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1

Patient pain drawing in diagnosing the cause of exercise-induced leg pain  

Microsoft Academic Search

IntroductionClassifying symptoms by patient pain drawing (PPD) may be helpful in diagnosing chronic anterior compartment syndrome (CACS). We have investigated the sensitivity and interobserver reliability of the PPD to diagnose CACS among patients with exercise-induced leg pain (EILP).MethodsThis study included 88 consecutive patients (48 men, 40 women; mean age 33, range 13–66, years). Two observers independently diagnosed the causes of

K Rennerfelt; Q Zhang; J Styf

2011-01-01

2

Pain drawings in somatoform-functional pain  

PubMed Central

Background Pain drawings are a diagnostic adjunct to history taking, clinical examinations, and biomedical tests in evaluating pain. We hypothesized that somatoform-functional pain, is mirrored in distinctive graphic patterns of pain drawings. Our aim was to identify the most sensitive and specific graphic criteria as a tool to help identifying somatoform-functional pain. Methods We compared 62 patients with somatoform-functional pain with a control group of 49 patients with somatic-nociceptive pain type. All patients were asked to mark their pain on a pre-printed body diagram. An investigator, blinded with regard to the patients’ diagnoses, analyzed the drawings according to a set of numeric or binary criteria. Results We identified 13 drawing criteria pointing with significance to a somatoform-functional pain disorder (all p-values???0.001). The most specific and most sensitive criteria combination for detecting somatoform-functional pain included the total number of marks, the length of the longest mark, and the presence of symmetric patterns. The area under the ROC-curve was 96.3% for this criteria combination. Conclusion Pain drawings are an easy-to-administer supplementary technique which helps to identify somatoform-functional pain in comparison to somatic-nociceptive pain. PMID:23256679

2012-01-01

3

Patient Education on Pain  

MedlinePLUS

... Education Annual Meeting Safe Prescribing Resources Clinical Pearls Patient Center Home > Patient Center > Patient Education > Patient Education ... to People with Pain Press Room Position Statements Patient Education on Pain AAPM Past President, Perry G. ...

4

Sensitization in patients with painful knee osteoarthritis  

Microsoft Academic Search

Pain is the dominant symptom in osteoarthritis (OA) and sensitization may contribute to the pain severity. This study investigated the role of sensitization in patients with painful knee OA by measuring (1) pressure pain thresholds (PPTs); (2) spreading sensitization; (3) temporal summation to repeated pressure pain stimulation; (4) pain responses after intramuscular hypertonic saline; and (5) pressure pain modulation by

Lars Arendt-Nielsen; Hongling Nie; Mogens B. Laursen; Birgitte S. Laursen; Pascal Madeleine; Ole H. Simonsen; Thomas Graven-Nielsen

2010-01-01

5

JAMA Patient Page: Acute Pain Treatment  

MedlinePLUS

... your pain. The Wong-Baker FACES Pain Rating Scale (below) may help young patients rate pain intensity. ... Hurts Little More 3 Hurts Even More FACES scale from Hockenbery MJ, Wilson D, Winkelstein ML. Wong’s ...

6

[Pain in multimorbid internistic patients].  

PubMed

Pain and pain management in multimorbid patients is a subject which is mostly unknown. General rules in pain management like the WHO analgesic ladder and its recommendations are to be equally respected as with other patients. As multimorbidity is a common problem especially in the elderly population, some changes in physiology, pharmacodynamics and pharmacokinetics have to be taken into consideration. A careful and slow adoption of dosage leads to more safety and tolerability. Other main problems of multimorbidity are drug-drug, drug-disease or disease-disease interactions, which influence the choice of analgesic medication. As especially the number of drug-drug interactions is endless, available software is a valuable aid to become aware of interactions and help weight the compromises. PMID:23233099

Schneider, D; Zimmerli, L

2012-12-12

7

Pain Coping Strategies in Osteoarthritis Patients.  

ERIC Educational Resources Information Center

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…

Keefe, Francis J.; And Others

1987-01-01

8

Effective pain management in patients with dementia: benefits beyond pain?  

PubMed

This current opinion aims to provide a literature overview of the associations between pain and neuropsychiatric symptoms and the efficacy of pain management for both pain and neuropsychiatric symptoms in patients with dementia. In addition, international guidelines and recommendations for pain management have been collated, and important developing research areas are highlighted. Pain is, in general, under-recognized and undertreated in people with dementia and may therefore trigger or exacerbate neuropsychiatric symptoms. While there is an abundance of pain assessment instruments intended for people with dementia, few have been adequately tested for their feasibility, reliability and validity. In patients with dementia, vocalizations, facial expressions and body movements may be the only valid expressions of pain. Further, pain has been related to the neuropsychiatric symptoms of agitation, aggression, mood syndrome and sleep problems. Unfortunately, health personnel may misinterpret these symptoms as neuropsychiatric symptoms of dementia. A differential assessment of dementia, its presenting neuropsychiatric symptoms and the potential presence of pain is crucial to provide the correct treatment. To achieve this, use of pain assessment tools that are responsive to change and are validated for use in patients with dementia is a prerequisite. To date, there have been few studies, with inconsistent findings on the association between pain and neuropsychiatric symptoms. To ensure a better differential assessment of pain and neuropsychiatric symptoms, and consequently more accurate treatment for patients with dementia, studies with adequate statistical power and high-quality study designs, including randomized controlled trials, are needed. PMID:25373921

Flo, Elisabeth; Gulla, Christine; Husebo, Bettina S

2014-12-01

9

Postoperative pain: nurses' knowledge and patients' experiences.  

PubMed

The aim of this study was to determine nurses' knowledge and attitudes regarding postoperative pain and identify postoperative patients' pain intensity experiences. The assessment and management of acute postoperative pain is important in the care of postoperative surgical patients. Inadequate relief of postoperative pain can contribute to postoperative complications such as atelectasis, deep vein thrombosis, and delayed wound healing. A pilot study with an exploratory design was conducted at a large teaching hospital in the eastern United States. The convenience samples included 31 nurses from the gastrointestinal and urologic surgical units and 14 first- and second-day adult postoperative open and laparoscopic gastrointestinal and urologic patients who received patient-controlled analgesia (PCA). The Knowledge and Attitudes Survey Regarding Pain was used to measure nurses' knowledge about pain management. The Short-Form McGill Pain Questionnaire (SF-MPQ) was used to measure patients' pain intensity. The nurses' mean score on the Knowledge and Attitudes Survey Regarding Pain was 69.3%. Patients experienced moderate pain, as indicated by the score on the SF-MPQ. There is a need to increase nurses' knowledge of pain management. PMID:24315258

Francis, Lavonia; Fitzpatrick, Joyce J

2013-12-01

10

Chronic Pain Patients: Implications for Rehabilitation Counseling.  

ERIC Educational Resources Information Center

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…

Scott, Lori T.

11

[Pain treatment in patients with hemophilia].  

PubMed

Pain in patients with hemophilia is an urgent problem. The possibilities of using analgesic drugs are interesting by virtue of the specific features of pain syndrome and the problems of treatment in these patients. Foreign and Russian trials using current analgesics are analyzed; difficulties in choosing analgesic therapy and in performing anesthesia mode in patients with congenital hypocoagulation and hyperalgesia are discussed. PMID:24754078

Levchenko, O K

2014-01-01

12

JAMA Patient Page: Chest Pain  

MedlinePLUS

... have many causes. Pain can come from the heart, lungs, gastrointestinal tract, muscles and bones of the chest ... CAUSES OF CHEST PAIN FOR MORE INFORMATION • National Heart, Lung, and Blood Institute www.nhlbi.nih.gov/health/ • ...

13

Pain in cognitively impaired nursing home patients  

Microsoft Academic Search

Pain is an understudied problem in frail elderly patients, especially those with cognitive impairment, delirium, or dementia. The focus of this study was to describe the pain experienced by patients in skilled nursing homes, which have a high prevalence of cognitive impairment. A random sample of 325 subjects was selected from ten community skilled nursing homes. Subjects underwent a cross-sectional

Bruce A. Ferrell; Betty R. Ferrell; Lynne Rivera

1995-01-01

14

Usefulness of Cordotomy in Patients With Cancer Who Experience Bilateral Pain: Implications of Increased Pain and New Pain  

PubMed Central

BACKGROUND: Although mirror pain occurs after cordotomy in patients experiencing unilateral pain via a referred pain mechanism, no studies have examined whether this pain mechanism operates in patients who have bilateral pain. OBJECTIVE: To assess the usefulness of cordotomy for bilateral pain from the viewpoint of increased pain or new pain caused by a referred pain mechanism. METHODS: Twenty-six patients who underwent percutaneous cordotomy through C1-C2 for severe bilateral cancer pain in the lumbosacral nerve region were enrolled. Pain was dominant on 1 side in 23 patients, and pain was equally severe on both sides in 3 patients. Unilateral cordotomy was performed for the dominant side of pain, and bilateral cordotomy was performed for 13 patients in whom pain on the nondominant side developed or remained severe after cordotomy. RESULTS: After unilateral cordotomy, 19 patients (73.1%) exhibited increased pain, which for 14 patients was as severe as the original dominant pain. After bilateral cordotomy, 7 patients (53.4%) exhibited new pain, which was located cephalad to the region rendered analgesic by cordotomy and was better controlled than the original pain. No pathological organic causes of new pain were found in any patient, and evidence of a referred pain mechanism was found in 3 patients after bilateral cordotomy. CONCLUSION: These results show that a referred pain mechanism causes increased or new pain after cordotomy in patients with bilateral pain. Nevertheless, cordotomy can still be indicated for patients with bilateral pain because postoperative pain is better controlled than the original pain. PMID:25603110

Higaki, Nobuhiro; Yorozuya, Toshihiro; Tsubota, Shinzo; Fujii, Tomomi; Fukunaga, Tomoe; Moriyama, Mitsuhide; Yoshikawa, Takeki

2015-01-01

15

Chronic neuropathic pain: issues in patient education.  

PubMed

Chronic neuropathic pain is difficult to diagnose and treat. For the patient, multiple aspects of his or her life may be altered, including physical, emotional, and spiritual health, as well as the ability to work, and family and social relationships. Successful treatment plans require more than just pharmacotherapy. Patients often need to receive a lot of information about complex regimens related to both pharmacologic and nonpharmacologic strategies. Additionally, patients with neuropathic pain need nursing support and guidance to help them master the self-management and coping skills required to minimize pain flares, while optimizing mood and functioning. A number of specific strategies are available based on the cognitive-behavioral model. These include the ability to interpret changes in pain in a helpful way, engagement in health promoting behaviors (including diet and exercise), and the development of an action plan for coping with pain exacerbations. A central element in this approach is to help patients become experts in understanding and managing their pain, then addressing the toll it has taken on their emotions, daily activities, and important relationships. Self-initiated techniques, such as relaxation, imagery, and hypnosis, can also be used to alter the subjective experience of pain. This article presents an overview of patient education approaches useful in the management of chronic pain. PMID:15644857

Arnstein, Paul

2004-12-01

16

[Treatment of pain in patients after tonsillectomy].  

PubMed

The aim of the study was to evaluate post-operative pain in patients after tonsillectomy, treated with non-steroid anti-inflammatory and opioid drugs. A group of 57 patients aged from 16 to 53 years was examined. 32 of them were treated with ketoprofen (Ketonal, Lek) in a dose 100 mg, 3 times a day and the remaining 25 with tramadol hydrochloride (Tramal) in daily doses 150-200 mg. The numerical 0 to 10 (VAS) and 6-grade verbal scales were used to assess pain intensity. Pain intensity was highest 3-4 days after tonsillectomy. The scores below 5 points (VAS) were noted by 65% of patients treated with ketoprofen and 90% of patients treated with tramadol after the first 24 postoperative hours. The pain reacted relatively well to oral analgesics and did not require prolonged hospitalisation. A double mechanism of reducing pain by tramadol--central and spinal--may be more effective in patients after tonsillectomy than ketoprofen that blocks production of arachidonic acid cascade. In the course of the first few postoperative days, inflammation is aggravated due to infection of the wound in the throat and the latter mechanism alone may be insufficient. Effectiveness of either ketoprofen or tramadol in treatment of post-tonsillectomy pain is good but better in the case of tramadol. Patients must be informed in advance about a possibility of more intense pain a few days after tonsillectomy, in order to avoid unjustified fear. PMID:17642138

Zagólski, Olaf; Kulisiewicz, Jan; Berna?, Marek; Keku?, Jerzy

2006-01-01

17

Chronic Pain and PTSD: A Guide for Patients  

MedlinePLUS

... here Chronic Pain and PTSD: A Guide for Patients Chronic Pain and PTSD: A Guide for Patients What is chronic pain? Chronic pain is when ... consistency when different doctors try to measure a patient's pain. Sometimes the care provider may not believe ...

18

Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey  

Microsoft Academic Search

Breakthrough pain (BKP) is a transitory flare of pain that occurs on a background of relatively well controlled baseline pain. Previous surveys have found that BKP is highly prevalent among patients with cancer pain and predicts more severe pain, pain-related distress and functional impairment, and relatively poor quality of life. An international group of investigators assembled by a task force

Augusto Caraceni; Cinzia Martini; Ernesto Zecca; Russell K Portenoy; M. A. Ashby; G. Hawson; K. A. Jackson; N. Lickiss; N. Muirden; M. Pisasale; D. Moulin; V. N. Schulz; M. A. Rico Pazo; J. A. Serrano; H. S. Andersen; H. T. Henriksen; I. Mejholm; P. M. Sjogren; T. Heiskanen; E. Kalso; P. Pere; R. Poyhia; E. Vuorinen; I. Tigerstedt; P. Ruismaki; M. Bertolino; F. Larue; J. Y. Ranchere; G. Hege-Scheuing; I. Bowdler; F. Helbing; E. Kostner; L. Radbruch; K. Kastrinaki; S. Shah; S. Vijayaram; K. S. Sharma; P. S. Devi; P. N. Jain; P. V. Ramamani; A. Beny; C. Brunelli; M. Maltoni; S. Mercadante; R. Plancarte; S. Schug; P. Engstrand; A. F. Ovalle; X. Wang; M. F. Alves; M. R. Abrunhosa; W. Z. Sun; L. Zhang; A. Gazizov; M. Vaisman; S. Rudoy; M. G. Sancho; P. Vila; J. Trelis; P. Chaudakshetrin; M. L. Koh; R. T. M. van Dongen; A. Vielvoye-Kerkmeer; M. V. Boswell; T. Elliott; E. Hargus; L. Lutz

2004-01-01

19

Cerebral responses to pain in patients with atypical facial pain measured by positron emission tomography  

Microsoft Academic Search

The localised PET cerebral correlates of the painful experience in the normal human brain have previously been demonstrated. This study examined whether these responses are different in patients with chronic atypical facial pain. The regional cerebral responses to non-painful and painful thermal stimuli in six female patients with atypical facial pain and six matched female controls were studied by taking

S W Derbyshire; A K Jones; P Devani; K J Friston; C Feinmann; M Harris; S Pearce; J D Watson; R S Frackowiak

1994-01-01

20

Pharmacological pain management in the elderly patient  

PubMed Central

With the increasing number of elderly patients the issue of pain management for older people is of increasing relevance. The alterations with aging of the neurobiology of pain have impacts of pain threshold, tolerance and treatment. In this review the available evidence from animal and human experimentation is discussed to highlight the differences between young and older subjects along with consideration of how these changes have practical effect on drug treatment of pain. Cognitive impairment, physical disability and social isolation can also impact on the accessibility of treatment and have to be considered along with the biological changes with ageing. Conventional pain therapies, while verified in younger adults cannot be automatically applied to the elderly without consideration of all these factors and in no other group of patients is a holistic approach to treatment more important. PMID:18225465

McCleane, Gary

2007-01-01

21

Drug management of pain in cancer patients.  

PubMed Central

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

Tuttle, C B

1985-01-01

22

Pain and Its Treatment in Patients with Cancer in Korea  

Microsoft Academic Search

Substantial pain is experienced by a lot of patients with cancer, and undertreated pain significantly undermines their quality of life. Despite international and national guidelines on cancer pain management, the practical effectiveness of management is still problematic. We did a prospective cross-sectional survey on pain prevalence, pain intensity, its impact on daily activity, and adequacy of pain management in 823

Myung Soo Hyun; Jae Lyun Lee; Kyung Hee Lee; Ki Young Kwon; Hong Suk Song; Ok Bae Kim; Sang Kyun Sohn; Kyu Bo Lee; Hun Mo Rhu; Gun Wook Park; Dong Gun Shin; Jeong Lim Lee

2003-01-01

23

Pain management in patients with dementia.  

PubMed

There are an estimated 35 million people with dementia across the world, of whom 50% experience regular pain. Despite this, current assessment and treatment of pain in this patient group are inadequate. In addition to the discomfort and distress caused by pain, it is frequently the underlying cause of behavioral symptoms, which can lead to inappropriate treatment with antipsychotic medications. Pain also contributes to further complications in treatment and care. This review explores four key perspectives of pain management in dementia and makes recommendations for practice and research. The first perspective discussed is the considerable uncertainty within the literature on the impact of dementia neuropathology on pain perception and processing in Alzheimer's disease and other dementias, where white matter lesions and brain atrophy appear to influence the neurobiology of pain. The second perspective considers the assessment of pain in dementia. This is challenging, particularly because of the limited capacity of self-report by these individuals, which means that assessment relies in large part on observational methods. A number of tools are available but the psychometric quality and clinical utility of these are uncertain. The evidence for efficient treatment (the third perspective) with analgesics is also limited, with few statistically well-powered trials. The most promising evidence supports the use of stepped treatment approaches, and indicates the benefit of pain and behavioral interventions on both these important symptoms. The fourth perspective debates further difficulties in pain management due to the lack of sufficient training and education for health care professionals at all levels, where evidence-based guidance is urgently needed. To address the current inadequate management of pain in dementia, a comprehensive approach is needed. This would include an accurate, validated assessment tool that is sensitive to different types of pain and therapeutic effects, supported by better training and support for care staff across all settings. PMID:24204133

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

2013-01-01

24

Pain management in patients with dementia  

PubMed Central

There are an estimated 35 million people with dementia across the world, of whom 50% experience regular pain. Despite this, current assessment and treatment of pain in this patient group are inadequate. In addition to the discomfort and distress caused by pain, it is frequently the underlying cause of behavioral symptoms, which can lead to inappropriate treatment with antipsychotic medications. Pain also contributes to further complications in treatment and care. This review explores four key perspectives of pain management in dementia and makes recommendations for practice and research. The first perspective discussed is the considerable uncertainty within the literature on the impact of dementia neuropathology on pain perception and processing in Alzheimer’s disease and other dementias, where white matter lesions and brain atrophy appear to influence the neurobiology of pain. The second perspective considers the assessment of pain in dementia. This is challenging, particularly because of the limited capacity of self-report by these individuals, which means that assessment relies in large part on observational methods. A number of tools are available but the psychometric quality and clinical utility of these are uncertain. The evidence for efficient treatment (the third perspective) with analgesics is also limited, with few statistically well-powered trials. The most promising evidence supports the use of stepped treatment approaches, and indicates the benefit of pain and behavioral interventions on both these important symptoms. The fourth perspective debates further difficulties in pain management due to the lack of sufficient training and education for health care professionals at all levels, where evidence-based guidance is urgently needed. To address the current inadequate management of pain in dementia, a comprehensive approach is needed. This would include an accurate, validated assessment tool that is sensitive to different types of pain and therapeutic effects, supported by better training and support for care staff across all settings. PMID:24204133

Achterberg, Wilco P; Pieper, Marjoleine JC; van Dalen-Kok, Annelore H; de Waal, Margot WM; Husebo, Bettina S; Lautenbacher, Stefan; Kunz, Miriam; Scherder, Erik JA; Corbett, Anne

2013-01-01

25

Epiduroscopy for patients with lumbosacral radicular pain.  

PubMed

Lumbosacral radicular pain is a pain in the distribution area of one of the nerves of the lumbosacral plexus, with or without sensory and/or motor impairment. A major source of lumbosacral radicular pain is failed back surgery, which is defined as persistent or recurrent pain, mainly in the region of the lower back and legs even after technically, anatomically successful spine surgeries. If lumbosacral radicular neuropathic pain fails to respond to conservative or interventional treatments, epiduroscopy can be performed as part of a multidisciplinary approach. Epiduroscopy aids in identifying painful structures in the epidural space, establishing a diagnosis and administering therapy. The novelty consists in the use of an epiduroscope to deliver therapies such as adhesiolysis and targeted administration of epidural medications. Clinical trials report favorable treatment outcomes in 30% to 50% of patients. Complications are rare and related to the rate or volume of epidural fluid infusion or inadvertent dural puncture. In patients with lumbosacral radicular pain, especially after back surgery, epiduroscopy with adhesiolysis may be considered (evidence rating 2 B+). PMID:23941663

Kallewaard, Jan Willem; Vanelderen, Pascal; Richardson, Jonathan; Van Zundert, Jan; Heavner, James; Groen, Gerbrand Jan

2014-04-01

26

How to image patients with spine pain.  

PubMed

Different radiological methods play an important role in the work-up of patients complaining of spine pain. Depending on the symptoms and the suspected underlying etiology different methods are selected. In the following presentation we briefly present the different radiological and magnetic resonance tomography methods that are at hand, give some guidance in which method to use, and present the typical imaging findings in some of the most common conditions that presents with spine pain. PMID:25048978

Siemund, R; Thurnher, M; Sundgren, P C

2015-05-01

27

Pain Management in Cancer Patients  

Microsoft Academic Search

\\u000a Cancer is one of the most debilitating and deadly diseases that, broadly speaking, shows no preference for demographic, sex,\\u000a age, or culture. It is the second leading cause of mortality of all Americans as a single disease [1], and the sheer potential\\u000a for mortality from cancer can be a horrifying experience for anyone bearing this diagnosis. Pain is probably one

Hrachya Nersesyan; Jeffrey J. Mucksavage; Eljim Tesoro; Konstantin V. Slavin

28

[Pain management in patients with liver cirrhosis].  

PubMed

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

Ojeda, Antonio; Moreno, Luis A

2014-01-01

29

Effects of performance feedback on patient pain outcomes.  

PubMed

The purpose of this study was to examine the effects of an individual feedback intervention provided to nurses on selected patient outcomes related to postoperative pain management Individual performance feedback served as the intervention. Thirty orthopedic staff nurses received feedback information on their past performance of recommended pain management practices. Data were collected preintervention and postintervention on selected patient pain outcomes from the medical records of 240 patients who had undergone total knee arthroplasty. The patient outcome measures were mean 4-hour pain intensity ratings, mean highest pain intensity ratings, mean number of times pain ratings exceeded patients' acceptable level of pain, mean administered morphine equivalents, and mean pain ratings on reassessment following analgesia administration. An improvement was noted in all pain outcomes following the feedback intervention. Results indicate that providing nurses with feedback on their past performance of pain management practices may contribute to decreased postoperative pain. PMID:11881696

Duncan, K; Pozehl, B

2000-11-01

30

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

ERIC Educational Resources Information Center

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…

Weldt, Cristina

2003-01-01

31

Neuropathic Pain in Patients with Sickle Cell Disease  

PubMed Central

Background Despite the suggestion of a neuropathic component to sickle cell disease (SCD) pain, there are minimal data on the systematic assessment of neuropathic pain in patients with SCD. Neuropathic pain is defined as pain primarily initiated by dysfunction of the peripheral or central nervous system. Procedure In a cross-sectional study, we used the painDETECT questionnaire, a one-page validated neuropathic pain screening tool, to determine the presence of neuropathic pain in patients with SCD and to evaluate the relationship between neuropathic pain, age, and gender. We hypothesized that 20% of patients with SCD will experience neuropathic pain and that neuropathic pain will be associated with older age and female gender. The completed painDETECT questionnaire yields a total score between 0–38 (?19=definite neuropathic pain, 13–18=probable neuropathic pain, ?12=no neuropathic pain). Scores ?13 were designated as having evidence of neuropathic pain. Results A total of 56 patients participated. Median age was 20.3 years and 77% were female. We found 37% of patients had evidence of neuropathic pain. Age was positively correlated with total score [r=0.43; p=0.001] suggesting older patients experience more neuropathic pain. Females had higher mean total scores [13 vs 8.4; p=0.04]. Significantly more patients with neuropathic pain were taking hydroxyurea [90% vs 59%; p=0.015]. Despite 37% of patients experiencing neuropathic pain, only 5% were taking a neuropathic pain drug. Conclusions Neuropathic pain exists in SCD. Valid screening tools can identify patients that would benefit from existing and future neuropathic pain therapies and could determine the impact of these therapies. PMID:24167104

Brandow, Amanda M.; Farley, Rebecca A.; Panepinto, Julie A.

2015-01-01

32

Pain control in cancer patients in tertiary care setting  

Microsoft Academic Search

Objective: To investigate the prevalence of significant pain and the appropriateness of analgesics treatment prescribed among cancer patients with pain in tertiary care hospitals. Material and Method: A cross-sectional study was conducted between October 2007 and June 2008 on 228 cancer patients with pain in the outpatient pain clinic of a university hospital and the inpatient ward of a regional

Naiyana Patcharapisarn; Penkae Ketumarn

33

Pain measurement in patients with low back pain  

Microsoft Academic Search

Pain is a multidimensional experience that is a prominent feature of many musculoskeletal disorders. Despite its subjective nature, pain is a highly relevant complaint; hence, nothing should deter physicians from attempting to formally assess it. This Review summarizes the main aspects of pain measurement from a practical standpoint, with a specific focus on low back pain. On balance, for the

Federico Balagué; Ferran Pellisé; Christine Cedraschi; Anne F Mannion

2007-01-01

34

Characteristics of Neuropathic Pain in Patients With Spinal Cord Injury  

PubMed Central

Objective To characterize neuropathic pain in patients with spinal cord injury (SCI) according to classification used in the study by Baron et al. (Baron classification), a classification of neuropathic pain based on the mechanism. To also compare the patterns of neuropathic pain in SCI patients with those in patients with other etiologies and to determine the differences in patterns of neuropathic pain between the etiologies. Methods This was a descriptive cross-sectional study. We used the Baron classification to investigate the characteristics of neuropathic pain in SCI. Sixty-one SCI patients with neuropathic pain (The Leeds assessment of neuropathic symptoms and signs score ?12) were enrolled in this study between November 2012 and August 2013, after excluding patients <20 of age, patients with visual analog scale (VAS) score <3, pregnant patients, and patients with systemic disease or pain other than neuropathic pain. Results The most common pain characteristic was pricking pain followed by electrical pain and numbness. The mean VAS score of at-level neuropathic pain was 7.51 and that of below-level neuropathic pain was 6.83. All of the patients suffered from rest pain, but 18 (54.6%) patients with at-level neuropathic pain and 20 (50.0%) patients with below-level neuropathic pain suffered from evoked pain. There was no significant difference in between at-level and below-level neuropathic pains. Conclusion The result was quite different from the characteristics of post-herpetic neuralgia, but it was similar to the characteristics of diabetic neuropathy as shown in the study by Baron et al., which means that sensory nerve deafferentation may be the most common pathophysiologic mechanism of neuropathic pain after SCI. Since in our study, we included short and discrete symptoms and signs based on diverse mechanisms, our results could be helpful for determining further evaluation and treatment. PMID:25024955

Jang, Joon Young; Lee, Seung Hoon; Kim, MinYoung

2014-01-01

35

Pain. Author manuscript A patient-based national survey on postoperative pain management in  

E-print Network

Pain. Author manuscript Page /1 18 A patient-based national survey on postoperative pain management.fletcher@rpc.aphp.fr> Abstract We carried out a national survey on postoperative pain (POP) management in a representative sample pain, evaluation, treatment and side effects. A local consultant provided information about POP

Boyer, Edmond

36

Determination of Clinically Meaningful Levels of Pain Reduction in Patients Experiencing Acute Postoperative Pain  

Microsoft Academic Search

Assessment is an essential, but challenging, component of any pain management plan. Nurses who care for postoperative patients quantify and document pain by use of unidimensional scales such as the numeric rating scale, the visual analogue scale, or a verbal descriptor scale. Improvements in pain ratings on these scales are viewed as a welcome result by nurses and doctors. Pain,

Rod Sloman; Anna Woloski Wruble; Gila Rosen; Miriam Rom

2006-01-01

37

Comparison of pain scale preferences and pain intensity according to pain scales among Turkish Patients: a descriptive study.  

PubMed

Pain scale preferences may vary among patients. Providing a choice of which pain scale to use might be helpful for patients. The aim of this study was to determine patient pain scale preferences and compare the level of agreement among pain scales commonly used during postoperative pain assessment. A total of 621 patients during the early postoperative period were enrolled in this descriptive study. A questionnaire form, the faces pain scale (FPS), visual analog scale (VAS), numeric rating scale (NRS), verbal descriptor scale (VDS), thermometer pain scale (TPS), McGill Pain Questionnaire (MPQ), Short-form McGill Pain Questionnaire (SFMPQ), and Brief Pain Inventory (BPI) were used to collect data. Most patients reported that their pain was not measured with any of the pain scales. Patient preference for pain scales were as follows: 97.4% FPS, 88.6% NRS, 84.1% VDS, 78.1% TPS, 60.1% SFMPQ, 37.0% BPI, 11.4% VAS, and 10.5% MPQ. Education was an important factor in the preferences for all scales (p < .000). The level of pain determined by the VAS did not correlate with the level of pain identified by the NRS, TPS, FPS, and VDS (p < .05). There was no difference among the levels of pain for the NRS, TPS, FPS and VDS (p > .05), but there was for the VAS (p < .05). The pain scales chosen should be reliable, valid, and able to evaluate the effects of treatment. The results suggest that the NRS, TPS, FPS, and VDS were appropriate pain rating scales for the participants in this study, and that the VAS should be used in combination with one of these scales. PMID:24602433

Yazici Sayin, Yazile; Akyolcu, Neriman

2014-03-01

38

Pharmacotherapy in pain patients with substance abuse.  

PubMed

Definitions and difficulties relating to managing acute and chronic pain in patients with current or past substance abuse disorders are discussed. Problems with too rapid discontinuation of drugs are described. An interdisciplinary approach involving pain specialists, substance abuse clinicians and mental health professional is advocated. This report is adapted from paineurope 2014; Issue 3, ©Haymarket Medical Publications Ltd, and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, LTD and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication. PMID:25643233

Schäfer, Michael; Denke, Claudia; Krampe, Henning; Spies, Claudia

2015-03-01

39

The Relationship Between Depression and Pain Language in Cancer and Chronic Non-Cancer Pain Patients  

Microsoft Academic Search

The present study investigated the relationship between depression and pain description among cancer and chronic non-cancer pain patients in a large outpatient sample. Participants consisted of 312 patients (158 men and 154 women) attending a pain management clinic at a comprehensive cancer institute. Sixty-one percent of the patients (190\\/312) were experiencing pain related to cancer and 39% (122\\/312) were experiencing

Thomas C. Sist; Gerard A. Florio; Marguerite F. Miner; Mark J. Lema; Michael A. Zevon

1998-01-01

40

Patient Pain in Primary Care: Factors That Influence Physician Diagnosis  

PubMed Central

BACKGROUND The accurate recognition of patient pain is a crucial, but sometimes difficult, task in medical care. This study explored factors related to the physician’s diagnosis of pain in primary care patients. METHODS New adult patients were prospectively randomized to care by primary care providers at a university medical center clinic. Study participants were interviewed prior to the initial visit, and their level of self-reported pain was measured with the Visual Analog Pain Scale and the Medical Outcomes Study Short Form-36. The medical encounter was videotaped in its entirety and later analyzed using the Davis Observation Code to characterize physician practice style. Patient satisfaction was measured immediately after the visit. A review of the medical record was used to assess physician recognition of patient pain. RESULTS For all patients (N = 509), as the amount of pain increased, the percentage of patients having pain diagnosed by the physician also increased. Female patients reported a greater amount of pain than male patients. When women were in severe pain, they were more likely than men to have their pain accurately recognized by their physician. The correct diagnosis of pain was not significantly related to patient satisfaction. Physician practice styles emphasizing technically oriented activities and health behavior discussions were strongly predictive of the physician diagnosing patient pain. CONCLUSIONS The diagnosis of pain is influenced by the severity of patient pain, patient gender, and physician practice style. If the routine use of pain assessment tools is found to be effective in improving physician recognition and treatment of patientspain, then application of these tools in patient care settings should be encouraged. PMID:15209199

Bertakis, Klea D.; Azari, Rahman; Callahan, Edward J.

2004-01-01

41

The effects of abdominal draw-in maneuver and core exercise on abdominal muscle thickness and Oswestry disability index in subjects with chronic low back pain  

PubMed Central

The purpose of this study was to effects of abdominal draw-in maneuver and core exercise with 4 weeks using the musculoskeletal ultrasonography on muscle thickness and disability in subjects with low back pain. Twenty patients with nonspecific back pain (abdominal draw-in maneuver group: n= 10, core exercise group: n= 10) were recruited in the study. Both group received exercise intervention 3 times a week for 4weeks. The test were based on muscle thickness (transversus abdominis; Tra, internal oblique; IO and external oblique; EO), disability (Oswestry disability index; ODI) measured immediately before and after intervention. The data was measured by SPSS program 12.0 version and analyzed by Paired t-test and Independent t-test. The following results were obtained. The thickness of IO, EO for both group significantly improved except for muscle thickness of Tra. The ODI were significant difference for both groups. As the results of this study, we suggest that it may be effective method to apply to increase for the thickness of Tra, EO using abdominal draw-in maneuver and thickness of IO using core exercise. PMID:24278873

Park, Seong-Doo; Yu, Seong-Hun

2013-01-01

42

Duloxetine vs. placebo in patients with painful diabetic neuropathy  

Microsoft Academic Search

The aim of this study was to examine the efficacy and safety of duloxetine, a balanced and potent dual reuptake inhibitor of serotonin and norepinephrine, in the management of diabetic peripheral neuropathic pain. Serotonin and norepinephrine are thought to inhibit pain via descending pain pathways. In a 12-week, multicenter, double-blind study, 457 patients experiencing pain due to polyneuropathy caused by

David J. Goldstein; Yili Lu; Michael J. Detke; Thomas C. Lee; Smriti Iyengar

2005-01-01

43

Determination of clinically meaningful levels of pain reduction in patients experiencing acute postoperative pain.  

PubMed

Assessment is an essential, but challenging, component of any pain management plan. Nurses who care for postoperative patients quantify and document pain by use of unidimensional scales such as the numeric rating scale, the visual analogue scale, or a verbal descriptor scale. Improvements in pain ratings on these scales are viewed as a welcome result by nurses and doctors. Pain, however, is a multidimensional phenomenon. Furthermore, pain is subjective, and therefore no objective measure of pain exists that captures every aspect of the pain experience. Given that clinical decisions are made on the basis of existing scales, it is important to know how much reduction in pain is clinically meaningful from the patient's perspective. The aim of this study was to investigate this issue by comparing levels of postsurgical pain reduction measured by a numeric rating scale (NRS) with the patients' verbal descriptions of how meaningful they consider their pain reduction to be. A convenience sample of 150 postoperative patients was obtained. The patients' postoperative pain intensity levels before and after analgesia were measured and compared with their verbal descriptions of what constitutes a clinically meaningful pain reduction. The results of the study showed a significant correlation between the percentage of reduction in pain severity and the patients' descriptive ratings of pain improvement. A unique finding of the study was that the degree of incremental shift on an NRS of pretreatment and posttreatment pain levels is not a good predictor of clinical relevance from the patient's perspective. A more accurate predictor was found by converting the changes on the NRS to percentages. An important implication of this study is the need to include a scale in pain assessment instruments for assessing the level of clinical meaningfulness of pain reduction from the patient's perspective. PMID:17145489

Sloman, Rod; Wruble, Anna Woloski; Rosen, Gila; Rom, Miriam

2006-12-01

44

Nurses Managing Patients' Pain May Experience Moral Distress.  

PubMed

Bedside nurses care for patients with pain every day but the task is often challenging. A previous qualitative study that investigated nurses' experiences as they treated patients with pain suggested that nurses may suffer from moral distress if they are unsuccessful in providing adequate pain relief. As 20 of the original 48 nurses interviewed described frustration and distress when constrained from doing the right thing to provide pain relief for their patients, the purpose of this secondary qualitative analysis was to answer new research questions on nurse moral distress related to managing pain. Findings indicated that difficulties in nurse/physician communication and lack of pain education were contributors to nurses' frustrations and provided barriers to optimal pain management. Many participants indicated a need for interprofessional pain management education. Further investigation is needed to clarify the impact of moral distress on nurses managing hospitalized patients' pain. PMID:24836821

Bernhofer, Esther I; Sorrell, Jeanne M

2014-05-16

45

Functional Restoration of Patients with Pain  

Microsoft Academic Search

\\u000a This chapter will introduce a different group of clinicians who treat pain with a primary focus of improvement in functional\\u000a mobility of the patients. One of these disciplines is physical medicine and rehabililtation, also called physiatry. Like any other clinician, a physiatrist follows the established algorithms for the diagnosis and treatment of a variety\\u000a of medical conditions. The same is

Ali Nemat; Yogi Matharu

46

[Family emotional climate of pain patients].  

PubMed

Personal clinical experiences in an interdisciplinary pain clinic and their integration into family interaction theories led to a concept of an explorative study of chronic pain patients. Therefore 32 patients and their spouses were investigated with the "family-environment-scale" (by Moos and Moos 1981, adapted by Schneewind et al. 1985). Most of the couples showed agreement with regard to familial solidarity, combined with few expressions of anger and conflict and low achievement orientation. The typical profile of these factors led to one group with the "positive-emotional family climate", in contrast to one group with the "normative-authoritative family climate". In addition, a potentially new factor was described as a so-called "symbiotic family climate". The latter constellation was on the one hand quite similar compared to the "positive-emotional climate", but differed on the other hand because of the small amount of structural control. The interference of these family climate profiles with the process of chronification for pain patients is discussed. PMID:8693056

Gralow, I; Hannich, H J; Hürter, A; Timmer, H

1996-05-01

47

Infrequent assessment of pain in elderly trauma patients.  

