When the Pain Becomes Unbearable: Case-Control Study of Mental Pain Characteristics Among Medically Serious Suicide Attempters.

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Levi-Belz, Y; Gvion, Y; Grisaru, S; Apter, A

2018-01-01

The unbearable mental pain experience is recognized as a key antecedent of suicidal behavior. We aimed to examine the precise nature of the mental pain among medically serious suicide attempters (MSSAs), a population closely resembling those who died by suicide. We evaluated various factors of mental pain from the Orbach and Mikulincer Mental Pain Scale, as well as medical lethality and suicide intent. MSSAs were higher than non-MSSAs and psychiatric controls for Irreversibility of pain. Moreover, Emptiness predicted medical lethality, while Cognitive Confusion negatively predicted suicide intent level, controlling for hopelessness and depression. high sense of Irreversibility of pain as well as high Emptiness and low Cognitive Confusion are important risk factors for more severe suicidal behavior. Implications for identification of at-risk groups for suicide as well as for suicide prevention and treatment of suicidal individuals are discussed.

Medical Judgments Across the Range of Reported Pain Severity: Clinician and Lay Perspectives.

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Tait, Raymond C; Chibnall, John T; House, Kylie; Biehl, Joann

2016-07-01

While increasing evidence suggests that observers discount high-severity chronic pain, factors that occasion such discounting are poorly understood, particularly regarding health provider vs lay perspectives. This study examined the effects of supporting medical evidence and comorbid psychological distress (pain behavior) on medical student and lay clinical judgments of increasingly severe patient pain reports. In a 2 × 2 × 2 × (7) mixed between- and within-subject design, participants (medical students vs lay) made clinical judgments after reading vignettes describing a hypothetical patient that varied in levels of medical evidence and pain behavior (low vs high) and pain severity (4/10-10/10). Fourth-year medical students (N = 115) and lay persons in the community (N = 300) participated in this research. While both medical student and lay judgments plateaued at high levels of pain severity, judgments regarding cause (medical vs psychological), treatment (opioid prescription), and disability showed growing divergence as levels of reported pain severity increased. Divergence relative to medical and psychological causes of pain was found irrespective of the level of supporting medical evidence; divergence relative to opioid treatment and support for a disability claim was found when supporting medical evidence was low. The results indicate differing expectations of chronic pain treatment for health care providers relative to the lay public that could impact clinical care, especially at high pain severity levels, where lay expectations diverge significantly from those of health professionals. © 2015 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Medical cannabis: considerations for the anesthesiologist and pain physician.

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Beaulieu, Pierre; Boulanger, Aline; Desroches, Julie; Clark, Alexander J

2016-05-01

New regulations are in place at the federal and provincial levels in Canada regarding the way medical cannabis is to be controlled. We present them together with guidance for the safe use of medical cannabis and recent clinical trials on cannabis and pain. The new Canadian regulations on the use of medical cannabis, the provincial regulations, and the various cannabis products available from the Canadian Licensed Producers were reviewed from Health Canada, provincial licensing authorities, and the licensed producers website, respectively. Recent clinical trials on cannabis and pain were reviewed from the existing literature. Health Canada has approved a new regulation on medical marijuana/cannabis, the Marihuana for Medical Purposes Regulations: The production of medical cannabis by individuals is illegal. Health Canada, however, has licensed authorized producers across the country, limiting the production to specific licenses of certain cannabis products. There are currently 26 authorized licensed producers from seven Canadian provinces offering more than 200 strains of marijuana. We provide guidance for the safe use of medical cannabis. The recent literature indicates that currently available cannabinoids are modestly effective analgesics that provide a safe, reasonable therapeutic option for managing chronic non-cancer-related pain. The science of medical cannabis and the need for education of healthcare professionals and patients require continued effort. Although cannabinoids work to decrease pain, there is still a need to confirm these beneficial effects clinically and to exploit them with acceptable benefit-to-risk ratios.

Social, Psychological, and Medical Aspects of Chronic Pain.

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Sparks, Jayne A.; Clark, Donald W.

1981-01-01

Discusses certain factors that contribute to the development of chronic pain. Psychosocial factors are explored with a summary of their implications for treatment. Medical treatment for chronic pain is reviewed and holistic treatment is surveyed. (Author)

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.

Morphine as first medication for treatment of cancer pain

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Beatriz C. Nunes

2014-07-01

Full Text Available BACKGROUND AND OBJECTIVES: the medications used according to the recommendation of the World Health Organization do not promote pain relief in a number of patients with cancer pain. The aim of this study was to evaluate the use of morphine as first medication for the treatment of moderate cancer pain in patients with advanced and/or metastatic disease, as an option to the recommendations of the World Health Organization analgesic ladder. METHOD: sixty patients without opioid therapy, with >18 years of age, were randomized into two groups. G1 patients received medication according to the analgesic ladder and started treatment with non-opioids in the first, weak opioids in the second, and strong opioids in the third step; G2 patients received morphine as first analgesic medication. The efficacy and tolerability of initial use of morphine were evaluated every two weeks for three months. RESULTS: the groups were similar with respect to demographic data. There was no significant difference between the groups regarding pain intensity, quality of life, physical capacity, satisfaction with treatment, need for complementation and dose of morphine. In G1 there was a higher incidence of nausea (p = 0.0088, drowsiness (p = 0.0005, constipation (p = 0.0071 and dizziness (p = 0.0376 in the second visit and drowsiness (p = 0.05 in the third. CONCLUSIONS: the use of morphine as first medication for pain treatment did not promote better analgesic effect than the ladder recommended by World Health Organization, with higher incidence of adverse effects.

Do Medical Marijuana Laws Reduce Addictions and Deaths Related to Pain Killers?

OpenAIRE

David Powell; Rosalie Liccardo Pacula; Mireille Jacobson

2015-01-01

Many medical marijuana patients report using marijuana to alleviate chronic pain from musculoskeletal problems and other sources. If marijuana is used as a substitute for powerful and addictive pain relievers in medical marijuana states, a potential overlooked positive impact of medical marijuana laws may be a reduction in harms associated with opioid pain relievers, a far more addictive and potentially deadly substance. To assess this issue, we study the impact of medical marijuana laws on p...

Medical marijuana use for chronic pain: risks and benefits.

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Greenwell, Garth T

2012-01-01

Questions from patients about medical marijuana use for chronic pain are becoming more common. The information in this report will help patients understand the potential risks and benefits of using this substance for painful conditions.

Health Care Professionals’ Pain Narratives in Hospitalized Children’s Medical Records. Part 1: Pain Descriptors

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Judy Rashotte

2013-01-01

Full Text Available BACKGROUND: Although documentation of children’s pain by health care professionals is frequently undertaken, few studies have explored the nature of the language used to describe pain in the medical records of hospitalized children.

Risky business: rhesus monkeys exhibit persistent preferences for risky options.

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Xu, Eric R; Kralik, Jerald D

2014-01-01

Rhesus monkeys have been shown to prefer risky over safe options in experiential decision-making tasks. These findings might be due, however, to specific contextual factors, such as small amounts of fluid reward and minimal costs for risk-taking. To better understand the factors affecting decision-making under risk in rhesus monkeys, we tested multiple factors designed to increase the stakes including larger reward amounts, distinct food items rather than fluid reward, a smaller number of trials per session, and risky options with greater variation that also included non-rewarded outcomes. We found a consistent preference for risky options, except when the expected value of the safe option was greater than the risky option. Thus, with equivalent mean utilities between the safe and risky options, rhesus monkeys appear to have a robust preference for the risky options in a broad range of circumstances, akin to the preferences found in human children and some adults in similar tasks. One account for this result is that monkeys make their choices based on the salience of the largest payoff, without integrating likelihood and value across trials. A related idea is that they fail to override an impulsive tendency to select the option with the potential to obtain the highest possible outcome. Our results rule out strict versions of both accounts and contribute to an understanding of the diversity of risky decision-making among primates.

Optimizing urine drug testing for monitoring medication compliance in pain management.

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Melanson, Stacy E F; Ptolemy, Adam S; Wasan, Ajay D

2013-12-01

It can be challenging to successfully monitor medication compliance in pain management. Clinicians and laboratorians need to collaborate to optimize patient care and maximize operational efficiency. The test menu, assay cutoffs, and testing algorithms utilized in the urine drug testing panels should be periodically reviewed and tailored to the patient population to effectively assess compliance and avoid unnecessary testing and cost to the patient. Pain management and pathology collaborated on an important quality improvement initiative to optimize urine drug testing for monitoring medication compliance in pain management. We retrospectively reviewed 18 months of data from our pain management center. We gathered data on test volumes, positivity rates, and the frequency of false positive results. We also reviewed the clinical utility of our testing algorithms, assay cutoffs, and adulterant panel. In addition, the cost of each component was calculated. The positivity rate for ethanol and 3,4-methylenedioxymethamphetamine were us to optimize our testing panel for monitoring medication compliance in pain management and reduce cost. Wiley Periodicals, Inc.

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

[Medical Devices Law for pain therapists].

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Regner, M; Sabatowski, R

2016-08-01

Medical Devices Law is a relatively new legal system, which has replaced the Medical Devices Regulations still well-known in Germany. German Medical Devices Law is based on European directives, which are, in turn, incorporated into national law by the Medical Devices Act. The Medical Devices Act is a framework law and covers a number of regulations that address specific topics within Medical Devices Law. In turn, in individual regulations, reference is made to guidelines, recommendations, etc. from other sources that provide detailed technical information on specific topics. Medical Devices Law is a very complex legal system, which needs to be permanently observed due to constant updating and adjustment. In the current article, the design and the structure of the system will be described, but special emphasis will be laid on important problem areas that need to be considered when applying and operating medical products, in this case by pain therapists in particular.

Effectiveness of an interprofessional workshop on pain management for medical and nursing students.

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Erickson, Jeanne M; Brashers, Valentina; Owen, John; Marks, Jennifer R; Thomas, Shannon M

2016-07-01

Interprofessional (IP) care is critical for effective pain management, but evidence is lacking about the best way to teach pain management skills to medical and nursing students using IP strategies. In 2013 and 2014, 307 medical and 169 nursing students participated in an IP case-based pain management workshop. The aims of this study were to determine (1) if students who participate in IP case-based learning groups will have improved pain management skills compared to students who participate in uniprofessional case-based learning groups, and (2) if students mentored by faculty with IP training will have improved pain management skills compared to students who are not mentored by IP-trained faculty. Student learning was assessed and compared using scored checklists for each group's pain management plans. Findings show that IP mentorship and IP group participation improved medical students' pain management skills but did not have the same effect on nursing student performance. Continued work is needed to develop, refine, and integrate innovative and tailored IP strategies into the curricula of medical and nursing schools to advance the pain management competencies of students before they enter clinical practice.

[Delegation of medical activities in acute pain therapy].

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

2018-01-01

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

Current pain education within undergraduate medical studies across Europe: Advancing the Provision of Pain Education and Learning (APPEAL) study

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Briggs, Emma V; Battelli, Daniele; Gordon, David; Kopf, Andreas; Ribeiro, Sofia; Puig, Margarita M; Kress, Hans G

2015-01-01

Objectives Unrelieved pain is a substantial public health concern necessitating improvements in medical education. The Advancing the Provision of Pain Education and Learning (APPEAL) study aimed to determine current levels and methods of undergraduate pain medicine education in Europe. Design and methods Using a cross-sectional design, publicly available curriculum information was sought from all medical schools in 15 representative European countries in 2012–2013. Descriptive analyses were performed on: the provision of pain teaching in dedicated pain modules, other modules or within the broader curriculum; whether pain teaching was compulsory or elective; the number of hours/credits spent teaching pain; pain topics; and teaching and assessment methods. Results Curriculum elements were publicly available from 242 of 249 identified schools (97%). In 55% (133/242) of schools, pain was taught only within compulsory non-pain-specific modules. The next most common approaches were for pain teaching to be provided wholly or in part via a dedicated pain module (74/242; 31%) or via a vertical or integrated approach to teaching through the broader curriculum, rather than within any specific module (17/242; 7%). The curricula of 17/242 schools (7%) showed no evidence of any pain teaching. Dedicated pain modules were most common in France (27/31 schools; 87%). Excluding France, only 22% (47/211 schools) provided a dedicated pain module and in only 9% (18/211) was this compulsory. Overall, the median number of hours spent teaching pain was 12.0 (range 4–56.0 h; IQR: 12.0) for compulsory dedicated pain modules and 9.0 (range 1.0–60.0 h; IQR: 10.5) for other compulsory (non-pain specific) modules. Pain medicine was principally taught in classrooms and assessed by conventional examinations. There was substantial international variation throughout. Conclusions Documented pain teaching in many European medical schools falls far short of what might be expected given the

An over-the-counter central sensitization therapy: a chronic back pain registry study of pain relief, medication use and their adverse effects.

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Staelin, Richard; Koneru, Sree N; Rawe, Ian M

2017-03-01

Back pain, the most prevalent musculoskeletal chronic pain condition, is usually treated with analgesic medications of questionable efficacy and frequent occurrence of adverse side effects. The objective was to determine the effectiveness of the ActiPatch medical devices in reducing chronic back pain, document medication related adverse side effects and establish their impact on quality of life. Upon completing a 7-day trial, subjects were contacted via email with an assessment form using the Constant Contact email program. A total of 1394 responses were collected from subjects who used the device for back pain. Medication adverse effects are common and impact quality of life in the lay population. ActiPatch is an effective intervention for the majority of subjects for treating chronic back pain, although this requires further investigation in randomized clinical trials.

Pain medicine: The case for an independent medical specialty and training programs.

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Dubois, Michel Y; Follett, Kenneth A

2014-06-01

Over the last 30 years, pain has become one of the most dynamic areas of medicine and a public health issue. According to a recent Institute of Medicine report, pain affects approximately 100 million Americans at an estimated annual economic cost of $560 to $635 billion and is poorly treated overall. The American Board of Medical Specialties (ABMS) recognizes a pain subspecialty, but pain care delivery has struggled with increasing demand and developed in an inconsistent and uncoordinated fashion. Pain education is insufficient and highly variable. Multiple pain professional organizations have led to fragmentation of the field and lack of interdisciplinary agreement, resulting in confusion regarding who speaks for pain medicine. In this Perspective, the authors argue that ABMS recognition of pain medicine as an independent medical specialty would provide much needed structure and oversight for the field and would generate credibility for the specialty and its providers among medical peers, payers, regulatory and legislative agencies, and the public at large. The existing system, managed by three ABMS boards, largely excludes other specialties that contribute to pain care, fails to provide leadership from a single professional organization, provides suboptimal training exposure to pain medicine, and lengthens training, which results in inefficient use of time and educational resources. The creation of a primary ABMS conjoint board in pain medicine with its own residency programs and departments would provide better coordinated training, ensure the highest degree of competence of pain medicine specialists, and improve the quality of pain care and patient safety.

Prevalence of different pain categories based on pain spreading on the bodies of older adults in Sweden: a descriptive-level and multilevel association with demographics, comorbidities, medications, and certain lifestyle factors (PainS65+

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Dragioti E

2016-11-01

Full Text Available E Dragioti,1 B Larsson,1 L Bernfort,2 LÅ Levin,2 B Gerdle1 1Pain and Rehabilitation Medicine, 2Division of Health Care Analysis, Department of Medical and Health Sciences (IMH, Faculty of Health Sciences, Linköping University, Linköping, Sweden Background and objective: There is limited knowledge about the prevalence of pain and its relation to comorbidities, medication, and certain lifestyle factors in older adults. To address this limitation, this cross-sectional study examined the spreading of pain on the body in a sample of 6611 subjects ≥65 years old (mean age = 75.0 years; standard deviation [SD] = 7.7 living in southeastern Sweden.Methods: Sex, age, comorbidities, medication, nicotine, alcohol intake, and physical activity were analyzed in relation to the following pain categories: local pain (LP (24.1%, regional pain medium (RP-Medium (20.3%, regional pain heavy (RP-Heavy (5.2%, and widespread pain (WSP (1.7%.Results: RP-Medium, RP-Heavy, and WSP were associated more strongly with women than with men (all p<0.01. RP-Heavy was less likely in the 80–84 and >85 age groups compared to the 65–69 age group (both p<0.01. Traumatic injuries, rheumatoid arthritis/osteoarthritis, and analgesics were associated with all pain categories (all p<0.001. An association with gastrointestinal disorders was found in LP, RP-Medium, and RP-Heavy (all p<0.01. Depressive disorders were associated with all pain categories, except for LP (all p<0.05. Disorders of the central nervous system were associated with both RP-Heavy and WSP (all p<0.05. Medication for peripheral vascular disorders was associated with RP-Medium (p<0.05, and hypnotics were associated with RP-Heavy (p<0.01.Conclusion: More than 50% of older adults suffered from different pain spread categories. Women were more likely to experience greater spreading of pain than men. A noteworthy number of common comorbidities and medications were associated with increased likelihood of pain

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

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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.

Medically Unexplained Pain Is Not Caused by Psychopathology

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Lucia Gagliese

2000-01-01

Full Text Available This paper highlights Professor Ronald Melzack's theoretical contributions to the understanding of psychological factors in pain. His work continues to have profound influences on pain theory, research, management and public policy. His ideas have been pivotal to the acceptance of the role of the brain and psychological factors in the experience of pain. This article briefly outlines the prevailing theories of the psychology of pain before the gate-control theory. Melzack's contributions argue against the simplistic linear thinking inherent in specificity theory, which leads to the attribution of pain to either 'organic' or 'psychogenic' causes. Nevertheless, Cartesian dualism continues to thrive. The authors illustrate the nature and extent to which dualistic thinking pervades the field, show that a dualistic conceptualization of pain introduces an element of distrust to the relationship between patient and health professional, and conclude that the available data fail to reach today's standards for an evidence-based approach to pain. The authors believe that medically unexplained pain is not a symptom of a psychological disorder and that it is time to abandon the thinking that separates mind and body. The challenge remains for proponents to provide the empirical evidence to prove that psychopathology causes pain and, in so doing, to specify the mechanisms by which it is generated.

Effect of Concomitant Pain Medications on Response to Pregabalin in Patients with Postherpetic Neuralgia or Spinal Cord Injury-Related Neuropathic Pain.

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Schug, Stephan A; Parsons, Bruce; Almas, Mary; Whalen, Ed

2017-01-01

Patients with neuropathic pain (NeP) often receive combination therapy with multiple agents in the hopes of improving both pain and any comorbidities that may be present. While pregabalin is often recommended as a first-line treatment of NeP, few studies have examined the effects of concomitant medications on the efficacy of pregabalin. To examine the effects of concomitant medications on the efficacy and safety of pregabalin for the treatment of NeP. Data were derived from 7 randomized placebo-controlled trials of pregabalin (150, 300, 600, and flexible 150 - 600 mg/d) for the treatment of postherpetic neuralgia (PHN) and 2 randomized placebo-controlled trials for the treatment of NeP due to spinal cord injury (SCI-NeP). On each day, patients rated the severity of their pain and pain-related sleep interference (PRSI) over the previous 24 hours on a scale from 0 to 10, with higher scores indicating greater severity. Patients were also continually monitored for the occurrence of adverse events. A pooled retrospective analyses of data from randomized clinical trials. Changes from baseline in mean weekly pain and PRSI scores were compared between patients who received concomitant NeP medications and patients who did not receive concomitant NeP medications. Results of these comparisons are presented separately for the PHN (through 4, 8, and 12 weeks) and SCI-NeP (through 12 weeks) cohorts. Common adverse events are also presented for each treatment group. Pregabalin significantly improved both pain and PRSI scores relative to placebo at most dose levels and time points examined. Notably, little difference was observed in the extent of therapeutic response to pregabalin between patients who received concomitant NeP medications and patients who did not receive concomitant NeP medications. Additionally, the profile of treatment-emergent adverse events appeared to be largely unaffected by the use of concomitant NeP medications in the pooled patient population. Our analysis

Alcohol consumption and risky drinking patterns in Malaysia: findings from NHMS 2011.

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Mutalip, Mohd Hatta B Abdul; Kamarudin, Rozanim Bt; Manickam, Mala; Abd Hamid, Hamizatul Akmal Bt; Saari, Riyanti Bt

2014-01-01

To identify the characteristics of current drinker and risky alcohol-drinking pattern by profiles in Malaysia. We analyzed data from the National Health and Morbidity Survey 2011. It was a cross-sectional population-based with two stages stratified random sampling design. A validated Alcohol Use Disorder Identification Test Malay questionnaire was used to assess the alcohol consumption and its alcohol related harms. Analysis of complex survey data using Stata Version 12 was done for descriptive analysis on alcohol use and risky drinking by socio-demography profiles. Logistic regression analysis was used to measure the association of risky drinking status with the socio-demography characteristics. The prevalence of current alcohol use was 11.6% [95% confidence interval (CI): 10.5, 12.7], among them 23.6% (95% CI: 21.0, 26.4) practiced risky drinking. The onset for alcohol drinking was 21 years old (standard deviation 7.44) and majority preferred Beer. Males significantly consumed more alcohol and practiced risky drinking. Current alcohol use was more prevalent among urbanites, Chinese, those with high household income, and high education. Conversely, risky drinking was more prevalent among rural drinkers, Bumiputera Sabah and Sarawak, low education and low household income. The estimated odds of risky drinking increased by a factor of 3.5 among Males while a factor of 2.7 among Bumiputera Sabah and Sarawak. Education status and household income was not a significant predictor to risky drinking. There was an inverse drinking pattern between current drinker and risky drinking by the socio-demography profiles. Initiating early screening and focused intervention might avert further alcohol related harms and dependence among the risky drinkers. © The Author 2014. Medical Council on Alcohol and Oxford University Press. All rights reserved.

Improving undergraduate medical education about pain assessment and management: A qualitative descriptive study of stakeholders’ perceptions

Science.gov (United States)

Tellier, Pierre-Paul; Bélanger, Emmanuelle; Rodríguez, Charo; Ware, Mark A; Posel, Nancy

2013-01-01

BACKGROUND Pain is one of the most common reasons for individuals to seek medical advice, yet it remains poorly managed. One of the main reasons that poor pain management persists is the lack of adequate knowledge and skills of practicing clinicians, which stems from a perceived lack of pain education during the training of undergraduate medical students. OBJECTIVE: To identify gaps in knowledge with respect to pain management as perceived by students, patients and educators. METHODS: A qualitative descriptive study was conducted. Data were generated through six focus groups with second- and fourth-year medical students, four focus groups with patients and individual semistructured interviews with nine educators. All interviews were audiotaped and an inductive thematic analysis was performed. RESULTS: A total of 70 individuals participated in the present study. Five main themes were identified: assessment of physical and psychosocial aspects of pain; clinical management of pain with pharmacology and alternative therapies; communication and the development of a good therapeutic relationship; ethical considerations surrounding pain; and institutional context of medical education about pain. CONCLUSION: Participating patients, students and pain experts recognized a need for additional medical education about pain assessment and management. Educational approaches need to teach students to gather appropriate information about pain, to acquire knowledge of a broad spectrum of therapeutic options, to develop a mutual, trusting relationship with patients and to become aware of their own biases and prejudice toward patients with pain. The results of the present study should be used to develop and enhance existing pain curricula content. PMID:23985579

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

Science.gov (United States)

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

2018-01-01

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

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.

"Just Advil": Harm reduction and identity construction in the consumption of over-the-counter medication for chronic pain.

Science.gov (United States)

Eaves, Emery R

2015-12-01

Direct-to-consumer marketing has sparked ongoing debate concerning whether ads empower consumers to be agents of their own care or shift greater control to the pharmaceutical industry. Ads for over-the-counter (OTC) medications in particular portend to offer simple, harmless solutions for meeting the demands of social life. Rather than join the longstanding debate between consumer agency and social control in pharmaceutical advertising, I approach self-medication with over-the-counter (OTC) analgesics using Harm Reduction as a framework. From this perspective, consumption of OTC analgesics by chronic pain sufferers is a means of seeking some level of relief while also avoiding the stigma associated with prescription pain medication. Qualitative methods are used to analyze data from two sources: (1) semi-structured qualitative interviews with 95 participants in a trial examining the effectiveness of Traditional Chinese Medicine for Temporomandibular Disorders (TMD) from 2006 to 2011 in Tucson, AZ and Portland, OR; and (2) print, online, and television advertisements for three major brands of OTC pain medication. Participants described their use of OTC medications as minimal, responsible, and justified by the severity of their pain. OTC medication advertising, while ostensibly ambiguous and targeting all forms of pain, effectively lends support to the consumption of these medications as part of the self-projects of chronic pain sufferers, allowing them to reconcile conflicting demands for pain relief while being stoic and maintaining a positive moral identity. Describing OTC medication as "just over-the-counter" or "not real pain medication," sufferers engage in ideological harm reduction, distinguishing themselves from "those people who like taking pain medication" while still seeking relief. Justifying one's use of OTC medication as minimal and "normal," regardless of intake, avoids association with the addictive potential of prescription pain medications and

[Structure of pain management facilities in Germany : Classification of medical and psychological pain treatment services-Consensus of the Joint Commission of the Professional Societies and Organizations for Quality in Pain Medicine].

Science.gov (United States)

Müller-Schwefe, G H H; Nadstawek, J; Tölle, T; Nilges, P; Überall, M A; Laubenthal, H J; Bock, F; Arnold, B; Casser, H R; Cegla, T H; Emrich, O M D; Graf-Baumann, T; Henning, J; Horlemann, J; Kayser, H; Kletzko, H; Koppert, W; Längler, K H; Locher, H; Ludwig, J; Maurer, S; Pfingsten, M; Schäfer, M; Schenk, M; Willweber-Strumpf, A

2016-06-01

On behalf of the Medical/Psychological Pain Associations, Pain Patients Alliance and the Professional Association of Pain Physicians and Psychologists, the Joint Commission of Professional Societies and Organizations for Quality in Pain Medicine, working in close collaboration with the respective presidents, has developed verifiable structural and process-related criteria for the classification of medical and psychological pain treatment facilities in Germany. Based on the established system of graded care in Germany and on existing qualifications, these criteria also argue for the introduction of a basic qualification in pain medicine. In addition to the first-ever comprehensive description of psychological pain facilities, the criteria presented can be used to classify five different levels of pain facilities, from basic pain management facilities, to specialized institutions, to the Centre for Interdisciplinary Pain Medicine. The recommendations offer binding and verifiable criteria for quality assurance in pain medicine and improved pain treatment.

Patients' use of the Internet for pain-related medical information

NARCIS (Netherlands)

de Boer, Maaike J.; Versteegen, Gerbrig J.; van Wijhe, Marten

Objective: Patients increasingly use the Internet for medical information. For doctor-patient communication it is important to gain insight into the use and impact of medical Internet searches of patients. This study aims to evaluate patients' use of the Internet for information about their pain

The prevalence and characterization of self-medication for obtaining pain relief among undergraduate nursing students

OpenAIRE

Souza,Layz Alves Ferreira; Silva,Camila Damázio da; Ferraz,Gisely Carvalho; Sousa,Fátima Aparecida Emm Faleiros; Pereira,Lílian Varanda

2011-01-01

This study investigates the prevalence of self-medication among undergraduate nursing students seeking to relieve pain and characterizes the pain and relief obtained through the used medication. This epidemiological and cross-sectional study was carried out with 211 nursing students from a public university in Goiás, GO, Brazil. A numerical scale (0-10) measured pain intensity and relief. The prevalence of self-medication was 38.8%. The source and main determining factor of this practice were...

Incidence, characteristics and management of pain in one operational area of medical emergency teams.

Science.gov (United States)

Kosiński, Sylweriusz; Bryja, Magdalena; Wojtaszowicz, Rafał; Górka, Andrzej

2014-01-01

Experience of pain associated with both chronic as well as acute medical conditions is a main cause for call for ambulance. The aim of this study was to establish both frequency and characteristics of pain reported by patients treated in pre-hospital environment in a single operational area. The supplementary goal was an analysis of methods of pain alleviation applied by medical personnel in the above described scenario. The written documentation of 6 months of year 2009 provided by doctor-manned as well as paramedic-only ambulances operating in Tatra county, Małopolska, Poland was analyzed. Medical personnel inquired about pain experienced in 57.4% of cases, 10-point numerical rating scale was used in 22.3% of patients. Pain was reported by 43.8% of patients, the most frequent reasons of experienced pain were trauma and cardiovascular diseases. In almost half of the cases pain was referred to the areas of chest and abdomen. Non-traumatic pain was reported by 47.7% of patients, post-traumatic in 41.3% of cases, 11% of subjects reported ischemic chest pain. 42.3% of pain-reporting patients received some form of analgesia, yet only 3% of subjects in this group received opiates. Personnel of paramedic-only ambulances tended to use pain intensity scale more often (P < 0.01), yet administered pain alleviating drugs noticeably less often than the doctor-manned teams (P < 0.01). The use of pain alleviating drugs, opiates especially, was inadequate in proportion to frequency and intensity of pain reported by patients. General, nation-wide standards of pain measurement and treatment in pre-hospital rescue are suggested as a means to improve the efficacy of pain reduction treatment.

Pain clinic definitions in the medical literature and U.S. state laws: an integrative systematic review and comparison.

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Andraka-Christou, Barbara; Rager, Joshua B; Brown-Podgorski, Brittany; Silverman, Ross D; Watson, Dennis P

2018-05-22

In response to widespread opioid misuse, ten U.S. states have implemented regulations for facilities that primarily manage and treat chronic pain, called "pain clinics." Whether a clinic falls into a state's pain clinic definition determines the extent to which it is subject to oversight. It is unclear whether state pain clinic definitions model those found in the medical literature, and potential differences lead to discrepancies between scientific and professionally guided advice found in the medical literature and actual pain clinic practice. Identifying discrepancies could assist states to design laws that are more compatible with best practices suggested in the medical literature. We conducted an integrative systematic review to create a taxonomy of pain clinic definitions using academic medical literature. We then identified existing U.S. state pain clinic statutes and regulations and compared the developed taxonomy using a content analysis approach to understand the extent to which medical literature definitions are reflected in state policy. In the medical literature, we identified eight categories of pain clinic definitions: 1) patient case mix; 2) single-modality treatment; 3) multidisciplinary treatment; 4) interdisciplinary treatment; 5) provider supervision; 6) provider composition; 7) marketing; and 8) outcome. We identified ten states with pain clinic laws. State laws primarily include the following definitional categories: patient case mix; single-modality treatment, and marketing. Some definitional categories commonly found in the medical literature, such as multidisciplinary treatment and interdisciplinary treatment, rarely appear in state law definitions. This is the first study to our knowledge to develop a taxonomy of pain clinic definitions and to identify differences between pain clinic definitions in U.S. state law and medical literature. Future work should explore the impact of different legal pain clinic definitions on provider decision

Predictors of risky sexual behavior in African American adolescent girls: implications for prevention interventions.

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Bachanas, Pamela J; Morris, Mary K; Lewis-Gess, Jennifer K; Sarett-Cuasay, Eileen J; Sirl, Kimberly; Ries, Julie K; Sawyer, Mary K

2002-09-01

To describe empirically the risky sexual behavior of an at-risk sample of adolescent girls, to assess psychosocial correlates of risky behavior, and to examine the utility of applying a risk and protective model to predicting teens' risky sexual behavior. Participants included 158 African American girls, ages 12 to 19, who were receiving medical care in an adolescent primary care clinic. Teens completed measures of depression, conduct problems, substance use, peer norms, social support, HIV knowledge, sexual self-efficacy, and sexual behavior. Teens in this sample reported high rates of risky sexual behaviors, including early sexual debuts and frequent unprotected sexual encounters with multiple partners. African American girls who reported high rates of substance use and who reported that their peers engaged in risky behaviors also reported engaging in high rates of risky sexual behaviors. Little support was obtained for protective factors (HIV knowledge, social support, sexual self-efficacy) moderating the relations between risk factors and adolescents' risky sexual behavior in this sample. Teens presenting in primary care settings in urban environments seem to be at high risk for HIV, STDs, and substance abuse, and risk reduction strategies should be introduced during the preteen years. An interdisciplinary model of care in primary care settings serving adolescents is clearly indicated, and prevention-oriented interventions aimed at reducing risky behaviors and preventing the development of more significant health, mental health, or substance abuse disorders are needed.

The prevalence and characterization of self-medication for obtaining pain relief among undergraduate nursing students.

Science.gov (United States)

Souza, Layz Alves Ferreira; da Silva, Camila Damázio; Ferraz, Gisely Carvalho; Sousa, Fátima Aparecida Emm Faleiros; Pereira, Lílian Varanda

2011-01-01

This study investigates the prevalence of self-medication among undergraduate nursing students seeking to relieve pain and characterizes the pain and relief obtained through the used medication. This epidemiological and cross-sectional study was carried out with 211 nursing students from a public university in Goiás, GO, Brazil. A numerical scale (0-10) measured pain intensity and relief. The prevalence of self-medication was 38.8%. The source and main determining factor of this practice were the student him/herself (54.1%) and lack of time to go to a doctor (50%), respectively. The most frequently used analgesic was dipyrone (59.8%) and pain relief was classified as good (Md=8.5;Max=10;Min=0). The prevalence of self-medication was higher than that observed in similar studies. Many students reported that relief obtained through self-medication was good, a fact that can delay the clarification of a diagnosis and its appropriate treatment.

Dopaminergic Modulation of Risky Decision-Making

Science.gov (United States)

Simon, Nicholas W.; Montgomery, Karienn S.; Beas, Blanca S.; Mitchell, Marci R.; LaSarge, Candi L.; Mendez, Ian A.; Bañuelos, Cristina; Vokes, Colin M.; Taylor, Aaron B.; Haberman, Rebecca P.; Bizon, Jennifer L.; Setlow, Barry

2012-01-01

Many psychiatric disorders are characterized by abnormal risky decision-making and dysregulated dopamine receptor expression. The current study was designed to determine how different dopamine receptor subtypes modulate risk-taking in young adult rats, using a “Risky Decision-making Task” that involves choices between small “safe” rewards and large “risky” rewards accompanied by adverse consequences. Rats showed considerable, stable individual differences in risk preference in the task, which were not related to multiple measures of reward motivation, anxiety, or pain sensitivity. Systemic activation of D2-like receptors robustly attenuated risk-taking, whereas drugs acting on D1-like receptors had no effect. Systemic amphetamine also reduced risk-taking, an effect which was attenuated by D2-like (but not D1-like) receptor blockade. Dopamine receptor mRNA expression was evaluated in a separate cohort of drug-naive rats characterized in the task. D1 mRNA expression in both nucleus accumbens shell and insular cortex was positively associated with risk-taking, while D2 mRNA expression in orbitofrontal and medial prefrontal cortex predicted risk preference in opposing nonlinear patterns. Additionally, lower levels of D2 mRNA in dorsal striatum were associated with greater risk-taking. These data strongly implicate dopamine signaling in prefrontal corticalstriatal circuitry in modulating decision-making processes involving integration of reward information with risks of adverse consequences. PMID:22131407

The Effect of Adolescent Training Program on Risky Health Behaviours and Health Perception

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Meltem KÜRTÜNCÜ

2015-09-01

Full Text Available The aim of this study was to determine the risky health behaviors and to raise the awareness of adolescents (attending high school education about prevention of risky behaviors and solutions by the effect of module-based training courses (about reproductive health and birth control, sexually transmitted infections, harmful habits, psychosocial behavior. Being planned as cross-sectional, this study was performed between September 2013-June 2014 in three states and a private high school in Zonguldak and conducted with a group of students aged between 14 and 19.926 students have participated before the training and 534 students have participated after training. It was seen that the mean scores of ‘The Adolescent Risk-Taking Questionnaire', ‘The Adolescent's Attitudes Towards Violence Scale' and ‘taking risk about social status', ‘traffic', ‘subtance use' subscales have decreased after the risk prevention trainings. The means scores of ‘Adolescent Coping with Problems Scale', ‘Nutrition Behaviour Scale' and ‘Nutrition Attitude Scale' have raised. Hence, the scores of domains reflecting adolescent health perception such as hygiene, sleep and exercise have raised while the scores of somatic symptoms domain, such as abdominal pain, headache, and fatigue have been failed. Consequently, it was determined that the training courses about risky health behaviours were effective in preventing risky health behaviors and creating positive health perceptions of adolescents.

A selective review of medical cannabis in cancer pain management.

Science.gov (United States)

Blake, Alexia; Wan, Bo Angela; Malek, Leila; DeAngelis, Carlo; Diaz, Patrick; Lao, Nicholas; Chow, Edward; O'Hearn, Shannon

2017-12-01

Insufficient management of cancer-associated chronic and neuropathic pain adversely affects patient quality of life. Patients who do not respond well to opioid analgesics, or have severe side effects from the use of traditional analgesics are in need of alternative therapeutic op-tions. Anecdotal evidence suggests that medical cannabis has potential to effectively manage pain in this patient population. This review presents a selection of representative clinical studies, from small pilot studies conducted in 1975, to double-blind placebo-controlled trials conducted in 2014 that evaluated the efficacy of cannabinoid-based therapies containing tetrahydrocannabinol (THC) and cannabidiol (CBD) for reducing cancer-associated pain. A review of literature published on Medline between 1975 and 2017 identified five clinical studies that evaluated the effect of THC or CBD on controlling cancer pain, which have been reviewed and summarised. Five studies that evaluated THC oil capsules, THC:CBD oromucosal spray (nabiximols), or THC oromucosal sprays found some evidence of cancer pain reduction associated with these therapies. A variety of doses ranging from 2.7-43.2 mg/day THC and 0-40 mg/day CBD were administered. Higher doses of THC were correlated with increased pain relief in some studies. One study found that significant pain relief was achieved in doses as low as 2.7-10.8 mg THC in combination with 2.5-10.0 mg CBD, but there was conflicting evidence on whether higher doses provide superior pain relief. Some reported side effects include drowsiness, hypotension, mental clouding, and nausea and vomiting. There is evidence suggesting that medical cannabis reduces chronic or neu-ropathic pain in advanced cancer patients. However, the results of many studies lacked statistical power, in some cases due to limited number of study subjects. Therefore, there is a need for the conduct of further double-blind, placebo-controlled clinical trials with large sample sizes in order to

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

Complementary and alternative medications for chronic pelvic pain.

Science.gov (United States)

Leong, Fah Che

2014-09-01

Chronic pelvic pain is common, but rarely cured, thus patients seek both second opinions and alternative means of controlling their pain. Complementary and alternative medicine accounts for 11.2% of out-of-pocket medical expenditures for adults for all conditions in the United States. Although there are many treatments, rigorous testing and well-done randomized studies are lacking. Dietary changes and physical modalities such as physical therapy have often been included in the category of alternative medicine, but their use is now considered mainstream. This article concentrates on other sources of alternative and complementary medicine, such as dietary supplementation and acupuncture. Copyright © 2014 Elsevier Inc. All rights reserved.

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

Science.gov (United States)

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

2009-10-01

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

Prevalence and relief of pain in trauma patients in Emergency Medical Services

NARCIS (Netherlands)

Lisette Schoonhoven; T. Meijs; Sivera Berben; A. van Vugt; P. van Grunsven

2011-01-01

The aim of this study was to give insight in the prevalence of pain, and the (effect of) pain management according to the national emergency medical services analgesia protocol in trauma patients in the Netherlands. The retrospective document study included adult and alert trauma patients. Data

Improving Undergraduate Medical Education about Pain Assessment and Management: A Qualitative Descriptive Study of Stakeholders’ Perceptions

Directory of Open Access Journals (Sweden)

Pierre-Paul Tellier

2013-01-01

Full Text Available BACKGROUND: Pain is one of the most common reasons for individuals to seek medical advice, yet it remains poorly managed. One of the main reasons that poor pain management persists is the lack of adequate knowledge and skills of practicing clinicians, which stems from a perceived lack of pain education during the training of undergraduate medical students.

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

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de León-Casasola OA

2016-02-01

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

Risky driving and lifestyles in adolescence.

Science.gov (United States)

Bina, Manuela; Graziano, Federica; Bonino, Silvia

2006-05-01

Several studies have shown that risky driving is especially prevalent among young drivers and recent research has pointed out that driving in adolescence should be investigated in the more general context of adolescent development. The first aim of this contribution was to analyze involvement in risky driving in a normative sample of 645 Italian adolescents, boys and girls, aged 14-17, through a self-report questionnaire. A second aim was to evaluate the association between risky driving and lifestyle, defined as involvement in other health risk behaviors and leisure activities. The main results showed that many adolescents drove cars and motorcycles without the required driving license and the most frequent offences were speeding and failure to maintain a safe braking distance. Gender and age differences were also investigated. Results concerning the association between risky driving and lifestyle showed that risky driving was not an isolated behavior. Boys who displayed risky driving practices were more likely to adopt a lifestyle characterized by high involvement in antisocial behaviors, tobacco smoking, comfort eating and time spent in non-organized activities with friends. Girls involved in risky driving were more likely to be involved in other risk-taking behaviors, antisocial behaviors and drug use.

Adding chiropractic to standard medical therapy for nonspecific low back pain

DEFF Research Database (Denmark)

Goertz, Christine M; Long, Cynthia R; Hondras, Maria

2013-01-01

Study Design. Randomized controlled trial.Objective. To assess changes in pain levels and physical functioning in response to standard medical care (SMC) versus SMC plus chiropractic manipulative therapy (CMT) for the treatment of low back pain (LBP) among 18 to 35-year-old active-duty military...... physical functioning when compared with only standard care, for men and women between 18 and 35 years of age with acute LBP........ The primary outcome measures were changes in back-related pain on the numerical rating scale and physical functioning at 4 weeks on the Roland-Morris Disability Questionnaire and back pain functional scale (BPFS).Results. Mean Roland-Morris Disability Questionnaire scores decreased in both groups during...

Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain.

Science.gov (United States)

Boehnke, Kevin F; Litinas, Evangelos; Clauw, Daniel J

2016-06-01

Opioids are commonly used to treat patients with chronic pain (CP), though there is little evidence that they are effective for long term CP treatment. Previous studies reported strong associations between passage of medical cannabis laws and decrease in opioid overdose statewide. Our aim was to examine whether using medical cannabis for CP changed individual patterns of opioid use. Using an online questionnaire, we conducted a cross-sectional retrospective survey of 244 medical cannabis patients with CP who patronized a medical cannabis dispensary in Michigan between November 2013 and February 2015. Data collected included demographic information, changes in opioid use, quality of life, medication classes used, and medication side effects before and after initiation of cannabis usage. Among study participants, medical cannabis use was associated with a 64% decrease in opioid use (n = 118), decreased number and side effects of medications, and an improved quality of life (45%). This study suggests that many CP patients are essentially substituting medical cannabis for opioids and other medications for CP treatment, and finding the benefit and side effect profile of cannabis to be greater than these other classes of medications. More research is needed to validate this finding. This article suggests that using medical cannabis for CP treatment may benefit some CP patients. The reported improvement in quality of life, better side effect profile, and decreased opioid use should be confirmed by rigorous, longitudinal studies that also assess how CP patients use medical cannabis for pain management. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

Risky Decision Making in Juvenile Myoclonic Epilepsy

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Iris Unterberger

2018-03-01

Full Text Available It is not known whether patients with juvenile myoclonic epilepsy (JME differ from healthy people in decision making under risk, i.e., when the decision-making context offers explicit information about options, probabilities, and consequences already from the beginning. In this study, we adopted the Game of Dice Task-Double to investigate decision making under risk in a group of 36 patients with JME (mean age 25.25/SD 5.29 years and a group of 38 healthy controls (mean age 26.03/SD 4.84 years. Participants also underwent a comprehensive neuropsychological assessment focused on frontal executive functions. Significant group differences were found in tests of psychomotor speed and divided attention, with the patients scoring lower than the controls. Importantly, patients made risky decisions more frequently than controls. In the patient group, poor decision making was associated with poor executive control, poor response inhibition, and a short interval since the last seizure episode. Executive control and response inhibition could predict 42% of variance in the frequency of risky decisions. This study indicates that patients with JME with poorer executive functions are more likely to make risky decisions than healthy controls. Decision making under risk is of major importance in every-day life, especially with regard to treatment decisions and adherence to long-term medical therapy. Since even a single disadvantageous decision may have long-lasting consequences, this finding is of high relevance.

Risky Decision Making in Juvenile Myoclonic Epilepsy.

Science.gov (United States)

Unterberger, Iris; Zamarian, Laura; Prieschl, Manuela; Bergmann, Melanie; Walser, Gerald; Luef, Gerhard; Javor, Andrija; Ransmayr, Gerhard; Delazer, Margarete

2018-01-01

It is not known whether patients with juvenile myoclonic epilepsy (JME) differ from healthy people in decision making under risk, i.e., when the decision-making context offers explicit information about options, probabilities, and consequences already from the beginning. In this study, we adopted the Game of Dice Task-Double to investigate decision making under risk in a group of 36 patients with JME (mean age 25.25/SD 5.29 years) and a group of 38 healthy controls (mean age 26.03/SD 4.84 years). Participants also underwent a comprehensive neuropsychological assessment focused on frontal executive functions. Significant group differences were found in tests of psychomotor speed and divided attention, with the patients scoring lower than the controls. Importantly, patients made risky decisions more frequently than controls. In the patient group, poor decision making was associated with poor executive control, poor response inhibition, and a short interval since the last seizure episode. Executive control and response inhibition could predict 42% of variance in the frequency of risky decisions. This study indicates that patients with JME with poorer executive functions are more likely to make risky decisions than healthy controls. Decision making under risk is of major importance in every-day life, especially with regard to treatment decisions and adherence to long-term medical therapy. Since even a single disadvantageous decision may have long-lasting consequences, this finding is of high relevance.

Pain Management for Sickle Cell Disease in the Pediatric Emergency Department: Medications and Hospitalization Trends.

Science.gov (United States)

Cacciotti, Chantel; Vaiselbuh, Sarah; Romanos-Sirakis, Eleny

2017-10-01

The majority of emergency department (ED) visits and hospitalizations for patients with sickle cell disease (SCD) are pain related. Adequate and timely pain management may improve quality of life and prevent worsening morbidities. We conducted a retrospective chart review of pediatric patients with SCD seen in the ED, selected by sickle cell-related ICD-9 codes. A total of 176 encounters were reviewed from 47 patients to record ED pain management and hospitalization trends. Mean time to pain medication administration was 63 minutes. Patients received combination (nonsteroidal anti-inflammatory drug [NSAID] + narcotic) pain medications for initial treatment at a minority of ED encounters (19%). A higher percentage of patients who received narcotics alone as initial treatment were hospitalized as compared with those who received combination treatment initially ( P= 0.0085). Improved patient education regarding home pain management as well as standardized ED guidelines for assessment and treatment of sickle cell pain may result in superior and more consistent patient care.

Subgrouping of risky behaviors among Iranian college students: a latent class analysis

Directory of Open Access Journals (Sweden)

Safiri S

2016-07-01

Full Text Available Saeid Safiri,1,2 Afarin Rahimi-Movaghar,3 Masud Yunesian,4,5 Homayoun Sadeghi-Bazargani,6 Mansour Shamsipour,5 Mohammad Ali Mansournia,1 Akbar Fotouhi1 1Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, 2Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, 3Iranian National Center for Addiction Studies (INCAS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, 4Department of Environmental Health Engineering, School of Public Health, 5Department of Research Methodology and Data Analysis, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, 6Road Traffic Injury Research Center, Department of Statistics & Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran Background: Risky behaviors may interrupt development or cause considerable morbidity or mortality. This study’s purpose was to determine subgroups of students based on risky behaviors and assess the prevalence of risky behaviors in each of the subgroups.Participants and methods: This anonymous cross-sectional study was carried out in October 2015 and November 2015, with 1,777 students from Tabriz University of Medical Sciences, through multistage random sampling method. The data were analyzed by latent class analysis.Results: The prevalence rates of cigarette smoking (more than or equal to ten cigarettes, hookah use (≥1 time/month, and alcohol consumption (≥1 time/month during the last year were 12.4% (95% confidence interval [CI]: 10.9–14.0, 11.6% (95% CI: 10.0–13.1, and 4.9% (95% CI: 3.8–5.9, respectively. The prevalence rates of illicit opioids (1.8%, 95% CI: 1.2–2.5, cannabis (1.2%, 95% CI: 0.7–1.7, methamphetamine (1.1%, 95% CI: 0.6–1.6, methylphenidate (2.5%, 95% CI: 1.7–3.2, and extramarital sex (5.5%, 95% CI: 4.5–6.6 over the last year were

Prescribing of pain medication in palliative care. A survey in general practice

NARCIS (Netherlands)

Borgsteede, Sander D.; Deliens, Luc; Zuurmond, Wouter W. A.; Schellevis, François G.; Willems, Dick L.; van der Wal, Gerrit; van Eijk, Jacques Th M.

2009-01-01

Purpose To examine what pain and adjuvant medication is prescribed in palliative care patients at home in The Netherlands. Methods In a nationwide, representative, prospective study in general practice in The Netherlands, prescribed medication was registered in 95 general practices with a listed

Prescribing of pain medication in palliative care: a survey in general practice.

NARCIS (Netherlands)

Borgsteede, S.D.; Deliens, L.; Zuurmond, W.W.A.; Schellevis, F.; Willems, D.L.; Wal, G. van der; Eijk, J.T.M. van

2009-01-01

PURPOSE: To examine what pain and adjuvant medication is prescribed in palliative care patients at home in The Netherlands. METHODS: In a nationwide, representative, prospective study in general practice in The Netherlands, prescribed medication was registered in 95 general practices with a listed

Does direct-to-consumer advertising affect patients' choice of pain medications?

