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Sample records for patient pain drawings

  1. Pain drawing as an investigative tool in hand surgery.

    PubMed

    Arner, M; Kopylov, P; Holmberg, J

    1992-01-01

    Fifty consecutive patients referred to the departments of hand surgery in Malmö and Lund were asked to chart their pain on a diagram of the body before their first visit to the clinic. Three patients never answered the questionnaire and were excluded. The drawings were evaluated separately by a senior hand surgeon without access to the case records. In 19 of 47 cases (40%) the evaluation of the pain drawings agreed with the clinical diagnosis. In another 17% (8 of 47), in which the pain drawings had indicated a condition not related to hand surgery, clinical examination failed to establish a diagnosis. The evaluation of the drawings had a false negative rate of 4% (2 of 47). In the remaining 18 cases pain drawings did not give enough information for diagnosis because of the variety of symptoms. Pain drawing seems to be valuable in the evaluation of patients with chronic pain in the upper extremity. PMID:1470874

  2. Hospitalized children drawing their pain: the contents and cognitive and emotional characteristics of pain drawings.

    PubMed

    Kortesluoma, Riitta-Liisa; Punamäki, Raija-Leena; Nikkonen, Merja

    2008-12-01

    Describing pain is difficult. Children like to draw, and through their drawing they reveal worrying issues. This study aimed to examine how hospitalized children express pain through drawings, and was carried out by examining children's thematic drawings of pain. A comparison was made between hospitalized children and healthy control groups with respect to the thematic contents and cognitive and emotional characteristics of pain drawings. The drawings were sorted in categories on the basis of content, and cognitive competence and emotional disturbances by the Draw-a-Person procedure. The hospitalized children showed a lower level of cognitive capacity than their healthy controls. The control group children revealed a higher level of emotional disturbance than the hospitalized children. The groups differed in the contents of their drawings. The drawings of the hospitalized children frequently depicted medical procedures, whereas the drawings of the healthy controls depicted more consoling human and family relations. PMID:19052187

  3. Patients with chronic pain.

    PubMed

    Salama-Hanna, Joseph; Chen, Grace

    2013-11-01

    Preoperative evaluation of patients with chronic pain is important because it may lead to multidisciplinary preoperative treatment of patients' pain and a multimodal analgesia plan for effective pain control. Preoperative multidisciplinary management of chronic pain and comorbid conditions, such as depression, anxiety, deconditioning, and opioid tolerance, can improve patient satisfaction and surgical recovery. Multimodal analgesia using pharmacologic and nonpharmacologic strategies shifts the burden of analgesia away from simply increasing opioid dosing. In more complicated chronic pain patients, multidisciplinary treatment, including pain psychology, physical therapy, judicious medication management, and minimally invasive interventions by pain specialists, can improve patients' satisfaction and surgical outcome. PMID:24182727

  4. Patient Education on Pain

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  5. 3-D pain drawings-mobile data collection using a PDA.

    PubMed

    Ghinea, G; Spyridonis, F; Serif, T; Frank, A O

    2008-01-01

    A large number of the adult population suffers from some kind of back pain during their lifetime. Part of the process of diagnosing and treating such back pain is for a clinician to collect information as to the type and location of the pain that is being suffered. Traditional approaches to gathering and visualizing this pain data have relied on simple 2-D representations of the human body, where different types of sensation are recorded with various monochrome symbols. Although patients have been shown to prefer such drawings to traditional questionnaires, these pain drawings can be limited in their ability to accurately record pain. The work described in this paper proposes an alternative that uses a 3-D representation of the human body, which can be marked in color to visualize and record the pain data. This study has shown that the new approach is a promising development in this area of medical practice and has been positively received by patients and clinicians alike. PMID:18270034

  6. Pain phenomena and possible mechanisms in patients with painful polyneuropathy.

    PubMed

    Otto, Marit; Bak, Sűren; Bach, Flemming W; Jensen, Troels S; Sindrup, Sűren H

    2003-01-01

    Painful polyneuropathy is a common neuropathic pain condition characterized by different typical pain phenomena and symptoms. The present study determined the frequency of pain phenomena and signs in painful polyneuropathy, and compared the symptomatology in patients with signs of increased small fiber response with that in patients with signs of deafferentation. Eighty-one consecutive patients with painful polyneuropathy were studied. The most common pain phenomena were deep aching pain (88%) and pain on pressure (69%), followed by pain paroxysms (59%) and less frequently pain on light touch (31%). Patients with increased cold and heat detection thresholds were more likely to have pain paroxysms (odds ratio (OR) 2.5 and 5.2) and patients with pain summation on repetitive mechanical stimulation more often had touch-evoked pain (OR=4.0) than patients without these phenomena. Findings compatible with increased small fiber response were found in six patients (7.4%), in 41 (50.6%) unequivocal signs of deafferentation were found, and 34 patients (42%) could not be classified. There was no significant difference in presenting symptoms between these groups. In conclusion, in painful polyneuropathy, (1). deep aching pain is the most frequently reported pain symptom; (2). the association between pain paroxysms with decreased small fiber function and touch-evoked pain with abnormal pain summation on mechanical stimulation indicate that central nervous system mechanisms are responsible for these symptoms; (3). sensitized small fibers as the single mechanism of pain is rare; and (4). pain symptomatology cannot predict pain mechanisms as being mainly deafferentation or sensitized small fibers. PMID:12507713

  7. Altered pain modulation in patients with persistent postendodontic pain

    PubMed Central

    Nasri-Heir, Cibele; Khan, Junad; Benoliel, Rafael; Feng, Changyong; Yarnitsky, David; Kuo, Fengshen; Hirschberg, Craig; Hartwell, Gary; Huang, Ching-Yu; Heir, Gary; Korczeniewska, Olga; Diehl, Scott R.; Eliav, Eli

    2015-01-01

    Abstract Persistent pain may follow nerve injuries associated with invasive therapeutic interventions. About 3% to 7% of the patients remain with chronic pain after endodontic treatment, and these are described as suffering from painful posttraumatic trigeminal neuropathy (PTTN). Unfortunately, we are unable to identify which patients undergoing such procedures are at increased risk of developing PTTN. Recent findings suggest that impaired endogenous analgesia may be associated with the development of postsurgical chronic pain. We hypothesized that patients with PTTN display pronociceptive pain modulation, in line with other chronic pain disorders. Dynamic (conditioned pain modulation, temporal summation) and static (response to mechanical and cold stimulation) psychophysical tests were performed intraorally and in the forearm of 27 patients with PTTN and 27 sex- and age-matched controls. The dynamic sensory testing demonstrated less efficient conditioned pain modulation, suggesting reduced function of the inhibitory endogenous pain-modulatory system, in patients with PTTN, mainly in those suffering from the condition for more than a year. The static sensory testing of patients with PTTN demonstrated forearm hyperalgesia to mechanical stimulation mainly in patients suffering from the condition for less than a year and prolonged painful sensation after intraoral cold stimulus mainly in patients suffering from the condition for more than a year. These findings suggest that PTTN is associated more with the inhibitory rather than the facilitatory arm of pain modulation and that the central nervous system has a role in PTTN pathophysiology, possibly in a time-dependent fashion. PMID:26098442

  8. Pain Coping Strategies in Osteoarthritis Patients.

    ERIC Educational Resources Information Center

    Keefe, Francis J.; And Others

    1987-01-01

    Investigated the relation of pain coping strategies to pain, health status, and psychological distress in a group of osteoarthritis patients with chronic pain. Patients completed various questionnaires. Medical status variables were also used. The Pain Control and Rational Thinking factor derived from the Coping Strategies Questionnaire proved to…

  9. Patients' perceptions of colposcopy pain.

    PubMed

    Kola-Palmer, S; Walsh, J C; Rogers, M

    2016-01-01

    This study aimed to examine the sensory descriptors used by women undergoing their first ever colposcopy examination as part of cervical cancer screening. Immediately following colposcopy, women were asked to provide detailed information about the sensory, affective, evaluative and intensity properties of the colposcopy examination using a validated, standardised questionnaire. Overall, 160 colposcopy patients with different management options were assessed [53 women underwent diagnostic colposcopy only, 76 had colposcopy plus punch biopsy, 31 women had colposcopy plus see-and-treat large loop excision of the transformation zone (LLETZ) treatment]. The results demonstrated that women report greater pain intensity with more intensive management options, such that women who have punch biopsy or LLETZ treatment report significantly more pain than women who have diagnostic colposcopy. In addition, with increasing intensity of treatment, the number of qualitative sensory and pain descriptors increase. This information can usefully be incorporated into colposcopy information leaflets, to ensure the sensory and affective experience of colposcopy is fully explained to women prior to attending. Expanding the preparatory information that women receive may serve to reduce anxiety, pain and distress associated with colposcopy. PMID:26087280

  10. Pain management in patients with hidradenitis suppurativa.

    PubMed

    HorvĂĄth, Barbara; Janse, Ineke C; Sibbald, Gary R

    2015-11-01

    Hidradenitis suppurativa (HS) is a chronic, relapsing, and painful inflammatory disease. HS patients' quality of life is severely impaired, and this impairment correlates strongly with their pain. Pain in HS can be acute or chronic and has both inflammatory and noninflammatory origins. The purpose of this review is to provide a summary of the existing literature regarding pain management in patients with HS. While there are no formal studies investigating pain management in HS, existing recommendations are based on general pain guidelines and expert opinion. Documentation of pain requires an assessment of the severity and timing of the pain. Although anti-inflammatory drugs and surgery for HS can alleviate pain, adjunctive pain medications are typically necessary. Topical analgesics, oral acetaminophen, and oral nonsteroidal anti-inflammatory drugs are considered first-line agents for the treatment of pain in patients with HS. If pain management is ineffective with those agents, oral opiates can be considered. In addition, anticonvulsants and selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors possess neuropathic pain-relieving properties that offer not only control of HS-associated pain but beneficial effects on itch and depression. There is clearly a need for additional studies on pain management in patients with HS. PMID:26470616

  11. Pain Drawing

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  12. Pain management for the geriatric patient.

    PubMed

    Roche, R J; Forman, W B

    1994-01-01

    Pain is a common and complex problem in the geriatric population. Successful pain management in this patient population requires a comprehensive approach involving both pharmacologic and nonpharmacologic interventions. PMID:8124655

  13. Pain management strategies used by patients with breast and gynecologic cancer with postoperative pain.

    PubMed

    Kwekkeboom, K L

    2001-10-01

    Many people with cancer will experience pain when they are outside of structured care settings. Patients must provide their own self-care, drawing on instructions from healthcare providers and on independently developed plans for pain management. With growing interest in complementary therapies, the scope of nonpharmacologic interventions used by patients with cancer to manage pain may be very different than 10-15 years ago. The purpose of this study was to describe steps taken by patients with breast and gynecologic cancer to manage pain after discharge from a surgical hospitalization. A secondary analysis was completed using data from 34 women who participated in a randomized trial of guided imagery. Techniques used included positioning, distraction, relaxation, heat, and eating/drinking. Compared to results of previous studies, increased use of relaxation strategies (breathing, imagery, music, meditation) was noted in the current study. The majority of participants used nonpharmacologic strategies in addition to analgesic medications. Pain-related outcomes were similar among persons who used analgesic medications alone and those who used a combination of analgesics and nonpharmacologic strategies. Nurses may benefit from knowing which pain management strategies patients find helpful so that they can encourage their use and teach similar strategies to the patients who find them useful. PMID:11605708

  14. Chronic Pain Patients: Implications for Rehabilitation Counseling.

    ERIC Educational Resources Information Center

    Scott, Lori T.

    Chronic pain syndrome appears to have certain dimensions which make it unique as a disabling condition. When pain persists, the resulting anxiety and depression, others' reactions to the patient's sick role behaviors, and situational variables such as disability benefits may all contribute to the pain syndrome and complicate the rehabilitation…

  15. [Pain assessment in patients with dementia].

    PubMed

    Bornemann-Cimenti, H; Wejbora, M; Michaeli, K; Kern-Pirsch, C; Sandner-Kiesling, A

    2012-04-01

    Recent literature demonstrates that pain in patients with dementia is often undertreated. This can partially be explained by a lack of training in the possibilities of assessing pain in patients with dementia. Subjective reports are the most valid approach for the assessment of the subjective experience of pain and should therefore be preferred over other methods. The assessment of the context, behavior, and physiological markers is advised if the patient is unable to provide a subjective report. Pain assessment scales are useful for documentation and monitoring. PMID:21932148

  16. Expression of pain and distress in children during dental extractions through drawings as a projective measure: A clinical study

    PubMed Central

    Pala, Sai Priya; Nuvvula, Sivakumar; Kamatham, Rekhalakshmi

    2016-01-01

    AIM: To evaluate the efficacy of drawings as a projective measure of pain and distress in children undergoing dental extractions. METHODS: Children in the age range of 4-13 years with existence of untreatable caries or over-retained primary teeth, indicated for extractions were included. Pain was assessed using one behavioral [faces, legs, activity, cry and consolability (FLACC)] scale; and a self report measure; faces pain scale-revised (FPS-R), at two points of time, after completion of local anesthetic administration and after extraction. The general behavior of children was assessed with Wright’s modification of Frankl rating scale. At the end of the session, children were instructed to represent, themselves along with the dentist and their experiences of the dental treatment through drawing. The drawings were scored utilizing Child drawing: Hospital scale (CD: H) manual and correlated with FLACC, FPS-R and Frankl using Pearson correlation test. RESULTS: A positive correlation, though statistically not significant, was observed between CD: H scores and all other considered parameters (Frankl, FPS-R and FLACC) in the present study. CONCLUSION: Drawings could not act as surrogate measure of child’s pain; however, they acted as a narrative of his/her experiences and reflection of inner emotions. Hence, drawings can be used as an additional dental armamentarium. PMID:26862509

  17. PAIN INTENSITY MODERATES THE RELATIONSHIP BETWEEN AGE AND PAIN INTERFERENCE IN CHRONIC OROFACIAL PAIN PATIENTS

    PubMed Central

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

    2015-01-01

    Background/Study Context Chronic pain is associated with increased interference in daily functioning that becomes more pronounced as pain intensity increases. Based on previous research showing that older adults maintain well-being in the face of pain as well as or better than their younger counterparts, the current study examined the interaction of age and pain intensity on interference in a sample of chronic orofacial pain patients. Methods Data were obtained from the records of 508 chronic orofacial pain patients being seen for an initial evaluation from 2008 to 2012. Collected data included age (range: 18–78) and self-reported measures of pain intensity and pain interference. Bivariate correlations and regression models were used to assess for statistical interactions. Results Regression analyses revealed that pain intensity positively predicted pain interference (R2 = .35, B = 10.40, SE = 0.62, t(507) = 16.70, p < .001). A significant interaction supported the primary hypothesis that aging was associated with reduced interference at high levels of pain intensity (?R2 = .01, B = ?1.31, SE = 0.63, t(505) = ?2.90, p = .04). Conclusion At high levels of pain intensity, interference decreased with age, although the age by pain intensity interaction effect was small. This evidence converges with aging theories, including socioemotional selectivity theory, which posits that as people age, they become more motivated to maximize positive emotions and minimize negative ones. The results highlight the importance of studying the mechanisms older adults use to successfully cope with pain. PMID:26214102

  18. Drug management of pain in cancer patients.

    PubMed Central

    Tuttle, C B

    1985-01-01

    Chronic severe cancer pain is often not well controlled because both patient and physician have a poor understanding of the nature of the pain and of the actions of various potent analgesics. Physicians often fail to tailor analgesic dosages to the needs of the individual and unnecessarily limit the dosage because they have an ill founded fear that the patient will become addicted. The basis of rational management of cancer pain with drugs is an appropriate analgesic given regularly in doses adequate to suppress pain continuously. This review compares the potent analgesics and identifies and discusses those that have a role in treating chronic cancer pain. It emphasizes the value of morphine sulfate and gives information on starting and individualizing dosages and managing side effects. PMID:2856896

  19. The accuracy of pain drawing in identifying psychological distress in low back pain—systematic review and meta-analysis of diagnostic studies

    PubMed Central

    Bertozzi, Lucia; Rosso, Anna; Romeo, Antonio; Villafańe, Jorge Hugo; Guccione, Andrew A.; Pillastrini, Paolo; Vanti, Carla

    2015-01-01

    The aim of this systematic review and meta-analysis was to estimate the accuracy of qualitative pain drawings (PDs) in identifying psychological distress in subacute and chronic low back pain (LBP) patients. [Subjects and Methods] Data were obtained from searches of PubMed, EBSCO, Scopus, PsycINFO and ISI Web of Science from their inception to July 2014. Quality assessments of bias and applicability were conducted using the Quality of Diagnostic Accuracy Studies-2 (QUADAS-2). [Results] The summary estimates were: sensitivity=0.45 (95% CI 0.34, 0.61), specificity=0.66 (95% CI 0.53, 0.82), positive likelihood ratio=1.23 (95% CI 0.93, 1.62), negative likelihood ratio=0.84 (95% CI 0.70, 1.01), and diagnostic odds ratio=1.46 (95% CI 0.79, 2.68). The area under the curve was 78% (CI, 57 to 99%). [Conclusion] The results of this systematic review do not show broad and unqualified support for the accuracy of PDs in detecting psychological distress in subacute and chronic LBP. PMID:26644701

  20. Psychophysiological decoupling in alexithymic pain disorder patients.

    PubMed

    Kleiman, Alexandra; Kramer, Karen Anne; Wegener, Ingo; Koch, Anne Sarah; Geiser, Franziska; Imbierowicz, Katrin; Zur, Berndt; Conrad, Rupert

    2016-03-30

    Considering that impaired coping with stress is closely linked with emergence of stress-sensitive disorders most notably in alexithymic individuals, we conducted the first study examining stress-related autonomic reactivity in alexithymic pain disorder patients. Twenty-one pain disorder patients with high and an equivalent patient group with low alexithymia scores were exposed to three types of affect-inductive stimuli with variable affective involvement: arithmetic task, watching arousing video material and giving an oral presentation. Subjective appraisal of the induced emotional experience and physiological reactivity (heart rate, muscle tension and skin conductance) was documented. During oral presentation high alexithymia patients showed significantly lower skin conductance in combination with increased subjective negative affect compared to low alexithymia patients. Our results thus demonstrate a decoupling between physiological and affect processing in pain disorder patients with high alexithymia during a stressful situation that was subjectively associated with negative affect. PMID:26804974

  1. Evaluation of the patient with hip pain.

    PubMed

    Wilson, John J; Furukawa, Masaru

    2014-01-01

    Hip pain is a common and disabling condition that affects patients of all ages. The differential diagnosis of hip pain is broad, presenting a diagnostic challenge. Patients often express that their hip pain is localized to one of three anatomic regions: the anterior hip and groin, the posterior hip and buttock, or the lateral hip. Anterior hip and groin pain is commonly associated with intra-articular pathology, such as osteoarthritis and hip labral tears. Posterior hip pain is associated with piriformis syndrome, sacroiliac joint dysfunction, lumbar radiculopathy, and less commonly ischiofemoral impingement and vascular claudication. Lateral hip pain occurs with greater trochanteric pain syndrome. Clinical examination tests, although helpful, are not highly sensitive or specific for most diagnoses; however, a rational approach to the hip examination can be used. Radiography should be performed if acute fracture, dislocations, or stress fractures are suspected. Initial plain radiography of the hip should include an anteroposterior view of the pelvis and frog-leg lateral view of the symptomatic hip. Magnetic resonance imaging should be performed if the history and plain radiograph results are not diagnostic. Magnetic resonance imaging is valuable for the detection of occult traumatic fractures, stress fractures, and osteonecrosis of the femoral head. Magnetic resonance arthrography is the diagnostic test of choice for labral tears. PMID:24444505

  2. Acute Pain Management in Opioid Dependent Patients

    PubMed Central

    Mehta, Vivek; Langford, Richard

    2009-01-01

    Acute pain management remains a challenge in opioid dependent patients, and it has been recognised that these patients are commonly under-treated. Chronic opioid exposure leads to widespread adaptations both at cellular and synaptic level. Physical dependence is a neuropharmacological phenomenon as a result of neuroadaptation and neuroplasticity, in contrast to addiction that is both neuropharmacological and behavioural. While providing the patient's pre-existing opioid requirement, the acute pain episode should be managed using additional multimodal analgesia: non-opioid medications in combination with local anaesthetic techniques and as required, short-acting opioid titrated to effect. Patients on long term buprenorphine and methadone with acute pain episode should be continued with their maintenance therapy and an additional short-acting opioid analgesic titrated to achieve therapeutic effect. PMID:26525109

  3. Evaluating Patients with Left Upper Quadrant Pain.

    PubMed

    Ecanow, Jacob S; Gore, Richard M

    2015-11-01

    Imaging plays a major role in the evaluation of patients who present to the emergency department with acute left upper quadrant (LUQ) pain. Multidetector computed tomography is currently the primary modality used for imaging these patients. The peritoneal reflections, subperitoneal compartment, and peritoneal spaces of the LUQ are key anatomic features in understanding the imaging appearance of acute diseases in this area. Diseases of the stomach, spleen, pancreas, and splenic flexure are encountered in patients with acute LUQ pain. Optimization of the imaging protocol is vital for accurate diagnosis and characterization of these diseases in the acute setting. PMID:26526430

  4. Effective pain management and improvements in patients' outcomes and satisfaction.

    PubMed

    Glowacki, Diane

    2015-06-01

    Adequate pain management is a compelling and universal requirement in health care. Despite considerable advancements, the adverse physiological and psychological implications of unmanaged pain remain substantially unresolved. Ineffective pain management can lead to a marked decrease in desirable clinical and psychological outcomes and patients' overall quality of life. Effective management of acute pain results in improved patient outcomes and increased patient satisfaction. Although research and advanced treatments in improved practice protocols have documented progressive improvements in management of acute and postoperative pain, little awareness of the effectiveness of best practices persists. Improved interventions can enhance patients' attitudes to and perceptions of pain. What a patient believes and understands about pain is critical in influencing the patient's reaction to the pain therapy provided. Use of interdisciplinary pain teams can lead to improvements in patients' pain management, pain education, outcomes, and satisfaction. PMID:26033099

  5. [Pain management in patients with liver cirrhosis].

    PubMed

    Ojeda, Antonio; Moreno, Luis A

    2014-01-01

    Pain management in patients with liver cirrhosis is a real challenge and is often inadequate due to a lack of therapeutic efficacy or the high incidence of adverse effects. The focus of treatment differs depending on whether the pain is acute or chronic and involves understanding the causative pathophysiological mechanism. Analgesics should be started with the minimum effective dose and should be titrated slowly with avoidance of polypharmacy. Adverse effects must be monitored, especially sedation and constipation, which predispose the patient to the development of hepatic encephalopathy. The first-line drug is paracetamol, which is safe at doses of 2-3g/day. Non-steroidal anti-inflammatory agents are contraindicated because they can cause acute renal failure and/or gastrointestinal bleeding. Tramadol is a safe option for moderate-severe pain. The opioids with the best safety profile are fentanyl and hydromorphone, with methadone as an alternative. Topical treatment can reduce oral drug consumption. In neuropathic pain the first-line therapeutic option is gabapentin. The use of antidepressants such as amitriptyline can be considered in some patients. Interventional techniques are a valuable tool in moderate to severe pain, since they allow a reduction in drug therapy and consequently its adverse effects. Psychological treatment, physical therapy and rehabilitation should be considered as part of multimodality therapy in the management of chronic pain. PMID:24309482

  6. Improving pain assessment and managment in stroke patients

    PubMed Central

    Nesbitt, Julian; Moxham, Sian; ramadurai, gopinath; Williams, Lucy

    2015-01-01

    Stroke patients can experience a variety of pain. Many stroke patients have co-morbidities such as osteoporosis, arthritis or diabetes causing diabetic neuropathy. As well as pain from other long term conditions, stroke patients can experience central post-stroke pain, headaches, and musculoskeletal issues such as hypertonia, contractures, spasticity, and subluxations. These stroke patients can also have communication difficulties in the form of expressive dysphasia and/or global aphasia. Communication difficulties can result in these patients not expressing their pain and therefore not having it assessed, leading to inadequate pain relief that could impact their rehabilitation and recovery. By implementing an observational measurement of pain such as the Abbey pain scale, patients with communication difficulties can have their pain assessed and recorded. Initially 30% of patients on the acute stroke ward did not have their pain assessed and adequately recorded and 15% of patients had inadequate pain relief. The patient was assessed if they were in pain and therefore not receiving adequate pain relief by measuring their pain on the Abbey pain scale. After introducing the Abbey pain scale and creating a nurse advocate, an improvement was shown such that only 5% of patients did not have their pain recorded and all had adequate pain relief. PMID:26732690

  7. Improving pain assessment and managment in stroke patients.

    PubMed

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

    2015-01-01

    Stroke patients can experience a variety of pain. Many stroke patients have co-morbidities such as osteoporosis, arthritis or diabetes causing diabetic neuropathy. As well as pain from other long term conditions, stroke patients can experience central post-stroke pain, headaches, and musculoskeletal issues such as hypertonia, contractures, spasticity, and subluxations. These stroke patients can also have communication difficulties in the form of expressive dysphasia and/or global aphasia. Communication difficulties can result in these patients not expressing their pain and therefore not having it assessed, leading to inadequate pain relief that could impact their rehabilitation and recovery. By implementing an observational measurement of pain such as the Abbey pain scale, patients with communication difficulties can have their pain assessed and recorded. Initially 30% of patients on the acute stroke ward did not have their pain assessed and adequately recorded and 15% of patients had inadequate pain relief. The patient was assessed if they were in pain and therefore not receiving adequate pain relief by measuring their pain on the Abbey pain scale. After introducing the Abbey pain scale and creating a nurse advocate, an improvement was shown such that only 5% of patients did not have their pain recorded and all had adequate pain relief. PMID:26732690

  8. Patients' Responses to a Drawing Experience in a Hemodialysis Unit: A Step towards Healing.

    ERIC Educational Resources Information Center

    Weldt, Cristina

    2003-01-01

    Investigates patients' responses to drawing experiences while in a hemodialysis unit. It was postulated that patients would be stimulated to talk about issues and experiences and improve their confidence and self-esteem. Results indicate that all patients enjoyed the experience of drawing; they became focused on doing the drawings and the hours…

  9. Patient satisfaction and pain management: an educational approach.

    PubMed

    Innis, Jennifer; Bikaunieks, Nancy; Petryshen, Patricia; Zellermeyer, Valerie; Ciccarelli, Lorraine

    2004-01-01

    The importance of assessing and managing pain has become paramount in today's hospital environment. Poor pain management is associated with impaired health, decreased patient satisfaction, and increased healthcare costs. This quality improvement project on an internal medicine unit at an urban teaching hospital examined the impact of pain education on patient satisfaction with pain management. Although pain scores did not improve, there were improvements made with respect to patient assessment, patient satisfaction, and nursing knowledge. PMID:15535537

  10. Persistence behavior of chronic low back pain patients in an acute pain situation.

    PubMed

    Schmidt, A J; Brands, A M

    1986-01-01

    The test behavior of 24 chronic low back pain patients was compared with the behavior of 24 healthy control Ss., matched for age and sex, in an experimental, acute pain situation (cold pressor-test). Chronic low back pain patients showed poorer persistence behavior and reported more pain. Thus, elements of typical chronic low back pain behavior were also present in an acute pain situation. These findings are discussed within the framework of stimulus-generalization theory. In addition, the effect of different coping strategies on pain tolerance was reconfirmed. The chronic low back pain group and the control group did not cope differently. PMID:2942681

  11. Judging patients' pain from external cues.

    PubMed

    Igier, Valérie; Sorum, Paul C; Mullet, Etienne

    2014-04-01

    Nurses, nurse's aides, and physicians were presented with vignettes describing elderly patients and were asked to assess their level of pain from four external cues (facial expression, verbalizations, avoidance of movements and positions, and interpersonal contact) in three conditions: when the illness was not known, when it was known to be arthritis, and when it was known to be cancer. For all health caregivers, the most important cue for judging pain was patients' facial expression. When the nature of the illness was not known, the impact of this cue was stronger than when the nature of the illness was known. PMID:23431130

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

    PubMed Central

    Kovacs, Francisco M; Abraira, Víctor; Royuela, Ana; Corcoll, Josep; Alegre, Luis; Tomás, Miquel; Mir, María Antonia; Cano, Alejandra; Muriel, Alfonso; Zamora, Javier; del Real, María Teresa Gil; Gestoso, Mario; Mufraggi, Nicole

    2008-01-01

    Background The minimal detectable change (MDC) and the minimal clinically important changes (MCIC) have been explored for nonspecific low back pain patients and are similar across different cultural settings. No data on MDC and MCIC for pain severity are available for neck pain patients. The objectives of this study were to estimate MDC and MCIC for pain severity in subacute and chronic neck pain (NP) patients, to assess if MDC and MCIC values are influenced by baseline values and to explore if they are different in the subset of patients reporting referred pain, and in subacute versus chronic patients. Methods Subacute and chronic patients treated in routine clinical practice of the Spanish National Health Service for neck pain, with or without pain referred to the arm, and a pain severity ? 3 points on a pain intensity number rating scale (PI-NRS), were included in this study. Patients' own "global perceived effect" over a 3 month period was used as the external criterion. The minimal detectable change (MDC) was estimated by means of the standard error of measurement in patients who self-assess as unchanged. MCIC were estimated by the mean value of change score in patients who self-assess as improved (mean change score, MCS), and by the optimal cutoff point in receiver operating characteristics curves (ROC). The effect on MDC and MCIC of initial scores, duration of pain, and existence of referred pain were assessed. Results 658 patients were included, 487 of them with referred pain. MDC was 4.0 PI-NRS points for neck pain in the entire sample, 4.2 for neck pain in patients who also had referred pain, and 6.2 for referred pain. MCS was 4.1 and ROC was 1.5 for referred and for neck pain, both in the entire sample and in patients who also complained of referred pain. ROC was lower (0.5 PI-NRS points) for subacute than for chronic patients (1.5 points). MCS was higher for patients with more intense baseline pain, ranging from 2.4 to 4.9 PI-NRS for neck pain and from 2.4 to 5.3 for referred pain. Conclusion In general, improvements ? 1.5 PI-NRS points could be seen as irrelevant. Above that value, the cutoff point for clinical relevance depends on the methods used to estimate MCIC and on the patient's baseline severity of pain. MDC and MCIC values in neck pain patients are similar to those for low back pain and other painful conditions. PMID:18402665

  13. The Impact of Pain Assessment on Critically Ill Patients' Outcomes: A Systematic Review

    PubMed Central

    Georgiou, Evanthia; Hadjibalassi, Maria; Lambrinou, Ekaterini; Andreou, Panayiota; Papathanassoglou, Elizabeth D. E.

    2015-01-01

    In critically ill patients, pain is a major problem. Efficient pain management depends on a systematic, comprehensive assessment of pain. We aimed to review and synthesize current evidence on the impact of a systematic approach to pain assessment on critically ill patients' outcomes. A systematic review of published studies (CINAHL, PUBMED, SCOPUS, EMBASE, and COCHRANE databases) with predetermined eligibility criteria was undertaken. Methodological quality was assessed by the EPHPP quality assessment tool. A total of 10 eligible studies were identified. Due to big heterogeneity, quantitative synthesis was not feasible. Most studies indicated the frequency, duration of pain assessment, and types of pain assessment tools. Methodological quality assessment yielded “strong” ratings for 5/10 and “weak” ratings for 3/10 studies. Implementation of systematic approaches to pain assessment appears to associate with more frequent documented reports of pain and more efficient decisions for pain management. There was evidence of favorable effects on pain intensity, duration of mechanical ventilation, length of ICU stay, mortality, adverse events, and complications. This systematic review demonstrates a link between systematic pain assessment and outcome in critical illness. However, the current level of evidence is insufficient to draw firm conclusions. More high quality randomized clinical studies are needed. PMID:26558273

  14. Breakthrough pain in patients with controlled or uncontrolled pain: An observational study

    PubMed Central

    Gatti, Antonio; Gentili, Marta; Baciarello, Marco; Lazzari, Marzia; Marzi, Rossella; Palombo, Elisa; Sabato, Alessandro F; Fanelli, Guido

    2014-01-01

    BACKGROUND: Breakthrough pain (BTP) is traditionally defined as a pain exacerbation in patients with chronic controlled pain. However, this definition has recently been challenged. OBJECTIVES: To evaluate the prevalence of unsatisfactory control in patients with chronic cancer pain, and investigate the frequency and intensity of BTP episodes. METHODS: A total of 665 patients with chronic cancer pain attending 21 pain therapy units in Italy were evaluated for baseline pain intensity and number of BTP episodes over a 30-day period. All patients started, continued or modified treatment for BTP at enrollment, according to medical judgment. RESULTS: The number of BTP events was higher in patients with uncontrolled baseline pain, although the intensity and duration of episodes were similar. In patients with uncontrolled baseline pain, the number of events decreased with time and reached values comparable with those reported in patients with controlled pain. Both the intensity of the pain and the duration of the BTP events exhibited similar values in the two groups at all time points, following increased monitoring and the prescription of analgesic medication. CONCLUSION: Patients with uncontrolled baseline pain experienced BTP flares with higher frequency, but similar intensity and duration with respect to patients with controlled pain at baseline. Notably, a close follow-up and adequate management of the BTP episodes led to an improvement of BTP in the observed patients. PMID:24945289

  15. Imaging the Patient With Sacroiliac Pain.

    PubMed

    Kok, Hong Kuan; Mumtaz, Aizad; O'Brien, Ciara; Kane, David; Torreggiani, William C; Delaney, Holly

    2016-02-01

    Sacroiliac (SI) region pain is a common clinical presentation and is often due to pathology involving the SI joints, usually of inflammatory, infective, neoplastic, or post-traumatic etiology. The SI joints have a unique anatomic layout and composition and can be imaged with a variety of techniques including conventional radiographs, computed tomography, isotope bone scintigraphy, and magnetic resonance imaging. This article reviews a range of common SI joint conditions, illustrated by multimodality imaging findings. We also discuss strategies for choosing the optimal imaging modality, pearls, and pitfalls of imaging and discuss an algorithm for approaching the patient with suspected inflammatory back pain. PMID:26632100

  16. A comparison of pain measures used with patients with fibromyalgia.

    PubMed

    Bigatti, Silvia M; Cronan, Terry A

    2002-01-01

    The objective of the present study was to evaluate instruments used to assess pain in patients with fibromyalgia (FMS). Participants were 602 patients with FMS. Pain was measured with five scales: a visual analog scale (VAS), the Pain Rating, Present Pain, and Number of Words Chosen Indexes from the McGill Pain Questionnaire; and intensity of pain obtained from a manual tender point exam. The VAS had the highest correlations with other measures of pain and with self-efficacy for pain, physical functioning, fatigue, and stiffness. The correlations between the VAS and fatigue and stiffness were significantly higher than those of other pain measures (p < .01). Our findings suggest that the easy-to-administer VAS may be the most useful measure of pain with patients with FMS. PMID:12048970

  17. Pain management: an adolescent scoliosis patient.

    PubMed

    Koya-Rawlinson, Christine

    2009-07-01

    Recovery units can be busy environments not often conducive to reflective practice. Reflection is, however, an important aspect of high quality care. Using Gibbs model of reflection (see Figure 1), applied to the experience of caring for a 15 year old patient who had undergone surgery to correct a scoliosis deformity, this article illustrates how a deeper understanding of holistic pain management and assessment can be achieved and high standards of care maintained through careful reflective practice. PMID:19743676

  18. The Brompton mixture: effects on pain in cancer patients.

    PubMed Central

    Melzack, R.; Ofiesh, J. G.; Mount, B. M.

    1976-01-01

    Terminally ill cancer patients were given the Brompton mixture and a phenothiazine in an attempt to control their pain. The mixture was administered to patients in three hospital environments: a palliative care unit (PCU), general wards and private rooms. Pain was measured in 92 patients with the McGill-Melzack Pain Questionnaire. The Brompton mixture controlled pain in 90% of patients in the PCU and in 75% to 80% of patients in the wards or private rooms. The differences in pain scores between the PCU patients and the other groups were significant. The mixture produced substantial decreases in the three major dimensions of pain: sensory, affective and evaluative. Comparison of these results with data obtained in an outpatient pain clinic showed that the Brompton mixture was strikingly more effective than the traditional methods of managing cancer pain. PMID:58710

  19. [Pain school. Therapeutic offers to patients with fibromyalgia and other non-malignant pain problems].

    PubMed

    Kogstad, O; Hintringer, F; Jonsson, Y M

    1991-05-30

    A prospective study of 71 patients with fibromyalgia (Yunus 1981 criteria) experience improved quality of life and management of pain after treatment at a pain school for one year. There was no significant improvement in total pain score (VAS) and sickness impact profile (SIP) for these patients compared with 71 paired controls with fibromyalgia matched by age and sex. The need for health care services was reduced and more patients from the pain school group returned to work. The main programme in the pain school classes consisted of information on chronic, non-malignant pain, psychomotoric physiotherapy and group therapy. The pupils evaluated all three items as important, with group dynamics as most beneficial. Good results have also been achieved in other chronic, non-malignant patients. Organized and structural pain management programmes in pain school classes have a favourable cost benefit profile and we recommend more use of such classes in the Norwegian health care system. PMID:2063381

  20. Predictors of Pain Intensity and Pain Functioning in Patients with the Hepatitis C Virus

    PubMed Central

    Morasco, Benjamin J.; Huckans, Marilyn; Loftis, Jennifer M.; Woodhouse, Jonathan; Seelye, Adriana; Turk, Dennis C.; Hauser, Peter

    2010-01-01

    OBJECTIVE To examine the relationships among biological and psychological variables with pain intensity and pain functioning in patients with the hepatitis C virus (HCV). METHODS Participants were 49 patients with HCV who completed well-validated assessments of pain intensity and pain functioning. Participants also completed measures of psychological functioning and medical records were reviewed. RESULTS Thirty-three of 49 participants (67.3%) had a current diagnosis for a pain-related condition. Regression analyses were conducted to examine variables associated with pain intensity and pain functioning. The psychosocial variables, particularly depression severity, accounted for an additional 21% of the variance in average pain intensity (p = 0.002) and 33% of the variance in pain functioning (p < 0.001). These results remained significant even after controlling for demographic characteristics, opioid prescription status, and disease-related variables. CONCLUSION These results provide preliminary support for the role of biological and psychological factors in the development and exacerbation of pain in HCV patients. Future studies should include a more comprehensive assessment of pain-related factors and examine their associations with additional disease-related and biological variables. Developing a better understanding of the factors associated with pain in HCV patients will help to inform future interventions for chronic pain in this patient population. PMID:20633746

  1. Assessing and managing pain in AIDS care: the patient perspective.

    PubMed

    Holzemer, W L; Henry, S B; Reilly, C A

    1998-01-01

    Although the prevalence and complexity of pain management in HIV/AIDS has been described in the literature, little is known about the management of pain from the patient perspective. This study used a set of standardized instruments, a medication chart audit, and a semistructured interview to elicit patients' self-reports of pain and patients' perceptions of nursing and self-care pain management strategies and examined potential physiological and psychosocial correlates of pain. The sample of 249 AIDS patients from three types of care settings (hospital, home care, skilled nursing facility) reported a modest overall current pain intensity (M = .14, range = 0-1). They reported experiencing pain in all body parts as measured by a body outline and characterized their pain with an average of 8.96 words from a list of 67 words. A lower pain rating was correlated with higher ratings on quality of life and perceived psychological support. An audit of the medication record revealed that the study sample received the following medications: narcotic analgesics (49%), nonnarcotic analgesics (47%), and antidepressants (22%). In a semistructured interview, medications were rated as effective by 80% of patients experiencing pain who stated that their health care providers included pain medications as part of the patient's pain management plan. Patients reported few nonpharmacologic self-care or health care provider interventions to manage their pain, and the effectiveness ratings of the interventions demonstrated wide variability. The study findings suggest that because pain was related to quality of life ratings and the pain management strategies reported by patients were not completely effective, further work is needed to examine pain management strategies that incorporate both pharmacologic and nonpharmacologic interventions with particular attention to self-care interventions. In addition, the data suggest that nursing assessments should include questions aimed at eliciting potentially harmful (e.g., street drugs, self-prescribed medications) strategies that patients may be using to manage their pain. PMID:9436165

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2014-01-01

    Background Patients undergoing hemodialysis frequently report pain with multifactorial causes, not limited to that experienced directly from hemodialysis treatment. Their pain may be nociceptive, neuropathic, somatic or visceral in nature. Despite this, pain in this population remains under-recognized and under-treated. Although several tools have been used to measure pain in patients undergoing hemodialysis as reported in the literature, none of them have been validated specifically in this population. The objective for this review was to compare and contrast these pain assessment tools and discuss their clinical utility in this patient population. Methods To identify pain assessment tools studied in patients undergoing hemodialysis, a literature search was performed in PubMed and Medline. An expert panel of dialysis and pain clinicians reviewed each tool. Each pain assessment tool was assessed on how it is administered and scored, its psychometric properties such as reliability, validity and responsiveness to change, and its clinical utility in a hemodialysis population. Brief Pain Inventory, McGill Pain Questionnaire, Pain Management Index, Edmonton Symptom Assessment System, Visual Analogue Scale and Faces Pain Scale were evaluated and compared. Results This assessment will help clinicians practicing in nephrology to determine which of these pain assessment tools is best suited for use in their individual clinical practice. PMID:25852910

  4. Characteristics of Chronic Pain Patients Who Take Opioids and Persistently Report High Pain Intensity

    PubMed Central

    Wasserman, Ronald A.; Brummett, Chad M.; Goesling, Jenna; Tsodikov, Alex; Hassett, Afton L.

    2014-01-01

    Background and Objectives The use of self-report questionnaires to detect characteristics of altered central pain processing, as seen in centralized pain disorders such as fibromyalgia, allow for the epidemiological studies of pain patients. Here, we assessed the relationship between reporting high levels of pain while taking opioids and the presence of characteristics associated with centralized pain. Methods We evaluated 582 patients taking opioid medications using validated measures of clinical pain, neuropathic pain symptoms, mood, and functioning. A multivariate linear regression model was used to assess the association between levels of pain while taking opioids and presenting with characteristics consistent with having centralized pain. Results We found that 49% of patients taking opioids continued to report severe pain (≄ 7/10). In multivariate analysis, factors associated with having higher levels of pain in opioid users included higher fibromyalgia survey scores (P = 0.001), more neuropathic pain symptoms (P < 0.001), and higher levels of depression (P = 0.002). While only 3.2% were given a primary diagnosis of fibromyalgia by their physician, 40.8% met American College of Rheumatology survey criteria for fibromyalgia. Conclusions Our findings suggest that patients with persistently high pain scores despite opioid therapy are more likely than those with lower levels of pain to present with characteristics associated with having centralized pain. This study cannot determine whether these characteristics were present before (fibromyalgia-like patient) or after the initiation of opioids (opioid-induced hyperalgesia). Regardless, patients with a centralized pain phenotype are thought to be less responsive to opioids and may merit alternative approaches. PMID:24310048

  5. Burn patients' experience of pain management: a qualitative study.

    PubMed

    Yuxiang, Li; Lingjun, Zhou; Lu, Tang; Mengjie, Liu; Xing, Ming; Fengping, Shen; Jing, Cui; Xianli, Meng; Jijun, Zhao

    2012-03-01

    Pain is a major problem after burns and researchers continue to report that pain from burns remains undertreated. The inadequate pain control results in adverse sequalae physically and psychologically in the burn victims. A better understanding of a burn patient's experience is important in identifying the factors responsible for undertreated pain and establishing effective pain management guidelines or recommendation in the practice of pain relief for burn injuries. This study sought to explore and describe the experience that patients have about pain related to burn-injury during hospitalization. Semi-structured interviews were conducted on eight patients with moderate to severe pain from burn injuries recruited from a Burn Centre in Northwest China. Data was collected by in-depth interviews and qualitative description after full transcription of each interview. Analysis involved the identification of themes and the development of a taxonomy of patients' experience of burn pain and its management. Three themes were indentified: (1) patients' experience of pain control, (2) patients' perception on burn pain management, and (3) patients' expectation of burn pain management. Findings from this study suggested that patients experience uncontrolled pain both physically and psychologically which may serve as an alert for awareness of health professionals to recognize and establish a multidisciplinary pain management team for burn victims, including surgeons, critical care specialists, anesthesiologists, nurses, psychologists, and social workers to accomplish safe and effective strategies for pain control to reach an optimal level of pain management in burn patients. It also provides insights and suggestions for future research directions to address this significant clinical problem. PMID:22079543

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

    PubMed

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

    2015-12-01

    The combination of prescription opioid dependence and chronic pain is increasingly prevalent and hazardous to public health. Variability in pain may explain poor prescription opioid addiction treatment outcomes in persons with chronic pain. This study examined pain trajectories and pain volatility in patients with chronic pain receiving treatment for prescription opioid addiction. We conducted secondary analyses of adults with chronic pain (n = 149) who received buprenorphine/naloxone (BUP/NLX) and counseling for 12 weeks in an outpatient, multisite clinical trial. Good treatment outcome was defined as urine-verified abstinence from opioids at treatment endpoint (Week 12) and during at least 2 of the previous 3 weeks. Pain severity significantly declined over time during treatment (b = -0.36, p < .001). Patients with greater pain volatility were less likely to have a good treatment outcome (odds ratio = 0.55, p < .05), controlling for baseline pain severity and rate of change in pain over time. A 1 standard deviation increase in pain volatility was associated with a 44% reduction in the probability of endpoint abstinence. The significant reduction in subjective pain during treatment provides observational support for the analgesic effects of BUP/NLX in patients with chronic pain and opioid dependence. Patients with greater volatility in subjective pain during treatment have increased risk of returning to opioid use by the conclusion of an intensive treatment with BUP/NLX and counseling. Future research should examine underlying mechanisms of pain volatility and identify related therapeutic targets to optimize interventions for prescription opioid addiction and co-occurring chronic pain. (PsycINFO Database Record PMID:26302337

  7. Reduced Cold Pain Tolerance in Chronic Pain Patients Following Opioid Detoxification

    PubMed Central

    Younger, Jarred; Barelka, Peter; Carroll, Ian; Kaplan, Kim; Chu, Larry; Prasad, Ravi; Gaeta, Ray; Mackey, Sean

    2009-01-01

    Objective One potential consequence of chronic opioid analgesic administration is a paradoxical increase of pain sensitivity over time. Little scientific attention has been given to how cessation of opioid medication affects the hyperalgesic state. In this study, we examined the effects of opioid tapering on pain sensitivity in chronic pain patients. Design Twelve chronic pain patients on long-term opioid analgesic treatment were observed in a 7- to 14-day inpatient pain rehabilitation program, with cold pain tolerance assessed at admission and discharge. The majority of participants were completely withdrawn from their opioids during their stay. Outcome Measures We hypothesized that those patients with the greatest reduction in daily opioid use would show the greatest increases in pain tolerance, as assessed by a cold pressor task. Results A linear regression revealed that the amount of opioid medication withdrawn was a significant predictor of pain tolerance changes, but not in the direction hypothesized. Greater opioid reduction was associated with decreased pain tolerance. This reduction of pain tolerance was not associated with opioid withdrawal symptoms or changes in general pain. Conclusions These findings suggest that the withdrawal of opioids in a chronic pain sample leads to an acute increase in pain sensitivity. PMID:18564998

  8. [Clinical variants of pain syndromes in patients with Parkinson's disease].

    PubMed

    Makhnev, S O; Levin, O S

    2013-01-01

    Parkinson's disease (PD) is characterized by well-known motor symptoms as well as by non-motor symptoms including pain syndrome which remains poorly understood and often ignored by physicians. The purpose of this study was to determine the frequency of chronic pain syndrome and develop approaches to its diagnosis, treatment and systematization. Authors examined 130 patients with PD. Chronic pain was found in 68 (52%) patients. In 51 (75%) patients, pain was located on the side of more severe motor symptoms. The main types of pain in PD were identified related to regional changes in muscle tone, motor fluctuations and primary ("central" pain). More severe symptoms of parkinsonism, cognitive and affective disorders as well as lower pain threshold were identified in patients with pain compared to those without pain. A negative impact of pain on quality of life was shown. The positive effect of dopaminergic therapy on the severity of pain was found in one-third of patients with PD. Criteria for the association of pain with PD and approaches to the correction of different types of pain are discussed. PMID:23994930

  9. Foot massage: effectiveness on postoperative pain in breast surgery patients.

    PubMed

    Ucuzal, Meral; Kanan, Nevin

    2014-06-01

    The aim of this study was to determine the effect of foot massage on pain after breast surgery, and provide guidance for nurses in nonpharmacologic interventions for pain relief. This was a quasiexperimental study with a total of 70 patients who had undergone breast surgery (35 in the experimental group and 35 in the control group). Patients in the control group received only analgesic treatment, whereas those in the experimental group received foot massage in addition to analgesic treatment. Patients received the first dose of analgesics during surgery. As soon as patients came from the operating room, they were evaluated for pain severity. Patients whose pain severity scored ?4 according to the Short-Form McGill Pain Questionnaire were accepted into the study. In the experimental group, pain and vital signs (arterial blood pressure, pulse, and respiration) were evaluated before foot massage at the time patients complained about pain (time 0) and then 5, 30, 60, 90, and 120 minutes after foot massage. In the control group, pain and vital signs were also evaluated when the patients complained about pain (time 0) and again at 5, 30, 60, 90, and 120 minutes, in sync with the times when foot massage was completed in the experimental group. A patient information form was used to collect descriptive characteristics data of the patients, and the Short-Form McGill Pain Questionnaire was used to determine pain severity. Data were analyzed for frequencies, mean, standard deviation, chi-square, Student t, Pillai trace, and Bonferroni test. The results of the statistical analyses showed that patients in the experimental group experienced significantly less pain (p ? .001). Especially notable, patients in the experimental group showed a decrease in all vital signs 5 minutes after foot massage, but patients in the control group showed increases in vital signs except for heart rate at 5 minutes. The data obtained showed that foot massage in breast surgery patients was effective in postoperative pain management. PMID:24882025

  10. Pain management among medical in-patients in Blantyre, Malawi

    PubMed Central

    Muula, Adamson S; Misiri, Humphreys E

    2009-01-01

    Background Pain is a leading symptom which influences patients to seek medical attention. The management of pain among patients attending in-patient care in southern African countries has been little described. Information regarding the prevalence of pain and the quality of its management may be useful in guiding clinical decisions, training of health workers and health care quality improvements. Methods A hospital-based audit was conducted to estimate the prevalence of pain and examine the quality of its management among patients admitted to adult medical wards at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi in 2004. Data were abstracted from ward charts of consecutive patients' who had been either been discharged or had died within a specified period. Characteristics of interest included; socio-demographic data, presence or absence of pain at admission, characterization or description of pain when present, and drug treatment given. Data were analyzed to obtain frequencies and proportions of the characteristics and assess the prevalence of pain and quality of care. Results A total of 121 patients' case notes were reviewed and the prevalence of pain was recorded for 91 (75.2%) of the patients. Clinicians had recorded pertinent information regarding pain management with the following frequency: pain severity or intensity 5/91 (5.5%), alleviating factors 5 (5.5%), pain radiation 7 (7.7%), exacerbating factors in 9 (9.9%) and periodicity in 43 (47.3%) of the cases. Males with pain were more than 3 times more likely to receive analgesic as compared to females, p < 0.01. Paracetamol was the commonest analgesic prescribed. Conclusion Inadequate management of pain among patients attending medical wards at QECH was found. There is need for prospective studies to further characterize pain management and identify pain management gaps in Malawi. Interviews of clinicians and documentation of observations within clinical practice are likely to be of value. PMID:19323817

  11. Perspectives of Swedish patients on postoperative pain management.

    PubMed

    Idvall, Ewa; Bergqvist, Anna; Silverhjelm, Jenny; Unosson, Mitra

    2008-06-01

    This study aimed to describe the perspectives of surgical patients towards postoperative pain management during their hospital stay. Thirty strategically chosen postoperative inpatients from different surgical wards in a university hospital in Sweden participated. A qualitative, descriptive approach using individual interviews was chosen. These were tape-recorded, transcribed verbatim, and analyzed according to a qualitative content analysis. The patients' descriptions of postoperative pain management indicated that pain was a symptom that was always in focus, either because it was constantly present or because pain could appear abruptly during different activities and movements. Although the focus was on pain and an awareness that it should be relieved or avoided, the solutions were often routine, short-term, and involved the regular intake of drugs, plus additional medication if needed for an acute pain episode. From the patients' descriptions of their experience with postoperative pain management, we distinguished three categories: "patients' pain knowledge", "patients' pain management approaches", and "patients' views of health-care professionals". The findings from this study highlight important aspects of nursing care that should receive greater attention in postoperative pain management. The patients' narratives could be a valuable asset in the quality improvement of postoperative pain management as these narratives highlight episodes difficult to elicit in other ways. PMID:18466386

  12. Patient attitudes and beliefs regarding pain medication after cardiac surgery: barriers to adequate pain management.

    PubMed

    Cogan, Jennifer; Ouimette, Marie-France; Vargas-Schaffer, Grisell; Yegin, Zeynep; Deschamps, Alain; Denault, André

    2014-09-01

    Several studies have outlined the impact of patient's beliefs on their level of pain relief after surgery and have underlined that misconceptions are barriers to effective pain relief. The aim of this survey was to evaluate the beliefs of the patients to help create a specifically adapted pain education program. After ethics approval, all patients scheduled to undergo cardiac surgery of any kind were approached and asked to complete a voluntary, non-nominative questionnaire that included the Barriers Questionnaire and the Screening Tool for Addiction Risk (STAR) Questionnaire. All completed questionnaires were collected from the charts every evening or the morning before surgery. Of 564 patients scheduled for surgery, 379 patients (67.5%) returned questionnaires. The average age was 60.3 years, and 66.0% were male. Results of the Barriers Questionnaire showed that 31% of patients were in strong agreement that "it is easy to become addicted to pain medication," 20% agreed that "good patients do not speak of their pain," and 36% believe that "pain medication should be saved in case pain worsens." Little or no gains have been made in decreasing misconceptions related to the treatment of pain. This study underlines the considerable need for and absolute necessity to provide pain education to patients undergoing cardiac surgery. PMID:23485659

  13. Pathogenesis and clinical aspects of pain in patients with osteoporosis

    PubMed Central

    Mediati, Rocco Domenico; Vellucci, Renato; Dodaro, Lucia

    2014-01-01

    Summary Bone pain is one of the most frequent kinds of chronic pain, mainly in elderly patients. It causes a significant worsening of functional capacity and deterioration in the quality of life in people affected. Mechanisms of pain in osteoporosis are poorly known and often extrapolated by other pathologies or other experimental model. One of principal causes would be a “hyper-remodeling” of bone, that involves osteoclasts activity and pathological modifications of bone innervation. Several studies show that osteoclasts play a significant role in bone pain etiology. Pain in osteoporosis is mainly nociceptive, if it become persistent a sensitization of peripheral and central nervous system can occur, so underlining the transition to a chronic pain syndrome. Central sensitization mechanisms are complex and involve several neuromediators and receptors (Substance P, NMDA, etc.). Most common manifestations of osteoporosis are vertebral compression fractures that cause persistent pain, though to differentiate from pain originating in structures as joint or muscle. First manifestation can be an acute pain due to pathological fracture, those of hip often causes disability. Pain in osteoporosis is an important clinical challenge. Often its complications and consequences on patient quality of life are underestimated with not negligible social implications. A balanced and early multimodal pain therapy including opioids as necessary, even in cases of acute pain, improve the functional capacity of patients and helps to prevent neurological alterations that seems to contribute in significant way in causing irreversible pain chronic syndromes. PMID:25568647

  14. Pathogenesis and clinical aspects of pain in patients with osteoporosis.

    PubMed

    Mediati, Rocco Domenico; Vellucci, Renato; Dodaro, Lucia

    2014-09-01

    Bone pain is one of the most frequent kinds of chronic pain, mainly in elderly patients. It causes a significant worsening of functional capacity and deterioration in the quality of life in people affected. Mechanisms of pain in osteoporosis are poorly known and often extrapolated by other pathologies or other experimental model. One of principal causes would be a "hyper-remodeling" of bone, that involves osteoclasts activity and pathological modifications of bone innervation. Several studies show that osteoclasts play a significant role in bone pain etiology. Pain in osteoporosis is mainly nociceptive, if it become persistent a sensitization of peripheral and central nervous system can occur, so underlining the transition to a chronic pain syndrome. Central sensitization mechanisms are complex and involve several neuromediators and receptors (Substance P, NMDA, etc.). Most common manifestations of osteoporosis are vertebral compression fractures that cause persistent pain, though to differentiate from pain originating in structures as joint or muscle. First manifestation can be an acute pain due to pathological fracture, those of hip often causes disability. Pain in osteoporosis is an important clinical challenge. Often its complications and consequences on patient quality of life are underestimated with not negligible social implications. A balanced and early multimodal pain therapy including opioids as necessary, even in cases of acute pain, improve the functional capacity of patients and helps to prevent neurological alterations that seems to contribute in significant way in causing irreversible pain chronic syndromes. PMID:25568647

  15. Pain Assessment and Treatment Decisions for Virtual Human Patients

    PubMed Central

    George, Steven Z.; Lok, Benjamin C.; Torres, Calia A.; Chuah, Joon Hao; Robinson, Michael E.

    2013-01-01

    Abstract Laypeople and healthcare professionals use demographic cues when making pain management decisions. These decisions can negatively affect patient outcomes. This study examined whether laypeople base their pain management decisions in part on pain-related postures and demographic cues. Virtual human (VH) technology was used to research whether sex and race, as well as body posture, influenced pain management decisions. Ninety-seven laypersons examined VH patients exhibiting low back pain related body postures whose demographic cues varied by VH sex and VH race. T tests validated that participants were able to distinguish between high pain related body postures and low pain related body postures. The participants assessed male VH patients to be experiencing more pain than female VH patients. This study suggests that participants use sex as a cue when assessing pain. Participants may perceive VH male patients as experiencing high pain intensity if the participants are willing to counter male stereotypes and acknowledge that the male VH patients display pain behaviors. PMID:23971429

  16. Pain assessment and treatment decisions for virtual human patients.

    PubMed

    Wandner, Laura D; George, Steven Z; Lok, Benjamin C; Torres, Calia A; Chuah, Joon Hao; Robinson, Michael E

    2013-12-01

    Laypeople and healthcare professionals use demographic cues when making pain management decisions. These decisions can negatively affect patient outcomes. This study examined whether laypeople base their pain management decisions in part on pain-related postures and demographic cues. Virtual human (VH) technology was used to research whether sex and race, as well as body posture, influenced pain management decisions. Ninety-seven laypersons examined VH patients exhibiting low back pain related body postures whose demographic cues varied by VH sex and VH race. T tests validated that participants were able to distinguish between high pain related body postures and low pain related body postures. The participants assessed male VH patients to be experiencing more pain than female VH patients. This study suggests that participants use sex as a cue when assessing pain. Participants may perceive VH male patients as experiencing high pain intensity if the participants are willing to counter male stereotypes and acknowledge that the male VH patients display pain behaviors. PMID:23971429

  17. Postoperative Pain Management in DIEP Flap Breast Reconstruction: Identification of Patients With Poor Pain Control

    PubMed Central

    Bar-Meir, Eran D.; Yueh, Janet H.; Hess, Philip E.; Hartmann, Christoph E. A.; Maia, Munique; Tobias, Adam M.; Lee, Bernard T.

    2010-01-01

    Objective: Adequate control of postoperative pain directly improves patient satisfaction and outcomes, and timely identification of patients with poorly controlled pain is essential. Pain management protocols are best studied in patients recovering from the same operation. In our institution, the postoperative pain regimen for patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction is standardized using patient-controlled analgesia (PCA) followed by conversion to oral narcotics. From this uniform population, we were able to identify a subgroup of patients with poor pain control. Methods: Over a 44-month period, 179 consecutive patients underwent DIEP flap breast reconstruction with 242 flaps performed. A retrospective chart review recorded PCA usage, visual analog scale pain scores, and length of stay. Results: Pain management with PCA after DIEP flap breast reconstruction was uniformly controlled. Most patients (74.9%) required PCA usage in the first 2 days with conversion to oral analgesics. A subgroup of patients (25.1%) continued to require PCA usage on the third postoperative day. These “nonresponder” patients had a higher visual analog scale score on the first postoperative day, higher total intravenous morphine use, and a longer length of stay (all, P < .05). A multivariate analysis revealed more nonresponders among patients undergoing immediate breast reconstruction (P < .05); however, all other factors analyzed had no correlation. Conclusion: We report a subgroup of patients with poor pain control after DIEP flap breast reconstruction. This group of patients required a longer course of pain management and subsequently a longer hospital stay. Pain management protocols that identify these patients promptly can allow for appropriate modifications. PMID:20862295

  18. Biopsychosocial Approach to Assessing and Managing Patients with Chronic Pain.

    PubMed

    Cheatle, Martin D

    2016-01-01

    Chronic pain affects nearly one-third of the American population. Chronic pain can lead to a variety of problems for a pain sufferer, including developing secondary medical problems, depression, functional and vocational disability, opioid abuse and suicide. Current pain care models are deficient in providing a necessary comprehensive approach. Most patients with chronic pain are managed by primary care clinicians who are typically ill prepared to effectively and efficiently manage these cases. A biopsychosocial approach to evaluate and treat chronic pain is clinically and economically efficacious, but unique delivery systems are required to meet the challenge of access to specialty care. PMID:26614718

  19. Pain sensitivity and tactile spatial acuity are altered in healthy musicians as in chronic pain patients

    PubMed Central

    Zamorano, Anna M.; Riquelme, Inmaculada; Kleber, Boris; AltenmĂŒller, Eckart; Hatem, Samar M.; Montoya, Pedro

    2015-01-01

    Extensive training of repetitive and highly skilled movements, as it occurs in professional classical musicians, may lead to changes in tactile sensitivity and corresponding cortical reorganization of somatosensory cortices. It is also known that professional musicians frequently experience musculoskeletal pain and pain-related symptoms during their careers. The present study aimed at understanding the complex interaction between chronic pain and music training with respect to somatosensory processing. For this purpose, tactile thresholds (mechanical detection, grating orientation, two-point discrimination) and subjective ratings to thermal and pressure pain stimuli were assessed in 17 professional musicians with chronic pain, 30 pain-free musicians, 20 non-musicians with chronic pain, and 18 pain-free non-musicians. We found that pain-free musicians displayed greater touch sensitivity (i.e., lower mechanical detection thresholds), lower tactile spatial acuity (i.e., higher grating orientation thresholds) and increased pain sensitivity to pressure and heat compared to pain-free non-musicians. Moreover, we also found that musicians and non-musicians with chronic pain presented lower tactile spatial acuity and increased pain sensitivity to pressure and heat compared to pain-free non-musicians. The significant increment of pain sensitivity together with decreased spatial discrimination in pain-free musicians and the similarity of results found in chronic pain patients, suggests that the extensive training of repetitive and highly skilled movements in classical musicians could be considered as a risk factor for developing chronic pain, probably due to use-dependent plastic changes elicited in somatosensory pathways. PMID:25610384

  20. Background pain in burn patients: routine measurement and recording of pain intensity in a burn unit.

    PubMed

    Jonsson, C E; Holmsten, A; Dahlström, L; Jonsson, K

    1998-08-01

    It goes without saying that pain following a burn must be treated but it is not so evident to measure and document the intensity of pain and the efficacy of treatment. Since 1994 the authors have routinely measured background pain, that is, at rest, along with temperature and pulse rate. For analysis and quality assessment a relational database programme is used in the ward. In this paper the authors' experience is reported from a consecutive series of 98 patients with burn injuries who assessed the intensity of pain on a visual analogue scale. There were great intra- and inter-individual variations in pain intensity. Highest values were found during the first week of treatment when female patients experienced pain more intensively than male. For other time periods there was no statistical significant difference between the sexes. Pain intensity and severity of burn was not related except during the second week when patients with major burns had a tendency to express more pain than moderate burns. Measurement of background pain along with other routine registrations is easy and not time-consuming. Patients needing intensified pain treatment can be identified. For research and quality assessment a computerized patient register is of great help. PMID:9725686

  1. Pain status of patients with severe haemophilic arthropathy.

    PubMed

    Wallny, T; Hess, L; Seuser, A; Zander, D; Brackmann, H H; Kraft, C N

    2001-09-01

    Patients with severe haemophilia A growing up before the establishment of prophylactic treatment frequently developed significant haemarthropathies. The goal of the following study was to clarify the role of haemarthropathic pain for haemophilic patients. Furthermore, we aimed to determine to what degree daily activities are influenced by the impairment and which therapeutic modalities are used in pain management. Using a questionnaire we consulted 71 haemophiliacs concerning their complaints and how they were treated in 1999 (average age 43 years; range 21-63 years). The pain in the large joints and spine and the effect of specific treatment was estimated by a visual analogue scale. On average, there were four joints with major pain and 0.5 with minor pain. The most frequent sources of pain were the ankle joints (45%), followed by the knee (39%), spine (14%) and elbow (7%). Fifty percent of all patients complained of pain throughout the day if no treatment was applied. In 29% of patients, pain persisted after application of factor VIII (FVIII), while 12% claimed that pain still remained after use of FVIII and pain killers. Restriction in activities of daily life was reported by 89% of the group and 85% reported on an impact of pain on their mood. Patients primarily used FVIII to decrease pain, followed in frequency by use of anti-inflammatory drugs, orthopaedic footwear, liniments and bandages. Haemophilic patients with haemarthropathy are chronic pain patients. By means of the questionnaire, it is possible to reveal the 'silent' sufferers. Sufficient pain treatment is essential so as to increase the patient's quality of life and avoid inadvertent abnormal postures possibly resulting in increased loading of joints and subsequent bleeding episodes. PMID:11554931

  2. Pain catastrophizing predicts poor response to topical analgesics in patients with neuropathic pain

    PubMed Central

    Mankovsky, Tsipora; Lynch, Mary E; Clark, AJ; Sawynok, J; Sullivan, Michael JL

    2012-01-01

    BACKGROUND: Previous research suggests that high levels of pain catastrophizing might predict poorer response to pharmacological interventions for neuropathic pain. OBJECTIVE: The present study sought to examine the clinical relevance of the relation between catastrophizing and analgesic response in individuals with neuropathic pain. Clinically meaningful reductions were defined in terms of the magnitude of reductions in pain through the course of treatment, and in terms of the number of patients whose end-of-treatment pain ratings were below 4/10. METHODS: Patients (n=82) with neuropathic pain conditions completed a measure of pain catastrophizing at the beginning of a three-week trial examining the efficacy of topical analgesics for neuropathic pain. RESULTS: Consistent with previous research, high scores on the measure of pain catastrophizing prospectively predicted poorer response to treatment. Fewer catastrophizers than noncatastrophizers showed moderate (?2 points) or substantial reductions in pain ratings through the course of treatment. Fewer catastrophizers than noncatastrophizers achieved end-of-treatment pain ratings below 4/10. CONCLUSIONS: The results of the present study suggest that the development of brief interventions specifically targeting catastrophic thinking might be useful for enhancing the effects of pharmacological interventions for neuropathic pain. Furthermore, failure to account for the level of catastrophizing might contribute to null findings in clinical trials of analgesic medication. PMID:22518362

  3. Subgrouping Patients With Low Back Pain

    PubMed Central

    Hebert, Jeffrey J.; Koppenhaver, Shane L.; Walker, Bruce F.

    2011-01-01

    Context: Low back pain (LBP) is a prevalent condition imposing a large socioeconomic burden. Despite intensive research aimed at the efficacy of various therapies for patients with LBP, most evidence has failed to identify a superior treatment approach. One proposed solution to this dilemma is to identify subgroups of patients with LBP and match them with targeted therapies. Among the subgrouping approaches, the system of treatment-based classification (TBC) is promoted as a means of increasing the effectiveness of conservative interventions for patients with LBP. Evidence acquisition: MEDLINE and PubMed databases were searched from 1985 through 2010, along with the references of selected articles. Results: TBC uses a standardized approach to categorize patients into 1 of 4 subgroups: spinal manipulation, stabilization exercise, end-range loading exercise, and traction. Although the TBC subgroups are in various stages of development, recent research lends support to the effectiveness of this approach. Conclusions: While additional research is required to better elucidate this method, the TBC approach enhances clinical decision making, as evidenced by the improved clinical outcomes experienced by patients with LBP. PMID:23016055

  4. Pain management in patients with chronic kidney disease

    PubMed Central

    Pham, Phuong-Chi T.; Toscano, Edgar; Pham, Phuong-Mai T.; Pham, Phuong-Anh T.; Pham, Son V.; Pham, Phuong-Thu T.