PubMed

There are inherent difficulties in assessing and managing pain in elderly trauma patients, especially those with chronic health conditions or diminished capacities for self-reporting pain. This retrospective study identifies and describes patterns of pain assessment for a trauma population of older adults (age ?65 years). Gaps between patient assessments existed in all phases of hospitalization and did not meet hospital guidelines for frequency of assessment. In addition, assessment methods were not always appropriate for the patient population. We conclude that older patients were not assessed for pain frequently enough, and that more regular and routine pain assessments may improve patient outcomes. PMID:25198078

Spilman, Sarah K; Baumhover, Lisa A; Lillegraven, Cheryl L; Lederhaas, George; Sahr, Sheryl M; Schirmer, Lori L; Smoot, Dustin L; Swegle, James R

2014-01-01

48

Thalamic Pain Syndrome (Central Post-Stroke Pain) in a patient presenting with right upper limb pain: a case report  

PubMed Central

In the elderly, pain of a widespread nature can often be debilitating. It is not uncommon to attribute this widespread pain to osteoarthritis within the spinal column structures and peripheral joints or to other musculoskeletal etiology. However, chiropractors should remain wary regarding pain experienced by the elderly, especially if pain is widespread and exhibits neuropathic features. Common features of neuropathic pain involve the presence of allodynia, hyperpathia and hyperalgesia. This characteristic widespread pain can sometimes be the sequelae of a central nervous system lesion such as a “Thalamic Pain Syndrome”, or “Central Post-Stroke Pain”, which are terms commonly used to describe pain that originates in the central nervous system. Following is the case of a 90-year-old patient presenting with widespread pain attributed to Thalamic Pain Syndrome or Central Post-Stroke Pain. Discussion of the characteristics of neuropathic pain and bedside testing techniques are presented to help the chiropractor identify a patient who may be presenting with Central Post-Stroke Pain.

Tuling, Jeffrey R; Tunks, Eldon

1999-01-01

49

Monitoring of opioid therapy in advanced cancer pain patients  

Microsoft Academic Search

Until now, there have not been any parameters to monitor opioid therapy in cancer patients with pain. In this study, 325 consecutive advanced cancer patients were scheduled for a prospective longitudinal survey. After exclusions, 67 patients were surveyed. All included patients were advanced cancer patients with pain that required opioid therapy for more than 6 weeks before death. Opioid escalation,

Sebastiano Mercadante; Gabriella Dardanoni; Leonardo Salvaggio; Maria Gabriella Armata; Antonio Agnello

1997-01-01

50

Predictors of Pain Control in Patients Undergoing Flexible Bronchoscopy  

Microsoft Academic Search

The purpose of this study was to assess the extent to which pa- tients undergoing flexible bronchoscopy (FOB) experience pain and to identify patient factors and process of care factors that are associated with pain. We conducted a prospective cohort study on 481 patients undergoing FOB. Overall control of pain during FOB was the primary outcome. The mean age of

NOAH LECHTZIN; HAYA R. RUBIN; MOLLIE JENCKES; PETER WHITE; LI-MING ZHOU; DAVID A. THOMPSON; GREGORY B. DIETTE

2000-01-01

51

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

PubMed Central

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.

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

2014-01-01

52

Emotional and neurobehavioural status in chronic pain patients  

PubMed Central

OBJECTIVE: To investigate the emotional and neurobehavioural status of patients suffering from chronic pain. METHODS: Fifteen male patients with chronic lower back pain and 15 healthy control subjects were studied for approximately six months. Pain was measured using a visual analogue scale. The WHO Neurobehavioral Core Test Battery (NCTB) was used to assess neurobehavioural effects of environmental and occupational exposures. RESULTS: Visual analogue scale results demonstrated a modest range of reported pain (mean [± SD] 62.0±10.8) in chronic pain patients, whereas control subjects reported no measurable pain. With the NCTB, it was found that scores of negative mood state, including anger-hostility, depression-dejection, fatigue-inertia and tension-anxiety in pain patients were significantly higher than scores in the control subjects. By contrast, scores of positive mood state (vigour-activity) in chronic pain patients were lower than those in the control group. The NCTB scores of the Santa Ana Dexterity and Pursuit Aiming II tests in chronic lower back pain patients were lower than those of the control group. Scores for other NCTB sub-tests, including the Digit Span, Benton Visual Retention and Digit Symbol tests, were not significantly different compared with controls. CONCLUSIONS: Chronic lower back pain patients had more negative mood and less positive mood than controls. These patients also demonstrated neuromotor deficits in coordination and reaction time. Further studies are required to examine possible neurological mechanisms and research potential intervention strategies for patients suffering from chronic pain. PMID:21369540

Shuchang, He; Mingwei, He; Hongxiao, Jia; Si, Wu; Xing, Yang; Antonius, Daniel; Opler, Mark GA

2011-01-01

53

Evoked Pain Analgesia in Chronic Pelvic Pain Patients Using Respiratory-Gated Auricular  

E-print Network

Evoked Pain Analgesia in Chronic Pelvic Pain Patients Using Respiratory-Gated Auricular Vagal branch of the vagus nerve in the ear. The dorsal medullary vagal system operates in tune with respiration pain analgesia for respiratory-gated auricular vagal affer- ent nerve stimulation (RAVANS) compared

Napadow, Vitaly

54

Management of shoulder pain in patients with stroke  

PubMed Central

Shoulder pain affects from 16% to 72% of patients after a cerebrovascular accident. Hemiplegic shoulder pain causes considerable distress and reduced activity and can markedly hinder rehabilitation. The aetiology of hemiplegic shoulder pain is probably multifactorial. The ideal management of hemiplegic stroke pain is prevention. For prophylaxis to be effective, it must begin immediately after the stroke. Awareness of potential injuries to the shoulder joint reduces the frequency of shoulder pain after stroke. The multidisciplinary team, patients, and carers should be provided with instructions on how to avoid injuries to the affected limb. Foam supports or shoulder strapping may be used to prevent shoulder pain. Overarm slings should be avoided. Treatment of shoulder pain after stroke should start with simple analgesics. If shoulder pain persists, treatment should include high intensity transcutaneous electrical nerve stimulation or functional electrical stimulation. Intra-articular steroid injections may be used in resistant cases.???Keywords: shoulder pain; stroke PMID:11571371

Walsh, K

2001-01-01

55

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

PubMed

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

Ucuzal, Meral; Kanan, Nevin

2014-06-01

56

A survey of pain in patients with advanced cancer.  

PubMed

One hundred eleven patients with advanced cancer and pain newly referred to a palliative care center completed the Brief Pain Inventory (BPI) weekly for up to 4 weeks. The aims were (a) to review the numbers and causes of pain, (b) to consider the usefulness of the BPI in the evaluation of pain in cancer patients, and (c) to determine the impact of treatment. A total of 370 pains were recorded initially, a median of 3 per patient; 85% had more than 1 pain and more than 40% had 4 or more pains. Causes of pain were cancer (46%), debility (29%), treatment (5%), concurrent disorder (8%), and no stated cause (12%). The top 10 individual causes accounted for 73% of the pains. Seventy-six (68%) of the patients completed two BRIs, but only 46 (41%) completed 5. After 4 weeks, the median number of pains had fallen to 1.5; 78% still had more than 1 pain, but only 20% had 4 or more pains. Intensity of pain also declined, particularly in the first 2 weeks. With their last BPI, 23% had become completely pain free and a further 27% achieved acceptable relief (worst pain scores 1-4), compared with none and 24% initially. Of those who completed all five BPIs, the final respective figures were 22% and 29%. In contrast, 23% of patients still had unacceptable severe pain noted on their last BPI (worst pain scores 8-10), compared with 36% initially. Of those who completed five BPIs, the final figure was 20%. Highly significant correlations were observed between all seven interference factors and present, worst, and average pain intensities. After 4 weeks, the pattern was more variable, particularly in relation to present pain, suggesting that interference factors may have a limited utility as a measure of satisfactory pain management. Many patients did not answer all the questions in the BPI. It was concluded that the BPI is not brief enough for routine clinical use, and that the short form of the BPI (BPI-SF) is too short. A pain diary card will be developed comprising mainly pain scores, a pain relief score and a satisfaction with pain management score. PMID:8942122

Twycross, R; Harcourt, J; Bergl, S

1996-11-01

57

Imaging pain: a potent means for investigating pain mechanisms in patients  

PubMed Central

Summary Chronic pain is a state of physical suffering strongly associated with feelings of anxiety, depression and despair. Disease pathophysiology, psychological state, and social milieu can influence chronic pain, but can be difficult to diagnose based solely on clinical presentation. Here, we review brain neuroimaging research that is shaping our understanding of pain mechanisms, and consider how such knowledge might lead to useful diagnostic tools for the management of persistent pain in individual patients. PMID:23794647

Lee, M. C.; Tracey, I.

2013-01-01

58

Changing practice to improve pain control for renal patients.  

PubMed

Pain is a common symptom described by patients with end-stage kidney disease (ESKD) but remains ineffectively managed. The aim of this audit was to determine what proportion of these patients report pain, then introduce the use of an analgesic ladder adapted specifically for ESKD, and finally re-evaluate the prevalence of pain symptoms, looking for an improvement. A cohort of inpatients on the renal wards of a West London teaching hospital was studied. The number of patients reporting pain and the severity of their pain on a scale of 1-10 were recorded. A considerable number of patients were barred from participating because of a language barrier. Interpreters were introduced, and the phase was repeated. The World Health Organization (WHO) three-step analgesic ladder was adapted for patients with ESKD and introduced to medical staff on the renal wards. The number of patients reporting pain and the severity of their pain were re-recorded. There was a significant reduction in the number of patients reporting pain and the severity of their pain. Pain control in patients with ESKD is improved through the use of an adapted version of the WHO analgesic ladder. Strategies must be in place for effective communication with foreign patients. PMID:19240285

Salisbury, E M; Game, D S; Al-Shakarchi, I; Chan, M; Fishman, L; Tookman, L; Brown, E A

2009-01-01

59

3-D Pain Drawings and Seating Pressure Maps: Relationships and Challenges  

Microsoft Academic Search

Mobility impaired people constitute a significant por- tion of the adult population, which often experience back pain at some point during their lifetime. Such pain is usually character- ized by severe implications reflected on both their personal lives, as well as on a country's health and economic systems. The traditional 2-D representations of the human body often used can be

Fotios Spyridonis; Gheorghita Ghinea

2011-01-01

60

Pathogenesis and clinical aspects of pain in patients with osteoporosis  

PubMed Central

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

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

2014-01-01

61

Pressure Mapping as a Complement in 3D Pain Drawings in the Back-Pain Assessment Process: A Proposed Method  

Microsoft Academic Search

Over the years, an increasing number of the adult population suffers from some form of back pain during their lifetime, something that consecutively has a very important impact on a country's health, as well as economic systems. Traditional methods of diagnosing and treating such problems normally involve the collection and visualization of such medical information on a paper and a

Fotios Spyridonis; Gheorghita Ghinea

2010-01-01

62

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

PubMed Central

Backround Fibromyalgia has a plethorae of symptoms, which can be confusing and even misleading. Accurate evaluation is necessary when patients with fibromyalgia are treated. Different types of instruments are available for the clinicians to supplement evaluation. Our objective was to study the applicability of the PainDETECT instrument to screen neuropathic pain in patients with fibromyalgia. Methods 158 patients with primary fibromyalgia underwent a neurological examination including bedside sensory testing. They also fulfilled four questionnaires: PainDETECT, Beck depression inventory IA (BDI IA), Fibromyalgia Impact Questionnaire (FIQ) and a self-made questionnaire regarding present pain and pain relieving methods of the patients. The results of the clinical evaluation and questionnaires were then compared. Results Clinically verified neuropathic pain was diagnosed in 53/158 [34% (95% Cl: 26 to 41)] patients. The ROC curve achieved a maximum Youden´s index at score of 17 when sensitivity was 0.79 (95% Cl: 0.66 to 0.89) and specificity 0.53 (95% Cl: 0.43 to 0.63). The PainDETECT total score (OR: 1.14 95% Cl: 1.06 to 1.22), FM as the worst current pain (OR: 0.31; 95% 0.16 to 0.62), body mass index (BMI) (OR: 1.05; 95% Cl: 1.00 to 1.11) and the intensity of current pain (OR: 1.20; 95% Cl: 1.01 to 1.41) were significantly associated with the presence of neuropathic pain in univariate analyses. Conclusion This study highlights the importance of thorough clinical examination. The Neuropathic pain screening tool PainDETECT is not as useful in patients with fibromyalgia as in patients with uncompromised central pain control. PMID:23409793

2013-01-01

63

Presleep Cognitions in Patients with Insomnia Secondary to Chronic Pain  

Microsoft Academic Search

This study had two primary objectives: (1) characterize the content of presleep cognitions of chronic pain patients and (2) evaluate the association between presleep cognitions and sleep disturbance. Thirty-one outpatients with benign chronic pain completed the Beck Depression Inventory, pain and sleep diaries and participated in an in vivo, presleep thought sampling procedure for 1 week in their homes. The

M. T. Smith; M. L. Perlis; T. P. Carmody; M. S. Smith; D. E. Giles

2001-01-01

64

Prefrontal cortical hyperactivity in patients with sympathetically mediated chronic pain  

E-print Network

Prefrontal cortical hyperactivity in patients with sympathetically mediated chronic pain A. Vania form 12 July 2001; accepted 12 July 2001 Abstract Chronic pain continues to impose a large burden of suffering, yet its neural correlates remain poorly understood. In sympathetically mediated chronic pain (SMP

Apkarian, A. Vania

65

Painful crises in sickle cell disease--patients' perspectives  

Microsoft Academic Search

One hundred and two patients returned structured questionnaires sent to clinics for sickle cell disease in the United Kingdom in order to gain greater insight into the patients' perception of painful crises. Most patients who suffer pain crises experience a prodromal stage that should be investigated further to find out if prophylaxis is possible. Cold, exertion, and tiredness were the

N. Murray; A. May

1988-01-01

66

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

PubMed Central

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

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

2015-01-01

67

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

PubMed

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

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

2014-01-01

68

Pain assessment and management strategies for elderly patients.  

PubMed

Home healthcare nurses play a critical role in pain assessment and management in elderly patients. People 65 years of age and older are the largest consumers of prescription and nonprescription pain medications in the United States and are at increased risk for adverse reactions and inadequate pain management. This article seeks to explore strategies to assist hospice and home healthcare nurses in assessing and managing elderly patients' pain. The goal is to provide tools to assist nurses in streamlining elderly patient care and improving quality of life while decreasing mortality and morbidity for this patient population. PMID:24802598

MacSorley, Robyn; White, Jill; Conerly, Vicki H; Walker, Jean T; Lofton, Susan; Ragland, Gaye; Davey, DeBrynda; Robertson, Amy

2014-05-01

69

Is number sense impaired in chronic pain patients?  

PubMed Central

Background Recent advances in imaging have improved our understanding of the role of the brain in painful conditions. Discoveries of morphological changes have been made in patients with chronic pain, with little known about the functional consequences when they occur in areas associated with ‘number-sense’; thus, it can be hypothesized that chronic pain impairs this sense. Methods First, an audit of the use of numbers in gold-standard pain assessment tools in patients with acute and chronic pain was undertaken. Secondly, experiments were conducted with patients with acute and chronic pain and healthy controls. Participants marked positions of numbers on lines (number marking), before naming numbers on pre-marked lines (number naming). Finally, subjects bisected lines flanked with ‘2’ and ‘9’. Deviations from expected responses were determined for each experiment. Results Four hundred and ninety-four patients were audited; numeric scores in the ‘moderate’ and ‘severe’ pain categories were significantly higher in chronic compared with acute pain patients. In experiments (n=150), more than one-third of chronic pain patients compared with 1/10th of controls showed greater deviations from the expected in number marking and naming indicating impaired number sense. Line bisection experiments suggest prefrontal and parietal cortical dysfunction as cause of this impairment. Conclusions Audit data suggest patients with chronic pain interpret numbers differently from acute pain sufferers. Support is gained by experiments indicating impaired number sense in one-third of chronic pain patients. These results cast doubts on the appropriateness of the use of visual analogue and numeric rating scales in chronic pain in clinics and research. PMID:25082664

Wolrich, J.; Poots, A. J.; Kuehler, B. M.; Rice, A. S. C.; Rahman, A.; Bantel, C.

2014-01-01

70

Postoperative pain management in patients with chronic kidney disease  

PubMed Central

Chronic kidney disease (CKD) is a health care problem with increasing prevalence worldwide. Pain management represents one of the challenges in providing perioperative care for this group of patients. Physicians from different specialties may be involved in pain management of CKD patients, especially in advanced stages. It is important to understand the clinical staging of kidney function in CKD patients as the pharmacotherapeutic pain management strategies change as kidney function becomes progressively impaired. Special emphasis should be placed on dose adjustment of certain analgesics as well as prevention of further deterioration of renal function that could be induced by certain classes of analgesics. Chronic pain is a common finding in CKD patients which may be caused by the primary disease that led to kidney damage or can be a direct result of CKD and hemodialysis. The presence of chronic pain in some of the CKD patients makes postoperative pain management in these patients more challenging. This review focuses on the plans and challenges of postoperative pain management for patient at different stages of CKD undergoing surgical intervention to provide optimum pain control for this patient population. Further clinical studies are required to address the optimal medication regimen for postoperative pain management in the different stages of CKD. PMID:25788766

Tawfic, Qutaiba A.; Bellingham, Geoff

2015-01-01

71

Health care provider perceptions of pain treatment in Hispanic patients.  

PubMed

Despite increasing numbers of Hispanic patients in the United States, this group continues to face disparities in access and quality of pain treatment. Although previous surveys have examined treatment disparities experienced by minority patients, none have provided a provider-centric perspective on issues and concerns surrounding pain relief among pain patients of Hispanic/Latino origin. The goal of this study was to assess the relationship between provider characteristics (ie, Spanish fluency, Hispanic caseload size, and experience with Hispanic pain patients) and their perceptions of pain treatment in these patients. One hundred eighty-seven health professionals completed an online survey. The major findings indicated that: (1) less than 20% of health professionals treating Hispanic pain patients reported Spanish proficiency at an advanced level; (2) surveyed health professionals were involved treating a significant proportion of Hispanic patients in their caseloads, but reported a lack of cultural competence training; (3) Spanish fluency and experience with Hispanic pain patients exerts a strong effect on the use of established pain treatment practices; (4) providers with greater Spanish fluency report a significantly greater effect of patients' cultural beliefs and attitudes on treatment; and (5) providers did not regard cultural or language barriers as significantly impacting opioid prescribing or patient compliance. PMID:21070592

Chiauzzi, Emil; Black, Ryan A; Frayjo, Kezia; Reznikova, Margarita; Grimes Serrano, Jill M; Zacharoff, Kevin; Wood, Mollie

2011-01-01

72

Painful Skin Ulcers in a Hemodialysis Patient  

PubMed Central

Summary Calciphylaxis, also referred to as calcific uremic arteriolopathy, is a relatively rare but well described syndrome that occurs most commonly in patients with late stage CKD. It is characterized by very painful placques or subcutaneous nodules and violaceous, mottled skin lesions that may progress to nonhealing ulcers, tissue necrosis, and gangrene with a 1-year mortality rate >50%. The pathogenesis of calciphylaxis is poorly understood. Risk factors include female sex, obesity, hyperphosphatemia, hypercalcemia, hyperparathyroidism, longer dialysis vintage, hypercoagulable states, and use of calcium-containing phosphate binders and warfarin. Treatment strategies for calciphylaxis are limited by inadequate understanding of its pathophysiology. Therapy is generally focused on correcting disturbances of calcium, phosphorus, and parathyroid hormone metabolism. Additional therapy focuses on decreasing inflammation and on dissolution of tissue calcium deposits with sodium thiosulfate and/or bisphosphonates. Successful treatment generally results in improvement of pain and healing of the lesions within 2–4 weeks, but the disorder generally takes many months to completely resolve. PMID:24202137

2014-01-01

73

Assessment of pain caused by invasive procedures in cancer patients.  

PubMed

Invasive procedures are commonly required in the diagnosis and management of cancer in adults. However, little is known regarding the prevalence and severity of procedure-related pain in this patient population. This prospective study was conducted to determine the frequency and types of invasive procedures performed in a large comprehensive cancer center, the intensity of pain associated with these procedures, the types of periprocedural analgesics administered, and how these patients would like their procedural pain to be managed in the future. During a 6-week period, 102 cancer patients were interviewed immediately after undergoing an invasive procedure. They were asked to rate the pain they experienced before, during, and after their procedure using a verbal descriptor scale (VDS) ranging from 0 to 10. They also were asked if they would want more, less, or the same amount of pain medication if they were to undergo the same procedure again. The most frequently performed procedures were bone marrow aspirates and biopsies (68%), lumbar punctures (14%), and placements of central venous catheters (10%). The average pain rating during these procedures was 4.2 (standard deviation [SD], 3.0). However, 26% of patients experienced severe pain (VDS score > or = 7) during the procedures. Twenty-four percent of patients surveyed received conscious sedation for their procedure. There was no statistical relationship between patients' pain ratings and their satisfaction with the pain control they received during the procedures. This study represents the largest descriptive study of procedural pain in adult cancer patients. As more than 50% of these patients experienced moderate to severe pain during procedures, further studies are needed to improve the control of procedure-related pain in patients with cancer. PMID:19761075

Portnow, Jana; Lim, Christine; Grossman, Stuart A

2003-07-01

74

Medical-legal issues regarding patients with low back pain.  

PubMed

Low back pain can present legal issues that require input from the patient's treating physicians. Because low back pain can lead to partial or complete disability, either on a short-term or long-term basis, patients may be unable to earn a living, which may make it necessary for patients to seek government aid, personal insurance benefits, or insurance benefits through workers compensation or even, when the low back pain was caused by an incident that was the fault of a third party, through a personal injury claim lawsuit. This article reviews the legal issues relevant to low back pain. PMID:22958567

Nokes, Shari Elizabeth; Nokes, Beau James

2012-09-01

75

Sensory profiles of patients with neuropathic pain based on the neuropathic pain symptoms and signs.  

PubMed

This manuscript aimed to characterize the clinical profile of various neuropathic pain (NeP) disorders and to identify whether patterns of sensory symptoms/signs exist, based on baseline responses on the Neuropathic Pain Symptom Inventory (NPSI) questionnaire and the quantitative sensory testing (QST). These post hoc analyses were based on data from 4 randomized, double-blind, placebo-controlled clinical studies of pregabalin (150-600mg/day) in patients with NeP syndromes: central poststroke pain, posttraumatic peripheral pain, painful HIV neuropathy, and painful diabetic peripheral neuropathy. The NPSI questionnaire includes 10 different pain symptom descriptors. QST was used to detect sensory thresholds of accurately calibrated sensory stimuli and to quantify the intensity of evoked sensation. To identify symptoms/signs clusters and select the number of clusters, a principal component analysis (PCA) and hierarchical clustering methods with clinical input were used. Analysis of the NPSI pain qualities and individual QST measures at baseline indicated no clear association between particular symptoms/signs profiles and etiologies. Based on NPSI symptoms, PCA identified 3 pain dimensions: provoked, deep, and pinpoint. A hierarchical cluster analysis identified 3 clusters with distinct pain characteristics profiles independent of NeP syndrome. Based on QST signs, PCA identified 2 pain dimensions: evoked by cold and evoked by touch. A hierarchical cluster analysis identified 4 clusters with distinct pain characteristics profiles. These "trans-etiological" profiles may reflect distinct pathophysiological mechanisms and therefore, potential differential responses to treatment. PMID:24472518

Freeman, Roy; Baron, Ralf; Bouhassira, Didier; Cabrera, Javier; Emir, Birol

2014-02-01

76

Medication misuse, abuse and dependence in chronic pain patients  

Microsoft Academic Search

We report the prevalence of drug use, misuse, abuse, and dependence in 125 chronic pain patients attending specialist pain clinics in South London. A total of 110 patients (88%) were taking medications for their pain problem. Opioid analgesics (69.6%), nonopioids (48%), antidepressants (25%), and benzodiazepines (17.6%) were the drugs most frequently used. Psychoactive substance abuse or dependence (DSM-III-R) was diagnosed

Kyriaki Kouyanou; Charles E. Pither; Simon Wessely

1997-01-01

77

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

PubMed Central

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

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

2014-01-01

78

GUIDELINE Open Access Pain care for patients with epidermolysis bullosa  

E-print Network

GUIDELINE Open Access Pain care for patients with epidermolysis bullosa: best care practice present with a number of both acute and chronic pain care needs. Effects on quality of life and itch care for these patients is minimal. Evidence-based best care practice guidelines are needed

79

The facial expression of pain in patients with dementia.  

PubMed

The facial expression of pain has emerged as an important pain indicator in demented patients, who have difficulties in providing self-report ratings. In a few clinical studies an increase of facial responses to pain was observed in demented patients compared to healthy controls. However, it had to be shown that this increase can be verified when using experimental methods, which also allows for testing whether the facial responses in demented patients are still typical for pain. We investigated facial responses in 42 demented patients and 54 aged-matched healthy controls to mechanically induced pain of various intensities. The face of the subject was videotaped during pressure stimulation and was later analysed using the Facial Action Coding System. Besides facial responses we also assessed self-report ratings. Comparable to previous findings, we found that facial responses to noxious stimulation were significantly increased in demented patients compared to healthy controls. This increase was mainly due to an increase of pain-indicative facial responses in demented patients. Moreover, facial responses were closely related to the intensity of stimulation, especially in demented patients. Regarding self-report ratings, we found no significant group differences; however, the capacity to provide these self-report ratings was diminished in demented patients. The preserved pain typicalness of facial responses to noxious stimulation suggests that pain is reflected as validly in the facial responses of demented patients as it is in healthy individuals. Therefore, the facial expression of pain has the potential to serve as an alternative pain assessment tool in demented patients, even in patients who are verbally compromised. PMID:17949906

Kunz, Miriam; Scharmann, Siegfried; Hemmeter, Uli; Schepelmann, Karsten; Lautenbacher, Stefan

2007-12-15

80

Progress in Pain Assessment: The Cognitively Compromised Patient  

PubMed Central

Purpose of review Pain assessment is essential for patient care in many settings, but it proves difficult when the patient is cognitively compromised or otherwise unable to produce a conventional pain report. This review describes progress in pain assessment technology that involves the coding of human facial expression. Recent findings It is possible to quantify facial expression by coding patterns of facial muscle contraction and relaxation. These patterns are action units, and they can gauge the intensity of pain as well as signal its occurrence. The experience of pain seems to generate a unique facial expression comprising several action units. Concerns have existed about whether demented patients produce diagnostically meaningful facial expressions of pain because they tend to generate more non-specific facial expressions and perhaps code pain intensity less well than normals. Recent work shows that facial expression reflects pain as well or better in demented patients compared to normals. Summary Although still nascent, coded facial expression appears to work reliably as a pain assessment tool with cognitively compromised patients. Clinical application awaits the development of technology that can automate facial coding and scoring. PMID:18784487

Chapman, C. Richard

2009-01-01

81

Pain threshold and pain recovery after experimental stimulation in patients with burning mouth syndrome.  

PubMed

The aim of the present study was to examine pain threshold and pain recovery in patients with burning mouth syndrome (BMS) and matched no-pain controls. Twenty female patients diagnosed with BMS without organic gross changes were enrolled in the study. Twenty control subjects were chosen from age-matched healthy female volunteers. We compared the thermal pain threshold using heat beam dolorimeter on the finger and tongue between patients and controls. Warm (at 50 degrees C for 5 s), cold (at 0 degrees C for 30 s) and mechanical (stimulation by electric tooth brush for 15 s) stimulation was applied to the tongue for both groups. Participants were asked to rate the subjective pain using a visual analogue scale (VAS). Although there was no significant differences between patients and controls in terms of the threshold on the finger, the threshold on the tongue was significantly higher in patients than in controls. We suggest there were peripheral dysfunction at the tongue, and/or central dysfunction in patients with BMS. Among the three types of stimulation, the patients perceived significantly the highest pain from the mechanical stimulation for the first 5 min after the stimulation. Furthermore, when patients with BMS perceived some pain, they continued to complain of the pain longer and more intricately than the controls. This indicates that the pain of the patients is strongly affected not only at a sensory component but also at an affective/motivational component than the controls. However, we should be cautious of simply advancing psychogenic theory in this etiology. PMID:11952919

Ito, Mikiko; Kurita, Kenichi; Ito, Takako; Arao, Munetaka

2002-04-01

82

Exploring the information needs of patients with unexplained chest pain  

PubMed Central

Background Unexplained chest pain is a common condition. Despite negative findings, a large number of these patients will continue to suffer from chest pain after being investigated at cardiac outpatient clinics. Unexplained chest pain covers many possible complaints, and diagnosing a single cause for a patient’s pain is often described as difficult, as there are a number of possible factors that can contribute to the condition. For health professionals to meet patients’ expectations, they must know more about the information needs of patients with unexplained chest pain. The aim of this study was to describe information needs among patients with unexplained chest pain and how those needs were met by health professionals during medical consultations. Methods A qualitative design was used. Data were collected by means of seven individual interviews with four women and three men, aged 21–62 years. The interviews were analyzed by qualitative content analysis. Results The results are described in two subthemes, ie, “experiencing lack of focus on individual problems” and “experiencing unanswered questions”. These were further abstracted under the main theme “experiencing unmet information needs”. Conclusion Existing models of consultations should be complemented to include a person-centered approach to meeting patients’ beliefs, perceptions, and expressions of feelings related to experiencing unexplained chest pain. This is in line with a biopsychosocial model with active patient participation, shared decision-making, and a multidisciplinary approach. Such an approach is directly within the domain of nursing, and aims to take into account patient experience. PMID:24043934

Røysland, Ingrid Ølfarnes; Dysvik, Elin; Furnes, Bodil; Friberg, Febe

2013-01-01

83

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

PubMed Central

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

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

2013-01-01

84

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

PubMed Central

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

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

2014-01-01

85

Specificity of Stroop interference in patients with pain and PTSD.  

PubMed

The authors investigated processing of threat words in motor vehicle accident survivors using a modified Stroop procedure. Three samples were included: 28 participants with comorbid posttraumatic stress disorder (PTSD) and pain, 26 participants with pain without PTSD, and 21 participants without pain or any psychiatric conditions. Four word categories were used: (a) accident words, (b) pain words, (c) positive words, and (d) neutral words. This study examined whether processing biases would occur to accident words only in participants with PTSD or if these biases would also be noted in the No PTSD/Pain sample. Additionally, this study examined whether processing biases would be noted to pain words in the 2 pain samples, irrespective of PTSD. Overall, color naming was significantly slower in the PTSD/Pain group in comparison with the other groups. As well, the PTSD/Pain sample showed significant response delays to both accident and pain-related words, whereas patients with No PTSD/Pain showed delays to pain stimuli only. PMID:11727943

Beck, J G; Freeman, J B; Shipherd, J C; Hamblen, J L; Lackner, J M

2001-11-01

86

Patient satisfaction and pain severity as outcomes in pain management: A longitudinal view of one setting's experience  

Microsoft Academic Search

Longitudinal data from quality assurance studies of pain. outcomes (pain severity and patient satisfaction) were critically examined to explore the reasons that patients are satisfied with their care even when they are in pain. Data were acquired from three sources: self-report surveys of patients during inpatient admission or ambulatory clinic visit (N = 306), telephone interviews of patients after discharge

Sandra E. Ward; Debra B. Gordon

1996-01-01

87

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

PubMed Central

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

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

2013-01-01

88

Talking about the pain: A patient-centered study of low back pain in primary care  

Microsoft Academic Search

Despite considerable research, low back pain (LBP) often proves resistant to treatment. This study was designed to increase the understanding of low back pain through access to patients' perceptions, beliefs, illness behaviors and lived experiences. The findings are based on focus groups, individual interviews and participant observation conducted in primary care practices and community settings in three regions in Israel.

Jeffrey Borkan; Shmuel Reis; Doron Hermoni; Aya Biderman

1995-01-01

89

Patients' vs nurses' assessments of postoperative pain and anxiety during patient- or nurse-controlled analgesia  

Microsoft Academic Search

We have compared patients' and nurses' assessments of postoperative pain and anxiety after different analgesic treatments. Sixty orthopaedic patients were allocated randomly to receive i.v. piritramide (either nurse-controlled or patient-controlled) or subarachnoid bupivacaine (nurse-controlled or patient-controlled). Patients and nurses assessed pain and anxiety using a visual analogue scale (VAS; 1-100 mm). Pain and anxiety ratings of patients and nurses were

I. Rundshagen; K. Schnabel; T. Standl

1999-01-01

90

Effect of Massage on Pain Management for Thoracic Surgery Patients  

PubMed Central

Background: Integrative therapies such as massage have gained support as interventions that improve the overall patient experience during hospitalization. Thoracic surgery patients undergo long procedures and commonly have postoperative back, neck, and shoulder pain. Purpose: Given the promising effects of massage therapy for alleviation of pain, we studied the effectiveness and feasibility of massage therapy delivered in the postoperative thoracic surgery setting. Methods: Patients who received massage in the postoperative setting had pain scores evaluated pre and post massage on a rating scale of 0 to 10 (0 = no pain, 10 = worst possible pain). Results: In total, 160 patients completed the pilot study and received massage therapy that was individualized. Patients receiving massage therapy had significantly decreased pain scores after massage (p ? .001), and patients’ comments were very favorable. Patients and staff were highly satisfied with having massage therapy available, and no major barriers to implementing massage therapy were identified. Conclusions: Massage therapy may be an important additional pain management component of the healing experience for patients after thoracic surgery. PMID:21847428

Dion, Liza; Rodgers, Nancy; Cutshall, Susanne M.; Cordes, Mary Ellen; Bauer, Brent; Cassivi, Stephen D.; Cha, Stephen

2011-01-01

91

The risk of suicide mortality in chronic pain patients.  

PubMed

Chronic pain has long been considered an important risk factor for suicidal behavior. Less well understood are the factors associated with the increased risk for suicide death within chronic pain populations. The purpose of this review is to examine recent research with regard to rates of and risk factors for suicide mortality in patients with chronic musculoskeletal pain. We conclude that patients with a number of chronic pain states are at increased risk for suicide death, and that this risk appears to be due, at least in part, to other well-known correlates of pain such as depression and substance use disorders. However, in all likelihood, there are aspects of chronic pain itself that add uniquely to an individual's suicide risk profile. Lastly, we address a theoretical perspective and offer recommendations for clinical practice. PMID:24952608

Hassett, Afton L; Aquino, Jordan K; Ilgen, Mark A

2014-08-01

92

Pain Management in Patients with Cancer: Focus on Opioid Analgesics  

Microsoft Academic Search

Cancer pain is generally treated with pharmacological measures, relying on using opioids alone or in combination with adjuvant\\u000a analgesics. Weak opioids are used for mild-to-moderate pain as monotherapy or in a combination with nonopioids. For patients\\u000a with moderate-to-severe pain, strong opioids are recommended as initial therapy rather than beginning treatment with weak\\u000a opioids. Adjunctive therapy plays an important role in

Wojciech Leppert

93

Pharmacokinetics and Pharmacodynamics of Intrathecal Ziconotide in Chronic Pain Patients  

Microsoft Academic Search

The pharmacokinetics and pharmacodynamics of ziconotide were assessed over a 48-hour period following intrathecal (IT) administration (1, 5, 7.5, or 10 &mgr;g) to 22 patients with chronic, nonmalignant pain. Plasma and cerebrospinal fluid (CSF) samples were obtained over a 24-hour period. Analgesic efficacy was monitored using Visual Analog Scale of Pain Intensity (VASPI) and Category Pain Relief Scores (CPRS) measurements.

Daniel Wermeling; Michael Drass; David Ellis; Martha Mayo; Dawn McGuire; Damian OConnell; Victoria Hale; Stella Chao

2003-01-01

94

Pain and the choice to hasten death in patients with painful metastatic cancer.  

PubMed

Unrelieved pain has been cited as an important reason why cancer patients may seek to hasten their deaths. We interviewed 48 patients with painful metastatic cancer to ascertain their interest in various active and passive modes of hastening death. Ninety percent of these patients supported the general right of terminally ill patients to passive modes of hastening death and 80% supported the right to active modes such as assisted suicide and euthanasia. If they developed severe pain that could not be relieved, 80% would instruct their physician write a "do not attempt resuscitation" order, 40%-50% would want to receive suicide information or a lethal prescription from their physician, and 34% would request a lethal injection from their physician. Current pain and depression levels were not associated with interest in hastening death, but current somatic symptom burden was significantly associated with this interest. PMID:9354037

Sullivan, M; Rapp, S; Fitzgibbon, D; Chapman, C R

1997-01-01

95

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

PubMed Central

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

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

96

Ketamine reduces muscle pain, temporal summation, and referred pain in fibromyalgia patients  

Microsoft Academic Search

Central mechanisms related to referred muscle pain and temporal summation of muscular nociceptive activity are facilitated in fibromyalgia syndrome (FMS) patients. The present study assessed the effects of an NMDA-antagonist (ketamine) on these central mechanisms. FMS patients received either i.v. placebo or ketamine (0.3 mg\\/kg, Ketalar®) given over 30 min on two separate occasions. Habitual pain intensity was assessed on

Thomas Graven-Nielsen; Sally Aspegren Kendall; Karl G. Henriksson; Mats Bengtsson; Jan Sörensen; Anders Johnson; Björn Gerdle; Lars Arendt-Nielsen

2000-01-01

97

Determinants of Pain in Patients with Carpal Tunnel Syndrome  

Microsoft Academic Search

Background  Carpal tunnel syndrome causes numbness, weakness, and atrophy. Pain without numbness is not characteristic of this disease.\\u000a \\u000a \\u000a \\u000a Questions\\/purposes  We tested the hypothesis that among patients with carpal tunnel syndrome confirmed by electrophysiologic testing, pain catastrophizing\\u000a and\\/or depression would be good predictors of pain intensity at the time of diagnosis, whereas nerve conduction velocity would\\u000a not.\\u000a \\u000a \\u000a \\u000a \\u000a Patients and Methods  Fifty-four patients completed a

Fiesky Nunez; Ana-Maria Vranceanu; David Ring

2010-01-01

98

Nursing attitudes toward patients with substance use disorders in pain.  

