WorldWideScience

Sample records for british pain clinic

  1. Ethnic differences in thermal pain responses: a comparison of South Asian and White British healthy males.

    Science.gov (United States)

    Watson, Paul J; Latif, R Khalid; Rowbotham, David J

    2005-11-01

    The expression and report of pain is influenced by social environment and culture. Previous studies have suggested ethnically determined differences in report of pain threshold, intensity and affect. The influence of ethnic differences between White British and South Asians has remained unexplored. Twenty age-matched, male volunteers in each group underwent evaluation. Cold and warm perception and cold and heat threshold were assessed using an ascending method of limits. Magnitude estimation of pain unpleasantness and pain intensity were investigated with thermal stimuli of 46, 47, 48 and 49 degrees C. Subjects also completed a pain anxiety questionnaire. Data was analysed using t-test, Mann-Whitney and repeated measures analysis of variance as appropriate. There were no differences in cold and warm perception between the two groups. There was a statistically significant difference between the two groups for heat pain threshold (P=0.006) and heat pain intensity demonstrated a significant effect for ethnicity (F=13.84, P=0.001). Although no group differences emerged for cold pain threshold and heat unpleasantness, South Asians demonstrated lower cold pain threshold and reported more unpleasantness at all temperatures but this was not statistically significant. Our study shows that ethnicity plays an important role in heat pain threshold and pain report, South Asian males demonstrated lower pain thresholds and higher pain report when compared with matched White British males. There were no differences in pain anxiety between the two groups and no correlations were identified between pain and pain anxiety Haemodynamic measures and anthropometry did not explain group differences.

  2. Descriptive Study of a Military Pain Clinic

    Science.gov (United States)

    1996-09-13

    pain syndromes (Wu & Grzesiak, 1987). The clinic generally accepts only patients with all types of pain syndromes lasting greater than six...Dystrophy (RSD) 2 4 Sciatic pain 2 4 Disseminated Varicella I 2 Myofascial pain I 2 Pathologic Rib Fracture I 2 RCM pain I 2 Rt sided pain I 2 Sickle...Philadelphia: W.B. Saunders Co. Clifford, J.C. (1993) . Successful management of chronic pain syndrome . Canadian Family Physician. 39. (3), 549- 559.

  3. Clinical images. Atypical midcycle pain.

    LENUS (Irish Health Repository)

    Alsinnawi, Mazen

    2012-01-31

    A 16-year-old female presented with acute-onset abdominal pain and an initial diagnosis of midcycle pain. Subsequent pelvic ultrasound and diagnostic laparoscopy showed a large mass in the pouch of Douglas. The patient underwent a laparotomy and excision of a mass from a loop of jejunum. This case highlights the difficulties in diagnostic differentiation relating to large pelvic masses in young females.

  4. A review of physician anaesthesia prescribing practices in an abortion clinic in British Columbia.

    Science.gov (United States)

    Fitzsimmons, Brian P; MacKay-Dunn, Marion H; Mo, David; Hodgson, Zoë G

    2010-01-01

    The primary purpose of this study was to review the standard prescribing practices of physicians providing local anaesthesia in a major abortion clinic in British Columbia. We conducted a retrospective review of patients who underwent a first trimester surgical abortion at the Comprehensive Abortion and Reproductive Education (CARE) Program at BC Women's Hospital and Health Centre during 2004 (n = 1546). Patients' demographics and reproductive history including age, weight, gestational age, and gravidity were recorded. Main outcomes recorded were dosage of lidocaine administered and amount of conscious sedation (midazolam and fentanyl) administered for pain management. Incidence of toxicity was also recorded. Almost one half (49.9%) of the patients received 20 mL of 0.5% lidocaine, and the remainder received 20 mL of 1.0% lidocaine. The volume of conscious sedation did not differ between groups. There was a positive correlation computed between midazolam and fentanyl dosages (r = 0.583, P fentanyl dose (r = 0.05, P = 0.047; r = 0.06, P = 0.024). There was no reported incidence of toxicity. Similar doses of midazolam and fentanyl were administered to patients regardless of the amount of lidocaine given (20 mL of either 0.5% or 1.0%). Further investigation is required to assess whether fentanyl and midazolam doses used during procedures can be used as surrogate measurements of pain. Our findings suggest it would be reasonable to consider using a lower dose of local anaesthetic for first trimester abortions to further reduce the risk of toxicity.

  5. Cannabis and Pain: A Clinical Review

    Science.gov (United States)

    Hill, Kevin P.; Palastro, Matthew D.; Johnson, Brian; Ditre, Joseph W.

    2017-01-01

    Abstract Introduction: Cannabis has been used for medical purposes across the world for centuries. As states and countries implement medical and recreational cannabis policies, increasing numbers of people are using cannabis pharmacotherapy for pain. There is a theoretical rationale for cannabis' efficacy for pain management, although the subjective pain relief from cannabis may not match objective measurements of analgesia. As more patients turn to cannabis for pain relief, there is a need for additional scientific evidence to evaluate this increase. Materials and Methods: Research for this review was performed in the PubMed/National Library of Medicine database. Discussion: Preclinical studies demonstrate a narrow therapeutic window for cannabis as pharmacotherapy for pain; the body of clinical evidence for this indication is not as extensive. A recent meta-analysis of clinical trials of cannabis and cannabinoids for pain found modest evidence supporting the use of cannabinoid pharmacotherapy for pain. Recent epidemiological studies have provided initial evidence for a possible reduction in opioid pharmacotherapy for pain as a result of increased implementation of medical cannabis regimens. Conclusion: With increased use of medical cannabis as pharmacotherapy for pain comes a need for comprehensive risk-benefit discussions that take into account cannabis' significant possible side effects. As cannabis use increases in the context of medical and recreational cannabis policies, additional research to support or refute the current evidence base is essential to attempt to answer the questions that so many healthcare professionals and patients are asking. PMID:28861509

  6. Pain in Sleepwalking: A Clinical Enigma.

    Science.gov (United States)

    Lopez, Régis; Jaussent, Isabelle; Dauvilliers, Yves

    2015-11-01

    Sleepwalking is a disorder characterized by arousal specifically from slow wave sleep with dissociated brain activity that may be related to lower nociceptive state. Our objectives were to assess the frequency of chronic pain, headache, and migraine in sleepwalkers compared to controls, examine the impact and determinants of pain in sleepwalkers, and report analgesia frequency during injurious parasomnia episodes. Cross-sectional case-control study. Data were collected at the Sleep Disorders Center, Montpellier, France. One hundred patients with sleepwalking were assessed for disease characteristics, sleep (polysomnography, sleepiness, and insomnia), pain (chronic pain, multidimensional pain inventory, headache, and migraine), depressive symptoms, and quality of life compared to 100 adult controls. Pain perception was retrospectively assessed during injurious parasomnia episodes. Raw association data showed that lifetime headache, migraine, and chronic pain at time of study were significantly associated with sleepwalking (also called somnambulism). Compared to controls, sleepwalkers reported more frequent daytime sleepiness, and depressive and insomnia symptoms. After adjustments, sleepwalking was associated with increased risk for headache and migraine only. Compared to pain-free sleepwalkers, sleepwalkers with chronic pain were more likely to be older and to have greater daytime sleepiness, insomnia, and depressive symptoms, with no difference in polysomnography assessment. Of the 47 sleepwalkers with at least one previous violent parasomnia episode, 78.7% perceived no pain during episodes, allowing them to remain asleep despite injury. Our results highlight the clinical enigma of pain in sleepwalking patients with complaints of frequent chronic pain, migraine, and headache during wakefulness but who report retrospectively experience of analgesia during severe parasomnia episodes, suggesting a relationship between dissociated brain activity and nociceptive

  7. Depression in the work of British health visitors: clinical facets.

    Science.gov (United States)

    Sheppard, M

    1996-12-01

    The primary health care setting has been established as a key venue for identifying and working with depression. Despite this, and the high risk of depression experienced by women in the post-natal period, maternal depression has been little examined in the work of health visitors. This study focuses on clinical facets of this work, including the rate and content of depression amongst health visitor attenders, the capacity of health visitors to identify accurately the presence of depression, the relationship between depression and child abuse and child behavioural issues, variations in the practice of health visitors and work with other professionals. In a cohort of 701, 11% of women were depressed, with distinguishing symptoms including fatigability, disgust/hate of herself and a sense of failure. Health visitors were not generally accurate in their identification of depression, were significantly more likely to see depressed women at home (than at clinic), but there was little difference in mean frequency of consultations according to whether or not the women were depressed. Urban health visitors had a higher mean frequency of consultations, but rural health visitors showed a rather greater tendency to increase frequency of consultation with the presence of depression. Child abuse concerns and behavioural problems were significantly associated with depression and these were three times as frequent amongst depressed women with no children aged under one compared with women in their post-natal year. Depressed women were far more likely to be involved with other agencies, but the GP was by far the most likely other professional to be involved. Health visitors are in a strategic position to help women with depression, and it is important that they are able to identify its presence. The association with child abuse is very important and indicates the need for multi-professional involvement, particularly with social workers, to a greater degree than was evident. The

  8. Learning to ensure patient safety in clinical settings: comparing Finnish and British nursing students' perceptions.

    Science.gov (United States)

    Tella, Susanna; Smith, Nancy-Jane; Partanen, Pirjo; Jamookeeah, David; Lamidi, Marja-Leena; Turunen, Hannele

    2015-10-01

    To explore and compare Finnish and British nursing students' perceptions of their learning about patient safety in clinical settings. Patient safety culture and practices in different health care organisations and clinical units varies, posing challenges for nursing students' learning about patient safety during their clinical placements. Patient safety as a growing international concern has challenged health care professionals globally requiring a comprehensive review. International studies comparing nursing education about patient safety are lacking. A cross-sectional comparative study. The participants were final year preregistration nursing students from two universities of applied sciences in Finland (n = 195) and from two universities in England, UK (n = 158). The data were collected with the Patient Safety in Nursing Education Questionnaire and analysed with principal component analysis, Pearson Chi-Square and Mann-Whitney U tests and logistic regression. Finnish nursing students had significantly more critical perceptions on their learning about patient safety in clinical settings than their British peers. A strong predictor for differences was supportive and systems-based approaches in learning to ensure patient safety. Notably, fewer Finnish students had practiced reporting of incidents in clinical settings compared to British students. In both countries, the students held learning about patient safety in higher esteem compared to their learning experiences in clinical settings. Nursing students appear to want more learning opportunities related to patient safety compared to the reality in clinical settings. Learning systematically from errors in a supportive environment and having systems-based approaches to ensure patient safety are essential elements for nursing students' learning about safe practice. Finnish students seem to experience more barriers in learning about safe practices and to report errors than the British students. Health care

  9. Swearing as a response to pain: a cross-cultural comparison of British and Japanese participants

    OpenAIRE

    Robertson, O; Robinson, SJ; Stephens, R.

    2017-01-01

    Background and aims: Research suggests swearing can moderate pain perception. The present study assessed whether changes in pain perception due to swearing reflect a "scripting" effect by comparing swearing as a response to pain in native English and Japanese speakers. Cognitive psychology denotes a 'script' to be a sequence of learnt behaviours expected for given situations. Japanese participants were included as they rarely, if ever, swear as a response to pain and therefore do not possess ...

  10. Comparison of clinical and evoked pain measures in fibromyalgia.

    Science.gov (United States)

    Harris, Richard E; Gracely, Richard H; McLean, Samuel A; Williams, David A; Giesecke, Thorsten; Petzke, Frank; Sen, Ananda; Clauw, Daniel J

    2006-07-01

    Evoked pain measures such as tender point count and dolorimetry are often used to determine tenderness in studies of fibromyalgia (FM). However, these measures frequently do not improve in clinical trials and are known to be influenced by factors other than pain such as distress and expectancy. The purpose of this investigation was to determine whether evoked pain paradigms that present pressure stimuli in a random fashion (eg, Multiple Random Staircase [MRS]) would track with clinical pain improvement in patients with FM better than traditional measures. Sixty-five subjects enrolled in a randomized clinical trial of acupuncture were observed longitudinally. Clinical pain was measured on a 101-point numerical rating scale (NRS) and the Short Form McGill Pain Questionnaire (SF-MPQ), whereas evoked pressure sensitivity was assessed via manual tender point count, dolorimetry, and MRS methods. Improvements in clinical pain and evoked pain were assessed irrespective of group assignment. Improvement was seen in clinical pain during the course of the trial as measured by both NRS (P = .032) and SF-MPQ (P = .001). The MRS was the only evoked pain measure to improve correspondingly with treatment (MRS, P = .001; tender point count and dolorimeter, P > .05). MRS change scores were correlated with changes in NRS pain ratings (P = .003); however, this association was not stronger than tender point or dolorimetry correlations with clinical pain improvement (P > .05). Pain sensitivity as assessed by random paradigms was associated with improvements in clinical FM pain. Sophisticated pain testing paradigms might be responsive to change in clinical trials. Trials in fibromyalgia often use both clinical and experimental methods of pain assessment; however, these two outcomes are often poorly correlated. We explore the relationship between changes in clinical and experimental pain within FM patients. Pressure pain testing that applies stimuli in a random order is associated with

  11. Pain modulatory phenotypes differentiate subgroups with different clinical and experimental pain sensitivity

    DEFF Research Database (Denmark)

    Vaegter, Henrik Bjarke; Graven-Nielsen, Thomas

    2016-01-01

    between subgroups. Cuff algometry was performed on lower legs in 400 chronic pain patients to assess pressure pain threshold (cPPT), pressure pain tolerance (cPTT), temporal summation of pain (TSP: increase in pain scores to ten repeated stimulations), and conditioned pain modulation (CPM: increase in c......PPT during cuff pain conditioning on the contralateral leg). Heat detection (HDT) and heat pain thresholds (HPT) at clinical painful and non-painful body areas were assessed. Based on TSP and CPM four distinct groups were formed: Group 1 (n=85) had impaired CPM and facilitated TSP. Group 2 (n=148) had...... impaired CPM and normal TSP. Group 3 (n=45) had normal CPM and facilitated TSP. Group 4 (n=122) had normal CPM and normal TSP. Group 1 showed more pain regions compared with the other three groups (PTSP plays an important role in widespread pain. Group 1...

  12. Pain Sensitivity Subgroups in Individuals With Spine Pain: Potential Relevance to Short-Term Clinical Outcome

    Science.gov (United States)

    Bialosky, Joel E.; Robinson, Michael E.

    2014-01-01

    Background Cluster analysis can be used to identify individuals similar in profile based on response to multiple pain sensitivity measures. There are limited investigations into how empirically derived pain sensitivity subgroups influence clinical outcomes for individuals with spine pain. Objective The purposes of this study were: (1) to investigate empirically derived subgroups based on pressure and thermal pain sensitivity in individuals with spine pain and (2) to examine subgroup influence on 2-week clinical pain intensity and disability outcomes. Design A secondary analysis of data from 2 randomized trials was conducted. Methods Baseline and 2-week outcome data from 157 participants with low back pain (n=110) and neck pain (n=47) were examined. Participants completed demographic, psychological, and clinical information and were assessed using pain sensitivity protocols, including pressure (suprathreshold pressure pain) and thermal pain sensitivity (thermal heat threshold and tolerance, suprathreshold heat pain, temporal summation). A hierarchical agglomerative cluster analysis was used to create subgroups based on pain sensitivity responses. Differences in data for baseline variables, clinical pain intensity, and disability were examined. Results Three pain sensitivity cluster groups were derived: low pain sensitivity, high thermal static sensitivity, and high pressure and thermal dynamic sensitivity. There were differences in the proportion of individuals meeting a 30% change in pain intensity, where fewer individuals within the high pressure and thermal dynamic sensitivity group (adjusted odds ratio=0.3; 95% confidence interval=0.1, 0.8) achieved successful outcomes. Limitations Only 2-week outcomes are reported. Conclusions Distinct pain sensitivity cluster groups for individuals with spine pain were identified, with the high pressure and thermal dynamic sensitivity group showing worse clinical outcome for pain intensity. Future studies should aim to confirm

  13. Diet, Lifestyle and Chronic Widespread Pain: Results from the 1958 British Birth Cohort Study

    Directory of Open Access Journals (Sweden)

    Elizabeth G VanDenKerkhof

    2011-01-01

    Full Text Available OBJECTIVES: To examine the relationship between diet and lifestyle, and chronic widespread pain (CWP. If persons with CWP have dietary and lifestyle habits consistent with an increased risk of cancer or cardiovascular disease, it may partially explain evidence in the literature suggesting an association between CWP and these diseases.

  14. Spinal Pain and Occupational Disability: A Cohort Study of British Apache AH Mk1 Pilots

    Science.gov (United States)

    2013-09-01

    difficulty reaching and fully operating critical and emergency control switches with seat in normal position and normal flying posture with inertia ...and normal flying posture with inertia reel locked in NAP...2002) likewise reported significant pain-related deficits to aircrew: interference with flying (66 percent), sleep (51 percent), and duties outside

  15. [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.

  16. Attachment style and its relationship to working alliance in the supervision of British clinical psychology trainees.

    Science.gov (United States)

    Dickson, Joanne M; Moberly, Nicholas J; Marshall, Yehuda; Reilly, James

    2011-01-01

    Although the supervisory relationship is thought to be critical in training clinical psychologists, little is known about factors affecting the supervisory alliance. We conducted an Internet survey of British clinical doctoral trainees (N = 259) in which participants rated their supervisory working alliance, parental style during childhood, pathological adult attachment behaviours and attachment style for themselves and their supervisors. Trainees' ratings of the working alliance were associated with perceptions of supervisors' attachment style, but not with perceptions of trainees' own attachment styles. Path analysis supported a causal chain linking parental indifference, compulsive self-reliance, insecure supervisor attachment style and lower ratings of the working alliance. Our results broadly replicate data from a US sample and suggest that attachment theory is helpful in understanding clinical supervisory processes. Copyright © 2010 John Wiley & Sons, Ltd.

  17. National survey of pain clinics in Croatia: Organization and services

    Directory of Open Access Journals (Sweden)

    Mahir Fidahić

    2015-05-01

    Full Text Available Objective. To analyze organization and therapeutic procedures administered in tertiary outpatient pain clinics in Croatia. Methods. Data about organization of pain clinics, its personnel, equipment, continuing medical education, therapeutic procedures, research activities and relations with pharmaceutical industry were collected using questionnaires. Results. Twenty-two Croatian pain clinics were included in the study. Most of the pain clinics employ exclusively anesthesiologists and nurses. The most frequently prescribed therapeutic procedures in pain clinics were pharmacotherapy, transcutaneous electrical nerve stimulation, acupuncture and trigger point injections. Almost all pain clinics provide educational material for patients. Most of the pain clinics have regular interactions with pharmaceutical companies. Prescribing decisions were based mostly on information from scientific meetings, research articles and consultations with colleagues. Information sources which are considered to be the gold standard – the systematic reviews of The Cochrane Collaboration – were used less frequently (n=12; 57% than advertising materials from pharmaceutical companies (n=16; 76%. Few physicians and other pain clinics staff had scientific degrees or academic titles or were involved in a research project. Conclusion. The national study about pain clinics in Croatia pointed out that there is room for improvement of their organization and services. Pain clinics should employ health-care professionals with diverse backgrounds. They should offer treatments backed by the highest-level of scientific evidence. Since pain is a major public health issue, pain clinic staff should engage more in research to contribute to the growing field of pain research, to enhance capacities for pain research in Croatia, to incorporate scientific evidence into their daily decision-making and to enable evidence-based practice.

  18. Chronic pain and psychiatric morbidity: a comparison between patients attending specialist orthopedics clinic and multidisciplinary pain clinic.

    Science.gov (United States)

    Wong, Wing S; Chen, Phoon P; Yap, Jackequaline; Mak, Kan Hing; Tam, Barry Ka H; Fielding, Richard

    2011-02-01

    The objective of this study was to examine the associations between chronic pain and psychiatric morbidity using interview-based assessments of psychiatric symptomatology. We compared the prevalence of common mental disorder (CMD; consistent with neurotic and somatic symptoms, fatigue, and negative affect), depression, and anxiety disorder(s), and associated factors with these psychiatric illnesses among Chinese patients with chronic pain attending specialist orthopedics clinic and multidisciplinary pain clinic. A total of 370 patients with chronic pain were recruited from an Orthopedics Clinic (N=185) and a Pain Clinic (N=185) in Hong Kong. Psychiatric morbidity was assessed using the Revised Clinical Interview Schedule. Individual scores for neurotic symptoms and neurotic disorders (including depression and four types of anxiety disorders) were also calculated. The reported lifetime prevalence rates of CMD were 35.3% and 75.3% for the Orthopedics and Pain Clinic samples, respectively. Rates of depression and anxiety disorders in the Pain Clinic (57.1% and 23.2%, respectively) were significantly higher than those in the Orthopedics sample (20.2% and 5.9%, respectively) (all P<0.001). Pain characteristics including number of pain sites, pain duration, pain intensity, and pain interference were all significantly associated with psychiatric morbidity after controlling for sociodemographic factors. Pain duration and litigation/compensation status consistently predicted concurrent pain intensity and disability. Chronic pain is associated with psychiatric morbidity. The higher rate of depression than anxiety disorder(s) among patients with chronic pain is consistent with previous studies that have found depression to be highly prevalent in chronic pain. Wiley Periodicals, Inc.

  19. Diagnostic and clinical factors associated with pulpal and periapical pain.

    Science.gov (United States)

    Estrela, Carlos; Guedes, Orlando Aguirre; Silva, Júlio Almeida; Leles, Cláudio Rodrigues; Estrela, Cyntia Rodrigues de Araújo; Pécora, Jesus Djalma

    2011-01-01

    A retrospective survey was designed to identify diagnostic subgroups and clinical factors associated with odontogenic pain and discomfort in dental urgency patients. A consecutive sample of 1,765 patients seeking treatment for dental pain at the Urgency Service of the Dental School of the Federal University of Goiás, Brazil, was selected. Inclusion criteria were pulpal or periapical pain that occurred before dental treatment (minimum 6 months after the last dental appointment), and the exclusion criteria were teeth with odontogenic developmental anomalies and missing information or incomplete records. Clinical and radiographic examinations were performed to assess clinical presentation of pain complaints including origin, duration, frequency and location of pain, palpation, percussion and vitality tests, radiographic features, endodontic diagnosis and characteristics of teeth. Chi-square test and multiple logistic regression were used to analyze association between pulpal and periapical pain and independent variables. The most frequent endodontic diagnosis of pulpal pain were symptomatic pulpitis (28.3%) and hyperreactive pulpalgia (14.4%), and the most frequent periapical pain was symptomatic apical periodontitis of infectious origin (26.4%). Regression analysis revealed that closed pulp chamber and caries were highly associated with pulpal pain and, conversely, open pulp chamber was associated with periapical pain (pfactors associated with pulpal and periapical pain suggest that the important clinical factor of pulpal pain was closed pulp chamber and caries, and of periapical pain was open pulp chamber.

  20. Are preoperative experimental pain assessments correlated with clinical pain outcomes after surgery?

    DEFF Research Database (Denmark)

    Sangesland, Anders; Støren, Carl; Vaegter, Henrik B.

    2017-01-01

    was to evaluate whether assessment of experimental pain processing including measures of central pain mechanisms prior to surgery was associated with pain intensity after surgery. Methods Systematic database searches in PubMed and EMBASE with the following search components: QST, association, and postoperative......Background Pain after surgery is not uncommon with 30% of patients reporting moderate to severe postoperative pain. Early identification of patients prone to postoperative pain may be a step forward towards individualized pain medicine providing a basis for improved clinical management through...... treatment strategies targeting relevant pain mechanisms in each patient. Assessment of pain processing by quantitative sensory testing (QST) prior to surgery has been proposed as a method to identify patients at risk for postoperative pain, although results have been conflicting. Since the last systematic...

  1. A Comparison of Expectations of Physicians and Patients with Chronic Pain for Pain Clinic Visits.

    Science.gov (United States)

    Calpin, Pádraig; Imran, Ather; Harmon, Dominic

    2017-03-01

    The patient-physician encounter forms the cornerstone of every health service. However, optimal medical outcomes are often confounded by inadequate patient-physician communication. Chronic pain is estimated to affect over 25% of the population. Its effects are multifaceted with patients at increased risk of experiencing emotional and functional disturbances. Therefore, it is crucial to address all components of the patient's pain experience, including beliefs and expectations. It is our understanding that no other study to date has evaluated the expectations of physicians and compared them to those of patients for pain clinic visits. We sought to describe and compare expectations of chronic pain patients and their physicians during a clinic consultation. We performed a retrospective review on patients attending the pain clinic for the first time who were enrolled and completed a questionnaire asking their expectations for their clinic visit as well as outcomes that would satisfy and disappoint them. Pain physicians were also included. We compared physicians' to patients' responses and evaluated relationships between patient responses and age, gender, pain location, Pain Self-Efficacy, Pain Catastrophizing Scale, and the Hospital Anxiety and Depression Scale. One hundred chronic pain patients and 10 pain physicians were surveyed. Patients' clinical expectations for visits focused primarily on some pain relief (34%), education on the cause of pain (24%), and a definitive diagnosis (18%). Physician's expectations included formulation and communication of a management plan (70%), patient assessment for cause of pain (50%), and the education of patients on the cause of pain (40%) as important aims. Pain relief would satisfy the majority of patients (74%) and physicians (70%). No improvement would cause greatest dissatisfaction for patients (52%), but causing more harm would be disappointing to physicians (50%). Gender, age, pain location, and sleep quality all

  2. Minimum detectable and minimal clinically important changes for pain in patients with nonspecific neck pain

    Directory of Open Access Journals (Sweden)

    Zamora Javier

    2008-04-01

    Full Text Available Abstract Background The minimal detectable change (MDC and the minimal clinically important changes (MCIC have been explored for nonspecific low back pain patients and are similar across different cultural settings. No data on MDC and MCIC for pain severity are available for neck pain patients. The objectives of this study were to estimate MDC and MCIC for pain severity in subacute and chronic neck pain (NP patients, to assess if MDC and MCIC values are influenced by baseline values and to explore if they are different in the subset of patients reporting referred pain, and in subacute versus chronic patients. Methods Subacute and chronic patients treated in routine clinical practice of the Spanish National Health Service for neck pain, with or without pain referred to the arm, and a pain severity ≥ 3 points on a pain intensity number rating scale (PI-NRS, were included in this study. Patients' own "global perceived effect" over a 3 month period was used as the external criterion. The minimal detectable change (MDC was estimated by means of the standard error of measurement in patients who self-assess as unchanged. MCIC were estimated by the mean value of change score in patients who self-assess as improved (mean change score, MCS, and by the optimal cutoff point in receiver operating characteristics curves (ROC. The effect on MDC and MCIC of initial scores, duration of pain, and existence of referred pain were assessed. Results 658 patients were included, 487 of them with referred pain. MDC was 4.0 PI-NRS points for neck pain in the entire sample, 4.2 for neck pain in patients who also had referred pain, and 6.2 for referred pain. MCS was 4.1 and ROC was 1.5 for referred and for neck pain, both in the entire sample and in patients who also complained of referred pain. ROC was lower (0.5 PI-NRS points for subacute than for chronic patients (1.5 points. MCS was higher for patients with more intense baseline pain, ranging from 2.4 to 4.9 PI

  3. Clinical and functional correlates of foot pain in diabetic patients.

    NARCIS (Netherlands)

    Rijken, P.M.; Dekker, J.; Rauwerda, J.A.; Dekker, E.; Lankhorst, G.J.; Bakker, K.; Dooren, J.

    1998-01-01

    Purpose: patients with diabetes mellitus frequently suffer from foot pain. This pain seems to be a neglected area in studies on the diabetic foot. The purpose of this study was to identify clinical variables associated with foot pain in diabetic patients. In addition, the relationships between foot

  4. Psychosocial Aspects of Dental Anxiety and Clinical Pain Phenomena

    DEFF Research Database (Denmark)

    Moore, Rod

    This Danish Doctoral Dissertation in the science of Odontology contains 7 chapters: 1) Introduction to a social perspective on dental treatment, anxiety and pain throughout time, 2) research models and methods to study dental anxiety and clinical pain phenomena, 3) the fear of dental treatment...... .. what it is and what it is not and how many have it, 4) clinical pain treatment, psychosocial aspects in relation to anxiety, 4) patients and dentists' roles, pain perception and anxiety, 6) psychosocial aspects of managing anxiety and pain phenomena, and 7) Conclusions and proposals for the future...

  5. Profiles of Urine Drug Test in Clinical Pain Patients vs Pain Research Study Subjects.

    Science.gov (United States)

    Lee, Cheng-ting; Vo, Trang T; Cohen, Abigail S; Ahmed, Shihab; Zhang, Yi; Mao, Jianren; Chen, Lucy

    2016-04-01

    To examine similarities and differences in urine drug test (UDT) results in clinical pain patients and pain subjects participating in pain research studies. An observational study with retrospective chart review and data analysis. We analyzed 1,874 UDT results obtained from 1) clinical pain patients (Clinical Group; n = 1,529) and 2) pain subjects consented to participate in pain research studies (Research Group; n = 345). Since several medications such as opioids used in pain management are drugs of abuse (DOA) and can result in a positive UDT, we specifically identified those cases of positive UDT due to nonprescribed DOA and designated these cases as positive UDT with DOA (PUD). We found that 1) there was a higher rate of PUD in clinical pain patients (41.3%) than in pain research study subjects (14.8%); 2) although subjects in the Research Group were informed ahead of time that UDT will be conducted as a screening test, a substantial number (14.8%) of pain research study subjects still showed PUD; 3) there were different types of DOA between clinical pain patients (cannabinoids as the top DOA) and research study subjects (cocaine as the top DOA); and 4) a common factor associated with PUD was opioid therapy in both Clinical Group and Research Group. These results support previous findings that PUD is a common finding in clinical pain patients, particularly in those prescribed opioid therapy, and we suggest that UDT be used as routine screening testing in pain research studies. © 2015 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Cannabis and Pain: A Clinical Review

    OpenAIRE

    Hill, Kevin P.; Palastro, Matthew D.; Johnson, Brian; Ditre, Joseph W.

    2017-01-01

    Abstract Introduction: Cannabis has been used for medical purposes across the world for centuries. As states and countries implement medical and recreational cannabis policies, increasing numbers of people are using cannabis pharmacotherapy for pain. There is a theoretical rationale for cannabis' efficacy for pain management, although the subjective pain relief from cannabis may not match objective measurements of analgesia. As more patients turn to cannabis for pain relief, there is a need f...

  7. Orofacial pain of cardiac origin: Review literature and clinical cases

    Science.gov (United States)

    Garcia-Vicente, Laia; Jané-Salas, Enric; Estrugo-Devesa, Albert; Chimenos-Küstner, Eduardo; Roca-Elias, Josep

    2012-01-01

    The most common types of orofacial pain originate at the dental or periodontal level or in the musculoskeletal structures. However, the patient may present pain in this region even though the source is located elsewhere in the body. One possible source of heterotopic pain is of cardiac origin. Objectives: Report two cases of orofacial pain of cardiac origin and review the clinical cases described in the literature. Study Design: Description of clinical cases and review of clinical cases. Results and conclusions: Nine cases of atypical pain of cardiac origin are recorded, which include 5 females and 4 males. In craniofacial structures, pain of cardiac origin is usually bilateral. At the craniofacial level, the most frequent location described is in the throat and jaw. Pain of cardiac origin is considered atypical due to its location, although roughly 10% of the cases of cardiac ischemia manifest primarily in craniofacial structures. Finally, the differential diagnosis of pain of odontogenic origin must be taken into account with pain of non-odontogenic origin (muscle, psychogenic, neuronal, cardiac, sinus and neurovascular pain) in order to avoid diagnostic errors in the dental practice as well as unnecessary treatments. Key words:Orofacial pain, ischemic heart disease, heterotopic pain, odontalgia. PMID:22322488

  8. Vibration for Pain Reduction in a Plastic Surgery Clinic.

    Science.gov (United States)

    Eichhorn, Mitchell George; Karadsheh, Murad Jehad; Krebiehl, Johanna Ruth; Ford, Dawn Marie; Ford, Ronald D

    2016-01-01

    Patients can experience significant pain during routine procedures in the plastic surgery clinic. Methods for clinical pain reduction are often impractical, time-consuming, or ineffective. Vibration is a safe, inexpensive, and highly applicable modality for pain reduction that can be readily utilized for a wide variety of procedures. This study evaluated the use of vibration as a viable pain-reduction strategy in the clinical plastic surgery setting. Patients requiring at least 2 consecutive procedures that are considered painful were enrolled in the study. These included injections, staple removal, and suture removal. In the same patient, one half of the procedures were performed without vibration and the other half with vibration. After completing the procedures, the patients rated their pain with vibration and without vibration. The patient and the researcher also described the experience with a short questionnaire. Twenty-eight patients were enrolled in the study. Patients reported significantly less pain on the Numeric Rating Scale pain scale when vibration was used compared with the control group (p vibration and 1.93 with vibration, and vibration with injections resulted in the greatest improvement. Eighty-six percent of the patients claimed that vibration significantly reduced their pain. Vibration is an effective method of pain reduction. It significantly reduces the pain experienced by patients during minor office procedures. Given its practicality and ease of use, it is a welcome tool in the plastic surgery clinic.

  9. Compliance with clinical practice guidelines in family physicians managing worker's compensation board patients with acute lower back pain.

    Science.gov (United States)

    Bishop, Paul B; Wing, Peter C

    2003-01-01

    Family physician compliance with acute lower back pain clinical practice guidelines remains uncertain. To determine the degree of guideline compliance of family physicians managing patients with workers' compensation claims and acute mechanical lower back pain. Observational study. One hundred thirty-nine family physicians in British Columbia. Compliance with guideline recommendations for history, examination procedures, diagnostic testing and treatments. Physician workers' compensation board patient reports for acute lower back pain without leg symptoms and not greater than 2 to 3 weeks duration were scored for guideline adherence up until 12 weeks after onset. Physicians demonstrated a high degree of compliance with the guideline-recommended history, examination procedures and medications, but low compliance with recommended imaging and many treatment recommendations. Recently published clinical practice guidelines regarding the management of patients with acute mechanical lower back pain have not been fully implemented into the patterns of practice of the family physicians.

  10. Chronic Pain and Complementary Health Approaches

    Science.gov (United States)

    ... Complementary and alternative medications for chronic pelvic pain. Obstetrics and Gynecology Clinics of North America. 2014;41( ... a systematic review of their effects on clinical outcomes in rheumatoid arthritis. British Journal of Nutrition. 2012; ...

  11. Back pain: a randomized clinical trial of rotational manipulation of the trunk

    Science.gov (United States)

    Glover, J. R.; Morris, Jean G.; Khosla, T.

    1974-01-01

    Glover, J. R., Morris, Jean G., and Khosla, T. (1974).British Journal of Industrial Medicine,31, 59-64. Back pain: a randomized clinical trial of rotational manipulation of the trunk. A therapeutic trial was conducted in a medium-sized engineering works on patients suffering from back pain with its accompanying tenderness and hyperaesthesia. The patients were randomly allocated to two treatment groups, (a) manipulation, and (b) de-tuned (i.e., simulated) short-wave diathermy, the latter acting as a placebo. The manipulated group were given one lumbar rotational manipulation session of 15 minutes or less and this was followed by four daily detuned short-wave diathermy sessions of 15 minutes. The control group were given five 15-minute daily sessions of detuned short-wave diathermy only. The patients' own subjective assessment of relief from pain was recorded in the range 0% (no relief) to 100% (complete relief). The responses were measured at three stages, (1) within 15 minutes, (2) three days after treatment, and (3) seven days after treatment. Although each of the two treatment groups showed progressive and marked improvement in the percentage of relief from pain during the seven-day period, there was no demonstrable difference between the two, except that at the 15-minute stage the relief from pain in the manipulated group was always greater than in the controls. PMID:4274488

  12. Responsiveness of clinical tests for people with neck pain

    DEFF Research Database (Denmark)

    Jørgensen, René; Ris, Inge; Juhl, Carsten

    2017-01-01

    BACKGROUND: Responsiveness of a clinical test is highly relevant in order to evaluate the effect of a given intervention. However, the responsiveness of clinical tests for people with neck pain has not been adequately evaluated. The objective of the present study was to examine the responsiveness...... of four clinical tests which are low cost and easy to perform in a clinical setting, including the craniocervical flexion test, cervical active range of movement, test for the cervical extensors and pressure pain threshold testing. METHODS: This study is a secondary analysis of data collected...... in a previously published randomised controlled trial. Participants were randomized to either physical training, exercises and pain education combined or pain education only. Participants were tested on the clinical tests at baseline and at 4-month follow-up. An anchor-based approach using Receiver Operator...

  13. Clinical Characteristics of Dry Eye Patients With Chronic Pain Syndromes

    NARCIS (Netherlands)

    Vehof, Jelle; Smitt-Kamminga, Nicole Sillevis; Kozareva, Diana; Nibourg, Simone A.; Hammond, Christopher J.

    PURPOSE: To investigate clinical characteristics of dry eye disease (DED) patients with a chronic pain syndrome. DESIGN: Cross-sectional. study. METHODS: Four hundred twenty-five patients of a tertiary care DED patient cohort in the Netherlands were included. Chronic pain syndromes irritable bowel

  14. Research design considerations for chronic pain prevention clinical trials

    DEFF Research Database (Denmark)

    Gewandter, Jennifer S; Dworkin, Robert H; Turk, Dennis C

    2015-01-01

    Although certain risk factors can identify individuals who are most likely to develop chronic pain, few interventions to prevent chronic pain have been identified. To facilitate the identification of preventive interventions, an IMMPACT meeting was convened to discuss research design considerations...... for clinical trials investigating the prevention of chronic pain. We present general design considerations for prevention trials in populations that are at relatively high risk for developing chronic pain. Specific design considerations included subject identification, timing and duration of treatment...... element exposure), and are chronically painful conditions that are treated with a range of interventions. Improvements in the design of chronic pain prevention trials could improve assay sensitivity and thus accelerate the identification of efficacious interventions. Such interventions would have...

  15. Clinical biopsychosocial physiotherapy assessment of patients with chronic pain: The first step in pain neuroscience education.

    Science.gov (United States)

    Wijma, Amarins J; van Wilgen, C Paul; Meeus, Mira; Nijs, Jo

    2016-07-01

    Pain neuroscience education (PNE) is increasingly used as part of a physical therapy treatment in patients with chronic pain. A thorough clinical biopsychosocial assessment is recommended prior to PNE to allow proper explanation of the neurophysiology of pain and the biopsychosocial interactions in an interactive and patient-centered manner. However, without clear guidelines, clinicians are left wondering how a biopsychosocial assessment should be administered. Therefore, we provided a practical guide, based on scientific research and clinical experience, for the biopsychosocial assessment of patients with chronic pain in physiotherapy practice. The purpose of this article is to describe the use of the Pain - Somatic factors - Cognitive factors - Emotional factors - Behavioral factors - Social factors - Motivation - model (PSCEBSM-model) during the intake, as well as a pain analysis sheet. This model attempts to clearly establish what the dominant pain mechanism is (predominant nociceptive, neuropathic, or non-neuropathic central sensitization pain), as well as to assess the provoking and perpetuating biopsychosocial factors in patients with chronic pain. Using this approach allows the clinician to specifically classify patients and tailor the plan of care, including PNE, to individual patients.

  16. Does hemiplegic shoulder pain share clinical and sensory characteristics with central neuropathic pain? A comparative study.

    Science.gov (United States)

    Zeilig, Gabi; Rivel, Michal; Doron, Dana; Defrin, Ruth

    2016-10-01

    Hemiplegic shoulder pain (HSP) is a common poststroke complication and is considered to be a chronic pain syndrome. It is negatively correlated with the functional recovery of the affected arm and the quality of life of the individual. It also leads to a longer length of stay in rehabilitation. Today, there is no consensus as to the underlying mechanism causing HSP, making the syndrome difficult to treat. The aim of this study was to compare the clinical and sensory profile of individuals with HSP to that of individuals with established central neuropathic pain (CNP) in order to identify common features and the presence of neuropathic components in HSP. Cross sectional controlled study. Outpatient rehabilitation clinics. Sixteen chronic HSP patients and 18 chronic CNP patients with spinal cord injury (SCI-CNP). The chronic pain characteristics, thresholds of thermal and tactile sensations and presence of pathological sensations were compared between groups, and between painful and pain free body regions within groups. Correlations were calculated between HSP intensity and sensory and musculoskeletal characteristics. Patients with HSP and patients with SCI-CNP had similar decrease of thermal sensibility in the painful compared to intact body regions and both groups presented similar rates of pathological sensations in painful regions. HSP and SCI-CNP differed however, in the quality of pain and aggravating factors. Significant correlations were found between HSP intensity and heat-pain threshold, presence of subluxation and spasticity. The similarities between HSP and SCI-CNP and the altered spinothalamic function and sensitization suggest that HSP has neuropathic components in its mechanism. Nevertheless, the unique features of HSP point towards additional possible mechanisms. The use of specific therapy options for neuropathic pain should be considered when treating patients with HSP.

  17. Pain in the Blood? Envisioning Mechanism-Based Diagnoses and Biomarkers in Clinical Pain Medicine

    Directory of Open Access Journals (Sweden)

    Emmanuel Bäckryd

    2015-03-01

    Full Text Available Chronic pain is highly prevalent, and pain medicine lacks objective biomarkers to guide diagnosis and choice of treatment. The current U.S. “opioid epidemic” is a reminder of the paucity of effective and safe treatment options. Traditional pain diagnoses according to the International Classification of Diseases are often unspecific, and analgesics are often prescribed on a trial-and-error basis. In contrast to this current state of affairs, the vision of future mechanism-based diagnoses of chronic pain conditions is presented in this non-technical paper, focusing on the need for biomarkers and the theoretical complexity of the task. Pain is and will remain a subjective experience, and as such is not objectively measurable. Therefore, the concept of “noci-marker” is presented as an alternative to “pain biomarker”, the goal being to find objective, measurable correlates of the pathophysiological processes involved in different chronic pain conditions. This vision entails a call for more translational pain research in order to bridge the gap between clinical pain medicine and preclinical science.

  18. Brief pain inventory--facial minimum clinically important difference.

    Science.gov (United States)

    Sandhu, Sukhmeet K; Halpern, Casey H; Vakhshori, Venus; Mirsaeedi-Farahani, Keyvan; Farrar, John T; Lee, John Y K

    2015-01-01

    Neurosurgeons are frequently the primary physicians measuring pain relief in patients with trigeminal neuralgia (TN). Unfortunately, the measurement of pain can be complex. The Brief Pain Inventory-Facial (BPI-Facial) is a reliable and validated multidimensional tool that consists of 18 questions. It measures 3 domains of pain: 1) pain intensity (worst and average pain intensity), 2) interference with general activities of daily living (ADL), and 3) face-specific pain interference. The objective of this paper is to determine the patient-reported minimum clinically important difference (MCID) using the BPI-Facial. The authors conducted a retrospective study of 234 patients with TN seen in a single neurosurgeon's office. Patients completed baseline and 1-month follow-up BPI-Facial questionnaires. The MCID was calculated using an anchor-based approach in which the defined anchor was the 7-point patient global impression of change (PGIC). Two statistical methods were employed: mean change score and optimal cutoff point. Using the mean change score method, the investigators calculated the MCID for the 3 domains of the BPIFacial: 44% and 30% improvement in pain intensity at its worst and average, respectively, 54% improvement in interference with general ADL, and 63% improvement in interference with facial ADL. Using the optimal cutoff point method, they also calculated the MCID for the 3 domains of the BPI-Facial: 57% and 28% improvement in pain intensity at its worst and average, respectively, 75% improvement in interference with general ADL, and 62% improvement in interference with facial ADL. The BPI-Facial is a multidimensional pain scale that measures 3 domains of pain. Although 2 statistical methods were used to calculate the MCID, the optimal cutoff point method was the superior one because it used data from the majority of subjects included in this study. A 57% improvement in pain intensity at its worst and a 28% improvement in pain intensity at its average were

  19. The clinical application of teaching people about pain.

    Science.gov (United States)

    Louw, Adriaan; Zimney, Kory; O'Hotto, Christine; Hilton, Sandra

    2016-07-01

    Teaching people about the neurobiology and neurophysiology of their pain experience has a therapeutic effect and has been referred to as pain neuroscience education (PNE). Various high-quality randomized controlled trials and systematic reviews have shown increasing efficacy of PNE decreasing pain, disability, pain catastrophization, movement restrictions, and healthcare utilization. Research studies, however, by virtue of their design, are very controlled environments and, therefore, in contrast to the ever-increasing evidence for PNE, little is known about the clinical application of this emerging therapy. In contrast, case studies, case series, and expert opinion and perspectives by authorities in the world of pain science provide clinicians with a glimpse into potential "real" clinical application of PNE in the face of the ever-increasing chronic pain epidemic. By taking the material from the randomized controlled trials, systematic reviews, case series, case studies, and expert opinion, this article aims to provide a proposed layout of the clinical application of PNE. The article systematically discusses key elements of PNE including examination, educational content, and delivery methods, merging of PNE with movement, goal setting, and progression. This perspectives article concludes with a call for research into the clinical application of PNE.

  20. Clinical examination findings as prognostic factors in low back pain

    DEFF Research Database (Denmark)

    Hartvigsen, Lisbeth; Kongsted, Alice; Hestbaek, Lise

    2015-01-01

    BACKGROUND: There is a strong tradition of performing a clinical examination of low back pain (LBP) patients and this is generally recommended in guidelines. However, establishing a pathoanatomic diagnosis does not seem possible in most LBP patients and clinical tests may potentially be more...

  1. [Clinical assessment of pain in Spanish Neonatal Intensive Care Units].

    Science.gov (United States)

    Avila-Alvarez, Alejandro; Carbajal, Ricardo; Courtois, Emilie; Pertega-Diaz, Sonia; Anand, Kanwaljeet J S; Muñiz-Garcia, Javier

    2016-10-01

    Clinical scales are currently the best method to assess pain in the neonate, given the impossibility of self-report in this age group. A study is designed with the aim of determining the current practices as regards the clinical assessment of pain in Spanish Neonatal Units and the factors associated with the use of clinical scales. A prospective longitudinal observational study was conducted. A total of 30 Units participated and 468 neonates were included. Only 13 Units (43.3%) had pain assessment protocols. Pain was evaluated with a scale in 78 neonates (16.7%, 95% CI; 13.1-20.1) and the mean number of pain assessments per patient and per day was 2.3 (Standard Deviation; 4.8), with a median of 0.75. Of the total number of 7,189 patient-days studied, there was at least one pain assessment in 654 (9.1%). No pain assessment was performed with a clinical scale on any patient in 20 (66.7%) Units. Among those that did, a wide variation was observed in the percentage of patients in whom pain was assessed, as well as in the scales used. The CRIES (C-Crying; R-Requires increased oxygen administration; I-Increased vital signs; E-Expression; S-Sleeplessness) scale was that used in most Units. In the multivariate analysis, only invasive mechanical ventilation was associated with receiving a pain assessment with a scale (OR 1.46, P=.042). The majority of neonates admitted into Intensive Care in Spain do not receive a pain assessment. Many units still do not routinely use clinical scales, and there is a wide variation between those that do use them. These results could serve as a basis for preparing national guidelines as regards pain in the neonate. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Animal-assisted therapy at an outpatient pain management clinic.

    Science.gov (United States)

    Marcus, Dawn A; Bernstein, Cheryl D; Constantin, Janet M; Kunkel, Frank A; Breuer, Paula; Hanlon, Raymond B

    2012-01-01

    The objective of this study was to evaluate the effects of brief therapy dog visits to an outpatient pain management facility compared with time spent in a waiting room. The design of this study is open-label. Setting.  This study was conducted in a university tertiary care adult chronic pain outpatient clinic. The subjects of this study include outpatients, adults accompanying outpatients to their appointments, and clinic staff. Intervention.  Participants were able to spend clinic waiting time with a certified therapy dog instead of waiting in the outpatient waiting area. When the therapy dog was not available, individuals remained in the waiting area. Self-reported pain, fatigue, and emotional distress were recorded using 11-point numeric rating scales before and after the therapy dog visit or waiting room time. Two hundred ninety-five therapy dog visits (235 with patients, 34 family/friends, and 26 staff) and 96 waiting room surveys (83 from patients, 6 family/friends, and 7 staff) were completed over a 2-month study period. Significant improvements were reported for pain, mood, and other measures of distress among patients after the therapy dog visit but not the waiting room control, with clinically meaningful pain relief (decrease ≥2 points) in 23% after the therapy dog visit and 4% in the waiting room control. Significant improvements were likewise seen after therapy dog visits for family/friends and staff. Therapy dog visits in an outpatient setting can provide significant reduction in pain and emotional distress for chronic pain patients. Therapy dog visits can also significantly improve emotional distress and feelings of well-being in family and friends accompanying patients to appointments and clinic staff. Wiley Periodicals, Inc.

  3. The impact of group singing on mood, coping, and perceived pain in chronic pain patients attending a multidisciplinary pain clinic.

    Science.gov (United States)

    Kenny, Dianna T; Faunce, Gavin

    2004-01-01

    This study explored the impact of group singing on mood, coping, and perceived pain in chronic pain patients attending a multidisciplinary pain clinic. Singers participated in nine 30-minute sessions of small group singing, while comparisons listened to music while exercising. A short form of The Profile of Mood States (POMS) was administered before and after selected singing sessions to assess whether singing produced short-term elevations in mood. Results indicated that pre to post difference scores were significantly different between singing and control groups for only one of the 15 mood variables (i.e., uneasy). To test the longer term impacts of singing the Profile of Mood States, Zung Depression Inventory, Pain Self-Efficacy Questionnaire, Pain Rating Self-Statement, and Pain Disability Questionnaire were administered immediately before and after the singing sessions. All inventories other than the POMS were re-administered 6 months later. One-way ANCOVAs indicated that participants who attended the singing sessions showed evidence of postintervention improvements in active coping, relative to those who failed to attend, when preintervention differences in active coping were controlled for. While the singing group showed marked improvements from pre to postintervention on all mood, coping, and perceived pain variables, these improvements were also observed among comparison participants. The results of this study suggest that active singing may have some benefits, in terms of enhancing active coping, though the limitations of the study and small effect sizes observed suggest that further research is required to fully explore such effects.

  4. [Orofacial idiopathic pain: clinical signs, causes and mechanisms].

    Science.gov (United States)

    Woda, A; Pionchon, P

    2001-03-01

    Atypical facial pain, stomatodynia, atypical odontalgia, masticatory muscle and some temporomandibular joint disorders are grouped together under the category of orofacial idiopathic pain as they reveal numerous common clinical features. For each of these entities, problems of definition and terminology are discussed. Epidemiological and demographic data and a semiological description are given. Proposed diagnostic criteria and some of the causes or mechanisms common to these entities are also described in this article. Firstly, the rôle of female hormones in the physiology and treatment of certain patients is suggested with regard to the marked prevalence of changes in oestrogen levels in patients with orofacial idiopathic pain. Postmenopausal osteoporosis and the hypothesis of neuralgia due to the presence of cavities of osteonecrosis are placed within the context of atypical facial pain. A neuropathic component is suggested for these pain entities. These latter may be linked to a phenomenon of central sensitisation that is induced and maintained by activity in the peripheral tissues. Clinical features of both atypical facial pain and atypical odontalgia have led several authors to advocate the existence of a sympathetic mechanism in the physiopathology of these entities. Moreover, some arguments emphasize similarities with Complex Regional Pain Syndromes of limbs. Lastly, psychosocial components are also considered as a common factor, but it is currently impossible to determine if the pain is the cause or the result of psychosocial problems. Currently, none of these mechanisms can be considered as a single established etiological factor. Indeed, each of these mechanisms can be observed in all types of orofacial idiopathic pain. This leads to the hypothesis that these different mechanisms may act on each target tissue but the details of interaction are still unknown.

  5. Clinical assessment of the impact of pelvic pain on women.

    Science.gov (United States)

    Chalmers, K Jane; Catley, Mark J; Evans, Susan F; Moseley, G Lorimer

    2017-03-01

    We aimed to develop a questionnaire that assesses the impact of pelvic pain on women, regardless of diagnosis, that has high utility, sound psychometric performance, easy scoring, and high reliability. Two studies, with 3 separate cohorts, were undertaken. Both studies were completed online. Studies included women with self-reported pelvic pain. Women were eligible to participate regardless of whether their pelvic pain was undiagnosed, self-diagnosed, or diagnosed by a clinician. Study 1 used a 3-round "patient-as-expert" Delphi technique. These rounds defined the 10 aspects of life with the self-reported greatest impact on the lives of women with pelvic pain, which formed the questionnaire. Study 2 used Rasch analysis to assess the psychometric properties of the resultant 10-item questionnaire. To assess its reliability, a subgroup completed the questionnaire 3 times over a 3-week period. In study 1, 443 women with pelvic pain participated. The resultant 10-item questionnaire consisted of 8 Likert questions and 2 supplemental, nonscored questions. In study 2, 1203 women with pelvic pain completed the questionnaire. Rasch analysis showed that the questionnaire targeted the pelvic pain population well, had appropriate Likert categories, constituted a unidimensional scale, and showed internal consistency. Twenty-seven women with pelvic pain completed the reliability trial. Test-retest reliability was high (intraclass correlation coefficient 0.91, P Pelvic Pain Impact Questionnaire assesses the life impact of pelvic pain. It uses patient-generated language, is easily administered and scored, has very strong psychometric properties, and it is suitable for research and clinical settings across primary, secondary, and tertiary care.

  6. Clinical Holistic Medicine: Chronic Pain in the Locomotor System

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2005-01-01

    Full Text Available Most pains from the locomotor system arise due to involuntary, chronic tensions in the muscles or other tissues. When the patient is motivated, the pain is easily cured in most of the cases by using the tools of consciousness-based medicine, primarily therapeutic touch, conversation, and coaching the patient in a positive philosophy of life. The pains are often caused by “blockages” that may cause problems other than just pain. Often it turns out that the blocked areas develop actual physical damage over time: a slipped disk in the back, articular degeneration, or osteoarthritis when the cartilage is affected, can often be explained in this way. Apparently, the exact areas where the blockage is situated cause cellular problems, disrupting cellular order. The holistic process theory of healing and the related quality of life theories state that return to the natural state of being is possible, whenever the person gets the resources needed for existential healing. The resources needed are “holding” in the dimensions of awareness, respect, care, acknowledgment, and acceptance with support and processing in the dimensions of feeling, understanding, and letting go of negative attitudes and beliefs. The preconditions for holistic healing are trust and the intention for the healing to take place. Case stories of holistic treatment of patients with chronic back pain, low back pain, muscle problems, knee pain, and symptoms of rheumatoid arthritis are discussed with exercises relevant for patients with these conditions in the holistic clinic.

  7. Clinical Holistic Medicine: Chronic Pain in Internal Organs

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2005-01-01

    Full Text Available Holistic medicine seems to be efficient in the treatment of chronic pain in internal organs, especially when the pain has no known cause. It is quite surprising that while chronic pain can be one of the toughest challenges in the biomedical clinic, it is often one of the simplest things to alleviate in the holistic clinic. These pains are regarded as being caused by repressed emotions and are explained as psychosomatic reactions. Using holistic medicine, the patients can often be cured of their suffering when they assume responsibility for the repressed feelings. The holistic process theory of healing states that the return to the natural (pain free state of being is possible whenever the person obtains the resources needed for existential healing. This shift is explained by the related quality of life and life mission theories. The resources needed are “holding” or genuine care in the dimensions of awareness, respect, care, acknowledgment, and acceptance with support and processing in the dimensions of feeling, understanding, and letting go of negative attitudes and beliefs. The preconditions for the holistic healing to take place are “love” and trust. Obtaining the full trust of the patient, therefore, seems to be the biggest challenge of holistic medicine, especially when dealing with a patient in pain.

  8. Suggestions to Reduce Clinical Fibromyalgia Pain and Experimentally Induced Pain Produce Parallel Effects on Perceived Pain but Divergent Functional MRI-Based Brain Activity.

    Science.gov (United States)

    Derbyshire, Stuart W G; Whalley, Matthew G; Seah, Stanley T H; Oakley, David A

    Hypnotic suggestion is an empirically validated form of pain control; however, the underlying mechanism remains unclear. Thirteen fibromyalgia patients received suggestions to alter their clinical pain, and 15 healthy controls received suggestions to alter experimental heat pain. Suggestions were delivered before and after hypnotic induction with blood oxygen level-dependent (BOLD) activity measured concurrently. Across groups, suggestion produced substantial changes in pain report (main effect of suggestion, F2, 312 = 585.8; p pain report in regions previously associated with pain, including thalamus and anterior cingulate cortex. In controls, BOLD response decreased with pain report. All changes were greater after induction. Region-of-interest analysis revealed largely linear patient responses with increasing pain report. Control responses, however, were higher after suggestion to increase or decrease pain from baseline. Based on behavioral report alone, the mechanism of suggestion could be interpreted as largely similar regardless of the induction or type of pain experience. The functional magnetic resonance imaging data, however, demonstrated larger changes in brain activity after induction and a radically different pattern of brain activity for clinical pain compared with experimental pain. These findings imply that induction has an important effect on underlying neural activity mediating the effects of suggestion, and the mechanism of suggestion in patients altering clinical pain differs from that in controls altering experimental pain. Patient responses imply that suggestions altered pain experience via corresponding changes in pain-related brain regions, whereas control responses imply suggestion engaged cognitive control.

  9. Responsiveness of clinical tests for people with neck pain

    DEFF Research Database (Denmark)

    Jørgensen, René; Ris, Inge; Juhl, Carsten

    2017-01-01

    in a previously published randomised controlled trial. Participants were randomized to either physical training, exercises and pain education combined or pain education only. Participants were tested on the clinical tests at baseline and at 4-month follow-up. An anchor-based approach using Receiver Operator...... Characteristics (ROC) curves was used to evaluate responsiveness of the clinical tests. The Neck Disability Index was used to discriminate between those who had improved and those who were unchanged at the 4-month follow-up. Minimum Clinically Important Difference (MCID), together with sensitivity, specificity......-six participants didn't complete all of the clinical tests, leaving a total of 138 to be included for analyses. Area Under Curve (AUC) ranged from 0.50-0.62 for the clinical tests, and were all below an acceptable level. MCID was generally large, and the corresponding sensitivity and specificity was low...

  10. Clinical examination findings as prognostic factors in low back pain

    DEFF Research Database (Denmark)

    Hartvigsen, Lisbeth; Kongsted, Alice; Hestbaek, Lise

    2015-01-01

    BACKGROUND: There is a strong tradition of performing a clinical examination of low back pain (LBP) patients and this is generally recommended in guidelines. However, establishing a pathoanatomic diagnosis does not seem possible in most LBP patients and clinical tests may potentially be more...... from inception to June 2012. Prospective clinical studies of adult patients with LBP with or without leg pain and/or signs of nerve root involvement or spinal stenosis, receiving non-surgical or no treatment, which investigated the association between low-tech clinical tests and outcome were included...... relevant as prognostic factors. The aim of this review of the literature was to systematically assess the association between low-tech clinical tests commonly used in adult patients with acute, recurrent or chronic LBP and short- and long-term outcome. METHODS: MEDLINE, Embase, and MANTIS were searched...

  11. Effect of training on corticomotor excitability in clinical neck pain.

    Science.gov (United States)

    Rittig-Rasmussen, B; Kasch, H; Fuglsang-Frederiksen, A; Svensson, P; Jensen, T S

    2014-09-01

    Corticomotor excitability has been shown to correlate with motor learning and functional recovery. The aim of the present study was to monitor changes in excitability of the corticomotor pathways induced by neck training and to compare the effects in patients with neck or knee pain and pain-free participants. Corticomotor excitability was assessed using transcranial magnetic stimulation and electromyography at baseline, after 30 min and 1 h, and at a 1-week follow-up visit. The primary outcome measures were changes in amplitudes and latencies of motor evoked potentials (MEPs) at 1-week follow-up. MEP responses induced by neck training yielded significantly different outcomes in the three groups. In the group with neck pain and training, MEP amplitudes were significantly reduced between baseline and 30 min (p ≤ 0.05), but with no significant difference between baseline, 1 h (p = 0.178) and 1 week (p = 0.067). In the group with knee pain and training, MEP amplitudes significantly increased between baseline and 30 min (p ≤ 0.01) and 1 h (p pain-free group, there were no changes over time. Neck training reduced neuroplastic responsiveness of corticomotor pathways in neck pain patients in contrast to knee pain patients and pain-free participants. Increased attention to adaptive and maladaptive neuroplastic responses induced by training may prove valuable in the process of optimizing clinical outcomes. © 2014 European Pain Federation - EFIC®

  12. Breast Pain: Clinical pattern and aetiology in a breast clinic in Eastern Nigeria

    Directory of Open Access Journals (Sweden)

    Ochonma A Egwuonwu

    2016-01-01

    Full Text Available Background: Patients with breast pain are likely to be very worried because some consider pain in the breast as an indication of malignancy. Objective: To highlight the causes of pain in the patients are presenting to our breast clinic. Materials and Methods: A prospective study of all consenting patients with breast disease presenting to the breast clinic was conducted from January 2004 to December 2008. Results: A total of 664 patients presented to the breast clinic during the study period. Of this number, 127 presented with breast pain either as the sole symptom or in association with other symptoms. The presenting complaints were a pain, pain with lump, and pain with nipple discharge in 63 (49.6%, 59 (46.4%, and 5 (4.0% patients, respectively. The pain was noncyclical in 96 (75.6% patients. The site of the pain was whole breast in 87 (68.5% patients and a lump in 40 (31.5%. The clinical diagnosis in 31 (24.4% cases was fibrocystic disease, 28 (22.0% cancer, 23 (18.1% unknown, 10 (7.9% fibroadenoma, 8 (6.3% duct ectasia, 6 (4.7% normal breast, and others 21 (16.5% cases benign diseases were diagnosed. The histological diagnosis was fibrocystic changes, carcinoma, and fibroadenoma in 15 (42.9%, 10 (28.6%, and 5 (14.3% patients, respectively. Others were benign phyllodes, abscess, duct ectasia, chronic mastitis, and lipoma, each constituting 1 (2.9% case. Conclusion: Breast pain constitutes a small proportion of complaints to our breast clinic. Fibrocystic changes were the most common cause of breast pain both clinically and histologically.

  13. Responsiveness and minimal clinically important difference for pain and disability instruments in low back pain patients

    Directory of Open Access Journals (Sweden)

    Korsholm Lars

    2006-10-01

    Full Text Available Abstract Background The choice of an evaluative instrument has been hampered by the lack of head-to-head comparisons of responsiveness and the minimal clinically important difference (MCID in subpopulations of low back pain (LBP. The objective of this study was to concurrently compare responsiveness and MCID for commonly used pain scales and functional instruments in four subpopulations of LBP patients. Methods The Danish versions of the Oswestry Disability Index (ODI, the 23-item Roland Morris Disability Questionnaire (RMQ, the physical function and bodily pain subscales of the SF36, the Low Back Pain Rating Scale (LBPRS and a numerical rating scale for pain (0–10 were completed by 191 patients from the primary and secondary sectors of the Danish health care system. Clinical change was estimated using a 7-point transition question and a numeric rating scale for importance. Responsiveness was operationalised using standardardised response mean (SRM, area under the receiver operating characteristic curve (ROC, and cut-point analysis. Subpopulation analyses were carried out on primary and secondary sector patients with LBP only or leg pain +/- LBP. Results RMQ was the most responsive instrument in primary and secondary sector patients with LBP only (SRM = 0.5–1.4; ROC = 0.75–0.94 whereas ODI and RMQ showed almost similar responsiveness in primary and secondary sector patients with leg pain (ODI: SRM = 0.4–0.9; ROC = 0.76–0.89; RMQ: SRM = 0.3–0.9; ROC = 0.72–0.88. In improved patients, the RMQ was more responsive in primary and secondary sector patients and LBP only patients (SRM = 1.3–1.7 while the RMQ and ODI were equally responsive in leg pain patients (SRM = 1.3 and 1.2 respectively. All pain measures demonstrated almost equal responsiveness. The MCID increased with increasing baseline score in primary sector and LBP only patients but was only marginally affected by patient entry point and pain location. The MCID of the

  14. Management of low back pain: knowledge and adherence to clinical ...

    African Journals Online (AJOL)

    Objective: The therapeutic management of patients with Low Back Pain (LBP) has long been characterized by considerable variation among physiotherapists within and between countries. Over the past decade, systematic reviews have been written, and clinical practice guidelines have been made available. However ...

  15. Clinical classification in low back pain

    DEFF Research Database (Denmark)

    Petersen, Tom; Laslett, Mark; Juhl, Carsten Bogh

    2017-01-01

    -anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles, nerve roots, muscles, peripheral nerve tissue, and central nervous system sensitization. METHODS: A sensitive electronic search strategy using MEDLINE, EMBASE and CINAHL databases was combined with hand...... permitting calculation of diagnostic value. Quality assessments were made independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Clinical examination findings that were investigated by at least two studies were included and results that met our predefined threshold...

  16. Prescription opioid abuse, pain and addiction: clinical issues and implications.

    Science.gov (United States)

    Ling, Walter; Mooney, Larissa; Hillhouse, Maureen

    2011-05-01

    Prescription opioid misuse in the USA has increased over threefold since 1990 to epidemic proportions, with substantial increases in prescription opioid use also reported in other countries, such as Australia and New Zealand. The broad availability of prescription pain medications, coupled with public misconceptions about their safety and addictive potential, have contributed to the recent surge in non-medical use of prescription opioids and corresponding increases in treatment admissions for problems related to opioid misuse. Given competing pressures faced by physicians to both diagnose and treat pain syndromes and identify individuals at risk for addictive disorders, the use of opioids in the treatment of pain poses a significant clinical challenge. This paper reviews the interaction between pain and opioid addiction with a focus on clinical management issues, including risk factors for opioid dependence in patients with chronic pain and the use of assessment tools to identify and monitor at-risk individuals. Treatment options for opioid dependence and pain are reviewed, including the use of the partial µ agonist buprenorphine in the management of concurrent pain and opioid addiction. Physicians should strive to find a reasonable balance between minimising potential adverse effects of opioid medications without diminishing legitimate access to opioids for analgesia. The article discusses the need to identify methods for minimising risks and negative consequences associated with opioid analgesics and poses research directions, including the development of abuse-deterrent opioid formulations, genetic risk factors for opioid dependence and opioid-induced hyperalgesia as a potential target for medication therapy. © 2011 Australasian Professional Society on Alcohol and other Drugs.

  17. Evidence-based interventional pain medicine according to clinical diagnoses. 16. Complex regional pain syndrome.

    Science.gov (United States)

    van Eijs, Frank; Stanton-Hicks, Michael; Van Zundert, Jan; Faber, Catharina G; Lubenow, Timothy R; Mekhail, Nagy; van Kleef, Maarten; Huygen, Frank

    2011-01-01

    Complex regional pain syndrome (CRPS), formerly known as reflex sympathetic dystrophy is a pain syndrome with an unclear pathophysiology and unpredictable clinical course. The disease is often therapy resistant, the natural course not always favorable. The diagnosis of CRPS is based on signs and symptoms derived from medical history and physical examination. Pharmacological pain management and physical rehabilitation of limb function are the main pillars of therapy and should be started as early as possible. If, however, there is no improvement of limb function and persistent severe pain, interventional pain management techniques may be considered. Intravenous regional blocks with guanethidine did not prove superior to placebo but frequent side effects occurred.Therefore this technique receives a negative recommendation (2 A-). Sympathetic block is the interventional treatment of first choice and has a 2 B+ rating. Ganglion stellatum (stellate ganglion) block with repeated local anesthetic injections or by radiofrequency denervation after positive diagnostic block is documented in prospective and retrospective trials in patients suffering from upper limb CRPS. Lumbar sympathetic blocks can be performed with repeated local anesthetic injections. For a more prolonged lumbar sympathetic block radiofrequency treatment is preferred over phenol neurolysis because effects are comparable whereas the risk for side effects is lower (2 B+). For patients suffering from CRPS refractory to conventional treatment and sympathetic blocks, plexus brachialis block or continuous epidural infusion analgesia coupled with exercise therapy may be tried (2 C+). Spinal cord stimulation is recommended if other treatments fail to improve pain and dysfunction (2 B+). Alternatively peripheral nerve stimulation can be considered, preferentially in study conditions (2 C+). © 2010 The Authors. Pain Practice © 2010 World Institute of Pain.

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

    DEFF Research Database (Denmark)

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

    2008-01-01

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

  19. CLINICAL-EVALUATION OF PAIN TREATMENT WITH ELECTROSTIMULATION - A STUDY OF TENS IN PATIENTS WITH DIFFERENT PAIN SYNDROMES

    NARCIS (Netherlands)

    MEYLER, WJ; DEJONGSTE, MJL; ROLF, CAM

    Objective: We evaluated the clinical efficacy and the unwanted side effects of transcutaneous electrical nerve stimulation (TENS) in a consecutive group of patients with intractable pain due to different pain syndromes. Methods: Two hundred eleven patients with different pain syndromes, coded

  20. The Efficacy of Thermotherapy and Cryotherapy on Pain Relief in Patients with Acute Low Back Pain, A Clinical Trial Study

    OpenAIRE

    Dehghan, Morteza; Farahbod, Farinaz

    2014-01-01

    Introduction: Acute low back pain is one of the most common health problems especially in industrialized countries where 75 per cent of the population develop it at least once during their life. This study examined the efficacy of thermotherapy and cryotherapy, alongside a routine pharmacologic treatment, on pain relief in patients with acute low back pain referring an orthopedic clinic in Shahrekord, Iran.

  1. Central Hyperexcitability in Chronic Musculoskeletal Pain: A Conceptual Breakthrough with Multiple Clinical Implications

    Directory of Open Access Journals (Sweden)

    Jan Lidbeck

    2002-01-01

    Full Text Available Recent investigations of dysfunctional pain processing in the central nervous system have contributed much knowledge about the development of chronic musculoskeletal pain. Many common chronic musculoskeletal pain syndromes - including regional myofascial pain syndromes, whiplash pain syndromes, refractory work-related neck-shoulder pain, certain types of chronic low back pain, fibromyalgia and others - may essentially be explained by abnormalities in central pain modulation. The growing awareness of dysfunctional central pain modulation may be a conceptual breakthrough leading to a better understanding of common chronic pain disorders. A new paradigm will have multiple clinical implications, including re-evaluation of clinical practice routines and rehabilitation methods, and will focus on controversial issues of medicolegal concern. The concept of dysfunctional central pain processing will also necessitate a mechanism-based classification of pain for the selection of individual treatment and rehabilitation programs for subgroups of patients with chronic musculoskeletal pain due to different pathophysiological mechanisms.

