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Sample records for pain patient successfully

  1. Abnormalities of somatosensory perception in patients with painful osteoarthritis normalize following successful treatment.

    Science.gov (United States)

    Kosek, E; Ordeberg, G

    2000-01-01

    To investigate the effect of chronic nociceptive pain on somatosensory perception, quantitative sensibility testing was performed in the most painful area and the homologous contralateral side in 14 patients with painful osteoarthritis of the hip. Twelve patients were reassessed in a painfree state 6-14 months following surgery. Von Frey filaments were used to test low-threshold mechanoreceptive function. Pressure pain sensitivity was assessed with a pressure algometer and thermal sensitivity with a Thermotest. Sex- and age-matched controls were examined in the corresponding areas at similar time intervals. There was no statistically significant difference between groups in the sensitivity to light touch and innocuous cold in either session. Compared to controls, patients had increased sensitivity to pressure pain in the most painful area (p pain (ppain (p = 0.054) before surgery. In the painful area, patients' sensitivity to pressure pain decreased (p pain. Copyright 2000 European Federation of Chapters of the International Association for the Study of Pain.

  2. Successful management of a difficult cancer pain patient by appropriate adjuvant and morphine titration

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    Shiv PS Rana

    2011-01-01

    Full Text Available Morphine has been used for many years to relieve cancer pain. Oral morphine (in either immediate release or modified release form remains the analgesic of choice for moderate or severe cancer pain. The dose of oral morphine is titrated up to achieve adequate relief from pain with minimal side effects. Antidepressant and anticonvulsant drugs, when used in addition to conventional analgesics, give excellent relief from cancer pain. Most cancer pain responds to pharmacological measures with oral morphine but some pain like neuropathic and bony pain, pain in children and elderly age group, and advanced malignancy pain are very difficult to treat. Here, we report the management of a similar patient of severe cancer pain and the difficulty that we came across during dose titration of oral morphine and adjuvant analgesic.

  3. Strontium-89 therapy and subarachnoid phenol block successfully eliminated intractable pain of metastasis in the patient with advanced urachal carcinoma

    International Nuclear Information System (INIS)

    Arakawa, Yasuhiro; Inoue, Daisuke; Sakuyama, Toshikazu; Nagasaki, Eijiro; Aiba, Keisuke

    2011-01-01

    We report a case of a 39-year-old man with intractable multifocal pain caused by metastatic urachal carcinoma to the bone. The patient underwent a partial cystectomy in May 2008, and lung metastasis occurred 9 months after the surgery. He then received salvage chemotherapy, but developed metastasis to the liver, brain, and bone. He was hospitalized due to a shoulder pain, a lower back pain, buttocks pain, numbness in both legs, and drop foot in right leg. MRI revealed metastases to the spine, and lumbar spinal canal stenosis with cauda equina compression. Even a combination of fentanyl-patch, oral acetaminophen, gabapentin and paroxetine was not effective for pain control. Strontium-89 therapy and subarachnoid phenol block successfully eliminated intractable pain. The patient could be discharged from hospital and received a palliative care at home for a short period of time. (author)

  4. Success or failure of chronic pain rehabilitation: the importance of good interaction - a qualitative study under patients and professionals.

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    Oosterhof, B; Dekker, J H M; Sloots, M; Bartels, E A C; Dekker, J

    2014-01-01

    The aim of this study was to explore which factors are associated with a successful treatment outcome in chronic pain patients and professionals participating in a multidisciplinary rehabilitation program, with a specific focus on the patient-professional interaction. Patients (n = 16) and professionals (n = 10) were interviewed and/or observed. The transcribed interviews and observations were analyzed and themes were described. Patients with a positive treatment outcome came to a shared understanding of their pain with their professional, demonstrated new learned behavior and were able to continue their learning process at home. Patients with a negative treatment outcome did not reach a shared understanding of their pain with their professional, were not able to change their behavior and wanted more help to achieve this. Both patient groups experienced organizational barriers within the treatment process. Factors associated with a high quality of patient-professional interaction included the patient experience of being taken seriously, the involvement of the professional with the patient, a clear explanation of the pain, and an open interaction between patient and professional. This study provides insight into factors which were related to a positively or negatively experienced outcome of pain rehabilitation. A good match within the patient-professional interaction seems essential. IMPLICATIONS OF REHABILITATION: Within chronic pain rehabilitation good didactic skills and a client-centered attitude of the professional may be helpful in order to make the patient feel being taken seriously. An assessment of the patient's learning style might lead to a better fit of the patient education and training according to an individual's learning style. Relapse might be prevented by paying special attention to the integration of new behavior within important life areas as work and sports.

  5. The changes of regional cerebral blood flow: successful pain relief of intractable CRPS type II patients by motor cortex stimulation

    International Nuclear Information System (INIS)

    Jung, J. A.; Son, H. S.; Kim, S. H.; Jung, S. G

    2004-01-01

    Authors report the effectiveness of MCS in extraordinarily extended pain due to intractable CRPS type II and rCBF study result for mechanism of pain control by MCS. A 43-year-old male presented severe spontaneous burning pain in his left hand and forearm and allodynia over the left arm and left hemibody. Authors planned MCS as a neuromodulation therapy for this intractable peripheral neuropathic pain patient because further neurodestructive procedure did not work anymore and have a potential risk of further aggrevation of neuopathic pain. We performed baseline and stimulation brain perfusion SPECT using 20 mCi of Tc-99m ECD. The baseline CBD studies were done with stimulator 'off' state and stimulation studies were done after stimulator 'on' with satisfactory pain relief. For the stimulation study, the radioisotope was injected immediately after pain-relief and the images were taken about 50 minutes after injection of radioisotope. In resting rCBF in the patient was compared with normal control datas, we found significant increase in rCBF in the bilateral prefrontal cortex, right dorsolateral prefrontal cortex, right superior temporal gyrus, left temporooccipital area. When rCBF datas obtained after alleviation of pain with stimulator 'on' . there were significant increase in rCBF in bilateral prefrontal cortex and left temporoocipital area. After subtraction of ECD SPECT, we found significant increase in rCBF in the right premotor and supplementary motor cortex left sensorimotor cortex, right cingulated cortex, right posterior insular cortex, right anterior limb of internal capsule. left orbitofrontal cortex and right pyramidal tract in cerebral peduncle. Authors report exellent pain control by MCS in a case of severe CRPS type II with hemibody involvement and regional cerebral blood flow changes according to successful pain control

  6. The changes of regional cerebral blood flow: successful pain relief of intractable CRPS type II patients by motor cortex stimulation

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    Jung, J. A.; Son, H. S.; Kim, S. H.; Jung, S. G [The Catholic University of Korea, Seoul (Korea, Republic of)

    2004-07-01

    Authors report the effectiveness of MCS in extraordinarily extended pain due to intractable CRPS type II and rCBF study result for mechanism of pain control by MCS. A 43-year-old male presented severe spontaneous burning pain in his left hand and forearm and allodynia over the left arm and left hemibody. Authors planned MCS as a neuromodulation therapy for this intractable peripheral neuropathic pain patient because further neurodestructive procedure did not work anymore and have a potential risk of further aggrevation of neuopathic pain. We performed baseline and stimulation brain perfusion SPECT using 20 mCi of Tc-99m ECD. The baseline CBD studies were done with stimulator 'off' state and stimulation studies were done after stimulator 'on' with satisfactory pain relief. For the stimulation study, the radioisotope was injected immediately after pain-relief and the images were taken about 50 minutes after injection of radioisotope. In resting rCBF in the patient was compared with normal control datas, we found significant increase in rCBF in the bilateral prefrontal cortex, right dorsolateral prefrontal cortex, right superior temporal gyrus, left temporooccipital area. When rCBF datas obtained after alleviation of pain with stimulator 'on' . there were significant increase in rCBF in bilateral prefrontal cortex and left temporoocipital area. After subtraction of ECD SPECT, we found significant increase in rCBF in the right premotor and supplementary motor cortex left sensorimotor cortex, right cingulated cortex, right posterior insular cortex, right anterior limb of internal capsule. left orbitofrontal cortex and right pyramidal tract in cerebral peduncle. Authors report exellent pain control by MCS in a case of severe CRPS type II with hemibody involvement and regional cerebral blood flow changes according to successful pain control.

  7. Elderly patient refractory to multiple pain medications successfully treated with integrative East–West medicine

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    Bill Tu

    2008-07-01

    Full Text Available Bill Tu, Michael Johnston, Ka-Kit HuiUCLA Center for East–West Medicine, Department of Internal Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USABackground: Polypharmacy is a common and serious problem in the elderly today. Few solutions have been effective in reducing its incidence.Case summary: An 87-year-old female with a history of osteoarthritis and spinal stenosis presented with a five month history of severe right hip pain. She had been seen by multiple specialists and hospitalized many times. During these encounters, she was prescribed a long list of pain medications. However, these medications did not improve her pain and added to her risk of adverse drug events. After exhausting traditional Western medical therapies, she received a referral to the UCLA Center for East–West Medicine. There, clinicians treated her with a nonpharmacological integrative East-West medicine approach that included acupuncture, dry needling of trigger points, and education on self-acupressure. Her pain began improving and she was able to cut back on analgesic use under physician supervision. Ultimately, she improved to the point where she was able to discontinue all of her pain medications. Symptomatic relief was evidenced by improvement in health-related quality of life (HRQOL.Conclusions: This case study suggests that integrative East–West medicine may have the potential to reduce the incidence of polypharmacy in elderly patients presenting with pain conditions and improve their quality of life.Keywords: polypharmacy, pain, osteoarthritis, acupuncture, complementary and alternative medicine, integrative medicine, adverse drug reaction, elderly

  8. Predictive value of lidocaine for treatment success of oxcarbazepine in patients with neuropathic pain syndrome.

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    Schipper, Sivan; Gantenbein, Andreas R; Maurer, Konrad; Alon, Eli; Sándor, Peter S

    2013-06-01

    Pharmacotherapy in patients with neuropathic pain syndromes (NPS) can be associated with long periods of trial and error before reaching satisfactory analgesia. The aim of this study was to investigate whether a short intravenous (i.v.) infusion of lidocaine may have a predictive value for the efficacy of oxcarbazepine. In total, 16 consecutive patients with NPS were studied in a prospective, uncontrolled, open-label study design. Each patient received i.v. lidocaine (5 mg/kg) within 30 min followed by a long-term oral oxcarbazepine treatment (900-1,500 mg/day). During an observation period of 28 days, treatment response was documented by a questionnaire including the average daily pain score documented on a numeric rating scale (NRS). A total of 6 out of 16 patients (38%) were lidocaine responders (defined as pain reduction >50% during the infusion), and 4 of 16 (25%) were oxcarbazepine responders. In total, 6 out of 16 participants (38%) discontinued oxcarbazepine treatment due to side effects. In an interim analysis predictive value of the lidocaine infusion was low with a Kendall's tau correlation coefficient of 0.29 and coefficient of determination R(2) of 0.119 (95% confidence interval -0.29 to 0.72). As a consequence of this low correlation, the study was discontinued for ethical reasons. In conclusion, lidocaine infusion has a low predictive value for effectiveness of oxcarbazepine-if at all.

  9. Cut-Off Value for Pain Sensitivity Questionnaire in Predicting Surgical Success in Patients with Lumbar Disc Herniation.

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    Parisa Azimi

    Full Text Available Various factors related to predict surgical success were studied; however, a standard cut-off point for the Pain Sensitivity Questionnaire (PSQ measure has not yet been established for a favorable surgical outcome for lumbar disc herniation (LDH. This study was to find the optimal cut-off point on the PSQ to distinguish surgical success in patients with LDH. A total of 154 patients with LDH consecutively referred to our clinic were enrolled into this prospective study between February 2011 and January 2014. All participants completed the PSQ. Patients completed the Oswestry Disability Index (ODI score before surgery, and at 2 years after surgery. Surgical success was defined as a 13-point improvement from the baseline ODI scores. The cut-off value for PSQ was determined by the receiver-operating characteristic curve (ROC. The mean age of patients was 49.3±9.6 years, and there were 80 women. The mean time for follow-up assessment was 31±5 months (range 24-35. Post-surgical success was 79.9% (n = 123 at 2 years follow up. The mean score for the total PSQ, PSQ-minor, and PSQ-moderate were 6.0 (SD = 1.6, 5.4 (SD = 1.9 and 6.5 (SD = 1.7, respectively. Total PSQ score was also significantly correlated with the total scores of the ODI. The optimal total PSQ cut-off point was determined as > 5.2 to predict surgical success in LDH patients, with 80.0% sensitivity and 75.6% specificity (AUC-0.814, 95% CI 0.703-0.926. This study showed that the PSQ could be considered a parameter for predicting surgical success in patients with LDH, and can be useful in clinical practice.

  10. Successful treatment of radiation-induced proctitis pain by blockade of the ganglion impar in an elderly patient with prostate cancer: a case report.

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    Khosla, Ankur; Adeyefa, Oludayo; Nasir, Syed

    2013-05-01

    Chronic rectal pain secondary to radiation-induced proctitis is fast-becoming a leading cause of chronic pain, especially for prostate cancer survivors. Currently, many elderly patients resort to increased opioid intake to alleviate the pain. However, this increase in opioid consumption often leads to constipation and further aggravates the anorectal pain, thus leading to a perpetual, vicious cycle. We reasoned that blocking the ganglion impar could attenuate this sympathetically maintained pain, which would lead to a reduction in the consumption of opioids, lessen constipation, and lead to an improvement in the patient's quality of life. Case report. An academic tertiary pain management clinic. The authors report the case of a 73-year-old African American man with a history of prostate cancer who presented to the pain management clinic for evaluation and treatment of his chronic anorectal pain secondary to radiation-induced proctitis. The patient underwent a ganglion impar block, using the transcoccygeal technique, and consequently reported excellent pain relief with little or no use for opioid pain medications at a 2-month follow-up. Ultimately, this approach led to improved mobility and an increase in the patient's quality of life. Based on this case's success, a prospective study or randomized control trial evaluating the efficacy of the ganglion impar block as a treatment option for chronic anorectal pain secondary to radiation-induced proctitis appears warranted. Wiley Periodicals, Inc.

  11. Home-Based Palliative Care Program Relieves Chronic Pain in Kerala, India: Success Realized Through Patient, Family Narratives.

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    Ajjarapu, Aparna Sai; Broderick, Ann

    2018-06-14

    An estimated 1.5 billion people across the globe live with chronic pain, and an estimated 61 million people worldwide experience unrelieved serious health-related suffering. One-sixth of the global population lives in India, where approximately 10 million people endure unrelieved serious health-related suffering. The state of Kerala is home to Pallium India, one of the most sophisticated palliative care programs in the country. This private organization in Trivandrum provides palliative and hospice care to underresourced populations and emphasizes holistic pain treatment. The current project features the pain stories of six patients who received treatment from Pallium India. Basic patient demographic information was collected, and a Pallium India staff member who was fluent in Malayalam and English asked questions about each patient's pain experience. Pain narratives illustrate the substantial impact of Pallium India's home visit program and the role of total pain assessment in delivering high-quality palliative care.

  12. Predictive Value of Lidocaine infusion for treatment success of Oxcarbazepine long-term therapy in patients with Neuropathic Pain Syndrome

    OpenAIRE

    Maurer, Konrad; Schipper, Sivan; Gantenbein, Andreas; Alon, Eli; Sandor, Peter S

    2013-01-01

    INTRODUCTION: Pharmacotherapy in patients with neuropathic pain syndromes (NPS) can be associated with long periods of trial and error before reaching satisfactory analgesia. The aim of this study was to investigate whether a short intravenous (i.v.) infusion of lidocaine may have a predictive value for the efficacy of oxcarbazepine. METHODS: In total, 16 consecutive patients with NPS were studied in a prospective, uncontrolled, open-label study design. Each patient received i.v. lidocaine...

  13. The periodontal pain paradox: Difficulty on pain assesment in dental patients (The periodontal pain paradox hypothesis

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    Haryono Utomo

    2006-12-01

    Full Text Available In daily dental practice, the majority of patients’ main complaints are related to pain. Most patients assume that all pains inside the oral cavity originated from the tooth. One particular case is thermal sensitivity; sometimes patients were being able to point the site of pain, although there is neither visible caries nor secondary caries in dental radiograph. In this case, gingival recession and dentin hypersensitivity are first to be treated to eliminate the pain. If these treatments failed, pain may misdiagnose as pulpal inflammation and lead to unnecessary root canal treatment. Study in pain during periodontal instrumentation of plaque-related periodontitis revealed that the majority of patients feel pain and discomfort during probing and scaling. It seems obvious because an inflammation, either acute or chronic is related to a lowered pain threshold. However, in contrast, in this case report, patient suffered from chronic gingivitis and thermal sensitivity experienced a relative pain-free sensation during probing and scaling. Lowered pain threshold which accompanied by a blunted pain perception upon periodontal instrumentation is proposed to be termed as the periodontal pain paradox. The objective of this study is to reveal the possibility of certain factors in periodontal inflammation which may involved in the periodontal pain paradox hypothesis. Patient with thermal hypersensitivity who was conducted probing and scaling, after the relative pain-free instrumentation, thermal hypersensitivity rapidly disappeared. Based on the successful periodontal treatment, it is concluded that chronic gingivitis may modulate periodontal pain perception which termed as periodontal pain paradox

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

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    Suneel M. Agerwala

    2017-01-01

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

  15. Successful Use of Magnetic Resonance-Guided Focused Ultrasound Surgery for Long-Term Pain Palliation in a Patient Suffering from Metastatic Bone Tumor

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    Lee, Ji Eun; Yoon, Sang Wook; Kim, Kyoung Ah; Lee, Jong Tae [Dept. of Diagnostic Radiology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam (Korea, Republic of); Shay, Lilach [InSightec. Ltd, Hifa, (Israel); Lee, Kyong Sik [Dept. of General Surgery, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam (Korea, Republic of)

    2011-08-15

    Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) is a clinically effective, non-invasive treatment for thermal ablation of various soft tissue tumors, and is effective in pain palliation following radiation therapy, as has been demonstrated in the initial studies of bone metastases. The current study evaluated the safety and clinical efficacy of MRgFUS for pain palliation prior to radiation therapy, in a patient with a solitary metastatic bone lesion. This is the first case report of MRgFUS treatment with a 1-year follow-up in a patient.

  16. Successful Use of Magnetic Resonance-Guided Focused Ultrasound Surgery for Long-Term Pain Palliation in a Patient Suffering from Metastatic Bone Tumor

    International Nuclear Information System (INIS)

    Lee, Ji Eun; Yoon, Sang Wook; Kim, Kyoung Ah; Lee, Jong Tae; Shay, Lilach; Lee, Kyong Sik

    2011-01-01

    Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) is a clinically effective, non-invasive treatment for thermal ablation of various soft tissue tumors, and is effective in pain palliation following radiation therapy, as has been demonstrated in the initial studies of bone metastases. The current study evaluated the safety and clinical efficacy of MRgFUS for pain palliation prior to radiation therapy, in a patient with a solitary metastatic bone lesion. This is the first case report of MRgFUS treatment with a 1-year follow-up in a patient.

  17. Pain Intensity Moderates the Relationship Between Age and Pain Interference in Chronic Orofacial Pain Patients.

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    Boggero, Ian A; Geiger, Paul J; Segerstrom, Suzanne C; Carlson, Charles R

    2015-01-01

    BACKGROUND/STUDY CONTEXT: Chronic pain is associated with increased interference in daily functioning that becomes more pronounced as pain intensity increases. Based on previous research showing that older adults maintain well-being in the face of pain as well as or better than their younger counterparts, the current study examined the interaction of age and pain intensity on interference in a sample of chronic orofacial pain patients. Data were obtained from the records of 508 chronic orofacial pain patients being seen for an initial evaluation from 2008 to 2012. Collected data included age (range: 18-78) and self-reported measures of pain intensity and pain interference. Bivariate correlations and regression models were used to assess for statistical interactions. Regression analyses revealed that pain intensity positively predicted pain interference (R(2) = .35, B = 10.40, SE = 0.62, t(507) = 16.70, p theories, including socioemotional selectivity theory, which posits that as people age, they become more motivated to maximize positive emotions and minimize negative ones. The results highlight the importance of studying the mechanisms older adults use to successfully cope with pain.

  18. [Pain in edentulous patients

    NARCIS (Netherlands)

    Baat, C. de

    2006-01-01

    In daily social life, orofacial pain is strongly associated with teeth. However, edentulousness is no lifetime guarantee of being pain-free in the orofacial region. Common oral pains in edentulous people are caused by denture misfits or occlusal errors, by alveolar ridge atrophy, by (sharp)

  19. Pain-related worry in patients with chronic orofacial pain.

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    Davis, C Ervin; Stockstill, John W; Stanley, William D; Wu, Qiang

    2014-07-01

    Pain-related worry is distinct from, but related to, pain catastrophizing (PC) and anxiety. Worry and its relationship with other variables have been studied in people with chronic pain but not in people with chronic orofacial pain. The authors explored the prevalence of trait, general and pain-related worry and the association of worry with higher pain levels and other variables. The authors assessed people who had a diagnosis of chronic orofacial pain by using nonpain-related trait worry, state anxiety, trait anxiety, PC and pain measures. The participants' answers to an open-ended question about what they were most worried about led to the identification of worry domains, including worry about pain. The authors found that worrying about pain was related significantly to worst and least pain levels, pain interference and pain duration, as well as moderated trait worry in predicting pain interference. Although trait worry was not correlated directly with pain, when moderated by PC, it made substantial contributions in predicting pain interference. Participants with chronic orofacial pain reported experiencing substantial levels of trait worry, anxiety, PC and worry about pain that related to pain ratings directly and indirectly. Clinicians should assess pain-related worry in patients with chronic orofacial pain to understand the effects of worry on pain and functioning. Clinicians could treat these patients more effectively by helping them reduce their levels of pain-related worry and focusing on improved coping.

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

    OpenAIRE

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

    2017-01-01

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

  1. A comprehensive protocol to diagnose and treat pain of muscular origin may successfully and reliably decrease or eliminate pain in a chronic pain population.

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    Marcus, Norman J; Gracely, Edward J; Keefe, Kelly O

    2010-01-01

    A comprehensive protocol is presented to identify muscular causes of regional pain syndromes utilizing an electrical stimulus in lieu of palpation, and combining elements of Prolotherapy with trigger point injections. One hundred seventy-six consecutive patients were evaluated for the presence of muscle pain by utilizing an electrical stimulus produced by the Muscle Pain Detection Device. The diagnosis of "Muscle Pain Amenable to Injection" (MPAI), rather than trigger points, was made if pain was produced for the duration of the stimulation. If MPAI was found, muscle tendon injections (MTI) were offered to patients along with post-MTI physical therapy, providing neuromuscular electrical stimulation followed by a validated exercise program [1]. A control group, evaluated 1 month prior to their actual consultation/evaluation when muscle pain was identified but not yet treated, was used for comparison. Forty-five patients who met criteria completed treatment. Patients' scores on the Brief Pain Inventory decreased an average of 62%; median 70% (P < 0.001) for pain severity and 68%; median 85% (P < 0.001) for pain interference one month following treatment. These changes were significantly greater (P < 0.001) than those observed in the untreated controls. A protocol incorporating an easily reproducible electrical stimulus to diagnose a muscle causing pain in a region of the body followed by an injection technique that involves the entirety of the muscle, and post injection restoration of muscle function, can successfully eliminate or significantly reduce regional pain present for years.

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

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    Simon Elison NM

    2006-01-01

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

  3. Multidimensional features of pain in patients with chronic neck pain

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    Fabianna Resende de Jesus-Moraleida

    Full Text Available Abstract Introduction: Chronic neck pain is associated with significant health costs and loss of productivity at work. Objective: to assess pain and disability in individuals with chronic neck pain. Methods: 31 volunteers with chronic neck pain, mean age 29, 65 years, were assessed using the McGill Pain Questionnaire in Brazilian version (Br-MPQ and Neck Disability Index (NDI. The Br-MPQ analysis was performed based on the numerical values associated with the words selected to describe the experience of pain (Pain Rating Index - PRI, and present pain intensity (PPI. NDI was used to evaluate the influence of neck pain in performance of everyday tasks. Finally, we investigated the association between PPI and NDI. Results: PRI revealed that the most significant dimension was the sensory pain (70%, and the number of chosen words was 10 (2,62 out of 20 words. Mean PPI value was 1,23 (0,76 in five points; 40% of participants described pain intensity as moderate. NDI score was 9,77 (3,34, indicating mild disability. There was a positive association between disability and pain intensity (r = 0,36; p =0,046. Pain intensity and duration of pain were not associated. Conclusions: Findings of this study identified important information related to neck pain experienced by patients when suffering from chronic neck pain, moreover, the association between disability and pain intensity reinforces the importance of complementary investigation of these aspects to optimize function in them.

  4. Association of postoperative nausea/vomiting and pain with breastfeeding success

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    Ramon Abola

    2017-11-01

    Full Text Available Abstract Background Successful breastfeeding is a goal set forth by the World Health Organization to improve neonatal care. Increasingly, patients express the desire to breastfeed, and clinicians should facilitate successful breastfeeding. The primary aim of this study is to determine if postoperative nausea and vomiting (PONV or postoperative pain are associated with decreased breastfeeding success after cesarean delivery. Methods This is a historical cohort study using the Stony Brook Elective Cesarean Delivery Database. Self-reported breastfeeding success at 4 weeks postoperative was analyzed for associations with postoperative antiemetic use and postoperative pain scores. Breastfeeding success was also analyzed for associations with patient factors and anesthetic medications. Results Overall, 86% of patients (n = 81 who intended on breastfeeding reported breastfeeding success. Breastfeeding success was not associated with postoperative nausea or vomiting as measured by post anesthesia care unit antiemetic use (15% use in successful vs. 18% use in unsuccessful, p = 0.67 or 48-h antiemetic use (28% use in successful group vs 36% use in unsuccessful group, p = 0.732. Pain visual analog scale scores at 6, 12 and 24 h postoperatively were not significantly different between patients with or without breastfeeding success. Breastfeeding success was associated with having had at least 1 previous child (86% vs 36%, p < 0.001. Patients with asthma were less likely to have breastfeeding success (45% vs 4%, p = 0.002. Conclusions Efforts to improve PONV and pain after cesarean delivery may not be effective in improving breastfeeding success. To possibly improve breastfeeding rates, resources should be directed toward patients with no previous children and patients with asthma.

  5. Colorectal surgery patients' pain status, activities, satisfaction, and beliefs about pain and pain management.

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    Brown, Carolyn; Constance, Kristel; Bédard, Denise; Purden, Margaret

    2013-12-01

    This study describes surgical colorectal cancer patients' pain levels, recovery activities, beliefs and expectations about pain, and satisfaction with pain management. A convenience sample of 50 adult inpatients who underwent colorectal surgery for cancer participated. Patients were administered the modified American Pain Society Patient Outcome Questionnaire on postoperative day 2 and asked to report on their status in the preceding 24 hours. Patients reported low current (mean 1.70) and average (mean 2.96) pain scores but had higher scores and greater variation for worst pain (mean 5.48). Worst pain occurred mainly while turning in bed or mobilizing, and 25% of patients experienced their worst pain at rest. Overall, patients expected to have pain after surgery and were very satisfied with pain management. Patients with worst pain scores >7 reported interference with recovery activities, mainly general activity (mean 5.67) and walking ability (mean 5.15). These patients were likely to believe that "people can get addicted to pain medication easily" (mean 3.39 out of 5) and that "pain medication should be saved for cases where pain gets worse" (mean 3.20 out of 5). These beliefs could deter patients from seeking pain relief and may need to be identified and addressed along with expectations about pain in the preoperative nursing assessment. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  6. Successful treatment of mixed (mainly cancer) pain by tramadol preparations.

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    Kawahito, Shinji; Soga, Tomohiro; Mita, Naoji; Satomi, Shiho; Kinoshita, Hiroyuki; Arase, Tomoko; Kondo, Akira; Miki, Hitoshi; Takaishi, Kazumi; Kitahata, Hiroshi

    2017-01-01

    The patient, a 70-year-old Japanese woman diagnosed with parotid gland cancer, underwent wide excision and reconstruction (facial nerve ablation, nerve transposition). At 1 month after the surgery, she was brought to our hospital's pain medicine department because her postoperative pain and cancer-related pain were poorly controlled. She had already been prescribed a tramadol (37.5 mg)/acetaminophen (325 mg) combination tablet (5 tablets/day). However, in addition to the continuous pain in her face and lower limbs, she was troubled by a trigeminal neuralgia-like prominence ache. Because this pain could not be controlled by an increase to eight combination tablets per day, we switched her medication to a tramadol capsule. At 11 months post-surgery, we then switched her medication to an orally disintegrating tramadol tablet to improve medication adherence of the drug. From 14 months post-surgery, the patient also used a sustained-release tramadol preparation, and she was then able to sleep well. Her current regimen is an orally disintegrating sustained-release tablet combination (total 300 mg tramadol) per day, and she achieved sufficient pain relief. Because tramadol is not classified as a medical narcotic drug, it widely available and was shown here to be extremely useful for the treatment of our patient's mixed (mainly cancer) pain. J. Med. Invest. 64: 311-312, August, 2017.

  7. Is high hypnotic suggestibility necessary for successful hypnotic pain intervention?

    Science.gov (United States)

    Milling, Leonard S

    2008-04-01

    Hypnotic suggestibility is a trait-like, individual difference variable reflecting the general tendency to respond to hypnosis and hypnotic suggestions. Research with standardized measures of hypnotic suggestibility has demonstrated that there are substantial individual differences in this variable. Higher suggestibility has been found to be associated with greater relief from hypnotic pain interventions. Although individuals in the high suggestibility range show the strongest response to hypnotic analgesia, people of medium suggestibility, who represent approximately one third of the population, also have been found to obtain significant relief from hypnosis. Thus, high hypnotic suggestibility is not necessary for successful hypnotic pain intervention. However, the available evidence does not support the efficacy of hypnotic pain interventions for people who fall in the low hypnotic suggestibility range. However, some studies suggest that these individuals may benefit from imaginative analgesia suggestions, or suggestions for pain reduction that are delivered while the person is not in hypnosis.

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

    DEFF Research Database (Denmark)

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

    2018-01-01

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

  9. Dysfunctional pain modulation in somatoform pain disorder patients.

    Science.gov (United States)

    Klug, Stefanie; Stefanie, Klug; Anderer, Peter; Peter, Anderer; Saletu-Zyhlarz, Gerda; Gerda, Saletu-Zyhlarz; Freidl, Marion; Marion, Freidl; Saletu, Bernd; Bernd, Saletu; Prause, Wolfgang; Wolfgang, Prause; Aigner, Martin; Martin, Aigner

    2011-06-01

    To date, pain perception is thought to be a creative process of modulation carried out by an interplay of pro- and anti-nociceptive mechanisms. Recent research demonstrates that pain experience constitutes the result of top-down processes represented in cortical descending pain modulation. Cortical, mainly medial and frontal areas, as well as subcortical structures such as the brain stem, medulla and thalamus seem to be key players in pain modulation. An imbalance of pro- and anti-nociceptive mechanisms are assumed to cause chronic pain disorders, which are associated with spontaneous pain perception without physiologic scaffolding or exaggerated cortical activation in response to pain exposure. In contrast to recent investigations, the aim of the present study was to elucidate cortical activation of somatoform pain disorder patients during baseline condition. Scalp EEG, quantitative Fourier-spectral analyses and LORETA were employed to compare patient group (N = 15) to age- and sex-matched controls (N = 15) at rest. SI, SII, ACC, SMA, PFC, PPC, insular, amygdale and hippocampus displayed significant spectral power reductions within the beta band range (12-30 Hz). These results suggest decreased cortical baseline arousal in somatoform pain disorder patients. We finally conclude that obtained results may point to an altered baseline activity, maybe characteristic for chronic somatoform pain disorder.

  10. Pain acceptance and opiate use disorders in addiction treatment patients with comorbid pain.

    Science.gov (United States)

    Lin, Lewei Allison; Bohnert, Amy S B; Price, Amanda M; Jannausch, Mary; Bonar, Erin E; Ilgen, Mark A

    2015-12-01

    Studies from pain treatment settings indicate that poor acceptance of pain may be an important and modifiable risk factor for higher severity of opioid use. However, the degree to which pain acceptance relates to opioid use severity in the addiction treatment population is unknown. In this study of addiction treatment patients with co-morbid pain, we examined correlates of severity of opiate (heroin and prescription opioid) use, with a particular focus on the role of pain acceptance. Patients in residential addiction treatment with comorbid pain (N=501) were stratified into low, moderate and high severity of opiate use. Demographic and clinical characteristics were compared across opiate severity categories. 72% (N=360) of the participants had symptoms that were consistent with an opiate use disorder. Younger age, Caucasian race, female gender, cocaine use and lower pain acceptance were associated with higher severity of opiate use, whereas pain intensity was not. Controlling for demographic and other risk factors, such as substance use and pain intensity, higher pain acceptance was associated with lower odds of severe prescription opioid (AOR 0.50, 95% CI 0.38-0.68 for a one SD increase in pain acceptance) and heroin use (AOR 0.57, 95% CI 0.44-0.75 for a one SD increase in pain acceptance). Problematic opiate use is common in addictions treatment patients with chronic pain. Lower pain acceptance is related to greater opiate use severity, and may be an important modifiable target for interventions to successfully treat both pain and opiate use disorders. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Conditioned pain modulation in patients with nonspecific chronic back pain with chronic local pain, chronic widespread pain, and fibromyalgia.

    Science.gov (United States)

    Gerhardt, Andreas; Eich, Wolfgang; Treede, Rolf-Detlef; Tesarz, Jonas

    2017-03-01

    Findings considering conditioned pain modulation (CPM) in chronic back pain (CBP) are contradictory. This might be because many patients with CBP report pain in further areas of the body, and altered CPM might influence spatial extent of pain rather than CBP per se. Therefore, we compared CPM in patients with CBP with different pain extent. Patients with fibromyalgia syndrome (FMS), for whom CPM impairment is reported most consistently, were measured for comparison. Based on clinical evaluation and pain drawings, patients were categorized into chronic local back pain (CLP; n = 53), chronic widespread back pain (CWP; n = 32), and FMS (n = 92). Conditioned pain modulation was measured by the difference in pressure pain threshold (test stimuli) at the lower back before and after tonic heat pain (conditioning stimulus). We also measured psychosocial variables. Pressure pain threshold was significantly increased in CLP patients after tonic heat pain (P pain modulation in CLP was significantly higher than that in CWP and FMS (P painful areas (0-10) were associated with lower CPM (r = 0.346, P = 0.001) in CBP but not in FMS (r = -0.013, P = 0.903). Anxiety and depression were more pronounced in FMS than in CLP or CWP (P values pain inhibition seem to be more indicated the higher the pain extent.

  12. Pain and pain mechanisms in patients with inflammatory arthritis

    DEFF Research Database (Denmark)

    Rifbjerg-Madsen, S; Christensen, A W; Christensen, R

    2017-01-01

    completed the PDQ (RA: 3,826, PsA: 1,180, SpA: 1,093). 52% of all patients and 63% of PDQ-completers had VAS pain score ≥ 30 mm. The distribution of the PDQ classification-groups (18) were; RA: 56%/24%/20%. PsA: 45%/ 27%/ 28%. SpA: 55% / 24%/ 21%. More patients with PsA had PDQ score >18....... The objectives were to quantify and characterize pain phenotypes (non-neuropathic vs. neuropathic features) among Danish arthritis patients using the PDQ, and to assess the association with on-going inflammation. METHODS: The PDQ was included onto the DANBIO touch screens at 22 departments of Rheumatology......28-CRP and VAS pain but not with indicators of peripheral inflammation (CRP and SJC). Thus, pain classification by PDQ may assist in mechanism-based pain treatment....

  13. Assessment and management of chronic pain in patients with stable total hip arthroplasty

    OpenAIRE

    Classen, Tim; Zaps, Daniela; Landgraeber, Stefan; Li, Xinning; Jäger, Marcus

    2012-01-01

    Total hip arthroplasty (THA) is one of the most successful operations that can restore function and relieve pain. Although a majority of the patients achieve significant pain relief after THA, there are a number of patients that develop chronic pain for unknown reasons. A literature search was performed looking for chronic pain after total hip arthroplasty and stable THA. Major causes of chronic pain include aseptic loosening or infection. However, there is a subset of patients with a stable ...

  14. Electronic diary assessment of pain-related fear, attention to pain, and pain intensity in chronic low back pain patients.

    NARCIS (Netherlands)

    Roelofs, J.; Peters, M.L.; Patijn, J.; Schouten, E.G.; Vlaeyen, J.W.

    2004-01-01

    The present study investigated the relationships between pain-related fear, attention to pain, and pain intensity in daily life in patients with chronic low back pain. An experience sampling methodology was used in which electronic diary data were collected by means of palmtop computers from 40

  15. Pain management in patients with dementia

    NARCIS (Netherlands)

    Achterberg, W.P.; Pieper, M.J.C.; van Dalen-Kok, A.H.; de Waal, M.W.M.; Husebo, B.S.; Lautenbacher, S.; Kunz, M.; Scherder, E.J.A.; Corbett, A.

    2013-01-01

    There are an estimated 35 million people with dementia across the world, of whom 50% experience regular pain. Despite this, current assessment and treatment of pain in this patient group are inadequate. In addition to the discomfort and distress caused by pain, it is frequently the underlying cause

  16. Pain management in patients with hidradenitis suppurativa

    NARCIS (Netherlands)

    Horvath, Barbara; Janse, Ineke C.; Sibbald, Gary R.

    Hidradenitis suppurativa (HS) is a chronic, relapsing, and painful inflammatory disease. HS patients' quality of life is severely impaired, and this impairment correlates strongly with their pain. Pain in HS can be acute or chronic and has both inflammatory and noninflammatory origins. The purpose

  17. Use of sequential diagnostic pain blocks in a patient of posttraumatic complex regional pain syndrome-not otherwise specified complicated by myofascial trigger points and thoracolumbar pain syndrome

    Directory of Open Access Journals (Sweden)

    Kailash Kothari

    2017-01-01

    Full Text Available We are presenting a case of posttraumatic lower limb Complex regional pain syndrome – Not otherwise specified (CRPS – NOS. As it was not treated in acute phase, the pain became chronic and got complicated by myofascial and thoracolumbar pain syndrome. This case posed us a diagnostic challenge. We used sequential diagnostic pain blocks to identify the pain generators and successfully treat the patient. We used diagnostic blocks step by step to identify and treat pain generators – T12,L1 and L2 Facet joints, Lumbar sympathetic block for CRPS NOS and Trigger point injection with dry needling for myofascial pain syndrome. This case highlights the facet that additional pain generators unrelated to original pain may complicate the presentation. Identifying these pain generators requires out of box thinking and high index of suspicion.

  18. PAIN RELIEF IN POLYTRAUMA PATIENTS

    Directory of Open Access Journals (Sweden)

    M. C. Rajesh

    2016-09-01

    Full Text Available BACKGROUND Pain management in Polytrauma is a poorly-addressed concern at the time of active resuscitation. But, very often, pain assessment is also a challenge! Opioids belong to conventional analgesics of choice in any acute pain conditions. But, recently application of regional anaesthesia techniques and subanaesthetic doses of ketamine are satisfactorily employed. A clear understanding of neuropathic element of pain must be made as they require specific therapy. It must be emphasised that effective pain therapy is a multidisciplinary team work with active involvement of pain psychologist.

  19. Acute pain management in burn patients

    DEFF Research Database (Denmark)

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

    2014-01-01

    OBJECTIVE: Burn patients suffer excruciating pain due to their injuries and procedures related to surgery, wound care, and mobilization. Acute Stress Disorder, Post-Traumatic Stress Disorder, chronic pain and depression are highly prevalent among survivors of severe burns. Evidence-based pain...... patients. The most highly recommended guidelines provided clear and accurate recommendations for the nursing and medical staff on pain management in burn patients. We recommend the use of a validated appraisal tool such as the AGREE instrument to provide more consistent and evidence-based care to burn...

  20. Diagnosing patients with longstanding shoulder joint pain

    DEFF Research Database (Denmark)

    Nørregaard, J; Krogsgaard, M R; Lorenzen, T

    2002-01-01

    OBJECTIVE: To examine the interobserver agreement of commonly used clinical tests and diagnoses in patients with shoulder pain, and the accuracy of these tests and ultrasonographic findings in comparison with arthroscopic findings. METHODS: Eighty six patients with longstanding shoulder joint pain...

  1. Medical conditions and body pain in patients presenting orofacial pain.

    Science.gov (United States)

    Franco, Ana Lúcia; Runho, Gabriel Henrique Farto; Siqueira, José Tadeu Tesseroli de; Camparis, Cinara Maria

    2012-05-01

    To verify the frequency of self-reported medical conditions and pain areas in orofacial pain patients, comparing them with patients from the routine dental care. Data were collected from archives of the Orofacial Pain Clinic (Group A, n=319) and of the routine dental care clinics (Group B, n=84) at Faculdade de Odontologia de Araraquara, São Paulo, in Brazil. All individuals answered a standardized clinical questionnaire and completed a body map indicating their pain areas. The Mann-Whitney's test demonstrated that Group A presented a higher mean number of medical reports than Group B (p=0.004). In both groups, Pearson's correlation test showed that the highest frequencies of medical conditions were positively correlated to highest frequencies of painful areas (0.478, p=0.001 and 0.246, p=0.000, respectively). Group A tended to report more medical conditions and there was a positive correlation between the number of medical conditions and the one of pain areas for both groups.

  2. Enhanced Brain Responses to Pain-Related Words in Chronic Back Pain Patients and Their Modulation by Current Pain

    OpenAIRE

    Ritter, Alexander; Franz, Marcel; Puta, Christian; Dietrich, Caroline; Miltner, Wolfgang H. R.; Weiss, Thomas

    2016-01-01

    Previous functional magnetic resonance imaging (fMRI) studies in healthy controls (HC) and pain-free migraine patients found activations to pain-related words in brain regions known to be activated while subjects experience pain. The aim of the present study was to identify neural activations induced by pain-related words in a sample of chronic back pain (CBP) patients experiencing current chronic pain compared to HC. In particular, we were interested in how current pain influences brain acti...

  3. Successful spinal cord stimulation for neuropathic below-level spinal cord injury pain following complete paraplegia: a case report.

    Science.gov (United States)

    Reck, Tim A; Landmann, Gunther

    2017-01-01

    Neuropathic pain is common in patients with spinal cord injury (SCI) and often difficult to treat. We report a case where epidural spinal cord stimulation (SCS) below the level of injury has been successfully applied in a patient with a complete spinal cord lesion. A 53-year-old female presented with neuropathic below-level SCI pain of both lower legs and feet due to complete SCI below T5. Time and pain duration since injury was 2 years. Pain intensity was reported on numeric rating scale with an average of 7/10 (0 meaning no pain, 10 meaning the worst imaginable pain), but also with about 8-10 pain attacks during the day with an intensity of 9/10, which lasted between some minutes and half an hour. SCS was applied below the level of injury at-level T11-L1. After a successful 2 weeks testing period the pulse generator has been implanted permanently with a burst-stimulation pattern. The average pain was reduced to a bearable intensity of 4/10, in addition attacks could be reduced both in frequency and in intensity. This effects lasted for at least three months of follow-up. Even in case of complete SCI, SCS might be effective. Mechanisms of pain relief remain unclear. A modulation of suggested residual spinothalamic tract function may play a role. Further investigation has to be carried out to support this theory.

  4. Successful Treatment of Gluteal Pain from Obturator Internus Tendinitis and Bursitis with Ultrasound-Guided Injection.

    Science.gov (United States)

    Chen, Boqing; Rispoli, Leia; Stitik, Todd; Leong, Michelle

    2017-10-01

    This case report describes what the authors believe is the first case of a patient with obturator internus tendinitis and bursitis successfully treated with a corticosteroid injection using a trans-tendinous lateral to medial approach. The patient presented with right gluteal pain not relieved by physical therapy or right hip and ischial bursa corticosteroid injections. Pelvic and lumbar spine MRIs and EMG/NCS findings were unremarkable. Physical examination demonstrated tenderness to palpation at the right middle lower gluteal region. Ultrasound imaging with sonopalpation identified the maximal local tender point as the right obturator internus muscle and/or its underlying bursa. A 22-gauge 3.5-inch needle was inserted in-plane to the transducer and longitudinal to the obturator internus from a lateral to medial direction, an approach previously described in cadavers. The obturator internus tendon sheath and bursa were injected with 2.5 ml of 0.5% lidocaine combined with 10 mg of triamcinolone. The patient reported immediate complete relief of pain with continued relief at 2 and 6 months post-injection. This case report demonstrates an injection of the obturator internus tendon sheath and bursa using a trans-tendinous approach, which may be successful for treatment of patients presenting with persistent gluteal pain from obturator internus tendinitis and bursitis.

  5. Postural balance in low back pain patients

    DEFF Research Database (Denmark)

    Maribo, Thomas; Schiøttz-Christensen, Berit; Jensen, Lone Donbæk

    2012-01-01

    INTRODUCTION: Altered postural control has been observed in low back pain (LBP) patients. They seem to be more dependent on vision when standing. The objective of the study was to determine concurrent and predictive validity of measures of postural stability in LBP patients. MATERIALS AND METHODS......: Centre of Pressure (CoP) measurements were tested against pain, fear of pain, and physical function. Velocity, anterior-posterior displacement, and the Romberg Ratio obtained on a portable force platform were used as measures of postural stability. RESULTS: Baseline and 12-week follow-up results of 97....... CONCLUSION: This first study of concurrent and predictive validity of postural balance in LBP patients revealed no association between CoP measures and pain, fear of pain, and physical function....

  6. Pain management: association with patient satisfaction among emergency department patients.

    Science.gov (United States)

    Bhakta, Hemangini C; Marco, Catherine A

    2014-04-01

    Patient satisfaction with emergency care is associated with timeliness of care, empathy, technical competence, and information delivery. Previous studies have demonstrated inconsistent findings regarding the association between pain management and patient satisfaction. This study was undertaken to determine the association between pain management and patient satisfaction among Emergency Department (ED) patients presenting with acute painful conditions. In this survey study, a standardized interview was conducted at the Emergency Department at the University of Toledo Medical Center in May-July 2011. Participants were asked to answer 18 questions pertaining to patient satisfaction. Additional data collected included demographic information, pain scores, and clinical management. Among 328 eligible participants, 289 (88%) participated. The mean triage pain score on the verbal numeric rating scale was 8.2 and the mean discharge score was 6.0. The majority of patients (52%) experienced a reduction in pain of 2 or more points. Participants received one pain medication dose (44%), two medication doses (14%), three medication doses (5%), or four medication doses (2%). Reduction in pain scores of 2 or more points was associated with a higher number of medications administered. Reduction in pain scores was associated with higher satisfaction as scored on questions of patient perceptions of adequate assessment and response to pain, and treatment of pain. There was a significant association between patient satisfaction and a reduction in pain of 2 or more points and number of medications administered. Effective pain management is associated with improved patient satisfaction among ED patients with painful conditions. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Radiofrequency thermal ablation for pain control in patients with single painful bone metastasis from hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Carrafiello, Gianpaolo [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: gcarraf@tin.it; Lagana, Domenico [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: donlaga@gmail.com; Ianniello, Andrea [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: ianand@libero.it; Nicotera, Paolo [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: paolonicotera@virgilio.it; Fontana, Federico [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: fede.fontana@libero.it; Dizonno, Massimiliano [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: massimilianodizonno@libero.it; Cuffari, Salvatore [Service of Anaesthesiology and Palliative Care, University of Insubria, 21100 Varese (Italy)], E-mail: salvatore.cuffari@libero.it; Fugazzola, Carlo [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: carlo.fugazzola@ospedale.varese.it

    2009-08-15

    Objective: The aim of this study was to assess the safety and the efficacy of radiofrequency thermal ablation (RFA) for pain relief and analgesics use reduction in two patients with painful bone metastases from hepatocellular carcinoma (HCC). Materials and methods: Two patients with lytic metastases from HCC located at the left superior ileo-pubic branch and at the middle arch of VII rib, performed RFA displacing a LeVeen Needle (3.5 and 4.0 cm diameter) under US (ultrasonography) and fluoroscopic guidance. Two methods were used to determine the response of both patients: the first method was to measure patient's worst pain with a Brief Pain Inventory (BPI) 1 day after the procedure, every week for 1 month, and thereafter at week 8 and 12 (total follow-up 3 months); Second method was to evaluate patient's analgesics use recorded at week 1, 4, 8 and 12. Analgesic medication use was translated into a morphine-equivalent dose. Results: The RFA were well tolerated by the patients who did not develop any complication. Both patients obtained substantial reduction of pain, which decreased from a mean score of 8 to approximately 2 in 4 weeks. In both patients we observed a reduction in the use of morphine dose-equivalent after a peak at week 1. CT (computed tomography) imaging, performed at 1 month after RFA, demonstrated that both procedures were technically successful and safe because consistent necrosis and no evidence for complications were observed. Conclusion: RFA provides a potential alternative method for palliation of painful osteolytic metastases from HCC; the procedure is safe, and the pain relief is substantial.

  8. Radiofrequency thermal ablation for pain control in patients with single painful bone metastasis from hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Carrafiello, Gianpaolo; Lagana, Domenico; Ianniello, Andrea; Nicotera, Paolo; Fontana, Federico; Dizonno, Massimiliano; Cuffari, Salvatore; Fugazzola, Carlo

    2009-01-01

    Objective: The aim of this study was to assess the safety and the efficacy of radiofrequency thermal ablation (RFA) for pain relief and analgesics use reduction in two patients with painful bone metastases from hepatocellular carcinoma (HCC). Materials and methods: Two patients with lytic metastases from HCC located at the left superior ileo-pubic branch and at the middle arch of VII rib, performed RFA displacing a LeVeen Needle (3.5 and 4.0 cm diameter) under US (ultrasonography) and fluoroscopic guidance. Two methods were used to determine the response of both patients: the first method was to measure patient's worst pain with a Brief Pain Inventory (BPI) 1 day after the procedure, every week for 1 month, and thereafter at week 8 and 12 (total follow-up 3 months); Second method was to evaluate patient's analgesics use recorded at week 1, 4, 8 and 12. Analgesic medication use was translated into a morphine-equivalent dose. Results: The RFA were well tolerated by the patients who did not develop any complication. Both patients obtained substantial reduction of pain, which decreased from a mean score of 8 to approximately 2 in 4 weeks. In both patients we observed a reduction in the use of morphine dose-equivalent after a peak at week 1. CT (computed tomography) imaging, performed at 1 month after RFA, demonstrated that both procedures were technically successful and safe because consistent necrosis and no evidence for complications were observed. Conclusion: RFA provides a potential alternative method for palliation of painful osteolytic metastases from HCC; the procedure is safe, and the pain relief is substantial.

  9. Chronic Kidney Pain in Autosomal Dominant Polycystic Kidney Disease : A Case Report of Successful Treatment by Catheter-Based Renal Denervation

    NARCIS (Netherlands)

    Casteleijn, Niek F.; de Jager, Rosa L.; Neeleman, M. Peer; Blankestijn, Peter J.; Gansevoort, Ron T.

    Chronic pain is a common concern in patients with autosomal dominant polycystic kidney disease (ADPKD). We report what to our knowledge is the first catheter-based renal denervation procedure in a patient with ADPKD resulting in successful management of chronic pain. The patient was a 43-year-old

  10. Knee Pain in a Renal Transplant Patient

    Science.gov (United States)

    2017-04-26

    MATERIAL TO BE PUBLISHED OR PRESENTED: Knee Pain in a Renal Transplant Patient 7. FUNDING RECEIVED FOR THIS STUDY? 0 YES IZJNO FUNDING SOURCE: 8. DO... renal transplant patient with progressive posterior knee pain secondary to amyloidosis. Case: A 57 year-old black-male presented with 6 months of...idiopathic causes, for which he had received hemodialysis for 20 years followed by cadaveric renal transplant four years prior to development of the

  11. Pain management in patients with dementia.

    Science.gov (United States)

    Achterberg, Wilco P; Pieper, Marjoleine J C; van Dalen-Kok, Annelore H; de Waal, Margot W M; Husebo, Bettina S; Lautenbacher, Stefan; Kunz, Miriam; Scherder, Erik J A; Corbett, Anne

    2013-01-01

    There are an estimated 35 million people with dementia across the world, of whom 50% experience regular pain. Despite this, current assessment and treatment of pain in this patient group are inadequate. In addition to the discomfort and distress caused by pain, it is frequently the underlying cause of behavioral symptoms, which can lead to inappropriate treatment with antipsychotic medications. Pain also contributes to further complications in treatment and care. This review explores four key perspectives of pain management in dementia and makes recommendations for practice and research. The first perspective discussed is the considerable uncertainty within the literature on the impact of dementia neuropathology on pain perception and processing in Alzheimer's disease and other dementias, where white matter lesions and brain atrophy appear to influence the neurobiology of pain. The second perspective considers the assessment of pain in dementia. This is challenging, particularly because of the limited capacity of self-report by these individuals, which means that assessment relies in large part on observational methods. A number of tools are available but the psychometric quality and clinical utility of these are uncertain. The evidence for efficient treatment (the third perspective) with analgesics is also limited, with few statistically well-powered trials. The most promising evidence supports the use of stepped treatment approaches, and indicates the benefit of pain and behavioral interventions on both these important symptoms. The fourth perspective debates further difficulties in pain management due to the lack of sufficient training and education for health care professionals at all levels, where evidence-based guidance is urgently needed. To address the current inadequate management of pain in dementia, a comprehensive approach is needed. This would include an accurate, validated assessment tool that is sensitive to different types of pain and therapeutic

  12. Enhanced Brain Responses to Pain-Related Words in Chronic Back Pain Patients and Their Modulation by Current Pain.

    Science.gov (United States)

    Ritter, Alexander; Franz, Marcel; Puta, Christian; Dietrich, Caroline; Miltner, Wolfgang H R; Weiss, Thomas

    2016-08-10

    Previous functional magnetic resonance imaging (fMRI) studies in healthy controls (HC) and pain-free migraine patients found activations to pain-related words in brain regions known to be activated while subjects experience pain. The aim of the present study was to identify neural activations induced by pain-related words in a sample of chronic back pain (CBP) patients experiencing current chronic pain compared to HC. In particular, we were interested in how current pain influences brain activations induced by pain-related adjectives. Subjects viewed pain-related, negative, positive, and neutral words; subjects were asked to generate mental images related to these words during fMRI scanning. Brain activation was compared between CBP patients and HC in response to the different word categories and examined in relation to current pain in CBP patients. Pain-related words vs. neutral words activated a network of brain regions including cingulate cortex and insula in subjects and patients. There was stronger activation in medial and dorsolateral prefrontal cortex (DLPFC) and anterior midcingulate cortex in CPB patients than in HC. The magnitude of activation for pain-related vs. negative words showed a negative linear relationship to CBP patients' current pain. Our findings confirm earlier observations showing that pain-related words activate brain networks similar to noxious stimulation. Importantly, CBP patients show even stronger activation of these structures while merely processing pain-related words. Current pain directly influences on this activation.

  13. Caregivers' attentional bias to pain : does it affect caregiver accuracy in detecting patient pain behaviors?

    NARCIS (Netherlands)

    Mohammadi, Somayyeh; Dehghani, Mohsen; Khatibi, Ali; Sanderman, Robbert; Hagedoorn, Mariet

    Attentional bias to pain among family caregivers of patients with pain may enhance the detection of pain behaviors in patients. However, both relatively high and low levels of attentional bias may increase disagreement between patients and caregivers in reporting pain behaviors. This study aims to

  14. Postoperative patients' perspectives on rating pain : A qualitative study

    NARCIS (Netherlands)

    van Dijk, J.F.M.; Vervoort, Sigrid; van Wijck, Albert J.M.; Kalkman, CJ; Schuurmans, Marieke

    Background: In postoperative pain treatment patients are asked to rate their pain experience on a single uni-dimensional pain scale. Such pain scores are also used as indicator to assess the quality of pain treatment. However, patients may differ in how they interpret the Numeric Rating Scale (NRS)

  15. Pain distribution in primary care patients with hip osteoarthritis

    DEFF Research Database (Denmark)

    Poulsen, Erik; Overgaard, Søren; Vestergaard, Jacob T

    2016-01-01

    BACKGROUND: Hip osteoarthritis (OA) is the most common diagnosis in primary care adult patients presenting with hip pain but pain location and pain distribution in primary care patients with hip OA have been reported inadequately. OBJECTIVE: To describe pain location and pain distribution...

  16. Effect of orthodontic pain on quality of life of patients undergoing orthodontic treatment.

    Science.gov (United States)

    Banerjee, Sujoy; Banerjee, Rajlakshmi; Shenoy, Usha; Agarkar, Sanket; Bhattacharya, Sangeeta

    2018-01-01

    Pain is an important aspect of oral health-related quality of life (OHRQOL). Understanding how patients' pain experiences during their treatment affect their quality of life (QOL) is important and the absence of pain/discomfort is important for achieving a high QOL. The objective of this study was to assess the relationship between pain and OHRQOL among patients wearing fixed orthodontic appliances and to evaluate whether patient motivation and counseling had an effect on the pain and discomfort. The McGill-Short-Form with visual analog scale and present pain intensity and Oral Health Impact Profile-14 indices were used to determine the intensity and severity of pain and to evaluate the QOL of 200 adolescents undergoing fixed orthodontic treatment during different phases of treatment. There was a significant correlation found between pain and the QOL of patients undergoing orthodontic treatment. Overall score of OHRQOL increased significantly (mean 43.5 ± 10.9) in the initial phase of treatment where the incidence of severe to moderate pain was reported in 80% patients. Ninety-five percent patients felt pain or discomfort. After 1 day of appliance placement, more than 85% of patients experienced severe to mild pain whereas 9% of patients suffered very severe pain. Pain reduced over a week, and at the end of a month, 10.5% patients had moderate pain whereas majority, i.e., 58% of patients complained of only mild pain (P orthodontic treatment and has a significant effect on the QOL of orthodontic patients, especially during the initial phases of treatment. Patient motivation and counseling by the orthodontist have a profounding effect in reducing the pain and discomfort, improving the QOL, and an overall improvement in the patient compliance affecting the successful outcome of the treatment.

  17. Sacroiliac pain in a dialysis patient

    Science.gov (United States)

    Tristano, Antonio G

    2009-01-01

    The case is reported of a 47-year-old man with a history of chronic renal failure, treated with peritoneal dialysis, who presented with acute sacroiliac joint pain secondary to a pelvic abscess. Initially a diagnosis of infectious sacroiliitis of the left sacroiliac joint was suspected, but following investigation a pain referable to the sacroiliac joint was suspected. The patient recovered with a combination of antibiotics for the pelvic abscess and non-steroidal anti-inflammatory drugs. PMID:21994518

  18. High prevalence of posttraumatic stress disorder (PTSD) and pain sensitization in two Scandinavian samples of patients referred for pain rehabilitation

    DEFF Research Database (Denmark)

    Jensen, Troels Staehelin

    2012-01-01

    Introduction: Correctly identifying chronic pain patients with posttraumatic stress disorder (PTSD) is important because the comorbidity of a chronic pain condition and PTSD is found to compromise treatment success. In addition, the existence of PTSD is associated with pain sensitisation, elevated...... no gender differences in PTSD. The three most reported traumatic events: traffic accidents, serious illness personally or in the family, and the actual loss of someone, were reported as the primary traumatic events by almost 50% of those with PTSD. No particular pain diagnosis was significantly related...

  19. Successful Treatment of Opioid-Refractory Cancer Pain with Short-Course, Low-Dose Ketamine.

    Science.gov (United States)

    Waldfogel, Julie M; Nesbit, Suzanne; Cohen, Steven P; Dy, Sydney M

    2016-12-01

    Opioids remain the mainstay of treatment for severe cancer pain, but up to 20% of patients have persistent or refractory pain despite rapid and aggressive opioid titration, or develop refractory pain after long-term opioid use. In these scenarios, alternative agents and mechanisms for analgesia should be considered. This case report describes a 28-year-old man with metastatic pancreatic neuroendocrine cancer with severe, intractable pain despite high-dose opioids including methadone and a hydromorphone patient-controlled analgesia (PCA). After treatment with short-course, low-dose ketamine, his opioid requirements decreased by 99% and pain ratings by 50%, with the majority of this decrease occurring in the first 48 hours. As this patient's pain and opioid regimen escalated, he likely experienced some component of central sensitization and hyperalgesia. Administration of ketamine reduced opioid consumption by 99% and potentially "reset" neuronal hyperexcitability and reduced pain signaling, allowing for improved pain control.

  20. Pain Correlates with Sleep Disturbances in Parkinson's Disease Patients.

    Science.gov (United States)

    Fu, Yun-Ting; Mao, Cheng-Jie; Ma, Li-Jing; Zhang, Hui-Jun; Wang, Yi; Li, Jie; Huang, Jun-Ying; Liu, Jun-Yi; Liu, Chun-Feng

    2018-01-01

    Both sleep disorders and pain decrease quality of life in patients with Parkinson's disease (PD). However, little is known about the relationship between objective sleep disturbances and pain in patients with PD. This study aimed to (1) examine the clinical characteristics of pain in PD patients and (2) explore the correlation between pain and sleep disturbances in PD patients. Parkinson's disease patients (N = 144) underwent extensive clinical evaluations of motor and nonmotor symptoms and characteristics of pain. Overnight video-polysomnography was also conducted. Clinical characteristics and sleep parameters were compared between PD patients with or without pain. Pain was reported by 75 patients (52.1%), with 49 (65.3%) reporting pain of at least moderate severity. PD patients with pain were older and had longer disease duration, more severe PD symptoms as assessed by Hoehn and Yahr stage and the Unified Parkinson's Disease Rating Scale, and higher L-dopa equivalent daily dose compared with PD patients without pain. PD patients with pain also showed significantly decreased sleep efficiency (57.06% ± 15.84% vs. 73.80% ± 12.00%, P daily living, depressed mood, higher percentage of N1 sleep, and lower sleep efficiency were independent predictors of pain in patients with PD. Musculoskeletal pain is the most common type of pain in patients with PD. Disrupted sleep continuity, altered sleep architecture, depressed mood, and compromised activities of daily living may be associated with pain in patients with PD. © 2017 World Institute of Pain.

  1. Consideration of pain felt by patients in the ICU.

    Science.gov (United States)

    Hasegawa, Ryuichi

    2017-01-01

    Patients in the ICU are often treated under extreme conditions, with the patient often fearful of losing his life or experiencing severe pain. As a result, high-quality pain management is required. However, response to pain is often inadequate due to continuous administration of sedatives, difficulties in communicating with intubated patients, and/or poor awareness of pain in patients not receiving surgery. Reports on difficulties in pain management in the ICU are many, but few consider the correlation between pain management and patient prognosis. Consequently, consideration on how to implement pain control activities in the ICU to improve patient prognosis is needed.