PubMed

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

Morgan, Betty D

2014-03-01

99

Comparing nurses' and patients' pain evaluations: A study of hospitalized patients in Kuwait  

Microsoft Academic Search

All eligible patients hospitalized on the general medical, surgical and pediatric wards of a distinct hospital in Kuwait during the first 2 weeks of April 1990 (N = 199) were interviewed about their pain and the medical care provided. Patients rated their current pain using a 0-10 visual analogue scale (VAS) on which 0 was labelled 'no pain' and 10

Ann Harrison

1993-01-01

100

Pain threshold correlates with functional scores in osteoarthritis patients.  

PubMed

Background and purpose - Pain sensitization may be one of the reasons for persistent pain after technically successful joint replacement. We analyzed how pain sensitization, as measured by quantitative sensory testing, relates preoperatively to joint function in patients with osteoarthritis (OA) scheduled for joint replacement. Patients and methods - We included 50 patients with knee OA and 49 with hip OA who were scheduled for joint replacement, and 15 control participants. Hip/knee scores, thermal and pressure detection, and pain thresholds were examined. Results - Median pressure pain thresholds were lower in patients than in control subjects: 4.0 (range: 0-10) vs. 7.8 (4-10) (p = 0.003) for the affected knee; 4.5 (2-10) vs. 6.8 (4-10) (p = 0.03) for the affected hip. Lower pressure pain threshold values were found at the affected joint in 26 of the 50 patients with knee OA and in 17 of the 49 patients with hip OA. The American Knee Society score 1 and 2, the Oxford knee score, and functional questionnaire of Hannover for osteoarthritis score correlated with the pressure pain thresholds in patients with knee OA. Also, Harris hip score and the functional questionnaire of Hannover for osteoarthritis score correlated with the cold detection threshold in patients with hip OA. Interpretation - Quantitative sensory testing appeared to identify patients with sensory changes indicative of mechanisms of central sensitization. These patients may require additional pain treatment in order to profit fully from surgery. There were correlations between the clinical scores and the level of sensitization. PMID:25323797

Kuni, Benita; Wang, Haili; Rickert, Markus; Ewerbeck, Volker; Schiltenwolf, Marcus

2015-04-01

101

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

PubMed

Hypnosis modulates pain perception but the associated brain mechanisms in chronic pain conditions are poorly understood. Brain activity evoked by painful repetitive pin-prick stimulation of the left mental nerve region was investigated with use of fMRI in 19 patients with painful temporomandibular disorders (TMD) during hypnotic hypoalgesia and hyperalgesia and a control condition. Pain intensity and unpleasantness of the painful stimulation was scored on a 0-10 Numerical Rating Scale (NRS). NRS pain and unpleasantness scores during hypnotic hypoalgesia were significantly lower than in the control condition and significantly higher in the hypnotic hyperalgesia condition. In the control condition, painful stimulation caused significant activation of right posterior insula, primary somatosensory cortex (SI), BA21, and BA6, and left BA40 and BA4. Painful stimulation during hypnotic hyperalgesia was associated with increased activity in right posterior insula and BA6 and left BA40 whereas hypnotic hypoalgesia only was associated with activity in right posterior insula. Unexpectedly, direct contrasts between control and hypnotic hyperalgesia conditions revealed significant decreases in S1 during hyperalgesia. Direct contrasts between control and hypnotic hypoalgesia conditions demonstrated significant decreases in right posterior insula and BA21, as well as left BA40 during hypoalgesia. These findings are the first to describe hypnotic modulation of brain activity associated with nociceptive processing in chronic TMD pain patients and demonstrate that hypnotic hypoalgesia is associated with a pronounced suppression of cortical activity and a disconnection between patient-based scores and cortical activity in S1 during hypnotic hyperalgesia. PMID:20933331

Abrahamsen, Randi; Dietz, Martin; Lodahl, Sanne; Roepstorff, Andreas; Zachariae, Robert; Østergaard, Leif; Svensson, Peter

2010-12-01

102

Brain processing of pain in patients with unresponsive wakefulness syndrome.  

PubMed

By definition, patients with unresponsive wakefulness syndrome (UWS) do not experience pain, but it is still not completely understood how far their brain can process noxious stimuli. The few positron emission tomography studies that have examined pain processing did not yield a clear and consistent result. We performed an functional magnetic resonance imaging scan in 30 UWS patients of nontraumatic etiology and 15 age- and sex-matched healthy control participants (HC). In a block design, noxious electrical stimuli were presented at the patients' left index finger, alternating with a resting baseline condition. Sixteen of the UWS patients (53%) showed neural activation in at least one subsystem of the pain-processing network. More specifically, 15 UWS patients (50%) showed responses in the sensory-discriminative pain network, 30% in the affective pain network. The data indicate that some patients completely fulfilling the clinical UWS criteria have the neural substrates of noxious stimulation processing, which resemble that in control individuals. We therefore suppose that at least some of these patients can experience pain. PMID:23533065

Markl, Alexandra; Yu, Tao; Vogel, Dominik; Müller, Friedemann; Kotchoubey, Boris; Lang, Simone

2013-03-01

103

Active and passive coping strategies in chronic pain patients  

E-print Network

This study assessed the validity of an active/passive conceptualization of coping in a sample of chronic pain patients (N = 84). The validity of active and passive coping dimensions was supported. The Coping Strategies Questionnaire...

Snow-Turek, Andrea Lynn

1994-01-01

104

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

PubMed Central

Patients with chronic pain syndromes, like fibromyalgia (FM) complain of widespread pain and tenderness, as well as non-refreshing sleep, cognitive dysfunction, and negative mood. Several lines of evidence implicate abnormalities of central pain processing as contributors for chronic pain, including dysfunctional descending pain inhibition. One form of endogenous pain inhibition, diffuse noxious inhibitory controls (DNIC), has been found to be abnormal in some chronic pain patients and evidence exists for deficient spatial summation of pain, specifically in FM. Similar findings have been reported in patients with localized musculoskeletal pain (LMP) disorders, like neck and back pain. Whereas DNIC reduces pain through activation of nociceptive afferents, vibro-tactile pain inhibition involves innocuous A-beta fiber. To assess whether patients with localized or widespread pain disorders have dysfunctional A-beta related pain inhibition we enrolled 28 normal pain-free controls (NC), 29 FM patients, and 19 subjects with neck or back pain. All received 10 s sensitivity-adjusted noxious heat stimuli to the forearms as test stimuli. To assess endogenous analgesic mechanisms of study subjects, vibro-tactile conditioning stimuli were simultaneously applied with test stimuli either homotopically or heterotopically. Additionally, the effect of distraction on experimental pain was assessed. Homotopic vibro-tactile stimulation resulted in 40% heat pain reductions in all subject groups. Distraction did not seem to affect experimental pain ratings. Conclusions Vibro-tactile stimulation effectively recruited analgesic mechanisms not only in NC but also in patients with chronic musculoskeletal pain, including FM. Distraction did not seem to contribute to this analgesic effect. PMID:21339076

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

2011-01-01

105

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

SciTech Connect

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.

Andrade, Regiane S. [University of Pittsburgh Cancer Institute, UPMC Shadyside Hospital, Radiation Oncology Department, Pittsburgh, PA (United States); UPMC Radiation Oncology Outreach Program (ROCOG), UPMC McKeesport Hospital, McKeesport, PA (United States); Proctor, Julian W., E-mail: proctorj@upmc.ed [UPMC Jameson Cancer Center, Radiation Oncology Department, New Castle, PA (United States); UPMC Radiation Oncology Outreach Program (ROCOG), UPMC McKeesport Hospital, McKeesport, PA (United States); Slack, Robert; Marlowe, Ursula [UPMC Jameson Cancer Center, Radiation Oncology Department, New Castle, PA (United States); Ashby, Karlotta R. [University of Pittsburgh Cancer Institute, UPMC Shadyside Hospital, Radiation Oncology Department, Pittsburgh, PA (United States); UPMC Radiation Oncology Outreach Program (ROCOG), UPMC McKeesport Hospital, McKeesport, PA (United States); Schenken, Larry L. [UPMC Radiation Oncology Outreach Program (ROCOG), UPMC McKeesport Hospital, McKeesport, PA (United States)

2010-11-01

106

Distinctive neural responses to pain stimuli during induced sadness in patients with somatoform pain disorder: An fMRI study?  

PubMed Central

Pain is a multidimensional phenomenon. Patients with somatoform pain disorder suffer from long-lasting pain, with the pathology being closely associated with cognitive–emotional components. Differences between these patients and controls in cerebral responses to pain stimuli have been reported. However, to our knowledge, no studies of somatoform pain disorder have evaluated altered pain-related brain activation as modulated by emotional dysregulation. We examined the distinct neural mechanism that is engaged in response to two different pain intensities in a sad emotional condition, performing functional magnetic resonance imaging (fMRI) on a group of 11 somatoform pain patients and an age-matched control group. Our results showed that the ratio for low-pain intensity ratings between the sad and neutral conditions in patients was higher than in controls. They also showed significant increased activation in the anterior/posterior insula in the low pain sadness condition. Furthermore, there was specific functional connectivity between the anterior insula and the parahippocampus in patients during presentation of low-pain stimuli in the sad context. These findings suggest that a negative emotional context such as sadness contributes to dysfunctional pain processing in somatoform pain disorder. Greater sensitivity to low levels of pain in an emotional context of sadness might be an important aspect of the psychopathology of somatoform pain disorder. PMID:24179828

Yoshino, Atsuo; Okamoto, Yasumasa; Yoshimura, Shinpei; Shishida, Kazuhiro; Toki, Shigeru; Doi, Mitsuru; Machino, Akihiko; Fukumoto, Takuji; Yamashita, Hidehisa; Yamawaki, Shigeto

2013-01-01

107

Exercise Testing and Training in Patients with (Chronic) Pain  

Microsoft Academic Search

A vast body of literature supports the idea that exercise training is an important modality in the treatment and rehabilitation\\u000a of the chronic pain patient. Exercise testing and prescription should therefore be incorporated in the therapeutic armamentarium\\u000a of health care professionals working with chronic pain patients. In this chapter we present the scientific basis of the positive\\u000a effects regular exercise

Harriët Wittink; Tim Takken

108

Perception of pain among pediatric patients with sickle cell pain crisis.  

PubMed

Pain related to vasoocclusion is the most common reason for emergency department visits and hospital stays among pediatric patients with sickle cell disease. Using a prospective descriptive design, patients hospitalized with sickle cell pain were asked to complete the Adolescent Pediatric Pain Tool on each day of their hospital stay, providing data on the location, intensity, and quality of their pain. Data for 82 hospital stays were collected from 40 African American study participants. Mean age was 14.8 years, and mean length of stay (LOS) was 5.1 days. Mean LOS for 8 to 12 year olds (3.23 days; n = 22) was shorter than mean LOS for 13 to 19 year olds (5.85 days; n = 60). This LOS difference was significant (P = .004). Difference in LOS by gender was not significant. Higher initial number of body sites with pain was significantly associated with longer LOS (r = .39; P < .001). Higher initial pain intensity scores were significantly associated with longer LOS (r = .37; P = .001). Higher initial number of word descriptors was only weakly associated with longer LOS. Neither gender nor age differences were significant for Adolescent Pediatric Pain Tool data. PMID:25416521

Fosdal, Marian B

2015-01-01

109

Overview of pain in the lame patient.  

PubMed

Pain is often the limiting factor associated with joint disease. Pain results from the stimulation of nociceptors by excessive mechanical stimulation, chemical stimulation associated with the inflammatory process, or a combination of both. Even though OA is considered to be a noninflammatory disease, the mild degree of inflammation frequently associated with this condition can result in peripheral sensitization. This results in increased spontaneous activity and decreased activation threshold of nociceptive fibers. Activity of the primary joint afferents also leads to changes within the dorsal spinal horn, resulting in central sensitization and changes in the neural structures of the dorsal horn that facilitate and amplify the nociceptive response. Changes in the periarticular tissues correspond to the neurobiologic changes, resulting in increased stimulation of nociceptors caused by mechanical and chemical alterations resulting from tissue damage. Similar pathophysiologic events occur regardless of whether the initiating event is an acute joint injury or a chronic condition such as OA. The combination of these events results in the complex dynamic of joint pain. Because of this complex interaction of the musculoskeletal and nervous systems, it is difficult to imagine a single treatment that is effective for the alleviation of pain, because that agent would require inhibition of a number of stimulatory pathways. Instead, restoration of mechanical integrity, relief of peripheral inflammation, and blockage of central neurotransmission are all likely to have a role in the relief of joint pain and resolution of lameness. PMID:11787263

Johnston, S A

2001-01-01

110

Capacitively Coupled Electric Field for Pain Relief in Patients with Vertebral Fractures and Chronic Pain  

Microsoft Academic Search

Fragility vertebral fractures often are associated with chronic back pain controlled by analgesic compounds. Capacitive coupling\\u000a electrical stimulation is a type of electrical stimulation technology approved by the US FDA to noninvasively enhance fracture\\u000a repair and spinal fusion. These uses suggest it would be a possible treatment for patients with back pain attributable to\\u000a vertebral fractures. We therefore randomized 51

Maurizio Rossini; Ombretta Viapiana; Davide Gatti; Francesca de Terlizzi; Silvano Adami

2010-01-01

111

Neck pain patients’ preference scores for their current health  

Microsoft Academic Search

Purpose  To elicit neck pain (NP) patients’ preference scores for their current health, and investigate the association between their\\u000a scores and NP disability.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Rating scale scores (RSs) and standard gamble scores (SGs) for current health were elicited from chronic NP patients (n = 104) and patients with NP following a motor vehicle accident (n = 116). Patients were stratified into Von Korff Pain Grades: Grade

Gabrielle van der Velde; Sheilah Hogg-Johnson; Ahmed M. Bayoumi; Pierre Côté; Hilary Llewellyn-Thomas; Eric L. Hurwitz; Murray Krahn

2010-01-01

112

Psychological profile of Iranian patients with low-back pain.  

PubMed

A hospital case-control study in Isfahan, Islamic Republic of Iran, compared the psychological features of 200 patients with low-back pain with 350 matched controls. The control group scored lower than patients in all dimensions of the Symptom Checklist-90 checklist. Female patients were more psychologically affected by low-back pain than males. In both groups, grudge, general complaints, anxiety, depression, obsessive-compulsive behaviours, somatization and phobia varied with level of education. Patients' levels of depression and anxiety were related to occupational background. Longer duration of illness was accompanied by higher levels of anxiety, depression, obsessive-compulsive behaviours and somatization. PMID:17684856

Fanian, H; Ghassemi, Gh R; Jourkar, M; Mallik, S; Mousavi, M R

2007-01-01

113

Predictors of Shoulder Pain and Disability Index (SPADI) and work status after 1 year in patients with subacromial shoulder pain  

Microsoft Academic Search

BACKGROUND: Shoulder pain is a common complaint in primary health care and has an unfavourable outcome in many patients. The objectives were to identify predictors for pain and disability (SPADI) and work status in patients with subacromial shoulder pain. METHODS: Secondary analyses of data from a randomized clinical controlled trial were performed. Outcome measures were the absolute values of the

Kaia Engebretsen; Margreth Grotle; Erik Bautz-Holter; Ole Marius Ekeberg; Jens Ivar Brox

2010-01-01

114

The diagnostic workup of patients with neuropathic pain.  

PubMed

Determining the causes of neuropathic pain is more than an epistemological exercise. At its essence, it is a quest to delineate mechanisms of dysfunction through which treatment strategies can be created that are effective in reducing, ameliorating, or eliminating symptomatology. To date, predictors of which patients will develop neuropathic pain or who will respond to specific therapies are lacking, and present therapies have been developed mainly through trial and error. Our current inability to make therapeutically meaningful decisions based on ancillary test data is illustrated by the following: In a study specifically designed to assess the response of patients with painful distal sensory neuropathies to the 5% lidocaine patch, no relationship between treatment response and distal leg skin biopsy, QST, or sensory nerve conduction study results could be established. From a mechanistic perspective, the hypothesis that the lidocaine patch would be most effective in patients with relatively intact epidermal innervation, whose neuropathic pain is presumed attributable to "irritable nociceptors," and least effective in patients with few surviving epidermal nociceptors, presumably with "deafferentation pain," was unproven. The possible explanations are multiple and outside the scope of this review. However, these findings, coupled with the disparity in C-fiber subtype involvement in diabetic small-fiber neuropathy, and the recently reported inability of enzyme replacement therapy in Fabry disease to influence intraepidermal innervation density, while having mixed effects on cold and warm QST thresholds, and beneficial effects on sudomotor findings, when therapeutic benefit was demonstrated, lead one to conclude that the specificity of ancillary testing in neuropathic pain is inadequate at present, and reinforce the aforementioned caveats about inferential conclusions from indirect data. The diagnosis of neuropathic pain mechanisms is in its nascent stages and ancillary testing remains "subordinate," "subsidiary," and "auxiliary" as defined in Webster's Third New International Dictionary. As a consequence of these difficulties, the recent approach by Bennett and his colleagues may have merit. They have hypothesized (and provide data in support) that chronic pain can be more or less neuropathic on a spectrum between "likely," "possible," and "unlikely," based on patient responses on validated neuropathic pain symptom scales, when compared with specialist pain physician certainty of the presence of neuropathic pain on a 100-mm visual analog scale. The symptoms most associated with neuropathic pain were dysesthesias, evoked pain, paroxysmal pain, thermal pain, autonomic complaints, and descriptions of the pain as being sharp, hot, or cold, with high sensitivity. Higher scores for these symptoms correlated with greater clinician certainty of the presence of neuropathic pain mechanisms. Considering each individual patient's chronic pain as being somewhere on a continuum between "purely nociceptive" and "purely neuropathic" may have diagnostic and therapeutic relevance by enhancing specificity, but this requires clinical confirmation. Thus, symptom assessment remains indispensable in the evaluation of neuropathic pain, ancillary testing notwithstanding PMID:17164102

Horowitz, Steven H

2007-01-01

115

Pain management in patients with rheumatoid arthritis.  

PubMed

Rheumatoid arthritis (RA) is one of the most common inflammatory conditions in the United States affecting approximately 1 million adults. This article briefly reviews the evidence-based diagnosis of RA, mainstays of treatment to prevent joint destruction, and pain management. PMID:25882452

Durham, Catherine O; Fowler, Terri; Donato, AnneMarie; Smith, Whitney; Jensen, Elizabeth

2015-05-15

116

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

PubMed Central

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

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

2014-01-01

117

Perioperatory pain in oncological patient - physiopathological and therapeutical implications  

PubMed Central

Perioperatory pain in oncological patients represents a witness of anesthetic-surgical aggression, frequently exacerbated by the complementary radio-chemotherapy and also a predictive factor for postoperatory evolution. The objectivation of perioperative pain by scales of clinical evaluation does not offer a certain and objective quantification; so, the dosing of some hormonal and acute phase inflammation mediators could realize a more realistic projection. Clinical and biological correlation can offer a support for an adequate and well-balanced treatment. Divinum est sedare dolorum Blessed are those who treat pain. Galen

Diaconu, C; Pantis, C; Cirimbei, C; Bordea, C; Blidaru, A

2014-01-01

118

Cancer patient supportive care and pain management. Special listing  

SciTech Connect

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.

Not Available

1981-04-01

119

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

PubMed

Post Thoracotomy Pain Syndrome (PTPS) is defined as pain that occurs or persists in the area of the thoracotomy incision for at least 2 months following the initial procedure.  The true incidence of PTPS is hard to define as literature reports a wide range of occurrence from 5% to 90%.  Thoracotomy is associated with a high risk of severe chronic postoperative pain.  Presenting symptoms include both neuropathic pain in the area of the incision, as well as myofascial pain commonly in the ipsilateral scapula and shoulder.  Pain management can be challenging in these patients.  Multiple treatments have been described including conservative treatments with oral nonsteroidal anti-inflammatory drugs (NSAIDs); topically applied, peripherally acting drugs; neuromodulating agents; physical therapy; transcutaneous electrical nerve stimulation as well as more invasive treatments including intercostal nerve blocks, trigger point steroid injections, epidural steroid injections, radiofrequency nerve ablation, cryoablation, and one case report of spinal cord stimulation.  Unfortunately, a portion of these patients will have persistent pain in spite of multiple treatment modalities, and in some cases will experience worsening of pain. This case report describes the novel utility and complete resolution of symptoms with spinal cord stimulation (SCS) in treatment of a patient with persistent PTPS. In the operating room, a percutaneous octet electrode lead was placed using sterile technique under fluoroscopic guidance and loss-of-resistance technique.  The octet electrode lead was subsequently advanced with the aid of fluoroscopy to the level of the T3 superior endplate just right of midline.  The patient's pain distribution was captured optimally with stimulation at this level.  With the assistance of a neurosurgeon, the lead was anchored, tunneled, and connected to a generator, which was implanted over the right iliac crest.  The patient tolerated the procedure well with no complications. We report the successful use of SCS as well as complete resolution of symptoms at 4 months follow-up, in a patient with persistent PTPS, which was resistant to other modalities. In conclusion, studies designed to evaluate the effectiveness of SCS for PTPS may be warranted. PMID:21927048

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

2011-01-01

120

Impaired modulation of pain in patients with postherpetic neuralgia  

PubMed Central

BACKGROUND: The efficiency of inhibitory pain descending pathways (evaluated using conditioned pain modulation [CPM]) has not been studied in postherpetic neuralgia (PHN). OBJECTIVE: To compare CPM in PHN patients with healthy controls. METHODS: Nine PHN patients and nine control individuals were matched according to age and sex. Amplitudes of cortical thermal-evoked potentials were recorded on the surface of the scalp; clinical pain and thermal pain were evaluated on a 0 to 10 numerical rating scale, at baseline and at intervals during the 6 min after CPM (elicited by a cold pressor test, 8°C). A battery of cognitive tests was performed. Amplitude differences, percentages and related areas under the curve (AUCCPM) were calculated and all data were compared between both groups; P<0.05 was considered to be statistically significant. RESULTS: AUCCPM0–6 min was significantly lower in PHN patients compared with controls (?39±51 ?V/min versus ?144±66 ?V/min; P=0.0012) and correlated (P=0.04) with clinical pain intensity. Pain ratings before CPM were similar in both groups but were significantly lower in the control group 3 min after the cold pressor test. Cognitive test results were not significantly different. CONCLUSION: Psychophysical and electrophysiological approaches have shown that patients with PHN exhibit a deficiency of pain inhibition modulation, which could signal a predisposing factor to developing chronic pain. This deficiency was not linked to the cognitive performance but rather to subtle in situ cognitivoemotional adaptations, which remain to be investigated. PMID:24427769

Pickering, Gisèle; Pereira, Bruno; Dufour, Elodie; Soule, Sylvie; Dubray, Claude

2014-01-01

121

Development of a new pain scale: Colorado Behavioral Numerical Pain Scale for sedated adult patients undergoing gastrointestinal procedures.  

PubMed

A limited number of studies have addressed pain assessment among sedated patients undergoing a gastrointestinal examination. The Colorado Behavioral Numerical Pain Scale is a quick, simple tool that can provide an estimation of the patient's comfort level while sedated. Multiple studies completed in intensive care unit and postanesthesia care unit settings provide ample evidence of the accuracy of behavioral pain scales ratings. In developing the Colorado Behavioral Numerical Pain Scale, experienced endoscopy nurses provided suggestions and modifications of descriptive words for behavioral assessment of pain selected from the relevant literature. Three nurses simultaneously rated pain using the scale for 30 procedures. Interrater reliability was high with 82% of observations in total agreement and 17% having one of the three persons disagreeing on the rating. Nurses from four hospitals and one ambulatory facility also evaluated the Colorado Behavioral Numerical Pain Scale tool. In this evaluation, 98% of the 52 respondents agreed that the words described what they observed during a gastrointestinal examination and 94% felt it was a better descriptor of pain than a patient self-report numerical scale. Assessment of pain for the sedated patient undergoing gastrointestinal procedures is often difficult due to the patient's inability to report pain levels. The sedated patient undergoing painful procedures depends on the nurse to interpret physical signs to quantify his or her distress. The Acute Pain Management Guidelines (AHCPR, 1992) promotes the use of both physiological and behavioral responses to pain for assessment when self-report is absent. While an individual's self-report of pain intensity and distress is the most accurate assessment measurement, the validity of a sedated patient's elicited response about pain is questionable. It is the nurse, through observation, who attempts to assess the sedated individual's pain levels. PMID:12488689

Salmore, Rochelle

2002-01-01

122

Sleep problems in stroke patients: relationship with shoulder pain  

Microsoft Academic Search

This study was designed to document the occurrence and the type of sleep problems in stroke patients and to examine the importance of shoulder pain in stroke in relation to sleep disturbances. Forty-six stroke patients were evaluated for the presence of sleep disturbances, general health problems (Nottingham Health Profile) and anxiety-depression (Hospital Anxiety Depression Scale) and compared with 47 age-

Ayse A Küçükdeveci; Alan Tennant; Philip Hardo; M Anne Chamberlain

1996-01-01

123

Sickle cell disease patients' perceptions of emergency department pain management.  

PubMed

Patients with sickle cell disease (SCD) experience painful crises that often require admission to the emergency department (ED) for pain management. Factors such as ED overcrowding and negative perception and stigmatization of SCD may impact patients' perceptions of the quality of pain management in the ED. Data from a multisite prospective cohort study was assessed to determine whether demographic (age and sex), clinical (time to administration of initial analgesia, number of analgesic doses, discharge disposition, and clinical site), or interpersonal factors (separately measured perceptions of being treated with trust and respect by ED triage nurses, nurses, and physicians) were associated with patient ratings of their pain management in the ED. Patients were adults with SCD seen at 3 EDs (2 urban and 1 rural). Demographic and clinical information was derived from medical record review; interpersonal and ED pain management ratings were derived from interviews conducted 1 week post ED visit. A total of 209 interviews by 98 patients were analyzed. Results indicated significant differences among the ED sites on the demographic, clinical, and interpersonal factors. Overall, patients reported being treated with trust and respect by ED clinicians. Adjusted logistic regression analyses indicated that ED clinical site 1 (odds ratio [OR], 10.42; 95% confidence interval [Cl], 1.44-7.36) and being treated with trust and respect by the ED physician (OR, 25.53; 95% CI, 2.07-314.96) predicted good ED pain management ratings. Interpersonal health care experiences may be an important indicator of patient satisfaction and quality of care received by patients with SCD in the ED. PMID:23342819

Porter, Jerlym; Feinglass, Joe; Artz, Nicole; Hafner, John; Tanabe, Paula

2012-01-01

124

Topical preparations for pain relief: efficacy and patient adherence  

PubMed Central

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

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

2011-01-01

125

Treatment Considerations for Elderly and Frail Patients With Neuropathic Pain  

PubMed Central

Currently, an estimated 38 million individuals 65 years or older live in the United States, and more than 11 million of these individuals are 80 years or older. Older people are at high risk of neuropathic pain because many diseases that cause neuropathic pain increase in incidence with age. Depending on their underlying health, older adults with neuropathic pain may have to cope with multiple coexisting diseases, polypharmacy, and impaired functional ability. The objective of this article is to review how aging and frailty affect the treatment of older adults with neuropathic pain. Specific topics reviewed include the complexity of treatment decisions in older patients due to aged heterogeneity, multimorbidity, and polypharmacy; selection of treatment in an effort to maximize patients' functional abilities in addition to relieving their pain; more careful dosing (usually lower) and monitoring of pharmacotherapy relative to younger patients due to age-related changes in pharmacokinetics and pharmacodynamics; and underrepresentation of older adults in clinical trials of neuropathic pain treatments, which further compromises physicians' ability to make informed treatment decisions. PMID:20194145

Schmader, Kenneth E.; Baron, Ralf; Haanpää, Maija L.; Mayer, John; O'Connor, Alec B.; Rice, Andrew S. C.; Stacey, Brett

2010-01-01

126

Topical preparations for pain relief: efficacy and patient adherence.  

PubMed

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

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

2011-01-01

127

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

PubMed Central

Objectives To examine the temporal stability of conditioned pain modulation (CPM), formerly termed diffuse noxious inhibitory controls (DNIC), among a sample of patients with chronic pain. The study also examined the factors that might be responsible for the stability of CPM. Design & subjects, and methods In this test-retest study, patients underwent a series of standardized psychophysical pain testing procedures designed to assess CPM on two separate occasions (i.e., baseline, follow-up). Patients also completed self-report measures of catastrophizing (PCS) and negative affect (NA). Results Overall, results provided evidence for the stability of CPM among patients with chronic pain. Results, however, revealed considerable sex differences in the stability of CPM. For women, results revealed a significant test-retest correlation between baseline and follow-up CPM scores. For men, however, the test-retest correlation between baseline and follow-up CPM scores was not significant. Results of a Fisher’s Z-test revealed that the stability of CPM was significantly greater for women than for men. Follow-up analyses revealed that the difference between men and women in the stability of CPM could not be accounted for by any demographic (e.g., age) and/or psychologic factors (PCS, NA). Conclusions Our findings suggest that CPM paradigms possess sufficient reliability to be incorporated into bedside clinical evaluation of patients with chronic pain, but only among women. The lack of CPM reproducibility/stability observed among men places limits on the potential use of CPM paradigms in clinical settings for the assessment of men’s endogenous pain-inhibitory function. PMID:23924369

Martel, MO; Wasan, AD; Edwards, RR

2013-01-01

128

Value of diagnostic ultrasound in patients with chronic scrotal pain and normal findings on clinical examination  

Microsoft Academic Search

Objectives. Chronic scrotal pain is a frequent complaint. In many patients with scrotal pain, scrotal ultrasound is performed when the physical examination reveals no abnormalities. We evaluated the yield of scrotal ultrasound in patients with chronic scrotal pain and a normal physical examination.Methods. The study involved the findings in 111 patients with scrotal pain lasting longer than 2 weeks, in

E. P van Haarst; G van Andel; T. H Pels Rijcken; T. J. M Schlatmann; W. K Taconis

1999-01-01

129

Neuropathic and nociceptive pain in head and neck cancer patients receiving radiation therapy  

Microsoft Academic Search

BACKGROUND: Pain is common in head and neck cancer (HNC) patients and may be attributed to the malignancy and\\/or cancer treatment. Pain mechanisms and patient report of pain in HNC are expected to include both nociceptive and neuropathic components. The purpose of this study was to assess the trajectory of orofacial and other pain during and following treatment, using patient

Joel B Epstein; Diana J Wilkie; Dena J Fischer; Young-Ok Kim; Dana Villines

2009-01-01

130

Evidence for brain glial activation in chronic pain patients.  

PubMed

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 (11)C-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 (11)C-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

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

2015-03-01

131

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

PubMed Central

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

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

2012-01-01

132

The Effect of Pressure Pain Sensitivity and Patient Factors on Self-Reported Pain-Disability in Patients with Chronic Neck Pain  

PubMed Central

The study was conducted to estimate the extent to which pressure pain sensitivity (PPS) and patient factors predict pain-related disability in patients with neck pain (NP), and to determine if PPS differs by gender. Forty-four participants with a moderate level of chronic NP were recruited for this cross sectional study. All participants were asked to complete self-reported assessments of pain, disability and comorbidity and then underwent PPS testing at 4-selected body locations. Pearson`s r w was computed to explore relationships between the PPS measures and the self-reported assessments. Regression models were built to identify predictors of pain and disability. An independent sample t-test was done to identify gender-related differences in PPS, pain-disability and comorbidity. In this study, greater PPS (threshold and tolerance) was significantly correlated to lower pain-disability (r = -.30 to -.53, p?0.05). Age was not correlated with pain or disability but comorbidity was (r= 0.42-.43, p?0.01). PPS at the 4-selected body locations was able to explain neck disability (R2=25-28%). Comorbidity was the strongest predictor of neck disability (R2 =30%) and pain (R2=25%). Significant mean differences for gender were found in PPS, disability and comorbidity, but not in pain intensity or rating. This study suggests that PPS may play a role in outcome measures of pain and disability but between-subject comparisons should consider gender and comorbidity issues. PMID:25320651

Uddin, Zakir; MacDermid, Joy C.; Woodhouse, Linda J.; Triano, John J.; Galea, Victoria; Gross, Anita R.

2014-01-01

133

Saphenous neuropathy in a patient with low back pain  

PubMed Central

Saphenous nerve, a pure sensory nerve, may compromise as a result or complication of a surgical procedure or secondary to trauma or insidiously. We present a male patient with low back pain concomitant with pain in medial portion of left thigh in addition to pain and numbness in medial part of leg and inferior part of patella after a strenuous activity. Preliminary diagnosis suggested that the patient had radiculopathy but electrodiagnostic tests revealed the absence of left saphenous response both in medial leg and infrapatellar region, while normal findings were recorded from right side. Needle electromyography in L4 innervated muscles were normal. The patient had saphenous nerve entrapment in left thigh. Two months later symptoms relieved with conservative therapy. PMID:20205890

2010-01-01

134

Saphenous neuropathy in a patient with low back pain.  

PubMed

Saphenous nerve, a pure sensory nerve, may compromise as a result or complication of a surgical procedure or secondary to trauma or insidiously. We present a male patient with low back pain concomitant with pain in medial portion of left thigh in addition to pain and numbness in medial part of leg and inferior part of patella after a strenuous activity. Preliminary diagnosis suggested that the patient had radiculopathy but electrodiagnostic tests revealed the absence of left saphenous response both in medial leg and infrapatellar region, while normal findings were recorded from right side. Needle electromyography in L4 innervated muscles were normal. The patient had saphenous nerve entrapment in left thigh. Two months later symptoms relieved with conservative therapy. PMID:20205890

Ahadi, Tannaz; Raissi, Gholam Reza; Togha, Mansoureh; Nejati, Parisa

2010-01-01

135

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

PubMed Central

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

Im, Sang Hee

2013-01-01

136

Efficacy of Coronary Revascularization in Patients With Acute Chest Pain Managed in a Chest Pain Unit  

PubMed Central

OBJECTIVE: To investigate the safety of discharge of patients deemed at low risk of cardiac events after evaluation in a chest pain unit and to determine the prognostic effect of revascularization of patients deemed at high risk. PATIENTS AND METHODS: The study population consisted of 1088 patients presenting at the emergency department from January 15, 2001, to September 1, 2006, with chest pain but without ischemia on electrocardiography or troponin elevation. Patients were managed by a chest pain unit protocol that included early exercise testing. Three groups of patients were distinguished: (1) those discharged after exercise testing (424 [39%]); (2) those in whom unstable angina was ruled out after in-hospital evaluation (208 [19%]); and (3) those in whom unstable angina was confirmed or not ruled out (456 [42%]). Of the 456 patients in group 3, 183 (40%) were revascularized at the index episode. The primary end point was the occurrence of myocardial infarction or death within 1 year. Adjustments were made for patient characteristics and a propensity score for revascularization (c statistic [0.83]). RESULTS: Groups 1 and 2 showed lower rates of the primary end point than group 3 (group 1: 7 [1.7%]; group 2: 1 [0.5%]; group 3: 62 [13.6%]; P=.001). In group 3, revascularization at the index episode did not reduce the primary end point in the univariate (22 [12%] vs 29 [11%]; P=.80) and multivariate (hazard ratio, 1.4; 95% confidence interval, 0.7-2.5; P=.40) analyses. In-hospital revascularization decreased the need for postdischarge revascularization (hazard ratio, 0.3; 95% confidence interval, 0.1-0.7; P=.01). CONCLUSION: Chest pain unit protocols are associated with safe patient discharge. Although early revascularizations may decrease the need for postdischarge revascularizations, they may not improve 1-year outcomes by reducing the number of myocardial infarctions or deaths. PMID:19339649

Sanchis, Juan; Bodí, Vicent; Núñez, Julio; Mainar, Luis; Núñez, Eduardo; Merlos, Pilar; Rúmiz, Eva; Miñana, Gema; Bosch, Xavier; Llácer, Angel

2009-01-01

137

Pain management: a review of organisation models with integrated processes for the management of pain in adult cancer patients  

Microsoft Academic Search

AIMS AND OBJECTIVES: This paper reports a review of the literature conducted to identify organisation models in cancer pain management that contain integrated care processes and describe their effectiveness. BACKGROUND: Pain is experienced by 30-50% of cancer patients receiving treatment and by 70-90% of those with advanced disease. Efforts to improve pain management have been made through the development and

Anita Brink-Huis; Theo van Achterberg; Lisette Schoonhoven

2008-01-01

138

Factors That Influence Patient Advocacy by Pain Management Nurses: Results of the American Society for Pain Management Nursing Survey  

Microsoft Academic Search

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

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

2011-01-01

139

Precordial chest pain in patients with chronic Chagas disease.  

