anterior insula, the anterior midcingulate cortex, and the primary somatosensory cortex. In addition, we found increased prosocial behavior under stress. Furthermore, activation in the anterior midcingulate cortex mediated the effects of stress on prosocial behavior. However, stressed participants also displayed stronger and inappropriate other-related responses in situations which required them to take the perspective of another person, and to regulate their automatic affective responses. Thus, while acute stress may increase prosocial behavior by intensifying the sharing of others' emotions, this comes at the cost of reduced cognitive appraisal abilities. Depending on the contextual constraints, stress may therefore affect empathy in ways that are either beneficial or detrimental. © The Author (2016). Published by Oxford University Press.

  3. A rapid evidence assessment of immersive virtual reality as an adjunct therapy in acute pain management in clinical practice.

    Science.gov (United States)

    Garrett, Bernie; Taverner, Tarnia; Masinde, Wendy; Gromala, Diane; Shaw, Chris; Negraeff, Michael

    2014-12-01

    Immersive virtual reality (IVR) therapy has been explored as an adjunct therapy for the management of acute pain among children and adults for several conditions. Therapeutic approaches have traditionally involved medication and physiotherapy but such approaches are limited over time by their cost and side effects. This review seeks to critically evaluate the evidence for and against IVR as an adjunctive therapy for acute clinical pain applications. A rapid evidence assessment (REA) strategy was used. CINAHL, Medline, Web of Science, IEEE Xplore Digital Library, and the Cochrane Library databases were screened in from December 2012 to March 2013 to identify studies exploring IVR therapies as an intervention to assist in the management of pain. Main outcome measures were for acute pain and functional impairment. Seventeen research studies were included in total including 5 RCTs, 6 randomized crossover studies, 2 case series studies, and 4 single-patient case studies. This included a total of 337 patients. Of these studies only 4 had a low risk of bias. There was strong overall evidence for immediate and short-term pain reduction, whereas moderate evidence was found for short-term effects on physical function. Little evidence exists for longer-term benefits. IVR was not associated with any serious adverse events. This review found moderate evidence for the reduction of pain and functional impairment after IVR in patients with acute pain. Further high-quality studies are required for the conclusive judgment of its effectiveness in acute pain, to establish potential benefits for chronic pain, and for safety.

  4. [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.

  5. Outpatient Pain Predicts Subsequent One-Year Acute Health Care Utilization Among Adults With Sickle Cell Disease

    Science.gov (United States)

    Ezenwa, Miriam O.; Molokie, Robert E.; Wang, Zaijie Jim; Yao, Yingwei; Suarez, Marie L.; Angulo, Veronica; Wilkie, Diana J.

    2014-01-01

    Context Patient demographic and clinical factors have known associations with acute health care utilization (AHCU) among patients with sickle cell disease (SCD), but it is unknown if pain measured predominantly in an outpatient setting is a predictor of future AHCU in patients with SCD. Objectives To determine whether multidimensional pain scores obtained predominantly in an outpatient setting predicted subsequent one-year AHCU by 137 adults with SCD and whether the pain measured at a second visit also predicted AHCU. Methods Pain data included the Composite Pain Index (CPI), a single score representative of a multidimensional pain experience (number of pain sites, intensity, quality, and pattern). Based on the distribution of AHCU events, we divided patients into three groups: (1) zero events (Zero), (2) 1–3 events (Low), or (3) 4–23 events (High). Results The initial CPI scores differed significantly by the three groups (F(2,134)=7.38, P=0.001). Post hoc comparisons showed that the Zero group had lower CPI scores than both the Low group (Pgroup (Page, and CPI scores (at both measurement times) were statistically significant predictors of utilization events. Pain intensity scores at both measurement times were significant predictors of utilization, but other pain scores (number of pain sites, quality, and pattern) were not. Conclusion Findings support use of outpatient CPI scores or pain intensity and age to identify at-risk young adults with SCD who are likely to benefit from improved outpatient pain management plans. PMID:24636960

  6. 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  personality traits only neuroticism exhibited a weak positive association with the recalled ratings. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  7. Nursing patients with acute chest pain: practice guided by the Prince Edward Island conceptual model for nursing.

    Science.gov (United States)

    Blanchard, Janelle F; Murnaghan, Donna A

    2010-01-01

    Current research suggests that pain is a relatively common phenomenon with 60-90% of patients presenting to emergency departments reporting pain (e.g., chest pain, trauma, extremity fractures and migraine headache) that require treatment [Hogan, S.L., 2005. Patient satisfaction with pain management in the emergency department. Advanced Emergency Nursing Journal 27(4), 284-294]. This article explores the use of conceptual theoretical empirical (C-T-E) framework to guide a senior nursing student in a case study of patient with chest pain. The Middle Range Theory of Pain described by Good [Good, M., 1998. A middle-range theory of acute pain management: use in research. Nursing Outlook 46(3), 120-124] and Melzack's [Melzack, R., 1987. The short-form McGill pain questionnaire. Pain, 30, 191-197] short form McGill pain questionnaire were applied along with the Prince Edward Island conceptual model (PEICM) for nursing. Results indicate that the nursing student increased her ability to work in partnership, assess relevant and specific information, and identify a number of strategies to help the patient achieve pain control by using a complement of pharmacological and non-pharmacological interventions. Moreover, the C-T-E approach provided an organized and systematic theoretical approach for the nursing student to assist a patient in pain control.

  8. The role of intercostal nerve preservation in acute pain control after thoracotomy

    Directory of Open Access Journals (Sweden)

    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.

  9. 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.

  10. 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

    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. PMID:25397867

  11. 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.

  12. Yellow flag scores in a compensable New Zealand cohort suffering acute low back pain

    Directory of Open Access Journals (Sweden)

    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

  13. Effect of painless diabetic neuropathy on pressure pain hypersensitivity (hyperalgesia after acute foot trauma

    Directory of Open Access Journals (Sweden)

    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.

  14. Mesotherapy versus Systemic Therapy in the Treatment of Acute Low Back Pain: A Randomized Trial.

    Science.gov (United States)

    Costantino, Cosimo; Marangio, Emilio; Coruzzi, Gabriella

    2011-01-01

    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.

  15. 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.

  16. 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.

  17. Long-term prognosis of acute low back pain in patients seen in general practice

    DEFF Research Database (Denmark)

    Schiøttz-Christensen, Berit; Nielsen, G L; Hansen, V K

    1999-01-01

    OBJECTIVES: We aimed to examine the prognosis of acute low back pain (LBP) in patients in general practice and to identify prognostic factors associated with the long-term prognosis based on information immediately available to the GP. METHOD: We conducted a prospective cohort study in general...... to develop chronic LBP and (iii) a history of LBP having caused previous sick leave. CONCLUSIONS: LBP in general practice has a good prognosis with regard to sick leave, but a high proportion of patients continue to complain of LBP. We were not able to identify objective measures that strongly predict...

  18. 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.

  19. Ultrasound study of scrotal pathology presenting as acute scrotal pain in the emergency room setting

    International Nuclear Information System (INIS)

    Lozano, C.; Serrano, C.; Revilla, Y.; Miralles, M.; Pozo, G. del; Lopez, U.

    1998-01-01

    The purpose of this reports is to review the most significant ultrasonographic features of the clinical entries that most frequently present as acute scrotal pain in childhood. We review 145 cases of acute scrotal referred by the emergency unit to the Radiology Service over a four-year period (1992-1995). All the patients were studied by B-mode ultrasound and the great majority also underwent color duplex-Doppler ultrasound. A wide variety of diseases were recorded, comprised of epididymitis (n=38), epididymo-orchitis (n=24), hydrocele (n=26), testicular torsion (n=9), cord cyst (n=9), epididymal cyst (n=7), persisting peritoneal-vagina fistula (n=6), hydatid torsion (n=4), sheath hematoma (n=4), laceration (n=4), hematocele (n=3), varicocele (n=3), epididymal hematoma (n=2), testicular hematoma (n=2), tumor (n=2) and inguinoscrotal hernia (n=2). (Author) 20 refs

  20. The Case for Improved Interprofessional Care: Fatal Analgesic Overdose Secondary to Acute Dental Pain during Pregnancy

    Directory of Open Access Journals (Sweden)

    Sarah K. Y. Lee

    2016-01-01

    Full Text Available Prenatal oral health extends beyond the oral cavity, impacting the general well-being of the pregnant patient and her fetus. This case report follows a 19-year-old pregnant female presenting with acute liver failure secondary to acetaminophen overdose for management of dental pain following extensive dental procedures. Through the course of her illness, the patient suffered adverse outcomes including fetal demise, acute kidney injury, spontaneous bacterial peritonitis, and septic shock before eventual death from multiple organ failure. In managing the pregnant patient, healthcare providers, including physicians and dentists, must recognize and optimize the interconnected relationships shared by the health disciplines. An interdisciplinary approach of collaborative and coordinated care, the timing, sequence, and treatment for the pregnant patient can be improved and thereby maximize overall quality of health. Continued efforts toward integrating oral health into general healthcare education through interprofessional education and practice are necessary to enhance the quality of care that will benefit all patients.

  1. Effects of Adding Segmental Traction Therapy to Routine Physiotherapy on Pain and Functional Ability of Patients with Acute Low Back Pain

    Directory of Open Access Journals (Sweden)

    Parvin Akberov

    2015-06-01

    Full Text Available Background: Low back pain (LBP is one of the most common musculoskeletal complications of today’s societies which, poses a big portion of health expenses and work absentees. Lumbar disc herniation is claimed to be one of the several causes of LBP. Conservative therapies like physiotherapy are found to be beneficial for treatment in such a kind of LBP. However, there is low evidence proving traction therapy can be effective. Therefore, the aim of this study was to evaluate effects of a 7-day physiotherapy protocol along with segmental traction therapy on pain and range of motion in patients with acute LBP Methods: A total of 9 patients with acute LBP voluntarily participated in this study. They undertook a 7-day conventional physiotherapy along with segmental traction therapy. Pain, functional ability and lumbar flexion range of motion (ROM were measured before and after the therapeutic intervention. Results: A significant reduction in pain was observed after the intervention (P=0.006. In addition, patients’ functional ability increased significantly (P=0.03.However, there were no significant changes in lumbar in flexion ROM. Conclusion: According to results of the present study segmental traction therapy along with a physiotherapy protocol consisting of TENS, Ultrasound and Hot pack reduces pain and improves functional ability in patient with acute LBP. Although no effect on lumbar ROM is expected.

  2. Neurochemical dynamics of acute orofacial pain in the human trigeminal brainstem nuclear complex.

    Science.gov (United States)

    de Matos, Nuno M P; Hock, Andreas; Wyss, Michael; Ettlin, Dominik A; Brügger, Mike

    2017-11-15

    The trigeminal brainstem sensory nuclear complex is the first central relay structure mediating orofacial somatosensory and nociceptive perception. Animal studies suggest a substantial involvement of neurochemical alterations at such basal CNS levels in acute and chronic pain processing. Translating this animal based knowledge to humans is challenging. Human related examining of brainstem functions are challenged by MR related peculiarities as well as applicability aspects of experimentally standardized paradigms. Based on our experience with an MR compatible human orofacial pain model, the aims of the present study were twofold: 1) from a technical perspective, the evaluation of proton magnetic resonance spectroscopy at 3 T regarding measurement accuracy of neurochemical profiles in this small brainstem nuclear complex and 2) the examination of possible neurochemical alterations induced by an experimental orofacial pain model. Data from 13 healthy volunteers aged 19-46 years were analyzed and revealed high quality spectra with significant reductions in total N-acetylaspartate (N-acetylaspartate + N-acetylaspartylglutamate) (-3.7%, p = 0.009) and GABA (-10.88%, p = 0.041) during the pain condition. These results might reflect contributions of N-acetylaspartate and N-acetylaspartylglutamate in neuronal activity-dependent physiologic processes and/or excitatory neurotransmission, whereas changes in GABA might indicate towards a reduction in tonic GABAergic functioning during nociceptive signaling. Summarized, the present study indicates the applicability of 1 H-MRS to obtain neurochemical dynamics within the human trigeminal brainstem sensory nuclear complex. Further developments are needed to pave the way towards bridging important animal based knowledge with human research to understand the neurochemistry of orofacial nociception and pain. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. 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 

  4. 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.

  5. 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

  6. 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...... to treatment guided by either coronary CTA or standard care (bicycle exercise electrocardiogram or myocardial perfusion imaging). In the coronary CTA-guided group, a functional test was included in cases of nondiagnostic coronary CTA images or coronary stenoses of borderline severity. The primary endpoint...... electrocardiograms and troponin values compared to standard care with a functional test. (Cardiac-CT in the Treatment of Acute Chest Pain [CATCH]; NCT01534000)....

  7. 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.

  8. [Acute renal pain as an adverse reaction of the rabies immunization].

    Science.gov (United States)

    Lalosević, Dusan

    2009-01-01

    HRIG is the best preparate in rabies prophylaxis, and it's considered that optimal dose is 20 international units per kilogram and must not been reduced or overdosed. HRIG have to be injected infiltrative around bite wounds, and if after that remains a part of the dose, it has to be given in gluteal muscle. Application only in gluteus is vitium artis. At one patient immunized against rabies has occured acute bilateral renal pain and fever at time of immunization against rabies, and because of that vaccination must been stopped after the 3rd dose of vaccine. Patient was a 26-year-old female without significant pre-existing disease, bitten by stray dog. After the start of immunization, because the wrong direction, she received about 2.5 more amount of human rabies immunoglobuline (HRIG) then is recommended on declaration at etiquette of ampoule, and only in gluteus in quantity of 10.5 ml. Glomerulonephritis after rabies vaccination until now was described just once by Singhal et al. in 1981. year. Acute renal pain, after rabies vaccine, which aggravated after repeated vaccine doses in our patient who received overdosed HRIG, may be explained by immunopathological mechanism, rather with formation of circulating immune complexes, their precipitation on the glomerular basement membrane and developing glomerulonephritis. Low weight soluble molecular immune complexes formed when antigen is in excess, as in case after repeated doses of rabies vaccine, circulate and precipitate on glomerular membrane and causes glomerulonephritis. As contribution to this explanation, is that symptoms as renal pain disappeared after interrupting vaccination protocol in our patient.

  9. 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.

  10. A novel and effective acupuncture modality as a complementary therapy to acute pain relief in inpatients with rib fractures.