    2009-01-01

    Pain has been reported to be a common problem in the general population and end-stage renal disease (ESRD) patients. Although similar data for pre-ESRD patients are lacking, we recently reported that the prevalence of pain is also very high (>70%) among pre-ESRD patients at a Los Angeles County tertiary referral centre. The high prevalence of pain in the CKD population is particularly concerning because pain has been shown to be associated with poor quality of life. Of greater concern, poor quality of life, at least in dialysis patients, has been shown to be associated with poor survival. We herein discuss the pathophysiology of common pain conditions, review a commonly accepted approach to the management of pain in the general population, and discuss analgesic-induced renal complications and therapeutic issues specific for patients with reduced renal function. PMID:25949305

  5. Somatosensory investigation of patients with orofacial pain compared with controls.

    PubMed

    de Siqueira, Silvia R D T; Teixeira, Manoel J; de Siqueira, Jose T T

    2014-01-01

    The objective of this study was to investigate the sensorial characteristics of orofacial pain in patients compared with control subjects. A total of 336 subjects (282 patients and 54 control subjects) were evaluated to identify their thermal (cold and warm), tactile, and pain thresholds. Numbness was reported by 61.7% of the patients (p<0.001). Patients with trigeminal postherpetic neuralgia and burning mouth syndrome showed loss of thermal perception; patients with postherpetic neuralgia, burning mouth syndrome, and posttraumatic painful neuropathy had a decrease in tactile perception compared with the control subjects (p<0.001). In conclusion, other sensorial modalities besides pain are affected by neuropathic orofacial pain; these findings can help in the understanding of the pathophysiological mechanisms in orofacial pain. PMID:25162286

  6. Pain and Agitation Management in Critically Ill Patients.

    PubMed

    Stephens, Julie; Wright, Michael

    2016-03-01

    Pain and agitation may be difficult to assess in a critically ill patient. Pain is best assessed by self-reporting pain scales; but in patients who are unable to communicate, behavioral pain scales seem to have benefit. Patients' sedation level should be assessed each shift and preferably by a validated ICU tool, such as the RASS or SAS scale. Pain is most appropriately treated with the use of opiates, and careful consideration should be given to the pharmacokinetic and pharmacodynamic properties of various analgesics to determine the optimal agent for each individual patient. Sedation levels should preferably remain light or with the use of a daily awakening trial. Preferred treatment of agitation is analgosedation with the addition of nonbenzodiazepine sedatives if necessary. There are risks associated with each agent used in the treatment of pain and agitation, and it is important to monitor patients for effectiveness, signs of toxicity, and adverse drug reactions. PMID:26897427

  7. [Pain and cancer Information dedicated to cancer patients and relatives].

    PubMed

    Krakowski, Ivan; Déchelette, Marie; Arbiol, Evelyne; Chvetzoff, Gisèle; Cullet, Danièle; Delorme, Thierry; Fontaine, Alain; Lavillat, Dominique; Marec-Bérard, Perrine; Torloting, Gérard; Vuillemin, Nicole; Brusco, Sylvie; Carretier, Julien; Delavigne, Valérie; Leichtnam-Dugarin, Line; Fervers, Béatrice; Philip, Thierry

    2008-04-01

    Patient information is a major challenge for public health. It has become part of the patients' rights, in response to their need for information and involvement in medical decision-making. Since 1998, the French National Federation of Comprehensive Cancer Centres (FNCLCC) has developed an information and education program dedicated to patients and relatives: the SOR SAVOIR PATIENT program. The methodology of the program adheres to the quality criteria established for the elaboration of documents containing patient information. The SOR SAVOIR PATIENT guide Pain and Cancer aims to answer patients' questions regarding cancer specific pain and to help them become actively involved in their care. It was elaborated by a multidisciplinary workgroup, which included methodologists, one linguist, pain specialists and twenty patients and relatives. Patients' information needs and personal experience of pain were assessed using focus groups, semi-structured interviews and questionnaires. Through eight chapters, which can be read in an independent way, Pain and cancer provides key information on the causes, the mechanisms, the evaluation, the prevention and the treatment of pain. The guide also presents advices and practical tools to facilitate the assessment of the pain and the communication between patients and professionals. Finally, this guide aims to overcome ideas such as that morphine is synonymous of end of life or drug addiction, that pain is a sign of aggravation of cancer and that nurses know how to detect the pain. Intended first for the patients and their close relations, Pain and Cancer is also a useful tool for health professionals. Indeed, it presents knowledge based on the most recent recommendations developed for clinical practice. Thanks to a wide distribution of the guide to patients, their families and the professionals, we trust that this guide will facilitate dialogue around pain, and ultimately its care. This article is an abstract of the guide. The complete SOR SAVOIR PATIENT guide can be downloaded from the SOR website at: www.sor-cancer.fr. PMID:18495574

  8. Our youngest patients' pain--from disbelief to belief?

    PubMed

    Zisk, Rachel Yaff

    2003-03-01

    Though human pain has existed since the dawn of time, formal medical pain relief in the form of anesthesia and analgesia has been available only since the mid-nineteenth century. Even after these measures became available, they were used very selectively for the first 100 years of their existence. The youngest patients, especially, were denied pain relief, probably because they could not complain about their pain as articulately and as effectively as adult patients could. A desperate need existed for health care professionals to recognize and appreciate the fact that their youngest patients could suffer immensely and to adequately address the issue. This article reviews the evolution of knowledge and attitudes regarding young patients' pain and addresses why and how this process occurred. The evolution of knowledge was traced by reviewing the literature found in MEDLINE, CINAHL, and LEXIS-NEXIS searches and through hand searches of articles that were frequently cited. Physiologic, pharmacologic, ethical, and psychologic aspects of young patients' pain are addressed. A unique phenomenon arose from the data reviewed. The process of belief and changes in practice were encouraged not only by advances in science, but also by consumer demand. Advances in the past decade in the management of young patients' pain were profound, but are still not complete. Understanding the evolution surrounding pain recognition in young patients provides a stepping stone that can facilitate further improvements in the management of pain in young patients. PMID:12707867

  9. Communication between Health Care Professionals and Chronic Pain Patients Time to change the "Pain Game".

    PubMed

    Lavand'Homme, P

    2015-12-01

    Patient satisfaction is currently used as a comparative measure to evaluate the quality of health care programs. This seems the best way to evaluate results although an important discordance might exist between patient's perception and doctor's opinion regarding satisfactory outcome after surgery, including that after joint replacement. Pain remains a major cause of dissatisfaction for many patients. To understand the meaning of pain, i.e. "why does pain hurt" in some patients but not in other ones, and to decipher -patient's pain expression is a key feature of patient-doctor communication. Questionnaires based on -patient's personality traits (integrated and comprehensive reflection of psychological traits) are still -underused but might help the doctors to get closer to their patients and understand them better. Besides the source of the relationship, dysfunction should not be attributed only to the person with pain, as the lack of doctors' training to capture and understand the psycho-social dimensions of pain can be pointed out too. Failure to address the psycho-social dimensions of patient's pain and suffering, a skill which relies on patients-doctor communication, represents a major socio-economic problem as it may negatively impact postoperative outcome both in terms of poor management of treatment failure and in term of poor prediction of surgical outcome. PMID:26790800

  10. Investigating patient characteristics on pain assessment using virtual human technology.

    PubMed

    Stutts, Lauren A; Hirsh, Adam T; George, Steven Z; Robinson, Michael E

    2010-11-01

    Pain assessment and treatment is challenging and can be influenced by patient demographic characteristics. Few research studies have been able to specifically examine these influences experimentally. The present study investigated the effects of patients' sex, race, age, and pain expression on healthcare students' assessment of pain and pain-related sequelae using virtual human (VH) technology. A lens model design was employed, which is an analogue method for capturing how individuals use environmental information to make judgments. In this study, decision-making policies were captured at the nomothetic and idiographic level. Participants included 107 healthcare students who viewed 32 VH patients that differed in sex, race, age, and pain expression in an online study. Participants provided ratings on a 100-point scale on the VH pain intensity, pain unpleasantness, negative mood, coping, and need for medical treatment. Nomothetic analyses revealed that female, African-American, older, and high pain expression VH were rated higher than male, Caucasian, younger, and low pain expression VH, respectively, on most of the five ratings. Idiographic analyses revealed detailed findings for individuals' decision-making policies. VH technology and the lens model design were shown to be highly effective in examining individuals' decision-making policies. Pain assessment often varied among individuals based on patient demographic and facial expression cues. This study could serve as a model for future investigations of pain assessment and treatment in healthcare students and providers. PMID:20435492

  11. Renal autotransplantation in patients with loin pain–hematuria syndrome

    PubMed Central

    Karvelas, John P.; Ramsey, Ernest W.

    1996-01-01

    Objective To determine if renal autotransplantation is an effective treatment for the loin pain–hematuria syndrome. Design Retrospective chart review. Setting Tertiary care referral centre in Manitoba. Patients Four patients referred for diagnosis and management of loin pain–hematuria syndrome. Follow-up for each of the four was 2, 24, 29 and 48 months. Intervention Renal autotransplantation. Main Outcome Measures Relief of pain with preservation of renal function and blood pressure. Results All four patients experienced relief of the pain of loin pain–hematuria syndrome. Renal function was preserved and blood pressure maintained. Narcotic analgesia was discontinued in all cases. Conclusion Renal autotransplantation appears to be an effective treatment for patients with loin pain–hematuria syndrome. PMID:8769922

  12. Virtual Reality as a Distraction Technique in Chronic Pain Patients

    PubMed Central

    Gao, Kenneth; Sulea, Camelia; Wiederhold, Mark D.

    2014-01-01

    Abstract We explored the use of virtual reality distraction techniques for use as adjunctive therapy to treat chronic pain. Virtual environments were specifically created to provide pleasant and engaging experiences where patients navigated on their own through rich and varied simulated worlds. Real-time physiological monitoring was used as a guide to determine the effectiveness and sustainability of this intervention. Human factors studies showed that virtual navigation is a safe and effective method for use with chronic pain patients. Chronic pain patients demonstrated significant relief in subjective ratings of pain that corresponded to objective measurements in peripheral, noninvasive physiological measures. PMID:24892196

  13. Neuropathic Pain Components in Patients with Lumbar Spinal Stenosis

    PubMed Central

    An, Howard S; Moon, Seong Hwan; Lee, Hwan Mo; Suh, Seung Woo; Chen, Ding; Jeon, Jin Ho

    2015-01-01

    Purpose To determine the prevalence and characteristics of neuropathic pain (NP) in patients with lumbar spinal stenosis (LSS) according to subgroup analysis of symptoms. Materials and Methods We prospectively enrolled subjects with LSS (n=86) who were scheduled to undergo spinal surgery. The patients were divided into two groups according to a chief complaint of radicular pain or neurogenic claudication. We measured patient's pain score using the visual analog scale (VAS), Oswestry Disability Index (ODI) and Leads Assessment of Neuropathic Symptoms and Signs (LANSS). According to LANSS value, the prevalence of NP component pain in patients with LSS was assessed. Statistical analysis was performed to find the relationship between LANSS scores and the other scores. Results From our sample of 86 patients, 31 (36.0%) had a NP component, with 24 (63.4%) in the radicular pain group having NP. However, only seven patients (15.6%) in the neurogenic claudication group had NP. The LANSS pain score was not significantly correlated with VAS scores for back pain, but did correlate with VAS scores for leg pain (R=0.73, p<0.001) and with ODI back pain scores (R=0.54, p<0.01). Conclusion One-third of the patients with LSS had a NP component. The presence of radicular pain correlated strongly with NP. The severity of leg pain and ODI score were also closely related to a NP component. This data may prove useful to understanding the pain characteristics of LSS and in better designing clinical trials for NP treatment in patients with LSS. PMID:26069129

  14. ‘Two Pains Together’: Patient Perspectives on Psychological Aspects of Chronic Pain while Living with HIV

    PubMed Central

    Merlin, Jessica S.; Walcott, Melonie; Ritchie, Christine; Herbey, Ivan; Kertesz, Stefan G.; Chamot, Eric; Saag, Michael; Turan, Janet M.

    2014-01-01

    Objective Chronic pain is common in HIV-infected individuals. Understanding HIV-infected patients’ chronic pain experience not just from a biological, but also from a psychological perspective, is a critical first step toward improving care for this population. Our objective was to explore HIV-infected patients’ perspectives on psychological aspects of chronic pain using in-depth qualitative interviews. Methods Investigators engaged in an iterative process of independent and group coding until theme saturation was reached. Results Of the 25 patients with chronic pain interviewed, 20 were male, 15 were younger than age 50, and 15 were African-American. Key themes that emerged included the close relationship between mood and pain; mood and pain in the context of living with HIV; use of alcohol/drugs to self-medicate for pain; and the challenge of receiving prescription pain medications while dealing with substance use disorders. Conclusions The results suggest that psychological approaches to chronic pain treatment may be well received by HIV-infected patients. PMID:25365306

  15. Distribution of naloxone for overdose prevention to chronic pain patients.

    PubMed

    Coe, Marion A; Walsh, Sharon L

    2015-11-01

    In this commentary, we reflect on the growing opioid overdose epidemic and propose that chronic pain patients prescribed opioids are contributing to growing mortality rates. We advocate for expanding naloxone access and overdose prevention training, which has historically been directed when available to injection drug users, to chronic pain patients who may be at high risk for accidental opioid overdose. PMID:26024850

  16. Amantadine sulfate reduces experimental sensitization and pain in chronic back pain patients.

    PubMed

    Kleinböhl, Dieter; Görtelmeyer, Roman; Bender, Hans-Joachim; Hölzl, Rupert

    2006-03-01

    We investigated if established psychophysical measures of enhanced experimental sensitization in chronic musculoskeletal pain can be reduced by adjuvant treatment with a N-methyl-d-aspartate receptor antagonist, amantadine sulfate, and whether a reduction in sensitization might be accompanied by a concurrent improvement in clinical pain. Sensitization was evaluated by an experimental tonic heat model of short-term sensitization with concurrent subjective and behavioral psychophysical scaling. Twenty-six patients with chronic back pain were included in the randomized, double-blind, placebo-controlled study and received daily dosages of either placebo or 100 mg of amantadine sulfate during a 1-wk treatment. Participants completed quantitative sensory testing of pain thresholds and experimental sensitization before and after treatment and clinical pain ratings before, during, and after treatment. Experimental sensitization and clinical pain were reduced in patients receiving verum. Initially, experimental sensitization was enhanced in patients, with early sensitization at nonpainful intensities of contact heat and enhanced sensitization at painful intensities, as shown previously. After 1 wk of treatment, experimental sensitization was reduced with amantadine sulfate but not with placebo. We conclude that adjuvant chronic pain treatment with N-methyl-d-aspartate receptor antagonists might be beneficial for chronic pain if enhanced sensitization is involved and that the quantitative sensory test of temporal summation may be used to verify this. PMID:16492838

  17. Anterior Knee Pain in Patients with Cerebral Palsy

    PubMed Central

    Choi, Young; Lee, Sang Hyeong; Chung, Chin Youb; Park, Moon Seok; Lee, Kyoung Min; Sung, Ki Hyuk; Won, Sung Hun; Lee, In Hyeok; Choi, In Ho; Cho, Tae-Joon; Yoo, Won Joon

    2014-01-01

    Background The aim of this study was to identify the risk factors for anterior knee pain in patients with cerebral palsy. Methods This prospective study investigated the risk factors for anterior knee pain in 127 ambulatory patients with spastic cerebral palsy in terms of walking pain, resting pain, and provocative pain. Demographic data analysis and physical examination for measuring the knee flexion contracture and unilateral and bilateral popliteal angles were performed. Patellar height was measured on radiographs, and patella alta was identified. The risk factors for anterior knee pain were analyzed using multivariate analysis with a generalized estimating equation. Results Seventy-seven patients were found to have patella alta based on the radiographic measurements (60.6%). Overall, sixteen patients (12.6%) had either unilateral or bilateral anterior knee pain. Of these, 6 patients showed a visual analogue scale (VAS) ? 3, 9 patients showed 3 < VAS ? 7, and one patient showed a VAS > 7. Age was found to be a significant risk factor for walking pain and resting pain with odds ratios (ORs) of 1.08 (95% confidence interval [CI], 1.02 to 1.14) and 1.09 (95% CI, 1.03 to 1.15), respectively. In the multivariate analysis, knee flexion contracture was a significant protective factor with an OR of 0.92 (95% CI, 0.85 to 0.98). Conclusions Approximately 12.6% of ambulatory patients with spastic cerebral palsy were found to have anterior knee pain in our hospital-based cohort study. Age was found to be a significant risk factor for anterior knee pain while walking and resting. PMID:25436067

  18. Substance P and Acute Pain in Patients Undergoing Orthopedic Surgery

    PubMed Central

    Lisowska, Barbara; Siewruk, Katarzyna; Lisowski, Aleksander

    2016-01-01

    Objective There is a limited information about the role of Substance P (SP) in acute pain nociception following surgical stimulation in patients with a chronic inflammatory state not to mention the link between this neuropeptide level changes and intensity of pain. The goal of the research was to find the correlation between SP level changes and acute pain intensity in patients with rheumatoid arthritis undergoing elective orthopedic surgery. Material and Methods Patients with rheumatoid arthritis (RA) were enrolled in the study. The correlation between acute pain intensity and concentration of SP in serum as well as in drainage fluid from postoperative wound was assessed in patients with RA who underwent Total Knee Replacement (TKA) under spinal anesthesia. Results In patients with RA a correlation between intensity of acute pain and serum SP was found postoperatively, whereas there was no correlation between intensity of acute pain and concentration of SP in drainage fluid. Conclusions 1. The correlation between acute pain intensity and SP serum concentration was found postoperatively in patients with RA. 2. The correlation between acute pain intensity and SP concentration in drainage fluid was not found postoperatively in patients with RA. PMID:26731421

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

    PubMed Central

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

    2013-01-01

    The American Society for Pain Management Nursing (ASPMN) has updated its position statement on managing pain in patients with substance use disorders. This position statement is endorsed by the International Nurses Society on Addictions (IntNSA) and includes clinical practice recommendations based on current evidence. It is the position of ASPMN and IntNSA that every patient with pain, including those with substance use disorders, has the right to be treated with dignity, respect, and high quality pain assessment and management. Failure to identify and treat the concurrent conditions of pain and substance use disorders will compromise the ability to treat either condition effectively. Barriers to caring for these patients include stigmatization, misconceptions, and limited access to providers skilled in these two categories of disorders. Topics addressed in this position statement include the scope of substance use and related disorders, conceptual models of addiction, ethical considerations, addiction risk stratification, and clinical recommendations. PMID:22929604

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

    PubMed Central

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

    2014-01-01

    The American Society for Pain Management Nursing (ASPMN) has updated its position statement on managing pain in patients with substance use disorders. This position statement is endorsed by the International Nurses Society on Addictions (IntNSA) and includes clinical practice recommendations based on current evidence. It is the position of ASPMN and IntNSA that every patient with pain, including those with substance use disorders, has the right to be treated with dignity, respect, and high quality pain assessment and management. Failure to identify and treat the concurrent conditions of pain and substance use disorders will compromise the ability to treat either condition effectively. Barriers to caring for these patients include stigmatization, misconceptions, and limited access to providers skilled in these two categories of disorders. Topics addressed in this position statement include the scope of substance use and related disorders, conceptual models of addiction, ethical considerations, addiction risk stratification, and clinical recommendations. PMID:24335741

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

    PubMed

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

    2012-10-01

    The American Society for Pain Management Nursing (ASPMN) has updated its position statement on managing pain in patients with substance use disorders. This position statement is endorsed by the International Nurses Society on Addictions (IntNSA) and includes clinical practice recommendations based on current evidence. It is the position of ASPMN and IntNSA that every patient with pain, including those with substance use disorders, has the right to be treated with dignity, respect, and high-quality pain assessment and management. Failure to identify and treat the concurrent conditions of pain and substance use disorders will compromise the ability to treat either condition effectively. Barriers to caring for these patients include stigmatization, misconceptions, and limited access to providers skilled in these two categories of disorders. Topics addressed in this position statement include the scope of substance use and related disorders, conceptual models of addiction, ethical considerations, addiction risk stratification, and clinical recommendations. PMID:24335741

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

    PubMed Central

    Lauridsen, Henrik H; Hartvigsen, Jan; Manniche, Claus; Korsholm, Lars; Grunnet-Nilsson, Niels

    2006-01-01

    Background The choice of an evaluative instrument has been hampered by the lack of head-to-head comparisons of responsiveness and the minimal clinically important difference (MCID) in subpopulations of low back pain (LBP). The objective of this study was to concurrently compare responsiveness and MCID for commonly used pain scales and functional instruments in four subpopulations of LBP patients. Methods The Danish versions of the Oswestry Disability Index (ODI), the 23-item Roland Morris Disability Questionnaire (RMQ), the physical function and bodily pain subscales of the SF36, the Low Back Pain Rating Scale (LBPRS) and a numerical rating scale for pain (0–10) were completed by 191 patients from the primary and secondary sectors of the Danish health care system. Clinical change was estimated using a 7-point transition question and a numeric rating scale for importance. Responsiveness was operationalised using standardardised response mean (SRM), area under the receiver operating characteristic curve (ROC), and cut-point analysis. Subpopulation analyses were carried out on primary and secondary sector patients with LBP only or leg pain +/- LBP. Results RMQ was the most responsive instrument in primary and secondary sector patients with LBP only (SRM = 0.5–1.4; ROC = 0.75–0.94) whereas ODI and RMQ showed almost similar responsiveness in primary and secondary sector patients with leg pain (ODI: SRM = 0.4–0.9; ROC = 0.76–0.89; RMQ: SRM = 0.3–0.9; ROC = 0.72–0.88). In improved patients, the RMQ was more responsive in primary and secondary sector patients and LBP only patients (SRM = 1.3–1.7) while the RMQ and ODI were equally responsive in leg pain patients (SRM = 1.3 and 1.2 respectively). All pain measures demonstrated almost equal responsiveness. The MCID increased with increasing baseline score in primary sector and LBP only patients but was only marginally affected by patient entry point and pain location. The MCID of the percentage change score remained constant for the ODI (51%) and RMQ (38%) specifically and differed in the subpopulations. Conclusion RMQ is suitable for measuring change in LBP only patients and both ODI and RMQ are suitable for leg pain patients irrespectively of patient entry point. The MCID is baseline score dependent but only in certain subpopulations. Relative change measured using the ODI and RMQ was not affected by baseline score when patients quantified an important improvement. PMID:17064410

  3. Experimental Pain Responses Support Peripheral and Central Sensitization in Patients with Unilateral Shoulder Pain

    PubMed Central

    Coronado, Rogelio A.; Simon, Corey B.; Valencia, Carolina; George, Steven Z.

    2013-01-01

    Objective The aims of this study were to 1) examine the pattern of experimental pain responses in the affected and non-affected extremities in patients with shoulder pain and 2) explore the intra-individual association between sensitization states derived from experimental pain testing. Methods Experimental pain responses from 58 patients with shoulder pain (17 females, ages 18 to 52) were compared to those from 56 age- and sex-matched healthy volunteers (16 females, ages 21 to 58). Experimental pain responses included pressure pain threshold (PPT), thermal pain threshold and tolerance, and suprathreshold heat pain response (SHPR). Comparisons were made between the affected and non-affected extremity of clinical participants and the average response of extremities in healthy participants. Peripheral and central sensitization indexes were computed for clinical participants using standardized scores and percentile cut-offs based on the data from the healthy control sample. Experimental pain responses in clinical participants observed beyond the 25th and 75th percentile of healthy control sample responses were used for investigation of intra-individual association of sensitization states. Results PPT on the affected side acromion and masseter of clinical participants were diminished compared to their non-affected side (p < 0.015). Bilateral sensitivity in clinical participants was noted for PPT at the acromion and SHPR (p < 0.015). Peripheral and central sensitization indexes demonstrated that individuals with shoulder pain present with variable patterns of peripheral and central sensitization. Conclusions Collectively, experimental pain responses supported peripheral and central sensitization in response to pressure and thermal stimuli. No clear association was made between individuals exhibiting peripheral or central sensitization and suggests heterogeneity in pain processing in this clinical population. PMID:23619203

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

    PubMed

    Korhan, Esra Ak?n; Uyar, Meltem; Eyigör, Can; Hakverdio?lu Yönt, Gülendam; Çelik, Serkan; Khorsh?d, Leyla

    2014-03-01

    The aim of this study was to investigate the effect of relaxing music on pain intensity in patients with neuropathic pain. A quasi-experimental study, repeated measures design was used. Thirty patients, aged 18-70 years, with neuropathic pain and hospitalized in an Algology clinic were identified as a convenience sample. Participants received 60 minutes of music therapy. Classical Turkish music was played to patients using a media player (MP3) and headphones. Participants had pain scores taken immediately before the intervention and at the 30th and 60th minutes of the intervention. Data were collected over a 6-month period in 2012. The patients' mean pain intensity scores were reduced by music, and that decrease was progressive over the 30th and 60th minutes of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of music therapy in the routine care of patients with neuropathic pain could provide nurses with an effective practice for reducing patients' pain intensity. PMID:23375348

  5. Pain management in veterinary patients with cancer.

    PubMed

    Fan, Timothy M

    2014-09-01

    Pain is a widespread clinical symptom in companion animals with cancer, and its aggressive management should be a priority. Education and skills can be acquired by health care professionals and caregivers to better understand, recognize, and treat cancer-associated pain. The early and rational institution of multimodality analgesic protocols can be highly effective and maximize the chances of improving quality of life in dogs and cats with cancer. This article describes the pathophysiology of pain in companion animals diagnosed with cancer. The foundational causes of cancer-associated pain and treatment strategies for alleviating discomfort in companion animals with cancer are discussed. PMID:25174912

  6. The Impact of Pain on Patient and Physician

    PubMed Central

    Longhurst, Mark F.

    1984-01-01

    A patient's pain has lost its status as an expression of personal suffering and is seen by both physician and patient as a strictly physical attribute. Because of this, their communication may become oblique and subversive, effectively destroying a therapeutic relationship. The patient's failure to recover causes the physician to suffer unease and begin assuming pain-reducing postures of anger, indifference and assertiveness. The physician, to avoid this scenario, must acknowledge the existential component of the patient's pain, the reality of his own discomfort, and be open enough to give personal suffering a place in the relationship. PMID:21279065

  7. Nurse-led pain management program: effect on self-efficacy, pain intensity, pain-related disability, and depressive symptoms in chronic pain patients.

    PubMed

    Wells-Federman, Carol; Arnstein, Paul; Caudill, Margaret

    2002-12-01

    Nurses routinely use a variety of nonpharmacologic and patient education interventions designed to reduce pain and promote independence. Research on group programs that combine these nursing strategies in a systematic approach provides evidence that chronic pain patients can realize an enhanced confidence in their ability to manage pain (improved self-efficacy) in addition to reductions in pain, emotional distress, and disability. The purpose of this study was to investigate the effect of participating in a nurse-led cognitive-behavioral treatment (CBT) pain management program on self-efficacy, pain intensity, pain-related disability, and depressive symptoms among patients with chronic pain. Pre- and postprogram data from 154 participants were examined to identify changes in pain intensity, self-efficacy, disability, and depressive symptoms. Mean differences, effect sizes, and 95% confidence intervals were computed for the study variables and paired t-tests were done to determine if changes were significant. Z-scores were then calculated. Pearson product moment correlations were examined to test the association between changes in self-efficacy and changes in the other variables of interest. Patients in this study reported significant improvements in all scores postprogram. Self-efficacy, pain-intensity, pain-related disability, and symptoms of depression can be changed through participation in a nurse-led outpatient CBT program. In concert with results from other research on CBT pain programs this study provides further evidence that reduction in suffering and improved sense of well-being is possible even for people who have experienced pain for many years. PMID:12454805

  8. Safety of "pain exposure" physical therapy in patients with complex regional pain syndrome type 1.

    PubMed

    van de Meent, Hendrik; Oerlemans, Margreet; Bruggeman, Almar; Klomp, Frank; van Dongen, Robert; Oostendorp, Rob; Frölke, Jan Paul

    2011-06-01

    "Pain exposure" physical therapy (PEPT) is a new treatment for patients with complex regional pain syndrome type 1 (CRPS-1) that consists of a progressive-loading exercise program and management of pain-avoidance behavior without the use of specific CRPS-1 medication or analgesics. The aim of this study was to investigate primarily whether PEPT could be applied safely in patients with CRPS-1. Twenty patients with CRPS-1 were consecutively enrolled in the study after giving informed consent. The diagnosis of CRPS-1 was defined using the Bruehl and Harden/IASP diagnostic criteria. CRPS-1 was diagnosed between 3 and 18 months after the inciting event (trauma). According to a multiple single-case design (baseline [A1], treatment [B], follow-up [A2]), multiple baseline and follow-up measurements were performed to evaluate changes in CRPS signs and symptoms and to assess functional parameters. When comparing the baseline with the follow-up phase, patients improved significantly with respect to pain on the visual analogue scale (57%), pain intensity (48%), muscle strength (52%), arm/shoulder/hand disability (36%), 10-meter walking speed (29%), pain disability index (60%), kinesiophobia (18%), and the domains of perceived health change in the SF-36 survey (269%). Three patients initially showed increased vegetative signs but improved in all other CRPS parameters and showed good functional recovery at follow-up. We conclude that PEPT is a safe and effective treatment for patients with CRPS-1. A progressive-loading exercise program and management of pain-avoidance behavior without the use of specific medication ("pain exposure" physical therapy) is safe and effective for patients with complex regional pain syndrome. PMID:21474244

  9. Opioid use behaviors, mental health and pain-Development of a typology of chronic pain patients*

    PubMed Central

    Banta-Green, Caleb J.; Merrill, Joseph O.; Doyle, Suzanne R.; Boudreau, Denise M.; Calsyn, Donald A.

    2009-01-01

    Background The intersection of pain, addiction and mental health has not been adequately described. We describe the roles of these three conditions in a chronic pain patient population using opioid analgesics. Aims were to improve our understanding of this population as well as to explore ways of identifying different types of patients. Methods We conducted a retrospective cohort study in a large integrated group medical practice in Washington State with persons using opioids chronically (n=704). Patient classes were derived with latent class analysis using factors representing DSM-IV opioid abuse and dependence, opioid misuse, pain, anxiety and depression. Regression analyses explored the utility of automated and interview data to distinguish the empirically-derived patient groups. Results Three classes were identified: a Typical group, the substantial majority that had persistent, moderate mental health and pain symptoms; an Addictive Behaviors group with elevated mental health symptoms and opioid problems, but pain similar to the Typical class; and a Pain Dysfunction class with significantly higher pain interference as well as elevated mental health and opioid problems. Prescribed average daily dose of opioids was three times higher for those in the two atypical groups and was strongly associated with class membership after adjusting for other variables. Conclusion We describe three distinct types of patient classes as well as data elements that could help identify the two atypical types. Further research is needed to confirm these findings and determine the utility of this approach in other clinical settings. PMID:19473786

  10. Painful prosthesis: approaching the patient with persistent pain following total hip and knee arthroplasty

    PubMed Central

    Piscitelli, Prisco; Iolascon, Giovanni; Innocenti, Massimo; Civinini, Roberto; Rubinacci, Alessandro; Muratore, Maurizio; D’Arienzo, Michele; Leali, Paolo Tranquilli; Carossino, Anna Maria; Brandi, Maria Luisa

    2013-01-01

    Summary Background Symptomatic severe osteoarthritis and hip osteoporotic fractures are the main conditions requiring total hip arthroplasty (THA), whereas total knee arthroplasty (TKA) is mainly performed for pain, disability or deformity due to osteoarthritis. After surgery, some patients suffer from “painful prosthesis”, which currently represents a clinical problem. Methods A systematic review of scientific literature has been performed. A panel of experts has examined the issue of persistent pain following total hip or knee arthroplasty, in order to characterize etiopathological mechanisms and define how to cope with this condition. Results Four major categories (non infective, septic, other and idiopathic causes) have been identified as possible origin of persistent pain after total joint arthroplasty (TJA). Time to surgery, pain level and function impairment before surgical intervention, mechanical stress following prosthesis implant, osseointegration deficiency, and post-traumatic or allergic inflammatory response are all factors playing an important role in causing persistent pain after joint arthroplasty. Diagnosis of persistent pain should be made in case of post-operative pain (self-reported as VAS ≄3) persisting for at least 4 months after surgery, or new onset of pain (VAS ≄3) after the first 4 months, lasting ≄2 months. Acute pain reported as VAS score ≄7 in patients who underwent TJA should be always immediately investigated. Conclusions The cause of pain needs always to be indentified and removed whenever possible. Implant revision is indicated only when septic or aseptic loosening is diagnosed. Current evidence has shown that peri-and/or post-operative administration of bisphosphonates may have a role in pain management and periprosthetic bone loss prevention. PMID:24133526

  11. Myofascial pain in patients waitlisted for total knee arthroplasty

    PubMed Central

    Henry, Richard; Cahill, Catherine M; Wood, Gavin; Hroch, Jennifer; Wilson, Rosemary; Cupido, Tracy; VanDenKerkhof, Elizabeth

    2012-01-01

    BACKGROUND: Knee pain is one of the major sources of pain and disability in developed countries, particularly in aging populations, and is the primary indication for total knee arthroplasty (TKA) in patients with osteoarthritis (OA). OBJECTIVES: To determine the presence of myofascial pain in OA patients waitlisted for TKA and to determine whether their knee pain may be alleviated by trigger point injections. METHODS: Following ethics approval, 25 participants were recruited from the wait list for elective unilateral primary TKA at the study centre. After providing informed consent, all participants were examined for the presence of active trigger points in the muscles surrounding the knee and received trigger point injections of bupivacaine. Assessments and trigger point injections were implemented on the first visit and at subsequent visits on weeks 1, 2, 4 and 8. Outcome measures included the Timed Up and Go test, Brief Pain Inventory, Centre for Epidemiologic Studies Depression Scale, State-Trait Anxiety Inventory and Short-Form McGill Pain Questionnaire. RESULTS: Myofascial trigger points were identified in all participants. Trigger point injections significantly reduced pain intensity and pain interference, and improved mobility. All participants had trigger points identified in medial muscles, most commonly in the head of the gastrocnemius muscle. An acute reduction in pain and improved functionality was observed immediately following intervention, and persisted over the eight-week course of the investigation. CONCLUSION: All patients had trigger points in the vastus and gastrocnemius muscles, and 92% of patients experienced significant pain relief with trigger point injections at the first visit, indicating that a significant proportion of the OA knee pain was myofascial in origin. Further investigation is warranted to determine the prevalence of myofascial pain and whether treatment delays or prevents TKA. PMID:23061082

  12. Non-Coronary Patients with Severe Chest Pain Show More Irrational Beliefs Compared to Patients with Mild Pain

    PubMed Central

    Bahremand, Mostafa; Saeidi, Mozhgan

    2015-01-01

    Background Despite providing insufficient medical evidence of the existence of a real cardiac condition, patients with non-coronary chest pain still interpret their pain incorrectly. The present study, therefore, sought to compare the irrational beliefs in non-coronary patients with mild chest pain against those with severe chest pain. Methods A cross-sectional design was used. The statistical population comprised non-coronary patients who presented to the Heart Emergency Center of Kermanshah city, Iran. Using a matching method, 96 participants were selected and studied in two groups of 48. The instruments used were the Comorbidity Index, Brief Pain Index, and the Jones Irrational Beliefs Test (short-form). The multivariate analysis of variance, chi-square test, and t-test were used for data analysis. Results Controlling for the effects of age and comorbid conditions, the severity of three types of irrational beliefs, including emotional irresponsibility (P<0.001), hopelessness changes (P<0.001), and problem avoiding (P=0.002) was higher among patients with severe chest pain (according to effect level). However, in terms of demand for approval, no difference was seen between the two groups (P=0.180). Conclusion Non-coronary patients with severe chest pain showed a greater number of irrational beliefs in comparison to patients with mild pain. Irrational beliefs are common mental occurrences in patients with non-coronary chest pain, and they should be attended to by health professionals, especially in severe non-coronary chest pain. Further investigation to determine the association between irrational beliefs and non-coronary chest pain is necessary. PMID:26217482

  13. Pain Management Issues for the Geriatric Surgical Patient.

    PubMed

    McKeown, Jason L

    2015-09-01

    Adequate treatment of pain is of utmost importance in making uncomplicated the perioperative course for geriatric surgical patients. Effective analgesia reduces morbidity, improves patient and family satisfaction, and is a natural expectation of high-quality care. Pain treatment in older adults is more complicated than in younger counterparts, and great consideration must be given to age-related changes in physiology and pharmacokinetics. Pain treatment must be individualized based on each patient's profile. Side effects must be minimized and organ toxicity avoided. When complications occur they may be more severe, and treatment must be prompt. Alternative plans for analgesia must be readily enacted. PMID:26315638

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

    PubMed

    Morgan, Betty D

    2014-03-01

    The problem of inadequate pain management in hospitals is well documented. Patients who have substance use disorders (SUD) have many medical problems and are often in pain as a result of these problems. Nurses often lack knowledge of appropriate treatment of both pain and SUD, and have been identified as having negative attitudes toward patients with SUD. The negative attitudes may affect the quality of care delivered to patients with problems of pain and SUD. The purpose of this study was to identify and explore nurses' attitudes toward hospitalized patients with SUD who are in pain, to expand the knowledge about nurses' attitudes and interactions with patients with SUD in pain, and to generate theory that will contribute to a greater understanding of the problem. Grounded theory methodology was used to interview hospital-based nurses who work with patients with SUD who are in pain. Individual interviews, using a semistructured interview guide, were conducted with 14 nurses who worked with this population. Additionally, an expert addictions nurse was interviewed at the end of the study to validate the findings. Interviews were analyzed and coded with the use of grounded theory concepts. A model illustrating the categories and their relationships was developed based on the theory generated as a result of the study. The implications for nursing practice, education, research, and policy are discussed. PMID:24602434

  15. Neuropathic Pain in Patients with Upper-Extremity Nerve Injury

    PubMed Central

    Katz, Joel

    2010-01-01

    ABSTRACT Purpose: The purpose of this review was to present an analysis of the literature of the outcome studies reported in patients following traumatic upper-extremity (UE) nerve injuries (excluding amputation), to assess the presence of an association between neuropathic pain and outcome in patients following traumatic UE nerve injuries, and to provide recommendations for inclusion of more comprehensive outcome measures by clinicians who treat these patients. Summary of Key Points: A Medline and CINAHL literature search retrieved 48 articles. This review identified very few studies of patients with peripheral nerve injury that reported neuropathic pain. When pain was reported, visual analogue or numeric rating scales were most frequently used; standardized questionnaires measuring pain or psychosocial function were rarely administered. Recent evidence shows substantial long-term disability and pain in patients following peripheral nerve injury. Recommendation: To better understand neuropathic pain in patients following peripheral nerve injury, future outcome studies should include valid, reliable measures of physical impairment, pain, disability, health-related quality of life, and psychosocial functioning. PMID:21629596

  16. Changes in proprioception and pain in patients with neck pain after upper thoracic manipulation

    PubMed Central

    Yang, Jinmo; Lee, Byoungkwon; Kim, Changbeom

    2015-01-01

    [Purpose] The purpose of this study was to conduct cervical stability training and upper thoracic manipulation for patients with chronic neck pain and then investigate the changes of cervical proprioception and pain. [Subjects and Methods] Subjects were 30 workers with mechanical neck pain, who were randomly divided into an upper thoracic manipulation group and a cervical stability training group. Upper thoracic manipulation after cervical stability training was conducted for the upper thoracic manipulation group, and only stability training was conducted for the cervical stability training group. The intervention period was six weeks, and consisted of three sessions a week, each of which lasted for 30 minutes. For proprioception measurement, an electro-goniometer was used to measure reposition sense before and after the intervention. The visual analogue scale was used to assess pain. [Results] After the intervention, the error angle was significantly smaller in flexion and right left side-bending, and pain was significantly reduced in the upper thoracic manipulation group. According to the post intervention comparison of the two groups, there were significant differences in the proprioception and pain values. [Conclusion] Conducting both cervical stability training and upper thoracic manipulation for patients with chronic neck pain was more helpful for the improvement of proprioception and pain than cervical stability training alone. PMID:25931733

  17. Effects of shoulder stabilization exercise on pain and function in patients with neck pain

    PubMed Central

    Lee, Youna; Shin, Mary Myong Sook; Lee, Wanhee

    2015-01-01

    [Purpose] The objective of this study was to investigate the effects of shoulder stability exercise on pain and function in neck pain patients. [Subjects] The study design consisted of a shoulder stability exercise group and a control group. [Methods] The effects of the therapies were evaluated using a visual analog scale of pain, a pressure pain threshold, neck disability index, cervical range of motion, and a closed kinetic chain test. Each group received treatment five times per week for 4 weeks. [Results] Pain levels showed no significant differences between groups, while pain threshold in all muscles, showed significant increases for both control groups. Neck disability significantly decreased for both groups and the differences between the groups were statistically significant. Ranges of motion and limb stability were measured before and after the exercise period. Flexion, extension, and right rotation were not significantly different between groups. The results showed no significant differences in shoulder stability between the groups. [Conclusion] The use of this exercise should have pronounced effects on pain reduction and functional improvement and should also improve the quality of life in patients with neck pain. PMID:26834317

  18. Pain Among High-Risk Patients on Methadone Maintenance Treatment.

    PubMed

    Voon, Pauline; Hayashi, Kanna; Milloy, M-J; Nguyen, Paul; Wood, Evan; Montaner, Julio; Kerr, Thomas

    2015-09-01

    The complexity of treating concurrent pain and opioid dependence among many methadone-maintained individuals presents a major challenge in many clinical settings. Furthermore, recent expert guidelines have called for increased research on the safety of methadone in the context of chronic pain. This study explores the prevalence and correlates of pain among a prospective cohort of people who use illicit drugs in Vancouver, British Columbia, Canada, who reported enrollment in methadone maintenance treatment (MMT) between 2011 and 2014. Among the 823 participants eligible for this analysis, 338 (40.9%) reported moderate pain and 91 (11.1%) reported extreme pain at the first study visit. In multivariable, generalized, linear mixed model analyses, higher pain severity was positively and independently associated with self-managing pain (adjusted odds ratio [AOR] 2.15, 95% confidence interval [CI] 1.77-2.60), patient perception of methadone dose being too low (AOR 1.82, 95% CI 1.41-2.34), older age (AOR 1.31, 95% CI 1.13-1.51), having a physical disability (AOR 4.59, 95% CI 3.73-5.64), having ever been diagnosed with a mental illness (AOR 1.44, 95% CI 1.13-1.84), white ethnicity (AOR 1.42, 95% CI 1.10-1.83), and marijuana use (AOR 1.25, 95% CI 1.02-1.52). These findings suggest several areas for clinical intervention, particularly related to patient education and alternative analgesic approaches for MMT patients experiencing pain. Perspective: To better understand the complexity of concurrent pain and opioid dependency among individuals on methadone maintenance treatment, this article describes the prevalence and correlates of higher pain severity among methadone-maintained people who use illicit drugs. Patients on methadone with comorbid pain may benefit from education and alternative analgesic approaches. PMID:26101814

  19. Intensity of pain due to separators in adolescent orthodontic patients

    PubMed Central

    Aldrees, Abdullah M.

    2015-01-01

    Objective: To investigate the intensity of pain adolescent orthodontic patients experience following the insertion of separators. Materials and Methods: Elastomeric separators were placed mesially and distally to the first molars in 62 adolescents (20 male, 42 female, age 12–15 years), and the participants were given self-administrated questionnaires to document perceived pain, pain upon chewing, and the severity of pain's affecting daily life, using a visual analog scale for seven days. Results: The mean perceived pain scores out of 100 on the first 3 days were 54.6 ± 32.7, 51.7 ± 29.9, and 32.3 ± 28.4, respectively; chewing pain scores were: 61.9 ± 35.3, 52.6 ± 30.4, and 39.5 ± 32.1, respectively; the pain's affecting daily life scores were 24.9 ± 35.5, 21.1 ± 30.9, and 11.9 ± 23.7, respectively. A Kruskal–Wallis test showed a statistically significant difference in the reported pain between the three studied parameters. A Mann–Whitney U-test showed an insignificant difference between male and female adolescents. Conclusion: Pain perception varies among adolescent patients, but it decreases significantly after the first 2 days, with no gender differences.

  20. Prefrontal cortical hyperactivity in patients with sympathetically mediated chronic pain.

    PubMed

    Apkarian, A V; Thomas, P S; Krauss, B R; Szeverenyi, N M

    2001-10-01

    Chronic pain continues to impose a large burden of suffering, yet its neural correlates remain poorly understood. In sympathetically mediated chronic pain (SMP), peripheral sympathetic blockade temporarily relieves this pain, so that related neural activity can be studied without perturbing sensory inputs. We used functional magnetic resonance imaging and thermal painful stimuli applied to the chronically painful body site, before and after sympathetic blockade, to examine the cortical network of chronic pain. The chronic SMP state was associated with a widely spread prefrontal hyperactivity, increased anterior cingulate activity and decreased activity in the thalamus contralateral to the body side suffering from SMP, but was unrelated to sensorimotor activity. Ineffective sympathetic blocks, i.e. blocks that did not diminish the SMP pain, did not change the cortical responses to the painful thermal stimulus; while effective placebo resulted in similar responses to those of effective blocks. These findings provide evidence for abnormal brain responses to pain in patients with chronic SMP, which engages prefrontal/limbic networks more extensively than in acute pain-states. PMID:11578827

  1. Prediction of Quality of life by Self-Efficacy, Pain Intensity and Pain Duration in Patient with Pain Disorders

    PubMed Central

    Yazdi-Ravandi, Saeid; Taslimi, Zahra; Jamshidian, Narges; Saberi, Hayede; Shams, Jamal; Haghparast, Abbas

    2013-01-01

    The quality of life (QOL) has been defined as “a person's sense of well-being that stems from satisfaction or dissatisfaction with the areas of life that are important to him/her”. It is generally accepted that pain intensity and duration have a negative impact on the QOL. One specific type of control is “self-efficacy”, or the belief that one has the ability to successfully engage in specific actions. The ability to adapt to pain may play an important role in maintaining the QOL. In this study, we investigated the role of self-efficacy, pain intensity, and pain duration in various domains of quality of life such as physical, psychological, social and environmental domains. In this study, 290 adult patients (146 men, 144 women) completed coping self-efficacy and the WHOQOL-BREF Questionnaire. Moreover, we illustrated numerical rating scale for pain intensity. The results were analyzed using SPSS version of 19.0 and means, descriptive correlation, and regression were calculated. Our data revealed that self-efficacy but not the pain duration could significantly anticipate the QOL and its four related domains (P<0.001). In addition, it is noticeable that the effect of self-efficacy on the prediction of QOL is much more obvious in the psychological domain. However, the pain intensity could predict all of the QOL domains (P<0.001) except social and environmental ones. In conclusion, to predict the quality of life (QOL) in person suffering from chronic pain, self-efficacy and pain intensity are more important factors than the pain duration and demographic variables. PMID:25337337

  2. Many Patients with Cancer Need Better Treatments for Pain

    Cancer.gov

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

  3. For Cancer Patients, Pain May Rise as Finances Dwindle

    MedlinePLUS

    ... Care Task Force. Stress is "tightly connected to perceptions of pain," Schnipper said, noting cancer patients face "intense worry because of all the other obligations people have caring for themselves through what ...

  4. Pain Relief Advice May Help ER Patients with Terminal Cancer

    MedlinePLUS

    ... who received usual care in the emergency department. Palliative care is a type of therapy for very ill patients with the goal of offering support and pain relief without attempting to cure the underlying cause ...

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

    SciTech Connect

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

    2010-11-01

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

  6. Implementation of Later Morning Specimen Draws to Improve Patient Health and Satisfaction.

    PubMed

    Ramarajan, Vasundara; Chima, Harjinder S; Young, LaWanda

    2016-02-01

    Traditionally, morning blood draws are collected by hospital staff from 3:00 AM through 6:00 AM to have the results ready by 9:00 AM for physician rounds. These laboratory results help physicians to make important patient disposition decisions, including discharging patients within the daily hospital cutoff times. However, morning draws can adversely impact patient care due to sleep disruption. In this paper, we describe the systematic implementation of later-morning blood draw times at our large urban hospital. The sustainability of this shift was of special concern to us, so we used the rapid improvement model (RIM) of change to ensure that every aspect was tested and that the changes were viable. The RIM model enabled us to successfully implement the change in 6 months and sustained this change until the present time. PMID:26656891

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

    PubMed

    Kenny, Dianna T; Faunce, Gavin

    2004-01-01

    This study explored the impact of group singing on mood, coping, and perceived pain in chronic pain patients attending a multidisciplinary pain clinic. Singers participated in nine 30-minute sessions of small group singing, while comparisons listened to music while exercising. A short form of The Profile of Mood States (POMS) was administered before and after selected singing sessions to assess whether singing produced short-term elevations in mood. Results indicated that pre to post difference scores were significantly different between singing and control groups for only one of the 15 mood variables (i.e., uneasy). To test the longer term impacts of singing the Profile of Mood States, Zung Depression Inventory, Pain Self-Efficacy Questionnaire, Pain Rating Self-Statement, and Pain Disability Questionnaire were administered immediately before and after the singing sessions. All inventories other than the POMS were re-administered 6 months later. One-way ANCOVAs indicated that participants who attended the singing sessions showed evidence of postintervention improvements in active coping, relative to those who failed to attend, when preintervention differences in active coping were controlled for. While the singing group showed marked improvements from pre to postintervention on all mood, coping, and perceived pain variables, these improvements were also observed among comparison participants. The results of this study suggest that active singing may have some benefits, in terms of enhancing active coping, though the limitations of the study and small effect sizes observed suggest that further research is required to fully explore such effects. PMID:15327342

  8. Pain Catastrophizing, Pain Intensity, and Dyadic Adjustment Influence Patient and Partner Depression in Metastatic Breast Cancer

    PubMed Central

    Badr, Hoda; Shen, Megan J.

    2015-01-01

    Objective Metastatic breast cancer can be challenging for couples given the significant pain and distress caused by the disease and its treatment. While the use of catastrophizing (e.g., ruminating, exaggerating) as a pain coping strategy has been associated with depression in breast cancer patients, little is known about the effects of pain intensity on this association. Moreover, even though social relationships are a fundamental resource for couples coping with cancer, no studies have examined whether the quality of the spousal relationship affects the association between catastrophizing and depression. This study prospectively examined these associations. Methods Couples (N=191) completed surveys at the start of treatment for metastatic breast cancer (baseline), and 3 and 6 months later. Results Multilevel models using the couple as the unit of analysis showed patients and partners (i.e., spouses or significant others) who had high levels (+1SD) of dyadic adjustment (DAS7) experienced fewer depressive symptoms than those who had low levels (?1SD) of dyadic adjustment (ps<.01). Moreover, at low levels of dyadic adjustment, when patients engaged in high levels of catastrophizing and had high levels of pain, both patients and their partners reported significantly (p=.002) higher levels of depression than when patients engaged in high levels of catastrophizing but had low levels of pain. Discussion Findings showed that catastrophizing and pain exacerbate depression in couples experiencing marital distress. Programs that seek to alleviate pain and depressive symptoms in metastatic breast cancer may benefit from targeting both members of the couple, screening for marital distress, and teaching more adaptive pain coping strategies. PMID:24402001

  9. Practical management strategies for the chronic pain patient.

    PubMed

    Forde, Grace; Stanos, Steven

    2007-08-01

    When presented with a chronic pain patient, a thorough diagnostic workup and clinical assessment are essential. A key component of this initial evaluation is to obtain the information necessary to identify the underlying cause of the pain. Although a definitive diagnosis is not always possible, pain is most effectively managed when the underlying cause is identified. Chronic pain is now viewed as a biopsychosocial phenomenon, in which biological, psychological, and social factors are at work. Although one or more chronic diseases may be responsible for at least some of the pain experienced by chronic pain patients, psychological factors also play a prominent role. According to several published reports, major depression occurs in up to 60% of chronic pain patients, and an adjustment disorder with anxious mood can be found in up to nearly a third. In addition, numerous studies have identified a high rate of substance abuse in those suffering from chronic pain, with lifetime prevalence rates ranging from 23% to 41%, according to one source. A pain history is another essential component of the initial workup. A thorough pain history includes questions on any previous therapies tried (including nonpharmacologic interventions) and the success rate of those therapies, an assessment of patient function and overall quality of life, and a review of any personal or family history of substance abuse. One of the complexities of pain diagnosis is the subjective nature of the condition. Simple validated measures, such as the 0 to 10 numerical scale, pictorial scales (eg, faces), and visual analog scales can assist in the assessment of pain intensity and the guidance of subsequent treatments. Of no less relevance in the initial workup of a patient with chronic pain is the establishment of a secure physician-patient relationship. Open and clear communication between these parties is a key component in the treatment process and will help guide the therapy more safely and efficaciously. Realistic expectations and exit strategies for each therapeutic intervention should also be discussed at the initial evaluation and again at the onset of treatment. PMID:18667140

  10. Care of the patient with chronic pain: Part I.

    PubMed

    Wells-Federman, C L

    1999-07-01

    Chronic nonmalignant pain is estimated to affect over 50 million Americans. It frequently results in significant physical, behavioral, psychological, social, and spiritual problems for patients and their families. In spite of its prevalence and consequences, chronic pain is often misunderstood and inadequately managed by healthcare professionals. Advanced practice nurses who are knowledgeable about chronic pain and the complex biopsychosocial-spiritual needs of this patient population serve an important role in recognizing these patients and intervening appropriately in their care. The purpose of this two-part article is to provide that information. Part I outlines the pathophysiology, assessment, biopsychosocial-spiritual aspects, and pharmacological treatment of chronic pain. Part II addresses a variety of nonpharmacologic and self-management interventions one can use in the primary care setting to treat these difficult health problems. PMID:10711057

  11. Vulnerability in Clinical Research with Patients in Pain

    PubMed Central

    Tait, Raymond C.

    2011-01-01

    Some have characterized patients living with intractable pain as a vulnerable population in both clinical and research settings. Labeling the population as vulnerable, however, does not provide clarity regarding the potential risks that they face when they participate in research. Instead, research vulnerability for patients in pain is a function of an interaction between their pain conditions and elements of the research enterprise. Therefore, the identification of potential risks requires consideration not only of characteristics of patients with chronic pain, but also consideration of features of researchers, the quality of institutional oversight, and the medical/social environment within which the research is conducted. This paper provides an analysis of those risks and provides some suggestions as to how the risks might be better managed. PMID:19245603

  12. [Medial pain syndrome in patients with total ankle replacement].

    PubMed

    Barg, A; Suter, T; Zwicky, L; Knupp, M; Hintermann, B

    2011-11-01

    Total ankle replacement is an increasingly recommended treatment for patients with end-stage ankle osteoarthritis. The increasing experience with this procedure explains its acceptance as a therapeutic option in complex cases as part of reconstruction surgery. However, the complication rate including failure of the prosthesis should not be underestimated. Previous studies have shown that most patients developed ankle osteoarthritis secondary to previous trauma. Patients with posttraumatic osteoarthritis often have varus or valgus misalignment of the hindfoot. In cases with incorrectly addressed hindfoot misalignment and/or incorrectly positioned prosthesis components, pain may remain postoperatively because of biomechanical dysbalance and asymmetrical load. The pain is mostly localized on the medial side the so-called medial pain syndrome.The following classification of the medial pain syndrome has been established in our practice: type I medial impingement/contracture of medial ligaments, type II valgus deformity, type III varus deformity, type IV combined varus-valgus deformity. PMID:21989688

  13. Characteristics and associations of pain intensity in patients referred to a specialist cancer pain clinic

    PubMed Central

    Pina, Paulo; Sabri, Elham; Lawlor, Peter G

    2015-01-01

    BACKGROUND: Uncontrolled cancer pain (CP) may impair quality of life. Given the multidimensional nature of CP, its poor control is often attributed to poor assessment and classification. OBJECTIVES: To determine the characteristics and associations of pain intensity in a specialist CP clinic. METHODS: Consecutive patients referred to the CP clinic of the Portuguese Cancer Institute (Lisbon, Portugal) had standardized initial assessments and status documentation of the following: Brief Pain Inventory ratings for ‘pain now’ as the outcome variable; initial pain intensity (iPI) on a 0 to 10 scale; pain mechanism (using the Douleur Neuropathique 4 tool to assess neuropathic pain); episodic pain; Eastern Cooperative Oncology Group rating; oral morphine equivalent daily dose (MEDD); Hospital Anxiety Depression Scale and Emotional Thermometer scores; and cancer diagnosis, metastases, treatment and pain duration. Univariable analyses were conducted to test the association of independent variables with iPI. Variables with P<0.1 were entered into a multivariable regression model, using backward elimination and a cut-point of P=0.2 for final model selection. RESULTS: Of 371 participants, 285 (77%) had moderate (4 to 6) or severe (7 to 10) iPI. The initial median MEDD was relatively low (30 mg [range 20 mg to 60 mg]). In the multivariable model, higher income, Eastern Cooperative Oncology Group rating 3 to 4, cancer diagnosis (head and neck, genitourinary and gastrointestinal), adjuvant use and initial MEDD were associated with iPI (P<0.05). The model’s R2 was 18.6, which explained only 19% of iPI variance. CONCLUSIONS: The diversity of factors associated with pain intensity and their limited explanation of its variance underscore the biopsychosocial complexity of CP. Adequacy of CP management warrants further exploration. PMID:26291125

  14. Effect of intravenous sodium amytal on cutaneous sensory abnormalities, spontaneous pain and algometric pain pressure thresholds in neuropathic pain patients: a placebo-controlled study. II.

    PubMed

    Mailis, A; Amani, N; Umana, M; Basur, R; Roe, S

    1997-03-01

    This study investigated the behaviour exhibited by 17 neuropathic pain patients (almost half of whom had documented neurological injury) with diffuse pain and extraterritorial sensory, sudomotor and vasomotor abnormalities, under the influence of intravenous administration of saline-controlled sodium amytal (SA), a medium action barbiturate. After SA (but not after normal saline) infusion, there was a dramatic and selective reduction of allodynia (touch-evoked pain) in all patients displaying this phenomenon, while pin prick and cold hypo- or hyperalgesia, as well as algometric pressure thresholds of the symptomatic limb (as a measurement of deep pain) were minimally changed in most patients. Spontaneous subjective pain was reduced substantially but not totally. The patients were able (once allodynia was eliminated) to recognize a deep-seated pain of which they were unaware before, evoked by firm but gentle palpation of the limb. Sympathetic blocks and A-fibre ischemic blocks in several patients and spinal stimulation in one patient produced effects identical to those observed during SA administration. The deep pain component was maintained despite elimination of allodynia even under stages of sleep induced by SA, at which time the patients would withdraw only the symptomatic limb upon firm but gentle palpation. We argue that neuropathic pain patients have two separate pain components, a cutaneous one (touch-evoked pain or allodynia) mediated by large fibres as a product of central sensitization, and a deep pain component mediated via nociceptors, which can be easily discriminated during systemic administration of SA. PMID:9106811

  15. Cancer patient supportive care and pain management. Special listing

    SciTech Connect

    Not Available

    1981-04-01

    This Special Listing of Current Cancer Research Projects is a publication of the International Cancer Research Data Bank (ICRDB) Program of the National Cancer Institute. Each Listing contains descriptions of ongoing projects in one selected cancer research area. The research areas include: Infectious disease in cancer patients; Immunological aspects of supportive care of cancer patients; Nutritional evaluation and support of cancer patients; Pain management of cancer patients.

  16. Topical preparations for pain relief: efficacy and patient adherence

    PubMed Central

    Jorge, Liliana L; Feres, Caroline C; Teles, Vitor EP

    2011-01-01

    There has been an increasing focus on development of new routes of drug administration to provide tailored treatments for patients, without decreasing efficacy of analgesia, in proportion to the progression of the knowledge of pain mechanisms. While acute pain acts as an alarm, chronic pain is a syndrome requiring meticulous selection of analgesic drugs of high bioavailability for long-term use. Such criteria are challenges that topical medications aim to overcome, allowing progressive delivery of active component, maintaining stable plasma levels, with a good safety profile. This review presents recent findings regarding topical formulations of the most widely used drugs for pain treatment, such as nonsteroidal anti-inflammatory agents, anesthetics, and capsaicin, and the role of physical agents as delivery enhancers (phonophoresis and iontophoresis). Although the number of topical agents is limited for use in peripheral conditions, increasing evidence supports the efficacy of these preparations in blocking nociceptive and neuropathic pain. Patient adherence to medical treatment is also a challenge, especially in chronic painful conditions. It is known that reduction of treatment complexity and pill burden are good strategies to increase patient compliance, as discussed here. However, the role of topical presentations, when compared to traditional routes, has not yet been fully explored and thus remains unclear. PMID:21386951

  17. Pain after total knee arthroplasty: a narrative review focusing on the stratification of patients at risk for persistent pain.

    PubMed

    Lavand'homme, P; Thienpont, E

    2015-10-01

    The patient with a painful arthritic knee awaiting total knee arthroplasty (TKA) requires a multidisciplinary approach. Optimal control of acute post-operative pain and the prevention of chronic persistent pain remains a challenge. The aim of this paper is to evaluate whether stratification of patients can help identify those who are at particular risk for severe acute or chronic pain. Intense acute post-operative pain, which is itself a risk factor for chronic pain, is more common in younger, obese female patients and those suffering from central pain sensitisation. Pre-operative pain, in the knee or elsewhere in the body, predisposes to central sensitisation. Pain due to osteoarthritis of the knee may also trigger neuropathic pain and may be associated with chronic medication like opioids, leading to a state of nociceptive sensitisation called 'opioid-induced hyperalgesia'. Finally, genetic and personality related risk factors may also put patients at a higher risk for the development of chronic pain. Those identified as at risk for chronic pain would benefit from specific peri-operative management including reduction in opioid intake pre-operatively, the peri-operative use of antihyperalgesic drugs such as ketamine and gabapentinoids, and a close post-operative follow-up in a dedicated chronic pain clinic. PMID:26430086

  18. Development and Validation of a Pain Behavior Assessment in Patients with Chronic Low Back Pain.

    PubMed

    Meyer, Katharina; Klipstein, Andreas; Oesch, Peter; Jansen, Beatrice; Kool, Jan; Niedermann, Karin

    2016-03-01

    Purpose High levels of pain behavior adversely affect the success of multidisciplinary rehabilitation of patients with chronic nonspecific low back pain (CNSLBP). Functional capacity evaluation (FCE) assessment should detect high levels of pain behavior to prevent the inclusion of unsuitable patients to functional rehabilitation programs. The aim of this study was to develop a Pain Behavior Assessment (PBA) and to evaluate its construct validity. Methods The PBA was developed by experts in the field and is literature-based. Inclusion criteria for participants of the validation study were: CNSLBP, age 20-60 years, referral for fitness-for-work evaluation. The PBA was applied by physiotherapists during FCE. Rasch analysis was performed to evaluate the construct validity of the PBA. Internal consistency was indicated by the person separation index (PSI), which corresponds to Cronbach's alpha. Results 145 male (72.5 %) and 55 female patients were included. Rasch analysis removed 11 items due to misfit and redundancy, resulting in a final PBA of 41 items. Item mean fit residual was -0.33 (SD 1.06) and total item Chi square 100.39 (df = 82, p = 0.08). The PSI value was 0.83. DIF analysis for age and gender revealed no bias. Conclusions The PBA is a valid assessment tool to describe pain behavior in CNSLBP patients. The high PSI-value justifies the use of the PBA in individuals. The PBA may help to screen patients for high levels of pain behavior. PMID:26149617

  19. Evidence report on the treatment of pain in cancer patients.

    PubMed

    Carr, Daniel B; Goudas, Leonidas C; Balk, Ethan M; Bloch, Rina; Ioannidis, John P A; Lau, Joseph

    2004-01-01

    Pain associated with cancer is of widespread concern. We conducted a systematic review to evaluate the best available evidence on the efficacy of treatments of cancer-related pain. The sources used were MEDLINE, CancerLit, and the Cochrane Library from 1966 through April 2001, as well as bibliographies of meta-analyses and review articles. We selected randomized controlled trials (RCTs) reporting on cancer pain treatment. We recorded the study characteristics, patient and disease characteristics, treatment comparisons, outcome measures, and results. The methodological quality, applicability, and magnitude of treatment effect for each study were graded. We screened 24 822 titles and selected 213 RCTs to address specific questions. RCTs of cancer pain control often enroll few subjects, have low methodological quality, offer little detail about pain characteristics and mechanisms, and involve heterogeneous interventions and outcomes. Nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, selected adjuvant medications, bisphosphonates, radionuclides, external radiation, palliative chemotherapy, and neurolytic celiac plexus block are each efficacious in relieving cancer pain. However, the retrieved RCTs indicate no difference in the analgesic efficacies of NSAIDs versus other NSAIDs, NSAIDs plus opioids versus NSAIDs alone, or NSAIDs versus opioids. Studies of adjuvant medications and behavioral therapies are too few and varied to synthesize. RCTs of the analgesic effects of corticosteroids were not retrieved in our review, although we did conduct supplemental evidence reviews concerning pain control in oral mucositis, acute herpes zoster, or postherpetic neuralgia. RCTs confirm the efficacy of diverse interventions in relieving cancer pain. The optimal initial and subsequent sequence of choices among analgesic drug types cannot be inferred from the retrieved RCTs. Patient preferences, the relative efficacy of different routes of drug administration, the side effects of analgesics, and the relation of pain control to quality of life have not been studied comprehensively. The quantity and quality of scientific evidence on cancer pain relief compare unfavorably with evidence related to treatment of other high-impact conditions, including cancer itself. One contributor to this gap is the heterogeneity of outcomes instruments employed: of 218 retrieved trials, there were 125 distinct pain outcomes assessed. In the current era of patient-centered care, improving the quality and combinability of trials on cancer pain relief should be a high research priority. PMID:15263038

  20. Evidence for brain glial activation in chronic pain patients

    PubMed Central

    Loggia, Marco L.; Chonde, Daniel B.; Akeju, Oluwaseun; Arabasz, Grae; Catana, Ciprian; Edwards, Robert R.; Hill, Elena; Hsu, Shirley; Izquierdo-Garcia, David; Ji, Ru-Rong; Riley, Misha; Wasan, Ajay D.; Zürcher, Nicole R.; Albrecht, Daniel S.; Vangel, Mark G.; Rosen, Bruce R.; Napadow, Vitaly; Hooker, Jacob M.

    2015-01-01

    Although substantial evidence has established that microglia and astrocytes play a key role in the establishment and maintenance of persistent pain in animal models, the role of glial cells in human pain disorders remains unknown. Here, using the novel technology of integrated positron emission tomography-magnetic resonance imaging and the recently developed radioligand 11C-PBR28, we show increased brain levels of the translocator protein (TSPO), a marker of glial activation, in patients with chronic low back pain. As the Ala147Thr polymorphism in the TSPO gene affects binding affinity for 11C-PBR28, nine patient–control pairs were identified from a larger sample of subjects screened and genotyped, and compared in a matched-pairs design, in which each patient was matched to a TSPO polymorphism-, age- and sex-matched control subject (seven Ala/Ala and two Ala/Thr, five males and four females in each group; median age difference: 1 year; age range: 29–63 for patients and 28–65 for controls). Standardized uptake values normalized to whole brain were significantly higher in patients than controls in multiple brain regions, including thalamus and the putative somatosensory representations of the lumbar spine and leg. The thalamic levels of TSPO were negatively correlated with clinical pain and circulating levels of the proinflammatory citokine interleukin-6, suggesting that TSPO expression exerts pain-protective/anti-inflammatory effects in humans, as predicted by animal studies. Given the putative role of activated glia in the establishment and or maintenance of persistent pain, the present findings offer clinical implications that may serve to guide future studies of the pathophysiology and management of a variety of persistent pain conditions. PMID:25582579

  1. Deciphering the Temporal Link between Pain and Sleep in a Heterogeneous Chronic Pain Patient Sample: A Multilevel Daily Process Study

    PubMed Central

    Tang, Nicole K.Y.; Goodchild, Claire E.; Sanborn, Adam N.; Howard, Jonathan; Salkovskis, Paul M.