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Liu, Yifei; Doucette, William R

2008-04-01

In the United States, direct-to-consumer advertising (DTCA) has grown rapidly to promote prescription medications, including analgesics. Few studies in the literature directly examine the association between DTCA and patients' choice of pain medications. This article discusses how DTCA affects such choice from a behavioral perspective, because DTCA-prompted behaviors are important indicators of DTCA's influence. After DTCA exposure, patients may request prescriptions, seek further medication information, and ask about advertised conditions. Patients who suffer from pain may seek more communication with their health care providers because they are cautious about the information quality of DTCA, mainly because of the recall of rofecoxib (Vioxx; Merck, Whitehouse Station, NJ). However, the availability and DTCA of over-the-counter analgesics complicate their treatment choice. Patients could use DTCA as a tool to launch health communication and make an informed treatment choice with the guidance of their health care providers.

Recommendations for a new curriculum in pain medicine for medical students: toward a career distinguished by competence and compassion.

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Murinson, Beth B; Gordin, Vitaly; Flynn, Susie; Driver, Larry C; Gallagher, Rollin M; Grabois, Martin

2013-03-01

The education of physicians is a fundamental obligation within medicine that must remain closely aligned with clinical care. And although medical education in pain care is essential, the current state of medical education does not meet the needs of physicians, patients, or society. To address this, we convened a committee of pain specialist medical student educators. Tasked with creating systematically developed and valid recommendations for clinical education, we conducted a survey of pain medicine leadership within the American Academy of Pain Medicine (AAPM). The survey was conducted in two waves. We asked AAPM board members to rate 194 previously published pain medicine learning objectives for medical students; 79% of those eligible for participation responded. The "Top 5" list included the awareness of acute and chronic pain, skillfulness in clinical appraisal, promotion of compassionate practices, displaying empathy toward the patient, and knowledge of terms and definitions for substance abuse. The "Top 10" list included the major pharmacological classes as well as skills in examination, communication, prescribing, and interviewing. The "Top 20" list included the pain care of cognitively impaired populations, those with comorbid illness, and older adults. With the survey results in consideration, the committee produced a new recommended topic list for curricula in pain medicine. We strongly recommend that adequate resources are devoted to fully integrated medical curricula in pain so that students will learn not only the necessary clinical knowledge but also be prepared to address the professional, personal, and ethical challenges that arise in caring for those with pain. We conclude that improved medical education in pain is essential to prepare providers who manifest both competence and compassion toward their patients. Wiley Periodicals, Inc.

Xiaozhi decoction reduced posthemorrhoidectomy pain and analgesic medication consumption: a prospective study

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Shen JB

2017-01-01

Full Text Available Jianbin Shen,1,* Xiagang Luo,2,* Xiao Zhou,3 Chengwu Tang,1 Huanyu Ju,2 Yongqiang Xu,1 Lianjin Qin1 1Department of General Surgery, First People’s Hospital Affiliated to Huzhou Normal College, Huzhou, Zhejiang, 2Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 3Department of Orthopedics, People’s Hospital of Zhangqiu, Jinan, Shandong, People’s Republic of China *These authors contributed equally to this work Objective: The aim of this study was to investigate the effect of Xiaozhi decoction (XZD on posthemorrhoidectomy pain and analgesic medication consumption.Methods: From May 2013 to March 2015, 315 patients who underwent open hemorrhoidectomy in our hospital were enrolled in this study, of whom, 160 patients were randomly assigned to accept sitz bath with warm water after hemorrhoidectomy (control group and 155 patients were randomly assigned to accept sitz bath with XZD (XZD group after hemorrhoidectomy. Postoperative pain at 12 hours after surgery and on postoperative days (PODs 1, 2, 7, 14 and 28 was evaluated by Visual Analog Scale (VAS. Pain on defecation on PODs 1, 2, 7, 14 and 28 was also recorded using the VAS. The consumption of analgesics was also analyzed.Results: No significant difference was found in baseline characteristics between the two groups. Postoperative pain score of the XZD group was significantly lower on POD 2 (6.04±1.11 vs 6.33±1.14, P=0.0229, POD 7 (3.35±0.75 vs 4.22±0.87, P=0.0000 and POD 14 (2.87±0.64 vs 3.64±0.77, P=0.0000 than that of the control group. Similarly, patients in the XZD group experienced significantly less pain on defecation on POD 2 (5.02±1.34 vs 5.43±1.56, P=0.0130, POD 7 (3.08±1.17 vs 3.52±1.29, P=0.0017 and POD 14 (2.31±0.85 vs 2.68±0.99, P=0.0004. Patients in the XZD group consumed significantly less analgesic medication on POD 2 (P=0.0136, POD 7 (P=0.0074 and POD 14 (P=0.0046 than the control group. Conclusion

Reduction of painful area as new possible therapeutic target in post-herpetic neuropathic pain treated with 5% lidocaine medicated plaster: a case series

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Casale R

2014-06-01

Full Text Available Roberto Casale,1,2 Maria Di Matteo,3,7 Cristina E Minella,4,7 Guido Fanelli,5,7 Massimo Allegri4,6,71Department of Clinical Neurophysiology and Pain Rehabilitation Unit, Foundation Salvatore Maugeri, IRCCS, Pavia, 2EFIC Montescano School, Montescano, 3Anesthesia and Intensive Care I, 4Pain Therapy Service, Fondazione IRCCS Policlinico San Matteo, Pavia, 5Department of Anesthesia, Intensive Care and Pain Therapy, Azienda Ospedaliera Universitaria Parma, University of Parma, Parma, 6Department of Clinical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, 7Study In Multidisciplinary Pain Research Group, Parma, ItalyAbstract: Post-herpetic neuralgia (PHN is neuropathic pain persisting after an acute episode of herpes zoster, and is associated with severe pain and sensory abnormalities that adversely affect the patient's quality of life and increase health care costs. Up to 83% of patients with PHN describe localized neuropathic pain, defined as “a type of neuropathic pain characterized by consistent and circumscribed area(s of maximum pain”. Topical treatments have been suggested as a first-line treatment for localized neuropathic pain. Use of 5% lidocaine medicated plaster could reduce abnormal nervous peripheral discharge and via the plaster could have a “protective” function in the affected area. It has been suggested that use of this plaster could reduce pain as well as the size of the painful area. To evaluate this possible outcome, we retrospectively reviewed eight patients with PHN, treated using 5% lidocaine medicated plaster. During a follow-up period of 3 months, we observed good pain relief, which was associated with a 46% reduction in size of the painful area after one month (from 236.38±140.34 cm2 to 128.80±95.7 cm2 and a 66% reduction after 3 months (81.38±59.19 cm2. Our study cohort was composed mainly of elderly patients taking multiple drugs to treat comorbidities, who have a high risk of drug�

Chronic Pain

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... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. × ... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. ...

Pain and functional impairment as mediators of the link between medical symptoms and depression in type 2 diabetes.

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Sacco, William P; Bykowski, Cathy A; Mayhew, Laura L

2013-03-01

Among people with diabetes, depression is more common and is associated with greater morbidity and mortality. A better understanding of mechanisms underlying the link between poor health and depression is needed. Pain and functional impairment may account for the effect of poor health on depression in diabetes. The purpose of the study was to examine whether pain and functional impairment mediate the association between diabetes-related medical symptoms and depression in type 2 diabetes. Adults diagnosed with type 2 diabetes (N = 77) completed the following measures: Patient Health Questionnaire (PHQ), Diabetes Symptom Checklist (DSC), and Medical Outcomes Study 12-item Short-Form Health Survey (SF-12). Body mass index (BMI) was computed using height and weight data from medical records. Mediation and linear regression analyses were conducted. Pain and functional impairment made significant, independent contributions to depression. Functional impairment mediated the link between diabetes-related medical symptoms and depression. Pain mediated the association between higher BMI and depression. Pain and functional impairment appear to play important, independent roles in depression in type 2 diabetes. Mediation analyses suggest the following: 1. diabetes-related medical problems increase functional impairment, which in turn leads to greater depression; and 2. the burden of carrying greater body mass (higher BMI) increases pain, which leads to increased depression.

Denial of pain medication by health care providers predicts in-hospital illicit drug use among individuals who use illicit drugs.

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Ti, Lianping; Voon, Pauline; Dobrer, Sabina; Montaner, Julio; Wood, Evan; Kerr, Thomas

2015-01-01

Undertreated pain is common among people who use illicit drugs (PWUD), and can often reflect the reluctance of health care providers to provide pain medication to individuals with substance use disorders. To investigate the relationship between having ever been denied pain medication by a health care provider and having ever reported using illicit drugs in hospital. Data were derived from participants enrolled in two Canadian prospective cohort studies between December 2012 and May 2013. Using bivariable and multivariable logistic regression analyses, the relationship between having ever been denied pain medication by a health care provider and having ever reported using illicit drugs in hospital was examined. Among 1053 PWUD who had experienced ≥ 1 hospitalization, 452 (44%) reported having ever used illicit drugs while in hospital and 491(48%) reported having ever been denied pain medication. In a multivariable model adjusted for confounders, having been denied pain medication was positively associated with having used illicit drugs in hospital (adjusted OR 1.46 [95% CI 1.14 to 1.88]). The results of the present study suggest that the denial of pain medication is associated with the use of illicit drugs while hospitalized. These findings raise questions about how to appropriately manage addiction and pain among PWUD and indicate the potential role that harm reduction programs may play in hospital settings.

Is Utilitarianism Risky? How the Same Antecedents and Mechanism Produce Both Utilitarian and Risky Choices.

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Lucas, Brian J; Galinsky, Adam D

2015-07-01

Philosophers and psychologists have long been interested in identifying factors that influence moral judgment. In the current analysis, we compare the literatures on moral psychology and decision making under uncertainty to propose that utilitarian choices are driven by the same forces that lead to risky choices. Spanning from neurocognitive to hormonal to interpersonal levels of analysis, we identify six antecedents that increase both utilitarian and risky choices (ventromedial prefrontal cortex brain lesions, psychopathology, testosterone, incidental positive affect, power, and social connection) and one antecedent that reduces these choices (serotonin activity). We identify the regulation of negative affect as a common mechanism through which the effects of each antecedent on utilitarian and risky choices are explained. By demonstrating that the same forces and the same underlying mechanism that produce risky choices also promote utilitarian choices, we offer a deeper understanding of how basic psychological systems underlie moral judgment. © The Author(s) 2015.

Efficacy and adverse effects of medical marijuana for chronic noncancer pain: Systematic review of randomized controlled trials.

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Deshpande, Amol; Mailis-Gagnon, Angela; Zoheiry, Nivan; Lakha, Shehnaz Fatima

2015-08-01

To determine if medical marijuana provides pain relief for patients with chronic noncancer pain (CNCP) and to determine the therapeutic dose, adverse effects, and specific indications. In April 2014, MEDLINE and EMBASE searches were conducted using the terms chronic noncancer pain, smoked marijuana or cannabinoids, placebo and pain relief, or side effects or adverse events. An article was selected for inclusion if it evaluated the effect of smoked or vaporized cannabinoids (nonsynthetic) for CNCP; it was designed as a controlled study involving a comparison group, either concurrently or historically; and it was published in English in a peer-review journal. Outcome data on pain, function, dose, and adverse effects were collected, if available. All articles that were only available in abstract form were excluded. Synthesis A total of 6 randomized controlled trials (N = 226 patients) were included in this review; 5 of them assessed the use of medical marijuana in neuropathic pain as an adjunct to other concomitant analgesics including opioids and anticonvulsants. The 5 trials were considered to be of high quality; however, all of them had challenges with masking. Data could not be pooled owing to heterogeneity in delta-9-tetrahydrocannabinol potency by dried weight, differing frequency and duration of treatment, and variability in assessing outcomes. All experimental sessions in the studies were of short duration (maximum of 5 days) and reported statistically significant pain relief with nonserious side effects. There is evidence for the use of low-dose medical marijuana in refractory neuropathic pain in conjunction with traditional analgesics. However, trials were limited by short duration, variability in dosing and strength of delta-9-tetrahydrocannabinol, and lack of functional outcomes. Although well tolerated in the short term, the long-term effects of psychoactive and neurocognitive effects of medical marijuana remain unknown. Generalizing the use of medical

Modifying Evaluations and Decisions in Risky Situations.

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Maldonado, Antonio; Serra, Sara; Catena, Andrés; Cándido, Antonio; Megías, Alberto

2016-09-20

The main aim of this research was to investigate the decision making process in risky situations. We studied how different types of feedback on risky driving behaviors modulate risk evaluation and risk-taking. For a set of risky traffic situations, participants had to make evaluative judgments (judge the situation as risky or not) and urgent decisions (brake or not). In Experiment 1, participants received feedback with and without negative emotional content when they made risky behaviors. In Experiment 2 we investigated the independent effects of feedback and negative emotional stimuli. The results showed three important findings: First, urgent decisions were faster [F(1, 92) = 6.76, p = .01] and more cautious [F(1, 92) = 17.16, p towards more cautious responses [F(1, 111) = 14.09, p emotional stimuli had an effect only when they were presented as feedback. The results of this research increase our understanding of the processes involved in risky driving behavior and suggest efficient ways to control risk taking through the use of feedback.

Surgical pain management at the Medical School of Salerno (11th-13th centuries).

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Giuffra, Valentina

2013-06-01

Before the advent of general anesthesia, only poorly effective remedies were known to relieve pain. Although classical medical authorities describe a number of elaborate surgical techniques, no references about some forms of anesthesia are reported. Only the authors of pharmaceutical or botanical texts mention the use of substances, especially mandrake, to induce sleep in the patient. The first and most detailed evidences of general anesthesia described in medical texts of the western world can be found at the Medical School of Salerno. However, the use of substances aimed to relieve pain or to induce sleep during surgery is mentioned only by the authors of pharmaceutical or botanical texts and not by surgeons. Furthermore, the efficacy of these preparations to produce a profound and lasting sleep is doubtful. The general impression is that surgeons knew how to relieve pain, but considered it a necessary appendix of surgery and therefore an incisive effort to eliminate it was not pursued.

Long-term pain relief with optimized medical treatment including antioxidants and step-up interventional therapy in patients with chronic pancreatitis.

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Shalimar; Midha, Shallu; Hasan, Ajmal; Dhingra, Rajan; Garg, Pramod Kumar

2017-01-01

Abdominal pain is difficult to treat in patients with chronic pancreatitis (CP). Medical therapy including antioxidants has been shown to relieve pain of CP in the short-term. Our aim was to study the long-term results of optimized medical and interventional therapy for pain relief in patients with CP with a step-up approach. All consecutive patients with CP were included prospectively in the study. They were treated medically with a well-balanced diet, pancreatic enzymes, and antioxidants (9000 IU beta-carotene, 0.54 g vitamin C, 270 IU vitamin E, 600 µg organic selenium, and 2 g methionine). Endoscopic therapy and/or surgery were offered if medical therapy failed. Pain relief was the primary outcome measure. A total of 313 patients (mean age 26.16 ± 12.17; 244 males) with CP were included; 288 (92%) patients had abdominal pain. The etiology of CP was idiopathic in 224 (71.6%) and alcohol in 82 (26.2%). At 1-year follow-up, significant pain relief was achieved in 84.7% of patients: 52.1% with medical therapy, 16.7% with endoscopic therapy, 7.6% with surgery, and 8.3% spontaneously. The mean pain score decreased from 6.36 ± 1.92 to 1.62 ± 2.10 (P pain free at those follow-up periods. Significant pain relief is achieved in the majority of patients with optimized medical and interventional treatment. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Risky Behavior, Ecstasy, and Education

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Callier, Heather H.

2011-01-01

Ecstasy is a risky behavior that continues to be a concern in the education system today. The review of the Ecstasy literature focused on the definition of risky behavior, prevalence, and other basis aspects of Ecstasy; discovering life events that are associated with Ecstasy use, the function of this behavior, interventions for substance abuse,…

Impact of FDA Actions, DTCA, and Public Information on the Market for Pain Medication.

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Bradford, W David; Kleit, Andrew N

2015-07-01

Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most important classes of prescription drugs used by primary care physicians to manage pain. The NSAID class of products has a somewhat controversial history, around which a complex regulatory and informational environment has developed. This history includes a boxed warning mandated by the Food and Drug Administration (FDA) for all NSAIDs in 2005. We investigate the impact that various information shocks have had on the use of prescription medications for pain in primary care in the USA. We accomplish this by extracting data on nearly 600,000 patients from a unique nationwide electronic medical record database and estimate the probability of any active prescription for the four types of pain medications as a function of FDA actions, advertising, media coverage, and patient characteristics. We find that even after accounting for multiple sources of information, the FDA label changes and boxed warnings had a significant effect on pain medication prescribing. The boxed warning did not have the same impact on the use of all NSAID inhibitors. We find that the boxed warning reduced the use of NSAID COX-2 inhibitor use, which was the focus of much of the press attention. In contrast, however, the warning actually increased the use of non-COX-2 NSAID inhibitors. Thus, the efficacy of the FDA's black box warning is clearly mixed. Copyright © 2014 John Wiley & Sons, Ltd.

Pharmacoeconomic Analysis of Pain Medications Used to Treat Adult Patients with Chronic Back Pain in the United States.

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Shah, Drishti; Anupindi, Vamshi Ruthwik; Vaidya, Varun

2016-12-01

Chronic back pain is an extremely common health problem. The largest category for pain therapy costs includes nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids. However, there has been limited evidence outlining their effectiveness in terms of quality of life for the treatment of chronic back pain. The authors performed a comparative pharmacoeconomic analysis of chronic back pain patients using NSAIDs versus those using opioids alone or combination opioid analgesics. This pharmacoeconomic evaluation was conducted using the Medical Expenditure Panel Survey (MEPS). Adults ≥18 years with chronic back pain diagnosis were included in the study. Individuals using opioids were matched in 1:1 ratio with those using only NSAIDs using propensity scores. All direct medical costs were included, and utility scores from Short Form 6D (SF-6D) were used to calculate QALYs (quality-adjusted life years). Monte Carlo probabilistic simulation technique was employed to determine the cost-effectiveness acceptability curve. After matching, there were 1109 patients in each cohort. The total mean annual cost was found to be $6137.41 for NSAIDs and $8982.28 for opioids. The mean utility gain for NSAIDs was found to be 0.661, whereas for opioids it was 0.633. Probabilistic sensitivity analysis showed that at all willingness-to-pay thresholds, the probability of NSAIDs being cost-effective was higher than the probability of the opioids being cost-effective. The authors found NSAIDs to be a dominant strategy as compared with opioids. Considering the higher cost associated with opioids/combination opioid analgesics, it might be cost-effective if they are used in patients who did not respond to the NSAIDs.

Knowledge for unintentional injury and risky behavior among the school-age children in Changsha city of China.

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Tian, Lingyun; Liu, Minhui; Li, Li; Fang, Zhengqing; Xiao, Hongling; Wu, Ying; Xia, Yanping

2016-07-01

To investigate the current status on knowledge for unintentional injury and risky behavior among school-age children in Changsha, China, and to provide scientific evidence for the preventive strategies.
 A cross-sectional study was conducted on 866 students who were between 6 and 12 years old in Changsha. Two primary schools were selected by stratified cluster random sampling from all primary schools of Changsha city to collect the information regarding knowledge for unintentional injury and risky behavior occurring in the 6-month period before the survey.
 The mean score for knowledge of unintentional injury was 11.83±2.38. The levels of knowledge for unintentional injury differed significantly in child's age, parents' education background and child's injury history (Pchild's knowledge level was correlated with child's age, mother's education, child's injury history. The mean score for risky behavior was 17.61±10.35. The levels of risky behavior differed significantly in child's gender, father's age to have the child, parents' marriage status, whom does/do child live with, child's injury history and medical history since the birthday (Pchild's injury history, parents' marriage status, child's gender. There was no significant correlation between knowledge and risky behavior (P>0.05).
 It is a common phenomenon in school-age children who are lack of the knowledge for unintentional injury and risky behavior. This study provides useful information on the risk factors for unintentional injury and risky behavior, which would be significant for prevention program.

Social-cognitive correlates of risky adolescent cycling behavior

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Ruiter Robert AC

2010-07-01

Full Text Available Abstract Background Bicycle use entails high safety and health risks especially for adolescents. Most safety education programs aimed at adolescents focus on accident statistics and risk perceptions. This paper proposes the investigation of the social-cognitive correlates of risky cycling behaviors of adolescents prior to developing safety education programs. Method Secondary school students aged 13 to 18 years (n = 1446 filled out questionnaires regarding bicycle behavior, risky intentions, accident experience, and social-cognitive determinants as suggested by the theory of planned behavior. Results Regression analysis revealed that the proximal variables (i.e., self-efficacy, attitudes towards drunk driving, personal norm regarding safekeeping of self and others, and compared risk were able to predict 17% of the variance of risky behavior and 23% of the variance of risky intentions. The full model explained respectively 29% and 37% of the variance in risky behavior and risky intentions. Adolescents with positive attitudes towards risky behavior and low sense of responsibility report risky behavior, even when having been (close to an accident. Conclusions Adolescents realize whether they are risk takers or not. This implies that the focus of education programs should not be on risk perceptions, but on decreasing positive attitudes towards alcohol in traffic and increasing sense of responsibility instead. Cognitions regarding near accidents should be studied, the role of safe cycling self-efficacy is unclear.

Sociocultural Determinants of Risky Sexual Behaviors among Adult Latinas: A Longitudinal Study of a Community-Based Sample.

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Rojas, Patria; Huang, Hui; Li, Tan; Ravelo, Gira J; Sanchez, Mariana; Dawson, Christyl; Brook, Judith; Kanamori, Mariano; De La Rosa, Mario

2016-11-23

Few studies have examined the sociocultural determinants of risky sexual behavior trajectories among adult Latinas. To longitudinally examine the link between sociocultural determinants of risky sexual behaviors, we followed a sample of adult Latina mother-daughter dyads ( n = 267) across a 10-year span through four waves of data collection. The present study investigates how risky sexual behavior (operationalized as sex under the influence of alcohol or other drugs, sex without a condom, or multiple sex partners) is affected by: (a) socioeconomic conditions; (b) mental health; (c) medical health; (d) acculturation to U.S. culture; (e) interpersonal support; (f) relationship stress; (g) mother-daughter attachment; (h) intimate partner violence; (i) religious involvement; and (j) criminal justice involvement. Results indicate the following factors are negatively associated with risky sexual behavior: drug and alcohol use, treating a physical problem with prescription drugs, religious involvement, and mother-daughter attachment. The following factors are positively associated with risky sexual behavior: higher number of mental health symptoms, being U.S.-born, and criminal justice involvement. We discuss implications for the future development of culturally relevant interventions based on the study findings.

Management of non-traumatic chest pain by the French Emergency Medical System: Insights from the DOLORES registry.

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Manzo-Silberman, Stéphane; Assez, Nathalie; Vivien, Benoît; Tazarourte, Karim; Mokni, Tarak; Bounes, Vincent; Greffet, Agnès; Bataille, Vincent; Mulak, Geneviève; Goldstein, Patrick; Ducassé, Jean Louis; Spaulding, Christian; Charpentier, Sandrine

2015-03-01

The early recognition of acute coronary syndromes is a priority in health care systems, to reduce revascularization delays. In France, patients are encouraged to call emergency numbers (15, 112), which are routed to a Medical Dispatch Centre where physicians conduct an interview and decide on the appropriate response. However, the effectiveness of this system has not yet been assessed. To describe and analyse the response of emergency physicians receiving calls for chest pain in the French Emergency Medical System. From 16 November to 13 December 2009, calls to the Medical Dispatch Centre for non-traumatic chest pain were included prospectively in a multicentre observational study. Clinical characteristics and triage decisions were collected. A total of 1647 patients were included in the study. An interview was conducted with the patient in only 30.5% of cases, and with relatives, bystanders or physicians in the other cases. A Mobile Intensive Care Unit was dispatched to 854 patients (51.9%) presenting with typical angina chest pains and a high risk of cardiovascular disease. Paramedics were sent to 516 patients (31.3%) and a general practitioner was sent to 169 patients (10.3%). Patients were given medical advice only by telephone in 108 cases (6.6%). Emergency physicians in the Medical Dispatch Centre sent an effecter to the majority of patients who called the Emergency Medical System for chest pain. The response level was based on the characteristics of the chest pain and the patient's risk profile. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Teaching Pain Management in Interprofessional Medical Education: A Review of Three Portal of Geriatric Online Education Modules.

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Madaus, Stacy M; Lim, Lionel S

2016-10-01

Chronic pain is an international healthcare crisis that affects an estimated 1.5 billion individuals worldwide, but pain management is not emphasized in the medical school curriculum, and thus supplemental education is essential. The Portal of Geriatric Online Education (POGOe) is a free repository of teaching modules for use by geriatric educators and learners. This article highlights three teaching modules available on this site: It's My Old Back Again: An Approach to Diagnosing and Managing Back Pain in the Older Adult (POGOe ID: 21670), Computer Based Learning Workbook, Third Edition module on Pain Management (POGOe ID: 21036), and Aging Q3 Curriculum on Pain Management of Older Adult Patients (POGOe ID: 21187). These modules were chosen based on their ability to address the major topics that the International Association for the Study of Pain proposes should be included in medical school curricula: mulitdimensional nature of pain, pain assessment and measurement, management of pain, and clinical conditions resulting in pain in older adults. They were also selected for their ability to be adapted for interprofessional education and how well they integrate basic science and clinical principles. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Physician Contacts and Their Influence on the Appropriateness of Pain Medication in Nursing Home Residents: A Cross-Sectional Study.

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Flaig, Tanja Maria; Budnick, Andrea; Kuhnert, Ronny; Kreutz, Reinhold; Dräger, Dagmar

2016-09-01

This study assessed the frequency of physician contacts for individual nursing home residents (NHRs) and investigated whether the frequency of contacts influences the appropriateness of pain medication in NHRs. Observational cross-sectional study conducted between March 2009 and April 2010. Forty nursing homes in Berlin and Brandenburg, Germany. A total of 560 NHRs. The number and type of NHR physician contacts were obtained by face-to-face interviews. To assess the appropriateness of pain medication, the German version of the Pain Medication Appropriateness Scale (PMASD) was used. The influence of physician contacts on the appropriateness of pain medication was calculated with a linear mixed-effect model. The proportions of NHRs with at least 1 contact with their attending physicians were 61.8% (primary care physicians), 55.2% (general practitioners), 9.6% (neurologists), 9.4% (other), 5.4% (internists), 2.2% (orthopedic surgeons), and 0.7% (psychiatrists). The number of all physician contacts correlated weakly with the appropriateness of pain medication (r = 0.166, P = .039). With every physician contact, the PMASD score rose by about 2 points (P = .056). Physician care in German nursing homes is mainly provided by primary care physicians. A higher number of physician contacts had a modest impact on more appropriate pain medication use. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Prevalence and correlates of sleep-related problems in adults receiving medical cannabis for chronic pain.

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Cranford, James A; Arnedt, J Todd; Conroy, Deirdre A; Bohnert, Kipling M; Bourque, Carrie; Blow, Frederic C; Ilgen, Mark

2017-11-01

To examine the prevalence and correlates of sleep problems in a sample of medical cannabis patients. Adults ages 21 and older (N=801,M age=45.8) who were seeking medical cannabis certification (either for the first time or as a renewal) for chronic pain at medical cannabis clinics in southern Michigan completed baseline measures of cannabis use, sleep, pain, and other related constructs. Over half of the sample (59%) met criteria for past 1-month sleep disturbance, defined as at least one sleep problem occurring on 15 or more nights in the past month. Most participants (86%) reported that sleep problems were due to their current pain. Approximately 80% of participants reported using cannabis in the past 6 months to improve sleep and, among these participants, cannabis was rated as helpful for improving sleep. Sleep-related cannabis side effects were rare (35%), but sleep-related cannabis withdrawal symptoms were relatively common (65%). Statistically significant correlates of past 1-month sleep disturbance included a) being female, b) being white, c) being on disability, d) not having a medical cannabis card, and e) frequency of using cannabis to help sleep. Sleep problems are highly prevalent and frequent in medical cannabis patients and are closely tied to pain. Sleep-related cannabis withdrawal symptoms are relatively common but their clinical relevance is unknown. The association between frequency of cannabis use to help sleep with higher odds of sleep problems will need to be clarified by longitudinal studies. Copyright © 2017 Elsevier B.V. All rights reserved.

Knowledge Toward Cancer Pain and the Use of Opioid Analgesics Among Medical Students in their Integrated Clinical Clerkship

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Maria Fidelis C. Manalo

2008-01-01

Full Text Available Introduction: Among the focal issues of barriers to pain management include the physicians’ lack of knowledge about cancer pain and negative attitudes towards opioids. Many physicians and educators attribute this, at least in part, to limited exposure to pain and palliative care education during medical school.Aim: The researcher investigated the medical students’ knowledge about cancer pain and the use of opioid analgesics.Methods: The subjects were a sample of 50 students of the University of the Philippines College of Medicine in their integrated clinical clerkship year. Descriptive statistics (frequencies, means, standard deviation, rating scales were used to determine mean knowledge score and level of confidence with opioid use. The study also identified specific areas where students exhibited good or poor knowledge of opioids.Results: Approximately sixty-nine (69% of the study respondents mentioned that pain management was given to them during their Anesthesiology lectures while a few recalled that they had these lectures during their Family Medicine rotation in Supportive, Palliative and Hospice Care. More than a third (35% of the respondents admitted to not being confident with morphine use at present. The top three reasons cited as limitations in choice of opioids for cancer pain include fear of addiction, lack of adequate knowledge and experience and fear of side effects and complications. Out of a maximum of 13 correct answers, the mean knowledge score of the medical students was 6.6 ± 2.9. Less than 16% of the respondents had adequate knowledge on cancer pain and opioid use.Conclusions: The results show that basic knowledge of the role of opioids in cancer pain management among medical students in their integrated clinical clerkship year at the University of the Philippines is poor. The findings imply a need to look into making revisions in the medical curriculum to include a training program that will enable all students to

Mixed Frames and Risky Decision-Making.

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Peng, Jiaxi; Zhang, Jiaxi; Sun, Hao; Zeng, Zhicong; Mai, Yuexia; Miao, Danmin

2017-01-01

By applying unitive vocabulary, "die" or "save," to respective frames of the Asian disease problem, Tversky and Kahneman were able to define framing effect. In this study, we preliminarily explored the effect of mixed frames, which are characterized by the use of different vocabulary in one frame. In study 1, we found that only the sure option description had significant effect on decision-making, while the effects of risky option descriptions were not significant, nor were interactions between descriptions. In study 2, the results suggested that after controlling the effects of the hedonic tone of the sure options, risky option description did not significantly predict decision-making. In study 3, we found that neither the sure-to-risky option presentation order nor presentation order within risky options had significant effect on decision-making. We thus concluded that sure option description can serve as the decision-making foundation (reference point) for decision-makers in mixed frames.

Three essays in risky behaviors

OpenAIRE

Sampaio, Mafalda

2012-01-01

A PhD Dissertation, presented as part of the requirements for the Degree of Doctor of Philosophy from the NOVA - School of Business and Economics This dissertation consists of three essays on the relationship between risky behaviors and social environment, including the strategic construction of conversational networks to discuss HIV related issues, the impact of social stigma on risky behaviors, and how subjective expectations from parents can influence childhood obesity. Underst...

Epidemiology of chronic pain in the office of a pain specialist neurologist

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Karen dos Santos Ferreira

2015-07-01

Full Text Available Objective The objective of the present report was to describe the working experience of a pain specialist neurologist after concluding a medical residency program on neurology, area of concentration pain. Method A retrospective study was conducted for one year in the office of a pain specialist neurologist. Patients older than 18 years with chronic pain according to the criteria of the International Association for the Study of Pain, were included. Demographic data, chronic pain data and the treatments instituted were investigated. Results A total of 241 medical records were reviewed, mean patient age was 52.4 years and 79 (66.9% were women, and the mean score on a numeric pain scale was 8.69. The diagnoses were headaches (74.6%, neuropathic pain (17% and ostheomuscular pain (8.2%. We did not detect cancer pain. Patients received medication and procedures of anesthetic blockade. Conclusion This data can guide new medical residency programs on Neurology, area of concentration pain, to plan activities and studies.

Randomized controlled trial about pain medication flupirtine ignores recent pharmacovigilance warnings

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Puljak L

2018-01-01

Full Text Available Livia Puljak1,2 1Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia; 2Department for Development, Research and Health Technology Assessment, Agency for Quality and Accreditation in Health Care and Social Welfare, Zagreb, CroatiaOn October 16, 2017 in the Journal of Pain Research, a randomized controlled trial (RCT comparing efficacy and safety of flupirtine versus piroxicam in postoperative pain in patients undergoing lower limb surgery was published.1 However, this paper fails to report important information. Author’s reply Sowmya Chinnaiyan,1 Narayana Sarala,1 Heddur Shanthappa Arun21Department of Pharmacology, 2Department of Orthopedics, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India We thank Livia Puljak for the valuable insights on the article titled “A comparative study of efficacy and safety of flupirtine  versus piroxicam in postoperative pain in patients undergoing lower limb surgery” published in the Journal of Pain Research. The concerns highlighted in the Letter to the Editor have been answered.View the original paper by Chinnaiyan and colleagues. 

Risky driving behaviors in Tehran, Iran.

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Shams, Mohsen; Rahimi-Movaghar, Vafa

2009-03-01

Iran has one of the highest fatality rates due to road traffic crashes (RTC) in the world. The disability adjusted life years (DALYs) for RTC in Iran is more than 1,300,000 years, which is more than that for any other disease such as cardiovascular or cancer. We evaluated risky driving behaviors in Tehran, the capital of Iran. A retrospective analysis was conducted based on the data obtained from the Tehran Police Safety Driving Department. Offenses and crashes were studied in different municipal districts in Tehran from March 2006 to March 2007. The inclusion criteria were risky driving behaviors fined by the police. Nonbehavioral offences were excluded. There were 3,821,798 offenses in Tehran. Not wearing a seat belt was the most common (59%) example of risky driving behavior, followed by tailgating, not wearing motorcycle helmets, talking on the cell phone while driving, overtaking from the wrong side, speeding, not driving between the lanes, weaving in and out of traffic, left deviation, and changing lanes without signals. The most common causes of RTC in Tehran are speeding, overtaking from the wrong side, and the rapid changing of driving lanes. The study factors effective in preventing risky driving behaviors in Tehran is recommended. The consideration of specific characteristics of the municipal districts is necessary to reduce risky driving behaviors.

Implicit attitudes towards risky and safe driving

DEFF Research Database (Denmark)

Martinussen, Laila Marianne; Sømhovd, Mikael Julius; Møller, Mette

; further, self-reports of the intention to drive safely (or not) are socially sensitive. Therefore, we examined automatic preferences towards safe and risky driving with a Go/No-go Association Task (GNAT). The results suggest that (1) implicit attitudes towards driving behavior can be measured reliably...... with the GNAT; (2) implicit attitudes towards safe driving versus towards risky driving may be separable constructs. We propose that research on driving behavior may benefit from routinely including measures of implicit cognition. A practical advantage is a lesser susceptibility to social desirability biases......, compared to self-report methods. Pending replication in future research, the apparent dissociation between implicit attitudes towards safe versus risky driving that we observed may contribute to a greater theoretical understanding of the causes of unsafe and risky driving behavior....

A Contemporary Medicolegal Analysis of Outpatient Medication Management in Chronic Pain.

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Abrecht, Christopher R; Brovman, Ethan Y; Greenberg, Penny; Song, Ellen; Rathmell, James P; Urman, Richard D

2017-11-01

Opioids are frequently used in chronic pain management but are associated with significant morbidity and mortality in some patient populations. An important avenue for identifying complications-including serious or rare complications-is the study of closed malpractice claims. The present study is intended to complement the existing closed claims literature by drawing on claims from a more recent timeframe through a partnership with a large malpractice carrier, the Controlled Risk Insurance Company (CRICO). The goal of this study was to identify patient medical comorbidities and aberrant drug behaviors, as well as prescriber practices associated with patient injury and malpractice claims. Another objective was to identify claims most likely to result in payments and use this information to propose a strategy for reducing medicolegal risk. The CRICO Strategies Comparative Benchmarking System is a database of claims drawing from >350,000 malpractice claims from Harvard-affiliated institutions and >400 other academic and community institutions across the United States. This database was queried for closed claims from January 1, 2009, to December 31, 2013, and identified 37 cases concerning noninterventional, outpatient chronic pain management. Each file consisted of a narrative summary, including expert witness testimony, as well as coded fields for patient demographics, medical comorbidities, the alleged damaging event, the alleged injurious outcome, the total financial amount incurred, and more. We performed an analysis using these claim files. The mean patient age was 43.5 years, with men representing 59.5% of cases. Payments were made in 27% of cases, with a median payment of $72,500 and a range of $7500-$687,500. The majority of cases related to degenerative joint disease of the spine and failed back surgery syndrome; no patients in this series received treatment of malignant pain. Approximately half (49%) of cases involved a patient death. The use of long

Risky movies, risky behaviors, and ethnic identity among Black adolescents.

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Bleakley, Amy; Ellithorpe, Morgan E; Hennessy, Michael; Jamieson, Patrick E; Khurana, Atika; Weitz, Ilana

2017-12-01

To investigate how exposure to sex, alcohol and violent content in mainstream and Black-oriented movies relates to corresponding adolescent behavior among Black youth from the United States and whether those relationships are moderated by ethnic identity. The present study uses survey data from an online sample of 1000 Black adolescents and content analysis ratings on top-grossing 2014 films and 2013/2014 Black-oriented films. Content-specific exposure measures for alcohol, sexual activity, and violence were calculated from self-reported exposure data and content analysis ratings. Regression analyses estimated the associations among exposures to risky health content in mainstream and Black-oriented films and adolescent behaviors as well as moderation by ethnic group identity. Black adolescents were mostly unaffected by exposure to risk portrayals in mainstream films, but exposure to risk in Black-oriented films was related to their behavior in all three domains. Strong group identity strengthened the relationship between exposure to sex in Black-oriented and mainstream films depending on the sexual outcome. The type of movie (i.e., mainstream or Black-oriented) through which Black adolescents are exposed to risky health portrayals is important for understanding its relationship to their behavior, and variations by ethnic identity were limited to sex content. Future research should identify the mechanisms through which risk content in Black-oriented films is associated with Black adolescents' risky behaviors to determine how media influence contributes to behavioral disparities among youth. Copyright © 2017 Elsevier Ltd. All rights reserved.

Perceived racial discrimination, but not mistrust of medical researchers, predicts the heat pain tolerance of African Americans with symptomatic knee osteoarthritis.

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Goodin, Burel R; Pham, Quyen T; Glover, Toni L; Sotolongo, Adriana; King, Christopher D; Sibille, Kimberly T; Herbert, Matthew S; Cruz-Almeida, Yenisel; Sanden, Shelley H; Staud, Roland; Redden, David T; Bradley, Laurence A; Fillingim, Roger B

2013-11-01

Studies have shown that perceived racial discrimination is a significant predictor of clinical pain severity among African Americans. It remains unknown whether perceived racial discrimination also alters the nociceptive processing of painful stimuli, which, in turn, could influence clinical pain severity. This study examined associations between perceived racial discrimination and responses to noxious thermal stimuli among African Americans and non-Hispanic Whites. Mistrust of medical researchers was also assessed given its potential to affect responses to the noxious stimuli. One-hundred and 30 (52% African American, 48% non-Hispanic White) community-dwelling older adults with symptomatic knee osteoarthritis completed two study sessions. In session one, individuals provided demographic, socioeconomic, physical and mental health information. They completed questionnaires related to perceived lifetime frequency of racial discrimination and mistrust of medical researchers. In session two, individuals underwent a series of controlled thermal stimulation procedures to assess heat pain sensitivity, particularly heat pain tolerance. African Americans were more sensitive to heat pain and reported greater perceived racial discrimination as well as greater mistrust of medical researchers compared with non-Hispanic Whites. Greater perceived racial discrimination significantly predicted lower heat pain tolerance for African Americans but not non-Hispanic Whites. Mistrust of medical researchers did not significantly predict heat pain tolerance for either racial group. These results lend support to the idea that perceived racial discrimination may influence the clinical pain severity of African Americans via the nociceptive processing of painful stimuli.

Migraine Medications and Antidepressants: A Risky Mix?

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... What are the health risks associated with taking migraine medications and antidepressants at the same time? Answers ... W. Swanson, M.D. Reports suggest that combining migraine medications called triptans with certain antidepressants — including selective ...

FEATURES OF THE CHRONIC PAIN SYNDROME IN PATIENTS WITH RHEUMATOID ARTHRITIS AND MEDICAL DIAGNOSTIC TACTICS

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M. A. Gromova

2016-01-01

medical tactics for rheumatoid arthritis patients with a chronic pain syndrome in therapeutic practice based on pain strength gradation, assessment of chronic pain syndrome variations, definition of anxiety and depression signs. All this allows to validate consultation of medical specialists and to differentiate treatment. Conclusions. The integrated approach to diagnostics of a chronic pain syndrome for rheumatoid arthritis allows to estimate pain strengths in dynamics of disease development, to reveal existence of pain variations, anxiety and depression. It enables usage of patient maintenance tactics and increases efficiency of treatment in therapeutic practice. 

Beyond pain: modeling decision-making deficits in chronic pain

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Hess, Leonardo Emanuel; Haimovici, Ariel; Muñoz, Miguel Angel; Montoya, Pedro

2014-01-01

Risky decision-making seems to be markedly disrupted in patients with chronic pain, probably due to the high cost that impose pain and negative mood on executive control functions. Patients’ behavioral performance on decision-making tasks such as the Iowa Gambling Task (IGT) is characterized by selecting cards more frequently from disadvantageous than from advantageous decks, and by switching often between competing responses in comparison with healthy controls (HCs). In the present study, we developed a simple heuristic model to simulate individuals’ choice behavior by varying the level of decision randomness and the importance given to gains and losses. The findings revealed that the model was able to differentiate the behavioral performance of patients with chronic pain and HCs at the group, as well as at the individual level. The best fit of the model in patients with chronic pain was yielded when decisions were not based on previous choices and when gains were considered more relevant than losses. By contrast, the best account of the available data in HCs was obtained when decisions were based on previous experiences and losses loomed larger than gains. In conclusion, our model seems to provide useful information to measure each individual participant extensively, and to deal with the data on a participant-by-participant basis. PMID:25136301

Beyond pain: modeling decision-making deficits in chronic pain.

Science.gov (United States)

Hess, Leonardo Emanuel; Haimovici, Ariel; Muñoz, Miguel Angel; Montoya, Pedro

2014-01-01

Risky decision-making seems to be markedly disrupted in patients with chronic pain, probably due to the high cost that impose pain and negative mood on executive control functions. Patients' behavioral performance on decision-making tasks such as the Iowa Gambling Task (IGT) is characterized by selecting cards more frequently from disadvantageous than from advantageous decks, and by switching often between competing responses in comparison with healthy controls (HCs). In the present study, we developed a simple heuristic model to simulate individuals' choice behavior by varying the level of decision randomness and the importance given to gains and losses. The findings revealed that the model was able to differentiate the behavioral performance of patients with chronic pain and HCs at the group, as well as at the individual level. The best fit of the model in patients with chronic pain was yielded when decisions were not based on previous choices and when gains were considered more relevant than losses. By contrast, the best account of the available data in HCs was obtained when decisions were based on previous experiences and losses loomed larger than gains. In conclusion, our model seems to provide useful information to measure each individual participant extensively, and to deal with the data on a participant-by-participant basis.

Prevalence of pain medication prescriptions in France, Germany, and the UK - a cross-sectional study including 4,270,142 patients.

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Jacob, Louis; Kostev, Karel

2018-01-01

The goal of the present study was to analyze the prevalence of pain medication prescriptions in general practices in France, Germany, and the UK. This study included all patients aged ≥18 years followed in 2016 in general practitioner practices in France, Germany and the UK. The primary outcome was the prevalence of patients receiving prescriptions for pain medications in France, Germany, and the UK in 2016. The following drugs were included in the analysis: anti-inflammatory and antirheumatic products, non-steroids and analgesics including opioids, antimigraine preparations, and other analgesics and antipyretics. Demographic variables included age and gender. This study included 4,270,142 patients. The prevalences of pain medication prescriptions were 57.3% in France, 29.6% in Germany, and 21.7% in the UK. Although this prevalence generally remained consistent between age groups in France (54.3%-60.3%), it increased with age in Germany (18-30 years: 23.8%; >70 years: 35.8%) and in the UK (18-30 years: 9.3%; >70 years: 43.8%). Finally, the prevalence of pain medication prescriptions was higher in women than in men in all three countries. Paracetamol was prescribed to 82.3% and 60.1% of patients receiving pain medication in France and the UK, respectively, whereas ibuprofen was prescribed to 46.5% of individuals in Germany. The prevalence of pain medication prescriptions was higher in France than in Germany and the UK. Further research is needed to gain a better understanding of the differences in the prescription patterns between these three European countries.

Evaluation of Prevalence of Low Back Pain Among Residents of Tabriz University of Medical Sciences in Relation with Their Position in Work

OpenAIRE

SHAMS VAHDATI, Samad; SARKHOSH KHIAVI, Reza; RAJAEI GHAFOURI, Rouzbeh; ADIMI, Ida

2016-01-01

SUMMARY: Objectives: Lower back pain is one of the most common complaints among the general population and among health professionals. Multiple workplace-related risk factors may contribute to back pain among physicians. The aim of this study was to assess the prevalence of lower back pain among medical residents of different medical specialties and to evaluate the relevant risk factors. Methods: A Dutch Musculoskeletal Questionnaire (DMQ) was completed by 125 medical residents. Part I conce...

Erectile dysfunction drug receipt, risky sexual behavior and sexually transmitted diseases in HIV-infected and HIV-uninfected men.

Science.gov (United States)

Cook, Robert L; McGinnis, Kathleen A; Samet, Jeffrey H; Fiellin, David A; Rodriguez-Barradas, Maria C; Rodriquez-Barradas, Maria C; Kraemer, Kevin L; Gibert, Cynthia L; Braithwaite, R Scott; Goulet, Joseph L; Mattocks, Kristin; Crystal, Stephen; Gordon, Adam J; Oursler, Krisann K; Justice, Amy C

2010-02-01

Health care providers may be concerned that prescribing erectile dysfunction drugs (EDD) will contribute to risky sexual behavior. To identify characteristics of men who received EDD prescriptions, determine whether EDD receipt is associated with risky sexual behavior and sexually transmitted diseases (STDs), and determine whether these relationships vary for certain sub-groups. Cross-sectional study. Two thousand seven hundred and eighty-seven sexually-active, HIV-infected and HIV-uninfected men recruited from eight Veterans Health Affairs outpatient clinics. Data were obtained from participant surveys, electronic medical records, and administrative pharmacy data. EDD receipt was defined as two or more prescriptions for an EDD, risky sex as having unprotected sex with a partner of serodiscordant or unknown HIV status, and STDs, according to self-report. Overall, 28% of men received EDD in the previous year. Eleven percent of men reported unprotected sex with a serodiscordant/unknown partner in the past year (HIV-infected 15%, HIV-uninfected 6%, P sexual behavior (11% vs. 10%, p = 0.9) and STDs (7% vs 7%, p = 0.7). In multivariate analyses, EDD receipt was not significantly associated with risky sexual behavior or STDs in the entire sample or in subgroups of substance users or men who had sex with men. EDD receipt was common but not associated with risky sexual behavior or STDs in this sample of HIV-infected and uninfected men. However, risky sexual behaviors persist in a minority of HIV-infected men, indicating ongoing need for prevention interventions.

Evaluation of Prevalence of Low Back Pain Among Residents of Tabriz University of Medical Sciences in Relation with Their Position in Work.

Science.gov (United States)

Shams Vahdati, Samad; Sarkhosh Khiavi, Reza; Rajaei Ghafouri, Rouzbeh; Adimi, Ida

2014-09-01

Lower back pain is one of the most common complaints among the general population and among health professionals. Multiple workplace-related risk factors may contribute to back pain among physicians. The aim of this study was to assess the prevalence of lower back pain among medical residents of different medical specialties and to evaluate the relevant risk factors. A Dutch Musculoskeletal Questionnaire (DMQ) was completed by 125 medical residents. Part I concerned general demographic information, part II evaluated workplace-specific factors, and part III assessed the individual characteristics of lower back pain. The overall prevalence of lower back pain among residents was 56.8%, with 45.1% of men and 76.5% of women reporting lower back pain. A total of 94.4% of affected individuals believed that their lower back pain was related to their current job, and 72.6% claimed that the onset of lower back pain occurred after beginning medical work. Statistical analysis revealed a significant correlation between lower back pain and certain risk factors, such as working in the same position for long periods, repetitive movement (bending, twisting) of the lumbar region, working in uncomfortable postures, stress, walking, and standing for long periods. However, no significant relationship was found between lower back pain and heavy lifting, smoking, or prolonged sitting. The role of exercise as a protective factor in reducing the incidence of lower back pain was supported by the statistical analysis. The prevalence of lower back pain among residents is high and is associated with a number of workplace-related risk factors.

Risky substance exposure during pregnancy: a pilot study from Lebanese mothers

OpenAIRE

Rachidi, Samar; Awada, Sanaa; Al-Hajje, Amal; Bawab, Wafaa; Zein, Salam; Saleh, Nadine; Salameh, Pascale

2013-01-01

Samar Rachidi,1 Sanaa Awada,1 Amal Al-Hajje,1 Wafaa Bawab,1 Salam Zein,1 Nadine Saleh,1,2 Pascale Salameh1,21Laboratory of Epidemiological and Clinical Research, Lebanese University, Beirut, Lebanon; 2Faculty of Public Health Labanese University, Beirut, LebanonBackground: The harmful effects of medication and licit substance use during pregnancy may potentially constitute a major public health concern. Our study aims to assess risky exposure of Lebanese pregnant women to drugs, tobacco, caff...