  2. The clinical efficacy of kinesio tape for shoulder pain: a randomized, double-blinded, clinical trial.

    Science.gov (United States)

    Thelen, Mark D; Dauber, James A; Stoneman, Paul D

    2008-07-01

    Prospective, randomized, double-blinded, clinical trial using a repeated-measures design. To determine the short-term clinical efficacy of Kinesio Tape (KT) when applied to college students with shoulder pain, as compared to a sham tape application. Tape is commonly used as an adjunct for treatment and prevention of musculoskeletal injuries. A majority of tape applications that are reported in the literature involve nonstretch tape. The KT method has gained significant popularity in recent years, but there is a paucity of evidence on its use. Forty-two subjects clinically diagnosed with rotator cuff tendonitis/impingement were randomly assigned to 1 of 2 groups: therapeutic KT group or sham KT group. Subjects wore the tape for 2 consecutive 3-day intervals. Self-reported pain and disability and pain-free active ranges of motion (ROM) were measured at multiple intervals to assess for differences between groups. The therapeutic KT group showed immediate improvement in pain-free shoulder abduction (mean +/- SD increase, 16.9 degrees +/- 23.2 degrees ; P = .005) after tape application. No other differences between groups regarding ROM, pain, or disability scores at any time interval were found. KT may be of some assistance to clinicians in improving pain-free active ROM immediately after tape application for patients with shoulder pain. Utilization of KT for decreasing pain intensity or disability for young patients with suspected shoulder tendonitis/impingement is not supported. Therapy, level 1b-.

  3. Evaluation and management of shoulder pain in primary care clinics.

    Science.gov (United States)

    House, Jeff; Mooradian, Arshag

    2010-11-01

    Shoulder pain is a frequent clinical problem facing primary care physicians. Despite its common occurrence, many clinicians are unfamiliar with the diagnosis and treatment of many common shoulder ailments. Because therapy for most shoulder disorders can be made at the initial consultation, a good history and physical remain paramount. The purpose of this paper is to review the basic approach to diagnosis and management of shoulder pain. It will summarize a pragmatic approach to the initial history, with particular attention to differentiating extrinsic and intrinsic etiologies. Physical exam techniques for evaluating shoulder pain will be reviewed, including provocation testing for specific disorders. Specific disorders covered include supraspinatus tendonitis, subdeltoid bursitis, frozen shoulder, biceps tendonitis, and acromioclavicular (AC) joint arthritis.

  4. Reactivity in pain-free subjects and a clinical pain population: evaluation of the Kohn Reactivity Scale-dutch Version.

    Science.gov (United States)

    Veldhuijzen, Dieuwke S; Noordermeer, Siri D S; van Wijck, Albert J M; Snijders, Tom J; Geenen, Rinie

    2013-07-01

    Patients with pain are more reactive to various types of sensations, not limited to pain alone. A potential useful instrument to assess reactivity is the Kohn Reactivity Scale (KRS). This study examines the psychometric characteristics of the KRS-Dutch version and its ability to differentiate between subjects with and without pain. Internal consistency, convergent validity, and test-retest reliability of the Dutch translation of the KRS were assessed in 321 pain-free control subjects and different subgroups of this sample. Subsequently, reactivity scores were compared between the pain-free subjects and 291 pain patients who were referred to a pain clinic for treatment. Reliability analyses indicated good internal consistency (α ≥ 0.77) and high test-retest reliability (intraclass correlation = 0.95) of the KRS in the control subjects. Validity analyses yielded positive correlations of the KRS with related constructs like pain vigilance and awareness (r = 0.37), symptom severity (r = 0.29), and the personality characteristic neuroticism (r = 0.20). Pain patients had overall significantly higher KRS scores than the pain-free subjects indicating increased reactivity, particularly for the patients with medically unexplained pain. These findings indicate that the KRS is a useful instrument to screen for reactivity in pain patients, which may be of particular relevance for those suffering from medically unexplained pain. © 2012 The Authors Pain Practice © 2012 World Institute of Pain.

  5. Myofascial face pain. Clinical characteristics of those with regional vs. widespread pain.

    Science.gov (United States)

    Raphael, K G; Marbach, J J; Klausner, J

    2000-02-01

    The authors conducted a study to determine whether there are differences in salient clinical characteristics between patients who have both myofascial face pain, or MFP, and comorbid fibromyalgia, or FM, and patients who have MFP but not FM. The authors enrolled in the study 162 female subjects who had histories of MFP. In physical examinations at the time of initial consultation, they recorded facial pain signs and symptoms. At the research interview follow-up (seven years post-consultation), participants were screened for a lifetime history of FM and other health problems. In addition, psychiatric interviewers conducted the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised, to assess each patient's history of depression and other psychiatric disorders. Of the 162 participants, 38 (23.5 percent) reported a history of FM. At the time of treatment for MFP, both the FM and non-FM groups had similar signs and symptoms of MFP. At the time of the research interview follow-up, participants with FM histories were significantly less likely than those without FM histories to report that they were free of MFP. On recall, those with FM histories reported experiencing more symptoms of MFP. Those with FM histories also were more likely to have had major depression and to report somatization symptoms. Finally, those who had FM more commonly had a history of facial pain's interference with social and occupational functioning and had more severe pain than did those without FM. Patients who have MFP and a history of widespread pain suggestive of FM are likely to have more persistent and debilitating MFP and to have higher rates of depression and somatization symptoms than those who have no history of widespread pain.

  6. Spinal Disinhibition in Experimental and Clinical Painful Diabetic Neuropathy.

    Science.gov (United States)

    Marshall, Andrew G; Lee-Kubli, Corinne; Azmi, Shazli; Zhang, Michael; Ferdousi, Maryam; Mixcoatl-Zecuatl, Teresa; Petropoulos, Ioannis N; Ponirakis, Georgios; Fineman, Mark S; Fadavi, Hassan; Frizzi, Katie; Tavakoli, Mitra; Jeziorska, Maria; Jolivalt, Corinne G; Boulton, Andrew J M; Efron, Nathan; Calcutt, Nigel A; Malik, Rayaz A

    2017-05-01

    Impaired rate-dependent depression (RDD) of the Hoffman reflex is associated with reduced dorsal spinal cord potassium chloride cotransporter expression and impaired spinal γ-aminobutyric acid type A receptor function, indicative of spinal inhibitory dysfunction. We have investigated the pathogenesis of impaired RDD in diabetic rodents exhibiting features of painful neuropathy and the translational potential of this marker of spinal inhibitory dysfunction in human painful diabetic neuropathy. Impaired RDD and allodynia were present in type 1 and type 2 diabetic rats but not in rats with type 1 diabetes receiving insulin supplementation that did not restore normoglycemia. Impaired RDD in diabetic rats was rapidly normalized by spinal delivery of duloxetine acting via 5-hydroxytryptamine type 2A receptors and temporally coincident with the alleviation of allodynia. Deficits in RDD and corneal nerve density were demonstrated in patients with painful diabetic neuropathy compared with healthy control subjects and patients with painless diabetic neuropathy. Spinal inhibitory dysfunction and peripheral small fiber pathology may contribute to the clinical phenotype in painful diabetic neuropathy. Deficits in RDD may help identify patients with spinally mediated painful diabetic neuropathy who may respond optimally to therapies such as duloxetine. © 2017 by the American Diabetes Association.

  7. Chronic Pain in Children: A Look at the Referral Process to a Pediatric Pain Clinic.

    Science.gov (United States)

    Cucchiaro, Giovanni; Schwartz, Jennifer; Hutchason, Alec; Ornelas, Beatriz

    2017-01-01

    We reviewed the referral pattern of children with chronic pain to a specialized pediatric pain clinic. Data were obtained from referring physicians and medical records and during an interview with patients and their parents by physicians and a psychologist. We analyzed the following: referral diagnosis, demographics, duration of symptoms, number of physicians previously consulted, school attendance, sports activities, presence of psychological disorders, final team diagnosis, and outcomes. Children had been experiencing pain for 34 ± 55 months. Patients had consulted on average 3 physicians in addition to their pediatrician. 32% of the patients had missed at least 10 days of school in a calendar year, and 47% had stopped playing sports. 15% had an operation because of pain that had been unsuccessful. The most common missed diagnosis was anxiety (25%) and depression (13%). 69% of the patients were back to school and/or playing sports within 4 months from our initial consultation. 32% of the patients did not make any progress during the follow-up period. The most common reasons for failure to improve were no compliance with the recommended treatments and poorly controlled major mood disorder. The time to refer children with chronic pain for specialized care could be extremely long causing significant social and psychological consequence.

  8. Chronic Pain in Children: A Look at the Referral Process to a Pediatric Pain Clinic

    Directory of Open Access Journals (Sweden)

    Giovanni Cucchiaro

    2017-01-01

    Full Text Available We reviewed the referral pattern of children with chronic pain to a specialized pediatric pain clinic. Data were obtained from referring physicians and medical records and during an interview with patients and their parents by physicians and a psychologist. We analyzed the following: referral diagnosis, demographics, duration of symptoms, number of physicians previously consulted, school attendance, sports activities, presence of psychological disorders, final team diagnosis, and outcomes. Children had been experiencing pain for 34±55 months. Patients had consulted on average 3 physicians in addition to their pediatrician. 32% of the patients had missed at least 10 days of school in a calendar year, and 47% had stopped playing sports. 15% had an operation because of pain that had been unsuccessful. The most common missed diagnosis was anxiety (25% and depression (13%. 69% of the patients were back to school and/or playing sports within 4 months from our initial consultation. 32% of the patients did not make any progress during the follow-up period. The most common reasons for failure to improve were no compliance with the recommended treatments and poorly controlled major mood disorder. The time to refer children with chronic pain for specialized care could be extremely long causing significant social and psychological consequence.

  9. Temporomandibular disorders and painful comorbidities: clinical association and underlying mechanisms.

    Science.gov (United States)

    Costa, Yuri Martins; Conti, Paulo César Rodrigues; de Faria, Flavio Augusto Cardoso; Bonjardim, Leonardo Rigoldi

    2017-03-01

    The association between temporomandibular disorders (TMDs) and headaches, cervical spine dysfunction, and fibromyalgia is not artefactual. The aim of this review is to describe the comorbid relationship between TMD and these three major painful conditions and to discuss the clinical implications and the underlying pain mechanisms involved in these relationships. Common neuronal pathways and central sensitization processes are acknowledged as the main factors for the association between TMD and primary headaches, although the establishment of cause-effect mechanisms requires further clarification and characterization. The biomechanical aspects are not the main factors involved in the comorbid relationship between TMD and cervical spine dysfunction, which can be better explained by the neuronal convergence of the trigeminal and cervical spine sensory pathways as well as by central sensitization processes. The association between TMD and fibromyalgia also has supporting evidence in the literature, and the proposed main mechanism underlying this relationship is the impairment of the descending pain inhibitory system. In this particular scenario, a cause-effect relationship is more likely to occur in one direction, that is, fibromyalgia as a risk factor for TMD. Therefore, clinical awareness of the association between TMD and painful comorbidities and the support of multidisciplinary approaches are required to recognize these related conditions. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Clinical disorders in a post war British cohort reaching retirement: evidence from the First National Birth Cohort study.

    Directory of Open Access Journals (Sweden)

    Mary B Pierce

    Full Text Available The medical needs of older people are growing because the proportion of the older population is increasing and disease boundaries are widening. This study describes the distribution and clustering of 15 common clinical disorders requiring medical treatment or supervision in a representative British cohort approaching retirement, and how health tracked across adulthood.The data come from a cohort of 2661 men and women, 84% of the target sample, followed since birth in England, Scotland and Wales in 1946, and assessed at 60-64 years for: cardio and cerebro-vascular disease, hypertension, raised cholesterol, renal impairment, diabetes, obesity, hypothyroidism, hyperthyroidism, anaemia, respiratory disease, liver disease, psychiatric problems, cancers, atrial fibrillation on ECG and osteoporosis. We calculated the proportions disorder-free, with one or more disorders, and the level of undiagnosed disorders; and how these disorders cluster into latent classes and relate to health assessed at 36 years. Participants had, on average, two disorders (range 0-9; only 15% were disorder-free. The commonest disorders were hypertension (54.3%, 95% CI 51.8%-56.7%, obesity (31.1%, 28.8%-33.5%, raised cholesterol (25.6%, 23.1-28.26%, and diabetes or impaired fasting glucose (25.0%, 22.6-27.5%. A cluster of one in five individuals had a high probability of cardio-metabolic disorders and were twice as likely than others to have been in the poorest health at 36 years. The main limitations are that the native born sample is entirely white, and a combination of clinical assessments and self reports were used.Most British people reaching retirement already have clinical disorders requiring medical supervision. Widening disease definitions and the move from a disease-based to a risk-based medical model will increase pressure on health services. The promotion of healthy ageing should start earlier in life and consider the individual's ability to adapt to and self manage

  11. Effects of LLLT for pain: a clinical study on different pain types

    Science.gov (United States)

    Tam, Giuseppe

    2002-10-01

    Objective: The aim of this clinical study is to determine the efficacy of the JR diode laser 904 nm pulsed on pain reduction therapy. Summary Background Data: With respect to pain, the existence of a filter (Rolando's substantia gelatinosa) in the spinal marrow is fundamental. Opening or closing, this filter is able to block transmission of pain impulses to a higher cerebral center. This is in proportion with the A big fibres and C small fibres. The action of the laser influences this mechanism. Additionally, laser interferes in the cytochines (TNf-α , interleukin-1 and interleukin-6) that drive inflammation in the arthritis and are secreted from CD4 e T cells. Low power density laser increases the endorphin synthesis in the dorsal posterior horn of the spinal cord. Besides, laser causes local vasodilatation of the capillaries and an improved circulation of drainage liquids in interstitial space causing an analgesic effect. Methods: Treatment was carried out on 482 cases and 464 patients (274 women and 190 men) in the period between 1987 and 2000. The patients, whose age ranged from 25 to 70, with a mean age of 45 years, were suffering from rheumatic, degenerative and traumatic pathologies as well as cutaneous ulcers. The majority of the patients had been seen by orthopaedists and rheumatologists and had undergone x-ray, ultrasound scanning, TAC, RM examination. All patients had previously received drug-based treatment and/or physiotherapy with poor results. Two thirds were experiencing acute symptomatic pain, while the others presented a chronic pathology with recurrent crises. We used a pulsed JR diode laser, GaAs 904 nm wavelength. Results: Jn the evaluation of the results the following parameters have been considered: disappearance of spontaneous and induced pain, anatomic and functional evaluation of the joints, muscular growth, verbal rating scales, hand dinamometer, patient's pain diary. Very good results were achieved especially with cases of symptomatic

  12. Patterns and predictors of health service utilization in adolescents with pain: comparison between a community and a clinical pain sample.

    Science.gov (United States)

    Toliver-Sokol, Marisol; Murray, Caitlin B; Wilson, Anna C; Lewandowski, Amy; Palermo, Tonya M

    2011-07-01

    There is limited research describing the patterns of healthcare utilization in adolescents with chronic pain. This study describes healthcare utilization in a clinical chronic pain sample, and compares the patterns of service use of this group to a community sample with intermittent pain complaints. We also investigated demographic and clinical factors that predicted healthcare visits and medication use in the clinical sample. Data on 117 adolescents (aged 12-18; n = 59 clinical pain sample, n = 58 community) were collected. Caregivers and adolescents reported on sociodemographics, medical visits, current medications, pain, activity limitations, and depression. As hypothesized, the clinical pain sample had higher rates of healthcare consultation on all types of medical visits (general, specialty care, complementary medicine, mental health, OT/PT), and higher medication use compared to the community sample. Regression analyses revealed that higher annual income, greater pain frequency, and higher levels of caregiver-reported activity limitations were associated with a greater number of healthcare visits for the total sample. Within the clinical pain sample, higher pain frequency and greater activity limitations (caregiver report) predicted more specialty care visits. Additionally, higher income and greater levels of depressive symptoms predicted a higher number of prescribed medications. This study contributes to the limited available data on health service and medication use in a clinical chronic pain sample versus a community sample of adolescents. We also identify clinical factors (pain frequency, parent-reported activity limitations, depressive symptoms) and demographic factors (gender, income) associated with healthcare utilization. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.

  13. Impact of national low back pain guidelines on clinical practice.

    Science.gov (United States)

    Jackson, Jeffrey L; Browning, Robert

    2005-02-01

    The purpose of this study was to assess the impact of the 1994 Agency for Health Research and Quality (AHRQ) clinical practice guidelines on the management of acute low back pain. From the National Ambulatory Medical Care Service database, the authors abstracted data on patients being seen in primary care settings, presenting with low back pain as their primary reason for visit, and aged between 20 and 55 years. Patients with an inflammatory or secondary diagnosis to explain their back pain were excluded. Using the sampling weights assigned by the National Ambulatory Medical Care Service, we assessed the medications prescribed, referrals for physiotherapy, and radiography usage for 3 years before (1991 to 1993) and after (1995 to 1997) release of the back pain guidelines. During these 6 years, more than 10 million ambulatory office visits were available for analysis, 5.2 million visits between 1991 to 1993 and 5.0 million visits between 1995 to 1997. The most common diagnosis was lumbago, present in 21% of these visits. Acetaminophen use increased 20-fold from 0.1 to 2%, nonsteroidal use increased from 40 to 43%, muscle relaxant use decreased from 29 to 20%, radiography ordering increased slightly from 15.4 to 19.4%, and physical therapy referrals declined from 27 to 22%. There was no evidence of a trend toward increased compliance with the AHRQ guidelines over time. The AHRQ clinical practice guidelines for the management of acute low back pain had a modest impact on physician behavior, increasing the use of acetaminophen and nonsteroidals and decreasing the use of muscle relaxants and physical therapy referrals.

  14. Effects of auriculotherapy on labour pain: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Reginaldo Roque Mafetoni

    Full Text Available Abstract OBJECTIVE Assessing the effects of auriculotherapy in pain control and its outcomes on the duration of labour. METHOD This is a randomized, controlled, double-blind trial with preliminary data. Thirty pregnant women with gestational age ≥ 37 weeks, cervical dilatation ≥ 4 cm and two or more contractions in 10 minutes were selected and randomly divided into three groups: auriculotherapy, placebo and control. Auriculotherapy was applied using crystal beads on four strategic points. RESULTS No statistical significance was found between the groups with regard to pain; however, the women from the auriculotherapy group had lower intensity and less perception of pain at 30, 60 and 120 minutes of treatment. The average duration of labour was shorter in the auriculotherapy group (248.7 versus placebo 414.8 versus control 296.3 minutes; caesarean section rates were higher in the placebo group (50% and the same in the other groups (10%. CONCLUSION Mothers who received auriculotherapy presented a tendency for greater pain control and shorter labour duration; however, caesarean section rates in this group were similar to the control group. This trial precedes a larger study in progress. Registration of Brazilian Clinical Trials: RBR-47hhbj.

  15. Reliability and validity of a simple and clinically applicable pain stimulus

    DEFF Research Database (Denmark)

    O'Neill, Søren; Graven-Nielsen, Thomas; Manniche, Claus

    2014-01-01

    and after conditioned pain modulation by cold-pressor test (CPT). Correlation to pressure pain threshold (PPT) of the infraspinatus muscle and cold-pressor test pain intensity, time to pain onset and time to non-tolerance, was examined. Test/re-test reliability of clamp pain was also assessed......Background: Generalized hyperalgesia, a widespread increased sensitivity to painful stimuli, has been demonstrated in a range of chronic pain conditions including low-back pain. The evidence suggests, that generalized hyperalgesia may be an important factor in the development of chronicity......, but it is not commonly assessed in clinical practice. Whereas a range of tools and procedures for the quantitative sensory testing of pain sensitivity is available for laboratory pain research, most experimental pain stimuli are not well suited for clinical practice. In the current study, a simple and inexpensive...

  16. The Impact of Enrollment in a Specialized Interdisciplinary Neuropathic Pain Clinic

    Directory of Open Access Journals (Sweden)

    Alex Garven

    2011-01-01

    Full Text Available BACKGROUND: Chronic pain clinics have been created because of the increasing recognition of chronic pain as a very common, debilitating condition that requires specialized care. Neuropathic pain (NeP is a multifaceted, specialized form of chronic pain that often requires input from multiple disciplines for assessment and management.

  17. Stress-related clinical pain and mood in women with chronic pain: moderating effects of depression and positive mood induction.

    Science.gov (United States)

    Davis, Mary C; Thummala, Kirti; Zautra, Alex J

    2014-08-01

    Chronic pain with comorbid depression is characterized by poor mood regulation and stress-related pain. This study aims to compare depressed and non-depressed pain patients in mood and pain stress reactivity and recovery, and test whether a post-stress positive mood induction moderates pain recovery. Women with fibromyalgia and/or osteoarthritis (N = 110) underwent interpersonal stress and were then randomly assigned by pain condition and depression status, assessed via the Center for Epidemiological Studies-Depression scale, to positive versus neutral mood induction. Depression did not predict stress-related reactivity in despondency, joviality, or clinical pain. However, depression × mood condition predicted recovery in joviality and clinical pain; depressed women recovered only in the positive mood condition, whereas non-depressed women recovered in both mood conditions. Depression does not alter pain and mood stress reactivity, but does impair recovery. Boosting post-stress jovial mood ameliorates pain recovery deficits in depressed patients, a finding relevant to chronic pain interventions.

  18. Painful shoulder? Remote clinical management of a Field Guide with shoulder pain and loss of shoulder function in Antarctica

    Directory of Open Access Journals (Sweden)

    Gareth Jones

    2017-06-01

    Full Text Available We report the case of a female Field Guide based at the British Antarctic Survey’s Rothera Science Research Station on Adelaide Island, Antarctica who independently contacted a physiotherapist specialising in climbing related injuries (GJ located in the UK. for a second opinion. The Field Guide was experiencing significant work difficulties due to shoulder pain and subsequent loss of function particularly in overhead activities. The case raises important issues about the medical management of Field Guides operating in extreme environments and remote locations

  19. Norming clinical questionnaires with multiple regression: the Pain Cognition List.

    Science.gov (United States)

    Van Breukelen, Gerard J P; Vlaeyen, Johan W S

    2005-09-01

    Questionnaires for measuring patients' feelings or beliefs are commonly used in clinical settings for diagnostic purposes, clinical decision making, or treatment evaluation. Raw scores of a patient can be evaluated by comparing them with norms based on a reference population. Using the Pain Cognition List (PCL-2003) as an example, this article shows how clinical questionnaires can be normed with multiple regression of raw scores on demographic and other patient variables. Compared with traditional norm tables for subgroups based on age or gender, this approach offers 2 advantages. First, multiple regression allows determination of which patient variables are relevant to the norming and which are not (validity). Second, by using information from the entire sample, multiple regression leads to continuous and more stable norms for any subgroup defined in terms of prognostic variables (reliability).

  20. Clinical Disorders in a Post War British Cohort Reaching Retirement: Evidence from the First National Birth Cohort Study

    Science.gov (United States)

    Pierce, Mary B.; Silverwood, Richard J.; Nitsch, Dorothea; Adams, Judith E.; Stephen, Alison M.; Nip, Wing; Macfarlane, Peter; Wong, Andrew; Richards, Marcus; Hardy, Rebecca; Kuh, Diana

    2012-01-01

    Background The medical needs of older people are growing because the proportion of the older population is increasing and disease boundaries are widening. This study describes the distribution and clustering of 15 common clinical disorders requiring medical treatment or supervision in a representative British cohort approaching retirement, and how health tracked across adulthood. Methods and Findings The data come from a cohort of 2661 men and women, 84% of the target sample, followed since birth in England, Scotland and Wales in 1946, and assessed at 60–64 years for: cardio and cerebro-vascular disease, hypertension, raised cholesterol, renal impairment, diabetes, obesity, hypothyroidism, hyperthyroidism, anaemia, respiratory disease, liver disease, psychiatric problems, cancers, atrial fibrillation on ECG and osteoporosis. We calculated the proportions disorder-free, with one or more disorders, and the level of undiagnosed disorders; and how these disorders cluster into latent classes and relate to health assessed at 36 years. Participants had, on average, two disorders (range 0–9); only 15% were disorder-free. The commonest disorders were hypertension (54.3%, 95% CI 51.8%–56.7%), obesity (31.1%, 28.8%–33.5%), raised cholesterol (25.6%, 23.1–28.26%), and diabetes or impaired fasting glucose (25.0%, 22.6–27.5%). A cluster of one in five individuals had a high probability of cardio-metabolic disorders and were twice as likely than others to have been in the poorest health at 36 years. The main limitations are that the native born sample is entirely white, and a combination of clinical assessments and self reports were used. Conclusions Most British people reaching retirement already have clinical disorders requiring medical supervision. Widening disease definitions and the move from a disease-based to a risk-based medical model will increase pressure on health services. The promotion of healthy ageing should start earlier in life and consider the

  1. The clinical implementation of pain neuroscience education: A survey study.

    Science.gov (United States)

    Louw, Adriaan; Puentedura, Emilio J; Zimney, Kory; Cox, Terry; Rico, Debbie

    2017-11-01

    Pain neuroscience education (PNE) has gained considerable attention in research. Three systematic reviews have shown increasing efficacy of PNE decreasing pain, disability, pain catastrophization, movement restrictions, and healthcare utilization. In the development of any new therapeutic approach, it is proposed that there are three stages: development, validation, and implementation. To date, the development and validation of PNE have been well-established. The third stage, implementation, however, lacks when it comes to PNE. The purpose of this study was to survey physical therapists (PT) on their experience and implementation of PNE, following a 15-hour PNE class. Upon development and validation of a PT-PNE survey, a random sample of PTs was invited to take the online survey. Two hundred and eighty-six PTs (female 56%) completed the PNE questionnaire. Ninety-one percent of PTs reported not being taught PNE in PT school. PT's are applying PNE into clinical practice to a variety of patients, experience outcomes in line with the current best-evidence, but struggle establishing which patients are ideal for PNE. The same five patient characteristics associated with success were also associated with failure, albeit in a different ranking order. This finding highlight the need to further investigate the factors associated with success and failure of PNE.

  2. DRY NEEDLING FOR MYOFASCIAL TRIGGER POINT PAIN: A CLINICAL COMMENTARY.

    Science.gov (United States)

    Unverzagt, Casey; Berglund, Kathy; Thomas, J J

    2015-06-01

    Sports and orthopaedic physical therapists have long used a multitude of techniques in order to address pain and dysfunction associated with myofascial trigger points. One technique in particular has recently received overwhelming attention: trigger point dry needling (DN). Despite its efficacy and low risk, questions remain as to its effectiveness, safety, and whether the technique is within the scope of practice of physical therapists. Therefore, the purpose of this clinical commentary is to summarize the current literature related to the associated mechanisms of action of DN, the safety of DN, as well as to discuss relevant scope of practice concerns. 5.

  3. Clinical Research Abstracts of the British Equine Veterinary Association Congress 2015.

    Science.gov (United States)

    Malton, R; Nagy, A

    2015-09-01

    Diffusion of local anaesthetic solution after a mid-pastern ring block has not been investigated. To demonstrate potential distribution of local anaesthetic solution following injection of radiodense contrast medium as performed for a mid-pastern ring block. Experimental. Twelve mature horses were used. One and a half ml radiodense contrast medium was injected over the medial or lateral palmar digital nerve at the level of the proximal aspect of the ungular cartilages. A dorsal ring block was performed on the ipsilateral side, 1.5 cm proximal to the palpable palmar aspect of the proximal eminence of the middle phalanx, using 2 or 5 ml contrast medium. Both forelimbs were injected on 2 days (48 injections). Four standard radiographic views of the pastern were obtained immediately, 10 and 20 min after injections. Images were analysed subjectively and objectively. After dorsal injections the contrast medium was distributed in a diffuse patch over the ipsilateral half of the proximal phalanx (PP), extending proximally over the half of the length of PP in all limbs (greatest proximal extension: 89.0% of the length of PP [from distal] after 2 ml, 94.2% after 5 ml). There was significant proximal diffusion in the first 10 min after injection and significant dorsal diffusion between all time points (PFetlock region pain may be influenced by a mid-pastern ring block. Ethical animal research: Written consent had been obtained from a representative of the horses' owner prior to starting the study. None. Competing interests: None declared. © 2015 The Author(s). Equine Veterinary Journal © 2015 EVJ Ltd.

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    outcome. Predictive variables collected prior to surgery included demographics, nociceptive testing (pressure pain threshold (PPT), cold pressor tolerance, electrical pain threshold and tolerance) and psychological profile (pain catastrophizing scale (PCS) and hospital anxiety and depression scale...... catastrophizing are predictive of moderate severe post-TKA pain. If validated in a larger population, the clinically applicable tests should be considered in future interventions aiming to minimize post-operative pain in high-risk patients....

  5. Metaphyseal osteopathy in a British Shorthair cat.

    Science.gov (United States)

    Adagra, Carl; Spielman, Derek; Adagra, Angela; Foster, Darren J

    2015-04-01

    Metaphyseal osteopathy, otherwise known as hypertrophic osteodystrophy, is a disease that causes pyrexia and lethargy accompanied by pain in the thoracic and pelvic limbs of rapidly growing large-breed dogs. While metaphyseal osteopathy has been descibed in association with slipped capital femoral epiphysis in cats, it has not previously been reported as a cause of limb pain and pyrexia in this species. A 7-month-old British Shorthair cat presented with a 1 month history of pyrexia, lethargy and pain in all limbs. Investigation included radiographs of the limbs and chest, abdominal ultrasound, serum biochemical analysis, haematology, bone biopsy, joint fluid aspiration and cytology. Findings were consistent with a diagnosis of metaphyseal osteopathy. The cat's clinical signs resolved following the administration of prednisolone. Symptoms recurred 1 month after the cessation of prednisolone therapy, but resolved when administration was resumed. © ISFM and AAFP 2014.

  6. A combined nurse-pharmacist managed pain clinic: joint venture of public and private sectors.

    Science.gov (United States)

    Hadi, Muhammad Abdul; Alldred, David Phillip; Briggs, Michelle; Closs, S José

    2012-02-01

    Chronic pain has become one of the most prevalent problems in primary care. The management of chronic pain is complex and often requires a multidisciplinary approach. The limited capacity of general practitioners to manage chronic pain and long waiting time for secondary care referrals further add to the complexity of chronic pain management. Restricted financial and skilled human capital make it hard for healthcare systems across the world to establish and maintain multidisciplinary pain clinics, in spite of their documented effectiveness. Affordability and accessibility to such multidisciplinary pain clinics is often problematic for patients. The purpose of this paper is to share our experience and relevant research evidence of a community based combined nurse-pharmacist managed pain clinic. The pain clinic serves as an example of public-private partnership in healthcare.

  7. Pain perception in people with Down syndrome: a synthesis of clinical and experimental research

    Science.gov (United States)

    McGuire, Brian E.; Defrin, Ruth

    2015-01-01

    People with an intellectual disability experience both acute and chronic pain with at least the same frequency as the general population. However, considerably less is known about the pain perception of people with Down syndrome. In this review paper, we evaluated the available clinical and experimental evidence. Some experimental studies of acute pain have indicated that pain threshold was higher than normal but only when using a reaction time method to measure pain sensitivity. However, when reaction time is not part of the calculation of the pain threshold, pain sensitivity in people with Down syndrome is in fact lower than normal (more sensitive to pain). Clinical studies of chronic pain have shown that people with an intellectual disability experience chronic pain and within that population, people with Down syndrome also experience chronic pain, but the precise prevalence of chronic pain in Down syndrome has yet to be established. Taken together, the literature suggests that people with Down syndrome experience pain, both acute and chronic, with at least the same frequency as the rest of the population. Furthermore, the evidence suggests that although acute pain expression appears to be delayed, once pain is registered, there appears to be a magnified pain response. We conclude by proposing an agenda for future research in this area. PMID:26283936

  8. Chronic pain disorders in HIV primary care: clinical characteristics and association with healthcare utilization.

    Science.gov (United States)

    Jiao, Jocelyn M; So, Eric; Jebakumar, Jebakaran; George, Mary Catherine; Simpson, David M; Robinson-Papp, Jessica

    2016-04-01

    Chronic pain is common in HIV, but incompletely characterized, including its underlying etiologies, its effect on healthcare utilization, and the characteristics of affected patients in the HIV primary care setting. These data are needed to design and justify appropriate clinic-based pain management services. Using a clinical data warehouse, we analyzed one year of data from 638 patients receiving standard-of-care antiretroviral therapy in a large primary care HIV clinic, located in the Harlem neighborhood of New York City. We found that 40% of patients carried one or more chronic pain diagnoses. The most common diagnoses were degenerative musculoskeletal disorders (eg, degenerative spinal disease and osteoarthritis), followed by neuropathic pain and headache disorders. Many patients (16%) had multiple chronic pain diagnoses. Women, older patients, and patients with greater burdens of medical illness, and psychiatric and substance use comorbidities were disproportionately represented among those with chronic pain diagnoses. Controlling for overall health status, HIV patients with chronic pain had greater healthcare utilization including emergency department visits and radiology procedures. In summary, our study demonstrates the high prevalence of chronic pain disorders in the primary care HIV clinic. Colocated interventions for chronic pain in this setting should not only focus on musculoskeletal pain but also account for complex multifaceted pain syndromes, and address the unique biopsychosocial features of this population. Furthermore, because chronic pain is prevalent in HIV and associated with increased healthcare utilization, developing clinic-based pain management programs could be cost-effective.

  9. Clinical Research Abstracts of the British Equine Veterinary Association Congress 2015.

    Science.gov (United States)

    Hammersley, E; Duz, M; Marshall, J F

    2015-09-01

    Triamcinolone is commonly used in equine practice for the treatment of orthopaedic conditions. A serious potential adverse effect of triamcinolone is laminitis. However, evidence for the risk of laminitis associated with triamcinolone use is limited. To determine the risk of laminitis within 90 days of triamcinolone administration and compare with the risk of laminitis in a veterinary-attended horse population. Retrospective study of clinical records. Text mining and data extraction was performed using content analysis software (SimStat-WordStat v.6) on a database of anonymous digital clinical records from a convenience sample of North American equine practices (n = 9). Medical records were retrieved using a dictionary of keywords for 3 groups of horses: 1) treated with triamcinolone, 2) age and practice matched control population (no triamcinolone) and 3) all laminitic horses. Records of horses within Groups 1 and 2 were mined for evidence of laminitis within a 90-day period of treatment or a random date respectively. Data manipulation and analysis was performed using R v3.0.0 (R Development Core Team). The prevalence of laminitis within all groups was determined and relative risk of developing laminitis determined by single logistic regression. The clinical records of 225,777 horses were examined. Overall prevalence of laminitis within the database was 1.1% (n = 2533). Triamcinolone was administered to 12.4% (n = 27,898) horses and 0.07% of treated horses (n = 20) developed laminitis. In the control population (n = 56,695), 0.2% of horses (n = 134) developed laminitis. The risk of developing laminitis was significantly lower in the triamcinolone treatment group than the control population (OR 0.3 95%CI, 0.18-0.48 PVeterinary Medicine at the University of Glasgow. Owners gave informed consent for their horses' inclusion in the study. Sources of funding: John Crawford Endowment Fund, University of Glasgow. Competing interests

  10. Treatment expectations among adolescents with chronic musculoskeletal pain and their parents before an initial pain clinic evaluation.

    Science.gov (United States)

    Guite, Jessica W; Kim, Sohee; Chen, Chia-Pei; Sherker, Jennifer L; Sherry, David D; Rose, John B; Hwang, Wei-Ting

    2014-01-01

    To understand expectations regarding treatment recommendations among treatment-seeking adolescents with chronic musculoskeletal pain and their parents. A total of 102 adolescent-parent dyads were recruited at the time of initial contact with a multidisciplinary pain management clinic. Each participant completed reports of adolescent pain intensity and disability, biopsychosocial perspective of pain, and treatment expectations related to recommendations and feedback for a vignette description of an adolescent presenting at an initial multidisciplinary pain clinic evaluation. Descriptive findings for individual treatment expectations and adolescent-parent dyad agreement statistics were examined. Slight to fair levels of agreement occurred for 50% of the expectations assessed. The strongest shared expectations were for recommendations to return to school, pursue psychological counseling, and pursue PT/OT treatment. Stronger agreement occurred for items reflecting alternative, emotional, behavioral, and activity recommendations with weaker agreement for medical interventions (eg, medication and surgery). Correlations emerged between individual expectations and adolescent pain intensity, disability, with the greatest number of significant relationships found for adolescent and parent expectations and biopsychosocial perspectives of pain. Our results document that adolescents and parents show modest levels of agreement on expectations for treatment at the time of an initial pain clinic evaluation. This may relate to expectations being internal perspectives not clearly expressed within families; thus, the initial treatment consultation may provide an important opportunity to create and align appropriate expectations. Implications of our findings are considered with respect to education, treatment, and future research to understand factors that contribute to treatment adherence and outcomes.

  11. Chronic Pain Features Relate to Quality of Life More than Physiopathology: A Cross-Sectional Evaluation in Pain Clinics.

    Science.gov (United States)

    Pérez, Concepción; Margarit, César; Sánchez-Magro, Isabel; de Antonio, Ana; Villoria, Jesús

    2017-09-01

    To compare the impact of chronic pain physiopathology on health-related quality of life (HR-QoL), considering the influence of pain features and psychosocial adjustment (intensity, interference, psychological comorbidities, and sleep quality). A cross-sectional study involving 1,025 noncancer patients with predominantly neuropathic, nociceptive, or mixed chronic pain conditions was conducted in 88 pain clinics within Spain. The EuroQol-5 Dimensions instrument (EQ-5D) was used to measure HR-QoL. The Brief Pain Inventory (BPI), Hospital Anxiety and Depression Scale (HADS), and sleep scale developed for the MOS study (MOS-SQ) were used to measure pain features and psychosocial adjustment. Multivariate analyses were used to model HR-QoL measures. All patients reported very low HR-QoL. The mean EQ-5D index scores were 0.33, 0.36, and 0.37 in the mixed, neuropathic, and nociceptive pain groups, respectively. The differences did not reach statistical significance (P = 0.057). Patients with nociceptive pain had less pain (least pain intensity score: 4.7 vs. 5.2 in the other groups; P = 0.006), less interference with daily activities (BPI average interference score: 6.3 vs. 6.6 and 6.7 in the neuropathic and mixed pain groups, respectively; P = 0.013), less anxiety (HADS score: 8.5 vs. 9.6 and 9.7 in the same respective groups; P = 0.001), and fewer sleep problems (MOS-SQ sleep problems index: 46.8 vs. 52.2 and 50.2 in the same respective groups; P = 0.005). In the adjusted analyses, HR-QoL measures were explained by pain intensity, anxiety, and sleep quality, but not by physiopathological pain type. Pain features, particularly intensity, have a greater impact than pain physiopathology on HR-QoL. Distinct physiopathological mechanisms give rise to different pain features that, in turn, may mediate the HR-QoL of patients with chronic pain. This could be used to improve pain management strategies. © 2016 World Institute of Pain.

  12. Clinical Pain Catastrophizing in Women With Migraine and Obesity.

    Science.gov (United States)

    Bond, Dale S; Buse, Dawn C; Lipton, Richard B; Thomas, J Graham; Rathier, Lucille; Roth, Julie; Pavlovic, Jelena M; Evans, E Whitney; Wing, Rena R

    2015-01-01

    Obesity is related to migraine. Maladaptive pain coping strategies (eg, pain catastrophizing) may provide insight into this relationship. In women with migraine and obesity, we cross-sectionally assessed: (1) prevalence of clinical catastrophizing; (2) characteristics of those with and without clinical catastrophizing; and (3) associations of catastrophizing with headache features. Obese women migraineurs seeking weight loss treatment (n = 105) recorded daily migraine activity for 1 month via smartphone and completed the Pain Catastrophizing Scale (PCS). Clinical catastrophizing was defined as total PCS score ≥30. The six-item Headache Impact Test (HIT-6), 12-item Allodynia Symptom Checklist (ASC-12), Headache Management Self-Efficacy Scale (HMSE), and assessments for depression (Centers for Epidemiologic Studies Depression Scale) and anxiety (seven-item Generalized Anxiety Disorder Scale) were also administered. Using PCS scores and body mass index (BMI) as predictors in linear regression, we modeled a series of headache features (ie, headache days, HIT-6, etc) as outcomes. One quarter (25.7%; 95% confidence interval [CI] = 17.2-34.1%) of participants met criteria for clinical catastrophizing: they had higher BMI (37.9 ± 7.5 vs 34.4 ± 5.7 kg/m(2) , P = .035); longer migraine attack duration (160.8 ± 145.0 vs 97.5 ± 75.2 hours/month, P = .038); higher HIT-6 scores (68.7 ± 4.6 vs 64.5 ± 3.9, P anxiety (11.0 ± 5.2 vs 5.6 ± 4.1, P < .001); and lower self-efficacy (80.1 ± 25.6 vs 104.7 ± 18.9, P < .001) compared with participants without clinical catastrophizing. The odds of chronic migraine were nearly fourfold greater in those with (n = 8/29.6%) vs without (n = 8/10.3%) clinical catastrophizing (odds ratio = 3.68; 95%CI = 1.22-11.10, P = .021). In all participants, higher PCS scores were related to more migraine days (β = 0.331, P = .001), longer attack

  13. Vitamin D Deficiency and Pain: Clinical Evidence of Low Levels of Vitamin D and Supplementation in Chronic Pain States

    OpenAIRE

    Shipton, Elspeth E.; Shipton, Edward A.

    2015-01-01

    Introduction A number of studies suggest a link between low levels of 25-hydroxy vitamin D and incidence of acute and chronic pain. Clinical studies of vitamin D supplementation in patients with known vitamin D deficiency have shown mixed results in improving pain scores. Methods In this article, vitamin D deficiency risk factors are observed and adequate levels of 25-hydroxy vitamin D defined. Clinical supplementation with vitamin D is explored, including the schedules used in published clin...

  14. The challenges of translating the clinical outcomes in Routine Evaluation-Outcome Measure (CORE-OM) into British Sign Language.

    Science.gov (United States)

    Rogers, Katherine D; Young, Alys; Lovell, Karina; Evans, Chris

    2013-01-01

    This article discusses translation issues arising during the production of a British Sign Language (BSL) version of the psychological outcome measure "Clinical Outcomes in Routine Evaluation-Outcome Measure" (CORE-OM). The process included forward translation, meeting with a team of translators, producing a second draft of the BSL version and back translating into English. Further modifications were made to the BSL version before piloting it with d/Deaf populations. Details of the translation process are addressed, including (a) the implications of translating between modalities (written text to visual language); (b) clarity of frequency anchors: analog versus digital encoding; (c) pronouns and the direction of signing; and (iv) the influence of the on-screen format. The discussion of item-specific issues encountered when producing a BSL version of the CORE-OM includes the expression of precise emotional states in a language that uses visual modifiers, problems associated with iconic signs, and the influence of Deaf world knowledge when interpreting specific statements. Finally, it addresses the extent to which lessons learned through this translation process are generalizable to other signed languages and spoken language translations of standardized instruments. Despite the challenges, a BSL version of the CORE-OM has been produced and found to be reliable.

  15. Anaesthesia-associated hypersensitivity reactions: seven years' data from a British bi-specialty clinic.

    Science.gov (United States)

    Low, A E; McEwan, J C; Karanam, S; North, J; Kong, K-L

    2016-01-01

    Our bi-specialty clinic was established to systematically investigate patients with suspected peri-operative hypersensitivity reactions. Four hundred and ten patients were studied; 316 following an intra-operative reaction ('postoperative' group) and 94 with a previous history of reaction, referred before undergoing anaesthesia ('pre-operative' group). In the postoperative group, 173 (54.7%) were diagnosed with IgE-mediated reactions: 65 (37.6%) to neuromuscular blocking drugs; 54 (31.2%) antibiotics; 15 (8.7%) chlorhexidine and 12 (6.9%) patent blue dye. Reactions were severe in 114 patients (65.9%). All reactions to patent blue dye were severe. We identified IgE sensitisation in 22 (13.2%) cases with isolated mucocutaneous reactions. Only 173 (54.7%) patients had serum tryptase samples taken. Referrers' suspected causal agent was confirmed in only 37.2% of patients. Of 94 patients reviewed 'pre-operatively', 29 (30.8%) were diagnosed with IgE-mediated hypersensitivity reactions, reinforcing the importance of investigating this group of patients. Knowledge of the range of causative agents identified in our study should guide the investigation of suspected peri-operative hypersensitivity reactions. © 2015 The Association of Anaesthetists of Great Britain and Ireland.

  16. British passports

    CERN Multimedia

    IT Department

    2008-01-01

    Please note that from 01/01/2009, the passport section of the British Consulate will move from Geneva to Paris. This change is part of a global initiative to rationalize passport services and reduce administrative costs while ensuring that the quality of the service remains high. The aim is to issue new passports within 10 working days of receiving applications (excluding transit time). From 1st January 2009 passport applications should be sent by courier or registered post directly to: British Consulate General BP111-08 75363 Paris CEDEX 08 France For further information please refer to: http://ukinswitzerland.fco.gov.uk/en/passports/passport-move/

  17. Clinical value of single versus composite provocative clinical tests in the assessment of painful shoulder.

    Science.gov (United States)

    Salaffi, Fausto; Ciapetti, Alessandro; Carotti, Marina; Gasparini, Stefania; Filippucci, Emilio; Grassi, Walter

    2010-04-01

    The aims of the present study were to investigate the clinical value of the provocative clinical tests and propose a composite index for the assessment of painful shoulder, using ultrasonography (US) as reference method. Two hundred three patients with painful shoulder underwent both clinical and US evaluations. The physical examination was carried out performing the Hawkins, Jobe, Patte, Gerber, and Speed tests. Each test was included in a composite index namely, SNAPSHOT (Simple Numeric Assessment of Pain by SHOulder Tests). The US examination was performed by a rheumatologist experienced in US and blinded to clinical findings. Sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratio of each clinical test were calculated. The receiver operating characteristic (ROC) curve analysis was used to assess the performance of the composite SNAPSHOT index. Sensitivity was low for the clinical diagnosis of all shoulder abnormalities. The highest sensitivity and smallest negative likelihood ratio were found for the Hawkins (63.88% and 0.50%) and Patte (62.21% and 0.52%) tests. Specificity was good for Speed (76.33%), Gerber (75.42%), and Patte (74.20%) tests. Patte and Speed tests were the most accurate (71.12% and 66.41%, respectively). The calculated area under the ROC curve related to the SNAPSHOT composite index was 0.881 +/- 0.026. With an optimal cut-off point of 3, the sensitivity and specificity were 75.8% and 87.5%, respectively. The results of the present study showed that SNAPSHOT is a feasible, informative and quantitative composite index for the assessment of painful shoulder in the clinical setting.

  18. Modern pain neuroscience in clinical practice: applied to post-cancer, paediatric and sports-related pain.

    Science.gov (United States)

    Malfliet, Anneleen; Leysen, Laurence; Pas, Roselien; Kuppens, Kevin; Nijs, Jo; Van Wilgen, Paul; Huysmans, Eva; Goudman, Lisa; Ickmans, Kelly

    In the last decade, evidence regarding chronic pain has developed exponentially. Numerous studies show that many chronic pain populations show specific neuroplastic changes in the peripheral and central nervous system. These changes are reflected in clinical manifestations, like a generalized hypersensitivity of the somatosensory system. Besides a hypersensitivity of bottom-up nociceptive transmission, there is also evidence for top-down facilitation of pain due to malfunctioning of the endogenous descending nociceptive modulatory systems. These and other aspects of modern pain neuroscience are starting to be applied within daily clinical practice. However, currently the application of this knowledge is mostly limited to the general adult population with musculoskeletal problems, while evidence is getting stronger that also in other chronic pain populations these neuroplastic processes may contribute to the occurrence and persistence of the pain problem. Therefore, this masterclass article aims at giving an overview of the current modern pain neuroscience knowledge and its potential application in post-cancer, paediatric and sports-related pain problems. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

  19. Caregiver placebo effect in analgesic clinical trials for cats with naturally occurring degenerative joint disease-associated pain.

    Science.gov (United States)

    Gruen, M E; Dorman, D C; Lascelles, B D X

    2017-05-13

    A literature review identified six placebo-controlled studies of analgesics in client-owned cats with degenerative joint disease-associated pain. Five studies with 96 cats had available data. Caregiver responses on a clinical metrology instrument, Client-Specific Outcome Measure (CSOM), were compared to measured activity. Cats were categorised as 'successes' or 'failures' based on change in CSOM score and activity counts from baseline. Effect sizes based on CSOM score were calculated; factors that were associated with success/failure were analysed using logistic regression. Effect sizes ranged from 0.97 to 1.93. The caregiver placebo effect was high, with 54-74 per cent of placebo-treated cats classified as CSOM successes compared with 10-63 per cent of cats classified as successes based on objectively measured activity. 36 per cent of CSOM successes were also activity successes, while 19 per cent of CSOM failures were activity successes. No significant effects of cat age, weight, baseline activity, radiographic score, orthopaedic pain score or study type on CSOM success in the placebo groups were found. The caregiver placebo effect across these clinical trials was remarkably high, making demonstration of efficacy for an analgesic above a placebo difficult. Further work is needed to determine whether a potential placebo-by-proxy effect could benefit cats in clinical settings. British Veterinary Association.

  20. Effect of Radiofrequency Denervation on Pain Intensity Among Patients With Chronic Low Back Pain: The Mint Randomized Clinical Trials.

    Science.gov (United States)

    Juch, Johan N S; Maas, Esther T; Ostelo, Raymond W J G; Groeneweg, J George; Kallewaard, Jan-Willem; Koes, Bart W; Verhagen, Arianne P; van Dongen, Johanna M; Huygen, Frank J P M; van Tulder, Maurits W

    2017-07-04

    Radiofrequency denervation is a commonly used treatment for chronic low back pain, but high-quality evidence for its effectiveness is lacking. To evaluate the effectiveness of radiofrequency denervation added to a standardized exercise program for patients with chronic low back pain. Three pragmatic multicenter, nonblinded randomized clinical trials on the effectiveness of minimal interventional treatments for participants with chronic low back pain (Mint study) were conducted in 16 multidisciplinary pain clinics in the Netherlands. Eligible participants were included between January 1, 2013, and October 24, 2014, and had chronic low back pain, a positive diagnostic block at the facet joints (facet joint trial, 251 participants), sacroiliac joints (sacroiliac joint trial, 228 participants), or a combination of facet joints, sacroiliac joints, or intervertebral disks (combination trial, 202 participants) and were unresponsive to conservative care. All participants received a 3-month standardized exercise program and psychological support if needed. Participants in the intervention group received radiofrequency denervation as well. This is usually a 1-time procedure, but the maximum number of treatments in the trial was 3. The primary outcome was pain intensity (numeric rating scale, 0-10; whereby 0 indicated no pain and 10 indicated worst pain imaginable) measured 3 months after the intervention. The prespecified minimal clinically important difference was defined as 2 points or more. Final follow-up was at 12 months, ending October 2015. Among 681 participants who were randomized (mean age, 52.2 years; 421 women [61.8%], mean baseline pain intensity, 7.1), 599 (88%) completed the 3-month follow-up, and 521 (77%) completed the 12-month follow-up. The mean difference in pain intensity between the radiofrequency denervation and control groups at 3 months was -0.18 (95% CI, -0.76 to 0.40) in the facet joint trial; -0.71 (95% CI, -1.35 to -0.06) in the sacroiliac joint

  1. Long term clinical outcome of peripheral nerve stimulation in patients with chronic peripheral neuropathic pain

    DEFF Research Database (Denmark)

    Calenbergh, F. Van; Gybels, J.; Laere, K. Van

    2009-01-01

    of the present study was to evaluate the long-term clinical efficacy of PNS in a group of patients with peripheral neuropathic pain treated with PNS since the 1980s. METHODS: Of an original series of 11 patients, 5 patients could be invited for clinical examination, detailed assessment of clinical pain and QST...

  2. Prevalence of Burnout Among Pain Medicine Physicians and Its Potential Effect upon Clinical Outcomes in Patients with Oncologic Pain or Chronic Pain of Nononcologic Origin.

    Science.gov (United States)

    Riquelme, Irene; Chacón, José-Ignacio; Gándara, Alba-Violeta; Muro, Inmaculada; Traseira, Susana; Monsalve, Vicente; Soriano, José-Francisco

    2018-01-19

    To evaluate the prevalence of burnout among physicians treating patients with chronic pain and to assess the potential relationships between the presence of burnout and patients' clinical outcomes such as pain relief, satisfaction with pain control, and quality of life. An observational, prospective, and noncomparative study. Pain medicine clinics. Physicians from medical departments involved in the management of chronic pain. Patients aged ≥18 years who exhibited moderate chronic pain lasting at least three months. Physicians were evaluated with the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Patients were evaluated with the Charlson Comorbidity Index, the Brief Pain Inventory-Short Form (BPI-SF), the EuroQol-5D (EQ-5D), and ad hoc instruments for evaluating satisfaction with pain control, the extent to which the treatment met patients' expectations, and subjective impressions of improvement. Of the 301 physician participants, 22 (7.3%, 95% confidence interval [CI] = 4.9 to 10.8) met the criteria of burnout. Burnout was higher among physicians from pain units, while none of the 35 primary care physicians reported burnout. The presence of burnout was positively associated with patients' pain relief (odds ratio [OR] = 1.423, 95% CI = 1.090 to 1.858) but not with satisfaction with pain control or quality of life. Of the remaining independent variables, being treated by pain unit physicians was significantly associated with worse pain relief (OR = 0.592, 95% CI = 0.507 to 0.691), lower satisfaction (β = -0.680, 95% CI = -0.834 to -0.525), and worse quality of life (β = -4.047, 95% CI = -5.509 to -2.585) compared with being treated by physicians from other specialties (e.g., traumatologists, oncologists, etc.). Our study shows a lack of negative or clinically relevant (as shown by the negligible to small effect sizes) impact of burnout on patient-reported outcomes (namely, pain relief, satisfaction, and quality of life) in patients with

  3. British Columbia

    Science.gov (United States)

    Walton, Gerald

    2006-01-01

    The province of British Columbia has a dubious history where support for lesbian, gay, bisexual, and transgendered (LGBT) issues in education is concerned. Most notable is the Surrey School Board's decision in 1997 to ban three picture books for children that depict families with two moms or two dads. The North Vancouver School Board has also…

  4. Research design considerations for chronic pain prevention clinical trials: IMMPACT recommendations

    Science.gov (United States)

    Gewandter, Jennifer S.; Dworkin, Robert H.; Turk, Dennis C.; Farrar, John T.; Fillingim, Roger B.; Gilron, Ian; Markman, John D.; Oaklander, Anne Louise; Polydefkis, Michael J.; Raja, Srinivasa N.; Robinson, James P.; Woolf, Clifford J.; Ziegler, Dan; Ashburn, Michael A.; Burke, Laurie B.; Cowan, Penney; George, Steven Z.; Goli, Veeraindar; Graff, Ole X.; Iyengar, Smriti; Jay, Gary W.; Katz, Joel; Kehlet, Henrik; Kitt, Rachel A.; Kopecky, Ernest A.; Malamut, Richard; McDermott, Michael P.; Palmer, Pamela; Rappaport, Bob A.; Rauschkolb, Christine; Steigerwald, Ilona; Tobias, Jeffrey; Walco, Gary A.

    2018-01-01

    Although certain risk factors can identify individuals who are most likely to develop chronic pain, few interventions to prevent chronic pain have been identified. To facilitate the identification of preventive interventions, an IMMPACT meeting was convened to discuss research design considerations for clinical trials investigating the prevention of chronic pain. We present general design considerations for prevention trials in populations that are at relatively high risk for developing chronic pain. Specific design considerations included subject identification, timing and duration of treatment, outcomes, timing of assessment, and adjusting for risk factors in the analyses. We provide a detailed examination of 4 models of chronic pain prevention (i.e., chronic post-surgical pain, postherpetic neuralgia, chronic low back pain, and painful chemotherapy-induced peripheral neuropathy). The issues discussed can, in many instances, be extrapolated to other chronic pain conditions. These examples were selected because they are representative models of primary and secondary prevention, reflect persistent pain resulting from multiple insults (i.e., surgery, viral infection, injury, and toxic/noxious element exposure), and are chronically painful conditions that are treated with a range of interventions. Improvements in the design of chronic pain prevention trials could improve assay sensitivity and thus accelerate the identification of efficacious interventions. Such interventions would have the potential to reduce the prevalence of chronic pain in the population. Additionally, standardization of outcomes in prevention clinical trials will facilitate meta-analyses and systematic reviews and improve detection of preventive strategies emerging from clinical trials. PMID:25887465

  5. Research design considerations for chronic pain prevention clinical trials: IMMPACT recommendations.

    Science.gov (United States)

    Gewandter, Jennifer S; Dworkin, Robert H; Turk, Dennis C; Farrar, John T; Fillingim, Roger B; Gilron, Ian; Markman, John D; Oaklander, Anne Louise; Polydefkis, Michael J; Raja, Srinivasa N; Robinson, James P; Woolf, Clifford J; Ziegler, Dan; Ashburn, Michael A; Burke, Laurie B; Cowan, Penney; George, Steven Z; Goli, Veeraindar; Graff, Ole X; Iyengar, Smriti; Jay, Gary W; Katz, Joel; Kehlet, Henrik; Kitt, Rachel A; Kopecky, Ernest A; Malamut, Richard; McDermott, Michael P; Palmer, Pamela; Rappaport, Bob A; Rauschkolb, Christine; Steigerwald, Ilona; Tobias, Jeffrey; Walco, Gary A

    2015-07-01

    Although certain risk factors can identify individuals who are most likely to develop chronic pain, few interventions to prevent chronic pain have been identified. To facilitate the identification of preventive interventions, an IMMPACT meeting was convened to discuss research design considerations for clinical trials investigating the prevention of chronic pain. We present general design considerations for prevention trials in populations that are at relatively high risk for developing chronic pain. Specific design considerations included subject identification, timing and duration of treatment, outcomes, timing of assessment, and adjusting for risk factors in the analyses. We provide a detailed examination of 4 models of chronic pain prevention (ie, chronic postsurgical pain, postherpetic neuralgia, chronic low back pain, and painful chemotherapy-induced peripheral neuropathy). The issues discussed can, in many instances, be extrapolated to other chronic pain conditions. These examples were selected because they are representative models of primary and secondary prevention, reflect persistent pain resulting from multiple insults (ie, surgery, viral infection, injury, and toxic or noxious element exposure), and are chronically painful conditions that are treated with a range of interventions. Improvements in the design of chronic pain prevention trials could improve assay sensitivity and thus accelerate the identification of efficacious interventions. Such interventions would have the potential to reduce the prevalence of chronic pain in the population. Additionally, standardization of outcomes in prevention clinical trials will facilitate meta-analyses and systematic reviews and improve detection of preventive strategies emerging from clinical trials.

  6. Effects of auriculotherapy on labour pain: a randomized clinical trial.

    Science.gov (United States)

    Mafetoni, Reginaldo Roque; Shimo, Antonieta Keiko Kakuda

    2016-01-01

    Assessing the effects of auriculotherapy in pain control and its outcomes on the duration of labour. This is a randomized, controlled, double-blind trial with preliminary data. Thirty pregnant women with gestational age ≥ 37 weeks, cervical dilatation ≥ 4 cm and two or more contractions in 10 minutes were selected and randomly divided into three groups: auriculotherapy, placebo and control. Auriculotherapy was applied using crystal beads on four strategic points. No statistical significance was found between the groups with regard to pain; however, the women from the auriculotherapy group had lower intensity and less perception of pain at 30, 60 and 120 minutes of treatment. The average duration of labour was shorter in the auriculotherapy group (248.7 versus placebo 414.8 versus control 296.3 minutes); caesarean section rates were higher in the placebo group (50%) and the same in the other groups (10%). Mothers who received auriculotherapy presented a tendency for greater pain control and shorter labour duration; however, caesarean section rates in this group were similar to the control group. This trial precedes a larger study in progress. Registration of Brazilian Clinical Trials: RBR-47hhbj. Avaliar os efeitos da auriculoterapia no controle da dor e seus desfechos na duração do trabalho de parto. Trata-se de um ensaio controlado, randomizado e duplo-cego, com dados preliminares. Foram selecionadas 30 parturientes com idade gestacional ≥ 37 semanas, dilatação cervical ≥ 4 cm e duas ou mais contrações em 10 minutos, divididas aleatoriamente em três grupos: auriculoterapia, placebo ou controle. A auriculoterapia foi aplicada com microesferas de cristais em quatro pontos estratégicos. Não houve significância estatística entre os grupos com relação à dor; no entanto, as mulheres do grupo de auriculoterapia, apresentaram menor intensidade e menor percepção da dor aos 30, 60 e 120 minutos do tratamento. A média de duração do trabalho de

  7. [Clinical management of low back pain in primary health care].

    Science.gov (United States)

    Lie, H

    1999-06-10

    Diagnostic differentiation seems crucial in the treatment of patients with low back pain. We must try to distinguish between pain originating from the moving segments or the soft tissue in the columna, and differentiate between radicular pain and referred pain to the leg. Principles of treatment for the acute and recurrent low back pain attacks are dealt with, as well as the treatment of patients with acute chronic sciatica and spinal stenosis. The special problems concerning treatment of degenerative disc disease and patients with back pain caused by psychosocial problems are further discussed.

  8. Hormones in pain modulation and their clinical implications for pain control: a critical review.

    Science.gov (United States)

    Chen, Xueyin; Zhang, Jinyuan; Wang, Xiangrui

    2016-07-01

    Recently, more and more studies have found that pain generation, transmission and modulation are under hormonal regulation. Indeed, hormonal dysregulation is a common component of chronic pain syndromes. Studies have attempted to determine whether the relationship between the pain and its perception and hormones is a causative relationship and how these processes interrelate. This review summarizes and analyzes the current experimental data and provides an overview of the studies addressing these questions. The relationship between pain perception and endocrine effects suggests that hormones can be used as important biomarkers of chronic pain syndromes and/or be developed into therapeutic agents in the fight against pain.

  9. Capsaicin: Current Understanding of Its Mechanisms and Therapy of Pain and Other Pre-Clinical and Clinical Uses

    Directory of Open Access Journals (Sweden)

    Victor Fattori

    2016-06-01

    Full Text Available In this review, we discuss the importance of capsaicin to the current understanding of neuronal modulation of pain and explore the mechanisms of capsaicin-induced pain. We will focus on the analgesic effects of capsaicin and its clinical applicability in treating pain. Furthermore, we will draw attention to the rationale for other clinical therapeutic uses and implications of capsaicin in diseases such as obesity, diabetes, cardiovascular conditions, cancer, airway diseases, itch, gastric, and urological disorders.

  10. Promoting culturally competent chronic pain management using the clinically relevant continuum model.

    Science.gov (United States)

    Monsivais, Diane B

    2011-06-01

    This article reviews the culture of biomedicine and current practices in pain management education, which often merge to create a hostile environment for effective chronic pain care. Areas of cultural tensions in chronic pain frequently involve the struggle to achieve credibility regarding one's complaints of pain (or being believed that the pain is real) and complying with pain medication protocols. The clinically relevant continuum model is presented as a framework allowing providers to approach care from an evidence-based, culturally appropriate (patient centered) perspective that takes into account the highest level of evidence available, provider expertise, and patient preferences and values. Copyright © 2011 Elsevier Inc. All rights reserved.

  11. Neuropathic pain. Redefinition and a grading system for clinical and research purposes

    DEFF Research Database (Denmark)

    Treede, R.-D.; Jensen, Troels Staehelin; Campbell, J.N.

    2008-01-01

    potentially tissue-damaging stimuli. Pain may also arise by activity generated within the nervous system without adequate stimulation of its peripheral sensory endings. For this type of pain, the International Association for the Study of Pain introduced the term neuropathic pain, defined as "pai...... evidence from a neurologic examination. This grading system is proposed for clinical and research purposes....... activation (e.g., by central sensitization), it has been difficult to distinguish neuropathic dysfunction from physiologic neuroplasticity. We present a more precise definition developed by a group of experts from the neurologic and pain community: pain arising as a direct consequence of a lesion or disease...... affecting the somatosensory system. This revised definition fits into the nosology of neurologic disorders. The reference to the somatosensory system was derived from a wide range of neuropathic pain conditions ranging from painful neuropathy to central poststroke pain. Because of the lack of a specific...

  12. Shoulder pain in primary care: diagnostic accuracy of clinical examination tests for non-traumatic acromioclavicular joint pain.

    Science.gov (United States)

    Cadogan, Angela; McNair, Peter; Laslett, Mark; Hing, Wayne

    2013-05-01

    Despite numerous methodological flaws in previous study designs and the lack of validation in primary care populations, clinical tests for identifying acromioclavicular joint (ACJ) pain are widely utilised without concern for such issues. The aim of this study was to estimate the diagnostic accuracy of traditional ACJ tests and to compare their accuracy with other clinical examination features for identifying a predominant ACJ pain source in a primary care cohort. Consecutive patients with shoulder pain were recruited prospectively from primary health care clinics. Following a standardised clinical examination and diagnostic injection into the subacromial bursa, all participants received a fluoroscopically guided diagnostic block of 1% lidocaine hydrochloride (XylocaineTM) into the ACJ. Diagnostic accuracy statistics including sensitivity, specificity, predictive values, positive and negative likelihood ratios (LR+ and LR-) were calculated for traditional ACJ tests (Active Compression/O'Brien's test, cross-body adduction, localised ACJ tenderness and Hawkins-Kennedy test), and for individual and combinations of clinical examination variables that were associated with a positive anaesthetic response (PAR) (P≤0.05) defined as 80% or more reduction in post-injection pain intensity during provocative clinical tests. Twenty two of 153 participants (14%) reported an 80% PAR. None of the traditional ACJ tests were associated with an 80% PAR (P0.05). Five clinical examination variables (repetitive mechanism of pain onset, no referred pain below the elbow, thickened or swollen ACJ, no symptom provocation during passive glenohumeral abduction and external rotation) were associated with an 80% PAR (Ppain of non-traumatic onset, traditional ACJ tests were of limited diagnostic value. Combinations of other history and physical examination findings were able to more accurately identify injection-confirmed ACJ pain in this cohort.

  13. Effectiveness of a community based nurse-pharmacist managed pain clinic: A mixed-methods study.

    OpenAIRE

    Hadi, MA; Alldred, DP; Briggs, M; Marczewski, K; Closs, SJ

    2016-01-01

    BACKGROUND: Chronic pain is predominantly managed in primary care, although often ineffectively. There is growing evidence to support the potential role of nurses and pharmacists in the effective management of chronic pain. OBJECTIVES: To evaluate the effectiveness of a pain clinic jointly managed by a nurse and pharmacist. DESIGN: A mixed-methods design consisting of qualitative interviews embedded within a quasi-experimental study. SETTINGS: A community-based nurse-pharmacist led pain clini...

  14. Low back pain among patients attending rheumatology clinic in the ...

    African Journals Online (AJOL)

    Background: Back pain is among the common musculoskeletal complaints for patients seeking medical care. Back pain encompasses a spectrum of conditions, those with acute and short duration, to life-long disorders. Generally, causes of back pain include osteoarthritis (spondylosis), disc degeneration, osteoporotic ...

  15. Neuromuscular adaptations predict functional disability independently of clinical pain and psychological factors in patients with chronic non-specific low back pain.

    Science.gov (United States)

    Dubois, Jean-Daniel; Abboud, Jacques; St-Pierre, Charles; Piché, Mathieu; Descarreaux, Martin

    2014-08-01

    Patients with chronic low back pain exhibit characteristics such as clinical pain, psychological symptoms and neuromuscular adaptations. The purpose of this study was to determine the independent contribution of clinical pain, psychological factors and neuromuscular adaptations to disability in patients with chronic low back pain. Clinical pain intensity, pain catastrophizing, fear-avoidance beliefs, anxiety, neuromuscular adaptations to chronic pain and neuromuscular responses to experimental pain were assessed in 52 patients with chronic low back pain. Lumbar muscle electromyographic activity was assessed during a flexion-extension task (flexion relaxation phenomenon) to assess both chronic neuromuscular adaptations and neuromuscular responses to experimental pain during the task. Multiple regressions showed that independent predictors of disability included neuromuscular adaptations to chronic pain (β=0.25, p=0.006, sr(2)=0.06), neuromuscular responses to experimental pain (β=-0.24, p=0.011, sr(2)=0.05), clinical pain intensity (β=0.28, p=0.002, sr(2)=0.08) and psychological factors (β=0.58, ppain intensity and psychological factors, and contribute to inter-individual differences in patients' disability. This suggests that disability, in chronic low back pain patients, is determined by a combination of factors, including clinical pain, psychological factors and neuromuscular adaptations. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. Regulation of peripheral blood flow in Complex Regional Pain Syndrome: clinical implication for symptomatic relief and pain management

    Directory of Open Access Journals (Sweden)

    Coderre Terence J

    2009-09-01

    Full Text Available Abstract Background During the chronic stage of Complex Regional Pain Syndrome (CRPS, impaired microcirculation is related to increased vasoconstriction, tissue hypoxia, and metabolic tissue acidosis in the affected limb. Several mechanisms may be responsible for the ischemia and pain in chronic cold CPRS. Discussion The diminished blood flow may be caused by either sympathetic dysfunction, hypersensitivity to circulating catecholamines, or endothelial dysfunction. The pain may be of neuropathic, inflammatory, nociceptive, or functional nature, or of mixed origin. Summary The origin of the pain should be the basis of the symptomatic therapy. Since the difference in temperature between both hands fluctuates over time in cold CRPS, when in doubt, the clinician should prioritize the patient's report of a persistent cold extremity over clinical tests that show no difference. Future research should focus on developing easily applied methods for clinical use to differentiate between central and peripheral blood flow regulation disorders in individual patients.

  17. [A comparative study of immune and clinical indicators in radicular and myofascial back pain].