PubMed

Precordial chest pain affects about 15% to 33% of patients with chronic Chagas disease. In the absence of megaesophagus, it should be ascribed to chronic Chagas heart disease. Precordial chest pain is atypical because it can usually neither be associated to physical exercise nor be alleviated by nitroglycerin. However, in certain circumstances, precordial chest pain can masquerade as acute coronary syndrome. Although obstructive coronary artery disease can occasionally be found, microvascular angina seems to be the mechanism behind such phenomenon. Precordial chest pain not always has a benign clinical course; sometimes, it can herald a dismal prognosis. On the basis of cases previously reported, it seems that nitrates, betablockers and/or calcium channel blockers can be of value in the treatment of this condition. PMID:25127335

Bestetti, Reinaldo B; Restini, Carolina Baraldi A

2014-09-20

140

When race matters: disagreement in pain perception between patients and their physicians in primary care.  

PubMed Central

Patients and physicians often disagree in their assessment of pain intensity. This study explores the impact of patient factors on underestimation of pain intensity in chronic noncancer pain. We surveyed patients and their physicians in 12 primary care centers. To measure pain intensity, patients completed an 11-point numeric rating scale for which pain scores range from 0 (no pain) to 10 (unbearable pain). Physicians rated patients' pain on the same scale. We defined disagreement of pain intensity as underestimation or overestimation by 22 points. Of 601 patients approached, 463 (77%) completed the survey. The majority of participants were black (39%) or white (47%), 67% were female, and the mean age was 53 years. Physicians underestimated pain intensity relative to their patients 39% of the time. Forty-six percent agreed with their patients' pain perception, and 15% of physicians overestimated their patients' pain levels by > or =2 points. In both the bivariate and multivariable models, black race was a significant variable associated with underestimation of pain by physicians (p < 0.05; OR = 1.92; 95% CI: 1.31-2.81). This study finds that physicians are twice as likely to underestimate pain in blacks patients compared to all other ethnicities combined. A qualitative study exploring why physicians rate blacks patients' pain low is warranted. PMID:17534011

Staton, Lisa J.; Panda, Mukta; Chen, Ian; Genao, Inginia; Kurz, James; Pasanen, Mark; Mechaber, Alex J.; Menon, Madhusudan; O'Rorke, Jane; Wood, JoAnn; Rosenberg, Eric; Faeslis, Charles; Carey, Tim; Calleson, Diane; Cykert, Sam

2007-01-01

141

Chronic abdominal pain in a patient with escobar syndrome.  

PubMed

Escobar syndrome is characterized with multiple pterygia or webs of the skin and multiple congenital anomalies. We present a 15-year-old patient with Escobar syndrome who complained of persistent blunt abdominal pain for 1 year. Preoperative evaluation confirmed the diagnosis of imperforate hymen, and the patient underwent hymenectomy under intravenous sedation. The patient's postoperative course was uneventful and her complaints resolved completely. After a 3-month follow-up, she reported having normal menstrual bleeding intervals each month without any complications. Patients with Escobar syndrome may suffer from abdominal pain due to imperforate hymen. Careful evaluation of these patients must include a complete gynaecological assessment and, if indicated, surgical treatment must be performed without delay. PMID:25196531

Ural, Ülkü Mete; Tek?n, Ye?im Bayo?lu; Kir ?ah?n, Figen; Erd?vanli, Ba?ar; Kazdal, H?z?r

2015-01-01

142

Pain epidemiology and health related quality of life in chronic non-malignant pain patients referred to a Danish multidisciplinary pain center  

Microsoft Academic Search

This paper presents the results of a detailed study of the pain epidemiology and health related quality of life (HRQL) in 150 chronic non-malignant pain patients consecutively referred to a Danish multidisciplinary pain center. Mean pain severity was 71.6 (SD=18.5) on the VAS scale. Forty-two percent reported poor quality of sleep. HRQL was evaluated with the Medical Outcome Study-Short Form

Niels Becker; Annemarie Bondegaard Thomsen; Alf Kornelius Olsen; Per Sjøgren; Per Bech; Jørgen Eriksen

1997-01-01

143

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

PubMed

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

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

2014-03-01

144

Management and relief of pain in an emergency department from the adult patients' perspective.  

PubMed

To estimate the prevalence of pain in adult patients attending an emergency department (ED) and to identify risk markers for insufficient pain relief, a cross-sectional survey was conducted for 16 days, 24 hours each day, in the ED of a Paris university hospital. A structured questionnaire was used to collect characteristics of pain and its management from patients. Pain intensity was evaluated both on arrival and before discharge using two scales (a numerical descriptor scale or a verbal pain intensity scale). On arrival, 78% of the patients complained of pain; among them, 54% complained of intense pain and 47% suffered procedural pain. Insufficient pain relief was assessed in 289 (77%) patients. We identified the following risk markers for insufficient pain relief: moderate or low pain intensity, no intervention in the ED before the medical examination, and no use of medication before arrival. PMID:12782434

Tcherny-Lessenot, Stéphanie; Karwowski-Soulié, Fabienne; Lamarche-Vadel, Agathe; Ginsburg, Christine; Brunet, Fabrice; Vidal-Trecan, Gwenaëlle

2003-06-01

145

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

PubMed Central

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

Husebo, BS; Ostelo, R; Strand, LI

2014-01-01

146

Altered rectal sensory response induced by balloon distention in patients with functional abdominal pain syndrome  

Microsoft Academic Search

BACKGROUND: Functional abdominal pain syndrome (FAPS) has chronic unexplained abdominal pain and is similar to the psychiatric diagnosis of somatoform pain disorder. A patient with irritable bowel syndrome (IBS) also has chronic unexplained abdominal pain, and rectal hypersensitivity is observed in a majority of the patients. However, no reports have evaluated the visceral sensory function of FAPS precisely. We aimed

Tsukasa Nozu; Miwako Kudaira

2009-01-01

147

Patient satisfaction with spinal cord stimulation for predominant complaints of chronic, intractable low back pain  

Microsoft Academic Search

Background context: Results of subsequent surgical intervention in patients with intractable pain after lumbar spine surgery are typically worse than for initial surgery, particularly in those with predominant complaints of back pain rather than lower extremity pain. Spinal cord stimulation (SCS) has been found to yield good results in patients with primary complaints of intractable lower extremity pain. Technological advances

Donna D Ohnmeiss; Ralph F Rashbaum

2001-01-01

148

Management and Relief of Pain in an Emergency Department from the Adult Patients' Perspective  

Microsoft Academic Search

To estimate the prevalence of pain in adult patients attending an emergency department (ED) and to identify risk markers for insufficient pain relief, a cross-sectional survey was conducted for 16 days, 24 hours each day, in the ED of a Paris university hospital. A structured questionnaire was used to collect characteristics of pain and its management from patients. Pain intensity

Stéphanie Tcherny-Lessenot; Fabienne Karwowski-Soulié; Agathe Lamarche-Vadel; Christine Ginsburg; Fabrice Brunet; Gwenaëlle Vidal-Trecan

2003-01-01

149

Neurodegenerative Properties of Chronic Pain: Cognitive Decline in Patients with Chronic Pancreatitis  

Microsoft Academic Search

Chronic pain has been associated with impaired cognitive function. We examined cognitive performance in patients with severe chronic pancreatitis pain. We explored the following factors for their contribution to observed cognitive deficits: pain duration, comorbidity (depression, sleep disturbance), use of opioids, and premorbid alcohol abuse. The cognitive profiles of 16 patients with severe pain due to chronic pancreatitis were determined

Marijtje L. A. Jongsma; Simone A. E. Postma; Pierre Souren; Martijn Arns; Evian Gordon; Kris Vissers; Oliver Wilder-Smith; Clementina M. van Rijn; Harry van Goor

2011-01-01

150

Effect of Therapeutic Modalities on Patients With Patellofemoral Pain Syndrome  

PubMed Central

Context: Patellofemoral pain syndrome (PFPS) is a common orthopaedic condition for which operative and nonoperative treatments have been used. Therapeutic modalities have been recommended for the treatment of patients with PFPS—including cold, ultrasound, phonophoresis, iontophoresis, neuromuscular electrical stimulation, electrical stimulation for pain control, electromyographic biofeedback, and laser. Objective: To determine the effectiveness of therapeutic modalities for the treatment of patients with PFPS. Data Sources: In May and August 2010, Medline was searched using the following databases: PubMed, CINAHL, Web of Science Citation Index, Science Direct, ProQuest Nursing & Allied Health, and Your Journals@OVID. Study Selection: Selected studies were randomized controlled trials that used a therapeutic modality to treat patients with PFPS. The review included articles with all outcome measures relevant for the PFPS patient: knee extension and flexion strength (isokinetic and isometric), patellofemoral pain assessment during activities of daily life, functional tests (eg, squats), Kujala patellofemoral score, and electromyographic recording from knee flexors and extensors and quadriceps femoris cross-sectional areas. Data Extraction: Authors conducted independent quality appraisals of studies using the PEDro Scale and a system designed for analysis of studies on interventions for patellofemoral pain. Results: Twelve studies met criteria: 1 on the effects of cold and ultrasound together, ice alone, iontophoresis, and phonophoresis; 3, neuromuscular electrical stimulation; 4, electromyographic biofeedback; 3, electrical stimulation for control of pain; and 1, laser. Discussion: Most studies were of low to moderate quality. Some reported that therapeutic modalities, when combined with other treatments, may be of some benefit for pain management or other symptoms. There was no consistent evidence of any beneficial effect when a therapeutic modality was used alone. Studies did not consistently provide added benefit to conventional physical therapy in the treatment of PFPS. Conclusions: None of the therapeutic modalities reviewed has sound scientific justification for the treatment of PFPS when used alone. PMID:23016007

Lake, David A.; Wofford, Nancy H.

2011-01-01

151

Uncomplicated mechanically induced pelvic pain and organic dysfunction in low back pain patients  

PubMed Central

Mechanical disorders of the lumbar spine have been given much attention in the literature. Short of an acute cauda equina syndrome, few reports exist detailing the findings and clinical course of patients with pelvic and disorders of bladder, bowel and gynecologic/sexual function of spinal origin. Two uncomplicated representative cases of mechanically induced pelvic pain and organic dysfunction (PPOD) in patients presenting with low back pain are detailed. These patients typically reveal a wide range of individual symptoms and demonstrate clinical features characteristic of a mechanical disorder of the lumbar spine as the cause of their PPOD. The clinical features of the mechanically induced PPOD syndrome are reviewed and the response to distractive decompressive manipulation of the lumbar spine is presented.

Browning, James E

1991-01-01

152

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

SciTech Connect

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.

Simone, Charles B. [Department of Radiation Oncology, Hospital of University of Pennsylvania, Philadelphia, PA (United States); Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (United States)], E-mail: simonec@mail.nih.gov; Vapiwala, Neha; Hampshire, Margaret K.; Metz, James M. [Department of Radiation Oncology, Hospital of University of Pennsylvania, Philadelphia, PA (United States)

2008-09-01

153

Treating Pain in Addicted Patients: Recommendations from an Expert Panel  

PubMed Central

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

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

2014-01-01

154

[Health maintenance, relaxation and hypnosis for chronic pain patients].  

PubMed

The treatment of chronic pain patients integrates more and more complementary therapies such as relaxation and hypnosis, implemented by specially trained nurses. These techniques are offered on the basis of nurses' diagnoses carried out in the framework of a clinical approach. PMID:25518140

Boiron, Clare

2014-10-01

155

Opioid addiction screening tools for patients with chronic noncancer pain.  

PubMed

Recent reports of the sharp increase in overdose deaths from prescription opioids have raised concerns regarding the widespread use and abuse of these medications in the treatment of chronic noncancer pain (CNCP). The Centers for Disease Control and Prevention has described prescription drug overdose deaths as an epidemic, with recommendations that strategies for preventing opioid-related deaths should focus on the 10 percent of patients prescribed high doses of medication from a single health professional and the 10 percent of patients who receive high doses from multiple physicians. The CDC report also encourages more education for physicians on prescription of opioids, pain management, and addiction, and specifically encourages physicians to consult state-run prescription databases and to discontinue opioid therapy for patients not receiving benefit. This article reviews important terms for understanding prescription opioid addiction and describes several tools that health professionals can use to screen patients with CNCP being considered for opioid therapy. PMID:25705942

Dela Cruz, Adriane M; Trivedi, Madhukar H

2015-01-01

156

[Diagnosis and treatment of pain in the elderly patient].  

PubMed

For the diagnosis of pain in the elderly patient, special instruments are available for measuring cognitive and sensory deficits. With regard to treatment, too, age-specific peculiarities must be taken into account. Musculoskeletal diseases, and especially osteoarthritic conditions, are the most common pathologies that are the cause of pain in old age. To a particular degree they result in a restriction of mobility and pose a threat to the patient's independence. Physical inactivity is a major risk factor for the development of chronicity and for patient withdrawal. An improvement in the patient's training status can be achieved by pharmacological and physical treatment applied in association with active physical exercise and psychological measures. PMID:15884500

Basler, H D; Wörz, R

2005-04-14

157

Cross-sectional assessment of pain and physical function in skeletal dysplasia patients.  

PubMed

Short stature skeletal dysplasia (SD) patients have orthopedic and neurologic complications causing significant pain and physical disability. We conducted a large cross-sectional online survey in 361 people with short stature SD (>10?years) to describe pain prevalence, characteristics, and the relationship between pain and function. Chronic pain prevalence per Brief Pain Inventory (BPI) was 70.3%. Women reported more pain than men (73% vs 63% p?=?0.04). Pain Severity Score (average of current, worst, least and average pain) averaged 3.3?±?2, while the Pain Interference Score (with daily activities) averaged 3.4?±?2.7 on a 10-point scale. Per Bleck scale, 20.5% had little or no functional capacity. Increasing age and decreased ambulation independently predicted chronic pain. Chronic pain is prevalent in short stature SD patients and associated with poor physical function. Further study is required to clarify the temporal relationship among pain, function and treatments. PMID:23106480

Alade, Y; Tunkel, D; Schulze, K; McGready, J; Jallo, G; Ain, M; Yost, T; Hoover-Fong, J

2013-09-01

158

Etifoxine for pain patients with anxiety.  

PubMed

Etifoxine (etafenoxine, Stresam®) 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

Choi, Yun Mi; Kim, Kyung Hoon

2015-01-01

159

Etifoxine for Pain Patients with Anxiety  

PubMed Central

Etifoxine (etafenoxine, Stresam®) 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

Choi, Yun Mi

2015-01-01

160

Effectiveness of intercostal nerve block for management of pain in rib fracture patients  

PubMed Central

Controlling pain in patients with fractured ribs is essential for preventing secondary complications. Conventional medications that are administered orally or by using injections are sufficient for the treatment of most patients. However, additional aggressive pain control measures are needed for patients whose pain cannot be controlled effectively as well as for those in whom complications or a transition to chronic pain needs to be prevented. In this study, we retrospectively analyzed the medical records of patients in our hospital to identify the efficacy and characteristics of intercostal nerve block (ICNB), as a pain control method for rib fractures. Although ICNB, compared to conventional methods, showed dramatic pain reduction immediately after the procedure, the pain control effects decreased over time. These findings suggest that the use of additional pain control methods (e.g. intravenous patient-controlled analgesia and/or a fentanyl patch) is recommended for patients in who the pain level increases as the ICNB efficacy decreases. PMID:25210700

Hwang, Eun Gu; Lee, Yunjung

2014-01-01

161

CT Scans Might Spot Heart Risks More Clearly in Patients with Chest Pain  

MedlinePLUS

... Scans Might Spot Heart Risks More Clearly in Patients With Chest Pain Study found they changed treatments, ... a better job of diagnosing heart disease in patients with chest pain, compared to standard tests. A ...

162

ER Patients with Chest Pain May Not Always Need Heart Tests  

MedlinePLUS

... features on this page, please enable JavaScript. ER Patients With Chest Pain May Not Always Need Heart ... Services MONDAY, Jan. 26, 2015 (HealthDay News) -- For patients seen in emergency rooms solely for chest pain, ...

163

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

PubMed Central

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

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

2015-01-01

164

Is Treating Chronic Pain Torture? Internal Medicine Residents' Experience With Patients With Chronic Nonmalignant Pain  

Microsoft Academic Search

Purpose: To assess internal medicine residents' confidence in, experiences with, and attitudes toward managing chronic nonmalignant pain (CNMP) in their outpatient practices.Methods: We surveyed internal medicine residents with regard to their experiences with and attitudes toward patients with CNMP. Mean responses across residency year of training were analyzed.Results: Sixty-three percent of respondents reported feeling somewhat or much less confident in

Joyce T. Chen; Mark J. Fagan; Joseph A. Diaz; Steven E. Reinert

2007-01-01

165

Managing Pain in the Addicted Patient  

Microsoft Academic Search

\\u000a Approximately 20 million Americans have some form of substance abuse disorder, and about one-third of the US population has\\u000a used illicit drugs (Substance Abuse and Mental Health Services Administration office of Applied Studies 2007). Substance abuse\\u000a is known to occur in 10–16% of outpatients in general medical practice, 25–40% of hospital admissions, and 40–60% of major\\u000a trauma patients (Manchikanti et

Susan Dabu-Bondoc; Robert Zhang; Nalini Vadivelu

166

Patient satisfaction about using patient controlled analgesia in managing pain post surgical intervention.  

PubMed

Management of postoperative pain using patient controlled analgesia (PCA) has increased for its proven advantages over conventional methods of pain control. The purpose of this study was to investigate patients' satisfaction about using PCA post surgical intervention among patients at Saudi health care settings. A cross-sectional, descriptive correlational design was used to collect data from patients using PCA post surgical interventions. The analysis showed that patients had a moderate to high level of perception about efficacy of PCA, and had a moderate level of knowledge about PCA use and its function. The duration of using a PCA pump, patients' age, gender, marital status, educational level, type of surgery, and their work status were significant predictors (F 7, 76 = 5.13, p < .001; R (2)= 0.59). PCA offers patients with an individualized analgesic therapy that meets the patients' demand of pain control. The implications for nurses and medical staff are discussed. PMID:23729021

Ratrout, Hamza F; Hamdan-Mansour, Ayman M; Seder, Samer S; Salim, Wisam M

2014-08-01

167

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

PubMed Central

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

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

168

Effects of the CORE Exercise Program on Pain and Active Range of Motion in Patients with Chronic Low Back Pain  

PubMed Central

[Purpose] This study aimed to identify the effects of the CORE exercise program on pain and active range of motion (AROM) in patients with chronic low back pain. [Subjects and Methods] Thirty subjects with chronic low back pain were randomly allocated to two groups: the CORE group (n = 15) and the control group (n = 15). The CORE group performed the CORE exercise program for 30 minutes a day, 3 times a week, for 4 weeks, while the control group did not perform any exercise. The visual analog scale (VAS) and an algometer were used to measure pain, and pain-free AROM in the trunk was measured before and after the intervention. [Results] The CORE group showed significantly decreased VAS scores at rest and during movement and had a significantly increased pressure pain threshold in the quadratus lumborum and AROM in the trunk compared with those in the control group. [Conclusion] This study demonstrated that the CORE exercise program is effective in decreasing pain and increasing AROM in patients with chronic low back pain. Thus, the CORE exercise program can be used to manage pain and AROM in patients with chronic low back pain. PMID:25202188

Cho, Hwi-young; Kim, Eun-hye; Kim, Junesun

2014-01-01

169

Exercise radionuclide ventriculographic responses in hypertensive patients with chest pain  

SciTech Connect

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.

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

170

[Patient-controlled analgesia in cancer pain: practical aspects].  

PubMed

Allowing a suffering patient with cancer to control his pain is a challenge that numerous medical teams intend to take up. Although the best treatment is the etiologic one, in many situations the symptomatic and adjuvant therapies are both indispensable. Among them, the patient controlled analgesia (PCA) is a concept referring to the management of the pain, but also to the administration of some analgesic drugs. Even with genuine advantages the limits of the PCA do exist and need to be well known. PCA is not limited to palliative treatment; it can be used in many circonstances during each evolutionary step of the cancer, temporarily or for longer periods, at the hospital and at home as well. All patients disposing of such an equiment could determine their own best level of analgesia, at the good time, depending upon the temporal variability of the pain and its previsibility or not. The availability and the pedagogic concern of the members of the team, the link between the patient and his family, the involvement of both the regular general practioner and the "algologic" team are essential to maintain the best effects of this method. PMID:8745652

Lakdja, F; Parienté, F; Cros, P; Dutin, V; Lobera, A; Monnin, D; Roubault, N; Thonnier, C

1995-01-01

171

Anger Suppression and Subsequent Pain Behaviors among Chronic Low Back Pain Patients: Moderating Effects of Anger Regulation Style  

PubMed Central

Background Suppression of anger is linked to subsequent pain intensity among chronic low back patients, but it is not clear whether anger regulation style (trait anger-out, anger-in) moderates these effects or if aroused anger accounts for links between anger regulation style and pain. Method Chronic low back pain patients (N=58) were assigned to Suppression or No Suppression conditions for a task with harassing confederate and then underwent structured pain behavior procedures. Spielberger Anger Expression Inventory tapped trait anger-out (AOS) and anger-in (AIS). Results Regressions tested Emotion Regulation condition × AOS and AIS effects on outcomes. AOS was related to grimacing and sighing for Suppression condition patients. AIS was related negatively to guarding and bracing for Suppression condition patients. Anger report partly mediated effects for AOS and AIS. Conclusions Anger regulation style moderated effects of state anger suppression on subsequent pain behaviors, effects that were partly explained by aroused anger. PMID:21544702

Quartana, Phillip; Bruehl, Stephen

2013-01-01

172

Profile of sexuality in Moroccan chronic low back pain patients  

PubMed Central

Background Sexual life had an important role in preserving the good quality of life for patients and for their partner. Chronic Low Back Pain (CLBP) as other musculoskeletal diseases may affect all aspects of life including sexual functioning. The purpose of this study is to describe the impact of CLBP on the sexual life of patients and to identify the factors that affect their Sexual Quality of Life (SQOL). Methods One hundred CLBP sexually active patients were included. Patients and disease Characteristics were collected. Impact on sexual life (sexual intercourse and SQOL) was also assessed. Univariate and multivariate analysis were performed to analyze significant determinants associated with the SQOL disturbance. Results Eighty one percent of our patients complained about sexual difficulties related to CLBP. Libido decrease and painful intercourse position were reported respectively in 14.8 and 97.5% of cases. The most pain generating position was supine. Mean of sexual intercourse frequency decrease was at ?10.4?±?4.8 per month. SQOL score mean was at 44.6?±?17.4%. Men suffered more than women from sexual problems (respectively 90% vs. 72%; p?=?0.02). Men had worse SQOL than women (respectively 38.9?±?17.2 vs. 50.3?±?15.7%; p?=?0.001). Univariate and multivariate analysis showed that advanced age (p?=?0.009), poor functional status (p?=?0.03), male gender (p?=?0.03) and sexual intercourse frequency decrease (p?=?0.005) were the independent variables associated with the SQOL disturbance. Conclusion Our study suggests that sexuality is profoundly disturbed in CLBP patients; both their sexual intercourse and SQOL were affected. This disturbance seems to be associated with patient and disease characteristics. Sexuality should be taken into account in managing CLBP patients. PMID:23413914

2013-01-01

173

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

PubMed Central

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

Staud, Roland

2009-01-01

174

Somatosensory Profiles but Not Numbers of Somatosensory Abnormalities of Neuropathic Pain Patients Correspond with Neuropathic Pain Grading  

PubMed Central

Due to the lack of a specific diagnostic tool for neuropathic pain, a grading system to categorize pain as ‘definite’, ‘probable’, ‘possible’ and ‘unlikely’ neuropathic was proposed. Somatosensory abnormalities are common in neuropathic pain and it has been suggested that a greater number of abnormalities would be present in patients with ‘probable’ and ‘definite’ grades. To test this hypothesis, we investigated the presence of somatosensory abnormalities by means of Quantitative Sensory Testing (QST) in patients with a clinical diagnosis of neuropathic pain and correlated the number of sensory abnormalities and sensory profiles to the different grades. Of patients who were clinically diagnosed with neuropathic pain, only 60% were graded as ‘definite’ or ‘probable’, while 40% were graded as ‘possible’ or ‘unlikely’ neuropathic pain. Apparently, there is a mismatch between a clinical neuropathic pain diagnosis and neuropathic pain grading. Contrary to the expectation, patients with ‘probable’ and ‘definite’ grades did not have a greater number of abnormalities. Instead, similar numbers of somatosensory abnormalities were identified for each grade. The profiles of sensory signs in ‘definite’ and ‘probable’ neuropathic pain were not significantly different, but different from the ‘unlikely’ grade. This latter difference could be attributed to differences in the prevalence of patients with a mixture of sensory gain and loss and with sensory loss only. The grading system allows a separation of neuropathic and non-neuropathic pain based on profiles but not on the total number of sensory abnormalities. Our findings indicate that patient selection based on grading of neuropathic pain may provide advantages in selecting homogenous groups for clinical research. PMID:22927981

Konopka, Karl-Heinz; Harbers, Marten; Houghton, Andrea; Kortekaas, Rudie; van Vliet, Andre; Timmerman, Wia; den Boer, Johan A.; Struys, Michel M. R. F.; van Wijhe, Marten

2012-01-01

175

Somatosensory profiles but not numbers of somatosensory abnormalities of neuropathic pain patients correspond with neuropathic pain grading.  

PubMed

Due to the lack of a specific diagnostic tool for neuropathic pain, a grading system to categorize pain as 'definite', 'probable', 'possible' and 'unlikely' neuropathic was proposed. Somatosensory abnormalities are common in neuropathic pain and it has been suggested that a greater number of abnormalities would be present in patients with 'probable' and 'definite' grades. To test this hypothesis, we investigated the presence of somatosensory abnormalities by means of Quantitative Sensory Testing (QST) in patients with a clinical diagnosis of neuropathic pain and correlated the number of sensory abnormalities and sensory profiles to the different grades. Of patients who were clinically diagnosed with neuropathic pain, only 60% were graded as 'definite' or 'probable', while 40% were graded as 'possible' or 'unlikely' neuropathic pain. Apparently, there is a mismatch between a clinical neuropathic pain diagnosis and neuropathic pain grading. Contrary to the expectation, patients with 'probable' and 'definite' grades did not have a greater number of abnormalities. Instead, similar numbers of somatosensory abnormalities were identified for each grade. The profiles of sensory signs in 'definite' and 'probable' neuropathic pain were not significantly different, but different from the 'unlikely' grade. This latter difference could be attributed to differences in the prevalence of patients with a mixture of sensory gain and loss and with sensory loss only. The grading system allows a separation of neuropathic and non-neuropathic pain based on profiles but not on the total number of sensory abnormalities. Our findings indicate that patient selection based on grading of neuropathic pain may provide advantages in selecting homogenous groups for clinical research. PMID:22927981

Konopka, Karl-Heinz; Harbers, Marten; Houghton, Andrea; Kortekaas, Rudie; van Vliet, Andre; Timmerman, Wia; den Boer, Johan A; Struys, Michel M R F; van Wijhe, Marten

2012-01-01

176

Implementation of a portable electronic system for providing pain relief to patellofemoral pain syndrome patients  

NASA Astrophysics Data System (ADS)

In this study, a portable electromyogram (EMG) system and a stimulator are developed for patellofemoral pain syndrome patients, with the objective of reducing the pain experienced by these patients; the patellar pain is caused by an imbalance between the vastus medialis obliquus (VMO) and the vastus lateralis (VL). The EMG measurement circuit and the electrical stimulation device proposed in this study are specifically designed for the VMO and the VL; they are capable of real-time waveform recording, possess analyzing functions, and can upload their measurement data to a computer for storage and analysis. The system can calculate and record the time difference between the EMGs of the VMO and the VL, as well as the signal strengths of both the EMGs. As soon as the system detects the generation of the EMG of the VL, it quickly calculates and processes the event and stimulates the VMO as feedback through electrical stimulation units, in order to induce its contraction. The system can adjust the signal strength, time length, and the sequence of the electrical stimulation, both manually and automatically. The output waveform of the electrical stimulation circuit is a dual-phase asymmetrical pulse waveform. The primary function of the electrical simulation circuit is to ensure that the muscles contract effectively. The performance of the device can be seen that the width of each pulse is 20-1000 ?s, the frequency of each pulse is 10-100 Hz, and current strength is 10-60 mA.

Chang Chien, Jia-Ren; Lin, Guo-Hong; Hsu, Ar-Tyan

2011-10-01

177

Components of Mindfulness in Patients with Chronic Pain  

Microsoft Academic Search

Methods of mindfulness are gaining increasing popularity within the behavioral and cognitive therapies and appear helpful\\u000a for a range of clinical problems. The purpose of this study was to examine cognitive and behavioral processes underlying mindfulness.\\u000a One hundred fifty patients seeking treatment for chronic pain completed a battery of questionnaires, including the 15-item\\u000a Mindful Attention Awareness Scale (MAAS; Brown and

Lance M. McCracken; Miles Thompson

2009-01-01

178

Can attitudes of stoicism and cautiousness explain observed age-related variation in levels of self-rated pain, mood disturbance and functional interference in chronic pain patients?  

Microsoft Academic Search

The aims of the present study were (a) to examine the relationship between age, attitudes and self-reported pain and suffering in a sample of chronic pain patients and (b) to determine the extent to which attitudes of stoicism and cautiousness might mediate between age and chronic pain experience. Psychometric measures were administered to 338 chronic pain patients. The results indicate

Hua-Hie Yong

2006-01-01

179

The relationship between symptoms of post-traumatic stress disorder and pain, affective disturbance and disability among patients with accident and non-accident related pain  

Microsoft Academic Search

Recent studies have reported a high prevalence of symptoms of post-traumatic stress disorder (PTSD) among individuals with chronic pain. Studies suggest that persons with pain and PTSD also display higher levels of affective disturbance. In the present study we examined self-reports of pain, affective disturbance, and disability among pain patients with and without symptoms of PTSD. Patients without PTSD symptoms

Michael E. Geisser; Randy S. Roth; Jan E. Bachman; Thomas A. Eckert

1996-01-01

180

Intrathecal ziconotide and baclofen provide pain relief in seven patients with neuropathic pain and spasticity: case reports.  

PubMed

Seven cases of combination of intrathecal (IT) ziconotide and baclofen therapy in patients with refractory neuropathic pain and spasticity were reviewed. Five of the seven adult patients were receiving IT baclofen treatment when ziconotide was initiated. All five patients had experienced at least one previous failed IT treatment regimen. Pain intensity scores improved by a mean of 50.3% with the use of ziconotide-baclofen therapy. Mean time to onset of pain relief was 15 weeks, at a mean ziconotide dose of 3.7 microg/day. Within this group of patients, adverse events were observed in one patient, but they were not considered to be ziconotide related and subsequently resolved. The remaining two patients were receiving ziconotide treatment when baclofen was initiated. Pain intensity scores improved by 75% and 30%, respectively. Pain relief was evident at two weeks and one week, with corresponding ziconotide doses of 2.4 microg/day and 14.4 microg/day, respectively. One patient in this group reported adverse events, but all resolved during continued treatment with the study drugs. Treatment regimens varied between patients in these case series; each regimen used a different titration strategy and different concentrations of ziconotide and baclofen. Combination IT ziconotide and baclofen therapy may be a treatment option for patients with neuropathic pain and spasticity. Future studies are warranted to determine the optimal dosing and titration schedules for ziconotide-baclofen usage. PMID:19156022

Saulino, M; Burton, A W; Danyo, D A; Frost, S; Glanzer, J; Solanki, D R

2009-03-01

181

Pain catastrophizing mediates the relationship between worry and pain suffering in patients with irritable bowel syndrome  

Microsoft Academic Search

Although separate lines of behaviorally oriented pain research have drawn attention to the importance of pain catastrophizing and trait worry, little is known about how they work together to influence aspects of chronic pain. Integrating pain research with the broader anxiety, cognitive science, and learning literature, we hypothesized that the process (vs. content) of worry influences pain through catastrophizing. One

Jeffrey M. Lackner; Brian M. Quigley

2005-01-01

182

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

PubMed Central

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.

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

2015-01-01

183

Effects of Micronised Purified Flavonoid Fraction on Pain, Spermiogram and Scrotal Color Doppler Parameters in Patients with Painful Varicocele  

Microsoft Academic Search

Purpose: Micronised purified flavonoid fraction (MPFF) is a phlebotropic drug improving venous tone, elasticity and lymphatic drainage, decreasing venous distensibility, venous emptying times, reflux time of venous blood and capillary hyperpermeability, and having antioxidant activities. Since varicocele is a venous pathology, we evaluated the effects of MPFF on pain, spermiogram and color Doppler parameters in patients with painful varicocele. Material

Süleyman Kiliç; Deniz Ipek; Abdurrahim Dusak; Mevlana Derya Balbay

2005-01-01

184

Assessing pain in non-intubated critically ill patients unable to self report: an adaptation of the Behavioral Pain Scale  

Microsoft Academic Search

Purpose  To validate an adaptation of the Behavioral Pain Scale (BPS) for its use in non-intubated intensive care unit (ICU) patients\\u000a unable to self-report their pain because of the occurrence of delirium. The “vocalization” domain was inserted to construct\\u000a the BPS-non intubated (BPS-NI) scale, ranging from 3 (no pain) to 12 (most pain).\\u000a \\u000a \\u000a \\u000a Design  Prospective psychometric study in a medical-surgical ICU.\\u000a \\u000a \\u000a \\u000a Methods  The

Gérald Chanques; Jean-François Payen; Grégoire Mercier; Sylvie de Lattre; Eric Viel; Boris Jung; Moussa Cissé; Jean-Yves Lefrant; Samir Jaber

2009-01-01

185

Intractable Abdominal Pain in a Patient With Spinal Cord Injury: A Case Report  

PubMed Central

Patients with spinal cord injury (SCI) may experience several types of chronic pains. Abdominal pain in patients with SCI has gained limited attention and little is yet known about its characteristics and mechanisms. It often has been regarded as visceral pain associated with constipation and distention. Neuropathic pains localized in the abdomen have rarely been reported. We experience a case of intractable abdominal pain in a patient with SCI, neither of visceral pathology nor of musculoskeletal origin. The nature of pain fulfilled the diagnostic criteria for neuropathic pains. The pain was therefore regarded as neuropathic and managed accordingly. The first- and second-line oral drugs available were being performed, unfortunately, adequate pain control was not achieved. We tried an intrathecal lidocaine injection as another treatment option, and the injection had considerable effects. PMID:24236262

Park, Hye Kyung; Song, Dae Heon; Kim, Young Moon; Kim, Hong Geum; Kim, Soo Yeon

2013-01-01

186

Does patient-physiotherapist agreement influence the outcome of low back pain? A prospective cohort study  

Microsoft Academic Search

BACKGROUND: Recent research suggests that agreement between patients' and health professionals' perceptions may influence the outcome of various painful conditions. This issue has received little attention in the context of low back pain and physiotherapy interventions. The current study aimed at exploring the relationship between patient-physiotherapist agreement on baseline low back pain intensity and related functional limitations, and changes in

Kadija Perreault; Clermont E Dionne

2006-01-01

187

[Diagnostic and therapeutic devices for patients with chronic intractable pain: preface and comments].  

PubMed

New diagnostic and therapeutic devices for patients with chronic intractable pain are used in Japan. The following articles describe topics of new diagnostic and therapeutic devices for patients with chronic intractable pain including thermography, functional MRI, device for the quantitative analysis of perception and pain sensation, epiduroscopy, device for phototherapy, Racz catheter and device for spinal cord stimulation (SCS). PMID:25098129

Hanaoka, Kazuo

2014-07-01

188

Lymphocyte Subsets and the Role of Th1\\/Th2 Balance in Stressed Chronic Pain Patients  

Microsoft Academic Search

Background: The complex regional pain syndrome (CRPS) and fibromyalgia (FM) are chronic pain syndromes occurring in highly stressed individuals. Despite the known connection between the nervous system and immune cells, information on distribution of lymphocyte subsets under stress and pain conditions is limited. Methods: We performed a comparative study in 15 patients with CRPS type I, 22 patients with FM

Ines Kaufmann; Christoph Eisner; Peter Richter; Volker Huge; Antje Beyer; Alexander Chouker; Gustav Schelling; Manfred Thiel

2007-01-01

189

Relationships between changes in pain severity and other patient-reported outcomes: an analysis in patients with posttraumatic peripheral neuropathic pain  

Microsoft Academic Search

Background  The objective of this study is to use the pain numeric rating scale (NRS) to evaluate associations between change in pain\\u000a severity and changes in sleep, function, and mood assessed via patient-reported outcomes (PROs) in patients with posttraumatic\\u000a pain.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  This is a secondary analysis of a clinical trial evaluating pregabalin in patients with posttraumatic peripheral neuropathic\\u000a pain (N = 254).

Robert van Seventer; Michael Serpell; Flemming W Bach; Bart Morlion; Gergana Zlateva; Andrew G Bushmakin; Joseph C Cappelleri; Meryem Nimour

2011-01-01

190

Assessment of pain in less severely ill and injured aeromedical evacuation patients: a prospective field study.  