Self - care strategies among risky profession workers

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Katarína Vasková

2015-01-01

Full Text Available Taking care of oneself is crucial for maintaining one´s psychical and physical health. In the context of risky profession this topic can play an even more important role, because it can be the source of necessary information for improvement of coping capacity when one is confronted with crisis situations. The aim of the present study is to identify the most common forms of self-care among selected risky professions. In the second part is the attention focused on the comparison of the specificities of risky to non-risky professions in self-care. Methods: For data collection Self-regulation Self-care Questionnaire by authors Hricová and Lovaš (in press is used. The sample consists of two groups. In the first one participated 156 respondents, who worked in risky professions - namely police officers (60 at the age between 22 to 55 years (average age is 36.88, SD=9.49, fire fighters (46 at the age between 22 to 62 years (average age is 35.13, SD=8.31 and paramedics (50 at the age between 25 to 55 years (average age is 40.3, SD=6.62. 76.2% of the sample are men, 19.0% are women and 4,8% didn´t state their gender. The second sample consists of 161 participants who work in administrative, industry production or IT sphere. They were at the age between 23 to 61 years (average age is 38.01, SD=10.45. 74% of the sample are men and 21.7% are women. Results and discussion: Results confirmed the dominance of psychological self-care above physical among risky professions. To the forefront gets the need to live meaningful life, to fully use one´s skills and to be satisfied with one´s life and decisions. All this needs can be assigned to the necessity of sense, which could be seen as a result of everyday contact with critical and life threaten situations. Equally important sphere of self-care is the necessity of high-quality relationships, which doesn´t mean only relationships with family or friends. It is important to highlight also relationships with

Topical Pain Medications

Science.gov (United States)

... Clinic Staff After an especially active weekend of hiking or work around the yard, your joints might ... their arthritis pain, scientific research reveals only modest benefits. Some products work only slightly or no better ...

Smoking and Bone Healing - A Risky Surgical Combination

Science.gov (United States)

... Risky Surgical Combination A A A | Print | Share Smoking and Bone Healing – A Risky Surgical Combination Imagine ... saying that they'd prefer patients to quit smoking. There hasn't been a great deal of ...

Reducing Risky Security Behaviours: Utilising Affective Feedback to Educate Users

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Lynsay A. Shepherd

2014-11-01

Full Text Available Despite the number of tools created to help end-users reduce risky security behaviours, users are still falling victim to online attacks. This paper proposes a browser extension utilising affective feedback to provide warnings on detection of risky behaviour. The paper provides an overview of behaviour considered to be risky, explaining potential threats users may face online. Existing tools developed to reduce risky security behaviours in end-users have been compared, discussing the success rates of various methodologies. Ongoing research is described which attempts to educate users regarding the risks and consequences of poor security behaviour by providing the appropriate feedback on the automatic recognition of risky behaviour. The paper concludes that a solution utilising a browser extension is a suitable method of monitoring potentially risky security behaviour. Ultimately, future work seeks to implement an affective feedback mechanism within the browser extension with the aim of improving security awareness.

Beyond pain: modeling decision-making deficits in chronic pain

Directory of Open Access Journals (Sweden)

Leonardo Emanuel Hess

2014-08-01

Full Text Available Risky decision-making seems to be markedly disrupted in patients with chronic pain, probably due to the high cost that impose pain and negative mood on executive control functions. Patients’ behavioral performance on decision-making tasks such as the Iowa Gambling Task (IGT is characterized by selecting cards more frequently from disadvantageous than from advantageous decks, and by switching often between competing responses in comparison with healthy controls. In the present study, we developed a simple heuristic model to simulate individuals’ choice behavior by varying the level of decision randomness and the importance given to gains and losses. The findings revealed that the model was able to differentiate the behavioral performance of patients with chronic pain and healthy controls at the group, as well as at the individual level. The best fit of the model in patients with chronic pain was yielded when decisions were not based on previous choices and when gains were considered more relevant than losses. By contrast, the best account of the available data in healthy controls was obtained when decisions were based on previous experiences and losses loomed larger than gains. In conclusion, our model seems to provide useful information to measure each individual participant extensively, and to deal with the data on a participant-by-participant basis.

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

Science.gov (United States)

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.

Comparative Effect of Collaborative Care, Pain Medication, and Duloxetine in the Treatment of Major Depressive Disorder and Comorbid (SubChronic Pain: Results of an Exploratory Randomized, Placebo-Controlled, Multicenter Trial (CC:PAINDIP

Directory of Open Access Journals (Sweden)

Eric W. de Heer

2018-04-01

Full Text Available ObjectiveEvidence exists for the efficacy of collaborative care (CC for major depressive disorder (MDD, for the efficacy of the consequent use of pain medication against pain, and for the efficacy of duloxetine against both MDD and neuropathic pain. Their relative effectiveness in comorbid MDD and pain has never been established so far. This study explores the effectiveness of CC with pain medication and duloxetine, and CC with pain medication and placebo, compared with duloxetine alone, on depressive and pain symptoms. This study was prematurely terminated because of massive reorganizations and reimbursement changes in mental health care in the Netherlands during the study period and is therefore of exploratory nature.MethodsThree-armed, randomized, multicenter, placebo-controlled trial at three specialized mental health outpatient clinics with patients who screened positive for MDD. Interventions lasted 12 weeks. Pain medication was administered according to an algorithm that avoids opiate prescription as much as possible, where paracetamol, COX inhibitors, and pregabalin are offered as steps before opiates are considered. Patients who did not show up for three or more sessions were registered as non-compliant. Explorative, intention-to-treat and per protocol, multilevel regression analyses were performed. The trial is listed in the trial registration (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1089; NTR number: NTR1089.ResultsSixty patients completed the study. Patients in all treatment groups reported significantly less depressive and pain symptoms after 12 weeks. CC with placebo condition showed the fastest decrease in depressive symptoms compared with the duloxetine alone group (b = −0.78; p = 0.01. Non-compliant patients (n = 31 did not improve over the 12-week period, in contrast to compliant patients (n = 29. Pain outcomes did not differ between the three groups.ConclusionIn MDD and pain, patient�

Personality psychopathology differentiates risky behaviors among women with bulimia nervosa.

Science.gov (United States)

Pearson, Carolyn M; Pisetsky, Emily M; Goldschmidt, Andrea B; Lavender, Jason M; Wonderlich, Stephen A; Crosby, Ross D; Engel, Scott G; Mitchell, James E; Crow, Scott J; Peterson, Carol B

2016-07-01

Individuals with bulimia nervosa (BN) frequently endorse risky behaviors such as self-harm and substance use. However, no studies of BN to date have examined factors associated with engaging in individual or co-occurring risky behaviors. Given that individuals with BN often have personality psychopathology, which has been linked to symptoms and course of illness, this study sought to examine how personality may differentiate engagement in risky behaviors among BN individuals. A sample of 133 women with BN completed self-report measures of personality psychopathology at baseline, and then reported on bulimic and risky behaviors (e.g., substance misuse, self-harm) over 2 weeks using ecological momentary assessment. A series of hierarchical multiple regression analyses were conducted to examine the unique associations between state-level predictor variables (each risky behavior, e.g., substance misuse, and combination of risky behaviors, e.g., substance misuse plus self-harm) and trait-level personality constructs. Substance misuse behavior, above and beyond all other risky behaviors, was significantly associated with higher scores on trait dissocial behavior (P = 0.004). Substance misuse in BN has a unique association with dissocial behavior, a personality trait characterized by hostility, impulsivity, and entitlement. These results suggest that targeting personality variables may help facilitate more effective treatment of risky behaviors, including substance use in BN. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:681-688). © 2016 Wiley Periodicals, Inc.

Modelling system development of risky industry on world experience base

Directory of Open Access Journals (Sweden)

O.T. Polishchuk

2017-12-01

Full Text Available The paper researches the tendencies and dynamic characteristics of risky business. The means of development stimulation in risky business in the USA are examined. The factors for insurance companies, banks, retirement funds of their investors’ function inability are explained. The multichoice model of economy structure transformation according to the innovative changes and regulatory policy is developed. The authors systematize the factors, which determine the branch attraction for risky investment. Four scenarios for the development of risky industry in Ukraine are studied and the matrix of their development is formed.

Medical clowns ease anxiety and pain perceived by children undergoing allergy prick skin tests.

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Goldberg, A; Stauber, T; Peleg, O; Hanuka, P; Eshayek, L; Confino-Cohen, R

2014-10-01

Intervention of medical clowns (MC) during various medical procedures performed in children has been used to relieve anxiety and pain. Their role in allergy skin testing has never been evaluated. To evaluate whether MC can diminish pain and anxiety perceived by children undergoing allergy skin prick tests (SPT). In a prospective, randomized, controlled, and blinded study, children undergoing SPT were or were not accompanied by MC. All parents and children ≥8 years completed the State-Trait Anxiety Inventory (STAI) before and after SPT. Videotapes recorded during the procedure were scored for anxiety (m-YPAS) for all children and for pain (FLACC) for children 2-7 years old by a psychologist who was unaware of the MC's presence. After SPT, children ≥8 years completed a visual analog score (VAS) for pain. Ninety-one children (mean age 8.2 years, M/F = 54/37) were recruited of whom 45 were accompanied by clowns. A significant reduction in state-STAI was found in the clowns group, in both parents and children, when compared with the regular group (26.9 ± 6.6 and 32.3 ± 10.0; P = 0.004, and 27.1 ± 4.2 and 34.3 ± 7.6; P = 0.002, respectively). Both m-YPAS and FLACC were reduced in the clowns group compared with the regular one. In the clowns group, m-YPAS positively correlated with both VAS and FLACC (P = 0.000 and 0.002, respectively). m-YPAS was positively correlated with FLACC in the regular group (P = 0.000). Medical clowns significantly decrease the level of anxiety perceived by both children undergoing allergy SPT and their parents, as well as the pain perceived by young children. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Pain and pain behavior in burning mouth syndrome: a pain diary study.

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Forssell, Heli; Teerijoki-Oksa, Tuija; Kotiranta, Ulla; Kantola, Rosita; Bäck, Marjaliina; Vuorjoki-Ranta, Tiina-Riitta; Siponen, Maria; Leino, Ari; Puukka, Pauli; Estlander, Ann-Mari

2012-01-01

To characterize pain related to primary burning mouth syndrome (BMS) in terms of intensity, interference, and distress caused by the pain, as well as factors influencing the pain across a period of 2 weeks, and to study the use of coping and management strategies on a daily basis. Fifty-two female patients with primary BMS completed a 2-week pain diary. Pain intensity, interference, distress, and mood on a 0 to 10 numeric rating scale (NRS), as well as pain amplifying and alleviating factors, were recorded three times a day. The use of treatments (medication or other means) and coping strategies were recorded at the end of each day. Coefficient of variation, repeated measures analysis of variance, and correlative methods were used to assess the between- and within-subject variation, pain patterns, and associations between various pain scores. The overall mean pain intensity score of the 14 diary days was 3.1 (SD: 1.7); there was considerable variation in pain intensity between patients. Most patients experienced intermittent pain. On average, pain intensity increased from the morning to the evening. Intercorrelations between pain intensity, interference, distress, and mood were high, varying between rs = .75 and rs = .93 (P < .001). Pungent or hot food or beverages, stress, and tiredness were the most frequently mentioned pain-amplifying factors. The corresponding pain-alleviating factors were eating, sucking pastilles, drinking cold beverages, and relaxation. Thirty (58%) patients used pain medication and 35% reported using other means to alleviate their BMS pain. There was large variation in the use of coping strategies -between subjects. There were considerable differences in pain, in factors influencing the pain, and in pain behavior across BMS patients. This indicates that patient information and education as well as treatment of BMS pain should be individualized.

Topical Medical Cannabis: A New Treatment for Wound Pain-Three Cases of Pyoderma Gangrenosum.

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Maida, Vincent; Corban, Jason

2017-11-01

Pain associated with integumentary wounds is highly prevalent, yet it remains an area of significant unmet need within health care. Currently, systemically administered opioids are the mainstay of treatment. However, recent publications are casting opioids in a negative light given their high side effect profile, inhibition of wound healing, and association with accidental overdose, incidents that are frequently fatal. Thus, novel analgesic strategies for wound-related pain need to be investigated. The ideal methods of pain relief for wound patients are modalities that are topical, lack systemic side effects, noninvasive, self-administered, and display rapid onset of analgesia. Extracts derived from the cannabis plant have been applied to wounds for thousands of years. The discovery of the human endocannabinoid system and its dominant presence throughout the integumentary system provides a valid and logical scientific platform to consider the use of topical cannabinoids for wounds. We are reporting a prospective case series of three patients with pyoderma gangrenosum that were treated with topical medical cannabis compounded in nongenetically modified organic sunflower oil. Clinically significant analgesia that was associated with reduced opioid utilization was noted in all three cases. Topical medical cannabis has the potential to improve pain management in patients suffering from wounds of all classes. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Effectiveness of medical hypnosis for pain reduction and faster wound healing in pediatric acute burn injury: study protocol for a randomized controlled trial.

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Chester, Stephen J; Stockton, Kellie; De Young, Alexandra; Kipping, Belinda; Tyack, Zephanie; Griffin, Bronwyn; Chester, Ralph L; Kimble, Roy M

2016-04-29

Burns and the associated wound care procedures can be extremely painful and anxiety-provoking for children. Burn injured children and adolescents are therefore at greater risk of experiencing a range of psychological reactions, in particular posttraumatic stress disorder, which can persist for months to years after the injury. Non-pharmacological intervention is critical for comprehensive pain and anxiety management and is used alongside pharmacological analgesia and anxiolysis. However, effective non-pharmacological pain and anxiety management during pediatric burn procedures is an area still needing improvement. Medical hypnosis has received support as a technique for effectively decreasing pain and anxiety levels in adults undergoing burn wound care and in children during a variety of painful medical procedures (e.g., bone marrow aspirations, lumbar punctures, voiding cystourethrograms, and post-surgical pain). Pain reduction during burn wound care procedures is linked with improved wound healing rates. To date, no randomized controlled trials have investigated the use of medical hypnosis in pediatric burn populations. Therefore this study aims to determine if medical hypnosis decreases pain, anxiety, and biological stress markers during wound care procedures; improves wound healing times; and decreases rates of traumatic stress reactions in pediatric burn patients. This is a single-center, superiority, parallel-group, prospective randomized controlled trial. Children (4 to 16 years, inclusive) with acute burn injuries presenting for their first dressing application or change are randomly assigned to either the (1) intervention group (medical hypnosis) or (2) control group (standard care). A minimum of 33 participants are recruited for each treatment group. Repeated measures of pain, anxiety, stress, and wound healing are taken at every dressing change until ≥95 % wound re-epithelialization. Further data collection assesses impact on posttraumatic stress

Subgrouping of risky behaviors among Iranian college students: a latent class analysis

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Safiri, Saeid; Rahimi-Movaghar, Afarin; Yunesian, Masud; Sadeghi-Bazargani, Homayoun; Shamsipour, Mansour; Mansournia, Mohammad Ali; Fotouhi, Akbar

2016-01-01

Background Risky behaviors may interrupt development or cause considerable morbidity or mortality. This study’s purpose was to determine subgroups of students based on risky behaviors and assess the prevalence of risky behaviors in each of the subgroups. Participants and methods This anonymous cross-sectional study was carried out in October 2015 and November 2015, with 1,777 students from Tabriz University of Medical Sciences, through multistage random sampling method. The data were analyzed by latent class analysis. Results The prevalence rates of cigarette smoking (more than or equal to ten cigarettes), hookah use (≥1 time/month), and alcohol consumption (≥1 time/month) during the last year were 12.4% (95% confidence interval [CI]: 10.9–14.0), 11.6% (95% CI: 10.0–13.1), and 4.9% (95% CI: 3.8–5.9), respectively. The prevalence rates of illicit opioids (1.8%, 95% CI: 1.2–2.5), cannabis (1.2%, 95% CI: 0.7–1.7), methamphetamine (1.1%, 95% CI: 0.6–1.6), methylphenidate (2.5%, 95% CI: 1.7–3.2), and extramarital sex (5.5%, 95% CI: 4.5–6.6) over the last year were also estimated. Three latent classes were determined: 1) low risk; 2) cigarette and hookah smoker; and 3) high risk. It is worth mentioning that 3.7% of males and 0.4% of females were in the high risk group. Conclusion Subgrouping of college students showed that a considerable percentage of them, especially males, were classified into the high risk and cigarette and hookah smoker groups. Appropriate preventive measures that consider multiple different risky behaviors simultaneously are needed for this part of the population. PMID:27524898

Comparative effect of collaborative care, pain medication, and duloxetine in the treatment of major depressive disorder and comorbid (Sub)chronic pain: Results of an exploratory randomized, placebo-controlled, multicenter trial (CC:PAINDIP)

NARCIS (Netherlands)

de Heer, Eric W.; Dekker, Jack; Beekman, Aartjan T.F.; van Marwijk, Harm W.J.; Holwerda, Tjalling J.; Bet, Pierre M.; Roth, Joost; Timmerman, Lotte; van der Feltz-Cornelis, Christina M.

2018-01-01

Objective: Evidence exists for the efficacy of collaborative care (CC) for major depressive disorder (MDD), for the efficacy of the consequent use of pain medication against pain, and for the efficacy of duloxetine against both MDD and neuropathic pain. Their relative effectiveness in comorbid MDD

Risky music-listening behaviors and associated health-risk behaviors.

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Vogel, Ineke; van de Looij-Jansen, Petra M; Mieloo, Cathelijne L; Burdorf, Alex; de Waart, Frouwkje

2012-06-01

To examine, among adolescents and emerging adults attending inner-city lower education, associations between risky music-listening behaviors (from MP3 players and in discotheques and at pop concerts) and more traditional health-risk behaviors: substance use (cigarettes, alcohol, cannabis, and hard drugs) and unsafe sexual intercourse. A total of 944 students in Dutch inner-city senior-secondary vocational schools completed questionnaires about their music-listening and traditional health-risk behaviors. Multiple logistic regression analyses were used to examine associations between music-listening and traditional health-risk behaviors. Risky MP3-player listeners used cannabis more often during the past 4 weeks. Students exposed to risky sound levels during discotheque and pop concert attendance used cannabis less often during the past 4 weeks, were more often binge drinkers, and reported inconsistent condom use during sexual intercourse. The coexistence of risky music-listening behaviors with other health-risk behaviors provides evidence in support of the integration of risky music-listening behaviors within research on and programs aimed at reducing more traditional health-risk behaviors, such as substance abuse and unsafe sexual intercourse.

Serotonin shapes risky decision making in monkeys.

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Long, Arwen B; Kuhn, Cynthia M; Platt, Michael L

2009-12-01

Some people love taking risks, while others avoid gambles at all costs. The neural mechanisms underlying individual variation in preference for risky or certain outcomes, however, remain poorly understood. Although behavioral pathologies associated with compulsive gambling, addiction and other psychiatric disorders implicate deficient serotonin signaling in pathological decision making, there is little experimental evidence demonstrating a link between serotonin and risky decision making, in part due to the lack of a good animal model. We used dietary rapid tryptophan depletion (RTD) to acutely lower brain serotonin in three macaques performing a simple gambling task for fluid rewards. To confirm the efficacy of RTD experiments, we measured total plasma tryptophan using high-performance liquid chromatography (HPLC) with electrochemical detection. Reducing brain serotonin synthesis decreased preference for the safe option in a gambling task. Moreover, lowering brain serotonin function significantly decreased the premium required for monkeys to switch their preference to the risky option, suggesting that diminished serotonin signaling enhances the relative subjective value of the risky option. These results implicate serotonin in risk-sensitive decision making and, further, suggest pharmacological therapies for treating pathological risk preferences in disorders such as problem gambling and addiction.

Serotonin shapes risky decision making in monkeys

OpenAIRE

Long, Arwen B.; Kuhn, Cynthia M.; Platt, Michael L.

2009-01-01

Some people love taking risks, while others avoid gambles at all costs. The neural mechanisms underlying individual variation in preference for risky or certain outcomes, however, remain poorly understood. Although behavioral pathologies associated with compulsive gambling, addiction and other psychiatric disorders implicate deficient serotonin signaling in pathological decision making, there is little experimental evidence demonstrating a link between serotonin and risky decision making, in ...

Psychiatric side effects of ketamine in hospitalized medical patients administered subanesthetic doses for pain control.

Science.gov (United States)

Rasmussen, Keith G

2014-08-01

To assess the psychiatric side effects of ketamine when administered in subanesthetic doses to hospitalized patients. It is hypothesized that such effects occur frequently. In this retrospective study, the medical records of 50 patients hospitalized on medical and surgical units at our facility who had continuous intravenous infusions of ketamine for pain or mild sedation were reviewed. Patient progress in the days following the start of ketamine infusion was reviewed and response to ketamine was noted. Twenty-two percent of the patients were noted to have some type of psychiatric reaction to ketamine, including agitation, confusion, and hallucinations. These reactions were relatively short lived, namely, occurring during or shortly after the infusions. No association was found between patient response to ketamine and gender, age, or infusion rate. Awareness of the psychiatric side effects of ketamine is an important consideration for clinicians administering this medication either for pain control or for depressive illness.

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

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

2014-02-01

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

An Item Bank for Abuse of Prescription Pain Medication from the Patient-Reported Outcomes Measurement Information System (PROMIS®).

Science.gov (United States)

Pilkonis, Paul A; Yu, Lan; Dodds, Nathan E; Johnston, Kelly L; Lawrence, Suzanne M; Hilton, Thomas F; Daley, Dennis C; Patkar, Ashwin A; McCarty, Dennis

2017-08-01

There is a need to monitor patients receiving prescription opioids to detect possible signs of abuse. To address this need, we developed and calibrated an item bank for severity of abuse of prescription pain medication as part of the Patient-Reported Outcomes Measurement Information System (PROMIS ® ). Comprehensive literature searches yielded an initial bank of 5,310 items relevant to substance use and abuse, including abuse of prescription pain medication, from over 80 unique instruments. After qualitative item analysis (i.e., focus groups, cognitive interviewing, expert review, and item revision), 25 items for abuse of prescribed pain medication were included in field testing. Items were written in a first-person, past-tense format, with a three-month time frame and five response options reflecting frequency or severity. The calibration sample included 448 respondents, 367 from the general population (ascertained through an internet panel) and 81 from community treatment programs participating in the National Drug Abuse Treatment Clinical Trials Network. A final bank of 22 items was calibrated using the two-parameter graded response model from item response theory. A seven-item static short form was also developed. The test information curve showed that the PROMIS ® item bank for abuse of prescription pain medication provided substantial information in a broad range of severity. The initial psychometric characteristics of the item bank support its use as a computerized adaptive test or short form, with either version providing a brief, precise, and efficient measure relevant to both clinical and community samples. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Tile relations between subjective or objective risky driving and motives for risky driving or attitudes towards road safety

OpenAIRE

Žardeckaitė-Matulaitienė, Kristina; Markšaitytė, Rasa; Endriulaitienė, Auksė; Šeibokaitė, Laura; Pranckevičienė, Aistė

2012-01-01

The study aims to evaluate how the factors of motivation and attitudes about traffic safety are related to risky driving evaluated by young drivers both subjectively and objectively. Risky driving was evaluated in three ways: self-knowledge, driving in a simulation environment, and recalled violations of road traffic regulations as well as accidents caused. 226 respondents aged 18–29 answered the questions from the self-knowledge questionnaire, 40 of them participated in the experiment of dri...

Affective and cognitive mechanisms of risky decision making.

Science.gov (United States)

Shimp, Kristy G; Mitchell, Marci R; Beas, B Sofia; Bizon, Jennifer L; Setlow, Barry

2015-01-01

The ability to make advantageous decisions under circumstances in which there is a risk of adverse consequences is an important component of adaptive behavior; however, extremes in risk taking (either high or low) can be maladaptive and are characteristic of a number of neuropsychiatric disorders. To better understand the contributions of various affective and cognitive factors to risky decision making, cohorts of male Long-Evans rats were trained in a "Risky Decision making Task" (RDT), in which they made discrete trial choices between a small, "safe" food reward and a large, "risky" food reward accompanied by varying probabilities of footshock. Experiment 1 evaluated the relative contributions of the affective stimuli (i.e., punishment vs. reward) to RDT performance by parametrically varying the magnitudes of the footshock and large reward. Varying the shock magnitude had a significant impact on choice of the large, "risky" reward, such that greater magnitudes were associated with reduced choice of the large reward. In contrast, varying the large, "risky" reward magnitude had minimal influence on reward choice. Experiment 2 compared individual variability in RDT performance with performance in an attentional set shifting task (assessing cognitive flexibility), a delayed response task (assessing working memory), and a delay discounting task (assessing impulsive choice). Rats characterized as risk averse in the RDT made more perseverative errors on the set shifting task than did their risk taking counterparts, whereas RDT performance was not related to working memory abilities or impulsive choice. In addition, rats that showed greater delay discounting (greater impulsive choice) showed corresponding poorer performance in the working memory task. Together, these results suggest that reward-related decision making under risk of punishment is more strongly influenced by the punishment than by the reward, and that risky and impulsive decision making are associated with

Complementary and alternative medical therapies for chronic low back pain: What treatments are patients willing to try?

Directory of Open Access Journals (Sweden)

Erro Janet

2004-07-01

Full Text Available Abstract Background Although back pain is the most common reason patients use complementary and alternative medical (CAM therapies, little is known about the willingness of primary care back pain patients to try these therapies. As part of an effort to refine recruitment strategies for clinical trials, we sought to determine if back pain patients are willing to try acupuncture, chiropractic, massage, meditation, and t'ai chi and to learn about their knowledge of, experience with, and perceptions about each of these therapies. Methods We identified English-speaking patients with diagnoses consistent with chronic low back pain using automated visit data from one health care organization in Boston and another in Seattle. We were able to confirm the eligibility status (i.e., current low back pain that had lasted at least 3 months of 70% of the patients with such diagnoses and all eligible respondents were interviewed. Results Except for chiropractic, knowledge about these therapies was low. Chiropractic and massage had been used by the largest fractions of respondents (54% and 38%, respectively, mostly for back pain (45% and 24%, respectively. Among prior users of specific CAM therapies for back pain, massage was rated most helpful. Users of chiropractic reported treatment-related "significant discomfort, pain or harm" more often (23% than users of other therapies (5–16%. Respondents expected massage would be most helpful (median of 7 on a 0 to 10 scale and meditation least helpful (median of 3 in relieving their current pain. Most respondents indicated they would be "very likely" to try acupuncture, massage, or chiropractic for their back pain if they did not have to pay out of pocket and their physician thought it was a reasonable treatment option. Conclusions Most patients with chronic back pain in our sample were interested in trying therapeutic options that lie outside the conventional medical spectrum. This highlights the need for additional

Complementary and alternative medical therapies for chronic low back pain: What treatments are patients willing to try?

Science.gov (United States)

Sherman, Karen J; Cherkin, Daniel C; Connelly, Maureen T; Erro, Janet; Savetsky, Jacqueline B; Davis, Roger B; Eisenberg, David M

2004-07-19

Although back pain is the most common reason patients use complementary and alternative medical (CAM) therapies, little is known about the willingness of primary care back pain patients to try these therapies. As part of an effort to refine recruitment strategies for clinical trials, we sought to determine if back pain patients are willing to try acupuncture, chiropractic, massage, meditation, and t'ai chi and to learn about their knowledge of, experience with, and perceptions about each of these therapies. We identified English-speaking patients with diagnoses consistent with chronic low back pain using automated visit data from one health care organization in Boston and another in Seattle. We were able to confirm the eligibility status (i.e., current low back pain that had lasted at least 3 months) of 70% of the patients with such diagnoses and all eligible respondents were interviewed. Except for chiropractic, knowledge about these therapies was low. Chiropractic and massage had been used by the largest fractions of respondents (54% and 38%, respectively), mostly for back pain (45% and 24%, respectively). Among prior users of specific CAM therapies for back pain, massage was rated most helpful. Users of chiropractic reported treatment-related "significant discomfort, pain or harm" more often (23%) than users of other therapies (5-16%). Respondents expected massage would be most helpful (median of 7 on a 0 to 10 scale) and meditation least helpful (median of 3) in relieving their current pain. Most respondents indicated they would be "very likely" to try acupuncture, massage, or chiropractic for their back pain if they did not have to pay out of pocket and their physician thought it was a reasonable treatment option. Most patients with chronic back pain in our sample were interested in trying therapeutic options that lie outside the conventional medical spectrum. This highlights the need for additional studies evaluating their effectiveness and suggests that

Safety and efficiency of prehospital pain management with fentanyl administered by emergency medical technicians

DEFF Research Database (Denmark)

Nielsen, Niels Dalsgaard; Brogaard, Kjeld; Dahl, Michael

2007-01-01

Introduction: In our region Advanced Emergency Medical Technicians (AEMTs) respond to acutely ill or injured patients in rural areas. The AEMTs have been authorized to administer fentanyl intravenously in doses up to 2 μg/kg to selected groups of patients in pain. Higher doses can be allowed...... by a physician after a teleconference. We examined the effect of intravenous (IV) fentanyl treatment, expressed as pain reduction on a 10-point Numeric Rating Scale (NRS). Moreover we examined the occurrence of negative coincident events to assess whether it was safe to let non-medical staff administer potent...... opioids intravenously.   Methods: Retrospectively we collected the case sheets for all patients treated with IV fentanyl by the AEMTs in 2005 and 2006. We excluded all patients where a physician had been directly involved in the prehospital treatment. We recorded the IV fentanyl dose, NRS-score before...

"I was a little surprised": Qualitative Insights from Patients Enrolled in a 12-Month Trial Comparing Opioids to Non-Opioid Medications for Chronic Musculoskeletal Pain.

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Marianne S Matthias; Donaldson, Melvin T; Jensen, Agnes C; Krebs, Erin E

2018-04-28

Chronic musculoskeletal pain is a major public health problem. Although opioid prescribing for chronic pain has increased dramatically since the 1990s, this practice has come under scrutiny because of increases in opioid-related harms and lack of evidence for long-term effectiveness. The Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE) trial was a pragmatic 12-month randomized trial comparing benefits and harms of opioid versus non-opioid medications for chronic musculoskeletal pain. The current qualitative study was designed to better understand trial results by exploring patients' experiences, including perceptions of medications, experiences with the intervention, and whether expectations were met. Thirty-four participants who were purposefully sampled based on treatment group and intervention response participated in semi-structured interviews. The constant comparison method guided analysis. Results revealed that participants often held strong beliefs about opioid medications, which sometimes changed during the trial as they gained experience with medications; participants described a wide variety of experiences with treatment effectiveness, regardless of study group or their response to the intervention; and participants highly valued the personalized pain care model used in SPACE. SPACE trial results indicated no advantage for opioid over non-opioid medications. Qualitative findings suggest that, for patients in both treatment groups, pre-existing expectations of medications and of anticipated improvement in pain shaped experiences with and responses to medications. In addition, the personalized pain care model was described as contributing to positive outcomes in both groups. Copyright © 2018. Published by Elsevier Inc.

Dissecting the risky-choice framing effect

Directory of Open Access Journals (Sweden)

Ellen Peters

2008-08-01

Full Text Available Using five variants of the Asian Disease Problem, we dissected the risky-choice framing effect by requiring each participant to provide preference ratings for the full decision problem and also to provide attractiveness ratings for each of the component parts, i.e., the sure-thing option and the risky option. Consistent with previous research, more risky choices were made by respondents receiving negatively framed versions of the decision problems than by those receiving positively framed versions. However, different processes were evident for those scoring high and low on numeracy. Whereas the choices of the less numerate showed a large effect of frame above and beyond any influence of their evaluations of the separate options, the choices of the highly numerate were almost completely accounted for by their attractiveness ratings of the separate options. These results are consistent with an increased tendency of the highly numerate to integrate complex numeric information in the construction of their preferences and a tendency for the less numerate to respond more superficially to non-numeric sources of information.

Use of ibuprofen sustained release for treating osteoarthritic pain: findings from 15 general medical practices in Egypt

Directory of Open Access Journals (Sweden)

Khalifa N

2014-05-01

Full Text Available Nabil Khalifa,1 Timour El-Husseini,1 Ahmed Morrah,2 Elshenawy Mostafa,3 Hesham Hamoud41Department of Orthopedic Surgery, Ain Shams University, Cairo, Egypt; 2Department of Orthopedic Surgery, Cairo University, Cairo, Egypt; 3Department of Orthopedic Surgery, Mansoura University, Mansoura, Egypt; 4Department of Rheumatology, Azhar University, Cairo, EgyptPurpose: Ibuprofen sustained release (SR has been shown to provide effective symptomatic pain relief in chronic arthritic conditions such as osteoarthritis in European and US patient populations. Few studies have been conducted in other patient populations. A 4-week prospective multicenter open-label observational study was designed to explore and describe the combined effect of ibuprofen SR and standard medical care in patients suffering from osteoarthritis in 15 general medical practices in Egypt.Patients and methods: In total, 519 patients were prescribed ibuprofen SR 2 ×800 mg once daily for 4 weeks.Results: Ibuprofen SR combined with standard medical care significantly improved day and night pain, with 99.4% of the patients reporting improvement. The treatment reduced the symptom severity of joint tenderness/stiffness and the duration of morning stiffness, and allowed more patients to carry out normal activities. Overall compliance with the prescribed ibuprofen SR regimen was 98.6%. Ibuprofen SR was generally well tolerated with no serious adverse events reported during the study. There was no increase in blood pressure or heart rate.Conclusion: The combined treatment provided effective relief of pain in patients with osteoarthritis in a large real-life general medical practice setting in Egypt. Owing to its convenient once-daily dosing regimen, ibuprofen SR may enhance patient compliance.Keywords: chronic arthritis, compliance, pain score, real-life

Patient Perceptions of the Use of Medical Marijuana in the Treatment of Pain After Musculoskeletal Trauma: A Survey of Patients at 2 Trauma Centers in Massachusetts.

Science.gov (United States)

Heng, Marilyn; McTague, Michael F; Lucas, Robert C; Harris, Mitchel B; Vrahas, Mark S; Weaver, Michael J

2018-01-01

To evaluate musculoskeletal trauma patients' beliefs regarding the usefulness of marijuana as a valid medical treatment for postinjury and postoperative pain and anxiety. Prospective survey. Two academic Level 1 trauma centers. Five hundred patients in an orthopedic outpatient clinic. Survey. (1) Do patients believe that marijuana can be used as medicine? (2) Do patients believe that marijuana can help treat postinjury pain? (3) Are patients comfortable speaking with their health care providers about medical marijuana? The majority of patients felt that marijuana could be used to treat pain (78%, 390) and anxiety (62%, 309). Most patients (60%, 302) had used marijuana at least once previously, whereas only 14% reported using marijuana after their injury. Of those who used marijuana during their recovery, 90% (63/70) believed that it reduced symptoms of pain, and 81% (57/70) believed that it reduced the amount of opioid pain medication they used. The majority of patients in this study believed that medical marijuana is a valid treatment and that it does have a role in reducing postinjury and postoperative pain. Those patients who used marijuana during their recovery felt that it alleviated symptoms of pain and reduced their opioid intake. Our results help inform clinicians regarding the perceptions of patients with trauma regarding the usefulness of marijuana in treating pain and support further study into the utility of medical marijuana in this population.

Factors Influencing the Application of a Biopsychosocial Perspective in Clinical Judgement of Chronic Pain: Interactive Management with Medical Students.

Science.gov (United States)

Dwyer, Christopher P; McKenna-Plumley, Phoebe E; Durand, Hannah; Gormley, Emer M; Slattery, Brian W; Harney, Owen M; MacNeela, Padraig; McGuire, Brian E

2017-09-01

Though there is wide support for the application of biopsychosocial perspectives in clinical judgement of chronic pain cases, such perspectives are often overlooked due to either inadequate training or attitudes favoring a biomedical approach. Recent research has indicated that despite such explanations, both established general practitioners (GP) and medical students account for some psychosocial factors when making clinical judgements regarding chronic pain cases, but report not being likely to apply these in real-world, clinical settings due to numerous factors, including available time with patients. Thus, it is evident that a greater understanding of clinical judgement-making processes and the factors that affect application of these processes is required, particularly regarding chronic pain. The aims of the current study were to investigate medical students' conceptualizations of the factors that influence application of a biopsychosocial approach to clinical judgement-making in cases of chronic pain using interactive management (IM), model the relationships among these factors, and make recommendations to chronic pain treatment policy in light of the findings. The current study used IM to identify and model factors that influence the application of a biopsychosocial approach to clinical judgement-making in cases of chronic pain, based on medical students' conceptualizations of these factors. Two university classrooms. IM is a systems thinking and action mapping strategy used to aid groups in developing outcomes regarding complex issues, through integrating contributions from individuals with diverse views, backgrounds, and perspectives. IM commonly utilizes the nominal group technique and interpretive structural modeling, which in this context were employed to help medical students identify, clarify, and model influences on the application of biopsychosocial perspectives in treating chronic pain patients. Results of IM group work revealed 7 core

Lead intoxication due to ayurvedic medications as a cause of abdominal pain in adults.

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Mehta, Varun; Midha, Vandana; Mahajan, Ramit; Narang, Vikram; Wander, Praneet; Sood, Ridhi; Sood, Ajit

2017-02-01

Though a majority of cases of lead intoxication come from occupational exposures, traditional and folk remedies have also been reported to contain toxic amounts of lead. We present a large series of patients with lead poisoning due to intake of Ayurvedic medicines, all of whom presented with unexplained abdominal pain. This was a retrospective, observational case series from a tertiary care center in India. The charts of patients who underwent blood lead level (BLL) testing as a part of workup for unexplained abdominal pain between 2005 and 2013 were reviewed. The patients with lead intoxication (BLLs >25 μg/dl) were identified and demographics, history, possible risk factors, clinical presentation and investigations were reviewed. Treatment details, duration, time to symptomatic recovery, laboratory follow-up and adverse events during therapy were recorded. BLLs were tested in 786 patients with unexplained abdominal pain and high levels were identified in 75 (9.5%) patients, of which a majority (73 patients, 9.3%) had history of Ayurvedic medication intake and only two had occupational exposure. Five randomly chosen Ayurvedic medications were analyzed and lead levels were impermissibly high (14-34,950 ppm) in all of them. Besides pain in abdomen, other presenting complaints were constipation, hypertension, neurological symptoms and acute kidney injury. Anemia and abnormal liver biochemical tests were observed in all the 73 patients. Discontinuing the Ayurvedic medicines and chelation with d-penicillamine led to improvement in symptoms and reduction in BLLs in all patients within 3-4 months. The patients presenting with severe recurrent abdominal pain, anemia and history of use of Ayurvedic medicines should be evaluated for lead toxicity. Early diagnosis in such cases can prevent unnecessary investigations and interventions, and permits early commencement of the treatment.

Biomedicine and 'Risky' Retirement Destinations: Older Western Residents in Ubud, Bali.

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Green, Paul

2016-01-01

International retirement migration is often conflated with the generic emergence of a new stage in the life course, the third age. I describe how well-travelled, globally orientated retirees are drawn to and experience biomedical provision in 'risky' retirement destinations. Drawing on ethnographic research in Ubud, Bali, Indonesia, I consider how older Western residents shape, share, and manage their health concerns in light of an Indonesian biomedical system that is transforming in the context of modern medical provision and an emerging retirement industry. Building on Rose and Novas's notion of biological citizenship, I illustrate the ways in which Western retirees engage with multiple biomedical realities built around localized, symbolic distinctions between 'hospital' and 'doctor,' immigration frameworks, the transregional context of medical tourism, and broader concerns relating to change and overdevelopment in Ubud and Bali.

Men with pelvic pain: perceived helpfulness of medical and self-management strategies.

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Turner, Judith A; Ciol, Marcia A; Von Korff, Michael; Liu, Yung-Wen; Berger, Richard

2006-01-01

To assess the frequency of use of different treatments and pain management strategies and their perceived helpfulness in male patients with pelvic pain. Approximately 1 month after a health maintenance organization visit for pelvic pain, 286 men (mean age 46.7 years) completed telephone interviews about their symptoms and treatments and pain management strategies used in the past year. Participants rated the helpfulness of each treatment and strategy used on 0 to 10 scales. Even though men with identified bacterial etiology were excluded from the study, antibiotic medication was the most commonly reported treatment (67% of patients) and rated as the second most helpful treatment [mean (SD)=6.3 (3.6)]. Opiates were rated as the most helpful treatment on average [mean (SD)=7.9 (2.1)], but were used by only 12% of patients. Substantial minorities of patients reported several behaviors as helpful, including urinating (reported as helpful by 26%), taking warm baths (23%), and drinking water (23%), although patterns of effects differed for men with versus without urinary symptoms. Activities most commonly reported as worsening symptoms were sitting (42%), walking/jogging (27%), and sexual activity (25%). Patients with male pelvic pain syndrome are commonly prescribed antibiotics, which they perceive as moderately helpful, despite the lack of scientific evidence of efficacy. Clinicians may find it useful to support patient use of safe, inexpensive, self-management approaches, especially warm baths, increased water intake, and avoidance of prolonged sitting.

Prevalence of knee pain and knee OA in southern Sweden and the proportion that seeks medical care

DEFF Research Database (Denmark)

Turkiewicz, Aleksandra; Gerhardsson de Verdier, Maria; Engström, Gunnar

2015-01-01

OBJECTIVE: The aim of this study was to estimate the prevalence of frequent knee pain in radiographic, symptomatic and clinically defined knee OA in middle-aged and elderly patients and the proportion that seeks medical care. METHODS: In 2007 a random sample of 10 000 56- to 84-year-old residents...... of Malmö, Sweden, were questioned about knee pain. We classified subjects reporting knee pain with a duration of at least 4 weeks as having frequent knee pain. A random sample of 1300 individuals with frequent knee pain and 650 without were invited for assessment by the ACR clinical knee OA criteria...... and for bilateral weight-bearing knee radiography. We considered a Kellgren-Lawrence grade ≥2 as radiographic knee OA and that in combination with frequent knee pain as symptomatic knee OA. By linkage with the Skåne Healthcare Register, we determined the proportion of subjects that had consulted for knee OA or pain...

Successful schools and risky behaviors among low-income adolescents.

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Wong, Mitchell D; Coller, Karen M; Dudovitz, Rebecca N; Kennedy, David P; Buddin, Richard; Shapiro, Martin F; Kataoka, Sheryl H; Brown, Arleen F; Tseng, Chi-Hong; Bergman, Peter; Chung, Paul J

2014-08-01

We examined whether exposure to high-performing schools reduces the rates of risky health behaviors among low-income minority adolescents and whether this is due to better academic performance, peer influence, or other factors. By using a natural experimental study design, we used the random admissions lottery into high-performing public charter high schools in low-income Los Angeles neighborhoods to determine whether exposure to successful school environments leads to fewer risky (eg, alcohol, tobacco, drug use, unprotected sex) and very risky health behaviors (e.g., binge drinking, substance use at school, risky sex, gang participation). We surveyed 521 ninth- through twelfth-grade students who were offered admission through a random lottery (intervention group) and 409 students who were not offered admission (control group) about their health behaviors and obtained their state-standardized test scores. The intervention and control groups had similar demographic characteristics and eighth-grade test scores. Being offered admission to a high-performing school (intervention effect) led to improved math (P performance of public schools in low-income communities may be a powerful mechanism to decrease very risky health behaviors among low-income adolescents and to decrease health disparities across the life span. Copyright © 2014 by the American Academy of Pediatrics.

Measuring risky adolescent cycling behaviour.

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Feenstra, Hans; Ruiter, Robert A C; Schepers, Jan; Peters, Gjalt-Jorn; Kok, Gerjo

2011-09-01

Adolescents are at a greater risk of being involved in traffic accidents than most other age groups, even before they start driving cars. This article aims to determine the factor structure of a self-report questionnaire measuring adolescent risky cycling behaviour, the ACBQ (Adolescent Cycling Behaviour Questionnaire). The questionnaire's structure was based on the widely used Driver Behaviour Questionnaire (DBQ). A sample of secondary school students (N = 1749; age range: 13-18 years) filled out the questionnaire. Factor analysis revealed a three-factor structure underlying the questionnaire, which was confirmed on two equally large portions of the entire sample. These three underlying factors were identified as errors, common violations and exceptional violations. The ACBQ is a useful instrument for measuring adolescents' risky cycling behaviour.

A pilot study: the effect of healing touch on anxiety, stress, pain, pain medication usage, and physiological measures in hospitalized sickle cell disease adults experiencing a vaso-occlusive pain episode.

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Thomas, Linda S; Stephenson, Nancy; Swanson, Mel; Jesse, D Elizabeth; Brown, Sylvia

2013-12-01

This pilot study was conducted to determine the effectiveness of Healing Touch on anxiety, stress, pain, pain medication usage, and selected physiological measures of hospitalized adults with sickle cell disease experiencing a vaso-occlusive pain episode. Healing Touch sessions were administered for 30 minutes on four consecutive days, and the self-reported data on anxiety, stress, pain, and the selected physiological data were collected while controlling for music and presence. A parallel-group randomized control trial comparing the effects of Healing Touch with Music (HTM) to Attention Control with Music (ACM). Due to the small sample size, there were no statistically significant changes in any between-group comparisons, except for present pain on Day 4 for the ACM group. For both groups, the within-group comparison showed a nonsignificant reduction in physiological parameters, a statistically significant reduction in anxiety and stress for the ACM group after Day 4, and a statistically significant reduction in stress in the HTM group after Days 2 and 4. The pre- to postintervention reductions in present pain were greater in the HTM group across all 4 days, but the only statistically significant within groups findings were in the HTM group (p < .01) on Day 1. Further research is needed.

Effects of a pain education program in Complementary and Alternative Medicine treatment utilization at a VA medical center.

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Cosio, David; Lin, Erica H

2015-06-01

Past studies have shown that U.S. Veterans are consumers of CAM. However, more than 75% of Veteran non-users report they would utilize these treatment options if made available. Thus, Veterans may not be fully aware of the CAM options currently available to them in the current U.S. VA health care system. The current study tested the hypothesis that Veterans would report an increase in CAM utilization after completing a formal pain education program in a VA medical center. The study used a quasi-experimental, one-group, pre/post-test design. Midwestern, U.S. VA Medical Center. The responses from 103 Veterans who elected to participate in the program and the assessment measures were included in the outcome analyses. "Pain Education School" is a 12-week, educational program that is open to all Veterans and their families. It is a comprehensive program that introduces patients to 23 different disciplines at the VA Medical Center that deal with chronic, non-cancer pain. An adaptation of the Complementary and Alternative Medicine Questionnaire(©), SECTION A: Use of Alternative Health Care Providers. There was a significant difference found in overall utilization of CAM after completing the pain education program. The most utilized CAM modality was the chiropractor; the least utilized were hypnosis and aromatherapy. Not all health care systems or providers may have access to an education-focused, professionally driven program as an amenity. However, lessons can be learned from this study in terms of what pain providers may be able to accomplish in their practice. Published by Elsevier Ltd.

Safety and efficiency of prehospital pain management with fentanyl administered by emergency medical technicians

DEFF Research Database (Denmark)

Nielsen, Niels Dalsgaard; Brogaard, Kjeld; Dahl, Michael

2007-01-01

minor, and were not treated with naloxone.   Conclusions: Our results suggest that non-medical personnel safely can administer IV fentanyl to selected groups of patients with a satisfactory result in terms of a considerable reduction in pain score and an acceptable rate of negative coincident events....

Risky behaviours among university students in Italy

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Andrea Poscia

2015-06-01

Full Text Available BACKGROUND: The use of psychoactive substances is one of the most important public health issues. Tobacco, alcohol and illicit drugs are among the top risk factors for ill-health defined by World Health Organisation. The risky behaviours acquired in teenage can be magnified or decreased during university when a person starts having more awareness about the importance of own wellness. This paper describes the results of the project "Sportello Salute Giovani" ("Youth Health Information Desk" with respect to risky behaviours in a large sample of Italian university students. MATERIALS AND METHODS: 18 questions of the survey "Sportello Salute Giovani" dealing with risky behaviors, the use of psychoactive substances such as tobacco, alcohol and illicit drugs were included. Absolute and relative frequencies were calculated. Besides, chi square test were used to test the differences in sex, age class and socio-economic status. RESULTS: About 24% of the interviewed students currently smokes. 89% and 42.2% respectively drinks at least rarely or weekly beer, wine or spirits. About 40% of students smoked at least a joint and about 2% used other drugs (mostly cocaine. CONCLUSION: The "Sportello Salute Giovani" survey suggests that the frequency of risky behaviours in Italian university students is not reassuring, although they should be aware about the negative consequences on their and others health because of their educational level.

Pain Medications After Surgery

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... be used for outpatient procedures or more-involved inpatient surgery. For pain relief lasting several hours, an ... surgical care, such as rest, ice packs, rehabilitative exercises and wound care. Ask to have written instructions ...

A plea for rational mitigation of poor outcomes in the 'off-label use' of medications for the management of pain.

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Khursheed, Faraz; Ioffe, Julia; Gould, Harry J

2015-02-15

Neuropathic pain is a common and difficult to manage public health problem characterized by frequent treatment failure and high management costs. The variable presentation and response to treatment among patients make it difficult for physicians to apply a single, standardized approach for management. The physician's role in treating neuropathic pain is complex. Clinical decisions must be drawn from personal and shared experience, case reports, and evidence-based, controlled trials performed on selected populations of patients with common, narrowly-defined conditions. Recent advances in our understanding of the mechanisms that underlie the processing of nociceptive stimuli and the perception of pain have led to the increased 'off-label use' of adjuvant medications in an attempt to provide relief for many patients who heretofore have suffered unnecessarily with intractable neuropathic pain. Unfortunately, as with any treatment, sound clinical decisions can occasionally result in an untoward adverse response. It is therefore imperative that potential adverse effects inherent to all medications be considered and weighed against the untoward consequences of withholding treatment prior to incorporating their use in any course of management. This commentary presents a case report that illustrates a particularly devastating consequence that was encountered when a medication was selected for 'off-label use' in the treatment of intractable pain and presents an opinion for consideration in developing guidelines for determining acceptable risk and standard of care based upon rational adherence or deviation from the approved indications offered for the use of a medication at the time of its introduction into practice is granted. Copyright © 2014 Elsevier B.V. All rights reserved.