    Science.gov (United States)

    Levashova, A I; Morozova, V S; Petrochenko, S N; Myagkova, М А; Moseikin, I A

    To compare immunochemical and clinical parameters in patients with chronic radicular and myofascial back pain. A study included 92 patients (55 men and 37 women) with radicular pain syndrome and 97 patients (33 men and 64 women) with myofascial pain syndrome. Pain status was assessed with the differential visual analogous scale (at rest, on movement, at night and during spontaneous pain). Tensor algometry was used to measure pain intolerance thresholds at day and night. Levels of natural antibodies (nAB) to endogenous pain regulators (β-endorphin, orphanin, serotonin, dopamine, histamine and angiotensin) were determined in the blood serum by ELISA. Patients were examined at admission to the hospital, on 10th and 21st days of treatment. There was a significant decrease in pain syndrome in all patients to the 21st day. Pain intensity was higher in patients with radicular pain syndrome (рPain intolerance thresholds were initially reduced in both groups. No significant between-group differences in the dynamics were not found either in men or women. Women had lower pain intolerance thresholds compared to men. An analysis of nAB profiles to pain regulators showed that they were correlated with higher and high indices, with the predominance of nAB to β-endorphin, orphanin and histamine in both groups. The increased levels of antibodies circulate in the blood serum of patients with dorsalgia for a long time can further be a factor of pain chronification.

  18. Shoulder pain in primary care--part 2: predictors of clinical outcome to 12 months.

    Science.gov (United States)

    Laslett, Mark; Steele, Michael; Hing, Wayne; McNair, Peter; Cadogan, Angela

    2015-01-01

    Identify predictor variables and models for clinical outcomes for primary care shoulder pain patients to 12 months follow-up. A non-randomized audit with measures of pain and disability at 3 weeks, 3, 6 and 12 months. Of 208 patients, 161 agreed to participate with 96.9, 98.1, 87.0 and 83.9% follow-up at 3 weeks, 3, 6 and 12 months respectively. Treatment consisted of exercise and manual therapy-based physiotherapy and corticosteroid injection under specified selection criteria. Potentially useful baseline variables were evaluated in univariate logistic regressions with the dependent variables determined by SPADI Questionnaire at 3 weeks, 3, 6 and 12 months. Variables associated (p-value ≤ 0.2) were retained for potential inclusion within multiple logistic regression analyses. Pain not improved by rest, intermittent pain, lower pain intensity with physical tests and absence of subacromial bursa pathology on ultrasound at the 3-week follow-up, constant pain and lower pain intensity with physical tests are predictors of excellent outcomes at the 3-month follow- up. Worse baseline pain and disability, no history of asthma, pain better with rest, better physical functioning, greater fear avoidance, male gender, no history of pain in the opposite shoulder, pain referred below the elbow, sleep disturbed by pain, smaller waist circumference, lower pain intensity with physical tests are factors predictive of excellent outcomes at the 12-month follow-up. Only higher pain intensity with physical tests was associated with a poor clinical outcome. Predictive models for clinical outcomes in primary-care patients with shoulder pain were achieved for excellent clinical outcomes, successfully classifying 70-90% of cases.

  19. Tapentadol Prolonged Release for Chronic Pain: A Review of Clinical Trials and 5 Years of Routine Clinical Practice Data.

    Science.gov (United States)

    Baron, Ralf; Eberhart, Leopold; Kern, Kai-Uwe; Regner, Stefan; Rolke, Roman; Simanski, Christian; Tölle, Thomas

    2017-06-01

    Tapentadol prolonged release (PR) for the treatment of moderate to severe chronic pain combines 2 modes of action. These are μ-opioid receptor agonism and noradrenaline reuptake inhibition in a single molecule that allow higher analgesic potency through modulation of different pharmacological targets within the pain transmitting systems. At the same time, this can also serve as a clue for modulation of different pain-generating mechanisms according to nociceptive, neuropathic, or mixed pain conditions. Tapentadol PR has now been on the market for 5 years, with over 4.6 million people treated worldwide. A panel of pain specialists convened in Germany to review the clinical program and to discuss the role of tapentadol PR in the management of chronic pain. The clinical study program demonstrated effective and generally well-tolerated treatment for up to 2 years in a broad range of chronic pain conditions, including those with neuropathic pain components. This was confirmed in routine clinical practice observations. Head-to-head studies with World Health Organization (WHO) III opioids such as oxycodone controlled release and oxycodone/naloxone PR showed at least comparable pain relief in the treatment of moderate-to-severe musculoskeletal pain. Rotation from poorly tolerated WHO III opioids to tapentadol PR provided effective pain relief and better symptom control for musculoskeletal pain compared to previous medication. Functionality, health status and quality of life also improved under tapentadol PR treatment. The gastrointestinal tolerability profile was more favorable compared to other tested WHO III opioids. Tapentadol PR has a good safety profile and no evidence of acquired tolerance from the long-term data so far collected. Overall, tapentadol PR represents an effective and generally well-tolerated alternative to "classical" opioidergic drugs. © 2016 The Authors. Pain Practice published by Wiley Periodicals, Inc. on behalf of World Institute of Pain.

  20. Low back pain as seen in orthopedic clinics of a Nigerian Teaching ...

    African Journals Online (AJOL)

    Objective: We aimed to determine the etiology and pattern of presentation of low back pain among patients seen in our orthopedic outpatient clinics. Materials and Methods: This was a retrospective review of database of all new patients with low back pain seen at the orthopedics clinics of Federal Teaching Hospital, ...

  1. Pain detection by clinical questionnaire in patients referred for temporomandibular disorders in a Chilean hospital.

    Directory of Open Access Journals (Sweden)

    Tomás Maturana

    2015-10-01

    Full Text Available Aim: To determine pain frequency by means of a clinical screening questionnaire in patients with temporomandibular disorders (TMD referred to the general Hospital of Valdivia (HBV between September and December 2014. Material and method: A descriptive study, which included patients referred to the TMD Unit of the dental service at HBV between September and December 2014, was carried out. A clinical screening questionnaire was applied by an examiner in order to detect painful Temporomandibular Joint Disorders. The variables age, sex, wait time, and presence of related TMD pain were measured. Results: 101 patients were surveyed; 88.17% (84 patients were women. Average age was 33.5 (11-70 years; 66% of patients had mandibular pain or stiffness upon awakening; 80% informed pain related to painful TMD. Conclusion: Most surveyed patients were women. Pain was highly frequent in the surveyed population; its main location was in temporal areas.

  2. Evidence-based clinical practice guidelines for interventional pain management in cancer pain

    Directory of Open Access Journals (Sweden)

    Sushma Bhatnagar

    2015-01-01

    Full Text Available Intractable cancer pain not amenable to standard oral or parenteral analgesics is a horrifying truth in 10-15% of patients. Interventional pain management techniques are an indispensable arsenal in pain physician′s armamentarium for severe, intractable pain and can be broadly classified into neuroablative and neuromodulation techniques. An array of neurolytic techniques (chemical, thermal, or surgical can be employed for ablation of individual nerve fibers, plexuses, or intrathecalneurolysis in patients with resistant pain and short life-expectancy. Neuraxial administration of drugs and spinal cord stimulation to modulate or alter the pain perception constitutes the most frequently employed neuromodulation techniques. Lately, there is a rising call for early introduction of interventional techniques in carefully selected patients simultaneously or even before starting strong opioids. After decades of empirical use, it is the need of the hour to head towards professionalism and standardization in order to secure credibility of specialization and those practicing it. Even though the interventional management has found a definite place in cancer pain, there is a dearth of evidence-based practice guidelines for interventional therapies in cancer pain. This may be because of paucity of good quality randomized controlled trials (RCTs evaluating their safety and efficacy in cancer pain. Laying standardized guidelines based on existing and emerging evidence will act as a foundation step towards strengthening, credentialing, and dissemination of the specialty of interventional cancer pain management. This will also ensure an improved decision-making and quality of life (QoL of the suffering patients.

  3. Psychological and physical pain as predictors of suicide risk: evidence from clinical and neuroimaging findings.

    Science.gov (United States)

    Rizvi, Sakina J; Iskric, Adam; Calati, Raffaella; Courtet, Philippe

    2017-03-01

    Suicide is a multidimensional clinical phenomenon with complex biological, social and psychological risk factors. Therefore, it is imperative for studies to focus on developing a unified understanding of suicide risk that integrates current clinical and neurobiological findings. A recent line of research has implicated different classifications of pain in understanding suicide risk, including the concepts of psychache and pain tolerance. Although psychache is defined as the experience of unbearable psychological pain, pain tolerance refers to the greatest duration or intensity of painful stimuli that one is able to bear. This review will focus on integrating current clinical and neurobiological findings by which psychache and pain tolerance confer suicide risk. Results indicate that psychache has been identified as a significant risk factor for suicide and that psychache may be associated with the neurocircuitry involved in the modulation of physical pain. Converging evidence has also been found linking pain tolerance to self-injurious behaviours and suicide risk. The experience of psychache and physical pain in relation to other predictors of suicide, including reward processing, hopelessness and depression, are further discussed. Future research examining the pain-suicide connection is required to understand the mechanism behind clinically relevant risk factors for suicide, which can ultimately inform the construction of empirically supported suicide risk assessment and intervention techniques.

  4. Association of clinical findings of temporomandibular disorders (TMD) with self-reported musculoskeletal pains.

    Science.gov (United States)

    Sipilä, Kirsi; Suominen, Anna Liisa; Alanen, Pentti; Heliövaara, Markku; Tiittanen, Pekka; Könönen, Mauno

    2011-11-01

    Temporomandibular disorders (TMD) can be related to self-reported musculoskeletal pains. The aim of the study was to investigate the association of clinical findings of TMD with self-reported pain in other parts of the body, and to discriminate pain clusters according to definite profiles of pain conditions including TMD among subjects in general population. A nationally representative Health 2000 Survey was carried out in 2000-2001 in Finland. The data were obtained from 6227 subjects aged ⩾30years. Information about pain in different parts of the body was collected from a questionnaire. The associations between clinically assessed TMD findings and pain in other areas were analyzed using chi-square test and logistic regression analyses. Latent class analysis (LCA) was used to form natural clusters, i.e., groups in which the individuals had similar profiles of pain conditions. Masticatory muscle pain on palpation associated with back, neck and shoulder pain and pain in joints. Temporomandibular joint (TMJ) pain on palpation associated with back, neck, shoulder and other joint pain. These associations did not change essentially after adjustment for confounders. After clustering of the study population with the LCA, 5.8% of the study population showed a multiple pain condition linked with TMD findings. Female gender, intermediate/poor self-reported health and presence of a longstanding illness increased the probability to belong to this cluster. TMD findings associate with pain in several locations. Female gender and presence of impaired health were particularly related to occurrence of multiple pain conditions. Copyright © 2011 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.

  5. University of Victoria Genome British Columbia Proteomics Centre Partners with CPTAC | Office of Cancer Clinical Proteomics Research

    Science.gov (United States)

    University of Victoria Genome British Columbia Proteomics Centre, a leader in proteomic technology development, has partnered with the U.S. National Cancer Institute (NCI) to make targeted proteomic assays accessible to the community through NCI’s CPTAC Assay Portal (https://assays.cancer.gov).

  6. Hypnotherapy of a pain disorder: a clinical case study.

    Science.gov (United States)

    Artimon, Henrieta Mihaela

    2015-01-01

    Hypnotherapy's effectiveness in improving and controlling chronic pain of various etiologies has been demonstrated by studies; the mechanism by which hypnosis does this is more complex than a simple induction of muscle relaxation. This study reveals, in addition to this mechanism, a deeper dimension of hypnotherapy from the vantage of a patient with a medical-surgical background, diagnosed with a pain disorder and major severe depressive disorder in addition to incurable painful symptoms, through treatment associated with hypnoanalysis. Following psychotherapy, which included some elements of cognitive-behavioral therapy, a complete remission of the anxious-depressive mood and the painful symptoms was achieved.

  7. Pain

    Science.gov (United States)

    ... Grant Funding for Pain Initiatives Current Funding Opportunities Research on the Impact of Creative Arts in Military Populations More Health Professional Information Earn CME More Related Topics Chronic Pain ( NINDS ) NIH Pain Seminar Series Pain: You Can Get Help ( NIA ) NIH ...

  8. [The effectiveness of therapeutic touch on pain, depression and sleep in patients with chronic pain: clinical trial].

    Science.gov (United States)

    Marta, Ilda Estefani Ribeiro; Baldan, Sueli Santiago; Berton, Ani Fabiana; Pavam, Michele; da Silva, Maria Júlia Paes

    2010-12-01

    This research aimed to check the effectiveness of Therapeutic Touch on decreased pain intensity, depression self-assessment scores and improved sleep quality. A clinical before-after trial is presented. The study was carried out at a Basic Health Unit in Fernandópolis, SP-Brazil, involving 30 elderly patients with chronic non-oncologic pain who received 8 sessions of Therapeutic Touch in accordance with the Krieger-Kunz method. The Visual Analogue Scale for pain was applied before and after each session, and Beck Depression Inventory and the Pittsburgh Sleep Quality Index before the first and after the last session. Data analysis showed a significant decrease (p Touch was effective to decrease pain intensity and depressive attitudes and symptoms, as well as to improve sleep quality.

  9. Pain relief that matters to patients: systematic review of empirical studies assessing the minimum clinically important difference in acute pain.

    Science.gov (United States)

    Olsen, Mette Frahm; Bjerre, Eik; Hansen, Maria Damkjær; Hilden, Jørgen; Landler, Nino Emanuel; Tendal, Britta; Hróbjartsson, Asbjørn

    2017-02-20

    The minimum clinically important difference (MCID) is used to interpret the clinical relevance of results reported by trials and meta-analyses as well as to plan sample sizes in new studies. However, there is a lack of consensus about the size of MCID in acute pain, which is a core symptom affecting patients across many clinical conditions. We identified and systematically reviewed empirical studies of MCID in acute pain. We searched PubMed, EMBASE and Cochrane Library, and included prospective studies determining MCID using a patient-reported anchor and a one-dimensional pain scale (e.g. 100 mm visual analogue scale). We summarised results and explored reasons for heterogeneity applying meta-regression, subgroup analyses and individual patient data meta-analyses. We included 37 studies (8479 patients). Thirty-five studies used a mean change approach, i.e. MCID was assessed as the mean difference in pain score among patients who reported a minimum degree of improvement, while seven studies used a threshold approach, i.e. MCID was assessed as the threshold in pain reduction associated with the best accuracy (sensitivity and specificity) for identifying improved patients. Meta-analyses found considerable heterogeneity between studies (absolute MCID: I2 = 93%, relative MCID: I2 = 75%) and results were therefore presented qualitatively, while analyses focused on exploring reasons for heterogeneity. The reported absolute MCID values ranged widely from 8 to 40 mm (standardised to a 100 mm scale) and the relative MCID values from 13% to 85%. From analyses of individual patient data (seven studies, 918 patients), we found baseline pain strongly associated with absolute, but not relative, MCID as patients with higher baseline pain needed larger pain reduction to perceive relief. Subgroup analyses showed that the definition of improved patients (one or several categories improvement or meaningful change) and the design of studies (single or multiple measurements

  10. A qualitative study: Clinical decision making in low back pain.

    Science.gov (United States)

    Davies, Claire; Howell, Dana

    2012-02-01

    Classification systems are available to subgroup patients with acute/nonspecific low back pain (LBP) to determine interventions. The use of classification systems by physical therapists (PT) has little published evidence. The aims of this study were to understand the process PTs use when assessing and determining interventions for patients with acute/nonspecific LBP in outpatient settings and what classification systems, if any, are used in clinical practice. Qualitative methods were used to investigate the decision-making process PTs use when managing patients with LBP. Semi-structured interviews focused on the decision-making process of examination and intervention selection for patients with LBP. Findings were verified through member checking, triangulation, and audit trail. Thirteen PTs were included in the study. Four decision-making preferences emerged from the data: (1) identifying the root cause, (2) eclectic approach, (3) experience-based management, and (4) evidence-based management. Experience, education, and other aspects of the PTs' backgrounds influenced their preferred decision-making style, and use of resources, such as classification systems, varied broadly.

  11. The efficacy of thermotherapy and cryotherapy on pain relief in patients with acute low back pain, a clinical trial study.

    Science.gov (United States)

    Dehghan, Morteza; Farahbod, Farinaz

    2014-09-01

    Acute low back pain is one of the most common health problems especially in industrialized countries where 75 per cent of the population develop it at least once during their life. This study examined the efficacy of thermotherapy and cryotherapy, alongside a routine pharmacologic treatment, on pain relief in patients with acute low back pain referring an orthopedic clinic in Shahrekord, Iran. This clinical trial study was conducted on 87 patients randomly assigned to three (thermotherapy and cryotherapy as intervention, and naproxen as control) groups of 29 each. The first (thermotherapy) group underwent treatment with hot water bag and naproxen, the second (cryotherapy) group was treated with ice and naproxen, and the naproxen group was only treated with naproxen, all for one week. All patients were examined on 0, 3(rd), 8(th), and 15(th) day after the first visit and the data gathered by McGill Pain Questionnaire. The data were analyzed by SPSS software using paired t-test, ANOVA, and chi-square. In this study, mean age of the patients was 34.48 (20-50) years and 51.72 per cent were female. Thermotherapy patients reported significantly less pain compared to cryotherapy and control (p≤0.05). In thermotherapy and cryotherapy groups, mean pain in the first visit was 12.70±3.7 and 12.06±2.6, and on the 15(th) day after intervention 0.75±0.37 and 2.20±2.12, respectively. The results indicated that the application of thermo-therapy and cryotherapy accompanied with a pharmacologic treatment could relieve pain in the patients with acute low back pain.

  12. Clinical correlates of painful diabetic neuropathy and relationship of neuropathic pain with sensorimotor and autonomic nerve function.

    Science.gov (United States)

    Spallone, Vincenza; Morganti, Roberto; D'Amato, Cinzia; Cacciotti, Laura; Fedele, Tiziana; Maiello, Maria R; Marfia, Girolama

    2011-02-01

    This study investigated the clinical correlates of painful diabetic polyneuropathy (PDPN) and the relationship of neuropathic pain with sensorimotor and autonomic nerve function. Seventy-eight diabetic patients with PDPN (PDPN(+)), 57 with non-painful diabetic polyneuropathy (DPN(+)), and 56 without diabetic polyneuropathy (DPN(-)) were prospectively studied. Autonomic neuropathy, neuropathic symptoms and signs, vibration perception threshold, and neuropathic pain were assessed using 4 cardiovascular tests, scoring systems for symptoms and signs (Michigan Diabetic Neuropathy Score, MDNS), Biothesiometer, and a numerical rating scale. Compared to DPN(+), PDPN(+) patients displayed higher BMI (P=0.0043), waist circumference (P=0.0057), neuropathy symptom score (Pbody mass index (BMI), abdominal obesity, diabetes type, diabetes duration, HbA1c, blood pressure, triglycerides, smoking, peripheral arterial disease, Valsalva ratio and MDNS as the independent variables, BMI (OR 1.22, P=0.0012) and MDNS (OR 1.27, P=0.0005) were significantly and independently associated with PDPN. In a multivariate regression analysis including as independent variables also sex, age, diabetes type, diabetes duration and Valsalva ratio, 24-h pain score was significantly related to neuropathy symptom score (P=0.0011), MDNS (P=0.0158), and 10g monofilament (P=0.018). BMI and sensorimotor deficits were the main determinants of PDPN and, as a novel finding, neuropathic pain intensity was related to the degree of neuropathy deficits. Thus, some peculiarity exists in metabolic correlates of diabetic neuropathic pain compared to insensate neuropathy but painfulness can still coexist with insensitivity. Copyright © 2010 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.

  13. [Clinical research of music in relieving orthodontic pain].

    Science.gov (United States)

    Xu, Xiaomei; Zhang, Lihua; Jiang, Yahua; Huang, Yue; Huang, Suhua; Yang, Siwei

    2013-08-01

    To discuss the effect of music in relieving pain during orthodontic treatment. One hundred and sixty-five cases who wore arches the first time were selected and treated. These patients were randomly divided into two groups: Music group and blank group. The music intervention was used in reducing orthodontic treatment pain, while blank group experienced no intervention measures. Visual analogue scales (VAS) were adopted to record patients' perception of pain, and Eysenck personality questionnaire (EPQ) to evaluate personality traits of all samples. In 165 patients, 85.45% were effective. The music group showed significantly less pain than the blank group (P music and blank group, the pain was stronger in the patients with a tendency of introversion than those with a tendency of extroversion, as well as the irritability ones than steady-minded (P music group, the pain was stronger in the females than the males (P Music helps to relieve pain during orthodontics treatment. The effect of music to relieve the pain during orthodontics treatment for the males are better than that for the females, extroverted personality ones are superior to introversive personality ones, and the steady-minded patients are better than irritability ones.

  14. VIOXX® Relieved Pain and Improved Clinical Outcomes in Patients ...

    African Journals Online (AJOL)

    Adele

    between two and four. After one hour, if patients were still experiencing a high level of pain (with scores between four and ten) and the maximum amount of epidural analgesic medi- cine was already given, patients were allowed to request intra- venous morphine. During the post-operative hospital stay, pain scores for the.

  15. Exploring the Facets of Empathy and Pain in Clinical Practice: A Review.

    Science.gov (United States)

    Roche, Jenny; Harmon, Dominic

    2017-11-01

    Empathy is an essential element in providing quality patient care. The significance of empathy is even more striking in pain medicine, as chronic pain is notorious for the way it can compromise an individual, leaving him or her isolated and feeling misconceived. This review examines the role of empathy in pain medicine practice. Current and past literature focusing on empathy and pain was searched for in PubMed, Science Direct, MEDLINE (Ovid), MEDLINE (Ebsco), Research Gate, and Google Scholar in July 2015. Search dates were not limited and languages included English only. Search terms were "empathy and pain," "empathy and chronic pain," "physician empathy and pain," "neural mechanisms and empathy," "empathy in clinical practice," "empathy and stigma," and "empathy and medical students". To select relevant publications, the title and abstract of every publication were examined, and when in doubt, the rest of the publication was read. Four major themes were identified: (1) the neural basis for empathy and pain; (2) the value and challenges of practicing empathy pain medicine; (3) stigma and empathy for pain; and (4) empathy and physician education and training. The review reveals that empathy deserves an unchallenged place in medical care, especially in pain medicine and medical education. It highlights the need to nurture empathy at all levels of professional expertise from medical student to senior doctors. © 2017 World Institute of Pain.

  16. Assessment of pain and other patient symptoms in routine clinical care as quantitative, standardised, "scientific" data.

    Science.gov (United States)

    Chua, Jacquelin R; Castrejon, Isabel; Pincus, Theodore

    2017-01-01

    Pain is the most common basis for visits to a rheumatologist, and reduction of pain is a primary goal of clinical care. Pain is assessed optimally by the patient on a self-report questionnaire. In clinical trials and other clinical research concerning pain and pain relief, detailed questionnaires are generally completed by patients. However, in routine clinical care, pain is generally assessed only according to narrative descriptions by the physician, and only a minority of settings assess pain using a standard, quantitative measure. Accurate, standard, quantitative assessment of pain in routine care is easily assessed in all patients with all diagnoses on a 0-10 visual analogue scale (VAS), by asking each patient to complete a 2-page multidimensional health assessment questionnaire/routine assessment of patient index data 3 (MDHAQ/RAPID3) at all visits. The MDHAQ includes VAS for pain, patient global assessment, and fatigue, as well as a quantitative physical function scale, RAPID3, review of systems, and recent medical history. The questionnaire provides the doctor with a 10-15 second overview of medical history data that otherwise would require about 10-15 minutes of conversation, saving time for the doctor and patient to focus on the most prominent concerns for the visit. MDHAQ scores from patients with 10 different rheumatic diagnoses, and specific data indicating similarity of scores in patients with osteoarthritis versus rheumatoid arthritis on the same questionnaire, are presented to illustrate the value of the MDHAQ in routine care.

  17. Topical ambroxol for the treatment of neuropathic pain. An initial clinical observation.

    Science.gov (United States)

    Kern, K-U; Weiser, T

    2015-12-01

    Neuropathic pain is difficult to treat, and the available options are often inadequate. The expectorant ambroxol also acts as a strong local anaesthetic and blocks sodium channels about 40 times more potently than lidocaine. It preferentially inhibits the channel subtype Nav 1.8, which is expressed especially in nociceptive C-fibres. In view of the low toxicity of ambroxol, it seemed reasonable to try using it for the treatment of neuropathic pain that failed to respond to other standard options. The medical records of seven patients with severe neuropathic pain and pain reduction following topical ambroxol treatment are reported retrospectively. As standard therapies had not proved sufficient, a topical ambroxol 20% cream was repeatedly applied by the patients in the area of neuropathic pain. The reasons for neuropathic pain were postherpetic neuralgia (2 ×), mononeuropathy multiplex, phantom pain, deafferentation pain, postoperative neuralgia and foot neuropathy of unknown origin. The individual mean pain intensity reported was between 4 and 6/10 (NRS), maximum pain at 6-10/10 (NRS). The pain reduction achieved individually following ambroxol cream was 2-8 points (NRS) within 5-30 min and lasted for 3-8 h. Pain attacks were reduced in all five patients presenting with this problem. Four patients with no improvement after lidocaine 5% and one patient with no response to capsaicin 8% nevertheless experienced a pain reduction with topical ambroxol. No patient reported any side effects or skin changes during a treatment that has since been continued for up to 4 years. Ambroxol acts as a strong local anaesthetic and preferentially inhibits the nociceptively relevant sodium channel subtype Nav 1.8. For the first time, we report below on a relevant pain relief following topical ambroxol 20% cream in patients with neuropathic pain. In view of the positive side effect profile, the clinical benefit in patients with pain should be investigated further.

  18. Adequacy of cancer-related pain management and predictors of undertreatment at referral to a pain clinic

    Directory of Open Access Journals (Sweden)

    Reis-Pina P

    2017-08-01

    Full Text Available Paulo Reis-Pina,1,2 Peter G Lawlor,3–5 António Barbosa6,7 1Palliative Care Unit, Casa de Saúde da Idanha, Sintra, 2Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; 3Ottawa Hospital Research Institute, 4Bruyère Research Institute, Bruyère Continuing Care, 5Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; 6Department of Psychiatry, North Lisbon Hospital Centre, Lisbon, 7Centre of Bioethics and Palliative Care Studies Division, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal Background: Several guidelines have advocated the need for adequate cancer-related pain (CRP management. The pain management index (PMI has been proposed as an auditable measure of the appropriateness for analgesic therapy. Objectives: To determine the adequacy of CRP management based on the PMI status and its patient-related predictors at the point of referral to a pain clinic (PC. Methods: Consecutive patients referred to a PC had standardized initial assessments and status documentation on the Brief Pain Inventory (BPI ratings; pain mechanism, using a neuropathic pain diagnostic questionnaire (the Douleur Neuropathique 4 tool; episodic pain; oral morphine equivalent daily dose; the Hospital Anxiety Depression Scale and the Emotion Thermometer scores; and cancer diagnosis, metastases, treatment, and pain duration. Predictors of “negative PMI status” [PMI(−] were examined in logistic regression models. Variables with p<0.25 in an initial bivariable analysis were entered into a multivariable model. Results: Of 371 participants, 95 (25.6% had PMI(−, suggesting undertreatment of CRP. Both female sex and higher scores on the BPI’s “interference with general activity” more strongly predicted PMI(−. Patients who received either radiotherapy or one or more adjuvant analgesics prior to the initial consultation at the PC, those who had neuropathic pain, those who had a greater need

  19. Pain pattern classification and directional preference are associated with clinical outcomes for patients with low back pain.

    Science.gov (United States)

    Yarznbowicz, Richard; Tao, Minjing; Owens, Alexa; Wlodarski, Matt; Dolutan, Jonathan

    2018-02-01

    Pain Pattern Classification (PPC) and Directional Preference (DP) have shown merit as reliable and predictable clinical solutions to help reduce the burden posed by low back pain (LBP). We conducted a prospective, observational cohort study to verify the association between PPC, DP, and clinical outcomes. We hypothesized that (1) patients who demonstrated DP Centralization (CEN) would have lower pain intensity and disability at follow-up than patients who demonstrated Non-DP Non-CEN, and (2) the prevalence of DP at first examination would be lowest for patients with chronic LBP and are greater than 65 years old. First examination and follow-up data were completed by 639 patients. Clinical outcome measures, including pain intensity and disability, were collected at first examination and follow-up. Baseline comparisons were made between groups with first examination data only and groups with first examination data and follow-up data. A Pearson's chi-squared test was used to determine differences in prevalence rates for the categorical variables, and two-sample t -tests were used for the continuous variables. A Turkey's range test was used to determine differences in follow-up pain intensity and disability for LBP dual-classifications. Multiple regression was used to investigate DP prevalence considering risk adjusted factors. Overall prevalence of DP was 84.5% and prevalence was lowest for patients with sub-acute symptoms. No significant difference existed for the prevalence of DP for patients based on age. Patients classified as DP CEN had, on average, 1.99 pain intensity units less than patients classified as Non-DP Non-CEN at follow-up. Patients classified as DP CEN had, on average, 3.43 RMDQ units less than patients classified as Non-DP Non-CEN at follow-up.These findings support previous reports, verifying the association between LBP dual-classification schemes and clinical outcomes.

  20. The Effect of Pain Neuroscience Education on Sports Therapy and Rehabilitation Students' Knowledge, Attitudes and Clinical Recommendations Towards Athletes with Chronic Pain.

    Science.gov (United States)

    Maguire, Neil; Chesterton, Paul; Ryan, Cormac

    2018-02-06

    Pain education is a fundamental part of a holistic approach to athlete injury management. Investigate the effect of Pain Neuroscience Education (PNE) on Sports Therapy and Rehabilitation (STR) students: 1) knowledge of persistent pain; 2) attitudes towards athletes with persistent pain; 3) clinical recommendations for athletes with persistent pain. Parallel groups, single-blind randomised control trial. A UK University. Sixty-one undergraduate and postgraduate STR students. The PNE session (intervention group) provided detailed information on the neuroscience of persistent pain, the modulating role of psychosocial factors on pain biology, and how this information could be used to inform clinical practice. The red flags (control group) session provided information on screening patients with persistent pain for serious/sinister pathologies. Each education session lasted 70 minutes. (1). Knowledge - the Revised Pain Neuroscience Questionnaire; (2). Attitudes - the Health Care Pain Attitudes and Impairment Relationship Scale (HC-PAIRS); (3). Clinical recommendations - an athlete case vignette. Post education, the PNE group had a greater increase in pain neuroscience knowledge (mean difference 3.2 [CI 2.1 to 4.3], pneuroscience, improve attitudes towards athletes with pain and shift their clinical recommendations in line with current guidelines. Such changes could lead to enhanced rehabilitation for athletes with persistent pain.

  1. Development and Implementation of a Registry of Patients Attending Multidisciplinary Pain Treatment Clinics: The Quebec Pain Registry

    Directory of Open Access Journals (Sweden)

    M. Choinière

    2017-01-01

    Full Text Available The Quebec Pain Registry (QPR is a large research database of patients suffering from various chronic pain (CP syndromes who were referred to one of five tertiary care centres in the province of Quebec (Canada. Patients were monitored using common demographics, identical clinical descriptors, and uniform validated outcomes. This paper describes the development, implementation, and research potential of the QPR. Between 2008 and 2013, 6902 patients were enrolled in the QPR, and data were collected prior to their first visit at the pain clinic and six months later. More than 90% of them (mean age ± SD: 52.76 ± 4.60, females: 59.1% consented that their QPR data be used for research purposes. The results suggest that, compared to patients with serious chronic medical disorders, CP patients referred to tertiary care clinics are more severely impaired in multiple domains including emotional and physical functioning. The QPR is also a powerful and comprehensive tool for conducting research in a “real-world” context with 27 observational studies and satellite research projects which have been completed or are underway. It contains data on the clinical evolution of thousands of patients and provides the opportunity of answering important research questions on various aspects of CP (or specific pain syndromes and its management.

  2. Emergency nurses' knowledge, attitude and clinical decision making skills about pain.

    Science.gov (United States)

    Ucuzal, Meral; Doğan, Runida

    2015-04-01

    Pain is the most common reason that patients come to the emergency department. Emergency nurses have an indispensable role in the management of this pain. The aim of this study was to examine emergency nurses' knowledge, attitude and clinical decision-making skills about pain. This descriptive study was conducted in a state and a university hospital between September and October 2012 in Malatya, Turkey. Of 98 nurses working in the emergency departments of these two hospitals, 57 returned the questionnaires. The response rate was 58%. Data were collected using the Demographic Information Questionnaire, Knowledge and Attitude Questionnaire about Pain and Clinical Decision Making Survey. Frequency, percentage, mean and standard deviation were used to evaluate data. 75.4% of participant nurses knew that patients' own statement about their pain was the most reliable indicator during pain assessment. Almost half of the nurses believed that patients should be encouraged to endure the pain as much as possible before resorting to a pain relief method. The results also indicate that most of nurses think that a sleeping patient does not have any pain and pain relief should be postponed as it can influence the diagnosis negatively. It is determined that the pain scale was not used frequently. Only 35.1% of nurses reported keeping records of pain. Despite all the recommendations of substantial past research the results of this study indicate that emergency nurses continue to demonstrate inadequate knowledge, clinical decision-making skills and negative attitudes about pain. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Pain and ketoprofen: what is its role in clinical practice?

    Directory of Open Access Journals (Sweden)

    F. Fischer

    2011-06-01

    Full Text Available Patients fear pain because it causes considerable suffering, and clinicians may not handle it appropriately because they fail to understand it (1. The International Association for the Study of Pain (IASP defines it as “… is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (2. Individual patients perceive it differently, depending on the context of the stimulus, their previous experience, and their current psychological and physical condition. Furthermore, painful stimuli cannot be ignored, disturb behavioural and cognitive activities, and give rise to anxiety and/or depression (3, 4. Acute pain is one of the most frequent reasons for consulting a doctor in all parts of the world (5, and is often associated with already distressing...

  4. The effect of manual therapy with augmentative exercises for neck pain: a randomised clinical trial.

    Science.gov (United States)

    Petersen, Shannon Bravo; Cook, Chad; Donaldson, Megan; Hassen, Amy; Ellis, Alyson; Learman, Ken

    2015-12-01

    To compare the effect of manual therapy (MT) and an augmentative exercise programme (AEP) versus MT and general neck range of motion (ROM) on functional outcomes for patients with neck pain. A secondary objective was to examine changes in self-report measures and quantitative sensory testing (QST) following MT and AEP. This was a randomised clinical trial. Seventy-two patients with neck pain were recruited. All patients received a single session of MT. Patients were randomly assigned to MT+AEP or MT+ROM. Clinical self-report outcome measures for disability and pain, and QST measures (pain and vibration thresholds) were collected at baseline, post MT treatment, at ∼48 hours, and at ∼96 hours. Repeated measures ANOVA and MANOVA were used to analyse within and between-group effects for clinical and QST measures. There were no between-group differences for disability, pain and QST measures. There was, however, a significant difference between groups for Global Rating of Change (GRoC) scores (P = 0.037). Patients in both groups showed improvements in pain, disability and trapezius pressure-pain threshold (PPT) (all P < 0.001). Augmentative exercise programme does not significantly improve disability, pain or QST measures in patients with chronic neck pain although it may enhance their GRoC scores. Over a 96-hour period, patients benefitted from MT plus exercise whether the exercise was general or specific.

  5. [Topical ambroxol for the treatment of neuropathic pain: A first clinical observation. German version].

    Science.gov (United States)

    Kern, K-U; Weiser, T

    2015-12-01

    Neuropathic pain is difficult to treat and available options are frequently not sufficient. The expectorant ambroxol also works as a strong local anesthetic and blocks sodium channels about 40 times more potently than lidocaine. Ambroxol preferentially inhibits the channel subtype Nav 1.8, which is expressed particularly in nociceptive C fibers. Due to the low toxicity, topical ambroxol seemed to represent a reasonable therapeutic attempt for treatment of neuropathic pain resistant to other standard options. Medical records of 7 patients with severe neuropathic pain, in whom many attempts at treatment with approved substances were not sufficient or possible, are reported retrospectively. Patients were then treated with topical ambroxol 20% cream applied in the area of neuropathic pain. Causes of neuropathic pain were postherpetic neuralgia (2-×), mononeuropathy multiplex, phantom pain, deafferentation pain, postoperative neuralgia and an unclear allodynia of the foot. Mean pain intensity was reported as 4-6/10 on a numeric rating scale (NRS) and maximum pain intensity as 6-10/10. Pain reduction following ambroxol cream was 2-8 points (NRS) within 15-30 min and lasted 3-8 h. Pain attacks were reduced in all 5 patients presenting this problem. Topical ambroxol achieved pain reduction in 4 patients with no improvement after lidocaine 5% and 1 patient with no response to capsaicin 8%. No adverse events or skin changes have been observed, and the longest treatment duration is currently 4 years. Ambroxol acts as a strong local anesthetic and preferentially inhibits the nociceptive-relevant sodium channel subtype Nav 1.8. For the first time, we report relevant pain reduction following topical Ambroxol 20% cream in patients with neuropathic pain. Regarding the advantageous profile with rare side effects, the clinical benefit for pain patients should be further investigated.

  6. Research design considerations for single-dose analgesic clinical trials in acute pain: IMMPACT recommendations.

    Science.gov (United States)

    Cooper, Stephen A; Desjardins, Paul J; Turk, Dennis C; Dworkin, Robert H; Katz, Nathaniel P; Kehlet, Henrik; Ballantyne, Jane C; Burke, Laurie B; Carragee, Eugene; Cowan, Penney; Croll, Scott; Dionne, Raymond A; Farrar, John T; Gilron, Ian; Gordon, Debra B; Iyengar, Smriti; Jay, Gary W; Kalso, Eija A; Kerns, Robert D; McDermott, Michael P; Raja, Srinivasa N; Rappaport, Bob A; Rauschkolb, Christine; Royal, Mike A; Segerdahl, Märta; Stauffer, Joseph W; Todd, Knox H; Vanhove, Geertrui F; Wallace, Mark S; West, Christine; White, Richard E; Wu, Christopher

    2016-02-01

    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 to many other acute pain studies conducted in different settings.

  7. Barriers to primary care clinician adherence to clinical guidelines for the management of low back pain

    DEFF Research Database (Denmark)

    Slade, Susan C; Kent, Peter; Bucknall, Tracey

    2015-01-01

    INTRODUCTION: Low back pain is the highest ranked condition contributing to years lived with disability, and is a significant economic and societal burden. Evidence-based clinical practice guidelines are designed to improve quality of care and reduce practice variation by providing graded...... recommendations based on the best available evidence. Studies of low back pain guideline implementation have shown no or modest effects at changing clinical practice. OBJECTIVES: To identify enablers and barriers to adherence to clinical practice guidelines for the management of low back pain. METHODS...

  8. Non-specific abdominal pain--a clinical entity.

    Directory of Open Access Journals (Sweden)

    Deodhar S

    1989-04-01

    Full Text Available A total of 48 cases of non-specific abdominal pain admitted in one year period were studied. Routine investigations of blood, urine, stool and X-ray examinations done after admission were negative. The pain was relieved in 48 hours time with analgesics and antispasmodics. During their follow-up in the out-patient department a variety of causes were discovered on investigations.

  9. Pain relief and clinical outcome: from opioids to balanced analgesia

    DEFF Research Database (Denmark)

    Kehlet, H

    1996-01-01

    If it is generally accepted that adequate postoperative pain relief will improve outcome from surgery, several controlled trials demonstrated this only for lower body surgical procedures with epidural and spinal anesthetics. Important effects on outcome were not shown when postoperative opioids...... were administered with patient controlled (PCA) or epidural techniques. However, the most optimal pain relief seems to be best achieved with balanced analgesia techniques using combinations of epidural opioids and local anesthetics and systemic non-steroidal antiinflammatory drugs. Future efforts...

  10. Comparison of Graded Exercise and Graded Exposure Clinical Outcomes for Patients With Chronic Low Back Pain

    Science.gov (United States)

    George, Steven Z.; Wittmer, Virgil T.; Fillingim, Roger B.; Robinson, Michael E.

    2017-01-01

    STUDY DESIGN Quasi-experimental clinical trial. OBJECTIVES This study compared outcomes from graded exercise and graded exposure activity prescriptions for patients participating in a multidisciplinary rehabilitation program for chronic low back pain. Our primary purpose was to investigate whether pain and disability outcomes differed based on treatment received (graded exercise or graded exposure). Our secondary purpose was to investigate if changes in selected psychological factors were associated with pain and disability outcomes. BACKGROUND Behavioral interventions have been advocated for decreasing pain and disability from low back pain, yet relatively few comparative studies have been reported in the literature. METHODS Consecutive sample with chronic low back pain recruited over a 16-month period from an outpatient chronic pain clinic. Patients received physical therapy supplemented with either graded exercise (n = 15) or graded exposure (n = 18) principles. Graded exercise included general therapeutic activities and was progressed with a quota-based system. Graded exposure included specific activities that were feared due to back pain and was progressed with a hierarchical exposure paradigm. Psychological measures were pain-related fear (Fear-Avoidance Beliefs Questionnaire, Tampa Scale for Kinesiophobia, Fear of Pain Questionnaire), pain catastrophizing (Coping Strategies Questionnaire), and depressive symptoms (Beck Depression Inventory). Primary outcome measures were pain intensity (visual analog scale) and self-report of disability (modified Oswestry Disability Questionnaire). RESULTS Statistically significant improvements (P.05 for these comparisons). Overall, 50% of patients met criterion for minimally important change for pain intensity, while 30% met this criterion for disability. Change in depressive symptoms was associated with change in pain intensity, while change in pain catastrophizing was associated with change in disability. CONCLUSIONS

  11. [Treatment of myofascial lumbar dorsal pain. Effective clinical diagnostics and therapy].

    Science.gov (United States)

    Levene, R; Günther, O; Rothkötter, H-J; Bitterlich, N; Buchmann, J

    2014-12-01

    Lumbar dorsal pain is a problem that must be taken seriously and is part of many people's everyday lives. Not only does it cause high costs for the health system, it also frequently leads to inability to work. The significance of the myofascial system is still not taken seriously enough in therapy and clinical diagnostics, when treating dorsal pain. In the following article, the effectiveness of specifically targeted therapy for myofascial pain is evaluated. Included in the study were 44 patients referred for lumbar dorsal treatment-resistant pain to a practice specializing in pain therapy. Therapy focused on treatment of the affected muscle area with physiotherapy and the additional techniques of infiltrating trigger points, neural therapy, and general relaxation exercises. Medication was optimized according to the specific guidelines for the condition. The effect of therapy was evaluated using the German pain questionnaire (Deutsche Schmerzfragebogen). After the therapy phase, patients had a significantly lower intensity of pain, anxiety, and depression, as well as an increased quality of life. The results indicate that targeted treatment of muscles and fascia in patients with chronic back pain can lead to a reduction of pain symptoms. The consideration of the myofascial systems, particularly in relation to nonspecific back pain, could contribute to improving the treatment of pain and contribute to lowering costs.

  12. Psychiatric disorders in children and adolescents presenting with unexplained chronic pain: what is the prevalence and clinical relevancy?

    NARCIS (Netherlands)

    Knook, L.M.; Konijnenberg, A.Y.; Hoeven, J. van der; Kimpen, J.L.L.; Buitelaar, J.K.; Engeland, H. van; Graeff-Meeder, E.R. de

    2011-01-01

    The prevalence of psychiatric disorders among children with unexplained chronic pain (UCP) is high in unselected populations and pain clinics, yet the clinical relevance of these disorders in children referred for unexplained pain is not known. This study assessed the prevalence of clinically

  13. Crossover clinical trial of pain relief in cataract surgery.

    Science.gov (United States)

    Choi, Suvin; Park, Sang-Gue; Bellan, Lorne; Lee, Hyung-Hwan; Chung, Sung Kun

    2017-06-20

    To determine the effects of intra-operative Korean traditional music on pain experienced by Korean patients undergoing sequential bilateral cataract surgery. This was a two-sequence, two-period, and two-treatment crossover study. Fifty-two patients with cataracts were divided into two groups by block randomization, and bilateral cataract surgery was performed. In group 1, patients listened to Korean traditional music (KTM) during their first but not second cataract surgery. This sequence was reversed for patients in group 2. After each surgery, patients scored their pain intensity (PI) using a visual analog scale (VAS) ranging from 0 to 10, where 0 was 'no pain' and 10 was 'unbearable pain.' There was a statistically significant reduction in the mean VAS score with KTM (3.1 ± 2.0) compared to that without KTM (4.1 ± 2.2; p = 0.013). However, there were no statistically significant differences in blood pressure or pulse rates. KTM had a significant effect on reducing pain experienced by patients during cataract surgery. This may be useful in the context of other surgical procedures to reduce pain in Korean patients.

  14. How well do clinical pain assessment tools reflect pain in infants?

    OpenAIRE

    Rebeccah Slater; Anne Cantarella; Linda Franck; Judith Meek; Maria Fitzgerald

    2008-01-01

    Editors' Summary Background. Pain is a sensory and emotional experience. It is normally triggered by messages transmitted from specialized receptors (nociceptors) in the body to integrative centers in the spinal cord and brainstem and on to the brain, where it undergoes higher sensory and cognitive analysis, allowing the body to respond appropriately to the stimuli. While the experience of pain may be considered to be unpleasant, it is a useful tool in communicating to us and to others that t...

  15. A clinical contrast: physical therapists with low back pain treating patients with low back pain.

    Science.gov (United States)

    Louw, Adriaan; Puentedura, Emilio J; Zimney, Kory

    2015-01-01

    Patients with low back pain (LBP) often display faulty beliefs and cognitions regarding their pain experience. Pain neuroscience education (PNE) aims to alter the pain experience by targeting these faulty beliefs and cognitions. One PNE strategy aims specifically to reframe commonly held beliefs about tissues by patients with LBP as the single source of pain. In line with this reasoning, it is hypothesized that physical therapists (PT) treating patients with LBP may indeed experience similar, if not worse, pain experiences while treating a patient with LBP. To date, this assumption has never been studied. A PT LBP questionnaire was developed, validated and distributed to a convenience sample of attendees of an international PT conference. One-hundred and ten PTs completed the questionnaire for a 71% response rate. Ninety percent of the PTs reported having experienced LBP, with 27% at the conference experiencing LBP at the time. Of the PTs that have experienced LBP 75% reported not having received any imaging; 81% no formal diagnoses, 58% no treatment and 86% not having missed work due to LBP. Eighty-six percent of therapists reported having experienced LBP while treating a patient with LBP, with 50% convinced their LBP was higher than the LBP experienced by the patient they were treating. The results from this study indicate PTs often treat patients with LBP while suffering LBP. It is suggested that this knowledge may potentially help patients with LBP reconceptualize their LBP experience leading to expedited recovery.

  16. The Most Common Causes of Eye Pain at 2 Tertiary Ophthalmology and Neurology Clinics.

    Science.gov (United States)

    Bowen, Randy C; Koeppel, Jan N; Christensen, Chance D; Snow, Karisa B; Ma, Junjie; Katz, Bradley J; Krauss, Howard R; Landau, Klara; Warner, Judith E A; Crum, Alison V; Straumann, Dominik; Digre, Kathleen B

    2018-01-12

    Eye pain is a common complaint, but no previous studies have determined the most common causes of this presenting symptom. Our objective was to determine the most common causes of eye pain in 2 ophthalmology and neurology departments at academic medical centers. This was a retrospective cross-sectional analysis and chart review at the departments of ophthalmology and neurology at the University Hospital Zurich (USZ), University of Zürich, Switzerland, and the University of Utah (UU), USA. Data were analyzed from January 2012 to December 2013. We included patients aged 18 years or older presenting with eye pain as a major complaint. Two thousand six hundred three patient charts met inclusion criteria; 742 were included from USZ and 1,861 were included from UU. Of these, 2,407 had been seen in an ophthalmology clinic and 196 had been seen in a neurology clinic. Inflammatory eye disease (conjunctivitis, blepharitis, keratitis, uveitis, dry eye, chalazion, and scleritis) was the underlying cause of eye pain in 1,801 (69.1%) of all patients analyzed. Although only 71 (3%) of 2,407 patients had migraine diagnosed in an ophthalmology clinic as the cause of eye pain, migraine was the predominant cause of eye pain in the neurology clinics (100/196; 51%). Other causes of eye pain in the neurology clinics included optic neuritis (44 patients), trigeminal neuralgia, and other cranial nerve disorders (8 patients). Eye pain may be associated with a number of different causes, some benign and others sight- or life-threatening. Because patients with eye pain may present to either a neurology or an ophthalmology clinic and because the causes of eye pain may be primarily ophthalmic or neurologic, the diagnosis and management of these patients often requires collaboration and consultation between the 2 specialties.

  17. Dystonia in complex regional pain syndrome : clinical, pathophysiological and therapeutic aspects

    NARCIS (Netherlands)

    Rijn, Monica Adriana van

    2010-01-01

    The clinical characteristics of Complex Regional Pain Syndrome (CRPS) are defined by pain and various combinations of sensory disturbances, autonomic features, and sudomotor and trophic changes. Furthermore, patients with CRPS may suffer from movement disorders, of which dystonia is the most

  18. Clinical examination and physical assessment of hip joint-related pain in athletes

    DEFF Research Database (Denmark)

    Reiman, Michael P; Thorborg, Kristian

    2014-01-01

    UNLABELLED: Evidence-based clinical examination and assessment of the athlete with hip joint related pain is complex. It requires a systematic approach to properly differentially diagnose competing potential causes of athletic pain generation. An approach with an initial broad focus (and hence us...

  19. Core outcome measurement instruments for clinical trials in non-specific low back pain

    NARCIS (Netherlands)

    Chiarotto, Alessandro; Boers, Maarten; Deyo, Richard A; Buchbinder, Rachelle; Corbin, Terry P; Costa, Leonardo O P; Foster, Nadine E; Grotle, Margreth; Koes, Bart W; Kovacs, Francisco M; Christine Lin, Chung-Wei; Maher, Chris G; Pearson, Adam M; Peul, Wilco C; Schoene, Mark L; Turk, Dennis C; van Tulder, Maurits W; Terwee, Caroline B; Ostelo, Raymond W

    2017-01-01

    To standardize outcome reporting in clinical trials of patients with non-specific low back pain (LBP), an international multidisciplinary panel recommended physical functioning, pain intensity, and health-related quality of life (HRQoL) as core outcome domains. Given the lack of consensus on

  20. A decade of improvement in pain education and clinical practice in developing countries: IASP initiatives.

    Science.gov (United States)

    Bond, Michael

    2012-05-01

    1. Epidemiological studies, in the late 1990s and early 2000s, on the extent of pain in the community of western countries revealed a prevalence of around 18%, with significant effects on work and social activities despite 30 years of pain education programmes. 2. A survey by the International Association for the Study of Pain (IASP) Developing Countries on the extent of pain education and clinical training, and the barriers to them, was published as report in 2007 and confirmed significant deficiencies and problems in all areas. 3. An IASP Developing Countries Taskforce was established in 2002 to facilitate improvements in pain education and management in developing countries through a grants support programme for bottom-up projects from developing country members. 4. Clinical training posts in centres in Thailand, South America and South Africa have been established to improve the clinical training of pain clinicians and, through them, to develop pain services in their countries of origin in which services are poorly developed or absent. 5. There has been a major surge in the demand for and development of programmes and clinical training in developing countries since 2002, reflected in greatly increased local activity in various regions of the world. 6. Based on the ethical/moral belief that pain treatment is a human right, the IASP has recently increased its levels of advocacy to support this belief.

  1. Incidence of shoulder pain after neck dissection: a clinical explorative study for risk factors

    NARCIS (Netherlands)

    Dijkstra, P. U.; van Wilgen, P. C.; Buijs, R. P.; Brendeke, W.; de Goede, C. J.; Kerst, A.; Koolstra, M.; Marinus, J.; Schoppink, E. M.; Stuiver, M. M.; van de Velde, C. F.; Roodenburg, J. L.

    2001-01-01

    It is the purpose of this study to determine the incidence of shoulder pain and restricted range of motion of the shoulder after neck dissection, and to identify risk factors for the development of shoulder pain and restricted range of motion. Clinical patients who underwent a neck dissection

  2. Incidence of shoulder pain after neck dissection : A clinical explorative study for risk factors

    NARCIS (Netherlands)

    Dijkstra, PU; van Wilgen, PC; Brendeke, W; de Goede, CJT; Kerst, A; Koolstra, M; Marinus, J; Schoppink, EM; Stuiver, MM; van de Velde, CF; Roodenburg, JLN

    2001-01-01

    Background. It is the purpose of this study to determine the incidence of shoulder pain and restricted range of motion of the shoulder after neck dissection, and to identify risk factors for the development of shoulder pain and restricted range of motion. Methods. Clinical patients who underwent a

  3. The effects of anger and sadness on clinical pain reports and experimentally-induced pain thresholds in women with and without fibromyalgia.

    NARCIS (Netherlands)

    Middendorp, H. van; Lumley, M.A.; Jacobs, J.W.G.; Bijlsma, J.W.J.; Geenen, R.

    2010-01-01

    OBJECTIVE: Negative emotions are commonly experienced in fibromyalgia and may affect pain. This study examined the effects of anger and sadness on clinical pain reports and on pain threshold and tolerance in response to electrical stimulation in women with and without fibromyalgia. METHODS: In an

  4. Adherence to Back Pain Clinical Practice Guidelines by Brazilian Physical Therapists: A Cross-sectional Study.

    Science.gov (United States)

    de Souza, Fabrício S; Ladeira, Carlos E; Costa, Leonardo O P

    2017-11-01

    This was a cross-sectional observational study. (i) to investigate whether Brazilian physical therapists make clinical decisions for patients with low back pain based upon clinical practice guidelines and (ii) to determine whether the physical therapists are able to recognize differential diagnoses of low back pain associated with red or yellow flags. Early adherence to clinical practice guidelines may accelerate recovery and reduce the costs associated with low back pain. It is unknown whether Brazilian physical therapists follow clinical practice guidelines to make their clinical decisions in the treatment of patients with low back pain. The sample consisted of physical therapists from two Brazilian physical therapy associations. The data were collected via electronic survey and face-to-face interviews. The survey was composed of six hypothetical clinical cases of low back pain, which served as a basis to evaluate clinical decisions and adherence to clinical practice guidelines for low back pain. The study participants had 27 possible answers for each clinical case and could choose up to five answers. The results were analyzed in three ways: full adherence, partial adherence, or no adherence to the recommendations from clinical practice guidelines. A total of 530 physical therapists were invited and 189 participated in the study (response rate = 35.6%). Full adherence to the guidelines was low for all six cases (rates ranging from 5%-24%). Partial adherence to the guidelines was higher when compared with full adherence (rates ranging from 32%-75%). The participants were more likely to identify differential diagnoses associated with yellow flags than with red flags. Brazilian physical therapists are not using the best available evidence in their clinical decision making for patients with low back pain. Wider dissemination of clinical practice guidelines should be urgently undertaken. 2.

  5. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations

    DEFF Research Database (Denmark)

    Dworkin, R.H.; Turk, D.C.; Wyrwich, K.W.

    2008-01-01

    for 4 core chronic pain outcome domains: (1) Pain intensity, assessed by a 0 to 10 numerical rating scale; (2) physical functioning, assessed by the Multidimensional Pain Inventory and Brief Pain Inventory interference scales; (3) emotional functioning, assessed by the Beck Depression Inventory...

  6. Clinical descriptors for the recognition of central sensitization pain in patients with knee osteoarthritis

    DEFF Research Database (Denmark)

    Lluch, Enrique; Nijs, Jo; Courtney, Carol A

    2017-01-01

    and its association with structural joint changes, pain distribution, behavior of knee pain, presence of neuropathic-like or centrally mediated symptoms and responsiveness to previous treatment. The latter includes assessment of response to clinical test, mechanical hyperalgesia and allodynia, thermal......BACKGROUND: Despite growing awareness of the contribution of central pain mechanisms to knee osteoarthritis pain in a subgroup of patients, routine evaluation of central sensitization is yet to be incorporated into clinical practice. AIM: The objective of this perspective is to design a set...... of clinical descriptors for the recognition of central sensitization in patients with knee osteoarthritis that can be implemented in clinical practice. METHODS: A narrative review of original research papers was conducted by nine clinicians and researchers from seven different countries to reach agreement...

  7. 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.

  8. 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.

  9. Mechanism-based classification of pain for physical therapy management in palliative care: A clinical commentary

    Directory of Open Access Journals (Sweden)

    Senthil P Kumar

    2011-01-01

    Full Text Available Pain relief is a major goal for palliative care in India so much that most palliative care interventions necessarily begin first with pain relief. Physical therapists play an important role in palliative care and they are regarded as highly proficient members of a multidisciplinary healthcare team towards management of chronic pain. Pain necessarily involves three different levels of classification-based upon pain symptoms, pain mechanisms and pain syndromes. Mechanism-based treatments are most likely to succeed compared to symptomatic treatments or diagnosis-based treatments. The objective of this clinical commentary is to update the physical therapists working in palliative care, on the mechanism-based classification of pain and its interpretation, with available therapeutic evidence for providing optimal patient care using physical therapy. The paper describes the evolution of mechanism-based classification of pain, the five mechanisms (central sensitization, peripheral neuropathic, nociceptive, sympathetically maintained pain and cognitive-affective are explained with recent evidence for physical therapy treatments for each of the mechanisms.

  10. Pain in early-stage Parkinson's disease: Implications from clinical features to pathophysiology mechanisms

    Directory of Open Access Journals (Sweden)

    Ming-Tsung Tseng

    2017-08-01

    Full Text Available Pain is a common non-motor symptom of Parkinson's disease (PD that markedly impacts patients' quality of life. Although pain occurs mostly secondary to motor disability of PD, pain may antedate motor symptoms by years. Numerous studies have shown that PD patients manifest altered sensory and pain thresholds compared with control subjects. Although both levodopa and deep brain stimulation improve motor symptoms, there remains no direct correlation between motor improvement and altered pain sensitivity, suggesting that motor symptoms and pain do not necessarily share pathogenetic mechanisms. Whether nociceptive processing is dysfunctional in the early stages of PD, when motor symptoms are not prominent, remains uncertain. In this review, we highlight the evidence for disrupted nociceptive processing in patients with early-stage PD. Painful symptoms and aberrant pain processing in early PD are associated with both central and peripheral deafferentation. Dopamine depletion in selective striatal regions, and the development of Lewy pathology in specific non-dopaminergic subcortical areas, underlie the clinical features of pain at this early disease stage. An increased awareness of pain as an early feature of PD might provide further insights into a mechanism-based approach to sensory system dysregulation in this disease.

  11. Guidelines in the management of diabetic nerve pain clinical utility of pregabalin

    Directory of Open Access Journals (Sweden)

    Vinik AI

    2013-02-01

    Full Text Available Aaron I Vinik, Carolina M Casellini Strelitz Diabetes Center for Endocrine and Metabolic Disorders, Eastern Virginia Medical School, Norfolk, VA, USA Abstract: Diabetic peripheral neuropathy is a common complication of diabetes. It presents as a variety of syndromes for which there is no universally accepted unique classification. Sensorimotor polyneuropathy is the most common type, affecting about 30% of diabetic patients in hospital care and 25% of those in the community. Pain is the reason for 40% of patient visits in a primary care setting, and about 20% of these have had pain for greater than 6 months. Chronic pain may be nociceptive, which occurs as a result of disease or damage to tissue with no abnormality in the nervous system. In contrast, neuropathic pain is defined as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system.” Persistent neuropathic pain interferes significantly with quality of life, impairing sleep and recreation; it also significantly impacts emotional well-being, and is associated with depression, anxiety, and noncompliance with treatment. Painful diabetic peripheral neuropathy is a difficult-to-manage clinical problem, and patients with this condition are more apt to seek medical attention than those with other types of diabetic neuropathy. Early recognition of psychological problems is critical to the management of pain, and physicians need to go beyond the management of pain per se if they are to achieve success. This evidence-based review of the assessment of the patient with pain in diabetes addresses the state-of-the-art management of pain, recognizing all the conditions that produce pain in diabetes and the evidence in support of a variety of treatments currently available. A search of the full Medline database for the last 10 years was conducted in August 2012 using the terms painful diabetic peripheral neuropathy, painful diabetic peripheral polyneuropathy

  12. Cupping therapy for acute and chronic pain management: a systematic review of randomized clinical trials

    OpenAIRE

    Cao, Huijuan; Li, Xun; Yan, Xue; Wang, Nissi S.; Bensoussan, Alan; Liu, Jianping

    2014-01-01

    Objective: Cupping as a traditional therapy is used to treat a myriad of health conditions, including pain. This systematic review assessed the effectiveness and safety of cupping for different types of pain. Methods: Thirteen databases and four trial registries were searched for randomized clinical trials. Meta-analysis of data was conducted if there was non-significant clinical and statistical heterogeneity (measured by I2 test) among trials. Results: Sixteen trials with 921 participa...

  13. Minimum reporting standards for clinical research on groin pain in athletes

    DEFF Research Database (Denmark)

    Delahunt, Eamonn; Thorborg, Kristian; Khan, Karim M

    2015-01-01

    are provided in relation to: (1) study methodology, (2) study participants and injury history, (3) clinical examination, (4) clinical assessment and (5) radiology. Adherence to these minimum reporting standards will strengthen the quality and transparency of research conducted on groin pain in athletes......Groin pain in athletes is a priority area for sports physiotherapy and sports medicine research. Heterogeneous studies with low methodological quality dominate research related to groin pain in athletes. Low-quality studies undermine the external validity of research findings and limit the ability...... to generalise findings to the target patient population. Minimum reporting standards for research on groin pain in athletes are overdue. We propose a set of minimum reporting standards based on best available evidence to be utilised in future research on groin pain in athletes. Minimum reporting standards...

  14. Effectiveness of a community based nurse-pharmacist managed pain clinic: A mixed-methods study.

    Science.gov (United States)

    Hadi, Muhammad Abdul; Alldred, David Phillip; Briggs, Michelle; Marczewski, Kathryn; Closs, S José

    2016-01-01

    Chronic pain is predominantly managed in primary care, although often ineffectively. There is growing evidence to support the potential role of nurses and pharmacists in the effective management of chronic pain. To evaluate the effectiveness of a pain clinic jointly managed by a nurse and pharmacist. A mixed-methods design consisting of qualitative interviews embedded within a quasi-experimental study. A community-based nurse-pharmacist led pain clinic in the north of England. Adult chronic pain (non-malignant) patients referred to the pain clinic. Pain intensity was the primary outcome. Questionnaires (the Brief Pain Inventory, the Hospital Anxiety and Depression Scale, the SF-36 and the Chronic Pain Grade questionnaire) were administered at the baseline, on discharge and at 3-month post-discharge (Brief Pain Inventory and Hospital Anxiety and Depression Scale only). Patient satisfaction was explored using face-to-face, semi-structured qualitative interviews. Seventy-nine patients with a mean age of 46.5 years (SD±14.4) took part in the quasi-experimental study. Thirty-six and nine patients completed the discharge and 3-month follow-up questionnaires respectively. Compared to baseline, statistically significant reductions were noted for two of the outcome measures: pain intensity (P=0.02), and interference of pain with physical functioning (P=0.02) on discharge from the service. Nineteen patients participated in qualitative interviews. The patients were, in general, satisfied with the quality of service. Four contributing factors to patient satisfaction were identified: ample consultation time, in-depth specialised knowledge, listening and understanding to patients' needs, and a holistic approach. Nurse and pharmacist managed community-based pain clinics can effectively deliver quality pain management services as they offer an interdisciplinary holistic approach to pain management. Such services have the potential not only to reduce the burden on secondary care

  15. The management of HIV- and AIDS-related pain in a primary health clinic in Tshwane, South Africa.

    Science.gov (United States)

    Maree, Johanna Elizabeth; Dreyer Wright, Susanna Catharina; Makua, Mogalagadi Rachel

    2013-06-01

    Pain has been recognized as an important, highly prevalent, and debilitating symptom of HIV and AIDS. In South Africa, many people living with HIV and AIDS utilize primary health clinics for pain management. Primary health clinics are nurse led and face a variety of challenges pertaining to pain management. The purpose of this study was to explore if HIV and AIDS pain is effectively managed in a primary health clinic in Tshwane, South Africa. The study aimed to explore the level and characteristics of HIV- and AIDS-related pain, the pain-related experiences of patients and if pain was managed according to the applicable guidelines of the Department of Health. A quantitative survey was conducted. The target population was HIV and AIDS patients who had been using the primary health clinic for chronic pain management. The sampling method was convenience (n = 500). Data were gathered by means of structured interviews and structured observation. The data were analyzed using the SSPS 15 program and open coding. The study provided evidence that HIV- and AIDS-related pain is not managed effectively. Despite repeated visits to the primary health clinic, the overwhelming majority of patients still experienced pain. Nurses added to the suffering, because they lacked knowledge of pain and pain management. It is recommended that nurses practicing in primary health clinics should be trained and supervised to effectively manage the pain of people living with HIV and AIDS. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  16. Low back pain as seen in orthopedic clinics of a Nigerian Teaching ...

    African Journals Online (AJOL)

    2015-08-25

    Aug 25, 2015 ... our orthopedic outpatient clinics. Materials and Methods: This was a retrospective review of database of all new patients with low back pain seen at the orthopedics clinics of Federal Teaching Hospital, Abakaliki between 2003 and 2013. Results: There were 2914 new patients seen in the orthopedic clinics ...

  17. Ask the Experts: Facial expressions of pain: clinical meaning and research possibilities.

    Science.gov (United States)

    Williams, Amanda

    2011-07-01

    Amanda Williams qualified as a clinical psychologist in 1985. She joined the first residential pain management programme, INPUT, at St Thomas' Hospital (London, UK) at its start in 1988, running the research program, initially a large randomized controlled trial and generalization trial, and then a series of studies nested within the ongoing program. In 1996 she completed her PhD on the psychology of pain management and took a part-time academic post in the Guy's, King's & St Thomas' medical school (London, UK). In 2004, she moved to University College London (UK), teaching and supervising undergraduate and postgraduate psychologists, and continuing some clinical work in the long-established Pain Management Centre of the National Hospital (London, UK). For over 10 years she has been a volunteer and then a consultant at the Medical Foundation for Victims of Torture (London, UK) working clinically and developing audit and evaluation of clinical work there. She continues these strands of work and they include: evaluation of psychological methods of pain management, mainly in systematic reviews with Chris Eccleston and Stephen Morley; and understanding chronic pain from torture. She has worked extensively on facial expression of pain and its recognition by others, applying an explicitly evolutionary model. This work has led to a major grant to develop automated therapeutic feedback to people with pain, using their behavior as input. She has spoken at many national and international pain meetings, including a plenary at the World Congress of Pain in 2002; she has published over 100 papers and chapters and is on the editorial boards of several major pain journals.

  18. Assessment and clinical factors associated with pain in patients undergoing transrectal prostate biopsy.

    Science.gov (United States)

    Gómez-Gómez, E; Ramírez, M; Gómez-Ferrer, A; Rubio-Briones, J; Iborra, I; J Carrasco-Valiente; Campos, J P; Ruiz-García, J; Requena-Tapia, M J; Solsona, E

    2015-09-01

    To quantify the degree of pain experienced by patients who undergo ultrasound-guided transrectal prostate biopsy in standard clinical practice and assess the clinical factors associated with increased pain. Analysis of a multicenter series of patients with prostate biopsy according to standard clinical practice. The biopsy was performed transrectally with a protocol of local anesthesia on the posterolateral nerve bundle. The pain was assessed at 20minutes into the procedure using the visual analog scale (0-10). The degree of pain was analyzed, and the association was studied using a univariate/multivariate analysis of selected clinical variables and the degree of pain. A total of 1188 patients with a median age of 64 years were analyzed. Thirty percent of the biopsies were diagnosed with a tumor. The median pain score was 2, with 65% of the patients reporting a pain score ≤2. The multivariate analysis showed that the prostate volume (RR, 1.34; 95% CI 1.01-1.77; P=.04), having a previous biopsy (RR, 2.25; 95% CI 1.44-3.52; P<.01), age (RR, .63; 95% CI .47-.85; P<.01) and feel palpation (RR, 1.95; 95% CI 1.28-2.96; P<.01) were factors independently associated with greater pain during the procedure. Transrectal biopsy with local anesthesia is a relatively painless technique. Factors such as age, a previous biopsy, pain on being touched and prostate volume were associated with the presence of greater pain during the procedure. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. [Electric stimulation acupuncture in peripheral neuropathic pain syndromes. Clinical pilot study on analgesic effectiveness].

    Science.gov (United States)

    Irnich, D; Winklmeier, S; Beyer, A; Peter, K

    2002-04-01

    The aim of this pilot study was to investigate the potential value of acupuncture in the treatment of peripheral neuropathic pain. Explorative analysis should provide data for further randomised controlled trials. In an uncontrolled clinical trial electroacupuncture was given to 17 patients with chronic neuropathic pain of peripheral origin which was resistant to preceding pain therapy. Patients were treated twice weekly for 4 weeks. Assessment of outcome measurements comprised: Intensity of continuous pain (visual analogue scale, VAS), intensity of pain attacks (VAS), duration of pain attacks, number of pain attacks and changes in mood (VAS). All measures were evaluated by diary (1 week before treatment to 2 weeks after treatment and 1 week at follow up three months after treatment). Changes of global complaints and patients' beliefs in treatment (credibility assessment) were also assessed. At re-evaluation two weeks after treatment, mean continuous pain was reduced by 32.9% and intensity of pain attacks was reduced by 59%. Mean number of daily pain attacks decreased from 4.2 (SD +/- 4.6, 0.14-13.3) before treatment to 2.2 (SD +/- 3.8, 0-7.5) two weeks after treatment. Duration of pain attacks and mood showed no substantial changes. Three months after treatment, continuous pain was reduced by 15.9% and intensity of pain attacks was reduced by 44% compared to baseline. No serious adverse events were observed On the basis of this small pilot study, trial treatment by electroacupuncture seems to be justified in these patients given a lack of success of standard treatments. The apparent beneficial analgesic effects of electroacupuncture appear to warrant further investigation.