    2012-01-01

    Objectives: Because insomnia is a common comorbidity of chronic pain, scientific and clinical interest in the relationship of pain and sleep has surged in recent years. Although experimental studies suggest a sleep-interfering property of pain and a pain-enhancing effect of sleep deprivation/fragmentation, the temporal association between pain and sleep as experienced by patients is less understood. The current study was conducted to examine the influence of presleep pain on subsequent sleep and sleep on pain reports the next day, taking into consideration other related psychophysiologic variables such as mood and arousal. Design: A daily process study, involving participants to monitor their pain, sleep, mood, and presleep arousal for 1 wk. Multilevel modeling was used to analyze the data. Setting: In the patients' natural living and sleeping environment. Patients: One hundred nineteen patients (73.9% female, mean age = 46 years) with chronic pain and concomitant insomnia. Measurement: An electronic diary was used to record patients' self-reported sleep quality/efficiency and ratings of pain, mood, and arousal at different times of the day; actigraphy was also used to provide estimates of sleep efficiency. Results: Results indicated that presleep pain was not a reliable predictor of subsequent sleep. Instead, sleep was better predicted by presleep cognitive arousal. Although sleep quality was a consistent predictor of pain the next day, the pain-relieving effect of sleep was only evident during the first half of the day. Conclusions: These findings challenge the often-assumed reciprocal relationship between pain and sleep and call for a diversification in thinking of the daily interaction of these 2 processes. Citation: Tang NKY; Goodchild CE; Sanborn AN; Howard J; Salkovskis PM. Deciphering the temporal link between pain and sleep in a heterogeneous chronic pain patient sample: a multilevel daily process study. SLEEP 2012;35(5):675-687. PMID:22547894

  2. Breakthrough pain in elderly patients with cancer: treatment options.

    PubMed

    Pautex, Sophie; Vogt-Ferrier, Nicole; Zulian, Gilbert B

    2014-06-01

    The prevalence of pain is high in the elderly and increases with the occurrence of cancer. Pain treatment is challenging because of age-related factors such as co-morbidities, and over half of the patients with cancer pain experience transient exacerbation of pain that is known as breakthrough pain (BTP). As with background pain, BTP should be properly assessed before being treated. The first step to be taken is optimizing around-the-clock analgesia with expert titration of the painkiller. Rescue medication should then be provided as per the requested need, while at the same time preventing identified potential precipitating factors. In the elderly, starting treatment with a lower dose of analgesics may be justified because of age-related physiological changes such as decreased hepatic and renal function. Whenever possible, oral medication should be provided prior to a painful maneuver. In the case of unpredictable BTP, immediate rescue medication is mandatory and the subcutaneous route is preferred unless patient-controlled analgesia via continuous drug infusion is available. Recently, transmucosal preparations have appeared in the medical armamentarium but it is not yet known whether they represent a truly efficient alternative, although their rapid onset of activity is already well recognized. Adjuvant analgesics, topical analgesics, anesthetic techniques and interventional techniques are all valid methods to help in the difficult management of pain and BTP in elderly patients with cancer. However, none has reached a satisfying scientific level of evidence as to nowadays make the development of undisputed best practice guidelines possible. Further research is therefore on the agenda. PMID:24817569

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

    PubMed Central

    Im, Sang Hee

    2013-01-01

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

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

    PubMed Central

    2011-01-01

    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 understanding of the problems in the relation. Several studies have defined the issues that frequently cause problems, but few have described the process. The aim of this study was to understand and illustrate what GPs' experience in contact with chronic pain patients and what works and does not work in these consultations. Methods Our theoretical perspective is constructivist, based upon the relativist view that individuals construct realities to understand and navigate the world. Five Swedish General Practitioners (GPs), two male and three female, were interviewed and asked to tell a story about a difficult encounter with a chronic pain patient. Tapes of the interviews were transcribed and analysed using narrative analysis. Three GPs told narratives suited for our analytic tools and these were included in the final results. Results Each narrative highlights a certain dilemma and a strategy. The dilemmas were: power game; good intentions that fail when a patient is persuaded against her own conviction; persuasion of the unwilling; transferred tiredness; distrust and dissociation from the patient. Professional strategies of listening, encouraging and teamwork were central to handling difficult situations. Conclusions The narratives show that GP's consultations with chronic pain patients sometimes are characterized by conflicts and difficult situations. They are facilitated by methods such as active listening and teamwork, but still may remain hard to handle. This has not before been studied among Swedish GPs. Narratives based on experience are known to be successful in education and this study suggest how narratives can serve as a training of consultation for medical students, but also in Continuing Professional Development groups for experienced doctors in practice. PMID:21575158

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

    PubMed

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

    2013-07-01

    Chest pain is a common reason for presentation in hospital emergency departments and general practice. Some patients presenting with chest pain to emergency departments and, to a lesser extent, general practice will be found to have a life-threatening cause, but most will not. The challenge is to identify those who do in a safe, timely and cost-effective manner. An acute coronary syndrome cannot be excluded on clinical grounds alone. In patients with ongoing symptoms of chest pain, without an obvious other cause, ST-segment-elevation myocardial infarction should be excluded with a 12-lead electrocardiogram at the first available opportunity. Significant recent advances in the clinical approach to patients with acute chest pain, including better understanding of risk stratification, increasingly sensitive cardiac biomarkers and new non-invasive tests for coronary disease, can help clinicians minimise the risk of unexpected short-term adverse cardiac events. An approach that integrates these advances is needed to deliver the best outcomes for patients with chest pain. All hospital emergency departments should adopt such a strategic approach, and general practitioners should be aware of when and how to access these facilities. PMID:23829259

  6. Care of the patient with chronic pain: part II.

    PubMed

    Wells-Federman, C L

    2000-01-01

    Chronic nonmalignant pain frequently results in significant physical, behavioral, psychological, social, and spiritual issues for patients and their families. It is often misunderstood and unsuccessfully managed. Advanced practice nurses who are knowledgeable about chronic pain and the complex biopsychosocial-spiritual needs of this patient population serve an important role in recognizing these patients and intervening appropriately in their care. The purpose of this two-part article is to provide that information. Part I [Clinical Excellence for Nurse Practitioners, 3 (4), 192-204] outlined the pathophysiology, assessment, biopsychosocial-spiritual aspects, and pharmacologic treatment of chronic pain. In Part II, a variety of nonpharmacologic and self-management interventions one can use in the primary care setting to treat these difficult health problems are introduced. PMID:11858295

  7. The role of patient pain and physical function on depressive symptoms in couples with lung cancer: a longitudinal dyadic analysis.

    PubMed

    Lyons, Karen S; Bennett, Jill A; Nail, Lillian M; Fromme, Erik K; Dieckmann, Nathan; Sayer, Aline G

    2014-10-01

    Drawing on the Developmental-Contextual Model (Berg & Upchurch, 2007), we examined the association between changes in patient physical health (pain severity and physical function) and changes in depressive symptoms in couples with lung cancer over a 12-month period. Patients and their spouses or partners (n = 77) were recruited using rapid case ascertainment and completed five waves of data collection (baseline, 3, 6, 9, and 12 months). Multilevel modeling was used to examine aggregate and time-varying effects of patient physical health on depressive symptoms. Results indicated that for patients and spouses, patient-rated mean pain severity was significantly positively associated with patient and spouse depressive symptoms and patient-rated mean physical function was significantly negatively associated with patient and spouse depressive symptoms. More importantly, increases in patient pain severity and declines in patient physical function were significantly associated with increases in patient depressive symptoms. However, only declines in patient physical function were significantly associated with increases in spouse depressive symptoms. These time-varying effects remained even when controlling for patient gender, patient age, patient stage of disease, spouse physical health, and relationship quality. Findings suggest the importance of examining the changing illness context on the couple as a unit and the complexity of interpersonal processes in the presence of a life-threatening illness. PMID:25090253

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

    PubMed Central

    2012-01-01

    Background Prevalence of pain as a recurrent symptom in children is known to be high, but little is known about children with high impairment from chronic pain seeking specialized treatment. The purpose of this study was the precise description of children with high impairment from chronic pain referred to the German Paediatric Pain Centre over a 5-year period. Methods Demographic variables, pain characteristics and psychometric measures were assessed at the first evaluation. Subgroup analysis for sex, age and pain location was conducted and multivariate logistic regression applied to identify parameters associated with extremely high impairment. Results The retrospective study consisted of 2249 children assessed at the first evaluation. Tension type headache (48%), migraine (43%) and functional abdominal pain (11%) were the most common diagnoses with a high rate of co-occurrence; 18% had some form of musculoskeletal pain disease. Irrespective of pain location, chronic pain disorder with somatic and psychological factors was diagnosed frequently (43%). 55% of the children suffered from more than one distinct pain diagnosis. Clinically significant depression and general anxiety scores were expressed by 24% and 19% of the patients, respectively. Girls over the age of 13 were more likely to seek tertiary treatment compared to boys. Nearly half of children suffered from daily or constant pain with a mean pain value of 6/10. Extremely high pain-related impairment, operationalized as a comprehensive measure of pain duration, frequency, intensity, pain-related school absence and disability, was associated with older age, multiple locations of pain, increased depression and prior hospital stays. 43% of the children taking analgesics had no indication for pharmacological treatment. Conclusion Children with chronic pain are a diagnostic and therapeutic challenge as they often have two or more different pain diagnoses, are prone to misuse of analgesics and are severely impaired. They are at increased risk for developmental stagnation. Adequate treatment and referral are essential to interrupt progression of the chronic pain process into adulthood. PMID:22591492

  9. Neuropsychological function, anxiety, depression and pain impact in fibromyalgia patients.

    PubMed

    Cuevas-Toro, Ana M; López-Torrecillas, Francisca; Díaz-Batanero, M Carmen; Pérez-Marfil, M Nieves

    2014-01-01

    Cognitive deficits have a significant impact on the daily performance of fibromyalgia patients. This paper analyzes executive functioning and decision-making performance, and the relationships between these functions and pain, anxiety, depression and medication in fibromyalgia patients. A group of fibromyalgia patients (FG) (n = 85) was compared with a healthy control group (CG) (n = 85) in their performance in the Wisconsin Card Sorting Test (WCST) and the Iowa Gambling Task (IGT). In the WCST, results showed a percentage of non-perseverative errors significantly higher in the CG than in the FG (p = .026), the other variables (percentage of perseverative errors, number of categories and failures to maintain set) showed no significant differences. In relation to decision-making (IGT), once the rules had been learnt, the FG made fewer advantageous choices than the CG, but these differences were not statistically significant (p = .325). In the FG, pain severity (p = .010) and impact on daily activities (p = .016) interfered with decision-making, unlike anxiety, depression or medication, which did no relate to it. In executive function, pain and impact on daily activities were associated with the percentage of perseverative errors (p = .051) and the number of categories (p = .031), whereas pain severity was related to failures to maintain set (p = .039), indicative of increased distractibility and poor attentional ability. In conclusion, FG showed normal performance in executive functioning and decision-making. Moreover, pain was associated with neuropsychological functioning whereas anxiety, depression and medication were not. PMID:26054236

  10. Persistent pain in postmastectomy patients: comparison of psychophysical, medical, surgical, and psychosocial characteristics between patients with and without pain.

    PubMed

    Schreiber, Kristin L; Martel, Marc O; Shnol, Helen; Shaffer, John R; Greco, Carol; Viray, Nicole; Taylor, Lauren N; McLaughlin, Meghan; Brufsky, Adam; Ahrendt, Gretchen; Bovbjerg, Dana; Edwards, Robert R; Belfer, Inna

    2013-05-01

    Persistent postmastectomy pain (PPMP) is a major individual and public health problem. Increasingly, psychosocial factors such as anxiety and catastrophizing are being revealed as crucial contributors to individual differences in pain processing and outcomes. Furthermore, differences in patients' responses to standardized quantitative sensory testing (QST) may aid in the discernment of who is at risk for acute and chronic pain after surgery. However, characterization of the variables that differentiate those with PPMP from those whose acute postoperative pain resolves is currently incomplete. The purpose of this study was to investigate important surgical, treatment-related, demographic, psychophysical, and psychosocial factors associated with PPMP by comparing PPMP cases with PPMP-free controls. Pain was assessed using the breast cancer pain questionnaire to determine the presence and extent of PPMP. Psychosocial and demographic information were gathered via phone interview, and women underwent a QST session. Consistent with most prior research, surgical and disease-related variables did not differ significantly between cases and controls. Furthermore, treatment with radiation, chemotherapy, or hormone therapy was also not more common among those with PPMP. In contrast, women with PPMP did show elevated levels of distress-related psychosocial factors such as anxiety, depression, catastrophizing, and somatization. Finally, QST in nonsurgical body areas revealed increased sensitivity to mechanical stimulation among PPMP cases, while thermal pain responses were not different between the groups. These findings suggest that an individual's psychophysical and psychosocial profile may be more strongly related to PPMP than their surgical treatment. PMID:23290256

  11. Linear and nonlinear analyses of EEG dynamics during non-painful somatosensory processing in chronic pain patients.

    PubMed

    Sitges, Carolina; Bornas, Xavier; Llabrés, Jordi; Noguera, Miquel; Montoya, Pedro

    2010-08-01

    The aim of our study was to characterize brain dynamics of affective modulation of somatosensory processing in chronic pain. We hypothesized that chronic pain patients will show abnormal EEG activity under negative mood conditions compared to healthy controls. Nineteen patients with chronic pain and 21 healthy subjects participated in the experiment. Multiscale entropy, fractal dimension, event-related potentials, and fast Fourier transform were used to analyze EEG data. A significant enhancement of entropy was found in pain patients at P4 compared to P3. Analysis of fractal dimension also revealed significantly higher values at P4 than P3 when pain patients were viewing unpleasant pictures. By contrast, no significant differences due to hemisphere or affective condition were found on nonlinear measures for healthy controls. Analyses of somatosensory ERPs showed that P50 amplitudes elicited by pleasant pictures were more reduced in chronic pain patients than in healthy controls. Finally, we observed that EEG band power was lower in pain patients than in healthy controls, in particular for theta and beta bands over sensorimotor cortices and temporal regions when viewing pleasant images. These findings suggest that sustained pain seems to be accompanied by an abnormal activation and dynamic of brain networks related to emotional processing of somatosensory information in chronic pain. Furthermore, our findings suggest that both linear and nonlinear measures of EEG time series may contribute to the understanding of brain dysfunction in chronic pain. PMID:20538021

  12. The MOBID-2 pain scale: Reliability and responsiveness to pain in patients with dementia

    PubMed Central

    Husebo, BS; Ostelo, R; Strand, LI

    2014-01-01

    Background Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) pain scale is a staff-administered pain tool for patients with dementia. This study explores MOBID-2's test–retest reliability, measurement error and responsiveness to change. Methods Analyses are based upon data from a cluster randomized trial including 352 patients with advanced dementia from 18 Norwegian nursing homes. Test–retest reliability between baseline and week 2 (n = 163), and weeks 2 and 4 (n = 159) was examined in patients not expected to change (controls), using intraclass correlation coefficient (ICC2.1), standard error of measurement (SEM) and smallest detectable change (SDC). Responsiveness was examined by testing six priori-formulated hypotheses about the association between change scores on MOBID-2 and other outcome measures. Results ICCs of the total MOBID-2 scores were 0.81 (0–2 weeks) and 0.85 (2–4 weeks). SEM and SDC were 1.9 and 3.1 (0–2 weeks) and 1.4 and 2.3 (2–4 weeks), respectively. Five out of six hypotheses were confirmed: MOBID-2 discriminated (p < 0.001) between change in patients with and without a stepwise protocol for treatment of pain (SPTP). Moderate association (r = 0.35) was demonstrated with Cohen-Mansfield Agitation Inventory, and no association with Mini-Mental State Examination, Functional Assessment Staging and Activity of Daily Living. Expected associations between change scores of MOBID-2 and Neuropsychiatric Inventory – Nursing Home version were not confirmed. Conclusion The SEM and SDC in connection with the MOBID-2 pain scale indicate that the instrument is responsive to a decrease in pain after a SPTP. Satisfactory test–retest reliability across test periods was demonstrated. Change scores ≄ 3 on total and subscales are clinically relevant and are beyond measurement error. PMID:24799157

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

    PubMed

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

    2014-03-01

    Patients with dementia receive suboptimal palliative care, and this patient group is at risk to have pain at the end of life. Because communicative impairments are common in this patient group, nurses play an important caregiver role in identifying, assessing, and relieving patients' pain. This study aimed to describe nurses' experiences regarding end-of-life pain relief in patients with dementia. This descriptive exploratory qualitative study was based on seven semistructured interviews. Burnard's content analysis inspired the data analysis. Two main categories were identified: (1) nurses' experience of difficulties concerning pain relief and (2) nurses' experience of resources concerning pain relief. Nurses experienced difficulties, such as feeling of powerlessness because of difficulties in obtaining adequate prescriptions for analgesics, ethical dilemmas, feeling of inadequacy because analgesia did not have the desired effect, and a feeling of not being able to connect with the patient. Factors, including knowledge about the patient, professional experience, utilization of pain assessment tools, interpersonal relationships, and interprofessional cooperation, served as resources and enabled end-of-life pain relief. The results of this study highlight the complexity of pain relief in patients with dementia at the end of life from a nursing perspective. The inability of patients with dementia to verbally communicate their pain makes them a vulnerable patient group, dependent on their caregivers. Knowing the life story of the patient, professional experience, teamwork based on good communication, and use of a pain assessment tool were reported by the nurses to improve pain relief at the end of life for patients with dementia. PMID:23453467

  14. Assessment of pain and impact of care among patients with painful diabetic peripheral neuropathy.

    PubMed

    Schumacher, Christie; Glosner, Scott E

    2014-01-01

    OBJECTIVES To assess the prevalence of painful diabetic peripheral neuropathy (DPN), evaluate the impact of DPN on patients' function and quality of life, and assess patient satisfaction with their current DPN treatment. DESIGN Cross-sectional study. SETTING Patient-centered medical home model at an internal medicine clinic in Chicago, from November 1, 2011, through November 1, 2012. PARTICIPANTS 71 patients with type 1 or type 2 diabetes aged 45 to 85 years and receiving diabetes education and medication management from the clinic pharmacist. INTERVENTION Paper survey administered to patients during clinic visits. MAIN OUTCOME MEASURES DPN history; DPN impact on activity level, sleep, and quality of life; and satisfaction with current DPN treatment. RESULTS Of the 71 participants, 22% (n = 15) reported a diagnosis of DPN from their providers; however, 54% (n = 37) reported burning, aching, or tenderness in their hands, arms, legs, or feet. More than 50% of patients with these symptoms had experienced them for more than 1 year. Fewer than one in five patients (14% [n = 5]) reporting symptoms indicative of painful DPN were receiving treatment. CONCLUSION DPN may be underdiagnosed and undertreated in this patient population, which represents a potential opportunity for pharmacists to help patients with diabetes meet their quality of care goals. PMID:24257634

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

    PubMed

    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 < .001). When the scores from each follow-up test (Times 2-5) were compared with those from the baseline test (Time 1), the effect sizes were -0.70, -1.05, -1.20, and -1.31, and the standardized response means were -1.17, -1.59, -1.66, and -1.82, respectively. The mean change in pain intensity, but not gender-time interaction effect, over the five time points was significant (F = 182.03, p < .001). Our results support that the 11-face Faces Pain Scale is appropriate for measuring acute postoperative pain in adults. PMID:25962544

  16. Tactile, thermal and pain sensibility in burned patients with and without chronic pain and paresthesia problems.

    PubMed

    Malenfant, A; Forget, R; Amsel, R; Papillon, J; Frigon, J Y; Choinière, M

    1998-09-01

    Abnormal return of cutaneous sensibility is common after burn injuries and many patients complain of painful and/or paresthetic sensations in their healed wounds. However, little is known about the exact nature and severity of these problems. The present study was designed to provide a quantitative evaluation of the cutaneous sensibility in burned patients. Tactile, thermal and pain thresholds were measured in 121 patients with healed burns paired-matched to 121 control healthy subjects more than 18 months after the burns. Testing was confined to both upper limbs and was performed in a healed burn area and its contralateral burned or unburned counterpart. The tested sites were also divided into symptomatic and asymptomatic ones, depending on the presence or not of pain or paresthesia at the site. The results showed significantly higher sensory thresholds in burned patients than control subjects. Severity of the deficits of the various sensory modalities was, however, a function of burn depth. Deep burn injuries which had required skin grafts to heal were more seriously affected than superficial burns which had healed spontaneously. Significant sensory losses were found not only in burn sites but also in the non-injured areas suggesting changes in the central nervous system. When symptomatic and asymptomatic sites were compared, significant deficits were observed in the tactile modality (touch-pressure). Other significant predictors of chronic sensory problems were burn depth and patients' age. Pathophysiological mechanisms of diminished sensibility in burned and unburned skin as long as several years after the injury are discussed along with those implicated in pain and paresthesia problems reported by the patients. PMID:9808349

  17. Patient versus parental perceptions about pain and disability in children and adolescents with a variety of chronic pain conditions

    PubMed Central

    Vetter, Thomas R; Bridgewater, Cynthia L; Ascherman, Lee I; Madan-Swain, Avi; McGwin, Gerald L

    2014-01-01

    BACKGROUND: Cross-informant variance is often observed in patient self-reports versus parent proxy reports of pediatric chronic pain and disability. OBJECTIVE: To assess the relationship and merit of the child versus parent perspective. METHODS: A total of 99 patients (eight to 17 years of age [mean 13.2 years]; 71% female, 81% Caucasian) and parents completed the Pediatric Pain Questionnaire and Functional Disability Inventory at their initial clinic visit. Patients’ and parents’ pain intensity and disability scores were analyzed using an intraclass correlation coefficient (ICC), Wilcoxon signed-rank test, Bland-Altman plot and Spearman’s correlation coefficient. The association between clinical/demographic variables and differences in patient/parent pain intensity and disability scores was assessed using multivariable regression. RESULTS: There was significant agreement between patients’ self-reports and parents’ proxy reports of their child’s pain intensity (ICC=0.52; P<0.001) and disability (ICC=0.57; P=0.004) at the individual level. There were no significant group differences in patient versus parent-proxy pain intensity scores (P=0.40) and disability scores (P=0.54). The difference between patient and parent-proxy pain intensity was associated with patients’ self-reported pain intensity (P<0.001). The difference between patient and parent-proxy disability was associated with patient’s self-reported pain disability (P<0.001). Bland-Altman plots revealed major inter-rater variation in the Pediatric Pain Questionnaire and Functional Disability Inventory across their score ranges. A significant relationship (r=0.38; P<0.001) was observed between patients’ self-reported pain intensity and disability. CONCLUSIONS: While equal merit should ideally be given to pediatric chronic pain patients’ self-reports and their parents’ proxy reports of pain intensity and disability, it would appear that, as needed, pediatric patients or parents can offer a clinically valid, single clinical perspective. PMID:24147272

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

    PubMed Central

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

    2014-01-01

    Background and Aims: Chronic knee joint pain is one of the most frequent complaints which is seen in the outpatient clinic in our medical institute. In previous studies we have reported the benefits of low level laser therapy (LLLT) for chronic pain in the shoulder joints, elbow, hand, finger and the lower back. The present study is a report on the effects of LLLT for chronic knee joint pain. Materials and Methods: Over the past 5 years, 35 subjects visited the outpatient clinic with complaints of chronic knee joint pain caused by the knee osteoarthritis-induced degenerative meniscal tear. They received low level laser therapy. A 1000 mW semi-conductor laser device was used to deliver 20.1 J/cm2 per point in continuous wave at 830nm, and four points were irradiated per session (1 treatment) twice a week for 4 weeks. Results: A visual analogue scale (VAS) was used to determine the effects of LLLT for the chronic pain and after the end of the treatment regimen a significant improvement was observed (p<0.001). After treatment, no significant differences were observed in the knee joint range of motion. Discussions with the patients revealed that it was important for them to learn how to avoid postures that would cause them knee pain in everyday life in order to have continuous benefits from the treatment. Conclusion: The present study demonstrated that 830 nm LLLT was an effective form of treatment for chronic knee pain caused by knee osteoarthritis. Patients were advised to undertake training involving gentle flexion and extension of the knee. PMID:25705083

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

    PubMed Central

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

    2015-01-01

    [Purpose] Through core strength training, patients with chronic low back pain can strengthen their deep trunk muscles. However, independent training remains challenging, despite the existence of numerous core strength training strategies. Currently, no standardized system has been established analyzing and comparing the results of core strength training and typical resistance training. Therefore, we conducted a systematic review of the results of previous studies to explore the effectiveness of various core strength training strategies for patients with chronic low back pain. [Methods] We searched for relevant studies using electronic databases. Subsequently, we evaluated their quality by analyzing the reported data. [Results] We compared four methods of evaluating core strength training: trunk balance, stabilization, segmental stabilization, and motor control exercises. According to the results of various scales and evaluation instruments, core strength training is more effective than typical resistance training for alleviating chronic low back pain. [Conclusion] All of the core strength training strategies examined in this study assist in the alleviation of chronic low back pain; however, we recommend focusing on training the deep trunk muscles to alleviate chronic low back pain. PMID:25931693

  20. Treating Pain in Addicted Patients: Recommendations from an Expert Panel

    PubMed Central

    Cheatle, Martin; Wunsch, Martha; Skoufalos, Alexis; Reddy, Yeshwant

    2014-01-01

    Abstract Clinicians may face pragmatic, ethical, and legal issues when treating addicted patients. Equal pressures exist for clinicians to always address the health care needs of these patients in addition to their addiction. Although controversial, mainly because of the lack of evidence regarding their long-term efficacy, the use of opioids for the treatment of chronic pain management is widespread. Their use for pain management in the addicted population can present even more challenges, especially when evaluating the likelihood of drug-seeking behavior. As the misuse and abuse of opioids continues to burgeon, clinicians must be particularly vigilant when prescribing chronic opioid therapy. The purpose of this article is to summarize recommendations from a recent meeting of experts convened to recommend how primary care physicians should approach treatment of chronic pain for addicted patients when an addiction specialist is not available for a referral. As there is a significant gap in guidelines and recommendations in this specific area of care, this article serves to create a foundation for expanding chronic pain guidelines in the area of treating the addicted population. This summary is designed to be a practical how-to guide for primary care physicians, discussing risk assessment, patient stratification, and recommended therapeutic approaches. (Population Health Management 2014;17:79–89) PMID:24138341

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

    SciTech Connect

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

    2008-09-01

    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.

  2. Psychophysiology of pain and opioid use: Implications for managing pain in patients with an opioid use disorder

    PubMed Central

    Wachholtz, Amy; Foster, Simmie; Cheatle, Martin

    2014-01-01

    Background Opioid therapy is one component of an effective pain management regimen for patients with chronic pain and the majority of these patients use their medications responsibly. However, there are a growing number of these patients who develop an opioid use disorder and in some cases require opioid replacement therapy. Managing these patients is complex and the underlying mechanisms of pain and addiction are not well understood. Developing an effective interdisciplinary treatment program for the individual with pain and an opioid use disorder will depend on enhancing our knowledge of the psychophysiology of pain and addiction. Method Authors gathered key empirical and theoretical papers examining the psychophysiology of comorbid pain and opioid misuse disorders. Results This article reviews the current theory of the effect of pain on patients with pain and concomitant addiction, the psychophysiology of pain, opioid use and addiction, and future research in this area. Conclusions Individuals with a history of opioid misuse have greater levels of hyperalgesia which may be due to alterations in psychophysiological pathways. More research is needed into the psychophysiological biomarkers among individuals with comorbid pain and addiction in order to develop better treatment approaches and improve outcomes among this difficult to treat population. PMID:25468815

  3. [Diagnosis in patients with a painful arthroplasty].

    PubMed

    Carrega, Giuliana; Antonini, Andrea; Burastero, Giorgio; Casalino-Finocchio, Giorgetta; Ronca, Agostina; Salomone, Carlo; Riccio, Giovanni

    2015-06-01

    The differential diagnosis between asepting loosening or prosthetic joint infection is not always easy. Tc-99m-labelled leucocyte scans, frozen section and histology can help recognise doubtful cases. We report the experience of the Unit for Infectious Diseases and Septic Orthopaedics of the ASL-2 Liguria, Italy, with a Tc-99m-labelled leucocyte scan and intraoperative frozen section to choose the best therapeutic approach: one-stage or two-stage exchange or arthrodesis-arthroplastica. All cases underwent histology and intraoperative cultures to confirm the diagnosis, and the effectiveness of the approach was evaluated at follow up after 18 months. From January 2011 to December 2012, 36 patients were evaluated (21 hip and 15 knee arthroprosthesis). The Tc-99m-labelled leukocyte scan was positive in 31 and negative in 5 patients. Frozen section was negative in 7 patients. Five of them were patients with a negative Tc-99m-labelled leucocyte scan and were treated successfully with one-stage exchange, even if, in one of them, Enterococcus faecalis was isolated at replacement and suppressive antibiotic treatment was needed. The other 31 patients were treated with arthrodesis arthroplasty (3 patients) or a two-stage exchange. In this group the Tc-99m-labelled leucocyte scan was positive in all patients and the frozen section was positive in 29/31 cases with 6% false negative. Histology was positive in 27/31 with 13% of false negative. The sensitivity and specificity value was respectively 90% and 100% in the frozen section, 84% and 100% in histology. Cultures were positive in 23/31 cases. Patients subjected to two-stage exchange were evaluated again during prosthesis replacement but the results of the Tc-99m-labelled leucocyte scan and histology showed unclear results more frequently: the Tc-99m-labelled leucocyte scan was positive in two cases, the frozen section in three and histology in seven in spite of positive culture in three cases and one relapse in a patient with a frozen section and histology positive but negative culture. In the second step sensitivity and specificity were respectively 67% and 96% in the frozen section, 75% and 88% in histology. Finally, our experience suggests the utility of nuclear and histological tests during diagnostic work-up for differential diagnosis of aseptic loosening or prosthetic joint infection. The same tests produce more uncertain data when performed in two-stage exchange during the second step. PMID:26110294

  4. What is the pain source? A case report of a patient with low back pain and bilateral hip osteonecrosis

    PubMed Central

    Minkalis, Amy L.; Vining, Robert D.

    2015-01-01

    Background: Low back pain is a common symptom arising from many possible sources and includes the possibility of the contribution of remote pathology. This report describes a patient with bilateral osteonecrosis of the femoral heads presenting with a primary symptom of low back pain. Case presentation: A 37-year-old male presented for evaluation of dominant pain that existed for approximately 6–12 months and was located in the right low back. Milder pain was also reported in the right hip. Low back and hip pain were both aggravated by weight-bearing activities. An evidence-based diagnostic evaluation revealed little indication for a primary pain source originating from low back structures. Radiographs revealed bilateral osteonecrosis with evidence of left femoral head collapse. Conclusion: Hip osteonecrosis may have contributed to an atypical presentation of low back pain due to aberrant localization of pain and/or combined with altered biomechanical loading of musculoskeletal structures. PMID:26500365

  5. Etifoxine for Pain Patients with Anxiety

    PubMed Central

    Choi, Yun Mi

    2015-01-01

    Etifoxine (etafenoxine, Stresamź) is a non-benzodiazepine anxiolytic with an anticonvulsant effect. It was developed in the 1960s for anxiety disorders and is currently being studied for its ability to promote peripheral nerve healing and to treat chemotherapy-induced pain. In addition to being mediated by GABAA?2 receptors like benzodiazepines, etifoxine appears to produce anxiolytic effects directly by binding to ?2 or ?3 subunits of the GABAA receptor complex. It also modulates GABAA receptors indirectly via stimulation of neurosteroid production after etifoxine binds to the 18 kDa translocator protein (TSPO) of the outer mitochondrial membrane in the central and peripheral nervous systems, previously known as the peripheral benzodiazepine receptor (PBR). Therefore, the effects of etifoxine are not completely reversed by the benzodiazepine antagonist flumazenil. Etifoxine is used for various emotional and bodily reactions followed by anxiety. It is contraindicated in situations such as shock, severely impaired liver or kidney function, and severe respiratory failure. The average dosage is 150 mg per day for no more than 12 weeks. The most common adverse effect is drowsiness at the initial stage. It does not usually cause any withdrawal syndromes. In conclusion, etifoxine shows less adverse effects of anterograde amnesia, sedation, impaired psychomotor performance, and withdrawal syndromes than those of benzodiazepines. It potentiates GABAA receptor-function by a direct allosteric effect and by an indirect mechanism involving the activation of TSPO. It seems promising that non-benzodiazepine anxiolytics including etifoxine will replenish shortcomings of benzodiazepines and selective serotonin reuptake inhibitors according to animated studies related to TSPO. PMID:25589941

  6. Tough guys or sensitive guys? Disentangling the role of examiner sex on patient pain reports

    PubMed Central

    Vigil, Jacob M; Alcock, Joe

    2014-01-01

    BACKGROUND: Experimental and clinical pain studies are conflicting regarding whether individuals report heightened or dampened pain sensitivity in the presence of other men or women. OBJECTIVES: In the present preliminary study, two small medical record reviews of patients admitted for emergency care were conducted to examine the possibility that patients may report differential pain intensity to male and female health care examiners. The study also sought to determine whether these effects are moderated by and, thus, only detectable by examining patients at different pain (debilitation) levels. METHODS: Pain intensity scores were extracted from two medical record reviews of patients admitted for emergency care (n=64 and n=135, respectively). Pain intensity was measured using an 11-point numerical scale during standard triage assessments and the sex of the examiner was recorded. RESULTS: Mean pain scores reported to male and female emergency staff did not differ in either set of medical records. However, when patients were split between low and high pain levels, male patients reported higher pain scores to male practitioners when experiencing relatively low pain levels, and both male and female patients reported higher pain scores to female practitioners when experiencing relatively high pain levels. DISCUSSION: The statistical magnitudes of these effects were large, suggesting that this phenomenon may be a pervasive feature in clinical settings and experimental pain studies. CONCLUSION: These preliminary findings warrant larger-scale investigations of social contextual influences on patient pain reports, which are necessary for creating more standardized protocols for reliably assessing and treating patient pain experiences. PMID:24511573

  7. Pain Expectancies, Pain, and Functional Self-Efficacy Expectancies as Determinants of Disability in Patients with Chronic Low Back Disorders.

    ERIC Educational Resources Information Center

    Lackner, Jeffrey M.; And Others

    1996-01-01

    Tested the predictive power of self-efficacy expectations of physical capabilities, expectations of pain, and expectations of reinjury on physical function in chronic back pain patients. Before assessment of function, patients rated their abilities to perform essential job tasks--functional self-efficacy (FSE)--and the likelihood working would…

  8. Pain Expectancies, Pain, and Functional Self-Efficacy Expectancies as Determinants of Disability in Patients with Chronic Low Back Disorders.

    ERIC Educational Resources Information Center

    Lackner, Jeffrey M.; And Others

    1996-01-01

    Tested the predictive power of self-efficacy expectations of physical capabilities, expectations of pain, and expectations of reinjury on physical function in chronic back pain patients. Before assessment of function, patients rated their abilities to perform essential job tasks--functional self-efficacy (FSE)--and the likelihood working would


  9. Reflecting on pain management for patients with osteoarthritis and other rheumatic disorders: there's more to pain management than managing pain

    PubMed Central

    Perret, Danielle; Chang, Eric Y; Pang, Winnie; Shinada, Shuntaro; Panush, Richard S

    2015-01-01

    SUMMARY Medical progress is measured by advances in science and technology. The pace of discovery will surely accelerate. We are increasingly challenged not only to assimilate new information, but also to reconcile our learning with our art. We present the common clinical problem of managing pain in osteoarthritis as a paradigm for this dilemma in contemporary patient care. We do not yet have the understanding and interventions to do this optimally for all with osteoarthritis, leaving us with uncertainties as we struggle to care for these patients. In a world of growing complexity and sophistication we must not overlook the person who is our patient. It is easy to be seduced by electronic and informational advances, to be entranced by machinery, and to forget the unique individuality and needs of each patient. Osler taught that “the practice of medicine is an art, based on science”. This doesn't change. PMID:24654815

  10. Correlations of Radiographic Findings in Patients with Low Back Pain

    PubMed Central

    Igbinedion, B. O. E; Akhigbe, A.

    2011-01-01

    Background: Low back pain can cause severe debilitating pain that may lead to loss of productivity. The pain is usually non-specific and imaging request protocols varies. However, physicians may order lumbo-sacral x-ray in the initial radiologic assessment of the patient. This study aims to determine the frequency of occurrence of radiographic findings in patients reporting low back pain including the presence of osteophytes, spondylolisthesis and degenerative disc diseases and determine the relationship with patients’ features including age, sex, marital status, level of education, body mass index and other radiographic findings. Method: Patients who presented at our department for radiographic assessment of the lumbo-sacral spine were voluntarily recruited. Their radiographs were reviewed and questionnaire administered. Height and weight were measured. The radiographic findings were documented and data analysis using Chi square with significant level set at p < 0.05. Result: Lumbo-sacral x-rays of 337 patients were reviewed with more females than males, ratio 1:1.4. Osteophytes were demonstrable in 73.6%; spondylolisthesis, 13.4%; and disc degeneration, 28.2%. Disc degeneration correlated with age, educational status, osteophytosis, osteopenia and spondylolisthesis. Osteophytosis correlated with age, BMI and educational level. While spondylolisthesis correlated with educational level and sex. Conclusion: Osteophytosis was the commonest finding in patients presenting with LBP. Disc degeneration shows a strong association with osteophytosis and spondylolisthesis and it is reported to herald these changes. Radiography still shows some correlations between the findings in LBP and patients’ characteristics. PMID:21969104

  11. Methadone use in cancer patients with pain: a review.

    PubMed

    Bruera, Eduardo; Sweeney, Catherine

    2002-02-01

    In recent years a better understanding of the pharmacologic and pharmacokinetic properties of methadone, including equianalgesic ratios has led to its increased use as a second line opioid for the treatment of pain in patients with cancer. Methadone may be an important alternative for those who have side effects related to the use of other opioids because it has no known active metabolites, is well absorbed by oral and rectal routes, and also has the advantage of very low cost. However, it has a long, unpredictable half-life, which can result in accumulation and toxicity in some patients. In addition, rotation to methadone as a second line agent is more complex than with other opioids because of its increased potency in those patients who are opioid tolerant, particularly those who have been on higher doses of other opioids. Future research should address the use of methadone as a first-line agent in the management of cancer pain, its use in patients with neuropathic pain, and in those who develop rapid tolerance to other opioids. In some patients with cancer the long half-life of methadone offers the advantage of extended dosing intervals to 12 and even 24 hours, further research is also needed in this area. PMID:11839235

  12. Utilization of Brief Pain Inventory as an Assessment Tool for Pain in Patients with Cancer: A Focused Review

    PubMed Central

    Kumar, Senthil P

    2011-01-01

    The Pain Research Group of the world health organization (WHO) Collaborating Centre for Symptom Evaluation in Cancer Care had developed the Brief Pain Inventory (BPI), a pain assessment tool for use with cancer patients. The BPI measures both the intensity of pain (sensory dimension) and interference of pain in the patient's life (reactive dimension). The objective of this review paper was to provide a detailed update of existing evidence on applicability of BPI in evaluation of patients with cancer pain. The BPI demonstrated good construct and concurrent validity. It was translated and validated into many languages – Brazilian, Chinese, Greek, Hindi, Italian, Japanese, Korean, Malay, Norwegian, Polish, Russian, Spanish, Taiwanese and Thai. The BPI was validated in patient populations such as bone metastases, breast cancer and postoperative cancer patients. The BPI can be used both as a quantitative or a qualitative measure for statistical analysis. The BPI was a powerful tool and, having demonstrated both reliability and validity across cultures and languages, was being adopted in many countries for clinical pain assessment, epidemiological studies, and in studies on the effectiveness of pain treatment. Future studies are warranted on its responsiveness and cross-cultural adaptation into other cancer pain syndromes and into other Indian languages. PMID:21976850

  13. LACK OF CORRELATION BETWEEN OPIOID DOSE ADJUSTMENT AND PAIN SCORE CHANGE IN A GROUP OF CHRONIC PAIN PATIENTS

    PubMed Central

    Chen, Lucy; Vo, Trang; Seefeld, Lindsey; Malarick, Charlene; Houghton, Mary; Ahmed, Shihab; Zhang, Yi; Cohen, Abigail; Retamozo, Cynthia; Hilaire, Kristen St.; Zhang, Vivian; Mao, Jianren

    2013-01-01

    Despite the increasing use of opioid analgesics for chronic pain management, it is unclear whether opioid dose escalation leads to better pain relief during chronic opioid therapy. In this study, we retrospectively analyzed clinical data collected from the Massachusetts General Hospital (MGH) Center for Pain Medicine over a 7-year period. We examined 1) the impact of opioid dose adjustment (increase or decrease) on clinical pain score, 2) gender and age differences in response to opioid therapy, and 3) the influence of clinical pain conditions on the opioid analgesic efficacy. A total of 109 subjects met the criteria for data collection. We found that neither opioid dose increase, nor decrease, correlated with point changes in clinical pain score in a subset of chronic pain patients over a prolonged course of opioid therapy (an average of 704 days). This lack of correlation was consistent regardless of the type of chronic pain including neuropathic, nociceptive, or mixed pain conditions. Neither gender nor age differences showed a significant influence on the clinical response to opioid therapy in these subjects. These results suggest that dose adjustment during opioid therapy may not necessarily alter long-term clinical pain score in a group of chronic pain patients and that individualized opioid therapy based on the clinical effectiveness should be considered to optimize the treatment outcome. Perspectives The study reports a relationship, or lack thereof, between opioid dose change and clinical pain score in a group of chronic pain patients. The study also calls for further investigation into the effectiveness of opioid therapy in the management of chronic non-malignant pain conditions. PMID:23452826

  14. Pain in patients with COPD: a systematic review and meta-analysis

    PubMed Central

    van Dam van Isselt, Eléonore F; Groenewegen-Sipkema, Karin H; Spruit-van Eijk, Monica; Chavannes, Niels H; de Waal, Margot W M; Janssen, Daisy J A; Achterberg, Wilco P

    2014-01-01

    Objectives To systematically investigate the prevalence of pain, factors related with pain and pain management interventions in patients with chronic obstructive pulmonary disease (COPD). Design Systematic review and meta-analysis. Data sources and study eligibility criteria PubMed (MEDLINE), EMBASE, CINAHL and PsychINFO from 1966 to December 2013. Studies were included if they presented clinical data on pain or symptom burden in patients with COPD, or pain as a domain of quality of life (QoL). All types of study designs were included. Results Of the 1571 articles that were identified, 39 met the inclusion criteria and were included in this review. Fourteen studies focused on pain and symptom burden (including pain) in patients with COPD and 25 studies focused on QoL using a questionnaire that included a separate pain domain. Reported pain prevalence in high-quality studies ranged from 32 to 60%. Included studies report that pain is more prevalent in patients with COPD compared to participants from the general population. Comorbidity, nutritional status, QoL and several symptoms were related to pain. None of the included studies reported a significant relationship between lung function and pain prevalence or severity. However, studies investigating pain in patients with moderate COPD reported higher pain prevalence compared to studies in patients with severe of very severe COPD. Conclusions Although literature on this topic is limited and shows substantial heterogeneity, pain seems to be a significant problem in patients with COPD and is related to several other symptoms, comorbidity and QoL. Data synthesis suggests that pain is more prevalent in patients with moderate COPD compared to patients with severe or very severe COPD. Further research is needed and should focus on determining a more accurate pain prevalence, investigating the relationship between pain prevalence, disease severity and comorbidity and explore implementation and efficacy of pain management interventions in patients with COPD. PMID:25260370

  15. Abnormal Pain Modulation in Patients with Spatially Distributed Chronic Pain: Fibromyalgia

    PubMed Central

    Staud, Roland

    2009-01-01

    Many chronic pain syndromes including fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome, migraine headache, chronic back pain, and complex regional pain syndrome are associated with hypersensitivity to painful stimuli and with reduced endogenous pain inhibition. These findings suggest that modulation of pain-related information may be related to the onset and/or maintenance of chronic pain. Although pain sensitivity and pain inhibition are normally distributed in the general population, they are not useful as reliable predictors of future pain. The combination of heightened pain sensitivity and reduced pain-inhibition, however, appears to predispose individuals to greater risk for increased acute clinical pain (e.g., postoperative pain). It is unknown at this time whether such pain processing abnormalities may also place individuals at increased risk for chronic pain. Psychophysical methods, including heat sensory and pressure pain testing have become increasingly available and can be used for the evaluation of pain sensitivity and pain inhibition. However, long-term prospective studies in the general population are lacking which could yield insight into the role of heightened pain sensitivity and pain disinhibition for the development of chronic pain disorders like fibromyalgia. PMID:19647141

  16. Exercise radionuclide ventriculographic responses in hypertensive patients with chest pain

    SciTech Connect

    Wasserman, A.G.; Katz, R.J.; Varghese, P.J.; Leiboff, R.H.; Bren, G.G.; Schlesselman, S.; Varma, V.M.; Reba, R.C.; Ross, A.M.

    1984-11-15

    The effectiveness of exercise-treadmill testing in diagnosing coronary-artery disease in hypertensive patients is limited by a high rate of false positivity. Exercise radionuclide ventriculography, however, relies on different criteria (ejection fraction and wall motion), and we have evaluated this procedure in 37 hypertensive and 109 normotensive patients with chest pain, using coronary arteriography as an indicator of coronary disease. In the hypertensive cohort there was no difference in the ejection fraction at rest between the 17 patients with coronary disease and the 20 without it. Neither group had a significant mean (+/- S.E.M.) change in ejection fraction from rest to exercise (-1.9 +/- 2 and 1.4 +/- 1%, respectively). A wall-motion abnormality developed during exercise in 5 of the 17 hypertensive patients with coronary disease (29%) and in 4 of the 20 without it (20%) (P = not significant). In the normotensive cohort, however, the peak-exercise ejection fractions were significantly different. The 71 patients with coronary disease had a mean decrease of 3.6 +/- 1%, in contrast to the patients without coronary disease, who had an increase of +/- 1% (P < 0.001). An exercise-induced wall-motion abnormality was seen in 35 of the 71 patients with coronary disease (48%), as compared with 3 of the 38 without it (8%) (P < 0.001). We conclude that exercise radionuclide ventriculography is inadequate as a screening test for coronary atherosclerosis in hypertensive patients with chest pain. 28 references, 2 figures, 3 tables.

  17. Avascular necrosis in a patient with hip pain.

    PubMed

    Sabadis, Sebastian; Gattie, Eric; Cleland, Joshua

    2015-06-01

    The patient was a 64-year-old man who was referred to a physical therapist 3 weeks following a right L3 hemilaminectomy and an L3-4 facetectomy. At the time of the initial evaluation, the patient was ambulating with a rolling walker due to low back and anterolateral right hip pain, as well as a giving-way sensation of the right hip with weight bearing. The patient was referred to his surgeon, where radiographs revealed collapse/dissolution of the femoral head that was consistent with avascular necrosis. PMID:26027745

  18. Hospice care and patients' pain: communication between patients, relatives, nurses and doctors.

    PubMed

    Ashby, M E; Dowding, C

    2001-02-01

    This article describes a study that sought to assess how patients, relatives, doctors and nurses in a palliative care unit viewed pain and pain management, and how standards and expectations for pain relief can be raised by upholding statements of care and agreed partnership values. The results showed that research-based pain management enables the provision of pain control that is acceptable to patients, relatives, doctors and nurses. By valuing patient-centred care, where assessment tools assist communication and information sharing, a partnership of care is established in which patient and professional autonomy are recognized and respected, international recommendations for pain relief are practised and professional codes of conduct upheld. Good pain management requires accurate assessment that is best achieved by open and honest discussion in a supportive environment. Hospices provide specialist symptom control aimed at improving quality of life for patients with advanced disease. They are not only an ideal setting to provide evidence for practice, but also a learning environment for specialist understanding of symptom control and a resource base for other professionals. PMID:12271251

  19. Juvenile fibromyalgia in an adolescent patient with sickle cell disease presenting with chronic pain.

    PubMed

    Ramprakash, Stalin; Fishman, Daniel

    2015-01-01

    Juvenile fibromyalgia in children with sickle cell disease has not been reported in the literature. We report an adolescent patient with sickle cell whose pain symptoms progressed from having recurrent acute sickle cell pain crisis episodes to a chronic pain syndrome over several years. He was eventually diagnosed with juvenile fibromyalgia based on the clinical history and myofascial tender points and his pain symptoms responded better to multidisciplinary strategies for chronic fibromyalgia pain. Chronic pain in sickle cell disease is an area of poor research, and in addition there is inconsistency in the definition of chronic pain in sickle cell disease. Central sensitisation to pain is shown to occur after recurrent painful stimuli in a genetically vulnerable individual. In a chronic pain condition such as fibromyalgia central sensitisation is thought to play a key role. Fibromyalgia should be considered as one of the main differential diagnosis in any sickle cell patient with chronic pain. PMID:26430233

  20. Pain assessment and management in the patient with mild to moderate cognitive impairment.

    PubMed

    Wheeler, Mary S

    2006-06-01

    The gold standard for pain screening and assessment is the patient report. Research shows that many patients with mild to moderate cognitive impairment retain the ability to report pain. All patients should be given the opportunity to self-report their pain using valid and reliable tools. PMID:16849938

  1. Chronic widespread musculoskeletal pain in patients with obstructive sleep apnea syndrome and the relationship between sleep disorder and pain level, quality of life, and disability

    PubMed Central

    Aytekin, Ebru; Demir, Saliha Eroglu; Komut, Ece Akyol; Okur, Sibel Caglar; Burnaz, Ozer; Caglar, Nil Sayiner; Demiryontar, Dilay Yilmaz

    2015-01-01

    [Purpose] The aim of this study was to ascertain the prevalence of chronic widespread musculoskeletal pain in patients with obstructive sleep apnea syndrome and to assess the relationship between sleep disorder and pain, quality of life, and disability. [Subjects and Methods] Seventy-four patients were included in the study and classified as having mild, moderate, or severe obstructive sleep apnea. Chronic widespread pain, quality of life, and disability were evaluated. [Results] Forty-one patients (55.4%) had chronic widespread pain. Female patients had a higher incidence of chronic pain, and female patients with chronic pain had higher body mass indexes, pain levels, and disability scores than did male patients. Physical component scores of female patients with chronic pain were lower than those of male patients. No correlation was observed between the degree of sleep disorder and severity of pain, pain duration, disability, or quality of life in obstructive sleep apnea patients with pain. [Conclusion] This study showed a 55.4% prevalence of chronic widespread pain in patients with obstructive sleep apnea and a greater risk of chronic pain in female than in male patients. Female patients with obstructive sleep apnea and chronic pain have higher pain and disability levels and a lower quality of life. PMID:26504332

  2. Experience with transcutaneous electrical nerve stimulation for relief of intractable pain in cancer patients.

    PubMed

    Avellanosa, A M; West, C R

    1982-01-01

    Sixty patients with intractable cancer pain were subjected to transcutaneous electrical stimulation for pain control. Evaluation, after two weeks of treatment, revealed: 17 (28.3%) excellent response, 22 (36.2%) fair and 21 (35.0%) no relief. Re-assessment after 3 months revealed 9 (15%) excellent responses, 11 (18.3%) fair and 40 (67%) failures. Extremity and trunk pains appeared to be most rewarding to patient pain, so far as pain relief is concerned. Perineal and pelvic pains were most difficult to control, only 5 of 12 (41%) cases obtained some short term relief. Pain location and sources correlated with treatment results. PMID:6983553

  3. Translation of random painful stimuli into numerical responses in fibromyalgia and perioperative patients.

    PubMed

    Oudejans, Linda; van Velzen, Monique; Olofsen, Erik; Beun, Robert; Dahan, Albert; Niesters, Marieke

    2016-01-01

    Number-based assessment tools are used to evaluate pain perception in patients and determine the effect of pain management. The aim of this study was to determine the ability of chronic and acute pain patients to score their response to randomly applied noxious stimuli and assess the effect of opioid treatment. Thirty-seven healthy controls, 30 fibromyalgia patients, and 62 postoperative patients with acute pain received random heat pain (Hp) and electrical pain (Ep) stimuli. All subjects rated their pain on an 11-point numerical rating scale (NRS). The data were analyzed using a penalty score system, based on the assumption that stimuli of higher intensity are scored with a greater NRS, and stratified into cohorts corresponding to "good," "mediocre," and "poor" scoring. Healthy controls were well able to score pain with 73% (Hp) and 81% (Ep) of subjects classified into cohort "good." Fibromyalgia had a negative effect on scoring with 45% (Hp, P = 0.03 vs controls) and 67% (Ep) of patients in cohort "good." In controls, scoring deteriorated during opioid administration leaving just 40% (Hp, P = 0.015 vs baseline) and 70% (Ep) of subjects in the cohort "good." Similar observations were made in fibromyalgia patients (P = 0.02) but not in surgical patients with postoperative pain. Consistency to grade pain using an NRS is high in healthy volunteers but deteriorates in chronic pain and during opioid administration to volunteers and chronic pain patients but not to acute pain patients. PMID:26307857

  4. [Pain management for cancer patients with critical pathway on computer].

    PubMed

    Hori, Natsuki; Konishi, Toshiro

    2005-02-01

    For relief from cancer pain, we developed critical pathway (CP) as an effective strategy for the medical staff treating cancer patients. This CP was made out of Microsoft Excel, and was used on personal computers. "Good sleeping" was set as the first goal and the second was "No pain in rest position." To achieve this, physicians and nurses evaluate medical efficacy and complications including nausea/vomiting, constipation, somnolence and hallucination everyday using controlled release oxycodone in addition to NSAIDs and prochlorperazine, stool softener and peristaltic stimulant for adverse effects. These outcomes lead to the medication change the next day by calculation using visual basic function due to opioid titration theory. In twelve patients this CP was acceptable, and all of them achieved the second goal within a week without severe adverse effects except constipation. PMID:15751627

  5. [Multimodal pain management in a patient with atypical cervicogenic headache].

    PubMed

    Flöther, Lilit; Raspé, Christoph; Bucher, Michael; Benndorf, Ralf A

    2015-11-01

    A 45-year-old patient presented with an eight-year history of persistent unilateral headache associated with recurrent episodes of ipsilateral conjunctival injections, eyelid edema and ptosis. Prior ineffective pharmacological treatment strategies included tramadol, non-steroidal anti-inflammatory drugs and triptans. Palpation of right suboccipital trigger points revealed tenderness in the area of the greater occipital nerve and reinforced the symptoms. The diagnosis of cervicogenic headache was confirmed by symptom resolution following right greater occipital nerve blockade. A multimodal treatment strategy (physical therapy, nerve blockade, pharmacological treatment) was chosen and an emphasis was put on optimizing pharmacological pain relief using the opioid analgesic tapentadol and the tricyclic antidepressant amitriptyline as an adjuvant analgesic. Importantly, the patient reported a substantial and consistent pain reduction and considerable quality of life improvement during implementation of the treatment regimen. PMID:26742212

  6. Facial asymmetry in patients with cervicobrachial pain and headache.

    PubMed

    Nakamura, T; Okamoto, K; Maruyama, T

    2001-11-01

    An increasing number of patients are visiting our hospital who have a chief complaint of neck and shoulder pain and/or headache but who do not have temporomandibular disorders (TMD). We carried out this study with a view to comparing the asymmetry of the facial skeleton or expression of such patients with those of healthy subjects. The incidence of such symptoms of patients and healthy subjects was examined by means of questionnaires. Asymmetry of the facial skeleton of patients was investigated by means of posterioanterior (PA) cephalograms. Facial asymmetry was analysed using the frontal view photographs of faces. We found that the patients had a higher incidence of various symptoms, including fatigability and irritability, in addition to neck and shoulder pain and headache, than the healthy subjects did. Both the healthy subjects and the patients had mandibular skeletal asymmetry to some degree, however, there was no significant difference between the two groups. On the other hand, the patients had a greater level of asymmetry of facial expression, chiefly of the lower face, than the healthy subjects did. PMID:11722716

  7. Observer trait anxiety is associated with response bias to patient facial pain expression independent of pain catastrophizing

    PubMed Central

    Rash, Joshua A; Prkachin, Kenneth M; Campbell, Tavis S

    2015-01-01

    BACKGROUND: Top-down characteristics of an observer influence the detection and estimation of a sufferer’s pain. A comprehensive understanding of these characteristics is important because they influence observer helping behaviours and the sufferer’s experience of pain. OBJECTIVES: To examine the hypothesis that individuals who score high in trait anxiety would perceive more intense pain in others, as indicated by a larger negative response bias, and that this association would persist after adjusting for pain catastrophizing. METHODS: Healthy young adult participants (n=99; 50 male) watched videos containing excerpts of facial expressions taken from patients with shoulder pain and were asked to rate how much pain the patient was experiencing using an 11-point numerical rating scale. Sensitivity and response bias were calculated using signal detection methods. RESULTS: Trait anxiety was a predictor of response bias after statistically adjusting for pain catastrophizing and observer sex. More anxious individuals had a proclivity toward imputing greater pain to a sufferer. CONCLUSIONS: Individuals scoring higher on trait anxiety were more likely to impute pain to a sufferer. Anxious caregivers may be better able to respond with appropriate intervention once pain behaviour is detected, or they may exacerbate symptoms by engaging in excessive palliative care and solicitous behaviour. PMID:25299592

  8. What's the risk? Assessment of patients with stable chest pain

    PubMed Central

    Cubukcu, Arzu; Anderson, Simon

    2015-01-01

    In 2010, the National Institute for Heath and Clinical Excellence published guidelines for the management of stable chest pain of recent onset. Implementation has occurred to various degrees throughout the NHS; however, its effectiveness has yet to be proved. A retrospective study was undertaken to assess the impact and relevance of this guideline, comparing the estimated risk of coronary artery disease (CAD) with angiographic outcomes. Findings were compared with the recently published equivalent European guideline. A total of 457 patients who attended a Rapid Access Chest Pain Clinic were retrospectively reviewed. CAD risk was assessed according to NICE guidelines and patients were separated into typical, atypical and non-anginal chest pain groups. Risk stratification using typicality of symptoms in conjunction with NICE risk scoring and exercise tolerance testing was used to determine the best clinical course for each patient. The results include non-anginal chest pain – 92% discharged without needing further testing; atypical angina – 15% discharged, 40% referred for stress echocardiography, 35% referred for angiogram and significant CAD revealed in 8%; typical angina – 4% discharged, 19% referred for stress echocardiography, 71% referred for angiogram and 40% demonstrated CAD. Both guidelines appear to overestimate the risk of CAD leading to an excessive number of coronary angiograms being undertaken to investigate patients with typical or atypical sounding angina, with a low pick up rate of CAD. Given the high negative predictive value of stress echocardiography and the confidence this brings, there is much scope for expanding its use and potentially reduce the numbers going for invasive angiography. PMID:26693332

  9. Static Balance in Patients With Patellofemoral Pain Syndrome

    PubMed Central

    Citaker, Seyit; Kaya, Defne; Yuksel, Inci; Yosmaoglu, Baran; Nyland, John; Atay, Ozgur Ahmet; Doral, Mahmut Nedim

    2011-01-01

    Background: The relationship between one-leg static standing balance (OLSSB) and patellofemoral pain syndrome (PFPS) is unknown. Hypothesis: OLSSB decreases in patients with PFPS. Design: Prospective case series. Methods: Fifty-two women with unilateral PFPS were enrolled in this study. OLSSB was evaluated with a stabilometer. Q angle was measured with a lengthened-arm universal goniometer. Lower extremity alignment was analyzed with full-length standing anteroposterior teleroentgenograms. Quadriceps and hamstring strength was measured on an isokinetic dynamometer. Results: There were significant differences in OLSSB, Q angle, and strength of quadriceps and hamstring between the symptomatic and asymptomatic sides. There was a correlation between the strength of the quadriceps and hamstring and OLSSB, while there was no correlation between OLSSB and the severity of pain, lower extremity alignment, and Q angle on the symptomatic side. Conclusions: OLSSB and quadriceps and hamstring strength decreased and Q angle increased on the symptomatic side in PFPS patients. A relationship between OLSSB and pain, Q angle, and lower extremity alignment was not detected, while there was a correlation between the strength of the quadriceps and hamstring and OLSSB. Clinical Relevance: A quadriceps and hamstring strengthening may be beneficial to improve OLSSB in patients with PFPS. PMID:23016053

  10. Associations Between Pain, Current Tobacco Smoking, Depression, and Fibromyalgia Status Among Treatment-Seeking Chronic Pain Patients

    PubMed Central

    Goesling, Jenna; Brummett, Chad M.; Meraj, Taha S.; Moser, Stephanie E.; Hassett, Afton L.; Ditre, Joseph W.

    2016-01-01

    Objective As smoking impacts physiological pathways in the central nervous system, it is important to consider the association between smoking and fibromyalgia, a pain condition caused predominantly by central nervous system dysfunction. The objectives were to assess the prevalence of current smoking among treatment-seeking chronic pain patients with (FM+) and without (FM−) a fibromyalgia-like phenotype; test the individual and combined influence of smoking and fibromyalgia on pain severity and interference; and examine depression as a mediator of these processes. Methods Questionnaire data from 1566 patients evaluated for a range of conditions at an outpatient pain clinic were used. The 2011 Survey Criteria for Fibromyalgia were used to assess the presence of symptoms associated with fibromyalgia. Results Current smoking was reported by 38.7% of FM+ patients compared to 24.7% of FM− patients. FM+ smokers reported higher pain and greater interference compared to FM+ nonsmokers, FM− smokers, and FM− nonsmokers. There was no interaction between smoking and fibromyalgia. Significant indirect effects of fibromyalgia and smoking via greater depression were observed for pain severity and interference. Conclusions Current smoking and positive fibromyalgia status were associated with greater pain and impairment among chronic pain patients, possibly as a function of depression. Although FM+ smokers report the most negative clinical symptomatology (i.e., high pain, greater interference) smoking does not appear to have a unique association with pain or functioning in FM+ patients, rather the effect is additive. The 38.7% smoking rate in FM+ patients is high, suggesting FM+ smokers present a significant clinical challenge. PMID:25801019

  11. Comparison of numerical and verbal rating scales to measure pain exacerbations in patients with chronic cancer pain

    PubMed Central

    2010-01-01

    Background Numerical rating scales (NRS), and verbal rating scales (VRS) showed to be reliable and valid tools for subjective cancer pain measurement, but no one of them consistently proved to be superior to the other. Aim of the present study is to compare NRS and VRS performance in assessing breakthrough or episodic pain (BP-EP) exacerbations. Methods In a cross sectional multicentre study carried out on a sample of 240 advanced cancer patients with pain, background pain and BP-EP intensity in the last 24 hours were measured using both a 6-point VRS and a 0-10 NRS. In order to evaluate the reproducibility of the two scales, a subsample of 60 patients was randomly selected and the questionnaire was administered for a second time three to four hours later. The proportion of "inconsistent" (background pain intensity higher than or equal to peak pain intensity) evaluations was calculated to compare the two scales capability in discriminating between background and peak pain intensity and Cohen's K was calculated to compare their reproducibility. Results NRS revealed higher discriminatory capability than VRS in distinguishing between background and peak pain intensity with a lower proportion of patients giving inconsistent evaluations (14% vs. 25%). NRS also showed higher reproducibility when measuring pain exacerbations (Cohen's K of 0.86 for NRS vs. 0.53 for VRS) while the reproducibility of the two scales in evaluating background pain was similar (Cohen's K of 0.80 vs. 0.77). Conclusions Our results suggest that, in the measurement of cancer pain exacerbations, patients use NRS more appropriately than VRS and as such NRS should be preferred to VRS in this patient's population. PMID:20412579

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

    PubMed Central

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

    2015-01-01

    Objectives This cross-sectional correlation study explored the relationships between craniocervical posture and pain-related disability in patients with chronic cervico-craniofacial pain (CCFP). Moreover, we investigated the test–retest intrarater reliability of two craniocervical posture measurements: head posture (HP) and the sternomental distance (SMD). Methods Fifty-three asymptomatic subjects and 60 CCFP patients were recruited. One rater measured HP and the SMD using a cervical range of motion device and a digital caliper, respectively. The Spanish versions of the neck disability index and the craniofacial pain and disability inventory were used to assess pain-related disability (neck disability and craniofacial disability, respectively). Results We found no statistically significant correlations between craniocervical posture and pain-related disability variables (HP and neck disability [r=0.105; P>0.05]; HP and craniofacial disability [r=0.132; P>0.05]; SMD and neck disability [r=0.126; P>0.05]; SMD and craniofacial disability [r=0.195; P>0.05]). A moderate positive correlation was observed between HP and SMD for both groups (asymptomatic subjects, r=0.447; CCFP patients, r=0.52). Neck disability was strongly positively correlated with craniofacial disability (r=0.79; P<0.001). The test–retest intrarater reliability of the HP measurement was high for asymptomatic subjects and CCFP patients (intraclass correlation coefficients =0.93 and 0.81, respectively) and for SMD (intra-class correlation coefficient range between 0.76 and 0.99); the test–retest intrarater reliability remained high when evaluated 9 days later. The HP standard error of measurement range was 0.54–0.75 cm, and the minimal detectable change was 1.27–1.74 cm. The SMD standard error of measurement was 2.75–6.24 mm, and the minimal detectable change was 6.42–14.55 mm. Independent t-tests showed statistically significant differences between the asymptomatic individuals and CCFP patients for measures of craniocervical posture, but these differences were very small (mean difference =1.44 cm for HP; 6.24 mm for SMD). The effect sizes reached by these values were estimated to be small for SMD (d=0.38) and medium for HP (d=0.76). Conclusion The results showed no statistically significant correlations between craniocervical posture and variables of pain-related disability, but a strong correlation between the two variables of disability was found. Our findings suggest that small differences between CCFP patients and asymptomatic subjects exist with respect to the two measurements used to assess craniocervical posture (HP and SMD), and these measures demonstrated high test–retest intrarater reliability for both CCFP patients and asymptomatic subjects. PMID:26261425

  13. Analysis of codeine positivity in urine of pain management patients.

    PubMed

    Colby, Jennifer M; Wu, Alan H B; Lynch, Kara L

    2015-06-01

    The opioids codeine and morphine have legitimate uses in managing chronic pain conditions, but they are frequently abused. Patients prescribed opioids submit urine samples for medication compliance monitoring, and the interpretation of the results is complex. The purpose of this study was to evaluate the percentage of codeine- and morphine-positive urine drug tests that result from morphine use only, with the positive codeine result arising from low levels of codeine present in pharmaceutical formulations of morphine. This study included 80 urine samples which tested positive for codeine and morphine after pre-analytical hydrolysis and analysis by gas chromatography-mass spectrometry. Quantitative results were correlated with patient prescription information and immunoassay results to classify patients into one of four categories: heroin users (50%), codeine users (34%), codeine and morphine users (5%), and morphine users (11%). The percentage of codeine-positive resulting from morphine use was higher than previous estimates. Urine from patients prescribed morphine only was found to contain codeine at <1% of the morphine concentration, a ratio that was also observed in patients who used heroin. Careful analysis of urine drug testing results, including assessing the ratio of codeine to morphine (C/M), can help providers determine if patients are compliant with their pain management regimens. PMID:25840440

  14. Talking about painful subjects: flexibility and constraints in patient interviews.

    PubMed

    Moore, John; Lieberman, Henry

    2009-01-01

    Increasing understanding of how to categorize patient symptoms for efficient diagnosis has led to structured patient interviews and diagnostic flowcharts that can provide diagnostic accuracy and save valuable physician time. But the rigidity of predefined questions and controlled vocabulary for answers can leave patients feeling over-constrained, like the doctor (or computer system) is not really listening to them. In addition, not hearing the patient's own words can lead to the physician overlooking subtle details that are diagnostically relevant. How can we reconcile the need for patients to express themselves with the doctor's need to understand the patient's experience in medically appropriate terms? We present I'm Listening, a system for automatically conducting patient pre-visit interviews. It does not replace a human doctor, but can be used before an office visit to elicit complaint details. This information can be used to triage care and prepare patients for visits with educational materials and appropriate tests, making better use of both doctor and patient time. It uses an on-screen avatar and natural language processing to (partially) understand the patient's response. Key is a Commonsense reasoning system that lets patients express themselves in unconstrained natural language, even using metaphor, and that maps the language to medically relevant categories. For example, if a patient describes his or her pain like, "someone sticking in a knife and then turning it", the system could categorize it as sharp, intense, and localized. PMID:19745477

  15. Neuropathic Pain in Elderly Patients with Chronic Low Back Painand Effects of Pregabalin: A Preliminary Study

    PubMed Central

    Ito, Kenyu; Hida, Tetsuro; Ito, Sadayuki; Harada, Atsushi

    2015-01-01

    Study Design Preliminary study. Purpose To assess the association of neuropathic pain with chronic low back pain (LBP) and the effect of pregabalin on neuropathic pain in the elderly. Overview of Literature Of those with chronic LBP, 37% were predominantly presenting with neuropathic pain in young adults. Pregabalin is effective for pain in patients with diabetic neuropathy and peripheral neuralgia. No study has reported on the effects of pregabalin for chronic LBP in elderly patients yet. Methods Pregabalin was administered to 32 patients (age, ≄65 years) with chronic LBP for 4 weeks. Pain and activities of daily living were assessed using the Neuropathic Pain Screening Questionnaire (NePSQ), the pain DETECT questionnaire, visual analog scale, the Japanese Orthopedic Association score, the short form of the McGill Pain Questionnaire and the Roland Morris Disability Questionnaire. Modic change and spinal canal stenosis were investigated using magnetic resonance imaging. Results Altogether, 43.3% of patients had neuropathic pain according to the NePSQ and 15.6% patients had pain according to the pain DETECT. The efficacy rate of pregabalin was 73.3%. A significant effect was observed in patients with neuropathic pain after 4 weeks of administration. Conclusions Neuropathic pain was slightly less frequently associated with chronic LBP in the elderly. Pregabalin was effective in reducing pain in patients with chronic LBP accompanied with neuropathic pain. Lumbar spinal stenosis and lower limb symptoms were observed in patients with neuropathic pain. We recommend the use of pregabalin for patients after evaluating a screening score, clinical symptoms and magnetic resonance imaging studies. PMID:25901238

  16. Chest pain in young patients in an office setting: cardiac diagnoses, outcomes, and test burden.

    PubMed

    Cohn, Herbert E; Arnold, Lucy W

    2012-09-01

    This study determined the incidence of cardiac diagnoses demonstrably related to chest pain in young patients and determined whether those with exertional chest pain were more likely to have a cardiac diagnosis. It evaluated the course of patients with chest pain after pediatric cardiology evaluation regarding interventions, outcomes, and additional test burden. This was a retrospective study of 203 patients with an office pediatric cardiology assessment of chest pain from January 2000 through December 2004. Fifteen patients (7.4%) had cardiac diagnoses, 5 (2.5%) had cardiac diagnoses demonstrably related to their chest pain complaints (arrhythmias, mitral valve prolapse), and none had ischemia. Exertional chest pain, in this study, did not increase the risk of having a cardiac diagnosis. Following evaluation, 80% of patients did not return for complaints of chest pain. Ten percent had 2 or more additional visits to any medical site for chest pain but no additional cardiac diagnoses were found. PMID:22752294

  17. Relationships between spinal mobility, physical performance tests, pain intensity and disability assessments in chronic low back pain patients.