  2. Pain Threshold Tests in Patients With Heel Pain Syndrome.

    Science.gov (United States)

    Saban, Bernice; Masharawi, Youssef

    2016-07-01

    Pressure pain threshold (PPT) is a useful tool for evaluating mechanical sensitivity in patients suffering from various musculoskeletal disorders. However, no previous study has investigated PPT in the heel of patients experiencing plantar heel pain syndrome (PHPS). The aim of this study was to compare PPT levels and topographic presentation of sensitivity in the heel of patients with PHPS and in healthy controls. The reliability of PPT testing in patients with PHPS was assessed for intra- and interrater recordings. The PPT levels of 40 feet in each group were then assessed on 5 predetermined sites in the heel using a standardized measurement protocol. Patient functional status (FS) as measured by the Foot & Ankle Computerized Adaptive Test was employed as an external reference. Multivariate analysis of covariance revealed no group differences for PPTs at all sites (P = .406). Age (P = .099) or BMI (P = .510) did not affect PPT values, although there was an effect on gender (P = .006). The analysis revealed significant differences between sites (P < .001) demonstrating a diverse topographic distribution. In the PHPS group, PPT levels at the anterior/medial, posterior/medial and central sites were significantly lower than at the posterior/lateral and anterior/lateral sites (P < .05). For the control group, PPT levels at the anterior/medial site were significantly lower than all other sites (P < .001). No significant differences were found between PPT of the PHPS patients and controls, therefore, PPT cannot be recommended as an assessment tool for these patients. The topographic distribution indicated low PPT levels at the anterior/medial area of the heel in patients with PHPS and controls. Level II, comparative study. © The Author(s) 2016.

  3. Predictors of opioid efficacy in patients with chronic pain

    DEFF Research Database (Denmark)

    Grosen, Kasper; Olesen, Anne E; Gram, Mikkel

    2017-01-01

    of life after 14 days of opioid treatment. Secondary outcomes included patient's global impression of clinical change and side effects. Logistic regression models adjusted for age and sex were used to identify biomarkers predictive for successful treatment, defined as at least a 30% reduction in average.......03), relative delta (OR: 0.76; P = 0.03) and beta EEG activity (OR: 1.18; P = 0.04) induced by experimental cold pain. None of the study variables were related to improvement in quality of life. For the first time, individual pain processing characteristics have been linked to opioid response in a mixed chronic...

  4. Implicit associations between pain and self-schema in patients with chronic pain.

    Science.gov (United States)

    Van Ryckeghem, Dimitri M L; De Houwer, Jan; Van Bockstaele, Bram; Van Damme, Stefaan; De Schryver, Maarten; Crombez, Geert

    2013-12-01

    Chronic pain often interferes with daily functioning, and may become a threat to an individual's sense of self. Despite the development of a recent theoretical account focussing upon the relationship between the presence of chronic pain and a person's self, research investigating this idea is limited. In the present study we aimed to (1) compare the strength of association between self- and pain schema in patients with chronic pain and healthy control subjects and (2) research whether the strength of association between self- and pain-schema is related to particular pain-related outcomes and individual differences of patients with chronic pain. Seventy-three patients with chronic pain (M(age) = 49.95; SD = 9.76) and 53 healthy volunteers (M(age) = 48.53; SD = 10.37) performed an Implicit Association Test (IAT) to assess the strength of association between pain- and self-schema. Patients with chronic pain also filled out self-report measures of pain severity, pain suffering, disability, depression, anxiety, acceptance, and helplessness. Results indicated that the pain- and self-schema were more strongly associated in patients with chronic pain than in healthy control subjects. Second, results indicated that, in patients with chronic pain, a stronger association between self- and pain-schema, as measured with the IAT, is related to a heightened level of pain severity, pain suffering, anxiety, and helplessness. Current findings give first support for the use of an IAT to investigate the strength of association between self- and pain-schema in patients with chronic pain and suggest that pain therapies may incorporate techniques that intervene on the level of self-pain enmeshment. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  5. Improving pain assessment and managment in stroke patients.

    Science.gov (United States)

    Nesbitt, Julian; Moxham, Sian; Ramadurai, Gopinath; Williams, Lucy

    2015-01-01

    Stroke patients can experience a variety of pain. Many stroke patients have co-morbidities such as osteoporosis, arthritis or diabetes causing diabetic neuropathy. As well as pain from other long term conditions, stroke patients can experience central post-stroke pain, headaches, and musculoskeletal issues such as hypertonia, contractures, spasticity, and subluxations. These stroke patients can also have communication difficulties in the form of expressive dysphasia and/or global aphasia. Communication difficulties can result in these patients not expressing their pain and therefore not having it assessed, leading to inadequate pain relief that could impact their rehabilitation and recovery. By implementing an observational measurement of pain such as the Abbey pain scale, patients with communication difficulties can have their pain assessed and recorded. Initially 30% of patients on the acute stroke ward did not have their pain assessed and adequately recorded and 15% of patients had inadequate pain relief. The patient was assessed if they were in pain and therefore not receiving adequate pain relief by measuring their pain on the Abbey pain scale. After introducing the Abbey pain scale and creating a nurse advocate, an improvement was shown such that only 5% of patients did not have their pain recorded and all had adequate pain relief.

  6. Spinal cord stimulation for treatment of pain in a patient with post thoracotomy pain syndrome.

    Science.gov (United States)

    Graybill, Jordan; Conermann, Till; Kabazie, Abraham J; Chandy, Sunil

    2011-01-01

    Post Thoracotomy Pain Syndrome (PTPS) is defined as pain that occurs or persists in the area of the thoracotomy incision for at least 2 months following the initial procedure.  The true incidence of PTPS is hard to define as literature reports a wide range of occurrence from 5% to 90%.  Thoracotomy is associated with a high risk of severe chronic postoperative pain.  Presenting symptoms include both neuropathic pain in the area of the incision, as well as myofascial pain commonly in the ipsilateral scapula and shoulder.  Pain management can be challenging in these patients.  Multiple treatments have been described including conservative treatments with oral nonsteroidal anti-inflammatory drugs (NSAIDs); topically applied, peripherally acting drugs; neuromodulating agents; physical therapy; transcutaneous electrical nerve stimulation as well as more invasive treatments including intercostal nerve blocks, trigger point steroid injections, epidural steroid injections, radiofrequency nerve ablation, cryoablation, and one case report of spinal cord stimulation.  Unfortunately, a portion of these patients will have persistent pain in spite of multiple treatment modalities, and in some cases will experience worsening of pain. This case report describes the novel utility and complete resolution of symptoms with spinal cord stimulation (SCS) in treatment of a patient with persistent PTPS. In the operating room, a percutaneous octet electrode lead was placed using sterile technique under fluoroscopic guidance and loss-of-resistance technique.  The octet electrode lead was subsequently advanced with the aid of fluoroscopy to the level of the T3 superior endplate just right of midline.  The patient's pain distribution was captured optimally with stimulation at this level.  With the assistance of a neurosurgeon, the lead was anchored, tunneled, and connected to a generator, which was implanted over the right iliac crest.  The patient tolerated the procedure well with

  7. Psychophysical examination in patients with post-mastectomy pain

    DEFF Research Database (Denmark)

    Gottrup, Hanne; Andersen, Jørn; Arendt-Nielsen, Lars

    2000-01-01

    and contralateral sides in 15 women with spontaneous pain and sensory abnormalities and 11 pain-free women. Testing included the VAS score of spontaneous pain, detection and pain threshold to thermal and mechanical stimuli, temporal summation to repetitive heat and pinprick stimuli, and assessment of skin blood...... to side difference was seen in pressure pain threshold in the pain-free group. Evoked pain intensity to repetitive stimuli at 0.2 and 2.0 Hz was significantly higher on the operated side in pain patients compared to the control area while no such difference was seen in pain-free patients. Cutaneous blood...

  8. Pain management in patients with dementia

    Directory of Open Access Journals (Sweden)

    Achterberg WP

    2013-11-01

    Full Text Available Wilco P Achterberg,1 Marjoleine JC Pieper,2 Annelore H van Dalen-Kok,1 Margot WM de Waal,1 Bettina S Husebo,3 Stefan Lautenbacher,4 Miriam Kunz,4 Erik JA Scherder,5 Anne Corbett6 1Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, 2Department of General Practice and Elderly Care Medicine, VU University Medical Center Amsterdam, Amsterdam, The Netherlands; 3Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; 4Physiological Psychology, Otto Friedrich University Bamberg, Bamberg, Germany; 5Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands; 6Wolfson Centre for Age-Related Diseases, King's College London, London, UK Abstract: There are an estimated 35 million people with dementia across the world, of whom 50% experience regular pain. Despite this, current assessment and treatment of pain in this patient group are inadequate. In addition to the discomfort and distress caused by pain, it is frequently the underlying cause of behavioral symptoms, which can lead to inappropriate treatment with antipsychotic medications. Pain also contributes to further complications in treatment and care. This review explores four key perspectives of pain management in dementia and makes recommendations for practice and research. The first perspective discussed is the considerable uncertainty within the literature on the impact of dementia neuropathology on pain perception and processing in Alzheimer's disease and other dementias, where white matter lesions and brain atrophy appear to influence the neurobiology of pain. The second perspective considers the assessment of pain in dementia. This is challenging, particularly because of the limited capacity of self-report by these individuals, which means that assessment relies in large part on observational methods. A number of tools are available but the psychometric quality and clinical utility of these are

  9. Pain still hurts : pain assessment and pain management in intensive care patients

    NARCIS (Netherlands)

    S.J.G.M. Ahlers (Sabine)

    2012-01-01

    textabstractIntensive care patients are subject to many factors that may influence the patients’ state of comfort or distress. Pain is the main cause of distress experienced by many adult intensive care patients, which can be caused by different factors like underlying disease, prolonged immobility

  10. Ethics of research for patients in pain.

    Science.gov (United States)

    Waisel, David B

    2017-04-01

    This review describes advances in rising and continuing ethical issues in research in patients in pain. Although some of the issues focus directly on pain research, such as research in neonatal pain management, others focus on widespread ethical issues that are relevant to pain research, such as scientific misconduct, deception, placebo use and genomics. Scientific misconduct is more widespread than realized and requires greater awareness of the markers of misconduct like irreproducibility. More education about what qualifies as misconduct, such as consent violations, plagiarism and inappropriate patient recruitment along with data falsification needs to be implemented. Wayward researchers may attend a rehabilitation conference to improve their practices. Studies in neonatal pain management do not require comparing an intervention with the inadequate analgesia of a placebo; comparing with a standard approach is sufficient. Deception of research patients may be acceptable under narrow circumstances. The legitimacy of using broad informed consent for biobanking and genomic studies are being challenged as changes to the Common Rule are being considered. Increasing complexity and the desire to further medical knowledge complicates research methods and informed consent. The ethical issues surrounding these and offshoot areas will continue to develop.

  11. Improving patient satisfaction with pain management using Six Sigma tools.

    Science.gov (United States)

    DuPree, Erin; Martin, Lisa; Anderson, Rebecca; Kathuria, Navneet; Reich, David; Porter, Carol; Chassin, Mark R

    2009-07-01

    Patient satisfaction as a direct and public measure of quality of care is changing the way hospitals address quality improvement. The feasibility of using the Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) methodology to improve patient satisfaction as it relates to pain management was evaluated. This project used the DMAIC methodology to improve patients' overall satisfaction with pain management on two inpatient units in an urban academic medical center. Pre- and postintervention patient surveys were conducted. The DMAIC methodology provided a data-driven structure to determine the optimal improvement strategies, as well as a long-term plan for maintaining any improvements. In addition, the Change Acceleration Process (CAP) was used throughout the project's various DMAIC stages to further the work of the team by creating a shared need to meet the objectives of the project. Overall satisfaction with pain management "excellent" ratings increased from 37% to 54%. Both units surpassed the goal of at least 50% of responses in the "excellent" category. Several key drivers of satisfaction with pain management were uncovered in the Analyze phase of the project, and each saw rating increases from the pre-intervention to postintervention surveys. Ongoing monitoring by the hospital inpatient satisfaction survey showed that the pain satisfaction score improved in subsequent quarters as compared with the pre-intervention period. The Six Sigma DMAIC methodology can be used successfully to improve patient satisfaction. The project led to measurable improvements in patient satisfaction with pain management, which have endured past the duration of the Six Sigma project. The Control phase of DMAIC allows the improvements to be incorporated into daily operations.

  12. 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

  13. A typology of pain coping strategies in pediatric patients with chronic abdominal pain.

    Science.gov (United States)

    Walker, Lynn S; Baber, Kari Freeman; Garber, Judy; Smith, Craig A

    2008-07-15

    This study aimed to identify clinically meaningful profiles of pain coping strategies used by youth with chronic abdominal pain (CAP). Participants (n=699) were pediatric patients (ages 8-18 years) and their parents. Patients completed the Pain Response Inventory (PRI) and measures of somatic and depressive symptoms, disability, pain severity and pain efficacy, and perceived competence. Parents rated their children's pain severity and coping efficacy. Hierarchical cluster analysis based on the 13 PRI subscales identified pain coping profiles in Sample 1 (n=311) that replicated in Sample 2 (n=388). Evidence was found of external validity and distinctiveness of the profiles. The findings support a typology of pain coping that reflects the quality of patients' pain mastery efforts and interpersonal relationships associated with pain coping. Results are discussed in relation to developmental processes, attachment styles, and treatment implications.

  14. Anterior Cutaneous Nerve Entrapment Syndrome in a Pediatric Patient Previously Diagnosed With Functional Abdominal Pain: A Case Report.

    Science.gov (United States)

    DiGiusto, Matthew; Suleman, M-Irfan

    2018-03-23

    Chronic abdominal pain is common in children and adolescents but challenging to diagnose, because practitioners may be concerned about missing serious occult disease. Abdominal wall pain is an often ignored etiology for chronic abdominal pain. Anterior cutaneous nerve entrapment syndrome causes abdominal wall pain but is frequently overlooked. Correctly diagnosing patients with anterior cutaneous nerve entrapment syndrome is important because nerve block interventions are highly successful in the remittance of pain. Here, we present the case of a pediatric patient who received a diagnosis of functional abdominal pain but experienced pain remittance after receiving a trigger-point injection and transverse abdominis plane block.

  15. Spiritual pain among patients with advanced cancer in palliative care.

    Science.gov (United States)

    Mako, Caterina; Galek, Kathleen; Poppito, Shannon R

    2006-10-01

    The large body of empirical research suggesting that patients' spiritual and existential experiences influence the disease process has raised the need for health care professionals to understand the complexity of patients' spiritual pain and distress. The current study explores the multidimensional nature of spiritual pain, in patients with end-stage cancer, in relation to physical pain, symptom severity, and emotional distress. The study combines a quantitative evaluation of participants' intensity of spiritual pain, physical pain, depression, and intensity of illness, with a qualitative focus on the nature of patients' spiritual pain and the kinds of interventions patients believed would ameliorate their spiritual pain. Fifty-seven patients with advanced stage cancer in a palliative care hospital were interviewed by chaplains. Overall, 96% of the patients reported experiencing spiritual pain, but they expressed it in different ways: (1) as an intrapsychic conflict, (2) as interpersonal loss or conflict, or (3) in relation to the divine. Intensity of spiritual pain was correlated with depression (r = 0.43, p spiritual pain did not vary by age, gender, disease course or religious affiliation. Given both the universality of spiritual pain and the multifaceted nature of pain, we propose that when patients report the experience of pain, more consideration be given to the complexity of the phenomena and that spiritual pain be considered a contributing factor. The authors maintain that spiritual pain left unaddressed both impedes recovery and contributes to the overall suffering of the patient.

  16. PAIN INTENSITY AND PAIN INTERFERENCE AMONG TRAUMA PATIENTS: A LITERATURE REVIEW

    Directory of Open Access Journals (Sweden)

    Deya Prastika

    2016-12-01

    Full Text Available Background: The incidence of trauma has been high and has gained attention worldwide. The energy involved in trauma results in specific tissue damage. Such tissue damage generally leads to pain. The high pain intensity possibly is consequence of trauma due to transfer energy to the body from external force and absorbed in wide area. This pain affected patients’ physical and psychological function, in which well known as pain interference. Objective: The aim of this review is to describe the pain intensity and pain interference among trauma patients. Method: A systematic search of electronic databases (CINHAL, ProQuest, Science Direct, and Google scholar was conducted for quantitative and qualitative studies measuring pain intensity and pain interference. The search limited to hospitalized trauma patients in adult age. Results: The search revealed 678 studies. A total of 10 descriptive studies examined pain intensity and pain interference and met inclusion criteria. The pain intensity and pain interference was assessed using Brief Pain Inventory (BPI. Pain intensity of hospitalized trauma patients were moderate to severe. These including 6 studies in orthopedic trauma, one study in musculoskeletal, two in studies in combinational between orthopedic and musculoskeletal, and two studies in burn injury. Moreover, the patients also reported pain was relentless & unbearable. In accordance, data showed that pain interference was moderate to severe from six studies. These studies result in vary of functional interference. However, those studies examined pain interference on sleep, enjoyment of life, mood, relationship with other, walking, general activity, and walking. Conclusion: The evidence from 10 studies included in this review indicates that hospitalized trauma patients perceived moderate to severe pain intensity and pain interference. Further research is needed to better evaluate the pain of hospitalized trauma patients.

  17. Successful emergency pain control for posterior rib fractures with ultrasound-guided erector spinae plane block.

    Science.gov (United States)

    Luftig, Josh; Mantuani, Daniel; Herring, Andrew A; Dixon, Brittany; Clattenburg, Eben; Nagdev, Arun

    2017-12-28

    The Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society Guidelines recommend prompt and effective multimodal analgesia for rib fractures that combines regional anesthesia (RA) techniques with pharmacotherapy to treat pain, optimize pulmonary function, and reduce opioid related complications. However, RA techniques such as epidurals and paravertebral blocks, are generally underutilized or unavailable for emergency department (ED) patients. The recently described serratus anterior plane block (SAPB) is a promising technique, but failures with posterior rib fractures have been observed. The erector spinae plane block (ESPB) is conceptually similar to the SAPB, but targets the posterior thorax making it likely more effective for ED patients with posterior rib fractures. Our initial experience demonstrates consistent success with the ESPB for traumatic posterior rib fracture analgesia. Herein, we present the first description of the ESPB utilized in the ED. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Ability to Cope with Pain Puts Migraine Surgery Patients in Perspective.

    Science.gov (United States)

    Gfrerer, Lisa; Lans, Jonathan; Faulkner, Heather R; Nota, Sjoerd; Bot, Arjan G J; Austen, William Gerald

    2018-01-01

    Candidates for migraine surgery are chronic pain patients with significant disability. Currently, migraine-specific questionnaires are used to evaluate these patients. Analysis tools widely used in evaluation of better understood pain conditions are not typically applied. This is the first study to include a commonly used pain questionnaire, the Pain Self-Efficacy Questionnaire (PSEQ) that is used to determine patients' pain coping abilities and function. It is an important predictor of pain intensity/disability in patients with musculoskeletal pain, as low scores have been associated with poor outcome. Ninety patients were enrolled prospectively and completed the Migraine Headache Index and PSEQ preoperatively and at 12 months postoperatively. Scores were evaluated using paired t tests and Pearson correlation. Representative PSEQ scores for other pain conditions were chosen for score comparison. All scores improved significantly from baseline (p migraine surgery was higher than seen in other pain conditions after treatment (112 percent). Preoperative PSEQ scores did not influence postoperative outcome. The PSEQ successfully demonstrates the extent of debility in migraine surgery patients by putting migraine pain in perspective with other known pain conditions. It further evaluates functional status, rather than improvement in migraine characteristics, which significantly adds to our understanding of outcome. Poor preoperative PSEQ scores do not influence outcome and should not be used to determine eligibility for migraine surgery. Therapeutic, IV.

  19. Do psychological states associate with pain and disability in chronic neck pain patients?

    Science.gov (United States)

    Dimitriadis, Zacharias; Kapreli, Eleni; Strimpakos, Nikolaos; Oldham, Jacqueline

    2015-01-01

    Chronic neck pain is one of the most usual neuromusculoskeletal pain conditions which can lead patients to chronic disability. Similarly to other pain conditions, the changed psychological status of these patients is believed to be associated with their pain condition and disability. However, the association between the psychological status of patients with idiopathic neck pain and their pain intensity and disability is minimally explored. This study was aimed at investigating the association between psychological states (anxiety, depression, kinesiophobia, catastrophizing) of patients with chronic idiopathic neck pain and self-reported pain and disability. Forty five patients with idiopathic chronic neck pain (more than 6 months, at least once a week) participated. Their psychological states were assessed by using the Hospital Anxiety and Depression scale, Pain Catastrophizing scale and Tampa Scale for Kinesiophobia. Self-reported disability was recorded with the Neck Disability Index. Pain intensity was recorded by using a visual analog scale. Neck pain intensity was significantly correlated with anxiety (pneck pain is associated with their self-reported disability, whereas anxiety is also associated with their pain intensity. Anxiety and catastrophizing may be important predicting markers of patients' self-reported disability.

  20. Characteristics of neuropathic pain in patients with spinal cord injury.

    Science.gov (United States)

    Jang, Joon Young; Lee, Seung Hoon; Kim, MinYoung; Ryu, Ju Seok

    2014-06-01

    To characterize neuropathic pain in patients with spinal cord injury (SCI) according to classification used in the study by Baron et al. (Baron classification), a classification of neuropathic pain based on the mechanism. To also compare the patterns of neuropathic pain in SCI patients with those in patients with other etiologies and to determine the differences in patterns of neuropathic pain between the etiologies. This was a descriptive cross-sectional study. We used the Baron classification to investigate the characteristics of neuropathic pain in SCI. Sixty-one SCI patients with neuropathic pain (The Leeds assessment of neuropathic symptoms and signs score ≥12) were enrolled in this study between November 2012 and August 2013, after excluding patients patients with visual analog scale (VAS) score patients, and patients with systemic disease or pain other than neuropathic pain. The most common pain characteristic was pricking pain followed by electrical pain and numbness. The mean VAS score of at-level neuropathic pain was 7.51 and that of below-level neuropathic pain was 6.83. All of the patients suffered from rest pain, but 18 (54.6%) patients with at-level neuropathic pain and 20 (50.0%) patients with below-level neuropathic pain suffered from evoked pain. There was no significant difference in between at-level and below-level neuropathic pains. The result was quite different from the characteristics of post-herpetic neuralgia, but it was similar to the characteristics of diabetic neuropathy as shown in the study by Baron et al., which means that sensory nerve deafferentation may be the most common pathophysiologic mechanism of neuropathic pain after SCI. Since in our study, we included short and discrete symptoms and signs based on diverse mechanisms, our results could be helpful for determining further evaluation and treatment.

  1. Pain, power and patience - A narrative study of general practitioners' relations with chronic pain patients

    OpenAIRE

    Hemborg Kristiansson, Mia; Brorsson, Annika; Wachtler, Caroline; Troein, Margareta

    2011-01-01

    Abstract Background Chronic pain patients are common in general practice. In this study "chronic pain" is defined as diffuse musculoskeletal pain not due to inflammatory diseases or cancer. Effective patient-physician relations improve treatment results. The relationship between doctors and chronic pain patients is often dysfunctional. Consultation training for physicians and medical students can improve the professional ability to build effective relations, but this demands a thorough unders...

  2. Reports of chronic pain in childhood and adolescence among patients at a tertiary care pain clinic.

    Science.gov (United States)

    Hassett, Afton L; Hilliard, Paul E; Goesling, Jenna; Clauw, Daniel J; Harte, Steven E; Brummett, Chad M

    2013-11-01

    Although chronic pain in childhood can last into adulthood, few studies have evaluated the characteristics of adults with chronic pain who report childhood chronic pain. Thus, 1,045 new patients (mean age, 49.5 ± 15.4) at an academic tertiary care pain clinic were prospectively evaluated using validated self-report questionnaires. Patients also responded to questions about childhood pain. We found that almost 17% (n = 176) of adult chronic pain patients reported a history of chronic pain in childhood or adolescence, with close to 80% indicating that the pain in childhood continues today. Adults reporting childhood chronic pain were predominantly female (68%), commonly reported widespread pain (85%), and had almost 3 times the odds of meeting survey criteria for fibromyalgia (odds ratio [OR] = 2.94, 95% confidence interval [CI] = 2.04-4.23) than those denying childhood chronic pain. Similarly, those with childhood pain had twice the odds of having biological relatives with chronic pain (OR = 2.03, 95% CI = 1.39-2.96) and almost 3 times the odds of having relatives with psychiatric illness (OR = 2.85, 95% CI = 1.97-4.11). Lastly, compared to patients who did not report childhood chronic pain, those who did were more likely to use neuropathic descriptors for their pain (OR = 1.82, 95% CI = 1.26-2.64), have slightly worse functional status (B = -2.12, t = -3.10, P = .002), and have increased anxiety (OR = 1.77, 95% CI = 1.24-2.52). Our study revealed that 1 in 6 adult pain patients reported pain that dated back to childhood or adolescence. In such patients, evidence suggested that their pain was more likely to be widespread, neuropathic in nature, and accompanied by psychological comorbidities and decreased functional status. Copyright © 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.

  3. Chronic Pain and PTSD: A Guide for Patients

    Science.gov (United States)

    ... Chronic Pain and PTSD: A Guide for Patients PTSD: National Center for PTSD Menu Menu PTSD PTSD Home For the Public ... here Enter ZIP code here Chronic Pain and PTSD: A Guide for Patients Public This section is ...

  4. Integrative Medicine Patients Have High Stress, Pain, and Psychological Symptoms.

    Science.gov (United States)

    Wolever, Ruth Q; Goel, Nikita S; Roberts, Rhonda S; Caldwell, Karen; Kligler, Benjamin; Dusek, Jeffery A; Perlman, Adam; Dolor, Rowena; Abrams, Donald I

    2015-01-01

    Integrative medicine (IM) is a rapidly growing field whose providers report clinical success in treating significant stress, chronic pain, and depressive and anxiety symptoms. While IM therapies have demonstrated efficacy for numerous medical conditions, IM for psychological symptoms has been slower to gain recognition in the medical community. This large, cross-sectional study is the first of its kind to document the psychosocial profiles of 4182 patients at 9 IM clinics that form the BraveNet Practice-Based Research Network (PBRN). IM patients reported higher levels of perceived stress, pain, and depressive symptoms, and lower levels of quality of life compared with national norms. Per provider reports, 60% of patients had at least one of the following: stress (9.3%), fatigue (10.2%), anxiety (7.7%), depression (7.2%), and/or sleep disorders (4.8%). Pain, having both physiological and psychological components, was also included and is the most common condition treated at IM clinics. Those with high stress, psychological conditions, and pain were most frequently treated with acupuncture, IM physician consultation, exercise, chiropractic services, diet/nutrition counseling, and massage. With baseline information on clinical presentation and service utilization, future PBRN studies can examine promising interventions delivered at the clinic to treat stress and psychological conditions. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Descending volleys generated by efficacious epidural motor cortex stimulation in patients with chronic neuropathic pain

    NARCIS (Netherlands)

    Lefaucheur, Jean-Pascal; Holsheimer, J.; Goujon, Colette; Keravel, Yves; Nguyen, Jean-Paul

    Epidural motor cortex stimulation (EMCS) is a therapeutic option for chronic, drug-resistant neuropathic pain, but its mechanisms of action remain poorly understood. In two patients with refractory hand pain successfully treated by EMCS, the presence of implanted epidural cervical electrodes for

  6. Postoperative pain : Knowledge and beliefs of patients and nurses

    NARCIS (Netherlands)

    van Dijk, Jacqueline Fm; Schuurmans, Marieke J.; Alblas, Eva E.; Kalkman, Cor J.; van Wijck, Albert Jm

    2017-01-01

    Aims and objectives: To describe patients' and nurses' knowledge and beliefs regarding pain management. Moreover, to explore the effect of information and education on patients' and nurses' knowledge and beliefs regarding pain management. Background: In the treatment of postoperative pain, patients'

  7. Postoperative groin pain and success rates following transobturator midurethral sling placement: TVT ABBREVO® system versus TVT™ obturator system.

    Science.gov (United States)

    Canel, Virginie; Thubert, Thibault; Wigniolle, Ingrid; Fernandez, Hervé; Deffieux, Xavier

    2015-10-01

    Placement of a transobturator midurethral sling (MUS) is the standard surgical treatment for stress urinary incontinence. Most recent MUS procedures have been poorly evaluated. We compared the results using a "new" device expected to reduce postoperative pain, the TVT ABBREVO® system (TVT-Abb), with those using the TVT™ obturator system (TVT-O). This was a retrospective study comparing the use of the TVT-Abb (in 50 patients) and the TVT-O (in 50 patients). The main outcomes were the amount of postoperative pain, the success rate (no reported urinary leakage and negative cough test) with both MUS procedures, and the prevalence of complications. The mean follow-up time was 12 months. The preoperative characteristics of the two groups were comparable. There was less postoperative pain (VAS, 0 to 100) in the TVT-Abb group than in the TVT-O group (12.2 vs. 24.4, p TVT-Abb group and the TVT-O group (8 % vs. 12 %, p = 0.74). The prevalences of perioperative and postoperative complications (bladder/urethral injury, haemorrhage) in the two groups were equal. The success rates were similar at 12 months after surgery (88 % vs. 78 %, p = 0.29). The success rates with TVT-Abb and TVT-O were equal at 12 months after surgery, but there was less immediate postoperative pain with TVT-Abb.

  8. Neuropathic Pain Experiences of Spinal Cord Injury Patients.

    Science.gov (United States)

    Li, Chin-Ching; Lin, Hung-Ru; Tsai, Ming-Dar; Tsay, Shiow-Luan

    2017-11-09

    Neuropathic pain (NP) is a common, severe problem that affects spinal cord injury (SCI) patients. Only SCI patients truly understand the impact and extent of this type of pain. The aim of this study was to understand the NP experienced by SCI patients and the influence of this type of pain on their daily life. A qualitative design was used. An interview guide including a semistructured questionnaire and in-depth interviews was conducted with SCI patients with NP in a neurorehabilitation department at a medical center in northern Taiwan. The data were collected using a purposive sampling method. Content analysis was performed on the interview data, which were obtained from 13 SCI patients with NP. Three themes and eight subthemes were identified that described the NP experience of the participants and the influence of NP on their daily life. The three themes included elusive pain (changing and individual pain sensations, erratically haunting threat, and phantom limb sensations), complicated feelings about pain (converting depression into an active attitude toward life, having feelings of anticipation and anxiety about future pain relief, and facing and experiencing pain), and renewed hope (bravely fighting pain and seeking pain relief methods). This study revealed three important themes of NP experienced by SCI patients, including elusive pain, complicated feelings about pain, and renewed hope. Nurses should understand the nature of NP, provide a thorough pain assessment, and design a proper pain management plan to care effectively for patients with NP.

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

    NARCIS (Netherlands)

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

    2015-01-01

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

  10. Aberrant cervical vasculature anastomosis as cause of neck pain and successful treatment with embolization technique.

    Science.gov (United States)

    He, Lucy; Ladner, Travis R; Cobb, Mark; Mocco, J

    2016-01-27

    We report a patient with non-dermatomal radiating neck pain without focal neurologic deficit. Traditional workup could not identify an anatomic or biomechanical cause. Imaging showed a deep cervical vessel centered in the region of pain. Angiography later identified an aberrant anastomosis of this vessel with the occipital artery. Subsequent endovascular embolization of this arterial trunk resulted in complete pain relief. 2016 BMJ Publishing Group Ltd.

  11. MRI in patients with low back pain

    DEFF Research Database (Denmark)

    Jensen, Rikke Krüger; Manniche, Claus; Leboeuf-Yde, Charlotte

    MRI in LBP patients: good or bad? Background: The routine use of radiology is presently discouraged in patients with low back pain (LBP). MRI provides clinicians and patients with detailed knowledge of the spinal structures and has no known physical side effects. It is possible that detailed...... of MRI (the "old" group). As a new approach, all patients with certain criteria are now referred to MRI before the clinical examination (the "new" group).   Objectives: The aims of this study were to investigate if the two different MRI approaches, the "old" and "new", resulted in differences in relation...... to: 1) duration of treatment, 2) number of contacts with clinicians and participation in group exercise, and 3) admission to primary care or another hospital department.   Design: Retrospective inspection of patient files. Method: Files were retrieved from consecutive patients from the "old" and "new...

  12. Measuring pain in patients undergoing hemodialysis: a review of pain assessment tools

    OpenAIRE

    Upadhyay, Chandani; Cameron, Karen; Murphy, Laura; Battistella, Marisa

    2014-01-01

    Background Patients undergoing hemodialysis frequently report pain with multifactorial causes, not limited to that experienced directly from hemodialysis treatment. Their pain may be nociceptive, neuropathic, somatic or visceral in nature. Despite this, pain in this population remains under-recognized and under-treated. Although several tools have been used to measure pain in patients undergoing hemodialysis as reported in the literature, none of them have been validated specifically in this ...

  13. Implementing a pain management nursing protocol for orthopaedic surgical patients: Results from a PAIN OUT project.

    Science.gov (United States)

    Cui, Cui; Wang, Ling-Xiao; Li, Qi; Zaslansky, Ruth; Li, Li

    2018-04-01

    To investigate the effect of introducing a standardised pain management nursing protocol in orthopaedic patients undergoing surgery. Postoperative pain is a common phenomenon but is still undertreated in hospitalised patients. Nurses' lack of sufficient knowledge and skills about pain management may be a contributing factor to poor outcomes. An interventional, separate sample pre- and post-test. A pain management nursing protocol was introduced and a handbook and training sessions regarding management of postsurgical pain were provided to the nurses on a Joint Orthopaedic ward at a university-affiliated general hospital in Guangzhou, China. Before and after the intervention, nurses' knowledge about pain management and attitudes were assessed, and perioperative management practices and pain-related patient-reported outcomes were evaluated. Sixteen and 15 registered nurses, and 77 and 71 patients participated in the study before and after the intervention, respectively. Nurses' scores related to knowledge and skills increased significantly after the protocol was introduced but were still insufficient with regard to pharmacological-related items. The proportion of patients receiving a combined opioid and nonopioid increased after the intervention. Clinically significant changes were observed in some patient-reported outcomes, such as worst pain since surgery, percentage of time experiencing severe pain, and pain interference with activities out of bed. There were significant changes in nonpharmacological methods administered by nurses to patients or used by patients to relieve pain. Implementation of a pain management nursing protocol combined with education in one surgical ward was associated with nurses' increased knowledge and attitudes regarding pain, a change in some management practices, and improvement in a number of pain-related patient-reported outcomes. It was feasible to develop and implement a standardised pain management nursing protocol and use it in the

  14. Are Pain-Related Fears Mediators for Reducing Disability and Pain in Patients with Complex Regional Pain Syndrome Type 1? An Explorative Analysis on Pain Exposure Physical Therapy

    Science.gov (United States)

    Barnhoorn, Karlijn J.; Staal, J. Bart; van Dongen, Robert T. M.; Frölke, Jan Paul M.; Klomp, Frank P.; van de Meent, Henk; Samwel, Han; Nijhuis-van der Sanden, Maria W. G.

    2015-01-01

    Objective To investigate whether pain-related fears are mediators for reducing disability and pain in patients with Complex Regional Pain Syndrome type 1 when treating with Pain Exposure Physical Therapy. Design An explorative secondary analysis of a randomised controlled trial. Participants Fifty-six patients with Complex Regional Pain Syndrome type 1. Interventions The experimental group received Pain Exposure Physical Therapy in a maximum of five treatment sessions; the control group received conventional treatment following the Dutch multidisciplinary guideline. Outcome measures Levels of disability, pain, and pain-related fears (fear-avoidance beliefs, pain catastrophizing, and kinesiophobia) were measured at baseline and after 3, 6, and 9 months follow-up. Results The experimental group had a significantly larger decrease in disability of 7.77 points (95% CI 1.09 to 14.45) and in pain of 1.83 points (95% CI 0.44 to 3.23) over nine months than the control group. The potential mediators pain-related fears decreased significantly in both groups, but there were no significant differences between groups, which indicated that there was no mediation. Conclusion The reduction of pain-related fears was comparable in both groups. We found no indication that pain-related fears mediate the larger reduction of disability and pain in patients with Complex Regional Pain Syndrome type 1 treated with Pain Exposure Physical Therapy compared to conventional treatment. Trial registration International Clinical Trials Registry NCT00817128 PMID:25919011

  15. Cancer Pain Management Education Rectifies Patients' Misconceptions of Cancer Pain, Reduces Pain, and Improves Quality of Life.

    Science.gov (United States)

    Koh, Su-Jin; Keam, Bhumsuk; Hyun, Min Kyung; Ju Seo, Jeong; Uk Park, Keon; Oh, Sung Yong; Ahn, Jinseok; Lee, Ja Youn; Kim, JinShil

    2018-03-26

    More than half of the patients have reported improper management of breakthrough cancer pain. Empirical evidence is lacking concerning the effectiveness of cancer pain education on breakthrough pain control. This study aimed to examine the effects of individual pain education on pain control, use of short-acting analgesics for breakthrough pain, quality of life outcomes, and rectification of patients' misconceptions regarding cancer pain. A quasi-experimental design was used. In total, 176 (102 inpatients and 74 outpatients) and 163 (93 inpatients and 70 outpatients) cancer patients completed questionnaires on pain intensity, quality of life, use of short-acting medication for breakthrough pain, and misconceptions about cancer pain and opioid use before and immediately and/or seven days after individual pain education. The mean age of the participants was 60.9 years (±11.2), and 56.3% were male. The most common cancers were lung cancer (17.0%), colon cancer (15.9%), and breast cancer (12.5%). The subjects' reasons for attrition were conditional deterioration, death, or voluntary withdrawal (N = 13, 7.4%). Following the education, there was a significant reduction in overall pain intensity over 24 hours (P < 0.001). The outpatients showed more use of short-acting analgesics for breakthrough pain. Sleep quality change was most significantly associated with intervention; other quality of life aspects (e.g., general feelings and life enjoyment) also improved. Pain education also significantly reduced misconceptions regarding cancer pain management. The present educational intervention was effective in encouraging short-acting analgesic use for breakthrough pain, improving quality of life outcomes, and rectifying patients' misconceptions about analgesic use.

  16. A comprehensive Fabry-related pain questionnaire for adult patients.

    Science.gov (United States)

    Üçeyler, Nurcan; Magg, Barbara; Thomas, Phillip; Wiedmann, Silke; Heuschmann, Peter; Sommer, Claudia

    2014-11-01

    Pain may be the earliest symptom in Fabry disease and presents with a distinct phenotype including triggerable pain attacks, evoked pain, pain crises, and chronic pain. Current pain questionnaires do not reflect the special phenotype of Fabry disease-associated pain, which hampers its systematic evaluation as the basis of correct diagnosis and effective treatment. A questionnaire specifically designed to assess Fabry disease-associated pain is thus urgently needed. At the Würzburg Fabry Center for Interdisciplinary Therapy (FAZIT), Germany, we developed and validated the first face-to-face Fabry Pain Questionnaire (FPQ) for adult patients. The initial version of the FPQ was tested in a pilot study with 20 consecutive Fabry disease patients. The performance of the revised FPQ was assessed in a first (n=56) and second (n=20) validation phase in consecutive Fabry disease patients. For this, patients were interviewed at baseline and 2 weeks later. We determined the test-retest reliability and validity of the FPQ in comparison to data obtained with the Neuropathic Pain Symptom Inventory. The FPQ contains 15 questions on the 4 pain phenotypes of Fabry disease (pain attacks, pain crises, evoked pain, chronic pain) in childhood and adulthood, on pain development during life with and without enzyme replacement therapy, and on everyday life impairment due to pain. This first disease-specific questionnaire is a valuable tool for baseline and follow-up assessment of pain in Fabry disease patients and may guide treatment in this distinct pain phenotype. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  17. Differential pain modulation in patients with peripheral neuropathic pain and fibromyalgia.

    Science.gov (United States)

    Gormsen, Lise; Bach, Flemming W; Rosenberg, Raben; Jensen, Troels S

    2017-12-29

    Background The definition of neuropathic pain has recently been changed by the International Association for the Study of Pain. This means that conditions such as fibromyalgia cannot, as sometimes discussed, be included in the neuropathic pain conditions. However, fibromyalgia and peripheral neuropathic pain share common clinical features such as spontaneous pain and hypersensitivity to external stimuli. Therefore, it is of interest to directly compare the conditions. Material and methods In this study we directly compared the pain modulation in neuropathic pain versus fibromyalgia by recording responses to a cold pressor test in 30 patients with peripheral neuropathic pain, 28 patients with fibromyalgia, and 26 pain-free age-and gender-matched healthy controls. Patients were asked to rate their spontaneous pain on a visual analog scale (VAS (0-100 mm) immediately before and immediately after the cold pressor test. Furthermore the duration (s) of extremity immersion in cold water was used as a measure of the pain tolerance threshold, and the perceived pain intensity at pain tolerance on the VAS was recorded on the extremity in the water after the cold pressor test. In addition, thermal (thermo tester) and mechanical stimuli (pressure algometer) were used to determine sensory detection, pain detection, and pain tolerance thresholds in different body parts. All sensory tests were done by the same examiner, in the same room, and with each subject in a supine position. The sequence of examinations was the following: (1) reaction time, (2) pressure thresholds, (3) thermal thresholds, and (4) cold pressor test. Reaction time was measured to ensure that psychomotoric inhibitions did not influence pain thresholds. Results Pain modulation induced by a cold pressor test reduced spontaneous pain by 40% on average in neuropathic pain patients, but increased spontaneous pain by 2.6% in fibromyalgia patients. This difference between fibromyalgia and neuropathic pain patients was

  18. Pressure pain thresholds, clinical assessment, and differential diagnosis: reliability and validity in patients with myogenic pain.

    Science.gov (United States)

    Ohrbach, R; Gale, E N

    1989-11-01

    Four studies are presented testing the validity and reliability of pressure pain thresholds (PPTs) and of examination parameters believed to be important in the clinical assessment of sites commonly used for such measures in patient samples. Forty-five patients with a myogenous temporomandibular disorder were examined clinically prior to PPT measures. Criteria for history and examination included functional aspects of the pain, tissue quality of the pain site, and the type of pain elicited from palpation. Control sites within the same muscle and in the contralateral muscle were also examined. PPTs were measured as an index of tenderness using a strain gauge algometer at these sites. The data from the 5 male subjects were excluded from subsequent analyses due to the higher PPT in the males and to their unequal distribution among the various factorial conditions. The first study demonstrated strong validity in PPT measures between patients (using pain sites replicating the patients' pain) and matched controls (n = 11). The PPT was not significantly different between the primary pain site (referred pain and non-referred pain collapsed) and the no-pain control site in the same muscle (n = 16). The PPT was significantly lower at the pain site compared to the no-pain control site in the contralateral muscle (n = 13). The second study indicated adequate reliability in patient samples of the PPT measures. In the third study, the PPT was significantly lower at sites producing referred pain on palpation compared to sites producing localized pain on palpation. The PPT findings from the control sites were inconsistent on this factor. The fourth study presented preliminary evidence that palpable bands and nodular areas in muscle were most commonly associated with muscle regions that produce pain; such muscle findings were not specific, however, for regions that produce pain. Further, the intraexaminer reliability in reassessing these pain sites qualitatively was only fair

  19. Surgical management of symptomatic low back pain and monoradicular leg pain in adolescent and young adult patients

    Directory of Open Access Journals (Sweden)

    Kalevski Svetoslav

    2014-07-01

    Full Text Available Objectives: The purpose of the present retrospective study is to draw attention to symptomatic low back pain in adolescent patients, in order to encourage earlier diagnosis and surgical treatment. The study assessed the radiological, clinical features and surgical outcomes of 13of this kind of patient. Materials and Methods: Out of a series of 983 consecutive cases (1999-2011 of lumbar disc excisions from our neurosurgical institution, 13-1,32% of the patients were between the ages of 15 and 20 mean 17,84. Fifteen operations, including two reoperations, were performed on this patient group, by a conventional microsurgical procedure. The indications for surgery were failure of conservative treatment, intractable pain and/or progressive neurological impairment. Results: Low back pain and monoradicular sciatica were the main complaints in 77%, but findings of neurological deficits were rare - 1 case. The surgical findings revealed a protruding disc in eleven cases, one lateral recess stenosis and one lumbar synovial cyst. Initially, all patients were treated conservatively by their physicians more than 3 months without success. On the day of discharge, Kirkaldy-Willis criteria results were excellent or good in 92% of patients. The follow-up period ranged from 6 months to 2 years with an average of 1 year and 2 months. The results were excellent in 10 patients and good in 3 patients. Discussion: We demonstrate that the cause of low back pain and monoradicular leg pain in adolescent patients may not only be a cause of herniated lumbar disc or lateral recess narrowing. Very rarely these symptoms may be caused by lumbar synovial cysts. Conclusion: Surgical treatment of adolescent patients is able to relieve the clinical symptoms quickly. Clinical symptoms such as low back pain and leg pain and the neurologic deficit disappear within 3 months after surgery.

  20. SURGICAL MANAGEMENT OF SYMPTOMATIC LOW BACK PAIN AND MONORADICULAR LEG PAIN IN ADOLESCENT AND YOUNG ADULT PATIENTS

    Directory of Open Access Journals (Sweden)

    Kalevski Svetoslav

    2014-07-01

    Full Text Available Objectives: The purpose of the present retrospective study is to draw attention to symptomatic low back pain in adolescent patients, in order to encourage earlier diagnosis and surgical treatment. The study assessed the radiological, clinical features and surgical outcomes of 13 of this kind of patient. Materials and Methods: Out of a series of 983 consecutive cases (1999–2011 of lumbar disc excisions from our neurosurgical institution, 13–1,32% of the patients were between the ages of 15 and 20 mean 17,84. Fifteen operations, including two reoperations,were performed on this patient group, by a conventional microsurgical procedure. The indications for surgery were failure of conservative treatment, in tractable pain and/or progressive neurological impairment. Results: Low back pain and monoradicular sciatica were the main complaints in 77%, but findings of neurological deficits were rare — 1 case. The surgical findings revealed a protruding disc in eleven cases, one lateral recess stenosis and one lumbar synovial cyst. Initially, all patients were treated conservatively by their physicians more than 3 months without success. On the day of discharge, Kirkaldy-Willis criteria results were excellent or good in 92% of patients. The follow-up period ranged from 6 months to 2 years with an average of 1 year and 2 months. The results were excellent in 10 patients and good in 3 patients. Discussion: We demonstrate that the cause of low back pain and monoradicular leg pain in adolescent patients may not only be a cause of herniated lumbar disc or lateral recess narrowing. Very rarely these symptoms may be caused by lumbar synovial cysts. Conclusion: Surgical treatment of adolescent patients is able to relieve the clinical symptoms quickly. Clinical symptoms such as low back pain and leg pain and the neurologic deficit disappear within 3 months after surgery.

  1. Cognitive function in patients with chronic pain treated with opioids

    DEFF Research Database (Denmark)

    Kurita, G P; de Mattos Pimenta, C A; Braga, P E

    2012-01-01

    The paucity of studies regarding cognitive function in patients with chronic pain, and growing evidence regarding the cognitive effects of pain and opioids on cognitive function prompted us to assess cognition via neuropsychological measurement in patients with chronic non-cancer pain treated...

  2. 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

  3. Abnormal pain perception in patients with Multiple System Atrophy.

    Science.gov (United States)

    Ory-Magne, F; Pellaprat, J; Harroch, E; Galitzsky, M; Rousseau, V; Pavy-Le Traon, A; Rascol, O; Gerdelat, A; Brefel-Courbon, C

    2018-03-01

    Patients with Parkinson's disease or Multiple System Atrophy frequently experience painful sensations. The few studies investigating pain mechanisms in Multiple System Atrophy patients have reported contradictory results. In our study, we compared pain thresholds in Multiple System Atrophy and Parkinson's disease patients and healthy controls and evaluated the effect of l-DOPA on pain thresholds. We assessed subjective and objective pain thresholds (using a thermotest and RIII reflex), and pain tolerance in OFF and ON conditions, clinical pain, motor and psychological evaluation. Pain was reported in 78.6% of Multiple System Atrophy patients and in 37.5% of Parkinson's disease patients. In the OFF condition, subjective and objective pain thresholds were significantly lower in Multiple System Atrophy patients than in healthy controls (43.8 °C ± 1.3 vs 45.7 °C ± 0.8; p = 0.0005 and 7.4 mA ± 3.8 vs 13.7 mA ± 2.8; p = 0.002, respectively). They were also significantly reduced in Multiple System Atrophy compared to Parkinson's disease patients. No significant difference was found in pain tolerance for the 3 groups and in the effect of l-DOPA on pain thresholds in Multiple System Atrophy and Parkinson's disease patients. In the ON condition, pain tolerance tended to be reduced in Multiple System Atrophy versus Parkinson's disease patients (p = 0.05). Multiple System Atrophy patients had an increase in pain perception compared to Parkinson's disease patients and healthy controls. The l-DOPA effect was similar for pain thresholds in Multiple System Atrophy and Parkinson's disease patients, but tended to worsen pain tolerance in Multiple System Atrophy. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Effects of Spinal Cord Stimulation on Pain Thresholds and Sensory Perceptions in Chronic Pain Patients.

    Science.gov (United States)

    Ahmed, Shihab U; Zhang, Yi; Chen, Lucy; St Hillary, Kristin; Cohen, Abigail; Vo, Trang; Houghton, Mary; Mao, Jianren

    2015-07-01

    Spinal cord stimulation (SCS) has been in clinical use for nearly four decades. In earliest observations, researchers found a significant increase in pain threshold during SCS therapy without changes associated with touch, position, and vibration sensation. Subsequent studies yielded diverse results regarding how SCS impacts pain and other sensory thresholds. This pilot study uses quantitative sensory testing (QST) to objectively quantify the impact of SCS on warm sensation, heat pain threshold, and heat pain tolerance. Nineteen subjects with an indwelling SCS device for chronic pain were subjected to QST with heat stimuli. QST was performed on an area of pain covered with SCS-induced paresthesia and an area without pain and without paresthesia, while the SCS was turned off and on. The temperature at which the patient detected warm sensation, heat pain, and maximal tolerable heat pain was used to define the thresholds. We found that all three parameters, the detection of warm sensation, heat pain threshold, and heat pain tolerance, were increased during the period when SCS was on compared with when it was off. This increase was observed in both painful and non-painful sites. The observed pain relief during SCS therapy seems to be related to its impact on increased sensory threshold as detected in this study. The increased sensory threshold on areas without pain and without the presence of SCS coverage may indicate a central (spinal and/or supra-spinal) influence from SCS. © 2015 International Neuromodulation Society.

  5. Postural balance in low back pain patients

    DEFF Research Database (Denmark)

    Maribo, Thomas; Stengaard-Pedersen, Kristian; Jensen, Lone Donbæk

    2011-01-01

    Low back pain (LBP) patients have poorer postural control compared to healthy controls, and the importance of assessing and addressing balance is a matter of debate. In the clinic, balance is often tested by means of the one leg stand test (OLST) while research often employs center of pressure (Co......P) on a force platform. Portable force platforms might be of clinical relevance, but their reliability for LBP patients in a clinical setting has not been demonstrated. As LBP patients are more dependent on vision compared to healthy controls, the ratio of tests performed with eyes open and eyes closed (Romberg...... Ratio) might be of clinical interest. This study aimed to assess postural balance in LBP patients by analyzing intra-session reliability of CoP parameters on a portable force platform, the Romberg Ratio, and the OLST. Furthermore, we aimed to determine whether CoP parameters and OLST measure identical...

  6. Pain in neurosurgically treated patients: A prospective observational study

    NARCIS (Netherlands)

    M. Klimek (Markus); J.F. Ubben (Johannes); J. Ammann (Jan); K. Borner (Katy); J. Klein (Jan); S.J.C. Verbrugge (Serge)

    2006-01-01

    textabstractObject. This is the first observational study to compare perioperative pain character and intensity in patients undergoing different types of elective neurosurgical procedures. Methods. A structured questionnaire was used to inquire about pain intensity, character, and management during

  7. Myofascial Pain in Patients Waitlisted for Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Richard Henry

    2012-01-01

    Full Text Available BACKGROUND: Knee pain is one of the major sources of pain and disability in developed countries, particularly in aging populations, and is the primary indication for total knee arthroplasty (TKA in patients with osteoarthritis (OA.

  8. Extensive Validation of the Pain Disability Index in 3 Groups of Patients With Musculoskeletal Pain

    NARCIS (Netherlands)

    Soer, Remko; Koke, Albere J. A.; Vroomen, C.A.J.; Stegeman, Patrick; Smeets, Rob J. E. M.; Coppes, Maarten H.; Reneman, Michiel F.

    2013-01-01

    Study Design. A cross-sectional study design was performed. Objective. To validate the pain disability index (PDI) extensively in 3 groups of patients with musculoskeletal pain. Summary of Background Data. The PDI is a widely used and studied instrument for disability related to various pain

  9. Cognitive-emotional sensitization contributes to wind-up-like pain in phantom limb pain patients

    DEFF Research Database (Denmark)

    Vase, Lene; Nikolajsen, Lone; Christensen, Bente

    2011-01-01

    ). Catastrophizing accounted for 35% of the variance in phantom limb pain (p=0.001) independently of anxiety and depression. Catastrophizing was also positively associated with wind-up-like pain in non-medicated patients (p=0.015), but not to pain thresholds. These findings suggest that cognitive-emotional...

  10. Pain in patients with chronic fatigue syndrome: time for specific pain treatment?

    NARCIS (Netherlands)

    Nijs, J.; Crombez, G.; Meeus, M.; Knoop, H.; Damme, S.V.; Cauwenbergh, V.; Bleijenberg, G.

    2012-01-01

    BACKGROUND: Besides chronic fatigue, patients with chronic fatigue syndrome (CFS) have debilitating widespread pain. Yet pain from CFS is often ignored by clinicians and researchers. OBJECTIVES: To examine whether pain is a unique feature of CFS, or does it share the same underlying mechanisms as

  11. Increased pain sensitivity in accident-related chronic pain patients with comorbid posttraumatic stress

    DEFF Research Database (Denmark)

    Vaegter, Henrik Bjarke; Andersen, Tonny Elmose; Harvold, Mathea

    2018-01-01

    , anxiety, pain catastrophizing, and fear of movement) in patients with accident-related chronic spinal pain with (N=44) and without (N=64) comorbid PTSD characteristics. METHODS: Cuff algometry was performed on lower legs to assess pressure pain threshold (cPPT), tolerance (cPTT), temporal summation...

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

    OpenAIRE

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

    2006-01-01

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

  13. Musculoskeletal pain in patients with myotonic dystrophy type 2.

    Science.gov (United States)

    George, Annette; Schneider-Gold, Christiane; Zier, Sandra; Reiners, Karlheinz; Sommer, Claudia

    2004-12-01

    Myotonic dystrophy type 2/proximal myotonic myopathy (DM2/PROMM) is an autosomal dominant multisystem disorder. Musculoskeletal pain is one of its frequent symptoms but also occurs in other chronic noninflammatory muscle disorders (OMD). To characterize the phenotype of DM2/PROMM-associated musculoskeletal pain and to test whether it shows features distinct from OMD. Outpatient clinic for patients with neuromuscular disorders, university hospital. Twenty-four patients with DM2/PROMM (12 women and 12 men; median age, 57 years) and 24 age- and sex-matched patients with OMD consecutively recruited during a 3-year period were examined for musculoskeletal pain. Standardized pain assessment; McGill Pain Questionnaire; depression score; and quantification of pain thresholds to blunt pressure on limb muscles with analgometer. Unlike patients with OMD who have musculoskeletal pain, patients with DM2/PROMM distinguished a wide spectrum of coexisting pain types. The major pain type in patients with DM2/PROMM was exercise-related, temperature-modulated, and palpation-induced, whereas, cramps were rare. In 8 of the patients with DM2/PROMM and in 3 of the patients with OMD, musculoskeletal pain was the most disabling symptom. Besides many similarities, DM2/PROMM-associated musculoskeletal pain shows features distinct from OMD.

  14. Painful Memories: Reliability of Pain Intensity Recall at 3 Months in Senior Patients

    Directory of Open Access Journals (Sweden)

    Raoul Daoust

    2017-01-01

    Full Text Available Background. Validity of pain recall is questioned in research. Objective. To evaluate the reliability of pain intensity recall for seniors in an emergency department (ED. Methods. This study was part of a prospective multicenter project for seniors (≥65 years old treated in an ED for minor traumatic injury. Pain intensity (0–10 numerical rating scale was evaluated at the initial ED visit, at one week (baseline, and 3 months. At three months, patients were asked to recall the pain intensity they had at baseline. Results. 482 patients were interviewed (mean age 76.6 years, SD ± 7.3 and 72.8% were female. Intraclass correlation coefficient between pain at baseline and its recall was 0.24 (95% CI: 0.14–0.33. Senior patients tended to overestimate their pain intensity by a mean of 1.2 (95% CI: 0.9–1.5 units. A stepwise multiple regression analysis showed that the variance of baseline pain recall at 3 months was explained by pain at ED visit (11%, pain at 3 months (7%, and pain at baseline (2%. Conclusion. The accuracy of pain intensity recall after three months is poor in seniors and seems to be influenced by the pain experienced at the time of injury.

  15. Pain relief that matters to patients

    DEFF Research Database (Denmark)

    Olsen, Mette Frahm; Bjerre, Eik; Hansen, Maria Damkjær

    2017-01-01

    BACKGROUND: 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...... 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...

  16. Severe back pain a cirrhotic patient : a diagnostic challenge

    Directory of Open Access Journals (Sweden)

    Ioana Stănescu

    2018-05-01

    Full Text Available Spondylodiscitis is an infection of the intervertebral disc space, involves the vertebrae, causing vertebral osteomyelitis and spread to adjacent epidural space, causing dural, radicular or spinal cord compression. Appears mainly in adult and immunocompromised patients, mainly by haematogenous inoculation from systemic infections with bacteriemia. Patients with hepatic cirrhosis have frequent bacteriemias, produced by increased gut permeability, immune dysfunction and frequent need for invasive procedures. Despite high frequency of blood stream infections, discitis and vestebral osteomyelitis are rarely reported. We present the case of a 53 years old woman, diagnosed with class B Child Pugh cirrhosis, which presents with intense back pain and cauda equina syndrome, without clinical signs of infection. Diagnosis was confirmed by spinal MRI, but very soon after treatment onset, the patient suffered a septic shock with haemodynamic instability, which leads to patient’s death. This case illustrates how an unusual complication of cirrhosis – bacteriemia - could precipitate the unfavorable evolution of the patient by producing a remote septic complication. Persistent back pain in a cirrhotic patient should also raise the hypothesis of an infectious cause, in which early management is essential. Early diagnosis in essential for successful treatment, and good prognosis after long-term antibiotic treatment can be achieved in the majority of patients.

  17. Attenuation of Experimental Pain by Vibro-Tactile Stimulation in Patients with Chronic Local or Widespread Musculoskeletal Pain

    OpenAIRE

    Staud, Roland; Robinson, Michael E.; Goldman, Casey T.; Price, Donald D.

    2011-01-01

    Patients with chronic pain syndromes, like fibromyalgia (FM) complain of widespread pain and tenderness, as well as non-refreshing sleep, cognitive dysfunction, and negative mood. Several lines of evidence implicate abnormalities of central pain processing as contributors for chronic pain, including dysfunctional descending pain inhibition. One form of endogenous pain inhibition, diffuse noxious inhibitory controls (DNIC), has been found to be abnormal in some chronic pain patients and eviden...

  18. Pain cognition versus pain intensity in patients with endometriosis: toward personalized treatment.

    Science.gov (United States)

    van Aken, Mieke A W; Oosterman, Joukje M; van Rijn, C M; Ferdek, Magdalena A; Ruigt, Gé S F; Peeters, B W M M; Braat, Didi D M; Nap, Annemiek W

    2017-10-01

    To explore how pain intensity and pain cognition are related to health-related quality of life (HRQoL) in women with endometriosis. Cross-sectional questionnaire-based survey. Multidisciplinary referral center. Women with laparoscopically and/or magnetic resonance imaging-proven endometriosis (n = 50) and healthy control women (n = 42). For HRQoL, two questionnaires: the generic Short Form Health Survey (SF-36) and the Endometriosis Health Profile 30 (EHP-30). For pain cognition, three questionnaires: the Pain Catastrophizing Scale (PCS), the Pain Vigilance and Awareness Questionnaire (PVAQ), and the Pain Anxiety Symptoms Scale (PASS). For pain intensity, the verbal Numeric Rating Scale (NRS). Association between pain intensity and pain cognition with HRQoL in women with endometriosis, and the differences in HRQoL and pain cognition between women with endometriosis and healthy controls. Health-related quality of life was statistically significantly impaired in women with endometriosis as compared with healthy control women. The variables of pain intensity and pain cognition were independent factors influencing the HRQoL of women with endometriosis. Patients with endometriosis had statistically significantly more negative pain cognition as compared with controls. They reported more pain anxiety and catastrophizing, and they were hypervigilant toward pain. Pain cognition is independently associated with the HRQoL in endometriosis patients. Clinicians should be aware of this phenomenon and may consider treating pain symptoms in a multidimensional, individualized way in which the psychological aspects are taken into account. In international guidelines on management of women with endometriosis more attention should be paid to the psychological aspects of care. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  19. Dopaminergic tone does not influence pain levels during placebo interventions in patients with chronic neuropathic pain.

    Science.gov (United States)

    Skyt, Ina; Moslemi, Kurosh; Baastrup, Cathrine; Grosen, Kasper; Benedetti, Fabrizio; Petersen, Gitte L; Price, Donald D; Hall, Kathryn T; Kaptchuk, Ted J; Svensson, Peter; Jensen, Troels S; Vase, Lene

    2017-10-23

    Placebo effects have been reported in patients with chronic neuropathic pain. Expected pain levels and positive emotions are involved in the observed pain relief, but the underlying neurobiology is largely unknown. Patients with neuropathic pain are highly motivated for pain relief, and as motivational factors such as expectations of reward, as well as pain processing in itself, are related to the dopaminergic system, it can be speculated that dopamine release contributes to placebo effects in neuropathic pain. Nineteen patients with neuropathic pain after thoracic surgery were tested during a placebo intervention consisting of open and hidden applications of the pain-relieving agent lidocaine (2 mL) and no treatment. The dopamine antagonist haloperidol (2 mg) and the agonist levodopa/carbidopa (100/25 mg) were administered to test the involvement of dopamine. Expected pain levels, desire for pain relief, and ongoing and evoked pain were assessed on mechanical visual analog scales (0-10). Significant placebo effects on ongoing (P ≤ 0.003) and evoked (P ≤ 0.002) pain were observed. Expectancy and desire accounted for up to 41.2% and 71.5% of the variance in ongoing and evoked pain, respectively, after the open application of lidocaine. We found no evidence for an effect of haloperidol and levodopa/carbidopa on neuropathic pain levels (P = 0.071-0.963). Dopamine seemed to influence the levels of expectancy and desire, yet there was no evidence for indirect or interaction effects on the placebo effect. This is the first study to suggest that dopamine does not contribute to placebo effects in chronic neuropathic pain.

  20. Can consistent benchmarking within a standardized pain management concept decrease postoperative pain after total hip arthroplasty? A prospective cohort study including 367 patients.

    Science.gov (United States)

    Benditz, Achim; Greimel, Felix; Auer, Patrick; Zeman, Florian; Göttermann, Antje; Grifka, Joachim; Meissner, Winfried; von Kunow, Frederik

    2016-01-01

    The number of total hip replacement surgeries has steadily increased over recent years. Reduction in postoperative pain increases patient satisfaction and enables better mobilization. Thus, pain management needs to be continuously improved. Problems are often caused not only by medical issues but also by organization and hospital structure. The present study shows how the quality of pain management can be increased by implementing a standardized pain concept and simple, consistent, benchmarking. All patients included in the study had undergone total hip arthroplasty (THA). Outcome parameters were analyzed 24 hours after surgery by means of the questionnaires from the German-wide project "Quality Improvement in Postoperative Pain Management" (QUIPS). A pain nurse interviewed patients and continuously assessed outcome quality parameters. A multidisciplinary team of anesthetists, orthopedic surgeons, and nurses implemented a regular procedure of data analysis and internal benchmarking. The health care team was informed of any results, and suggested improvements. Every staff member involved in pain management participated in educational lessons, and a special pain nurse was trained in each ward. From 2014 to 2015, 367 patients were included. The mean maximal pain score 24 hours after surgery was 4.0 (±3.0) on an 11-point numeric rating scale, and patient satisfaction was 9.0 (±1.2). Over time, the maximum pain score decreased (mean 3.0, ±2.0), whereas patient satisfaction significantly increased (mean 9.8, ±0.4; p benchmarking a standardized pain management concept. But regular benchmarking, implementation of feedback mechanisms, and staff education made the pain management concept even more successful. Multidisciplinary teamwork and flexibility in adapting processes seem to be highly important for successful pain management.