  20. Chronic widespread pain : clinical comorbidities and psychological correlates

    NARCIS (Netherlands)

    Burri, Andrea; Ogata, Soshiro; Vehof, Jelle; Williams, Frances

    Recent studies have provided consistent evidence for a genetic influence on chronic widespread pain (CWP). The aim of this study was to investigate (1) the etiological structure underlying CWP by examining the covariation between CWP and psychological comorbidities and psychoaffective correlates and

  1. Clinical evaluation of nonarthritic shoulder pain: Diagnosis and treatment.

    Science.gov (United States)

    Holmes, Robert E; Barfield, William R; Woolf, Shane K

    2015-07-01

    Shoulder pain and dysfunction is a complex problem frequently encountered by primary care physicians. Common nonarthritic conditions seen in the primary care setting include rotator cuff syndrome, impingement, posttraumatic stiffness, adhesive capsulitis, and instability. A thorough history and physical examination can aid in the diagnosis of many common shoulder complaints. Pain and instability are the most common shoulder complaints. Pain that is sharp or burning is commonly radicular in origin, whereas pain caused by tendinitis is often dull, diffuse, and aching. Instability is frequently found in patients with a history of dislocation, but also may occur with no prior history. Imaging modalities such as magnetic resonance imaging can be helpful for more advanced pathology. However, many common shoulder conditions can be diagnosed without imaging, and may be initially treated with a short course of rest, ice, topical analgesics, nonsteroidal anti-inflammatory drugs, directed and supervised physical therapy, and occasionally subacromial corticosteroid injections. As always, a detailed history and a thorough physical exam by a primary care physician are vital for diagnosis. When conservative measures fail, referral to an orthopaedic surgeon may be necessary for further patient management.

  2. Knowledge, compliance with good clinical practices and barriers to effective control of postoperative pain among nurses from hospitals with and without a "Hospital without Pain" certificate.

    Science.gov (United States)

    Tomaszek, Lucyna; Dębska, Grażyna

    2017-12-08

    (1) To compare knowledge and compliance with good clinical practices regarding control of postoperative pain among nurses employed at hospitals with and without a "Hospital without Pain" certificate. (2) To identify the determinants of nurses' knowledge. (3) To define barriers to effective control of postoperative pain. Only a slight improvement in postoperative pain control has been observed recently, if any. Implementation of good clinical practices in the control of postoperative pain requires involvement of nurses. A cross-sectional study. The study included 257 nurses from hospitals with a "Hospital without Pain" certificate and 243 nurses from non-certified hospitals, with mean job seniority of 17.6±9.6 years. All respondents answered 26 questions regarding postoperative pain control-related issues. Based on the answers, overall scores were calculated for: (1) nurses' knowledge, (2) compliance with good clinical practices, and (3) barriers to effective control of postoperative pain. Nurses from the certified hospitals presented with significantly higher levels of knowledge and compliance with good clinical practices, and identified significantly more barriers to effective control of postoperative pain. Aside from certification of a hospital, better knowledge of postoperative pain control was determined by higher education, participation in postgraduate training programs and other relevant courses, self-education from medical journals, employment at pediatric ward or intensive care unit. The most commonly reported barriers to effective control of pain included too low doses of painkillers prescribed by physicians and inability to modify the protocol of pain treatment by the nurse. Control of postoperative pain can be improved by enrolling nurses in various forms of continuous training and by providing them with greater autonomy in administering painkillers to surgical patients. Better quality of care offered to patients with postoperative pain can be achieved

  3. Facilitators of and barriers to accessing clinical prevention services for the South Asian population in Surrey, British Columbia: a qualitative study.

    Science.gov (United States)

    Majid, Sanaa; Douglas, Rachel; Lee, Victoria; Stacy, Elizabeth; Garg, Arun K; Ho, Kendall

    2016-01-01

    British Columbia falls short in uptake of recommended clinical prevention services, with even lower rates among immigrant populations. This study explored facilitators of and barriers to uptake of clinical prevention services among people from South Asia, who represent 31% of the population in Surrey, British Columbia. We used a qualitative descriptive approach and employed vignettes in a focus group setting to elicit perspectives of South Asian people on accessing clinical prevention services. Participants aged 40 years or more were recruited between October 2014 and February 2015 from health care and community settings such as older-adult housing, day programs and health education events. Letters of introduction to the study were provided in English or Punjabi or both to all potential participants. We conducted qualitative content analysis of the results. Sixty-two South Asian adults (36 women and 26 men) aged 40-87 years participated in 1 of 8 focus groups in health care or community settings. Facilitators of and barriers to accessing clinical prevention services were noted at the patient, primary care provider and health care system levels. Facilitators at the patient level included taking ownership over one's health, health literacy and respecting the provider's advice; barriers included fear of the diagnosis, death and/or procedures, perceived low risk of disease or utility of the intervention, and side effects of procedures. Provider factors centred on a trust-based patient-provider relationship, strong communication and adequate time during visits. Health care system factors included such facilitators as processes to routinely offer prevention services as part of other health care or social services, systems that encourage prevention-oriented family practice and services at low or no cost to the patient. Our findings validate previously identified facilitators of and barriers to accessing preventive care for immigrant populations. However, the results

  4. Depressive Symptoms, Anatomical Region, and Clinical Outcomes for Patients Seeking Outpatient Physical Therapy for Musculoskeletal Pain

    Science.gov (United States)

    Coronado, Rogelio A.; Beneciuk, Jason M.; Valencia, Carolina; Werneke, Mark W.; Hart, Dennis L.

    2011-01-01

    Background Clinical guidelines advocate the routine identification of depressive symptoms for patients with pain in the lumbar or cervical spine, but not for other anatomical regions. Objective The purpose of this study was to investigate the prevalence and impact of depressive symptoms for patients with musculoskeletal pain across different anatomical regions. Design This was a prospective, associational study. Methods Demographic, clinical, depressive symptom (Symptom Checklist 90–Revised), and outcome data were collected by self-report from a convenience sample of 8,304 patients. Frequency of severe depressive symptoms was assessed by chi-square analysis for demographic and clinical variables. An analysis of variance examined the influence of depressive symptoms and anatomical region on intake pain intensity and functional status. Separate hierarchical multiple regression models by anatomical region examined the influence of depressive symptoms on clinical outcomes. Results Prevalence of severe depression was higher in women, in industrial and pain clinics, and in patients who reported chronic pain or prior surgery. Lower prevalence rates were found in patients older than 65 years and those who had upper- or lower-extremity pain. Depressive symptoms had a moderate to large effect on pain ratings (Cohen d=0.55–0.87) and a small to large effect on functional status (Cohen d=0.28–0.95). In multivariate analysis, depressive symptoms contributed additional variance to pain intensity and functional status for all anatomical locations, except for discharge values for the cervical region. Conclusions Rates of depressive symptoms varied slightly based on anatomical region of musculoskeletal pain. Depressive symptoms had a consistent detrimental influence on outcomes, except on discharge scores for the cervical anatomical region. Expanding screening recommendations for depressive symptoms to include more anatomical regions may be indicated in physical therapy

  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. Demographic characteristics and clinical predictors of patients discharged from university hospital-affiliated pain clinic due to breach in narcotic use contract.

    Science.gov (United States)

    Chakrabortty, Shushovan; Gupta, Deepak; Rustom, David; Berry, Hussein; Rai, Ajit

    2014-01-01

    The current retrospective study was completed with the aim to identify demographic characteristics and clinical predictors (if any) of the patients discharged from our pain clinic due to breach in narcotic use contract (BNUC). Retrospective patient charts' review and data audit. University hospital-affiliated pain clinic in the United States. All patient charts in our pain clinic for a 2-year period (2011-2012). The patients with BNUC were delineated from the patients who had not been discharged from our pain clinic. Pain characteristics, pain management, and substance abuse status were compared in each patient with BNUC between the time of admission and the time of discharge. The patients with BNUC discharges showed significant variability for the discharging factors among the pain physicians within a single pain clinic model with this variability being dependent on their years of experience and their proactive interventional pain management. The patients with BNUC in our pain clinic setting were primarily middle-aged, obese, unmarried males with nondocumented stable occupational history who were receiving only noninterventional pain management. Substance abuse, doctor shopping, and potential diversion were the top three documented reasons for BNUC discharges. In 2011-2012, our pain clinic discharged 1-in-16 patients due to breach in narcotic use contract.

  7. Chronic female pelvic pain--part 1: clinical pathoanatomy and examination of the pelvic region.

    Science.gov (United States)

    Apte, Gail; Nelson, Patricia; Brismée, Jean-Michel; Dedrick, Gregory; Justiz, Rafael; Sizer, Phillip S

    2012-02-01

    Chronic pelvic pain is defined as the presence of pain in the pelvic girdle region for over a 6-month period and can arise from the gynecologic, urologic, gastrointestinal, and musculoskeletal systems. As 15% of women experience pelvic pain at some time in their lives with yearly direct medical costs estimated at $2.8 billion, effective evaluation and management strategies of this condition are necessary. This merits a thorough discussion of a systematic approach to the evaluation of chronic pelvic pain conditions, including a careful history-taking and clinical examination. The challenge of accurately diagnosing chronic pelvic pain resides in the degree of peripheral and central sensitization of the nervous system associated with the chronicity of the symptoms, as well as the potential influence of the affective and biopsychosocial factors on symptom development as persistence. Once the musculoskeletal origin of the symptoms is identified, a clinical examination schema that is based on the location of primary onset of symptoms (lumbosacral, coccygeal, sacroiliac, pelvic floor, groin or abdominal region) can be followed to establish a basis for managing the specific pain generator(s) and manage tissue dysfunction. © 2011 The Authors. Pain Practice © 2011 World Institute of Pain.

  8. Effectiveness of dry needling for chronic nonspecific neck pain: a randomized, single-blinded, clinical trial.

    Science.gov (United States)

    Cerezo-Téllez, Ester; Torres-Lacomba, María; Fuentes-Gallardo, Isabel; Perez-Muñoz, Milagros; Mayoral-Del-Moral, Orlando; Lluch-Girbés, Enrique; Prieto-Valiente, Luis; Falla, Deborah

    2016-09-01

    Chronic neck pain attributed to a myofascial pain syndrome is characterized by the presence of muscle contractures referred to as myofascial trigger points. In this randomized, parallel-group, blinded, controlled clinical trial, we examined the effectiveness of deep dry needling (DDN) of myofascial trigger points in people with chronic nonspecific neck pain. The study was conducted at a public Primary Health Care Centre in Madrid, Spain, from January 2010 to December 2014. A total of 130 participants with nonspecific neck pain presenting with active myofascial trigger points in their cervical muscles were included. These participants were randomly allocated to receive: DDN plus stretching (n = 65) or stretching only (control group [n = 65]). Four sessions of treatment were applied over 2 weeks with a 6-month follow-up after treatment. Pain intensity, mechanical hyperalgesia, neck active range of motion, neck muscle strength, and perceived neck disability were measured at baseline, after 2 sessions of intervention, after the intervention period, and 15, 30, 90, and 180 days after the intervention. Significant and clinically relevant differences were found in favour of dry needling in all the outcomes (all P stretching is more effective than passive stretching alone in people with nonspecific neck pain. The results support the use of DDN in the management of myofascial pain syndrome in people with chronic nonspecific neck pain.

  9. Vaginal microbiological flora, and behavioural and clinical findings in women with vulvar pain.

    Science.gov (United States)

    Tchoudomirova, K; Mårdh, P A; Hellberg, D

    2001-05-01

    To study genital symptoms and signs in women with vulvar pain, and the association with potential risk factors such as microbiological agents, sexual behaviour and genital hygiene. Prospective cohort study of apparently healthy women attending for contraceptive advice. Two family planning clinics and one youth clinic in Sweden. Out of 996 women recruited, 79 women (7.9%) had, on request, complaints of current burning and smarting vulvar pain and/or superficial dyspareunia (our definition of vulvar pain) while 917 women without such symptoms served as controls. Complaints of dysmenorrhoea, vaginal discharge, genito-anal pruritus, dysuria, and abdominal pain were more frequent in the study group, than in the control group. In the women with vulvar pain, erythemas, superficial ulcerations, and fissures were found significantly more frequently. Vaginal candidosis was the only current genital infection that occurred more often in the study group, than among the controls. There were no differences in the history of gonorrhoea, genital chlamydial infection, genital herpes, genital warts, and candidosis between the two groups. The sexual debut of the women with vulvar pain occurred later in life, compared with the control group. Control subjects were more likely to use tampons for menstrual sanitation, than the women with vulvar pain. Neither infectious conditions caused by current known agents, with the exception of candidosis in some cases, nor behavioural factors, such as sexual behaviour and genital hygiene habits could in this study explain vulvar pain.

  10. Pain in hospitalized HIV-positive patients: clinical and therapeutical issues

    Directory of Open Access Journals (Sweden)

    Elisa Miranda Aires

    Full Text Available Pain is frequently reported by patients infected with Acquired Immunodeficiency Virus (HIV, and its causes and specific treatment should be appropriately investigated. We evaluated 197 hospitalized HIV-positive patients with serial interviews and analysis of prescriptions and clinical evolution charts. The main characteristics of pain reported by these patients were: high intensity (60.7%, high frequency (72.0% and well-known causes (88.8%. Fifty-two per cent of the patients reported persistent or frequent pain during the two weeks before hospital admission. Parameters such as gender, educational level and Karnofsky Index showed no direct relation to the presence or absence of pain. The most commonly affected sites were the head (28.0% and the abdomen (26.2%. The frequency of indications of pain in the clinical evolution charts (46.2% was considerably lower than the frequency of complaints reported by patients during the interviews (76.3%. Pain was undertreated in 83.2% of patients, both due to poor efficacy of the prescribed medications and to the excessive and inefficient use of standing order ("if necessary" regimens. We observed that pain was better managed during the hospitalization period, although this cannot be explained by improvement of the analgesic treatment; it might be due to successful treatment of the underlying disease. We concluded that pain reported by hospitalized HIV-positive patients is often underestimated and inadequately treated by assisting doctors, in spite of its severity and frequency.

  11. [Tapentadol prolonged release for the treatment of severe chronic tumor pain in routine clinical practice].

    Science.gov (United States)

    Agbalaka, A; Schwenke, K; Litzenburger, B

    2012-12-17

    This subgroup analysis of a non-interventional study involving general practitioners and internists investigated the administration of tapentadol prolonged release (Palexia retard) for the treatment of severe chronic tumor pain in routine clinical practice in Germany. Data of all patients in the study cohort who were exclusively diagnosed with tumor pain (n = 143) were included in this analysis. Data collection during the 3-month observation period included previous and concomitant analgesic treatment, tapentadol PR dosage, pain intensity, sleep and quality of life parameters, and tolerability of tapentadol PR. A total of 96.5% of all patients with tumor pain had already received analgesic long-term treatment prior to initiation of tapentadol PR therapy, 49.0% of those strong opioids. Switching to tapentadol PR resulted in a mean pain reduction of 3.8 points from 7.1 +/- 1.4 at baseline to 3.3 +/- 1.9 at end of observation (NRS-11, 11-point pain scale; descriptive pvalue or = 50%, and 89.9% of the patients attained either their intended pain reduction and/or an additional individual treatment goal; both goals had been predefined at start of tapentadol PR treatment. This was accompanied by a significant decrease in pain-related impairments of daily activities and an improvement in quality of life (descriptive p value tapentadol PR. Treatment with tapentadol PR was assessed positively by physicians and patients. Treatment with tapentadol PR resulted in marked effective and well tolerated relief of severe tumor pain accompanied by an improvement of pain-related impairments of daily activities and quality of life in this routine clinical practice non-interventional study. Tapentadol PR--an innovative effective analgesic--might thus provide an alternative treatment option in the management of tumor pain.

  12. Scrotal calculi in clinical practice and their role in scrotal pain: A prospective study.

    Science.gov (United States)

    Aslan, Ahmet; Tan, Sinan; Yıldırım, Halil; Dönmez, Uğur; Çam, Ali; Gezer, Mehmet Can; Teber, Mehmet Akif; Arslan, Halil

    2015-09-01

    Scrotal calculi are rare, and their clinical significance is uncertain. Scrotal pain is a frequent, hard-to-manage problem in urology clinics. Our purpose in this study was to determine the relationship between the presence of scrotal calculi and scrotal pain in a prospective manner. Sonography and color Doppler ultrasound of the scrotum were performed in 758 consecutive patients referred with scrotal pain. The pain was rated by using an 11-point numeric rating scale; scores were compared among patients with scrotal calculi with and without additional scrotal pathology. Scrotal calculi were detected in 73 of the 758 patients (9.6%). Scrotal pain (n = 50 [61%]) and a palpable mass in the scrotum (n = 25 [30.5%]) were the most common complaints in patients with scrotal calculi. Hydrocele (n = 17 [29.8%]) and varicocele (n = 15 [26.3%]) were the most commonly associated abnormalities; there was a statistically significant association between the presence of scrotal calculi and hydrocele (p pain was present in 61 (83.5%) patients with scrotal calculi, and this association was significant (p pain and the correlation between location of calculi and pain in patients without additional scrotal abnormalities were also significant (p = 0.04 and p pain. Because the etiology of scrotal pain is essential for appropriate treatment, scrotal calculi should be kept in mind when making a differential diagnosis of scrotal pain. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43:406-411, 2015. © 2014 Wiley Periodicals, Inc.

  13. The clinical psychologist and the management of inpatient pain: a small case series.

    Science.gov (United States)

    Childs, Susan R; Casely, Emma M; Kuehler, Bianca M; Ward, Stephen; Halmshaw, Charlotte L; Thomas, Sarah E; Goodall, Ian D; Bantel, Carsten

    2014-01-01

    Recent research has confirmed that between 25% and 33% of all hospitalized patients experience unacceptable levels of pain. Studies further indicate that this reduces patient satisfaction levels, lengthens hospital stays, and increases cost. Hospitals are aiming to discharge patients earlier, and this can interfere with adequate pain management. Therefore, the pain service at Chelsea and Westminster Hospital has adapted to this changing model of care. An increasing body of evidence demonstrates that psychological factors are key components of patients' pain experiences in both acute and chronic pain. Therefore, it is reasonable to suggest a clinical psychologist should be involved in inpatient pain management. This small study discusses three cases that highlight how patient care could be improved by including a clinical psychologist as part of the inpatient pain team. Two cases particularly highlight the active role of the psychologist in the diagnosis and management of common conditions such as fear and anxiety, along with other psychiatric comorbidities. The management therefore employed an eclectic approach adapted from chronic pain and comprising of behavioral, cognitive behavioral, and dialectical behavioral therapeutic techniques blended with brief counseling. The third case exemplifies the importance of nurse-patient interactions and the quality of nurse-patient relationships on patient outcomes. Here, the psychologist helped to optimize communication and to resolve a difficult and potentially risk-laden situation. This small case series discusses the benefits derived from the involvement of a clinical psychologist in the management of inpatient pain, and therefore illustrates the need for novel initiatives for inpatient pain services. However, future research is warranted to validate this approach.

  14. The cortical responses to evoked clinical pain in patients with hip osteoarthritis.

    Directory of Open Access Journals (Sweden)

    Mikkel Gram

    Full Text Available Experimental models have been used extensively to evaluate pain using e.g., visual analogue scales or electroencephalography (EEG. Stimulation using tonic pain has been shown to better mimic the unpleasantness of chronic pain, but has mainly been evoked by non-clinical stimuli. This study aims to, evaluate the EEG during clinical pain in patients scheduled for total hip replacement with control and resting conditions.The hip scheduled for replacement was moved by the examiner to evoke pain for 30 seconds while recording EEG. The control condition entailed movement of the opposite hip in a similar fashion and holding it for 30 seconds. In addition, EEG was recorded during the resting condition with open eyes. The relative spectral content was calculated from the EEG as well as functional connectivity using phase-lag index for frequency bands delta (1-4Hz, theta (4-8Hz, alpha (8-12Hz and beta (12-32Hz. A mixed model was used for statistical comparison between the three recording conditions.Spectral content differed between conditions in all bands. Functional connectivity differed in delta and theta frequency bands. Post-hoc analysis revealed differences between the painful and control condition in delta, theta and beta for spectral content. Pain during the hip rotation was correlated to the theta (r = -0.24 P = 0.03 and beta (r = 0.25 P = 0.02 content in the EEG.EEG differences during hip movements in the affected and unaffected hip appeared in the spectral beta and theta content. This was correlated to the reported pain perceived, pointing towards pain specific brain activity related to clinical pain.

  15. Acute pain management in burn patients: appraisal and thematic analysis of four clinical guidelines.

    Science.gov (United States)

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

    2014-12-01

    Burn patients suffer excruciating pain due to their injuries and procedures related to surgery, wound care, and mobilization. Acute Stress Disorder, Post-Traumatic Stress Disorder, chronic pain and depression are highly prevalent among survivors of severe burns. Evidence-based pain management addresses and alleviates these complications. The aim of our study was to compare clinical guidelines for pain management in burn patients in selected European and non-European countries. We included pediatric guidelines due to the high rate of children in burn units. The study had a comparative retrospective design using combined methodology of instrument appraisal and thematic analysis. Three investigators appraised guidelines from burn units in Denmark (DK), Sweden (SE), New Zealand (NZ), and USA using the AGREE Instrument (Appraisal of Guidelines for Research & Evaluation), version II, and identified core themes in the guidelines. The overall scores expressing quality in six domains of the AGREE instrument were variable at 22% (DK), 44% (SE), 100% (NZ), and 78% (USA). The guidelines from NZ and USA were highly recommended, the Swedish was recommended, whereas the Danish was not recommended. The identified core themes were: continuous pain, procedural pain, postoperative pain, pain assessment, anxiety, and non-pharmacological interventions. The study demonstrated variability in quality, transparency, and core content in clinical guidelines on pain management in burn 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 patients in the clinic, to unify guideline construction, and to enable interdepartmental comparison of treatment and outcomes. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  16. Temporomandibular Joint Pain: Clinical Presentations and Response to Conservative Treatments in a Nigerian Tertiary Hospital.

    Science.gov (United States)

    Oyetola, Elijah Olufemi; Adesina, Olufunlola Motunrayo; Oluwadaisi, Adeniyi; Adewale, Adedotun; Adewole, Opeyemi; Anizoba, E

    2017-01-01

    The aims of this study are to determine the prevalence, pattern of presentation, and response to conservative (medical) interventions among patients who presented with temporomandibular joint (TMJ) pain in a Nigerian teaching hospital. Consecutive patients who presented in Oral Medicine and Periodontology Clinic of Obafemi Awolowo University Teaching Hospitals' Complex on account of TMJ pain from January 2015 to December 2015 were recruited for the study. They were all interviewed and examined. The severity of pain was recorded using visual analog scale (VAS). Patients were treated with medications and physiotherapy. They were reviewed at 2, 4, and 6 weeks. Those who could not make the appointment were contacted through phone. The findings were recorded and analyzed using STATA version 11. A total of 401 participants were seen, 55 presented on account of TMJ pain. The mean age of patients with TMJ pain was 54 ± 16.9 with 60% being female. Pain was present in all participants; other signs include clicking joint sound (85%), jaw deviation (64%), attrition (24%), and reduced mouth opening (23%). The left joint was more frequently affected (75%). Following 6 weeks of conservative treatments, none of the respondents had VAS score of more than 3. The prevalence of TMJ pain was 13%. TMJ was found to be more common in participants above 50 years with female predilection. Pain was most common symptom seen, and response to conservative treatments as assessed using VAS following 6-week of treatment showed complete remission of the pain.

  17. Perspectives on the clinical significance of functional pain syndromes in children

    Directory of Open Access Journals (Sweden)

    Basch MC

    2015-10-01

    Full Text Available Molly C Basch,1,2 Erika T Chow,1,3 Deirdre E Logan,1,4 Neil L Schechter,4 Laura E Simons1,2,4 1Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, 2Boston Children's Hospital, Center for Pain and the Brain, PAIN Research Group, 3Boston University School of Medicine, Boston University, 4Department of Psychiatry, Harvard Medical School, Boston, MA, USA Abstract: Functional pain syndromes (FPS characterize a subset of individuals who experience pain and related symptoms and disability without clear structural or disease etiology. In the pediatric population, FPS hold high clinical importance due to significant prevalence rates and potential to persist into adulthood. Although extensive research has been executed to disambiguate FPS, the syndromes that fall within its spectrum remain conceptually complex and sometimes ill-defined. This paper provides an overview of available research on the classification and multifaceted etiology of FPS in youth and their effects on interpersonal, psychological, and familial function. Vital aspects of a successful multidisciplinary approach to treating this population are described; however, it is evident that future research requires more longitudinal studies. Keywords: overlapping chronic pain, functional pain, primary pain disorders, pediatrics, biopsychosocial model

  18. Transforming long-term care pain management in north america: the policy-clinical interface.

    Science.gov (United States)

    Hadjistavropoulos, Thomas; Marchildon, Gregory P; Fine, Perry G; Herr, Keela; Palley, Howard A; Kaasalainen, Sharon; Béland, François

    2009-04-01

    The undertreatment of pain in older adults who reside in long-term care (LTC) facilities has been well documented, leading to clinical guideline development and professional educational programs designed to foster better pain assessment and management in this population. Despite these efforts, little improvement has occurred, and we postulate that focused attention to public policy and cost implications of systemic change is required to create positive pain-related outcomes. Our goal was to outline feasible and cost-effective clinical and public policy recommendations designed to address the undermanagement of pain in LTC facilities. We arranged a 2-day consensus meeting of prominent United States and Canadian pain and public policy experts. An initial document describing the problem of pain undermanagement in LTC was developed and circulated prior to the meeting. Participants were also asked to respond to a list of relevant questions before arriving. Following formal presentations of a variety of proposals and extensive discussion among clinicians and policy experts, a set of recommendations was developed. We outline key elements of a transformational model of pain management in LTC for the United States and Canada. Consistent with previously formulated clinical guidelines but with attention to readily implementable public policy change in both countries, this transformational model of LTC has important implications for LTC managers and policy makers as well as major quality of life implications for LTC residents.

  19. Clinical and Psychological Variables Present in Patients with Chronic Back Pain

    Directory of Open Access Journals (Sweden)

    Ahmed José Pomares Avalos

    2016-03-01

    Full Text Available Background: chronic back pain is regarded as a major public health problem with a substantial socio-economic impact. Objective: to determine the main clinical and psychological variables present in patients with chronic back pain. Methods: a case series study including the comparison of variables was conducted from July to December 2015 at the Dr. Gustavo Aldereguía Lima Hospital in Cienfuegos. The study variables were: age, sex, educational level, occupation, origin, characteristics of pain (intensity, frequency, duration, type of treatment used for its relief, anxiety, depression, anger and hostility as personality traits, and anxiety, depression and stress as negative emotional states. A non-probability sample of patients with chronic back pain was used. The information was obtained through a questionnaire and various psychological instruments. Results: predominant psychological variables were pathological stress as negative emotional state, as well as trait anxiety and depression. The prevailing clinical variables were moderate intensity of pain, episodic occurrence, duration longer than 2 years and medical treatment as the most frequent type of treatment used.Conclusions: high trait anxiety and pathological stress as negative emotional state coexist in patients with chronic back pain. These psychological aspects may be influencing the presence and clinical characteristics of pain.

  20. [Opinions and attitudes of clinical staff on systems for the assessment and treatment of children's pain].

    Science.gov (United States)

    Ullan, A M; Fernández, E; Badia, M; Lorente, F; Malmierca, F; Zapatero, I

    2013-08-01

    Many factors affect the assessment and treatment of pain, among them being the knowledge and attitudes of clinical staff. The goal of this work was to determine the opinions and attitudes of clinical staff from two hospitals on the different aspects of the assessment and treatment of children's pain. A cross-sectional, descriptive study was conducted using a self-administered questionnaire issued to clinical staff. The questionnaire was given to the professionals, doctors, and nursing staff of the paediatric services of two hospitals, and to an incidental sample of paediatric doctors. Of the 146 questionnaires sent out, 105 were completed. Participants indicated that standardised scales and physiological recordings were the least frequently used methods to assess children's pain. Participants considered that pharmacological techniques for the treatment of pain were used more frequently than non-pharmacological techniques, at all ages. Participants acknowledged being significantly more knowledgeable about pharmacological methods to relieve paediatric pain than about non-pharmacological methods. There is margin for improvement in systems for the assessment and treatment of children's pain as regards the more frequent and standardised use of techniques and standardised tools for the assessment of pain, and the greater administration of non-pharmacological strategies for its treatment. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  1. Depressive Disorder, Anxiety Disorder and Chronic Pain: Multiple Manifestations of a Common Clinical and Pathophysiological Core.

    Science.gov (United States)

    Arango-Dávila, Cesar A; Rincón-Hoyos, Hernán G

    A high proportion of depressive disorders are accompanied by anxious manifestations, just as depression and anxiety often present with many painful manifestations, or conversely, painful manifestations cause or worsen depressive and anxious expressions. There is increasingly more evidence of the pathophysiological, and neurophysiological and technical imaging similarity of pain and depression. Narrative review of the pathophysiological and clinical aspects of depression and chronic pain comorbidity. Research articles are included that emphasise the most relevant elements related to understanding the pathophysiology of both manifestations. The pathological origin, physiology and clinical approach to these disorders have been more clearly established with the latest advances in biochemical and cellular techniques, as well as the advent of imaging technologies. This information is systematised with comprehensive images and clinical pictures. The recognition that the polymorphism of inflammation-related genes generates susceptibility to depressive manifestations and may modify the response to antidepressant treatments establishes that the inflammatory response is not only an aetiopathogenic component of pain, but also of stress and depression. Likewise, the similarity in approach with images corroborates not only the structural, but the functional and pathophysiological analogy between depression and chronic pain. Knowledge of depression-anxiety-chronic pain comorbidity is essential in the search for effective therapeutic interventions. Copyright © 2016 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  2. Relationships among pain and depressive and anxiety symptoms in clinical trials of pregabalin in fibromyalgia.

    Science.gov (United States)

    Arnold, Lesley M; Leon, Teresa; Whalen, Ed; Barrett, Jeannette

    2010-01-01

    Fibromyalgia, as defined by the American College of Rheumatology, is characterized by widespread pain lasting for at least 3 months, with pain in at least 11 out of 18 tender points when palpated with digital pressure. The authors investigated the relationship between changes in pain and symptoms of anxiety and depression, using data from pregabalin clinical trials. Results from three double-blind, placebo-controlled trials of pregabalin monotherapy in fibromyalgia (8-14 weeks) were pooled, and baseline to end-point changes in pain and Hospital Anxiety and Depression Scale (HADS) scores were analyzed. Path-analysis evaluated the association between improvements in anxiety and depression and pain relief. Baseline HADS scores indicated moderate-to-severe anxiety in 38% of patients and moderate-to-severe depressive symptoms in 27%. The improvement in pain was not related to baseline levels of anxiety or depression. The correlation between changes in pain and depressive or anxiety symptoms was low-to-moderate. Path-analysis showed that most of the pain relief observed with pregabalin treatment was a direct analgesic effect and was not explained by improvement in mood. Response to treatment of pain in the pregabalin trials did not depend on baseline levels of anxiety or depressive symptoms, and pregabalin improved pain in fibromyalgia patients with or without depressive or anxiety symptoms. Changes in the level of anxiety or depression had a low-to-moderate impact on pain reduction. Pain reduction with pregabalin treatment appeared to result mostly from a direct treatment effect, rather than an indirect effect mediated through improvement in anxiety or depressive symptoms.

  3. Clinical Practice Guideline: Chiropractic Care for Low Back Pain.

    Science.gov (United States)

    Globe, Gary; Farabaugh, Ronald J; Hawk, Cheryl; Morris, Craig E; Baker, Greg; Whalen, Wayne M; Walters, Sheryl; Kaeser, Martha; Dehen, Mark; Augat, Thomas

    2016-01-01

    The purpose of this article is to provide an update of a previously published evidence-based practice guideline on chiropractic management of low back pain. This project updated and combined 3 previous guidelines. A systematic review of articles published between October 2009 through February 2014 was conducted to update the literature published since the previous Council on Chiropractic Guidelines and Practice Parameters (CCGPP) guideline was developed. Articles with new relevant information were summarized and provided to the Delphi panel as background information along with the previous CCGPP guidelines. Delphi panelists who served on previous consensus projects and represented a broad sampling of jurisdictions and practice experience related to low back pain management were invited to participate. Thirty-seven panelists participated; 33 were doctors of chiropractic (DCs). In addition, public comment was sought by posting the consensus statements on the CCGPP Web site. The RAND-UCLA methodology was used to reach formal consensus. Consensus was reached after 1 round of revisions, with an additional round conducted to reach consensus on the changes that resulted from the public comment period. Most recommendations made in the original guidelines were unchanged after going through the consensus process. The evidence supports that doctors of chiropractic are well suited to diagnose, treat, co-manage, and manage the treatment of patients with low back pain disorders. Copyright © 2016 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

  4. Stress and visceral pain: from animal models to clinical therapies

    Science.gov (United States)

    Larauche, Muriel; Mulak, Agata; Taché, Yvette

    2011-01-01

    Epidemiological studies have implicated stress (psychosocial and physical) as a trigger of first onset or exacerbation of irritable bowel syndrome (IBS) symptoms of which visceral pain is an integrant landmark. A number of experimental acute or chronic exteroceptive or interoceptive stressors induce visceral hyperalgesia in rodents although recent evidence also points to stress-related visceral analgesia as established in the somatic pain field. Underlying mechanisms of stress-related visceral hypersensitivity may involve a combination of sensitization of primary afferents, central sensitization in response to input from the viscera and dysregulation of descending pathways that modulate spinal nociceptive transmission or analgesic response. Biochemical coding of stress involves the recruitment of corticotropin releasing factor (CRF) signaling pathways. Experimental studies established that activation of brain and peripheral CRF receptor subtype 1 plays a primary role in the development of stress-related delayed visceral hyperalgesia while subtype 2 activation induces analgesic response. In line with stress pathways playing a role in IBS, non-pharmacologic and pharmacologic treatment modalities aimed at reducing stress perception using a broad range of evidence-based mind-body interventions and centrally-targeted medications to reduce anxiety impact on brain patterns activated by visceral stimuli and dampen visceral pain. PMID:21575632

  5. Telecare collaborative management of chronic pain in primary care: a randomized clinical trial.

    Science.gov (United States)

    Kroenke, Kurt; Krebs, Erin E; Wu, Jingwei; Yu, Zhangsheng; Chumbler, Neale R; Bair, Matthew J

    2014-07-16

    Chronic musculoskeletal pain is among the most prevalent, costly, and disabling medical disorders. However, few clinical trials have examined interventions to improve chronic pain in primary care. To determine the effectiveness of a telecare intervention for chronic pain. The Stepped Care to Optimize Pain Care Effectiveness (SCOPE) study was a randomized trial comparing a telephone-delivered collaborative care management intervention vs usual care in 250 patients with chronic (≥3 months) musculoskeletal pain of at least moderate intensity (Brief Pain Inventory [BPI] score ≥5). Patients were enrolled from 5 primary care clinics in a single Veterans Affairs medical center from June 2010 through May 2012, with 12-month follow-up completed by June 2013. Patients were randomized either to an intervention group (n = 124) or to a usual care group whose members received all pain care as usual from their primary care physicians (n = 126). The intervention group received 12 months of telecare management that coupled automated symptom monitoring with an algorithm-guided stepped care approach to optimizing analgesics. Primary outcome was the BPI total score, which ranges from 0 ("no pain") to 10 ("pain as bad as you can imagine") and for which a 1-point change is considered clinically important. Secondary pain outcomes included BPI interference and severity, global pain improvement, treatment satisfaction, and use of opioids and other analgesics. Overall, mean (SD) baseline BPI scores in the intervention and control groups were 5.31 (1.81) and 5.12 (1.80), respectively. Compared with usual care, the intervention group had a 1.02-point lower (95% CI, -1.58 to -0.47) BPI score at 12 months (3.57 vs 4.59). Patients in the intervention group were nearly twice as likely to report at least a 30% improvement in their pain score by 12 months (51.7% vs 27.1%; relative risk, 1.9 [95% CI, 1.4 to 2.7]), with a number needed to treat of 4.1 (95% CI, 3.0 to 6.4) for a 30

  6. Advanced Genetic Testing Comes to the Pain Clinic to Make a Diagnosis of Paroxysmal Extreme Pain Disorder

    Directory of Open Access Journals (Sweden)

    Ashley Cannon

    2016-01-01

    Full Text Available Objective. To describe the use of an advanced genetic testing technique, whole exome sequencing, to diagnose a patient and their family with a SCN9A channelopathy. Setting. Academic tertiary care center. Design. Case report. Case Report. A 61-year-old female with a history of acute facial pain, chronic pain, fibromyalgia, and constipation was found to have a gain of function SCN9A mutation by whole exome sequencing. This mutation resulted in an SCN9A channelopathy that is most consistent with a diagnosis of paroxysmal extreme pain disorder. In addition to the patient being diagnosed, four siblings have a clinical diagnosis of SCN9A channelopathy as they have consistent symptoms and a sister with a known mutation. For treatment, gabapentin was ineffective and carbamazepine was not tolerated. Nontraditional therapies improved symptoms and constipation resolved with pelvic floor retraining with biofeedback. Conclusion. Patients with a personal and family history of chronic pain may benefit from a referral to Medical Genetics. Pelvic floor retraining with biofeedback should be considered for patients with a SCN9A channelopathy and constipation.

  7. Changes in pain catastrophizing predict later changes in fibromyalgia clinical and experimental pain report: cross-lagged panel analyses of dispositional and situational catastrophizing.

    Science.gov (United States)

    Campbell, Claudia M; McCauley, Lea; Bounds, Sara C; Mathur, Vani A; Conn, Lora; Simango, Mpepera; Edwards, Robert R; Fontaine, Kevin R

    2012-10-25

    Fibromyalgia (FM), characterized by wide-spread diffuse pain and sensory abnormalities, is associated with elevated indices of distress and pain-related catastrophizing compared to both pain-free samples and those with chronic pain conditions. Catastrophizing is a pervasive negative mental set, and is a strong predictor of negative pain-related outcomes such as clinical pain intensity, and physical disability. Situational catastrophizing, measured in the context of experimentally-induced pain, is strongly related to enhanced pain sensitivity, a core aspect of the pathophysiology of fibromyalgia. However, little is known regarding the temporal course of the association between catastrophizing and pain-related "outcomes". Most studies involve only static assessments of pain and catastrophizing at a single time point, which provides little insight into the direction of the observed associations. We sought to investigate the temporal relationships between catastrophizing and indices of both clinical pain (substudy 1) and experimentally-induced pain (substudy 2) in a larger randomized controlled longitudinal trial. Fifty-seven patients with FM completed catastrophizing, depression, and pain questionnaires as well as laboratory cold pressor pain testing at baseline, post-intervention and three month follow-up during a lifestyle physical activity study. Cross-lagged panel analyses were used to address these temporal relationships. In substudy 1, analyses revealed that pre-to-post changes in dispositional catastrophizing ratings prospectively accounted for unique variance in subsequent post-to-follow-up changes in clinical pain ratings (p = 0.005), while pre-to-post changes in pain ratings did not account for unique variance in post-to-follow-up changes in catastrophizing ratings. An identical pattern was observed experimentally in substudy 2, with pre-to-post changes in situational catastrophizing ratings prospectively accounting for unique variance in subsequent post

  8. 1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain.

    Science.gov (United States)

    Waddell, G

    1987-09-01

    Because there is increasing concern about low-back disability and its current medical management, this analysis attempts to construct a new theoretic framework for treatment. Observations of natural history and epidemiology suggest that low-back pain should be a benign, self-limiting condition, that low back-disability as opposed to pain is a relatively recent Western epidemic, and that the role of medicine in that epidemic must be critically examined. The traditional medical model of disease is contrasted with a biopsychosocial model of illness to analyze success and failure in low-back disorders. Studies of the mathematical relationship between the elements of illness in chronic low-back pain suggest that the biopsychosocial concept can be used as an operational model that explains many clinical observations. This model is used to compare rest and active rehabilitation for low-back pain. Rest is the commonest treatment prescribed after analgesics but is based on a doubtful rationale, and there is little evidence of any lasting benefit. There is, however, little doubt about the harmful effects--especially of prolonged bed rest. Conversely, there is no evidence that activity is harmful and, contrary to common belief, it does not necessarily make the pain worse. Experimental studies clearly show that controlled exercises not only restore function, reduce distress and illness behavior, and promote return to work, but actually reduce pain. Clinical studies confirm the value of active rehabilitation in practice. To achieve the goal of treating patients rather than spines, we must approach low-back disability as an illness rather than low-back pain as a purely physical disease. We must distinguish pain as a purely the symptoms and signs of distress and illness behavior from those of physical disease, and nominal from substantive diagnoses. Management must change from a negative philosophy of rest for pain to more active restoration of function. Only a new model and

  9. British citizens in a regional community of southeastern Spain with a pre-clinical organ xenotransplantation program. A study of attitude toward xenotransplantation.

    Science.gov (United States)

    Ríos, A; Ramírez, P; Martínez, L; Jarvis, N; Sánchez, J; Rodríguez, M M; Alcaraz, J; Montoya, M J; Parrilla, P

    2007-05-01

    It is important to find out about the social acceptance of xenotransplantation, especially in populations where there are pre-clinical xenotransplantation projects, and therefore the possibility of xenotransplantation to humans. In the native population of southeastern Spain this situation is well-known, but in recent years there has been an important social change because of a considerable migrational flow into Spain, especially from the British Isles. To analyze the attitude toward xenotransplantation among the population living in southeastern Spain born in the British Isles and to determine the variables that affect this attitude. A random sample was taken of British and Irish citizens resident in southeast Spain and stratified according to a respondent's nationality (n = 1700). The data were obtained between November 2005 and April 2006. Attitude was evaluated using a validated questionnaire that was completed anonymously and self-administered. The control group comprised a random sample (n = 250) of the native population. Student's t-test, the chi-squared test, Fischer's exact test and a logistic regression analysis were used in the statistical analysis. The questionnaire completion rate was 91% (n = 1546), with 69% of respondents in favor of xenotransplantation, 8% against and 23% unsure, an attitude that is similar to that of the control group (P = 0.1616). These attitudes were based on the assumption that transplanted animal organs had the same outcomes and involved the same risks as human ones. This attitude is related to the following factors: (i) being of male sex (P = 0.0477); (ii) level of education (P = 0.012); (iii) being natives from England or Wales (P = 0.016); (iv) participation in voluntary pro-social activities (P = 0.035); (v) the respondent's religion (P organ donation and transplantation within the family (P donation or transplantation (P = 0.024); (x) the belief that in the future one might need a transplant (P = 0.007) and (xi) a

  10. Elimination of pain improves specificity of clinical diagnostic criteria for adult chronic rhinosinusitis.

    Science.gov (United States)

    Hirsch, Scott D; Reiter, Evan R; DiNardo, Laurence J; Wan, Wen; Schuman, Theodore A

    2017-05-01

    Determine whether the elimination of pain improves accuracy of clinical diagnostic criteria for adult chronic rhinosinusitis. Retrospective cohort study. History, symptoms, nasal endoscopy, and computed tomography (CT) results were analyzed for 1,186 adults referred to an academic otolaryngology clinic with presumptive diagnosis of chronic rhinosinusitis. Clinical diagnosis was rendered using the 1997 Rhinosinusitis Taskforce (RSTF) Guidelines and a modified version eliminating facial pain, ear pain, dental pain, and headache. Four hundred seventy-nine subjects (40%) met inclusion criteria. Among subjects positive by RSTF guidelines, 45% lacked objective evidence of sinonasal inflammation by CT, 48% by endoscopy, and 34% by either modality. Applying modified RSTF diagnostic criteria, 39% lacked sinonasal inflammation by CT, 38% by endoscopy, and 24% by either modality. Using either abnormal CT or endoscopy as the reference standard, modified diagnostic criteria yielded a statistically significant increase in specificity from 37.1% to 65.1%, with a nonsignificant decrease in sensitivity from 79.2% to 70.3%. Analysis of comorbidities revealed temporomandibular joint disorder, chronic cervical pain, depression/anxiety, and psychiatric medication use to be negatively associated with objective inflammation on CT or endoscopy. Clinical diagnostic criteria overestimate the prevalence of chronic rhinosinusitis. Removing facial pain, ear pain, dental pain, and headache increased specificity without a concordant loss in sensitivity. Given the high prevalence of sinusitis, improved clinical diagnostic criteria may assist primary care providers in more accurately predicting the presence of inflammation, thereby reducing inappropriate antibiotic use or delayed referral for evaluation of primary headache syndromes. 4. Laryngoscope, 127:1011-1016, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  11. Evidenced-based clinical practice guideline for management of newborn pain.

    Science.gov (United States)

    Spence, Kaye; Henderson-Smart, David; New, Karen; Evans, Cheryl; Whitelaw, Jan; Woolnough, Rowena

    2010-04-01

    To facilitate the uptake of evidence and to reduce the evidence practice gap for management of newborn pain through the development of a clinical practice guideline. An audit of practice and an appraisal of clinical practice guidelines were undertaken to establish current practices and guideline availability for the management of newborn pain in 23 hospitals in Australia. Guidelines were appraised using the Appraisal of Guidelines for Research and Evaluation instrument. A literature search was undertaken to acquire the evidence for best practice for management of newborn pain. Neonatal units in 17 hospitals had clinical practice guidelines. Each was peer reviewed and assessed according to the domains of the Appraisal of Guidelines for Research and Evaluation instrument. There was lack of consistency across the guidelines. As a result, a best practice guideline was developed based on current best evidence and the Royal Australian College of Physicians recommendations. To facilitate an ongoing compliance with the guideline, an audit tool was included together with algorithms for procedural pain and pain assessment. The clinical practice guideline can be used by clinicians in varying settings such as the neonatal intensive care and special care unit. The document can be used to support existing practices or challenge clinicians to close the evidence practice gap for the management of newborn pain.

  12. Subjective and clinical assessment criteria suggestive for five clinical patterns discernible in nonspecific neck pain patients. A Delphi-survey of clinical experts.

    Science.gov (United States)

    Dewitte, Vincent; Peersman, Wim; Danneels, Lieven; Bouche, Katie; Roets, Arne; Cagnie, Barbara

    2016-12-01

    Nonspecific neck pain patients form a heterogeneous group with different musculoskeletal impairments. Classifying nonspecific neck pain patients into subgroups based on clinical characteristics might lead to more comprehensive diagnoses and can guide effective management. To establish consensus among a group of experts regarding the clinical criteria suggestive of a clinical dominance of 'articular', 'myofascial', 'neural', 'central' and 'sensorimotor control' dysfunction patterns distinguishable in patients with nonspecific neck pain. Delphi study. A focus group with 10 academic experts was organized to elaborate on the different dysfunction patterns discernible in neck pain patients. Consecutively, a 3-round online Delphi-survey was designed to obtain consensual symptoms and physical examination findings for the 5 distinct dysfunction patterns resulting from the focus group. A total of 21 musculoskeletal physical therapists from Belgium and the Netherlands experienced in assessing and treating neck pain patients completed the 3-round Delphi-survey. Respectively, 33 (response rate, 100.0%), 27 (81.8%) and 21 (63.6%) respondents replied to rounds 1, 2 and 3. Eighteen 'articular', 16 'myofascial', 20 'neural', 18 'central' and 10 'sensorimotor control' clinical indicators reached a predefined ≥80% consensus level. These indicators suggestive of a clinical dominance of 'articular', 'myofascial', 'neural', 'central', and 'sensorimotor control' dysfunction patterns may help clinicians to assess and diagnose patients with nonspecific neck pain. Future validity testing is needed to determine how these criteria may help to improve the outcome of physical therapy interventions in nonspecific neck pain patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: A randomised clinical trial

    Directory of Open Access Journals (Sweden)

    Darnell Ross

    2008-02-01

    Full Text Available Abstract Background Patellofemoral pain syndrome is a highly prevalent musculoskeletal overuse condition that has a significant impact on participation in daily and physical activities. A recent systematic review highlighted the lack of high quality evidence from randomised controlled trials for the conservative management of patellofemoral pain syndrome. Although foot orthoses are a commonly used intervention for patellofemoral pain syndrome, only two pilot studies with short term follow up have been conducted into their clinical efficacy. Methods/design A randomised single-blinded clinical trial will be conducted to investigate the clinical efficacy and cost effectiveness of foot orthoses in the management of patellofemoral pain syndrome. One hundred and seventy-six participants aged 18–40 with anterior or retropatellar knee pain of non-traumatic origin and at least six weeks duration will be recruited from the greater Brisbane area in Queensland, Australia through print, radio and television advertising. Suitable participants will be randomly allocated to receive either foot orthoses, flat insoles, physiotherapy or a combined intervention of foot orthoses and physiotherapy, and will attend six visits with a physiotherapist over a 6 week period. Outcome will be measured at 6, 12 and 52 weeks using primary outcome measures of usual and worst pain visual analogue scale, patient perceived treatment effect, perceived global effect, the Functional Index Questionnaire, and the Anterior Knee Pain Scale. Secondary outcome measures will include the Lower Extremity Functional Scale, McGill Pain Questionnaire, 36-Item Short-Form Health Survey, Hospital Anxiety and Depression Scale, Patient-Specific Functional Scale, Physical Activity Level in the Previous Week, pressure pain threshold and physical measures of step and squat tests. Cost-effectiveness analysis will be based on treatment effectiveness against resource usage recorded in treatment logs and

  14. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: A randomised clinical trial

    Science.gov (United States)

    Vicenzino, Bill; Collins, Natalie; Crossley, Kay; Beller, Elaine; Darnell, Ross; McPoil, Thomas

    2008-01-01

    Background Patellofemoral pain syndrome is a highly prevalent musculoskeletal overuse condition that has a significant impact on participation in daily and physical activities. A recent systematic review highlighted the lack of high quality evidence from randomised controlled trials for the conservative management of patellofemoral pain syndrome. Although foot orthoses are a commonly used intervention for patellofemoral pain syndrome, only two pilot studies with short term follow up have been conducted into their clinical efficacy. Methods/design A randomised single-blinded clinical trial will be conducted to investigate the clinical efficacy and cost effectiveness of foot orthoses in the management of patellofemoral pain syndrome. One hundred and seventy-six participants aged 18–40 with anterior or retropatellar knee pain of non-traumatic origin and at least six weeks duration will be recruited from the greater Brisbane area in Queensland, Australia through print, radio and television advertising. Suitable participants will be randomly allocated to receive either foot orthoses, flat insoles, physiotherapy or a combined intervention of foot orthoses and physiotherapy, and will attend six visits with a physiotherapist over a 6 week period. Outcome will be measured at 6, 12 and 52 weeks using primary outcome measures of usual and worst pain visual analogue scale, patient perceived treatment effect, perceived global effect, the Functional Index Questionnaire, and the Anterior Knee Pain Scale. Secondary outcome measures will include the Lower Extremity Functional Scale, McGill Pain Questionnaire, 36-Item Short-Form Health Survey, Hospital Anxiety and Depression Scale, Patient-Specific Functional Scale, Physical Activity Level in the Previous Week, pressure pain threshold and physical measures of step and squat tests. Cost-effectiveness analysis will be based on treatment effectiveness against resource usage recorded in treatment logs and self-reported diaries

  15. What Do the Parents of Children Who Have Chronic Pain Expect from Their First Visit to a Pediatric Chronic Pain Clinic?

    Directory of Open Access Journals (Sweden)

    Kathy Reid

    2010-01-01

    Full Text Available BACKGROUND: Chronic pain in childhood is increasingly recognized as a significant clinical problem. Best-practice management of pediatric chronic pain in a multidisciplinary pain clinic involves a variety of treatment modalities. It is important that parents of children treated in these settings understand the different treatment options available for their children. By involving parents more effectively, care providers may more efficiently address unmet treatment needs and improve tailoring of treatment programs aimed at increasing function, reducing pain-related disability and improving quality of life.

  16. Overlapping mechanisms of stress-induced relapse to opioid use disorder and chronic pain: Clinical implications

    Directory of Open Access Journals (Sweden)

    Udi E Ghitza

    2016-05-01

    Full Text Available Over the past two decades, a steeply growing number of persons with chronic non-cancer pain have been using opioid analgesics chronically to treat it, accompanied by a markedly increased prevalence of individuals with opioid-related misuse, opioid use disorders, emergency department visits, hospitalizations, admissions to drug treatment programs, and drug overdose deaths. This opioid misuse and overdose epidemic calls for well-designed randomized-controlled clinical trials into more skillful and appropriate pain management and for developing effective analgesics which have lower abuse liability and are protective against stress induced by chronic non-cancer pain. However, incomplete knowledge regarding effective approaches to treat various types of pain has been worsened by an under-appreciation of overlapping neurobiological mechanisms of stress, stress-induced relapse to opioid use, and chronic non-cancer pain in patients presenting for care for these conditions. This insufficient knowledge base has unfortunately encouraged common prescription of conveniently-available opioid pain-relieving drugs with abuse liability, as opposed to treating underlying problems using team-based multidisciplinary, patient-centered, collaborative-care approaches for addressing pain and co-occurring stress and risk for opioid use disorder. This paper reviews recent neurobiological findings regarding overlapping mechanisms of stress-induced relapse to opioid misuse and chronic non-cancer pain, and then discusses these in the context of key outstanding evidence gaps and clinical-treatment research directions which may be pursued to fill these gaps. Such research directions, if conducted through well-designed randomized controlled trials, may substantively inform clinical practice in general medical settings on how to effectively care for patients presenting with pain-related distress and these common co-occurring conditions.

  17. A New Clinical Pain Knowledge Test for Nurses: Development and Psychometric Evaluation.

    Science.gov (United States)

    Bernhofer, Esther I; St Marie, Barbara; Bena, James F

    2017-08-01

    All nurses care for patients with pain, and pain management knowledge and attitude surveys for nurses have been around since 1987. However, no validated knowledge test exists to measure postlicensure clinicians' knowledge of the core competencies of pain management in current complex patient populations. To develop and test the psychometric properties of an instrument designed to measure pain management knowledge of postlicensure nurses. Psychometric instrument validation. Four large Midwestern U.S. hospitals. Registered nurses employed full time and part time August 2015 to April 2016, aged M = 43.25 years; time as RN, M = 16.13 years. Prospective survey design using e-mail to invite nurses to take an electronic multiple choice pain knowledge test. Content validity of initial 36-item test "very good" (95.1% agreement). Completed tests that met analysis criteria, N = 747. Mean initial test score, 69.4% correct (range 27.8-97.2). After revision/removal of 13 unacceptable questions, mean test score was 50.4% correct (range 8.7-82.6). Initial test item percent difficulty range was 15.2%-98.1%; discrimination values range, 0.03-0.50; final test item percent difficulty range, 17.6%-91.1%, discrimination values range, -0.04 to 1.04. Split-half reliability final test was 0.66. A high decision consistency reliability was identified, with test cut-score of 75%. The final 23-item Clinical Pain Knowledge Test has acceptable discrimination, difficulty, decision consistency, reliability, and validity in the general clinical inpatient nurse population. This instrument will be useful in assessing pain management knowledge of clinical nurses to determine gaps in education, evaluate knowledge after pain management education, and measure research outcomes. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  18. Cardiac CT for the assessment of chest pain: Imaging techniques and clinical results

    Energy Technology Data Exchange (ETDEWEB)

    Becker, Hans-Christoph, E-mail: christoph.becker@med.uni-muenchen.de [Ludwig-Maximilians-University, Grosshadern Clinic, Department of Clinical Radiology, Marchioninistr. 15, 81377 Munich (Germany); Johnson, Thorsten [Ludwig-Maximilians-University, Grosshadern Clinic, Department of Clinical Radiology, Marchioninistr. 15, 81377 Munich (Germany)

    2012-12-15

    Immediate and efficient risk stratification and management of patients with acute chest pain in the emergency department is challenging. Traditional management of these patients includes serial ECG, laboratory tests and further on radionuclide perfusion imaging or ECG treadmill testing. Due to the advances of multi-detector CT technology, dedicated coronary CT angiography provides the potential to rapidly and reliably diagnose or exclude acute coronary artery disease. Life-threatening causes of chest pain, such as aortic dissection and pulmonary embolism can simultaneously be assessed with a single scan, sometimes referred to as “triple rule out” scan. With appropriate patient selection, cardiac CT can accurately diagnose heart disease or other sources of chest pain, markedly decrease health care costs, and reliably predict clinical outcomes. This article reviews imaging techniques and clinical results for CT been used to evaluate patients with chest pain entering the emergency department.

  19. Clinical effectiveness of the obturator externus muscle injection in chronic pelvic pain patients.

    Science.gov (United States)

    Kim, Shin Hyung; Kim, Do Hyeong; Yoon, Duck Mi; Yoon, Kyung Bong

    2015-01-01

    Because of its anatomical location and function, the obturator externus (OE) muscle can be a source of pain; however, this muscle is understudied as a possible target for therapeutic intervention in pain practice. In this retrospective observational study, we evaluated the clinical effectiveness of the OE muscle injection with a local anesthetic in chronic pelvic pain patients with suspected OE muscle problems. Twenty-three patients with localized tenderness on the inferolateral side of the pubic tubercle accompanied by pain in the groin, anteromedial thigh, or hip were studied. After identifying the OE with contrast dye under fluoroscopic guidance, 5 to 8 mL of 0.3% lidocaine was injected. Pain scores were assessed before and after injection; patient satisfaction was also assessed. Mean pain score decreased by 44.7% (6.6 ± 1.8 to 3.5 ± 0.9, P pain score before injection. In addition, 82% of patients (19 of 23 patients) reported excellent or good satisfaction during 2 weeks after injection. No patients reported complications from OE muscle injection. Fluoroscopy-guided injection of the OE muscle with local anesthetic reduced pain scores and led to a high level of satisfaction at short-term follow-up in patients with suspected OE muscle problem. The results of this study suggest that OE muscle injection may be a valuable therapeutic option for a select group of chronic pelvic pain patients who present with localized tenderness in the OE muscle that is accompanied by groin, anteromedial thigh, or hip pain. © 2013 World Institute of Pain.

  20. Clinical and functional profile of patients with the Painful Shoulder Syndrome (PSS).

    Science.gov (United States)

    Dias, Daniela; Matos, Marcos; Daltro, Carla; Guimarães, Armênio

    2008-01-01

    The Painful Shoulder Syndrome (PSS) is characterized by varying degrees of pain and functional limitation. The aim of this study is to describe the clinical and functional profile of these patients. 136 patients undergoing clinical treatment for PSS were evaluated by a questionnaire regarding the following variables: sex, age, occupation, affected shoulder and its dominance, image diagnosis, pain location, intensity and characteristics, physical activity involving the shoulder, preferential position of upper limbs during occupational activity, limitation of movements during activities o daily living, and job absenteeism. 74.3% of the patients were women (pshoulder was affected most frequently (58.8%) and dominant (91.9%). Rotator cuff tear was the most frequent shoulder pathology (75.4%). Treatment was sought more commonly in the chronic stage of pain (61.0%). Pain, moderate in intensity, predominated in males (54.3%) and severe pain was more frequent in females (47.5%), restricted to the shoulder in 44.1% and worsening at night (50%). The upper limbs were used more frequently below shoulder level during usual daily activities (68.4%), and limitation of movements was present mainly in women (63.4%, p=0.017). Rotator cuff tear is the most frequent cause of PSS. PSS produces pain and functional limitation, especially in women.

  1. Procedural pain and anxiety in pediatric patients in a Mexican dental clinic.

    Science.gov (United States)

    Ortiz, M I; Rangel-Barragán, R O; Contreras-Ayala, M; Mora-Alba, J D; Gómez-Bonifaz, L G; Murguía-Cánovas, G; Varela-Ibáñez, E

    2014-06-01

    In dental examining rooms, children experience diagnostic and therapeutic pain related to dental procedures that may be associated with anxiety. Therefore, the main objective of the present study was to evaluate anxiety and pain levels related to dental procedures in children. Children in a Mexican pediatric dental clinic rated their dental anxiety using the Modified Dental Anxiety Scale (MDAS), the Children's Fear Survey Schedule Dental Subscale (CFSS-DS) and a 100-mm Visual Analogue Scale (VAS). Pain was evaluated with the VAS. A total of 437 children with a mean age of 9.8 (±2.2) years were evaluated. Four hundred eighty-one dental procedures were completed. The averages in the MDAS and the CFSS-DS were 8.5 (±3.4) and 22.7 (±7.6), respectively. Of all dental procedures, 275 (57.2 %) were rated as stressful prior to their realization, 222 (46.2 %) were stressful during their realization and 175 (36.4 %) were rated as painful. Overall, 12.6 % of the painful events were rated as severe, 25.1 % were rated as moderate, and 62.3 % were rated as slight. This study provides data on common procedures performed in dental clinics that cause pain and anxiety in children and young adolescents. Dentistry must consider the best non-pharmacological and pharmacological interventions to reduce dental anxiety and pain.

  2. A new tool for real-time pain assessment in experimental and clinical environments.

    Directory of Open Access Journals (Sweden)

    Nils Schaffner

    Full Text Available Pain measurement largely depends on the ability to rate personal subjective pain. Nevertheless, pain scales can be difficult to use during medical procedures. We hypothesized that pain can be expressed intuitively and in real-time by squeezing a pressure sensitive device. We developed such a device called "Painmouse(®" and tested it on healthy volunteers and patients in two separate studies: Sixteen male participants rated different painful heat stimuli via Painmouse(® and a Visual Analog Scale (VAS. Retest was done one week later. Participants clearly distinguished four distinct pain levels using both methods. Values from the first and second sessions were comparable. Thereafter, we tested the Painmouse(® by asking twelve female and male leg- ulcer patients to continuously squeeze it during the whole length of their wound-dressing change. Patients rated each step of dressing change on an 11-point numeric rating scale. Painmouse(® ratings were highest for the wound cleaning and debridement step. Application of the new dressing was not evaluated as very painful. On the other hand, numeric scale ratings did not differentiate between dressing change steps. We conclude that the Painmouse(® enables pain assessment even under difficult clinical circumstances, such as during a medical treatment in elderly patients.

  3. The cortical responses to evoked clinical pain in patients with hip osteoarthritis

    DEFF Research Database (Denmark)

    Gram, Mikkel; Erlenwein, Joachim; Petzke, Frank

    2017-01-01

    of the opposite hip in a similar fashion and holding it for 30 seconds. In addition, EEG was recorded during the resting condition with open eyes. The relative spectral content was calculated from the EEG as well as functional connectivity using phase-lag index for frequency bands delta (1-4Hz), theta (4-8Hz...... appeared in the spectral beta and theta content. This was correlated to the reported pain perceived, pointing towards pain specific brain activity related to clinical pain....

  4. Effect of myofascial release technique on pain, disability, maximum isometric contraction of the extensor muscles, and pressure pain threshold in patients with chronic nonspecific neck pain: Double blinded randomized clinical trial

    OpenAIRE

    Hasan Namvar; Gholamreza olyaei; Behrouz Attarbashi Moghadam; Mohammad Hosseinifar

    2016-01-01

    The impact of myofascial release technique alone has not been investigated in the patients with non-specific chronic neck pain. Thus, the aim of this study was to investigate the impacts of myofascial release technique on pain, disability, the maximum contraction of isometric extensor muscles of neck and pressure pain threshold in the patient with non-specific chronic neck pain compared with control group. In this clinical, randomized, double-blind trial, the patients with non-specific chr...

  5. Chronic pain coping styles in patients with herniated lumbar discs and coexisting spondylotic changes treated surgically: Considering clinical pain characteristics, degenerative changes, disability, mood disturbances, and beliefs about pain control

    OpenAIRE

    Misterska, Ewa; Jankowski, Roman; Głowacki, Maciej

    2013-01-01

    Background Pain catastrophizing, appraisals of pain control, styles of coping, and social support have been suggested to affect functioning in patients with low back pain. We investigated the relation of chronic pain coping strategies to psychological variables and clinical data, in patients treated surgically due to lumbar disc herniation and coexisting spondylotic changes. Material/Methods The average age of study participants (n=90) was 43.47 years (SD 10.21). Patients completed the Polish...

  6. Development of Pain Endpoint Models for Use in Prostate Cancer Clinical Trials and Drug Approval

    Science.gov (United States)

    2017-10-01

    per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing...manuscript resulting from the work described in Aim 2 has been published in the journal European Urology, titled: “Effects of Cabozantinib on Pain...resulting from work described in Aim 3 has been published by the journal Cancer, titled: “Pain Palliation Measurement in Cancer Clinical Trials: The

  7. Spine and pain clinics serving North Carolina patients with back and neck pain: what do they do, and are they multidisciplinary?

    Science.gov (United States)

    Castel, Liana D; Freburger, Janet K; Holmes, George M; Scheinman, Rachael P; Jackman, Anne M; Carey, Timothy S

    2009-03-15

    Cross-sectional survey. Our primary objective was to describe spine and pain clinics serving North Carolina residents with respect to organizational characteristics. Our secondary objective was to assess the multidisciplinary nature of the clinics surveyed. Pain clinics have become common in the United States, and patients with chronic back pain have increasingly been seeking services at these clinics. Little is known about the organizational characteristics of spine and pain clinics. We identified and surveyed spine and pain clinics serving North Carolina residents with chronic back and neck pain. Practice managers at 46 clinics completed a 20-minute questionnaire about the characteristics of their clinic, including providers on staff and services offered. Descriptive and exploratory analyses were conducted to summarize the data. Several variables were constructed to assess the multidisciplinary nature of the clinics. The response rate was 75%. There was marked heterogeneity among the clinics surveyed. Fifty-nine percent of practices were free-standing (n = 27) and 61% were physician-owned (n = 28). Twenty-five clinics (54%) had an anesthesiologist. Other common physician providers were physiatrists and surgeons. Less than one third of sites had mental health providers (n = 12; 26%); only 26% employed physical therapists. Seventy-six percent of sites offered epidural injections, 74% long-term narcotic prescriptions, and 67% antidepressants. The majority of clinics (30 of 33) prescribing narcotics provided monitoring of therapy using periodic urine toxicology testing. Forty-eight percent of sites (n = 22) offered exercise instruction. Few clinics were multidisciplinary in nature. Only 3 (7%) met the criteria of having a medical physician, registered nurse, physical therapist, and mental health specialist. Clinics varied widely in their organizational characteristics, including providers and scope of services available. Few clinics were multidisciplinary in nature

  8. Triage of the child with abdominal pain: A clinical algorithm for emergency patient management

    Science.gov (United States)

    Michalowski, Wojtek; Rubin, Steven; Slowinski, Roman; Wilk, Szymon

    2001-01-01

    OBJECTIVE: To create a simplified clinical algorithm for the triage of children with abdominal pain. DESIGN: Retrospective analysis. SETTING: Emergency room at the Children’s Hospital of Eastern Ontario, Ottawa, Ontario. METHODS: A data mining methodology (rough sets analysis) was applied to a randomized data set obtained from 175 emergency room admission charts of patients. Patients were placed into two diagnostic decision classes: appendicitis confirmed by a pathological report, and resolution (this classification implied the resolution of all clinical complaints and physical findings, with no pathological diagnosis and no operative procedure). RESULTS: Nine clinical symptoms and signs were identified as being important in the management of children with abdominal pain. A clinically based algorithm for the triage of such children was developed. CONCLUSIONS: It is possible to develop a clinical algorithm for the triage of children with abdominal pain that can also be used by nonmedical professionals. A template for such an algorithm can be used as the basis for diagnosing other paediatric emergencies, such as chest pain, headaches and joint pain. PMID:20084204

  9. Correlation of MRI findings with clinical findings of trochanteric pain syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Blankenbaker, Donna G.; Ullrick, Steven R.; Davis, Kirkland W.; De Smet, Arthur A. [University of Wisconsin School of Medicine and Public Health, Department of Radiology, Madison, WI (United States); Haaland, Ben; Fine, Jason P. [University of Wisconsin School of Medicine and Public Health, Departments of Biostatistics and Medical Informatics and Statistics, Madison, WI (United States)

    2008-10-15

    Greater trochanter pain syndrome due to tendinopathy or bursitis is a common cause of hip pain. The previously reported magnetic resonance (MR) findings of trochanteric tendinopathy and bursitis are peritrochanteric fluid and abductor tendon abnormality. We have often noted peritrochanteric high T2 signal in patients without trochanteric symptoms. The purpose of this study was to determine whether the MR findings of peritrochanteric fluid or hip abductor tendon pathology correlate with trochanteric pain. We retrospectively reviewed 131 consecutive MR examinations of the pelvis (256 hips) for T2 peritrochanteric signal and abductor tendon abnormalities without knowledge of the clinical symptoms. Any T2 peritrochanteric abnormality was characterized by size as tiny, small, medium, or large; by morphology as feathery, crescentic, or round; and by location as bursal or intratendinous. The clinical symptoms of hip pain and trochanteric pain were compared to the MR findings on coronal, sagittal, and axial T2 sequences using chi-square or Fisher's exact test with significance assigned as p<0.05. Clinical symptoms of trochanteric pain syndrome were present in only 16 of the 256 hips. All 16 hips with trochanteric pain and 212 (88%) of 240 without trochanteric pain had peritrochanteric abnormalities (p=0.15). Eighty-eight percent of hips with trochanteric symptoms had gluteus tendinopathy while 50% of those without symptoms had such findings (p=0.004). Other than tendinopathy, there was no statistically significant difference between hips with or without trochanteric symptoms and the presence of peritrochanteric T2 abnormality, its size or shape, and the presence of gluteus medius or minimus partial thickness tears. Patients with trochanteric pain syndrome always have peritrochanteric T2 abnormalities and are significantly more likely to have abductor tendinopathy on magnetic resonance imaging (MRI). However, although the absence of peritrochanteric T2 MR abnormalities

  10. The clinical psychologist and the management of inpatient pain: a small case series

    Directory of Open Access Journals (Sweden)

    Childs SR

    2014-12-01

    Full Text Available Susan R Childs,1,* Emma M Casely,2,* Bianca M Kuehler,1 Stephen Ward,1 Charlotte L Halmshaw,1 Sarah E Thomas,1 Ian D Goodall,1 Carsten Bantel1,3 1Pain Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, 2Anaesthetic Department, Hillingdon Hospital, Uxbridge, 3Section of Anaesthetics, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK *These authors contributed equally to this manuscript Abstract: Recent research has confirmed that between 25% and 33% of all hospitalized patients experience unacceptable levels of pain. Studies further indicate that this reduces patient satisfaction levels, lengthens hospital stays, and increases cost. Hospitals are aiming to discharge patients earlier, and this can interfere with adequate pain management. Therefore, the pain service at Chelsea and Westminster Hospital has adapted to this changing model of care. An increasing body of evidence demonstrates that psychological factors are key components of patients’ pain experiences in both acute and chronic pain. Therefore, it is reasonable to suggest a clinical psychologist should be involved in inpatient pain management. This small study discusses three cases that highlight how patient care could be improved by including a clinical psychologist as part of the inpatient pain team. Two cases particularly highlight the active role of the psychologist in the diagnosis and management of common conditions such as fear and anxiety, along with other psychiatric comorbidities. The management therefore employed an eclectic approach adapted from chronic pain and comprising of behavioral, cognitive behavioral, and dialectical behavioral therapeutic techniques blended with brief counseling. The third case exemplifies the importance of nurse-patient interactions and the quality of nurse-patient relationships on patient outcomes. Here, the psychologist helped to optimize

  11. Nebulized fentanyl vs intravenous morphine for ED patients with acute limb pain: a randomized clinical trial.

    Science.gov (United States)

    Farahmand, Shervin; Shiralizadeh, Said; Talebian, Mohammad-Taghi; Bagheri-Hariri, Shahram; Arbab, Mona; Basirghafouri, Hamed; Saeedi, Morteza; Sedaghat, Mojtaba; Mirzababai, Habibolla

    2014-09-01

    Intravenous morphine has been used as a common method of pain control in emergency care. Nebulized fentanyl is also an effective temporary substitute. This study was designed to compare the effectiveness of nebulized fentanyl with intravenous (IV) morphine on management of acute limb pain. This was a placebo-controlled, double-blind randomized clinical trial. Ninety emergency department patients with moderate to severe pain aged 15 to 50 years were blocked randomized and enrolled in this study. Forty-seven patients in the experimental group received nebulized fentanyl (4 μg/kg) and IV normal saline as placebo, and the remaining 43 patients in the control group received IV morphine (0.1 mg/kg) and nebulized normal saline as placebo. All participants' pain scores were assessed by Numerical Rating Scale before and after intervention at 5-, 10-, 15-, 30-, 45-, and 60-minute intervals. Patients' vital sign and possible adverse effects were recorded respectively. Finally, all participants were assessed for their satisfaction. The mean initial pain score in the experimental group was 8.7 and 8.4 in the control group (P = .1). Pain relief in both groups after 5 and 10 minutes were similar (P = .72). Although the pain relief was significantly greater with fentanyl at 15 minutes, this difference is not clinically significant. Pain management in both groups was successful and was more than 3 scores reduction in Numerical Rating Scale. Patient satisfaction in both groups was similar. No adverse effects were reported in the experimental group. This study suggests that nebulized fentanyl is a rapid, safe, and effective method for temporary control of acute limb pain in emergency department patients. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. The effect of jaw relaxation on pain anxiety during burn dressings: randomised clinical trial.

