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Sample records for acute pain therapy

  1. Contemporary therapy: aromatherapy in the management of acute pain?

    PubMed

    Ching, M

    1999-12-01

    Recent surveys indicate that people are increasingly using complementary therapies as an adjunct or alternative to conventional treatment options as well as for general health and well being. Whilst complementary therapies such as aromatherapy have been utilised in clinical settings as diverse as long term care facilities and palliative care, its application to the acute care setting has not been explored in depth. The changes in contemporary health care practices such as post-operative pain management and length of hospital admissions have provided nurses with the challenge of examining the range of therapeutic interventions that can be applied to their practice. The purpose of this paper is to examine critically the potential uses of aromatherapy in the management of acute post-operative pain. The concept of aromatherapy will be explored in relation to its effects on the pain pathways, methods of administration and therapeutic effects. Specific reference will be made to Lavender (Lavandula angustifolia) and its use in aromatherapy. A review of the literature points to gaps in the knowledge related to the clinical application of aromatherapy in relation to issues of dosage, methods of administration and therapeutic effects. The relatively small number of studies that have looked at aromatherapy in the acute care setting supports the literature reviewed. Issues such as small sample sizes and the difficulty in replicating these studies make it difficult to generalize the findings. In order to achieve best practice, further research is necessary to explore the use of aromatherapy in the management of acute post-operative pain.

  2. Use of Scrambler Therapy in Acute Paediatric Pain: A Case Report and Review of the Literature.

    PubMed

    Congedi, Sabrina; Spadini, Silvia; Di Pede, Chiara; Ometto, Martina; Franceschi, Tatiana; De Tommasi, Valentina; Agosto, Caterina; Lazzarin, Pierina; Benini, Franca

    2016-01-01

    We report our clinical experience on the effect of Scrambler Therapy (ST) for a child with acute mixed pain refractory to pharmacological treatment. ST, recently proposed as an alternative treatment for chronic neuropathic pain in adults, is a noninvasive approach to relieve pain, by changing pain perception at brain level. It is safe and has no side effects. Further research is needed to assess its efficacy for acute pain and for paediatric population.

  3. Use of Scrambler Therapy in Acute Paediatric Pain: A Case Report and Review of the Literature

    PubMed Central

    Spadini, Silvia; De Tommasi, Valentina; Benini, Franca

    2016-01-01

    We report our clinical experience on the effect of Scrambler Therapy (ST) for a child with acute mixed pain refractory to pharmacological treatment. ST, recently proposed as an alternative treatment for chronic neuropathic pain in adults, is a noninvasive approach to relieve pain, by changing pain perception at brain level. It is safe and has no side effects. Further research is needed to assess its efficacy for acute pain and for paediatric population. PMID:26977329

  4. From acute musculoskeletal pain to chronic widespread pain and fibromyalgia: application of pain neurophysiology in manual therapy practice.

    PubMed

    Nijs, Jo; Van Houdenhove, Boudewijn

    2009-02-01

    During the past decade, scientific research has provided new insight into the development from an acute, localised musculoskeletal disorder towards chronic widespread pain/fibromyalgia (FM). Chronic widespread pain/FM is characterised by sensitisation of central pain pathways. An in-depth review of basic and clinical research was performed to design a theoretical framework for manual therapy in these patients. It is explained that manual therapy might be able to influence the process of chronicity in three different ways. (I) In order to prevent chronicity in (sub)acute musculoskeletal disorders, it seems crucial to limit the time course of afferent stimulation of peripheral nociceptors. (II) In the case of chronic widespread pain and established sensitisation of central pain pathways, relatively minor injuries/trauma at any locations are likely to sustain the process of central sensitisation and should be treated appropriately with manual therapy accounting for the decreased sensory threshold. Inappropriate pain beliefs should be addressed and exercise interventions should account for the process of central sensitisation. (III) However, manual therapists ignoring the processes involved in the development and maintenance of chronic widespread pain/FM may cause more harm then benefit to the patient by triggering or sustaining central sensitisation.

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

    PubMed

    McCarberg, Bill; D'Arcy, Yvonne

    2013-07-01

    The traditional cornerstones of analgesic therapy for patients with acute pain have been oral therapies; however, all oral agents exhibit a variety of potentially dose-limiting or intolerable adverse effects in patients. Elderly patients and those with concomitant conditions already being managed with multiple systemic drugs may be particularly susceptible to systemic toxicities with oral analgesic therapies. Topical agents offer an alternative to oral modalities and can effectively treat patients with acute pain while offering lower systemic absorption and conferring little risk of systemic toxicity. The objective of this article is to review the therapeutic usefulness of available topical therapies in their most thoroughly investigated applications, the treatment of patients with acute musculoskeletal and herpetic pain. For example, although heating pads/wraps and cold packs are widely used to alleviate pain associated with sprains, strains, and contusions, evidence of the effectiveness of these methods is lacking. However, there are sufficient data supporting the use of various topical formulations of nonsteroidal anti-inflammatory drugs (NSAIDs) for these indications (ketoprofen gel or patch, ibuprofen gel or cream, and diclofenac gel or patch), and demonstrating markedly less patient risk of systemic toxicity than is associated with oral NSAID therapy. A ketoprofen patch was shown to be effective and well tolerated in the treatment of patients with tendinopathies. In the treatment of acute neck or low back pain, cold and heat therapies have demonstrated limited effectiveness for patients, and the efficacy of topical NSAIDs has not been established. Use of topical NSAID therapy has been useful in reducing acute-phase herpes zoster pain, and the lidocaine 5% patch has been shown to reduce acute herpetic pain intensity once lesions have healed (the patch cannot be applied to open skin lesions). Topical analgesics represent an alternative treatment modality for

  6. [Postoperative pain management. Aims and organization of a strategy for postoperative acute pain therapy].

    PubMed

    Nolli, M; Nicosia, F

    2000-09-01

    The Health Services, not only the Italian one, is under pressure because of request for improving treatment quality and the financial need for reorganization and cost-saving. It's required a rationalization of intervention, together with a careful choice of the best and cheapest techniques and the demonstration of their efficacy. The anaesthesia service activity, in a period of cost rationalization and funds restriction should be aimed to appropriate outcome measures corrected by both patient's risk factors and surgical-anaesthesiological case-mix. The development of a complete strategy for surgical pain management might run into two phases. The first phase, internal and mono-specialistic, should develop like the creation of an Acute Pain Team. The main processes are: focusing the problem (charge of the care), training, information, teaching methodology (timing, methods, drugs, techniques, etc.) and the audit (before and after changes). The main aims are the evaluation of the level of analgesia and pain relief or patient's satisfaction which are partial endpoints useful to demonstrate the improvement and the efficacy of the new pain management strategies. The second phase, multidisciplinary, is directed toward the creation of a Postoperative Evaluation Team. The main objective is to set up a collaborative clinical group able to identify the criteria for quality, efficacy and safety. The major purpose is the evaluation of major outcome measures: surgical outcome, morbidity, mortality and length of hospitalization. The improvement in the quality of postoperative pain treatment goes through a better organization and a progressive increase of the already available therapy. The achievement of the result and the quality projects depend on the interaction among staff members with different behaviours and settings. Internal teaching and training, continuous education for doctors and nurses, and external information, marketing and improvement of attractive capability of

  7. Neurofeedback therapy in patients with acute and chronic pain syndromes--literature review and own experience.

    PubMed

    Kubik, Alicja; Biedroń, Agnieszka

    2013-01-01

    Pain management is based mainly on pharmacotherapy which has many limitations. Non-pharmacological techniques, like neurofeedback (EEG-biofeedback) are alternative methods of pain treatment. Data from literature confirm high efficacy of neurofeedback in pain syndromes treatment, chronic and acute as well. Neurofeedback plays an important role in management of post stroke, post traumatic headaches and in primary headaches like tension type headaches or migraine. Literature review and own experience indicate importance of number and frequency of performed neurofeedback trainings on treatment effectiveness. Satisfactory results have already been observed after 30 trainings however usually 40-60 training have to be performed. Effectiveness of such therapy in pain syndromes is usually good or less often acceptable (50% reduction of headaches). Children with tension type headaches (differently than adults) need reminder therapy every 6-12 months, otherwise recurrence of headaches is observed. Based on our own experience neurofeedback therapy seems to play role in neuropathic pain and cancer pain management.

  8. Management Patterns in Acute Low Back Pain: the Role of Physical Therapy

    PubMed Central

    Gellhorn, Alfred Campbell; Chan, Leighton; Martin, Brook; Friedly, Janna

    2010-01-01

    Study Design Retrospective cohort study. Objective To evaluate the relationship between early physical therapy (PT) for acute low back pain and subsequent use of lumbosacral injections, lumbar surgery, and frequent physician office visits for low back pain. Summary of Background Data Wide practice variations exist in the treatment of acute low back pain. Physical Therapy (PT) has been advocated as an effective treatment in this setting though disagreement exists regarding its purported benefits. Methods A national 20% sample of the Centers for Medicare & Medicaid Services physician outpatient billing claims was analyzed. Patients were selected who received treatment for low back pain between 2003 and 2004 (n=439,195). To exclude chronic low back conditions, patients were excluded if they had a prior visit for back pain, lumbosacral injection, or lumbar surgery within the previous year. Main outcome measures were rates of lumbar surgery, lumbosacral injections, and frequent physician office visits for low back pain over the following year. Results Based on logistic regression analysis, the adjusted odds ratio for undergoing surgery in the group of enrollees that received PT in the acute phase (<4 weeks) compared to those receiving PT in the chronic phase (>3 months) was 0.38 (95% CI, 0.36 to 0.41), adjusting for age, gender, diagnosis, treating physician specialty, and comorbidity. The adjusted OR for receiving a lumbosacral injection in the group receiving PT in the acute phase was 0.46 (95% CI, 0.44 to 0.49), and the adjusted OR for frequent physician office usage in the group receiving PT in the acute phase was 0.47 (95% CI, 0.44 to 0.50). Conclusions There was a lower risk of subsequent medical service usage among patients who received PT early after an episode of acute low back pain relative to those who received PT at later times. Medical specialty variations exist regarding early use of PT, with potential underutilization among generalist specialties. PMID

  9. Manipulative therapy and/or NSAIDs for acute low back pain: design of a randomized controlled trial [ACTRN012605000036617

    PubMed Central

    Hancock, Mark J; Maher, Christopher G; Latimer, Jane; McLachlan, Andrew J; Cooper, Chris W; Day, Richard O; Spindler, Megan F; McAuley, James H

    2005-01-01

    Background Acute low back pain is a common condition resulting in pain and disability. Current national and international guidelines advocate general practitioner care including advice and paracetamol (4 g daily in otherwise well adults) as the first line of care for people with acute low back pain. Non-steroidal anti-inflammatory drugs (NSAIDs) and spinal manipulative therapy (SMT) are advocated in many guidelines as second line management options for patients with acute low back pain who are not recovering. No studies have explored the role of NSAIDs and/or SMT in addition to first line management for acute low back pain. The primary aim of this study is to investigate if NSAIDs and/or SMT in addition to general practitioner advice and paracetamol results in shorter recovery times for patients with acute low back pain. The secondary aims of the study are to evaluate whether the addition of SMT and/or NSAIDs influences pain, disability and global perceived effect at 1, 2, 4 and 12 weeks after onset of therapy for patients with significant acute low back pain. Methods/design This paper presents the rationale and design of a randomised controlled trial examining the addition of NSAIDs and/or SMT in 240 people who present to their general practitioner with significant acute low back pain. PMID:16280089

  10. Acute pain medicine in anesthesiology

    PubMed Central

    Munro, Anastacia P.; Tighe, Patrick J.

    2013-01-01

    The American Academy of Pain Medicine and the American Society for Regional Anesthesia have recently focused on the evolving practice of acute pain medicine. There is increasing recognition that the scope and practice of acute pain therapies must extend beyond the subacute pain phase to include pre-pain and pre-intervention risk stratification, resident and fellow education in regional anesthesia and multimodal analgesia, as well as a deeper understanding of the pathophysiologic mechanisms that are integral to the variability observed among individual responses to nociception. Acute pain medicine is also being established as a vital component of successful systems-level acute pain management programs, inpatient cost containment, and patient satisfaction scores. In this review, we discuss the evolution and practice of acute pain medicine and we aim to facilitate further discussion on the evolution and advancement of this field as a subspecialty of anesthesiology. PMID:24381730

  11. Mesotherapy versus Systemic Therapy in the Treatment of Acute Low Back Pain: A Randomized Trial

    PubMed Central

    Costantino, Cosimo; Marangio, Emilio; Coruzzi, Gabriella

    2011-01-01

    Pharmacological therapy of back pain with analgesics and anti-inflammatory drugs is frequently associated with adverse effects, particularly in the elderly. Aim of this study was to compare mesotherapic versus conventional systemic administration of nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids in patients with acute low back pain. Eighty-four patients were randomized to receive anti-inflammatory therapy according to the following protocols: (a) mesotherapy group received the 1st and 4th day 2% lidocaine (1 mL) + ketoprofen 160 mg (1 mL) + methylprednisolone 40 mg (1 mL), then on 7th, 10th, and 13th day, 2% lidocaine (1 mL) + ketoprofen 160 mg (1 mL) + methylprednisolone 20 mg (1 mL) (b) conventional therapy group received ketoprofen 80 mg × 2/die and esomeprazole 20 mg/die orally for 12 days, methylprednisolone 40 mg/die intramuscularly for 4 days, followed by methylprednisolone 20 mg/die for 3 days, and thereafter, methylprednisolone 20 mg/die at alternate days. Pain intensity and functional disability were assessed at baseline (T0), at the end of treatment (T1), and 6 months thereafter (T2) by using visual analogic scale (VAS) and Roland-Morris disability questionnaire (RMDQ). In both groups, VAS and RMDQ values were significantly reduced at the end of drug treatment and after 6 months, in comparison with baseline. No significant differences were found between the two groups. This suggests that mesotherapy may be a valid alternative to conventional therapy in the treatment of acute low back pain with corticosteroids and NSAIDs. PMID:20953425

  12. Low back pain - acute

    MedlinePlus

    Backache; Low back pain; Lumbar pain; Pain - back; Acute back pain; Back pain - new; Back pain - short-term; Back strain - new ... lower back supports most of your body's weight. Low back pain is the number two reason that Americans see ...

  13. Spinal Manipulative Therapy for Acute Low Back Pain: A Clinical Perspective

    PubMed Central

    Hancock, Mark J.; Maher, Christopher G.; Latimer, Jane

    2008-01-01

    Low back pain (LBP) is an extremely common cause of pain and disability. While many treatments for acute LBP exist, one of the most widely used, but also most controversial, is spinal manipulative therapy (SMT). This therapy includes both high-velocity manipulative techniques and low-velocity mobilization techniques. The literature regarding the use of SMT is often conflicting, which explains the difference in recommendations regarding SMT in international LBP guidelines. The lack of a clear tissue diagnosis in the majority of patients with LBP combined with the unknown mechanism of action of SMT adds to the difficulty for clinicians in providing SMT in a logical and effective manner. Despite these limitations, the existing literature does provide some assistance to clinicians on when to provide SMT and how to provide it in an optimal way. This review aims to summarize the key research literature investigating SMT in LBP in order to help clinicians make informed decisions about the use of SMT for their patients with acute LBP. PMID:19771190

  14. [Management of acute pain therapy: guidelines, recommendations and current practice in german hospitals].

    PubMed

    Erlenwein, Joachim

    2016-01-01

    Organisational requirements and the education and training of stuff provide the basis for an adequate supply of quality in acute pain and should be the focus of efforts. Although organizational recommendations of the German guideline on "treatment of acute perioperative and post-traumatic pain" have been increasingly established in practice within the last few years, in many German hospitals there is still lagging far behind in the implementation of general supply conditions, such as regular pain measurement or the introduction of appropriate standardized treatment protocols for all areas of the hospital.As specialized care structures acute pain services have been implemented in 80% of the German hospitals, but only 45% of them meet quality criteria. Due to the heterogeneous realization of acute pain management in different hospitals, it comes apparent, that general guideline recommendations and binding definitions are required to achieve adequate supply conditions. PMID:26863643

  15. [Drug therapy of pain].

    PubMed

    Meier, P J; Ziegler, W H

    1989-08-01

    Pain represents the most frequent complaint for which patients ask for medical help. Successful treatment of acute and chronic pain syndromes largely depends on the knowledge and the therapy of the underlying disease process and on the rational use of analgesics, such as the nonnarcotic analgesic-antipyretics, the anti-inflammatory agents and the opioid analgesics. In addition, so-called 'adjuvant' analgesics of different chemical structures can be used in special clinical conditions to increase the efficacy of the common analgesics. For optimal therapy, the selection and dosing of a specific agent has to be tailored to the individual needs of the patient. For this purpose it is important to follow some general principles of pain management and to consider the relevant pharmacokinetic and pharmacodynamic properties of the various analgesics. This overview summarizes the most important pharmacological properties of the widely used analgetic drugs, with special emphasis on their risk-benefit ratio in various clinical situations.

  16. Acupuncture in acute herpes zoster pain therapy (ACUZoster) – design and protocol of a randomised controlled trial

    PubMed Central

    Fleckenstein, Johannes; Kramer, Sybille; Hoffrogge, Philipp; Thoma, Sarah; Lang, Philip M; Lehmeyer, Lukas; Schober, Gabriel M; Pfab, Florian; Ring, Johannes; Weisenseel, Peter; Schotten, Klaus J; Mansmann, Ulrich; Irnich, Dominik

    2009-01-01

    Background Acute herpes zoster is a prevalent condition. One of its major symptoms is pain, which can highly influence patient's quality of life. Pain therapy is limited. Acupuncture is supposed to soften neuropathic pain conditions and might therefore act as a therapeutic alternative. Objective of the present study is to investigate whether a 4 week semi-standardised acupuncture is non-inferior to sham laser acupuncture and the anticonvulsive drug gabapentine in the treatment of pain associated with herpes zoster. Methods/Design Three-armed, randomised, placebo-controlled trial with a total follow-up time of 6 months. Up to estimated 336 patients (interim analyses) with acute herpes zoster pain (VAS > 30 mm) will be randomised to one of three groups (a) semi-standardised acupuncture (168 patients); (b) gabapentine with individualised dosage between 900–3600 mg/d (84 patients); (c) sham laser acupuncture. Intervention takes place over 4 weeks, all patients will receive analgesic therapy (non-opioid analgesics: metamizol or paracetamol and opioids: tramadol or morphine). Therapy phase includes 4 weeks in which group (a) and (c) consist of 12 sessions per patient, (b) visits depend on patients needs. Main outcome measure is to assess the alteration of pain intensity before and 1 week after treatment sessions (visual analogue scale VAS 0–100 mm). Secondary outcome measure are: alteration of pain intensity and frequency of pain attacks; alteration of different aspects of pain evaluated by standardised pain questionnaires (NPI, PDI, SES); effects on quality of life (SF 36); analgesic demand; alteration of sensoric perception by systematic quantitative sensory testing (QST); incidence of postherpetic neuralgia; side effects and cost effectiveness. Credibility of treatments will be assessed. Discussion This study is the first large-scale randomised placebo controlled trial to evaluate the efficacy of acupuncture compared to gabapentine and sham treatment and will

  17. Acute pain management.

    PubMed

    Hansen, B

    2000-07-01

    We encounter patients with acute pain many times each day, and few aspects of veterinary practice offer such an opportunity to help so many in such a profoundly rewarding way. As emphasized here and elsewhere, we now have excellent tools with which to help these animals, and the biggest impediment to optimal treatment of their pain is often our own difficulty in recognizing its presence. Perhaps the single most important aspect of treating acute pain is to cultivate an ability to see past our personal biases and expectations which may limit treatment and to rediscover the common sense we had about pain before we entered the profession. By rededicating ourselves to seeking out, preventing, and relieving pain, we not only perform a vital service for our patients but also elevate our profession even as we reap financial and spiritual rewards for our efforts. What could be better? PMID:10932832

  18. Pain Part 3: Acute Orofacial Pain.

    PubMed

    Khawaja, Nadine; Renton, Tara

    2015-06-01

    Acute trigeminal pain is a common presentation in the dental surgery, with a reported 22% of the US adult population experiencing orofacial pain more than once during a 6-month period. This article discusses the mechanisms underlying the pain experience, diagnosis and subsequent management of acute trigeminal pain, encompassing pre-, peri- and post-operative analgesia. The dental team spend most of their working lives managing patients and acute pain. The patient may present to the clinician in existing pain, which may often provide a diagnostic challenge. Prevention and managing intra-operative and post-surgical pain are implicit in providing your patient with optimum care. CPD/CLINICAL RELEVANCE: This paper aims to provide an overview of conditions that may present with acute orofacial pain and their management using the most recent evidence base. Intra-operative and post-surgical pain management are also scrutinized and evidence based treatment is recommended.

  19. [Acute Chest Pain].

    PubMed

    Gmür, Christian

    2016-02-17

    Acute chest pain is a frequent consultation reason in general practice as well as in emergency departments. With the help of history, physical examination, ECG, laboratory and newly developed risk scores, potentially life-threatening diseases and high-risk patients may be detected and treated early, quickly and cost-effectively. New biomarkers and their combination with risk scores can increase the negative predictive value to exclude certain diseases. PMID:26886697

  20. Acute and Chronic Low Back Pain.

    PubMed

    Patrick, Nathan; Emanski, Eric; Knaub, Mark A

    2016-01-01

    Low back pain is an extremely common presenting complaint that occurs in upward of 80% of persons. Treatment of an acute episode of back pain includes relative rest, activity modification, nonsteroidal anti-inflammatories, and physical therapy. Patient education is also imperative, as these patients are at risk for further future episodes of back pain. Chronic back pain (>6 months' duration) develops in a small percentage of patients. Clinicians' ability to diagnose the exact pathologic source of these symptoms is severely limited, making a cure unlikely. Treatment of these patients should be supportive, the goal being to improve pain and function.

  1. Acute and Chronic Low Back Pain.

    PubMed

    Patrick, Nathan; Emanski, Eric; Knaub, Mark A

    2016-01-01

    Low back pain is an extremely common presenting complaint that occurs in upward of 80% of persons. Treatment of an acute episode of back pain includes relative rest, activity modification, nonsteroidal anti-inflammatories, and physical therapy. Patient education is also imperative, as these patients are at risk for further future episodes of back pain. Chronic back pain (>6 months' duration) develops in a small percentage of patients. Clinicians' ability to diagnose the exact pathologic source of these symptoms is severely limited, making a cure unlikely. Treatment of these patients should be supportive, the goal being to improve pain and function. PMID:26614726

  2. Acute and chronic low back pain.

    PubMed

    Patrick, Nathan; Emanski, Eric; Knaub, Mark A

    2014-07-01

    Low back pain is an extremely common presenting complaint that occurs in upward of 80% of persons. Treatment of an acute episode of back pain includes relative rest, activity modification, nonsteroidal anti-inflammatories, and physical therapy. Patient education is also imperative, as these patients are at risk for further future episodes of back pain. Chronic back pain (>6 months' duration) develops in a small percentage of patients. Clinicians' ability to diagnose the exact pathologic source of these symptoms is severely limited, making a cure unlikely. Treatment of these patients should be supportive, the goal being to improve pain and function. PMID:24994051

  3. [Postoperative pain therapy in Germany. Status quo].

    PubMed

    Pogatzki-Zahn, E M; Meissner, W

    2015-10-01

    A great deal of progress has been made in the field of postoperative pain therapy in the last 20 years. Beginning from clinical trials on the effectiveness of individual procedures, such as epidural anesthesia and patient-controlled analgesia, a wide range of healthcare services research as well as basic research with human and animal experiments has been established. Whereas health services research in the 1980s and 1990s focused more on the implementation of acute pain services, outcome-oriented research approaches are nowadays the center of attention. Acute pain registries and pain certification projects initiated in Germany have to be mentioned particularly in this respect. Basic research papers from recent years increasingly address specific aspects of acute postoperative pain and have provided translational approaches that are applied around the world for studying neurobiological mechanisms of postoperative pain. At the same time, interdisciplinary cooperation in research projects has led to a better understanding of complex correlations regarding predictors and mechanisms (including psychosocial aspects) of acute and in recent times also chronic pain after surgery. In parallel, evidence-based medicine has found its way into acute pain medicine in Germany. In 2007, clinical acute pain therapy in Germany was enhanced by S3 level guidelines for the first time; however, the implementation is still incomplete. In future, questions concerning mechanism-based therapy of acute pain need to be equally in the center of attention of research, such as prevention of persisting pain after surgery and acute pain of different origins. PMID:26289394

  4. Managing acute enigmatic chest pain.

    PubMed

    Wielgosz, A T

    1996-09-01

    The author comments on the report by Dr. Akbar Panju and associates (see pages 541 to 547 of this issue) on patient outcomes associated with a discharge diagnosis of "chest pain not yet diagnosed." Acute chest pain without evidence of cardiac involvement presents a diagnostic challenge for the clinician, particularly in the present climate of cost containment. Esophageal disorders and psychiatric conditions appear to be the most prevalent causes of noncardiac chest pain. Although screening by means of electrocardiography and cardiac enzyme testing may rule out acute ischemia, and other tests may clearly point to a gastrointestinal cause, it is possible for cardiac and gastrointestinal problems to present simultaneously. Understanding and managing persistent chest pain even after a diagnosis has been made continues to challenge clinicians and researchers, and further progress in this area will depend on multidisciplinary collaboration.

  5. Managing acute enigmatic chest pain.

    PubMed Central

    Wielgosz, A T

    1996-01-01

    The author comments on the report by Dr. Akbar Panju and associates (see pages 541 to 547 of this issue) on patient outcomes associated with a discharge diagnosis of "chest pain not yet diagnosed." Acute chest pain without evidence of cardiac involvement presents a diagnostic challenge for the clinician, particularly in the present climate of cost containment. Esophageal disorders and psychiatric conditions appear to be the most prevalent causes of noncardiac chest pain. Although screening by means of electrocardiography and cardiac enzyme testing may rule out acute ischemia, and other tests may clearly point to a gastrointestinal cause, it is possible for cardiac and gastrointestinal problems to present simultaneously. Understanding and managing persistent chest pain even after a diagnosis has been made continues to challenge clinicians and researchers, and further progress in this area will depend on multidisciplinary collaboration. PMID:8804262

  6. [Pain and anesthesiology : aspects of the development of modern pain therapy in the twentieth century].

    PubMed

    Witte, W

    2011-06-01

    The connection between the development of anesthesiology and pain therapy in the twentieth century is close. The optimistic idea to overcome pain by using general anesthesia derives from the nineteenth century. Treatment of nonsurgical pain remained in the background for a long time and innovations in pain medicine did not improve the insufficient care for patients with postoperative pain. Therapy of chronic pain was mainly surgical and the extreme of this surgical approach was psychosurgery. In the years following World War II leucotomy and lobotomy were established as methods to separate the psychological processing of pain from the experience of pain. Meanwhile, the French "pain surgeon" René Leriche elaborated a theory of pain where chronic pain was no longer seen as a symptom but as a "douleur-maladie", a pain disease. His theory was considered on various occasions but did not gain acceptance before the 1950s. Research in anesthesiology, such as that conducted by the American scientist Henry Beecher separated psyche and physiology with respect to pathological pain. This was contrasted by the approach of clinical anesthesia to pain therapy, which was based on regional anesthesia. The first "pain clinics" were "nerve block clinics". John Bonica, a regional anesthesiologist, extended the framework of pain therapy by introducing multidisciplinary teamwork into the therapy of chronic pain. From today's viewpoint his 1953 monograph The Management of Chronic Pain is a milestone in the development of modern pain therapy. However, Bonica's work did not attain major importance until 1960 when he was appointed to a newly established chair. Gradually, chronic pain was recognized as an independent illness and differentiated as such from acute pain. In 1965 the gate control theory by Melzack and Wall offered a possible explanation for the mechanisms of chronic pain. By the end of the 1970s the spectrum was extended to the biopsychosocial approach which was foremost

  7. Inclusion of thoracic spine thrust manipulation into an electro-therapy/thermal program for the management of patients with acute mechanical neck pain: a randomized clinical trial.

    PubMed

    González-Iglesias, Javier; Fernández-de-las-Peñas, Cesar; Cleland, Joshua A; Alburquerque-Sendín, Francisco; Palomeque-del-Cerro, Luis; Méndez-Sánchez, Roberto

    2009-06-01

    Our aim was to examine the effects of a seated thoracic spine distraction thrust manipulation included in an electrotherapy/thermal program on pain, disability, and cervical range of motion in patients with acute neck pain. This randomized controlled trial included 45 patients (20 males, 25 females) between 23 and 44 years of age presenting with acute neck pain. Patients were randomly divided into 2 groups: an experimental group which received a thoracic manipulation, and a control group which did not receive the manipulative procedure. Both groups received an electrotherapy program consisting of 6 sessions of TENS (frequency 100Hz; 20min), superficial thermo-therapy (15min) and soft tissue massage. The experimental group also received a thoracic manipulation once a week for 3 consecutive weeks. Outcome measures included neck pain (numerical pain rate scale; NPRS), level of disability (Northwick Park Neck Pain Questionnaire; NPQ) and neck mobility. These outcomes were assessed at baseline and 1 week after discharge. A 2-way repeated-measures ANOVA with group as between-subject variable and time as within-subject variable was used. Patients receiving thoracic manipulation experienced greater reductions in both neck pain, with between-group difference of 2.3 (95% CI 2-2.7) points on a 11-NPRS, and perceived disability with between-group differences 8.5 (95% CI 7.2-9.8) points. Further, patients receiving thoracic manipulation experienced greater increases in all cervical motions with between-group differences of 10.6 degrees (95% CI 8.8-12.5 degrees) for flexion; 9.9 degrees (95% CI 8.1-11.7 degrees) for extension; 9.5 degrees (95% CI 7.6-11.4 degrees) for right lateral-flexion; 8 degrees (95% CI 6.2-9.8 degrees) for left lateral-flexion; 9.6 degrees (95% CI 7.7-11.6 degrees) for right rotation; and 8.4 degrees (95% CI 6.5-10.3 degrees) for left rotation. We found that the inclusion of a thoracic manipulation into an electrotherapy/thermal program was effective in

  8. Acute Abdominal Pain in Children.

    PubMed

    Reust, Carin E; Williams, Amy

    2016-05-15

    Acute abdominal pain accounts for approximately 9% of childhood primary care office visits. Symptoms and signs that increase the likelihood of a surgical cause for pain include fever, bilious vomiting, bloody diarrhea, absent bowel sounds, voluntary guarding, rigidity, and rebound tenderness. The age of the child can help focus the differential diagnosis. In infants and toddlers, clinicians should consider congenital anomalies and other causes, including malrotation, hernias, Meckel diverticulum, or intussusception. In school-aged children, constipation and infectious causes of pain, such as gastroenteritis, colitis, respiratory infections, and urinary tract infections, are more common. In female adolescents, clinicians should consider pelvic inflammatory disease, pregnancy, ruptured ovarian cysts, or ovarian torsion. Initial laboratory tests include complete blood count, erythrocyte sedimentation rate or C-reactive protein, urinalysis, and a pregnancy test. Abdominal radiography can be used to diagnose constipation or obstruction. Ultrasonography is the initial choice in children for the diagnosis of cholecystitis, pancreatitis, ovarian cyst, ovarian or testicular torsion, pelvic inflammatory disease, pregnancy-related pathology, and appendicitis. Appendicitis is the most common cause of acute abdominal pain requiring surgery, with a peak incidence during adolescence. When the appendix is not clearly visible on ultrasonography, computed tomography or magnetic resonance imaging can be used to confirm the diagnosis. PMID:27175718

  9. [Pain management and music therapy].

    PubMed

    Hoareau, Sophie Gwenaelle; De Diego, Emmanuelle; Guétin, Stéphane

    2016-01-01

    The benefit of music in the treatment of pain is now recognised. The U sequence is a music therapy technique specifically developed for this purpose. It improves the overall management of pain and facilitates patient support. Its standardised use by caregivers has been made possible thanks to the development of a digital application.

  10. [Pain management and music therapy].

    PubMed

    Hoareau, Sophie Gwenaelle; De Diego, Emmanuelle; Guétin, Stéphane

    2016-01-01

    The benefit of music in the treatment of pain is now recognised. The U sequence is a music therapy technique specifically developed for this purpose. It improves the overall management of pain and facilitates patient support. Its standardised use by caregivers has been made possible thanks to the development of a digital application. PMID:26743370

  11. [Endoscopic therapy of acute and chronic pancreatitis].

    PubMed

    Veltzke-Schlieker, W; Adler, A; Abou-Rebyeh, H; Wiedenmann, B; Rösch, T

    2005-02-01

    Endoscopic therapy is valuable for both acute and chronic pancreatitis. Early endoscopic papillotomy appears, in the case of a severe course of acute biliary pancreatitis, to be advantageous. Endoscopic drainage can be considered in cases of acute fluid retention and necrosis as well as subacute, non-healing pancreatitis or cyst development. By acute chronic pancreatitis with strictures or bile duct stones, papillotomy, dilation and stent insertion can lead to an improvement in pain symptoms. An improvement in endo- or exocrine function, however, is not expected. Studies on the endoscopic therapy of pancreatitis are still very limited, and recommendations can usually only be made based on retrospective case series. PMID:15657718

  12. [Physiotherapy and physical therapy in pain management].

    PubMed

    Egan, M; Seeger, D; Schöps, P

    2015-10-01

    Patients attend physiotherapy and physical therapy (PT) due to pain problems and/or functional impairments. Although the main focus for therapists has traditionally been physical examination and treatment of tissue structures and biomechanics, over the last few decades a growing body of research has highlighted the importance of central nervous system processing and psychosocial contributors to pain perception. Treatment with PT aims to reduce disability and suffering by reducing pain and increasing tolerance to movement. In Germany, pain management conducted by physiotherapists is currently undergoing major changes. Firstly, PT education is transitioning from a vocational to a degree level and additionally new concepts for improved multidisciplinary treatment approaches are being developed. However, there still remain substantial differences between therapists working in multidisciplinary pain clinics and those following medical referral in private practices. This article provides information on how national and international impulses have contributed to the development of different concepts of passive therapies and active/functional pain rehabilitation in Germany. In the future PT will need to provide more evidence about efficiency and modes of actions for different treatment options to selectively reason the application to patients with acute, subacute and chronic pain. PMID:26373552

  13. Biofield therapies and cancer pain.

    PubMed

    Anderson, Joel G; Taylor, Ann Gill

    2012-02-01

    The public and healthcare professionals have become increasingly aware and accepting of the benefit in physical, psychological, social, and spiritual support for patients with cancer. Patients with cancer often seek nonpharmacologic interventions to complement conventional care and decrease the pain associated with cancer and its treatment. Most often referred to as complementary and alternative medicine (CAM), these supportive therapies consist of a heterogeneous group of modalities used as adjuncts to allopathic health care. Biofield therapies are CAM modalities that involve the direction of healing energy through the hands to facilitate well-being by modifying the energy field of the body. This critical review of studies of biofield therapies emphasizes research using these modalities to decrease pain in patients with cancer. Although the therapies have demonstrated clinical efficacy, additional research is warranted. Oncology nurses should familiarize themselves with biofield therapies so they can offer informed recommendations to patients with cancer experiencing pain.

  14. Basic aspects of musculoskeletal pain: from acute to chronic pain

    PubMed Central

    Arendt-Nielsen, Lars; Fernández-de-las-Peñas, César; Graven-Nielsen, Thomas

    2011-01-01

    The transition from acute to chronic musculoskeletal pain is not well understood. To understand this transition, it is important to know how peripheral and central sensitization are manifested and how they can be assessed. A variety of human pain biomarkers have been developed to quantify localized and widespread musculoskeletal pain. In addition, human surrogate models may be used to induce sensitization in otherwise healthy volunteers. Pain can arise from different musculoskeletal structures (e.g. muscles, joints, ligaments, or tendons), and differentiating the origin of pain from those different structures is a challenge. Tissue specific pain biomarkers can be used to tease these different aspects. Chronic musculoskeletal pain patients in general show signs of local/central sensitization and spread of pain to degrees which correlate to pain intensity and duration. From a management perspective, it is therefore highly important to reduce pain intensity and try to minimize the duration of pain. PMID:23115471

  15. A descriptive study of the usage of spinal manipulative therapy techniques within a randomized clinical trial in acute low back pain.

    PubMed

    Hurley, Deirdre A; McDonough, Suzanne M; Baxter, G David; Dempster, Martin; Moore, Ann P

    2005-02-01

    The majority of randomized clinical trials (RCTs) of spinal manipulative therapy have not adequately defined the terms 'mobilization' and 'manipulation', nor distinguished between these terms in reporting the trial interventions. The purpose of this study was to describe the spinal manipulative therapy techniques utilized within a RCT of manipulative therapy (MT; n = 80), interferential therapy (IFT; n = 80), and a combination of both (CT; n = 80) for people with acute low back pain (LBP). Spinal manipulative therapy was defined as any 'mobilization' (low velocity manual force without a thrust) or 'manipulation' (high velocity thrust) techniques of the spine described by Maitland and Cyriax. The 16 physiotherapists, all members of the Society of Orthopaedic Medicine, utilized three spinal manipulative therapy patterns in the RCT: Maitland Mobilization (40.4%, n = 59), Maitland Mobilization/Cyriax Manipulation (40.4%, n = 59) and Cyriax Manipulation (19.1%, n = 28). There was a significant difference between the MT and CT groups in their usage of spinal manipulative therapy techniques (chi2 = 9.178; df = 2; P = 0.01); subjects randomized to the CT group received three times more Cyriax Manipulation (29.2%, n = 21/72) than those randomized to the MT group (9.5%, n = 7/74; df = 1; P = 0.003). The use of mobilization techniques within the trial was comparable with their usage by the general population of physiotherapists in Britain and Ireland for LBP management. However, the usage of manipulation techniques was considerably higher than reported in physiotherapy surveys and may reflect the postgraduate training of trial therapists.

  16. Changes in Pain, Dysfunction, and Grip Strength of Patients with Acute Lateral Epicondylitis Caused by Frequency of Physical Therapy: A Randomized Controlled Trial

    PubMed Central

    Lee, Soyoung; Ko, Youngjun; Lee, Wanhee

    2014-01-01

    [Purpose] The purpose of this study was to investigate the changes in pain, dysfunction, and grip strength of patients with acute lateral epicondylitis and to suggest the appropriate treatment frequency and period. [Subjects] The subjects were divided into three: 2 days per week group (n=12), 3 days per week group (n=15), and 6 days per week group (n=13). [Methods] All groups received conventional physical therapy for 40 minutes and therapeutic exercises for 20 minutes per session during 6 weeks. The outcome measurements were the visual analogue scale (VAS), Patient-Rated Tennis Elbow Evaluation (PRTEE), and grip strength. [Results] The results of this study were as follows: at 3 weeks, there were no significant differences in VAS and PRTEE in the 3 groups, but at 6 weeks, 6 days per week group significantly decreased these two outcomes. Grip strength was significantly increased in 3 and 6 days per week groups at 6 weeks. [Conclusion] In conclusion, physical therapy is needed 3 days per week for 3 weeks in patients with acute lateral epicondylitis. After 3 weeks, 6 days per week is the most effective treatment frequency. PMID:25140091

  17. Pain Management: Part 1: Managing Acute and Postoperative Dental Pain

    PubMed Central

    Becker, Daniel E.

    2010-01-01

    Abstract Safe and effective management of acute dental pain can be accomplished with nonopioid and opioid analgesics. To formulate regimens properly, it is essential to appreciate basic pharmacological principles and appropriate dosage strategies for each of the available analgesic classes. This article will review the basic pharmacology of analgesic drug classes, including their relative efficacy for dental pain, and will suggest appropriate regimens based on pain intensity. Management of chronic pain will be addressed in the second part of this series. PMID:20553137

  18. [Intranasal opioids for acute pain].

    PubMed

    Añez Simón, C; Rull Bartomeu, M; Rodríguez Pérez, A; Fuentes Baena, A

    2006-12-01

    Intranasal drug administration is an easy, well-tolerated, noninvasive transmucosal route that avoids first-pass metabolism in the liver. The nasal mucosa provides an extensive, highly vascularized surface of pseudostratified ciliated epithelium. It secretes mucus that is subjected to mucociliary movement that can affect the time of contact between the drug and the surface. Absorption is influenced by anatomical and physiological factors as well as by properties of the drug and the delivery system. We review the literature on intranasal administration of fentanyl, meperidine, diamorphine, and butorphanol to treat acute pain. The adverse systemic effects are similar to those described for intravenous administration, the most common being drowsiness, nausea, and vomiting. Local effects reported are a burning sensation with meperidine and a bad taste. PMID:17302079

  19. [Pain and anesthesiology : aspects of the development of modern pain therapy in the twentieth century].

    PubMed

    Witte, W

    2011-06-01

    The connection between the development of anesthesiology and pain therapy in the twentieth century is close. The optimistic idea to overcome pain by using general anesthesia derives from the nineteenth century. Treatment of nonsurgical pain remained in the background for a long time and innovations in pain medicine did not improve the insufficient care for patients with postoperative pain. Therapy of chronic pain was mainly surgical and the extreme of this surgical approach was psychosurgery. In the years following World War II leucotomy and lobotomy were established as methods to separate the psychological processing of pain from the experience of pain. Meanwhile, the French "pain surgeon" René Leriche elaborated a theory of pain where chronic pain was no longer seen as a symptom but as a "douleur-maladie", a pain disease. His theory was considered on various occasions but did not gain acceptance before the 1950s. Research in anesthesiology, such as that conducted by the American scientist Henry Beecher separated psyche and physiology with respect to pathological pain. This was contrasted by the approach of clinical anesthesia to pain therapy, which was based on regional anesthesia. The first "pain clinics" were "nerve block clinics". John Bonica, a regional anesthesiologist, extended the framework of pain therapy by introducing multidisciplinary teamwork into the therapy of chronic pain. From today's viewpoint his 1953 monograph The Management of Chronic Pain is a milestone in the development of modern pain therapy. However, Bonica's work did not attain major importance until 1960 when he was appointed to a newly established chair. Gradually, chronic pain was recognized as an independent illness and differentiated as such from acute pain. In 1965 the gate control theory by Melzack and Wall offered a possible explanation for the mechanisms of chronic pain. By the end of the 1970s the spectrum was extended to the biopsychosocial approach which was foremost

  20. Managing acute back pain patients to avoid the transition to chronic pain.

    PubMed

    Chou, Roger; McCarberg, Bill

    2011-01-01

    Chronic back pain is a major source of disability, decreased quality of life and healthcare costs. Treating chronic back pain is difficult, with even effective therapies only being modestly effective. Helping patients avoid the transition from acute to chronic low back pain is a promising strategy for preventing suffering and reducing healthcare utilization. The biopsychosocial model provides a useful framework for understanding factors that contribute to chronicity in low back pain, and are important targets for interventions. This article reviews recent research on predictors of chronicity and treatment strategies in higher risk patients that may be helpful for preventing chronicity. PMID:24654586

  1. Listening is therapy: Patient interviewing from a pain science perspective.

    PubMed

    Diener, Ina; Kargela, Mark; Louw, Adriaan

    2016-07-01

    The interview of a patient attending physical therapy is the cornerstone of the physical examination, diagnosis, plan of care, prognosis, and overall efficacy of the therapeutic experience. A thorough, skilled interview drives the objective tests and measures chosen, as well as provides context for the interpretation of those tests and measures, during the physical examination. Information from the interview powerfully influences the treatment modalities chosen by the physical therapist (PT) and thus also impacts the overall outcome and prognosis of the therapy sessions. Traditional physical therapy focuses heavily on biomedical information to educate people about their pain, and this predominant model focusing on anatomy, biomechanics, and pathoanatomy permeates the interview and physical examination. Although this model may have a significant effect on people with acute, sub-acute or postoperative pain, this type of examination may not only gather insufficient information regarding the pain experience and suffering, but negatively impact a patient's pain experience. In recent years, physical therapy treatment for pain has increasingly focused on pain science education, with increasing evidence of pain science education positively affecting pain, disability, pain catastrophization, movement limitations, and overall healthcare cost. In line with the ever-increasing focus of pain science in physical therapy, it is time for the examination, both subjective and objective, to embrace a biopsychosocial approach beyond the realm of only a biomedical approach. A patient interview is far more than "just" collecting information. It also is a critical component to establishing an alliance with a patient and a fundamental first step in therapeutic neuroscience education (TNE) for patients in pain. This article highlights the interview process focusing on a pain science perspective as it relates to screening patients, establishing psychosocial barriers to improvement, and pain

  2. Listening is therapy: Patient interviewing from a pain science perspective.

    PubMed

    Diener, Ina; Kargela, Mark; Louw, Adriaan

    2016-07-01

    The interview of a patient attending physical therapy is the cornerstone of the physical examination, diagnosis, plan of care, prognosis, and overall efficacy of the therapeutic experience. A thorough, skilled interview drives the objective tests and measures chosen, as well as provides context for the interpretation of those tests and measures, during the physical examination. Information from the interview powerfully influences the treatment modalities chosen by the physical therapist (PT) and thus also impacts the overall outcome and prognosis of the therapy sessions. Traditional physical therapy focuses heavily on biomedical information to educate people about their pain, and this predominant model focusing on anatomy, biomechanics, and pathoanatomy permeates the interview and physical examination. Although this model may have a significant effect on people with acute, sub-acute or postoperative pain, this type of examination may not only gather insufficient information regarding the pain experience and suffering, but negatively impact a patient's pain experience. In recent years, physical therapy treatment for pain has increasingly focused on pain science education, with increasing evidence of pain science education positively affecting pain, disability, pain catastrophization, movement limitations, and overall healthcare cost. In line with the ever-increasing focus of pain science in physical therapy, it is time for the examination, both subjective and objective, to embrace a biopsychosocial approach beyond the realm of only a biomedical approach. A patient interview is far more than "just" collecting information. It also is a critical component to establishing an alliance with a patient and a fundamental first step in therapeutic neuroscience education (TNE) for patients in pain. This article highlights the interview process focusing on a pain science perspective as it relates to screening patients, establishing psychosocial barriers to improvement, and pain

  3. Chronic pain management: nonpharmacological therapies for chronic pain.

    PubMed

    Chang, Ku-Lang; Fillingim, Roger; Hurley, Robert W; Schmidt, Siegfried

    2015-05-01

    Nonpharmacologic therapies have become a vital part of managing chronic pain (CP). Although these can be used as stand-alone therapies, nonpharmacologic treatments often are used to augment and complement pharmacologic treatments (ie, multimodal therapy). Nonpharmacologic approaches can be classified as behavioral, cognitive, integrative, and physical therapies. Core principles in developing a treatment plan are explaining the nature of the CP condition, setting appropriate goals, and developing a comprehensive treatment approach and plan for adherence. Clinicians should become familiar with these interventions so that they can offer patients flexibility in the pain management approach. Effective noninvasive treatment modalities for CP include behavioral therapy for short-term pain relief; cognitive behavioral therapy for reducing long-term pain and disability; hypnosis as adjunctive therapy; guided imagery, diaphragmatic breathing, and muscle relaxation, especially for cancer-related pain; mindfulness-based stress reduction for patients with chronic low back pain; acupuncture for multiple pain conditions; combination manipulation, manual therapy, endurance exercise, stretching, and strengthening for chronic neck pain; animal-assisted therapy; and S-adenosyl-L-methionine for joint pain. Guidelines for use of these treatment modalities are based on expert panel recommendations in combination with data from randomized controlled trials. PMID:25970869

  4. Low-level laser therapy of acute and chronic pain: results of the trials and light delivery optimization

    NASA Astrophysics Data System (ADS)

    Stoykova, Elena V.; Roeva, Tatiana

    2003-09-01

    The work presents the results of the low-level laser therapy (LLLT) of two groups of volunteers with a variety of conditions performed with a GaAs-system. The volunteers were randomly selected among the patients who were usually treated by conventional therapy that included massage and acupuncture needles. The LLLT was proposed to the first group as extension of conventional treatment. The second group underwent only the LLLT. The effectiveness of the therapy was graded under four categories. Short-term and long-term side effects as well as conditions responding only to LLLT were recorded. The successful treatments were up to 70% for both groups, which coincided with the result of the control group treated by the conventional therapy. For optimization of the light delivery, the spatial maps of the absorbed dose in a homogeneous medium, both in the proximity of the light source and at a distance from it, were compared for collimated and divergent light beams using a reduced variance Monte-Carlo code.

  5. [Management of acute low back pain].

    PubMed

    Marty, Marc

    2008-02-15

    Acute low back pain is evolving for less than 4 or 6 weeks. The diagnostic stake in front of an acute low back pain is not to ignore a condition requiring a specific treatment (vertebral fracture, tumours, infections, inflammatory diseases...). Signs of alerts from patient history are to be looked for to enable it. Once the diagnosis of non specific low back pain has been confirmed and in absence of neurological complications, the therapeutic stake is to avoid chronicity by a treatment adapted to every patient. Numerous scientific quality data questioned the interest of the bed rest for non specific acute low back pain and the beneficial role of the preservation of the activities to avoid chronicity. The interest to inform and to reassure the patient on his future is also an important condition of the care. PMID:18536202

  6. The role of manual therapies in equine pain management.

    PubMed

    Haussler, Kevin K

    2010-12-01

    Manual therapy includes a diverse array of techniques, such as touch therapies, massage, physical therapy, osteopathy, and chiropractic, that were originally developed for use in humans and have been gradually applied to horses. All forms of manual therapy have variable reported levels of effectiveness for treating musculoskeletal issues in humans, but mostly only anecdotal evidence exists in horses. This article explores the scientific literature for evidence of efficacy, safety, and common mechanisms of action of the different forms of manual therapies for potential use in managing acute or chronic pain syndromes in horses. Currently, there is limited evidence supporting the effectiveness of spinal mobilization and manipulation in reducing pain and muscle hypertonicity. Further research is needed to assess the efficacy of specific manual therapy techniques and their contribution to multimodal protocols for managing specific somatic pain conditions in horses.

  7. Photodynamic therapy--aspects of pain management.

    PubMed

    Fink, Christine; Enk, Alexander; Gholam, Patrick

    2015-01-01

    Topical photodynamic therapy (PDT) is a highly effective and safe treatment method for actinic keratoses with an excellent cosmetic outcome and is commonly used for the therapy of large areas of photodamaged skin with multiple clinically manifest and subclinical lesions. However, the major drawback of photodynamic therapy is the pain experienced during the treatment that can be intense and sometimes even intolerable for patients, requiring interruption or termination of the process. Several strategies for controlling pain during photodynamic therapy have been studied but few effective methods are currently available. Therefore, this review puts the spotlight on predictors on pain intensity and aspects of pain management during photodynamic therapy. PMID:25640485

  8. Acute Achilles tendinopathy: effect of pain control on leg stiffness.

    PubMed

    Maquirriain, J; Kokalj, A

    2014-03-01

    Tendinopathies are a major cause of disability in the athletic population; the main purpose of the treatment of these injuries is to reduce pain and improve function. The aim of this study was to evaluate the effect of NSAIDs on leg stiffness of patients suffering acute unilateral Achilles tendinopathy. Twenty-eight eligible male athletes (aged 39.1 ± 10.3 y) suffering acute Achilles tendinopathy were treated with etoricoxib (120 mg oral once daily) during 7 days. Pain (100-mm visual analogue scale-VAS), analgesic effect (percentage of 100-mm VAS reduction), and leg stiffness were evaluated pre- and post- anti-inflammatory treatment. Results of this study showed that over the 7-day treatment period, etoricoxib provided significant relief of Achilles tendon pain (VAS) compared to that experienced at baseline: 54.5 ± 21.6 and 24.5 ± 24.8, respectively (p<0.001). Leg stiffness showed a significant improvement after one-week NSAID therapy: LSR 0.89 ± 0.1 vs. 0.97 ± 0.1; (p=0.02). In conclusion, findings of this study demonstrated that patients suffering acute unilateral Achilles tendinopathy increased their leg stiffness of the affected side after oral anti-inflammatory therapy. Effective control of tendon pain in the acute phase of such sports-related injuries may contribute to improve capabilities associated with high performance like leg stiffness. PMID:24583548

  9. Results of the trials and light-delivery evaluation at low-level laser therapy of acute and chronic pain

    NASA Astrophysics Data System (ADS)

    Roeva, Tatiana; Petrov, Todor S.; Minkovski, Nikolai I.

    2004-06-01

    Although the low-level laser therapy (LLLT) is accepted in the clinical practice, its efficiency is still questionable because of the unclear mechanisms of LLLT action. This work presents the results of LLLT applied to volunteers who need recovery from trauma or suffer from rheumatic diseases, inflammatory disorders, etc. The control group we used for comparison consisted of patients being treated by conventional therapy that included massage and acupuncture needles. The effectiveness of the LLLT was graded under four categories. Short-term and long-term side effects as well as conditions responding only to LLLT were recorded. The successful treatments were up to 70%, which coincided with the result of the control group. The LLLT was performed with a GaAs laser system SIX LASER IR - Bulgaria provided with additional set of six light CW emitting diodes to scan a larger area of a tissue surface. To evaluate the light delivery inside the tissue, the spatial maps of the light spot at the laser output in different operating regimes were measured. On their basis, the absorbed dose was calculated both in the boundary layer under the tissue surface and in depth using a reduced variance Monte-Carlo code.

  10. Results of the trials and light delivery evaluation on low-level laser therapy of acute and chronic pain

    NASA Astrophysics Data System (ADS)

    Stoykova, Elena V.; Roeva, Tatiana; Petrova, Kremena S.; Petrov, Todor S.; Minkovski, Nikolai

    2003-11-01

    Although the low-level laser therapy (LLLT) has been accepted in the clinical practice, its efficiency is still questionable because of the unclear mechanisms of LLLT action. This work presents the results of LLLT applied to volunteers who need recovery from trauma or suffer from rheumatic diseases, inflammatory disorders, etc. The control group we used for comparison consisted of patients being treated by conventional therapy that included massage and acupuncture needles. The effectiveness of the LLLT was graded under four categories. Short-term and long-term side effects as well as conditions responding only to LLLT were recorded. The successful treatments were up to 70%, which coincided with the result of the control group. The LLLT was performed with a GaAs laser system provided with additional set of six light CW emitting diodes to scan a larger area of a tissue surface. To evaluate the light delivery inside the tissue, the spatial energy distribution within the laser beam was measured with a CCD camera. On its basis, the light dose absorbed in the tissue was calculated both in the boundary layer under the surface and in depth using a reduced variance Monte-Carlo code.

  11. Usefulness of the Pain Tracking Technique in Acute Mechanical Low Back Pain

    PubMed Central

    Bravo Acosta, Tania; Martín Cordero, Jorge E.; Hernández Tápanes, Solangel; Pedroso Morales, Isis; Fernández Cuesta, José Ignacio; Leyva Serrano, Maritza

    2015-01-01

    Objective. To evaluate the usefulness of the pain tracking technique in acute mechanical low back pain. Method. We performed an experimental prospective (longitudinal) explanatory study between January 2011 and September 2012. The sample was randomly divided into two groups. Patients were assessed at the start and end of the treatment using the visual analogue scale and the Waddell test. Treatment consisted in applying the pain tracking technique to the study group and interferential current therapy to the control group. At the end of treatment, cryotherapy was applied for 10 minutes. The Wilcoxon signed-rank test and the Mann Whitney test were used. They were performed with a predetermined significance level of p ≤ 0.05. Results. Pain was triggered by prolonged static posture and intense physical labor and intensified through trunk movements and when sitting and standing. The greatest relief was reported in lateral decubitus position and in William's position. The majority of the patients had contracture. Pain and disability were modified with the rehabilitation treatment in both groups. Conclusions. Both the pain tracking and interferential current techniques combined with cryotherapy are useful treatments for acute mechanical low back pain. The onset of analgesia is faster when using the pain tracking technique. PMID:26240758

  12. Usefulness of the Pain Tracking Technique in Acute Mechanical Low Back Pain.

    PubMed

    Bravo Acosta, Tania; Martín Cordero, Jorge E; Hernández Tápanes, Solangel; Pedroso Morales, Isis; Fernández Cuesta, José Ignacio; Leyva Serrano, Maritza

    2015-01-01

    Objective. To evaluate the usefulness of the pain tracking technique in acute mechanical low back pain. Method. We performed an experimental prospective (longitudinal) explanatory study between January 2011 and September 2012. The sample was randomly divided into two groups. Patients were assessed at the start and end of the treatment using the visual analogue scale and the Waddell test. Treatment consisted in applying the pain tracking technique to the study group and interferential current therapy to the control group. At the end of treatment, cryotherapy was applied for 10 minutes. The Wilcoxon signed-rank test and the Mann Whitney test were used. They were performed with a predetermined significance level of p ≤ 0.05. Results. Pain was triggered by prolonged static posture and intense physical labor and intensified through trunk movements and when sitting and standing. The greatest relief was reported in lateral decubitus position and in William's position. The majority of the patients had contracture. Pain and disability were modified with the rehabilitation treatment in both groups. Conclusions. Both the pain tracking and interferential current techniques combined with cryotherapy are useful treatments for acute mechanical low back pain. The onset of analgesia is faster when using the pain tracking technique. PMID:26240758

  13. [Imaging of acute pelvic pain in women].

    PubMed

    Genevois, A; Marouteau, N; Lemercier, E; Dacher, J N; Thiebot, J

    2008-01-01

    Acute pelvic pain in women is a routine situation in any emergency unit. The radiologist should know how to explore the patient with regards to the history and clinical findings. Ultrasonography is the primary and sometimes the only necessary imaging tool in the assessment of acute pelvic pain in women. MRI is the preferred technique in pregnant or young women. CT is more valuable for assessing nongynecologic disorders or post-partum and post-operative infections. This article reviews the contribution of each imaging technique in this clinical situation. Emphasis is put on the importance of age and clinical findings in the diagnostic strategy. PMID:18288036

  14. [Imaging of acute pelvic pain in women].

    PubMed

    Genevois, A; Marouteau, N; Lemercier, E; Dacher, J N; Thiebot, J

    2008-01-01

    Acute pelvic pain in women is a routine situation in any emergency unit. The radiologist should know how to explore the patient with regards to the history and clinical findings. Ultrasonography is the primary and sometimes the only necessary imaging tool in the assessment of acute pelvic pain in women. MRI is the preferred technique in pregnant or young women. CT is more valuable for assessing nongynecologic disorders or post-partum and post-operative infections. This article reviews the contribution of each imaging technique in this clinical situation. Emphasis is put on the importance of age and clinical findings in the diagnostic strategy.

  15. Evaluation and treatment of acute low back pain.

    PubMed

    Kinkade, Scott

    2007-04-15

    Acute low back pain with or without sciatica usually is self-limited and has no serious underlying pathology. For most patients, reassurance, pain medications, and advice to stay active are sufficient. A more thorough evaluation is required in selected patients with "red flag" findings associated with an increased risk of cauda equina syndrome, cancer, infection, or fracture. These patients also require closer follow-up and, in some cases, urgent referral to a surgeon. In patients with nonspecific mechanical low back pain, imaging can be delayed for at least four to six weeks, which usually allows the pain to improve. There is good evidence for the effectiveness of acetaminophen, nonsteroidal anti-inflammatory drugs, skeletal muscle relaxants, heat therapy, physical therapy, and advice to stay active. Spinal manipulative therapy may provide short-term benefits compared with sham therapy but not when compared with conventional treatments. Evidence for the benefit of acupuncture is conflicting, with higher-quality trials showing no benefit. Patient education should focus on the natural history of the back pain, its overall good prognosis, and recommendations for effective treatments. PMID:17477101

  16. Acute parotitis and hyperamylasemia following whole-brain radiation therapy

    SciTech Connect

    Cairncross, J.G.; Salmon, J.; Kim, J.H.; Posner, J.B.

    1980-04-01

    Parotitis, an infrequent, previously unreported complication of whole-brain radiation therapy, was observed in 4 patients. The acute symptoms, which include fever, dry mouth, pain, swelling, and tenderness, are accompanied by hyperamylasemia. Among 10 patients receiving whole-brain irradiation, 8 had serum amylase elevations without symptoms. Both acute parotitis and asymptomatic hyperamylasemia result from irradiation of the parotid glands.

  17. [Laughter therapy for chronic skeletal muscular pain].

    PubMed

    De La Fuente Mochales, María B; González Cascante, M Eugenia

    2010-06-01

    The authors explain the effects introducing workshops for laughter therapy and relaxation to a unit dedicated to therapeutic education and functional rehabilitation; the authors test to see if the application of this therapy helps to decrease pain, to improve mobility and to reduce an altered emotional state, such as anxiety-depression, common among chronic pain patients.

  18. [Percutaneous therapy of painful arthritis].

    PubMed

    Chlud, K

    1991-01-01

    Pain in osteoarthrosis of the big weight bearing joints is either derived from periarticular ligaments, tendons, fasciae, muscles, bursae--peri-arthropathy as sign of decompensation--or from the reactive synovitis with or without effusion. NSAIDs systemically administered have been so far considered as first choice medication together with physical therapy. New pharmacokinetic data on the topical, percutaneous application of NSAIDs (ibuprofen, diclofenac, indomethacin, some salicylates and to a lesser degree for etofenamate and piroxicam) have demonstrated relevant advantages of the percutaneous route over the systemic one in soft tissue rheumatism. NSAIDs, mentioned above, locally administered as cream, gel or spray, quickly penetrate through the corneal layer of the skin at the site of application, reach high effective concentrations in subcutis, fasciae, tendons, ligaments and muscles, lesser in joint-capsule and -fluid indicating direct penetration. The blood levels of topical NSAIDs are extremely low with no systemic side effects, especially no gastric toxicity; however, local skin irritation is observed (1 to 2%). In contrast to this, systemic (oral) NSAIDs lead primarily via high blood levels to a much lesser concentration--only one tenth--in particular soft tissues with a high incidence of side effects. In conclusion the percutaneous application of certain NSAIDs has become a well established therapeutic regimen in painful osteoarthrosis and in all other inflammatory degenerative and posttraumatic alterations of soft tissue structures. PMID:2011838

  19. Epipericardial fat necrosis as a cause of acute chest pain

    PubMed Central

    Bogale, Vivek; Hurst, David; dePrisco, Gregory

    2016-01-01

    Acute chest pain is one of the most common reasons for presentation to the emergency department. Although most etiologies of chest pain are easy to clinically ascertain with routine history, physical, and laboratory examinations, we present an important benign cause of acute chest pain that may mimic acute coronary syndrome.

  20. Epipericardial fat necrosis as a cause of acute chest pain

    PubMed Central

    Bogale, Vivek; Hurst, David; dePrisco, Gregory

    2016-01-01

    Acute chest pain is one of the most common reasons for presentation to the emergency department. Although most etiologies of chest pain are easy to clinically ascertain with routine history, physical, and laboratory examinations, we present an important benign cause of acute chest pain that may mimic acute coronary syndrome. PMID:27695190

  1. Exercise therapy for chronic nonspecific low-back pain.

    PubMed

    van Middelkoop, Marienke; Rubinstein, Sidney M; Verhagen, Arianne P; Ostelo, Raymond W; Koes, Bart W; van Tulder, Maurits W

    2010-04-01

    Exercise therapy is the most widely used type of conservative treatment for low back pain. Systematic reviews have shown that exercise therapy is effective for chronic but not for acute low back pain. During the past 5 years, many additional trials have been published on chronic low back pain. This articles aims to give an overview on the effectiveness of exercise therapy in patients with low back pain. For this overview, existing Cochrane reviews for the individual interventions were screened for studies fulfilling the inclusion criteria, and the search strategy outlined by the Cochrane Back Review Group (CBRG) was followed. Studies were included if they fulfilled the following criteria: (1) randomised controlled trials,(2) adult (> or =18 years) population with chronic (> or =12 weeks) nonspecific low back pain and (3) evaluation of at least one of the main clinically relevant outcome measures (pain, functional status, perceived recovery or return to work). Two reviewers independently selected studies and extracted data on study characteristics, risk of bias and outcomes at short-term, intermediate and long-term follow-up. The GRADE approach (GRADE, Grading of Recommendations Assessment, Development and Evaluation) was used to determine the quality of evidence. In total, 37 randomised controlled trials met the inclusion criteria and were included in this overview. Compared to usual care, exercise therapy improved post-treatment pain intensity and disability, and long-term function. The authors conclude that evidence from randomised controlled trials demonstrated that exercise therapy is effective at reducing pain and function in the treatment of chronic low back pain. There is no evidence that one particular type of exercise therapy is clearly more effective than others. However, effects are small and it remains unclear which subgroups of patients benefit most from a specific type of treatment. PMID:20227641

  2. Buprenorphine-naloxone therapy in pain management.

    PubMed

    Chen, Kelly Yan; Chen, Lucy; Mao, Jianren

    2014-05-01

    Buprenorphine-naloxone (bup/nal in 4:1 ratio; Suboxone; Reckitt Benckiser Pharmaceuticals Incorporation, Richmond, VA) is approved by the Food and Drug Administration for outpatient office-based addiction treatment. In the past few years, bup/nal has been increasingly prescribed off-label for chronic pain management. The current data suggest that bup/nal may provide pain relief in patients with chronic pain with opioid dependence or addiction. However, the unique pharmacological profile of bup/nal confers it to be a weak analgesic that is unlikely to provide adequate pain relief for patients without opioid dependence or addiction. Possible mechanisms of pain relief by bup/nal therapy in opioid-dependent patients with chronic pain may include reversal of opioid-induced hyperalgesia and improvement in opioid tolerance and addiction. Additional studies are needed to assess the implication of bup/nal therapy in clinical anesthesia and perioperative pain management. PMID:24509068

  3. BUPRENORPHINE-NALXONE THERAPY IN PAIN MANAGEMENT

    PubMed Central

    Chen, Kelly Yan; Chen, Lucy; Mao, Jianren

    2014-01-01

    Buprenorphine-naloxone (bup/nal in 4:1 ratio; Suboxone®, Reckitt Benckiser Pharmaceuticals Incorporation, Richmond, VA) is approved by the Food and Drug Administration for outpatient office-based addiction treatment. In the past few years, bup/nal has been increasingly prescribed off-label for chronic pain management. The current data suggests that bup/nal may provide pain relief in chronic pain patients with opioid dependence or addiction. However, the unique pharmacological profile of bup/nal confers it to be a weak analgesic that is unlikely to provide adequate pain relief for patients without opioid dependence or addiction. Possible mechanisms of pain relief by bup/nal therapy in opioid-dependent chronic pain patients may include reversal of opioid-induced hyperalgesia as well as improvement in opioid tolerance and addiction. Additional studies are needed to assess the implication of bup/nal therapy in clinical anesthesia and perioperative pain management. PMID:24509068

  4. Exercise therapy for chronic pain.

    PubMed

    Kroll, Heather R

    2015-05-01

    The benefit of exercise for pain control likely comes from the impact of exercise on the endogenous opioid system and on central pain modulatory systems. Patients with some chronic pain conditions seem to have a dysfunctional endogenous pain modulatory system, which should be considered when prescribing exercise. The prescription of exercise for chronic pain must address the biomechanical issues and the psychosocial factors that contribute to the patient's pain and disability. Patient education, coordination of care within the health care team, and selecting an exercise regimen that is meaningful to and achievable by the patient are all important components to promote a successful rehabilitation program. PMID:25952064

  5. [Acute low back pain--assessment and management].