Influence of risky and protective behaviors connected with listening to music on hearing loss and the noise induced threshold shift among students of the Medical University of Bialystok

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Beata Modzelewska

2017-03-01

Full Text Available Background . Currently, significant changes have occurred in the character of sound exposure, along with the properties of the group affected by it. Thus, primary care physicians have to keep in mind that a sizable group of young adults comprises groups in which the prevalence of hearing loss is increasing. Objectives . The goal of the following study was to determine the auditory ability of the students attending the Medical University in Bialystok and to analyze their risky and protective behaviors relating to music consumption. Material and methods . In total, 230 students (age: 18–26 years completed a questionnaire about general personal information and their music-listening habits. Thereafter, pure tone audiometry at standard frequencies (0.25 kHz–8 kHz was performed. Results . Hearing loss was more frequent in subjects who listened to music at higher volumes (‘very loud’ – 22.2%, ‘loud’ – 3.9%, ‘not very loud’ – 2.1%, ‘quiet’ – 9.1%, p = 0.046. Hearing loss was more prevalent among those students who were living in a city with more than 50,000 inhabitants before starting higher education compared to the remaining subjects (7.95% vs. 0.97%, p = 0.025. Conclusions . The study demonstrated that surprisingly few medical students suffer from hearing loss or a noise induced threshold shift. There is no correlation between risky behavior such as a lengthy daily duration of listening to music or the type of headphone used and hearing loss. Hearing screening tests connected with education are indicated in the group of young adults due to the accumulative character of hearing damage.

Personality and attitudes as predictors of risky driving among older drivers.

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Lucidi, Fabio; Mallia, Luca; Lazuras, Lambros; Violani, Cristiano

2014-11-01

Although there are several studies on the effects of personality and attitudes on risky driving among young drivers, related research in older drivers is scarce. The present study assessed a model of personality-attitudes-risky driving in a large sample of active older drivers. A cross-sectional design was used, and structured and anonymous questionnaires were completed by 485 older Italian drivers (Mean age=68.1, SD=6.2, 61.2% males). The measures included personality traits, attitudes toward traffic safety, risky driving (errors, lapses, and traffic violations), and self-reported crash involvement and number of issued traffic tickets in the last 12 months. Structural equation modeling showed that personality traits predicted both directly and indirectly traffic violations, errors, and lapses. More positive attitudes toward traffic safety negatively predicted risky driving. In turn, risky driving was positively related to self-reported crash involvement and higher number of issued traffic tickets. Our findings suggest that theoretical models developed to account for risky driving of younger drivers may also apply in the older drivers, and accordingly be used to inform safe driving interventions for this age group. Copyright © 2014 Elsevier Ltd. All rights reserved.

Training of medical staff positively influences postoperative pain management at home in children.

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Sepponen, K; Kokki, H; Ahonen, R

1999-08-01

The aim of this study was to describe how parents manage their child's postoperative pain at home following day-case surgery. The incidence of pain, different analgesics used and problems related to administering medications were the main interests of the study. A postal questionnaire was sent to the parents of 275 children who were under 8 years of age and had undergone an ear, nose and throat (ENT) day-case operation. The questionnaire was sent to the parents a week after discharge from hospital. Altogether, the parents of 227 children answered the questionnaire (response rate 83%). The study was divided into two phases (preintervention and postintervention), and incorporated a training program for doctors and nurses between these two phases. The training program aimed to improve the treatment practices of postoperative pain in children. Seventy-eight per cent of the children in the preintervention study and 75% in the postintervention study experienced at least mild pain after discharge. The training program for doctors and nurses affected the home treatment practices of postoperative pain. The proportion of parents treating their children increased from 68% to 80% after the training program (p = 0.028). Many parents faced problems while treating their children; for example, 19% (n = 30) of the children refused to take their medicine, and suppositories were regarded to be an especially unpleasant dosage form. However, no serious adverse effects were reported. We conclude that due to the pain experienced at home by the great majority of children following day-case ENT operations, parents need information on how to manage their child's pain. A training program for doctors and nurses can improve the treatment of children's pain even at home. Since some children dislike suppositories, it would be worth considering the use of small tablets or mixtures instead.

Diagnosis and medical treatment of neuropathic pain in leprosy.

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Arco, Rogerio Del; Nardi, Susilene Maria Tonelli; Bassi, Thiago Gasperini; Paschoal, Vania Del Arco

2016-08-08

to identify the difficulties in diagnosing and treating neuropathic pain caused by leprosy and to understand the main characteristics of this situation. 85 patients were treated in outpatient units with reference to leprosy and the accompanying pain. We used a questionnaire known as the Douleur Neuropathic 4 test and we conducted detailed neurological exams. As a result, 42 patients were excluded from the study for not having proved their pain. Out of the 37 patients that experienced pain, 22 (59.5%) had neuropathic pain (or a mixture of this pain and their existing pain) and of these 90.8% considered this pain to be moderate or severe. 81.8% of the sample suffered with this pain for more than 6 months. Only 12 (54.5%) of the patients had been diagnosed with neuropathic pain and in almost half of these cases, this pain had not been diagnosed. With reference to medical treatment (n=12) for neuropathic pain, 5 (41.6%) responded that they became better. For the other 7 (58.4%) there were no changes in relation to the pain or in some cases the pain worsened in comparison to their previous state. Statistical analysis comparing improvements in relation to the pain amongst the patients that were treated (n=12) and those that were not, showed significant differences (value p=0.020). we noted difficulties in diagnosing neuropathic pain for leprosy in that almost half of the patients that were studied had not had their pain diagnosed. We attributed this to some factors such as the non-adoption of the appropriate protocols which led to inadequate diagnosis and treatment that overlooked the true picture. identificar as dificuldades em diagnosticar e tratar a dor neuropática causada pela hanseníase, bem como determinar as características principais dessa situação. examinaram-se 85 pacientes tratados no ambulatório de referência para hanseníase e referiam dor. Aplicou-se questionário, o teste Douleur Neuropathic 4, e criterioso exame neurológico pelo qual exclu

Risky sexual behavior and predisposing factors among students of ...

African Journals Online (AJOL)

BACKGROUND: Students of higher institutions are assumed to be exposed to many risky sexual behaviors. However, little has been explored about the magnitude of risky behavior and predisposing factors in the context of higher education institutions in Ethiopia. Thus, the objective of this study was to assess the pattern of ...

Pubertal Development and Peer Influence on Risky Decision Making

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Kretsch, Natalie; Harden, Kathryn Paige

2014-01-01

Adolescents engage in more risky behavior when they are with peers and show, on average, heightened susceptibility to peer influence relative to children and adults. However, individual differences in susceptibility to peer influence are not well understood. The current study examined whether the effect of peers on adolescents' risky decision…

Not so risky business?

DEFF Research Database (Denmark)

Rapp, Carolin; Shore, Jennifer; Tosun, Jale

2017-01-01

This article addresses ongoing debates about whether the welfare state hinders or fosters self-employment. Starting a business can be an inherently risky undertaking and is thus not a feasible option for all people. Policies that have the potential to shoulder some of this risk can be particularly...

A developmental, body-oriented intervention for children and adolescents with medically unexplained chronic pain.

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Kozlowska, Kasia; Khan, Rubina

2011-10-01

The regulation of pain and other emotions is a developmental process that takes place in the context of attachment relationships. Children with chronic, medically unexplained pain struggle to accurately identify, communicate and regulate negative body states, and to connect these body states to their day-to-day experience. This article describes an individual intervention - one component of a multimodal treatment programme - whose aim is to help children find skills to manage their pain. The intervention incorporates ideas and practices from several theoretical models - the dynamic-maturational model of attachment, cognitive-behavioural theories, narrative therapy, art therapy, sensorimotor approaches -pragmatically selected and adapted to help children presenting to our Chronic Pain Service achieve good clinical outcomes. At the outset we assess the child's capacity to identify, regulate and communicate positive and negative body states, and tailor our individual intervention so as to extend each child's proximal level of development. We initially focus on the body in an effort to equip the child with a non-verbal, image-based language for identifying and communicating pain and other negative body states. Once the child has developed a non-verbal way of knowing her body, a range of cognitive-behavioural, narrative and other strategies are introduced. The intervention aims to increase the child's emotional functioning: her skill in identifying, symbolically representing, communicating and managing pain and other negative body states.

The typological approach to the risky behavior of adolescents

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Mitrović D.

2006-01-01

Full Text Available The main research problem is focused on the following question: Is it possible to identify specific patterns of interaction between precipitating and protective factors for the risky behavior among adolescents. The research was conducted on the sample of 204 adolescents of both genders (18 to 20 years old. Specific personality traits and socio-demographic characteristics are manifested as the most important precipitating and/or protective factors for the risky behavior. The frame of reference for personality assessment was the alternative five-factor model (Zuckerman, 2002, specified in the ZKPQ-50-CC questionnaire, and consisted of the five biologically determined personality traits: activity, aggressiveness/hostility, impulsive sensation seeking, neuroticism/anxiety and sociability. Latent dimensions of the risky behavior: risky activities and life - conditions, were extracted by applying the homogeneity analyses (HOMALS. The matrix of squared Euclidean distances (in the common space of factor scores on the principal components of ZKPQ questionnaire, scores on HOMALS dimensions and school grades was a subject of the Ward hierarchical cluster analysis method, extracting three clusters. According to the discriminant functions: risk proneness and pro-social activity, the clusters were identified: the group of pro-social oriented adolescents, the aloof group and the group of adolescents prone to risky behavior. The results have considerable implications for the prevention programs’ development and implementation.

Factors Influencing Quality of Pain Management in a Physician Staffed Helicopter Emergency Medical Service.

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Oberholzer, Nicole; Kaserer, Alexander; Albrecht, Roland; Seifert, Burkhardt; Tissi, Mario; Spahn, Donat R; Maurer, Konrad; Stein, Philipp

2017-07-01

Pain is frequently encountered in the prehospital setting and needs to be treated quickly and sufficiently. However, incidences of insufficient analgesia after prehospital treatment by emergency medical services are reported to be as high as 43%. The purpose of this analysis was to identify modifiable factors in a specific emergency patient cohort that influence the pain suffered by patients when admitted to the hospital. For that purpose, this retrospective observational study included all patients with significant pain treated by a Swiss physician-staffed helicopter emergency service between April and October 2011 with the following characteristics to limit selection bias: Age > 15 years, numerical rating scale (NRS) for pain documented at the scene and at hospital admission, NRS > 3 at the scene, initial Glasgow coma scale > 12, and National Advisory Committee for Aeronautics score helicopter emergency service associated with insufficient pain management. A total of 778 patients were included in the analysis. Insufficient pain management (NRS > 3 at hospital admission) was identified in 298 patients (38%). Factors associated with insufficient pain management were higher National Advisory Committee for Aeronautics scores, high NRS at the scene, nontrauma patients, no analgesic administration, and treatment by a female physician. In 16% (128 patients), despite ongoing pain, no analgesics were administered. Factors associated with this untreated persisting pain were short time at the scene (below 10 minutes), secondary missions of helicopter emergency service, moderate pain at the scene, and nontrauma patients. Sufficient management of severe pain is significantly better if ketamine is combined with an opioid (65%), compared to a ketamine or opioid monotherapy (46%, P = .007). In the studied specific Swiss cohort, nontrauma patients, patients on secondary missions, patients treated only for a short time at the scene before transport, patients who receive no

The association between ethnicity and delay in seeking medical care for chest pain: a systematic review.

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Wechkunanukul, Kannikar; Grantham, Hugh; Damarell, Raechel; Clark, Robyn A

2016-07-01

Acute coronary syndrome (ACS) is a leading cause of mortality and morbidity worldwide, and chest pain is one of the most common symptoms of ACSs. A rapid response to chest pain by patients and appropriate management by health professionals are vital to improve survival rates.People from different ethnic groups are likely to have different perceptions of chest pain, its severity and the need for urgent treatment. These differences in perception may contribute to differences in response to chests pain and precipitate unique coping strategies. Delay in seeking medical care for chest pain in the general population has been well documented; however, limited studies have focused on delay times within ethnic groups. There is little research to date as to whether ethnicity is associated with the time taken to seek medical care for chest pain. Consequently, addressing this gap in knowledge will play a crucial role in improving the health outcomes of culturally and linguistically diverse (CALD) patients suffering from chest pain and for developing appropriate clinical practice and public awareness for these populations. The current review aimed to determine if there is an association between ethnicity and delay in seeking medical care for chest pain among CALD populations. Patients from different ethnic minority groups presenting to emergency departments (EDs) with chest pain. The current review will examine studies that evaluate the association between ethnicity and delay in seeking medical care for chest pain among CALD populations. The current review will consider quantitative studies including randomized controlled trials (RCTs), non-RCTs, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies. The current review will consider studies that measure delay time as the main outcome. The time will be measured as the interval between the time of symptom onset and time to reach an

Risky decision making in adults with ADHD.

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Matthies, S; Philipsen, A; Svaldi, J

2012-09-01

Risky decision making and disadvantageous choices constitute core characteristics of patients with attention-deficit/hyperactivity disorder (ADHD). Consequences include negative psychosocial and health-related outcomes. However, risky decision making and its interrelations with emotional states in ADHD are poorly understood. Therefore, the authors investigated risky decision making without and after boredom induction in adults with and without ADHD. In study 1, ADHD patients (n = 15) and age/education matched controls (CG; n = 16) were compared on the Game of Dice Task (GDT), an established task measuring decision making in unambiguous situations. In study 2, ADHD patients (n = 14) and CG (n = 13) underwent boredom induction prior to the GDT. In study 1, ADHD patients selected the disadvantageous alternatives significantly more often than CG. In study 2, no significant group differences were found due to an increase in risky decision making in CG following the boredom induction. Even if severity of depression did not affect our results, it may be necessary to compare GDT responses in ADHD patients with and without current depression. Risk as a motor of disadvantageous decision making needs to be taken into account in therapeutic contexts as a maintenance factor of dysfunctional behaviour. The findings of study 2 are in line with postulated alterations of emotional state adjustment in ADHD. The link between decisions making and emotional regulation in ADHD needs further attention in research. Copyright © 2012 Elsevier Ltd. All rights reserved.

Painful procedures and analgesia in the NICU: what has changed in the medical perception and practice in a ten‐year period?

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Ana Claudia Yoshikumi Prestes

2016-01-01

Conclusions: Despite an increase in the medical perception of neonatal pain and in analgesic use during painful procedures, the gap between clinical practice and neonatologist perception of analgesia need did not change during the ten‐year period.

Alcohol Dependence and Altered Engagement of Neural Networks in Risky Decisions

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Xi eZhu

2016-03-01

Full Text Available Alcohol dependence is associated with heightened risk tolerance and altered decision- making. This raises the question as to whether alcohol dependent patients (ADP are incapable of proper risk assessment. We investigated how healthy controls (HC and ADP engage neural networks to cope with the increased cognitive demands of risky decisions. We collected fMRI data while 34 HC and 16 ADP played a game that included safe and risky trials. In safe trials, participants accrued money at no risk of a penalty. In risky trials, reward and risk simultaneously increased as participants were instructed to decide when to stop a reward accrual period. If the participant failed to stop before an undisclosed time, the trial would bust and participants would not earn the money from that trial. Independent Component Analysis was used to identify networks engaged during the anticipation and the decision execution of risky compared with safe trials. Like HC, ADP demonstrated distinct network engagement for safe and risky trials at anticipation. However, at decision execution, ADP exhibited severely reduced discrimination in network engagement between safe and risky trials. Although ADP behaviorally responded to risk they failed to appropriately modify network engagement as the decision continued, leading ADP to assume similar network engagement regardless of risk prospects. This may reflect disorganized network switching and a facile response strategy uniformly adopted by ADP across risk conditions. We propose that aberrant salience network (SN engagement in ADP might contribute to ineffective network switching and that the role of the SN in risky decisions warrants further investigation.

A Randomized Double-Blind Controlled Trial Comparing Davanloo Intensive Short-Term Dynamic Psychotherapy as Internet-Delivered Vs Treatment as Usual for Medically Unexplained Pain: A 6-Month Pilot Study.

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Chavooshi, Behzad; Mohammadkhani, Parvaneh; Dolatshahi, Behrouz

2016-01-01

Research has shown that Intensive Short-Term Dynamic Psychotherapy (ISTDP) can effectively decrease pain intensity and improve quality of life in patients with medically unexplained pain. Understanding that not all patients with medically unexplained pain have access to in-person ISTDP, this study aims to investigate the efficacy of an Internet-delivered ISTDP for individuals with medically unexplained pain using Skype in comparison with treatment as usual. In this randomized controlled trial, 100 patients were randomly allocated into Internet-delivered ISTDP (n = 50) and treatment-as- usual (n = 50) groups. Treatment intervention consisted of 16 weekly, hour-long therapy sessions. The primary outcome was perceived pain assessed using the Numeric Pain Rating Scale. The secondary outcome included Depression Anxiety Stress Scale-21, Emotion Regulation Questionnaire, Mindful Attention Awareness Scale, and Quality-of-Life Inventory. Blind assessments were conducted at the baseline, posttreatment, and at a 6-month follow-up. In the intention-to-treat analysis, pain symptoms in the intervention group were significantly reduced (p Skype can significantly improve pain intensity and clinical symptoms of medically unexplained pain. Copyright © 2016 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

Depression and anxiety among chronic pain patients receiving prescription opioids and medical marijuana.

Science.gov (United States)

Feingold, Daniel; Brill, Silviu; Goor-Aryeh, Itay; Delayahu, Yael; Lev-Ran, Shaul

2017-08-15

High rates of depression and anxiety have been consistently reported among patients suffering from chronic pain. Prescription opioids are one of the most common modalities for pharmacological treatment of pain, however in recent years medical marijuana(MM) has been increasingly used for pain control in the US and in several countries worldwide. The aim of this study was to compare levels of depression and anxiety among pain patients receiving prescription opioids and MM. Participants were patients suffering from chronic pain treated with prescription opioids (OP,N=474), MM (N=329) or both (OPMM,N=77). Depression and anxiety were assessed using the depression module of the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder scale (GAD-7). Prevalence of depression among patients in the OP, MM and OPMM groups was 57.1%, 22.3% and 51.4%, respectively and rates of anxiety were 48.4%, 21.5% and 38.7%, respectively. After controlling for confounders, patients in the OP group were significantly more likely to screen positive for depression (Adjusted Odds Ratio(AOR)=6.18;95%CI=4.12-9.338) and anxiety(AOR=4.12;CI=3.84-5.71)) compared to those in the MM group. Individuals in the OPMM group were more prone for depression (AOR for depression=3.34;CI=1.52-7.34)) compared to those in the MM group. Cross-sectional study, restricting inference of causality. Levels of depression and anxiety are higher among chronic pain patients receiving prescription opioids compared to those receiving MM. Findings should be taken into consideration when deciding on the most appropriate treatment modality for chronic pain, particularly among those at risk for depression and anxiety. Copyright © 2017 Elsevier B.V. All rights reserved.

Distress tolerance as a predictor of risky and aggressive driving.

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Beck, Kenneth H; Ali, Bina; Daughters, Stacey B

2014-01-01

The purpose of this investigation was to determine the relationship between distress tolerance and risky and aggressive driving. Distress tolerance, defined as an individual's capability to experience and endure negative emotional states, was hypothesized to be related negatively to aggressive driving and risky driving. An anonymous, web-based survey of 769 college students was conducted at a large East Coast university. After controlling for age, gender, race, ethnicity, year in school, grade point average, and driving frequency, distress tolerance was significantly inversely related to reported risky driving and aggressive driving. College drivers who have a diminished capacity to endure frustration without experiencing negative emotional states (i.e., low distress tolerance) tend to drive aggressively and in a risky manner. Traditional deterrence-based approaches to highway safety may benefit from inclusion of a wider array of prevention strategies that focus on emotion regulation while driving.

Effects of combat deployment on risky and self-destructive behavior among active duty military personnel.

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Thomsen, Cynthia J; Stander, Valerie A; McWhorter, Stephanie K; Rabenhorst, Mandy M; Milner, Joel S

2011-10-01

Although research has documented negative effects of combat deployment on mental health, few studies have examined whether deployment increases risky or self-destructive behavior. The present study addressed this issue. In addition, we examined whether deployment effects on risky behavior varied depending on history of pre-deployment risky behavior, and assessed whether psychiatric conditions mediated effects of deployment on risky behavior. In an anonymous survey, active duty members of the U.S. Marine Corps and U.S. Navy (N = 2116) described their deployment experiences and their participation in risky recreational activities, unprotected sex, illegal drug use, self-injurious behavior, and suicide attempts during three time frames (civilian, military pre-deployment, and military post-deployment). Respondents also reported whether they had problems with depression, anxiety, or PTSD during the same three time frames. Results revealed that risky behavior was much more common in civilian than in military life, with personnel who had not deployed, compared to those who had deployed, reporting more risky behavior and more psychiatric problems as civilians. For the current time period, in contrast, personnel who had deployed (versus never deployed) were significantly more likely to report both risky behavior and psychiatric problems. Importantly, deployment was associated with increases in risky behavior only for personnel with a pre-deployment history of engaging in risky behavior. Although psychiatric conditions were associated with higher levels of risky behavior, psychiatric problems did not mediate associations between deployment and risky behavior. Implications for understanding effects of combat deployment on active duty personnel and directions for future research are discussed. Published by Elsevier Ltd.

Peer harassment and risky behavior among sexual minority girls and boys.

Science.gov (United States)

Martin-Storey, Alexa; Crosnoe, Robert

2014-01-01

The role of peer harassment in the association between sexual minority status and adolescent risky behavior was examined for 15-year-olds in the NICHD Study of Early Child Care and Youth Development (n = 957). The findings, although exploratory, suggest the importance of gender. For girls, peer harassment was best viewed as a moderator of the link between sexual minority status and increased risky behavior. It intensified an existing association, reflecting the gendered nature of the impact of sexual minority status on the adolescent social context. For boys, peer harassment was primarily a mediator, such that sexual minority status was associated with more risky behavior via elevated harassment, although sexual minority status itself was associated with lower risky behavior overall. (c) 2014 APA, all rights reserved.

Difficulties in emotion regulation and risky driving among Lithuanian drivers.

Science.gov (United States)

Šeibokaitė, Laura; Endriulaitienė, Auksė; Sullman, Mark J M; Markšaitytė, Rasa; Žardeckaitė-Matulaitienė, Kristina

2017-10-03

Risky driving is a common cause of traffic accidents and injuries. However, there is no clear evidence of how difficulties in emotion regulation contribute to risky driving behavior, particularly in small post-Soviet countries. The present study aimed to investigate the relationship between difficulties in emotion regulation and self-reported risky driving behavior in a sample of Lithuanian drivers. A total of 246 nonprofessional Lithuanian drivers participated in a cross-sectional survey. Difficulties in emotion regulation were assessed using the Difficulties in Emotion Regulation Scale (DERS; Gratz and Roemer 2004), and risky driving behavior was assessed using the Manchester Driver Behaviour Questionnaire (DBQ; Lajunen et al. 2004). Males scored higher than females in aggressive violations and ordinary violations. Females scored higher for the nonacceptance of emotional responses, whereas males had more difficulties with emotional awareness than females. More difficulties in emotion regulation were positively correlated with driving errors, lapses, aggressive violations, and ordinary violations for both males and females. Structural equation modeling showed that difficulties in emotion regulation explained aggressive and ordinary violations more clearly than lapses and errors. When controlling for interactions among the distinct regulation difficulties, difficulties with impulse control and difficulties engaging in goal-directed behavior predicted risky driving. Furthermore, nonacceptance of emotional responses and limited access to emotion regulation strategies were related to less violations and more driving errors. Emotion regulation difficulties were associated with the self-reported risky driving behaviors of Lithuanian drivers. This provides useful hints for improving driver training programs in order to prevent traffic injuries.

Self-esteem and risky decision-making: an ERP study.

Science.gov (United States)

Yang, Juan; Dedovic, Katarina; Zhang, Qinglin

2010-12-01

Self-esteem, a value one places on oneself, influences one's cognitive, emotional and behavioral responses across various situations. In the case of risky decision-making, high self-esteem (SE) individuals rely on their positive self-views and tend to be less defensive in response to a risky task; low SE individuals, on the contrary, tend to have fewer accessible positive resources and thus, are more prone to risk-aversion. While past studies have provided evidence for a link between self-esteem and a behaviorally-risky response, no study has explored the relation between self-esteem and the electrophysiological correlates of risky response. Therefore, the current study investigated the correlates of risky decision-making in high SE compared to low SE participants using event-related potentials (ERP) technology in 28 undergraduate students playing a blackjack game. The results showed that there was no difference between the high SE participants and the low SE participants with respect to the behavioral assessments of the risk-taking decision-making. However, for the electrophysiological data, we observed that the amplitude of P2 (150-300 ms) was more positive in the high SE participants compared to the low SE participants over the central-posterior scalp region. Dipole source analysis indicated that this positive component was generated in posterior cingulate cortex (PCC). These findings suggest that the high SE participants experienced more emotional signals than the low SE participants during decision-making.

Acute stress does not affect risky monetary decision-making

Directory of Open Access Journals (Sweden)

Peter Sokol-Hessner

2016-12-01

Full Text Available The ubiquitous and intense nature of stress responses necessitate that we understand how they affect decision-making. Despite a number of studies examining risky decision-making under stress, it is as yet unclear whether and in what way stress alters the underlying processes that shape our choices. This is in part because previous studies have not separated and quantified dissociable valuation and decision-making processes that can affect choices of risky options, including risk attitudes, loss aversion, and choice consistency, among others. Here, in a large, fully-crossed two-day within-subjects design, we examined how acute stress alters risky decision-making. On each day, 120 participants completed either the cold pressor test or a control manipulation with equal probability, followed by a risky decision-making task. Stress responses were assessed with salivary cortisol. We fit an econometric model to choices that dissociated risk attitudes, loss aversion, and choice consistency using hierarchical Bayesian techniques to both pool data and allow heterogeneity in decision-making. Acute stress was found to have no effect on risk attitudes, loss aversion, or choice consistency, though participants did become more loss averse and more consistent on the second day relative to the first. In the context of an inconsistent previous literature on risk and acute stress, our findings provide strong and specific evidence that acute stress does not affect risk attitudes, loss aversion, or consistency in risky monetary decision-making.

Struggles for medical legitimacy among women experiencing sexual pain: A qualitative study.

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Braksmajer, Amy

2018-04-01

Given the prominent role of medical institutions in defining what is "healthy" and "normal," many women turn to medicine when experiencing pain during intercourse (dyspareunia). The medical encounter can become a contest between patients and providers when physicians do not grant legitimacy to patients' claims of illness. Drawing on interviews conducted from 2007 to 2008 and 2011 to 2012 with 32 women experiencing dyspareunia (ages 18-60 years) and living in New York City and its surrounding areas, this study examined women's and their physicians' claims regarding bodily expertise, particularly women's perceptions of physician invalidation, their understanding of this invalidation as gendered, and the consequences for women's pursuit of medicalization. Women overwhelmingly sought a medical diagnosis for their dyspareunia, in which they believed that providers would relieve uncertainty about its origin, give treatment alternatives, and permit them to avoid sexual activity. When providers did not give diagnoses, women reported feeling that their bodily self-knowledge was dismissed and their symptoms were attributed to psychosomatic causes. Furthermore, some women linked their perceptions of invalidation to both historical and contemporary forms of gender bias. Exploration of women's struggles for medical legitimacy may lead to a better understanding of the processes by which medicalization of female sexuality takes place.

Is international exploration really more risky

International Nuclear Information System (INIS)

Chua, J.; Woodward, R.

1992-01-01

Over the past few years many Canadian oil producers have shifted their exploration efforts to finding larger reserves outside of Canada. Evaluation of such international projects requires the same type of economic analysis as is carried out for domestic projects, essentially discounted cash flow or net present value analysis. Applying this evaluation methodology requires two types of data: a series of forecasted cash flows and an appropriate hurdle rate. Conventional wisdom states that foreign projects should be evaluated at a higher discount rate than domestic projects. This wisdom is called into question. While some overseas projects may indeed be of higher risk, especially unconventional projects or those located in politically unstable areas, it is not obvious that overseas projects located in politically stable economies and comparable technologically to domestic projects are indeed more risky. In addition to evaluating the market riskiness of overseas projects, the extent to which on-going globalization of world financial markets might impact the riskiness of both domestic and overseas investments in the energy industry is assessed. It is indicated that it may be appropriate for Canadian oil and gas companies to revisit the methods used to measure their corporate hurdle rates in light of this globalization process. 3 tabs

Virtual reality in the treatment of pain

OpenAIRE

Botella Arbona, Cristina; García Palacios, Azucena; Baños Rivera, Rosa María; Quero Castellano, Soledad; Bretón-López, Juana

2008-01-01

Many medical procedures produce acute pain that in most cases is quite disturbing for the individual. Medication is the treatment of choice for acute pain. However, given the involvement of psychological aspects in the experience of pain, psychological techniques are being used as an effective adjunct to alleviate pain related to medical procedures. In the last years a new technology is demonstrating an enormous potential in this field: Virtual Reality (VR) distraction. In this ar...

The neurosurgical treatment of neuropathic facial pain.

Science.gov (United States)

Brown, Jeffrey A

2014-04-01

This article reviews the definition, etiology and evaluation, and medical and neurosurgical treatment of neuropathic facial pain. A neuropathic origin for facial pain should be considered when evaluating a patient for rhinologic surgery because of complaints of facial pain. Neuropathic facial pain is caused by vascular compression of the trigeminal nerve in the prepontine cistern and is characterized by an intermittent prickling or stabbing component or a constant burning, searing pain. Medical treatment consists of anticonvulsant medication. Neurosurgical treatment may require microvascular decompression of the trigeminal nerve. Copyright © 2014 Elsevier Inc. All rights reserved.

Parental distress and catastrophic thoughts about child pain: implications for parental protective behavior in the context of child leukemia-related medical procedures.

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Caes, Line; Vervoort, Tine; Devos, Patricia; Verlooy, Joris; Benoit, Yves; Goubert, Liesbet

2014-09-01

Treatment for childhood leukemia requires frequent lumbar punctures (LP) and bone marrow aspirations (BMA), often described by children and parents as more distressing than the disease itself. Findings in schoolchildren and chronic pain samples indicate that increased parental distress may increase parental protective, pain-attending behavior, which is associated with more child pain and distress. However, in the context of invasive medical procedures, it is unknown which parents are likely to become most distressed and engage in pain-attending behavior, and how this impacts the children's experiences. The present study investigated the impact of parental catastrophic thoughts upon parental distress and pain-attending behavior (verbal and nonverbal). Furthermore, the association between parental responses and the children's pain behavior, pain, and distress was examined. A total of 46 parents of children with leukemia (range, 0.6 to 15 y) who underwent a LP/BMA procedure participated in this study. Parental catastrophizing was assessed before and parental and child distress was assessed after the LP/BMA procedure. Parental pain-attending behavior and the child's pain behavior were observed before and after the LP/BMA procedure. Findings indicated that heightened parental catastrophic thinking contributed to increased parental distress during LP/BMA and less pain-attending behavior before the LP/BMA procedure, especially in young children. In contrast, heightened distress in parents with high levels of catastrophizing contributed to increased engagement in postprocedural pain-attending behavior. For young children, increased preprocedural pain-attending behavior was related to more child distress, pain, and pain behavior. The findings demonstrate the importance of parental catastrophic thinking in understanding their caregiving responses and preparing parents and children for painful invasive medical procedures.

Management of mydriasis and pain in cataract and intraocular lens surgery: review of current medications and future directions

Directory of Open Access Journals (Sweden)

Grob SR

2014-07-01

Full Text Available Seanna R Grob,1–3 Luis A Gonzalez-Gonzalez,1–3 Mary K Daly1,2,4 1Department of Ophthalmology, Veterans Administration Boston Healthcare System, Boston, MA, USA; 2Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; 3Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; 4Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA Abstract: The maintenance of mydriasis and the control of postoperative pain and ­inflammation are critical to the safety and success of cataract and intraocular lens replacement surgery. Appropriate mydriasis is usually achieved by topical and/or intracameral administration of anticholinergic agents, sympathomimetic agents, or both, with the most commonly used being cyclopentolate, tropicamide, and phenylephrine. Ocular inflammation is common after cataract surgery. Topical steroids and nonsteroidal anti-inflammatory drugs are widely used because they have been proved effective to control postsurgical inflammation and decrease pain. Topical nonsteroidal anti-inflammatory drugs have also been shown to help maintain dilation. However, use of multiple preoperative drops for pupil dilation, inflammation, and pain control have been shown to be time consuming, resulting in delays to the operating room, and they cause dissatisfaction among perioperative personnel; their use can also be associated with systemic side effects. Therefore, ophthalmologists have been in search of new options to streamline this process. This article will review the current medications commonly used for intraoperative mydriasis, as well as pain and inflammation control. In addition, a new combination of ketorolac, an anti-inflammatory agent, and phenylephrine, a mydriatic agent has recently been designed to maintain intraoperative mydriasis and to reduce postoperative pain and irritation from intraocular lens replacement surgery. Two Phase III clinical trials evaluating this

Risky markets

International Nuclear Information System (INIS)

Hammond, G.

1998-01-01

The Export Development Corporation (EDC) supports Canadian exporters and investors in international projects by providing export credit insurance for commodities and by providing financing for projects ranging from chemical plants to pipeline projects. EDC has been an active participant in financing projects in 'risky markets' in China, Columbia, India, Indonesia, Mexico, Russia and Venezuela. This presentation reviewed the origins and dimensions of the Asian crisis and how the spillover effects are showing up in most regions of the world. It was suggested that the factors which contributed to the crisis were: (1) growing macroeconomic imbalances, (2) excessive private capital inflows financing risky and low-profitability ventures, (3) financial sector mismanagement, (4) political uncertainty, and (5) decline in investor confidence. The Asian financial crisis will affect other developing countries in the following ways: (1) shrinking foreign private capital flows, (2) widening spreads for foreign and private borrowers, (3) reduced trade volumes due to import compression, (4) lower prices for traded goods, (5) depressed international interest rates. As a result of the Asian crisis, banks in Japan, Korea, Singapore, Europe and North America have cancelled or restructured several billion dollars in loans. Several projects are now under review, have been delayed or cancelled. It was suggested that significant changes in risk management strategies must be made in order for the countries of Asia to restructure their economies. Putting an end to 'cronyism' establishing well-supervised banking, legal and court systems that are up-to-date and transparent, are also essential ingredients of recovery

Risky family processes prospectively forecast shorter telomere length mediated through negative emotions.

Science.gov (United States)

Brody, Gene H; Yu, Tianyi; Shalev, Idan

2017-05-01

This study was designed to examine prospective associations of risky family environments with subsequent levels of negative emotions and peripheral blood mononuclear cell telomere length (TL), a marker of cellular aging. A second purpose was to determine whether negative emotions mediate the hypothesized link between risky family processes and diminished telomere length. Participants were 293 adolescents (age 17 years at the first assessment) and their primary caregivers. Caregivers provided data on risky family processes when the youths were age 17 years, youths reported their negative emotions at age 18 years, and youths' TL was assayed from a blood sample at age 22 years. The results revealed that (a) risky family processes forecast heightened negative emotions (β = .316, p emotions forecast shorter TL (β = -.187, p = .012), and (c) negative emotions served as a mediator connecting risky family processes with diminished TL (indirect effect = -0.012, 95% CI [-0.036, -0.002]). These findings are consistent with the hypothesis that risky family processes presage premature cellular aging through effects on negative emotions, with potential implications for lifelong health. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Impulsivity-like traits and risky driving behaviors among college students.

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Pearson, Matthew R; Murphy, Elaine M; Doane, Ashley N

2013-04-01

The present study examined the predictive effects of five impulsivity-like traits (Premeditation, Perseverance, Sensation Seeking, Negative Urgency, and Positive Urgency) on driving outcomes (driving errors, driving lapses, driving violations, cell phone driving, traffic citations, and traffic collisions). With a convenience sample of 266 college student drivers, we found that each of the impulsivity-like traits was related to multiple risky driving outcomes. Positive Urgency (tendency to act impulsively when experiencing negative affect) was the most robust predictor of risky driving outcomes. Positive Urgency is a relatively newly conceptualized impulsivity-like trait that was not examined in the driving literature previously, suggesting a strong need to further examine its role as a personality trait related to risky driving. These findings generally support the multidimensional assessment of impulsivity-like traits, and they specifically support the addition of Positive Urgency to a list of risk factors for risky driving behaviors. Copyright © 2013 Elsevier Ltd. All rights reserved.

Implicit attitudes towards risky and safe driving in a Danish sample

DEFF Research Database (Denmark)

Martinussen, Laila Marianne

; further, self-reports of the intention to drive safely (or not) are socially sensitive. Therefore, we examined automatic preferences towards safe and risky driving with a Go/No-go Association Task (GNAT). The results suggest that (1) implicit attitudes towards driving behavior can be measured reliably...... with the GNAT; (2) implicit attitudes towards safe driving versus towards risky driving may be separable constructs. We propose that research on driving behavior may benefit from routinely including measures of implicit cognition. A practical advantage is a lesser susceptibility to social desirability biases......, compared to self-report methods. Pending replication in future research, the apparent dissociation between implicit attitudes towards safe versus risky driving that we observed may contribute to a greater theoretical understanding of the causes of unsafe and risky driving behavior....

Pain-relevant anxiety affects desire for pain relief, but not pain perception

Directory of Open Access Journals (Sweden)

Adriana Banozic

2017-01-01

Full Text Available Background: Pain context plays a significant role in the perception of pain. Despite recent interest in vicarious learning and anxiety in pain modulation, there have been no attempts to explore pain modulation by specific environmental cues. Aims: Therefore, the present study evaluated pain responses in the condition that was attributed as either anxiety relevant (AR or anxiety irrelevant. Materials and Methods: Participants were exposed to both conditions through social observational learning. Pain perception was assessed by means of a visual analog scale ranging from 0 = no pain to 10 = maximum imaginable pain. State anxiety, empathy, expectancy, and desire for pain relief were also measured at both neutral and emotionally inducing conditions. Results: No effect of relevancy of anxiety for the pain context on any of the pain-related constructs was found. However, participants in the AR condition reported an increased desire for pain relief. Maximizing similarities between observed and experienced pain context did not enhance observational learning effects in the emotionally inducing condition regardless of its relevance, but significant changes were found in comparison to the affectively neutral group. Conclusions: These results could have potentially significant clinical implications suggesting that even though observing painful procedures does not increase pain it could affect medication usage.

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.

Pain and the ethics of pain management.

Science.gov (United States)

Edwards, R B

1984-01-01

In this article I clarify the concepts of 'pain', 'suffering', 'pains of body', 'pains of soul'. I explore the relevance of an ethic to the clinical setting which gives patients a strong prima facie right to freedom from unnecessary and unwanted pain and which places upon medical professionals two concomitant moral obligations to patients. First, there is the duty not to inflict pain and suffering beyond what is necessary for effective diagnosis, treatment and research. Next, there is the duty to do all that can be done to relieve all the pain and suffering which can be alleviated. I develop in some detail that individuality of pain sensitivity must be taken into account in fulfilling these obligations. I explore the issue of the relevance of informed consent and the right to refuse treatment to the matter of pain relief. And I raise the question of what conditions, if any, should override the right to refuse treatment where pain relief is of paramount concern.

Attention deficit hyperactivity symptoms and risky sexual behavior in young adult women.

Science.gov (United States)

Hosain, G M Monawar; Berenson, Abbey B; Tennen, Howard; Bauer, Lance O; Wu, Z Helen

2012-04-01

This study was undertaken to assess the association between adult attention deficit/hyperactivity disorder (ADHD) symptoms and high-risk sexual behavior. This cross-sectional study interviewed 462 low-income women aged 18-30 years. We used the 18-item Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist to assess ADHD symptoms. Risky sexual behaviors included sex before 15 years of age, risky sex partners in lifetime, number of sex partners in the last 12 months, condom use in the last 12 months, alcohol use before sex in the last 12 months, traded sex in lifetime, and diagnosed with sexually transmitted infection (STI) in lifetime. Mean ADHD symptom score was 19.8 (SD±12.9), and summary index of all risky sexual behavior was 1.77 (SD±1.37). Using unadjusted odds ratios (OR), women who endorsed more ADHD symptoms reported engaging in more risky sexual behaviors of all types. However, when multivariable logistic regression was applied adjusting for various sociodemographic covariates, the adjusted ORs remained significant for having risky sex partners and having ≥3 sex partners in the prior 12 months. We observed some differences in risky sexual behavior between two domains of ADHD. The ADHD symptom score appears to be associated with some risky sexual behaviors and deserves further attention. A brief ADHD screening can identify this high-risk group for timely evaluation and safe sex counseling.

Overprescription of postoperative narcotics: a look at postoperative pain medication delivery, consumption and disposal in urological practice.

Science.gov (United States)

Bates, Cory; Laciak, Robert; Southwick, Andrew; Bishoff, Jay

2011-02-01

Prescription narcotic abuse is a significant social problem. Surplus medication following surgery is 1 source of prescription diversion. We assessed prescribing practices, consumption and disposal of prescribed narcotics after urological surgery. Surveys were administered to a 3-month consecutive sample of adult patients who underwent surgery performed by full and adjunct University of Utah Urology faculty. Surveys were performed 2 to 4 weeks postoperatively. With the exception of the investigators, prescribing physicians had no prior knowledge of the study. Data collected included perception of pain control, type and quantity of medication prescribed, quantity of leftover medication, refills needed, disposal instructions and surplus medication disposition. Overall 47% of 586 patients participated in the study. Hydrocodone was prescribed most commonly (63%), followed by oxycodone (35%), and 86% of the patients were satisfied with pain control. Of the dispensed narcotics 58% was consumed and 12% of patients requested refills. A total of 67% of patients had surplus medication from the initial prescription and 92% received no disposal instructions for surplus medication. Of those patients with leftover medication 91% kept the medication at home while 6% threw it in the trash, 2% flushed it down the toilet and less than 1% returned it to a pharmacy. Overprescription of narcotics is common and retained surplus medication presents a readily available source of opioid diversion. It appears that no entity on the prescribing or dispensing ends of prescription opioid delivery is fulfilling the responsibility to accurately educate patients on proper surplus medication disposal. Surgeons should analyze prescribing practices and consider decreasing the quantity of postoperative narcotics prescribed. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

The Disparagement of Pain: Social Influences on Medical Thinking

Directory of Open Access Journals (Sweden)

Harold Merskey

2000-01-01

Full Text Available Patients with pain often feel that their suffering is taken lightly, dismissed or denied. Before the introduction of anesthesia, pain was regarded as an awful affliction. This view diminished somewhat once anesthesia became available, although it still holds true for some forms of pain, eg, pain associated with terminal cancer. Pain was then treated as less troublesome when it became a reason for disability compensation to be paid. Examples are given of the disparagement of complaints by individuals reporting pain in the past 150 years. Factors that encourage doctors to underestimate patients' pain include the requirement for doctors to control the issue of narcotics; circumstances in which patients may benefit from compensation by claiming that their pain is great; and the development of attitudes that understate the importance of the relief of pain and overstate the importance of activity, exercise and not complaining. Current attitudes in this respect are associated with the insurance industry, but it has been shown that, even patients who do not have a compensable injury or have pain that is not disabling fail to receive the treatment for pain that is appropriate, eg, postoperatively. The present paper reviews and discusses these problems and suggests that disparagement of pain and disability in the medicolegal field also leads to the rejection of pain in other contexts.

Pain management discussion forum: prevention of chronic postoperative pain.

Science.gov (United States)

Breivik, Harald

2014-09-01

ABSTRACT A case of a 35-year-old woman scheduled for removal of a painful breast tumor is discussed. Ways to reduce risk of chronic pain developing postoperatively are described. Preoperative medications, nerve blocks, local anesthetics, and postoperative epidural pharmacotherapy are described. This report is adapted from paineurope 2014; Issue 1, Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be accessed via the Web site: http://www.paineurope.com, at which European health professionals can register online to receive copies of the quarterly publication.

Dating Violence and Substance Use as Longitudinal Predictors of Adolescents’ Risky Sexual Behavior

Science.gov (United States)

Shorey, Ryan C.; Fite, Paula J.; Choi, HyeJeong; Cohen, Joseph R.; Stuart, Gregory L.; Temple, Jeff R.

2015-01-01

Objective To examine dating violence perpetration and victimization (physical, psychological, and sexual) and lifetime substance use (alcohol, marijuana, and hard drugs) as longitudinal predictors of adolescents’ risky sexual behavior across one year, and to determine whether predictors varied across adolescents’ gender and ethnicity. Methods A sample of Caucasian, African American, and Hispanic male and female adolescents from 7 public high schools in Texas (N = 882) participated. Adolescents completed self-report measures of dating violence, lifetime substance use, and risky sexual behavior at baseline and, 1-year later, completed a second assessment of their risky sexual behavior. Results Path analysis demonstrated that greater physical dating violence victimization, lifetime alcohol use, lifetime marijuana use, and age (being older) were all significant predictors of risky sexual behavior at the 1-year follow-up. These results did not vary across gender or the three ethnic groups (Caucasian, African American, and Hispanic). Conclusions Overall, substance use was a longitudinal predictor of risky sexual behavior across the three ethnic groups, with physical dating violence victimization being the only type of dating violence longitudinally predicting risky sexual behavior. Prevention efforts should consider the roles of physical dating violence and substance use in preventing risky sexual behavior. PMID:25797949

Dating Violence and Substance Use as Longitudinal Predictors of Adolescents' Risky Sexual Behavior.

Science.gov (United States)

Shorey, Ryan C; Fite, Paula J; Choi, HyeJeong; Cohen, Joseph R; Stuart, Gregory L; Temple, Jeff R

2015-08-01

The objectives of this study is to examine dating violence perpetration and victimization (physical, psychological, and sexual) and lifetime substance use (alcohol, marijuana, and hard drugs) as longitudinal predictors of adolescents' risky sexual behavior across 1 year and to determine whether predictors varied across adolescents' gender and ethnicity. A sample of Caucasian, African American, and Hispanic male and female adolescents from seven public high schools in Texas (N = 882) participated. Adolescents completed self-report measures of dating violence, lifetime substance use, and risky sexual behavior at baseline and, 1-year later, completed a second assessment of their risky sexual behavior. Path analysis demonstrated that greater physical dating violence victimization, lifetime alcohol use, lifetime marijuana use, and age (being older) were all significant predictors of risky sexual behavior at the 1-year follow-up. These results did not vary across gender or the three ethnic groups (Caucasian, African American, and Hispanic). Overall, substance use was a longitudinal predictor of risky sexual behavior across the three ethnic groups, with physical dating violence victimization being the only type of dating violence longitudinally predicting risky sexual behavior. Prevention efforts should consider the roles of physical dating violence and substance use in preventing risky sexual behavior.

Multisite musculoskeletal pain in adolescence as a predictor of medical and social welfare benefits in young adulthood: The Norwegian Arctic Adolescent Health Cohort Study.

Science.gov (United States)

Eckhoff, C; Straume, B; Kvernmo, S

2017-11-01

Pain in adolescence is associated with mental health problems, the main reason for work disability in young adults. This study explores the relationship between multisite musculoskeletal pain in adolescence and later medical (sickness and medical rehabilitation benefits) and social welfare benefits, adjusted for sociodemographic, adolescent psychosocial and mental health problems. Data were obtained by linkage between the National Insurance Registry (2003-11) and the Norwegian Arctic Adolescent Health Study, a school-based survey in North Norway (2003-05), accepted by 3987 fifteen- to sixteen-year-olds (68% of the total population). The start of the follow-up time was July 1st of the corresponding year the participants responded to the health study. Musculoskeletal pain was measured by the number of musculoskeletal pain sites. We found a positive linear relationship between adolescent musculoskeletal pain sites and the occurrence of medical and social welfare benefits in young adulthood (p ≤ 0.001). Adolescent musculoskeletal pain was a significant predictor of sickness (p adolescent psychosocial and mental health problems. The most important adolescent psychosocial predictors were externalizing problems, less parental involvement and adverse life events. Adolescent multisite musculoskeletal pain was found to be an important predictor of later sickness and social welfare benefit receipt from adolescence to young adulthood. Adolescents with multisite musculoskeletal pain are at substantially increased risk of health and social difficulties into young adulthood. Identification and interventions for these adolescent problems could alleviate this risk and be a sound socioeconomic investment. © 2017 European Pain Federation - EFIC®.

Virtual Reality as a Distraction Intervention to Relieve Pain and Distress During Medical Procedures: A Comprehensive Literature Review.