    Science.gov (United States)

    Mohammadi Fakhar, Fahimeh; Rafii, Forough; Jamshidi Orak, Roohangiz

    2013-02-01

    The purpose of this randomised clinical trial (RCT) was to determine the effect of jaw relaxation on pain anxiety related to dressing changes in burn injuries. Patients hospitalised with burns experience high levels of anticipatory anxiety during dressing changes, which cannot be completely managed by anxiolytic drugs. Nurses as members of the burn care team contribute to pain management by using relaxation techniques as one of the most frequently used approaches to pain anxiety management. However, there is not enough information about the effects of these techniques on pain anxiety of patients with burns. The aim of this study was to determine the effect of jaw relaxation on pain anxiety related to dressing changes in burn injuries. It was a randomised clinical trial with a control group. A total of 100 patients hospitalised in Shahid Motahari Burn Centre affiliated with Tehran University of Medical Sciences were recruited by convenience sampling and were randomly assigned to either experimental or control groups using minimisation. With institutional approval and written consent, the experimental group practiced jaw relaxation for 20 min before entering the dressing room. Data were collected by the Burn Specific Pain Anxiety Scale (BSPAS) during July-December 2009 and analysed using Statistical Package for the Social Sciences (SPSS)-PC (17). An independent t-test showed no significant difference between mean pain anxiety scores in the experimental and control group before intervention (p=0.787). A dependent t-test showed significantly less pain anxiety after intervention (before dressing) in the experimental group (pdressing pain anxiety of the experimental group was less than the control group (pdressing pain anxiety (after intervention) in the experimental group (p=0.303). Nurses can independently decrease the pain anxiety of patients with burns and its subsequent physical and psychological burden by teaching the simple and inexpensive technique of jaw

  13. A clinical perspective on a pain neuroscience education approach to manual therapy.

    Science.gov (United States)

    Louw, Adriaan; Nijs, Jo; Puentedura, Emilio J

    2017-07-01

    In recent years, there has been an increased interest in pain neuroscience education (PNE) in physical therapy. There is growing evidence for the efficacy of PNE to decrease pain, disability, fear-avoidance, pain catastrophization, limited movement, and health care utilization in people struggling with pain. PNE teaches people in pain more about the biology and physiology of their pain experience including processes such as central sensitization, peripheral sensitization, allodynia, inhibition, facilitation, neuroplasticity and more. PNE's neurobiological model often finds itself at odds with traditional biomedical models used in physical therapy. Traditional biomedical models, focusing on anatomy, pathoanatomy, and biomechanics have been shown to have limited efficacy in helping people understand their pain, especially chronic pain, and may in fact even increase a person's pain experience by increasing fear-avoidance and pain catastrophization. An area of physical therapy where the biomedical model is used a lot is manual therapy. This contrast between PNE and manual therapy has seemingly polarized followers from each approach to see PNE as a 'hands-off' approach even having clinicians categorize patients as either in need of receiving PNE (with no hands-on), or hands-on with no PNE. In this paper, we explore the notion of PNE and manual therapy co-existing. PNE research has shown to have immediate effects of various clinical signs and symptoms associated with central sensitization. Using a model of sensitization (innocuous, noxious, and allodynia), we argue that PNE can be used in a manual therapy model, especially treating someone where the nervous system has become increasingly hypervigilant. Level of Evidence: VII.

  14. Designing an automated clinical decision support system to match clinical practice guidelines for opioid therapy for chronic pain

    Directory of Open Access Journals (Sweden)

    Clark Michael E

    2010-04-01

    Full Text Available Abstract Background Opioid prescribing for chronic pain is common and controversial, but recommended clinical practices are followed inconsistently in many clinical settings. Strategies for increasing adherence to clinical practice guideline recommendations are needed to increase effectiveness and reduce negative consequences of opioid prescribing in chronic pain patients. Methods Here we describe the process and outcomes of a project to operationalize the 2003 VA/DOD Clinical Practice Guideline for Opioid Therapy for Chronic Non-Cancer Pain into a computerized decision support system (DSS to encourage good opioid prescribing practices during primary care visits. We based the DSS on the existing ATHENA-DSS. We used an iterative process of design, testing, and revision of the DSS by a diverse team including guideline authors, medical informatics experts, clinical content experts, and end-users to convert the written clinical practice guideline into a computable algorithm to generate patient-specific recommendations for care based upon existing information in the electronic medical record (EMR, and a set of clinical tools. Results The iterative revision process identified numerous and varied problems with the initially designed system despite diverse expert participation in the design process. The process of operationalizing the guideline identified areas in which the guideline was vague, left decisions to clinical judgment, or required clarification of detail to insure safe clinical implementation. The revisions led to workable solutions to problems, defined the limits of the DSS and its utility in clinical practice, improved integration into clinical workflow, and improved the clarity and accuracy of system recommendations and tools. Conclusions Use of this iterative process led to development of a multifunctional DSS that met the approval of the clinical practice guideline authors, content experts, and clinicians involved in testing. The

  15. Designing an automated clinical decision support system to match clinical practice guidelines for opioid therapy for chronic pain.

    Science.gov (United States)

    Trafton, Jodie A; Martins, Susana B; Michel, Martha C; Wang, Dan; Tu, Samson W; Clark, David J; Elliott, Jan; Vucic, Brigit; Balt, Steve; Clark, Michael E; Sintek, Charles D; Rosenberg, Jack; Daniels, Denise; Goldstein, Mary K

    2010-04-12

    Opioid prescribing for chronic pain is common and controversial, but recommended clinical practices are followed inconsistently in many clinical settings. Strategies for increasing adherence to clinical practice guideline recommendations are needed to increase effectiveness and reduce negative consequences of opioid prescribing in chronic pain patients. Here we describe the process and outcomes of a project to operationalize the 2003 VA/DOD Clinical Practice Guideline for Opioid Therapy for Chronic Non-Cancer Pain into a computerized decision support system (DSS) to encourage good opioid prescribing practices during primary care visits. We based the DSS on the existing ATHENA-DSS. We used an iterative process of design, testing, and revision of the DSS by a diverse team including guideline authors, medical informatics experts, clinical content experts, and end-users to convert the written clinical practice guideline into a computable algorithm to generate patient-specific recommendations for care based upon existing information in the electronic medical record (EMR), and a set of clinical tools. The iterative revision process identified numerous and varied problems with the initially designed system despite diverse expert participation in the design process. The process of operationalizing the guideline identified areas in which the guideline was vague, left decisions to clinical judgment, or required clarification of detail to insure safe clinical implementation. The revisions led to workable solutions to problems, defined the limits of the DSS and its utility in clinical practice, improved integration into clinical workflow, and improved the clarity and accuracy of system recommendations and tools. Use of this iterative process led to development of a multifunctional DSS that met the approval of the clinical practice guideline authors, content experts, and clinicians involved in testing. The process and experiences described provide a model for development of

  16. Clinical course and prognosis of musculoskeletal pain in patients referred for physiotherapy

    DEFF Research Database (Denmark)

    de Vos Andersen, Nils-Bo; Kent, Peter; Hjort, Jakob

    2017-01-01

    BACKGROUND: Danish patients with musculoskeletal disorders are commonly referred for primary care physiotherapy treatment but little is known about their general health status, pain diagnoses, clinical course and prognosis. The objectives of this study were to 1) describe the clinical course...... of patients with musculoskeletal disorders referred to physiotherapy, 2) identify predictors associated with a satisfactory outcome, and 3) determine the influence of the primary pain site diagnosis relative to those predictors. METHODS: This was a prospective cohort study of patients (n = 2,706) newly...... referred because of musculoskeletal pain to 30 physiotherapy practices from January 2012 to May 2012. Data were collected via a web-based questionnaire 1-2 days prior to the first physiotherapy consultation and at 6 weeks, 3 and 6 months, from clinical records (including primary musculoskeletal symptom...

  17. The Comparative Effects of Spinal and Peripheral Thrust Manipulation and Exercise on Pain Sensitivity and the Relation to Clinical Outcome: A Mechanistic Trial Using a Shoulder Pain Model

    Science.gov (United States)

    Coronado, Rogelio A.; Bialosky, Joel E.; Bishop, Mark D.; Riley, Joseph L.; Robinson, Michael E.; Michener, Lori A.; George, Steven Z.

    2016-01-01

    STUDY DESIGN Single-blind randomized trial. OBJECTIVES To compare the effects of cervical and shoulder thrust manipulation (TM) and exercise on pain sensitivity, and to explore associations with clinical outcomes in patients with shoulder pain. BACKGROUND Experimental studies indicate that spinal TM has an influence on central pain processes, supporting its application for treatment of extremity conditions. Direct comparison of spinal and peripheral TM on pain sensitivity has not been widely examined. METHODS Seventy-eight participants with shoulder pain (36 female; mean ± SD age, 39.0 ± 14.5 years) were randomized to receive 3 treatments of cervical TM (n = 26), shoulder TM (n = 27), or shoulder exercise (n = 25) over 2 weeks. Twenty-five healthy participants (13 female; mean ± SD age, 35.2 ± 11.1 years) were assessed to compare pain sensitivity with that in clinical participants at baseline. Primary outcomes were changes in local (eg, shoulder) and remote (eg, tibialis anterior) pressure pain threshold and heat pain threshold occurring over 2 weeks. Secondary outcomes were shoulder pain intensity and patient-rated function at 4, 8, and 12 weeks. Analysis-of-variance models and partial-correlation analyses were conducted to examine comparative effects and the relationship between measures. RESULTS At baseline, clinical participants demonstrated lower local (mean difference, −1.63 kg; 95% confidence interval [CI]: −2.40, −0.86) and remote pressure pain threshold (mean difference, −1.96 kg; 95% CI: −3.09, −0.82) and heat pain threshold (mean difference, −1.15°C; 95% CI: −2.06, −0.24) compared to controls, suggesting enhanced pain sensitivity. Following intervention, there were no between-group differences in pain sensitivity or clinical outcome (P>.05). However, improvements were noted, regardless of intervention, for pressure pain threshold (range of mean differences, 0.22–0.32 kg; 95% CI: 0.03, 0.43), heat pain threshold (range of mean

  18. The prevalence of pain and its association with psychosocial factors for indigent adults enrolled in a primary care clinic.

    Science.gov (United States)

    Vallerand, April H; Pieper, Barbara; Crawley, Jamie; Nordstrom, Cheryl; DiNardo, Ellen

    2013-10-01

    Pain is a symptom reported in 50% to 70% of primary care visits and negatively impacts both physical and psychological functioning. People at risk of receiving inadequate management of pain include the indigent and people of color. The purpose of this exploratory, descriptive, cross-sectional study was to describe the prevalence of pain and its relation to functional status, depressive symptoms, perception of control over pain and coping in an urban, primary care clinic for indigent adults. Individuals (N=301) attending a primary care clinic for indigent adults were surveyed. Patients were 22 to 64 years of age, experienced pain during the past 2 weeks, and were able to understand and respond in English. Ninety-two percent of the sample was African American and the average worst pain score was 8.4/10. The majority of patients had depression symptoms (77%), with pain most affecting patients' function with sleep, ability to work, and walking. Patients reporting higher pain scores had significantly lower perception of control over pain and reduced control over life in general. Higher reported pain levels were also significantly correlated with higher catastrophizing, depressive symptoms, and interference with function scores. Pain levels were reported as high and affected psychological and physical functioning. This study was unique in the high percentage of African American participants and being conducted in a primary care clinic for indigent adults. Greater understanding of this population's pain will assist clinicians to assess pain comprehensively, provide education, and make treatment decisions for these patients.

  19. Clinical pilates versus general exercise for chronic low back pain: randomized trial.

    Science.gov (United States)

    Wajswelner, Henry; Metcalf, Ben; Bennell, Kim

    2012-07-01

    This single-assessor-blinded randomized controlled trial aimed to compare the efficacy of physiotherapy-delivered clinical Pilates and general exercise for chronic low back pain. Eighty-seven community volunteers with low back pain for ≥3 months and age 18-70 were randomized to either the Pilates (n = 44) or general exercise (n = 43) group. The primary outcome was pain/disability measured with the Quebec scale. Secondary outcomes included pain on a numeric rating scale, Patient-Specific Functional Scale, Pain Self-efficacy Questionnaire, quality of life, and global perceived effect of treatment. All participants attended 60-min exercise sessions twice weekly for 6 wk supervised by a physiotherapist and performed daily home exercises that were continued during the follow-up. Participants from the clinical Pilates group received an individualized direction-specific exercise program prescribed by the physiotherapist after a clinical examination. The general exercise group received a generic set of exercises that were multidirectional and nonspecific. Outcomes were assessed after 6 wk (primary time point) and at 12 and 24 wk. Differences in mean change were compared between groups using ANCOVA adjusted for baseline values of the outcome. Eighty-three participants (96%) completed the 6-wk intervention and 60 (69%) completed the 24-wk follow-up. At 6 wk, no difference was found between groups for change in the Quebec scale (3.5, 95% confidence interval = -7.3 to 0.3, P = 0.07); both groups showed significant improvements. Similar results were found at the 12- and 24-wk follow-up and for the secondary outcome measures. An individualized clinical Pilates program produced similar beneficial effects on self-reported disability, pain, function and health-related quality of life as a general exercise program in community volunteers with chronic low back pain.

  20. Clinical trials focusing on cancer pain educational interventions: core components to include during planning and reporting.

    Science.gov (United States)

    Stiles, Carla R; Biondo, Patricia D; Cummings, Greta; Hagen, Neil A

    2010-08-01

    Robust recommendations on the reporting of methods and results of clinical trials such as therapeutic intervention trials are widely used, such as the Consolidated Standards of Reporting Trials (CONSORT) recommendation. There has not been agreement on analogous publication standards for educational intervention trials, making interpretation of educational intervention studies difficult. The purpose of this report is to describe common deficiencies in reporting of educational intervention trials for cancer pain control, and to offer suggestions for authors to consider as they plan their studies, and report and publish research findings for educational interventions that use randomized controlled trials and other educational trial methodologies. A systematic review of published knowledge translation intervention trials intended to improve cancer pain was undertaken, of which most were educational interventions. Many educational intervention clinical trials designed to improve management of cancer pain appeared methodologically weak, and their results were more difficult to interpret because of reporting deficiencies. In the course of the review, patterns of deficiencies in reporting of methods and trial results were documented. Deficiencies in reporting were compared with the CONSORT recommendations for reporting clinical trials, and parallel recommendations were drafted for educational intervention trials. Patterns of deficiency in reporting cancer pain educational intervention trials were synthesized into seven domains, generically applicable to a range of study designs. Draft recommendations intended to address these deficiencies were constructed to improve communication of educational research results. Development of a standardized reporting template for clinical trials in cancer pain educational interventions could advance knowledge transfer research and thereby increase effectiveness of national and international cancer control policy designed to support cancer

  1. Knowledge discovery in clinical decision support systems for pain management: a systematic review.

    Science.gov (United States)

    Pombo, Nuno; Araújo, Pedro; Viana, Joaquim

    2014-01-01

    The occurrence of pain accounts for billions of dollars in annual medical expenditures; loss of quality of life and decreased worker productivity contribute to indirect costs. As pain is highly subjective, clinical decision support systems (CDSSs) can be critical for improving the accuracy of pain assessment and offering better support for clinical decision-making. This review is focused on computer technologies for pain management that allow CDSSs to obtain knowledge from the clinical data produced by either patients or health care professionals. A comprehensive literature search was conducted in several electronic databases to identify relevant articles focused on computerised systems that constituted CDSSs and include data or results related to pain symptoms from patients with acute or chronic pain, published between 1992 and 2011 in the English language. In total, thirty-nine studies were analysed; thirty-two were selected from 1245 citations, and seven were obtained from reference tracking. The results highlighted the following clusters of computer technologies: rule-based algorithms, artificial neural networks, nonstandard set theory, and statistical learning algorithms. In addition, several methodologies were found for content processing such as terminologies, questionnaires, and scores. The median accuracy ranged from 53% to 87.5%. Computer technologies that have been applied in CDSSs are important but not determinant in improving the systems' accuracy and the clinical practice, as evidenced by the moderate correlation among the studies. However, these systems play an important role in the design of computerised systems oriented to a patient's symptoms as is required for pain management. Several limitations related to CDSSs were observed: the lack of integration with mobile devices, the reduced use of web-based interfaces, and scarce capabilities for data to be inserted by patients. Copyright © 2013 Elsevier B.V. All rights reserved.

  2. Radiating low back pain in general practice : Incidence, prevalence, diagnosis, and long-term clinical course of illness

    NARCIS (Netherlands)

    Spijker-Huiges, Antje; Groenhof, Feikje; Winters, Jan C.; van Wijhe, Marten; Groenier, Klaas H.; van der Meer, Klaas

    Objective. The aim of this study was to calculate the incidence and prevalence of radiating low back pain, to explore the long-term clinical course of radiating low back pain including the influence of radiculopathy (in a subsample of the study population) and non-radiating low back pain thereon,

  3. Clinical and sonographic risk factors for hemiplegic shoulder pain: A longitudinal observational study.

    Science.gov (United States)

    Kim, Yeo Hyung; Jung, Sung Jin; Yang, Eun Joo; Paik, Nam Jong

    2014-01-01

    To identify baseline risk factors associated with hemiplegic shoulder pain during the first 6 months after a stroke and to investigate changes in these risk factors over time. Longitudinal observational study. A total of 94 patients with first-ever unilateral stroke lesion within 1 month after stroke. Clinical, radiological and sonographic evaluations were performed at baseline. Hemiplegic shoulder pain was assessed at 1, 3 and 6 months post-stroke. Associations between baseline factors and hemiplegic shoulder pain during the first 6 months and hemiplegic shoulder pain at 1, 3 and 6 months poststroke were analysed. Poor arm motor function, indicated by a poor National Institutes of Health Stroke Scale item 5 score (odds ratio (OR) = 3.0; 95% confidence interval (CI) = 1.1-7.7) and the presence of supraspinatus tendon pathology (OR = 4.2; 95% CI = 1.4-12.9), were associated with hemiplegic shoulder pain. While patients with adhesive capsulitis, glenohumeral subluxation, or long head of biceps tendon effusion showed a higher prevalence of hemiplegic shoulder pain at 1 month after stroke, those with supraspinatus tendon pathology showed a higher prevalence at 3 and 6 months. Patients at high risk of hemiplegic shoulder pain with severe arm paralysis and supraspinatus tendon pathology require more careful attention during the rehabilitation period.

  4. Dry needling of the trapezius muscle in office workers with neck pain: a randomized clinical trial.

    Science.gov (United States)

    Cerezo-Téllez, Ester; Lacomba, María Torres; Fuentes-Gallardo, Isabel; Mayoral Del Moral, Orlando; Rodrigo-Medina, Beatriz; Gutiérrez Ortega, Carlos

    2016-09-01

    Neck pain is a frequent complaint in office workers. This pain can be caused by myofascial trigger points (MTrPs) in the trapezius muscle. This study aimed to determine the effectiveness of deep dry needling (DDN) of active MTrPs in the trapezius muscle. A randomized, single blinded clinical trial was carried out at the Physical Therapy Department at Physiotherapy in Women's Health Research Group at Physical Therapy Department of University of Alcalá, in Alcalá de Henares, Madrid, Spain. Forty-four office workers with neck pain and active MTrPs in the trapezius muscle were randomly allocated to either the DDN or the control group (CG). The participants in the DDN group were treated with DDN of all MTrPs found in the trapezius muscle. They also received passive stretch of the trapezius muscle. The CG received the same passive stretch of the trapezius muscle only. The primary outcome measure was subjective pain intensity, measured using a visual analogue scale (VAS). Secondary outcomes were pressure pain threshold (PPT), cervical range of motion (CROM) and muscle strength. Data were collected at baseline, after interventions and 15 days after the last treatment. Differences were found between the DDN group and the CG for the VAS (P stretch seems to be more effective than passive stretch only. The effects are maintained in the short term. The results support the use of DDN in the management of trapezius muscle myofascial pain syndrome in neck pain.

  5. Clinical effects of deep cervical flexor muscle activation in patients with chronic neck pain.

    Science.gov (United States)

    Kim, Jin Young; Kwag, Kwang Il

    2016-01-01

    [Purpose] The purpose of this study was to investigate clinical effects of deep cervical flexor (DCF) muscles exercise on pain, Neck Disability Index (NDI), and neck and shoulder postures in patients with chronic neck pain. [Subjects and Methods] Twenty-eight patients with chronic neck pain were randomly assigned into either the general strengthening exercise (GSE) group or the DCF activation group as control and experimental groups, respectively. All exercises were performed three times per week over 4 weeks. NDI and numeric rating scale (NRS) score for pain were determined and radiological assessment of neck-shoulder postures (head tilt angle [HTA], neck flexion angle [NFA], and forward shoulder angle [FSA]) was performed before (baseline), 4 weeks after, and 8 weeks after exercise in order to directly compare the exercise effects between the groups. [Results] In the DCF group, the NDI, NRS score, and neck-shoulder postures (analyzed by uisng HTA, NFA, and FSA) were significantly improved. [Conclusion] DCF activation exercise was effective to alleviate pain, recover functions, and correct forward head posture in the patients with neck pain. Hence, it might be recommended in the rehabilitation of patients with chronic neck pain.

  6. Does group training during pregnancy prevent lumbopelvic pain? A randomized clinical trial.

    Science.gov (United States)

    Mørkved, Siv; Salvesen, Kjell Asmund; Schei, Berit; Lydersen, Stian; Bø, Kari

    2007-01-01

    Prevention of lumbopelvic pain in pregnancy has been sparsely studied. One aim of this study was to assess if a 12-week training program during pregnancy can prevent and/or treat lumbopelvic pain. A randomized controlled trial was conducted at Trondheim University Hospital and three outpatient physiotherapy clinics. Three hundred and one healthy nulliparous women were included at 20 weeks of pregnancy and randomly allocated to a training group (148) or a control group (153). The outcome measures were self-reported symptoms of lumbopelvic pain (once per week or more), sick leave, and functional status. Pain drawing was used to document the painful area of the body. The intervention included daily pelvic floor muscle training at home, and weekly group training over 12 weeks including aerobic exercises, pelvic floor muscle and additional exercises, and information related to pregnancy. At 36 weeks of gestation women in the training group were significantly less likely to report lumbopelvic pain: 65/148 (44%) versus 86/153 (56%) (p=0.03). Three months after delivery the difference was 39/148 (26%) in the training group versus 56/153 (37%) in the control group (p=0.06). There was no difference in sick leave during pregnancy, but women in the training group had significantly (p=0.01) higher scores on functional status. A 12-week specially designed training program during pregnancy was effective in preventing lumbopelvic pain in pregnancy.

  7. Effect of Kinesio Taping on Pain and Functional Disability in Chronic Nonspecific Low Back Pain: A Randomized Clinical Trial.

    Science.gov (United States)

    Al-Shareef, Amal T; Omar, Mohammed T A; Ibrahim, Amal H M

    2016-07-15

    A randomized controlled trial with 2-week Kinesio taping intervention. The aim of the study was to investigate the effectiveness of Kinesio taping application on pain, functional disability, and trunk flexion range of motion (ROM) in patients with chronic nonspecific low back pain (chronic NSLBP). Kinesio taping is a therapeutic tool used for treatment of chronic NSLBP. However, there is little scientific evidence that describes its clinical efficacy. Forty-four patients with chronic NSLBP were randomized into experimental group (n = 21) and placebo group (n = 23). The experimental group was treated with Erector Spinae Taping, whereas the placebo group was treated with placebo taping. The primary endpoint was pain intensity on visual analog scale. Secondary endpoints were functional disability on Arabic version of Oswestry disability index (ODI) and trunk flexion ROM on Modified Schober's test. All measurements were recorded at baseline (W0), after 2-week intervention (W2), and at 4-week (W4) follow-up. Both group were comparable at baseline (P > 0.05). The experimental group had a greater decrease in pain than the placebo group after W2 of intervention (mean between-group difference 2.05 cm, 95% confidence interval [CI] = 1.38-2.71 points). This was maintained to W4 follow-up (2.25 cm, 95% CI = 1.67-2.82 points). At W2, the experimental group had significantly greater improvement in disability, by 3.90 points (95% CI = 1.68-8.54 points). This effect was significant at W4 follow-up (5.6, 95% CI = 2.65-8.54 points). Similarly trunk flexion ROM was significantly better at W2 (-0.71 cm, 95% CI = -0.85 to -0.56) and W4 follow-up (-0.73 cm, 95% CI = -0.88 to -0.58). Kinesio taping reduces pain and disability and improves trunk flexion ROM after 2 weeks of application. However, thesis effects were very small to be considered clinically relevant and meaningful when compared with placebo taping. 2.

  8. The use of phototherapy in the management of TMJ pain: clinical evidence of benefits and limitations

    Science.gov (United States)

    Pinheiro, A. L. B.; Soares, A. P.; Marques, A. M. C.; de Carvalho, F. B.; Soares, L. G. P.; de Oliveira, S. C. P. S.; Cangussú, M. C. T.

    2017-02-01

    Temporomandibular disorders - TMDs are common painful multifactorial conditions affecting the temporomandibular joint whose treatment depends on the type and symptoms. Initially it requires pain control and for this, drugs, biting plates, occlusal adjustment, physiotherapy or their association are used. Laser-phototherapy (LPT) has been used on the treatment of pain of several origins including TMDs. It is known that wavelength, energy density, frequency of application influences the outcome of many clinical protocols. This work reports a series of patients of the Center of Biophotonics of the Federal University of Bahia over 15 years. Following standard anamneses, clinical and imaginologic examination and with the diagnosis of any type of TMD, the patients were set for light treatment. Treatment consisted of three sessions a week during six week. Prior irradiation, the patients were asked to score their pain using a VAS. IR and/or Red diode lasers were used on each session. The medical records of 432 patients (73 male and 359 female) suffering from TMJ disorders were revised. Most patients were female ( 47.9 years old). At the end of the 12 sessions the patients were again examined and score their pain using VAS. No other intervention was carried out during the treatment. The results were statistically analyzed and showed that 51.16 % of the patients were asymptomatic or improved after treatment. It is concluded that LPT was effective on pain reduction on TMJ disorders of several origins.

  9. Resource reduction in pediatric chest pain: Standardized clinical assessment and management plan.

    Science.gov (United States)

    Saleeb, Susan F; McLaughlin, Sarah R; Graham, Dionne A; Friedman, Kevin G; Fulton, David R

    2018-01-01

    Using a Standardized Clinical Assessment and Management Plan (SCAMP) for pediatric patients presenting to clinic with chest pain, we evaluated the cost impact associated with implementation of the care algorithm. Prior to introduction of the SCAMP, we analyzed charges for 406 patients with chest pain, seen in 2009, and predicted 21% reduction of overall charges had the SCAMP methodology been used. The SCAMP recommended an echocardiogram for history, examination, or ECG findings suggestive of a cardiac etiology for chest pain. Resource utilization was reviewed for 1517 patients (7-21 years) enrolled in the SCAMP from July 2010 to April 2014. Compared to the 2009 historic cohort, patients evaluated by the SCAMP had higher rates of exertional chest pain (45% vs 37%) and positive family history (5% vs 1%). The SCAMP cohort had fewer abnormal physical examination findings (1% vs 6%) and abnormal electrocardiograms (3% vs 5%). Echocardiogram use increased in the SCAMP cohort compared to the 2009 historic cohort (45% vs 41%), whereas all other ancillary testing was reduced: exercise stress testing (4% SCAMP vs 28% historic), Holter (4% vs 7%), event monitors (3% vs 10%), and MRI (1% vs 2%). Total charges were reduced by 22% ($822 625) by use of the Chest Pain SCAMP, despite a higher percentage of patients for whom echocardiogram was recommended compared to the historic cohort. The Chest Pain SCAMP effectively streamlines cardiac testing and reduces resource utilization. Further reductions can be made by algorithm refinement regarding echocardiograms for exertional symptoms. © 2017 Wiley Periodicals, Inc.

  10. Using Guasha to treat musculoskeletal pain: A systematic review of controlled clinical trials

    Directory of Open Access Journals (Sweden)

    Choi Sun-Mi

    2010-01-01

    Full Text Available Abstract Background Guasha is a therapeutic method for pain management using tools to scrape or rub the surface of the body to relieve blood stagnation. This study aims to systematically review the controlled clinical trials on the effectiveness of using Guasha to treat musculoskeletal pain. Methods We searched 11 databases (without language restrictions: MEDLINE, Allied and Complementary Medicine (AMED, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL, Korean Studies Information (KSI, DBPIA, Korea Institute of Science and Technology Information (KISTI, KoreaMed, Research Information Service System (RISS, China National Knowledge Infrastructure (CNKI and the Cochrane Library. The search strategy was Guasha (OR scraping AND pain. Risk of bias was assessed with the Cochrane criteria (i.e. sequence generation, blinding, incomplete outcome measures and allocation concealment. Results Five randomized controlled trials (RCTs and two controlled clinical trials (CCTs were included in the present study. Two RCTs compared Guasha with acupuncture in terms of effectiveness, while the other trials compared Guasha with no treatment (1 trial, acupuncture (4 trials, herbal injection (1 trial and massage or electric current therapy (1 trial. While two RCTs suggested favorable effects of Guasha on pain reduction and response rate, the quality of these RCTs was poor. One CCT reported beneficial effects of Guasha on musculoskeletal pain but had low methodological quality. Conclusion Current evidence is insufficient to show that Guasha is effective in pain management. Further RCTs are warranted and methodological quality should be improved.

  11. Clinical features and pathophysiology of Complex Regional Pain Syndrome – current state of the art

    Science.gov (United States)

    Marinus, Johan; Moseley, G. Lorimer; Birklein, Frank; Baron, Ralf; Maihöfner, Christian; Kingery, Wade S.; van Hilten, Jacobus J.

    2017-01-01

    That a minor injury can trigger a complex regional pain syndrome (CRPS) - multiple system dysfunction, severe and often chronic pain and disability - has fascinated scientists and perplexed clinicians for decades. However, substantial advances across several medical disciplines have recently increased our understanding of CRPS. Compelling evidence implicates biological pathways that underlie aberrant inflammation, vasomotor dysfunction, and maladaptive neuroplasticity in the clinical features of CRPS. Collectively, the evidence points to CRPS being a multifactorial disorder that is associated with an aberrant host response to tissue injury. Varying susceptibility to perturbed regulation of any of the underlying biological pathways probably accounts for the clinical heterogeneity of CRPS. PMID:21683929

  12. SpineData – a Danish clinical registry of people with chronic back pain

    Directory of Open Access Journals (Sweden)

    Kent P

    2015-08-01

    Full Text Available Peter Kent,1 Alice Kongsted,1,2 Tue Secher Jensen,2,3 Hanne B Albert,4 Berit Schiøttz-Christensen,3 Claus Manniche3 1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; 2Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark; 3Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Research, University of Southern Denmark, Middelfart, Denmark; 4The Modic Clinic, Odense, Denmark Background: Large-scale clinical registries are increasingly recognized as important resources for quality assurance and research to inform clinical decision-making and health policy. We established a clinical registry (SpineData in a conservative care setting where more than 10,000 new cases of spinal pain are assessed each year. This paper describes the SpineData registry, summarizes the characteristics of its clinical population and data, and signals the availability of these data as a resource for collaborative research projects. Methods: The SpineData registry is an Internet-based system that captures patient data electronically at the point of clinical contact. The setting is the government-funded Medical Department of the Spine Centre of Southern Denmark, Hospital Lillebaelt, where patients receive a multidisciplinary assessment of their chronic spinal pain. Results: Started in 2011, the database by early 2015 contained information on more than 36,300 baseline episodes of patient care, plus the available 6-month and 12-month follow-up data for these episodes. The baseline questionnaire completion rate has been 93%; 79% of people were presenting with low back pain as their main complaint, 6% with mid-back pain, and 15% with neck pain. Collectively, across the body regions and measurement time points, there are approximately 1,980 patient-related variables in the database across a broad range of biopsychosocial factors. To date, 36 research

  13. Clinical, psychological and demographic parameters of body pain in multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Ghasem Salehpoor

    2017-02-01

    Full Text Available Background: Body pain in multiple sclerosis (MS is a common phenomenon that can create or exacerbate by different parameters of clinical, psychological and demographic. The aim of this study was to investigate the relationship between parameters of clinical (fatigue, clinical course, body mass index and duration, psychological (depression, anxiety and stress and demographic (age, gender, marital status and education characters with multiple sclerosis patient’s body pain. Methods: This cross-sectional study has been performed in the Multiple Sclerosis Society of Guilan Province and Imam Reza Specialized and Sub-specialized Clinic, Rasht City, Iran during June to February 2010. In this study 162 patients with MS were selected by consecutive sampling. We used the clinical and demographic variables inventory, body pain subscale of the health survey questionnaire, depression, anxiety and stress scale and fatigue severity scale along with identical analog-spring balance. The data were analyzed by Pearson correlation coefficient and point bi-serial, one-way analysis of variance, Gabriel test and stepwise multiple regression. Results: The findings showed that patients who scored 3 or higher in relapses experienced significantly more body pain than patients who scored 1-2 times of relapses (P= 0.031. In the meantime, significant differences were not found between the two groups of patients with a score of 3 or higher in relapses and non-relapse and between non-relapse patients and with a score 1-2 times of relapses in terms of body pain. Also, significant differences were not found in different groups of hospitalization in terms of body pain. However, anxiety and fatigue together could explain significantly 25% of the shared variance of body pain (F= 26.29, P≤ 0.0009. Conclusion: This study showed the effect of psychological and clinical factors on body pain exacerbation in MS patients. Therefore, it is necessary for clinicians to consider

  14. Clinical Prediction Model and Tool for Assessing Risk of Persistent Pain After Breast Cancer Surgery

    DEFF Research Database (Denmark)

    Meretoja, Tuomo J; Andersen, Kenneth Geving; Bruce, Julie

    2017-01-01

    Purpose Persistent pain after breast cancer surgery is a well-recognized problem, with moderate to severe pain affecting 15% to 20% of women at 1 year from surgery. Several risk factors for persistent pain have been recognized, but tools to identify high-risk patients and preventive interventions...... are missing. The aim was to develop a clinically applicable risk prediction tool. Methods The prediction models were developed and tested using three prospective data sets from Finland (n = 860), Denmark (n = 453), and Scotland (n = 231). Prediction models for persistent pain of moderate to severe intensity...... at 1 year postoperatively were developed by logistic regression analyses in the Finnish patient cohort. The models were tested in two independent cohorts from Denmark and Scotland by assessing the areas under the receiver operating characteristics curves (ROC-AUCs). The outcome variable was moderate...

  15. Clinical features in patients with chronic muscle pain--with special reference to fibromyalgia

    DEFF Research Database (Denmark)

    Jacobsen, Søren; Petersen, I S; Danneskiold-Samsøe, B

    1993-01-01

    Clinical characteristics were studied in patients with chronic muscle pain, divided into three groups according to the characteristics of their pain; "fibromyalgia" (n = 23), "widespread muscle pain" (n = 21), and "regional muscle pain" (n = 28). Typical fibromyalgia features were also seen...... in the other groups of patients, but not to the same extent. In particular, sleep disturbance, subjective swelling, cold and exercise intolerance and low self-reported physical performance were significantly related to fibromyalgia. The major components of fibromyalgia were not wholly different compared...... with other European and North American studies, except for sleep disturbance and subjective swelling, which was somewhat more pronounced in this study. The most used medications in fibromyalgia patients at referral were analgesics, anxiolytic drugs and female sex hormones. Medication in fibromyalgia...

  16. Clinical commentary of the evolution of the treatment for chronic painful mid-portion Achilles tendinopathy

    Directory of Open Access Journals (Sweden)

    Håkan Alfredson

    2015-10-01

    Full Text Available ABSTRACTThe chronic painful Achilles tendon mid-portion was for many years, and still is in many countries, treated with intratendinous revision surgery. However, by coincidence, painful eccentric calf muscle training was tried, and it showed very good clinical results. This finding was unexpected and led to research into the pain mechanisms involved in this condition. Today we know that there are very few nerves inside, but multiple nerves outside, the ventral side of the chronic painful Achilles tendon mid-portion. These research findings have resulted in new treatment methods targeting the regions with nerves outside the tendon, methods that allow for a rapid rehabilitation and fast return to sports.

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

    Science.gov (United States)

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

    2014-04-01

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

  18. Chronic widespread pain: clinical comorbidities and psychological correlates.

    Science.gov (United States)

    Burri, Andrea; Ogata, Soshiro; Vehof, Jelle; Williams, Frances

    2015-08-01

    Recent studies have provided consistent evidence for a genetic influence on chronic widespread pain (CWP). The aim of this study was to investigate (1) the etiological structure underlying CWP by examining the covariation between CWP and psychological comorbidities and psychoaffective correlates and (2) the decomposition of the covariation into genetic and environmental components. A total of 3266 female twins (mean age 56.6 years) were subject to multivariate analyses. Using validated questionnaires to classify twins as having CWP, the prevalence of CWP was 20.8%. In the multivariate analysis, the most suitable model was the common pathway model. This model revealed 2 underlying latent variables, one common to anxiety, emotional intelligence, and emotional instability (f1) and the other common to depression and CWP (f2), the latter being highly heritable (86%). Both latent variables (f1 and f2) shared an additive genetic and a nonshared environmental factor. In addition, a second additive genetic factor loading only on f2 was found. This study reveals the structure of genetic and environmental influences of CWP and its psychoaffective correlates. The results show that the clustering of CWP and depression is due to a common, highly heritable, underlying latent trait. In addition, we found evidence that CWP, anxiety, emotional instability, and emotional intelligence are influenced by different underlying latent traits sharing the same genetic and nonshared environmental factors. This is the first study to reveal the structure and relative importance of genetic and environmental influences on complex etiological mechanisms of CWP and its correlates.

  19. Clinical assessment of chest pain and guidelines for imaging

    Energy Technology Data Exchange (ETDEWEB)

    Gruettner, J., E-mail: joachim.gruettner@umm.de [1st Department of Medicine (Cardiology), University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany); Henzler, T. [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany); Sueselbeck, T. [1st Department of Medicine (Cardiology), University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany); Fink, C. [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany); Borggrefe, M.; Walter, T. [1st Department of Medicine (Cardiology), University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany)

    2012-12-15

    For many emergency facilities, risk assessment of patients with diffuse chest pain still poses a major challenge. In their currently valid recommendations, the international cardiological societies have defined a standardized assessment of the prognostically relevant cardiac risk criteria. Here the classic sequence of basic cardiac diagnostics including case history (cardiac risk factors), physical examination (haemodynamic and respiratory vital parameters), ECG (ST segment analysis) and laboratory risk markers (troponin levels) is paramount. The focus is, on the one hand, on timely indication for percutaneous catheterization, especially in patients at high cardiac risk with or without ST-segment elevation in the ECG, and, on the other hand, on the possibility of safely discharging patients with intermediate or low cardiac risk after non-invasive exclusion of a coronary syndrome. For patients in the intermediate or low risk group, physical or pharmacological stress testing in combination with scintigraphy, echocardiography or magnetic resonance imaging is recommended in addition to basic diagnostics. Moreover, the importance of non-invasive coronary imaging, primarily cardiac CT angiography (CCTA), is increasing. Current data show that in intermediate or low risk patients this method is suitable to reliably rule out coronary heart disease. In addition, attention is paid to the major differential diagnoses of acute coronary syndrome, particularly pulmonary embolism and aortic dissection. Here the diagnostic method of choice is thoracic CT, possibly also in combination with CCTA aiming at a triple rule-out.

  20. Limb Laterality Recognition Score: A Reliable Clinical Measure Related to Phantom Limb Pain.

    Science.gov (United States)

    Wong, Christopher Kevin; Wong, Caitlin Kimberly

    2017-08-24

    To explore the usefulness of the limb laterality recognition score as a clinical measure of phantom limb pain, regarding test-retest reliability and association of limb laterality recognition scores with phantom limb pain measures. Retrospective cohort. Community support group. Eleven adults who averaged 4.8 years since lower limb amputation due to vascular pathologies (N = 9), trauma (N = 1), and cancer (N = 1). Subjects self-reported amputated limb pain using the sensation subsection of the Prosthetic Evaluation Questionnaire and back and sound limb pain. Using numbered iPads that corresponded to the self-reports, subjects played the Recognise Foot game to assess limb laterality recognition ability. Subjects identified the laterality of 20 foot images, within two seconds each. The software collected accuracy and speed scores in basic, vanilla, and context conditions for two rounds in random order. Basic showed feet against black backgrounds, vanilla showed feet with various monochromatic backgrounds, and context showed feet in clothed or environmental contexts. So that greater accuracy in less time meant a better score, accuracy scores were divided by completion speed. Intraclass correlation coefficient (ICC)3,1 assessed test-retest reliability. Correlations between accuracy/speed and phantom limb pain measures were assessed with Spearman's rho (categorical) and Pearson coefficients (continuous). Accuracy/speed test-retest reliability was strong (ICC = 0.72) and inversely associated with phantom limb pain frequency (context rho = 0.72). Limb laterality recognition accuracy/speed in the context condition had good test-retest reliability and correlated strongly with phantom limb pain frequency. Accuracy/speed limb laterality recognition ability relates to phantom limb pain and may be a valid clinical or research measure.

  1. Clinical decision aids for chest pain in the emergency department: identifying low-risk patients

    Directory of Open Access Journals (Sweden)

    Alley W

    2015-11-01

    Full Text Available William Alley, Simon A Mahler Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA Abstract: Chest pain is one of the most common presenting complaints in the emergency department, though only a small minority of patients are subsequently diagnosed with acute coronary syndrome (ACS. However, missing the diagnosis has potential for significant morbidity and mortality. ACS presentations can be atypical, and their workups are often prolonged and costly. In order to risk-stratify patients and better direct the workup and care given, many decision aids have been developed. While each may have merit in certain clinical settings, the most useful aid in the emergency department is one that finds all cases of ACS while also identifying a substantial subset of patients at low risk who can be discharged without stress testing or coronary angiography. This review describes several of the chest pain decision aids developed and studied through the recent past, starting with the thrombolysis in myocardial infarction (TIMI risk score and Global Registry of Acute Coronary Events (GRACE scores, which were developed as prognostic aids for patients already diagnosed with ACS, then subsequently validated in the undifferentiated chest pain population. Asia-Pacific Evaluation of Chest Pain Trial (ASPECT; Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins (ADAPT; North American Chest Pain Rule (NACPR; and History, Electrocardiogram, Age, Risk factors, Troponin (HEART score have been developed exclusively for use in the undifferentiated chest pain population as well, with improved performance compared to their predecessors. This review describes the relative merits and limitations of these decision aids so that providers can determine which tool fits the needs of their clinical practice setting. Keywords: chest pain, decision aid, risk score, acute coronary syndrome

  2. The topical 5% lidocaine medicated plaster in localized neuropathic pain: a reappraisal of the clinical evidence

    Directory of Open Access Journals (Sweden)

    de León-Casasola OA

    2016-02-01

    Full Text Available Oscar A de León-Casasola,1,2 Victor Mayoral3 1Department of Anesthesiology, Division of Pain Medicine, Roswell Park Cancer Institute, 2University at Buffalo, School of Medicine and Biomedical Sciences. NY, USA; 3Anesthesiology Department, Pain Management Unit, University Hospital of Bellvitge, L'Hospitalet de Llobregat, Spain Abstract: Topical 5% lidocaine medicated plasters represent a well-established first-line option for the treatment of peripheral localized neuropathic pain (LNP. This review provides an updated overview of the clinical evidence (randomized, controlled, and open-label clinical studies, real-life daily clinical practice, and case series. The 5% lidocaine medicated plaster effectively provides pain relief in postherpetic neuralgia, and data from a large open-label controlled study indicate that the 5% lidocaine medicated plaster is as effective as systemic pregabalin in postherpetic neuralgia and painful diabetic polyneuropathy but with an improved tolerability profile. Additionally, improved analgesia and fewer side effects were experienced by patients treated synchronously with the 5% lidocaine medicated plaster, further demonstrating the value of multimodal analgesia in LNP. The 5% lidocaine medicated plaster provides continued benefit after long-term (≤7 years use and is also effective in various other LNP conditions. Minor application-site reactions are the most common adverse events associated with the 5% lidocaine medicated plaster; there is minimal risk of systemic adverse events and drug–drug interactions. Although further well-controlled studies are warranted, the 5% lidocaine medicated plaster is efficacious and safe in LNP and may have particular clinical benefit in elderly and/or medically compromised patients because of the low incidence of adverse events. Keywords: 5% lidocaine medicated plaster, clinical evidence, localized neuropathic pain, postherpetic neuralgia, review

  3. Clinical effect of deep water running on non-specific low back pain: A randomised trial

    Directory of Open Access Journals (Sweden)

    A.I. Cuesta-Vargas

    2009-02-01

    Full Text Available Objectives: To evaluate clinical effect of deep water running(DW R on non-specific low back pain. Outcome measures were pain, disability,general health and physical fitness.  Materials and methods: Experimental, randomized,  controlled trial involving 46 persons with CLBP over 15 weekswith two experimental processes, each three times a week. Evidence-basedProgram (EBP, personalized physical exercise program, manual therapy andhealth educa tion was the common process to which was added 20 minutes ofpersonalized intensity DW R at the aerobic threshold. Measurements were made at the beginning and end of the studyof pain, disability, general health and physical fitness.  R esults: The pain of CLBP were homogeneous at baseline.Significant changes between group were don’t found for pain in favour of the EBP+DW R group (p<0.3. The within-group differences were highly significant for all clinical and functional variables. The effect was clinically relevant forpain in the EBP+DW R group (0.70 and in the EBP group (0.58, and for disability degree it was also relevant in theEBP+DW R group (0.48 and relevant for the EBP group (0.36. Conclusion: Significant improvement was seen inCLBP when EBP was complemented with the high-intensity exercise of DW R.

  4. Effectiveness of neuromuscular taping on painful hemiplegic shoulder: a randomised clinical trial.

    Science.gov (United States)

    Pillastrini, Paolo; Rocchi, Giulia; Deserri, Deborah; Foschi, Paola; Mardegan, Michele; Naldi, Maria Teresa; Villafañe, Jorge Hugo; Bertozzi, Lucia

    2016-08-01

    The purpose of this trial was to investigate changes in pain, the range of motion (ROM) and spasticity in people with painful hemiplegic shoulder (PHS) after the application of an upper limb neuromuscular taping (NMT). We conducted a randomised clinical trial. The study included 32 people, 31% female (mean ± SD age: 66 ± 9 years), with PHS after stroke with pain at rest and during functional movements. The experimental group received the application of NMT and a standard physical therapy programme (SPTP), whereas the control group received SPTP. The groups received four 45-minute long sessions over four weeks. The VAS, ROM and spasticity were assessed before and after the intervention with follow-up at four weeks. The experimental group had a greater reduction in pain compared to the control group at the end of the intervention, as well as at one month after the intervention (p shoulder flexion (95% CI: 37.3-22.7) at 4 weeks and by 24.8° (95% CI: 32.1-17.6) at 8 weeks as well as in abduction by 30.6° (95% CI: 37.5-23.7) at 4 weeks and 25.1° (95% CI: 33.8-16.3) at 8 weeks. Our study demonstrates that NMT decreases pain and increases the ROM in subjects with shoulder pain after a stroke. Implications for Rehabilitation Painful hemiplegic shoulder is a frequent complication after stroke with negative impacts on functional activities and on quality of life of people, moreover restricts rehabilitation intervention. Neuromuscular taping is a technique introduced by David Blow for the treatment of neuromuscoloskeletal problems. This study shows the reduction of pain and the improvement of range of motion after the application of an upper limb neuromuscular taping. Rehabilitation professionals who are involved in the management of painful hemiplegic shoulder may like to consider the benefits that neuromuscular taping can produce on upper limb.

  5. Clinical monitoring scales in acute brain injury: assessment of coma, pain, agitation, and delirium.

    Science.gov (United States)

    Riker, Richard R; Fugate, Jennifer E

    2014-12-01

    Serial clinical examination represents the most fundamental and basic form of neurological monitoring, and is often the first and only form of such monitoring in patients. Even in patients subjected to physiological monitoring using a range of technologies, the clinical examination remains an essential tool to follow neurological progress. Key aspects of the clinical examination have now been systematized into scoring schemes, and address consciousness, pain, agitation, and delirium (PAD). The Glasgow Coma Scale has been the traditional tool to measure consciousness, but the full outline of unresponsiveness (FOUR) score has recently been validated in a variety of settings, and at present, both represent clinically useful tools. Assessment of PAD in neurologically compromised patients present special challenges. For pain, the Numeric Rating Scale is the preferred initial approach, with either the Behavioral Pain Scale or the Critical Care Pain Observation Tool in subjects who are not able to respond. The Nociception Coma Scale-Revised may be useful in patients with severe disorders of consciousness. Conventional sedation scoring tools for critical care, such as the Richmond Area Sedation Scale (RASS) and Sedation-Agitation Scale (SAS) may provide reasonable tools in some neurocritical care patients. The use of sedative drugs and neuromuscular blockers may invalidate the use of some clinical examination tools in others. The use of sedation interruption to assess neurological status can result in physiological derangement in unstable patients (such as those with uncontrolled intracranial hypertension), and is not recommended.

  6. The effects of total knee replacement and non-surgical treatment on pain sensitization and clinical pain

    DEFF Research Database (Denmark)

    Skou, Søren Thorgaard; Roos, Ewa M.; Simonsen, Ole

    2016-01-01

    BACKGROUND: The objective was to compare the effect of total knee replacement (TKR) followed by a 3-month non-surgical treatment with the non-surgical treatment alone in reducing pain sensitization and other pain-related measures in patients with knee osteoarthritis. METHODS: One hundred patients...... pain sensitization than non-surgical treatment alone. Both treatments are equally efficacious in reducing the pain-related measures of this study. WHAT DOES THIS STUDY ADD?: Knee replacement followed by non-surgical treatment is more effective in reducing pain sensitization, but not other pain...... (PPTs) at the knee (localized sensitization) and the lower leg (spreading sensitization), (2) peak pain intensity during the previous 24 h, (3) pain intensity after 30 min of walking, (4) pain location and pattern, (5) spreading of pain on a region-divided body chart and (6) the usage of pain medication...

  7. Walking down 'Via Dolorosa' from primary health care to the specialty pain clinic - patient and professional perceptions of inequity in rehabilitation of chronic pain.

    Science.gov (United States)

    Lehti, Arja; Fjellman-Wiklund, Anncristine; Stålnacke, Britt-Marie; Hammarström, Anne; Wiklund, Maria

    2017-03-01

    To analyse patient and professional perceptions about (in)equity of care and rehabilitation of chronic pain patients from primary health care to assessment at a specialty rehabilitation clinic. This qualitative study consists one focus group interview with eight general practitioners who refer patients to pain rehabilitation clinics, 10 individual interviews with patients who were assessed at a pain rehabilitation clinic and seven interviews with professionals participating in multimodal assessment teams at a pain rehabilitation clinic. Interview analysis was conducted by the grounded theory method. The core category Via Dolorosa, the way of suffering and pain, captured how gender and sociocultural context may contribute to advantages and disadvantages during patient journeys from primary health care to a pain rehabilitation clinic. Patients and professionals perceived pain as a low-ranking illness, and women and men used different gendered strategies to legitimise the pain and to be taken seriously. Being 'a proper patient ready to change' and having 'likeness' between patients and professionals were viewed as advantageous in rehabilitation of pain patients. Patients with higher educational levels were perceived as easier to interact with and had better access to health care. Professional thoughts about gender norms influenced the rehabilitation options. The rehabilitation programme was seen by several professionals to be better suited for women than men, which could lead to unequal care. From an equity and gender perspective, our study highlights the complexity in rehabilitation of chronic pain patients - both from patient and professional perspectives. Awareness of gendered and the biased preconceptions and norms is crucial when professionals struggle to offer equitable health care and rehabilitation. © 2016 Nordic College of Caring Science.

  8. Diagnostic Accuracy of Clinical Examination and Imaging Findings for Identifying Subacromial Pain.

    Directory of Open Access Journals (Sweden)

    Angela Cadogan

    Full Text Available The diagnosis of subacromial pathology is limited by the poor accuracy of clinical tests for specific pathologies. The aim of this study was to estimate the diagnostic accuracy of clinical examination and imaging features for identifying subacromial pain (SAP defined by a positive response to diagnostic injection, and to evaluate the influence of imaging findings on the clinical diagnosis of SAP.In a prospective, diagnostic accuracy design, 208 consecutive patients presenting to their primary healthcare practitioner for the first time with a new episode of shoulder pain were recruited. All participants underwent a standardized clinical examination, shoulder x-ray series and diagnostic ultrasound scan. Results were compared with the response to a diagnostic block of xylocaineTM injected into the SAB under ultrasound guidance using ≥80% post-injection reduction in pain intensity as the positive anaesthetic response (PAR criterion. Diagnostic accuracy statistics were calculated for combinations of clinical and imaging variables demonstrating the highest likelihood of a PAR. A PAR was reported by 34% of participants. In participants with no loss of passive external rotation, combinations of three clinical variables (anterior shoulder pain, strain injury, absence of symptoms at end-range external rotation (in abduction demonstrated 100% specificity for a PAR when all three were positive (LR+ infinity; 95%CI 2.9, infinity. A full-thickness supraspinatus tear on ultrasound increased the likelihood of a PAR irrespective of age (specificity 98% (95%CI 94, 100; LR+ 6.2; 95% CI 1.5, 25.7. Imaging did not improve the ability to rule-out a PAR.Combinations of clinical examination findings and a full-thickness supraspinatus tear on ultrasound scan can help confirm, but not exclude, the presence of subacromial pain. Other imaging findings were of limited value for diagnosing SAP.

  9. A diagnosis-based clinical decision rule for spinal pain part 2: review of the literature

    Directory of Open Access Journals (Sweden)

    Hurwitz Eric L

    2008-08-01

    Full Text Available Abstract Background Spinal pain is a common and often disabling problem. The research on various treatments for spinal pain has, for the most part, suggested that while several interventions have demonstrated mild to moderate short-term benefit, no single treatment has a major impact on either pain or disability. There is great need for more accurate diagnosis in patients with spinal pain. In a previous paper, the theoretical model of a diagnosis-based clinical decision rule was presented. The approach is designed to provide the clinician with a strategy for arriving at a specific working diagnosis from which treatment decisions can be made. It is based on three questions of diagnosis. In the current paper, the literature on the reliability and validity of the assessment procedures that are included in the diagnosis-based clinical decision rule is presented. Methods The databases of Medline, Cinahl, Embase and MANTIS were searched for studies that evaluated the reliability and validity of clinic-based diagnostic procedures for patients with spinal pain that have relevance for questions 2 (which investigates characteristics of the pain source and 3 (which investigates perpetuating factors of the pain experience. In addition, the reference list of identified papers and authors' libraries were searched. Results A total of 1769 articles were retrieved, of which 138 were deemed relevant. Fifty-one studies related to reliability and 76 related to validity. One study evaluated both reliability and validity. Conclusion Regarding some aspects of the DBCDR, there are a number of studies that allow the clinician to have a reasonable degree of confidence in his or her findings. This is particularly true for centralization signs, neurodynamic signs and psychological perpetuating factors. There are other aspects of the DBCDR in which a lesser degree of confidence is warranted, and in which further research is needed.

  10. Daily Practice Clinic of Scientific Evidence in the Physiotherapy Management of Chronic Nonspecific Low Back Pain

    Directory of Open Access Journals (Sweden)

    María Constanza Trillos Chacón

    2015-05-01

    Full Text Available Introduction: 80 % of adults experience back pain at least once in their life. Back pain is the third leading cause of consultation in the emergency room, the fourth in general practice, the second of disability pension and the first job relocation. Objective: To compare the criteria that guide decision making of a group of physiotherapists in Bogota Colombia for the management of chronic nonspecific low back pain management criteria contained in the guide COST B13 (European Guidelines For The Management Of Chronic Non- specific Low Back Pain, 2004. Material and methods: This was a descriptive study, for which clinical practice guideline COST B13 for the management of chronic nonspecific low back pain through the AGREE tool is selected and a survey was applied to 50 physiotherapists through a convenience sample with to compare the clinical practices that are performed with the recommendations given guidance. Results: 56 % of respondents had some type of training for the management of chronic nonspecific low back pain (DLCI. 94 % of patients with DLCI served range in age from 40 to 59, with female predominance. In 80 % of respondents stated that physiotherapists diagnostic help with counting for the management of patients is the radiological image. 80 % of physiotherapists evaluated variable lumbar pain experienced by the patient and 54 % stance. Other aspects were reported in lower percentage. In the treatment of DLCI, physiotherapists reported use of stretching in 80 % of cases, the superficial thermotherapy in 70 % and isometric muscle strength in 70 %, all with favorable results.Conclusion: There are differences between clinical practice of physiotherapists and guidelines contained in the recommendations of the guide in the cost DLCI B13. Mainly in the processes of physiotherapy assessment of the surveyed population as they are often focused on observation and not always in the rigorous measurement, which makes it difficult to establish

  11. Clarification of developing and established clinical allodynia and pain-free outcomes.

    Science.gov (United States)

    Landy, Stephen H; McGinnis, Judy E; McDonald, Susan A

    2007-02-01

    The aim of this study was to determine whether clinical indicators of cutaneous allodynia predict the success of migraine therapy with sumatriptan using a brief questionnaire. Using quantitative sensory testing (QST) recent studies demonstrate that the presence of cutaneous allodynia, a clinical manifestation of central sensitization, can be detrimental to the success of migraine therapy with sumatriptan. QST is costly and requires much time, therefore it is not feasible to use in clinical practice. In this prospective study, migraineurs completed a questionnaire about their skin sensitivity during migraine. Each migraineur treated 2 migraine headaches with sumatriptan (100 mg): 1 headache at the earliest sign of migraine pain (mild, within 1 hour of onset) and 1 headache at least 4 hours after the onset of pain while moderate or severe. Thirty-six migraine headaches were evaluated in 18 migraineurs. A total of 44% of the headaches were not associated with allodynia at any time. Irrespective of allodynic status, headaches were more likely to become pain-free with early versus late treatment (2 hours; 78% vs. 33%, respectively). Headaches were equally likely to become pain-free when allodynia was reported before treatment but not 2 and 4 hours after treatment (2 hours; 67 vs. 63%, respectively, 4 hours 80 vs. 81%, respectively). However, no headaches were pain-free when allodynia was reported at 2 and 4 hours after treatment. Headaches without allodynia were aborted when treated early or late, and headaches with allodynia were aborted only when allodynia was not present after treatment. These findings suggest that different mechanisms account for allodynia before and after treatment; a developing phase in which central sensitization depends on incoming pain signals from the peripheral nociceptors and an established phase in which the sensitization becomes independent of the pain signals that come from the dura.

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

    Science.gov (United States)

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

    2017-02-01

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

  13. Using Social Media While Waiting in Pain: A Clinical 12-Week Longitudinal Pilot Study.

    Science.gov (United States)

    Merolli, Mark; Gray, Kathleen; Martin-Sanchez, Fernando; Mantopoulos, Steven; Hogg, Malcolm

    2015-08-07

    Chronic pain places an enormous burden on health care systems. Multidisciplinary pain management services are well documented as an effective means to improve patient outcomes. However, waiting lists to access these services are long and outcomes deteriorate. Innovative solutions such as social media are gaining attention as a way to decrease this burden and improve outcomes. It is a challenge to design research that demonstrates whether social media are acceptable to patients and clinically effective. The aim was to conduct a longitudinal pilot study to understand what aspects of research design are key to the success of running a larger-scale study of social media use in the clinical management of chronic pain. A 12-week study examined social media use by patients on the waiting list for the Royal Melbourne Hospital Pain Management Service. Selected social media resources were suggested for use by patients waiting for an appointment at the clinic. Patients filled out measures for pain interference and pain self-efficacy before and after the study. Follow-up was conducted at monthly intervals via telephone semistructured interviews to discuss engagement and garner individual perceptions towards social media use. A social media-use instrument was also administered as part of the after-study questionnaire. Targeted recruitment refined 235 patient referrals to 138 (58.7%) suitable potential participants. Contact was made with 84 out of 138 (60.9%) patients. After a further exclusion of 54 out of 84 (64%) patients for various reasons, this left 30 out of 84 (36%) patients fitting the inclusion criteria and interested in study participation. A final study cohort of 17 out of 30 (57%) was obtained. Demographics of the 17 patients were mixed. Low back pain was the primary condition reported as leading to chronic pain. Semistructured interviews collected data from 16 out of 17 (94%) patients who started the trial, and at final follow-up 9 out of 17 (53%) patients

  14. British Sign Name Customs

    Science.gov (United States)

    Day, Linda; Sutton-Spence, Rachel

    2010-01-01

    Research presented here describes the sign names and the customs of name allocation within the British Deaf community. While some aspects of British Sign Language sign names and British Deaf naming customs differ from those in most Western societies, there are many similarities. There are also similarities with other societies outside the more…

  15. Relationship between Travel Time from Home to a Regional Sleep Apnea Clinic in British Columbia, Canada, and the Severity of Obstructive Sleep.

    Science.gov (United States)

    Allen, A J M Hirsch; Amram, Ofer; Tavakoli, Hamid; Almeida, Fernanda R; Hamoda, Mona; Ayas, Najib T

    2016-05-01

    In the majority of people with obstructive sleep apnea, the disorder remains undiagnosed. This may be partly a result of inadequate access to diagnostic sleep services. We thus hypothesized that even modest travel times to a sleep clinic may delay diagnosis and reduce detection of milder disease. We sought to determine whether travel time between an individual's home and a sleep clinic is associated with sleep apnea severity at presentation. We recruited patients referred for suspected sleep apnea to the University of British Columbia Hospital Sleep Clinic between May 2003 and July 2011. The patient's place of residence was geocoded at the postal code level. Travel times between the population-weighted dissemination areas for each patient and the sleep clinic were calculated using ArcGIS (ESRI, Redlands, CA) network analyst and the Origin-Destination matrix function. All patients underwent full polysomnography. There were 1,275 patients; 69% were male, the mean age was 58 years. (SD = 11.9), and the mean apnea-hypopnea index was 22 per hour (SD = 21.6). In the univariate model, travel time was a significant predictor of obstructive sleep apnea severity (P = 0.02). After controlling for confounders including sex, age, obesity, and education, travel time remained a significant predictor of sleep apnea severity (P travel time was associated with an increase in the apnea-hypopnea index of 1.4 events per hour. For reasons that remain to be determined, travel times are associated with the severity of obstructive sleep apnea at presentation to a sleep clinic. If the results can be verified at other centers, this may help guide the geographic distribution of sleep centers within a health care system.

  16. Process of Change in Pain-Related Fear: Clinical Insights From a Single Case Report of Persistent Back Pain Managed With Cognitive Functional Therapy.

    Science.gov (United States)

    Caneiro, J P; Smith, Anne; Rabey, Martin; Moseley, G Lorimer; O'Sullivan, Peter

    2017-09-01

    Study Design Single case report with repeated measures over 18 months. Background Management of persistent low back pain (PLBP) associated with high pain-related fear is complex. This case report aims to provide clinicians with insight into the process of change in a person with PLBP and high bending-related fear, who was managed with an individualized behavioral approach of cognitive functional therapy. Case Description A retired manual worker with PLBP believed that his spine was degenerating, that bending would hurt him, and that avoidance was the only form of pain control. At baseline, he presented high levels of pain-related fear on the Tampa Scale of Kinesiophobia (score, 47/68) and a high-risk profile on the Örebro Musculoskeletal Pain Questionnaire (score, 61/100). Unhelpful beliefs and behaviors led to a vicious cycle of fear and disengagement from valued life activities. Guided behavioral experiments were used to challenge his thoughts and protective responses, indicating that his behavior was modifiable and the pain controllable. Using a multidimensional clinical-reasoning framework, cognitive functional therapy management was tailored to target key drivers of PLBP and delivered over 6 sessions in a 3-month period. Outcomes Over an 18-month clinical journey, he demonstrated improvements in bending-related fear, pain expectancy, and pain experience, and substantial changes in pain-related fear (Tampa Scale of Kinesiophobia: 33/68; change, -14 points) and risk profile (Örebro Musculoskeletal Pain Questionnaire: 36/100; change, -25 points). Clinical interviews at 6 and 18 months revealed positive changes in mindset, understanding of pain, perceived pain control, and behavioral responses to pain. Discussion This case report provides clinicians with an insight to using a multidimensional clinical-reasoning framework to identify and target the key drivers of the disorder, and to using cognitive functional therapy to address unhelpful psychological and

  17. Prevalence and clinical profile of chronic pain and its association with mental disorders

    Directory of Open Access Journals (Sweden)

    Flávia Garcia Pereira

    2017-11-01

    Full Text Available ABSTRACT OBJECTIVE To identify the prevalence of 12-month self-reported pain and chronic pain in a general population and to describe their clinical profile to assess if chronic pain is associated with 12-month mental disorders. METHODS The data used comes from the São Paulo Megacity Mental Health Survey, a population-based study assessing adult (≥ 18 years residents of the São Paulo metropolitan area, Brazil. We have assessed the respondents (n = 5,037 using the Composite International Diagnostic Interview (CIDI 3.0, with a global response rate of 81.3%. Descriptive analyses have been performed, and crude and adjusted odds ratios (OR have been calculated with logistic and multinomial regression and presented with respective 95% confidence intervals (95%CI. RESULTS The prevalence of pain and chronic pain in the past 12 months were 52.6% (95%CI 50.3–54.8 and 31.0% (95%CI 29.2–32.7, respectively. Joints (16.5%, 95%CI 15.4–17.5 and back or neck (15.5%, 95%CI 14.2–16.9 were the most frequently reported anatomical sites of chronic pain. On a 10-point analogue scale, the mean intensity of the worst pain was 7.7 (95%CI 7.4–7.8, and the mean average pain was 5.5 (95%CI 5.2–5.6; the mean treatment response was 6.3 (95%CI 6.0–6.6. Mean pain duration was 16.1 (95%CI 15.6–17.0 days a month and 132 (95%CI 126–144 minutes a day. Chronic pain was associated with 12-month DSM-IV mental disorders (OR = 2.7, 95%CI 2.3–3.3, anxiety disorders (OR = 2.1, 95%CI 1.9–3.0, and mood disorders (OR = 3.3, 95%CI 2.4–4.1. CONCLUSIONS A high prevalence of chronic pain in multiple sites is observed among the general adult population, and associations between chronic pain and mental disorders are frequent.