    PubMed

    Grönblad, M; Hurri, H; Kouri, J P

    1997-03-01

    Correlations between the Oswestry Disability Questionnaire (ODQ), the Pain Disability Index (PDI), PDI subscales PDI factor 1 (PDI 1), PDI factor 2 (PDI 2) and visual analogue scale (VAS) pain intensity on the one hand and spine range of motion measures and static and dynamic functional performance tests on the other, were studied in 52 chronic low back pain patients. Comparable groups of male and female patients were studied. A moderately significant (p < 0.01) inverse correlation was observed between the ODQ and rotation to the left even after correction for age, but not when men and women were studied separately. A significant (r = -0.480, p < 0.001) inverse correlation was observed between the repeated squatting test and pain intensity and in men both pain intensity and disability correlated (r = -0.607, p < 0.001) with this particular test. Only for the women were there moderately significant (p < 0.01) inverse correlations between disability assessments and all the physical performance tests with the exception of the static back muscle test. In the women only the isometric lifting test showed a moderately significant inverse correlation (r = -0.504, p < 0.01) with pain intensity. Such apparent gender differences in the overlap between physical performance tests and self-report disability assessments and pain intensity may be clinically relevant. The results will, however, require confirmation on larger groups of chronic low back pain patients. PMID:9084101

  18. The effects of whole body vibration on static balance, spinal curvature, pain, and disability of patients with low back pain

    PubMed Central

    Yang, Jinmo; Seo, Dongkwon

    2015-01-01

    [Purpose] The purpose of this study was to investigate the impact of whole body vibration (WBV) on static balance, spinal curvature, pain, and the disability of patients with chronic lower back pain. [Subjects and Methods] The subjects were of 40 patients, who were randomly assigned to WBV and control groups. Twenty-five minutes of lumbar stability training and 5 minutes of WBV were conducted for the WBV group, and 30 minutes of lumbar stability training was conducted for the control group. The training was conducted three times per week for a total of 6 weeks. Static balance, spinal curvature, pain, and disability were measured before and after the intervention. [Results] After the intervention, the WBV group showed a significant differences in static balance, spinal curvature, pain, and disability. The control group presented significant differences in pain, and disability. In the comparison of the two groups, the WBV group showed more significant improvements in the fall index and pain. [Conclusion] WBV can be recommended for the improvement of the balance ability and pain of chronic lower back pain patients. PMID:25931735

  19. Innate Immune Signalling Genetics of Pain, Cognitive Dysfunction and Sickness Symptoms in Cancer Pain Patients Treated with Transdermal Fentanyl

    PubMed Central

    Barratt, Daniel T.; Klepstad, Pćl; Dale, Ola; Kaasa, Stein; Somogyi, Andrew A.

    2015-01-01

    Common adverse symptoms of cancer and chemotherapy are a major health burden; chief among these is pain, with opioids including transdermal fentanyl the mainstay of treatment. Innate immune activation has been implicated generally in pain, opioid analgesia, cognitive dysfunction, and sickness type symptoms reported by cancer patients. We aimed to determine if genetic polymorphisms in neuroimmune activation pathways alter the serum fentanyl concentration-response relationships for pain control, cognitive dysfunction, and other adverse symptoms, in cancer pain patients. Cancer pain patients (468) receiving transdermal fentanyl were genotyped for 31 single nucleotide polymorphisms in 19 genes: CASP1, BDNF, CRP, LY96, IL6, IL1B, TGFB1, TNF, IL10, IL2, TLR2, TLR4, MYD88, IL6R, OPRM1, ARRB2, COMT, STAT6 and ABCB1. Lasso and backward stepwise generalised linear regression were used to identify non-genetic and genetic predictors, respectively, of pain control (average Brief Pain Inventory < 4), cognitive dysfunction (Mini-Mental State Examination ? 23), sickness response and opioid adverse event complaint. Serum fentanyl concentrations did not predict between-patient variability in these outcomes, nor did genetic factors predict pain control, sickness response or opioid adverse event complaint. Carriers of the MYD88 rs6853 variant were half as likely to have cognitive dysfunction (11/111) than wild-type patients (69/325), with a relative risk of 0.45 (95% CI: 0.27 to 0.76) when accounting for major non-genetic predictors (age, Karnofsky functional score). This supports the involvement of innate immune signalling in cognitive dysfunction, and identifies MyD88 signalling pathways as a potential focus for predicting and reducing the burden of cognitive dysfunction in cancer pain patients. PMID:26332828

  20. Cerebral activation in patients with somatoform pain disorder exposed to pain and stress: an fMRI study.

    PubMed

    Stoeter, P; Bauermann, Th; Nickel, R; Corluka, L; Gawehn, J; Vucurevic, G; Vossel, G; Egle, U T

    2007-06-01

    Patients with somatoform pain disorders are supposed to suffer from an early acquired defect in stress regulation. In order to look for common alterations of the pain- and stress-responsive cortical areas, we prospectively recorded cerebral activations induced by pin-prick pain, by cognitive stress and emotional stress using functional magnetic resonance imaging (fMRI) in a group of 17 patients and an age-matched control group. In addition, the hippocampal volumes of both groups were measured. Patients showed increased activations of the known pain-processing areas (thalamus, basal ganglia, operculo-insular cortex), but also of some prefrontal, temporal and parietal regions during first pain exposure and of temporal and parietal areas during cognitive stress, but reduced activations during emotional stress. In contrast to these functional differences, hippocampal volume was not significantly reduced in patients. Although the superior temporal gyrus was the only common area of an "overactivation" in patients in the pain and stress condition, findings of our study support the current concept of mechanisms involved in somatoform pain disorders: central processing of pain and of cognitive stress is increased in patients possibly due to exaggerated memory and/or anticipation of pain exposure and to a disturbance of stress-regulating systems which has to be worked out on a cortical level in more detail. Our finding of a reduced responsiveness to emotional stress is surprising, but not contradictive to these results because some sort of neglect or coping mechanisms may have developed over time as a response to early adversities. PMID:17428684

  1. Special needs related to the pain and discomfort of patients with gynecologic cancer.

    PubMed

    Miaskowski, C

    1996-02-01

    Patients with gynecologic malignancies can experience pain associated with a variety of causes. Chronic pain associated with the disease or treatment presents the most problems. Chronic cancer-related pain is associated with negative mood states and a decrease in the patient's quality of life. Clinicians must conduct pain assessments on a routine basis to accurately diagnose the specific pain syndrome in patients with gynecologic cancer. An overview of how to conduct a pain assessment with such patients is provided. The etiology, clinical manifestations, and treatment strategies for the most common pain syndromes seen in patients with gynecologic cancer are reviewed. The use of nonpharmacologic interventions with this patient population is discussed. PMID:8656310

  2. Management of pain, agitation, and delirium in critically ill patients.

    PubMed

    Pandharipande, Pratik P; Patel, Mayur B; Barr, Juliana

    2014-01-01

    Pain, agitation, and delirium (PAD) are common in critically ill patients. Consequently, analgesic and sedative medications are frequently administered to critically ill patients to treat PAD, to improve synchrony with mechanical ventilation, and to decrease the physiological stress response. However, prolonged, continuous deep sedation of intensive care unit (ICU) patients is associated with numerous adverse outcomes, including longer durations of mechanical ventilation, prolonged ICU stays, acute brain dysfunction, and an increased risk of death. The 2013 ICU PAD Guidelines were developed to provide a clear, evidence-based road map for clinicians to better manage PAD in critically ill patients. Significant knowledge gaps in these areas still remain, but if widely adopted, the PAD Guidelines can help bridge these gaps and will be transformative in terms of their impact on ICU care. Strong evidence indicates that linking PAD management strategies with ventilator weaning, early mobility, and sleep hygiene in ICU patients will result in significant synergistic benefits to patient care and reductions in costs. An interdisciplinary team-based approach, using proven process improvement strategies, and ICU patient and family activation and engagement, will help ensure successful implementation of the ICU PAD Care Bundle in ICUs. This paper highlights the major recommendations of the 2013 ICU PAD Guidelines. We hope this review will help ICU physicians and other health care providers advance the management of PAD in critically ill patients, and improve patients' clinical outcomes. PMID:24424616

  3. Injection of Bupivacaine into Disc Space to Detect Painful Nonunion after Anterior Lumbar Interbody Fusion (ALIF) Surgery in Patients with Discogenic Low Back Pain

    PubMed Central

    Kimura, Seiji; Orita, Sumihisa; Inoue, Gen; Eguchi, Yawara; Takaso, Masashi; Ochiai, Nobuyasu; Kuniyoshi, Kazuki; Aoki, Yasuchika; Ishikawa, Tetsuhiro; Miyagi, Masayuki; Kamoda, Hiroto; Suzuki, Miyako; Sakuma, Yoshihiro; Kubota, Gou; Oikawa, Yasuhiro; Inage, Kazuhide; Sainoh, Takeshi; Yamauchi, Kazuyo; Toyone, Tomoaki; Nakamura, Junichi; Kishida, Shunji; Sato, Jun; Takahashi, Kazuhisa

    2014-01-01

    Purpose Bupivacaine is commonly used for the treatment of back pain and the diagnosis of its origin. Nonunion is sometimes observed after spinal fusion surgery; however, whether the nonunion causes pain is controversial. In the current study, we aimed to detect painful nonunion by injecting bupivacaine into the disc space of patients with nonunion after anterior lumbar interbody fusion (ALIF) surgery for discogenic low back pain. Materials and Methods From 52 patients with low back pain, we selected 42 who showed disc degeneration at only one level (L4-L5 or L5-S1) on magnetic resonance imaging and were diagnosed by pain provocation on discography and pain relief by discoblock (the injection of bupivacaine). They underwent ALIF surgery. If the patients showed low back pain and nonunion 2 years after surgery, we injected bupivacaine into the nonunion disc space. Patients showing pain relief after injection of bupivacaine underwent additional posterior fixation using pedicle screws. These patients were followed up 2 years after the revision surgery. Results Of the 42 patient subjects, 7 showed nonunion. Four of them did not show low back pain; whereas 3 showed moderate or severe low back pain. These 3 patients showed pain reduction after injection of bupivacaine into their nonunion disc space and underwent additional posterior fixation. They showed bony union and pain relief 2 years after the revision surgery. Conclusion Injection of bupivacaine into the nonunion disc space after ALIF surgery for discogenic low back pain is useful for diagnosis of the origin of pain. PMID:24532522

  4. Somatosensory and Affective Contributions to Emotional, Social, and Daily Functioning in Chronic Pain Patients

    PubMed Central

    Boggero, Ian A; Carlson, Charles R

    2015-01-01

    Objective The present study tested the independent and interactive contributions of the somatosensory component of pain (pain intensity) and the affective component of pain (pain unpleasantness) on emotional, social, and daily functioning in chronic pain patients. Subjects Participants were 472 patients seeking treatment for chronic orofacial pain. Mean age of the sample was 46.0 years (standard deviation [SD] = 14.67, range 18–78), with 82.2% female. Average pain duration at the time of initial appointment was 75.7 months (SD = 106.66). Methods Participants completed self-report measures of pain intensity, unpleasantness, and functional outcomes at the time of their first appointment. These data were later extracted from participant’s de-identified medical records. Multivariate linear regression was used to test the interaction of pain intensity and unpleasantness on outcome measures of emotional, social, and daily functioning. Results Results revealed that pain intensity contributed to poorer functional outcomes but higher levels of social support even after controlling for pain unpleasantness. After controlling for pain intensity, unpleasantness was associated with higher pain interference and affective distress. There was also pain intensity by unpleasantness interaction on pain interference. Specifically, at lower levels of pain unpleasantness, changes in pain intensity produced greater changes in pain interference than they did at higher levels of pain unpleasantness. Conclusions Results suggest that both intensity and unpleasantness contribute unique variance to functional outcomes. The results highlight the importance of interventions that not only try to reduce pain levels but also reduce levels of pain unpleasantness. PMID:25351790

  5. Factors that influence patient advocacy by pain management nurses: results of the American society for pain management nursing survey.

    PubMed

    Ware, Laurie Jowers; Bruckenthal, Patricia; Davis, Gail C; O'Conner-Von, Susan K

    2011-03-01

    What is the meaning of advocacy, and how does it relate to the nurse who wants patients to experience optimum pain management? This question and the lack of empirical data provided the stimulus for the American Society for Pain Management Nursing (ASPMN) Research Committee to explore ASPMN members' beliefs, knowledge, and skills regarding pain management advocacy activities. The specific aim of the study was to determine the educational needs for and barriers of advocacy for nurses working with patients experiencing pain. An ASPMN Advocacy Survey Instrument was developed to gather data about advocacy activities and interventions. The sample consisted of 188 ASPMN nurses (20% of the membership) who responded via the internet. Study findings revealed that the majority of nurse respondents were active in personal advocacy, serving as guardians of the patient. They confronted physicians as necessary and assisted patients to evaluate their pain management. Regarding making the public aware of pain management-related issues (i.e., public awareness advocacy), the respondents were not as active. Respondents were knowledgeable about pain management and best practices/best evidence, with the exceptions of legislative issues and media training. These two areas need support and educational intervention. Additional areas in need of education and training, as identified by respondents, are social and political advocacy interventions. "Lack of time" was identified as the barrier to advocacy experienced by the greatest number of nurses. PMID:21349446

  6. Pain Associated with Wound Care Treatment among Buruli Ulcer Patients from Ghana and Benin

    PubMed Central

    Alferink, Marike; de Zeeuw, Janine; Sopoh, Ghislain; Agossadou, Chantal; Abass, Karibu M.; Phillips, Richard O.; Loth, Susanne; Jutten, Emma; Barogui, Yves T.; Stewart, Roy E.; van der Werf, Tjip S.; Stienstra, Ymkje; Ranchor, Adelita V.

    2015-01-01

    Buruli ulcer (BU) is a necrotizing skin disease caused by Mycobacterium ulcerans. People living in remote areas in tropical Sub Saharan Africa are mostly affected. Wound care is an important component of BU management; this often needs to be extended for months after the initial antibiotic treatment. BU is reported in the literature as being painless, however clinical observations revealed that some patients experienced pain during wound care. This was the first study on pain intensity during and after wound care in BU patients and factors associated with pain. In Ghana and Benin, 52 BU patients above 5 years of age and their relatives were included between December 2012 and May 2014. Information on pain intensity during and after wound care was obtained during two consecutive weeks using the Wong-Baker Pain Scale. Median pain intensity during wound care was in the lower range (Mdn = 2, CV = 1), but severe pain (score > 6) was reported in nearly 30% of the patients. Nevertheless, only one patient received pain medication. Pain declined over time to low scores 2 hours after treatment. Factors associated with higher self-reported pain scores were; male gender, fear prior to treatment, pain during the night prior to treatment, and pain caused by cleaning the wound. The general idea that BU is painless is incorrect for the wound care procedure. This procedural pain deserves attention and appropriate intervention. PMID:26030764

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

    PubMed Central

    Banth, Sudha; Ardebil, Maryam Didehdar

    2015-01-01

    Background and Aim: Recovery of patients with chronic low back pain (LBP) is depended on several physical and psychological factors. Therefore, the authors aimed to examine the efficacy of mindfulness based stress reduction (MBSR) as a mind-body intervention on quality of life and pain severity of female patients with nonspecific chronic LBP (NSCLBP). Methods: 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. PMID:26170592

  8. Affective brain regions are activated during the processing of pain-related words in migraine patients.

    PubMed

    Eck, Judith; Richter, Maria; Straube, Thomas; Miltner, Wolfgang H R; Weiss, Thomas

    2011-05-01

    Several brain areas that constitute the neural matrix of pain can be activated by noxious stimuli and by pain-relevant cues, such as pictures, facial expressions, and pain-related words. Although chronic pain patients are frequently exposed to pain-related words, it remains unclear whether their pain matrix is specifically activated during the processing of such stimuli in comparison to healthy subjects. To answer this question, we compared the neural activations induced by verbal pain descriptors in a sample of migraine patients with activations in healthy controls using functional magnetic resonance imaging. Participants viewed pain-related adjectives and negative, non-pain-related adjectives that were matched for valence and arousal and were instructed to either generate mental images (imagination condition) or to count the number of vowels (distraction condition). In migraine patients, pain-related adjectives as compared with negative adjectives elicited increased activations in the left orbitofrontal cortex and anterior insula during imagination and in the right secondary somatosensory cortex and posterior insula during distraction. More pronounced pain-related activation was observed in affective pain-related regions in the patient as compared with the control group during imagination. During distraction, no differential engagement of single brain structures in response to pain-related words could be observed between groups. Overall, our findings indicate that there is an involvement of brain regions associated with the affective and sensory-discriminative dimension of pain in the processing of pain-related words in migraine patients, and that the recruitment of those regions associated with pain-related affect is enhanced in patients with chronic pain experiences. PMID:21377797

  9. Naltrexone metabolism and concomitant drug concentrations in chronic pain patients.

    PubMed

    Liu, Janet C; Ma, Joseph D; Morello, Candis M; Atayee, Rabia S; Best, Brookie M

    2014-05-01

    Naltrexone is effective in treating opioid dependence by blocking ”, Îș and ÎŽ opiate receptors. Naltrexone is mainly metabolized to an active metabolite 6ÎČ-naltrexol by dihydrodiol dehydrogenase enzymes. Concomitant opioids will not be effective while patients are taking this antagonist. This was a retrospective analysis of urinary excretion data collected from patients being treated with pain between November 2011 and May 2012. Naltrexone, 6ÎČ-naltrexol and concomitant opiate concentrations were measured by liquid chromatography-tandem mass spectrometry. Interpatient variability was calculated from first-visit specimens, and intrapatient variability was calculated from patients with two or more visits. Relationships of the metabolic ratio (MR; 6ÎČ-naltrexol/naltrexone) with age, gender and urinary pH were also explored. From 88 first-visit patient specimens, the median MR was 3.28 (range 0.73-17.42). The MR was higher in women than men (5.00 vs. 3.14, P< 0.05). The MR showed no association based on age and urinary pH. Eighteen of 88 patients taking oral naltrexone tested positive for concomitant opiate use. Urinary MRs of 6ÎČ-naltrexol/naltrexone were highly variable, which may contribute to variability in efficacy, toxicity and patient willingness to take naltrexone as directed. Twenty percent of patients tested positive for opiates and naltrexone, thus showing the importance of monitoring patients taking naltrexone. PMID:24659754

  10. Heavy metals and pain in the dysfunctional patient

    PubMed Central

    Di Paolo, Carlo; Serritella, Emanuela; Panti, Fabrizio; Falisi, Giovanni; Manna, Fedele

    2014-01-01

    Summary Aims The aim of this research is to verify the quality and quantity of heavy metals (HM) of dental origin in TMD patients. Methods A population of 100 subject was studied and divided in two homogeneous groups: Study Group (SG) and Control Group (CG). Organism heavy metals were tested by a spot sampling method in which the first urine of the day, through Inductively Coupled Plasma-Mass Spectrometry (ICP-MS), were analyzed. The results obtained were compared with reference values (RV) of Italian people. Descriptive statistical analysis and student’s t-test has been applied (statistical significance for p > 0.05). Results The SG presented the absolute highest levels of HM compared to the CG (p=0.787). As regards the relation between pain and HM, the subjects that refer “severe/very severe” values of pain present the highest levels of HM in urines. Conclusions The obtained results seem to highlight a possible direct proportionality between the level of pain the increase of the concentration of heavy metals in all the examined groups and subgroups. PMID:25002917

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

    PubMed

    Rana, Shiv Ps; Ahmed, Arif; Kumar, Vindo; Chaudhary, Prakash K; Khurana, Deepa; Mishra, Seema

    2011-05-01

    Morphine has been used for many years to relieve cancer pain. Oral morphine (in either immediate release or modified release form) remains the analgesic of choice for moderate or severe cancer pain. The dose of oral morphine is titrated up to achieve adequate relief from pain with minimal side effects. Antidepressant and anticonvulsant drugs, when used in addition to conventional analgesics, give excellent relief from cancer pain. Most cancer pain responds to pharmacological measures with oral morphine but some pain like neuropathic and bony pain, pain in children and elderly age group, and advanced malignancy pain are very difficult to treat. Here, we report the management of a similar patient of severe cancer pain and the difficulty that we came across during dose titration of oral morphine and adjuvant analgesic. PMID:21976860

  12. Validation and reliability of the German version of the Chronic Pain Grade questionnaire in primary care back pain patients

    PubMed Central

    Klasen, Bernhard W.; Hallner, Dirk; Schaub, Claudia; Willburger, Roland; Hasenbring, Monika

    2004-01-01

    In 1992 Von Korff and his co-workers developed a simple, brief questionnaire to assess the severity of chronic pain problems, the Chronic Pain Grade (CPG). The present study was conducted to analyse the psychometric properties of the translated German version of the CPG within a population of primary care back pain patients (n=130). Factor analysis yielded two factors which accounted for 72% of the variance of the questionnaire. The first factor 'Disability Score' (53.56% of the variance) revealed a good internal consistency (alpha=.88), the internal consistency of the second factor 'Characteristic Pain Intensity' was moderate (alpha=.68). The reliability of the whole instrument was good (alpha=.82). The CPG and its subscales show moderate to high relations with other instruments assessing the patient's disability (FFbH-R, Pain Disability Index PDI). Additionally weak to moderate but significant correlations were found between the CPG and other measures of grading and staging chronic pain (MPSS, RGS). Further, positive correlations between the CPG and both, the frequency of doctor visits and the frequent use of pain medication have been seen. The reported findings suggest, that the German version of the CPG is a reliable, valid and useful instrument if a brief, simple method of grading the severity of chronic pain is needed. The German version leads to a better comparability between German and English language studies and facilitates an international collaboration in this field of research. PMID:19742049

  13. [Pain patients in street traffic. Do analgesics impair driving safety?].

    PubMed

    Sohn, W

    2003-06-01

    Analgesics--in particular when self-prescribed or taken over the long term--may have a negative effect on safety on the road. This applies not only to vehicle drivers, but also to cyclists and pedestrians. Psychotropic effects of analgesics of all three WHO categories play a major causal role. Impairments may take the form of sleepiness, impaired vision, giddiness, loss of muscular tone or cardiovascular reactions. On the other hand, untreated severe pain has a high risk potential, since it may reduce both cognitive and psychomotoric performance. During the stabilization phase or dose adjustment of opioids, the patient must cautioned not to drive, and particular care must be taken in patients on concomitant or long-term medication or drinking excessive alcohol. In the last resort, the prescription of an analgesic is an individual decision involving both physician and patient. PMID:12854223

  14. The Effect of Shiatsu Massage on Pain Reduction in Burn Patients

    PubMed Central

    Ardabili, Fatemeh Mohaddes; Purhajari, Soybeh; Najafi Ghezeljeh, Tahereh; Haghani, Hamid

    2014-01-01

    BACKGROUND Burn is a tragedy that follows multiple problems in a patient including pain, anxiety and lack of confidence into medical team. This study evaluated the effect of shiatsu massage on pain intensity of burn patients. METHODS A total of 120 burn patients from Motahhari Burn Hospital and of both genders were randomly divided into 4 groups of undergoing hand massage, leg massage, both hand and leg massages, and the control group. The effect of shiatsu massage in pain relief of burned patients was evaluated. The visual analog scale (VAS) was used to assess pain in burn patients. RESULTS Pain intensity in the control group before and after the intervention was not statistically significant (p=1). In all massage groups, the difference for pain intensity before and after the intervention was statistically significant. CONCLUSION According to our data, shiatsu method over both hands and legs were effective in pain reduction and can be recommended together with analgesics to decrease the dose. PMID:25489534

  15. [Exploiting placebo and nocebo effects in patients with chronic pain].

    PubMed

    Klinger, Regine

    2015-10-01

    In recent years, the knowledge behind placebo analgesia has strongly increased. The underlying mechanisms are depictable in a comprehensive way. They can be used to enhance placebo responses in all active pain treatments. Expectations of the patient are pivotal and can be influenced specifically by learning processes and instructions, both in the positive direction (placebo response), as well as in the negative direction (nocebo response). In conversations, these principles can be considered to optimize the expectation with respect to treatment outcome and to reduce negative cognitions. PMID:26488104

  16. Body awareness therapy for patients with fibromyalgia and chronic pain.

    PubMed

    Gard, Gunvor

    2005-06-17

    There are several therapies designed to increase body awareness. They are commonly known as body awareness therapies (BAT) and include Basic BAT, Mensendieck and Feldenkrais therapy. A focus on emotions is important in all these therapies. In this article the aim and development of Basic BAT is described together with evaluations of treatments including Basic BAT. Multidisciplinary studies have shown that Basic BAT can increase health-related quality of life and cost-effectiveness. However Basic BAT needs to be further studied in relation to patients with fibromyalgia (FM) and chronic pain. Studies so far indicate that Basic BAT has positive effects. PMID:16012065

  17. Perceptions of disability and occupational stress as discriminators of work disability in patients with chronic pain.

    PubMed

    Feuerstein, M; Thebarge, R W

    1991-09-01

    Pain-related work disability can be influenced by a number of medical, physical, and psychosocial factors. The present study investigated the role of perceived disability, occupational stress, pain, and distress in patients with chronic pain disorders who work despite pain and patients who are work disabled. A total of 165 patients referred to a multidisciplinary pain treatment center for chronic pain (> 6 months) were studied. The two groups were compared on age, gender, education, marital status, duration of pain problem, pain severity, psychological distress, perceived disability, and perception of the work environment. A discriminant function analysis was computed entering pain severity, distress, perceived disability (physical and psychosocial) and work environment variables. The two groups were equivalent on age, gender, education, marital status, and duration of pain problem. The groups differed on diagnosis and insurance coverage with the work-disabled group diagnosed with low back pain and receiving Workers Compensation coverage more frequently than working controls. Univariate analyses indicated that the work-disabled group reported higher pain severity, perceived physical and psychosocial disability, and job stress than their working cohorts. The discriminant function analysis indicated that the perception of physical disability, supervisor support, distress, and work pressure were capable of correctly classifying patients with chronic pain who continued to work from those who were work disabled. These findings indicate the importance of evaluating perceived disability and job stress, and if present, directing intervention effort at these factors in order to facilitate work re-entry. PMID:24242740

  18. Auditory instructional cues benefit unimanual and bimanual drawing in Parkinson’s disease patients

    PubMed Central

    Ringenbach, Shannon D. R.; Van Gemmert, Arend W. A.; Shill, Holly A.; Stelmach, George E.

    2011-01-01

    The present study investigated performance of unimanual and bimanual anti-phase and in-phase upper limb line drawing using three different types of cues. Fifteen Parkinson’s disease (PD) patients, 15 elderly, and 15 young adults drew lines away from and towards their body on a tabletop every 1000 ms for 30 s under three different cueing conditions: (1) verbal (‘up’, ‘down’); (2) auditory (high tone, low tone); (3) visual (target line switched from top to bottom). PD patients had larger and more variable amplitudes which may be related to the finding that they also produced more curvilinear movements than young and elderly adults. Consistent with previous research, when compared to the elderly and young adult group PD patients produced a mean relative phase which deviated more from the instructed coordination modes and they showed larger variability of relative phase in bimanual coordination, especially in anti-phase conditions. For all groups, auditory and verbal cues resulted in lower coefficient of variance of cycle time, lower variability of amplitude and lower variability of relative phase than visual cues. The benefit of auditory cues may be related to the timing nature of the task or factors related to the auditory cues (e.g., reduced attentional demands, more kinesthetic focus). PMID:21168929

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

    PubMed Central

    Dehghan, Morteza

    2014-01-01

    Introduction: Acute low back pain is one of the most common health problems especially in industrialized countries where 75 per cent of the population develop it at least once during their life. This study examined the efficacy of thermotherapy and cryotherapy, alongside a routine pharmacologic treatment, on pain relief in patients with acute low back pain referring an orthopedic clinic in Shahrekord, Iran. Materials and Methods: This clinical trial study was conducted on 87 patients randomly assigned to three (thermotherapy and cryotherapy as intervention, and naproxen as control) groups of 29 each. The first (thermotherapy) group underwent treatment with hot water bag and naproxen, the second (cryotherapy) group was treated with ice and naproxen, and the naproxen group was only treated with naproxen, all for one week. All patients were examined on 0, 3rd, 8th, and 15th day after the first visit and the data gathered by McGill Pain Questionnaire. The data were analyzed by SPSS software using paired t-test, ANOVA, and chi-square. Results: In this study, mean age of the patients was 34.48 (20–50) years and 51.72 per cent were female. Thermotherapy patients reported significantly less pain compared to cryotherapy and control (p?0.05). In thermotherapy and cryotherapy groups, mean pain in the first visit was 12.70±3.7 and 12.06±2.6, and on the 15th day after intervention 0.75±0.37 and 2.20±2.12, respectively. Conclusion: The results indicated that the application of thermo–therapy and cryotherapy accompanied with a pharmacologic treatment could relieve pain in the patients with acute low back pain. PMID:25386469

  20. Nurse practitioners can effectively deliver pain coping skills training to osteoarthritis patients with chronic pain: A randomized, controlled trial

    PubMed Central

    Broderick, Joan E.; Keefe, Francis J.; Bruckenthal, Patricia; Junghaenel, Doerte U.; Schneider, Stefan; Schwartz, Joseph E.; Kaell, Alan T.; Caldwell, David S.; McKee, Daphne; Reed, Shelby; Gould, Elaine

    2014-01-01

    A multisite, randomized, controlled clinical effectiveness trial was conducted for osteoarthritis patients with chronic pain of the knee or hip. Adult health nurse practitioners provided a 10-session intervention, pain coping skills training (PCST), in patients’ doctors’ offices (N = 129 patients); the control group received usual care (N = 127 patients). Primary outcomes assessed at baseline, posttreatment, 6-month follow-up, and 12-month follow-up were: pain intensity, physical functioning, psychological distress, self-efficacy, catastrophizing, use of coping strategies, and quality of life. Secondary measures included fatigue, social functioning, health satisfaction, and use of pain medication. Methods favoring external validity, consistent with pragmatic, effectiveness research, were utilized. Primary ITT and secondary per-protocol analyses were conducted. Attrition was within the expected range: 11% at posttreatment and 29% at 12-month follow-up; rates did not differ between groups. Omnibus ITT analyses across all assessment points indicated significant improvement for the PCST group compared with the control group for pain intensity, physical functioning, psychological distress, use of pain coping strategies, and self-efficacy, as well as fatigue, satisfaction with health, and reduced use of pain medication. Treatment effects were robust to covariates (demographics and clinical sites). Trends in the outcomes across the assessments were examined. All outcomes, except for self-efficacy, were maintained through the 12-month follow-up; effects for self-efficacy degraded over time. Per-protocol analyses did not yield greater effect sizes. Comparisons of PCST patients who were more vs less treatment adherent suggested greater effectiveness for patients with high adherence. Results support the effectiveness of nurse practitioner delivery of PCST for chronic osteoarthritis pain. PMID:24865795

  1. Evoked Pain Analgesia in Chronic Pelvic Pain Patients using Respiratory-gated Auricular Vagal Afferent Nerve Stimulation

    PubMed Central

    Napadow, Vitaly; Edwards, Robert R; Cahalan, Christine M; Mensing, George; Greenbaum, Seth; Valovska, Assia; Li, Ang; Kim, Jieun; Maeda, Yumi; Park, Kyungmo; Wasan, Ajay D.

    2012-01-01

    Objective Previous Vagus Nerve Stimulation (VNS) studies have demonstrated anti-nociceptive effects, and recent non-invasive approaches; termed transcutaneous-VNS, or t-VNS, have utilized stimulation of the auricular branch of the vagus nerve in the ear. The dorsal medullary vagal system operates in tune with respiration, and we propose that supplying vagal afferent stimulation gated to the exhalation phase of respiration can optimize t-VNS. Design counterbalanced, crossover study. Patients patients with chronic pelvic pain (CPP) due to endometriosis in a specialty pain clinic. Interventions/Outcomes We evaluated evoked pain analgesia for Respiratory-gated Auricular Vagal Afferent Nerve Stimulation (RAVANS) compared with Non-Vagal Auricular Stimulation (NVAS). RAVANS and NVAS were evaluated in separate sessions spaced at least one week apart. Outcome measures included deep tissue pain intensity, temporal summation of pain, and anxiety ratings, which were assessed at baseline, during active stimulation, immediately following stimulation, and 15 minutes after stimulus cessation. Results RAVANS demonstrated a trend for reduced evoked pain intensity and temporal summation of mechanical pain, and significantly reduced anxiety in N=15 CPP patients, compared to NVAS, with moderate to large effect sizes (eta2>0.2). Conclusion Chronic pain disorders such as CPP are in great need of effective, non-pharmacological options for treatment. RAVANS produced promising anti-nociceptive effects for QST outcomes reflective of the noted hyperalgesia and central sensitization in this patient population. Future studies should evaluate longer-term application of RAVANS to examine its effects on both QST outcomes and clinical pain. PMID:22568773

  2. In Lumbar Fusion Patients, How Does Establishing a Comfort Function Goal Preoperatively Impact Postoperative Pain Scores?

    PubMed

    Hennessy, Winnie; Wagner, Elizabeth; Dumas, Bonnie P; Handley, Patricia

    2015-12-01

    The purpose of this feasibility study was to determine the impact of establishing a comfort function goal preoperatively on postoperative pain scores and opiate requirements in lumbar fusion patients. A comfort function goal is defined as the pain score identified by the patient describing the level of pain tolerance to participate in healing activities such as deep breathing, ambulation and participation in activities of daily living. The design was prospective, nonrandomized, intervention group (n = 30) compared with retrospective chart review as control group (n = 30). Sample included patients scheduled for routine lumbar fusion in an urban southeastern hospital. The study intervention established a comfort function goal during a routine preoperative patient education class. No significant difference in pain score or opiate requirement was found for these data. However, a fundamental clinical question arose surrounding opiate requirements and dosing management. In our hospital, the norm for postoperative pain management is to categorize pain scores as mild (1-3), moderate (4-6), and severe (7-10) pain. Physician orders commonly use this differential to order opiate dose ranges. In this sample, the mean pain score for the intervention group at home is 5.8 and the mean comfort function goal is 4.9. Based on normative categories of pain scores, if a patient's baseline of tolerable pain is 4.9, this has potential impact on clinician responses to managing pain, as 4.9-5.8 is, for this patient, perhaps a mild range of pain, not moderate. If a patient reports a pain score of 7, and their norm is 5.8, the delta is only 1.2. Does this imply that the patient is experiencing mild or severe pain? Does the nurse deliver a dose of pain medication that is in the mild or severe dose range? PMID:26293197

  3. Factors associated with chronic musculoskeletal pain in patients with chronic kidney disease

    PubMed Central

    2014-01-01

    Background Chronic musculoskeletal (MS) pain is common in patients with chronic kidney disease (CKD) undergoing haemodialysis. However, epidemiological data for chronic MS pain and factors associated with chronic MS pain in patients with early- or late-stage CKD who are not undergoing dialysis are limited. Method A cross-sectional study to evaluate the prevalence of chronic MS pain and factors associated with chronic MS pain in patients with early- and late-stage CKD who were not undergoing dialysis, was conducted. In addition, the distribution of pain severity among patients with different stages of CKD was evaluated. Results Of the 456 CKD patients studied, 53.3% (n?=?243/456) had chronic MS pain. Chronic MS pain was independently and significantly associated with hyperuricemia as co-morbidity, as well as with the calcium?Ś?phosphate product levels. In CKD patients with hyperuricemia, chronic MS pain showed a negative, independent significant association with diabetes mellitus as a co-morbidity (odds ratio: 0.413, p?=?0.020). However, in the CKD patients without hyperuricemia as a co-morbidity, chronic MS pain showed an independent significant association with the calcium?Ś?phosphate product levels (odds ratio: 1.093, p?=?0.027). Furthermore, stage-5 CKD patients seemed to experience more severe chronic MS pain than patients with other stages of CKD. Conclusion Chronic MS pain is common in CKD patients. Chronic MS pain was independently and significantly associated with hyperuricemia as co-morbidity, and with the calcium?Ś?phosphate product levels in early- and late-stage CKD patients who were not on dialysis. PMID:24400957

  4. A web-based neurological pain classifier tool utilizing Bayesian decision theory for pain classification in spinal cord injury patients

    NASA Astrophysics Data System (ADS)

    Verma, Sneha K.; Chun, Sophia; Liu, Brent J.

    2014-03-01

    Pain is a common complication after spinal cord injury with prevalence estimates ranging 77% to 81%, which highly affects a patient's lifestyle and well-being. In the current clinical setting paper-based forms are used to classify pain correctly, however, the accuracy of diagnoses and optimal management of pain largely depend on the expert reviewer, which in many cases is not possible because of very few experts in this field. The need for a clinical decision support system that can be used by expert and non-expert clinicians has been cited in literature, but such a system has not been developed. We have designed and developed a stand-alone tool for correctly classifying pain type in spinal cord injury (SCI) patients, using Bayesian decision theory. Various machine learning simulation methods are used to verify the algorithm using a pilot study data set, which consists of 48 patients data set. The data set consists of the paper-based forms, collected at Long Beach VA clinic with pain classification done by expert in the field. Using the WEKA as the machine learning tool we have tested on the 48 patient dataset that the hypothesis that attributes collected on the forms and the pain location marked by patients have very significant impact on the pain type classification. This tool will be integrated with an imaging informatics system to support a clinical study that will test the effectiveness of using Proton Beam radiotherapy for treating spinal cord injury (SCI) related neuropathic pain as an alternative to invasive surgical lesioning.

  5. Pain Management in the Post-Operative Pediatric Urologic Patient.

    PubMed

    Merkel, Sandra I; Danaher, Judith A; Williams, Jean

    2015-01-01

    Optimizing pain management is a component of enhanced perioperative recovery for children undergoing urologic surgery. Incisional pain and discomfort from bladder spasms are two types of pain associated with bladder surgery. A child's developmental level and verbal skills must be considered when selecting pain assessment tools. Assessing pain location, type, and intensity is essential in developing a multimodal plan of care for post-operative pain. Pharmacological interventions provide effective pain management, which facilitates early ambulation, return to oral intake, and recovery. Pre-operative preparation, non-pharmacological interventions, and parental presence help decrease anxiety and promote comfort, as well as support a child's coping skills. PMID:26197625

  6. The effects of extracorporeal shock wave therapy on pain, disability, and depression of chronic low back pain patients

    PubMed Central

    Han, Hyeonjee; Lee, Daehee; Lee, Sangyong; Jeon, Chunbae; Kim, Taehoon

    2015-01-01

    [Purpose] The purpose of this study was to examine the effects of extracorporeal shock wave therapy on pain, disability, and depression of chronic low back pain patients. [Subjects] In this study, 30 chronic low back pain patients were divided into an extracorporeal shock wave therapy group (ESWTG, n=15) and a conservative physical therapy group (CPTG, n=15). [Methods] The ESWTG received extracorporeal shock wave therapy and the CPTG received general conservative physical therapy two times per week for six weeks. Pain was measured using a visual analog scale (VAS), the degree of disability of the patients was assessed using the Oswestry Disability Index (ODI), and their degree of depression was measured using the Beck depression index (BDI). [Results] In intra-group comparisons, ESWTG and CPTG showed significant decreases in VAS, ODI, and BDI scores. Intergroup comparisons revealed that these decreases in VAS, ODI, and BDI scores were significantly larger in ESWTG than in CPTG. [Conclusion] Extracorporeal shock wave therapy is an effective intervention for the treatment of pain, disability, and depression in chronic low back pain patients. PMID:25729177

  7. INTESTINAL PARASITES IN PATIENTS WITH CHRONIC ABDOMINAL PAIN.

    PubMed

    Omran, Eman Kh; Mohammad, Asmaa N

    2015-08-01

    Information about intestinal parasites in Sohag (Upper Egypt) in patients with chronic abdominal pain is scarce. This study determined the intestinal parasites symptoms in 130 patients with chronic abdominal pain and cross-matched 20 healthy persons. Parasitic infection was confirmed by stool analysis.The most commonest clinical data with stool analysis was as following: 1-Entamoeba histolytica associated with nausea 20 (3 7.74%) followed by anorexia 19 (35.85%), 2-Entamoeba coli associated with diarrhea 3 (100%) followed by nausea 2 (66.67%) and vomiting 2 (66.67%), 3-Enetrobius vermicularis associated with nausea 2 (66.67%), diarrhea 2 (66.67%) followed by flatulence 1(33.33%), 4-Giardia lamblia associated with anorexia 3 (42.86%), vomiting 3 (42.86%) followed by diarrhea 2 (28.57%)., 6-Hymenolepis nana associated with anorexia 10 (40.00%) followed by flatulence 9 (36.00%), 7-Taenia saginata associated with dyspepsia 3 (60.00%) followed by flatulence 2 (40.00%), and 8-Ancylostoma duodenal associated with anorexia 2 (66.67%) and diarrhea 2 (66.67%). PMID:26485858

  8. Dyspeptic patients with visceral hypersensitivity: sensitisation of pain specific or multimodal pathways?

    PubMed Central

    Vandenberghe, J; Vos, R; Persoons, P; Demyttenaere, K; Janssens, J; Tack, J

    2005-01-01

    Background and aims: Patients with functional dyspepsia who have hypersensitivity to gastric distension have more prevalent pain, suggesting the presence of hyperalgesia. It is unclear whether this reflects activation of pain specific afferent pathways or multimodal afferent pathways that also mediate non-painful sensations. In the former case, hyperalgesia should occur when intensity of non-painful sensations is still low. The aim of the study was to analyse whether the symptom profile during gastric dissentions in functional dyspepsia patients with hyperalgesia reflects sensitisation of pain specific or multimodal pathways. Methods: Forty eight consecutive dyspeptic patients (35 female) underwent gastric sensitivity testing with a barostat balloon using a double random staircase protocol. At the end of every distending step, patients scored perception of upper abdominal sensations on a graphic 0–6 rating scale and completed visual analogue scales (VAS 0–100 mm) for pain, nausea, satiety, and fullness. The end point was a rating scale of 5 or more. Results: Hypersensitivity was present in 20 patients (40%); gastric compliance did not differ between normo- and hypersensitive patients. At maximal distension (score 5 or more), hypersensitive patients had significantly lower distending pressures and intra-balloon volumes, but similar VAS scores for pain, nausea, satiety, and fullness compared with normosensitive patients. In both normosensitive and hypersensitive patients, elevation of pain VAS scores with increasing distending pressures paralleled the elevation in VAS scores for nausea, satiety, and fullness. Conclusions: Hypersensitive dyspeptic patients reach the same intensity of painful and non-painful sensations as normosensitive patients but at lower distending pressures. Hyperalgesia occurs in hypersensitive dyspeptic patients at distending pressures that also induce intense non-painful sensations. These findings argue against isolated upregulation of pain specific afferents in functional dyspepsia patients with visceral hypersensitivity. PMID:15951533

  9. Sensitivity to itch and pain in patients with psoriasis and rheumatoid arthritis.

    PubMed

    van Laarhoven, Antoinette I M; Kraaimaat, Floris W; Wilder-Smith, Oliver H; van Riel, Piet L C M; van de Kerkhof, Peter C M; Evers, Andrea W M

    2013-08-01

    Symptoms of itch and pain in chronic inflammatory conditions of psoriasis (PS) and rheumatoid arthritis (RA) can highly affect patients' quality of life. Studies in other patient groups indicate that sensitivity to itch and pain is altered in line with the patient's main symptom of either chronic itch or pain, as a result of sensitization processes. This study directly compared whether patients with chronic inflammatory conditions associated with chronic itch or pain display a heightened sensitivity to itch and pain, respectively. Sensitivity to itch and pain was measured by applying stimuli of quantitative sensory testing (QST) in female patients with chronic itch due to PS or chronic pain due to RA. Levels of itch and pain evoked by the QST stimuli as well as the tolerance to the stimuli were determined. Patients with PS reacted to the stimuli with a higher itch response (histamine), while the patients with RA displayed a lowered tolerance to the stimuli (cold pressor test and mechanical stimulation) in comparison with the other patient group. In line with previous studies in other patient groups with chronic itch or pain, further support was found that somatosensory stimuli are processed in line with the patients' main symptom through generic sensitization processes, also in chronic inflammatory conditions such as PS and RA. PMID:23802713

  10. The Use of Analgesic Drugs in Patients with Sickle Cell Painful Crisis

    PubMed Central

    Boyd, I; Gossell-Williams, M; Lee, MG

    2014-01-01

    ABSTRACT Objective: To determine the drug options used for pain in patients with acute sickle cell painful crisis at the University Hospital of the West Indies (UHWI), Jamaica. Method: This retrospective study assessed all patients admitted to the UHWI between January 1, 2006, and December 31, 2010, with acute sickle cell anaemia painful crisis and the data obtained regarding site, severity, outcome and drug options selected for pain. Results: There were 101 patients with a mean age (± SD) of 18.6 (± 14.3) years; there was no difference in gender (42 females, 59 males). Eight sites of pain were reported, with the most common site being the lower limbs (44.6%) and 60.3% experienced pain in more than one site. Most of the patients (75.2%) were diagnosed with severe pain. Drug options included opioid, non-opioid or a combination, with pethidine (76) and paracetamol (79) being the most common chosen opioid and non-opioid drugs selected for therapy. There was low correlation between pain severity and appropriate first-line treatment (Spearman's rho = 0.344; p < 0.000). All patients with “mild” and “mild to moderate” pain were initially treated and obtained resolution of pain with non-opioid based therapy. However, most of the patients with severe pain (55.3%) required a second-line and some third line (14.5%) of therapy for resolution at the time of discharge from the hospital. Conclusion: Painful crisis in patients with sickle cell anaemia is associated with severe pain in 75% and most will require second-line therapy for adequate resolution. Physicians need to provide adequate pain relief to decrease morbidity in these patients. PMID:25781286

  11. White Cancer Patients’ Perception of Gender and Ethnic Differences in Pain Experience

    PubMed Central

    Im, Eun-Ok

    2008-01-01

    Not considering cancer patients’ own views and experience with pain, especially gender and ethnic differences in their cancer pain experience, was reported to be a major contributor to the miscommunication that frequently results in inadequate cancer pain management. The purpose of this study was to explore white cancer patients’ perception of gender and ethnic differences in pain experience through an online forum. This was a descriptive qualitative study among 29 white cancer patients based on a feminist approach. Nine topics related to cancer pain experience were used. The data were analyzed using thematic analysis: 5 themes were identified. First, the participants perceived that pain accompanies cancer throughout the diagnosis and treatment process. Second, the specific characteristics of the participants’ individual culture and its view of pain and cancer could result in different cancer pain experience even among white cancer patients. Third, the participants complained that women’s pain was not taken seriously by health care providers. Fourth, the participants reported highly individualized pain experience with emotional pain. Finally, the participants wanted to have a control of their own pain management process. Based on the findings, implications for nursing research and practice are proposed. PMID:17135816

  12. Process evaluation of podiatric treatment of patients with forefoot pain

    PubMed Central

    2013-01-01

    Background Foot pain is a common problem for people aged 50 and over and occurs more often in women than in men. About 60% of the foot problems are forefoot problems and slightly more than half of these patients seek medical help, mainly in the form of podiatric care. Podiatric treatment of forefoot problems is known to be heterogeneous. The aims of the present study are to describe the podiatric treatment of patients with forefoot pain and to evaluate the podiatric examination and treatment using an expert panel. Method We invited twenty-five randomly selected subjects with forefoot problems who had received podiatric treatment in a pragmatic randomised clinical trial to participate in an analysis of their treatment by an expert panel. The panel retrospectively established the cause of the foot problem as well as the therapeutic goals and evaluated the treatment. These findings were compared to those reported by the treating podiatrist. Results Two fundamentally different approaches were found in approach of podiatric examination; a functional approach (n?=13) and a non-functional approach (n?=12). In nine cases the expert panel agreed with the cause recorded by the podiatrist. In five other cases the expert panel concluded that the treatment of the podiatrist was not consistent with the cause of the problem recorded by the podiatrist. Of the 10 patients for whom the podiatrist had recorded to have given shoe advice, only two were able to recollect the proper advice. Three patients did not remember receiving advice at all. Conclusion In this study almost half of the podiatrists worked according to a non-functional approach where the other half (like the expert panel) chose a functional strategy that analyses the underlying problem. Fundamental differences in treatment plans and thus heterogeneous treatments could be a consequence. PMID:23919765

  13. Nurses Use of Critical Care Pain Observational Tool in Patients with Low Consciousness

    PubMed Central

    Asadi-Noghabi, Ahmad-Ali; Gholizadeh, Mohammad; Zolfaghari, Mitra; Mehran, Abbas; Sohrabi, Maryam

    2015-01-01

    Objectives The diagnosis of pain in patients with low consciousness is a major challenge in the intensive care unit (ICU). Therefore, the use of behavioral tools for pain assessment could be an effective tool to manage pain in this group of patients. The aim of this study was to determine the effects on pain management by nurses using a critical care pain observational tool in patients with a decreased level of consciousness.  Methods Our research used a before and after design to evaluate the ability of nurses to manage pain in patients with low consciousness. A total of 106 ICU nurses were included in the study. The study was divided into three phases: pre-implementation, implementation, and post-implementation. The researchers first observed the nurses management of pain in their patients; this was done three times using a checklist following tracheal suctioning and position change procedures. The nurses were then taught how to apply the critical-care pain observational tool (CPOT). Post-implementation of the tool, the researchers re-evaluated trained the nurses’ pain management.  Results Performance scores after training improved with relation to the nurses diagnosis of pain, pharmacological and nonpharmacological actions, reassessment of pain, and re-relieving of any pain. However, use of the tool did not improve the recording of the patient’s pain and the relief measures used.  Conclusion Use of the CPOT can increase nurse’s sensitivity to pain in non-conscious patients and drive them to track and perform pain management. PMID:26366262

  14. [Analgesic management of acute pain in patients receiving methadone or buprenorphine].

    PubMed

    Zinck, Louise; Sonne, Nan M; Madsen, Sidsel Lægdsgaard; Nikolajsen, Lone

    2015-03-01

    In Denmark, approximately 7,600 patients receive maintenance therapy with methadone or buprenorphine because of opioid addiction. These patients have an increased risk of inadequate pain treatment during hospitalization, among others because of tolerance to opioids and poor communication with the staff. The present article describes four common misconceptions among health-care providers that underlie inadequate pain treatment and provides practical recommendations for the analgesic management of acute pain in patients receiving methadone or buprenorphine. PMID:25749118

  15. Quality Improvement Project to Improve Patient Satisfaction With Pain Management: Using Human-Centered Design.

    PubMed

    Trail-Mahan, Tracy; Heisler, Scott; Katica, Mary

    2016-01-01

    In this quality improvement project, our health system developed a comprehensive, patient-centered approach to improving inpatient pain management and assessed its impact on patient satisfaction across 21 medical centers. Using human-centered design principles, a bundle of 6 individual and team nursing practices was developed. Patient satisfaction with pain management, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems pain composite score, increased from the 25th to just under the 75th national percentile. PMID:26447343

  16. Drawing Inventors

    ERIC Educational Resources Information Center

    Szekely, George

    2012-01-01

    Children are drawing inventors. Their art is certainly not what most adults think of as drawing. Almost instinctively, kids know that drawing is everywhere--that they can draw with almost anything, and that innumerable surfaces can be converted for art use. Teaching drawing is showing interest and enthusiasm for kids' drawing inventions--instead…

  17. Drawing Inventors

    ERIC Educational Resources Information Center

    Szekely, George

    2012-01-01

    Children are drawing inventors. Their art is certainly not what most adults think of as drawing. Almost instinctively, kids know that drawing is everywhere--that they can draw with almost anything, and that innumerable surfaces can be converted for art use. Teaching drawing is showing interest and enthusiasm for kids' drawing inventions--instead


  18. Microneurographic findings of relevance to pain in patients with erythromelalgia and patients with diabetic neuropathy.

    PubMed

    Orstavik, Kristin; Jűrum, Ellen

    2010-02-19

    Mechanisms responsible for neuropathic pain are still unclear. By using microneurography we have been able to record from single C-nociceptive and sympathetic fibers in patients and attempted to uncover possible abnormal functional properties of these fibers of relevance for pain. In two previously published studies conducted on patients with erythromelalgia and patients with diabetic neuropathy, some of the major findings were: (1) spontaneous activity in nociceptive fibers, (2) sensitization of mechano-insensitive C-fibers, and (3) an altered distribution of C-afferent nerve fibers with a reversal of the proportion of the two main subtypes of C-nociceptive fibers, indicating a loss of function of polymodal nociceptors. Although some degree of spontaneous activity and sensitization also was found in patients without pain, these mechanisms may still be of importance for the development and maintenance of neuropathic pain. A change in the distribution of C-nociceptive fibers in the skin as shown in the patients with diabetic neuropathy may help to reveal mechanisms responsible for small-fiber dysfunction. PMID:19481586

  19. New Pain Management Options for the Surgical Patient on Methadone and Buprenorphine.

    PubMed

    Sen, Sudipta; Arulkumar, Sailesh; Cornett, Elyse M; Gayle, Julie A; Flower, Ronda R; Fox, Charles J; Kaye, Alan D

    2016-03-01

    Perioperative management of patients receiving opioid addiction therapy presents a unique challenge for the anesthesiologist. The goal of pain management in this patient population is to effectively manage postoperative pain, to improve patient satisfaction and outcomes, and to reduce the cost of health care. Multimodal analgesics, including nonsteroid anti-inflammatory drugs, intravenous acetaminophen, gabapentanoid agents, and low-dose ketamine infusions, have been used to improve postoperative pain and to reduce postoperative opioid use. Patients on long-term opioid management therapy with methadone and buprenorphine require special considerations. Recommendations and options for treating postoperative pain in patients on methadone and buprenorphine are outlined below. Other postoperative pain management options include patient-controlled analgesia, intravenous, and transdermal, in addition to neuraxial and regional anesthesia techniques. Special patient populations include the parturient on long-term opioid therapy. Recommendations for use of opioids in these patients during labor and delivery and in the postpartum period are discussed. PMID:26879874

  20. Current State of Pain Care for Hospitalized Patients at End of Life

    PubMed Central

    Yao, Yingwei; Keenan, Gail; Al-Masalha, Fadi; Lopez, Karen Dunn; Khokar, Ashfaq; Johnson, Andrew; Ansari, Rashid; Wilkie, Diana J.

    2013-01-01

    We report findings on the current state of pain care in hospitals for end-of-life (EOL) patients using longitudinal data from eight diverse medical-surgical units located in 4 different Midwestern hospitals over 24 months. We identified 1,425 EOL care episodes, 596 (41.3%) of which had a pain diagnosis. The percentage of EOL patients with pain varied significantly across units (p<.001), and was even lower (27.7%) for those with “acute confusion.” Additionally, 30% of EOL patients had severe or significant pain at death or discharge to hospice and only 42.7% actually met the expected pain related outcome ratings. Pain often improved within 48 hours of admission (p<.005), the improvement, however, stagnated following this initial time period (p=.92). A sizable gap between pain science and clinical practice continues. PMID:22556281

  1. The Utility of the Faces Pain Scale in the Assessment of Shoulder Pain in Turkish Stroke Patients: Its Relation with Quality of Life and Psychologic Status

    ERIC Educational Resources Information Center

    Dogan, Sebnem Koldas; Ay, Saime; Oztuna, Derya; Aytur, Yesim Kurtais; Evcik, Deniz

    2010-01-01

    This study was planned to investigate the utility of the vertical Faces Pain Scale (FPS) in the assessment of pain in stroke patients using the shoulder pain model and to assess its utility in the Turkish patient population. The secondary aim was to analyze the association of FPS with the quality of life and depression in the study population.


  2. The Utility of the Faces Pain Scale in the Assessment of Shoulder Pain in Turkish Stroke Patients: Its Relation with Quality of Life and Psychologic Status

    ERIC Educational Resources Information Center

    Dogan, Sebnem Koldas; Ay, Saime; Oztuna, Derya; Aytur, Yesim Kurtais; Evcik, Deniz

    2010-01-01

    This study was planned to investigate the utility of the vertical Faces Pain Scale (FPS) in the assessment of pain in stroke patients using the shoulder pain model and to assess its utility in the Turkish patient population. The secondary aim was to analyze the association of FPS with the quality of life and depression in the study population.…

  3. The transition from acute to chronic pain: might intensive care unit patients be at risk?

    PubMed Central

    2012-01-01

    Pain remains a significant problem for patients hospitalized in intensive care units (ICUs). As research has shown, for some of these patients pain might even persist after discharge and become chronic. Exposure to intense pain and stress during medical and nursing procedures could be a risk factor that contributes to the transition from acute to chronic pain, which is a major disruption of the pain neurological system. New evidence suggests that physiological alterations contributing to chronic pain states take place both in the peripheral and central nervous systems. The purpose of this paper is to: 1) review cutting-edge theories regarding pain and mechanisms that underlie the transition from acute to chronic pain, such as increases in membrane excitability of peripheral and central nerve fibers, synaptic plasticity, and loss of the function of descending inhibitory pain fibers; 2) provide information on the association between the immune system and pain and its crucial contribution to development of chronic pain syndromes, and 3) discuss mechanisms at brain levels in the nervous system and their contribution to affective (i.e., emotional) states associated with chronic pain conditions. Finally, we will offer suggestions for ICU clinical interventions to attempt to prevent the transition from acute to chronic pain. PMID:22898192

  4. The Influence of Pain Distribution on Walking Velocity and Horizontal Ground Reaction Forces in Patients with Low Back Pain

    PubMed Central

    Simmonds, Maureen J.; Lee, C. Ellen; Etnyre, Bruce R.; Morris, G. Stephen

    2012-01-01

    Objective. The primary purpose of this paper was to evaluate the influence of pain distribution on gait characteristics in subjects with low back problems (LBP) during walking at preferred and fastest speeds. Design. Cross-sectional, observational study. Setting. Gait analysis laboratory in a health professions university. Participants. A convenience age- and gender-matched sample of 20 subjects with back pain only (BPO), 20 with referred leg pain due to back problems (LGP), and 20 pain-free individuals (CON). Methods and Measures. Subjects completed standardized self-reports on pain and disability and were videotaped as they walked at their preferred and fastest speeds along a walkway embedded with a force plate. Temporal and spatial gait characteristics were measured at the midsection of the walkway, and peak medial, lateral, anterior, and posterior components of horizontal ground reaction forces (hGRFs) were measured during the stance phase. Results. Patients with leg pain had higher levels of pain intensity and affect compared to those with back pain only (t = 4.91, P < .001 and t = 5.80, P < 0.001, resp.) and walking had an analgesic effect in the BPO group. Gait velocity was highest in the control group followed by the BPO and LGP group and differed between groups at both walking speeds (F2.57 = 13.62, P < .001 and F2.57 = 9.09, P < .001, for preferred and fastest speed condition, resp.). When normalized against gait velocity, the LGP group generated significantly less lateral force at the fastest walking speed (P = .005) and significantly less posterior force at both walking speeds (P ? .01) compared to the control group. Conclusions. Pain intensity and distribution differentially influence gait velocity and hGRFs during gait. Those with referred leg pain tend to utilize significantly altered gait strategies that are more apparent at faster walking speeds. PMID:22550576

  5. Self-reports of medication side effects and pain-related activity interference in patients with chronic pain: a longitudinal cohort study.

    PubMed

    Martel, Marc O; Finan, Patrick H; Dolman, Andrew J; Subramanian, Subu; Edwards, Robert R; Wasan, Ajay D; Jamison, Robert N

    2015-06-01

    The primary purpose of this study was to examine the association between self-reports of medication side effects and pain-related activity interference in patients with chronic pain. The potential moderators of the association between reports of side effects and pain-related activity interference were also examined. A total of 111 patients with chronic musculoskeletal pain were asked to provide, once a month for a period of 6 months, self-reports of medication use and the presence of any perceived side effects (eg, nausea, dizziness, headaches) associated with their medications. At each of these time points, patients were also asked to provide self-reports of pain intensity, negative affect, and pain-related activity interference. Multilevel modeling analyses revealed that month-to-month increases in perceived medication side effects were associated with heightened pain-related activity interference (P < 0.05). Importantly, multilevel models revealed that perceived medication side effects were associated with heightened pain-related activity interference even after controlling for the influence of patient demographics, pain intensity, and negative affect. This study provides preliminary evidence that reports of medication side effects are associated with heightened pain-related activity interference in patients with chronic pain beyond the influence of other pain-relevant variables. The implications of our findings for clinical practice and the management of patients with chronic pain conditions are discussed. PMID:25782367

  6. Managing a Female Patient with Left Low Back Pain and Sacroiliac Joint Pain with Therapeutic Exercise: A Case Report

    PubMed Central

    2011-01-01

    ABSTRACT Purpose: The purpose of this case study is to describe the management of a female patient with chronic left low back pain and sacroiliac joint pain (LBP/SIJP) using unique unilateral exercises developed by the Postural Restoration Institute (PRI) to address pelvic asymmetry and left hip capsule restriction, which is consistent with a Right Handed and Left Anterior Interior Chain pattern of postural asymmetry. Client Description: The client was 65-year-old woman with a 10-month history of constant left LBP/SIJP and leg pain. Intervention: The patient was seen six times to correct pelvic position/posture and left hip posterior capsule restriction via (1) muscle activation (left hamstrings, adductor magnus, and anterior gluteus medius) and (2) left hip adduction to lengthen the left posterior capsule/ischiofemoral ligament. Stabilization exercises included bilateral hamstrings, gluteus maximus, adductors, and abdominals to maintain pelvic position/posture. Measures and Outcome: Left Ober's test (initially positive) was negative at discharge. Pain as measured on the Numeric Pain Rating Scale (initially 1/10 at best and 8/10 at worst) was 0/10–0/10 at discharge. Oswestry Disability Index score (initially 20%) was 0% at discharge. The patient no longer had numbness in her left leg, and sexual intercourse had become pain free. Implications: Interventions to restore and maintain the optimal position of pelvis and hip (femoral head in the acetabulum) may be beneficial for treating patients with chronic LBP/SIJP. The patient's pain was eliminated 13 days after she first performed three exercises to reposition the pelvis and restore left posterior hip capsule extensibility and internal rotation. PMID:22379254

  7. Nonpharmacologic treatment of pain.

    PubMed

    Titler, M G; Rakel, B A

    2001-06-01

    Nonpharmacologic interventions for pain treatment are important complementary therapies but are not substitutes for pharmacologic management of pain. Use of nonpharmacologic pain treatments in critical care settings is helpful to decrease pain, but the challenge remains for nurses to have the knowledge, time, and skill to use these interventions in a busy daily practice with severely ill patients. Although numerous studies testing the effectiveness of nonpharmacologic interventions for pain management are available, the varying methods and interventions used in these studies make it difficult to draw conclusions. Further research on the use of these interventions for pain reduction is necessary to determine the most effective treatments and the conditions under which they should be used. PMID:11866404

  8. Suicidal ideation and the risk of suicide in patients with fibromyalgia: a comparison with non-pain controls and patients suffering from low-back pain

    PubMed Central

    Jimenez-Rodríguez, Irene; Garcia-Leiva, Juan Miguel; Jimenez-Rodriguez, Beatriz M; Condés-Moreno, Emilia; Rico-Villademoros, Fernando; Calandre, Elena P

    2014-01-01

    Fibromyalgia is associated with an increased rate of mortality from suicide. In fact, this disease is associated with several characteristics that are linked to an increased risk of suicidal behaviors, such as being female and experiencing chronic pain, psychological distress, and sleep disturbances. However, the literature concerning suicidal behaviors and their risk factors in fibromyalgia is sparse. The objectives of the present study were to evaluate the prevalence of suicidal ideation and the risk of suicide in a sample of patients with fibromyalgia compared with a sample of healthy subjects and a sample of patients with chronic low-back pain. We also aimed to evaluate the relevance of pain intensity, depression, and sleep quality as variables related to suicidal ideation and risks. Logistic regression was applied to estimate the likelihood of suicidal ideation and the risk of suicide adjusted by age and sex. We also used two logistic regression models using age, sex, pain severity score, depression severity, sleep quality, and disease state as independent variables and using the control group as a reference. Forty-four patients with fibromyalgia, 32 patients with low-back pain, and 50 controls were included. Suicidal ideation, measured with item 9 of the Beck Depression Inventory, was almost absent among the controls and was low among patients with low-back pain; however, suicidal ideation was prominent among patients with fibromyalgia (P<0.0001). The risk of suicide, measured with the Plutchik Suicide Risk Scale, was also higher among patients with fibromyalgia than in patients with low-back pain or in controls (P<0.0001). The likelihood for suicidal ideation and the risk of suicide were higher among patients with fibromyalgia (odds ratios of 26.9 and 48.0, respectively) than in patients with low-back pain (odds ratios 4.6 and 4.7, respectively). Depression was the only factor associated with suicidal ideation or the risk of suicide. PMID:24790444

  9. Disability and Psychologic Distress in Patients with Nonspecific and Specific Arm Pain

    PubMed Central

    Vranceanu, Ana-Maria; Safren, Steven; Zhao, Meijuan; Cowan, James

    2008-01-01

    Psychological illness influences the experience and expression of pain and disability. We tested three null hypotheses: (1) patients with nonspecific pain (medically unexplained and idiopathic) and patients with specific pain (discrete and verifiable) are equally likely to screen for psychiatric illnesses based on a validated screening questionnaire; (2) the presence of psychiatric illness (from a screening questionnaire) will not predict whether patients have specific or nonspecific pain type; and (3) across all patients and regardless of whether they have specific or nonspecific pain, psychiatric illness will not predict disability as measured by the Disabilities of the Arm Shoulder and Hand (DASH) questionnaire. We rejected all null hypotheses. The 41 patients with nonspecific arm pain were more likely than the 40 patients with specific arm pain to screen for a somatoform disorder (34% versus 7.5%), posttraumatic stress disorder (24% versus 7.5%), and panic disorder (12.2% versus 5%). The presence of anxiety and somatoform disorders predicted pain type (nonspecific versus specific) and arm-specific disability (DASH). Somatoform disorder was the strongest predictor of pain type and DASH scores. Based on a screening questionnaire, a comorbid psychiatric illness, a somatoform disorder in particular, is associated with nonspecific arm pain and arm-specific disability. Level of Evidence: Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18636306

  10. The Kinetic Family Drawing with Donor and Nondonor Siblings of Pediatric Bone Marrow Transplant Patients.

    ERIC Educational Resources Information Center

    Packman, Wendy L.; Crittenden, Mary R.; Fischer, Jodie B. Rieger; Cowan, Morton J.; Long, Janet K.; Gruenert, Carol; Schaeffer, Evonne; Bongar, Bruce

    1998-01-01

    Utilizes the Kinetic Family Drawings-Revised (KFD-R) to measure siblings' (N=44) feelings and attitudes toward bone marrow transplants. Data from drawings and discussions with siblings underscore that not all children are affected by stress in the same way. How a particular child responds depends on factors such as life history, personality,…

  11. The Kinetic Family Drawing with Donor and Nondonor Siblings of Pediatric Bone Marrow Transplant Patients.

    ERIC Educational Resources Information Center

    Packman, Wendy L.; Crittenden, Mary R.; Fischer, Jodie B. Rieger; Cowan, Morton J.; Long, Janet K.; Gruenert, Carol; Schaeffer, Evonne; Bongar, Bruce

    1998-01-01

    Utilizes the Kinetic Family Drawings-Revised (KFD-R) to measure siblings' (N=44) feelings and attitudes toward bone marrow transplants. Data from drawings and discussions with siblings underscore that not all children are affected by stress in the same way. How a particular child responds depends on factors such as life history, personality,


  12. Illness representations, psychological distress and non-cardiac chest pain in patients attending an emergency department

    PubMed Central

    Webster, R.; Norman, P.; Goodacre, S.; Thompson, A.R.; McEachan, R.R.C.