    Science.gov (United States)

    Ho, Hsin-Yi; Chen, Chao-Wei; Li, Ming-Chieh; Hsu, Yu-Pao; Kang, Shih-Ching; Liu, Erh-Hao; Lee, Ko-Hung

    2014-01-01

    Pain control has been emphasized as a priority for both practitioners and inpatients with rib fractures, since analgesia could only offer limited relief from severe pain. A prospective and randomized controlled trial was conducted to analyze the efficacy and efficiency of acupuncture in acute pain relief for inpatients with rib fractures. A total of 58 inpatients were recruited and allocated to two groups, receiving identical doses of conventional oral analgesics as well as filiform needles as treatment and thumbtack intradermal (TI) needles placed upon the skin surface as a control, respectively, via novel acupuncture modality once daily for three consecutive days. The effect of pain relief was evaluated during activities that induce pain, and sustained maximal inspiration (SMI) lung volumes and sleep quality were assessed. The patients treated with filiform needles had more effective pain relief than those in the TI needle group during deep breathing, coughing, and turning over the body (p pain relief via acupuncture. The active evaluation could provide a more adaptive model for assessing pain intensity due to rib fractures. This novel acupuncture modality in which the needle insertion sites are corresponding to the pain spots can be a safe and viable therapy for relieving pain in inpatients with rib fractures.

  11. A novel and effective acupuncture modality as a complementary therapy to acute pain relief in inpatients with rib fractures

    Directory of Open Access Journals (Sweden)

    Hsin-Yi Ho

    2014-06-01

    Full Text Available Background: Pain control has been emphasized as a priority for both practitioners and inpatients with rib fractures, since analgesia could only offer limited relief from severe pain. A prospective and randomized controlled trial was conducted to analyze the efficacy and efficiency of acupuncture in acute pain relief for inpatients with rib fractures. Methods: A total of 58 inpatients were recruited and allocated to two groups, receiving identical doses of conventional oral analgesics as well as filiform needles as treatment and thumbtack intradermal (TI needles placed upon the skin surface as a control, respectively, via novel acupuncture modality once daily for three consecutive days. The effect of pain relief was evaluated during activities that induce pain, and sustained maximal inspiration (SMI lung volumes and sleep quality were assessed. Results: The patients treated with filiform needles had more effective pain relief than those in the TI needle group during deep breathing, coughing, and turning over the body (p < 0.05, and the effect persisted for at least 6 h in most patients. Sustained maximal inspiration lung volumes and sleep quality did not show improvement through every acupuncture intervention, and they could not respond accurately to pain relief via acupuncture. Conclusion: The active evaluation could provide a more adaptive model for assessing pain intensity due to rib fractures. This novel acupuncture modality in which the needle insertion sites are corresponding to the pain spots can be a safe and viable therapy for relieving pain in inpatients with rib fractures.

  12. 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

  13. Mobile Virtual Learning Object for the Assessment of Acute Pain as a Learning Tool to Assess Acute Pain in Nursing: An Analysis of the Mental Workload.

    Science.gov (United States)

    Alvarez, Ana Graziela; Sasso, Grace; Iyengar, Sriram

    2015-11-06

    The inclusion of new technologies in education has motivated the development of studies on mental workload. These technologies are now being used in the teaching and learning process. The analysis enables identification of factors intervening in this workload as well as planning of overload prevention for educational activities using these technologies. To analyze the mental workload of an educational intervention with the Mobile Virtual Learning Object for the Assessment of Acute Pain in adults and newborns, according to the NASA Task Load Index criteria. A methodological study with data collected from 5 nurses and 75 students, from November of 2013 to February of 2014. The highest students' and specialists' means were in the dimensions of "Mental demand" (57.20 ± 22.27; 51 ± 29.45) and "Performance" (58.47 ± 24.19; 73 ± 28.85). The specialists' mental workload index was higher (50.20 ± 7.28) when compared with students' (47.87 ± 16.85) on a scale from 0 to 100 (P=.557). The instrument allowed for the assessment of mental workload after an online educational intervention with a mobile learning virtual object. An excessive overload was not identified among participants. Assessing mental workload from the use of educational technologies at the end of a task is a key to their applicability, with the aim of providing a more effective, stimulating, and long-lasting experience of the learning process.

  14. Diagnostic Role of Hyperechoic Fatty Tissue at Ultrasonography in Women with Acute Pelvic Pain

    International Nuclear Information System (INIS)

    Park, Seong Jin; Yi, Boem Ha; Lee, Hae Kyung; Hong, Hyun Sook; Kim, Hyun Cheol

    2009-01-01

    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

  15. 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

  16. Comparison between massage and routine physical therapy in women with sub acute and chronic nonspecific low back pain.

    Science.gov (United States)

    Kamali, Fahimeh; Panahi, Fatemeh; Ebrahimi, Samaneh; Abbasi, Leila

    2014-01-01

    The aim of this study was to investigate the comparison of massage therapy and routine physical therapy on patients with sub acute and chronic nonspecific low back pain. Thirty volunteer female subjects with a sub acute or chronic nonspecific low back pain were randomly enrolled in two groups, massage therapy and routine physical therapy. After massage application, the hamstring and paravertebral muscles stretching and also stabilizing exercises were prescribed. In the routine physical therapy group, TENS, US and vibrator were used besides exercises. Pain intensity according to Numerical Rating Scale, functional disability level in accordance to Oswestry Disability Index, and modified Schober test, for measurement of flexion range of motion, before and after ten sessions of treatment were used to evaluate the effectiveness of the treatment. Pain intensity, Oswestry Disability Index and flexion range of motion had shown significant differences before and after intervention in both groups (ppain intensity and Oswestry Disability Index compared to routine physical therapy (p=0.015, p=0.013 respectively), but the range of motion changes were not significant between two groups (p=1.00). It can be concluded that both massage therapy and routine physical therapy are useful for sub acute and chronic nonspecific low back pain treatment especially if accompanied with exercise. However, massage is more effective than other electrotherapy modalities, and it can be used alone or with electrotherapy for the treatment of patients with low back pain.

  17. 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

  18. 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

  19. Acute and chronic craniofacial pain: brainstem mechanisms of nociceptive transmission and neuroplasticity, and their clinical correlates.

    Science.gov (United States)

    Sessle, B J

    2000-01-01

    This paper reviews the recent advances in knowledge of brainstem mechanisms related to craniofacial pain. It also draws attention to their clinical implications, and concludes with a brief overview and suggestions for future research directions. It first describes the general organizational features of the trigeminal brainstem sensory nuclear complex (VBSNC), including its input and output properties and intrinsic characteristics that are commensurate with its strategic role as the major brainstem relay of many types of somatosensory information derived from the face and mouth. The VBSNC plays a crucial role in craniofacial nociceptive transmission, as evidenced by clinical, behavioral, morphological, and electrophysiological data that have been especially derived from studies of the relay of cutaneous nociceptive afferent inputs through the subnucleus caudalis of the VBSNC. The recent literature, however, indicates that some fundamental differences exist in the processing of cutaneous vs. other craniofacial nociceptive inputs to the VBSNC, and that rostral components of the VBSNC may also play important roles in some of these processes. Modulatory mechanisms are also highlighted, including the neurochemical substrate by which nociceptive transmission in the VBSNC can be modulated. In addition, the long-term consequences of peripheral injury and inflammation and, in particular, the neuroplastic changes that can be induced in the VBSNC are emphasized in view of the likely role that central sensitization, as well as peripheral sensitization, can play in acute and chronic pain. The recent findings also provide new insights into craniofacial pain behavior and are particularly relevant to many approaches currently in use for the management of pain and to the development of new diagnostic and therapeutic procedures aimed at manipulating peripheral inputs and central processes underlying nociceptive transmission and its control within the VBSNC.

  20. 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

  1. Elderly female with acute abdominal pain presenting with Superior Mesenteric Artery Thrombus

    Directory of Open Access Journals (Sweden)

    Sassan Ghassemzadeh, MD

    2018-04-01

    Full Text Available History of present illness: An 80-year-old female with history of hypertension and atrial fibrillation, presented with sudden onset of abdominal pain after eating at a restaurant. The patient denied any fever, vomiting or diarrhea. She admitted to being noncompliant with medications including warfarin. Initial vital signs were within normal limits. On exam, the patient was very uncomfortable and could not lay still in bed, even after multiple doses of intravenous narcotic pain medications. The patient had generalized abdominal tenderness without rebound or guarding. Labs revealed a white-blood-cell count of 13.8, lactic acid of 3.6, and international normalized ratio (INR of 1.1, with normal renal function. Significant findings: Computed tomography (CT angiogram of the abdomen and pelvis revealed a superior mesenteric artery (SMA thrombosis 5 cm from the origin off of the abdominal aorta. As seen in the sagittal view, there does not appear to be any contrast 5 cm past the origin of the SMA. On the axial views, you can trace the SMA until the point that there is no longer any contrast visible which indicates the start of the thrombus. The SMA does not appear to be reconstituted. There was normal flow to the celiac artery. (See annotated images. Discussion: This case involves a classic presentation of acute mesenteric ischemia, which is defined as the sudden onset of abdominal pain due to small intestinal hypo-perfusion secondary to reduction or complete occlusion of arterial blood flow to the intestines. The most common artery affected is the SMA. The main two reasons for this phenomenon are either due to an arterial embolus or from arterial thrombus from underlying atherosclerosis. The ratio of superior mesenteric embolus to thrombus has been shown to be 1.4:1.1 Embolism to the mesenteric arteries is most frequently from a thrombus that breaks off from the left atrium, left ventricle, or proximal aorta, as in this case from underlying atrial

  2. Single dose oral ibuprofen plus paracetamol (acetaminophen) for acute postoperative pain.

    Science.gov (United States)

    Derry, Christopher J; Derry, Sheena; Moore, R Andrew

    2013-06-24

    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. Some combinations of ibuprofen and paracetamol are available for use without prescription in some acute pain situations. To assess the efficacy and adverse effects of single dose oral ibuprofen plus paracetamol for acute 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) on The Cochrane Library (Issue 4 of 12, 2013), MEDLINE (1950 to May 21st 2013), EMBASE (1974 to May 21st 2013), the Oxford Pain Database, ClinicalTrials.gov, and reference lists of articles. Randomised, double-blind clinical trials of single dose, oral ibuprofen plus paracetamol compared with placebo or the same dose of ibuprofen alone for acute postoperative pain in adults. Two review authors independently considered trials for inclusion in the review, assessed quality, and extracted data. We used validated equations to calculate the area under the pain relief versus time curve and derive the proportion of participants with at least 50% of maximum pain relief over six hours. We calculated relative risk (RR) and number needed to treat to benefit (NNT) for ibuprofen plus paracetamol, ibuprofen alone, or placebo. We used information on 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 events. Searches identified three studies involving 1647 participants. Each of them examined several dose combinations. Included studies provided data from 508 participants for the comparison of ibuprofen 200 mg + paracetamol 500 mg with placebo, 543

  3. 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

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

    DEFF Research Database (Denmark)

    Andersen, Johan Hviid; Harhoff, Mette; Grimstrup, Søren

    2007-01-01

    BACKGROUND: Computer use is one of the commonest work place exposures in modern society. An adverse effect on musculoskeletal outcomes has been claimed for decades, mainly on the basis of self reports of exposure. The purpose of this study was to assess the risk of neck and shoulder pain associat...... psychosocial factors predicted the risk of prolonged pain. CONCLUSIONS: From the NUDATA-study we can conclude that most computer workers have no or minor neck and shoulder pain, few experience prolonged pain, and even fewer, chronic neck and shoulder pain....

  5. Inhibition by local bupivacaine-releasing microspheres of acute postoperative pain from hairy skin incision.

    Science.gov (United States)

    Ohri, Rachit; Wang, Jeffrey Chi-Fei; Blaskovich, Phillip D; Pham, Lan N; Costa, Daniel S; Nichols, Gary A; Hildebrand, William P; Scarborough, Nelson L; Herman, Clifford J; Strichartz, Gary R

    2013-09-01

    Acute postoperative pain causes physiological deficits and slows recovery. Reduction of such pain by local anesthetics that are delivered for several days postoperatively is a desirable clinical objective, which is approached by a new formulation and applied in animal studies reported here. We subcutaneously injected a new formulation of poly-lactic-co-glycolic acid polymer microspheres, which provides steady drug release for 96+ hours into rats at the dorsal region 2 hours before surgery. A single 1.2-cm-long skin incision was followed by blunt dissection of skin away from the underlying fascia, and closed by 2 sutures, followed by 14 days of testing. Microspheres containing 5, 10, 20, and 40 mg bupivacaine were injected locally 2 hours before surgery; bupivacaine-free microspheres were the vehicle control, and bupivacaine HCl solution (0.5%), the positive control. Mechanical sensitivity was determined by the frequency of local muscle contractions to repeated pokes with nylon monofilaments (von Frey hairs) exerting 4 and 15 g forces, testing, respectively, allodynia and hyperalgesia, and by pinprick. Injection of bupivacaine microspheres (40 mg drug) into intact skin reduced responses to 15 g von Frey hairs for 6 hours and to pinprick for 36 hours. Respective reductions from bupivacaine HCl lasted for 3 and 2 hours. Skin incision and dissection alone caused mechanical allodynia and hyperalgesia for 14 days. Microspheres containing 20 or 40 mg bupivacaine suppressed postoperative hypersensitivity for up to 3 days, reduced integrated allodynia (area under curve of response versus time) over postoperative days 1 to 5 by 51% ± 20% (mean ± SE) and 78% ± 12%, and reduced integrated hyperalgesia by 55% ± 13% and 64% ± 11%, for the respective doses. Five and ten milligrams bupivacaine in microspheres and the 0.5% bupivacaine solution were ineffective in reducing postoperative hypersensitivity, as were 40 mg bupivacaine microspheres injected contralateral to the

  6. Advice for acute low back pain: a comparison of what research supports and what guidelines recommend.

    Science.gov (United States)

    Stevens, Matthew L; Lin, Chung-Wei C; de Carvalho, Flavia A; Phan, Kevin; Koes, Bart; Maher, Chris G

    2017-10-01

    Advice is widely considered an effective treatment for acute low back pain (LBP); however, details on what and how to deliver this intervention is less clear. We assessed and compared clinical trials that test advice for acute LBP with practice guidelines for their completeness of reporting and concordance on the content, method of delivery, and treatment regimen of advice interventions. Systematic review. Advice randomized controlled trials were identified through a systematic search. Guidelines were taken from recent overviews of guidelines for LBP. Completeness of reporting was assessed using the Template for Intervention Description and Replication checklist. Thematic analysis was used to characterize advice interventions into topics across the aspects of content, method of delivery, and regimen. Concordance between clinical trials and guidelines was assessed by comparing the number of trials that found a statistically significant treatment effect for an intervention that included a specific advice topic with the number of guidelines recommending that topic. The median (interquartile range) completeness of reporting for clinical trials and guidelines was 8 (7-9) and 3 (2-4) out of nine items on the Template for Intervention Description and Replication checklist, respectively. Guideline recommendations were discordant with clinical trials for 50% of the advice topics identified. Completeness of reporting was less than ideal for randomized controlled trials and extremely poor for guidelines. The recommendations made in guidelines of advice for acute LBP were often not concordant with the results of clinical trials. Taken together, these findings mean that the potential clinical value of advice interventions for patients with acute LBP is probably not being realized. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. 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.