    PubMed

    Gautschi, O P; Hildebrandt, G; Cadosch, D

    2008-01-23

    Acute low back pain is a very common symptom. Up to 90% of all adults suffer at least once in their life from a low back pain episode, in the majority of cases a nonspecific lumbago. They are, with or without sciatica, usually self-limited and have no serious underlying pathology and subside in 80-90% of the concerned patients within six weeks. Beside a sufficient pain medication and physiotherapy, reassurance about the overall benign character and the favourable prognosis of the medical condition should be in the centre of the therapeutic efforts. A more thorough assessment is required for selected patients with warning signs, so called "red flags" findings, because they are associated with an increased risk of cauda equina syndrome, cancer, infection, or fracture. These patients also require a closer follow-up and, in some cases, an urgent surgical intervention. Among patients with acute nonspecific mechanical low back pain, imaging diagnostic can be delayed for at least four to six weeks, which usually allows the medical condition to improve. From a therapeutic viewpoint, there is enough evidence for the effectiveness of paracetamol, nonsteroidal anti-inflammatory drugs, skeletal muscle relaxants, heat therapy, physiotherapy, and the advice to stay "active". A complete relief and protection represent an out-dated concept, because the deconditioning is stimulated and the return to the workplace is needlessly delayed. Spinal manipulative therapy may provide short-term benefits in certain patients. In a multimodal therapeutic concept, the patient education should focus on the natural history of an acute back pain episode, the overall good prognosis, and recommendations for an effective treatment.

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

    PubMed Central

    Nyerere, Joachim W; Matee, Mecky I; Simon, Elison NM

    2006-01-01

    Background In Tanzania, oral health services are mostly in the form of dental extractions aimed at alleviating acute dental pain. Conservative methods of alleviating acute dental pain are virtually non-existent. Therefore, it was the aim of this study to determine treatment success of emergency pulpotomy in relieving acute dental pain. Methods Setting: School of Dentistry, Muhimbili National Hospital, Dar es Salaam, Tanzania. Study design: Longitudinal study. Participants: 180 patients who presented with dental pain due to acute irreversible pulpitis during the study period between July and August 2001. Treatment and evaluation: Patients were treated by emergency pulpotomy on permanent posterior teeth and were evaluated for pain after one, three and six week's post-treatment. Pain, if present, was categorised as either mild or acute. Results Of the patients with treated premolars, 25 (13.9%) patients did not experience pain at all while 19 (10.6%) experienced mild pain. None of the patients with treated premolars experienced acute pain. Among 136 patients with treated molars 56 (31%) did not experience any pain, 76 (42.2%) experienced mild pain and the other 4 (2.2%) suffered acute pain. Conclusion The short term treatment success of emergency pulpotomy was high being 100% for premolars and 97.1% for molars, suggesting that it can be recommended as a measure to alleviate acute dental pain while other conservative treatment options are being considered. PMID:16426455

  7. Mechanical therapy for low back pain.

    PubMed

    Guild, Donald Grant

    2012-09-01

    Physical therapy and manual medicine for low back pain encompass many different treatment modalities. There is a vast variety of techniques that physical therapists commonly use in the treatment of low back pain. Some of the therapies include, but are certainly not limited to, education, exercise, lumbar traction, manual manipulation, application of heat, cryotherapy, and ultrasonography. Many of these approaches are discussed specifically in this article.

  8. Acute chest pain emergencies - spouses' prehospital experiences.

    PubMed

    Forslund, Kerstin; Quell, Robin; Sørlie, Venke

    2008-10-01

    The call to the Emergency Medical Dispatch Centre is often a person's first contact with the health-care system in cases of acute illness or injury and acute chest pain is a common reason for calling. The aim was to illuminate how spouses to persons with acute chest pain experienced the alarm situation, the emergency call and the prehospital emergency care. Interviews were conducted with nineteen spouses. A phenomenological-hermeneutic approach was used for the analyses. The themes responsibility and uneasiness emerged as well as an overall theme of aloneness. Being a spouse to a person in need of acute medical and nursing assistance was interpreted as "Being responsible and trying to preserve life" and "Being able to manage the uneasiness and having trust in an uncertain situation." When their partners' life was at risk the spouses were in an escalating spiral of worry, uncertainty, stress, fear of loss, feeling of loneliness and desperation. They had to manage emotional distress and felt compelled to act to preserve life, a challenging situation. PMID:18929341

  9. Single dose dipyrone for acute postoperative pain

    PubMed Central

    Derry, Sheena; Faura, Clara; Edwards, Jayne; McQuay, Henry J; Moore, R Andrew

    2014-01-01

    Background Dipyrone (metamizole) is a non-steroidal anti-inflammatory drug used in some countries to treat pain (postoperative, colic, cancer, and migraine); it is banned in others because of an association with life-threatening blood agranulocytosis. This review updates a 2001 Cochrane review, and no relevant new studies were identified, but additional outcomes were sought. Objectives To assess the efficacy and adverse events of single dose dipyrone in acute postoperative pain. Search methods The earlier review searched CENTRAL, MEDLINE, EMBASE, LILACS and the Oxford Pain Relief Database to December 1999. For the update we searched CENTRAL, MEDLINE,EMBASE and LILACS to February 2010. Selection criteria Single dose, randomised, double-blind, placebo or active controlled trials of dipyrone for relief of established moderate to severe postoperative pain in adults. We included oral, rectal, intramuscular or intravenous administration of study drugs. Data collection and analysis Studies were assessed for methodological quality and data extracted by two review authors independently. Summed total pain relief over six hours (TOTPAR) was used to calculate the number of participants achieving at least 50% pain relief. Derived results were used to calculate, with 95% confidence intervals, relative benefit compared to placebo, and the number needed to treat (NNT) for one participant to experience at least 50% pain relief over six hours. Use and time to use of rescue medication were additional measures of efficacy. Information on adverse events and withdrawals was collected. Main results Fifteen studies tested mainly 500 mg oral dipyrone (173 participants), 2.5 g intravenous dipyrone (101), 2.5 g intramuscular dipyrone (99); fewer than 60 participants received any other dose. All studies used active controls (ibuprofen, paracetamol, aspirin, flurbiprofen, ketoprofen, dexketoprofen, ketorolac, pethidine, tramadol, suprofen); eight used placebo controls. Over 70% of participants

  10. Pharmacologic therapy for acute pancreatitis

    PubMed Central

    Kambhampati, Swetha; Park, Walter; Habtezion, Aida

    2014-01-01

    While conservative management such as fluid, bowel rest, and antibiotics is the mainstay of current acute pancreatitis management, there is a lot of promise in pharmacologic therapies that target various aspects of the pathogenesis of pancreatitis. Extensive review of preclinical studies, which include assessment of therapies such as anti-secretory agents, protease inhibitors, anti-inflammatory agents, and anti-oxidants are discussed. Many of these studies have shown therapeutic benefit and improved survival in experimental models. Based on available preclinical studies, we discuss potential novel targeted pharmacologic approaches that may offer promise in the treatment of acute pancreatitis. To date a variety of clinical studies have assessed the translational potential of animal model effective experimental therapies and have shown either failure or mixed results in human studies. Despite these discouraging clinical studies, there is a great clinical need and there exist several preclinical effective therapies that await investigation in patients. Better understanding of acute pancreatitis pathophysiology and lessons learned from past clinical studies are likely to offer a great foundation upon which to expand future therapies in acute pancreatitis. PMID:25493000

  11. Chronic Pain and Exercise Therapy.

    ERIC Educational Resources Information Center

    Raithel, Kathryn Simmons

    1989-01-01

    Aerobic and resistance exercise are currently prescribed by physicians to treat chronic pain. However, patient fitness level must improve before he/she feels better. Pain management programs help patients become more active so they can function at work and home. (SM)

  12. Acute psychosocial stress reduces pain modulation capabilities in healthy men.

    PubMed

    Geva, Nirit; Pruessner, Jens; Defrin, Ruth

    2014-11-01

    Anecdotes on the ability of individuals to continue to function under stressful conditions despite injuries causing excruciating pain suggest that acute stress may induce analgesia. However, studies exploring the effect of acute experimental stress on pain perception show inconsistent results, possibly due to methodological differences. Our aim was to systematically study the effect of acute stress on pain perception using static and dynamic, state-of-the-art pain measurements. Participants were 29 healthy men who underwent the measurement of heat-pain threshold, heat-pain intolerance, temporal summation of pain, and conditioned pain modulation (CPM). Testing was conducted before and during exposure to the Montreal Imaging Stress Task (MIST), inducing acute psychosocial stress. Stress levels were evaluated using perceived ratings of stress and anxiety, autonomic variables, and salivary cortisol. The MIST induced a significant stress reaction. Although pain threshold and pain intolerance were unaffected by stress, an increase in temporal summation of pain and a decrease in CPM were observed. These changes were significantly more robust among individuals with stronger reaction to stress ("high responders"), with a significant correlation between the perception of stress and the performance in the pain measurements. We conclude that acute psychosocial stress seems not to affect the sensitivity to pain, however, it significantly reduces the ability to modulate pain in a dose-response manner. Considering the diverse effects of stress in this and other studies, it appears that the type of stress and the magnitude of its appraisal determine its interactions with the pain system.

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

    PubMed

    Schmidt, A J; Brands, A M

    1986-01-01

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

  14. Topical NSAIDs for acute pain in adults

    PubMed Central

    Massey, Thomas; Derry, Sheena; Moore, R Andrew; McQuay, Henry J

    2014-01-01

    Background Use of topical NSAIDs to treat acute musculoskeletal conditions is widely accepted in some parts of the world, but not in others. Their main attraction is their potential to provide pain relief without associated systemic adverse events. Objectives To review the evidence from randomised, double-blind, controlled trials on the efficacy and safety of topically applied NSAIDs in acute pain. Search methods We searched MEDLINE, EMBASE, The Cochrane Library, and our own in-house database to December 2009. We sought unpublished studies by asking personal contacts and searching on-line clinical trial registers and manufacturers web sites. Selection criteria We included randomised, double-blind, active or placebo (inert carrier)-controlled trials in which treatments were administered to adult patients with acute pain resulting from strains, sprains or sports or overuse-type injuries (twisted ankle, for instance). There had to be at least 10 participants in each treatment arm, with application of treatment at least once daily. Data collection and analysis Two review authors independently assessed trial quality and validity, and extracted data. Numbers of participants achieving each outcome were used to calculate relative risk and numbers needed to treat (NNT) or harm (NNH) compared to placebo or other active treatment. Main results Forty-seven studies were included; most compared topical NSAIDs in the form of a gel, spray, or cream with a similar placebo, with 3455 participants in the overall analysis of efficacy. For all topical NSAIDs combined, compared with placebo, the number needed to treat to benefit (NNT) for clinical success, equivalent to 50% pain relief, was 4.5 (3.9 to 5.3) for treatment periods of 6 to 14 days. Topical diclofenac, ibuprofen, ketoprofen, and piroxicam were of similar efficacy, but indomethacin and benzydamine were not significantly better than placebo. Local skin reactions were generally mild and transient, and did not differ from

  15. Targeted Therapy for Acute Lymphocytic Leukemia

    MedlinePlus

    ... Monoclonal antibodies to treat acute lymphocytic leukemia Targeted therapy for acute lymphocytic leukemia In recent years, new ... These drugs are often referred to as targeted therapy. Some of these drugs can be useful in ...

  16. Acute oxygen therapy.

    PubMed

    Akbar, Fazal; Campbell, Ian Allen

    2004-05-01

    Oxygen therapy is a central part of our clinical practice and is widely used in many pulmonary and non-pulmonary conditions worldwide but it is sometimes used unnecessarily and can be harmful. Optimum use is not only important for patient care but is also sound fiscally because of the expense of oxygen and the cost of devices utilised. This article is aimed both at reviewing available research and guidelines for the use of oxygen and providing knowledge of different administering and monitoring devices and equipment. Various hospital based audits have shown oxygen as being poorly prescribed and inappropriately administered and it is important for everyone involved in patient care to understand the basics of oxygen therapy before optimum practice can be implemented and followed. PMID:15225466

  17. An 86-year-old man with acute abdominal pain.

    PubMed

    van Dam, Paul M E L; Posthouwer, Dirk

    2016-01-01

    An 86-year-old man presented with severe pain in the upper abdomen along with fever. On physical examination, we found an arterial blood pressure of 84/43 mm Hg, a heart rate of 80 bpm and a temperature of 38.3°C. The abdomen was painful and peristalsis was absent. Empiric antibiotic therapy for sepsis was started with amoxicillin/clavulanate and gentamicin. CT scan of the abdomen revealed an emphysematous cholecystitis. Percutaneous ultrasound-guided cholecystostomy was applied. Bile cultures revealed Clostridium perfringens. Emphysematous cholecystitis is a life-threatening form of acute cholecystitis that occurs as a consequence of ischaemic injury to the gallbladder, followed by translocation of gas-forming bacteria (ie, C. perfringens, Escherichia coli, Klebsiella and Streptococci). The mortality associated with emphysematous cholecystitis is higher than in non-emphysematous cholecystitis (15% vs 4%). Therefore, early diagnosis with radiological imaging is of vital importance. PMID:26869625

  18. Hypnosis for Acute Procedural Pain: A Critical Review.

    PubMed

    Kendrick, Cassie; Sliwinski, Jim; Yu, Yimin; Johnson, Aimee; Fisher, William; Kekecs, Zoltán; Elkins, Gary

    2016-01-01

    Clinical evidence for the effectiveness of hypnosis in the treatment of acute procedural pain was critically evaluated based on reports from randomized controlled clinical trials (RCTs). Results from the 29 RCTs meeting inclusion criteria suggest that hypnosis decreases pain compared to standard care and attention control groups and that it is at least as effective as comparable adjunct psychological or behavioral therapies. In addition, applying hypnosis in multiple sessions prior to the day of the procedure produced the highest percentage of significant results. Hypnosis was most effective in minor surgical procedures. However, interpretations are limited by considerable risk of bias. Further studies using minimally effective control conditions and systematic control of intervention dose and timing are required to strengthen conclusions. PMID:26599994

  19. ACUTE PELVIC PAIN IN THE ADOLESCENT: A CASE REPORT

    PubMed Central

    Samuels-Kalow, M.; Mollen, C.

    2015-01-01

    Diagnosis and treatment of acute pelvic pain in the adolescent female requires differentiating among a broad differential diagnosis that includes potentially serious illness across several organ systems. The case presented provides an illustration of the assessment and management of acute pelvic pain, and key teaching points about important potential causes. PMID:26273230

  20. [Fluid therapy in acute pancreatitis].

    PubMed

    de-Madaria, Enrique

    2013-12-01

    Severe acute pancreatitis (AP) is associated with an increased need for fluids due to fluid sequestration and, in the most severe cases, with decreased peripheral vascular tone. For several decades, clinical practice guidelines have recommended aggressive fluid therapy to improve the prognosis of AP. This recommendation is based on theoretical models, animal studies, and retrospective studies in humans. Recent studies suggest that aggressive fluid administration in all patients with AP could have a neutral or harmful effect. Fluid therapy based on Ringer's lactate could improve the course of the disease, although further studies are needed to confirm this possibility. Most patients with AP do not require invasive monitoring of hemodynamic parameters to guide fluid therapy administration. Moreover, the ability of these parameters to improve prognosis has not been demonstrated.

  1. Psychological Evaluation of Acute Low Back Pain in Hospital Workers

    PubMed Central

    Lamontagne, Yves; Bousquet, Pierre; Elie, Robert; Courtois, Monique

    1983-01-01

    Personality, anxiety and depression were assessed in 62 hospital workers divided in three experimental groups: those with acute organic low back pain, those with acute functional low back pain, and asymptomatic control subjects. Results showed no statistical differences between groups in the evaluation of personality. Asymptomatic subjects had significantly lower scores for trait anxiety and depression than did patients suffering from low back pain. Patients with pain of organic origin were also more depressed than were patients with pain of functional origin. Anxiety and depression are two psychological variables which must be examined in acute back pain problems. Further studies should be conducted to develop more accurate psychological instruments to evaluate the large population of patients suffering from low back pain. PMID:21283394

  2. Managing pain using heat and cold therapy.

    PubMed

    Lane, Elaine; Latham, Tracy

    2009-07-01

    Evidence supports the use of superficial heating and cooling of tissues to provide pain relief in low to moderate levels of acute and chronic pain in adults, but there are no standards or guidelines in children's centres across the UK for administering these modalities in children, so a project was undertaken to develop these locally. Evidence from the literature was used to identify best practice in relation to equipment, safety and infection control. Implementation was supported by educational input and a detailed protocol for assessment and application of the devices. Three years after their introduction a review of the guidelines and an audit demonstrated that these modalities have been beneficial, providing cost-effective, holistic care for children experiencing pain in hospital. PMID:19623797

  3. Responses to acute pain and the nursing implications.

    PubMed

    Wells, N

    1984-01-01

    Management of acute pain offers many techniques--peripherally, to reduce the sensory input from the nociceptors and ascending fibres, and centrally by altering cognition, evaluation and emotional arousal to the sensory input. Scientifically-based nursing intervention is imperative. Therefore, nurses needed a better understanding of recent research regarding pain. As well, recognition that all individuals express and cope with pain in different ways, and therefore exhibit different pain behaviours, is necessary if effective nursing care is to be given. Finally, with all the interacting variables and methods of intervention available, pain medication should never be the only intervention used for the patient with pain. PMID:6142910

  4. Acute pain management in the opioid-tolerant patient.

    PubMed

    Bourne, Nicola

    The main goals in treating acute pain in opioid-tolerant patients are effective pain relief and prevention of withdrawal symptoms. This article provides an overview of the issues that practitioners need to consider when caring for potential and actual opioid-tolerant patients experiencing acute pain, for example following surgery or injury. It highlights the importance of a multimodal analgesic approach to pain control and the prevention of withdrawal. It defines the terminology used in managing opioid-tolerant patients in order to allay healthcare professionals' misconceptions.

  5. Effects of Acute Low Back Pain on Postural Control

    PubMed Central

    Sohn, Min Kyun; Lee, Sang Sook

    2013-01-01

    Objective To evaluate the changes in static and dynamic postural control after the development of acute low back pain. Methods Thirty healthy right-handed volunteers were divided into three groups; the right back pain group, the left back pain group, and the control group. 0.5 mL of 5% hypertonic saline was injected into L4-5 paraspinal muscle for 5 seconds to cause muscle pain. The movement of the center of gravity (COG) during their static and dynamic postural control was measured with their eyes open and with their eyes closed before and 2 minutes after the injection. Results The COGs for the healthy adults shifted to the right quadrant and the posterior quadrant during their static and dynamic postural control test (p<0.05). The static and dynamic instability index while they had their eyes closed was significantly increased than when they had their eyes open with and without acute back pain. After pain induction, their overall and anterior/posterior instability was increased in both the right back pain group and the left back pain group during the static postural control test (p<0.05). A right deviation and a posterior deviation of the COG still remained, and the posterior deviation was greater in the right back pain group (p<0.05). Conclusion The static instability, particularly the anterior/posterior instability was increased in the presence of acute low back pain, regardless of the visual information and the location of pain. PMID:23526750

  6. Integrative oncology: complementary therapies for pain, anxiety, and mood disturbance.

    PubMed

    Deng, Gary; Cassileth, Barrie R

    2005-01-01

    Many people with cancer experience pain, anxiety, and mood disturbance. Conventional treatments do not always satisfactorily relieve these symptoms, and some patients may not be able to tolerate their side effects. Complementary therapies such as acupuncture, mind-body techniques, massage, and other methods can help relieve symptoms and improve physical and mental well-being. Self-hypnosis and relaxation techniques help reduce procedural pain. Acupuncture is well documented to relieve chronic cancer pain. Massage and meditation improve anxiety and other symptoms of distress. Many dietary supplements contain biologically active constituents with effects on mood. However, not all complementary therapies are appropriate or useful, and even helpful complementary modalities may not be optimal under some circumstances. Situations when precaution is indicated include acute onset of symptoms and severe symptoms, which require immediate mainstream intervention. Dietary supplements are associated with serious negative consequences under some circumstances. The authors summarize the research on these modalities and discuss the rationale, expectation, and necessary precautions involved with combining complementary therapies and mainstream care. Practical clinical issues are addressed.

  7. Pain associated with negative pressure wound therapy.

    PubMed

    Waldie, Karen

    Negative pressure wound therapy (NPWT) has emerged as an effective treatment option for a variety of complex wounds. However, pain is anecdotally a common side effect of NPWT affecting quality of life and even precluding some patients from continuing with the treatment. This literature review examines the evidence relating to pain management for patients undergoing NPWT with a view to identifying methods of administration that could minimise pain and allow more patients to benefit from the treatment. The Cumulative Index to Nursing and Allied Health Literature (CINAHL), British Nursing Index (BNI), Embase and Medline databases were accessed to identify relevant studies. Ten studies were found that matched the review inclusion criteria. These demonstrate some potential areas for further research but more evidence is required before any recommendations can be made.

  8. Acute Pancreatitis and Diabetic Ketoacidosis following L-Asparaginase/Prednisone Therapy in Acute Lymphoblastic Leukemia.

    PubMed

    Quintanilla-Flores, Dania Lizet; Flores-Caballero, Miguel Ángel; Rodríguez-Gutiérrez, René; Tamez-Pérez, Héctor Eloy; González-González, José Gerardo

    2014-01-01

    Acute pancreatitis and diabetic ketoacidosis are unusual adverse events following chemotherapy based on L-asparaginase and prednisone as support treatment for acute lymphoblastic leukemia. We present the case of a 16-year-old Hispanic male patient, in remission induction therapy for acute lymphoblastic leukemia on treatment with mitoxantrone, vincristine, prednisone, and L-asparaginase. He was hospitalized complaining of abdominal pain, nausea, and vomiting. Hyperglycemia, acidosis, ketonuria, low bicarbonate levels, hyperamylasemia, and hyperlipasemia were documented, and the diagnosis of diabetic ketoacidosis was made. Because of uncertainty of the additional diagnosis of acute pancreatitis as the cause of abdominal pain, a contrast-enhanced computed tomography was performed resulting in a Balthazar C pancreatitis classification.

  9. Acute Pancreatitis and Diabetic Ketoacidosis following L-Asparaginase/Prednisone Therapy in Acute Lymphoblastic Leukemia

    PubMed Central

    Quintanilla-Flores, Dania Lizet; Flores-Caballero, Miguel Ángel; Rodríguez-Gutiérrez, René; Tamez-Pérez, Héctor Eloy; González-González, José Gerardo

    2014-01-01

    Acute pancreatitis and diabetic ketoacidosis are unusual adverse events following chemotherapy based on L-asparaginase and prednisone as support treatment for acute lymphoblastic leukemia. We present the case of a 16-year-old Hispanic male patient, in remission induction therapy for acute lymphoblastic leukemia on treatment with mitoxantrone, vincristine, prednisone, and L-asparaginase. He was hospitalized complaining of abdominal pain, nausea, and vomiting. Hyperglycemia, acidosis, ketonuria, low bicarbonate levels, hyperamylasemia, and hyperlipasemia were documented, and the diagnosis of diabetic ketoacidosis was made. Because of uncertainty of the additional diagnosis of acute pancreatitis as the cause of abdominal pain, a contrast-enhanced computed tomography was performed resulting in a Balthazar C pancreatitis classification. PMID:24716037

  10. Acute pain services in Europe: a 17-nation survey of 105 hospitals. The EuroPain Acute Pain Working Party.

    PubMed

    Rawal, N; Allvin, R

    1998-05-01

    A 17-nation survey was undertaken with the aim of studying the availability of acute pain services (APS) and the use of newer analgesic techniques, such as epidural and patient-controlled analgesia (PCA). A questionnaire was mailed to selected anaesthesiologists in 105 European hospitals from 17 countries. Depending on the population, between five and ten representative hospitals from each country were selected by a country coordinator. A total of 101 (96.2%) completed questionnaires were returned. A majority of respondents were dissatisfied with pain management on surgical wards. Pain management was better in post-anaesthesia care units (PACUs); however, 27% of participating hospitals did not have PACUs. There were no organized APS in 64% of hospitals, although anaesthesiologists from chronic pain centres were available for consultation. In the hospitals that had APS, the responsible person for the APS was either: (1) a junior anaesthesiologist (senior anaesthesiologist available for consultation); or (2) a specially trained nurse (supervised by consultant anaesthesiologists). Many anaesthesiologists were unable to introduce techniques such as PCA on wards because of the high equipment costs. Although 40% of hospitals used a visual analogue scale (VAS) or other methods for assessment of pain intensity, routine pain assessment and documenting on a vital sign chart was rarely practised. There was a great variation in routines for opioid prescription and documentation procedures. Nursing regulations regarding injection of drugs into epidural and intrathecal catheters also varied considerably between countries. This survey of 105 hospitals from 17 European countries showed that over 50% of anaesthesiologists were dissatisfied with post-operative pain management on surgical wards. Only 34% of hospitals had an organized APS, and very few hospitals used quality assurance measures such as frequent pain assessment and documentation. There is a need to establish organized

  11. A rationale for the treatment of back pain and joint pain by manual therapy.

    PubMed

    Twomey, L T

    1992-12-01

    Manual therapy, with its emphasis on joint movement and exercise, has become increasingly important for the treatment of pain and dysfunction of the musculoskeletal system. The rationale used to explain the success of manual therapy has changed radically in recent years. Early explanations, which included concepts such as adjusting joint subluxations, restoring bony alignment, and reducing nuclear protrusion, have been shown to have no basis in fact. Current biological research shows the value of movement in maintaining the health and strength of collagenous, muscular, and bony tissues and emphasizes the need for joint movement and for relatively high levels of activity throughout the life cycle. The musculoskeletal system thrives on stress and movement and reacts adversely to prolonged rest or immobilization. The problems associated with working or recreational postures involving prolonged loading at or near the limit of joint range of motion are considered together with a rationale for appropriate therapeutic management. Explanations are provided to enable an understanding of the success of intensive physical therapy for chronic back pain and for manipulation in the treatment of the acute painful locked back.

  12. A Community Art Therapy Group for Adults with Chronic Pain

    ERIC Educational Resources Information Center

    O'Neill, Aimee; Moss, Hilary

    2015-01-01

    This paper describes a community art therapy group for people living with chronic pain. Nine adults were offered 12 weekly group art therapy sessions that included art therapy activities such as guided imagery focusing on body scans followed by art responses and artistic expressions of the pain experience. This pilot group art therapy program is…

  13. Fentanyl-induced hyperalgesia in acute pain management.

    PubMed

    Lyons, Pamela J; Rivosecchi, Ryan M; Nery, Jose P; Kane-Gill, Sandra L

    2015-06-01

    There are safety concerns with the use of fentanyl, including respiratory depression, nausea, constipation, and possibly opioid-induced hyperalgesia (OIH). The purpose of this review is to evaluate the occurrence and significance of opioid-induced hyperalgesia (OIH) after acute fentanyl exposure. A literature search was conducted from October 1995 through January 2015 using MEDLINE, Embase, and Scopus with the terms hyperalgesia, fentanyl, pronociceptive, acute tolerance, and acute. Published articles evaluating the adverse effects of fentanyl during acute pain management (≤96 hours) in humans were included. Opioid-induced hyperalgesia is a phenomenon defined by increasing pain after opioid exposure with the worsening of pain occurring when opioid doses are increased. Hyperalgesia has been described following remifentanil and morphine use, but the question remains about the associated risk with acute fentanyl exposure. Six randomized, controlled trials evaluating the effect of fentanyl on pain in the acute setting have been conducted. Two trials oppose whereas four trials support the occurrence of fentanyl-induced hyperalgesia. The data on OIH after acute fentanyl exposure are limited and conflicting. Hyperalgesia should be considered in patients with uncontrolled pain despite escalating fentanyl doses, since the possibility of fentanyl-induced OIH exists in the acute setting. Well-designed trials are needed to determine the clinical significance of this phenomenon.

  14. Acute scrotal pain: an uncommon manifestation of renal vein thrombosis.

    PubMed

    Jou, Yeong-Chin; Jong, Ing-Chin; Hsieh, Ying-Chen; Kang, Chun-Hsiung

    2014-03-01

    The clinical manifestation of renal vein thrombosis varies with the speed and degree of venous occlusion. Such patients may be asymptomatic, have minor nonspecific symptoms such as nausea or weakness, or have more specific symptoms such as upper abdominal pain, flank pain, or hematuria. Acute scrotal pain is a very uncommon clinical expression of renal vein thrombosis. Here, we report a case of membranous glomerulonephritis-induced renal vein thrombosis presented with the symptom of acute scrotal pain caused by thrombosis-induced varicocele. This case report suggests that renal vein thrombosis should be considered in the diagnosis of acute scrotal pain; it also emphasizes that an investigation of retroperitoneum should be performed for adult patients with the sudden onset of varicocele.

  15. Avoidance of affective pain stimuli predicts chronicity in patients with acute low back pain.

    PubMed

    Sharpe, Louise; Haggman, Sonia; Nicholas, Michael; Dear, Blake F; Refshauge, Kathryn

    2014-01-01

    This prospective study of acute and sub-acute low back pain (LBP) patients was conducted to assess whether attentional biases predicted chronic pain status 3 and 6 months later. The attentional biases of 100 LBP patients were assessed within 3 months of developing pain and 6 months later. Participants also completed measures associated with outcome at 3 assessment points: baseline, 3 and 6 months later. Current pain status was assessed at follow-ups. Patients were classified as those that met standard criteria for chronic pain or those who did not (i.e., the comparison group). At baseline, participants demonstrated a bias toward sensory pain words. However, biases toward sensory pain words did not differentiate those who subsequently developed chronic pain and those who did not at either follow-up. The same bias was observed 6 months later, but again it failed to distinguish between the chronic pain and comparison groups. However, subjects who developed chronic pain at both 3 (n=22) and 6 (n=21) months demonstrated biases away from affective pain words at baseline but not 6 months later, in comparison to other participants. These results remained significant in multivariate analyses. These findings are consistent with patterns observed in the previous research, and suggest that avoidance of emotionally laden pain-related stimuli (i.e., affective pain words) is associated with negative outcomes for LBP patients in the acute and sub-acute phase. This research suggests that attentional biases in relation to pain-related stimuli are important for the development of chronic pain, but are more complex than initially thought. PMID:24028848

  16. Acute low back pain: systematic review of its prognosis

    PubMed Central

    Pengel, Liset H M; Herbert, Robert D; Maher, Chris G; Refshauge, Kathryn M

    2003-01-01

    Objectives To describe the course of acute low back pain and sciatica and to identify clinically important prognostic factors for these conditions. Design Systematic review. Data sources Searches of Medline, Embase, Cinahl, and Science Citation Index and iterative searches of bibliographies. Main outcome measures Pain, disability, and return to work. Results 15 studies of variable methodological quality were included. Rapid improvements in pain (mean reduction 58% of initial scores), disability (58%), and return to work (82% of those initially off work) occurred in one month. Further improvement was apparent until about three months. Thereafter levels for pain, disability, and return to work remained almost constant. 73% of patients had at least one recurrence within 12 months. Conclusions People with acute low back pain and associated disability usually improve rapidly within weeks. None the less, pain and disability are typically ongoing, and recurrences are common. PMID:12907487

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

    PubMed Central

    Dehghan, Morteza

    2014-01-01

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

  18. Outpatient diagnosis of acute chest pain in adults.

    PubMed

    McConaghy, John R; Oza, Rupal S

    2013-02-01

    Approximately 1 percent of primary care office visits are for chest pain, and 1.5 percent of these patients will have unstable angina or acute myocardial infarction. The initial goal in patients presenting with chest pain is to determine if the patient needs to be referred for further testing to rule in or out acute coronary syndrome and myocardial infarction. The physician should consider patient characteristics and risk factors to help determine initial risk. Twelve-lead electrocardiography is typically the test of choice when looking for ST segment changes, new-onset left bundle branch block, presence of Q waves, and new-onset T wave inversions. For persons in whom the suspicion for ischemia is lower, other diagnoses to consider include chest wall pain/costochondritis (localized pain reproducible by palpation), gastroesophageal reflux disease (burning retrosternal pain, acid regurgitation, and a sour or bitter taste in the mouth), and panic disorder/anxiety state. Other less common but important diagnostic considerations include pneumonia (fever, egophony, and dullness to percussion), heart failure, pulmonary embolism (consider using the Wells criteria), acute pericarditis, and acute thoracic aortic dissection (acute chest or back pain with a pulse differential in the upper extremities). Persons with a higher likelihood of acute coronary syndrome should be referred to the emergency department or hospital.

  19. Acute Pain Medicine in the United States: A Status Report

    PubMed Central

    Tighe, Patrick; Buckenmaier, Chester C.; Boezaart, Andre P.; Carr, Daniel B.; Clark, Laura L.; Herring, Andrew A.; Kent, Michael; Mackey, Sean; Mariano, Edward R.; Polomano, Rosemary C.; Reisfield, Gary M.

    2015-01-01

    Background Consensus indicates that a comprehensive, multimodal, holistic approach is foundational to the practice of acute pain medicine (APM), but lack of uniform, evidence-based clinical pathways leads to undesirable variability throughout U. S. healthcare systems. Acute pain studies are inconsistently synthesized to guide educational programs. Advanced practice techniques involving regional anesthesia assume the presence of a physician-led, multidisciplinary acute pain service, which is often unavailable or inconsistently applied. This heterogeneity of educational and organizational standards may result in unnecessary patient pain and escalation of healthcare costs. Methods A multidisciplinary panel was nominated through the Acute Pain Medicine Shared Interest Group (APMSIG) of the American Academy of Pain Medicine (AAPM). The panel met in Chicago, Illinois, in July 2014, to identify gaps and set priorities in APM research and education. Results The panel identified 3 areas of critical need: 1) an open-source acute pain data registry and clinical support tool to inform clinical decision making and resource allocation and to enhance research efforts; 2) a strong professional APM identity as an accredited subspecialty; and 3) educational goals targeted toward third-party payers, hospital administrators, and other key stakeholders to convey the importance of APM. Conclusion This report is the first step in a 3-year initiative aimed at creating conditions and incentives for the optimal provision of APM services to facilitate and enhance the quality of patient recovery after surgery, illness, or trauma. The ultimate goal is to reduce the conversion of acute pain to the debilitating disease of chronic pain. PMID:26535424

  20. Chest Pain in Adolescent Japanese Male Mimicking Acute Coronary Syndrome

    PubMed Central

    Gupta, Sachin K.; Naheed, Zahra

    2014-01-01

    Acute chest pain with very elevated troponin level and abnormal EKG in adult population is considered sine qua non to acute coronary syndrome (ACS) unless proved otherwise. Similar presentation in adolescent population is seen less often but raises suspicion for ACS. Most common etiology for chest pain with cardiac enzyme elevation in adolescent population is usually viral myopericarditis. The adolescent population presenting with chest pain and elevated cardiac enzymes should be carefully evaluated for ACS and other etiologies including myocarditis, myopericarditis, pulmonary embolism, acute rheumatic fever, and trauma. We report one Japanese adolescent male with mycoplasma pneumoniae myocarditis who presented to the ER with chest pain, elevated cardiac enzymes, and abnormal EKG. PMID:25202456

  1. Role of Alternative Therapies for Chronic Pain Syndromes.

    PubMed

    Thomas, Donna-Ann; Maslin, Benjamin; Legler, Aron; Springer, Erin; Asgerally, Abbas; Vadivelu, Nalini

    2016-05-01

    There is increasing interest in the use of complimentary and alternative medicine (CAM) for the treatment of chronic pain. This review examines alternative and complimentary therapies, which can be incorporated as part of a biopsychosocial approach in the treatment of chronic pain syndromes. In the present investigation, literature from articles indexed on PubMed was evaluated including topics of alternative therapies, complimentary therapies, pain psychology, biofeedback therapy, physical exercise therapies, acupuncture, natural and herbal supplements, whole-body cryotherapy, and smartphone technologies in the treatment of chronic pain syndromes. This review highlights the key role of psychology in the treatment of chronic pain. Cognitive behavior therapy appears to be the most impactful while biofeedback therapy has also been shown to be effective for chronic pain. Exercise therapy has been shown to be effective in short-, intermediate-, and long-term pain states. When compared to that in sham controls, acupuncture has shown some benefit for neck pain immediately after the procedure and in the short term and improvement has also been demonstrated in the treatment of headaches. The role of smartphones and whole-body cryotherapy are new modalities and further studies are needed. Recent literature suggests that several alternate therapies could play a role in the treatment of chronic pain, supporting the biopsychosocial model in the treatment of pain states. PMID:27038968

  2. Diver with acute abdominal pain, right leg paresthesias and weakness: a case report.

    PubMed

    Wang, J; Corson, K; Minky, K; Mader, J

    2002-01-01

    A 29-year-old man was brought to an emergency department by the United States Coast Guard with chief complaints of severe abdominal pain, right leg paresthesia and weakness following four deep air dives. Physical examination before recompression treatment was remarkable for diffuse abdominal tenderness and right leg weakness. The patient was diagnosed in the emergency room with type II decompression sickness (DCS) and underwent standard recompression therapy. He experienced complete resolution of weakness after hyperbaric oxygen (HBO) therapy, but his abdominal pain was persistent. Further investigation led to the diagnosis of acute appendicitis with perforation. The patient underwent appendectomy and intravenous antibiotic therapy and was discharged to his home on hospital day five without complications. This case reinforces the importance of careful clinical assessment of divers and illustrates the potentially wide differential diagnosis of DCS. This is the first reported case of recompression treatment of a diver with acute appendicitis and type II DCS.

  3. Therapy of acute gastroenteritis: role of antibiotics.

    PubMed

    Zollner-Schwetz, I; Krause, R

    2015-08-01

    Acute infectious diarrhoea remains a very common health problem, even in the industrialized world. One of the dilemmas in assessing patients with acute diarrhoea is deciding when to test for aetiological agents and when to initiate antimicrobial therapy. The management and therapy of acute gastroenteritis is discussed in two epidemiological settings: community-acquired diarrhoea and travellers' diarrhoea. Antibiotic therapy is not required in most patients with acute gastroenteritis, because the illness is usually self-limiting. Antimicrobial therapy can also lead to adverse events, and unnecessary treatments add to resistance development. Nevertheless, empirical antimicrobial therapy can be necessary in certain situations, such as patients with febrile diarrhoeal illness, with fever and bloody diarrhoea, symptoms persisting for >1 week, or immunocompromised status.

  4. Patient-controlled modalities for acute postoperative pain management.

    PubMed

    Miaskowski, Christine

    2005-08-01

    Although numerous clinical practice guidelines for pain management have been published throughout the last 12 years, inadequate pain relief remains a significant health care issue. Several patient-controlled analgesia (PCA) modalities are currently available for the treatment of acute postoperative pain, including intravenous (IV) PCA, epidural (PCEA), and oral PCA. Although PCEA and IV PCA are both commonly used modalities, IV PCA is considered the standard of care for postoperative pain management. Limitations of this modality do exist, however. Consequently, noninvasive PCA systems are under development to circumvent many of these limitations, including the fentanyl hydrochloride patient-controlled transdermal system (PCTS); (IONSYS Ortho-McNeil Pharmaceutical, Raritan, NJ) and a number of patient-controlled intranasal analgesia (PCINA) delivery systems. The objective of this article is to review the PCA modalities currently in use and to discuss those in development for the treatment of acute postoperative pain.

  5. Preventing Chronic Pain following Acute Pain: Risk Factors, Preventive Strategies, and their Efficacy

    PubMed Central

    McGreevy, Kai; Bottros, Michael M.; Raja, Srinivasa N.

    2011-01-01

    Chronic pain is the leading cause of disability in the United States. The transition from acute to persistent pain is thought to arise from maladaptive neuroplastic mechanisms involving three intertwined processes, peripheral sensitization, central sensitization, and descending modulation. Strategies aimed at preventing persistent pain may target such processes. Models for studying preventive strategies include persistent post-surgical pain (PPP), persistent post-trauma pain (PTP) and post-herpetic neuralgia (PHN). Such entities allow a more defined acute onset of tissue injury after which study of the long-term effects is more easily examined. In this review, we examine the pathophysiology, epidemiology, risk factors, and treatment strategies for the prevention of chronic pain using these models. Both pharmacological and interventional approaches are described, as well as a discussion of preventive strategies on the horizon. PMID:22102847

  6. Distraction, exposure therapy, counterconditioning, and topical anesthetic for acute pain management during needle sticks in children with intellectual and developmental disabilities.

    PubMed

    Slifer, Keith J; Hankinson, Jessica C; Zettler, Melissa A; Frutchey, Robin A; Hendricks, Melissa C; Ward, Cynthia M; Reesman, Jennifer

    2011-08-01

    A behavior therapy approach for obtaining cooperation during needle sticks was provided to 8 pediatric patients with intellectual and developmental disabilities. Therapy was provided during mock needle sticks. Hand lotion was applied to simulate topical anesthetic. Distracting activities established relaxation while needle stick materials were gradually introduced. Positive reinforcement was provided for cooperation. Behavioral distress was ignored, blocked, or redirected. After cooperating with mock needle sticks, needle sites were prepared with topical anesthetic (EMLA), then therapists and medical staff implemented the behavioral protocol while completing the actual needle stick(s). Observational measures of cooperation and interfering were obtained. Results were replicated across 8 children and evaluated using paired samples t tests. Initially, all children were uncooperative with needle sticks. With treatment, behavioral distress decreased, and patients cooperated with mock and actual needle sticks. Results support the effectiveness of behavior therapy for promoting cooperation in children with intellectual and developmental disabilities during needle sticks.

  7. Psychological aspects of acute low back pain in general practice

    PubMed Central

    Gilchrist, Iain C.

    1983-01-01

    A prospective controlled study of acute low back pain in general practice was carried out. The presence of psychiatric illness was measured by use of the general health questionnaire (GHQ), by clinical assessment, and personality factors by use of the Eysenck personality inventory (EPI). It was found that overall the amount of psychiatric illness did not differ between patients with back pain and their controls at the time of presentation, although there was a higher prevalence of previous psychiatric illness in the back-pain group. The only difference in the personality factors measured was a higher degree of extraversion in the back-pain patients. PMID:6224930

  8. Chiropractic Care of Acute Low Back Pain and Incidental Spina Bifida Occulta: A Case Report

    PubMed Central

    Cofano, Gregory P.; Anderson, Benjamin C.; Stumpff, Eric R.

    2014-01-01

    Objective The purpose of this case report is to describe chiropractic care of an adolescent with acute low back pain and incidental finding of spina bifida occulta managed with high-velocity low-amplitude manipulation. Clinical Features A 10-year-old boy was referred for chiropractic care by his pediatrician for the management of low back pain after a fall 3 days prior. Examination and medical records revealed the patient also had spina bifida occulta at the level of L5. Intervention and Outcome High-velocity low-amplitude treatment for lower back pain showed resolution of patient's pain after 6 visits. No adverse effects were reported. Conclusion An adolescent patient with lower back pain and incidental finding of spina bifida occulta improved with a course of care that included with high-velocity low-amplitude manipulation therapy. PMID:25435841

  9. Scrambler therapy for patients with cancer pain - case series -.

    PubMed

    Park, Hong Sik; Sin, Woo Kyung; Kim, Hye Young; Moon, Jee Youn; Park, Soo Young; Kim, Yong Chul; Lee, Sang Chul

    2013-01-01

    More than 80% of cancer patients experience cancer pain. Among them, more than 50% experience moderate to severe pain. To control cancer pain, a variety of methods have been used, including medications and nerve blocks. In some patients, however, it is impossible to perform nerve blocks due to caner metastasis into the epidural space, while in other patients, opioid dose escalation is impossible due to opioid side effects; thus, cancer pain management is difficult. Scrambler therapy is a novel approach for pain control that uses EKG-like pads, which are applied above and below the site of pain. Scrambler therapy synthesizes 16 different types of nerve action potentials that provide "non-pain" information via cutaneous nerves. The advantages of this treatment are that it is non-invasive and safe and has no significant side effects. In this case series, we report the treatment results of using scrambler therapy in three cancer patients with intractable pain. PMID:23342211

  10. Single dose oral flurbiprofen for acute postoperative pain in adults

    PubMed Central

    Sultan, Asquad; McQuay, Henry J; Moore, R Andrew; Derry, Sheena

    2014-01-01

    Background Flurbiprofen is a non-selective non-steroidal anti-inflammatory drug (NSAID), related to ibuprofen and naproxen, used to treat acute and chronic painful conditions. There is no systematic review of its use in acute postoperative pain. Objectives To assess efficacy, duration of action, and associated adverse events of single dose oral flurbiprofen in acute postoperative pain in adults. Search methods We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to January 2009. Selection criteria Randomised, double blind, placebo-controlled trials of single dose orally administered flurbiprofen in adults with moderate to severe acute postoperative pain. Data collection and analysis Two review authors independently assessed trial quality and extracted data. Pain relief or pain intensity data were extracted and converted into the dichotomous outcome of number of participants with at least 50% pain relief over 4 to 6 hours, from which relative risk (RR) and number needed to treat to benefit (NNT) were calculated. Numbers of participants using rescue medication over specified time periods, and time to use of rescue medication, were sought as additional measures of efficacy. Information on adverse events and withdrawals were collected. Main results Eleven studies compared flurbiprofen (699 participants) with placebo (362 participants) in studies lasting 6 to 12 hours. Studies were of adequate reporting quality, and most participants had pain following dental extractions. The dose of flurbiprofen used was 25 mg to 100 mg, with most information for 50 mg and 100 mg. The NNT for at least 50% pain relief over 4 to 6 hours for flurbiprofen 50 mg compared with placebo (692 participants) was 2.7 (2.3 to 3.3) and for 100 mg (416 participants) it was 2.5 (2.0 to 3.1). With flurbiprofen 50 mg and 100 mg 65% to 70% of participants experienced at least 50% pain relief, compared with 25% to 30% with placebo. Rescue medication was used by 25

  11. Low Level Laser Therapy (LLLT) for Neck Pain: A Systematic Review and Meta-Regression

    PubMed Central

    Gross, Anita R; Dziengo, Stephanie; Boers, Olga; Goldsmith, Charlie H; Graham, Nadine; Lilge, Lothar; Burnie, Stephen; White, Roger

    2013-01-01

    Purpose: This systematic review update evaluated low level laser therapy (LLLT) for adults with neck pain. Methods: Computerized searches (root up to Feb 2012) included pain, function/disability, quality of life (QoL) and global perceived effect (GPE). GRADE, effect-sizes, heterogeneity and meta-regression were assessed. Results: Of 17 trials, 10 demonstrated high risk of bias. For chronic neck pain, there was moderate quality evidence (2 trials, 109 participants) supporting LLLT over placebo to improve pain/disability/QoL/GPE up to intermediate-term (IT). For acute radiculopathy, cervical osteoarthritis or acute neck pain, low quality evidence suggested LLLT improves ST pain/function/QoL over a placebo. For chronic myofascial neck pain (5 trials, 188 participants), evidence was conflicting; a meta-regression of heterogeneous trials suggests super-pulsed LLLT increases the chance of a successful pain outcome. Conclusions: We found diverse evidence using LLLT for neck pain. LLLT may be beneficial for chronic neck pain/function/QoL. Larger long-term dosage trials are needed. PMID:24155802

  12. A 51-year-old woman with acute onset of facial pressure, rhinorrhea, and tooth pain: review of acute rhinosinusitis.

    PubMed

    Hwang, Peter H

    2009-05-01

    Acute rhinosinusitis is a common ailment accounting for millions of office visits annually, including that of Mrs D, a 51-year-old woman presenting with 5 days of upper respiratory illness and facial pain. Her case is used to review the diagnosis and treatment of acute rhinosinusitis. Acute viral rhinosinusitis can be difficult to distinguish from acute bacterial rhinosinusitis, especially during the first 10 days of symptoms. Evidence-based clinical practice guidelines developed to guide diagnosis and treatment of acute viral and bacterial rhinosinusitis recommend that the diagnosis of acute rhinosinusitis be based on the presence of "cardinal symptoms" of purulent rhinorrhea and either facial pressure or nasal obstruction of less than 4 weeks' duration. Antibiotic treatment generally can be withheld during the first 10 days of symptoms for mild to moderate cases, given the likelihood of acute viral rhinosinusitis or of spontaneously resolving acute bacterial rhinosinusitis. After 10 days, the likelihood of acute bacterial rhinosinusitis increases, and initiation of antibiotic therapy is supported by practice guidelines. Complications of sinusitis, though rare, can be serious and require early recognition and treatment.

  13. Misdiagnosis of Abdominal Pain in Pregnancy: Acute Pancreatitis

    PubMed Central

    Samal, Sunita; Gupta, Shweta; Begum, Jasmina; Ghose, Seetesh

    2015-01-01

    We report a case of acute pancreatitis in a pregnant woman who presented to our emergency department with complaints of severe abdominal pain, was misdiagnosed as scar dehiscence and underwent emergency repeat caesarean section at 33 wks for fetal distress. The preterm baby developed severe respiratory distress and succumbed on the second postnatal day. Persistent severe pain in the postoperative period in the mother prompted further evaluation which led to a diagnosis of acute pancreatitis. Conservative and supportive management was instituted leading to an eventual favourable maternal outcome. PMID:25738042

  14. Cognitive behavioral therapy for back pain

    MedlinePlus

    ... cognitive behavioral; Pain - back - chronic - cognitive behavioral; Chronic back pain - low - cognitive behavioral ... Assendelft WJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev . 2010;(7). PMID: 20614428 ...

  15. Connecting parents of children with chronic pain through art therapy

    PubMed Central

    Pielech, Melissa; Sieberg, Christine B.; Simons, Laura E.

    2014-01-01

    Objectives To help address the unique needs of parents of children with chronic pain, a four module, parent-only, group art therapy curriculum was designed and implemented within an interdisciplinary pain rehabilitation treatment program. We evaluated perceived satisfaction and helpfulness of the group intervention. Methods Fifty-three parents of children experiencing chronic pain enrolled in a day hospital interdisciplinary pain rehabilitation program participated. The voluntary parent art therapy group was offered one time per week for one hour. Participants completed a measure of satisfaction, helpfulness, and perceived social support at the end of each group session. Results Parents enjoyed participating in the group, agreed that they would try art therapy again, and found it to be a helpful, supportive, and validating experience. Conclusions Initial results are promising that group art therapy is an appropriate and helpful means of supporting parents of children with chronic pain during interdisciplinary pain rehabilitation. PMID:24563827

  16. Predicting Outcome in Acute Low-Back Pain

    PubMed Central

    Singer, Joel; Gilbert, J.R.; Hutton, Tim; Taylor, D.W.

    1987-01-01

    Patients presenting to their family physician with acute low-back pain were studied prospectively. Demographic factors and patient history at the initial visit were assessed to determine important predictors of selected clinical outcomes, including time to resumption of normal activities and time to relief from pain. While several predictors were significantly correlated with each of the outcomes assessed, the most consistent predictor of outcome proved to be the reported pain intensity at the initial visit. Baseline levels of pain intensity were related to expected time of recovery and probability of periodic pain in the future. Data collected in the initial history and physical examination of patients permit an assessment of factors that may be useful in establishing prognosis for relevant clinical outcomes. PMID:21263854

  17. Psychometric properties of the Brazilian version of the Pain Catastrophizing Scale for acute low back pain.

    PubMed

    Lopes, Renata Antunes; Dias, Rosângela Corrêa; Queiroz, Bárbara Zille de; Rosa, Nayza Maciel de Britto; Pereira, Leani de Souza Máximo; Dias, João Marcos Domingues; Magalhães, Lívia de Castro

    2015-05-01

    Measurement instruments of pain catastrophizing for middle-aged and elderly individuals are needed to understand its impact on low back pain. The goals were to cross-culturally adapt the Pain Catastrophizing Scale, assess the construct validity through Rasch analysis, and verify reliability and convergent validity of pain catastrophizing with psychosocial factors. 131 individuals aged 55 years and older with acute low back pain were interviewed . The intra-rater reliability was Kp = 0.80 and interrater Kp = 0.75. The Rasch analysis found adequate reliability coefficients (0.95 for items and 0.90 for individuals ). The separation index for the elderly was 2.95 and 4.59 items. Of the 13 items, one did not fit the model, which was justified in the sample evaluated. The pain catastrophizing correlated with most psychosocial factors. The instrument proved to be clinically useful. Subsequent studies should carry out the same analysis in different populations. PMID:26017211

  18. [Biofeedback therapy in a traumatised migrant with chronic pain].

    PubMed

    Morina, Naser; Müller, J

    2010-07-28

    We report on a 40-year-old Kurdish patient, who was imprisoned for six years for political reasons. The patient suffers from post-traumatic stress disorder and comorbid chronic pain. For a better pain management the patient was treated initially using biofeedback therapy. The intervention showed good effects on pain. Medical history, diagnosis, treatment plan and course of therapy are described. PMID:20715008

  19. Acute pancreatitis induced by paclitaxel and carboplatin therapy in an ovarian cancer patient.

    PubMed

    Shintani, D; Yoshida, H; Imai, Y; Fujiwara, K

    2016-01-01

    A 46-year-old female was treated with a regimen of paclitaxel and carboplatin (TC therapy) as adjuvant chemotherapy for Stage IC ovarian adenocarcinoma. There was no severe toxicity except for grade 3 neutropenia during the first four cycles of TC therapy. However, she developed acute pancreatitis at 14 days after fifth cycle. TC therapy is commonly associated with adverse effects such as myelosuppression, hypersensitivity, alopecia, and peripheral neuropathy, but acute pancreatitis has rarely been reported. Ovarian cancer patients often present with nausea and abdominal pain, which are the same symptoms of pancreatitis. It is very important to keep in mind that acute pancreatitis may be concealed in these common symptoms of ovarian cancer during and after TC therapy. Because acute pancreatitis is fatal complication and quitting the drug usually leads to complete cure. The authors report an uncommon case in which TC therapy may have caused acute pancreatitis. PMID:27172765

  20. Acute pancreatitis induced by paclitaxel and carboplatin therapy in an ovarian cancer patient.

    PubMed

    Shintani, D; Yoshida, H; Imai, Y; Fujiwara, K

    2016-01-01

    A 46-year-old female was treated with a regimen of paclitaxel and carboplatin (TC therapy) as adjuvant chemotherapy for Stage IC ovarian adenocarcinoma. There was no severe toxicity except for grade 3 neutropenia during the first four cycles of TC therapy. However, she developed acute pancreatitis at 14 days after fifth cycle. TC therapy is commonly associated with adverse effects such as myelosuppression, hypersensitivity, alopecia, and peripheral neuropathy, but acute pancreatitis has rarely been reported. Ovarian cancer patients often present with nausea and abdominal pain, which are the same symptoms of pancreatitis. It is very important to keep in mind that acute pancreatitis may be concealed in these common symptoms of ovarian cancer during and after TC therapy. Because acute pancreatitis is fatal complication and quitting the drug usually leads to complete cure. The authors report an uncommon case in which TC therapy may have caused acute pancreatitis.

  1. Evaluation of acute pelvic pain in women.

    PubMed

    Kruszka, Paul S; Kruszka, Stephen J

    2010-07-15

    Diagnosis of pelvic pain in women can be challenging because many symptoms and signs are insensitive and nonspecific. As the first priority, urgent life-threatening conditions (e.g., ectopic pregnancy, appendicitis, ruptured ovarian cyst) and fertility-threatening conditions (e.g., pelvic inflammatory disease, ovarian torsion) must be considered. A careful history focusing on pain characteristics, review of systems, and gynecologic, sexual, and social history, in addition to physical examination helps narrow the differential diagnosis. The most common urgent causes of pelvic pain are pelvic inflammatory disease, ruptured ovarian cyst, and appendicitis; however, many other diagnoses in the differential may mimic these conditions, and imaging is often needed. Transvaginal ultrasonography should be the initial imaging test because of its sensitivities across most etiologies and its lack of radiation exposure. A high index of suspicion should be maintained for pelvic inflammatory disease when other etiologies are ruled out, because the presentation is variable and the prevalence is high. Multiple studies have shown that 20 to 50 percent of women presenting with pelvic pain have pelvic inflammatory disease. Adolescents and pregnant and postpartum women require unique considerations.

  2. Evaluation of acute pelvic pain in women.

    PubMed

    Kruszka, Paul S; Kruszka, Stephen J

    2010-07-15

    Diagnosis of pelvic pain in women can be challenging because many symptoms and signs are insensitive and nonspecific. As the first priority, urgent life-threatening conditions (e.g., ectopic pregnancy, appendicitis, ruptured ovarian cyst) and fertility-threatening conditions (e.g., pelvic inflammatory disease, ovarian torsion) must be considered. A careful history focusing on pain characteristics, review of systems, and gynecologic, sexual, and social history, in addition to physical examination helps narrow the differential diagnosis. The most common urgent causes of pelvic pain are pelvic inflammatory disease, ruptured ovarian cyst, and appendicitis; however, many other diagnoses in the differential may mimic these conditions, and imaging is often needed. Transvaginal ultrasonography should be the initial imaging test because of its sensitivities across most etiologies and its lack of radiation exposure. A high index of suspicion should be maintained for pelvic inflammatory disease when other etiologies are ruled out, because the presentation is variable and the prevalence is high. Multiple studies have shown that 20 to 50 percent of women presenting with pelvic pain have pelvic inflammatory disease. Adolescents and pregnant and postpartum women require unique considerations. PMID:20642266

  3. Acute low back pain: a comprehensive review.

    PubMed

    Della-Giustina, D; Kilcline, B A

    2000-01-01

    Low back pain is commonly seen in the primary care setting. Although the majority of patients have a benign etiology for their symptoms, one must approach these patients in a systematic fashion, looking for "red flags" of serious disease. PMID:10984818

  4. Acute renal infarction: an unusual cause of abdominal pain.

    PubMed

    Javaid, Muhammad M; Butt, Mohammed A; Syed, Yadullah; Carr, Patrick

    2009-01-01

    Acute renal infarction is an uncommon and under-diagnosed disease. Its clinical presentation is nonspecific and often mimics other more common disease entities. The diagnosis is usually missed or delayed, which frequently results in irreversible renal parenchyma damage. High index of suspicion is required for early diagnosis, as timely intervention may prevent loss of kidney function. We report a case of acute renal infarction following coronary angiography in a patient with paroxysmal atrial fibrillation who initially presented with acute abdominal pain mimicking appendicitis.

  5. A nurse-initiated pain protocol in the ED improves pain treatment in patients with acute musculoskeletal pain.

    PubMed

    Pierik, Jorien G J; Berben, Sivera A; IJzerman, Maarten J; Gaakeer, Menno I; van Eenennaam, Fred L; van Vugt, Arie B; Doggen, Carine J M

    2016-07-01

    While acute musculoskeletal pain is a frequent complaint, its management is often neglected. An implementation of a nurse-initiated pain protocol based on the algorithm of a Dutch pain management guideline in the emergency department might improve this. A pre-post intervention study was performed as part of the prospective PROTACT follow-up study. During the pre- (15 months, n = 504) and post-period (6 months, n = 156) patients' self-reported pain intensity and pain treatment were registered. Analgesic provision in patients with moderate to severe pain (NRS ≥4) improved from 46.8% to 68.0%. Over 10% of the patients refused analgesics, resulting into an actual analgesic administration increase from 36.3% to 46.1%. Median time to analgesic decreased from 10 to 7 min (P < 0.05), whereas time to opioids decreased from 37 to 15 min (P < 0.01). Mean pain relief significantly increased to 1.56 NRS-points, in patients who received analgesic treatment even up to 2.02 points. The protocol appeared to lead to an increase in analgesic administration, shorter time to analgesics and a higher clinically relevant pain relief. Despite improvements, suffering moderate to severe pain at ED discharge was still common. Protocol adherence needs to be studied in order to optimize pain management. PMID:26968352

  6. An overview of novel therapies for acute hereditary angioedema.

    PubMed

    Firszt, Rafael; Frank, Michael M

    2010-12-01

    Hereditary angioedema is an episodic swelling disorder with autosomal dominant inheritance. Attacks are characterized by nonpitting edema of external or mucosal body surfaces. Patients often present with swelling of the extremities, abdominal pain, and swelling of the mouth and throat, which can at times lead to asphyxiation. The disease is caused by a mutation in the gene encoding the complement C1-inhibitor protein, which leads to unregulated production of bradykinin. Long-term therapy has depended on the use of attenuated androgens or plasmin inhibitors but in the US there was, until recently, no specific therapy for acute attacks. As well, many patients with hereditary angioedema in the US were either not adequately controlled on previously available therapies or required doses of medications that exposed them to the risk of serious adverse effects. Five companies have completed or are currently conducting phase III clinical trials in the development of specific therapies to terminate acute attacks or to be used as prophylaxis. These products are based on either replacement therapy with purified plasma-derived or recombinant C1-inhibitor, or inhibition of the kinin-generating pathways with a recombinant plasma kallikrein inhibitor or bradykinin type 2 receptor antagonist. Published studies thus far suggest that all of these products are likely to be effective. These new therapies will likely lead to a totally new approach in treating hereditary angioedema. PMID:20866113

  7. Complementary and alternative pain therapy in the emergency department.

    PubMed

    Dillard, James N; Knapp, Sharon

    2005-05-01

    One primary reason patients go to emergency departments is for pain relief. Understanding the physiologic dynamics of pain, pharmacologic methods for treatment of pain, as well CAM therapies used in treatment of pain is important to all providers in emergency care. Asking patients about self-care and treatments used outside of the emergency department is an important part of the patient history. Complementary and alternative therapies are very popular for painful conditions despite the lack of strong research supporting some of their use. Even though evidenced-based studies that are double blinded and show a high degree of interrater observer reliability do not exist, patients will likely continue to seek out CAM therapies as a means of self-treatment and a way to maintain additional life control. Regardless of absolute validity of a therapy for some patients, it is the bottom line: "it seems to help my pain." Pain management distills down to a very simple endpoint, patient relief, and comfort. Sham or science, if the patient feels better, feels comforted, feels less stressed, and more functional in life and their practices pose no health risk, then supporting their CAM therapy creates a true wholistic partnership in their health care.CAM should be relatively inexpensive and extremely safe. Such is not always the case, as some patients have discovered with the use of botanicals. It becomes an imperative that all providers be aware of CAM therapies and informed about potential interactions and side effects when helping patients manage pain and explore adding CAM strategies for pain relief. The use of regulated breathing, meditation, guided imagery, or a massage for a pain sufferer are simple but potentially beneficial inexpensive aids to care that can be easily employed in the emergency department. Some CAM therapies covered here, while not easily practiced in the emergency department, exist as possibilities for exploration of patients after they leave, and may

  8. Complementary and alternative pain therapy in the emergency department.

    PubMed

    Dillard, James N; Knapp, Sharon

    2005-05-01

    One primary reason patients go to emergency departments is for pain relief. Understanding the physiologic dynamics of pain, pharmacologic methods for treatment of pain, as well CAM therapies used in treatment of pain is important to all providers in emergency care. Asking patients about self-care and treatments used outside of the emergency department is an important part of the patient history. Complementary and alternative therapies are very popular for painful conditions despite the lack of strong research supporting some of their use. Even though evidenced-based studies that are double blinded and show a high degree of interrater observer reliability do not exist, patients will likely continue to seek out CAM therapies as a means of self-treatment and a way to maintain additional life control. Regardless of absolute validity of a therapy for some patients, it is the bottom line: "it seems to help my pain." Pain management distills down to a very simple endpoint, patient relief, and comfort. Sham or science, if the patient feels better, feels comforted, feels less stressed, and more functional in life and their practices pose no health risk, then supporting their CAM therapy creates a true wholistic partnership in their health care.CAM should be relatively inexpensive and extremely safe. Such is not always the case, as some patients have discovered with the use of botanicals. It becomes an imperative that all providers be aware of CAM therapies and informed about potential interactions and side effects when helping patients manage pain and explore adding CAM strategies for pain relief. The use of regulated breathing, meditation, guided imagery, or a massage for a pain sufferer are simple but potentially beneficial inexpensive aids to care that can be easily employed in the emergency department. Some CAM therapies covered here, while not easily practiced in the emergency department, exist as possibilities for exploration of patients after they leave, and may

  9. Role of the Cannabinoid System in Pain Control and Therapeutic Implications for the Management of Acute and Chronic Pain Episodes

    PubMed Central

    Manzanares, J; Julian, MD; Carrascosa, A

    2006-01-01

    Cannabis extracts and synthetic cannabinoids are still widely considered illegal substances. Preclinical and clinical studies have suggested that they may result useful to treat diverse diseases, including those related with acute or chronic pain. The discovery of cannabinoid receptors, their endogenous ligands, and the machinery for the synthesis, transport, and degradation of these retrograde messengers, has equipped us with neurochemical tools for novel drug design. Agonist-activated cannabinoid receptors, modulate nociceptive thresholds, inhibit release of pro-inflammatory molecules, and display synergistic effects with other systems that influence analgesia, especially the endogenous opioid system. Cannabinoid receptor agonists have shown therapeutic value against inflammatory and neuropathic pains, conditions that are often refractory to therapy. Although the psychoactive effects of these substances have limited clinical progress to study cannabinoid actions in pain mechanisms, preclinical research is progressing rapidly. For example, CB1mediated suppression of mast cell activation responses, CB2-mediated indirect stimulation of opioid receptors located in primary afferent pathways, and the discovery of inhibitors for either the transporters or the enzymes degrading endocannabinoids, are recent findings that suggest new therapeutic approaches to avoid central nervous system side effects. In this review, we will examine promising indications of cannabinoid receptor agonists to alleviate acute and chronic pain episodes. Recently, Cannabis sativa extracts, containing known doses of tetrahydrocannabinol and cannabidiol, have granted approval in Canada for the relief of neuropathic pain in multiple sclerosis. Further double-blind placebo-controlled clinical trials are needed to evaluate the potential therapeutic effectiveness of various cannabinoid agonists-based medications for controlling different types of pain. PMID:18615144

  10. A Brain Signature to Differentiate Acute and Chronic Pain in Rats

    PubMed Central

    Guo, Yifei; Wang, Yuzheng; Sun, Yabin; Wang, Jin-Yan

    2016-01-01

    The transition from acute pain to chronic pain entails considerable changes of patients at multiple levels of the nervous system and in psychological states. An accurate differentiation between acute and chronic pain is essential in pain management as it may help optimize analgesic treatments according to the pain state of patients. Given that acute and chronic pain could modulate brain states in different ways and that brain states could greatly shape the neural processing of external inputs, we hypothesized that acute and chronic pain would show differential effects on cortical responses to non-nociceptive sensory information. Here by analyzing auditory-evoked potentials (AEPs) to pure tones in rats with acute or chronic pain, we found opposite influences of acute and chronic pain on cortical responses to auditory inputs. In particular, compared to no-pain controls, the N100 wave of rat AEPs was significantly enhanced in rats with acute pain but significantly reduced in rats with chronic pain, indicating that acute pain facilitated cortical processing of auditory information while chronic pain exerted an inhibitory effect. These findings could be justified by the fact that individuals suffering from acute or chronic pain would have different vigilance states, i.e., the vigilance level to external sensory stimuli would be increased with acute pain, but decreased with chronic pain. Therefore, this auditory response holds promise of being a brain signature to differentiate acute and chronic pain. Instead of investigating the pain system per se, the study of pain-induced influences on cortical processing of non-nocicpetive sensory information might represent a potential strategy to monitor the progress of pain chronification in clinical applications. PMID:27199727

  11. Actinomyces infection causing acute right iliac fossa pain

    PubMed Central

    Govindarajah, Narendranath; Hameed, Waseem; Middleton, Simon; Booth, Michael

    2014-01-01

    This is a case of a 75-year-old man being admitted to the on-call surgical department with acute abdominal pain. On arrival he was clinically dehydrated and shocked with localised pain over McBurney's point and examination findings were suggestive of appendiceal or other colonic pathology. Full blood testing revealed a white cell count of 38×109/L and a C reactive protein (CRP) of 278 mg/L. A CT scan revealed a gallbladder empyema that extended into the right iliac fossa. This case highlights the potential for a hyperdistended gallbladder empyema to present as acute right iliac fossa pain with blood tests suggestive of complicated disease. Further analysis confirmed Actinomyces infection as the underlying aetiology prior to a laparoscopic subtotal cholecystectomy. This case serves to remind clinicians of this as a rare potential cause of atypical gallbladder pathology. PMID:24872493

  12. Acute abdominal pain and constipation due to lead poisoning.

    PubMed

    Mongolu, S; Sharp, P

    2013-01-01

    Although uncommon, lead poisoning should be considered as a differential diagnosis in cases of unexplained acute abdominal pain in both adults and children. We present the case of a 35-year-old Asian male who presented with abdominal pain and constipation secondary to lead poisoning. Initially, the source of lead exposure was not apparent; this was later found to be due to ingestion of an Ayurvedic herbal medicine for the treatment of infertility. Lead poisoning due to the ingestion of Ayurvedic remedies is well described. We discuss the diagnosis, pathophysiology and treatment of lead poisoning. This case illustrates one of the rarer medical causes of acute abdominal pain and emphasizes the need to take a thorough history (including specific questioning regarding the use of over-the-counter and traditional/ herbal remedies) in cases of suspected poisoning or drug toxicity.