  1. [Qualitative research on pain experiences of adult burn patients].

    Science.gov (United States)

    Li, L; Pan, Q; Xu, L; Lin, R Q; Dai, J X; Chen, Z H

    2018-03-20

    Objective: To explore the pain experiences of adult burn patients so as to lay foundation for practical analgesic measures. Methods: Using phenomenological method in qualitative research, semi-structured interviews were conducted on 12 adult burn patients hospitalized in our burn units from May to November 2015, aiming at pain experiences from immediately after burns to 3 to 7 months after being discharged from hospital. Then the Colaizzi's analysis method was applied to analyze, induce, and refine themes of interview data. Results: After analysis, pain experiences of adult burn patients were generalized into 6 themes: deep pain experiences, heavy psychological burden, limited daily life, poor assessment and treatment of pain, different attributions of pain, and different ways of coping of pain. Conclusions: Burn pain brings harm to the patients' physiology, mentality, and daily life. Nevertheless, pain processing modes of medical staff and patients themselves are the key factors affecting patients' pain experiences. Therefore, according to the deficiency of current situation of pain management, the targeted analgesic intervention measures should be carried out from the perspectives of medical staff and patients.

  2. A comparison of coping strategies in patients with fibromyalgia, chronic neuropathic pain, and pain-free controls

    DEFF Research Database (Denmark)

    Baastrup, Sidsel; Schultz, Rikke; Brødsgaard, Inger

    2016-01-01

    different groups of chronic pain patients and a group of healthy controls. Thirty neuropathic pain (NP) patients, 28 fibromyalgia (FM) patients, and 26 pain-free healthy controls completed the Coping Strategy Questionnaire (CSQ-48/27) and rated their daily pain. The results showed that FM and NP patients...

  3. Neuropathic pain and use of PainDETECT in patients with fibromyalgia: a cohort study.

    Science.gov (United States)

    Gauffin, Jarno; Hankama, Tiina; Kautiainen, Hannu; Hannonen, Pekka; Haanpää, Maija

    2013-02-14

    Fibromyalgia has a plethorae of symptoms, which can be confusing and even misleading. Accurate evaluation is necessary when patients with fibromyalgia are treated. Different types of instruments are available for the clinicians to supplement evaluation. Our objective was to study the applicability of the PainDETECT instrument to screen neuropathic pain in patients with fibromyalgia. 158 patients with primary fibromyalgia underwent a neurological examination including bedside sensory testing. They also fulfilled four questionnaires: PainDETECT, Beck depression inventory IA (BDI IA), Fibromyalgia Impact Questionnaire (FIQ) and a self-made questionnaire regarding present pain and pain relieving methods of the patients. The results of the clinical evaluation and questionnaires were then compared. Clinically verified neuropathic pain was diagnosed in 53/158 [34% (95% Cl: 26 to 41)] patients. The ROC curve achieved a maximum Youden´s index at score of 17 when sensitivity was 0.79 (95% Cl: 0.66 to 0.89) and specificity 0.53 (95% Cl: 0.43 to 0.63). The PainDETECT total score (OR: 1.14 95% Cl: 1.06 to 1.22), FM as the worst current pain (OR: 0.31; 95% 0.16 to 0.62), body mass index (BMI) (OR: 1.05; 95% Cl: 1.00 to 1.11) and the intensity of current pain (OR: 1.20; 95% Cl: 1.01 to 1.41) were significantly associated with the presence of neuropathic pain in univariate analyses. This study highlights the importance of thorough clinical examination. The Neuropathic pain screening tool PainDETECT is not as useful in patients with fibromyalgia as in patients with uncompromised central pain control.

  4. Neuropathic pain and use of PainDETECT in patients with fibromyalgia: a cohort study

    Directory of Open Access Journals (Sweden)

    Gauffin Jarno

    2013-02-01

    Full Text Available Abstract Backround Fibromyalgia has a plethorae of symptoms, which can be confusing and even misleading. Accurate evaluation is necessary when patients with fibromyalgia are treated. Different types of instruments are available for the clinicians to supplement evaluation. Our objective was to study the applicability of the PainDETECT instrument to screen neuropathic pain in patients with fibromyalgia. Methods 158 patients with primary fibromyalgia underwent a neurological examination including bedside sensory testing. They also fulfilled four questionnaires: PainDETECT, Beck depression inventory IA (BDI IA, Fibromyalgia Impact Questionnaire (FIQ and a self-made questionnaire regarding present pain and pain relieving methods of the patients. The results of the clinical evaluation and questionnaires were then compared. Results Clinically verified neuropathic pain was diagnosed in 53/158 [34% (95% Cl: 26 to 41] patients. The ROC curve achieved a maximum Youden´s index at score of 17 when sensitivity was 0.79 (95% Cl: 0.66 to 0.89 and specificity 0.53 (95% Cl: 0.43 to 0.63. The PainDETECT total score (OR: 1.14 95% Cl: 1.06 to 1.22, FM as the worst current pain (OR: 0.31; 95% 0.16 to 0.62, body mass index (BMI (OR: 1.05; 95% Cl: 1.00 to 1.11 and the intensity of current pain (OR: 1.20; 95% Cl: 1.01 to 1.41 were significantly associated with the presence of neuropathic pain in univariate analyses. Conclusion This study highlights the importance of thorough clinical examination. The Neuropathic pain screening tool PainDETECT is not as useful in patients with fibromyalgia as in patients with uncompromised central pain control.

  5. Hypoalgesia after exercise and the cold pressor test is reduced in chronic musculuskeletal pain patients with high pain sensitivity

    DEFF Research Database (Denmark)

    Vægter, Henrik Bjarke; Handberg, Gitte; Graven-Nielsen, Thomas

    2016-01-01

    OBJECTIVES: In chronic pain patients, impaired conditioned pain modulation (CPM) and exercise-induced hypoalgesia (EIH) have been reported. No studies have compared CPM and EIH in chronic musculoskeletal pain patients with high pain sensitivity (HPS) and low pain sensitivity (LPS). MATERIALS.......005). Pain tolerance increased after the cold pressor test and exercise in both groups (PCPM and EIH were partly impaired in chronic pain patients with high versus less pain sensitivity, suggesting that the CPM and EIH responses depend on the degree of pain sensitivity. This has clinical...

  6. Pain patterns and descriptions in patients with radicular pain: Does the pain necessarily follow a specific dermatome?

    Directory of Open Access Journals (Sweden)

    Hurwitz Eric L

    2009-09-01

    Full Text Available Abstract Background It is commonly stated that nerve root pain should be expected to follow a specific dermatome and that this information is useful to make the diagnosis of radiculopathy. There is little evidence in the literature that confirms or denies this statement. The purpose of this study is to describe and discuss the diagnostic utility of the distribution of pain in patients with cervical and lumbar radicular pain. Methods Pain drawings and descriptions were assessed in consecutive patients diagnosed with cervical or lumbar nerve root pain. These findings were compared with accepted dermatome maps to determine whether they tended to follow along the involved nerve root's dermatome. Results Two hundred twenty-six nerve roots in 169 patients were assessed. Overall, pain related to cervical nerve roots was non-dermatomal in over two-thirds (69.7% of cases. In the lumbar spine, the pain was non-dermatomal in just under two-thirds (64.1% of cases. The majority of nerve root levels involved non-dermatomal pain patterns except C4 (60.0% dermatomal and S1 (64.9% dermatomal. The sensitivity (SE and specificity (SP for dermatomal pattern of pain are low for all nerve root levels with the exception of the C4 level (Se 0.60, Sp 0.72 and S1 level (Se 0.65, Sp 0.80, although in the case of the C4 level, the number of subjects was small (n = 5. Conclusion In most cases nerve root pain should not be expected to follow along a specific dermatome, and a dermatomal distribution of pain is not a useful historical factor in the diagnosis of radicular pain. The possible exception to this is the S1 nerve root, in which the pain does commonly follow the S1 dermatome.

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

    Science.gov (United States)

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

    2018-06-12

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

  8. Postoperative pain: knowledge and beliefs of patients and nurses.

    Science.gov (United States)

    van Dijk, Jacqueline Fm; Schuurmans, Marieke J; Alblas, Eva E; Kalkman, Cor J; van Wijck, Albert Jm

    2017-11-01

    To describe patients' and nurses' knowledge and beliefs regarding pain management. Moreover, to explore the effect of information and education on patients' and nurses' knowledge and beliefs regarding pain management. In the treatment of postoperative pain, patients' and nurses' inadequate knowledge and erroneous beliefs may hamper the appropriate use of analgesics. A randomised controlled trial and a cross-sectional study. In 2013, half of 760 preoperative patients were allocated to the intervention group and received written information about the complications of postoperative pain. The knowledge and beliefs of 1184 nurses were studied in 2014 in a cross-sectional study. All data were collected with the same questionnaires. In the intervention group, patients' knowledge level was significant higher than in the control group, while no differences were found in beliefs. Nurses had higher knowledge and more positive beliefs towards pain management compared with both patient groups. Nurses with additional pain education scored better than nurses without additional pain education. Nurses were also asked what percentage of pain scores matched their impression of the patient's pain, and the mean was found to be 63%. Written information was effective for increasing patients' knowledge. However, it was not effective for changing beliefs about analgesics and patients and nurses had erroneous beliefs about analgesics. It is necessary to continue to inform patients and nurses about the need for analgesics after surgery. Such education could also emphasise that a discrepancy between a patient's reported pain score and the nurse's own assessment of the patient's pain should prompt a discussion with the patient about his/her pain. © 2017 John Wiley & Sons Ltd.

  9. American Society for Pain Management Nursing Position Statement: Pain Management in Patients with Substance Use Disorders

    OpenAIRE

    Oliver, June; Coggins, Candace; Compton, Peggy; Hagan, Susan; Matteliano, Deborah; Stanton, Marsha; St. Marie, Barbara; Strobbe, Stephen; Turner, Helen N.

    2012-01-01

    The American Society for Pain Management Nursing (ASPMN) has updated its position statement on managing pain in patients with substance use disorders. This position statement is endorsed by the International Nurses Society on Addictions (IntNSA) and includes clinical practice recommendations based on current evidence. It is the position of ASPMN and IntNSA that every patient with pain, including those with substance use disorders, has the right to be treated with dignity, respect, and high qu...

  10. Addiction to opioids in chronic pain patients: a literature review

    DEFF Research Database (Denmark)

    Højsted, Jette; Sjøgren, Per

    2007-01-01

    , incidence and prevalence of addiction in opioid treated pain patients, screening tools for assessing opioid addiction in chronic pain patients and recommendations regarding addiction problems in national and international guidelines for opioid treatment in cancer patients and chronic non-malignant pain...... patients. The review indicates that the prevalence of addiction varied from 0% up to 50% in chronic non-malignant pain patients, and from 0% to 7.7% in cancer patients depending of the subpopulation studied and the criteria used. The risk of addiction has to be considered when initiating long-term opioid...... treatment as addiction may result in poor pain control. Several screening tools were identified, but only a few were thoroughly validated with respect to validity and reliability. Most of the identified guidelines mention addiction as a potential problem. The guidelines in cancer pain management...

  11. Patients with Concomitant Chronic Neck Pain and Myofascial Pain in Masticatory Muscles Have More Widespread Pain and Distal Hyperalgesia than Patients with Only Chronic Neck Pain.

    Science.gov (United States)

    Muñoz-García, Daniel; López-de-Uralde-Villanueva, Ibai; Beltrán-Alacreu, Héctor; La Touche, Roy; Fernández-Carnero, Josué

    2017-03-01

    Insufficient evidence exists to compare widespread pain (WP), pain sensibility, and psychological factors that occur in patients presenting with chronic neck pain (CNP) or a combination of temporomandibular disorder (TMD) and other complaints. The present study compared the pain sensibility and psychological factors of subjects with CNP with those with TMD + CNP. Cross-sectional study. Local community. A nonprobabilistic convenience sample of 86 persons with CNP or TMD was recruited into three groups: CNP, TMD with myofascial pain in masticatory muscles with cocomitant CNP (TMD + CNP), and asymptomatic control groups consisted of 27, 29, and 30 participants, respectively. Participants underwent a clinical examination to evaluate WP with computerized assessment based on the pain drawing, pressure pain thresholds (PPT), and psychological factors, which were evaluated using the pain catastrophizing scale (PCS) and the state-trait anxiety inventory (STAI). Statistically significant differences were observed between participants with CNP and TMD + CNP for WP (t = -2.80, P  < 0.01, d = -1.06). Post hoc analyses only revealed significant differences between TMD + CNP participants and asymptomatic controls for PPT at extratrigeminal areas. Pearson correlation analyses showed a moderate positive association between symptomatic groups within the WP and STAI ( P  < 0.05) and a moderate negative association between PCS and PPT ( P  < 0.05) at the right tibialis muscle. TMD + CNP participants had more areas of pain and also showed widespread pain hyperalgesia. Both groups of participants had psychological factors positively associated with STAI and WP; further, PCS and the PPT at the extratrigeminal region were negatively associated with each other in both groups, except for the left tibialis in the TMD + CNP group. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  12. Patient satisfaction with a pilot chronic pain management programme in Cape Town, South Africa

    Directory of Open Access Journals (Sweden)

    R. Parker

    2009-01-01

    Full Text Available Background: The goals of a chronic pain management clinic includeincreasing patient knowledge about pain, developing pain management skillsand increasing patients’ confidence in their pain management abilities.A  Chronic Pain Management Programme (CPMP based on evidence basedguidelines was developed at a chronic pain management clinic to facilitatepatient discharge to a primary healthcare level. Aim: The aim of this study was to explore patient satisfaction with, acceptability of and the perceived success which could be due to the CPMP developed at the Chronic Pain Management Clinic of Groote Schuur Hospital,Cape Town.Methods: Patients (n=14 were referred to the pilot study from the Chronic Pain Management Clinic. A s a pilot, four courses were run over a period ofone year. In order to reach the research aim, an eleven-question, structuredopen-ended interview was conducted with all participants. Results: Fourteen patients enrolled in the CPMP. Responses were favourable with participants emphasising the roleof increased knowledge about pain, the role of exercise and of stress management techniques. Participants also recog-nised a positive change in behaviours and attitudes following participation in the CPMP.Conclusions: Findings suggest that participants found the format of the course acceptable as regards course content,structure and delivery. Participant responses suggest that the course was acceptable and perceived as useful. However,future courses would benefit from refresher courses or structured support groups.

  13. Differences in pain processing between patients with chronic low back pain, recurrent low back pain and fibromyalgia

    OpenAIRE

    Goubert, Dorien; Danneels, Lieven; Graven-Nielsen, Thomas; Descheemaeker, Filip; Coppieters, Iris; Meeus, Mira

    2017-01-01

    Background: The impairment in musculoskeletal structures in patients with low back pain (LBP) is often disproportionate to their complaint. Therefore, the need arises for exploration of alternative mechanisms contributing to the origin and maintenance of non-specific LBP. The recent focus has been on central nervous system phenomena in LBP and the pathophysiological mechanisms underlying the various symptoms and characteristics of chronic pain. Knowledge concerning changes in pain processing ...

  14. Two similar cases of elderly women with moderate abdominal pain and pneumoperitoneum of unknown origin: a surgeon's successful conservative management.

    Science.gov (United States)

    Vinzens, Fabrizio; Zumstein, Valentin; Bieg, Christian; Ackermann, Christoph

    2016-05-26

    Patients presenting with abdominal pain and pneumoperitoneum in radiological examination usually require emergency explorative laparoscopy or laparotomy. Pneumoperitoneum mostly associates with gastrointestinal perforation. There are very few cases where surgery can be avoided. We present 2 cases of pneumoperitoneum with unknown origin and successful conservative treatment. Both patients were elderly women presenting to our emergency unit, with moderate abdominal pain. There was neither medical intervention nor trauma in their medical history. Physical examination revealed mild abdominal tenderness, but no clinical sign of peritonitis. Cardiopulmonary examination remained unremarkable. Blood studies showed only slight abnormalities, in particular, inflammation parameters were not significantly increased. Finally, obtained CTs showed free abdominal gas of unknown origin in both cases. We performed conservative management with nil per os, nasogastric tube, total parenteral nutrition and prophylactic antibiotics. After 2 weeks, both were discharged home. 2016 BMJ Publishing Group Ltd.

  15. A Study on the Correlation between Pain and Pain Anxiety during Wound Care in Burn Patients

    Directory of Open Access Journals (Sweden)

    Seyed Reza Mazlom

    2017-05-01

    Full Text Available Background and Objectives: Wound care in burn patients is associated with severe anxiety that is characterized by feeling of fear and prediction of burn dressing pain. The purpose of this study was to determine the correlation between pain and pain anxiety in burn patients. Methods: In this descriptive-analytical study, 60 eligible patients hospitalized in men’s and women’s burn wards of Mashhad Imam Reza Hospital, were selected using available sampling. Pain anxiety and pain severity were measured using self-report pain anxiety questionnaire and visual analog scale, respectively, before and after burn dressing during three weeks (once a week. Data were analyzed by descriptive statistics and Pearson correlation test. Results: In this study, there was a significant linear correlation between pain and pain anxiety in the first week (r=0.512, p<0.001, but there was no significant linear correlation between these variables in the second (r=0.079, p=0.547 and third (r=0.167, p=0.203 weeks. Conclusion: According to the results of this study, assessment and treatment of pain anxiety are essential elements of pain care and management in burn patients.            

  16. Multi-centre European study of breakthrough cancer pain: pain characteristics and patient perceptions of current and potential management strategies

    DEFF Research Database (Denmark)

    Davies, Andrew; Zeppetella, Giovambattista; Andersen, Steen

    2011-01-01

    This study involved 320 cancer patients from four Northern European countries. Patients with breakthrough pain were questioned about the characteristics of their pain, the current management of their pain, and the acceptability/utility of alternative routes of administration. The median number...... of episodes was 3/day. Forty-four percent patients reported incident-type pain, 39% spontaneous-type pain, and 17% a combination of these pains. The median duration was 60 min, and the median time to peak intensity was 15 min. Three percent patients reported "mild" pain, 37% "moderate" pain, and 60% "severe......" pain. Ninety percent patients stated that the pain interfered with their daily activities. All patients were using opioids as rescue medication (mainly oral morphine/oxycodone), whilst 28% patients were using non-opioids, and 50% patients were using non-pharmacological interventions. Only 55% patients...

  17. Differences in Pain Processing Between Patients with Chronic Low Back Pain, Recurrent Low Back Pain, and Fibromyalgia.

    Science.gov (United States)

    Goubert, Dorien; Danneels, Lieven; Graven-Nielsen, Thomas; Descheemaeker, Filip; Meeus, Mira

    2017-05-01

    The impairment in musculoskeletal structures in patients with low back pain (LBP) is often disproportionate to their complaint. Therefore, the need arises for exploration of alternative mechanisms contributing to the origin and maintenance of non-specific LBP. The recent focus has been on central nervous system phenomena in LBP and the pathophysiological mechanisms underlying the various symptoms and characteristics of chronic pain. Knowledge concerning changes in pain processing in LBP remains ambiguous, partly due to the diversity in the LBP population. The purpose of this study is to compare quantitative sensory assessment in different groups of LBP patients with regard to chronicity. Recurrent low back pain (RLBP), mild chronic low back pain (CLBP), and severe CLBP are compared on the one hand with healthy controls (HC), and on the other hand with fibromyalgia (FM) patients, in which abnormal pain processing has previously been reported. Cross-sectional study. Department of Rehabilitation Sciences, Ghent University, Belgium. Twenty-three RLBP, 15 mild CLBP, 16 severe CLBP, 26 FM, and 21 HC participated in this study. Quantitative sensory testing was conducted by manual pressure algometry and computer-controlled cuff algometry. A manual algometer was used to evaluate hyperalgesia as well as temporal summation of pain and a cuff algometer was used to evaluate deep tissue hyperalgesia, the efficacy of the conditioned pain modulation and spatial summation of pain. Pressure pain thresholds by manual algometry were significantly lower in FM compared to HC, RLBP, and severe CLBP. Temporal summation of pain was significantly higher in FM compared to HC and RLBP. Pain tolerance thresholds assessed by cuff algometry were significantly lower in FM compared to HC and RLBP and also in severe CLBP compared to RLBP. No significant differences between groups were found for spatial summation or conditioned pain modulation. No psychosocial issues were taken into account for this

  18. 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

  19. Leveraging Interactive Patient Care Technology to Improve Pain Management Engagement.

    Science.gov (United States)

    Rao-Gupta, Suma; Kruger, David; Leak, Lonna D; Tieman, Lisa A; Manworren, Renee C B

    2017-12-15

    Most children experience pain in hospitals; and their parents report dissatisfaction with how well pain was managed. Engaging patients and families in the development and evaluation of pain treatment plans may improve perceptions of pain management and hospital experiences. The aim of this performance improvement project was to engage patients and families to address hospitalized pediatric patients' pain using interactive patient care technology. The goal was to stimulate conversations about pain management expectations and perceptions of treatment plan effectiveness among patients, parents, and health care teams. Plan-Do-Study-Act was used to design, develop, test, and pilot new workflows to integrate the interactive patient care technology system with the automated medication dispensing system and document actions from both systems into the electronic health record. The pediatric surgical unit and hematology/oncology unit of a free-standing, university-affiliated, urban children's hospital were selected to pilot this performance improvement project because of the high prevalence of pain from surgeries and hematologic and oncologic diseases, treatments, and invasive procedures. Documentation of pain assessments, nonpharmacologic interventions, and evaluation of treatment effectiveness increased. The proportion of positive family satisfaction responses for pain management significantly increased from fiscal year 2014 to fiscal year 2016 (p = .006). By leveraging interactive patient care technologies, patients and families were engaged to take an active role in pain treatment plans and evaluation of treatment outcomes. Improved active communication and partnership with patients and families can effectively change organizational culture to be more sensitive to patients' pain and patients' and families' hospital experiences. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  20. Pain volatility and prescription opioid addiction treatment outcomes in patients with chronic pain.

    Science.gov (United States)

    Worley, Matthew J; Heinzerling, Keith G; Shoptaw, Steven; Ling, Walter

    2015-12-01

    The combination of prescription opioid dependence and chronic pain is increasingly prevalent and hazardous to public health. Variability in pain may explain poor prescription opioid addiction treatment outcomes in persons with chronic pain. This study examined pain trajectories and pain volatility in patients with chronic pain receiving treatment for prescription opioid addiction. We conducted secondary analyses of adults with chronic pain (n = 149) who received buprenorphine/naloxone (BUP/NLX) and counseling for 12 weeks in an outpatient, multisite clinical trial. Good treatment outcome was defined as urine-verified abstinence from opioids at treatment endpoint (Week 12) and during at least 2 of the previous 3 weeks. Pain severity significantly declined over time during treatment (b = -0.36, p opioid dependence. Patients with greater volatility in subjective pain during treatment have increased risk of returning to opioid use by the conclusion of an intensive treatment with BUP/NLX and counseling. Future research should examine underlying mechanisms of pain volatility and identify related therapeutic targets to optimize interventions for prescription opioid addiction and co-occurring chronic pain. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  1. Migraine pain location in adult patients from eastern India

    Directory of Open Access Journals (Sweden)

    Chakravarty Ambar

    2008-01-01

    Full Text Available Background: Sparse literature documenting the location of pain at the onset of migraine attacks and during established headaches is available. Objectives: A prospective study (2003-05 on 800 adult migraine patients (International Classifications of Headache Disorders (ICHD, 2:1.1, 1.2.1 and 1.6.1 was conducted to document (a sites of onset of pain and (b location of pain during established attacks (in> 50% occasions through semistructured interviews. Results: Demography: N = 800; M:F = 144:656 (1:4.56; age, 16-42 years (mean, 26 years; duration of migraine, 1-18 years (mean, 6.8 years. 87% of the subjects were ethnic Bengalis from the eastern Indian state of West Bengal, Calcutta being the capital city. Migraine types (on the basis of> 50% headache spells: N = 800; 1.1:668 (83.5%; 1.2.1:18 (2.25%; 1.6.1:114 (14.25%. Location of pain at onset: Unilateral onset was present in 41.38% of the patients; of these, 53.17% had eye pain; 8.16%, frontal pain and 38.67%, temporal pain. In 32.25% of the patients, bilateral/central location of pain, mostly bitemporal or at vertex was noted. Cervico-occipital pain onset was noted in 26.43% patients (predominantly occipital, 14.68%; predominantly cervical, 11.75%. Location of established headaches: In 47.4% of the patients, with unilateral ocular or temporal onset, pain remained at the same site. Pain became hemicranial in 32.9%. In most patients, unilateral frontal onset pain (55.5% became bilateral or holocranial. Most bilateral ocular (69.4% and temporal onset (69.7% pains remained at the same location. However, most bifrontal (55.6% and vertex onset (56.9% pains subsequently became holocranial. Most occipital pains at onset became holocranial (45.3%, but cervical pains subsequently became either hemicranial (38.3% or holocranial (36.2%. Conclusions: This study documents location of pain at the onset and during established headaches in migraine patients largely from a specific ethnic group. Migraine with

  2. Prediction of pain in orthodontic patients based on preoperative pain assessment

    Science.gov (United States)

    Zheng, Baoyu; Ren, Manman; Lin, Feiou; Yao, Linjie

    2016-01-01

    Aim To investigate whether pretreatment assessment of experimental pain can predict the level of pain after archwire placement. Methods One hundred and twenty-one general university students seeking orthodontic treatment were enrolled in this study. A cold pressor test was performed to estimate the pain tolerance of subjects before treatment. Self-reported pain intensity was calculated using a 10 cm visual analog scale during the 7 days after treatment. The relationship between pain tolerance and orthodontic pain was analyzed using Spearman’s correlation analysis. Results The maximum mean level of pain intensity occurred at 24 hours after bonding (53.31±16.13) and fell to normal levels at day 7. Spearman’s correlation analysis found a moderate positive association between preoperative pain tolerance and self-reported pain after archwire placement (P0.05). Conclusion A simple and noninvasive preoperative sensory test (the cold pressor test) was useful in predicting the risk of developing unbearable pain in patients after archwire placement. Self-reported pain after archwire placement decreased as individual pain tolerance increased. PMID:27042019

  3. Cognitive Impairment in Patients with Chronic Neuropathic or Radicular Pain: An Interaction of Pain and Age

    Directory of Open Access Journals (Sweden)

    Orla Moriarty

    2017-06-01

    Full Text Available A growing body of empirical research has confirmed an association between chronic pain and cognitive dysfunction. The aim of the present study was to determine whether cognitive function is affected in patients with a diagnosis of chronic neuropathic or radicular pain relative to healthy control participants matched by age, gender, and years of education. We also examined the interaction of pain with age in terms of cognitive performance. Some limitations of previous clinical research investigating the effects of chronic pain on cognitive function include differences in the pain and cognitive scale materials used, and the heterogeneity of patient participants, both in terms of their demographics and pathological conditions. To address these potential confounds, we have used a relatively homogenous patient group and included both experimental and statistical controls. We have also specifically investigated the interaction effect of pain and age on cognitive performance. Patients (n = 38 and controls (n = 38 were administered a battery of cognitive tests measuring IQ, spatial and verbal memory, attention, and executive function. Educational level, depressive symptoms, and state anxiety were assessed as were medication usage, caffeine, and nicotine consumption to control for possible confounding effects. Both the level of depressive symptoms and the state anxiety score were higher in chronic pain patients than in matched control participants. Chronic pain patients had a lower estimated IQ than controls, and showed impairments on measures of spatial and verbal memory. Attentional responding was altered in the patient group, possibly indicative of impaired inhibitory control. There were significant interactions between chronic pain condition and age on a number of cognitive outcome variables, such that older patients with chronic pain were more impaired than both age-matched controls and younger patients with chronic pain. Chronic pain did not appear

  4. Lidocaine patches reduce pain in trauma patients with rib fractures.

    Science.gov (United States)

    Zink, Karen A; Mayberry, John C; Peck, Ellen G; Schreiber, Martin A

    2011-04-01

    Rib fracture pain is notoriously difficult to manage. The lidocaine patch is effective in other pain scenarios with an excellent safety profile. This study assesses the efficacy of lidocaine patches for treating rib fracture pain. A prospectively gathered cohort of patients with rib fracture was retrospectively analyzed for use of lidocaine patches. Patients treated with lidocaine patches were matched to control subjects treated without patches. Subjective pain reports and narcotic use before and after patch placement, or equivalent time points for control subjects, were gathered from the chart. All patients underwent long-term follow-up, including a McGill Pain Questionnaire (MPQ). Twenty-nine patients with lidocaine patches (LP) and 29 matched control subjects (C) were analyzed. During the 24 hours before patch placement, pain scores and narcotic use were similar (LP 5.3, C 4.6, P = 0.19 and LP 51, C 32 mg morphine, P = 0.17). In the 24 hours after patch placement, LP patients had a greater decrease in pain scores (LP 1.2, C 0.0, P = 0.01) with no change in narcotic use (LP -8.4, C 0.5-mg change in morphine, P = 0.25). At 60 days, LP patients had a lower MPQ pain score (LP 7.7, C 12.2, P rib fracture pain. Lidocaine patches resulted in a sustained reduction in pain, outlasting the duration of therapy.

  5. Overgeneral autobiographical memory in patients with chronic pain.

    Science.gov (United States)

    Liu, Xianhua; Liu, Yanling; Li, Li; Hu, Yiqiu; Wu, Siwei; Yao, Shuqiao

    2014-03-01

    Overgenerality and delay of the retrieval of autobiographical memory (AM) are well documented in a range of clinical conditions, particularly in patients with emotional disorder. The present study extended the investigation to chronic pain, attempting to identify whether the retrieval of AM in patients with chronic pain tends to be overgeneral or delayed. With an observational cross-sectional design, we evaluated the AM both in patients with chronic pain and healthy controls by Autobiographical Memory Test. Pain conditions were assessed using the pain diagnostic protocol, the short-form McGill Pain Questionnaire (SF-MPQ), and the Pain Self-Efficacy Questionnaire (PSEQ). Emotion was assessed using the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory. Subjects included 176 outpatients with chronic pain lasting for at least 6 months and 170 healthy controls. 1) Compared with the healthy group, the chronic pain group had more overgeneral memories (OGMs) (F = 29.061, P OGM were significant (P OGM scores could be predicted by the BDI score (9.7%), pain chronicity (4.3%), PSEQ score (7.1%), and Affective Index (of SF-MPQ) score (2.7%). 3) In the chronic pain group, the stepwise multiple regression models for variables predicting latency were significant (P < 0.05). Specifically, the variance in latency could be predicted by age (3.1%), pain chronicity (2.7%), pain duration (4.3%), and PSEQ score (2.0%). The retrieval of AM in patients with chronic pain tends to be overgeneral and delayed, and the retrieval style of AM may be contributed to negative emotions and chronic pain conditions. Wiley Periodicals, Inc.

  6. Pronociceptive pain modulation in patients with painful chemotherapy-induced polyneuropathy.

    Science.gov (United States)

    Nahman-Averbuch, Hadas; Yarnitsky, David; Granovsky, Yelena; Sprecher, Elliot; Steiner, Mariana; Tzuk-Shina, Tzahala; Pud, Dorit

    2011-08-01

    Several chemotherapy agents induce polyneuropathy that is painful for some patients, but not for others. We assumed that these differences might be attributable to varying patterns of pain modulation. The aim of the present study was to evaluate pain modulation in such patients. Twenty-seven patients with chemotherapy-induced polyneuropathy were tested for detection thresholds (cold, warm, and mechanical) in both the forearm and foot, as well as for heat pain threshold, mechanical temporal summation (TS), and conditioned pain modulation (CPM; also known as the diffuse noxious inhibitory control-like effect), which were tested in the upper limbs. Positive correlations were found between clinical pain levels and both TS (r=0.52, P=0.005) and CPM (r=0.40, P=0.050) for all patients. In addition, higher TS was associated with less efficient CPM (r=0.56, P=0.004). The group of patients with painful polyneuropathy (n=12) showed a significantly higher warm detection threshold in the foot (P=0.03), higher TS (P<0.01), and less efficient CPM (P=0.03) in comparison to the group with nonpainful polyneuropathy. The painfulness of polyneuropathy is associated with a "pronociceptive" modulation pattern, which may be primary to the development of pain. The higher warm sensory thresholds in the painful polyneuropathy group suggest that the severity of polyneuropathy may be another factor in determining its painfulness. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  7. Rehabilitation of scoliosis patients with pain after surgery.

    Science.gov (United States)

    Weiss, Hans-Rudolf

    2002-01-01

    In our centre, the postoperative scoliosis rehabilitation consists in stabilizing postural and respiratory exercises lasting several hours a day (5 1/2 to 7 hours). Additionally to pain treatment, we apply pain physiotherapy, physical therapy, acupuncture and besides manual medicine, also a psychological intervention and pain treatment by medication. 46 patients suffered from heavier pain 10 or more years after scoliosis surgery. The patients reported their pain at the beginning and at the end of 3-6 week in-patient rehabilitation programme. We applied a visual analogous scale (VAS), a numerical scale (NS), a standardized adjective scale (VRS), and a pain frequency scale. All the patients with an average age of 36 years old (SD=16) and an average curve angle of 35 degrees thoracic (SD=36) and 26 degrees lumbar (SD=22) showed a decrease of the values on the pain intensity scale. Pain reduction was highly significant, as well as pain frequency. Chronic pain as a late result following scoliosis surgery can be reduced by an intensive in-patient rehabilitation, at least in the short term. There are further necessary studies in order to follow-up the long-term effect of postoperative rehabilitation.

  8. Pelvic pain syndrome - successful treatment by ovarian vein embolization : a case report

    International Nuclear Information System (INIS)

    Yun, Ji Young; Hahn, Seong Tai; Lee, Jae Mun; Kim, Choon Yul; Yim, Jung Ik; Jang, Jae Soon; Kim, Sang Woo; Kim Jae Kwang; Sun, Hee Sik; Shinn, Kyung Sub

    1998-01-01

    Pelvic pain syndrome or pelvic congestion syndrome, with no apparent organic cause, is a common gynecological disorder. Ovarian varix, one of the causes of this syndrome, presents a difficult diagnostic and therapeutic problem, though surgical ligation of the ovarian vein is an effective method of treatment. although ovarian vein embolization has been recently developed as a useful alternative, no previous reports have described this procedure in Korea. We report a case of pelvic pain syndrome successfully treated by ovarian vein embolization. (author). 10 refs., 3 figs

  9. The effects of music therapy on pain in patients with neuropathic pain.

    Science.gov (United States)

    Korhan, Esra Akın; Uyar, Meltem; Eyigör, Can; Hakverdioğlu Yönt, Gülendam; Çelik, Serkan; Khorshıd, Leyla

    2014-03-01

    The aim of this study was to investigate the effect of relaxing music on pain intensity in patients with neuropathic pain. A quasi-experimental study, repeated measures design was used. Thirty patients, aged 18-70 years, with neuropathic pain and hospitalized in an Algology clinic were identified as a convenience sample. Participants received 60 minutes of music therapy. Classical Turkish music was played to patients using a media player (MP3) and headphones. Participants had pain scores taken immediately before the intervention and at the 30th and 60th minutes of the intervention. Data were collected over a 6-month period in 2012. The patients' mean pain intensity scores were reduced by music, and that decrease was progressive over the 30th and 60th minutes of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of music therapy in the routine care of patients with neuropathic pain could provide nurses with an effective practice for reducing patients' pain intensity. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  10. A prospective analysis of pain experience, beliefs and attitudes, and pain management of a cohort of Danish surgical patients

    DEFF Research Database (Denmark)

    Lorentzen, Vibeke; Hermansen, I.L.; Botti, M

    2012-01-01

    Abstract: ABSTRACT Background: Adequacy of pain management is a process indicator of health care quality with consequences for patient outcomes and satisfaction. The reported incidence of moderate to severe postoperative pain worldwide is between 20 to 80%. Objectives: The purpose was to assess...... the quality of pain management in a cohort of Danish postoperative patients by examining their pain experience, beliefs about pain and pain treatment, and relationships between pain intensity, its effect on function, and pharmacological pain management. Methods: The American Pain Society's Patient Outcome...... Questionnaire was used in a consecutive cohort of Danish patients who had undergone gastrointestinal, gynaecological, orthopaedic or urological surgery in the previous 48 hours. Results: Findings indicated uncontrolled pain in 45.5% of patients, who experienced moderate to severe intensity average pain...

  11. Sensory Testing in Patients With Postthoracotomy Pain Syndrome

    DEFF Research Database (Denmark)

    Werner, Mads Utke; Ringsted, Thomas K; Kehlet, Henrik

    2013-01-01

    pain syndrome [PTPS (n=14)]. The primary outcome was investigation of the areas of sensory dysfunction, evaluated twice by dynamic sensory mapping with metal rollers and a brush. RESULTS:: In PTPS patients, sensory dysfunction was present on the surgical side, and in 12 of 14 patients MISD......OBJECTIVES:: Mirror-image sensory dysfunction (MISD) has not been systematically characterized in persistent postoperative pain. METHODS:: The presence of MISD was evaluated with standardized stimuli, in preoperative patients scheduled for a thoracotomy (n=14) and in patients with postthoracotomy...... of the PTPS patients experienced mirror pain. DISCUSSION:: MISD is a common finding in PTPS patients and deserves further study involving mechanism and clinical implications....

  12. The Level of Anxiety and Pain Perception of Endodontic Patients

    Directory of Open Access Journals (Sweden)

    Ivana Perković

    2014-01-01

    Full Text Available Objectives: to compare the level of anxiety reported by patients and assessed by dentists. Also, the expected and actual pain during the treatment perceived by the patient and dentist were assessed. Methods: sixty six endodontic patients filled in two questionnaires, prior to and after the treatment, so did their therapists. The first set of questions for patients was regarding demographics, the frequency of dental visits, the level of anxiety and expectations about the level of pain. Before the treatment, dentists estimated the level of patients’ anxiety and the expected intensity of pain. After the treatment, the patients evaluated the level of experienced pain and dentists’ empathy during the treatment, while dentists reassessed the intensity of patients’ pain.The data were statistically analysed by t-test for paired samples and by Spearmans’s Rho correlation coefficient at level of significance set at 0.05. Results: Patients’ expectation of pain intensity was higher than the actual pain during the treatment (t-test=3.540, p=0.001. There was no difference in the level of pain which dentists expected and their perception of pain during the procedure. There was a statistically significant correlation between the patients’ level of anxiety and recognition of it by dentists (Spearman Rho=0.460, p<0.001. A higher level of anxiety increased the expected intensity of pain (Spearman Rho=0.401, p=0.001. Actual intensity of pain was not significantly associated with dental anxiety (Spearman Rho=0.080, p=0.524. Conclusion: Since the level of dental anxiety was associated with the increased intensity of expected pain, a vicious cycle of pain and anxiety may be terminated by giving positive information to the patient before and during endodontic procedures.

  13. Sympathetic Blocks Provided Sustained Pain Relief in a Patient with Refractory Painful Diabetic Neuropathy

    Directory of Open Access Journals (Sweden)

    Jianguo Cheng

    2012-01-01

    Full Text Available The sympathetic nervous system has been implicated in pain associated with painful diabetic neuropathy. However, therapeutic intervention targeted at the sympathetic nervous system has not been established. We thus tested the hypothesis that sympathetic nerve blocks significantly reduce pain in a patient with painful diabetic neuropathy who has failed multiple pharmacological treatments. The diagnosis of small fiber sensory neuropathy was based on clinical presentations and confirmed by skin biopsies. A series of 9 lumbar sympathetic blocks over a 26-month period provided sustained pain relief in his legs. Additional thoracic paravertebral blocks further provided control of the pain in the trunk which can occasionally be seen in severe diabetic neuropathy cases, consequent to extensive involvement of the intercostal nerves. These blocks provided sustained and significant pain relief and improvement of quality of life over a period of more than two years. We thus provided the first clinical evidence supporting the notion that sympathetic nervous system plays a critical role in painful diabetic neuropathy and sympathetic blocks can be an effective management modality of painful diabetic neuropathy. We concluded that the sympathetic nervous system is a valuable therapeutic target of pharmacological and interventional modalities of treatments in painful diabetic neuropathy patients.

  14. Addiction to opioids in chronic pain patients: a literature review

    DEFF Research Database (Denmark)

    Højsted, Jette; Sjøgren, Per

    2007-01-01

    , incidence and prevalence of addiction in opioid treated pain patients, screening tools for assessing opioid addiction in chronic pain patients and recommendations regarding addiction problems in national and international guidelines for opioid treatment in cancer patients and chronic non-malignant pain...... patients. The review indicates that the prevalence of addiction varied from 0% up to 50% in chronic non-malignant pain patients, and from 0% to 7.7% in cancer patients depending of the subpopulation studied and the criteria used. The risk of addiction has to be considered when initiating long-term opioid...... long-term opioid treatment, and specialised treatment facilities for pain management or addiction medicine should be consulted in these cases....

  15. Music therapy in relief of pain in oncology patients

    Directory of Open Access Journals (Sweden)

    Mariana Franco

    2009-03-01

    Full Text Available Objective: To evaluate the perception of oncology patients with chronic pain as to the effects of music in alleviating pain, to identify if there are changes in the vital signs of these patients before and after the musicotherapy session, and to identify whether the intensity of pain is diminished after the music session as per an analogic scale of pain. Methods: This level II, descriptive-exploratory and cross-sectional study used a quantitative and qualitative approach. The sample consisted of ten oncology patients with chronic pain. Rresults: There was a reduction in vital signs and in intensity of pain in ten patients of the sample; after the music sessions, the patients reported a sensation of relief of pain, relaxation, and a belief in the power of music as a supplementary therapy. Cconclusions: Music showed an influence in reducing vital signs and pain intensity, and the patients perceived a reduction of pain and anxiety, and began to believe in music as a form of therapy.

  16. Chronic pain and quality of life in schizophrenic patients

    Directory of Open Access Journals (Sweden)

    Jouce Gabriela de Almeida

    2013-03-01

    Full Text Available OBJECTIVE: To identify the prevalence and characteristics of chronic pain in schizophrenic patients and to compare the quality of life in patients with and without chronic pain. METHODS: Crossover design with a probablistic sample of 205 adult schizophrenic outpatients (80% paranoid schizophrenia. Socio-demographic, psychiatric disorder, pain and quality of life (WHOQOL- brief data were collected between June and September 2008. RESULTS: Mean age was 37 years, 65% were men, and the mean time spent in school was 9 years; 87% were single, 65% lived with parents and 25% had a job. Among patients with chronic pain, 70% did not receive treatment for pain. Regarding quality of life, patients with pain had more physical disabilities compared to those without pain (p < .001. There were no differences in other domains. Comparisons between patients with and without pain did not show any differences in how much they felt their mental health problems disabled them. Conclusion: Chronic pain was common in schizophrenic patients (similar to the general population of a similar age and decreased their quality of life. It is necessary to pay more attention to this co-morbidity.

  17. Pain in Alzheimer's disease : nursing assistants' and patients' evaluations

    NARCIS (Netherlands)

    Scherder, E; van Manen, F

    2005-01-01

    Aim. This paper reports on a study examining the level of agreement between the pain perceptions of nursing assistants, older people without dementia and patients with Alzheimer's dementia. It was hypothesized that nursing assistants would overestimate the pain experience of patients with

  18. Attitudes of Irish patients with chronic pain towards medicinal cannabis.

    Science.gov (United States)

    Rochford, Ciaran; Edgeworth, Deirdre; Hashim, Mohammad; Harmon, Dominic

    2018-02-08

    Medicinal cannabis use is topical in the media in Ireland. A recent Health Products Regulatory Authority review, however, has recommended against its use for patients with chronic pain. This is despite evidence for its effectiveness in this patient's cohort and the inadequate pain management of these patients. The aim of this study was to evaluate the attitudes of Irish patients with chronic pain towards medicinal cannabis. After institutional ethics committee approval, a 12-item questionnaire (excluding demographics) was randomly assigned to patients attending a chronic pain clinic (University Hospital Limerick). The questionnaire was designed to incorporate patient's attitudes on a variety of medicinal cannabis related topics. Ninety-six adult patients were surveyed. 88.54% agreed that cannabis should be legalised for chronic pain medicinal purposes. 80.21% believed it would have health benefits for them and 73.96% agreed it would be socially acceptable to use cannabis for this purpose. 33.33% perceived cannabis to be addictive while 68.75% would be willing to try it if prescribed by a medical professional. The study highlights the attitudes of chronic pain patients in Ireland towards medicinal cannabis. It shows their desire to have medical cannabis legalised for chronic pain and that they view it as a reasonable pain management option.

  19. Musculoskeletal pain in patients with type 2 diabetes

    DEFF Research Database (Denmark)

    Molsted, S; Tribler, J; Snorgaard, O

    2012-01-01

    The aims were to investigate the prevalence of musculoskeletal pain in patients with type 2 diabetes and demonstrate possible associated factors.......The aims were to investigate the prevalence of musculoskeletal pain in patients with type 2 diabetes and demonstrate possible associated factors....

  20. American Society for Pain Management nursing position statement: pain management in patients with substance use disorders.

    Science.gov (United States)

    Oliver, June; Coggins, Candace; Compton, Peggy; Hagan, Susan; Matteliano, Deborah; Stanton, Marsha; St Marie, Barbara; Strobbe, Stephen; Turner, Helen N

    2012-10-01

    The American Society for Pain Management Nursing (ASPMN) has updated its position statement on managing pain in patients with substance use disorders. This position statement is endorsed by the International Nurses Society on Addictions (IntNSA) and includes clinical practice recommendations based on current evidence. It is the position of ASPMN and IntNSA that every patient with pain, including those with substance use disorders, has the right to be treated with dignity, respect, and high-quality pain assessment and management. Failure to identify and treat the concurrent conditions of pain and substance use disorders will compromise the ability to treat either condition effectively. Barriers to caring for these patients include stigmatization, misconceptions, and limited access to providers skilled in these two categories of disorders. Topics addressed in this position statement include the scope of substance use and related disorders, conceptual models of addiction, ethical considerations, addiction risk stratification, and clinical recommendations.

  1. Neuropathic pain and use of PainDETECT in patients with fibromyalgia: a cohort study

    OpenAIRE

    Gauffin, Jarno; Hankama, Tiina; Kautiainen, Hannu; Hannonen, Pekka; Haanp??, Maija

    2013-01-01

    Abstract Backround Fibromyalgia has a plethorae of symptoms, which can be confusing and even misleading. Accurate evaluation is necessary when patients with fibromyalgia are treated. Different types of instruments are available for the clinicians to supplement evaluation. Our objective was to study the applicability of the PainDETECT instrument to screen neuropathic pain in patients with fibromyalgia. Methods 158 patients with primary fibromyalgia underwent a neurological examination includin...

  2. Postoperative Visual Analog Pain Scores and Overall Anesthesia Patient Satisfaction.

    Science.gov (United States)

    Burch, Tony; Seipel, Scott J; Coyle, Nina; Ortega, Keri H; DeJesus, Ozzie

    2017-12-01

    Patient satisfaction is evolving into an important measure of high-quality health care and anesthesia care is no exception. Pain management is an integral part of anesthesia care and must be assessed to determine patient satisfaction; therefore, it is a measure for quality of care. One issue is how patients reflect individual experiences into their overall anesthesia experience. There is a need to identify how postoperative pain scores correlate with anesthesia patient satisfaction survey results. Postoperative pain is not a dominant measure in determining anesthesia patient satisfaction. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Can consistent benchmarking within a standardized pain management concept decrease postoperative pain after total hip arthroplasty? A prospective cohort study including 367 patients

    Directory of Open Access Journals (Sweden)

    Benditz A

    2016-12-01

    significantly increased (mean 9.8, ±0.4; p<0.05. Among 49 anonymized hospitals, our clinic stayed on first rank in terms of lowest maximum pain and patient satisfaction over the period.Conclusion: Results were already acceptable at the beginning of benchmarking a standardized pain management concept. But regular benchmarking, implementation of feedback mechanisms, and staff education made the pain management concept even more successful. Multidisciplinary teamwork and flexibility in adapting processes seem to be highly important for successful pain management. Keywords: postoperative pain, total hip arthroplasty, pain management concept, benchmarking

  4. On the relationship between pain intensity and postural sway in patients with non-specific neck pain

    DEFF Research Database (Denmark)

    Ruhe, Alexander; Fejer, René; Walker, Bruce

    2013-01-01

    Increased center of pressure excursions are well documented in patients with non-specific neck pain. While a linear relationship between pain intensity and postural sway has been described in low back pain patients, no such investigation has been conducted in adults with non-specific neck pain....

  5. HYPNOTHERAPY AS A TREATMENT FOR PAIN IN PATIENTS WITH BURNS

    Directory of Open Access Journals (Sweden)

    F SHAKIBAEI

    2002-03-01

    Full Text Available Introduction. Burning is an event with many psychosomatic complications. Pain is one of the most trouble matter in these patients that affect on their psychologic features. This study presents a hypnotherapeutics intervention for controlling pain in patients suffered from burning. Methods. In a randomized clinical trial (without placebo, two 22 members group burned patients were selected. In interventional group we conduct a 5 sessions hypnotherapy course. Severity of pain and itching were assessed by visual analogue scale before and after intervention and results were compaired between two groups. Results. All pain parameters were decreased more in interventional group (P < 0.05. Discussion. It seems that hypnotherapy can playa positive role in pain reduction of patients. It is recommended that it would be applied in adjunct to current medications in these patients.

  6. Alexithymia and anxiety in female chronic pain patients

    Directory of Open Access Journals (Sweden)

    Saatcioglu Omer

    2006-08-01

    Full Text Available Abstract Objectives Alexithymia is highly prevalent among chronic pain patients. Pain is a remarkable cause for high levels of chronic anxiety. The purpose of this study was to investigate the prevalence of alexithymia and to determine anxiety levels among DSM-IV somatoform pain disorder (chronic pain female patients and to examine the relationship between alexithymia and the self-reporting of pain. Methods Thirty adult females (mean age: 34,63 ± 10,62 years, who applied to the outpatient psychiatry clinic at a public hospital with the diagnosis of chronic pain disorder (DSM-IV, were included in the study. Thirty seven healthy females (mean age: 34,46 ± 7,43 years, who matched for sociodemographic features with the patient group, consisted the control group. A sociodemographic data form, 26-item Toronto Alexithymia Scale (TAS-26, Spielberger Trait Anxiety Inventory (STAI were administered to each subject and information was obtained on several aspects of the patients' pain, including intensity (measured by VAS, and duration. Results Chronic pain patients were found significantly more alexithymic than controls. There was a positive correlation between TAS-26 scores and the duration of pain. The alexithymic and nonalexithymic group did not differ in their perception of pain. Neither positive correlation nor significant difference was found between alexithymia and trait anxiety in pain patients. Discussion Alexithymia may be important in addressing the diversity of subjective factors involved in pain. The conceptualization of alexithymia as a personality trait as well as a secondary state reaction is underlined by our data.

  7. Taping reduces pain and disability in patients with knee osteoarthritis.

    NARCIS (Netherlands)

    Ende, E. van den

    2004-01-01

    Question: Is taping of the knee effective in improving pain and disability in patients with osteoarthritis of the knee? Design Randomised controlled trial. Setting University and private practices in Melbourne, Australia. Patients: Volunteers who responded to advertisements in local newspapers.

  8. Multidimensional Patient Impression of Change Following Interdisciplinary Pain Management.

    Science.gov (United States)

    Gagnon, Christine M; Scholten, Paul; Atchison, James

    2018-04-20

    To assess patient impression of change following interdisciplinary pain management utilizing a newly developed Multidimensional Patient Impression of Change (MPIC) questionnaire. A heterogeneous group of chronic pain patients (N = 601) participated in an interdisciplinary treatment program. Programs included individual and group therapies (pain psychology, physical therapy, occupational therapy, relaxation training/biofeedback, aerobic conditioning, patient education and medical management). Patients completed measures of pain, mood, coping, physical functioning and pain acceptance both prior to and at completion of their treatment programs. The newly developed MPIC is an expansion to the Patient Global Impression of Change (PGIC) including seven additional domains (Pain, Mood, Sleep, Physical Functioning, Cope with Pain, Manage Pain Flare-ups, and Medication Effectiveness). The MPIC was administered to the patients post-treatment. There were statistically significant pre- to post-treatment improvements found on all outcome measures. The majority of these improvements were significantly correlated with all domains of the MPIC. The original PGIC item was significantly associated with all of the new MPIC domains and the domains were significantly associated with each other; but there were variations in the distribution of responses highlighting variation of perceived improvements among the domains. Our results support the use of the MPIC as a quick and easy post-treatment assessment screening tool. Future research is needed to examine relevant correlates to Medication Effectiveness. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  9. Intraarticular Pulsed Radiofrequency to Treat Refractory Lumbar Facet Joint Pain in Patients with Low Back Pain.

    Science.gov (United States)

    Chang, Min Cheol; Cho, Yun-Woo; Ahn, Da Hyun; Do, Kyung Hee

    2018-04-01

    Many treatment techniques have been used for refractory lumbar facet joint pain; however, their efficacy has been controversial. In this study, we investigated the clinical efficacy and safety of intra-articular pulsed radiofrequency for the treatment of refractory lumbar facet joint pain in patients with low back pain. Twenty patients with refractory lumbar facet joint pain were recruited, and each patient was treated via intra-articular pulsed radiofrequency. The treatment effects were measured with a numerical rating scale, and the technical accuracy of intra-articular pulsed radiofrequency treatment was evaluated independently by 2 radiologists. Any adverse events or complications also were checked. We performed intra-articular pulsed radiofrequency treatment at 48 levels of the lumbar facet joints in 20 patients (5 men and 15 women; mean age, 64.50 ± 10.65 years) with refractory lumbar facet joint pain. Pain scores were significantly reduced at 1 month, 3 months, and 6 months after treatment (P radiofrequency results in all 20 patients, without any serious adverse effects. Treatment using intra-articular pulsed radiofrequency is an alternative to other techniques in patients with refractory lumbar facet joint pain. Copyright © 2018 Elsevier Inc. All rights reserved.

  10. Effect of hypnotic pain modulation on brain activity in patients with temporomandibular disorder pain

    DEFF Research Database (Denmark)

    Abrahamsen, Randi; Dietz, Martin; Lodahl, Sanne

    2010-01-01

    hyperalgesia. Direct contrasts between control and hypnotic hypoalgesia conditions demonstrated significant decreases in right posterior insula and BA21, as well as left BA40 during hypoalgesia. These findings are the first to describe hypnotic modulation of brain activity associated with nociceptive......Hypnosis modulates pain perception but the associated brain mechanisms in chronic pain conditions are poorly understood. Brain activity evoked by painful repetitive pin-prick stimulation of the left mental nerve region was investigated with use of fMRI in 19 patients with painful temporomandibular...... condition and significantly higher in the hypnotic hyperalgesia condition. In the control condition, painful stimulation caused significant activation of right posterior insula, primary somatosensory cortex (SI), BA21, and BA6, and left BA40 and BA4. Painful stimulation during hypnotic hyperalgesia...

  11. Pain assessment according to the International Spinal Cord Injury Pain classification in patients with spinal cord injury referred to a multidisciplinary pain center.

    Science.gov (United States)

    Mahnig, S; Landmann, G; Stockinger, L; Opsommer, E

    2016-10-01

    This is a retrospective study. The aim of this study was to investigate the epidemiology of pain types in patients with spinal cord injury (SCI) according to the International Spinal Cord Injury Pain (ISCIP) classification. This study was conducted in a multidisciplinary pain center. Socio-demographic and clinical data were examined and ISCIP classification was applied. Sixty-six individuals (51±13 years) with SCI had pain, a lesion older than 5 years in 67% and a pain history older than 5 years in 54% of patients. According to the ISCIP classification, nociceptive pain was present in 58% (musculoskeletal pain) and 3% (visceral pain) of the patients. At-level, below-level neuropathic pain and other neuropathic pain were observed, respectively in 53, 42 and 5% of patients. Unknown pain type was found in 8% of patients. Patients with complete lesions showed significantly more frequent neuropathic pain (P=0.021) and more frequent at-level SCI pain (P=0.00) compared with those with incomplete lesions. Patients with paraplegia had more often at-level pain (P=0.00), whereas patients with tetraplegia reported more often below-level pain (P=0.00). Patients had severe pain (mean intensity: 8.2 (±1.6) on a 0 to 10 numerical scale) and showed high grades of pain chronicity. Mild to severe depression and anxiety were present, respectively in 53 and 56% of patients. The health-related quality of life was low. The use of the ISCIP classification in a clinical setting is mirroring the very complex pain situation in patients with SCI referred to a multidisciplinary pain center, and it might be an important step for adequate pain therapy.

  12. Pain management in patients with Parkinson's disease: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Skogar O

    2016-09-01

    Full Text Available Orjan Skogar,1,2 Johan Lokk2 1Academy for Health and Care (FUTURUM, Region Jönköping County, Jönköping, 2Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden Abstract: This review focuses on the diagnosis and management of Parkinson-related pain which is one of the more frequently reported nonmotor symptoms in Parkinson’s disease (PD, which is the second most common neurodegenerative disease after Alzheimer’s disease. Pain is ranked high by patients as a troublesome symptom in all stages of the disease. In early-stage PD, pain is rated as the most bothersome symptom. Knowledge of the correct diagnosis of pain origin and possible methods of treatments for pain relief in PD is of great importance. The symptoms have a great negative impact on health-related quality of life. Separating PD-related pain from pain of other origins is an important challenge and can be characterized as “many syndromes under the same umbrella”. Among the different forms of PD-related pain, musculoskeletal pain is the most common form, accounting for 40%–90% of reported pain in PD patients. Augmentation by pathophysiological pathways other than those secondary to rigidity, tremor, or any of the other motor manifestations of the disease seems most probable. In PD, the basal ganglia process somatosensory information differently, and increased subjective pain sensitivity with lower electrical and heat-pain thresholds has been reported in PD patients. The mechanism is assumed to be diminished activity of the descending inhibitory control system of the basal ganglia. PD pain, like many of the nonmotor symptoms, remains underdiagnosed and, thus, poorly managed. A systematic collection of patient descriptions of type, quality, and duration of pain is, therefore, of utmost importance. Recent studies have validated new and more specific and dedicated pain scales for PD-related symptoms. Symptomatic treatments based

  13. Nursing attitudes toward patients with substance use disorders in pain.

    Science.gov (United States)

    Morgan, Betty D

    2014-03-01

    The problem of inadequate pain management in hospitals is well documented. Patients who have substance use disorders (SUD) have many medical problems and are often in pain as a result of these problems. Nurses often lack knowledge of appropriate treatment of both pain and SUD, and have been identified as having negative attitudes toward patients with SUD. The negative attitudes may affect the quality of care delivered to patients with problems of pain and SUD. The purpose of this study was to identify and explore nurses' attitudes toward hospitalized patients with SUD who are in pain, to expand the knowledge about nurses' attitudes and interactions with patients with SUD in pain, and to generate theory that will contribute to a greater understanding of the problem. Grounded theory methodology was used to interview hospital-based nurses who work with patients with SUD who are in pain. Individual interviews, using a semistructured interview guide, were conducted with 14 nurses who worked with this population. Additionally, an expert addictions nurse was interviewed at the end of the study to validate the findings. Interviews were analyzed and coded with the use of grounded theory concepts. A model illustrating the categories and their relationships was developed based on the theory generated as a result of the study. The implications for nursing practice, education, research, and policy are discussed. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  14. Differential effect of ketamine and lidocaine on spontaneous and mechanical evoked pain in patients with nerve injury pain

    DEFF Research Database (Denmark)

    Gottrup, Hanne; Bach, Flemming Winther; Juhl, Gitte Irene

    2006-01-01

    ketamine, an N-methyl-D-aspartate receptor antagonist and lidocaine, a sodium channel blocker, on spontaneous pain, brush-evoked pain, and pinprick-evoked pain in patients with nerve injury pain. METHODS: Twenty patients participated in two randomized, double-blinded, placebo-controlled, crossover...... experiments in which they, on four different days, received a 30-minute intravenous infusion of ketamine (0.24 mg/kg), lidocaine (5 mg/kg), or saline. Ongoing pain, pain evoked by brush and repetitive pinprick stimuli, and acetone was measured before, during, and after infusion. RESULTS: Ketamine...... significantly reduced ongoing pain and evoked pain to brush and pinprick, whereas lidocaine only reduced evoked pain to repetitive pinprick stimuli. In individual patients, there was no correlation between the pain-relieving effect of lidocaine and ketamine on ongoing or mechanically evoked pains. CONCLUSIONS...

  15. Patients' perception of postoperative pain management: validation of the International Pain Outcomes (IPO) questionnaire.

    Science.gov (United States)

    Rothaug, Judith; Zaslansky, Ruth; Schwenkglenks, Matthias; Komann, Marcus; Allvin, Renée; Backström, Ragnar; Brill, Silviu; Buchholz, Ingo; Engel, Christoph; Fletcher, Dominique; Fodor, Lucian; Funk, Peter; Gerbershagen, Hans J; Gordon, Debra B; Konrad, Christoph; Kopf, Andreas; Leykin, Yigal; Pogatzki-Zahn, Esther; Puig, Margarita; Rawal, Narinder; Taylor, Rod S; Ullrich, Kristin; Volk, Thomas; Yahiaoui-Doktor, Maryam; Meissner, Winfried

    2013-11-01

    PAIN OUT is a European Commission-funded project aiming at improving postoperative pain management. It combines a registry that can be useful for quality improvement and research using treatment and patient-reported outcome measures. The core of the project is a patient questionnaire-the International Pain Outcomes questionnaire-that comprises key patient-level outcomes of postoperative pain management, including pain intensity, physical and emotional functional interference, side effects, and perceptions of care. Its psychometric quality after translation and adaptation to European patients is the subject of this validation study. The questionnaire was administered to 9,727 patients in 10 languages in 8 European countries and Israel. Construct validity was assessed using factor analysis. Discriminant validity assessment used Mann-Whitney U tests to detect mean group differences between 2 surgical disciplines. Internal consistency reliability was calculated as Cronbach's alpha. Factor analysis resulted in a 3-factor structure explaining 53.6% of variance. Cronbach's alpha at overall scale level was high (.86), and for the 3 subscales was low, moderate, or high (range, .53-.89). Significant mean group differences between general and orthopedic surgery patients confirmed discriminant validity. The psychometric quality of the International Pain Outcomes questionnaire can be regarded as satisfactory. The International Pain Outcomes questionnaire provides an instrument for postoperative pain assessment and improvement of quality of care, which demonstrated good psychometric quality when translated into a variety of languages in a large European and Israeli patient population. This measure provides the basis for the first comprehensive postoperative pain registry in Europe and other countries. Copyright © 2013. Published by Elsevier Inc.