  18. Prevalence and clinical profile of chronic pain and its association with mental disorders

    Science.gov (United States)

    Pereira, Flávia Garcia; França, Mariane Henriques; de Paiva, Maria Cristina Alochio; Andrade, Laura Helena; Viana, Maria Carmen

    2017-01-01

    ABSTRACT OBJECTIVE To identify the prevalence of 12-month self-reported pain and chronic pain in a general population and to describe their clinical profile to assess if chronic pain is associated with 12-month mental disorders. METHODS The data used comes from the São Paulo Megacity Mental Health Survey, a population-based study assessing adult (≥ 18 years) residents of the São Paulo metropolitan area, Brazil. We have assessed the respondents (n = 5,037) using the Composite International Diagnostic Interview (CIDI 3.0), with a global response rate of 81.3%. Descriptive analyses have been performed, and crude and adjusted odds ratios (OR) have been calculated with logistic and multinomial regression and presented with respective 95% confidence intervals (95%CI). RESULTS The prevalence of pain and chronic pain in the past 12 months were 52.6% (95%CI 50.3–54.8) and 31.0% (95%CI 29.2–32.7), respectively. Joints (16.5%, 95%CI 15.4–17.5) and back or neck (15.5%, 95%CI 14.2–16.9) were the most frequently reported anatomical sites of chronic pain. On a 10-point analogue scale, the mean intensity of the worst pain was 7.7 (95%CI 7.4–7.8), and the mean average pain was 5.5 (95%CI 5.2–5.6); the mean treatment response was 6.3 (95%CI 6.0–6.6). Mean pain duration was 16.1 (95%CI 15.6–17.0) days a month and 132 (95%CI 126–144) minutes a day. Chronic pain was associated with 12-month DSM-IV mental disorders (OR = 2.7, 95%CI 2.3–3.3), anxiety disorders (OR = 2.1, 95%CI 1.9–3.0), and mood disorders (OR = 3.3, 95%CI 2.4–4.1). CONCLUSIONS A high prevalence of chronic pain in multiple sites is observed among the general adult population, and associations between chronic pain and mental disorders are frequent. PMID:29166447

  19. Pain associated with the sacroiliac joint region: a clinical study of 74 horses.

    Science.gov (United States)

    Dyson, S; Murray, R

    2003-05-01

    There has been no large study of horses with suspected sacroiliac (SI) joint region pain in which the clinical diagnosis has been supported by either abnormal radiopharmaceutical activity in the SI joint region or by periarticular infiltration of local anaesthetic solution. To describe the clinical features of horses with SI joint region pain, to document the age, breed, sex, discipline, size and conformation of affected horses and to compare these with the author's (SD) normal case population and to document the results of infiltration of local anaesthetic solution around the SI joint region. Horses were selected for inclusion in the study based upon the exclusion of other causes of lameness or poor performance, together with clinical signs suggestive of SI joint pain and abnormal radiopharmaceutical activity in the SI joint region and/or a positive response to periarticular infiltration of local anaesthetic solution. Sacroiliac joint region disease was identified in 74 horses between November 1997 and March 2002. Dressage and showjumping horses appeared to be at particular risk (P bit and poor quality canter were common. Sacroiliac joint region pain was seen alone (47%), or in conjunction with thoracolumbar pain (16%), hindlimb lameness (20%), forelimb lameness (7%) or a combination of problems (10%). Seventy-three horses (99%) had abnormalities of the SI joint region identified using nuclear scintigraphy. Infiltration of local anaesthetic solution around the SI joint region produced profound improvement in gait in all 34 horses in which it was performed. Careful clinical examination combined with scintigraphic evaluation of the SI joint region and local analgesia can enable a more definitive diagnosis of SI joint region pain than has previously been possible.

  20. Integrating interdisciplinary pain management into primary care: development and implementation of a novel clinical program.

    Science.gov (United States)

    Dorflinger, Lindsey M; Ruser, Christopher; Sellinger, John; Edens, Ellen L; Kerns, Robert D; Becker, William C

    2014-12-01

    The aims of this study were to develop and implement an interdisciplinary pain program integrated in primary care to address stakeholder-identified gaps. Program development and evaluation project utilizing a Plan-Do-Study-Act (PDSA) approach to address the identified problem of insufficient pain management resources within primary care. A large Healthcare System within the Veterans Health Administration, consisting of two academically affiliated medical centers and six community-based outpatients clinics. An interprofessional group of stakeholders participated in a Rapid Process Improvement Workshop (RPIW), a consensus-building process to identify systems-level gaps and feasible solutions and obtain buy-in. Changes were implemented in 2012, and in a 1-year follow-up, we examined indicators of engagement in specialty and multimodal pain care services as well as patient and provider satisfaction. In response to identified barriers, RPIW participants proposed and outlined two readily implementable, interdisciplinary clinics embedded within primary care: 1) the Integrated Pain Clinic, providing in-depth assessment and triage to targeted resources; and 2) the Opioid Reassessment Clinic, providing assessment and structured monitoring of patients with evidence of safety, efficacy, or misuse problems with opioids. Implementation of these programs led to higher rates of engagement in specialty and multimodal pain care services; patients and providers reported satisfaction with these services. Our PDSA cycle engaged an interprofessional group of stakeholders that recommended introduction of new systems-based interventions to better integrate pain resources into primary care to address reported barriers. Early data suggest improved outcomes; examination of additional outcomes is planned. Wiley Periodicals, Inc.

  1. Back Pain

    Science.gov (United States)

    ... Accessed May 29, 2015. Adult acute and subacute low back pain. Bloomington, Minn.: Institute for Clinical Systems Improvement. http://www.icsi.org/low_back_pain/adult_low_back_pain__8.html. Accessed June ...

  2. Effects of combining opioids and clinically available NMDA receptor antagonists in the treatment of pain

    NARCIS (Netherlands)

    Snijdelaar, D.G.

    2005-01-01

    This thesis concerns the effects of combining opioids with clinically available NMDA receptor antagonists in the treatment of acute and chronic pain. There are a number of problems with the use of opioids, such as, the development of tolerance/hyperalgesia, the reduced effectiveness in (central)

  3. Statistical significance versus clinical importance: trials on exercise therapy for chronic low back pain as example.

    NARCIS (Netherlands)

    van Tulder, M.W.; Malmivaara, A.; Hayden, J.; Koes, B.

    2007-01-01

    STUDY DESIGN. Critical appraisal of the literature. OBJECIVES. The objective of this study was to assess if results of back pain trials are statistically significant and clinically important. SUMMARY OF BACKGROUND DATA. There seems to be a discrepancy between conclusions reported by authors and

  4. Clinical and laboratory findings in 220 children with recurrent abdominal pain

    NARCIS (Netherlands)

    Gijsbers, C. F. M.; Benninga, M. A.; Büller, H. A.

    2011-01-01

    Aim: To investigate the clinical and laboratory findings in children with recurrent abdominal pain (RAP). Methods: Consecutive patients with RAP (Apley criteria), age 4-16 years, referred to a secondary medical centre were evaluated by a standardized history, physical examination and laboratory

  5. Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients With Nonspecific Neck Pain

    NARCIS (Netherlands)

    Bier, Jasper D; Scholten-Peeters, Wendy G M; Staal, J Bart; Pool, Jan; van Tulder, Maurits W; Beekman, Emmylou; Knoop, Jesper; Meerhoff, Guus; Verhagen, Arianne P

    2017-01-01

    The Royal Dutch Society for Physical Therapy (KNGF) issued a clinical practice guideline for physical therapists that addresses the assessment and treatment of patients with nonspecific neck pain, including cervical radiculopathy, in Dutch primary care. Recommendations were based on a review of

  6. The value of clinical and laboratory diagnostics for chest pain patients at the emergency department

    NARCIS (Netherlands)

    Jellema, Laurens-Jan C.; Backus, Barbra E.; Six, A. Jacob; Braam, Richard; Groenemeijer, Bjorn; van der Zaag-Loonen, Hester J.; Tio, Rene; van Suijlen, Jeroen D. E.

    Background: The focus during the diagnostic process for patients with acute chest pain is to discriminate patients who can be safely discharged from those who are at risk for an acute coronary syndrome (ACS). In this study the diagnostic value of the clinical examination is compared with laboratory

  7. Clinical Study of the Effects of Juglandis Semen Pharmacopuncture Therapy on Shoulder Pain

    Directory of Open Access Journals (Sweden)

    Han-Na Choi

    2011-12-01

    Full Text Available Objectives: The purpose of this study is to examine the effects of Juglandis Semen Pharmaco-puncture Therapy on Shoulder Pain. Methods & Results: Clinical studies on shoulder pain were carried out on 34 patients who were treated at Department of Acupuncture & Moxibusition, Samse Oriental Medical Hospital from June to October, 2009. Patients were divided into two groups, i.e.Sample group(Group A and Control group(Group B. Group B were treated by body acupuncture and cupping therapies while Group A were added juglandis semen pharmacopuncture therapy to therapies of Group A. All patients of both groups were treated three times a week for three weeks. In order to evaluate pain degree, we apply Shoulder Pain and Disability Index(SPADI, Visual Analogue Scale(VAS and the tool developed by Japan’s Industrial Hygienics Society and modified by Korean Doctor. Evaluations were done after first week, second week and third week during period of treatment. Results: Both groups showed significant pain decreasing tendencies. But Group A showed more efficiency comparing to Group B. Conclusions: According to the above-mentioned results, it seems that Juglandis Semen pharmacopuncture therapy could be applied as the effective method for reducing shoulder pain.

  8. Clinical Characteristics of Pruritus and Pain in Patients with Hidradenitis Suppurativa

    Directory of Open Access Journals (Sweden)

    Łukasz Matusiak

    2017-10-01

    Full Text Available A growing body of research has indicated that pruritus is an important feature of hidradenitis suppurativa (HS. This study evaluated pruritus and pain among 103 patients with HS. Pruritus and pain intensity were assessed with a visual analogue scale, numerical rating scale and 4-item Itch Questionnaire. Dermatology Life Quality Index (DLQI was implemented to assess quality of life (QoL issues. Various clinical features and factors influencing pruritus were also examined. Pruritus and pain during the last week were reported among 41.7% and 77.5% of patients, respectively. The presence of pruritus did not have an impact on DLQI, nor did it show interaction with the pain in this regard. The presence of pain was a crucial contributor, even more relevant than disease severity. None­theless, intensity of pruritus correlated positively with DLQI. The most troublesome symptom of HS was pain, followed by exudation, pruritus, appearance and smell, consecutively. Pruritus of mild-to-moderate intensity is a common HS-associated symptom that adversely affects patients’ QoL.

  9. Predictive value of fear avoidance in developing chronic neck pain disability: consequences for clinical decision making.

    Science.gov (United States)

    Nederhand, Marc J; Ijzerman, Maarten J; Hermens, Hermie J; Turk, Dennis C; Zilvold, Gerrit

    2004-03-01

    To improve clinical decision making in posttraumatic neck pain by investigating the additional value of fear-avoidance variables in predicting chronic neck pain disability. An inception cohort with baseline assessment 1 week posttrauma and outcome assessment 24 weeks posttrauma. Predictive factors include pain intensity, Neck Disability Index (NDI), catastrophizing, fear of movement (Tampa Scale for Kinesiophobia [TSK]), and avoidance muscle behavior. Hospital emergency department of a general hospital. A consecutive sample of 90 people reporting of pain in neck or head region after a motor vehicle collision. Eighty-two subjects (91.1%) of the sample provided 24-week follow-up on the outcome. Not applicable. The NDI assessing physical disability of subjects with neck pain. By using a combination of the baseline NDI and TSK, it appears to be possible to predict chronic disability with a probability of 54.3% (95% confidence interval [CI], 35.2%-72.3%) after entering the NDI (cutoff, 15) as a first test, and with a probability of 83.3% (95% CI, 70.3%-91.3%) after entering the TSK (cutoff, 40) in a second test. A simple rating of baseline neck pain disability within a week of the trauma, separately or in combination with a test for fear of movement, can be used to predict future outcome. Patients showing fear of movement can be offered an intervention that focuses on reduction of this fear.

  10. A randomized placebo-controlled clinical trial of phonophoresis for the treatment of chronic neck pain.

    Science.gov (United States)

    Durmus, Dilek; Alayli, Gamze; Tufekci, Tugce; Kuru, Omer

    2014-05-01

    The aim of this trial was to investigate and compare the effects of phonophoresis (PP), placebo PP and exercise therapies on pain, disability, sleep quality, and depression in the patients with chronic neck pain (CNP). This is a randomized, single-blind, placebo-controlled study. A total of 61 patients with definite CNP were included in this study. The patients were randomized into three groups. Group 1 (n = 21) received PP with capsaicin treatment and exercises. Group 2 (n = 20) received placebo PP with capsaicin and exercises. Group 3 (n = 20) was given only exercises. All of the programs were performed 3 days a week, for 6 weeks. The pain (visual analog scale), disability (the neck pain disability index), depression (Beck Depression Inventory scores), and sleep quality (Pittsburgh Sleep Quality Index) of all participants were evaluated. Measurements were taken before and after treatment. All of the groups showed statistically significant improvements in pain, disability, sleep quality, and depression. While there was no difference between groups regarding depression and sleep quality, intergroup comparison showed significant differences in pain and disability among three groups. These differences were statistically significant in group 1 and 2 compared to group 3, and also in group 1 compared to group 2. We observed that PP treatment was effective in the treatment for patients with CNP. A combination of PP with exercises can be used to obtain optimal clinical results.

  11. The Evaluation of Patients Presenting with Chest Pain to Pediatric Cardiology Outpatient Clinics

    Directory of Open Access Journals (Sweden)

    Mehmet Kervancıoğlu

    2005-01-01

    Full Text Available Although the possibility of the cardiac origin of chest pains in childhood is low, perception of the chest pain as heart pain by families makes this issue more important. A total of 223 patients (134 male, 99 female with a mean age of 11.3±4.3 years ranging between 4 and 15 years, who were admitted with chest pain to the Pediatric Cardiology Outpatient Clinics of Dicle University Hospital between April 2004 and January 2005, were enrolled into the study. Investigations with electrocardiography, holter monitoring and echocardiography revealed MVP in 12, pulmonary valve stenosis in three, pericardial effusion in two, focal septal hypertrophy in one, mild cardiomyopathic changes in two and operated ASD in two patients. There were Wolf-Parkinson-White in one, premature supraventricular beats in three, sinus tachycardia in two, ventricular tachycardia attack in one, and frequent single ventricular premature beats in one patient. In conclusion, despite scarcity of cardiac origin in chest pain of childhood, differential diagnosis should be made carefully due to possibility of life threatening consequences of cardiac disorders. The chest pains, with acute onset,triggered by exercise, awakening the child from sleep, accompanied with dyspnea, palpitation, dizziness, pre-syncope and syncope should be evaluated in detail for cardiac pathologies.

  12. The Influence of a New Clinical Motion for Endodontic Instruments on the Incidence of Postoperative Pain.

    Science.gov (United States)

    Gambarini, G; Di Nardo, D; Miccoli, G; Guerra, F; Di Giorgio, R; Di Giorgio, G; Glassman, G; Piasecki, L; Testarelli, L

    2017-01-01

    Previous studies showed that motor motions play an important role in determining apical extrusion of debris. Therefore a new clinical motion (MIMERACI) has been proposed. The basic idea is to progress slowly (1mm advancement), and after each 1mm, to remove the instrument from the canal, clean flutes and irrigate. The aim of the study was to prove whether the clinical use of MIMERACI technique would influence or not postoperative pain. 100 teeth requesting endodontic treatment were selected for the study and divided into two similar groups based on anatomy, pre-operative symptoms and vitality, presence or absence of periapical lesion. All teeth were shaped, cleaned and obturated by the same operator, using the same NiTi instruments. The only difference between the two groups was the instrumentation technique: tradional (group A) vs MIMERACI (group B). Assessment of postoperative pain was performed 3 days after treatment. Presence, absence and degree of pain were recorded with a visual analogue scale (VAS), validated in previous studies. Collected data statistically analyzed using one-way ANOVA post hoc Tukey test. For VAS pain scores MIMERACI technique showed significantly better results than group A (p=0,031). Overall, both incidence and intensity of symptoms were significantly lower. Flare ups occurred in 3 patients, but none treated with the MIMERACI Technique. Since extruded debris can elicit more postoperative pain, results obtained by using MIMERACI technique are probably due to many factors: better mechanical removal and less production of debris and more efficient irrigation during instrumentation.

  13. Ultrasound-Guided Percutaneous Electrolysis and Eccentric Exercises for Subacromial Pain Syndrome: A Randomized Clinical Trial

    Science.gov (United States)

    Arias-Buría, José L.; Truyols-Domínguez, Sebastián; Valero-Alcaide, Raquel; Salom-Moreno, Jaime; Atín-Arratibel, María A.; Fernández-de-las-Peñas, César

    2015-01-01

    Objective. To compare effects of ultrasound- (US-) guided percutaneous electrolysis combined with an eccentric exercise program of the rotator cuff muscles in subacromial pain syndrome. Methods. Thirty-six patients were randomized and assigned into US-guided percutaneous electrolysis (n = 17) group or exercise (n = 19) group. Patients were asked to perform an eccentric exercise program of the rotator cuff muscles twice every day for 4 weeks. Participants assigned to US-guided percutaneous electrolysis group also received the application of galvanic current through acupuncture needle on each session once a week (total 4 sessions). Shoulder pain (NPRS) and disability (DASH) were assessed at baseline, after 2 sessions, and 1 week after the last session. Results. The ANOVA revealed significant Group∗Time interactions for shoulder pain and disability (all, P electrolysis combined with the eccentric exercises experienced greater improvement than those receiving eccentric exercise alone. Conclusions. US-guided percutaneous electrolysis combined with eccentric exercises resulted in small better outcomes at short term compared to when only eccentric exercises were applied in subacromial pain syndrome. The effect was statistically and clinically significant for shoulder pain but below minimal clinical difference for function. Future studies should investigate the long-term effects and potential placebo effect of this intervention. PMID:26649058

  14. Ultrasound-Guided Percutaneous Electrolysis and Eccentric Exercises for Subacromial Pain Syndrome: A Randomized Clinical Trial.

    Science.gov (United States)

    Arias-Buría, José L; Truyols-Domínguez, Sebastián; Valero-Alcaide, Raquel; Salom-Moreno, Jaime; Atín-Arratibel, María A; Fernández-de-Las-Peñas, César

    2015-01-01

    Objective. To compare effects of ultrasound- (US-) guided percutaneous electrolysis combined with an eccentric exercise program of the rotator cuff muscles in subacromial pain syndrome. Methods. Thirty-six patients were randomized and assigned into US-guided percutaneous electrolysis (n = 17) group or exercise (n = 19) group. Patients were asked to perform an eccentric exercise program of the rotator cuff muscles twice every day for 4 weeks. Participants assigned to US-guided percutaneous electrolysis group also received the application of galvanic current through acupuncture needle on each session once a week (total 4 sessions). Shoulder pain (NPRS) and disability (DASH) were assessed at baseline, after 2 sessions, and 1 week after the last session. Results. The ANOVA revealed significant Group∗Time interactions for shoulder pain and disability (all, P percutaneous electrolysis combined with the eccentric exercises experienced greater improvement than those receiving eccentric exercise alone. Conclusions. US-guided percutaneous electrolysis combined with eccentric exercises resulted in small better outcomes at short term compared to when only eccentric exercises were applied in subacromial pain syndrome. The effect was statistically and clinically significant for shoulder pain but below minimal clinical difference for function. Future studies should investigate the long-term effects and potential placebo effect of this intervention.

  15. Ultrasound-Guided Percutaneous Electrolysis and Eccentric Exercises for Subacromial Pain Syndrome: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    José L. Arias-Buría

    2015-01-01

    Full Text Available Objective. To compare effects of ultrasound- (US- guided percutaneous electrolysis combined with an eccentric exercise program of the rotator cuff muscles in subacromial pain syndrome. Methods. Thirty-six patients were randomized and assigned into US-guided percutaneous electrolysis (n=17 group or exercise (n=19 group. Patients were asked to perform an eccentric exercise program of the rotator cuff muscles twice every day for 4 weeks. Participants assigned to US-guided percutaneous electrolysis group also received the application of galvanic current through acupuncture needle on each session once a week (total 4 sessions. Shoulder pain (NPRS and disability (DASH were assessed at baseline, after 2 sessions, and 1 week after the last session. Results. The ANOVA revealed significant Group∗Time interactions for shoulder pain and disability (all, P<0.01: individuals receiving US-guided percutaneous electrolysis combined with the eccentric exercises experienced greater improvement than those receiving eccentric exercise alone. Conclusions. US-guided percutaneous electrolysis combined with eccentric exercises resulted in small better outcomes at short term compared to when only eccentric exercises were applied in subacromial pain syndrome. The effect was statistically and clinically significant for shoulder pain but below minimal clinical difference for function. Future studies should investigate the long-term effects and potential placebo effect of this intervention.

  16. Effect of menstrual cycle on orthodontic pain perception : A controlled clinical trial.

    Science.gov (United States)

    Ileri, Zehra; Baka, Zeliha Muge; Akin, Mehmet; Apiliogullari, Seza; Basciftci, Faruk Ayhan

    2016-05-01

    The aim of this prospective, single-center, controlled clinical trial was to evaluate the effects of menstrual cycle phases on orthodontic pain perception. A total of 48 women between 16 and 20 years old with regular menstrual periods who were scheduled to undergo extraction of two upper first premolars for orthodontic treatment were enrolled in this study. Laceback ligatures were used to move canines distally. After activating the laceback ligatures, each patient completed a questionnaire in order to assess pain and quality of life. Pain perception was recorded by patients on a visual analogue scale (VAS) and a verbal rating scale-4 (VRS) immediately after activation (T1) and 24 h after activation (T2). During the appointment, each patient's menstrual-cycle phase (follicular or luteal) was determined by asking some questions about her cycle. For statistical analysis of data, the Mann-Whitney U, independent t test, and Wilcoxon tests were applied. Mean orthodontic pain score was 1.96 ± 0.80 and 47.08 ± 21.68 in the follicular phase, 1.92 ± 0.82 and 46.25 ± 18.92 in the luteal phase at T1 using the VRS and VAS, respectively. Orthodontic pain scores were worse in those patients in the luteal phase than those in the follicular phase (p  0.05) were observed. The menstrual phase has an influence on the perception of orthodontic pain which is higher in the luteal phase following the activation of laceback ligatures. In clinical practice, the phases of the menstrual cycle may have a significant role in how women perceive orthodontic pain.

  17. Effects of Myofascial Release in Non-specific Chronic Low Back Pain: A Randomized Clinical Trial.

    Science.gov (United States)

    Arguisuelas, Maria Dolores; Lisón, Juan Francisco; Sánchez-Zuriaga, Daniel; Martínez-Hurtado, Isabel; Doménech-Fernández, Julio

    2016-09-09

    Double-blind, randomized parallel sham-controlled trial with concealed allocation and intention-to treat analysis. To investigate the effects of an isolate Myofascial Release protocol (MFR) on pain, disability and fear- avoidance beliefs in patients with chronic low back pain (CLBP). MFR is a form of manual medicine widely used by physiotherapists in the management of different musculoskeletal pathologies. Up to this moment, no previous studies have reported the effects of an isolated MFR treatment in patients with CLBP. Fifty four participants, with nonspecific CLBP, were randomized to MFR group (n = 27) receiving four sessions of myofascial treatment, each lasting 40 minutes, and to control group (n = 27) receiving a sham MFR. Variables studied were pain measured by means Short Form McGill Pain questionnaire (SF-MPQ) and visual analogue scale (VAS), disability measured with Roland Morris questionnaire and Fear-Avoidance Beliefs measured with FAB questionnaire (FABQ). Subjects receiving MFR displayed significant improvements in pain (SF-MPQ) (mean difference -7.8; 95% CI: -14.5 to -1.1, P = 0.023) and sensory SF-MPQ subscale (mean difference -6.1; 95% CI: -10.8 to -1.5, P = 0.011) compared to the sham group, but no differences were found in VAS between groups. Disability and the FABQ score also displayed a significant decrease in the MFR group (P Myofascial Release Therapy produced a significant improvement in both pain and disability. However, as the minimal clinically important differences in pain and disability are included in the 95% IC, we can not know if this improvement is clinically relevant. 2.

  18. Effects of Myofascial Release in Nonspecific Chronic Low Back Pain: A Randomized Clinical Trial.

    Science.gov (United States)

    Arguisuelas, María D; Lisón, Juan Francisco; Sánchez-Zuriaga, Daniel; Martínez-Hurtado, Isabel; Doménech-Fernández, Julio

    2017-05-01

    Double-blind, randomized parallel sham-controlled trial with concealed allocation and intention-to treat analysis. To investigate the effects of an isolate myofascial release (MFR) protocol on pain, disability, and fear-avoidance beliefs in patients with chronic low back pain (CLBP). MFR is a form of manual medicine widely used by physiotherapists in the management of different musculoskeletal pathologies. Up to this moment, no previous studies have reported the effects of an isolated MFR treatment in patients with CLBP. Fifty-four participants, with nonspecific CLBP, were randomized to MFR group (n = 27) receiving four sessions of myofascial treatment, each lasting 40 minutes, and to control group (n = 27) receiving a sham MFR. Variables studied were pain measured by means Short Form McGill Pain Questionnaire (SF-MPQ) and visual analog scale (VAS), disability measured with Roland Morris Questionnaire, and fear-avoidance beliefs measured with Fear-Avoidance Beliefs Questionnaire. Subjects receiving MFR displayed significant improvements in pain (SF-MPQ) (mean difference -7.8; 95% confidence interval [CI]: -14.5 to -1.1, P = 0.023) and sensory SF-MPQ subscale (mean difference -6.1; 95% CI: -10.8 to -1.5, P = 0.011) compared to the sham group, but no differences were found in VAS between groups. Disability and the Fear-Avoidance Beliefs Questionnaire score also displayed a significant decrease in the MFR group (P < 0.05) as compared to sham MFR. MFR therapy produced a significant improvement in both pain and disability. Because the minimal clinically important differences in pain and disability are, however, included in the 95% CI, we cannot know whether this improvement is clinically relevant. 2.

  19. Clinical decision aids for chest pain in the emergency department: identifying low-risk patients

    Science.gov (United States)

    Alley, William; Mahler, Simon A

    2015-01-01

    Chest pain is one of the most common presenting complaints in the emergency department, though only a small minority of patients are subsequently diagnosed with acute coronary syndrome (ACS). However, missing the diagnosis has potential for significant morbidity and mortality. ACS presentations can be atypical, and their workups are often prolonged and costly. In order to risk-stratify patients and better direct the workup and care given, many decision aids have been developed. While each may have merit in certain clinical settings, the most useful aid in the emergency department is one that finds all cases of ACS while also identifying a substantial subset of patients at low risk who can be discharged without stress testing or coronary angiography. This review describes several of the chest pain decision aids developed and studied through the recent past, starting with the thrombolysis in myocardial infarction (TIMI) risk score and Global Registry of Acute Coronary Events (GRACE) scores, which were developed as prognostic aids for patients already diagnosed with ACS, then subsequently validated in the undifferentiated chest pain population. Asia-Pacific Evaluation of Chest Pain Trial (ASPECT); Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins (ADAPT); North American Chest Pain Rule (NACPR); and History, Electrocardiogram, Age, Risk factors, Troponin (HEART) score have been developed exclusively for use in the undifferentiated chest pain population as well, with improved performance compared to their predecessors. This review describes the relative merits and limitations of these decision aids so that providers can determine which tool fits the needs of their clinical practice setting. PMID:27147894

  20. CLINICAL TESTS FOR THE ASSESSMENT OF THE PELVIC GIRDLE PAIN IN PREGNANCY AND POSTPARTUM

    Directory of Open Access Journals (Sweden)

    Darija Šćepanović

    2018-02-01

    Full Text Available Background: Pregnancy-related pelvic girdle pain (PGP refers to the pain in the lumbosacral region, the sacroiliac joints and the symphysis pubis joint. The results of the high methodological quality studies indicate that the point prevalence of pregnant women suffering from PGP is about 20 %. Pregnancy-related PGP requires a comprehensive physiotherapy assessment in order to make or confirm a diagnosis, plan the treatment and evaluate the patient’s condi- tion. Physiotherapy assessment includes clinical diagnostic tests which should satisfy the criteria of safety, feasibility, reliability, sensitivity, specificity and validity. The aim of the present paper was to systematically review the literature on clinical diagnostic tests of PGP in order to determine which clinical tests meet the necessary criteria and are appropriate for clinical examination of PGP in pregnancy and postpartum. Methods: PubMed, Cinahl, Embase, Index Medicus databases and the Cochrane controlled trials reg- ister from 1980 to 2008 were searched using the key words, pregnancy/pelvic girdle pain, pregnancy/clinical tests/sacroiliac joint/symphysis pubis. Only the articles/texts in English and Slovene were reviewed unless translated abstract was available. Additional manual searches of the reference lists in books and review articles were undertaken. Along with the randomized clinical studies the literature search encompassed also the basic studies. Results: Nine studies evaluating the tests for clinical examination of the pregnancy-related PGP met the criteria for inclusion in this review. The studies evaluated and analysed six provocation tests for the sacroiliac joint, namely, the Posterior pelvic pain provocation test (P4, Patrick’s Faber test, palpation of the long dorsal ligament, compression test, separation test, Menell’s test as well as two provocation tests for the symphysis pubis joint (pain palpation and a modified Trendelenburg test and one functional

  1. Ultrasonographic and clinical study of post-stroke painful hemiplegic shoulder

    OpenAIRE

    Mohamed, Rania E.; Amin, Mohamed A.; Aboelsafa, Ashraf A.

    2014-01-01

    Aim of the work: To describe the structural abnormalities of the painful hemiplegic shoulder (PHS) by ultrasound (U/S) and their relationship with some clinical variables. Materials and methods: Eighty consecutive patients with post-stroke PHS were subjected to both clinical assessment and ultrasonographic examination of both shoulders. Ultrasonographic imaging data were classified into five grades. Results: The biceps tendon sheath effusion (51.25%) and the SA–SD bursitis (43.75%) were...

  2. Oxycodone and Dexamethasone for pain management after tonsillectomy: A placebo-controlled EMG assessed clinical trial

    Science.gov (United States)

    Vaiman, Michael; Krakovski, Daniel; Haitov, Zoe

    2011-01-01

    Summary Background Surface electromyographic (sEMG) study of post-tonsillectomy swallow-evoked muscular reactions was performed in order to evaluate the efficacy and safety of oxycodone and dexamethasone in pain management after tonsillectomy. Material/Methods 90 randomly chosen operated adults were divided into three groups. Group 1 (n=30) was treated with OxyContin (Oxycodone) injections; Group 2 (n=30) was treated with Dexacort (Dexamethasone), and Group 3 (n=30) was a placebo group. Pain assessment included visual analogue scale (VAS) pain score and the EMG data like the timing, electric amplitude and graphic patterns of muscular activity during deglutition. We investigated masseter, infrahyoid and submental-submandibular muscles. Records from trapezius muscle were used for control. The results were compared with previously established normative database. The patients were tested 24 h after surgery. The sEMG data were compared with VAS pain score with regard to changes in clinical condition of the patients. Results Analgesia with oxycodone smoothed the recorded sEMG swallow peaks and increases time of deglutition. Dexamethasone normalized muscular activity in deglutition in cases with edema as detected by the EMG records. Statistically significant difference in muscle reactions was detected between the two Groups and the placebo group. Conclusions Application of oxycodone significantly reduces the postoperative pain. Application of dexamethasone after tonsillectomy is advisable because of the reduction of postoperative morbidity while the reduction of the postoperative pain is secondary to the reduction of edema. SEMG might be used as an adjunctive measure of pain behavior via assessment of muscular reactions to pain and to analgesia. PMID:21959624

  3. Correlation of findings in clinical and high resolution ultrasonography examinations of the painful shoulder.

    Science.gov (United States)

    Micheroli, Raphael; Kyburz, Diego; Ciurea, Adrian; Dubs, Beat; Toniolo, Martin; Bisig, Samuel Pascal; Tamborrini, Giorgio

    2015-03-01

    High resolution ultrasonography is a non-painful and non-invasive imaging technique which is useful for the assessment of shoulder pain causes, as clinical examination often does not allow an exact diagnosis. The aim of this study was to compare the findings of clinical examination and high resolution ultrasonography in patients presenting with painful shoulder. Non-interventional observational study of 100 adult patients suffering from unilateral shoulder pain. Exclusion criteria were shoulder fractures, prior shoulder joint surgery and shoulder injections in the past month. The physicians performing the most common clinical shoulder examinations were blinded to the results of the high resolution ultrasonography and vice versa. In order to detect pathology of the m. supraspinatus tendon, the Hawkins and Kennedy impingement test showed the highest sensitivity (0.86) whereas the Jobe supraspinatus test showed the highest specificity (0.55). To identify m. subscapularis tendon pathology the Gerber lift off test showed a sensitivity of 1, whereas the belly press test showed the higher specificity (0.72). The infraspinatus test showed a high sensitivity (0.90) and specificity (0.74). All AC tests (painful arc II(a), AC joint tenderness(b), cross body adduction stress test(c)) showed high specificities ((a)0.96, (b)0.99, (c)0.96). Evaluating the long biceps tendon, the palm up test showed the highest sensitivity (0.47) and the Yergason test the highest specificity (0.88). Knowledge of sensitivity and specificity of various clinical tests is important for the interpretation of clinical examination test results. High resolution ultrasonography is needed in most cases to establish a clear diagnosis.

  4. Correlation of findings in clinical and high resolution ultrasonography examinations of the painful shoulder

    Directory of Open Access Journals (Sweden)

    Raphael Micheroli

    2015-03-01

    Full Text Available Objective: High resolution ultrasonography is a non-painful and non-invasive imaging technique which is useful for the assessment of shoulder pain causes, as clinical examination often does not allow an exact diagnosis. The aim of this study was to compare the fi ndings of clinical examination and high resolution ultrasonography in patients presenting with painful shoulder. Methods: Non-interventional observational study of 100 adult patients suffering from unilateral shoulder pain. Exclusion criteria were shoulder fractures, prior shoulder joint surgery and shoulder injections in the past month. The physicians performing the most common clinical shoulder examinations were blinded to the results of the high resolution ultrasonography and vice versa. Results: In order to detect pathology of the m. supraspinatus tendon, the Hawkins and Kennedy impingement test showed the highest sensitivity (0.86 whereas the Jobe supraspinatus test showed the highest specifi city (0.55. To identify m. subscapularis tendon pathology the Gerber lift off test showed a sensitivity of 1, whereas the belly press test showed the higher specifi city (0.72. The infraspinatus test showed a high sensitivity (0.90 and specifi city (0.74. All AC tests (painful arc IIa, AC joint tendernessb, cross body adduction stress testc showed high specifi cities (a0.96, b0.99, c 0.96. Evaluating the long biceps tendon, the palm up test showed the highest sensitivity (0.47 and the Yergason test the highest specifi city (0.88. Conclusion: Knowledge of sensitivity and specifi city of various clinical tests is important for the interpretation of clinical examination test results. High resolution ultrasonography is needed in most cases to establish a clear diagnosis.

  5. Adverse Event Reporting in Clinical Trials of Intravenous and Invasive Pain Treatments: An ACTTION Systematic Review.

    Science.gov (United States)

    Williams, Mark R; McKeown, Andrew; Pressman, Zachary; Hunsinger, Matthew; Lee, Kendrick; Coplan, Paul; Gilron, Ian; Katz, Nathaniel P; McDermott, Michael P; Raja, Srinivasa N; Rappaport, Bob A; Rowbotham, Michael C; Turk, Dennis C; Dworkin, Robert H; Smith, Shannon M

    2016-11-01

    Thorough assessment and reporting of adverse events (AEs) facilitates a detailed understanding of a treatment's risk-benefit profile. Although the Consolidated Standards of Reporting Trials (CONSORT) 2004 statement provides recommendations regarding AE reporting, adherence to these standards is often inadequate. We investigated AE reporting in clinical trials of intravenous and invasive pain treatments published in 6 major anesthesiology and pain journals between 2000 to 2003 and 2006 to 2012. We examined whether AE reporting improved after publication of the 2004 CONSORT recommendations and also comprehensively reviewed AE assessment using the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) AE reporting recommendations. No improvement was found overall in CONSORT harms reporting scores from pre- to postpublication of the CONSORT recommendations, with only 5 of 10 fulfilled on average. AE reporting assessed using the ACTTION coding manual was generally inadequate, and 8% of articles failed to report any AE information at all. Anesthesiology and pain journals were similar in AE reporting quality, although industry-sponsored trials reported more AE information than nonindustry sponsored trials. Improvement is needed in AE reporting in analgesic clinical trials. The CONSORT checklist and ACTTION AE recommendations can assist investigators and editors in improving clinical trial transparency and quality. This systematic review of AE reporting in intravenous and invasive pain treatment trials shows that little improvement has been made since the 2004 CONSORT harms reporting guidelines. Better assessment and reporting of treatment AEs is necessary to understand the full clinical effect of intravenous and invasive treatments. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

  6. Efficacy of non-steroidal anti-inflammatory drugs for low back pain: a systematic review of randomised clinical trials

    NARCIS (Netherlands)

    Koes, B. W.; Scholten, R. J.; Mens, J. M.; Bouter, L. M.

    1997-01-01

    To assess the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) for low back pain. Computer aided search of published randomised clinical trials and assessment of the methods of the studies. 26 randomised clinical trials evaluating NSAIDs for low back pain were identified. Score for quality

  7. Assessment of pain in children with cerebral palsy focused on translation and clinical feasibility of the revised FLACC score

    DEFF Research Database (Denmark)

    Pedersen, Line Kjeldgaard; Rahbek, Ole; Nikolajsen, Lone

    2015-01-01

    AbstractBackground and aims Assessment of pain in children with cognitive impairment (CI) including cerebral palsy (CP) is difficult. Several pain assessment tools have been developed and validated for use in children with CI. The revised Face, Legs, Activity, Cry and Consolability score (r......-FLACC) includes core behaviours of children with CI and adds an open-ended descriptor for individualisation (5 items assigned 0–2 points, total range 0–10). Other pain assessment tools including individual pain behaviours are the Individualised Numeric Rating Scale (INRS) and the Paediatric Pain Profile (PPP......). Both the Noncommunicating Childrens's Pain Checklist – Postoperative version (NCCPC-PV) and the Echelle Douleur Enfant San Salvador (DESS) are developed from core pain behaviours for children with CI but have no possibility for individualisation. For successful clinical application a pain assessment...

  8. Usability Evaluation of a Clinical Decision Support System for Geriatric ED Pain Treatment.

    Science.gov (United States)

    Genes, Nicholas; Kim, Min Soon; Thum, Frederick L; Rivera, Laura; Beato, Rosemary; Song, Carolyn; Soriano, Jared; Kannry, Joseph; Baumlin, Kevin; Hwang, Ula

    2016-01-01

    Older adults are at risk for inadequate emergency department (ED) pain care. Unrelieved acute pain is associated with poor outcomes. Clinical decision support systems (CDSS) hold promise to improve patient care, but CDSS quality varies widely, particularly when usability evaluation is not employed. To conduct an iterative usability and redesign process of a novel geriatric abdominal pain care CDSS. We hypothesized this process would result in the creation of more usable and favorable pain care interventions. Thirteen emergency physicians familiar with the Electronic Health Record (EHR) in use at the study site were recruited. Over a 10-week period, 17 1-hour usability test sessions were conducted across 3 rounds of testing. Participants were given 3 patient scenarios and provided simulated clinical care using the EHR, while interacting with the CDSS interventions. Quantitative System Usability Scores (SUS), favorability scores and qualitative narrative feedback were collected for each session. Using a multi-step review process by an interdisciplinary team, positive and negative usability issues in effectiveness, efficiency, and satisfaction were considered, prioritized and incorporated in the iterative redesign process of the CDSS. Video analysis was used to determine the appropriateness of the CDS appearances during simulated clinical care. Over the 3 rounds of usability evaluations and subsequent redesign processes, mean SUS progressively improved from 74.8 to 81.2 to 88.9; mean favorability scores improved from 3.23 to 4.29 (1 worst, 5 best). Video analysis revealed that, in the course of the iterative redesign processes, rates of physicians' acknowledgment of CDS interventions increased, however most rates of desired actions by physicians (such as more frequent pain score updates) decreased. The iterative usability redesign process was instrumental in improving the usability of the CDSS; if implemented in practice, it could improve geriatric pain care. The

  9. Measurement of adherence to clinical practice guidelines for opioid therapy for chronic pain.

    Science.gov (United States)

    Midboe, Amanda M; Lewis, Eleanor T; Paik, Meenah C; Gallagher, Rollin M; Rosenberg, Jack M; Goodman, Francine; Kerns, Robert D; Becker, William C; Trafton, Jodie A

    2012-03-01

    The safe and effective prescribing of opioid therapy for chronic pain has become a significant health care priority over the last several years. Substantial research has focused on patient-oriented interventions toward preventing problematic use, but provider and system level factors may be more amenable to quality improvement approaches. Here, we outline administrative data-based metrics that are intended to assess adherence to key practices outlined in the 2010 Department of Veterans Affairs/Department of Defense Clinical Practice Guideline for management of opioid therapy for chronic pain. In addition to the metrics, we discuss their development process, which was done in consultation with experts on chronic opioid therapy.

  10. 1988 Volvo award in clinical sciences. Facet joint injection in low-back pain. A prospective statistical study.

    Science.gov (United States)

    Jackson, R P; Jacobs, R R; Montesano, P X

    1988-09-01

    From January 1980 through December 1984, 454 patients were evaluated with facet joint injections. All had the chief complaint of low-back pain, normal neurologic examinations and no root tension signs. Three hundred and ninety completed the protocol, which included a lumbar motion pain assessment before and after facet injection. A total of 127 variables were studied. There were 229 males and 161 females with a median age of 38. Facet joint arthrograms were performed prior to intra-articular injection of local anesthetic and cortisone. Initial mean pain relief was only 29%. Variables correlating significantly (P less than 0.05) with more postinjection pain relief were older age, prior history of low-back pain, normal gait, maximum pain on extension following forward flexion in the standing position, and the absence of leg pain, muscle spasm and aggravation of pain on Valsalva. Greatest pain relief immediately after injection was seen with lumbar extension and rotation, motions reported to stress the facet joints or aggravate pain of facet joint origin. Patients with more pain on lumbar extension and rotation as a group, however, did not get more pain relief. From this study we were not able to identify clinical facet joint syndromes or predict patients responding better to this procedure. The facet joints were not commonly the single or primary source for low-back pain in the great majority (greater than 90%) of patients studied.

  11. Impact of Empathy in the Patient-Doctor Relationship on Chronic Pain Relief and Quality of Life: A Prospective Study in Spanish Pain Clinics.

    Science.gov (United States)

    Cánovas, Luz; Carrascosa, Antonio-José; García, Modesto; Fernández, Mariano; Calvo, Almudena; Monsalve, Vicente; Soriano, José-Francisco

    2017-07-13

    To assess the impact of the empathy of physicians, perceived by patients with chronic pain, regarding pain relief and health-related quality of life (HR-QoL). A prospective noninterventional study was conducted in 2,898 patients with moderate to severe chronic pain who were referred to pain clinics. The same physician visited each patient at baseline and after one and three months. Study questionnaires included the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE), the Life Orientation Test-Revised (LOT-R), the Pain Coping Questionnaire (CAD-R), the Brief Pain Inventory Short Form (BPI-SF), and the EuroQol-5D (EQ-5D). Regression analyses were used to evaluate the independent contribution of the changes in perceived empathy over pain intensity and improvement of HR-QoL. BPI-SF scores for pain intensity, rated as worst, least, average, and current pain, decreased significantly ( P  < 0.001) from baseline to month 3, with reductions of 33.7%, 42.5%, 40.0%, and 46.9%, respectively. Pain intensity decreased from 6.3 ± 1.5 at baseline to 4.7 ± 1.8 at one month and 3.8 ± 1.9 at three months ( P  < 0.050). Significant ( P  < 0.001) improvements in the EQ-5D tariff (+37.1%) and EQ-5D VAS (+26.7%) were also recorded. In the linear regression analysis, JSPPPE and LOT-R, but not CAD-R, were significantly associated with pain relief and HR-QoL. Physicians' empathy and patients' dispositional optimism have a role in determining positive outcomes in patients with chronic pain. Physicians' empathy may therefore be a suitable, yet relatively unexplored, target for intervention.

  12. Effect of myofascial release technique on pain, disability, maximum isometric contraction of the extensor muscles, and pressure pain threshold in patients with chronic nonspecific neck pain: Double blinded randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Hasan Namvar

    2016-07-01

    Full Text Available The impact of myofascial release technique alone has not been investigated in the patients with non-specific chronic neck pain. Thus, the aim of this study was to investigate the impacts of myofascial release technique on pain, disability, the maximum contraction of isometric extensor muscles of neck and pressure pain threshold in the patient with non-specific chronic neck pain compared with control group. In this clinical, randomized, double-blind trial, the patients with non-specific chronic neck pain have been entered the study by the available sampling method and have been located randomly into two groups of myofascial release therapy group, and control group. Pressure pain threshold, pain intensity, disability and isometric power of neck extensor muscles before and after intervention were registered through pressure algometer, visual analogue scale, neck disability index, and pressure biofeedback. The treatment was performed for 4 sessions and each session for 20 minutes. The paired t-tests and independent t-test were used for within group and between group comparison respectively. Comparing the mean of pain intensity, pressure pain threshold, neck disability index in the intervention group compared with control group showed significant reduction (P0.05. Myofascial Release is one of the effective manual therapy techniques in reducing pain, disability, improving the isometric extension strength of neck in patients with nonspecific chronic neck pain.

  13. Adverse event reporting in nonpharmacologic, noninterventional pain clinical trials: ACTTION systematic review.

    Science.gov (United States)

    Hunsinger, Matthew; Smith, Shannon M; Rothstein, Daniel; McKeown, Andrew; Parkhurst, Melissa; Hertz, Sharon; Katz, Nathaniel P; Lin, Allison H; McDermott, Michael P; Rappaport, Bob A; Turk, Dennis C; Dworkin, Robert H

    2014-11-01

    Assessment of treatment safety is 1 of the primary goals of clinical trials. Organizations and working groups have created reporting guidelines for adverse events (AEs). Previous research examining AE reporting for pharmacologic clinical trials of analgesics in major pain journals found many reporting inadequacies, suggesting that analgesic trials are not adhering to existing AE reporting guidelines. The present systematic review documented AE reporting in 3 main pain journals for nonpharmacologic, noninterventional (NP/NI) trials examining pain treatments. To broaden our pool of nonpharmacologic trials, we also included trials examining acupuncture, leech therapy, and noninvasive stimulation techniques (eg, transcutaneous electrical nerve stimulation). We documented AE reporting at 2 levels of specificity using coding manuals based on the Consolidated Standards of Reporting Trials (CONSORT) harms reporting standards and Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) AE reporting checklist. We identified a number of inadequacies in AE reporting across the 3 journals. For example, using the ACTTION coding manual, we found that less than one-half of the trials reported specific AE assessment methods; approximately one-third of the trials reported withdrawals due to AEs for each study arm; and about one-fourth of the trials reported all specific AEs. We also examined differences in AE reporting across several trial characteristics, finding that AE reporting was generally more detailed in trials with patients versus those using healthy volunteers undergoing experimentally evoked pain. These results suggest that investigators conducting and reporting NP/NI clinical trials are not adequately describing the assessment and occurrence of AEs. Copyright © 2014 International Association for the Study of Pain. All rights reserved.

  14. Clinical Evaluation Versus Undetectable High-Sensitivity Troponin for Assessment of Patients With Acute Chest Pain.

    Science.gov (United States)

    Sanchis, Juan; García-Blas, Sergio; Carratalá, Arturo; Valero, Ernesto; Mollar, Anna; Miñana, Gema; Ruiz, Vicente; Balaguer, Jose Vicente; Roqué, Mercé; Bosch, Xavier; Núñez, Julio

    2016-12-01

    Decision-making in acute chest pain remains challenging despite normal (below ninety-ninth percentile) high-sensitivity troponin (hs-cTn). Some studies suggest that undetectable hs-cTn, far below the ninety-ninth percentile, might rule out acute coronary syndrome. We investigated clinical data in comparison to undetectable hs-cTnT. The study comprised 682 patients (November 2010 to September 2011) presenting at the emergency department with chest pain and normal hs-cTnT (pain) and 2 points (recurrent pain and prior ischemic heart disease). The negative predictive values of the clinical score and undetectable hs-cTnT (patients suffered long-term MACE. The C-statistics of the clinical score for long-term (0.75) and 30-day (0.88) MACE were higher than with the TIMI(Thrombolysis In Myocardial Infarction) risk (0.68, 0.77) or GRACE(Global Registry of Acute Coronary Events) (0.50, 0.47) scores. Likewise, the negative predictive values of score = 0 (97.5%, 100%) and ≤1 point (95.9%, 100%) were higher than using undetectable hs-cTnT (91.9%, 98.1%). Both clinical scores of 0 and ≤1 better classified patients at risk of MACE (p = 0.0001, log-rank test) than hs-cTnT patients presenting at the emergency department with chest pain and normal hs-cTnT. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Low back pain in adolescents: a comparison of clinical outcomes in sports participants and nonparticipants.

    Science.gov (United States)

    Fritz, Julie M; Clifford, Shannon N

    2010-01-01

    Back pain is common in adolescents. Participation in sports has been identified as a risk factor for the development of back pain in adolescents, but the influence of sports participation on treatment outcomes in adolescents has not been adequately examined. To examine the clinical outcomes of rehabilitation for adolescents with low back pain (LBP) and to evaluate the influence of sports participation on outcomes. Observational study. Outpatient physical therapy clinics. Fifty-eight adolescents (age = 15.40 +/- 1.44 years; 56.90% female) with LBP referred for treatment. Twenty-three patients (39.66%) had developed back pain from sports participation. Patients completed the Modified Oswestry Disability Questionnaire and numeric pain rating before and after treatment. Treatment duration and content were at the clinician's discretion. Adolescents were categorized as sports participants if the onset of back pain was linked to organized sports. Additional data collected included diagnostic imaging before referral, clinical characteristics, and medical diagnosis. Baseline characteristics were compared based on sports participation. The influence of sports participation on outcomes was examined using a repeated-measures analysis of covariance with the Oswestry and pain scores as dependent variables. The number of sessions and duration of care were compared using t tests. Many adolescents with LBP receiving outpatient physical therapy treatment were involved in sports and cited sports participation as a causative factor for their LBP. Some differences in baseline characteristics and clinical treatment outcomes were noted between sports participants and nonparticipants. Sports participants were more likely to undergo magnetic resonance imaging before referral (P = .013), attended more sessions (mean difference = 1.40, 95% confidence interval [CI] = 0.21, 2.59, P = .022) over a longer duration (mean difference = 12.44 days, 95% CI = 1.28, 23.10, P = .024), and experienced

  16. Chronic neuropathic facial pain after intense pulsed light hair removal. Clinical features and pharmacological management.

    Science.gov (United States)

    Gay-Escoda, Cosme; Párraga-Manzol, Gabriela; Sánchez-Torres, Alba; Moreno-Arias, Gerardo

    2015-10-01

    Intense Pulsed Light (IPL) photodepilation is usually performed as a hair removal method. The treatment is recommended to be indicated by a physician, depending on each patient and on its characteristics. However, the use of laser devices by medical laypersons is frequent and it can suppose a risk of damage for the patients. Most side effects associated to IPL photodepilation are transient, minimal and disappear without sequelae. However, permanent side effects can occur. Some of the complications are laser related but many of them are caused by an operator error or mismanagement. In this work, we report a clinical case of a patient that developed a chronic neuropathic facial pain following IPL hair removal for unwanted hair in the upper lip. The specific diagnosis was painful post-traumatic trigeminal neuropathy, reference 13.1.2.3 according to the International Headache Society (IHS). Neuropathic facial pain, photodepilation, intense pulse light.

  17. Increasing frequency of opioid prescriptions for chronic abdominal pain in US outpatient clinics.

    Science.gov (United States)

    Dorn, Spencer D; Meek, Patrick D; Shah, Nilay D

    2011-12-01

    Opioids are sometimes used to treat chronic abdominal pain. However, opioid analgesics have not been proven to be an effective treatment for chronic abdominal pain and have been associated with drug misuse, constipation, and worsening abdominal pain. We sought to estimate the national prescribing trends and factors associated with opioid prescribing for chronic abdominal pain. Chronic abdominal pain-related visits by adults to US outpatient clinics were identified using reason-for-visit codes from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (1997-2008). Data were weighted to produce national estimates of opioid prescriptions over time. Logistic regression analyses, adjusted for complex survey design, were performed to identify factors associated with opioid use. The number of outpatient visits for chronic abdominal pain consistently decreased over time from 14.8 million visits (95% confidence interval [CI], 11.6-18.0 visits) in 1997 through 1999 to 12.2 million visits (95% CI, 9.0-15.6 visits) or 1863 visits per 100,000 population in 2006 through 2008 (P for trend = 0.04). Conversely, the adjusted prevalence of visits for which an opioid was prescribed increased from 5.9% (95% CI, 3.5%-8.3%) in 1997 through 1999 to 12.2% (95% CI, 7.5%-17.0%) in 2006 through 2008 (P = 0.03 for trend). Opioid prescriptions were most common among patients aged 25 to 40 years old (odds ratio [OR] 4.6; 95% CI, 1.2-18.4). Opioid prescriptions were less common among uninsured (OR 0.1; 95% CI, 0.04-0.40) and African American (OR 0.3; 95% CI, 0.1-0.9) patients. From 1997 to 2008 opioid prescriptions for chronic abdominal pain more than doubled. Further studies are needed to better understand the reasons for and consequences of this trend. Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.

  18. Clinical characteristics of veterans prescribed high doses of opioid medications for chronic non-cancer pain.

    Science.gov (United States)

    Morasco, Benjamin J; Duckart, Jonathan P; Carr, Thomas P; Deyo, Richard A; Dobscha, Steven K

    2010-12-01

    Little is known about patients prescribed high doses of opioids to treat chronic non-cancer pain, though these patients may be at higher risk for medication-related complications. We describe the prevalence of high-dose opioid use and associated demographic and clinical characteristics among veterans treated in a VA regional healthcare network. Veterans with chronic non-cancer pain prescribed high doses of opioids (≥ 180 mg/day morphine equivalent; n=478) for 90+ consecutive days were compared to two groups with chronic pain: Traditional-dose (5-179 mg/day; n=500) or no opioid (n=500). High-dose opioid use occurred in 2.4% of all chronic pain patients and in 8.2% of all chronic pain patients prescribed opioids long-term. The average dose in the high-dose group was 324.9 (SD=285.1)mg/day. The only significant demographic difference among groups was race (p=0.03) with black veterans less likely to receive high doses. High-dose patients were more likely to have four or more pain diagnoses and the highest rates of medical, psychiatric, and substance use disorders. After controlling for demographic factors and VA facility, neuropathy, low back pain, and nicotine dependence diagnoses were associated with increased likelihood of high-dose prescriptions. High-dose patients frequently did not receive care consistent with treatment guidelines: there was frequent use of short-acting opioids, urine drug screens were administered to only 25.7% of patients in the prior year, and 32.0% received concurrent benzodiazepine prescriptions, which may increase risk for overdose and death. Further study is needed to identify better predictors of high-dose usage, as well as the efficacy and safety of such dosing. Published by Elsevier B.V.

  19. Oral pregabalin for postoperative pain relief after third molar extraction: a randomized controlled clinical trial.

    Science.gov (United States)

    Olmedo-Gaya, Maria Victoria; Manzano-Moreno, Francisco J; Galvez-Mateos, Rafael; González-Rodriguez, Maria Paloma; Talero-Sevilla, Cristina; Vallecillo-Capilla, Manuel

    2016-09-01

    The aim of this randomized controlled clinical trial was to evaluate the efficacy and safety of pregabalin administered pre- and postoperatively in patients with pain and swelling due to the surgical removal of impacted lower third molars. The final study sample comprised 60 volunteers (23 males and 37 females). Group 1 (n = 30) received 75 mg oral pregabalin 1 h before surgery and 1 h after surgery. Group 2 (n = 30) served as a control group and received no pregabalin. Both groups were administered with 650 mg paracetamol every 8 h for 2 days. Postoperative pain intensity and swelling were measured using a visual analog scale (VAS); pain relief experienced was reported using a four-point verbal rating scale (VRS); the rescue medication requirement, adverse effects, and global impression of the medication were also recorded. No significant difference in pain intensity (VAS) was observed between the groups. However, fewer rescue medication tablets were needed by pregabalin-treated patients than by controls (p = 0.021). The frequency and intensity of adverse effects were significantly higher in pregabalin-treated patients (p medication received was more positive in the pregabalin group (p = 0.042). The administration of pregabalin reduces the requirement for rescue medication after third molar surgery and results in a more constant pain level, with fewer peaks of pain intensity. These findings suggest that pregabalin may be useful to control acute postoperative pain. Adverse effects are known to be reduced at the low pregabalin dose used in our study.

  20. Efficacy of Selected Electrical Therapies on Chronic Low Back Pain: A Comparative Clinical Pilot Study

    Science.gov (United States)

    Rajfur, Joanna; Pasternok, Małgorzata; Rajfur, Katarzyna; Walewicz, Karolina; Fras, Beata; Bolach, Bartosz; Dymarek, Robert; Rosinczuk, Joanna; Halski, Tomasz; Taradaj, Jakub

    2017-01-01

    Background In the currently available research publications on electrical therapy of low back pain, generally no control groups or detailed randomization were used, and such studies were often conducted with relatively small groups of patients, based solely on subjective questionnaires and pain assessment scales (lacking measurement methods to objectify the therapeutic progress). The available literature also lacks a comprehensive and large-scale clinical study. The purpose of this study was to assess the effects of treating low back pain using selected electrotherapy methods. The study assesses the influence of individual electrotherapeutic treatments on reduction of pain, improvement of the range of movement in lower section of the spine, and improvement of motor functions and mobility. Material/Methods The 127 patients qualified for the therapy (ultimately, 123 patients completed the study) and assigned to 6 comparison groups: A – conventional TENS, B – acupuncture-like TENS, C – high-voltage electrical stimulation, D – interferential current stimulation, E – diadynamic current, and F – control group. Results The research showed that using electrical stimulation with interferential current penetrating deeper into the tissues results in a significant and more efficient elimination of pain, and an improvement of functional ability of patients suffering from low back pain on the basis of an analysis of both subjective and objective parameters. The TENS currents and high voltage were helpful, but not as effective. The use of diadynamic currents appears to be useless. Conclusions Selected electrical therapies (interferential current, TENS, and high voltage) appear to be effective in treating chronic low back pain. PMID:28062862

  1. Synergistic Effects of Citalopram and Morphine in the Renal Colic Pain Relief; a Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Mehrdad Esmailian

    2014-03-01

    Full Text Available Introduction: Although the synergistic effects of opioids and other analgesic drugs such as non-steroidal anti-inflammatory drugs (NSAIDs have been established in relieving acute pain due to renal calculi, no studies today have evaluated the concomitant administration of opiates and other drugs with analgesic effects, such as serotonin re-uptake inhibitors. Considering the high prevalence of renal colic, the present study was carried out to compare the effect of concomitant prescription of morphine and a placebo with that of morphine and citalopram on the management of acute pain due to renal calculi. Methods: The present double-blind randomized clinical trial was carried out from October 2012 to March 2013 in the Al-Zahra educational Hospital in Isfahan, Iran. A total of 90 patients with acute renal colic pain were randomly divided into two groups of 45 subjects. The subjects in one group received morphine/ placebo and another one morphine/citalopram. The patients’ pain severity was determined by visual analogue scale (VAS before and 20 minutes after administration of medications. In case of persistent pain the second or even third dose was administered and the pain severity was once again determined. Data were analyzed with STATA 11.0 using chi-squared, two-way ANOVA, Bonferroni post hoc test, and log rank test. Results: The decrease in pain severity in the morphine/citalopram group was significantly compared to the morphine/placebo group and the time before administration of the medications (p<0.001. In contrast, administration of morphine/placebo did not have a significant effect on pain severity at this interval (p=0.32. Kaplan-Meier curve showed that the first injection was successful in relieving pain in 15 (33.3% and 26 (57.8% subjects in the morphine/placebo and morphine/citalopram groups, respectively. The second injection of these medications resulted in therapeutic success in 35 (87.8% and 42 (95.6% subjects in the above groups

  2. The impact of clinical, demographic and risk factors on rates of HIV transmission: a population-based phylogenetic analysis in British Columbia, Canada.

    Science.gov (United States)

    Poon, Art F Y; Joy, Jeffrey B; Woods, Conan K; Shurgold, Susan; Colley, Guillaume; Brumme, Chanson J; Hogg, Robert S; Montaner, Julio S G; Harrigan, P Richard

    2015-03-15

    The diversification of human immunodeficiency virus (HIV) is shaped by its transmission history. We therefore used a population based province wide HIV drug resistance database in British Columbia (BC), Canada, to evaluate the impact of clinical, demographic, and behavioral factors on rates of HIV transmission. We reconstructed molecular phylogenies from 27,296 anonymized bulk HIV pol sequences representing 7747 individuals in BC-about half the estimated HIV prevalence in BC. Infections were grouped into clusters based on phylogenetic distances, as a proxy for variation in transmission rates. Rates of cluster expansion were reconstructed from estimated dates of HIV seroconversion. Our criteria grouped 4431 individuals into 744 clusters largely separated with respect to risk factors, including large established clusters predominated by injection drug users and more-recently emerging clusters comprising men who have sex with men. The mean log10 viral load of an individual's phylogenetic neighborhood (composed of 5 other individuals with shortest phylogenetic distances) increased their odds of appearing in a cluster by >2-fold per log10 viruses per milliliter. Hotspots of ongoing HIV transmission can be characterized in near real time by the secondary analysis of HIV resistance genotypes, providing an important potential resource for targeting public health initiatives for HIV prevention. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  3. Modern pain neuroscience in clinical practice: applied to post-cancer, paediatric and sports-related pain

    OpenAIRE

    Malfliet, Anneleen; Leysen, Laurence; Pas, Roselien; Kuppens, Kevin; Nijs, Jo; van Wilgen, Paul; Huysmans, Eva; Goudman, Lisa; Ickmans, Kelly

    2017-01-01

    Highlights ? Generalized hypersensitivity in post-cancer, sports-related and pediatric pain. ? Rationale for pain education, stress management and cognition targeted exercises. ? Need to change from a biomedical or psychosocial to an integrated approach.

  4. Role of anxiety and depression in adolescents with chest pain referred to a cardiology clinic.

    Science.gov (United States)

    Khairandish, Zahra; Jamali, Leila; Haghbin, Saeedeh

    2017-01-01

    We carried out this study in order to evaluate the causes of chest pain in teenagers and the role of anxiety and depression in this age group compared with the normal population. In this prospective case-control study, all patients aged 11-18 years with chest pain and no history of trauma and referred to a paediatric cardiology clinic from March, 2009-April, 2010 were selected. A chest pain protocol including a detailed history, full physical examination, required blood tests, electrocardiography, and echocardiography was performed for all. The presence of depression and anxiety and their severity were assessed by Beck questionnaires. The patients were compared with age- and sex-matched, randomly selected healthy controls. In total, 194 patients with a mean age of 14±2 years were selected. The most frequent presentation was idiopathic chest pain (43.3%), followed by the psychological group (29.9%). These groups had no abnormal points in history, physical, and para-clinical tests. Moderate-to-severe depression was found in 45.9% in the patients group, compared with 17.6% of controls, which was statistically significant (p=0.016). Moreover, anxiety was detected in 67.5% of patients versus 15.4% in controls, which is a statistically significant difference (p=0.009). Cardiac chest pain with 9.27% was the most common type of organic causes. Chest pain during teenage is more prevalent, but not risky. Undergoing a detailed history and full physical examination can help diagnose the causes in the majority of cases. Given the prevalence of a psychological group as well as role of anxiety and depression in most patients, referring to a psychiatrist is suggested.

  5. Contribution of Dry Needling to Individualized Physical Therapy Treatment of Shoulder Pain: A Randomized Clinical Trial.

    Science.gov (United States)

    Pérez-Palomares, Sara; Oliván-Blázquez, Bárbara; Pérez-Palomares, Ana; Gaspar-Calvo, Elena; Pérez-Benito, Marina; López-Lapeña, Elena; de la Torre-Beldarraín, Maria Luisa; Magallón-Botaya, Rosa

    2017-01-01

    Study Design Multicenter, parallel randomized clinical trial. Background Myofascial trigger points (MTrPs) are implicated in shoulder pain and functional limitations. An intervention intended to treat MTrPs is dry needling. Objectives To investigate the effectiveness of dry needling in addition to evidence-based personalized physical therapy treatment in the treatment of shoulder pain. Methods One hundred twenty patients with nonspecific shoulder pain were randomly allocated into 2 parallel groups: (1) personalized, evidencebased physical therapy treatment; and (2) trigger point dry needling in addition to personalized, evidence-based physical therapy treatment. Patients were assessed at baseline, posttreatment, and 3-month follow-up. The primary outcome measure was pain assessed by a visual analog scale at 3 months, and secondary variables were joint range-of-motion limitations, Constant-Murley score for pain and function, and number of active MTrPs. Clinical efficacy was assessed using intention-to-treat analysis. Results Of the 120 enrolled patients, 63 were randomly assigned to the control group and 57 to the intervention group. There were no significant differences in outcome between the 2 treatment groups. Both groups showed improvement over time. Conclusion Dry needling did not offer benefits in addition to personalized, evidencebased physical therapy treatment for patients with nonspecific shoulder pain. Level of Evidence Therapy, level 1b. Registered February 11, 2009 at www.isrctn.com (ISRCTN30907460). J Orthop Sports Phys Ther 2017;47(1):11-20. Epub 9 Dec 2016. doi:10.2519/jospt.2017.6698.

  6. Effect of Premedication with Indomethacin and Ibuprofen on Postoperative Endodontic Pain: A Clinical Trial.

    Science.gov (United States)

    Mokhtari, Fatemeh; Yazdi, Kamal; Mahabadi, Amir Mohammad; Modaresi, Seyed Jalil; Hamzeheil, Zeinab

    2016-01-01

    Post-endodontic pain is one of the main problems for both patients and dentists. The purpose of this study was to compare the effectiveness of premedication with indomethacin and ibuprofen for management of postoperative endodontic pain. In this clinical trial, mandibular molars with irreversible pulpitis were endodontically treated in 66 patients. The medicines were prepared similarly in the form of capsules containing 400 mg ibuprofen (group A), 25 mg indomethacin (group B) and placebo (group C). The patients were given one capsule 1 h before the start of treatment. Patients recorded their pain measured by a visual analogue scale (VAS) at medication time, during treatment and 8, 12 and 24 h after treatment. The data were analyzed using the chi-square, repeated measures ANOVA, paired t-test, Tamhane and Pearson correlation coefficient. Ibuprofen and indomethacin significantly reduced the postoperative pain in comparison with placebo during treatment and 8 h after treatment; however, there were no significant differences between them 12 and 24 h after treatment. Premedication with ibuprofen and indomethacin can effectively control short term post-operative pain; the lower incidence of side effects and greater analgesic power of ibuprofen make it a superior choice.

  7. Effect of warming anaesthetic solutions on pain during dental injection. A randomized clinical trial.

    Directory of Open Access Journals (Sweden)

    Pedro Christian Aravena

    2015-10-01

    Full Text Available Objective: To determine the effectiveness of warming anesthetic solutions on pain produced during the administration of anesthesia in maxillary dental infiltration technique. Material and Methods: A double-blind cross-over clinical study was designed. Fifty-six volunteer students (mean age 23.1±2.71 years of the Dental School at Universidad Austral de Chile (Valdivia, Chile participated in the study. Subjects were given 0.9ml of 2% lidocaine with 1:100.000 epinephrine (Alphacaine®; Nova DFL - Brazil by two punctions at buccal vestibule of lateral incisor. Warm anesthesia at 42°C (107.6°F was administered in a hemi-arch; and after one week anesthesia at room temperature (21°C; 69.8°F and at a standardized speed was administered at the contralateral side. The intensity of pain felt during injection was registered and compared using visual analog scale (VAS of 100mm (Wilcoxon test p<0.05. Results: The use of anesthesia at room temperature caused a VAS-pain intensity of 34.2±16.6mm, and anesthesia at 42°C a VAS-pain intensity of 15.7±17.4mm (p<0.0001. Conclusion: The use of anesthesia at 42°C resulted in a significantly lower pain intensity perception during injection compared with the use of anesthesia at room temperature during maxillary infiltration technique.

  8. The effect of experimental low back pain on lumbar muscle activity in people with a history of clinical low back pain: a muscle functional MRI study.

    Science.gov (United States)

    Danneels, Lieven; Cagnie, Barbara; D'hooge, Roseline; De Deene, Yves; Crombez, Geert; Vanderstraeten, Guy; Parlevliet, Thierry; Van Oosterwijck, Jessica

    2016-02-01

    In people with a history of low back pain (LBP), structural and functional alterations have been observed at several peripheral and central levels of the sensorimotor pathway. These existing alterations might interact with the way the sensorimotor system responds to pain. We examined this assumption by evaluating the lumbar motor responses to experimental nociceptive input of 15 participants during remission of unilateral recurrent LBP. Quantitative T2 images (muscle functional MRI) were taken bilaterally of multifidus, erector spinae, and psoas at several segmental levels (L3 upper and L4 upper and lower endplate) and during several conditions: 1) at rest, 2) upon trunk-extension exercise without pain, and 3) upon trunk-extension exercise with experimental induced pain at the clinical pain-side (1.5-ml intramuscular hypertonic saline injections in erector spinae). Following experimental pain induction, muscle activity levels similarly reduced for all three muscles, on both painful and nonpainful sides, and at multiple segmental levels (P = 0.038). Pain intensity and localization from experimental LBP were similar as during recalled clinical LBP episodes. In conclusion, unilateral and unisegmental experimental LBP exerts a generalized and widespread decrease in lumbar muscle activity during remission of recurrent LBP. This muscle response is consistent with previous observed patterns in healthy people subjected to the same experimental pain paradigm. It is striking that similar inhibitory patterns in response to pain could be observed, despite the presence of preexisting alterations in the lumbar musculature during remission of recurrent LBP. These results suggest that motor output can modify along the course of recurrent LBP. Copyright © 2016 the American Physiological Society.

  9. Music and 25% glucose pain relief for the premature infant: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Maria Vera Lúcia Moreira Leitão Cardoso

    2014-10-01

    Full Text Available OBJECTIVE: to analyze the total Premature Infant Pain Profile scores of premature infants undergoing arterial puncture during music and 25% glucose interventions, and to assess their association with neonatal and therapeutic variables.METHOD: a randomized clinical trial with 80 premature infants; 24 in the Experimental Group 1 (music, 33 in the Experimental Group 2 (music and 25% glucose, 23 in the Positive Control Group (25% glucose. All premature infants were videotaped and a lullaby was played for ten minutes before puncture in Experimental Groups 1 and 2; 25% glucose administered in Experimental Group 2 and the Positive Control Group two minutes before puncture.RESULTS: 60.0% of premature infants had moderate or maximum pain; pain scores and intervention groups were not statistically significant. Statistically significant variables: Experimental Group 1: head and chest circumference, Apgar scores, corrected gestational age; Experimental Group 2: chest circumference, Apgar scores, oxygen therapy; Positive Control group: birth weight, head circumference.CONCLUSION: neonatal variables are associated with pain in premature infants. Brazilian Registry of Clinical Trials: UTN: U1111-1123-4821.