  13. The transcendental meditation technique and acute experimental pain.

    PubMed

    Mills, W W; Farrow, J T

    1981-04-01

    The Transcendental Meditation (TM) technique decreases the distress associated with the experience of acute experimental pain. Fifteen advanced mediators and 15 controls were administered the cold pressor test before and after a 20 minute period of meditation (TM group) or relaxation (control group). Verbal reports of the intensity of pain sensation and pain distress were obtained at intervals during the cold pressor trials. Skin resistance and heart rate were measured throughout. The mean distress level for the TM group was significantly lower than controls during both trials; the mean pain sensation level for the TM group did not differ significantly from controls during either trial. Heart rate and skin resistant changed for both groups in the expected manner, with no significant differences between groups. The validity, implications, and possible causes of these results are discussed.

  14. Evaluating and Managing Acute Low Back Pain in the Primary Care Setting

    PubMed Central

    Atlas, Steven J; Deyo, Richard A

    2001-01-01

    Acute low back pain is a common reason for patient calls or visits to a primary care clinician. Despite a large differential diagnosis, the precise etiology is rarely identified, although musculoligamentous processes are usually suspected. For most patients, back symptoms are nonspecific, meaning that there is no evidence for radicular symptoms or underlying systemic disease. Because episodes of acute, nonspecific low back pain are usually self-limited, many patients treat themselves without contacting their primary care clinician. When patients do call or schedule a visit, evaluation and management by primary care clinicians is appropriate. The history and physical examination usually provide clues to the rare but potentially serious causes of low back pain, as well as to identify patients at risk for prolonged recovery. Diagnostic testing, including plain x-rays, is often unnecessary during the initial evaluation. For patients with acute, nonspecific low back pain, the primary emphasis of treatment should be conservative care, time, reassurance, and education. Current recommendations focus on activity as tolerated (though not active exercise while pain is severe) and minimal if any bed rest. Referral for physical treatments is most appropriate for patients whose symptoms are not improving over 2 to 4 weeks. Specialty referral should be considered for patients with a progressive neurologic deficit, failure of conservative therapy, or an uncertain or serious diagnosis. The prognosis for most patients is good, although recurrence is common. Thus, educating patients about the natural history of acute low back pain and how to prevent future episodes can help ensure reasonable expectations. PMID:11251764

  15. Trajectories of acute low back pain: a latent class growth analysis.

    PubMed

    Downie, Aron S; Hancock, Mark J; Rzewuska, Magdalena; Williams, Christopher M; Lin, Chung-Wei Christine; Maher, Christopher G

    2016-01-01

    Characterising the clinical course of back pain by mean pain scores over time may not adequately reflect the complexity of the clinical course of acute low back pain. We analysed pain scores over 12 weeks for 1585 patients with acute low back pain presenting to primary care to identify distinct pain trajectory groups and baseline patient characteristics associated with membership of each cluster. This was a secondary analysis of the PACE trial that evaluated paracetamol for acute low back pain. Latent class growth analysis determined a 5 cluster model, which comprised 567 (35.8%) patients who recovered by week 2 (cluster 1, rapid pain recovery); 543 (34.3%) patients who recovered by week 12 (cluster 2, pain recovery by week 12); 222 (14.0%) patients whose pain reduced but did not recover (cluster 3, incomplete pain recovery); 167 (10.5%) patients whose pain initially decreased but then increased by week 12 (cluster 4, fluctuating pain); and 86 (5.4%) patients who experienced high-level pain for the whole 12 weeks (cluster 5, persistent high pain). Patients with longer pain duration were more likely to experience delayed recovery or nonrecovery. Belief in greater risk of persistence was associated with nonrecovery, but not delayed recovery. Higher pain intensity, longer duration, and workers' compensation were associated with persistent high pain, whereas older age and increased number of episodes were associated with fluctuating pain. Identification of discrete pain trajectory groups offers the potential to better manage acute low back pain.

  16. Trajectories of acute low back pain: a latent class growth analysis.

    PubMed

    Downie, Aron S; Hancock, Mark J; Rzewuska, Magdalena; Williams, Christopher M; Lin, Chung-Wei Christine; Maher, Christopher G

    2016-01-01

    Characterising the clinical course of back pain by mean pain scores over time may not adequately reflect the complexity of the clinical course of acute low back pain. We analysed pain scores over 12 weeks for 1585 patients with acute low back pain presenting to primary care to identify distinct pain trajectory groups and baseline patient characteristics associated with membership of each cluster. This was a secondary analysis of the PACE trial that evaluated paracetamol for acute low back pain. Latent class growth analysis determined a 5 cluster model, which comprised 567 (35.8%) patients who recovered by week 2 (cluster 1, rapid pain recovery); 543 (34.3%) patients who recovered by week 12 (cluster 2, pain recovery by week 12); 222 (14.0%) patients whose pain reduced but did not recover (cluster 3, incomplete pain recovery); 167 (10.5%) patients whose pain initially decreased but then increased by week 12 (cluster 4, fluctuating pain); and 86 (5.4%) patients who experienced high-level pain for the whole 12 weeks (cluster 5, persistent high pain). Patients with longer pain duration were more likely to experience delayed recovery or nonrecovery. Belief in greater risk of persistence was associated with nonrecovery, but not delayed recovery. Higher pain intensity, longer duration, and workers' compensation were associated with persistent high pain, whereas older age and increased number of episodes were associated with fluctuating pain. Identification of discrete pain trajectory groups offers the potential to better manage acute low back pain. PMID:26397929

  17. Fentanyl Iontophoretic Transdermal System: A Review in Acute Postoperative Pain.

    PubMed

    Scott, Lesley J

    2016-04-01

    Fentanyl iontophoretic transdermal system (ITS) [Ionsys(®)] is indicated for the management of acute postoperative pain in adults requiring opioid analgesia in the hospital setting. This article reviews the clinical use of fentanyl ITS for postoperative pain management, and summarizes the pharmacology of fentanyl and the characteristics of the two-component fentanyl ITS (Ionsys(®)) device. In well-designed, multicentre clinical trials, fentanyl ITS was an effective and generally well tolerated method for managing acute postoperative pain in inpatients who had undergone major abdominal, thoracic or orthopaedic surgery. Overall, fentanyl ITS provided equivalent analgesic efficacy to that with morphine patient-controlled intravenous analgesia (PCIA), but was perceived to be more convenient/easier to use than morphine PCIA by patients, nurses and physical therapists. Patients receiving fentanyl ITS also had a greater ability to mobilize after surgery than patients receiving morphine PCIA. In addition, relative to morphine PCIA, fentanyl ITS offers advantages in terms of the noninvasive administrative route (i.e. transdermal needle-free administration), pre-programmed delivery (no risk of programming errors/incorrect dosing) and improved tolerability with regard to the overall incidence of opioid-related adverse events (ORAEs) and some individual ORAEs. Hence, fentanyl ITS is a useful option for the management of acute postoperative pain in adults requiring opioid analgesia in the hospital setting.

  18. Systematic review of dexketoprofen in acute and chronic pain

    PubMed Central

    Moore, R Andrew; Barden, Jodie

    2008-01-01

    Background Dexketoprofen, an NSAID used in the management of acute and chronic pains, is licensed in several countries but has not previously been the subjected of a systematic review. We used published and unpublished information from randomised clinical trials (RCTs) of dexketoprofen in painful conditions to assess evidence on efficacy and harm. Methods PubMed and Cochrane Central were searched for RCTs of dexketoprofen for pain of any aetiology. Reference lists of retrieved articles and reviews were also searched. Menarini Group produced copies of published and unpublished studies (clinical trial reports). Data were abstracted into a standard form. For studies reporting results of single dose administration, the number of patients with at least 50% pain relief was derived and used to calculate the relative benefit (RB) and number-needed-to-treat (NNT) for one patient to achieve at least 50% pain relief compared with placebo. Results Thirty-five trials were found in acute pain and chronic pain; 6,380 patients were included, 3,381 receiving dexketoprofen. Information from 16 trials (almost half the total patients) was obtained from clinical trial reports from previously unpublished trials or abstracts. Almost all of the trials were of short duration in acute conditions or recent onset pain. All 12 randomised trials that compared dexketoprofen (any dose) with placebo found dexketoprofen to be statistically superior. Five trials in postoperative pain yielded NNTs for 12.5 mg dexketoprofen of 3.5 (2.7 to 4.9), 25 mg dexketoprofen of 3.0 (2.4 to 3.9), and 50 mg dexketoprofen of 2.1 (1.5 to 3.5). In 29/30 active comparator trials, dexketoprofen at the dose used was at least equivalent in efficacy to comparator drugs. Adverse event withdrawal rates were low in postoperative pain and somewhat higher in trials of longer duration; no serious adverse events were reported. Conclusion Dexketoprofen was at least as effective as other NSAIDs and paracetamol/opioid combinations

  19. Complementary and alternative medicine therapies for chronic pain.

    PubMed

    Bauer, Brent A; Tilburt, Jon C; Sood, Amit; Li, Guang-Xi; Wang, Shi-Han

    2016-06-01

    Pain afflflicts over 50 million people in the US, with 30.7% US adults suffering with chronic pain. Despite advances in therapies, many patients will continue to deal with ongoing symptoms that are not fully addressed by the best conventional medicine has to offer them. The patients frequently turn to therapies outside the usual purview of conventional medicine (herbs, acupuncture, meditation, etc.) called complementary and alternative medicine (CAM). Academic and governmental groups are also starting to incorporate CAM recommendations into chronic pain management strategies. Thus, for any physician who care for patients with chronic pain, having some familiarity with these therapies-including risks and benefits-will be key to helping guide patients in making evidence-based, well informed decisions about whether or not to use such therapies. On the other hand, if a CAM therapy has evidence of both safety and efficacy then not making it available to a patient who is suffering does not meet the need of the patient. We summarize the current evidence of a wide variety of CAM modalities that have potential for helping patients with chronic pain in this article. The triad of chronic pain symptoms, ready access to information on the internet, and growing patient empowerment suggest that CAM therapies will remain a consistent part of the healthcare of patients dealing with chronic pain. PMID:27339090

  20. Complementary and alternative medicine therapies for chronic pain.

    PubMed

    Bauer, Brent A; Tilburt, Jon C; Sood, Amit; Li, Guang-Xi; Wang, Shi-Han

    2016-06-01

    Pain afflflicts over 50 million people in the US, with 30.7% US adults suffering with chronic pain. Despite advances in therapies, many patients will continue to deal with ongoing symptoms that are not fully addressed by the best conventional medicine has to offer them. The patients frequently turn to therapies outside the usual purview of conventional medicine (herbs, acupuncture, meditation, etc.) called complementary and alternative medicine (CAM). Academic and governmental groups are also starting to incorporate CAM recommendations into chronic pain management strategies. Thus, for any physician who care for patients with chronic pain, having some familiarity with these therapies-including risks and benefits-will be key to helping guide patients in making evidence-based, well informed decisions about whether or not to use such therapies. On the other hand, if a CAM therapy has evidence of both safety and efficacy then not making it available to a patient who is suffering does not meet the need of the patient. We summarize the current evidence of a wide variety of CAM modalities that have potential for helping patients with chronic pain in this article. The triad of chronic pain symptoms, ready access to information on the internet, and growing patient empowerment suggest that CAM therapies will remain a consistent part of the healthcare of patients dealing with chronic pain.

  1. [Drug treatment and interventional pain therapy in back pain patients].

    PubMed

    Sprott, Haiko; Klauke, Wolfgang

    2013-09-01

    The treatment of chronic, non-malignant low-back pain is based on the patients' history and the clinical examination. It can be assumed that half of the cases present with a neuropathic pain component which needs to be treated with antidepressive and antiepileptic drugs instead of "pure" analgesics. Opioids should be considered with extreme caution because of their toxicity. Chronic non-malignant back pain is the prototype for interdisciplinary treatment approaches and multi-modal interdisciplinary settings, including pain programmes. However, a personalised strategy has to be preferred in most cases. A quick relief of pain is important in order to improve function as well as to re-integrate the patient into professional life. Spinal infiltrations can be of both diagnostic as well as therapeutic benefits. Their indication must be considered carefully, especially if the invasive diagnostic intervention has no therapeutic consequences. The interventional procedures should only be used as part of a multimodal approach in patients without any psychological problem. The sole use of interventions supports the purely somatic orientation of many patients and thus leads us in the wrong direction.

  2. Acute low back pain: diagnostics and treatment.

    PubMed

    Becker, F C

    2001-03-01

    How many times have you heard from a patient or groaned yourself "Oh, my aching back?" Innocuous movements such as reaching, stooping, or leaning are halted mid-performance as you sense "something" give, catch, snap, grab, or slide in your lower back. Such subjective complaints may also include sensations of discomfort described as stabbing, sharp, dull, hot/burning, tingling, or numbing. In practice, you will be required to assess these subjective symptoms, effectively document objective data, formulate a diagnosis, and plan appropriate treatment for your patients. Careful attention to history, associated symptoms, and following a systematic approach to back pain can make the rule-in/out differentials less taxing on both the practitioner and the patient.

  3. Topical rubefacients for acute and chronic pain in adults

    PubMed Central

    Matthews, Paul; Derry, Sheena; Moore, R Andrew; McQuay, Henry J

    2014-01-01

    Background Rubefacients (containing salicylates or nicotinamides) cause irritation of the skin, and are believed to relieve various musculoskeletal pains. They are available on prescription, and are common components in over-the-counter remedies. A non-Cochrane review in 2004 found limited evidence for efficacy. Objectives To review current evidence for efficacy and safety of topically applied rubefacients in acute and chronic painful musculoskeletal conditions in adults. Search methods Cochrane CENTRAL, MEDLINE, EMBASE, the Oxford Pain Relief Database, and reference lists of articles were searched; last search December 2008. Selection criteria Randomised, double blind, placebo or active controlled clinical trials of topical rubefacient for musculoskeletal pain in adults, with at least 10 participants per treatment arm, and reporting outcomes at close to 7 (minimum 3, maximum 10) days for acute conditions and 14 (minimum 7) days or longer for chronic conditions. Data collection and analysis Two review authors independently assessed trials for inclusion and quality, and extracted data. Relative benefit or risk and number needed to treat to benefit or harm (NNT or NNH) were calculated with 95% confidence intervals (CI). Acute and chronic conditions were analysed separately. Main results Six placebo and one active controlled studies (560 and 137 participants) in acute pain, and seven placebo and two active controlled studies (489 and 90 participants) in chronic pain were included. All used topical salicylates. The evidence in acute conditions was not robust; using only better quality, valid studies, there was no difference between topical rubefacient and topical control, though overall, including lower quality studies, the NNT for clinical success compared with placebo was 3.2 (95% CI: 2.4 to 4.9). In chronic conditions the NNT was 6.2 (95% CI: 4.0 to 13) compared with topical placebo. Adverse events and withdrawals occurred more often with rubefacients than placebo

  4. Acute abdominal pain in childhood, with special reference to cases not due to acute appendicitis.

    PubMed

    Jones, P F

    1969-02-01

    Appendicitis is not the only common cause of acute abdominal pain in childhood. Almost equally common is an acute episode which in its early stages resembles acute appendicitis but which subsides without treatment in 24 to 48 hours. The clinical features of this syndrome are contrasted with those of appendicitis. The two conditions cannot always be distinguished on clinical grounds, leading to admission to hospital for observation and the finding of a normal appendix in 14% of operations for suspected appendicitis. Reasons are given for abandoning attempts to diagnose acute mesenteric adenitis at the bedside.

  5. Lumbar Disc Screening Using Back Pain Questionnaires: Oswestry Low Back Pain Score, Aberdeen Low Back Pain Scale, and Acute Low Back Pain Screening Questionnaire

    PubMed Central

    Kim, Do Yeon; Oh, Chang Hyun; Park, Hyung Chun; Park, Chong Oon

    2012-01-01

    Objective To evaluate the usefulness of back pain questionnaires for lumbar disc screening among Korean young males. Methods We carried out a survey for lumbar disc screening through back pain questionnaires among the volunteers with or without back pain. Three types of back pain questionnaire (Oswestry Low Back Pain Score, Aberdeen Low Back Pain Scale, and Acute Low Back Pain Screeing Questionnaire) were randomly assigned to the examinees. The authors reviewed lumbar imaging studies (simple lumbar radiographs, lumbar computed tomography, and magnetic resolutional images), and the severity of lumbar disc herniation was categorized according to the guidelines issued by the Korean military directorate. We calculated the relationship between the back pain questionnaire scores and the severity of lumbar disc herniation. Results The scores of back pain questionnaires increased according to the severity of lumbar disc herniation. But, the range of scores was very vague, so it is less predictable to detect lumbar disc herniation using only back pain questionnaires. The sensitivity between the back pain questionnaires and the presence of lumbar disc herniation was low (16-64%). Conclusion Screening of lumbar disc herniation using only back pain questionnaires has limited value. PMID:25983807

  6. Pain management in the acute care setting: Update and debates.

    PubMed

    Palmer, Greta M

    2016-02-01

    Pain management in the paediatric acute care setting is underutilised and can be improved. An awareness of the analgesic options available and their limitations is an important starting point. This article describes the evolving understanding of relevant pharmacogenomics and safety data of the various analgesic agents with a focus on agents available in Australia and New Zealand. It highlights the concerns with the use of codeine in children and discusses alternative oral opioids. Key features of oral, parenteral, inhaled and intranasal analgesic agents are discussed, as well as evidence supported use of sweet tasting solutions and non-pharmacological interventions. One of the biggest changes in acute care pain management has been the advent of intranasal fentanyl providing reliable potent analgesia without the need for intravenous access. The article will also address the issue of multimodal analgesia where a single agent is insufficient.

  7. Carbamazepine for acute and chronic pain in adults

    PubMed Central

    Wiffen, Philip J; Derry, Sheena; Moore, R Andrew; McQuay, Henry J

    2014-01-01

    Background Carbamazepine is used to treat chronic neuropathic pain. Objectives Evaluation of analgesic efficacy and adverse effects of carbamazepine for acute and chronic pain management (except headaches). Search methods Randomised controlled trials (RCTs) of carbamazepine in acute, chronic or cancer pain were identified, searching MEDLINE, EMBASE, SIGLE and Cochrane CENTRAL to June 2010, reference lists of retrieved papers, and reviews. Selection criteria RCTs reporting the analgesic effects of carbamazepine. Data collection and analysis Two authors independently extracted results and scored for quality. Numbers needed to treat to benefit (NNT) or harm (NNH) with 95% confidence intervals (CI) were calculated from dichotomous data for effectiveness, adverse effects and adverse event withdrawal. Issues of study quality, size, duration, and outcomes were examined. Main results Fifteen included studies (12 cross-over design; three parallel-group) with 629 participants. Carbamazepine was less effective than prednisolone in preventing postherpetic neuralgia following acute herpes zoster (1 study, 40 participants). No studies examined acute postoperative pain. Fourteen studies investigated chronic neuropathic pain: two lasted eight weeks, others were four weeks or less (mean 3 weeks, median 2 weeks). Five had low reporting quality. Ten involved fewer than 50 participants; mean and median maximum treatment group sizes were 34 and 29. Outcome reporting was inconsistent. Most placebo controlled studies indicated that carbamazepine was better than placebo. Five studies with 298 participants provided dichotomous results; 70% improved with carbamazepine and 12% with placebo. Carbamazepine at any dose, using any definition of improvement was significantly better than placebo (70% versus 12% improved; 5 studies, 298 participants); relative benefit 6.1 (3.9 to 9.7), NNT 1.7 (1.5 to 2.0). Four studies (188 participants) reporting outcomes equivalent to 50% pain reduction or more

  8. Topical NSAIDs for acute pain: a meta-analysis

    PubMed Central

    Mason, Lorna; Moore, R Andrew; Edwards, Jayne E; Derry, Sheena; McQuay, Henry J

    2004-01-01

    Background A previous systematic review reported that topical NSAIDs were effective in relieving pain in acute conditions like sprains and strains, with differences between individual drugs for efficacy. More trials, a better understanding of trial quality and bias, and a reclassification of certain drugs necessitate a new review. Methods Studies were identified by searching electronic databases and writing to manufacturers. We selected randomised double blind trials comparing topical NSAID with either placebo or another active treatment in adults with acute pain, and extracted dichotomous information approximating to a 50% reduction in pain at one week, together with details of adverse events and withdrawals. Relative benefit and number-needed-to-treat (NNT), and relative risk and number-needed-to-harm (NNH) were calculated, with sensitivity analyses where appropriate to investigate differences between individual drugs and aspects of trial design. Results Twenty-six double blind placebo controlled trials had information from 2,853 patients for evaluation of efficacy. Topical NSAID was significantly better than placebo in 19 of the 26 trials, with a pooled relative benefit of 1.6 (95% confidence interval 1.4 to 1.7), and NNT of 3.8 (95% confidence interval 3.4 to 4.4) compared with placebo for the outcome of half pain relief at seven days. Results were not affected by outcome reported, or condition treated, but smaller trials yielded a larger estimate of efficacy. Indirect comparisons of individual topical NSAIDs showed that ketoprofen was significantly better than all other topical NSAIDs, while indomethacin was barely distinguished from placebo. Three trials, with 433 patients, compared topical with oral NSAID (two trials compared the same drug, one compared different drugs) and found no difference in efficacy. Local adverse events, systemic adverse events, or withdrawals due to an adverse event were rare, and no different between topical NSAID and placebo

  9. Acute Abdominal Pain in the Bariatric Surgery Patient.

    PubMed

    Lewis, Kyle D; Takenaka, Katrin Y; Luber, Samuel D

    2016-05-01

    Obesity is present in epidemic proportions in the United States, and bariatric surgery has become more common. Thus, emergency physicians will undoubtedly encounter many patients who have undergone one of these procedures. Knowledge of the anatomic changes specific to these procedures aids the clinician in understanding potential complications and devising an organized differential diagnosis. This article reviews common bariatric surgery procedures, their complications, and the approach to acute abdominal pain in these patients. PMID:27133251

  10. [Pain, agitation and delirium in acute respiratory failure].

    PubMed

    Funk, G-C

    2016-02-01

    Avoiding pain, agitation and delirium as well as avoiding unnecessary deep sedation is a powerful yet challenging strategy in critical care medicine. A number of interactions between cerebral function and respiratory function should be regarded in patients with respiratory failure and mechanical ventilation. A cooperative sedation strategy (i.e. patient is awake and free of pain and delirium) is feasible in many patients requiring invasive mechanical ventilation. Especially patients with mild acute respiratory distress syndrome (ARDS) seem to benefit from preserved spontaneous breathing. While completely disabling spontaneous ventilation with or without neuromuscular blockade is not a standard strategy in ARDS, it might be temporarily required in patients with severe ARDS, who have substantial dyssynchrony or persistent hypoxaemia. Since pain, agitation and delirium compromise respiratory function they should also be regarded during noninvasive ventilation and during ventilator weaning. Pharmacological sedation can have favourable effects in these situations, but should not be given routinely or uncritically. PMID:26817653

  11. Cardiac computed tomography in patients with acute chest pain.

    PubMed

    Nieman, Koen; Hoffmann, Udo

    2015-04-14

    The efficient and reliable evaluation of patients with acute chest pain is one of the most challenging tasks in the emergency department. Coronary computed tomography (CT) angiography may play a major role, since it permits ruling out coronary artery disease with high accuracy if performed with expertise in properly selected and prepared patients. Several randomized trials have established early cardiac CT as a viable safe and potentially more efficient alternative to functional testing in the evaluation of acute chest pain. Ongoing investigations explore whether advanced anatomic and functional assessments such as high-risk coronary plaque, resting myocardial perfusion, and left ventricular function, or the simulation of the fractional coronary flow reserve will add information to the anatomic assessment for stenosis, which would allow expanding the benefits of cardiac CT from triage to treatment decisions. Especially, the combination of high-sensitive troponins and coronary computed tomography angiography may play a valuable role in future strategies for the management of patients presenting with acute chest pain.

  12. Acute postoperative pain management: focus on iontophoretic transdermal fentanyl

    PubMed Central

    Mattia, Consalvo; Coluzzi, Flaminia

    2007-01-01

    Despite progress in the management of chronic pain, acute pain remains an issue for many postoperative patients. Although patient-controlled analgesia (PCA) has demonstrated efficacy and patient satisfaction, current techniques using intravenous (IV) administration present limitations, including the risk of programming errors and the potential to limit patient mobility due to pumps, lines, and tubing. The patient-controlled fentanyl hydrochloride (HCl) iontophoretic transdermal system (fentanyl ITS) was designed to address these concerns. Fentanyl ITS is an innovative, needle-free, self-contained drug-delivery system that uses iontophoretic technology to deliver fentanyl through the skin by application of a low-intensity electrical field. The results of several clinical studies are presented in this review. In three phase 3 placebo-controlled trials, fentanyl ITS was shown to be superior to placebo for the treatment of postoperative pain following major abdominal, orthopedic, and thoracic surgery. The results of one active-comparator phase 3 trial demonstrated comparable safety and efficacy with a standard morphine IV PCA dosing regimen, without significant difference in the side effect profile. Fentanyl ITS represents a safe, easy to use, non-invasive, and convenient alternative to current acute postoperative pain management modalities. PMID:18360612

  13. Diclofenac Sodium Bolus Injection (Dyloject(TM)): A Review in Acute Pain Management.

    PubMed

    Hoy, Sheridan M

    2016-08-01

    An intravenous bolus formulation of the non-steroidal anti-inflammatory drug diclofenac sodium has been developed using hydroxypropyl-β-cyclodextrin (HPβCD) as a solubility enhancer. HPβCD diclofenac (Dyloject(TM)) is available for use in adults in the USA for the management of mild to moderate pain, and as monotherapy or in combination with opioid analgesics for the management of moderate to severe pain. In two multicentre, phase III studies in adults with acute moderate to severe postoperative pain, HPβCD diclofenac significantly reduced pain intensity and the need for rescue medication compared with placebo. In these studies, the tolerability profile of HPβCD diclofenac was generally similar to that of placebo and adverse events were mostly mild to moderate in severity. Constipation, infusion-site pain and dizziness were the most frequently reported adverse reactions occurring numerically more frequently with HPβCD diclofenac than placebo. Therapy with HPβCD diclofenac does not appear to be associated with an increased risk of cardiovascular, renal or bleeding-related adverse events versus placebo. Thus, HPβCD diclofenac extends the treatment options currently available for the management of moderate to severe postoperative pain in adults. PMID:27447189

  14. Hypnosis: adjunct therapy for cancer pain management.

    PubMed

    Kravits, Kathy

    2013-03-01

    Pain is a symptom associated with prolonged recovery from illness and procedures, decreased quality of life, and increased health-care costs. While there have been advances in the management of cancer pain, there is a need for therapeutic strategies that complement pharmaceutical management without significantly contributing to the side-effect profile of these agents. Hypnosis provides a safe and efficacious supplement to pharmaceutical management of cancer pain. One barrier to the regular use of hypnosis is health-care providers' lack of current knowledge of the efficacy and safety of hypnosis. Advanced practitioners who are well-informed about hypnosis have an opportunity to increase the treatment options for patients who are suffering with cancer pain by suggesting to the health-care team that hypnosis be incorporated into the plan of care. Integration of hypnosis into the standard of care will benefit patients, caregivers, and survivors by reducing pain and the suffering associated with it. PMID:25031986

  15. Hypnosis: Adjunct Therapy for Cancer Pain Management

    PubMed Central

    Kravits, Kathy

    2013-01-01

    Pain is a symptom associated with prolonged recovery from illness and procedures, decreased quality of life, and increased health-care costs. While there have been advances in the management of cancer pain, there is a need for therapeutic strategies that complement pharmaceutical management without significantly contributing to the side-effect profile of these agents. Hypnosis provides a safe and efficacious supplement to pharmaceutical management of cancer pain. One barrier to the regular use of hypnosis is health-care providers’ lack of current knowledge of the efficacy and safety of hypnosis. Advanced practitioners who are well-informed about hypnosis have an opportunity to increase the treatment options for patients who are suffering with cancer pain by suggesting to the health-care team that hypnosis be incorporated into the plan of care. Integration of hypnosis into the standard of care will benefit patients, caregivers, and survivors by reducing pain and the suffering associated with it. PMID:25031986

  16. [Group therapy of patients with chronic pain].

    PubMed

    Rosén, G; Kvåle, A; Husebø, S

    1990-11-20

    51 patients suffering chronic pain, with different diagnoses, were treated in groups as outpatients using a cognitive behavioural approach. Groups of 7-8 patients met for two hours a week for six weeks. The groups were led by a team consisting of a clinical psychologist, a physiotherapist and a doctor. The patients learned about different aspects of pain, self-exercise and relaxation by selfhypnosis. Group dynamics was used to strengthen self-esteem, facilitate learning and encourage a change of attitude towards pain. Each patient answered a questionnaire about activities, level of pain, drugs and psychological symptoms before and immediately after treatment, and at follow-up one year later. At follow-up, 43% were less depressed, 70% felt less pain and 50% were more active and used less drugs.

  17. Can a back pain screening tool help classify patients with acute pain into risk levels for chronic pain?

    PubMed Central

    Mehling, W.E.; Avins, A.L.; Acree, M.C.; Carey, T.S.; Hecht, F.M.

    2016-01-01

    Background The 9-item STarT-Back screening tool was developed in primary care patients with low back pain (LBP) to identify those at greatest risk for chronic pain and requiring targeted treatment. We conducted a secondary data analysis study to examine the performance of comparable questionnaire items in a sample of primary care patients with well-defined acute LBP. Methods In a prospective cohort study, 605 primary care patients with LBP of less than 30 days answered a questionnaire with 6 items identical and 3 items analogous to the 9-item STarT-Back. Participants were followed up at 6 months and 2 years. STarT-Back rules were applied to classify participant's risk of chronic LBP, and the performance of the screening items in predicting outcomes was assessed using likelihood ratios. Results The proportion of patients with chronic pain at follow-up was considerably lower (6 months: 22%; 2 years: 25%) than in the STarT-Back validation cohort (40%) of patients with pain of any duration. The probability of developing chronic pain given a high-risk designation by items similar to the STarT-Back increased the pre-test probability to 31% and 35%. Likelihood ratios were close to 1. Conclusions A risk classification schema using the recommended cut-off scores with items similar to the STarT-Back in a primary care population with strictly defined acute LBP had limited ability to identify persons who progressed to chronic pain. The results suggest caution when applying the STarT-Back in patients with acute LBP and a need to consider a modification of its cut-offs. PMID:25381748

  18. Backfire: AHCPR practice guideline for acute low back pain.

    PubMed

    de Jong, R H

    1995-11-01

    The AHCPR "Guideline for Acute Low Back Problems in Adults" is a must-read for every South Carolina physician treating low back pain. The 25-page pamphlet excels as a practical guide for swiftly triaging acute low back problems into the 90 percent majority who recover within a month, from the few "red flag" and "red herring" serious back problems requiring urgent attention. But the Guideline panel overstepped its policymaking mandate by venturing into the quicksand of treatment by committee edict, rather than by on-the-spot caretakers. The rumbling backfire is that U. S. Government document, intended as practice guideline for routine acute back care, will come to haunt us as a practice standard for all back care. One-size-fits-all proposals for the majority short-change the few with more demanding healthcare resource requirements. Be sure to read the pamphlet; your patients, insurers, providers, administrators, journalists and attorneys will! PMID:8544439

  19. Pain control during fixed orthodontic appliance therapy.

    PubMed

    Polat, Omur; Karaman, Ali Ihya

    2005-03-01

    The control of pain during orthodontic treatment is of great interest to both clinicians and patients. However, there has been limited research into the control of this pain, and there is no standard of care for controlling this discomfort. This prospective study determines the pain sequelae in fixed orthodontic treatment and evaluates comparatively the analgesic effects of nonsteroidal anti-inflammatory drugs for the control of this pain. One hundred and fifty orthodontic patients who were to have teeth bonded in at least one arch were randomly assigned to one of six groups: (1) placebo/placebo, (2) ibuprofen/ibuprofen, (3) flurbiprofen/flurbiprofen, (4) acetaminophen/acetaminophen, (5) naproxen sodium/naproxen sodium, and (6) aspirin/aspirin. The pain evaluations were made during chewing, biting, fitting the front teeth, and fitting the back teeth using a 100-mm visual analogue scale (VAS) for seven days. All the analgesics succeeded in decreasing the pain levels compared with the placebo group. However, naproxen sodium and aspirin groups showed the lowest pain values, and the acetaminophen group showed VAS results similar to those of the two analgesics.

  20. [Principles of pain therapy with local anesthesia].

    PubMed

    Klaus, E

    1996-04-01

    The treatment of chronic pain consists of four basic concepts: Drugs (analgetic drugs, TAD, etc.), treatment by physicians (chiropraxis, massage, TENS, etc.), injection with local anesthetics and autosuggestion. Necessary for diagnosis and treatment of chronical pain is the knowledge of pathophysiology and anatomy of nerves, ligaments, muscles and the sympathetic nervous system. Diagnosis of chronical pain rarely includes roentgenograms or other technical procedures, mainly to exclude tumors, fractures or specific infections. The knowledge of pathophysiology means the knowledge of sympathetic and motoric efferences on one side and the functional examination of the anatomic structures on the other side.

  1. Influence of the application of inelastic taping on shoulder subluxation and pain changes in acute stroke patients

    PubMed Central

    Heo,, Min-Yeong; Kim,, Cheol-Yong; Nam, Chan-Woo

    2015-01-01

    [Purpose] The purpose of this study was to investigate the impact on the shoulder joints of performing inelastic taping and bed physical therapy for acute stroke. [Subjects and Methods] The intervention was conducted for eight weeks with an experimental group of 18 stroke patients who received bed physical therapy and inelastic taping and a control group of 18 stroke patients who received only bed physical therapy. [Results] After the intervention, the subluxation degree of the experimental group, which received bed physical therapy and inelastic taping, was found to be significantly different from that of the control group, which received only bed physical therapy. [Conclusion] In conclusion, the application of inelastic taping for acute stroke patients was confirmed to be effective at reducing shoulder subluxation and pain, and was confirmed to be a good physical therapy intervention, based on its efficacy. PMID:26696705

  2. Chronic Pain and Cognitive Behavioral Therapy: An Integrative Review.

    PubMed

    Knoerl, Robert; Lavoie Smith, Ellen M; Weisberg, James

    2016-05-01

    Cognitive behavioral therapy (CBT) is often used to treat chronic pain; however, more information is needed about what are the most efficacious dose and delivery methods. The aims of this review were to determine (a) which CBT doses, delivery methods, strategies, and follow-up periods have been explored in recent intervention studies of individuals with chronic pain and (b) whether the outcomes described in the selected studies were consistent with recommendations by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials. The CINAHL, EMBASE, PubMed, PsycInfo, and SCOPUS databases were searched for randomized controlled trials published from 2009 to 2015 testing CBT for adults with chronic pain. Thirty-five studies were included in this review. Results revealed that CBT reduced pain intensity in 43% of trials, the efficacy of online and in-person formats were comparable, and military veterans and individuals with cancer-related chronic pain were understudied. PMID:26604219

  3. Endogenous pain inhibition is unrelated to autonomic responses in acute whiplash-associated disorders.

    PubMed

    De Kooning, Margot; Daenen, Liesbeth; Roussel, Nathalie; Cras, Patrick; Buyl, Ronald; Ickmans, Kelly; Struyf, Filip; Nijs, Jo

    2015-01-01

    Patients with acute whiplash-associated disorder (WAD) demonstrate an inefficient endogenous pain inhibition and may experience a dysfunction in autonomic nervous system reactivity to pain. This study compared the autonomic response to painful stimuli between patients with acute and chronic WAD and healthy controls. In addition, the role of the autonomic nervous system for explaining inefficient endogenous pain inhibition was examined in acute WAD. Seventeen patients with acute WAD, 30 patients with chronic WAD, and 31 healthy controls participated in an experiment evaluating the autonomic nervous system at rest and during painful stimuli. Skin conductance and heart rate variability (HRV) parameters were monitored continuously during conditioned pain modulation. A significant autonomic response to pain was present for skin conductance and two HRV parameters in all experimental groups. There was an interaction effect in the skin conductance response to pain but not in HRV responses in any of the groups. In patients with acute WAD, no significant correlations were present between pain, pressure pain thresholds, pain inhibition, and any of the autonomic parameters. This study refutes autonomic dysfunction at rest and in response to pain in acute WAD. The dysfunctional conditioned pain modulation appears unrelated to autonomic responses to pain. PMID:26348457

  4. Endogenous pain inhibition is unrelated to autonomic responses in acute whiplash-associated disorders.

    PubMed

    De Kooning, Margot; Daenen, Liesbeth; Roussel, Nathalie; Cras, Patrick; Buyl, Ronald; Ickmans, Kelly; Struyf, Filip; Nijs, Jo

    2015-01-01

    Patients with acute whiplash-associated disorder (WAD) demonstrate an inefficient endogenous pain inhibition and may experience a dysfunction in autonomic nervous system reactivity to pain. This study compared the autonomic response to painful stimuli between patients with acute and chronic WAD and healthy controls. In addition, the role of the autonomic nervous system for explaining inefficient endogenous pain inhibition was examined in acute WAD. Seventeen patients with acute WAD, 30 patients with chronic WAD, and 31 healthy controls participated in an experiment evaluating the autonomic nervous system at rest and during painful stimuli. Skin conductance and heart rate variability (HRV) parameters were monitored continuously during conditioned pain modulation. A significant autonomic response to pain was present for skin conductance and two HRV parameters in all experimental groups. There was an interaction effect in the skin conductance response to pain but not in HRV responses in any of the groups. In patients with acute WAD, no significant correlations were present between pain, pressure pain thresholds, pain inhibition, and any of the autonomic parameters. This study refutes autonomic dysfunction at rest and in response to pain in acute WAD. The dysfunctional conditioned pain modulation appears unrelated to autonomic responses to pain.

  5. Medicinal leech therapy in pain syndromes: a narrative review.

    PubMed

    Koeppen, Detlev; Aurich, Michael; Rampp, Thomas

    2014-03-01

    Medicinal leech therapy is used in a variety of conditions; most of which have pain as a major symptom. Its mode of action relies on the injection of leech saliva into patients' tissues during the process of blood withdrawal. Leech saliva contains active ingredients with anti-inflammatory, thrombolytic, anti-coagulant and blood- and lymph-circulation enhancing properties. A specific analgesic substance within the leech saliva is yet to be identified. Pain relief from leech therapy is rapid, effective and long-lasting in many conditions. This review compiles studies and case reports that provide clinical evidence for leech therapy's analgesic effects.

  6. [Neuropathic pain: pathophysiology, assessment, and therapy].

    PubMed

    Sommer, C

    2013-12-01

    Neuropathic pain is caused by lesions in the somatosensory system. Characteristic but not exclusive features are spontaneous burning pain, electrifying and shooting pain, hyperalgesia, and allodynia. The basic concept of the pathophysiology of neuropathic pain is the combination of peripheral and central sensitization. Knowledge on the molecular mechanisms has grown exponentially in recent years. The problem lies in identifying the individual mechanisms and in determining a comprehensive concept. Progress has also been made in assessment, e.g., methods for detecting dysfunction of nociceptors have significantly improved. In addition, there are many more therapeutic options available than 15 years ago. The drugs available include antidepressants, anticonvulsants, opioids, and topical medications. Data from controlled trials and recommendations from guidelines are available. PMID:24217854

  7. Acute Coronary Syndrome: Focus on Antiplatelet Therapy.

    PubMed

    Bobadilla, Rodel V

    2016-02-01

    The American Heart Association/American College of Cardiology in 2014 published a focused update of the 2007 and 2012 guidelines for non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The management of ST-segment elevation myocardial infarction (STEMI) is described in a separate guideline published in 2013. The focused updates to the guidelines contain updated recommendations for dual antiplatelet therapy, including use of the P2Y12 inhibitor ticagrelor, which was recently approved by the Food and Drug Administration. Nurses caring for patients with acute coronary syndrome must have a good understanding of the current treatment guidelines for such patients, to help ensure delivery of evidence-based care. This review article uses a case study-based approach to describe how the new guidelines affect clinical decision making when choosing appropriate antiplatelet therapy for patients with NSTE-ACS or STEMI, depending on the patient's clinical history and presenting characteristics. PMID:26830177

  8. A data-driven acute inflammation therapy

    PubMed Central

    2013-01-01

    Acute inflammation is a severe medical condition defined as an inflammatory response of the body to an infection. Its rapid progression requires quick and accurate decisions from clinicians. Inadequate and delayed decisions makes acute inflammation the 10th leading cause of death overall in United States with the estimated cost of treatment about $17 billion annually. However, despite the need, there are limited number of methods that could assist clinicians to determine optimal therapies for acute inflammation. We developed a data-driven method for suggesting optimal therapy by using machine learning model that is learned on historical patients' behaviors. To reduce both the risk of failure and the expense for clinical trials, our method is evaluated on a virtual patients generated by a mathematical model that emulates inflammatory response. In conducted experiments, acute inflammation was handled with two complimentary pro- and anti-inflammatory medications which adequate timing and doses are crucial for the successful outcome. Our experiments show that the dosage regimen assigned with our data-driven method significantly improves the percentage of healthy patients when compared to results by other methods used in clinical practice and found in literature. Our method saved 88% of patients that would otherwise die within a week, while the best method found in literature saved only 73% of patients. At the same time, our method used lower doses of medications than alternatives. In addition, our method achieved better results than alternatives when only incomplete or noisy measurements were available over time as well as it was less affected by therapy delay. The presented results provide strong evidence that models from the artificial intelligence community have a potential for development of personalized treatment strategies for acute inflammation. PMID:24565439

  9. TRPM8 is the principal mediator of menthol-induced analgesia of acute and inflammatory pain.

    PubMed

    Liu, Boyi; Fan, Lu; Balakrishna, Shrilatha; Sui, Aiwei; Morris, John B; Jordt, Sven-Eric

    2013-10-01

    Menthol, the cooling natural product of peppermint, is widely used in medicinal preparations for the relief of acute and inflammatory pain in sports injuries, arthritis, and other painful conditions. Menthol induces the sensation of cooling by activating TRPM8, an ion channel in cold-sensitive peripheral sensory neurons. Recent studies identified additional targets of menthol, including the irritant receptor, TRPA1, voltage-gated ion channels and neurotransmitter receptors. It remains unclear which of these targets contribute to menthol-induced analgesia, or to the irritating side effects associated with menthol therapy. Here, we use genetic and pharmacological approaches in mice to probe the role of TRPM8 in analgesia induced by L-menthol, the predominant analgesic menthol isomer in medicinal preparations. L-menthol effectively diminished pain behavior elicited by chemical stimuli (capsaicin, acrolein, acetic acid), noxious heat, and inflammation (complete Freund's adjuvant). Genetic deletion of TRPM8 completely abolished analgesia by L-menthol in all these models, although other analgesics (acetaminophen) remained effective. Loss of L-menthol-induced analgesia was recapitulated in mice treated with a selective TRPM8 inhibitor, AMG2850. Selective activation of TRPM8 with WS-12, a menthol derivative that we characterized as a specific TRPM8 agonist in cultured sensory neurons and in vivo, also induced TRPM8-dependent analgesia of acute and inflammatory pain. L-menthol- and WS-12-induced analgesia was blocked by naloxone, suggesting activation of endogenous opioid-dependent analgesic pathways. Our data show that TRPM8 is the principal mediator of menthol-induced analgesia of acute and inflammatory pain. In contrast to menthol, selective TRPM8 agonists may produce analgesia more effectively, with diminished side effects. PMID:23820004

  10. TRPM8 is the Principal Mediator of Menthol-induced Analgesia of Acute and Inflammatory Pain

    PubMed Central

    Liu, Boyi; Fan, Lu; Balakrishna, Shrilatha; Sui, Aiwei; Morris, John B.; Jordt, Sven-Eric

    2013-01-01

    Menthol, the cooling natural product of peppermint, is widely used in medicinal preparations for the relief of acute and inflammatory pain in sports injuries, arthritis and other painful conditions. Menthol induces the sensation of cooling by activating TRPM8, an ion channel in cold-sensitive peripheral sensory neurons. Recent studies identified additional targets of menthol, including the irritant receptor, TRPA1, voltage-gated ion channels and neurotransmitter receptors. It remains unclear which of these targets contribute to menthol-induced analgesia, or to the irritating side effects associated with menthol therapy. Here, we use genetic and pharmacological approaches in mice to probe the role of TRPM8 in analgesia induced by L-menthol, the predominant analgesic menthol isomer in medicinal preparations. L-menthol effectively diminished pain behavior elicited by chemical stimuli (capsaicin, acrolein, acetic acid), noxious heat and inflammation (complete Freund's adjuvant). Genetic deletion of TRPM8 completely abolished analgesia by L-menthol in all these models, while other analgesics (acetaminophen) remained effective. Loss of L-menthol-induced analgesia was recapitulated in mice treated with a selective TRPM8 inhibitor, AMG2850. Selective activation of TRPM8 with WS-12, a menthol derivative we characterized as a specific TRPM8 agonist in cultured sensory neurons and in vivo, also induced TRPM8-dependent analgesia of acute and inflammatory pain. L-menthol and WS-12 induced analgesia was blocked by naloxone, suggesting activation of endogenous opioid-dependent analgesic pathways. Our data show that TRPM8 is the principal mediator of menthol-induced analgesia of acute and inflammatory pain. In contrast to menthol, selective TRPM8 agonists may produce analgesia more effectively with diminished side effects. PMID:23820004

  11. [Acute tonsillopharyngitis: the effectiveness of topical therapy].

    PubMed

    Nosulya, E V; Kim, I A; Chernykh, N M; Karnoukhova, O A

    2015-01-01

    The objective of the present study was to evaluate the clinical effectiveness of a furasol sore throat gargle solution for the treatment of acute tonsillopharyngitis. Forty patients presenting with acute tonsillopharyngitis were allocated to two groups, 20 subjects in each, by means of independent sequential randomization. Prior to the onset of the treatment, all the patients were examined for determining the species composition of pharyngeal microflora with the use of an «AutoScan4 System» analyzer («Siemens», USA) and estimating the resistance to antibacterial preparations (by the disk diffusion method). All the participants of the study were prescribed antibacterial therapy. In the patients of group 1 (study group), the antibacterial treatment of acute tonsillopharyngitis was supplemented by a furasol sore throat gargle solution whereas those of group 2 (controls) were treated without topical therapy. The quantitative evaluation of the severity of manifestations of the disease before and after the treatment was based on a 5-point visual-analog scale. It was shown that systemic antibacterial therapy resulted in the consistent decrease of the frequency of occurrence of pathogenic and potentially pathogenic microflora in the patients comprising both groups. Treatment with a furasol sore throat gargle solution did not lead to the appearance of bacterial species alien to the oropharynx, nor was it accompanied by the impairment of resistance of its mucous membrane to the colonization by microorganisms. The results of the study give evidence of the well apparent regression of the subjective signs of tonsillopharyngitis and the inflammatory changes in the mucous membrane of the pharynx in the patients given the topical treatment in the form of a furasol sore throat gargle solution in addition to antibacterial therapy. It is concluded that a furasol sore throat gargle solution can be recommended for the introduction into the combined treatment of the patients

  12. Ultrasound guided, painful electrical stimulation of lumbar facet joint structures: an experimental model of acute low back pain.

    PubMed

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

    2009-07-01

    Quantitative sensory testing has indicated generalized muscle hyperalgesia in patients with chronic low back pain. The temporal development of such hyperalgesia is not well understood. The aim of the present study was to demonstrate whether generalized muscle hyperalgesia can develop within minutes of acute low back pain using a new experimental model of lumbar facet joint pain. Thirteen healthy volunteers were included and baseline pressure pain thresholds were assessed at eight separate sites, outside the area of evoked low back and referred pain. Using ultrasonography, two electrode needles were placed either side of a lumbar facet joint (right L3-4) and used to induce experimental low back pain for 10 min with continuous stimulation. Thresholds, stimulus-response relationships, distribution and quality of the electrically induced pain were recorded. Electrical facet joint stimulation induced low back pain and pain referral into the anterior leg, ipsilaterally, proximal to the knee, similar to what is observed clinically. Pressure pain thresholds did not change significantly before, during and after facet joint stimulation. In conclusion, we describe a novel model of acute experimental low back pain and demonstrate that generalized hyperalgesia did not develop within minutes of acute low back pain. PMID:19376652

  13. Single dose oral naproxen and naproxen sodium for acute postoperative pain (Review)

    PubMed Central

    Mason, L; Edwards, JE; Moore, RA; McQuay, HJ

    2014-01-01

    Background Postoperative pain is often poorly managed. Treatment options include a range of drug therapies such as non-steroidal anti-inflammatory drugs (NSAIDs) of which naproxen is one. Naproxen is used to treat a variety of painful conditions including acute postoperative pain, and is often combined with sodium to improve its solubility for oral administration. Naproxen sodium 550 mg (equivalent to 500 mg of naproxen) is considered to be an effective dose for treating postoperative pain but to date no systematic review of the effectiveness of naproxen/naproxen sodium at different doses has been published. Objectives To assess the efficacy, safety and duration of action of a single oral dose of naproxen or naproxen sodium for acute postoperative pain in adults. Search strategy We searched The Cochrane Library, MEDLINE, EMBASE and the Oxford Pain Relief Database for relevant studies. Additional studies were identified from the reference list of retrieved reports. The most recent search was undertaken in July 2004. Selection criteria Included studies were randomised, double blind, placebo-controlled trials of a single dose of orally administered naproxen or naproxen sodium in adults with moderate to severe acute postoperative pain. Data collection and analysis Pain relief or pain intensity data were extracted and converted into dichotomous information to give the number of patients with at least 50% pain relief over four to six hours. Relative risk estimates (RR) and the number-needed-to-treat (NNT) for at least 50% pain relief were then calculated. Information was sought on the percentage of patients experiencing any adverse event, and the number-needed-to-harm was derived. Time to remedication was also estimated. Main results Ten trials (996 patients) met the inclusion criteria: nine assessed naproxen sodium; one combined the results from two small trials of naproxen alone. Included studies scored well for methodological quality. Meta-analysis of six trials (500

  14. Mind-body therapies for the management of pain.

    PubMed

    Astin, John A

    2004-01-01

    This paper reviews the evidence for mind-body therapies (eg, relaxation, meditation, imagery, cognitive-behavioral therapy) in the treatment of pain-related medical conditions and suggests directions for future research in these areas. Based on evidence from randomized controlled trials and in many cases, systematic reviews of the literature, the following recommendations can be made: 1) multi-component mind-body approaches that include some combination of stress management, coping skills training, cognitive restructuring and relaxation therapy may be an appropriate adjunctive treatment for chronic low back pain; 2) multimodal mind-body approaches such as cognitive-behavioral therapy, particularly when combined with an educational/informational component, can be an effective adjunct in the management of rheumatoid and osteoarthritis; 3) relaxation and thermal biofeedback may be considered as a treatment for recurrent migraine while relaxation and muscle biofeedback can be an effective adjunct or stand alone therapy for recurrent tension headache; 4) an array of mind-body therapies (eg, imagery, hypnosis, relaxation) when employed pre-surgically, can improve recovery time and reduce pain following surgical procedures; 5) mind-body approaches may be considered as adjunctive therapies to help ameliorate pain during invasive medical procedures.

  15. Mind-body therapies for the management of pain.

    PubMed

    Astin, John A

    2004-01-01

    This paper reviews the evidence for mind-body therapies (eg, relaxation, meditation, imagery, cognitive-behavioral therapy) in the treatment of pain-related medical conditions and suggests directions for future research in these areas. Based on evidence from randomized controlled trials and in many cases, systematic reviews of the literature, the following recommendations can be made: 1) multi-component mind-body approaches that include some combination of stress management, coping skills training, cognitive restructuring and relaxation therapy may be an appropriate adjunctive treatment for chronic low back pain; 2) multimodal mind-body approaches such as cognitive-behavioral therapy, particularly when combined with an educational/informational component, can be an effective adjunct in the management of rheumatoid and osteoarthritis; 3) relaxation and thermal biofeedback may be considered as a treatment for recurrent migraine while relaxation and muscle biofeedback can be an effective adjunct or stand alone therapy for recurrent tension headache; 4) an array of mind-body therapies (eg, imagery, hypnosis, relaxation) when employed pre-surgically, can improve recovery time and reduce pain following surgical procedures; 5) mind-body approaches may be considered as adjunctive therapies to help ameliorate pain during invasive medical procedures. PMID:14668653

  16. Changing Paradigms for Acute Dental Pain: Prevention Is Better Than PRN.

    PubMed

    Dionne, Raymond A; Gordon, Sharon M

    2015-11-01

    A B S T R A C T The drugs available for the management of acute orofacial pain have changed very little since the introduction of ibuprofen into practice 40 years ago. Orally effective opioids, acetaminophen, aspirin and NSAIDs remain the mainstay of analgesic therapy. Increased recognition of the societal and personal impact of opioid diversion and abuse requires re-examination of the traditional approach of prescribing an opioid-containing analgesic combination to be administered by the patient "as needed" (PRN) starting postoperatively. PMID:26798882

  17. [High-dose buprenorphine for outpatient palliative pain therapy].

    PubMed

    Gastmeier, K; Freye, E

    2009-04-01

    The case of a 78-year-old patient with cancer-related pain and additionally mixed-pain syndrome is presented. Pain therapy with buprenorphine TTS 210 microg/h every 3 days was sufficient in the beginning, later the therapy was changed because of increasing problems of tape fixing during fever periods under chemotherapy to a continuous infusion of buprenorphine intravenously via an external medication pump. During the course of therapy it became necessary to increase the dose to 99.9 mg/day buprenorphine. Under this medication a sufficient pain reduction (median NRS 2-3) over a period of 135 days could be achieved. At the same time the patient was vigilant and cooperative without signs of intoxication until the end of life at home in the presence of his family.If no signs of intoxication occur under extreme opioid therapy and a sufficient pain therapy can be achieved, a rotation to another opioid is not necessary. However, outpatient palliative care requires a frequent adaptation to the individually varying opioid demand of the patient and time-consuming nursing care. PMID:19066981

  18. [High-dose buprenorphine for outpatient palliative pain therapy].

    PubMed

    Gastmeier, K; Freye, E

    2009-04-01

    The case of a 78-year-old patient with cancer-related pain and additionally mixed-pain syndrome is presented. Pain therapy with buprenorphine TTS 210 microg/h every 3 days was sufficient in the beginning, later the therapy was changed because of increasing problems of tape fixing during fever periods under chemotherapy to a continuous infusion of buprenorphine intravenously via an external medication pump. During the course of therapy it became necessary to increase the dose to 99.9 mg/day buprenorphine. Under this medication a sufficient pain reduction (median NRS 2-3) over a period of 135 days could be achieved. At the same time the patient was vigilant and cooperative without signs of intoxication until the end of life at home in the presence of his family.If no signs of intoxication occur under extreme opioid therapy and a sufficient pain therapy can be achieved, a rotation to another opioid is not necessary. However, outpatient palliative care requires a frequent adaptation to the individually varying opioid demand of the patient and time-consuming nursing care.

  19. Effective management of intractable neuropathic pain using an intrathecal morphine pump in a patient with acute transverse myelitis

    PubMed Central

    Wu, Wei-Ting; Huang, Yu-Hui; Chen, Der-Cherng; Huang, Yu-Hsuan; Chou, Li-Wei

    2013-01-01

    Transverse myelitis is a rare inflammatory myelopathy characterized by loss of motor and sensory function below the affected level of the spinal cord, and causes neurogenic bowel and bladder. Occasionally, it also causes neuropathic pain with spasticity. Traditional therapies for neuropathic pain are multiple, including multimodal analgesic regimens, antiepileptic or antidepressant medications, opioids, sympathetic blocks, and spinal cord stimulation. Persistent neuropathic pain can cause emotional distress by affecting sleep, work, recreation, and emotional well-being. Here we report the case of a patient suffering from intractable neuropathic pain following acute transverse myelitis that was not relieved by combinations of nonsteroidal anti-inflammatory, anti-epileptic, antidepressant, and opioid medications, or by acupuncture. Implantation of an intrathecal morphine pump controlled the pain successfully without side effects, and enabled the patient to embark on intensive rehabilitation. The patient’s muscle strength has improved significantly and the patient may soon be able to use a walker with minimal assistance. PMID:23935366

  20. Efficacy of disintegrating aspirin in two different models for acute mild-to-moderate pain: sore throat pain and dental pain.

    PubMed

    Voelker, M; Schachtel, B P; Cooper, S A; Gatoulis, S C

    2016-02-01

    A recently developed fast-release aspirin tablet formulation has been evaluated in two different pain models. The dental impaction pain model and the sore throat pain model are widely used for assessing analgesia, including acute mild-to-moderate pain. Both studies were double-blind, randomized, parallel group and compared a single dose of 1000 mg aspirin with 1000 mg paracetamol and with placebo and investigated the onset and overall time course of pain relief. Speed of onset was measured by the double-stopwatch method for time to meaningful pain relief and time to first perceptible pain relief. Pain intensity and pain relief were rated subjectively over a 6-h (dental pain) and 2-h (sore throat pain) time period. In both models fast-release aspirin and commercial paracetamol were statistically significantly different from placebo for onset of action, summed pain intensity differences and total pain relief. Meaningful pain relief was achieved within a median of 42.3 and 42.9 min for aspirin and paracetamol, respectively, in the dental pain model. The corresponding numbers in sore throat pain were 48.0 and 40.4 min. All treatments in both studies were safe and well tolerated. No serious adverse events were reported and no subject was discontinued due to an adverse event. Overall the two studies clearly demonstrated efficacy over placebo in the two pain models and a comparable efficacy and safety profile between aspirin and an equivalent dose of paracetamol under the conditions of acute dental pain and acute sore throat pain. Trial registration These trials were registered with ClinicalTrials.gov, registration number: NCT01420094, registration date: July 27, 2011 and registration number: NCT01453400, registration date: October 13, 2011. PMID:26603742

  1. Efficacy of disintegrating aspirin in two different models for acute mild-to-moderate pain: sore throat pain and dental pain.

    PubMed

    Voelker, M; Schachtel, B P; Cooper, S A; Gatoulis, S C

    2016-02-01

    A recently developed fast-release aspirin tablet formulation has been evaluated in two different pain models. The dental impaction pain model and the sore throat pain model are widely used for assessing analgesia, including acute mild-to-moderate pain. Both studies were double-blind, randomized, parallel group and compared a single dose of 1000 mg aspirin with 1000 mg paracetamol and with placebo and investigated the onset and overall time course of pain relief. Speed of onset was measured by the double-stopwatch method for time to meaningful pain relief and time to first perceptible pain relief. Pain intensity and pain relief were rated subjectively over a 6-h (dental pain) and 2-h (sore throat pain) time period. In both models fast-release aspirin and commercial paracetamol were statistically significantly different from placebo for onset of action, summed pain intensity differences and total pain relief. Meaningful pain relief was achieved within a median of 42.3 and 42.9 min for aspirin and paracetamol, respectively, in the dental pain model. The corresponding numbers in sore throat pain were 48.0 and 40.4 min. All treatments in both studies were safe and well tolerated. No serious adverse events were reported and no subject was discontinued due to an adverse event. Overall the two studies clearly demonstrated efficacy over placebo in the two pain models and a comparable efficacy and safety profile between aspirin and an equivalent dose of paracetamol under the conditions of acute dental pain and acute sore throat pain. Trial registration These trials were registered with ClinicalTrials.gov, registration number: NCT01420094, registration date: July 27, 2011 and registration number: NCT01453400, registration date: October 13, 2011.

  2. [Use of botulinum toxin for pain therapy].

    PubMed

    Nodera, Hiroyuki

    2008-05-01

    Preventive measures are necessary against contraction of botulism through food intake or due to other factors because the botulinum neurotoxin (BoNT) is one of the strongest toxins. Despite this, given its therapeutic utility in the controll of neuromuscular transmission, BoNT has been utilized to treat diseases related to muscular hyperactivity, such as dystonia and spasticity. Furthermore, it has been recognized that BoNT is also useful in controlling the neurotransmitter release of sensory and autonomic nerve terminals as well. This paper reviews the recent progress in the therapeutic use of BoNT in pain management, for example, in condition such as migraine, myofascial pain syndrome, pelvic pain, and interstitial cystitis. PMID:18516972

  3. Multiwave low-laser therapy in the pain treatment

    NASA Astrophysics Data System (ADS)

    Moldovan, Corneliu I.; Antipa, Ciprian; Bratila, Florin; Brukner, Ion; Vasiliu, Virgil V.

    1995-03-01

    Sixteen patients with knee pain, 17 patients with low back pain and 23 patients with vertebral pain were randomly allocated to multiwave laser therapy (MWL). The MWL was performed through an original method by a special designed laser system. The stimulation parameters adaptably optimized in a closed loop by measuring the reflected laser radiation. A control group of 11 patients was conventionally treated with a single infrared laser system. All patients were assessed by single observer using a visual analogue scale in a controlled trial. Our results indicate that the treatment with different laser wavelengths, different output power and frequencies, simultaneously applied through optic-fibers, has significant effects on the pain when compared with the common low laser therapy.