PubMed

Pain management is vitally important to injured patients being evacuated from the warzone. A prospective assessment of real-time ratings of pain acceptability, intensity, and satisfaction of a convenience sample of 114 less severely ill and injured U.S. military patients being evacuated on Aeromedical Evacuation (AE) missions from Ramstein Air Field, Germany, to Andrews Air Force Base, Maryland, was conducted. Data were collected before and during 12 AE flights in December 2012 and May 2013. Acceptable pain intensity was a median of 6/10 (range 2-9), with 76% of patients indicating an acceptable pain intensity greater than 4. During AE transport, 75% of patients reported at least one pain score ?4. Despite these high pain ratings, there was documentation of administration for only 58% of routine and 48% for as-needed analgesics/adjuvants. Over 47% of patients experienced pain that exceeded their acceptable intensity level, but of those patients with pain that was more severe than acceptable, only 10% rated their satisfaction with their pain management as poor or fair. This is the first study to provide real-time concurrent assessment of pain and pain management during en route care. The worst pain was reported for the hospital to aircraft arrival, suggesting the need for interventions to safely optimize pain management during this handoff period. PMID:25747630

Bridges, Elizabeth; Dukes, Susan; Serres, Jennifer

2015-03-01

191

Pain Management in the Cirrhotic Patient: The Clinical Challenge  

PubMed Central

Pain management in patients with cirrhosis is a difficult clinical challenge for health care professionals, and few prospective studies have offered an evidence-based approach. In patients with end-stage liver disease, adverse events from analgesics are frequent, potentially fatal, and often avoidable. Severe complications from analgesia in these patients include hepatic encephalopathy, hepatorenal syndrome, and gastrointestinal bleeding, which can result in substantial morbidity and even death. In general, acetaminophen at reduced dosing is a safe option. In patients with cirrhosis, nonsteroidal anti-inflammatory drugs should be avoided to avert renal failure, and opiates should be avoided or used sparingly, with low and infrequent dosing, to prevent encephalopathy. For this review, we searched the available literature using PubMed and MEDLINE with no limits. PMID:20357277

Chandok, Natasha; Watt, Kymberly D. S.

2010-01-01

192

Pain  

MedlinePLUS

... Active Medical Research Studies on Pain (ClinicalTrials.gov) Multimedia NCCAM Intramural Pain Research Program Safety Information Remoufan ... News Press Releases Alerts & Advisories Events Highlighted Information Multimedia (Video, Images, and Audio) NCCIH Clinical Digest A ...

193

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

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

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

194

Barriers to postoperative pain management in hip fracture patients with dementia as evaluated by nursing staff.  

PubMed

This paper reports a study of the perceptions of nursing staff regarding barriers to postoperative pain management in hip fracture patients with dementia, their expectations, and facilitators offered by their employers to overcome these barriers. Patients with dementia are at high risk for insufficient postoperative pain treatment, mainly owing to inability to articulate or convey their pain experience. Nursing staff have an essential role in the treatment and care of patients who are vulnerable, and therefore unable to advocate for their own pain treatment. Questionnaires with both structured and open-ended questions were used to collect data from nursing staff members in seven university hospitals and ten city-center hospitals from March to May 2011. The response rate was 52% (n = 331). According to nursing staff, the biggest barrier in pain management was the difficulty in assessing pain owing to a patient's cognitive impairment (86%). Resisting care and restlessness among patients with dementia can lead to use of restraints, although these kinds of behavioral changes can point to the occurrence of pain. There were statistically significant differences between the sufficiency of pain management and barriers. Those who expected pain management to be insufficient identified more barriers than those who expected pain management to be sufficient (p < .001). Further updating education for nursing staff in pain detection and management is needed so that nursing staff are also able to recognize behavioral symptoms as potential signs of pain and provide appropriate pain management. PMID:24602437

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

2014-03-01

195

Reactive effects of diary self-assessment in chronic pain patients  

Microsoft Academic Search

Several studies of experimental and acute clinical pain have indicated reactive effects of self-assessment on pain intensity and tolerance. A recent study of chronic pain patients (vonBaeyer 1994), however, failed to show these effects. The present investigation sought to determine whether reactive effects can be produced in chronic pain patients by an intensive self-assessment protocol. Using the methodology of ecological

Charles E. Cruise; Joan Broderick; Laura Porter; Alan Kaell; Arthur A. Stone

1996-01-01

196

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

PubMed Central

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

Boggero, Ian A; Carlson, Charles R

2015-01-01

197

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

PubMed

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

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

2011-03-01

198

Helping patients decide: From Hippocrates to videodiscs—an application for patients with low back pain  

Microsoft Academic Search

This paper outlines a modular, microcomputer and videodisc expert system, for patients with mechanical low back pain. The system incorporate facts, rules, and methods to extract data, opinions, information, and user preferences. It supports individual patient needs with a broad knowledge base, and analytical modelling techniques that connect flexible inference structures and user choices. Videodisc based expert systems help break

Carl W. Nelson

1988-01-01

199

Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain  

Microsoft Academic Search

Background: Low-back pain with leg pain (sciatica) may be caused by a herniated intervertebral disc exerting pressure on the nerve root. Most patients will respond to conservative treatment, but in carefully selected patients, surgical discectomy may provide faster relief of symptoms. Primary care clinicians use patient history and physical examination to evaluate the likelihood of disc herniation and select patients

D. A. W. M. van der Windt; E. Simons; I. I. Riphagen; C. Ammendolia; A. P. Verhangen; M. Laslett; W. Devillé; R. A. Deyo; L. M. Bouter; H. C. W. de Vet; B. Aertgeerts

2010-01-01

200

Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain  

Microsoft Academic Search

Background Low-back pain with leg pain (sciatica) may be caused by a herniated intervertebral disc exerting pressure on the nerve root. Most patients will respond to conservative treatment, but in carefully selected patients, surgical discectomy may provide faster relief of symptoms. Primary care clinicians use patient history and physical examination to evaluate the likelihood of disc herniation and select patients

Windt van der D. A. W. M; E. Simons; I. I. Riphagen; C. Ammendolia; A. P. Verhagen; M. Laslett; W. Devillé; R. A. Deyo; L. M. Bouter; Vet de H. C. W; B. Aertgeerts

2010-01-01

201

Evaluation of Factors Associated with Chronic Low Back Pain in Hemodialysis Patients  

Microsoft Academic Search

Background\\/Aims: Low back pain is a common and disabling symptom that has not been properly studied in hemodialysis patients. The aim of this study was to evaluate factors associated with chronic low back pain in these patients. Methods: We evaluated 205 patients undergoing chronic hemodialysis. Data were obtained through medical records, patient interviews and physical examination. Balance was evaluated through

Tatiana Cristofolini; Sergio Draibe; Ricardo Sesso

2008-01-01

202

Naltrexone metabolism and concomitant drug concentrations in chronic pain patients.  

PubMed

Naltrexone is effective in treating opioid dependence by blocking µ, ? and ? opiate receptors. Naltrexone is mainly metabolized to an active metabolite 6?-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, 6?-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; 6?-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 6?-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

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

2014-05-01

203

The prevalence of episodic pain in cancer: a survey of hospice patients on admission.  

PubMed

Pain that varies with time, referred to here as episodic pain, is a commonly encountered but under-investigated clinical problem. Previous studies of cancer patients have found that a significant proportion of their pains are episodic. To establish the prevalence and characteristics of episodic pains in hospice in-patients we assessed 245 consecutive admissions to four hospices in Yorkshire. The admitting doctor completed a questionnaire, detailing the characteristics of all pains experienced by the patient in the previous 24 h. Two hundred and forty-two questionnaires were entered into the study. One hundred and thirty-two patients reported pain in the preceding 24 h, of these 93% had at least one episodic pain. In total, 228 pains were described, of which 211 were episodic with a wide variation in their temporal characteristics, intensities and limitation. One hundred and fifty-two episodic pains had a precipitating factor; movement and weight bearing being the most frequent precipitants. One hundred and sixty-eight episodic pains had a relieving factor, medication improving 54%. Ninety-five pains were related to the malignancy and 47 to concurrent illness. The study confirms that episodic pain is extremely common in cancer patients referred for in-patient hospice care and highlights the need for further evaluation of its management. PMID:11212475

Swanwick, M; Haworth, M; Lennard, R F

2001-01-01

204

Validation and Clinical Application of a Biopsychosocial Model of Pain Intensity and Functional Disability in Patients with a Pediatric Chronic Pain Condition Referred to a Subspecialty Clinic  

PubMed Central

Background. Pediatric chronic pain is considered to be a multidimensional construct that includes biological, psychological, and social components. Methods. The 99 enrolled study patients (mean age 13.2 years, 71% female, 81% Caucasian) and an accompanying parent completed a series of health-related questionnaires at the time of their initial appointment in a pediatric chronic pain medicine clinic. Results. Significant correlations (r ? 0.30, P < 0.05) were observed between pediatric chronic pain intensity and patient anxiety, patient depression, patient pain coping, parent chronic pain intensity, and parent functional disability. Pediatric chronic pain intensity was significantly associated with patient anxiety (P = 0.002). Significant correlations (r ? 0.30, P < 0.05) were observed between pediatric functional disability and patient chronic pain intensity, patient anxiety, patient depression, patient pain coping, parent chronic pain intensity, parent functional disability, parent anxiety, parent depression, and parent stress. Pediatric functional disability was significantly associated with patient chronic pain intensity (P = 0.025), patient anxiety (P = 0.021), patient pain coping (P = 0.009), and parent functional disability (P = 0.027). Conclusions. These findings provide empirical support of a multidimensional Biobehavioral Model of Pediatric Pain. However, the practical clinical application of the present findings and much of the similar previously published data may be tenuous. PMID:24251035

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

2013-01-01

205

The Effect of Shiatsu Massage on Pain Reduction in Burn Patients  

PubMed Central

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

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

2014-01-01

206

Heavy metals and pain in the dysfunctional patient  

PubMed Central

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

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

2014-01-01

207

Different underlying pain mechanisms despite identical pain characteristics: a case report of a patient with spinal cord injury.  

PubMed

Pain following spinal cord injury has been classified as nociceptive (musculoskeletal, visceral) or neuropathic (above, at, below level). There is no clear relation between the etiology and reported symptoms. Thus, due to different underlying mechanisms, the treatment is often ineffective. We report on a patient with spinal cord injury with neurological level of injury at T8 suffering from bilateral burning and prickling pain in the T9-11 dermatomes bilaterally (at-level pain), as well as diffusely in both legs from below the torso (below-level pain), accompanied by musculoskeletal low back pain. Bilateral comparison of quantitative sensory testing (QST) and skin biopsy revealed completely different findings in the dermatome T9 despite identical at-level pain characteristics. On the right side, QST revealed a normal sensory profile; the intraepidermal nerve fiber density (IENFD) was reduced, but not as severe as the contralateral side. On the left side there was a severe sensory loss with a stronger reduction of the IENDF, similar to the areas below the neurological level. These findings were significantly related to the treatment results. Pregabalin induced unilateral pain relief only in the area with remaining sensory function, whereas the left-sided at-level pain was unchanged. Thus, 2 different underlying mechanisms leading to bilaterally neuropathic pain with identical symptoms and with different treatment success were demonstrated in a single patient. The at-level pain in areas with remaining sensory function despite IENFD reduction could be relieved by pregabalin. Thus, in an individual case, QST may be helpful to better understand pain-generating mechanisms and to initiate successful treatment. PMID:22444186

Westermann, Andrea; Krumova, Elena K; Pennekamp, Werner; Horch, Christoph; Baron, Ralf; Maier, Christoph

2012-07-01

208

Clinical Presentation and Self-Reported Patterns of Pain and Function in Patients with Plantar Heel Pain  

PubMed Central

Background Plantar heel pain is a common disorder of the foot for which patients seek medical treatment. The purpose of this study is to explore the relationship between duration of symptoms in plantar fasciitis patients and demographic factors, the intensity and location of pain, extent of previous treatment and self reported pain and function. Methods The charts of patients presenting with plantar heel pain between June 2008 and October 2010 were reviewed retrospectively and 182 patients with a primary diagnosis of plantar fasciitis were identified. Patients with symptoms less than 6 months were identified as acute and patients with symptoms greater than or equal to six months were defined as having chronic symptoms. Comparisons based on duration of symptoms were performed for age, gender, BMI, comorbidities, pain location and intensity, and a functional score measured by the Foot and Ankle Ability Measure (FAAM). Results The two groups were similar in age, BMI, gender, and comorbidities. Pain severity, as measured by a VAS, was not statistically significant between the two groups (6.6 and 6.2). The acute and chronic groups of patients reported similar levels of function on both the activity of daily living (62 and 65) and sports (47 and 45) subscales of the FAAM. Patients in the chronic group were more likely to have seen more providers and tried more treatment options for this condition. Conclusion As plantar fasciitis symptoms extend beyond 6 months, patients do not experience increasing pain intensity or functional limitation. No specific risk factors have been identified to indicate a risk of developing chronic symptoms. PMID:22995253

Klein, Sandra E.; Dale, Ann Marie; Hayes, Marcie Harris; Johnson, Jeffrey E.; McCormick, Jeremy J.; Racette, Brad A.

2014-01-01

209

The prevalence of pain at pressure areas and pressure ulcers in hospitalised patients  

PubMed Central

Background Patients with pressure ulcers (PUs) report that pain is their most distressing symptom, but there are few PU pain prevalence studies. We sought to estimate the prevalence of unattributed pressure area related pain (UPAR pain) which was defined as pain, soreness or discomfort reported by patients, on an “at risk” or PU skin site, reported at a patient level. Methods We undertook pain prevalence surveys in 2 large UK teaching hospital NHS Trusts (6 hospitals) and a district general hospital NHS Trust (3 hospitals) during their routine annual PU prevalence audits. The hospitals provide secondary and tertiary care beds in acute and elective surgery, trauma and orthopaedics, burns, medicine, elderly medicine, oncology and rehabilitation. Anonymised individual patient data were recorded by the ward nurse and PU prevalence team. The analysis of this prevalence survey included data summaries; no inferential statistical testing was planned or undertaken. Percentages were calculated using the total number of patients from the relevant population as the denominator (i.e. including all patients with missing data for that variable). Results A total of 3,397 patients in 9 acute hospitals were included in routine PU prevalence audits and, of these, 2010 (59.2%) patients participated in the pain prevalence study. UPAR pain prevalence was 16.3% (327/2010). 1769 patients had no PUs and of these 223 patients reported UPAR pain, a prevalence of 12.6%. Of the 241 people with pressure ulcers, 104 patients reported pain, a UPAR pain prevalence of 43.2% (104/241). Conclusion One in six people in acute hospitals experience UPAR pain on ‘at risk’ or PU skin sites; one in every 8 people without PUs and, more than 2 out of every five people with PUs. The results provide a clear indication that all patients should be asked if they have pain at pressure areas even when they do not have a PU. PMID:23902583

2013-01-01

210

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

PubMed Central

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

Dehghan, Morteza

2014-01-01

211

Laboratory and sonographic findings in dialyzed patients with bilateral chronic knee pain versus dialyzed asymptomatic patients.  

PubMed

The aim of this study is to evaluate connection of plasma level of beta2-microglobulin, C-reactive protein and uric acid as well as sonographic parameters like thickness of synovial membrane, thickness of femoral condylar cartilage and presence of joint effusion and Baker's cysts with bilateral knee pain in dialyzed patients, comparing them with parameters in asymptomatic dialyzed patients. Plasma levels of beta2-microglobulin and C-reactive protein were significantly higher in symptomatic patients while uric acid level showed no difference among the groups. In symptomatic patients synovial membrane was thicker and in those patients there were more knee effusions and Baker's cysts. Thickness of femoral condylar cartilage showed no difference between groups. That suggests that inflammatory mechanisms developing from beta2-microglobulin accumulation could be important factor in bilateral knee pain in dialyzed patients even in shorter duration dialysis. PMID:17847928

Barisi?, Igor; Ljuti?, Dragan; Vlak, Tonko; Bekavac, Josip; Jankovi?, Stipan

2007-06-01

212

Functional Abdominal Pain Patient Subtypes in Childhood Predict Functional Gastrointestinal Disorders with Chronic Pain and Psychiatric Comorbidities in Adolescence and Adulthood  

PubMed Central

Although pediatric functional abdominal pain (FAP) has been linked to abdominal pain later in life, childhood predictors of long-term outcomes have not been identified. This study evaluated whether distinct FAP profiles based on patterns of pain and adaptation in childhood could be identified and whether these profiles predicted differences in clinical outcomes and central sensitization (wind-up) on average 9 years later. In 843 pediatric FAP patients, cluster analysis was used to identify subgroups at initial FAP evaluation based on profiles of pain severity, gastrointestinal (GI) and non-GI symptoms, pain threat appraisal, pain coping efficacy, catastrophizing, negative affect, and activity impairment. Three profiles were identified: High Pain Dysfunctional, High Pain Adaptive, and Low Pain Adaptive. Logistic regression analyses controlling for age and sex showed that, compared to pediatric patients with the Low Pain Adaptive profile, those with the High Pain Dysfunctional profile were significantly more likely at long-term follow-up to meet criteria for pain-related functional gastrointestinal disorder (FGID) (OR: 3.45; CI: 1.95–6.11), FGID with comorbid non-abdominal chronic pain (OR: 2.6; CI:1.45–4.66), and FGID with comorbid anxiety or depressive psychiatric disorder (OR: 2.84; CI: 1.35–6.00). Pediatric patients with the High Pain Adaptive profile had baseline pain severity comparable to the High Pain Dysfunctional profile, but had outcomes as favorable as the Low Pain Adaptive profile. In laboratory pain testing at follow-up, High Pain Dysfunctional patients exhibited significantly greater thermal wind-up than Low Pain Adaptive patients, suggesting that a subgroup of FAP patients has outcomes consistent with widespread effects of heightened central sensitization. PMID:22721910

Walker, Lynn S.; Sherman, Amanda L.; Bruehl, Stephen; Garber, Judy; Smith, Craig A.

2012-01-01

213

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

PubMed Central

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?×?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?×?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?×?phosphate product levels in early- and late-stage CKD patients who were not on dialysis. PMID:24400957

2014-01-01

214

[Experience in treatment of patients with neuropathic facial pain using ziconotide].  

PubMed

We report on the intrathecal use of ziconotide in three patients with idiopathic facial pain after surgery of the mouth, jaw or face and one patient with neuropathic pain after damage of the lingual nerve. The therapy was successful in three patients but one patient with idiopathic facial pain had pain relief only during the test phase of ziconotide with an external pump and not after implanting the Synchromed® pump. With intrathecal morphine therapy this patient achieved good pain relief. We recommend that patients with neuropathic facial pain should be treated with ziconotide after implementation of guideline-based therapy. In the test phase the ziconotide dose should be increased by 0.6 µg/day per week after an initial dose of 0.6-1.2 µg/day to avoid side-effects. PMID:21818721

Lux, E A; Rasche, D

2011-08-01

215

Multi-method assessment of experimental and clinical pain in patients with fibromyalgia.  

PubMed

Experimental measures of responsiveness to painful and non-painful stimuli as well as measures of typical and present clinical pain were assessed in 26 female patients with fibromyalgia and in an equal number of age-matched healthy women. Pressure pain thresholds, determined by means of a dolorimeter, were lower in the patients compared to the control subjects both at a tender point (trapezius) and at a non-tender control point (inner forearm). The same was true for the heat pain thresholds, measured using a contact thermode. In contrast, the pain thresholds for electrocutaneous stimuli were decreased only at the tender point. The detection thresholds for non-painful stimuli (warmth, cold and electrical stimuli) seemed to be less affected in the fibromyalgia patients, with only the detection threshold for cold being lower at both sites. Tender points were more sensitive than control points for mechanical pressure. The reverse was found for the other modalities which were tested. Although the 3 experimental pain thresholds showed patterns of either generalized or site-specific pain hyperresponsiveness, the between-methods correlations were not very high. While the correlations between the experimental pain thresholds and the various measures of clinical pain (Localized Pain Rating, McGill Pain Questionnaire) in the patients were generally low, there were significant negative correlations between pressure pain thresholds at the two sites and the level of present pain assessed by the Localized Pain Rating. We conclude that a pattern of pain hyperresponsiveness, generalized across the site of noxious stimulation and across the physical nature of the stressor, is associated with fibromyalgia.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7854801

Lautenbacher, S; Rollman, G B; McCain, G A

1994-10-01

216

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

NASA Astrophysics Data System (ADS)

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.

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

2014-03-01

217

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

PubMed

[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

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

2015-02-01

218

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

PubMed Central

[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

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

2015-01-01

219

Differential Diagnosis and Treatment in a Patient With Posterior Upper Thoracic Pain  

Microsoft Academic Search

Background and Purpose. Determining the source of a patient's pain in the upper thoracic region can be difficult. Costovertebral (CV) and costotransverse (CT) joint hypomobility and active trigger points (TrPs) are possible sources of upper thoracic pain. This case report describes the clinical decision-making process for a patient with posterior upper thoracic pain. Case Description. The patient had a 4-month

Stacie J Fruth

2006-01-01

220

Increased taste intensity perception exhibited by patients with chronic back pain  

E-print Network

to pain, we reasoned that the sense of taste might also be enhanced in CBP. Detection and recognitionIncreased taste intensity perception exhibited by patients with chronic back pain Dana M. Small a between brain regions involved in taste and pain perception, and cortical injuries may lead to increases

Apkarian, A. Vania

221

Epidemiology of complex regional pain syndrome: a retrospective chart review of 134 patients  

Microsoft Academic Search

Complex regional pain syndrome (CRPS) remains a poorly understood chronic pain disorder. Little data has been published assessing the epidemiology of CRPS (and reflex sympathetic dystrophy, RSD). This study assessed epidemiological variables in 134 CRPS patients evaluated at a tertiary chronic pain clinic in the US, including demographic, health care utilization and legal\\/workman's compensation measures. In addition, the frequency of

Ginger Allen; Bradley S. Galer; Lauren Schwartz

1999-01-01

222

MIGRAINE HEADACHES AND PAIN WITH NEUROPATHIC CHARACTERISTICS: COMORBID CONDITIONS IN PATIENTS WITH MULTIPLE  

E-print Network

1 MIGRAINE HEADACHES AND PAIN WITH NEUROPATHIC CHARACTERISTICS: COMORBID CONDITIONS IN PATIENTS-Dol; Inserm U1107, Douleur Trigéminale et Migraine, Faculté de chirurgie dentaire, Clermont-Ferrand F-63000.moisset@gmail.com Running title: Migraine and neuropathic pain in multiple sclerosis Key words: pain, multiple sclerosis

Paris-Sud XI, Université de

223

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

PubMed Central

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

Im, Eun-Ok

2008-01-01

224

Cystatin C in Cerebrospinal Fluid is Upregulated in Elderly Patients With Chronic Osteoarthritis Pain and Modulated  

E-print Network

of CSF were obtained from 8 elderly patients (65 y and above) suffering from OA with lower limb pain Pain and Modulated Through Matrix Metalloproteinase 9­Specific Pathway Shu-Lin Guo, MD, PhD,*w Cheng (CSF) is well known, its ambiguous role associated with pain still remains unclear. This study

Lee, H.C. Paul

225

A patient with acute kidney pain and high blood pressure.  

PubMed

This case presented challenging diagnostic and management issues in a young healthy man who presented with abdominal pain and new-onset hypertension. The differential diagnosis evolved over the course of the clinical presentation. The patient had severe vascular involvement of his renal and basal cerebral arteries that initially was assumed to be due to a vasculitic process or hypercoagulable state. Finally it became apparent that the patient did not have a systemic illness but rather a localized vascular disease most likely due to segmental arterial mediolysis, a rare, under-recognized condition that can potentially be fatal. This condition is often difficult to distinguish from fibromuscular dysplasia. It is important to recognize and correctly diagnose the condition, particularly in the acute phase of the disease, because delay in diagnosis can contribute to morbidity and mortality. PMID:25583291

Cohen, Debbie L; Soulen, Michael C

2015-04-01

226

Coping strategies, stress, physical activity and sleep in patients with unexplained chest pain  

Microsoft Academic Search

BACKGROUND: The number of patients suffering from unexplained chest pain (UCP) is increasing. Intervention programmes are needed to reduce the chest pain and suffering experienced by these patients and effective preventive strategies are also required to reduce the incidence of these symptoms. The aim of this study was to describe general coping strategies in patients with UCP and examine the

Margaretha Jerlock; Fannie Gaston-Johansson; Karin I Kjellgren; Catharina Welin

2006-01-01

227

Brief presurgery hypnosis reduces distress and pain in excisional breast biopsy patients  

Microsoft Academic Search

Each year, hundreds of thousands of women undergo excisional breast biopsies for definitive diagnosis. Not only do these patients experience pain associated with the procedure, but they also endure distress associated with the threat of cancer. Hypnosis has been demonstrated as effective for controlling patients' pain in other surgical settings, but breast surgery patients have received little attention. To determine

Guy H. Montgomery; Christina R. Weltz; Megan Seltz; Dana H. Bovbjerg

2002-01-01

228

Enhanced temporal summation of second pain and its central modulation in fibromyalgia patients  

Microsoft Academic Search

We have previously shown that fibromyalgia (FMS) patients have enhanced temporal summation (windup) and prolonged decay of heat-induced second pain in comparison to control subjects, consistent with central sensitization. It has been hypothesized that sensory abnormalities of FMS patients are related to deficient pain modulatory mechanisms. Therefore, we conducted several analyses to further characterize enhanced windup in FMS patients and

Donald D. Price; Roland Staud; Michael E. Robinson; Andre P. Mauderli; Richard Cannon; Charles J. Vierck

2002-01-01

229

Influence of comorbidity with depression on interdisciplinary therapy: outcomes in patients with chronic low back pain  

Microsoft Academic Search

INTRODUCTION: Our previous work showed higher tumour necrosis factor (TNF)-? levels in patients with chronic low back pain (cLBP) compared to healthy controls. However, patients with depression as a comorbidity did not have higher TNF-? levels in comparison to patients without depression. In this study we investigated the influence of depression on therapy outcomes such as TNF-? serum levels, pain

Haili Wang; Carsten Ahrens; Winfried Rief; Marcus Schiltenwolf

2010-01-01

230

Esophageal contribution to chest pain in patients with coronary artery disease.  

PubMed

We conducted a prospective study to determine the role of the esophagus in causing chest pain in patients with established CAD on optimum therapy. Thirty-two men with documented CAD who complained of frequent and usually daily retrosternal chest pain were evaluated. Following a standard esophageal manometry and acid perfusion test, simultaneous two-channel ambulatory Holter monitor and esophageal pH record tests were performed for 24 hours. Fifty-three episodes of chest pain were documented in 20 patients; 11 patients were free of pain. Of the 20 patients who complained of chest pains, 17 (85 percent) demonstrated at least one episode of PPR, defined as a drop in distal esophageal pH to less than 4 within ten minutes before or after the onset chest pain. Episodes of asymptomatic GER were common. The correlation of PPR with chest pain was 70 percent (37/53 episodes) and of ischemic ECG changes with chest pain 13 percent (7/53); in the remaining, there was no correlation with either. Two patients demonstrated simultaneous PPR and ischemic ECG changes. Seventeen esophageal motility abnormalities were observed in 14 patients (45 percent). It is our conclusion that esophageal disorders contribute to chest pain in patients with documented CAD. In this group, GER plays a greater role than in those with normal coronary arteries. In addition, esophageal motility disorders are common in these patients. Esophageal testing can be undertaken safely in these patients. PMID:2209134

Garcia-Pulido, J; Patel, P H; Hunter, W C; Douglas, J E; Thomas, E

1990-10-01

231

Conversing rate from morphine to continuous infusion of fentanyl in patients suffering cancer pain  

Microsoft Academic Search

Objective  To investigate the proper conversing rate from morphine to continuous infusion of fentanyl in patients suffering cancer pain.\\u000a \\u000a \\u000a \\u000a Methods  A retrospective study was carried on in 20 patients with cancer pain in Shizuoka Cancer Center from Sep. 2002 to Nov. 2003.\\u000a Pain intensity, adverse reactions, and satisfaction index of patients were evaluated.\\u000a \\u000a \\u000a \\u000a Results  The pain intensity was stable in 17 patients indicating

Wen-ping Wang; Da-yong An

2007-01-01

232

The psychological assessment of patients with chronic pain  

Microsoft Academic Search

This article reviews the objectives of psychological evaluations, as well as the standard pain center evaluation protocol\\u000a that uses a pain questionnaire, a structured clinical interview, and pain assessment measures that include pain intensity\\u000a rating scales and the McGill Pain Questionnaire. The most frequently used measures of psychological status, such as the Beck\\u000a Depression Inventory and the Minnesota Multiphasic Personality

Allen H. Lebovits

2000-01-01

233

Pain  

MedlinePLUS

... women. For instance, after puberty, when sex hormone levels rise, girls start to have more migraines than boys. But other painful conditions, such as joint pain, don’t become more common in women until after menopause, when sex hormone levels drop. It’s not clear yet which hormones affect ...

234

Beyond Patient Reported Pain: Perfusion Magnetic Resonance Imaging Demonstrates Reproducible Cerebral Representation of Ongoing Post-Surgical Pain  

Microsoft Academic Search

Development of treatments for acute and chronic pain conditions remains a challenge, with an unmet need for improved sensitivity and reproducibility in measuring pain in patients. Here we used pulsed-continuous arterial spin-labelling [pCASL], a relatively novel perfusion magnetic-resonance imaging technique, in conjunction with a commonly-used post-surgical model, to measure changes in regional cerebral blood flow [rCBF] associated with the experience

Matthew A. Howard; Kristina Krause; Nadine Khawaja; Nathalie Massat; Fernando Zelaya; Gunter Schumann; John P. Huggins; William Vennart; Steven C. R. Williams; Tara F. Renton; Bernhard Baune

2011-01-01

235

Patient Expectations as Predictors of Outcome In Patients with Acute Low Back Pain  

Microsoft Academic Search

BACKGROUND  Few studies have evaluated the association between patient expectations for recovery and clinical outcomes, and no study has\\u000a evaluated whether asking patients to choose their therapy modifies such an association.\\u000a \\u000a \\u000a \\u000a OBJECTIVE  To evaluate the association between patients’ expectations and functional recovery in patients with acute low back pain (LBP),\\u000a and to determine whether that association is affected by giving patients choice

Samuel S. Myers; Russell S. Phillips; Roger B. Davis; Daniel C. Cherkin; Anna Legedza; Ted J. Kaptchuk; Andrea Hrbek; Julie E. Buring; Diana Post; Maureen T. Connelly; David M. Eisenberg

2008-01-01

236

Pain judgements of patients’ relatives: examining the use of social contract theory as theoretical framework  

Microsoft Academic Search

Observer underestimation of others’ pain was studied using a concept from evolutionary psychology: a cheater detection mechanism\\u000a from social contract theory, applied to relatives and friends of chronic pain patients. 127 participants estimated characters’\\u000a pain intensity and fairness of behaviour after reading four vignettes describing characters suffering from pain. Four cues\\u000a were systematically varied: the character continuing or stopping liked

Judith Kappesser; Amanda C. de C. Williams

2008-01-01

237

Recognizing Myofascial Pelvic Pain in the Female Patient with Chronic Pelvic Pain  

PubMed Central

Myofascial pelvic pain (MFPP) is a major component of chronic pelvic pain (CPP) and often is not properly identified by healthcare providers. The hallmark diagnostic indicator of MFPP is myofascial trigger points in the pelvic floor musculature that refer pain to adjacent sites. Effective treatments are available to reduce MFPP, including myofascial trigger point release, PMID:22862153

Pastore, Elizabeth Anne; Katzman, Wendy B.

2012-01-01

238

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

PubMed Central

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

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

2011-01-01

239

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

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.…

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

2010-01-01

240

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

PubMed Central

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

2012-01-01

241

Pain tolerance in patients presenting to primary care and physiotherapy services with upper limb disorders  

PubMed Central

Background Arm pain is a common cause of incapacity for work and is often attributed to occupational activities, but in many cases the pathogenesis is unclear. Objective To investigate whether arm pain in the absence of identifiable underlying pathology is associated with reduced tolerance of painful sensory stimuli. Methods 133 incident cases of arm pain, recruited from primary care and physiotherapy services, were classified according to a validated diagnostic algorithm. Pain tolerance was measured at three sites in each arm in response to electrocutaneous stimulation. Associations with pain tolerance (the geometric mean of the six measurements at 5?Hz) were assessed by linear regression, and findings were summarised as proportional changes in pain tolerance. Results Pain tolerance was generally lower than in an earlier community survey. Women had a lower tolerance than men. After allowance for sex, age, use of analgesics and anatomical extent of pain, there was no indication of reduced tolerance in patients with non?specific pain relative to those with specific local pathology. Conclusions Pain tolerance may be generally reduced in patients presenting to medical services with arm pain, but those with non?specific pain do not seem to have lower tolerance than those with identifiable local pathology. PMID:17182647

Ryall, Claire; Coggon, David; Peveler, Robert; Reading, Isabel; Palmer, Keith T

2007-01-01

242

Postoperative Pain Management among Surgically Treated Patients in an Ethiopian Hospital  

PubMed Central

Background Incidence of postoperative pain has been reported to be between 47–100%. Ineffective postoperative pain management results in tangible and intangible costs. The purpose of this study was to assess the processes and outcomes of pain management in the surgical wards of Jimma University Specialized Hospital, Ethiopia. Methods and Findings A prospective cross sectional study was conducted among 252 postoperative patients during February 13 to April 30, 2012. A contextually modified and validated (Cronbach’s ? coefficient of 0.78) American Pain Society Patient Outcome Questionnaire was used to assess pain experience of patients. Patients’ charts were reviewed to assess the pattern of analgesic use. Incidence of postoperative pain was 91.4%, and remained high over 3 measurements (McNemar’s; p<0.05), and 80.1% of the patients were undertreated. The mean pain intensity, and pain interference on functional status were 6.72±1.44 and 5.61±1.13 on a 10 point Numerical rating scale respectively; both being strongly correlated(r?=?0.86: p<0.001). Pain intensity was varied by ethnicity, education and preoperative information (ANOVA; P<0.05). Only 50% of the patients were adequately satisfied with their pain management. As needed (prn), solo analgesic, null analgesic, and intramuscular orders were noted for 31.3%, 89.29%, 9.7% and 20.1% of the prescription orders respectively. Though under dose, diclofenac and tramadol were the top prescribed medications, and only 57% of their dose was administered. Linear regression model showed that the predictors of satisfaction were sex of an individual and pain interference with functional status. Conclusion Despite patients’ paradoxical high satisfaction with pain management, the majority of patients were inadequately and inappropriately treated. Thus, further research is needed to determine how best to break down current barriers to effective pain management. PMID:25033399

Woldehaimanot, Tewodros Eyob; Eshetie, Tesfahun Chanie; Kerie, Mirkuzie Woldie

2014-01-01

243

[Management of chronic and acute pain in patients with cancer diseases].  

PubMed

Pain is one of the most important and most frequent symptoms of malignancy. Its intensity and prevalence is growing with disease status. Pain should be present in early stage cancer patients also. Pain is, together with other symptoms (anorexia, nausea, depression, anxiety, sleep disturbances), factor of patients quality?oflife and proper therapy is responsible for overall patient satisfaction and activity. Right pain management is always multidimensional and pain should be assessed at each contact. In review article we would like to bring some alerts of pain context in complexity of cancer and we would like to stress some forms of acute pain management.Key words: chronic pain -? acute pain -? cancer pain -? breakthrough pain -? procedural pain -? opioids -? fentanyl The authors declare they have no potential conflicts of interest concerning drugs, products, or?services used in the study. The Editorial Board declares that the manuscript met the ICMJE "uniform requirements" for biomedical papers.Submitted: 25. 2. 2015Accepted: 10. 3. 2015. PMID:25882018

Sochor, M; Sláma, O

2015-01-01

244

Opportunities to improve pain management outcomes in total knee replacements: patient-centered care across the continuum.  

PubMed

Despite the importance of pain management to each patient's overall experience with a total knee replacement, opportunities to improve pain care exist. The authors target an unnecessarily fragmented pain management trajectory as one cause of variability in pain outcomes. They propose that a technology-enhanced patient-centered pain management continuum running from the preoperative through the recovery phase offers effective and efficient pain management. PMID:25607613

Samuels, Joanne G; Woodward, Robert S

2015-01-01

245

Early adjunct treatment with topical lidocaine results in improved pain and function in a patient with complex regional pain syndrome.  

PubMed

Complex regional pain syndrome (CRPS) is a pain disorder characterized by sensory, motor, trophic and autonomic dysfunction. The hallmark of the disorder is pain out of proportion of the inciting event. CRPS is difficult for clinicians to manage as there is no gold standard for diagnosis or treatment. Patients with CRPS are at risk of developing contractures, tissue atrophy, joint dislocation and severe chronic pain. While CRPS is thought to be due to peripheral and central nervous system dysfunction, there is limited understanding of the pathophysiology of CRPS. The proposed mechanisms are multifactorial and consequently, so are the proposed treatments. These treatments can be invasive, such as intrathecal drug delivery or sympathectomy, which have poor evidence for efficacy. Thus, highlighting the need for a safe, effective, and early intervention. We present a case of topical 5% lidocaine ointment as a non-invasive, inexpensive and effective adjunct treatment in the management of pain in a spinal cord injured patient presenting with early CRPS. The clinically important effect of topical lidocaine for reducing severe allodynia allowed the patient to participate in rehabilitation strategies to further manage the debilitating consequences of her CRPS, including decreased range of motion (ROM) and function. The immediate pain relief from topical lidocaine allowed the patient to tolerate physical therapy sessions directed at her CRPS. A successful outcome was measured subjectively and objectively by our patient's reduction in symptoms and improvement in ROM and function, respectively. This case study provides preliminary support for improved pain and functional outcome with early adjunct treatment of CRPS with topical lidocaine. PMID:25247913

Hanlan, Amy K L; Mah-Jones, Dianna; Mills, Patricia B

2014-01-01

246

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

PubMed Central

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

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

2012-01-01

247

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

PubMed Central

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

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

2015-01-01

248

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

PubMed Central

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. R²?=?.38), depression (Adj. R²?=?.18) and mental QoL (Adj. R²?=?.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

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

2014-01-01

249

Pain (PDQ)  

MedlinePLUS

... cancer treatment ends. Pain control can improve your quality of life. Pain can be controlled in most patients with ... in most patients. Pain control can improve your quality of life all through your cancer treatment and after it ...