  10. Music and 25% glucose pain relief for the premature infant: a randomized clinical trial.

    Science.gov (United States)

    Cardoso, Maria Vera Lúcia Moreira Leitão; Farias, Leiliane Martins; de Melo, Gleicia Martins

    2014-10-01

    To analyze the total Premature Infant Pain Profile scores of premature infants undergoing arterial puncture during music and 25% glucose interventions, and to assess their association with neonatal and therapeutic variables. A randomized clinical trial with 80 premature infants; 24 in the Experimental Group 1 (music), 33 in the Experimental Group 2 (music and 25% glucose), 23 in the Positive Control Group (25% glucose). All premature infants were videotaped and a lullaby was played for ten minutes before puncture in Experimental Groups 1 and 2; 25% glucose administered in Experimental Group 2 and the Positive Control Group two minutes before puncture. 60.0% of premature infants had moderate or maximum pain; pain scores and intervention groups were not statistically significant. Statistically significant variables: Experimental Group 1: head and chest circumference, Apgar scores, corrected gestational age; Experimental Group 2: chest circumference, Apgar scores, oxygen therapy; Positive Control group: birth weight, head circumference. Neonatal variables are associated with pain in premature infants. Brazilian Registry of Clinical Trials: UTN: U1111-1123-4821.

  11. The treatment of painful temporomandibular joint clicking with oral splints: a randomized clinical trial.

    Science.gov (United States)

    Conti, Paulo César Rodrigues; dos Santos, Carlos Neanes; Kogawa, Evelyn Mikaela; de Castro Ferreira Conti, Ana Claudia; de Araujo, Carlos dos Reis Pereira

    2006-08-01

    The authors compared the efficacy of bilateral balanced and canine guidance (occlusal) splints in the treatment of temporomandibular joint (TMJ) pain in subjects who experienced joint clicking with a nonoccluding splint in a double-blind, controlled randomized clinical trial. The authors randomly assigned 57 people with signs of disk displacement and TMJ pain into three groups according to the type of splint: bilateral balanced, canine guidance and nonoccluding. The authors followed the groups for six months using analysis of a visual analog scale (VAS), palpation of the TMJ and masticatory muscles, mandibular movements and joint sounds. They used repeated analysis of variance and a chi(2) test to test the hypothesis. The type of guidance used did not influence the pain reduction, yet both occlusal splints were superior to the nonoccluding splint, on the basis of the VAS. Despite similar outcomes in relation to opening, left lateral and protrusive movements, TMJ and muscle pain on palpation, subjects who used the occlusal splints had improved clinical outcomes. The frequency of joint noises decreased over time, with no significant differences among groups. Subjects in the groups using the occlusal splints reported more comfort. The type of lateral guidance did not influence the subjects' improvement. All of the subjects had a general improvement on the VAS, though subjects in the occlusal splint groups had better results that did subjects in the nonoccluding splint group.

  12. How to measure pain in neurological conditions? A systematic review of psychometric properties and clinical utility of measurement tools.

    Science.gov (United States)

    Tyson, Sarah F; Brown, Philip

    2014-07-01

    To systematically review the psychometric properties and clinical utility of measures of pain in neurological conditions. Electronic databases (AMED, CINAHL, MEDLINE, PEDro and Web of Knowledge) were searched from their inception to February 2013. Studies investigating any measurement tool to assess pain in central nervous system conditions were systematically identified. Data about their psychometric properties and clinical utility were extracted and analysed independently. The strength of the psychometric properties and clinical utility were assessed. A total of 13 articles met the selection criteria, which assessed 11 measurement tools; eight pain rating scales; one Neuropathic Pain Scale; and two measures of pain interference with every-day life. Most of the pain rating scales were specifically for hemiplegic shoulder pain. None had been sufficiently developed to recommend for use in clinical practice or research. Evaluation of reliability and the ability to detect change were particularly sparse. Reliability depended on the type of tools used. Patients with right hemisphere damage favoured verbal/written responses, while people with left hemisphere damage preferred and reported more effectively using visual/numeric responses. Validity between measures of pain intensity was moderate, while validity with mood or quality of life was weak to moderate. None of the selected measures of pain have been fully developed or evaluated to demonstrate that they provide accurate, relevant reproducible information. © The Author(s) 2013.

  13. Pain-relieving effectiveness, quality of life and tolerability of repeated capsaicin 8% patch treatment of peripheral neuropathic pain in Scandinavian clinical practice

    DEFF Research Database (Denmark)

    Hansson, P; Jensen, Troels Staehelin; Kvarstein, G

    2018-01-01

    CONTEXT: Clinical trials have demonstrated the efficacy and safety of the capsaicin 8% patch in patients with peripheral neuropathic pain (PNP); however, few studies have assessed this treatment in a clinical practice. OBJECTIVE: To determine whether treatment and re-treatment with the capsaicin ...

  14. Psychological Factors Are Related to Pain Intensity in Back-Healthy People Who Develop Clinically Relevant Pain During Prolonged Standing: A Preliminary Study.

    Science.gov (United States)

    Sorensen, Christopher J; George, Steven Z; Callaghan, Jack P; Van Dillen, Linda R

    2016-11-01

    An induced-pain paradigm has been used to examine risk factors for the development of low back pain (LBP) during prolonged standing in back-healthy people (standing paradigm). Previous studies that used induced-pain methods suggest that pain intensity may be related to psychologic factors. It is not currently known, however, whether pain intensity reported during the standing paradigm is related to psychologic factors. To examine the relationship between LBP symptom intensity and psychological factors (fear of pain and pain catastrophizing) in back-healthy people who develop LBP during prolonged standing. We hypothesized that symptom intensity during standing would be positively related to initial levels of fear of pain and pain catastrophizing in people who developed LBP during standing. Cross-sectional. Movement science research center at an academic medical center. Fifty seven back-healthy participants. Participants completed the Fear of Pain Questionnaire-III (FPQ-III) and Pain Catastrophizing Scale (PCS) before a 2-hour standing protocol. Participants rated LBP intensity on a 100-mm visual analogue scale (VAS) throughout standing and were classified as pain developers (PDs) or nonpain developers (NPDs). Relationships between LBP intensity and psychological measures were examined in PDs that did and did not have a ≥20 mm maximum VAS score. FPQ-III and PCS total scores, maximum and average VAS scores during standing. There were 24 (42%) PDs. Five PDs reported a maximum VAS score ≥20 mm. For PDs with a maximum VAS score <20 mm, correlations between average VAS scores and each psychological measure were small and nonsignificant (FPQ-III: r = 0.16, P = .50; PCS: r = 0.27, P = .26). For PDs with a maximum VAS score ≥20 mm, correlation between average VAS scores and FPQ-III was large and significant (r = 0.91, P = .03), and large for PCS but nonsignificant (r = 0.87, P = .06). These preliminary data suggest that if pain exceeds a clinically meaningful threshold

  15. Earthquakes in British Columbia

    National Research Council Canada - National Science Library

    1991-01-01

    This pamphlet provides information about the causes of earthquakes, where earthquakes occur, British Columbia plate techtonics, earthquake patterns, earthquake intensity, geology and earthquake impact...

  16. Knowledge and attitudes of low back pain in physicians based in clinical practice guidelines

    Directory of Open Access Journals (Sweden)

    Jorge Ruiz Sabido

    2014-01-01

    Full Text Available Objective: To determine the level of knowledge and attitudes of physicians in Tijuana based on Clinical Practice Guidelines (CPG for the prevention, diagnosis and treatment of Nonspecific Low Back Pain (NLBP. Methods: Prospective, cross-sectional, descriptive study. Data were obtained from doctors who practice in clinics, private surgeries, and/or government institutions. Results: Of a total of 56 doctors surveyed, 37 were men and 19 women. None of the doctors said they had not seen a patient with Back Pain. 49% knew the GPC, and 51% did not know of its existence. Conclusions: Although some physicians reported knowledge of the GPC, according to the results, there was a lack of full knowledge of, and adherence to these guidelines. Not knowing the GPC did not make it impossible to complete the questionnaire. The doctors felt more connected to the health system, but with less confidence in the management of cases of NLBP.

  17. Effect of pre-cooling injection site on pain perception in pediatric dentistry: "A randomized clinical trial"

    OpenAIRE

    Faezeh Ghaderi; Shahin Banakar; Shima Rostami

    2013-01-01

    Background: Injection of local anesthesia is one of the most important reasons for development of avoidance behavior in children. Efforts have been performed to decrease pain perception of injection. The present research evaluated the effect of cooling the injection site on pain perception before infiltration of local anesthetics. Materials and Methods: A prospective single-blind crossover clinical trial was used to investigate pain perception in 50 healthy pediatric patients who needed b...

  18. High Intensity Laser Therapy (HILT) versus TENS and NSAIDs in low back pain: clinical study

    Science.gov (United States)

    Zati, Allesandro; Fortuna, Damiano; Valent, A.; Filippi, M. V.; Bilotta, Teresa W.

    2004-09-01

    Low back pain, caused by lumbar disc herniation, is prevalently treated with a conservative approach. In this study we valued the efficacy of High Intensity Laser Therapy (HILT), compared with accepted therapies such as TENS and NSAIDs. Laser therapy obtained similar results in the short term, but better clinical effect over time than TENS and NSAIDs. In conclusion high intensity laser therapy appears to be a interesting new treatment, worthy of further research.

  19. Application of a diagnosis-based clinical decision guide in patients with neck pain

    Science.gov (United States)

    2011-01-01

    Background Neck pain (NP) is a common cause of disability. Accurate and efficacious methods of diagnosis and treatment have been elusive. A diagnosis-based clinical decision guide (DBCDG; previously referred to as a diagnosis-based clinical decision rule) has been proposed which attempts to provide the clinician with a systematic, evidence-based guide in applying the biopsychosocial model of care. The approach is based on three questions of diagnosis. The purpose of this study is to present the prevalence of findings using the DBCDG in consecutive patients with NP. Methods Demographic, diagnostic and baseline outcome measure data were gathered on a cohort of NP patients examined by one of three examiners trained in the application of the DBCDG. Results Data were gathered on 95 patients. Signs of visceral disease or potentially serious illness were found in 1%. Centralization signs were found in 27%, segmental pain provocation signs were found in 69% and radicular signs were found in 19%. Clinically relevant myofascial signs were found in 22%. Dynamic instability was found in 40%, oculomotor dysfunction in 11.6%, fear beliefs in 31.6%, central pain hypersensitivity in 4%, passive coping in 5% and depression in 2%. Conclusion The DBCDG can be applied in a busy private practice environment. Further studies are needed to investigate clinically relevant means to identify central pain hypersensitivity, oculomotor dysfunction, poor coping and depression, correlations and patterns among the diagnostic components of the DBCDG as well as inter-examiner reliability, validity and efficacy of treatment based on the DBCDG. PMID:21871119

  20. The Use of Wet Cupping for Persistent Nonspecific Low Back Pain: Randomized Controlled Clinical Trial

    OpenAIRE

    AlBedah,Abdullah; Khalil, Mohamed; ElOlemy, Ahmed; Asim A. Hussein; Alqaed,Meshari; Al Mudaiheem, Abdullah; Abutalib, Raid A.; Bazaid, Faisal Mohamed; Bafail, Ahmad Saeed; Essa, AboBakr; Bakrain, Mohammed Yahia

    2015-01-01

    Abstract Objectives: To evaluate the effectiveness and safety of wet cupping therapy as a single treatment for persistent nonspecific low back pain (PNSLBP). Design: Randomized controlled trial comparing wet cupping versus no treatment in PNSLBP. Setting: Outpatient clinic in three secondary care hospitals in Saudi Arabia. Patients: Eighty eligible participants with PNSLBP for at least 3 months were randomly allocated to an intervention group (n=40) or to a control group (n=40). Interventions...

  1. Application of a diagnosis-based clinical decision guide in patients with neck pain

    Directory of Open Access Journals (Sweden)

    Murphy Donald R

    2011-08-01

    Full Text Available Abstract Background Neck pain (NP is a common cause of disability. Accurate and efficacious methods of diagnosis and treatment have been elusive. A diagnosis-based clinical decision guide (DBCDG; previously referred to as a diagnosis-based clinical decision rule has been proposed which attempts to provide the clinician with a systematic, evidence-based guide in applying the biopsychosocial model of care. The approach is based on three questions of diagnosis. The purpose of this study is to present the prevalence of findings using the DBCDG in consecutive patients with NP. Methods Demographic, diagnostic and baseline outcome measure data were gathered on a cohort of NP patients examined by one of three examiners trained in the application of the DBCDG. Results Data were gathered on 95 patients. Signs of visceral disease or potentially serious illness were found in 1%. Centralization signs were found in 27%, segmental pain provocation signs were found in 69% and radicular signs were found in 19%. Clinically relevant myofascial signs were found in 22%. Dynamic instability was found in 40%, oculomotor dysfunction in 11.6%, fear beliefs in 31.6%, central pain hypersensitivity in 4%, passive coping in 5% and depression in 2%. Conclusion The DBCDG can be applied in a busy private practice environment. Further studies are needed to investigate clinically relevant means to identify central pain hypersensitivity, oculomotor dysfunction, poor coping and depression, correlations and patterns among the diagnostic components of the DBCDG as well as inter-examiner reliability, validity and efficacy of treatment based on the DBCDG.

  2. Patterns and clinical correlates of pain among brain injury patients in critical care assessed with the critical care pain observation tool.

    Science.gov (United States)

    Lee, Kangim; Oh, Hyunsoo; Suh, Yeonok; Seo, Whasook

    2013-12-01

    This study was conducted to assess the patterns and clinical correlates of acute pain in brain injury patients during the critical care period using the Critical Care Pain Observation Tool (CPOT). Data were collected from 31 brain-injury patients admitted to an intensive care unit (ICU) at a university hospital located in Incheon, Republic of Korea. Glasgow Coma Scale and CPOT scores were assessed on days 1, 3, 6, 9, and 14 after ICU admission. Results showed that temporal changes in pain intensity displayed a consistent pattern in critical care patients with a brain injury during the first 14 days of ICU admission. Mean pain score was highest on day 1, decreased rapidly to reach a minimum on day 3 or 6, and then increased on day 9. In most patients, pain reduced slightly on day 14. Mean CPOT scores were significantly higher in the nonsurgery group than in the surgery group. There was also a nonsignificant trend of higher pain intensity scores among patients with moderate brain injury compared with those with severe injury. CPOT scores immediately after endotracheal suctioning were significantly higher than before endotracheal suctioning, but CPOT scores 20 minutes after suctioning were similar to those before suctioning. The present study may be meaningful in terms of presenting valid clinical information regarding the patterns and characteristics of acute pain in brain injury patients who are often unable to self-report on the presence and intensity of pain. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  3. Gabapentin May Relieve Post-Coronary Artery Bypass Graft Pain: A Double Blind Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    MSoltanzadeh

    2011-09-01

    Full Text Available Background: One of the most common complaints after coronary artery bypass graft (CABG is post-operative pain. Gabapentin is an anticonvulsant and antineuralgic agent. Objective: To evaluate the analgesic effect of preemptive gabapentin on post-operative pain and morphine consumption after cardiac surgery. Methods: A double-blind randomized clinical trial was conducted on 60 male candidates for CABG. The patients were divided into two groups—the gabapentin (n=30 and the control group (n=30. The test group received 800 mg gabapentin orally two hours before the surgery followed by 400 mg of the drug two hours post-extubation. The control group received placebo instead. Then severity of pain was recorded according to an 11-point visual analog pain scale. The amount of morphine consumed, its side effects and hemodynamic changes were also recorded during and at 2, 6, 12, 18 and 24 hours after extubation. Results: The mean±SD cumulative morphine consumption at the first 24 hours after extubation in gabapentin group was 0.9±1.5 mg while it was 1.5±4 mg for the control group. Therefore, gabapentin group consumed 38% less than the control group (P=0.01. The pain scores during rest and coughing at 2, 6, and 12 hours after extubation were also significantly lower in the gabapentin group compared with the control group (P=0.02. The mean±SD mechanical ventilation time was 5.4±1.7 hours for gabapentin group and 1.6±4.4 hours for the control group (P=0.035. The other variables including hemodynamic changes (HR, SBP and DBP, and incidence of nausea, vomiting and respiratory depression showed no significant difference between the studied groups within 24 hours after extubation. Conclusion: Oral pre-medication with gabapentin before CABG significantly reduces post-operative pain and morphine consumption in adult cardiac surgery.

  4. A randomized clinical trial of ibuprofen versus acetaminophen with codeine for acute pediatric arm fracture pain.

    Science.gov (United States)

    Drendel, Amy L; Gorelick, Marc H; Weisman, Steven J; Lyon, Roger; Brousseau, David C; Kim, Michael K

    2009-10-01

    We compare the treatment of pain in children with arm fractures by ibuprofen 10 mg/kg versus acetaminophen with codeine 1 mg/kg/dose (codeine component). This was a randomized, double-blind, clinical trial of children during the first 3 days after discharge from the emergency department (ED). The primary outcome was failure of the oral study medication, defined as use of the rescue medication. Pain medication use, pain scores, functional outcomes, adverse effects, and satisfaction were also assessed. Three hundred thirty-six children were randomized to treatment, 169 to ibuprofen and 167 to acetaminophen with codeine; 244 patients were analyzed. Both groups used a median of 4 doses (interquartile range 2, 6.5). The proportion of treatment failures for ibuprofen (20.3%) was lower than for acetaminophen with codeine (31.0%), though not statistically significant (difference=10.7%; 95% confidence interval -0.2 to 21.6). The proportion of children who had any function (play, sleep, eating, school) affected by pain when pain was analyzed by day after injury was significantly lower for the ibuprofen group. Significantly more children receiving acetaminophen with codeine reported adverse effects and did not want to use it for future fractures. Ibuprofen was at least as effective as acetaminophen with codeine for outpatient analgesia for children with arm fractures. There was no significant difference in analgesic failure or pain scores, but children receiving ibuprofen had better functional outcomes. Children receiving ibuprofen had significantly fewer adverse effects, and both children and parents were more satisfied with ibuprofen. Ibuprofen is preferable to acetaminophen with codeine for outpatient treatment of children with uncomplicated arm fractures.

  5. [Improving the quality of cancer pain management in palliative care unit: Targeted clinical audit].

    Science.gov (United States)

    Tricou, Colombe; Ruer, Murielle; Ledoux, Mathilde; Perceau-Chambard, Élise; Decrept, Dorothée; Chabloz, Claire; Filbet, Marilène

    Goal This study aims to assess the quality of the cancer pain management in Palliative care unit. The method used was the targeted clinical audit. The audit grid was built according to the recommendations of the pilot Committee, and tested until the final version with 19 items was obtained. In this retrospective study, 60 consecutive patients were studied on 2 periods of time. The first one (T1) shows the gap between the patient's chart and the expected standard, and proposes corrective measures. The second one (T2) re-assesses, using the same items list, the efficacy of these measures. After the corrective measures, the patients' medical record documentation was significantly improved at T2 for: neuropathic pain assessment improved, from 3% (T1) to 67% (T2) (P<0.001), so did pain assessment during the titration, from 6.7% (T1) to 90% (T2) (P<0.001). The overdoses symptoms assessment improved from 17% at T1 to 93% at T2, (P=0.002) and breakthrough pain evaluation improved from 3% at T1 to 73% at T2, (P<0.001). The pain reassessment after the rescue doses improved from 10% at T1 to 73% at T2 (P<0.001). The other points improved but not significantly. The quality of the pain cancer management was improved during the audit, but some points (patient education and in patient medical record documentation) can be improved. We need to continue to implement the improvement measures in our unit. Copyright © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  6. EFFECT OF THERAPEUTIC TOUCH ON PAIN RELATED PARAMETERS IN PATIENTS WITH CANCER: A RANDOMIZED CLINICAL TRIAL.

    Science.gov (United States)

    Tabatabaee, Amir; Tafreshi, Mansoureh Zagheri; Rassouli, Maryam; Aledavood, Seyed Amir; AlaviMajd, Hamid; Farahmand, Seyed Kazem

    2016-06-01

    In patients with cancer, pain may influence their life style, and feeling of satisfaction and comfort, leading to fatigue, and cause impairment of their quality of life, personal relationships, sleep and daily activities. The aim of this study was to evaluate the effect of therapeutic touch (TT) on pain related parameters of in patients with cancer. In a randomized clinical trial a total of 90 male patients referring to Specialized Oncology Hospital in Mashhad, were conveniently selected and randomly divided into three intervention, placebo, and control groups. The intervention consisted of TT in 7 sessions for a 4-week period. The data were collected using a demographic questionnaire along with the Brief Pain Inventory, which were then analyzed and compared using Kruskal-Wallis and Mann-Whitney tests. By comparing scores parameters of pain scales (general activity, mood, walking ability, relations with other people and sleep) in the three groups, there was no significant difference at the beginning of the first session. However, a significant difference was observed at the end of TT sessions between the three groups (p= 0.001). Furthermore, the groups were compared two-by-two by using Mann-Whitney test and Bonferroni correction, and the result indicated significant differences between the two intervention and placebo groups as well as between the two intervention and control groups. The results of the study showed that TT had a positive impact on the positive management of pain related parameters in cancer patients. Therefore, TT is suggested to be used by healthcare providers as a complementary method for managing pain and its parameters.

  7. Multidisciplinary Intervention in Patients with Musculoskeletal Pain: a Randomized Clinical Trial.

    Science.gov (United States)

    Brendbekken, Randi; Harris, Anette; Ursin, Holger; Eriksen, Hege R; Tangen, Tone

    2016-02-01

    Musculoskeletal pain is associated with comorbidity, extensive use of health services, long-term disability and reduced quality of life. The scientific literature on effects of treatment for musculoskeletal pain is inconclusive. The purpose of this study is to compare a multidisciplinary intervention (MI), including use of the novel Interdisciplinary Structured Interview with a Visual Educational Tool (ISIVET), with a brief intervention (BI), on effects on mental and physical symptoms, functioning ability, use of health services and coping in patients sick-listed due to musculoskeletal pain. Two hundred eighty-four adults aged 18-60, referred to a specialist clinic in physical rehabilitation, were randomized to MI or BI. Patients received a medical examination at baseline and completed a comprehensive questionnaire at baseline, 3 months and 12 months. Both groups reported improvements in mental and physical symptoms, including pain, and improved functioning ability at 3 and 12 months, but the MI group improved faster than the BI group except from reports of pain, which had a similar course. Significant interactions between group and time were found on mental symptoms (anxiety (p < 0.05), depression (p < 0.01), somatization (p < 0.01)) and functioning ability (p < 0.01) due to stronger effects in the MI group at 3 months. At 3 and 12 months, the MI group reported significantly less use of health services (general practitioner (p < 0.05)). At 12 months, the MI group reported better self-evaluated capability of coping with complaints (p < 0.001) and they took better care of their own health (p < 0.001), compared to the BI group. The results indicate that the MI may represent an important supplement in the treatment of musculoskeletal pain.

  8. Multicenter Prospective Clinical Series Evaluating Radiofrequency Ablation in the Treatment of Painful Spine Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Bagla, Sandeep, E-mail: sandeep.bagla@gmail.com [Vascular Institute of Virginia, LLC (United States); Sayed, Dawood [University of Kansas Medical Center (United States); Smirniotopoulos, John [New York Presbyterian Hospital/Weill Cornell Medical Center (United States); Brower, Jayson [Providence Sacred Heart Medical Center and Children’s Hospital (United States); Neal Rutledge, J. [Seton Medical Center (United States); Dick, Bradley [Suburban Hospital (United States); Carlisle, James [St. Mark’s Hospital (United States); Lekht, Ilya [University of Southern California (United States); Georgy, Bassem [San Diego Imaging (United States)

    2016-09-15

    BackgroundRadiofrequency ablation (RFA) of vertebral body metastases (VBM) has been reported as safe and effective in retrospective studies. This single-arm prospective multicenter clinical study evaluates RFA in the treatment of painful VBM.MethodsFifty patients with VBM were prospectively enrolled during a 13-month period at eight US centers under an IRB-approved study. Percutaneous RFA was performed under imaging guidance with cement augmentation at the discretion of the operator. Pain, disability and quality of life were evaluated at baseline, prior to discharge, days 3, 7, 30 and 90 using the Numerical Pain Rating Scale, Oswestry Disability Index (ODI), the Functional Assessment of Cancer Therapy-General 7 (FACT-G7) and Functional Assessment of Cancer Therapy Quality-of-Life Measurement in Patients with Bone Pain (FACT-BP). Adverse events were monitored throughout this time interval.ResultsTwenty-six male and 24 female patients (mean age 61.0) underwent 69 treatments (30 thoracic and 39 lumbar). Cement augmentation was performed in 96 % of reported levels. Significant improvement in mean scores for pain, disability and cancer-specific health-related quality of life from baseline to all time intervals was seen. NRPS improved from 5.9 to 2.1 (p < 0.0001). ODI improved from 52.9 to 37.0 (p < 0.08). FACT-G7 improved form 10.9 to 16.2 (p = 0.0001). FACT-BP improved from 22.6 to 38.9 (p < 0.001). No complications related to the procedure were reported.ConclusionRFA with cement augmentation safely and effectively reduces pain and disability rapidly, while increasing quality of life in patients suffering from vertebral body metastases.

  9. The Effect of Magnesium Sulfate on Renal Colic Pain Relief; a Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Abolfazl Jokar

    2017-01-01

    Full Text Available Introduction: Renal colic can be managed by preventing the contraction movements of ureter muscles. By reducing acetylcholine in the nerve terminals, magnesium sulfate could be effective in this regard. The aim of this study is to investigate the effect of magnesium sulfate on acute renal colic pain relief. Method: The present study was a double-blind clinical trial in which the patients suffering from acute renal colic were randomly divided into 2 groups of who either received standard protocol (intravenous infusion of 0.1 mg/Kg morphine sulfate, 30 mg of Ketorolac, and 100 ml normal saline as placebo/15 minutes or standard protocol plus 15 mg/Kg of intravenous magnesium sulfate 50%/100 ml normal saline/15 minutes. Severity of patients’ pain was measured by visual analogue scale (VAS at baseline, and 30 and 60 minutes after infusion. The collected data were analyzed using STATA statistical software. Results: 100 cases were randomly allocated to intervention or control group. The two groups were similar in baseline pain score and demographic characteristics. At 30 and 60 minutes, mean pain score was less in the intervention group compared to the control group. Moreover, the difference between the two groups was statistically significant regarding the additional amount of morphine, suggesting that the intervention group needed less additional morphine than the control group. Conclusion: The results of this study showed that Magnesium sulfate can be used as an adjunct drug in treatment of patients suffering from renal colic. It not only alleviates the pain in the patients, but also diminishes the need for pain medications.

  10. Effects of Vitamin D on Endometriosis-Related Pain: A Double-Blind Clinical Trial.

    Science.gov (United States)

    Almassinokiani, Fariba; Khodaverdi, Sepideh; Solaymani-Dodaran, Masoud; Akbari, Peyman; Pazouki, Abdolreza

    2016-12-17

    BACKGROUND Endometriosis is a disabling disease of reproductive-age women. Dysmenorrhea, dyspareunia, and pelvic pain are the main symptoms of endometriosis. Its etiology is not clear. Endometriosis may have various causes, including vitamin D deficiency, but its effect is controversial. MATERIAL AND METHODS In this double-blind clinical trial, we enrolled patients with endometriosis diagnosed and treated by laparoscopy, with scores of at least 3 for of dysmenorrhea and/or pelvic pain at 8 weeks after surgical treatment. They were randomly prescribed vitamin D (50 000 IU weekly for 12 weeks) or placebo. Severity of pain in the 2 groups (placebo and treatment) was compared by VAS test at 24 weeks after surgical treatment. RESULTS There were 19 patients in the vitamin D group and 20 in the placebo group. Baseline characteristics in the 2 groups were similar. Following the treatment with vitamin D or placebo, we did not find significant differences in severity of pelvic pain (p=0.24) and dysmenorrhea (p=0.45) between the 2 groups. Mean pelvic pain at 24 weeks after laparoscopy in the vitamin D group was 0.84±1.74 and in placebo group it was 0.68±1.70 (p=0.513). Mean dysmenorrhea was 2.10±2.33 in the vitamin D group and 2.73±2.84 in the placebo group (p=0.45). CONCLUSIONS After ablative surgery for endometriosis, vitamin D treatment did not have a significant effect in reducing dysmenorrhea and/or pelvic pain.

  11. Bone scintigraphy in evaluation of heel pain in Reiter's disease: compared with radiography and clinical examination.

    Science.gov (United States)

    Lin, W Y; Wang, S J; Lang, J L; Hsu, C Y; Kao, C H; Liao, S Q; Yeh, H W

    1995-01-01

    Tc-99m MDP bone scans were used to evaluate the heel pain (talalgia) in 38 patients with Reiter's disease, and compared with clinical examination and radiologic findings. In our work, 58% (22/38) patients presented talalgia with a total of 35 lesions. Only two lesions of clinical talalgia were missed by the bone scan. The diagnostic sensitivity was as high as 94% (33/35). However, the diagnostic sensitivity of radiography was only 69% (11/16) when the disease duration was more than one year; furthermore, it declined to 33% (4/12) when the disease duration was less than one year. Based on the bone scans, the correlation between positive scintigraphic findings and clinical talalgia was extremely good. Clinical talalgia occurred in all the 33 lesions demonstrated by bone scan. However, three lesions demonstrated by radiography were not consistent with clinical talalgia and not visualized by radioscintigraphy. Our data show that the radionuclide scan is a more sensitive indicator and has better correlation with clinical talalgia than radiography. We consider that bone scintigraphy is superior to radiography in the evaluation of heel pain in Reiter's disease.

  12. Use of a modified Comprehensive Pain Evaluation Questionnaire (CPEQ): characteristics and functional status of patients on entry to a tertiary care pain clinic.

    Science.gov (United States)

    Nelli, Jennifer Maria; Nicholson, Keith; Fatima Lakha, S; Louffat, Ada F; Chapparo, Luis; Furlan, Julio C; Furlan, Julio; Mailis-Gagnon, Angela

    2012-01-01

    With increasing knowledge of chronic pain, clinicians have attempted to assess chronic pain patients with lengthy assessment tools. To describe the functional and emotional status of patients presenting to a tertiary care pain clinic; to assess the reliability and validity of a diagnostic classification system for chronic pain patients modelled after the Multidimensional Pain Inventory; to provide psychometric data on a modified Comprehensive Pain Evaluation Questionnaire (CPEQ); and to evaluate the relationship between the modified CPEQ construct scores and clusters with Diagnostic and Statistical Manual, Fourth Edition - Text Revision Pain Disorder diagnoses. Data on 300 new patients over the course of nine months were collected using standardized assessment procedures plus a modified CPEQ at the Comprehensive Pain Program, Toronto Western Hospital, Toronto, Ontario. Cluster analysis of the modified CPEQ revealed three patient profiles, labelled Adaptive Copers, Dysfunctional, and Interpersonally Distressed, which closely resembled those previously reported. The distribution of modified CPEQ construct T scores across profile subtypes was similar to that previously reported for the original CPEQ. A novel finding was that of a strong relationship between the modified CPEQ clusters and constructs with Diagnostic and Statistical Manual, Fourth Edition - Text Revision Pain Disorder diagnoses. The CPEQ, either the original or modified version, yields reproducible results consistent with the results of other studies. This technique may usefully classify chronic pain patients, but more work is needed to determine the meaning of the CPEQ clusters, what psychological or biomedical variables are associated with CPEQ constructs or clusters, and whether this instrument may assist in treatment planning or predict response to treatment.

  13. Clinical tests for differentiating between patients with and without patellofemoral pain syndrome

    Directory of Open Access Journals (Sweden)

    Konstantinos Papadopoulos, MSc

    2014-06-01

    Full Text Available Patellofemoral pain syndrome (PFPS is a very common knee condition with various aetiologies. Because of the nebulous factors of the syndrome, physiotherapists often find it difficult to assess and treat these patients. The aim of this study was to identify the clinical assessment tool that can differentiate PFPS patients from patients with other lower limb conditions. Fifty-two patients from the National Health System (26 with PFPS and 26 with other lower limb conditions took part in this study. They underwent a series of strength, flexibility, and stress tests. Their pain levels were also recorded. The results showed that among the various clinical tests, only the hip flexion component of the Thomas test was able to differentiate between the two groups. In addition, the stress test showed that the PFPS group could not recover their gluteal muscle strength in the same way the group with the other lower limb conditions did. The Lower Extremity Functional Scale was found to be more able to differentiate between the two groups than the Anterior Knee Pain Scale. This study has shown that it is difficult to find specific clinical tests to diagnose PFPS. More research is needed in this important area.

  14. Clinical prediction of occupational and non-specific low back pain

    Directory of Open Access Journals (Sweden)

    Ingrid Tolosa-Guzmán

    2012-09-01

    Full Text Available Non-specific Occupational Low Back Pain (NOLBP is a health condition that generates a high absenteeism and disability. Due to multifactorial causes is difficult to determine accurate diagnosis and prognosis. The clinical prediction of NOLBP is identified as a series of models that integrate a multivariate analysis to determine early diagnosis, course, and occupational impact of this health condition. Objective: to identify predictor factors of NOLBP, and the type of material referred to in the scientific evidence and establish the scopes of the prediction. Materials and method: the title search was conducted in the databases PubMed, Science Direct, and Ebsco Springer, between 1985 and 2012. The selected articles were classified through a bibliometric analysis allowing to define the most relevant ones. Results: 101 titles met the established criteria, but only 43 met the purpose of the review. As for NOLBP prediction, the studies varied in relation to the factors for example: diagnosis, transition of lumbar pain from acute to chronic, absenteeism from work, disability and return to work. Conclusion: clinical prediction is considered as a strategic to determine course and prognostic of NOLBP, and to determine the characteristics that increase the risk of chronicity in workers with this health condition. Likewise, clinical prediction rules are tools that aim to facilitate decision making about the evaluation, diagnosis, prognosis and intervention for low back pain, which should incorporate risk factors of physical, psychological and social.

  15. Opioid Pharmacokinetics-Pharmacodynamics: Clinical Implications in Acute Pain Management in Trauma.

    Science.gov (United States)

    MacKenzie, Meghan; Zed, Peter J; Ensom, Mary H H

    2016-03-01

    To evaluate acute traumatic pain protocols and to suggest optimization by characterizing opioid pharmacokinetics and pharmacodynamics (PK-PD). MEDLINE (1946 to November 2015), EMBASE (1974 to November 2015), International Pharmaceutical Abstracts (1970 to December 2014), and Cochrane Database of Systematic Reviews (2005 to November 2015). morphine, hydromorphone, fentanyl, trauma, acute pain, intravenous, opioid, pharmacokinetics, and pharmacodynamics. Literature characterizing opioid PK-PD was included. Additionally, studies evaluatingoutcomes of opioids for acute severe pain in adult trauma patients were selected. PK-PD literature suggests that morphine exhibits an effect delay of 1.6 to 4.8 hours; however, clinical significance is doubtful. The relative onset of morphine is approximately 6 minutes, and duration, 96 minutes. Morphine 0.1 mg/kg IV then 0.05 mg/kg every 5 minutes achieved pain control in 40% of patients at 10 minutes and 76% at 60 minutes. The effect delay of hydromorphone (orally) is 18 to 38 minutes; its relative onset (IV), 5 minutes; and duration, 120 minutes. Hydromorphone every 15 minutes achieved variable success in clinical trials. The effect delay of fentanyl IV is 16.4 minutes; relative onset, 2 minutes; and duration, 7 minutes. One randomized controlled trial used fentanyl 0.1 µg/kg IV every 5 minutes. Further integration of opioid PK-PD into acutepain protocols is possible. One opioid should not be deemed more effective but rather titrated to effect. Morphine and hydromorphone can be titrated IV every 5 minutes until adequate pain control. Fentanyl can be titrated every 3 minutes. © The Author(s) 2016.

  16. Clinical validity of outcome pain measures in naturally occurring canine osteoarthritis

    Directory of Open Access Journals (Sweden)

    Rialland Pascale

    2012-09-01

    Full Text Available Abstract Background The conceptual validity of kinetic gait analysis and disability outcome assessment methods has guided their use in the assessment of pain caused by osteoarthritis (OA. No consensus on the best clinical methods for pain evaluation in canine OA exists, particularly, when evaluating treatments where a smaller treatment effect is anticipated than with pharmacological pain killers. This study thus aimed at determining the technical validity of some clinical endpoints on OA pain in dogs using the green-lipped mussel (GLM-enriched diet. Twenty-three adult dogs with clinical OA completed the prospective controlled study. All the dogs were fed a balanced diet over a 30-day control period followed by a GLM-enriched diet over a 60-day period. The kinetic gait analysis parameter (PVFBW, peak vertical force adjusted for body weight change, electrodermal activity (EDA, and a standardized multifactorial pain questionnaire (MFQ were performed on day (D 0 (inclusion, D30 (start and D90 (end. The owners completed a client-specific outcome measures (CSOM instrument twice a week. Motor activity (MA was continuously recorded in seven dogs using telemetered accelerometric counts. We hypothesized that these methods would produce convergent results related to diet changes. A Type I error of 0.05 was adjusted to correct for the multiplicity of the primary clinical endpoints. Results Neither the EDA nor the MFQ were found reliable or could be validated. Changes in the PVFBW (Padj = 0.0004, the CSOM (Padj = 0.006 and the MA intensity (Padj = 0.02 from D0 to D90 suggested an effect of diet(s. Only the PVFBW clearly increased after the GLM-diet (Padj = 0.003. The CSOM exhibited a negative relationship with the PVFBW (P = 0.02 and MA duration (P = 0.02. Conclusions The PVFBW exhibited the best technical validity for the characterization of the beneficial effect of a GLM-enriched diet. The CSOM and MA appeared less responsive

  17. Prediction of persistent shoulder pain in general practice: Comparing clinical consensus from a Delphi procedure with a statistical scoring system

    Science.gov (United States)

    2011-01-01

    Background In prognostic research, prediction rules are generally statistically derived. However the composition and performance of these statistical models may strongly depend on the characteristics of the derivation sample. The purpose of this study was to establish consensus among clinicians and experts on key predictors for persistent shoulder pain three months after initial consultation in primary care and assess the predictive performance of a model based on clinical expertise compared to a statistically derived model. Methods A Delphi poll involving 3 rounds of data collection was used to reach consensus among health care professionals involved in the assessment and management of shoulder pain. Results Predictors selected by the expert panel were: symptom duration, pain catastrophizing, symptom history, fear-avoidance beliefs, coexisting neck pain, severity of shoulder disability, multisite pain, age, shoulder pain intensity and illness perceptions. When tested in a sample of 587 primary care patients consulting with shoulder pain the predictive performance of the two prognostic models based on clinical expertise were lower compared to that of a statistically derived model (Area Under the Curve, AUC, expert-based dichotomous predictors 0.656, expert-based continuous predictors 0.679 vs. 0.702 statistical model). Conclusions The three models were different in terms of composition, but all confirmed the prognostic importance of symptom duration, baseline level of shoulder disability and multisite pain. External validation in other populations of shoulder pain patients should confirm whether statistically derived models indeed perform better compared to models based on clinical expertise. PMID:21718463

  18. Prediction of persistent shoulder pain in general practice: comparing clinical consensus from a Delphi procedure with a statistical scoring system.

    Science.gov (United States)

    Vergouw, David; Heymans, Martijn W; de Vet, Henrica C W; van der Windt, Daniëlle A W M; van der Horst, Henriëtte E

    2011-06-30

    In prognostic research, prediction rules are generally statistically derived. However the composition and performance of these statistical models may strongly depend on the characteristics of the derivation sample. The purpose of this study was to establish consensus among clinicians and experts on key predictors for persistent shoulder pain three months after initial consultation in primary care and assess the predictive performance of a model based on clinical expertise compared to a statistically derived model. A Delphi poll involving 3 rounds of data collection was used to reach consensus among health care professionals involved in the assessment and management of shoulder pain. Predictors selected by the expert panel were: symptom duration, pain catastrophizing, symptom history, fear-avoidance beliefs, coexisting neck pain, severity of shoulder disability, multisite pain, age, shoulder pain intensity and illness perceptions. When tested in a sample of 587 primary care patients consulting with shoulder pain the predictive performance of the two prognostic models based on clinical expertise were lower compared to that of a statistically derived model (Area Under the Curve, AUC, expert-based dichotomous predictors 0.656, expert-based continuous predictors 0.679 vs. 0.702 statistical model). The three models were different in terms of composition, but all confirmed the prognostic importance of symptom duration, baseline level of shoulder disability and multisite pain. External validation in other populations of shoulder pain patients should confirm whether statistically derived models indeed perform better compared to models based on clinical expertise.

  19. Neuropathic pain other than CRPS in children and adolescents: incidence, referral, clinical characteristics, management, and clinical outcomes.

    Science.gov (United States)

    Kachko, Ludmyla; Ben Ami, Shiri; Lieberman, Alon; Shor, Rita; Tzeitlin, Elena; Efrat, Rachel

    2014-06-01

    Chronic pain in children and adolescents is common, but proportion of neuropathic pain (NP), a heterogeneous group of diseases with major impact on health-related quality of life, significant economic burden, and limited treatment options, is unclear. Many studies have focused only on complex regional pain syndrome (CRPS). Our aim was to examine the incidence, clinical features, management, and outcome of non-CRPS NP in patients referred to a chronic pediatric pain clinic (CPPC) at a tertiary-care hospital. Retrospective analyses of the patient's files with non-CRPS NP from 2008 until 2012. Twenty patients (9.9-22.0 years; 10.7% of new referrals) were treated with non-CRPS NP (postoperative 8/20, trauma-related 5/20, disease-related 7/20). The number of consultations performed and the number of medications used before CPPC were significantly higher than in CPPC (Z = 0.75, P = 0.005; Z = 1.68, P = 0.003; respectively, Wilcoxon test). The number of diagnostic procedures was not statistically significant. Invasive treatments were used in 50% of patients. Full/partial recovery was accomplished in 95%. anova with repeated measures yielded a highly significant difference between the initial and final visual analog scale (VAS) scores (8.2 ± 1.3; 1.19 ± 2.01, respectively; P CRPS NP is crucial to timely and correct diagnosis and effective management, but even children with delayed diagnosis still have a good outcome. The management of this condition by an experienced team is recommended. © 2014 John Wiley & Sons Ltd.

  20. Adductor-related groin pain in athletes: correlation of MR imaging with clinical findings

    Energy Technology Data Exchange (ETDEWEB)

    Robinson, P. [Department of Radiology, Leeds Teaching Hospitals, Leeds (United Kingdom); MRI Department, Clarendon Wing, Leeds General Infirmary, Great George Street, LS1 3EX, Leeds (United Kingdom); Barron, D.A.; Grainger, A.J.; O' Connor, P.J. [Department of Radiology, Leeds Teaching Hospitals, Leeds (United Kingdom); Parsons, W. [Research and Development Department, Leeds Teaching Hospitals, Leeds (United Kingdom); Schilders, E.M.G. [Department of Orthopaedic Surgery, Bradford Royal Infirmary, Bradford (United Kingdom)

    2004-08-01

    To evaluate gadolinium-enhanced MR imaging in athletes with chronic groin pain and correlate with the clinical features. MR examinations performed in 52 athletes (51 male, 1 female; median age 26 years) with chronic groin pain and 6 asymptomatic control athletes (6 male; median age 29 years) were independently reviewed by two radiologists masked to the clinical details. Symptom duration (median 6 months) and clinical side of severity were recorded. Anatomical areas in the pelvis were scored for abnormality (as normal, mildly abnormal or abnormal) and an overall assessment for side distribution of abnormality was recorded, initially without post-gadolinium sequences and then, 3 weeks later (median 29 days), the post-gadolinium sequences only. Correlation between radiological and clinical abnormality was calculated by Spearman's correlation. Abnormal anterior pubis and enthesis enhancement significantly correlated with clinical side for both radiologists (both P=0.008). Abnormal anterior pubis and adductor longus enthesis oedema was significant for one radiologist (P=0.009). All other features showed no significant correlation (P>0.05). In the control cases there was no soft tissue abnormality but symphyseal irregularity was present (n=2). For both radiologists assessment of imaging side severity significantly correlated with clinical side for post-gadolinium (P=0.048 and P=0.023) but not non-gadolinium sequences (P>0.05). The extent and side of anterior pubis and adductor longus enthesis abnormality on MR imaging significantly and reproducibly correlates with the athletes' current symptoms in chronic adductor-related groin pain. (orig.)

  1. Treatment success in neck pain: The added predictive value of psychosocial variables in addition to clinical variables.

    Science.gov (United States)

    Groeneweg, Ruud; Haanstra, Tsjitske; Bolman, Catherine A W; Oostendorp, Rob A B; van Tulder, Maurits W; Ostelo, Raymond W J G

    2017-01-01

    Identification of psychosocial variables may influence treatment outcome. The objective of this study was to prospectively examine whether psychosocial variables, in addition to clinical variables (pain, functioning, general health, previous neck pain, comorbidity), are predictive factors for treatment outcome (i.e. global perceived effect, functioning and pain) in patients with sub-acute and chronic non-specific neck pain undergoing physical therapy or manual therapy. Psychosocial factors included treatment outcome expectancy and treatment credibility, health locus of control, and fear avoidance beliefs. This study reports a secondary analysis of a primary care-based pragmatic randomized controlled trial. Potential predictors were measured at baseline and outcomes, in 181 patients, at 7 weeks and 26 weeks. Hierarchical logistic regression models showed that treatment outcome expectancy predicted outcome success, in addition to clinical and demographic variables. Expectancy explained additional variance, ranging from 6% (pain) to 17% (functioning) at 7 weeks, and 8% (pain) to 16% (functioning) at 26 weeks. Locus of control and fear avoidance beliefs did not add significantly to predicting outcome. Based on the results of this study we conclude that outcome expectancy, in patients with non-specific sub-acute and chronic neck pain, has additional predictive value for treatment success above and beyond clinical and demographic variables. Psychological processes, health perceptions and how these factors relate to clinical variables may be important for treatment decision making regarding therapeutic options for individual patients. Copyright © 2016 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  2. Managing cancer pain and symptoms of outpatients by rotation to sustained-release hydromorphone: a prospective clinical trial

    NARCIS (Netherlands)

    Wirz, Stefan; Wartenberg, Hans Christian; Elsen, Christian; Wittmann, Maria; Diederichs, Marta; Nadstawek, Joachim

    2006-01-01

    PURPOSE: In this prospective clinical trial we examined the technique of opioid rotation to oral sustained-release hydromorphone for controlling pain and symptoms in outpatients with cancer pain. METHODS: Before and after rotation, 50 patients were assessed by Numerical Analog Scales [Numerical

  3. Predictive value of fear avoidance in developing chronic neck pain disability-consequences for clinical decision making

    NARCIS (Netherlands)

    Nederhand, Marcus Johannes; IJzerman, Maarten Joost; Hermens, Hermanus J.; Turk, Dennis C.; Zilvold, Gerrit; Zilvold, G.

    2004-01-01

    Objective To improve clinical decision making in posttraumatic neck pain by investigating the additional value of fear-avoidance variables in predicting chronic neck pain disability. Design An inception cohort with baseline assessment 1 week posttrauma and outcome assessment 24 weeks posttrauma.

  4. Persistent idiopathic facial pain - a prospective systematic study of clinical characteristics and neuroanatomical findings at 3.0 Tesla MRI

    DEFF Research Database (Denmark)

    Maarbjerg, Stine; Wolfram, Frauke; Heinskou, Tone Bruvik

    2017-01-01

    INTRODUCTION: Persistent idiopathic facial pain (PIFP) is a poorly understood chronic orofacial pain disorder and a differential diagnosis to trigeminal neuralgia. To address the lack of systematic studies in PIFP we here report clinical characteristics and neuroimaging findings in PIFP. METHODS:...

  5. Music to reduce pain and distress in the pediatric emergency department: a randomized clinical trial.

    Science.gov (United States)

    Hartling, Lisa; Newton, Amanda S; Liang, Yuanyuan; Jou, Hsing; Hewson, Krista; Klassen, Terry P; Curtis, Sarah

    2013-09-01

    Many medical procedures aimed at helping children cause them pain and distress, which can have long-lasting negative effects. Music is a form of distraction that may alleviate some of the pain and distress experienced by children while undergoing medical procedures. To compare music with standard care to manage pain and distress. Randomized clinical trial conducted in a pediatric emergency department with appropriate sequence generation and adequate allocation concealment from January 1, 2009, to March 31, 2010. Individuals assessing the primary outcome were blind to treatment allocation. A total of 42 children aged 3 to 11 years undergoing intravenous placement were included. Music (recordings selected by a music therapist via ambient speakers) vs standard care. The primary outcome was behavioral distress assessed blinded using the Observational Scale of Behavioral Distress-Revised. The secondary outcomes included child-reported pain, heart rate, parent and health care provider satisfaction, ease of performing the procedure, and parental anxiety. With or without controlling for potential confounders, we found no significant difference in the change in behavioral distress from before the procedure to immediately after the procedure. When children who had no distress during the procedure were removed from the analysis, there was a significantly less increase in distress for the music group (standard care group = 2.2 vs music group = 1.1, P Pain scores among children in the standard care group increased by 2 points, while they remained the same in the music group (P = .04); the difference was considered clinically important. The pattern of parent satisfaction with the management of children's pain was different between groups, although not statistically significant (P = .07). Health care providers reported that it was easier to perform the procedure for children in the music group (76% very easy) vs the standard care group (38% very easy) (P

  6. 'Chest pain typicality' in suspected acute coronary syndromes and the impact of clinical experience.

    Science.gov (United States)

    Carlton, Edward W; Than, Martin; Cullen, Louise; Khattab, Ahmed; Greaves, Kim

    2015-10-01

    Physicians rely upon chest pain history to make management decisions in patients with suspected acute coronary syndromes, particularly where the diagnosis is not immediately apparent through electrocardiography and troponin testing. The objective of this study was to establish the discriminatory value of "typicality of chest pain" and the effect of clinician experience, for the prediction of acute myocardial infarction and presence of significant coronary artery disease. This prospective single-center observational study was undertaken in a UK General Hospital emergency department. We recruited consecutive adults with chest pain and a nondiagnostic electrocardiogram, for whom the treating physician determined that delayed troponin testing was necessary. Using their own clinical judgment, physicians recorded whether the chest pain described was typical or atypical for acute coronary syndrome. Physicians were defined as "experienced" or "novice" according to postgraduate experience. Acute myocardial infarction was adjudicated using a high-sensitivity troponin (hs-cTn) assay, whereas coronary artery disease was adjudicated angiographically. Overall, 912 patients had typicality of chest pain assessed, of whom 114/912 (12.5%) had an acute myocardial infarction and 157/912 (17.2%) underwent angiography. In patients undergoing angiography, 90/157 (57.3%) had hs-cTn elevation, of whom 60 (66.7%) had significant coronary artery disease. Sixty-seven of 157 (42.7%) patients had angiography without hs-cTn elevation; of these, 31 (46.2%) had significant coronary artery disease. For the diagnosis of acute myocardial infarction, chest pain typicality had an area under the curve (AUC) of 0.54 (95% confidence interval [CI], 0.49-0.60). For the prediction of significant coronary artery disease with hs-cTn elevation AUC: 0.54 (95% CI, 0.40-0.67), and without hs-cTn elevation AUC: 0.45 (95% CI, 0.31-0.59). When assessed by experienced physicians, specificity for the diagnosis of acute

  7. Teaching a Machine to Feel Postoperative Pain: Combining High-Dimensional Clinical Data with Machine Learning Algorithms to Forecast Acute Postoperative Pain.

    Science.gov (United States)

    Tighe, Patrick J; Harle, Christopher A; Hurley, Robert W; Aytug, Haldun; Boezaart, Andre P; Fillingim, Roger B

    2015-07-01

    Given their ability to process highly dimensional datasets with hundreds of variables, machine learning algorithms may offer one solution to the vexing challenge of predicting postoperative pain. Here, we report on the application of machine learning algorithms to predict postoperative pain outcomes in a retrospective cohort of 8,071 surgical patients using 796 clinical variables. Five algorithms were compared in terms of their ability to forecast moderate to severe postoperative pain: Least Absolute Shrinkage and Selection Operator (LASSO), gradient-boosted decision tree, support vector machine, neural network, and k-nearest neighbor (k-NN), with logistic regression included for baseline comparison. In forecasting moderate to severe postoperative pain for postoperative day (POD) 1, the LASSO algorithm, using all 796 variables, had the highest accuracy with an area under the receiver-operating curve (ROC) of 0.704. Next, the gradient-boosted decision tree had an ROC of 0.665 and the k-NN algorithm had an ROC of 0.643. For POD 3, the LASSO algorithm, using all variables, again had the highest accuracy, with an ROC of 0.727. Logistic regression had a lower ROC of 0.5 for predicting pain outcomes on POD 1 and 3. Machine learning algorithms, when combined with complex and heterogeneous data from electronic medical record systems, can forecast acute postoperative pain outcomes with accuracies similar to methods that rely only on variables specifically collected for pain outcome prediction. Wiley Periodicals, Inc.

  8. Effect of access site, gender, and indication on clinical outcomes after percutaneous coronary intervention: Insights from the British Cardiovascular Intervention Society (BCIS).

    Science.gov (United States)

    Kwok, Chun Shing; Kontopantelis, Evangelos; Kunadian, Vijay; Anderson, Simon; Ratib, Karim; Sperrin, Mathew; Zaman, Azfar; Ludman, Peter F; de Belder, Mark A; Nolan, James; Mamas, Mamas A

    2015-07-01

    Gender is a strong predictor of periprocedural major bleeding complications after percutaneous coronary intervention (PCI). The access site represents an important site of such bleeding complications, which has driven adoption of the transradial access (TRA) use during PCI, although female gender is an independent predictor of transradial PCI failure. This study sought to define gender differences in access site practice and study associations between access site choice and clinical outcomes for PCI over a 6-year period, through the analysis of the British Cardiovascular Intervention Society observational database. In-hospital major adverse cardiovascular events (a composite of in-hospital mortality and in-hospital myocardial reinfarction and target vessel revascularization), in-hospital bleeding complications, and 30-day mortality were studied based on gender and access site choice (transfemoral access, TRA) in 412,122 patients who underwent PCI between 2007 and 2012 in the United Kingdom. Use of TRA increased in both genders over time, although this lagged behind in women (21% in 2007 to 58% in 2012) compared with men (24% in 2007 to 64% in 2012). In both men and women, TRA was independently associated with a lower in-hospital major adverse cardiovascular event (odds ratio [OR] 0.82, 95% CI 0.76-0.90; OR 0.75, 95% CI 0.66-0.84), in-hospital major bleeding (OR 0.54, 95% CI 0.44-0.66; OR 0.26, 95% CI 0.20-0.33), and 30-day mortality (OR 0.80, 95% CI 0.73-0.89; OR 0.82, 95% CI 0.71-0.94), respectively. Where possible, TRA should be considered as the preferred access site choice for PCI, particularly in women in whom the greatest reductions bleeding end points were observed across all indications. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Obesity-associated severe asthma represents a distinct clinical phenotype: analysis of the British Thoracic Society Difficult Asthma Registry Patient cohort according to BMI.

    Science.gov (United States)

    Gibeon, David; Batuwita, Kannangara; Osmond, Michelle; Heaney, Liam G; Brightling, Chris E; Niven, Rob; Mansur, Adel; Chaudhuri, Rekha; Bucknall, Christine E; Rowe, Anthony; Guo, Yike; Bhavsar, Pankaj K; Chung, Kian Fan; Menzies-Gow, Andrew

    2013-02-01

    Obesity has emerged as a risk factor for the development of asthma and it may also influence asthma control and airway inflammation. However, the role of obesity in severe asthma remains unclear. Thus, our objective was to explore the association between obesity (defied by BMI) and severe asthma. Data from the British Thoracic Society Difficult Asthma Registry were used to compare patient demographics, disease characteristics, and health-care utilization among three BMI categories (normal weight: 18.5-24.99; overweight: 25-29.99; obese: 30) in a well-characterized group of adults with severe asthma. The study population consisted of 666 patients with severe asthma; the group had a median BMI of 29.8 (interquartile range, 22.5-34.0). The obese group exhibited greater asthma medication requirements in terms of maintenance corticosteroid therapy (48.9% vs 40.4% and 34.5% in the overweight and normal-weight groups, respectively), steroid burst therapy, and short-acting b 2 -agonist use per day. Significant differences were seen with gastroesophageal reflux disease (53.9% vs 48.1% and 39.7% in the overweight and normal weight groups, respectively) and proton pump inhibitor use. Bone density scores were higher in the obese group, while pulmonary function testing revealed a reduced FVC and elevated carbon monoxide transfer coefficient. Serum IgE levels decreased with increasing BMI and the obese group was more likely to report eczema, but less likely to have a history of nasal polyps. Patients with severe asthma display particular characteristics according to BMI that support the view that obesity-associated severe asthma may represent a distinct clinical phenotype.

  10. Fear-avoidance beliefs and pain avoidance in low back pain--translating research into clinical practice

    DEFF Research Database (Denmark)

    Rainville, James; Smeets, Rob J E M; Bendix, Tom

    2011-01-01

    For patients with low back pain, fear-avoidance beliefs (FABs) represent cognitions and emotions that underpin concerns and fears about the potential for physical activities to produce pain and further harm to the spine. Excessive FABs result in heightened disability and are an obstacle for recov......For patients with low back pain, fear-avoidance beliefs (FABs) represent cognitions and emotions that underpin concerns and fears about the potential for physical activities to produce pain and further harm to the spine. Excessive FABs result in heightened disability and are an obstacle...

  11. [Monitoring of pain, nociception, and analgesia under general anesthesia: Relevance, current scientific status, and clinical practice].

    Science.gov (United States)

    von Dincklage, F

    2015-10-01

    To avoid negative effects of painful stimuli under general anesthesia, an adequate analgesia is needed. Since both overdosing and underdosing of analgesics may lead to negative consequences, an optimal dosing is crucial, requiring a continuous monitoring of the balance between the ongoing nociception and the level of analgesia. This review describes current methods for the monitoring of nociception and analgesia as well as their inherent differences. Monitors of nociception register organic responses that are triggered through painful stimuli and therefore allow the detection of phases of excessive nociception during inadequate analgesia. In contrast, monitors of analgesia register nociception-specific organic responses that are triggered through test stimuli and allow a preemptive adaption of the level of analgesia, before a painful clinical stimulus is applied, but require the application of test stimuli. Preliminary proof-of-concept studies were able to demonstrate the potential of the here described methods; however, an effect on the clinical outcome of patients has not yet been shown for either of the two types of monitoring. For the routine application of monitors of nociception and analgesia in daily clinical practice, large clinical studies are necessary, proving a positive outcome effect. Without reliable parameters for nociception and analgesia it was hitherto impossible to perform such studies. The progress made in recent years generates optimism that in the not too distant future the currently available methods to monitor nociception and analgesia might improve to a level of reliability to allow them to be used to investigate the clinical outcome relevance of nociception and analgesia.

  12. Effectiveness of core stabilization exercises and routine exercise therapy in management of pain in chronic non-specific low back pain: A randomized controlled clinical trial.

    Science.gov (United States)

    Akhtar, Muhammad Waseem; Karimi, Hossein; Gilani, Syed Amir

    2017-01-01

    Low back pain is a frequent problem faced by the majority of people at some point in their lifetime. Exercise therapy has been advocated an effective treatment for chronic low back pain. However, there is lack of consensus on the best exercise treatment and numerous studies are underway. Conclusive studies are lacking especially in this part of the world. Thisstudy was designed to compare the effectiveness of specific stabilization exercises with routine physical therapy exerciseprovided in patients with nonspecific chronic mechanical low back pain. This is single blinded randomized control trial that was conducted at the department of physical therapy Orthopedic and Spine Institute, Johar Town, Lahore in which 120 subjects with nonspecific chronic low back pain participated. Subjects with the age between 20 to 60 years and primary complaint of chronic low back pain were recruited after giving an informed consent. Participants were randomly assigned to two treatment groups A & B which were treated with core stabilization exercise and routine physical therapy exercise respectively. TENS and ultrasound were given as therapeutic modalities to both treatment groups. Outcomes of the treatment were recorded using Visual Analogue Scale (VAS) pretreatment, at 2 nd , 4 th and 6 th week post treatment. The results of this study illustrate that clinical and therapeutic effects of core stabilization exercise program over the period of six weeks are more effective in terms of reduction in pain, compared to routine physical therapy exercise for similar duration. This study found significant reduction in pain across the two groups at 2 nd , 4 th and 6 th week of treatment with p value less than 0.05. There was a mean reduction of 3.08 and 1.71 on VAS across the core stabilization group and routine physical therapy exercise group respectively. Core stabilization exercise is more effective than routine physical therapy exercise in terms of greater reduction in pain in patients with

  13. Diagnostic values of chest pain history, ECG, troponin and clinical gestalt in patients with chest pain and potential acute coronary syndrome assessed in the emergency department.

    Science.gov (United States)

    Mokhtari, Arash; Dryver, Eric; Söderholm, Martin; Ekelund, Ulf

    2015-01-01

    In the assessment of chest pain patients with suspected acute coronary syndrome (ACS) in the emergency department (ED), physicians rely on global diagnostic impressions ('gestalt'). The aim of this study was to determine the diagnostic value of the ED physician's overall assessment of ACS likelihood, and the values of the main diagnostic modalities underlying this assessment, namely the chest pain history, the ECG and the initial troponin result. 1,151 consecutive ED chest pain patients were prospectively included. The ED physician's interpretation of the chest pain history, the ECG, and the global likelihood of ACS were recorded on special forms. The discharge diagnoses were retrieved from the medical records. A chart review was carried out to determine whether patients with a non-ACS diagnosis at the index visit had ACS or suffered cardiac death within 30 days. The gestalt was better than its components both at ruling in ("Obvious ACS", LR 29) and at ruling out ("No Suspicion of ACS", LR 0.01) ACS. In the "Strong suspicion of ACS" group, 60% of the patients did not have ACS. A positive TnT (LR 24.9) and an ischemic ECG (LR 8.3) were strong predictors of ACS and seemed superior to pain history for ruling in ACS. In patients with a normal TnT and non-ischemic ECG, chest pain history typical of AMI was not a significant predictor of AMI (LR 1.9) while pain history typical of unstable angina (UA) was a moderate predictor of UA (LR 4.7). Clinical gestalt was better than its components both at ruling in and at ruling out ACS, but overestimated the likelihood of ACS when cases were assessed as strong suspicion of ACS. Among the components of the gestalt, TnT and ECG were superior to the chest pain history for ruling in ACS, while pain history was superior for ruling out ACS.

  14. Effectiveness of core stabilization exercises and routine exercise therapy in management of pain in chronic non-specific low back pain: A randomized controlled clinical trial

    Science.gov (United States)

    Akhtar, Muhammad Waseem; Karimi, Hossein; Gilani, Syed Amir

    2017-01-01

    Background & Objective: Low back pain is a frequent problem faced by the majority of people at some point in their lifetime. Exercise therapy has been advocated an effective treatment for chronic low back pain. However, there is lack of consensus on the best exercise treatment and numerous studies are underway. Conclusive studies are lacking especially in this part of the world. Thisstudy was designed to compare the effectiveness of specific stabilization exercises with routine physical therapy exerciseprovided in patients with nonspecific chronic mechanical low back pain. Methods: This is single blinded randomized control trial that was conducted at the department of physical therapy Orthopedic and Spine Institute, Johar Town, Lahore in which 120 subjects with nonspecific chronic low back pain participated. Subjects with the age between 20 to 60 years and primary complaint of chronic low back pain were recruited after giving an informed consent. Participants were randomly assigned to two treatment groups A & B which were treated with core stabilization exercise and routine physical therapy exercise respectively. TENS and ultrasound were given as therapeutic modalities to both treatment groups. Outcomes of the treatment were recorded using Visual Analogue Scale (VAS) pretreatment, at 2nd, 4th and 6th week post treatment. Results: The results of this study illustrate that clinical and therapeutic effects of core stabilization exercise program over the period of six weeks are more effective in terms of reduction in pain, compared to routine physical therapy exercise for similar duration. This study found significant reduction in pain across the two groups at 2nd, 4th and 6th week of treatment with p value less than 0.05. There was a mean reduction of 3.08 and 1.71 on VAS across the core stabilization group and routine physical therapy exercise group respectively. Conclusion: Core stabilization exercise is more effective than routine physical therapy exercise in terms

  15. Novel Signs and Their Clinical Utility in Diagnosing Complex Regional Pain Syndrome (CRPS): A Prospective Observational Cohort Study.

    Science.gov (United States)

    Kuttikat, Anoop; Shaikh, Maliha; Oomatia, Amin; Parker, Richard; Shenker, Nicholas

    2017-06-01

    Delays in diagnosis occur with complex regional pain syndrome (CRPS). We define and prospectively demonstrate that novel bedside tests measuring body perception disruption can identify patients with CRPS postfracture. The objectives of our study were to define and validate 4 bedside tests, to identify the prevalence of positive tests in patients with CRPS and other chronic pain conditions, and to assess the clinical utility (sensitivity, specificity, positive predictive value, negative predictive value) for identifying CRPS within a Fracture cohort. This was a single UK teaching hospital prospective cohort study with 313 recruits from pain-free volunteers and patients with chronic pain conditions.Four novel tests were Finger Perception (FP), Hand Laterality identification (HL), Astereognosis (AS), and Body Scheme (BS) report. Five questionnaires (Brief Pain Inventory, Upper Extremity Functional Index, Lower Extremity Functional Index, Neglect-like Symptom Questionnaire, Hospital Anxiety and Depression Score) assessed the multidimensional pain experience. FP and BS were the best performing tests. Prospective monitoring of fracture patients showed that out of 7 fracture patients (total n=47) who had both finger misperception and abnormal BS report at initial testing, 3 developed persistent pain with 1 having a formal diagnosis of CRPS. Novel signs are reliable, easy to perform, and present in chronic pain patients. FP and BS have significant clinical utility in predicting persistent pain in a fracture group thereby allowing targeted early intervention.

  16. Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain

    Science.gov (United States)

    Paige, Neil M.; Miake-Lye, Isomi M.; Booth, Marika Suttorp; Beroes, Jessica M.; Mardian, Aram S.; Dougherty, Paul; Branson, Richard; Tang, Baron; Morton, Sally C.

    2017-01-01

    Importance Acute low back pain is common and spinal manipulative therapy (SMT) is a treatment option. Randomized clinical trials (RCTs) and meta-analyses have reported different conclusions about the effectiveness of SMT. Objective To systematically review studies of the effectiveness and harms of SMT for acute (≤6 weeks) low back pain. Data Sources Search of MEDLINE, Cochrane Database of Systematic Reviews, EMBASE, and Current Nursing and Allied Health Literature from January 1, 2011, through February 6, 2017, as well as identified systematic reviews and RCTs, for RCTs of adults with low back pain treated in ambulatory settings with SMT compared with sham or alternative treatments, and that measured pain or function outcomes for up to 6 weeks. Observational studies were included to assess harms. Data Extraction and Synthesis Data extraction was done in duplicate. Study quality was assessed using the Cochrane Back and Neck (CBN) Risk of Bias tool. This tool has 11 items in the following domains: randomization, concealment, baseline differences, blinding (patient), blinding (care provider [care provider is a specific quality metric used by the CBN Risk of Bias tool]), blinding (outcome), co-interventions, compliance, dropouts, timing, and intention to treat. Prior research has shown the CBN Risk of Bias tool identifies studies at an increased risk of bias using a threshold of 5 or 6 as a summary score. The evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Main Outcomes and Measures Pain (measured by either the 100-mm visual analog scale, 11-point numeric rating scale, or other numeric pain scale), function (measured by the 24-point Roland Morris Disability Questionnaire or Oswestry Disability Index [range, 0-100]), or any harms measured within 6 weeks. Findings Of 26 eligible RCTs identified, 15 RCTs (1711 patients) provided moderate-quality evidence that SMT has a statistically significant

  17. Daily pilates exercise or inactivity for patients with low back pain: a clinical prospective observational study.

    Science.gov (United States)

    Notarnicola, A; Fischetti, F; Maccagnano, G; Comes, R; Tafuri, S; Moretti, B

    2014-02-01

    Studies have shown the effectiveness of a few weekly pilates sessions as helping to reduce lower back pain (LBP). However many patients fear that physical activity can actually make the pain and disability worse. We carried out this observational prospective clinical study to look at the effects that taking part in daily pilates has one on side and on the other the effects of LBP management without physical exercise. The volunteers who participated in this study were recruited from among some local cultural associations. Patients affected by LBP were evaluated. The subjects were 60 volunteers (27 males and 33 females) with a mean age of 51.2 years who had chronic low back pain (CLBP). They were allocated to pilates group (N.=30) or inactivity control group (N.=30). The pilates group performed one-hour lesson of pilates exercise, 5 lessons per week during the following 6 months. The inactivity group continued with their normal daily activities. The Roland-Morris Disability, the Oswestry, the SF-36 and the Spinal Functional Sort Questionaries of all subjects were measured at the baseline (T1) and at 6 months (T2). At T2 improvements were observed in the pilates group with increases in physical and social functioning, general health and vitality (Pmeasures at T2. We found an important improvement of pain, disability and physical and psychological perception of health in individuals who did the daily sessions of pilates. Some authors underlined the possible risk of a lack of adherence to an exercise program at home. This study suggests that a daily pilates program is effective for the management of CLBP. On the other hand, the inactivity contributes to further worsening, inducing a vicious cycle in which pain and physical activity intolerance follow each other.

  18. The Effect of Chamomile Cream on Episiotomy Pain in Primiparous Women: A Randomized Clinical Trial.

    Science.gov (United States)

    Aradmehr, Maryam; Azhari, Sedigheh; Ahmadi, Sedigheh; Azmoude, Elham

    2017-03-01

    Introduction: Episiotomy is a surgical incision made in the perineum to enlarge it. Perineal pain is the most common complaint of mothers after episiotomy. Chamomile extract has been proposed as a sedative in traditional medicine. This study was conducted to assess the effect of chamomile cream on the pain after episiotomy. Methods: This triple blind clinical trial was performed on 114 eligible women at Ommolbanin Hospital in Mashhad, Iran in 2014.They were randomly assigned to two groups using random blocks. After delivery, mothers in the intervention group used 0.5 g of prescribed chamomile while the control group used placebo cream on the stitch twice a day lasting ten days. Episiotomy pain was evaluated before intervention and 12 hours after episiotomy repair and also on the first, seventh, tenth and fourteenth day after delivery by McGill pain questionnaire. Data was analyzed by SPSS ver.13. Results: There was no significant difference between the two groups before the intervention, 12 hours and the first day after delivery. However, a significant difference was found on the seventh, tenth and fourteenth day after delivery. McGill mean (SD) score on the seventh, tenth and fourteenth in experimental group was 11.36 (5.04), 4.44 (3.43) and 7.16 (4.10) respectively. It was reported 14.88 (7.34), 7.41(4.92) and 9.96 (4.81) in placebo group, respectively. Conclusion: Chamomile cream can be used to reduce episiotomy pain in Primiparous us women.