  4. Diagnostic peritoneal lavage in evaluating acute abdominal pain.

    PubMed

    Barbee, C L; Gilsdorf, R B

    1975-06-01

    A study was performed to determine the value of peritoneal lavage in the acute abdomen not related to trauma. Lavage was performed in 33 patients in the evaluation of abdominal pain of sufficient degree to warrant consideration for surgical intervention. Peritoneal lavage was truly positive or truly negative in 64% of the cases. It showed false negative results in 28% and false positive results in 8%. The lavage was most accurate in the evaluation of appendicitis, colonic disease, and intra abdominal bleeding. It was highly inaccurate in the evaluation of cholecystitis and peptic ulcer disease. It was concluded that the peritoneal lavage can be a useful adjunct in the evaluation of patients with abdominal pain and should be considered in difficult diagnostic problems but not routinely employed.

  5. Presentation of Osteitis and Osteomyelitis Pubis as Acute Abdominal Pain

    PubMed Central

    Pham, Diane V; Scott, Kendall G

    2007-01-01

    Osteitis pubis is the most common inflammatory condition of the pubic symphysis and may present as acute abdominal, pelvic, or groin pain. Osteomyelitis pubis can occur concurrently and spontaneously with osteitis pubis. Primary care physicians should consider these conditions in patients presenting with abdominal and pelvic pain. A thorough history, including type of physical activity, and a focused physical examination will be useful, and imaging modalities may be helpful. A biopsy and culture of the pubic symphysis will usually confirm the diagnosis. Treatment for osteitis pubis generally involves rest and anti-inflammatory medications. Failure with this conservative treatment should alert the physician to the possibility of osteomyelitis, which needs treatment with antibiotics. Prognosis for recovery is excellent with definitive diagnosis and treatment. PMID:21461096

  6. A surprising cause of acute right upper quadrant pain.

    PubMed

    Stitt, Rodger Scott; Greenwood, Robert; Laczek, Jeffrey

    2014-08-06

    A 42 year-old African-American woman was admitted for severe acute right upper quadrant pain. Her liver function tests showed a cholestatic pattern of hepatitis. She had no known history of liver disease or sarcoidosis. Imaging of her liver and biliary tree did not reveal any apparent cause for her right upper quadrant pain. A liver biopsy was performed which showed granulomatous disease. This prompted a CT chest that showed mediastinal lymphadenopathy. Biopsy of the mediastinal lymphnode revealed non-caseating granulomas. Despite having no pulmonary symptoms or history of pulmonary sarcoidosis, she was diagnosed with systemic pulmonary sarcoidosis. She was treated with corticosteroids and had complete resolution of symptoms over the next several weeks.

  7. Preventive Analgesic Efficacy of Nefopam in Acute and Chronic Pain After Breast Cancer Surgery

    PubMed Central

    Na, Hyo-Seok; Oh, Ah-Young; Koo, Bon-Wook; Lim, Dae-Jin; Ryu, Jung-Hee; Han, Ji-Won

    2016-01-01

    Abstract Breast cancer surgery is known to cause severe acute postoperative pain, which can persist for a long time. We administered nefopam preventively to patients undergoing lumpectomy with axillary lymph node dissection or sentinel lymph node biopsy, and evaluated its efficacy on acute and chronic postoperative pain. Enrolled patients were assigned to the nefopam (n = 41) or the control (n = 42) group. Before initiating the operation, 20 mg of nefopam was given to the patients of the nefopam group, and normal saline was used in the control group. Ketorolac was given at the end of surgery, and meloxicam was prescribed in the postoperative period to all patients in both groups. Pain was assessed using a numerical rating scale (NRS), and the rescue analgesic drug was given when the NRS was >5. Implementation of postoperative chemotherapy, radiotherapy (RT), or hormone therapy was evaluated. The NRS of postoperative pain was significantly lower in the nefopam than in the control group in the postanesthetic care unit (4.5 ± 2.2 vs 5.7 ± 1.5, respectively; P = 0.01), at postoperative 6 h (3.0 ± 1.6 vs 4.5 ± 1.3, respectively; P < 0.001), and at postoperative 24 h (3.1 ± 1.1 vs 3.8 ± 1.5, respectively; P = 0.01) with reduced use of rescue analgesic drugs. Significantly fewer patients suffered from chronic postoperative pain in the nefopam than in the control group at postoperative 3 months (36.6% vs 59.5%, P = 0.04). Considering only the cohort without postoperative adjuvant RT, the difference in the proportion of patients reporting chronic pain increased (23.5% in the nefopam group vs 61.5% in the control group, P = 0.04). Preventive nefopam was helpful in reducing the acute postoperative pain, with reduced use of rescue analgesic drugs, and it contributed to reduced occurrence of chronic pain at postoperative 3 months after breast cancer surgery. PMID:27196485

  8. Meta-Analysis of Massage Therapy on Cancer Pain.

    PubMed

    Lee, Sook-Hyun; Kim, Jong-Yeop; Yeo, Sujung; Kim, Sung-Hoon; Lim, Sabina

    2015-07-01

    Cancer pain is the most common complaint among patients with cancer. Conventional treatment does not always relieve cancer pain satisfactorily. Therefore, many patients with cancer have turned to complementary therapies to help them with their physical, emotional, and spiritual well-being. Massage therapy is increasingly used for symptom relief in patients with cancer. The current study aimed to investigate by meta-analysis the effects of massage therapy for cancer patients experiencing pain. Nine electronic databases were systematically searched for studies published through August 2013 in English, Chinese, and Korean. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) and Cochrane risk-of-bias scales. Twelve studies, including 559 participants, were used in the meta-analysis. In 9 high-quality studies based on the PEDro scale (standardized mean difference, -1.24; 95% confidence interval, -1.72 to -0.75), we observed reduction in cancer pain after massage. Massage therapy significantly reduced cancer pain compared with no massage treatment or conventional care (standardized mean difference, -1.25; 95% confidence interval, -1.63 to -0.87). Our results indicate that massage is effective for the relief of cancer pain, especially for surgery-related pain. Among the various types of massage, foot reflexology appeared to be more effective than body or aroma massage. Our meta-analysis indicated a beneficial effect of massage for relief of cancer pain. Further well-designed, large studies with longer follow-up periods are needed to be able to draw firmer conclusions regarding the effectiveness. PMID:25784669

  9. [Caffeine as adjuvant analgeticum for treating acute pain].

    PubMed

    Nikolajsen, Lone; Haroutiunian, Simon

    2013-10-14

    Based on 19 studies (7,238 participants) a Cochrane review concludes that the addition of caffeine to an analgesic drug provides superior analgesia compared with the analgesic drug alone. The benefit is small, with a number needed to treat of approx. 16. The use of analgesics containing caffeine is associated with an increased risk of the development of physical dependence, overuse headache, and withdrawal symptoms upon abrupt discontinuation. Combination analgesics with caffeine should only be used temporarily and exclusively for the treatment of acute pain conditions. PMID:24629115

  10. Uncommon Causes of Acute Abdominal Pain – A Pictorial Essay

    PubMed Central

    Hariharan, Mahesh; Balasubramaniam, Rajan; Shetty, Sharath Kumar; Yadavalli, Shanthala; Ahetasham, Mohammed; Devarapalli, Sravya

    2016-01-01

    Acute abdomen is one of the most common clinical conditions requiring a radiological investigation. Ultrasound is the primary modality of choice which can diagnose some of the common causes of acute abdomen. However, sometimes the underlying cause for the pain is far more complicated than expected mandating a high degree of suspicion to suggest further investigation with contrast enhanced computed tomography or magnetic resonance imaging. Here, we have compiled a comprehensive series of selected cases to highlight the conditions which can be easily overlooked unless carefully sought for. This article also emphasizes the importance of multimodality approach to arrive at the final diagnosis with an increased overall diagnostic accuracy which in turn improves patient management and prognosis. PMID:27014500

  11. Use of Therapeutic Neuroscience Education to address psychosocial factors associated with acute low back pain: a case report.

    PubMed

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

    2014-04-01

    Acute low back pain (LBP) from injuries is prevalent in the work place. It has been shown that patients with psychosocial factors often progress with persistent pain and lead to significant workers compensation costs. Therapeutic Neuroscience Education (TNE) has been shown to be beneficial in changing a patient's cognition regarding their pain state, which may result in decrease fear, anxiety and catastrophization. A 19-year-old female who developed LBP from a work injury was the patient for this case report. A physical examination, Numeric Pain Rating Scale (NRPS), Oswestry Disability Index (ODI), Fear-Avoidance Beliefs Questionnaire (FABQ), Keele STarT Back Screening Tool (Keele SBST) and Acute Low Back Pain Screening (ALBPS) Questionnaires were assessed during initial physical therapy visit and discharge. Treatment consisted of use of TNE, manual therapy and exercises. She attended five total visits over a 2-week period prior to full discharge. During the initial visit the patient reported NRPS = 3/10, ODI = 36%, FABQ-PA = 23, FABQ-W = 30, Keele SBST = 4/9, ALBPS = 101. At discharge the patient reported a 0 on all outcome questionnaires with ability to return to full work and no pain complaints. PMID:24252071

  12. [Effectiveness of manipulative therapy in low back pain: systematic literature reviews and guidelines are inconclusive].

    PubMed

    Assendelft, W J; Lankhorst, G J

    1998-03-28

    In the Dutch general practitioners' guidelines spinal manipulative therapy (SMT) is not recommended for treatment of acute low back pain. This is in contrast to the recent American and English guidelines, which explicitly recommend SMT for this indication. Randomized clinical trials (RCTs) on SMT are on average of low methodological quality. Most systematic reviews, however, lead to positive conclusions. The potential sources of discrepancy between the recommendations in the national guidelines are: interpretation of the available RCTs and systematic reviews, composition of the guideline-setting committee, values of the participants and appreciation of direct and indirect costs. Definite conclusions on the efficacy of SMT for (acute) low back pain cannot yet be drawn. Therefore, more RCTs in various settings and on different indications are clearly needed. PMID:9623139

  13. Chronic vulvar pain from a physical therapy perspective.

    PubMed

    Hartmann, Dee

    2010-01-01

    When assessing women with chronic vulvar pain, women's health physical therapists search for comorbid mechanical components (including musculoskeletal, fascial, and visceral) and other disorders that may contribute to or be caused by chronic vulvar pain (CVP). Pelvic floor hypertonicity is a key perpetuating factor for CVP. Comprehensive physical therapy evaluation and suggested physical therapy interventions are described. Anatomy of the pelvis, common evaluative findings, and specifics for pelvic floor muscle rehabilitation are presented. Normalization of pelvic floor muscle function contributes to the reduction of CVP. Successful treatment includes the identification and treatment of co-existing physical abnormalities throughout the trunk and pelvis.

  14. Effects of manual therapy on shoulder pain in office workers

    PubMed Central

    Go, Seong-Uk; Lee, Byoung-Hee

    2016-01-01

    [Purpose] The purpose of this study was to determine the effects of manual therapy on shoulder pain in office workers. [Subjects and Methods] Subjects included 38 office workers who were randomly divided into two groups: a manual therapy group of 19 subjects and a shoulder stabilization exercise group of 19 subjects. All subjects underwent evaluation of the pressure pain threshold in the splenius capitis and upper, middle, and lower trapezius muscles on both sides. The manual therapy used in the study was designed to include soft-tissue mobilization, prone thoracic mobilization, prone selected thoracic mobilization, cervical mobilization, and thoracic manipulation. Both groups underwent training of two 40-minute sessions per week for 6 weeks. [Results] After the intervention, both groups showed significantly increased pressure pain thresholds in the splenius capitis and upper, middle, and lower trapezius muscles on both sides. The manual therapy group showed greater improvements than did the shoulder stabilization exercise group in the splenius capitis on both sides, left upper trapezius, middle trapezius on both sides, and right lower trapezius. [Conclusion] The results of this study suggest that manual therapy for shoulder pain is feasible and suitable for office workers and may be useful in clinical rehabilitation. PMID:27799661

  15. [Pharmacological therapy of temporomandibular joint pain].

    PubMed

    Hugger, Alfons; Schindler, Hans J; Türp, Jens C; Hugger, Sybille

    2013-01-01

    Pharmacological interventions in temporomandibular joint (TMJ) pain differ from corresponding therapeutic interventions of jaw muscle (myofascial) pain. An actual systematic literature search lists and evaluates available articles on randomised controlled trials for treatment of arthralgia of the TMJ. On the basis of the few available trial reports, non-steroidal anti-inflammatory drugs (NSAIDs) seem to be effective, but side effects and drug interactions need to be considered. In relation to other therapeutic modalities, the rapidity of the onset of action of NSAIDs seems to be different, and the extension of side effects can be varied or reduced by changing the application route (oral versus topical). Palmitoylethanolamide (PEA) as dietary supplement for special medical purposes can apparently evoke positive therapeutic effects in TMJ arthralgia which need to be analysed in further studies.

  16. Management of acute Achilles tendinopathy: effect of etoricoxib on pain control and leg stiffness.

    PubMed

    Maquirriain, Javier; Kokalj, Antonio

    2013-09-01

    Tendinopathies are a major cause of disability in the athletic population; the main purpose of the treatment of these injuries is to reduce pain and improve function promptly. The objective of this randomized, active comparator controlled, blinded study was to evaluate etoricoxib efficacy in pain control and leg stiffness in athletes suffering acute unilateral Achilles tendinopathy. Fifty-six eligible male athletes (mean age 37.5 ± 11.0 y) suffering acute Achilles tendinopathy were randomized to receive either etoricoxib 120 mg oral once daily (n=28) or diclofenac 100 mg oral once daily (n=28). Pain (100-mm visual analogue scale-VAS), analgesic effect (percentage of 100-mm VAS reduction), satisfaction with pain management (PGART), and leg stiffness (LSR) were evaluated after one week of anti-inflammatory treatment. Over the 7-day treatment period, both etoricoxib and diclofenac provided significantly relief of Achilles tendon pain compared to that experienced at baseline (mean VAS 26.7 ± 2.2 and 56.4 ± 1.8, respectively; p<.001). Analgesic effect averaged 53.7 ± 38.1% (etoricoxib= 56.4% and diclofenac 50.6%, p=0.64). Patients referred high level of satisfaction with anti-inflammatory treatment (PGART = 2.0 ± 1.3), while leg stiffness showed a significant improvement after one-week therapy (LSR 0.89 ± 0.1 vs. 0.95 ± 0.1; p=0.038). PGART and LSR values within etoricoxib and diclofenac groups were not significant (p=0.46, and p=0.37, respectively). Both drugs were generally well tolerated; patients receiving etoricoxib reported significantly less side effects than those in the diclofenac group (0% and 14,2%, respectively, p=0.037). Etoricoxib is clinically effective in treatment of acute Achilles tendinopathy providing a magnitude of effect comparable to that of diclofenac with fewer side effects. Effective control of tendon pain in the acute phase of such sports-related injuries may be helpful to reduce morbidity and improve capabilities associated with high

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

    PubMed

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

    2014-03-01

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

  18. Craniosacral Therapy for the Treatment of Chronic Neck Pain

    PubMed Central

    Lauche, Romy; Cramer, Holger; Rampp, Thomas; Saha, Felix J.; Ostermann, Thomas; Dobos, Gustav

    2016-01-01

    Objectives: With growing evidence for the effectiveness of craniosacral therapy (CST) for pain management, the efficacy of CST remains unclear. This study therefore aimed at investigating CST in comparison with sham treatment in chronic nonspecific neck pain patients. Materials and Methods: A total of 54 blinded patients were randomized into either 8 weekly units of CST or light-touch sham treatment. Outcomes were assessed before and after treatment (week 8) and again 3 months later (week 20). The primary outcome was the pain intensity on a visual analog scale at week 8; secondary outcomes included pain on movement, pressure pain sensitivity, functional disability, health-related quality of life, well-being, anxiety, depression, stress perception, pain acceptance, body awareness, patients’ global impression of improvement, and safety. Results: In comparison with sham, CST patients reported significant and clinically relevant effects on pain intensity at week 8 (−21 mm group difference; 95% confidence interval, −32.6 to −9.4; P=0.001; d=1.02) and at week 20 (−16.8 mm group difference; 95% confidence interval, −27.5 to −6.1; P=0.003; d=0.88). Minimal clinically important differences in pain intensity at week 20 were reported by 78% within the CST group, whereas 48% even had substantial clinical benefit. Significant between-group differences at week 20 were also found for pain on movement, functional disability, physical quality of life, anxiety and patients’ global improvement. Pressure pain sensitivity and body awareness were significantly improved only at week 8. No serious adverse events were reported. Discussion: CST was both specifically effective and safe in reducing neck pain intensity and may improve functional disability and the quality of life up to 3 months after intervention. PMID:26340656

  19. Prospective Evaluation of Severe Skin Toxicity and Pain During Postmastectomy Radiation Therapy

    SciTech Connect

    Pignol, Jean-Philippe; Vu, Thi Trinh Thuc; Mitera, Gunita; Bosnic, Sandy; Verkooijen, Helena M.; Truong, Pauline

    2015-01-01

    Purpose: To prospectively capture acute toxicities and pain associated with postmastectomy radiation therapy (PMRT), to analyze patient and treatment risk factors for severe side effects. Methods and Materials: Women referred for PMRT were prospectively enrolled and assessed weekly during and after radiation therapy. The endpoint included severe National Cancer Institute Common Terminology Criteria for Adverse Effects grade 3 moist desquamation, other skin symptoms, and pain. Results: Of 257 patients, 73 (28.4%) experienced extensive moist desquamation, 84 (32.7%) Common Terminology Criteria for Adverse Effects skin toxicity grade 3, and 57 (22.2%) a pain impacting on daily life activities. Among symptoms only grade 3 moist desquamation was significantly associated with severe pain (P<.001). On multivariate analysis, smoking, high-energy photons, and skin bolus were significantly associated with severe moist desquamation. Skin toxicity doubled for smokers, with 40% severe pain, 48% grade 3 moist desquamation, and 64% grade 3 skin toxicity. Without skin bolus 4.2% had severe pain, none moist desquamation, and 2.1% grade 3 skin toxicity. When skin bolus was used on alternate days, the frequency increased to 15% for pain, 22% for moist desquamation, and 26% for grade 3 skin toxicity. When bolus was used daily, 32% had pain, 41% moist desquamation, and 47% grade 3 skin toxicity. Symptoms peaked 1 to 2 weeks after the end of PMRT. Conclusions: The present cohort study suggests excessive radiation toxicity after PMRT. Among factors associated with an increase of toxicity are smoking habits and the use of skin bolus.

  20. Accelerated Resolution Therapy for treatment of pain secondary to symptoms of combat-related posttraumatic stress disorder

    PubMed Central

    Kip, Kevin E.; Rosenzweig, Laney; Hernandez, Diego F.; Shuman, Amy; Diamond, David M.; Girling, Sue Ann; Sullivan, Kelly L.; Wittenberg, Trudy; Witt, Ann M.; Lengacher, Cecile A.; Anderson, Brian; McMillan, Susan C.

    2014-01-01

    Background As many as 70% of veterans with chronic pain treated within the US Veterans Administration (VA) system may have posttraumatic stress disorder (PTSD), and conversely, up to 80% of those with PTSD may have pain. We describe pain experienced by US service members and veterans with symptoms of PTSD, and report on the effect of Accelerated Resolution Therapy (ART), a new, brief exposure-based therapy, on acute pain reduction secondary to treatment of symptoms of PTSD. Methods A randomized controlled trial of ART versus an attention control (AC) regimen was conducted among 45 US service members/veterans with symptoms of combat-related PTSD. Participants received a mean of 3.7 sessions of ART. Results Mean age was 41.0 + 12.4 years and 20% were female. Most veterans (93%) reported pain. The majority (78%) used descriptive terms indicative of neuropathic pain, with 29% reporting symptoms of a concussion or feeling dazed. Mean pre-/post-change on the Pain Outcomes Questionnaire (POQ) was −16.9±16.6 in the ART group versus −0.7±14.2 in the AC group (p=0.0006). Among POQ subscales, treatment effects with ART were reported for pain intensity (effect size = 1.81, p=0.006), pain-related impairment in mobility (effect size = 0.69, p=0.01), and negative affect (effect size = 1.01, p=0.001). Conclusions Veterans with symptoms of combat-related PTSD have a high prevalence of significant pain, including neuropathic pain. Brief treatment of symptoms of combat-related PTSD among veterans by use of ART appears to acutely reduce concomitant pain. PMID:24959325

  1. Methylprednisolone pulse therapy in severe acute asthma.

    PubMed

    Pedersen, B K; Laursen, L C; Lervang, H H; Stjernebjerg, T; Weeke, B

    1987-02-01

    In a group comparative double blind pilot study six asthmatic patients with an acute exacerbation of their disease were randomly treated with either methylprednisolone pulse therapy (MPPT) (1000 mg daily for 3 days) (n = 2) followed by placebo tablets, or standard doses of methylprednisolone (MP) (50 mg daily gradually decreased to zero over 3 weeks) (n = 4). The results showed that the effect of MPPT did not differ from that of standard doses of MP. MPPT has, however, the potential of being preferable to standard treatment with MP, because of easy administration and optimal patient compliance. PMID:3296841

  2. Prognosis of acute low back pain: design of a prospective inception cohort study

    PubMed Central

    Henschke, Nicholas; Maher, Christopher G; Refshauge, Kathryn M; Herbert, Robert D; Cumming, Robert G; Bleasel, Jane; York, John; Das, Anurina; McAuley, James H

    2006-01-01

    Background Clinical guidelines generally portray acute low back pain as a benign and self-limiting condition. However, evidence about the clinical course of acute low back pain is contradictory and the risk of subsequently developing chronic low back pain remains uncertain. There are few high quality prognosis studies and none that have measured pain, disability and return to work over a 12 month period. This study aims to provide the first estimates of the one year prognosis of acute low back pain (pain of less than 2 weeks duration) in patients consulting primary care practitioners. A secondary aim is to identify factors that are associated with the prognosis of low back pain. Methods/Design The study is a prospective inception cohort study. Consecutive patients consulting general medical practitioners, physiotherapists and chiropractors in the Sydney metropolitan region will complete a baseline questionnaire regarding their back pain. Subsequently these patients will be followed up by telephone 6 weeks, 3 months and 12 months after the initial consultation. Patients will be considered to have recovered from the episode of back pain if they have no pain and no limitation of activity, and have returned to pre-injury work status. Life tables will be generated to determine the one year prognosis of acute low back pain. Prognostic factors will be assessed using Cox regression. Discussion This study will provide the first estimates of the one year prognosis of acute low back pain in a representative sample of primary care patients. PMID:16790069

  3. Diagnosis and treatment of acute low back pain.

    PubMed

    Casazza, Brian A

    2012-02-15

    Acute low back pain is one of the most common reasons for adults to see a family physician. Although most patients recover quickly with minimal treatment, proper evaluation is imperative to identify rare cases of serious underlying pathology. Certain red flags should prompt aggressive treatment or referral to a spine specialist, whereas others are less concerning. Serious red flags include significant trauma related to age (i.e., injury related to a fall from a height or motor vehicle crash in a young patient, or from a minor fall or heavy lifting in a patient with osteoporosis or possible osteoporosis), major or progressive motor or sensory deficit, new-onset bowel or bladder incontinence or urinary retention, loss of anal sphincter tone, saddle anesthesia, history of cancer metastatic to bone, and suspected spinal infection. Without clinical signs of serious pathology, diagnostic imaging and laboratory testing often are not required. Although there are numerous treatments for nonspecific acute low back pain, most have little evidence of benefit. Patient education and medications such as nonsteroidal anti-inflammatory drugs, acetaminophen, and muscle relaxants are beneficial. Bed rest should be avoided if possible. Exercises directed by a physical therapist, such as the McKenzie method and spine stabilization exercises, may decrease recurrent pain and need for health care services. Spinal manipulation and chiropractic techniques are no more effective than established medical treatments, and adding them to established treatments does not improve outcomes. No substantial benefit has been shown with oral steroids, acupuncture, massage, traction, lumbar supports, or regular exercise programs. PMID:22335313

  4. Does weather affect daily pain intensity levels in patients with acute low back pain? A prospective cohort study.

    PubMed

    Duong, Vicky; Maher, Chris G; Steffens, Daniel; Li, Qiang; Hancock, Mark J

    2016-05-01

    The aim of this study was to investigate the influence of various weather parameters on pain intensity levels in patients with acute low back pain (LBP). We performed a secondary analysis using data from the PACE trial that evaluated paracetamol (acetaminophen) in the treatment of acute LBP. Data on 1604 patients with LBP were included in the analysis. Weather parameters (precipitation, temperature, relative humidity, and air pressure) were obtained from the Australian Bureau of Meteorology. Pain intensity was assessed daily on a 0-10 numerical pain rating scale over a 2-week period. A generalised estimating equation analysis was used to examine the relationship between daily pain intensity levels and weather in three different time epochs (current day, previous day, and change between previous and current days). A second model was adjusted for important back pain prognostic factors. The analysis did not show any association between weather and pain intensity levels in patients with acute LBP in each of the time epochs. There was no change in strength of association after the model was adjusted for prognostic factors. Contrary to common belief, the results demonstrated that the weather parameters of precipitation, temperature, relative humidity, and air pressure did not influence the intensity of pain reported by patients during an episode of acute LBP.

  5. Does weather affect daily pain intensity levels in patients with acute low back pain? A prospective cohort study.

    PubMed

    Duong, Vicky; Maher, Chris G; Steffens, Daniel; Li, Qiang; Hancock, Mark J

    2016-05-01

    The aim of this study was to investigate the influence of various weather parameters on pain intensity levels in patients with acute low back pain (LBP). We performed a secondary analysis using data from the PACE trial that evaluated paracetamol (acetaminophen) in the treatment of acute LBP. Data on 1604 patients with LBP were included in the analysis. Weather parameters (precipitation, temperature, relative humidity, and air pressure) were obtained from the Australian Bureau of Meteorology. Pain intensity was assessed daily on a 0-10 numerical pain rating scale over a 2-week period. A generalised estimating equation analysis was used to examine the relationship between daily pain intensity levels and weather in three different time epochs (current day, previous day, and change between previous and current days). A second model was adjusted for important back pain prognostic factors. The analysis did not show any association between weather and pain intensity levels in patients with acute LBP in each of the time epochs. There was no change in strength of association after the model was adjusted for prognostic factors. Contrary to common belief, the results demonstrated that the weather parameters of precipitation, temperature, relative humidity, and air pressure did not influence the intensity of pain reported by patients during an episode of acute LBP. PMID:26759130

  6. Scrambler Therapy for the management of chronic pain

    PubMed Central

    Majithia, Neil; Smith, Thomas J.; Coyne, Patrick J.; Abdi, Salahadin; Pachman, Deirdre R.; Lachance, Daniel; Shelerud, Randy; Cheville, Andrea; Basford, Jeffrey R.; Farley, David; O’Neill, Carrie; Ruddy, Kathryn J.; Sparadeo, Frank; Beutler, Andreas; Loprinzi, Charles L

    2016-01-01

    Purpose Chronic pain is a widespread and debilitating condition, encountered by physicians in a variety of practice settings. Although many pharmacologic and behavioral strategies exist for the management of this condition, treatment is often unsatisfactory. Scrambler Therapy is a novel, non-invasive pain modifying technique that utilizes transcutaneous electrical stimulation of pain fibers with the intent of re-organizing maladaptive signaling pathways. This review was conducted to further evaluate what is known regarding the mechanisms and mechanics of Scrambler Therapy and to investigate the preliminary data pertaining to the efficacy of this treatment modality. Methods The PubMed/Medline, SCOPUS, EMBASE, and Google Scholar databases were searched for all articles published on Scrambler Therapy prior to November 2015. All case studies and clinical trials were evaluated and reported in a descriptive manner. Results To date, 20 reports, of varying scientific quality, have been published regarding this device; all but one small study, published only as an abstract, provided results that appear positive. Conclusion The positive findings from preliminary studies with Scrambler Therapy support that this device provides benefit for patients with refractory pain syndromes. Larger, randomized studies are required to further evaluate the efficacy of this approach. PMID:27041741

  7. Painful periostitis in the setting of chronic voriconazole therapy.

    PubMed

    Skaug, Margaret; Spak, Cedric; Oza, Umesh

    2014-10-01

    A 72-year-old woman on chronic voriconazole therapy for recurrent histoplasmosis developed a painful forearm mass. Laboratory and imaging findings were consistent with a diffuse periostitis. Her symptoms resolved after discontinuation of voriconazole. To our knowledge, this is the first case of voriconazole-induced periostitis to be reported in a patient with chronic histoplasmosis.

  8. [Acupuncture--propagated indications beyond pain-relief therapy].

    PubMed

    Hakimi, R

    2009-03-01

    Acupuncture originates from China and has developed out of Traditional Chinese Medicine (TCM). Since the 1970s acupuncture has been carried out more and more in Germany - especially within the context of pain-relief therapy. Acupuncture is more or less considered to be a medically necessary measure in the case of chronic knee or back pains and of chronic headaches, even if the German Acupuncture Trials (GERAC) leave some issues regarding its effectiveness unresolved. Less known is the fact that acupuncture is not only used for pain-relief therapy, but that a lot more indications have emerged over the last 20 years. Acupuncture is increasingly used for the treatment of allergies, asthma bronchial, addictions, tinnitus, but also to stimulate pregnancy and against adipositas, neurodermitis and a lot of other diseases. The available statistics state that acupuncture is used in appr. 20% of all cases for indications apart from pain-relief therapy. There are about 150 indications for which acupuncture is used as a therapy. However, for the majority of the apparent indications no proof is available in the sense of medical studies of an acceptable scientific level. Very often acupuncture has mild side-effects and rather rarely serious side-effects or health hazards. Patients are fequently not informed about them sufficiently. PMID:19370841

  9. [Diuretic therapy in acute heart failure].

    PubMed

    Trullàs, Joan Carles; Morales-Rull, José Luis; Formiga, Francesc

    2014-03-01

    Diuretics are widely recommended in patients with acute heart failure (AHF). Unfortunately, despite their widespread use, limited data are available from randomized clinical trials to guide clinicians on the appropriate management of diuretic therapy. Loop diuretics are considered the first-line diuretic therapy, especially intravenous furosemide, but the best mode of administration (high-dose versus low-dose and continuous infusion versus bolus) is unclear. When diuretic resistance develops, different therapeutic strategies can be adopted, including combined diuretic therapy with thiazide diuretics and/or aldosterone antagonists. Low or "non-diuretic" doses (25-50mg QD) of aldosterone antagonists have been demonstrated to confer a survival benefit in patients with heart failure and reduced ejection fraction and consequently should be prescribed in all such patients, unless contraindicated by potassium and/or renal function values. There is less evidence on the use of aldosterone antagonists at higher or "diuretic" doses (≥ 100mg QD) but these drugs could be useful in relieving congestive symptoms in combination with furosemide. Thiazide diuretics can also be helpful as they have synergic effects with loop diuretics by inhibiting sodium reabsorption in distal parts of the nephron. The effect of diuretic therapy in AHF should be monitored with careful observation of clinical signs and symptoms of congestion. Serum electrolytes and kidney function should also be monitored during the use of intravenous diuretics.

  10. Availability of services to treat patients with acute low back pain.

    PubMed Central

    Underwood, M R; Vickers, M R; Barnett, A G

    1997-01-01

    Guidelines for the management of acute low back pain were published in 1994. This national survey, conducted soon after, showed that the availability of services for general practitioners (GPs) to treat acute back pain fell short of the guideline recommendations. A repeat survey will be performed to measure the impact of guideline publication and dissemination. PMID:9302790

  11. Management of acute painful crises in sickle cell disease.

    PubMed

    Kotila, T R

    2005-08-01

    Pain is a common mode of manifestation of sickle cell disease (SCD) but there is limited information on pain management in this disorder. This study examines the use of opioids and non-opioid analgesia in the management of painful crisis in adult SCD patients; the routine use of antimalarials and antibiotics as adjunct therapy was also examined. A total of 87% of the patients had had a form of analgesics before presentation, 20% of which had parenteral analgesia. Ten per cent had not used any form of medication while another 10% used non-steroidal anti-inflammatory drugs. When asked, 59% of the patients desired oral non-opioid analgesics while 31% were not concerned about the type of analgesic given. Only 8% requested opioids. Hospital admission was not necessary in 65% of the patients; they were observed in the day-care unit and allowed home within 24 h. Sixty per cent did not have a test for malaria; 66% of those who had the test performed were negative, 35% of those whose thick film for malaria was negative had antimalarials prescribed. Only five patients (7%) were febrile at presentation. Thirty-four per cent had antibiotics prescribed, a third of these parenterally. Thirty-nine per cent had no fever but received antibiotics.

  12. Cognitive behavioral therapy for orthodontic pain control: a randomized trial.

    PubMed

    Wang, J; Jian, F; Chen, J; Ye, N S; Huang, Y H; Wang, S; Huang, R H; Pei, J; Liu, P; Zhang, L; Zhao, Z H; Chen, Q M; Lai, W L; Lin, Y F

    2012-06-01

    The objective of this study was to evaluate the efficacy of cognitive behavioral therapy intervention for patients who experienced pain during orthodontic treatment. The baseline characteristics were assessed via questionnaires and oral examinations. Four hundred and fifty eligible individuals were recruited and randomized by computer-generated block randomization into three groups: cognitive behavioral therapy intervention (n = 150), ibuprofen intervention (n = 150), and no intervention (control; n = 150). Primary outcomes were the change from baseline in pain intensity measured with 100-mm Visual Analog Scale (VAS) scores at 1, 2, 3, 7, 14, and 30 days after initial archwire placement. Outcomes assessment was blinded and followed the intention-to-treat principle. One hundred forty-three (95.30%), 145 (96.70%), and 141 (94.00%) individuals in the cognitive behavioral therapy, the ibuprofen, and the control groups, respectively, completed the one-month follow-up evaluations. Those in the cognitive behavioral therapy group showed a greater decrease in mean VAS scores than did those in the control group over the previous five time-points (p < 0.001). Cognitive behavioral therapy was shown to be effective in pain control during the initial stage of orthodontic treatment. The study registration number was ChiCTR-TRC-00000556.

  13. Does 48 hours' bed rest influence the outcome of acute low back pain?

    PubMed Central

    Wilkinson, M J

    1995-01-01

    BACKGROUND. Bed rest is a traditional treatment for back pain, yet only in recent years has the therapeutic benefit of this been questioned. AIM. The aim of this pilot study was to ascertain whether or not 48 hours' bed rest had an effect on the outcome of acute low back pain. METHOD. The study was conducted as a randomized controlled trial to compare a prescription of 48 hours' strict bed rest with controls; the control subjects were encouraged to remain mobile and to have no daytime rest. Nine general practitioners from practices in the West Midlands recruited patients in the age range 16-60 years who presented with low back pain of less than seven days' duration, with or without pain radiation. The outcome measures assessed were: change in straight leg raise and lumbar flexion after seven days, Oswestry and Roland-Morris disability scores after seven days and 28 days, and time taken from work. RESULTS. Forty two patients were recruited: 20 were allocated to bed rest and 22 as controls. Compared with the bed rest group the control group had statistically better Roland-Morris scores at day seven (P < 0.05) but not at day 28. At day seven, there were no statistically significant differences between groups in straight leg raise or lumbar flexion measurements although the control group had a better mean lumbar flexion than the bed rest group. The improvement in disability scores at day seven compared with day one was similar for the two groups but more of the control group had fully recovered (defined as scores of one or zero on the Roland-Morris disability scale and five or less on the Oswestry disability scale) by day seven. Remaining mobile did not appear to cause any adverse effects. The number of days lost from work in both groups was equal. A large number of self-remedies and physical therapies were recorded by subjects from both groups. CONCLUSION. The results of this pilot study did not indicate whether bed rest or remaining mobile was superior for the

  14. [Pain treatment with low reactive level laser therapy (LLLT)].

    PubMed

    Hosokawa, Toyoshi; Kawabata, Yasuyo

    2012-07-01

    Noninvasive and low reactive level laser (LLLT) is used as one of the light therapies without giving pain to the patient. Therefore, it is used often clinically in pain treatment, orthopedics, plastic surgery, dermatology, and dentistry. In the pain clinic field, it is one of the procedures indispensable to treatment of various pain including postherpetic neuralgia, diabetic neuropathy or myofascial pain. In recent years the mechanism has been gradually elucidated by basic study. The action is on sensory nerve, sympathetic nerve, blood vessel, immunity, inflammation and central nervous system, and is thought to contribute to analgesia. Also, many reports such as action to inhibit "itch", a promotor action of the bone metabolism, and the follicular maturation acceleration action have tested and elucidated these mechanisms, and will add further adaptation that will be new in future. Furthermore, development and downsizing of the free electron laser will promote elucidation of the low response level laser therapy. We expect much in the future of the LLLT. PMID:22860300

  15. High Frequency Migraine Is Associated with Lower Acute Pain Sensitivity and Abnormal Insula Activity Related to Migraine Pain Intensity, Attack Frequency, and Pain Catastrophizing

    PubMed Central

    Mathur, Vani A.; Moayedi, Massieh; Keaser, Michael L.; Khan, Shariq A.; Hubbard, Catherine S.; Goyal, Madhav; Seminowicz, David A.

    2016-01-01

    Migraine is a pain disorder associated with abnormal brain structure and function, yet the effect of migraine on acute pain processing remains unclear. It also remains unclear whether altered pain-related brain responses and related structural changes are associated with clinical migraine characteristics. Using fMRI and three levels of thermal stimuli (non-painful, mildly painful, and moderately painful), we compared whole-brain activity between 14 migraine patients and 14 matched controls. Although, there were no significant differences in pain thresholds nor in pre-scan pain ratings to mildly painful thermal stimuli, patients did have aberrant suprathreshold nociceptive processing. Brain imaging showed that, compared to controls, patients had reduced activity in pain modulatory regions including left dorsolateral prefrontal, posterior parietal, and middle temporal cortices and, at a lower-threshold, greater activation in the right mid-insula to moderate pain vs. mild pain. We also found that pain-related activity in the insula was associated with clinical variables in patients, including associations between: bilateral anterior insula and pain catastrophizing (PCS); bilateral anterior insula and contralateral posterior insula and migraine pain intensity; and bilateral posterior insula and migraine frequency at a lower-threshold. PCS and migraine pain intensity were also negatively associated with activity in midline regions including posterior cingulate and medial prefrontal cortices. Diffusion tensor imaging revealed a negative correlation between fractional anisotropy (a measure of white matter integrity; FA) and migraine duration in the right mid-insula and a positive correlation between left mid-insula FA and PCS. In sum, while patients showed lower sensitivity to acute noxious stimuli, the neuroimaging findings suggest enhanced nociceptive processing and significantly disrupted modulatory networks, particularly involving the insula, associated with indices

  16. Pain and trauma in negative pressure wound therapy: a review.

    PubMed

    Upton, Dominic; Andrews, Abbye

    2015-02-01

    Negative pressure wound therapy (NPWT) is considered an effective wound treatment, but there are a number of issues that need to be addressed for improvements to be made. This review aimed to explore the literature relating to the pain and skin trauma that may be experienced during NPWT. A literature search was carried out using the following databases: Academic Search Complete, CINAHL, PsychINFO, MEDLINE and PsyARTICLES. A total of 30 articles were reviewed. Studies reported varying levels of pain in patients undergoing NPWT, with certain treatment factors affecting the level of pain, such as the NPWT system and the dressing/filler used. Similarly, although there is much less research exploring NPWT-related trauma, findings suggest that dressing and filler type may impact on whether trauma occurs. However, further research needs to consider the different stages of NPWT and how pain and trauma can be minimised during the whole procedure. As both pain and skin trauma impact on the patient's well-being and on wound healing, it is essential that research further explores the factors that may affect the experience of pain and trauma, so as to inform developments in wound care. PMID:23489350

  17. Pain and trauma in negative pressure wound therapy: a review.

    PubMed

    Upton, Dominic; Andrews, Abbye

    2015-02-01

    Negative pressure wound therapy (NPWT) is considered an effective wound treatment, but there are a number of issues that need to be addressed for improvements to be made. This review aimed to explore the literature relating to the pain and skin trauma that may be experienced during NPWT. A literature search was carried out using the following databases: Academic Search Complete, CINAHL, PsychINFO, MEDLINE and PsyARTICLES. A total of 30 articles were reviewed. Studies reported varying levels of pain in patients undergoing NPWT, with certain treatment factors affecting the level of pain, such as the NPWT system and the dressing/filler used. Similarly, although there is much less research exploring NPWT-related trauma, findings suggest that dressing and filler type may impact on whether trauma occurs. However, further research needs to consider the different stages of NPWT and how pain and trauma can be minimised during the whole procedure. As both pain and skin trauma impact on the patient's well-being and on wound healing, it is essential that research further explores the factors that may affect the experience of pain and trauma, so as to inform developments in wound care.

  18. Preoperative Pain, Symptoms, and Psychological Factors related to Higher Acute Pain Trajectories during Hospitalization for Total Knee Arthroplasty

    PubMed Central

    Lindberg, Maren Falch; Miaskowski, Christine; Rustøen, Tone; Rosseland, Leiv Arne; Paul, Steven M.

    2016-01-01

    Objectives Unrelieved postoperative pain after total knee arthroplasty (TKA) is a significant problem. This longitudinal study investigated how preoperative pain intensity, as well as a comprehensive list of preoperative and perioperative factors, influenced the severity of acute average and worst pain after TKA. Methods Prior to surgery, 203 patients completed a demographic questionnaire, Lee Fatigue Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, and Brief Illness Perception Questionnaire. Brief Pain Inventory was completed prior to surgery as well as through postoperative days (POD) 0 to 4. Clinical data were extracted from medical records. Results Several factors were associated with higher levels of preoperative and postoperative pain. Lower preoperative average and worst pain intensity scores were associated with increases in average and worst postoperative pain from POD1 to POD4. A higher number of comorbidities, higher C-reactive protein values, and higher pain interference with function were associated with higher preoperative levels of average pain. Older age, higher fatigue levels, and higher scores on identity and emotional responses to osteoarthritis (OA) were associated with higher preoperative levels of worst pain. Lower perceived consequences of OA were associated with higher pain from POD1 to POD4. Males and patients with lower preoperative scores for average pain had higher worst pain following surgery. Discussion Patients at higher risk for more severe postoperative pain can be identified through an assessment of pain and other risk factors identified in this study. Future research needs to test the efficacy of interventions that modify patients’ perceptions of living with OA and pain intensity before surgery on short and long term postoperative outcomes. PMID:27583551

  19. Radionuclide therapy for palliation of pain due to osteoblastic metastases.

    PubMed

    Hellman, R S; Krasnow, A Z

    1998-01-01

    Beta-emitting, bone-seeking radiopharmaceuticals, administered systemically, represent a good alternative or adjuvant to external beam radiotherapy for palliation of painful osteoblastic bone metastases. The most frequently used radiopharmaceutical for this purpose is strontium 89, followed by samarium 153 ethylenediaminetetramethylene phosphonate, and infrequently phosphorus 32 orthophosphate. Prior to consideration for radionuclide therapy, recent bone scans should be evaluated in order to determine if the patient has painful osteoblastic lesions likely to respond to therapy. Approximately 70% of patients with prostate and breast cancer will have a reduction in pain in response to radionuclide therapy, beginning within 2 to 4 weeks and lasting between 2 and 6 months. Patients who are expected to live 3 or more months are more likely to benefit than patients with shorter duration life expectancy. Hematosuppression is the chief side effect of radionuclide therapy, with leukopenia and thrombocytopenia more likely to be clinically significant than anemia. Relative contraindications for treatment include osteolytic lesions, pending spinal cord compression or pathologic fracture, preexisting severe myelosuppression, urinary incontinence, inability to follow radiation safety precautions, and severe renal insufficiency. PMID:15859838

  20. Acute migraine: Current treatment and emerging therapies

    PubMed Central

    Kalra, Arun A; Elliott, Debra

    2007-01-01

    Migraine is a common disabling primary headache disorder. Despite the need for a perfect treatment of this debilitating condition, the ideal “cure” eludes us. In 1992, the first triptan was released in the US for use in acute migraine. Triptans are more specific for the serotonin receptor 5-hydroxy triptamine (5-HT) 1 than previously prescribed drugs, such as ergotamines, with fewer side effects. This was an important first step in specific acute migraine therapy. Today however, triptans continue to be underutilized. There remains a concern, among practitioners and patients, about possible cardiovascular safety issues, despite the lack of strong evidence of serious adverse events. In fact, triptans now have a safe track record over more than a decade of use. Other perceived downfalls to use, include cost and variable efficacy. The more we learn about the clinical features and pathophysiology of migraine, the closer we are to finding a satisfactory monotherapy. Until then, recognizing that mixed mechanisms underlie migraine symptoms, rational polytherapy can be useful. Research on the roles of serotonin, calcitonin gene related peptide, glutamine and N-methyl-D-aspartate in the trigeminovascular system holds promise for those searching for the perfect migraine headache cure. PMID:18488069

  1. Interprofessional Education for the Dentist in Managing Acute and Chronic Pain.

    PubMed

    Shaefer, Jeffry; Barreveld, Antje M; Arnstein, Paul; Kulich, Ronald J

    2016-10-01

    Dental education is at the intersection of affordable health care, opioid-abuse crisis, and collaborative practice benefits. Students must engage in interprofessional education (IPE) for pain management. Graduates must recognize appropriate management of acute dental pain and understand the dentist's role in interprofessional treatment of chronic disease, including management of temporomandibular disorders and orofacial neuropathic pain, chronic pain in general, and the consideration of opioids. This article reviews accreditation standards, compares these standards with recommendations from the International Association for the Study of Pain and regulatory boards, and presents examples of enhanced pain education. PMID:27671956

  2. Nanotechnology approaches for pain therapy through transdermal drug delivery.

    PubMed

    Peptu, Cristian; Rotaru, Razvan; Ignat, Leonard; Humelnicu, Andra Cristina; Harabagiu, Valeria; Peptu, Catalina Anisoara; Leon, Maria-Magdalena; Mitu, Florin; Cojocaru, Elena; Boca, Andreea; Tamba, Bogdan Ionel

    2015-01-01

    The paper focuses on the advances in the field of pain treatment by transdermal delivery of specific drugs. Starting from a short description of the skin barrier, the pharmacodynamics and pharmacokinetics including absorption, distribution, action mechanism, metabolism and toxicity, aspects related to the use of pain therapy drugs are further discussed. Most recent results on topical anesthetic agents as well as the methods proved to overcome the skin barrier and to provide efficient delivery of the drug are also discussed. The present review is proposing to summarize the recent literature on the pharmacotherapeutic principles of local anesthetics and non-steroidal anti-inflammatory drugs, generally used to alleviate pain but also the drugs as nanoformulations with potential applications in transdermal delivery. A special attention is given to efficient formulations meant for transdermal penetration enhancement of anesthetics where the drug is encapsulated into macrocyclic molecules (cyclodextrins, cyclodextrin derivatives), liposomes or polymer nanoparticles and hydrogels. PMID:26503147

  3. Guideline update: what's the best approach to acute low back pain?

    PubMed

    Bach, Son M; Holten, Keith B

    2009-12-01

    GRADE A RECOMMENDATIONS (based on good-quality patient-oriented evidence): Advise patients to stay active and continue ordinary activity within the limits permitted by pain, avoid bed rest, and return to work early, which is associated with less disability. Consider McKenzie exercises, which are helpful for pain radiating below the knee. Recommend acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) if medication is necessary. COX-2 inhibitors, muscle relaxants, and opiate analgesics have not been shown to be more effective than NSAIDs for acute low back pain. Consider imaging if patients have no improvement after 6 weeks, although diagnostic tests or imaging is not usually required. GRADE B RECOMMENDATIONS (based on inconsistent or limited-quality patient-oriented evidence): Reassure patients that 90% of episodes resolve within 6 weeks-regardless of treatment. Advise patients that minor flares-ups may occur in the subsequent year. Consider a plain lumbosacral spine x-ray if there is suspicion of spinal fracture or compression. Consider a bone scan after 10 days, if fracture is still suspected or the patient has multiple sites of pain. Suspect cauda equina syndrome or severe or progressive neurological deficit if red flags are present. Obtain complete blood count, urinalysis, and sedimentation rate if cancer or infection are possibilities. If still suspicious, consider referral or perform other studies. Remember that a negative plain film x-ray does not rule out disease. GRADE C RECOMMENDATIONS (based on consensus, usual practice, opinion, disease-oriented evidence, or case series): Recommend ice for painful areas and stretching exercises. Discuss the use of proper body mechanics and safe back exercises for injury prevention. Refer for goal-directed manual physical therapy if there is no improvement in 1 to 2 weeks, not modalities such as heat, traction, ultrasound, or transcutaneous electrical nerve stimulation. Do not refer for surgery in the absence of

  4. Correlates of satisfaction with pain treatment in the acute postoperative period: results from the international PAIN OUT registry.

    PubMed

    Schwenkglenks, Matthias; Gerbershagen, Hans J; Taylor, Rod S; Pogatzki-Zahn, Esther; Komann, Marcus; Rothaug, Judith; Volk, Thomas; Yahiaoui-Doktor, Maryam; Zaslansky, Ruth; Brill, Silviu; Ullrich, Kristin; Gordon, Debra B; Meissner, Winfried

    2014-07-01

    Patient ratings of satisfaction with their postoperative pain treatment tend to be high even in those with substantial pain. Determinants are poorly understood and have not previously been studied in large-scale, international datasets. PAIN OUT, a European Union-funded acute pain registry and research project, collects patient-reported outcome data on postoperative day 1 using the self-reported International Pain Outcome Questionnaire (IPO), and patient, clinical, and treatment characteristics. We investigated correlates of satisfaction and consistency of effects across centres and countries using multilevel regression modelling. Our sample comprised 16,868 patients (median age 55 years; 55% female) from 42 centres in 11 European countries plus Israel, USA, and Malaysia, who underwent a wide range of surgical procedures, for example, joint, limb, and digestive tract surgeries. Median satisfaction was 9 (interquartile range 7-10) on a 0-10 scale. Three IPO items showed strong associations and explained 35% of the variability present in the satisfaction variable: more pain relief received, higher allowed participation in pain treatment decisions, and no desire to have received more pain treatment. Patient factors and additional IPO items reflecting pain experience (eg, worst pain intensity), pain-related impairment, and information on pain treatment added little explanatory value, partially due to covariate correlations. Effects were highly consistent across centres and countries. We conclude that satisfaction with postoperative pain treatment is associated with the patients' actual pain experience, but more strongly with impressions of improvement and appropriateness of care. To the degree they desire, patients should be provided with information and involved in pain treatment decisions. PMID:24785269

  5. DoD–NCCAM/NIH Workshop on Acupuncture for Treatment of Acute Pain

    PubMed Central

    Belard, Jean Louis; Glowa, John; Khalsa, Partap; Weber, Wendy; Huntley, Kristen

    2013-01-01

    Abstract The Department of Defense (DoD) and the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) cosponsored a workshop that explored the possible benefits of acupuncture treatment for acute pain. One goal of the workshop was to establish a roadmap to building an evidence base on that would indicate whether acupuncture is helpful for treating active-duty military personnel experiencing acute pain. The workshop highlighted brief presentations on the most current research on acupuncture and acute pain mechanisms. The impact of various modifiers (stress, genetics, population, phenotypes, etc.) on acute pain pathways and response to acupuncture treatment was discussed. Additional presentations focused on common neural mechanisms, an overview of real-world experience with using acupuncture to treat traumatic acute pain, and best tools and methods specific for acupuncture studies. Three breakout groups addressed the gaps, opportunities, and barriers to acupuncture use for acute pain in military and trauma settings. Different models of effectiveness research and optimal research designs for conducting trials in acute traumatic pain were also discussed. PMID:23020611

  6. DoD-NCCAM/NIH workshop on acupuncture for treatment of acute pain.

    PubMed

    Edwards, Emmeline; Belard, Jean Louis; Glowa, John; Khalsa, Partap; Weber, Wendy; Huntley, Kristen

    2013-03-01

    The Department of Defense (DoD) and the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) cosponsored a workshop that explored the possible benefits of acupuncture treatment for acute pain. One goal of the workshop was to establish a roadmap to building an evidence base on that would indicate whether acupuncture is helpful for treating active-duty military personnel experiencing acute pain. The workshop highlighted brief presentations on the most current research on acupuncture and acute pain mechanisms. The impact of various modifiers (stress, genetics, population, phenotypes, etc.) on acute pain pathways and response to acupuncture treatment was discussed. Additional presentations focused on common neural mechanisms, an overview of real-world experience with using acupuncture to treat traumatic acute pain, and best tools and methods specific for acupuncture studies. Three breakout groups addressed the gaps, opportunities, and barriers to acupuncture use for acute pain in military and trauma settings. Different models of effectiveness research and optimal research designs for conducting trials in acute traumatic pain were also discussed.

  7. Dietary Supplements and Alternative Therapies for Pain Management.

    PubMed

    Gregory, Philip J

    2015-11-01

    The use of complementary and alternative medicines (CAM) continues to grow in North America. The most recent National Health Interview Survey found that in 2012, 33.2 percent of respondents reported usage of some form of CAM in the previous 12 months. A survey of adult patients in a U.S. dental school clinic found that 24 percent reported the use of herbal supplements. Dietary supplements and alternative therapies are often used for pain management. PMID:26798883

  8. Decreased Cortisol and Pain in Breast Cancer: Biofield Therapy Potential

    PubMed Central

    Running, Alice

    2015-01-01

    Breast cancer is one of the leading causes of cancer death among women of all races. Pain is a common symptom associated with cancer; 75–90% of cancer patients experience pain during their illness and up to 50% of that pain is undertreated. Unrelieved pain leads to increased levels of the stress hormone cortisol. The purpose of this study was to examine the impact of bioenergy on fecal cortisol levels for mice injected with murine mammary carcinoma 4T1 in two separate pilot studies. Using a multiple experimental group design, six to eight week old female BALB/c mice were injected with tumor and randomly assigned, in groups of 10, to daily treatment, every other day treatment, and no treatment groups. Five days after tumor cell injection, bioenergy interventions were begun for a period of ten consecutive days. Fecal samples were collected for each study and ELISA analysis was conducted at the end of both studies. For both studies, cortisol levels were decreased in the every other day treatment groups but remained high in the no treatment groups. Future studies utilizing bioenergy therapies on cortisol levels in a murine breast cancer model can begin to describe pain outcomes and therapeutic dose. PMID:26170887

  9. Decreased Cortisol and Pain in Breast Cancer: Biofield Therapy Potential.

    PubMed

    Running, Alice

    2015-01-01

    Breast cancer is one of the leading causes of cancer death among women of all races. Pain is a common symptom associated with cancer; 75-90% of cancer patients experience pain during their illness and up to 50% of that pain is undertreated. Unrelieved pain leads to increased levels of the stress hormone cortisol. The purpose of this study was to examine the impact of bioenergy on fecal cortisol levels for mice injected with murine mammary carcinoma 4T1 in two separate pilot studies. Using a multiple experimental group design, six to eight week old female BALB/c mice were injected with tumor and randomly assigned, in groups of 10, to daily treatment, every other day treatment, and no treatment groups. Five days after tumor cell injection, bioenergy interventions were begun for a period of ten consecutive days. Fecal samples were collected for each study and ELISA analysis was conducted at the end of both studies. For both studies, cortisol levels were decreased in the every other day treatment groups but remained high in the no treatment groups. Future studies utilizing bioenergy therapies on cortisol levels in a murine breast cancer model can begin to describe pain outcomes and therapeutic dose.

  10. Occupational Therapy Interventions in Chronic Pain--A Systematic Review.

    PubMed

    Hesselstrand, Malin; Samuelsson, Kersti; Liedberg, Gunilla

    2015-12-01

    The use of interventions based on the best available evidence in occupational therapy is essential, and evaluation of research is part of an evidence-based practice. The aim of this study was to assess the quality of studies describing and evaluating the effects of occupational therapy interventions on chronic pain. A systematic review of studies with diverse designs was carried out. A quality assessment was conducted, and the level of evidence was defined using the Research Pyramid Model. Of 19 included studies, three received the highest evidence level, and three were considered to be of high quality. The clinical recommendations that can be derived from this study are the following: occupational therapy interventions should start from the identified needs of the person with chronic pain; no support exists for the effectiveness of electromyographic biofeedback training as a supplement, more studies are needed to confirm this result; the efficacy of instructions on body mechanics was significant during work-hardening treatment; and occupational therapists need to perform and present more clinical studies of high quality and high-evidence level to build up a trustworthy arsenal of evidence-based interventions, for example, in persons with chronic pain.

  11. Association of worker characteristics and early reimbursement for physical therapy, chiropractic and opioid prescriptions with workers’ compensation claim duration, for cases of acute low back pain: an observational cohort study

    PubMed Central

    Busse, Jason W; Ebrahim, Shanil; Heels-Ansdell, Diane; Wang, Li; Couban, Rachel; Walter, Stephen D

    2015-01-01

    Objective To assess the association between early reimbursement for physiotherapy, chiropractic and opioid prescriptions for acute low back pain (LBP) with disability claim duration. Design Observational cohort study. Setting and participants From a random sample of 6665 claims for acute, uncomplicated LBP approved by the Ontario Workplace Safety and Insurance Board (WSIB) in 2005, we analysed 1442 who remained on full benefits at 4 weeks after claim approval. Primary outcome measure Our primary outcome was WSIB claim duration. Results We had complete data for all but 3 variables, which had <15% missing data, and we included missing data as a category for these factors. Our time-to-event analysis was adjusted for demographic, workplace and treatment factors, but not injury severity, although we attempted to include a sample with very similar, less-severe injuries. Regarding significant factors and treatment variables in our adjusted analysis, older age (eg, HR for age ≥55 vs <25=0.52; 99% CI 0.36 to 0.74) and WSIB reimbursement for opioid prescription in the first 4 weeks of a claim (HR=0.68; 99% CI 0.53 to 0.88) were associated with longer claim duration. Higher predisability income was associated with longer claim duration, but only among persistent claims (eg, HR for active claims at 1 year with a predisability income >$920 vs ≤$480/week=0.34; 99% CI 0.17 to 0.68). Missing data for union membership (HR=1.27; 99% CI 1.01 to 1.59), and working for an employer with a return-to-work programme were associated with fewer days on claim (HR=1.78; 99% CI 1.45 to 2.18). Neither reimbursement for physiotherapy (HR=1.01; 99% CI 0.86 to 1.19) nor chiropractic care (HR for active claims at 60 days=1.15; 99% CI 0.94 to 1.41) within the first 4 weeks was associated with claim duration. Our meta-analysis of 3 studies (n=51 069 workers) confirmed a strong association between early opioid use and prolonged claim duration (HR=0.57, 95% CI 0.48 to 0.69; low certainty

  12. Obesity Increases the Risk of Chest Wall Pain From Thoracic Stereotactic Body Radiation Therapy

    SciTech Connect

    Welsh, James; Thomas, Jimmy; Shah, Deep; Allen, Pamela K.; Wei, Xiong; Mitchell, Kevin; Gao, Song; Balter, Peter; Komaki, Ritsuko; Chang, Joe Y.

    2011-09-01

    Purpose: Stereotactic body radiation therapy (SBRT) is increasingly being used to treat thoracic tumors. We attempted here to identify dose-volume parameters that predict chest wall toxicity (pain and skin reactions) in patients receiving thoracic SBRT. Patients and Methods: We screened a database of patients treated with SBRT between August 2004 and August 2008 to find patients with pulmonary tumors within 2.5 cm of the chest wall. All patients received a total dose of 50 Gy in four daily 12.5-Gy fractions. Toxicity was scored according to the NCI-CTCAE V3.0. Results: Of 360 patients in the database, 265 (268 tumors) had tumors within <2.5 cm of the chest wall; 104 (39%) developed skin toxicity (any grade); 14 (5%) developed acute pain (any grade), and 45 (17%) developed chronic pain (Grade 1 in 22 cases [49%] and Grade 2 or 3 in 23 cases [51%]). Both skin toxicity and chest wall pain were associated with the V{sub 30}, or volume of the chest wall receiving 30 Gy. Body mass index (BMI) was also strongly associated with the development of chest pain: patients with BMI {>=}29 had almost twice the risk of chronic pain (p = 0.03). Among patients with BMI >29, diabetes mellitus was a significant contributing factor to the development of chest pain. Conclusion: Safe use of SBRT with 50 Gy in four fractions for lesions close to the chest wall requires consideration of the chest wall volume receiving 30 Gy and the patient's BMI and diabetic state.

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

    SciTech Connect

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

    2010-11-01

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

  14. Meperidine (pethidine) versus morphine in acute pain management of opioid-dependent patients

    PubMed Central

    Solhi, Hassan; Sanaei-Zadeh, Hossein; Solhi, Sadra; Azizi Nadian, Mohammad Ali; Gharibi, Morteza; Sadeghi Sedeh, Bahman

    2016-01-01

    The present study aimed to evaluate the effectiveness of morphine and meperidine (pethidine) as pain relief in opioid-dependent patients with acute pain. A total of 122 opioid-dependent patients with acute pain were included in the study. Their pain severity was assessed, using visual analog scale (VAS) scores ranging from 0 to 10. The patients randomly received intravenous morphine (up to 0.15 mg/kg) or meperidine (up to 1.5 mg/kg) for pain control by patient control analgesia (PCA) pump. The clinical opioid withdrawal scale (COWS) was employed for the assessment of withdrawal symptoms. The pain relief and the emergence of withdrawal symptoms were measured at 15, 30, and 60 minutes after drug administration. The patients who received morphine reported a better pain control compared to those who received meperidine (mean ± standard deviation [SD] VAS scores 4.11±1.90 vs 5.85±2.08 at the end of the study; P<0.001). On the other hand, the patients who received meperidine indicated prominent withdrawal symptoms (mean ± SD COWS scores 4.80±2.18 vs. 1.98±0.82 at the end of the study; P<0.001). Our findings revealed that morphine can be recommended in acute pain management of opioid-dependent patients. In addition, emergency physicians should ask their patients about any drug dependence before selecting the appropriate drug for their acute pain management. PMID:27621675

  15. Meperidine (pethidine) versus morphine in acute pain management of opioid-dependent patients

    PubMed Central

    Solhi, Hassan; Sanaei-Zadeh, Hossein; Solhi, Sadra; Azizi Nadian, Mohammad Ali; Gharibi, Morteza; Sadeghi Sedeh, Bahman

    2016-01-01

    The present study aimed to evaluate the effectiveness of morphine and meperidine (pethidine) as pain relief in opioid-dependent patients with acute pain. A total of 122 opioid-dependent patients with acute pain were included in the study. Their pain severity was assessed, using visual analog scale (VAS) scores ranging from 0 to 10. The patients randomly received intravenous morphine (up to 0.15 mg/kg) or meperidine (up to 1.5 mg/kg) for pain control by patient control analgesia (PCA) pump. The clinical opioid withdrawal scale (COWS) was employed for the assessment of withdrawal symptoms. The pain relief and the emergence of withdrawal symptoms were measured at 15, 30, and 60 minutes after drug administration. The patients who received morphine reported a better pain control compared to those who received meperidine (mean ± standard deviation [SD] VAS scores 4.11±1.90 vs 5.85±2.08 at the end of the study; P<0.001). On the other hand, the patients who received meperidine indicated prominent withdrawal symptoms (mean ± SD COWS scores 4.80±2.18 vs. 1.98±0.82 at the end of the study; P<0.001). Our findings revealed that morphine can be recommended in acute pain management of opioid-dependent patients. In addition, emergency physicians should ask their patients about any drug dependence before selecting the appropriate drug for their acute pain management.

  16. Paclitaxel induces acute pain via directly activating toll like receptor 4.

    PubMed

    Yan, Xisheng; Maixner, Dylan W; Yadav, Ruchi; Gao, Mei; Li, Pei; Bartlett, Michael G; Weng, Han-Rong

    2015-12-01

    Paclitaxel, a powerful anti-neoplastic drug, often causes pathological pain, which significantly reduces the quality of life in patients. Paclitaxel-induced pain includes pain that occurs immediately after paclitaxel treatment (paclitaxel-associated acute pain syndrome, P-APS) and pain that persists for weeks to years after cessation of paclitaxel treatment (paclitaxel induced chronic neuropathic pain). Mechanisms underlying P-APS remain unknown. In this study, we found that paclitaxel causes acute pain in rodents in a dose-dependent manner. The paclitaxel-induced acute pain occurs within 2 hrs after a single intravenous injection of paclitaxel. This is accompanied by low levels of paclitaxel penetrating into the cerebral spinal fluid and spinal dorsal horn. We demonstrated that an intrathecal injection of paclitaxel induces mechanical allodynia in a dose-dependent manner. Paclitaxel causes activation of toll like receptor 4 (TLR4) in the spinal dorsal horn and dorsal root ganglions. Through activating TLR4, paclitaxel increases glutamatergic synaptic activities and reduces glial glutamate transporter activities in the dorsal horn. Activations of TLR4 are necessary in the genesis of paclitaxel-induced acute pain. The cellular and molecular signaling pathways revealed in this study could provide rationales for the development of analgesics and management strategies for P-APS in patients. PMID:25775962

  17. Meperidine (pethidine) versus morphine in acute pain management of opioid-dependent patients.

    PubMed

    Solhi, Hassan; Sanaei-Zadeh, Hossein; Solhi, Sadra; Azizi Nadian, Mohammad Ali; Gharibi, Morteza; Sadeghi Sedeh, Bahman

    2016-01-01

    The present study aimed to evaluate the effectiveness of morphine and meperidine (pethidine) as pain relief in opioid-dependent patients with acute pain. A total of 122 opioid-dependent patients with acute pain were included in the study. Their pain severity was assessed, using visual analog scale (VAS) scores ranging from 0 to 10. The patients randomly received intravenous morphine (up to 0.15 mg/kg) or meperidine (up to 1.5 mg/kg) for pain control by patient control analgesia (PCA) pump. The clinical opioid withdrawal scale (COWS) was employed for the assessment of withdrawal symptoms. The pain relief and the emergence of withdrawal symptoms were measured at 15, 30, and 60 minutes after drug administration. The patients who received morphine reported a better pain control compared to those who received meperidine (mean ± standard deviation [SD] VAS scores 4.11±1.90 vs 5.85±2.08 at the end of the study; P<0.001). On the other hand, the patients who received meperidine indicated prominent withdrawal symptoms (mean ± SD COWS scores 4.80±2.18 vs. 1.98±0.82 at the end of the study; P<0.001). Our findings revealed that morphine can be recommended in acute pain management of opioid-dependent patients. In addition, emergency physicians should ask their patients about any drug dependence before selecting the appropriate drug for their acute pain management. PMID:27621675

  18. Acute low back pain: patients' perceptions of pain four weeks after initial diagnosis and treatment in general practice

    PubMed Central

    Chavannes, A.W.; Gubbels, J.; Post, D.; Rutten, G.; Thomas, S.