Science.gov (United States)

Indovina, Paola; Barone, Daniela; Gallo, Luigi; Chirico, Andrea; De Pietro, Giuseppe; Antonio, Giordano

2018-02-26

This review aims to provide a framework for evaluating the utility of virtual reality (VR) as a distraction intervention to alleviate pain and distress during medical procedures. We firstly describe the theoretical bases underlying the VR analgesic and anxiolytic effects and define the main factors contributing to its efficacy, which largely emerged from studies on healthy volunteers. Then, we provide a comprehensive overview of the clinical trials using VR distraction during different medical procedures, such as burn injury treatments, chemotherapy, surgery, dental treatment, and other diagnostic and therapeutic procedures. A broad literature search was performed using as main terms "virtual reality", "distraction" and "pain". No date limit was applied and all the retrieved studies on immersive VR distraction during medical procedures were selected. VR has proven to be effective in reducing procedural pain, as almost invariably observed even in patients subjected to extremely painful procedures, such as patients with burn injuries undergoing wound care and physical therapy. Moreover, VR seemed to decrease cancer-related symptoms in different settings, including during chemotherapy. Only mild and infrequent side effects were observed. Despite these promising results, future long-term randomized controlled trials with larger sample sizes and evaluating not only self-report measures but also physiological variables are needed. Further studies are also required both to establish predictive factors to select patients who can benefit from VR distraction and to design hardware/software systems tailored to the specific needs of different patients and able to provide the greatest distraction at the lowest cost.

The Danish version of the Medication Adherence Report Scale: preliminary validation in cancer pain patients

DEFF Research Database (Denmark)

Jacobsen, Ramune; Møldrup, Claus; Christrup, Lona Louring

2009-01-01

into Danish following the repeated back-translation procedure. Cancer patients for the study were recruited from specialized pain management facilities. Thirty-three patients responded to the DMARS-4, the Danish Barriers Questionnaire II, The Danish version of Patient Perceived Involvement in Care Scale......OBJECTIVE: To examine the psychometric properties of the Danish version of the Medication Adherence Report Scale (DMARS-4) adapted to measure adherence to analgesic regimen among cancer patients. METHODS: The validated English version of the Medication Adherence Report Scale was translated...

Assessment and Treatment of Pain during Treatment of Buruli Ulcer.

Directory of Open Access Journals (Sweden)

Janine de Zeeuw

Full Text Available Buruli ulcer (BU is described as a relatively painless condition; however clinical observations reveal that patients do experience pain during their treatment. Knowledge on current pain assessment and treatment in BU is necessary to develop and implement a future guideline on pain management in BU.A mixed methods approach was used, consisting of information retrieved from medical records on prescribed pain medication from Ghana and Benin, and semi-structured interviews with health care personnel (HCP from Ghana on pain perceptions, assessment and treatment. Medical records (n = 149 of patients treated between 2008 and 2012 were collected between November 2012 and August 2013. Interviews (n = 11 were audio-taped, transcribed verbatim and qualitatively analyzed.In 113 (84% of the 135 included records, pain medication, mostly simple analgesics, was prescribed. In 48% of the prescriptions, an indication was not documented. HCP reported that advanced BU could be painful, especially after wound care and after a skin graft. They reported not be trained in the assessment of mild pain. Pain recognition was perceived as difficult, as patients were said to suppress or to exaggerate pain, and to have different expectations regarding acceptable pain levels. HCP reported a fear of side effects of pain medication, shortage and irregularities in the supply of pain medication, and time constraints among medical doctors for pain management.Professionals perceived BU disease as potentially painful, and predominantly focused on severe pain. Our study suggests that pain in BU deserves attention and should be integrated in current treatment.

Linking mind wandering tendency to risky driving in young male drivers.

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Albert, Derek A; Ouimet, Marie Claude; Jarret, Julien; Cloutier, Marie-Soleil; Paquette, Martin; Badeau, Nancy; Brown, Thomas G

2018-02-01

Risky driving is a significant contributor to road traffic crashes, especially in young drivers. Transient mind wandering states, an internal form of distraction, are associated with faster driving, reduced headway distance, slower response times, reduced driver vigilance, and increased crash risk. It is unclear whether a trait tendency to mind wander predicts risky driving, however. Mind wandering is also associated with poor executive control, but whether this capacity moderates the putative link between mind wandering tendency and risky driving is uncertain. The present study tested whether mind wandering tendency predicts risky driving behaviour in young male drivers aged 18-21 (N=30) and whether this relationship is mediated by driver vigilance and moderated by executive control capacity. Mind wandering was measured with the Sustained Attention to Response Task (SART) and the Daydreaming Frequency Scale (DDFS). Risky driving was assessed by mean speed in a driving simulator and driver vigilance was quantified by horizontal eye movements measured with eye tracking. Results showed that greater mind wandering tendency based on SART performance significantly predicts faster mean speed, confirming the main hypothesis. Neither driver vigilance mediated nor executive control capacity moderated this relationship as hypothesized. These findings speak to the complexity of individual differences in mind wandering. Overall, mind wandering tendency is a significant marker of risky driving in young drivers, which could guide the development of targeted interventions. Copyright © 2017 Elsevier Ltd. All rights reserved.

Pain, Cannabis Species, and Cannabis Use Disorders

Science.gov (United States)

Cohen, Nicole L.; Heinz, Adrienne J.; Ilgen, Mark; Bonn-Miller, Marcel O.

2016-01-01

Objective: The purpose of this study was to examine whether individuals who used medical cannabis for chronic pain were at increased risk for cannabis use problems compared with individuals who used medical cannabis for other reasons (e.g., anxiety, insomnia, and muscle spasms). An additional aim was to determine whether individuals who used cannabis for chronic pain, as well as those who reported greater within-group pain levels, demonstrated a species preference (i.e., sativa, indica, hybrids) and the extent to which species preference was associated with cannabis use problems. Method: Participants were 163 medical cannabis users (77% male), recruited from a medical marijuana dispensary in California, who completed assessments of medical cannabis use motives, history, preferences (species type), and problems, as well as current pain level. Results: Individuals who used cannabis to manage chronic pain experienced fewer cannabis use problems than those who did not use it for pain; among those who used it for pain, the average pain level in the past week was not associated with cannabis use problems. Furthermore, individuals who used cannabis for chronic pain were more likely to use indica over sativa. Preference for indica was associated with fewer cannabis use problems than preference for hybrid species. Conclusions: Individuals who use cannabis to manage chronic pain may be at a lower risk for cannabis use problems, relative to individuals who use it for other indications, potentially as a function of their species preference. PMID:27172585

Pain, Cannabis Species, and Cannabis Use Disorders.

Science.gov (United States)

Cohen, Nicole L; Heinz, Adrienne J; Ilgen, Mark; Bonn-Miller, Marcel O

2016-05-01

The purpose of this study was to examine whether individuals who used medical cannabis for chronic pain were at increased risk for cannabis use problems compared with individuals who used medical cannabis for other reasons (e.g., anxiety, insomnia, and muscle spasms). An additional aim was to determine whether individuals who used cannabis for chronic pain, as well as those who reported greater within-group pain levels, demonstrated a species preference (i.e., sativa, indica, hybrids) and the extent to which species preference was associated with cannabis use problems. Participants were 163 medical cannabis users (77% male), recruited from a medical marijuana dispensary in California, who completed assessments of medical cannabis use motives, history, preferences (species type), and problems, as well as current pain level. Individuals who used cannabis to manage chronic pain experienced fewer cannabis use problems than those who did not use it for pain; among those who used it for pain, the average pain level in the past week was not associated with cannabis use problems. Furthermore, individuals who used cannabis for chronic pain were more likely to use indica over sativa. Preference for indica was associated with fewer cannabis use problems than preference for hybrid species. Individuals who use cannabis to manage chronic pain may be at a lower risk for cannabis use problems, relative to individuals who use it for other indications, potentially as a function of their species preference.

Cannabis and Pain: A Clinical Review

OpenAIRE

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

2017-01-01

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

The effects of common medical interventions on pain, back function, and work resumption in patients with chronic low back pain: A prospective 2-year cohort study in six countries.

Science.gov (United States)

Hansson, T H; Hansson, E K

2000-12-01

A prospective cohort study with identical questionnaires and inclusion criteria was performed. To compare in six different countries the frequencies and effects of the common medical interventions used for patients with low back pain who are work incapacitated. Low back pain is a huge problem with increasing costs for health care, industry, and society. Cohorts of employed men and women ages 18 to 59 years who had been sick-listed (100%) for a minimum of 90 days because of low back pain were recruited in Denmark, Germany, Israel, Sweden, the Netherlands, and the United States. The subjects received three separate questionnaires with identical questions after 90 days, 1 year, and 2 years. The questionnaires included separate questions about background factors, treatment, and the like, as well as validated scales such as the Hannover Activities of Daily Living, von Korff pain score, Short Form-36, and Karasek-Theorell. Working status was obtained from registers. Main outcome measures were working/not working, back function, and pain. All three questionnaires were completed by 2080 subjects in the six countries. With few exceptions, there were great similarities in the appointments, examinations, and treatments in the different countries. Considerable differences were found between the back surgery rates, which ranged from 6% in Sweden to 32% in the United States during the first 90 days of the study. Very few of the interventions had any noticeable positive effects on work resumption, pain, or back function. Back surgery in Sweden was a striking exception, positively affecting all three outcome measures. The frequencies of work resumption within the first year ranged from 73% in the Netherlands to 32% in Denmark. Almost none of the commonly occurring and frequently practiced medical interventions for patients who are sick-listed because of low back pain had any positive effects on either the recorded health measures or work resumption.

Pain severity and the economic burden of neuropathic pain in the United States: BEAT Neuropathic Pain Observational Study

Directory of Open Access Journals (Sweden)

Schaefer C

2014-10-01

Full Text Available Caroline Schaefer,1 Alesia Sadosky,2 Rachael Mann,3 Shoshana Daniel,4 Bruce Parsons,2 Michael Tuchman,5 Alan Anschel,6 Brett R Stacey,7 Srinivas Nalamachu,8 Edward Nieshoff9 1Covance Market Access Services Inc., Gaithersburg, MD, 2Pfizer, Inc., New York, NY, 3Covance Market Access Services Inc., San Diego, CA, 4Covance Market Access Services Inc., Conshohocken, PA, 5Palm Beach Neurological Center, Palm Beach Gardens, FL, 6Rehabilitation Institute of Chicago, Chicago, IL, 7Oregon Health and Science University, Portland, OR, 8International Clinical Research Institute, Overland Park, KS, 9Rehabilitation Institute of Michigan/Wayne State University, Detroit, MI, USABackground: As with many chronic conditions, patients with neuropathic pain (NeP are high consumers of health care resources. However, limited literature exists on the economic burden of NeP, including its impact on productivity. The aim of this study was to characterize health care resource utilization, productivity, and costs associated with NeP by pain severity level in US adults.Methods: Subjects (n=624 with painful diabetic peripheral neuropathy, human immunodeficiency virus-related peripheral NeP, post-trauma/post-surgical NeP, spinal cord injury with NeP, chronic low back pain with NeP, and small fiber neuropathy were recruited during routine office visits to US community-based general practitioners and specialists. Clinicians captured clinical characteristics, NeP-related medications, and health care resource utilization based on 6-month retrospective medical chart review. Subjects completed questionnaires on demographics, pain/symptoms, costs, and productivity. Brief Pain Inventory pain severity scores were used to classify subjects by mild, moderate, or severe pain. Annualized NeP-related costs (adjusted for covariates were estimated, and differences across pain severity groups were evaluated.Results: In total, 624 subjects were recruited (mean age 55.5±13.7 years; 55.4% male

ANTISPASMODIC MEDICATION WITH DIRECTIVE EFFECT IN CHILDREN WITH ABDOMINAL PAIN AT THE STAGE OF DIAGNOSTIC SEARCH

Directory of Open Access Journals (Sweden)

Yu.A. Kozlova

2010-01-01

Full Text Available Additional examination is needed for the purpose of detection of its etiology in some patients with abdominal pain, and it takes several days to prove a diagnosis. In most cases this pain is a result of muscle spasm in gastrointestinal tract. The administration of antispasmodic medication with directive effect, particularly, of hyoscine butylbromide (Buscopan, is well-grounded. Hyoscine butylbromide is M-cholinergic antagonist, it does not penetrates blood-brain barrier, does not induce common for cholinergic antagonists vascular reactions and decrease of blood pressure. This drug is used in pediatric practice for a long time, it can be used in patients 6 years old anв older, and it has good safety profile. Key words: abdominal pain, hyoscine butylbromide.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2010;9(1:168-170

What is the Relationship between Risky Outdoor Play and Health in Children? A Systematic Review

Directory of Open Access Journals (Sweden)

Mariana Brussoni

2015-06-01

Full Text Available Risky outdoor play has been associated with promoting children’s health and development, but also with injury and death. Risky outdoor play has diminished over time, concurrent with increasing concerns regarding child safety and emphasis on injury prevention. We sought to conduct a systematic review to examine the relationship between risky outdoor play and health in children, in order to inform the debate regarding its benefits and harms. We identified and evaluated 21 relevant papers for quality using the GRADE framework. Included articles addressed the effect on health indicators and behaviours from three types of risky play, as well as risky play supportive environments. The systematic review revealed overall positive effects of risky outdoor play on a variety of health indicators and behaviours, most commonly physical activity, but also social health and behaviours, injuries, and aggression. The review indicated the need for additional “good quality” studies; however, we note that even in the face of the generally exclusionary systematic review process, our findings support the promotion of risky outdoor play for healthy child development. These positive results with the marked reduction in risky outdoor play opportunities in recent generations indicate the need to encourage action to support children’s risky outdoor play opportunities. Policy and practice precedents and recommendations for action are discussed.

What is the Relationship between Risky Outdoor Play and Health in Children? A Systematic Review

Science.gov (United States)

Brussoni, Mariana; Gibbons, Rebecca; Gray, Casey; Ishikawa, Takuro; Sandseter, Ellen Beate Hansen; Bienenstock, Adam; Chabot, Guylaine; Fuselli, Pamela; Herrington, Susan; Janssen, Ian; Pickett, William; Power, Marlene; Stanger, Nick; Sampson, Margaret; Tremblay, Mark S.

2015-01-01

Risky outdoor play has been associated with promoting children’s health and development, but also with injury and death. Risky outdoor play has diminished over time, concurrent with increasing concerns regarding child safety and emphasis on injury prevention. We sought to conduct a systematic review to examine the relationship between risky outdoor play and health in children, in order to inform the debate regarding its benefits and harms. We identified and evaluated 21 relevant papers for quality using the GRADE framework. Included articles addressed the effect on health indicators and behaviours from three types of risky play, as well as risky play supportive environments. The systematic review revealed overall positive effects of risky outdoor play on a variety of health indicators and behaviours, most commonly physical activity, but also social health and behaviours, injuries, and aggression. The review indicated the need for additional “good quality” studies; however, we note that even in the face of the generally exclusionary systematic review process, our findings support the promotion of risky outdoor play for healthy child development. These positive results with the marked reduction in risky outdoor play opportunities in recent generations indicate the need to encourage action to support children’s risky outdoor play opportunities. Policy and practice precedents and recommendations for action are discussed. PMID:26062038

Economic Booms and Risky Sexual Behavior: Evidence from Zambian Copper Mining Cities

OpenAIRE

Nicholas Wilson

2010-01-01

Existing studies suggest that individual and household level economic shocks affect the demand for and supply of risky sex. However, little evidence exists on the effects of an aggregate shock on equilibrium risky sexual behavior. This paper examines the effects of the early twenty-first century copper boom on risky sexual behavior in Zambian copper mining cities. The results indicate that the copper boom substantially reduced rates of transactional sex and multiple partnerships in copper min...

A Cross-Sectional Study of Depressive Symptoms and Risky Alcohol Use Behaviors Among HIV Primary Care Patients in New York City.

Science.gov (United States)

Algur, Yasemin; Elliott, Jennifer C; Aharonovich, Efrat; Hasin, Deborah S

2018-05-01

An association between problem drinking and depression among HIV-infected individuals has been previously demonstrated; however, which specific risky drinking behaviors are associated with higher levels of depression has not yet been investigated. Using an adult sample of HIV-infected primary care patients (78% male, 94% Black or Hispanic), we investigated whether depressive symptoms are associated with various risky drinking behaviors. Participants were administered the Beck Depression Inventory-II to assess depressive symptoms, and the Alcohol Use Disorders and Associated Disabilities Interview Schedule-IV to evaluate alcohol involvement. Participants with depressive symptoms (26%) were at higher risk for alcohol dependence [adjusted odds ratio (AOR) 3.8; 95% CI 2.0-7.2], regular binge drinking (AOR 2.0; 95% CI 1.1-3.8), and regular daytime drinking (AOR 2.1; 95% CI 1.2-3.8), in comparison with their non-depressed counterparts. Because both depression and unhealthy drinking negatively affect medication adherence and clinical outcomes, a better understanding of the association between depression and certain risky drinking behaviors among HIV-infected individuals is vital to improving their care and prognoses.

Specific Physician Orders Improve Pain Detection and Pain Reports in Nursing Home Residents: Preliminary Data.

Science.gov (United States)

Monroe, Todd B; Misra, Sumathi; Habermann, Ralf C; Dietrich, Mary S; Bruehl, Stephen P; Cowan, Ronald L; Newhouse, Paul A; Simmons, Sandra F

2015-10-01

Despite evidence that many nursing home residents' pain is poorly managed, reasons for this poor management remain unanswered. The aim of this study was to determine if specific order sets related to pain assessment would improve pain management in nursing home (NH) residents. Outcomes included observed nurse pain assessment queries and resident reports of pain. The pretest/post-test study was performed in a 240-bed for-profit nursing home in the mid-southern region of the United States and participants were 43 nursing home residents capable of self-consent. Medical chart abstraction was performed during a 2-week (14-day) period before the implementation of specific order sets for pain assessment (intervention) and a 2-week (14-day) period after the intervention. Trained research assistants observed medication administration passes and performed participant interviews after each medication pass. One month after intervention implementation, 1 additional day of observations was conducted to determine data reliability. Nurses were observed to ask residents about pain more frequently, and nurses continued to ask about pain at higher rates 1 month after the intervention was discontinued. The proportion of residents who reported pain also significantly increased in response to increased nurse queries (e.g., "Do you have any pain right now?"), which underscores the importance of nurses directly asking residents about pain. Notably 70% of this long-stay NH population only told the nurses about their pain symptoms when asked directly. Findings uncover that using specific pain order sets seems to improve the detection of pain, which should be a routine part of nursing assessment. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Acceptance of and Engagement in Risky Driving Behaviors by Teenagers

Science.gov (United States)

Sarkar, Sheila; Andreas, Marie

2004-01-01

Data gathered from 1,430 teenage student drivers and 880 teenage traffic violators were used to examine the levels of exposure to risky driving behaviors and perceptions concerning the level of danger of such behaviors. For student drivers, 55% reported exposure to risky driving by being in a car with a driver engaging in such activities as drunk…

Medical decision-making among Hispanics and non-Hispanic Whites with chronic back and knee pain: a qualitative study.

Science.gov (United States)

Katz, Jeffrey N; Lyons, Nancy; Wolff, Lisa S; Silverman, Jodie; Emrani, Parastu; Holt, Holly L; Corbett, Kelly L; Escalante, Agustin; Losina, Elena

2011-04-21

Musculoskeletal disorders affect all racial and ethnic groups, including Hispanics. Because these disorders are not life-threatening, decision-making is generally preference-based. Little is known about whether Hispanics in the U.S. differ from non-Hispanic Whites with respect to key decision making preferences. We assembled six focus groups of Hispanic and non-Hispanic White patients with chronic back or knee pain at an urban medical center to discuss management of their conditions and the roles they preferred in medical decision-making. Hispanic groups were further stratified by socioeconomic status, using neighborhood characteristics as proxy measures. Discussions were led by a moderator, taped, transcribed and analyzed using a grounded theory approach. The analysis revealed ethnic differences in several areas pertinent to medical decision-making. Specifically, Hispanic participants were more likely to permit their physician to take the predominant role in making health decisions. Also, Hispanics of lower socioeconomic status generally preferred to use non-internet sources of health information to make medical decisions and to rely on advice obtained by word of mouth. Hispanics emphasized the role of faith and religion in coping with musculoskeletal disability. The analysis also revealed broad areas of concordance across ethnic strata including the primary role that pain and achieving pain relief play in patients' experiences and decisions. These findings suggest differences between Hispanics and non-Hispanic Whites in preferred information sources and decision-making roles. These findings are hypothesis-generating. If confirmed in further research, they may inform the development of interventions to enhance preference-based decision-making among Hispanics.

Cancer pain and current theory for pain control.

Science.gov (United States)

Kahan, Brian

2014-05-01

This article discusses current trends in managing cancer pain, with specific regard to opioid transmission, descending pathway inhabitation, and ways to facilitate the endogenous antinociceptive chemicals in the human body. Various techniques for opioid and nonopioid control of potential pain situations of patients with cancer are discussed. The benefits of using pharmacogenetics to assess the appropriate medications are addressed. Finally, specific treatment of abdominal cancer pain using radiofrequency lesioning is discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

Differences in Risky Sexual Behavior According to Sexual Orientation in Korean Adolescents.

Science.gov (United States)

Kim, Ji-Su; Kim, Kyunghee; Kwak, Yeunhee

2017-10-13

Adolescents in sexual minority groups are known to be at risk of contracting sexually transmitted diseases through risky sexual behavior. However, few studies have examined associations between sexual orientation and risky sexual behavior and sexually transmitted diseases in Korean adolescents. Therefore, this cross-sectional study used raw data from the Tenth Korea Youth Risk Behavior Web-Based Survey to explore these relationships. Logistic regression analyses were performed to examine the associations between risky sexual behavior and sexual orientation in adolescents. The participants were 6,884 adolescents who provided data regarding demographic characteristics, sexual orientation, and risky sexual behavior. The proportions of homosexual and bisexual subjects who used condoms, engaged in sexual intercourse after drinking alcohol, and experienced sexually transmitted diseases were higher relative to those of heterosexual subjects. Associations between homosexuality and bisexuality and sexually transmitted diseases and engagement in sexual intercourse after drinking remained after multivariate adjustment. Interventions to prevent risky sexual behavior should target sexual orientation, to improve sexual health and prevent sexually transmitted disease in homosexual and bisexual adolescents.

Risky sexual behaviour among young men in Nepal

OpenAIRE

Dahal, Govinda P.; Hennink, Monique; Hinde, Andrew

2005-01-01

We use the Nepal Adolescents and Young Adults (NAYA) Survey of 2000 to analyse the prevalence of sexual activity and risky sexual behaviour among Nepalese males aged 14-22 years. Risky sexual behaviour is considered to be characterised by having multiple partners, or having one non-regular partner with whom a condom was not used, in the 12 months before the survey. About 9 per cent of the sexually active married men aged 14-22 years, and about 20 per cent of sexually active single men in the ...

Radiologic intervention: patient anxiety, fear of pain, understanding of the procedure and satisfaction with the medication-a prospective study

International Nuclear Information System (INIS)

Kim, Tae Hoon

2006-01-01

I wanted to prospectively assess patients' anxiety, their understanding of the procedure being performed, the perception of the pain level and the satisfaction with the administered medication for interventional procedures. I investigated 78 patients before and after they underwent 93 interventional procedures. The patients responded to a series of questions by using a visual analogue scale (VAS). Two different procedures were performed on 15 patients at different times. Based on the patient's body weight, a combination of sedative and analgesic was intravenously administered. The mean anxiety VAS score for the interventional procedures was about 5.3. The mean anxiety score of the experienced patients was about 3.8 and that of the inexperienced patients was about 5.5 (ρ < .001). The mean score for the understanding of the procedure, which was recorded both before and after the procedure, was about 4.1 and 7.1, respectively. The mean scores for the understanding of the procedure were about 7.0 in the experienced patients and about 3.6 in the inexperienced patients (ρ < .001). The anticipated level of pain recorded before the procedure was about 5.2 and the level of pain during the procedure was 2.9, and the latter was recorded after the procedure (ρ < .001). The level of satisfaction with the medication provided during the procedure was about 8.0 on the VAS score. The patients had a moderate amount of anxiety about the interventional procedures. Most patients had a high level of satisfaction with the medication despite the amount of pain they experienced during the procedure. The patients who were experienced with a procedure tended to have less anxiety and anticipated pain, and they had a greater understanding of the procedure

Are Drinkers Prone to Engage in Risky Sexual Behaviors?

OpenAIRE

Ana I. Gil Lacruz; Marta Gil Lacruz; Juan Oliva

2009-01-01

Sexually transmitted diseases pose an important public health problem around the world. Although many studies have explored the link between alcohol use and risky sexual practices, the unobserved differences among individuals make it difficult to assess whether the associations are casual in nature. In order to overcome these difficulties, we have obtained data from the Spanish Health and Sexual Behavior Survey (2003) in order to analyze risky sexual behaviors using four alternative methodolo...

Towards comprehensive and transparent reporting: context-specific additions to the ICF taxonomy for medical evaluations of work capacity involving claimants with chronic widespread pain and low back pain.

Science.gov (United States)

Schwegler, Urban; Anner, Jessica; Glässel, Andrea; Brach, Mirjam; De Boer, Wout; Cieza, Alarcos; Trezzini, Bruno

2014-08-29

Medical evaluations of work capacity provide key information for decisions on a claimant's eligibility for disability benefits. In recent years, the evaluations have been increasingly criticized for low transparency and poor standardization. The International Classification of Functioning, Disability and Health (ICF) provides a comprehensive spectrum of categories for reporting functioning and its determinants in terms of impairments and contextual factors and could facilitate transparent and standardized documentation of medical evaluations of work capacity. However, the comprehensiveness of the ICF taxonomy in this particular context has not been empirically examined. In this study, we wanted to identify potential context-specific additions to the ICF for its application in medical evaluations of work capacity involving chronic widespread pain (CWP) and low back pain (LBP). A retrospective content analysis of Swiss medical reports was conducted by using the ICF for data coding. Concepts not appropriately classifiable with ICF categories were labeled as specification categories (i.e. context-specific additions) and were assigned to predefined specification areas (i.e. precision, coverage, personal factors, and broad concepts). Relevant specification categories for medical evaluations of work capacity involving CWP and LBP were determined by calculating their relative frequency across reports and setting a relevance threshold. Forty-three specification categories for CWP and fifty-two for LBP reports passed the threshold. In both groups of reports, precision was the most frequent specification area, followed by personal factors. The ICF taxonomy represents a universally applicable standard for reporting health and functioning information. However, when applying the ICF for comprehensive and transparent reporting in medical evaluations of work capacity involving CWP and LBP context-specific additions are needed. This is particularly true for the documentation of

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.

Pain in Children: Neglected, unaddressed and mismanaged

Directory of Open Access Journals (Sweden)

Lulu Mathews

2011-01-01

Full Text Available Pain is one of the most misunderstood, under diagnosed, and under treated/untreated medical problems, particularly in children. One of the most challenging roles of medical providers serving children is to appropriately assess and treat their pain. New JCAHO regulations regard pain as "the fifth vital sign" and require caregivers to regularly assess and address pain. Pain being a personal experience, many different terms are used to describe different sensations. Assessment of pain in children is linked to their level of development. Children of the same age vary widely in their perception and tolerance of pain.

Use and costs of prescription medications and alternative treatments in patients with osteoarthritis and chronic low back pain in community-based settings.

Science.gov (United States)

Gore, Mugdha; Tai, Kei-Sing; Sadosky, Alesia; Leslie, Douglas; Stacey, Brett R

2012-09-01

To evaluate the use and direct medical costs of pharmacologic and alternative treatments for patients with osteoarthritis (OA) and chronic low back pain (CLBP). The LifeLink™ Health Plan Claims Database was used to identify patients ≥18 years old, diagnosed with OA (N = 112,951) or CLBP (N = 101,294). Of these patients, 64,085 with OA and 47,386 with CLBP received pain-related treatments during CY2008 and were selected for inclusion. For patients in both cohorts, pharmacologic and alternative treatments, and direct medical costs were examined during CY2008. Opioids were the most frequently prescribed medication (>70%) in both groups, followed by nonselective nonsteroidal anti-inflammatory drugs (>50%). Over 30% received antidepressants, >20% received benzodiazepines, and 15% in each group received sedative hypnotics. Use of alternative treatments was as follows: chiropractor, OA 11%, CLBP 34%; physical therapy, 20% in both groups; transcutaneous electrical nerve stimulations (TENS), OA 14%, CLBP 22%; acupuncture, hydrotherapy, massage therapy, and biofeedback, patients were, OA: $15,638 ($22,595); CLBP: $11,829 ($20,035). Pharmacologic therapies accounted for approximately 20% of these costs, whereas alternative treatments accounted for only 3% to 4% of the total costs. Patients with OA and CLBP used a variety of pain-related and adjunctive medications. Although, alternative treatments are widely recommended, we found limited use of several of these in clinical practice, potentially due to the source of our data (commercial claims). Further research is needed to ascertain the extent to which such therapies contribute to the total costs of OA and CLBP management. © 2012 The Authors. Pain Practice © 2012 World Institute of Pain.

Drug repositioning: playing dirty to kill pain.

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Bastos, Leandro Francisco Silva; Coelho, Márcio Matos

2014-01-01

The number of approved new molecular entity drugs has been decreasing as the pharmaceutical company investment in research and development is increasing. As we face this painful crisis, called an innovation gap, there is increasing awareness that development of new uses of existing drugs may be a powerful tool to help overcome this obstacle because it takes too long, costs too much and can be risky to release drugs developed de novo. Consequently, drug repositioning is emerging in different therapeutic areas, including the pain research area. Worldwide, pain is the main reason for seeking healthcare, and pain relief represents an unmet global clinical need. Therefore, development of analgesics with better efficacy, safety and cost effectiveness is of paramount importance. Despite the remarkable advancement in research on cellular and molecular mechanisms underlying pain pathophysiology over the past three decades, target-based therapeutic opportunities have not been pursued to the same extent. Phenotypic screening remains a more powerful tool for drug development than target-based screening so far. It sounds somewhat heretical, but some multi-action drugs, rather than very selective ones, have been developed intentionally. In the present review, we first critically discuss the utility of drug repositioning for analgesic drug development and then show examples of 'old' drugs that have been successfully repositioned or that are under investigation for their analgesic actions. We conclude that drug repositioning should be more strongly encouraged to help build a bridge between basic research and pain relief worldwide.

Safe models for risky decisions

NARCIS (Netherlands)

Steingröver, H.M.

2017-01-01

In everyday life, we often have to decide between options that differ in their immediate and long-term consequences. Would you, for example, opt for a delicious piece of cake or rather eat a healthy apple? To investigate how people make risky decisions, this thesis focuses on the Iowa gambling task

Medical Treatments for Endometriosis-Associated Pelvic Pain

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Gabriella Zito

2014-01-01

Full Text Available The main sequelae of endometriosis are represented by infertility and chronic pelvic pain. Chronic pelvic pain causes disability and distress with a very high economic impact. In the last decades, an impressive amount of pharmacological agents have been tested for the treatment of endometriosis-associated pelvic pain. However, only a few of these have been introduced into clinical practice. Following the results of the controlled studies available, to date, the first-line treatment for endometriosis associated pain is still represented by oral contraceptives used continuously. Progestins represent an acceptable alternative. In women with rectovaginal lesions or colorectal endometriosis, norethisterone acetate at low dosage should be preferred. GnRH analogues may be used as second-line treatment, but significant side effects should be taken into account. Nonsteroidal anti-inflammatory drugs are widely used, but there is inconclusive evidence for their efficacy in relieving endometriosis-associated pelvic pain. Other agents such as GnRH antagonist, aromatase inhibitors, immunomodulators, selective progesterone receptor modulators, and histone deacetylase inhibitors seem to be very promising, but there is not enough evidence to support their introduction into routine clinical practice. Some other agents, such as peroxisome proliferator activated receptors-γ ligands, antiangiogenic agents, and melatonin have been proven to be efficacious in animal studies, but they have not yet been tested in clinical studies.

Prevalence and determinants of risky sexual practice in Ethiopia: Systematic review and Meta-analysis.

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Muche, Achenef Asmamaw; Kassa, Getachew Mullu; Berhe, Abadi Kidanemariam; Fekadu, Gedefaw Abeje

2017-09-06

Risky sexual practice is a major public health problem in Ethiopia. There are various studies on the prevalence and determinants of risky sexual practice in different regions of the country but there is no study which shows the national estimate of risky sexual practices in Ethiopia. Therefore, this review was conducted to estimate the national pooled prevalence of risky sexual practice and its risk factors in Ethiopia. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed to review published and unpublished studies in Ethiopia. The databases used were; PubMed, Google Scholar, CINAHL and African Journals Online. Search terms were; risky sexual behavior, risky sexual practice, unprotected sex, multiple sexual partner, early sexual initiation, and/or Ethiopia. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was used for critical appraisal. The meta-analysis was conducted using Review Manager software. Descriptive information of studies was presented in narrative form and quantitative results were presented in forest plots. The Cochran Q test and I 2 test statistics were used to test heterogeneity across studies. The pooled estimate prevalence and the odd ratios with 95% confidence intervals were computed by a random effect model. A total of 31 studies with 43,695 participants were included in the meta-analysis. The pooled prevalence of risky sexual practice was 42.80% (95% CI: 35.64%, 49.96%). Being male (OR: 1.69; 95% CI: 1.21, 2.37), substance use (OR: 3.42; 95% CI: 1.41, 8.31), peer pressure (OR: 3.41; 95% CI: 1.69, 6.87) and watching pornography (OR: 3.6; 95% CI: 2.21, 5.86) were factors associated with an increase in risky sexual practices. The prevalence of risky sexual practices is high in Ethiopia. Being male, substance use, peer pressure and viewing pornographic materials were found to be associated with risky sexual practices. Therefore, life skills training is recommended to

[Effect of Medicated-catgut Embedding at "Changqiang" (GV 1) on Mechanical Pain Threshold and P 38 MAPK Expression in Spinal Cord Tissue in Anus Incisional Pain Rats].

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Shu, Tao; Zhang, Shi-Ti; Yan, Feng; Ke, Yu-Pei; Wang, Jun

2017-10-25

To observe the effect of medicated-catgut embedding at "Changqiang"(GV 1) on regional pain reaction and expression of p 38 MAPK in the dorsal horn of spinal cord in anus incisional pain rats, so as to explore its analgesic mechanism. Forty male SD rats were randomly divided into control, model, GV 1-embedding and sham acupoint embedding groups ( n =10 rats in each group). The anus incisional pain model was established by making a radial incision (about 10 mm length) at the left lithotomy position of the anus with a surgical knife, and the mechanical pain threshold (PT) was measured by using a Von Frey before and 4, 8, 12, 24 h after operation. The medicated-catgut (about 12.5 mm length/kg body weight) was implanted in the subcutaneous tissue of GV 1 region. The immunoactivity of p 38 MAPK was determined by immunohistochemistry. Compared with the control group, the mechanical PTs were significantly decreased 4, 8, 12 and 24 h after operation both at the site of incision and about 15 mm proximal to the site of incision in the model group ( P <0.05), and the immunoactivity of phosphorylated (p)-p 38 MAPK in the superficial layer of dorsal horns of lumbar spinal cord was significantly increased(24 h)after operation( P <0.05). Compared with the model group, the PTs were significantly increased 8, 12 and 24 h after operation at the site of incision, and 12 h and 24 h at the site about 15 mm proximal to the incision region ( P <0.05), and the immunoactivity level of p-p 38 MAPK was significantly down-regulated in the GV 1-embedding group ( P <0.05). No significant changes were found in the PT and p-p 38 MAPK immunoactivity levels in the sham acupoint embedding group ( P <0.05). Medicated-catgut embedding at "Changqiang"(GV 1) has an analgesic effect in anus incisional pain model rats, which may be related to its effect in down-regulating the expression of p 38 MAPK in the dorsal horn of lumbar spinal cord.

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...

Passport to promiscuity or lifesaver: press coverage of HPV vaccination and risky sexual behavior.

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Forster, Alice; Wardle, Jane; Stephenson, Judith; Waller, Jo

2010-03-01

A significant minority of parents are concerned about adolescents engaging in risky sexual behavior following human papillomavirus (HPV) vaccination. The way the HPV vaccine is reported in the media has the potential to influence public understanding and vaccination decisions. The present study examined the content of articles published between 2003 and 2008 in British national newspapers that addressed the issue of adolescents engaging in risky sexual behavior following HPV vaccination. We used mixed methods to analyze 92 articles in which the issue was mentioned. Qualitative framework analysis highlighted three main types of discussion: news stories proposing that adolescents will engage in risky sexual behavior following HPV vaccination, counterarguments insisting that adolescents will not engage in risky sexual behavior after HPV vaccination, and parents' views of the issue of risky sexual behavior. The results indicated that newspapers provide parents with broadly positive descriptive norms about vaccination; however, the issue that adolescents will engage in risky sexual behaviors following HPV vaccination is regularly discussed in the national press and has the potential to increase parents' concerns about vaccination.

Measuring cervical cancer risk: development and validation of the CARE Risky Sexual Behavior Index.

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Reiter, Paul L; Katz, Mira L; Ferketich, Amy K; Ruffin, Mack T; Paskett, Electra D

2009-12-01

To develop and validate a risky sexual behavior index specific to cervical cancer research. Sexual behavior data on 428 women from the Community Awareness Resources and Education (CARE) study were utilized. A weighting scheme for eight risky sexual behaviors was generated and validated in creating the CARE Risky Sexual Behavior Index. Cutpoints were then identified to classify women as having a low, medium, or high level of risky sexual behavior. Index scores ranged from 0 to 35, with women considered to have a low level of risky sexual behavior if their score was less than six (31.3% of sample), a medium level if their score was 6–10 (30.6%), or a high level if their score was 11 or greater (38.1%). A strong association was observed between the created categories and having a previous abnormal Pap smear test (p Sexual Behavior Index provides a tool for measuring risky sexual behavior level for cervical cancer research. Future studies are needed to validate this index in varied populations and test its use in the clinical setting.

Risky drinking patterns are being continued into pregnancy: a prospective cohort study.

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Anderson, Amy E; Hure, Alexis J; Forder, Peta M; Powers, Jennifer; Kay-Lambkin, Frances J; Loxton, Deborah J

2014-01-01

Risky patterns of alcohol use prior to pregnancy increase the risk of alcohol-exposed pregnancies and subsequent adverse outcomes. It is important to understand how consumption changes once women become pregnant. The aim of this study was to describe the characteristics of women that partake in risky drinking patterns before pregnancy and to examine how these patterns change once they become pregnant. A sample of 1577 women from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health were included if they first reported being pregnant in 2000, 2003, 2006, 2009 and reported risky drinking patterns prior to that pregnancy. Multinomial logistic regression was used to determine which risky drinking patterns were most likely to continue into pregnancy. When reporting risky drinking patterns prior to pregnancy only 6% of women reported weekly drinking only, whereas 46% reported binge drinking only and 48% reported both. Women in both binge categories were more likely to have experienced financial stress, not been partnered, smoked, used drugs, been nulliparous, experienced a violent relationship, and were less educated. Most women (46%) continued these risky drinking patterns into pregnancy, with 40% reducing these behaviors, and 14% completely ceasing alcohol consumption. Once pregnant, women who binged only prior to pregnancy were more likely to continue (55%) rather than reduce drinking (29%). Of the combined drinking group 61% continued to binge and 47% continued weekly drinking. Compared with the combined drinking group, binge only drinkers prior to pregnancy were less likely to reduce rather than continue their drinking once pregnant (OR = 0.37, 95% CI  =  0.29, 0.47). Over a third of women continued risky drinking into pregnancy, especially binge drinking, suggesting a need to address alcohol consumption prior to pregnancy.

Risky drinking patterns are being continued into pregnancy: a prospective cohort study.

Directory of Open Access Journals (Sweden)

Amy E Anderson

Full Text Available BACKGROUND: Risky patterns of alcohol use prior to pregnancy increase the risk of alcohol-exposed pregnancies and subsequent adverse outcomes. It is important to understand how consumption changes once women become pregnant. OBJECTIVE: The aim of this study was to describe the characteristics of women that partake in risky drinking patterns before pregnancy and to examine how these patterns change once they become pregnant. METHODS: A sample of 1577 women from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health were included if they first reported being pregnant in 2000, 2003, 2006, 2009 and reported risky drinking patterns prior to that pregnancy. Multinomial logistic regression was used to determine which risky drinking patterns were most likely to continue into pregnancy. RESULTS: When reporting risky drinking patterns prior to pregnancy only 6% of women reported weekly drinking only, whereas 46% reported binge drinking only and 48% reported both. Women in both binge categories were more likely to have experienced financial stress, not been partnered, smoked, used drugs, been nulliparous, experienced a violent relationship, and were less educated. Most women (46% continued these risky drinking patterns into pregnancy, with 40% reducing these behaviors, and 14% completely ceasing alcohol consumption. Once pregnant, women who binged only prior to pregnancy were more likely to continue (55% rather than reduce drinking (29%. Of the combined drinking group 61% continued to binge and 47% continued weekly drinking. Compared with the combined drinking group, binge only drinkers prior to pregnancy were less likely to reduce rather than continue their drinking once pregnant (OR = 0.37, 95% CI  =  0.29, 0.47. CONCLUSIONS: Over a third of women continued risky drinking into pregnancy, especially binge drinking, suggesting a need to address alcohol consumption prior to pregnancy.

Frequent nonprescription stimulant use and risky behaviors in college students: the role of effortful control.

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Reid, Adam M; Graziano, Paulo A; Balkhi, Amanda M; McNamara, Joseph P H; Cottler, Linda B; Meneses, Evander; Geffken, Gary R

2015-01-01

The goal of this study was to (a) investigate the association between nonprescription stimulant use (NPSU) and risky behaviors, including risky sex, driving, financial behaviors, and drug use and (b) collect preliminary evidence on mechanisms that may link NPSU to risky behaviors. A sample of 555 college students was collected between August 2010 and February 2012. Students completed several self-report measures assessing their drug use history, attention-deficit and hyperactivity symptoms, temperament, and risky behaviors beyond drug use. Those who reported more frequent NPSU were more likely to engage in high-risk behavior across all 4 domains studied. Further, effortful control abilities partially mediated the link between NPSU and risky behaviors. These results highlight the associated risks of frequent NPSU for college students as well as provide future directions for examining effortful control as a potentially important mechanism linking NPSU to other risky behaviors.

Chronic, unexplained pain

NARCIS (Netherlands)

Snijders, T.J.

2012-01-01

Chronic, unexplained pain (CUP) is a common clinical problem. The core symptom in this heterogeneous group of patients is pain for which no medical explanation is found. Patients also have many other characteristics (symptoms and psychosocial features) in common. Pathophysiologically, increased

Medical marijuana policies and hospitalizations related to marijuana and opioid pain reliever.

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Shi, Yuyan

2017-04-01

Twenty-eight states in the U.S have legalized medical marijuana, yet its impacts on severe health consequences such as hospitalizations remain unknown. Meanwhile, the prevalence of opioid pain reliever (OPR) use and outcomes has increased dramatically. Recent studies suggested unintended impacts of legalizing medical marijuana on OPR, but the evidence is still limited. This study examined the associations between state medical marijuana policies and hospitalizations related to marijuana and OPR. State-level annual administrative records of hospital discharges during 1997-2014 were obtained from the State Inpatient Databases (SID). The outcome variables were rates of hospitalizations involving marijuana dependence or abuse, opioid dependence or abuse, and OPR overdose in 1000 discharges. Linear time-series regressions were used to assess the associations of implementing medical marijuana policies to hospitalizations, controlling for other marijuana- and OPR-related policies, socioeconomic factors, and state and year fixed effects. Hospitalizations related to marijuana and OPR increased sharply by 300% on average in all states. Medical marijuana legalization was associated with 23% (p=0.008) and 13% (p=0.025) reductions in hospitalizations related to opioid dependence or abuse and OPR overdose, respectively; lagged effects were observed after policy implementation. The operation of medical marijuana dispensaries had no independent impacts on OPR-related hospitalizations. Medical marijuana polices had no associations with marijuana-related hospitalizations. Medical marijuana policies were significantly associated with reduced OPR-related hospitalizations but had no associations with marijuana-related hospitalizations. Given the epidemic of problematic use of OPR, future investigation is needed to explore the causal pathways of these findings. Copyright © 2017 Elsevier B.V. All rights reserved.

Medical marijuana policies and hospitalizations related to marijuana and opioid pain reliever*

Science.gov (United States)

Shi, Yuyan

2017-01-01

Objectives Twenty-eight states in the U.S. have legalized medical marijuana, yet its impacts on severe health consequences such as hospitalizations remain unknown. Meanwhile, the prevalence of opioid pain reliever (OPR) use and outcomes has increased dramatically. Recent studies suggested unintended impacts of legalizing medical marijuana on OPR, but the evidence is still limited. This study examined the associations between state medical marijuana policies and hospitalizations related to marijuana and OPR. Methods State-level annual administrative records of hospital discharges during 1997–2014 were obtained from the State Inpatient Databases (SID). The outcome variables were rates of hospitalizations involving marijuana dependence or abuse, opioid dependence or abuse, and OPR overdose in 1,000 discharges. Linear time-series regressions were used to assess the associations of implementing medical marijuana policies to hospitalizations, controlling for other marijuana- and OPR-related policies, socioeconomic factors, and state and year fixed effects. Results Hospitalizations related to marijuana and OPR increased sharply by 300% on average in all states. Medical marijuana legalization was associated with 23% (p=.008) and 13% (p=.025) reductions in hospitalizations related to opioid dependence or abuse and OPR overdose, respectively; lagged effects were observed after policy implementation. The operation of medical marijuana dispensaries had no independent impacts on OPR- related hospitalizations. Medical marijuana polices had no associations with marijuana-related hospitalizations. Conclusion Medical marijuana policies were significantly associated with reduced OPR-related hospitalizations but had no associations with marijuana-related hospitalizations. Given the epidemic of problematic use of OPR, future investigation is needed to explore the causal pathways of these findings. PMID:28259087

The ACTTION-American Pain Society Pain Taxonomy (AAPT): an evidence-based and multidimensional approach to classifying chronic pain conditions.

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Fillingim, Roger B; Bruehl, Stephen; Dworkin, Robert H; Dworkin, Samuel F; Loeser, John D; Turk, Dennis C; Widerstrom-Noga, Eva; Arnold, Lesley; Bennett, Robert; Edwards, Robert R; Freeman, Roy; Gewandter, Jennifer; Hertz, Sharon; Hochberg, Marc; Krane, Elliot; Mantyh, Patrick W; Markman, John; Neogi, Tuhina; Ohrbach, Richard; Paice, Judith A; Porreca, Frank; Rappaport, Bob A; Smith, Shannon M; Smith, Thomas J; Sullivan, Mark D; Verne, G Nicholas; Wasan, Ajay D; Wesselmann, Ursula

2014-03-01

Current approaches to classification of chronic pain conditions suffer from the absence of a systematically implemented and evidence-based taxonomy. Moreover, existing diagnostic approaches typically fail to incorporate available knowledge regarding the biopsychosocial mechanisms contributing to pain conditions. To address these gaps, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION) public-private partnership with the U.S. Food and Drug Administration and the American Pain Society (APS) have joined together to develop an evidence-based chronic pain classification system called the ACTTION-APS Pain Taxonomy. This paper describes the outcome of an ACTTION-APS consensus meeting, at which experts agreed on a structure for this new taxonomy of chronic pain conditions. Several major issues around which discussion revolved are presented and summarized, and the structure of the taxonomy is presented. ACTTION-APS Pain Taxonomy will include the following dimensions: 1) core diagnostic criteria; 2) common features; 3) common medical comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors. In coming months, expert working groups will apply this taxonomy to clusters of chronic pain conditions, thereby developing a set of diagnostic criteria that have been consistently and systematically implemented across nearly all common chronic pain conditions. It is anticipated that the availability of this evidence-based and mechanistic approach to pain classification will be of substantial benefit to chronic pain research and treatment. The ACTTION-APS Pain Taxonomy is an evidence-based chronic pain classification system designed to classify chronic pain along the following dimensions: 1) core diagnostic criteria; 2) common features; 3) common medical comorbidities; 4) neurobiological, psychosocial

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

DEFF Research Database (Denmark)

Skou, S. T.; Roos, E. M.; Simonsen, O.

2016-01-01

(PPTs) at the knee (localized sensitization) and the lower leg (spreading sensitization), (2) peak pain intensity during the previous 24 h, (3) pain intensity after 30 min of walking, (4) pain location and pattern, (5) spreading of pain on a region-divided body chart and (6) the usage of pain medication...

Medical hypnotherapy for pain management.

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Colón, Yvette; Avnet, Mark S

2014-06-01

Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. Hypnotherapy, its uses and process, and certification and training of hypnotherapy professionals are addressed.

A cross-cultural perspective of medical clowning: comparison of its effectiveness in reducing pain and anxiety among hospitalized Bedouin and Jewish Israeli children.

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Gilboa-Negari, Zehavit; Abu-Kaf, Sarah; Huss, Ephrat; Hain, Gavriel; Moser, Asher

2017-01-01

Medical clowning has proven effective for reducing pain, anxiety, and stress, however, its differential effects on children from different cultures have not yet been researched. This study evaluated the effects of medical-clowning intervention on anxiety and pain among Jewish and Bedouin children, and anxiety among their parents, in southern Israel. The study was conducted in hospital pediatric departments and employed a pre-post design involving quantitative and qualitative methods. The study included 89 children whose ages ranged from 7.5 to 12 years (39 Jewish and 50 Bedouin) and 69 parents (19 Jewish and 50 Bedouin). Questionnaires assessing pain, anxiety, and demographics were used at the pre-intervention stage and pain, anxiety, and enjoyment of different aspects of the intervention were evaluated following the intervention. The intervention stage lasted for 8-10 minutes and included the use of word play, body language, and making faces, as well as the use of props brought by the clown. Semi-structured interviews were also conducted at the post-intervention stage. The intervention reduced pain and anxiety among both groups of children and reduced anxiety among both groups of parents. However, anxiety levels were reduced more significantly among Bedouin children. The nonverbal components of the clowns' humor were most central, but it was the verbal components that mediated the reduction in anxiety among the Bedouin children. This study underscored the effectiveness and importance of medical clowning in reducing pain and anxiety among children in different cultural contexts. Moreover, the issue of culturally appropriate humor was underscored and implications for intercultural clown training are discussed.