  8. Low-dose ketamine improves pain relief in patients receiving intravenous opioids for acute pain in the emergency department: results of a randomized, double-blind, clinical trial.

    Science.gov (United States)

    Beaudoin, Francesca L; Lin, Charlie; Guan, Wentao; Merchant, Roland C

    2014-11-01

    Low-dose ketamine has been used perioperatively for pain control and may be a useful adjunct to intravenous (IV) opioids in the control of acute pain in the emergency department (ED). The aim of this study was to determine the effectiveness of low-dose ketamine as an adjunct to morphine versus standard care with morphine alone for the treatment of acute moderate to severe pain among ED patients. A double-blind, randomized, placebo-controlled trial with three study groups was conducted at a large, urban academic ED over a 10-month period. Eligible patients were 18 to 65 years old with acute moderate to severe pain (score of at least 5 out of 10 on the numerical pain rating scale [NRS] and pain duration ketamine (group 1), or 3) morphine and 0.3 mg/kg ketamine (group 2). Participants were assessed at 30, 60, and 120 minutes after study medication administration and received rescue analgesia as needed to target a 50% reduction in pain. The primary outcome measure of pain relief, or pain intensity reduction, was derived using the NRS and calculated as the summed pain-intensity (SPID) difference over 2 hours. The amount and timing of rescue opioid analgesia was evaluated as a secondary outcome. The occurrence of adverse events was also measured. Sixty patients were enrolled (n = 20 in each group). There were no differences between study groups with respect to age, sex, race/ethnicity, preenrollment analgesia, or baseline NRS. Over the 2-hour poststudy medication administration period, the SPIDs were higher (greater pain relief) for the ketamine study groups than the control group (standard care 4.0, interquartile range [IQR] = 1.8 to 6.5; group 1 7.0, IQR = 4.3 to 10.8; and group 2 7.8, IQR = 4.8 to 12.8; p ketamine groups were similar (p pain intensity up to 2 hours, whereas group 1 was similar to standard care by 2 hours. Similar numbers of patients received rescue analgesia: standard care group, seven of 20, 35%; group 1, four of 20, 20%; and group 2, four of 20, 20

  9. Acute Abdominal Pain Secondary to Retroperitoneal Bleeding From a Giant Adrenal Lipoma With Review of Literature

    Directory of Open Access Journals (Sweden)

    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.

  10. 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.)

  11. Long-term prognosis of acute back pain in patients seen in general practice

    DEFF Research Database (Denmark)

    Schiøttz-Christensen, Berit; Nielsen, Gunnar Lauge; Hansen, Vivian Kjær

    1999-01-01

    to develop chronic LBP and (iii) a history of LBP having caused previous sick leave. CONCLUSIONS: LBP in general practice has a good prognosis with regard to sick leave, but a high proportion of patients continue to complain of LBP. We were not able to identify objective measures that strongly predict......OBJECTIVES: We aimed to examine the prognosis of acute low back pain (LBP) in patients in general practice and to identify prognostic factors associated with the long-term prognosis based on information immediately available to the GP. METHOD: We conducted a prospective cohort study in general...... practice in Denmark. The patients were those aged 18-60 years consulting their GP due to an episode of LBP lasting less than 2 weeks. The GPs collected data regarding 34 exposure variables, including their global assessment of the likelihood of chronic LBP. Outcome variables were collected from...

  12. 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.

  13. [Stress fractures of the ribs with acute thoracic pain in a young woman, diagnosed by the bone scan].

    Science.gov (United States)

    Georgitzikis, Athanasios; Siopi, Dimitra; Doumas, Argyrios; Mitka, Ekaterini; Antoniadis, Antonios

    2010-01-01

    We report the unusual case of a 29 -year old woman with emotional instability who presented with acute onset chest pain after severe chronic cough. The chest X-ray and the serological tests were normal but the CT scanning, and the bone scanning revealed multiple bilateral rib stress fractures, caused by severe coughing and physical activity and worsened by the patient's emotional instability.

  14. Characterisation of tramadol, morphine and tapentadol in an acute pain model in Beagle dogs.

    Science.gov (United States)

    Kögel, Babette; Terlinden, Rolf; Schneider, Johannes

    2014-05-01

    To evaluate the analgesic potential of the centrally acting analgesics tramadol, morphine and the novel analgesic tapentadol in a pre-clinical research model of acute nociceptive pain, the tail-flick model in dogs. Prospective part-randomized pre-clinical research trial. Fifteen male Beagle dogs (HsdCpb:DOBE), aged 12-15 months. On different occasions separated by at least 1 week, dogs received intravenous (IV) administrations of tramadol (6.81, 10.0 mg kg(-1) ), tapentadol (2.15, 4.64, 6.81 mg kg(-1) ) or morphine (0.464, 0.681, 1.0 mg kg(-1) ) with subsequent measurement of tail withdrawal latencies from a thermal stimulus (for each treatment n = 5). Blood samples were collected immediately after the pharmacodynamic measurements of tramadol to determine pharmacokinetics and the active metabolite O-demethyltramadol (M1). Tapentadol and morphine induced dose-dependent antinociception with ED50-values of 4.3 mg kg(-1) and 0.71 mg kg(-1) , respectively. In contrast, tramadol did not induce antinociception at any dose tested. Measurements of the serum levels of tramadol and the M1 metabolite revealed only marginal amounts of the M1 metabolite, which explains the absence of the antinociceptive effect of tramadol in this experimental pain model in dogs. Different breeds of dogs might not or only poorly respond to treatment with tramadol due to low metabolism of the drug. Tapentadol and morphine which act directly on μ-opioid receptors without the need for metabolic activation are demonstrated to induce potent antinociception in the experimental model used and should also provide a reliable pain management in the clinical situation. The non-opioid mechanisms of tramadol do not provide antinociception in this experimental setting. This contrasts to many clinical situations described in the literature, where tramadol appears to provide useful analgesia in dogs for post-operative pain relief and in more chronically pain states. © 2014 Association of Veterinary

  15. 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.

  16. A 58-year-old Man with Abdominal Pain; Acute Appendicitis due to an Appendicolith

    Directory of Open Access Journals (Sweden)

    Seyed Mojtaba Aghili

    2017-12-01

    Full Text Available Case presentation: A 58-year-old man presented to the emergency department with abdominal pain, nausea and loss of appetite for the last 8 hours. He reported diffuse pain that had been localized to the right lower quadrant (RLQ. Physical examination revealed muscular defense and tenderness in the RLQ. Computed tomography (CT of the abdomen and pelvis confirmed luminal distension with a thickened enhancing wall with an appendicolith. Learning points: Appendicitis may be developed by an appendicolith, a calcified deposit within the appendix. It may be an incidental finding on an abdominal radiograph, ultrasound (US examination or CT. It appears as echogenic focus and casts an acoustic shadow on US examination and manifests as a calcified mass on plain radiograph or CT. The incidence of appendicolith is higher among patients with a retrocaecal appendix. In our patient, a clinical diagnosis of acute appendicitis was made and the patient was immediately transferred to the operating room and an appendectomy was performed.

  17. How Safe Are Common Analgesics for the Treatment of Acute Pain for Children? A Systematic Review

    Directory of Open Access Journals (Sweden)

    Lisa Hartling

    2016-01-01

    Full Text Available Background. Fear of adverse events and occurrence of side effects are commonly cited by families and physicians as obstructive to appropriate use of pain medication in children. We examined evidence comparing the safety profiles of three groups of oral medications, acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids, to manage acute nonsurgical pain in children (<18 years treated in ambulatory settings. Methods. A comprehensive search was performed to July 2015, including review of national data registries. Two reviewers screened articles for inclusion, assessed methodological quality, and extracted data. Risks (incidence rates were pooled using a random effects model. Results. Forty-four studies were included; 23 reported on adverse events. Based on limited current evidence, acetaminophen, ibuprofen, and opioids have similar nausea and vomiting profiles. Opioids have the greatest risk of central nervous system adverse events. Dual therapy with a nonopioid/opioid combination resulted in a lower risk of adverse events than opioids alone. Conclusions. Ibuprofen and acetaminophen have similar reported adverse effects and notably less adverse events than opioids. Dual therapy with a nonopioid/opioid combination confers a protective effect for adverse events over opioids alone. This research highlights challenges in assessing medication safety, including lack of more detailed information in registry data, and inconsistent reporting in trials.

  18. 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.

  19. Ibuprofen plus paracetamol versus ibuprofen in acute low back pain: a randomized open label multicenter clinical study

    Directory of Open Access Journals (Sweden)

    Predrag Ostojic

    2017-01-01

    Full Text Available Objective: to estimate whether combination of ibuprofen and paracetamol is more effective than ibuprofen in monotherapy, in the treatment of acute low back pain. Methods: 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. Results: A statistically significant decrease in pain intensity, assessed using a visual analogue scale (p

  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. 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.

  2. 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

  3. 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

  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. 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 < 0.001). The most common antibiotic prescribed for AOM was amoxicillin clavulanate (76.7%). The mean recommended treatment period for AOM was 9.3 ± 2.2 days. The choices for systemic ear pain treatment were acetaminophen (26.8%), ibuprofen (29.4%), and alternating between ibuprofen and acetaminophen (43.9%). Moreover, 34.6% of the participants recommended topical agents for otalgia. Topical agents

  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. Nurses’ knowledge of the principles of acute pain assessment in critically ill adult patients who are able to self-report

    Directory of Open Access Journals (Sweden)

    Irene Betty Kizza

    2016-01-01

    Conclusion: The nurses had adequate general knowledge about the principles of acute pain assessment in CIAP. However, some knowledge gaps exist about key concepts in pain assessment and these can curtail the efforts to ensure quality pain assessment and management in CIAP. The findings entrench the need for focused professional training and continuing professional education about best practices for pain assessment and management in CIAP.

  8. Biosorbable poly-L-lactide rib-connecting pins may reduce acute pain after thoracotomy.

    Science.gov (United States)

    Iwasaki, A; Hamatake, D; Shirakusa, T

    2004-02-01

    Conventional thoracotomy is currently used as a standard procedure, and is often required to treat numerous diseases. Additionally, rib resections are occasionally required to maintain an adequate field of view for surgery. The benefits of using rib pins for chest closure following such procedures have not yet been established. This study sought to evaluate the usefulness of rib pins in reducing acute postoperative pain. Thirty-three consecutive patients with lung cancer underwent lobectomies using the posterolateral approach. The patients were rib-resected and reconstructed with two techniques: 21 patients with absorbable rib pins (ARP group) and 12 patients by ligation with absorbable sutures (LAS group). Intensity of pain was assessed during the 3 days immediately following surgery. The two groups were assessed using the visual analogue scale (VAS) as a pain scale, amounts consumed of patient-controlled analgesics (PCA), and additional chest x-rays. On the first day following surgery, the mean VAS intensity of the ARP group for patient motion was 2.71 +/- 2.14, compared to 5.33 +/- 2.99 in the LAS group. After three days, the mean score for the ARP group was 1.98 +/- 1.89, compared to 4.60 +/- 1.97 in the LAS group. Scores in the ARP group were significantly lower than in the LAS group one day and three days following thoracotomy. The LAS group (55.0 +/- 15.9 times) made more frequent requests than the ARP group (16.1 +/- 10.3 times). The PCA requirement was also significantly lower in the ARP group. Excessive derangement of the rib (grade 2) was found in one case (4.7 %) in the ARP group compared to five cases (41.6 %) in the LAS group. Rib shifts were seen in numerous cases in the LAS group compared to the ARP group as measured by chest x-rays. Use of absorbable rib pins reduced postoperative pain and may improve long-term prospects for the post-thoracotomy course.

  9. 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

  10. 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.

  11. Routines and rituals: a grounded theory of the pain management of drug users in acute care settings.

    Science.gov (United States)

    McCreaddie, May; Lyons, Imogen; Watt, Debbie; Ewing, Elspeth; Croft, Jeanette; Smith, Marion; Tocher, Jennifer

    2010-10-01

    This study reviewed the perceptions and strategies of drug users and nurses with regard to pain management in acute care settings. Drug users present unique challenges in acute care settings with pain management noted to be at best suboptimal, at worst non-existent. Little is known about why and specifically how therapeutic effectiveness is compromised. Qualitative: constructivist grounded theory. A constructivist grounded theory approach incorporating a constant comparative method of data collection and analysis was applied. The data corpus comprised interviews with drug users (n = 11) and five focus groups (n = 22) of nurses and recovering drug users. Moral relativism as the core category both represents the phenomenon and explains the basic social process. Nurses and drug users struggle with moral relativism when addressing the issue of pain management in the acute care setting. Drug users lay claim to expectations of compassionate care and moralise via narration. Paradoxically, nurses report that the caring ideal and mutuality of caring are diminished. Drug users' individual sensitivities, anxieties and felt stigma in conjunction with opioid-induced hyperalgesia complicate the processes. Nurses' and hospitals' organisational routines challenge drug user rituals and vice versa leading both protagonists to become disaffected. Consequently, key clinical issues such as preventing withdrawal and managing pain are left unaddressed and therapeutic effectiveness is compromised. This study provides a robust account of nurses' and drug users' struggle with pain management in the acute care setting. Quick technological fixes such as urine screens, checklists or the transient effects of (cognitive-based) education (or training) are not the answer. This study highlights the need for nurses to engage meaningfully with this perceptibly 'difficult' group of patients. The key aspects likely to contribute to problematic interactions with this patient cohort are outlined so that

  12. 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.