  16. Impaired insula functional connectivity associated with persistent pain perception in patients with complex regional pain syndrome

    Science.gov (United States)

    Jang, Joon Hwan; Lee, Do-Hyeong; Lee, Kyung-Jun; Lee, Won Joon; Moon, Jee Youn; Kim, Yong Chul

    2017-01-01

    Given that the insula plays a contributory role in the perception of chronic pain, we examined the resting-state functional connectivity between the insular cortex and other brain regions to investigate neural underpinnings of persisting perception of background pain in patients with complex regional pain syndrome (CRPS). A total of 25 patients with CRPS and 25 matched healthy controls underwent functional magnetic resonance imaging at rest. With the anterior and posterior insular cortices as seed regions, we compared the strength of the resting-state functional connectivity between the two groups. Functional connectivity between the anterior and posterior insular cortices and the postcentral and inferior frontal gyri, cingulate cortices was reduced in patients with CRPS compared with controls. Additionally, greater reductions in functional connectivity between the anterior insula and right postcentral gyrus were associated with more severe sensory pain in patients with CRPS (short-form McGill Pain Questionnaire sensory subscores, r = -.517, P = .023). The present results imply a possible role of the insula in aberrant processing of pain information in patients with CRPS. The findings suggest that a functional derangement of the connection between one of the somatosensory cortical functions of perception and one of the insular functions of awareness can play a significant role in the persistent experience of regional pain that is not confined to a specific nerve territory. PMID:28692702

  17. Dynamic Changes in Nociception and Pain Perception After Spinal Cord Stimulation in Chronic Neuropathic Pain Patients.

    Science.gov (United States)

    Biurrun Manresa, José A; Sörensen, Jan; Andersen, Ole K; Arendt-Nielsen, Lars; Gerdle, Björn

    2015-12-01

    Patients with an implanted spinal cord stimulation (SCS) system for pain management present an opportunity to study dynamic changes in the pain system in a situation where patients are not stimulated (ie, experiencing severe pain) compared with a situation in which patients have just been stimulated (ie, pain free or greatly reduced pain). The aims of this study were (1) to determine if there are differences in nociceptive withdrawal reflex thresholds (NWR-T) and electrical pain thresholds (EP-T) before and after SCS; and (2) to establish if these differences are related to psychological factors associated with chronic pain. Seventeen volunteers with chronic neuropathic pain participated in the experiment. Electrical stimuli were applied to assess the NWR-T and the EP-T. In addition, psychological factors (ie, pain characteristics, depression, anxiety, and disability indexes) were also recorded. The NWR-T and EP-T were assessed with the SCS system off (at least 8 h before the experiment), and then reassessed 1 hour after the SCS system was turned on. Ongoing pain intensity ratings decreased (P=0.018), whereas the NWR-T increased (P=0.028) after the SCS was turned on, whereas no significant difference was found for EP-T (P=0.324). Psychological factors were significant predictors for EP-T but not for NWR-T. The results of this study suggest that pain relief after SCS is partially mediated by a decrease in the excitability of dorsal horn neurons in the spinal cord.

  18. Pain increases during sympathetic arousal in patients with complex regional pain syndrome.

    Science.gov (United States)

    Drummond, P D; Finch, P M; Skipworth, S; Blockey, P

    2001-10-09

    To investigate the effect of sympathetic arousal on pain and vasomotor responses in healthy control subjects and patients with complex regional pain syndrome (CRPS), and to determine whether pain increases in patients with particular symptoms. In experiments 1 and 2, capsaicin was applied to the forearm of 24 healthy subjects to induce thermal hyperalgesia. Vascular responses were monitored and subjects rated thermal hyperalgesia before and after being startled (experiment 1), and before, during, and after mental arithmetic, breath holding, forehead cooling, the Valsalva maneuver, and a cold pressor test in experiment 2. In a third experiment, sensitivity to heat, cold, and mechanical stimulation was investigated in 61 patients with CRPS. Pain ratings and vascular and electrodermal responses were recorded after patients were startled and during forehead cooling. In experiment 1, thermal hyperalgesia decreased in healthy control subjects after they were startled, and digital blood vessels constricted symmetrically. In experiment 2, thermal hyperalgesia decreased during and after other forms of sympathetic arousal. However, in experiment 3, ratings of clinical pain increased during forehead cooling or after being startled in over 70% of patients with CRPS. Pain increased most consistently during forehead cooling in patients with cold allodynia or punctate allodynia. Digital blood vessels constricted more intensely on the symptomatic than the nonsymptomatic side in patients with CRPS during sympathetic arousal. Normal inhibitory influences on pain during sympathetic arousal are compromised in the majority of patients with CRPS. The augmented vasoconstrictor response in the symptomatic limb during sympathetic arousal is consistent with adrenergic supersensitivity. An adrenergic sensitivity in nociceptive afferents might contribute to pain and hyperalgesia during sympathetic arousal in certain patients with CRPS.

  19. Chronic Neuropathic Pain in Spinal Cord Injury: The Patient's Perspective

    Directory of Open Access Journals (Sweden)

    Penelope Henwood

    2004-01-01

    Full Text Available BACKGROUND: Chronic neuropathic pain (CNP in spinal cord injury (SCI is recognized as severely compromising, in both adjustment after injury and quality of life. Studies indicate that chronic pain in SCI is associated with great emotional distress over and above that of the injury itself. Currently, little is known about the SCI patient's perception of the impact of living with chronic neuropathic pain.

  20. Diagnosis and treatment of orofacial pain in a patient with unserviceable complete dentures: A clinical report.

    Science.gov (United States)

    Selecman, Audrey M; Ahuja, Swati A

    2018-02-08

    An ill-fitting complete denture has the potential to create pain and discomfort as well as conceal or confound the diagnosis of other primary sources of orofacial pain such as trigeminal neuralgia. Guidelines of the American Academy of Orofacial Pain offer an evidence-based approach for the assessment, diagnosis, and management of orofacial pain. A complete and accurate differential diagnosis is paramount to the success of treatment as well as to the circumvention of unnecessary therapy. The purpose of this clinical report was to emphasize an evidence-based approach to the diagnosis and treatment of orofacial pain in a patient with edentulism and a history of prolonged denture wear. Copyright © 2017 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  1. Patient satisfaction with private physiotherapy for musculoskeletal pain.

    LENUS (Irish Health Repository)

    Casserley-Feeney, Sarah N

    2008-01-01

    BACKGROUND: Despite emphasis on patient centred healthcare, healthcare professionals have been slow to use validated measurements of patient satisfaction in physiotherapy practice. The aim of this cross sectional survey was to measure patient satisfaction with private physiotherapy in Ireland, for patients with musculoskeletal pain, using a previously validated survey instrument. METHODS: A multidimensional patient satisfaction questionnaire \\'PTOPS\\

  2. Sense of social support in chonic pain patients

    Directory of Open Access Journals (Sweden)

    Ancane G.

    2012-10-01

    Full Text Available Statistical data show that one in five adults of the European citizen suffer from some type of chronic pain. One of the most common types of chronic pain is chronic low back and neck pain. Emotional factors are currently viewed as important determinants in pain perception and behaviour. The perceived social and emotional support have impact to the individual’s adaptation to chronic disease (Cohen, Wills, 1985. The material: 110 chronic low back pain (CLBP patients (48 male and 62 female; in age from 24 to 60 years, mean: 44.2±8, 0 and pilot study of 23 chronic neck pain (CNP patients (19 female and 4 male; in age from 35 to 60 years, mean: 48, 1 ±6. The assessment methods: structured interview; Hospital Anxiety and Depression Scale (HADS. SF-36 ® Health Survey: assessment of emotional and social support. Results and conclusions: CLBP patients in presence of symptoms of depression and elevated level of anxiety matched for socio-demographic features had less sense of social support and marked pain impact to daily activities, lower self rating health relating quality of life. In CLBP patients the sense of social and emotional support had relevant interaction with level of participation in daily activities both in patients with and without mental health problems. This fact has to be considered in process of rehabilitation and in managing of health care of CLBP patients. The results of CNP patients pilot study revealed interesting trend that chronic back and neck pain patients seems to be quite different according to sense of social and emotional support, therefore sense of social and emotional support in different chronic pain patients need further research to improve the process and results of rehabilitation in these patients.

  3. Pain management in patients with Parkinson's disease: challenges and solutions.

    Science.gov (United States)

    Skogar, Orjan; Lokk, Johan

    2016-01-01

    This review focuses on the diagnosis and management of Parkinson-related pain which is one of the more frequently reported nonmotor symptoms in Parkinson's disease (PD), which is the second most common neurodegenerative disease after Alzheimer's disease. Pain is ranked high by patients as a troublesome symptom in all stages of the disease. In early-stage PD, pain is rated as the most bothersome symptom. Knowledge of the correct diagnosis of pain origin and possible methods of treatments for pain relief in PD is of great importance. The symptoms have a great negative impact on health-related quality of life. Separating PD-related pain from pain of other origins is an important challenge and can be characterized as "many syndromes under the same umbrella". Among the different forms of PD-related pain, musculoskeletal pain is the most common form, accounting for 40%-90% of reported pain in PD patients. Augmentation by pathophysiological pathways other than those secondary to rigidity, tremor, or any of the other motor manifestations of the disease seems most probable. In PD, the basal ganglia process somatosensory information differently, and increased subjective pain sensitivity with lower electrical and heat-pain thresholds has been reported in PD patients. The mechanism is assumed to be diminished activity of the descending inhibitory control system of the basal ganglia. PD pain, like many of the nonmotor symptoms, remains underdiagnosed and, thus, poorly managed. A systematic collection of patient descriptions of type, quality, and duration of pain is, therefore, of utmost importance. Recent studies have validated new and more specific and dedicated pain scales for PD-related symptoms. Symptomatic treatments based on clinical pain classification include not only pharmacological but also nonpharmacological methods and, to some degree, invasive approaches. In the clinic, pharmacological and nonpharmacological interventions can be effective to varying degrees - as

  4. The Effect of Listening to Music During Percutaneous Nephrostomy Tube Placement on Pain, Anxiety, and Success Rate of Procedure: A Randomized Prospective Study.

    Science.gov (United States)

    Hamidi, Nurullah; Ozturk, Erdem

    2017-05-01

    To evaluate the effect of listening to music on pain, anxiety, and success of procedure during office-based percutaneous nephrostomy tube placement (PNTP). One hundred consecutive patients (age >18 years) with hydronephrosis were prospectively enrolled in this study. All patients were prospectively randomized to undergo office-based PNTP with (Group I, n = 50) or without music (Group II, n = 50). Anxiety levels were evaluated with State Trait Anxiety Inventory. A visual analog scale was used to evaluate pain levels, patient's satisfaction, and willingness to undergo the procedure. We also compared success rates of procedures. The mean age, duration of procedure, and gender distribution were statistically similar between the two groups. The mean postprocedural heart rates and systolic blood pressures in Group I patients were significantly lower than Group II patients (p = 0.01 and p = 0.028, respectively), whereas preprocedural pulse rate and systolic blood pressure were similar. The mean anxiety level and mean pain score of Group I were significantly lower than those of Group II (p = 0.008 and p music during office-based PNTP decreases anxiety or pain and increases success rate of procedure. As an alternative to sedation or general anesthesia, music is easily accessible without side effect and cost.

  5. Thermal and pressure pain sensitivity in patients with unilateral shoulder pain: comparison of involved and uninvolved sides.

    Science.gov (United States)

    Coronado, Rogelio A; Kindler, Lindsay L; Valencia, Carolina; George, Steven Z

    2011-03-01

    Cross-sectional. In the examination of patients with unilateral shoulder pain, pain provocation testing to compare the involved and uninvolved sides has been considered useful. However, side-to-side comparisons of experimental pain sensitivity in patients with unilateral shoulder pain are not widely reported in the literature. To compare experimental pain sensitivity between the involved and uninvolved sides in patients with unilateral shoulder pain. In consecutive patients seeking operative treatment for shoulder pain, sensitivity measures of bilateral pressure pain threshold at the shoulder and forearm, and thermal pain threshold, tolerance, and temporal summation at the forearm, were examined. Pressure sensitivity was tested with a Fischer pressure algometer, and thermal sensitivity with a computer-controlled Medoc neurosensory analyzer. The involved and uninvolved sides were compared with an analysis of variance. Influence of sex and location of testing were considered as covariates in the analysis. Fifty-nine consecutively recruited participants completed experimental pain sensitivity testing. Participants reported significantly lower pressure pain thresholds in the involved side compared to the uninvolved side (F1,56 = 4.96, P = .030). In addition, female compared to male participants demonstrated lower pressure pain thresholds in the bilateral shoulder regions (F1,56 = 10.84, P = .002). There was no difference in thermal pain sensitivity between sides. Average clinical pain intensity was negatively correlated with pressure pain threshold at the involved local site (r = -0.284, P = .029), indicating an influence of clinical pain intensity on local pressure pain. The results of this study provide evidence for higher experimental pressure pain sensitivity in the involved side of patients with unilateral shoulder pain and no difference between sides for thermal pain sensitivity. Females demonstrated higher pain sensitivity than males to pressure stimuli at the

  6. Individual and dyadic coping in chronic pain patients

    Directory of Open Access Journals (Sweden)

    Burri A

    2017-03-01

    Full Text Available Andrea Burri,1–3 Michèle Blank Gebre,4 Guy Bodenmann1 1Department of Psychology, University of Zurich, Zurich, Switzerland; 2Health and Rehabilitation Research Institute, Auckland University of Technology, 3Waitemata Pain Service, Department of Anaesthesia and Perioperative Medicine, North Shore Hospital, Auckland, New Zealand; 4Private Practice, Zurich, Switzerland Abstract: The purpose of the current cross-sectional study was to test the associations between individual coping responses to pain, dyadic coping, and perceived social support, with a number of pain outcomes, including pain intensity, functional disability, and pain adjustment, in a sample of N = 43 patients suffering from chronic pain in Switzerland. In contrast to previous research, we were interested not only in specific pain coping but also in more general stress coping strategies and their potential influence on pain outcomes. Analyses were performed using correlation and regression analyses. “Praying and hoping” turned out to be an independent predictor of higher pain intensity and higher anxiety levels, whereas both “coping self-instructions” and “diverting attention” were associated with higher well-being, less feelings of helplessness, and less depression and anxiety. We further found a link between “focusing on and venting emotions” and “worse pain adjustment”. No significant relationship between dyadic coping and social support with any of our pain outcomes could be observed. Overall, our results indicate that individual coping strategies outweigh the effects of social support and dyadic coping on pain-related outcomes and pain adjustment. However, results need to be interpreted with caution given the small sample size. Keywords: individual coping, dyadic coping, social support, chronic pain

  7. Predictors of Adverse Outcomes of Patients with Chest Pain and ...

    African Journals Online (AJOL)

    Background: Chest pain is a common symptom for referring patients to emergency departments (ED). Among those referred, some are admitted to hospitals with a definite or tentative diagnosis of acute coronary syndrome and some are discharged with primary diagnosis of non-cardiac chest pain. This study aimed at ...

  8. Topical review: orofacial pain in dementia patients: a diagnostic challenge

    NARCIS (Netherlands)

    Lobbezoo, F.; Weijenberg, R.A.F.; Scherder, E.J.A.

    2011-01-01

    This article presents a comprehensive review of the literature on the diagnosis of pain in the orofacial region of patients suffering from a cognitive impairment or a dementia. This review was based on a literature search yielding 74 papers, most of which dealt with the assessment of pain in general

  9. Pain severity, coping and satisfaction with life in patients with ...

    African Journals Online (AJOL)

    Objectives: The primary study aim was to determine whether or not a statistically significant relationship exists between pain severity and satisfaction with life in patients with chronic pain. The second aim was to explore the extent to which coping responses might influence this relationship. Design: A cross-sectional ...

  10. Understanding Facial Expressions of Pain in Patients With Depression

    NARCIS (Netherlands)

    Lautenbacher, Stefan; Baer, Karl-Juergen; Eisold, Patricia; Kunz, Miriam

    Although depression is associated with more clinical pain complaints, psychophysical data sometimes point to hypoalgesic alterations. Studying the more reflex-like facial expression of pain in patients with depression may offer a new perspective. Facial and psychophysical responses to nonpainful and

  11. Comparison of pain intensity, emotional status and disability level in patients with chronic neck and low back pain.

    Science.gov (United States)

    Altuğ, Filiz; Kavlak, Erdoğan; Kurtca, Mine Pekesen; Ünal, Ayşe; Cavlak, Uğur

    2015-01-01

    This study was planned to compare of pain, emotional status and disability level in patients with chronic neck pain and low back pain. In this study, fifty patients with chronic low back pain (Group I) and fifty patients with chronic neck pain (Group II) at least 6 months were evaluated. A Visual Analog Scale was used to describe pain intensity. To determine emotional status of the subjects, the Beck Depression Scale was used The Oswestry Disability Index and the Neck Disability Index were used to evaluate disability level. The mean age of the patients with low back pain and neck pain were 39.70 ± 9.71 years, 45.44 ± 10.39 years, respectively. It was not found a significant difference between in low back pain (Group I) and neck pain (Group II) in results of pain intensity (p= 0.286) and pain duration (p= 0.382). It was found a significant difference between group I and group II in results of emotional status (p= 0.000) and disability level (p= 0.000). The emotional status and disability level scores were found highest in patient's with low back pain. Chronic low back pain is affect in patients than chronic neck pain as a emotional status and disability level.

  12. [Perceived pain and weather changes in rheumatic patients].

    Science.gov (United States)

    Miranda, L Cunha; Parente, M; Silva, C; Clemente-Coelho, P; Santos, H; Cortes, S; Medeiros, D; Ribeiro, J Saraiva; Barcelos, F; Sousa, M; Miguel, C; Figueiredo, R; Mediavilla, M; Simões, E; Silva, M; Patto, J Vaz; Madeira, H; Ferreira, J; Micaelo, M; Leitão, R; Las, V; Faustino, A; Teixeira, A

    2007-01-01

    Rheumatic patients with chronic pain describe in a vivid way the influence of climate on pain and disease activity. Several studies seem to confirm this association. To evaluate and compare in a population of rheumatic patients the perceived influence of weather changes on pain and disease activity This is a retrospective cross-sectional study. For three weeks an assisted self-reported questionnaire with nine dimensions and a VAS pain scale was performed on consecutive out-patients in our clinic. 955 patients 787 female 168 male mean age 57.9 years with several rheumatologic diagnosis were evaluated. Overall 70 of the patients believed that the weather influenced their disease and 40 believed that the influence was high. Morning stiffness was influenced in 54 high influenced in 34 . Autumn and Winter were the most influential periods as well as humidity 67 and low temperatures 59 . In our study as well as in literature we found that a high percentage of patients 70 perceived that weather conditions influenced their pain and disease. Fibromyalgia patients seemed to be strongly influenced by weather changes. Our study confirms that patients perception on the influence of climate on pain and therefore their disease is an important clinical factor and it should be considered when evaluating rheumatic patients.

  13. Attentional Avoidance is Associated with Increased Pain Sensitivity in Patients with Chronic Posttraumatic Pain and Comorbid Posttraumatic Stress

    DEFF Research Database (Denmark)

    Harvold, Mathea; MacLeod, Colin; Vaegter, Henrik Bjarke

    2018-01-01

    posttraumatic pain patients is unknown. This study investigated AB for linguistic pain- and trauma-related stimuli, and clinical and thermal sensitivity in patients with chronic posttraumatic pain with and without PTSD. METHODS: Thirty-four patients with chronic posttraumatic cervical pain performed the visual......OBJECTIVES: Posttraumatic stress disorder (PTSD) is common in chronic posttraumatic pain. Theoretical models suggest that attentional biases (AB) contribute to the development and maintenance of chronic pain and PTSD, however, the influence of AB on clinical and heat pain sensitivity in chronic...... attentional probe task assessing patterns of selective attentional responding to trauma cues and to pain cues. The task used short (500 ms) and long (1250 ms) stimulus exposure durations to ensure sensitivity to both the orienting and maintenance of attention. Heat pain threshold (HPT) was assessed at the non-painful...

  14. Quantitative Sensory Testing in Patients With Postthoracotomy Pain Syndrome

    DEFF Research Database (Denmark)

    Wildgaard, Kim; Ringsted, Thomas K; Kehlet, Henrik

    2013-01-01

    -retest variability of thermal thresholds in patients (n=14) with the postthoracotomy pain syndrome. METHODS:: Sensory mapping with a metal roller (25°C) on the surgical side delineated an area with cool sensory dysfunction. In this area and in a contralateral area, 4 prespecified sites (2.6 cm) were outlined...... was demonstrated, the much lower within-patient than between-patient variances facilitated estimations of highly statistical significant, within-patient differences in thermal thresholds. DISCUSSION:: In patients with postthoracotomy pain syndrome, several statistical methods indicated an excessively high......, in addition to the maximum pain site on the surgical side. In these total 9 sites, warmth detection threshold, cool detection threshold, and heat pain threshold were assessed. RESULTS:: Comparisons of thermal test-retest assessments did not demonstrate any significant intraside differences. The SDs...

  15. Pain sensitivity profiles in patients with advanced knee osteoarthritis

    Science.gov (United States)

    Frey-Law, Laura A.; Bohr, Nicole L.; Sluka, Kathleen A.; Herr, Keela; Clark, Charles R.; Noiseux, Nicolas O.; Callaghan, John J; Zimmerman, M Bridget; Rakel, Barbara A.

    2016-01-01

    The development of patient profiles to subgroup individuals on a variety of variables has gained attention as a potential means to better inform clinical decision-making. Patterns of pain sensitivity response specific to quantitative sensory testing (QST) modality have been demonstrated in healthy subjects. It has not been determined if these patterns persist in a knee osteoarthritis population. In a sample of 218 participants, 19 QST measures along with pain, psychological factors, self-reported function, and quality of life were assessed prior to total knee arthroplasty. Component analysis was used to identify commonalities across the 19 QST assessments to produce standardized pain sensitivity factors. Cluster analysis then grouped individuals that exhibited similar patterns of standardized pain sensitivity component scores. The QST resulted in four pain sensitivity components: heat, punctate, temporal summation, and pressure. Cluster analysis resulted in five pain sensitivity profiles: a “low pressure pain” group, an “average pain” group, and three “high pain” sensitivity groups who were sensitive to different modalities (punctate, heat, and temporal summation). Pain and function differed between pain sensitivity profiles, along with sex distribution; however no differences in OA grade, medication use, or psychological traits were found. Residualizing QST data by age and sex resulted in similar components and pain sensitivity profiles. Further, these profiles are surprisingly similar to those reported in healthy populations suggesting that individual differences in pain sensitivity are a robust finding even in an older population with significant disease. PMID:27152688

  16. Psychometric Properties of the Multidimensional Pain Inventory Applied to Brazilian Patients with Orofacial Pain.

    Science.gov (United States)

    Zucoloto, Miriane Lucindo; Maroco, João; Duarte Bonini Campos, Juliana Alvares

    2015-01-01

    To evaluate the psychometric properties of the Multidimensional Pain Inventory (MPI) in a Brazilian sample of patients with orofacial pain. A total of 1,925 adult patients, who sought dental care in the School of Dentistry of São Paulo State University's Araraquara campus, were invited to participate; 62.5% (n=1,203) agreed to participate. Of these, 436 presented with orofacial pain and were included. The mean age was 39.9 (SD=13.6) years and 74.5% were female. Confirmatory factor analysis was conducted using χ²/df, comparative fit index, goodness of fit index, and root mean square error of approximation as indices of goodness of fit. Convergent validity was estimated by the average variance extracted and composite reliability, and internal consistency by Cronbach's alpha standardized coefficient (α). The stability of the models was tested in independent samples (test and validation; dental pain and orofacial pain). The factorial invariance was estimated by multigroup analysis (Δχ²). Factorial, convergent validity, and internal consistency were adequate in all three parts of the MPI. To achieve this adequate fit for Part 1, item 15 needed to be deleted (λ=0.13). Discriminant validity was compromised between the factors "activities outside the home" and "social activities" of Part 3 of the MPI in the total sample, validation sample, and in patients with dental pain and with orofacial pain. A strong invariance between different subsamples from the three parts of the MPI was detected. The MPI produced valid, reliable, and stable data for pain assessment among Brazilian patients with orofacial pain.

  17. Patient characteristics and treatment outcome in functional anorectal pain.

    Science.gov (United States)

    Atkin, Gary K; Suliman, Amna; Vaizey, Carolynne J

    2011-07-01

    Functional anorectal pain occurs in the absence of any clinical abnormality. It is common and disabling; it has previously been reported in only a few studies involving small patient numbers. This study aimed to report the clinical characteristics and treatment outcomes for patients with functional anorectal pain. Patient demographics, clinical history, and tests results for all referrals for anorectal physiological testing between 1997 and 2009 were prospectively recorded. For patients with functional anorectal pain, further information was gained from clinical notes. Clinical history, anorectal physiology, and radiological imaging data were recorded for all patients; treatment outcome was noted for patients treated and followed up at the present unit. One hundred seventy patients, 99 female, with a median age of 48 years (range, 18-86), were studied. Patients were classified as having chronic proctalgia (pain duration ≥20 min, 158 patients) or proctalgia fugax (pain duration proctalgia fugax had a higher internal anal sphincter thickness and resting pressure than patients with chronic proctalgia, whereas patients with a family history of similar symptoms were more likely to have proctalgia fugax and higher resting pressures and internal anal sphincter thickness compared with those without a family history of these symptoms. Patients referred for treatment underwent a range of interventions including biofeedback (29 patients, 17 improved), tricyclic antidepressants (26 patients, 10 improved), Botox injection (9 patients, 5 improved), and sacral nerve stimulation (3 patients, 2 improved). Biofeedback had the greatest treatment effect, especially in patients with defecatory dysfunction. Biofeedback is beneficial in the subset of patients with functional anorectal pain and difficulty with defecation. Tricyclic antidepressants, Botox, and sacral nerve stimulation may also have a role.

  18. Tactile allodynia in patients with lumbar radicular pain (sciatica).

    Science.gov (United States)

    Defrin, Ruth; Devor, Marshall; Brill, Silviu

    2014-12-01

    We report a novel symptom in many patients with low back pain (LBP) that sheds new light on the underlying pain mechanism. By means of quantitative sensory testing, we compared patients with radicular LBP (sciatica), axial LBP (LBP without radiation into the leg), and healthy controls, searching for cutaneous allodynia in response to weak tactile and cooling stimuli on the leg and low back. Most patients with radicular pain (~60%) reported static and dynamic tactile allodynia, as well as cooling allodynia, on the leg, often extending into the foot. Some also reported allodynia on the low back. In axial LBP, allodynia was almost exclusively on the back. The degree of dynamic tactile allodynia correlated with the degree of background pain. The presence of allodynia suggests that the peripheral nerve generators of background leg and back pain have also induced central sensitization. The distal (foot) location of the allodynia in patients who have it indicates that the nociceptive drive that maintains the central sensitization arises paraspinally (ectopically) in injured ventral ramus afferents; this is not an instance of somatic referred pain. The presence of central sensitization also provides the first cogent account of shooting pain in sciatica as a wave of activity sweeping vectorially across the width of the sensitized dorsal horn. Finally, the results endorse leg allodynia as a pain biomarker in animal research on LBP, which is commonly used but has not been previously validated. In addition to informing the underlying mechanism of LBP, bedside mapping of allodynia might have practical implications for prognosis and treatment. How can you tell whether pain radiating into the leg in a patient with sciatica is neuropathic, ie, due to nerve injury? Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  19. A Simple and Effective Daily Pain Management Method for Patients Receiving Radiation Therapy for Painful Bone Metastases

    International Nuclear Information System (INIS)

    Andrade, Regiane S.; Proctor, Julian W.; Slack, Robert; Marlowe, Ursula; Ashby, Karlotta R.; Schenken, Larry L.

    2010-01-01

    Purpose: The incidence of painful bone metastases increases with longer survival times. Although external beam radiation therapy (EBRT) is an effective palliative treatment, it often requires several days from the start of treatment to produce a measurable reduction in pain scores and a qualitative amelioration of patient pain levels. Meanwhile, the use of analgesics remains the best approach early on in the treatment course. We investigated the role of radiation therapists as key personnel for collecting daily pain scores to supplement assessments by physician and oncology nursing staff and manage pain more effectively during radiation treatment. Methods and Materials: Daily pain scores were obtained by the radiation therapists for 89 patients undertaking a total of 124 courses of EBRT for bone metastases and compared with pretreatment pain scores. The majority of patients (71%) were treated to 30 Gy (range, 20-37.5) in 10 fractions (range, 8-15 fractions). Results: One hundred nineteen treatment courses (96%) were completed. Pain scores declined rapidly to 37.5%, 50%, and 75% of the pretreatment levels by Days 2, 4, and 10, respectively. Pain was improved in 91% of patients with only 4% of worse pain at the end of treatment. Improved pain scores were maintained in 83% of patients at 1-month follow-up, but in 35% of them, the pain was worse than at the end of treatment. Conclusions: Collection of daily pain scores by radiation therapists was associated with an effective reduction in pain scores early on during EBRT of painful osseous metastases.

  20. Pelvic pain in a young patient: Sclerosing stromal tumor

    Directory of Open Access Journals (Sweden)

    Huriye Ayşe Parlakgümüş

    2013-03-01

    Full Text Available Introduction: Sclerosing stromal tumors are rare, benign sex chord stromal tumors. They are usually unilateral and are seen in second or third decades. The complaint at admission may be menstrual irregularity, pelvic pain, palpable pelvic mass, precocious puberty and postmenopausal bleeding. Because the complaint at admission and radiological findings are not specific to SSTs preoperative diagnosis is challenging. Herein we present the sonographical, intraoperative and histopathological findings of a SST diagnosed during laparoscopy in a patient who admitted with chronic pelvic pain and received pelvic inflammatory disease and endometriosis treatment and differential diagnosis of SSTs with the other ovarian tumors. Case report: 24 years old nulliparous patient first admitted to the gynecology department with the complaint of foul smelling vaginal discharge and pelvic pain. The diagnosis was pelvic inflammatory disease and the patient received antibiotics. The pelvic examination was normal except the mass in the right ovary which had similar echogenity to the ovary. Because of the pelvic pain the mass was assumed to be an endometrioma and the patient was prescribed an oral contraceptive treatment for 3 months. Because of the persistent pelvic pain a diagnostic laparoscopy was performed which revealed a 2 cm, pinkish- white, exophytic lesion originating from the right ovary. Pathological examination reported the mass to be a sclerosing stromal tumor. After the treatment the patient no longer complained of vaginal discharge but pelvic pain still persisted. After the operation the patient no longer complained of pelvic pain. Conclusion: Although SSTs are rare, they should be kept in mind when a young patient admits with menstrual irregularity, pelvic pain and hirsutism, particularly if the pain is refractory to treatment.

  1. Calibration of the Dutch-Flemish PROMIS Pain Behavior item bank in patients with chronic pain.

    Science.gov (United States)

    Crins, M H P; Roorda, L D; Smits, N; de Vet, H C W; Westhovens, R; Cella, D; Cook, K F; Revicki, D; van Leeuwen, J; Boers, M; Dekker, J; Terwee, C B

    2016-02-01

    The aims of the current study were to calibrate the item parameters of the Dutch-Flemish PROMIS Pain Behavior item bank using a sample of Dutch patients with chronic pain and to evaluate cross-cultural validity between the Dutch-Flemish and the US PROMIS Pain Behavior item banks. Furthermore, reliability and construct validity of the Dutch-Flemish PROMIS Pain Behavior item bank were evaluated. The 39 items in the bank were completed by 1042 Dutch patients with chronic pain. To evaluate unidimensionality, a one-factor confirmatory factor analysis (CFA) was performed. A graded response model (GRM) was used to calibrate the items. To evaluate cross-cultural validity, Differential item functioning (DIF) for language (Dutch vs. English) was evaluated. Reliability of the item bank was also examined and construct validity was studied using several legacy instruments, e.g. the Roland Morris Disability Questionnaire. CFA supported the unidimensionality of the Dutch-Flemish PROMIS Pain Behavior item bank (CFI = 0.960, TLI = 0.958), the data also fit the GRM, and demonstrated good coverage across the pain behavior construct (threshold parameters range: -3.42 to 3.54). Analysis showed good cross-cultural validity (only six DIF items), reliability (Cronbach's α = 0.95) and construct validity (all correlations ≥0.53). The Dutch-Flemish PROMIS Pain Behavior item bank was found to have good cross-cultural validity, reliability and construct validity. The development of the Dutch-Flemish PROMIS Pain Behavior item bank will serve as the basis for Dutch-Flemish PROMIS short forms and computer adaptive testing (CAT). © 2015 European Pain Federation - EFIC®

  2. Quality Pain Management in Adult Hospitalized Patients: A Concept Evaluation.

    Science.gov (United States)

    Zoëga, Sigridur; Gunnarsdottir, Sigridur; Wilson, Margaret E; Gordon, Debra B

    2016-01-01

    To explore the concept of quality pain management (QPM) in adult hospitalized patients. Pain is common in hospitalized patients, and pain management remains suboptimal in some settings. A concept evaluation based on Morse et al.'s method. Of more than 5,000 articles found, data were restricted to 37 selected key articles published in peer-reviewed journals. Data were extracted from the selected articles and then synthesized according to the following: definition, characteristics, boundaries, preconditions, and outcomes. QPM relates to the Structure: organizationally supported evidence-based policies, competent staff, interprofessional and specialized care, and staff accountability; screening, assessment/reassessment and communication of pain and its treatment, patient/family education, individualized evidence-based treatment, embedded in safe, effective, patient-centered, timely, efficient, and equitable services; and reduced pain severity and functional interference, decreased prevalence/severity of adverse consequences from pain or pain treatment, and increase in patient satisfaction. QPM is a multifaceted concept that remains poorly defined in the literature. Studies should aim to develop valid, reliable, and operational measures of the pillars of QPM and to look at the relationship among these factors. Authors need to state how they define and what aspects of QPM they are measuring. © 2014 Wiley Periodicals, Inc.

  3. A Pilot Comparison of a Smartphone App With or Without 2-Way Messaging Among Chronic Pain Patients: Who Benefits From a Pain App?

    Science.gov (United States)

    Jamison, Robert N; Jurcik, Dylan C; Edwards, Robert R; Huang, Chuan-Chin; Ross, Edgar L

    2017-08-01

    The overall aim of this study was to determine the effect of introducing a smartphone pain application (app), for both Android and iPhone devices that enables chronic pain patients to assess, monitor, and communicate their status to their providers. This study recruited 105 chronic pain patients to use a smartphone pain app and half of the patients (N=52) had 2-way messaging available through the app. All patients completed baseline measures and were asked to record their progress every day for 3 months, with the opportunity to continue for 6 months. All participants were supplied a Fitbit to track daily activity. Summary line graphs were posted to each of the patients' electronic medical records and physicians were notified of their patient's progress. Ninety patients successfully downloaded the pain app. Average age of the participants was 47.1 (range, 18 to 72), 63.8% were female and 32.3% reported multiple pain sites. Adequate validity and reliability was found between the daily assessments and standardized questionnaires (r=0.50) and in repeated daily measures (pain, r=0.69; sleep, r=0.83). The app was found to be easily introduced and well tolerated. Those patients assigned to the 2-way messaging condition on average tended to use the app more and submit more daily assessments (95.6 vs. 71.6 entries), but differences between groups were not significant. Pain-app satisfaction ratings overall were high. This study highlights some of the challenges and benefits in utilizing smartphone apps to manage chronic pain patients, and provides insight into those individuals who might benefit from mHealth technology.

  4. Many Patients with Cancer Need Better Treatments for Pain

    Science.gov (United States)

    Inadequate pain treatment in patients with cancer remains a significant problem and appears to be more frequent among minorities, according to a new study published online April 16, 2012, in the Journal of Clinical Oncology.

  5. Patellofemoral morphometry in patients with idiopathic patellofemoral pain syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Mar Carrion Martin, Maria del [Department of Rehabilitation, Hospital of Traumatology (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18014 Granada (Spain); Ruiz Santiago, Fernando, E-mail: ferruizsan@terra.e [Department of Radiology, Hospital of Traumatology (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18014 Granada (Spain); Pozuelo Calvo, Rocio [Department of Rehabilitation, Hospital of Traumatology (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18014 Granada (Spain); Guzman Alvarez, Luis [Department of Radiology, Hospital of Traumatology (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18014 Granada (Spain)

    2010-07-15

    Purpose: To compare clinical and computed tomography (CT) measures in extension, 20{sup o} and 30{sup o} of flexion of symptomatic knees of patient with idiopathic patellofemoral pain syndrome with the contra lateral asymptomatic knee. Materials and methods: Knees of 52 consecutive patients with idiopathic patellofemoral pain were studied with CT. In 28 patients this condition was unilateral and asymptomatic knee was used as control; 76 knees were symptomatic. Results: In patients with idiopathic patellofemoral pain we found a greater Q angle and internal condylar facet width in symptomatic knees with regard to asymptomatic knees. Conclusion: Greater Q angle and medial condylar facet can lead to overpressure on the medial knee compartment during maneuvers that increase contact between patella and medial condylar facet, such as knee flexion and squatting, contributing to development of idiopathic patellofemoral pain.

  6. Patellofemoral morphometry in patients with idiopathic patellofemoral pain syndrome

    International Nuclear Information System (INIS)

    Mar Carrion Martin, Maria del; Ruiz Santiago, Fernando; Pozuelo Calvo, Rocio; Guzman Alvarez, Luis

    2010-01-01

    Purpose: To compare clinical and computed tomography (CT) measures in extension, 20 o and 30 o of flexion of symptomatic knees of patient with idiopathic patellofemoral pain syndrome with the contra lateral asymptomatic knee. Materials and methods: Knees of 52 consecutive patients with idiopathic patellofemoral pain were studied with CT. In 28 patients this condition was unilateral and asymptomatic knee was used as control; 76 knees were symptomatic. Results: In patients with idiopathic patellofemoral pain we found a greater Q angle and internal condylar facet width in symptomatic knees with regard to asymptomatic knees. Conclusion: Greater Q angle and medial condylar facet can lead to overpressure on the medial knee compartment during maneuvers that increase contact between patella and medial condylar facet, such as knee flexion and squatting, contributing to development of idiopathic patellofemoral pain.

  7. Predictors of Pain among Head and Neck Cancer Patients

    Science.gov (United States)

    Shuman, Andrew G.; Terrell, Jeffrey E.; Light, Emily; Wolf, Gregory T.; Bradford, Carol R.; Chepeha, Douglas; Jiang, Yunyun; McLean, Scott; Ghanem, Tamer A.; Duffy, Sonia A.

    2014-01-01

    Objective Pain is a strong contributor to cancer patients’ quality of life. The objective of this study was to determine predictors of pain 1 year after the diagnosis of head and neck cancer. Design Prospective, multi-site cohort study. Setting Three academically-affiliated medical centers. Patients Previously untreated patients with carcinoma of the upper aerodigestive tract (n=374). Main Outcome Measures Participants were surveyed pre-treatment and 1 year thereafter. Multivariate analyses were conducted to determine predictors of the SF-36 bodily pain score 1 year after diagnosis. Results The mean SF-36 bodily pain score at 1 year was 65, compared to 61 at diagnosis (p=.004), compared to 75 among population norms (lower scores indicate worse pain). Variables independently associated with pain included pre-treatment pain score (p<0.001), less education (p=0.02), neck dissection (p=0.001), feeding tube (p=0.05), xerostomia (p<0.001), depressive symptoms (p<0.001), taking more pain medication (p<0.001), less physical activity (p=.02), and poor sleep quality (p=0.006). Current smoking and problem drinking were marginally significant (p=0.07 and 0.08, respectively). Conclusions Aggressive pain management may be indicated for head and neck cancer patients who undergo neck dissections, complain of xerostomia, require feeding tubes, and have medical comorbidities. Treatment of modifiable risk factors such as depression, poor sleep quality, tobacco and alcohol abuse may also reduce pain and improve quality of life among head and neck cancer patients. PMID:23165353

  8. Neuropathic pain in patients with spinal cord injury: report of 213 patients.

    Science.gov (United States)

    Teixeira, Manoel Jacobsen; Paiva, Wellingson Silva; Assis, Maruska Salles; Fonoff, Erich Talamoni; Bor-Seng-Shu, Edson; Cecon, Angelo Daros

    2013-09-01

    Management of neuropathic pain following spinal cord injury (SCI) can be a frustrating experience for patients since it poses a therapeutic challenge. In this article the authors describe the clinical characteristics of a group of patients with pain after spinal cord injury. In this retrospective study, 213 patients with SCI and neuropathic pain were assessed. We analyzed clinical characteristics, treatment options, and pain intensity for these patients. The main cause of SCI was spine trauma, which occurred in 169 patients, followed by tumors and infection. Complete lesions were verified in 144 patients. In our study, patients with traumatic SCI and partial lesions seem to be presented with more intense pain; however, this was not statistically significant. Neuropathic pain is a common complaint in patients with SCI and presents a treatment challenge. Knowledge of the clinical characteristics of this group of patients may help determine the best approach to intervention.

  9. Neuropathic pain in patients with spinal cord injury: report of 213 patients

    Directory of Open Access Journals (Sweden)

    Manoel Jacobsen Teixeira

    2013-09-01

    Full Text Available Objective Management of neuropathic pain following spinal cord injury (SCI can be a frustrating experience for patients since it poses a therapeutic challenge. In this article the authors describe the clinical characteristics of a group of patients with pain after spinal cord injury. Methods In this retrospective study, 213 patients with SCI and neuropathic pain were assessed. We analyzed clinical characteristics, treatment options, and pain intensity for these patients. Results The main cause of SCI was spine trauma, which occurred in 169 patients, followed by tumors and infection. Complete lesions were verified in 144 patients. In our study, patients with traumatic SCI and partial lesions seem to be presented with more intense pain; however, this was not statistically significant. Conclusions Neuropathic pain is a common complaint in patients with SCI and presents a treatment challenge. Knowledge of the clinical characteristics of this group of patients may help determine the best approach to intervention.

  10. Success of torsional correction surgery after failed surgeries for patellofemoral pain and instability

    OpenAIRE

    Stevens, Peter M.; Gililland, Jeremy M.; Anderson, Lucas A.; Mickelson, Jennifer B.; Nielson, Jenifer; Klatt, Joshua W.

    2013-01-01

    Torsional deformities of the femur and/or tibia often go unrecognized in adolescents and adults who present with anterior knee pain, and patellar maltracking or instability. While open and arthroscopic surgical techniques have evolved to address these problems, unrecognized torsion may compromise the outcomes of these procedures. We collected a group of 16 consecutive patients (23 knees), with mean age of 17, who had undergone knee surgery before torsion was recognized and subsequently treate...

  11. Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain.

    Science.gov (United States)

    Turk, Dennis C

    2002-01-01

    Chronic pain is a prevalent and costly problem. This review addresses the question of the clinical effectiveness and cost-effectiveness of the most common treatments for patients with chronic pain. Representative published studies that evaluate the clinical effectiveness of pharmacological treatments, conservative (standard) care, surgery, spinal cord stimulators, implantable drug delivery systems (IDDSs), and pain rehabilitation programs (PRPs) are examined and compared. The cost-effectiveness of these treatment approaches is also considered. Outcome criteria including pain reduction, medication use, health care consumption, functional activities, and closure of disability compensation cases are examined. In addition to clinical effectiveness, the cost-effectiveness of PRPs, conservative care, surgery, spinal cord stimulators, and IDDSs are compared using costs to return a treated patient to work to illustrate the relative expenses for each of these treatments. There are limitations to the success of all the available treatments. The author urges caution in interpreting the results, particularly in comparisons between treatments and across studies, because there are broad differences in the pain syndromes and inclusion criteria used, the drug dosages, comparability of treatments, the definition of "chronic" used, the outcome criteria selected to determine success, and societal differences. None of the currently available treatments eliminates pain for the majority of patients. Pain rehabilitation programs provide comparable reduction in pain to alternative pain treatment modalities, but with significantly better outcomes for medication use, health care utilization, functional activities, return to work, closure of disability claims, and with substantially fewer iatrogenic consequences and adverse events. Surgery, spinal cord stimulators, and IDDSs appear to have substantial benefits on some outcome criteria for carefully selected patients. These modalities are

  12. [Preoperative, neuropathic component in patients with back pain].

    Science.gov (United States)

    Lee, Y-J; Koch, E M W; Breidebach, J B; Bornemann, R; Wirtz, D C; Pflugmacher, R

    2017-04-01

    The objectification of pain is essential for evaluation, treatment plan and follow-up; therefore, it is necessary to find reliable clinical parameters. The goal of the study was the preoperative screening of a neuropathic component in patients with vertebral compression fracture (WKF), herniated disc (NPP) or spinal cord compression (SKS). Depending on the preoperative condition on admittance, patients were classified into three groups: group 1 WKF, group 2 NPP and group 3 SKS. To characterize the pain we used the painDETECT questionnaire, the Oswestry questionnaire and further questionnaires. All patients were surgically treated according to the diagnosis, e.g. radiofrequency kyphoplasty, nucleotomy or spondylodesis. We evaluated the data from 139 patients (45% WKF, 34% NPP and 21% SKS). There were no differences in preoperative pain intensity (median ordinal scale 0-10) with a mean preoperative score of 7 for all groups. The total score of the painDETECT questionnaire showed significantly higher results in group 2 (median 18) and in group 3 (median 14) than in group 1 (median 9). There was even a significant difference between groups 2 and 3 (p = 0.03). The highest pain intensity was detected in group 1 with a median visual analog scale (VAS) of 71 mm. The total scores in the painDETECT questionnaire and the scores in the Oswestry questionnaire correlated in groups 2 and 3. The painDETECT questionnaire was shown to be a very suitable instrument for evaluating the neuropathic pain component in patients with dorsalgia. This could be very useful in planning further therapy.

  13. The success rate of bupivacaine and lidocaine as anesthetic agents in inferior alveolar nerve block in teeth with irreversible pulpitis without spontaneous pain

    Directory of Open Access Journals (Sweden)

    Masoud Parirokh

    2015-05-01

    Full Text Available Objectives Achieving adequate anesthesia with inferior alveolar nerve blocks (IANB is of great importance during dental procedures. The aim of the present study was to assess the success rate of two anesthetic agents (bupivacaine and lidocaine for IANB when treating teeth with irreversible pulpitis. Materials and Methods Sixty volunteer male and female patients who required root canal treatment of a mandibular molar due to caries participated in the present study. The inclusion criteria included prolonged pain to thermal stimulus but no spontaneous pain. The patients were randomly allocated to receive either 2% lidocaine with 1:80,000 epinephrine or 0.5% bupivacaine with 1:200,000 epinephrine as an IANB injection. The sensitivity of the teeth to a cold test as well as the amount of pain during access cavity preparation and root canal instrumentation were recorded. Results were statistically analyzed with the Chi-Square and Fischer's exact tests. Results At the final step, fifty-nine patients were included in the study. The success rate for bupivacaine and lidocaine groups were 20.0% and 24.1%, respectively. There was no significant difference between the two groups at any stage of the treatment procedure. Conclusions There was no difference in success rates of anesthesia when bupivacaine and lidocaine were used for IANB injections to treat mandibular molar teeth with irreversible pulpitis. Neither agent was able to completely anesthetize the teeth effectively. Therefore, practitioners should be prepared to administer supplemental anesthesia to overcome pain during root canal treatment.

  14. The success rate of bupivacaine and lidocaine as anesthetic agents in inferior alveolar nerve block in teeth with irreversible pulpitis without spontaneous pain

    Science.gov (United States)

    Yosefi, Mohammad Hosein; Nakhaee, Nouzar

    2015-01-01

    Objectives Achieving adequate anesthesia with inferior alveolar nerve blocks (IANB) is of great importance during dental procedures. The aim of the present study was to assess the success rate of two anesthetic agents (bupivacaine and lidocaine) for IANB when treating teeth with irreversible pulpitis. Materials and Methods Sixty volunteer male and female patients who required root canal treatment of a mandibular molar due to caries participated in the present study. The inclusion criteria included prolonged pain to thermal stimulus but no spontaneous pain. The patients were randomly allocated to receive either 2% lidocaine with 1:80,000 epinephrine or 0.5% bupivacaine with 1:200,000 epinephrine as an IANB injection. The sensitivity of the teeth to a cold test as well as the amount of pain during access cavity preparation and root canal instrumentation were recorded. Results were statistically analyzed with the Chi-Square and Fischer's exact tests. Results At the final step, fifty-nine patients were included in the study. The success rate for bupivacaine and lidocaine groups were 20.0% and 24.1%, respectively. There was no significant difference between the two groups at any stage of the treatment procedure. Conclusions There was no difference in success rates of anesthesia when bupivacaine and lidocaine were used for IANB injections to treat mandibular molar teeth with irreversible pulpitis. Neither agent was able to completely anesthetize the teeth effectively. Therefore, practitioners should be prepared to administer supplemental anesthesia to overcome pain during root canal treatment. PMID:25984478

  15. The success rate of bupivacaine and lidocaine as anesthetic agents in inferior alveolar nerve block in teeth with irreversible pulpitis without spontaneous pain.

    Science.gov (United States)

    Parirokh, Masoud; Yosefi, Mohammad Hosein; Nakhaee, Nouzar; Abbott, Paul V; Manochehrifar, Hamed

    2015-05-01

    Achieving adequate anesthesia with inferior alveolar nerve blocks (IANB) is of great importance during dental procedures. The aim of the present study was to assess the success rate of two anesthetic agents (bupivacaine and lidocaine) for IANB when treating teeth with irreversible pulpitis. Sixty volunteer male and female patients who required root canal treatment of a mandibular molar due to caries participated in the present study. The inclusion criteria included prolonged pain to thermal stimulus but no spontaneous pain. The patients were randomly allocated to receive either 2% lidocaine with 1:80,000 epinephrine or 0.5% bupivacaine with 1:200,000 epinephrine as an IANB injection. The sensitivity of the teeth to a cold test as well as the amount of pain during access cavity preparation and root canal instrumentation were recorded. Results were statistically analyzed with the Chi-Square and Fischer's exact tests. At the final step, fifty-nine patients were included in the study. The success rate for bupivacaine and lidocaine groups were 20.0% and 24.1%, respectively. There was no significant difference between the two groups at any stage of the treatment procedure. There was no difference in success rates of anesthesia when bupivacaine and lidocaine were used for IANB injections to treat mandibular molar teeth with irreversible pulpitis. Neither agent was able to completely anesthetize the teeth effectively. Therefore, practitioners should be prepared to administer supplemental anesthesia to overcome pain during root canal treatment.

  16. Effect of Patient Education on Reducing Medication in Spinal Cord Injury Patients With Neuropathic Pain.

    Science.gov (United States)

    Shin, Ji Cheol; Kim, Na Young; Chang, Shin Hye; Lee, Jae Joong; Park, Han Kyul

    2017-08-01

    To determine whether providing education about the disease pathophysiology and drug mechanisms and side effects, would be effective for reducing the use of pain medication while appropriately managing neurogenic pain in spinal cord injury (SCI) patients. In this prospective study, 109 patients with an SCI and neuropathic pain, participated in an educational pain management program. This comprehensive program was specifically created, for patients with an SCI and neuropathic pain. It consisted of 6 sessions, including educational training, over a 6-week period. Of 109 patients, 79 (72.5%) initially took more than two types of pain medication, and this decreased to 36 (33.0%) after the educational pain management program was completed. The mean pain scale score and the number of pain medications decreased, compared to the baseline values. Compared to the non-response group, the response group had a shorter duration of pain onset (p=0.004), and a higher initial number of different medications (ppain management program, can be a valuable complement to the treatment of spinal cord injured patients with neuropathic pain. Early intervention is important, to prevent patients from developing chronic SCI-related pain.

  17. The pain experience of patients with sickle cell anemia.

    Science.gov (United States)

    Jacob, E

    2001-09-01

    Sickle cell anemia is a genetic disorder that affects 1 in 600 black infants in the United States. The painful crisis is one of its most characteristic manifestations and consists of pain in the extremities, back, abdomen, or chest. It may occur in 4 phases and may be precipitated by a variety of factors. The frequency, location, duration, severity, and character of pain differ both within and among patients. The pain may be localized, involve several areas, be diffuse, or be migratory. The intensity of pain varies from mild to excruciating and is perceived to be more intense by those who have experienced other forms of pain such as postoperative pain. Patients with sickle cell anemia who experience frequent painful crises exhibit problems with self-concept and low self-esteem, anxiety, depression, dissatisfaction with body image, poor school performance, social isolation, decreased participation in normal activities of daily living, and poor peer and family relationships. The periodic and unpredictable episodes can be incapacitating and may affect the way children see and feel about themselves, the way they relate to other people, the goals they set for themselves, and the way they approach a range of activities and situations. Research is very limited, and most of the available literature is based on personal observations, opinions, and anecdotal reports. The purpose of this report is to describe the phases of a painful episode as well as to examine the predisposing factors to, defining characteristics of, and patient outcomes associated with a painful crisis from sickle cell anemia.

  18. Pain and somatosensory findings in patients 3 years after total hip arthroplasty

    DEFF Research Database (Denmark)

    Nikolajsen, Lone; Kristensen, Anders D; Thillemann, Theis M

    2009-01-01

    in patients and controls. Patients with chronic hip pain had higher scores on the mental vulnerability scale (Poperated side, which was more prominent in patients...... with chronic hip pain and 18 controls without chronic hip pain were recruited from a previous questionnaire study about hip pain after total hip arthroplasty. All participants answered questions about pain and mental vulnerability and underwent clinical examination followed by quantitative sensory testing...... with pain. Pain referred from the back or deeper structures in the hip seems to play a role for the pain in subgroups of patients. In addition, chronic hip pain was associated with mental vulnerability....

  19. Success of torsional correction surgery after failed surgeries for patellofemoral pain and instability.

    Science.gov (United States)

    Stevens, Peter M; Gililland, Jeremy M; Anderson, Lucas A; Mickelson, Jennifer B; Nielson, Jenifer; Klatt, Joshua W

    2014-04-01

    Torsional deformities of the femur and/or tibia often go unrecognized in adolescents and adults who present with anterior knee pain, and patellar maltracking or instability. While open and arthroscopic surgical techniques have evolved to address these problems, unrecognized torsion may compromise the outcomes of these procedures. We collected a group of 16 consecutive patients (23 knees), with mean age of 17, who had undergone knee surgery before torsion was recognized and subsequently treated by means of rotational osteotomy of the tibia and/or femur. By follow-up questionnaire, we sought to determine the role of rotational correction at mean 59-month follow-up. We reasoned that, by correcting torsional alignment, we might be able to optimize long-term outcomes and avert repeated knee surgery. Knee pain was significantly improved after torsional treatment (mean 8.6 pre-op vs. 3.3 post-op, p instability, and 57 % could trust their knee after surgery. Activity level remained the same or increased in 78 % of patients after torsional treatment. Excluding planned rod removal, subsequent knee surgery for continued anterior knee pain was undertaken on only 3 knees in 2 patients. We believe that malrotation of the lower limb not only raises the propensity for anterior knee symptoms, but is also a under-recognized etiology in the failure of surgeries for anterior knee pain and patellar instability. Addressing rotational abnormalities in the index surgery yields better clinical outcomes than osteotomies performed after other prior knee surgeries.

  20. The psychometric properties of the cervical nonorganic signs in patients with neck pain: an assessment of pain expression.

    Science.gov (United States)

    Lue, Yi-Jing; Chang, Jyh-Jong; Wu, Yuh-Yih; Lin, Rong-Fong; Lu, Yen-Mou

    2018-04-01

    Neck pain is a common cause of disability. This study investigated the psychometric properties of the cervical nonorganic signs (CNOS), a tool for assessing abnormal illness behaviors in patients with neck pain. The CNOS was administered on patients with neck pain. Reliability and validity analyses were used to evaluate the psychometric properties. Exploratory factor analysis was used to investigate the dimensionality. Correlations with the Short Form-36 were used to investigate the convergent validity. The results supported the reliability (inter-rater reliability intra-class correlation: 0.920), validity (correlated with body pain (|ρ|=0.31) and vitality (|ρ| =0.30), and two-factor dimensionality (χ 2 =   5.904, p= 0.66; χ 2 /df = 0.738; RMSEApain (severe pain) and vitality (poor vitality) expressed by the patients. The CNOS is a reliable and valid instrument for assessing pain and vitality problems. It helps patients to express severe pain and lack of vitality. The rehabilitation discipline could use the scale to understand pain expression and to design proper rehabilitation programs. Implications for Rehabilitation The cervical nonorganic signs has two domains (pain and vitality). The scale is reliable and valid for patients with neck pain. Patients with high scores on the pain domain have severe body pain that may interfere with normal social activities. Clinicians should understand their suffering and try to help them to alleviate the pain.

  1. 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

  2. Barriers to cancer pain management in danish and lithuanian patients treated in pain and palliative care units

    DEFF Research Database (Denmark)

    Jacobsen, Ramune; Samsanaviciene, Jurgita; Liubarskiene, Zita

    2014-01-01

    -related barriers to cancer pain management in patient samples from Denmark and Lithuania. Thirty-three Danish and 30 Lithuanian patients responded to, respectively, Danish and Lithuanian versions of the Brief Pain Inventory pain scale, the Barriers Questionnaire II, the Hospital Anxiety and Depression Scale...

  3. Management of patients with low back pain

    DEFF Research Database (Denmark)

    Debarle, Michel; Aigron, Rémi; Depernet, Laure

    2014-01-01

    BACKGROUND: Little is known about the level of consensus within the French chiropractic profession regarding management of clinical issues. A previous Swedish study showed that chiropractors agreed relatively well on the management strategy for nine low back pain scenarios. We wished to investiga...

  4. Sex differences in the stability of conditioned pain modulation (CPM) among patients with chronic pain.

    Science.gov (United States)

    Martel, Marc O; Wasan, Ajay D; Edwards, Robert R

    2013-11-01

    To examine the temporal stability of conditioned pain modulation (CPM), formerly termed diffuse noxious inhibitory controls, among a sample of patients with chronic pain. The study also examined the factors that might be responsible for the stability of CPM. In this test-retest study, patients underwent a series of standardized psychophysical pain-testing procedures designed to assess CPM on two separate occasions (i.e., baseline and follow up). Patients also completed self-report measures of catastrophizing (Pain Catastrophizing Scale [PCS] and negative affect [NA]). Overall, results provided evidence for the stability of CPM among patients with chronic pain. Results, however, revealed considerable sex differences in the stability of CPM. For women, results revealed a significant test-retest correlation between baseline and follow-up CPM scores. For men, however, the test-retest correlation between baseline and follow-up CPM scores was not significant. Results of a Fisher's Z-test revealed that the stability of CPM was significantly greater for women than for men. Follow-up analyses revealed that the difference between men and women in the stability of CPM could not be accounted for by any demographic (e.g., age) and/or psychological factors (PCS and NA). Our findings suggest that CPM paradigms possess sufficient reliability to be incorporated into bedside clinical evaluation of patients with chronic pain, but only among women. The lack of CPM reproducibility/stability observed among men places limits on the potential use of CPM paradigms in clinical settings for the assessment of men's endogenous pain-inhibitory function. Wiley Periodicals, Inc.

  5. Brain perfusion abnormality in patients with chronic pain

    International Nuclear Information System (INIS)

    Honda, Tetsumi; Maruta, Toshihiko; Takahashi, Kumiko

    2007-01-01

    We performed single photon emission computed tomography (SPECT) of the brain in 15 patients with chronic pain (males, 7; females, 8; average age 49.1±17.9 years) and identified the locus of cerebral blood flow reduction by a new analytical method (easy Z-score Imaging System: eZIS) to clarify the functional neuroanatomical basis of chronic pain. Of the 15 patients, 6 had backache, 2 neck pain, 2 gonalgia, and 5 pain at other sites, with an average Visual analog scale of pain (VAS) value of 6.1±1.9. In comparison with a information on a data base on physically unimpaired persons, the dorsolateral prefrontal area (both sides, right dominant), medial prefrontal area (both sides), dorsal aspect of the anterior cingulate gyrus nociceptive cortex (both sides) and the lateral part of the orbitofrontal cortex (right side) were found to have blood flow reduction in the group of patients with chronic pain. As for chronic pain and its correlation with clinical features such as a depressive state, anticipation anxiety, post-traumatic stress disorder (PTSD), and conversion hysteria, the mechanism in the brain that was suggested by this study should be followed-up by functional neuroimaging studies. (author)

  6. Extensive validation of the pain disability index in 3 groups of patients with musculoskeletal pain.

    Science.gov (United States)

    Soer, Remko; Köke, Albère J A; Vroomen, Patrick C A J; Stegeman, Patrick; Smeets, Rob J E M; Coppes, Maarten H; Reneman, Michiel F

    2013-04-20

    A cross-sectional study design was performed. To validate the pain disability index (PDI) extensively in 3 groups of patients with musculoskeletal pain. The PDI is a widely used and studied instrument for disability related to various pain syndromes, although there is conflicting evidence concerning factor structure, test-retest reliability, and missing items. Additionally, an official translation of the Dutch language version has never been performed. For reliability, internal consistency, factor structure, test-retest reliability and measurement error were calculated. Validity was tested with hypothesized correlations with pain intensity, kinesiophobia, Rand-36 subscales, Depression, Roland-Morris Disability Questionnaire, Quality of Life, and Work Status. Structural validity was tested with independent backward translation and approval from the original authors. One hundred seventy-eight patients with acute back pain, 425 patients with chronic low back pain and 365 with widespread pain were included. Internal consistency of the PDI was good. One factor was identified with factor analyses. Test-retest reliability was good for the PDI (intraclass correlation coefficient, 0.76). Standard error of measurement was 6.5 points and smallest detectable change was 17.9 points. Little correlations between the PDI were observed with kinesiophobia and depression, fair correlations with pain intensity, work status, and vitality and moderate correlations with the Rand-36 subscales and the Roland-Morris Disability Questionnaire. The PDI-Dutch language version is internally consistent as a 1-factor structure, and test-retest reliable. Missing items seem high in sexual and professional items. Using the PDI as a 2-factor questionnaire has no additional value and is unreliable.

  7. Validity, Sensitivity, and Responsiveness of the 11-Face Faces Pain Scale to Postoperative Pain in Adult Orthopedic Surgery Patients.

    Science.gov (United States)

    Van Giang, Nguyen; Chiu, Hsiao-Yean; Thai, Duong Hong; Kuo, Shu-Yu; Tsai, Pei-Shan

    2015-10-01

    Pain is common in patients after orthopedic surgery. The 11-face Faces Pain Scale has not been validated for use in adult patients with postoperative pain. To assess the validity of the 11-face Faces Pain Scale and its ability to detect responses to pain medications, and to determine whether the sensitivity of the 11-face Faces Pain Scale for detecting changes in pain intensity over time is associated with gender differences in adult postorthopedic surgery patients. The 11-face Faces Pain Scale was translated into Vietnamese using forward and back translation. Postoperative pain was assessed using an 11-point numerical rating scale and the 11-face Faces Pain Scale on the day of surgery, and before (Time 1) and every 30 minutes after (Times 2-5) the patients had taken pain medications on the first postoperative day. The 11-face Faces Pain Scale highly correlated with the numerical rating scale (r = 0.78, p Scale is appropriate for measuring acute postoperative pain in adults. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  8. How do patients with chest pain access Emergency Department care?