250

Pain and distress among elderly intensive care unit patients: Comparison of patients' experiences and nurses' assessments  

Microsoft Academic Search

OBJECTIVE: To investigate elderly intensive care unit (ICU) patients' experiences of pain and distress, as well as interventions aimed at reducing these conditions, and to compare these experiences with the way nurses and assistant nurses, respectively, assess their patients' responses related to these issues.DESIGN: Descriptive, correlational, comparative.SETTING: Two medical-surgical ICUs at county hospitals in two medium-sized cities in Sweden.SUBJECTS: Fifty-one

Marie Louise Hall-Lord; Gerry Larsson; Bertil Steen

1998-01-01

251

Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain.  

PubMed

The aim of this study was to find the cut-off points on the visual analogue scale (VAS) to distinguish among mild, moderate, and severe pain, in relation to the following: pain-related interference with functioning; verbal description of the VAS scores; and latent class analysis for patients with chronic musculoskeletal pain. A total of 456 patients were included. Pain was assessed using the VAS and verbal rating scale; functioning was assessed using the domains of the Short Form (36) Health Survey (SF-36). Eight cut-off point schemes were tested using multivariate analysis of variance (MANOVA), ordinal logistic regression, and latent class analysis. The study results showed that VAS scores ? 3.4 corresponded to mild interference with functioning, whereas 3.5 to 6.4 implied moderate interference, and ? 6.5 implied severe interference. VAS scores ? 3.4 were best described for patients with chronic musculoskeletal pain as mild pain, 3.5 to 7.4 as moderate pain, and ? 7.5 as severe pain. Latent class analysis found that a 3-class solution fitted best, resulting in the classes 0.1 to 3.8, 3.9 to 5.7, and 5.8 to 10 cm. Findings from our study agree with those of some other studies, although many other studies found different optimal cut-off point schemes. As there appear to be no universally accepted cut-off points, and in view of the low-to-moderate associations between VAS scores and functioning and between VAS and verbal rating scale scores, the correct classification of VAS scores as mild, moderate. or severe in clinical practice seems doubtful. PMID:25239073

Boonstra, Anne M; Schiphorst Preuper, Henrica R; Balk, Gerlof A; Stewart, Roy E

2014-12-01

252

The effect of exercise on percentile rank aerobic capacity, pain, and self-rated disability in patients with chronic low-back pain: A retrospective chart review  

Microsoft Academic Search

van der Velde G, Mierau D. Effect of exercise on percentile rank aerobic capacity, pain, and self-rated disability in patients with chronic low-back pain: a retrospective chart review. Arch Phys Med Rehabil 2000;81:1457-63. Objective: To determine the effect of 6 weeks of exercise on aerobic capacity and on measures of pain and disability in patients with chronic low-back pain (LBP).

Gabrielle van der Velde; Dale Mierau

2000-01-01

253

Assessment of post-operative pain and its management among patients undergoing craniotomy.  

PubMed

Pain assessment and its management in patients undergoing craniotomy, especially those with communication barriers, continue to present challenges to nurses. The present study was undertaken to assess the level of post-operative pain suffered by patients after craniotomy, to identify the activities that increase/relieve pain and to find out association between pain score of patients and selected variables. A self-prepared validated questionnaire and Wong Bakers Faces pain scale were used as the tools. The post-operative pain was mild to moderate and decreased from first to third postoperative day. Pain relief was adequate with the combination therapy of non-narcotic analgesics and non-steroidal anti-inflammatory drugs. The study revealed that there was no significant difference between the pain perception and age or gender of the patient. The activities that increased pain were surgical dressing removal and position changing. Nursing staff should focus on assessing and managing post-operative pain to improve quality of nursing care in order to improve the comfort of craniotomy patients. PMID:24683754

Saramma, P P; Mathew, Rikku

2013-01-01

254

Gastric electrical stimulation for abdominal pain in patients with symptoms of gastroparesis.  

PubMed

Abdominal pain physiology may be better understood studying electrophysiology, histology, and symptom scores in patients with the symptoms of gastroparesis (Gp) treated with gastric electrical stimulation (GES). Ninety-five Gp patients' symptoms were recorded at baseline and during temporary and permanent GES. Gastric-emptying times and cutaneous, mucosal, and serosal electrogastrograms were obtained. S100-stained, full-thickness gastric biopsies were compared with autopsy controls. Sixty-eight patients reported severe pain at baseline. Severe pain patients' mean pain scores decreased with temporary GES from 3.62 to 1.29 (P < 0.001) and nonsevere pain from 1.26 to 0.67 (P = 0.01). With permanent GES, severe mean pain scores fell to 2.30 (P < 0.001); nonsevere pain changed to 1.60 (P = 0.221). Mean follow-up was 275 days. Mean cutaneous, mucosal, and serosal frequencies and frequency-to-amplitude ratios were markedly higher than literature controls. For patients with Gp overall and subdivided by etiology and severity of pain, S-100 neuronal fibers were significantly reduced in both muscularis propria layers. GES improved severe pain associated with symptoms of Gp. This severe pain is associated with abnormal electrogastrographic activity and loss of S100 neuronal fibers in the stomach's inner and outer muscularis propria and, therefore, could be the result of gastric neuropathy. PMID:23635579

Lahr, Christopher J; Griffith, James; Subramony, Charu; Halley, Lindsey; Adams, Kristen; Paine, Elizabeth R; Schmieg, Robert; Islam, Saleem; Salameh, Jay; Spree, Danielle; Kothari, Truptesh; Kedar, Archana; Nikitina, Yana; Abell, Thomas

2013-05-01

255

Allopathic, complementary, and alternative medical treatment utilization for pain among methadone-maintained patients: An exploratory study1  

PubMed Central

We surveyed 150 methadone maintenance treatment program (MMTP) patients about pain, pain treatment utilization, perceived efficacy of prior pain treatment, and interest in pursuing pain treatment at the MMTP. Respondents with chronic severe pain (CSP) (i.e., pain lasting at least 6 months with moderate to severe pain intensity or significant pain interference) and “some pain” (i.e., pain reported in the previous week but not CSP) endorsed similar rates of past-week and lifetime allopathic or standard medical (with the exception of lifetime medical use of non-opiate medication) and complementary and alternative medicine (CAM) utilization for pain reduction. Prior pain treatments were perceived to be less effective by CSP than SP patients but both groups had equivalent high rates of interest in pain treatment associated with the MMTP. These findings may have implications for resource and program planning in MMT programs. PMID:19874157

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

2009-01-01

256

Acceptance of pain, self-compassion and psychopathology: using the chronic pain acceptance questionnaire to identify patients' subgroups.  

PubMed

The present study explores whether specific subgroups of patients could be identified based on Chronic Pain Acceptance Questionnaire scores. A battery of self-report questionnaire was used to assess acceptance of pain, self-compassion and psychopathology in 103 participants with chronic pain, from Portuguese health care units. K-Means cluster were performed and the results supported three subgroups of patients (low acceptance subgroup; high acceptance subgroup; intermediate subgroup with activity engagement near to the mean and low willingness to pain). One-way ANOVA's showed that the three subgroups identified differed significantly from each other on psychopathology and self-compassion. Results indicated that the intermediate subgroup presented less depression and stress, compared with the low acceptance subgroup. In what concerns self-compassion, the low acceptance subgroup reported higher self-judgment, isolation and over identification, compared with the intermediate subgroup. These subgroups also differed from each other in common humanity and mindfulness. Implications and clinical utility of the results were discussed, suggesting the increase of willingness to pain as an important key in chronic pain interventions.? PMID:20806418

Costa, Joana; Pinto-Gouveia, José

2011-01-01

257

Drawing/s  

E-print Network

Drawing has become essential to the making of architecture. Though some of the most magnificent structures were created without documentation, testified by The Pyramids, the Parthenon, primitive dwellings, treehouses and ...

Sammis, Kim

1986-01-01

258

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

PubMed Central

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

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

2014-01-01

259

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

PubMed

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

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

260

The validity of using an electrocutaneous device for pain assessment in patients with cervical radiculopathy.  

PubMed

The purpose of this study was to evaluate the validity and preference for assessing pain magnitude with electrocutaneous testing (ECT) compared to the visual analogue scale (VAS) and Borg CR10 scale in men and women with cervical radiculopathy of varying sensory phenotypes. An additional purpose was to investigate ECT sensory and pain thresholds in men and women with cervical radiculopathy of varying sensory phenotypes. This is a cross-sectional study of 34 patients with cervical radiculopathy. Scatterplots and linear regression were used to investigate bivariate relationships between ECT, VAS and Borg CR10 methods of pain magnitude measurement as well as ECT sensory and pain thresholds. The use of the ECT pain magnitude matching paradigm for patients with cervical radiculopathy with normal sensory phenotype shows good linear association with arm pain VAS (R(2)?=?0.39), neck pain VAS (R(2)?=?0.38), arm pain Borg CR10 scale (R(2)?=?0.50) and neck pain Borg CR10 scale (R(2)?=?0.49) suggesting acceptable validity of the procedure. For patients with hypoesthesia and hyperesthesia sensory phenotypes, the ECT pain magnitude matching paradigm does not show adequate linear association with rating scale methods rendering the validity of the procedure as doubtful. ECT for sensory and pain threshold investigation, however, provides a method to objectively assess global sensory function in conjunction with sensory receptor specific bedside examination measures. PMID:24666409

Abbott, Allan; Ghasemi-Kafash, Elaheh; Dedering, Åsa

2014-10-01

261

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

PubMed Central

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

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

2012-01-01

262

Sleep continuity and architecture: Associations with pain-inhibitory processes in patients with temporomandibular joint disorder  

PubMed Central

Recent research suggests bi-directional interactions between the experience of pain and the process of sleep; pain interferes with the ability to obtain sleep, and disrupted sleep contributes to enhanced pain perception. Our group recently reported, in a controlled experimental study, that sleep fragmentation among healthy adults resulted in subsequent decrements in endogenous pain inhibition. The present report follows up that observation by extending this line of research to a sample of patients experiencing persistent pain. Patients with chronic temporomandibular joint disorder (TMD) pain were studied using polysomnography and psychophysical evaluation of pain responses. We assessed whether individual differences in sleep continuity and/or architecture were related to diffuse noxious inhibitory controls (DNIC), a measure of central nervous system pain inhibition. Among 53 TMD patients, higher sleep efficiency and longer total sleep time were positively associated with better functioning of DNIC (r=.42 ? .44, p< .01; p’s< .05 for the multivariate analyses). These results suggest the possibility that disrupted sleep may serve as a risk factor for inadequate pain-inhibitory processing and hint that aggressive efforts to treat sleep disturbance early in the course of a pain condition might be beneficial in reducing the severity or impact of clinical pain. PMID:19168380

Edwards, R.R.; Grace, E; Peterson, S.; Klick, B.; Haythornthwaite, J.A.; Smith, M.T.

2009-01-01

263

Relation between pain and skeletal metastasis in patients with prostate or breast cancer.  

PubMed

The aim of this study was to examine the relation between pain and bone metastases in a group of patients with prostate or breast cancer that had been referred for bone scintigraphy. Whole-body bone scans, anterior and posterior views obtained with a dual detector gamma camera were studied from 101 consecutive patients who had undergone scintigraphy (600?MBq Tc-99m MDP) because of suspected bone metastatic disease. At the time of the examination, all patients were asked whether they felt any pain or had recently a trauma. This information was correlated with the classifications regarding the presence or absence of bone metastases made by a group of three experienced physicians. In patients with prostate cancer, we found metastases in 47% (18/38) of the patients with pain, but only in 12% (2/17) of the patients without pain (p?=?0.01). In patients with breast cancer, on the other hand, metastases were more common in patients without pain (71%; 10/14) than in patients with pain (34%; 11/32) (p?=?0.02). In conclusion, a significant relation between pain and skeletal metastases could be found in patients with prostate cancer and a reverse relation in patients with breast cancer. PMID:21114613

Levren, Gabriella; Sadik, May; Gjertsson, Peter; Lomsky, Milan; Michanek, Annika; Edenbrandt, Lars

2011-05-01

264

Home Delivery of Pain Therapy to Elderly Patients.  

ERIC Educational Resources Information Center

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…

Dietrich, Coralie

265

Urinary hydrocodone and metabolite distributions in pain patients.  

PubMed

Hydrocodone combined with acetaminophen is commonly used for moderate pain. Hydrocodone is metabolized by cytochrome P450 (CYP) 2D6 into hydromorphone and by CYP3A4 into norhydrocodone. This was a retrospective study evaluating hydrocodone, hydromorphone and norhydrocodone distributions in urine. Urine specimens (n = 76,924) were obtained from patients on chronic opioid therapy during their first or single visit and were analyzed by liquid chromatography-tandem mass spectrometry (LC-MS-MS). The patients were at least 16 years of age and had documented hydrocodone use via a medication list. There were 48,710 specimens that were positive for all three analytes. Mean hydrocodone, hydromorphone and norhydrocodone mole fractions (95% confidence interval) were 0.39 (0.38-0.39), 0.12 (0.11-0.12) and 0.49 (0.48-0.49), respectively. Hydromorphone fractions were lower in women compared with men (0.11 versus 0.13; P < 0.0001). Hydrocodone mole fractions were higher in the 65-year and older age group compared with the 16- to 39-year age group (0.4 versus 0.36; P ? 0.005). Concurrent use of a CYP2D6 and/or CYP3A4 inhibitor altered hydromorphone and norhydrocodone mole fractions, compared with the control group. Patient factors affect hydrocodone and metabolite mole fractions and suggest increased awareness of their contribution when attempting to interpret urine drug testing results. PMID:24836897

Barakat, Neveen H; Atayee, Rabia S; Best, Brookie M; Ma, Joseph D

2014-09-01

266

FACTORS RELATED TO ABDOMINAL PAIN IN GASTROPARESIS: CONTRAST TO PATIENTS WITH PREDOMINANT NAUSEA AND VOMITING  

PubMed Central

Background Factors associated with abdominal pain in gastroparesis are incompletely evaluated and comparisons of pain versus other symptoms are limited. This study related pain to clinical factors in gastroparesis and contrasted pain/discomfort- with nausea/vomiting-predominant disease. Methods Clinical and scintigraphy data were compared in 393 patients from 7 centers of the NIDDK Gastroparesis Clinical Research Consortium with moderate-severe (Patient Assessment of Upper Gastrointestinal Disorders Symptoms [PAGI-SYM] score ?3) vs. none-mild (PAGI-SYM <3) upper abdominal pain and predominant pain/discomfort vs. nausea/vomiting. Key Results Upper abdominal pain was moderate-severe in 261 (66%). Pain/discomfort was predominant in 81 (21%); nausea/vomiting was predominant in 172 (44%). Moderate-severe pain was more prevalent with idiopathic gastroparesis and with lack of infectious prodrome (P?0.05) and correlated with scores for nausea/vomiting, bloating, lower abdominal pain/discomfort, bowel disturbances, and opiate and antiemetic use (P<0.05) but not gastric emptying or diabetic neuropathy or control. Gastroparesis severity, quality of life, and depression and anxiety were worse with moderate-severe pain (P?0.008). Factors associated with moderate-severe pain were similar in diabetic and idiopathic gastroparesis. Compared to predominant nausea/vomiting, predominant pain/discomfort was associated with impaired quality of life, greater opiate, and less antiemetic use (P<0.01), but similar severity and gastric retention. Conclusions & Inferences Moderate-severe abdominal pain is prevalent in gastroparesis, impairs quality of life, and is associated with idiopathic etiology, lack of infectious prodrome, and opiate use. Pain is predominant in one fifth of gastroparetics. Predominant pain has at least as great an impact on disease severity and quality of life as predominant nausea/vomiting. PMID:23414452

2013-01-01

267

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

PubMed Central

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

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

2015-01-01

268

Predictors for the immediate responders to cervical manipulation in patients with neck pain  

Microsoft Academic Search

Cervical manipulation has been considered an effective treatment for managing neck pain. However, clinical observation showed that cervical manipulation was not effective for every patient. Development of clinical prediction rules for identifying patients with neck pain who are likely to respond to cervical manipulation may improve clinical decision-making and the treatment success rate. The purpose of the study was to

Yuh-Liang Tseng; Wendy T. J. Wang; Wen-Yin Chen; Tsun-Jen Hou; Tzu-Ching Chen; Fu-Kong Lieu

2006-01-01

269

The Immediate Effects of a Cervical Lateral Glide Treatment Technique in Patients With Neurogenic Cervicobrachial Pain  

Microsoft Academic Search

Study Design: Randomized clinical trial. Objectives: To analyze the immediate treatment effects of cervical mobilization and therapeutic ultrasound in patients with neurogenic cervicobrachial pain. Background: Different treatment modalities have been described for patients with neurogenic cervicobrachial pain. Although it has been suggested that a more specific approach, like cervical mobilization, would be more effective, effect studies are scarce. Methods and

Michel W. Coppieters; Karel H. Stappaerts; Leo L. Wouters; Koen Janssens

270

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

ERIC Educational Resources Information Center

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)

Pellecchia, Geraldine L.

1993-01-01

271

Chronic pain\\/dysaesthesiae in spinal cord injury patients: results of a multicentre study  

Microsoft Academic Search

The aim of the multicentre study* entitled `Description and Documentation of Painful States in Spinal Cord Injury Patients', in addition to the description and documentation of chronic pain and stressful dysaesthesiae in SCI patients, was the search for correlations between these symptoms and medical and psychosocial variables. To this end, the sample was selected to be as representative as possible.

S Störmer; H J Gerner; W Grüninger; K Metzmacher; S Föllinger; Ch Wienke; W Aldinger; N Walker; M Zimmermann; V Paeslack

1997-01-01

272

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

ERIC Educational Resources Information Center

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…

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

2007-01-01

273

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

ERIC Educational Resources Information Center

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…

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

2011-01-01

274

Deficient Discrimination of EMG Levels and Overestimation of Perceived Tension in Chronic Pain Patients  

Microsoft Academic Search

Twenty chronic low back pain patients (CBP), twenty tension headache (THA) patients, and twenty healthy controls (HC) participated in a tension production task where subjects had to attain four levels (4, 8, 12, 16 µV) of muscle tension at the m. frontalis and the m. erector spinae. Ratings of perceived tension, pain, and aversiveness as well as EMG, heart rate,

Herta Flor; Michael Fiirst; Niels Birbaumer

1999-01-01

275

Patient's Knowledge, Perception and Belief about the Reasons of Low Back Pain  

Microsoft Academic Search

Patients with chronic low back pain (LBP) hold various knowledge, perceptions and beliefs about their pain which are based on prior learning and social conditions. Since LBP is a bio- psycho-social phenomenon and there are not any reports about awareness and attitude of Iranian patients' views regarding it, this descriptive study was employed to earn this information P to apply

SS Tavafian; H Eftekhar; K Mohammad; AR Jamshidi; N Assasi

276

Predictors of opioid misuse in patients with chronic pain: a prospective cohort study  

Microsoft Academic Search

BACKGROUND: Opioid misuse can complicate chronic pain management, and the non-medical use of opioids is a growing public health problem. The incidence and risk factors for opioid misuse in patients with chronic pain, however, have not been well characterized. We conducted a prospective cohort study to determine the one-year incidence and predictors of opioid misuse among patients enrolled in a

Timothy J Ives; Paul R Chelminski; Catherine A Hammett-Stabler; Robert M Malone; J Stephen Perhac; Nicholas M Potisek; Betsy Bryant Shilliday; Darren A DeWalt; Michael P Pignone

2006-01-01

277

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

PubMed Central

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

Haggiag, Isabelle; Os, Pnina; Bernheim, Jacques

2009-01-01

278

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

PubMed Central

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

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

2015-01-01

279

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 ...

280

Effect of Telecare Management on Pain and Depression in Patients with Cancer: A Randomized Trial  

PubMed Central

Context Pain and depression are two of the most prevalent and treatable cancer-related symptoms, yet frequently go unrecognized and/or undertreated. Objective To determine whether centralized telephone-based care management coupled with automated symptom monitoring can improve depression and pain in cancer patients. Design, Setting, and Patients Randomized controlled trial conducted in 16 community-based urban and rural oncology practices across the state of Indiana. Recruitment occurred from March 2006 through August 2008 and follow-up concluded in August 2009. The 405 patients had depression (Patient Health Questionnaire-9 score ? 10), cancer-related pain (Brief Pain Inventory worst pain score ? 6), or both. Intervention Patients were randomly assigned to the intervention (n=202) or to usual care (n=203), stratified by symptom type. Intervention patients received centralized telecare management by a nurse-physician specialist team coupled with automated home-based symptom monitoring by interactive voice recording or internet. Main Outcome Measures Blinded assessment at baseline, 1, 3, 6, and 12 months for depression (20-item Hopkins Symptom Checklist [HSCL-20]) and pain (Brief Pain Inventory [BPI]) severity. Results There were 131 patients enrolled with depression only, 96 with pain only, and 178 with both depression and pain. Of the 274 patients enrolled for pain, the 137 intervention patients had greater improvements than the 137 usual care patients in BPI pain severity over the 12 months of the trial whether measured as a continuous severity score or as a categorical pain responder (P < .0001 for both). Similarly, of the 309 patients enrolled for depression, the 154 intervention patients had greater improvements than the 155 usual care patients in HSCL-20 depression severity over the 12 months of the trial whether measured as a continuous severity score (P < .0001) or as a categorical depression responder (P < .001). The standardized effect size for between-group differences at 3 and 12 months was .67 and .39 for pain, and .42 and .44 for depression. Conclusion Centralized telecare management coupled with automated symptom monitoring resulted in improved pain and depression outcomes in cancer patients receiving care in geographically-dispersed urban and rural oncology practices. PMID:20628129

Kroenke, Kurt; Theobald, Dale; Wu, Jingwei; Norton, Kelli; Morrison, Gwendolyn; Carpenter, Janet; Tu, Wanzhu

2010-01-01

281

Cupping for Treating Pain: A Systematic Review  

Microsoft Academic Search

The objective of this study was to assess the evidence for or against the effectiveness of cupping as a treatment option for pain. Fourteen databases were searched. Randomized clinical trials (RCTs) testing cupping in patients with pain of any origin were considered. Trials using cup- ping with or without drawing blood were included, while trials comparing cupping with other treatments

Jong-In Kim; Myeong Soo Lee; Dong-Hyo Lee; Kate Boddy; Edzard Ernst

282

Predictors of Shoulder Pain and Disability Index (SPADI) and work status after 1 year in patients with subacromial shoulder pain  

PubMed Central

Background Shoulder pain is a common complaint in primary health care and has an unfavourable outcome in many patients. The objectives were to identify predictors for pain and disability (SPADI) and work status in patients with subacromial shoulder pain. Methods Secondary analyses of data from a randomized clinical controlled trial were performed. Outcome measures were the absolute values of the combined Shoulder Pain and Disability Index (SPADI) and work status 1 year after treatment with supervised exercises (SE) or radial extracorporeal shockwave therapy (rESWT). Predictors of outcome were investigated using multiple linear regression (SPADI) and logistic regression (work status). Results 104 patients were included. Low education (? 12 years), previous shoulder pain, and a high baseline SPADI score predicted poor results with these variables explaining 29.9% of the variance in SPADI score at 1 year. Low education and poor self-reported health status predicted a work status of "not working": Odds Ratio, OR = 4.3(95% CI (1.3 to 14.9)), p = 0.02 for education, and OR = 1.06 (95% CI (1.0 to 1.1)), p = 0.001 for self-reported health status, respectively. Adjustments for age, gender, and treatment group were performed, but did not change the results. Conclusion Education was the most consistent predictor of pain and disability, and work status at 1 year follow-up. Also, baseline SPADI score, previous shoulder pain and self-reported health status predicted outcome. Trial registration Clinical trials NCT00653081 PMID:20863369

2010-01-01

283

Use of picture communication aids to assess pain location in pediatric postoperative patients.  

PubMed

Children undergoing surgical procedures may have difficulty communicating. Augmentative and alternative communication (AAC) picture communication may provide a standard communication strategy for postoperative children and facilitate nurse-patient communication. The study purposes were to (1) determine if inconsistency exists between nurse assessments of pain location versus identification of pain location using AAC picture communication aids and (2) determine parent satisfaction with use of AAC picture communication aids. A convenience sample of patients aged 3 to 9 years were recruited in a Midwestern freestanding pediatric hospital's postanesthesia care unit (PACU). The patient's pain location was assessed using an AAC picture communication aid and compared with the PACU nurses' pain assessment. Nurses did not consistently document location of pain, and, when documented, the surgical site was inaccurately identified as the location of pain. Parent satisfaction was measured through completion of a 10-item satisfaction survey. Respondents were satisfied with the use of AAC picture communication aids. PMID:22099132

Mesko, Phyllis J; Eliades, Aris Beoglos; Christ-Libertin, Cheryl; Shelestak, Debra

2011-12-01

284

Quantitative sensory testing of neuropathic pain patients: potential mechanistic and therapeutic implications.  

PubMed

Quantitative sensory testing (QST) is a widely accepted tool to investigate somatosensory changes in pain patients. Many different protocols have been developed in clinical pain research within recent years. In this review, we provide an overview of QST and tested neuroanatomical pathways, including peripheral and central structures. Based on research studies using animal and human surrogate models of neuropathic pain, possible underlying mechanisms of chronic pain are discussed. Clinically, QST may be useful for 1) the identification of subgroups of patients with different underlying pain mechanisms; 2) prediction of therapeutic outcomes; and 3) quantification of therapeutic interventions in pain therapy. Combined with sensory mapping, QST may provide useful information on the site of neural damage and on mechanisms of positive and negative somatosensory abnormalities. The use of QST in individual patients for diagnostic purposes leading to individualized therapy is an interesting concept, but needs further validation. PMID:22535540

Pfau, Doreen B; Geber, Christian; Birklein, Frank; Treede, Rolf-Detlef

2012-06-01

285

Family dynamics and emotional expression among patients with chronic pain and depression.  

PubMed

Exploration of the relative roles of family dynamics and release of constrained, negative emotion in changing pain and depressive symptoms. Eighteen patients presenting mild to moderate depression and diagnoses of psychogenic pain disorder were randomly assigned to 1 of 2 treatment groups. One group was designed to facilitate the release of constrained and overcontrolled negative affect while the other was designed to provide information about pain and depression. Findings suggest that initial incongruity between patient's and significant other's ratings of family relationships retard changes in pain status and depressive symptoms. No significant differences were noted between patients who were taught to express negative feelings and those who were taught simply to understand those feelings. Results are discussed in terms of theories about family dynamics in the initiation and maintenance of pain conditions and in terms of the role of constrained affect as a precursor to both psychogenic pain and depression. PMID:3340423

Beutler, L E; Daldrup, R; Engle, D; Guest, P; Corbishley, A; Meredith, K E

1988-01-01

286

Drawing Inventors  

ERIC Educational Resources Information Center

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…

Szekely, George

2012-01-01

287

186Re-HEDP for metastatic bone pain in breast cancer patients.  

PubMed

Two-thirds of patients with metastatic cancer suffer from pain. Pain originating from skeletal metastases is the most common form of cancer-related pain. Bone pain, often exacerbated by pressure or movement, limits the patient's autonomy and social life. Pain palliation with bone-seeking radiopharmaceuticals has proven to be an effective treatment modality in patients with metastatic bone pain. These bone-seeking radiopharmaceuticals are extremely powerful in treating scattered painful bone metastases, for which external beam radiotherapy is impossible because of the large field of irradiation. (186)Re-hydroxyethylidene diphosphonate (HEDP) is a potentially useful radiopharmaceutical for this purpose, having numerous advantageous characteristics. Bone marrow toxicity is limited and reversible, which makes repetitive treatment safe. Studies have shown encouraging clinical results of palliative therapy using (186)Re-HEDP, with an overall response rate of ca. 70% in painful bone metastases. It is effective for fast palliation of painful bone metastases from various tumours and the effect tends to last longer if patients are treated early in the course of their disease. (186)Re-HEDP is at least as effective in breast cancer patients with painful bone metastases as in patients with metastatic prostate cancer. It is to be preferred to radiopharmaceuticals with a long physical half-life in this group of patients, who tend to have more extensive haematological toxicity since they have frequently been pretreated with bone marrow suppressive chemotherapy. This systemic form of radionuclide therapy is simple to administer and complements other treatment options. It has been associated with marked pain reduction, improved mobility in many patients, reduced dependence on analgesics, and improved performance status and quality of life. PMID:15118846

Lam, Marnix G E H; de Klerk, John M H; van Rijk, Peter P

2004-06-01

288

Treatment Expectation for Pain Coping Skills Training: Relationship to Osteoarthritis Patients' Baseline Psychosocial Characteristics  

PubMed Central

Objectives This study examined predictors of treatment expectation among osteoarthritis (OA) patients in a multi-site clinical trial of pain coping strategies training (CST). Methods Patients (N=171) completed a pre-treatment assessment battery that asked questions about treatment expectations, pain coping variables, pain, physical function, psychological distress, quality of life, and depression as well as background demographic and medical variables. Results Regression analyses indicated that several variables accounted for 21% of the variance in treatment expectations (p < .0001). Patients who were classified as adaptive copers, reported higher self efficacy and social interaction, had higher quality of life, and who had lower levels of affective distress and depression had more positive expectations about engaging in pain coping skills training. Variables that were not associated with treatment expectation were level of pain and physical dysfunction, duration of disease, and disability status as well as demographic variables. Discussion Thus, while many OA patients will approach pain coping skills training with positive expectations, others have lower expectations. This study suggests that a multidimensional assessment of OA patients with chronic pain can identify those who have higher expectations versus lower expectations. The results suggest that patients who are psychologically distressed are less optimistic about engaging in treatment and that these patients, in particular, may benefit from and need pre-treatment motivational interviewing to enhance their uptake of pain coping skills PMID:21178591

Broderick, Joan E.; Junghaenel, Doerte U.; Schneider, Stefan; Bruckenthal, Patricia; Keefe, Francis J.

2010-01-01

289

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

PubMed Central

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

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

2010-01-01

290

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

ERIC Educational Resources Information Center

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,…

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

291

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

PubMed Central

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

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

2014-01-01

292

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

PubMed

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

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

2014-01-01

293

IDENTIFICATION OF PATIENT SUBGROUPS AND RISK FACTORS FOR PERSISTENT BREAST PAIN FOLLOWING BREAST CANCER SURGERY  

PubMed Central

Study purposes were to determine the prevalence of persistent pain in the breast; characterize distinct persistent pain classes using growth mixture modeling, and evaluate for differences among these pain classes in demographic, preoperative, intraoperative, and postoperative characteristics. In addition, differences in the severity of common symptoms and quality of life outcomes measured prior to surgery, among the pain classes, were evaluated. Patients (n=398) were recruited prior to surgery and followed for six months. Using growth mixture modeling, patients were classified into no (31.7%), mild (43.4%), moderate (13.3%), and severe (11.6%) pain groups based on ratings of worst breast pain. Differences in a number of demographic, preoperative, intraoperative, and postoperative characteristics differentiated among the pain classes. In addition, patients in the moderate and severe pain classes reported higher preoperative levels of depression, anxiety, and sleep disturbance than the no pain class. Findings suggest that approximately 25% of women experience significant and persistent levels of breast pain in the first six months following breast cancer surgery. PMID:23182226

Miaskowski, Christine; Cooper, Bruce; Paul, Steven M.; West, Claudia; Langford, Dale; Levine, Jon D.; Abrams, Gary; Hamolsky, Deborah; Dunn, Laura; Dodd, Marylin; Neuhaus, John; Baggott, Christina; Dhruva, Anand; Schmidt, Brian; Cataldo, Janine; Merriman, John; Aouizerat, Bradley E.

2012-01-01

294

Pain Treatment and Antiretroviral Medication Adherence Among Vulnerable HIV-Positive Patients.  

PubMed

Pain represents a significant source of morbidity, function loss, and decreased quality of life among people living with HIV. The present study examined the associations among pain, pain treatment, and ARV adherence among indigent, HIV-positive substance abusers. Participants were recruited via targeted sampling strategies, and completed a one-time computer-assisted personal interview. ANOVA and chi-square tests were used to analyze differences in demographics, health and psychological status, health behaviors, by pain and pain treatment status; a multivariate logistic regression model was constructed to examine the contribution of pain/treatment status to recent ARV adherence. Results indicated that those with untreated pain had lower odds of achieving gold-standard 95% ARV adherence as compared to the pain-free and treated pain groups; higher substance dependence symptoms were also associated with significantly lower odds of 95% ARV adherence. Findings suggest that pain management is critical to the health of people living with HIV, specifically those with high levels of co-morbid health and psychological problems. The prevalence of untreated pain was elevated among this group, and contributed to reduced ARV adherence. Providers of clinical care to disadvantaged HIV-positive patients should emphasize routine assessment and appropriate treatment of pain in order to provide comprehensive HIV care. PMID:24984142

Surratt, Hilary L; Kurtz, Steven P; Levi-Minzi, Maria A; Cicero, Theodore J; Tsuyuki, Kiyomi; O'Grady, Catherine L

2015-04-01

295

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

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…

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

296

Validity of the French-language version of the Quebec Back Pain Disability Scale in low back pain patients in France  

Microsoft Academic Search

Objectives. The primary objectives were to evaluate the acceptability in France of the Quebec Back Pain Disability Scale (QBPDS) in its original French-language version and to study its correlational validity against indicators of impairment, pain, disability, psychological status, and perceived health status. Material and methods. Thirty-two patients with chronic low back pain were recruited at the rheumatology outpatient clinic of

Murielle Yvanes-Thomas; Paul Calmels; François Béthoux; Anne Richard; Philippe Nayme; Dominique Payre; Bernard Laurent

2002-01-01

297

Salivary cortisol and psychological mechanisms in patients with acute versus chronic low back pain.  

PubMed

This study was designed to explore whether the basal adrenocortical activity is related with pain-related coping, nonverbal pain behavior, depressive mood, and fatigue in patients with acute and chronic nonspecific low back pain. 19 patients with acute low back pain (ALBP) and 24 with chronic low back pain (CLBP) participated in the study. The adrenocortical activity was assessed through the cortisol awakening response. All participants provided five saliva samples (0, 15, 30, 45, and 60min after waking) on two consecutive days off work. Pain-related coping [fear-avoidance coping (FAC) and endurance coping (EC)], nonverbal pain behavior (NPB), depressive mood, and fatigue were assessed through questionnaires. Among ALPB patients, EC was negatively associated with the cortisol release, whereas fatigue was positively associated with it. Among CLBP patients, FAC, NPB, depressive mood, and fatigue were negatively associated with the cortisol awakening response, whereas EC tended to be positively associated with it. The results indicate that pain-related coping strategies which are expected to be successful appear to lower the adrenocortical activity among ALBP patients, whereas affective distress may enhance the level of cortisol in this group. Among CLBP patients, long-term maladaptive coping strategies might contribute to hypocortisolism. PMID:19028020

Sudhaus, Sigrid; Fricke, Britta; Stachon, Axel; Schneider, Stefan; Klein, Harald; von Düring, Monika; Hasenbring, Monika

2009-05-01

298

Acupuncture for postoperative pain in day surgery patients undergoing arthroscopic shoulder surgery.  

PubMed

The purpose of this quasi-experimental study was to examine the effect of acupuncture on postoperative pain in day surgery patients undergoing arthroscopic shoulder surgery. Twenty-two participants scheduled to undergo arthroscopic shoulder surgery were included. The results showed that on postoperative day one pain decreased (-1.1) in patients receiving acupuncture compared to the control group in which pain increased (2.0), p=.014. Sleep quality was also significantly higher in the acupuncture group compared to the control group, p=.042. In conclusions, acupuncture seems to have a reducing effect on postoperative pain as well as increase sleep quality in day surgery patients undergoing arthroscopic shoulder surgery. In regards to application, nurses should be encouraged to use additional nonpharmacologic approaches like acupuncture in postoperative pain management, as this can be a part of the multimodal analgesic regimes to improve patients care. PMID:22843248

Ward, Ulla; Nilsson, Ulrica G

2013-02-01

299

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

PubMed

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

Paice, Judith A; Von Roenn, Jamie H

2014-06-01

300

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

PubMed Central

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

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

2014-01-01

301

Knowledge of doctors and nurses on pain in patients undergoing craniotomy.  

PubMed

The study objectives were to characterize the profile of the doctors and nurses caring for patients in the craniotomy postoperative period, checking pain assessment methods and to identify the existence of analgesia protocols. Cross-sectional and analytical study. The casuistry is constituted of 30 doctors and 30 nurses. The results revealed that 83.3 % of the nurses were female, 63.3% knew pain scales, and 16.6% said that analgesia protocols exist. Regarding doctors 60% were male, 70% knew the pain scales, 3.3% had specialization in pain treatment, 13.3% they stated that there are analgesia protocols. The ignorance on the part of doctors and nurses about the assessment scales and pain assessment methods reveals the need for the creation of institutional policies on controlling pain, the use of instruments for the measurement of the pain phenomenon and analgesia protocols in the institution. PMID:23258718

Ribeiro, Maria do Carmo de Oliveira; Pereira, Carlos Umberto; Sallum, Ana Maria Calil; Alves, José Antonio Barreto; Albuquerque, Marcelly Freitas; Fujishima, Paula Akemi

2012-01-01

302

Treatment for Chronic Pain in Patients With Advanced Cancer  

ClinicalTrials.gov

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

2010-11-07

303

Reduced intraepidermal nerve fiber density in patients with chronic ischemic pain in peripheral arterial disease.  