    2014-01-01

    Objective: Many patients who attend an emergency department (ED) with chest pain receive a diagnosis of non-cardiac chest pain (NCCP), and often suffer poor psychological outcomes and continued pain. This study assessed the role of illness representations in explaining psychological distress and continued chest pain in patients attending an ED. Methods: ED NCCP patients (N = 138) completed measures assessing illness representations, anxiety, depression and quality of life (QoL) at baseline, and chest pain at one month. Results: Illness representations explained significant amounts of the variance in anxiety (Adj. RÂČ = .38), depression (Adj. RÂČ = .18) and mental QoL (Adj. RÂČ = .36). A belief in psychological causes had the strongest associations with outcomes. At one month, 28.7% of participants reported experiencing frequent pain, 13.2% infrequent pain and 58.1% no pain. Anxiety, depression and poor QoL, but not illness representations, were associated with continued chest pain. Conclusions: The findings suggest that (i) continued chest pain is related to psychological distress and poor QoL, (ii) interventions should be aimed at reducing psychological distress and improving QoL and (iii) given the associations between perceived psychological causes and psychological distress/QoL, NCCP patients in the ED might benefit from psychological therapies to manage their chest pain. PMID:24831735

  13. Effect of Music Therapy on Postoperative Pain Management in Gynecological Patients: A Literature Review.

    PubMed

    Sin, Wai Man; Chow, Ka Ming

    2015-12-01

    Unrelieved postoperative pain may have a negative impact on the physiological and psychological well-being of patients. Pharmacological methods are currently used to relieve such pain in gynecological patients; however, inadequate pain control is still reported, and the use of nonpharmacological pain-relieving methods is increasingly being advocated, one of which is music therapy. The purpose of this literature review was to identify, summarize, and critically appraise current evidence on music therapy and postoperative pain management among gynecological patients. A systematic search of MEDLINE, CINAHL, PsycINFO, British Nursing Index, and Allied and Complementary Medicine was conducted using the search terms music, gynecological, pain, surgery, operative, and post-operative to identify relevant articles in English from 1995 to the present. All identified articles were assessed independently for inclusion into review. A total of 7 articles were included after removal of duplicates and exclusion of irrelevant studies. All the included studies assessed the effects of music therapy on postoperative pain intensity, and three of them measured pain-related physiological symptoms. The findings indicated that music therapy, in general, was effective in reducing pain intensity, fatigue, anxiety, and analgesic consumption in gynecological patients during the postoperative period. It is recommended as an adjunct to pharmacological pain-relieving methods in reducing postoperative pain. Future researches on music therapy to identify the most effective application and evaluate its effect by qualitative study are recommended. PMID:26697822

  14. Pain and Self-Care Behaviors in Adult Patients with ESLD: A Longitudinal Description

    PubMed Central

    Leo, Michael C.; Chang, Michael F.; Zucker, Betsy L.; Sasaki, Anna

    2015-01-01

    This prospective descriptive study investigated pain characteristics in 20 outpatients with end-stage liver disease (ESLD) approaching end of life, described variability in pain between and within patients, and described pharmacological and non-pharmacological pain management strategies used. The instruments utilized were: the Wisconsin Brief Pain Inventory (BPI) and the Self-Care Behavior Log for Pain (SCB). Data were collected once a month over a 6-month period. BPI severity of and interference from pain mean scores ranged from 5.52 to 6.03 and 5.36 to 6.64, respectively. The top three behaviors for relieving pain patients reported were “taking pain medication,” “taking a nap,” and “asking for help.” Pain medication intake differed between patients who were pursuing a liver transplant and those who were not eligible for transplantation. To effectively improve care for ESLD, it is essential to understand the ways in which these patients experience pain and the pain management strategies they employ. PMID:24826441

  15. Barriers and enablers to emergency department nurses' management of patients' pain.

    PubMed

    Pretorius, Annatjie; Searle, Judy; Marshall, Bob

    2015-06-01

    Pain is the most common reason for presentation to the emergency department (ED). On presentation patients expect rapid pain relief, yet this is often not met. Despite extensive improvements in analgesia medication there are still barriers to nurses' assessment, management, documentation, and reassessment of pain. The aim of this study is to identify barriers, enablers, and current nursing knowledge regarding pain management. Using an anonymous quantitative web-based survey, members of the College of Emergency Nurses New Zealand were invited to complete a questionnaire on pain assessment and management. The questionnaires were analyzed using descriptive statistics. Enablers to ED nurses' improved management of pain were the provision of nurse-initiated analgesic protocols and pain management champions. Common barriers perceived by the respondents were the responsibility of caring for acutely ill patients as well as a patient with pain. Similar barriers to previous research were identified and included lack of time, workload, reluctance of clinicians to prescribe analgesia, and the lack of nursing knowledge regarding opioid administration. Raising awareness that oligoanalgesia exists in the ED is essential. This research suggested that nurses would benefit from ongoing education on the usage of opioids. Nurses' attitude regarding patients' right to expect total pain relief as a consequence of treatment was also an issue. ED nurses, by virtue of their role, are in a unique position to be leaders in pain assessment and pain management. PMID:25440235

  16. Effects of the active release technique on pain and range of motion of patients with chronic neck pain

    PubMed Central

    Kim, Jun Ho; Lee, Han Suk; Park, Sun Wook

    2015-01-01

    [Purpose] To compare the influences of the active release technique (ART) and joint mobilization (JM) on the visual analog scale (VAS) pain score, pressure pain threshold (PPT), and neck range of motion (ROM) of patients with chronic neck pain. [Subjects] Twenty-four individuals with chronic neck pain were randomly and equally assigned to 3 groups: an ART group, a joint mobilization (JM) group, and a control group. Before and after the intervention, the degree of pain, PPT, and ROM of the neck were measured using a VAS, algometer, and goniometer, respectively. [Results] The ART group and JM group demonstrated significant changes in VAS and ROM between pre and post-intervention, while no significant change was observed in the control group. Significant differences in the PPT of all muscles were found in the ART group, while significant differences in all muscles other than the trapezius were found in the JM group. No significant difference in PPT was observed in any muscle of the control group. The posthoc test indicated no statistically significant difference between the ART and JM group, but the differences of variation in VAS, PPT, and ROM were greater in the ART group than in the JM and control groups. [Conclusion] ART for the treatment of chronic neck pain may be beneficial for neck pain and movement. PMID:26357426

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

    PubMed Central

    2012-01-01

    Background Neck pain is a common complaint in patients presenting for chiropractic treatment. The few studies on predictors for improvement in patients while undergoing treatment identify duration of symptoms, neck stiffness and number of previous episodes as the strong predictor variables. The purpose of this study is to continue the research for predictors of a positive outcome in neck pain patients undergoing chiropractic treatment. Methods Acute (< 4 weeks) (n?=?274) and chronic (> 3 months) (n?=?255) neck pain patients with no chiropractic or manual therapy in the prior 3 months were included. Patients completed the numerical pain rating scale (NRS) and Bournemouth questionnaire (BQ) at baseline prior to treatment. At 1 week, 1 month and 3 months after start of treatment the NRS and BQ were completed along with the Patient Global Impression of Change (PGIC) scale. Demographic information was provided by the clinician. Improvement at each of the follow up points was categorized using the PGIC. Multivariate regression analyses were done to determine significant independent predictors of improvement. Results Baseline mean neck pain and total disability scores were significantly (p?patients. Both groups reported significant improvement at all data collection time points, but was significantly larger for acute patients. The PGIC score at 1 week (OR?=?3.35, 95% CI?=?1.13-9.92) and the baseline to 1 month BQ total change score (OR?=?1.07, 95% CI?=?1.03-1.11) were identified as independent predictors of improvement at 3 months for acute patients. Chronic patients who reported improvement on the PGIC at 1 month were more likely to be improved at 3 months (OR?=?6.04, 95% CI?=?2.76-13.69). The presence of cervical radiculopathy or dizziness was not predictive of a negative outcome in these patients. Conclusions The most consistent predictor of clinically relevant improvement at both 1 and 3 months after the start of chiropractic treatment for both acute and chronic patients is if they report improvement early in the course of treatment. The co-existence of either radiculopathy or dizziness however do not imply poorer prognosis in these patients. PMID:22920497

  18. Physician-to-physician telephone consultations for chronic pain patients: A pragmatic randomized trial

    PubMed Central

    Clark, Alexander J; Taenzer, Paul; Drummond, Neil; Spanswick, Christopher C; Montgomery, Lori S; Findlay, Ted; Pereira, John X; Williamson, Tyler; Palacios-Derflingher, Luz; Braun, Ted

    2015-01-01

    BACKGROUND: The impact of telephone consultations between pain specialists and primary care physicians regarding the care of patients with chronic pain is unknown. OBJECTIVES: To evaluate the impact of telephone consultations between pain specialists and primary care physicians regarding the care of patients with chronic pain. METHODS: Patients referred to an interdisciplinary chronic pain service were randomly assigned to either receive usual care by the primary care physician, or to have their case discussed in a telephone consultation between a pain specialist and the referring primary care physician. Patients completed a numerical rating scale for pain, the Pain Disability Index and the Short Form-36 on referral, as well as three and six months later. Primary care physicians completed a brief survey to assess their impressions of the telephone consultation. RESULTS: Eighty patients were randomly assigned to either the usual care group or the standard telephone consultation group, and 67 completed the study protocol. Patients were comparable on baseline pain and demographic characteristics. No differences were found between the groups at six months after referral in regard to pain, disability or quality of life measures. Eighty percent of primary care physicians indicated that they learned new patient care strategies from the telephone consultation, and 97% reported that the consultation answered their questions and helped in the care of their patient. DISCUSSION: Most primary care physicians reported that a telephone consultation with a pain specialist answered their questions, improved their patients’ care and resulted in new learning. Differences in patient status compared with a usual care control group were not detectable at six-month follow-up. CONCLUSIONS: While telephone consultations are clearly an acceptable strategy for knowledge translation, additional strategies may be required to actually impact patient outcomes. PMID:26474380

  19. Home Delivery of Pain Therapy to Elderly Patients.

    ERIC Educational Resources Information Center

    Dietrich, Coralie

    Chronic pain occurs most frequently in the elderly. Unfortunately, most pain clinics are located in large urban areas and are not readily accessible to the rural elderly. Recent advances in behavioral medicine have provided pain relief techniques that can be used by a wide variety of professional and paraprofessional workers who do not have…

  20. Pain.

    PubMed

    Lefaucheur, Jean-Pascal

    2013-01-01

    Invasive stimulation of the motor (precentral) cortex using surgically implanted epidural electrodes is indicated for the treatment of neuropathic pain that is refractory to medical treatment. Controlled trials have demonstrated the efficacy of epidural motor cortex stimulation (MCS), but MCS outcome remains variable and validated criteria for selecting good candidates for implantation are lacking. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive approach that could be used as a preoperative tool to predict MCS outcome and also could serve as a therapeutic procedure in itself to treat pain disorders. This requires repeated rTMS sessions and a maintenance protocol. Other studies have also demonstrated the efficacy of transcranial direct current stimulation (tDCS) in relieving chronic pain syndromes. The most studied target is the precentral cortex, but other targets, such as the prefrontal and parietal cortices, could be of interest. The analgesic effects of cortical stimulation relate to the activation of various circuits modulating neural activities in remote structures, such as the thalamus, limbic cortex, insula, or descending inhibitory controls. In addition to the treatment of refractory neuropathic pain by epidural MCS, new developments of this type of strategy are ongoing, for other types of pain syndrome and stimulation techniques. PMID:24112914

  1. Prevalence of heroin markers in urine for pain management patients.

    PubMed

    Knight, Julie; Puet, Brandi L; DePriest, Anne; Heltsley, Rebecca; Hild, Cheryl; Black, David L; Robert, Timothy; Caplan, Yale H; Cone, Edward J

    2014-10-01

    Surveys of current trends indicate heroin abuse is associated with nonmedical use of pain relievers. Consequently, there is an interest in evaluating the presence of heroin-specific markers in chronic pain patients who are prescribed controlled substances. A total of 926,084 urine specimens from chronic pain patients were tested for heroin/diacetylmorphine (DAM), 6-acetylmorphine (6AM), 6-acetylcodeine (6AC), codeine (COD), and morphine (MOR). Heroin and markers were analyzed using liquid chromatography tandem mass spectrometry (LC-MS-MS). Opiates were analyzed following hydrolysis using LC-MS-MS. The prevalence of heroin use was 0.31%, as 2871 were positive for one or more heroin-specific markers including DAM, 6AM, or 6AC (a known contaminant of illicit heroin). Of these, 1884 were additionally tested for the following markers of illicit drug use: 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxyamphetamine (MDA), methamphetamine (MAMP), 11-nor-9-carboxy-?(9)-tetracannabinol (THCCOOH), and benzoylecgonine (BZE); 654 (34.7%) had positive findings for one or more of these analytes. The overall prevalence of heroin markers were as follows: DAM 1203 (41.9%), 6AM 2570 (89.5%), 6AC 1082 (37.7%). MOR was present in 2194 (76.4%) and absent (

  2. Reasons for opioid use among patients with dependence on prescription opioids: the role of chronic pain.

    PubMed

    Weiss, Roger D; Potter, Jennifer Sharpe; Griffin, Margaret L; McHugh, R Kathryn; Haller, Deborah; Jacobs, Petra; Gardin, John; Fischer, Dan; Rosen, Kristen D

    2014-08-01

    The number of individuals seeking treatment for prescription opioid dependence has increased dramatically, fostering a need for research on this population. The aim of this study was to examine reasons for prescription opioid use among 653 participants with and without chronic pain, enrolled in the Prescription Opioid Addiction Treatment Study, a randomized controlled trial of treatment for prescription opioid dependence. Participants identified initial and current reasons for opioid use. Participants with chronic pain were more likely to report pain as their primary initial reason for use; avoiding withdrawal was rated as the most important reason for current use in both groups. Participants with chronic pain rated using opioids to cope with physical pain as more important, and using opioids in response to social interactions and craving as less important, than those without chronic pain. Results highlight the importance of physical pain as a reason for opioid use among patients with chronic pain. PMID:24814051

  3. Reasons for opioid use among patients with dependence on prescription opioids: The role of chronic pain

    PubMed Central

    Weiss, Roger D.; Potter, Jennifer Sharpe; Griffin, Margaret L.; McHugh, R. Kathryn; Haller, Deborah; Jacobs, Petra; Gardin, John; Fischer, Dan; Rosen, Kristen D.

    2014-01-01

    The number of individuals seeking treatment for prescription opioid dependence has increased dramatically, fostering a need for research on this population. The aim of this study was to examine reasons for prescription opioid use among 653 participants with and without chronic pain, enrolled in the Prescription Opioid Addiction Treatment Study, a randomized controlled trial of treatment for prescription opioid dependence. Participants identified initial and current reasons for opioid use. Participants with chronic pain were more likely to report pain as their primary initial reason for use; avoiding withdrawal was rated as the most important reason for current use in both groups. Participants with chronic pain rated using opioids to cope with physical pain as more important, and using opioids in response to social interactions and craving as less important, than those without chronic pain. Results highlight the importance of physical pain as a reason for opioid use among patients with chronic pain. PMID:24814051

  4. Active Despite Pain: Patient Experiences With Guided Imagery With Relaxation Compared to Planned Rest.

    PubMed

    Adeola, Mope T; Baird, Carol L; Sands, Laura; Longoria, Nancy; Henry, Una; Nielsen, Jacqueline; Shields, Cleveland G

    2015-12-01

    Inadequate pain control remains a threat to the quality of life of patients with cancer. Guided imagery with relaxation (GIR) is a mind-body therapy that has shown promise in reducing chronic pain. This article discusses a qualitative, descriptive study for which the objective was to compare the experiences of patients with cancer with reported pain using GIR compared to planned rest.?. PMID:26583627

  5. Opioid-induced hyperalgesia in chronic pain patients and the mitigating effects of gabapentin.

    PubMed

    Stoicea, Nicoleta; Russell, Daric; Weidner, Greg; Durda, Michael; Joseph, Nicholas C; Yu, Jeffrey; Bergese, Sergio D

    2015-01-01

    Chronic pain patients receiving opioid drugs are at risk for opioid-induced hyperalgesia (OIH), wherein opioid pain medication leads to a paradoxical pain state. OIH involves central sensitization of primary and secondary afferent neurons in the dorsal horn and dorsal root ganglion, similar to neuropathic pain. Gabapentin, a gamma-aminobutyric acid (GABA) analog anticonvulsant used to treat neuropathic pain, has been shown in animal models to reduce fentanyl hyperalgesia without compromising analgesic effect. Chronic pain patients have also exhibited lower opioid consumption and improved pain response when given gabapentin. However, few human studies investigating gabapentin use in OIH have been performed in recent years. In this review, we discuss the potential mechanisms that underlie OIH and provide a critical overview of interventional therapeutic strategies, especially the clinically-successful drug gabapentin, which may reduce OIH. PMID:26074817

  6. Opioid-induced hyperalgesia in chronic pain patients and the mitigating effects of gabapentin

    PubMed Central

    Stoicea, Nicoleta; Russell, Daric; Weidner, Greg; Durda, Michael; Joseph, Nicholas C.; Yu, Jeffrey; Bergese, Sergio D.

    2015-01-01

    Chronic pain patients receiving opioid drugs are at risk for opioid-induced hyperalgesia (OIH), wherein opioid pain medication leads to a paradoxical pain state. OIH involves central sensitization of primary and secondary afferent neurons in the dorsal horn and dorsal root ganglion, similar to neuropathic pain. Gabapentin, a gamma-aminobutyric acid (GABA) analog anticonvulsant used to treat neuropathic pain, has been shown in animal models to reduce fentanyl hyperalgesia without compromising analgesic effect. Chronic pain patients have also exhibited lower opioid consumption and improved pain response when given gabapentin. However, few human studies investigating gabapentin use in OIH have been performed in recent years. In this review, we discuss the potential mechanisms that underlie OIH and provide a critical overview of interventional therapeutic strategies, especially the clinically-successful drug gabapentin, which may reduce OIH. PMID:26074817

  7. Minimally Painful Local Anesthetic Injection for Cleft Lip/Nasal Repair in Grown Patients

    PubMed Central

    Price, Christopher; Wong, Alison L.; Chokotho, Tilinde

    2014-01-01

    Introduction: There has been a recent interest in injecting large body and face areas with local anesthetic in a minimally painful manner. The method includes adherence to minimal pain injection details as well feedback from the patient who counts the number of times he feels pain during the injection process. This article describes the successes and limitations of this technique as applied to primary cleft lip/nasal repair in grown patients. Methods: Thirty-two primary cleft lip patients were injected with local anesthesia by 3 surgeons and then underwent surgical correction of their deformity. At the beginning of the injection of the local anesthetic, patients were instructed to clearly inform the injector each and every time they felt pain during the entire injection process. Results: The average patient felt pain only 1.6 times during the injection process. This included the first sting of the first 27-gauge needle poke. The only pain that 51% of the patients felt was that first poke of the first needle; 24% of the patients only felt pain twice during the whole injection process. The worst pain score occurred in a patient who felt pain 6 times during the injection process. Ninety-one percent of the patients felt no pain at all after the injection of the local anesthetic and did not require a top-up. Conclusion: It is possible to successfully and reliably inject local anesthesia in a minimally painful manner for cleft lip and nasal repair in the fully grown cleft patient. PMID:25289364

  8. Lack of disability in patients with chronic orofacial pain. a retrospective study.

    PubMed

    Haegerstam, G; Allerbring, M

    1995-12-01

    Although patients with chronic orofacial pain are frequently disabled, the disability is not necessarily due to the orofacial pain: various other factors may contribute. This retrospective study investigated the possible relationship between reports of pain, fatigue, disease conviction (DC), and denial of psychologic factors as explanation of the suffering (P-S) and limitations in occupational, domestic, physical, social, and sexual activities. The subjects comprised 30 patients referred to the Facial Pain Diagnostic Group at the Karolinska Institute, School of Dentistry, Huddinge, Sweden. None of the disability measures were significantly (p < or = 0.01) correlated with the facial pain reports. Fatigue was not correlated with degree of reported pain. DC was significantly (p < or = 0.01) correlated only with the minimum pain intensity. P-S was negatively correlated (p < or = 0.01) with maximum pain intensity and pain distribution (number of zones) outside the face. In 50% of the patients chronic orofacial pain was the formal reason for their occupational disability. However, such disability was related only to pain distribution (number of zones) outside the face. Social activity was negatively correlated (p < or = 0.01) with fatigue and positively correlated (p < or = 0.01) with P-S. It is suggested that the findings could be satisfactorily explained by a symptom perception hypothesis. PMID:8849866

  9. Assessment of acute and persistent pain management in patients with haemophilia.

    PubMed

    Witkop, M; Lambing, A; Kachalsky, E; Divine, G; Rushlow, D; Dinnen, J

    2011-07-01

    A descriptive survey was conducted in Region V-E of the United States to bridge the gap in available information on pain issues in the bleeding disorders population. The aim of this study was to a) determine language used by patients to describe and differentiate acute and persistent pain, b) describe pharmacological and non-pharmacological strategies utilized to control pain, c) determine the providers of pain management to this population and d) evaluate quality of life incorporating the SF-36 QOL tool. A total of 202 surveys were returned. For the purposes of this paper, it was decided to analyse only haemophilia data (n?= 114). Average persistent daily pain levels were 5/10 (P pain were the same - achy, throbbing and tender; the most utilized pain medications were NSAIDs and acetaminophen. Factor replacement was used for what respondents described as acute pain management 79% of the time and for persistent pain management 38% of the time. Participants described acute and persistent pain with the same pain descriptors leading to the conclusion that patients have difficulty distinguishing between acute and persistent pain. This lack of differentiation was further displayed by the use of factor replacement to treat persistent pain associated with arthritic discomfort (38%) which would be viewed as inappropriate, as well as lack of factor replacement use by 21% of respondents who identified pain as from an acute bleed. Opportunities exist to improve pain management through patient and provider-directed educational programs. PMID:21323802

  10. Massage Impact on Pain in Opioid-dependent Patients in Substance Use Treatment

    PubMed Central

    Wiest, Katharina L.; Asphaug, Victoria J.; Carr, Kathryn E.; Gowen, Emily A.; Hartnett, Timothy T.

    2015-01-01

    Background: Chronic pain is a common cause of health care utilization and high levels of pain are pronounced in individuals engaged in methadone maintenance treatment. Although massage has been demonstrated to alleviate chronic pain symptoms, its use as an adjunctive therapy to modify pain during opioid-replacement treatment is absent from the literature. Purpose: To consider the efficacy of Swedish massage in reducing pain in opioid-dependent patients with chronic pain receiving methadone treatment. Setting: Trial was conducted at a nonprofit methadone treatment center serving low-income patients. Research Design: A randomized clinical trial with randomized to either 1) massage plus treatment-as-usual (TAU) (n = 27) or 2) TAU (n = 24). Durability of treatment effect was evaluated at Week 12. Intervention: Eight weekly 50-minute Swedish massage sessions plus TAU or TAU alone. Main Outcome Measures: Pain, anxiety, depression, physical functioning, decreased substance use, and improvement in treatment engagement. Results: Randomized participants were comparable at Baseline for demographic, pain, physical, and emotional variables. Massage group reported improved pain scores; worst pain had a clinically significant 2-point improvement while the other pain scores did not. Overall improvements were not observed in treatment engagement or levels of anxiety, depression, or physical functioning. A subgroup of the participants, who felt they could be pain-free, consistently reported improvements in pain from Baseline to Week 8, and this was most pronounced and clinically significant in the massage group. Conclusions: These preliminary findings do not support an overall clinically significant positive effect of Swedish massage on reduction in pain ratings or improvement in anxiety, depression, or treatment engagement in a substance-using, opioid-dependent population with chronic pain. Future nonpharmacologic pain research in marginalized substance-using populations may wish to consider some of the challenges and limitations faced in this project. PMID:25780471

  11. The effects of isometric exercise types on pain and muscle activity in patients with low back pain

    PubMed Central

    Rhyu, Hyun-Seung; Park, Hun-Kyung; Park, Jung-Sub; Park, Hye-Sang

    2015-01-01

    The purpose of the present study is to evaluate the effects of isometric exercise types on low back pain (LBP) patients. Isometric exercise types were mat exercise and I-Zer exercise. Subjects were divided into 3 groups: LBP control group, LBP mat exercise group, and LBP I-Zer exercise group in 23–25 aged men. Visual analogue scale (VAS) and electromyography (EMG) were used to evaluate the degree of pain and the muscle activity in LBP patients. Root mean square (RMS), median frequency (MDF), and mean frequency (MNF) were checked by EMG power spectrum analysis on longissimus thoracic (LT), iliocostalis lumborum (IL), mulitifidus (M), and rectus abdominis (RA). LBP mat exercise program and LBP I-Zer exercise program were conducted 5 sets once time, 3 times per week during 6 weeks. The two-way ANOVA with repeated measure was used to check the pain degree and muscle activity. The present results showed that muscle activity in the LBP I-Zer exercise group was increased compared to the LBP mat exercise group and LBP control group (P<0.05). LBP I-Zer exercise group and LBP mat exercise group showed increased mean frequency in LT, IL, M, and RA muscles than the LBP control group. Therefore, LBP patients performed isometric exercise may have positive effect to reduce pain degree and to increase muscle activity. Especially, LBP I-Zer exercise type showed more effectiveness in reducing pain degree and enhancing muscle activity. PMID:26331136

  12. The impact of pain control on physical and psychiatric functions of cancer patients: a nation-wide survey in Taiwan

    PubMed Central

    Rau, Kun-Ming; Chen, Jen-Shi; Wu, Hung-Bo; Lin, Sheng-Fung; Lai, Ming-Kuen; Chow, Jyh-Ming; Huang, Ming-Lih; Wang, Cyuan-Jheng; Tai, Cheng-Jeng; Hwang, Wen-Li; Lu, Yin-Che; Chan, Chung-Huang; Hsieh, Ruey Kuen

    2015-01-01

    Objective To investigate the prevalence of pain in cancer patients at different disease statuses, the impact of pain on physical and psychiatric functions of patients and the satisfaction of pain control of patients at outpatient clinic department in Taiwan. Methods Short form of the Brief Pain Inventory was used as the outcome questionnaire. Unselected patients of different cancers and different disease statuses at outpatient clinic department were included. The impacts of their current pain control on physical function, psychiatric function and the satisfaction of doctors were evaluated. Logistic regression analyses were performed to evaluate whether the interference scale performed identically in the different analgesic ladders. The dependent variables were satisfaction toward physician and treatment. Results A total of 14 sites enrolled 2075 patients in the study. One thousand and fifty-one patients reported pain within the last 1 week. In patients whose diseases deteriorated, >60% of them need analgesics for pain control. Pain influenced physical and psychiatric functions of patients, especially in the deteriorated status. More than 80% of patients were satisfied about current pain control, satisfaction rate related to disease status, pain intensities and treatments for pain. Conclusion Our study found that different cancers at different statuses had pain at variable severity. Pain can influence physical and psychological functions significantly. More than 75% of subjects reported satisfaction over physician and pain management in outpatient clinic department patients with cancer pain in Taiwan. PMID:26292698

  13. Duration Analysis for Coronary Artery Disease Patients With Chronic Chest Pain: An Output From Saudi Arabia

    PubMed Central

    Hussain, Mehwish; Khan, Nazeer; Uddin, Mudassir; Al-Nozha, Mansour M.

    2015-01-01

    Introduction: Coronary artery disease (CAD) is a persistent public health problem worldwide. Chest pain is one of the perceptible symptoms of the same disease. Literature has found acute chest pain as plausible risk factors for CAD. Nevertheless, none of the study has estimated duration from chronic chest pain to the diagnosis of CAD. The objective of the study was to estimate duration from chronic chest pain to CAD and to assess impact of risk factors on same duration. Methods: Data were obtained from community based study on 17,232 Saudi adults. History of patients about onset of chest pain and other risk factors were inquired. Descriptive measures were obtained by Kaplan-Meier curve. Effect of demographic and clinical factors was assessed by Cox regression models. Results: Out of 24% patients with chest pain, 21% diagnosed with CAD. The average duration was 5 years. About 12% of patients with chest pain diagnosed with CAD after one year. Advancing age, female gender, no exercise and reduced high density lipoprotein (HDL) were significantly hazardous predictors throughout duration from chest pain to diagnosis of CAD. Conclusion: The duration from chest pain to CAD was 5 years. Age, gender, exercise and HDL can be variables of concern to deteriorate hazards of CAD for patients with chest pain. PMID:25859309

  14. Cognitive-Behavioral Classifications of Chronic Pain in Patients with Multiple Sclerosis

    ERIC Educational Resources Information Center

    Khan, Fary; Pallant, Julie F.; Amatya, Bhasker; Young, Kevin; Gibson, Steven

    2011-01-01

    The aim of this study was to replicate, in patients with multiple sclerosis (MS), the three-cluster cognitive-behavioral classification proposed by Turk and Rudy. Sixty-two patients attending a tertiary MS rehabilitation center completed the Pain Impact Rating questionnaire measuring activity interference, pain intensity, social support, and


  15. Overcoming the Influence of Chronic Pain on Older Patients' Difficulty with Recommended Self-Management Activities

    ERIC Educational Resources Information Center

    Krein, Sarah L.; Heisler, Michele; Piette, John D.; Butchart, Amy; Kerr, Eve A.

    2007-01-01

    Purpose: Many older patients with common chronic conditions also experience chronic pain. We examined how chronic pain affects patients' difficulty with recommended self-management activities and the potential intervening role of self-efficacy (the level of confidence in one's own ability to perform a specific task). Design and Methods: We…

  16. Prior History of Back Pain in Patients with Compensable and Non-Compensable Injuries.

    ERIC Educational Resources Information Center

    Pellecchia, Geraldine L.

    1993-01-01

    Data were collected retrospectively from insurance information forms and histories of 111 patients (ages 14-84) referred to physical therapy for evaluation of back and/or neck pain. Analysis indicated that patients with compensable (work-related or motor vehicle accident) injuries infrequently acknowledged prior episodes of back or neck pain. (JDD)

  17. Cognitive-Behavioral Classifications of Chronic Pain in Patients with Multiple Sclerosis

    ERIC Educational Resources Information Center

    Khan, Fary; Pallant, Julie F.; Amatya, Bhasker; Young, Kevin; Gibson, Steven

    2011-01-01

    The aim of this study was to replicate, in patients with multiple sclerosis (MS), the three-cluster cognitive-behavioral classification proposed by Turk and Rudy. Sixty-two patients attending a tertiary MS rehabilitation center completed the Pain Impact Rating questionnaire measuring activity interference, pain intensity, social support, and…

  18. Patient-reported quality of care and pain severity in cancer

    PubMed Central

    Martinez, Kathryn A.; Snyder, Claire F.; Malin, Jennifer L.; Dy, Sydney M.

    2015-01-01

    Objective Despite treatment availability, many cancer patients experience severe pain. Although patient assessments of care are increasingly employed to evaluate quality of care, little is known about its association with cancer symptom burden. The objective of our study was to examine the association between patient-reported quality of care and pain severity in a nationally representative cohort of cancer patients. Method Quality of care was measured in three domains: physician communication, care coordination/responsiveness, and nursing care. Quality scores were dichotomized as optimal versus nonoptimal. Pain was measured on a scale of 0 (least) to 100 (worst). We utilized multivariable linear regression to examine the association between patient-reported quality of care and pain severity. Results The analytic sample included 2,746 individuals. Fifty and 54% of patients, respectively, rated physician communication and care coordination/responsiveness as nonoptimal; 28% rated nursing care as nonoptimal. In adjusted models, rating physician communication as nonoptimal (versus optimal) was associated with a 1.8-point higher pain severity (p = 0.018), and rating care coordination/responsiveness as nonoptimal was associated with a 2.2-point higher pain severity (p = 0.006). Significance of results Patient-reported quality of care was significantly associated with pain severity, although the differences were small. Interventions targeting physician communication and care coordination/responsiveness may result in improved pain control for some patients. PMID:24967597

  19. Calcium, Parathyroid Hormone, and Vitamin D: Major Determinants of Chronic Pain in Hemodialysis Patients

    PubMed Central

    Haggiag, Isabelle; Os, Pnina; Bernheim, Jacques

    2009-01-01

    Background and objectives: Pain is a frequent complaint of hemodialysis (HD) patients, yet information regarding its causes and frequency is relatively scarce. The aim of this study was to evaluate the frequency and possible causes of chronic pain in patients who are on long-term HD. Design, setting, participants, & measurements: We prospectively enrolled 100 patients who were undergoing maintenance HD for at least 3 mo. Pain was evaluated using the Brief Pain Inventory. Data collected on each participant included age, gender, ethnic origin, body mass index, smoking habits, time on dialysis, type of blood access, comorbidities, and biochemical and hematologic parameters. Results: The average age was 64.5 yr; the average time on dialysis 40.4 mo. Forty-five patients were male. Thirty-one participants were of Arabic origin. Fifty-three patients had diabetes, 36 of whom had diabetic retinopathy. Although 51 patients experienced chronic pain, only 19.6% described the pain as severe. Musculoskeletal pain, neuropathic pain, and headache were the most prevalent forms of pain. The presence of diabetic retinopathy and neuropathy (but not diabetes per se) and levels of intact parathyroid hormone, calcium, and calcitriol (but not 25-hydroxyvitamin D3) differed significantly between those who experienced chronic pain and those who did not. On a logistic regression model, higher serum calcium levels and intact parathyroid hormone levels >250 pg/ml were independently associated with chronic pain, as well as the presence of diabetic retinopathy. Calcitriol had a marginal effect. Conclusions: Disturbed mineral metabolism is strongly associated with chronic pain in long-term HD patients, along with microangiopathy. PMID:19578003

  20. Assessment and Management of Pain in Patients With Disorders of Consciousness.

    PubMed

    Schnakers, Caroline; Zasler, Nathan

    2015-11-01

    Pain is a first-person experience that must be reported, verbally or nonverbally, to be correctly assessed. How, then, is pain perception determined in persons who are noncommunicative? This determination is a major clinical challenge because patients with disorders of consciousness are unable to communicate their feelings and possible pain experiences. This review will describe the current knowledge of evaluating pain perception in a minimally conscious state compared with an unconscious state (also known as vegetative state/unresponsive wakefulness syndrome) and how to approach the management of pain in these 2 populations. PMID:26568506

  1. Managed care and patient ratings of the quality of specialty care among patients with pain or depressive symptoms

    PubMed Central

    Grembowski, David; Paschane, David; Diehr, Paula; Katon, Wayne; Martin, Diane; Patrick, Donald L

    2007-01-01

    Background Managed care efforts to regulate access to specialists and reduce costs may lower quality of care. Few studies have examined whether managed care is associated with patient perceptions of the quality of care provided by physician and non-physician specialists. Aim is to determine whether associations exist between managed care controls and patient ratings of the quality of specialty care among primary care patients with pain and depressive symptoms who received specialty care for those conditions. Methods A prospective cohort study design was conducted in the offices of 261 primary physicians in private practice in Seattle in 1997. Patients (N = 17,187) were screened in waiting rooms, yielding a sample of 1,514 patients with pain only, 575 patients with depressive symptoms only, and 761 patients with pain and depressive symptoms. Patients (n = 1,995) completed a 6-month follow-up survey. Of these, 691 patients received specialty care for pain, and 356 patients saw mental health specialists. For each patient, managed care was measured by the intensity of managed care controls in the patient's health plan and primary care office. Quality of specialty care at follow-up was measured by patient rating of care provided by the specialists. Outcomes were pain interference and bothersomeness, Symptom Checklist for Depression, and restricted activity days. Results The intensity of managed care controls in health plans and primary care offices was generally not associated with patient ratings of the quality of specialty care. However, pain patients in more-managed primary care offices had lower ratings of the quality of specialty care from physician specialists and ancillary providers. Conclusion For primary care patients with pain or depressive symptoms and who see specialists, managed care controls may influence ratings of specialty care for patients with pain but not patients with depressive symptoms. PMID:17306028

  2. Differences in the ratios of morphine to methadone in patients with neuropathic pain versus non-neuropathic pain.

    PubMed

    Gagnon, B; Bruera, E

    1999-08-01

    The use of methadone in the treatment of cancer pain is becoming more attractive mainly because of its known efficacy, lack of active metabolites, and low cost. Methadone also blocks the n-methyl-D-aspartate (NMDA) receptor, and this property may result in other clinical advantages. Because of this capacity of methadone to block the NMDA receptors, we have hypothesized that the equianalgesic dose ratio of hydromorphone or morphine to methadone will be different in patients with neuropathic pain than in patients with non-neuropathic pain. To explore this hypothesis, we reviewed computerized patient records and determined the ratio of morphine and hydromorphone (expressed as morphine subcutaneous equivalent dose) to methadone in patients who underwent rotation from morphine or hydromorphone to methadone. We found that the ratio of morphine subcutaneous equivalent dose to methadone is between 5 and 7, which is different from previously described dose ratios. However, our study failed to show a difference in the ratios of patients with neuropathic or non-neuropathic pain syndromes. PMID:10484859

  3. A Systematic Review of Health Care Interventions for Pain in Patients With Advanced Cancer

    PubMed Central

    Martinez, Kathryn A.; Aslakson, Rebecca A.; Wilson, Renee F.; Apostol, Colleen C.; Fawole, Oluwakemi A.; Lau, Brandyn D.; Vollenweider, Daniela; Bass, Eric B.; Dy, Sydney M.

    2015-01-01

    Purpose Poorly controlled pain is common in advanced cancer. The objective of this article was to synthesize the evidence on the effectiveness of pain-focused interventions in this population. Methods We searched MEDLINE, CINAHL, PsycINFO, Cochrane, and DARE from 2000 through December 2011. We included prospective, controlled health care intervention studies in advanced cancer populations, focusing on pain. Results Nineteen studies met the inclusion criteria; most focused on nurse-led patient-centered interventions. In all, 9 (47%) of the 19 studies found a significant effect on pain. The most common intervention type was patient/caregiver education, in 17 (89%) of 19 studies, 7 of which demonstrated a significant decrease in pain. Conclusions We found moderate strength of evidence that pain in advanced cancer can be improved using health care interventions, particularly nurse-led patient-centered interventions. PMID:23408371

  4. Simplified approach for delivering medicine to patients with severe pain shows promise.

    PubMed

    2015-08-01

    A new study suggests that in a busy emergency environment, a protocol based on simply asking patients if they need more pain medicine at 30-minute intervals can be effective at controlling pain, although some experts urge stricter limits on the automatic authorization of hydromorphone, and a mechanism to keep physicians more involved in care. Experts suggest that soliciting patient input is more effective than relying on numbered pain scales to gauge whether pain has been adequately controlled. For non-elderly patients in severe pain, the protocol includes an automatic authorization for an additional milligram of hydromorphone up to four times at 30-minute intervals. Study results indicate that all but two of 207 study participants achieved satisfactory pain control at one or more points in the study, and that most were satisfied with their treatment. PMID:26258202

  5. Quality of Life After Bypass Surgery in Patients with Chest Pain and Heart Failure

    MedlinePLUS

    ... Bypass Surgery in Patients With Chest Pain and Heart Failure The full report is titled “Quality-of-Life ... in patients who have coronary artery disease plus heart failure, which can cause additional symptoms, such as shortness ...

  6. The effects of stabilization exercise with an oral assistive device on pain and functionality of low back pain patients

    PubMed Central

    Lee, Jung-Ho; Park, Young-Han; Jang, Sang-Hun

    2015-01-01

    [Purpose] This study examined low back pain patients’ decrease in pain and improvement in functionality after performance of a lumbar stabilization exercise using an oral assistive device, which can replace a lumbar assistive device. [Subjects and Methods] The experimental group (n=12) conducted a stabilization exercise using an oral assistive device after conventional physical therapy. The control group (n=12) received conventional physical therapy. In order to objectively measure pain in this study, a visual analogue scale (VAS) was used. In order to evaluate the subjects’ functional aspects while living with low back pain, the Oswestry Disability Index (ODI) was used. [Results] There were statistically significant improvements in the comparison of the VAS and ODI of the experimental group and the control group. The experimental group’s VAS and ODI significantly improved after the intervention compared to the control group. [Conclusion] The stabilization exercise using the assistive device after conventional physical therapy in the rehabilitation of low back pain patients reduced subjects’ pain and increased their functional activities. PMID:26644637

  7. Pain-only complaint about cochlear implant device: A five-patient pediatric experience.

    PubMed

    Todd, Norman Wendell; Fainberg, Jolie C; Ukatu, CeIsha Chinwe; Venable, Claudia Y; Segel, Phil

    2015-09-01

    Objectives To present the case histories and management of five pediatric patients who experienced pain at the receiver-stimulator site, but no other indication that the device was failing. Patients were from a sole-surgeon pediatric practice (600 + implant surgeries before June 2013; about even proportions of Advanced Bionics, Cochlear Corporation, and MED-EL devices). Methods The University Institutional Review Board-approved review of sole-surgeon pediatric case series. Results The onset of pain ranged from 2 to 16 years post implantation. Pain, not amenable to conventional medical therapy, was present regardless of whether or not the external appliance was 'on', or even being worn on the head. Four of the five patients were bilaterally implanted, but pain was only at one receiver-stimulator package. Clinical management ultimately included revision surgery in all five cases, with immediate resolution of the pain in four. For those four, the replacement cochlear implant (CI) performed well; the other patient fears pain if her replacement device is used, but continues enjoying her contralateral implant. At analysis by the company, two of five explanted devices exhibited problems: loss of hermeticity; insulation failure. Discussion Though infrequently reported, pain-only complaint by a CI user is a challenging dilemma. Conclusion Pain may be the sole clinical manifestation of cochlear implant device failure. We offer a flowchart for the care of CI patients with pain, encourage a worldwide registry of such cases, and offer ideas to try to understand better the problem. PMID:25563523

  8. Pseudogout Associated Hip Pain in a Patient with HIV Infection

    PubMed Central

    Dala-Ali, Benan M.; Welck, Matthew; Lloyd, Mary Anne; Atkinson, Henry D.

    2010-01-01

    HIV infection is a global pandemic, currently affecting approximately 77,000 people in the UK and 33 million people around the world. The infection has widespread effects on the body and can involve the musculoskeletal system. It is therefore important that orthopaedic surgeons are aware of the condition and its sequelae. We present the case of a 46-year-old man with a 10-year history of HIV who presented with acute hip pain, difficulty weight-bearing, and constitutional symptoms. Following radiological, microbiological, and serological tests a diagnosis of pseudogout was established following microscopic analysis of the hip joint aspirate. The patient's symptoms resolved completely following the joint aspiration and NSAID therapy. Studies have shown a relationship between HIV infection and gout. The virus has also been linked to osteonecrosis, osteopenia, bone and joint tuberculosis, and septic arthritis from rare pathogens. However, it is difficult to fully ascertain whether these conditions are related to the HIV infection itself or the HAART (highly active antiretroviral therapy). There are no previously reported cases of HIV-infected patients with pseudogout. The case is discussed with reference to the literature. PMID:21209737

  9. Systematic Review of the Literature on Pain in Patients with Polytrauma Including Traumatic Brain Injury

    PubMed Central

    Dobscha, Steven K.; Clark, Michael E.; Morasco, Benjamin J.; Freeman, Michele; Campbell, Rose; Helfand, Mark

    2010-01-01

    Objective To review the literature addressing the assessment and management of pain in patients with polytraumatic injuries including traumatic brain injury (TBI) and blast-related headache, and to identify patient, clinician and systems factors associated with pain-related outcomes. Design Systematic review. Methods We conducted searches in MEDLINE of literature published from 1950 through July 2008. Due to a limited number of studies using controls or comparators, we included observational and rigorous qualitative studies. We systematically rated the quality of systematic reviews, cohort, and case-control design studies. Results One systematic review, 93 observational studies, and one qualitative research study met inclusion criteria. The literature search yielded no published studies that assessed measures of pain intensity or pain-related functional interference among patients with cognitive deficits due to TBI, that compared patients with blast-related headache with patients with other types of headache, or that assessed treatments for blast-related headache pain. Studies on the association between TBI severity and pain reported mixed findings. There was limited evidence that the following factors are associated with pain among TBI patients: severity, location, and multiplicity of injuries; insomnia; fatigue; depression; and post-traumatic stress disorder. Conclusions Very little evidence is currently available to guide pain assessment and treatment approaches in patients with polytrauma. Further research employing systematic observational as well as controlled intervention designs is clearly indicated. PMID:19818031

  10. Pain management in patients with inflammatory bowel disease: insights for the clinician

    PubMed Central

    Srinath, Arvind Iyengar; Walter, Chelsea; Newara, Melissa C.

    2012-01-01

    Abdominal pain is a common symptom in patients with inflammatory bowel disease (IBD) and has a profound negative impact on patients’ lives. There are growing data suggesting that pain is variably related to the degree of active inflammation. Given the multifactorial etiologies underlying the pain, the treatment of abdominal pain in the IBD population is best accomplished by individualized plans. This review covers four clinically relevant categories of abdominal pain in patients with IBD, namely, inflammation, surgical complications, bacterial overgrowth, and neurobiological processes and how pain management can be addressed in each of these cases. The role of genetic factors, psychological factors, and psychosocial stress in pain perception and treatment will also be addressed. Lastly, psychosocial, pharmacological, and procedural pain management techniques will be discussed. An extensive review of the existing literature reveals a paucity of data regarding pain management specific to IBD. In addition, there is growing consensus suggesting a spectrum between IBD and irritable bowel syndrome (IBS) symptoms. Thus, this review for adult and pediatric clinicians also incorporates the literature for the treatment of functional abdominal pain and the clinical consensus from IBD and IBS experts on pharmacological, behavioral, and procedural methods to treat abdominal pain in this population. PMID:22973418

  11. Efficacy of Massage Therapy on Pain and Dysfunction in Patients with Neck Pain: A Systematic Review and Meta-Analysis

    PubMed Central

    2014-01-01

    Objective. To systematically evaluate the evidence of whether massage therapy (MT) is effective for neck pain. Methods. Randomized controlled trials (RCTs) were identified through searches of 5 English and Chinese databases (to December 2012). The search terms included neck pain, neck disorders, cervical vertebrae, massage, manual therapy, Tuina, and random. In addition, we performed hand searches at the library of Nanjing University of Traditional Chinese Medicine. Two reviewers independently abstracted data and assessed the methodological quality of RCTs by PEDro scale. And the meta-analyses of improvements on pain and neck-related function were conducted. Results. Fifteen RCTs met inclusion criteria. The meta-analysis showed that MT experienced better immediate effects on pain relief compared with inactive therapies (n = 153; standardised mean difference (SMD), 1.30; 95% confidence interval (CI), 0.09 to 2.50; P = 0.03) and traditional Chinese medicine (n = 125; SMD, 0.73; 95% CI 0.13 to 1.33; P = 0.02). There was no valid evidence of MT on improving dysfunction. With regard to follow-up effects, there was not enough evidence of MT for neck pain. Conclusions. This systematic review found moderate evidence of MT on improving pain in patients with neck pain compared with inactive therapies and limited evidence compared with traditional Chinese medicine. There were no valid lines of evidence of MT on improving dysfunction. High quality RCTs are urgently needed to confirm these results and continue to compare MT with other active therapies for neck pain. PMID:24695806

  12. Practical considerations and patient selection for intrathecal drug delivery in the management of chronic pain.

    PubMed

    Saulino, Michael; Kim, Philip S; Shaw, Erik

    2014-01-01

    Chronic pain continues to pose substantial and growing challenges for patients, caregivers, health care professionals, and health care systems. By the time a patient with severe refractory pain sees a pain specialist for evaluation and management, that patient has likely tried and failed several nonpharmacologic and pharmacologic approaches to pain treatment. Although relegated to one of the interventions of "last resort", intrathecal drug delivery can be useful for improving pain control, optimizing patient functionality, and minimizing the use of systemic pain medications in appropriately selected patients. Due to its clinical and logistical requirements, however, intrathecal drug delivery may fit poorly into the classic pain clinic/interventional model and may be perceived as a "critical mass" intervention that is feasible only for large practices that have specialized staff and appropriate office resources. Potentially, intrathecal drug delivery may be more readily adopted into larger practices that can commit the necessary staff and resources to support patients' needs through the trialing, initiation, monitoring, maintenance, and troubleshooting phases of this therapy. Currently, two agents - morphine and ziconotide - are approved by the United States Food and Drug Administration for long-term intrathecal delivery. The efficacy and safety profiles of morphine have been assessed in long-term, open-label, and retrospective studies of >400 patients with chronic cancer and noncancer pain types. The efficacy and safety profiles of ziconotide have been assessed in three double-blind, placebo-controlled trials of 457 patients, and safety has been assessed in 1,254 patients overall, with severe chronic cancer, noncancer, and acquired immunodeficiency syndrome pain types. Both agents are highlighted as first-line intrathecal therapy for the management of neuropathic or nociceptive pain. The purpose of this review is to discuss practical considerations for intrathecal drug delivery, delineate criteria for the identification and selection of candidates for intrathecal drug delivery, and consider which agent may be more appropriate for individual patients. PMID:25419158

  13. Patient perception of pain care in hospitals in the United States

    PubMed Central

    Gupta, Anita; Daigle, Sarah; Mojica, Jeffrey; Hurley, Robert W

    2009-01-01

    Study objective Assessment of patients’ perception of pain control in hospitals in the United States. Background Limited data are available regarding the quality of pain care in the hospitalized patient. This is particularly valid for data that allow for comparison of pain outcomes from one hospital to another. Such data are critical for numerous reasons, including allowing patients and policy-makers to make data-driven decisions, and to guide hospitals in their efforts to improve pain care. The Hospital Quality Alliance was recently created by federal policy makers and private organizations in conjunction with the Centers for Medicare and Medicare Services to conduct patient surveys to evaluate their experience including pain control during their hospitalization. Methods In March 2008, the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was released for review for health care providers and researchers. This survey includes a battery of questions for patients upon discharge from the hospital including pain-related questions and patient satisfaction that provide valuable data regarding pain care nationwide. This study will review the results from the pain questions from this available data set and evaluate the performance of these hospitals in pain care in relationship to patient satisfaction. Furthermore, this analysis will be providing valuable information on how hospital size, geographic location and practice setting may play a role in pain care in US hospitals. Results The data indicates that 63% of patients gave a high rating of global satisfaction for their care, and that an additional 26% of patients felt that they had a moderate level of global satisfaction with the global quality of their care. When correlated to satisfaction with pain control, the relationship with global satisfaction and “always” receiving good pain control was highly correlated (r >0.84). In respect to the other HCAHPS components, we found that the patient and health care staff relationship with the patient is also highly correlated with pain relief (r >0.85). The patients’ reported level of pain relief was significantly different based upon hospital ownership, with government owned hospitals receiving the highest pain relief, followed by nonprofit hospitals, and lastly proprietary hospitals. Hospital care acuity also had an impact on the patient’s perception of their pain care; patients cared for in acute care hospitals had lower levels of satisfaction than critical access hospitals. Conclusions The results of this study are a representation of the experiences of patients in US hospitals with regard to pain care specifically and the need for improved methods of treating and evaluating pain care. This study provides the evidence needed for hospitals to make pain care a priority in to achieve patient satisfaction throughout the duration of their hospitalization. Furthermore, future research should be developed to make strategies for institutions and policy-makers to improve and optimize patient satisfaction with pain care. PMID:21197302

  14. High-Dose Fentanyl Patch for Cancer Pain of a Patient with Cholangiocarcinoma

    PubMed Central

    Kim, Mi; Sung, Chong Won; Kim, Hyeoung Su; Jang, Hyun Joo; Shin, Young Chul; Jung, Joo Young

    2010-01-01

    We describe here a patient who obtained a good analgesic effect with high-dose fentanyl patches for controlling cancer pain. A 52-year-old man was referred to our hospital because of severe cancer pain that was 7/10 on a numeric rating scale (NRS). He had been diagnosed with locally advanced cholangiocarcinoma 3 months previously. We prescribed weak opioids and an antidepressant, but his pain was not relieved. We introduced strong opioids (transdermal fentanyl patches for the background pain and a short-acting opioid for the breakthrough pain) and his pain was tolerable on 250 ”g/hr of fentanyl patches for 3 months. With time, however, his pain intensity became worse and this reached up to 8/10 to 9/10 on the NRS. Percutaneous transhepatic biliary drainage was performed, which did not relieve his pain. We increased gradually the dose of transdermal fentanyl to 1,050 ”g/hr (20 patches). At this dose, the patient was mentally alert, with good pain control (NRS 2/10 to 3/10) and no exacerbation of side effects. To the best of our knowledge, we report here on the highest dose of transdermal fentanyl that has been successfully used for treating a patient suffering from visceral cancer pain. PMID:20830233

  15. Case Report: Neuropathic pain in a patient with congenital insensitivity to pain

    PubMed Central

    Wheeler, Daniel W.; Lee, Michael C.H.; Harrison, E. Katherine; Menon, David K.; Woods, C. Geoffrey

    2015-01-01

    We report a unique case of a woman with Channelopathy-associated Insensitivity to Pain (CIP) Syndrome, who developed features of neuropathic pain after sustaining pelvic fractures and an epidural hematoma that impinged on the right fifth lumbar (L5) nerve root. Her pelvic injuries were sustained during painless labor, which culminated in a Cesarean section. She had been diagnosed with CIP as child, which was later confirmed when she was found to have null mutations of the SCN9A gene that encodes the voltage-gated sodium channel Nav1.7. She now complains of troubling continuous buzzing in both legs and a vice-like squeezing in the pelvis on walking. Quantitative sensory testing showed that sensory thresholds to mechanical stimulation of the dorsum of both feet had increased more than 10-fold on both sides compared with tests performed before her pregnancy. These findings fulfill the diagnostic criteria for neuropathic pain. Notably, she mostly only experiences the negative symptoms (such as numbness and tingling, but also electric shocks), and she has not reported sharp or burning sensations, although the value of verbal descriptors is somewhat limited in a person who has never felt pain before. However, her case strongly suggests that at least some of the symptoms of neuropathic pain can persist despite the absence of the Nav1.7 channel. Pain is a subjective experience and this case sheds light on the transmission of neuropathic pain in humans that cannot be learned from knockout mice.

  16. Morbidity of "DSM-IV" Axis I Disorders in Patients with Noncardiac Chest Pain: Psychiatric Morbidity Linked with Increased Pain and Health Care Utilization

    ERIC Educational Resources Information Center

    White, Kamila S.; Raffa, Susan D.; Jakle, Katherine R.; Stoddard, Jill A.; Barlow, David H.; Brown, Timothy A.; Covino, Nicholas A.; Ullman, Edward; Gervino, Ernest V.

    2008-01-01

    The present study examined current and lifetime psychiatric morbidity, chest pain, and health care utilization in 229 patients with noncardiac chest pain (NCCP), angina-like pain in the absence of cardiac etiology. Diagnostic interview findings based on the "Diagnostic and Statistical Manual of Mental Disorders" (4th ed.; "DSM-IV"; American…

  17. Treatment for Chronic Pain in Patients With Advanced Cancer

    ClinicalTrials.gov

    2010-11-07

    Chronic Myeloproliferative Disorders; Leukemia; Lymphoma; Multiple Myeloma and Plasma Cell Neoplasm; Myelodysplastic Syndromes; Pain; Precancerous/Nonmalignant Condition; Small Intestine Cancer; Unspecified Adult Solid Tumor, Protocol Specific

  18. Evaluating the Patient with Left Lower Quadrant Abdominal Pain.

    PubMed

    Bodmer, Nicholas A; Thakrar, Kiran H

    2015-11-01

    Left lower quadrant pain is a frequent indication for imaging in the emergency department. Most causes of pain originate from the colon, including diverticulitis, colitis, fecal impaction, and epiploic appendagitis. Left-sided urolithiasis and spontaneous hemorrhage in the retroperitoneum or rectus sheath are additional causes of pain. Computed tomography is the preferred imaging modality in the emergent setting for all of these pathologic conditions. Gynecologic, testicular, and neoplastic pathology may also cause left lower quadrant pain but are not discussed in this article. PMID:26526432

  19. Does the epidermal nerve fibre density measured by skin biopsy in patients with peripheral neuropathies correlate with neuropathic pain?

    PubMed

    Truini, A; Biasiotta, A; Di Stefano, G; Leone, C; La Cesa, S; Galosi, E; Piroso, S; Pepe, A; Giordano, C; Cruccu, G

    2014-04-01

    The different neuropathic pain types (e.g., ongoing burning pain and allodynia) are frequent and disabling complaints in patients with peripheral neuropathies. Although the reference standard technique for diagnosing painful small-fibre neuropathies is nerve fibre density assessment by skin biopsy, the relationship between the epidermal nerve fibre (ENF) density and neuropathic pain is still unclear. In a clinical and skin biopsy study designed to investigate whether changes in ENF density are directly related to pain, we enrolled 139 consecutive patients with distal symmetric peripheral neuropathy. All patients underwent clinical examination. The Neuropathic Pain Symptom Inventory was used to distinguish the different neuropathic pain types. A skin biopsy was conducted, and ENFs were immunostained with the antiprotein gene product 9.5, and their linear density was quantified with bright-field microscopy. No difference was found in ENF density between patients with and without neuropathic pain, nor between patients with and without ongoing burning pain. Conversely, ENF density was higher in patients with provoked pains (including mechanical dynamic allodynia) than in those without. The variable association between ENF density and symptoms of neuropathic pain supports the idea that neuropathic pain symptoms arise through distinct underlying mechanisms. The lack of relationship between ongoing burning pain and ENF density suggests that this type of pain reflects factors other than loss of nociceptive afferents. The association between ENF density and provoked pain (including mechanical dynamic allodynia) suggests that this type of pain might be mediated by spared and sensitised nociceptive afferents. PMID:24486884

  20. Practical considerations and patient selection for intrathecal drug delivery in the management of chronic pain

    PubMed Central

    Saulino, Michael; Kim, Philip S; Shaw, Erik

    2014-01-01

    Chronic pain continues to pose substantial and growing challenges for patients, caregivers, health care professionals, and health care systems. By the time a patient with severe refractory pain sees a pain specialist for evaluation and management, that patient has likely tried and failed several nonpharmacologic and pharmacologic approaches to pain treatment. Although relegated to one of the interventions of “last resort”, intrathecal drug delivery can be useful for improving pain control, optimizing patient functionality, and minimizing the use of systemic pain medications in appropriately selected patients. Due to its clinical and logistical requirements, however, intrathecal drug delivery may fit poorly into the classic pain clinic/interventional model and may be perceived as a “critical mass” intervention that is feasible only for large practices that have specialized staff and appropriate office resources. Potentially, intrathecal drug delivery may be more readily adopted into larger practices that can commit the necessary staff and resources to support patients’ needs through the trialing, initiation, monitoring, maintenance, and troubleshooting phases of this therapy. Currently, two agents – morphine and ziconotide – are approved by the United States Food and Drug Administration for long-term intrathecal delivery. The efficacy and safety profiles of morphine have been assessed in long-term, open-label, and retrospective studies of >400 patients with chronic cancer and noncancer pain types. The efficacy and safety profiles of ziconotide have been assessed in three double-blind, placebo-controlled trials of 457 patients, and safety has been assessed in 1,254 patients overall, with severe chronic cancer, noncancer, and acquired immunodeficiency syndrome pain types. Both agents are highlighted as first-line intrathecal therapy for the management of neuropathic or nociceptive pain. The purpose of this review is to discuss practical considerations for intrathecal drug delivery, delineate criteria for the identification and selection of candidates for intrathecal drug delivery, and consider which agent may be more appropriate for individual patients. PMID:25419158

  1. FMRI of spinal and supra-spinal correlates of temporal pain summation in fibromyalgia patients.

    PubMed

    Bosma, Rachael L; Mojarad, Elham Ameli; Leung, Lawrence; Pukall, Caroline; Staud, Roland; Stroman, Patrick W

    2016-04-01

    Fibromyalgia syndrome (FM) is a debilitating chronic pain condition, which afflicts primarily females. Although the etiology of this illness is not completely understood, FM pain is thought to rely on enhanced pain sensitivity maintained by central mechanisms. One of these mechanisms is central pain amplification, which is characterized by altered temporal summation of second pain (TSSP). Here we use a TSSP paradigm and functional MRI (fMRI) of the spinal cord, brainstem, and brain to noninvasively examine the central nervous system contributions to TSSP in FM patients and normal controls (NC). Functional MRI of pain-free female adults (N = 15) and FM patients (N = 14) was conducted while brief, repetitive heat pain stimuli (0.33 Hz) were applied to the thenar eminence of the hand (C6 dermatome). The stimulus intensity was adjusted to each participant's heat pain sensitivity to achieve moderate pain. Data were analyzed by means of a General Linear Model and region-of-interest analyses. All participants demonstrated significant pain summation in the TSSP condition. FM subjects, however, required significantly lower stimulus intensities than NC to achieve similar TSSP. fMRI analyses of perceptually equal TSSP identified similar brain activity in NC and FM subjects; however, multiple areas in the brainstem (rostral ventromedial medulla and periaqueductal grey region) and spinal cord (dorsal horn) exhibited greater activity in NC subjects. Finally, increased after-sensations and enhanced dorsal horn activity was demonstrated in FM patients. In conclusion, the spinal and brainstem BOLD responses to TSSP are different between NC and FM patients, which may indicate alterations to descending pain control mechanisms suggesting contributions of these mechanisms to central sensitization and pain of FM patients. Hum Brain Mapp 37:1349-1360, 2016. © 2016 Wiley Periodicals, Inc. PMID:26749315

  2. Reasons for Repeated Medical Visits Among Patients with Chronic Back Pain

    PubMed Central

    McPhillips-Tangum, Carol A; Cherkin, Daniel C; Rhodes, Lorna A; Markham, Christine

    1998-01-01

    OBJECTIVE This study identifies the key motivations of patients repeatedly seeking medical care for chronic back problems. DESIGN We conducted one-on-one, in-depth interviews with patients to discuss their experiences with low back pain and its care. To validate our interpretation of the qualitative data, participants were mailed questionnaires listing the themes identified in the interviews and asked to rate the importance to them of each of the themes. SETTING Managed health care plans in Atlanta, Dallas, and Seattle. PARTICIPANTS Fifty-four patients (37% male, 63% female) who were 25 to 65 years of age and had three or more medically attended episodes of low back pain during the 3 years preceding the study. MAIN RESULTS In describing their motivations for seeking medical care for back pain, nearly all participants cited difficulty in performing normal activities and the desire to discover the cause of the pain. Other motivations for seeking medical care for back pain included increased pain and the desire for a diagnostic test or a new treatment. Many of the verbalized reasons for repeated medical visits among patients with chronic back pain are probably best understood as seeking validation of their suffering. CONCLUSIONS Patients with chronic back pain report many unmet needs and expectations. Overall satisfaction might be improved if clinicians elicit patients' views of underlying causes and their expectations from office visits. PMID:9613883

  3. Relationship of sleep deficiency to perceived pain and functional limitations in hospital patient care workers

    PubMed Central

    Buxton, Orfeu M.; N.P., Karen Hopcia; Sembajwe, Grace; Porter, James H.; Dennerlein, Jack T.; Kenwood, Christopher; M.Stoddard, Anne; Hashimoto, Dean; Sorensen, Glorian

    2013-01-01

    Objective Health care workers are at high risk of developing musculoskeletal symptoms and pain. This study tested the hypothesis that sleep deficiency is associated with pain, functional limitations, and work-interfering physical limitations. Methods Hospital patient care workers completed a survey (79% response rate) including measures of health, sociodemographic, and workplace factors. Associations of sleep deficiency with pain, work interference due to this pain, and functional limitations were determined. Results Of 1572 respondents (90% women; mean age 41 years) fifty-seven percent reported sleep deficiency, 73% pain in last 3 months, 33% work interference, 18% functional limitation. Sleep deficiency was associated with higher rates of pain, work interference, and functional limitation controlling for socioeconomic, individual, and workplace characteristics. Conclusions Sleep Deficiency is significantly associated with pain, functional limitation and workplace interference, suggesting modifiable outcomes for workplace health and safety interventions. PMID:22796931

  4. Patients visiting the complementary medicine clinic for pain: a cross sectional study

    PubMed Central

    2011-01-01

    Background Pain is one of the most common reasons for seeking medical care. The purpose of this study was to characterize patients visiting the complementary medicine clinic for a pain complaint. Methods This is a cross-sectional study. The study took place at Clalit Health Services (CHS) complementary clinic in Beer-Sheva, Israel. Patients visiting the complementary clinic, aged 18 years old and older, Hebrew speakers, with a main complaint of pain were included. Patients were recruited consecutively on random days of the month during a period of six months. Main outcome measures were: pain levels, location of pain, and interference with daily activities. Once informed consent was signed patients were interviewed using a structured questionnaire by a qualified nurse. The questionnaire included socio-demographic data, and the Brief Pain Inventory (BPI). Results Three-hundred and ninety-five patients were seen at the complementary medicine clinic during the study period, 201 (50.8%) of them met the inclusion criteria. Of them, 163 (81.1%) agreed to participate in the study and were interviewed. Pain complaints included: 69 patients (46.6%) with back pain, 65 (43.9%) knee pain, and 28 (32.4%) other limbs pain. Eighty-two patients (50.3%) treated their pain with complementary medicine as a supplement for their conventional treatment, and 55 (33.7%) felt disappointed from the conventional medicine experience. Eighty-three patients (50.9%) claimed that complementary medicine can result in better physical strength, or better mental state 51 (31.3%). Thirty-seven patients (22.7%) were hoping that complementary medicine will prevent invasive procedures. Conclusion Given the high proportion of patients with unsatisfactory pain relief using complementary and alternative medicine (CAM), general practitioners should gain knowledge about CAM and CAM providers should gain training in pain topics to improve communication and counsel patients. More clinical research to evaluate safety and efficiency of CAM for pain is needed to provide evidence based counseling. PMID:21545733

  5. Under- or overtreatment of pain in the patient with cancer: how to achieve proper balance.

    PubMed

    Paice, Judith A; Von Roenn, Jamie H

    2014-06-01

    Achieving balance in the appropriate use of opioids for the treatment of cancer pain is complex. The definition of "balance" is continually being modified. Palliative care professionals, pain specialists, and oncologists have long been advocating for the aggressive management of pain for patients with advanced cancer. Some progress has been made in this arena but barriers persist. Fear of addiction by patients, family members, and oncology professionals presents a serious obstacle to the provision of adequate pain control. This is further complicated by societal factors that receive extensive media coverage, such as diversion of prescribed opioids for recreational use and increasing deaths as a result of this inappropriate use of prescription opioids. This growing concern has led to more opioid regulation, which increases obstacles to pain management in this population. Another evolving concern is whether the long-term use of opioids is safe and effective. Data from the chronic nonmalignant pain literature suggest that toxicities may result and misuse has been underestimated, yet little information is available in the cancer population. These issues lead to serious questions regarding how balance might be successfully achieved for patients in an oncology setting. Can pain relief be provided while reducing negative consequences of treatment? Which patient should be prescribed what medications, in what situations, for what kind of pain, and who should be managing the pain? PMID:24799468

  6. Management of chronic pain with chronic opioid therapy in patients with substance use disorders

    PubMed Central

    2013-01-01

    Substance use disorders (SUDs), whether active or in remission, are often encountered in patients with chronic nonmalignant pain. Clinicians are challenged when managing chronic pain while facing substance abuse issues during the course of chronic opioid therapy (COT). Further, the interrelated behavioral symptomatology of addiction and chronic pain suggests that if one disorder is untreated, effective treatment of the other in not possible. Incomplete understanding of the overlapping presentations of the two disorders, coupled with insufficient management of both conditions, leads to undertreated pain and premature discharge of SUD patients from pain treatment. In order to achieve pain relief and optimal functionality, both conditions need to be carefully managed. This paper reviews the prevalence of SUDs in chronic pain patents; the overlapping presentation of the two disorders; risk factors and stratification for addiction; identification of addiction in the chronic pain population; and suggestions for treating patients with COT, with an emphasis on relapse prevention. With appropriate assessment and treatment, COT for chronic pain patients with a history of SUD can be successful, leading to improved functionality and quality of life. PMID:24341916

  7. Post-Operative Pain Management Practices in Patients with Dementia - The Current Situation in Finland

    PubMed Central

    Rantala, Maija; Kankkunen, Päivi; Kvist, Tarja; Hartikainen, Sirpa

    2012-01-01

    The aim of this study is to describe current post-operative pain management practices for patients with dementia and hip fracture in Finland. Older adults with hip fracture are at high risk of under treatment for pain, especially if they also have a cognitive disorder at the stage of dementia. Previous studies have provided limited information about the quality of acute pain treatment for persons with dementia. In this study data concerning current pain management practices was collected by questionnaire from 333 nursing staff. They worked in surgical wards of seven universities and ten city-centre hospitals. The response rate to the questionnaire was 53%. The data was analysed using factor analysis and parametric methods. Half the respondents (53%) considered that post-operative pain management was sufficient for patients with dementia. Less than one third of respondent nurses reported that pain scales were in use on their unit: the most commonly used scale was VAS. The use of pain scales was significantly related to the respondents’ opinion of the sufficiency of post-operative pain management in this patient group (p<0.001). The findings can be utilised in nursing practice and research when planning suitable complementary educational interventions for nursing staff of surgical wards. Further research is needed to explain the current situation of pain management practices from the viewpoint of patients with dementia. PMID:22723810

  8. [Advances in the research of effects of music therapy on pain and anxiety in burn patients].