  13. The Use of Ketamine for Acute Treatment of Pain: A Randomized, Double-Blind, Placebo-Controlled Trial.

    Science.gov (United States)

    Sin, Billy; Tatunchak, Tamara; Paryavi, Mohammad; Olivo, Maria; Mian, Usman; Ruiz, Josel; Shah, Bupendra; de Souza, Sylvie

    2017-05-01

    Pain is one of the most common reasons for emergency department (ED) visits in the United States. Ketamine is a sedative with N-methyl-D-aspartate (NMDA) receptor antagonism. Recent literature has suggested that the use of subdissociative dose ketamine (SDDK) may be safe and effective for acute pain. The objective of our study was to evaluate ketamine in subdissociative doses as an adjunct for acute pain in the ED. This was a single-center, prospective, randomized, double-blind, placebo-controlled trial that evaluated the use of SDDK in adult patients who presented to the ED with acute pain. Patients received ketamine 0.3 mg/kg via intravenous piggyback over 15 min or placebo. Morphine 0.1 mg/kg intravenous push was administered with the study interventions. The primary outcome was the patient's pain score 15 min after initiation of the intervention. Secondary outcomes included adverse events, consumption of rescue analgesia, patient's length of stay, and patient satisfaction with treatment. Thirty patients were enrolled in each group. Median pain scores in patients who received ketamine were lower than in controls at 15 min (3.5 [interquartile range {IQR} 1.0-7.3 vs. 6.0 [IQR 4.0-9.0], respectively; p = 0.018). No serious adverse events occurred. No difference was detected in the amount of rescue analgesia used or in length of stay. Patients who received ketamine reported a higher mean satisfaction score with their pain management (8.57 [standard deviation {SD} 2.1]) than patients who received placebo (6.05 [SD 2.6]; p = 0.01). When used as an adjunct, SDDK administered at 0.3 mg/kg over 15 min resulted in safe and effective analgesia for ≤30 min in patients who presented with acute pain in the ED. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Durapain in symptomatic treatment of severe acute pain: a post-marketing, prospective, multicenter, observational study – PRIME study

    Directory of Open Access Journals (Sweden)

    Shah K

    2017-05-01

    Full Text Available Kshitij Shah,1 Omvijay B Chaudhari,2 Palash Gupta,3 R Hom Chaudhuri,4 Ranjan Kamilya,5 Shreedhar S Kulkarni,6 S Subbaiah,7 Zubair H Sorathia,8 Gauri Billa9 1MS Orthopedic, Prime Hospital, Andheri (West, 2Vatsalya Nursing Home, Kalyan (West, Mumbai, 3Dr. Palash Gupta Clinic, Rohini, New Delhi, 4Homchaudhuri’s Clinic, 5Apollo Gleneagles Hospital, Kolkata, West Bengal, 6Amrit Clinic, Matunga, Mumbai, 7Subbaiah’s Clinic, West Mambalam, Chennai, 8Medicare Hospital, Marol, Andheri East, 9Medical Services, Abbott Healthcare Pvt. Ltd, Mulund (West, Mumbai, Maharashtra, India Objective: To assess the effectiveness, overall tolerability, and gastrointestinal (GI tolerability of Durapain (fixed dose combination of tramadol hydrochloride immediate release [50 mg] and diclofenac sodium sustained release [75 mg] in symptomatic treatment of severe acute pain in physician’s routine clinical practice. Materials and methods: In this prospective, multicenter, observational, post-marketing study, adult patients (aged 18–60 years with severe acute pain were treated with tramadol hydrochloride/diclofenac sodium as per approved prescribing information. Evaluation was done at baseline, day 2, and day 5. Primary end point was pain intensity difference from baseline to day 5. Results: A total of 351 patients (mean age 44.2 years; male 43%; female 57% were included. The mean pain score was reduced from 9.2±1.09 at baseline to 2.8±1.73 at day 5 (p<0.0001. The number of patients with severe intensity of pain reduced from 100% at baseline to 18.3% at day 2 and 6.96% at day 5. According to the patient assessment, 68.36% of patients reported tolerability as “very good to good”, whereas according to physician’s assessment, “very good to good” tolerability was reported in 68.27% of patients. Five (1.43 % patients discontinued the study because of adverse drug reaction. Five patients developed nine GI-related events of moderate intensity. Two patients

  15. Platelet-activating factor acether (PAF-acether) involvement in acute inflammatory and pain processes.

    Science.gov (United States)

    Bonnet, J; Loiseau, A M; Orvoen, M; Bessin, P

    1981-12-01

    PAF-acether is a potent aggregating agent released by various cells involved in acute inflammatory process. In this paper, exogenous PAF-acether has been investigated for its ability to generate signs of inflammation (edema measured by plethysmometry) and hyperalgesia (Randall-Sellito test) by standard subplantar injection in the rat paw. From 0.005 microgram. PAF-acether induced significant edema of the paw, maximal 1 hour after injection; it was dose-dependent from 0.1 to 5 microgram. Significant dose-dependent hyperalgesia occurred from 1.25 microgram; it reached a plateau from 2 to 4 hours after injection. Both phenomena were long-lasting (greater than 6 h). PAF-acether was 1.5 to 10 times stronger than PGI2 and PGE2 in inducing edema, pain, and in increasing vascular permeability. We investigated the interaction of miscellaneous drugs with the edema and the hyperalgesia caused by 2.5 microgram of PAF-acether. Non-steroidal anti-inflammatory (NSAI) drugs exerted only moderate effects on the edema without affecting hyperalgesia. Edema was highly reduced by various agents: prednisolone, L-cysteine, anti-calcic drugs, theophylline, PGI2, salbutamol, clonidine. All of them, except clonidine, and in contrast to NSAI drugs, were more potent on PAF-acether edema than on kaolin edema; a possible link between these agents is their ability to increase cyclic AMP levels in the cells and consequently to reduce lysosomal enzyme release. PAF-acether itself, injected intra-peritoneally, inhibited PAF-acether edema without preventing pain, at doses inactive on arterial pressure and hematocrit, but inducing marked gastric mucosal damage. Among the drugs tested, including analgesics, only PGI2 and imidazole improved PAF-induced hyperalgesia, showing a dissociation between edema and hyperalgesia not only in their induction (doses of PAF required, time course of the phenomena), but in the drugs able to antagonize their development too.

  16. Effects of intracutaneous injections of sterile water in patients with acute low back pain: a randomized, controlled, clinical trial

    Directory of Open Access Journals (Sweden)

    J.Z. Cui

    2016-03-01

    Full Text Available Intracutaneous sterile water injection (ISWI is used for relief of low back pain during labor, acute attacks of urolithiasis, chronic neck and shoulder pain following whiplash injuries, and chronic myofascial pain syndrome. We conducted a randomized, double-blinded, placebo-controlled trial to evaluate the effect of ISWI for relief of acute low back pain (aLBP. A total of 68 patients (41 females and 27 males between 18 and 55 years old experiencing aLBP with moderate to severe pain (scores ≥5 on an 11-point visual analogue scale [VAS] were recruited and randomly assigned to receive either ISWIs (n=34 or intracutaneous isotonic saline injections (placebo treatment; n=34. The primary outcome was improvement in pain intensity using the VAS at 10, 45, and 90 min and 1 day after treatment. The secondary outcome was functional improvement, which was assessed using the Patient-Specific Functional Scale (PSFS 1 day after treatment. The mean VAS score was significantly lower in the ISWI group than in the control group at 10, 45, and 90 min, and 1 day after injection (P<0.05, t-test. The mean increment in PSFS score of the ISWI group was 2.9±2.2 1 day after treatment, while that in the control group was 0.9±2.2. Our study showed that ISWI was effective for relieving pain and improving function in aLBP patients at short-term follow-up. ISWI might be an alternative treatment for aLBP patients, especially in areas where medications are not available, as well as in specific patients (e.g., those who are pregnant or have asthma, who are unable to receive medications or other forms of analgesia because of side effects.

  17. 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

  18. 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

  19. Postoperative pain

    DEFF Research Database (Denmark)

    Kehlet, H; Dahl, J B

    1993-01-01

    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......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...

  20. The impact and effectiveness of nurse-led care in the management of acute and chronic pain: a review of the literature.

    Science.gov (United States)

    Courtenay, Molly; Carey, Nicola

    2008-08-01

    To identify, summarise and critically appraise the current evidence regarding the impact and effectiveness of nurse-led care in acute and chronic pain. A diverse range of models of care exist within the services available for the management of acute and chronic pain. Primary studies have been conducted evaluating these models, but, review and synthesis of the findings from these studies has not been undertaken. Literature review. Searches of Pubmed (NLM) Medline, CINAHL, Web of Knowledge (Science Index, Social Science index), British Nursing Index from January 1996-March 2007 were conducted. The searches were supplemented by an extensive hand search of the literature through references identified from retrieved articles and by contact with experts in the field. Twenty-one relevant publications were identified and included findings from both primary and secondary care. The areas, in which nurses, caring for patients in pain are involved, include assessment, monitoring, evaluation of pain, interdisciplinary collaboration and medicines management. Education programmes delivered by specialist nurses can improve the assessment and documentation of acute and chronic pain. Educational interventions and the use of protocols by specialist nurses can improve patients understanding of their condition and improve pain control. Acute pain teams, led by nurses, can reduce pain intensity and are cost effective. Nurses play key roles in the diverse range of models of care that exist in acute and chronic pain. However, there are methodological weaknesses across this body of research evidence and under researched issues that point to a need for further rigorous evaluation. Nurse-led care is an integral element of the pain services offered to patients. This review highlights the effect of this care and the issues that require consideration by those responsible for the development of nurse-led models in acute and chronic pain.

  1. From acute to persistent low back pain: a longitudinal investigation of somatosensory changes using quantitative sensory testing—an exploratory study

    Science.gov (United States)

    Marcuzzi, Anna; Wrigley, Paul J.; Dean, Catherine M.; Graham, Petra L.; Hush, Julia M.

    2018-01-01

    Abstract Introduction: Chronic low back pain (LBP) is commonly associated with generalised pain hypersensitivity. It is suggested that such somatosensory alterations are important determinants for the transition to persistent pain from an acute episode of LBP. Although cross-sectional research investigating somatosensory function in the acute stage is developing, no longitudinal studies designed to evaluate temporal changes have been published. Objectives: This exploratory study aimed to investigate the temporal development of somatosensory changes from the acute stage of LBP to up to 4 months from onset. Methods: Twenty-five people with acute LBP (pain-free controls were prospectively assessed at baseline using quantitative sensory testing with the assessor blinded to group allocation, and again at 2 and 4 months. Psychological variables were concurrently assessed. People with acute LBP were classified based on their average pain severity over the previous week at 4 months as recovered (≤1/10 numeric rating scale) or persistent (≥2/10 numeric rating scale) LBP. Results: In the persistent LBP group, (1) there was a significant decrease in pressure pain threshold between 2 and 4 months (P pain threshold was significantly different from the recovered LBP group (P pain-free control reference value. Pain-related psychological variables were significantly higher in those with persistent LBP compared with the recovered LBP group at all time points (P pain sensitivity occurring in the subacute stage warrant further longitudinal evaluation to better understand the role of somatosensory changes in the development of persistent LBP. Pain-related cognitions at baseline distinguished persistent from the recovered LBP groups, emphasizing the importance of concurrent evaluation of psychological contributors in acute LBP. PMID:29756087

  2. Acute ECG changes and chest pain induced by neck motion in patients with cervical hernia--a case report.

    Science.gov (United States)

    Güler, N; Bilge, M; Eryonucu, B; Cirak, B

    2000-10-01

    We report two cases of acute cervical angina and ECG changes induced by anteflexion of the head. Cervical angina is defined as chest pain that resembles true cardiac angina but originates from cervical discopathy with nerve root compression. In these patients, Prinzmetal's angina, valvular heart disease, congenital heart disease, left ventricular aneurysm, and cardiomyopathy were excluded. After all, the patient's chest pain was reproduced by anteflexion of head, at this time, their ECGs showed nonspecific ST-T changes in the inferior and anterior leads different from the basal ECG. ECG changes returned to normal when the patient's neck moved to the neutral position. To our knowledge, these are the first cases of cervical angina associated with acute ECG changes by neck motion.

  3. 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.

  4. 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...

  5. 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.

  6. Targeted nanoparticles that mimic immune cells in pain control inducing analgesic and anti-inflammatory actions: a potential novel treatment of acute and chronic pain condition.

    Science.gov (United States)

    Hua, Susan; Cabot, Peter J

    2013-01-01

    The peripheral immune-derived opioid analgesic pathway has been well established as a novel target in the clinical pain management of a number of painful pathologies, including acute inflammatory pain, neuropathic pain, and rheumatoid arthritis. Our objective was to engineer targeted nanoparticles that mimic immune cells in peripheral pain control to deliver opioids, in particular loperamide HCl, specifically to peripheral opioid receptors to induce analgesic and anti-inflammatory actions for use in painful inflammatory conditions. This peripheral analgesic system is devoid of central opioid mediated side effects (e.g., respiratory depression, sedation, dependence, tolerance). A randomized, double blind, controlled animal trial. Thirty-six adult male Wistar rats (200 - 250 g) were randomly divided into 6 groups: loperamide HCl-encapsulated anti-ICAM-1 immunoliposomes, naloxone methiodide + loperamide HCl-encapsulated anti-ICAM-1 immunoliposomes, loperamide HCl-encapsulated liposomes, empty anti-ICAM-1 immunoliposomes, empty liposomes, and loperamide solution. Animals received an intraplantar injection of 150 μL Complete Freund's Adjuvant (CFA) into the right hindpaw and experiments were performed 5 days post-CFA injection, which corresponded to the peak inflammatory response. All formulations were administered intravenously via tail vein injection. The dose administered was 200 μL, which equated to 0.8 mg of loperamide HCl for the loperamide HCl treatment groups (sub-therapeutic dose). Naloxone methiodide (1 mg/kg) was administered via intraplantar injection, 15 minutes prior to loperamide-encapsulated anti-ICAM-1 immunoliposomes. An investigator blinded to the treatment administered assessed the time course of the antinociceptive and anti-inflammatory effects using a paw pressure analgesiometer and plethysmometer, respectively. Biodistribution studies were performed 5 days post-CFA injection with anti-ICAM-1 immunoliposomes and control liposomes via tail vein

  7. Post-traumatic stress symptom clusters in acute whiplash associated disorder and their prediction of chronic pain-related disability

    OpenAIRE

    Annick Maujean; Matthew J. Gullo; Tonny Elmose Andersen; Sophie Lykkegaard Ravn; Michele Sterling

    2017-01-01

    Abstract. Introduction:. The presence of post-traumatic stress disorder (PTSD) symptoms has been found to be associated with an increased risk of persisting neck pain and disability in motor vehicle crash (MVC) survivors with whiplash injuries. The findings are mixed as to which PTSD symptom(s) best predicts recovery in this population. Objectives:. The aims were (1) to explore the factor structure of the Post-traumatic Stress Diagnostic Scale (PDS) in a sample of acute whiplash-injured in...

  8. Application of triple rule-out with 64-slice spiral CT in the diagnosis of acute chest pain

    International Nuclear Information System (INIS)

    Li Pengyu; Li Kuncheng; Du Xiangyin; Cao Lizhen; Liu Jiabin; Yang Yanhuui; Liang Zhigang; Zhu Xiaolian; Liu Jian

    2007-01-01

    Objective: To investigate the performance of triple rule-out with 64-slice spiral CT in the combined examination of pulmonary artery, thoracic aorta and coronary artery for patients with acute chest pain. Methods: Seventy patients who presented with acute chest pain were included in the study. All of the patients underwent retrospective ECG-gated 64-slice computed tomography triple rule-out examination to evaluate the pulmonary arteries, thoracic aorta and coronary arteries. Multi-planar reconstruction (MPR), maximum intensity projection (MIP), curved-planar reconstruction (CPR) and volume rendering (VR) were used to display pulmonary arteries, thoracic aorta and coronary arteries. We evaluated the image quality of coronary artery and the enhancement of the pulmonary artery and thoracic aorta to estimate if the examination can fulfill the clinical demand for the differential diagnosis of acute chest pain. Results: The mean scan time was (8.5±1.0) s, and the dose of contrast medium injected was 100 ml. There were 95.7% (67/70) of patients whose CT values detected in the pulmonary artery and thoracic aorta after enhancement Were ≥200 HU. The image quality of 85.8% (720/839) coronary segments was classified as excellent, 8.6% (72/839) as good, and 5.6% (47/839) as poor. There were 20 eases with coronary stenoses ≥50%, 2 cases with pulmonary embolism, and 2 cases with aortic dissection. Conclusion: The triple rule-out examination with 64-slice spiral CT could depict pulmonary artery, thoracic aorta, and coronary artery in 8 s with good image quality. It has great potential in the etiological diagnosis for the patients with acute chest pain. (authors)

  9. 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

  10. Post-traumatic stress symptom clusters in acute whiplash associated disorder and their prediction of chronic pain-related disability.