    Science.gov (United States)

    Van Severen, Evie; Willemsen, Robert; Vandervoort, Pieter; Sabbe, Marc; Dinant, Geert-Jan; Buntinx, Frank

    2017-12-01

    It is important that patients with symptoms of acute coronary syndrome receive appropriate medical care as soon as possible. Little is known about the preadmission actions that patients with chest pain take before arrival at the Emergency Department (ED). This study aimed to describe the actions of patients with chest pain or pressure after onset of symptoms. What is the first action following onset of symptoms? Who is the first lay or professional person to be contacted? Which steps are taken first? How is the patient transported to the hospital? Consecutive patients, arriving at the ED of two large hospitals in Belgium, were asked additional questions during the initial assessment. Overall, 35% of 412 consecutive patients with chest pain admitted to the ED were diagnosed with acute coronary syndrome. A total of 57% contacted a GP between symptom onset and arrival at the ED. Only 32% of the patients were transported to the ED by ambulance, 16% drove themselves and 52% arrived by other means of transport (by family, neighbour, GP, public transport). In Belgium, the GP is still the first professional to be contacted for most patients. Other patients initially rely on their partner, family or friends when symptoms emerge. Too often, patients with chest pain rely on other transport to get to the ED instead of calling the Emergency Medical Services. This study included only patients who ultimately attended the ED.

  9. Effects of Reflexology on Pain in Patients With Fibromyalgia.

    Science.gov (United States)

    Akin Korhan, Esra; Uyar, Meltem; Eyigör, Can; Yönt, Gülendam Hakverdioğlu; Khorshid, Leyla

    The aim of this study was to investigate the effect of reflexology on pain intensity in patients with fibromyalgia, using an experimental repeated-measures design, and a convenience sample of 30 fibromyalgia inpatients. Thirty patients aged 18 to 70 years with fibromyalgia and hospitalized in the algology clinic were taken as a convenience sample. Patients received a total of 12 60-minute sessions of reflexology over a period of 6 consecutive weeks. Reflexology was carried out bilaterally on the hands and feet of patients at the reflex points relating to their pain at a suitable intensity and angle. Subjects had pain scores taken immediately before the intervention (0 minute), and at the 60th minute of the intervention. Data were collected over a 10-month period in 2012. The patients' mean pain intensity scores were reduced by reflexology, and this decrease improved progressively in the first and sixth weeks of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of reflexology in the routine care of patients with fibromyalgia could provide nurses with an effective practice for reducing pain intensity in these patients.

  10. Life satisfaction in patients with chronic pain – relation to pain intensity, disability, and psychological factors

    Directory of Open Access Journals (Sweden)

    Stålnacke BM

    2011-11-01

    Full Text Available Britt-Marie StålnackeDepartment of Community Medicine and Rehabilitation, Umeå University, Umeå, SwedenAims: To investigate pain intensity, posttraumatic stress, depression, anxiety, disability, and life satisfaction in patients with injury-related chronic pain and to analyze differences in these variables regarding gender.Methods: Questionnaires addressing pain intensity (visual analogue scale [VAS], anxiety and depression (hospital anxiety and depression [HAD] scale, posttraumatic stress (impact of event scale, disability (disability rating index, and life satisfaction [LiSat-11] were answered by 160 patients at assessment at the Pain Rehabilitation Clinic at the Umeå University Hospital (Umeå, Sweden.Results: High level of pain intensity was scored on the VAS (mean value 64.5 ± 21.1 mm together with high levels of anxiety, depression, and posttraumatic stress. Activity limitations in everyday life and decreased life satisfaction were reported, especially on the items physical health and psychological health. A multivariate logistic regression model showed a statistically significant association between low scores on the overall life satisfaction on LiSat-11 and high scores on HAD-depression (odds ratio = 1.141, confidence interval 1.014–1.285. Few gender differences were found.Conclusion: These findings highlight the value of a broad screening in patients with injury-related chronic pain with respect to the relationship of life satisfaction with pain intensity, anxiety, depression, posttraumatic stress, and disability. In addition, these findings support the biopsychosocial approach to assess and treat these patients optimally.Keywords: whiplash injuries, depression, quality of life

  11. Pain assessment strategies in patients with musculoskeletal conditions

    Directory of Open Access Journals (Sweden)

    M. Carotti

    2012-09-01

    Full Text Available Valid and reliable assessment of pain is fundamental for both clinical trials and effective pain management. The nature of pain makes objective measurement impossible. Chronic musculoskeletal pain assessment and its impact on physical, emotional and social functions require multidimensional qualitative tools and healthrelated quality of life instruments. The recommendations concerning outcome measurements for pain trials are useful for making routine assessments that should include an evaluation of pain, fatigue, disturbed sleep, physical functioning, emotional functioning, patient global ratings of satisfaction, and quality of life. Despite the growing availability of instruments and theoretical publications related to measuring the various aspects of chronic pain, there is still little agreement and no unified approach has been devised. There is, therefore, still a considerable need for the development of a core set of measurement tools and response criteria, as well as for the development and refinement of the related instruments, standardized assessor training, the cross-cultural adaptation of health status questionnaires, electronic data capture, and the introduction of valid, reliable and responsive standardized quantitative measurement procedures into routine clinical care. This article reviews a selection of the instruments used to assess chronic musculoskeletal pain, including validated newly developed and well-established screening instruments, and discusses their advantages and limitations.

  12. Low Level Laser Therapy for chronic knee joint pain patients.

    Science.gov (United States)

    Nakamura, Takashi; Ebihara, Satoru; Ohkuni, Ikuko; Izukura, Hideaki; Harada, Takashi; Ushigome, Nobuyuki; Ohshiro, Toshio; Musha, Yoshiro; Takahashi, Hiroshi; Tsuchiya, Kazuaki; Kubota, Ayako

    2014-12-27

    Chronic knee joint pain is one of the most frequent complaints which is seen in the outpatient clinic in our medical institute. In previous studies we have reported the benefits of low level laser therapy (LLLT) for chronic pain in the shoulder joints, elbow, hand, finger and the lower back. The present study is a report on the effects of LLLT for chronic knee joint pain. Over the past 5 years, 35 subjects visited the outpatient clinic with complaints of chronic knee joint pain caused by the knee osteoarthritis-induced degenerative meniscal tear. They received low level laser therapy. A 1000 mW semi-conductor laser device was used to deliver 20.1 J/cm(2) per point in continuous wave at 830nm, and four points were irradiated per session (1 treatment) twice a week for 4 weeks. A visual analogue scale (VAS) was used to determine the effects of LLLT for the chronic pain and after the end of the treatment regimen a significant improvement was observed (pknee joint range of motion. Discussions with the patients revealed that it was important for them to learn how to avoid postures that would cause them knee pain in everyday life in order to have continuous benefits from the treatment. The present study demonstrated that 830 nm LLLT was an effective form of treatment for chronic knee pain caused by knee osteoarthritis. Patients were advised to undertake training involving gentle flexion and extension of the knee.

  13. Association of Hip Radiograph Findings With Pain and Function in Patients Presenting With Low Back Pain.

    Science.gov (United States)

    Prather, Heidi; Cheng, Abby; Steger-May, Karen; Maheshwari, Vaibhav; VanDillen, Linda

    2018-01-01

    Relationships between low back pain (LBP) and the hip in patient cohorts have been described primarily in patients with moderate to severe hip osteoarthritis (OA). Less is known about the links of LBP with hip radiographic findings of hip deformity and minimal OA. To describe the incidence of radiographic hip deformity or hip OA; to describe and compare spine- and hip-related pain and function in the subset of patients who were found to have radiographic hip deformity or hip OA; and to compare patients with evidence of radiographic hip deformity or hip OA to patients without hip radiographic findings. Prospective cohort study with cross-sectional design. Tertiary university. A total of 63 patients (40 women, 23 men) with a mean age of 48.5 ± 14 years with LBP and a minimum of one positive provocative hip test. Hip radiographs were assessed by an independent examiner for hip OA and deformity. Comparisons of hip and lumbar spine pain and function were completed for patients with radiographic findings of hip OA or deformity. Moderate to severe hip OA was found in 12 of 60 patients (20.0%). At least one measurement of femoroacetabular impingement (FAI) was found in 14 of 60 patients (23.3%) to 33 of 45 patients (73.3%). At least one measurement of developmental hip dysplasia (DDH) was found in 7 of 60 patients (11.6%) to 11 of 63 patients (17.4%). Greater pain and reduced hip and lumbar spine function were found in the patients with moderate to severe hip OA. Patients with LBP and FAI were found to have significantly greater extremes of pain and reduced lumbar spine function. Links between the hip and the spine affecting pain and function may be found in patients with LBP and hip deformity and before the onset of radiographic hip OA, and may be associated with hip deformity. Further investigation is needed to better understand these links and their potential impact on prognosis and treatment of LBP. II. Copyright © 2018 American Academy of Physical Medicine and

  14. Chronic Neck Pain and Cervico-Craniofacial Pain Patients Express Similar Levels of Neck Pain-Related Disability, Pain Catastrophizing, and Cervical Range of Motion

    Science.gov (United States)

    Muñoz-García, Daniel; Gil-Martínez, Alfonso; López-López, Almudena; Lopez-de-Uralde-Villanueva, Ibai; La Touche, Roy; Fernández-Carnero, Josué

    2016-01-01

    Background. Neck pain (NP) is strongly associated with cervico-craniofacial pain (CCFP). The primary aim of the present study was to compare the neck pain-related disability, pain catastrophizing, and cervical and mandibular ROM between patients with chronic mechanical NP and patients with CCFP, as well as asymptomatic subjects. Methods. A total of 64 participants formed three groups. All participants underwent a clinical examination evaluating the cervical range of motion and maximum mouth opening, neck disability index (NDI), and psychological factor of Pain Catastrophizing Scale (PCS). Results. There were no statistically significant differences between patients with NP and CCFP for NDI and PCS (P > 0.05). One- way ANOVA revealed significant differences for all ROM measurements. The post hoc analysis showed no statistically significant differences in cervical extension and rotation between the two patient groups (P > 0.05). The Pearson correlation analysis shows a moderate positive association between NDI and the PCS for the group of patients with NP and CCFP. Conclusion. The CCFP and NP patient groups have similar neck disability levels and limitation in cervical ROM in extension and rotation. Both groups had positively correlated the NDI with the PCS. PMID:27119020

  15. A Small Randomized Controlled Pilot Trial Comparing Mobile and Traditional Pain Coping Skills Training Protocols for Cancer Patients with Pain

    Directory of Open Access Journals (Sweden)

    Tamara J. Somers

    2016-01-01

    Full Text Available Psychosocial pain management interventions are efficacious for cancer pain but are underutilized. Recent advances in mobile health (mHealth technologies provide new opportunities to decrease barriers to access psychosocial pain management interventions. The objective of this study was to gain information about the accessibility and efficacy of mobile pain coping skills training (mPCST intervention delivered to cancer patients with pain compared to traditional in-person pain coping skills training intervention. This study randomly assigned participants (N=30 to receive either mobile health pain coping skills training intervention delivered via Skype or traditional pain coping skills training delivered face-to-face (PCST-trad. This pilot trial suggests that mPCST is feasible, presents low burden to patients, may lead to high patient engagement, and appears to be acceptable to patients. Cancer patients with pain in the mPCST group reported decreases in pain severity and physical symptoms as well as increases in self-efficacy for pain management that were comparable to changes in the PCST-trad group (p’s < 0.05. These findings suggest that mPCST, which is a highly accessible intervention, may provide benefits similar to an in-person intervention and shows promise for being feasible, acceptable, and engaging to cancer patients with pain.

  16. [Rehabilitation for the patients with low-back pain].

    Science.gov (United States)

    Shirado, Osamu; Watanabe, Yasuyuki; Kawase, Masafumi

    2005-03-01

    The first choice for the treatment of low-back pain should be physical therapy, or rehabilitation. These are mainly divided into two modalities; passive and active modality. The former includes bed rest, hot pack, massage, and brace. The latter includes therapeutic exercise. The modality used should be dependent of the stages in each patient. Bed rest is indicated in the acute stage within a week after the occurrence low-back pain. The rest longer than a week is basically contraindicated, because of disuse syndrome such as muscle weakness, osteoporosis, and soft tissue contracture. Therapeutic exercise is the mainstay in the chronic stage. It includes trunk muscles strengthening exercise and stretching. Lumbar stabilization exercise has currently drawn attention for the treatment of low-back pain. Patient education such as back-school also plays an important role to manage low-back pain.

  17. Musculoskeletal Dysfunctions in Patients With Chronic Pelvic Pain

    DEFF Research Database (Denmark)

    Mieritz, Rune Mygind; Thorhauge, Kirsten; Forman, Axel

    2016-01-01

    stratified levels of self-reported pelvic pain, self-rated health, education, and work status based on musculoskeletal dysfunction status. METHODS: This study used a cross-sectional design to determine the prevalence of musculoskeletal dysfunctions in women with CPP who were referred to a tertiary care...... between the groups with respect to self-rated health, education, work status, and pain level. Pain location was significantly different after Bonferroni correction in 1 out of the 36 aspects. CONCLUSIONS: In this sample of CPP patients, 51% were categorized as having a musculoskeletal dysfunction. Overall...

  18. [Pain assessment of tracheal suctioning on brain injury patients by pain behavioral indicator scale (ESCID)].

    Science.gov (United States)

    López-López, C; Murillo-Pérez, M A; Morales-Sánchez, C; Torrente-Vela, S; Orejana-Martín, M; García-Iglesias, M; Cuenca-Solanas, M; Alted-López, E

    2014-01-01

    To assess pain response on patients with moderate to severe head injury before a common nursing procedure: tracheal suctioning. An observational longitudinal pilot study with consecutive sampling performed from September to December of 2012. Pain was assessed by a pain behavioral indicator scale 5 minutes before, meanwhile and 15 minutes after tracheal suctioning the days 1, 3 and 6 of their intensive care unit (ICU) stay, as well as a non-painful procedure: rubbing with gauze the forearm of the patient. Pseudo-analgesia and hemodynamic variables were also recorded. Descriptive analysis of the variables, inferential statistics with t-student and Anova with SPSS 17.0; statistical tests were considered significant if the critical level observed was less than 5% (P.05) were shown. Data for the painless procedure were significantly different on day 6 (P<.05) CONCLUSION: During tracheal suctioning in patients with head injury in the first 6 days in the ICU, objective mild-moderate pain according to ESCID scale has been detected. Copyright © 2013 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  19. Selective attention towards painful faces among chronic pain patients: evidence from a modified version of the dot-probe.

    Science.gov (United States)

    Khatibi, Ali; Dehghani, Mohsen; Sharpe, Louise; Asmundson, Gordon J G; Pouretemad, Hamidreza

    2009-03-01

    Evidence that patients with chronic pain selectively attend to pain-related stimuli presented in modified Stroop and dot-probe paradigms is mixed. The pain-related stimuli used in these studies have been primarily verbal in nature (i.e., words depicting themes of pain). The purpose of the present study was to determine whether patients with chronic pain, relative to healthy controls, show selective attention for pictures depicting painful faces. To do so, 170 patients with chronic pain and 40 age- and education-matched healthy control participants were tested using a dot-probe task in which painful, happy, and neutral facial expressions were presented. Selective attention was denoted using the mean reaction time and the bias index. Results indicated that, while both groups shifted attention away from happy faces (and towards neutral faces), only the control group shifted attention away from painful faces. Additional analyses were conducted on chronic pain participants after dividing them into groups on the basis of fear of pain/(re)injury. The results of these analyses revealed that while chronic pain patients with high and low levels of fear both shifted attention away from happy faces, those with low fear shifted attention away from painful faces, whereas those with high fear shifted attention towards painful faces. These results suggest that patients with chronic pain selectively attend to facial expressions of pain and, importantly, that the tendency to shift attention towards such stimuli is positively influenced by high fear of pain/(re)injury. Implications of the findings and future research directions are discussed.

  20. Relationships between craniocervical posture and pain-related disability in patients with cervico-craniofacial pain

    Science.gov (United States)

    López-de-Uralde-Villanueva, Ibai; Beltran-Alacreu, Hector; Paris-Alemany, Alba; Angulo-Díaz-Parreño, Santiago; La Touche, Roy

    2015-01-01

    Objectives This cross-sectional correlation study explored the relationships between craniocervical posture and pain-related disability in patients with chronic cervico-craniofacial pain (CCFP). Moreover, we investigated the test–retest intrarater reliability of two craniocervical posture measurements: head posture (HP) and the sternomental distance (SMD). Methods Fifty-three asymptomatic subjects and 60 CCFP patients were recruited. One rater measured HP and the SMD using a cervical range of motion device and a digital caliper, respectively. The Spanish versions of the neck disability index and the craniofacial pain and disability inventory were used to assess pain-related disability (neck disability and craniofacial disability, respectively). Results We found no statistically significant correlations between craniocervical posture and pain-related disability variables (HP and neck disability [r=0.105; P>0.05]; HP and craniofacial disability [r=0.132; P>0.05]; SMD and neck disability [r=0.126; P>0.05]; SMD and craniofacial disability [r=0.195; P>0.05]). A moderate positive correlation was observed between HP and SMD for both groups (asymptomatic subjects, r=0.447; CCFP patients, r=0.52). Neck disability was strongly positively correlated with craniofacial disability (r=0.79; Pposture, but these differences were very small (mean difference =1.44 cm for HP; 6.24 mm for SMD). The effect sizes reached by these values were estimated to be small for SMD (d=0.38) and medium for HP (d=0.76). Conclusion The results showed no statistically significant correlations between craniocervical posture and variables of pain-related disability, but a strong correlation between the two variables of disability was found. Our findings suggest that small differences between CCFP patients and asymptomatic subjects exist with respect to the two measurements used to assess craniocervical posture (HP and SMD), and these measures demonstrated high test–retest intrarater reliability for

  1. Effects of music on pain in patients with fibromyalgia.

    Science.gov (United States)

    Alparslan, Güler Balcı; Babadağ, Burcu; Özkaraman, Ayşe; Yıldız, Pınar; Musmul, Ahmet; Korkmaz, Cengiz

    2016-05-01

    Fibromyalgia syndrome (FMS) is a chronic syndrome characterized by diffuse musculoskeletal system pain and painful tender points in certain areas of the body. The aim of the investigation was to determine the effects of music on pain in fibromyalgia patients. This randomized clinical trial was carried out with 37 fibromyalgia outpatients as an experimental group (n = 21) and control group (n = 16) at a University Hospital Internal Medicine and Rheumatology Clinic between 1 June and 1 December 2014. The research instruments used were descriptive characteristics questionnaire, Visual Analogue Scale (VAS), music CD which includes water and wave sounds recommended by the Turkish Psychological Association for psychological relaxation, and pain evaluation form. According to the findings, the average age of patients was 43.59 years ± 10.30, 94.6 % were women and 81.1 % were married. The fibromyalgia patients had the disease ranged from 1 month to 20 years, the average of disease duration was 23.6 ± 45.5 months, and the average of pain intensity was 6.89 ± 1.64 on the VAS. Average pain was reported in the experimental group in VAS on day 1 (5.45 ± 2.73), day 7 (4.57 ± 2.71), and day 14 (4.14 ± 2.45), and significant reduction in pain in the listening music group was seen (p = 0.026). A repeated measure analysis of variance controlling for differences between days demonstrated a significant decrease in pain between day 1 and day 14 (p = 0.022). There was no significant decrease in pain among control group participants. The effect of music has been found to control pain in fibromyalgia patients. Music therapy should be suggested in pain management for fibromyalgia patients as an non-pharmacologic nursing intervention.

  2. Lower back pain: clinical features and examination of patients

    Directory of Open Access Journals (Sweden)

    I.V. Damulin

    2014-01-01

    Full Text Available This article discusses the clinical and paraclinical aspects of pain syndromes of the lumbosacral localization. The past medical history (including the working conditions of the patient and the presence of constant stress, physical and paraclinical examination, and assessment of psychological condition are important for establishing the correct diagnosis. It should be noted that there is no strict parallelism between the presence of back pain and the results of paraclinical examination of the spine. Therefore, the comprehensive assessment of the patient's clinical status, including the state of the musculoskeletal system, has a leading value for correct diagnosis and selection of therapy. Increasing pain when coughing or sneezing is noted in patients with discogenic pain syndromes; the development of pain along the root innervation often occurs simultaneously with the reduction of localized pain in the lumbar region. The diagnostic value of the radiography and neuroimaging data is unquestioned; however, these methods allow one to evaluate mainly the anatomical rather than pathophysiological changes. The direct dependence between the anatomical changes and the clinical situation is not typical of back pain. Magnetic resonance imaging (MRI is when the injury level is unclear and the clinical examination data indicate pathology of the spinal cord or soft tissues. Moreover, MRI data help either to eliminate or confirm a tumor or the inflammatory nature of the pain syndrome. MRI is also an informative method in patients who have undergone surgery for vertebral pathology. Computed tomography is an effective diagnosis method only in those cases where the symptomatology clearly indicates the injury level and the bone changes are the pain cause with a high degree of probability. Electromyography (EMG is very informative in patients with radiculopathies; it allows one to evaluate the pathophysiological changes in such patients. However, there usually is

  3. IMPACT OF INTERFERENTIAL CURRENT ON PAIN RELIEF AMONG PATIENTS WITH ORCHIALGIA

    Directory of Open Access Journals (Sweden)

    Hany M.I. Elgohary

    2016-08-01

    Full Text Available Background: Scrotal discomfort can contribute to unusual impact on body scheme and result in behavioral alterations, as well as changes in sexual function such as delay of sexual ability that may affect both man and his companion. There are many physiotherapy modalities to reduce the intratesticular pain such as pelvic floor muscle training, hydrotherapy, ultrasound and electrotherapy. Interferential current therapy is a noninvasive therapy used to reduce acute and chronic, post-operative and post-trauma acute pain. It provides a safe and effective alternative to pharmacological approaches to pain control. The purpose of the current study was to investigate the efficacy of interferential current in alleviating testicular pain. Methods: Randomized clinical study conducted on 50 participants. They divided into two equal groups: Group A received interferential current with two electrodes placed over the upper medial aspects of thighs and the other two electrodes were positioned over the suprapubic area. While group B received placebo interferential current. The treatment protocol was applied 3 times/ week for six successive weeks, in a total of 18 sessions. Patients were evaluated before and after the six weeks of the treatment by visual analogue scale and pain intensity while pain relief scale was measured after the treatment. Results: Group A showed a significant pain improvement in both inter and intra group comparison in all measured parameters (visual analogue scale and pain intensity while pain relief scale (p <0.05. Conclusion: The findings show that interferential current is an effective modality and can be recommended for the treatment of testicular pain.

  4. Pain, Depression and Quality of Life in Patients with Chronic Cervical Miyofascial Pain Syndrome

    Directory of Open Access Journals (Sweden)

    Ümit Dundar

    2014-03-01

    Aim: The aim of this study was to investigate the levels of depression, pain and disability in patients with chronic cervical miyofascial pain syndrome (MPS and to determine their association with quality of life. Material and Method: Forty patients with Cervical MPS and 40 age and sex-matched healthy controls enrolled in this study. The social and demographic characteristics of the patients and controls were examined. All patients and controls were evaluated with respect to pain (at night, rest and movement and assessed by visual analog scale (VAS. Neck disability index (NDI was used to calculate functional disability. Quality of life was evaluated with the the Short Form 36 Health Survey (SF-36. Also all of the patients and controls underwent Beck depression inventory (BDI. Results: There was no statistical difference between the patients and control cases according to demographical data. The SF-36 scores of the study patients were lower than controls. NDI, BDI and VAS scores were higher in the patients with chronic cervical MPS compared to controls. BDI scores of the patients with chronic cervical MPS  were negatively and closely associated with subparameters of the SF-36 (physical function (r:-0,599, p<0.001, role limitations due to physical functioning (r:-0,558, p<0.001, bodily pain (r:-0.540, p<0.001, general health (r:- 0,708 p<0.001, vitality (r:-0,692, p<0.001, social functioning (r:-0,559, p<0.001, role limitations due to emotional problems (r:-0,537, p<0.001 and mental health (r: -0,787, p<0.001. Discussion: BDI scores are higher in patients with chronic cervical MPS than healthy controls and negatively affect their quality of life. Psychiatric evaluation of the patients with chronic cervical MPS may improve their quality of life and treatments outcome.

  5. [Assessment of pain in a patient with pressure ulcer].

    Science.gov (United States)

    Píriz-Campos, Rosa María; Martín-Espinosa, Noelia María; Cobo-Cuenca, Ana Isabel

    2010-01-01

    This is a summary of a presentation made in the symposium "Improved Continuous Quality Care in Patients with Pressure Ulcers and Chronic Injuries", which was held in Toledo in 2009. A 76 year old woman had been assessed (she belonged to the age group that frequently suffers this condition). She lived in a social healthcare centre and had a III stage sacral pressure ulcer. Using Gordon's Functional Health Patterns for assessing "Acute pain", a nursing diagnosis is described and the nursing care plan has been presented according to NANDA, NIC, NOC taxonomy. The aim of this article is to show the importance of considering the pain in patients who suffer from this type of lesion, which, although almost always present, it is often undervalued by nursing staff, resulting in an even worse quality of life for the patient, due to both physical and psychological effects. This case shows how to assess pain in a patient with ulcers, and helps establish an individualised care plan with a priority on pain treatment and relief. As as result of the interventions carried out, a better perception of pain is achieved, thus helping to improve patient's mobility and night rest. Copyright (c) 2010 Elsevier España, S.L. All rights reserved.

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

    African Journals Online (AJOL)

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

  7. Interdisciplinary rehabilitation of patients with chronic widespread pain:

    DEFF Research Database (Denmark)

    Amris, Kirstine; Wæhrens, Eva E; Christensen, Robin

    2014-01-01

    This study examined the functional and psychological outcomes of a 2-week, group-based multicomponent treatment course that targeted patients with chronic widespread pain. Patients (192 included in the intention-to-treat population), all fulfilling the 1990 American College of Rheumatology...

  8. Improvement in Anxiety and Pain After Whole Body Whirlpool Hydrotherapy Among Patients With Myofascial Pain Syndrome

    Science.gov (United States)

    Im, Sang Hee

    2013-01-01

    Objective To evaluate the effect of the Whirlpool hydrotherapy on pain and anxiety in chronic myofascial pain syndrome (MPS) patients, compared to the conventional hydrocollator pack therapy. Methods Forty-one subjects who have MPS in the upper trapezius muscles without depression were recruited. The patients were randomly assigned into two groups: the whirlpool therapy group whose bodies were immersed in a whirlpool bath at 34℃-36℃ for 30 minutes; the hydrocollator group who took a 30-minute application of a standard hot hydrocollator pack. Patients in both groups received therapy three days a week for 2 weeks and underwent several evaluations at baseline and after treatment. The variables we analyzed during evaluations were as follows: the primary outcome we considered was pain severity using a visual analogue scale. And the secondary outcomes examined included anxiety using the Korean version of the Beck Anxiety Inventory and quality of life (QoL) using the Korean version of the World Health Organization QoL Assessment, Brief Form. All follow-up values were compared with the baseline values. Results The baseline parameters did not show significant differences between two groups. And after 2-week treatment, both groups revealed significant improvement in anxiety levels and QoL, as well as in pain. However, the improvement on pain (p=0.002) and anxiety (p=0.010) was significantly greater in the whirlpool group, compared to the hydrocollator group. Conclusion The whirlpool hydrotherapy can be used as a more effective therapeutic method to reduce pain and anxiety in chronic MPS patients without depression. PMID:24020034

  9. Pain Perception: Computerized versus Traditional Local Anesthesia in Pediatric Patients.

    Science.gov (United States)

    Mittal, M; Kumar, A; Srivastava, D; Sharma, P; Sharma, S

    2015-01-01

    Local anesthetic injection is one of the most anxiety- provoking procedure for both children and adult patients in dentistry. A computerized system for slow delivery of local anesthetic has been developed as a possible solution to reduce the pain related to the local anesthetic injection. The present study was conducted to evaluate and compare pain perception rates in pediatric patients with computerized system and traditional methods, both objectively and subjectively. It was a randomized controlled study in one hundred children aged 8-12 years in healthy physical and mental state, assessed as being cooperative, requiring extraction of maxillary primary molars. Children were divided into two groups by random sampling - Group A received buccal and palatal infiltration injection using Wand, while Group B received buccal and palatal infiltration using traditional syringe. Visual Analog scale (VAS) was used for subjective evaluation of pain perception by patient. Sound, Eye, Motor (SEM) scale was used as an objective method where sound, eye and motor reactions of patient were observed and heart rate measurement using pulse oximeter was used as the physiological parameter for objective evaluation. Patients experienced significantly less pain of injection with the computerized method during palatal infiltration, while less pain was not statistically significant during buccal infiltration. Heart rate increased during both buccal and palatal infiltration in traditional and computerized local anesthesia, but difference between traditional and computerized method was not statistically significant. It was concluded that pain perception was significantly more during traditional palatal infiltration injection as compared to computerized palatal infiltration, while there was no difference in pain perception during buccal infiltration in both the groups.

  10. Pain acceptance potentially mediates the relationship between pain catastrophizing and post-surgery outcomes among compensated lumbar fusion patients

    Directory of Open Access Journals (Sweden)

    Dance C

    2016-12-01

    Full Text Available Cassie Dance,1 M. Scott DeBerard,1 Jessica Gundy Cuneo2 1Department of Psychology, Utah State University, Logan, UT, 2Department of Psychiatry, University of California, San Diego, CA, USA Purpose: Chronic low back pain is highly prevalent and often treatment recalcitrant condition, particularly among workers’ compensation patients. There is a need to identify psychological factors that may predispose such patients to pain chronicity. The primary aim of this study was to examine whether pain acceptance potentially mediated the relationship between pain catastrophizing and post-surgical outcomes in a sample of compensated lumbar fusion patients.Patients and methods: Patients insured with the Workers Compensation Fund of Utah and who were at least 2 years post-lumbar fusion surgery completed an outcome survey. These data were obtained from a prior retrospective-cohort study that administered measures of pain catastrophizing, pain acceptance, mental and physical health, and disability.Results: Of the 101 patients who completed the outcome survey, 75.2% were male with a mean age of 42.42 years and predominantly identified as White (97.0%. The majority of the participants had a posterior lumbar interbody fusion surgery. Pain acceptance, including activity engagement and pain willingness, was significantly correlated with better physical health and mental health, and lower disability rates. Pain catastrophizing was inversely correlated with measures of pain acceptance (activity engagement r=–0.67, p<0.01, pain willingness r=–0.73, p<0.01 as well as the outcome measures: mental health, physical health, and disability. Pain acceptance significantly mediated the relationship between pain catastrophizing and both mental and physical health and also the relationship between pain catastrophizing and disability. Conclusion: This study demonstrated that the relationship between pain catastrophizing and negative patient outcomes was potentially mediated

  11. Development of a patient-reported outcome instrument for patients with lumbar radicular pain

    OpenAIRE

    Ibsen, Charlotte; Schiøttz-Christensen, Berit; Handberg, Charlotte; Nielsen, Claus Vinther; Hørder, Mogens; Maribo, Thomas

    2017-01-01

    Background Low back pain (LBP) is the leading cause to years lived with disability. 10–20% of patients with LBP experience radicular pain (lumbar radiculopathy). Patient-reported outcomes (PROs) play an important role in advancing patient-centered health care. Although patient involvement is essential to develop valid patient-centred PRO instruments patients are not always involved. The International Classification of Functioning, Disability and Health (ICF) are proposed to facilitate consist...

  12. Characteristics of highly impaired children with severe chronic pain: a 5-year retrospective study on 2249 pediatric pain patients

    Directory of Open Access Journals (Sweden)

    Zernikow Boris

    2012-05-01

    Full Text Available Abstract Background Prevalence of pain as a recurrent symptom in children is known to be high, but little is known about children with high impairment from chronic pain seeking specialized treatment. The purpose of this study was the precise description of children with high impairment from chronic pain referred to the German Paediatric Pain Centre over a 5-year period. Methods Demographic variables, pain characteristics and psychometric measures were assessed at the first evaluation. Subgroup analysis for sex, age and pain location was conducted and multivariate logistic regression applied to identify parameters associated with extremely high impairment. Results The retrospective study consisted of 2249 children assessed at the first evaluation. Tension type headache (48%, migraine (43% and functional abdominal pain (11% were the most common diagnoses with a high rate of co-occurrence; 18% had some form of musculoskeletal pain disease. Irrespective of pain location, chronic pain disorder with somatic and psychological factors was diagnosed frequently (43%. 55% of the children suffered from more than one distinct pain diagnosis. Clinically significant depression and general anxiety scores were expressed by 24% and 19% of the patients, respectively. Girls over the age of 13 were more likely to seek tertiary treatment compared to boys. Nearly half of children suffered from daily or constant pain with a mean pain value of 6/10. Extremely high pain-related impairment, operationalized as a comprehensive measure of pain duration, frequency, intensity, pain-related school absence and disability, was associated with older age, multiple locations of pain, increased depression and prior hospital stays. 43% of the children taking analgesics had no indication for pharmacological treatment. Conclusion Children with chronic pain are a diagnostic and therapeutic challenge as they often have two or more different pain diagnoses, are prone to misuse of

  13. Mechanisms-based classifications of musculoskeletal pain: part 2 of 3: symptoms and signs of peripheral neuropathic pain in patients with low back (± leg) pain.

    LENUS (Irish Health Repository)

    Smart, Keith M

    2012-08-01

    As a mechanisms-based classification of pain \\'peripheral neuropathic pain\\' (PNP) refers to pain arising from a primary lesion or dysfunction in the peripheral nervous system. Symptoms and signs associated with an assumed dominance of PNP in patients attending for physiotherapy have not been extensively studied. The purpose of this study was to identify symptoms and signs associated with a clinical classification of PNP in patients with low back (± leg) pain. Using a cross-sectional, between-subjects design; four hundred and sixty-four patients with low back (± leg) pain were assessed using a standardised assessment protocol. Patients\\' pain was assigned a mechanisms-based classification based on experienced clinical judgement. Clinicians then completed a clinical criteria checklist specifying the presence or absence of various clinical criteria. A binary logistic regression analysis with Bayesian model averaging identified a cluster of two symptoms and one sign predictive of PNP, including: \\'Pain referred in a dermatomal or cutaneous distribution\\

  14. Assessment of Adequacy of Pain Management and Analgesic Use in Patients With Advanced Cancer Using the Brief Pain Inventory and Pain Management Index Calculation

    Directory of Open Access Journals (Sweden)

    Harminder Singh

    2017-06-01

    Full Text Available Purpose: The objective of this cross-sectional, noninterventional, 6-month observational study was to assess the adequacy of pain management in patients with cancer admitted to the Oncology Department of Guru Gobind Singh Medical College in Faridkot, India. Methods and Materials: A total of 348 patients with cancer were recruited for evaluation of the prevalence of inadequate cancer pain management using the Brief Pain Inventory Pain Management Index. Results: The current study included 127 males (36.5% and 221 females (63.5%. The most prevalent cancer type was genitourinary; 268 patients (77% had inadequately managed pain. A significant correlation was observed between poorly managed pain and age groups, analgesic used, and body mass index. Conclusion: Our observation of inadequate pain management among 77% of patients indicates that pain management was insufficient in three quarters of the patients in this study. Accumulating data regarding the inadequacy of cancer pain management is crucial to improve symptom management. Better management of pain not only alleviates pain symptoms but also increases the quality of life for patients with cancer.

  15. Oncology patient-reported claims: maximising the chance for success.

    Science.gov (United States)

    Kitchen, H; Rofail, D; Caron, M; Emery, M-P

    2011-01-01

    To review Patient Reported Outcome (PRO) labelling claims achieved in oncology in Europe and in the United States and consider the benefits, and challenges faced. PROLabels database was searched to identify oncology products with PRO labelling approved in Europe since 1995 or in the United States since 1998. The US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) websites and guidance documents were reviewed. PUBMED was searched for articles on PRO claims in oncology. Among all oncology products approved, 22 were identified with PRO claims; 10 in the United States, 7 in Europe, and 5 in both. The language used in the labelling was limited to benefit (e.g. "…resulted in symptom benefits by significantly prolonging time to deterioration in cough, dyspnoea, and pain, versus placebo") and equivalence (e.g. "no statistical differences were observed between treatment groups for global QoL"). Seven products used a validated HRQoL tool; two used symptom tools; two used both; seven used single-item symptom measures (one was unknown). The following emerged as likely reasons for success: ensuring systematic PRO data collection; clear rationale for pre-specified endpoints; adequately powered trials to detect differences and clinically significant changes; adjusting for multiplicity; developing an a priori statistical analysis plan including primary and subgroup analyses, dealing with missing data, pooling multiple-site data; establishing clinical versus statistical significance; interpreting failure to detect change. End-stage patient drop-out rates and cessation of trials due to exceptional therapeutic benefit pose significant challenges to demonstrating treatment PRO improvement. PRO labelling claims demonstrate treatment impact and the trade-off between efficacy and side effects ultimately facilitating product differentiation. Reliable and valid instruments specific to the desired language, claim, and target population are required. Practical

  16. Percutaneous Vertebroplasty for Pain Management in Patients with Multiple Myeloma: Is Radiofrequency Ablation Necessary?

    International Nuclear Information System (INIS)

    Orgera, Gianluigi; Krokidis, Miltiadis; Matteoli, Marco; Varano, Gianluca Maria; La Verde, Giacinto; David, Vincenzo; Rossi, Michele

    2014-01-01

    PurposeThis study was designed to investigate the added role of radiofrequency ablation (RFA) to vertebroplasty on the pain management of patients with multiple myeloma (MM).MethodsThirty-six patients (51–82 years) with vertebral localization of MM were randomly divided into two groups: 18 patients (group A) who underwent RFA and then vertebroplasty, and 18 patients (group B) who underwent only vertebroplasty. Primary endpoints were technical success and pain relief score rate measured by the visual analogue pain scores (VAS) and Roland–Morris Questionnaire (RMQ); secondary endpoint was the amount of administered analgesia. Survival and complications were compared.ResultsTechnical success was 100 % in both groups. The VAS score (at 24 h and 6 weeks postprocedure) decreased in equal manner for both groups from a mean of 9.1–3.4 and 2.0 for group A and from a mean of 9.3–3.0 and 2.3 for group B; RMQ mean score was 19.8 for group A and 19.9 for group B and decreased to a mean of 9.6 and 8.2 for group A and 9.5 and 8.7 for group B. The amount of medication was equally decreased in the two groups. No statistically significant difference was noted. No major complication occurred and two patients died from other causes.ConclusionsThe use of percutaneous vertebroplasty alone appears to be effective for the pain management of the patients with vertebral involvement of multiple myeloma. The use of RFA that includes cost and time does not offer any clear added benefit on the midterm pain management of such patients

  17. Percutaneous Vertebroplasty for Pain Management in Patients with Multiple Myeloma: Is Radiofrequency Ablation Necessary?

    Energy Technology Data Exchange (ETDEWEB)

    Orgera, Gianluigi [Sapienza Rome University, Department of Radiology, S. Andrea Hospital (Italy); Krokidis, Miltiadis, E-mail: mkrokidis@hotmail.com [Cambridge University Hospitals NHS Trust, Department of Radiology (United Kingdom); Matteoli, Marco; Varano, Gianluca Maria [Sapienza Rome University, Department of Radiology, S. Andrea Hospital (Italy); La Verde, Giacinto [Sapienza Rome University, Department of Medical Oncology, S. Andrea Hospital (Italy); David, Vincenzo; Rossi, Michele [Sapienza Rome University, Department of Radiology, S. Andrea Hospital (Italy)

    2013-05-08

    PurposeThis study was designed to investigate the added role of radiofrequency ablation (RFA) to vertebroplasty on the pain management of patients with multiple myeloma (MM).MethodsThirty-six patients (51–82 years) with vertebral localization of MM were randomly divided into two groups: 18 patients (group A) who underwent RFA and then vertebroplasty, and 18 patients (group B) who underwent only vertebroplasty. Primary endpoints were technical success and pain relief score rate measured by the visual analogue pain scores (VAS) and Roland–Morris Questionnaire (RMQ); secondary endpoint was the amount of administered analgesia. Survival and complications were compared.ResultsTechnical success was 100 % in both groups. The VAS score (at 24 h and 6 weeks postprocedure) decreased in equal manner for both groups from a mean of 9.1–3.4 and 2.0 for group A and from a mean of 9.3–3.0 and 2.3 for group B; RMQ mean score was 19.8 for group A and 19.9 for group B and decreased to a mean of 9.6 and 8.2 for group A and 9.5 and 8.7 for group B. The amount of medication was equally decreased in the two groups. No statistically significant difference was noted. No major complication occurred and two patients died from other causes.ConclusionsThe use of percutaneous vertebroplasty alone appears to be effective for the pain management of the patients with vertebral involvement of multiple myeloma. The use of RFA that includes cost and time does not offer any clear added benefit on the midterm pain management of such patients.

  18. Can a single pain rating replace a multiple pain rating in third molar surgery studies? Analysis of 220 patients

    NARCIS (Netherlands)

    Martin, W.J.J.M.; Heymans, M.W.; Skorpil, N.E.; Forouzanfar, T.

    2012-01-01

    This study describes the comparison of multiple and single pain ratings in patients after surgical removal of the third molar. Correlation and agreement analysis were performed between the average pain intensity measured three times a day over a period of 7 days and one single pain rating

  19. Effect of adductor canal block on pain in patients with severe pain after total knee arthroplasty

    DEFF Research Database (Denmark)

    Grevstad, Jens Ulrik; Mathiesen, Ole; Lind, T

    2014-01-01

    the patients had received a comprehensive multimodal analgesic regimen. Group A received an ACB with ropivacaine 0.75%, 30 ml at time 0 and isotonic saline after 45 min. Group B received an ACB with isotonic saline at time 0 and ropivacaine 0.75%, 30 ml after 45 min. RESULTS: A 32-mm difference in VAS pain...

  20. Pain measurement in mechanically ventilated patients after cardiac surgery : comparison of the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT)

    NARCIS (Netherlands)

    Rijkenberg, Saskia; Stilma, Willemke; Bosman, Robert J; van der Meer, Nardo J; van der Voort, Peter H J

    OBJECTIVES: The Behavioral Pain Scale (BPS) and Critical-Care Pain Observation Tool (CPOT) are behavioral pain assessment tools for sedated and unconscious critically ill patients. The aim of this study was to compare the reliability, internal consistency, and discriminant validation of the BPS and

  1. Estimates of success in patients with sciatica due to lumbar disc herniation depend upon outcome measure.

    Science.gov (United States)

    Haugen, Anne Julsrud; Grøvle, Lars; Brox, Jens Ivar; Natvig, Bård; Keller, Anne; Soldal, Dag; Grotle, Margreth

    2011-10-01

    The objectives were to estimate the cut-off points for success on different sciatica outcome measures and to determine the success rate after an episode of sciatica by using these cut-offs. A 12-month multicenter observational study was conducted on 466 patients with sciatica and lumbar disc herniation. The cut-off values were estimated by ROC curve analyses using Completely recovered or Much better on a 7-point global change scale as external criterion for success. The cut-off values (references in brackets) at 12 months were leg pain VAS 17.5 (0-100), back pain VAS 22.5 (0-100), Sciatica Bothersomeness Index 6.5 (0-24), Maine-Seattle Back Questionnaire 4.5 (0-12), and the SF-36 subscales bodily pain 51.5, and physical functioning 81.7 (0-100, higher values indicate better health). In conclusion, the success rates at 12 months varied from 49 to 58% depending on the measure used. The proposed cut-offs may facilitate the comparison of success rates across studies.

  2. Classification and identification of opioid addiction in chronic pain patients

    DEFF Research Database (Denmark)

    Højsted, Jette; Nielsen, Per Rotbøll; Guldstrand, Sally Kendall

    2010-01-01

    Addiction is a feared consequence of long-term opioid treatment of chronic pain patients. The ICD-10 and DSM-IV diagnostic addiction criteria may not be appropriate in these patients. Therefore Portenoy's criteria (PC) were launched. The aim was to estimate the prevalence of addiction, to investi......Addiction is a feared consequence of long-term opioid treatment of chronic pain patients. The ICD-10 and DSM-IV diagnostic addiction criteria may not be appropriate in these patients. Therefore Portenoy's criteria (PC) were launched. The aim was to estimate the prevalence of addiction......, to investigate whether PC were applicable and to compare these criteria with the ICD-10 criteria. The study was cross-sectional and included 253 patients with chronic pain at a tertiary pain centre. Patients were screened for addiction by a physician and a nurse. The addiction prevalence was 14.4% according...... as addicted were treated with significantly higher opioid doses, drank more alcohol, smoked more tobacco, used benzodiazepines and had higher levels of depression. According to ICD-10 patients classified as addicted used higher doses of opioids, drank more alcohol and had higher scores of anxiety...

  3. The approach to patients with possible cardiac chest pain.

    Science.gov (United States)

    Parsonage, William A; Cullen, Louise; Younger, John F

    2013-07-08

    Chest pain is a common reason for presentation in hospital emergency departments and general practice. Some patients presenting with chest pain to emergency departments and, to a lesser extent, general practice will be found to have a life-threatening cause, but most will not. The challenge is to identify those who do in a safe, timely and cost-effective manner. An acute coronary syndrome cannot be excluded on clinical grounds alone. In patients with ongoing symptoms of chest pain, without an obvious other cause, ST-segment-elevation myocardial infarction should be excluded with a 12-lead electrocardiogram at the first available opportunity. Significant recent advances in the clinical approach to patients with acute chest pain, including better understanding of risk stratification, increasingly sensitive cardiac biomarkers and new non-invasive tests for coronary disease, can help clinicians minimise the risk of unexpected short-term adverse cardiac events. An approach that integrates these advances is needed to deliver the best outcomes for patients with chest pain. All hospital emergency departments should adopt such a strategic approach, and general practitioners should be aware of when and how to access these facilities.

  4. Postconcussion Symptoms in Patients with Injury-Related Chronic Pain

    Directory of Open Access Journals (Sweden)

    Britt Marie Stålnacke

    2012-01-01

    Full Text Available Background. Postconcussion symptoms (PCSs—such as fatigue, headache, irritability, dizziness, and impaired memory—are commonly reported in patients who have mild traumatic brain injuries (MTBIs. Evaluation of PCS after MTBI is proposed to have a diagnostic value although it is unclear whether PCS are specific to MTBI. After whiplash injuries, patients most often complain of headaches and neck pain; the other PCS are not as closely evaluated. In patients with chronic pain because of other injuries, the presence of PCS is unclear. This study aimed to describe the frequency of PCS in patients with injury-related pain and to examine the relationships between PCS, pain, and psychological factors. Methods. This study collected data using questionnaires addressing PCS (Rivermead Postconcussion Questionnaire, RPQ, pain intensity (Visual Analogue Scale, depression, anxiety (Hospital, Anxiety, and Depression Scale, and posttraumatic stress (Impact of Event Scale. Results. Fatigue (90.7%, sleep disturbance (84.9%, headache (73.5%, poor concentration (88.2%, and poor memory (67.1% were some of the most commonly reported PCS. Significant relationships were found between PCS and posttraumatic stress, depression, and anxiety. Conclusion. To optimize treatment, it is important to assess each patient’s PCS, the mechanism of injury, and factors such as posttraumatic stress and depression.

  5. Lumbar CT findings of patients with low back pain

    International Nuclear Information System (INIS)

    Lee, Yong Chul; Kim, Yang Soo; Kim, Kyun Sang

    1986-01-01

    Low back pain is probably the second most common disease entity to upper respiratory infection in developed country. We were missing at least 50% of the pathologic conditions by using conventional diagnostic modalities in low back pain. They did tell us nothing or little about facet abnormalities, lateral recesses, vertebral canal and soft tissue surrounding lumbar spines. High resolutional CT has been the biggest turning point in the diagnosis and management of low back pain. CT make a contribution to reducing the morbidity and probably the cost of evaluating patients with low back pain, and to increasing diagnostic accuracy. We observed 100 cases of lumbar CT using TCT 80A scanner for the evaluation of low back pain during the period from Apr. 1985 to Sept. 1985 at Chung-Ang University Hospital. Lumbar CT scan reveals high-positive findings (98%) in low back pain patients. Common low back disorders in CT are disc bulging (53%), herniated nucleus pulposus (32%), degenerative arthritis in posterior facet joints (27%), spinal stenosis (20%) and postoperative spines (15%). Uncommon low back disorders in CT are compression fracture of vertebral bodies, spondylolysis or spondylolisthesis, tropism, transitional vertebra, Scheueman's disease, limbic fracture, transverse process or articular process fracture, sacroiliac joint subluxation, conjoined nerve root and meningocele.

  6. Lumbar CT findings of patients with low back pain

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    Lee, Yong Chul; Kim, Yang Soo; Kim, Kyun Sang [Chung-Ang University, Seoul (Korea, Republic of)

    1986-04-15

    Low back pain is probably the second most common disease entity to upper respiratory infection in developed country. We were missing at least 50% of the pathologic conditions by using conventional diagnostic modalities in low back pain. They did tell us nothing or little about facet abnormalities, lateral recesses, vertebral canal and soft tissue surrounding lumbar spines. High resolutional CT has been the biggest turning point in the diagnosis and management of low back pain. CT make a contribution to reducing the morbidity and probably the cost of evaluating patients with low back pain, and to increasing diagnostic accuracy. We observed 100 cases of lumbar CT using TCT 80A scanner for the evaluation of low back pain during the period from Apr. 1985 to Sept. 1985 at Chung-Ang University Hospital. Lumbar CT scan reveals high-positive findings (98%) in low back pain patients. Common low back disorders in CT are disc bulging (53%), herniated nucleus pulposus (32%), degenerative arthritis in posterior facet joints (27%), spinal stenosis (20%) and postoperative spines (15%). Uncommon low back disorders in CT are compression fracture of vertebral bodies, spondylolysis or spondylolisthesis, tropism, transitional vertebra, Scheueman's disease, limbic fracture, transverse process or articular process fracture, sacroiliac joint subluxation, conjoined nerve root and meningocele.

  7. Altered resting state EEG in chronic pancreatitis patients: toward a marker for chronic pain

    NARCIS (Netherlands)

    Vries, M. de; Wilder-Smith, O.H.G.; Jongsma, M.L.A.; Broeke, E.N. van den; Arns, M.W.; Goor, H. van; Rijn, C.M. van

    2013-01-01

    OBJECTIVES: Electroencephalography (EEG) may be a promising source of physiological biomarkers accompanying chronic pain. Several studies in patients with chronic neuropathic pain have reported alterations in central pain processing, manifested as slowed EEG rhythmicity and increased EEG power in

  8. Altered resting state EEG in chronic pancreatitis patients: toward a marker for chronic pain

    NARCIS (Netherlands)

    Vries, M. de; Wilder-Smith, O.H.G.; Jongsma, M.L.A.; Broeke, E.N. van den; Arns, M.W.; Goor, H. van; Rijn, C.M. van

    2013-01-01

    Objectives: Electroencephalography (EEG) may be a promising source of physiological biomarkers accompanying chronic pain. Several studies in patients with chronic neuropathic pain have reported alterations in central pain processing, manifested as slowed EEG rhythmicity and increased EEG power in

  9. Changes of brain microstructure in patients with painful chronic pancreatitis assessed by diffusion tensor imaging

    DEFF Research Database (Denmark)

    Frøkjær, Jens Brøndum; Olesen, Søren Schou; Gram, Mikkel

    Objective In patients with painful chronic pancreatitis (CP) there is increasing evidence of abnormal pain processing in the central nervous system. Using magnetic resonance (MR) diffusion tensor imaging, brain microstructure in areas involved in processing of visceral pain was characterised...

  10. The relationship between pain severity and patient-reported outcomes among patients with chronic low back pain in Japan

    Directory of Open Access Journals (Sweden)

    Montgomery W

    2016-06-01

    Full Text Available William Montgomery,1 Jeffrey Vietri,2 Jing Shi,3 Kei Ogawa,4 Sawako Kariyasu,4 Levent Alev,4 Masaya Nakamura5 1Eli Lilly Australia Pty Ltd., Sydney, NSW, Australia; 2Health Outcomes Practice, Kantar Health, Horsham, PA, 3Health Outcomes Practice, Kantar Health, Princeton, NJ, USA; 4Eli Lilly Japan K.K., Kobe, Japan; 5Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan Objective: The aim of this study was to quantify the impact of pain severity on patient-reported outcomes among individuals diagnosed with chronic low back pain in Japan. Methods: Data were provided by the 2012 Japan National Health and Wellness Survey (N=29,997, a web-based survey of individuals in Japan aged ≥18 years. This analysis included respondents diagnosed with low back pain of ≥3-month duration. Measures included the revised Medical Outcomes Study 36-Item Short-Form Survey Instrument, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 scale, the Work Productivity and Activity Impairment: General Health questionnaire, and self-reported all-cause health care visits (6 months. Generalized linear models were used to assess the relationship between outcomes and severity of pain in the past week as reported on a numeric rating scale ranging from 0 (no pain to 10 (pain as bad as you can imagine, controlling for length of diagnosis, sociodemographics, and general health characteristics. Results: A total of 290 respondents were included in the analysis; mean age was 56 years, 41% were females, and 56% were employed. Pain severity was 3/10 for the first quartile, 5/10 for the median, and 7/10 for the third quartile of this sample. Increasing severity was associated with lower scores for mental and physical component summaries and Short-Form 6D health utility, higher depression (Patient Health Questionnaire-9 and anxiety (Generalized Anxiety Disorder-7 scores, greater absenteeism and presenteeism, greater activity impairment

  11. The MOBID-2 pain scale: reliability and responsiveness to pain in patients with dementia.

    Science.gov (United States)

    Husebo, B S; Ostelo, R; Strand, L I

    2014-11-01

    Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) pain scale is a staff-administered pain tool for patients with dementia. This study explores MOBID-2's test-retest reliability, measurement error and responsiveness to change. Analyses are based upon data from a cluster randomized trial including 352 patients with advanced dementia from 18 Norwegian nursing homes. Test-retest reliability between baseline and week 2 (n = 163), and weeks 2 and 4 (n = 159) was examined in patients not expected to change (controls), using intraclass correlation coefficient (ICC2.1 ), standard error of measurement (SEM) and smallest detectable change (SDC). Responsiveness was examined by testing six priori-formulated hypotheses about the association between change scores on MOBID-2 and other outcome measures. ICCs of the total MOBID-2 scores were 0.81 (0-2 weeks) and 0.85 (2-4 weeks). SEM and SDC were 1.9 and 3.1 (0-2 weeks) and 1.4 and 2.3 (2-4 weeks), respectively. Five out of six hypotheses were confirmed: MOBID-2 discriminated (p Mini-Mental State Examination, Functional Assessment Staging and Activity of Daily Living. Expected associations between change scores of MOBID-2 and Neuropsychiatric Inventory - Nursing Home version were not confirmed. The SEM and SDC in connection with the MOBID-2 pain scale indicate that the instrument is responsive to a decrease in pain after a SPTP. Satisfactory test-retest reliability across test periods was demonstrated. Change scores ≥ 3 on total and subscales are clinically relevant and are beyond measurement error. © 2014 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC®.

  12. Validation of the Pain Resilience Scale in Chinese-speaking patients with temporomandibular disorders pain.

    Science.gov (United States)

    He, S L; Wang, J H; Ji, P

    2018-03-01

    To validate the Pain Resilience Scale (PRS) for use in Chinese patients with temporomandibular disorders (TMD) pain. According to international guidelines, the original PRS was first translated and cross-culturally adapted to formulate the Chinese version of PRS (PRS-C). A total of 152 patients with TMD pain were recruited to complete series of questionnaires. Reliability of the PRS-C was investigated using internal consistency and test-retest reliability. Validity of the PRS-C was calculated using cross-cultural validity and convergent validity. Cross-cultural validity was evaluated by examining the confirmatory factor analysis (CFA). And convergent validity was examined through correlating the PRS-C scores with scores of 2 commonly used pain-related measures (the Connor-Davidson Resilience Scale [CD-RISC] and the Tampa Scale for Kinesiophobia for Temporomandibular Disorders [TSK-TMD]). The PRS-C had a high internal consistency (Cronbach's alpha = 0.92) and good test-retest reliability (intra-class correlation coefficient [ICC] = 0.81). The CFA supported a 2-factor model for the PRS-C with acceptable fit to the data. The fit indices were chi-square/DF = 2.21, GFI = 0.91, TLI = 0.97, CFI = 0.98 and RMSEA = 0.08. As regards convergent validity, the PRS-C evidenced moderate-to-good relationships with the CD-RISC and the TSK-TMD. The PRS-C shows good psychometric properties and could be considered as a reliable and valid measure to evaluate pain-related resilience in patients with TMD pain. © 2017 John Wiley & Sons Ltd.

  13. Pain relief at the end of life: nurses' experiences regarding end-of-life pain relief in patients with dementia.

    Science.gov (United States)

    Brorson, Hanna; Plymoth, Henrietta; Örmon, Karin; Bolmsjö, Ingrid

    2014-03-01

    Patients with dementia receive suboptimal palliative care, and this patient group is at risk to have pain at the end of life. Because communicative impairments are common in this patient group, nurses play an important caregiver role in identifying, assessing, and relieving patients' pain. This study aimed to describe nurses' experiences regarding end-of-life pain relief in patients with dementia. This descriptive exploratory qualitative study was based on seven semistructured interviews. Burnard's content analysis inspired the data analysis. Two main categories were identified: (1) nurses' experience of difficulties concerning pain relief and (2) nurses' experience of resources concerning pain relief. Nurses experienced difficulties, such as feeling of powerlessness because of difficulties in obtaining adequate prescriptions for analgesics, ethical dilemmas, feeling of inadequacy because analgesia did not have the desired effect, and a feeling of not being able to connect with the patient. Factors, including knowledge about the patient, professional experience, utilization of pain assessment tools, interpersonal relationships, and interprofessional cooperation, served as resources and enabled end-of-life pain relief. The results of this study highlight the complexity of pain relief in patients with dementia at the end of life from a nursing perspective. The inability of patients with dementia to verbally communicate their pain makes them a vulnerable patient group, dependent on their caregivers. Knowing the life story of the patient, professional experience, teamwork based on good communication, and use of a pain assessment tool were reported by the nurses to improve pain relief at the end of life for patients with dementia. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  14. Effects of neural mobilization on pain, straight leg raise test and disability in patients with radicular low back pain

    OpenAIRE

    Haris Čolaković; Dijana Avdić

    2013-01-01

    Introduction: Radicular low back pain is a disorder involving the dysfunction of the lumbosacral nerve roots. Clinical rehabilitation approaches for low back pain include kinesiotherapy, and physical therapyprocedures: ice , rest , heat, ultrasound, TENS, but evidences regarding their effectiveness are lacking. The purpose of this study was to determine if nerve mobilization brings better improvements in pain, SLR testand functional disability in patients with radicular low back pain compared...

  15. Patients with low back pain differ from those who also have leg pain or signs of nerve root involvement

    DEFF Research Database (Denmark)

    Kongsted, Alice; Kent, Peter; Albert, Hanne

    2012-01-01

    ABSTRACT: BACKGROUND: Leg pain associated with low back pain (LBP) is recognized as a risk factor for a poor prognosis, and is included as a component in most LBP classification systems. The location of leg pain relative to the knee and the presence of a positive straight leg raise test have been...... only, 2) LBP and pain above the knee, 3) LBP and pain below the knee, and 4) LBP and signs of nerve root involvement. METHODS: Analysis of routine clinical data from an outpatient department. Based on patient reported data and clinical findings, patients were allocated to the QTF subgroups...

  16. in Critically Ill Patients: Success and Limits

    Directory of Open Access Journals (Sweden)

    Filippo Mariano

    2011-01-01

    Full Text Available Citrate anticoagulation has risen in interest so it is now a real alternative to heparin in the ICUs practice. Citrate provides a regional anticoagulation virtually restricted to extracorporeal circuit, where it acts by chelating ionized calcium. This issue is particularly true in patients ongoing CRRT, when the “continuous” systemic anticoagulation treatment is per se a relevant risk of bleeding. When compared with heparin most of studies with citrate reported a longer circuit survival, a lower rate of bleeding complications, and transfused packed red cell requirements. As anticoagulant for CRRT, the infusion of citrate is prolonged and it could potentially have some adverse effects. When citrate is metabolized to bicarbonate, metabolic alkalosis may occur, or for impaired metabolism citrate accumulation leads to acidosis. However, large studies with dedicated machines have indeed demonstrated that citrate anticoagulation is well tolerated, safe, and an easy to handle even in septic shock critically ill patients.

  17. ABDOMINAL DRAWING IN MANEUVER: EFFECT ON GAIT PARAMETERS AND PAIN REDUCTION IN PATIENTS WITH CHRONIC LOW BACK PAIN

    Directory of Open Access Journals (Sweden)

    Paramasivan Mani

    2016-08-01

    Full Text Available Background: Back pain is the common musculoskeletal condition with a high prevalence of up to 80% among the general and work force population at some times in their lives.Muscular injury, fatigue, or facet or disc degeneration can compromise the stabilizing effects resulting in shearing forces that cause pain.Abdominal drawing in maneuver is used to facilitate the re-education of neuromuscular control mechanisms provided by local stabilizing muscles. Objective of the study is to measure the gait parameters and pain control before and after abdominal drawing in maneuver in patient with chronic mechanical low back pain. Methods: Total number of 30 consecutive patients and they were divided into two groups by purposive sampling. Group A is subjects with low back pain and Group B is subjects without low back pain. Outcome measures were average step cycle, average step length, coefficient of variation, time on each foot, Ambulation index measured with Biodex gait trainer. Pain is measured with Revised-Oswestry low back pain questionnaire. Results: Significant difference between gait parameters were observed in both low back pain group and the group without low back pain group with abdominal drawing in maneuver and the changes without abdominal drawing in maneuver was minimal. There was no significant difference found between both groups with or without abdominal drawing in maneuver. Conclusion: Gait parameters and Pain control can be improved by training with abdominal drawing in maneuver thereby it reduces pain and improves gait symmetry in subjects with low back pain.

  18. Clinical assessment of patients with orofacial pain and temporomandibular disorders.

    Science.gov (United States)

    Stern, Ilanit; Greenberg, Martin S

    2013-07-01

    Accurate diagnosis of chronic pain disorders of the mouth, jaws, and face is frequently complex. It is common for patients with chronic orofacial pain to consult multiple clinicians and receive ineffective treatment before a correct diagnosis is reached. This problem is a significant public health concern. Clinicians can minimize error by starting the diagnostic procedure with a careful, accurate history and thorough head and neck examination followed by a thoughtfully constructed differential diagnosis. The possibility that the patient has symptoms of a life-threatening underlying disease rather than a more common dental, sinus, or temporomandibular disorder must always be considered. Published by Elsevier Inc.

  19. Benefits of nurse prescribing for patients in pain: nurses' views.

    Science.gov (United States)

    Stenner, Karen; Courtenay, Molly

    2008-07-01

    This paper is a report of a study to explore nurses' views on the benefits of adopting the role of prescribing for patients with acute and chronic pain. It was envisioned that the advent of nurse prescribing would be beneficial to the efficiency and effectiveness of the United Kingdom National Health Service. Research to date does indeed indicate that nurse prescribing can be beneficial to patients, nurses and the health service in general. Despite the expansion of nurse prescribing, there is little evidence of its impact according to nurses working in specialist areas, such as with patients in acute and chronic pain. Interviews were conducted during 2006 and 2007 with 26 nurses qualified to prescribe medicines for patients in acute and chronic pain. This was a qualitative study and a thematic analysis was conducted. Nurses reported a number of benefits, including faster access to treatment, improved quality of care, more appropriate prescribing of medication, improved safety, improved relations and communication with patients, greater efficiency and cost effectiveness. Nurses benefited from increased job satisfaction, credibility with patients and healthcare professionals and also gained knowledge through prescribing. There is potential for the benefits of nurse prescribing to be expanded beyond the United Kingdom in settings where nurses hold similar roles in the treatment of pain, although further research using a wider range of research methods is recommended to substantiate these findings.