    1986-01-01

    In a nationwide study of the treatment of acute low back pain with and without radiation in general practice in the Netherlands the subjective well-being of patients was evaluated by means of a short questionnaire sent to patients four weeks after the initial contact with their general practitioner. After this period pain had disappeared in 28% of the patients, was diminished in 47%, was unchanged in 2% and was aggravated in 4%. There was no difference in the pain score of patients with and without follow-up encounters with their general practitioner. In all instances patients with low back pain without radiation fared significantly better than those with radiation. Radiation of pain was not constant — during the four-week follow-up period it developed in 19% of the patients originally without radiation and it disappeared in 44% of the patients originally suffering radiation. PMID:2945009

  19. Systematic Review and Meta-Analysis of Psychological Therapies for Children With Chronic Pain

    PubMed Central

    Heathcote, Lauren; Palermo, Tonya M.; de C Williams, Amanda C; Lau, Jennifer; Eccleston, Christopher

    2014-01-01

    Objectives This systematic review and meta-analysis examined the effects of psychological therapies for management of chronic pain in children. Methods Randomized controlled trials of psychological interventions treating children (<18 years) with chronic pain conditions including headache, abdominal, musculoskeletal, or neuropathic pain were searched for. Pain symptoms, disability, depression, anxiety, and sleep outcomes were extracted. Risk of bias was assessed and quality of the evidence was rated using GRADE. Results 35 included studies revealed that across all chronic pain conditions, psychological interventions reduced pain symptoms and disability posttreatment. Individual pain conditions were analyzed separately. Sleep outcomes were not reported in any trials. Optimal dose of treatment was explored. For headache pain, higher treatment dose led to greater reductions in pain. No effect of dosage was found for other chronic pain conditions. Conclusions Evidence for psychological therapies treating chronic pain is promising. Recommendations for clinical practice and research are presented. PMID:24602890

  20. [The use of nimesulide in the treatment of acute low back pain].

    PubMed

    Shikhkerimov, R K

    2016-01-01

    The objective is to study the efficacy and safety of nimesulide (nemulex) in the treatment of acute low back pain (LBP). The medical documentation of 54 patients with primary syndrome of LBP, which were treated in a polyclinic with nemulex at a dose of 200 mg per day had been studied. The assessment of patients' condition and efficacy and safety of the treatment was conducted based on the information after three visits (1-st, 5-th and 10-th day). The analysis took into account the data of clinical-neurological examination and the assessment of pain intensity at rest and at movement according to the visual analogue scale (VAS) and the severity of Lasegue symptom and limitation of movements in the lumbar spine. Safety of the therapy was evaluated on the basis of accounting of undesirable side reactions and data analysis and physical examination and laboratory testing. Cardiovascular safety was assessed by blood pressure and blood lipid profile on day 10. The use of nemulex at a dose of 200 mg per day resulted in relief of pain and increase of mobility in the lumbar spine on the 5th day of treatment that indicates the effectiveness of anti-inflammatory therapy to restore the previous functional status of patients with LBP. The use of nemulex was accompanied not only by statistically significant analgesic effect (0,78±0,14 points alone; 1,12±0,18 points when moving by VAS on the 10th day of the treatment) and high security (only 1 of the 54 patients was recorded to have elevation of hepatic transaminases; and 2 patients with dyspepsia without endoscopic changes of gastrointestinal tract). PMID:27240177

  1. [The use of nimesulide in the treatment of acute low back pain].

    PubMed

    Shikhkerimov, R K

    2016-01-01

    The objective is to study the efficacy and safety of nimesulide (nemulex) in the treatment of acute low back pain (LBP). The medical documentation of 54 patients with primary syndrome of LBP, which were treated in a polyclinic with nemulex at a dose of 200 mg per day had been studied. The assessment of patients' condition and efficacy and safety of the treatment was conducted based on the information after three visits (1-st, 5-th and 10-th day). The analysis took into account the data of clinical-neurological examination and the assessment of pain intensity at rest and at movement according to the visual analogue scale (VAS) and the severity of Lasegue symptom and limitation of movements in the lumbar spine. Safety of the therapy was evaluated on the basis of accounting of undesirable side reactions and data analysis and physical examination and laboratory testing. Cardiovascular safety was assessed by blood pressure and blood lipid profile on day 10. The use of nemulex at a dose of 200 mg per day resulted in relief of pain and increase of mobility in the lumbar spine on the 5th day of treatment that indicates the effectiveness of anti-inflammatory therapy to restore the previous functional status of patients with LBP. The use of nemulex was accompanied not only by statistically significant analgesic effect (0,78±0,14 points alone; 1,12±0,18 points when moving by VAS on the 10th day of the treatment) and high security (only 1 of the 54 patients was recorded to have elevation of hepatic transaminases; and 2 patients with dyspepsia without endoscopic changes of gastrointestinal tract).

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

    PubMed

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

    2016-02-01

    This article summarizes the results of a meeting convened by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) on key considerations and best practices governing the design of acute pain clinical trials. We discuss the role of early phase clinical trials, including pharmacokinetic-pharmacodynamic (PK-PD) trials, and the value of including both placebo and active standards of comparison in acute pain trials. This article focuses on single-dose and short-duration trials with emphasis on the perioperative and study design factors that influence assay sensitivity. Recommendations are presented on assessment measures, study designs, and operational factors. Although most of the methodological advances have come from studies of postoperative pain after dental impaction, bunionectomy, and other surgeries, the design considerations discussed are applicable to many other acute pain studies conducted in different settings. PMID:26683233

  3. Young children's behavioural responses to acute pain: strategies for getting better.

    PubMed

    Woodgate, R; Kristjanson, L J

    1995-08-01

    Behavioural responses of hospitalized young children in acute pain were examined and described. Eleven children, aged 24-79 months, who experienced acute pain in response to surgical intervention, and their parents, participated in the study. A qualitative, naturalistic methodology was used. Participant observation and child and parent interviews were the primary data collection methods. The constant comparative method of data analysis was employed to identify beginning behavioural response categories. Findings revealed that the children used the process of 'getting better' in response to pain. This process involved three strategies: 'hiding away', 'fighting it' and 'making it good'. Each of these strategies was characterized by specific behaviours. The more pain the children experienced, the more frequently these strategies were employed. Recommendations specific to assessing behavioural responses in young children experiencing acute pain are offered.

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

    PubMed

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

    2016-02-01

    This article summarizes the results of a meeting convened by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) on key considerations and best practices governing the design of acute pain clinical trials. We discuss the role of early phase clinical trials, including pharmacokinetic-pharmacodynamic (PK-PD) trials, and the value of including both placebo and active standards of comparison in acute pain trials. This article focuses on single-dose and short-duration trials with emphasis on the perioperative and study design factors that influence assay sensitivity. Recommendations are presented on assessment measures, study designs, and operational factors. Although most of the methodological advances have come from studies of postoperative pain after dental impaction, bunionectomy, and other surgeries, the design considerations discussed are applicable to many other acute pain studies conducted in different settings.

  5. Development of Cardiovascular Indices of Acute Pain Responding in Infants: A Systematic Review

    PubMed Central

    Waxman, Jordana A.; Pillai Riddell, Rebecca R.; Tablon, Paula; Schmidt, Louis A.; Pinhasov, Angelina

    2016-01-01

    Background. Cardiovascular indices of pain are pervasive in the hospital setting. However, no prospective research has examined the development of cardiac responses to acutely painful procedures in the first year of life. Objectives. Our main goal was to synthesize existing evidence regarding the development of cardiovascular responses to acutely painful medical procedures over the first year of life in preterm and term born infants. Methods. A systematic search retrieved 6994 articles to review against inclusion criteria. A total of 41 studies were included in the review. Results. In response to acutely painful procedures, most infants had an increase in mean heart rate (HR) that varied in magnitude both across and within gestational and postnatal ages. Research in the area of HR variability has been inconsistent, limiting conclusions. Conclusions. Longitudinal research is needed to further understand the inherent variability of cardiovascular pain responses across and within gestational and postnatal ages and the causes for the variability. PMID:27445630

  6. Interstitial cystitis/bladder pain syndrome and glycosaminoglycans replacement therapy

    PubMed Central

    2015-01-01

    Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating chronic disease characterized by discomfort or recurrent abdominal and pelvic pains in the absence of urinary tract infections. Its symptomatology includes discomfort, increased bladder pressure, sensitivity and intense pain in the bladder and pelvic areas, increased voiding frequency and urgency, or a combination of these symptoms. For these reasons, this pathology has a very negative impact on quality of life. The etiology of IC/BPS is still not well understood and different hypotheses have been formulated, including autoimmune processes, allergic reactions, chronic bacterial infections, exposure to toxins or dietary elements, and psychosomatic factors. The finding of an effective and specific therapy for IC/BPS remains a challenge for the scientific community because of the lack of a consensus regarding the causes and the inherent difficulties in the diagnosis. The last recent hypothesis is that IC/BPS could be pathophysiologically related to a disruption of the bladder mucosa surface layer with consequent loss of glycosaminoglycans (GAGs). This class of mucopolysaccharides has hydrorepellent properties and their alteration expose the urothelium to many urinary toxic agents. It has been hypothesized that when these substances penetrate the bladder wall a chain is triggered in the submucosa. In order to improve the integrity and function of the bladder lining, GAG layer replenishment therapy is widely accepted as therapy for patients with IC/BPS who have poor or inadequate response to conventional therapy. Currently, Chondroitin sulfate (CS), heparin, hyaluronic acid (HA), and pentosan polysulphate (PPS), and combinations of two GAGs (CS and HA) are the available substances with different effectiveness rates in patients with IC/BPS. There are four different commercially available products for GAG replenishment including CS, heparin, HA and PPS. Each product has different concentrations and

  7. Experiences of Indonesian mother managing preschool children's acute abdominal pain in Taiwan.

    PubMed

    Tseng, Chiu-Lien; Huang, Chu-Yu; Park, Jeong-Hwan; Lin, Hung-Ru; Liang, Shu-Yuan; Cheng, Su-Fen

    2015-01-01

    The aim of this study was to understand the Indonesian mothers' experiences of managing preschool children's acute abdominal pain. The descriptive qualitative research design comprises semi-structured interviews with 11 Indonesian mothers. The qualitative content analysis revealed three themes, including (1) insight of abdominal pain, (2) "inheritance of the strategies for assessment of management for abdominal pain from the family of origin", (3) "obstacles and insights related to cultural differences". The results presented that pain management was affected by family, environment, cultural background and religious beliefs. Healthcare providers should provide culturally competent pain management care for the patients of difference nationalities.

  8. Treatment of shoulder pain utilizing mechanical diagnosis and therapy principles.

    PubMed

    Kidd, Joshua

    2013-08-01

    This case report describes the effectiveness of mechanical diagnosis and therapy (MDT) in the management of a patient referred with a diagnosis of shoulder tendonitis. The patient was a 56-year-old male with a 3-month history of left anterior shoulder pain. Upon initial assessment, he presented with a positive open-can test, lift-off test, and Hawkins-Kennedy impingement test. A MDT assessment quickly ruled out cervical involvement and identified a loss of end-range shoulder mobility and pain during active shoulder movement. After the patient underwent a repeated movement examination and treatment based on responses to end-range movements over three visits, his shoulder pain was abolished and motion was fully restored. Despite having positive rotator cuff and impingement signs, this patient was effectively treated with repeated end-range movements over a short period of 2 weeks. This case demonstrates that treatment based on MDT sub-classification principles may be an effective way to manage shoulder pain as it is in the spine.

  9. Brain Network Response to Acupuncture Stimuli in Experimental Acute Low Back Pain: An fMRI Study

    PubMed Central

    Shi, Yu; Liu, Ziping; Zhang, Shanshan; Li, Qiang; Guo, Shigui; Yang, Jiangming; Wu, Wen

    2015-01-01

    Most neuroimaging studies have demonstrated that acupuncture can significantly modulate brain activation patterns in healthy subjects, while only a few studies have examined clinical pain. In the current study, we combined an experimental acute low back pain (ALBP) model and functional magnetic resonance imaging (fMRI) to explore the neural mechanisms of acupuncture analgesia. All ALBP subjects first underwent two resting state fMRI scans at baseline and during a painful episode and then underwent two additional fMRI scans, once during acupuncture stimulation (ACUP) and once during tactile stimulation (SHAM) pseudorandomly, at the BL40 acupoint. Our results showed that, compared with the baseline, the pain state had higher regional homogeneity (ReHo) values in the pain matrix, limbic system, and default mode network (DMN) and lower ReHo values in frontal gyrus and temporal gyrus; compared with the OFF status, ACUP yielded broad deactivation in subjects, including nearly all of the limbic system, pain status, and DMN, and also evoked numerous activations in the attentional and somatosensory systems; compared with SHAM, we found that ACUP induced more deactivations and fewer activations in the subjects. Multiple brain networks play crucial roles in acupuncture analgesia, suggesting that ACUP exceeds a somatosensory-guided mind-body therapy for ALBP. PMID:26161117

  10. Brain Network Response to Acupuncture Stimuli in Experimental Acute Low Back Pain: An fMRI Study.

    PubMed

    Shi, Yu; Liu, Ziping; Zhang, Shanshan; Li, Qiang; Guo, Shigui; Yang, Jiangming; Wu, Wen

    2015-01-01

    Most neuroimaging studies have demonstrated that acupuncture can significantly modulate brain activation patterns in healthy subjects, while only a few studies have examined clinical pain. In the current study, we combined an experimental acute low back pain (ALBP) model and functional magnetic resonance imaging (fMRI) to explore the neural mechanisms of acupuncture analgesia. All ALBP subjects first underwent two resting state fMRI scans at baseline and during a painful episode and then underwent two additional fMRI scans, once during acupuncture stimulation (ACUP) and once during tactile stimulation (SHAM) pseudorandomly, at the BL40 acupoint. Our results showed that, compared with the baseline, the pain state had higher regional homogeneity (ReHo) values in the pain matrix, limbic system, and default mode network (DMN) and lower ReHo values in frontal gyrus and temporal gyrus; compared with the OFF status, ACUP yielded broad deactivation in subjects, including nearly all of the limbic system, pain status, and DMN, and also evoked numerous activations in the attentional and somatosensory systems; compared with SHAM, we found that ACUP induced more deactivations and fewer activations in the subjects. Multiple brain networks play crucial roles in acupuncture analgesia, suggesting that ACUP exceeds a somatosensory-guided mind-body therapy for ALBP. PMID:26161117

  11. Acute low back pain is marked by variability: An internet-based pilot study

    PubMed Central

    2011-01-01

    Background Pain variability in acute LBP has received limited study. The objectives of this pilot study were to characterize fluctuations in pain during acute LBP, to determine whether self-reported 'flares' of pain represent discrete periods of increased pain intensity, and to examine whether the frequency of flares was associated with back-related disability outcomes. Methods We conducted a cohort study of acute LBP patients utilizing frequent serial assessments and Internet-based data collection. Adults with acute LBP (lasting ≤3 months) completed questionnaires at the time of seeking care, and at both 3-day and 1-week intervals, for 6 weeks. Back pain was measured using a numerical pain rating scale (NPRS), and disability was measured using the Oswestry Disability Index (ODI). A pain flare was defined as 'a period of increased pain lasting at least 2 hours, when your pain intensity is distinctly worse than it has been recently'. We used mixed-effects linear regression to model longitudinal changes in pain intensity, and multivariate linear regression to model associations between flare frequency and disability outcomes. Results 42 of 47 participants (89%) reported pain flares, and the average number of discrete flare periods per patient was 3.5 over 6 weeks of follow-up. More than half of flares were less than 4 hours in duration, and about 75% of flares were less than one day in duration. A model with a quadratic trend for time best characterized improvements in pain. Pain decreased rapidly during the first 14 days after seeking care, and leveled off after about 28 days. Patients who reported a pain flare experienced an almost 3-point greater current NPRS than those not reporting a flare (mean difference [SD] 2.70 [0.11]; p < 0.0001). Higher flare frequency was independently associated with a higher final ODI score (ß [SE} 0.28 (0.08); p = 0.002). Conclusions Acute LBP is characterized by variability. Patients with acute LBP report multiple distinct flares

  12. Multidetector CT in emergency radiology: acute and generalized non-traumatic abdominal pain.

    PubMed

    Paolantonio, Pasquale; Rengo, Marco; Ferrari, Riccardo; Laghi, Andrea

    2016-01-01

    Multidetector CT (MDCT) is an imaging technique that provides otherwise unobtainable information in the diagnostic work-up of patients presenting with acute abdominal pain. A correct working diagnosis depends essentially on understanding the individual patient's clinical data and laboratory findings. In haemodynamically stable patients with acute severe and generalized abdominal pain, MDCT is now the preferred imaging test and gives invaluable diagnostic information, also in unstable patients after stabilization. In this descriptive review, we focus our attention on acute, severe and generalized or undifferentiated non-traumatic abdominal pain. The main differential diagnoses are acute pancreatitis, gastrointestinal perforation, ruptured abdominal aneurysm and acute mesenteric ischaemia. We will provide radiologist readers with a technical guide to optimize MDCT imaging protocols and list the major CT signs essential to reach a correct diagnosis and guide the best treatment. PMID:26689097

  13. The multilevel organization of vicarious pain responses: effects of pain cues and empathy traits on spinal nociception and acute pain.

    PubMed

    Vachon-Presseau, Etienne; Martel, Marc O; Roy, Mathieu; Caron, Etienne; Jackson, Philip L; Rainville, Pierre

    2011-07-01

    The shared-representation model of empathy suggests that vicarious pain processes rely partly on the activation of brain systems underlying self-pain in the observer. Here, we tested the hypothesis that self-pain may be facilitated by the vicarious priming of neural systems underlying pain perception. Pictures illustrating painful agents applied to the hand or the foot (sensory information), or painful facial expressions (emotional information) were shown to 43 participants to test the effects of vicarious pain on the nociceptive flexion reflex (NFR) of the lower limb and pain intensity and unpleasantness produced by transcutaneous electrical stimulation applied over the sural nerve. Results confirmed the expected priming effects of vicarious pain on spinal and perceptual processes. However, for comparable pain intensity and arousal evoked by the pain pictures, the facilitation of the NFR and the self-pain unpleasantness measurements was more robust in response to pictures depicting pain sensory compared to emotional information. Furthermore, the facilitation of the NFR by pain pictures was positively correlated with the empathy trait of the observer. In contrast, the change in perceived shock-pain intensity was negatively correlated with empathic traits. This dissociation implies that low-level vicarious priming processes underlying pain facilitation may be downregulated at higher pain-processing stages in individuals reporting higher levels of empathy. We speculate that this process contributes to reducing self-other assimilation and is necessary to adopt higher-order empathic responses and altruistic behaviors.

  14. Abdominal pain and syndrome of inappropriate antidiuretic hormone secretion as clinical presentation of acute intermittent porphyria.

    PubMed

    Valle Feijóo, M L; Bermúdez Sanjurjo, J R; González Vázquez, L; Rey Martínez, M; de la Fuente Aguado, J

    2015-01-01

    Acute intermittent porphyria (AIP) is a rare condition characterized by abdominal pain and a wide range of nonspecific symptoms. We report the case of a woman with abdominal pain and syndrome of inappropriate antidiuretic hormone secretion (SIADH) as clinical presentation of AIP. The diagnosis was achieved through the etiologic study of the SIADH.

  15. Extended-release morphine sulfate in treatment of severe acute and chronic pain

    PubMed Central

    Balch, Robert J; Trescot, Andrea

    2010-01-01

    Morphine is the archetypal opioid analgesic. Because it is a short-acting opioid, its use has been limited to the management of acute pain. The development of extended-release formulations have resulted in the increased utilization of morphine in chronic pain conditions. This review documents the history of morphine use in pain treatment, and describes the metabolism, pharmacodynamics, formulations, and efficacy of the currently available extended-release morphine medications. PMID:21197323

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

    PubMed Central

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

    2007-01-01

    BACKGROUND Few studies have evaluated the association between patient expectations for recovery and clinical outcomes, and no study has evaluated whether asking patients to choose their therapy modifies such an association. OBJECTIVE To evaluate the association between patients’ expectations and functional recovery in patients with acute low back pain (LBP), and to determine whether that association is affected by giving patients choice of therapy. DESIGN AND PARTICIPANTS A secondary analysis of a randomized controlled trial comparing usual care alone to usual care plus choice of chiropractic, acupuncture, or massage in 444 adults with acute LBP, lasting less than 21 days. MEASUREMENTS AND MAIN RESULTS Primary outcome was functional disability (Roland score) at 5 and 12 weeks. Patients’ general expectations for improvement were associated with improvement in functional status (β = 0.96, 95% CI = 0.56, 1.36). A 1-point increase in general expectations was associated with a 0.96-point improvement in Roland score. The association of expectation with outcome was 2–3 times greater in the usual care group than the choice group. However, these differences did not reach statistical significance. CONCLUSIONS In patients with acute LBP, higher expectations for recovery are associated with greater functional improvement. Eliciting patient expectations for improvement may be a simple way to identify patients with the highest (or lowest) likelihood of experiencing functional improvement. Incorporating questions about patient expectations in future trials may clarify the role of this important correlate of clinical outcomes. PMID:18066631

  17. Gender differences in acute and chronic pain in the emergency department: results of the 2014 Academic Emergency Medicine consensus conference pain section.

    PubMed

    Musey, Paul I; Linnstaedt, Sarah D; Platts-Mills, Timothy F; Miner, James R; Bortsov, Andrey V; Safdar, Basmah; Bijur, Polly; Rosenau, Alex; Tsze, Daniel S; Chang, Andrew K; Dorai, Suprina; Engel, Kirsten G; Feldman, James A; Fusaro, Angela M; Lee, David C; Rosenberg, Mark; Keefe, Francis J; Peak, David A; Nam, Catherine S; Patel, Roma G; Fillingim, Roger B; McLean, Samuel A

    2014-12-01

    Pain is a leading public health problem in the United States, with an annual economic burden of more than $630 billion, and is one of the most common reasons that individuals seek emergency department (ED) care. There is a paucity of data regarding sex differences in the assessment and treatment of acute and chronic pain conditions in the ED. The Academic Emergency Medicine consensus conference convened in Dallas, Texas, in May 2014 to develop a research agenda to address this issue among others related to sex differences in the ED. Prior to the conference, experts and stakeholders from emergency medicine and the pain research field reviewed the current literature and identified eight candidate priority areas. At the conference, these eight areas were reviewed and all eight were ratified using a nominal group technique to build consensus. These priority areas were: 1) gender differences in the pharmacological and nonpharmacological interventions for pain, including differences in opioid tolerance, side effects, or misuse; 2) gender differences in pain severity perceptions, clinically meaningful differences in acute pain, and pain treatment preferences; 3) gender differences in pain outcomes of ED patients across the life span; 4) gender differences in the relationship between acute pain and acute psychological responses; 5) the influence of physician-patient gender differences and characteristics on the assessment and treatment of pain; 6) gender differences in the influence of acute stress and chronic stress on acute pain responses; 7) gender differences in biological mechanisms and molecular pathways mediating acute pain in ED populations; and 8) gender differences in biological mechanisms and molecular pathways mediating chronic pain development after trauma, stress, or acute illness exposure. These areas represent priority areas for future scientific inquiry, and gaining understanding in these will be essential to improving our understanding of sex and gender

  18. Gender Differences in Acute and Chronic Pain in the Emergency Department: Results of the 2014 Academic Emergency Medicine Consensus Conference Pain Section

    PubMed Central

    Musey, Paul I.; Linnstaedt, Sarah D.; Platts-Mills, Timothy F.; Miner, James R.; Bortsov, Andrey V.; Safdar, Basmah; Bijur, Polly; Rosenau, Alex; Tsze, Daniel S.; Chang, Andrew K.; Dorai, Suprina; Engel, Kirsten; Feldman, James A.; Fusaro, Angela M.; Lee, David C.; Rosenberg, Mark; Keefe, Francis J.; Peak, David A.; Nam, Catherine S.; Patel, Roma G.; Fillingim, Roger B.; McLean, Samuel A.

    2015-01-01

    Pain is a leading public health problem in the United States, with an annual economic burden of more than $630 billion, and is one of the most common reasons that individuals seek emergency department (ED) care. There is a paucity of data regarding sex differences in the assessment and treatment of acute and chronic pain conditions in the ED. The Academic Emergency Medicine consensus conference convened in Dallas, Texas in May of 2014 to develop a research agenda to address this issue among others related to sex differences in the ED. Prior to the conference, experts and stakeholders from emergency medicine and the pain research field reviewed the current literature and identified eight candidate priority areas. At the conference, these eight areas were reviewed and all eight were ratified using a nominal group technique to build consensus. These priority areas were: 1) gender differences in the pharmacologic and non-pharmacologic interventions for pain, including differences in opioid tolerance, side effects, or misuse; 2) gender differences in pain severity perceptions, clinically meaningful differences in acute pain, and pain treatment preferences; 3) gender differences in pain outcomes of ED patients across the lifespan; 4) gender differences in the relationship between acute pain and acute psychological responses; 5) the influence of physician-patient gender differences and characteristics on the assessment and treatment of pain; 6) gender differences in the influence of acute stress and chronic stress on acute pain responses; 7) gender differences in biologic mechanisms and molecular pathways mediating acute pain in ED populations; and 8) gender differences in biologic mechanisms and molecular pathways mediating chronic pain development after trauma, stress, or acute illness exposure. These areas represent priority areas for future scientific inquiry, and gaining understanding in these will be essential to improving our understanding of sex and gender

  19. Effectiveness of Behavioral Therapy for Chronic Low Back Pain: A Component Analysis.

    ERIC Educational Resources Information Center

    Turner, Judith A.; And Others

    1990-01-01

    Evaluated effects of group behavioral therapy including aerobic exercise, behavioral therapy alone, and aerobic exercise alone on pain and physical and psychological disability among mildly disabled chronic low-back-pain patients (n=96). The combined behavioral therapy and exercise group improved significantly more pretreatment to posttreatment…

  20. Reduced acute nociception and chronic pain in Shank2-/- mice.

    PubMed

    Ko, Hyoung-Gon; Oh, Seog-Bae; Zhuo, Min; Kaang, Bong-Kiun

    2016-01-01

    Autism spectrum disorder is a debilitating mental illness and social issue. Autism spectrum disorder patients suffer from social isolation, cognitive deficits, compulsive behavior, and sensory deficits, including hyposensitivity to pain. However, recent studies argued that autism spectrum disorder patients show physiological pain response and, in some cases, even extremely intense pain response to harmless stimulation. Recently, Shank gene family was reported as one of the genetic risk factors of autism spectrum disorder. Thus, in this study, we used Shank2(-) (/) (-) (Shank2 knock-out, KO) mice to investigate the controversial pain sensitivity issue and found that Shank2 KO mice showed reduced tactile perception and analgesia to chronic pain. PMID:27145803

  1. Pain control.

    PubMed

    Boey, W K

    1991-01-01

    There are two components to the perception of pain; the 'sensory' and the 'reactive'. Psychological factors control the latter. Pain research is rapidly advancing: the discovery of endorphins and opioid receptors, the appreciation of the psychological component of pain and the multidisciplinary approach to chronic pain are major advances. Pain can be classified as acute or chronic. Acute pain is easy to diagnose, the cause of pain obvious and the treatment logical, chronic pain has a greater psychological component, is difficult to diagnose and treatment is often empirical. Methods of pain control include drugs, injection techniques, electro stimulation, non invasive therapies, denervation procedures and palliative procedures. A multidisciplinary approach and a combination of methods is necessary to treat chronic pain. Spinal opioids, radiofrequency thermocoagulation, intrapleural bupivacaine, cryoanalgesia and patient controlled analgesia are recent advances in pain control. However, most pain can be controlled adequately with simple methods; what is essential is the interest and commitment of the physician towards achieving optimum therapeutics. PMID:1674199

  2. Natural course of acute neck and low back pain in the general population: the HUNT study.

    PubMed

    Vasseljen, Ottar; Woodhouse, Astrid; Bjørngaard, Johan Håkon; Leivseth, Linda

    2013-08-01

    In this prospective cohort study we aimed to describe the natural course of acute neck and low back pain in a general population of Norway. We screened 9056 subjects aged 20-67 years who participated in a general health survey for a new episode of neck or low back pain the previous month. The screening identified 219 subjects who formed the cohort for this study. Pain intensity was reported on a numeric rating scale (0-10) at 1, 2, 3, 6, and 12 months after start of the new pain episode. The course of pain was described for neck and low back pain, different baseline pain levels, age groups, and number of pain sites at baseline. Use of medication and health care was described and associations between pain intensity and seeking health care were estimated. Pain declined rapidly within 1 month after a new pain episode, with a reduction of 0.91 (95% confidence interval [CI] 0.50-1.32) for neck pain and 1.40 (95% CI 0.82-1.99) for low back pain with little change thereafter. However, pain remained unchanged over the follow-up year for those with equal pain in the neck and low back areas at baseline and for those reporting 4 or more pain sites at baseline. Only 1 in 5 sought health care for their complaints. Still, the course of pain was comparable to effect sizes reported in interventional studies. This study thus contributes natural course reference data for comparisons of pain outcome in clinical trials and practice.

  3. Lumbar manipulation and exercise for the treatment of acute low back pain in adolescents: a randomized controlled trial

    PubMed Central

    Selhorst, Brittany

    2015-01-01

    Objectives Low back pain (LBP) is a common condition in adolescents. Although much has been written about the efficacy of lumbar manipulation for adults with LBP, little is known about its effectiveness in adolescents. This study had two primary aims: (1) to assess the efficacy of adding lumbar manipulation to an exercise program in adolescents with acute (<90 days) LBP and (2) to report and assess any adverse reactions associated with lumbar manipulation noted in this study. Methods Patients were randomly assigned to receive lumbar manipulation or sham manipulation. All patients performed 4 weeks of physical therapy exercise. Pain, patient-specific functional scale (PSFS), and global rating of change (GROC) scores were measured at evaluation, 1 week, 4 weeks, and 6 months. Relative risk was calculated for adverse reactions noted. Results We recruited 35 consecutive patients with acute LBP. One patient was excluded after being diagnosed with a spondylolysis, 34 patients remained for analysis. Both groups experienced significant improvement over time in all measures. There were no differences between groups for pain, PSFS, or GROC scores. No increased risk of adverse reaction from lumbar manipulation was noted. Discussion The addition of lumbar manipulation to exercise did not benefit adolescents with acute LBP. There was not an increased risk of an adverse reaction noted in this study from lumbar manipulation performed on adolescents. Further research needs to be done to identify factors that predict positive outcomes following lumbar manipulation in adolescents. PMID:26917941

  4. Clinical decision rule for primary care patient with acute low back pain at risk of developing chronic pain

    PubMed Central

    Mehling, Wolf E.; Ebell, Mark H.; Avins, Andrew L.; Hecht, Frederick M.

    2015-01-01

    Background Context Primary care clinicians need to identify candidates for early interventions to prevent patients with acute pain from developing chronic pain. Purpose We conducted a 2-year prospective cohort study of risk factors for the progression to chronic pain and developed and internally validated a clinical decision rule (CDR) that stratifies patients into low, medium and high-risk groups for chronic pain. Study Design/Setting Prospective cohort study in primary care. Patient Sample Patients with acute low back pain (LBP; ≤30 days duration) Outcome measures Self-reported perceived non-recovery and chronic pain. Methods Patients were surveyed at baseline, 6 months and 2 years. We conducted bivariate and multivariate regression analyses of demographic, clinical and psychosocial variables for chronic pain outcomes, developed a CDR and assessed its performance by calculating the bootstrapped areas under the receiver operating characteristic curve (AUC) and likelihood ratios. This study was supported by NIH/NCCAM grants K23 AT002298, R21 AT004467, NIH/NCCAM K24 AT007827, the Research Evaluation and Allocation Committee (REAC) of the University of California San Francisco, and the Mount Zion Health Fund, San Francisco. The funding agencies played no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. The authors report no conflict of interests. Results 605 patients enrolled. 13% had chronic pain at 6 months, 19% at 2 years. An eight-item CDR was most parsimonious for classifying patients into three risk levels. Bootstrapped AUC was 0.76 (0.70–0.82) for the 6-month CDR. Each 10-point score increase (60-point range) was associated with an odds ratio of 11.1 (10.8–11.4) for developing chronic pain. Using a <5% probability of chronic pain as the cutoff for low risk and a >40% probability for high risk, likelihood ratios were 0.26 (0.14–0.48) and 4

  5. Acute Low Back Pain and Primary Care: How to Define Recovery and Chronification?

    PubMed Central

    Mehling, Wolf E.; Gopisetty, Viranjini; Acree, Michael; Pressman, Alice; Carey, Tim; Goldberg, Harley; Hecht, Frederick; Avins, Andrew L

    2011-01-01

    Study Design Prospective cohort study Objective to establish outcome measures for recovery and chronic pain for studies with patients that present with recent-onset acute low back pain in primary care Summary of Background Data Among back pain researchers, no consensus exists about outcome definitions or how to identify primary-care patients as not-recovered from an episode of low back pain. Cut points for outcome scales have mostly been arbitrarily chosen. Theoretical models for establishing minimal important change (MIC) values in studies of patients with low back pain have been proposed and need to be applied to real data. Methods In a sample of 521 patients which presented with acute low back pain (<4 weeks) in primary care clinics and were followed for 6 months, scores for pain and disability were compared with ratings on a global perceived effect scale. Using multiple potential “gold standards” as anchors (reference standards), the receiver operating characteristics method was used to determine optimal cut points for different ways of defining non-recovery from acute low back pain. Results MIC values and upper limits for pain and disability scores as well as minimal important percent changes are presented for five different definitions of recovery. A previously suggested 30% change from baseline scores does not accurately discriminate between recovered and not recovered patients in patients presenting with acute low back pain in primary care. Conclusions Outcome definitions that combine ratings from perceived recovery scales with pain and disability measures provide the highest accuracy in discriminating recovered from non-recovered patients. PMID:21311400

  6. Mesenchymal stem cell therapy for acute radiation syndrome.

    PubMed

    Fukumoto, Risaku

    2016-01-01

    Acute radiation syndrome affects military personnel and civilians following the uncontrolled dispersal of radiation, such as that caused by detonation of nuclear devices and inappropriate medical treatments. Therefore, there is a growing need for medical interventions that facilitate the improved recovery of victims and patients. One promising approach may be cell therapy, which, when appropriately implemented, may facilitate recovery from whole body injuries. This editorial highlights the current knowledge regarding the use of mesenchymal stem cells for the treatment of acute radiation syndrome, the benefits and limitations of which are under investigation. Establishing successful therapies for acute radiation syndrome may require using such a therapeutic approach in addition to conventional approaches. PMID:27182446

  7. Trunk Motor Control Deficits in Acute and Subacute Low Back Pain are Not Associated with Pain or Fear of Movement

    PubMed Central

    Sung, Won; Abraham, Mathew; Plastaras, Christopher; Silfies, Sheri P.

    2015-01-01

    Background Context A subgroup of patients with acute/sub-acute low back pain (LBP) presenting with trunk movement control deficits, pain provocation with segmental testing, and segmental hypermobility have been clinically identified as having movement coordination impairments (MCI) of the trunk. It is hypothesized that these patients have proprioceptive, postural and movement control impairments of the trunk associated with LBP. While, trunk control impairments have been identified in patients with chronic LBP, they have not been investigated in this subgroup or closer to symptom onset. Purpose To identify trunk motor control (postural control and movement precision) impairments in a subgroup of patients with acute/sub-acute LBP who have been clinically identified to have MCI and determine association of these impairments with pain and fear of movement. Study Design/Setting Observational design; University biomechanics lab and clinical practice. Patient Sample Thirty-three patients with acute/sub-acute LBP identified with trunk MCI and 33 gender, age, and BMI matched healthy controls. Outcome Measures Self-report Measures Numeric Pain Rating Scale, Oswestry Disability Questionnaire, Fear Avoidance Beliefs Questionnaire. Physiologic Measures Postural control, Movement precision Methods Center of pressure movement was measured while subjects attempted to volitionally control trunk posture and movement while sitting on a platform with a hemisphere mounted underneath. This created an unstable surface that required coordinated trunk control to maintain an upright-seated posture. Postural control was tested using eyes-open and eyes-closed balance protocols. Movement precision was tested with a dynamic control test requiring movement of the center of pressure along a discrete path. Group trunk motor control performance was compared with ANOVA and t-Test. Performance association with pain and fear of movement were assessed with Pearson’s Correlations. Funding for this

  8. A Pilot Feasibility Study of Massage to Reduce Pain in People with Spinal Cord Injury during Acute Rehabilitation

    PubMed Central

    Chase, Theresa; Jha, Amitabh; Brooks, C. A.; Allshouse, Amanda

    2013-01-01

    Objective To determine the feasibility of conducting a randomized controlled trial of massage therapy for patients with new spinal cord injury (SCI) during acute inpatient rehabilitation. Design A pilot single-center, randomized, single-blind, cross-over clinical trial. Setting Free-standing, not-for-profit, comprehensive rehabilitation center specializing in SCI rehabilitation Participants Forty adults ages 18 years and older undergoing acute rehabilitation following spinal cord injury reporting any type of pain. Intervention Rehabilitation nurses trained to give broad compression massage (BCM) and a control light contact touch (LCT) treatments. Participants were randomized to receive either BCM or LCT first, in six 20 minute treatment sessions over two weeks, with a one week wash-out between the two-week treatment periods. Main Outcome Measures Primary outcomes were changes in pain intensity and in fatigue, measured daily. Secondary outcomes included depressive symptoms measured by the Patient Health Questionnaire-9 (PHQ-9) and an assessment of pain medication usage. Results Pain intensity was higher at baseline and reduced more in the LCT-first group compared to the BCM-first group in period 1 (p=0.014); although this pattern was not found in period 2 (p=0.58). LCT and BCM groups did not significantly differ on any secondary measures except PHQ-9. Conclusions This study demonstrates the feasibility of using rehabilitation nurses to provide tactile therapy to patients with SCI and suggests a model for controlled clinical trials examining the efficacy of massage therapies. While efficacy was difficult to assess, broad compression massage was safe and well tolerated. PMID:24042991

  9. Central effect of histamine in a rat model of acute trigeminal pain.

    PubMed

    Tamaddonfard, Esmaeal; Khalilzadeh, Emad; Hamzeh-Gooshchi, Nasrin; Seiednejhad-Yamchi, Sona

    2008-01-01

    In conscious rats implanted with an intracerebroventricular (icv) cannula, effect of icv injections of histamine, chlorpheniramine (H(1)-receptor antagonist) and ranitidine (H(2)-receptor blocker) was investigated in a rat model of acute trigeminal pain. Acute trigeminal pain was induced by putting a drop of 5 M NaCl solution on the corneal surface of the eye and the numbers of eye wipes were counted during the first 30 s. Histamine (20, 40 microg) and chlorpheniramine (80 microg) significantly decreased the numbers of eye wipes. Ranitidine alone had no effect. Pretreatment with chlorpheniramine did not change the histamine-induced analgesia, whereas the histamine effect on pain was inhibited with ranitidine pretreatment. These results indicate that the brain histamine, through central H(2) receptors, may be involved in the modulation of the acute trigeminal pain in rats.

  10. IB4-saporin attenuates acute and eliminates chronic muscle pain in the rat.

    PubMed

    Alvarez, Pedro; Gear, Robert W; Green, Paul G; Levine, Jon D

    2012-02-01

    The function of populations of nociceptors in muscle pain syndromes remain poorly understood. We compared the contribution of two major classes, isolectin B4-positive (IB4(+)) and IB4-negative (IB4(-)) nociceptors, in acute and chronic inflammatory and ergonomic muscle pain. Baseline mechanical nociceptive threshold was assessed in the gastrocnemius muscle of rats treated with IB4-saporin, which selectively destroys IB4(+) nociceptors. Rats were then submitted to models of acute inflammatory (intramuscular carrageenan)- or ergonomic intervention (eccentric exercise or vibration)-induced muscle pain, and each of the three models also evaluated for the transition from acute to chronic pain, manifest as prolongation of prostaglandin E2 (PGE(2))-induced hyperalgesia, after recovery from the hyperalgesia induced by acute inflammation or ergonomic interventions. IB4-saporin treatment did not affect baseline mechanical nociceptive threshold. However, compared to controls, IB4-saporin treated rats exhibited shorter duration mechanical hyperalgesia in all three models and attenuated peak hyperalgesia in the ergonomic pain models. And, IB4-saporin treatment completely prevented prolongation of PGE(2)-induced mechanical hyperalgesia. Thus, IB4(+) and IB4(-) neurons contribute to acute muscle hyperalgesia induced by diverse insults. However, only IB4+ nociceptors participate in the long term consequence of acute hyperalgesia.

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

    PubMed

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

    2015-02-01

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

  12. Effectiveness of Tai-Chi for decreasing acute pain in fibromyalgia patients.

    PubMed

    Segura-Jiménez, V; Romero-Zurita, A; Carbonell-Baeza, A; Aparicio, V A; Ruiz, J R; Delgado-Fernández, M

    2014-05-01

    Tai-Chi has shown benefits in physical and psychological outcomes in diverse populations. We aimed to determine the changes elicited by a Tai-Chi program (12 and 24 weeks) in acute pain (before vs. after session) in fibromyalgia patients. We also assessed the cumulative changes in pain brought about by a Tai-Chi program. Thirty-six patients (29 women) with fibromyalgia participated in a low-moderate intensity Tai-Chi program for 12 weeks (3 sessions/week). Twenty-eight patients (27 women) continued the program for an additional 12 weeks (i. e., 24 weeks). We assessed pain by means of a Visual Analogue Scale (VAS) before and after each single session (i. e., 72 sessions). We observed significant immediate changes (P-values from 0.037 to 0.0001) with an approximately 12% mean decrease of acute pain in the comparison of VAS-values before and after each session (72 sessions in total), with the exception of 4 sessions. We observed significant changes in cumulative pain pre-session (95% CI=-0.019; -0.014; P<0.001) and cumulative pain post-session (95% CI=-0.021; -0.015; P<0.001) along the 24-week intervention only. In conclusion, a low-moderate intensity Tai-Chi program for 12 weeks (3 times/week) decreased levels of acute pain in fibromyalgia patients. A longer period is necessary (e. g. 24 weeks) for observing cumulative changes in pain.

  13. Acute psychosocial stress and emotion regulation skills modulate empathic reactions to pain in others.

    PubMed

    Buruck, Gabriele; Wendsche, Johannes; Melzer, Marlen; Strobel, Alexander; Dörfel, Denise

    2014-01-01

    Psychosocial stress affects resources for adequate coping with environmental demands. A crucial question in this context is the extent to which acute psychosocial stressors impact empathy and emotion regulation. In the present study, 120 participants were randomly assigned to a control group vs. a group confronted with the Trier Social Stress Test (TSST), an established paradigm for the induction of acute psychosocial stress. Empathy for pain as a specific subgroup of empathy was assessed via pain intensity ratings during a pain-picture task. Self-reported emotion regulation skills were measured as predictors using an established questionnaire. Stressed individuals scored significantly lower on the appraisal of pain pictures. A regression model was chosen to find variables that further predict the pain ratings. These findings implicate that acute psychosocial stress might impair empathic processes to observed pain in another person and the ability to accept one's emotion additionally predicts the empathic reaction. Furthermore, the ability to tolerate negative emotions modulated the relation between stress and pain judgments, and thus influenced core cognitive-affective functions relevant for coping with environmental challenges. In conclusion, our study emphasizes the necessity of reducing negative emotions in terms of empathic distress when confronted with pain of another person under psychosocial stress, in order to be able to retain pro-social behavior. PMID:24910626

  14. Acute psychosocial stress and emotion regulation skills modulate empathic reactions to pain in others.

    PubMed

    Buruck, Gabriele; Wendsche, Johannes; Melzer, Marlen; Strobel, Alexander; Dörfel, Denise

    2014-01-01

    Psychosocial stress affects resources for adequate coping with environmental demands. A crucial question in this context is the extent to which acute psychosocial stressors impact empathy and emotion regulation. In the present study, 120 participants were randomly assigned to a control group vs. a group confronted with the Trier Social Stress Test (TSST), an established paradigm for the induction of acute psychosocial stress. Empathy for pain as a specific subgroup of empathy was assessed via pain intensity ratings during a pain-picture task. Self-reported emotion regulation skills were measured as predictors using an established questionnaire. Stressed individuals scored significantly lower on the appraisal of pain pictures. A regression model was chosen to find variables that further predict the pain ratings. These findings implicate that acute psychosocial stress might impair empathic processes to observed pain in another person and the ability to accept one's emotion additionally predicts the empathic reaction. Furthermore, the ability to tolerate negative emotions modulated the relation between stress and pain judgments, and thus influenced core cognitive-affective functions relevant for coping with environmental challenges. In conclusion, our study emphasizes the necessity of reducing negative emotions in terms of empathic distress when confronted with pain of another person under psychosocial stress, in order to be able to retain pro-social behavior.

  15. Acute psychosocial stress and emotion regulation skills modulate empathic reactions to pain in others

    PubMed Central

    Buruck, Gabriele; Wendsche, Johannes; Melzer, Marlen; Strobel, Alexander; Dörfel, Denise

    2014-01-01

    Psychosocial stress affects resources for adequate coping with environmental demands. A crucial question in this context is the extent to which acute psychosocial stressors impact empathy and emotion regulation. In the present study, 120 participants were randomly assigned to a control group vs. a group confronted with the Trier Social Stress Test (TSST), an established paradigm for the induction of acute psychosocial stress. Empathy for pain as a specific subgroup of empathy was assessed via pain intensity ratings during a pain-picture task. Self-reported emotion regulation skills were measured as predictors using an established questionnaire. Stressed individuals scored significantly lower on the appraisal of pain pictures. A regression model was chosen to find variables that further predict the pain ratings. These findings implicate that acute psychosocial stress might impair empathic processes to observed pain in another person and the ability to accept one's emotion additionally predicts the empathic reaction. Furthermore, the ability to tolerate negative emotions modulated the relation between stress and pain judgments, and thus influenced core cognitive-affective functions relevant for coping with environmental challenges. In conclusion, our study emphasizes the necessity of reducing negative emotions in terms of empathic distress when confronted with pain of another person under psychosocial stress, in order to be able to retain pro-social behavior. PMID:24910626

  16. Therapy of Acute Hypertension in Hospitalized Children and Adolescents

    PubMed Central

    Webb, Tennille N.; Shatat, Ibrahim F.

    2014-01-01

    Acute hypertension (HTN) in hospitalized children and adolescents occurs relatively frequently and in some cases, if not recognized and treated promptly, it can lead to hypertensive crisis with potentially significant morbidity and mortality. In contrast to adults, where acute HTN is most likely due to uncontrolled primary HTN, children and adolescents with acute HTN are more likely to have secondary HTN. This review will briefly cover evaluation of acute HTN and various age specific etiologies of secondary HTN and provide more in-depth discussion on treatment target, potential risks of acute HTN therapy, available pediatric data on intravenous and oral antihypertensive agents, and propose treatment schema including unique therapy of specific secondary HTN scenarios. PMID:24522943

  17. Incidence and Predictive Factors of Pain Flare After Spine Stereotactic Body Radiation Therapy: Secondary Analysis of Phase 1/2 Trials

    SciTech Connect

    Pan, Hubert Y.; Allen, Pamela K.; Wang, Xin S.; Chang, Eric L.; Rhines, Laurence D.; Tatsui, Claudio E.; Amini, Behrang; Wang, Xin A.; Tannir, Nizar M.; Brown, Paul D.; Ghia, Amol J.

    2014-11-15

    Purpose/Objective(s): To perform a secondary analysis of institutional prospective spine stereotactic body radiation therapy (SBRT) trials to investigate posttreatment acute pain flare. Methods and Materials: Medical records for enrolled patients were reviewed. Study protocol included baseline and follow-up surveys with pain assessment by Brief Pain Inventory and documentation of pain medications. Patients were considered evaluable for pain flare if clinical note or follow-up survey was completed within 2 weeks of SBRT. Pain flare was defined as a clinical note indicating increased pain at the treated site or survey showing a 2-point increase in worst pain score, a 25% increase in analgesic intake, or the initiation of steroids. Binary logistic regression was used to determine predictive factors for pain flare occurrence. Results: Of the 210 enrolled patients, 195 (93%) were evaluable for pain flare, including 172 (88%) clinically, 135 (69%) by survey, and 112 (57%) by both methods. Of evaluable patients, 61 (31%) had undergone prior surgery, 57 (29%) had received prior radiation, and 34 (17%) took steroids during treatment, mostly for prior conditions. Pain flare was observed in 44 patients (23%). Median time to pain flare was 5 days (range, 0-20 days) after the start of treatment. On multivariate analysis, the only independent factor associated with pain flare was the number of treatment fractions (odds ratio = 0.66, P=.004). Age, sex, performance status, spine location, number of treated vertebrae, prior radiation, prior surgery, primary tumor histology, baseline pain score, and steroid use were not significant. Conclusions: Acute pain flare after spine SBRT is a relatively common event, for which patients should be counseled. Additional study is needed to determine whether prophylactic or symptomatic intervention is preferred.

  18. Optimizing asparaginase therapy for acute lymphoblastic leukemia.

    PubMed

    Rizzari, Carmelo; Conter, Valentino; Starý, Jan; Colombini, Antonella; Moericke, Anja; Schrappe, Martin

    2013-03-01

    Asparaginases are important agents used in the treatment of children with acute lymphoblastic leukemia (ALL). Three types of asparaginase are currently available: two are derived from Escherichia coli [native asparaginase and pegylated asparaginase (PEG-asparaginase)] and one from Erwinia chrysanthemi (crisantaspase). All three products share the same mechanism of action but have different pharmacokinetic properties, which do not make them easily interchangeable. Among the known toxicities and side-effects, allergic reactions and silent inactivation represent the most important limitations to the prolonged use of any asparaginase product, with associated reduced therapeutic effects and poorer outcomes. Routine real time monitoring can help to identify patients with silent inactivation and facilitate a switch to a different product to ensure continued depletion of asparagine, completion of the treatment schedule and maintenance of outcomes. However, the most appropriate second-line treatment is still a matter of debate. PEG-asparaginase has lower immunogenicity and a longer half-life than native Escherichia coli (E. coli) asparaginase, which makes it useful for both first-line and second-line use with a reduced number of doses. However, PEG-asparaginase displays cross-reactivity with native E. coli asparaginase that may harm its therapeutic effects. Crisantaspase does not display cross-reactivity to either of the E. coli-derived products, which has made crisantaspase the second-line treatment option in a number of recent protocols. As crisantaspase has a much shorter biological half-life than the E. coli-derived products, the appropriate dosage and administration schedule are of paramount importance in delivering treatment with this product. In the ongoing trial AIEOP-BFM ALL 2009 (Associazione Italiana Ematologia Oncologia Pediatrica - Berlin-Franklin-Munster), in which PEG-asparaginase is used first-line, one dose of PEG-asparaginase is substituted by seven doses

  19. [Pharmacodynamic and pharmacokinetic characteristics of pain therapy in neonates: Austrian interdisciplinary recommendations on pediatric perioperative pain management].

    PubMed

    Jaksch, W; Messerer, B; Keck, B; Lischka, A; Urlesberger, B

    2014-02-01

    The false assumption that neonates are less sensitive to pain than adults led to a long delay in the introduction of a reasonable pain therapy for children. Even if the basic principles of the development, transmission and perception of pain in premature infants and neonates are not completely understood, the results of studies have clearly shown that pain can be perceived from 22 weeks of gestation onwards. This knowledge results in the necessity to also administer an adequate pain therapy to premature and newly born infants. However, for the use of pharmaceuticals in neonates and infants the pharmacodynamic and pharmacokinetic characteristics must also be considered. The immaturity of the organs liver and kidneys limits the metabolism and also excretion processes. The different physical proportions also modify the dosing of pharmaceuticals. Children in the first year of life differ substantially from adults in physiology, pharmacodynamics and pharmacokinetics. The care of neonates and infants requires specialist knowledge which is described in this article. PMID:24550024

  20. Fear of movement/(re)injury, disability and participation in acute low back pain.

    PubMed

    Swinkels-Meewisse, Ilse E J; Roelofs, Jeffrey; Verbeek, André L M; Oostendorp, Rob A B; Vlaeyen, Johan W S

    2003-09-01

    Fear of movement/(re)injury and its associated avoidance behavior have shown to be strongly associated with functional disability in chronic low back pain. In acute low back pain disability, the role of pain-related fear has received little research attention so far. Measures of pain-related fear such as the Tampa Scale for Kinesiophobia (TSK) are increasingly being used in primary care. The aim of the present study was: (1). to further investigate the factor structure of the TSK in a population of acute low back pain (LBP) patients in primary care by means of a confirmatory factor analysis (CFA); (2). to examine the relationship between fear of movement/(re)injury and disability, as well as participation in daily and social life activities in 615 acute LBP patients seen by general practitioners and physical therapists in primary care settings; and (3). to examine whether disability mediates the association between pain-related fear and participation. CFA, and a subsequent explorative factor analysis on the TSK revealed a two-factor model. The factors consisted of items associated with 'harm', and items representing the 'avoidance of activity'. Both constructs were significantly associated with disability and participation. Additionally, and in contrast to what is often observed in chronic pain, disability, and to a lesser degree participation, were also associated with pain intensity. Finally, the association between pain-related fear, pain intensity and participation was indeed mediated by disability. The results suggest that early on in the development of LBP disability, the successful reduction of pain-related fear and disability might foster increased participation in daily and social life activities. PMID:14499456

  1. Improving the management of post-operative acute pain: priorities for change.

    PubMed

    Meissner, Winfried; Coluzzi, Flaminia; Fletcher, Dominique; Huygen, Frank; Morlion, Bart; Neugebauer, Edmund; Pérez, Antonio Montes; Pergolizzi, Joseph

    2015-11-01

    Poor management of post-operative acute pain can contribute to medical complications including pneumonia, deep vein thrombosis, infection and delayed healing, as well as the development of chronic pain. It is therefore important that all patients undergoing surgery should receive adequate pain management. However, evidence suggests this is not currently the case; between 10% and 50% of patients develop chronic pain after various common operations, and one recent US study recorded >80% of patients experiencing post-operative pain. At the first meeting of the acute chapter of the Change Pain Advisory Board, key priorities for improving post-operative pain management were identified in four different areas. Firstly, patients should be more involved in decisions regarding their own treatment, particularly when fateful alternatives are being considered. For this to be meaningful, relevant information should be provided so they are well informed about the various options available. Good physician/patient communication is also essential. Secondly, better professional education and training of the various members of the multidisciplinary pain management team would enhance their skills and knowledge, and thereby improve patient care. Thirdly, there is scope for optimizing treatment. Examples include the use of synergistic analgesia to target pain at different points along pain pathways, more widespread adoption of patient-controlled analgesia, and the use of minimally invasive rather than open surgery. Fourthly, organizational change could provide similar benefits; introducing acute pain services and increasing their availability towards the 24 hours/day ideal, greater adherence to protocols, increased use of patient-reported outcomes, and greater receptivity to technological advances would all help to enhance performance and increase patient satisfaction. It must be acknowledged that implementing these recommendations would incur a considerable cost that purchasers of

  2. Tri-wave laser therapy for spinal cord injury, neuropathic pain management, and restoration of motor function

    NASA Astrophysics Data System (ADS)

    Chariff, Mark D.; Olszak, Peter

    2015-03-01

    A laser therapy device using three combined wavelengths 532nm, 808nm, and 1064nm has been demonstrated in clinical studies. Primarily, therapeutic lasers have used wavelengths in the ranges of 632nm through 1064nm, where the optical density (OD) < 5, to achieve pain relief and tissue regeneration. Conventional wisdom would argue against using wavelengths in the region of 532nm, due to poor penetration (OD ~ 8); however, the author's observations are to the contrary. The 532nm light is efficiently absorbed by chromophores such as oxyhemoglobin, deoxyhemoglobin, and cytochrome c oxidase thereby providing energy to accelerate the healing process. The 808nm light is known to result in Nitric Oxide production thereby reducing inflammation and oxidative stress. All three laser wavelengths likely contribute to pain relief by inhibiting nerve conduction; however, the 1064nm has the deepest penetration. Through the use of this device on over 1000 patients with a variety of acute and chronic neuro-musculoskeletal disorders, the author observed that a majority of these individuals experienced rapid relief from their presenting conditions and most patients reported a tingling sensation upon irradiation. Patient testimonials and thermal images have been collected to document the results of the laser therapy. These studies demonstrate the ability of laser therapy to rapidly alleviate pain from both acute and chronic conditions.

  3. Involvement of the Melanocortin-1 Receptor in Acute Pain and Pain of Inflammatory but Not Neuropathic Origin

    PubMed Central

    Delaney, Ada; Keighren, Margaret; Fleetwood-Walker, Susan M.; Jackson, Ian J.

    2010-01-01

    Background Response to painful stimuli is susceptible to genetic variation. Numerous loci have been identified which contribute to this variation, one of which, MC1R, is better known as a gene involved in mammalian hair colour. MC1R is a G protein-coupled receptor expressed in melanocytes and elsewhere and mice lacking MC1R have yellow hair, whilst humans with variant MC1R protein have red hair. Previous work has found differences in acute pain perception, and response to analgesia in mice and humans with mutations or variants in MC1R. Methodology and Principal Findings We have tested responses to noxious and non-noxious stimuli in mutant mice which lack MC1R, or which overexpress an endogenous antagonist of the receptor, as well as controls. We have also examined the response of these mice to inflammatory pain, assessing the hyperalgesia and allodynia associated with persistent inflammation, and their response to neuropathic pain. Finally we tested by a paired preference paradigm their aversion to oral administration of capsaicin, which activates the noxious heat receptor TRPV1. Female mice lacking MC1R showed increased tolerance to noxious heat and no alteration in their response to non-noxious mechanical stimuli. MC1R mutant females, and females overexpressing the endogenous MC1R antagonist, agouti signalling protein, had a reduced formalin-induced inflammatory pain response, and a delayed development of inflammation-induced hyperalgesia and allodynia. In addition they had a decreased aversion to capsaicin at moderate concentrations. Male mutant mice showed no difference from their respective controls. Mice of either sex did not show any effect of mutant genotype on neuropathic pain. Conclusions We demonstrate a sex-specific role for MC1R in acute noxious thermal responses and pain of inflammatory origin. PMID:20856883

  4. Anger regulation style, anger arousal and acute pain sensitivity: evidence for an endogenous opioid "triggering" model.

    PubMed

    Burns, John W; Bruehl, Stephen; Chont, Melissa

    2014-08-01

    Findings suggest that greater tendency to express anger is associated with greater sensitivity to acute pain via endogenous opioid system dysfunction, but past studies have not addressed the role of anger arousal. We used a 2 × 2 factorial design with Drug Condition (placebo or opioid blockade with naltrexone) crossed with Task Order (anger-induction/pain-induction or pain-induction/anger-induction), and with continuous Anger-out Subscale scores. Drug × Task Order × Anger-out Subscale interactions were tested for pain intensity during a 4-min ischemic pain task performed by 146 healthy people. A significant Drug × Task Order × Anger-out Subscale interaction was dissected to reveal different patterns of pain intensity changes during the pain task for high anger-out participants who underwent pain-induction prior to anger-induction compared to those high in anger-out in the opposite order. Namely, when angered prior to pain, high anger-out participants appeared to exhibit low pain intensity under placebo that was not shown by high anger-out participants who received naltrexone. Results hint that people with a pronounced tendency to express anger may suffer from inadequate opioid function under simple pain-induction, but may experience analgesic benefit to some extent from the opioid triggering properties of strong anger arousal.

  5. Current Therapy in Acute Mouth Infections

    ERIC Educational Resources Information Center

    Goldfarb, George; Burnstein, Irwin L.

    1970-01-01

    Until a dental department is added to a college health service, a physician or nurse can give treatment for acute oral infections. Treatment excludes the use of caustic, escharotic chemicals in favor of more benign agents. (Author)

  6. Drug Therapy for Acute Heart Failure.

    PubMed

    Di Somma, Salvatore; Magrini, Laura

    2015-08-01

    Acute heart failure is globally one of most frequent reasons for hospitalization and still represents a challenge for the choice of the best treatment to improve patient outcome. According to current international guidelines, as soon as patients with acute heart failure arrive at the emergency department, the common therapeutic approach aims to improve their signs and symptoms, correct volume overload, and ameliorate cardiac hemodynamics by increasing vital organ perfusion. Recommended treatment for the early management of acute heart failure is characterized by the use of intravenous diuretics, oxygen, and vasodilators. Although these measures ameliorate the patient's symptoms, they do not favorably impact on short- and long-term mortality. Consequently, there is a pressing need for novel agents in acute heart failure treatment with the result that research in this field is increasing worldwide.

  7. Systematic reviews of bed rest and advice to stay active for acute low back pain.

    PubMed Central

    Waddell, G; Feder, G; Lewis, M

    1997-01-01

    BACKGROUND: In the United Kingdom (UK), 9% of adults consult their doctor annually with back pain. The treatment recommendations are based on orthopaedic teaching, but the current management is causing increasing dissatisfaction. Many general practitioners (GPs) are confused about what constitutes effective advice. AIM: To review all randomized controlled trials of bed rest and of medical advice to stay active for acute back pain. METHOD: A systematic review based on a search of MEDLINE and EMBASE from 1966 to April 1996 with complete citation tracking for randomized controlled trials of bed rest or medical advice to stay active and continue ordinary daily activities. The inclusion criteria were: primary care setting, patients with low back pain of up to 3 months duration, and patient-centred outcomes (rate of recovery from the acute attack, relief of pain, restoration of function, satisfaction with treatment, days off work and return to work, development of chronic pain and disability, recurrent attacks, and further health care use). RESULTS: Ten trials of bed rest and eight trials of advice to stay active were identified. Consistent findings showed that bed rest is not an effective treatment for acute low back pain but may delay recovery. Advice to stay active and to continue ordinary activities results in a faster return to work, less chronic disability, and fewer recurrent problems. CONCLUSION: A simple but fundamental change from the traditional prescription of bed rest to positive advice about staying active could improve clinical outcomes and reduce the personal and social impact of back pain. PMID:9474831

  8. Balancing the focus: art and music therapy for pain control and symptom management in hospice care.

    PubMed

    Trauger-Querry, B; Haghighi, K R

    1999-01-01

    Pain and symptom management are a major part of hospice care. Literature and direct experience suggest that pain can be resistant if psychological, emotional, or spiritual issues are not addressed. This article explains how art and music therapies can work in conjunction with traditional medical treatment of pain control in the hospice setting. The process of pain modulation through the use of art and music interventions is diagrammed and described. Brief clinical examples demonstrate the use of art and music therapies for pain reduction with a variety of hospice patients. Information regarding appropriate education and training necessary for art and music therapists to practice in their field is presented.