    Science.gov (United States)

    Maujean, Annick; Gullo, Matthew J; Andersen, Tonny Elmose; Ravn, Sophie Lykkegaard; Sterling, Michele

    2017-11-01

    The presence of post-traumatic stress disorder (PTSD) symptoms has been found to be associated with an increased risk of persisting neck pain and disability in motor vehicle crash (MVC) survivors with whiplash injuries. The findings are mixed as to which PTSD symptom(s) best predicts recovery in this population. The aims were (1) to explore the factor structure of the Post-traumatic Stress Diagnostic Scale (PDS) in a sample of acute whiplash-injured individuals following a MVC and (2) to identify the PTSD-symptom clusters that best predict long-term neck pain-related disability in this population as measured by the Neck Pain Disability Index (NDI). A sample (N = 146) of whiplash-injured individuals completed the NDI and the PDS at baseline (whiplash-injured individuals following a MVC.

  11. 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.

  12. Interactive versus passive distraction for acute pain management in young children: the role of selective attention and development.

    Science.gov (United States)

    Wohlheiter, Karen A; Dahlquist, Lynnda M

    2013-03-01

    To examine whether age and developmental differences in selective attention influence young children's differential responses to interactive and passive distraction. 65 3- to 6-year-old children underwent three cold-pressor trials while receiving no intervention, playing a video game (interactive distraction), or watching a video game (passive distraction). In addition, children completed a test of selective attention, and parents completed ratings of attention. Consistent with neurocognitive models of pain, children benefited more from interactive distraction than from passive distraction. Although older children demonstrated superior pain tolerance overall, age and selective attention skills did not moderate children's responses to the distraction intervention. These findings suggest that younger preschoolers can benefit from interactive distraction to manage acute pain, provided that the distraction activity is developmentally appropriate. Research is needed to determine whether developmental issues are more important moderators of children's responses to distraction when faced with more challenging task demands.

  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. Microsatellites grant more stable flanking genes

    Directory of Open Access Journals (Sweden)

    Joukhadar Reem

    2012-10-01

    Full Text Available Abstract Background Microsatellites, or simple sequence repeats (SSRs, are DNA sequences that include tandem copies of specific sequences no longer than six bases. SSRs are ubiquitous in all genomes and highly mutable. Presentation of the hypothesis Results from previous studies suggest that flanking regions of SSR are exhibit high stability in a wide range of organisms. We hypothesized that the SSRs ability to discard weak DNA polymerases could be responsible for this unusual stability. . When the weak polymerases are being decayed over SSRs, the flanking sequences would have higher opportunity to be replicated by more stable DNA polymerases. We present evidence of the molecular basis of our hypothesis. Testing the hypothesis The hypothesis could be tested by examining the activity of DNA polymerase during and after a number of PCRs. The PCR reactions should be run with the same SSR locus possessing differences in the SSR length. The hypothesis could also be tested by comparing the mutational rate of a transferred gene between two transformations. The first one has a naked T-DNA (transferred DNA, while the second one has the same T-DNA flanked with two SSRs. Implications of the hypothesis In any transformation experiment, flanking the T-DNA fragment with SSR sequences would result in more stably transferred genes. This process would decrease the unpredictable risks that may occur because of the mutational pressure on this foreign segment.

  15. 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.)

  16. Diagnostic performance of contrast-enhanced MR for acute appendicitis and alternative causes of abdominal pain in children

    International Nuclear Information System (INIS)

    Koning, Jeffrey L.; Naheedy, John H.; Kruk, Peter G.

    2014-01-01

    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.)

  17. 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 (ptechnology and method applied. The use of persuasive 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.

  18. The role of inter-professional relationships and support for nurse prescribing in acute and chronic pain.

    Science.gov (United States)

    Stenner, Karen; Courtenay, Molly

    2008-08-01

    This paper is a report of a study to explore nurse prescribers' views on the role of inter-professional relationships and other means of support for nurse prescribing for patients in acute and chronic pain. Research indicates that good team relationships are important for supporting nurse prescribing but that poor understanding of the role by other healthcare professionals can act as a barrier. While collaborative working is central to the role of pain nurses, there is a lack of research on the impact of nurse prescribing on inter-professional working or the support needs of these nurses. A qualitative approach was adopted using thematic analysis of semi-structured interview data collected during 2006 and 2007. Participants were 26 nurses who prescribed medicines for patients with acute and/or chronic pain. Nurses' believed that prescribing encouraged collaborative working and sharing of knowledge across professional boundaries and that this helped to broaden understanding of the wider remit of pain management. Collaboration with doctors served a number of functions, including support and continuous learning. Barriers to effective nurse prescribing were a lack of understanding of its role amongst healthcare professionals and inadequate support. Formal support structures, such as regular clinical supervision, were seen as crucial to meeting nurses' ongoing learning. Factors that promote understanding of nurse prescribing and support inter-professional relationships are likely to have a positive impact on the effectiveness of nurse prescribing. A more consistent approach is required within organisations to support nurse prescribing.

  19. [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.

  20. Comparison of traditional cardiovascular risk models and coronary atherosclerotic plaque as detected by computed tomography for prediction of acute coronary syndrome in patients with acute chest pain.

    Science.gov (United States)

    Ferencik, Maros; Schlett, Christopher L; Bamberg, Fabian; Truong, Quynh A; Nichols, John H; Pena, Antonio J; Shapiro, Michael D; Rogers, Ian S; Seneviratne, Sujith; Parry, Blair Alden; Cury, Ricardo C; Brady, Thomas J; Brown, David F; Nagurney, John T; Hoffmann, Udo

    2012-08-01

    The objective was to determine the association of four clinical risk scores and coronary plaque burden as detected by computed tomography (CT) with the outcome of acute coronary syndrome (ACS) in patients with acute chest pain. The hypothesis was that the combination of risk scores and plaque burden improved the discriminatory capacity for the diagnosis of ACS. The study was a subanalysis of the Rule Out Myocardial Infarction Using Computer-Assisted Tomography (ROMICAT) trial-a prospective observational cohort study. The authors enrolled patients presenting to the emergency department (ED) with a chief complaint of acute chest pain, inconclusive initial evaluation (negative biomarkers, nondiagnostic electrocardiogram [ECG]), and no history of coronary artery disease (CAD). Patients underwent contrast-enhanced 64-multidetector-row cardiac CT and received standard clinical care (serial ECG, cardiac biomarkers, and subsequent diagnostic testing, such as exercise treadmill testing, nuclear stress perfusion imaging, and/or invasive coronary angiography), as deemed clinically appropriate. The clinical providers were blinded to CT results. The chest pain score was calculated and the results were dichotomized to ≥10 (high-risk) and modeling was performed to examine the association of risk scores and coronary plaque burden to the outcome of ACS. Unadjusted models were individually fitted for the coronary plaque burden and for Goldman, Sanchis, TIMI, and chest pain scores. In adjusted analyses, the authors tested whether the association between risk scores and ACS persisted after controlling for the coronary plaque burden. The prognostic discriminatory capacity of the risk scores and plaque burden for ACS was assessed using c-statistics. The differences in area under the receiver-operating characteristic curve (AUC) and c-statistics were tested by performing the -2 log likelihood ratio test of nested models. A p value capacity for the diagnosis of ACS. Plaque burden was

  1. The use of sub-anesthetic intravenous ketamine and adjuvant dexmedetomidine when treating acute pain from CRPS.

    Science.gov (United States)

    Nama, Sharanya; Meenan, Daniel R; Fritz, William T

    2010-01-01

    Complex regional pain syndrome (CRPS) is a pain condition of the extremities that presents with pain and allodynia, decreased range of motion, swelling and skin changes. There are 2 forms of CRPS - Type I which does not have demonstrable nerve lesions and Type 2, which has evidence of obvious nerve damage. Management of refractory CRPS has been challenging. Some studies have revealed that the N-methyl-D-aspartic acid receptor (NMDAR) may be involved in the etiology of the pain in CRPS and perhaps that a NMDA receptor antagonist like ketamine is a potential treatment for CRPS. However, the side effect profile of ketamine is concerning, and limiting the adverse effects of the drug is beneficial. Dexmedetomidine is an alpha 2 agonist similar to clonidine with analgesic properties that can be used in combination with ketamine to provide additional analgesia in CRPS. This case describes the treatment of acute pain symptoms from Chronic Regional Pain Syndrome-Type 1 (CRPS-1) with sub-anesthetic intravenous infusion of ketamine with adjunct dexmedetomidine. A 47-year-old female patient presented with severe pain, burning and allodynia from CRPS-1 refractory to conventional therapy. She was then admitted to a monitored bed, received a sub-anesthetic intravenous infusion of ketamine with adjunct dexmedetomidine for 19 hours and subsequently discharged with complete resolution of her pain and associated symptoms. Here, the synergistic effect of the ketamine and dexmedetomidine together is shown to provide excellent symptom relief while decreasing the total ketamine administered. The combination minimized unwanted side effects and eliminated the need for intensive care unit admission secondary to anesthetic doses of ketamine.

  2. 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.

  3. Patient participation in quality pain management during an acute care admission.

    Science.gov (United States)

    McTier, Lauren J; Botti, Mari; Duke, Maxine

    2014-04-01

    The objective of the study was to explore patient participation in the context of pain management during a hospital admission for a cardiac surgical intervention of patients with cardiovascular disease. This is a single-institution study, with a case-study design. The unit of analysis was a cardiothoracic ward of a major metropolitan, tertiary referral hospital in Melbourne, Australia. Multiple methods of data collection were used including preadmission and predischarge patient interviews (n=98), naturalistic observations (n=48), and focus group interviews (n=2). Patients' preference for participation in pain management was not always commensurate with their involvement in pain management. Patients displayed a greater understanding of their role in pain management in terms of reporting pain and the use of multimodal analgesics after surgery. The majority of patients, however, did not understand the importance of reporting pain to avoid complications. Patients had limited opportunity to participate in their pain management. On occasions in which clinicians did involve patients, the involvement appeared to be focused on reporting pain rather than treatment of pain. Patient participation in pain management during hospitalization is not optimal. This has implications for the quality of pain management patients receive. Higher engagement of patients in their pain management during hospitalization is required to ensure comfort, reduce potential for complications, and adequately prepare the patients to manage their pain following discharge from hospital.

  4. 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.

  5. The effects of topical heat therapy on chest pain in patients with acute coronary syndrome: a randomised double-blind placebo-controlled clinical trial.

    Science.gov (United States)

    Mohammadpour, Ali; Mohammadian, Batol; Basiri Moghadam, Mehdi; Nematollahi, Mahmoud Reza

    2014-12-01

    To investigate the effects of local heat therapy on chest pain in patients with acute coronary syndrome. Chest pain is a very common complaint in patients with acute coronary syndrome. It is managed both pharmacologically and nonpharmacologically. Pharmacological pain management is associated with different side effects. This was a randomised double-blind placebo-controlled clinical trial conducted in 2013. A convenience sample of 66 patients with acute coronary syndrome was selected from a coronary care unit of a local teaching hospital affiliated to Gonabad University of Medical Sciences, Gonabad, Iran. Patients were randomly assigned to either the experimental or the placebo group. Patients in the experimental and the placebo groups received local heat therapy using a hot pack warmed to 50 and 37 °C, respectively. We assessed chest pain intensity, duration and frequency as well as the need for opioid analgesic therapy both before and after the study. The study instrument consisted of a demographic questionnaire, the McGill Pain Questionnaire, and a data sheet for documenting pain frequency and duration as well as the need for analgesic therapy. The placebo heat therapy did not significantly decrease the intensity, the duration and the frequency of pain episodes. However, pain intensity, duration and frequency in the experimental group decreased significantly after the study. Moreover, the groups differed significantly in terms of the need for opioid analgesic therapy neither before nor after the intervention. Local heat therapy is an effective intervention for preventing and relieving chest pain in patients with acute coronary syndrome. Effective pain management using local heat therapy could help nurses play an important role in providing effective care to patients with acute coronary syndrome and in minimising adverse effects associated with pain medications. © 2014 John Wiley & Sons Ltd.

  6. Clinical characteristics of acute renal failure with severe loin pain and patchy renal vasoconstriction

    Directory of Open Access Journals (Sweden)

    Jeonghwan Lee

    2012-09-01

    Conclusion: ARF with severe loin pain and PRV can present with loin or abdominal pain, even without a history of anaerobic exercise. Careful history taking and appropriate imaging studies are critical in the diagnosis and management of this syndrome.

  7. Pain patterns after distension of the gallbladder in patients with acute cholecystitis

    DEFF Research Database (Denmark)

    Middelfart, H V; Jensen, P; Højgaard, L

    1998-01-01

    BACKGROUND: Visceral pain is characterized by poor pain localization and a referred or radiating pain pattern. Its clinical importance in the abdomen is stressed by the finding that about one-third of patients still complain of abdominal pain after cholecystectomy. A better understanding...... were performed. After each injection of saline the localization of pain and the presence of nausea and vomiting were registered. The injections continued until the patient felt abdominal pain necessitating cessation of the investigation or until the cystic duct opened (visualized on cholescintigraphy......). RESULTS: Distension of the gallbladder caused pain in 10 of the 12 patients. In 70% the pain was localized under the right costal margin or in the epigastrium. No mathematical formula could describe the pressure-volume relation in the gallbladder. The cystic duct opening pressure varied between 3 and 44...

  8. Nebulized fentanyl vs intravenous morphine for ED patients with acute abdominal pain: a randomized double-blinded, placebo-controlled clinical trial.