    PubMed

    Jinyi, Li; Yungui, Wang

    2015-06-01

    Pain and anxiety engender major psychic problems during all phases of treatment for burn patients. Analgesic alone does not allay these problems satisfactorily in these patients. Music therapy, as an important complementary and alternative therapy, has been widely used in multiple medical fields. However, its positive effect on alleviation of pain and anxiety in burn patients is undefined. The objective of this review is to summarize the feasibility, application fields, methods, and the effectiveness of music therapy in allaying pain and anxiety of burn patients during the whole course of treatment. PMID:26564564

  9. Influences of the Aging Process on Acute Perioperative Pain Management in Elderly and Cognitively Impaired Patients

    PubMed Central

    Halaszynski, Thomas

    2013-01-01

    Background The aging process results in physiological deterioration and compromise along with a reduction in the reserve capacity of the human body. Because of the reduced reserves of mammalian organ systems, perioperative stressors may result in compromise of physiologic function or clinical evidence of organ insult secondary to surgery and anesthesia. The purpose of this review is to present evidence-based indications and best practice techniques for perioperative pain management in elderly surgical patients. Results In addition to pain, cognitive dysfunction in elderly surgical patients is a common occurrence that can often be attenuated with appropriate drug therapy. Modalities for pain management must be synthesized with intraoperative anesthesia and the type of surgical intervention and not simply considered a separate entity. Conclusions Pain in elderly surgical patients continues to challenge physicians and healthcare providers. Current studies show improved surgical outcomes for geriatric patients who receive multimodal therapy for pain control. PMID:23789010

  10. The Relationship Between Ethnicity and the Pain Experience of Cancer Patients: A Systematic Review

    PubMed Central

    Kwok, Wingfai; Bhuvanakrishna, Thakshyanee

    2014-01-01

    Background: Cancer pain is a complex multidimensional construct. Physicians use a patient-centered approach for its effective management, placing a great emphasis on patient self-reported ratings of pain. In the literature, studies have shown that a patient's ethnicity may influence the experience of pain as there are variations in pain outcomes among different ethnic groups. At present, little is known regarding the effect of ethnicity on the pain experience of cancer patients; currently, there are no systematic reviews examining this relationship. Materials and Methods: A systematic search of the literature in October 2013 using the keywords in Group 1 together with Group 2 and Group 3 was conducted in five online databases (1) Medline (1946–2013), (2) Embase (1980–2012), (3) The Cochrane Library, (4) Pubmed, and (5) Psycinfo (1806–2013). The search returned 684 studies. Following screening by inclusion and exclusion criteria, the full text was retrieved for quality assessment. In total, 11 studies were identified for this review. The keywords used for the search were as follows: Group 1-Cancer; Group 2- Pain, Pain measurement, Analgesic, Analgesia; Group 3- Ethnicity, Ethnic Groups, Minority Groups, Migrant, Culture, Cultural background, Ethnic Background. Results: Two main themes were identified from the included quantitative and qualitative studies, and ethnic differences were found in: (1) The management of cancer pain and (2) The pain experience. Six studies showed that ethnic groups face barriers to pain treatment and one study did not. Three studies showed ethnic differences in symptom severity and one study showed no difference. Interestingly, two qualitative studies highlighted cultural differences in the perception of cancer pain as Asian patients tended to normalize pain compared to Western patients who engage in active health-seeking behavior. Conclusion: There is an evidence to suggest that the cancer pain experience is different between ethnicities. Minority patients face potential barriers for effective pain management due to problems with communication and poor pain assessment. Cultural perceptions of cancer may influence individual conceptualization of pain and affect health-seeking behavior. PMID:25191006

  11. How to Assess a New Patient for a Multidisciplinary Chronic Pain Rehabilitation Program: A Review Article

    PubMed Central

    Malaty, Adham; Sabharwal, Josephine; Lirette, Lesley Smallwood; Chaiban, Gassan; Eissa, Hazem; Tolba, Reda

    2014-01-01

    Background Chronic pain is a debilitating condition that affects people all over the world. To effectively treat chronic pain patients, assignment to patient-centered functional restoration and psychological pain rehabilitation programs at an early stage is essential. Methods This article describes the initial patient screening and evaluation process for an interdisciplinary chronic pain rehabilitation program and highlights the relevant points that should be covered in each section of the initial assessment. Results A thorough, detailed history that includes an evaluation of the patient's pain, functional limitations, prior medications, prior procedures/interventions, substance abuse, and psychiatric disorders, as well as the patient's social, legal, and developmental histories, are key to the proper screening and appropriate treatment of patients with chronic pain. Conclusion Thorough initial evaluation of patients is essential for proper enrollment in a chronic pain rehabilitation program. Such programs allow early treatment and reduce unnecessary health costs. Future prospective studies are needed to identify additional screening methods and triage tools to allow early admission of appropriate patients to these rehabilitation programs. PMID:24688340

  12. Foetal pain?

    PubMed

    Derbyshire, Stuart W G

    2010-10-01

    The majority of commentary on foetal pain has looked at the maturation of neural pathways to decide a lower age limit for foetal pain. This approach is sensible because there must be a minimal necessary neural development that makes pain possible. Very broadly, it is generally agreed that the minimal necessary neural pathways for pain are in place by 24 weeks gestation. Arguments remain, however, as to the possibility of foetal pain before or after 24 weeks. Some argue that the foetus can feel pain earlier than 24 weeks because pain can be supported by subcortical structures. Others argue that the foetus cannot feel pain at any stage because it is maintained in a state of sedation in the womb and lacks further neural and conceptual development necessary for pain. Much of this argument rests on the definition of terms such as 'wakefulness' and 'pain'. If a behavioural and neural reaction to a noxious stimulus is considered sufficient for pain, then pain is possible from 24 weeks and probably much earlier. If a conceptual subjectivity is considered necessary for pain, however, then pain is not possible at any gestational age. Regardless of how pain is defined, it is clear that pain for conceptual beings is qualitatively different than pain for non-conceptual beings. It is therefore a mistake to draw an equivalence between foetal pain and pain in the older infant or adult. PMID:20356798

  13. An Examination of Adherence to Pain Medication Plans in Older Cancer Patients in Hospice Care

    PubMed Central

    Sanders, Sara; Herr, Keela; Fine, Perry G.; Fiala, Cate; Tang, Xiongwen; Forcucci, Chris

    2012-01-01

    Context Timely and appropriate management of pain is essential to promote comfort at the end of life. Objectives To determine if pain-related factors and non-pharmacological interventions affect medication adherence in older cancer patients in community-based hospices. Methods The study involved cancer patients 55 years and older, newly admitted to one of 13 community-based hospices in the Midwest U.S. A descriptive design with patients or their proxies providing information during two telephone interviews and review of their hospice medical records was used. Results A total sample of 65 patients was obtained, with data directly from 32 patients during interview one (T1); 25 at interview two (T2), and proxy reports for 33 (T1) and 30 (T2) patients. The overall mean pain medication adherence scores (maximum 9) for all patients were 8.43 (T1) and 8.38 (T2). For component analysis (three components; maximum of three points each), patients were the least adherent with opioid orders at both time points (2.65). Patients were the most adherent to nonsteroidal anti-inflammatory/acetaminophen orders at T1 (2.91) and to medications for neuropathic pain at T2 (2.89). Data provided statistical evidence that patients with more hours of controlled pain in the past 24 hours were more likely to have had better adherence, whereas patients with higher levels of comfort over the last few days were more likely to have had worse adherence. Conclusion This study identified that pain medication adherence among older adults with cancer receiving hospice care is high. However, hospices must be alert to the fact that even as patients become more comfortable, adherence must continue to be emphasized to ensure pain does not re-develop or exacerbate, if pain relief is a patient priority. PMID:22841408

  14. Pain Management in Cancer Patients Using a Mobile App: Study Design of a Randomized Controlled Trial

    PubMed Central

    Kamdar, Mihir; Flanagan, Clare; Searl, Meghan; Traeger, Lara; Kvedar, Joseph; Jethwani, Kamal

    2014-01-01

    Background Despite the availability of effective medications and clinical guidelines for pain management, pain control is suboptimal in a sizeable proportion of patients with cancer pain. The National Comprehensive Cancer Network guidelines recommend a comprehensive and multimodal approach for management of cancer pain. We developed a mobile phone application, ePAL, based on clinical guidelines to empower patients for cancer pain management by prompting regular pain assessments and coaching for self-management. Objective The objective of this study is to evaluate the effect of a multidimensional mobile phone-based pain management application, ePAL, on controlling cancer pain and improving quality of life in patients with cancer pain being treated at an academic palliative care clinic. Methods The study will be implemented as a 2-arm randomized controlled trial with 110 adult patients with CP who own a mobile phone over a follow-up period of two months. Participants will be randomized to either the intervention group receiving ePAL and usual care or to a control group receiving only usual care. The brief pain inventory will be used to assess our primary outcome which is pain intensity. We will also evaluate the effect of the intervention on secondary outcomes which include the effect of the intervention on hospital utilization for pain crisis, quality of life, adherence to analgesic medications, barriers to pain control, anxiety and patient engagement. Instruments that will be used in evaluating secondary outcomes include the Brief Pain Inventory, Morisky Medication Adherence Scale, Barriers Questionnaire-II, Functional Assessment of Cancer Therapy–General, Edmonton Symptom Assessment System, Generalized Anxiety Disorder 7-item scale, and the Functional Assessment of Chronic Illness Therapy-Fatigue. The intention-to-treat approach will be used to evaluate outcomes. Our primary outcome, pain intensity, measured longitudinally over eight weeks, will be assessed by mixed model repeated analysis. Effect sizes will be calculated as mean group differences with standard deviations. Results The study is still in progress. We hope to have results by the end of 2015. Conclusions The multidimensional approach to pain management implemented on a mobile phone application could lead to significant improvements in patient outcomes. Trial Registration ClinicalTrials.gov NCT02069743; https://clinicaltrials.gov/ct2/show/NCT02069743 (Archived by WebCite at http://www.webcitation.org/6Qb65XGGA). PMID:25500281

  15. Comparison of Transforaminal and Parasagittal Epidural Steroid Injections in Patients With Radicular Low Back Pain

    PubMed Central

    Hashemi, Seyed Masoud; Aryani, Mohamad Reza; Momenzadeh, Sirus; Razavi, Seyed Sajad; Mohseni, Gholamreza; Mohajerani, Seyed Amir; Esmilijah, Ali Akbar

    2015-01-01

    Background: Epidural steroid injection (ESI), including transforaminal (TF) epidural injections and interlaminar (IL) epidural steroid injections are commonly performed procedures for the management of lumbosacral radicular pain. Parasagittal interlaminar (PIL) approach could enable higher ventral epidural spread, with fewer complications than TF. Objectives: This study aims to compare the effectiveness of PIL and TF ESI in relieving the pain and disability of patients with lumbosacral pain. Patients and Methods: This prospective study enrolled 64 patients, aged between 18 to 75 years, with a diagnosis of low back pain and unilateral lumbosacral radicular pain. The patients were randomized to receive fluoroscopically guided epidural injection, through either the PIL or TF approach. Patients were evaluated for effective pain relief [numerical rating scale (NRS) < 3] by 0 - 10 numeric rating scale (NRS) and functional improvement by the Oswestry Disability Index (ODI). Results: Effective pain relief [numeric rating scale (NRS) < 3] was observed in 77.3% (95% CI: 67?90.5%) of patients in PIL group and 74.2% (95% CI: 62.4 - 89.4%) of patients in the TF group (P = 0.34), at 4 weeks. Mean NRS score was not significantly different between the PIL group compared to the TF group, at 4 weeks (P = 0.19). Number of patients with improved disability (measured by ODI < 20%) was not significantly different in PIL group (78% of cases) compared to the TF group (76% of cases), at 4 weeks (P = 0.21). There were no adverse effects observed in any of our patients. Conclusions: The PIL epidural injection is as effective as TF epidural injection in improving pain and functional status, in patients with chronic lumbosacral low back pain, due to disc degeneration. PMID:26587400

  16. Ethnocultural and sex characteristics of patients attending a tertiary care pain clinic in Toronto, Ontario

    PubMed Central

    Mailis-Gagnon, Angela; Yegneswaran, Balaji; Nicholson, Keith; Lakha, SF; Papagapiou, Marios; Steiman, Amanda J; Ng, Danny; Cohodarevic, Tea; Umana, Margarita; Zurowski, Mateusz

    2007-01-01

    BACKGROUND: Ethnocultural factors and sex may greatly affect pain perception and expression. Emerging literature is also documenting racial and ethnic differences in pain access and care. OBJECTIVE: To define the sex and ethnocultural characteristics of patients attending a tertiary care, university-affiliated pain clinic in Toronto, Ontario. METHODS: Data were collected on 1242 consecutive, new patients seen over a three-year period at the Comprehensive Pain Program (CPP) in downtown Toronto. Data were compared with the Canada 2001 Census. RESULTS: English-speaking, Canadian-born patients constituted 58.6% of the CPP population, similar to the 2001 Canadian Census data for the Greater Toronto Area. Certain visible minority groups (Indo-Pakistani and Chinese) were significantly under-represented, while European groups were over-represented. While women outnumbered men, they presented with lower levels of physical pathology in general, particularly in certain ethnic groups. Patients from Europe (representing primarily immigrants who arrived in Canada before 1960), were older, by 10 years to 15 years, than the average CPP population, and had a much higher incidence of physical or medical disorders. CONCLUSIONS: The implications of the study and the importance of sex and ethnicity in terms of presentation to Canadian pain clinics are discussed. Future well-designed studies are needed to shed light on the role of both patients’ and physicians’ ethnicity and sex in pain perception and expression, decision-making regarding pain treatments and acceptance of pain treatments. PMID:17505571

  17. Patients’ experiences of chronic non-malignant musculoskeletal pain: a qualitative systematic review

    PubMed Central

    Toye, Francine; Seers, Kate; Allcock, Nick; Briggs, Michelle; Carr, Eloise; Andrews, JoyAnn; Barker, Karen

    2013-01-01

    Background Musculoskeletal (MSK) pain is one of the most predominant types of pain and accounts for a large portion of the primary care workload. Aim To systematically review and integrate the findings of qualitative research to increase understanding of patients’ experiences of chronic non-malignant MSK pain. Design and setting Synthesis of qualitative research using meta-ethnography using six electronic databases up until February 2012 (Medline, Embase, Cinahl, Psychinfo, Amed and HMIC). Method Databases were searched from their inception until February 2012, supplemented by hand-searching contents lists of specific journals for 2001–2011 and citation tracking. Full published reports of qualitative studies exploring adults’ own experience of chronic non-malignant MSK pain were eligible for inclusion. Results Out of 24 992 titles, 676 abstracts, and 321 full texts were screened, 77 papers reporting 60 individual studies were included. A new concept of pain as an adversarial struggle emerged. This adversarial struggle was to: 1) affirm self; 2) reconstruct self in time; 3) construct an explanation for suffering; 4) negotiate the healthcare system; and 5) prove legitimacy. However, despite this struggle there is also a sense for some patients of 6) moving forward alongside pain. Conclusions This review provides a theoretical underpinning for improving patient experience and facilitating a therapeutic collaborative partnership. A conceptual model is presented, which offers opportunities for improvement by involving patients, showing them their pain is understood, and forming the basis to help patients move forward alongside their pain. PMID:24351499

  18. Effect of preoperative pregabalin on postoperative pain relief in thyroidectomy patients: A prospective observational study

    PubMed Central

    Bindu, M.; Kumar, A. Arun; Kesavan, M.; Suresh, Varun

    2015-01-01

    Background: Effective management of postoperative pain leads to increased patient satisfaction, earlier mobilization, reduced hospital stay and costs. One of the methods used for management of postoperative pain is preemptive analgesia-blockade of afferent nerve fibers before a painful stimulus. It modifies peripheral and central nervous system processing of noxious stimuli and reduces postoperative opioid consumption. In this study, we sought to determine whether the preoperative use of pregabalin reduced postoperative pain and morphine consumption in thyroidectomy. Materials and Methods: The observation was conducted on patients undergoing thyroidectomy surgery in two groups of 30 each. Of the two groups, one received a single oral dose of pregabalin 1 h preoperatively. Both the group of patients undergoes anesthesia in a similar manner. Following surgery the efficacy of the preoperative dose of pregabalin is observed by measuring the total opioid consumption 6 h postoperatively and assessing verbal numeric pain scales. Results: The mean time to request of rescue analgesia in pregabalin group was 322.07 ± 69.106 min when compared to morphine group 256.33 ± 111.978 min (P < 0.05). The mean pain scores in the postoperative period were also significantly lower in patients receiving pregabalin. Conclusion: Single oral dose of pregabalin was effective in reducing acute postoperative pain in thyroidectomy patients. It prolongs the time to the request of rescue analgesia and also results in lower postoperative pain scores in the immediate postoperative period. However a statistically significant low opioid consumption could not be proved. PMID:26417121

  19. Applications of virtual reality for pain management in burn-injured patients

    PubMed Central

    Miller, William; Teeley, Aubriana; Soltani, Maryam; Hoffman, Hunter G; Jensen, Mark P; Patterson, David R

    2009-01-01

    The pain associated with burn injuries is intense, unremitting and often exacerbated by anxiety, depression and other complicating patient factors. On top of this, modern burn care involves the repetitive performance – often on a daily basis for weeks to months – of painful and anxiety-provoking procedures that create additional treatment-related pain, such as wound care, dressing changes and rehabilitation activities. Pain management in burn patients is primarily achieved by potent pharmacologic analgesics (e.g., opioids), but is necessarily complemented by nonpharmacologic techniques, including distraction or hypnosis. Immersive virtual reality provides a particularly intense form of cognitive distraction during such brief, painful procedures, and has undergone preliminary study by several research groups treating burn patients over the past decade. Initial reports from these groups are consistent in suggesting that immersive virtual reality is logistically feasible, safe and effective in ameliorating the pain and anxiety experienced in various settings of post-burn pain. Furthermore, the technique appears applicable to a wide age range of patients and may be particularly well-adapted for use in children, one of the most challenging populations of burn victims to treat. However, confirmation and extension of these results in larger numbers of patients in various types of burn-related pain is necessary to more clearly define the specific benefits and limitations of virtual reality analgesia in the burn care setting. PMID:18986237

  20. Parents’ Empathic Responses and Pain and Distress in Pediatric Patients

    PubMed Central

    Penner, Louis A.; Cline, Rebecca J. W.; Albrecht, Terrance L.; Harper, Felicity W. K.; Peterson, Amy M.; Taub, Jeffrey M.; Ruckdeschel, John C.

    2010-01-01

    We investigated the relationship between parents’ empathic responses prior to their children undergoing cancer treatment procedures and children’s pain/distress during the procedures. We hypothesized: (1) parents’ empathic distress would be positively associated with children’s pain/distress, (2) parents’ empathic concern would be negatively associated with children’s pain/distress; and (3) parents’ enduring dispositions and social support would be associated with their empathic responses. Parents completed: (1) measures of dispositions and perceived social support several weeks before their children underwent the procedures, and (2) state measures of empathic distress and empathic concern just before the procedures. Empathic distress was positively associated with children’s pain; empathic concern was negatively associated with children’s pain/distress. Predictions about dispositions and social support were also substantially confirmed. PMID:20514359

  1. Pain Coping Skills Training for Patients with Elevated Pain Catastrophizing who are Scheduled for Knee Arthroplasty: A Quasi-Experimental Study

    PubMed Central

    Riddle, Daniel L.; Keefe, Francis J.; Nay, William T.; McKee, Daphne; Attarian, David E.; Jensen, Mark P.

    2011-01-01

    Objectives To (1) describe a behavioral intervention designed for patients with elevated pain catastrophizing who are scheduled for knee arthroplasty, and (2) use a quasi-experimental design to evaluate the potential efficacy of the intervention on pain severity, catastrophizing cognitions, and disability. Design Quasi-experimental non-equivalent control group design with a 2 month follow-up. Setting Two university-based Orthopedic Surgery departments. Participants Adults scheduled for knee replacement surgery who reported elevated levels of pain catastrophizing. Patients were recruited from two clinics and were assessed prior to surgery and 2 months following surgery. Intervention A group of 18 patients received a psychologist directed pain coping skills training intervention comprising 8 sessions and the other group, a historical cohort of 45 patients, received usual care. Main Outcome Measures WOMAC Pain and Disability scores as well as scores on the Pain Catastrophizing Scale. Results Two months following surgery, the patients who received pain coping skills training reported significantly greater reductions in pain severity and catastrophizing, and greater improvements in function as compared to the usual care cohort. Conclusion Pain catastrophizing is known to increase risk of poor outcome following knee arthroplasty. The findings provide preliminary evidence that the treatment may be highly efficacious for reducing pain, catastrophizing, and disability, in patients reporting elevated catastrophizing prior to knee arthroplasty. A randomized clinical trial is warranted to confirm these effects. PMID:21530943

  2. Orofacial pain: patient satisfaction and delay of urgent care.

    PubMed Central

    Riley, Joseph L.; Gilbert, Gregg H.; Heft, Marc W.

    2005-01-01

    OBJECTIVE: Accomplishing the Healthy People 2010 goal of eliminating disparities in oral disease will require a better understanding of the patterns of health care associated with orofacial pain. This study examined factors associated with pain-related acute oral health care. METHODS: The authors used data on 698 participants in the Florida Dental Care Study, a study of oral health among dentate adults aged 45 years and older at baseline. RESULTS: Fifteen percent of the respondents reported having had at least one dental visit as the result of orofacial pain. The majority of the respondents reportedly delayed contacting a dentist for at least one day; however, there was no difference between respondents reporting pain as the initiating symptom and those with other problems. Once respondents decided that dental services were needed, those with a painful symptom were nearly twice as likely as those without pain to want to be seen immediately. Rural adults were more likely than urban adults to report having received urgent dental care for a painful symptom. When orofacial pain occurred, those who identified as non-Hispanic African American were more likely than those who identified as non-Hispanic white to delay care rather than to seek treatment immediately, and women were more likely then men. Having a pain-related oral problem was associated with significantly less satisfaction with the services provided; non-Hispanic African American respondents were less likely than non-Hispanic white respondents to report being very satisfied, and rural residents were less likely than urban residents. Furthermore, men were more likely than women to suffer with orofacial pain without receiving either scheduled dental care or an urgent visit. CONCLUSIONS: Barriers to care are complex and likely to be interactive, but must be understood before the goals of Healthy People 2010 can be accomplished. PMID:15842115

  3. Benefits of treating highly disabled migraine patients with zolmitriptan while pain is mild.

    PubMed

    Klapper, J; Lucas, C; RÞsjÞ, Ø; Charlesworth, B

    2004-11-01

    Clinical trials of migraine therapy often require treatment when migraine pain intensity is moderate or severe, but many physicians find this practice artificial and patients often prefer to treat while pain is mild. This randomized, placebo-controlled study assessed the efficacy of zolmitriptan 2.5 mg in treating migraine while pain is mild, in patients who typically experience migraine attacks that are initially mild, but progress to moderate or severe. The intent-to-treat population comprised 280 patients (138 zolmitriptan; 148 placebo), with mean MIDAS grades of 29.6 (zolmitriptan) and 27.6 (placebo). Zolmitriptan 2.5 mg provided a significantly higher pain-free rate at 2 h (43.4% vs. 18.4% placebo; P < 0.0001). Significantly fewer zolmitriptan patients reported progression of headache pain to moderate or severe intensity 2 h postdose (53.7% vs. 70.4% placebo; P < 0.01), or required further medication within 24 h (46.4% vs. 71.1% placebo; P < 0.0001). The efficacy of zolmitriptan was more pronounced in patients treating during the first 15 min following pain onset. Adverse events were reported in 31.2% of patients treated with zolmitriptan (vs. 11.3% for placebo), and the incidence was lower in patients who treated early after attack onset. Zolmitriptan provides high efficacy when treating migraine while pain is mild, with the clinical benefits being more pronounced when treating early after migraine onset. PMID:15482352

  4. A Study of the Diagnostic Drawing Series with Eating Disordered Patients.

    ERIC Educational Resources Information Center

    Kessler, Kathie

    1994-01-01

    Examined possible existence of structural and content elements in Diagnostic Drawing Series (DDS) significant to eating-disordered population. Findings from 81 women with eating-disorders revealed that profile of eating disordered subjects did not vary from control group profile except for groundline and falling apart trees. (Author/NB)

  5. The Human Figure Drawing with Donor and Nondonor Siblings of Pediatric Bone Marrow Transplant Patients.

    ERIC Educational Resources Information Center

    Packman, Wendy L.; Beck, Vanessa L.; VanZutphen, Kelly H.; Long, Janet K.; Spengler, Gisele

    2003-01-01

    There is little research on the psychological impact of bone marrow transplantation (BMT) on family members. This study uses the Human Figure Drawing (HFD) to measure siblings' emotional distress toward BMT. Among the siblings, feelings of isolation, anger, depression, anxiety, and low self-esteem emerged as major themes. Findings indicate the


  6. Capsaicin 8 % as a cutaneous patch (Qutenza™): analgesic effect on patients with peripheral neuropathic pain.

    PubMed

    Raber, Julia Marie; Reichelt, Doris; Grüneberg-Oelker, Ute; Philipp, Konstanze; Stubbe-Dräger, Bianca; Husstedt, Ingo-W

    2015-09-01

    Evaluation of the analgesic effect after a single application of the capsaicin 8 % cutaneous patch (Qutenza™) in 37 patients suffering from painful, distal symmetric polyneuropathy (PNP) for an average of 5 years. Patients ranged from 40 to 78 years of age and 22 subjects were HIV-positive. Patients were observed 4 weeks prior to 12 weeks post administration. An evaluation of the therapeutic effect of capsaicin 8 % as a dermal patch in terms of pain reduction, change of sleeping behavior and social activities was performed and statistical analysis of data was conducted using non-parametric methods. Patients were selected according to clinical criteria. Numerical rating scale (NRS 0-10) was used to inquire pain intensity and a pain score was calculated using the painDETECT(©) questionnaire Freynhagen R (Curr Med Res Opin 22:1911-1920, [2006]). A significant reduction of pain was achieved for up to 12 weeks, with a maximum after 2-4 weeks post administration. After patient education and before application of capsaicin patch, a significant reduction of three levels on the NRS was observed. Symptoms of painful PNP decreased over the period of investigation and 8 patients reported a reduction of systemic pain medication. In patients with an HIV infection, a significant extension of sleep was achieved for 2, 4 and 8 weeks after application. Thus, the application of the capsaicin 8 % patch resulted in a significant relief of neuropathic pain, a prolongation of sleep, a reduction of oral pain medication and a resumption of social activities. PMID:25421590

  7. Experience of Barriers to Pain Management in Patients Receiving Outpatient Palliative Care

    PubMed Central

    Kwon, Jung Hye; Hui, David; Chisholm, Gary; Hong, Woo Taik; Nguyen, Linh

    2013-01-01

    Abstract Background Patient-reported barriers are an important obstacle to cancer pain management. For effective pain management, exploring patient-reported barriers and related factors is important. Objectives The study's objective is to determine factors associated with patient-reported barriers to cancer pain management. Method We conducted a secondary analysis of data from a prospective observational study examining opioid adherence in palliative care outpatients. We evaluated the association between high score on patient-reported barriers to cancer pain management, on the Barriers Questionnaire II (BQ-II), and patients' race, sex, smoking history, pain intensity, opioid dose, and depression. Results Of 196 patients evaluated (median age 55 years), 147 (75%) were white, 41 (21%) had gastrointestinal cancer, and 121 (62%) were receiving anticancer treatment when data were collected. The median pain score was 4 (interquartile range [IQR] 3–7); 98% were receiving strong opioids; and 63% were satisfied with their pain medication. The median Edmonton symptom assessment scale (ESAS) depression score was 1 (IQR 0–3). Mean (SD) BQ-II scores were 1.8 (0.9) for physiologic effects, 1.6 (0.9) for fatalism, 0.9 (0.9) for communication, 2.3 (1.1) for harmful effects, and 1.7 (0.8) in total. Only racial differences were associated with high total BQ-II score in multivariable analysis (R2=0.05, overall F test significance=0.02). Pain related factors including opioids dose, pain intensity, and satisfaction were not associated with high BQ-II score. Conclusion Patients receiving palliative care expressed low barriers to pain control. There were minimal associations of BQ-II score with demographics and clinical factors. PMID:23758527

  8. The Efficacy of a Perceptive Rehabilitation on Postural Control in Patients with Chronic Nonspecific Low Back Pain

    ERIC Educational Resources Information Center

    Paolucci, Teresa; Fusco, Augusto; Iosa, Marco; Grasso, Maria R.; Spadini, Ennio; Paolucci, Stefano; Saraceni, Vincenzo M.; Morone, Giovanni

    2012-01-01

    Patients with chronic low back pain have a worse posture, probably related to poor control of the back muscles and altered perception of the trunk midline. The aim of this study was to evaluate the efficacy of a perceptive rehabilitation in terms of stability and pain relief in patients with chronic nonspecific low back pain. Thirty patients were…

  9. A cross-sectional survey to investigate the prevalence of pain in Japanese patients with major depressive disorder and schizophrenia.

    PubMed

    Kishi, Taro; Matsuda, Yuki; Mukai, Tomohiko; Matsunaga, Shinji; Yasue, Ichiro; Fujita, Kiyoshi; Okochi, Tomo; Hirano, Shigeki; Kajio, Yusuke; Funahashi, Toshihiko; Akamatsu, Kaku; Ino, Kei; Okuda, Momoko; Tabuse, Hideaki; Iwata, Nakao

    2015-05-01

    We conducted a cross-sectional survey to assess the prevalence of physical pain in Japanese major depressive disorder (MDD) and schizophrenia (SZ) patients as well as in healthy controls (HCs). We also examined the association between their psychopathology and characteristics of pain according to a face-to-face survey by an experienced psychiatrist and psychologist. We analyzed 233 HCs, 94 MDD patients, and 75 SZ patients using the McGill Pain Questionnaire (MPQ) and SF-8 (all participants), the Hamilton Depression Rating Scale 21 items (MDD patients), and the Positive and Negative Symptom Scale (SZ patients). Although MDD patients experienced more pain than HCs, there was no difference in the prevalence of pain between SZ patients and HCs. Moreover, HCs with pain did not have higher SF-8 total scores than those without pain, whereas both MDD and SZ patients with pain had higher SF-8 total scores than those without pain. The severity of psychopathology in MDD and SZ patients was also positively associated with both the prevalence of pain and MPQ scores. MPQ scores were also associated with positive symptoms in SZ patients. Considering these results, physicians need to query MDD patients about physical pain during examination if they are to ensure a favorable and quick response to treatment. The severity of positive symptoms (i.e., clinical status) in SZ patients might also be associated with pain sensitivity, and warrants further investigation. PMID:25724075

  10. The Efficacy of a Perceptive Rehabilitation on Postural Control in Patients with Chronic Nonspecific Low Back Pain

    ERIC Educational Resources Information Center

    Paolucci, Teresa; Fusco, Augusto; Iosa, Marco; Grasso, Maria R.; Spadini, Ennio; Paolucci, Stefano; Saraceni, Vincenzo M.; Morone, Giovanni

    2012-01-01

    Patients with chronic low back pain have a worse posture, probably related to poor control of the back muscles and altered perception of the trunk midline. The aim of this study was to evaluate the efficacy of a perceptive rehabilitation in terms of stability and pain relief in patients with chronic nonspecific low back pain. Thirty patients were


  11. Pelvic Belt Effects on Health Outcomes and Functional Parameters of Patients with Sacroiliac Joint Pain

    PubMed Central

    Hammer, Niels; Möbius, Robert; Schleifenbaum, Stefan; Hammer, Karl-Heinz; Klima, Stefan; Lange, Justin S.; Soisson, Odette; Winkler, Dirk; Milani, Thomas L.

    2015-01-01

    Introduction The sacroiliac joint (SIJ) is a common source of low back pain. However, clinical and functional signs and symptoms correlating with SIJ pain are widely unknown. Pelvic belts are routinely applied to treat SIJ pain but without sound evidence of their pain-relieving effects. This case-control study compares clinical and functional data of SIJ patients and healthy control subjects and evaluates belt effects on SIJ pain. Methods 17 SIJ patients and 17 healthy controls were included in this prospective study. The short-form 36 survey and the numerical rating scale were used to characterize health-related quality of life in patients in a six-week follow-up and the pain-reducing effects of pelvic belts. Electromyography data were obtained from the gluteus maximus, biceps femoris, rectus femoris and medial vastus. Alterations of muscle activity, variability and gait patterns were compared in patients and controls along with the belts’ effects in a dynamic setting when walking. Results Significant improvements were observed in the short-form 36 survey of the SIJ patients, especially in the physical health subscores. Minor declines were also observed in the numerical rating scale on pain. Belt-related changes of muscle activity and variability were similar in patients and controls with one exception: the rectus femoris activity decreased significantly in patients with belt application when walking. Further belt effects include improved cadence and gait velocity in patients and controls. Conclusions Pelvic belts improve health-related quality of life and are potentially attributed to decreased SIJ-related pain. Belt effects include decreased rectus femoris activity in patients and improved postural steadiness during locomotion. Pelvic belts may therefore be considered as a cost-effective and low-risk treatment of SIJ pain. Trial Registration ClinicalTrials.gov NCT02027038 PMID:26305790

  12. Effects of increased standing balance on pain in patients with knee osteoarthritis

    PubMed Central

    Kim, Kyung; Lee, Hae-Yong; Lim, Sung-Joon

    2016-01-01

    [Purpose] The purpose of this study was to examine the relationship between standing balance increased through muscle-strengthening exercises and pain in knee osteoarthritis patients. [Subjects and Methods] Thirty knee osteoarthritis patients were equally divided into a strengthening exercise group and an unstable exercise group. Before and after the six-week experiment, the visual analogue scale was measured, and bilateral one-leg standing tests were performed. [Results] In both the strengthening exercise group and unstable exercise group, the bilateral one-leg standing time significantly increased after the six-week experiment. Regarding the visual analogue scale, a pain measurement scale, the strengthening exercise group had significantly decreased pain. The unstable exercise group also had decreased pain, but the decrease was not statistically significant. [Conclusion] In knee osteoarthritis patients, exercises using an unstable base of support and knee-extensor strengthening exercises with gradually increased loads had a positive effect on improving balance ability and decreasing pain.

  13. Management of patients with chronic pelvic pain associated with endometriosis refractory to conventional treatment.

    PubMed

    Martínez, Blanca; Canser, Enrique; Gredilla, Elena; Alonso, Eduardo; Gilsanz, Fernando

    2013-01-01

    The literature contains numerous studies on the diagnosis, pathogenesis, atypical locations, and clinical (hormonal) and surgical management of the disorder. However, no information is available on the management of endometriosis involving pain refractory to the usual treatment from the perspective of a pain unit. Our hospital has a pain unit specifically dedicated to pain in gynecology and obstetrics. The unit has been functioning since December 2005, and 52% of the attended patients have CPP of different origins. Endometriosis is present in 48% of all patients with CPP and is the most prevalent pathology in our practice. It moreover poses an important challenge in view of its enormous complexity. A descriptive study was made of the management of 44 patients with endometriosis refractory to therapy, evaluated and treated over a period of 3 years in the Pain Unit of the Maternity Center of La Paz University Hospital (Madrid, Spain). PMID:22568860

  14. PAin SoluTions In the Emergency Setting (PASTIES)—patient controlled analgesia versus routine care in emergency department patients with non-traumatic abdominal pain: randomised trial

    PubMed Central

    Rockett, Mark; Creanor, Siobhan; Squire, Rosalyn; Hayward, Chris; Ewings, Paul; Barton, Andy; Pritchard, Colin; Eyre, Victoria; Cocking, Laura; Benger, Jonathan

    2015-01-01

    Objective To determine whether patient controlled analgesia (PCA) is better than routine care in providing effective analgesia for patients presenting to emergency departments with moderate to severe non-traumatic abdominal pain. Design Pragmatic, multicentre, parallel group, randomised controlled trial Setting Five English hospitals. Participants 200 adults (66% (n=130) female), aged 18 to 75 years, who presented to the emergency department requiring intravenous opioid analgesia for the treatment of moderate to severe non-traumatic abdominal pain and were expected to be admitted to hospital for at least 12 hours. Interventions Patient controlled analgesia or nurse titrated analgesia (treatment as usual). Main outcome measures The primary outcome was total pain experienced over the 12 hour study period, derived by standardised area under the curve (scaled from 0 to 100) of each participant’s hourly pain scores, captured using a visual analogue scale. Pre-specified secondary outcomes included total morphine use, percentage of study period in moderate or severe pain, percentage of study period asleep, length of hospital stay, and satisfaction with pain management. Results 196 participants were included in the primary analyses (99 allocated to PCA and 97 to treatment as usual). Mean total pain experienced was 35.3 (SD 25.8) in the PCA group compared with 47.3 (24.7) in the treatment as usual group. The adjusted between group difference was 6.3 (95% confidence interval 0.7 to 11.9). Participants in the PCA group received significantly more morphine (mean 36.1 (SD 22.4) v 23.6 (13.1) mg; mean difference 12.3 (95% confidence interval 7.2 to 17.4) mg), spent less of the study period in moderate or severe pain (32.6% v 46.9%; mean difference 14.5% (5.6% to 23.5%)), and were more likely to be perfectly or very satisfied with the management of their pain (83% (73/88) v 66% (57/87); adjusted odds ratio 2.56 (1.25 to 5.23)) in comparison with participants in the treatment as usual group. Conclusions Significant reductions in pain can be achieved by PCA compared with treatment as usual in patients presenting to the emergency department with non-traumatic abdominal pain. Trial registration European Clinical Trials Database EudraCT2011-000194-31; Current Controlled Trials ISRCTN25343280. PMID:26094712

  15. The Association between Patient-Reported Pain and Doctors' Language Proficiency in Clinical Practice

    PubMed Central

    Mustajoki, Marianne; Forsén, Tom; Kauppila, Timo

    2015-01-01

    Patients' limited literacy and language fluency of different kinds cause them problems in navigating the medical interview. However, it is not known how physicians' native language skills affect the reported intensity of pain among Finnish emergency patients. Data were collected with two consecutive questionnaires in 16 healthcare centres and outpatient departments along the Finnish coast. Swedish and Finnish speaking 18–65-year-old emergency patients were eligible for this study. Our patients were predominantly Finnish speakers. Patient-rated poor language skills in Finnish among the physicians in ED setting increased statistically significantly pain reported by the Finnish speaking patients and their dissatisfaction with the health service. These patients were also less motivated to adhere to the instructions given by their physician. Patients speaking various languages reported less degree of pain. Foreign physicians' poor language proficiency in Finnish was expected to explain only some of the patients' pain experience. Physicians' good native language skills may help to reduce pain experience. Despite concordant language communication, other unknown barriers in the interaction might reduce the magnitude of pain reported. PMID:26483976

  16. The Association between Patient-Reported Pain and Doctors' Language Proficiency in Clinical Practice.

    PubMed

    Mustajoki, Marianne; Forsén, Tom; Kauppila, Timo

    2015-01-01

    Patients' limited literacy and language fluency of different kinds cause them problems in navigating the medical interview. However, it is not known how physicians' native language skills affect the reported intensity of pain among Finnish emergency patients. Data were collected with two consecutive questionnaires in 16 healthcare centres and outpatient departments along the Finnish coast. Swedish and Finnish speaking 18-65-year-old emergency patients were eligible for this study. Our patients were predominantly Finnish speakers. Patient-rated poor language skills in Finnish among the physicians in ED setting increased statistically significantly pain reported by the Finnish speaking patients and their dissatisfaction with the health service. These patients were also less motivated to adhere to the instructions given by their physician. Patients speaking various languages reported less degree of pain. Foreign physicians' poor language proficiency in Finnish was expected to explain only some of the patients' pain experience. Physicians' good native language skills may help to reduce pain experience. Despite concordant language communication, other unknown barriers in the interaction might reduce the magnitude of pain reported. PMID:26483976

  17. Use of Transversus Abdominis Plane (TAP) Blocks for Pain Management in Elderly Surgical Patients.

    PubMed

    Sammons, Gay; Ritchey, William

    2015-11-01

    Elderly patients who require surgical interventions often have multiple comorbidities that complicate their intraoperative and postoperative care. Surgical team members should consider all potential problems that elderly patients may experience and base perioperative care on their assessment. This article discusses the use of the transversus abdominis plane (TAP) block in elderly patients undergoing surgical procedures to relieve pain and reduce the use of narcotics or sedatives during the immediate and extended postoperative recovery period. By reducing postoperative pain and the use of sedatives and narcotics, the TAP block improves pain management and helps reduce the incidence of postoperative delirium, pneumonia, urinary retention, and falls. PMID:26514706

  18. Effects of rehabilitation for pain relief in patients with rheumatoid arthritis: a systematic review

    PubMed Central

    Park, Youngju; Chang, Moonyoung

    2016-01-01

    [Purpose] The purpose of this study was to find evidence for the effectiveness of rehabilitation for pain relief in patients with rheumatoid arthritis. [Subjects and Methods] A systematic review was conducted of MEDLINE, The Cochrane Central Register of Controlled Trials (CENTRAL), and OVID, for studies published from July 2005 to July 2015. We extracted data regarding patients, intervention, comparison, and outcomes, and assessed the methodological quality of the data. [Results] Nine randomized controlled trials comparing the effects of pain relief in patients with rheumatoid arthritis were found. [Conclusion] Physical therapy and occupational therapy can reduce pain in rheumatoid arthritis. PMID:26957779

  19. A Guide for Pain Management in Low and Middle Income Communities. Managing the Risk of Opioid Abuse in Patients with Cancer Pain

    PubMed Central

    Pergolizzi, Joseph V.; Zampogna, Gianpietro; Taylor, Robert; Gonima, Edmundo; Posada, Jose; Raffa, Robert B.

    2016-01-01

    Most patients who present with cancer have advanced disease and often suffer moderate to severe pain. Opioid therapy can be safe and effective for use in cancer patients with pain, but there are rightful concerns about inappropriate opioid use even in the cancer population. Since cancer patients live longer than ever before in history (and survivors may have long exposure times to opioid therapy), opioid misuse among cancer patients is an important topic worthy of deeper investigation. Cancer patients with pain must be evaluated for risk factors for potential opioid misuse and aberrant drug-taking behaviors assessed. A variety of validated screening tools should be used. Of particular importance is the fact that pain in cancer patients changes frequently, whether it is related to their underlying disease (progression or remission), pain related to treatment (such as painful chemotherapy-induced peripheral neuropathy), and concomitant pain unrelated to cancer (such as osteoarthritis, headache, or back pain). Fortunately, clinicians can use universal precautions to help reduce the risk of opioid misuse while still assuring that cancer patients get the pain therapy they need. Another important new “tool” in this regard is the emergence of abuse-deterrent opioid formulations. PMID:26973529

  20. A Guide for Pain Management in Low and Middle Income Communities. Managing the Risk of Opioid Abuse in Patients with Cancer Pain.

    PubMed

    Pergolizzi, Joseph V; Zampogna, Gianpietro; Taylor, Robert; Gonima, Edmundo; Posada, Jose; Raffa, Robert B

    2016-01-01

    Most patients who present with cancer have advanced disease and often suffer moderate to severe pain. Opioid therapy can be safe and effective for use in cancer patients with pain, but there are rightful concerns about inappropriate opioid use even in the cancer population. Since cancer patients live longer than ever before in history (and survivors may have long exposure times to opioid therapy), opioid misuse among cancer patients is an important topic worthy of deeper investigation. Cancer patients with pain must be evaluated for risk factors for potential opioid misuse and aberrant drug-taking behaviors assessed. A variety of validated screening tools should be used. Of particular importance is the fact that pain in cancer patients changes frequently, whether it is related to their underlying disease (progression or remission), pain related to treatment (such as painful chemotherapy-induced peripheral neuropathy), and concomitant pain unrelated to cancer (such as osteoarthritis, headache, or back pain). Fortunately, clinicians can use universal precautions to help reduce the risk of opioid misuse while still assuring that cancer patients get the pain therapy they need. Another important new "tool" in this regard is the emergence of abuse-deterrent opioid formulations. PMID:26973529

  1. The Effectiveness of Mechanical Traction Among Subgroups of Patients With Low Back Pain and Leg Pain: A Randomized Trial.

    PubMed

    Thackeray, Anne; Fritz, Julie M; Childs, John D; Brennan, Gerard P

    2016-03-01

    Study Design Randomized clinical trial. Background The recommended initial management strategy for patients with low back pain and signs of nerve root compression is conservative treatment, but there is little evidence to guide the most appropriate management strategy. Preliminary research suggests that a treatment protocol of mechanical traction and extension-oriented exercises may be effective, particularly in a specific subgroup of patients. Objective To examine the effectiveness of mechanical traction in patients with lumbar nerve root compression and within a predefined subgroup. Methods One hundred twenty patients with low back pain with nerve root compression were recruited from physical therapy clinics. Using predefined subgrouping criteria, patients were stratified at baseline and randomized to receive an extension-oriented treatment approach with or without the addition of mechanical traction. During a 6-week period, patients received up to 12 treatment visits. Primary outcomes of pain and disability were collected at 6 weeks, 6 months, and 1 year by assessors blinded to group allocation. Outcomes were examined using linear mixed-model analyses examining change over time by treatment and the interaction between treatment and subgrouping status. Results The mean ± SD age of participants was 41.1 ± 11.3 years, median duration of symptoms was 62 days, and 57% were male. No significant differences in disability or pain outcomes were noted between treatment groups at any time point, nor was any interaction found between subgroup status and treatment. Conclusion Patients with lumbar nerve root compression presenting for physical therapy can expect significant changes in disability and pain over a 6-week treatment period. There is no evidence that mechanical lumbar traction in combination with an extension-oriented treatment is superior to extension-oriented exercises alone in the management of these patients or within a predefined subgroup of patients. The study protocol was registered with ClinicalTrials.gov (NCT00942227). Level of Evidence Therapy, level 2b. J Orthop Sports Phys Ther 2016;46(3):144-154. Epub 26 Jan 2016. doi:10.2519/jospt.2016.6238. PMID:26813755

  2. Hormone replacement therapy in morphine-induced hypogonadic male chronic pain patients

    PubMed Central

    2011-01-01

    Background In male patients suffering from chronic pain, opioid administration induces severe hypogonadism, leading to impaired physical and psychological conditions such as fatigue, anaemia and depression. Hormone replacement therapy is rarely considered for these hypogonadic patients, notwithstanding the various pharmacological solutions available. Methods To treat hypogonadism and to evaluate the consequent endocrine, physical and psychological changes in male chronic pain patients treated with morphine (epidural route), we tested the administration of testosterone via a gel formulation for one year. Hormonal (total testosterone, estradiol, free testosterone, DHT, cortisol), pain (VAS and other pain questionnaires), andrological (Ageing Males' Symptoms Scale - AMS) and psychological (POMS, CES-D and SF-36) parameters were evaluated at baseline (T0) and after 3, 6 and 12 months (T3, T6, T12 respectively). Results The daily administration of testosterone increased total and free testosterone and DHT at T3, and the levels remained high until T12. Pain rating indexes (QUID) progressively improved from T3 to T12 while the other pain parameters (VAS, Area%) remained unchanged. The AMS sexual dimension and SF-36 Mental Index displayed a significant improvement over time. Conclusions In conclusion, our results suggest that a constant, long-term supply of testosterone can induce a general improvement of the male chronic pain patient's quality of life, an important clinical aspect of pain management. PMID:21332999

  3. Psychopathology and pain correlates of dispositional optimism in methadone-maintained patients

    PubMed Central

    Beitel, Mark; Savant, Jonathan D.; Cutter, Christopher J.; Peters, Skye; Belisle, Nicole; Barry, Declan T.

    2012-01-01

    While higher levels of dispositional optimism are associated with decreased levels of psychopathology and pain, and higher levels of mental health functioning—important outcomes in opioid treatment programs—a paucity of studies has examined dispositional optimism among individuals with opioid use disorders. The aim of this study was to examine the clinical correlates (i.e., psychopathology, pain status) of dispositional optimism in opioid dependent patients enrolled in methadone maintenance treatment (MMT). A survey targeting demographics, pain, psychopathology, and dispositional optimism was administered to 150 MMT patients. In multivariable analyses, higher levels of dispositional optimism were significantly associated with lower levels of depression, screened personality disorder criteria, screened symptoms of PTSD, and pain-related emotional strain. In comparison to those without a history of chronic pain (i.e., non-cancer related physical pain lasting at least 3 months), MMT patients who reported either lifetime or current chronic pain exhibited significantly lower levels of dispositional optimism. The associations among higher levels of dispositional optimism, lower levels of psychopathology, and lower pain-related emotional strain suggest that research focusing on the efficacy of specific interventions to promote dispositional optimism in MMT patients is warranted. PMID:23786512

  4. The experience of pain and redness in patients with moderate to severe plaque psoriasis

    PubMed Central

    Martin, Mona L.; Gordon, Kenneth; Pinto, Lionel; Bushnell, Donald M.; Chau, Dina; Viswanathan, Hema N.

    2015-01-01

    Abstract Introduction: The Psoriasis Symptom Inventory is a patient-reported outcome instrument that assesses severity of psoriasis signs and symptoms. In early qualitative research, patients reported pain related to psoriasis skin lesions and redness of affected areas of skin as key symptoms. Methods: Individual concept elicitation interviews and cognitive interviews were conducted in adults with moderate to severe plaque psoriasis. Interviews were audio-recorded and transcribed. Concepts were identified, coded and grouped by similar content using Atlas.ti software. Results were evaluated using qualitative research methods. Results: Of 30 patients recruited, 20 patients participated in concept elicitation interviews and 10 participated in cognitive interviews. Concept codes for skin pain and descriptions of color comprised 11% and 15%, respectively, of all symptom-related expressions. Of 90 pain-related expressions, 22 were about pain related to unconscious scratching and 68 were about pain from the psoriasis lesions. Of 199 color-related expressions, 72 were about red or reddish lesion color. Patients with darker skin tones were found to interpret redness consistently. Discussion: These results provide further support to content validity of pain and redness concepts in the Psoriasis Symptom Inventory. Conclusions: Symptoms of skin pain and redness are highly relevant to patients with psoriasis. PMID:25822169

  5. Predictors of Abdominal Pain in Depressed Pediatric Inflammatory Bowel Disease Patients

    PubMed Central

    Srinath, Arvind I.; Goyal, Alka; Zimmerman, Lori A.; Newara, Melissa C.; Kirshner, Margaret A.; McCarthy, F. Nicole; Keljo, David; Binion, David; Bousvaros, Athos; DeMaso, David R.; Youk, Ada; Szigethy, Eva M.

    2015-01-01

    Background Pediatric patients with inflammatory bowel disease (IBD) have high rates of abdominal pain. The study aims were to (1) Evaluate biological and psychological correlates of abdominal pain in depressed youth with IBD, (2) Determine predictors of abdominal pain in Crohn’s disease (CD) and ulcerative colitis (UC). Methods 765 patients ages 9–17 with IBD seen over 3 years at two sites were screened for depression. Depressed youth completed comprehensive assessments for abdominal pain, psychological (depression and anxiety), and biological (IBD-related, through disease activity indices and laboratory values) realms. Results 217 patients with IBD (161 CD, 56 UC) were depressed. 163 (120 CD, 43 UC) patients had complete API scores. In CD, abdominal pain was associated with depression (r=0.33; p<0.001), diarrhea (r=0.34; p=0.001), ESR (r=0.22; p=0.02), low albumin (r=0.24; p=.01), weight loss (r=0.33; p=0.001), and abdominal tenderness (r=0.38, p=0.002). A multivariate model with these significant correlates represented 32% of the variance in pain. Only depression (p=0.03), weight loss (p=0.04), and abdominal tenderness (p=0.01) predicted pain for CD patients. In UC, pain was associated with depression (r=0.46; p=0.002) and nocturnal stools (r=.32; p=.046). In the multivariate model with these significant correlates 23% of the variance was explained, and only depression (p=0.02) predicted pain. Conclusions The psychological state of pediatric patients with IBD may increase the sensitivity to abdominal pain. Thus, screening for and treating comorbid depression may prevent excessive medical testing and unnecessary escalation of IBD medications. PMID:24983975

  6. Substance P and Chronic Pain in Patients with Chronic Inflammation of Connective Tissue

    PubMed Central

    2015-01-01

    Objective Evidence suggests that substance P (SP) is involved in chronic joint inflammation, such as the pathogenesis of rheumatoid arthritis and osteoarthritis. The goal of the research was to evaluate the correlation between chronic pain and changes in the SP level in patients with chronic inflammation of the connective tissue. Methods Patients with osteoarthritis and rheumatoid arthritis were enrolled in this study. The relationship between chronic pain intensity and the serum SP concentration was evaluated in these groups of patients with osteoarthritis and rheumatoid arthritis. Results The results showed a positive correlation between the serum SP concentrations and chronic pain intensity. Conclusions 1. The SP serum concentration was significantly different between the groups of patients with OA and RA. 2. There was a positive correlation between the serum SP concentration and chronic pain intensity in OA and RA patients. PMID:26444559

  7. Elderly Patients With Painful Bone Metastases Should be Offered Palliative Radiotherapy

    SciTech Connect

    Campos, Sarah; Presutti, Roseanna; Zhang Liying; Salvo, Nadia; Hird, Amanda; Tsao, May; Barnes, Elizabeth A.; Danjoux, Cyril; Sahgal, Arjun; Mitera, Gunita; Sinclair, Emily; DeAngelis, Carlo; Nguyen, Janet; Napolskikh, Julie; Chow, Edward

    2010-04-15

    Purpose: To investigate the efficacy of palliative radiotherapy (RT) in relieving metastatic bone pain in elderly patients. Methods and Materials: The response to RT for palliation of metastatic bone pain was evaluated from a prospective database of 558 patients between 1999 and 2008. The pain scores and analgesic intake were used to calculate the response according to the International Bone Metastases Consensus Working Party palliative RT endpoints. Subgroup analyses for age and other demographic information were performed. Results: No significant difference was found in the response rate in patients aged >=65, >=70, and >=75 years compared with younger patients at 1, 2, or 3 months after RT. The response was found to be significantly related to the performance status. Conclusion: Age alone did not affect the response to palliative RT for bone metastases. Elderly patients should be referred for palliative RT for their painful bone metastases, regardless of age, because they receive equal benefit from the treatment.

  8. Influence of Dopaminergic Medication on Conditioned Pain Modulation in Parkinson's Disease Patients

    PubMed Central

    Buhmann, Carsten; Forkmann, Katarina; Diedrich, Sabrina; Wesemann, Katharina; Bingel, Ulrike

    2015-01-01

    Background Pain is highly prevalent in patients with Parkinson’s disease (PD), but little is known about the underlying pathophysiological mechanisms. The susceptibility to pain is known to depend on ascending and descending pathways. Because parts of the descending pain inhibitory system involve dopaminergic pathways, dysregulations in dopaminergic transmission might contribute to altered pain processing in PD. Deficits in endogenous pain inhibition can be assessed using conditioned pain modulation (CPM) paradigms. Methods Applying such a paradigm, we investigated i) whether CPM responses differ between PD patients and healthy controls, ii) whether they are influenced by dopaminergic medication and iii) whether there are effects of disease-specific factors. 25 patients with idiopathic PD and 30 healthy age- and gender-matched controls underwent an established CPM paradigm combining heat pain test stimuli at the forearm and the cold pressor task on the contralateral foot as the conditioning stimulus. PD patients were tested under dopaminergic medication and after at least 12 hours of medication withdrawal. Results No significant differences between CPM responses of PD patients and healthy controls or between PD patients “on” and “off” medication were found. These findings suggest (i) that CPM is insensitive to dopaminergic modulations and (ii) that PD is not related to general deficits in descending pain inhibition beyond the known age-related decline. However, at a trend level, we found differences between PD subtypes (akinetic-rigid, tremor-dominant, mixed) with the strongest impairment of pain inhibition in the akinetic-rigid subtype. Conclusions There were no significant differences between CPM responses of patients compared to healthy controls or between patients “on” and “off” medication. Differences between PD subtypes at a trend level point towards different pathophysiological mechanisms underlying the three PD subtypes which warrant further investigation and potentially differential therapeutic strategies in the future. PMID:26270817

  9. Self-Report of Depressive Symptoms in Low Back Pain Patients.

    ERIC Educational Resources Information Center

    Crisson, James; And Others

    1986-01-01

    Presents two studies designed to examine the self-report of depressive symptoms in low back pain patients (N=134). Both studies found that patients were more likely to report somatic than cognitive symptoms of depression. Patients with multiple physical findings were not more likely to report somatic symptoms than patients with few physical…

  10. Self-Report of Depressive Symptoms in Low Back Pain Patients.

    ERIC Educational Resources Information Center

    Crisson, James; And Others

    1986-01-01

    Presents two studies designed to examine the self-report of depressive symptoms in low back pain patients (N=134). Both studies found that patients were more likely to report somatic than cognitive symptoms of depression. Patients with multiple physical findings were not more likely to report somatic symptoms than patients with few physical


  11. Strategies for Coping with Chronic Lower Back Pain in Patients with Long Physiotherapy Wait Time.

    PubMed

    Cabak, Anna; D?browska-Zimakowska, Anna; Truszczy?ska, Aleksandra; Rogala, Patryk; Laprus, Katarzyna; Tomaszewski, Wies?aw

    2015-01-01

    BACKGROUND Treatment efficacy for the increasing prevalence of back pain is a great challenge for both health care providers and individuals coping with this problem. This study aimed to evaluate pain coping strategies used by primary care patients with chronic lower back pain (CLBP) as a supplementation of medical diagnosis before a physiotherapy programme. MATERIAL AND METHODS A total of 88 people were divided into 3 age groups: young adults (21-40 years old), middle-aged adults (41-60 years old), and the elderly (over 60 years old). Data was gathered from rehabilitation centers and primary medical care facilities. A cross-sectional design was used. The Coping Strategies Questionnaire (CSQ) was completed before the physiotherapy course. RESULTS Patients complained of CLBP for 11.32±6.81 years on average. The most common strategies to cope with back pain included declaring that the pain is manageable, praying and hoping, as well as increased behavioral activity. Statistically significant differences in coping strategies were found between age groups. The elderly patients were more likely to "declare coping with pain" in comparison to the younger age groups (p<0.01). People over 60 years of age were more likely to declare active coping with pain, while young people reported catastrophizing. CONCLUSIONS Patients in different age groups had various difficulties in pain coping. Most of them required support in self-management of pain in addition to physiotherapy. The basic assessment of pain coping strategies should be consistently taken into account and included in rehabilitation protocols in chronic pain treatment. PMID:26670743

  12. Strategies for Coping with Chronic Lower Back Pain in Patients with Long Physiotherapy Wait Time

    PubMed Central

    Cabak, Anna; D?browska-Zimakowska, Anna; Truszczy?ska, Aleksandra; Rogala, Patryk; Laprus, Katarzyna; Tomaszewski, Wies?aw

    2015-01-01

    Background Treatment efficacy for the increasing prevalence of back pain is a great challenge for both health care providers and individuals coping with this problem. This study aimed to evaluate pain coping strategies used by primary care patients with chronic lower back pain (CLBP) as a supplementation of medical diagnosis before a physiotherapy programme. Material/Methods A total of 88 people were divided into 3 age groups: young adults (21–40 years old), middle-aged adults (41–60 years old), and the elderly (over 60 years old). Data was gathered from rehabilitation centers and primary medical care facilities. A cross-sectional design was used. The Coping Strategies Questionnaire (CSQ) was completed before the physiotherapy course. Results Patients complained of CLBP for 11.32±6.81 years on average. The most common strategies to cope with back pain included declaring that the pain is manageable, praying and hoping, as well as increased behavioral activity. Statistically significant differences in coping strategies were found between age groups. The elderly patients were more likely to “declare coping with pain” in comparison to the younger age groups (p<0.01). People over 60 years of age were more likely to declare active coping with pain, while young people reported catastrophizing. Conclusions Patients in different age groups had various difficulties in pain coping. Most of them required support in self-management of pain in addition to physiotherapy. The basic assessment of pain coping strategies should be consistently taken into account and included in rehabilitation protocols in chronic pain treatment. PMID:26670743

  13. [Neuralgic amyotrophy as the primary cause of shoulder pain in a patient with rotator cuff tear].

    PubMed

    Sahin, Ebru; Senocak, Ozlem; Bacako?lu, A Kadir; Oztura, Ibrahim; Gözüm, Mehtap; Peker, Ozlen

    2009-01-01

    A 66-year-old woman with no history of trauma presented with severe shoulder pain. Magnetic resonance imaging revealed rupture of the supraspinatus tendon, for which surgical treatment was considered. However, it was noted that shoulder pain was accompanied by weakness in the shoulder muscles, and the patient underwent electroneuromyographic examination, which revealed neuralgic amyotrophy. Following physical therapy and rehabilitation combined with appropriate medical therapy, her symptoms significantly improved. In cases with severe shoulder pain without a trauma history, characteristics of pain should be thoroughly analyzed and neuralgic amyotrophy considered in the differential diagnosis. PMID:19448361

  14. Predictors of communication preferences in patients with chronic low back pain

    PubMed Central

    Farin, Erik; Gramm, Lukas; Schmidt, Erika

    2013-01-01

    Background The objective of this exploratory study was to identify patient-related predictors of communication preferences in patients with chronic low back pain for various dimensions of patient-physician communication (patient participation and orientation, effective and open communication, emotionally supportive communication, communication about personal circumstances). Methods Eleven rehabilitation centers from various parts of Germany participated in collection of data between 2009 and 2011. A total of 701 patients with chronic low back pain were surveyed at the start of rehabilitation. The patient questionnaire captured communication preferences, pain impact, pain intensity, and psychologic variables (fear avoidance beliefs, illness coherence, control beliefs, communication self-efficacy, and personality characteristics). The rehabilitation physicians filled out a documentation sheet containing information on diagnosis, inability to work, duration of the illness, and comorbidity at the beginning and end of rehabilitation. Hierarchical regression analyses were performed. Results On average, effective, open, and patient-centered communication was very important for patients with back pain, emotionally supportive communication was important, and communication about personal circumstances was somewhat important. The variance in communication preferences explained by the predictors studied here was 8%–19%. Older patients showed a lower preference for patient-centered and open communication, but a higher preference for communication about personal circumstances. Patients with psychologic risk factors (eg, fear avoidance beliefs), extroverted patients, and patients with high self-efficacy in patient-physician interaction generally had higher expectations of the physician’s communicative behavior. Conclusion Providers should take into consideration the fact that patients with back pain have a strong need for effective, open, and patient-centered communication. A flexible approach to communication needs appears to be especially important for communication about emotional and personal circumstances, because the patients differ most clearly in this respect. Personal characteristics provided only initial clues to possible preferences; for more precision, an individual assessment (by means of questionnaires or discussion) is needed. PMID:24187489

  15. Prevalence of the Fibromyalgia Phenotype in Spine Pain Patients Presenting to a Tertiary Care Pain Clinic and the Potential Treatment Implications

    PubMed Central

    Brummett, Chad M.; Goesling, Jenna; Tsodikov, Alex; Meraj, Taha S.; Wasserman, Ronald A.; Clauw, Daniel J.; Hassett, Afton L.