  20. Discrete Pathophysiology is Uncommon in Patients with Nonspecific Arm Pain.

    Science.gov (United States)

    Kortlever, Joost T P; Janssen, Stein J; Molleman, Jeroen; Hageman, Michiel G J S; Ring, David

    2016-06-01

    Nonspecific symptoms are common in all areas of medicine. Patients and caregivers can be frustrated when an illness cannot be reduced to a discrete pathophysiological process that corresponds with the symptoms. We therefore asked the following questions: 1) Which demographic factors and psychological comorbidities are associated with change from an initial diagnosis of nonspecific arm pain to eventual identification of discrete pathophysiology that corresponds with symptoms? 2) What is the percentage of patients eventually diagnosed with discrete pathophysiology, what are those pathologies, and do they account for the symptoms? We evaluated 634 patients with an isolated diagnosis of nonspecific upper extremity pain to see if discrete pathophysiology was diagnosed on subsequent visits to the same hand surgeon, a different hand surgeon, or any physician within our health system for the same pain. There were too few patients with discrete pathophysiology at follow-up to address the primary study question. Definite discrete pathophysiology that corresponded with the symptoms was identified in subsequent evaluations by the index surgeon in one patient (0.16% of all patients) and cured with surgery (nodular fasciitis). Subsequent doctors identified possible discrete pathophysiology in one patient and speculative pathophysiology in four patients and the index surgeon identified possible discrete pathophysiology in four patients, but the five discrete diagnoses accounted for only a fraction of the symptoms. Nonspecific diagnoses are not harmful. Prospective randomized research is merited to determine if nonspecific, descriptive diagnoses are better for patients than specific diagnoses that imply pathophysiology in the absence of discrete verifiable pathophysiology.

  1. Virtual visual reminiscing pain stimulation of allodynia patients activates cortical representation of pain and emotions. fMRI study

    International Nuclear Information System (INIS)

    Ikemoto, Tatsunori; Ushida, Takahiro; Taniguchi, Shinichirou; Tania, Toshikazu; Zinchuk, V.; Morio, Kazuo; Sasaki, Toshikazu

    2004-01-01

    It is widely known that sensation of the pain is derived from sensory-discriminative factor and emotional factor. Especially in chronic pain, emotional factors and psychosocial backgrounds are more likely to contribute for the patients' discomfort. The aim of this study is to investigate how emotional factor of pain participates in intractable pain. We employed functional MRI (fMRI) to compare the brain activations occurring in the orthopaedic neuropathic pain patients with allodynia and normal individuals in response to the visual virtual painful experience. During fMRI scanning, a video demonstrating an actual tactile stimulation of the palm and its imitation were shown to participants. In contrast to normal individuals, allodynia patients also displayed activation of the areas reflecting emotions: frontal lobe and anterior cingulate. These findings suggest that brain have important role in the development and maintaining of peripheral originated chronic painful condition. (author)

  2. Pain experiences of patients with advanced cancer: A qualitative descriptive study.

    Science.gov (United States)

    Erol, Ozgul; Unsar, Serap; Yacan, Lale; Pelin, Meryem; Kurt, Seda; Erdogan, Bülent

    2018-04-01

    Uncontrolled pain, especially in patients with advanced cancer, affects quality of life negatively and causes negative physical and psychological conditions. The aim of this study was to explore the pain experiences of patients with advanced cancer and how they manage with pain, and to present a view of pain management approaches of nurses from the perspectives of the patients. This was a qualitative descriptive study of sixteen hospitalized patients with advanced cancer. Data were collected using semi-structured interviews with patients. Data were analysed by Colaizzi's phenomenological method. This study found that patients with advanced cancer who had pain experienced anxiety, helplessness, hopelessness and many restrictions in daily life as well as inability to manage with pain. Most of the patients with advanced cancer were not satisfied with their nursing care with regard to pain management. The themes that emerged were pain perception and experiences, effects of pain on daily life, pain management and management strategies and the patients' perspectives about nursing approaches to pain. This study demonstrated the difficulties of patients with advanced cancer who experienced pain in their daily lives, yet lack pain management strategies. Furthermore, nurses' caring approaches to patients with advanced cancer who experienced pain was found inadequate. Oncology nurses should provide educational interventions in order to enhance knowledge and skills about pain assessment and non-pharmacologic and pharmacologic strategies used in pain management. Copyright © 2018 Elsevier Ltd. All rights reserved.

  3. Unspecific chronic low back pain - a simple functional classification tested in a case series of patients with spinal deformities.

    Science.gov (United States)

    Weiss, Hans-Rudolf; Werkmann, Mario

    2009-02-17

    Up to now, chronic low back pain without radicular symptoms is not classified and attributed in international literature as being "unspecific". For specific bracing of this patient group we use simple physical tests to predict the brace type the patient is most likely to benefit from. Based on these physical tests we have developed a simple functional classification of "unspecific" low back pain in patients with spinal deformities. Between January 2006 and July 2007 we have tested 130 patients (116 females and 14 males) with spinal deformities (average age 45 years, ranging from 14 years to 69) and chronic unspecific low back pain (pain for > 24 months) along with the indication for brace treatment for chronic unspecific low back pain. Some of the patients had symptoms of spinal claudication (n = 16). The "sagittal realignment test" (SRT) was applied, a lumbar hyperextension test, and the "sagittal delordosation test" (SDT). Additionally 3 female patients with spondylolisthesis were tested, including one female with symptoms of spinal claudication and 2 of these patients were 14 years of age and the other 43yrs old at the time of testing. 117 Patients reported significant pain release in the SRT and 13 in the SDT (> or = 2 steps in the Roland & Morris VRS). 3 Patients had no significant pain release in both of the tests (manual investigation we found hypermobility at L5/S1 or a spondylolisthesis at level L5/S1. In the other patients who responded well to the SRT loss of lumbar lordosis was the main issue, a finding which, according to scientific literature, correlates well with low back pain. The 3 patients who did not respond to either test had a fair pain reduction in a generally delordosing brace with an isolated small foam pad inserted at the level of L 2/3, leading to a lordosation at this region. With the exception of 3 patients (2.3%) a clear distribution to one of the two classes has been possible. 117 patients were supplied successfully with a sagittal

  4. Allopathic, complementary, and alternative medical treatment utilization for pain among methadone-maintained patients.

    Science.gov (United States)

    Barry, Declan T; Beitel, Mark; Cutter, Christopher J; Garnet, Brian; Joshi, Dipa; Schottenfeld, Richard S; Rounsaville, Bruce J

    2009-01-01

    We surveyed 150 methadone maintenance treatment program (MMTP) patients about pain, pain treatment utilization, perceived efficacy of prior pain treatment, and interest in pursuing pain treatment at the MMTP. Respondents with chronic severe pain (CSP) (ie, pain lasting at least six months with moderate to severe pain intensity or significant pain interference) and "some pain" (ie, pain reported in the previous week but not CSP) endorsed similar rates of past-week and lifetime allopathic or standard medical (with the exception of lifetime medical use of non-opiate medication) and complementary and alternative medicine (CAM) utilization for pain reduction. Prior pain treatments were perceived to be less effective by CSP than SP patients but both groups had equivalent high rates of interest in pain treatment associated with the MMTP. These findings may have implications for resource and program planning in MMTPs.

  5. Relationship between onset of pain relief and patient satisfaction with fentanyl pectin nasal spray for breakthrough pain in cancer.

    Science.gov (United States)

    Torres, Luis M; Revnic, Julia; Knight, Alastair D; Perelman, Michael

    2014-10-01

    Satisfaction with pain relief in patients with breakthrough pain in cancer (BTPc) has typically been assessed by overall efficacy without consideration of the rapidity of that response. To determine the relationship between speed of onset of pain relief and patient satisfaction for treated BTPc episodes overall and for individual treatments. Pooled data from two randomized, double-blinded crossover studies. Patients having 1-4 BTPc episodes per day on ≥60 mg/day oral morphine or equivalent. Episodes treated with fentanyl pectin nasal spray (FPNS; 100-800 μg), immediate-release morphine sulfate (IRMS), or placebo. Pain intensity was measured on an 11-point scale (5-60 minutes posttreatment); satisfaction was measured on a 4-point scale (30 and 60 minutes). The primary analysis assessed the overall relationship of time to onset of pain relief (pain intensity difference [PID]≥1) or time to clinically meaningfully reduction in pain (PID≥2) versus patient satisfaction and overall pain intensity (summed pain intensity difference at 30 [SPID30] and 60 minutes [SPID60]) assessed by analysis of variance (ANOVA). A secondary analysis assessed whether satisfaction was different between treatments using a within-patient comparison. Eight hundred thirty-one FPNS-treated, 368 IRMS-treated, and 200 placebo-treated episodes were analyzed. Overall, within the pool there was a statistically significant relationship between time to onset of pain relief (PID≥1 and PID≥2) and patient satisfaction (both speed of relief and overall) at 30 and 60 minutes (ppain intensity reduction. When treatment groups were compared using within-patient data, FPNS provided earlier onset of pain relief than IRMS or placebo (ppain relief resulted in greater patient satisfaction and overall relief of pain; between-treatment comparisons showed that FPNS provided earlier pain relief and greater satisfaction than IRMS or placebo.

  6. Medical cannabis use among patients with chronic pain in an interdisciplinary pain rehabilitation program: Characterization and treatment outcomes.

    Science.gov (United States)

    Shah, Arya; Craner, Julia; Cunningham, Julie L

    2017-06-01

    Cannabis is increasingly being used in the treatment of chronic pain. However, there is a lack of available research in the population of patients with chronic pain who are using cannabis. The current study examines clinical and treatment characteristics for patients who are admitted to a 3-week outpatient interdisciplinary chronic pain rehabilitation program. Participants (N=48) included patients with a positive urine drug screen for 9-carboxy-tetrahydrocannabinol (THC(+); n=24) and a matched comparison sample of patients with a negative screen (THC(-); n=24). Participants were matched for age, gender, race, education, and current prescription opioid use. Measures of pain, functioning, and quality of life were completed at admission and discharge. Medical chart review was conducted to assess medication and substance use history. Participants with a positive screen for THC were more likely to report a past history of illicit substance use, alcohol abuse, and current tobacco use. Cannabis use was not associated with a significantly lower morphine equivalence level for participants using prescription opioids (n=14). Both groups of participants reported significant improvement in pain severity, pain interference, depressive symptoms, and pain catastrophizing. There were no group- or treatment-related differences in these outcome variables. Results provide preliminary evidence that patients with chronic pain using cannabis may benefit from an interdisciplinary chronic pain program. Patients with chronic pain using cannabis may be at higher risk for substance-related negative outcomes, although more research is needed to understand this relationship. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Smoking behavior and motivation to quit among chronic pain patients initiating multidisciplinary pain treatment: a prospective study.

    Science.gov (United States)

    Unrod, Marina; Gironda, Ronald J; Clark, Michael E; White, Kristi E; Simmons, Vani N; Sutton, Steven K; Brandon, Thomas H

    2014-08-01

    The primary aim of this study was to assess smoking characteristics and cessation motivation prior to and after initiation of multidisciplinary chronic pain treatment. A secondary aim was to identify predictors of cessation motivation among smokers initiating treatment for chronic pain. We used a prospective, nonrandomized, repeated measures design. The study was conducted in a multidisciplinary specialty pain treatment program at a veterans hospital. Smokers (N = 90) referred to a multidisciplinary pain program for the treatment of chronic pain. Patients completed questionnaires assessing pain-related and smoking-related factors prior to (baseline) and 8 weeks post (follow-up) specialty pain treatment initiation. Primary outcome measures were the Contemplation Ladder and the Stages of Change (SOC) algorithm. At baseline, patients reported moderate levels of cessation motivation, and 69% were in the contemplation stage or higher on the SOC. Motivation to quit smoking was higher at follow-up compared with baseline on both continuous, t(89) = 2.11, P motivation (e.g., pain intensity) were subsumed by more general predictors (e.g., nicotine dependence). Patients in this sample were more motivated to quit smoking a few weeks after, as compared with before initiating specialty pain treatment. Future research into pain-specific predictors of cessation motivation is warranted to inform the development of interventions that address pain patients' unique needs. Wiley Periodicals, Inc.

  8. Characteristics and prognostic factors for pain management in 152 patients with lung cancer

    Directory of Open Access Journals (Sweden)

    Shi L

    2016-04-01

    Full Text Available Lei Shi,1,* Yumei Liu,2,* Hua He,1 Cong Wang,1 Hongwei Li,1 Nanya Wang1 1Cancer Center, The First Hospital of Jilin University, Changchun, 2Department of Hematology, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China *These authors contributed equally to this work Objective: The objective of this study was to analyze the pain characteristics and factors influencing the outcome of pain control in patients with lung cancer having pain. Methods: Pain characteristics, the effectiveness, and prognostic factors for pain control were analyzed in 152 patients with lung cancer having moderate or severe chronic pain admitted to Cancer Center of The First Hospital of Jilin University, People’s Republic of China, between January 2012 and May 2013. Information about sex, age, pathological type, TNM stage, presence/absence of bone metastases, characteristics of pain, methods, and effectiveness of pain management was recorded. Results: Patients with non-small-cell lung cancer and small-cell carcinoma accounted for 132/152 (86.8% and 20/152 (13.2% cases, respectively. Among them, moderate (72.4% or severe pain (27.6% was reported in 73.7% of the cases at stage IV, chest or back pain was reported in 76.3% of the cases, and pain in other locations in the rest of the cases. Bone metastases were apparent in 44.1% of the patients. Neuropathic pain was noted in 46.7% of the patients, and frequent breakthrough pain was noted in 25.7% of the patients. High pain intensity was associated with frequent breakthrough pain. Pain was adequately controlled in 81.6% of the patients prescribed 3 days of analgesics. More patients reported a KPS higher than or equal to 80 after 3 days of analgesic treatment (P<0.001. Severe pain, frequent breakthrough pain, and presence of bone metastases were independent risk factors for poor pain control. Severe pain, frequent breakthrough pain, or neuropathic pain in the patients using opioids required higher

  9. Validation of the Persian Version of the Brief Pain Inventory (BPI-P) in Chronic Pain Patients.

    Science.gov (United States)

    Majedi, Hossein; Dehghani, S Sharareh; Soleyman-Jahi, Saeed; Emami Meibodi, S Ali; Mireskandari, S Mohammad; Hajiaghababaei, Marzieh; Tafakhori, Abbas; Mendoza, Tito R; Cleeland, Charles S

    2017-07-01

    Chronic pain needs to be evaluated with a standard instrument. The Brief Pain Inventory (BPI) is a pain assessment tool that has been validated in many languages. The aim of the present study was to develop the Persian version of the Brief Pain Inventory (BPI-P) and also to evaluate the psychometric properties of the BPI-P in the Iranian population. The BPI-P was translated from the original version of BPI using standard procedure. The Persian version of the BPI and 12-item Short-Form Health Survey (SF-12) were completed by 201 patients with chronic pain who were referred to a tertiary pain care clinic from 2013 to 2015. The performance status of the patients was evaluated by physicians using Eastern Cooperative Oncology Group performance test. Factor analysis of the BPI-P identified two scales: pain intensity and pain interference with life. These two factors explained 68.4% of the variance. Coefficient alpha values for BPI-P items ranging from 0.87 to 0.91 showed good internal consistency of the factors. The high intraclass correlation coefficients for the items of the questionnaire confirmed the test-retest reliability for the BPI-P. Patients with higher scores in Eastern Cooperative Oncology Group performance test reported higher levels of pain intensity and pain interference with life. Pain intensity in BPI-P correlated with physical functioning, bodily pain, mental health, and vitality of the SF-12 questionnaire, whereas pain interference was associated with general health, bodily pain, mental health, vitality, and social functioning. The present study demonstrated that the Persian version of the BPI could be a valid and reliable instrument for pain assessment in Persian-speaking patients. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  10. Thresholds and perception of cold pain, heat pain, and the thermal grill illusion in patients with major depressive disorder.

    Science.gov (United States)

    Boettger, Michael Karl; Grossmann, David; Bär, Karl-Jürgen

    2013-04-01

    The thermal grill illusion (TGI) in which interlacing cold and warm bars create the illusion of a painful sensation has been suggested as an experimental model for central pain states and pain processing. The aim of this study was to use this technique to gain further insights into the altered pain perception in major depressive disorder (MDD). In 18 unmedicated patients with MDD, cold and heat pain thresholds (CPT/HPT) as well as the perception of the TGI were examined and compared with 18 matched controls. CPT and HPT were significantly increased in patients (7.9°C and 47.5°C) compared with controls (15.9°C and 45.2°C, respectively; p painful by controls, the patients did not indicate painful sensations, thereby indicating a shift of the stimulus-response curve of TGI pain perception toward higher stimulus intensities, that is, greater temperature differentials between cold and warm bars (11.5°C for controls, 16.7°C for patients). The patients rated the pain intensity perceived at the respective pain thresholds (CPT and HPT) in tendency higher than did the controls, whereas they perceived the TGI less painful despite increased stimulus intensities. Unpleasantness ratings were similar between groups. CPT, HPT and temperature differentials for the perception of the TGI, were increased in patients with MDD as compared with controls. Pain intensity, however, was rated differently for CPT and HPT, where patients indicated higher ratings in tendency, and for the TGI stimulation, where pain was perceived less intense.

  11. The association between Modic changes and pain during 1-year follow-up in patients with lumbar radicular pain

    International Nuclear Information System (INIS)

    Schistad, Elina Iordanova; Roee, Cecilie; Espeland, Ansgar; Rygh, Lars Joergen; Gjerstad, Johannes

    2014-01-01

    To examine whether Modic changes influence pain during a 1-year follow-up in patients with lumbar radicular pain. A total of 243 patients with lumbar radicular pain due to disc herniation were recruited from two hospitals in Norway and followed up at 6 weeks, 6 months, and 12 months. On baseline lumbar magnetic resonance images, two observers independently evaluated Modic changes (types I-III; craniocaudal size 0-3). Outcomes were sensory pain (McGill Pain Questionnaire), back and leg pain (visual analogue scale, VAS). Association between Modic type and outcomes was explored with a mixed model and then by two-way analysis of variance (ANOVA) at each time point with Modic and treatment groups (surgical, n = 126; nonsurgical, n = 117) as fixed factors, adjusted for disc degeneration, age, sex, smoking, and duration of radicular pain. Modic size was also analyzed using ANOVA. Pain scores had decreased significantly at 1-year follow-up. Modic type was significantly related to McGill sensory scores (mixed model: p = 0.014-0.026; ANOVA: p = 0.007 at 6 weeks), but not to VAS back pain or VAS leg pain scores. At 6 weeks, the mean McGill sensory score was higher in Modic I than in Modic II-III patients (p = 0.003) and in patients without Modic changes (p = 0.018). Modic size L1-S1 was not associated with pain outcomes. Patients with lumbar radicular pain have a substantial pain reduction during 1-year follow-up, but Modic type I changes may imply a slower initial decrease in sensory pain. (orig.)

  12. The association between Modic changes and pain during 1-year follow-up in patients with lumbar radicular pain

    Energy Technology Data Exchange (ETDEWEB)

    Schistad, Elina Iordanova; Roee, Cecilie [Oslo University Hospital, Department of Physical Medicine and Rehabilitation, Ullevaal, Nydalen, Postbox 4956, Oslo (Norway); University of Oslo, Faculty of Medicine, Oslo (Norway); Espeland, Ansgar [Haukeland University Hospital, Department of Radiology, Bergen (Norway); University of Bergen, Section for Radiology, Department of Clinical Medicine, Bergen (Norway); Rygh, Lars Joergen [Haukeland University Hospital, Department of Anesthesiology, Bergen (Norway); Gjerstad, Johannes [National Institute of Occupational Health, Oslo (Norway); University of Oslo, Department of Molecular Biosciences, Oslo (Norway)

    2014-09-15

    To examine whether Modic changes influence pain during a 1-year follow-up in patients with lumbar radicular pain. A total of 243 patients with lumbar radicular pain due to disc herniation were recruited from two hospitals in Norway and followed up at 6 weeks, 6 months, and 12 months. On baseline lumbar magnetic resonance images, two observers independently evaluated Modic changes (types I-III; craniocaudal size 0-3). Outcomes were sensory pain (McGill Pain Questionnaire), back and leg pain (visual analogue scale, VAS). Association between Modic type and outcomes was explored with a mixed model and then by two-way analysis of variance (ANOVA) at each time point with Modic and treatment groups (surgical, n = 126; nonsurgical, n = 117) as fixed factors, adjusted for disc degeneration, age, sex, smoking, and duration of radicular pain. Modic size was also analyzed using ANOVA. Pain scores had decreased significantly at 1-year follow-up. Modic type was significantly related to McGill sensory scores (mixed model: p = 0.014-0.026; ANOVA: p = 0.007 at 6 weeks), but not to VAS back pain or VAS leg pain scores. At 6 weeks, the mean McGill sensory score was higher in Modic I than in Modic II-III patients (p = 0.003) and in patients without Modic changes (p = 0.018). Modic size L1-S1 was not associated with pain outcomes. Patients with lumbar radicular pain have a substantial pain reduction during 1-year follow-up, but Modic type I changes may imply a slower initial decrease in sensory pain. (orig.)

  13. Power of treatment success definitions when the Canine Brief Pain Inventory is used to evaluate carprofen treatment for the control of pain and inflammation in dogs with osteoarthritis.

    Science.gov (United States)

    Brown, Dorothy Cimino; Bell, Margie; Rhodes, Linda

    2013-12-01

    To determine the optimal method for use of the Canine Brief Pain Inventory (CBPI) to quantitate responses of dogs with osteoarthritis to treatment with carprofen or placebo. 150 dogs with osteoarthritis. Data were analyzed from 2 studies with identical protocols in which owner-completed CBPIs were used. Treatment for each dog was classified as a success or failure by comparing the pain severity score (PSS) and pain interference score (PIS) on day 0 (baseline) with those on day 14. Treatment success or failure was defined on the basis of various combinations of reduction in the 2 scores when inclusion criteria were set as a PSS and PIS ≥ 1, 2, or 3 at baseline. Statistical analyses were performed to select the definition of treatment success that had the greatest statistical power to detect differences between carprofen and placebo treatments. Defining treatment success as a reduction of ≥ 1 in PSS and ≥ 2 in PIS in each dog had consistently robust power. Power was 62.8% in the population that included only dogs with baseline scores ≥ 2 and 64.7% in the population that included only dogs with baseline scores ≥ 3. The CBPI had robust statistical power to evaluate the treatment effect of carprofen in dogs with osteoarthritis when protocol success criteria were predefined as a reduction ≥ 1 in PIS and ≥ 2 in PSS. Results indicated the CBPI can be used as an outcome measure in clinical trials to evaluate new pain treatments when it is desirable to evaluate success in individual dogs rather than overall mean or median scores in a test population.

  14. Internet-Based Survey Evaluating Use of Pain Medications and Attitudes of Radiation Oncology Patients Toward Pain Intervention

    International Nuclear Information System (INIS)

    Simone, Charles B.; Vapiwala, Neha; Hampshire, Margaret K.; Metz, James M.

    2008-01-01

    Purpose: Pain is a common symptom among cancer patients, yet many patients do not receive adequate pain management. Few data exist quantifying analgesic use by radiation oncology patients. This study evaluated the causes of pain in cancer patients and investigated the reasons patients fail to receive optimal analgesic therapy. Methods and Materials: An institutional review board-approved, Internet-based questionnaire assessing analgesic use and pain control was posted on the OncoLink (available at (www.oncolink.org)) Website. Between November 2005 and April 2006, 243 patients responded. They were predominantly women (73%), white (71%), and educated beyond high school (67%) and had breast (38%), lung (6%), or ovarian (6%) cancer. This analysis evaluated the 106 patients (44%) who underwent radiotherapy. Results: Of the 106 patients, 58% reported pain from their cancer treatment, and 46% reported pain directly from their cancer. The pain was chronic in 51% and intermittent in 33%. Most (80%) did not use medication to manage their pain. Analgesic use was significantly less in patients with greater education levels (11% vs. 36%, p = 0.002), with a trend toward lower use by whites (16% vs. 32%, p 0.082) and women (17% vs. 29%, p = 0.178). The reasons for not taking analgesics included healthcare provider not recommending medication (87%), fear of addiction or dependence (79%), and inability to pay (79%). Participants experiencing pain, but not taking analgesics, pursued alternative therapies for relief. Conclusions: Many radiation oncology patients experience pain from their disease and cancer treatment. Most study participants did not use analgesics because of concerns of addiction, cost, or failure of the radiation oncologist to recommend medication. Healthcare providers should have open discussions with their patients regarding pain symptoms and treatment

  15. Efficient conditioned pain modulation despite pain persistence in painful diabetic neuropathy

    Directory of Open Access Journals (Sweden)

    Yelena Granovsky

    2017-06-01

    Conclusion:. Pro-nociception, expressed by less efficient CPM and high temporal summation that usually accompanies clinical painful conditions, seems to “normalize” with chronicity of the pain syndrome. This is despite continuing pain, suggesting that pro-nociceptivity in pain syndromes is multifactorial. Because the pain modulation profile affects success of therapy, this suggests that different drugs might express different efficacy pending on duration of the pain in patients with PDN.

  16. Core strength training for patients with chronic low back pain.

    Science.gov (United States)

    Chang, Wen-Dien; Lin, Hung-Yu; Lai, Ping-Tung

    2015-03-01

    [Purpose] Through core strength training, patients with chronic low back pain can strengthen their deep trunk muscles. However, independent training remains challenging, despite the existence of numerous core strength training strategies. Currently, no standardized system has been established analyzing and comparing the results of core strength training and typical resistance training. Therefore, we conducted a systematic review of the results of previous studies to explore the effectiveness of various core strength training strategies for patients with chronic low back pain. [Methods] We searched for relevant studies using electronic databases. Subsequently, we evaluated their quality by analyzing the reported data. [Results] We compared four methods of evaluating core strength training: trunk balance, stabilization, segmental stabilization, and motor control exercises. According to the results of various scales and evaluation instruments, core strength training is more effective than typical resistance training for alleviating chronic low back pain. [Conclusion] All of the core strength training strategies examined in this study assist in the alleviation of chronic low back pain; however, we recommend focusing on training the deep trunk muscles to alleviate chronic low back pain.

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

    Directory of Open Access Journals (Sweden)

    Hijaz NM

    2017-06-01

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

  18. Psychological Care, Patient Education, Orthotics, Ergonomics and Prevention Strategies for Neck Pain

    DEFF Research Database (Denmark)

    Gross, Anita R; Kaplan, Faith; Huang, Stacey

    2013-01-01

    To conduct an overview on psychological interventions, orthoses, patient education, ergonomics, and 1⁰/2⁰ neck pain prevention for adults with acute-chronic neck pain.......To conduct an overview on psychological interventions, orthoses, patient education, ergonomics, and 1⁰/2⁰ neck pain prevention for adults with acute-chronic neck pain....

  19. Leg pain location and neurological signs relate to outcomes in primary care patients with low back pain

    DEFF Research Database (Denmark)

    Hartvigsen, Lisbeth; Hestbæk, Lise; Leboeuf-Yde, Charlotte

    Background Low back pain (LBP) patients with related leg pain and signs of nerve root involvement are considered to have a worse prognosis than patients with LBP alone. However, it is unclear whether leg pain location above or below the knee and the presence of neurological signs are important...... in primary care patients. The objectives of this study were to explore whether the four Quebec Task Force categories (QTFC) based on the location of pain and on neurological signs have different characteristics at the time of care seeking, whether these QTFC are associated with outcome, and if so whether...

  20. Leg pain location and neurological signs relate to outcomes in primary care patients with low back pain

    DEFF Research Database (Denmark)

    Hartvigsen, Lisbeth; Hestbæk, Lise; Leboeuf-Yde, Charlotte

    2017-01-01

    BACKGROUND: Low back pain (LBP) patients with related leg pain and signs of nerve root involvement are considered to have a worse prognosis than patients with LBP alone. However, it is unclear whether leg pain location above or below the knee and the presence of neurological signs are important...... in primary care patients. The objectives of this study were to explore whether the four Quebec Task Force categories (QTFC) based on the location of pain and on neurological signs have different characteristics at the time of care seeking, whether these QTFC are associated with outcome, and if so whether...

  1. Mechanisms-based classifications of musculoskeletal pain: part 3 of 3: symptoms and signs of nociceptive pain in patients with low back (± leg) pain.

    LENUS (Irish Health Repository)

    Smart, Keith M

    2012-08-01

    As a mechanisms-based classification of pain \\'nociceptive pain\\' (NP) refers to pain attributable to the activation of the peripheral receptive terminals of primary afferent neurones in response to noxious chemical, mechanical or thermal stimuli. The symptoms and signs associated with clinical classifications of NP have not been extensively studied. The purpose of this study was to identify symptoms and signs associated with a clinical classification of NP in patients with low back (± leg) pain. Using a cross-sectional, between-subjects design; four hundred and sixty-four patients with low back (± leg) pain were assessed using a standardised assessment protocol after which their pain was assigned a mechanisms-based classification based on experienced clinical judgement. Clinicians then completed a clinical criteria checklist indicating the presence\\/absence of various symptoms and signs. A regression analysis identified a cluster of seven clinical criteria predictive of NP, including: \\'Pain localised to the area of injury\\/dysfunction\\

  2. Intravenous analgesics for pain management in postoperative patients

    African Journals Online (AJOL)

    Purpose: To compare the effectiveness of post-operative pain management and associated adverse effects of ketamine and nefopam. Methods: In total, 78 American Society of Anesthesiologists (ASA) grade 1 and 2 patients who had undergone abdominal surgery were given 3 mg of intravenous (IV) morphine as ...

  3. Pain symptoms in patients with severe cerebral palsy: Prevalence ...

    African Journals Online (AJOL)

    Purpose: To evaluate the presence of pain in patients diagnosed with severe cerebral palsy (CP) according to the degree of motor function impairment. Methods: A cross-sectional study was conducted on students of the Association of Parents and Friends of Exceptional Children (APAE) diagnosed with cerebral palsy and ...

  4. Obesity-Related Adipokines Predict Patient-Reported Shoulder Pain

    Directory of Open Access Journals (Sweden)

    Rajiv Gandhi

    2013-12-01

    Full Text Available Background/Aims: Increasingly, an inflammatory modulating effect of adipokines within synovial joints is being recognized. To date, there has been no work examining a potential association between the presence of adipokines in the shoulder and patient-reported outcomes. This study undertakes an investigation assessing these potential links. Methods: 50 osteoarthritis patients scheduled for shoulder surgery completed a pre-surgery questionnaire capturing demographic information including validated, patient-reported function (Disabilities of the Arm, Shoulder, and Hand questionnaire and pain (Short Form McGill Pain Questionnaire measures. Synovial fluid (SF samples were analyzed for leptin, adiponectin, and resistin levels using Milliplex MAP assays. Linear regression modeling was used to assess the association between adipokine levels and patient-reported outcomes, adjusted for age, sex, BMI, and disease severity. Results: 54% of the cohort was female (n = 27. The mean age (SD of the sample was 62.9 (9.9 years and the mean BMI (SD was 28.1 (5.4 kg/m2. From regression analyses, greater SF leptin and adiponectin levels, but not regarding resistin, were found to be associated with greater pain (p Conclusions: The identified association between shoulder-derived SF leptin and adiponectin and shoulder pain is likely explained by the pro-inflammatory characteristics of the adipokines and represents potentially important therapeutic targets.

  5. Obesity-related adipokines predict patient-reported shoulder pain.

    Science.gov (United States)

    Gandhi, Rajiv; Perruccio, Anthony V; Rizek, Randy; Dessouki, Omar; Evans, Heather M K; Mahomed, Nizar N

    2013-01-01

    Increasingly, an inflammatory modulating effect of adipokines within synovial joints is being recognized. To date, there has been no work examining a potential association between the presence of adipokines in the shoulder and patient-reported outcomes. This study undertakes an investigation assessing these potential links. 50 osteoarthritis patients scheduled for shoulder surgery completed a pre-surgery questionnaire capturing demographic information including validated, patient-reported function (Disabilities of the Arm, Shoulder, and Hand questionnaire) and pain (Short Form McGill Pain Questionnaire) measures. Synovial fluid (SF) samples were analyzed for leptin, adiponectin, and resistin levels using Milliplex MAP assays. Linear regression modeling was used to assess the association between adipokine levels and patient-reported outcomes, adjusted for age, sex, BMI, and disease severity. 54% of the cohort was female (n = 27). The mean age (SD) of the sample was 62.9 (9.9) years and the mean BMI (SD) was 28.1 (5.4) kg/m(2). From regression analyses, greater SF leptin and adiponectin levels, but not regarding resistin, were found to be associated with greater pain (p < 0.05). Adipokine levels were not associated with functional outcome scores. The identified association between shoulder-derived SF leptin and adiponectin and shoulder pain is likely explained by the pro-inflammatory characteristics of the adipokines and represents potentially important therapeutic targets. © 2013 S. Karger GmbH, Freiburg.

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

    African Journals Online (AJOL)

    jen

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

  7. Psychological and physical effects of pain on cancer patients in ...

    African Journals Online (AJOL)

    Psychological and physical effects of pain on cancer patients in Ibadan, Nigeria. FT Nuhu, OA Odejide, KO Adebayo, AJ Yusuf. Abstract. No Abstract. African Journal of Psychiatry Vol. 12 (1) 2009: pp. 64-70. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

  8. Relationships between craniocervical posture and pain-related disability in patients with cervico-craniofacial pain

    Directory of Open Access Journals (Sweden)

    López-de-Uralde-Villanueva I

    2015-07-01

    Full Text Available Ibai López-de-Uralde-Villanueva,1–4 Hector Beltran-Alacreu,1–3 Alba Paris-Alemany,1–4 Santiago Angulo-Díaz-Parreño,2,3,5 Roy La Touche1–4 1Department of Physiotherapy, Faculty of Health Science, 2Research Group on Movement and Behavioral Science and Study of Pain, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain; 3Institute of Neuroscience and Craniofacial Pain (INDCRAN, Madrid, Spain; 4Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain; 5Faculty of Medicine, Universidad San Pablo CEU, Madrid, Spain Objectives: This cross-sectional correlation study explored the relationships between craniocervical posture and pain-related disability in patients with chronic cervico-craniofacial pain (CCFP. Moreover, we investigated the test–retest intrarater reliability of two craniocervical posture measurements: head posture (HP and the sternomental distance (SMD. Methods: Fifty-three asymptomatic subjects and 60 CCFP patients were recruited. One rater measured HP and the SMD using a cervical range of motion device and a digital caliper, respectively. The Spanish versions of the neck disability index and the craniofacial pain and disability inventory were used to assess pain-related disability (neck disability and craniofacial disability, respectively. Results: We found no statistically significant correlations between craniocervical posture and pain-related disability variables (HP and neck disability [r=0.105; P>0.05]; HP and craniofacial disability [r=0.132; P>0.05]; SMD and neck disability [r=0.126; P>0.05]; SMD and craniofacial disability [r=0.195; P>0.05]. A moderate positive correlation was observed between HP and SMD for both groups (asymptomatic subjects, r=0.447; CCFP patients, r=0.52. Neck disability was strongly positively correlated with craniofacial disability (r=0.79; P>0.001. The test–retest intrarater reliability of the HP measurement was high for

  9. Immediate effects of Graston Technique on hamstring muscle extensibility and pain intensity in patients with nonspecific low back pain

    OpenAIRE

    Moon, Jong Hoon; Jung, Jin-Hwa; Won, Young Sik; Cho, Hwi-Young

    2017-01-01

    [Purpose] The purpose of this study was to analyze the effect of Graston Technique on hamstring extensibility and pain intensity in patients with nonspecific low back pain. [Subjects and Methods] Twenty-four patients with nonspecific low back pain (27?46 years of age) enrolled in the study. All participants were randomly assigned to one of two groups: Graston technique group (n=12) and a static stretching group (n=12). The Graston Technique was used on the hamstring muscles of the experimenta...

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

    Science.gov (United States)

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

    2016-12-01

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

  11. The Relationship between Fear of Movement and Pain Intensity with Physical Disability in Chronic Lew-Back Pain Patients

    Directory of Open Access Journals (Sweden)

    Taher Afshar-Nezhad

    2010-07-01

    Full Text Available Objective: There is growing evidence for the idea that fear of movement may be as disabling as pain intensity in chronic low back pain patients (CLBP. The purpose of the present paper is to investigate the relation between fear of movement and pain intensity with physical disability in chronic low back pain patients and the role of pain duration, gender and age differences in these relations. Materials & Methods: In this analytical and cross-sectional study, 194 patients with chronic low back pain for more than three months, referred to seven rehabilitation clinics in Rasht city during four months, were selected consecutively. Data were collected by Numerical Rating Scale, Roland–Morris Disability Questionnaire, Tampa Scale for Kinesiophobia and Demographic questionnaire and analyzed by Pearson Correlation Coefficient and Multi Regression. Results: Significant correlations were found between physical disability with fear of movement, pain intensity and age (P<0.001 and also pain duration (P=0.036. These relations were not different between males and females. In first Regression model, fear of movement and pain intensity, were the strongest predictors of physical disability. No differences were found between these factors. Then, prediction model was prepared adding age, sex and pain duration. Multiple regression analyses revealed that the fear of movement and pain intensity were superior in predicting disability. Among demographic variables, only the Beta Coefficient for age was significant in predicting disability (P=0.002. Conclusion: Fear of movement, pain intensity and age are important factors influencing physical disability in individuals suffering a chronic low back pain. Thus, for minimizing physical disability, alone with reducing pain intensity, patients showing fear of movement can be offered interventions that focus on reduction of the fear.

  12. Rare successful pregnancy in a patient with Swyer Syndrome.

    Science.gov (United States)

    Taneja, Jyoti; Ogutu, David; Ah-Moye, Michael

    2016-10-01

    To report a rare successful pregnancy after fertility treatment in a patient with Swyer syndrome. Case report. Herts & Essex Fertility Centre, Cheshunt, UK. A 36-year-old patient with 46, XY gonadal dysgenesis. 31 year old husband with normal sperm analysis. Chromosomal analysis, Saline infusion sonography, Pipelle endometrial scratch, ICSI using donor eggs, Embryo Transfer, and Caesarean delivery. Successful pregnancy and live birth. Successful treatment with donor eggs, pregnancy, and delivery. A patient with 46, XY gonadal dysgenesis in a specially tailored fertility program, can maintain a normal pregnancy and delivery.

  13. Patient expectations predict greater pain relief with joint arthroplasty.

    Science.gov (United States)

    Gandhi, Rajiv; Davey, John Roderick; Mahomed, Nizar

    2009-08-01

    We examined the relationship between patient expectations of total joint arthroplasty and functional outcomes. We surveyed 1799 patients undergoing primary hip or knee arthroplasty for demographic data and Western Ontario McMaster University Osteoarthritis Index scores at baseline, 3 months, and 1 year of follow-up. Patient expectations were determined with 3 survey questions. The patients with the greatest expectations of surgery were younger, male, and had a lower body mass index. Linear regression modeling showed that a greater expectation of pain relief with surgery independently predicted greater reported pain relief at 1 year of follow-up, adjusted for all relevant covariates (P relief after joint arthroplasty is an important predictor of outcomes at 1 year.

  14. Classification of neuropathic pain in cancer patients

    DEFF Research Database (Denmark)

    Brunelli, Cinzia; Bennett, Michael I; Kaasa, Stein

    2014-01-01

    and on the relevance of patient-reported outcome (PRO) descriptors for the screening of NP in this population. An international group of 42 experts was invited to participate in a consensus process through a modified 2-round Internet-based Delphi survey. Relevant topics investigated were: peculiarities of NP...... in patients with cancer, IASP NeuPSIG diagnostic criteria adaptation and assessment, and standardized PRO assessment for NP screening. Median consensus scores (MED) and interquartile ranges (IQR) were calculated to measure expert consensus after both rounds. Twenty-nine experts answered, and good agreement...... was proposed. Clinical research on PRO in the screening phase and on the application of the algorithm will be needed to examine their effectiveness in classifying NP in cancer patients....

  15. Somatization is associated with worse outcome in a chiropractic patient population with neck pain and low back pain.

    Science.gov (United States)

    Ailliet, L; Rubinstein, S M; Knol, D; van Tulder, M W; de Vet, H C W

    2016-02-01

    To determine if psychosocial factors are associated with outcome in patients with neck pain or low back pain. In a prospective, multi-center chiropractic practice-based cohort study in Belgium and The Netherlands, 917 patients, of which 326 with neck pain and 591 with low back pain, completed self-administered questionnaires at baseline, following the second visit, and at 1, 3, 6 and 12 months. Psychosocial factors assessed at baseline were: distress, depression, anxiety and somatization via the Four Dimensional Symptom Questionnaire, patient's beliefs regarding the effect of physical activity and work on their complaint via the Fear Avoidance Beliefs Questionnaire, and social support via the Feij social support scale. Primary outcome measures were perceived recovery, pain intensity, and functional status which was measured with the Neck Disability Index and Oswestry Disability Index. A univariable regression analysis to estimate the relation between each psychological variable and outcome was followed by a multivariable multilevel regression analysis. There were no differences in baseline patient characteristics between the patient population from Belgium and the Netherlands. Somatization scores are consistently associated with perceived recovery, functional status and pain for both neck pain and low-back pain. Depression was associated with poorer functioning in patients with LBP. There was a small association between fear and function and pain for patients with neck pain or low-back pain. Somatization was the only variable consistently found to be associated with diminished perceived recovery, higher degree of neck or low back disability, and increased neck or low back pain. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Predictive ability of an early diagnostic guess in patients presenting with chest pain; a longitudinal descriptive study.

    Science.gov (United States)

    Verdon, François; Junod, Michel; Herzig, Lilli; Vaucher, Paul; Burnand, Bernard; Bischoff, Thomas; Pécoud, Alain; Favrat, Bernard

    2010-02-21

    The intuitive early diagnostic guess could play an important role in reaching a final diagnosis. However, no study to date has attempted to quantify the importance of general practitioners' (GPs) ability to correctly appraise the origin of chest pain within the first minutes of an encounter. The validation study was nested in a multicentre cohort study with a one year follow-up and included 626 successive patients who presented with chest pain and were attended by 58 GPs in Western Switzerland. The early diagnostic guess was assessed prior to a patient's history being taken by a GP and was then compared to a diagnosis of chest pain observed over the next year. Using summary measures clustered at the GP's level, the early diagnostic guess was confirmed by further investigation in 51.0% (CI 95%; 49.4% to 52.5%) of patients presenting with chest pain. The early diagnostic guess was more accurate in patients with a life threatening illness (65.4%; CI 95% 64.5% to 66.3%) and in patients who did not feel anxious (62.9%; CI 95% 62.5% to 63.3%). The predictive abilities of an early diagnostic guess were consistent among GPs. The GPs early diagnostic guess was correct in one out of two patients presenting with chest pain. The probability of a correct guess was higher in patients with a life-threatening illness and in patients not feeling anxious about their pain.

  17. Vitamin D supplementation has no major effect on pain or pain behavior in bedridden geriatric patients with advanced dementia.

    Science.gov (United States)

    Björkman, Mikko; Sorva, Antti; Tilvis, Reijo

    2008-08-01

    In a few, earlier, uncontrolled trials, alleviation of chronic pain has been documented by vitamin D supplementation. This randomized double-blind placebo controlled trial addressed the association between pain and vitamin D deficiency and the effects of vitamin D supplementation on pain in institutionalized aged patients. 216 long-term care patients were enrolled in Helsinki, Finland. Pain was assessed by three tools: Resident Assessment Instrument (RAI), Discomfort Behavior Scale, and Pain Assessment in Advanced Dementia Scale. Scores for Cognitive Performance Scale (CPS) and other clinical assessments were also collected from the RAI-database. Levels of 25-hydroxyvitamin D (25- OHD) and parathyroid hormone were also determined. Patients in pain (n=202) were randomized into three treatment groups, each receiving 0, 400, or 1200 IU cholecalciferol per day, respectively. Assessments were repeated after six-month vitamin D supplementation. Patients were aged (84.5+/-7.5 yrs), demented (CPS= 4.9+/-1.4, range 1-6), and chronically bedridden. Pain was present in 38.4% to 83.8% of patients depending on assessment tool. Low 25-OHD levels (<50 nmol/L) were very common (98.1%). However, vitamin D deficiency was not associated with pain or pain behavior. The supplementation resulted in a marked increase in 25-OHD levels. However, neither prevalence of painlessness nor pain scores changed significantly after vitamin D supplementation. We were not able either to show an association between vitamin D deficiency and pain or to observe alleviation of pain by vitamin D supplementation. The independent role of vitamin D in the etiology of pain remains controversial.

  18. 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

  19. Influence of low back pain and prognostic value of MRI in sciatica patients in relation to back pain

    NARCIS (Netherlands)

    A. el Barzouhi (Abdelilah); C.L.A.M. Vleggeert-Lankamp (Carmen); G.J.L.A. Nijeholt (Geert J. Lycklama A); B.F.W. van der Kallen (Bas); W.B. van den Hout (Wilbert); B.W. Koes (Bart); W.C. Peul (Wilco)

    2014-01-01

    textabstractBackground: Patients with sciatica frequently complain about associated back pain. It is not known whether there are prognostic relevant differences in Magnetic Resonance Imaging (MRI) findings between sciatica patients with and without disabling back pain. Methods: The study population

  20. Validation and usefulness of the Danish version of the Pain Medication Questionnaire in opioid-treated chronic pain patients

    DEFF Research Database (Denmark)

    Højsted, J; Nielsen, P R; Kendall, S

    2011-01-01

    Addiction is a feared complication of long-term opioid therapy for chronic pain patients. A screening tool to assess the potential risk of addiction may be helpful.......Addiction is a feared complication of long-term opioid therapy for chronic pain patients. A screening tool to assess the potential risk of addiction may be helpful....

  1. Health care costs, work productivity and activity impairment in non-malignant chronic pain patients

    DEFF Research Database (Denmark)

    Kronborg, Christian; Handberg, Gitte; Axelsen, Flemming

    2009-01-01

    This study explores the costs of non-malignant chronic pain in patients awaiting treatment in a multidisciplinary pain clinic in a hospital setting. Health care costs due to chronic pain are particular high during the first year after pain onset, and remain high compared with health care costs be...... before pain onset. The majority of chronic pain patients incur the costs of alternative treatments. Chronic pain causes production losses at work, as well as impairment of non-work activities.......This study explores the costs of non-malignant chronic pain in patients awaiting treatment in a multidisciplinary pain clinic in a hospital setting. Health care costs due to chronic pain are particular high during the first year after pain onset, and remain high compared with health care costs...

  2. Pain relief is associated with decreasing postural sway in patients with non-specific low back pain

    DEFF Research Database (Denmark)

    Ruhe, A.; Fejer, René; Walker, B.

    2012-01-01

    is maintained if pain levels change in adults with non-specific low back pain. Methods: Thirty-eight patients with non-specific low back pain and a matching number of healthy controls were enrolled. Postural sway was measured by three identical static bipedal standing tasks of 90 sec duration with eyes closed......Background: Increased postural sway is well documented in patients suffering from non-specific low back pain, whereby a linear relationship between higher pain intensities and increasing postural sway has been described. No investigation has been conducted to evaluate whether this relationship...... in narrow stance on a firm surface. The perceived pain intensity was assessed by a numeric rating scale (NRS 11). The patients received three manual interventions (e. g. manipulation, mobilization or soft tissue techniques) at 3-4 day intervals, postural sway measures were obtained at each occasion. Results...

  3. A multicenter, primary-care-based, open-label study to assess the success of converting opioid-experienced patients with chronic moderate-to-severe pain to morphine sulfate and naltrexone hydrochloride extended-release capsules using a standardized conversion guide.

    Science.gov (United States)

    Setnik, Beatrice; Roland, Carl L; Sommerville, Kenneth W; Pixton, Glenn C; Berke, Robert; Calkins, Anne; Goli, Veeraindar

    2015-01-01

    To evaluate the conversion of opioid-experienced patients with chronic moderate-to-severe pain to extended-release morphine sulfate with sequestered naltrexone hydrochloride (MSN) using a standardized conversion guide. This open-label, single-arm study was conducted in 157 primary care centers in the United States. A total of 684 opioid-experienced adults with chronic moderate-to-severe pain were converted to oral administration of MSN from transdermal fentanyl and oral formulations of hydrocodone, hydromorphone, methadone, oxycodone, oxymorphone, and other morphine products using a standardized conversion guide. The primary endpoint was the percentage of patients achieving a stable MSN dose within a 6-week titration phase. Secondary endpoints included duration of time to stable dose, number of titration steps, safety and efficacy measures, and investigator assessment of conversion guide utility. Of the 684 patients, 51.3% were converted to a stable dose of MSN (95% confidence interval: 47.5%, 55.1%). The mean (standard deviation) number of days to stable dose was 20 (8.94), and number of titration steps to stable dose was 2.4 (1.37). The majority of adverse events were mild/moderate and consistent with opioid therapy. Mean pain scores at stable dose decreased from baseline. Investigators were generally satisfied with the conversion guide and, in 94% of cases, reported they would use it again. Conversion to MSN treatment using the standardized MSN conversion guide was an attainable goal in approximately half of the population of opioid-experienced patients with chronic moderate-to-severe pain. Investigators found the guide to be a useful tool to assist conversion of opioid-experienced patients to MSN.

  4. Recurrent severe abdominal pain in the pediatric patient.

    Science.gov (United States)

    Homme, James L; Foster, Ashley A

    2014-05-01

    Ureteropelvic junction obstruction (UPJO) is a blockage occurring at the junction of the ureter and the renal pelvis. Pediatric patients with UPJO pose a diagnostic challenge when they present to the emergency department (ED) with severe recurrent abdominal pain if there is not a level of suspicion for this condition. Our aim was to review presentation of UPJO to the ED, methods of diagnosis, and treatment of this common but often overlooked condition. We report on 2 patients, a 9-year-old and 3-year-old, who had multiple presentations to health care providers and the ED with intermittent and recurrent abdominal pain. Subsequent testing, including ultrasound (US) and computed tomography (CT) with diuretic-recreated symptoms, revealed UPJO. Open pyeloplasty was performed, resulting in complete resolution of symptoms. UPJO is an important diagnosis to consider when patients present to the ED with recurrent abdominal pain. US can be helpful in suspecting the diagnosis, but often CT, magnetic resonance urography, or diuretic scintigraphy is required for confirmation. Diuretics can be used to aid diagnostic testing by reproducing abdominal pain at the time of imaging. Referral to a urologist for open pyeloplasty is definitive treatment for this condition. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Physical function interfering with pain and symptoms in fibromyalgia patients.

    Science.gov (United States)

    Assumpção, A; Sauer, J F; Mango, P C; Pascual Marques, A

    2010-01-01

    The aim of this study was to assess the relationship between variables of physical assessment - muscular strength, flexibility and dynamic balance - with pain, pain threshold, and fibromyalgia symptoms (FM). Our sample consists of 55 women, with age ranging from 30 to 55 years (mean of 46.5, (standard deviation, SD=6.6)), mean body mass index (BMI) of 28.7 (3.8) and diagnosed for FM according to the American College of Rheumatology criteria. Pain intensity was measured using a visual analogue scale (VAS) and pain threshold (PT) using Fisher's dolorimeter. FM symptoms were assessed by the Fibromyalgia Impact Questionnaire (FIQ); flexibility by the third finger to floor test (3FF); the muscular strength index (MSI) by the maximum volunteer isometric contraction at flexion and extension of right knee and elbow using a force transducer, dynamic balance by the time to get up and go (TUG) test and the functional reach test (FRT). Data were analysed using Pearson's correlation, as well as simple and multivariate regression tests, with significance level of 5%. PT and FIQ were weakly but significantly correlated with the TUG, MSI and 3FF as well as VAS with the TUG and MSI (p<0.05). VAS, PT and FIQ was not correlated with FRT. Simple regression suggests that, alone, TUG, FR, MSI and 3FF are low predictors of VAS, PT and FIQ. For the VAS, the best predictive model includes TUG and MSI, explaining 12.6% of pain variability. For TP and total symptoms, as obtained by the FIQ, most predictive model includes 3FF and MSI, which respectively respond by 30% and 21% of the variability. Muscular strength, flexibility and balance are associated with pain, pain threshold, and symptoms in FM patients.

  6. Demographic and Clinical Outcomes of the Patients with Shoulder Pain

    Directory of Open Access Journals (Sweden)

    Bayram Kelle

    2013-04-01

    Full Text Available Purpose: Localized shoulder pain is one of the most important pathologies of musculoskeletal system. A prevalence study has revealed that it is the third most common pathology among the locomotor system diseases. The aim of this study was to evaluate the statistical results of the demographic and clinical information regarding patients, who applied to our clinic with shoulder pain. Methods: Information of 68 patients with shoulder pain, who were registered in the first 6 months of 2011 to our Physical medicine and rehabilitation Clinique were examined. Patients' demographic data and information regarding their complaints were obtained (e.g. duration, diagnosis, treatment, and so on. and statistical analyses were performed on these findings. Results: Totally findings of 42 patients were obtained. The majority of patients were female, who were housewives. A large proportion of complaints were chronic with multiple diagnoses. Almost all patients received combined treatments. Conclusion: Even though our findings are in accordance with the literature, the low sampling size was a significant limitation. [Cukurova Med J 2013; 38(2.000: 170-173

  7. Review of cancer pain management in patients receiving maintenance methadone therapy.

    LENUS (Irish Health Repository)

    Rowley, Dominic

    2011-05-01

    Methadone is commonly used in the treatment of heroin addiction. Patients with a history of opioid misuse or on methadone maintenance therapy (MMT) with cancer often have difficult to manage pain. We studied 12 patients referred to the palliative care service with cancer pain who were on MMT. All had difficult to control pain, and a third required 5 or more analgesic agents. Two patients had documented \\'\\'drug-seeking\\'\\' behavior. Methadone was used subcutaneously as an analgesic agent in 1 patient. We explore why patients on MMT have difficult to manage pain, the optimal management of their pain, and the increasing role of methadone as an analgesic agent in cancer pain.

  8. Somatosensory sensitivity in patients with persistent idiopathic orofacial pain is associated with pain relief from hypnosis and relaxation.

    Science.gov (United States)

    Baad-Hansen, Lene; Abrahamsen, Randi; Zachariae, Robert; List, Thomas; Svensson, Peter

    2013-06-01

    In a recent study hypnosis has been found to relieve persistent idiopathic orofacial pain. Quantitative sensory testing (QST) is widely used to evaluate somatosensory sensitivity, which has been suggested as a possible predictor of management outcome. The objectives of this study were to examine: (1) possible associations between clinical pain relief and baseline somatosensory sensitivity and (2) the effect of hypnosis management on QST parameters. Forty-one patients with persistent idiopathic orofacial pain completed this randomized controlled study in 1 of 2 groups: hypnosis (hypnotic analgesia suggestions) or control (relaxation). QST at 2 intraoral (pain region and contralateral mirror image region) and 3 extraoral (hand and both cheeks) sites was performed at baseline and after the hypnosis/control management, together with pressure pain thresholds and pressure pain tolerance thresholds determined bilaterally at the masseter and temporalis muscles, the temporomandibular joints, and the third finger. Degree of pain relief was negatively correlated with a summary statistic of baseline somatosensory sensitivity (summed z-score), that is, high baseline somatosensory sensitivity was associated with low pain relief (r=-0.372, P=0.020). Hypnosis had no major effect on any QST measure compared with relaxation (P>0.063). High pain sensitivity at baseline may predict poor pain management outcome. In addition, despite clear clinical pain relief, hypnosis did not significantly or specifically influence somatosensory sensitivity. Future studies should further explore QST measures as possible predictors of different management response in orofacial pain conditions.

  9. Acknowledging the patient with back pain

    DEFF Research Database (Denmark)

    Damsgaard, Janne Brammer; Jørgensen, Lene Bastrup; Norlyk, Annelise

    2015-01-01

    Rationale and aims: Research shows that back patients’ illness experiences affect their interaction with the healthcare system. It is important to examine the exact nature of these experiences in order to shed valuable light on how back patients perceive their illness and hospitalisation. The aim...... and translates into a certain way of perceiving and explaining illnesses and symptoms. Results: The thematic analysis shows that it is through experiences and memories that we create our identity and consciousness. Ignoring the illness experiences can therefore be seen as disregarding, the patient as a human...... of the included studies demonstrates the need for healthcare professionals to pay attention to back patients’ narratives in order to acknowledge them as human beings. This acknowledgement involves an ethical dimension and a sense of responsibility, manifested as respectful inclusion of the patient’s experiences...

  10. A Novel Collaborative Protocol for Successful Management of Penile Pain Mediated by Radiculitis of Sacral Spinal Nerve Roots From Tarlov Cysts.

    Science.gov (United States)

    Goldstein, Irwin; Komisaruk, Barry R; Rubin, Rachel S; Goldstein, Sue W; Elliott, Stacy; Kissee, Jennifer; Kim, Choll W

    2017-09-01

    Since 14 years of age, the patient had experienced extreme penile pain within seconds of initial sexual arousal through masturbation. Penile pain was so severe that he rarely proceeded to orgasm or ejaculation. After 7 years of undergoing multiple unsuccessful treatments, he was concerned for his long-term mental health and for his future ability to have relationships. To describe a novel collaboration among specialists in sexual medicine, neurophysiology, and spine surgery that led to successful management. Collaborating health care providers conferred with the referring physician, patient, and parents and included a review of all medical records. Elimination of postpubertal intense penile pain during sexual arousal. The patient presented to our sexual medicine facility at 21 years of age. The sexual medicine physician identifying the sexual health complaint noted a pelvic magnetic resonance imaging report of an incidental sacral Tarlov cyst. A subsequent sacral magnetic resonance image showed four sacral Tarlov cysts, with the largest measuring 18 mm. Neuro-genital testing result were abnormal. The neurophysiologist hypothesized the patient's pain at erection was produced by Tarlov cyst-induced neuropathic irritation of sensory fibers that course within the pelvic nerve. The spine surgeon directed a diagnostic injection of bupivacaine to the sacral nerve roots and subsequently morphine to the conus medullaris of the spinal cord. The bupivacaine produced general penile numbness; the morphine selectively decreased penile pain symptoms during sexual arousal without blocking penile skin sensation. The collaboration among specialties led to the conclusion that the Tarlov cysts were pathophysiologically mediating the penile pain symptoms during arousal. Long-term follow-up after surgical repair showed complete symptom elimination at 18 months after treatment. This case provides evidence that (i) Tarlov cysts can cause sacral spinal nerve root radiculitis through

  11. Pain Experience in Hemophilia Patients: A Hermeneutic Phenomenological Study

    Science.gov (United States)

    Rambod, Masoume; Sharif, Farkhondeh; Molazem, Zahra; Khair, Kate

    2016-01-01

    ABSTRACT Background: Pain, as a crucial subsequence of joint hemorrhages in hemophilia patients, is chronic, debilitating, and distracting. This study aimed to describe and interpret pain experiences of hemophilia patients in their lives. Methods: This qualitative study with hermeneutic phenomenological approach was conducted on fourteen hemophilia patients who had been referred to a hemophilia center affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. The study question was “what is the meaning of pain in hemophilia patients’ lives? The data were collected through semi-structured interviews and field notes through purposeful sampling. Then, thematic analysis with van Manen’s six-step methodological framework was used. MAX.QDA qualitative software package, 2010, was used to analyze the data. Results: The three main themes that emerged in this study were “alteration in physical health”, “engagement in psychological problems”, and “impairment in social relationships”. Alteration in physical health consisted of three subthemes, namely “impairment of physical function”, “change in body physics”, and “disturbance in sleep quality”. In addition, two subthemes including “nostalgia of pain in adults with hemophilia” and “psychological distress” emerged from engagement in psychological problems. Finally, “loss of social activity” and “change in relationships” were related to impairment in social relationships. Conclusion: The present study highlighted alteration in physical health, engagement in psychological problems, and impairment in social relationship as a result of pain in hemophilia patients. Thus, healthcare providers and family members have to pay special attention to these problems. Besides, providing complementary therapy interventions is suggested for reducing these issues. PMID:27713894

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

    Science.gov (United States)

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

    2014-01-01

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

  13. Pain Experience in Hemophilia Patients: A Hermeneutic Phenomenological Study

    Directory of Open Access Journals (Sweden)

    Masoume Rambod

    2016-10-01

    Full Text Available Background: Pain, as a crucial subsequence of joint hemorrhages in hemophilia patients, is chronic, debilitating, and distracting. This study aimed to describe and interpret pain experiences of hemophilia patients in their lives. Methods: This qualitative study with hermeneutic phenomenological approach was conducted on fourteen hemophilia patients who had been referred to a hemophiliacenter affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. The study question was “what is the meaning of pain in hemophilia patients’ lives? The data were collected through semi-structured interviews and field notes through purposeful sampling. Then, thematic analysis with van Manen’s six-step methodological framework was used. MAX.QDA qualitative software package, 2010, was used to analyze the data. Results: The three main themes that emerged in this study were “alteration in physical health”, “engagement in psychological problems”, and “impairment in social relationships”. Alteration in physical health consisted of three subthemes, namely “impairment of physical function”, “change in body physics”, and “disturbance in sleep quality”. In addition, two subthemes including “nostalgia of pain in adults with hemophilia” and “psychological distress” emerged from engagement in psychological problems. Finally, “loss of social activity” and “change in relationships” were related to impairment in social relationships. Conclusion: The present study highlighted alteration in physical health, engagement in psychological problems, and impairment in social relationship as a result of pain in hemophilia patients. Thus, healthcare providers and family members have to pay special attention to these problems. Besides, providing complementary therapy interventions is suggested for reducing these issues.

  14. Pain Control In Cancer Patients By Opiate Use

    Directory of Open Access Journals (Sweden)

    Mohagheghi M A

    2003-07-01

    Full Text Available Opioids are increasingly being recognized as the primary treatment for cancer pain management. Optimal treatment of cancer pain involves assessing its characteristics, considering different management strategies, evaluating side effects and adverse drug reactions and establishing the most appropriate therapeutic regimen. This study was designed to review the current status of pain management for advanced cancer cases using opioid analgesics."nMaterials and Methods: A questionnaire was used to collect data on demographics, disease characteristics, and opioids use indicators in 700 cases of advanced cancer patients."nResults: A total of 700 cancer cases, 42 percent females and 58 percent males, between 17-80 years age range (Mean age of 57.25 were studied retrospectively. Cancers of breast (21 percent, colorectal (12 percent, lung (7 percent, stomach (7 percent and bone either primary or metastatic (6 percent in women and stomach (17 percent, lung (12 percent, colorectal (11 percent, prostate (9 percent , and bone (8 percent in men were the most common causes of opioids prescription in study group respectively. Advanced primary cancer (in 52 percent, bone metastasis (in 32 percent, and treatment complications (in 7 percent were considered as physical basis for pain in patients. Morphine (by injection, Opium (by oral intake and methadone (injection and/or oral were the most common opioids prescribed. Using equianalgesic conversion chart, the daily dosages and therapeutics schedules of morphine administration were as follows:"n43 percent received 21-30 mg. in 2-4 divided doses"n27 percent received >30 mg. in 3-5 divided doses"n21 percent received 11-20 mg. in 2-3 divided doses"n9 percent received 5-10 mg. in 1-2 divided doses"nConclusion: Pain management of cancer patients is not adequate and opioid use is not rational. New educational and managerial strategies are needed to optimize cancer pain treatment in routine medical practice. To overcome

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

    Science.gov (United States)

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

    2014-04-01

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

  16. Cortical plasticity between the pain and pain-free phases in patients with episodic tension-type headache.

    Science.gov (United States)

    Chen, Bing; He, Yuan; Xia, Lei; Guo, Li-Li; Zheng, Jin-Long

    2016-12-01

    State-related brain structural alterations in patients with episodic tension-type headache (ETTH) are unclear. We aimed to conduct a longitudinal study to explore dynamic gray matter (GM) changes between the pain and pain-free phases in ETTH. We recruited 40 treatment-naïve ETTH patients and 40 healthy controls. All participants underwent brain structural scans on a 3.0-T MRI system. ETTH patients were scanned in and out of pain phases. Voxel-based morphometry analysis was used to determine the differences in regional gray matter density (GMD) between groups. Additional regression analysis was used to identify any associations between regional GMD and clinical symptoms. ETTH patients exhibited reduced GMD in the bilateral primary somatosensory cortex, and increased GMD in the bilateral anterior cingulate cortex (ACC) and anterior insula for the in pain phase compared with the out of pain phase. The out of pain phase of ETTH patients exhibited no regions with higher or lower GMD compared with healthy controls. GMD in the left ACC and left anterior insula was negatively correlated with headache days. GMD in the left ACC was negatively correlated with anxiety and depressive symptoms in ETTH patients. This is the first study to demonstrate dynamic and reversible GMD changes between the pain and pain-free phases in ETTH patients. However, this balance might be disrupted by increased headache days and progressive anxiety and depressive symptoms.