  9. A randomized, controlled trial of osteopathic manipulative treatment for acute low back pain in active duty military personnel

    PubMed Central

    Cruser, des Anges; Maurer, Douglas; Hensel, Kendi; Brown, Sarah K; White, Kathryn; Stoll, Scott T

    2012-01-01

    Objective Acute low back pain (ALBP) may limit mobility and impose functional limitations in active duty military personnel. Although some manual therapies have been reported effective for ALBP in military personnel, there have been no published randomized controlled trials (RCTs) of osteopathic manipulative treatment (OMT) in the military. Furthermore, current military ALBP guidelines do not specifically include OMT. Methods This RCT examined the efficacy of OMT in relieving ALBP and improving functioning in military personnel at Fort Lewis, Washington. Sixty-three male and female soldiers ages 18 to 35 were randomly assigned to a group receiving OMT plus usual care or a group receiving usual care only (UCO). Results The primary outcome measures were pain on the quadruple visual analog scale, and functioning on the Roland Morris Disability Questionnaire. Outcomes were measured immediately preceding each of four treatment sessions and at four weeks post-trial. Intention to treat analysis found significantly greater post-trial improvement in ‘Pain Now’ for OMT compared to UCO (P = 0·026). Furthermore, the OMT group reported less ‘Pain Now’ and ‘Pain Typical’ at all visits (P = 0·025 and P = 0·020 respectively). Osteopathic manipulative treatment subjects also tended to achieve a clinically meaningful improvement from baseline on ‘Pain at Best’ sooner than the UCO subjects. With similar baseline expectations, OMT subjects reported significantly greater satisfaction with treatment and overall self-reported improvement (P<0·01). Conclusion This study supports the effectiveness of OMT in reducing ALBP pain in active duty military personnel. PMID:23372389

  10. Reduced Maximal Force during Acute Anterior Knee Pain Is Associated with Deficits in Voluntary Muscle Activation

    PubMed Central

    Salomoni, Sauro; Tucker, Kylie; Hug, François; McPhee, Megan; Hodges, Paul

    2016-01-01

    Although maximal voluntary contraction (MVC) force is reduced during pain, studies using interpolated twitch show no consistent reduction of voluntary muscle drive. The present study aimed to test if the reduction in MVC force during acute experimental pain could be explained by increased activation of antagonist muscles, weak voluntary activation at baseline, or changes in force direction. Twenty-two healthy volunteers performed maximal voluntary isometric knee extensions before, during, and after the effects of hypertonic (pain) and isotonic (control) saline injections into the infrapatellar fat pad. The MVC force, voluntary activation, electromyographic (EMG) activity of agonist, antagonist, and auxiliary (hip) muscles, and pain cognition and anxiety scores were recorded. MVC force was 9.3% lower during pain than baseline (p < 0.001), but there was no systematic change in voluntary activation. Reduced MVC force during pain was variable between participants (SD: 14%), and was correlated with reduced voluntary activation (r = 0.90), baseline voluntary activation (r = − 0.62), and reduced EMG amplitude of agonist and antagonist muscles (all r > 0.52), but not with changes in force direction, pain or anxiety scores. Hence, reduced MVC force during acute pain was mainly explained by deficits in maximal voluntary drive. PMID:27559737

  11. Acute pain management services: a comparison between Air Force and U.S. hospitals.

    PubMed

    Rayos, C L; McDonough, J P

    1999-12-01

    The purpose of this descriptive study was to assess the prevalence of acute pain management services (APMS) in Air Force medical facilities. There are no published reports on the current status of Air Force pain programs. This study used a telephone survey to all facilities worldwide that house an anesthesia department. Anesthesia providers in charge of pain services or department chiefs were interviewed from December 1996 to May 1997. Respondents were asked questions related to the initiation of a formal APMS, components, and familiarity with the Agency for Health Care Policy and Research guidelines on pain management. Data analysis described current practices and used chi 2 analysis to compare results with a national study of U.S. hospitals. Air Force anesthesia departments (45%) had established as many acute pain services as U.S. hospitals (42%). Formal pain programs are becoming more prevalent in Air Force hospitals. These findings suggest an increased awareness of the need for pain management and future establishment of pain programs.

  12. Painful Diabetic Peripheral Neuropathy: Presentations, Mechanisms, and Exercise Therapy

    PubMed Central

    Yoo, Min; Sharma, Neena; Pasnoor, Mamatha; Kluding, Patricia M

    2013-01-01

    Diabetic peripheral neuropathy (DPN) is a frequent complication of diabetes and a major cause of morbidity and increased mortality. It is typically characterized by significant deficits in tactile sensitivity, vibration sense, lower-limb proprioception, and kinesthesia. Painful diabetic neuropathy (P-DPN) is a common phenotype of DPN that affects up to one-third of the general diabetic population. P-DPN has been shown to be associated with significant reductions in overall quality of life, increased levels of anxiety and depression, sleep impairment, and greater gait variability. The purpose of this review is to examine proposed mechanisms of P-DPN, summarize current treatment regimen, and assess exercise as a potential therapy for P-PDN. Although exercise has been shown to be an effective therapeutic modality for diabetes, its specific effects on DPN and especially the painful phenotype have not been sufficiently investigated in current literature. Several rodent models and clinical trials have presented promising results in this area, and warrant further investigations examining the effect of exercise on P-DPN. PMID:25360348

  13. Painful Diabetic Peripheral Neuropathy: Presentations, Mechanisms, and Exercise Therapy.

    PubMed

    Yoo, Min; Sharma, Neena; Pasnoor, Mamatha; Kluding, Patricia M

    2013-06-30

    Diabetic peripheral neuropathy (DPN) is a frequent complication of diabetes and a major cause of morbidity and increased mortality. It is typically characterized by significant deficits in tactile sensitivity, vibration sense, lower-limb proprioception, and kinesthesia. Painful diabetic neuropathy (P-DPN) is a common phenotype of DPN that affects up to one-third of the general diabetic population. P-DPN has been shown to be associated with significant reductions in overall quality of life, increased levels of anxiety and depression, sleep impairment, and greater gait variability. The purpose of this review is to examine proposed mechanisms of P-DPN, summarize current treatment regimen, and assess exercise as a potential therapy for P-PDN. Although exercise has been shown to be an effective therapeutic modality for diabetes, its specific effects on DPN and especially the painful phenotype have not been sufficiently investigated in current literature. Several rodent models and clinical trials have presented promising results in this area, and warrant further investigations examining the effect of exercise on P-DPN.

  14. Acute pancreatitis: etiology, clinical presentation, diagnosis, and therapy.

    PubMed

    Cappell, Mitchell S

    2008-07-01

    Acute pancreatitis is a relatively common disease that affects about 300,000 patients per annum in America with a mortality of about 7%. About 75% of pancreatitis is caused by gallstones or alcohol. Other important causes include hypertriglyceridemia, medication toxicity, trauma from endoscopic retrograde cholangiopancreatography, hypercalcemia, abdominal trauma, various infections, autoimmune, ischemia, and hereditary causes. In about 15% of cases the cause remains unknown after thorough investigation. This article discusses the causes, diagnosis, imaging findings, therapy, and complications of acute pancreatitis.

  15. Incidence and risk factors for acute low back pain in active duty infantry.

    PubMed

    Ernat, Justin; Knox, Jeffrey; Orchowski, Joseph; Owens, Brett

    2012-11-01

    Although much research has been performed on occupational risk factors for low back pain, little has been published on low back pain among infantrymen. This purpose of this study is to evaluate the incidence of acute low back pain amongst active duty infantrymen as compared to a matched control population. The Defense Medical Epidemiology Database was searched and incidence rates were calculated and compared between infantry and noninfantry soldiers. Data was stratified and controlled for age, race, marital status, rank, and branch of service using the Poisson multivariate regression analysis. Significantly lower rates of acute low back pain were discovered in active duty infantrymen when compared to matched controls (32.9 versus 49.5 cases per 1,000 person-years). Additionally, significantly lower rates were identified in the Marines versus the Army, and among junior enlisted compared to senior enlisted service members. PMID:23198512

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

    PubMed Central

    2014-01-01

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

  17. An observational retrospective/horizontal study to compare oxygen-ozone therapy and/or global postural re-education in complicated chronic low back pain.

    PubMed

    Apuzzo, Dario; Giotti, Chiara; Pasqualetti, Patrizio; Ferrazza, Paolo; Soldati, Paola; Zucco, Gesualdo M

    2014-01-01

    Acute low back pain (LBP) is the fifth most common reason for physician visits and about nine out of ten adults experience back pain at some point in their life. In a large number of patients LBP is associated with disc herniation (DH). Recently, oxygen-ozone (O2O3) therapy has been used successfully in the treatment of LBP, reducing pain after the failure of other conservative treatments. The aim of this study was to assess the effects of O2O3 therapy in back pain rehabilitation, comparing three groups of patients suffering from chronic back pain associated with DH submitted to three different treatments: intramuscular O2O3 infiltrations, global postural An observational retrospective/horizontal study to compare oxygen-ozone therapy and/or global postural re-education in complicated chronic low back pain re-education (GPR), or a combination of the two (O2O3+GPR). The data show that pain severity before treatment was significantly lower in the patients treated with GPR alone (VAS score 7.4) than in the O2O3+GPR patients (VAS score 8.5) and the O2O3 patients (VAS score 8.6). At the end of treatment, pain severity was lower in the O2O3 patients than in the GPR-alone patients. After some years of follow-up only the difference between O2O3+GPR and GPR-alone remained significant. PMID:25014047

  18. Wilderness Medical Society practice guidelines for the treatment of acute pain in remote environments: 2014 update.

    PubMed

    Russell, Katie W; Scaife, Courtney L; Weber, David C; Windsor, Jeremy S; Wheeler, Albert R; Smith, William R; Wedmore, Ian; McIntosh, Scott E; Lieberman, James R

    2014-12-01

    The Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the management of pain in austere environments. Recommendations are graded on the basis of the quality of supporting evidence as defined by criteria put forth by the American College of Chest Physicians. This is an updated version of the original WMS Practice Guidelines for the Treatment of Acute Pain in Remote Environments published in Wilderness & Environmental Medicine 2014;25(1):41-49.

  19. [Differential diagnosis of chest pain: a case of acute aortic syndrome].

    PubMed

    Córdoba-Soriano, J G; Hidalgo-Olivares, V; Cambronero-Cortinas, E; Fernández-Anguita, M

    2014-03-01

    Chest pain is one of the most frequent reasons for consulting in any healthcare setting, however its diagnosis remains a challenge for both Primary Care and Emergency Department physicians. We report a case of an Acute Aortic Syndrome which was diagnosed late after an insidious course of chest pain, repetitive syncope, and in which the delay in diagnosis and treatment could be fatal. We also describe the definition, diagnosis, treatment, and outcome of this condition. PMID:24655911

  20. [Lymphotropic therapy for acute purulent odontogenic jaw periostitis].

    PubMed

    Maĭborodin, I V; Lĭubarskiĭ, M S; Loĭko, E R; Sheplev, B V

    2003-01-01

    The structure of the gingival mucosa was studied by optic microscopy in patients with acute purulent odontogenic maxillary periostitis treated traditionally and receiving lymphotropic therapy. Lymphotropic administration of the antibiotic during 2 days resulted in less pronounced dilatation of the interstitial spaces and lymph vessels adjacent to the molars and higher counts of lymphocytes, monocytes, and macrophages. This indicated high efficiency of lymphotropic therapy of acute purulent maxillary periostitis for molars. Microcirculation parameters and tissue leukocyte cytogram in gingival mucosal tissue adjacent to the canines and premolars differed negligibly in patients treated by different methods.

  1. Routine primary care management of acute low back pain: adherence to clinical guidelines.

    PubMed

    González-Urzelai, Violeta; Palacio-Elua, Loreto; López-de-Munain, Josefina

    2003-12-01

    One of the major challenges for general practitioners is to manage individuals with acute low back pain appropriately to reduce the risk of chronicity. A prospective study was designed to assess the actual management of acute low back pain in one primary care setting and to determine whether existing practice patterns conform to published guidelines. Twenty-four family physicians from public primary care centers of the Basque Health Service in Bizkaia, Basque Country (Spain), participated in the study. A total of 105 patients aged 18-65 years presenting with acute low back pain over a 6-month period were included. Immediately after consultation, a research assistant performed a structured clinical interview. The patients' care provided by the general practitioner was compared with the Agency for Health Care Policy and Research (AHCPR) guidelines and guidelines issued by the Royal College of General Practitioners. The diagnostic process showed a low rate of appropriate use of history (27%), physical examination (32%), lumbar radiographs (31%), and referral to specialized care (33%). Although the therapeutic process showed a relatively high rate of appropriateness in earlier mobilization (77%) and educational advice (65%), only 23% of patients were taught about the benign course of back pain. The study revealed that management of acute low back pain in the primary care setting is far from being in conformance with published clinical guidelines. PMID:14605973

  2. Serum amylase and lipase in the evaluation of acute abdominal pain.

    PubMed

    Chase, C W; Barker, D E; Russell, W L; Burns, R P

    1996-12-01

    The purpose of this study was to determine 1) the incidence and magnitude of elevation in admission serum amylase and lipase levels in extrapancreatic etiologies of acute abdominal pain, and 2) the test most closely associated with the diagnosis of acute pancreatitis. Serum amylase and lipase levels were obtained in 306 patients admitted for evaluation of acute abdominal pain. Patients were categorized by anatomic location of identified pathology. Logistic regression analysis was used to compare the enzyme levels between patient groups and to determine the correlation between elevation in serum amylase and lipase. Twenty-seven (13%) of 208 patients with an extrapancreatic etiology of acute abdominal pain demonstrated an elevated admission serum amylase level with a maximum value of 385 units (U)/L (normal range 30-110 U/L). Twenty-six (12.5%) of these 208 patients had an elevated admission serum lipase value with a maximum of 3685 U/L (normal range 5-208 U/L). Of 48 patients with abdominal pain resulting from acute pancreatitis, admission serum amylase ranged from 30 to 7680 U/L and lipase ranged from 5 to 90,654 U/L. Both serum amylase and lipase elevations were positively associated with a correct diagnosis of acute pancreatitis (P < 0.001) with diagnostic efficiencies of 91 and 94 per cent, respectively. A close correlation between elevation of admission serum amylase and lipase was observed (r = 0.87) in both extrapancreatic and pancreatic disease processes. Serum amylase and lipase levels may be elevated in nonpancreatic disease processes of the abdomen. Significant elevations (greater than three times upper limit of normal) in either enzyme are uncommon in these disorders. The strong correlation between elevations in the two serum enzymes in both pancreatic and extrapancreatic etiologies of abdominal pain makes them redundant measures. Serum lipase is a better test than serum amylase either to exclude or to support a diagnosis of acute pancreatitis.

  3. Frutalin reduces acute and neuropathic nociceptive behaviours in rodent models of orofacial pain.

    PubMed

    Damasceno, Marina B M V; de Melo Júnior, José de Maria A; Santos, Sacha Aubrey A R; Melo, Luana T M; Leite, Laura Hévila I; Vieira-Neto, Antonio E; Moreira, Renato de A; Monteiro-Moreira, Ana Cristina de O; Campos, Adriana R

    2016-08-25

    Orofacial pain is a highly prevalent clinical condition, yet difficult to control effectively with available drugs. Much attention is currently focused on the anti-inflammatory and antinociceptive properties of lectins. The purpose of this study was to evaluate the antinociceptive effect of frutalin (FTL) using rodent models of inflammatory and neuropathic orofacial pain. Acute pain was induced by formalin, glutamate or capsaicin (orofacial model) and hypertonic saline (corneal model). In one experiment, animals were pretreated with l-NAME and naloxone to investigate the mechanism of antinociception. The involvement of the lectin domain in the antinociceptive effect of FTL was verified by allowing the lectin to bind to its specific ligand. In another experiment, animals pretreated with FTL or saline were submitted to the temporomandibular joint formalin test. In yet another, animals were submitted to infraorbital nerve transection to induce chronic pain, followed by induction of thermal hypersensitivity using acetone. Motor activity was evaluated with the rotarod test. A molecular docking was performed using the TRPV1 channel. Pretreatment with FTL significantly reduced nociceptive behaviour associated with acute and neuropathic pain, especially at 0.5 mg/kg. Antinociception was effectively inhibited by l-NAME and d-galactose. In line with in vivo experiments, docking studies indicated that FTL may interact with TRPV1. Our results confirm the potential pharmacological relevance of FTL as an inhibitor of orofacial nociception in acute and chronic pain mediated by TRPA1, TRPV1 and TRPM8 receptor. PMID:27302204

  4. Frutalin reduces acute and neuropathic nociceptive behaviours in rodent models of orofacial pain.

    PubMed

    Damasceno, Marina B M V; de Melo Júnior, José de Maria A; Santos, Sacha Aubrey A R; Melo, Luana T M; Leite, Laura Hévila I; Vieira-Neto, Antonio E; Moreira, Renato de A; Monteiro-Moreira, Ana Cristina de O; Campos, Adriana R

    2016-08-25

    Orofacial pain is a highly prevalent clinical condition, yet difficult to control effectively with available drugs. Much attention is currently focused on the anti-inflammatory and antinociceptive properties of lectins. The purpose of this study was to evaluate the antinociceptive effect of frutalin (FTL) using rodent models of inflammatory and neuropathic orofacial pain. Acute pain was induced by formalin, glutamate or capsaicin (orofacial model) and hypertonic saline (corneal model). In one experiment, animals were pretreated with l-NAME and naloxone to investigate the mechanism of antinociception. The involvement of the lectin domain in the antinociceptive effect of FTL was verified by allowing the lectin to bind to its specific ligand. In another experiment, animals pretreated with FTL or saline were submitted to the temporomandibular joint formalin test. In yet another, animals were submitted to infraorbital nerve transection to induce chronic pain, followed by induction of thermal hypersensitivity using acetone. Motor activity was evaluated with the rotarod test. A molecular docking was performed using the TRPV1 channel. Pretreatment with FTL significantly reduced nociceptive behaviour associated with acute and neuropathic pain, especially at 0.5 mg/kg. Antinociception was effectively inhibited by l-NAME and d-galactose. In line with in vivo experiments, docking studies indicated that FTL may interact with TRPV1. Our results confirm the potential pharmacological relevance of FTL as an inhibitor of orofacial nociception in acute and chronic pain mediated by TRPA1, TRPV1 and TRPM8 receptor.

  5. Clinical profile of non-traumatic acute abdominal pain presenting to an adult emergency department

    PubMed Central

    Chanana, Lakshay; Jegaraj, Moses A. K.; Kalyaniwala, Kimmin; Yadav, Bijesh; Abilash, Kundavaram

    2015-01-01

    Background: Abdominal pain is one of the most common reasons for presenting to the emergency depatment (ED) and the etiology is varied. Materials and Methods: This prospective observational study was conducted in a large ED of a tertiary care center in India. All patients older than 15 years and presenting with non-traumatic abdominal pain to the ED from May 2012 to October 2012 were recruited and the demographic characteristics, diagnosis and outcome were analyzed. Results: The study cohort included 264 patients over a 6 month period. More than half (55.6%) were aged between 15 and 40 years. There was a male predominance (56.8%). Majority of the patients (76.9%) presented with abdominal pain of less than 72 hour duration. The pain was sudden in onset in 54.9% of patients. Dull type was the most common character of pain (36%) followed by colicky type (22.3%). The most common site of pain was the lower abdomen (45.8%). Upper abdominal pain was seen in 26.9% and the pain was generalized in 27.3% of patients. The common causes were uretericcolic (16.3%), urinary tract infection (12.5%), acute pancreatitis (11%), acute appendicitis (10.6%) and acute gastritis (8%). More than half (51.9%) discharged from ED and 37% of cases were managed by the emergency physicians. Surgical intervention was required in 25.8% of patients. The mortality rate was 2.3%. Conclusions: Abdominal pain is a common ED symptom and clinicians must consider multiple diagnoses, especially those that require immediate intervention to limit morbidity and mortality. PMID:26288785

  6. Effects of a laser acupuncture therapy on treating pain

    NASA Astrophysics Data System (ADS)

    Wong, Wai-on; Xiao, Shaojun; Ip, Wing-Yuk; Guo, Xia

    2001-10-01

    Laser acupuncture (LA) has been utilized as a combined approach of Chinese traditional acupuncture and low-level laser therapy since its emergence in 1973. Its mechanisms are not well understood and the standardization of clinical protocols has not been established. In this study, we used a diode laser to irradiate on four acupuncture points for normal subjects to investigate the effect of LA. For each point, the irradiation lasted for three minutes. The median nerve conduction velocity was measured within a 30 minutes interval at day 1, day 5, and day 10 respectively. Patients with chronic carpal tunnel syndrome (CTS) were given LA therapy for three stages at most with a one-week interval between two stages. Treatment outcome measurements included patients' subjective feedback (McGill pain questionnaire, VAS) and objective measurements (physical examination, kinesiological properties and NCSs). It was a randomized single-blind controlled trial. For normal subjects, motor nerve fiber was sensitive to LA and the motor conduction velocity was decreased very significantly (p < 0.001). Besides, it was found that LA resulted that sensory nerve conduction velocity was decreased significantly when it was measured 30 minutes after the subject had received LA application. For CTS patients, the outcomes except pinch test indicated that LA could improve patient's conduction. These results suggested that LA could cause the change of nerve conduction.

  7. Does adherence to treatment mediate the relationship between patients' treatment outcome expectancies and the outcomes of pain intensity and recovery from acute low back pain?

    PubMed

    Haanstra, Tsjitske M; Kamper, Steven J; Williams, Christopher M; Spriensma, Alette S; Lin, Chung-Wei Christine; Maher, Christopher G; de Vet, Henrica C W; Ostelo, Raymond W J G

    2015-08-01

    It is believed that patients' expectancies about the effectiveness of treatment influence their treatment outcomes, but the working mechanism is rarely studied in patients with low back pain. Theoretical models suggest that adherence to treatment may be an important pathway. The aim of this study was to assess the mediating role of adherence to treatment in the relationship between expectancies and the outcomes of recovery and pain intensity in patients with acute low back pain. This study used data from a randomized placebo-controlled trial of paracetamol for acute low back pain. Expectancies were measured with the Credibility Expectancy Questionnaire. Adherence was measured with a medication diary. Pain intensity was recorded daily in a diary on a 0 to 10 pain scale, and recovery was defined as the first of 7 consecutive days scoring 0 or 1 on a 6-point pain scale. Cox regression (dependent variable: recovery) and linear mixed-model analyses (dependent variable: daily pain intensity scores) were performed. The "difference in coefficients" approach was used to establish mediation. A total of 1573 participants were included in current analyses. There was a small but highly significant relationship between expectancies and outcomes; 3.3% of the relationship between expectancies and recovery and 14.2% of the relationship between expectancies and pain intensity were mediated by adherence to treatment. This study does not convincingly support the theory that adherence is a key pathway in the relationship between treatment outcome expectancies and recovery and pain intensity in this acute low back pain population.

  8. Low-Dose Tramadol and Non-Steroidal Anti-Inflammatory Drug Combination Therapy Prevents the Transition to Chronic Low Back Pain

    PubMed Central

    Orita, Sumihisa; Yamauchi, Kazuyo; Suzuki, Takane; Suzuki, Miyako; Sakuma, Yoshihiro; Kubota, Go; Oikawa, Yasuhiro; Sainoh, Takeshi; Sato, Jun; Fujimoto, Kazuki; Shiga, Yasuhiro; Abe, Koki; Kanamoto, Hirohito; Inoue, Masahiro; Kinoshita, Hideyuki; Takahashi, Kazuhisa; Ohtori, Seiji

    2016-01-01

    Study Design Retrospective study. Purpose To determine whether low-dose tramadol plus non-steroidal anti-inflammatory drug combination therapy could prevent the transition of acute low back pain to chronic low back pain. Overview of Literature Inadequately treated early low back pain transitions to chronic low back pain occur in approximately 30% of affected individuals. The administration of non-steroidal anti-inflammatory drugs is effective for treatment of low back pain in the early stages. However, the treatment of low back pain that is resistant to non-steroidal anti-inflammatory drugs is challenging. Methods Patients who presented with acute low back pain at our hospital were considered for inclusion in this study. After the diagnosis of acute low back pain, non-steroidal anti-inflammatory drug administration was started. Forty patients with a visual analog scale score of >5 for low back pain 1 month after treatment were finally enrolled. The first 20 patients were included in a non-steroidal anti-inflammatory drug group, and they continued non-steroidal anti-inflammatory drug therapy for 1 month. The next 20 patients were included in a combination group, and they received low-dose tramadol plus non-steroidal anti-inflammatory drug combination therapy for 1 month. The incidence of adverse events and the improvement in the visual analog scale score at 2 months after the start of treatment were analyzed. Results No adverse events were observed in the non-steroidal anti-inflammatory drug group. In the combination group, administration was discontinued in 2 patients (10%) due to adverse events immediately following the start of tramadol administration. At 2 months, the improvement in the visual analog scale score was greater in the combination group than in the non-steroidal anti-inflammatory drug group (p<0.001). Conclusions Low-dose tramadol plus non-steroidal anti-inflammatory drug combination therapy might decrease the incidence of adverse events and prevent

  9. Thrombolytic Therapy in the Acute Management of Frostbite Injuries

    PubMed Central

    Wagner, Christopher; Pannucci, Christopher J.

    2015-01-01

    Frostbite injuries frequently result in devastating ischemic damage to the distal extremities. This ischemia and resultant necrosis have historically been managed expectantly, with amputation of devitalized tissue commonly being the end result after severe injury. Advances in nuclear medicine, interventional radiology, and thrombolytic therapy have contributed to the development of a therapy proving successful in reversing these acute ischemic effects and ameliorating the morbidity of these rare limb-threatening injuries. PMID:21211711

  10. Long-term potentiation in spinal nociceptive systems--how acute pain may become chronic.

    PubMed

    Rygh, Lars Jørgen; Svendsen, Frode; Fiskå, Atle; Haugan, Frøydis; Hole, Kjell; Tjølsen, Arne

    2005-11-01

    Chronic pain is a major problem since it is difficult to treat and the understanding of the underlying neurobiology is sparse. The mechanisms underpinning the transition of acute into chronic pain remain unclear. However, long-term potentiation (LTP) in spinal nociceptive systems may be one such mechanism. Here, we briefly review the literature regarding LTP in spinal nociceptive systems including our own data on LTP in deep convergent nociceptive neurons. Furthermore, we discuss the role of this phenomenon in understanding the neurobiology of chronic pain and the possible therapeutic implications.

  11. First year's experience with an acute pain service--University Hospital Kuala Lumpur.

    PubMed

    Vijayan, R; Delilkan, A E

    1994-12-01

    An Acute Pain Service (APS) was started in University Hospital, Kuala Lumpur by the Department of Anaesthesiology in October 1992 for more effective control of postoperative pain. The main modalities of treatment included patient controlled analgesia (PCA) using morphine or pethidine with PCA devises, epidural opiate analgesia (EOA) using tramadol or fentanyl/bupivacaine mixture and subcutaneous administration of morphine or pethidine. Five hundred and fifty-one patients were managed in the first year, with an overall patient satisfaction score of 83%. The majority (98.5%) of them were after abdominal or major orthopaedic surgery. Eighty per cent of patients scored < 3 on the verbal numeric pain scale, where 0 is no pain and 10 is the worst imaginable pain, on the first postoperative day. Nausea and vomiting was an unpleasant side effect in 20% of patients.

  12. Pain in the left ear as the presenting symptom of acute myocardial infarction in a renal transplant recipient.

    PubMed

    Basic-Jukic, N; Novosel, D; Ivanac, I; Danic-Hadzibegovic, A; Kes, P

    2014-01-01

    Chest pain is the main presenting symptom in patients with acute myocardial infarction. However, many patients present with atypical symptoms, which may delay proper diagnosis and treatment. We present the first documented case of pain in the left ear as an atypical presentation of acute myocardial infarction 5 days after renal transplantation.

  13. Recognition of central sensitization in patients with musculoskeletal pain: Application of pain neurophysiology in manual therapy practice.

    PubMed

    Nijs, Jo; Van Houdenhove, Boudewijn; Oostendorp, Rob A B

    2010-04-01

    Central sensitization plays an important role in the pathophysiology of numerous musculoskeletal pain disorders, yet it remains unclear how manual therapists can recognize this condition. Therefore, mechanism based clinical guidelines for the recognition of central sensitization in patients with musculoskeletal pain are provided. By using our current understanding of central sensitization during the clinical assessment of patients with musculoskeletal pain, manual therapists can apply the science of nociceptive and pain processing neurophysiology to the practice of manual therapy. The diagnosis/assessment of central sensitization in individual patients with musculoskeletal pain is not straightforward, however manual therapists can use information obtained from the medical diagnosis, combined with the medical history of the patient, as well as the clinical examination and the analysis of the treatment response in order to recognize central sensitization. The clinical examination used to recognize central sensitization entails the distinction between primary and secondary hyperalgesia.

  14. [Quality improvement in acute pain management in Germany].

    PubMed

    Meißner, Winfried

    2016-01-01

    In Germany, different quality management approaches in postoperative pain management have been established. In this context, quality is distinguished into structure quality (e.g. personnel and equipment resources), process quality (e. g. standardized treatment schemes) and outcome quality (e.g. pain intensity, side effects, satisfaction). While guidelines and recommendations help to set up evidence based structures and processes and offer support for decision making, benchmark projects offer insights in real life conditions. By use of feedback and benchmarking tools, they can be used for outcome-oriented quality improvement. Certification projects assess compliance with or achievement of defined quality criteria on the basis of predefined structure, process, and outcome parameter.

  15. Massage Therapy Protocol for Post–Anterior Cruciate Ligament Reconstruction Patellofemoral Pain Syndrome: A Case Report

    PubMed Central

    Zalta, Jennifer

    2008-01-01

    Background: The intent of the present study was to determine the effectiveness of massage therapy in the rehabilitation of post–anterior cruciate ligament reconstruction patellofemoral pain syndrome. The primary complications following surgical repair of the anterior cruciate ligament—classified as patellofemoral pain syndrome—are hamstring flexion contracture and quadriceps weakness, leading to patellofemoral dysfunction and retropatellar pain. Methods: Treatment included lymphatic drainage, myofascial release, neuromuscular techniques including trigger point release, muscle energy techniques and cross-fiber friction. Orthopedic physical assessment tests were used to chart changes in patellofemoral function and changes in range of motion in the knee during the course of the massage interventions. Subjective reporting on pain level and function were also documented. Results: A decrease in pain level, hamstring flexion contracture and lateral tracking of the patella were documented. Conclusion: Massage therapy was determined to be an effective complementary therapy in the treatment of patellofemoral pain syndrome. PMID:21589717

  16. Selected nonpharmacological therapies for chronic pain: the therapeutic use of the placebo effect.

    PubMed

    Seeley, D

    1990-01-01

    Chronic pain is a common problem requiring a multidisciplinary approach. Nursing can offer diverse therapies complementary to the medical-surgical approach. Guidelines for practice and challenges for research are outlined for selected nonpharmacological chronic pain therapies. This article discusses the placebo effect, which is common to all therapies. Placebos can therapeutically empower patients to stimulate their psychophysiologic self-regulation abilities. Effects, theories, ethics, and therapeutic methods of stimulating the placebo effect are explored.

  17. Cancer Pain: A Critical Review of Mechanism-based Classification and Physical Therapy Management in Palliative Care.

    PubMed

    Kumar, Senthil P

    2011-05-01

    Mechanism-based classification and physical therapy management of pain is essential to effectively manage painful symptoms in patients attending palliative care. The objective of this review is to provide a detailed review of mechanism-based classification and physical therapy management of patients with cancer pain. Cancer pain can be classified based upon pain symptoms, pain mechanisms and pain syndromes. Classification based upon mechanisms not only addresses the underlying pathophysiology but also provides us with an understanding behind patient's symptoms and treatment responses. Existing evidence suggests that the five mechanisms - central sensitization, peripheral sensitization, sympathetically maintained pain, nociceptive and cognitive-affective - operate in patients with cancer pain. Summary of studies showing evidence for physical therapy treatment methods for cancer pain follows with suggested therapeutic implications. Effective palliative physical therapy care using a mechanism-based classification model should be tailored to suit each patient's findings, using a biopsychosocial model of pain. PMID:21976851

  18. Evaluation of low-level laser therapy effectiveness on the pain and masticatory performance of patients with myofascial pain.

    PubMed

    de Moraes Maia, Mila Leite; Ribeiro, Maria Amália Gonzaga; Maia, Luiz Guilherme Martins; Stuginski-Barbosa, Juliana; Costa, Yuri Martins; Porporatti, André Luís; Conti, Paulo César Rodrigues; Bonjardim, Leonardo Rigoldi

    2014-01-01

    This study investigated the effect of low-level laser therapy (LLLT) on the masticatory performance (MP), pressure pain threshold (PPT), and pain intensity in patients with myofascial pain. Twenty-one subjects, with myofascial pain according to Research Diagnostic Criteria/temporomandibular dysfunction, were divided into laser group (n = 12) and placebo group (n = 9) to receive laser therapy (active or placebo) two times per week for 4 weeks. The measured variables were: (1) MP by analysis of the geometric mean diameter (GMD) of the chewed particles using Optocal test material, (2) PPT by a pressure algometer, and (3) pain intensity by the visual analog scale (VAS). Measurements of MP and PPT were obtained at three time points: baseline, at the end of treatment with low-level laser and 30 days after (follow-up). VAS was measured at the same times as above and weekly throughout the laser therapy. The Friedman test was used at a significance level of 5% for data analysis. The study was approved by the Ethics Committee of the Federal University of Sergipe (CAAE: 0025.0.107.000-10). A reduction in the GMD of crushed particles (p < 0.01) and an increase in PPT (p < 0.05) were seen only in the laser group when comparing the baseline and end-of-treatment values. Both groups showed a decrease in pain intensity at the end of treatment. LLLT promoted an improvement in MP and PPT of the masticatory muscles.

  19. Minocycline prevents the development of neuropathic pain, but not acute pain: possible anti-inflammatory and antioxidant mechanisms.

    PubMed

    Padi, Satyanarayana S V; Kulkarni, Shrinivas K

    2008-12-28

    Glia, particularly astrocytes and microglia, are known to play an important role in central sensitization and are strongly implicated in the exaggerated pain states. In the present study, we determined the effect of minocycline, an inhibitor of microglial activation, in acute nociception, peritonitis, and the development and maintenance of hypersensitivity following chronic constriction injury of the sciatic nerve in rats. A single dose of minocycline (30 or 100 mg/kg, i.p.) 30 min before acetic acid or zymosan injection did not attenuate the nociceptive behavior in mice. It had no effect on the early events of peritoneal inflammation (vascular permeability, inflammatory cell infiltration, and release of pro-inflammatory cytokines) in acetic acid or zymosan-injected mice. In addition, minocycline (30 or 100 mg/kg, i.p.) did not alter basal nociceptive responses in the tail immersion test. Chronic administration of minocycline (10 or 30 mg/kg, i.p.) for 7 days started before nerve injury significantly prevented the development of neuropathic pain, interestingly, it further delayed the development of hypersensitivity. In contrast, single injection of minocycline failed to reverse hypersensitivity when administered during the development of neuropathic pain. No significant effects were observed on hypersensitivity when treatment was started once neuropathic state was established. Pre-treatment, but not post-treatment, with minocycline markedly attenuated increased pro-inflammatory cytokines release and oxidative and nitrosative stress in mononeuropathic rats. These results suggest that minocycline had no effect on acute peritoneal inflammation, nociception, and chronic administration of minocycline when started early before peripheral nerve injury could attenuate and further delays the development of neuropathic pain. Concluding, this study clearly shows minocycline, an inhibitor of microglial activation, by inhibiting the release of pro-inflammatory mediators and

  20. Oral capsaicin provides temporary relief for oral mucositis pain secondary to chemotherapy/radiation therapy.

    PubMed

    Berger, A; Henderson, M; Nadoolman, W; Duffy, V; Cooper, D; Saberski, L; Bartoshuk, L

    1995-04-01

    Pain from oral mucositis afflicts from 40% to 70% of patients receiving chemotherapy or radiation therapy. Current methods of clinical pain management (for example, topical anesthetics, systemic analgesics) have limited success. In a pilot study, we examined the ability of oral capsaicin to provide temporary relief of oral mucositis pain. Capsaicin, the active ingredient in chili peppers, desensitizes some neurons and has provided moderate pain relief when applied to the skin surface. Oral capsaicin in a candy (taffy) vehicle produced substantial pain reduction in 11 patients with oral mucositis pain from cancer therapy. However, this pain relief was not complete for most patients and was only temporary. Additional research is needed to fully utilize the properties of capsaicin desensitization and thus optimize analgesia. PMID:7629418

  1. Effect of pain scrambler therapy on shoulder joint pain and range of motion in patients who had undergone arthroscopic rotator cuff repair for the first time

    PubMed Central

    Lee, Dong-Kyu; Kim, Eun-Kyung

    2016-01-01

    [Purpose] This study aimed to determine the effect of pain scrambler therapy on shoulder joint pain and range of motion in patients who had undergone arthroscopic rotator cuff repair for the first time. [Subjects and Methods] Pain scrambler therapy was administered once a day every 40 minutes for 10 days to patients that had undergone arthroscopic rotator cuff repair for the first time. The visual analog scale was used to measure pain, and a goniometer was used to measure shoulder range of motion. [Results] After 10 sessions of pain scrambler therapy, pain was significantly reduced from that before the treatment. In addition, shoulder range of motion was increased after 10 treatment sessions. [Conclusion] Thus, pain scrambler therapy greatly reduced pain and increased should range of motion in the patients who had undergone arthroscopic rotator cuff repair for the first time. PMID:27512291

  2. A Prevalence and Management Study of Acute Pain in Children Attending Emergency Departments by Ambulance.

    PubMed

    Murphy, Adrian; McCoy, Siobhan; O'Reilly, Kay; Fogarty, Eoin; Dietz, Jason; Crispino, Gloria; Wakai, Abel; O'Sullivan, Ronan

    2016-01-01

    Pain is the most common symptom in the emergency setting and remains one of the most challenging problems for emergency care providers, particularly in the pediatric population. The primary objective of this study was to determine the prevalence of acute pain in children attending emergency departments (EDs) in Ireland by ambulance. In addition, this study sought to describe the prehospital and initial ED management of pain in this population, with specific reference to etiology of pain, frequency of pain assessment, pain severity, and pharmacological analgesic interventions. A prospective cross-sectional study was undertaken over a 12-month period of all pediatric patients transported by emergency ambulance to four tertiary referral hospitals in Ireland. All children (<16 years) who had pain as a symptom (regardless of cause) at any stage during the prehospital phase of care were included in this study. Over the study period, 6,371 children attended the four EDs by emergency ambulance, of which 2,635 (41.4%, 95% confidence interval 40.2-42.3%) had pain as a documented symptom on the ambulance patient care report (PCR) form. Overall 32% (n = 856) of children who complained of pain were subject to a formal pain assessment during the prehospital phase of care. Younger age, short transfer time to the ED, and emergency calls between midnight and 6 am were independently associated with decreased likelihood of having a documented assessment of pain intensity during the prehospital phase of care. Of the 2,635 children who had documented pain on the ambulance PCR, 26% (n = 689) received some form of analgesic agent prior to ED arrival. Upon ED arrival 54% (n = 1,422) of children had a documented pain assessment and some form of analgesic agent was administered to 50% (n = 1,324). Approximately 41% of children who attend EDs in Ireland by ambulance have pain documented as their primary symptom. This study suggests that the management of acute pain in children transferred by

  3. The influence of music and music therapy on pain-induced neuronal oscillations measured by magnetencephalography.

    PubMed

    Hauck, Michael; Metzner, Susanne; Rohlffs, Fiona; Lorenz, Jürgen; Engel, Andreas K

    2013-04-01

    Modern forms of music therapy are clinically established for various therapeutic or rehabilitative goals, especially in the treatment of chronic pain. However, little is known about the neuronal mechanisms that underlie pain modulation by music. Therefore, we attempted to characterize the effects of music therapy on pain perception by comparing the effects of 2 different therapeutic concepts, referred to as receptive and entrainment methods, on cortical activity recorded by magnetencephalography in combination with laser heat pain. Listening to preferred music within the receptive method yielded a significant reduction of pain ratings associated with a significant power reduction of delta-band activity in the cingulate gyrus, which suggests that participants displaced their focus of attention away from the pain stimulus. On the other hand, listening to self-composed "pain music" and "healing music" within the entrainment method exerted major effects on gamma-band activity in primary and secondary somatosensory cortices. Pain music, in contrast to healing music, increased pain ratings in parallel with an increase in gamma-band activity in somatosensory brain structures. In conclusion, our data suggest that the 2 music therapy approaches operationalized in this study seem to modulate pain perception through at least 2 different mechanisms, involving changes of activity in the delta and gamma bands at different stages of the pain processing system. PMID:23414577

  4. The influence of music and music therapy on pain-induced neuronal oscillations measured by magnetencephalography.

    PubMed

    Hauck, Michael; Metzner, Susanne; Rohlffs, Fiona; Lorenz, Jürgen; Engel, Andreas K

    2013-04-01

    Modern forms of music therapy are clinically established for various therapeutic or rehabilitative goals, especially in the treatment of chronic pain. However, little is known about the neuronal mechanisms that underlie pain modulation by music. Therefore, we attempted to characterize the effects of music therapy on pain perception by comparing the effects of 2 different therapeutic concepts, referred to as receptive and entrainment methods, on cortical activity recorded by magnetencephalography in combination with laser heat pain. Listening to preferred music within the receptive method yielded a significant reduction of pain ratings associated with a significant power reduction of delta-band activity in the cingulate gyrus, which suggests that participants displaced their focus of attention away from the pain stimulus. On the other hand, listening to self-composed "pain music" and "healing music" within the entrainment method exerted major effects on gamma-band activity in primary and secondary somatosensory cortices. Pain music, in contrast to healing music, increased pain ratings in parallel with an increase in gamma-band activity in somatosensory brain structures. In conclusion, our data suggest that the 2 music therapy approaches operationalized in this study seem to modulate pain perception through at least 2 different mechanisms, involving changes of activity in the delta and gamma bands at different stages of the pain processing system.

  5. Acute epigastric and low back pain during amiodarone infusion; is it the drug or the vehicle to blame?

    PubMed

    Petrou, Emmanouil; Iakovou, Ioannis; Boutsikou, Maria; Girasis, Chrysafios; Mavrogeni, Sophie; Pavlides, Gregory

    2014-01-01

    Amiodarone is a Class III antiarrhythmic agent used for cardioversion and prevention of recurrences of atrial fibrillation. However, its use is limited due to its side-effects resulting from the drug's long-term administration. We have described acute epigastric pain following treatment with intravenous amiodarone for atrial fibrillation in a previous report. Hereby, we describe a second patient who suffered acute epigastric pain, as well as one who suffered acute low back pain. Intravenous amiodarone has been related to a series of minor and major adverse reactions, indicating other constituents of the intravenous solution as the possible cause, possibly polysorbate-80. A possible correlation between acute epigastric and low back pain after intravenous amiodarone loading is unproven; however it is of crucial importance for clinicians to be aware of this phenomenon, and especially since an acute epigastric pain is implicated in the differential diagnosis of cardiac ischemia. PMID:24239300

  6. Ultrasound in newborns and children suffering from non-traumatic acute abdominal pain: imaging with clinical and surgical correlation.

    PubMed

    di Giacomo, Vincenza; Trinci, Margherita; van der Byl, Giulia; Catania, Vincenzo Davide; Calisti, Alessandro; Miele, Vittorio

    2015-12-01

    The purpose of this article is to review ultrasonographic appearance of the most common causes of non-traumatic acute abdominal pain in pediatric patients and to understand the applications and limitations of this technique giving a practical approach showing different clinical cases. A pictorial review of cases was made presenting the most common causes of neonatal and pediatric non-traumatic acute abdominal pain; sonographic features are discussed. Ultrasound in conjunction with Color Doppler imaging is a valuable tool in the evaluation of neonatal and pediatric non-traumatic acute abdominal pain; causes of acute abdomen in children could vary depending on the ages of the children.

  7. Acute non-lymphocytic leukemia following multimodality therapy for retinoblastoma

    SciTech Connect

    White, L.; Ortega, J.A.; Ying, K.L.

    1985-02-01

    The genetic form of retinoblastoma carries a high risk of secondary malignant neoplasm, apparently not related to the use of chemotherapy. A child with unilateral non-genetic retinoblastoma who had received chemotherapy and radiation therapy and developed acute non-lymphocytic leukemia (ANLL) is reported. The occurrence of ANLL and retinoblastoma has not been previously reported.

  8. Laser therapy of acute and chronic maxillary sinusitis

    NASA Astrophysics Data System (ADS)

    Bashkatov, Alexey N.; Genina, Elina A.; Chikina, Elena E.; Meglinski, Igor V.; Tuchin, Valery V.; Knyazev, Anatoly B.; Mareev, Oleg V.

    2006-06-01

    The clinical results of photodynamic therapy of maxillary sinusitis have been presented. 0.1%-Methylene Blue aqueous solution in combination with He-Ne laser irradiation (632.8 nm) has been used for treatment of patients with acute and chronic maxillary sinusitis. Efficacy of the photodynamic therapy was estimated with the use of the following criteria: the state of respiration, olfaction, duration of purulent discharge, reconstruction of transport function of ciliary epithelium, etc. The obtained results have shown that the photodynamic therapy is effective in comparison with conservative methods of treatment of the diseases.

  9. Feasibility of Articulated Arm Mounted Oculus Rift Virtual Reality Goggles for Adjunctive Pain Control During Occupational Therapy in Pediatric Burn Patients

    PubMed Central

    Meyer, Walter J.; Ramirez, Maribel; Roberts, Linda; Seibel, Eric J.; Atzori, Barbara; Sharar, Sam R.; Patterson, David R.

    2014-01-01

    Abstract For daily burn wound care and therapeutic physical therapy skin stretching procedures, powerful pain medications alone are often inadequate. This feasibility study provides the first evidence that entering an immersive virtual environment using very inexpensive (∼$400) wide field of view Oculus Rift Virtual Reality (VR) goggles can elicit a strong illusion of presence and reduce pain during VR. The patient was an 11-year-old male with severe electrical and flash burns on his head, shoulders, arms, and feet (36 percent total body surface area (TBSA), 27 percent TBSA were third-degree burns). He spent one 20-minute occupational therapy session with no VR, one with VR on day 2, and a final session with no VR on day 3. His rating of pain intensity during therapy dropped from severely painful during no VR to moderately painful during VR. Pain unpleasantness dropped from moderately unpleasant during no VR to mildly unpleasant during VR. He reported going “completely inside the computer generated world”, and had more fun during VR. Results are consistent with a growing literature showing reductions in pain during VR. Although case studies are scientifically inconclusive by nature, these preliminary results suggest that the Oculus Rift VR goggles merit more attention as a potential treatment for acute procedural pain of burn patients. Availability of inexpensive but highly immersive VR goggles would significantly improve cost effectiveness and increase dissemination of VR pain distraction, making VR available to many more patients, potentially even at home, for pain control as well as a wide range of other VR therapy applications. This is the first clinical data on PubMed to show the use of Oculus Rift for any medical application. PMID:24892204

  10. Feasibility of articulated arm mounted Oculus Rift Virtual Reality goggles for adjunctive pain control during occupational therapy in pediatric burn patients.

    PubMed

    Hoffman, Hunter G; Meyer, Walter J; Ramirez, Maribel; Roberts, Linda; Seibel, Eric J; Atzori, Barbara; Sharar, Sam R; Patterson, David R

    2014-06-01

    For daily burn wound care and therapeutic physical therapy skin stretching procedures, powerful pain medications alone are often inadequate. This feasibility study provides the first evidence that entering an immersive virtual environment using very inexpensive (∼$400) wide field of view Oculus Rift Virtual Reality (VR) goggles can elicit a strong illusion of presence and reduce pain during VR. The patient was an 11-year-old male with severe electrical and flash burns on his head, shoulders, arms, and feet (36 percent total body surface area (TBSA), 27 percent TBSA were third-degree burns). He spent one 20-minute occupational therapy session with no VR, one with VR on day 2, and a final session with no VR on day 3. His rating of pain intensity during therapy dropped from severely painful during no VR to moderately painful during VR. Pain unpleasantness dropped from moderately unpleasant during no VR to mildly unpleasant during VR. He reported going "completely inside the computer generated world", and had more fun during VR. Results are consistent with a growing literature showing reductions in pain during VR. Although case studies are scientifically inconclusive by nature, these preliminary results suggest that the Oculus Rift VR goggles merit more attention as a potential treatment for acute procedural pain of burn patients. Availability of inexpensive but highly immersive VR goggles would significantly improve cost effectiveness and increase dissemination of VR pain distraction, making VR available to many more patients, potentially even at home, for pain control as well as a wide range of other VR therapy applications. This is the first clinical data on PubMed to show the use of Oculus Rift for any medical application.

  11. Feasibility of articulated arm mounted Oculus Rift Virtual Reality goggles for adjunctive pain control during occupational therapy in pediatric burn patients.

    PubMed

    Hoffman, Hunter G; Meyer, Walter J; Ramirez, Maribel; Roberts, Linda; Seibel, Eric J; Atzori, Barbara; Sharar, Sam R; Patterson, David R

    2014-06-01

    For daily burn wound care and therapeutic physical therapy skin stretching procedures, powerful pain medications alone are often inadequate. This feasibility study provides the first evidence that entering an immersive virtual environment using very inexpensive (∼$400) wide field of view Oculus Rift Virtual Reality (VR) goggles can elicit a strong illusion of presence and reduce pain during VR. The patient was an 11-year-old male with severe electrical and flash burns on his head, shoulders, arms, and feet (36 percent total body surface area (TBSA), 27 percent TBSA were third-degree burns). He spent one 20-minute occupational therapy session with no VR, one with VR on day 2, and a final session with no VR on day 3. His rating of pain intensity during therapy dropped from severely painful during no VR to moderately painful during VR. Pain unpleasantness dropped from moderately unpleasant during no VR to mildly unpleasant during VR. He reported going "completely inside the computer generated world", and had more fun during VR. Results are consistent with a growing literature showing reductions in pain during VR. Although case studies are scientifically inconclusive by nature, these preliminary results suggest that the Oculus Rift VR goggles merit more attention as a potential treatment for acute procedural pain of burn patients. Availability of inexpensive but highly immersive VR goggles would significantly improve cost effectiveness and increase dissemination of VR pain distraction, making VR available to many more patients, potentially even at home, for pain control as well as a wide range of other VR therapy applications. This is the first clinical data on PubMed to show the use of Oculus Rift for any medical application. PMID:24892204

  12. Craniofacial Pain as the Sole Sign of Prodromal Angina and Acute Coronary Syndrome: A Review and Report of a Rare Case.

    PubMed

    Fazlyab, Mahta; Esnaashari, Ehsan; Saleh, Mojgan; Shakerian, Farshad; Akhlagh Moayed, Davood; Asgary, Saeed

    2015-01-01

    Orofacial pain can arise from different regions and etiologies. Some of the most debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures). The problem with referred pain is the misdiagnosis and unnecessary therapy directed to the pain location instead of its origin. When craniofacial pain is the sole sign of myocardial ischemia, failure to recognize its cardiac source can endanger the patient. In particular, apart from unnecessary dental treatments, patients with acute myocardial infarction who do not experience chest pain run a very high risk of misdiagnosis and death. As endodontists, each of us may face many patients complaining of pain sensation in the teeth with the main source being other craniofacial/visceral organs. This review plots a diagnostically challenging case paving the way for further literature presentation in this regard. The aim of this compendious review was to gain knowledge about the prevalence, clinical characteristics and possible mechanisms of craniofacial pain of cardiac origin, in order to improve the clinician's ability to make a correct diagnosis. PMID:26523144

  13. Craniofacial Pain as the Sole Sign of Prodromal Angina and Acute Coronary Syndrome: A Review and Report of a Rare Case

    PubMed Central

    Fazlyab, Mahta; Esnaashari, Ehsan; Saleh, Mojgan; Shakerian, Farshad; Akhlagh Moayed, Davood; Asgary, Saeed

    2015-01-01

    Orofacial pain can arise from different regions and etiologies. Some of the most debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures). The problem with referred pain is the misdiagnosis and unnecessary therapy directed to the pain location instead of its origin. When craniofacial pain is the sole sign of myocardial ischemia, failure to recognize its cardiac source can endanger the patient. In particular, apart from unnecessary dental treatments, patients with acute myocardial infarction who do not experience chest pain run a very high risk of misdiagnosis and death. As endodontists, each of us may face many patients complaining of pain sensation in the teeth with the main source being other craniofacial/visceral organs. This review plots a diagnostically challenging case paving the way for further literature presentation in this regard. The aim of this compendious review was to gain knowledge about the prevalence, clinical characteristics and possible mechanisms of craniofacial pain of cardiac origin, in order to improve the clinician’s ability to make a correct diagnosis. PMID:26523144

  14. The American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, and the Asian Australasian Federation of Pain Societies Joint Committee recommendations for education and training in ultrasound-guided interventional pain procedures.

    PubMed

    Narouze, Samer N; Provenzano, David; Peng, Philip; Eichenberger, Urs; Lee, Sang Chul; Nicholls, Barry; Moriggl, Bernhard

    2012-01-01

    The use of ultrasound in pain medicine for interventional axial, nonaxial, and musculoskeletal pain procedures is rapidly evolving and growing. Because of the lack of specialty-specific guidelines for ultrasonography in pain medicine, an international collaborative effort consisting of members of the Special Interest Group on Ultrasonography in Pain Medicine from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, and the Asian Australasian Federation of Pain Societies developed the following recommendations for education and training in ultrasound-guided interventional pain procedures. The purpose of these recommendations is to define the required skills for performing ultrasound-guided pain procedures, the processes for appropriate education, and training and quality improvement. Training algorithms are outlined for practice- and fellowship-based pathways. The previously published American Society of Regional Anesthesia and Pain Medicine and European Society of Regional Anaesthesia and Pain Therapy education and teaching recommendations for ultrasound-guided regional anesthesia served as a foundation for the pain medicine recommendations. Although the decision to grant ultrasound privileges occurs at the institutional level, the committee recommends that the training guidelines outlined in this document serve as the foundation for educational training and the advancement of the practice of ultrasonography in pain medicine.

  15. The role of cognitive behavioral therapy for chronic pain in adolescents.

    PubMed

    Zagustin, Tamara K

    2013-08-01

    Chronic pain is frequently experienced in adolescents; it affects functionality and requires interventions to decrease the impairments caused by pain. Cognitive behavioral therapy (CBT) has been analyzed in numerous studies that evaluated its effects on reducing the different types of chronic pain in children and adolescents. Interestingly, the outcome of CBT was initially focused on pain intensity, but, because there is no correspondence between children's pain intensity and level of disability, the ability to participate in school and social and recreational activities have been the primary focus of recent studies. There are innovative methods of CBT (such as the third generation of CBT) with and without the use of technology that facilitates the availability of this psychological treatment to adolescents with chronic pain, optimizing its accessibility and comprehensiveness, and maintaining its effectiveness. In the future, specific types of CBT could be specific to the diagnosis of chronic pain in the adolescent, sociodemographics, and other unique features. Parents of children with chronic pain are usually included in these programs, either as coaches in the intervention or as recipients of psychological therapies (including CBT) to optimize benefits. CBT has no adverse effect on chronic pain in adolescents, and there is no literature that makes reference to the effectiveness of CBT in preventing chronic pain in adolescents. A review of the role of CBT in chronic pain in adolescents via a PubMed database search was performed to identify the role of CBT in the management of chronic pain in adolescents.

  16. The Effects of 830 nm Light-Emitting Diode Therapy on Acute Herpes Zoster Ophthalmicus: A Pilot Study

    PubMed Central

    Park, Kui Young; Han, Tae Young; Kim, In Su; Yeo, In Kwon; Kim, Myeung Nam

    2013-01-01

    Background Skin lesions and pain are the most distinctive features of herpes zoster. Light-emitting diode (LED) therapy is an effective treatment known for its wound-healing effects. Objective To determine whether the LED treatment affects wound healing and acute pain in acute herpes zoster ophthalmicus. Methods We recruited 28 consecutive Korean patients with acute herpes zoster ophthalmicus for the study. In the control group (group A), 14 subjects received oral famcyclovir. In the experimental group (group B), 14 subjects received oral famcyclovir and 830 nm LED phototherapy on days 0, 4, 7, and 10. In order to estimate the time for wound healing, we measured the duration from the vesicle formation to when the lesion crust fell off. The visual analogue scale (VAS) was used for the estimation of pain on days 4, 7, 10, and 14. Results The mean time required for wound healing was 13.14±2.34 days in group B and 15.92±2.55 days in group A (p=0.006). From day 4, the mean VAS score showed a greater improvement in group B, compared with group A. A marginal but not statistically significant difference in the VAS scores was observed between the two groups (p=0.095). Conclusion LED treatment for acute herpes zoster ophthalmicus leads to faster wound healing and a lower pain score. PMID:23717006

  17. Chronic pain associated with the Chikungunya Fever: long lasting burden of an acute illness

    PubMed Central

    2010-01-01

    Background Chikungunya virus (CHIKV) is responsible for major epidemics worldwide. Autochthonous cases were recently reported in several European countries. Acute infection is thought to be monophasic. However reports on chronic pain related to CHIKV infection have been made. In particular, the fact that many of these patients do not respond well to usual analgesics suggests that the nature of chronic pain may be not only nociceptive but also neuropathic. Neuropathic pain syndromes require specific treatment and the identification of neuropathic characteristics (NC) in a pain syndrome is a major step towards pain control. Methods We carried out a cross-sectional study at the end of the major two-wave outbreak lasting 17 months in Réunion Island. We assessed pain in 106 patients seeking general practitioners with confirmed infection with the CHIK virus, and evaluated its impact on quality of life (QoL). Results The mean intensity of pain on the visual-analogical scale (VAS) was 5.8 ± 2.1, and its mean duration was 89 ± 2 days. Fifty-six patients fulfilled the definition of chronic pain. Pain had NC in 18.9% according to the DN4 questionnaire. Conversely, about two thirds (65%) of patients with NC had chronic pain. The average pain intensity was similar between patients with or without NC (6.0 ± 1.7 vs 6.1 ± 2.0). However, the total score of the Short Form-McGill Pain Questionnaire (SF-MPQ)(15.5 ± 5.2 vs 11.6 ± 5.2; p < 0.01) and both the affective (18.8 ± 6.2 vs 13.4 ± 6.7; p < 0.01) and sensory subscores (34.3 ± 10.7 vs 25.0 ± 9.9; p < 0.01) were significantly higher in patients with NC. The mean pain interference in life activities calculated from the Brief Pain Inventory (BPI) was significantly higher in patients with chronic pain than in patients without it (6.8 ± 1.9 vs 5.9 ± 1.9, p < 0.05). This score was also significantly higher in patients with NC than in those without such a feature (7.2 ± 1.5 vs 6.1 ± 1.9, p < 0.05). Conclusions There

  18. [Chest pain units. Organization and protocol for the diagnosis of acute coronary syndromes].

    PubMed

    Bayón Fernández, Julián; Alegría Ezquerra, Eduardo; Bosch Genover, Xavier; Cabadés O'Callaghan, Adolfo; Iglesias Gárriz, Ignacio; Jiménez Nácher, José Julio; Malpartida De Torres, Félix; Sanz Romero, Ginés

    2002-02-01

    The two main goals of chest pain units are the early, accurate diagnosis of acute coronary syndromes and the rapid, efficient recognition of low-risk patients who do not need hospital admission. Many clinical, practical, and economic reasons support the establishment of such units. Patients with chest pain account for a substantial proportion of emergency room turnover and their care is still far from optimal: 8% of patients sent home are later diagnosed of acute coronary syndrome and 60% of admissions for chest pain eventually prove to have been unnecessary.We present a systematic approach to create and manage a chest pain unit employing specialists headed by a cardiologist. The unit may be functional or located in a separate area of the emergency room. Initial triage is based on the clinical characteristics, the ECG and biomarkers of myocardial infarct. Risk stratification in the second phase selects patients to be admitted to the chest pain unit for 6-12 h. Finally, we propose treadmill testing before discharge to rule out the presence of acute myocardial ischemia or damage in patients with negative biomarkers and non-diagnostic serial ECGs.

  19. Can Acute Pain Treatment Reduce Postsurgical Comorbidity after Breast Cancer Surgery? A Literature Review

    PubMed Central

    Amaya, Fumimasa; Hosokawa, Toyoshi; Okamoto, Akiko; Matsuda, Megumi; Yamaguchi, Yosuke; Yamakita, Shunsuke; Taguchi, Tetsuya; Sawa, Teiji

    2015-01-01

    Regional analgesia, opioids, and several oral analgesics are commonly used for the treatment of acute pain after breast cancer surgery. While all of these treatments can suppress the acute postsurgical pain, there is growing evidence that suggests that the postsurgical comorbidity will differ in accordance with the type of analgesic used during the surgery. Our current study reviewed the effect of analgesics used for acute pain treatments on the major comorbidities that occur after breast cancer surgery. A considerable number of clinical studies have been performed to investigate the relationship between the acute analgesic regimen and common comorbidities, including inadequate quality of recovery after the surgery, persistent postsurgical pain, and cancer recurrence. Previous studies have shown that the choice of the analgesic modality does affect the postsurgical comorbidity. In general, the use of regional analgesics has a beneficial effect on the occurrence of comorbidity. In order to determine the best analgesic choice after breast cancer surgery, prospective studies that are based on a clear definition of the comorbidity state will need to be undertaken in the future. PMID:26495309

  20. Acute lymphocytic leukemia presented as back pain and revealed by bone scintigraphy.

    PubMed

    Liu, Bin; Gwal, Kriti; Servaes, Sabah; Zhuang, Hongming

    2013-08-01

    A previously healthy 8-year-old girl underwent MDP bone scintigraphy to evaluate possible spondylolysis due to worsening back pain. Unexpectedly, the bone scan images revealed intense activity in several thoracic and lumbar vertebrae, which was not consistent with spondylolysis. Further examinations proved that the patient had acute lymphocytic leukemia.

  1. Guidelines for fellowship training in regional anesthesiology and acute pain medicine: third edition, 2014.

    PubMed

    2015-01-01

    Directors for Regional Anesthesiology and Acute Pain Medicine fellowships develop and maintain guidelines for fellowship training in the subspecialty. The first edition of the guidelines was published in 2005 with a revision published in 2010. This set of guidelines updates the 2010 revision. The guidelines address 3 major topics: organization and resources, the educational program, and the evaluation process.

  2. The Relationship of Depression to Work Status during the Acute Period of Low Back Pain.

    ERIC Educational Resources Information Center

    Beaudet, Joanne; Rasch, John

    1988-01-01

    Investigated relationship of Beck Depression Inventory (BDI) scores to employment status and time since injury among persons with acute low back pain. Work status was unrelated to BDI scores. Participants 5 to 6 months post-injury scored higher than participants l month post-injury; participants working 5 to 6 months post-injury scored higher than…

  3. Art Therapy for Chronic Pain: Applications and Future Directions

    ERIC Educational Resources Information Center

    Angheluta, Anne-Marie; Lee, Bonnie K.