    2014-01-01

    Objective Injections for spinal pain have high failure rates, emphasizing the importance of patient selection. It is possible that detecting the presence of a fibromyalgia-like phenotype could aid in prediction, because in these individuals a peripheral injection would not address pain due to alterations in central neurotransmission. We hypothesized that spine pain patients meeting survey criteria for fibromyalgia would be phenotypically distinct from those who do not meet criteria. Methods 548 patients with a primary spine pain diagnosis were studied. All patients completed validated self-report questionnaires, including the Brief Pain Inventory, PainDETECT, Hospital Anxiety and Depression Scale, measures of physical function, and the American College of Rheumatology survey criteria for fibromyalgia. Results 42% met survey criteria for fibromyalgia (FM+). When compared with criteria negative patients, FM+ patients were more likely to be younger, unemployed, receiving compensation, have greater pain intensity, pain interference and neuropathic pain descriptors, as well as higher levels of depression and anxiety, and lower level of physical function (p < 0.0001 for each comparison). Gender, neuropathic pain, pain interference, physical function, and anxiety were independently predictive of fibromyalgia status in a multivariate analysis (p < 0.01, all variables). ROC analysis showed the strength of association of 0.81 as measured by the cross-validated C-statistic. Conclusion Using the survey criteria for fibromyalgia, we demonstrated profound phenotypic differences in a spine pain population. Although centralized pain cannot be confirmed with a survey alone, the pathophysiology of fibromyalgia may help explain a portion of the variability of responses to spine interventions. PMID:24022710

  16. Medical Marijuana Seems Safe for Chronic Pain Patients, Study Finds

    MedlinePLUS

    ... pot is used. "Essentially, people who used vaporized cannabis would have no more adverse events than controls," ... Ware said. "Anybody who is interested in using cannabis to treat pain should know this information, as ...

  17. Reducing Cancer Patients' Painful Treatment - Duration: 3 minutes, 7 seconds.

    NASA Video Gallery

    A NASA light technology originally developed to aid plant growth experiments in space has proved to reduce the painful side effects resulting from chemotherapy and radiation treatment in bone marro...

  18. New concepts in restoring shoulder elevation in a stiff and painful shoulder patient.

    PubMed

    Donatelli, Robert; Ruivo, R M; Thurner, Michael; Ibrahim, Mahmoud Ibrahim

    2014-02-01

    The treatment and evaluation of a stiff and painful shoulder, characteristic of adhesive capsulitis and "frozen" shoulders, is a dilemma for orthopedic rehabilitation specialists. A stiff and painful shoulder is all-inclusive of Adhesive capsulitis and Frozen Shoulder diagnoses. Adhesive capsulitis and frozen shoulder will be referred to as a stiff and painful shoulder, throughout this paper. Shoulder motion occurs in multiple planes of movement. Loss of shoulder mobility can result in significant functional impairment. The traditional treatment approach to restore shoulder mobility emphasizes mobilization of the shoulder overhead. Forced elevation in a stiff and painful shoulder can be painful and potentially destructive to the glenohumeral joint. This manuscript will introduce a new biomechanical approach to evaluate and treat patients with stiff and painful shoulders. PMID:24315683

  19. A prospective study of primary care patients with musculoskeletal pain: the identification of predictive factors for chronicity.

    PubMed Central

    Potter, R G; Jones, J M; Boardman, A P

    2000-01-01

    Primary care faces the challenge of reducing the proportion of patients continuing with musculoskeletal pain beyond the acute phase. This study assessed patients presenting in general practice with a four- to 12-week history of pain and re-assessed them 12 weeks later. Patients whose pain was described as 'none' or 'slight' were allocated to the 'acute group', and those whose pain continued to be 'moderate' or 'severe' were allocated to the 'chronic group'. Comparative analysis of the two groups' responses at initial assessment identified pain intensity, active coping score, and previous pain episode to be factors independently predictive of chronicity. PMID:10750237

  20. Contribution of chronic pain and neuroticism to abnormal forebrain gray matter in patients with temporomandibular disorder.

    PubMed

    Moayedi, Massieh; Weissman-Fogel, Irit; Crawley, Adrian P; Goldberg, Michael B; Freeman, Bruce V; Tenenbaum, Howard C; Davis, Karen D

    2011-03-01

    Cortical plasticity is thought to occur following continuous barrage of nociceptive afferent signals to the brain. Hence, chronic pain is presumed to induce anatomical and physiological changes in the brain over time. Inherent factors, some pre-dating the onset of chronic pain, may also contribute to brain abnormalities present in patients. In this study we used structural MRI to examine whether patients with chronic temporomandibular (TMD) pain have abnormalities in gray matter (GM) within brain areas implicated in pain, modulation and sensorimotor function. We found that patients with TMD have cortical thickening in the primary somatosensory cortex (S1), frontal polar and the ventrolateral prefrontal cortex (PFC). These findings provide a structural basis for previous findings of TMD pain and cognitive sluggishness in TMD. We then examined the contribution of TMD characteristics to GM abnormalities. We found that 1) GM in the sensory thalamus positively correlated to TMD duration, 2) cortical thickness in the primary motor (M1) and the anterior mid-cingulate cortices (aMCC) were negatively correlated to pain intensity, and 3) pain unpleasantness was negatively correlated to cortical thickness in the orbitofrontal cortex (OFC). These findings suggest that an individual's TMD pain history contributes to GM in the brain. Lastly, we examined the contribution of a potential pre-existing vulnerability due to neuroticism. In the TMD patients, we found that there was an abnormal positive correlation between neuroticism and OFC thickness, in contrast to the negative correlation found in the healthy controls. Therefore, neuroticism may contribute to TMD pathophysiology. In sum, our data suggest that GM in the brain of patients with chronic TMD pain can be shaped by both personality and pain characteristics. PMID:21156210

  1. Calibration and Validation of the Dutch-Flemish PROMIS Pain Interference Item Bank in Patients with Chronic Pain

    PubMed Central

    Crins, Martine H. P.; Roorda, Leo D.; Smits, Niels; de Vet, Henrica C. W.; Westhovens, Rene; Cella, David; Cook, Karon F.; Revicki, Dennis; van Leeuwen, Jaap; Boers, Maarten; Dekker, Joost; Terwee, Caroline B.

    2015-01-01

    The Dutch-Flemish PROMIS Group translated the adult PROMIS Pain Interference item bank into Dutch-Flemish. The aims of the current study were to calibrate the parameters of these items using an item response theory (IRT) model, to evaluate the cross-cultural validity of the Dutch-Flemish translations compared to the original English items, and to evaluate their reliability and construct validity. The 40 items in the bank were completed by 1085 Dutch chronic pain patients. Before calibrating the items, IRT model assumptions were evaluated using confirmatory factor analysis (CFA). Items were calibrated using the graded response model (GRM), an IRT model appropriate for items with more than two response options. To evaluate cross-cultural validity, differential item functioning (DIF) for language (Dutch vs. English) was examined. Reliability was evaluated based on standard errors and Cronbach’s alpha. To evaluate construct validity correlations with scores on legacy instruments (e.g., the Disabilities of the Arm, Shoulder and Hand Questionnaire) were calculated. Unidimensionality of the Dutch-Flemish PROMIS Pain Interference item bank was supported by CFA tests of model fit (CFI = 0.986, TLI = 0.986). Furthermore, the data fit the GRM and showed good coverage across the pain interference continuum (threshold-parameters range: -3.04 to 3.44). The Dutch-Flemish PROMIS Pain Interference item bank has good cross-cultural validity (only two out of 40 items showing DIF), good reliability (Cronbach’s alpha = 0.98), and good construct validity (Pearson correlations between 0.62 and 0.75). A computer adaptive test (CAT) and Dutch-Flemish PROMIS short forms of the Dutch-Flemish PROMIS Pain Interference item bank can now be developed. PMID:26214178

  2. Depression, Pain, and Pain Behavior.

    ERIC Educational Resources Information Center

    Keefe, Francis J.; And Others

    1986-01-01

    Examined the degree to which depression predicted pain and pain behavior. The Beck Depression Inventory was administered to 207 low back pain patients. Depression and physical findings were the most important predictors of pain and pain behavior. Depression proved significant even after controlling for important demographic and medical status…

  3. Depression, Pain, and Pain Behavior.

    ERIC Educational Resources Information Center

    Keefe, Francis J.; And Others

    1986-01-01

    Examined the degree to which depression predicted pain and pain behavior. The Beck Depression Inventory was administered to 207 low back pain patients. Depression and physical findings were the most important predictors of pain and pain behavior. Depression proved significant even after controlling for important demographic and medical status


  4. Options in topical therapies in the management of patients with acute pain.

    PubMed

    McCarberg, Bill; D'Arcy, Yvonne

    2013-07-01

    The traditional cornerstones of analgesic therapy for patients with acute pain have been oral therapies; however, all oral agents exhibit a variety of potentially dose-limiting or intolerable adverse effects in patients. Elderly patients and those with concomitant conditions already being managed with multiple systemic drugs may be particularly susceptible to systemic toxicities with oral analgesic therapies. Topical agents offer an alternative to oral modalities and can effectively treat patients with acute pain while offering lower systemic absorption and conferring little risk of systemic toxicity. The objective of this article is to review the therapeutic usefulness of available topical therapies in their most thoroughly investigated applications, the treatment of patients with acute musculoskeletal and herpetic pain. For example, although heating pads/wraps and cold packs are widely used to alleviate pain associated with sprains, strains, and contusions, evidence of the effectiveness of these methods is lacking. However, there are sufficient data supporting the use of various topical formulations of nonsteroidal anti-inflammatory drugs (NSAIDs) for these indications (ketoprofen gel or patch, ibuprofen gel or cream, and diclofenac gel or patch), and demonstrating markedly less patient risk of systemic toxicity than is associated with oral NSAID therapy. A ketoprofen patch was shown to be effective and well tolerated in the treatment of patients with tendinopathies. In the treatment of acute neck or low back pain, cold and heat therapies have demonstrated limited effectiveness for patients, and the efficacy of topical NSAIDs has not been established. Use of topical NSAID therapy has been useful in reducing acute-phase herpes zoster pain, and the lidocaine 5% patch has been shown to reduce acute herpetic pain intensity once lesions have healed (the patch cannot be applied to open skin lesions). Topical analgesics represent an alternative treatment modality for patients experiencing acute pain who cannot or choose not to take oral therapies. PMID:24547600

  5. Micronized Palmitoylethanolamide Reduces the Symptoms of Neuropathic Pain in Diabetic Patients

    PubMed Central

    Schifilliti, Chiara; Cucinotta, Lelio; Fedele, Viviana; Ingegnosi, Carmela; Luca, Salvatore; Leotta, Carmelo

    2014-01-01

    The present study evaluated the effectiveness of micronized palmitoylethanolamide (PEA-m) treatment in reducing the painful symptoms experienced by diabetic patients with peripheral neuropathy. PEA-m, a fatty acid amide of the N-acylethanolamine family, was administered (300 mg twice daily) to 30 diabetic patients suffering from painful diabetic neuropathy. Before treatment start, after 30 and 60 days the following parameters were assessed: painful symptoms of diabetic peripheral neuropathy using the Michigan Neuropathy Screening instrument; intensity of symptoms characteristic of diabetic neuropathic pain by the Total Symptom Score; and intensity of different subcategories of neuropathic pain by the Neuropathic Pain Symptoms Inventory. Hematological and blood chemistry tests to evaluate metabolic control and safety were also performed. Statistical analysis (ANOVA) indicated a highly significant reduction in pain severity (P < 0.0001) and related symptoms (P < 0.0001) evaluated by Michigan Neuropathy Screening instrument, Total Symptom Score, and Neuropathic Pain Symptoms Inventory. Hematological and urine analyses did not reveal any alterations associated with PEA-m treatment, and no serious adverse events were reported. These results suggest that PEA-m could be considered as a promising and well-tolerated new treatment for symptomatology experienced by diabetic patients suffering from peripheral neuropathy. PMID:24804094

  6. Drawing Feat.

    ERIC Educational Resources Information Center

    Greenman, Geri

    2000-01-01

    Describes an art activity for a beginning drawing class in which students draw pictures of feet using either a foot model or their own feet. Explains three choices of papers and techniques that could be used for the assignment. (CMK)

  7. Identifying specific profiles in patients with different degrees of painful knee osteoarthritis based on serological biochemical and mechanistic pain biomarkers: a diagnostic approach based on cluster analysis.

    PubMed

    Egsgaard, Line Lindhardt; Eskehave, Thomas Navndrup; Bay-Jensen, Anne C; Hoeck, Hans Christian; Arendt-Nielsen, Lars

    2015-01-01

    Biochemical and pain biomarkers can be applied to patients with painful osteoarthritis profiles and may provide more details compared with conventional clinical tools. The aim of this study was to identify an optimal combination of biochemical and pain biomarkers for classification of patients with different degrees of knee pain and joint damage. Such profiling may provide new diagnostic and therapeutic options. A total of 216 patients with different degrees of knee pain (maximal pain during the last 24 hours rated on a visual analog scale [VAS]) (VAS 0-100) and 64 controls (VAS 0-9) were recruited. Patients were separated into 3 groups: VAS 10 to 39 (N = 81), VAS 40 to 69 (N = 70), and VAS 70 to 100 (N = 65). Pressure pain thresholds, temporal summation to pressure stimuli, and conditioning pain modulation were measured from the peripatellar and extrasegmental sites. Biochemical markers indicative for autoinflammation and immunity (VICM, CRP, and CRPM), synovial inflammation (CIIIM), cartilage loss (CIIM), and bone degradation (CIM) were analyzed. WOMAC, Lequesne, and pain catastrophizing scores were collected. Principal component analysis was applied to select the optimal variable subset, and cluster analysis was applied to this subset to create distinctly different knee pain profiles. Four distinct knee pain profiles were identified: profile A (N = 27), profile B (N = 59), profile C (N = 85), and profile D (N = 41). Each knee pain profile had a unique combination of biochemical markers, pain biomarkers, physical impairments, and psychological factors that may provide the basis for mechanism-based diagnosis, individualized treatment, and selection of patients for clinical trials evaluating analgesic compounds. These results introduce a new profiling for knee OA and should be regarded as preliminary. PMID:25599306

  8. The Dutch patients' perspective on oculopharyngeal muscular dystrophy: A questionnaire study on fatigue, pain and impairments.

    PubMed

    van der Sluijs, Barbara M; Knoop, Hans; Bleijenberg, Gijs; van Engelen, Baziel G M; Voermans, Nicol C

    2016-03-01

    Research on oculopharyngeal muscular dystrophy focuses mainly on genetic and pathophysiological aspects. Clinically, oculopharyngeal muscular dystrophy is often considered as a disease with a relatively mild initial disease course with no or only mild functional disabilities. However the occurrence of fatigue, pain and functional impairments other than dysphagia has never been studied systematically. The aim of this study is therefore to assess the prevalence of fatigue, pain, and functional limitations, and the social participation and psychological well-being of oculopharyngeal muscular dystrophy patients. We performed a questionnaire study on fatigue, pain, functional impairments, social participation and psychological distress in 35 genetically confirmed oculopharyngeal muscular dystrophy patients with an average disease duration of 11.6 years. We showed that 19 (54%) of the patients experienced severe fatigue and also 19 (54%) experienced pain. Limitations in daily life activities and social participation were detected in 33 (94%) of the patients. Many patients reported pelvic girdle weakness and limitations in ambulation. Fatigue severity was related to functional impairments, while pain and disease duration were not. Psychological distress was not different from healthy adults. In conclusion, fatigue and pain are present among approximately half of the patients, and almost all patients are impaired in daily life activities, social participation and ambulation. These data should be taken into account in symptomatic management of oculopharyngeal muscular dystrophy. PMID:26948710

  9. Is Response to Radiotherapy in Patients Related to the Severity of Pretreatment Pain?

    SciTech Connect

    Kirou-Mauro, Andrea; Hird, Amanda; Wong, Jennifer; Sinclair, Emily; Barnes, Elizabeth A.; Tsao, May; Danjoux, Cyril; Chow, Edward

    2008-07-15

    Purpose: The primary objective of this study was to determine whether there is a relationship between the severity of pretreatment pain and response to palliative radiotherapy (RT) for painful bone metastases. Methods and Materials: The database for patients with bone metastases seen at the Rapid Response Radiotherapy Program at the Odette Cancer Center from 1999 to 2006 was analyzed. The proportion of patients with mild (scores 1-4), moderate (scores 5-6), or severe (scores 7-10) pain at baseline who experienced a complete response, partial response, stable response, or progressive response after palliative RT was determined according to International Bone Metastases Consensus definitions. Results: During the 7-year study period 1,053 patients received palliative radiation for bone metastases. The median age was 68 years and the median Karnofsky performance status was 70. Of the patients, 53% had a complete or partial response at 1 month, 52% at 2 months, and 54% at 3 months post-RT. Conclusions: There was no significant difference in terms of the proportion of responders (patients with complete or partial response) and nonresponders in terms of painful bone metastases among patients presenting with mild, moderate, or severe pain. Patients with moderate pain should be referred for palliative RT.

  10. Management of Pain and Quality of Life in Patients with Chronic Kidney Disease Undergoing Hemodialysis.

    PubMed

    Zyga, Sofia; Alikari, Victoria; Sachlas, Athanasios; Stathoulis, John; Aroni, Adamantia; Theofilou, Paraskevi; Panoutsopoulos, Georgios

    2015-10-01

    An important dimension that influences the quality of life of hemodialysis patients is the pain they experience. Quality of life and self-efficacy in pain can play an important role in chronic kidney disease and treatment outcomes. The purpose of the study was to examine self-efficacy in pain and quality of life among patients with end stage renal disease undergoing hemodialysis. Between April 2013 and June 2013, 224 hemodialysis patients completed the Missoula-VITAS Quality of Life Index-15 and the Pain Self-Efficacy Questionnaire. The study was conducted in four dialysis units in hospitals of the Peloponnese region. Sociodemographic data of patients and their individual medical history were recorded. Statistical analysis was performed using SPSS version 19. The more effective the self-efficacy in pain, the lower the quality of life enjoyed by hemodialysis patients. The majority of respondents described the overall quality of life as "moderate," while the self-efficacy in pain depended on comorbidity or complications that accompany the process of hemodialysis. The findings of this study can be used in the development and improvement of health services for the management of patients. Healthcare professionals should understand the concerns and treat the symptoms of patients that affect quality of life, providing thereby holistic health care. PMID:26162558

  11. The influence of semantic priming on event-related potentials to painful laser-heat stimuli in migraine patients.

    PubMed

    Weiss, Thomas; Miltner, Wolfgang H R; Dillmann, Jennifer

    2003-04-10

    We investigated the effects of different semantic primes on the processing of painful stimuli in migraine patients. For prime stimuli, descriptors of three categories were used: somatosensory pain-related, affective pain-related, and neutral adjectives. While migraine patients (n = 17) processed these primes, a painful laser-heat stimulus was applied to the dorsum of the left hand. Laser-evoked potentials (LEPs) were recorded and pain intensity ratings were obtained after each single laser stimulus. Pain thresholds were significantly lower in patients than in control subjects. LEP amplitudes were also significantly smaller in patients than in controls, but this effect could be explained by differences in applied stimulus intensity. Within the group of migraine patients, LEP amplitudes at 300 ms post laser stimulus and N2-P2 peak-to-peak amplitudes were significantly enlarged when applied while subjects processed pain-related as compared to non-pain-related primes, i.e. patients showed a pattern of priming effect similar to that of the control group. Additionally, patients recognised more affective words than control subjects, and affective pain-related primes tended to enhance the P2 amplitude of LEP more than somatosensory pain-related primes. It is suggested that pain-related semantic primes might pre-activate neural networks subserving pain memory and pain processing. PMID:12668255

  12. Pain management in head and neck cancer patients undergoing chemo-radiotherapy: Clinical practical recommendations.

    PubMed

    Mirabile, A; Airoldi, M; Ripamonti, C; Bolner, A; Murphy, B; Russi, E; Numico, G; Licitra, L; Bossi, P

    2016-03-01

    Pain in head and neck cancer represents a major issue, before, during and after the oncological treatments. The most frequent cause of pain is chemo/radiation related oral mucositis, which involves 80% of the patients and worsens their quality of life inhibiting speaking, eating, drinking or swallowing and sometimes reducing the treatment compliance, the maximum dose intensity and thus the potential efficacy of treatment. Nevertheless pain is still often under estimated and undertreated. An Italian multidisciplinary group of head and neck cancer specialists met with the aim of reaching a consensus on pain management in this setting. The Delphi Appropriateness method was used for the consensus. External expert reviewers evaluated the final statements. The paper contains 30 consensus-reached statements about pain management in HNC patients and offers a review of recent literature in these topics. PMID:26712589

  13. New Insights Found in Pain Processing and Sleep Disturbance Among Rheumatoid Arthritis Patients

    MedlinePLUS

    ... historical) New Insights Found in Pain Processing and Sleep Disturbance Among Rheumatoid Arthritis Patients People with rheumatoid ... in the journal Arthritis and Rheumatism. In addition, sleep disruptions, which are common among people with RA, ...

  14. The effect of reflexology applied on haemodialysis patients with fatigue, pain and cramps.

    PubMed

    Ozdemir, Gülistan; Ovayolu, Nimet; Ovayolu, Ozlem

    2013-06-01

    The research was conducted to evaluate the effect of foot reflexology on fatigue, pain and cramps in haemodialysis patients. The sample consisted of 80 patients in total, 40 intervention and 40 control patients, receiving treatment in the haemodialysis units of two institutions. Data were collected by using a questionnaire, Piper Fatigue Scale and visual analogue scale for measuring the severity of cramp and pain. The intervention group received reflexology treatment for 1 week in three sessions following haemodialysis, each session lasting approximately 30?min. Parametric and non-parametric tests were used in data analysis. It was determined that reflexology reduced the fatigue subscale scores and total scale scores as well as pain and cramp mean scores in the intervention group. The research results revealed that the severity of fatigue, pain and cramp decreased in patients receiving reflexology. PMID:23730858

  15. Psychological Disturbance and Life Event Differences Among Patients With Low Back Pain.

    ERIC Educational Resources Information Center

    Leavitt, Frank; And Others

    1980-01-01

    Results of this study emphasized the importance of considering psychological disturbance in assessing functional components of low back pain. Psychologically disturbed patients had higher life-event scores regardless of organic pathology. (Author/BEF)

  16. Effect of Music on Postoperative Pain in Patients Under Open Heart Surgery

    PubMed Central

    Mirbagher Ajorpaz, Neda; Mohammadi, Abouzar; Najaran, Hamed; Khazaei, Shala

    2014-01-01

    Background: Music, as a non-pharmacological and inexpensive nursing intervention, can be used easily as a complementary technique in reducing pain along with other methods. While some studies have demonstrated pain to decrease after music, others found music to be ineffective on pain. Objectives: The aim of this study was to investigate the effect of music on postoperative pain in patients under open heart surgery. Patients and Methods: A quasi-experimental study was performed on 60 patients under open heart surgery referred to ICU of Shahid Beheshti hospital in Kashan city. Patients were randomly divided into two groups including experimental and control groups. Patients in music group listened to nonverbal music for 30 minutes after surgery by headphones. The control group did not receive any intervention other than routine care. Before and after intervention, pain intensity was measured and recorded by visual analog scale in two groups. Data was analyzed using Chi-Square and t-tests. Results: Before intervention, the mean of pain intensity was 6.32 ± 0.21 and 6.10 ± 0.21 for experimental and control groups, respectively; and the difference was not significant (P = 0.21). After intervention, the mean of pain intensity was 3.11 ± 0.12 and 5.81 ± 0.38 for experimental and control groups, respectively; and the difference was significant (P = 0.04). Conclusions: Listening to the relaxant music can reduce postoperative pain. It is suggested that relaxant music be used as a complementary method in patients in order to reduce prospective pain. PMID:25699280

  17. Self-reported interoceptive awareness in primary care patients with past or current low back pain

    PubMed Central

    Mehling, Wolf E; Daubenmier, Jennifer; Price, Cynthia J; Acree, Mike; Bartmess, Elizabeth; Stewart, Anita L

    2013-01-01

    Background Mind–body interactions play a major role in the prognosis of chronic pain, and mind–body therapies such as meditation, yoga, Tai Chi, and Feldenkrais presumably provide benefits for pain patients. The Multidimensional Assessment of Interoceptive Awareness (MAIA) scales, designed to measure key aspects of mind–body interaction, were developed and validated with individuals practicing mind–body therapies, but have never been used in pain patients. Methods We administered the MAIA to primary care patients with past or current low back pain and explored differences in the performance of the MAIA scales between this and the original validation sample. We compared scale means, exploratory item cluster and confirmatory factor analyses, scale–scale correlations, and internal-consistency reliability between the two samples and explored correlations with validity measures. Results Responses were analyzed from 435 patients, of whom 40% reported current pain. Cross-sectional comparison between the two groups showed marked differences in eight aspects of interoceptive awareness. Factor and cluster analyses generally confirmed the conceptual model with its eight dimensions in a pain population. Correlations with validity measures were in the expected direction. Internal-consistency reliability was good for six of eight MAIA scales. We provided specific suggestions for their further development. Conclusion Self-reported aspects of interoceptive awareness differ between primary care patients with past or current low back pain and mind–body trained individuals, suggesting further research is warranted on the question whether mind–body therapies can alter interoceptive attentional styles with pain. The MAIA may be useful in assessing changes in aspects of interoceptive awareness and in exploring the mechanism of action in trials of mind–body interventions in pain patients. PMID:23766657

  18. Ultrasound detection of a renal mass in a patient with flank pain and hematuria.

    PubMed

    Marzec, Karl; Mailhot, Thomas; Perera, Phillips

    2013-03-01

    Flank pain with hematuria is a common chief complaint in the emergency department (ED). Patients are often diagnosed with renal calculi or pyelonephritis and discharged with analgesics or antibiotics and follow-up. This case study describes a patient who presented to the ED with a 1 week history of flank pain and hematuria and was subsequently found to have a large renal mass on bedside ultrasound. PMID:23599845

  19. PAin SoluTions In the Emergency Setting (PASTIES)—patient controlled analgesia versus routine care in emergency department patients with pain from traumatic injuries: randomised trial

    PubMed Central

    Rockett, Mark; Squire, Rosalyn; Hayward, Chris; Ewings, Paul; Barton, Andy; Pritchard, Colin; Eyre, Victoria; Cocking, Laura; Benger, Jonathan

    2015-01-01

    Objective To determine whether patient controlled analgesia (PCA) is better than routine care in patients presenting to emergency departments with moderate to severe pain from traumatic injuries. Design Pragmatic, multicentre, parallel group, randomised controlled trial. Setting Five English hospitals. Participants 200 adults (71% (n=142) male), aged 18 to 75 years, who presented to the emergency department requiring intravenous opioid analgesia for the treatment of moderate to severe pain from traumatic injuries and were expected to be admitted to hospital for at least 12 hours. Interventions PCA (n=99) or nurse titrated analgesia (treatment as usual; n=101). Main outcome measures The primary outcome was total pain experienced over the 12 hour study period, derived by standardised area under the curve (scaled from 0 to 100) of each participant’s hourly pain scores, captured using a visual analogue scale. Pre-specified secondary outcomes included total morphine use, percentage of study period in moderate/severe pain, percentage of study period asleep, length of hospital stay, and satisfaction with pain management. Results 200 participants were included in the primary analyses. Mean total pain experienced was 47.2 (SD 21.9) for the treatment as usual group and 44.0 (24.0) for the PCA group. Adjusted analyses indicated slightly (but not statistically significantly) lower total pain experienced in the PCA group than in the routine care group (mean difference 2.7, 95% confidence interval ?2.4 to 7.8). Participants allocated to PCA used more morphine in total than did participants in the treatment as usual group (mean 44.3 (23.2) v 27.2 (18.2) mg; mean difference 17.0, 11.3 to 22.7). PCA participants spent, on average, less time in moderate/severe pain (36.2% (31.0) v 44.1% (31.6)), but the difference was not statistically significant. A higher proportion of PCA participants reported being perfectly or very satisfied compared with the treatment as usual group (86% (78/91) v 76% (74/98)), but this was also not statistically significant. Conclusions PCA provided no statistically significant reduction in pain compared with routine care for emergency department patients with traumatic injuries. Trial registration European Clinical Trials Database EudraCT2011-000194-31; Current Controlled Trials ISRCTN25343280. PMID:26094763

  20. Spontaneous Iliopsoas Tendon Rupture: An Uncommon Cause of Hip Pain in Elderly Patients.

    PubMed

    Emam, Mohammed; Farmakidis, Constantine; Lee, Se Won; Wainapel, Stanley F

    2016-01-01

    Iliopsoas tendon rupture is a relatively rare cause of hip pain. It has been described in children, in adults with pathologic avulsion secondary to metastatic disease, and in older individuals with multiple chronic illnesses. We are reporting a case of apparently spontaneous iliopsoas tendon rupture that occurred in an elderly patient presenting with severe debilitating hip pain whose etiology initially was unrecognized. Magnetic resonance imaging of the hip confirmed the diagnosis. This case highlights the importance of considering iliopsoas tear in the differential diagnosis of unexplained acute onset hip pain and illustrates that geriatric patients with this condition can be treated conservatively with satisfactory functional outcome. PMID:26226208

  1. [A comparison of multimodal programmes of patient education in the rehabilitation of chronic low back pain].

    PubMed

    Morfeld, M; KĂŒch, D; Greitemann, B; Dibbelt, S; Salewski, C; Franke, G H; Liebenau, A

    2010-04-01

    There is growing evidence for the effectiveness of multimodal intervention concepts for chronic low back pain in the international literature, and accordingly several German rehabilitation programmes for the treatment of chronic low back pain patients have been developed. Focus of this paper is to describe and compare frequently used German multimodal intervention programmes for in- and outpatient rehabilitation of patients with chronic low back pain. Programmes were chosen by searching the most relevant online resources as well as the online pages of Deutsche Rentenversicherung and Zentrum Patientenschulung during September 2008. Keywords guiding the search were: Patientenschulung, RĂŒckenschmerzen, Manual, psychologische multimodale Interventionskonzepte, Rehabilitationsprogramm, psychology, intervention, low back pain, manual and therapy. By this means, six manually supported multimodal rehabilitation programmes for the in- and outpatient therapy of patients with chronic back pain could be identified: Göttinger RĂŒcken-Intensiv-Programm (GRIP), the psychological programme for chronic head- and low back pain, the MĂŒnchner RĂŒcken-Intensiv-Programm (MRIP), Back to Balance, Arbeiten und Leben--Back to Balance (ALEBABA) und RĂŒckenfit: Lebenslust statt Krankheitsfrust. These programmes are depicted and compared with regard to their potentials and limitations in supporting the rehabilitation process of patients with chronic low back pain. While comparing the programmes, a number of similarities between them can be detected, as well as pronounced differences, e. g., regarding settings and complexity. In most programmes, lack of appropriate evaluation studies and lack of aftercare turn out to be critical aspects. PMID:20446189

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

    PubMed

    Kim, Jin Young; Kwag, Kwang Il

    2016-01-01

    [Purpose] The purpose of this study was to investigate clinical effects of deep cervical flexor (DCF) muscles exercise on pain, Neck Disability Index (NDI), and neck and shoulder postures in patients with chronic neck pain. [Subjects and Methods] Twenty-eight patients with chronic neck pain were randomly assigned into either the general strengthening exercise (GSE) group or the DCF activation group as control and experimental groups, respectively. All exercises were performed three times per week over 4 weeks. NDI and numeric rating scale (NRS) score for pain were determined and radiological assessment of neck-shoulder postures (head tilt angle [HTA], neck flexion angle [NFA], and forward shoulder angle [FSA]) was performed before (baseline), 4 weeks after, and 8 weeks after exercise in order to directly compare the exercise effects between the groups. [Results] In the DCF group, the NDI, NRS score, and neck-shoulder postures (analyzed by uisng HTA, NFA, and FSA) were significantly improved. [Conclusion] DCF activation exercise was effective to alleviate pain, recover functions, and correct forward head posture in the patients with neck pain. Hence, it might be recommended in the rehabilitation of patients with chronic neck pain. PMID:26957772

  3. The efficacy of a multidisciplinary group program for patients with refractory chronic pain

    PubMed Central

    Inoue, Masayuki; Inoue, Shinsuke; Ikemoto, Tatsunori; Arai, Young-Chang P; Nakata, Masatoshi; Miyazaki, Atsuko; Nishihara, Makoto; Kawai, Takashi; Hatakeyama, Noboru; Yamaguchi, Setsuko; Shimo, Kazuhiro; Miyagawa, Hirofumi; Hasegawa, Tomomi; Sakurai, Hiroki; Hasegawa, Yoshinobu; Ohmichi, Yusuke; Ushida, Takahiro

    2014-01-01

    BACKGROUND: Chronic pain is a major problem because it can result in not only a reduction in activities of daily living and quality of life but also requires initiation of social assistance. Seeking only to eliminate pain itself would appear to be too narrow an objective, in addition to often being unachievable; therefore, a multifaceted, comprehensive approach with multiple objectives is needed. OBJECTIVE: To describe the effects of a program (the ‘Chronic Pain Class’) offering cognitive behavioural therapy to small groups of individuals with refractory chronic pain in Japan. Exercise was an important feature of the program. METHODS: A total of 46 patients who were experiencing treatment difficulties and decreased activity participated in the program. The programs were conducted in groups of five to seven patients who met weekly for nine weeks. Weekly sessions, which were approximately 2 h in duration, combined lectures with exercise. Several measures related to pain and physical function were administered at the beginning and the conclusion of the program. RESULTS: Nine patients dropped out during the program. A number of measures (eg, pain intensity, disability, catastrophizing thoughts) showed significant improvements after intervention (P<0.002 after Bonferroni correction). Furthermore, most measures of physical function showed substantial improvement, especially seated forward bends, zig-zag walking, self-care and 6 min walk test (P<0.001). CONCLUSION: The results of the present study provide evidence that a combination of cognitive behavioural therapy and exercise should be recommended to patients with refractory chronic pain. PMID:24992454

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

    PubMed Central

    Kim, Jin Young; Kwag, Kwang Il

    2016-01-01

    [Purpose] The purpose of this study was to investigate clinical effects of deep cervical flexor (DCF) muscles exercise on pain, Neck Disability Index (NDI), and neck and shoulder postures in patients with chronic neck pain. [Subjects and Methods] Twenty-eight patients with chronic neck pain were randomly assigned into either the general strengthening exercise (GSE) group or the DCF activation group as control and experimental groups, respectively. All exercises were performed three times per week over 4 weeks. NDI and numeric rating scale (NRS) score for pain were determined and radiological assessment of neck-shoulder postures (head tilt angle [HTA], neck flexion angle [NFA], and forward shoulder angle [FSA]) was performed before (baseline), 4 weeks after, and 8 weeks after exercise in order to directly compare the exercise effects between the groups. [Results] In the DCF group, the NDI, NRS score, and neck-shoulder postures (analyzed by uisng HTA, NFA, and FSA) were significantly improved. [Conclusion] DCF activation exercise was effective to alleviate pain, recover functions, and correct forward head posture in the patients with neck pain. Hence, it might be recommended in the rehabilitation of patients with chronic neck pain. PMID:26957772

  5. Neuropathic Pain and Psychological Morbidity in Patients with Treated Leprosy: A Cross-Sectional Prevalence Study in Mumbai

    PubMed Central

    Lasry-Levy, Estrella; Hietaharju, Aki; Pai, Vivek; Ganapati, Ramaswamy; Rice, Andrew S. C.; Haanpää, Maija; Lockwood, Diana N. J.

    2011-01-01

    Background Neuropathic pain has been little studied in leprosy. We assessed the prevalence and clinical characteristics of neuropathic pain and the validity of the Douleur Neuropathique 4 questionnaire as a screening tool for neuropathic pain in patients with treated leprosy. The association of neuropathic pain with psychological morbidity was also evaluated. Methodology/Principal Findings Adult patients who had completed multi-drug therapy for leprosy were recruited from several Bombay Leprosy Project clinics. Clinical neurological examination, assessment of leprosy affected skin and nerves and pain evaluation were performed for all patients. Patients completed the Douleur Neuropathique 4 and the 12-item General Health Questionnaire to identify neuropathic pain and psychological morbidity. Conclusions/Significance One hundred and one patients were recruited, and 22 (21.8%) had neuropathic pain. The main sensory symptoms were numbness (86.4%), tingling (68.2%), hypoesthesia to touch (81.2%) and pinprick (72.7%). Neuropathic pain was associated with nerve enlargement and tenderness, painful skin lesions and with psychological morbidity. The Douleur Neuropathique 4 had a sensitivity of 100% and specificity of 92% in diagnosing neuropathic pain. The Douleur Neuropathique 4 is a simple tool for the screening of neuropathic pain in leprosy patients. Psychological morbidity was detected in 15% of the patients and 41% of the patients with neuropathic pain had psychological morbidity. PMID:21408111

  6. Distress correlates with the degree of chest pain: a description of patients awaiting revascularisation.

    PubMed Central

    Bengtson, A.; Herlitz, J.; Karlsson, T.; Hjalmarson, A.

    1996-01-01

    AIM: To describe various symptoms other than pain among consecutive patients on the waiting list for possible coronary revascularisation in relation to estimated severity of chest pain. DESIGN: All patients were sent a postal questionnaire for symptom evaluation. SUBJECTS: All patients in western Sweden on the waiting list in September 1990 who had been referred for coronary angiography or coronary revascularisation (n = 904). RESULTS: 88% of the patients reported chest pain symptoms that limited their daily activities to a greater or lesser degree. Various psychological symptoms including anxiety and depression were strongly associated with the severity of pain (P < 0.001), as were sleep disturbances (P < 0.001), and dyspnoea and various psychosomatic symptoms (P < 0.001). Nevertheless only 44% of the patients reported chest pain as the major disruptive symptom, whereas the remaining 56% reported uncertainty about the future, fear, or unspecified symptoms as being the most disturbing. CONCLUSIONS: In a consecutive series of patients on the waiting list for possible coronary revascularisation, half the participants reported that uncertainty and fear were more disturbing than chest pain. PMID:8800988

  7. Evaluation of Mental Health and Physical Pain in Patients with ?-Thalassemia Major in Northern Greece.

    PubMed

    Vlachaki, Efthymia; Neokleous, Nikolaos; Paspali, Dimitra; Vetsiou, Evaggelia; Onoufriadis, Elias; Sousos, Nicolaos; Hissan, Sofia; Vakalopoulou, Sofia; Garypidou, Vasilia; Boura, Panagiota

    2015-01-01

    ?-Thalassemia major (?-TM) is a chronic, genetic blood disorder. Patients are considered to be vulnerable to emotional and behavioral problems. The aim of this study was to assess mental health and somatic pain of patients with homozygous ?-TM, who are systematically transfused in our unit. In this survey, 54 adult patients were studied. The general health questionnaire (GHQ-28) was used as mental health assessment model aimed at detecting mental disorders. The model of Binary was used as scoring method of GHQ-28. Overall ratings below 5 indicate no psychiatric problem, while a total score over or equal to 5 indicated the likelihood of a psychiatric disorder. The visual analogue scale (VAS) of pain was used as model for pain evaluation. One out of four examined patients who presented with a GHQ-28 score above or equal to 5 had an increased chance of being diagnosed with a psychiatric disorder. Concerning the pain, the majority of the studied patients scored between 1 and 3, meaning that they were feeling mild pain. There was no statistical significant correlation between age and GHQ-28 score. There was a statistical significant correlation between age and somatic symptoms (p?=?0.026), anxiety and somatic symptoms (0.004) as well as anxiety and depression (p?=?0.022). Thalassemic patients tend to be diagnosed with psychiatric disorders and it seems that they do not feel severe pain. More quantitative and comprehensive studies have to be conducted in order to estimate specific effective factors in psychosocial health. PMID:25976778

  8. Intrathecal morphine in younger patients for postoperative pain following spinal fusion.

    PubMed

    Blackman, R G; Reynolds, J; Shively, J

    1991-09-01

    Intrathecal morphine in an average dose of 0.01 mg/kg was given to 33 patients between ages 11 and 16 years who had spinal arthrodesis for idiopathic scoliosis. The morphine was administered intrathecally as a 10 cc bolus at the conclusion of the arthrodesis, but before closure. The goal was to study safety in terms of respiratory depression and pain relief. Respirations occurred spontaneously in 30 of the 33 patients within 15 minutes of cessation of anesthesia. Respiratory depression occurred in five patients, four of whom had arterial blood pCO2 levels greater than 60 mm Hg. Thirty-one patients had relief of pain for 8 to greater than 40 hours, averaging 18 hours. Two patients had no noticeable pain relief. There appeared to be no relation between dose and pain relief in this limited dose range. We were unable to duplicate the long duration of pain relief reported elsewhere. We also were unable to decrease the side effects of respiratory depression and nausea to a level reported by others. It may be that the 10 cc bolus injected intrathecally circulates to the brain and ventricles faster than desired, or that factors relating to type of anesthesia or dose need to be considered. Low-dose intrathecal morphine does provide noticeable pain relief in younger patients undergoing spinal fusion. The side effects of nausea and respiratory depression can be managed safely with medication. PMID:1926302

  9. Outcomes of Prolotherapy in Chondromalacia Patella Patients: Improvements in Pain Level and Function

    PubMed Central

    Hauser, Ross A.; Sprague, Ingrid Schaefer

    2014-01-01

    We retrospectively evaluated the effectiveness of prolotherapy in resolving pain, stiffness, and crepitus, and improving physical activity in consecutive chondromalacia patients from February 2008 to September 2009. Sixty-nine knees that received prolotherapy in 61 patients (33 female and 36 male) who were 18–82 years old (average, 47.2 years) were enrolled. Patients received 24 prolotherapy injections (15% dextrose, 0.1% procaine, and 10% sarapin) with a total of 40 cc in the anterior knee. At least 6 weeks after their last prolotherapy session, patients provided self-evaluation of knee pain upon rest, activities of daily living (ADL) and exercise, range of motion (ROM), stiffness, and crepitus. Symptom severity, sustained improvement of symptoms, number of pain pills needed, and patient satisfaction before treatment and improvement after treatment were recorded. Following prolotherapy, patients experienced statistically significant decreases in pain at rest, during ADL, and exercise. Stiffness and crepitus decreased after prolotherapy, and ROM increased. Patients reported improved walking ability and exercise ability after prolotherapy. For daily pain level, ROM, daily stiffness, crepitus, and walking and exercise ability, sustained improvement of over 75% was reported by 85% of patients. Fewer patients required pain medication. No side effects of prolotherapy were noted. The average length of time from last prolotherapy session was 14.7 months (range, 6 months to 8 years). Only 3 of 16 knees were still recommended for surgery after prolotherapy. Prolotherapy ameliorates chondromalacia patella symptoms and improves physical ability. Patients experience long-term improvement without requiring pain medications. Prolotherapy should be considered a first-line, conservative therapy for chondromalacia patella. PMID:24596471

  10. Short-Term Effects of Patellar Kinesio Taping on Pain and Hop Function in Patients With Patellofemoral Pain Syndrome

    PubMed Central

    Freedman, Scott R.; Brody, Lori Thein; Rosenthal, Michael; Wise, Justin C.

    2014-01-01

    Background: Patellofemoral pain syndrome (PFPS) is the most prevalent orthopaedic condition among physically active individuals, contributing to an estimated 30% to 40% of all sports medicine visits. Techniques using Kinesio Tape (KT) have become increasingly popular; however, there has been scant research supporting its use on patients with PFPS. Hypothesis: The use of patellar KT to treat patients with PFPS will provide a statistically significant improvement in short-term pain and single-leg hop measures as compared with sham placement of KT. Study Design: Nonrandomized controlled clinical trial with repeated-measures design. Level of Evidence: Level 3. Methods: Forty-nine subjects (41 females, 8 males) between the ages of 12 and 24 years with PFPS participated in this study. Each subject underwent patellar kinesio taping with both experimental and sham applications while completing 4 functional tasks and the single-leg triple jump test (STJT). The treatment outcome was analyzed using separate paired t tests to measure improvement on a numeric pain rating scale. A 2-way, 2 × 2 analysis of variance was used to analyze the relationship between taping condition (experimental vs sham) and side (involved vs uninvolved) for STJT scores. Results: Separate paired t tests found step-up, step-down, and STJT pain improvement statistically significant between taping conditions. The 2-factor analysis of variance yielded a significant main effect for taping condition, but the main effect for side was not significant. The interaction between taping condition and side was significant. This showed there was little change in STJT distance between repeated measures performed on the untaped, noninvolved leg. However, subjects’ STJT distances were significantly greater for the experimental KT application than the sham application for the involved side. Conclusion: Patellar kinesio taping provided an immediate and statistically significant improvement in pain and single-leg hop function in patients with PFPS when compared with a sham application. However, improvement in STJT scores did not surpass the minimally detectable change value, and therefore, the clinical effectiveness of KT for improving single-leg hop function was not established in the current study. Clinical Relevance: Kinesio Tape provides a viable, short-term method to control pain. PMID:24982700

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

    PubMed Central

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

    2011-01-01

    Background Clinical guidelines advocate the routine identification of depressive symptoms for patients with pain in the lumbar or cervical spine, but not for other anatomical regions. Objective The purpose of this study was to investigate the prevalence and impact of depressive symptoms for patients with musculoskeletal pain across different anatomical regions. Design This was a prospective, associational study. Methods Demographic, clinical, depressive symptom (Symptom Checklist 90–Revised), and outcome data were collected by self-report from a convenience sample of 8,304 patients. Frequency of severe depressive symptoms was assessed by chi-square analysis for demographic and clinical variables. An analysis of variance examined the influence of depressive symptoms and anatomical region on intake pain intensity and functional status. Separate hierarchical multiple regression models by anatomical region examined the influence of depressive symptoms on clinical outcomes. Results Prevalence of severe depression was higher in women, in industrial and pain clinics, and in patients who reported chronic pain or prior surgery. Lower prevalence rates were found in patients older than 65 years and those who had upper- or lower-extremity pain. Depressive symptoms had a moderate to large effect on pain ratings (Cohen d=0.55–0.87) and a small to large effect on functional status (Cohen d=0.28–0.95). In multivariate analysis, depressive symptoms contributed additional variance to pain intensity and functional status for all anatomical locations, except for discharge values for the cervical region. Conclusions Rates of depressive symptoms varied slightly based on anatomical region of musculoskeletal pain. Depressive symptoms had a consistent detrimental influence on outcomes, except on discharge scores for the cervical anatomical region. Expanding screening recommendations for depressive symptoms to include more anatomical regions may be indicated in physical therapy settings. PMID:21233305

  12. Pain and Body Awareness: Evidence from Brain-Damaged Patients with Delusional Body Ownership

    PubMed Central

    Pia, Lorenzo; Garbarini, Francesca; Fossataro, Carlotta; Fornia, Luca; Berti, Anna

    2013-01-01

    A crucial aspect for the cognitive neuroscience of pain is the interplay between pain perception and body awareness. Here we report a novel neuropsychological condition in which right brain-damaged patients displayed a selective monothematic delusion of body ownership. Specifically, when both their own and the co-experimenter’s left arms were present, these patients claimed that the latter belonged to them. We reasoned that this was an ideal condition to examine whether pain perception can be “referred” to an alien arm subjectively experienced as one’s own. Seventeen patients (11 with, 6 without the delusion), and 10 healthy controls were administered a nociceptive stimulation protocol to assess pain perception. In the OWN condition, participants placed their arms on a table in front of them. In the ALIEN condition, the co-experimenter’s left (or right) arm was placed alongside the participants’ left (or right) arm, respectively. In the OWN condition, left (or right) participants’ hand dorsum were stimulated. In the ALIEN condition, left (or right) co-experimenter’s hand dorsum was stimulated. Participants had to rate the perceived pain on a 0–5 Likert scale (0?=?no pain, 5?=?maximal imaginable pain). Results showed that healthy controls and patients without delusion gave scores higher than zero only when their own hands were stimulated. On the contrary, patients with delusion gave scores higher than zero both when their own hands (left or right) were stimulated and when the co-experimenter’s left hand was stimulated. Our results show that in pathological conditions, a body part of another person can become so deeply embedded in one’s own somatosensory representation to effect the subjective feeling of pain. More in general, our findings are in line with a growing number of evidence emphasizing the role of the special and unique perceptual status of body ownership in giving rise to the phenomenological experience of pain. PMID:23801958

  13. Cervicocephalic kinesthetic sensibility and postural balance in patients with nontraumatic chronic neck pain – a pilot study

    PubMed Central

    Palmgren, Per J; Andreasson, Daniel; Eriksson, Magnus; Hägglund, Andreas

    2009-01-01

    Background Although cervical pain is widespread, most victims are only mildly and occasionally affected. A minority, however, suffer chronic pain and/or functional impairments. Although there is abundant literature regarding nontraumatic neck pain, little focuses on diagnostic criteria. During the last decade, research on neck pain has been designed to evaluate underlying pathophysiological mechanisms, without noteworthy success. Independent researchers have investigated postural balance and cervicocephalic kinesthetic sensibility among patients with chronic neck pain, and have (in most cases) concluded the source of the problem is a reduced ability in the neck's proprioceptive system. Here, we investigated cervicocephalic kinesthetic sensibility and postural balance among patients with nontraumatic chronic neck pain. Methods Ours was a two-group, observational pilot study of patients with complaints of continuous neck pain during the 3 months prior to recruitment. Thirteen patients with chronic neck pain of nontraumatic origin were recruited from an institutional outpatient clinic. Sixteen healthy persons were recruited as a control group. Cervicocephalic kinesthetic sensibility was assessed by exploring head repositioning accuracy and postural balance was measured with computerized static posturography. Results Parameters of cervicocephalic kinesthetic sensibility were not reduced. However, in one of six test movements (flexion), global repositioning errors were significantly larger in the experimental group than in the control group (p < .05). Measurements did not demonstrate any general impaired postural balance, and varied substantially among participants in both groups. Conclusion In patients with nontraumatic chronic neck pain, we found statistically significant global repositioning errors in only one of six test movements. In this cohort, we found no evidence of impaired postural balance. Head repositioning accuracy and computerized static posturography are imperfect measures of functional proprioceptive impairments. Validity of (and procedures for using) these instruments demand further investigation. Trial registration Current Controlled Trials ISRCTN96873990 PMID:19566929

  14. Fear reduction in patients with chronic pain: a learning theory perspective.

    PubMed

    den Hollander, Marlies; de Jong, Jeroen R; Volders, Stéphanie; Goossens, Mariëlle E J B; Smeets, Rob J E M; Vlaeyen, Johan W S

    2010-11-01

    Acute pain informs the individual that there is an imminent threat of body damage, and is associated with the urge to escape and avoid. Fear learning takes place when neutral stimuli receive the propensity to predict the occurrence of pain, and when defensive responses are initiated in anticipation of potential threats to the integrity of the body. Fear-avoidance models have been put forward featuring the role of individual differences in catastrophic interpretations of pain in the modulation of learning and avoidance. Based on extensive literature on fear reduction in anxiety disorders; cognitive-behavioral treatments have been developed and applied to patients with chronic pain reporting substantial pain-related fear. In this article, we discuss mechanisms underlying the acquisition, the assessment and extinction of pain-related fear through the cognitive-behavioral treatment of pain-related fear. Finally, we provide a number of critical notes and directions for future research in the field of chronic pain and pain-related fear. PMID:20977330

  15. The effect of spinal manipulative therapy (SMT) on pain reduction and range of motion in patients with acute unilateral neck pain: a pilot study

    PubMed Central

    Pikula, John R

    1999-01-01

    Objective: This experiment evaluated the response of acute neck pain patients to an intervention utilizing a single manipulation to either a) the same side of pain (ipsilateral) or b) opposite side (contralateral) and compared the results to a placebo group. Design: In this pre-test — post-test study, 36 subjects were randomly allocated to one of the three groups: (1) SMT applied to the same side as the pain (ipsilateral) (2) SMT applied to the side opposite the pain (contralateral) (3) A placebo group receiving only detuned ultrasound therapy Subjects: In a private chiropractic office, patients with acute unilateral neck pain and stiffness were studied. Inclusion criteria included the presence of acute unilateral neck pain, no prior similar history, no history of trauma, and no neurological deficit. Subjects had no previous chiropractic treatment of the cervical spine. Intervention: Patients in the two manipulation groups received a single cervical manipulation. Patients in the placebo group received detuned ultrasound therapy over the area of pain. Main Outcome Measures: There were two outcome measures. Pain intensity was rated on the 100 mm. visual analog scale (VAS) prior to and immediately following the intervention. Pre and Post test measurements of cervical spine range of motion utilizing the CROM instrument were also taken. Results: Degrees of ipsilateral lateral flexion, contralateral flexion, and VAS improved when ipsilateral versus contralateral spinal manipulative therapy was applied. Conclusions: Immediately following a single manipulation to acute neck pain patients there is less pain intensity and a greater range of motion when spinal manipulative therapy is applied to the side of neck pain versus manipulation on the side opposite the pain or to a placebo group.

  16. Bilateral heel pain in a patient with Diamond-Blackfan anaemia.

    PubMed

    Charles, Loren T R; Mehdi, Adil M S; Baker, Dennis; Edwards, Max R

    2015-06-01

    A rare case of bilateral calcaneal stress fractures in a patient with Diamond-Blackfan anaemia is described. This has not been previously reported in the literature. A calcaneal stress fracture is an important differential diagnosis in a patient presenting with heel pain. Bilaterality of symptoms should not exclude this diagnosis and clinicians should be especially vigilant with predisposed patients. PMID:26004126

  17. Patterns and clinical correlates of pain among brain injury patients in critical care assessed with the critical care pain observation tool.

    PubMed

    Lee, Kangim; Oh, Hyunsoo; Suh, Yeonok; Seo, Whasook

    2013-12-01

    This study was conducted to assess the patterns and clinical correlates of acute pain in brain injury patients during the critical care period using the Critical Care Pain Observation Tool (CPOT). Data were collected from 31 brain-injury patients admitted to an intensive care unit (ICU) at a university hospital located in Incheon, Republic of Korea. Glasgow Coma Scale and CPOT scores were assessed on days 1, 3, 6, 9, and 14 after ICU admission. Results showed that temporal changes in pain intensity displayed a consistent pattern in critical care patients with a brain injury during the first 14 days of ICU admission. Mean pain score was highest on day 1, decreased rapidly to reach a minimum on day 3 or 6, and then increased on day 9. In most patients, pain reduced slightly on day 14. Mean CPOT scores were significantly higher in the nonsurgery group than in the surgery group. There was also a nonsignificant trend of higher pain intensity scores among patients with moderate brain injury compared with those with severe injury. CPOT scores immediately after endotracheal suctioning were significantly higher than before endotracheal suctioning, but CPOT scores 20 minutes after suctioning were similar to those before suctioning. The present study may be meaningful in terms of presenting valid clinical information regarding the patterns and characteristics of acute pain in brain injury patients who are often unable to self-report on the presence and intensity of pain. PMID:24315249

  18. Sex Differences in the Medical Care of VA Patients with Chronic Non-Cancer Pain

    PubMed Central

    Weimer, Melissa B.; Macey, Tara A.; Nicolaidis, Christina; Dobscha, Steven K.; Duckart, Jonathan P.; Morasco, Benjamin J.

    2013-01-01

    Objective Despite a growing number of women seeking medical care in the VA system, little is known about the characteristics of their chronic pain or the pain care they receive. This study sought to determine if sex differences are present in the medical care veterans received for chronic pain. Design Retrospective cohort study using VA administrative data. Subjects 17,583 veteran patients with moderate to severe chronic non-cancer pain treated in the Pacific Northwest during 2008. Methods Multivariate logistic regression assessed for sex differences in primary care utilization, prescription of chronic opioid therapy, visits to emergency departments for a pain-related diagnosis, and physical therapy referral. Results Compared to male veterans, female veterans were more often diagnosed with two or more pain conditions and had more of the following pain-related diagnoses: fibromyalgia, low back pain, inflammatory bowel disease, migraine headache, neck or joint pain, and arthritis. After adjustment for demographic characteristics, pain diagnoses, mental health diagnoses, substance use disorders, and medical comorbidity, women had lower odds of being prescribed chronic opioid therapy (AOR 0.67, 95% CI 0.58–0.78), greater odds of visiting an emergency department for a pain-related complaint (AOR 1.40, 95% CI 1.18–1.65), and greater odds of receiving physical therapy (AOR 1.19, 95% CI 1.05–1.33). Primary care utilization was not significantly different between sexes. Conclusions Sex differences are present in the care female veterans receive for chronic pain. Further research is necessary to understand the etiology of the observed differences and their associations with clinical outcomes. PMID:23802846

  19. Stress-Induced Allodynia – Evidence of Increased Pain Sensitivity in Healthy Humans and Patients with Chronic Pain after Experimentally Induced Psychosocial Stress

    PubMed Central

    Crettaz, Benjamin; Marziniak, Martin; Willeke, Peter; Young, Peter; Hellhammer, Dirk; Stumpf, Astrid; Burgmer, Markus

    2013-01-01

    Background Experimental stress has been shown to have analgesic as well as allodynic effect in animals. Despite the obvious negative influence of stress in clinical pain conditions, stress-induced alteration of pain sensitivity has not been tested in humans so far. Therefore, we tested changes of pain sensitivity using an experimental stressor in ten female healthy subjects and 13 female patients with fibromyalgia. Methods Multiple sensory aspects of pain were evaluated in all participants with the help of the quantitative sensory testing protocol before (60 min) and after (10 and 90 min) inducing psychological stress with a standardized psychosocial stress test (“Trier Social Stress Test”). Results Both healthy subjects and patients with fibromyalgia showed stress-induced enhancement of pain sensitivity in response to thermal stimuli. However, only patients showed increased sensitivity in response to pressure pain. Conclusions Our results provide evidence for stress-induced allodynia/hyperalgesia in humans for the first time and suggest differential underlying mechanisms determining response to stressors in healthy subjects and patients suffering from chronic pain. Possible mechanisms of the interplay of stress and mediating factors (e.g. cytokines, cortisol) on pain sensitivity are mentioned. Future studies should help understand better how stress impacts on chronic pain conditions. PMID:23950894

  20. Impaired Empathic Abilities among Patients with Complex Regional Pain Syndrome (Type I)

    PubMed Central

    Sohn, Hong-Suk; Lee, Do-Hyeong; Lee, Kyung-Jun; Noh, Eun Chung; Choi, Soo-Hee; Jang, Joon Hwan; Kim, Yong Chul

    2016-01-01

    Objective The aims of this study were to evaluate differences in empathic abilities between patients with complex regional pain syndrome (CRPS) Type I and healthy control subjects (HCs) and to assess correlations between empathic abilities and multidimensional aspects of pain. Methods Empathic ability was measured in 32 patients with CRPS Type I and in 36 HCs using the Interpersonal Reactivity Index (IRI). A comprehensive assessment of pain was conducted in the patient group using the West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Psychiatric symptoms were assessed using the Beck Depression and Anxiety Inventories (BDI and BAI), and quality of life was evaluated using the WHO Quality of Life (WHOQOL-BREF) questionnaire. Results Patients with CRPS showed impaired cognitive and emotional empathic abilities compared with HCs. Significantly lower levels of perspective taking and empathic concern and higher levels of personal distress on the IRI were exhibited by the patient group. Perspective taking and personal distress were associated with affective distress and poor quality of life in social contexts (BDI, BAI, and WHOQOL). However, empathic concern was positively correlated with pain severity and social support from others (WHYMPI). Conclusion A tendency toward self-oriented distress in social cognition was exhibited among patients with CRPS Type I. Impaired empathic ability was shown to have potentially negative effects on subjective emotional outcomes and social performance in the lives of patients. Interventions to improve emotional awareness and theory of mind would be beneficial for enhancing social functioning in patients with CRPS Type I. PMID:26766944

  1. Pain and quality of life in patients undergoing radiotherapy for spinal metastatic disease treatment

    PubMed Central

    2013-01-01

    Background Radiotherapy is an important tool in the control of pain in patients with spinal metastatic disease. We aimed to evaluate pain and of quality of life of patients with spinal metastatic disease undergoing radiotherapy with supportive treatment. Methods The study enrolled 30 patients. From January 2008 to January 2010, patients selection included those treated with a 20 Gy tumour dose in five fractions. Patients completed the visual analogue scale for pain assessment and the SF-36 questionnaire for quality of life assessment. Results The most frequent primary sites were breast, multiple myeloma, prostate and lymphoma. It was found that 14 spinal metastatic disease patients (46.66%) had restricted involvement of three or fewer vertebrae, while 16 patients (53.33%) had cases involving more than three vertebrae. The data from the visual analogue scale evaluation of pain showed that the average initial score was 5.7 points, the value 30 days after the end of radiotherapy was 4.60 points and the average value 6 months after treatment was 4.25 points. Notably, this final value was 25.43% lower than the value from the initial analysis. With regard to the quality of life evaluation, only the values for the functional capability and social aspects categories of the questionnaire showed significant improvement. Conclusion Radiotherapy with supportive treatment appears to be an important tool for the treatment of pain in patients with spinal metastatic disease. PMID:23418821

  2. Pain management in rheumatoid arthritis patients. A cognitive-behavioral approach.

    PubMed

    Parker, J C; Frank, R G; Beck, N C; Smarr, K L; Buescher, K L; Phillips, L R; Smith, E I; Anderson, S K; Walker, S E

    1988-05-01

    To examine the effectiveness of a cognitive-behavioral pain management program for patients with rheumatoid arthritis, three patient groups were studied: a cognitive-behavioral group (CB), an attention-placebo group, and a control group. The CB group received a comprehensive, 12-month pain management program that taught coping strategies such as problem-solving techniques, relaxation training, strategies for attention diversion, and training in family dynamics and communication. Dependent measures included pain, coping strategies, psychological status, functional status, and disease status. Data analysis at 12 months revealed benefits for the CB group in the area of enhanced coping strategies. Specifically, the CB subjects showed significantly greater use of coping strategies and significantly more confidence in their ability to manage pain. The findings are discussed in terms of the importance of enhanced self-efficacy and personal control for patients with rheumatoid arthritis. PMID:2454118

  3. Predictive factors for the outcome of multidisciplinary treatments in chronic low back pain at the first multidisciplinary pain center of Japan.

    PubMed

    Hayashi, Kazuhiro; Arai, Young-Chang P; Ikemoto, Tatsunori; Nishihara, Makoto; Suzuki, Shigeyuki; Hirakawa, Tomoe; Matsuo, Shingo; Kobayashi, Mami; Haruta, Midori; Kawabata, Yuka; Togo, Hiroki; Noguchi, Taiji; Hase, Toshiyuki; Hatano, Genki; Ushida, Takahiro

    2015-09-01

    [Purpose] Multidisciplinary treatments are recommended for treatment of chronic low back pain. The aim of this study was to show the associations among multidisciplinary treatment outcomes, pretreatment psychological factors, self-reported pain levels, and history of pain in chronic low back pain patients. [Subjects and Methods] A total of 221 chronic low back pain patients were chosen for the study. The pretreatment scores for the 10-cm Visual Analogue Scale, Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, Short-Form McGill Pain Questionnaire, Pain Disability Assessment Scale, pain drawings, and history of pain were collected. The patients were divided into two treatment outcome groups a year later: a good outcome group and a poor outcome group. [Results] One-hundred eighteen patients were allocated to the good outcome group. The scores for the Visual Analogue Scale, Pain Disability Assessment Scale, and affective subscale of the Short-Form McGill Pain Questionnaire and number of nonorganic pain drawings in the good outcome group were significantly lower than those in the poor outcome group. Duration of pain in the good outcome group was significantly shorter than in the poor outcome group. [Conclusion] These findings help better predict the efficacy of multidisciplinary treatments in chronic low back pain patients. PMID:26504321

  4. Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial.

    PubMed

    Cleland, Joshua A; Childs, John D; McRae, Meghann; Palmer, Jessica A; Stowell, Thomas

    2005-05-01

    Mechanical neck pain is a common occurrence in the general population resulting in a considerable economic burden. Often physical therapists will incorporate manual therapies directed at the cervical spine including joint mobilization and manipulation into the management of patients with cervical pain. Although the effectiveness of mobilization and manipulation of the cervical spine has been well documented, the small inherent risks associated with these techniques has led clinicians to frequently utilize manipulation directed at the thoracic spine in this patient population. It is hypothesized that thoracic spine manipulation may elicit similar therapeutic benefits as cervical spine manipulation while minimizing the magnitude of risk associated with the cervical technique. The purpose of this randomized clinical trial was to investigate the immediate effects of thoracic spine manipulation on perceived pain levels in patients presenting with neck pain. The results suggest that thoracic spine manipulation results in immediate analgesic effects in patients with mechanical neck pain. Further studies are needed to determine the effects of thoracic spine manipulation in patients with neck pain on long-term outcomes including function and disability. PMID:15922233

  5. Prevalence of peripheral neuropathy and painful peripheral neuropathy in Turkish diabetic patients.

    PubMed

    Erbas, Tomris; Ertas, Mustafa; Yucel, Aysen; Keskinaslan, Abdulkadir; Senocak, Mustafa

    2011-02-01

    The aim of this study was to determine the prevalence of diabetic peripheral neuropathy (DPN) and neuropathic pain in diabetic patients attending university outpatient clinics in Turkey. In this multicenter cross-sectional study, neurologic examinations and nerve conduction studies along with clinical diabetic neuropathy score, and Leeds Assessment of Neuropathic Symptoms and Signs pain scale were performed on 1,113 patients (46.2% male) from 14 centers. Prevalence of DPN determined only by clinical examination was 40.4% and increased to 62.2%, by combining nerve conduction studies with clinical examination. According to Leeds Assessment of Neuropathic Symptoms and Signs scores, neuropathic pain prevalence was 16.0% in those who reported pain. Poor glycemic control, retinopathy, microalbuminuria, hyperlipidemia, diabetic foot, and foot amputation were more commonly observed in patients with DPN. Clinical DPN affected 40.4% of diabetic patients, and neuropathic pain prevalence in diabetic patient population was 14.0%. Clinical examinations and nerve conduction studies are important components for early detection and accurate diagnosis of DPN and painful DPN. PMID:21221008

  6. Biospectral analysis of the bladder channel point in chronic low back pain patients

    NASA Astrophysics Data System (ADS)

    Vidal, Alberto Espinosa; Nava, Juan José Godina; Segura, Miguel Ángel Rodriguez; Bastida, Albino Villegas

    2012-10-01

    Chronic pain is the main cause of disability in the productive age people and is a public health problem that affects both the patient and society. On the other hand, there isn't any instrument to measure it; this is only estimated using subjective variables. The healthy cells generate a known membrane potential which is part of a network of biologically closed electric circuits still unstudied. It is proposed a biospectral analysis of a bladder channel point as a diagnosis method for chronic low back pain patients. Materials and methods: We employed a study group with chronic low back pain patients and a control group without low back pain patients. The visual analog scale (VAS) to determine the level of pain was applied. Bioelectric variables were measured for 10 seconds and the respective biostatistical analyses were made. Results: Biospectral analysis on frequency domain shows a depression in the 60-300 Hz frequency range proportional to the chronicity of low back pain compared against healthy patients.

  7. Recommendations to the primary care practitioners and the patients for managing pelvic pain, especially in painful bladder syndrome for early and better prognosis

    PubMed Central

    Chung, Kyung Jin; Han, Adelaide Na Yeon; Kim, Khae Hawn

    2015-01-01

    Painful bladder syndrome (PBS) is a common disease presenting with chronic pelvic pain and discomfort with at least one urinary symptom with no identifiable cause. The etiology is still unknown, and the medication has limited effects on pelvic pain or other urinary symptoms. This article presents advanced insight regarding the approach to PBS, particularly pelvic pain for primary care practitioners and patients. We suggest six tips for medical staff and suspected patients for easy diagnosis and proper treatment of pelvic pain. These six tips cover: Self-awareness of the disease; immediate urine culture test; specifying the location of pain urinary incontinence; frequency, or urgency without functional disorder of an overactive bladder helpful dietary control; complementary, and alternative medicine, and finding an expert. These tips might be helpful in advancing the schematic approach and in achieving better prognosis of PBS. Further study should be conducted to achieve better treatment for this disease, including development of a definitive test and diagnosis. PMID:26535214

  8. Recommendations to the primary care practitioners and the patients for managing pelvic pain, especially in painful bladder syndrome for early and better prognosis.