Intensive interdisciplinary outpatient pain management program for chronic back pain: a pilot study

Directory of Open Access Journals (Sweden)

Artner J

2012-07-01

Full Text Available Juraj Artner, Stephan Kurz, Balkan Cakir, Heiko Reichel, Friederike LattigDepartment of Orthopaedic Surgery, University of Ulm, RKU, GermanyBackground: Chronic back pain is relatively resistant to unimodal therapy regimes. The aim of this study was to introduce and evaluate the short-term outcome of a three-week intensive multidisciplinary outpatient program for patients with back pain and sciatica, measured according to decrease of functional impairment and pain.Methods: The program was designed for patients suffering from chronic back pain to provide intensive interdisciplinary therapy in an outpatient setting, consisting of interventional injection techniques, medication, exercise therapy, back education, ergotherapy, traction, massage therapy, medical training, transcutaneous electrical nerve stimulation, aquatraining, and relaxation.Results: Based on Oswestry Disability Index (ODI and Numeric Rating Scale (NRS scores, a significant improvement in pain intensity and functionality of 66.83% NRS and an ODI of 33.33% were achieved by our pain program within 3 weeks.Conclusion: This paper describes the organization and short-term outcome of an intensive multidisciplinary program for chronic back pain on an outpatient basis provided by our orthopedic department, with clinically significant results.Keywords: chronic back pain, intense, multidisciplinary, program, outpatient

Canadian Orofacial Pain Team workshop report on the Global Year Against Orofacial Pain

Science.gov (United States)

Lavigne, Gilles J; Sessle, Barry J

2015-01-01

The year 2013–2014 has been designated the Global Year Against Orofacial Pain by the International Association for the Study of Pain. Accordingly, a multidisciplinary Canadian and international group of clinical, research and knowledge-transfer experts attended a workshop in Montreal, Quebec. The workshop had two aims: to identify new pathways for innovative diagnosis and management of chronic orofacial pain states; and to identify opportunities for further collaborative orofacial pain research and education in Canada. Three topics related to chronic orofacial pain were explored: biomarkers and pain signatures for chronic orofacial pain; misuse of analgesic and opioid pain medications for managing chronic orofacial pain; and complementary alternative medicine, topical agents and the role of stress in chronic orofacial pain. It was determined that further research is needed to: identify biomarkers of chronic orofacial post-traumatic neuropathic pain, with a focus on psychosocial, physiological and chemical-genetic factors; validate the short-and long-term safety (ie, no harm to health, and avoidance of misuse and addiction) of opioid use for two distinct conditions (acute and chronic orofacial pain, respectively); and promote the use of topical medications as an alternative treatment in dentistry, and further document the benefits and safety of complementary and alternative medicine, including stress management, in dentistry. It was proposed that burning mouth syndrome, a painful condition that is not uncommon and affects mainly postmenopausal women, should receive particular attention. PMID:25522352

Canadian Orofacial Pain Team workshop report on the global year against orofacial pain.

Science.gov (United States)

Lavigne, Gilles J; Sessle, Barry J

2015-01-01

The year 2013-2014 has been designated the Global Year Against Orofacial Pain by the International Association for the Study of Pain. Accordingly, a multidisciplinary Canadian and international group of clinical, research and knowledge-transfer experts attended a workshop in Montreal, Quebec. The workshop had two aims: to identify new pathways for innovative diagnosis and management of chronic orofacial pain states; and to identify opportunities for further collaborative orofacial pain research and education in Canada. Three topics related to chronic orofacial pain were explored: biomarkers and pain signatures for chronic orofacial pain; misuse of analgesic and opioid pain medications for managing chronic orofacial pain; and complementary alternative medicine, topical agents and the role of stress in chronic orofacial pain. It was determined that further research is needed to: identify biomarkers of chronic orofacial post-traumatic neuropathic pain, with a focus on psychosocial, physiological and chemical-genetic factors; validate the short- and long-term safety (i.e., no harm to health, and avoidance of misuse and addiction) of opioid use for two distinct conditions (acute and chronic orofacial pain, respectively); and promote the use of topical medications as an alternative treatment in dentistry, and further document the benefits and safety of complementary and alternative medicine, including stress management, in dentistry. It was proposed that burning mouth syndrome, a painful condition that is not uncommon and affects mainly postmenopausal women, should receive particular attention.

Over-imaging in uncomplicated low back pain: a 12-month audit of a general medical unit.

Science.gov (United States)

Rego, M H; Nagiah, S

2016-12-01

Low back pain is frequently encountered in hospitals and is a leading cause of disability, often involving costly imaging that exposes a patient to radiation. A retrospective 12-month audit at a South Australian tertiary hospital aimed to evaluate the frequency, modality and appropriateness of imaging in patients with low back pain. Results showed that the general medical unit was unnecessarily ordering imaging in 40% of patients who exhibited no indications warranting such a procedure. A standardised protocol is required to preventing clinicians from requesting imaging solely for the purposes of self-reassurance, patient reassurance or fear of litigation. © 2016 Royal Australasian College of Physicians.

Inter-Rater Reliability of Historical Data Collected by Non-Medical Research Assistants and Physicians in Patients with Acute Abdominal Pain

Directory of Open Access Journals (Sweden)

Mills, Angela M

2009-02-01

Full Text Available OBJECTIVES: In many academic emergency departments (ED, physicians are asked to record clinical data for research that may be time consuming and distracting from patient care. We hypothesized that non-medical research assistants (RAs could obtain historical information from patients with acute abdominal pain as accurately as physicians.METHODS: Prospective comparative study conducted in an academic ED of 29 RAs to 32 resident physicians (RPs to assess inter-rater reliability in obtaining historical information in abdominal pain patients. Historical features were independently recorded on standardized data forms by a RA and RP blinded to each others' answers. Discrepancies were resolved by a third person (RA who asked the patient to state the correct answer on a third questionnaire, constituting the "criterion standard." Inter-rater reliability was assessed using kappa statistics (kappa and percent crude agreement (CrA.RESULTS: Sixty-five patients were enrolled (mean age 43. Of 43 historical variables assessed, the median agreement was moderate (kappa 0.59 [Interquartile range 0.37-0.69]; CrA 85.9% and varied across data categories: initial pain location (kappa 0.61 [0.59-0.73]; CrA 87.7%, current pain location (kappa 0.60 [0.47-0.67]; CrA 82.8%, past medical history (kappa 0.60 [0.48-0.74]; CrA 93.8%, associated symptoms (kappa 0.38 [0.37-0.74]; CrA 87.7%, and aggravating/alleviating factors (kappa 0.09 [-0.01-0.21]; CrA 61.5%. When there was disagreement between the RP and the RA, the RA more often agreed with the criterion standard (64% [55-71%] than the RP (36% [29-45%].CONCLUSION: Non-medical research assistants who focus on clinical research are often more accurate than physicians, who may be distracted by patient care responsibilities, at obtaining historical information from ED patients with abdominal pain.

Bone pain

DEFF Research Database (Denmark)

Frost, Charlotte Ørsted; Hansen, Rikke Rie; Heegaard, Anne-Marie

2016-01-01

Skeletal conditions are common causes of chronic pain and there is an unmet medical need for improved treatment options. Bone pain is currently managed with disease modifying agents and/or analgesics depending on the condition. Disease modifying agents affect the underlying pathophysiology...... of the disease and reduce as a secondary effect bone pain. Antiresorptive and anabolic agents, such as bisphosphonates and intermittent parathyroid hormone (1-34), respectively, have proven effective as pain relieving agents. Cathepsin K inhibitors and anti-sclerostin antibodies hold, due to their disease...... modifying effects, promise of a pain relieving effect. NSAIDs and opioids are widely employed in the treatment of bone pain. However, recent preclinical findings demonstrating a unique neuronal innervation of bone tissue and sprouting of sensory nerve fibers open for new treatment possibilities....

Functional abdominal pain syndrome treated with Korean medication

Directory of Open Access Journals (Sweden)

Chang-Gue Son

2014-06-01

Full Text Available A 37-year-old female patient with chronic and stubborn abdominal pain had been hospitalized five times in three Western hospitals, but no effects were observed. No abnormalities were found in blood tests, gastrointestinal endoscopy, sonogram, and computed tomography of the abdomen, except mild paralytic ileus. The patient decided to rely on Korean medicine as an inpatient. She was diagnosed with functional abdominal pain syndrome, and her symptom differentiation was the “Yang deficiency of spleen and kidney.” A herbal drug, Hwangikyeji-tang, along with moxibustion and acupuncture, was given to the patient. Abdominal pain and related symptoms were reduced radically within 16 days of treatment. This report shows a therapeutic potential of Korean medicine-based treatment for functional abdominal pain syndrome.

Functional abdominal pain syndrome treated with Korean medication.

Science.gov (United States)

Son, Chang-Gue

2014-06-01

A 37-year-old female patient with chronic and stubborn abdominal pain had been hospitalized five times in three Western hospitals, but no effects were observed. No abnormalities were found in blood tests, gastrointestinal endoscopy, sonogram, and computed tomography of the abdomen, except mild paralytic ileus. The patient decided to rely on Korean medicine as an inpatient. She was diagnosed with functional abdominal pain syndrome, and her symptom differentiation was the " Yang deficiency of spleen and kidney ." A herbal drug, Hwangikyeji-tang , along with moxibustion and acupuncture, was given to the patient. Abdominal pain and related symptoms were reduced radically within 16 days of treatment. This report shows a therapeutic potential of Korean medicine-based treatment for functional abdominal pain syndrome.

Maintenance of Pain in Children With Functional Abdominal Pain.

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Czyzewski, Danita I; Self, Mariella M; Williams, Amy E; Weidler, Erica M; Blatz, Allison M; Shulman, Robert J

2016-03-01

A significant proportion of children with functional abdominal pain develop chronic pain. Identifying clinical characteristics predicting pain persistence is important in targeting interventions. We examined whether child anxiety and/or pain-stooling relations were related to maintenance of abdominal pain frequency and compared the predictive value of 3 methods for assessing pain-stooling relations (ie, diary, parent report, child report). Seventy-six children (7-10 years old at baseline) who presented for medical treatment of functional abdominal pain were followed up 18 to 24 months later. Baseline anxiety and abdominal pain-stooling relations based on pain and stooling diaries and child- and parent questionnaires were examined in relationship to the persistence of abdominal pain frequency. Children's baseline anxiety was not related to persistence of pain frequency. Children who, however, displayed irritable bowel syndrome (IBS) symptoms at baseline maintained pain frequency at follow-up, whereas in children in whom there was no relationship between pain and stooling, pain frequency decreased. Pain and stool diaries and parent report of pain-stooling relations were predictive of pain persistence but child-report questionnaires were not. The presence of IBS symptoms in school-age children with functional abdominal pain appears to predict persistence of abdominal pain over time, whereas anxiety does not. Prospective pain and stooling diaries and parent report of IBS symptoms were predictors of pain maintenance, but child report of symptoms was not.

Relationship of pain coping strategies and pain specific beliefs to pain experience in children with juvenile idiopathic arthritis

DEFF Research Database (Denmark)

Thastum, Mikael; Herlin, Troels; Zachariae, R.

2005-01-01

compared using t-tests for independent samples. Pearson's correlation coefficients were calculated to examine the direct associations between each individual coping and belief scale, and the pain measure. RESULTS: Only the CHAQ and the cognitive belief composite factor score made statistically significant...... subscale of harm (mean +/- SD 2.7 +/- 0.6 and 1.8 +/- 0.7, respectively). Significant correlations were obtained between the pain measure and the pain-coping subscale of catastrophizing, the pain belief subscales of disability, harm, solicitude (inverse), control, and medical cure. CONCLUSION...

The Barriers to High-Quality Inpatient Pain Management: A Qualitative Study.

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

2015-09-01

The current literature suggests deficiencies in the quality of acute pain management among general medical inpatients. The aim of this qualitative study is to identify potential barriers to high-quality acute pain management among general medical inpatients at an urban academic medical center during a 2-year period. Data are collected using retrospective chart reviews, survey questionnaires, and semistructured, open-ended interviews of 40 general medical inpatients who have experienced pain during their hospitalization. Our results confirm high prevalence and disabling impacts of pain and significant patient- and provider-related barriers to high-quality acute pain management. We also identify unique system-related barriers such as time delay and pain management culture. Efforts to improve the pain management experience of general medical inpatients will need to address all these barriers. © The Author(s) 2014.

Risky play and children's safety: balancing priorities for optimal child development.

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Brussoni, Mariana; Olsen, Lise L; Pike, Ian; Sleet, David A

2012-08-30

Injury prevention plays a key role in keeping children safe, but emerging research suggests that imposing too many restrictions on children's outdoor risky play hinders their development. We explore the relationship between child development, play, and conceptions of risk taking with the aim of informing child injury prevention. Generational trends indicate children's diminishing engagement in outdoor play is influenced by parental and societal concerns. We outline the importance of play as a necessary ingredient for healthy child development and review the evidence for arguments supporting the need for outdoor risky play, including: (1) children have a natural propensity towards risky play; and, (2) keeping children safe involves letting them take and manage risks. Literature from many disciplines supports the notion that safety efforts should be balanced with opportunities for child development through outdoor risky play. New avenues for investigation and action are emerging seeking optimal strategies for keeping children "as safe as necessary," not "as safe as possible." This paradigm shift represents a potential for epistemological growth as well as cross-disciplinary collaboration to foster optimal child development while preserving children's safety.

Evaluation of Evidence-based Nursing Pain Management Practice.

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Song, Wenjia; Eaton, Linda H; Gordon, Debra B; Hoyle, Christine; Doorenbos, Ardith Z

2015-08-01

It is important to ensure that cancer pain management is based on the best evidence. Nursing evidence-based pain management can be examined through an evaluation of pain documentation. The aim of this study was to modify and test an evaluation tool for nursing cancer pain documentation, and describe the frequency and quality of nursing pain documentation in one oncology unit via the electronic medical system. A descriptive cross-sectional design was used for this study at an oncology unit of an academic medical center in the Pacific Northwest. Medical records were examined for 37 adults hospitalized during April and May 2013. Nursing pain documentations (N = 230) were reviewed using an evaluation tool modified from the Cancer Pain Practice Index to consist of 13 evidence-based pain management indicators, including pain assessment, care plan, pharmacologic and nonpharmacologic interventions, monitoring and treatment of analgesic side effects, communication with physicians, and patient education. Individual nursing documentation was assigned a score ranging from 0 (worst possible) to 13 (best possible), to reflect the delivery of evidence-based pain management. The participating nurses documented 90% of the recommended evidence-based pain management indicators. Documentation was suboptimal for pain reassessment, pharmacologic interventions, and bowel regimen. The study results provide implications for enhancing electronic medical record design and highlight a need for future research to understand the reasons for suboptimal nursing documentation of cancer pain management. For the future use of the data evaluation tool, we recommend additional modifications according to study settings. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Frequent Nonprescription Stimulant Use and Risky Behaviors in College Students: The Role of Effortful Control

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Reid, Adam M.; Graziano, Paulo A.; Balkhi, Amanda M.; McNamara, Joseph P. H.; Cottler, Linda B.; Meneses, Evander; Geffken, Gary R.

2015-01-01

Objective: The goal of this study was to (a) investigate the association between nonprescription stimulant use (NPSU) and risky behaviors, including risky sex, driving, financial behaviors, and drug use and (b) collect preliminary evidence on mechanisms that may link NPSU to risky behaviors. Participants: A sample of 555 college students was…

Influence of Social Settings on Risky Sexual Behavior

Directory of Open Access Journals (Sweden)

James B. Hittner

2016-02-01

Full Text Available This study investigated the relevance of social settings as predictors of risky sexual behavior. In a young adult sample (n = 324, M age = 20.2 years, we examined the association between frequency of attendance at five different settings and frequency of engaging in four risky sexual behaviors (i.e., unprotected intercourse when not drunk or high, unprotected intercourse when drunk or high, casual sex when not drunk or high, casual sex when drunk or high. Predictive associations were examined using negative binomial regression, and all analyses controlled for frequency of recent alcohol use and age at first use of alcohol. Greater attendance at fraternity/sorority parties predicted more frequent intercourse for females in the not drunk or high and drunk or high contexts, and more frequent casual sex for males in the not drunk or high context. Greater attendance at large private parties predicted more frequent intercourse for females in the not drunk or high context. Greater attendance at bars without dance floors predicted more frequent intercourse for males in the drunk or high context. These findings highlight the importance of socializing habits in understanding risky sexual behavior.

Risky decision making in Attention-Deficit/Hyperactivity Disorder : A meta-regression analysis

NARCIS (Netherlands)

Dekkers, T.J.; Popma, A.; Agelink van Rentergem, J.A.; Bexkens, A.; Huizenga, H.M.

ADHD has been associated with various forms of risky real life decision making, for example risky driving, unsafe sex and substance abuse. However, results from laboratory studies on decision making deficits in ADHD have been inconsistent, probably because of between study differences. We therefore

Effects of personality on risky driving behavior and accident involvement for Chinese drivers.

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Yang, Jiaoyan; Du, Feng; Qu, Weina; Gong, Zhun; Sun, Xianghong

2013-01-01

Motor vehicle accidents are the leading cause of injury-related fatalities in China and pose the most serious threat to driving safety. Driver personality is considered as an effective predictor for risky driving behavior and accident liability. Previous studies have focused on the relationship between personality and risky driving behavior, but only a few of them have explored the effects of personality variables on accident involvement. In addition, few studies have examined the effects of personality on Chinese drivers' risky driving and accident involvement. The present study aimed to examine the effects of personality variables on Chinese drivers' unsafe driving behaviors and accident involvement. Two hundred and twenty-four Chinese drivers aged 20 to 50 were required to complete questionnaires assessing their personality traits (anger, sensation-seeking, altruism, and normlessness), risky driving behaviors (aggressive violations, ordinary violations), and accident involvement (all accidents, serious accidents, at-fault accidents). Multivariate regression analyses, adjusting for gender, age, and overall mileage, were conducted to identify the personality traits related to risky driving behaviors and accident involvement. Participants' personality traits were found to be significantly correlated with both risky driving behavior and accident involvement. Specifically, the traits of anger and normlessness were effective predictors for aggressive violations. The traits of anger, sensation-seeking, normlessness, and altruism were effective predictors for ordinary violations. Moreover, altruism and normlessness were significant predictors for the total number of accidents participants had during the past 3 years. Consistent with previous studies, the present study revealed that personality traits play an important role in predicting Chinese drivers' risky driving behaviors. In addition, Chinese drivers' personality characteristics were also associated with accident

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...

Relationship Between Methamphetamine Use and Risky Sexual Behavior in Adolescents

Directory of Open Access Journals (Sweden)

Cheng-Fang Yen

2004-04-01

Full Text Available Substance abuse and risky sexual behavior have been identified as behaviors that can endanger adolescent psychosocial development. This study examined the relationship between methamphetamine (MAMP use and risky sexual behavior in adolescents. Risky sexual behavior was compared not only between MAMP users and non-users, but also between high-frequency and low-frequency MAMP users. We compared the sexual intercourse histories of 85 adolescents formally charged as MAMP users with those of 170 gender-matched adolescents with no record of MAMP use. MAMP usage characteristics were compared between users who had and those who had not experienced sexual intercourse. Previous sexual experience was more likely in MAMP users than in non-users. MAMP users were also more likely to have had a greater total number of sexual partners and were more likely to have had unplanned sex under the influence of alcohol. High-frequency MAMP use was associated with increased tendencies to engage in unprotected sex and to use MAMP before sexual intercourse. In general, the chance of sexual intercourse increased in proportion to frequency of MAMP use. Given the clear link between MAMP use and risky sexual behavior, risk-reduction programs directed at teen MAMP users are urgently needed.

Gender differences in risky sexual behavior among urban adolescents exposed to violence.

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Collins Fantasia, Heidi; Sutherland, Melissa A; Kelly-Weeder, Susan

2012-07-01

The purpose of this study was to use an ecological lens to explore gender differences in risky sexual behavior among urban adolescents exposed to violence. This was a secondary analysis of data from a larger behavioral intervention trial that targeted drinking behaviors among adolescents. Data from a total of 2,560 male and female urban adolescents between the ages of 14 and 21 were analyzed for personal, interpersonal, and community exposure to violence and risky sexual behavior. Violence has an impact on sexual risk. For females, carrying a weapon (p= 0.020) and feeling safe in intimate relationships (p= 0.029) were individual correlates of risky sexual behavior, while for males, race/ethnicity (p= 0.019) and being in a physical fight (p= 0.001) were significant correlates of risky sexual behavior. Risky sexual behavior among adolescents may lead to negative reproductive health outcomes. Nurse practitioners are in an excellent position to affect change in this population through their frequent contact with adolescents in a variety of community and school-based venues. Nurse practitioners are also well-prepared to identify at-risk adolescents and provide them with individualized care, education, and support. ©2012 The Author(s) Journal compilation ©2012 American Academy of Nurse Practitioners.

A cross-cultural perspective of medical clowning: comparison of its effectiveness in reducing pain and anxiety among hospitalized Bedouin and Jewish Israeli children

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Gilboa-Negari Z

2017-07-01

Full Text Available Zehavit Gilboa-Negari,1 Sarah Abu-Kaf,2 Ephrat Huss,1 Gavriel Hain,3 Asher Moser4 1Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer-Sheva, Israel; 2Conflict Management and Resolution Program, Ben-Gurion University of the Negev, Beer-Sheva, Israel; 3Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel; 4Department of Pediatric Oncology, Soroka University Medical Center, Beer-Sheva, Israel Purpose: Medical clowning has proven effective for reducing pain, anxiety, and stress, however, its differential effects on children from different cultures have not yet been researched. This study evaluated the effects of medical-clowning intervention on anxiety and pain among Jewish and Bedouin children, and anxiety among their parents, in southern Israel. Patients and methods: The study was conducted in hospital pediatric departments and employed a pre–post design involving quantitative and qualitative methods. The study included 89 children whose ages ranged from 7.5 to 12 years (39 Jewish and 50 Bedouin and 69 parents (19 Jewish and 50 Bedouin. Questionnaires assessing pain, anxiety, and demographics were used at the pre-intervention stage and pain, anxiety, and enjoyment of different aspects of the intervention were evaluated following the intervention. The intervention stage lasted for 8–10 minutes and included the use of word play, body language, and making faces, as well as the use of props brought by the clown. Semi-structured interviews were also conducted at the post-intervention stage. Results: The intervention reduced pain and anxiety among both groups of children and reduced anxiety among both groups of parents. However, anxiety levels were reduced more significantly among Bedouin children. The nonverbal components of the clowns’ humor were most central, but it was the verbal components that mediated the reduction in anxiety among the Bedouin children. Conclusion: This study underscored

Medications (for IBS)

Medline Plus

Full Text Available ... Treating IBS Pain IBS Global Treatments IBS Diet Low FODMAP Diet Complementary or Alternative Treatments Medications Psychological ... Treating IBS Pain IBS Global Treatments IBS Diet Low FODMAP Diet Complementary or Alternative Treatments Medications Psychological ...

The effects of a medical hypnotherapy on clothing industry employees suffering from chronic pain.

Science.gov (United States)

Roja, Zenija; Kalkis, Valdis; Roja, Inara; Kalkis, Henrijs

2013-09-25

Problems associated with pain in several body regions due to work-related musculoskeletal disorders (WRMDs), repetitive movement and negative stress at work are quite common in many manufacturing industries of Latvia, int.al. clothing industry. The aim of this study was to evaluate efficiency of the psychotherapeutic intervention using medical hypnotherapy (MH) program for mind-body relaxation with pain-blocking imagery, cognitive restructuring of unpleasant physical and emotional experience. 300 sewers and 50 cutters with chronic pain were involved in the study. Self-rated WRMDs symptoms, pain intensity and interference were assessed using the extended version of Nordic Musculoskeletal Questionnaire and Brief Pain Inventory Scale. Assessment of the functional state of muscles was carried out using myotonometric (MYO) measurements. Work heaviness degree was estimated via heart rate monitoring (HRM). The MH program was composed of cognitive hypnotherapy and self-hypnosis training. Sunnen Trance Scale was used to determine person's hypnotic susceptibility. Life quality assessment before and after MH program was carried out using Quality of Life Scale. At the beginning of MH program sessions both sewers and cutters reported on pain interference with general activities, mood, sleep, normal work, etc., but after MH the interference of pain significantly decreased. HRM data confirmed that work heaviness degree of sewers and cutters can be referred to as light and moderate work (energy expenditure for their tasks varies from 3.4 till 4.7 kcal/min). Using MYO measurements it was stated that before MH 22% of workers involved in the study fell under III MYO category indices, consequently, their muscle tone was increased, which is associated with muscular fatigue. After MH muscle tone remained within the normal range meaning that they were able to adapt to the existing workload (II MYO category) or fully relax (I MYO category). MH program including exercises

Perspectives in Pancreatic Pain

Directory of Open Access Journals (Sweden)

A. S. Salim

1997-01-01

Full Text Available This review describes some of the mechanisms which are thought to be important in the causation of pain in chronic pancreatitis. Both medical and surgical techniques for treating this pain are described.

Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain.

Science.gov (United States)

Narouze, Samer; Benzon, Honorio T; Provenzano, David A; Buvanendran, Asokumar; De Andres, José; Deer, Timothy R; Rauck, Richard; Huntoon, Marc A

2015-01-01

Interventional spine and pain procedures cover a far broader spectrum than those for regional anesthesia, reflecting diverse targets and goals. When surveyed, interventional pain and spine physicians attending the American Society of Regional Anesthesia and Pain Medicine (ASRA) 11th Annual Pain Medicine Meeting exhorted that existing ASRA guidelines for regional anesthesia in patients on antiplatelet and anticoagulant medications were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors necessitated separate guidelines for pain and spine procedures. In response, ASRA formed a guidelines committee. After preliminary review of published complication reports and studies, committee members stratified interventional spine and pain procedures according to potential bleeding risk as low-, intermediate-, and high-risk procedures. The ASRA guidelines were deemed largely appropriate for the low- and intermediate-risk categories, but it was agreed that the high-risk targets required an intensive look at issues specific to patient safety and optimal outcomes in pain medicine. The latest evidence was sought through extensive database search strategies and the recommendations were evidence-based when available and pharmacology-driven otherwise. We could not provide strength and grading of these recommendations as there are not enough well-designed large studies concerning interventional pain procedures to support such grading. Although the guidelines could not always be based on randomized studies or on large numbers of patients from pooled databases, it is hoped that they will provide sound recommendations and the evidentiary basis for such recommendations.

Pain in Bali.

Science.gov (United States)

Rajagopal, M R; Ito, Kurnia

2015-01-01

There is a lot of unrelieved pain in developing countries. Here is a story from Bali, Indonesia, about a woman with advanced malignancy, who is in unbelievable agony. Expensive chemotherapy is available to her. But although the necessary medications for relieving her pain are available in hospitals, they do not reach the patient, in her home, or even when she is admitted to the hospital, because of ignorance of the medical profession about pain management and because of unnecessary regulatory restrictions. The woman's pain affects the whole family, endangering the family's income and the future of her children. The intervention of palliative care during part of her life gives her some relief, only for the agony to be repeated by pointless chemotherapy and neglect of the suffering during admission to the hospital. Whatever relief could be given to her was because of the intervention of a volunteer with no schooling in medicine or palliative care.

Medical history and the onset of complex regional pain syndrome (CRPS).

Science.gov (United States)

de Mos, M; Huygen, F J P M; Dieleman, J P; Koopman, J S H A; Stricker, B H Ch; Sturkenboom, M C J M

2008-10-15

Knowledge concerning the medical history prior to the onset of complex regional pain syndrome (CRPS) might provide insight into its risk factors and potential underlying disease mechanisms. To evaluate prior to CRPS medical conditions, a case-control study was conducted in the Integrated Primary Care Information (IPCI) project, a general practice (GP) database in the Netherlands. CRPS patients were identified from the records and validated through examination by the investigator (IASP criteria) or through specialist confirmation. Cases were matched to controls on age, gender and injury type. All diagnoses prior to the index date were assessed by manual review of the medical records. Some pre-specified medical conditions were studied for their association with CRPS, whereas all other diagnoses, grouped by pathogenesis, were tested in a hypothesis-generating approach. Of the identified 259 CRPS patients, 186 cases (697 controls) were included, based on validation by the investigator during a visit (102 of 134 visited patients) or on specialist confirmation (84 of 125 unvisited patients). A medical history of migraine (OR: 2.43, 95% CI: 1.18-5.02) and osteoporosis (OR: 2.44, 95% CI: 1.17-5.14) was associated with CRPS. In a recent history (1-year before CRPS), cases had more menstrual cycle-related problems (OR: 2.60, 95% CI: 1.16-5.83) and neuropathies (OR: 5.7; 95% CI: 1.8-18.7). In a sensitivity analysis, including only visited cases, asthma (OR: 3.0; 95% CI: 1.3-6.9) and CRPS were related. Psychological factors were not associated with CRPS onset. Because of the hypothesis-generating character of this study, the findings should be confirmed by other studies.

Risky business: Behaviors associated with indoor tanning in US high school students.

Science.gov (United States)

Chapman, Stephanie; Ashack, Kurt; Bell, Eric; Sendelweck, Myra Ann; Dellavalle, Robert

2017-09-15

Understanding of associations between indoor tanning and risky health related behaviors such as sexual activity and substance abuse among high school students across the United States is incomplete. To identify risky health related behaviors among high school students utilizing indoor tanning and analyze differences between state specific data. Results from the Youth Risk Behavior Surveillance System (YRBSS) 2013 in 14 different states were analyzed. Participants were 90,414 high school students. Responses to questions assessing indoor tanning habits, sexual activity, and use of substances were analyzed. Sexual activity was associated with indoor tanning in 10 of 14 states, with Nebraska having the strongest association (adjusted odds ratio, 3.8; 95% CI, 2.4-6.2; p<0.001). Indoor tanning was also associated with use of alcohol, marijuana, ecstasy, cocaine, prescription medications, and cigarettes. Only 15 states asked students about their personal history of indoor tanning use, and Minnesota was excluded from our analysis as they administered a non-YRBS questionnaire. Additionally, our study only analyzed results from the 2013 YRBS. Lastly, our data was analyzed in 14 individual data sets, giving a high likelihood of Type 1 error. High school students utilizing indoor tanning are more likely to engage in sexual activity and substance abuse as compared to students who do not utilize indoor tanning.

Risky business: is pubic hair removal by women associated with body image and sexual health?

Science.gov (United States)

Grossman, Stephanie L; Annunziato, Rachel A

2018-04-30

Background: Body hair removal is a behaviour that has become normative among women in Westernised cultures, and is presented by the media as the feminine ideal, despite being painful and a potential cause of infection. Of concern, removal may be part of a more global pattern of appearance dissatisfaction and risky sexual behaviour. The aim of the present study was to examine the relationships among pubic hair removal, body image and sexual health indicators. Methods: Women (n=264; Mage=33.82, s.d.=11.13, range=18-66) completed self-report questionnaires assessing these constructs, including an assessment of body hair removal practices. Results: Greater appearance concerns (as measured by thin-ideal internalisation, appearance investment and self-objectification) and sexual health indicators (i.e. less condom use self-efficacy when a partner disapproves of condom use) all predicted greater importance of reasons for pubic hair removal (R2=0.315, F(8184)=9.97, Pwomen who removed a greater amount of hair reported more thin-ideal internalisation and appearance investment than those who removed less hair. Conclusions: Women who express stronger reasoning for pubic hair removal, and remove a larger amount of it, may endorse problematic beliefs and behaviours particularly related to appearance concerns. It is important for practitioners to consider this practice as distinct from grooming and to be aware of its association with a broader array of risky beliefs and behaviours that can compromise women's well-being.

Effectiveness of Biomodulator in treating chronic pain and reducing medications pain and reducing medications

Science.gov (United States)

2017-01-12

care Nursing Competencies and Practice: Patient outcomes Quality and safety Translate research into practice/evidence-based practice...Preparing tomorrow’s leaders Care of the caregiver Other: Army Nurse Corps High Priority Research Topic: Evaluation of CAM for Pain and Well-Being... care + PEMF participants that cannot be fully explained; and it is in contrast to small, clinically insignificant decreases in reported depression

The role of peer, parent, and culture in risky sexual behavior for Cambodian and Lao/Mien adolescents.

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Le, Thao N; Kato, Tomoko

2006-03-01

The purpose of this study was to investigate the role of age, gender, peer, family, and culture in adolescent risky sexual behavior for Cambodian and Laotian (Lao)/Mien youth. We obtained cross-sectional, in-home interview data including measures of individualism, collectivism, acculturation, risky sexual behavior, peer delinquency, parent engagement, and parent discipline from a sample of mostly second-generation Cambodian (n = 112) and Lao/Mien (n = 67) adolescents. Data were analyzed using step-wise, hierarchical multiple regressions. Peer delinquency and age (older) were significant predictors of risky sexual behavior in both groups. Parent discipline also significantly predicted risky sexual behavior, but only for Lao/Mien adolescents. Vertical and horizontal individualism were associated positively with risky sexual behavior for Cambodian youth whereas collectivism (horizontal) was associated negatively with risky sexual behavior for Lao/Mien youth. Acculturation was nonsignificant in both groups. In addition to age, parents, and peer groups, the findings suggest that culture also matters in risky sexual behavior, particularly for Cambodian and Laotian youth.

Postoperative pain medication requirements in patients undergoing computer-assisted (“Robotic”) and standard laparoscopic procedures for newly diagnosed endometrial cancer.

Science.gov (United States)

Leitao, Mario M; Malhotra, Vivek; Briscoe, Gabriel; Suidan, Rudy; Dholakiya, Priyal; Santos, Kevin; Jewell, Elizabeth L; Brown, Carol L; Sonoda, Yukio; Abu-Rustum, Nadeem R; Barakat, Richard R; Gardner, Ginger J

2013-10-01

Laparoscopy (LSC) offers superior patient outcomes compared to laparotomy. Small retrospective/prospective series have suggested robotics offers further reduction in postoperative pain and pain medication use compared to standard LSC. Our objective was to compare postoperative pain in patients undergoing robotically assisted (RBT) versus standard LSC for newly diagnosed endometrial cancer. All preoperative endometrial cancer cases scheduled for RBT and LSC from May 1, 2007 to June 9, 2010 were identified. For this analysis, we only included cases not requiring conversion to laparotomy. All patients were offered intravenous (IV) patient-controlled analgesia (PCA) postoperatively. Intraoperative equivalent fentanyl doses (IEFDs) and pain scores in the postanesthesia care unit (PACU) were assessed. IV PCA was used in 206 RBTs (86 %) and 208 LSCs (88 %). Median IEFD was 425 μg for LSCs and 500 μg for RBTs (P = 0.03). Median pain scores on PACU arrival were similar in both groups. Median highest pain score was 5 for LSCs and 4 for RBTs (P = 0.007). Linear regression demonstrated that the IEFD was not correlated with the highest pain score (R = 0.09; P = 0.07). Fentanyl was used postoperatively in 196 of 206 RBTs (95 %) and 187 of 208 LSCs (90 %). The total fentanyl doses were 242.5 (range 0-2705) μg and 380 (range 0-2625) μg, respectively (P multiple regression analysis further demonstrated RBT was independently associated with a lower total fentanyl dose compared to LSC (P = 0.02). RBT is independently associated with significantly lower postoperative pain and pain medication requirements compared to LSC. The amount of intraoperative fentanyl analgesia does not appear to correlate with postoperative pain.Endometrial cancer is the most common gynecologic malignancy in the United States, with an estimated 47,130 new cases in 2012.1 An estimated 287,100 women were diagnosed with endometrial cancer worldwide in 2008.2 Surgery is the primary treatment of choice for the

From Racial Discrimination to Risky Sex: Prospective Relations Involving Peers and Parents

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Roberts, Megan E.; Gibbons, Frederick X.; Gerrard, Meg; Weng, Chih-Yuan; Murry, Velma M.; Simons, Leslie G.; Simons, Ronald L.; Lorenz, Frederick O.

2012-01-01

This study investigated how early experience with racial discrimination affected the subsequent risky sexual behaviors of a diverse sample of African American youths (N = 745). The analyses focused on 3 risk-promoting factors thought to mediate the hypothesized discrimination--risky sex relation: negative affect, affiliation with deviant peers,…

HIV/AIDS, poverty and risky sexual behaviour in South Africa | le R ...

African Journals Online (AJOL)

This paper employs data from the 1998 South African Demographic and Health Survey in exploring the nature of socio-economic inequalities in and determinants of risky sexual behaviour. Risky sexual behaviour was associated with poverty only in the case of multiple partnerships. Affluent women that have engaged in ...

Risky Business: Dealing with Your Teen's Behavior

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... Issues Subscribe September 2011 Print this issue Risky Business Dealing With Your Teen’s Behavior Send us your ... go it alone. You can find helpful resources online and in community and school programs (See our ...

Pain scales and the opioid crisis

Directory of Open Access Journals (Sweden)

Robbins RA

2017-03-01

Full Text Available No abstract available. Article truncated after 150 words. In the last year, physicians and nurses have increasingly voiced their dissatisfaction with pain as the fifth vital sign. In June 2016, the American Medical Association recommended that pain scales be removed in professional medical standards (1. In September 2016, the American Academy of Family Physicians did the same (2. A recent Medscape survey reported that over half of surveyed doctors and nurses supported removal of pain assessment as a routine vital sign (3. In the 1990’s there was a widespread impression that pain was undertreated. Whether this was true or an impression created by a few practitioners and undertreated patients is unclear. Nevertheless, the prevailing thought became that identifying and quantifying pain would lead to more appropriate pain therapy. The American Society of Anesthesiologists and the American Pain Society issued practice guidelines for pain management (4,5. Subsequently, both the Department of Veterans Affairs and the Joint Commission on the …

HIV-related social intolerance and risky sexual behavior in a high HIV prevalence environment.

Science.gov (United States)

Delavande, Adeline; Sampaio, Mafalda; Sood, Neeraj

2014-06-01

Although most countries state that fighting social intolerance against persons with HIV is part of their national HIV strategy, the impact of reducing intolerance on risky sexual behavior is largely unknown. In this paper, we estimate the effect of social intolerance against HIV+ persons on risky sexual behavior in rural Malawi using data from roughly 2000 respondents from the 2004 and 2006 waves of the Malawi Longitudinal Study of Families and Health (MLSFH). The effect of social intolerance on risky behavior is a priori ambiguous. On the one hand, higher social intolerance or stigma can lead people to disassociate from the stigmatized group and hence promote risky behavior. On the other hand, intolerance can be viewed as a social tax on being HIV+ and thus higher intolerance may reduce risky behavior. We find that a decrease in social intolerance is associated with a decrease in risky behavior, including fewer partners and a lower likelihood of having extra-marital relations. This effect is mainly driven by the impact of social intolerance on men. Overall the results suggests that reducing social intolerance might not only benefit the HIV positive but might also forestall the spread of HIV. Copyright © 2014 Elsevier Ltd. All rights reserved.

Strong interactions between learned helplessness and risky decision-making in a rat gambling model.

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Nobrega, José N; Hedayatmofidi, Parisa S; Lobo, Daniela S

2016-11-18

Risky decision-making is characteristic of depression and of addictive disorders, including pathological gambling. However it is not clear whether a propensity to risky choices predisposes to depressive symptoms or whether the converse is the case. Here we tested the hypothesis that rats showing risky decision-making in a rat gambling task (rGT) would be more prone to depressive-like behaviour in the learned helplessness (LH) model. Results showed that baseline rGT choice behaviour did not predict escape deficits in the LH protocol. In contrast, exposure to the LH protocol resulted in a significant increase in risky rGT choices on retest. Unexpectedly, control rats subjected only to escapable stress in the LH protocol showed a subsequent decrease in riskier rGT choices. Further analyses indicated that the LH protocol affected primarily rats with high baseline levels of risky choices and that among these it had opposite effects in rats exposed to LH-inducing stress compared to rats exposed only to the escape trials. Together these findings suggest that while baseline risky decision making may not predict LH behaviour it interacts strongly with LH conditions in modulating subsequent decision-making behaviour. The suggested possibility that stress controllability may be a key factor should be further investigated.

Documentation of pain care processes does not accurately reflect pain management delivered in primary care.

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Krebs, Erin E; Bair, Matthew J; Carey, Timothy S; Weinberger, Morris

2010-03-01

Researchers and quality improvement advocates sometimes use review of chart-documented pain care processes to assess the quality of pain management. Studies have found that primary care providers frequently fail to document pain assessment and management. To assess documentation of pain care processes in an academic primary care clinic and evaluate the validity of this documentation as a measure of pain care delivered. Prospective observational study. 237 adult patients at a university-affiliated internal medicine clinic who reported any pain in the last week. Immediately after a visit, we asked patients to report the pain treatment they received. Patients completed the Brief Pain Inventory (BPI) to assess pain severity at baseline and 1 month later. We extracted documentation of pain care processes from the medical record and used kappa statistics to assess agreement between documentation and patient report of pain treatment. Using multivariable linear regression, we modeled whether documented or patient-reported pain care predicted change in pain at 1 month. Participants' mean age was 53.7 years, 66% were female, and 74% had chronic pain. Physicians documented pain assessment for 83% of visits. Patients reported receiving pain treatment more often (67%) than was documented by physicians (54%). Agreement between documentation and patient report was moderate for receiving a new pain medication (k = 0.50) and slight for receiving pain management advice (k = 0.13). In multivariable models, documentation of new pain treatment was not associated with change in pain (p = 0.134). In contrast, patient-reported receipt of new pain treatment predicted pain improvement (p = 0.005). Chart documentation underestimated pain care delivered, compared with patient report. Documented pain care processes had no relationship with pain outcomes at 1 month, but patient report of receiving care predicted clinically significant improvement. Chart review measures may not accurately

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

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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.

Risky behavior in gambling tasks in individuals with ADHD--a systematic literature review.

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Yvonne Groen

Full Text Available OBJECTIVE: The aim of this review was to gain insight into the relationship between Attention deficit hyperactivity disorder (ADHD and risky performance in gambling tasks and to identify any potential alternate explanatory factors. METHODS: PsycINFO, PubMed, and Web of Knowledge were searched for relevant literature comparing individuals with ADHD to normal controls (NCs in relation to their risky performance on a gambling task. In total, fourteen studies in children/adolescents and eleven studies in adults were included in the review. RESULTS: Half of the studies looking at children/adolescents with ADHD found evidence that they run more risks on gambling tasks when compared to NCs. Only a minority of the studies on adults with ADHD reported aberrant risky behavior. The effect sizes ranged from small to large for both age groups and the outcome pattern did not differ between studies that applied an implicit or explicit gambling task. Two studies demonstrated that comorbid oppositional defiant disorder (ODD and conduct disorder (CD increased risky behavior in ADHD. Limited and/or inconsistent evidence was found that comorbid internalizing disorders (IDs, ADHD subtype, methylphenidate use, and different forms of reward influenced the outcomes. CONCLUSION: The evidence for increased risky performance of individuals with ADHD on gambling tasks is mixed, but is stronger for children/adolescents with ADHD than for adults with ADHD, which may point to developmental changes in reward and/or penalty sensitivity or a publication bias for positive findings in children/adolescents. The literature suggests that comorbid ODD/CD is a risk factor in ADHD for increased risky behavior. Comorbid IDs, ADHD subtype, methylphenidate use, and the form of reward received may affect risky performance in gambling tasks; however, these factors need further examination. Finally, the implications of the findings for ADHD models and the ecological validity of gambling tasks

Economic booms and risky sexual behavior: evidence from Zambian copper mining cities.

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Wilson, Nicholas

2012-12-01

Existing studies suggest that individual and household level economic shocks affect the demand for and supply of risky sex. However, little evidence exists on the effects of an aggregate shock on equilibrium risky sexual behavior. This paper examines the effects of the early twenty-first century copper boom on risky sexual behavior in Zambian copper mining cities. The results suggest that the copper boom substantially reduced rates of transactional sex and multiple partnerships in copper mining cities. These effects were partly concentrated among young adults and copper boom induced in-migration to mining cities appears to have contributed to these reductions. Copyright © 2012. Published by Elsevier B.V.

Your resting brain CAREs about your risky behavior.

Directory of Open Access Journals (Sweden)

Christine L Cox

2010-08-01

Full Text Available Research on the neural correlates of risk-related behaviors and personality traits has provided insight into mechanisms underlying both normal and pathological decision-making. Task-based neuroimaging studies implicate a distributed network of brain regions in risky decision-making. What remains to be understood are the interactions between these regions and their relation to individual differences in personality variables associated with real-world risk-taking.We employed resting state functional magnetic resonance imaging (R-fMRI and resting state functional connectivity (RSFC methods to investigate differences in the brain's intrinsic functional architecture associated with beliefs about the consequences of risky behavior. We obtained an individual measure of expected benefit from engaging in risky behavior, indicating a risk seeking or risk-averse personality, for each of 21 participants from whom we also collected a series of R-fMRI scans. The expected benefit scores were entered in statistical models assessing the RSFC of brain regions consistently implicated in both the evaluation of risk and reward, and cognitive control (i.e., orbitofrontal cortex, nucleus accumbens, lateral prefrontal cortex, dorsal anterior cingulate. We specifically focused on significant brain-behavior relationships that were stable across R-fMRI scans collected one year apart. Two stable expected benefit-RSFC relationships were observed: decreased expected benefit (increased risk-aversion was associated with 1 stronger positive functional connectivity between right inferior frontal gyrus (IFG and right insula, and 2 weaker negative functional connectivity between left nucleus accumbens and right parieto-occipital cortex.Task-based activation in the IFG and insula has been associated with risk-aversion, while activation in the nucleus accumbens and parietal cortex has been associated with both risk seeking and risk-averse tendencies. Our results suggest that

Exploring adolescents' perceptions of risky behaviour using the mobile phone / N. Gois De Gouveia.

OpenAIRE

De Gouveia, Natalie Gois

2013-01-01

The aim of this study was to examine adolescent perceptions of risky behaviour using a mobile phone. This research may contribute to creating an awareness of risky and healthy adolescent uses of mobile phones. Anonymous sketches were collected from Grade 10 learners depicting their understanding of risky behaviour using the mobile phone. Thereafter, 12 learners agreed, through informed consent, to participate in semi-structured interviews. All participants considered the mobile phone an i...

Low pain intensity after opioid withdrawal as a first step of a comprehensive pain rehabilitation program predicts long-term nonuse of opioids in chronic noncancer pain.

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Krumova, Elena K; Bennemann, Philipp; Kindler, Doris; Schwarzer, Andreas; Zenz, Michael; Maier, Christoph

2013-09-01

In specialized pain clinics there is an increasing number of patients with severe chronic noncancer pain (CNCP) despite long-term opioid medication. Few clinical studies show short-term pain relief after opioid withdrawal (OW). We have evaluated the relation between pain intensity after OW and long-term opioid nonuse. One hundred two consecutive patients with severe CNCP despite opioid medication (mean treatment duration, 43 mo) reported pain intensity (numerical rating scale, 0 to 10), Pain Disability Index, mood (CES-D), and quality of life (Short Form 36) before, shortly, and 12 to 24 months after inpatient OW. Total opioid withdrawal (n = 78) or significant dose reduction (DR; n = 24, mean reduction, 82%) was performed after individual decision. Opioid intake 12 to 24 months later, respectively dose increase ≥ 100% (DR group), was considered relapse. T tests, multivariable analysis of variance, logistic regression. After OW current pain intensity significantly decreased on an average by 41% (6.4 ± 2.4 vs. 3.8 ± 2.5), maximal and average pain by 18% and 24%, respectively. Twelve to 24 months later 42 patients (41%) relapsed (31 of the total opioid withdrawal group, 6 of the DR group, 5 lost). Patients without later relapse showed significantly lower pain scores than the later relapsed patients already shortly after OW (5.0 ± 2.2 vs. 5.9 ± 2.1) and 12 to 24 months later (5.5 ± 2.4 vs. 6.5 ± 2.0). There was a significant relation between relapse probability and pain intensity immediately after OW. In many patients with severe CNCP, despite opioid medication, sustainable pain relief can be achieved if OW is included in the rehabilitation program. Consequently, we recommend OW for opioid-resistant CNCP before any opioid escalation. Lower pain intensity shortly after OW may predict the long-term opioid nonuse probability.

Child Abuse, Early Maladaptive Schemas, and Risky Sexual Behavior in College Women

Science.gov (United States)

Roemmele, Melissa; Messman-Moore, Terri L.

2011-01-01

Previous research suggests that individuals abused as children are more likely to engage in risky sexual behavior during adulthood. The present study examined early maladaptive schemas as mediators of the child abuse-risky sexual behavior relationship among 653 college women. Self-report surveys assessed three forms of child abuse: Sexual,…

Do we need to change the medical curriculum: regarding the pain of others

Directory of Open Access Journals (Sweden)

Sundeep Mishra

2015-05-01

Full Text Available The current curriculum is behind its time and urgently requires to be reformed. The changes required are not only in the amount and type of desired information but also in the way this knowledge is acquired. Further, literature, art and philosophy require to be integrated in the curriculum so that a medical student can find his/her bearings in the society. Finally, but most importantly focus must be on developing empathy so that a prospective physician can correlate with the pain of patients and act towards relieving it rather than intellectualizing it.

Virtually 'in the heat of the moment': insula activation in safe sex negotiation among risky men.