  19. Fear-avoidance beliefs and pain avoidance in low back pain--translating research into clinical practice

    DEFF Research Database (Denmark)

    Rainville, James; Smeets, Rob J E M; Bendix, Tom

    2011-01-01

    For patients with low back pain, fear-avoidance beliefs (FABs) represent cognitions and emotions that underpin concerns and fears about the potential for physical activities to produce pain and further harm to the spine. Excessive FABs result in heightened disability and are an obstacle for recov...

  20. Association between Clinical and Neurophysiological Outcomes in Patients with Mechanical Neck Pain and Whiplash-associated Disorders.

    Science.gov (United States)

    Castaldo, Matteo; Catena, Antonella; Chiarotto, Alessandro; Villafañe, Jorge Hugo; Fernández-de-Las-Peñas, César; Arendt-Nielsen, Lars

    2017-07-03

    To investigate the association between pain, disability, trigger points (TrPs) and pressure pain thresholds (PPTs) in patients with mechanical (MNP) or whiplash-associated disorders (WAD). Forty-six MNP and fifty-one WAD patients underwent a physical examination consisting of cervical range of motion, PPTs in the upper trapezius and tibialis anterior muscles, TrPs examination in the upper trapezius, and collection of clinical data including disability, pain intensity and spontaneous symptomatic pain area. A significantly moderate positive association between pain and disability was found in both groups (Pactive TrPs in the upper trapezius exhibited higher intensity of neck pain, higher neck disability and lower PPTs than those with latent TrPs in upper trapezius in both groups. The association between pain, disability, and PPTs is common in subjects with neck pain regardless of the origin of neck pain. The presence of active TrPs was related to higher pain intensity and related-disability and lower PPTs.

  1. Clinical study of scrotum scintigraphy in 49 patients with acute scrotal pain. A comparison with ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Yuan Zhibin; Luo Quanyong; Chen Libo; Zhu Jifang; Zhu Ruisen [Shanghai 6th People' s Hospital, Shanghai (China)

    2001-06-01

    The significance of scrotum scintigraphy in differentiating acute testicular torsion from acute orchiepididymitis was evaluated. In this report, 49 patients with acute scrotal pain were examined with radionuclide scrotum scintigraphy and ultrasonography in parallel for comparison. Of 37 patients with decreased radioactivity in the abnormal side scrotum, 35 were diagnosed with testicular torsion surgically and the other 2 were diagnosed with indirect inguinal hernia. Only 17 among the 35 patients were diagnosed by ultrasonography as having testicular torsion. The remaining 12 patients with increased radioactivity in the abnormal side of the scrotum were all diagnosed with orchiepididymitis through conservative treatment and clinical follow-up, but only 8 of the 12 were correctly and exactly diagnosed by ultrasonography. In the process of diagnosing acute scrotal pain, radionuclide scrotum scintigraphy has obvious advantage over ultrasonography. It also has the advantage of being simple, fast and accurate but without any detrimental effect on the human body. (author)

  2. Clinically relevant pain relief with an ibuprofen-releasing foam dressing

    DEFF Research Database (Denmark)

    Fogh, Karsten; Andersen, Maibritt B; Bischoff-Mikkelsen, Morten

    2012-01-01

    The objective of this 6-week, 120-patient, double-blind, randomized, controlled trial was to investigate if a foam dressing with ibuprofen provided clinically relevant pain relief (PAR) for exuding, painful venous leg ulcers in comparison with a similar foam dressing without ibuprofen. Primary......) and the corresponding number needed to treat (NNT). Wound-related parameters such as ulcer healing, ulcer area reduction, and peri-ulcer skin condition as well as adverse events were recorded during all 6 weeks of the investigation. PAR was significantly greater in the ibuprofen foam group than the comparator group (p...... = 0.0438). There were 34% responders in the ibuprofen foam group vs. 19% in the comparator group (NNT = 6.8). When evening data were analyzed separately to evaluate PAR over daytime, NNT was 5.3. Wound healing parameters and adverse events were comparable. In conclusion, in this study, the ibuprofen...

  3. CLINICAL AND HAEMATO-BIOCHEMICAL ALTERATIONS FOLLOWING TREATMENT WITH INTERFERENTIAL THERAPY IN THE BACK PAIN IN DOGS

    Directory of Open Access Journals (Sweden)

    A.K. Sharma

    2017-06-01

    Full Text Available A total of sixteen clinical cases, comprising of 8 animals each in Group I (animals with hindquarter weakness, which could stand, and had staggering gait and intact pain sensation and Group II (animals with hind quarter paresis, which were unable to stand and dragged hind legs while walking with intact pain sensation were treated with Computerized interferential unit and conventional therapy. Different clinical and haematobiochemical study revealed that the post treatment changes were transient and remains within normal physiological limits.

  4. Cost-effectiveness evaluations of spinal neuromodulation with ziconotide continuous infusion in cancer pain in a real clinical practice

    OpenAIRE

    Orietta Zaniolo; Sergio Iannazzo; Gian Piero Patrucco; Roberto Bellini

    2011-01-01

    Introduction and objective: ziconotide is the first-in-class drug of selective N-type voltage-sensitive calcium-channel blockers used to control severe chronic pain. The present study is developed in order to analyze clinical and economical outcomes of spinal neuromodulation with ziconotide continuous infusion in cancer pain in a real clinical practice.Methods: costs and effects of ziconotide are compared with those of traditional neuromodulation with morphine and adjuvant drugs, administered...

  5. Efficacy of metronidazole versus placebo in pain control after hemorrhoidectomy: results of a controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Sergio Solorio-López

    2015-11-01

    Full Text Available Introduction: Hemorrhoidal disease occurs in 50% of people aged > 40 years and is the most common reason for anorectal surgery. Pain is the main complication. Multiple topical and systemic drugs have been investigated for pain control, but there is no ideal treatment. Metronidazole has been shown to decrease postoperative pain but is not used widely. Objective: To evaluate the effect of oral metronidazole versus placebo and to assess postoperative pain following hemorrhoidectomy. Material and methods: Controlled clinical trial in adult patients who underwent elective hemorrhoidectomy for grade III/IV hemorrhoids. Patients were assigned to receive metronidazole (500 mg q8 h orally; study group, SG or placebo (control group, CG for 7 days after surgery. Pain was assessed using a visual analog scale after surgery. Analgesic administration (time and use of analgesics and resumption of daily life activities were also assessed. Results: Forty-four patients were included, 22 in each group. Postoperative pain differed significantly between the SG and CG at 6 h (3.86 ± 0.56, 6.64 ± 1.49, 12 h (5.59 ± 1.33, 8.82 ± 0.79, 24 h (6.86 ± 1.49, 9.73 ± 0.45, day 4 (5.32 ± 2.10, 9.50 ± 0.59, day 7 (3.14 ± 1.03, 7.36 ± 1.39, and day 14 (2.14 ± 0.46, 5.45 ± 1.29. The first analgesia dose was required at 21.27 ± 5.47 h in the CG and 7.09 ± 2.36 h in the SG (p < 0.05, the time of analgesic use was 6.86 ± 1.61 days in the CG and 13.09 ± 2.48 days in the SG (p < 0.05, and resumption of daily activities occurred at 7.59 ± 1.56 days in the CG and 14.73 ± 3.76 days in the SG (p < 0.05. Conclusion: Oral administration of metronidazole is effective in pain management after hemorrhoidectomy.

  6. Pain during ice water test distinguishes clinical bladder hypersensitivity from overactivity disorders

    Directory of Open Access Journals (Sweden)

    Bountra Chas

    2006-12-01

    of the control or overactive (NDO/IDO patients reported any pain during the IWT. Conclusion The BCR in DO may reflect loss of central inhibition, which appears necessary to elicit this reflex; the pain elicited in PBS suggests afferent sensitisation, hence sensory symptoms are evoked but not reflex detrusor contractions. The ice water test may be a useful and simple marker for clinical trials in PBS, particularly for novel selective TRPM8 antagonists.

  7. Home cage wheel running is an objective and clinically relevant method to assess inflammatory pain in male and female rats.

    Science.gov (United States)

    Kandasamy, Ram; Calsbeek, Jonas J; Morgan, Michael M

    2016-04-01

    The assessment of nociception in preclinical studies is undergoing a transformation from pain-evoked to pain-depressed tests to more closely mimic the effects of clinical pain. Many inflammatory pain-depressed behaviors (reward seeking, locomotion) have been examined, but these tests are limited because of confounds such as stress and difficulties in quantifying behavior. The present study evaluates home cage wheel running as an objective method to assess the magnitude and duration of inflammatory pain in male and female rats. Injection of Complete Freund's Adjuvant (CFA) into the right hindpaw to induce inflammatory pain almost completely inhibited wheel running for 2 days in male and female rats. Wheel running gradually returned to baseline levels within 12 days despite persistent mechanical hypersensitivity (von Frey test). Continuously monitoring home cage wheel running improves on previous studies examining inflammatory pain-depressed wheel running because it is more sensitive to noxious stimuli, avoids the stress of removing the rat from its cage for testing, and provides a complete analysis of the time course for changes in nociception. The present data indicate that home cage wheel running is a clinically relevant method to assess inflammatory pain in the rat. The decrease in activity caused by inflammatory pain and subsequent gradual recovery mimics the changes in activity caused by pain in humans. The tendency for pain-depressed wheel running to be greater in female than male rats is consistent with the tendency for women to be at greater risk of chronic pain than men. Copyright © 2016 Elsevier B.V. All rights reserved.

  8. Painful left bundle branch block syndrome: Clinical and electrocardiographic features and further directions for evaluation and treatment.

    Science.gov (United States)

    Shvilkin, Alexei; Ellis, Ethan R; Gervino, Ernest V; Litvak, Anthony D; Buxton, Alfred E; Josephson, Mark E

    2016-01-01

    Painful left bundle branch block (LBBB) is a rarely diagnosed chest pain syndrome caused by intermittent LBBB in the absence of myocardial ischemia. Its prevalence, mechanism, detailed electrocardiographic (ECG) features, and effective treatments are not well described. The purpose of this study was to characterize clinical and ECG features of patients with painful LBBB syndrome with respect to the LBBB ECG morphology (in particular QRS axis and the precordial S/T wave ratio), clarify diagnostic criteria and possible mechanisms, and provide directions for further evaluation and treatment. We analyzed clinical (n = 50) and ECG (n = 15) features of patients with painful LBBB syndrome (4 patients in our practice and 46 cases identified in the literature). All 15 ECGs of patients with painful LBBB syndrome had an inferior QRS axis and a very low (<1.8) precordial S/T wave ratio, which was consistent with the "new LBBB" pattern. We report a case of painful LBBB syndrome coexisting with coronary artery disease. Right ventricular apical pacing resolved intractable chest pain in 1 case of painful LBBB. Painful LBBB ECG morphology within seconds/minutes of its onset is consistent with the new LBBB pattern with a very low (<1.8) precordial S/T wave ratio and inferior QRS axis. Painful LBBB syndrome can coexist with coronary artery disease, complicating the assessment of chest pain in the setting of LBBB. An electrophysiology study might be considered to investigate whether changing ventricular activation pattern by pacing provides consistent pain control and to select the most effective pacing configuration. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  9. Clinical management of occupational low back pain in Australia: what is the real picture?

    Science.gov (United States)

    Hush, Julia M

    2008-12-01

    The aim of this study was to compare the clinical management of patients with occupational low back pain (LBP) presenting to secondary care practitioners in Australia with national and international practice guidelines. A consecutive cohort of 401 patients with LBP following a work injury was assembled at the time of referral to secondary rehabilitation. A comprehensive assessment was performed to collect demographic, clinical and occupational data, which were analysed using descriptive statistics. Clinical and occupational management data were compared with evidence-based guidelines for the management of LBP. This study revealed that in this cohort presenting to secondary care, referral for guideline-based active treatment was delayed until, on average, 10 months post-injury; radiographic investigations had been ordered for almost every patient, including those presenting in the first three months of their injury; the prevalence of co-morbidities was high and there were signs that psychological distress was under-diagnosed. This study reveals a lack of compliance with clinical guidelines for occupational back pain management in Australia.

  10. Minimal Clinically Important Difference in Quality of Life for Patients With Low Back Pain.

    Science.gov (United States)

    Díaz-Arribas, María J; Fernández-Serrano, Mónica; Royuela, Ana; Kovacs, Francisco M; Gallego-Izquierdo, Tomás; Ramos-Sánchez, Mabel; Llorca-Palomera, Rosa; Pardo-Hervás, Pedro; Martín-Pariente, Oscar S

    2017-12-15

    Multicenter, prospective, cohort study. To estimate the Minimal Clinically Important Difference (MCID) for the physical (PCS) and mental (MCS) component summaries of Short Form SF-12 (SF-12), in patients with low back pain (LBP). Quality of life is one of the core domains recommended to be assessed in patients with LBP. SF-12 is the most widely used instrument for this purpose, but its MCID was unknown. A total of 458 patients with subacute and chronic LBP were consecutively recruited across 21 practices. LBP, referred pain, disability, PCS, and MCS were assessed upon recruitment and 12 months later. Self-reported health status change between baseline and 12 month-assessment, was used as the external criterion. The MCID for SF-12 was estimated following four anchor-based methods; minimal detectable change (MDC); average change (AC); change difference (CD); and receiver operating characteristic curve (ROC), for which the area under the curve (AUC) was calculated. The effect on MCID values of pain duration and baseline scores was assessed. Values for PCS were: MDC: 0.56, AC: 2.71, CD: 3.29, and ROC: 1.14. Values for MCS were: MDC: 3.77, AC: 3.54, CD: 1.13, and ROC: 4.23. AUC values were MCID values were smaller among chronic patients and those with better baseline quality of life. Different methods for MCID calculation lead to different results. In patients with subacute and chronic LBP, improvements >3.77 in MCS and >3.29 in PCS, can be considered clinically relevant. MCID is smaller in patients with longer pain duration and better baseline quality of life. 2.

  11. Application of a diagnosis-based clinical decision guide in patients with low back pain

    Directory of Open Access Journals (Sweden)

    Murphy Donald R

    2011-10-01

    Full Text Available Abstract Background Low back pain (LBP is common and costly. Development of accurate and efficacious methods of diagnosis and treatment has been identified as a research priority. A diagnosis-based clinical decision guide (DBCDG; previously referred to as a diagnosis-based clinical decision rule has been proposed which attempts to provide the clinician with a systematic, evidence-based means to apply the biopsychosocial model of care. The approach is based on three questions of diagnosis. The purpose of this study is to present the prevalence of findings using the DBCDG in consecutive patients with LBP. Methods Demographic, diagnostic and baseline outcome measure data were gathered on a cohort of LBP patients examined by one of three examiners trained in the application of the DBCDG. Results Data were gathered on 264 patients. Signs of visceral disease or potentially serious illness were found in 2.7%. Centralization signs were found in 41%, lumbar and sacroiliac segmental signs in 23% and 27%, respectively and radicular signs were found in 24%. Clinically relevant myofascial signs were diagnosed in 10%. Dynamic instability was diagnosed in 63%, fear beliefs in 40%, central pain hypersensitivity in 5%, passive coping in 3% and depression in 3%. Conclusion The DBCDG can be applied in a busy private practice environment. Further studies are needed to investigate clinically relevant means to identify central pain hypersensitivity, poor coping and depression, correlations and patterns among the diagnostic components of the DBCDG as well as inter-examiner reliability and efficacy of treatment based on the DBCDG.

  12. Management of Neuropathic Chronic Pain with Methadone Combined with Ketamine: A Randomized, Double Blind, Active-Controlled Clinical Trial.

    Science.gov (United States)

    Rigo, Flavia Karine; Trevisan, Gabriela; Godoy, Maria C; Rossato, Mateus Fortes; Dalmolin, Gerusa D; Silva, Mariane A; Menezes, Mirian S; Caumo, Wolnei; Ferreira, Juliano

    2017-03-01

    Methadone and ketamine are used in neuropathic pain management. However, the benefits of both drugs association are uncertain in the treatment of neuropathic pain. Our primary objective was test the hypothesis that oral methadone combined with oral ketamine is more effective than oral methadone or ketamine alone in reducing neuropathic pain. We conducted a randomized, double blind, active-controlled parallel-group clinical trial. Forty-two patients with neuropathic pain refractory to conventional therapy were randomly assigned to receive oral methadone (n = 14), ketamine (n = 14), or methadone plus ketamine (n = 14) over a 3-month period. During these 90 days, we observed pain scores using a visual analogical scale (VAS), allodynia, burning/shooting pain, and some side effects. All treatments were effective in reducing pain scores by at least 40%. However, a significant improvement in pain was observed only in the ketamine alone group compared with both the methadone or methadone/ketamine groups. No significant differences were observed among the treatment groups for the reduction of burning or shooting pain, while ketamine alone was more effective than methadone or methadone/ketamine for the reduction of allodynia. Formal assessment for awareness of the allocation was not performed, some co-intervention bias may have occurred, our results could be only relevant to the patient population investigated and the use of VAS as the primary outcome detect changes in pain intensity but not to assess neuropathic pain symptoms. This study indicates that ketamine was better than methadone or methadone/ketamine for treating neuropathic pain.Key words: Multimodal analgesia, refractory pain, NMDA receptor, opioid.

  13. Chronic pain coping styles in patients with herniated lumbar discs and coexisting spondylotic changes treated surgically: Considering clinical pain characteristics, degenerative changes, disability, mood disturbances, and beliefs about pain control.

    Science.gov (United States)

    Misterska, Ewa; Jankowski, Roman; Głowacki, Maciej

    2013-12-27

    Pain catastrophizing, appraisals of pain control, styles of coping, and social support have been suggested to affect functioning in patients with low back pain. We investigated the relation of chronic pain coping strategies to psychological variables and clinical data, in patients treated surgically due to lumbar disc herniation and coexisting spondylotic changes. The average age of study participants (n=90) was 43.47 years (SD 10.21). Patients completed the Polish versions of the Chronic Pain Coping Inventory-42 (PL-CPCI-42), Beck Depression Inventory (BDI-PL), Coping Strategies Questionnaire (CSQ-PL), Beliefs about Pain Control Questionnaire (BPCQ-PL), and Roland-Morris Disability Questionnaire (RMQ-PL). In the PL-CPCI-42 results, resting, guarding and coping self-statements were frequently used as coping strategies (3.96 SD 1.97; 3.72 SD 1.72; 3.47 SD 2.02, respectively). In the CSQ-PL domains, catastrophizing and praying/hoping were frequently used as coping strategies (3.62 SD 1.19). The mean score obtained from the BDI-PL was 11.86 SD 7.23, and 12.70 SD 5.49 from the RMDQ-PL. BPCQ-PL results indicate that the highest score was in the subscale measuring beliefs that powerful others can control pain (4.36 SD 0.97). Exercise correlated significantly with beliefs about internal control of pain (rs=0.22). We identified associations between radiating pain and guarding (p=0.038) and between sports recreation and guarding (p=0.013) and task persistence (p=0.041). Back pain characteristics, depressive mood, disability, and beliefs about personal control of pain are related to chronic LBP coping styles. Most of the variables related to advancement of degenerative changes were not associated with coping efforts.

  14. Evaluation of distracting pain and clinical judgment in cervical spine clearance of trauma patients.

    Science.gov (United States)

    Kamenetsky, Eric; Esposito, Thomas J; Schermer, Carol R

    2013-01-01

    The concept of distracting pain (DP) is a controversial subjective confounder that often impedes the efficient and timely clearance of the cervical spine (C-spine). This study attempted to define DP more objectively and assess its true potential to mask the presence of C-spine injury. It also evaluated reliability and safety of clinical judgment in discounting the significance of pain peripheral to the neck (PP). This prospective study included patients with a Glasgow Coma Score ≥14 at a level I trauma center presenting in a C-spine collar. Demographics, mechanism of injury, severity and location of all pain, and C-spine imaging data were obtained. Patient and examiner perception of DP were ascertained using the Verbal Numerical Rating Scale (VNRS) along with the examiner's clinical opinion as to the presence of a fracture. A total of 160 patients were studied: 65 % male, mean age 39 years, and 44 % presenting after a motor vehicle crash. In all, 16 % complained of neck pain (NP) and 82 % of PP. There were 134 patients without NP, 110 of whom (82 %) had PP. The mean VNRS in patients with no NP was 4.2; in patients with NP it was 4.8. When examined, 14 patients without NP exhibited posterior cervical tenderness, one of whom had a fracture (7 %). Of the patients with PP, 10 % stated it was DP. The mean VNRS described as DP by all patients was 7.5 but by clinician 6.5. VNRS described as not DP was 4.8 for both patients and clinicians. Overall, 8 of the 160 patients (5 %) had confirmed C-spine injuries. Regardless of NP or PP and its potentially distracting nature, clinicians believed no fracture was present in 95 % of all cases. Clinical impression was 98 % accurate. For patients with NP, clinical impression had a 91 % negative predictive value (NPV) and a 100 % a positive predictive value (PPV). In those without NP, the NPV was 99 % and the PPV 25 %. The concept of DP is subjective and unreliable as a method to mitigate missed C-spine injuries. If it is to be

  15. Clinical utility and validity of the Functional Disability Inventory (FDI) among a multicenter sample of youth with chronic pain

    Science.gov (United States)

    Kashikar-Zuck, Susmita; Flowers, Stacy R.; Claar, Robyn Lewis; Guite, Jessica W.; Logan, Deirdre E.; Lynch-Jordan, Anne M; Palermo, Tonya M.; Wilson, Anna C.

    2011-01-01

    The Functional Disability Inventory (FDI) is a well-established and commonly used measure of physical functioning and disability in youth with chronic pain. Further validation of the measure has been called for, in particular, examination of the clinical utility and factor structure of the measure. To address this need, we utilized a large multicenter dataset of pediatric patients with chronic pain who had completed the FDI and other measures assessing pain and emotional functioning. Clinical reference points to allow for interpretation of raw scores were developed to enhance clinical utility of the measure and exploratory factor analysis was performed to examine its factor structure. Participants included 1300 youth ages 8 to 18 years (M=14.2 years; 76% female) with chronic pain. Examination of the distribution of FDI scores and validation with measures of depressive symptoms and pain intensity yielded three distinct categories of disability: No/Minimal Disability, Moderate Disability and Severe Disability. Factor analysis of FDI scores revealed a two-factor solution representing vigorous Physical Activities and non-physically strenuous Daily Activities. The three-level classification system and factor structure were further explored via comparison across the four most commonly encountered pain conditions in clinical settings (head, back, abdominal and widespread pain). Our findings provide important new information regarding the clinical utility and validity of the FDI. This will greatly enhance the interpretability of scores for research and clinical use in a wide range of pediatric pain conditions. In particular these findings will facilitate use of the FDI as an outcome measure in future clinical trials. PMID:21458162

  16. 1970 British Cohort Study

    Directory of Open Access Journals (Sweden)

    Matt Brown

    2014-10-01

    Full Text Available The 1970 British Cohort Study (BCS70 is one of Britain’s world famous national longitudinal birth cohort studies, three of which are run by the Centre for Longitudinal Studies at the Institute of Education, University of London.  BCS70 follows the lives of more than 17,000 people born in England, Scotland and Wales in a single week of 1970. Over the course of cohort members lives, the BCS70 has collected information on health, physical, educational and social development, and economic circumstances among other factors. Since the birth survey in 1970, there have been nine ‘sweeps’ of all cohort members at ages 5, 10, 16, 26, 30, 34, 38 and most recently at 42. Data has been collected from a number of different sources (the midwife present at birth, parents of the cohort members, head and class teachers, school health service personnel and the cohort members themselves. The data has been collected in a variety of ways including via paper and electronic questionnaires, clinical records, medical examinations, physical measurements, tests of ability, educational assessments and diaries. The majority of BCS70 survey data can be accessed by bona fide researchers through the UK Data Service at the University of Essex.

  17. Complex regional pain syndrome in children: a systematic review of clinical features and movement disorders.

    Science.gov (United States)

    Abu-Arafeh, Hashem; Abu-Arafeh, Ishaq

    2017-03-01

    To ascertain clinical features of complex regional pain syndrome (CRPS) in children with a focus on movement disorders. all publications with original data on children with CRPS were assessed. Data were tabulated and descriptive statistics were applied. One population-based study and nine clinic-based studies provided data on demographic and clinical characteristics of childhood CRPS. Mean age of onset was 12.5 years and 85% of patients were females (risk ratio: 1.70; 95% CI: 1.54-1.88). History of trauma in 71% and the lower limbs were affected in 75% of patients. A secondary site involvement was present in 15%. Movement disorders and dystonia were reported in 30% of children. Majority of cases of CRPS in children are females with mean age of 12.5 years. Movement disorders (mainly dystonia) affect at least one in three children with CRPS.

  18. Derivation of a clinical decision guide in the diagnosis of cervical facet joint pain.

    Science.gov (United States)

    Schneider, Geoff M; Jull, Gwendolen; Thomas, Kenneth; Smith, Ashley; Emery, Carolyn; Faris, Peter; Cook, Chad; Frizzell, Bevan; Salo, Paul

    2014-09-01

    To derive a clinical decision guide (CDG) to identify patients best suited for cervical diagnostic facet joint blocks. Prospective cohort study. Pain management center. Consecutive patients with neck pain (N=125) referred to an interventional pain management center were approached to participate. Subjects underwent a standardized testing protocol, performed by a physiotherapist, prior to receiving diagnostic facet joint blocks. All subjects received the reference standard diagnostic facet joint block protocol, namely controlled medial branch blocks (MBBs). The physicians performing the MBBs were blinded to the local anesthetic used and findings of the clinical tests. Multivariate regression analyses were performed in the derivation of the CDGs. Sensitivity, specificity, positive and negative likelihood ratios, and 95% confidence intervals (CIs) were calculated for the index tests and CDGs. A CDG involving the findings of the manual spinal examination (MSE), palpation for segmental tenderness (PST), and extension-rotation (ER) test demonstrated a specificity of 84% (95% CI, 77-90) and a positive likelihood ratio of 4.94 (95% CI, 2.8-8.2). Sensitivity of the PST and MSE were 94% (95% CI, 90-98) and 92% (95% CI, 88-97), respectively. Negative findings on the PST were associated with a negative likelihood ratio of .08 (95% CI, .03-.24). MSE, PST, and ER may be useful tests in identifying patients suitable for diagnostic facet joint blocks. Further research is needed to validate the CDGs prior to their routine use in clinical practice. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  19. Investigation of paramedics' compliance with clinical practice guidelines for the management of chest pain.

    LENUS (Irish Health Repository)

    Figgis, Ken

    2012-01-31

    BACKGROUND: Acute coronary syndromes remain a leading cause of preventable early deaths. However, previous studies have indicated that paramedics\\' compliance with chest pain protocols is suboptimal and that many patients do not receive the benefits of appropriate prehospital treatment. AIMS: To evaluate paramedics\\' level of compliance with national clinical practice guidelines and to investigate why, in certain circumstances, they may deviate from the clinical guidelines. SETTING: The Health Service Executive Mid-Western Regional Ambulance Service which serves a mixed urban and rural population across three counties in the west of Ireland. METHOD: A retrospective review of completed ambulance Patient Care Report Forms was conducted for all adult patients with non-traumatic chest pain treated between 1 December 2007 and 31 March 2008. During the same study period, paramedics were asked to complete a prospective questionnaire survey investigating the rationale behind their treatment decisions, their estimation of patient risk and their attitudes towards the clinical practice guidelines and training. RESULTS: 382 completed Patient Care Report Forms were identified for patients with chest pain, of whom 84.8% received ECG monitoring, 75.9% were given oxygen, 44.8% were treated with sublingual glyceryl trinitrate (GTN) and 50.8% were treated with aspirin. Only 20.4% of patients had a prehospital 12-lead ECG recorded. 58 completed questionnaires were returned (response rate 15%); 64% of respondents said they had received insufficient training to identify ECG abnormalities. CONCLUSIONS: Prehospital treatment with oxygen, aspirin, sublingual GTN and ECG monitoring remains underused by paramedics, even though only a small number of patients had documented contraindications to their use. The small number of patients who received a prehospital 12-lead ECG is a cause of particular concern and suggests that incomplete patient assessment may contribute to undertreatment

  20. Investigation of paramedics' compliance with clinical practice guidelines for the management of chest pain.

    Science.gov (United States)

    Figgis, Ken; Slevin, Oliver; Cunningham, J Brian

    2010-02-01

    Acute coronary syndromes remain a leading cause of preventable early deaths. However, previous studies have indicated that paramedics' compliance with chest pain protocols is suboptimal and that many patients do not receive the benefits of appropriate prehospital treatment. To evaluate paramedics' level of compliance with national clinical practice guidelines and to investigate why, in certain circumstances, they may deviate from the clinical guidelines. The Health Service Executive Mid-Western Regional Ambulance Service which serves a mixed urban and rural population across three counties in the west of Ireland. A retrospective review of completed ambulance Patient Care Report Forms was conducted for all adult patients with non-traumatic chest pain treated between 1 December 2007 and 31 March 2008. During the same study period, paramedics were asked to complete a prospective questionnaire survey investigating the rationale behind their treatment decisions, their estimation of patient risk and their attitudes towards the clinical practice guidelines and training. 382 completed Patient Care Report Forms were identified for patients with chest pain, of whom 84.8% received ECG monitoring, 75.9% were given oxygen, 44.8% were treated with sublingual glyceryl trinitrate (GTN) and 50.8% were treated with aspirin. Only 20.4% of patients had a prehospital 12-lead ECG recorded. 58 completed questionnaires were returned (response rate 15%); 64% of respondents said they had received insufficient training to identify ECG abnormalities. Prehospital treatment with oxygen, aspirin, sublingual GTN and ECG monitoring remains underused by paramedics, even though only a small number of patients had documented contraindications to their use. The small number of patients who received a prehospital 12-lead ECG is a cause of particular concern and suggests that incomplete patient assessment may contribute to undertreatment. Further provision of training and equipment is necessary to

  1. [Interindividual variation of pharmacokinetic disposition of and clinical responses to opioid analgesics in cancer pain patients].

    Science.gov (United States)

    Naito, Takafumi; Kawakami, Junichi

    2015-01-01

    Use of prescription opioids for cancer pain according to the World Health Organization analgesic ladder has been accepted in Japan. Although oxycodone and fentanyl are commonly used as first-line analgesics, a few clinical reports have been published on interindividual variations in their pharmacokinetics and clinical responses in cancer patients. (1) Some factors relating to CYP2D6, CYP3A, ATP-binding cassette sub-family B member 1 (ABCB1), and opioid receptor mu 1 (OPRM1) involve oxycodone pharmacokinetics and sensitivity in humans. The relations between their genetic variations and clinical responses to oxycodone are being revealed in limited groups. In our study, the impact of genetic variants and pharmacokinetics on clinical responses to oxycodone were evaluated in Japanese populations. (2) Opioid switching improves the opioid tolerance related to the balance between analgesia and adverse effects. Some patients have difficulty in obtaining better opioid tolerance in recommended conversion ratios. The activities of CYP3A, ABCB1, and OPRM1 contribute to the interindividual variations in clinical responses to fentanyl in cancer patients. However, the variations in opioid switching remain to be clarified in clinical settings. In our study, genetic factors related to interindividual variations in clinical responses in opioid switching to fentanyl were revealed in Japanese populations. In this symposium review, the possibility of approaches to personalized palliative care using opioids based on genetic variants of CYP2D6, CYP3A5, ABCB1, and OPRM1 is discussed.

  2. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Leonice Fumiko Sato Kurebayashi

    Full Text Available RESUMEN Objectives: to evaluate the effectiveness of the auricular protocol (APPA in reducing pain and anxiety and improving the quality of life of the nursing staff of a hospital. Method: randomized clinical trial with an initial sample of 180 professionals divided into 4 groups Control (G1, Seed (G2, Needle (G3 and Tape (G4. The evaluation instruments were the State-Trait Anxiety Inventory, Pain Visual Analog Scale and Quality of Life instrument, applied at the start and after five and 10 sessions (five weeks. Descriptive statistics, analysis of variance (ANOVA and Cohen's d Index were used in the analysis. Results: there was a statistical difference (p < 0.05 for anxiety according to the repeated measures ANOVA, with better results for the G3 in the final assessment (Cohen's d index 1.08/17% reduction. There was a reduction of pain of 36% in G3 and 24% in G2 and a 13% increase in the mental aspect of quality of life for the G3, although without statistical significance. Conclusion: the APPA protocol reduced the anxiety levels of nursing staff after 10 sessions. Further studies are, however, suggested with new populations and in different contexts so that the results can be confirmed. RBR-5pc43m.

  3. The effects of acupressure on labor pains during child birth: randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Reginaldo Roque Mafetoni

    Full Text Available ABSTRACT Objective: to analyze the effects of acupressure on the sanyinjiao point for pregnant women in labor at public maternity wards. Method: single-blind controlled clinical trial, randomly done employing a pragmatic profile. We selected 156 pregnant women in their ≥ 37 week/s, who had cervical dilations of ≥ 4 cm and with two or more contractions in 10 minutes. The pregnant women were randomly divided into three groups at a university hospital in the suburbs of Sao Paulo, Brazil, in order to receive either acupressure treatment, a placebo or participate as part of a control group. The acupressure was applied on the sanyinjiao point during the contractions for 20 minutes. Then the intensity of the pain was evaluated using the Visual Analogue Scale (VAS. Results: The averages for the pain measured using the VAS were not different for the three groups that were a part of the study (p-value=0.0929, however they were less in the acupressure groups immediately after receiving the treatment (p-value=<0.0001. This was also the case where the treatment lasted for 1 hour (p-value=0.0001. This was the case in comparison with placebo and control groups. Conclusion: the use of acupressure on the sanyinjiao point is a useful way to alleviate pain in a non-invasive manner. It can improve the quality of care given to pregnant women in labor. Register: RBR-9mhs8r.

  4. Clinical effectiveness of aquatic exercise to treat chronic low back pain: a randomized controlled trial.

    Science.gov (United States)

    Dundar, Umit; Solak, Ozlem; Yigit, Ilknur; Evcik, Deniz; Kavuncu, Vural

    2009-06-15

    This study was a prospective, randomized, controlled study. To compare the effectiveness of aquatic exercise interventions with land-based exercises in the treatment of chronic low back pain (CLBP). Land-based exercise and physiotherapy are the main treatment tools used for CLBP. Clinical experience indicates that aquatic exercise may have advantages for patients with musculoskeletal disorders. A total of 65 patients with CLBP were included in this study. Patients were randomly assigned to receive aquatic exercise or land-based exercise treatment protocol. Aquatic exercise program consisted of 20 sessions, 5 x per week for 4 weeks in a swimming pool at 33 degrees C. Land-based exercise (home-based exercise) program were demonstrated by a physiotherapist on one occasion and then they were given written advice The patients were assessed for spinal mobility, pain, disability, and quality of life. Evaluations were performed before treatment (week 0) and after treatment (week 4 and week 12). In both groups, statistically significant improvements were detected in all outcome measures (except modified Schober test) compared with baseline. However, improvement in modified Oswestry Low Back Pain Disability questionnaire and physical function and role limitations due to physical functioning subpart of Short-Form 36 Health Survey were better in aquatic exercise group (P exercises produced better improvement in disability and quality of life of the patients with CLBP than land-based exercise.

  5. Ear Acupuncture Therapy for Masticatory Myofascial and Temporomandibular Pain: A Controlled Clinical Trial

    Directory of Open Access Journals (Sweden)

    Luciano Ambrosio Ferreira

    2015-01-01

    Full Text Available Ear acupuncture works by reducing painful sensations with analgesic effect through microsystem therapy and has been demonstrated to be as effective as conventional therapies in the control of facial pain. This clinical trial aimed to evaluate the adjuvant action of auricular acupuncture through an observation of the evolution of temporomandibular and masticatory myofascial symptoms in two groups defined by the therapies elected: auricular acupuncture associated with occlusal splint (study and the use of the occlusal splint plate alone (control. We have selected 20 patients, who were randomly allocated into two groups of ten individuals. Symptoms were evaluated in five different moments, every seven days. We analyzed the orofacial muscle and joint palpation in order to measure the intensity of the experienced pain. Both groups showed a statistically significant decrease in muscle and joint symptoms (p<0.05. However, comparisons between the groups showed an expressive and significant reduction of symptomatology in the study group (p<0.05 already on the first week of therapy. According to the results, to the methodological criteria developed and statistical analysis applied, the conclusion is that auricular acupuncture therapy has synergistic action on conventional occlusal splint treatment. It was demonstrated to be effective in the reduction of symptoms in the short term.

  6. The Effect of Acupressure on Sanyinjiao and Hugo Points on Labor Pain in Nulliparous Women : A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Reza Heshmat

    2013-06-01

    Full Text Available Introduction:Most women have experienced child birth and its pain, which is inevitable. If this pain is not controlled it leads to prolonged labor and injury to the mother and fetus. This study was conducted to identify the effect of acupressure on sanyinjiao and hugo points on delivery pain in nulliparous women. Methods:This was a randomized controlled clinical trial on 84 nulliparous women in hospitals of Ardebil, Iran. The participants were divided by randomized blocks of 4 and 6 into two groups. The intervention was in the form of applying pressure at sanyinjiao and hugo points based on different dilatations. The intensity of the pain before and after the intervention was recorded by visual scale of pain assessment. To determine the effect of pressure on the intensity of labor pain, analytical descriptive test was conducted in SPSS (version 13. Results:There was a significant decrease in mean intensity of pain after each intervention in the experimental group with different dilatations (4, 6, 8, and 10 cm. Moreover, the Student’s independent t-test results indicated that the mean intensity of pain in the experimental group after the intervention in all four dilatations was significantly lower than the control group. Repeated measures ANOVA test indicated that in both experimental and control groups in four time periods, there was a statistically significant difference. Conclusion:Acupressure on sanyinjiao and hugo points decreases the labor pain. Therefore, this method can be used effectively in the labor process.

  7. The Psychological Evaluation of Patients with Chronic Pain: a Review of BHI 2 Clinical and Forensic Interpretive Considerations.

    Science.gov (United States)

    Bruns, Daniel; Disorbio, John Mark

    2014-01-01

    Pain is the most common reason why patients see a physician. Within the USA, it has been estimated that at least 116 million US adults suffer from chronic pain, with an estimated annual national economic cost of $560-635 billion. While pain is in part a sensory process, like sight, touch, or smell, pain is also in part an emotional experience, like depression, anxiety, or anger. Thus, chronic pain is arguably the quintessential biopsychosocial condition. Due to the overwhelming evidence of the biopsychosocial nature of pain and the value of psychological assessments, the majority of chronic pain guidelines recommend a psychological evaluation as an integral part of the diagnostic workup. One biopsychosocial inventory designed for the assessment of patients with chronic pain is the Battery for Health Improvement 2 (BHI 2). The BHI 2 is a standardized psychometric measure, with three validity measures, 16 clinical scales, and a multidimensional assessment of pain. This article will review how the BHI 2 was developed, BHI 2 concepts, validation research, and an overview of the description and interpretation of its scales. Like all measures, the BHI 2 has strengths and weaknesses of which the forensic psychologist should be aware, and particular purposes for which it is best suited. Guided by that knowledge, the BHI 2 can play a useful role in the forensic psychologist's toolbox.

  8. The effect of acupressure on sanyinjiao and hugo points on labor pain in nulliparous women: a randomized clinical trial.

    Science.gov (United States)

    Sehhatie-Shafaie, Fahimeh; Kazemzadeh, Rafat; Amani, Firouz; Heshmat, Reza

    2013-06-01

    Most women have experienced child birth and its pain, which is inevitable. If this pain is not controlled it leads to prolonged labor and injury to the mother and fetus. This study was conducted to identify the effect of acupressure on sanyinjiao and hugo points on delivery pain in nulliparous women. This was a randomized controlled clinical trial on 84 nulliparous women in hospitals of Ardebil, Iran. The participants were divided by randomized blocks of 4 and 6 into two groups. The intervention was in the form of applying pressure at sanyinjiao and hugo points based on different dilatations. The intensity of the pain before and after the intervention was recorded by visual scale of pain assessment. To determine the effect of pressure on the intensity of labor pain, analytical descriptive test was conducted in SPSS (version 13). There was a significant decrease in mean intensity of pain after each intervention in the experimental group with different dilatations (4, 6, 8, and 10 cm). Moreover, the Student's independent t-test results indicated that the mean intensity of pain in the experimental group after the intervention in all four dilatations was significantly lower than the control group. Repeated measures ANOVA test indicated that in both experimental and control groups in four time periods, there was a statistically significant difference. Acupressure on sanyinjiao and hugo points decreases the labor pain. Therefore, this method can be used effectively in the labor process.

  9. The clinical implications of cytochrome p450 interactions with opioids and strategies for pain management.

    Science.gov (United States)

    Brennan, Michael J

    2012-12-01

    Pharmacokinetic differences among opioids influence a patient's response to opioid treatment. An important element affecting a drug's pharmacokinetics, its metabolism, may be altered under various circumstances, thereby enhancing or mitigating a patient's response to opioids. The genetic background of the metabolic enzymes involved in opioid metabolism, comorbid medical conditions, older age, and the presence of other drugs that influence metabolism are such factors that can cause the response to opioid therapy to vary greatly from the expected response to a standard dose. As a result of the variability in individual responses to opioids, clinical management of pain with opioids must be empirical. Copyright © 2012. Published by Elsevier Inc.

  10. A comparison of change in the 0-10 numeric rating scale to a pain relief scale and global medication performance scale in a short-term clinical trial of breakthrough pain intensity.

    Science.gov (United States)

    Farrar, John T; Polomano, Rosemary C; Berlin, Jesse A; Strom, Brian L

    2010-06-01

    Pain intensity is commonly reported using a 0-10 Numeric Rating Scale in pain clinical trials. Analysis of the change on the Pain Intensity Numerical Rating Scale as a proportion has most consistently correlated with clinically important differences reported on the patient's global impression of change. The correlation of data from patients with breakthrough pain with a Pain Relief Scale and a different global outcome measures will extend our understanding of these measures. Data were obtained from the open titration phase of a multiple crossover, randomized, double-blind clinical trial comparing oral transmucosal fentanyl citrate with immediate-release oral morphine sulfate for the treatment of cancer-related breakthrough pain. Raw and percentage changes in the pain intensity scores from 1,307 episodes of pain in 134 oral transmucosal fentanyl citrate-naïve patients were correlated with the clinically relevant secondary outcomes of Pain Relief Verbal Response Scale and the global medication performance scale. The changes in raw and percentage change were assessed over time and compared with the ordinal Pain Relief Verbal Response Scale and Global Medication Performance Scale. The P value of the interaction between the raw pain intensity difference was significant (P = 0.034) for four 15-min time periods but not for the percentage pain intensity difference score (P = 0.26). We found similar results in comparison with the ordinal Pain Relief Verbal Response Scale (P = 0.0048 and P = 0.36 respectively) and global medication performance categories (P = 0.048 and P = 0.45, respectively). The change in pain intensity in breakthrough pain was more consistent over time and when compared with both the Pain Relief Verbal Response Scale and the Global Medication Performance Scale when the percentage change is used rather than raw pain intensity difference.

  11. Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients With Nonspecific Neck Pain.

    Science.gov (United States)

    Bier, Jasper D; Scholten-Peeters, Wendy G M; Staal, J Bart; Pool, Jan; van Tulder, Maurits W; Beekman, Emmylou; Knoop, Jesper; Meerhoff, Guus; Verhagen, Arianne P

    2018-03-01

    The Royal Dutch Society for Physical Therapy (KNGF) issued a clinical practice guideline for physical therapists that addresses the assessment and treatment of patients with nonspecific neck pain, including cervical radiculopathy, in Dutch primary care. Recommendations were based on a review of published systematic reviews.During the intake, the patient is screened for serious pathologies and corresponding patterns. Patients with cervical radiculopathy can be included or excluded through corresponding signs and symptoms and possibly diagnostic tests (Spurling test, traction/distraction test, and Upper Limb Tension Test). History taking is done to gather information about patients' limitations, course of pain, and prognostic factors (eg, coping style) and answers to health-related questions.In case of a normal recovery (treatment profile A), management should be hands-off, and patients should receive advice from the physical therapist and possibly some simple exercises to supplement "acting as usual."In case of a delayed/deviant recovery (treatment profile B), the physical therapist is advised to use, in addition to the recommendations for treatment profile A, forms of mobilization and/or manipulation in combination with exercise therapy. Other interventions may also be considered. The physical therapist is advised not to use dry needling, low-level laser, electrotherapy, ultrasound, traction, and/or a cervical collar.In case of a delayed/deviant recovery with clear and/or dominant psychosocial prognostic factors (treatment profile C), these factors should first be addressed by the physical therapist, when possible, or the patient should be referred to a specialist, when necessary.In case of neck pain grade III (treatment profile D), the therapy resembles that for profile B, but the use of a cervical collar for pain reduction may be considered. The advice is to use it sparingly: only for a short period per day and only for a few weeks.

  12. Chronic shoulder pain of myofascial origin: a randomized clinical trial using ischemic compression therapy.

    Science.gov (United States)

    Hains, Guy; Descarreaux, Martin; Hains, François

    2010-06-01

    The aim of this clinical trial was to evaluate the effect of 15 myofascial therapy treatments using ischemic compression on shoulder trigger points in patients with chronic shoulder pain. Forty-one patients received 15 experimental treatments, which consisted of ischemic compressions on trigger points located in the supraspinatus muscle, the infraspinatus muscle, the deltoid muscle, and the biceps tendon. Eighteen patients received the control treatment involving 15 ischemic compression treatments of trigger points located in cervical and upper thoracic areas. Of the 18 patients forming the control group, 16 went on to receive 15 experimental treatments after having received their initial control treatments. Outcome measures included a validated 13-question questionnaire measuring shoulder pain and functional impairment. A second questionnaire was used to assess patients' perceived amelioration, using a scale from 0% to 100%. Outcome measure evaluation was completed for both groups at baseline after 15 treatments, 30 days after the last treatment, and finally for the experimental group only, 6 months later. A significant group x time interval interaction was observed after the first 15 treatments, indicating that the experimental group had a significant reduction in their Shoulder Pain and Disability Index (SPADI) score compared with the control group (62% vs 18% amelioration). Moreover, the patients perceived percentages of amelioration were higher in the experimental group after 15 treatments (75% vs 29%). Finally, the control group subjects significantly reduced their SPADI scores after crossover (55%). The results of this study suggest that myofascial therapy using ischemic compression on shoulder trigger points may reduce the symptoms of patients experiencing chronic shoulder pain. Copyright (c) 2010 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

  13. The effect of Tc99m Sestamibi scans during acute chest pain on clinical management

    Energy Technology Data Exchange (ETDEWEB)

    Baldey, A.; Cameron, P.; Grigg, L.; Knott, J.; Better, N. [The Royal Melbourne Hospital, Parkville, VIC (Australia). Departments of Nuclear Medicine and Cardiology

    1998-06-01

    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

  14. Testicle Pain

    Science.gov (United States)

    ... Scrotal pain. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2016. Jan. 11, 2018 Original article: http://www.mayoclinic.org/symptoms/testicle-pain/basics/definition/SYM-20050942 . Mayo Clinic Footer Legal Conditions and ...

  15. Capsaicin 8% patch treatment for amputation stump and phantom limb pain: a clinical and functional MRI study

    Directory of Open Access Journals (Sweden)

    Privitera R

    2017-07-01

    Full Text Available Rosario Privitera,1 Rolfe Birch,1 Marco Sinisi,2 Iordan R Mihaylov,3 Robert Leech,4 Praveen Anand1 1Peripheral Neuropathy Unit, Centre for Clinical Translation, Hammersmith Hospital, Imperial College London, London, UK; 2Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK; 3Department of Pain Medicine, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK; 4Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital Campus, London, UK Purpose: The aim of this study was to measure the efficacy of a single 60 min application of capsaicin 8% patch in reducing chronic amputation stump and phantom limb pain, associated hypersensitivity with quantitative sensory testing, and changes in brain cortical maps using functional MRI (fMRI scans. Methods: A capsaicin 8% patch (Qutenza treatment study was conducted on 14 patients with single limb amputation, who reported pain intensity on the Numerical Pain Rating Scale ≥4/10 for chronic stump or phantom limb pain. Pain assessments, quantitative sensory testing, and fMRI (for the lip pursing task were performed at baseline and 4 weeks after application of capsaicin 8% patch to the amputation stump. The shift into the hand representation area of the cerebral cortex with the lip pursing task has been correlated with phantom limb pain intensity in previous studies, and was the fMRI clinical model for cortical plasticity used in this study. Results: The mean reduction in spontaneous amputation stump pain, phantom limb pain, and evoked stump pain were −1.007 (p=0.028, −1.414 (p=0.018, and −2.029 (p=0.007, respectively. The areas of brush allodynia and pinprick hypersensitivity in the amputation stump showed marked decreases: −165 cm2, −80% (p=0.001 and −132 cm2, −72% (p=0.001, respectively. fMRI analyses provided objective evidence of the restoration of the brain map, that is

  16. The costs and benefits of extending the role of the acute pain service on clinical outcomes after major elective surgery.

    Science.gov (United States)

    Lee, Anna; Chan, Simon K C; Chen, Phoon Ping; Gin, Tony; Lau, Angel S C; Chiu, Chun Hung

    2010-10-01

    Acute pain services have received widespread acceptance and formal support from institutions and organizations, but available evidence on their costs and benefits is scarce. Although there is good agreement on the provision of acute pain services after many major surgical procedures, there are other procedures for which the benefits are unclear. Data are required to justify any expansion of acute pain services. In this randomized, controlled clinical trial we compared the costs and effects of acute pain service care on clinical outcomes with conventional pain management on the ward. Patients included in the trial were considered by their anesthesiologist to have either arm be suitable for the procedure. Four hundred twenty-three patients undergoing major elective surgery were randomized either to an anesthesiologist-led, nurse-based acute pain service group with patient-controlled analgesia or to a control group with IM or IV boluses of opioid analgesia. Both groups were treated with medications to treat opioid-related adverse effects and received the usual care from health professionals assigned to the ward. The main outcome measures were quality of recovery scores, pain intensity measures, global measure of treatment effectiveness, and overall pain treatment cost. Cost-effectiveness acceptability curves were drawn to detect a difference in the joint cost-effect relationship between groups. There was no difference in quality of recovery score on postoperative day 1 between treatment and control groups (mean difference, 0; 95% confidence interval [CI], -0.7 to 0.7; P = 0.94) or in the rate of improvement in quality of recovery score (mean difference, -0.1; 95% CI, -0.4 to 0.1; P = 0.34). The proportion of patients with 1 or more days of highly effective pain management was higher in the acute pain service group than in the control group (86% vs. 75%; P < 0.01). Costs were higher in the acute pain service group (mean difference, US$46; 95% CI, $44 to $48 per patient

  17. Moving towards multiple site outcomes in spinal cord injury pain clinical trials: An issue of clustered observations in trial design and analysis.

    Science.gov (United States)

    Richardson, Elizabeth; Redden, David T

    2014-05-01

    Pain remains a problem for many with spinal cord injury (SCI), and there is a need for sound, randomized clinical trials examining the efficacy of existing and novel therapeutics. SCI-related pain is complex, as more than one type of pain is often experienced. The purpose of this report is to (i) demonstrate how to design and power calculation of a clinical trial of SCI pain using multiple pain sites per individual; (ii) discuss consequences of failing to adjust for this; and (iii) provide intraclass correlation (ICC) estimates for common pain outcome measures that may be used to power future clinical trials in SCI pain. Using an existing dataset from a past SCI pain clinical trial, the ICC was calculated for common pain outcome measures to illustrate appropriate corrections for powering, analyzing and interpreting results from multiple pain sites per individual. The problem associated with not accounting for multiple pain sites per individual and the effect on the Type I error rate is also shown. Not accounting for the ICC can lead to (1) incorrect power estimates in the design of a trial, and (2) an inflated Type I error rate with a higher likelihood of misinterpretation of outcomes. Powering for future SCI pain trials and statistical analysis of trial outcomes may be substantially compromised if methods do not account for the intra-individual associations between pain sites, ultimately affecting study interpretations and evidence-based practice. We present ICC estimates based on SCI pain data for purposes of estimating power for future trials.

  18. The Effect of Topical Rosa damascena (Rose) Oil on Pregnancy-Related Low Back Pain: A Randomized Controlled Clinical Trial.

    Science.gov (United States)

    Shirazi, Mahbobeh; Mohebitabar, Safieh; Bioos, Sodabeh; Yekaninejad, Mir Saeed; Rahimi, Roja; Shahpiri, Zahra; Malekshahi, Farhad; Nejatbakhsh, Fatemeh

    2017-01-01

    The study aimed to assess the efficacy of topical rose oil in women with pregnancy-related low back pain. A randomized controlled clinical trial was conducted on 120 women with pregnancy-related low back pain. Patients were allocated to 3 parallel groups to receive topical rose oil (in the carrier of almond oil), placebo (carrier oil), or no intervention. All groups were followed for 4 weeks. All participants were evaluated by Visual Analog Scale and the Roland-Morris Disability Questionnaires to assess the pain intensity and its impact on daily activities before and after the intervention. Significant decrease in pain intensity compared to carrier oil or no intervention was observed. The rose oil also improves the functional ability of these patients in contrast with no intervention, while its effect on function is not significant compared to carrier oil. Rose oil reduced pregnancy-related low back pain intensity without any significant adverse effect. © The Author(s) 2016.

  19. Integrative treatment approaches: family satisfaction with a multidisciplinary paediatric Abdominal Pain Clinic

    Directory of Open Access Journals (Sweden)

    Jennifer Verrill Schurman

    2010-08-01

    Full Text Available Objectives: To assess patient and family satisfaction with evaluation received through a multidisciplinary paediatric Abdominal Pain Clinic (APC staffed by a paediatric gastroenterologist and a paediatric psychologist as compared to a traditional gastroenterology clinic (GI staffed by a paediatric gastroenterologist only. Methods: Two hundred and ninety-eight families (145 APC, 153 GI with a child or adolescent aged 8-17 years seen for initial evaluation of a chronic abdominal pain completed an anonymous survey to assess understanding of the treatment recommendations made, intent to follow through with various treatment recommendations, and the overall level of satisfaction with the evaluation service provided. Family perceptions of strengths and challenges of the APC evaluation process also were explored. Results: APC families reported being prescribed adjunctive mental health and other therapies at significantly higher rates than GI families, while the rates of medication were comparable. APC families also reported significantly greater receptivity to beginning the treatments prescribed and higher levels of overall satisfaction with the evaluation process. The contribution of integrated medical and psychological perspectives frequently was identified as a strength of the APC evaluation process. Challenges identified for the APC evaluation were few and focused on issues related to paperwork and scheduling issues. Conclusions: Integrative care approaches to the evaluation of paediatric abdominal pain appear well accepted by families, yielding high levels of satisfaction, and enhance receptivity to treatment recommendations. Integrative care starting at the time of first evaluation may be particularly well-tailored to enhance outcomes, reduce health care utilization, and yield financial savings within this population.

  20. Integrative treatment approaches: family satisfaction with a multidisciplinary paediatric Abdominal Pain Clinic

    Directory of Open Access Journals (Sweden)

    Jennifer Verrill Schurman

    2010-08-01

    Full Text Available Objectives: To assess patient and family satisfaction with evaluation received through a multidisciplinary paediatric Abdominal Pain Clinic (APC staffed by a paediatric gastroenterologist and a paediatric psychologist as compared to a traditional gastroenterology clinic (GI staffed by a paediatric gastroenterologist only.Methods: Two hundred and ninety-eight families (145 APC, 153 GI with a child or adolescent aged 8-17 years seen for initial evaluation of a chronic abdominal pain completed an anonymous survey to assess understanding of the treatment recommendations made, intent to follow through with various treatment recommendations, and the overall level of satisfaction with the evaluation service provided. Family perceptions of strengths and challenges of the APC evaluation process also were explored.Results: APC families reported being prescribed adjunctive mental health and other therapies at significantly higher rates than GI families, while the rates of medication were comparable. APC families also reported significantly greater receptivity to beginning the treatments prescribed and higher levels of overall satisfaction with the evaluation process. The contribution of integrated medical and psychological perspectives frequently was identified as a strength of the APC evaluation process. Challenges identified for the APC evaluation were few and focused on issues related to paperwork and scheduling issues.Conclusions: Integrative care approaches to the evaluation of paediatric abdominal pain appear well accepted by families, yielding high levels of satisfaction, and enhance receptivity to treatment recommendations. Integrative care starting at the time of first evaluation may be particularly well-tailored to enhance outcomes, reduce health care utilization, and yield financial savings within this population.

  1. Pubic apophysitis: a previously undescribed clinical entity of groin pain in athletes.

    Science.gov (United States)

    Sailly, Matthieu; Whiteley, Rod; Read, John W; Giuffre, Bruno; Johnson, Amanda; Hölmich, Per

    2015-06-01

    Sport-related pubalgia is often a diagnostic challenge in elite athletes. While scientific attention has focused on adults, there is little data on adolescents. Cadaveric and imaging studies identify a secondary ossification centre located along the anteromedial corner of pubis beneath the insertions of symphysial joint capsule and adductor longus tendon. Little is known about this apophysis and its response to chronic stress. We report pubic apophysitis as a clinically relevant entity in adolescent athletes. The clinical and imaging findings in 26 highly trained adolescent football players (15.6 years ± 1.3) who complained of adductor-related groin pain were reviewed. The imaging features (X-ray 26/26, US 9/26, MRI 11/26, CT 7/26) of the pubic apophyses in this symptomatic group were compared against those of a comparison group of 31 male patients (age range 9-30 years) with no known history of groin pain or pelvic trauma, who underwent pelvic CT scans for unrelated medical reasons. All symptomatic subjects presented with similar history and physical findings. The CT scans of these patients demonstrated open pubic apophyses with stress-related physeal changes (widening, asymmetry and small rounded cyst-like expansions) that were not observed in the comparison group. No comparison subject demonstrated apophyseal maturity before 21 years of age, and immaturity was seen up to the age of 26 years. This retrospective case series identifies pubic apophyseal stress (or 'apophysitis') as an important differential consideration in the adolescent athlete who presents with groin pain. 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.

  2. [Cancer pain management: Systematic review and critical appraisal of clinical practice guidelines].

    Science.gov (United States)

    Martínez-Nicolás, I; Ángel-García, D; Saturno, P J; López-Soriano, F

    2016-01-01

    Although several clinical practice guidelines have been developed in the last decades, cancer pain management is still deficient. The purpose of this work was to carry out a comprehensive and systematic literature review of current clinical practice guidelines on cancer pain management, and critically appraise their methodology and content in order to evaluate their quality and validity to cope with this public health issue. A systematic review was performed in the main databases, using English, French and Spanish as languages, from 2008 to 2013. Reporting and methodological quality was rated with the Appraisal of Guidelines, Research and Evaluation II (AGREE-II) tool, including an inter-rater reliability analysis. Guideline recommendations were extracted and classified into several categories and levels of evidence, aiming to analyse guidelines variability and evidence-based content comprehensiveness. Six guidelines were included. A wide variability was found in both reporting and methodological quality of guidelines, as well as in the content and the level of evidence of their recommendations. The Scottish Intercollegiate Guidelines Network guideline was the best rated using AGREE-II, while the Sociedad Española de Oncología Médica guideline was the worst rated. The Ministry of Health Malaysia guideline was the most comprehensive, and the Scottish Intercollegiate Guidelines Network guideline was the second one. The current guidelines on cancer pain management have limited quality and content. We recommend Ministry of Health Malaysia and Scottish Intercollegiate Guidelines Network guidelines, whilst Sociedad Española de Oncología Médica guideline still needs to improve. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

  3. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... Covington, MD, director of the Cleveland Clinic Pain Management Program, explains some of the physiology of pain. Narrator: Most pain is temporary and manageable, but chronic pain is different. And because it is different, we need to ...

  4. Aquatic therapy improves pain, disability, quality of life, body composition and fitness in sedentary adults with chronic low back pain. A controlled clinical trial.

    Science.gov (United States)

    Baena-Beato, Pedro Ángel; Artero, Enrique G; Arroyo-Morales, Manuel; Robles-Fuentes, Alejandro; Gatto-Cardia, María Claudia; Delgado-Fernández, Manuel

    2014-04-01

    To determine the effects of a two-month intensive aquatic therapy programme on back pain, disability, quality of life, body composition and health-related fitness in sedentary adults with chronic low back pain. Controlled clinical trial. Community. Forty-nine sedentary patients with chronic low back pain. Patients were allocated into active group (n = 24, two months, five times/week) or waiting list, control group (n = 25) according to space on the programme. Outcomes variables were pain (visual analogue scale), disability (Oswestry Disability Index), quality of life (Quality Short-Form Health Survey 36), body composition (weight, body mass index, body fat percentage and skeletal muscle mass) and health-related fitness (sit-and-reach, handgrip strength, curl-up, Rockport 1-mile test). The active group significantly improved low back pain (-3.83 ± 0.35 mm on the visual analogue scale ), disability (-12.7 ± 1.3 points for the Oswestry Disability Index) and the standardized physical component (10.3 ± 1.4 points for the Quality Short-Form Health Survey 36) of quality-of-life domains (P < 0.001), with no significant changes on the standardized mental component (P = 0.114). In relation to body composition and fitness, the active group showed significant improvements (all P-values < 0.01). The control group presented no significant change in any parameter. A two-month intensive aquatic therapy programme of high-frequency (five times/week) decreases levels of back pain and disability, increases quality of life, and improves body composition and health-related fitness in sedentary adults with chronic low back pain.

  5. A Comparison of Change in the 0–10 Numeric Rating Scale to a Pain Relief Scale and Global Medication Performance Scale in a Short-term Clinical Trial of Breakthrough Pain Intensity

    Science.gov (United States)

    Farrar, John T.; Polomano, Rosemary C.; Berlin, Jesse A.; Strom, Brian L.

    2010-01-01

    Background Pain intensity is commonly reported using a 0–10 numeric rating scale in breakthrough pain clinical trials. Analysis of the change on the Pain Intensity Numerical Rating Scale as a proportion as most consistently correlated with clinically important differences reported on the Patient Global Impression of Change. The analysis of data using a different global outcome measures and the pain relief scale will extend our understanding of these measures. Use of the pain relief scale is also explored in this study Methods Data came from the open titration phase of a multiple crossover, randomized, double-blind clinical trial comparing oral transmucosal fentanyl citrate to immediate-release oral morphine sulfate for treatment of cancer-related breakthrough pain. Raw and percent changes in the pain intensity scores on 1,307 from 134 oral transmucosal fentanyl citrate-naive patients were compared to the clinically relevant secondary outcomes of the pain relief verbal response scale and the global medication performance. The changes in raw and percent change were assessed over time and compared to the ordinal pain relief verbal response scale and global medication performance scales. Results The p-value of the interaction between the raw pain intensity difference was significant but not for the percent pain intensity difference score over 4 15 minute time periods (p = 0.034 and p = 0.26 respectively), in comparison with the ordinal pain relief verbal response scale (p = 0.0048 and p = 0.36 respectively), and global medication performance categories (p = 0.048 and p = 0.45 respectively). Conclusion The change in pain intensity in breakthrough pain was more consistent over time and when compared to both the pain relief verbal response scale and global medication performance scale when the percent change is used rather than raw pain intensity difference. PMID:20463579

  6. [Exercise program for chronic low back pain based on common clinical characteristics of patients].

    Science.gov (United States)

    Grgić, Vjekoslav

    2014-01-01

    1. To determine which clinical characteristics are common in patients with chronic low back pain (CLBP) and 2. To present an exercise program for CLBP composed on the basis of the common clinical characteristics of patients. In the prospective study, we have included 420 patients with nonspecific CLBP (group A), 420 patients with CLBP (with or without radicular pain) and degenerative changes of lumbosacral (LS) spine (group B) and 80 patients with CLBP after a lumbar disc herniation surgery (group C). The clinical characteristics of patients and especially the characteristics of the most important parameters for the selection of exercises have been evaluated by means of physiatric and manual functional examination. The vast majority of patients had these common clinical characteristics: 1. hypertonic/shortened lumbar extensors (A: 89,5%, B: 92%, C: 92,5%), 2. hypertonic/shortened psoas muscles (A: 83%, B: 90,5%, C: 92,5%), 3. restricted active (A: 71,4%, B: 89%, C: 94%) and passive (segmental) mobility (A: 86,4%, B: 92%, C: 95%) of LS spine, 4. painful active movements of LS spine (A: 44%, B: 88,6%, C: 95%), 5. scoliotic posture (more rarely scoliosis) usually in a combination with reduced/flattened lumbar lordosis (A: 87%, B: 89%, C: 90%), 6. hypotonic/ weak gluteal (A: 51,2%, B: 68%, C: 82,5%) and abdominal muscles (A: 33,8%, B: 56,5%, C: 60%) and 7. shortened hamstrings (A: 70,7%; hamstrings flexibility testing in patients from groups B and C is unreliable because of a frequently positive Lasegue's sign). In 6,7% of examinees from the group A, 4,8% examinees from the group B and 2,5% examinees from the group C, we have found LS spine hypermobility. Our exercise program for CLBP composed on the basis of the common clinical characteristics of the patients includes: 1. Stretching exercises for lumbar extensors, 2. Stretching exercises for psoas muscles, 3. Stretching exercises for hamstrings, 4. Strengthening exercises for abdominal muscles, 5. Strengthening

  7. Radiating low back pain in general practice: Incidence, prevalence, diagnosis, and long-term clinical course of illness

    Science.gov (United States)

    Groenhof, Feikje; Winters, Jan C.; van Wijhe, Marten; Groenier, Klaas H.; van der Meer, Klaas

    2015-01-01

    Abstract Objective. The aim of this study was to calculate the incidence and prevalence of radiating low back pain, to explore the long-term clinical course of radiating low back pain including the influence of radiculopathy (in a subsample of the study population) and non-radiating low back pain thereon, and to describe general practitioners’ (GPs’) treatment strategies for radiating low back pain. Design. A historic prospective cohort study. Setting. Dutch general practice. Subjects. Patients over 18 years of age with a first episode of radiating low back pain, registered by the ICPC code L86. Main outcome measures. Incidence and prevalence, clinical course of illness, initial diagnoses established by the GPs, and treatment strategies. Results. Mean incidence was 9.4 and mean prevalence was 17.2 per 1000 person years. In total, 390 patients had 1193 contacts with their GPs; 50% had only one contact with their GP. Consultation rates were higher in patients with a history of non-radiating low back pain and in patients with a diagnosis of radiculopathy in the first five years. In this study's subsample of 103 patients, L86 episodes represented radiculopathy in 50% of cases. Medication was prescribed to 64% of patients, mostly NSAIDs. Some 53% of patients were referred, mainly to physiotherapists and neurologists; 9% of patients underwent surgery. Conclusion. Watchful waiting seems to be sufficient general practice care in most cases of radiating low back pain. Further research should be focused on clarifying the relationship between radicular radiating low back pain, non-radicular radiating low back pain, and non-radiating low back pain. PMID:25693788

  8. Transversus Abdominis Plane Block in the Management of Acute Postoperative Pain Syndrome after Caesarean Section: A Randomized Controlled Clinical Trial.

    Science.gov (United States)

    Fusco, Pierfrancesco; Cofini, Vincenza; Petrucci, Emiliano; Scimia, Paolo; Pozone, Tullio; Paladini, Giuseppe; Carta, Gaspare; Necozione, Stefano; Borghi, Battista; Marinangeli, Franco

    2016-01-01

    The international literature is unclear regarding the analgesic efficacy of the transversus abdominis plane block (TAPB) after a Caesarean section (CS). The aim of this study was to determine whether a correctly performed ultrasound-guided TAPB (USG-TAPB) could provide better control of acute postoperative pain during the first 72 hours after CS and if it could provide a faster postoperative recovery. A double-blind, randomized, controlled clinical trial on pregnant women who underwent CS. Pain clinic and Anesthesia and Intensive Care Unit in an academic hospital. A double-blind, randomized, controlled study was conducted with 96 patients who underwent CS. The patients in both groups received subarachnoid anesthesia (SAB) with 13 mg of 0.5% isobaric levobupivacaine. The patients were randomized so that some received USG-TAPB with local anesthetic, and the remainder received USG-TAPB with saline. The patients' demographic information and data regarding anesthesia, hemodynamic changes, side effects, acute rest and incident postoperative pain, painkiller consumption, recovery time of bowel function, and the time of hospital discharge were recorded. Our data reinforce the assumption that if TAP block is performed correctly and is part of a multimodal analgesic scheme, effective pain control is possible both for somatic and visceral acute pain. Furthermore, the need for painkillers is reduced, and their related side effects are moderate, yielding a positive benefit/cost ratio. USG-TAPB provides good analgesia for acute postoperative somatic pain, but opiates were still needed for the management of visceral acute postoperative pain. These results could confirm the assumption that the correct performance of an USG-TAPB as part of a multimodal analgesic treatment could represent a viable alternative to common analgesic procedures performed for acute postoperative pain control after a CS.Key words: Bowel function, Caesarian section, incident pain, local anesthetics

  9. The effect of Kinesio taping application for acute non-specific low back pain: a randomized controlled clinical trial.

    Science.gov (United States)

    Kelle, Bayram; Güzel, Rengin; Sakallı, Hakan

    2016-10-01

    To investigate the effect of Kinesio taping application in acute non-specific low back pain. A randomized controlled clinical trial. Physical Medicine and Rehabilitation Clinic. A total of 109 patients with acute low back pain were randomized into either Kinesio taping (n = 54) or control (n = 55) groups. The intervention group was treated with information and reassurance plus Kinesio taping, while the control group received merely information and reassurance. All participants were allowed to use as-needed doses of paracetamol. Kinesio tape was applied to the most painful area of the low back for a total of 12 days. Worst pain and disability were assessed at baseline, after the 12-day intervention, and at four weeks follow-up. During the first 12 days, participants filled in a pain diary consisting of a n