PubMed

Chronic ischemic pain in peripheral arterial disease (PAD) is a leading cause of pain in the lower extremities. A neuropathic component of chronic ischemic pain has been shown independent of coexisting diabetes. We aimed to identify a morphological correlate potentially associated with pain and sensory deficits in PAD. Forty patients with symptomatic PAD (Fontaine stages II-IV), 20 with intermittent claudication (CI), and 20 with critical limb ischemia (CLI) were enrolled; 12 volunteers served as healthy controls. All patients were examined using pain scales and questionnaires. All study participants underwent quantitative sensory testing (QST) at the distal calf and skin punch biopsy at the distal leg for determination of intraepidermal nerve fiber density (IENFD). Additionally, S100 beta serum levels were measured as a potential marker for ischemic nerve damage. Neuropathic pain questionnaires revealed slightly higher scores and more pronounced pain-induced disability in CLI patients compared to CI patients. QST showed elevated thermal and mechanical detection pain thresholds as well as dynamic mechanical allodynia, particularly in patients with advanced disease. IENFD was reduced in PAD compared to controls (P<0.05), more pronounced in the CLI subgroup (CLI: 1.3 ± 0.5 fibers/mm, CI: 2.9 ± 0.5 fibers/mm, controls: 5.3 ± 0.6 fibers/mm). In particular, increased mechanical and heat pain thresholds negatively correlated with lower IENFD. Mean S100 beta levels were in the normal range but were higher in advanced disease. Patients with chronic ischemic pain had a reduced IENFD associated with impaired sensory functions. These findings support the concept of a neuropathic component in ischemic pain. PMID:24931568

Gröne, Eva; Üçeyler, Nurcan; Abahji, Thomas; Fleckenstein, Johannes; Irnich, Dominik; Mussack, Thomas; Hoffmann, Ulrich; Sommer, Claudia; Lang, Philip M

2014-09-01

304

Older People’s Experiences of Patient-Centered Treatment for Chronic Pain: A Qualitative Study  

PubMed Central

Introduction Older adults with chronic pain who seek treatment often are in a health care environment that emphasizes patient-directed care, a change from the patriarchal model of care to which many older adults are accustomed. Objective To explore the experiences of older adults seeking treatment for chronic pain, with respect to patient-directed care and the patient–provider relationship. Design In-depth interviews with 15 Caucasian older adults with chronic pain who had been evaluated at a university-based pain clinic. All interviews were audiotaped and the transcripts were analyzed using a grounded theory based approach. Results Older adults with chronic pain vary in their willingness to be involved in their treatment decisions. Many frequently participate in decisions about their pain treatment by asking for or refusing specific treatments, demanding quality care, or operating outside of the patient–provider relationship to manage pain on their own. However, others prefer to let their provider make the decisions. In either case, having a mutually respectful patient–provider relationship is important to this population. Specifically, participants described the importance of “being heard” and “being understood” by providers. Conclusions As some providers switch from a patriarchal model of care toward a model of care that emphasizes patient activation and patient-centeredness, the development and cultivation of valued patient–provider relationships may change. While it is important to encourage patient involvement in treatment decisions, high-quality, patient-centered care for older adults with chronic pain should include efforts to strengthen the patient–provider relationship by attending to differences in patients’ willingness to engage in patient-directed care and emphasizing shared decision-making. PMID:19207235

Teh, Carrie F.; Karp, Jordan F.; Kleinman, Arthur; Reynolds, Charles F.; Weiner, Debra K.; Cleary, Paul D.

2010-01-01

305

Thrombospondin-1 serum levels do not correlate with pelvic pain in patients with ovarian endometriosis  

PubMed Central

Objetive Thrombospondin-1 serum levels is correlate with pelvic pain in patients with ovarian endometriosis. Patients Thrombospondin-1 serum levels were prospectively analysed in 51 patients (group A asymptomatic patients or patients presenting mild dysmenorrhea and women comprised group B severe dysmenorrhea and/or chronic pelvic pain and/or dyspareunia) who underwent surgery for cystic ovarian endometriosis to asses whether a correlation exists among thrombospondin-1 serum levels and pelvic pain. Results From 56 patients, five cases were ultimateley excluded, because the histological diagnosis was other than cystic ovarian endometriosis (2 teratomas and 3 haemorragic cysts). The mean thrombospondin-1 serum levels in group A was 256,69 pg/ml_+37,07 and in group B was 291,41 pg/ml + 35,59. Conclusion Pain symptoms in ovarian endometriosis is not correlated with thrombospondin-1 serum levels. PMID:19917115

2009-01-01

306

Original Article INCIDENCE OF MUSCULOSKELETAL PAIN AND ITS IMPACT ON DAILY & FUNCTIONAL ACTIVITIES AMONG INDIAN SPINAL CORD INJURY PATIENTS  

E-print Network

Background: Pain is a common complication after spinal cord injury which can significantly impact upon a person’s functional ability and independence, ability to return to work and quality of life. Spinal cord injury patients suffer from several types of pain such as musculoskeletal pain, visceral pain, Neuropathic pain. Musculoskeletal pain generally arises from bones, joints, ligaments and muscles either in the acute post-injury phase or with chronic overuse in spinal cord injury patients. Purpose: The purpose of present study is to find out the incidence of musculoskeletal pain and its impact on daily and functional activities in Indian spinal cord injury patients. Materials and Methods: Hundred spinal cord injured patients were recruited for the study. Patients were asked to report any musculoskeletal pain and intensity of pain was measured by numerical rating scale. Impact on daily activities due to musculoskeletal pain was calculated by individual items score as well as total score of modified Brief pain inventory. Impact on functional activities was calculated by spinal cord independence measure. Results: Incidence of musculoskeletal pain was found to be 68%. Musculoskeletal pain intensity measured in numerical rating scale was found to be significantly correlated with impact on daily activities measured by total modified Brief pain inventory score as well as different items score of modified brief pain inventory (P< 0.001). Intensity of musculoskeletal pain was also significantly correlated with impact

307

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

PubMed Central

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

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

2014-01-01

308

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

PubMed Central

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

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

2013-01-01

309

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

Microsoft Academic Search

BACKGROUND: Although back pain is the most common reason patients use complementary and alternative medical (CAM) therapies, little is known about the willingness of primary care back pain patients to try these therapies. As part of an effort to refine recruitment strategies for clinical trials, we sought to determine if back pain patients are willing to try acupuncture, chiropractic, massage,

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

2004-01-01

310

Oral Doxepin Rinse: The Analgesic Effect and Duration of Pain Reduction in Patients with Oral Mucositis Due to Cancer Therapy  

Microsoft Academic Search

This research expands on our prior study, in which we assessed pain reduction after topical doxepin rinse in patients with oral mucositis resulting from cancer and cancer therapy. We continued to enroll patients with painful oral mucositis attributable solely to cancer therapy and performed further analysis on the duration of pain reduction. Fifty-one patients with oral mucositis were enrolled. Mucositis

Joel B. Epstein; Joshua D. Epstein; Matthew S. Epstein; Hal Oien; Edmond L. Truelove

2006-01-01

311

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

PubMed

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

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

312

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

ERIC Educational Resources Information Center

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…

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

2012-01-01

313

A qualitative and quantitative needs assessment of pain management for hospitalized orthopedic patients.  

PubMed

Despite advances in pain management, little formal teaching is given to practitioners and nurses in its use for postoperative orthopedic patients. The goal of our study was to determine the educational needs for orthopedic pain management of our residents, nurses, and physical therapists using a quantitative and qualitative assessment. The needs analysis was conducted in a 10-bed orthopedic unit at a teaching hospital and included a survey given to 20 orthopedic residents, 9 nurses, and 6 physical therapists, followed by focus groups addressing barriers to pain control and knowledge of pain management. Key challenges for nurses included not always having breakthrough pain medication orders and the gap in pain management between cessation of patient-controlled analgesia and ordering and administering oral medications. Key challenges for orthopedic residents included treating pain in patients with a history of substance abuse, assessing pain, and determining when to use long-acting vs short-acting opioids. Focus group assessments revealed a lack of training in pain management and the need for better coordination of care between nurses and practitioners and improved education about special needs groups (the elderly and those with substance abuse issues). This needs assessment showed that orthopedic residents and nurses receive little formal education on pain management, despite having to address pain on a daily basis. This information will be used to develop an educational program to improve pain management for postoperative orthopedic patients. An integrated educational program with orthopedic residents, nurses, and physical therapists would promote understanding of issues for each discipline. PMID:21815578

Cordts, Grace A; Grant, Marian S; Brandt, Lynsey E; Mears, Simon C

2011-08-01

314

Cognitive impairment in patients with chronic pain: The significance of stress  

Microsoft Academic Search

This review article examines the role of emotional distress and other aspects of suffering in the cognitive impairment that\\u000a often is apparent in patients with chronic pain. Research suggests that pain-related negative emotions and stress potentially\\u000a impact cognitive functioning independent of the effects of pain intensity. The anterior cingulate cortex is likely an integral\\u000a component of the neural system that

Robert P. Hart; James B. Wade; Michael F. Martelli

2003-01-01

315

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

PubMed

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

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

2004-11-01

316

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

PubMed Central

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

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

2011-01-01

317

Effects of Anodal Transcranial Direct Current Stimulation on Chronic Neuropathic Pain in Patients With Multiple Sclerosis  

Microsoft Academic Search

Neuropathic pain in patients with MS is frequent and is associated with a great interference with daily life activities. In the present study, we investigated whether anodal transcranial direct current stimulation (tDCS) may be effective in reducing central chronic pain in MS patients. Patients received sham tDCS or real tDCS in a 5-day period of treatment in a randomized, double

Francesco Mori; Claudia Codecà; Hajime Kusayanagi; Fabrizia Monteleone; Fabio Buttari; Stefania Fiore; Giorgio Bernardi; Giacomo Koch; Diego Centonze

2010-01-01

318

Psychological characteristics of Japanese patients with chronic pain assessed by the Rorschach test  

PubMed Central

Background The increasing number of patients with chronic pain in Japan has become a major issue in terms of the patient's quality of life, medical costs, and related social problems. Pain is a multi-dimensional experience with physiological, affective, cognitive, behavioral and social components, and recommended to be managed via a combination of bio-psycho-social aspects. However, a biomedical approach is still the dominant method of pain treatment in Japan. The current study aimed to evaluate comprehensive psychological functions and processes in Japanese chronic pain patients. Methods The Rorschach Comprehensive System was administered to 49 in-patients with non-malignant chronic pain. Major variables and frequencies from the test were then compared to normative data from non-patient Japanese adults by way of the t-test and chi-square test. Results Patients exhibited high levels of emotional distress with a sense of helplessness with regard to situational stress, confusion, and ambivalent feelings. These emotions were managed by the patients in an inappropriate manner. Cognitive functions resulted in moderate dysfunction in all stages. Information processing tended to focus upon minute features in an inflexible manner. Mediational dysfunction was likely to occur with unstable affective conditions. Ideation was marked by pessimistic and less effective thinking. Since patients exhibited negative self-perception, their interpersonal relationship skills tended to be ineffective. Originally, our patients displayed average psychological resources for control, stress tolerance, and social skills for interpersonal relationships. However, patient coping styles were either situation- or emotion-dependent, and patients were more likely to exhibit emotional instability influenced by external stimuli, resulting in increased vulnerability to pain. Conclusions Data gathered from the Rorschach test suggested psychological approaches to support chronic pain patients that are likely to be highly beneficial, and we thus recommend their incorporation into the course of current pain treatments. PMID:21110860

2010-01-01

319

Persistent postoperative pain and sensory changes following lymph node excision in melanoma patients: a topical review.  

PubMed

Studies on complications related to chronic nerve injury following sentinel lymph node biopsy (SLNB) and complete lymph node dissection (CLND) for melanoma are sparse. This review summarizes the existing literature on pain and neuropathic complications in melanoma patients undergoing SLNB with or without CLND. The Cochrane Central Register of Controlled Trials and the Embase and PubMed databases were searched. Full-text English language articles published before June 2013 were included. Prospective and retrospective studies assessing persistent (>1 month) sensory nerve injury, postoperative pain, neuropathic pain, and sensory disturbances following SLNB with or without CLND in melanoma patients were eligible. Nine studies (six prospective and three retrospective) including data for 3632 patients met our inclusion criteria. Outcome parameters were too heterogeneous to conduct a quantitative analysis, and few studies systematically evaluated pain and sensory abnormalities. Persistent postoperative pain was reported in 1-14% of patients following SLNB and in 6-34% following CLND and sensory abnormalities in 0.1-32 and 2-82%, respectively. In the one study that assessed the type of pain, neuropathic pain was suggested to explain persistent pain in 31-66% of patients with SLNB and 82-89% of patients with CLND. Sensory-nerve-related complications in melanoma patients seem to be less pronounced following SLNB compared with CLND. Prospective observational studies are necessary to identify predictors of persistent pain, to evaluate the prevalence and impact of pain and sensory abnormalities, and to develop strategies for prevention of long-term complications. PMID:24346167

Slagelse, Charlotte; Petersen, Karin L; Dahl, Jørgen B; Finnerup, Kenneth; Greene, Kaitlin; Leong, Stanley P; Levine, Jon; Rowbotham, Michael; Werner, Mads U; Finnerup, Nanna B

2014-04-01

320

Evaluation of Nonspecific Low Back Pain Using a New Detailed Visual Analogue Scale for Patients in Motion, Standing, and Sitting: Characterizing Nonspecific Low Back Pain in Elderly Patients  

PubMed Central

Because we have a clinical impression that elderly patients have low back pain while in motion and standing, but less pain when sitting, we investigate characteristics of nonspecific low back pain (NSLBP), using a new detailed visual analog scale (VAS) scoring system. One hundred eighty-nine patients with NSLBP were divided into an elderly group (?65 years old, n = 56) and a young group (<65 years old, n = 133). Low back pain was evaluated by a traditional VAS scoring system, the Oswestry Disability Index (ODI), and a new detailed VAS scoring system in which pain is independently evaluated in three different postural situations (in motion, standing, and sitting). No significant differences were observed in traditional VAS and ODI scores between the two groups. The results of the detailed VAS showed no significant differences between the two groups while in motion and standing. However, the elderly group showed significantly lower VAS score while sitting compared to the young group. In this study of the first use of a new detailed VAS scoring system, differences in characteristics of NSLBP between elderly and young patients were successfully detected. This minor modification of the traditional VAS may be useful for characterizing and evaluating low back pain. PMID:23213514

Aoki, Yasuchika; Sugiura, Shiro; Nakagawa, Koichi; Nakajima, Arata; Takahashi, Hiroshi; Ohtori, Seiji; Takahashi, Kazuhisa; Nishikawa, Satoru

2012-01-01

321

Biofeedback relaxation for pain associated with continuous passive motion in Taiwanese patients after total knee arthroplasty.  

PubMed

Effective pain management is crucial for patient recovery after total knee arthroplasty (TKA). Biofeedback therapy, which encourages relaxation and helps alleviate various conditions associated with stress, may help to decrease postoperative pain in patients undergoing TKA. A quasi- experimental design was used to investigate the efficacy of a biofeedback relaxation intervention in reducing pain associated with postoperative continuous passive motion (CPM) therapy. Sixty-six patients admitted to a general hospital in Taiwan for TKA were recruited and randomly assigned to the intervention or control group. The intervention group received biofeedback training twice daily for 5 days, concurrent with CPM therapy, whereas the control group did not receive the biofeedback intervention. Pain was measured using a numeric rating scale before and after each CPM therapy session on postoperative days 1 through 5. The CPM-elicited pain score was calculated by subtracting the pre-CPM pain score from the post-CPM pain score. Results of repeated-measures analysis of variance showed intervention group reported significantly less pain caused by CPM than did the control group (f?=?29.70, p?pain management in this population. PMID:25557776

Wang, Tsae-Jyy; Chang, Ching-Fen; Lou, Meei-Fang; Ao, Man-Kuan; Liu, Chiung-Chen; Liang, Shu-Yuan; Wu, Shu-Fang Vivienne; Tung, Heng-Hsing

2015-02-01

322

[A study of logotherapy for chronic low back pain patients].  

PubMed

DHEA-S (dehydroepiandrosterone sulfate) has many roles in human body as comprehensive vital power, whose metabolite is urine 17-KS-S (abbreviated S), having function of anti-cortisol. The metabolite of cortisol is urine 17-OHCS (abbreviated OH). DHEA-S is produced not only in adrenal glands but in brain. In order to examine the effects of logotherapy, urine S and OH were examined. Subjects were chronic low back pain patients treated by loxoprofen sodium (NSAID). In Group 1 (n = 11) logotherapy was not added, but in Group 2 (n = 10) it was added. Before the treatment, both groups showed low S and high OH. After 3 weeks, Group 2 showed higher S and lower OH than Group 1. After 18 weeks, 4 cases (40%) were relapsed in Group 2, and 10 (90.9%) were in Group 1 (p < 0.05). Group 2 was divided into 2 groups; relapsed group (n = 4) and non-relapsed group (n = 6). S, OH, S/OH were examined between 2 groups of Group 2 and Group 1. Relapsed group of Group 2 and Group 1 showed lower S and higher OH than non-relapsed group of Group 2. [Discussion] Logotherapy is a method to activate comprehensive human vital power. This is the mechanism through stimulating and activating human brain function. PMID:12806908

Nagata, Katsutaro

2003-01-01

323

Foetal pain?  

PubMed

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

Derbyshire, Stuart W G

2010-10-01

324

Bilateral Sensory Abnormalities in Patients with Unilateral Neuropathic Pain; A Quantitative Sensory Testing (QST) Study  

PubMed Central

In patients who experience unilateral chronic pain, abnormal sensory perception at the non-painful side has been reported. Contralateral sensory changes in these patients have been given little attention, possibly because they are regarded as clinically irrelevant. Still, bilateral sensory changes in these patients could become clinically relevant if they challenge the correct identification of their sensory dysfunction in terms of hyperalgesia and allodynia. Therefore, we have used the standardized quantitative sensory testing (QST) protocol of the German Research Network on Neuropathic Pain (DFNS) to investigate somatosensory function at the painful side and the corresponding non-painful side in unilateral neuropathic pain patients using gender- and age-matched healthy volunteers as a reference cohort. Sensory abnormalities were observed across all QST parameters at the painful side, but also, to a lesser extent, at the contralateral, non-painful side. Similar relative distributions regarding sensory loss/gain for non-nociceptive and nociceptive stimuli were found for both sides. Once a sensory abnormality for a QST parameter at the affected side was observed, the prevalence of an abnormality for the same parameter at the non-affected side was as high as 57% (for Pressure Pain Threshold). Our results show that bilateral sensory dysfunction in patients with unilateral neuropathic pain is more rule than exception. Therefore, this phenomenon should be taken into account for appropriate diagnostic evaluation in clinical practice. This is particularly true for mechanical stimuli where the 95% Confidence Interval for the prevalence of sensory abnormalities at the non-painful side ranges between 33% and 50%. PMID:22629414

Konopka, Karl-Heinz; Harbers, Marten; Houghton, Andrea; Kortekaas, Rudie; van Vliet, Andre; Timmerman, Wia; den Boer, Johan A.; Struys, Michel M.R.F.; van Wijhe, Marten

2012-01-01

325

Bilateral sensory abnormalities in patients with unilateral neuropathic pain; a quantitative sensory testing (QST) study.  

PubMed

In patients who experience unilateral chronic pain, abnormal sensory perception at the non-painful side has been reported. Contralateral sensory changes in these patients have been given little attention, possibly because they are regarded as clinically irrelevant. Still, bilateral sensory changes in these patients could become clinically relevant if they challenge the correct identification of their sensory dysfunction in terms of hyperalgesia and allodynia. Therefore, we have used the standardized quantitative sensory testing (QST) protocol of the German Research Network on Neuropathic Pain (DFNS) to investigate somatosensory function at the painful side and the corresponding non-painful side in unilateral neuropathic pain patients using gender- and age-matched healthy volunteers as a reference cohort. Sensory abnormalities were observed across all QST parameters at the painful side, but also, to a lesser extent, at the contralateral, non-painful side. Similar relative distributions regarding sensory loss/gain for non-nociceptive and nociceptive stimuli were found for both sides. Once a sensory abnormality for a QST parameter at the affected side was observed, the prevalence of an abnormality for the same parameter at the non-affected side was as high as 57% (for Pressure Pain Threshold). Our results show that bilateral sensory dysfunction in patients with unilateral neuropathic pain is more rule than exception. Therefore, this phenomenon should be taken into account for appropriate diagnostic evaluation in clinical practice. This is particularly true for mechanical stimuli where the 95% Confidence Interval for the prevalence of sensory abnormalities at the non-painful side ranges between 33% and 50%. PMID:22629414

Konopka, Karl-Heinz; Harbers, Marten; Houghton, Andrea; Kortekaas, Rudie; van Vliet, Andre; Timmerman, Wia; den Boer, Johan A; Struys, Michel M R F; van Wijhe, Marten

2012-01-01

326

Exercise despite pain--breast cancer patient experiences of muscle and joint pain during adjuvant chemotherapy and concurrent participation in an exercise intervention.  

PubMed

Chemotherapy-related pain is a well-known side effect in cancer patient receiving chemotherapy. However, limited knowledge exists describing whether exercise exacerbates existing pain. Aim of the research was to explore muscle and joint pain experienced by women with breast cancer receiving adjuvant chemotherapy with epirubicin and cyclophosphamide followed by docetaxel and factor support and concurrently participating in an exercise intervention. The study used individual semi-structured interviews (pre- and post-intervention). Fifteen women were interviewed. The multimodal group intervention comprised supervised training: high-intensity cardiovascular, heavy resistance and relaxation, massage and body-awareness (9?h weekly, 6 weeks). The analysis revealed five categories: Abrupt pain - a predominant side effect, cogitated pain management, the adapted training, non-immediate exacerbation of pain and summarised into the essence of chemotherapy related muscle and joint pain in exercise breast cancer patients; exercise despite pain. Findings indicate that the patients' perception of sudden onset of chemotherapy-related muscle and joint pain was not aggravated by training. Pain intensity peaked between 2 and 9 days after chemotherapy and is described to be stabbing pain with a feeling of restlessness in the body. The patients demonstrated a high adherence rate to the exercise intervention caused by their own willpower and camaraderie of the group. PMID:24750506

Andersen, C; Rørth, M; Ejlertsen, B; Adamsen, L

2014-09-01

327

[Pain in elderly people with dementia].  

PubMed

Aging is associated with an increased risk of cognitive impairment, such as Alzheimer's disease, vascular dementia and frontotemporal dementia. These diseases not only impair brain tissues and the nervous system, but also affect patients' verbal and non-verbal communicative ability. It is difficult, for instance, to assess pain in the cognitively impaired elderly because pain perception draws heavily on a patient's subjective interpretation and tolerance level. To seek an effective solution for pain detection in patients with dementia is therefore essential. From a systematic literature review covering the past decade, this paper presents a synopsis of the difficulty of pain assessment in the elderly with cognitive impairment, changes in the academic concept of pain, and explores factors resulting in obstacles to pain recognition. The obstacles to pain assessment derive mainly from three general factors. Firstly, classic definitions of early stage pain are inappropriate when applied to the elderly with cognitive impairment. Secondly, pain indicators are also unclear for this population. Thirdly, pain instruments and informants are ineffective in evaluating elderly patients with varying cognitive levels. To address these obstacles, a sound, multifaceted model of pain assessment for elderly patients with different severities of cognitive impairment is presented. On the basis of the above literature review, multiple methods for detecting aspects of pain in elderly people with cognitive impairment is recommended. To test the feasibility of the multidimensional model of pain assessment, further study is needed. PMID:18393211

Chen, Yi-Heng; Lin, Li-Chan

2008-04-01

328

Chronic Back Pain Patients Show Differences in Behavior and Brain Activity During a Loss-Aversion Gambling Task  

E-print Network

who endure long-term pain and suffering. · In the present study, we compare performance scoresChronic Back Pain Patients Show Differences in Behavior and Brain Activity During a Loss with chronic back pain. Additionally, many labs have observed that people with a variety of chronic pain

Apkarian, A. Vania

329

Perioperative Pain Management for Patients on Chronic Buprenorphine: A Case Report  

PubMed Central

Here we present a patient with a Type I Chiari malformation who was receiving buprenorphine for chronic pain who underwent two separate urogynecologic procedures for removal of vaginal mesh with two different pain management regimens. For the first procedure at an outside hospital, the patient’s usual dose of buprenorphine (8 mg sublingual every 8 hours) was continued up through her surgery and then a full opioid receptor agonist was used for postoperative pain management. The patient complained that this resulted in very poor pain control for her in the postoperative period. Prior to her second procedure, which was performed at our institution, buprenorphine was switched to a full opioid agonist (oral hydromorphone 4 mg every 4 to 6 hours, maximum 20 mg per day) for 5 days prior to surgery; postoperative pain was managed with full opioid receptor agonists. The patient again reported suboptimal pain control in spite of substantially increased doses of opioids. This case report highlights the difficulty of perioperative pain management for patients on chronic buprenorphine and emphasizes the need for additional investigation. PMID:24307971

Chern, Sy-Yeu S; Isserman, Rebecca; Chen, Linda; Ashburn, Michael; Liu, Renyu

2013-01-01

330

Transdermal Fentanyl Patches Versus Patient-Controlled Intravenous Morphine Analgesia for Postoperative Pain Management  

PubMed Central

Background: Acute and severe pain is common in patients postoperatively and should be correctly managed. In the past years studies on preparing better postoperative pain control have resulted in development of postoperative pain management guidelines. Perhaps, one of the major improvements in managing postoperative pain is the development of the patient-controlled analgesia systems (PCA), especially through intra venous (IV), extradural and transdermal routes, which has resulted in marked improvements in acute postoperative pain management. Physicians administrate potent opioids for moderate to severe post-surgical pains. Morphine is the most commonly IV-PCA administrated analgesic. The fentanyl iontophoretic transdermal system (fentanyl ITS) is also another efficient option for pain management. Objectives: The aim of this study was to compare the analgesic effects of these two routine postoperative pain control systems. Patients and Methods: We enrolled 281 patients (224 males, 57 females) in this blind randomized controlled clinical trial, who had undergone an orthopedic surgery, with the mean age of 33.91 ± 14.45 years. Patients were randomly divided into two groups; in group A patients received IV-morphine PCA pump and in group B fentanyl transdermal patches were attached on patients’ arms. The severity of the pain was registered according to Visual Analogue Scale in specially designed forms by pain-trained nurses in two steps; first after the surgery and next before the beginning of analgesic effects. After 24 hours, the pain score was assessed again. Results: No significant difference was observed in mean pain intensity score at the first patient assessment. Mean pain intensity scores were also similar in both groups at the last measured time point (P > 0.05). Differential pain intensity scores, showing the impacts of analgesic system on the pain experience of the patients was also similar between fentanyl patches (6.48 ± 2.20) and morphine PCIA (6.40 ± 1.80). (P > 0.05) Mean patient satisfactory score (scale: 0–100) was also similar in both groups (P > 0.05). The percentage of patients, whose differential pain intensity scores at 24 hours reached our pain management goal was similar between fentanyl and morphine groups (P > 0.05). The percentage of patients with at least one adverse event was significantly higher in fentanyl group (P < 0.05). The most frequent adverse events were nausea, vomiting and itching. In none of the groups, no patient experienced serious adverse events related to the studied medications. Conclusions: Although both pain killing therapeutic regimens are safe and effective for postoperative pain management, regarding the easy usage of the patches, lower risk of abuse and cost-effectiveness in the Iranian market, it is recommended for use in Iranian hospitals and trauma centers and in countries with similar socioeconomic situations. PMID:25031847

Ebrahimzadeh, Mohamad Hossein; Mousavi, Seyed Kamal; Ashraf, Hami; Abubakri, Rahil; Birjandinejad, Ali

2014-01-01

331

Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial  

Microsoft Academic Search

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

Joshua A. Cleland; Maj. John D. Childs; Meghann McRae; Jessica A. Palmer; Thomas Stowell

2005-01-01

332

The association of comorbidities, utilization and costs for patients identified with low back pain  

Microsoft Academic Search

BACKGROUND: Existing studies have examined the high prevalence of LBP along with the high treatment costs of patients with low back pain (LBP). Various factors have been shown to be correlated or predictive of chronic or episodic LBP including the characteristics of the initial episode, pain, comorbid conditions, psychosocial issues, and opiate use. This study replicates and extends earlier studies

Debra P Ritzwoller; Laurie Crounse; Susan Shetterly; Dale Rublee

2006-01-01

333

Investigation and Macroscopic Anatomical Study of Referred Pain in Patients with Hip Disease  

PubMed Central

[Purpose] The aim of this study was to examine the incidence and patterns of referred pain in patients with hip disease, as well as the nerve distribution in the hip and knee joints of 2 cadavers. [Subjects and Methods] A total of 113 patients with hip joint disease were included in the investigation. The incidence of regional pain and referred pain patterns were evaluated before and after arthroplasty. Two cadavers were macroscopically observed to verify the nerve innervation of the hip and knee joints. [Results] Anterior knee pain was observed preoperatively in 13.3% (in resting) and 33.6% (in motion) of the patients, which was comparable with the incidence of greater trochanter pain. In addition, the preoperative incidence rates of knee pain in resting and motion markedly decreased postoperatively. Of note is the remarkable incidence of pain radiating to the ventral lower limb. An anteromedial innervation was determined in the cadavers by the articular branches of the obturator and femoral nerve, which supply small branches to the knee joints. [Conclusion] Our results suggest that the distribution of the incidence of pain among the patients with hip disease is diverse owing to the sensory distribution of the femoral and obturator nerves. PMID:24648632

Sakamoto, Junya; Morimoto, Yosuke; Ishii, Shun; Nakano, Jiro; Manabe, Yoshitaka; Okita, Minoru; Tsurumoto, Toshiyuki

2014-01-01

334

Investigation and macroscopic anatomical study of referred pain in patients with hip disease.  

PubMed

[Purpose] The aim of this study was to examine the incidence and patterns of referred pain in patients with hip disease, as well as the nerve distribution in the hip and knee joints of 2 cadavers. [Subjects and Methods] A total of 113 patients with hip joint disease were included in the investigation. The incidence of regional pain and referred pain patterns were evaluated before and after arthroplasty. Two cadavers were macroscopically observed to verify the nerve innervation of the hip and knee joints. [Results] Anterior knee pain was observed preoperatively in 13.3% (in resting) and 33.6% (in motion) of the patients, which was comparable with the incidence of greater trochanter pain. In addition, the preoperative incidence rates of knee pain in resting and motion markedly decreased postoperatively. Of note is the remarkable incidence of pain radiating to the ventral lower limb. An anteromedial innervation was determined in the cadavers by the articular branches of the obturator and femoral nerve, which supply small branches to the knee joints. [Conclusion] Our results suggest that the distribution of the incidence of pain among the patients with hip disease is diverse owing to the sensory distribution of the femoral and obturator nerves. PMID:24648632

Sakamoto, Junya; Morimoto, Yosuke; Ishii, Shun; Nakano, Jiro; Manabe, Yoshitaka; Okita, Minoru; Tsurumoto, Toshiyuki

2014-02-01

335

Hypoalgesic effect of a passive accessory mobilisation technique in patients with lateral ankle pain  

Microsoft Academic Search

A randomised, double blind, repeated measures study was conducted to investigate the initial effects of an accessory mobilisation technique applied to the ankle joint in 13 patients with a unilateral sub-acute ankle supination injury. Ankle dorsiflexion range of motion, pressure pain threshold, visual analogue scale rating of pain during functional activity and ankle functional scores were assessed before and after

Hwee Koon Yeo; Anthony Wright

2011-01-01

336

Abnormal sensitization and temporal summation of second pain (wind-up) in patients with fibromyalgia syndrome  

Microsoft Academic Search

Although individuals with fibromyalgia syndrome (FMS) consistently report wide-spread pain, clear evidence of structural abnormalities or other sources of chronic stimulation of pain afferents in the involved body areas is lacking. Without convincing evidence for peripheral tissue abnormalities in FMS patients, it seems likely that a central pathophysiological process is at least partly responsible for FMS, as is the case

Roland Staud; Charles J Vierck; Richard L Cannon; Andre P Mauderli; Donald D Price

2001-01-01

337

Predictors of Abdominal Pain in Depressed Pediatric Inflammatory Bowel Disease Patients  

PubMed Central

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

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

338

Do Diabetic Patients with Acute Coronary Syndromes Have a Higher Threshold for Ischemic Pain?  

PubMed Central

Background: Data from over 4 decades have reported a higher incidence of silent infarction among patients with diabetes mellitus (DM), but recent publications have shown conflicting results regarding the correlation between DM and presence of pain in patients with acute coronary syndromes (ACS). Objective: Our primary objective was to analyze the association between DM and precordial pain at hospital arrival. Secondary analyses evaluated the association between hyperglycemia and precordial pain at presentation, and the subgroup of patients presenting within 6 hours of symptom onset. Methods: We analyzed a prospectively designed registry of 3,544 patients with ACS admitted to a Coronary Care Unit of a tertiary hospital. We developed multivariable models to adjust for potential confounders. Results: Patients with precordial pain were less likely to have DM (30.3%) than those without pain (34.0%; unadjusted p = 0.029), but this difference was not significant after multivariable adjustment, for the global population (p = 0.84), and for subset of patients that presented within 6 hours from symptom onset (p = 0.51). In contrast, precordial pain was more likely among patients with hyperglycemia (41.2% vs 37.0% without hyperglycemia, p = 0.035) in the overall population and also among those who presented within 6 hours (41.6% vs. 32.3%, p = 0.001). Adjusted models showed an independent association between hyperglycemia and pain at presentation, especially among patients who presented within 6 hours (OR = 1.41, p = 0.008). Conclusion: In this non-selected ACS population, there was no correlation between DM and hospital presentation without precordial pain. Moreover, hyperglycemia correlated significantly with pain at presentation, especially in the population that arrived within 6 hours from symptom onset. PMID:25076180

Nicolau, José Carlos; Barbosa, Carlos José Dornas Gonçalves; Franci, André; Baracioli, Luciano Moreira; Franken, Marcelo; Lima, Felipe Gallego; Giraldez, Roberto Rocha; Kalil Filho, Roberto; Ramires, José Antônio Franchini; Giugliano, Robert P.

2014-01-01

339

Metabolic syndrome and mean platelet volume variation in patients with chest pain and negative cardiac enzymes  

PubMed Central

Introduction. The mean platelet volume (MPV) is an easily measurable parameter directly correlated with platelet aggregation function, proven to be increased in acute coronary syndromes, but also in the presence of cardiovascular risk factors such as the metabolic syndrome, dyslipidemia, diabetes mellitus, arterial hypertension. Objective. This study intended to assess the role of the metabolic syndrome in MPV variation in patients presenting with chest pain. Materials and Methods. We retrospectively analyzed data from 122 patients with chest pain and negative cardiac enzymes admitted consecutively to our clinic from September 1st 2011 to January 30th 2012. Our group included 27 (22.13%) patients with stable angina (SA), 74 (60.65%) patients with unstable angina (UA) and 21 (17.22%) patients with non-coronary chest pain. Results. Patients with UA had a higher mean value of the MPV 9.31 ± 1.19 fL compared to patients with SA 8.72 ± 1.14 fL (p=0.0279) and patients with non-coronary chest pain 8.85 ± 0.90 L (p=0.0908). All the patients with metabolic syndrome had increased MPVs, regardless of the etiology of chest pain. Patients with non-coronary chest pain presented significantly higher MPVs if associated with metabolic syndrome or arterial hypertension. Conclusions. Patients with cardiovascular risk factors, especially complex ones like the metabolic syndrome had an increased MPV, as did the patients with UA whether or not associated with the risk factors. In patients without such comorbidities, the MPV could be useful in distinguishing unstable angina from non-coronary chest pain. PMID:23904875

Nechita, AC; Delcea, C; Enache, V; Ploesteanu, RL; Cazacu, C; Andronescu, AM; Stroi, AM; Stamate, CS

2013-01-01

340

PAIN SCALES (ATTACHMENT A)  

E-print Network

PAIN SCALES (ATTACHMENT A) 0-10 NUMERIC PAIN INTENSITY SCALE 0 1 2 3 4 5 6 7 8 9 10 NO PAIN MODERATE WORST PAIN PAIN #12;PAIN SCALES (ATTACHMENT A) FLACC PAIN SCALE The FLACC is a behavioral pain assessment scale for use in non-verbal patients unable to provide numeric reports of pain. SCORING Categories

Oliver, Douglas L.

341

Randomized trial of two physiotherapy interventions for primary care neck and back pain patients: 'McKenzie' vs brief physiotherapy pain management  

Microsoft Academic Search

Objectives. Interventions that take psychosocial factors into account are recommended for patients with persistent back or neck pain. We compared the effectiveness of a brief physiotherapy pain management approach using cognitive-behavioural principles (Solution-Finding Approach—SFA) with a commonly used method of physical therapy (McKenzie Approach—McK). Methods. Eligible patients referred by GPs to physiotherapy departments with neck or back pain lasting at

J. Klaber Moffett; D. A. Jackson; E. D. Gardiner; D. J. Torgerson; S. Coulton; S. Eaton; M. P. Mooney; C. Pickering; A. J. Green; L. G. Walker; S. May; S. Young

2006-01-01

342

Pain, disability, and satisfation outcomes and predictors of outcomes: A practice-based study of chronic low back pain patients attending primary care and chiropractic physicians  

Microsoft Academic Search

Background: Few studies exist on the prognostic value of demographic, clinical, or psychosocial factors on long-term outcomes for patients with chronic low back pain.Objective: This study reports on long-term pain and disability outcomes for patients with chronic low back pain, evaluates predictors of long-term outcomes, and assesses the influence of doctor type on clinical outcome.Methods: Sixty chiropractic (DC) and 111

Joanne Nyiendo; Mitchell Haas; Bruce Goldberg; Gary Sexton

2001-01-01

343

Pain and quality of life for patients with venous leg ulcers: proof of concept of the efficacy of BiatainR-Ibu, a new pain reducing wound dressing  

Microsoft Academic Search

Wound pain is a serious problem for elderly patients suffering from chronic leg ulcers, and it may lead to reduced wound healing rates and reduced quality of life. Biatains-Ibu Non-adhesive (Coloplast A\\/S), a new pain-reducing moist wound healing dressing containing ibuprofen was tested for pain reduction, safety, and efficacy on 1012 patients in a single-blinded crossover study against Biatain Non-adhesive

Bo Jorgensen; Gitte Juel Friis; Finn Gottrup

2006-01-01

344

A protocol-contract for opioid use in patients with chronic pain not due to malignancy.  