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Smith, Benjamin J; Xue, Feng; Droutman, Vita; Barkley-Levenson, Emily; Melrose, A James; Miller, Lynn C; Monterosso, John R; Bechara, Antoine; Appleby, Paul R; Christensen, John L; Godoy, Carlos G; Read, Stephen J

2018-01-01

HIV is most prevalent among men who have sex with men (MSM), and although most MSM use condoms consistently during casual sex, some take risks. To better understand the psychology of those risky decisions, we examined neural correlates of playing a virtual sexual 'hook up' game in an functional magnetic resonance imaging scanner in MSM who had, in the past 90 days, been sexually risky (N = 76) or safe (N = 31). We found that during potentially risky sexual choices, previously risky MSM had more right insula activity than previously safe MSM. Real-life sexual risk was related to trait positive and negative urgency. Insula activity that differentiated risky and safe MSM was related to trait positive and negative urgency. Future work should further examine if, and to what extent, insula activation during safe sex negotiation drives MSM's rash risky sexual decision-making. © The Author (2017). Published by Oxford University Press.

Pain grade and sleep disturbance in older adults: evaluation the role of pain, and stress for depressed and non-depressed individuals.

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Eslami, Vahid; Zimmerman, Molly E; Grewal, Trishdeep; Katz, Mindy; Lipton, Richard B

2016-05-01

The aim of this paper was to assess the relationship between pain and sleep in older adults taking depression, stress, and medical comorbidities into account. A cross-sectional analysis was performed using Einstein Aging Study, a community-based cohort study of adults aged 70 years and older. Ratings of pain intensity and interference from the Medical Outcomes Study (MOS) Short-Form 36 were used to assign individuals to low-pain versus high-pain severity. Sleep disturbance was assessed using the nine-item sleep problems index from the Medical Outcomes Study Sleep Scale. Other measures included the Geriatric Depression Scale and Perceived Stress Scale (PSS). Linear regression models were used to assess the association between pain grade and sleep disturbance adjusted for demographics, PSS, Geriatric Depression Scale, and other comorbidities. Five hundred sixty-two eligible participants with a mean age of 78.22 years (standard deviation = 5.43) were included; 64% were women. Pain grade [β = 5.40, 95% confidence interval (CI) 2.56-8.21, p pain grade (β = 3.08, 95% CI 0.32-5.85, p = 0.03) and PSS (β = 0.57, 95% CI 0.39-0.75, p pain and sleep by 34%. Depression, when added to previous model, was also associated with sleep (β = 2.17, 95% CI 1.48-2.85, p pain (β = 2.41, 95% CI -0.25 to 5.08, p = 0.07) and sleep by 22%. Stratified for depression, we found that pain, stress, and other medical comorbidities were significantly associated with sleep disturbance in non-depressed individuals but not individuals with depression. Pain, stress, and medical comorbidities are associated with sleep disturbance, especially in non-depressed older adults. Copyright © 2015 John Wiley & Sons, Ltd.

Preclinical Assessment of a Strategy to Minimize the Abuse Liability of Opiate Medications for Pain

Science.gov (United States)

2016-09-01

plans (3). In fact, Bray and colleagues found that pain medication is the most highly abused of all prescribed drugs in the military (4). Prescription...the drug gamma-vinyl GABA (GVG) prior to morphine treatment effectively eliminates the highly addictive nature of this opiate . In these studies, we...widespread risk of opiate addiction in this population. Preclinical imaging studies aim to build a foundation for effective clinical drug development, and the

The influence of children's pain memories on subsequent pain experience.

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Noel, Melanie; Chambers, Christine T; McGrath, Patrick J; Klein, Raymond M; Stewart, Sherry H

2012-08-01

Healthy children are often required to repeatedly undergo painful medical procedures (eg, immunizations). Although memory is often implicated in children's reactions to future pain, there is a dearth of research directly examining the relationship between the 2. The current study investigated the influence of children's memories for a novel pain stimulus on their subsequent pain experience. One hundred ten healthy children (60 boys) between the ages of 8 and 12 years completed a laboratory pain task and provided pain ratings. Two weeks later, children provided pain ratings based on their memories as well as their expectancies about future pain. One month following the initial laboratory visit, children again completed the pain task and provided pain ratings. Results showed that children's memory of pain intensity was a better predictor of subsequent pain reporting than their actual initial reporting of pain intensity, and mediated the relationship between initial and subsequent pain reporting. Children who had negatively estimated pain memories developed expectations of greater pain prior to a subsequent pain experience and showed greater increases in pain ratings over time than children who had accurate or positively estimated pain memories. These findings highlight the influence of pain memories on healthy children's expectations of future pain and subsequent pain experiences and extend predictive models of subsequent pain reporting. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Predictors of Risky Behavior and Offending for Adolescents with Mild Intellectual Disability

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Savage, Melissa N.; Bouck, Emily C.

2017-01-01

Adolescents with intellectual disability (ID) engage in risky behavior and offending. However, little is known on the impact school-related predictors have on engagement in risky behaviors for adolescents with ID. This study analyzed secondary data from the National Longitudinal Transition Study-2 (NLTS2) to determine levels of engagement in risky…

New Paradoxes of Risky Decision Making

Science.gov (United States)

Birnbaum, Michael H.

2008-01-01

During the last 25 years, prospect theory and its successor, cumulative prospect theory, replaced expected utility as the dominant descriptive theories of risky decision making. Although these models account for the original Allais paradoxes, 11 new paradoxes show where prospect theories lead to self-contradiction or systematic false predictions.…

Risky choice and brain CRF after adolescent ethanol vapor exposure and social stress in adulthood.

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Boutros, Nathalie; Der-Avakian, Andre; Semenova, Svetlana; Lee, Soon; Markou, Athina

2016-09-15

Adolescent ethanol exposure increases risky choice and alters corticotropin releasing factor (CRF) systems in adulthood. The impact of stress on risky choice after adolescent intermittent ethanol (AIE) exposure is not known. We investigated time-specific effects of AIE vapor exposure during early adolescence on risky choice after stress or no stress in adulthood. Male Wistar rats were exposed to air or AIE vapor on postnatal days 28-42 (adolescence) and were exposed to 10days of social defeat or no stress on postnatal days 172-181 (adulthood). Risky choice was assessed in the probability discounting task under baseline conditions and after days 1 and 10 of social defeat. CRF and CRF receptor 1 (CRFR1) mRNA levels were assessed in the prefrontal cortex (PFC) and the central nucleus of the amygdala (CeA) 24h post-stress to evaluate persistent effects of stress on the brain. AIE exposure had no effect on risky choice either at baseline or after social defeat. Additionally, neither acute nor chronic social defeat affected risky choice in air-exposed rats. In the PFC, chronic social defeat selectively decreased CRF mRNA levels in air-exposed rats and increased CRFR1 mRNA levels in all rats. AIE exposure increased CRF mRNA levels in the CeA with no effect of social stress. Our results indicate no effect of ethanol exposure via vapor during early adolescence on risky choice, while our previous findings indicated that AIE exposure via gavage affected risky choice. Both AIE exposure and social defeat altered CRF and CRFR1 mRNA levels in the brain. Copyright © 2016 Elsevier B.V. All rights reserved.

Comparative legal aspects of pain management.

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Vansweevelt, T

2008-12-01

Administering pain medication to terminal patients can cause legal problems when it has a life-shortening effect, because according to some authors it equates with manslaughter. The legal basis of the acceptance of pain alleviation with life-shortening effect can be found on the grounds of necessity. In different countries physicians have been prosecuted because of their pain management, which to the public prosecutor was in fact a sort of euthanasia. On the other hand, it is not unknown that physicians administer opioids to mask euthanasia. Pain management needs some rules, which can reassure the physician who alleviates pain. The physician who alleviates pain with life-shortening effect will have to act with due care to avoid a liability risk. This implies at least an informed consent, to observe the proportionality rule, and to keep a medical record.

Paracervical block as pain treatment during second-trimester medical termination of pregnancy: an RCT with bupivacaine versus sodium chloride.

Science.gov (United States)

Andersson, I-M; Benson, L; Christensson, K; Gemzell-Danielsson, K

2016-01-01

Can paracervical block (PCB) administered before the onset of pain decrease women's pain experience during second-trimester medical termination of pregnancy (MToP)? There were no clinically significant differences between groups receiving PCB with bupivacaine or saline with regard to the highest and lowest pain intensity, morphine consumption or induction-to abortion interval. The most common side effect of misoprostol is pain; nevertheless, there are sparse studies in pain and pain treatment during MToP, especially in second-trimester abortion. Pain reported in second-trimester medical abortion is often intense, and peaks when the fetal expulsion occurs. A double-blinded RCT was carried out from May 2012 until April 2015. A power calculation was based on a previous pilot study showing that the proportion of women with severe pain [visual analogue scale (VAS) ≥7] was 63%. A clinically significant reduction was considered to yield 35% with severe pain, and with a power of 80% and significance level of 5% (two-sided) 112 women were needed. Accounting for a 20% drop-out rate, a total of 140 women were needed. The primary outcome, pain intensity measured as any VAS ≥7, was analysed using a generalized estimating equations model. The level of significance was set to P sodium chloride 1 h after the first dose of misoprostol. The full analysis set (FAS) population was defined as all randomized women that had at least one value for any of the outcomes (n = 102). The per-protocol (PP) population was defined as a subset of the FAS excluding patients with major protocol deviations or without a value for the primary outcome (n = 99). Pain was measured by VAS at misoprostol initiation (baseline) and repeated every 30 min until fetal expulsion. The primary outcome was the highest VAS pain intensity at any time point. The highest pain intensity, did not show any differences at a cut-off of VAS ≥7 [risk ratio (RR): 1.1; 95% confidence interval (CI): 0.9-1.5; P = 0.0.292]. In

Prognostic Factor Analysis for Management of Chronic Neck Pain: Can We Predict the Severity of Neck Pain with Lateral Cervical Curvature?

Science.gov (United States)

Seong, Han Yu; Lee, Moon Kyu; Jeon, Sang Ryong; Roh, Sung Woo; Rhim, Seung Chul; Park, Jin Hoon

2017-07-01

Although little is known about its origins, neck pain may be related to several associated anatomical pathologies. We aimed to characterize the incidence and features of chronic neck pain and analyze the relationship between neck pain severity and its affecting factors. Between March 2012 and July 2013, we studied 216 patients with chronic neck pain. Initially, combined tramadol (37.5 mg) plus acetaminophen (325 mg) was administered orally twice daily (b.i.d.) to all patients over a 2-week period. After two weeks, patients were evaluated for neck pain during an outpatient clinic visit. If the numeric rating scale of the patient had not decreased to 5 or lower, a cervical medial branch block (MBB) was recommended after double-dosed previous medication trial. We classified all patients into two groups (mild vs. severe neck pain group), based on medication efficacy. Logistic regression tests were used to evaluate the factors associated with neck pain severity. A total of 198 patients were included in the analyses, due to follow-up loss in 18 patients. While medication was successful in reducing pain in 68.2% patients with chronic neck pain, the remaining patients required cervical MBB. Lateral cervical curvature, such as a straight or sigmoid type curve, was found to be significantly associated with the severity of neck pain. We managed chronic neck pain with a simple pharmacological management protocol followed by MBB. We should keep in mind that it may be difficult to manage the patient with straight or sigmoid lateral curvature only with oral medication.

Risky dieting amongst adolescent girls: Associations with family relationship problems and depressed mood.

Science.gov (United States)

Hinchliff, Gemma L M; Kelly, Adrian B; Chan, Gary C K; Patton, George C; Williams, Joanne

2016-08-01

This study examined the association of risky dieting amongst adolescent girls with depressed mood, family conflict, and parent-child emotional closeness. Grade 6 and 8 females (aged 11-14years, N=4031) were recruited from 231 schools in 30 communities, across three Australian States (Queensland, Victoria, and Western Australia). Key measures were based on the Adolescent Dieting Scale, Short Mood and Feelings Questionnaire, and widely used short measures of family relationship quality. Controls included age, early pubertal onset, and socioeconomic status. Risky dieting was significantly related to family conflict and depressed mood, depressed mood mediated the association of family conflict and risky dieting, and these associations remained significant with controls in the model. Family conflict and adolescent depressed mood are associated with risky dieting. Prevention programs may benefit from a broadening of behavioural targets to include depressed mood and family problems. Copyright © 2016 Elsevier Ltd. All rights reserved.

Forward-Thinking Teens: The Effects of College Costs on Adolescent Risky Behavior

Science.gov (United States)

Cowan, Benjamin W.

2011-01-01

This paper analyzes the effect of college costs on teenagers' engagement in risky behaviors before they are old enough to attend college. Individuals with brighter prospects for future schooling attainment may engage in less drug and alcohol use and risky sexual activity because they have more to lose if such behaviors have harmful effects in…

[Prevalence of pain in Andalusian public hospitals].

Science.gov (United States)

Echevarria Moreno, M; Ortega Garcia, J L; Herrera Silva, J; Galvez Mateo, R; Torres Morera, L M; de la Torre Liebanas, R

2014-12-01

To determine the prevalence of pain in medical and surgical patients admitted to reference hospitals in Andalusia, as well as their features and the most population groups most affected. A cross-sectional, multicenter epidemiological study was conducted simultaneously on the population admitted to 5 hospitals. Using a structured questionnaire the demographics, hospital area, presence of pain at the time of the interview, and pre- and post-variables related to the intensity of pain and its treatment at 24h were investigated. All patients over 18 years old were included, except those patients with difficulty in understanding the questionnaire, and psychiatric and obstetric patients. Pain intensity was assessed by simple verbal scale. Of the 1,236 patients included, 54.2% were male, with 51.1% of patients aged 65 years, and 69.17% were admitted to medical areas. Pain was observed in 52.9% of patients admitted to the surgical area compared to 29.4% in the medical area. Of the 19.4% who reported having had pain in the last 24h prior to the questionnaire, 57.7% of them were surgical patients and 32% were medical, PDolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Valuation of risky and uncertain choices

NARCIS (Netherlands)

Tobler, P.N.; Weber, E.U.; Glimcher, P.W.; Fehr, E.

2013-01-01

In this chapter, we describe how risk and ambiguity impact the value of choice options, how this impact can be modelled formally and how it is implemented in the brain. In particular, we give an overview of two distinct ways of how risky choice options can be decomposed – either into outcomes and

Non-medical influences on medical decision-making.

Science.gov (United States)

McKinlay, J B; Potter, D A; Feldman, H A

1996-03-01

The influence of non-medical factors on physicians' decision-making has been documented in many observational studies, but rarely in an experimental setting capable of demonstrating cause and effect. We conducted a controlled factorial experiment to assess the influence of non-medical factors on the diagnostic and treatment decisions made by practitioners of internal medicine in two common medical situations. One hundred and ninety-two white male internists individually viewed professionally produced video scenarios in which the actor-patient, presenting with either chest pain or dyspnea, possessed various balanced combinations of sex, race, age, socioeconomic status, and health insurance coverage. Physician subjects were randomly drawn from lists of internists in private practice, hospital-based practice, and HMO's, at two levels of experience. The most frequent diagnoses for both chest pain and dyspnea were psychogenic origin and cardiac problems. Smoking cessation was the most frequent treatment recommendation for both conditions. Younger patients (all other factors being the same) were significantly more likely to receive the psychogenic diagnosis. Older patients were more likely to receive the cardiac diagnosis for chest pain, particularly if they were insured. HMO-based physicians were more likely to recommend a follow-up visit for chest pain. Several interactions of patient and physician factors were significant in addition to the main effects. The variability in decision-making evidenced by physicians in this experiment was not entirely accounted for by strictly rational Bayesian inference (the common prescriptive model for medical decision-making), in-as-much as non-medical factors significantly affected the decisions that they made. There is a need to supplement idealized medical schemata with considerations of social behavior in any comprehensive theory of medical decision-making.

Traditional, Cyber and Combined Bullying Roles: Differences in Risky Online and Offline Activities

Directory of Open Access Journals (Sweden)

Sebastian Wachs

2015-02-01

Full Text Available This study (1 reports frequency rates of mutually exclusive traditional, cyber and combined (both traditional and cyber bullying roles; and (2 investigates whether adolescents belonging to particular bullying roles show higher levels of involvement in risky online activities (Compulsive Internet Use (CIU, online grooming victimization, and sexting and risky offline activities (bad behavior in school, drinking alcohol and truancy than non-involved adolescents. The sample comprised self-reports of 1928 German, Dutch and Thai adolescents (Age = 12–18; M = 14.52; SD = 1.6. The results revealed age, sex and country differences in bullying frequency rates. CIU, sending of sexts and risky offline activities were most strongly associated with combined bully-victims. The receiving of sexts was most strongly associated with combined bullies; and online grooming victimization was most strongly related to cyber bully-victims. Another important finding is that the associations between risky offline activities and combined bullying are stronger than for traditional and cyber bullying. The findings contribute to better understanding of the associations between varying bullying roles and risky online and offline activities among adolescents. In sum, the results underscore the need to promote life skills rather than adopting more conventional approaches, which focus almost exclusively on reduction of risks.

Everything's better in moderation: young women's gender role attitudes and risky sexual behavior.

Science.gov (United States)

Leech, Tamara G J

2010-05-01

This study examines the association between gender role attitudes and risky sexual behavior among young women. Previous studies have posed seemingly contradictory arguments: that either traditional attitudes or egalitarian attitudes are associated with riskier behavior. Data are based on the children of the National Longitudinal Survey of Youth, representing 520 sexually active 18-19-year-old women. Propensity radius matching was used to assess differences in rates of multiple sexual partners and sex outside of a committed relationship. Relative to moderate gender role attitudes, both egalitarian gender role attitudes and traditional gender role attitudes are associated with higher rates of risky sexual behavior. Both women with egalitarian role attitudes and those with traditional role attitudes have about a 10% higher prevalence of risky behavior compared to women with more moderate gender role attitudes. Existing, seemingly contradictory contentions about the relationship between gender role attitudes and risky sexual behavior may be more coherent than they seem. By shifting focus from risk to protection, the results suggest that moderate gender role attitudes are protective against risky sexual behavior. Future studies should investigate the causal mechanisms and intervention implications of this protective relationship. Copyright 2010 Society for Adolescent Medicine. Published by Elsevier Inc. All rights reserved.

Imaging in mechanical back pain

DEFF Research Database (Denmark)

Hansen, Bjarke Brandt; Hansen, Philip; Carrino, John A

2016-01-01

Low back pain is common and relates to a variety of overlapping pathologies. Within the last few decades, almost every medical imaging modality has been applied in the evaluation of low back pain. Imaging of the spine has a high priority in the assessment of patients with low back pain, who seem ...

Pain

OpenAIRE

H.W. Snyman

1980-01-01

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

Mechanisms That Link Parenting Practices to Adolescents' Risky Sexual Behavior: A Test of Six Competing Theories.

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Simons, Leslie Gordon; Sutton, Tara E; Simons, Ronald L; Gibbons, Frederick X; Murry, Velma McBride

2016-02-01

Risky sexual behavior, particularly among adolescents, continues to be a major source of concern. In order to develop effective education and prevention programs, there is a need for research that identifies the antecedents of such behavior. This study investigated the mediators that link parenting experiences during early adolescence to subsequent risky sexual behaviors among a diverse sample of African American youth (N = 629, 55 % female). While there is ample evidence that parenting practices (e.g., supportive parenting, harsh parenting, parental management) are antecedent to risky sexual behavior, few studies have examined whether one approach to parenting is more strongly related to risky sex than others. Using a developmental approach, the current study focused on factors associated with six theories of risky sexual behavior. While past research has provided support for all of the theories, few studies have assessed the relative contribution of each while controlling for the processes proposed by the others. The current study addresses these gaps in the literature and reports results separately by gender. Longitudinal analyses using structural equation modeling revealed that the mediating mechanisms associated with social learning and attachment theories were significantly related to the risky sexual behavior of males and females. Additionally, there was support for social control and self-control theories only for females and for life history theory only for males. We did not find support for problem behavior theory, a perspective that dominates the risky sex literature, after controlling for the factors associated with the other theories. Finally, supportive parenting emerged as the parenting behavior most influential with regard to adolescents' risky sexual behavior. These results provide insight regarding efficacious approaches to education and preventative programs designed to reduce risky sexual behaviors among adolescents.

Virtually ‘in the heat of the moment’: insula activation in safe sex negotiation among risky men

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Xue, Feng; Droutman, Vita; Barkley-Levenson, Emily; Melrose, A James; Miller, Lynn C; Monterosso, John R; Bechara, Antoine; Appleby, Paul R; Christensen, John L; Godoy, Carlos G; Read, Stephen J

2018-01-01

Abstract HIV is most prevalent among men who have sex with men (MSM), and although most MSM use condoms consistently during casual sex, some take risks. To better understand the psychology of those risky decisions, we examined neural correlates of playing a virtual sexual ‘hook up’ game in an functional magnetic resonance imaging scanner in MSM who had, in the past 90 days, been sexually risky (N = 76) or safe (N = 31). We found that during potentially risky sexual choices, previously risky MSM had more right insula activity than previously safe MSM. Real-life sexual risk was related to trait positive and negative urgency. Insula activity that differentiated risky and safe MSM was related to trait positive and negative urgency. Future work should further examine if, and to what extent, insula activation during safe sex negotiation drives MSM’s rash risky sexual decision-making. PMID:29149326

Pain medications - narcotics

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... other medical problems does not itself lead to dependence. Store narcotics safely and securely in your home. ... help with constipation, drink more fluids, get more exercise, eat foods with extra fiber, and use stool ...

Multiple Sources of Prescription Payment and Risky Opioid Therapy Among Veterans.

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Becker, William C; Fenton, Brenda T; Brandt, Cynthia A; Doyle, Erin L; Francis, Joseph; Goulet, Joseph L; Moore, Brent A; Torrise, Virginia; Kerns, Robert D; Kreiner, Peter W

2017-07-01

Opioid overdose and other related harms are a major source of morbidity and mortality among US Veterans, in part due to high-risk opioid prescribing. We sought to determine whether having multiple sources of payment for opioids-as a marker for out-of-system access-is associated with risky opioid therapy among veterans. Cross-sectional study examining the association between multiple sources of payment and risky opioid therapy among all individuals with Veterans Health Administration (VHA) payment for opioid analgesic prescriptions in Kentucky during fiscal year 2014-2015. Source of payment categories: (1) VHA only source of payment (sole source); (2) sources of payment were VHA and at least 1 cash payment [VHA+cash payment(s)] whether or not there was a third source of payment; and (3) at least one other noncash source: Medicare, Medicaid, or private insurance [VHA+noncash source(s)]. Our outcomes were 2 risky opioid therapies: combination opioid/benzodiazepine therapy and high-dose opioid therapy, defined as morphine equivalent daily dose ≥90 mg. Of the 14,795 individuals in the analytic sample, there were 81.9% in the sole source category, 6.6% in the VHA+cash payment(s) category, and 11.5% in the VHA+noncash source(s) category. In logistic regression, controlling for age and sex, persons with multiple payment sources had significantly higher odds of each risky opioid therapy, with those in the VHA+cash having significantly higher odds than those in the VHA+noncash source(s) group. Prescribers should examine the prescription monitoring program as multiple payment sources increase the odds of risky opioid therapy.

Neonatal pain management

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Tarun Bhalla

2014-01-01

Full Text Available The past 2-3 decades have seen dramatic changes in the approach to pain management in the neonate. These practices started with refuting previously held misconceptions regarding nociception in preterm infants. Although neonates were initially thought to have limited response to painful stimuli, it was demonstrated that the developmental immaturity of the central nervous system makes the neonate more likely to feel pain. It was further demonstrated that untreated pain can have long-lasting physiologic and neurodevelopmental consequences. These concerns have resulted in a significant emphasis on improving and optimizing the techniques of analgesia for neonates and infants. The following article will review techniques for pain assessment, prevention, and treatment in this population with a specific focus on acute pain related to medical and surgical conditions.

Balancing risk and reward: a rat model of risky decision making.

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Simon, Nicholas W; Gilbert, Ryan J; Mayse, Jeffrey D; Bizon, Jennifer L; Setlow, Barry

2009-09-01

We developed a behavioral task in rats to assess the influence of risk of punishment on decision making. Male Long-Evans rats were given choices between pressing a lever to obtain a small, 'safe' food reward and a large food reward associated with risk of punishment (footshock). Each test session consisted of 5 blocks of 10 choice trials, with punishment risk increasing with each consecutive block (0, 25, 50, 75, 100%). Preference for the large, 'risky' reward declined with both increased probability and increased magnitude of punishment, and reward choice was not affected by the level of satiation or the order of risk presentation. Performance in this risky decision-making task was correlated with the degree to which the rats discounted the value of probabilistic rewards, but not delayed rewards. Finally, the acute effects of different doses of amphetamine and cocaine on risky decision making were assessed. Systemic amphetamine administration caused a dose-dependent decrease in choice of the large risky reward (ie, it made rats more risk averse). Cocaine did not cause a shift in reward choice, but instead impaired the rats' sensitivity to changes in punishment risk. These results should prove useful for investigating neuropsychiatric disorders in which risk taking is a prominent feature, such as attention deficit/hyperactivity disorder and addiction.

Young novice drivers and the risky behaviours of parents and friends during the provisional (intermediate) licence phase: a brief report.

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Scott-Parker, Bridie; Watson, Barry; King, Mark J; Hyde, Melissa K

2014-08-01

While there is research indicating that many factors influence the young novice driver's increased risk of road crash injury during the earliest stages of their independent driving, there is a need to further understand the relationship between the perceived risky driving behaviour of parents and friends and the risky behaviour of drivers with a Provisional (intermediate) licence. As part of a larger research project, 378 drivers aged 17-25 years (M=18.22, SD=1.59, 113 males) with a Provisional licence completed an online survey exploring the perceived riskiness of their parents' and friends' driving, and the extent to which they pattern (i.e. base) their driving behaviour on the driving of their parents and friends. Young drivers who reported patterning their driving on their friends, and who reported they perceived their friends to be risky drivers, reported more risky driving. The risky driving behaviour of young male drivers was associated with the perceived riskiness of their fathers' driving, whilst for female drivers the perceived riskiness of their mothers' driving approached significance. The development and application of countermeasures targeting the risky behaviour of same-sex parents appears warranted by the robust research findings. In addition, countermeasures need to encourage young people in general to be non-risky drivers; targeting the negative influence of risky peer groups specifically. Social norms interventions may minimise the influence of potentially-overestimated riskiness. Copyright © 2013 Elsevier Ltd. All rights reserved.

Medically unexplained chronic pain in Australia: difficulties for rehabilitation providers and workers in pain.

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Wales, Coralie; Matthews, Lynda R; Donelly, Michelle

2010-01-01

In Australia, evidence of an ageing population and a skills shortage are imminent challenges for employers [5,50]. A further concern arises from the work injury and motor accident compensation schemes, where many claims for soft tissue injuries result in permanent impairment depriving the community of otherwise productive workers [85]. In many cases, it is chronic pain that becomes the major barrier to a return to productive work. This study will review the operation of rehabilitation within Australian Workers' and Motor Accidents compensation systems in order to identify values and attitudes underpinning the vocational rehabilitation ethos. The models underlying current practice will also be identified. A comprehensive review of published literature and policy documents was undertaken. We identified a variety of contextual factors that influenced progress back into the workforce for people living with persistent pain. The conceptual models underpinning these factors within rehabilitation systems were explored. They were all driven by a strong focus on early return to work and at the same time the sustainability of rehabilitation as a profitable industry. Implications of these findings on the relationship between the rehabilitation provider and the person in pain are discussed. Rehabilitation professionals are influenced by and in turn influence the context in which chronic pain is experienced. Empirical data about the experiences of vocational rehabilitation professionals in Australian personal injury rehabilitation systems is lacking, yet the implications of the cost of chronic pain to the nation are significant. It is recommended that rehabilitation providers increase their awareness of the perhaps unforeseen traps within the various practice models they might be using on the goal of sustainable return to work for people living with pain.

Predicting future traffic offenders by pre-drivers’ attitudes towards risky driving

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Slavinskienė, Justina; Žardeckaitė-Matulaitienė, Kristina; Endriulaitienė, Auksė; Šeibokaitė, Laura; Markšaitytė, Rasa

2017-01-01

Worldwide statistics indicate that novice drivers are still one of the riskiest drivers’ groups as they highly contribute to road accidents and traffic rules violations. Thus, the psychological variables that allow predicting whether novice drivers will violate traffic rules are important in risky driving research. The aim of this study is to find out if pre-drivers’ attitudes towards risky driving measured before obtaining driving license could predict future traffic offences during the firs...

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...

Over-, under- and misuse of pain treatment in Germany.

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Dietl, Markus; Korczak, Dieter

2011-04-19

The HTA-report (Health Technology Assessment) deals with over- and undertreatment of pain therapy. Especially in Germany chronic pain is a common reason for the loss of working hours and early retirement. In addition to a reduction in quality of life for the affected persons, chronic pain is therefore also an enormous economic burden for society. Which diseases are in particular relevant regarding pain therapy?What is the social-medical care situation regarding pain facilities in Germany?What is the social-medical care situation in pain therapy when comparing on international level?Which effects, costs or cost-effects can be seen on the micro-, meso- and macro level with regard to pain therapy?Among which social-medical services in pain therapy is there is an over- or undertreatment with regard to the micro-, meso- and macro level?Which medical and organisational aspects that have an effect on the costs and/or cost-effectiveness have to be particularly taken into account with regard to pain treatment/chronic pain?What is the influence of the individual patient's needs (micro level) in different situations of pain (e. g. palliative situation) on the meso- and macro level?Which social-medical and ethical aspects for an adequate treatment of chronic pain on each level have to be specially taken into account?Is the consideration of these aspects appropriate to avoid over- or undertreatment?Are juridical questions included in every day care of chronic pain patients, mainly in palliative care?On which level can appropriate interventions prevent over- or undertreatment? A systematic literature research is done in 35 databases. In the HTA, reviews, epidemiological and clinical studies and economic evaluations are included which report about pain therapy and in particular palliative care in the years 2005 till 2010. 47 studies meet the inclusion criteria. An undertreatment of acupuncture, over- and misuse with regard to opiate prescription and an overuse regarding

Risky driving behaviors for road traffic accident among drivers in Mekele city, Northern Ethiopia

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Hassen Abrahim

2011-12-01

Full Text Available Abstract Background Due to its perception as a disease of development, road traffic accident and related injuries tend to be under recognized as a major health problem in developing countries. However, majority of the world's fatalities on the roads occur in low income and middle income countries. Since the main cause of road traffic accident is attributed to human risky behaviors, it is important to identify significant factors for risky behaviors of drivers. Methods A quantitative cross-sectional study with a sample size of 350 drivers was conducted in April 2011. The study was conducted among Taxi, Bajaj (three tire vehicles and private owned car drivers. After proportion to size allocation for Taxi (75, Baja (103 and private owned car (172 drivers, we used systematic random sampling method to identify illegible study subjects. Data was collected with face to face interview using a pretested questioner. Univariate, bivariate and multivariate analysis was done using SPSS version 16. Results The mean age of the respondents was 28.7 (SD 9.9. Majority were 339 (96.9% males. Significant number of the study subjects 233 (66.6% had risky driving behaviors. More than a quarter 100 (28.6% had less knowledge about basic traffic signs. Majority of drivers 181 (51.7% had negative attitude towards risky driving behaviors. Significant percent of them 148 (42.3% had a habit of using mobile phone while driving vehicle and 28 (9.7% had experience of driving after drinking alcohol. All the Bajaj, 97(62.6% house car and 58(37.4% taxi unfasten their seat belt while driving. Majority 303 (86.6% followed the recommended speed limit of driving. About 66 (18.9% of them had experience of punishment or warning by traffic polices in the previous 1 year and 77 (22% ever had car accident while driving. Conclusions Drivers of secondary education and with high average monthly income were more likely to have risky driving behavior. Having supportive attitude towards risky

Risky business: Behaviors associated with indoor tanning in US high school students

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Chapman, Stephanie; Ashack, Kurt; Bell, Eric; Sendelweck, Myra Ann; Dellavalle, Robert

2017-01-01

Background: Understanding of associations between indoor tanning and risky health related behaviors such as sexual activity and substance abuse among high school students across the United States is incomplete. Objective: To identify risky health related behaviors among high school students utilizing indoor tanning and analyze differences between state specific data. Methods: Results from the Youth Risk Behavior Surveillance System (YRBSS) 2013 in...

HIV-transmission knowledge, five-factor personality traits and psychopathy as determinants of risky sexual behaviors

OpenAIRE

Hudek-Knežević, Jasna; Kardum, Igor; Krapić, Nada

2008-01-01

On a sample of 203 males and 219 females the effects of HIV-transmission knowledge, five-factor personality traits and three components of psychopathy (antisocial behavior, interpersonal manipulation and impulsive thrill seeking) on overall risky sexual behaviors as well as risky sexual behaviors during previous month were explored by using a series of hierarchical regression analyses. The main hypothesis tested in this research is that psychopathy is an important predictor of risky sexual be...

Decision-making for risky gains and losses among college students with Internet gaming disorder.

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Yuan-Wei Yao

Full Text Available Individuals with Internet gaming disorder (IGD tend to exhibit disadvantageous risky decision-making not only in their real life but also in laboratory tasks. Decision-making is a complex multifaceted function and different cognitive processes are involved in decision-making for gains and losses. However, the relationship between impaired decision-making and gain versus loss processing in the context of IGD is poorly understood. The main aim of the present study was to separately evaluate decision-making for risky gains and losses among college students with IGD using the Cups task. Additionally, we further examined the effects of outcome magnitude and probability level on decision-making related to risky gains and losses respectively. Sixty college students with IGD and 42 matched healthy controls (HCs participated. Results indicated that IGD subjects exhibited generally greater risk taking tendencies than HCs. In comparison to HCs, IGD subjects made more disadvantageous risky choices in the loss domain (but not in the gain domain. Follow-up analyses indicated that the impairment was associated to insensitivity to changes in outcome magnitude and probability level for risky losses among IGD subjects. In addition, higher Internet addiction severity scores were associated with percentage of disadvantageous risky options in the loss domain. These findings emphasize the effect of insensitivity to losses on disadvantageous decisions under risk in the context of IGD, which has implications for future intervention studies.

Label, nudge or tax? A review of health policies for risky behaviours.

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Galizzi, Matteo M

2012-02-17

This work proposes a critical, non systematic, review of the three main lines of health policy interventions to deal with risky behaviours, such as over-eating, smoking, sedentary lives, and excess alcohol drinking, namely: i) the release of information on health risks and consequences; ii) the use of incentives; and iii) direct policy intervention in markets, through regulation and taxation. First, the health and economic impact of the risky behaviours epidemics are briefly described. Then a critical review follows on the evidence existing on the effectiveness of each type of intervention. The review will also highlight the public health approach staying beyond each type of policy on risky behaviours and critically consider them within the context of more general health and social policy interventions.

Children's risky play from an evolutionary perspective: the anti-phobic effects of thrilling experiences.

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Sandseter, Ellen Beate Hansen; Kennair, Leif Edward Ottesen

2011-06-21

This theoretical article views children's risky play from an evolutionary perspective, addressing specific evolutionary functions and especially the anti-phobic effects of risky play. According to the non-associative theory, a contemporary approach to the etiology of anxiety, children develop fears of certain stimuli (e.g., heights and strangers) that protect them from situations they are not mature enough to cope with, naturally through infancy. Risky play is a set of motivated behaviors that both provide the child with an exhilarating positive emotion and expose the child to the stimuli they previously have feared. As the child's coping skills improve, these situations and stimuli may be mastered and no longer be feared. Thus fear caused by maturational and age relevant natural inhibition is reduced as the child experiences a motivating thrilling activation, while learning to master age adequate challenges. It is concluded that risky play may have evolved due to this anti-phobic effect in normal child development, and it is suggested that we may observe an increased neuroticism or psychopathology in society if children are hindered from partaking in age adequate risky play.

Children's Risky Play from an Evolutionary Perspective: The Anti-Phobic Effects of Thrilling Experiences

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Ellen Beate Hansen Sandseter

2011-04-01

Full Text Available This theoretical article views children's risky play from an evolutionary perspective, addressing specific evolutionary functions and especially the anti-phobic effects of risky play. According to the non-associative theory, a contemporary approach to the etiology of anxiety, children develop fears of certain stimuli (e.g., heights and strangers that protect them from situations they are not mature enough to cope with, naturally through infancy. Risky play is a set of motivated behaviors that both provide the child with an exhilarating positive emotion and expose the child to the stimuli they previously have feared. As the child's coping skills improve, these situations and stimuli may be mastered and no longer be feared. Thus fear caused by maturational and age relevant natural inhibition is reduced as the child experiences a motivating thrilling activation, while learning to master age adequate challenges. It is concluded that risky play may have evolved due to this anti-phobic effect in normal child development, and it is suggested that we may observe an increased neuroticism or psychopathology in society if children are hindered from partaking in age adequate risky play.

Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints.

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Friedrichsdorf, Stefan J; Giordano, James; Desai Dakoji, Kavita; Warmuth, Andrew; Daughtry, Cyndee; Schulz, Craig A

2016-12-10

Primary pain disorders (formerly "functional pain syndromes") are common, under-diagnosed and under-treated in children and teenagers. This manuscript reviews key aspects which support understanding the development of pediatric chronic pain, points to the current pediatric chronic pain terminology, addresses effective treatment strategies, and discusses the evidence-based use of pharmacology. Common symptoms of an underlying pain vulnerability present in the three most common chronic pain disorders in pediatrics: primary headaches, centrally mediated abdominal pain syndromes, and/or chronic/recurrent musculoskeletal and joint pain. A significant number of children with repeated acute nociceptive pain episodes develop chronic pain in addition to or as a result of their underlying medical condition "chronic-on-acute pain." We provide description of the structure and process of our interdisciplinary, rehabilitative pain clinic in Minneapolis, Minnesota, USA with accompanying data in the treatment of chronic pain symptoms that persist beyond the expected time of healing. An interdisciplinary approach combining (1) rehabilitation; (2) integrative medicine/active mind-body techniques; (3) psychology; and (4) normalizing daily school attendance, sports, social life and sleep will be presented. As a result of restored function, pain improves and commonly resolves. Opioids are not indicated for primary pain disorders, and other medications, with few exceptions, are usually not first-line therapy.

Pain

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H.W. Snyman

1980-09-01

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

Multisite musculoskeletal pain predicts medically certified disability retirement among Finns.

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Haukka, E; Kaila-Kangas, L; Ojajärvi, A; Saastamoinen, P; Holtermann, A; Jørgensen, M B; Karppinen, J; Heliövaara, M; Leino-Arjas, P

2015-09-01

Musculoskeletal pain at several sites (multisite pain) is more common than single-site pain. Little is known on its effects on disability pension (DP) retirement. A nationally representative sample comprised 4071 Finns in the workforce aged 30 to 63. Data (questionnaire, interview, clinical examination) were gathered in 2000-2001 and linked with national DP registers for 2000-2011. Pain during the preceding month in 18 locations was combined into four sites (neck, upper limbs, low back, lower limbs). Hazard ratios (HR) of DP were estimated by Cox regression. The HR of any DP (n = 477) was 1.6 (95% confidence interval 1.2-2.1) for one, 2.5 (1.9-3.3) for two, 3.1 (2.3-4.3) for three and 5.6 (4.0-7.8) for four pain sites, when adjusted for age and gender. When additionally adjusted for clinically assessed chronic diseases, the HRs varied from 1.4 (1.0-1.8) to 3.5 (2.5-4.9), respectively. When further adjusted for physical and psychosocial workload, education, body mass index, smoking, exercise and sleep disorders, the HRs were 1.3 (0.9-1.7), 1.6 (1.2-2.2), 1.8 (1.3-2.5) and 2.5 (1.8-3.6). The number of pain sites was especially strong in predicting DPs due to musculoskeletal diseases (HRs in the full model; 3.1 to 4.3), but it also predicted DPs due to other somatic diseases (respective HRs 1.3 to 2.3); pain in all four sites was also predictive of DPs due to mental disorders (full model HR 2.2). The number of pain sites independently predicted DP retirement. Employees with multisite pain may need specific support to maintain their work ability. © 2014 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC®.

Socio-economic factors associated with the 1‑year prevalence of severe pain and pain-related sickness absence in the Austrian population.

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Mittendorfer-Rutz, Ellenor; Dorner, Thomas Ernst

2018-01-01

The aim of this study was to (1) investigate the relation of socio-economic status (SES), measured as education, occupation, and income, with the 12-month prevalence of severe pain and with pain-related sickness absence, and (2) analyse to what extent sociodemographic and medical factors influence these associations. The study population comprised 8084 subjects aged between 15 and 65 years from the Austrian Health Interview Survey in 2006/07. Associations of SES with the 1‑year prevalence of severe pain and sickness absence due to pain in those with severe pain was assessed with logistic regression analysis and adjusted for socio-demographic and chronic medical conditions. The 1‑year prevalence of severe pain was 33.7%. Among those with severe pain, 32.9% were on sickness absence due to pain. SES was significantly associated with the prevalence of severe pain and even more strongly with sickness absence due to pain. Stepwise adjustment for socio-demographics and medical factors had only marginal effects on these associations. Multivariate odds ratios (ORs) for severe pain were 1.14; 1.18 and 1.32 for low income, blue-collar workers, and low education, respectively. Related ORs for sickness absence due to pain were 1.52; 1.14 and 2.05. There was an association between SES, particularly measured as educational level, and the prevalence of severe pain, which was even stronger with sickness absence due to pain.

Optogenetic Inhibition Reveals Distinct Roles for Basolateral Amygdala Activity at Discrete Time Points during Risky Decision Making.

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Orsini, Caitlin A; Hernandez, Caesar M; Singhal, Sarthak; Kelly, Kyle B; Frazier, Charles J; Bizon, Jennifer L; Setlow, Barry

2017-11-29

Decision making is a multifaceted process, consisting of several distinct phases that likely require different cognitive operations. Previous work showed that the basolateral amygdala (BLA) is a critical substrate for decision making involving risk of punishment; however, it is unclear how the BLA is recruited at different stages of the decision process. To this end, the current study used optogenetics to inhibit the BLA during specific task phases in a model of risky decision making (risky decision-making task) in which rats choose between a small, "safe" reward and a large reward accompanied by varying probabilities of footshock punishment. Male Long-Evans rats received intra-BLA microinjections of viral vectors carrying either halorhodopsin (eNpHR3.0-mCherry) or mCherry alone (control) followed by optic fiber implants and were trained in the risky decision-making task. Laser delivery during the task occurred during intertrial interval, deliberation, or reward outcome phases, the latter of which was further divided into the three possible outcomes (small, safe; large, unpunished; large, punished). Inhibition of the BLA selectively during the deliberation phase decreased choice of the large, risky outcome (decreased risky choice). In contrast, BLA inhibition selectively during delivery of the large, punished outcome increased risky choice. Inhibition had no effect during the other phases, nor did laser delivery affect performance in control rats. Collectively, these data indicate that the BLA can either inhibit or promote choice of risky options, depending on the phase of the decision process in which it is active. SIGNIFICANCE STATEMENT To date, most behavioral neuroscience research on neural mechanisms of decision making has used techniques that preclude assessment of distinct phases of the decision process. Here we show that optogenetic inhibition of the BLA has opposite effects on choice behavior in a rat model of risky decision making, depending on the phase

Risky decision making in Attention-Deficit/Hyperactivity Disorder: A meta-regression analysis.

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Dekkers, Tycho J; Popma, Arne; Agelink van Rentergem, Joost A; Bexkens, Anika; Huizenga, Hilde M

2016-04-01

ADHD has been associated with various forms of risky real life decision making, for example risky driving, unsafe sex and substance abuse. However, results from laboratory studies on decision making deficits in ADHD have been inconsistent, probably because of between study differences. We therefore performed a meta-regression analysis in which 37 studies (n ADHD=1175; n Control=1222) were included, containing 52 effect sizes. The overall analysis yielded a small to medium effect size (standardized mean difference=.36, pdecision making than control groups. There was a trend for a moderating influence of co-morbid Disruptive Behavior Disorders (DBD): studies including more participants with co-morbid DBD had larger effect sizes. No moderating influence of co-morbid internalizing disorders, age or task explicitness was found. These results indicate that ADHD is related to increased risky decision making in laboratory settings, which tended to be more pronounced if ADHD is accompanied by DBD. We therefore argue that risky decision making should have a more prominent role in research on the neuropsychological and -biological mechanisms of ADHD, which can be useful in ADHD assessment and intervention. Copyright © 2016 Elsevier Ltd. All rights reserved.

Risky Play and Children’s Safety: Balancing Priorities for Optimal Child Development

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David A. Sleet

2012-08-01

Full Text Available Injury prevention plays a key role in keeping children safe, but emerging research suggests that imposing too many restrictions on children’s outdoor risky play hinders their development. We explore the relationship between child development, play, and conceptions of risk taking with the aim of informing child injury prevention. Generational trends indicate children’s diminishing engagement in outdoor play is influenced by parental and societal concerns. We outline the importance of play as a necessary ingredient for healthy child development and review the evidence for arguments supporting the need for outdoor risky play, including: (1 children have a natural propensity towards risky play; and, (2 keeping children safe involves letting them take and manage risks. Literature from many disciplines supports the notion that safety efforts should be balanced with opportunities for child development through outdoor risky play. New avenues for investigation and action are emerging seeking optimal strategies for keeping children “as safe as necessary,” not “as safe as possible.” This paradigm shift represents a potential for epistemological growth as well as cross-disciplinary collaboration to foster optimal child development while preserving children’s safety.

Effectiveness of mindfulness meditation on pain and quality of life of patients with chronic low back pain

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Sudha Banth

2015-01-01

Effectiveness of mindfulness meditation on pain and quality of life of patients with chronic low back pain Eighty-eight patients diagnosed as NSCLBP by physician and randomly assigned to experimental (MBSR+ usual medical care and the control group (usual medical care only. The subjects assessed in 3 times frames; before, after and 4 weeks after intervention by Mac Gil pain and standard brief quality of life scales. Data obtained from the final sample analyzed by ANCOVA using SPSS software. Results: The findings showed MBSR was effective in reduction of pain severity and the patients who practiced 8 sessions meditation reported significantly lower pain than patients who only received usual medical care. There was a significant effect of the between subject factor group (F [1, 45] = 16.45, P < 0.001 and (F [1, 45] = 21.51, P < 0.001 for physical quality of life and (F [1, 45] = 13.80, P < 0.001 and (F [1, 45] = 25.07, P < 0.001 mental quality of life respectively. Conclusion: MBSR as a mind-body therapy including body scan, sitting and walking meditation was effective intervention on reduction of pain severity and improvement of physical and mental quality of life of female patients with NSCLBP.

Postoperative pain management experiences among school-aged children: a qualitative study.

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Sng, Qian Wen; Taylor, Beverley; Liam, Joanne Lw; Klainin-Yobas, Piyanee; Wang, Wenru; He, Hong-Gu

2013-04-01

To explore postoperative pain management experiences among school-aged children. Ineffective postoperative pain management among children has been commonly reported. School-aged children are able to evaluate how their pain is managed and what their preferred strategies are. Most studies in pain management have adopted quantitative methods and have overlooked children's pain management experiences. This is a qualitative study using face-to-face interviews. Data were collected from 15 school-aged children admitted to a tertiary hospital in Singapore by in-depth interviews conducted between November 2010 and January 2011. Data were analysed by thematic analysis. Five themes were identified: children's self-directed actions to relieve their postoperative pain (e.g. using cognitive-behavioural methods of distraction and imagery, physical method of positioning, sleeping and drinking, seeking other people's help by informing parents and crying and using pain medications); children's perceptions of actions parents take for their postoperative pain relief (assessing pain, administering pain medications, using various cognitive-behavioural, physical methods and emotional support strategies, assisting in activities and alerting health professionals); children's perception of actions nurses take for their postoperative pain relief (administering medication, using cognitive-behavioural methods, emotional support strategies and helping with activities of daily living) and suggestions for parents (using distraction and presence) and nurses (administering medications, distraction and positioning) for their postoperative pain relief improvement. This study contributed to the existing knowledge about children's postoperative pain management based on their own experiences. Children, their parents and nurses used various strategies, including pain medication and non-pharmacological methods, especially distraction, for children's postoperative pain relief. This study provides evidence

The management of chronic pain in Switzerland: a comparative survey of Swiss medical specialists treating chronic pain.

NARCIS (Netherlands)

Wilder-Smith, O.H.G.; Mohrle, J.J.; Dolin, P.J.; Martin, N.C.

2001-01-01

Chronic pain management by Swiss specialist physicians with the primary hypothesis that pain clinic practitioners conform better to good practice (interdisciplinarity, diagnostic/therapeutic routines, quality control, education) than other specialists treating chronic pain was surveyed. Management

Peer Harassment and Risky Behavior among Sexual Minority Girls and Boys

OpenAIRE

Martin-Storey, Alexa; Crosnoe, Robert

2014-01-01

The role of peer harassment in the association between sexual minority status and adolescent risky behavior was examined for 15 year olds in the NICHD Study of Early Child Care and Youth Development (n = 957). The findings, although exploratory, suggest the importance of gender. For girls, peer harassment was best viewed as a moderator of the link between sexual minority status and increased risky behavior. It intensified an existing association, reflecting the gendered nature of the impact o...

Intimate Violence as It Relates to Risky Sexual Behavior Among At-Risk Females.