    Science.gov (United States)

    Deaton, Travis; Auten, Jonathan D; Darracq, Michael A

    2015-06-01

    Patients with acute abdominal pain commonly present to emergency departments. The safe and effective relief of discomfort is a concern to patients and physicians. Intravenous opioids are the traditional method used to provide pain relief in this setting, but intravenous access is time consuming and not always achievable. Alternative methods of pain control may therefore be necessary for the acute management of painful conditions without adding to the overall physical or psychological discomfort. The purpose of this study was to evaluate the feasibility of nebulized fentanyl (NF) in the alleviation of acute and undifferentiated abdominal pain. We also sought to compare NF with intravenous morphine (IVM) and to assess patient and provider satisfaction with NF. Nebulized fentanyl (2 μg/kg) was compared to IVM (0.1 mg/kg) at 10, 20, 30, and 40 minutes; and patient and physician satisfaction was recorded. The NF group experienced more rapid pain relief and more sustained and clinically significant pain relief over the 40-minute study interval. There were no adverse effects noted in the NF group. Both patient and physician satisfaction scores were higher in the NF group. Fentanyl citrate at a dose of 2 μg/kg through a breath-actuated nebulizer appears to be a feasible and safe alternative to IVM (0.1 mg/kg) in the treatment of acute abdominal pain. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Efficacy of paracetamol, diclofenac and advice for acute low back pain in general practice: design of a randomized controlled trial (PACE Plus)

    NARCIS (Netherlands)

    M. Schreijenberg; P.A.J. Luijsterburg (Pim); Y. van Trier (Yvonne); D. Rizopoulos (Dimitris); M.A. Koopmanschap (Marc); L. Voogt; C. Maher (Chris); B.W. Koes (Bart)

    2017-01-01

    textabstractBackground: Low back pain is common and associated with a considerable burden to patients and society. There is uncertainty regarding the relative benefit of paracetamol and diclofenac and regarding the additional effect of pain medication compared with advice only in patients with acute

  10. The efficacy of preoperative versus postoperative rofecoxib for preventing acute postoperative dental pain: a prospective randomized crossover study using bilateral symmetrical oral surgery

    NARCIS (Netherlands)

    Ong, K. S.; Seymour, R. A.; Yeo, J. F.; Ho, K. H.; Lirk, P.

    2005-01-01

    Previous data have demonstrated that rofecoxib has good analgesic efficacy for acute postoperative dental pain. However, up to half of these patients require rescue analgesics within the first 24 hours. As the timing of analgesic interventions may be an important factor in pain control, the present

  11. Paracetamol (acetaminophen) or non-steroidal anti-inflammatory drugs, alone or combined, for pain relief in acute otitis media in children

    NARCIS (Netherlands)

    Sjoukes, Alies; Venekamp, Roderick P; van de Pol, Alma C; Hay, Alastair D; Little, Paul; Schilder, Anne GM; Damoiseaux, Roger Amj

    2016-01-01

    BACKGROUND: Acute otitis media (AOM) is one of the most common childhood infectious diseases and a significant reason for antibiotic prescriptions in children worldwide. Pain from middle ear infection and pressure behind the eardrum is the key symptom of AOM. Ear pain is central to children's and

  12. Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: a systematic review of the literature

    NARCIS (Netherlands)

    Steenstra, I. A.; Verbeek, J. H.; Heymans, M. W.; Bongers, P. M.

    2005-01-01

    Background: The percentages of patients with acute low back pain ( LBP) that go on to a chronic state varies between studies from 2% to 34%. In some of these cases low back pain leads to great costs. Aims: To evaluate the evidence for prognostic factors for return to work among workers sick listed

  13. Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: a systematic review of the literature

    NARCIS (Netherlands)

    Steenstra, I.A.; Verbeek, J.H.A.M.; Heymans, M.W.; Bongers, P.M.

    2005-01-01

    BACKGROUND: The percentages of patients with acute low back pain (LBP) that go on to a chronic state varies between studies from 2% to 34%. In some of these cases low back pain leads to great costs. AIMS: To evaluate the evidence for prognostic factors for return to work among workers sick listed

  14. From acute to persistent low back pain: a longitudinal investigation of somatosensory changes using quantitative sensory testing—an exploratory study

    Directory of Open Access Journals (Sweden)

    Anna Marcuzzi

    2018-04-01

    Conclusion:. Changes in mechanical pain sensitivity occurring in the subacute stage warrant further longitudinal evaluation to better understand the role of somatosensory changes in the development of persistent LBP. Pain-related cognitions at baseline distinguished persistent from the recovered LBP groups, emphasizing the importance of concurrent evaluation of psychological contributors in acute LBP.

  15. Measurement of acute nonspecific low back pain perception in primary care physical therapy : reliability and validity of the brief illness perception questionnaire

    NARCIS (Netherlands)

    Hallegraeff, Joannes M.; van der Schans, Cees P.; Krijnen, Wim P.; de Greef, Mathieu H. G.

    2013-01-01

    Background: The eight-item Brief Illness Perception Questionnaire is used as a screening instrument in physical therapy to assess mental defeat in patients with acute low back pain, besides patient perception might determine the course and risk for chronic low back pain. However, the psychometric

  16. Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: A systematic review of the literature

    NARCIS (Netherlands)

    Steenstra, I.A.; Verbeek, J.H.; Heymans, M.W.; Bongers, P.M.

    2005-01-01

    Background: The percentages of patients with acute low back pain (LBP) that go on to a chronic state varies between studies from 2% to 34%. In some of these cases low back pain leads to great costs. Aims: To evaluate the evidence for prognostic factors for return to work among workers sick listed

  17. Usefulness of computed tomography in patients with right inferior abdominal quadrant pain: acute appendicitis and its alternative diagnosis

    International Nuclear Information System (INIS)

    Rossini, Sebastian A.; Haberman, Diego; Gonzalez Villaveiran, Ruben F.

    2009-01-01

    Purpose: To review the tomography findings of the acute appendicitis, their complications and alternative diagnosis. To value the use of helicoidal computed tomography (HCT) in the diagnosis of acute appendicitis and in the study of patients with right inferior abdominal quadrant (RIQ) pain and acute abdomen, for diagnosis and eventual complications, in order to decide treatment. Materials and method: For five months, the populations included in this retrospectively study were all patients delivered for presenting with RIQ pain for a HCT exam. These exams were made with oral and intravenous contrasts, when there were not contraindications. The HCT results were correlated with clinical follow up, surgery and histopathologic exams. Results: Over a total of 100 patients studied, 53 presented tomographic diagnosis of appendicitis, 22 of which presented perforation signs; 27 showed an alternative diagnosis (ovaries follicles, ureteral litiasis, tiphlitis, diverticulitis, colitis, salpingitis), 18 patients did not present tomographic findings to support the clinical symptoms and 2 presented indeterminated results. These data represented a sensibility of 100%, specificity of 95,7%, positive predictive value (PPV) of 96,2% and negative predictive value (NPV) of 100% for the tomography diagnosis of acute appendicitis and a sensibility of 100%, specificity of 81,8%, PPV of 95,1% and NPV of 100% for the tomography diagnosis of the different etiology in patient with right inferior acute abdomen. Conclusion: HCT is extremely useful in the study of patients with acute abdomen with origin in the RIQ, not only to make a diagnosis, but also to evaluate the complications, so as to decide proper treatment. (authors) [es

  18. Diagnostic performance of a biomarker panel as a negative predictor for acute appendicitis in adult ED patients with abdominal pain.

    Science.gov (United States)

    Huckins, David S; Copeland, Karen; Self, Wesley; Vance, Cheryl; Hendry, Phyllis; Borg, Keith; Gogain, Joseph

    2017-03-01

    Evaluate the diagnostic accuracy of the APPY1TM biomarker panel, previously described for use in pediatric patients, for identifying adult ED patients with abdominal pain who are at low risk of acute appendicitis. This study prospectively enrolled subjects >18years of age presenting to seven U.S. emergency departments with pain suggesting possible acute appendicitis. The APPY1 panel was performed on blood samples drawn from each patient at the time of initial evaluation and results were correlated with the final diagnosis either positive or negative for acute appendicitis. 431 patients were enrolled with 422 completing all aspects of the study. The APPY1 biomarker panel exhibited a sensitivity of 97.5% (95% CI, 91.3-99.3%), a negative predictive value of 98.4% (95% CI, 94.4-99.6%), a negative likelihood ratio of 0.07 (95% CI, 0.02-0.27), with a specificity of 36.5% (95% CI, 31.6-41.8%) for acute appendicitis. The panel correctly identified 125 of 342 (36.6%) patients who did not have appendicitis with 2 (2.5%) false negatives. The CT utilization rate in this population was 72.7% (307/422). Of 307 CT scans, 232 were done for patients who did not have appendicitis and 79 (34%) of these patients were correctly identified as negative with "low risk" biomarker panel results, representing 26% (79/307) of all CT scans performed. This biomarker panel exhibited high sensitivity and negative predictive value for acute appendicitis in this prospective adult cohort, thereby potentially reducing the dependence on CT for the evaluation of possible acute appendicitis. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    1989-10-11

    presence of diverticular disease does not preclude development of acute appendicitis concxitantly. The initial medical treatment is the same as for...appendicitis see APPENDICITIS. c. Pelvic inflammatory disease see PID. d. Diverticulitis most commonly involves the descending (left) colon . Symptoms...Five additional categories are included for female patients. These are: pelvic inflammatory disease (PID), urinary tract infection (UTI), ovarian cyst

  20. Differential Efficacy of Ketamine in the Acute versus Chronic Stages of Complex Regional Pain Syndrome in Mice

    Science.gov (United States)

    Tajerian, Maral; Leu, David; Yang, Phillip; Huang, Ting Ting; Kingery, Wade S; Clark, J David

    2015-01-01

    Background Complex regional pain syndrome (CRPS) is a painful, disabling and often chronic condition, where many patients transition from an acute phase with prominent peripheral neurogenic inflammation to a chronic phase with evident central nervous system (CNS) changes. Ketamine is a centrally-acting agent believed to work through blockade of N-methyl-D-aspartate (NMDA) receptors and is being increasingly used for the treatment of refractory CRPS, although the basis for the drug’s effects and efficacy at different stages of the syndrome remain unclear. Methods We used a mouse model of CRPS (n=8–12/group) involving tibia fracture/cast immobilization to test the efficacy of ketamine (2 mg/kg/day; 7 days) or vehicle infusion during acute (3weeks [3w] post-fracture) and chronic (7w post-fracture) stages. Results Acute phase fracture mice displayed elevated limb temperature, edema and nociceptive sensitization that were not reduced by ketamine. Fracture mice treated with ketamine during the chronic phase showed reduced nociceptive sensitization that persisted beyond completion of the infusion. During this chronic phase, ketamine also reduced latent nociceptive sensitization and improved motor function at 18 weeks post-fracture. No side effects of the infusions were identified. These behavioral changes were associated with altered spinal astrocyte activation and expression of pain-related proteins including NMDA receptor 2b (NR2b), Ca2+/calmodulin-dependent protein kinase ii (CaMK2), and brain-derived neurotrophic factor (BNDF). Conclusions Collectively, these results demonstrate that ketamine is efficacious in the chronic, but not acute stages of CRPS, suggesting that the centrally-acting drug is relatively ineffective in early CRPS when peripheral mechanisms are more critical for supporting nociceptive sensitization. PMID:26492479

  1. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians.

    Science.gov (United States)

    Qaseem, Amir; Wilt, Timothy J; McLean, Robert M; Forciea, Mary Ann

    2017-04-04

    The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on noninvasive treatment of low back pain. Using the ACP grading system, the committee based these recommendations on a systematic review of randomized, controlled trials and systematic reviews published through April 2015 on noninvasive pharmacologic and nonpharmacologic treatments for low back pain. Updated searches were performed through November 2016. Clinical outcomes evaluated included reduction or elimination of low back pain, improvement in back-specific and overall function, improvement in health-related quality of life, reduction in work disability and return to work, global improvement, number of back pain episodes or time between episodes, patient satisfaction, and adverse effects. The target audience for this guideline includes all clinicians, and the target patient population includes adults with acute, subacute, or chronic low back pain. Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation). For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation). In patients with chronic

  2. Blockade of NMDA receptors decreased spinal microglia activation in bee venom induced acute inflammatory pain in rats.

    Science.gov (United States)

    Li, Li; Wu, Yongfang; Bai, Zhifeng; Hu, Yuyan; Li, Wenbin

    2017-03-01

    Microglial cells in spinal dorsal horn can be activated by nociceptive stimuli and the activated microglial cells release various cytokines enhancing the nociceptive transmission. However, the mechanisms underlying the activation of spinal microglia during nociceptive stimuli have not been well understood. In order to define the role of NMDA receptors in the activation of spinal microglia during nociceptive stimuli, the present study was undertaken to investigate the effect of blockade of NMDA receptors on the spinal microglial activation induced by acute peripheral inflammatory pain in rats. The acute inflammatory pain was induced by subcutaneous bee venom injection to the plantar surface of hind paw of rats. Spontaneous pain behavior, thermal withdrawal latency and mechanical withdrawal threshold were rated. The expression of specific microglia marker CD11b/c was assayed by immunohistochemistry and western blot. After bee venom treatment, it was found that rats produced a monophasic nociception characterized by constantly lifting and licking the injected hind paws, decreased thermal withdrawal latency and mechanical withdrawal threshold; immunohistochemistry displayed microglia with enlarged cell bodies, thickened, extended cellular processes with few ramifications, small spines, and intensive immunostaining; western blot showed upregulated expression level of CD11b/c within the period of hyperalgesia. Prior intrathecal injection of MK-801, a selective antagonist of NMDA receptors, attenuated the pain behaviors and suppressed up-regulation of CD11b/c induced by bee venom. It can be concluded that NMDA receptors take part in the mediation of spinal microglia activation in bee venom induced peripheral inflammatory pain and hyperalgesia in rats.

  3. Use of Fentanyl Iontophoretic Transdermal System (ITS) (IONSYS®) in the Management of Patients with Acute Postoperative Pain: A Case Series.

    Science.gov (United States)

    Poplawski, Steven; Johnson, Matthew; Philips, Philip; Eberhart, Leopold H J; Koch, Tilo; Itri, Loretta M

    2016-12-01

    Fentanyl iontophoretic transdermal system (ITS) [IONSYS ® , The Medicines Company, Parsippany, NJ, USA] is a needle-free, patient-controlled, postoperative opioid pain management treatment. It is indicated for the short-term management of acute postoperative pain in adults requiring opioid analgesia in the hospital. The safety and effectiveness of fentanyl ITS for acute postoperative pain management has been demonstrated in a range of surgery and patient types studied in seven phase 3 trials (three placebo-controlled trials and four active-comparator trials). The majority of the patients in the phase 3 trials had undergone either abdominal/pelvic, orthopedic, or thoracic surgery. Consistent with the prescribing information, physicians in clinical practice may treat patients with this system following any type of surgery including those that may not have been included in the phase 3 trials. The purpose of this case series is to illustrate how fentanyl ITS is being utilized for postoperative pain management in real-world clinical practice following a variety of surgeries and in current pain management protocols that may have evolved since the completion of the phase 3 program. There are seven cases from three clinical centers described within this case series, each using fentanyl ITS according to the prescribing information. The surgery types included are bariatric (N = 3), prostate (N = 2), colorectal (N = 1), and perirectal abscess drainage (N = 1). A systematic review of each patient chart was conducted via a standardized retrospective assessment by the clinicians who managed each patient. Additionally, each healthcare professional was interviewed regarding their overall experience and key learnings using fentanyl ITS. Overall, fentanyl ITS was effective and well tolerated in these case reports in current-day clinical practice settings. These case studies are informative about fentanyl ITS use shortly after product approval and set the stage for

  4. High-sensitivity troponin assays for the early rule-out or diagnosis of acute myocardial infarction in people with acute chest pain: A systematic review and cost-effectiveness analysis

    NARCIS (Netherlands)

    M. Westwood (Marie); T. van Asselt (Thea); B.L.T. Ramaekers (Bram); P. Whiting (Penny); P. Thokala (Praveen); M.A. Joore (Manuela); N. Armstrong (Nigel); J. Ross (Janine); J.L. Severens (Hans); J. Kleijnen (Jos)

    2015-01-01

    textabstractBackground The primary indication for this assessment is the early rule-out of acute myocardial infarction (AMI) in people presenting with acute chest pain and suspected, but not confirmed, non-ST segment elevation myocardial infarction (NSTEMI). Cardiac troponins (cTns) I and T are used

  5. Pain

    OpenAIRE

    H.W. Snyman

    1980-01-01

    The medical profession has always been under pressure to supply public explanations of the diseases with which it deals. On the other hand, it is an old characteristic of the profession to devise comprehensive and unifying theories on all sorts of medical problems. Both these statements apply to pain - one of the most important and clinically striking phenomena and expressions of man since his origin in the mists of time.