  17. Visuospatial and verbal memory in chronic pain patients: an explorative study.

    Science.gov (United States)

    Busch, Hillevi; Montgomery, William; Melin, Bo; Lundberg, Ulf

    2006-09-01

    Cognitive bias, such as selective memory for pain-related information, is frequently observed in chronic pain patients and is assessed mostly using verbal material. Beside word lists, the current study used photographs of people presenting pain behaviors to assess memory bias in chronic pain patients. Chronic pain patients were hypothesized to show better recall of pain-related words and pictures as compared to pain-free controls. Twenty-eight female chronic neck patients and 28 pain-free female controls completed two computerized pictorial memory games and two word recall tasks. Patients and controls performed equally well in the neutral pictorial memory game. In the pain-related game, patients performed significantly worse than controls. No significant differences were found in the word recall task. The result is discussed in terms of cognitive avoidance.

  18. Patients' experiences and actions when describing pain after surgery--a critical incident technique analysis.

    Science.gov (United States)

    Eriksson, Kerstin; Wikström, Lotta; Fridlund, Bengt; Årestedt, Kristofer; Broström, Anders

    2016-04-01

    Postoperative pain assessment remains a significant problem in clinical care despite patients wanting to describe their pain and be treated as unique individuals. Deeper knowledge about variations in patients' experiences and actions could help healthcare professionals to improve pain management and could increase patients' participation in pain assessments. The aim of this study was, through an examination of critical incidents, to describe patients' experiences and actions when needing to describe pain after surgery. An explorative design involving the critical incident technique was used. Patients from one university and three county hospitals in both urban and rural areas were included. To ensure variation of patients a strategic sampling was made according to age, gender, education and surgery. A total of 25 patients who had undergone orthopaedic or general surgery was asked to participate in an interview, of whom three declined. Pain experiences were described according to two main areas: "Patients' resources when in need of pain assessment" and "Ward resources for performing pain assessments". Patients were affected by their expectations and tolerance for pain. Ability to describe pain could be limited by a fear of coming into conflict with healthcare professionals or being perceived as whining. Furthermore, attitudes from healthcare professionals and their lack of adherence to procedures affected patients' ability to describe pain. Two main areas regarding actions emerged: "Patients used active strategies when needing to describe pain" and "Patients used passive strategies when needing to describe pain". Patients informed healthcare professionals about their pain and asked questions in order to make decisions about their pain situation. Selfcare was performed by distraction and avoiding pain or treating pain by themselves, while others were passive and endured pain or refrained from contact with healthcare professionals due to healthcare professionals

  19. Treatment of complex regional pain syndrome type 1 in a pediatric patient using the lidocaine patch 5%: a case report

    Directory of Open Access Journals (Sweden)

    Steven G Frost, MD

    2003-09-01

    Full Text Available Background: Successful treatment of complex regional pain syndrome type 1 (CRPS-1 requires a coordinated, multidisciplinary approach. Physical rehabilitation is an important component of long-term treatment. Unfortunately, patients with significant allodynia or hyperalgesia characteristic of CRPS-1 often have difficulty progressing through a physical therapy (PT regimen. In most adults with CRPS-1, the treatment of choice is PO opioids. Objective: This article presents a case report of the use of the lidocaine patch 5%, a targeted peripheral analgesic, in a pediatric patient and its effects on reducing pain, improving the patient's overall attitude, and facilitating compliance with ongoing PT. Results: A 10-year-old girl developed CRPS-1 after arthroscopic surgery for a sprained ankle. Attempts at PT were unsuccessful due to inadequate pain relief from various treatment modalities. Therapy with the lidocaine patch 5% was initiated and resulted in significant pain relief, improvements in the patient's attitude, and progress with PT. Conclusion: This case report of a child with CRPS-1 showed that therapy with lidocaine patch 5% may be efficacious in treating children with pain resulting from CRPS-1, thereby increasing the success of PT. Keywords: complex regional pain syndrome, lidocaine patch 5%, targeted peripheral analgesic, pediatrics

  20. Surgical treatment of pain in patients with chronic pancreatitis.

    Science.gov (United States)

    Prochorov, Alexandermiddle Victorovich; Oldhafer, Karl-Jurgen; Tretyak, Stanislaw Ivanovich; Rashchynski, Siarhei Markovich; Donati, Marcello; Rashchynskaya, Nina Timofeevna; Audzevich, Dzmitry Anatolyevich

    2012-06-01

    The objectives of the research were to compare the outcomes of pancreatoduodenectomy (PD) (Kausch-Whipple or Traverso-Longmire) and resection with drainage operations (RDO) (Frey or Partingtone-Rochelle) in patients suffering from chronic pancreatitis (CP), in management of pain syndrome and quality of life provided by these kinds of surgical procedures. From 2002 to 2008 sixteen patients suffering from CP underwent PD and 16 underwent RDO. Treatment results for the two groups were analyzed with respect to postoperative complications and results of the questionnaire MOS SF-36 v.2(TM). In the immediate postoperative period more complications were observed in the PD group (a<0.05). In both groups a positive effect on removing the painful syndrome and improvement of the quality of life (p<0.01) were observed. In the PD group there were the best results of management by General Health difference criterion (a<0.01). A greater improvement of Physical Functiong value (a<0.01) was noticed in patients who underwent RDO. Both PD and RDO adequately remove pain syndrome and improve the quality of life in patients suffering from CP. Under equal conditions the preference should be given to RDO, as improvement in life quality of operated patients is greater.

  1. Classification and identification of opioid addiction in chronic pain patients

    DEFF Research Database (Denmark)

    Højsted, Jette; Nielsen, Per Rotbøll; Guldstrand, Sally Kendall

    2010-01-01

    Addiction is a feared consequence of long-term opioid treatment of chronic pain patients. The ICD-10 and DSM-IV diagnostic addiction criteria may not be appropriate in these patients. Therefore Portenoy's criteria (PC) were launched. The aim was to estimate the prevalence of addiction......, to investigate whether PC were applicable and to compare these criteria with the ICD-10 criteria. The study was cross-sectional and included 253 patients with chronic pain at a tertiary pain centre. Patients were screened for addiction by a physician and a nurse. The addiction prevalence was 14.4% according...... to ICD-10 and 19.3% according to PC. A significant difference between the prevalence of addiction according to ICD-10 and to PC was found. The inter-rater reliability was 0.95 for ICD-10 and 0.93 for PC. The sensitivity of PC was 0.85 and the specificity was 0.96. According to PC patients classified...

  2. American football and other sports injuries may cause migraine/persistent pain decades later and can be treated successfully with electrical twitch-obtaining intramuscular stimulation (ETOIMS).

    Science.gov (United States)

    Chu, J; McNally, S; Bruyninckx, F; Neuhauser, D

    2017-04-01

    Autonomous twitch elicitation at myofascial trigger points from spondylotic radiculopathies-induced denervation supersensitivity can provide favourable pain relief using electrical twitch-obtaining intramuscular stimulation (ETOIMS). To provide objective evidence that ETOIMS is safe and efficacious in migraine and persistent pain management due to decades-old injuries to head and spine from paediatric American football. An 83-year-old mildly hypertensive patient with 25-year history of refractory migraine and persistent pain self-selected to regularly receive fee-for-service ETOIMS 2/week over 20 months. He had 180 sessions of ETOIMS. Pain levels, blood pressure (BP) and heart rate/pulse were recorded before and immediately after each treatment alongside highest level of clinically elicitable twitch forces/session, session duration and intervals between treatments. Twitch force grades recorded were from 1 to 5, grade 5 twitch force being strongest. Initially, there was hypersensitivity to electrical stimulation with low stimulus parameters (500 µs pulse-width, 30 mA stimulus intensity, frequency 1.3 Hz). This resolved with gradual stimulus increments as tolerated during successive treatments. By treatment 27, autonomous twitches were noted. Spearman's correlation coefficients showed that pain levels are negatively related to twitch force, number of treatments, treatment session duration and directly related to BP and heart rate/pulse. Treatment numbers and session durations directly influence twitch force. At end of study, headaches and quality of life improved, hypertension resolved and antihypertensive medication had been discontinued. Using statistical process control methodology in an individual patient, we showed long-term safety and effectiveness of ETOIMS in simultaneous diagnosis, treatment, prognosis and prevention of migraine and persistent pain in real time obviating necessity for randomised controlled studies.

  3. Associations Between Pain, Current Tobacco Smoking, Depression, and Fibromyalgia Status Among Treatment-Seeking Chronic Pain Patients.

    Science.gov (United States)

    Goesling, Jenna; Brummett, Chad M; Meraj, Taha S; Moser, Stephanie E; Hassett, Afton L; Ditre, Joseph W

    2015-07-01

    As smoking impacts physiological pathways in the central nervous system, it is important to consider the association between smoking and fibromyalgia, a pain condition caused predominantly by central nervous system dysfunction. The objectives were to assess the prevalence of current smoking among treatment-seeking chronic pain patients with (FM+) and without (FM-) a fibromyalgia-like phenotype; test the individual and combined influence of smoking and fibromyalgia on pain severity and interference; and examine depression as a mediator of these processes. Questionnaire data from 1566 patients evaluated for a range of conditions at an outpatient pain clinic were used. The 2011 Survey Criteria for Fibromyalgia were used to assess the presence of symptoms associated with fibromyalgia. Current smoking was reported by 38.7% of FM+ patients compared to 24.7% of FM- patients. FM+ smokers reported higher pain and greater interference compared to FM+ nonsmokers, FM- smokers, and FM- nonsmokers. There was no interaction between smoking and fibromyalgia. Significant indirect effects of fibromyalgia and smoking via greater depression were observed for pain severity and interference. Current smoking and positive fibromyalgia status were associated with greater pain and impairment among chronic pain patients, possibly as a function of depression. Although FM+ smokers report the most negative clinical symptomatology (i.e., high pain, greater interference) smoking does not appear to have a unique association with pain or functioning in FM+ patients, rather the effect is additive. The 38.7% smoking rate in FM+ patients is high, suggesting FM+ smokers present a significant clinical challenge. © 2015 American Academy of Pain Medicine.

  4. Sex Differences and Correlates of Pain in Patients with Comorbid Obesity and Binge Eating Disorder

    OpenAIRE

    Masheb, Robin M.; White, Marney A.; Grilo, Carlos M.

    2016-01-01

    Sex differences and correlates of pain were examined in a sample of patients with comorbid binge eating disorder (BED) and obesity. One hundred fifty-two treatment-seeking patients with BED completed the Brief Pain Inventory. Analysis of covariance was utilized to compare women and men on pain, and correlational analysis, overall and by sex, was performed to examine relationships among pain, eating behaviour and metabolic risk factors. Women reported significantly greater pain severity and pa...

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

    DEFF Research Database (Denmark)

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

    2018-01-01

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

  6. Rare successful pregnancy in a patient with Swyer Syndrome

    Directory of Open Access Journals (Sweden)

    Jyoti Taneja

    2016-10-01

    Full Text Available Objective: To report a rare successful pregnancy after fertility treatment in a patient with Swyer syndrome. Design: Case report. Setting: Herts & Essex Fertility Centre, Cheshunt, UK. Patient(s: A 36-year-old patient with 46, XY gonadal dysgenesis. 31 year old husband with normal sperm analysis. Intervention(s: Chromosomal analysis, Saline infusion sonography, Pipelle endometrial scratch, ICSI using donor eggs, Embryo Transfer, and Caesarean delivery. Main Outcome Measure(s: Successful pregnancy and live birth. Result(s: Successful treatment with donor eggs, pregnancy, and delivery. Conclusion(s: A patient with 46, XY gonadal dysgenesis in a specially tailored fertility program, can maintain a normal pregnancy and delivery. Keywords: Swyer syndrome, XY female, Gonadal dysgenesis, Primary amenorrhoea and HRT, Pregnancy in Swyer syndrome

  7. Is there a relationship between pain intensity and postural sway in patients with non-specific low back pain?

    Directory of Open Access Journals (Sweden)

    Fejer René

    2011-07-01

    Full Text Available Abstract Background Increased center of pressure excursions are well documented in patients suffering from non-specific low back pain, whereby the altered postural sway includes both higher mean sway velocities and larger sway area. No investigation has been conducted to evaluate a relationship between pain intensity and postural sway in adults (aged 50 or less with non-specific low back pain. Methods Seventy-seven patients with non-specific low back pain and a matching number of healthy controls were enrolled. Center of pressure parameters were measured by three static bipedal standing tasks of 90 sec duration with eyes closed in narrow stance on a firm surface. The perceived pain intensity was assessed by a numeric rating scale (NRS-11, an equal number of patients (n = 11 was enrolled per pain score. Results Generally, our results confirmed increased postural instability in pain sufferers compared to healthy controls. In addition, regression analysis revealed a significant and linear increase in postural sway with higher pain ratings for all included COP parameters. Statistically significant changes in mean sway velocity in antero-posterior and medio-lateral direction and sway area were reached with an incremental change in NRS scores of two to three points. Conclusions COP mean velocity and sway area are closely related to self-reported pain scores. This relationship may be of clinical use as an objective monitoring tool for patients under treatment or rehabilitation.

  8. Is there a relationship between pain intensity and postural sway in patients with non-specific low back pain?

    Science.gov (United States)

    Ruhe, Alexander; Fejer, René; Walker, Bruce

    2011-07-15

    Increased center of pressure excursions are well documented in patients suffering from non-specific low back pain, whereby the altered postural sway includes both higher mean sway velocities and larger sway area. No investigation has been conducted to evaluate a relationship between pain intensity and postural sway in adults (aged 50 or less) with non-specific low back pain. Seventy-seven patients with non-specific low back pain and a matching number of healthy controls were enrolled. Center of pressure parameters were measured by three static bipedal standing tasks of 90 sec duration with eyes closed in narrow stance on a firm surface. The perceived pain intensity was assessed by a numeric rating scale (NRS-11), an equal number of patients (n = 11) was enrolled per pain score. Generally, our results confirmed increased postural instability in pain sufferers compared to healthy controls. In addition, regression analysis revealed a significant and linear increase in postural sway with higher pain ratings for all included COP parameters. Statistically significant changes in mean sway velocity in antero-posterior and medio-lateral direction and sway area were reached with an incremental change in NRS scores of two to three points. COP mean velocity and sway area are closely related to self-reported pain scores. This relationship may be of clinical use as an objective monitoring tool for patients under treatment or rehabilitation.

  9. Rehabilitation of low back pain patients. A review.

    Science.gov (United States)

    Revel, M

    1995-01-01

    Numerous methods have been developed for the rehabilitation of low back pain patients, including spinal flexion and extension exercises, lumbar spine locking in an intermediate position, enhancement of spinal and pelvic proprioceptive sensibility, swimming pool therapy, back schools, and functional restoration. Each seeks to achieve a goal assumed to be central to the prevention of a first or recurrent episode of low back pain. Goals include short-term pain relief, an improved ability to achieve self-sedation, abdominal and lumbar muscle strengthening, increased hip and lumbar spine mobility, improved lumbar and pelvic proprioceptive sensibility, intervertebral joint stabilization, lumbar posture modification and improved general fitness. Less than 30 studies meeting widely accepted validity and applicability criteria for therapeutic trials have addressed the clinical efficacy of rehabilitation in low back pain patients. Most studies of the back school approach have found no benefit. Spinal flexion and extension exercise programs have yielded short-lived improvements, with no differences across methods. There is evidence that functional restoration programs based on graded activity may provide long-term benefits including better social and occupational outcomes. We have evaluated the physical therapy methods most commonly taught to and used by physical therapists in France.

  10. Cytokine and neuropeptide levels are associated with pain relief in patients with chronically painful total knee arthroplasty: a pilot study.

    Science.gov (United States)

    Singh, Jasvinder A; Noorbaloochi, Siamak; Knutson, Keith L

    2017-01-14

    There are few studies with an assessment of the levels of cytokines or neuropeptides as correlates of pain and pain relief in patients with painful joint diseases. Our objective was to assess whether improvements from baseline to 2-months in serum cytokine, chemokine and substance P levels were associated with clinically meaningful pain relief at 2-months post-injection in patients with painful total knee arthroplasty (TKA). Using data from randomized trial of 60 TKAs, we assessed the association of change in cytokine/chemokine/Substance P levels with primary study outcome, clinically important improvement in Western Ontario McMaster Osteoarthritis Index (WOMAC) pain subscale at 2-months post-injection using Student's t-tests and Spearman's correlation coefficient (non-parametric). Patients were categorized as pain responders (20-point reduction or more on 0-100 WOMAC pain) vs. pain non-responders. Sensitivity analysis used 0-10 daytime pain numeric rating scale (NRS) instead of WOMAC pain subscale. In a pilot study, compared to non-responders (n = 23) on WOMAC pain scale at 2-months, pain responders (n = 12) had significantly greater increase in serum levels of IL-7, IL-10, IL-12, eotaxin, interferon gamma and TNF-α from baseline to 2-months post-injection (p coefficients ranging -0.37 to -0.51: IL-2, IL-7, IL-8, IL-9, IL-16, IL-12p, GCSF, IFN gamma, IP-10, MCP, MIP1b, TNF-α and VEGF (n = 35). Sensitivity analysis showed that substance P decreased significantly more from baseline to 2-months in the pain responders (0.54 ± 0.53; n = 10) than in the pain non-responders (0.48 ± 1.18; n = 9; p = 0.023) and that this change in serum substance P correlated significantly with change in daytime NRS pain, correlation coefficient was 0.53 (p = 0.021; n = 19). Findings should be interpreted with caution, since cytokine analyses were performed for a sub-group of the entire trial population. Serum cytokine, chemokine and Substance

  11. Implementation of a portable electronic system for providing pain relief to patellofemoral pain syndrome patients

    Science.gov (United States)

    Chang Chien, Jia-Ren; Lin, Guo-Hong; Hsu, Ar-Tyan

    2011-10-01

    In this study, a portable electromyogram (EMG) system and a stimulator are developed for patellofemoral pain syndrome patients, with the objective of reducing the pain experienced by these patients; the patellar pain is caused by an imbalance between the vastus medialis obliquus (VMO) and the vastus lateralis (VL). The EMG measurement circuit and the electrical stimulation device proposed in this study are specifically designed for the VMO and the VL; they are capable of real-time waveform recording, possess analyzing functions, and can upload their measurement data to a computer for storage and analysis. The system can calculate and record the time difference between the EMGs of the VMO and the VL, as well as the signal strengths of both the EMGs. As soon as the system detects the generation of the EMG of the VL, it quickly calculates and processes the event and stimulates the VMO as feedback through electrical stimulation units, in order to induce its contraction. The system can adjust the signal strength, time length, and the sequence of the electrical stimulation, both manually and automatically. The output waveform of the electrical stimulation circuit is a dual-phase asymmetrical pulse waveform. The primary function of the electrical simulation circuit is to ensure that the muscles contract effectively. The performance of the device can be seen that the width of each pulse is 20-1000 μs, the frequency of each pulse is 10-100 Hz, and current strength is 10-60 mA.

  12. Development of the Chronic Pain Coding System (CPCS) for Characterizing Patient-Clinician Discussions About Chronic Pain and Opioids.

    Science.gov (United States)

    Henry, Stephen G; Chen, Meng; Matthias, Marianne S; Bell, Robert A; Kravitz, Richard L

    2016-10-01

    To describe the development and initial application of the Chronic Pain Coding System. Secondary analysis of data from a randomized clinical trial. Six primary care clinics in northern California. Forty-five primary care visits involving 33 clinicians and 45 patients on opioids for chronic noncancer pain. The authors developed a structured coding system to accurately and objectively characterize discussions about pain and opioids. Two coders applied the final system to visit transcripts. Intercoder agreement for major coding categories was moderate to substantial (kappa = 0.5-0.7). Mixed effects regression was used to test six hypotheses to assess preliminary construct validity. Greater baseline pain interference was associated with longer pain discussions (P = 0.007) and more patient requests for clinician action (P = 0.02) but not more frequent negative patient evaluations of pain (P = 0.15). Greater clinician-reported visit difficulty was associated with more frequent disagreements with clinician recommendations (P = 0.003) and longer discussions of opioid risks (P = 0.049) but not more frequent requests for clinician action (P = 0.11). Rates of agreement versus disagreement with patient requests and clinician recommendations were similar for opioid-related and non-opioid-related utterances. This coding system appears to be a reliable and valid tool for characterizing patient-clinician communication about opioids and chronic pain during clinic visits. Objective data on how patients and clinicians discuss chronic pain and opioids are necessary to identify communication patterns and strategies for improving the quality and productivity of discussions about chronic pain that may lead to more effective pain management and reduce inappropriate opioid prescribing. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  13. How does pain experience relate to the need for pain relief? A secondary exploratory analysis in a large sample of cancer patients.

    Science.gov (United States)

    Johnsen, Anna Thit; Petersen, Morten A; Snyder, Claire F; Pedersen, Lise; Groenvold, Mogens

    2016-10-01

    To explore (1) the information obtained from related but conceptually different approaches to pain assessment and (2) the extent to which the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) can be used as a screening tool to predict patient-reported need for pain relief. Cancer patients randomly sampled from 56 hospital departments were included. Questionnaire items assessed patients' (a) pain experience using the EORTC QLQ-C30 pain scale and its two pain items separately (pain intensity and pain interference) and (b) pain burden and (c) need for pain relief using the Three-Levels-of-Needs Questionnaire (3LNQ). Of the 2364 patients contacted by mail, 1447 (61 %) completed the questionnaires. Among these, 51 % reported at least "a little" pain on the pain intensity item. The number of patients reporting pain to be a burden was similar, and pain experience and pain burden were highly correlated (correlation coefficients ranged from 0.85 to 0.91). Pain experience and pain burden were moderately correlated with the need for pain relief. A receiver-operating characteristic (ROC) curve analysis showed that the EORTC QLQ-C30 discriminated between patients with and without a need for pain relief to an acceptable degree (area under the curve (AUC) 0.73-0.77). The cut-point a little gave a sensitivity of 84 % and specificity of 59 % for the item "Have you had pain?" and a sensitivity of 72 % and a specificity of 72 % for the pain scale. The majority of patients who experienced pain felt it to be a problem. Pain experience and pain burden were substantially related to need for pain relief, and the latter could be predicted from the EORTC QLQ-C30.

  14. Role of inflammation gene polymorphisms on pain and response to radiotherapy in multiple myeloma patients with painful bone destructions

    OpenAIRE

    Rudžianskienė, Milda; Inčiūra, Arturas; Gerbutavičius, Rolandas; Dambrauskienė, Rūta; Rudžianskas, Viktoras; Juozaitytė, Elona

    2016-01-01

    Background: Previous researches have demonstrated, that the severity of pain perception and it’s response to analgesia is highly dependent on gene polymorphism encoding for cytokines. We evaluated 12 single nucleotide polymorphisms (SNP) in 6 genes encoding for cytokines in multiple myeloma patients (n = 81) and assessed their influence on pain severity and response to palliative radiotherapy. Methods: Pain intensity was assessed by Visual Analogue Scale. The total dose of opioids was convert...

  15. The Effectiveness of Cognitive-Behavioral Therapy on Alexithymia and Pain Self-Efficacy of Patients with Chronic Pain

    Directory of Open Access Journals (Sweden)

    Sara Saedi

    2016-11-01

    Full Text Available Chronic pain is one of the most common reasons for visit to primary medical centers. Evidences show that cognitive-behavioral therapy is the effective therapy in chronic pains. The present study evaluates the effectiveness of cognitive-behavioral therapy on alexithymia and pains self-efficacy of patients with chronic pain. For this purpose, in a quasi-experimental plan and pre-test and post-test kind with control group, 45 patients with chronic musculoskeletal pain who visited to the therapeutic-sanitary centers in Ahwaz city were selected by using the available sampling method and they were assigned randomly in two experimental and control groups. Groups were tested in terms of alexithymia and self-effectiveness of pain at first. Then behavioral-cognitive training was presented in the time of 8 sessions of 90 minutes to the group and after ending the training program and three month consistency period, both groups were tested in terms of alexithymia and self-efficacy of pain. analyzing data by multivariate covariance method showed that the behavioral-cognitive therapy has been effective on alexithymia and pain intensity of patients with chronic musculoskeletal pain and these effects remain on patients in the high amount in the consistency stage, too. According to the results, behavioral-cognitive therapy causes to increasing the self-efficacy of pain and reducing the alexithymia and harmful effects of pain to the least level by changing nonefficiency behaviors, correction of adverse cognitions and destructive emotions related to pain.

  16. Erectile dysfunction in patients with chronic pain treated with opioids.

    Science.gov (United States)

    Ajo, Raquel; Segura, Ana; Inda, María-Del-Mar; Margarit, César; Ballester, Pura; Martínez, Emi; Ferrández, Guillermina; Sánchez-Barbie, Ángel; Peiró, Ana M

    2017-07-21

    Chronic pain is associated with comorbidities that have an impact on the quality of life of patients and, among others, affect their sexual functioning. One of the most relevant side effects of opioid analgesics is erectile dysfunction (ED), due in part to the inhibition of the gonadal-pituitary-hypothalamic axis and the decline in testosterone levels. To evaluate ED and effectiveness of treatment in men with chronic pain treated with long-term opioids. Prospective observational study lasting 3 years, where the intensity of pain (visual analogue scale, 0-10cm), erectile function (IIEF-EF, range 1-30 points), quality of life (EQ-VAS, 0-100mm), quality of sexual life (MSLQ-QOL, 0-100 points), anxiety/depression (HAD, 0-21 points) and testosterone levels, was assessed in patients who reported sexual dysfunction (ED or libido modification). A 6-month follow-up was applied to each patient after administering the usual treatment in the Andrology Unit. The study was approved by the Clinical Research Ethics Committee and data were statistically analyzed with the GraphPad Prism 5 software. ED was observed in 27.6% of patients (n=105, 57±12.2 years, mean dose of morphine equivalent=107.1±107.9mg/day, 84.3% adjuvant analgesics). After 6 months, 42% of patients showed a significant improvement after being treated with iPDE5 (48.5%) and/or testosterone gel (81.8%), with a resolution rate of 31% (p=0.000). A positive correlation was observed between the improvement of IIEF and quality of sexual life (55.5±25.7 points, p=0.000), as well as anxiety (7.4±4.3 points, p=0.048). No significant changes were observed in the levels of testosterone, in the levels of pain nor in the quality of life, which remained moderate. Erectile function and quality of sexual life, as well as anxiety, improved in patients treated chronically with opioids after administering andrological treatment. The management of patients with pain should include a review of their sexual health history given the

  17. Chronic Pain in Multiple Sclerosis Patients: Utility of Sensory Quantitative Testing in Patients with Fibromyalgia Comorbidity.

    Science.gov (United States)

    Pompa, Alessandra; Clemenzi, Allessandro; Troisi, Elio; Pace, Luca; Casillo, Paolo; Catani, Sheila; Grasso, Maria Grazia

    2015-01-01

    Lower thermal and discomfort thresholds may predispose multiple sclerosis (MS) patients to chronic pain, but a possible effect of fibromyalgia (FM) comorbidity has never been investigated. Aims were to investigate the thermal and discomfort thresholds in the evaluation of pain intensity between MS patients with FM (PFM+) and MS patients with pain not associated to FM (PFM-). One hundred thirty three MS patients were investigated for chronic pain. FM was assessed according to the 1990 ACR diagnostic criteria. An algometer was used to measure the thresholds in the patients and 60 matched healthy subjects. Chronic pain was present in 88 (66.2%) patients; 12 (13.6%) had neuropathic pain, 22 (17.3%) were PFM+ and 65 (48.9%) PFM-. PFM+ were predominantly female (p = 0.03) and had a greater EDSS (p = 0.01) than NoP; no other significant differences emerged than PFM-. The thresholds were lower in MS patients than controls (p < 0.01), mainly in the PFM+. FM severity influenced the thermal threshold (p < 0.001), while the female gender influenced the discomfort threshold (p < 0.001). Thermal and discomfort thresholds were lower in patients than controls and were the lowest in PFM+. Their more severely impaired thermal threshold supports a neurophysiological basis of such association. © 2015 S. Karger AG, Basel.

  18. Exercise radionuclide ventriculographic responses in hypertensive patients with chest pain

    International Nuclear Information System (INIS)

    Wasserman, A.G.; Katz, R.J.; Varghese, P.J.; Leiboff, R.H.; Bren, G.G.; Schlesselman, S.; Varma, V.M.; Reba, R.C.; Ross, A.M.

    1984-01-01

    The effectiveness of exercise-treadmill testing in diagnosing coronary-artery disease in hypertensive patients is limited by a high rate of false positivity. Exercise radionuclide ventriculography, however, relies on different criteria (ejection fraction and wall motion), and we have evaluated this procedure in 37 hypertensive and 109 normotensive patients with chest pain, using coronary arteriography as an indicator of coronary disease. In the hypertensive cohort there was no difference in the ejection fraction at rest between the 17 patients with coronary disease and the 20 without it. Neither group had a significant mean (+/- S.E.M.) change in ejection fraction from rest to exercise (-1.9 +/- 2 and 1.4 +/- 1%, respectively). A wall-motion abnormality developed during exercise in 5 of the 17 hypertensive patients with coronary disease (29%) and in 4 of the 20 without it (20%) (P = not significant). In the normotensive cohort, however, the peak-exercise ejection fractions were significantly different. The 71 patients with coronary disease had a mean decrease of 3.6 +/- 1%, in contrast to the patients without coronary disease, who had an increase of +/- 1% (P < 0.001). An exercise-induced wall-motion abnormality was seen in 35 of the 71 patients with coronary disease (48%), as compared with 3 of the 38 without it (8%) (P < 0.001). We conclude that exercise radionuclide ventriculography is inadequate as a screening test for coronary atherosclerosis in hypertensive patients with chest pain. 28 references, 2 figures, 3 tables

  19. Pharmacological Treatment of Pain in Cancer Patients : The Role of Adjuvant Analgesics, a Systematic Review

    NARCIS (Netherlands)

    van den Beuken-van Everdingen, Marieke H J; de Graeff, Alexander; Jongen, Joost L M; Dijkstra, Denise; Mostovaya, Irina; Vissers, Kris C P

    2017-01-01

    CONTEXT: In patients with cancer, pain is one of the most feared and burdensome symptoms. Adjuvant analgesics are an important cornerstone on which treatment of pain in patients with cancer is based. OBJECTIVES: To update our guidelines for the treatment of pain in patients with cancer, we performed

  20. Concordant pressure paresthesia during interlaminar lumbar epidural steroid injections correlates with pain relief in patients with unilateral radicular pain.

    Science.gov (United States)

    Candido, Kenneth D; Rana, Maunak V; Sauer, Ruben; Chupatanakul, Lalida; Tharian, Antony; Vasic, Vladimir; Knezevic, Nebojsa Nick

    2013-01-01

    Transforaminal and interlaminar epidural steroid injections are commonly used interventional pain management procedures in the treatment of radicular low back pain. Even though several studies have shown that transforaminal injections provide enhanced short-term outcomes in patients with radicular and low back pain, they have also been associated with a higher incidence of unintentional intravascular injection and often dire consequences than have interlaminar injections. We compared 2 different approaches, midline and lateral parasagittal, of lumbar interlaminar epidural steroid injection (LESI) in patients with unilateral lumbosacral radiculopathic pain. We also tested the role of concordant pressure paresthesia occurring during LESI as a prognostic factor in determining the efficacy of LESI. Prospective, randomized, blinded study. Pain management center, part of a teaching-community hospital in a major metropolitan US city. After Institutional Review Board approval, 106 patients undergoing LESI for radicular low back pain were randomly assigned to one of 2 groups (53 patients each) based on approach: midline interlaminar (MIL) and lateral parasagittal interlaminar (PIL). Patients were asked to grade any pressure paresthesia as occurring ipsilaterally or contralaterally to their "usual and customary pain," or in a distribution atypical of their daily pain. Other variables such as: the Oswestry Disability Index questionnaire, pain scores at rest and during movement, use of pain medications, etc. were recorded 20 minutes before the procedure, and on days 1, 7, 14, 21, 28, 60, 120, 180 and 365 after the injection. Results of this study showed statistically and clinically significant pain relief in patients undergoing LESI by both the MIL and PIL approaches. Patients receiving LESI using the lateral parasagittal approach had statistically and clinically longer pain relief then patients receiving LESI via a midline approach. They also had slightly better quality of

  1. Factors associated with successful decannulation in pediatric tracheostomy patients.

    Science.gov (United States)

    Takahashi, Nozomi; Takano, Kenichi; Mitsuzawa, Hiroaki; Kurose, Maokoto; Himi, Tetsuo

    2017-10-01

    To investigate the outcome of pediatric tracheostomy and identify predictive factors for successful decannulation. We performed a retrospective chart review of a series of 42 consecutive patients of less than 24 months of age who underwent a tracheostomy between 2012 and 2015. Successful decannulation was achieved in 11 patients (26%). Thirty-one patients (74%) remained tracheostomy-dependent. Of the 11 patients who were successfully decannulated, 10 (91%) had only structural disorders and nine (82%) were able to walk unassisted; importantly, nine (82%) were able to swallow following decannulation. In contrast, of the 31 patients who did not tolerate decannulation, 21 (68%) had functional disorders and 18 (58%) were unable to walk unassisted; 20 (65%) of the tracheostomy-dependent patients were unable to swallow after undergoing surgery. Following pediatric tracheostomy procedures, patients with solely structural disorders were significantly more likely to be successfully decannulated compared to patients with functional disorders. Furthermore, the capacity to walk unassisted and swallow after surgery is associated with positive outcomes for decannulation. Our results suggest that an objective evaluation of the ability to walk unassisted, and to ingest food, may be useful for predicting the outcome and effects of tracheostomy procedures and decannulation in children.

  2. Patient and social work factors related to successful placement of ...

    African Journals Online (AJOL)

    Patient and social work factors related to successful placement of long-term psychiatric in-patients from a specialist psychiatric hospital in South Africa. ... away; a low frequency of behavioural problems (especially of cannabis abuse, verbal or physical aggression, uncontrolled sexual activity), and agitation or restlessness.

  3. Prevention and management of shoulder pain in the hemiplegic patient.

    Science.gov (United States)

    Page, Tamara; Lockwood, Craig

    The objective of this review was to summarise the best available research related to the prevention and management of shoulder pain in the hemiplegic patient. This review considered all studies that included hemiplegic patients post-cerebral vascular accident (CVA). Interventions of interest were any treatments or programs used to manage or prevent shoulder pain secondary to hemiplegia. The primary outcomes of interest were those related to pain. This review considered any randomised controlled trials (RCT) that evaluated the effectiveness of interventions that addressed shoulder pain in hemiplegic patients. In the absence of RCT, other research designs such as non-randomised controlled trials, time series and case series were also considered for inclusion in a narrative summary. The search sought to find both published and unpublished studies. Databases were searched up to February 2002 and included Medline, CINAHL, Current Contents, Cochrane Library, Expanded Academic Index, Electronic Collections Online, Turning Research Into Practice (TRIP), Dissertation Abstracts and Proceedings First. The reference lists of all studies identified were searched for additional studies. All studies were checked for methodological quality by two reviewers and data was extracted using a data extraction tool. Current research evaluating the effectiveness of treatment interventions on hemiplegic shoulder pain is very limited. The studies were very diverse in their nature of research. There has been no replication of studies, with the studies found using different populations, interventions or outcome measures. Not one study could be compared with another. Meta-analysis was unable to be performed not only because of inadequate reporting of results, but more often due to differences between the studies' participants and the range of interventions used. The diversity in interval post-CVA also makes it difficult to make any comparisons between studies. For this reason the review is in

  4. Profile of sexuality in Moroccan chronic low back pain patients

    Directory of Open Access Journals (Sweden)

    Bahouq Hanane

    2013-02-01

    Full Text Available Abstract Background Sexual life had an important role in preserving the good quality of life for patients and for their partner. Chronic Low Back Pain (CLBP as other musculoskeletal diseases may affect all aspects of life including sexual functioning. The purpose of this study is to describe the impact of CLBP on the sexual life of patients and to identify the factors that affect their Sexual Quality of Life (SQOL. Methods One hundred CLBP sexually active patients were included. Patients and disease Characteristics were collected. Impact on sexual life (sexual intercourse and SQOL was also assessed. Univariate and multivariate analysis were performed to analyze significant determinants associated with the SQOL disturbance. Results Eighty one percent of our patients complained about sexual difficulties related to CLBP. Libido decrease and painful intercourse position were reported respectively in 14.8 and 97.5% of cases. The most pain generating position was supine. Mean of sexual intercourse frequency decrease was at −10.4 ± 4.8 per month. SQOL score mean was at 44.6 ± 17.4%. Men suffered more than women from sexual problems (respectively 90% vs. 72%; p = 0.02. Men had worse SQOL than women (respectively 38.9 ± 17.2 vs. 50.3 ± 15.7%; p = 0.001. Univariate and multivariate analysis showed that advanced age (p = 0.009, poor functional status (p = 0.03, male gender (p = 0.03 and sexual intercourse frequency decrease (p = 0.005 were the independent variables associated with the SQOL disturbance. Conclusion Our study suggests that sexuality is profoundly disturbed in CLBP patients; both their sexual intercourse and SQOL were affected. This disturbance seems to be associated with patient and disease characteristics. Sexuality should be taken into account in managing CLBP patients.

  5. The pathophysiology of glossal pain in patients with iron deficiency and anemia.

    Science.gov (United States)

    Osaki, T; Ueta, E; Arisawa, K; Kitamura, Y; Matsugi, N

    1999-11-01

    It is well known that prolonged anemia causes atrophy of tongue papillae, glossal pain, and dysphagia, but it is uncertain whether iron (Fe) deficiency induces glossal pain without any objective manifestation. To resolve this matter, the relationship between Fe deficiency and glossal pain was examined. Eighteen patients with Fe deficiency and 7 anemic patients manifesting spontaneous irritation or pain of the tongue without any objective abnormalities participated in this study. To ascertain the cause of glossal pain and the oral pathophysiology in Fe deficiency and anemia, peripheral blood was examined and the glossal pain threshold and salivary flow rates (SFRs) were estimated along with Candida albicans cell culture tests. Compared with patients with Fe deficiency, those with anemia had a longer history of tongue pain. In patients with anemia, painful areas of the tongue were more numerous than in patients with Fe deficiency. Pain thresholds were decreased in the painful portions, and both nonstimulated and stimulated SFRs were suppressed. Each patient was treated with oral Fe; within 2 months, most patients exhibited increased serum ferritin level (P< 0.02, paired t-test), pain threshold (P < 0.05) and salivation (P < 0.05) and glossal pain subsided. Fe deficiency causes glossal pain and the degree of glossal pain increases as Fe deficiency advances to anemia, manifesting hyposalivation and abnormalities of glossal papillae.

  6. Mode of action of cupping--local metabolism and pain thresholds in neck pain patients and healthy subjects.

    Science.gov (United States)

    Emerich, M; Braeunig, M; Clement, H W; Lüdtke, R; Huber, R

    2014-02-01

    Cupping worldwide has been part of traditional medicine systems and is in the western world used as CAM therapy mainly for treating pain syndromes. The mode of action is up to now unclear. In order to investigate its mechanism we measured in parallel metabolic changes in the tissue under the cupping glass and pressure pain thresholds. In 12 volunteers (6 healthy subjects and 6 patients with chronic neck pain) a microdialysis system was implanted subcutaneously on both sides (left and right) above the trapezius muscle. After baseline measures cupping was performed at one randomly selected side (left or right), the other side served as control. Every 20 min during baseline measures and for 280 min after cupping, microdialysis probes for detection of lactate, pyruvate, glucose and glycerin were taken. In addition, pain thresholds were measured before and after cupping with algometry. Cupping resulted in a strong increase of lactate (beginning 160 min after cupping until the end of the measurements) and the lactate/pyruvate ratio, indicating an anaerobe metabolism in the surrounding tissue. Baseline pain thresholds were non-significantly lower in neck pain patients compared to healthy controls and slightly increased immediately after cupping (pcupping in healthy subjects and on the foot in neck pain patients). After 280 min no more significant changes of pain thresholds were detected. Cupping induces >280 min lasting anaerobe metabolism in the subcutaneous tissue and increases immediate pressure pain thresholds in some areas. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Validation of the West Haven-Yale Multidimensional Pain Inventory (WHYMPI for Iranian Patients with Chronic Pain

    Directory of Open Access Journals (Sweden)

    S. M. Mirzamani

    2007-09-01

    Full Text Available Background and Objectives: This study aimed to validate the West Haven-Yale Multidimensional Pain Inventory (WHYMPI for Iranian patients with chronic pain. Methods: 585 patients with chronic pain in legs, back, hands, neck and shoulders were entered into this study. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI was used for assessment of pain in these patients. For validation of this inventory the results were compared with those obtained from Brief Pain Inventory (BPI, Beck Depression Inventory (BDI, State Trait Anxiety Questionnaire and Enrich marriage inventory. Results: Using Cronbach's alpha, validity of the first section of WHYMPI was 0.86, the second section was 0.78, and the third section was 0.75. The Test-retest correlation was 0.95. Also, the correlation of each individual section with the whole inventory was positive and significant.Conclusion: The results indicate that modified form of the West Haven-Yale Multidimensional Pain Inventory (WHYMPI can be used in Iran. Keywords: Inventory; Validity; Pain; Pain Measurement

  8. Evaluation and Management of Patients with Noncardiac Chest Pain

    Directory of Open Access Journals (Sweden)

    C. Shekhar

    2008-01-01

    Full Text Available Up to a third of patients undergoing coronary angiography for angina-like chest pain are found to have normal coronary arteries and a substantial proportion of these individuals continue to consult and even attend emergency departments. Initially, these patients are usually seen by cardiologists but with accumulating evidence that the pain might have a gastrointestinal origin, it may be more appropriate for them to be cared for by the gastroenterologist once a cardiological cause has been excluded. This review covers the assessment and management of this challenging condition, which includes a combination of education, reassurance, and pharmacotherapy. For the more refractory cases, behavioral treatments, such as cognitive behavioral therapy or hypnotherapy, may have to be considered.

  9. Prediction of outcome in patients with low back pain

    DEFF Research Database (Denmark)

    Kongsted, Alice; Andersen, Cathrine Hedegaard; Mørk Hansen, Martin

    2016-01-01

    The clinical course of low back pain (LBP) cannot be accurately predicted by existing prediction tools. Therefore clinicians rely largely on their experience and clinical judgement. The objectives of this study were to investigate 1) which patient characteristics were associated with chiropractors...... intensity (0-10) and disability (RMDQ) after 2-weeks, 3-months, and 12-months. The course of LBP in 859 patients was predicted to be short (54%), prolonged (36%), or chronic (7%). Clinicians' expectations were most strongly associated with education, LBP history, radiating pain, and neurological signs......' expectations of outcome from a LBP episode, 2) if clinicians' expectations related to outcome, 3) how accurate clinical predictions were as compared to those of the STarT Back Screening Tool (SBT), and 4) if accuracy was improved by combining clinicians' expectations and the SBT. Outcomes were measured as LBP...

  10. Pain management: a review of organisation models with integrated processes for the management of pain in adult cancer patients.

    Science.gov (United States)

    Brink-Huis, Anita; van Achterberg, Theo; Schoonhoven, Lisette

    2008-08-01

    This paper reports a review of the literature conducted to identify organisation models in cancer pain management that contain integrated care processes and describe their effectiveness. Pain is experienced by 30-50% of cancer patients receiving treatment and by 70-90% of those with advanced disease. Efforts to improve pain management have been made through the development and dissemination of clinical guidelines. Early improvements in pain management were focussed on just one or two single processes such as pain assessment and patient education. Little is known about organisational models with multiple integrated processes throughout the course of the disease trajectory and concerning all stages of the care process. Systematic review. The review involved a systematic search of the literature, published between 1986-2006. Subject-specific keywords used to describe patients, disease, pain management interventions and integrated care processes, relevant for this review were selected using the thesaurus of the databases. Institutional models, clinical pathways and consultation services are three alternative models for the integration of care processes in cancer pain management. A clinical pathway is a comprehensive institutionalisation model, whereas a pain consultation service is a 'stand-alone' model that can be integrated in a clinical pathway. Positive patient and process outcomes have been described for all three models, although the level of evidence is generally low. Evaluation of the quality of pain management must involve standardised measurements of both patient and process outcomes. We recommend the development of policies for referrals to a pain consultation service. These policies can be integrated within a clinical pathway. To evaluate the effectiveness of pain management models standardised outcome measures are needed.

  11. Can cancer patients assess the influence of pain on functions? A randomised, controlled study of the pain interference items in the Brief Pain Inventory

    Directory of Open Access Journals (Sweden)

    Kaasa Stein

    2007-03-01

    Full Text Available Abstract Background The Brief Pain Inventory (BPI is recommended as a pain measurement tool by the Expert Working Group of the European Association of Palliative Care. The BPI is designed to assess both pain severity and interference with functions caused by pain. The purpose of this study was to investigate if pain interference items are influenced by other factors than pain. Methods We asked adult cancer patients to complete the original and a revised BPI on two study days. In the original version of the BPI the patients were asked how, during the last 24 hours, pain has interfered with functions. In the revised BPI this question was changed to how, during the last 24 hours, these functions are affected in general. Heath related quality of life was assessed at both study days applying the European Organization for Research and Treatment of Cancer quality of life questionnaire. Results Forty-eight of the 55 included patients completed both assessments. The BPI pain intensities scores and the health related quality of life scores were similar at the two study days. Except for mood this study observed no significant distinctions between the patients' BPI interference items scores in the original (pain influence on function and the revised BPI (function in general. Seventeen patients reported higher influence from pain on functions than the total influence on function from all causes. Conclusion We observed similar scores in the original BPI interference scores (pain influence on function compared with the revised BPI interference scores (decreased function in general. This finding might imply that the BPI interference scale measures are partly responded to as more of a global interference measure.

  12. Pain, physical functioning, and overeating in obese rheumatoid arthritis patients: do thoughts about pain and eating matter?

    Science.gov (United States)

    Somers, Tamara J; Wren, Anava A; Blumenthal, James A; Caldwell, David; Huffman, Kim M; Keefe, Francis J

    2014-08-01

    Obese rheumatoid arthritis (RA) patients have higher levels of pain, disability, and disease activity than do nonobese patients with RA. Patients' health-related thoughts about arthritis and weight may be important to consider in obese patients with RA who face the dual challenge of managing RA and weight. The objective of this study was to examine the relationships of pain catastrophizing, self-efficacy (ie, confidence) for arthritis management and self-efficacy for weight management to important outcomes in obese patients with RA. We expected that after controlling for demographic and medical variables, higher levels of pain catastrophizing and lower levels of confidence would account for significant and unique variance in pain, physical functioning, and overeating. Participants had a diagnosis of RA and a body mass index of 28 kg/m or greater and completed self-report questionnaires assessing pain, physical functioning, overeating, pain catastrophizing, self-efficacy for arthritis management, self-efficacy for weight management, and a 6-minute walk test. Pain catastrophizing, self-efficacy for arthritis, and self-efficacy for weight management were significantly and uniquely related to RA-related outcomes. Pain catastrophizing was a significant independent predictor of pain severity (β = 0.38); self-efficacy for arthritis was a significant independent predictor of self-report physical functioning (β = -0.37) and the 6-minute walk performance (β = 0.44), and self-efficacy for weight management was a significant independent predictor of overeating (β = -0.58). Pain catastrophizing, self-efficacy for arthritis, and self-efficacy for weight management each contributed uniquely to relate to key outcomes in obese patients with RA. Clinicians should consider assessment of thought processes when assessing and intervening with patients who face dual health challenges; unique intervention approaches may be needed for addressing the challenges of arthritis and weight.

  13. Pathophysiology and clinical characteristics of pain in most common locations in cancer patients.

    Science.gov (United States)

    Leppert, W; Zajaczkowska, R; Wordliczek, J; Dobrogowski, J; Woron, J; Krzakowski, M

    2016-12-01

    Pain is one of the most common symptoms in cancer patients, especially in advanced disease. However, pain also accompanies a significant percentage of patients during diagnostic and therapeutic procedures. In some patients pain may be the first symptom of the disease. The causes of pain in cancer patients are often multifactorial including direct and indirect cancer effects, anticancer therapy and co-morbidities. Moreover, pain in cancer patients often has mixed pathophysiology including both nociceptive and neuropathic components, especially in patients with bone metastases. In this article, basic knowledge regarding epidemiology, pathophysiology and clinical features of pain in cancer patients with a primary tumour localised in lung, gastrointestinal tract (stomach, colon and pancreas), breast in women and prostate in men are presented. Pain is a common symptom in cancer patients and its appropriate assessment and treatment may significantly improve in patients' and families' quality of life.

  14. Core strength training for patients with chronic low back pain

    OpenAIRE

    Chang, Wen-Dien; Lin, Hung-Yu; Lai, Ping-Tung

    2015-01-01

    [Purpose] Through core strength training, patients with chronic low back pain can strengthen their deep trunk muscles. However, independent training remains challenging, despite the existence of numerous core strength training strategies. Currently, no standardized system has been established analyzing and comparing the results of core strength training and typical resistance training. Therefore, we conducted a systematic review of the results of previous studies to explore the effectiveness ...

  15. Dual pathology in a patient with right lower quadrant pain.

    Science.gov (United States)

    Deutsch, Gary B; Sathyanarayana, Sandeep Anantha; Nicastro, Jeffrey; Molmenti, Ernesto; Coppa, Gene; Rubach, Eugene; Friedman, Barak

    2012-09-01

    Meckel diverticula are remnants of the omphalomesenteric duct. They have 2% incidence in the general population, are usually asymptomatic, and tend to be diagnosed incidentally. The generally held principle had been that asymptomatic cases do not require resection, as exemplified by a 2008 systematic review of over 200 studies. However, a recent series reported an increased risk of malignancies, and recommended mandatory resection. We present a case of Meckel diverticulitis with concurrent infiltrative appendiceal carcinoid in a patient with right lower quadrant pain.

  16. Pain and symptom control. Patient rights and physician responsibilities.

    Science.gov (United States)

    Emanuel, E J

    1996-02-01

    In considering the care of patients with incurable and terminal diseases, there are three types of interventions: (1) palliative care and symptom management; (2) experimental therapies; and (3) active life-ending interventions. Relief of pain, other symptoms, and suffering should be the basic and standard treatment; the other interventions are meant to supplement, not replace, this intervention. This means the physician's primary obligation is to inform patients about the options for palliative care and to provide quality palliative care. Thus, physicians who care for terminally ill patients have an obligation to keep their knowledge base and skills in palliative care current. In those circumstances in which a patient's needs exceeds the physician's knowledge and skills, physicians have a responsibility to refer the patient to a palliative care specialist. With regard to experimental therapies, physicians must obtain full informed consent, provide especially accurate data on the risks and benefits of experimental therapies, and ensure that the patient understands the aims of the proposed therapy. Regarding active life-ending therapies, physicians have the obligation to withhold or withdraw life-sustaining treatment if the patient so desires and to provide adequate pain medication even if this hastens death. Even if euthanasia or physician-assisted suicide are legalized, there is unlikely to be an obligation to provide this intervention.

  17. Can We "Predict" Long-Term Outcome for Ambulatory Transcutaneous Electrical Nerve Stimulation in Patients with Chronic Pain?

    NARCIS (Netherlands)

    Koke, A.J.; Smeets, R.J.E.M.; Perez, R.S.G.M.; Kessels, A.; Winkens, B.; van Kleef, M.; Patijn, J.

    2015-01-01

    Background: Evidence for effectiveness of transcutaneous electrical nerve stimulation (TENS) is still inconclusive. As heterogeneity of chronic pain patients might be an important factor for this lack of efficacy, identifying factors for a successful long-term outcome is of great importance.

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

    Science.gov (United States)

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

    2013-09-01

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

  19. Persistence of pain in patients with chronic low back pain reported via weekly automated text messages over one year

    DEFF Research Database (Denmark)

    Leboeuf-Yde, Charlotte; Krüger Jensen, Rikke; Wedderkopp, Niels

    2015-01-01

    (Study 1) and the other without any pathological explanation for the pain (Study 2). In both studies, participants were followed over 1 year with weekly automated text messages (SMS-Track). Each week they reported the number of days they had experienced bothersome LBP (0-7 days). The number of weeks......BACKGROUND: A previous study has suggested that it is uncommon for patients with chronic bothersome low back pain (LBP), who consult the secondary health care sector, to report at least four consecutive weeks without such bothersome pain in 1 year. It is not yet known, however, how many days...... of the week they experience pain throughout the year. METHOD: The current study analyzed data collected in two randomized clinical studies conducted in 2007-9 on patients with back pain (Study 1 and 2). Study participants were patients with LBP for more than 2 months, one group with MRI-defined Modic changes...

  20. [Pain management nursing in hospitalized patients with non-oncological diseases].

    Science.gov (United States)

    Sepúlveda-Sánchez, Juana María; Canca-Sánchez, José Carlos; Rivas-Ruiz, Francisco; Martín-García, Mónica; Pérez-González, María Josefa; Timonet-Andreu, Eva María

    2016-01-01

    To assess pain management in patients hospitalized with a non-oncological disease and evaluate factors involved in pain assessment. A descriptive, cross-sectional study. We reviewed pain episodes documented in the medical records of 105 patients aged>18 years admitted to the medical units of a regional hospital between September and December 2014. Reports of pain episodes were evaluated by assessing 22 variables related to pain management quality criteria. A total of 184 reports were reviewed. Pain was measured using the visual analogue scale (VAS) in 70.1% of patients (n=129); pain was reassessed in 44.3% (n=54) of patients. Pain reassessment was significantly more frequent in patients agedPain was more frequently considered to be unrelated to the cause of admission in women as compared to men (50 vs. 25.7% p=0.027). Pain was identified in the patient care plan as a collaborative problem by the nurse for 21.1% of the patients. Some aspects of pain management should be improved, especially those regarding pain description and reassessment. The age and sex of patients significantly influence the approach of pain. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

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

    Science.gov (United States)

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

    2016-05-01

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

  2. Feelings of Clinician-Patient Similarity and Trust Influence Pain: Evidence From Simulated Clinical Interactions.

    Science.gov (United States)

    Losin, Elizabeth A Reynolds; Anderson, Steven R; Wager, Tor D

    2017-07-01

    Pain is influenced by many factors other than external sources of tissue damage. Among these, the clinician-patient relationship is particularly important for pain diagnosis and treatment. However, the effects of the clinician-patient relationship on pain remain underexamined. We tested the hypothesis that patients who believe they share core beliefs and values with their clinician will report less pain than patients who do not. We also measured feelings of perceived clinician-patient similarity and trust to see if these interpersonal factors influenced pain. We did so by experimentally manipulating perceptions of similarity between participants playing the role of clinicians and participants playing the role of patients in simulated clinical interactions. Participants were placed in 2 groups on the basis of their responses to a questionnaire about their personal beliefs and values, and painful thermal stimulation was used as an analog of a painful medical procedure. We found that patients reported feeling more similarity and trust toward their clinician when they were paired with clinicians from their own group. In turn, patients' positive feelings of similarity and trust toward their clinicians-but not clinicians' feelings toward patients or whether the clinician and patient were from the same group-predicted lower pain ratings. Finally, the most anxious patients exhibited the strongest relationship between their feelings about their clinicians and their pain report. These findings increase our understanding of context-driven pain modulation and suggest that interventions aimed at increasing patients' feelings of similarity to and trust in health care providers may help reduce the pain experienced during medical care. We present novel evidence that the clinician-patient relationship can affect the pain experienced during medical care. We found that "patients" in simulated clinical interactions who reported feeling more similarity and trust toward their

  3. Comparison of orofacial pain of patients with different stages of precancer and oral cancer.

    Science.gov (United States)

    Yang, Yanjie; Zhang, Peipei; Li, Wenlu

    2017-03-16

    Orofacial pain impairs a patient's speech, swallowing, eating and interpersonal relations. Thirty-seven patients with a premalignant oral lesion, 124 patients with oral squamous cell carcinoma (OSSC), and 21 patients with a recurrence of OSSC were evaluated for their orofacial pain. The University of California San Francisco Oral Cancer Pain Questionnaire was administered to these patients at their initial visit, before they were prescribed analgesics for pain and before any treatment. Significant differences with respect to orofacial pain between the groups could be evaluatedwere observed. Patients with recurrence had the highest facial pain and patients with precancer had the lowest. Patients with OSSC and recurrence of OSSC reported significant levels of orofacial pain and functional restriction because of pain. Moreover, patients with recurrence of OSSC experienced significantly higher function-related pain, rather than pain qualities. These findings suggest that an important predictor for recurrence of OSSC may be the onset of orofacial pain that is exacerbated during function. The present study examined orofacial pain depending on the disease severity of precancer and oral cancer patients. Earlier recognition of symptoms of OSSC may improve early detection of its recurrence.

  4. Chronic pain patients with possible co-morbid post-traumatic stress disorder admitted to multidisciplinary pain rehabilitation

    DEFF Research Database (Denmark)

    Andersen, Tonny Elmose; Andersen, Lou-Ann Christensen; Andersen, Per Grünwald

    2014-01-01

    BACKGROUND: Although post-traumatic stress disorder (PTSD) is a common co-morbidity in chronic pain, little is known about the association between PTSD and pain in the context of chronic pain rehabilitation. OBJECTIVE: The aim of the present study was two-fold: (1) to investigate the association......: A consecutively referred cohort of 194 patients completed a baseline questionnaire at admission covering post-traumatic stress, pain symptoms, physical and mental functioning, as well as self-reported sleep quality and cognitive difficulties. Medication use was calculated from their medical records. A total of 95...

  5. Cervicocephalic kinesthetic sensibility and postural balance in patients with nontraumatic chronic neck pain – a pilot study

    Science.gov (United States)

    Palmgren, Per J; Andreasson, Daniel; Eriksson, Magnus; Hägglund, Andreas

    2009-01-01

    Background Although cervical pain is widespread, most victims are only mildly and occasionally affected. A minority, however, suffer chronic pain and/or functional impairments. Although there is abundant literature regarding nontraumatic neck pain, little focuses on diagnostic criteria. During the last decade, research on neck pain has been designed to evaluate underlying pathophysiological mechanisms, without noteworthy success. Independent researchers have investigated postural balance and cervicocephalic kinesthetic sensibility among patients with chronic neck pain, and have (in most cases) concluded the source of the problem is a reduced ability in the neck's proprioceptive system. Here, we investigated cervicocephalic kinesthetic sensibility and postural balance among patients with nontraumatic chronic neck pain. Methods Ours was a two-group, observational pilot study of patients with complaints of continuous neck pain during the 3 months prior to recruitment. Thirteen patients with chronic neck pain of nontraumatic origin were recruited from an institutional outpatient clinic. Sixteen healthy persons were recruited as a control group. Cervicocephalic kinesthetic sensibility was assessed by exploring head repositioning accuracy and postural balance was measured with computerized static posturography. Results Parameters of cervicocephalic kinesthetic sensibility were not reduced. However, in one of six test movements (flexion), global repositioning errors were significantly larger in the experimental group than in the control group (p < .05). Measurements did not demonstrate any general impaired postural balance, and varied substantially among participants in both groups. Conclusion In patients with nontraumatic chronic neck pain, we found statistically significant global repositioning errors in only one of six test movements. In this cohort, we found no evidence of impaired postural balance. Head repositioning accuracy and computerized static posturography are

  6. Cervicocephalic kinesthetic sensibility and postural balance in patients with nontraumatic chronic neck pain--a pilot study.

    Science.gov (United States)

    Palmgren, Per J; Andreasson, Daniel; Eriksson, Magnus; Hägglund, Andreas

    2009-06-30

    Although cervical pain is widespread, most victims are only mildly and occasionally affected. A minority, however, suffer chronic pain and/or functional impairments. Although there is abundant literature regarding nontraumatic neck pain, little focuses on diagnostic criteria. During the last decade, research on neck pain has been designed to evaluate underlying pathophysiological mechanisms, without noteworthy success. Independent researchers have investigated postural balance and cervicocephalic kinesthetic sensibility among patients with chronic neck pain, and have (in most cases) concluded the source of the problem is a reduced ability in the neck's proprioceptive system. Here, we investigated cervicocephalic kinesthetic sensibility and postural balance among patients with nontraumatic chronic neck pain. Ours was a two-group, observational pilot study of patients with complaints of continuous neck pain during the 3 months prior to recruitment. Thirteen patients with chronic neck pain of nontraumatic origin were recruited from an institutional outpatient clinic. Sixteen healthy persons were recruited as a control group. Cervicocephalic kinesthetic sensibility was assessed by exploring head repositioning accuracy and postural balance was measured with computerized static posturography. Parameters of cervicocephalic kinesthetic sensibility were not reduced. However, in one of six test movements (flexion), global repositioning errors were significantly larger in the experimental group than in the control group (p < .05). Measurements did not demonstrate any general impaired postural balance, and varied substantially among participants in both groups. In patients with nontraumatic chronic neck pain, we found statistically significant global repositioning errors in only one of six test movements. In this cohort, we found no evidence of impaired postural balance.Head repositioning accuracy and computerized static posturography are imperfect measures of functional

  7. Chest pain in patients with arterial hypertension, angiographically normal coronary arteries and stiff aorta: the aortic pain syndrome.