    2011-01-01

    Chronic pain is acknowledged as a phenomenological experience resulting from biological, psychological, and social interactions. Consequently, treatment for this complex and debilitating health phenomenon is often approached from multidisciplinary and biopsychosocial perspectives. One approach to treating chronic pain involves implementing…

  4. Single dose oral indometacin for the treatment of acute postoperative pain

    PubMed Central

    Moore, R Andrew; Derry, Sheena; Mason, Lorna; McQuay, Henry J; Edwards, Jayne

    2014-01-01

    Background This is an updated version of the original Cochrane review published in Issue 4, 2004. Indometacin is a non-steroidal anti-inflammatory drug (NSAID) used most commonly for the treatment of inflammation and pain resulting from rheumatic disease (arthritis), and less commonly in postoperative pain management. When taken for chronic pain conditions, indometacin has been associated with a high incidence of adverse events. The benefits and harms of orally-administered indometacin for postoperative pain are not clear. Objectives To determine the efficacy of a single dose of oral indometacin compared with placebo in treating acute postoperative pain in adults, and to analyse information relating to adverse events. Search methods We searched the Cochrane CENTRAL Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE and the Oxford Pain Relief Database for relevant studies in January 2002 and for the updated search in December 2007. Additional studies were sought from the reference lists of retrieved studies. Selection criteria Studies were included in the review if they were randomised, double blind, placebo-controlled clinical trials using a single oral dose of indometacin in adults with acute postoperative pain. Data collection and analysis Studies were assessed independently by two review authors. Pain relief or pain intensity data were extracted and converted into dichotomous information to give the number of participants with at least 50% pain relief over four to six hours. The relative benefit for at least 50% pain relief was calculated. Main results In the original review one study of 59 women with post-episiotomy pain met the inclusion criteria. The dose of indometacin assessed against placebo was 50 mg, and the results concluded that indometacin was not significantly better than placebo for relieving postoperative pain at four to six hours. There was insufficient information to conduct further efficacy analyses or assess adverse events

  5. Single dose oral mefenamic acid for acute postoperative pain in adults

    PubMed Central

    Moll, Rachel; Derry, Sheena; Moore, R Andrew; McQuay, Henry J

    2014-01-01

    Background Mefenamic acid is a non-steroidal anti-inflammatory drug (NSAID). It is most often used for treating pain of dysmenorrhoea in the short term (seven days or less), as well as mild to moderate pain including headache, dental pain, postoperative and postpartum pain. It is widely available in many countries worldwide. Objectives To assess the efficacy of single dose oral mefenamic acid in acute postoperative pain, and any associated adverse events. Search methods We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to December 2010. Selection criteria Single oral dose, randomised, double-blind, placebo-controlled trials of mefenamic acid for relief of established moderate to severe postoperative pain in adults. Data collection and analysis Studies were assessed for methodological quality and the data extracted by two review authors independently. Summed total pain relief (TOTPAR) or pain intensity difference (SPID) over 4 to 6 hours was used to calculate the number of participants achieving at least 50% pain relief. These derived results were used to calculate, with 95% confidence intervals, the relative benefit compared to placebo, and the number needed to treat (NNT) for one participant to experience at least 50% pain relief over 4 to 6 hours. Numbers of participants using rescue medication over specified time periods, and time to use of rescue medication, were sought as additional measures of efficacy. Information on adverse events and withdrawals was collected. Main results Four studies with 842 participants met the inclusion criteria; 126 participants were treated with mefenamic acid 500 mg, 67 with mefenamic acid 250 mg, 197 with placebo, and 452 with lignocaine, aspirin, zomepirac or nimesulide. Participants had pain following third molar extraction, episiotomy and orthopaedic surgery. The NNT for at least 50% pain relief over 6 hours with a single dose of mefenamic acid 500 mg compared to placebo was 4.0 (2

  6. Regional anesthesia for management of acute pain in the intensive care unit.

    PubMed

    De Pinto, Mario; Dagal, Armagan; O'Donnell, Brendan; Stogicza, Agnes; Chiu, Sheila; Edwards, William Thomas

    2015-01-01

    Pain is a major problem for Intensive Care Unit (ICU) patients. Despite numerous improvements it is estimated that as many as 70% of the patients experience moderate-to-severe postoperative pain during their stay in the ICU. Effective pain management means not only decreasing pain intensity, but also reducing the opioids' side effects. Minimizing nausea, vomiting, urinary retention, and sedation may indeed facilitate patient recovery and it is likely to shorten the ICU and hospital stay. Adequate postoperative and post-trauma pain management is also crucial for the achievement of effective rehabilitation. Furthermore, recent studies suggest that effective acute pain management may be helpful in reducing the development of chronic pain. When used appropriately, and in combination with other treatment modalities, regional analgesia techniques (neuraxial and peripheral nerve blocks) have the potential to reduce or eliminate the physiological stress response to surgery and trauma, decreasing the possibility of surgical complications and improving the outcomes. Also they may reduce the total amount of opioid analgesics necessary to achieve adequate pain control and the development of potentially dangerous side effects. PMID:26557482

  7. Home Delivery of Pain Therapy to Elderly Patients.

    ERIC Educational Resources Information Center

    Dietrich, Coralie

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

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

    PubMed

    Jinyi, Li; Yungui, Wang

    2015-06-01

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

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

    PubMed

    Jinyi, Li; Yungui, Wang

    2015-06-01

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

  10. Initial approach to patients with acute lower back pain.

    PubMed

    Joaquim, Andrei Fernandes

    2016-04-01

    Low back pain is in one of the most common reasons for seeking medical care in emergency care units, and also the second most common cause of work absenteeism. The recognition of red flags for serious diseases such as tumors and fractures, through proper history-taking and clinical examination, is essential for proper treatment and to rule out differential diagnoses. In the absence of suspected severe underlying disease, subsidiary radiological examinations are unnecessary. Analgesic and anti-inflammatory drugs are the treatment of choice and can be cautiously associated with muscle relaxants and opioids in more severe cases. Most patients will have complete improvement of symptoms after a few months, but a minority can develop chronic low back pain or present with recurrent episodes. The proper understanding of all of the above can optimize results and avoid diagnostic and therapeutic errors. PMID:27167551

  11. The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain

    PubMed Central

    Cotler, Howard B; Chow, Roberta T; Hamblin, Michael R; Carroll, James

    2015-01-01

    Pain is the most common reason for physician consultation in the United States. One out of three Americans is affected by chronic pain annually. The number one reason for missed work or school days is musculoskeletal pain. Currently accepted therapies consist of non-steroidal anti-inflammatory drugs, steroid injections, opiate pain medications and surgery, each of which carries their own specific risk profiles. What is needed are effective treatments for pain which have an acceptably low risk-profile. For over forty years, low level laser (light) therapy (LLLT) and LED (light emitting diode) therapy (also known as photobiomodulation) has been shown to reduce inflammation and edema, induce analgesia, and promote healing in a range of musculoskeletal pathologies. The purpose of this paper is to review the use of LLLT for pain, the biochemical mechanisms of action, the dose response curves, and how LLLT may be employed by orthopedic surgeons to improve outcomes and reduce adverse events. With the predicted epidemic of chronic pain in developed countries, it is imperative to validate cost-effective and safe techniques for managing painful conditions which would allow people to live active and productive lives. Moreover the acceptance of LLLT (which is currently being used by many specialties around the world) into the armamentarium of the American health care provider would allow for additional treatment options for patients. A new cost-effective therapy for pain could elevate quality of life while reducing financial strains. PMID:26858986

  12. A case of Carney complex presenting as acute testicular pain.

    PubMed

    Alleemudder, Adam; Pillai, Rajiv

    2016-01-01

    We describe the case of a 7-year-old boy who presented with testicular pain but was found to have bilateral testicular lesions later confirmed as Sertoli cell tumors. Genetic testing confirmed a PRKAR1A gene mutation consistent with Carney complex, a rare genetic disorder characterized by skin lesions, myxomas, and multiple endocrine neoplasms. A review of the condition is made highlighting the association with testicular tumors, particularly of Sertoli cell origin. PMID:27453662

  13. A case of Carney complex presenting as acute testicular pain

    PubMed Central

    Alleemudder, Adam; Pillai, Rajiv

    2016-01-01

    We describe the case of a 7-year-old boy who presented with testicular pain but was found to have bilateral testicular lesions later confirmed as Sertoli cell tumors. Genetic testing confirmed a PRKAR1A gene mutation consistent with Carney complex, a rare genetic disorder characterized by skin lesions, myxomas, and multiple endocrine neoplasms. A review of the condition is made highlighting the association with testicular tumors, particularly of Sertoli cell origin. PMID:27453662

  14. A systematic literature review on the effectiveness of non-invasive therapy for cervicobrachial pain.

    PubMed

    Salt, Emma; Wright, Chris; Kelly, Sue; Dean, Allison

    2011-02-01

    Cervicobrachial pain is a common cervical spine disorder. It is frequently managed through non-invasive therapy. The objective of this systematic review was to assess effectiveness of non-invasive therapy for the management of cervicobrachial pain, in terms of pain, function and disability. Computerised searches were performed to January 2010. Studies were selected using pre-specified criteria. Methodological quality of included studies was assessed using PEDro and level of inter-reviewer agreement reported using Kappa values. Meta-analyses were conducted on pain scores for similar interventions using DerSimonian-Laird random-effects model to allow for heterogeneity. Effect sizes and 95% confidence intervals were reported. Qualitative analyses, based on Centre for Evidence Based Medicine levels of evidence, were conducted for function and disability. Eleven studies were included in the review. Interventions included general physiotherapy, cervical traction, manual therapy, exercise therapy, and behavioural change approaches. There was inconclusive evidence for the effectiveness of non-invasive management of cervicobrachial pain. Potential benefits were indicated in the provision of manual therapy and exercise and behavioural change approaches to reduce pain. General physiotherapy and traction were no more effective than comparators in reducing pain (level A evidence). Effects of non-invasive management on function and disability were mixed. Future studies should identify which sub-groups of cervicobrachial pain respond to specific interventions.

  15. Spinal epidural neurostimulation for treatment of acute and chronic intractable pain: initial and long term results.

    PubMed

    Richardson, R R; Siqueira, E B; Cerullo, L J

    1979-09-01

    Spinal epidural neurostimulation, which evolved from dorsal column stimulation, has been found to be effective in the treatment of acute and chronic intractable pain. Urban and Hashold have shown that it is a safe, simplified alternative to dorsal column stimulation, especially because laminectomy is not required if the electrodes are inserted percutaneously. Percutaneous epidural neurostimulation is also advantageous because there can be a diagnostic trial period before permanent internalization and implantation. This diagnostic and therapeutic modality has been used in 36 patients during the past 3 years at Northwestern Memorial Hospital. Eleven of these patients had acute intractable pain, which was defined as pain of less than 1 year in duration. Initial postimplantation results from the 36 patients indicate that spinal epidural neurostimulation is most effective in treating the intractable pain of diabetes, arachnoiditis, and post-traumatic and postamputation neuroma. Long term follow-up, varying from 1 year to 3 years postimplantation in the 20 initially responding patients, indicates that the neurostimulation continues to provide significant pain relief (50% or greater) in a majority of the patients who experienced initial significant pain relief.

  16. Alterations in attentional mechanisms in response to acute inflammatory pain and morphine administration.

    PubMed

    Boyette-Davis, J A; Thompson, C D; Fuchs, P N

    2008-01-24

    Research indicates that pain negatively impacts attention; however, the extent of this impact and the mechanisms of the effect of pain on normal attentional processing remain unclear. This study 1) examined the impact of acute inflammatory pain on attentional processing, 2) examined the impact of morphine on attentional processing, and 3) determined if an analgesic dose of morphine would return attentional processing to normal levels. Male Sprague-Dawley rats were trained on the 5 choice serial reaction time task (5CSRTT), a test commonly used to assess the attentional mechanisms of rodents. Animals were injected with saline or 1, 3, or 6 mg/kg of morphine. Twenty minutes later, animals received a formalin (or saline) injection into one hind paw to induce an inflammatory condition and were then immediately tested in the 5CSRTT. The results show that the formalin injection significantly impaired performance, as measured by an increase in the number of trials in which the animal failed to attend to the task. Likewise, a high dose of morphine (6 mg/kg) produced similar decrements in task performance. Of primary importance is that 3 mg/kg of morphine produced analgesia with only mild sedation, and performance in the 5CSRTT was improved with this dose. This is the first study to use an animal model of acute pain to demonstrate the negative impact of pain on attention, and provides a novel approach to examine the neural correlates that underlie the disruptive impact of pain on attention.

  17. Combination Chemotherapy in Treating Young Patients With Newly Diagnosed High-Risk B Acute Lymphoblastic Leukemia and Ph-Like TKI Sensitive Mutations

    ClinicalTrials.gov

    2016-11-02

    B Acute Lymphoblastic Leukemia; Bone Necrosis; Central Nervous System Leukemia; Cognitive Side Effects of Cancer Therapy; Neurotoxicity Syndrome; Pain; Testicular Leukemia; Therapy-Related Toxicity; Untreated Adult Acute Lymphoblastic Leukemia; Untreated Childhood Acute Lymphoblastic Leukemia

  18. Electromyographic response of shoulder muscles to acute experimental subacromial pain.

    PubMed

    Sole, Gisela; Osborne, Hamish; Wassinger, Craig

    2014-08-01

    This study investigated effects of experimentally-induced subacromial pain, induced via hypertonic saline injection, on shoulder muscles activity. Electromyographic activity of 20 healthy participants was assessed for humeral elevation and descent for the control and experimental pain conditions, using fine wire electrodes for subscapularis and supraspinatus and surface electrodes for middle deltoid, upper trapezius, lower trapezius, infraspinatus, and serratus anterior. Normalized mean amplitudes were analyzed for each muscle for four phases for elevation and descent, respectively. Repeated measures analysis of variances (ANOVAs) were used to determine differences between muscle activity in the control and experimental condition for the four phases of elevation and descent. Differences for mean normalized amplitudes were not significant during humeral elevation. Increased activity was found for the pain condition for serratus anterior and middle deltoid during the first (120-90°) and third (60-30°) parts and decreased activity for infraspinatus in the second half of descent (60-0°). No significant differences were found during descent for upper and lower trapezius, subscapularis and supraspinatus. While increased serratus anterior activity during 60-30° of descent may be protective, increased middle deltoid and decreased infraspinatus activity during the same range may threaten subacromial tissues in that range. Overall the changes in muscle activation were individual specific, particularly during the concentric elevation phase. PMID:24685367

  19. Acute and Chronic Pain on the Battlefield: Lessons Learned from Point of Injury to the United States.

    PubMed

    Croll, Scott M; Griffith, Scott R

    2016-01-01

    Historically, war tends to accelerate innovation within military medicine. In this article, the authors argue this truism has recurred in the case of acute and chronic pain management for combatants in the global war on terrorism (GWOT). Advances in regional anesthesia techniques and multimodal acute pain care are highlighted in light of the typical weapons, injuries, and comorbid conditions of the modern combat era. Reported success of providing chronic pain care in the war theater during GWOT is discussed in the context of operational requirements for current and future wars. A description is provided of the Pain Management Task Force (PMTF) and Pain Campaign Plan which was initiated during GWOT. The PMTF effort enhanced pain education and clinical pain care through leadership and organizational changes, which created broader access to pain treatments for patients and more standardized treatment capabilities across the enterprise. PMID:27215875

  20. Patients’ expectations of acute low back pain management: implications for evidence uptake

    PubMed Central

    2013-01-01

    Background In many countries, general practitioner (GP) care of acute low back pain often does not adhere to evidence-based clinical guidelines. There has been little exploration of this deviation from evidence-based care from the patients’ perspective, particularly in relation to patients’ care expectations. The aim of this study was to explore the care expectations in patients who present to their GP with acute low back pain, influences on expectation development, and congruence of these expectations with clinical guideline recommendations. Methods Qualitative study in an inner urban general practice in Brisbane, Australia. Semi-structured interviews were conducted with 11 patients who presented to their GP with acute low back pain. Results Patients had a biomechanical understanding of back pain, how it should be tested and treated, and a poor understanding of its natural history. Most expected x-rays, believing they were necessary to identify the “cause of the pain” without belief of any downsides to x-rays. Patients’ expectations were primarily influenced by the experiences of family and friends, their own previous experiences of low back pain care, and comments from other health professionals they were consulting. The GP-patient relationship was important in influencing patient satisfaction of care provided. Most patient expectations, and some of the care that they reported receiving, were incongruent with guideline recommendations. Conclusions A biomechanical approach to management rather than an awareness of empirical evidence was evident in patients’ expectations. Communication and education by the GP that includes specifically enquiring about patients’ expectations, provides an opportunity to correct misperceptions, explain acute low back pain natural history, and the rationale for test and treatment recommendations. PMID:23297840

  1. Ultrasound Imaging for Tailored Treatment of Patients With Acute Shoulder Pain

    PubMed Central

    Ottenheijm, Ramon P. G.; Cals, Jochen W. L.; Weijers, René; Vanderdood, Kurt; de Bie, Rob A.; Dinant, Geert-Jan

    2015-01-01

    PURPOSE The objective of this study was to assess the frequencies of ultrasound findings in patients with acute rotator cuff disorders in family medicine. METHODS In a prospective observational study, 129 patients aged 18 to 65 years with acute shoulder pain in whom the family physician suspected rotator cuff disease underwent ultrasound imaging. RESULTS Rotator cuff disease was present in 81% of the patients, and 50% of them had multiple disorders. Calcific tendonitis was the most frequently diagnosed specific disorder. An age of 40 years or older was most strongly related to rotator cuff disease. CONCLUSIONS Ultrasound imaging enables family physicians to rationalize treatment in nearly all patients who are aged 40 years and older with acute shoulder pain. PMID:25583893

  2. How a Better Understanding of Spontaneous Mental Imagery Linked to Pain Could Enhance Imagery-Based Therapy in Chronic Pain

    PubMed Central

    Berna, Chantal; Tracey, Irene; Holmes, Emily A.

    2015-01-01

    Therapy with mental images is prevalent in the field of chronic pain, and this has been the case for centuries. Yet few of the recent advances in the cognitive behavioural understanding of spontaneous (i.e. intrusive) mental imagery have been translated to this field. Such advances include imagery as a component of a psychopathological process, as an emotional amplifier and as a cognitive therapeutic target in its own right. Hence very little is known about the contents, prevalence and emotional impact of spontaneous mental imagery in the context of chronic pain. This article discusses the evidence in favour of spontaneous imagery being a potentially important part of patients’ pain experience, and makes a case, based on neurophysiological findings, for imagery having an impact on pain perception. Furthermore, it presents how mental imagery has been used in the treatment of chronic pain. A case report illustrates further how spontaneous negative imagery linked to pain can be distressing, and how this might be addressed in therapy. Additionally, the case report demonstrates the spontaneous use of coping imagery, and raises a discussion of how this might be enhanced. PMID:26457174

  3. Prostate Hypofractionated Radiation Therapy With Injection of Hyaluronic Acid: Acute Toxicities in a Phase 2 Study

    SciTech Connect

    Chapet, Olivier; Decullier, Evelyne; Bin, Sylvie; Faix, Antoine; Ruffion, Alain; Jalade, Patrice; Fenoglietto, Pascal; Udrescu, Corina; Enachescu, Ciprian; Azria, David

    2015-03-15

    Purpose: Hypofractionated radiation therapy (RT) in prostate cancer can be developed only if the risk of rectal toxicity is controlled. In a multicenter phase 2 trial, hypofractionated irradiation was combined with an injection of hyaluronic acid (HA) to preserve the rectal wall. Tolerance of the injection and acute toxicity rates are reported. Methods and Materials: The study was designed to assess late grade 2 toxicity rates. The results described here correspond to the secondary objectives. Acute toxicity was defined as occurring during RT or within 3 months after RT and graded according to the Common Terminology Criteria for Adverse Events version 4.0. HA tolerance was evaluated with a visual analog scale during the injection and 30 minutes after injection and then by use of the Common Terminology Criteria at each visit. Results: From 2010 to 2012, 36 patients with low-risk to intermediate-risk prostate cancer were included. The HA injection induced a mean pain score of 4.6/10 ± 2.3. Thirty minutes after the injection, 2 patients still reported pain (2/10 and 3/10), which persisted after the intervention. Thirty-three patients experienced at least 1 acute genitourinary toxicity and 20 patients at least 1 acute gastrointestinal toxicity. Grade 2 toxicities were reported for 19 patients with urinary obstruction, frequency, or both and for 1 patient with proctitis. No grade 3 or 4 toxicities were reported. At the 3-month visit, 4 patients described grade 2 obstruction or frequency, and no patients had any grade 2 gastrointestinal toxicities. Conclusions: The injection of HA makes it possible to deliver hypofractionated irradiation over 4 weeks with a dose per fraction of > 3 Gy, with limited acute rectal toxicity.

  4. Coronary CT Angiography versus Standard Evaluation in Acute Chest Pain

    PubMed Central

    Hoffmann, Udo; Truong, Quynh A.; Schoenfeld, David A.; Chou, Eric T.; Woodard, Pamela K.; Nagurney, John T.; Pope, J. Hector; Hauser, Thomas H.; White, Charles S.; Weiner, Scott G.; Kalanjian, Shant; Mullins, Michael E.; Mikati, Issam; Peacock, W. Frank; Zakroysky, Pearl; Hayden, Douglas; Goehler, Alexander; Lee, Hang; Gazelle, G. Scott; Wiviott, Stephen D.; Fleg, Jerome L.; Udelson, James E.

    2013-01-01

    Background It is unclear whether an evaluation incorporating coronary computed tomographic angiography (CCTA) is more effective than standard evaluation in the emergency department in patients with symptoms suggestive of acute coronary syndromes. Methods In this multicenter trial, we randomly assigned patients 40 to 74 years of age with symptoms suggestive of acute coronary syndromes but without ischemic electrocardiographic changes or an initial positive troponin test to early CCTA or to standard evaluation in the emergency department on weekdays during daylight hours between April 2010 and January 2012. The primary end point was length of stay in the hospital. Secondary end points included rates of discharge from the emergency department, major adverse cardiovascular events at 28 days, and cumulative costs. Safety end points were undetected acute coronary syndromes. Results The rate of acute coronary syndromes among 1000 patients with a mean (±SD) age of 54±8 years (47% women) was 8%. After early CCTA, as compared with standard evaluation, the mean length of stay in the hospital was reduced by 7.6 hours (P<0.001) and more patients were discharged directly from the emergency department (47% vs. 12%, P<0.001). There were no undetected acute coronary syndromes and no significant differences in major adverse cardiovascular events at 28 days. After CCTA, there was more downstream testing and higher radiation exposure. The cumulative mean cost of care was similar in the CCTA group and the standard-evaluation group ($4,289 and $4,060, respectively; P=0.65). Conclusions In patients in the emergency department with symptoms suggestive of acute coronary syndromes, incorporating CCTA into a triage strategy improved the efficiency of clinical decision making, as compared with a standard evaluation in the emergency department, but it resulted in an increase in downstream testing and radiation exposure with no decrease in the overall costs of care. (Funded by the National

  5. Calcium/calmodulin-dependent protein kinase IV mediates acute nicotine-induced antinociception in acute thermal pain tests

    PubMed Central

    Jackson, Kia J.; Damaj, M. Imad

    2014-01-01

    Calcium activated second messengers such as calcium/calmodulin-dependent protein kinase II have been implicated in drug-induced antinociception. The less abundant calcium activated second messenger, calcium/calmodulin-dependent protein kinase IV (CaMKIV), mediates emotional responses to pain and tolerance to morphine analgesia; however its role in nicotine-mediated antinociception is currently unknown. The goal of this study was to evaluate the role of CaMKIV in the acute effects of nicotine, primarily acute nicotine- induced antinociception. CaMKIV knockout (−/−), heterozygote (+/−), and wild-type (+/+) mice were injected with various doses of nicotine and evaluated in a battery of tests, including the tail-flick and hot-plate tests for antinociception, body temperature, and locomotor activity. Our results show a genotype-dependent reduction in tail-flick and hot- plate latency in CaMKIV (+/−) and (−/−) mice after acute nicotine treatment, while no difference was observed between genotypes in the body temperature and locomotor activity assessments. The results of this study support a role for CaMKIV in acute nicotine-induced spinal and supraspinal pain mechanisms, and further implicate involvement of calcium-dependent mechanisms in drug-induced antinociception. PMID:24196027

  6. Clinical decision support and acute low back pain: evidence-based order sets.

    PubMed

    Forseen, Scott E; Corey, Amanda S

    2012-10-01

    Low back pain is one of the most common reasons for visits to physicians in the ambulatory care setting. Estimated medical expenditures related to low back pain have increased disproportionately relative to the more modest increase in the prevalence of self-reported low back pain in the past decade. The increase in spine care expenditures has not been associated with improved patient outcomes. Evidence-based order templates presented in this article are designed to assist practitioners through the process of managing patients with acute low back pain. A logical method of choosing, developing, and implementing clinical decision support interventions is presented that is based on the best available scientific evidence. These templates may be reasonably expected to improve patient care, decrease inappropriate imaging utilization, reduce the inappropriate use of steroids and narcotics, and potentially decrease the number of inappropriate invasive procedures. PMID:23025864

  7. Effect of Music Therapy on Pain and Anxiety Levels of Cancer Patients: A Pilot Study

    PubMed Central

    Krishnaswamy, Priyadharshini; Nair, Shoba

    2016-01-01

    Background: The pain associated with cancer is highly detrimental to the quality of life of the affected individuals. It also contributes to the anxiety of the patient. There is a need for a nonpharmacological approach in addition to the pharmacological therapy for the management of the pain for a more holistic improvement in the individual. With this study, we wish to achieve this through music. Objective: To assess the effect of music therapy on pain scores and anxiety levels of cancer patients with pain. Study Design: In this quantitative study, a comparative study was done on fourteen cancer patients admitted for pain relief under the Department of Pain and Palliative Medicine, of a tertiary care hospital, having moderate to severe pain (numerical pain rating scale [NRS] – of 4 to 10). Subjects and Methods: Convenience sampling was used. Patients were allocated to test group or control group nonrandomly. The test group patients were subjected to music therapy for 20 min while the control group patients were kept occupied by talking to them for 20 min. The NRS scale was used to assess the pre- and post-interventional pain scores and the Hamilton anxiety rating scale was used to assess the pre- and post-interventional anxiety scores in the two groups. Statistics: Student's t-test was used for comparing the pre- and post-interventional data. Two sample t-test was used to compare the data obtained from the control and study groups. Results: Statistically significant reduction seen in the pain scores in the test group after music therapy (P = 0.003). No statistically significant reduction seen in the pain score in the control group (P = 0.356). There was a statistically significant reduction in the postintervention pain scores in the test group compared to the control group (P = 0.034). The reduction in anxiety levels in both groups after intervention was not statistically significant. Conclusion: Music therapy was found to lower the pain score of a patient who

  8. A case of pancreatic arteriovenous malformation identified by investigating the cause of upper abdominal pain associated with acute pancreatitis.

    PubMed

    Sato, Kohei; Monden, Kazuteru; Ueki, Toru; Tatsukawa, Masashi; Sadamori, Hiroshi; Sakaguchi, Kousaku; Takakura, Norihisa

    2016-07-01

    A man in his 60s with epigastric pain was diagnosed with acute pancreatitis and subsequently recovered following conservative treatment. However, because of repeated upper abdominal pain and the formation of a pancreatic pseudocyst, he was transferred to our institution for evaluation. Dynamic computed tomography (CT) scanning confirmed abnormal vessels in the tail of the pancreas and early venous return to the splenic vein in the early arterial phase. Abdominal angiography revealed a racemose vascular network in the tail of the pancreas, confirming the presence of an arteriovenous malformation (AVM) in this region. This AVM was thought to be the cause of the acute pancreatitis, so a distal pancreatectomy was performed. The patient's postoperative course was uneventful, and there has been no recurrence at the 7-month postoperative follow-up. Surgical resection has a low recurrence rate and good outcome;thus, if a pancreatic AVM appears difficult to treat with conservative medical therapy, surgical resection appears to be the definitive treatment. PMID:27383106

  9. MRI assessment of paraspinal muscles in patients with acute and chronic unilateral low back pain

    PubMed Central

    Wan, Q; Lin, C; Li, X; Zeng, W

    2015-01-01

    Objective: To investigate the changes in paraspinal muscle cross-sectional area (CSA) and composition, using the digital data from lumbar spine MRIs of patients with acute and chronic low back pain (LBP). Methods: In total, 178 patients with unilateral LBP who had lumbar MRI examination were recruited. The data were obtained by a retrospective documentation audit. The CSAs and mean signal intensities of the bilateral paraspinal muscles [psoas major (PM), quadratus lumborum, multifidus (MF) and erector spinae (ES)] were measured, and the percentage of fat infiltration was calculated. The data between the painful side and non-painful side were compared, and between-group comparisons were tested. 42 patients with chronic unilateral LBP could indicate the problem level, and the CSA and mean signal intensity of the MF muscle were analysed at the problem level, and one vertebral above and one vertebral level below the problem level. Results: The CSAs of the PM and ES muscles were significantly decreased in the acute LBP group, while in the chronic LBP group, significant reduction in CSA was found in the MF and ES muscles on the painful side compared with the non-painful side. The mean signal intensity and fat content of the ES muscle on the painful side in the chronic LBP group was significantly higher than that on the painful side in the acute LBP group. The significant decrease of CSA in the MF muscle was found at multiple levels on the painful side. Conclusion: The present findings show that there is selective ipsilateral atrophy of paraspinal muscles, specific to the symptomatic side, in patients with acute and chronic LBP. The reduction of the muscle CSA and increased fatty infiltration occurred synchronously, and the extent of change is significantly greater in chronic LBP in the ES muscle. Atrophy of the MF muscle appears to be at multiple levels but side specific in relation to symptoms in patients with chronic LBP, and the decreased muscle CSA may occur prior to

  10. Acute effects of single and multiple level thoracic manipulations on chronic mechanical neck pain: a randomized controlled trial

    PubMed Central

    Puntumetakul, Rungthip; Suvarnnato, Thavatchai; Werasirirat, Phurichaya; Uthaikhup, Sureeporn; Yamauchi, Junichiro; Boucaut, Rose

    2015-01-01

    Background Thoracic spine manipulation has become a popular alternative to local cervical manipulative therapy for mechanical neck pain. This study investigated the acute effects of single-level and multiple-level thoracic manipulations on chronic mechanical neck pain (CMNP). Methods Forty-eight patients with CMNP were randomly allocated to single-level thoracic manipulation (STM) at T6–T7 or multiple-level thoracic manipulation (MTM), or to a control group (prone lying). Cervical range of motion (CROM), visual analog scale (VAS), and the Thai version of the Neck Disability Index (NDI-TH) scores were measured at baseline, and at 24-hour and at 1-week follow-up. Results At 24-hour and 1-week follow-up, neck disability and pain levels were significantly (P<0.05) improved in the STM and MTM groups compared with the control group. CROM in flexion and left lateral flexion were increased significantly (P<0.05) in the STM group when compared with the control group at 1-week follow-up. The CROM in right rotation was increased significantly after MTM compared to the control group (P<0.05) at 24-hour follow-up. There were no statistically significant differences in neck disability, pain level at rest, and CROM between the STM and MTM groups. Conclusion These results suggest that both single-level and multiple-level thoracic manipulation improve neck disability, pain levels, and CROM at 24-hour and 1-week follow-up in patients with CMNP. PMID:25624764

  11. [Exercise test after acute myocardial infarction: without therapy?].

    PubMed

    Gregorio, G

    2001-12-01

    In this article we analyze the role of ECG exercise test in the clinical evaluation and prognostic stratification of patients after acute myocardial infarction. Moreover, we analyze if test results may be influenced by drugs. In clinical practice, most of the cardiologists working in hospital perform pre-discharge tests while patients are on medical therapy; after the acute event, exercise test is performed after pharmacological wash-out. In the thrombolytic age exercise test has a well-defined role in the evaluation and prognostic stratification of postinfarction patients, but some aspects regarding the way of performance and the opportunity of a pharmacological wash-out need further investigation.

  12. Neurophysiological mechanisms in acceptance and commitment therapy in opioid-addicted patients with chronic pain.

    PubMed

    Smallwood, Rachel F; Potter, Jennifer S; Robin, Donald A

    2016-04-30

    Acceptance and Commitment Therapy (ACT) has been effectively utilized to treat both chronic pain and substance use disorder independently. Given these results and the vital need to treat the comorbidity of the two disorders, a pilot ACT treatment was implemented in individuals with comorbid chronic pain and opioid addiction. This pilot study supported using neurophysiology to characterize treatment effects and revealed that, following ACT, participants with this comorbidity exhibited reductions in brain activation due to painful stimulus and in connectivity at rest.

  13. Chest pain in a 12-year-old girl with ulcerative colitis after therapy with mesalazine

    PubMed Central

    Mukherjee, Nirajan; Pandya, Nikila; Bhaduri, Bim; Bala, K

    2013-01-01

    This case of chest pain complicating therapy received for ulcerative colitis in a young patient highlights the importance of a thorough history and clinical examination. The complication can be rapidly fatal if not recognised and treated quickly. PMID:23761603

  14. Evaluating acute pain intensity relief: challenges when using an 11-point numerical rating scale.

    PubMed

    Chauny, Jean-Marc; Paquet, Jean; Lavigne, Gilles; Marquis, Martin; Daoust, Raoul

    2016-02-01

    Percentage of pain intensity difference (PercentPID) is a recognized way of evaluating pain relief with an 11-point numerical rating scale (NRS) but is not without flaws. A new metric, the slope of relative pain intensity difference (SlopePID), which consists in dividing PercentPID by the time between 2 pain measurements, is proposed. This study aims to validate SlopePID with 3 measures of subjective pain relief: a 5-category relief scale (not, a little, moderate, very, complete), a 2-category relief question ("I'm relieved," "I'm not relieved"), and a single-item question, "Wanting other medication to treat pain?" (Yes/No). This prospective cohort study included 361 patients in the emergency department who had an initial acute pain NRS > 3 and a pain intensity assessment within 90 minutes after analgesic administration. Mean age was 50.2 years (SD = 19.3) and 59% were women. Area under the curves of receiver operating characteristic curves analyses revealed similar discriminative power for PercentPID (0.83; 95% confidence interval [CI], 0.79-0.88) and SlopePID (0.82; 95% CI, 0.77-0.86). Considering the "very" category from the 5-category relief scale as a substantial relief, the average cutoff for substantial relief was a decrease of 64% (95% CI, 59-69) for PercentPID and of 49% per hour (95% CI, 44-54) for SlopePID. However, when a cutoff criterion of 50% was used as a measure of pain relief for an individual patient, PercentPID underestimated pain-relieved patients by 12.1% (P < 0.05) compared with the SlopePID measurement, when pain intensity at baseline was an odd number compared with an even number (32.9% vs 45.0%, respectively). SlopePID should be used instead of PercentPID as a metric to evaluate acute pain relief on a 0 to 10 NRS.

  15. Biofeedback and Relaxation Therapy for Chronic Temporomandibular Joint Pain: Predicting Successful Outcomes.

    ERIC Educational Resources Information Center

    Funch, Donna P.; Gale, Elliot N.

    1984-01-01

    Randomly assigned 57 patients with chronic temporomandibular joint (TMJ) pain to receive either relaxation or biofeedback therapy. Successful patients in the relaxation condition tended to be younger and had experienced TMJ pain for a shorter period of time than the successful biofeedback patients. (BH)

  16. Semantic Behavior Therapy and Psychosocial Variables in the Treatment of Chronic Pain in the Elderly.

    ERIC Educational Resources Information Center

    Dietrich, Coralie; And Others

    This study explored the efficacy of semantic behavior therapy in the management of chronic osteoarthritis pain in elderly patients as well as the relationships among pain, physical health, personality, and social characteristics in this population. The sample consisted of 8 elderly persons who had osteoarthritis of the knee, and 11 healthy elderly…

  17. Gene Therapy for the Treatment of Chronic Peripheral Nervous System Pain

    PubMed Central

    Goins, William F.; Cohen, Justus B.; Glorioso, Joseph C.

    2012-01-01

    Chronic pain is a major health concern affecting 80 million Americans at some time in their lives with significant associated morbidity and effects on individual quality of life. Chronic pain can result from a variety of inflammatory and nerve damaging events that include cancer, infectious diseases, autoimmune-related syndromes and surgery. Current pharmacotherapies have not provided an effective long-term solution as they are limited by drug tolerance and potential abuse. These concerns have led to the development and testing of gene therapy approaches to treat chronic pain. The potential efficacy of gene therapy for pain has been reported in numerous pre-clinical studies that demonstrate pain control at the level of the spinal cord. This promise has been recently supported by a Phase-I human trial in which a replication-defective herpes simplex virus (HSV) vector was used to deliver the human pre-proenkephalin (hPPE) gene, encoding the natural opioid peptides met- and leu-enkephalin (ENK), to cancer patients with intractable pain resulting from bone metastases (Fink et al., 2011). The study showed that the therapy was well tolerated and that patients receiving the higher doses of therapeutic vector experienced a substantial reduction in their overall pain scores for up to a month post vector injection. These exciting early clinical results await further patient testing to demonstrate treatment efficacy and will likely pave the way for other gene therapies to treat chronic pain. PMID:22668775

  18. Acute Hypoglycemia Induces Painful Neuropathy and the Treatment of Coenzyme Q10.

    PubMed

    Zhang, Yan Ping; Mei, Shanshan; Yang, Jinfeng; Rodriguez, Yiliam; Candiotti, Keith A

    2016-01-01

    Diabetic neuropathic pain is reduced with tight glycemic control. However, strict control increases the risk of hypoglycemic episodes, which are themselves linked to painful neuropathy. This study explored the effects of hypoglycemia-related painful neuropathy. Pretreatment with coenzyme Q10 (CoQ10) was performed to explore the preventive effect of CoQ10 on hypoglycemia-related acute neuropathic pain. Two strains of mice were used and 1 unit/kg of insulin was given to induce hypoglycemia. Mechanical sensitivity of hindpaw withdrawal thresholds was measured using von Frey filaments. Blood glucose levels were clamped at normal levels by joint insulin and glucose injection to test whether insulin itself induced hypersensitivity. Results suggest that the increased mechanical sensitivity after insulin injection is related to decreased blood glucose levels. When blood glucose levels remained at a normal level by the linked administration of insulin and glucose, mice demonstrated no significant change in mechanical sensitivity. Pretreatment with CoQ10 prevented neuropathic pain and the expression of the stress factor c-Fos. These results support the concept that pain in the diabetic scenario can be the result of hypoglycemia and not insulin itself. Additionally, pretreatment with CoQ10 may be a potent preventive method for the development of neuropathic pain. PMID:26824041

  19. Complementary and alternative therapies: what is their place in the management of chronic pain?

    PubMed

    Snyder, Mariah; Wieland, Joanne

    2003-09-01

    Nurses have used complementary therapies for many years to relieve anxiety, promote comfort, and reduce or alleviate pain. The therapies described in this article are examples of the many therapies available for nurses to consider when planning care for patients with chronic pain. The increasing body of scientific knowledge is providing more guidance about the efficacy of specific therapies. As with all interventions, ongoing evaluation about the effectiveness of a therapy for each patient is an important component of quality nursing care. Complementary therapies provide an avenue for nurses to be autonomous in furthering the relief of chronic pain, as many of these therapies fall within the domain of nursing. Incorporating selected therapies into the plan of care provides multiple opportunities for nurses to demonstrate caring, a premier characteristic of nursing. A number of the complementary therapies, such as journaling, hand massage, and imagery, can be taught to patients and their families, thus promoting self-care. Anecdotal evidence and findings from numerous smaller studies provide some support for the use of many complementary therapies to manage chronic pain or their use as adjuncts in the treatment regimen. Still, the nurse must weigh the risks and benefits before suggesting a therapy to a patient. Evaluating the effectiveness of the complementary therapy to promote comfort in patients with chronic pain is essential. Obtaining this information is not only critical to the care of a particular patient, but these data will assist nurses in learning more about specific therapies. Most importantly, nurses need to pursue research to further the scientific basis for many of the complementary therapies.

  20. Case Study: The Use of Massage Therapy to Relieve Chronic Low-Back Pain

    PubMed Central

    Allen, Laura

    2016-01-01

    Objectives To study the effects of massage on chronic low-back pain in a patient with four different diagnoses: osteoarthritis, scoliosis, spinal stenosis, and degenerative disc disease. The patient’s goal was to cut down on the amount of pain medication he takes. Methods A 63-year-old man with chronic back pain received four massages across a twenty-day period. Progress was recorded using the Oswestry Low Back Pain Scale, as he self-reported on levels of pain and interference with his activities of daily living. Results Improvement was noted in 9 out of 10 measurements of self-reported pain and activities of daily living, with the only exception being his ability to lift heavy objects, which remained unchanged. The most dramatic differences were improvements in his ability to walk, and in the changing degrees of pain. The client also self-reported being able to decrease his pain medication and the ability to ride his bicycle for the first time in years. Conclusions Massage therapy is a promising treatment for chronic low-back pain for patients who may have multiple pathologies, any one of which could be responsible for the condition. Further study is encouraged to determine the efficacy of massage therapy as a readily accessible, lower-cost alternative to more invasive therapies and as an adjunct to regular medical care, when appropriate. PMID:27648110

  1. Case Study: The Use of Massage Therapy to Relieve Chronic Low-Back Pain

    PubMed Central

    Allen, Laura

    2016-01-01

    Objectives To study the effects of massage on chronic low-back pain in a patient with four different diagnoses: osteoarthritis, scoliosis, spinal stenosis, and degenerative disc disease. The patient’s goal was to cut down on the amount of pain medication he takes. Methods A 63-year-old man with chronic back pain received four massages across a twenty-day period. Progress was recorded using the Oswestry Low Back Pain Scale, as he self-reported on levels of pain and interference with his activities of daily living. Results Improvement was noted in 9 out of 10 measurements of self-reported pain and activities of daily living, with the only exception being his ability to lift heavy objects, which remained unchanged. The most dramatic differences were improvements in his ability to walk, and in the changing degrees of pain. The client also self-reported being able to decrease his pain medication and the ability to ride his bicycle for the first time in years. Conclusions Massage therapy is a promising treatment for chronic low-back pain for patients who may have multiple pathologies, any one of which could be responsible for the condition. Further study is encouraged to determine the efficacy of massage therapy as a readily accessible, lower-cost alternative to more invasive therapies and as an adjunct to regular medical care, when appropriate.

  2. Self-Delivered Home-Based Mirror Therapy for Lower Limb Phantom Pain

    PubMed Central

    Darnall, Beth D.

    2016-01-01

    Home-based patient-delivered mirror therapy is a promising approach in the treatment of phantom limb pain. Previous studies and case reports of mirror therapy have used a therapist-guided, structured protocol of exercises. No case report has described treatment for either upper or lower limb phantom pain by using home-based patient-delivered mirror therapy. The success of this case demonstrates that home-based patient-delivered mirror therapy may be an efficacious, low-cost treatment option that would eliminate many traditional barriers to care. PMID:19096290

  3. Occlusal Therapy in the Management of Chronic Orofacial Pain

    PubMed Central

    Bush, Francis M.

    1984-01-01

    Review of the literature indicates that most routine orofacial dysfunctions are characterized by deep pain. Various disorders of the masticatory systems, particularly musculoskeletal conditions, are thought to be triggered by occlusal disharmonies. The pain component develops following a pattern of bruxism, muscle hyperactivity, fatigue and spasm. Treatment for most disorders has been to modify the occlusion, although the rational for doing so appears questionable. Critical issues in the field of occlusion related to orofacial pain are reviewed: occlusal disharmonies, coincidence of retruded-intercuspal contact positions, non-working side interferences, maximum intercuspation of teeth, occlusal adjustment, and occlusal appliances. The studies reviewed fail to support the clinical objective of obtaining equal contact at retruded and intercuspal positions and that the lateral pterygoid muscles stabilize the temporomandibular joint. The relationship between non-working side interferences and pain dysfunction is also not readily supported by controlled studies. Occlusal adjustment appears to be unsatisfactory as a modality for management of pain: not all patients improved following treatment, some relapse occurs even with the most stable contacts, and other treatments such as intra-articular injections of corticosteroids reduced symptoms more readily. Occlusal splints seem to reduce most clinical signs and symptoms on both a short-term and long-term basis. Placement of mandibular orthopedic repositioning appliances results in reduction of pain in some patients, but usually this treatment is followed by extensive rehabilitation. Six major areas are suggested for clinical studies that attempt to relate occlusion to management of orofacial pain. These include: establishment of an ideal jaw position, sequencing of symptoms in the pain history, relationship of pain to other symptoms, development of physiological methods to assess how occlusal modification affects pain

  4. Serial assessment of laser Doppler flow during acute pain crises in sickle cell disease

    PubMed Central

    Shi, Patricia Ann; Manwani, Deepa; Olowokure, Olugbenga; Nandi, Vijay

    2014-01-01

    Changes in basal laser Doppler flowmetry (LDF) of skin blood flow in sickle cell disease are reported to have pathophysiologic relevance in pain crisis. This is the first study to strictly control for LDF variability in determining the value of serial, basal (unprovoked) skin LDF as a practical method to assess resolution of acute pain crisis in sickle cell patients. Daily LDF measurements were repeated on the exact same skin areas of the calf and forehead throughout each of 12 hospital admissions for uncomplicated acute pain crisis. A progressive increase in perfusion was observed in the calf throughout hospitalization as pain crisis resolved, but measurement reproducibility in the calf was poor. Reproducibility in the forehead was better, but no significant trend over time in perfusion was seen. There was no significant correlation between perfusion and pain scores over time. There was also no significant pattern of LDF oscillations over time. In conclusion, only perfusion units and not oscillatory pattern of LDF has probable pathophysiological significance in sickle cell disease vaso-occlusion. The reproducibility of basal skin LDF specifically in sickle cell disease needs to be confirmed. PMID:24857171

  5. Serial assessment of laser Doppler flow during acute pain crises in sickle cell disease.

    PubMed

    Shi, Patricia Ann; Manwani, Deepa; Olowokure, Olugbenga; Nandi, Vijay

    2014-12-01

    Changes in basal laser Doppler flowmetry (LDF) of skin blood flow in sickle cell disease are reported to have pathophysiologic relevance in pain crisis. This is the first study to strictly control for LDF variability in determining the value of serial, basal (unprovoked) skin LDF as a practical method to assess resolution of acute pain crisis in sickle cell patients. Daily LDF measurements were repeated on the exact same skin areas of the calf and forehead throughout each of 12 hospital admissions for uncomplicated acute pain crisis. A progressive increase in perfusion was observed in the calf throughout hospitalization as pain crisis resolved, but measurement reproducibility in the calf was poor. Reproducibility in the forehead was better, but no significant trend over time in perfusion was seen. There was no significant correlation between perfusion and pain scores over time. There was also no significant pattern of LDF oscillations over time. In conclusion, only perfusion units and not oscillatory patterns of LDF have probable pathophysiological significance in sickle cell disease vaso-occlusion. The reproducibility of basal skin LDF specifically in sickle cell disease needs to be confirmed.

  6. High Intensity Laser Therapy (HILT) versus TENS and NSAIDs in low back pain: clinical study

    NASA Astrophysics Data System (ADS)

    Zati, Allesandro; Fortuna, Damiano; Valent, A.; Filippi, M. V.; Bilotta, Teresa W.

    2004-09-01

    Low back pain, caused by lumbar disc herniation, is prevalently treated with a conservative approach. In this study we valued the efficacy of High Intensity Laser Therapy (HILT), compared with accepted therapies such as TENS and NSAIDs. Laser therapy obtained similar results in the short term, but better clinical effect over time than TENS and NSAIDs. In conclusion high intensity laser therapy appears to be a interesting new treatment, worthy of further research.

  7. Occupational Therapy and Physiotherapy in Acute Stroke: Do Rural Patients Receive Less Therapy?

    PubMed Central

    Ashby, Samantha

    2016-01-01

    Objective. To assess whether acute stroke patients in rural hospitals receive less occupational therapy and physiotherapy than those in metropolitan hospitals. Design. Retrospective case-control study of health data in patients ≤10 days after stroke. Setting. Occupational therapy and physiotherapy services in four rural hospitals and one metropolitan hospital. Participants. Acute stroke patients admitted in one health district. Main Outcome Measures. Frequency and duration of face-to-face and indirect therapy sessions. Results. Rural hospitals admitted 363 patients and metropolitan hospital admitted 378 patients. Mean age was 73 years. Those in rural hospitals received more face-to-face (p > 0.0014) and indirect (p = 0.001) occupational therapy when compared to those in the metropolitan hospital. Face-to-face sessions lasted longer (p = 0.001). Patients admitted to the metropolitan hospital received more face-to-face (p > 0.000) and indirect (p > 0.000) physiotherapy when compared to those admitted to rural hospitals. Face-to-face sessions were shorter (p > 0.000). Almost all were seen within 24 hours of referral. Conclusions. Acute stroke patients in Australian rural hospital may receive more occupational therapy and less physiotherapy than those in metropolitan hospitals. The dose of therapy was lower than recommended, and the referral process may unnecessarily delay the time from admission to a patient's first therapy session. PMID:27752389

  8. Effects of nicotinic acetylcholine receptor agonists in assays of acute pain-stimulated and pain-depressed behaviors in rats.

    PubMed

    Freitas, Kelen C; Carroll, F Ivy; Negus, S Stevens

    2015-11-01

    Agonists at nicotinic acetylcholine receptors (nAChRs) constitute one drug class being evaluated as candidate analgesics. Previous preclinical studies have implicated α4β2 and α7 nAChRs as potential mediators of the antinociceptive effects of (–)-nicotine hydrogen tartrate (nicotine) and other nAChR agonists; however, these studies have relied exclusively on measures of pain-stimulated behavior, which can be defined as behaviors that increase in frequency, rate, or intensity after presentation of a noxious stimulus. Pain is also associated with depression of many behaviors, and drug effects can differ in assays of pain-stimulated versus pain-depressed behavior. Accordingly, this study compared the effects of nicotine, the selective α4/6β2 agonist 5-(123I)iodo-3-[2(S)-2-azetidinylmethoxy]pyridine (5-I-A-85380), and the selective α7 agonist N-(3R)-1-azabicyclo(2.2.2)oct-3-yl-4-chlorobenzamide in assays of pain-stimulated and pain-depressed behavior in male Sprague-Dawley rats. Intraperitoneal injection of dilute lactic acid served as an acute noxious stimulus to either stimulate a stretching response or depress the operant responding, which is maintained by electrical brain stimulation in an intracranial self-stimulation (ICSS) procedure. Nicotine produced a dose-dependent, time-dependent, and mecamylamine-reversible blockade of both acid-stimulated stretching and acid-induced depression of ICSS. 5-I-A-85380 also blocked both acid-stimulated stretching and acid-induced depression of ICSS, whereas N-(3R)-1-azabicyclo(2.2.2)oct-3-yl-4-chlorobenzamide produced no effect in either procedure. Both nicotine and 5-I-A-85380 were ≥10-fold more potent in blocking the acid-induced depression of ICSS than in blocking the acid-induced stimulation of stretching. These results suggest that stimulation of α4β2 and/or α6β2 nAChRs may be especially effective to alleviate the signs of pain-related behavioral depression in rats; however, nonselective behavioral effects

  9. COOP-WONCA charts: a suitable functional status screening instrument in acute low back pain?

    PubMed Central

    Andres, E; Temme, M; Raderschatt, B; Szecsenyi, J; Sandholzer, H; Kochen, M M

    1995-01-01

    BACKGROUND: Functional status is considered an important measure of health status in primary care. The COOP-WONCA charts, which comprise six single-item scales, have mainly been used to determine functional ability in chronically ill patients. AIM: A study was carried out to determine whether the charts are able to measure the degree of functional impairment associated with acute illness and the improvement in functional ability accompanying the process of recovery. METHOD: A total of 95 patients presenting with acute low back pain were recruited from 15 single-handed general practices in northern Germany. At presentation and at two-week follow up, these patients completed self-administered questionnaires which included the COOP-WONCA charts. The charts ask patients to use the timescale of the past two weeks when rating their condition. Baseline and follow-up measurements of the charts were compared and correlations of chart scores with patients' measurements of pain intensity on a visual analogue scale, general practitioners' ratings of impairment and patients' measurements of recovery were analysed. RESULTS: Only the chart measuring change in health revealed a deterioration in functional ability associated with the onset of pain and an improvement in functional status at follow up. Two of the other charts indicated a deterioration at follow up. Only the chart measuring change in health was correlated with ratings of pain and impairment at baseline. At follow up, strong correlations were found between general practitioners' assessments of impairment, patients' ratings of pain and patients' ratings of recovery for all scales except for those measuring social activities and daily activities. The patients interpreted the instructions for using the COOP-WONCA charts differently; some included the period of acute back pain while others did not. CONCLUSION: Of the six charts only the change in health chart proved to be a suitable scale for measuring short-term changes

  10. [Adsorption therapy for acute suppurative periostitis of the jaw].

    PubMed

    Maĭborodin, I V; Liubarskiĭ, M S; Loĭko, E R

    2002-01-01

    Capillaries and tissue leukocyte cytograms in soft gingival tissues were examined by optic microscopy in patients with acute purulent periostitis of the jaws treated by different methods. Disorders in the lymph outflow from gingival tissues were detected, which were due to dilatation of the lymph vessels and interstitial spaces in the mucosal lamina propria and stasis with leukocyte aggregation and purulent clots in the lumina of many lymph vessels. Less pronounced dilatation of interstitial spaces and lymph vessels, higher counts of lymphocytes, monocytes, and macrophages in the tissues of the gingival mucosa lamina propria, observed 2 days after the beginning of adsorption therapy of the subperiosteal abscess cavity, indicate that this therapy is more effective in acute purulent periostitis than traditional treatment.

  11. Acute paraspinal compartment syndrome as a rare cause of loin pain.

    PubMed

    Hoyle, A; Tang, V; Baker, A; Blades, R

    2015-03-01

    A significant proportion of emergency urological admissions are comprised of ureteric colic presenting as loin pain. A variety of alternative pathologies present in this manner and should be considered during systematic assessment. We report the case of a patient admitted with severe unilateral back and flank pain after strenuous deadlift exercise. Clinical examination and subsequent investigation following a significant delay demonstrated acute paraspinal compartment syndrome (PCS) after an initial misdiagnosis of ureteric colic. The patient was managed conservatively. We review the current literature surrounding the rare diagnosis of PCS and discuss the management options. PMID:25723672

  12. [Therapy of acute and subacute epiphysiolysis of the femur head].

    PubMed

    Kujat, R; Rogge, D; Tscherne, H

    1984-04-01

    Therapy and prognosis of the slipped capital femoral epiphysis are discussed in connection with the results obtained in the authors' own patients. Reduction of a dislocated femoral head is always desirable. If closed reduction fails, it will be necessary to reduce in full view. In smaller children, fixation is effected by means of several Kirschner wires, in older ones via screw osteosynthesis. Bone pegging or osteotomy are not suited for treatment of an acute or subacute slipped capital epiphysis.

  13. An observational retrospective/horizontal study to compare oxygen-ozone therapy and/or global postural re-education in complicated chronic low back pain

    PubMed Central

    Apuzzo, Dario; Giotti, Chiara; Pasqualetti, Patrizio; Ferrazza, Paolo; Soldati, Paola; Zucco, Gesualdo M.

    2014-01-01

    Summary Acute low back pain (LBP) is the fifth most common reason for physician visits and about nine out of ten adults experience back pain at some point in their life. In a large number of patients LBP is associated with disc herniation (DH). Recently, oxygen-ozone (O2O3) therapy has been used successfully in the treatment of LBP, reducing pain after the failure of other conservative treatments. The aim of this study was to assess the effects of O2O3 therapy in back pain rehabilitation, comparing three groups of patients suffering from chronic back pain associated with DH submitted to three different treatments: intramuscular O2O3 infiltrations, global postural re-education (GPR), or a combination of the two (O2O3+GPR). The data show that pain severity before treatment was significantly lower in the patients treated with GPR alone (VAS score 7.4) than in the O2O3+GPR patients (VAS score 8.5) and the O2O3 patients (VAS score 8.6). At the end of treatment, pain severity was lower in the O2O3 patients than in the GPR-alone patients. After some years of follow-up only the difference between O2O3+GPR and GPR-alone remained significant. PMID:25014047

  14. Effects of complex manual therapy on PTSD, pain, function, and balance of male torture survivors with chronic low back pain.

    PubMed

    Kim, Hyun Jin; Yu, Seong Hun

    2015-09-01

    [Purpose] This study aimed to identify the impact of physiotherapy using complex manual therapy as a part of an integrated treatment for sequelae in the musculoskeletal system of torture survivors. [Subjects] This study reviewed 30 male torture survivors presenting with chronic low back pain. They were randomly selected and divided into two groups: an experimental group and a control group. [Methods] For the experimental group, complex manual therapy was performed twice a week for 8 weeks to improve the physical sequelae of patients. Improvement was measured using the PDS-K for Post-traumatic Stress Disorder (PTSD), the Visual Analog Scale (VAS) for pain examination, the Korean Oswestry Disability Index (KODI) for back function assessment, and the Balance System SD as a dynamic balance test. The total period of the intervention for both groups was 8 weeks. [Results] For the experimental group, PDS-K, VAS, KODI, and the dynamic balance test all showed significant improvements after the intervention, which they did not for the control group. In the comparison of the groups, PDS-K, VAS, KODI, and the dynamic balance test all showed significant differences. [Conclusion] Complex manual therapy for torture survivors with chronic low back pain contributes to functional recovery by reducing back pain. The treatment can be considered to have positive effects on sequelae in the musculoskeletal system of torture survivors as they age. PMID:26504288

  15. Effects of complex manual therapy on PTSD, pain, function, and balance of male torture survivors with chronic low back pain

    PubMed Central

    Kim, Hyun Jin; Yu, Seong Hun

    2015-01-01

    [Purpose] This study aimed to identify the impact of physiotherapy using complex manual therapy as a part of an integrated treatment for sequelae in the musculoskeletal system of torture survivors. [Subjects] This study reviewed 30 male torture survivors presenting with chronic low back pain. They were randomly selected and divided into two groups: an experimental group and a control group. [Methods] For the experimental group, complex manual therapy was performed twice a week for 8 weeks to improve the physical sequelae of patients. Improvement was measured using the PDS-K for Post-traumatic Stress Disorder (PTSD), the Visual Analog Scale (VAS) for pain examination, the Korean Oswestry Disability Index (KODI) for back function assessment, and the Balance System SD as a dynamic balance test. The total period of the intervention for both groups was 8 weeks. [Results] For the experimental group, PDS-K, VAS, KODI, and the dynamic balance test all showed significant improvements after the intervention, which they did not for the control group. In the comparison of the groups, PDS-K, VAS, KODI, and the dynamic balance test all showed significant differences. [Conclusion] Complex manual therapy for torture survivors with chronic low back pain contributes to functional recovery by reducing back pain. The treatment can be considered to have positive effects on sequelae in the musculoskeletal system of torture survivors as they age. PMID:26504288

  16. Using Acceptance and Commitment Therapy in the Rehabilitation of an Adolescent Female with Chronic Pain: A Case Example

    ERIC Educational Resources Information Center

    Wicksell, Rikard K.; Dahl, JoAnne; Magnusson, Bo; Olsson, Gunnar L.

    2005-01-01

    This case example illustrates how Acceptance and Commitment Therapy (ACT) within a behavior medicine approach was used in the rehabilitation of an adolescent with debilitating chronic pain. For chronic pain with unclear etiology (idiopathic pain), pharmacological therapy alone is often insufficient. Psychological treatment strategies have been…

  17. Thrombolytic therapy in acute cerebral infarction complicating diagnostic cardiac catheterization.

    PubMed

    Chen, Yu-Wei; Sim, Ming-Ming; Smith, Eric E

    2006-10-01

    Diagnostic and interventional percutaneous coronary catheterization is associated with stroke. Many of such strokes are asymptomatic, but some are devastating. Once the diagnosis of acute cerebral infarction is confirmed, thrombolytic therapy should be administrated within the time window of 3 hours. We report a 61-year-old woman who suffered from an acute cerebral infarction during diagnostic cardiac catheterization for unstable angina, which manifested as sudden onset of global aphasia, right hemiplegia and gaze preponderance to the left side. Computed tomography of the head performed immediately after recognition of the symptoms showed a hyperdense middle cerebral artery (MCA) sign. Following prompt recognition and diagnosis, intravenous thrombolytic therapy was administered 2 hours after symptom onset. The patient had a favorable outcome. Initially, National Institutes of Health Stroke Scale score was 21, and 24 hours later it improved to 9. The hyperdense MCA lesion had resolved on the 24-hour follow-up scan. This case illustrates the clinical benefit of thrombolytic therapy in the setting of acute stroke associated with cardiac catheterization.

  18. Long-term potentiation in spinal nociceptive pathways as a novel target for pain therapy.

    PubMed

    Ruscheweyh, Ruth; Wilder-Smith, Oliver; Drdla, Ruth; Liu, Xian-Guo; Sandkühler, Jürgen

    2011-01-01

    Long-term potentiation (LTP) in nociceptive spinal pathways shares several features with hyperalgesia and has been proposed to be a cellular mechanism of pain amplification in acute and chronic pain states. Spinal LTP is typically induced by noxious input and has therefore been hypothesized to contribute to acute postoperative pain and to forms of chronic pain that develop from an initial painful event, peripheral inflammation or neuropathy. Under this assumption, preventing LTP induction may help to prevent the development of exaggerated postoperative pain and reversing established LTP may help to treat patients who have an LTP component to their chronic pain. Spinal LTP is also induced by abrupt opioid withdrawal, making it a possible mechanism of some forms of opioid-induced hyperalgesia. Here, we give an overview of targets for preventing LTP induction and modifying established LTP as identified in animal studies. We discuss which of the various symptoms of human experimental and clinical pain may be manifestations of spinal LTP, review the pharmacology of these possible human LTP manifestations and compare it to the pharmacology of spinal LTP in rodents.

  19. Development and validation of a screening tool to predict the risk of chronic low back pain in patients presenting with acute low back pain: a study protocol

    PubMed Central

    Traeger, Adrian; Henschke, Nicholas; Hübscher, Markus; Williams, Christopher M; Kamper, Steven J; Maher, Chris G; Moseley, G Lorimer; McAuley, James H

    2015-01-01

    Introduction Around 40% of people presenting to primary care with an episode of acute low back pain develop chronic low back pain. In order to reduce the risk of developing chronic low back pain, effective secondary prevention strategies are needed. Early identification of at-risk patients allows clinicians to make informed decisions based on prognostic profile, and researchers to select appropriate participants for secondary prevention trials. The aim of this study is to develop and validate a prognostic screening tool that identifies patients with acute low back pain in primary care who are at risk of developing chronic low back pain. This paper describes the methods and analysis plan for the development and validation of the tool. Methods/analysis The prognostic screening tool will be developed using methods recommended by the Prognosis Research Strategy (PROGRESS) Group and reported using the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) statement. In the development stage, we will use data from 1248 patients recruited for a prospective cohort study of acute low back pain in primary care. We will construct 3 logistic regression models to predict chronic low back pain according to 3 definitions: any pain, high pain and disability at 3 months. In the validation stage, we will use data from a separate sample of 1643 patients with acute low back pain to assess the performance of each prognostic model. We will produce validation plots showing Nagelkerke R2 and Brier score (overall performance), area under the curve statistic (discrimination) and the calibration slope and intercept (calibration). Ethics and dissemination Ethical approval from the University of Sydney Ethics Committee was obtained for both of the original studies that we plan to analyse using the methods outlined in this protocol (Henschke et al, ref 11-2002/3/3144; Williams et al, ref 11638). PMID:26179647

  20. [Acute and chronic limb ischemia in endurance athletes - a serious diagnosis of exercise-induced lower limb pain].

    PubMed

    Regus, Susanne; Lang, Werner

    2016-07-01

    Lower extremity pain due to acute or chronic ischemia in high performance endurance athletes is an often forgotten differential diagnosis. A variety of symptoms constitues a multi-disciplinary challenge. Intermittent claudication or acute ischemia are clinical symptoms indicative of this vascular disease. The most important basic methods of investigation are anamnesis and clinical examination. Furthermore, the determination of the ankle-brachial index (ABI) and duplexsonography should be considered. In addition, modern cross-sectional imaging techniques such as computed tomography angiography (CTA) or magnetic resonance angiography (MRA) are recommended. In case of suspect findings, the digital substraction angiography (DSA) represents a high resolution image technique for illustration of the vessel lumen. If necessary, interventional therapy (balloon angioplasty or clot lysing) can be performed simultaneously. Surgical revision remains the gold-standard of therapy and the fastest way in which athletes regain maximum performance abilities. Correct diagnosis of lower limb ischemia affecting endurance athletes should be performed without delays. Determining the ankle-brachial index following maximal exertion represents the most important diagnostic tool. Surgical treatment techniques as decompression and revascularisation provide the best long-term results. PMID:27464284

  1. The effect of rest break schedule on acute low back pain development in pain and non-pain developers during seated work.

    PubMed

    Sheahan, Peter J; Diesbourg, Tara L; Fischer, Steven L

    2016-03-01

    A significant portion of the population (25-50%) is known to develop acute low back pain (LBP) within a bout of prolonged sitting. Previous research has supported the use of frequent rest breaks, from seated office work, in order to reduce self-reported LBP, however, there is limited consensus about the recommended frequency and duration of rest breaks. This may be due to the limited consideration of individual differences in acute LBP development. The purpose of this study was to examine the effect of three different standing rest-break conditions on a group of pain developers (PD) and non-pain developers (NPD) engaged in prolonged seated work. Twenty participants completed four one-hour-long bouts of seated typing: Condition A - no rest; Condition B - 5 min of standing rest every 30 min; Condition C - 2.5 min of standing rest every 15 min; Condition D - 50 s of standing rest every 5 min. Self-reported LBP, self-reported mental fatigue and 30-s samples of EMG were collected every 10 min throughout each session. Eight out of 20 participants (40%) reported LBP during Condition A (classified as PD). Only PD demonstrated clinically relevant increases in LBP across conditions where Conditions B, C, or D provided some relief, but did not restore pain scores to their original level, prior to sitting. PD and NPD developed mental fatigue equally, with Conditions B and D helping to reduce fatigue. No differences in productivity were observed between conditions or groups and no main effects were observed for muscle activity, median power frequency or co-contraction. These data suggests that frequent, short, standing rest breaks may help to reduce symptoms of LBP, however they are only a temporary solution as PD still developed clinically important LBP, even with frequent rest breaks.

  2. The effect of rest break schedule on acute low back pain development in pain and non-pain developers during seated work.

    PubMed

    Sheahan, Peter J; Diesbourg, Tara L; Fischer, Steven L

    2016-03-01

    A significant portion of the population (25-50%) is known to develop acute low back pain (LBP) within a bout of prolonged sitting. Previous research has supported the use of frequent rest breaks, from seated office work, in order to reduce self-reported LBP, however, there is limited consensus about the recommended frequency and duration of rest breaks. This may be due to the limited consideration of individual differences in acute LBP development. The purpose of this study was to examine the effect of three different standing rest-break conditions on a group of pain developers (PD) and non-pain developers (NPD) engaged in prolonged seated work. Twenty participants completed four one-hour-long bouts of seated typing: Condition A - no rest; Condition B - 5 min of standing rest every 30 min; Condition C - 2.5 min of standing rest every 15 min; Condition D - 50 s of standing rest every 5 min. Self-reported LBP, self-reported mental fatigue and 30-s samples of EMG were collected every 10 min throughout each session. Eight out of 20 participants (40%) reported LBP during Condition A (classified as PD). Only PD demonstrated clinically relevant increases in LBP across conditions where Conditions B, C, or D provided some relief, but did not restore pain scores to their original level, prior to sitting. PD and NPD developed mental fatigue equally, with Conditions B and D helping to reduce fatigue. No differences in productivity were observed between conditions or groups and no main effects were observed for muscle activity, median power frequency or co-contraction. These data suggests that frequent, short, standing rest breaks may help to reduce symptoms of LBP, however they are only a temporary solution as PD still developed clinically important LBP, even with frequent rest breaks. PMID:26674405

  3. Should the General Practitioner Consider Mesotherapy (Intradermal Therapy) to Manage Localized Pain?

    PubMed

    Mammucari, Massimo; Maggiori, Enrica; Lazzari, Marzia; Natoli, Silvia

    2016-06-01

    Wide variations in the types of pain and response to analgesic pharmacotherapy mean that a variety of treatment strategies are needed. One approach is mesotherapy (intradermal therapy). This consists of microinjections into the skin and is ideally suited to the management of localized pain. Advantages include increasing the duration of drug activity, reduced risk of adverse events and interactions, and possible synergy with other therapies. Mesotherapy provides general practitioners with another tool for the treatment of local pain. However, it is important to provide patients with full details of the pros and cons of this approach and obtain informed patient consent. PMID:27229350

  4. [Phantom limb pain syndrome: therapeutic approach using mirror therapy in a Geriatric Department].

    PubMed

    González García, Paloma; Manzano Hernández, M Pilar; Muñoz Tomás, M Teresa; Martín Hernández, Carlos; Forcano García, Mercedes

    2013-01-01

    The clinical use of mirror visual feedback was initially introduced to alleviate phantom pain by restoring motor function through plastic changes in the human primary motor cortex. It is a promising novel technique that gives a new perspective to neurological rehabilitation. Using this therapy, the mirror neuron system is activated and decrease the activity of those systems that perceive protopathic pain, making somatosensory cortex reorganization possible. This paper reports the results of the mirror therapy in three patients with phantom limb pain after recent lower limb amputation, showing its analgesic effects and its benefits as a comprehensive rehabilitation instrument for lower limb amputee geriatric patients.