  6. Pain

    Directory of Open Access Journals (Sweden)

    H.W. Snyman

    1980-09-01

    Full Text Available The medical profession has always been under pressure to supply public explanations of the diseases with which it deals. On the other hand, it is an old characteristic of the profession to devise comprehensive and unifying theories on all sorts of medical problems. Both these statements apply to pain - one of the most important and clinically striking phenomena and expressions of man since his origin in the mists of time.

  7. The experiences of acute non-surgical pain of children who present to a healthcare facility for treatment: a systematic review protocol.

    Science.gov (United States)

    Pope, Nicole; Tallon, Mary; McConigley, Ruth; Wilson, Sally

    2015-10-01

    The qualitative objective of this systematic review is to identify and synthesize the best available evidence on experiences of acute non-surgical pain, including pain management, of children (between four to 18 years) when they present to a healthcare facility for treatment.The specific objectives are to identify: 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". The pain experience is multifaceted and complex, extending beyond the physiological interpretation of a noxious stimulus, encompassing other dimensions, including; psychological, cognitive, sociocultural, affective and emotional factors. Pain can be described as chronic (persisting for three months or more) or acute (a time limited response to a noxious stimuli). Over the past 50 years clinical research has made revolutionary contributions to better understanding pediatric pain. The once pervasive erroneous notion that infants do not experience pain the same way as adults has been firmly dispelled. We now know that nervous system structures associated with the physiological interpretation of pain are functional as early as fetal development. Despite this critical knowledge and the growing global commitment to improving pediatric pain management in clinical practice, evidence repeatedly suggests that pain management remains suboptimal and inconsistent, a phenomenon commonly referred to as oligoanalgesia. Research evidence has linked poorly managed pain in the pediatric population to negative behavioral and physiological consequences later in life. Effective pain management is therefore a priority area for health care professionals. Improved understanding of children's experiences of acute non-surgical pain may lead to improved pain management and a reduction in oligoanalgesia.In the 1970s and 1980s, studies began exploring the subjective experiences of

  8. Differences in disease features between childhood-onset and adult-onset systemic lupus erythematosus patients presenting with acute abdominal pain.

    Science.gov (United States)

    Tu, Yu-Ling; Yeh, Kuo-Wei; Chen, Li-Chen; Yao, Tsung-Chieh; Ou, Liang-Shiou; Lee, Wen-I; Huang, Jing-Long

    2011-04-01

    Abdominal pain in systemic lupus erythematosus (SLE) patients has rarely been analyzed in pediatric populations. We planned to investigate the potential differences between childhood-onset and adult-onset SLE patients who were hospitalized because of acute abdominal pain. A retrospective study including 23 childhood-onset SLE patients with 38 admissions and 88 adult-onset SLE patients with 108 admissions from 1999 to 2008 were conducted in our hospital. All of them had the chief complaint of diffuse abdominal pain. The etiologies of acute abdominal pain in adult-onset SLE patients were more diverse than childhood-onset SLE patients. The most common cause of acute abdominal pain in SLE patients was lupus mesenteric vasculitis (LMV) (18.5%), followed by acute gastroenteritis (14.4%), pancreatitis (10.3%), appendicitis (7.5%), and cholecystitis (6.2%). Compared with adults, children were admitted more often due to LMV (31.6% versus 13.9%; P = 0.016), had more frequently recurrent episodes (39.1% versus 14.8%; P = 0.009), and were more often treated with immunosuppressive agents (31.6% versus 7.4%; P abdominal pain should be considered in SLE patients. LMV is the most common cause of acute abdomen in childhood-onset SLE patients with low mortality and morbidity provided by prompt diagnosis and timely administration of high-dose intravenous corticosteroids after excluding real surgical abdomen. Crown Copyright © 2011. Published by Elsevier Inc. All rights reserved.

  9. A comparison of the accuracy of ultrasound and computed tomography in common diagnoses causing acute abdominal pain

    Energy Technology Data Exchange (ETDEWEB)

    Randen, Adrienne van; Stoker, Jaap [Academic Medical Centre, Department of Radiology (suite G1-227), Amsterdam (Netherlands); Lameris, Wytze; Boermeester, Marja A. [Academic Medical Center, Department of Surgery, Amsterdam (Netherlands); Es, H.W. van; Heesewijk, Hans P.M. van [St Antonius Hospital, Department of Radiology, Nieuwegein (Netherlands); Ramshorst, Bert van [St Antonius Hospital, Department of Surgery, Nieuwegein (Netherlands); Hove, Wim ten [Gelre Hospitals, Department of Radiology, Apeldoorn (Netherlands); Bouma, Willem H. [Gelre Hospitals, Department of Surgery, Apeldoorn (Netherlands); Leeuwen, Maarten S. van [University Medical Centre, Department of Radiology, Utrecht (Netherlands); Keulen, Esteban M. van [Tergooi Hospitals, Department of Radiology, Hilversum (Netherlands); Bossuyt, Patrick M. [Academic Medical Center, Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam (Netherlands)

    2011-07-15

    Head-to-head comparison of ultrasound and CT accuracy in common diagnoses causing acute abdominal pain. Consecutive patients with abdominal pain for >2 h and <5 days referred for imaging underwent both US and CT by different radiologists/radiological residents. An expert panel assigned a final diagnosis. Ultrasound and CT sensitivity and predictive values were calculated for frequent final diagnoses. Effect of patient characteristics and observer experience on ultrasound sensitivity was studied. Frequent final diagnoses in the 1,021 patients (mean age 47; 55% female) were appendicitis (284; 28%), diverticulitis (118; 12%) and cholecystitis (52; 5%). The sensitivity of CT in detecting appendicitis and diverticulitis was significantly higher than that of ultrasound: 94% versus 76% (p < 0.01) and 81% versus 61% (p = 0.048), respectively. For cholecystitis, the sensitivity of both was 73% (p = 1.00). Positive predictive values did not differ significantly between ultrasound and CT for these conditions. Ultrasound sensitivity in detecting appendicitis and diverticulitis was not significantly negatively affected by patient characteristics or reader experience. CT misses fewer cases than ultrasound, but both ultrasound and CT can reliably detect common diagnoses causing acute abdominal pain. Ultrasound sensitivity was largely not influenced by patient characteristics and reader experience. (orig.)

  10. Management of the acute painful crisis in sickle cell disease- a re-evaluation of the use of opioids in adult patients.

    Science.gov (United States)

    Telfer, Paul; Bahal, Nawal; Lo, Alice; Challands, Joanne

    2014-07-01

    Management of the acute painful crisis (APC) of sickle cell disease (SCD) remains unsatisfactory despite advances in the understanding and management of acute pain in other clinical settings. One reason for this is an unsophisticated approach to the use of opioid analgesics for pain management. This applies to haematologists who are responsible for developing acute sickle pain management protocols for their patients, and to health care staff in the acute care setting. The objective of this article is to evaluate the evidence for use of opioids in APC management. We have highlighted the possibilities for improving management by using alternatives to morphine, and intranasal (IN) or transmucosal routes of administration for rapid onset of analgesia in the emergency department (ED). We suggest how experience gained in managing acute sickle pain in children could be extrapolated to adolescents and young adults. We have also questioned whether patients given strong opioids in the acute setting are being safely monitored and what resources are required to ensure efficacy, safety and patient satisfaction. We also identify aspects of care where there are significant differences of opinion, which require further study by randomized controlled trial. © 2014 John Wiley & Sons Ltd.

  11. From acute to persistent low back pain: a longitudinal investigation of somatosensory changes using quantitative sensory testing-an exploratory study.

    Science.gov (United States)

    Marcuzzi, Anna; Wrigley, Paul J; Dean, Catherine M; Graham, Petra L; Hush, Julia M

    2018-03-01

    Chronic low back pain (LBP) is commonly associated with generalised pain hypersensitivity. It is suggested that such somatosensory alterations are important determinants for the transition to persistent pain from an acute episode of LBP. Although cross-sectional research investigating somatosensory function in the acute stage is developing, no longitudinal studies designed to evaluate temporal changes have been published. This exploratory study aimed to investigate the temporal development of somatosensory changes from the acute stage of LBP to up to 4 months from onset. Twenty-five people with acute LBP (testing with the assessor blinded to group allocation, and again at 2 and 4 months. Psychological variables were concurrently assessed. People with acute LBP were classified based on their average pain severity over the previous week at 4 months as recovered (≤1/10 numeric rating scale) or persistent (≥2/10 numeric rating scale) LBP. In the persistent LBP group, (1) there was a significant decrease in pressure pain threshold between 2 and 4 months ( P psychological variables were significantly higher in those with persistent LBP compared with the recovered LBP group at all time points ( P importance of concurrent evaluation of psychological contributors in acute LBP.

  12. An exploratory study of the association of acute posttraumatic stress, depression, and pain to cognitive functioning in mild traumatic brain injury.

    Science.gov (United States)

    Massey, Jessica S; Meares, Susanne; Batchelor, Jennifer; Bryant, Richard A

    2015-07-01

    Few studies have examined whether psychological distress and pain affect cognitive functioning in the acute to subacute phase (up to 30 days postinjury) following mild traumatic brain injury (mTBI). The current study explored whether acute posttraumatic stress, depression, and pain were associated with performance on a task of selective and sustained attention completed under conditions of increasing cognitive demands (standard, auditory distraction, and dual-task), and on tests of working memory, memory, processing speed, reaction time (RT), and verbal fluency. At a mean of 2.87 days (SD = 2.32) postinjury, 50 adult mTBI participants, consecutive admissions to a Level 1 trauma hospital, completed neuropsychological tests and self-report measures of acute posttraumatic stress, depression, and pain. A series of canonical correlation analyses was used to explore the relationships of a common set of psychological variables to various sets of neuropsychological variables. Significant results were found on the task of selective and sustained attention. Strong relationships were found between psychological variables and speed (r(c) = .56, p = .02) and psychological variables and accuracy (r(c) = .68, p = .002). Pain and acute posttraumatic stress were associated with higher speed scores (reflecting more correctly marked targets) under standard conditions. Acute posttraumatic stress was associated with lower accuracy scores across all task conditions. Moderate but nonsignificant associations were found between psychological variables and most cognitive tasks. Acute posttraumatic stress and pain show strong associations with selective and sustained attention following mTBI. (c) 2015 APA, all rights reserved).

  13. Role of Ketamine in Acute Postoperative Pain Management: A Narrative Review

    OpenAIRE

    Brian M. Radvansky; Khushbu Shah; Anant Parikh; Anthony N. Sifonios; Vanny Le; Jean D. Eloy

    2015-01-01

    Objectives. The objective of this narrative review was to examine the usage of ketamine as a postoperative analgesic agent across a wide variety of surgeries. Design. A literature search was performed using the phrases “ketamine” and “postoperative pain.” The authors analyzed the studies that involved testing ketamine’s effectiveness at controlling postoperative pain. Effectiveness was assessed through various outcomes such as the amount of opiate consumption, visual analog scale (VAS) pain ...

  14. Movement does not promote recovery of motor output following acute experimental muscle pain

    DEFF Research Database (Denmark)

    Schabrun, Siobhan M.; Palsson, Thorvaldur Skuli; Thapa, Tribikram

    2018-01-01

    Objective.:  To examine the effect of motor activity on the magnitude and duration of altered corticomotor output following experimental muscle pain. Design. : Experimental, pre-post test. Setting. : University laboratory. Subjects. : Twenty healthy individuals. Methods.:  Participants were rando....... Understanding corticomotor depression in the postpain period and what factors promote recovery has relevance for clinical pain syndromes where ongoing motor dysfunction, in the absence of pain, may predispose to symptom persistence or recurrence....

  15. Understanding Etna flank instability through numerical models

    Science.gov (United States)

    Apuani, Tiziana; Corazzato, Claudia; Merri, Andrea; Tibaldi, Alessandro

    2013-02-01

    As many active volcanoes, Mount Etna shows clear evidence of flank instability, and different mechanisms were suggested to explain this flank dynamics, based on the recorded deformation pattern and character. Shallow and deep deformations, mainly associated with both eruptive and seismic events, are concentrated along recognised fracture and fault systems, mobilising the eastern and south-eastern flank of the volcano. Several interacting causes were postulated to control the phenomenon, including gravity force, magma ascent along the feeding system, and a very complex local and/or regional tectonic activity. Nevertheless, the complexity of such dynamics is still an open subject of research and being the volcano flanks heavily urbanised, the comprehension of the gravitative dynamics is a major issue for public safety and civil protection. The present research explores the effects of the main geological features (in particular the role of the subetnean clays, interposed between the Apennine-Maghrebian flysch and the volcanic products) and the role of weakness zones, identified by fracture and fault systems, on the slope instability process. The effects of magma intrusions are also investigated. The problem is addressed by integrating field data, laboratory tests and numerical modelling. A bi- and tri-dimensional stress-strain analysis was performed by a finite difference numerical code (FLAC and FLAC3D), mainly aimed at evaluating the relationship among geological features, volcano-tectonic structures and magmatic activity in controlling the deformation processes. The analyses are well supported by dedicated structural-mechanical field surveys, which allowed to estimate the rock mass strength and deformability parameters. To take into account the uncertainties which inevitably occur in a so complicated model, many efforts were done in performing a sensitivity analysis along a WNW-ESE section crossing the volcano summit and the Valle del Bove depression. This was

  16. [A Comparative Study of Acute and Chronic Pain between Single Port and Triple Port Video-assisted Thoracic Surgery for Lung Cancer].