    Science.gov (United States)

    Stakos, Dimitrios A; Tziakas, Dimitrios N; Chalikias, George; Mitrousi, Konstantina; Tsigalou, Christina; Boudoulas, Harisios

    2013-01-01

    Arterial hypertension is often associated with a stiff aorta as a result of collagen accumulation in the aortic wall and may produce chest pain. In the present study, possible interrelationships between aortic function, collagen turnover and exercise-induced chest pain in patients with arterial hypertension and angiographically normal coronary arteries were investigated. Ninety-seven patients with arterial hypertension, angiographically normal coronary arteries and no evidence of myocardial ischemia on nuclear cardiac imaging during exercise test were studied. Of these, 43 developed chest pain during exercise (chest pain group) while 54 did not (no chest pain group). Carotid femoral pulse-wave velocity (PWVc-f) was used to assess the elastic properties of the aorta. Amino-terminal pro-peptides of pro-collagen type I, (PINP, reflecting collagen synthesis), serum telopeptides of collagen type I (CITP, reflecting collagen degradation), pro-metalloproteinase 1 (ProMMP-1), and tissue inhibitor of metalloproteinase 1 (TIMP-1, related to collagen turnover) were measured in plasma by immunoassay. The chest pain group had higher PWVc-f, higher and /CITP ratio, and lower proMMP-1/ TIMP-1 ratio compared to the no chest pain group. PWVc-f (t=2.53, p=0.02) and PINP (t=2.42, p=0.02) were independently associated with the presence of chest pain in multiple regression analysis. Patients with arterial hypertension, exercise-induced chest pain and angiographically normal coronary arteries, without evidence of exercise-induced myocardial ischemia, had a stiffer aorta compared to those without chest pain. Alterations in collagen type I turnover that favor collagen accumulation in the aortic wall may contribute to aortic stiffening and chest pain in these patients.

  8. Assessment of patient satisfaction with pain management in small community inpatient and outpatient settings.

    Science.gov (United States)

    Corizzo, C C; Baker, M C; Henkelmann, G C

    2000-09-01

    To describe patient outcomes (e.g., pain intensity and relief, satisfaction, expectations) and analgesic practices of healthcare providers for inpatients and outpatients in community hospital settings. Descriptive, correlational, and random sampling. Three community-based institutions in southeast Louisiana. 114 inpatients and outpatients with cancer-related or acute postoperative pain. Inpatients (n = 68) mostly were women and younger than 60 years of age. Outpatients (n = 46) mostly were men and older than 60 years of age. Both groups were predominantly well-educated and Caucasian. Subjects completed a modified version of the American Pain Society's Patient Satisfaction Survey. Researchers completed a chart audit tool reviewing analgesic prescriptive and administrative practices. Weak to moderately strong correlations existed for the relationships between the satisfaction variables and the pain intensity, pain relief, and expectation variables for all subjects. Satisfaction with current pain intensity was correlated most strongly with pain intensity and relief scores. Higher pain intensity and relief were related to lower satisfaction with current pain intensity. Regardless of setting or pain type, subjects experienced significant amounts of pain during a 24-hour period. Patient expectations for experiencing high levels of pain were realized, but expectations for significant pain relief were not. Institutional pain management programs that approach pain from a multidimensional perspective need to be developed. Continued education for healthcare professionals and patients is a vital part of this process.

  9. Pain judgements of patients' relatives: examining the use of social contract theory as theoretical framework.

    Science.gov (United States)

    Kappesser, Judith; de C Williams, Amanda C

    2008-08-01

    Observer underestimation of others' pain was studied using a concept from evolutionary psychology: a cheater detection mechanism from social contract theory, applied to relatives and friends of chronic pain patients. 127 participants estimated characters' pain intensity and fairness of behaviour after reading four vignettes describing characters suffering from pain. Four cues were systematically varied: the character continuing or stopping liked tasks; continuing or stopping disliked tasks; availability of medical evidence; and pain intensity as rated by characters. Results revealed that pain intensity and the two behavioural variables had an effect on pain estimates: high pain self-reports and stopping all tasks led to high pain estimates; pain was estimated to be lowest when characters stopped disliked but continued with liked tasks. This combination was also rated least fair. Results support the use of social contract theory as a theoretical framework to explore pain judgements.

  10. Reiki therapy for postoperative oral pain in pediatric patients: pilot data from a double-blind, randomized clinical trial.

    Science.gov (United States)

    Kundu, Anjana; Lin, Yuting; Oron, Assaf P; Doorenbos, Ardith Z

    2014-02-01

    To examine the effects of Reiki as an adjuvant therapy to opioid therapy for postoperative pain control in pediatric patients. This was a double-blind, randomized controlled study of children undergoing dental procedures. Participants were randomly assigned to receive either Reiki therapy or the control therapy (sham Reiki) preoperatively. Postoperative pain scores, opioid requirements, and side effects were assessed. Family members were also asked about perioperative care satisfaction. Multiple linear regressions were used for analysis. Thirty-eight children participated. The blinding procedure was successful. No statistically significant difference was observed between groups on all outcome measures. Our study provides a successful example of a blinding procedure for Reiki therapy among children in the perioperative period. This study does not support the effectiveness of Reiki as an adjuvant therapy to opioid therapy for postoperative pain control in pediatric patients. Copyright © 2013 Elsevier Ltd. All rights reserved.

  11. Symptoms of Fibromyalgia According to the 2016 Revised Fibromyalgia Criteria in Chronic Pain Patients Referred to Multidisciplinary Pain Rehabilitation: Influence on Clinical and Experimental Pain Sensitivity

    DEFF Research Database (Denmark)

    Plesner, Karin Bruun; Vaegter, Henrik Bjarke

    2018-01-01

    Fibromyalgia is a condition with chronic widespread pain and signs of generalized pain hypersensitivity. FM has previously been classified according to the ACR1990 criteria, where the presence of hypersensitivity is estimated by a tender point examination. Due to the limitations of these classifi......Fibromyalgia is a condition with chronic widespread pain and signs of generalized pain hypersensitivity. FM has previously been classified according to the ACR1990 criteria, where the presence of hypersensitivity is estimated by a tender point examination. Due to the limitations...... of these classification criteria, new diagnostic criteria have been proposed, abandoning this examination. This cross-sectional study investigated the prevalence of FM according to the revised 2016 FM criteria in a large cohort of chronic pain patients. Pain drawings, the Fibromyalgia Symptom Severity Scale...

  12. Neuropsychological assessment of chronic non-malignant pain patients treated in a multidisciplinary pain centre

    DEFF Research Database (Denmark)

    Sjøgren, Per; Christrup, Lona Louring; Petersen, Morten Aa

    2005-01-01

    for information processing and working memory and Mini Mental State Examination (MMSE). CRT and FTT were impaired in the total patient sample. Treatment with opioids was associated with poorer performance of PASAT. High scores of PVAS and SVAS were associated with poor performance of PASAT and CRT, respectively...... with a combination of long-term oral opioids and antidepressants and/or anticonvulsants. Assessments comprised pain (PVAS) and sedation (SVAS), Continuous Reaction Time (CRT) testing for sustained attention, Finger Tapping Test (FTT) testing for psychomotor speed, Paced Auditory Serial Addition Task (PASAT) testing...

  13. A multicenter, primary-care-based, open-label study to assess the success of converting opioid-experienced patients with chronic moderate-to-severe pain to morphine sulfate and naltrexone hydrochloride extended-release capsules using a standardized conversion guide

    Directory of Open Access Journals (Sweden)

    Setnik B

    2015-07-01

    Full Text Available Beatrice Setnik,1 Carl L Roland,1 Kenneth W Sommerville,1,2 Glenn C Pixton,1 Robert Berke,3,4 Anne Calkins,5 Veeraindar Goli1,2 1Pfizer Inc, 2Duke University Medical Center, Durham, NC, USA; 3Family Health Medical Services PLLC, Mayville, 4Department of Social and Preventive Medicine, State University of New York at Buffalo, Buffalo, 5New York Spine & Wellness Center, Syracuse, NY, USA Objective: To evaluate the conversion of opioid-experienced patients with chronic moderate-to-severe pain to extended-release morphine sulfate with sequestered naltrexone hydrochloride (MSN using a standardized conversion guide. Methods: This open-label, single-arm study was conducted in 157 primary care centers in the United States. A total of 684 opioid-experienced adults with chronic moderate-to-severe pain were converted to oral administration of MSN from transdermal fentanyl and oral formulations of hydrocodone, hydromorphone, methadone, oxycodone, oxymorphone, and other morphine products using a standardized conversion guide. The primary endpoint was the percentage of patients achieving a stable MSN dose within a 6-week titration phase. Secondary endpoints included duration of time to stable dose, number of titration steps, safety and efficacy measures, and investigator assessment of conversion guide utility. Results: Of the 684 patients, 51.3% were converted to a stable dose of MSN (95% confidence interval: 47.5%, 55.1%. The mean (standard deviation number of days to stable dose was 20 (8.94, and number of titration steps to stable dose was 2.4 (1.37. The majority of adverse events were mild/moderate and consistent with opioid therapy. Mean pain scores at stable dose decreased from baseline. Investigators were generally satisfied with the conversion guide and, in 94% of cases, reported they would use it again. Conclusion: Conversion to MSN treatment using the standardized MSN conversion guide was an attainable goal in approximately half of the population of

  14. Barriers to postoperative pain management in hip fracture patients with dementia as evaluated by nursing staff.

    Science.gov (United States)

    Rantala, Maija; Kankkunen, Päivi; Kvist, Tarja; Hartikainen, Sirpa

    2014-03-01

    This paper reports a study of the perceptions of nursing staff regarding barriers to postoperative pain management in hip fracture patients with dementia, their expectations, and facilitators offered by their employers to overcome these barriers. Patients with dementia are at high risk for insufficient postoperative pain treatment, mainly owing to inability to articulate or convey their pain experience. Nursing staff have an essential role in the treatment and care of patients who are vulnerable, and therefore unable to advocate for their own pain treatment. Questionnaires with both structured and open-ended questions were used to collect data from nursing staff members in seven university hospitals and ten city-center hospitals from March to May 2011. The response rate was 52% (n = 331). According to nursing staff, the biggest barrier in pain management was the difficulty in assessing pain owing to a patient's cognitive impairment (86%). Resisting care and restlessness among patients with dementia can lead to use of restraints, although these kinds of behavioral changes can point to the occurrence of pain. There were statistically significant differences between the sufficiency of pain management and barriers. Those who expected pain management to be insufficient identified more barriers than those who expected pain management to be sufficient (p nursing staff in pain detection and management is needed so that nursing staff are also able to recognize behavioral symptoms as potential signs of pain and provide appropriate pain management. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  15. Anatomical success in patients after retinectomy for complex retinal detachment

    International Nuclear Information System (INIS)

    Mukhtar, A.; Ishaq, M.; Islam, Q.U.

    2015-01-01

    To evaluate the efficacy of primary and redo retinectomy in eyes with complex retinal detachment. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Ophthalmology Rawalpindi from Jan 2012 to June 2013. Patients and Methods: Fifty eight eyes (patients) underwent relaxing retinectomies for complex retinal detachment with proliferative vitreoretinopathy or intrinsic retinal shortening. Operative technique included pars plana vitrectomy, proliferative vitreoretinopathy management, use of intraoperative perfluorocarbon liquid, retinectomy, endolaser and intraocular temponade. The main outcome was anatomic success, defined as complete retinal reattachment at four months follow up. Eighteen eyes out of the same primary group underwent second retinectomy because of anatomical failure. Results: Mean age of study population was 53.78 ± 15.11 years, 56.9% of patients were male(s). Anatomic success rate after 1st retinectomy was achieved in 68.96% (40 eyes out of 58). In eighteen eyes that underwent 2nd retinectomy, anatomic success rate was 72.22% (13 eyes out of 18). Overall success rate was 91.3% (53 eyes out of 58) in our study. Conclusions: Relaxing retinectomies for retinal shortening can improve the anatomical success rate in patients with complex RD. (author)

  16. Development of a patient-reported outcome instrument for patients with lumbar radicular pain

    DEFF Research Database (Denmark)

    Ibsen, Charlotte; Schiøttz-Christensen, Berit; Nielsen, Claus Vinther

    Background: Low back pain (LBP) is the leading contributor to years lived with disability. It is a complex biopsychosocial phenomenon where complete differential diagnosis and assessment is difficult and needs to be comprehensive. Therefore a biopsychosocial approach is recommended. Substantial...... pain. Methods: The development of the PRO will be based on ICF Comprehensive Core Set for Low Back Pain and Rehabilitation Set and existing items from the The Patient-Reported Outcomes Measurement Information System (PROMIS®). The development process will be divided into five steps: 1. Linking PROMIS....... Conclusion(s) : A PRO instrument is developed to systematise and qualify the description on functioning among patients with lumbar radicular pain. The development process is in progress and next step is to engage patients and clinicians in the development process.  Implications : With development of this PRO...

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

    Science.gov (United States)

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

    2007-02-01

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

  18. DO PATIENTS WITH CHRONIC LOW BACK PAIN EXPERIENCE PAIN REDUCTION AND FUNCTIONAL IMPROVEMENT AFTER TREATMENT AT A MULTIDISCIPLINARY OUTPATIENT CLINIC?

    Directory of Open Access Journals (Sweden)

    Norbye Anja

    2017-04-01

    Full Text Available Background: Low back pain is the most common affliction of the musculoskeletal system. Patients with chronic low back pain cost the society great expenses in treatments and other social benefits; however, the effects of interventions are discussed. The purpose of this study was to determine whether patients with chronic low back pain experience pain reduction and functional improvement after treatment at a multidisciplinary outpatient clinic. Methods: A prospective study design was used, including 446 patients who participated in follow-up questionnaires with data collection at 6 and 12 months after treatment. The primary outcome was alterations in pain and function. Result: By 12 months after treatment, 71.3 % of the included patients had completed the follow-up questionnaires. Based on these questionnaires, we identified statistically significant changes from baseline at all end points, with clinically significant changes in approximately half of the participants (p = 0.000. Conclusion: Treatment of chronic low back pain at a multidisciplinary outpatient clinic resulted in clinically significant pain reduction and functional improvement within 12 months for approximately half of affected patients.

  19. Patients With Knee Osteoarthritis Who Score Highly on the PainDETECT Questionnaire Present With Multimodality Hyperalgesia, Increased Pain, and Impaired Physical Function

    OpenAIRE

    Moss, Penny; Benson, Heather A.E.; Will, Rob; Wright, Anthony

    2017-01-01

    Objectives: PainDETECT is a self-report questionnaire that can be used to identify features of neuropathic pain. A proportion of patients with knee osteoarthritis (OA) score highly on the PainDETECT questionnaire. This study aimed to determine whether those with a higher “positive neuropathic” score on the PainDETECT questionnaire also had greater pain, hypersensitivity, and reduced function compared with individuals with knee OA with lower PainDETECT scores. Materials and Methods: In total, ...

  20. Pain relief is associated with decreasing postural sway in patients with non-specific low back pain.

    Science.gov (United States)

    Ruhe, Alexander; Fejer, René; Walker, Bruce

    2012-03-21

    Increased postural sway is well documented in patients suffering from non-specific low back pain, whereby a linear relationship between higher pain intensities and increasing postural sway has been described. No investigation has been conducted to evaluate whether this relationship is maintained if pain levels change in adults with non-specific low back pain. Thirty-eight patients with non-specific low back pain and a matching number of healthy controls were enrolled. Postural sway was measured by three identical static bipedal standing tasks of 90 sec duration with eyes closed in narrow stance on a firm surface. The perceived pain intensity was assessed by a numeric rating scale (NRS-11). The patients received three manual interventions (e.g. manipulation, mobilization or soft tissue techniques) at 3-4 day intervals, postural sway measures were obtained at each occasion. A clinically relevant decrease of four NRS scores in associated with manual interventions correlated with a significant decrease in postural sway. In contrast, if no clinically relevant change in intensity occurred (≤ 1 level), postural sway remained similar compared to baseline. The postural sway measures obtained at follow-up sessions 2 and 3 associated with specific NRS level showed no significant differences compared to reference values for the same pain score. Alterations in self-reported pain intensities are closely related to changes in postural sway. The previously reported linear relationship between the two variables is maintained as pain levels change. Pain interference appears responsible for the altered sway in pain sufferers. This underlines the clinical use of sway measures as an objective monitoring tool during treatment or rehabilitation.

  1. Escitalopram is Associated with Reductions in Pain Severity and Pain Interference in Opioid Dependent Patients with Depressive Symptoms

    Science.gov (United States)

    Tsui, Judith I.; Herman, Debra S.; Kettavong, Malyna; Anderson, Bradley J.; Stein, Michael D.

    2011-01-01

    Pain is common among opioid dependent patients, yet pharmacologic strategies are limited. The aim of this study was to explore whether escitalopram, a selective serotonin reuptake inhibitor, was associated with reductions in pain. The study used longitudinal data from a randomized, controlled trial that evaluated the effects of escitalopram on treatment retention in patients with depressive symptoms who were initiating buprenorphine/naloxone for treatment of opioid dependence. Participants were randomized to take escitalopram 10mg or placebo daily. Changes in pain severity, pain interference and depression were assessed at 1, 2 and 3 months visits using the Visual Analog Scale, Brief Pain Inventory and the Beck Depression Inventory II, respectively. Fixed-effects estimator for panel regression models were used to assess the effects of intervention on changes in outcomes over time. Additional models were estimated to explore whether the intervention effect was mediated by within-person changes in depression. In this sample of 147 adults, we found that participants randomized to escitalopram had significantly larger reductions on both pain severity (b = −14.34, t = −2.66, p < .01) and pain interference (b = −1.20, t = −2.23, p < .05) between baseline and follow-up. After adjusting for within-subject changes in depression, the estimated effects of escitalopram on pain severity and pain interference were virtually identical to the unadjusted effects. In summary, this study of opioid-dependent patients with depressive symptoms found that treatment with escitalopram was associated with clinically meaningful reductions in pain severity and pain interference during the first three months of therapy. PMID:21924552

  2. Pharmacological, psychological, and patient education interventions for patients with neck pain: results of an international survey.

    Science.gov (United States)

    Carlesso, Lisa C; Gross, Anita R; MacDermid, Joy C; Walton, David M; Santaguida, P Lina

    2015-01-01

    Examination of practice patterns compared to existing evidence identifies knowledge to practice gaps. To describe the utilization of pharmacological, patient education, primary psychological interventions and relaxation therapies in patients with neck pain by clinicians. An international cross-sectional survey was conducted to determine the use of these interventions amongst 326 clinicians treating patients with neck pain. Nineteen countries participated. Results were analyzed by usage amongst physical therapists (39%) and chiropractors (35%), as they were the predominant respondents. Patient education (95%) and relaxation therapies (59%) were the most utilized interventions. Tests of subgroup differences determined that physical therapists used patient education significantly more than chiropractors. Use of medications and primary psychological interventions were reported by most to be outside of scope of practice. The high rate of patient education is consistent with supporting evidence. However, usage of relaxation therapies is contrary to evidence suggesting no benefit for improved pain or function for chronic neck pain. This survey indicates that patient education and relaxation therapies are common treatments provided by chiropractors and physical therapists for patients with neck pain. Future research should address gaps associated with variable practice patterns and knowledge translation to reduce usage of interventions shown to be ineffective.

  3. Prevalence of esophageal disorders in patients with recurrent chest pain.

    Science.gov (United States)

    Manterola, C; Barroso, M S; Losada, H; Muñoz, S; Vial, M

    2004-01-01

    The objective of this study is to determine the prevalence of esophageal disorders (ED) associated with recurrent chest pain (RCP) and the utility of esophageal functional tests (EFT) in the study of these patients. The cross-sectional study was conducted at Hospital Clínico de La Frontera, Chile. One hundred and twenty-three patients with RCP were studied using esophageal manometry, edrophonium stimulation and 24-h pH monitoring. The performance of EFT was considered acceptable when they were capable of finding ED. To state the probability that RCP had an esophageal origin, patients were classified according to whether their pain had a probable, possible or unlikely esophageal origin. The prevalence of ED was determined according to diagnoses obtained after applying EFT and a multivariate analysis was performed to examine the association between the esophageal origin of RCP and ED. Rates of correct diagnosis of 65.9%, 56.9% and 31.7% was verified for 24-h pH monitoring, esophageal manometry and edrophonium stimulation, respectively. In 38.2% of patients with RCP, the pain was probably of esophageal origin, in 42.3% there was a possible esophageal origin and in 19.5% an unlikely esophageal origin. A 44.7% prevalence of GERD, 26.8% of GERD with secondary esophageal motor dysfunction and 8.9% of pure esophageal motor dysfunction were verified. The multivariate analysis allowed us to verify the association between the probability of esophageal origin of RCP, the variables RCP duration, esophagitis and dysphagia coexistence (P= 0.037, P= 0.030 and P= 0.024, respectively), and a statistically significant association between ED and dysphagia coexistence (P= 0.028). A high prevalence of ED was identified in patients with RCP.

  4. Is there a relationship between pain intensity and postural sway in patients with non-specific low back pain?

    DEFF Research Database (Denmark)

    Ruhe, A.; Fejer, R.; Walker, B.

    2011-01-01

    compared to healthy controls. In addition, regression analysis revealed a significant and linear increase in postural sway with higher pain ratings for all included COP parameters. Statistically significant changes in mean sway velocity in antero-posterior and medio-lateral direction and sway area were......Background: Increased center of pressure excursions are well documented in patients suffering from non-specific low back pain, whereby the altered postural sway includes both higher mean sway velocities and larger sway area. No investigation has been conducted to evaluate a relationship between...... pain intensity and postural sway in adults (aged 50 or less) with non-specific low back pain. Methods: Seventy-seven patients with non-specific low back pain and a matching number of healthy controls were enrolled. Center of pressure parameters were measured by three static bipedal standing tasks of 90...

  5. Influence of low back pain and prognostic value of MRI in sciatica patients in relation to back pain.

    Science.gov (United States)

    el Barzouhi, Abdelilah; Vleggeert-Lankamp, Carmen L A M; Lycklama à Nijeholt, Geert J; Van der Kallen, Bas F; van den Hout, Wilbert B; Koes, Bart W; Peul, Wilco C

    2014-01-01

    Patients with sciatica frequently complain about associated back pain. It is not known whether there are prognostic relevant differences in Magnetic Resonance Imaging (MRI) findings between sciatica patients with and without disabling back pain. The study population contained patients with sciatica who underwent a baseline MRI to assess eligibility for a randomized trial designed to compare the efficacy of early surgery with prolonged conservative care for sciatica. Two neuroradiologists and one neurosurgeon independently evaluated all MR images. The MRI readers were blinded to symptom status. The MRI findings were compared between sciatica patients with and without disabling back pain. The presence of disabling back pain at baseline was correlated with perceived recovery at one year. Of 379 included sciatica patients, 158 (42%) had disabling back pain. Of the patients with both sciatica and disabling back pain 68% did reveal a herniated disc with nerve root compression on MRI, compared to 88% of patients with predominantly sciatica (Psciatica at baseline was negatively associated with perceived recovery at one year (Odds ratio [OR] 0.32, 95% Confidence Interval 0.18-0.56, PSciatica patients with disabling back pain in absence of nerve root compression on MRI at baseline reported less perceived recovery at one year compared to those with predominantly sciatica and nerve root compression on MRI (50% vs 91%, PSciatica patients with disabling low back pain reported an unfavorable outcome at one-year follow-up compared to those with predominantly sciatica. If additionally a clear herniated disc with nerve root compression on MRI was absent, the results were even worse.

  6. Effects of noxious stimulation and pain expectations on neuromuscular control of the spine in patients with chronic low back pain.

    Science.gov (United States)

    Henchoz, Yves; Tétreau, Charles; Abboud, Jacques; Piché, Mathieu; Descarreaux, Martin

    2013-10-01

    Alterations of the neuromuscular control of the lumbar spine have been reported in patients with chronic low back pain (LBP). During trunk flexion and extension tasks, the reduced myoelectric activity of the low back extensor musculature observed during full trunk flexion is typically absent in patients with chronic LBP. To determine whether pain expectations could modulate neuromuscular responses to experimental LBP to a higher extent in patients with chronic LBP compared with controls. A cross-sectional, case-control study. Twenty-two patients with nonspecific chronic LBP and 22 age- and sex-matched control participants. Trunk flexion-extension tasks were performed under three experimental conditions: innocuous heat, noxious stimulation with low pain expectation, and noxious stimulation with high pain expectation. Noxious stimulations were delivered using a contact heat thermode applied on the skin of the lumbar region (L4-L5), whereas low or high pain expectations were induced by verbal and visual instructions. Surface electromyography of erector spinae at L2-L3 and L4-L5, as well as lumbopelvic kinematic variables were collected during the tasks. Pain was evaluated using a numerical rating scale. Pain catastrophizing, disability, anxiety, and fear-avoidance beliefs were measured using validated questionnaires. Two-way mixed analysis of variance revealed that pain was significantly different among the three experimental conditions (F2,84=317.5; plow back extensor musculature during full trunk flexion was observed in the high compared with low pain expectations condition at the L2-L3 level (F2,84=9.5; ppain catastrophizing in patients with chronic LBP (r=0.54; p=.012). Repeated exposure to pain appears to generate rigid and less variable patterns of muscle activation in patients with chronic LBP, which attenuate their response to pain expectations. Patients with high levels of pain catastrophizing show higher myoelectric activity of lumbar muscles in full flexion

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

    NARCIS (Netherlands)

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

    2016-01-01

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

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

    NARCIS (Netherlands)

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

    2016-01-01

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

  9. Markers of bone pain in the hemodialysis patients with renal insufficiency

    International Nuclear Information System (INIS)

    Oka, Fumitoshi; Sagawa, Hitoshi; Yabe, Kinji

    1988-01-01

    The patients receiving maintenance hemodialysis were divided into two groups in the absence and the presence of bone pain and investigated the markers of bone pain in these patients. These results suggested that the duration of receiving hemodialysis, serum contrations of alkaline phosphatase, osteocalcin and parathyroid hormone became to be the markers of bone pain. (author)

  10. Age Differences in Decoding Pain from the Facial Expression of Healthy Individuals and Patients with Dementia

    NARCIS (Netherlands)

    Lautenbacher, Stefan; Hofer, Wiebke; Kunz, Miriam

    Objective. Patients with dementia, whose ability to provide self-report of pain is often impaired, are in crucial need of observers who can detect the patients' pain-indicative behaviors appropriately, to initiate treatment. The facial display of pain promises to be especially informative for that

  11. Pregabalin reduces pain in patients with chronic pancreatitis in a randomized, controlled trial

    NARCIS (Netherlands)

    Olesen, S.S.; Bouwense, S.A.W.; Wilder-Smith, O.H.G.; Goor, H. van; Drewes, A.M.

    2011-01-01

    BACKGROUND & AIMS: Pain is a disabling symptom for patients with chronic pancreatitis (CP) and difficult to treat. Evidence from basic science and human studies indicates that pain processing by the central nervous system is abnormal and resembles that observed in patients with neuropathic pain

  12. Extent and characteristics of self-reported pain in patients with systemic lupus erythematosus.

    Science.gov (United States)

    Waldheim, E; Elkan, A-C; Bergman, S; Frostegård, J; van Vollenhoven, R; Henriksson, E Welin

    2013-02-01

    Patients' own experiences of subjective symptoms are scarcely covered, and the objective of this study was to investigate the extent and characteristics of self-reported pain in patients with systemic lupus erythematosus (SLE). This study comprised a cross-sectional design where 84 patients with SLE were asked to complete self-assessments: visual analogue scale of pain and the Short-Form McGill Pain Questionnaire. Medical assessments, including ESR, SLAM, SLEDAI, and SLICC, were also performed. Of the study population, 24% reported higher levels of SLE-related pain (≥40 mm on VAS). This group had a significantly shorter disease duration, higher ESR, and higher disease activity, according to the SLAM and SLEDAI, compared to the rest of the study population. This group mainly used the words "tender," "aching," and "burning" to describe moderate and severe pain, and they used a greater number of words to describe their pain. Of the patients with higher levels of pain, 70% reported their present pain as "distressing." The most common pain location for the whole patient population was the joints. Patients rated their disease activity significantly higher than physicians did. These findings expand the current knowledge of the extent of SLE-related pain and how patients perceive this pain. The results can contribute to affirmative, supportive and caring communication and especially highlight SLE-related pain in patients with a short disease duration and high disease activity.

  13. Neuropathic pain characteristics in patients from Curitiba (Brazil) with spinal cord injury.

    Science.gov (United States)

    Vall, Janaína; Costa, Carlos Mauricio de Castro; Santos, Terezinha de Jesus Teixeira; Costa, Samuel Bovy de Castro

    2011-02-01

    This was a descriptive cross-sectional study on patients with spinal cord injuries living in Curitiba, Paraná, Brazil. The aim was to evaluate the pain characteristics among such patients seen at referral care centers for spinal cord injury patients in Curitiba. A total of 109 adults with spinal cord injury in this city were evaluated regarding the presence of pain, especially neuropathic pain. Neuropathic pain was evaluated using the DN4 questionnaire, a universal instrument that has been translated and validated for Portuguese. A visual analog scale (VAS) was used to evaluate the intensity of pain. The prevalence of pain among these 109 patients was 31.2% (34 patients). The nociceptive pain presented was classified as musculoskeletal pain (nine patients), visceral pain (four patients) and mixed pain (one patient), thus totaling 14 patients (12.8%). Another 20 patients (18.3%) showed symptoms of neuropathic pain and fulfilled the criteria for neuropathic pain with scores greater than 4 out 10 in the DN4 questionnaire. Regarding the characteristics of the patients with neuropathic pain, most of them were male, younger than 40 years of age and paraplegic with incomplete lesions. They had become injured from 1 to more than 5 years earlier. The predominant etiology was gunshot wounds, and the intensity of their pain was high, with VAS scores greater than 5. This study partially corroborates other studies conducted on this subject. Studies of this type are important for understanding the profile of these patients, for the purpose of designing strategies for their rehabilitation, with a focus on the appropriate treatment and management of pain.

  14. Neuropathic pain characteristics in patients from Curitiba (Brazil with spinal cord injury

    Directory of Open Access Journals (Sweden)

    Janaína Vall

    2011-02-01

    Full Text Available This was a descriptive cross-sectional study on patients with spinal cord injuries living in Curitiba, Paraná, Brazil. The aim was to evaluate the pain characteristics among such patients seen at referral care centers for spinal cord injury patients in Curitiba. A total of 109 adults with spinal cord injury in this city were evaluated regarding the presence of pain, especially neuropathic pain. Neuropathic pain was evaluated using the DN4 questionnaire, a universal instrument that has been translated and validated for Portuguese. A visual analog scale (VAS was used to evaluate the intensity of pain. The prevalence of pain among these 109 patients was 31.2% (34 patients. The nociceptive pain presented was classified as musculoskeletal pain (nine patients, visceral pain (four patients and mixed pain (one patient, thus totaling 14 patients (12.8%. Another 20 patients (18.3% showed symptoms of neuropathic pain and fulfilled the criteria for neuropathic pain with scores greater than 4 out 10 in the DN4 questionnaire. Regarding the characteristics of the patients with neuropathic pain, most of them were male, younger than 40 years of age and paraplegic with incomplete lesions. They had become injured from 1 to more than 5 years earlier. The predominant etiology was gunshot wounds, and the intensity of their pain was high, with VAS scores greater than 5. This study partially corroborates other studies conducted on this subject. Studies of this type are important for understanding the profile of these patients, for the purpose of designing strategies for their rehabilitation, with a focus on the appropriate treatment and management of pain.

  15. Efficient conditioned pain modulation despite pain persistence in painful diabetic neuropathy.

    Science.gov (United States)

    Granovsky, Yelena; Nahman-Averbuch, Hadas; Khamaisi, Mogher; Granot, Michal

    2017-05-01

    Alleviation of pain, by either medical or surgical therapy, is accompanied by transition from less efficient, or pro-nociceptive, to efficient conditioned pain modulation (CPM). Spontaneous decrease or resolution of pain with disease progression is reported for some patients with painful diabetic neuropathy (PDN). To explore whether CPM changes similarly in parallel to spontaneous resolution of pain in PDN patients. In this cross-sectional study, thirty-three patients with PDN underwent psychophysical assessment of pain modulation on the forearm, remote from the clinical pain. Pain duration was not correlated with neuropathic pain intensity, yet, it correlated with CPM efficiency; patients with longer pain duration had same pain level, but more efficient CPM than those with short-pain duration (ρ = -0.417; P = 0.025, Spearman correlation). Patients with pain more than 2 years (median split) expressed efficient CPM that was not different from that of healthy controls. These patients also had lower temporal summation of pain than the short-pain duration patients group ( P < 0.05). The 2 patient groups did not differ in clinical pain characteristics or use of analgesics. Pro-nociception, expressed by less efficient CPM and high temporal summation that usually accompanies clinical painful conditions, seems to "normalize" with chronicity of the pain syndrome. This is despite continuing pain, suggesting that pro-nociceptivity in pain syndromes is multifactorial. Because the pain modulation profile affects success of therapy, this suggests that different drugs might express different efficacy pending on duration of the pain in patients with PDN.

  16. Bertolotti's syndrome: A commonly missed cause of back pain in young patients.

    Science.gov (United States)

    Manmohan, S; Dzulkarnain, A; Nor Azlin, Z A; Fazir, M

    2015-01-01

    Bertolotti's syndrome must be considered as a differential diagnosis for lower back pain in young people. Treatment, whether conservative or operative, is still debatable. In this paper, we report a case of a 20-year-old girl presenting with lower back pain for 8 years. We administered injection with local anaesthetic and steroid injections within the pseudo-articulation; however, the pain was relieved for 3 weeks. Surgical excision of the pseudo-articulation successfully treated her back pain and the sciatica.

  17. Back pain in patients with degenerative spine disease and intradural spinal tumor: what to treat? when to treat?

    Science.gov (United States)

    Bellut, David; Mutter, Urs M; Sutter, Martin; Eggspuehler, Andreas; Mannion, Anne F; Porchet, François

    2014-04-01

    Back pain is common in industrialized countries and one of the most frequent causes of work incapacity. Successful treatment is, therefore, not only important for improving the symptoms and the quality of life of these patients but also for socioeconomic reasons. Back pain is frequently caused by degenerative spine disease. Intradural spinal tumors are rare with an annual incidence of 2-4/1,00,000 and are mostly associated with neurological deficits and radicular and nocturnal pain. Back pain is not commonly described as a concomitant symptom, such that in patients with both a tumor and degenerative spine disease, any back pain is typically attributed to the degeneration rather than the tumor. The aim of the present retrospective investigation was to study and analyze the impact of microsurgery on back/neck pain in patients with intradural spinal tumor in the presence of degenerative spinal disease in adjacent spinal segments. Fifty-eight consecutive patients underwent microsurgical, intradural tumor surgery using a standardized protocol assisted by multimodal intraoperative neuromonitoring. Clinical symptoms, complications and surgery characteristics were documented. Standardized questionnaires were used to measure outcome from the surgeon's and the patient's perspectives (Spine Tango Registry and Core Outcome Measures Index). Follow-up included clinical and neuroradiological examinations 6 weeks, 3 months and 1 year postoperatively. Back/neck pain as a leading symptom and coexisting degenerative spine disease was present in 27/58 (47 %) of the tumor patients, and these comprised to group under study. Patients underwent tumor surgery only, without addressing the degenerative spinal disease. Remission rate after tumor removal was 85 %. There were no major surgical complications. Back/neck pain as the leading symptom was eradicated in 67 % of patients. There were 7 % of patients who required further invasive therapy for their degenerative spinal disease. Intradural

  18. Self-Efficacy for Pain Communication Moderates the Relation Between Ambivalence Over Emotional Expression and Pain Catastrophizing Among Patients With Osteoarthritis.

    Science.gov (United States)

    Van Denburg, Alyssa N; Shelby, Rebecca A; Caldwell, David S; O'Sullivan, Madeline L; Keefe, Francis J

    2018-04-06

    Pain catastrophizing (ie, the tendency to focus on and magnify pain sensations and feel helpless in the face of pain) is one of the most important and consistent psychological predictors of the pain experience. The present study examined, in 60 patients with osteoarthritis pain who were married or partnered: 1) the degree to which ambivalence over emotional expression and negative network orientation were associated with pain catastrophizing, and 2) whether self-efficacy for pain communication moderated these relations. Hierarchical multiple linear regression analyses revealed a significant main effect for the association between ambivalence over emotional expression and pain catastrophizing; as ambivalence over emotional expression increased, the degree of pain catastrophizing increased. In addition, the interaction between ambivalence over emotional expression and self-efficacy for pain communication was significant, such that as self-efficacy for pain communication increased, the association between ambivalence over emotional expression and pain catastrophizing became weaker. Negative network orientation was not significantly associated with pain catastrophizing. Findings suggest that higher levels of self-efficacy for pain communication may help weaken the effects of ambivalence over emotional expression on pain catastrophizing. In light of these results, patients may benefit from interventions that target pain communication processes and emotion regulation. This article examines interpersonal processes involved in pain catastrophizing. This study has the potential to lead to better understanding of maladaptive pain coping strategies and possibly better prevention and treatment strategies. Copyright © 2018 The American Pain Society. Published by Elsevier Inc. All rights reserved.

  19. Increased pain relief with remifentanil does not improve the success rate of external cephalic version: a randomized controlled trial.

    Science.gov (United States)

    Burgos, Jorge; Pijoan, José I; Osuna, Carmen; Cobos, Patricia; Rodriguez, Leire; Centeno, María del Mar; Serna, Rosa; Jimenez, Antonia; Garcia, Eugenia; Fernandez-Llebrez, Luis; Melchor, Juan C

    2016-05-01

    Our objective was to compare the effect of two pain relief methods (remifentanil vs. nitrous oxide) on the success rate of external cephalic version. We conducted a randomized open label parallel-group controlled single-center clinical trial with sequential design, at Cruces University Hospital, Spain. Singleton pregnancies in noncephalic presentation at term that were referred for external cephalic version were assigned according to a balanced (1:1) restricted randomization scheme to analgesic treatment with remifentanil or nitrous oxide during the procedure. The primary endpoint was external cephalic version success rate. Secondary endpoints were adverse event rate, degree of pain, cesarean rate and perinatal outcomes. The trial was stopped early after the second interim analysis due to a very low likelihood of finding substantial differences in efficacy (futility). The external cephalic version success rate was the same in the two arms (31/60, 51.7%) with 120 women recruited, 60 in each arm. The mean pain score was significantly lower in the remifentanil group (3.2 ± 2.4 vs. 6.0 ± 2.3; p external cephalic version-related complications. There was a trend toward a higher frequency of adverse effects in the remifentanil group (18.3% vs. 6.7%, p = 0.10), with a significantly higher incidence rate (21.7 events/100 women vs. 6.7 events/100 women with nitrous oxide, p = 0.03). All reported adverse events were mild and reversible. Remifentanil for analgesia decreased external cephalic version-related pain but did not increase the success rate of external cephalic version at term and appeared to be associated with an increased frequency of mild adverse effects. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

  20. Innate Immune Signalling Genetics of Pain, Cognitive Dysfunction and Sickness Symptoms in Cancer Pain Patients Treated with Transdermal Fentanyl

    Science.gov (United States)

    Barratt, Daniel T.; Klepstad, Pål; Dale, Ola; Kaasa, Stein; Somogyi, Andrew A.

    2015-01-01

    Common adverse symptoms of cancer and chemotherapy are a major health burden; chief among these is pain, with opioids including transdermal fentanyl the mainstay of treatment. Innate immune activation has been implicated generally in pain, opioid analgesia, cognitive dysfunction, and sickness type symptoms reported by cancer patients. We aimed to determine if genetic polymorphisms in neuroimmune activation pathways alter the serum fentanyl concentration-response relationships for pain control, cognitive dysfunction, and other adverse symptoms, in cancer pain patients. Cancer pain patients (468) receiving transdermal fentanyl were genotyped for 31 single nucleotide polymorphisms in 19 genes: CASP1, BDNF, CRP, LY96, IL6, IL1B, TGFB1, TNF, IL10, IL2, TLR2, TLR4, MYD88, IL6R, OPRM1, ARRB2, COMT, STAT6 and ABCB1. Lasso and backward stepwise generalised linear regression were used to identify non-genetic and genetic predictors, respectively, of pain control (average Brief Pain Inventory fentanyl concentrations did not predict between-patient variability in these outcomes, nor did genetic factors predict pain control, sickness response or opioid adverse event complaint. Carriers of the MYD88 rs6853 variant were half as likely to have cognitive dysfunction (11/111) than wild-type patients (69/325), with a relative risk of 0.45 (95% CI: 0.27 to 0.76) when accounting for major non-genetic predictors (age, Karnofsky functional score). This supports the involvement of innate immune signalling in cognitive dysfunction, and identifies MyD88 signalling pathways as a potential focus for predicting and reducing the burden of cognitive dysfunction in cancer pain patients. PMID:26332828

  1. Innate Immune Signalling Genetics of Pain, Cognitive Dysfunction and Sickness Symptoms in Cancer Pain Patients Treated with Transdermal Fentanyl.

    Directory of Open Access Journals (Sweden)

    Daniel T Barratt

    Full Text Available Common adverse symptoms of cancer and chemotherapy are a major health burden; chief among these is pain, with opioids including transdermal fentanyl the mainstay of treatment. Innate immune activation has been implicated generally in pain, opioid analgesia, cognitive dysfunction, and sickness type symptoms reported by cancer patients. We aimed to determine if genetic polymorphisms in neuroimmune activation pathways alter the serum fentanyl concentration-response relationships for pain control, cognitive dysfunction, and other adverse symptoms, in cancer pain patients. Cancer pain patients (468 receiving transdermal fentanyl were genotyped for 31 single nucleotide polymorphisms in 19 genes: CASP1, BDNF, CRP, LY96, IL6, IL1B, TGFB1, TNF, IL10, IL2, TLR2, TLR4, MYD88, IL6R, OPRM1, ARRB2, COMT, STAT6 and ABCB1. Lasso and backward stepwise generalised linear regression were used to identify non-genetic and genetic predictors, respectively, of pain control (average Brief Pain Inventory < 4, cognitive dysfunction (Mini-Mental State Examination ≤ 23, sickness response and opioid adverse event complaint. Serum fentanyl concentrations did not predict between-patient variability in these outcomes, nor did genetic factors predict pain control, sickness response or opioid adverse event complaint. Carriers of the MYD88 rs6853 variant were half as likely to have cognitive dysfunction (11/111 than wild-type patients (69/325, with a relative risk of 0.45 (95% CI: 0.27 to 0.76 when accounting for major non-genetic predictors (age, Karnofsky functional score. This supports the involvement of innate immune signalling in cognitive dysfunction, and identifies MyD88 signalling pathways as a potential focus for predicting and reducing the burden of cognitive dysfunction in cancer pain patients.

  2. Postpartum Patient Teaching Success: Implications from Nursing and Patient Perspectives

    Science.gov (United States)

    Day, Dawn

    2014-01-01

    A recent examination of postpartum patient satisfaction scores in an inner-city hospital revealed decreased satisfaction of discharge teaching practices. Guided by Knowles' model of andragogy and Donabedian's model of structure-process-outcome, the purpose of this study was to gain an understanding of how the structure and process of discharge…

  3. Relationship between pain and effusion on magnetic resonance imaging in temporomandibular disorder patients

    Science.gov (United States)

    Park, Ha-Na; Kim, Kyoung-A

    2014-01-01

    Purpose This study was performed to find the relationship between pain and joint effusion using magnetic resonance imaging (MRI) in temporomandibular disorder (TMD) patients. Materials and Methods The study subjects included 232 TMD patients. The inclusion criteria in this study were the presence of spontaneous pain or provoked pain on one or both temporomandibular joints (TMJs). The provoked pain was divided into three groups: pain on palpation (G1), pain on mouth opening (G2), and pain on mastication (G3). MRI examinations were performed using a 1.5-T MRI scanner. T1- and T2-weighted images with para-sagittal and para-coronal images were obtained. According to the T2-weighted image findings, the cases of effusions were divided into four groups: normal, mild (E1), moderate (E2), and marked effusion (E3). A statistical analysis was carried out using the χ2 test with SPSS (version 12.0, SPSS Inc., Chicago, IL, USA). Results Spontaneous pain, provoked pain, and both spontaneous and provoked pain were significantly related to joint effusion in TMD patients (peffusion in TMD patients (p>0.05). Conclusion Spontaneous pain was related to the MRI findings of joint effusion; however, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ was not related to the MRI findings of joint effusion. These results suggest that joint effusion has a significant influence on the prediction of TMJ pain. PMID:25473637

  4. Implementing the PAIN RelieveIt Randomized Controlled Trial in Hospice Care: Mechanisms for Success and Meeting PCORI Methodology Standards.

    Science.gov (United States)

    Ezenwa, Miriam O; Suarez, Marie L; Carrasco, Jesus D; Hipp, Theresa; Gill, Anayza; Miller, Jacob; Shea, Robert; Shuey, David; Zhao, Zhongsheng; Angulo, Veronica; McCurry, Timothy; Martin, Joanna; Yao, Yingwei; Molokie, Robert E; Wang, Zaijie Jim; Wilkie, Diana J

    2017-07-01

    This purpose of this article is to describe how we adhere to the Patient-Centered Outcomes Research Institute's (PCORI) methodology standards relevant to the design and implementation of our PCORI-funded study, the PAIN RelieveIt Trial. We present details of the PAIN RelieveIt Trial organized by the PCORI methodology standards and components that are relevant to our study. The PAIN RelieveIt Trial adheres to four PCORI standards and 21 subsumed components. The four standards include standards for formulating research questions, standards associated with patient centeredness, standards for data integrity and rigorous analyses, and standards for preventing and handling missing data. In the past 24 months, we screened 2,837 cancer patients and their caregivers; 874 dyads were eligible; 223.5 dyads consented and provided baseline data. Only 55 patients were lost to follow-up-a 25% attrition rate. The design and implementation of the PAIN RelieveIt Trial adhered to PCORI's methodology standards for research rigor.

  5. Optimizing delivery of a behavioral pain intervention in cancer patients using a sequential multiple assignment randomized trial SMART.

    Science.gov (United States)

    Kelleher, Sarah A; Dorfman, Caroline S; Plumb Vilardaga, Jen C; Majestic, Catherine; Winger, Joseph; Gandhi, Vicky; Nunez, Christine; Van Denburg, Alyssa; Shelby, Rebecca A; Reed, Shelby D; Murphy, Susan; Davidian, Marie; Laber, Eric B; Kimmick, Gretchen G; Westbrook, Kelly W; Abernethy, Amy P; Somers, Tamara J

    2017-06-01

    Pain is common in cancer patients and results in lower quality of life, depression, poor physical functioning, financial difficulty, and decreased survival time. Behavioral pain interventions are effective and nonpharmacologic. Traditional randomized controlled trials (RCT) test interventions of fixed time and dose, which poorly represent successive treatment decisions in clinical practice. We utilize a novel approach to conduct a RCT, the sequential multiple assignment randomized trial (SMART) design, to provide comparative evidence of: 1) response to differing initial doses of a pain coping skills training (PCST) intervention and 2) intervention dose sequences adjusted based on patient response. We also examine: 3) participant characteristics moderating intervention responses and 4) cost-effectiveness and practicality. Breast cancer patients (N=327) having pain (ratings≥5) are recruited and randomly assigned to: 1) PCST-Full or 2) PCST-Brief. PCST-Full consists of 5 PCST sessions. PCST-Brief consists of one 60-min PCST session. Five weeks post-randomization, participants re-rate their pain and are re-randomized, based on intervention response, to receive additional PCST sessions, maintenance calls, or no further intervention. Participants complete measures of pain intensity, interference and catastrophizing. Novel RCT designs may provide information that can be used to optimize behavioral pain interventions to be adaptive, better meet patients' needs, reduce barriers, and match with clinical practice. This is one of the first trials to use a novel design to evaluate symptom management in cancer patients and in chronic illness; if successful, it could serve as a model for future work with a wide range of chronic illnesses. Copyright © 2016. Published by Elsevier Inc.

  6. Day-surgery patients anesthetized with propofol have less postoperative pain than those anesthetized with sevoflurane.

    LENUS (Irish Health Repository)

    Tan, Terry

    2012-02-01

    BACKGROUND: There have been recent studies suggesting that patients anesthetized with propofol have less postoperative pain compared with patients anesthetized with volatile anesthetics. METHODS: In this randomized, double-blind study, 80 patients undergoing day-case diagnostic laparoscopic gynecological surgery were either anesthetized with IV propofol or sevoflurane. The primary outcome measured was pain on a visual analog scale. RESULTS: Patients anesthetized with propofol had less pain compared with patients anesthetized with sevoflurane (P = 0.01). There was no difference in any of the other measured clinical outcomes. CONCLUSIONS: The patients anesthetized with propofol appeared to have less pain than patients anesthetized with sevoflurane.

  7. Analgesic effects of manual therapy in patients with musculoskeletal pain: a systematic review

    NARCIS (Netherlands)

    J. Nijs; Dr. L.P. Voogt; F. Struyf; M. Meeys; D. Meuffels; J. de Vries

    2015-01-01

    BACKGROUND: Current evidence shows that manual therapy elicits analgesic effect in different populations (healthy, pain inflicted and patients with musculoskeletal pain) when carried out at the spinal column, although the clinical significance of these effects remains unclear. Also the analgesic

  8. Neurophysiological Pain-education for Patients with Chronic Low Back Pain - A Systematic Review and Meta-analysis

    DEFF Research Database (Denmark)

    Tegner, Heidi; Frederiksen, Pernille; Esbensen, Bente Appel

    2018-01-01

    OBJECTIVE: To evaluate the effect of Neurophysiological Pain-Education (NPE) for patients with Chronic Low Back Pain (CLBP). METHODS: A systematic search was performed in six electronic databases. Eligible RCTs were those with at least 50 % of patients with CLBP and in which NPE was compared...... with no intervention or usual care. Methodological quality was assessed independently by two of the authors using the Cochrane Collaboration Risk of Bias Tool. The effect of NPE was summarized in a random effect meta-analysis for pain, disability and behavioral attitudes. Effect was estimated as weighted mean...

  9. Pain management of opioid-treated cancer patients in hospital settings in Denmark

    DEFF Research Database (Denmark)

    Lundorff, L.; Peuckmann, V.; Sjøgren, Per

    2008-01-01

    AIM: To evaluate the performance and quality of cancer pain management in hospital settings. METHODS: Anaesthesiologists specialised in pain and palliative medicine studied pain management in departments of oncology and surgery. Study days were randomly chosen and patients treated with oral opioids......-treated patients in hospital settings: however, focussing on average pain intensity, the outcome seems favourable compared with other countries. Pain mechanisms were seldom examined and adjuvant drugs were not specifically used for neuropathic pain. Opioid dosing intervals and supplemental opioid doses were most...

  10. Introduction of a Successful Pregnancy in a Patient with Advanced Chronic Renal Insufficiency

    Directory of Open Access Journals (Sweden)

    H. Saghafi

    2008-04-01

    Full Text Available Background and ObjectiveIn the women with chronic renal insufficiency ovulation is suppressed therefore they rarely become pregnant. If pregnancy occurs, they might encounter many conflictions. It may lead to death (fetus or mother. The aim of this study was reporting a successful pregnancy in a patient with advanced chronic renal insufficiency.Case reportThe patient was a 32 years old woman with long period of infertility (8 years. The first main clinical symptom was abdominal pain especially in hypogastric area as well as hyperuremia, elevated levels of creatinine (2.9 mg/dl, mild proteinuria and hematuria. The urine specific gravity was 1010. Sonography data showed asymmetrical small kidneys. Other complaints were pruritus and flank pain during urination. The primary diagnosis was chronic renal failure due to probable chronic pyelonephritis. After an interval she returned with positive pregnancy test. She decided to continue the pregnancy in despite of obstetrician belief for aborting. During pregnancy, proteinuria reached to two plus, hemoglobin fell to 9.7, creatinine levels reached to 3.7 mg/dl and blood pressure was fluctuating between 110/80 and 130/85 mmHg. She admitted in the hospital in third trimester of pregnancy because of preterm labor. However the pain was suppressed after starting magnesium sulfate infusion. Keywords: Renal Insufficiency, Chronic Renal Insufficiency, Pregnancy

  11. Pain Assessment of Elderly Patients with Cognitive Impairment in the Emergency Department: Implications for Pain Management—A Narrative Review of Current Practices

    OpenAIRE

    Joshua Jones; Tin Fei Sim; Jeff Hughes

    2017-01-01

    Elderly people are susceptible to both falls and cognitive impairment making them a particularly vulnerable group of patients when it comes to pain assessment and management in the emergency department (ED). Pain assessment is often difficult in patients who present to the ED with a cognitive impairment as they are frequently unable to self-report their level of pain, which can have a negative impact on pain management. This paper aims to review how cognitive impairment influences pain assess...

  12. 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.

  13. Sensitivity and Specificity of the Comfort Scale to Assess Pain in Ventilated Critically Ill Adult Patients in Intensive Care Unit

    OpenAIRE

    Wahyuningsih, Indah Sri; Prasetyo, Awal; Utami, Reni Sulung

    2017-01-01

    Background: Pain is a common phenomenon experienced by ventilated and critically ill adult patients. It is urgent to measure the pain among these patients since they are unable to report their pain verbally. Comfort Scale is one of the instruments used to measure pain in adult patients. The scale is used to measure pain among children patients with fairly high sensitivity and specificity.Purpose: This study aimed to examine the sensitivity and specificity of the Comfort Scale to measure pain ...

  14. Head posture and neck pain of chronic nontraumatic origin: a comparison between patients and pain-free persons.

    Science.gov (United States)

    Silva, Anabela G; Punt, T David; Sharples, Paul; Vilas-Boas, João P; Johnson, Mark I

    2009-04-01

    To compare standing head posture measurements between patients with nontraumatic neck pain (NP) and pain-free individuals. Single-blind (assessor) cross-sectional study. Hospital and general community. Consecutive patients (n=40) with chronic nontraumatic NP and age- and sex-matched pain-free participants (n=40). Not applicable. Three angular measurements: the angle between C7, the tragus of the ear, and the horizontal; the angle between the tragus of the ear, the eye, and the horizontal; and the angle between the inferior margins of the right and the left ear and the horizontal were calculated through the digitization of video images. NP patients were found to have a significantly smaller angle between C7, the tragus, and the horizontal, resulting in a more forward head posture than pain-free participants (NP, mean +/- SD, 45.4 degrees +/-6.8 degrees ; pain-free, mean +/- SD, 48.6 degrees +/-7.1 degrees ; P50y) revealed an interaction, with a statistically significant difference in head posture for younger participants with NP compared with younger pain-free participants (NP, mean +/- SD, 46.1 degrees +/-6.7 degrees ; pain-free, mean +/- SD, 51.8 degrees +/-5.9 degrees ; P.05; CI for the difference between groups, -4.9 degrees -4.2 degrees ). No other differences were found between patients and pain-free participants. Younger patients with chronic nontraumatic NP were shown to have a more forward head posture in standing than matched pain-free participants. However, the difference, although statistically significant, was perhaps too small to be clinically meaningful.

  15. Autonomic nervous system function in patients with functional abdominal pain. An experimental study

    DEFF Research Database (Denmark)

    Jorgensen, L.S.; Christiansen, P.; Raundahl, U.

    1993-01-01

    Functional abdominal pain--that is, pain without demonstrable organic abnormalities--has often been associated with psychologic stress. The aim of the present study was to investigate whether sympathetic nervous system response to laboratory stress and basal parasympathetic neural activity were...... and serum cortisol did not increase at all in any of the groups. As a measure of parasympathetic neural activity, independent of sympathetic neural activity, the beat-to-beat variation of the heart rate was calculated. The functional patients had a significantly higher beat-to-beat variation expressed...... as the mean square successive differences of the R-R intervals (MSSD), indicating a higher basal parasympathetic neural activity (mean MSSD +/- SEM = 64 +/- 6 msec in the functional group, 46 +/- 6 msec in the healthy group, and 49 +/- 6 msec in the organic group; P = 0.03). A reduced sympathetic neural...

  16. Healthy and maladaptive dependency and its relationship to pain management and perceptions in physical therapy patients.

    Science.gov (United States)

    Huprich, Steven K; Hoban, Patrick; Boys, Ashley; Rosen, Alexandra

    2013-12-01

    This study examined the association among healthy and maladaptive aspects of interpersonal dependency and the management of pain in physical therapy outpatients. Ninety-eight patients were administered the Relationship Profile Test, West Haven-Yale Multidimensional Pain Inventory, and Pain Catastrophizing Scale. Results indicated that Destructive Overdependence was positively associated with an increased number of office visits, pain interference in one's daily life, pain severity, affective distress, and receiving positive partner responses. Dysfunctional Detachment was associated with affective distress, pain interference in one's daily life, and rumination about pain. Healthy Dependency was only associated with receiving distracting responses from others. Believing that a spouse/partner is supportive and caring about one's pain partially mediated the relationship between overdependency and pain interfering in one's life. These results support the clinical utility of assessing interpersonal dependency for its relationship to managing one's pain and health care utilization.

  17. Amelioration of Sickle Cell Pain after Parathyroidectomy in Two Patients with Concurrent Hyperparathyroidism: An Interesting Finding

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    John Muthu

    2016-01-01

    Full Text Available Patients with sickle cell disease have high morbidity and healthcare utilization due to repeated painful crises. Some coexisting conditions which cause pain similar to sickle cell disease may go undiagnosed in these patients. We report two adults with concurrent hyperparathyroidism who experienced significant improvement in sickle cell pain following parathyroidectomy thereby pointing to hyperparathyroidism as the principal causative factor for their pain. Meticulous evaluation for parathyroid disorders can be rewarding in sickle cell disease.

  18. Effectiveness of attentional bias modification and cognitive behavioral therapy on the reduction of pain intensity in patients with chronic pain

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    Fateme Babai

    2016-08-01

    Full Text Available The aim of the study was to determine the effectiveness of Attentional Bias Modification (ABM and Cognitive Behavioral Therapy (CBT on the reduction of pain intensityin patients with chronic pain. This study was a quasiexperimental pretest-posttest design with control group. All patients who referred to physiotherapy clinics for pain during 2015 were participated in the study. They completed the Brief Pain Inventory-short form (BPI-SF for assessing severity of pain. Attentional bias was evaluated using computerized Dot-Probe task. The patients with chronic pain were screened by diagnostic criteria of DSM-V; neurologic diagnosis, and interview. 36 people were selected and randomly divided to three groups computer-based ABM, CBT, and control (12 cases in each group. Group A was trained in 8 sessions-each 15 minutes with the modified computerized Dot-Probe task for attentional bias modification. Group B was trained in 11 sessions-each 45 minutes with CBT program of Turk and Ferry for the chronic pain treatment. And Placebo program was administered for group C in which they completed 8 classic DotProbe sessions. In the end, for the posttest (T2 the participants were tested to identify the changes in biased attention to the emotional stimuli using classing Dot-Probe tasks, and BPI questionnaire to evaluate the changes of severity of pain. Data were analyzed using one-way variance analysis(ANOVA. On the BPI-SF, CBT more reduced the pain intensitythan computer-based ABM.In addition ABM treatment is more effective in reduction of attentional bias.Both of treatments are effective but CBT is more effective than ABM in reduction of pain intensity.

  19. IMMEDIATE EFFECT OF CERVICAL MANIPULATION ON PAIN AND RANGE OF MOTION IN PATIENTS WITH CHRONIC MECHANICAL NECK PAIN

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    Kabir Isah Mayana

    2017-06-01

    Full Text Available Background: Neck pain has been reported as a prevalent musculoskeletal disorder globally with more than half of the general population being affected once or more within their life span. Methods: A randomized clinical trial research design was used which investigated the immediate effect of cervical manipulation on neck pain and cervical range of motion among patients with chronic mechanical neck pain. 20 male and female participants between the ages of 26 to 60 years with chronic mechanical neck pain attending physiotherapy clinics were recruited. They were randomly assigned into two groups (A and B of 10 patients each. Group A received soft tissue massage, and cervical manipulation and group B served as the control group, and they received only soft tissue massage. There were two outcomes measured; Pain intensity was rated using visual analog scale (VAS before and immediately after the intervention. Pre and Post intervention measurements of cervical spine range of motion using Goniometer were also taken. Results: Findings of the study revealed significant immediate improvement of pain and Cervical Range of Motions (p<0.05 in all dimensions in the experimental group while Pain, flexion and right side Cervical flexion significantly improved in the control group. It was also found out after comparing the outcomes between the two groups that, the experimental group had significantly (p<0.05 better improvement than the control group in post-intervention pain, cervical flexion, cervical extension and cervical (right and left lateral rotations. Conclusion: Cervical manipulation is effective in immediate pain relief and improvement in cervical range of motion in patients with mechanical neck pain

  20. Examining the Time to Therapeutic Effect of Pregabalin in Spinal Cord Injury Patients With Neuropathic Pain.

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    Cardenas, Diana D; Emir, Birol; Parsons, Bruce

    2015-05-01

    In 2 large-scale, placebo-controlled trials, pregabalin improved both pain and pain-related sleep interference in patients with neuropathic pain due to spinal cord injury (SCI). In both trials, pregabalin found statistically significant improvement compared with placebo after 1 week of treatment. However, the effects of pregabalin in the days immediately after initiation of treatment are unknown. The purpose of the present analysis was to determine timing of pregabalin's therapeutic effect in the days after initiation of treatment. Data were derived from 2 trials of pregabalin in patients with SCI-related neuropathic pain. Each day patients rated severity of pain and pain-related sleep interference over the past 24 hours on a scale from 0 to 10, with higher scores indicating greater severity. To quantify timing of therapeutic effect, we compared (pregabalin [vs] placebo) daily average pain and pain-related sleep interference scores over the first 14 days of treatment. Significant improvement was defined as the first day, of ≥2 consecutive days, that pregabalin significantly (P pain and pain-related sleep interference score among patients with a clinically meaningful and sustained response (≥30% improvement from baseline to end point) by using a time-to-event analysis method. Kaplan-Meier analyses were used to estimate the median (or 25th quartile) time (in days) required to achieve a ≥1-point improvement, among these responders, in pain and pain-related sleep interference scores. Comparisons between pregabalin and placebo were made with a log-rank test. In both trials, significant improvement of pain and pain-related sleep interference occurred within 2 days of initiating treatment with pregabalin. Among patients reporting a clinically meaningful and sustained response to treatment (patients with ≥30% improvement from baseline to end point), the time to a ≥1-point improvement of pain and pain-related sleep interference occurred significantly earlier among

  1. Is Transcranial Direct Current Stimulation an Effective Predictor for Invasive Occipital Nerve Stimulation Treatment Success in Fibromyalgia Patients?

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    Plazier, Mark; Tchen, Stephanie; Ost, Jan; Joos, Kathleen; De Ridder, Dirk; Vanneste, Sven

    2015-10-01

    Fibromyalgia is a disorder distinguished by pervasive musculoskeletal pain that has pervasive effects on affected individuals magnifying the importance of finding a safe and viable treatment option. The goal of this study is to investigate if transcranial direct current stimulation (tDCS) treatment can predict the outcome of occipital nerve field stimulation (ONFS) via a subcutaneous electrode. Nine patients with fibromyalgia were selected fulfilling the American College of Rheumatology-90 criteria. The patients were implanted with a subcutaneous trial-lead in the C2 dermatome innervated by the occipital nerve. After the treatment phase of ONFS using a C2 implant, each patient participated in three sessions of tDCS. Stimulation outcomes for pain suppression were examined between the two methods to determine possible correlations. Positive correlation of stimulation effect was noted between the numeric rating scale changes for pain obtained by tDCS treatments and short-term measures of ONFS, but no correlation was noted between tDCS and long-term ONFS outcomes. A correlation also was noted between short-term ONS C2 implant pain suppression and long-term ONS C2 implant treatment success. This pilot study suggests that tDCS is a predictive measure for success of OFNS in short-term but cannot be used as a predictive measure for success of long-term OFNS. Our data confirm previous findings that ONFS via an implanted electrode can improve fibromyalgia pain in a placebo-controlled way and exert a long-term pain suppression effect for ONFS via an implanted electrode. © 2015 International Neuromodulation Society.

  2. Testing the impact of a multimedia video CD of patient-controlled analgesia on pain knowledge and pain relief in patients receiving surgery.

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