Science.gov (United States)

Hill, Danielle C; Stein, L A R; Rossi, Joseph S; Magill, Molly; Clarke, Jennifer G

2017-10-05

Rates of sexually transmitted infections (STIs) among adolescents are on the rise. The majority of adolescents who contract STIs do so through risky sexual behavior. Previous literature has identified multiple correlates of risky sexual behaviors among adolescents, including physical and sexual victimization, mental health concerns, and substance use. Few studies, however, have examined these relationships together in a comprehensive model. The primary purpose of this study was to examine whether relationship violence was related to risky sexual behavior, and whether mental health symptoms and substance use mediated this relationship. A cross-sectional design was used, and adolescent females (N = 179), recruited from social service agencies, were 18.9 years old on average and were 37.2% White, 19.3% Black, 37.9% multiracial, and 5.6% other. Regression results revealed that females who were physically assaulted and sexually victimized by their intimate partners did engage in more sex without condoms. Mediational analyses indicated that PTSD symptoms significantly influenced the relationship between (1) physical assault and risky sexual behavior and (2) sexual victimization and risky sexual behavior. Contrary to expectations, PTSD may act to reduce risk perhaps by reducing interest in sex. It is important to address victimization, PTSD, and sexual risk in young women. More work is needed to understand these complex relationships using longitudinal designs. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Risky decision-making and affective features of impulse control disorders in Parkinson's disease.

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Martini, Alice; Ellis, Simon J; Grange, James A; Tamburin, Stefano; Dal Lago, Denise; Vianello, Greta; Edelstyn, Nicola M J

2018-02-01

Impulse control disorders (ICDs) in Parkinson's disease (PD) are considered dopaminergic treatment side effects. Cognitive and affective factors may increase the risk of ICD in PD. The aim is to investigate risky decision-making and associated cognitive processes in PD patients with ICDs within a four-stage conceptual framework. Relationship between ICDs and affective factors was explored. Thirteen PD patients with ICD (ICD+), 12 PD patients without ICD (ICD-), and 17 healthy controls were recruited. Overall risky decision-making and negative feedback effect were examined with the Balloon Analogue Risk Task (BART). A cognitive battery dissected decision-making processes according to the four-stage conceptual framework. Affective and motivational factors were measured. ANOVA showed no effect of group on overall risky decision-making. However, there was a group × feedback interaction [F (2, 39) = 3.31, p = 0.047]. ICD+, unlike ICD- and healthy controls, failed to reduce risky behaviour following negative feedback. A main effect of group was found for anxiety and depression [F(2, 38) = 8.31, p = 0.001], with higher symptoms in ICD+ vs. healthy controls. Groups did not differ in cognitive outcomes or affective and motivational metrics. ICD+ may show relatively preserved cognitive function, but reduced sensitivity to negative feedback during risky decision-making and higher symptoms of depression and anxiety.

Thoracic spine pain

Directory of Open Access Journals (Sweden)

Aleksey Ivanovich Isaikin

2013-01-01

Full Text Available Thoracic spine pain, or thoracalgia, is one of the common reasons for seeking for medical advice. The epidemiology and semiotics of pain in the thoracic spine unlike in those in the cervical and lumbar spine have not been inadequately studied. The causes of thoracic spine pain are varied: diseases of the cardiovascular, gastrointestinal, pulmonary, and renal systems, injuries to the musculoskeletal structures of the cervical and thoracic portions, which require a thorough differential diagnosis. Facet, costotransverse, and costovertebral joint injuries and myofascial syndrome are the most common causes of musculoskeletal (nonspecific pain in the thoracic spine. True radicular pain is rarely encountered. Traditionally, treatment for thoracalgia includes a combination of non-drug and drug therapies. The cyclooxygenase 2 inhibitor meloxicam (movalis may be the drug of choice in the treatment of musculoskeletal pain.

Interventional Analgesic Management of Lung Cancer Pain.

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Hochberg, Uri; Elgueta, Maria Francisca; Perez, Jordi

2017-01-01

Lung cancer is one of the four most prevalent cancers worldwide. Comprehensive patient care includes not only adherence to clinical guidelines to control and when possible cure the disease but also appropriate symptom control. Pain is one of the most prevalent symptoms in patients diagnosed with lung cancer; it can arise from local invasion of chest structures or metastatic disease invading bones, nerves, or other anatomical structures potentially painful. Pain can also be a consequence of therapeutic approaches like surgery, chemotherapy, or radiotherapy. Conventional medical management of cancer pain includes prescription of opioids and coadjuvants at doses sufficient to control the symptoms without causing severe drug effects. When an adequate pharmacological medical management fails to provide satisfactory analgesia or when it causes limiting side effects, interventional cancer pain techniques may be considered. Interventional pain management is devoted to the use of invasive techniques such as joint injections, nerve blocks and/or neurolysis, neuromodulation, and cement augmentation techniques to provide diagnosis and treatment of pain syndromes resistant to conventional medical management. Advantages of interventional approaches include better analgesic outcomes without experiencing drug-related side effects and potential for opioid reduction thus avoiding central side effects. This review will describe various pain syndromes frequently described in lung cancer patients and those interventional techniques potentially indicated for those cases.

Risky sexual behaviour among women: Does economic empowerment matter? Case of Gabon, Mozambique, Sierra-Leone and Zambia.

Science.gov (United States)

Odimegwu, Clifford O; De Wet, Nicole; Banda, Pamela C

2016-12-01

The link between economic empowerment and high risky sexual behaviour has been debated by different scholars in various settings. However, no consistently clear connection between poverty and lack of education has been found regarding engagement in risky sexual behaviour. Also, not much research has been done to examine the strength of these relationships for adolescents and women. The objectives of this study were to assess the relationship between female economic empowerment and risky sexual behaviour in Africa. Using the latest Demographic and Health Surveys Data (DHS 2011-2014) from Gabon, Mozambique, Sierra Leone and Zambia, univariate, bivariate and multivariate analysis was done on women aged 15 to 49 to examine the patterns of and differences in the association between women's economic empowerment and risky sexual behaviour. The findings both at community and individual level indicate that empowered women (higher education and wealth household) and adolescents aged 15 to 19 are highly significantly associated with engagement in high risky behaviour. The result of this study stresses the need to look further than individual factors in the quest to resolve risky sexual behaviour in Africa. The interrelations between female economic empowerment and engagement in risky sexual behaviour are more complicated and less straightforward than usually presumed.

GP pain management: what are the 'Ps' and 'As' of pain management?

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Wan, Aston

2014-08-01

Pain is one common reason for clinical encounters in primary care. The complex nature of chronic pain syndromes can make assessment and management daunting at times. This article presents an easy scheme to help general practitioners efficiently assess, manage and review/follow up patients with chronic pain. The mnemonic presented for assessment is the '4Ps' (pain, other pathology/past medical history, performance/function and psychological/psychiatric status). For management, we can also use '4Ps' (physical, psychological, pharmacological and procedural) and for review there are the '6As' (activities, analgesia, adverse effects, aberrance behaviours, affects and adequate documentation).

Central Neuropathic Pain in Spinal Cord Injury

Science.gov (United States)

Lee, Sujin; Zhao, Xing; Hatch, Maya; Chun, Sophia; Chang, Eric

2015-01-01

Spinal cord injury (SCI) is a devastating medical condition affecting 1.2 million people in the United States. Central neuropathic pain is one of the most common medical complications of SCI. Current treatment options include opioids, antiepileptic agents such as gabapentin, antispastic agents such as baclofen or tizanidine, and tricyclic acid. Other options include complementary, nonpharmacological treatment such as exercise or acupuncture, interventional treatments, and psychological approaches. Although these treatment options exist, central neuropathic pain in patients with SCI is still extremely difficult to treat because of its complexity. To develop and provide more effective treatment options to these patients, proper assessment of and classification tools for central neuropathic pain, as well as a better understanding of the pathophysiology, are needed. A combination of approaches, from standard general pain assessments to medically specific questions unique to SCI pathophysiology, is essential for this population. A multidisciplinary approach to patient care, in addition with a better understanding of pathophysiology and diagnosis, will lead to improved management and treatment of patients with SCI displaying central neuropathic pain. Here we summarize the most recent classification tools, pathophysiology, and current treatment options for patients with SCI with central neuropathic pain. PMID:25750485

Pain Sensitivity and Pain Catastrophizing are Associated with Persistent Pain and Disability after Lumbar Spine Surgery

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Coronado, Rogelio A.; George, Steven Z.; Devin, Clinton J.; Wegener, Stephen T.; Archer, Kristin R.

2015-01-01

Objective To examine whether pain sensitivity and pain catastrophizing are associated with persistent pain and disability after lumbar spine surgery. Design Prospective observational cohort study. Setting Academic medical center. Participants Patients (N = 68, mean ± SD age = 57.9 ± 13.1 years, N female = 40 (58.8%)) undergoing spine surgery for a degenerative condition from March 1, 2012 to April 30, 2013 were assessed 6 weeks, 3 months, and 6 months after surgery. Interventions Not applicable. Main Outcome Measure(s) The main outcome measures were persistent back pain intensity, pain interference, and disability. Patients with persistent back pain intensity, pain interference, or disability were identified as those patients reporting Brief Pain Inventory scores ≥ 4 and Oswestry Disability Index scores ≥ 21 at all postoperative time points. Results From 6 weeks to 6 months after surgery, approximately 12.9%, 24.2%, and 46.8% of patients reported persistent back pain intensity, pain interference, or disability, respectively. Increased pain sensitivity at 6 weeks was associated with having persistent back pain intensity (OR = 2.0, 95% CI = 1.0; 4.1) after surgery. Increased pain catastrophizing at 6 weeks was associated with having persistent back pain intensity (OR = 1.1, 95% CI = 1.0; 1.2), pain interference (OR = 1.1, 95% CI = 1.0; 1.2), and disability (OR = 1.3, 95% CI = 1.1; 1.4). An interaction effect was not found between pain sensitivity and pain catastrophizing on persistent outcomes (p > 0.05). Conclusion(s) Findings suggest the importance of early postoperative screening for pain sensitivity and pain catastrophizing in order to identify patients at-risk for poor postoperative pain intensity, interference, and/or disability outcomes. Future research should consider the benefit of targeted therapeutic strategies for patients with these postoperative prognostic factors. PMID:26101845

Complex Regional Pain Syndrome (CRPS/RSD and Neuropathic Pain: Role of Intravenous Bisphosphonates as Analgesics

Directory of Open Access Journals (Sweden)

Jennifer Yanow

2008-01-01

Full Text Available Neuropathic pain is a sequela of dysfunction, injuries, or diseases of the peripheral and/or central nervous system pain pathways, which has historically been extremely difficult to treat. Complex regional pain syndrome (CRPS types 1 and 2 are neuropathic pain conditions that have a long history in the medical literature but whose pathophysiology remains elusive and whose available treatment options remain few. While an exact animal model for CRPS doesn't yet exist, there are several animal models of neuropathic pain that develop behaviors of hypersensitivity, one of the hallmark signs of neuropathic pain in humans.

Does substance use moderate the effects of parents and peers on risky sexual behaviour?

Science.gov (United States)

Donenberg, Geri R; Emerson, Erin; Bryant, Fred B; King, Scott

2006-04-01

We investigated the moderating effects of drug/alcohol use in the past 3 months on the relationships of peer influence, parental permissiveness, and teen disposition (i.e., achievement motivation, attitude toward school, and value placed on health) with adolescent risky sexual behaviour. Participants were 207 adolescents receiving psychiatric care. Substance use did not moderate the relationship between adolescent disposition and risky sex. By contrast, peer influence and parental permissiveness were linked to risky sex but only for teens who reported using drugs/alcohol. Controlling for other predictors in the model, negative peer influence explained 21% and parental permissiveness explained 13% of the variance in risky sex among substance users, but less than half of 1% of the variance among non-substance users. The disinhibiting effects of substance use on decision-making and the need for effective parental monitoring to reduce opportunities for risk behaviour are discussed.

Asymmetric pain processing in Parkinson's disease.

Science.gov (United States)

Granovsky, Y; Schlesinger, I; Fadel, S; Erikh, I; Sprecher, E; Yarnitsky, D

2013-10-01

Reduced endogenous pain inhibition, as part of the degenerative process, is presumed to be the mechanism underlying the common presence of pain in patients with Parkinson's disease (PD). The present study aimed to assess an endogenous pain inhibitory system in PD using the conditioned pain modulation paradigm. Twenty-six predominantly unilateral PD patients and 19 controls underwent psychophysical pain assessment before and after patients' morning dopaminergic medication. An unexpected increase in several parameters of pain perception for PD patients was found after dopaminergic medication (e.g. for 49°C noxious heat stimulation an increase from 70.6 ± 4.0 to 77.6 ± 4.0 on the numerical pain scale, P < 0.001). This increase was seen in patients with predominantly left-sided PD, regardless of the stimulated side (for 49°C noxious heat stimulation, predominantly left-sided PD patients, pain perception increased from 73.5 ± 6.8 to 85.0 ± 6.8, P < 0.001, whereas predominantly right-sided PD patients did not show a significant increase, 68.3 ± 6.8 to 70.4 ± 6.5, P = 0.777). Baseline efficiency of conditioned pain modulation inversely correlated with age at disease onset (r = -0.522; P = 0.009) and disease severity (Unified PD Rating Scale, r = 0.447; P = 0.032) but did not differ between patients and controls. Increased sensory response causing hyperalgesia occurs after dopaminergic medication in patients with predominantly left-sided PD. © 2013 The Author(s) European Journal of Neurology © 2013 EFNS.

Label, nudge or tax? A review of health policies for risky behaviours

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Matteo M. Galizzi

2012-02-01

Full Text Available This work proposes a critical, non systematic, review of the three main lines of health policy interventions to deal with risky behaviours, such as over-eating, smoking, sedentary lives, and excess alcohol drinking, namely: i the release of information on health risks and consequences; ii the use of financial incentives; and iii direct policy intervention in markets, through regulation and taxation. First, the health and economic impact of the risky behaviours epidemics are briefly described. Then a critical review follows on the evidence existing on the effectiveness of each type of intervention. The review will also highlight the public health approach staying beyond each type of policy on risky behaviours and critically consider them within the context of more general health and social policy interventions.

Women's sexual pain disorders.

Science.gov (United States)

van Lankveld, Jacques J D M; Granot, Michal; Weijmar Schultz, Willibrord C M; Binik, Yitzchak M; Wesselmann, Ursula; Pukall, Caroline F; Bohm-Starke, Nina; Achtrari, Chahin

2010-01-01

Women's sexual pain disorders include dyspareunia and vaginismus and there is need for state-of-the-art information in this area. To update the scientific evidence published in 2004, from the 2nd International Consultation on Sexual Medicine pertaining to the diagnosis and treatment of women's sexual pain disorders. An expert committee, invited from six countries by the 3rd International Consultation, was comprised of eight researchers and clinicians from biological and social science disciplines, for the purpose of reviewing and grading the scientific evidence on nosology, etiology, diagnosis, and treatment of women's sexual pain disorders. Expert opinion was based on grading of evidence-based medical literature, extensive internal committee discussion, public presentation, and debate. Results. A comprehensive assessment of medical, sexual, and psychosocial history is recommended for diagnosis and management. Indications for general and focused pelvic genital examination are identified. Evidence-based recommendations for assessment of women's sexual pain disorders are reviewed. An evidence-based approach to management of these disorders is provided. Continued efforts are warranted to conduct research and scientific reporting on the optimal assessment and management of women's sexual pain disorders, including multidisciplinary approaches.

Continuing pain education in nursing: a literature review.

NARCIS (Netherlands)

Francke, A.L.; Garssen, B.; Huijer Abu-Saad, H.

1996-01-01

Twelve studies on the effects of pain programmes for nurses were reviewed. Most of the programmes focused on aspects of pain, pain medication or pain assessment. Only two programmes (Ferrell et al., 1993, J. Pain Symptom Management, Vol. 8, No. 8, pp. 549-556; Sofaer, 1983, Nurs. Times, Vol. 79, No.

Medically unexplained physical symptoms, misunderstood and wrongly treated? A semiotic perspective on chronic pain.

Science.gov (United States)

Busvold, Kari Irene H; Bondevik, Hilde

2018-06-01

Medically unexplained physical symptoms (MUPS) are a significant and increasing health issue in the western world. Chronic pain constitutes a considerable element of these symptoms, and the lack of a biomedical explanation of their cause challenges the clinical encounter. The limitations of biomedicine become evident in these encounters and expose the need for an expanded understanding of body and symptom. Semiotics, as an anti-dualistic meta-theory, closes the gap between natural science and the humanities and views the human body in an evolutionary and existential perspective. By focusing on interpretation and communication of signs as ongoing processes at all levels of life, biology and experience, the subjective and the measurable will be integrated. A special type of sign, the self-referential, is part of the body's internal communication. These signs may be viewed as the body's warnings to itself, for instance when the individual's consciousness, thought and action run counter to the organism's physiological and psychological needs. In a semiotic perspective, existential conditions may also activate the body's defense systems. In this context, the unexplained pain may be understood as a functional warning sign. The enhanced understanding of body and symptom that a semiotic approach calls for is relevant for the work of physiotherapists and may lead to more constructive clinical encounters with patients with unexplained chronic pain.

Risky internet behaviors of middle-school students: communication with online strangers and offline contact.

Science.gov (United States)

Burgess Dowdell, Elizabeth

2011-06-01

In today's world, more adolescents are using the Internet as an avenue for social communication and a source of information and to experiment with risky online behaviors. To better understand how early adolescents are using the Internet, a study was undertaken to more clearly identify online use and online risky behaviors and to describe any online relationships with strangers middle-school students may be participating in. This exploratory study adapted the Youth Internet Safety Survey of Finkelhor et al to identify the usage and characteristics of online youth, solicitation of youth, and risky behaviors. Four hundred and four students, with a mean age of 12 years, were recruited from public and parochial schools located in the Northeast. Findings from this study indicate that of a total sample of 404 middle-school students, a small grouping (n = 59; 14.6%) are beginning risky online communication behaviors with strangers. Students who communicated online with strangers were older and had higher rates of posting personal information, risky online behaviors, and stealing. The majority of this group (84%) met offline with the online stranger, and three students reported having been assaulted. Findings suggest that early adolescents are beginning risky online and offline behaviors. Understanding their experiences is important since they highlight how middle-school students are undertaking risks in a new environment that many adults and parents do not fully understand. Clinicians, educators, healthcare providers, and other professionals need to be informed of Internet behaviors in order to assess for risk, to make referrals, to intervene, and to educate.

Over-, under- and misuse of pain treatment in Germany

Directory of Open Access Journals (Sweden)

Dietl, Markus

2011-01-01

Full Text Available Background: The HTA-report (Health Technology Assessment deals with over- and undertreatment of pain therapy. Especially in Germany chronic pain is a common reason for the loss of working hours and early retirement. In addition to a reduction in quality of life for the affected persons, chronic pain is therefore also an enormous economic burden for society. Objectives: Which diseases are in particular relevant regarding pain therapy? What is the social-medical care situation regarding pain facilities in Germany? What is the social-medical care situation in pain therapy when comparing on international level? Which effects, costs or cost-effects can be seen on the micro-, meso- and macro level with regard to pain therapy? Among which social-medical services in pain therapy is there is an over- or undertreatment with regard to the micro-, meso- and macro level? Which medical and organisational aspects that have an effect on the costs and/or cost-effectiveness have to be particularly taken into account with regard to pain treatment/chronic pain? What is the influence of the individual patient's needs (micro level in different situations of pain (e. g. palliative situation on the meso- and macro level? Which social-medical and ethical aspects for an adequate treatment of chronic pain on each level have to be specially taken into account? Is the consideration of these aspects appropriate to avoid over- or undertreatment? Are juridical questions included in every day care of chronic pain patients, mainly in palliative care? On which level can appropriate interventions prevent over- or undertreatment? Methods: A systematic literature research is done in 35 databases. In the HTA, reviews, epidemiological and clinical studies and economic evaluations are included which report about pain therapy and in particular palliative care in the years 2005 till 2010. Results: 47 studies meet the inclusion criteria. An undertreatment of acupuncture, over- and misuse

Two-year comprehensive medical management of degenerative lumbar spine disease (lumbar spondylolisthesis, stenosis, or disc herniation): a value analysis of cost, pain, disability, and quality of life: clinical article.

Science.gov (United States)

Parker, Scott L; Godil, Saniya S; Mendenhall, Stephen K; Zuckerman, Scott L; Shau, David N; McGirt, Matthew J

2014-08-01

Current health care reform calls for a reduction of procedures and treatments that are less effective, more costly, and of little value (high cost/low quality). The authors assessed the 2-year cost and effectiveness of comprehensive medical management for lumbar spondylolisthesis, stenosis, and herniation by utilizing a prospective single-center multidisciplinary spine center registry in a real-world practice setting. Analysis was performed on a prospective longitudinal quality of life spine registry. Patients with lumbar spondylolisthesis (n = 50), stenosis (n = 50), and disc herniation (n = 50) who had symptoms persisting after 6 weeks of medical management and who were eligible for surgical treatment were entered into a prospective registry after deciding on nonsurgical treatment. In all cases, comprehensive medical management included spinal steroid injections, physical therapy, muscle relaxants, antiinflammatory medication, and narcotic oral agents. Two-year patient-reported outcomes, back-related medical resource utilization, and occupational work-day losses were prospectively collected and used to calculate Medicare fee-based direct and indirect costs from the payer and societal perspectives. The maximum health gain associated with medical management was defined as the improvement in pain, disability, and quality of life experienced after 2 years of medical treatment or at the time a patient decided to cross over to surgery. The maximum health gain in back pain, leg pain, disability, quality of life, depression, and general health state did not achieve statistical significance by 2 years of medical management, except for pain and disability in patients with disc herniation and back pain in patients with lumbar stenosis. Eighteen patients (36%) with spondylolisthesis, 11 (22%) with stenosis, and 17 (34%) with disc herniation eventually required surgical management due to lack of improvement. The 2-year improvement did not achieve a minimum clinically

The impact of HIV antiretroviral treatment perception on risky sexual behaviour in Botswana: a short report.

Science.gov (United States)

Letamo, Gobopamang; Keetile, Mpho; Navaneetham, Kannan

2017-12-01

The aim of this article is to investigate the impact of ART perception on risky sexual behaviours in Botswana. Using binary logistic regression analysis controlling for individual characteristics, the results tend to support the hypothesis that ART misconceptions do not necessarily increase risky sexual behaviours. In particular, the study findings suggest the belief that ARVs cure HIV and AIDS and that people on ARVs should not always use condoms do not necessarily lead to increased risky sexual behaviours, particularly among women. Gender differentials exist in the perceived sexual risk resulting from the use of ART. Risky sexual behaviours increase for women who, wrongly, believed that ARVs cure HIV and AIDS and people on ARVs should not always use condoms. Although there is evidence to suggest ART perceptions do not necessarily lead to increased risky sexual behaviours, HIV and AIDS prevention programmes are needed to strengthen their information, education and communication intervention component that can address misconceptions about ART treatment and provide correct information that is gender-appropriate.

Tempus fugit : Time pressure in risky decisions

NARCIS (Netherlands)

Kocher, M.G.; Pahlke, J.; Trautmann, S.T.

2013-01-01

We study the effects of time pressure on risky decisions for pure gain prospects, pure loss prospects, and mixed prospects involving both gains and losses. In two experiments we find that time pressure has no effect on risk attitudes for gains, but increases risk aversion for losses. For mixed

Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints

Directory of Open Access Journals (Sweden)

Stefan J. Friedrichsdorf

2016-12-01

Full Text Available Primary pain disorders (formerly “functional pain syndromes” are common, under-diagnosed and under-treated in children and teenagers. This manuscript reviews key aspects which support understanding the development of pediatric chronic pain, points to the current pediatric chronic pain terminology, addresses effective treatment strategies, and discusses the evidence-based use of pharmacology. Common symptoms of an underlying pain vulnerability present in the three most common chronic pain disorders in pediatrics: primary headaches, centrally mediated abdominal pain syndromes, and/or chronic/recurrent musculoskeletal and joint pain. A significant number of children with repeated acute nociceptive pain episodes develop chronic pain in addition to or as a result of their underlying medical condition “chronic-on-acute pain.” We provide description of the structure and process of our interdisciplinary, rehabilitative pain clinic in Minneapolis, Minnesota, USA with accompanying data in the treatment of chronic pain symptoms that persist beyond the expected time of healing. An interdisciplinary approach combining (1 rehabilitation; (2 integrative medicine/active mind-body techniques; (3 psychology; and (4 normalizing daily school attendance, sports, social life and sleep will be presented. As a result of restored function, pain improves and commonly resolves. Opioids are not indicated for primary pain disorders, and other medications, with few exceptions, are usually not first-line therapy.

Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints

Science.gov (United States)

Friedrichsdorf, Stefan J.; Giordano, James; Desai Dakoji, Kavita; Warmuth, Andrew; Daughtry, Cyndee; Schulz, Craig A.

2016-01-01

Primary pain disorders (formerly “functional pain syndromes”) are common, under-diagnosed and under-treated in children and teenagers. This manuscript reviews key aspects which support understanding the development of pediatric chronic pain, points to the current pediatric chronic pain terminology, addresses effective treatment strategies, and discusses the evidence-based use of pharmacology. Common symptoms of an underlying pain vulnerability present in the three most common chronic pain disorders in pediatrics: primary headaches, centrally mediated abdominal pain syndromes, and/or chronic/recurrent musculoskeletal and joint pain. A significant number of children with repeated acute nociceptive pain episodes develop chronic pain in addition to or as a result of their underlying medical condition “chronic-on-acute pain.” We provide description of the structure and process of our interdisciplinary, rehabilitative pain clinic in Minneapolis, Minnesota, USA with accompanying data in the treatment of chronic pain symptoms that persist beyond the expected time of healing. An interdisciplinary approach combining (1) rehabilitation; (2) integrative medicine/active mind-body techniques; (3) psychology; and (4) normalizing daily school attendance, sports, social life and sleep will be presented. As a result of restored function, pain improves and commonly resolves. Opioids are not indicated for primary pain disorders, and other medications, with few exceptions, are usually not first-line therapy. PMID:27973405

Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition): Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain.

Science.gov (United States)

Narouze, Samer; Benzon, Honorio T; Provenzano, David; Buvanendran, Asokumar; De Andres, José; Deer, Timothy; Rauck, Richard; Huntoon, Marc A

2018-04-01

The American Society of Regional Anesthesia and Pain Medicine (ASRA) 2012 survey of meeting attendees showed that existing ASRA anticoagulation guidelines for regional anesthesia were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors required separate guidelines for pain and spine procedures. In response, a guidelines committee was formed. After preliminary review of published complications reports and studies, the committee stratified interventional spine and pain procedures according to potential bleeding risk: low-, intermediate-, and high-risk procedures. The ASRA regional anesthesia anticoagulation guidelines were largely deemed appropriate for the low- and intermediate-risk categories, but the high-risk category required further investigation. The first guidelines specific to interventional spine and pain procedures were published in 2015. Recent reviews evaluating bleeding complications in patients undergoing specific interventional pain procedures, the development of new regional anesthesia and acute pain guidelines, and the development of new anticoagulants and antiplatelet medications necessitate complementary updated guidelines. The authors desired coordination with the authors of the recently updated regional and acute pain anticoagulation guidelines. The latest evidence was sought through extensive database search strategies and the recommendations were evidence based when available and pharmacology driven otherwise. We could not provide strength and grading of these recommendations because there are not enough well-designed large studies concerning interventional pain procedures to support such grading. Although the guidelines could not always be based on randomized studies or on large numbers of patients from pooled databases, it is hoped that they will provide sound recommendations and the evidentiary basis for such recommendations. This publication is intended as a living document to be updated

[Occupational low back pain in nursing workers: massage versus pain].

Science.gov (United States)

Borges, Talita Pavarini; Kurebayashi, Leonice Fumiko Sato; Silva, Maria Júlia Paes da

2014-08-01

To assess the efficacy of massage for decreasing occupational low back pain in workers of a Nursing team in an Emergency Room. A randomized controlled trial, using a socio-demographic/morbidity questionnaire and a Pain Numeric Scale. Forty-five subjects were randomly allocated for intervention (G1 - Massage by acupressure), placebo group (G2 - application of Garlium Arseneid Laser 904 nm turned off) and control (G3 - no intervention). The main triggering factor, as well as the worsening of pain, was the patient manipulation, both with a prevalence of 34.9%. The main treatment for low back pain before this research was the use of medication, with a prevalence of 44.2%. In accordance with a variance analysis, only G1 presented a significant statistical difference, with a better result after 12 sessions. Massage presented an enormous effect (d = 4.59), corresponding to 86% of reduction in the pain level. Massage was effective to decrease occupational low back pain of those Nursing workers.

The effects of emotional states and traits on risky decision-making.

Energy Technology Data Exchange (ETDEWEB)

Bernard, Michael Lewis; Smith, Bruce W., 1959- (,University of New Mexico, Albuquerque, NM-)

2006-12-01

Understanding the role of emotional states is critical for predicting the kind of decisions people will make in risky situations. Currently, there is little understanding as to how emotion influences decision-making in situations such as terrorist attacks, natural disasters, pandemics, and combat. To help address this, we used behavioral and neuroimaging methods to examine how emotion states and traits influence decisions. Specifically, this study used a wheel of fortune behavioral task and functional magnetic resonance imaging (fMRI) to examine the effects of emotional states and traits on decision-making pertaining to the degree of risk people are willing to make in specific situations. The behavioral results are reported here. The neural data requires additional time to analyze and will be reported at a future date. Biases caused by emotion states and traits were found regarding the likelihood of making risky decisions. The behavioral results will help provide a solid empirical foundation for modeling the effects of emotion on decision in risky situations.

Ankle Pain

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... home remedies for a while. Seek immediate medical attention if you: Have severe pain or swelling Have ... of Privacy Practices Notice of Nondiscrimination Manage Cookies Advertising Mayo Clinic is a not-for-profit organization ...

Abdominal Pain

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... or pain in your chest Seek immediate medical attention Have someone drive you to urgent care or ... of Privacy Practices Notice of Nondiscrimination Manage Cookies Advertising Mayo Clinic is a not-for-profit organization ...

Testicle Pain

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... is more common in adolescents. Seek immediate medical attention if you have: Sudden, severe testicle pain Testicle ... of Privacy Practices Notice of Nondiscrimination Manage Cookies Advertising Mayo Clinic is a not-for-profit organization ...

Functional abdominal pain syndrome treated with Korean medication

OpenAIRE

Chang-Gue Son

2014-01-01

A 37-year-old female patient with chronic and stubborn abdominal pain had been hospitalized five times in three Western hospitals, but no effects were observed. No abnormalities were found in blood tests, gastrointestinal endoscopy, sonogram, and computed tomography of the abdomen, except mild paralytic ileus. The patient decided to rely on Korean medicine as an inpatient. She was diagnosed with functional abdominal pain syndrome, and her symptom differentiation was the ?Yang deficiency of sp...

A Mixture IRT Analysis of Risky Youth Behavior

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Holmes eFinch

2011-05-01

Full Text Available The study reported in this manuscript used a mixture item response model with data from the Youth Risk Behavior Survey 2009 (N = 16,410 to identify subtypes of adolescents at-risk for engaging in unhealthy behaviors, and to find individual survey items that were most effective at identifying such students within each subtype. The goal of the manuscript is twofold: 1 To demonstrate the utility of the mixture item response theory model for identifying subgroups in the population and for highlighting the use of group specific item response parameters and 2 To identify typologies of adolescents based on their propensity for engaging in sexually and substance use risky behaviors. Results indicate that 4 classes of youth exist in the population, with differences in risky sexual behaviors and substance use. The first group had a greater propensity to engage in risky sexual behavior, while group 2 was more likely to smoke tobacco and drink alcohol. Group 3 was the most likely to use other substances, such as marijuana, methamphetamine, and other mind altering drugs, and group 4 had the lowest propensity for engaging in any of the sexual or substance use behaviors included in the survey. Finally, individual items were identified for each group that can be most effective at identifying individuals at greatest risk. Further proposed directions of research and the contribution of this analysis to the existing literature are discussed.

Pain. Part 2a: Trigeminal Anatomy Related to Pain.

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Renton, Tara; Egbuniwe, Obi

2015-04-01

In order to understand the underlying principles of orofacial pain it is important to understand the corresponding anatomy and mechanisms. Paper 1 of this series explains the central nervous and peripheral nervous systems relating to pain. The trigeminal nerve is the 'great protector' of the most important region of our body. It is the largest sensory nerve of the body and over half of the sensory cortex is responsive to any stimulation within this system. This nerve is the main sensory system of the branchial arches and underpins the protection of the brain, sight, smell, airway, hearing and taste, underpinning our very existence. The brain reaction to pain within the trigeminal system has a significant and larger reaction to the threat of, and actual, pain compared with other sensory nerves. We are physiologically wired to run when threatened with pain in the trigeminal region and it is a 'miracle' that patients volunteer to sit in a dental chair and undergo dental treatment. Clinical Relevance: This paper aims to provide the dental and medical teams with a review of the trigeminal anatomy of pain and the principles of pain assessment.

Complex Regional Pain Syndrome and Treatment Approaches

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Neslihan Gokcen

2013-08-01

Full Text Available Complex Regional Pain Syndrome is a symptom complex including severe pain which is disproportioned by the initiating event. Formerly, it was known as reflex sympathetic dystropy, Sudeck’s atrophy and algoneurodystrophy. There are two types of complex regional pain syndrome (CPRS. CRPS type 1 (Reflex sympathetic dystropy occurs after a minor trauma of the extremities, CRPS type 2 (Causalgia occurs following peripheral nevre injury. Diagnosis is made according to the history, symptoms and physical findings of the patients. Patient education, physical therapy and medical treatment are the most common treatment approaches of complex regional pain syndrome. The aim of this review is to revise the treatment options ofcomplex regional pain syndrome, as well as to overview the new treatment approaches and options for the refractory complex regional pain syndrome cases. [Archives Medical Review Journal 2013; 22(4.000: 514-531

Prevalence of Chronic Disabling Noncancer Pain and Associated Demographic and Medical Variables: A Cross-Sectional Survey in the General German Population.

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Häuser, Winfried; Schmutzer, Gabriele; Hilbert, Anja; Brähler, Elmar; Henningsen, Peter

2015-10-01

In population surveys, up to 30% of participants reported chronic pain. Reports of chronic pain do not necessarily imply disability associated with pain. We assessed the prevalence of chronic disabling noncancer pain and associated demographic and medical variables in a sample of the general German population. A cross-sectional survey was conducted with 4360 people aged 14 years and above, who were representative of the German population. Measures were obtained for demographic variables, presence of chronic pain (based on the definition of the International Association for the Study of Pain), chronic pain stages (based on a chronic pain grade questionnaire), and disease load (based on the self-reported comorbidity questionnaire). Responses were received from 2508 people. The prevalence of chronic pain was 28.3% (95% [confidence interval] CI, 26.5%-30.1%). In all, 7.3% (95% CI, 5.9%-8.7%) of participants met the criteria of chronic disabling noncancer pain. Chronic disabling noncancer pain was associated with age above 65 years (odds ratios [OR]=4.81 [95% CI, 1.57-14.79]), low family income (OR=2.54 [95% CI, 1.36-4.74]), obesity (OR=3.58 [95% CI, 2.21-5.79]), heart disease (OR=2.23 [95% CI, 3.69-11.40]), stomach disease (OR=4.24 [95% CI, 2.12-8.49]), and rheumatic disease (OR=3.67 [95% CI, 2.16-6.23]) when compared with no chronic pain. Chronic disabling noncancer pain was associated with low family income (OR=2.29 [95% CI, 1.23-4.27]), obesity (OR=2.14 [95% CI, 1.30-3.52]), and depression (OR=3.26 [95% CI, 1.90-5.66]) when compared with chronic nondisabling noncancer pain. Prevalence rates of chronic disabling pain in the general population rather than prevalence rates of chronic pain might provide evidence in support of pain specialist care. The association of chronic disabling noncancer pain with mental disorders highlights the need for psychosocial services in chronic pain management.

Medical cannabis - the Canadian perspective.

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Ko, Gordon D; Bober, Sara L; Mindra, Sean; Moreau, Jason M

2016-01-01

Cannabis has been widely used as a medicinal agent in Eastern medicine with earliest evidence in ancient Chinese practice dating back to 2700 BC. Over time, the use of medical cannabis has been increasingly adopted by Western medicine and is thus a rapidly emerging field that all pain physicians need to be aware of. Several randomized controlled trials have shown a significant and dose-dependent relationship between neuropathic pain relief and tetrahydrocannabinol - the principal psychoactive component of cannabis. Despite this, barriers exist to use from both the patient perspective (cost, addiction, social stigma, lack of understanding regarding safe administration) and the physician perspective (credibility, criminality, clinical evidence, patient addiction, and policy from the governing medical colleges). This review addresses these barriers and draws attention to key concerns in the Canadian medical system, providing updated treatment approaches to help clinicians work with their patients in achieving adequate pain control, reduced narcotic medication use, and enhanced quality of life. This review also includes case studies demonstrating the use of medical marijuana by patients with neuropathic low-back pain, neuropathic pain in fibromyalgia, and neuropathic pain in multiple sclerosis. While significant preclinical data have demonstrated the potential therapeutic benefits of cannabis for treating pain in osteoarthritis, rheumatoid arthritis, fibromyalgia, and cancer, further studies are needed with randomized controlled trials and larger study populations to identify the specific strains and concentrations that will work best with selected cohorts.

HIV Stigma and Substance Use Among HIV-Positive Russians with Risky Drinking.

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Edelman, E Jennifer; Lunze, Karsten; Cheng, Debbie M; Lioznov, Dmitry A; Quinn, Emily; Gnatienko, Natalia; Bridden, Carly; Chaisson, Christine E; Walley, Alexander Y; Krupitsky, Evgeny M; Raj, Anita; Samet, Jeffrey H

2017-09-01

The link between HIV stigma with substance use is understudied. We characterized individuals with high HIV stigma and examined whether HIV stigma contributes to substance use among HIV-positive Russians reporting risky alcohol use. We analyzed data from HERMITAGE, a randomized controlled trial of 700 people living with HIV/AIDS (PLWHA) with past 6-month risky sex and risky alcohol use in St. Petersburg, Russia (2007-2011). Participants who were female and reported depressive symptoms and lower social support were more likely to endorse high HIV stigma (all p's stigma was not significantly associated with the primary outcome unhealthy substance use and was not consistently associated with secondary substance use outcomes. Interventions to enhance social and mental health support for PLWHA, particularly women, may reduce stigma, though such reductions may not correspond to substantial decreases in substance use among this population.

Pregnant women's expectations about pain intensity during childbirth and their attitudes towards pain management: Findings from an Icelandic national study.

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Karlsdottir, Sigfridur Inga; Sveinsdottir, Herdis; Olafsdottir, Olof Asta; Kristjansdottir, Hildur

2015-12-01

Pregnant women expect childbirth to be painful. However, little is known about their expectations of the intensity of pain in childbirth (EIPC) and their attitudes to pain management. The design was a cross-sectional survey, with self-reported questionnaires used to collect data from low-risk pregnant women (N = 1111) early in pregnancy at 26 of the largest primary health care centres in Iceland. This consecutive national sample was stratified by residency. The mean score for the EIPC was 5.58 (SD = 1.38) measured on a 7 point scale. The strongest predictors of a high EIPC score were: negative attitude to the impending childbirth (OR = 2.39), low manifestation of a sense of security (OR = 1.80), and a positive attitude to pain management with medication (OR = 1.63). Women living outside the capital area were less likely to have a high EIPC (OR = 0.68). Most women (77%) had a positive attitude towards pain management without medication and 35% had a positive attitude to pain management with medication. The study detected multiple predictors of women's EIPC and attitude to pain management. Early and throughout pregnancy, midwives and health care professionals need to address these predictors in order to assist women to prepare themselves for the pain of labour. Copyright © 2015 Elsevier B.V. All rights reserved.

Attachment relationships shape pain-signaling behavior.

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Kozlowska, Kasia

2009-10-01

Attachment relationships shape the manner in which children signal pain to others. Open communication of pain affect, inhibition of pain affect, and exaggeration of pain affect, reflect adaptations to different relationship contexts. The open and direct signaling of pain is adaptive in sensitive relationship contexts where caregivers respond to the distressed child with behaviors that facilitate protection, recovery, and healing. Inhibition of pain signals has survival advantages in situations where the open expressions of pain elicit negative parental responses (absence of caregiving, withdrawal from the child, or frank displeasure or anger). Exaggerated pain signaling functions as a means to elicit a caregiving response from preoccupied, inattentive, or neglectful attachment figures. This paper considers how a child's developmental experiences-specifically, the repeating person-specific experiences which make up attachment relationships-produce individual differences in the manner in which pain is experienced and signaled. This article reviews recent advances in our understanding of child development as articulated by contemporary attachment theory-in particular, the dynamic-maturational model (DMM)-and discusses their implications for interpreting human pain, pain-signaling behavior, and medically unexplained pain. The development of the experience of pain, along with ways of signaling pain, is tied to familial relationships generally and, in particular, to the manner in which attachment relationships shape the infant's behavior and physiology, thereby regulating the experience of pain. In explaining how the child's early attachment relationships produce individual differences in the way that she learns to experience and signal pain, the article provides an innovative perspective that is helpful in understanding the wide variations in patients' experience and presentation of pain, in elaborating formulations of medically unexplained pain, and in planning

[Everything is valid in chronic pain: Interventions by older adults for pain relief].

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Alvarado-García, Alejandra María; Salazar-Maya, Ángela María

To describe interventions used by older adults with benign chronic pain. Qualitative study with 25 older adults with benign chronic pain, inhabitants of the cities of Medellín and Bogotá. The technique used to collect information was in-depth interview. The analysis was made using the tools of the theory based on the guidelines of Strauss and Corbin. Using open, axial and selective coding, the constant comparison method allowed the identification of categories and subcategories and simultaneously memos and diagrams were made to reach theoretical saturation. A number of categories were found in this study, suggesting interventions used by the elderly to address chronic pain. They started looking at a number of options such as: taking medication, self-prescribing, feeling fear of taking pills, identifying the damage caused by drugs, using hot water, staying still, taking right postures, walking and exercising, using attachments that help them and making home remedies; all of them become alternatives that can cause pain relief. The study allowed describing interventions that older adults use to mitigate their pain. This ranged from pharmacological to non-pharmacological interventions, as simple as posture, cold, heat, massage or distractions among others, which play an important role in pain relief. Knowing these interventions helps healthcare professionals consider care options different to medication intake, proposing strategies that are easily accessible and can operate at the time to address a patient with chronic pain. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Risky Decisions Despite Counter Evidence: Modeling a Culture of Safer Sexual Practices

OpenAIRE

Patel, Vimla L.; Yoskowitz, Nicole A.; Kaufman, David R.; Gutnik, Lily A.; Shortliffe, Edward H.

2005-01-01

To create a culture of safe practices, we need to understand how and under what conditions the public makes risky decisions about their health. Because risky sexual behaviors are known to be common in young adults, we investigated their decision making regarding sexual activities that could incur a high risk of HIV infection. Sixty young urban adults maintained journals for two weeks and were interviewed regarding condom use and sexual history. We characterized four patterns...

Interview with David Tauben: University of Washington, Chief of the Division of Pain Medicine.

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Tauben, David

2017-07-01

Dr Tauben is Clinical Professor jointly appointed in the Departments of Medicine and Anesthesia & Pain Medicine, and is the Hughes M & Katherine G Blake Endowed Professor, board certified in both Internal Medicine and Pain Medicine. He is also University of Washington (UW) Director of Medical Student and Resident Education in Pain Medicine, and Medical Director of UW TelePain, a tele-video-conferencing program intended to provide innovative pain education and consultative support to a five-state northwest regional primary care providers. He served as a member of the NIH National Pain Strategy task force on pain education and is principal investigator for the UW's prestigious NIH Pain Consortium Center of Excellence for Pain Education, leading curriculum development to extend the pain proficiency qualifications of interprofessional primary care providers. Dr Tauben is a member of the American Pain Society and the International Association for the Study of Pain special interest study groups on Pain Education. He is a founding member of the State of Washington Agency Medical Directors panel of medical experts developing opioid prescription guidelines for the state, and a regular clinical and content expert for regulatory and legislative bodies involved in public policy regarding pain medicine practice and standards. He speaks as a clinical expert in medical management of chronic pain, especially as it applies to primary care practices. Dr Tauben served as an expert for several US Centers for Disease Control clinical outreach programs and policy reviews advising primary care providers on how to prescribe opioids for chronic noncancer pain. He is annually recognized by his peers as recipient of regional awards in care of pain patients, and brings decades of clinical experience of best practice medication management of acute and chronic pain. Dr Tauben received his bachelors degree in philosophy from Yale University, medical degree from Tufts University School of

Immersive Virtual Reality for Pediatric Pain.

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Won, Andrea Stevenson; Bailey, Jakki; Bailenson, Jeremy; Tataru, Christine; Yoon, Isabel A; Golianu, Brenda

2017-06-23

Children must often endure painful procedures as part of their treatment for various medical conditions. Those with chronic pain endure frequent or constant discomfort in their daily lives, sometimes severely limiting their physical capacities. With the advent of affordable consumer-grade equipment, clinicians have access to a promising and engaging intervention for pediatric pain, both acute and chronic. In addition to providing relief from acute and procedural pain, virtual reality (VR) may also help to provide a corrective psychological and physiological environment to facilitate rehabilitation for pediatric patients suffering from chronic pain. The special qualities of VR such as presence, interactivity, customization, social interaction, and embodiment allow it to be accepted by children and adolescents and incorporated successfully into their existing medical therapies. However, the powerful and transformative nature of many VR experiences may also pose some risks and should be utilized with caution. In this paper, we review recent literature in pediatric virtual reality for procedural pain and anxiety, acute and chronic pain, and some rehabilitation applications. We also discuss the practical considerations of using VR in pediatric care, and offer specific suggestions and information for clinicians wishing to adopt these engaging therapies into their daily clinical practice.

Interactions between risky decisions, impulsiveness and smoking in young tattooed women

Science.gov (United States)

2013-01-01

Background According to previous studies, one of the common problems of everyday life of persons with tattoos is risky behavior. However, direct examination of the decision making process, as well as factors which determine women’s risk-taking decisions to get tattoos, have not been conducted. This study investigates whether risk taking decision-making is associated with the self-assessment impulsiveness in tattooed women. Methods Young women (aged 18–35 years) with (N = 60) and without (N = 60) tattoos, performed the Iowa Gambling Task (IGT), as a measure of decision-making processes, as well as completing the Barratt Impulsivity Scale (BIS-11). Results Tattooed women showed significantly higher scores in the BIS-11 and preference for disadvantageous decks on the IGT compared to non-tattooed women. There was no significant correlation between risky decision-making in the IGT and BIS-11 impulsivity measures. A significantly higher rate of smoking was observed in the tattooed women. However, the analysis did not reveal a group effect after adjustment for smoking in the IGT and the BIS-11 measures. Conclusions The present study was specifically designed to resolve questions regarding associations between impulsiveness and risky decision-making in tattooed women. It shows that in tattooed women, risky decisions are not a direct result of their self-reported impulsiveness. Smoking does not explain the psychometric differences between tattooed women and controls. PMID:24180254

Pain medicine versus pain management: ethical dilemmas created by contemporary medicine and business.

Science.gov (United States)

Loeser, John D; Cahana, Alex

2013-04-01

The world of health care and the world of business have fundamentally different ethical standards. In the past decades, business principles have progressively invaded medical territories, leading to often unanticipated consequences for both patients and providers. Multidisciplinary pain management has been shown to be more effective than all other forms of health care for chronic pain patients; yet, fewer and fewer multidisciplinary pain management facilities are available in the United States. The amazing increase in interventional procedures and opioid prescriptions has not led to a lessening of the burden of chronic pain patients. Ethical dilemmas abound in the treatment of chronic pain patients: many are not even thought about by providers, administrators, insurance companies, or patients. We call for increased pain educational experiences for all types of health care providers and the separation of business concepts from pain-related health care.

The association between kinematic risky driving among parents and their teenage children: moderation by shared personality characteristics.

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Ehsani, Johnathon P; Simons-Morton, Bruce; Xie, Yunlong; Klauer, Sheila G; Albert, Paul S

2014-08-01

This study examined the driving behavior of 42 parent-teenager dyads for 18 months, under naturalistic driving conditions. At baseline participants' personality characteristics were assessed. Objective risky driving measures (kinematic risky driving) were captured by accelerometers for the duration of the study. To estimate teenage and parent correlations in kinematic risky driving, separate Poisson regression models were fit for teenagers and parents. Standardized residuals were computed for each trip for each individual. Correlations were obtained by estimating the Spearman rank correlations of the individual average residuals across teenagers and parents. The bootstrap technique was used to estimate the standard errors associated with the parent-teenager correlations. The overall correlation between teenage and parent kinematic risky driving for the 18-month study period was positive, but weak (r=0.18). When the association between parent and teenagers' risky driving was adjusted for shared personality characteristics, the correlation reduced to 0.09. Although interesting, the 95% confidence intervals on the difference between these two estimates overlapped zero. We conclude that the weak similarity in parent-teen kinematic risky driving was partly explained by shared personality characteristics. Published by Elsevier Ltd.

Brief cognitive interventions for burn pain.

Science.gov (United States)

Haythronthwaite, J A; Lawrence, J W; Fauerbach, J A

2001-01-01

This study tested the efficacy of 2 brief cognitive interventions in supplementing regular medical treatment for pain during burn dressing change. Forty-two burn inpatients were randomly assigned to 3 groups: sensory focusing, music distraction, and usual care. Patients reported pain, pain relief satisfaction with pain control, and pain coping strategies. The sensory focusing group reported greater pain relief compared to the music distraction group and a reduction in remembered pain compared to the usual care group, although group differences were not observed on serial pain ratings. In addition, after controlling for burn size and relevant covariates, regression analyses indicated that catastrophizing predicted pain, memory for pain, and satisfaction with pain control. Refinement of the sensory focusing intervention is warranted to reduce catastrophic thinking and improve pain relief

Spinal cord stimulation for neuropathic pain: current perspectives

OpenAIRE

Wolter, Tilman

2014-01-01