    PubMed

    Chung, Kyung Jin; Han, Adelaide Na Yeon; Kim, Khae Hawn

    2015-10-01

    Painful bladder syndrome (PBS) is a common disease presenting with chronic pelvic pain and discomfort with at least one urinary symptom with no identifiable cause. The etiology is still unknown, and the medication has limited effects on pelvic pain or other urinary symptoms. This article presents advanced insight regarding the approach to PBS, particularly pelvic pain for primary care practitioners and patients. We suggest six tips for medical staff and suspected patients for easy diagnosis and proper treatment of pelvic pain. These six tips cover: Self-awareness of the disease; immediate urine culture test; specifying the location of pain urinary incontinence; frequency, or urgency without functional disorder of an overactive bladder helpful dietary control; complementary, and alternative medicine, and finding an expert. These tips might be helpful in advancing the schematic approach and in achieving better prognosis of PBS. Further study should be conducted to achieve better treatment for this disease, including development of a definitive test and diagnosis. PMID:26535214

  9. Effects of Therapy in Patients Suffering from Chronic Back Pain Treated with Spinal Cord Stimulation.

    PubMed

    Mosiewicz, Anna; Rutkowska, ElĆŒbieta; Matacz, Monika; Mosiewicz, Barbara; Kaczmarczyk, Robert; Trojanowski, Tomasz

    2015-10-01

    Pain in the lumbosacral part of the spine in the course of degenerative disease is the most common cause of physical activity limitation in adults. Treatment includes pharmacotherapy, physiotherapy, psychotherapy, health promotion, and sometimes surgery. Surgical treatment is not always successful, and the various clinical and psychosomatic symptoms that result from surgical treatment failure are known as failed back surgery syndrome. For some patients with this condition, spinal cord stimulation can provide relief. The aim of the work was to define subjective and objective spinal cord stimulation effects by assessing chosen disability and physical activity limitation ratios. Pain intensity, level of disability, and presence of neurological symptoms were assessed. The examination was performed twice: before the stimulator implantation and at least 6 months postimplantation. The study was conducted at the Department of Neurosurgery and Paediatric Neurosurgery in Lublin. Thirty-six patients suffering from failed back surgery syndrome were recruited for this study. The Visual Analog Scale, modified Laitinen's pain questionnaire, and Oswestry Disability Index were used in this work. The study showed that spinal cord stimulation was effective in treating spinal and lower limb pain in 64% of patients, similar to results obtained in other departments. Although back pain and neuropathic pain radiating to the lower limbs decreased, moderate physical activity impairment was still observed according to the Oswestry Disability Index scale. The decrease in neuropathic pain radiating to the lower limbs had the most significant influence on reducing physical activity impairment. PMID:26187548

  10. The Pain Experience of Hispanic Patients With Cancer in the U.S.

    PubMed Central

    Im, Eun-Ok; Guevara, Enrique; Chee, Wonshik

    2008-01-01

    Background: Several plausible reasons for inadequate cancer pain management among Hispanic patients with cancer in the U.S. have been postulated; however, this issue is understudied. Purpose: The purpose of the study was to explore Hispanic patients' cancer pain experience from a feminist perspective in order to find explanations for inadequate pain management for Hispanic patients with cancer. Design: A qualitative online forum study. Setting: Both Internet and community settings. Participants: 15 Hispanic patients with cancer recruited using a convenience sampling method. Methods: A 6-month online forum was conducted using nine discussion topics, and the data were processed using a thematic analysis. Phenomenon of Interest: Cancer Pain Experience Findings: Four major themes emerged: lack of communication with health care providers regarding undermedication; because of traditional gender roles guiding their behaviors, both women and men were enduring pain; participants placed the highest priority on family during the diagnosis and treatment process, thus setting aside their needs for pain management; finally, participants were enduring inconvenience and unfair treatment in the U.S. health care system while simultaneously appreciating what treatment they had been given. Conclusions: Because of cultural factors and marginalized status in the U.S. as Hispanics and as immigrants, most of the participants could not adequately describe and manage their pain. Implications: Findings suggest a need for further investigation of the influences of multiple factors, including financial issues, cultural norms, and gender stereotypes, on cancer pain experience among diverse subgroups of Hispanic patients with cancer. Key Points: Because of their Hispanic identity or immigrant status in the U.S., financial difficulties, language barriers, and cultural values placing family as the highest priority, most of the Hispanic participants of this study could not adequately describe and manage their pain. Because of traditional gender roles emphasizing machismo, Hispanic men rarely complained about their pain. Due to cultural traditions emphasizing women's obedience and obligation to sacrifice for their families, Hispanic women were also enduring pain while fulfilling their multiple roles and responsibilities. Because of familism, Hispanic patients with cancer placed the highest priority on family while managing cancer pain. PMID:17723987

  11. Attentional Bias For Prescription Opioid Cues Among Opioid Dependent Chronic Pain Patients

    PubMed Central

    Garland, Eric L.; Froeliger, Brett; Passik, Steven D.; Howard, Matthew O.

    2012-01-01

    Recurrent use of prescription opioid analgesics by chronic pain patients may result in opioid dependence, which involves implicit neurocognitive operations that organize and impel craving states and compulsive drug taking behavior. Prior studies have identified an attentional bias (AB) towards heroin among heroin dependent individuals. The aim of this study was to determine whether opioid-dependent chronic pain patients exhibit an AB towards prescription opioidrelated cues. Opioid-dependent chronic pain patients (n = 32) and a comparison group of non-dependent opioid users with chronic pain (n = 33) completed a dot probe task designed to measure opioid AB. Participants also rated their opioid craving and self-reported arousal associated with opioid-related and neutral images, pain severity, and relief from pain treatments. Repeated-measures ANOVA revealed a significant group (opioid-dependent vs. non-dependent opioid user) Ś presentation duration (200 ms. vs. 2000 ms.) interaction, such that opioid-dependent individuals evidenced a significant AB towards opioid cues presented for 200 ms but not for cues presented for 2000 ms, whereas non-dependent opioid users did not exhibit a significant mean AB at either stimulus duration. Among opioid-dependent individuals, 200 ms opioid AB was significantly associated with opioid craving, while among non-dependent opioid users, 200 ms opioid AB was significantly associated with relief from pain treatments. Furthermore, dependent and non-dependent opioid users experienced opioid cues as significantly more arousing than neutral cues. Opioid dependence among chronic pain patients appears to involve an automatic AB towards opioid-related cues. When coupled with chronic pain, attentional fixation on opioid cues may promote compulsive drug use and addictive behavior. PMID:22968666

  12. Cognitive behavioral therapy increases prefrontal cortex gray matter in patients with chronic pain

    PubMed Central

    Seminowicz, David A.; Shpaner, Marina; Keaser, Michael L.; Krauthamer, G. Michael; Mantegna, John; Dumas, Julie A.; Newhouse, Paul A.; Filippi, Christopher; Keefe, Francis J.; Naylor, Magdalena R.

    2013-01-01

    Several studies have reported reduced cerebral gray matter (GM) volume/density in chronic pain conditions, but there is limited research on plasticity of the human cortex in response to psychological interventions. We investigated GM changes after cognitive behavioral therapy (CBT) in patients with chronic pain. We used voxel based morphometry (VBM) to compare anatomical MRI scans of 13 patients with mixed chronic pain types before and after an 11-week CBT treatment and to 13 healthy control participants. CBT led to significant improvements in clinical measures. Patients did not differ from healthy controls in GM anywhere in the brain. After treatment, patients had increased GM in bilateral dorsolateral prefrontal (DLPFC), posterior parietal (PPC), subgenual anterior cingulate (ACC)/orbitofrontal, and sensorimotor cortices, as well as hippocampus, and reduced GM in supplementary motor area. In most of these areas showing GM increases, GM became significantly higher than in controls. Decreased pain catastrophizing was associated with increased GM in left DLPFC and ventrolateral prefrontal (VLPFC), right PPC, somatosensory cortex, and pregenual ACC. While future studies with additional control groups will be needed to determine the specific roles of CBT on GM and brain function, we propose that increased GM in the PFC and PPC reflects greater top-down control over pain and cognitive reappraisal of pain, and that changes in somatosensory cortices reflect alterations in the perception of noxious signals. Perspective An 11-week CBT intervention for coping with chronic pain resulted in increased gray matter volume in prefrontal and somatosensory brain regions, as well as increased dorsolateral prefrontal volume associated with reduced pain catastrophizing. These results add to mounting evidence that CBT can be a valuable treatment option for chronic pain. PMID:24135432

  13. More educated emergency department patients are less likely to receive opioids for acute pain.

    PubMed

    Platts-Mills, Timothy F; Hunold, Katie M; Bortsov, Andrey V; Soward, April C; Peak, David A; Jones, Jeffrey S; Swor, Robert A; Lee, David C; Domeier, Robert M; Hendry, Phyllis L; Rathlev, Niels K; McLean, Samuel A

    2012-05-01

    Inadequate treatment of pain in United States emergency departments (EDs) is common, in part because of the limited and idiosyncratic use of opioids by emergency providers. This study sought to determine the relationship between patient socioeconomic characteristics and the likelihood that they would receive opioids during a pain-related ED visit. We conducted a cross-sectional analysis of ED data obtained as part of a multicenter study of outcomes after minor motor vehicle collision (MVC). Study patients were non-Hispanic white patients between the ages of 18 and 65 years who were evaluated and discharged home from 1 of 8 EDs in 4 states. Socioeconomic characteristics include educational attainment and income. Of 690 enrolled patients, the majority had moderate or severe pain (80%). Patients with higher education attainment had lower levels of pain, pain catastrophizing, perceived life threat, and distress. More educated patients were also less likely to receive opioids during their ED visit. Opioids were given to 54% of patients who did not complete high school vs 10% of patients with post-college education (?(2) test P<.001). Differences in the frequency of opioid administration between patients with the lowest educational attainment (39%, 95% confidence interval 22% to 60%) and highest educational attainment (13%, 95% confidence interval 7% to 23%) remained after adjustment for age, sex, income, and pain severity (P=.01). In this sample of post-MVC ED patients, more educated patients were less likely to receive opioids. Further study is needed to assess the generalizability of these findings and to determine the reason for the difference. PMID:22386895

  14. Validation of the Korean Version of the DN4 Diagnostic Questionnaire for Neuropathic Pain in Patients with Lumbar or Lumbar-Radicular Pain

    PubMed Central

    Kim, Ho-Joong; Park, Joon-Hee; Bouhassira, Didier; Shin, Jae-Hoon; Chang, Bong-Soon; Lee, Choon-Ki; Baek, Chang Hyun

    2016-01-01

    Purpose To evaluate the diagnostic value of the Korean version of the Douleur Neuropathique 4 (DN4) questionnaire and to validate this questionnaire in terms of psychometric properties in patients with chronic pain due to degenerative spinal disease. Materials and Methods The Korean version of the DN4 questionnaire, which was translated and linguistically validated by the MAPI Research Group, was tested on 83 patients with lumbar or lumbar-radicular pain. Test-retest reliability was evaluated in a subsample of 40 patients who completed two assessments with an interval of 2 weeks. Nociceptive pain and neuropathic component pain were diagnosed in 40 and 43 patients, respectively. Results The Cronbach's α coefficient of internal consistency was 0.819, and the test-retest intraclass correlation coefficient (3, 1) (95% confidence interval) was 0.813 (0.776–0.847) (n=40). The area under the receiver-operator characteristics curve was 0.953 (p<0.001), with 95% confidence interval between 0.869 and 0.990. The Korean version of the DN4 questionnaire showed a sensitivity of 100% and 87.1%, and a specificity of 88.2% and 94.1% at the cutoff value of 3/10 and 4/10, respectively, for discriminating neuropathic component pain. Conclusion The present study demonstrated the good discriminatory power of DN4 between nociceptive pain and neuropathic component pain in patients with lumbar or lumbar-radicular pain. PMID:26847299

  15. Chronic Pain and Analgesic Use in CKD: Implications for Patient Safety

    PubMed Central

    Wu, Juliana; Ginsberg, Jennifer S.; Zhan, Min; Diamantidis, Clarissa J.; Chen, Jingjing; Woods, Corinne

    2015-01-01

    Background and objectives Chronic pain in predialysis CKD is not fully understood. This study examined chronic pain in CKD and its relationship with analgesic usage. Design, setting, participants, & measurements Data include baseline visits from 308 patients with CKD enrolled between 2011 and 2013 in the Safe Kidney Care cohort study in Baltimore, Maryland. The Wong–Baker FACES Pain Rating Scale measured chronic pain severity. Analgesic prescriptions and over-the-counter purchases were recorded up to 30 days before visits, and were classified as a drug-related problem (DRP) based on an analgesic’s nephrotoxicity and dose appropriateness at participants’ eGFR. Participants were sorted by pain frequency and severity and categorized into ordinal groups. Analgesic use and the rate of analgesics with a DRP were reported across pain groups. Multivariate regression determined the factors associated with chronic pain and assessed the relationship between chronic pain and analgesic usage. Results There were 187 (60.7%) participants who reported chronic pain. Factors associated with pain severity included arthritis, taking ≄12 medications, and lower physical function. Use of nonsteroidal anti-inflammatory drugs was reported by seven participants (5.8%) with no chronic pain. Mild and severe chronic pain were associated with analgesics with a DRP, with odds ratios of 3.04 (95% confidence interval [95% CI], 1.12 to 8.29) and 5.46 (95% CI, 1.85 to 16.10), respectively. The adjusted rate of analgesics with a DRP per participant increased from the group with none to severe chronic pain, with rates of 0.07 (95% CI, 0.04 to 0.13), 0.12 (95% CI, 0.07 to 0.20) and 0.16 (95% CI, 0.09 to 0.27), respectively. Conclusions Chronic pain is common in CKD with a significant relationship between the severity of pain and both proper and improper analgesic usage. Screening for chronic pain may help in understanding the role of DRPs in the delivery of safe CKD care. PMID:25710806

  16. Cognitive-behavioral classifications of chronic pain in patients with multiple sclerosis.

    PubMed

    Khan, Fary; Pallant, Julie F; Amatya, Bhasker; Young, Kevin; Gibson, Steven

    2011-09-01

    The aim of this study was to replicate, in patients with multiple sclerosis (MS), the three-cluster cognitive-behavioral classification proposed by Turk and Rudy. Sixty-two patients attending a tertiary MS rehabilitation center completed the Pain Impact Rating questionnaire measuring activity interference, pain intensity, social support, and emotional distress. The General Health Questionnaire-28 and the Multiple Sclerosis Impact Scale-29 assessed disability and restriction in participation. Cluster analysis classified patients into three cognitive-behavioral groups (40.4%, 'adaptive copers'; 36.5%, 'dysfunctional'; and 23.1%, 'interpersonally distressed'). Patients in groups with higher levels of activity interference, emotional distress due to pain, and lower perceived levels of social support had significantly higher levels of depression on the General Health Questionnaire-28 (P<0.003), and reported a greater impact on their physical and psychological functioning (P<0.001) on Multiple Sclerosis Impact Scale-29 subscales. Possible cut-points were identified to aid clinicians in classifying patients into clusters for individualized treatment. More research is needed to improve the understanding of pain and the potential use of cognitive-behavioral clusters in patients with MS. These may be useful in the development of tailored early intervention, which may reduce pain-related disability and contribute to patient's overall well being. PMID:21642854

  17. Complex regional pain syndrome type 1 in a pediatric patient: Case report

    PubMed Central

    Demirdal, Ümit Seçil; BĂŒkĂŒlmez, AyƟegĂŒl; Solak, Özlem

    2014-01-01

    Complex regional pain syndrome type 1 is one of the causes of morbidity of childhood which is also named reflex symphathetic dystrophia. The syndrome is characterized with regional pain and vasomotor, sudomotor and sensory changes in the distal parts of the extremities involved. Complex regional pain syndrome type 1 shows difference in children in terms of clinical picture and imaging methods compared to adults. The most important point is that the prognosis is generally better in children if early diagnosis and treatment is provided. On the other hand, causes including presence of psychological factors or less contribution of imaging methods in children lead to delayed diagnosis or erroneous diagnosis. In this article, a 10 year-old male patient who was diagnosed with complex regional pain syndrome type 1 was described. Thus, we aimed to remind clinicians that this syndrome should also be kept in mind in the differential diagnosis of pain in children. PMID:26078637

  18. The relationship of pathogenetic mechanisms to treatment in patients with pain.

    PubMed

    Ramsay, R A

    1984-01-01

    Pain is the somatic symptom par excellence, legitimizing more than any other the sick role and illness behavior. The functions and implications of pain are clearest in situations of acute illness or injury or in chronic, organically based conditions in which actual or threatened tissue damage is signaled by its report. Much greater complexity is found in a variety of clinical presentations (conversion hysteria, hypochondriasis, chronic pain syndromes, Briquet's syndrome, Munchausen's syndrome) in which pain may form part or all of the clinical picture. In such conditions the relationship of the patient's report of pain to other phenomena (tissue damage, physiopathology, perceptual and cognitive styles, personality type, individual and family psychodynamics, anxiety, depression, behavioral patterns, social and economic factors, cultural influences) is important in elucidating pathogenetic mechanisms of which several may be operating in any one case. Awareness of the existence and interaction of these mechanisms facilitates the development and integration of treatment approaches. PMID:6514972

  19. A Learning and Teaching Resource on Patient Self-Management of Chronic Pain

    PubMed Central

    Brown, Lin; Bundy, Anita; Ronaldson, Sue; McKenzie, Heather; Lewis, Peter; Bosnic-Anticevich, Sinthia

    2013-01-01

    Objective. To develop, pilot test, and evaluate an instructional module on patient self-management for undergraduate pharmacy students in an Australian university. Design. Learning outcomes and associated content and assessment tasks were developed, featuring lecture and readings, in-class discussions, and online delivery of in-depth interviews with patients who were living with chronic pain. Assessment. Students completed a premodule and postmodule questionnaire and were further assessed by multiple-choice questions following completion of the module and again at the end of the semester. Positive changes were identified in the students’ discourse surrounding patient self-management of chronic pain. Responses to multiple-choice questions showed that knowledge was sustained over the course of the semester. Conclusions. Completion of a comprehensive module on patient self-management increased undergraduate pharmacy students’ understanding and knowledge of patients experiencing chronic pain. The module could be implemented across other healthcare disciplines. PMID:23518902

  20. Pain, Delirium and Physical Function in Skilled Nursing Home Patients with Dementia

    PubMed Central

    Kolanowski, Ann; Mogle, Jacqueline; Fick, Donna M.; Hill, Nikki; Mulhall, Paula; Nadler, Jamie; Colancecco, Elise; Behrens, Liza

    2014-01-01

    Objective Skilled Nursing Facilities (SNFs) are major sites of post-acute care for patients with dementia. A recent Office of the Inspector General report indicated that outcomes in SNFs are sub-optimal due to poor-quality treatment, including the failure to provide needed care. Pain is frequently un-recognized and un-treated in patients with dementia. The aim of this exploratory study was to examine the effect daily pain has on delirium and physical function in patients with dementia in SNFs. The association of daily pain with discharge disposition was also examined. Design Secondary analysis of data from an on-going randomized clinical trial. Setting Eight SNFs located in central and northeast Pennsylvania. Participants One hundred and three SNF patients with adjudicated dementia and delirium diagnoses and a mean age of 86 (±6.8) years; most were female (66%) and Caucasian (98%). Measurements Measures of pain (Pain Assessment in Advanced Dementia), delirium (Confusion Assessment Method), and physical function (Barthel Index) were taken daily for 30 days or until discharge. Results On days when participants experienced greater than their average level of pain they also experienced more delirium symptoms (p < .001) and lower physical function (p < .001). Participants with higher levels of average daily pain were more likely to die (OR = 6.306, 95% CI: 1.914–20.771, p = .003) or be placed in a nursing home (OR= 4.77, 95% CI:1.7–13.2, p=.003) compared to returning to the community at 3-month follow-up. Conclusion Greater attention to pain in patients with dementia may be a potential solution to some of the quality problems and high costs of care in SNFs PMID:25239018

  1. Adverse effects and cognitive function among primary care patients taking opioids for chronic nonmalignant pain.

    PubMed

    Brown, Randall T; Zuelsdorff, Megan; Fleming, Michael

    2006-01-01

    Chronic opioid therapy is commonly prescribed for chronic nonmalignant pain. Few published data describe the adverse effects experienced by patients with chronic nonmalignant pain being treated by primary care physicians. A prevalence study was conducted on a sample of 1,009 patients (889 receiving chronic opioids) being treated by 235 primary care physicians. Standardized questionnaires and medical record reviews were used to assess rates of addiction, pain diagnosis and severity, opioid adverse effects, and mental health. The mean daily dose of opioids was 92 mg using a morphine-equivalent conversion. Side effects included constipation (40 percent), sleeping problems (25 percent), loss of appetite (23 percent), and sexual dysfunction (18 percent), with patients on daily opioids experiencing more side effects than subjects on intermittent medication. The Medical Outcomes Study Mental Health Inventory (MOS-MHI) cognitive functioning scale indicated poorer cognitive function in the overall sample of chronic pain patients as compared to a general clinical sample (delta x 95 percent CI = 9.28, 13.76). However, there were limited differences in MOS scores between chronic pain subjects on daily opioids vs. intermittent opioids vs. no prescription opioids. A regression model suggests that psychological measures and pain severity are more predictive of decrements in cognitive function than specific opioid preparations or daily opioid dose. Physicians should closely monitor patients for adverse effects and adequacy of pain control when using chronic opioid therapy for chronic pain treatment. Psychological health, an important predictor of cognitive dysfunction, is a particularly important measure to actively monitor and manage. PMID:17319447

  2. More Educated Emergency Department Patients are Less Likely to Receive Opioids for Acute Pain

    PubMed Central

    Platts-Mills, Timothy F.; Hunold, Katie M.; Bortsov, Andrey V.; Soward, April C.; Peak, David A.; Jones, Jeffrey S.; Swor, Robert A.; Lee, David C.; Domeier, Robert M.; Hendry, Phyllis L.; Rathlev, Niels K.; McLean, Samuel A.

    2012-01-01

    Inadequate treatment of pain in United States emergency departments (EDs) is common, in part due to the limited and idiosyncratic use of opioids by emergency providers. We sought to determine the relationship between patient socioeconomic characteristics and the likelihood they would receive opioids during a pain-related ED visit. We conducted a cross-sectional analysis of ED data obtained as part of a multi-center study of outcomes after minor motor vehicle collision (MVC). Study patients were non-hispanic whites between the ages of 18–65 who were evaluated and discharged home from one of nine EDs in four states. Socioeconomic characteristics included educational attainment and income. Of 690 enrolled patients, the majority had moderate or severe pain (80%). Patients with higher education attainment had lower levels of pain, pain catastrophizing, perceived life-threat, and distress. More educated patients were also less likely to receive opioids during their ED visit. Opioids were given to 54% of patients who did not complete high school vs. 10% of patients with post-college education (chi-square test p<.001). Differences in the frequency of opioid administration between patients with the lowest educational attainment (39%, 95% CI 22%–60%)and highest educational attainment (13%, 95% CI 7%–23%) remained after adjustment for age, sex, income, and pain severity (p=.01). In this sample of post-MVCED patients, more educated patients were less likely to receive opioids. Further study is needed to assess the generalizability of these findings and determine the reason for the difference. PMID:22386895

  3. The Efficacy of Gabapentin in Patients with Central Post-stroke Pain

    PubMed Central

    Hesami, Omid; gharagozli, Kourosh; Beladimoghadam, Nahid; Assarzadegan, Farhad; Mansouri, Behnam; Sistanizad, Mohammad

    2015-01-01

    Thalamic pain syndrome, a type of central post-stroke pain (CPSP), may develops after a hemorrhagic or ischemic stroke and results in impairment of the thalamus. There is limited experience about gabapentin in treatment of central pains like CPSP. In a prospective observational study, the intensity of pain was recorded using the Numeric Rating Scale (NRS) at the entrance to the study. Patients eligible for treating with gabapentin, received gabapentin 300 mg twice-daily. The pain intensity was measured at entrance to the study and after one month using NRS. Decrease of 3 points from the initial NRS considered being clinically significant. From a total of 180 primarily screened patients, 84 (44 men and 40 women) were recruited. There was a significant difference between pre-treatment and post-treatment NRS (5.9 ± 2.51 vs. 4.7 ± 3.01; 95% CI: 0.442-1.962, p = 0.002). Fisher's exact test showed no statistically significant effect of clinical and demographic characteristics of patients on their therapeutic response to gabapentin. Given the safety, efficacy, well tolerability and lack of interaction with other drugs we suggest gabapentin to be more considered as a first line therapy or as add-on therapy for reducing the pain severity in patients with thalamic syndrome. PMID:26185510

  4. Pain Analysis in Patients with Hepatocellular Carcinoma: Irreversible Electroporation versus Radiofrequency Ablation-Initial Observations

    SciTech Connect

    Narayanan, Govindarajan Froud, Tatiana; Lo, Kaming; Barbery, Katuska J. Perez-Rojas, Evelyn Yrizarry, Jose

    2013-02-15

    To retrospectively compare the postprocedure pain of hepatocellular carcinoma treated with irreversible electroporation (IRE) with radiofrequency ablation (RFA). This Health Insurance Portability and Accountability Act-compliant, institutional review board-approved study compared postprocedure pain in 21 patients (15 men, six women; mean age 61.5 years) who underwent IRE of 29 intrahepatic lesions (mean size 2.20 cm) in 28 IRE sessions with 22 patients (16 men, six women; mean age 60.2 years) who underwent RFA of 27 lesions (mean size 3.38 cm) in 25 RFA sessions. Pain was determined by patient-disclosed scores with an 11-point numerical rating scale and 24 h cumulative hydromorphone use from patient-controlled analgesia pump. Complications were noted. Statistical significance was evaluated by Fisher's exact test, the Chi-square test, and Student's t test. There was no significant difference in the cumulative hydromorphone dose (1.54 mg (IRE) vs. 1.24 mg (RFA); P = 0.52) and in the mean pain score (1.96 (IRE) vs. 2.25 (RFA); P = 0.70). In nine (32.14 %) of 28 IRE sessions and 11 (44.0 %) of 25 RFA sessions, patients reported no pain. Complications occurred in three (10.7 %) of 28 IRE treatments and included pneumothorax (n = 1), pleural effusion (n = 1), and bleeding in the form of hemothorax (n = 1); one (4 %) of 25 RFA treatments included burn. IRE is comparable to RFA in the amount of pain that patients experience and the amount of pain medication self-administered. Both modalities were well tolerated by patients. Prospective, randomized trials are necessary to further evaluate these findings.

  5. Improvement in Psoriasis Area and Severity Index score predicts improvement in skin pain over time in patients with psoriasis.

    PubMed

    Ljosaa, Tone Marte; Stubhaug, Audun; Mork, Cato; Moum, Torbjorn; Wahl, Astrid K

    2013-05-01

    Pain and discomfort are common and often severe skin symptoms in patients with psoriasis. However, no studies have investigated skin pain and discomfort over time, or factors that explain changes in these symptoms. The aims of the present study were to describe the changes in skin pain, skin discomfort and Psoriasis Area and Severity Index (PASI) over time, and to investigate whether change in PASI predicted change in skin pain intensity. A total of 129 patients participated in this exploratory, longitudinal study. Data were obtained through interviews and questionnaires. The results indicated reduction in skin symptoms and psoriasis severity over a period of 3 months. However, a majority of patients with skin pain at baseline reported also skin pain at follow-up. Furthermore, changes in PASI predicted changes in skin pain intensity. In conclusion, improvement in psoriasis severity predicts improvement in skin pain. PMID:23007130

  6. Back Pain During Pregnancy

    MedlinePLUS

    ... Management Education & Events Advocacy For Patients About ACOG Back Pain During Pregnancy Home For Patients Search FAQs Back ... Pain During Pregnancy FAQ115, January 2016 PDF Format Back Pain During Pregnancy Pregnancy What causes back pain during ...

  7. Association between work-family conflict and musculoskeletal pain among hospital patient care workers

    PubMed Central

    Kim, Seung-Sup; Okechukwu, Cassandra; Buxton, Orfeu M.; Dennerlein, Jack T.; Boden, Leslie I.; Hashimoto, Dean M.; Sorensen, Glorian

    2014-01-01

    Background A growing body of evidence suggests that work-family conflict is an important risk factor for workers' health and well-being. The goal of this study is to examine association between work-family conflict and musculoskeletal pain among hospital patient care workers. Methods We analyzed a cross-sectional survey of 1119 hospital patient care workers in 105 units in two urban, academic hospitals. Work-family conflict was measured by 5-item Work-Family Conflict Scale questionnaire. Multilevel logistic regression was applied to examine associations between work-family conflict and self-reported musculoskeletal pain in the past 3 months, adjusting for confounders including work-related psychosocial factors and physical work factors. Results In fully adjusted models, high work-family conflict was strongly associated with neck or shoulder pain (OR: 2.34, 95% CI: 1.64 - 3.34), arm pain (OR: 2.79, 95% CI: 1.64 - 4.75), lower extremity pain (OR: 2.20, 95% CI: 1.54- 3.15) and any musculoskeletal pain (OR: 2.45, 95% CI: 1.56 - 3.85), and a number of body areas in pain (OR: 2.47, 95% CI: 1.82 - 3.36) in the past 3 months. The association with low back pain was attenuated and became non-significant after adjusting for confounders. Conclusions Given the consistent associations between work-family conflict and self-reported musculoskeletal pains, the results suggest that work-family conflict could be an important domain for health promotion and workplace policy development among hospital patient care workers. PMID:23019044

  8. Telephone Consultation Partially Based on a Cognitive-Behavioral Approach Decreases Pain and Improves Quality of Life in Patients With Chronic Pain

    PubMed Central

    Ikemoto, Kayo; Yamagata, Yumiko; Ikemoto, Tatsunori; Kawai, Takashi; Aono, Syuichi; Arai, Young-Chang

    2015-01-01

    Background: Chronic pain tends to be difficult to manage because of its complex natural history and poor response to therapy. Recently, it has been reported that telecare management by nurses improved outcomes of patients with chronic pain. Objectives: The aim of this study was to investigate the effect of a telephone consultation approach partially based on a cognitive-behavioral approach on pain and quality of life (QOL) in patients with chronic pain in Japan. Patients and Methods: Telephonic consultation was provided by nurse care managers for the management of pain. They informed the patients how to correct or eliminate excessive fear of pain, improper thinking for treating pain, as well as how to control activity levels by appropriate pacing. We received 463 consultations about chronic pain; however, 153 patients allowed us to recall for follow-up assessment. Finally, we could evaluate the pain intensity for 121 patients and the EuroQOL 5 dimension (EQ-5D) for 37 patients at the initial call and on their condition at 3 to 6 months after that. Wilcoxon signed-rank test and Cohens’d were used for both analyses. We also asked them to rate, by feeling, marked signs of improvement, some improvement, no improvement, or deterioration in pain and QOL, depending on their condition 3 to 6 months after the initial call (n = 121). Results: The pain intensities were significantly decreased from 7.6 ± 2.0 at baseline to 5.7 ± 2.9 on follow-ups assessed by a numerical rating scale (range; 0 - 10, P < 0.001, effect size (ES); 0.76). The EuroQOL 5 dimension scores were also significantly improved after telephone intervention; 0.5 ± 0.2 to 0.6 ± 0.2 (range; 0 - 1, P < 0.001, ES; 0.65). Moreover, as a result of the consultation, approximately half of the participants felt an improvement in the intensity of pain and QOL. Conclusions: Telephone consultation partially based on a cognitive-behavioral approach significantly reduced the intensity of pain and improved the QOL in patients with chronic pain in Japan. PMID:26705530

  9. Can Chronic Pain Patients Be Adequately Treated Using Generic Pain Medications to the Exclusion of Brand-Name Ones?

    PubMed

    Candido, Kenneth D; Chiweshe, Joseph; Anantamongkol, Utchariya; Knezevic, Nebojsa Nick

    2016-01-01

    According to the Food and Drug Administration (FDA) reports, approximately 8 in 10 prescriptions filled in the United States are for generic medications, with an expectation that this number will increase over the next few years. The impetus for this emphasis on generics is the cost disparity between them and brand-name products. The use of FDA-approved generic drugs saved 158 billion dollars in 2010 alone. In the current health care climate, there is continually increasing pressure for prescribers to write for generic alternative medications, occasionally at the expense of best clinical practices. This creates a conflict wherein both physicians and patients may find brand-name medications clinically superior but nevertheless choose generic ones. The issue of generic versus brand medications is a key component of the discussion of health payers, physicians and their patients. This review evaluates some of the important medications in the armamentarium of pain physicians that are frequently used in the management of chronic pain, and that are currently at the forefront of this issue, including Opana (oxymorphone; Endo Pharmaceuticals, Inc., Malvern, PA), Gralise (gabapentin; Depomed, Newark, CA), and Horizant (gabapentin enacarbil; XenoPort, Santa Clara, CA) that are each available in generic forms as well. We also discuss the use of Lyrica (pregabalin; Pfizer, New York, NY), which is currently unavailable as generic medication, and Cymbalta (duloxetine; Eli Lilly, Indianapolis, IN), which has been recently FDA approved to be available in a generic form. It is clear that the use of generic medications results in large financial savings for the cost of prescriptions on a national scale. However, cost-analysis is only part of the equation when treating chronic pain patients and undervalues the relationships of enhanced compliance due to single-daily dosing and stable and reliable pharmacokinetics associated with extended-duration preparations using either retentive technologies or delayed absorption strategies. Medications given to chronic pain patients should be individualized to best serve analgesic needs and assure patient safety primarily, based on high levels of scientific and economic evidence. Decisions regarding utilization should not be made based solely on limited or faulty assessments of cost-benefit analyses. PMID:24914505

  10. Incobotulinum Toxin-A Improves Post-Surgical and Post-Radiation Pain in Cancer Patients

    PubMed Central

    Rostami, Rezvan; Mittal, Shivam Om; Radmand, Reza; Jabbari, Bahman

    2016-01-01

    Cancer patients who undergo surgery or radiation can develop persistent focal pain at the site of radiation or surgery. Twelve patients who had surgery or radiation for local cancer and failed at least two analgesic medications for pain control were prospectively enrolled in a research protocol. Patients were injected up to 100 units of incobotulinum toxin A (IncoA) intramuscularly or subcutaneously depending on the type and location of pain (muscle cramp or neuropathic pain). Two patients passed away, one dropped out due to a skin reaction and another patient could not return for the follow up due to his poor general condition. All remaining 8 subjects (Age 31–70, 4 female) demonstrated significant improvement of Visual Analog Scale (VAS) (3 to 9 degrees, average 3.9 degrees) and reported significant satisfaction in Patients’ Global Impression of Change scale (PGIC) (7 out of 8 reported the pain as much improved). Three of the 8 patients reported significant improvement of quality of life. PMID:26771640

  11. Ergonomic practices within patient care units are associated with musculoskeletal pain and limitations

    PubMed Central

    Dennerlein, Jack T.; Hopcia, Karen; Sembajwe, Grace; Kenwood, Christopher; Stoddard, Anne M.; Tveito, T. Helene; Hashimoto, Dean M.; Sorensen, Glorian

    2013-01-01

    Background With the high prevalence of musculoskeletal disorders (MSDs) for patient care unit workers, prevention efforts through ergonomic practices within units may be related to symptoms associated with typical work-related MSDs. Methods We completed a cross-sectional survey of patient care workers (n=1572) in two large academic hospitals in order to evaluate relationships between self-reported musculoskeletal pain, work interference due to this pain, and limitations during activities of daily living (functional limitations) and with ergonomic practices and other organizational policy and practices metrics within the unit. Bivariate and multiple logistic regression analyses tested the significance of these associations. Results Prevalence of self-reported musculoskeletal symptoms in the past 3-months was 74% with 53% reporting pain in the low back. 32.8% reported that this pain interfered with their work duties and 17.7% reported functional limitations in the prior week. Decreased ergonomic practices were significantly associated with reporting pain in four body areas (low back, neck/shoulder, arms, and lower extremity) in the previous 3-months, interference with work caused by this pain, symptom severity and limitations in completing activities of daily living in the past week. Except for low back pain and work interference, these associations remained significant when psychosocial covariates such as psychological demands were included in multiple logistic regressions, Conclusions Ergonomic practices appear to be associated with many of the musculoskeletal symptoms denoting their importance for prevention efforts in acute health care settings. PMID:22113975

  12. Effect of leg press training on patellar realignment in patients with patellofemoral pain

    PubMed Central

    Peng, Hsien-Te; Song, Chen-Yi

    2015-01-01

    [Purpose] The purpose of this study was to investigate the effect of leg press and leg press with hip adduction exercise training on patellar alignment and pain in patients with patellofemoral pain (PFP). [Subjects and Methods] Seventeen patients participated in this study. Eight weeks of leg press or leg press with hip adduction training, including progressive lower-limb weight-training and stretching, was given. Patellar alignment (tilt and displacement) and pain measurements were conducted before and after leg press or leg press with hip adduction training. Patellar tilt angle and the bisect offset index were measured on axial computed tomography scans of the fully extended knee position with the quadriceps relaxed and contracted. Pain was assessed by using a 10-cm visual analog scale. [Results] No differences were found in patellar tilt and displacement with the quadriceps either relaxed or contracted after leg press and leg press with hip adduction. However, significant pain reduction was evident in both leg press and leg press with hip adduction. [Conclusion] The results indicated that patellar realignment does not appear to mediate pain alleviation. Furthermore, hip adduction in addition to leg press training had no additive beneficial effect on patellar realignment or pain reduction. PMID:26834371

  13. Management of chronic pain in elderly, frail patients: finding a suitable, personalized method of control

    PubMed Central

    Rastogi, Rahul; Meek, Brian D

    2013-01-01

    The elderly population is projected to make up 20% of the total United States population by the year 2030. In addition, epidemiological data suggests increasing prevalence of chronic pain and frailty with advancing age. Pain, being a subjective symptom, is challenging to manage effectively. This is more so in elderly populations with age-specific physiological changes that affect drug action and metabolism. Elderly patients are also more likely to have multiple chronic health pathologies, declining function, and frailty. The barriers present for patients, providers, and health systems also negatively impact efficient and effective pain control. These factors result in disproportionate utilization of health resources by the older population group. The scientific literature is lagging behind in age-specific studies for the elderly population. As a result, there is a lack of age-specific standardized management guidelines for various health problems, including chronic pain. Increasing efforts are now being directed to studies on pain control in the elderly. However, pain management remains inconsistent and suboptimal. This article is an attempt to suggest an informed, comprehensive guide to achieve effective pain control in the presence of these limitations. PMID:23355774

  14. Chronic Back Pain: Assessing the Patient at Risk

    PubMed Central

    Koelink, Anthony F.C.

    1990-01-01

    Pain in the lower back is a growing and costly problem. A simple, effective diagnosis can usually be provided by the family physician, based on a clinical history, especially regarding the circumstances surrounding an injury, and physical examination. Work-related risk factors implicated in the cause of the disorder are also important. Spinal X-ray examinations are of little value in diagnosis during the acute stage of low back pain. Chronic cases can be avoided by appropriate early treatment: a short period of analgesia and rest, followed by education about the back, a graduated exercise program, and if the clinical condition is stable or improving, early return to a modified level of work, even in the presence of symptoms. PMID:21233988

  15. Evaluating the Patient with Right Lower Quadrant Pain.

    PubMed

    Patel, Neel B; Wenzke, Daniel R

    2015-11-01

    Right lower quadrant pain is one of the most common indications for imaging evaluation of the abdomen in the emergency department setting. This article reviews important imaging findings associated with acute appendicitis as well as major differential considerations including: mesenteric adenitis, Meckel diverticulum, neutropenic colitis, right-sided diverticulitis, epiploic appendagitis, omental infarction, and inflammatory bowel diseaseRight lower quadrant pain is one of the most common indications for imaging evaluation of the abdomen in the emergency department setting. This article reviews important imaging findings associated with acute appendicitis as well as major differential considerations including: mesenteric adenitis, Meckel diverticulum, neutropenic colitis, right-sided diverticulitis, epiploic appendagitis, omental infarction, and inflammatory bowel disease. PMID:26526431

  16. Can serum interleukin-6 levels predict the outcome of patients with right iliac fossa pain?

    PubMed Central

    Goodwin, A. T.; Swift, R. I.; Bartlett, M. J.; Fernando, B. S.; Chadwick, S. J.

    1997-01-01

    In patients with right iliac fossa (RIF) pain it can be difficult to distinguish between appendicitis and nonspecific abdominal pain (NSAP). In this study we sought to determine whether serum interleukin-6 (IL-6) levels, an early marker of acute inflammation, taken at the time of admission could predict the outcome of patients admitted with RIF pain. Data were collected in a prospective manner on 53 consecutive patients (23 male, 30 female), mean age 22.1 years (range 10-79 years). Nineteen (36%) patients underwent surgery, of whom 16 had appendicitis (histologically proven). The mean (SEM) IL-6 levels (pg/ml) in patients undergoing operation vs those receiving non-operative management were 270.8 (106.3) vs 265.0 (80.4) (P = NS). The mean white blood cell (WBC) counts (x10(9)/l) in these patients were 14.28 (0.81) vs 9.66 (0.67), respectively (P = 0.0002). When patients with a confirmed diagnosis of appendicitis were compared with patients with a diagnosis of NSAP, the IL-6 levels were 149.4 (69.1) vs 363.6 (113.2), respectively (P = NS). In the same groups of patients, the WBC counts were 14.21 (0.81) vs 9.51 (0.68) (P = 0.004). We conclude that IL-6 levels taken at the time of admission are not useful in predicting the outcome of RIF pain. PMID:9135242

  17. Management of Persistent Pain in the Older Patient A Clinical Review

    PubMed Central

    Makris, Una E.; Abrams, Robert C.; Gurland, Barry; Reid, M. Carrington

    2015-01-01

    Importance Persistent pain is highly prevalent, costly, and frequently disabling in later life. Objective To describe barriers to the management of persistent pain among older adults, summarize current management approaches, including pharmacologic and nonpharmacologic modalities; present rehabilitative approaches; and highlight aspects of the patient-physician relationship that can help to improve treatment outcomes. This review is relevant for physicians who seek an age-appropriate approach to delivering pain care for the older adult. Evidence Acquisition Search of MEDLINE and the Cochrane database from January 1990 through May 2014, using the search terms older adults, senior, ages 65 and above, elderly, and aged along with non-cancer pain, chronic pain, persistent pain, pain management, intractable pain, and refractory pain to identify English-language peer-reviewed systematic reviews, meta-analyses, Cochrane reviews, consensus statements, and guidelines relevant to the management of persistent pain in older adults. Findings Of the 92 identified studies, 35 evaluated pharmacologic interventions, whereas 57 examined nonpharmacologic modalities; the majority (n = 50) focused on older adults with osteoarthritis. This evidence base supports a stepwise approach with acetaminophen as first-line therapy. If treatment goals are not met, a trial of a topical nonsteroidal anti-inflammatory drug, tramadol, or both is recommended. Oral nonsteroidal anti-inflammatory drugs are not recommended for long-term use. Careful surveillance to monitor for toxicity and efficacy is critical, given that advancing age increases risk for adverse effects. A multimodal approach is strongly recommended–emphasizing a combination of both pharmacologic and nonpharmacologic treatments to include physical and occupational rehabilitation, as well as cognitive-behavioral and movement-based interventions. An integrated pain management approach is ideally achieved by cultivating a strong therapeutic alliance between the older patient and the physician. Conclusions and Relevance Treatment planning for persistent pain in later life requires a clear understanding of the patient's treatment goals and expectations, comorbidities, and cognitive and functional status, as well as coordinating community resources and family support when available. A combination of pharmacologic, nonpharmacologic, and rehabilitative approaches in addition to a strong therapeutic alliance between the patient and physician is essential in setting, adjusting, and achieving realistic goals of therapy. PMID:25157726

  18. Ultrasound imaging for the rheumatologist. XLII. Assessment of hip pain in rheumatic patients: the radiologist's view.

    PubMed

    Vitali, Saverio; Delle Sedie, Andrea; Filippucci, Emilio; Riente, Lucrezia; Iagnocco, Annamaria; Sakellariou, Garifallia; Meenagh, Gary; Paolicchi, Alessandro; Montecucco, Carlomaurizio; Valesini, Guido; Grassi, Walter; Bombardieri, Stefano; Caramella, Davide

    2012-01-01

    Hip pain is a common complaint in daily practice and the identification of the underlying pathologic condition is the first step for an adequate treatment. In this review, we discuss the available evidence for the application of conventional radiography, computed tomography and magnetic resonance imaging in rheumatologic patients with painful hip, presenting the main imaging findings due to osteoarthritis, inflammatory arthritis (rheumatoid arthritis and spondyloarthritides), osteonecrosis and some other soft tissue involvement (bursitis and synovial cyst) that could be the cause of hip pain. Because different imaging techniques show different sensitivity and specificity, the choice of technique to use depends on the type and stage of the disease itself. PMID:23253630

  19. Altered Cortical Responsiveness to Pain Stimuli after High Frequency Electrical Stimulation of the Skin in Patients with Persistent Pain after Inguinal Hernia Repair

    PubMed Central

    van den Broeke, Emanuel N.; Koeslag, Lonneke; Arendsen, Laura J.; Nienhuijs, Simon W.; Rosman, Camiel; van Rijn, Clementina M.; Wilder-Smith, Oliver H. G.; van Goor, Harry

    2013-01-01

    Background High Frequency electrical Stimulation (HFS) of the skin induces enhanced brain responsiveness expressed as enhanced Event-Related Potential (ERP) N1 amplitude to stimuli applied to the surrounding unconditioned skin in healthy volunteers. The aim of the present study was to investigate whether this enhanced ERP N1 amplitude could be a potential marker for altered cortical sensory processing in patients with persistent pain after surgery. Materials and Methods Nineteen male patients; 9 with and 10 without persistent pain after inguinal hernia repair received HFS. Before, directly after and thirty minutes after HFS evoked potentials and the subjective pain intensity were measured in response to electric pain stimuli applied to the surrounding unconditioned skin. Results The results show that, thirty minutes after HFS, the ERP N1 amplitude observed at the conditioned arm was statistically significantly larger than the amplitude at the control arm across all patients. No statistically significant differences were observed regarding ERP N1 amplitude between patients with and without persistent pain. However, thirty minutes after HFS we did observe statistically significant differences of P2 amplitude at the conditioned arm between the two groups. The P2 amplitude decreased in comparison to baseline in the group of patients with pain. Conclusion The ERP N1 effect, induced after HFS, was not different between patients with vs. without persistent pain. The decreasing P2 amplitude was not observed in the patients without pain and also not in the previous healthy volunteer study and thus might be a marker for altered cortical sensory processing in patients with persistent pain after surgery. PMID:24376568

  20. Changes in Quality of Life after 3 months of Usual Care in a Large Sample of Patients with Noncancer Pain: The "QOOL: Quality of Life and Pain" Study.

    PubMed

    Velázquez Rivera, Ignacio; García Escobar, Modesto; Moya Riera, Jorge Juan; Del Saz de la Torre, Javier Manuel; Fenollosa Vázquez, Pedro; González Mesa, José Manuel; Casado, Alfonso; Martín Fuentes, Mayte; de Andrés Ares, Javier

    2015-09-01

    Large-scale observational studies can provide useful information on changes in health outcomes over time. The aim of this study was to investigate the effect of 3 months of usual care on quality of life (QOL) and pain outcomes in noncancer chronic pain patients managed by pain specialists and to examine factors associated with changes in QOL. This was assessed using the EQ-5D and pain outcomes using the Brief Pain Inventory (BPI). Changes in QOL and pain were studied for the overall sample and in subgroups defined by baseline pain severity. Multivariate regression was used to investigate factors associated with change on EQ-5D. Three thousand and twenty-nine patients were included for analysis. After 3 months of usual care, a mean of 40.9% of patients showed improvement on individual EQ-5D dimensions, with the highest rates of improvement seen on the pain/discomfort (50.8%) and anxiety/depression (48.3%) dimensions. The EQ-5D Index increased from a mean (SD) of 0.35 (0.2) to 0.58 (0.21) points between baseline and month 3, and the thermometer from 41.5 (19.4) to 58.7 (17.8), indicating a large effect. Improvements in QOL were larger in those with severe baseline pain. The BPI severity summary score improved from a mean (SD) of 6.5 (1.4) to 4.1 (1.7) and the interference summary score from 6.6 (1.5) to 4.2 (1.9). Changes on the BPI severity and interference scores were associated with changes in the EQ-5D Index and thermometer. In conclusion, 3 months of usual care in noncancer pain patients led to substantial improvements in QOL and pain outcomes. PMID:25244352

  1. Translation, cross-cultural adaptation, and validity of the Korean version of the pain sensitivity questionnaire in chronic pain patients.

    PubMed

    Kim, Ho-Joong; Ruscheweyh, Ruth; Yeo, Ji-Hyun; Cho, Hyeon-Guk; Yi, Je-Min; Chang, Bong-Soon; Lee, Choon-Ki; Yeom, Jin S

    2014-11-01

    The purpose of this study was to translate pain sensitivity questionnaires (PSQ) into the Korean language, perform a cross-cultural adaption of the PSQ, and validate the Korean version of PSQ in patients with degenerative spinal disease. The PSQ was translated forward and backward, cross-culturally adapted by 2 independent translators, and approved by an expert committee. The final Korean version of the PSQ was tested on 72 patients with degenerative spinal disease. Test-retest reliability was evaluated for 60 patients (83%) who completed the second assessment in an interval of 4 weeks. The mean PSQ-minor, PSQ-moderate, and PSQ-total (standard deviation [SD]) were 5.40 (2.02), 6.46 (1.98), and 5.93 (1.93), respectively. The PSQ-total, PSQ-minor, and PSQ-moderate of the Korean version showed very good internal consistencies determined by the Cronbach's ? of 0.926, 0.869, and 0.877, respectively. For convergent validity, the PSQ scores of the Korean version showed significant correlations with pain catastrophizing scale (PCS) (r = 0.377, P = 0.002; r = 0.365, P = 0.003; r = 0.362, P = 0.003 for PSQ-total, PSQ-minor, and PSQ-moderate of the Korean version, respectively). For test-retest reliability, the intraclass correlation coefficients were 0.782 for PSQ-total, 0.752 for PSQ-minor, and 0.793 for PSQ-moderate. In conclusion, the validated Korean version of PSQ is a transculturally equivalent, reliable, and valid tool to assess individual pain sensitivity. PMID:24131768

  2. Spinal cord stimulation attenuates temporal summation in patients with neuropathic pain.

    PubMed

    Eisenberg, Elon; Burstein, Yulia; Suzan, Erica; Treister, Roi; Aviram, Joshua

    2015-03-01

    Evidence has shown that electrical stimulation at the dorsal columns attenuated the "wind-up" phenomenon in dorsal horn neurons in nerve-injured rats. This study was aimed to test the effect of spinal cord stimulation (SCS) on temporal summation (TS), the clinical correlate of the wind-up phenomenon in patients with radicular leg pain. Eighteen patients with SCS implants were tested both 30 minutes after SCS activation ("ON") and 2 hours after turning it off ("OFF"), in a random order. Temporal summation was evaluated in the most painful site in the affected leg and in the corresponding area in the contralateral leg by applying a tonic painful heat stimulus (46.5°C; 120 seconds) and simultaneous recording of the perceived heat pain intensity. Patients were also requested to report their clinical pain intensity (0-100 numerical pain scale) during SCS "ON" and "OFF". The Wilcoxon signed rank test was used in the comparisons between SCS "ON" and "OFF". Spinal cord stimulation activation significantly attenuated clinical pain intensity (from 66 ± 18 to 27 ± 31, P < 0.001). In the nonpainful leg, SCS activation failed to produce an effect on TS (24 ± 20 vs 21 ± 24 in SCS "OFF" and "ON", respectively; P = 0.277). In contrast, a significant decrease in the magnitude of TS in the affected leg was observed in response to SCS activation (from 32 ± 33 to 19 ± 24; P = 0.017). These results suggest that attenuation of TS, which likely represents suppression of hyperexcitability in spinal cord neurons, is a possible mechanism underlying SCS analgesia in patients with neuropathic pain. PMID:25599230

  3. Spinal cord stimulation in patients with painful diabetic neuropathy: a multicentre randomized clinical trial.

    PubMed

    de Vos, Cecile C; Meier, Kaare; Zaalberg, Paul Brocades; Nijhuis, Harold J A; Duyvendak, Wim; Vesper, Jan; Enggaard, Thomas P; Lenders, Mathieu W P M

    2014-11-01

    Painful diabetic neuropathy (PDN) is a peripheral neuropathic pain condition that is often difficult to relieve. Spinal cord stimulation (SCS) is a proven effective therapy for various types of mixed neuropathic conditions, yet effectiveness of SCS treatment for PDN is not well established. To our knowledge, ours is the first multicentre randomized controlled trial investigating the effectiveness of SCS in patients with PDN. Sixty patients with PDN in the lower extremities refractory to conventional medical therapy were enrolled and followed for 6 months. They were randomized 2:1 to best conventional medical practice with (SCS group) or without (control group) additional SCS therapy, and both groups were assessed at regular intervals. At each follow-up visit, the EuroQoL 5D, the short form McGill Pain Questionnaire (SF-MPQ) and a visual analogue scale (VAS, ranging 0-100) to measure pain intensity were recorded. The average VAS score for pain intensity was 73 in the SCS group and 67 in the control group at baseline. After 6 months of treatment, the average VAS score was significantly reduced to 31 in the SCS group (P<.001) and remained 67 (P=.97) in the control group. The SF-MPQ and EuroQoL 5D questionnaires also showed that patients in the SCS group, unlike those in the control group, experienced reduced pain and improved health and quality of life after 6 months of treatment. In patients with refractory painful diabetic neuropathy, spinal cord stimulation therapy significantly reduced pain and improved quality of life. PMID:25180016

  4. Post-Operative Pain Management in Patients Undergoing Robotic Urological Surgery

    PubMed Central

    Batley, Sian E.; Prasad, Venkat; Vasdev, Nikhil; Mohan-S, Gowrie

    2016-01-01

    Robotic urological surgery is being increasingly performed worldwide. The main focus currently is on the operative technique but post operative patient care is an essential part of the process to make this technique safe and successful. We present a review on multiple analgesic techniques available to prevent and treat pain specifically caused after by urological robotic surgery; this article will explain the mechanism of pain pathways involved in laparoscopic procedures and review current evidence pertaining to systemic and regional analgesia methods. PMID:26989364

  5. Treatment of Extraspinal Painful Bone Metastases with Percutaneous Cementoplasty: A Prospective Study of 50 Patients

    SciTech Connect

    Anselmetti, Giovanni Carlo Manca, Antonio; Ortega, Cinzia; Grignani, Giovanni; DeBernardi, Felicino; Regge, Daniele

    2008-11-15

    The aim of this study was to assess the efficacy of percutaneous cementoplasty (PC) with polymethylmethacrylate (PMMA) in painful extravertebral lytic bone metastases not responding to conventional therapy. Fifty patients (25 females), mean age 64.7 {+-} 11.2 years, underwent PC after giving informed consent. Procedures were performed under fluoroscopy (1/50) or combined fluoroscopy-CT (49/50) guidance in local anesthesia or under deep sedation in 7 patients with large metastases who underwent radiofrequency thermoablation (RFA) in the same session. Seventy lesions were treated (1-6 per patient; average, 1.4 {+-} 0.9), arranging in size from 1 to 10 cm (average, 3.6 {+-} 2.1 cm). Mean volume of PMMA per lesion was 5.9 {+-} 3.2 ml (range, 1.5-15.0 ml). Pain was prospectively evaluated on an 11-point visual analog scale (VAS) before and after the procedure (follow-up, 15 to 36 months). Mean VAS score dropped from 9.1 {+-} 1.2 (range: 6-10) to 2.1 {+-} 2.5 (range: 0-9). Mean VAS difference was 7.0 {+-} 2.3 (range, 1-10; p < 0.0001, Wilcoxon signed rank test). Forty-seven of the 50 patients (94%) suspended narcotic drugs, in 22 (44%) pain was controlled with a nonsteroidal anti-inflammatory drug, in 25 (50%) analgesic therapy was suspended, and 13 of 50 (26%) had complete pain regression. In 3 of the 50 patients (6%) pain was not improved. No statistical difference between osteoplasty and osteoplasty plus RFA was found (p = 0.8338, Mann-Whitney test). No complications arose during the procedure. Two patients with metastases in the femoral diaphysis reported a fracture 1 month after treatment. PC is effective to obtain pain regression in painful bone metastases not responding to conventional analgesic therapy; bone consolidation cannot be obtained in the diaphysis of long weight-bearing bones.

  6. Magnetic Resonance–Guided Focused Ultrasound for Patients With Painful Bone Metastases: Phase III Trial Results

    PubMed Central

    Ghanouni, Pejman; Kanaev, Sergey V.; Iozeffi, Dmitri; Gianfelice, David; Fennessy, Fiona Mary; Kuten, Abraham; Meyer, Joshua E.; LeBlang, Suzanne D.; Roberts, Ann; Choi, Junsung; Larner, James M.; Napoli, Alessandro; Turkevich, Vladimir G.; Inbar, Yael; Tempany, Clare Mary C.; Pfeffer, Raphael M.

    2014-01-01

    Background Pain due to bone metastases is a common cause of cancer-related morbidity, with few options available for patients refractory to medical therapies and who do not respond to radiation therapy. This study assessed the safety and efficacy of magnetic resonance-guided focused ultrasound surgery (MRgFUS), a noninvasive method of thermal tissue ablation for palliation of pain due to bone metastases. Methods Patients with painful bone metastases were randomly assigned 3:1 to receive MRgFUS sonication or placebo. The primary endpoint was improvement in self-reported pain score without increase of pain medication 3 months after treatment and was analyzed by Fisher’s exact test. Components of the response composite, Numerical Rating Scale for pain (NRS) and morphine equivalent daily dose intake, were analyzed by t test and Wilcoxon rank-sum test, respectively. Brief Pain Inventory (BPI-QoL), a measure of functional interference of pain on quality of life, was compared between MRgFUS and placebo by t test. Statistical tests were two-sided. Results One hundred forty-seven subjects were enrolled, with 112 and 35 randomly assigned to MRgFUS and placebo treatments, respectively. Response rate for the primary endpoint was 64.3% in the MRgFUS arm and 20.0% in the placebo arm (P < .001). MRgFUS was also superior to placebo at 3 months on the secondary endpoints assessing worst score NRS (P < .001) and the BPI-QoL (P < .001). The most common treatment-related adverse event (AE) was sonication pain, which occurred in 32.1% of MRgFUS patients. Two patients had pathological fractures, one patient had third-degree skin burn, and one patient suffered from neuropathy. Overall 60.3% of all AEs resolved on the treatment day. Conclusions This multicenter phase III trial demonstrated that MRgFUS is a safe and effective, noninvasive treatment for alleviating pain resulting from bone metastases in patients that have failed standard treatments. PMID:24760791

  7. Old fractures in two patients with congenital insensitivity to pain with anhidrosis: radiological findings.

    PubMed

    Yang, Li; Ji, Shao F; Yue, Rui J; Cheng, Jing L; Niu, Jun J

    2013-01-01

    Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive disease that is characterized by anhidrosis, insensitivity to noxious stimuli, and mental retardation. Patients who suffer from CIPA easily sustain injuries due to pain insensitivity. Radiological findings in two CIPA patients revealed several old fractures of which the patients were unaware of previous injury. An early diagnosis of CIPA is important for the prevention and treatment of various complications. Our data indicate that radiological findings may provide important information for the diagnosis of CIPA. PMID:23478071

  8. Effectiveness of hip muscle strengthening in patellofemoral pain syndrome patients: a systematic review

    PubMed Central

    Santos, Thiago R. T.; Oliveira, BĂĄrbara A.; Ocarino, Juliana M.; Holt, Kenneth G.; Fonseca, SĂ©rgio T.

    2015-01-01

    Introduction: Patellofemoral pain syndrome (PFPS) is characterized by anterior knee pain, which may limit the performance of functional activities. The influence of hip joint motion on the development of this syndrome has already been documented in the literature. In this regard, studies have investigated the effectiveness of hip muscle strengthening in patients with PFPS. Objectives: The aims of this systematic review were (1) to summarize the literature related to the effects of hip muscle strengthening on pain intensity, muscle strength, and function in individuals with PFPS and (2) to evaluate the methodological quality of the selected studies. Method: A search for randomized controlled clinical trials was conducted using the following databases: Google Scholar, MEDLINE, PEDro, LILACS, and SciELO. The selected studies had to distinguish the effects of hip muscle strengthening in a group of patients with PFPS, as compared to non-intervention or other kinds of intervention, and had to investigate the following outcomes: pain, muscle strength, and function. The methodological quality of the selected studies was analyzed by means of the PEDro scale. Results: Seven studies were selected. These studies demonstrated that hip muscle strengthening was effective in reducing pain. However, the studies disagreed regarding the treatments' ability to improve muscle strength. Improvement in functional capabilities after hip muscle strengthening was found in five studies. Conclusion: Hip muscle strengthening is effective in reducing the intensity of pain and improving functional capabilities in patients with PFPS, despite the lack of evidence for its ability to increase muscle strength. PMID:26039034

  9. Time perspective, socioeconomic status, and psychological distress in chronic pain patients.

    PubMed

    Dany, Lionel; Roussel, Philippe; Laguette, Vanessa; Lagouanelle-Simeoni, Marie-Claude; Apostolidis, Themis

    2016-04-01

    Time perspective (TP) is a fundamental dimension of the psychological construction of time. It refers to a subjective experience and can be defined as the relationship that individuals and groups have with the present, past, and future. Studies have shown that it is interesting to take into account TP in the field of health, especially for the study of the psychological distress (PD) of individuals faced with aversive situations. We conducted a research, which aimed to explore the relationship between TP and PD in patients with chronic pain. A total of 264 first-time patients (72.3% women; mean age = 49 years) at CHU Timone (Marseille) pain center answered a questionnaire included TP, socioeconomic status, pain beliefs (PB), pain characteristics, and sociodemographic characteristics. Using hierarchical regression analyses adjusted to the characteristics of pain, sociodemographic characteristics, and PB, we can observe significant relationships between different components of TP, socioeconomic status, and PD. These results emphasize the importance of TP as psychosocial variable in the analysis of PD in patients with chronic pain. These results also lead us to point out the role of the socioeconomic status that predicts levels of PD. PMID:26153853

  10. Differential diagnosis of a patient with low back and toe pain

    PubMed Central

    Wahl, Elizabeth Cooper; Smith, David; Sesto, Mary; Boissonnault, William

    2013-01-01

    Low back pain is one of the most commonly treated conditions by outpatient orthopedic physical therapists. The management of low back pain is also responsible for a large economic burden in the United States and internationally, which highlights one of the many reasons why appropriate medical screening and referral is important in the physical therapy setting. The purpose of this case report is to describe the successful physical therapist screening and subsequent medical differential diagnosis of a 36- year-old male with chronic lower back and toe pain. Initial physical therapy evaluation supported a diagnosis of mechanical low back pain, but symptom progression through two treatment sessions indicated that a non-mechanical source of pain was instead the likely cause of the patient’s symptoms. The referring physician was contacted by the physical therapist and the patient was scheduled for further medical examination. A consult to rheumatology was placed and through compilation of clinical, laboratory, and imaging findings, a diagnosis of human leukocyte antigen B-27-positive spondyloarthropathy was made. Even with physician referral, it is imperative for clinicians to be proficient in screening for non-mechanical low back pain that may mimic a musculoskeletal origin of symptoms. PMID:24421618

  11. Palmitoylethanolamide restores myelinated-fibre function in patients with chemotherapy-induced painful neuropathy.

    PubMed

    Truini, A; Biasiotta, A; Di Stefano, G; La Cesa, S; Leone, C; Cartoni, C; Federico, V; Petrucci, M T; Cruccu, G

    2011-12-01

    We assessed the effect of palmitoylethanolamide (PEA) on pain and nerve function in patients with chemotherapy-induced painful neuropathy, in 20 patients undergoing thalidomide and bortezomib treatment for multiple myeloma. All patients were evaluated before and after a two-month treatment with PEA 300 mg BID using pain and warmth thresholds; blinded examiners measured motor and sensory nerve fibre function and laser-evoked potentials. Although no variables returned to normal values, pain and all neurophysiological measures ? assessing A?, A?, and A? fibres ? significantly improved (P < 0.05). In contrast, warmth thresholds, assessing unmyelinated afferents, remained unchanged (P > 0.50). Although a placebo effect might play a role in the reported pain relief, the changes in neurophysiological measures indicate that PEA exerted a positive action on myelinated fibre groups. PEA, possibly by moderating mast cell hyperactivity, relieved conduction blocks secondary to endoneural edema. In a severe condition such as painful neuropathy associated with multiple myeloma and chemotherapy, a safe substance such as PEA provides significant restoration of nerve function. PMID:22229320

  12. Successful control of radicular pain in a pediatric patient with Guillain-Barré syndrome.

    PubMed

    Kajimoto, Madoka; Koga, Michiaki; Narumi, Hiroko; Inoue, Hirofumi; Matsushige, Takeshi; Ohga, Shouichi

    2015-10-01

    A 10-year-old boy was diagnosed as having the axonal form of Guillain-Barré syndrome (GBS). The patient noticed progressive weakness of the lower legs on the 1st day of illness. Intravenous immunoglobulin therapy was immediately started on the 2nd day of illness. Despite the favorable recovery of muscle weakness, he complained of severe needle-like pain in the thighs and buttocks and also painful numbness over the gastrocnemius regions. Acetaminophen and hydroxyzine therapy was ineffective for the pain control. Oral prednisolone therapy (0.7 mg/kg/day) led to drastic pain-relief with favorable improvement of the weakness. Corticosteroid therapy is not typically used in the management of GBS patients. Although GBS-associated pain frequently occurs in children, only a few reports have indicated the analgesic utility of steroids in the treatment of pediatric GBS. This observation may suggest the alternative of this therapy as for the as the limited, but potentially rapid, control of GBS-associated acute radicular pain in pediatric patients. PMID:25690256

  13. Risk Assessment of Opioid Misuse in Italian Patients with Chronic Noncancer Pain

    PubMed Central

    Ferrari, Renata; Duse, Genni; Capraro, Michela; Visentin, Marco

    2014-01-01

    Objective. Opioid therapy in patients with chronic noncancer pain must be preceded by evaluation of the risk of opioid misuse. The aim of this study was to evaluate the predictive validity of the Italian translation of the Pain Medication Questionnaire (PMQ) and of the Diagnosis Intractability Risk and Efficacy Score (DIRE) in chronic pain patients. Design. 75 chronic noncancer pain patients treated with opioids were enrolled and followed longitudinally. Risk of opioid misuse was evaluated through PMQ, DIRE, and the physician's clinical evaluation. Pain experience and psychological characteristics were assessed through specific self-report instruments. At follow-ups, pain intensity, aberrant drug behaviors, and presence of the prescribed opioid and of illegal substances in urine were also checked. Results. PMQ demonstrated good internal consistency (Cronbach's ? = 0.77) and test-retest reliability (r = 0.86). Significant correlations were found between higher PMQ scores and the number of aberrant drug behaviors detected at 2-, 4-, and 6-month follow-ups (P < 0.01). Also the DIRE demonstrated good predictive validity. Conclusions. The results obtained with specific tools are more reliable than the clinician's evaluation alone in predicting the risk of opioid misuse; regular monitoring and psychological intervention will contribute to improving compliance and outcome of long-term opioid use. PMID:25177499

  14. Nurses' Experiences of Patients with Substance-Use Disorder in Pain: A Phenomenological Study.

    PubMed

    Morley, Georgina; Briggs, Emma; Chumbley, Gillian

    2015-10-01

    Patients with substance-use disorder and pain are at risk of having their pain underestimated and undertreated. Unrelieved pain can exacerbate characteristics that are believed to be 'drug-seeking' and in turn, perceived drug-seeking behavior can contribute to a patient being stigmatized and labeled 'difficult'. Previous literature has indicated that negative attitudes towards patients with substance-use disorder may affect their pain management but little is known about the specific barriers. This study explored nurses' experiences of working with patients with substance-use disorder in pain, providing an in-depth insight into their perspective. Descriptive phenomenology was employed as a framework for conducting semi-structured interviews to reveal the experiences of registered nurses. A convenience sample of registered nurses from a variety of clinical backgrounds were recruited and interv