PubMed

The legal, psychosocial, and medical factors that we believe have contributed to the success of our protocol-contract in prescribing opioids to patients with chronic pain not due to malignancy are outlined. These factors may be applicable to the treatment of a variety of chronic nonmalignant pain syndromes such as postherpetic neuralgia or human immunodeficiency virus/acquired immunodeficiency syndrome. The intended target audience of this paper is the physician (primary care, chronic pain specialist) who is involved in prescribing opioids for the treatment of chronic, nonmalignant pain. PMID:9702628

Kirkpatrick, A F; Derasari, M; Kovacs, P L; Lamb, B D; Miller, R; Reading, A

1998-08-01

345

Prevalence of the Fibromyalgia Phenotype in Spine Pain Patients Presenting to a Tertiary Care Pain Clinic and the Potential Treatment Implications  

PubMed Central

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

Brummett, Chad M.; Goesling, Jenna; Tsodikov, Alex; Meraj, Taha S.; Wasserman, Ronald A.; Clauw, Daniel J.; Hassett, Afton L.

2014-01-01

346

OPTOELECTRONIC MOVEMENT ANALYSIS TO MEASURE MOTOR PERFORMANCE IN PATIENTS WITH CHRONIC LOW BACK PAIN: TEST OF RELIABILITY1  

Microsoft Academic Search

Objective: To assess test-retest reliability of the Posturo- Locomotion-Manual (PLM) test in patients with chronic low back pain. Design: A controlled study in which the PLM test was used repeatedly on patients with chronic low back pain and persons without back pain. Subjects: Twelve patients with treatment-resistant chronic low back pain, selected by 2 orthopaedic spine surgeons and 12 age-

Christina U. M. Schon-Ohlsson; Jan A. G. Willen

347

Cancer pain  

SciTech Connect

This book contains 13 chapters. Some of the chapter titles are: Importance of the Problem; Neurophysiology and Biochemistry of Pain; Assessment of Pain in Patients with Cancer; Drug Therapy; Chemotherapy and Radiotherapy for Cancer Pain; Sympton Control as it Relates to Pain Control; and Palliative Surgery in Cancer Pain Treatment.

Swerdlow, M.; Ventafridda, V.

1987-01-01

348

Bortezomib-induced painful neuropathy in patients with multiple myeloma  

PubMed Central

Neurotoxicity towards the peripheral nervous system which appears clinically in the form of painful neuropathy is an essential dose-limiting factor during the treatment of multiple myeloma. In this review article different forms of this painful neuropathy are presented together with currently available diagnostic tools which are usually applied to confirm the diagnosis. Also, the most often used neurological scales estimating neurological deficit are presented. Special attention is paid to the management of the reversibility of bortezomib-induced neuropathic pain. PMID:24596530

Usnarska-Zubkiewicz, Lidia; Pokryszko-Dragan, Anna

2013-01-01

349

Quality and intensity of low back pain in cronic PTSD patients.  

PubMed

The aim of this study was to analyze the association between chronic low back pain (LBP) in chronic post-traumatic stress disorder (PTSD) with quality and intensity of pain experience. A total of 406 war veterans from 1991-1995 war in Croatia participated in this study. They were divided into four groups, according to psychiatric interview, psychometric testing and the presence of LBP verified by the imaging of lumbar area, into: (i) war veterans suffering from PTSD and LBP (N = 102), (ii) war veterans suffering from PTSD only (N = 108), (iii) war veterans suffering from LBP only (N = 99) and (iv) healthy controls (N = 97). On the basis of medical records, interviews and different types of self-assessment questionnaires the inter-relationship between chronic pain and chronic PTSD was analyzed. PTSD was assessed by TSI-A (Trauma symptom Inventory, whereas pain was measured by Melzack-McGill Pain Questionnaire - short form (MPQ-SF) and Visual Analogue Scale (VAS). The patients with chronic PTSD had significantly higher total pain scores as well as affective and sensory pain components when compared to the patients without PTSD. No significant association was found between chronic LBP and symptoms of PTSD. Chronic LBP as functional painful syndrome in PTSD could be result of altered neuroanatomical and neurophysiological pain pathway and one of the markers of PTSD. PMID:24611339

Bili?, Morana; Mickovi?, Vlatko; Loncar, Zoran

2013-12-01

350

Navigating the health care system: perceptions of patients with chronic pain.  

PubMed

A new framework is needed for patients with chronic pain and their primary care physicians that acknowledges the individual's experiences and provides evidence-informed education and better linkages to community-based resources. This study describes the experience of 19 chronic-pain sufferers who seek relief via the health care system. Their experiences were recorded through in-depth semistructured interviews and analyzed through qualitative methods. The participants reported early optimism, then disillusionment, and finally acceptance of living with chronic pain. Both individuals with chronic pain and their health care professionals need evidence-informed resources and information on best practices to assist them to manage pain. Empathetic communication between health care professionals and individuals with chronic pain is crucial because insensitive communication negatively affects the individual, reduces treatment compliance and increases health care utilization. PMID:19804680

Dewar, A L; Gregg, K; White, M I; Lander, J

2009-01-01

351

Pain and Anxiety versus Sense of Family Support in Lung Cancer Patients  

PubMed Central

Lung cancer is a stressful condition for both patient and family. The anxiety and pain accompanying cancer and its treatment have a significant negative influence on the patient's quality of life. The aim of this study was to investigate the correlation between anxiety, pain, and perceived family support in a sample of lung cancer patients. The sample consisted of a total of 101 lung cancer outpatients receiving treatment at the oncology department of a general hospital. Anxiety, pain (severity and impact on everyday life), and perceived family support were assessed using Spielberger's State-Trait Anxiety Inventory, the Brief Pain Inventory, and the Family Support Scale, respectively. Statistical analyses revealed correlations between anxiety, pain, and family support as perceived by the patients. The intensity of pain had a positive correlation with both state and trait anxiety and a negative correlation with family support. Anxiety (state and trait) had a significant negative correlation with family support. In conclusion, high prevalence rates of anxiety disorders were observed in lung cancer patients. Females appeared more susceptible to anxiety symptoms with a less sense of family support. A negative correlation was evidenced between family support and anxiety and a positive one between anxiety and pain. PMID:25126424

Lekka, Dimitra; Pachi, Argiro; Zafeiropoulos, Georgios; Evmolpidi, Argiri; Ilias, Ioannis; Karkanias, Athanasios; Moussas, Georgios; Tzanakis, Nikolaos; Syrigos, Konstantinos N.

2014-01-01

352

Options in topical therapies in the management of patients with acute pain.  

PubMed

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

McCarberg, Bill; D'Arcy, Yvonne

2013-07-01

353

Cancer Patients with Pain: The Spouse/Partner Relationship and Quality of Life  

PubMed Central

Background A diagnosis of cancer affects not only the patient, but also their spouse/partner. In addition to facing a life-threatening illness, changes in role and financial threats can impact the dyad. Objective This dyadic study examined effects of financial concerns and pain on cancer patients’ and their partners’ quality of life (QOL). The partner relationship and the partners’ coping style were explored for mediating the couples’ outcomes. Methods Participants consisted of 177 dyads with both genders as patients and partners in committed, heterosexual relationships. Patients had a mix of cancer diagnoses and were in various phases of treatment. Each participant completed four of the same instruments. Partners also completed coping and financial concerns measures and patients completed pain and symptom distress measures. Results Pathway analysis, using Structural Equation Modeling, examined effects of pain and financial concerns on relationship quality, partners’ coping style and QOL for the dyad. Partners’ coping style affected only their own QOL .16 (p=0.05). Pain had a significantly negative direct effect -.51 (p=0.05) on patients’ QOL and no direct relationship to the partner’s QOL. Financial concerns affected both participants; patient -.13 (p=0.05) and partner QOL -.36 (p=0.05). The relationship mediated a decrease in patient pain from -.51 to -.58, a significant total effect (p=0.05). Conclusions The partners’ relationship lessened pain’s negative effect. Financial concerns were a significant issue for both dyad members, but the quality of the relationship was not compromised. Implications for Practice Patientspain may be affected by the quality of the marital relationship. PMID:21139453

Morgan, Mary Ann; Small, Brent J.; Donovan, Kristine A.; Overcash, Janine; McMillan, Susan

2010-01-01

354

Is Response to Radiotherapy in Patients Related to the Severity of Pretreatment Pain?  

SciTech Connect

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.

Kirou-Mauro, Andrea; Hird, Amanda; Wong, Jennifer; Sinclair, Emily; Barnes, Elizabeth A.; Tsao, May; Danjoux, Cyril [Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON (Canada); Chow, Edward [Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON (Canada)], E-mail: edward.chow@sunnybrook.ca

2008-07-15

355

Micronized Palmitoylethanolamide Reduces the Symptoms of Neuropathic Pain in Diabetic Patients  

PubMed Central

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

Schifilliti, Chiara; Cucinotta, Lelio; Fedele, Viviana; Ingegnosi, Carmela; Luca, Salvatore; Leotta, Carmelo

2014-01-01

356

Micronized palmitoylethanolamide reduces the symptoms of neuropathic pain in diabetic patients.  

PubMed

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

Schifilliti, Chiara; Cucinotta, Lelio; Fedele, Viviana; Ingegnosi, Carmela; Luca, Salvatore; Leotta, Carmelo

2014-01-01

357

Pain relief with percutaneous trochanteroplasty in a patient with bilateral trochanteric myelomatous lytic lesions.  

PubMed

Multiple myeloma is a hematologic malignancy associated with destructive bone loss. Lytic lesions, a hallmark of this cancer, can result in significant morbidity because of associated pain and structural osseous compromise. Osteoplasty has demonstrated efficacy in the treatment of myelomatous pain within the axial skeleton; however, there is limited evidence supporting the utility of osteoplasty to treat extra-spinal lesions. We describe a 67 year-old woman with stable IgA lambda multiple myeloma with sentinel bilateral greater trochanteric lytic lesions that was referred to our interventional pain management clinic for evaluation of bilateral lateral hip pain. Conservative treatment options including physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs), oral opiates, and local corticosteroid injections to bilateral trochanteric bursae failed to offer pain relief. The patient underwent minimally invasive percutaneous trochanteroplasty with concomitant core biopsy of her bilateral trochanteric lytic lesions. The intended goals of this novel procedure were to determine the cause of the suspected lytic lesions, provide pain relief, and offer structural stability by safely implanting bone cement as part of a fracture prevention strategy. At 12 month follow-up, the patient's pain improved by 70% and she no longer required the use of pain medication. The patient also displayed a significant improvement in her day-to-day functioning and quality of life. PMID:25675071

Wahezi, Sayed E; Silva, Kyle; Najafi, Shervin

2015-01-01

358

Reducing Cancer Patients' Painful Treatment - Duration: 3:07.  

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...

359

New Insights Found in Pain Processing and Sleep Disturbance Among Rheumatoid Arthritis Patients  

MedlinePLUS

... 2013 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, ...

360

Evidence Report on the Treatment of Pain in Cancer Patients  

Microsoft Academic Search

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 Co- chrane Library from 1966 through April 2001, as well as bibliographies of meta-analyses and review articles. We se- lected randomized controlled trials (RCTs) reporting

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

2004-01-01

361

[Epiduroscopy in patients with chronic low back pain without remarkable findings on magnetic resonance imaging].  

PubMed

Two patients with chronic low back pain and sciatica failed to respond to conservative treatments. In these patients, magnetic resonance imaging (MRI) showed no remarkable findings corresponding to their symptoms. We treated these patients using epiduroscopy. Epiduroscopic visualization of the spinal canal permits efficient adhesiolysis and irrigation. One patient got better after two epiduroscopic procedures, and the other did not. Epiduroscopy may be an effective, minimally invasive treatment as well as examination for patients with chronic low back pain without remarkable findings on MRI. PMID:11758339

Saitoh, K; Igarashi, T; Hirabayashi, Y; Horikawa, Y; Seo, N; Motegi, R; Miyashita, K

2001-11-01

362

Effect of Music on Postoperative Pain in Patients Under Open Heart Surgery  

PubMed Central

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

Mirbagher Ajorpaz, Neda; Mohammadi, Abouzar; Najaran, Hamed; Khazaei, Shala

2014-01-01

363

Self-reported interoceptive awareness in primary care patients with past or current low back pain  

PubMed Central

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

Mehling, Wolf E; Daubenmier, Jennifer; Price, Cynthia J; Acree, Mike; Bartmess, Elizabeth; Stewart, Anita L

2013-01-01

364

Extracorporal shock wave therapy in patients with tennis elbow and painful heel  

Microsoft Academic Search

The aim of this study was to evaluate the effect of extracorporal shock wave therapy (ESWT) in tennis elbow and painful heel.\\u000a Nineteen patients with tennis elbow and 44 patients with painful heel in which conservative treatment had failed underwent\\u000a ESWT. Both groups received 3000 shock waves of 0.12 mJ\\/mm2 three times at weekly intervals. After a follow-up of 5

Dietrich S. Hammer; Stefan Rupp; Stefan Ensslin; Dieter Kohn; Romain Seil

2000-01-01

365

Psychoneuroimmunological correlates of persisting sciatic pain in patients who underwent discectomy  

Microsoft Academic Search

Patients suffering from persisting sciatic pain 8 weeks following discectomy were compared with patients displaying low complaints and healthy, pain-free volunteers regarding their interleukin-6 (IL-6) levels, morning cortisol levels and degree of psychological distress. Whereas serum concentrations of IL-6 were measured by collecting blood samples between 0945 and 2400 h in intervals of 45 min, morning cortisol levels were obtained

Andrea Geiss; Enikö Varadi; Klaus Steinbach; Heinz W Bauer; Fernand Anton

1997-01-01

366

Back and hip extensor fatigability in chronic low back pain patients and controls  

Microsoft Academic Search

Objective: To compare the lumbar paraspinal and gluteus maximus muscle fatigability between chronic low back pain patients and healthy controls by using electromyographic (EMG) spectral analysis during a maximal isometric endurance task.Design: A cross-sectional comparative study between chronic low back pain patients and healthy control subjects.Setting: Physical medicine and rehabilitation clinic in Finland.Subjects: Twenty women with nonspecific chronic low back

Markku Kankaanpää; Simo Taimela; David Laaksonen; Osmo Hänninen; Olavi Airaksinen

1998-01-01

367

The relationship between self-efficacy and disability in chronic low back pain patients  

Microsoft Academic Search

This study examined the reliability of an adapted version of the Arthritis Self-Efficacy Scale in a sample of 59 chronic low back pain patients. The present study also investigated the relationship between self-efficacy and measures of disability. Regression analyses indicated a significant negative relationship between self-efficacy and low back pain disability. That is, patients who report higher levels of self-efficacy

Jennifer B. Levin; Kenneth R. Lofland; Jeffrey E. Cassisi; Amir M. Poreh; E. Richard Blonsky

1996-01-01

368

Maximal aerobic power in patients with chronic low back pain: a comparison with healthy subjects  

Microsoft Academic Search

The objective of the study was to compare the maximal aerobic capacity of patients with chronic low back pain with healthy\\u000a asymptomatic controls matched for age, gender and level of physical activity at work and during sports activities. Reported\\u000a data in the literature with respect to aerobic capacity in patients with chronic low back pain are not conclusive. Nevertheless,\\u000a based

Ivan DuqueJose; José-Hernán Parra; Alain Duvallet

2011-01-01

369

Middle and long latency somatosensory evoked potentials after painful laser stimulation in patients with fibromyalgia syndrome  

Microsoft Academic Search

Ten femalespatients with fibromyalgia syndrome (FS) were investigated with laser evoked potentials (LEPs) after hand stimulations and compared with 10 female pain-free and age-matched control patients. FS patients exhibited significantly lower heat pain thresholds than controls (P < 0.05) and had higher amplitudes of LEP components N170 (P < 0.01) and P390 (P < 0.05) in response to intensities of

J. Lorenz; K. Grasedyck; B. Bromm

1996-01-01

370

A 10Year Evaluation of Chronic Pain Patients Treated with Opioids  

Microsoft Academic Search

Summary Over the past 15 years laws and guidelines have been widely promulgated to allow physicians to prescribe opioids for severe, chronic pain patients who have non-malignant conditions. To date little is known about the outcomes of long-term opioid pain therapy. Reported here is an evaluation of 24 patients with non-malignant conditions who have been in continual opioid treat- ment

Forest Tennant

371

Direct conversion from oral morphine to transdermal fentanyl: a multicenter study in patients with cancer pain  

Microsoft Academic Search

Direct conversion from oral morphine to transdermal fentanyl with a ratio of oral morphine\\/transdermal fentanyl (100:1 mg) daily was examined in patients with cancer pain. Patients with a ‘stable and low level of cancer pain’ receiving a constant dosage of sustained release morphine during a pre-study phase of 6 days were included in the study. Initial fentanyl dosage was calculated

Barbara Donner; Michael Zenz; Michael Tryba; Michael Strumpf

1996-01-01

372

Pain and Physical and Psychological Symptoms in Ambulatory HIV Patients in the Current Treatment Era  

PubMed Central

Context HIV infection has become a manageable chronic disease. There are few studies of pain and symptoms in the current treatment era. Objectives The primary objective was to determine the prevalence of and risk factors for pain and physical and psychological symptoms in a population of ambulatory HIV patients. Methods We performed a cross-sectional study using the Brief Pain Inventory and the Memorial Symptom Assessment Scale. Results We evaluated 156 individuals with a median age of 47.5 years (range 21–71), median time since HIV diagnosis of 11 years (range <1–25), and median CD4+ cell count of 502 cells/mm3 (interquartile range [IQR] 308–683). The majority (125, 80.6%) had an undetectable viral load. Seventy-six (48.7%) reported pain, of whom 39 (51.3%) had moderate to severe pain, and 43 (57.3%) had pain that caused moderate to severe interference with their lives. The median number of symptoms was eight (IQR 5–14.5) of 32 queried. In multivariable analyses, patients with psychiatric illness were 39.8% more likely to have pain (P<0.001). Psychiatric illness was associated with 0.7 and 1.2 point higher MSAS subscale scores, and intravenous (IV) drug use was associated with 0.4 and 0.5 higher subscale scores (out of four). Conclusion Pain and other physical and psychological symptoms were common among ambulatory HIV patients. Pain and symptoms were strongly associated with psychiatric illness and IV drug use. Future investigation should evaluate interventions that include psychiatric and substance abuse components for HIV patients with pain. PMID:22115794

Merlin, Jessica S.; Cen, Liyi; Praestgaard, Amy; Turner, Michelle; Obando, Aura; Alpert, Craig; Woolston, Sophie; Casarett, David; Kostman, Jay; Gross, Robert; Frank, Ian

2013-01-01

373

The effects of slow-stroke back massage on anxiety and shoulder pain in elderly stroke patients  

Microsoft Academic Search

This study explores the effect of slow-stroke back massages on anxiety and shoulder pain in hospitalized elderly patients with stroke. An experimental quantitative design was conducted, comparing the scores for self-reported pain, anxiety, blood pressure, heart rate and pain of two groups of patients before and immediately after, and three days after the intervention. The intervention consisted of ten minutes

Esther Mok; Chin Pang Woo

2004-01-01

374

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

ERIC Educational Resources Information Center

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…

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

2003-01-01

375

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

ERIC Educational Resources Information Center

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)

Kessler, Kathie

1994-01-01

376

MRI findings are more common in selected patients with acute low back pain than controls?  

Microsoft Academic Search

Purpose  The purpose of this study is to investigate if lumbar disc pathology identified on MRI scans is more common in patients with\\u000a acute, likely discogenic, low back pain than matched controls.\\u000a \\u000a \\u000a \\u000a \\u000a Methods   We compared rates of MRI findings between 30 cases with low back pain and 30 pain-free controls. Cases were patients presenting\\u000a for care with likely discogenic low back

Mark Hancock; Chris Maher; Petra Macaskill; Jane Latimer; Walter Kos; Justin Pik

377

Effect of cryotherapy on arteriovenous fistula puncture-related pain in hemodialysis patients  

PubMed Central

Pain during areteriovenous fistula (AVF) cannulation remains a common problem in hemodialysis (HD) patients. This study was undertaken to assess the effect of cryotherapy on pain due to arteriovenous fistula puncture in hemodialysis patients. A convenience sample of 60 patients (30 each in experimental and control groups) who were undergoing hemodialysis by using AVF, was assessed in a randomized control trial. Hemodialysis patients who met the inclusion criteria, were randomly assigned to experimental and control groups using a randomization table. Objective and subjective pain scoring was done on two consecutive days of HD treatment (with cryotherapy for the experimental and without cryotherapy for the control group). The tools used were a questionnaire examining demographic and clinical characteristics, an observation checklist for assessing objective pain behavior, and a numerical rating scale for subjective pain assessment. Descriptive statistics were used as deemed appropriate. Chi square, two-sample and paired t-tests, the Mann Whitney test, Wilcoxon's signed rank test, the Kruskal Wallis test, and Spearman's and Pearson's correlations were used for inferential statistics. We found that the objective and subjective pain scores were found to be significantly (P = 0.001) reduced within the experimental group with the application of cryotherapy. This study highlights the need for adopting alternative therapies such as cryotherapy for effective pain management in hospital settings. PMID:20142927

P. B., Sabitha; Khakha, D. C.; Mahajan, S.; Gupta, S.; Agarwal, M.; Yadav, S. L.

2008-01-01

378

The efficacy of a multidisciplinary group program for patients with refractory chronic pain  

PubMed Central

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

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

379

Outcomes of Prolotherapy in Chondromalacia Patella Patients: Improvements in Pain Level and Function  

PubMed Central

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

Hauser, Ross A.; Sprague, Ingrid Schaefer

2014-01-01

380

Losing face: Sources of stigma as perceived by chronic facial pain patients  

Microsoft Academic Search

The purpose of this paper is to identify potential sources of estrangement and feeling psychologically flawed as perceived by temporomandibular pain and dysfunction syndrome (TMPDS) patients. It is our hypothesis that a primary source of patients' perceived stigma results from pejorative labeling by clinicians. The data come from a study of 151 women TMPDS patients. The results show that the

Joseph J. Marbach; Mary Clare Lennon; Bruce G. Link; Bruce P. Dohrenwend

1990-01-01

381

Meaning in life in chronic pain patients over time: associations with pain experience and psychological well-being.  

PubMed

We explored the relationship between meaning in life and adjustment to chronic pain in a three-wave, 2 year, longitudinal study of 273 Belgian chronic pain patients. We examined the directionality of the relationships among the meaning in life dimensions (Presence of Meaning and Search for Meaning) and indicators of adjustment (depressive symptoms, life satisfaction, pain intensity, and pain medication use). We found that Presence of Meaning was an important predictor of well-being. Secondly, we used a typological methodology to distinguish meaning in life profiles, and the relationship of individual meaning in life profiles with indicators of adjustment. Five meaning in life profiles emerged: High Presence High Search, High Presence Low Search, Moderate Presence Moderate Search, Low Presence Low Search, and Low Presence High Search. Each meaning in life profile was associated with a unique adjustment outcome. Profiles that scored high on Presence of Meaning showed more optimal adjustment. The profiles showed little change over time and did not moderate the development of adjustment indicators, except for life satisfaction. Practical implications and suggestions for future research are discussed. PMID:25537924

Dezutter, Jessie; Luyckx, Koen; Wachholtz, Amy

2015-04-01

382

Muscle hyperalgesia is widespread in patients with complex regional pain syndrome.  

PubMed

Patients with complex regional pain syndrome (CRPS) frequently show prominent sensory abnormalities in their affected limb, which may extend proximally and even to unaffected body regions. This study examines whether sensory dysfunction is observed in unaffected body parts of CRPS patients, and investigates whether the extent of dysfunction is similar for the various sensory modalities. Quantitative sensory testing was performed in the unaffected extremities and cheeks of 48 patients with CRPS of the arm (31 with dystonia), and the results were compared with values obtained among healthy controls. The most prominent abnormality was the pressure pain threshold, which showed a consistent pattern of higher sensitivity in unaffected contralateral arms and unaffected legs, as well as the cheek, and demonstrated the largest effect sizes. The cheeks of CRPS patients showed thermal hypoesthesia and hyperalgesia as well as a loss of vibration detection. Except for a lower vibration threshold in the contralateral leg of CRPS patients with dystonia, no differences in sensory modalities were found between CRPS patients with and without dystonia. These results point to a general disturbance in central pain processing in patients with CRPS, which may be attributed to impaired endogenous pain control. Since pressure pain is the most deviant sensory abnormality in both unaffected and affected body regions of CRPS patients, this test may serve as an important outcome parameter in future studies and may be used as a tool to monitor the course of the disease. PMID:23941915

van Rooijen, Diana E; Marinus, Johan; van Hilten, Jacobus J

2013-12-01

383

Self-reported pain severity, quality of life, disability, anxiety and depression in patients classified with 'nociceptive', 'peripheral neuropathic' and 'central sensitisation' pain. The discriminant validity of mechanisms-based classifications of low back (±leg) pain.  

PubMed

Evidence of validity is required to support the use of mechanisms-based classifications of pain clinically. The purpose of this study was to evaluate the discriminant validity of 'nociceptive' (NP), 'peripheral neuropathic' (PNP) and 'central sensitisation' (CSP) as mechanisms-based classifications of pain in patients with low back (±leg) pain by evaluating the extent to which patients classified in this way differ from one another according to health measures associated with various dimensions of pain. This study employed a cross-sectional, between-subjects design. Four hundred and sixty-four patients with low back (±leg) pain were assessed using a standardised assessment protocol. Clinicians classified each patient's pain using a mechanisms-based classification approach. Patients completed a number of self-report measures associated with pain severity, health-related quality of life, functional disability, anxiety and depression. Discriminant validity was evaluated using a multivariate analysis of variance. There was a statistically significant difference between pain classifications on the combined self-report measures, (p = .001; Pillai's Trace = .33; partial eta squared = .16). Patients classified with CSP (n = 106) reported significantly more severe pain, poorer general health-related quality of life, and greater levels of back pain-related disability, depression and anxiety compared to those classified with PNP (n = 102) and NP (n = 256). A similar pattern was found in patients with PNP compared to NP. Mechanisms-based pain classifications may reflect meaningful differences in attributes underlying the multidimensionality of pain. Further studies are required to evaluate the construct and criterion validity of mechanisms-based classifications of musculoskeletal pain. PMID:22074733

Smart, Keith M; Blake, Catherine; Staines, Anthony; Doody, Catherine

2012-04-01

384

Representation of verbal pain descriptors on a visual analogue scale by dental patients and dental students.  

PubMed

Verbal rating scales (VRS), composed of ranked pain descriptors, are often employed in pain research. Factors that may influence the subjective pain intensity values, however, are not well established. In this study, 5 common pain descriptor adjectives were represented on a visual analogue scale (VAS) by a group of 80 dental students, by a group of 48 patients undergoing periodontal therapy, and by a group of 31 dental phobic patients. It was thought that each group of individuals on conducting the test represented a different degree of apprehension, ranging from a relaxed to a very tense status. There were differences in the interpretation of the pain descriptors between groups. Furthermore, age seemed to influence the interpretation of the pain descriptors. No correlation was found with gender. The descriptors did not divide the analogue scale into equal segments. 71% of all subjects gave the adjective "mild" a lower pain intensity representation than the adjective "weak", while the order was reversed among remaining subjects. Findings cast doubt on the reliability of VRS and the data handling methods commonly adopted in clinical pain research. PMID:9249186

Tammaro, S; Berggren, U; Bergenholtz, G

1997-06-01

385

Stress-Induced Allodynia – Evidence of Increased Pain Sensitivity in Healthy Humans and Patients with Chronic Pain after Experimentally Induced Psychosocial Stress  

PubMed Central

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

Crettaz, Benjamin; Marziniak, Martin; Willeke, Peter; Young, Peter; Hellhammer, Dirk; Stumpf, Astrid; Burgmer, Markus

2013-01-01

386

Effects of hip exercises for chronic low-back pain patients with lumbar instability.  

PubMed

[Purpose] The purpose of this study was to compare hip range of motion between a lumbar stability group and a lumbar instability group, and to evaluate the effectiveness of hip exercises for low-back pain patients with lumbar instability. [Subjects] Seventy-eight patients with chronic low-back pain were the subjects. [Methods] The patients were divided into two groups: a lumbar stability group (n=45) and a lumbar instability group (n=33). They were assessed using the Korean version of the Oswestry Disability Index (KODI) to determine the level of disability of the patients with low-back pain. A 100?mm visual analog scale (VAS) was used to assess low-back pain. [Results] The limitation of hip range of motion of the lumbar instability group was significantly greater than that of the lumbar stability group. Comparisons among four groups at three weeks and six weeks after the start of hip exercises revealed that the VAS score of each group had significantly decreased. Comparisons among four groups at three weeks and at six weeks after the start of hip exercises revealed that the KODI score of each group had significantly decreased. [Conclusion] These findings suggest that the performance of hip exercises by chronic low-back pain patients with lumbar instability is more effective than conventional therapy at reducing low-back pain and levels of disability. PMID:25729164

Lee, Sang Wk; Kim, Suhn Yeop

2015-02-01

387

Biospectral analysis of the bladder channel point in chronic low back pain patients  

NASA Astrophysics Data System (ADS)

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.

Vidal, Alberto Espinosa; Nava, Juan José Godina; Segura, Miguel Ángel Rodriguez; Bastida, Albino Villegas

2012-10-01

388

Effects of hip exercises for chronic low-back pain patients with lumbar instability  

PubMed Central

[Purpose] The purpose of this study was to compare hip range of motion between a lumbar stability group and a lumbar instability group, and to evaluate the effectiveness of hip exercises for low-back pain patients with lumbar instability. [Subjects] Seventy-eight patients with chronic low-back pain were the subjects. [Methods] The patients were divided into two groups: a lumbar stability group (n=45) and a lumbar instability group (n=33). They were assessed using the Korean version of the Oswestry Disability Index (KODI) to determine the level of disability of the patients with low-back pain. A 100?mm visual analog scale (VAS) was used to assess low-back pain. [Results] The limitation of hip range of motion of the lumbar instability group was significantly greater than that of the lumbar stability group. Comparisons among four groups at three weeks and six weeks after the start of hip exercises revealed that the VAS score of each group had significantly decreased. Comparisons among four groups at three weeks and at six weeks after the start of hip exercises revealed that the KODI score of each group had significantly decreased. [Conclusion] These findings suggest that the performance of hip exercises by chronic low-back pain patients with lumbar instability is more effective than conventional therapy at reducing low-back pain and levels of disability. PMID:25729164

Lee, Sang wk; Kim, Suhn Yeop

2015-01-01

389

Abnormal brain processing of cutaneous pain in patients with chronic migraine.  

PubMed

Syndromes with chronic daily headache include chronic migraine (CM). The reason for the transformation of migraine into chronic daily headache is still unknown. In this study, we aimed to evaluate heat pain thresholds and event-related potentials following CO(2)-laser thermal stimulation (LEPS) in hand and facial regions in patients with CM, to show changes in nociceptive brain responses related to dysfunction of pain elaboration at the cortical level. The results were compared with findings from normal control subjects and from subjects who suffer from migraine without aura. The effects of stimulus intensity, subjective pain perception and attention were monitored and compared with features of the LEPS. Twenty-five CM patients, 15 subjects suffering from migraine without aura and 15 normal control subjects were enrolled in the study. LEPS amplitude variation was reduced in CM patients with respect to the perceived stimulus intensity, in comparison with migraine without aura patients and control subjects. In both headache groups, the distraction from the painful laser stimulus induced by an arithmetic task failed to suppress the LEPS amplitude, in comparison with control subjects. These results suggest an abnormal cortical processing of nociceptive input in CM patients, which could lead to the chronic state of pain. In both headache groups, an inability to reduce pain elaboration during an alternative cognitive task emerged as an abnormal behaviour probably predisposing to migraine. PMID:12507697

de Tommaso, Marina; Valeriani, Massimiliano; Guido, Marco; Libro, Giuseppe; Specchio, Luigi Maria; Tonali, Pietro; Puca, Francomichele

2003-01-01

390

Cancer Pain Control for Advanced Cancer Patients by Using Autonomic Nerve Pharmacopuncture  

PubMed Central

Objectives: The purpose of this study is to report a case series of advanced cancer patients whose cancer pain was relieved by using autonomic nerve pharmacopuncture (ANP) treatment. ANP is a subcutaneous injection therapy of mountain ginseng pharmacopuncture (MGP) along the acupoints on the spine (Hua-Tuo-Jia-Ji-Xue; 0.5 cun lateral to the lower border of the spinous processes of vertebrae) to enhance the immune system and to balance autonomic nerve function. Methods: Patients with three different types of cancer (gastric cancer, lung cancer, colon cancer with distant metastases) with cancer pain were treated with ANP. 1 mL of MGP was injected into the bilateral Hua-Tuo-Jia-Ji-Xue on the T1-L5 sites (total 12 ? 20 mL injection) of each patient’s dorsum by using the principle of symptom differentiation. During ANP treatment, the visual analogue scale (VAS) for pain was used to assess their levels of cancer pain; also, the dosage and the frequency of analgesic use were measured. Results: The cancer pain levels of all three patients improved with treatment using ANP. The VAS scores of the three patients decreased as the treatment progressed. The dosage and the frequency of analgesics also gradually decreased during the treatment period. Significantly, no related adverse events were found. Conclusion: ANP has shown benefit in controlling cancer pain for the three different types of cancer investigated in this study and in reducing the dosage and the frequency of analgesics. ANP is expected to be beneficial for reducing cancer pain and, thus, to be a promising new treatment for cancer pain. PMID:25780711

Kang, Hwi-joong; Yoon, Jung-won; Park, Ji-hye; Cho, Chong-kwan; Yoo, Hwa-seung

2014-01-01

391

Electrocortical Analysis of Patients with Intercostobrachial Pain Treated with TENS after Breast Cancer Surgery  

PubMed Central

[Purpose] Among the physical therapeutic procedures to decrease pain, there is transcutaneous electrical neural stimulation (TENS). There is no consensus about its efficacy for oncological patients, especially for post-mastectomy pain and eletrocortical changes in somatosensory areas. The aim of this study was to analyze acute electrocortical changes after TENS treatment of patients with intercostobrachial post mastectomy pain. [Subjects] Eighteen patients were divided into acupuncture (A) and burst (B) group. [Methods] In this pre and post-intervention study each group was measured for EEG analysis in absulte power in alpha band (8–14?Hz). Outcomes variables were the alpha waveband in the sensorymotor cortex and pain pre-and-post TENS intervention. Data were analyzed using ANOVA to compare times (rest, 10 and 15?min), group and electrodes. Pain was analyzed using percentual pain evaluation (PPE) in both groups. [Results] Outcomes indicate main effects of time and electrodes because of slow (8–10?Hz) and fast alpha (10–12?Hz) wavebands decreased. PPE reduced 88.4% in A and 66.3% in G. [Conclusion] TENS promoted electrical modification in the parietal region and a decrease in pain. Future studies should investigate other wave must be proposed for other bands and use different methods of EEG analysis to elucidate the actual mechanisms behind the efficacy of TENS treatment. PMID:24707082

Silva, Julio Guilherme; Santana, Camila Gonçalves; Inocêncio, Kelly Rosane; Orsini, Marco; Machado, Sergio; Bergmann, Anke

2014-01-01

392

Pain, Affective Symptoms and Cognitive Deficits in Patients with Cerebral Dopamine Dysfunction  

PubMed Central

Converging preclinical, and human epidemiological, neuroimaging and genetic evidence suggests a central role for dopamine neurotransmission in modulating pain perception and analgesia. Dysregulation in dopamine signaling may modulate the experience of pain both directly, by enhancing or diminishing the propagation of nociceptive signals, and indirectly, by influencing affective and cognitive processes, which affect the expectation, experience and interpretation of nociceptive signals. Hypersensitivity to pain, and high rates of comorbid chronic pain, are common in disorders linked with deficits in dopamine system function, including disorders of mood and affect, substance abuse, and Parkinson’s disease. Hyposensitivity to pain, however, is common in patients with schizophrenia, which has been linked with excessive dopamine neurotransimssion. Although patients are typically affected most by the primary symptoms of their disorders, alterations in pain perception may further increase the burden of their illness, compromising their quality of life. The present review focuses on this relationship, and discusses clinical and potential therapeutic implications both for patients with dopamine-related disorders, and those with chronic pain syndromes. PMID:22386471

Jarcho, Johanna M.; Mayer, Emeran A.; Jiang, Karen; Feier, Natasha; London, Edythe D.

2013-01-01

393

Electrocortical Analysis of Patients with Intercostobrachial Pain Treated with TENS after Breast Cancer Surgery.  

PubMed

[Purpose] Among the physical therapeutic procedures to decrease pain, there is transcutaneous electrical neural stimulation (TENS). There is no consensus about its efficacy for oncological patients, especially for post-mastectomy pain and eletrocortical changes in somatosensory areas. The aim of this study was to analyze acute electrocortical changes after TENS treatment of patients with intercostobrachial post mastectomy pain. [Subjects] Eighteen patients were divided into acupuncture (A) and burst (B) group. [Methods] In this pre and post-intervention study each group was measured for EEG analysis in absulte power in alpha band (8-14?Hz). Outcomes variables were the alpha waveband in the sensorymotor cortex and pain pre-an