    Science.gov (United States)

    Li, Caiwei; Xu, Meiqing; Xu, Guangwen; Xiong, Ran; Wu, Hanran; Xie, Mingran

    2018-04-20

    Through the comparative analysis of the acute and chronic pain postoperative between the single port and triple port video-assisted thoracic surgery to seek the better method which can reduce the incidence of acute and chronic pain in patients with lung cancer. Data of 232 patients who underwent single port -VATS (n=131) or triple port VATS (n=101) for non-small cell lung cancer (NSCLC) on January 1, 2016 to June 30, 2017 in our hospital were analyzed. The clinical and operative data were assessed, numeric rating scale (NRS) was used to evaluate the mean pain score on the 1th, 2th, 3th, 7th, 14th days, 3th months and 6th months postoperative. Both groups were similar in clinical characteristics, there were no perioperative death in two groups. In the 1th, 2th, 7th, 14th days and 3th, 6th months postoperative, the NRS score of the single port group was superior, and the difference was significant compared with the triple port (P0.05). Univariate and multivariate analysis of the occurrence on the chronic pain showed that the operation time, surgical procedure and the 14th NRS score were risk factors for chronic pain (Pport thoracoscopic surgery has an advantage in the incidence of acute and chronic pain in patients with non-small cell lung cancer. Shorter operative time can reduce the occurrence of chronic pain. The 14th day NRS score is a risk factor for chronic pain postoperative.

  17. Clinical and electrocardiographic characteristics of patients admitted to a thoracic pain unit in the context of a new definition of acute myocardial infarction

    International Nuclear Information System (INIS)

    Mora, Guillermo; Franco, Roberto; Fajardo, Hugo; Serrano, Daniel; Suarez, Martin

    2005-01-01

    In our environment we do ignore the clinical and para clinical characteristics from patients who come to a thoracic pain unit and more so with the new definition of acute myocardial infarction (Amid). 398 patients admitted to a thoracic pain unit were prospectively evaluated as to the pain characteristics, its risk factors, clinical examination findings, electrocardiographic findings and the troponin a T behaviour. 29.4% of the patients had a diagnosis of Amid, 29.9% of unstable angina and 40.7% of non-ischemic thoracic pain. retrosternal pain, irradiation to the neck, presence of diaphoresis, nausea or vomit are related with a higher probability to the diagnosis of Amid. Male sex and the presence of risk factors such as diabetes or dislipidemia increase the probability of the diagnosis. In the electrocardiogram, only the presence of a lesion, especially subepicardical favors the diagnosis. Unstable angina and in general acute coronary syndrome have a similar although not equal clinical behavior

  18. Utility of abdominal ultrasonography in acute painful tables of right iliac Fossa with appendicitis acute suspicion. Maciel Hospital Experience

    International Nuclear Information System (INIS)

    Dibarboure, P.; Sciuto, P.; Machado, F.

    2010-01-01

    Acute appendicitis is one of the most frequent causes of consultation and of indication of emergency laparotomy in most western countries. Despite its diagnostic being based mainly on clinical examination, there is a certain percentage of patients whose clinical presentation is atypical. In these cases image methods such as the abdominal ultrasound are particularly useful as diagnostic auxiliaries.The objective of this work is to compare the echographic with the Anatomopathological diagnosis in 80 patients who consulted the Hospital Maciel emergency service with episodes of acute appendicitis

  19. Efficacy and safety profile of combination of tramadol-diclofenac versus tramadol-paracetamol in patients with acute musculoskeletal conditions, postoperative pain, and acute flare of osteoarthritis and rheumatoid arthritis: a Phase III, 5-day open-label study

    Science.gov (United States)

    Chandanwale, Ajay S; Sundar, Subramanian; Latchoumibady, Kaliaperumal; Biswas, Swati; Gabhane, Mukesh; Naik, Manoj; Patel, Kamlesh

    2014-01-01

    Objective We aimed to evaluate the safety and efficacy of a fixed-dose combination (FDC) of tramadol and diclofenac versus a standard approved FDC of tramadol and paracetamol, in patients with acute moderate to severe pain. Methods A total of 204 patients with moderate to severe pain due to acute musculoskeletal conditions (n=52), acute flare of osteoarthritis (n=52), acute flare of rheumatoid arthritis (n=50), or postoperative pain (n=50) were enrolled in the study at baseline. Each disease category was then randomized to receive either of two treatments for 5 days: group A received an FDC of immediate-release tramadol hydrochloride (50 mg) and sustained-release diclofenac sodium (75 mg) (one tablet, twice daily), and group B received an FDC of tramadol hydrochloride (37.5 mg) and paracetamol (325 mg) (two tablets every 4–6 hours, up to a maximum of eight tablets daily). The primary efficacy end points were reductions in pain intensity from baseline at day 3 and day 5 as assessed by a Visual Analog Scale (VAS) score. Results Group A showed a significant reduction in the VAS score for overall pain from baseline on day 3 (P=0.001) and day 5 (Ppain, and gastritis), which required minimal management, without any treatment discontinuation. The number of adverse events in group A was nine (8.82%) compared with 22 (21.78%) in group B, after 5 days of treatment. Conclusion An FDC of tramadol-diclofenac showed a significantly greater reduction in pain intensity and was well tolerated compared with tramadol-paracetamol, resulting in better analgesia in patients suffering from moderate to severe pain due to acute musculoskeletal conditions, postoperative pain following orthopedic surgery, or acute flare of osteoarthritis and rheumatoid arthritis. PMID:25152629

  20. Coronary computed tomography and triple rule out CT in patients with acute chest pain and an intermediate cardiac risk for acute coronary syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Henzler, Thomas, E-mail: thomas.henzler@medma.uni-heidelberg.de [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Gruettner, Joachim, E-mail: joachim.gruettner@umm.de [Emergency Department, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Meyer, Mathias, E-mail: mr.meyer.mathias@gmail.com [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Rothhaar, Baerbel, E-mail: baerbel.rothhaar@umm.de [Business Development – Medical Controlling, University Medical Center, Mannheim (Germany); Apfaltrer, Paul, E-mail: Paul.Apfaltrer@umm.de [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Metzger, Franz, E-mail: franz.metzger@umm.de [Business Development – Medical Controlling, University Medical Center, Mannheim (Germany); Borggrefe, Martin, E-mail: martin.borggrefe@umm.de [1st Department of Medicine (Cardiology), University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Schoenberg, Stefan O., E-mail: stefan.schoenberg@umm.de [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); and others

    2013-01-15

    Objective: To evaluate the economic impact of integrating coronary CT angiography (cCTA) or whole chest “triple-rule-out” CTA (TRO-CTA) in the work-up of patients with acute chest pain. Materials and methods: 100 consecutive emergency department patients with acute chest pain and an intermediate cardiac risk for ACS underwent cCTA or TRO-CTA (cCTA group). Diagnostic performance, rate and length of hospitalization, hospital costs, hospital reimbursement and hospital profit were analyzed. All findings were compared to those of 100 different patients with acute chest pain that were evaluated with a standard of care (SOC) diagnostic algorithm (SOC group) that did not include cCTA. Diagnostic performance (“safety”) of both algorithms was defined as the absence of major adverse cardiac events (MACE) over a 90-day follow-up period. Results: In the cCTA group 60/100 patients were safely discharged at the same day. 19/100 patients were hospitalized due to significant coronary stenosis on cCTA, which was confirmed by invasive coronary catheterization (ICC) in 17/19 patients. Relevant non-coronary disease that led to hospitalization were found in 21 patients of the cCTA group. In the SOC group all patients were hospitalized. 87 of these hospitalized patients underwent ICC for exclusion of coronary artery stenosis. A significant coronary artery stenosis was found in only 25 of these patients. Within the cCTA group no patient suffered from MACE over the 90-day follow-up period. In the SOC group 2 patients were rehospitalized during the 90-day follow-up period due to recurrent chest pain and 1 patient because of a pseudoaneurym of the left femoral artery after ICC. The median hospital costs per patient were significantly lower in the cCTA group than in the SOC group (428.9€ vs. 1575.0€, p < 0.001). The median reimbursement of the cCTA group was less compared to the SOC group (589.8€ vs. 2412.1€, p < 0.001) and patients in the cCTA group gained less profit than

  1. Coronary computed tomography and triple rule out CT in patients with acute chest pain and an intermediate cardiac risk for acute coronary syndrome

    International Nuclear Information System (INIS)

    Henzler, Thomas; Gruettner, Joachim; Meyer, Mathias; Rothhaar, Baerbel; Apfaltrer, Paul; Metzger, Franz; Borggrefe, Martin; Schoepf, U. Joseph; Schoenberg, Stefan O.

    2013-01-01

    Objective: To evaluate the economic impact of integrating coronary CT angiography (cCTA) or whole chest “triple-rule-out” CTA (TRO-CTA) in the work-up of patients with acute chest pain. Materials and methods: 100 consecutive emergency department patients with acute chest pain and an intermediate cardiac risk for ACS underwent cCTA or TRO-CTA (cCTA group). Diagnostic performance, rate and length of hospitalization, hospital costs, hospital reimbursement and hospital profit were analyzed. All findings were compared to those of 100 different patients with acute chest pain that were evaluated with a standard of care (SOC) diagnostic algorithm (SOC group) that did not include cCTA. Diagnostic performance (“safety”) of both algorithms was defined as the absence of major adverse cardiac events (MACE) over a 90-day follow-up period. Results: In the cCTA group 60/100 patients were safely discharged at the same day. 19/100 patients were hospitalized due to significant coronary stenosis on cCTA, which was confirmed by invasive coronary catheterization (ICC) in 17/19 patients. Relevant non-coronary disease that led to hospitalization were found in 21 patients of the cCTA group. In the SOC group all patients were hospitalized. 87 of these hospitalized patients underwent ICC for exclusion of coronary artery stenosis. A significant coronary artery stenosis was found in only 25 of these patients. Within the cCTA group no patient suffered from MACE over the 90-day follow-up period. In the SOC group 2 patients were rehospitalized during the 90-day follow-up period due to recurrent chest pain and 1 patient because of a pseudoaneurym of the left femoral artery after ICC. The median hospital costs per patient were significantly lower in the cCTA group than in the SOC group (428.9€ vs. 1575.0€, p < 0.001). The median reimbursement of the cCTA group was less compared to the SOC group (589.8€ vs. 2412.1€, p < 0.001) and patients in the cCTA group gained less profit than

  2. A Multivariate Model for Prediction of Obstructive Coronary Disease in Patients with Acute Chest Pain: Development and Validation

    Directory of Open Access Journals (Sweden)

    Luis Cláudio Lemos Correia

    Full Text Available Abstract Background: Currently, there is no validated multivariate model to predict probability of obstructive coronary disease in patients with acute chest pain. Objective: To develop and validate a multivariate model to predict coronary artery disease (CAD based on variables assessed at admission to the coronary care unit (CCU due to acute chest pain. Methods: A total of 470 patients were studied, 370 utilized as the derivation sample and the subsequent 100 patients as the validation sample. As the reference standard, angiography was required to rule in CAD (stenosis ≥ 70%, while either angiography or a negative noninvasive test could be used to rule it out. As predictors, 13 baseline variables related to medical history, 14 characteristics of chest discomfort, and eight variables from physical examination or laboratory tests were tested. Results: The prevalence of CAD was 48%. By logistic regression, six variables remained independent predictors of CAD: age, male gender, relief with nitrate, signs of heart failure, positive electrocardiogram, and troponin. The area under the curve (AUC of this final model was 0.80 (95% confidence interval [95%CI] = 0.75 - 0.84 in the derivation sample and 0.86 (95%CI = 0.79 - 0.93 in the validation sample. Hosmer-Lemeshow's test indicated good calibration in both samples (p = 0.98 and p = 0.23, respectively. Compared with a basic model containing electrocardiogram and troponin, the full model provided an AUC increment of 0.07 in both derivation (p = 0.0002 and validation (p = 0.039 samples. Integrated discrimination improvement was 0.09 in both derivation (p < 0.001 and validation (p < 0.0015 samples. Conclusion: A multivariate model was derived and validated as an accurate tool for estimating the pretest probability of CAD in patients with acute chest pain.

  3. Emergency assessment of patients with acute abdominal pain using low-dose CT with iterative reconstruction: a comparative study

    Energy Technology Data Exchange (ETDEWEB)

    Poletti, Pierre-Alexandre; Becker, Minerva; Becker, Christoph D.; Zaidi, Habib; Platon, Alexandra [University Hospital of Geneva, Department of Radiology, Geneva (Switzerland); Halfon Poletti, Alice; Rutschmann, Olivier T. [University Hospital of Geneva, Department of Community, Primary Care and Emergency Medicine, Geneva (Switzerland); Perneger, Thomas [University Hospital of Geneva, Division of Clinical Epidemiology, Geneva (Switzerland)

    2017-08-15

    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. (orig.)

  4. Acute effects of walking with Nordic poles in persons with mild to moderate low-back pain.

    Science.gov (United States)

    Revord, Landon P; Lomond, Karen V; Loubert, Peter V; Hammer, Roger L

    2016-01-01

    Regular walking with or without Nordic poles is effective over time at reducing discomfort in individuals with chronic low back pain (LBP). Nordic pole use increases balance and stability, distributes weight through the arms and torso, and decreases loading of the spine and lower limbs. The purpose of this study was to determine if Nordic poles would reduce perceived acute discomfort while self-paced walking in individuals with LBP. We also examined whether walking with or without poles increased heart rate (HR) and ratings of perceived exertion (RPE) or speed of movement. Subjects included 20 adults (12 males, 8 females; mean age of 45.1±16.3) who were experiencing LBP of at least six months' duration (Oswestry Disability Index (ODI): mean 17 ± 8%, range 6-36% indicating minimal to moderate disability) with no current active flare-up. Participants walked a predetermined dirt-path course (805 m or 0.5 mi) with and without poles in randomized order. Data were analyzed using a 2 X 2 repeated measures ANOVA (Condition X Time), where Condition was poles vs no poles and Time was pre- and post-walk. HR and RPE increased significantly from walking the course, whereas pain did not change. There were also no differences between walking with or without poles for pain (ODI Sec #1: 0.2 points, p=0.324), HR (4 bpm, p=0.522) and RPE (0 points, p=0.759). The mean course time (sec) was slower with poles: 617±87 vs 566±65 (pNordic pole use is well tolerated in those with current back pain and can be encouraged, however it cannot be recommended as a superior method of addressing acute symptoms when walking.

  5. Diagnostic pattern of patients with acute chest pain and symptoms of patients with myocardial infarction

    DEFF Research Database (Denmark)

    Davodian, D.; Lindskou, T. A.; Søvsø, M. B.

    2018-01-01

    diseases, and 90.4% did not have MI. However, most MI-patients presented with chest pain and these had better outcomes than the ones without chest pain. Conflict of interest None Funding The professorship of EFC is supported by a grant administered by Aalborg University from the Danish philanthropic...

  6. Evaluation of a theory-informed implementation intervention for the management of acute low back pain in general medical practice

    DEFF Research Database (Denmark)

    French, Simon