  5. Effectiveness of Manual Physical Therapy for Painful Shoulder Conditions: A Systematic Review

    PubMed Central

    Camarinos, James; Marinko, Lee

    2009-01-01

    Multiple disease-specific systematic reviews on the effectiveness of physical therapy intervention for shoulder dysfunction have been inconclusive. To date, there have been two systematic reviews that examined manual therapy specifically but both considered effects within diagnoses. The purpose of this systematic review was to identify the effectiveness of manual therapy to the glenohumeral joint across all painful shoulder conditions. A search of MEDLINE, CINAHL, Web of Science, and Cochrane Central Register of Randomized Controlled Trials for articles dated 1996 to June 2009 was performed. Inclusion for review were manual therapy performed to the glenohumeral joint only; non-surgical painful shoulder disorders; subjects 18-80 years; and outcomes of range of motion, pain, function, and/or quality of life. Quality assessment was performed using the PEDro scale with subsequent data extraction. Seventeen related articles were found with seven fitting the inclusion criteria. The average PEDro score was 7.86, meeting the cutoff score for high quality. Significant heterogeneity in outcome measures prohibited meta-analysis. Five studies demonstrated benefits utilizing manual therapy for mobility, and four demonstrated a trend towards decreasing pain values. Functional outcomes and quality-of-life measures varied greatly among all studies. Manual therapy appears to increase either active or passive mobility of the shoulder. A trend was found favoring manual therapy for decreasing pain, but the effect on function and quality of life remains inconclusive. Future research utilizing consistent outcome measurements is necessary. PMID:20140151

  6. Spinal distribution of c-Fos activated neurons expressing enkephalin in acute and chronic pain models.

    PubMed

    Hossaini, Mehdi; Duraku, Liron S; Kohli, Somesh K; Jongen, Joost L M; Holstege, Jan C

    2014-01-16

    The endogenous opioid enkephalin is known to inhibit spinal nociceptive transmission. Here we investigated activation of spinal enkephalinergic neurons by determining the proportions of c-Fos expressing (activated) spinal neurons that were enkephalinergic after different acute and chronic peripheral nociceptive stimuli. The number of c-Fos-activated neurons in the dorsal horn was increased after hind paw injection of capsaicin, formalin or complete Freund's adjuvant (CFA, 1.5 hrs - 4 days). The numbers of these neurons that were enkephalinergic increased after paraformaldehyde, and at 20 hrs, but not 1.5 hrs or 4 days post-CFA as compared to saline. In the spared nerve injury (SNI) model of neuropathic pain, c-Fos expression was increased acutely (2 hrs) and chronically (2 weeks), and a greater number of these were enkephalinergic in the nerve-injured animals acutely compared to controls (sham-SNI). Combining all acute (=2 hrs) versus chronic (≥20 hrs) treatment groups, there was a significant decrease in the percentage of activated neurons that were enkephalinergic in superficial layers, but a significant increase in the deeper layers of the dorsal horn in the chronic treatment group. It is concluded that the overall percentage of c-Fos activated neurons that contained enkephalin was not significantly different between acute and chronic pain phases. However, the shift in localization of these neurons within the spinal dorsal horn indicates a noxious stimulus directed activation pattern.

  7. Acute right lower abdominal pain in women of reproductive age: Clinical clues

    PubMed Central

    Hatipoglu, Sinan; Hatipoglu, Filiz; Abdullayev, Ruslan

    2014-01-01

    AIM: To study possible gynecological organ pathologies in the differential diagnosis of acute right lower abdominal pain in patients of reproductive age. METHODS: Following Clinical Trials Ethical Committee approval, the retrospective data consisting of physical examination and laboratory findings in 290 patients with sudden onset right lower abdominal pain who used the emergency surgery service between April 2009 and September 2013, and underwent surgery and general anesthesia with a diagnosis of acute appendicitis were collated. RESULTS: Total data on 290 patients were obtained. Two hundred and twenty-four (77.2%) patients had acute appendicitis, whereas 29 (10%) had perforated appendicitis and 37 (12.8%) had gynecological organ pathologies. Of the latter, 21 (7.2%) had ovarian cyst rupture, 12 (4.2%) had corpus hemorrhagicum cyst rupture and 4 (1.4%) had adnexal torsion. Defense, Rovsing’s sign, increased body temperature and increased leukocyte count were found to be statistically significant in the differential diagnosis of acute appendicitis and gynecological organ pathologies. CONCLUSION: Gynecological pathologies in women of reproductive age are misleading in the diagnosis of acute appendicitis. PMID:24744594

  8. Therapy Related Acute Myeloid Leukemia with t(8;16) Mimicking Acute Promyelocytic Leukemia.

    PubMed

    Chharchhodawala, Taher; Gajendra, Smeeta; Tiwari, Priya; Gogia, Ajay; Gupta, Ritu

    2016-06-01

    Acute myeloid leukemia (AML) with t(8;16)(p11;q13) is a distinct clinical and morphological entity with poor prognosis, which is characterized by a high frequency of extramedullary involvement, most commonly leukemia cutis; association with therapy related AML; frequent coagulopathy and morphologic features overlapping acute promyelocytic leukemia(APL). Herein, we present a case of 47 year-old post-menopausal woman developing secondary AML with t(8;16)(p11;q13) after 1 year of completion of therapy for breast carcinoma. Blasts were granulated with few showing clefted nucleus resembling promyelocytes and immnuophenotyping showed high side scatter with MPO positivity and CD 34 and HLA-DR negativity. In view of promyelocyte like morphology and immunophenotyping of blasts, possibility of APL was considered but, reverse transcription polymerase chain reaction (RT-PCR) for PML-RARα fusion transcript came out to be negative. Conventional cytogenetics showed t(8;16)(p11;q13). So, we should keep possibility of t(8;16) (p11;q13) in therapy related acute myeloid leukemia in patient showing clinical and morphological features of acute promyelocytic leukemia. PMID:27408347

  9. Pleuritic Chest Pain in a Young Female: A Reminder for Acute Health Care Providers

    PubMed Central

    Ali, Alaa M.; Stroncek, Carolyn

    2014-01-01

    Chest pain is one of the most common reasons for emergency department visits. Emergency medicine doctors should focus their initial assessment on patients' stability. History, physical examination, and ancillary testing should exclude serious causes such as acute coronary syndrome, acute aortic syndromes, pulmonary embolism, pneumothorax, esophageal perforation, and rupture as well as pericardial tamponade. Young age should not be used alone as a predictor of a benign condition. Below we present a case of a 24-year-old female who was found to have ascending aortic dissection and was sent for emergent surgery. PMID:25247097

  10. Reduction of Pain Sensitivity After Somatosensory Therapy in Adults with Cerebral Palsy

    PubMed Central

    Riquelme, Inmaculada; Zamorano, Anna; Montoya, Pedro

    2013-01-01

    Objective: Pain and deficits in somatosensory processing seem to play a relevant role in cerebral palsy (CP). Rehabilitation techniques based on neuroplasticity mechanisms may induce powerful changes in the organization of the primary somatosensory cortex and have been proved to reduce levels of pain and discomfort in neurological pathologies. However, little is known about the efficacy of such interventions for pain sensitivity in CP individuals. Methods: Adults with CP participated in the study and were randomly assigned to the intervention (n = 17) or the control group (n = 20). The intervention group received a somatosensory therapy including four types of exercises (touch, proprioception, vibration, and stereognosis). All participants were asked to continue their standardized motor therapy during the study period. Several somatosensory (pain and touch thresholds, stereognosis, proprioception, texture recognition) and motor parameters (fine motor skills) were assessed before, immediately after and 3 months after the therapy (follow-up). Results: Participants of the intervention group showed a significant reduction on pain sensitivity after treatment and at follow-up after 3 months, whereas participants in the control group displayed increasing pain sensitivity over time. No improvements were found on touch sensitivity, proprioception, texture recognition, or fine motor skills. Conclusion: Data suggest the possibility that somatosensory therapy was effective in eliciting changes in central somatosensory processing. This hypothesis may have implications for future neuromodulatory treatment of pain complaints in children and adults with CP. PMID:23805086

  11. Clinical course and prognostic factors in acute low back pain: an inception cohort study in primary care practice.

    PubMed Central

    Coste, J.; Delecoeuillerie, G.; Cohen de Lara, A.; Le Parc, J. M.; Paolaggi, J. B.

    1994-01-01

    OBJECTIVE--To describe the natural course of recent acute low back pain in terms of both morbidity (pain, disability) and absenteeism from work and to evaluate the prognostic factors for these outcomes. DESIGN--Inception cohort study. SETTING--Primary care. PATIENTS--103 patients with acute localised non-specific back pain lasting less than 72 hours. MAIN OUTCOME MEASURES--Complete recovery (disappearance of both pain and disability) and return to work. RESULTS--90% of patients recovered within two weeks and only two developed chronic low back pain. Only 49 of 100 patients for whom data were available had bed rest and 40% of 75 employed patients lost no time from work. Proportional hazards regression analysis showed that previous chronic episodes of low back pain, initial disability level, initial pain worse when standing, initial pain worse when lying, and compensation status were significantly associated with delayed episode recovery. These factors were also related to absenteeism from work. Absenteeism from work was also influenced by job satisfaction and gender. CONCLUSIONS--The recovery rate from acute low back pain was much higher than reported in other studies. Those studies, however, did not investigate groups of patients enrolled shortly after the onset of symptoms and often mixed acute low back pain patients with patients with exacerbations of chronic pain or sciatica. Several sociodemographic and clinical factors were of prognostic value in acute low back pain. Factors which influenced the outcome in terms of episode recovery (mainly physical severity factors) were only partly predictive of absenteeism from work. Time off work and return to work depended more on sociodemographic and job related influences. PMID:8148683

  12. Integrative Care Therapies and Physiological and Pain-related Outcomes in Hospitalized Infants

    PubMed Central

    Hathaway, Elizabeth E.; Luberto, Christina M.; Bogenschutz, Lois H.; Geiss, Sue; Wasson, Rachel S.

    2015-01-01

    Background: Pain management is a frequent problem in the neonatal intensive care unit (NICU). Few studies examining effects of integrative care therapies on pain-related outcomes in neonates have included physiological outcomes or investigated the use of such therapies in a practice-based setting. Objective: The purpose of this practice-based retrospective study was to examine the associations between integrative care therapies, particularly massage and healing touch, and pain-related outcomes among hospitalized infants. Methods: We conducted a retrospective review of a clinical database from a level III NICU regularly delivering integrative care therapies. Paired-samples t-tests were used to examine associations between integrative care therapies and 4 pre-post outcome measures: therapist-rated pain and presentation (ranging from asleep to agitated) and neonates' heart rate and oxygen saturation. Results: Of 186 patients (Mage=68 days), 58% were male and 67% were Caucasian. Sixty-two percent received both massage and healing touch; the remainder received a single therapy. From pre-post therapy, statistically significant changes were observed in infants' heart rate (Mpre=156 vs Mpost=140 per minute; P<.001), oxygen saturation (Mpre=95.0% vs.Mpost=97.4%; P<.001), and therapist-reported pain (Mpre=2.8 vs Mpost=0.2; P<.001) and presentation (Mpre=3.2 vs. Mpost=1.0; P<.001). Conclusion: Observed improvements in pain-related outcomes suggest that massage and healing touch may be useful integrative therapies to consider as pain management options in the NICU. PMID:26331102

  13. An innovative approach to targeting pain in older people in the acute care setting.

    PubMed

    Phelan, Caroline

    2010-06-01

    This paper reports the findings of an exploratory pilot study which used mixed methods to determine (a) the feasibility of the study design for a larger multi site project and (b) whether a pain education promotion approach, termed 'Targeting Pain', using a multidisciplinary educational campaign and promotional media such as staff badges and ward signage, improves the detection and management of pain in older people in an acute care setting. Pre and post evaluation surveys and interviews were used to evaluate the approach. Findings showed an increase in pain assessment and documentation of pain by nursing staff, as well as an increase in the prescription of oral analgesics. However, the study indicated that the uptake regarding pain management from the education campaign was different between professional groups. Although there was a positive response by patients and staff to the use of staff badges, the ward signage failed to attract attention. The mixed methods approach used highlighted several areas that need to be improved for the next phase of the study.

  14. Premedication With Oral Pregabalin for the Prevention of Acute Postsurgical Pain in Coronary Artery Bypass Surgery

    PubMed Central

    Ziyaeifard, Mohsen; Mehrabanian, Mohammad Javad; Faritus, Seyedeh Zahra; Khazaei Koohpar, Mehrdad; Ferasatkish, Rasool; Hosseinnejad, Heidar; Mehrabanian, Mohammadreza

    2015-01-01

    Background: For coronary artery bypass grafting (CABG) sternotomy should be performed. The pain after surgery is severe and requires medical intervention. Use of the analgesics is limited by their side effects and studies suggest that prevention with some medications before surgery is effective in controlling the postoperative pain. Objectives: We investigated the efficacy of pregabalin administration before surgery in the treatment of acute postoperative pain after CABG surgery. Patients and Methods: Sixty patients indicated for elective CABG surgery were randomly allocated to two groups. One group received placebo and the other received 150 mg of oral pregabalin before surgery. Heart rates, blood pressure, respiratory rate, intensive care unit (ICU) stay duration, morphine consumption, and pain score according to the visual analog scale (VAS) were measured and recorded at 4, 12, and 24 hours of surgery. Results: Pregabalin consumption did not alter hemodynamic parameters and was safe in patients after CABG. Its consumption was associated with significant reduction in the pain score (P values were 0.035, 0.026, and 0.047 respectively at 4, 12, and 24 hours of surgery). Its use was not associated with changes in the morphine consumption at 4, 12, and 24 hours of surgery (P > 0.05). Conclusions: Premedication with studied dose of pregabalin is effective for the prevention of postoperative pain in patients after CABG and has no adverse effects. Trials with other treating schedule and doses of the drug should be performed to determine the best treatment plan. PMID:25830118

  15. National Heart Attack Alert Program position paper: chest pain centers and programs for the evaluation of acute cardiac ischemia.

    PubMed

    Zalenski, R J; Selker, H P; Cannon, C P; Farin, H M; Gibler, W B; Goldberg, R J; Lambrew, C T; Ornato, J P; Rydman, R J; Steele, P

    2000-05-01

    The National Heart Attack Alert Program (NHAAP), which is coordinated by the National Heart, Lung, and Blood Institute (NHLBI), promotes the early detection and optimal treatment of patients with acute myocardial infarction and other acute coronary ischemic syndromes. The NHAAP, having observed the development and growth of chest pain centers in emergency departments with special interest, created a task force to evaluate such centers and make recommendations pertaining to the management of patients with acute cardiac ischemia. This position paper offers recommendations to assist emergency physicians in EDs, including those with chest pain centers, in providing comprehensive care for patients with acute cardiac ischemia. PMID:10783408

  16. Root Canal Therapy Reduces Multiple Dimensions of Pain: A National Dental PBRN Study

    PubMed Central

    Law, Alan S.; Nixdorf, Donald R.; Rabinowitz, Ira; Reams, Gregory J.; Smith, James A.; Torres, Anibal V.; Harris, D. Robert

    2014-01-01

    Background Initial orthograde root canal therapy (RCT) is used to treat dentoalveolar pathosis. The affect RCT has on pain intensity has been frequently reported, but the affect on other dimensions of pain has not. Also, the lack of large prospective studies involving diverse groups of patients and practitioners that are not involved in data collection suggest that there are multiple opportunities for bias to be introduced when this data is systematically aggregated. Method This prospective observational study assessed pain intensity, duration, and its interference with daily activities among RCT patients. Sixty-two practitioners (46 general dentists, 16 endodontists) in the National Dental Practice-Based Research Network enrolled patients requiring RCT. Patient reported data were collected before, immediately following, and one week after treatment using the Graded Chronic Pain Scale. Results Enrollment of 708 patients was completed over 6 months with 655 patients (93%) providing one-week follow-up data. Prior to treatment, patients reported a mean (±standard deviation) worst pain intensity of 5.3±3.8 (0-10 scale), 50% had “severe” pain (≥7), and mean days in pain and days pain interfered with activities were 3.6±2.7 and 0.5±1.2, respectively. Following treatment, patients reported a mean worst pain intensity of 3.0±3.2, 19% had “severe” pain, and mean days in pain and days with pain interference were 2.1±2.4 and 0.4±1.1, respectively. All changes were statistically significant (p<0.0001). Conclusions RCT is an effective treatment for patients experiencing pain, significantly reducing pain intensity, duration, and related interference. Further research is needed to reduce the proportion of patients reporting “severe” post-operative pain. PMID:25190605

  17. Pilot Study of Exercise Therapy on Painful Diabetic Peripheral Neuropathy

    PubMed Central

    Yoo, Min; D’Silva, Linda; Martin, Katherine; Sharma, Neena; Pasnoor, Mamatha; LeMaster, Joseph

    2015-01-01

    Objective Painful diabetic peripheral neuropathy (DPN) is a common complication of diabetes. While the beneficial effect of exercise on diabetes is well established, its effect specifically on painful DPN has not been thoroughly explored. The objective of this pilot study was to examine the effect of aerobic exercise on pain in people with DPN. Methods Fourteen sedentary individuals (mean age 57±5.11 years) with painful DPN were enrolled in a 16-week, supervised aerobic exercise program. The Brief Pain Inventory-Diabetic Peripheral Neuropathy (BPI-DPN) was used to assess pain intensity (worst, least, average, now) and pain interference with daily life (activity, mood, walk, normal work, relationship, sleep, enjoyment of life) pre- and post -intervention. Body mass index (BMI), maximum oxygen uptake (VO2max), hemoglobin A1c (HbA1c), and blood pressure were also measured pre-and post-intervention as secondary outcomes of interest. Results Significant reductions in pain interference were observed with walking (4.93±3.03 pre to 3.29±2.89 post, p=0.016), normal work (5.39±3.32 pre to 3.79±3.04 post, p=0.032), relationship with others (3.96±3.53 pre to 1.29±1.27 post, p=0.006), sleep (5.11±3.04 pre to 3.5±3.03 post, p=0.02), and the overall pain interference (4.65±2.70 pre to 2.97±2.22 post, p=0.013) following the intervention; however, there was no change in pain intensity. VO2max increased significantly post-intervention (16.02±3.84ml/kg/min pre to 17.18±4.19ml/kg/min, p=0.028), while BMI, HbA1c, and blood pressure remained unchanged. Conclusion These preliminary results suggest that perceived pain interference may be reduced following an aerobic exercise intervention among people with painful DPN, without a change in pain intensity. Further validation by a RCT is needed. PMID:25800666

  18. Does adherence to treatment mediate the relationship between patients' treatment outcome expectancies and the outcomes of pain intensity and recovery from acute low back pain?

    PubMed

    Haanstra, Tsjitske M; Kamper, Steven J; Williams, Christopher M; Spriensma, Alette S; Lin, Chung-Wei Christine; Maher, Christopher G; de Vet, Henrica C W; Ostelo, Raymond W J G

    2015-08-01

    It is believed that patients' expectancies about the effectiveness of treatment influence their treatment outcomes, but the working mechanism is rarely studied in patients with low back pain. Theoretical models suggest that adherence to treatment may be an important pathway. The aim of this study was to assess the mediating role of adherence to treatment in the relationship between expectancies and the outcomes of recovery and pain intensity in patients with acute low back pain. This study used data from a randomized placebo-controlled trial of paracetamol for acute low back pain. Expectancies were measured with the Credibility Expectancy Questionnaire. Adherence was measured with a medication diary. Pain intensity was recorded daily in a diary on a 0 to 10 pain scale, and recovery was defined as the first of 7 consecutive days scoring 0 or 1 on a 6-point pain scale. Cox regression (dependent variable: recovery) and linear mixed-model analyses (dependent variable: daily pain intensity scores) were performed. The "difference in coefficients" approach was used to establish mediation. A total of 1573 participants were included in current analyses. There was a small but highly significant relationship between expectancies and outcomes; 3.3% of the relationship between expectancies and recovery and 14.2% of the relationship between expectancies and pain intensity were mediated by adherence to treatment. This study does not convincingly support the theory that adherence is a key pathway in the relationship between treatment outcome expectancies and recovery and pain intensity in this acute low back pain population. PMID:25906348

  19. The impact of unintentional pediatric trauma: a review of pain, acute stress, and posttraumatic stress.

    PubMed

    Gold, Jeffrey I; Kant, Alexis J; Kim, Seok Hyeon

    2008-04-01

    This article reviews current research on acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) resulting from pediatric simple (i.e., single, unpredictable, and unintentional) physical injury and how pain may act as both a trigger and a coexisting symptom. Although several studies have explored predictors of ASD and PTSD, as well as the relationship between these conditions in adults, there is less research on ASD and PTSD in children and adolescents. This review highlights the importance of early detection of pain and acute stress symptoms resulting from pediatric unintentional physical injury in the hopes of preventing long-term negative outcomes, such as the potential development of PTSD and associated academic, social, and psychological problems.

  20. [Acute and chronic progressive abdominal pain: what is the role of radiogical imaging?].

    PubMed

    Antes, G

    2005-06-01

    There are many causes for acute or chronic progressive abdominal pain. Although only about one percent of these patients suffer from acute mesenteric ischemia (MI), an efficient diagnostic work-up is mandatory to reduce the high mortality. An overview about the possibilities of conventional and modern imaging modalities is given. Plain films and ultrasonography are still important in the basic work-up, however, its sensitivity is limited. Angiography has a high sensitivity and specitivity. However, angiography is not always available. Modern spiral-CT is widely available and its sensitivity is already similar to angiography. An other advantage of CT is the possibility to detect the most other frequent causes of abdominal pain. Therefore CT should be performed as fast as possible.

  1. Acute chest pain after bench press exercise in a healthy young adult

    PubMed Central

    Smereck, Janet A; Papafilippaki, Argyro; Sudarshan, Sawali

    2016-01-01

    Bench press exercise, which involves repetitive lifting of weights to full arm extension while lying supine on a narrow bench, has been associated with complications ranging in acuity from simple pectoral muscle strain, to aortic and coronary artery dissection. A 39-year-old man, physically fit and previously asymptomatic, presented with acute chest pain following bench press exercise. Diagnostic evaluation led to the discovery of critical multivessel coronary occlusive disease, and subsequently, highly elevated levels of lipoprotein (a). Judicious use of ancillary testing may identify the presence of “high-risk” conditions in a seemingly “low-risk” patient. Emergency department evaluation of the young adult with acute chest pain must take into consideration an extended spectrum of potential etiologies, so as to best guide appropriate management. PMID:27703399

  2. Radiofrequency Ablation Therapy Combined with Cementoplasty for Painful Bone Metastases: Initial Experience

    SciTech Connect

    Toyota, Naoyuki Naito, Akira; Kakizawa, Hideaki; Hieda, Masashi; Hirai, Nobuhiko; Tachikake, Toshihiro; Kimura, Tomoki; Fukuda, Hideki; Ito, Katsuhide

    2005-06-15

    The purpose of this study was to assess the efficacy and safety of percutaneous radiofrequency (RF) ablation therapy combined with cementoplasty under computed tomography and fluoroscopic guidance for painful bone metastases. Seventeen adult patients with 23 painful bone metastases underwent RF ablation therapy combined with cementoplasty during a 2-year period. The mean tumor size was 52 x 40 x 59 mm. Initial pain relief, reduction of analgesics, duration of pain relief, recurrence rate of pain, survival rate, and complications were analyzed. The technical success rate was 100%. Initial pain relief was achieved in 100% of patients (n = 17). The mean VAS scores dropped from 63 to 24 (p < 0.001) (n = 8). Analgesic reduction was achieved in 41% (7 out of 17 patients). The mean duration of pain relief was 7.3 months (median: 6 months). Pain recurred in three patients (17.6%) from 2 weeks to 3 months. Eight patients died and 8 patients are still alive (a patient was lost to follow-up). The one-year survival rate was 40% (observation period: 1-30 months). No major complications occurred, but one patient treated with this combined therapy broke his right femur 2 days later. There was transient local pain in most cases, and a hematoma in the psoas muscle (n = 1) and a hematoma at the puncture site (n = 1) occurred as minor complications. Percutaneous RF ablation therapy combined with cementoplasty for painful bone metastases is effective and safe, in particular, for bulky tumors extending to extraosseous regions. A comparison with cementoplasty or RF ablation alone and their long-term efficacies is needed.

  3. Breast cancer pain management - A review of current & novel therapies

    PubMed Central

    Satija, Aanchal; Ahmed, Syed Mehmood; Gupta, Rahul; Ahmed, Arif; Rana, Shiv Pratap Singh; Singh, Suraj Pal; Mishra, Seema; Bhatnagar, Sushma

    2014-01-01

    Breast cancer is one of the most prevalent cancers amongst women in the world. Unfortunately, even after adequate treatment, some patients experience severe pain either due to disease progression or due to treatment related side effects. The persistent pain causes a negative physical and psychosocial impact on patients’ lives. Current rational pain management is patient-centred and requires a thorough psychological assessment. Usually adequate analgesia is achieved by adopting the WHO's three step analgesic ladder. As the disease progresses, the pain experienced by the patient also increases. This necessitates the administration of opioids and adjuvant analgesics to the breast cancer patients experiencing severe pain. However, opioid use is associated with intolerable side effects like constipation, nausea, vomiting, fear of dependence, and tolerance. Concomitant medications are required to combat these unacceptable side effects. Adjuvant analgesics need to be added to provide adequate and satisfactory analgesia. These factors worsen the psychological state of patients and deteriorate their quality of life. Hence, there is a need to develop therapeutic modalities to provide adequate analgesia with minimum side effects. This review article focuses on the current treatments available for cancer pain management, their limitations, and novel targets and non-pharmacological measures under investigation which have the potential to produce a radical change in pain management measures for the breast cancer patients. PMID:24718395

  4. Exploring patient satisfaction: a secondary analysis of a randomized clinical trial of spinal manipulation, home exercise, and medication for acute and subacute neck pain

    PubMed Central

    Leininger, Brent D; Evans, Roni; Bronfort, Gert

    2014-01-01

    Objective The purpose of this study was to assess satisfaction with specific aspects of care for acute neck pain and explore the relationship between satisfaction with care, neck pain and global satisfaction. Methods This study was a secondary analysis of patient satisfaction from a randomized trial of spinal manipulation therapy (SMT) delivered by doctors of chiropractic, home exercise and advice (HEA) delivered by exercise therapists, and medication (MED) prescribed by a medical physician for acute/subacute neck pain. Differences in satisfaction with specific aspects of care were analyzed using a linear mixed model. The relationship between specific aspects of care and 1) change in neck pain (primary outcome of the randomized trial) and 2) global satisfaction were assessed using Pearson’s correlation and multiple linear regression. Results Individuals receiving SMT or HEA were more satisfied with the information and general care received than MED group participants. SMT and HEA groups reported similar satisfaction with information provided during treatment; however, the SMT group was more satisfied with general care. Satisfaction with general care (r=−0.75 to −0.77, R2= 0.55 to 0.56) had a stronger relationship with global satisfaction compared to satisfaction with information provided (r=−0.65 to 0.67, R2=0.39 to 0.46). The relationship between satisfaction with care and neck pain was weak (r=0.17 to 0.38, R2=0.08 to 0.21). Conclusions Individuals with acute/subacute neck pain were more satisfied with specific aspects of care from SMT delivered by doctors of chiropractic or HEA interventions compared to MED prescribed by a medical physician. PMID:25199824

  5. The efficacy of music therapy protocols for decreasing pain, anxiety, and muscle tension levels during burn dressing changes: a prospective randomized crossover trial.

    PubMed

    Tan, Xueli; Yowler, Charles J; Super, Dennis M; Fratianne, Richard B

    2010-01-01

    The purpose of this study was to explore the efficacy of two music therapy protocols on pain, anxiety, and muscle tension levels during dressing changes in burn patients. Twenty-nine inpatients participated in this prospective, crossover randomized controlled trial. On two consecutive days, patients were randomized to receive music therapy services either on the first or second day of the study. On control days, they received no music. On music days, patients practiced music-based imagery (MBI), a form of music-assisted relaxation with patient-specific mental imagery before and after dressing changes. Also, on music days during dressing changes, the patients engaged in music alternate engagement (MAE), which consisted of active participation in music making. The dependent variables were the patients' subjective ratings of their pain and anxiety levels and the research nurse's objective ratings of their muscle tension levels. Two sets of data were collected before, three sets during, and another two sets after dressing changes. The results showed significant decrease in pain levels before (P < .025), during (P < .05), and after (P < .025) dressing changes on days the patients received music therapy in contrast to control days. Music therapy was also associated with a decrease in anxiety and muscle tension levels during the dressing changes (P < .05) followed by a reduction in muscle tension levels after dressing changes (P < .025). Music therapy significantly decreases the acute procedural pain, anxiety, and muscle tension levels associated with daily burn care.

  6. Implementation of RCGP guidelines for acute low back pain: a cluster randomised controlled trial.

    PubMed Central

    Dey, Paola; Simpson, Carl W R; Collins, Stuart I; Hodgson, G; Dowrick, Christopher F; Simison, A J M; Rose, M J

    2004-01-01

    BACKGROUND: The Royal College of General Practitioners (RCGP) has produced guidelines for the management of acute low back pain in primary care. AIM: To investigate the impact on patient management of an educational strategy to promote these guidelines among general practitioners (GPs). DESIGN OF STUDY: Group randomised controlled trial, using the health centre as the unit of randomisation. SETTING: Primary care teams in north-west England. METHOD: Twenty-four health centres were randomly allocated to an intervention or control arm. Practices in the intervention arm were offered outreach visits to promote national guidelines on acute low back pain, as well as access to fast-track physiotherapy and to a triage service for patients with persistent symptoms. RESULTS: Twenty-four centres were randomised. Two thousand, one hundred and eighty-seven eligible patients presented with acute low back pain during the study period: 1049 in the intervention group and 1138 in the control group. There were no significant differences between study groups in the proportion of patients who were referred for X-ray, issued with a sickness certificate, prescribed opioids or muscle relaxants, or who were referred to secondary care, but significantly more patients in the intervention group were referred to physiotherapy or the back pain unit (difference in proportion = 12.2%, 95% confidence interval [CI] = 2.8% to 21.6%). CONCLUSION: The management of patients presenting with low back pain to primary care was mostly unchanged by an outreach educational strategy to promote greater adherence to RCGP guidelines among GPs. An increase in referral to physiotherapy or educational programmes followed the provision of a triage service. PMID:14965404

  7. Acute Hepatitis after Ingestion of a Preparation of Chinese Skullcap and Black Catechu for Joint Pain.

    PubMed

    Papafragkakis, Charilaos; Ona, Mel A; Reddy, Madhavi; Anand, Sury

    2016-01-01

    Many herbal preparations are routinely used and have been occasionally associated with a wide range of side effects, from mild to severe. Chinese skullcap and black catechu are herbal medications commonly used for their hepatoprotective and other properties. We report a case of acute toxic hepatitis associated with ingestion of Chinese skullcap and black catechu in one preparation for the alleviation of joint pain. PMID:27144042

  8. Preservation of Acute pain and Efferent Functions Following Intrathecal Resiniferatoxin-Induced Analgesia in rats

    PubMed Central

    Bishnoi, Mahendra; Bosgraaf, Christine A.; Premkumar, Louis S.

    2013-01-01

    Resiniferatoxin (RTX) is a potent agonist of TRPV1, which possesses unique properties that can be utilized to treat certain modalities of pain. In the present study, systemic intraperitoneal (i.p.) administration of RTX resulted in a significant decrease in acute thermal pain sensitivity, whereas localized intrathecal (i.t.) administration had no effect on acute thermal pain sensitivity. Both i.p. and i.t. administration of RTX prevented TRPV1-induced nocifensive behavior and inflammatory thermal hypersensitivity. There were no alterations in mechanical sensitivity either by i.p. of i.t. administration of RTX. In spinal dorsal horn (L4-L6), TRPV1 and substance P immunoreactivity were abolished following i.p. and i.t. administration of RTX. In dorsal root ganglia (DRG), TRPV1 immunoreactivity was diminished following i.p. administration, but was unaffected following i.t. administration of RTX. Following i.p. administration, basal and evoked CGRP release was reduced both in the spinal cord and peripheral tissues. However, following i.t. administration, basal and evoked CGRP release was reduced in spinal cord (L4-L6), but was unaffected in peripheral tissues. Both i.p. and i.t. RTX administration lowered the body temperature acutely, but this effect reversed with time. Targeting TRPV1 expressing nerve terminals at the spinal cord can selectively abolish inflammatory thermal hypersensitivity without affecting acute thermal sensitivity and can preserve the efferent functions of DRG neurons at the peripheral nerve terminals. I.t. administration of RTX can be considered as a strategy for treating certain chronic and debilitating pain conditions. PMID:21680254

  9. Acute Hepatitis after Ingestion of a Preparation of Chinese Skullcap and Black Catechu for Joint Pain

    PubMed Central

    Papafragkakis, Charilaos; Ona, Mel A.; Reddy, Madhavi; Anand, Sury

    2016-01-01

    Many herbal preparations are routinely used and have been occasionally associated with a wide range of side effects, from mild to severe. Chinese skullcap and black catechu are herbal medications commonly used for their hepatoprotective and other properties. We report a case of acute toxic hepatitis associated with ingestion of Chinese skullcap and black catechu in one preparation for the alleviation of joint pain. PMID:27144042

  10. The effectiveness of complementary manual therapies for pregnancy-related back and pelvic pain

    PubMed Central

    Hall, Helen; Cramer, Holger; Sundberg, Tobias; Ward, Lesley; Adams, Jon; Moore, Craig; Sibbritt, David; Lauche, Romy

    2016-01-01

    Abstract Background: Low back pain and pelvic girth pain are common in pregnancy and women commonly utilize complementary manual therapies such as massage, spinal manipulation, chiropractic, and osteopathy to manage their symptoms. Objective: The aim of this systematically review was to critically appraise and synthesize the best available evidence regarding the effectiveness of manual therapies for managing pregnancy-related low back and pelvic pain. Methods: Seven databases were searched from their inception until April 2015 for randomized controlled trials. Studies investigating the effectiveness of massage and chiropractic and osteopathic therapies were included. The study population was pregnant women of any age and at any time during the antenatal period. Study selection, data extraction, and assessment of risk of bias were conducted by 2 reviewers independently, using the Cochrane tool. Separate meta-analyses were conducted to compare manual therapies to different control interventions. Results: Out of 348 nonduplicate records, 11 articles reporting on 10 studies on a total of 1198 pregnant women were included in this meta-analysis. The therapeutic interventions predominantly involved massage and osteopathic manipulative therapy. Meta-analyses found positive effects for manual therapy on pain intensity when compared to usual care and relaxation but not when compared to sham interventions. Acceptability did not differ between manual therapy and usual care or sham interventions. Conclusions: There is currently limited evidence to support the use of complementary manual therapies as an option for managing low back and pelvic pain during pregnancy. Considering the lack of effect compared to sham interventions, further high-quality research is needed to determine causal effects, the influence of the therapist on the perceived effectiveness of treatments, and adequate dose–response of complementary manual therapies on low back and pelvic pain outcomes during

  11. Using the Horse Grimace Scale (HGS) to Assess Pain Associated with Acute Laminitis in Horses (Equus caballus)

    PubMed Central

    Dalla Costa, Emanuela; Stucke, Diana; Dai, Francesca; Minero, Michela; Leach, Matthew C.; Lebelt, Dirk

    2016-01-01

    Simple Summary Acute laminitis is a common equine disease characterized by intense foot pain. This work aimed to investigate whether the Horse Grimace Scale (HGS), a facial-expression-based pain coding system, can be usefully applied to assess pain associated with acute laminitis in horses at rest. Ten horses, referred as acute laminitis cases with no prior treatment, were assessed at the admission and at seven days after the initial evaluation and treatment. The authors found that the Horse Grimace Scale is a potentially effective method to assess pain associated with acute laminitis in horses at rest, as horses showing high HGS scores also exhibited higher Obel scores, and veterinarians classified them in a more severe painful state. Abstract Acute laminitis is a common equine disease characterized by intense foot pain, both acutely and chronically. The Obel grading system is the most widely accepted method for describing the severity of laminitis by equine practitioners, however this method requires movement (walk and trot) of the horse, causing further intense pain. The recently developed Horse Grimace Scale (HGS), a facial-expression-based pain coding system, may offer a more effective means of assessing the pain associated with acute laminitis. The aims of this study were: to investigate whether HGS can be usefully applied to assess pain associated with acute laminitis in horses at rest, and to examine if scoring HGS using videos produced similar results as those obtained from still images. Ten horses, referred as acute laminitis cases with no prior treatment, were included in the study. Each horse was assessed using the Obel and HGS (from images and videos) scales: at the admission (before any treatment) and at seven days after the initial evaluation and treatment. The results of this study suggest that HGS is a potentially effective method to assess pain associated with acute laminitis in horses at rest, as horses showing high HGS scores also exhibited

  12. [Acute painful crisis in a female Nigerian patient with sickle cell disease].

    PubMed

    Nin, Sayaka; Seki, Masanori; Maie, Koichiro; Kuroda, Akihiro; Miyamoto, Kana; Ogawa, Shinichi; Ito, Yufu; Kurita, Naoki; Yokoyama, Yasuhisa; Sakata Yanagimoto, Mamiko; Obara, Naoshi; Hasegawa, Yuichi; Ogino, Yasuko; Ito, Takayoshi; Chiba, Shigeru

    2015-01-01

    We report a 38-year-old Nigerian woman with sickle cell disease. Sickle cell disease had been diagnosed when she experienced her first sickle cell crisis episode at age 8 years. Thereafter, she had infrequent minor episodes. She visited a hospital presenting with fever, anemia, jaundice, and systemic pain, and was then transferred to our hospital. Together with rehydration and red blood cell transfusion, analgesics and antibiotics were prescribed, and produced gradual improvement of all symptoms and signs. The patient was discharged on day 9 of hospitalization. Sickle cell crisis is an acute painful episode caused by occlusion of arterioles. The degree of pain and accompanying symptoms, as well as the frequencies of crises, are variable. Moreover, one third of individuals with sickle cell disease never experience a crisis. As our society becomes increasingly globalized, the probabilities of encountering sickle cell disease patients will be higher. PMID:25745965

  13. Microglia and monocytes synergistically promote the transition from acute to chronic pain after nerve injury

    PubMed Central

    Peng, Jiyun; Gu, Nan; Zhou, Lijun; B Eyo, Ukpong; Murugan, Madhuvika; Gan, Wen-Biao; Wu, Long-Jun

    2016-01-01

    Microglia and peripheral monocytes contribute to hypersensitivity in rodent models of neuropathic pain. However, the precise respective function of microglia and peripheral monocytes has not been investigated in these models. To address this question, here we combined transgenic mice and pharmacological tools to specifically and temporally control the depletion of microglia and monocytes in a mouse model of spinal nerve transection (SNT). We found that although microglia and monocytes are required during the initiation of mechanical allodynia or thermal hyperalgesia, these cells may not be as important for the maintenance of hypersensitivity. Moreover, we demonstrated that either resident microglia or peripheral monocytes are sufficient in gating neuropathic pain after SNT. We propose that resident microglia and peripheral monocytes act synergistically to initiate hypersensitivity and promote the transition from acute to chronic pain after peripheral nerve injury. PMID:27349690

  14. TRPA1 channels mediate acute neurogenic inflammation and pain produced by bacterial endotoxins

    NASA Astrophysics Data System (ADS)

    Meseguer, Victor; Alpizar, Yeranddy A.; Luis, Enoch; Tajada, Sendoa; Denlinger, Bristol; Fajardo, Otto; Manenschijn, Jan-Albert; Fernández-Peña, Carlos; Talavera, Arturo; Kichko, Tatiana; Navia, Belén; Sánchez, Alicia; Señarís, Rosa; Reeh, Peter; Pérez-García, María Teresa; López-López, José Ramón; Voets, Thomas; Belmonte, Carlos; Talavera, Karel; Viana, Félix

    2014-01-01

    Gram-negative bacterial infections are accompanied by inflammation and somatic or visceral pain. These symptoms are generally attributed to sensitization of nociceptors by inflammatory mediators released by immune cells. Nociceptor sensitization during inflammation occurs through activation of the Toll-like receptor 4 (TLR4) signalling pathway by lipopolysaccharide (LPS), a toxic by-product of bacterial lysis. Here we show that LPS exerts fast, membrane delimited, excitatory actions via TRPA1, a transient receptor potential cation channel that is critical for transducing environmental irritant stimuli into nociceptor activity. Moreover, we find that pain and acute vascular reactions, including neurogenic inflammation (CGRP release) caused by LPS are primarily dependent on TRPA1 channel activation in nociceptive sensory neurons, and develop independently of TLR4 activation. The identification of TRPA1 as a molecular determinant of direct LPS effects on nociceptors offers new insights into the pathogenesis of pain and neurovascular responses during bacterial infections and opens novel avenues for their treatment.

  15. TRPA1 channels mediate acute neurogenic inflammation and pain produced by bacterial endotoxins.

    PubMed

    Meseguer, Victor; Alpizar, Yeranddy A; Luis, Enoch; Tajada, Sendoa; Denlinger, Bristol; Fajardo, Otto; Manenschijn, Jan-Albert; Fernández-Peña, Carlos; Talavera, Arturo; Kichko, Tatiana; Navia, Belén; Sánchez, Alicia; Señarís, Rosa; Reeh, Peter; Pérez-García, María Teresa; López-López, José Ramón; Voets, Thomas; Belmonte, Carlos; Talavera, Karel; Viana, Félix

    2014-01-01

    Gram-negative bacterial infections are accompanied by inflammation and somatic or visceral pain. These symptoms are generally attributed to sensitization of nociceptors by inflammatory mediators released by immune cells. Nociceptor sensitization during inflammation occurs through activation of the Toll-like receptor 4 (TLR4) signalling pathway by lipopolysaccharide (LPS), a toxic by-product of bacterial lysis. Here we show that LPS exerts fast, membrane delimited, excitatory actions via TRPA1, a transient receptor potential cation channel that is critical for transducing environmental irritant stimuli into nociceptor activity. Moreover, we find that pain and acute vascular reactions, including neurogenic inflammation (CGRP release) caused by LPS are primarily dependent on TRPA1 channel activation in nociceptive sensory neurons, and develop independently of TLR4 activation. The identification of TRPA1 as a molecular determinant of direct LPS effects on nociceptors offers new insights into the pathogenesis of pain and neurovascular responses during bacterial infections and opens novel avenues for their treatment.

  16. Pain Management in Newborns

    PubMed Central

    Hall, Richard W.; Anand, Kanwaljeet J. S.

    2014-01-01

    Effective pain management is a desirable standard of care for preterm and term newborns and may potentially improve their clinical and neurodevelopmental outcomes. Neonatal pain should be assessed routinely using context-specific, validated and objective pain methods, despite the limitations of currently available tools. Reducing invasive procedures, and using pharmacological, behavioral or environmental measures can be used to manage neonatal pain. Non-pharmacologic approaches include kangaroo care, facilitated tucking, non-nutritive sucking, sucrose and other sweeteners, massage and acupuncture therapy. They are used for procedures causing acute, transient, or mild pain, or as adjunctive therapy for moderate or severe pain. Local and topical anesthetics can reduce the acute pain caused by skin-breaking or mucosa-injuring procedures. Opioids form the mainstay for treatment of severe pain; morphine and fentanyl are the most commonly used drugs, although other opioids are also available. Non-opioid drugs include various sedatives and anesthetic agents, mostly used as adjunctive therapy in ventilated neonates. Acetaminophen, ibuprofen and other drugs are used for neonates, although their efficacy and safety remains unproven. Approaches for implementing an effective pain management program in the Neonatal ICU are summarized, together with practical protocols for procedural, postoperative, and mechanical ventilation-associated neonatal pain and stress. PMID:25459780

  17. Acute phase response induced following tumor treatment by photodynamic therapy: relevance for the therapy outcome

    NASA Astrophysics Data System (ADS)

    Korbelik, Mladen; Merchant, Soroush; Stott, Brandon; Cecic, Ivana; Payne, Peter; Sun, Jinghai

    2006-02-01

    Acute phase response is an effector process orchestrated by the innate immune system for the optimal mobilization of the resources of the organism distant from the local insult site needed in the execution of a host-protecting reaction. Our research has shown that mice bearing tumors treated by photodynamic therapy (PDT) exhibit the three major hallmarks of acute phase response: release of acute phase reactants, neutrophilia, and pituitary/adrenal axis activation. Of particular interest in this study were acute phase proteins that have a pivotal role in the clearance of dead cells, since the occurrence of this process in PDT-treated tumors emerges as a critical event in the course of PDT-associated host response. It is shown that this type of acute phase reactants, including complement proteins (C3, C5, C9, mannose-binding lectin, and ficolin A) and related pentraxins (serum amyloid P component and PTX3), are upregulated following tumor PDT and accumulate in the targeted lesions. Based on the recently accumulated experimental evidence it is definitely established that the acute phase response is manifested in the hosts bearing PDT-treated tumors and it is becoming clear that this effector process is an important element of PDT-associated host response bearing in impact on the eventual outcome of this therapy.

  18. Unusual cause of acute low-back pain: sudden annulus fibrosus rupture

    PubMed Central

    Ozer, Ali Fahir; Oktenoglu, Tunc; Sasani, Mehdi; Kaner, Tuncay; Ercelen, Omur; Canbulat, Nazan

    2012-01-01

    Low-back pain is a common problem in neu-rosurgery practice, and an algorithm has been developed for assessing these cases. However, one subgroup of these patients shares several clinical features and these individuals are not easy to categorize and diagnose. We present our observations for 8 of these patients, individuals with low-back pain caused by atypical annulus fibrosus rupture (AAR). The aim of this study is to show the consequences of overlooked annular tears on acute onset of low back pain. Eight patients with acute-onset severe low-back pain were admitted. Physical examinations were normal and each individual was examined neurologically and assessed with neuroradiologic studies [plain x-rays, magnetic resonance imaging (MRI), discography and computed tomography (CT) discography]. AAR was ultimately diagnosed with provocative discography. In all cases, MRI showed a healthy disc or mild degeneration, whereas discography and CT discography demonstrated disc disease. Anterior interbody cage implantation was performed in 3 of the 8 cases and posterior dynamic stabilization was carried out in 3 cases. The other 2 individuals refused surgery, and we were informed that one of them developed disc herniation at the affected level 1 year after our diagnosis. Clinical and radiological outcomes were evaluated. In cases where AAR is suspected, MRI, discography, and CT discography should be performed in addition to routine neuroradiologic studies. PMID:22802990

  19. Coronary Computed Tomography Angiography in the Assessment of Acute Chest Pain in the Emergency Room

    PubMed Central

    dos Prazeres, Carlos Eduardo Elias; Cury, Roberto Caldeira; Carneiro, Adriano Camargo de Castro; Rochitte, Carlos Eduardo

    2013-01-01

    The coronary computed tomography angiography has recently emerged as an accurate diagnostic tool in the evaluation of coronary artery disease, providing diagnostic and prognostic data that correlate directly with the data provided by invasive coronary angiography. The association of recent technological developments has allowed improved temporal resolution and better spatial coverage of the cardiac volume with significant reduction in radiation dose, and with the crucial need for more effective protocols of risk stratification of patients with chest pain in the emergency room, recent evaluation of the computed tomography coronary angiography has been performed in the setting of acute chest pain, as about two thirds of invasive coronary angiographies show no significantly obstructive coronary artery disease. In daily practice, without the use of more efficient technologies, such as coronary angiography by computed tomography, safe and efficient stratification of patients with acute chest pain remains a challenge to the medical team in the emergency room. Recently, several studies, including three randomized trials, showed favorable results with the use of this technology in the emergency department for patients with low to intermediate likelihood of coronary artery disease. In this review, we show data resulting from coronary angiography by computed tomography in risk stratification of patients with chest pain in the emergency room, its diagnostic value, prognosis and cost-effectiveness and a critical analysis of recently published multicenter studies. PMID:24145392

  20. Unusual cause of acute low-back pain: sudden annulus fibrosus rupture.

    PubMed

    Ozer, Ali Fahir; Oktenoglu, Tunc; Sasani, Mehdi; Kaner, Tuncay; Ercelen, Omur; Canbulat, Nazan

    2012-05-01

    Low-back pain is a common problem in neu-rosurgery practice, and an algorithm has been developed for assessing these cases. However, one subgroup of these patients shares several clinical features and these individuals are not easy to categorize and diagnose. We present our observations for 8 of these patients, individuals with low-back pain caused by atypical annulus fibrosus rupture (AAR). The aim of this study is to show the consequences of overlooked annular tears on acute onset of low back pain. Eight patients with acute-onset severe low-back pain were admitted. Physical examinations were normal and each individual was examined neurologically and assessed with neuroradiologic studies [plain x-rays, magnetic resonance imaging (MRI), discography and computed tomography (CT) discography]. AAR was ultimately diagnosed with provocative discography. In all cases, MRI showed a healthy disc or mild degeneration, whereas discography and CT discography demonstrated disc disease. Anterior interbody cage implantation was performed in 3 of the 8 cases and posterior dynamic stabilization was carried out in 3 cases. The other 2 individuals refused surgery, and we were informed that one of them developed disc herniation at the affected level 1 year after our diagnosis. Clinical and radiological outcomes were evaluated. In cases where AAR is suspected, MRI, discography, and CT discography should be performed in addition to routine neuroradiologic studies. PMID:22802990

  1. Peripheral NLCR4 inflammasome participates in the genesis of acute inflammatory pain.

    PubMed

    Lopes, Alexandre H; Talbot, Jhimmy; Silva, Rangel L; Lima, Jonilson B; França, Rafael O; Verri, Waldiceu A; Mascarenhas, Danielle P; Ryffel, Bernhard; Cunha, Fernando Q; Zamboni, Dario S; Cunha, Thiago M

    2015-03-01

    Inflammatory hyperalgesia is a complex process that depends on the sensitization of primary nociceptive neurons triggered by proinflammatory mediators, such as interleukin 1β (IL-1β). Recently, the peripheral activation of caspase-1 (previously known as IL-1β-converting enzyme) was implicated in the induction of acute inflammatory pain by promoting the processing of IL-1β from its precursor form, pro-IL-1β. Caspase-1 activation in several systems requires the assembly of an intracellular molecular platform called an inflammasome. Inflammasomes consist of 1 nucleotide-binding oligomerization domain-like receptor (NLR), the adapter molecule apoptosis-associated speck-like protein containing a C-terminal caspase recruitment domain (ASC), and caspase-1. NLRP3 and NLRC4 inflammasomes are well described. However, the identity of the inflammasome that is involved in the peripheral activation of caspase-1 that accounts for acute inflammatory hyperalgesia has not been described. The present findings demonstrated that mice deficient in NLRC4 or ASC, but not in NLRP3, present reduced mechanical and thermal acute inflammatory hyperalgesia induced by carrageenan. The reduced hyperalgesia was accompanied by significant impairments in the levels of mature forms of IL-1β (p17) and caspase-1 (p20) compared to wild-type mice at the inflammatory site. Therefore, these results identified the inflammasome components NLRC4 and ASC as the molecular platform involved in the peripheral activation of caspase-1 and IL-1β maturation, which are responsible for the induction of acute inflammatory pain. In conclusion, our study provides new therapeutic targets for the control of acute inflammatory pain.

  2. The effects of extracorporeal shock wave therapy on frozen shoulder patients’ pain and functions

    PubMed Central

    Park, Chan; Lee, Sangyong; Yi, Chae-Woo; Lee, Kwansub

    2015-01-01

    [Purpose] The present study was conducted to examine the effects of extracorporeal shock wave therapy on frozen shoulder patients’ pain and functions. [Subjects] In the present study, 30 frozen shoulder patients were divided into two groups: an extracorporeal shock wave therapy group of 15 patients and a conservative physical therapy group of 15 patients. [Methods] Two times per week for six weeks, the extracorporeal shock wave therapy group underwent extracorporeal shock wave therapy, and the conservative physical therapy group underwent general physical therapy. Visual analog scales were used to measure frozen shoulder patients’ pain, and patient-specific functional scales were used to evaluate the degree of functional disorders. [Results] In intra-group comparisons, the two groups showed significant decreases in terms of visual analog scales and patient-specific functional scales, although the extracorporeal shock wave therapy group showed significantly lower scores than the conservative physical therapy group. [Conclusion] Extracorporeal shock wave therapy is considered an effective intervention for improving frozen shoulder patients’ pain and functions. PMID:26834326

  3. The effects of extracorporeal shock wave therapy on frozen shoulder patients' pain and functions.

    PubMed

    Park, Chan; Lee, Sangyong; Yi, Chae-Woo; Lee, Kwansub

    2015-12-01

    [Purpose] The present study was conducted to examine the effects of extracorporeal shock wave therapy on frozen shoulder patients' pain and functions. [Subjects] In the present study, 30 frozen shoulder patients were divided into two groups: an extracorporeal shock wave therapy group of 15 patients and a conservative physical therapy group of 15 patients. [Methods] Two times per week for six weeks, the extracorporeal shock wave therapy group underwent extracorporeal shock wave therapy, and the conservative physical therapy group underwent general physical therapy. Visual analog scales were used to measure frozen shoulder patients' pain, and patient-specific functional scales were used to evaluate the degree of functional disorders. [Results] In intra-group comparisons, the two groups showed significant decreases in terms of visual analog scales and patient-specific functional scales, although the extracorporeal shock wave therapy group showed significantly lower scores than the conservative physical therapy group. [Conclusion] Extracorporeal shock wave therapy is considered an effective intervention for improving frozen shoulder patients' pain and functions.

  4. Diagnostic importance of admission platelet volume indices in patients with acute chest pain suggesting acute coronary syndrome

    PubMed Central

    Dehghani, Mohammad Reza; Taghipour-Sani, Leila; Rezaei, Yousef; Rostami, Rahim

    2014-01-01

    Objective Acute coronary syndrome (ACS) is a challenging issue in cardiovascular medicine. Given platelet role in atherothrombosis, we sought to determine whether platelet indices can be used as diagnostic tests for patients who suffered from an acute chest discomfort. Methods We prospectively enrolled 862 patients with an acute chest pain and 184 healthy matched controls. They were divided into four groups: 184 controls, 249 of non-ACS, 421 of unstable angina (UA), and 192 of myocardial infarction (MI) cases. Blood samples were collected at admission to the emergency department for routine hematologic tests. Results The mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (P-LCR) were significantly greater in patients with MI compared with those of non-ACS or control subjects. Negative and significant correlations existed between MPV, PDW, and P-LCR values and platelet count (P < 0.001). Receiver operating characteristic (ROC) curves showed that the MPV, PDW, and P-LCR with cut-off values of 9.15 fL, 11.35 fL, and 20.25% and with area under the curves of 0.563, 0.557, and 0.560, respectively, detected MI patients among those who had chest discomfort. The sensitivities and specificities were found to be 72% and 40%, 73% and 37%, and 68% and 44% for MPV, PDW, and P-LCR, respectively. Conclusion An elevated admission MPV, PDW, and P-LCR may be of benefit to detect chest pain resulting in MI from that of non-cardiac one, and also for risk stratification of patients who suffered from an acute chest discomfort. PMID:25634396

  5. [The importance of the cortex and subcortical structures of the brain in the perception of acute and chronic pain].

    PubMed

    Reschetniak, V K; Kukushkin, M L; Gurko, N S

    2014-01-01

    This review presents the current data in the literature about the importance of the cortex and subcortical structures of the brain in the perception of acute and chronic pain. Discussed the importance of various areas of the brain in perception discriminative and affective components of pain. Discusses also gender differences in pain perception depending on the functional activity of brain cortex and antinociceptive subcortical structures. Analyzed the morphological changes of cortical and subcortical structures of the brain in chronic pain syndromes. It is proved that the decrease in the volume of gray and white matter of cerebral cortex and subcortical structures is a consequence and not the cause of chronic pain syndrome. Discusses the features activate and deactivate certain areas of the cortex of the brain in acute and chronic pain. Analyzed same features the activation of several brain structures in migraine and cluster headache.

  6. Psychological therapies for the management of chronic and recurrent pain in children and adolescents

    PubMed Central

    Eccleston, Christopher; Palermo, Tonya M; de C Williams, Amanda C; Lewandowski, Amy; Morley, Stephen; Fisher, Emma; Law, Emily

    2013-01-01

    Background Chronic pain affects many children, who report severe pain, distressed mood, and disability. Psychological therapies are emerging as effective interventions to treat children with chronic or recurrent pain. This update adds recently published randomised controlled trials (RCTs) to the review published in 2009. Objectives To assess the effectiveness of psychological therapies, principally cognitive behavioural therapy and behavioural therapy, for reducing pain, disability, and improving mood in children and adolescents with recurrent, episodic, or persistent pain. We also assessed the risk of bias and methodological quality of the included studies. Search methods Searches were undertaken of MEDLINE, EMBASE, and PsycLIT. We searched for RCTs in references of all identified studies, meta-analyses and reviews. Date of most recent search: March 2012. Selection criteria RCTs with at least 10 participants in each arm post-treatment comparing psychological therapies with active treatment were eligible for inclusion (waiting list or standard medical care) for children or adolescents with episodic, recurrent or persistent pain. Data collection and analysis All included studies were analysed and the quality of the studies recorded. All treatments were combined into one class: psychological treatments; headache and non-headache outcomes were separately analysed on three outcomes: pain, disability, and mood. Data were extracted at two time points; post-treatment (immediately or the earliest data available following end of treatment) and at follow-up (at least three months after the post-treatment assessment point, but not more than 12 months). Main results Eight studies were added in this update of the review, giving a total of 37 studies. The total number of participants completing treatments was 1938. Twenty-one studies addressed treatments for headache (including migraine); seven for abdominal pain; four included mixed pain conditions including headache pain, two

  7. OPAL: a randomised, placebo-controlled trial of opioid analgesia for the reduction of pain severity in people with acute spinal pain. Trial protocol

    PubMed Central

    Lin, Chung-Wei Christine; McLachlan, Andrew J; Latimer, Jane; Day, Ric O; Billot, Laurent; Koes, Bart W; Maher, Chris G

    2016-01-01

    Introduction Low back pain and neck pain are extremely prevalent and are responsible for an enormous burden of disease globally. Strong analgesics, such as opioid analgesics, are recommended by clinical guidelines for people with acute low back pain or neck pain who are slow to recover and require more pain relief. Opioid analgesics are widely and increasingly used, but there are no strong efficacy data supporting the use of opioid analgesics for acute low back pain or neck pain. Concerns regarding opioid use are further heightened by the risks of adverse events, some of which can be serious (eg, dependency, misuse and overdose). Methods and analysis OPAL is a randomised, placebo-controlled, triple-blinded trial that will investigate the judicious use of an opioid analgesic in 346 participants with acute low back pain and/or neck pain who are slow to recover. Participants will be recruited from general practice and randomised to receive the opioid analgesic (controlled release oxycodone plus naloxone up to 20 mg per day) or placebo in addition to guideline-based care (eg, reassurance and advice of staying active) for up to 6 weeks. Participants will be followed-up for 3 months for effectiveness outcomes. The primary outcome will be pain severity. Secondary outcomes will include physical functioning and time to recovery. Medication-related adverse events will be assessed and a cost-effectiveness analysis will be conducted. We will additionally assess long-term use and risk of misuse of opioid analgesics for up to 12 months. Ethics and dissemination Ethical approval has been obtained. Trial results will be disseminated by publications and conference presentations, and via the media. Trial registration number ACTRN12615000775516: Pre-results. PMID:27558901

  8. [Antibacterial therapy in surgery of patients with acute destructive appendicitis].

    PubMed

    Bezrodnyĭ, B H; Kolosovych, I V; Iovitsa, A V; Martynovych, L D; Sydorenko, R A; Sysak, O M

    2012-01-01

    Character of microflora of exsudate of abdominals and mucosis microflora of vermicular appendix is studied for patients with the destructive forms of appendicitis with the purpose of development of variants of antibacterial therapy at surgical treatment of patients with acute appendicitis. The patients with the destructive forms of appendicitis, which were on treatment in a municipal clinical hospital N 4 Kyiv for period 2004-2010. An Inflammatory-destructive process in an appendix is conditioned by both aerobic (Escherichia coli - 46,6 %, Enterobacter - 4,2 %, Citrobacter - 4,2 %, Klebsiella - 3,3 %, Pseudomonas aeruginosa - 5,8 %, Staphylococcus - 4,2 %) and anaerobic microorganisms (Bacteroides - 100 %) and increase Candida - 17,5 %. Antibacterial therapy is effective at 46,7 % patients with acute appendicitis. At 49,6 % patients acute appendicitis develops on a background dysbiotic intestinal disturbances. Clinically the effective charts of empiric antibacterial monotherapy 6 days it is been: Moxifloxacini intravenously 400 mgs one time in twenty-four hours during, Ertapenemi for a 1 g one time in twenty-four hours intravenously and combined - Aztreonami for a 1 g twice in twenty-four hours and of Clindamycini for 600 mgs twice in twenty-four hours, intramuscular during; Cefepimumi for a 1 g twice in twenty-four hours and of Clindamycini for 600 mgs twice in twenty-four hours, intramuscular.

  9. Comparison of Acute and Chronic Pain after Open Nephrectomy versus Laparoscopic Nephrectomy

    PubMed Central

    Alper, Isik; Yüksel, Esra

    2016-01-01

    Abstract We evaluated postoperative pain intensity and the incidence of chronic pain in patients with renal cell carcinoma undergoing laparoscopic or open radical nephrectomy. In this prospective study, 27 laparoscopic nephrectomy (Group LN) and 25 open nephrectomy (Group ON) patients were included. All patients received paracetamol infusion and intramuscular morphine 30 minutes before the end of the operation and intravenous patient controlled analgesia with morphine postoperatively. Data including patients’ demographics, visual analog scale (VAS) pain scores at postoperative 0.5, 1, 2, 4, 6, 12, and 24 hours, postoperative morphine consumption, analgesic demand, analgesic delivery, number of patients requiring rescue analgesics, side effects because of analgesic medications, and overall patient satisfaction were recorded and compared between the two groups. Two and 6 months after the operation, patients were evaluated for chronic postsurgical pain (CPSP). Postoperative average VAS pain scores were not different between the two groups. However, only at 2 hours postoperatively, pain score was significantly higher in Group ON than in Group LN. In both groups, the highest pain scores were recorded at 30 minutes and 1 hour after surgery. Ninety-six percent of group ON patients and 88% of group LN patients required additional analgesia in the early postoperative period (P = 0.33). Postoperative morphine consumption and analgesic demand were found to be similar between the two groups. CPSP at 2 months after surgery was observed in 4 out of 25 patients (16%) in the ON group and 3 out of 27 patients (11.1%) in the LN group (P = 0.6). Chronic pain at 6 months after surgery was observed in 1 ON patient (4%) and 1 LN patient (3.7%, P = 0.9). This study demonstrated that postoperative acute pain scores were not different after laparoscopic or open nephrectomy and patients undergoing laparoscopic or open nephrectomy were at equal risk of developing CPSP. Pain

  10. Physical therapy modalities and rehabilitation techniques in the management of neuropathic pain.

    PubMed

    Akyuz, Gulseren; Kenis, Ozge

    2014-03-01

    Neuropathic pain is an important problem because of its complex natural history, unclear etiology, and poor response to standard physical therapy agents. It causes severe disability unrelated to its etiology. The primary goals of the management of neuropathic pain are to detect the underlying cause, to define the differential diagnosis and eliminate risk factors, and to reduce the pain. The physician should also know the functional and psychologic conditions of the patient. Therefore, a multimodal management plan in neuropathic pain is essential. This review aimed to reflect a diverse point of view about various physical therapy modalities and rehabilitation techniques. Physical therapy modalities and rehabilitation techniques are important options and must be considered when pharmacotherapy alone is not sufficient. In addition, psychosocial support and cognitive behavioral therapy could also be taken into consideration. It has been suggested that the importance of pain rehabilitation techniques will increase in time and these will take a larger part in the management of neuropathic pain. However, it is now early to comment on these methods because of the lack of adequate publications.

  11. Effect of extracorporeal shock wave therapy on scar pain in burn patients

    PubMed Central

    Cho, Yoon Soo; Joo, So Young; Cui, Huisong; Cho, Sung-Rae; Yim, Haejun; Seo, Cheong Hoon

    2016-01-01

    Abstract Background: Extracorporeal shock wave therapy (ESWT) has been used to reduce pain in patients with various musculoskeletal diseases and wounds. We investigated the effect of ESWT on scar pain after complete wound epithelialization in burn patients. Methods: A prospective, single-blind, placebo-controlled study was conducted from February 2014 to 2015. Forty patients with burn scar pain despite standard therapy (medication, physical therapy, and burn rehabilitation massage therapy) were randomized into ESWT or control (sham ESWT) groups. ESWT was administered at 100 impulses/cm2 (0.05–0.15 mJ/mm2) once per week for 3 weeks. The treatment effects were assessed using the numerical rating scale (NRS), pain threshold, Nirschl pain phase system, and Roles and Maudsley scores. Results: The characteristics of patients between the 2 study groups were balanced (P >0.05) for age, sex, and total burn surface area (%). In both groups, the NRS, pain threshold (Ib/cm2), and Nirschl pain phase system values significantly improved (P <0.05) after 3 sessions of ESWT or sham therapy, and there were significant differences between the 2 groups in terms of these 3 variables (P <0.001, P <0.001, P = 0.013, respectively). The Roles and Maudsley scores significantly improved; among 20 patients, 17 reported a score of poor (85%) and 3 reported fair (15%) before ESWT, whereas 3 reported poor (15%), 8 reported fair (40%), 5 reported good (25%), and 4 reported excellent (20%) after ESWT (P = 0.004). The scores did not improve in the control group (P = 0.128). Conclusion: ESWT significantly reduced scar pain in burn patients after wound recovery. PMID:27512886

  12. Comparison the efficacy of phonophoresis and ultrasound therapy in myofascial pain syndrome.

    PubMed

    Ay, Saime; Doğan, Sebnem Koldaş; Evcik, Deniz; Başer, Ozgün Cakmak

    2011-09-01

    The aim of this study is to compare the effect of phonophoresis, ultrasound and placebo ultrasound therapies in the treatment of myofascial pain syndrome (MPS). This is a randomized, double-blind placebo controlled study. Sixty patients (48 women, 12 men, mean age 37.9 ± 12.2 years) with MPS were included in this study. Patients were allocated into three groups. Group 1(n = 20) was received diclofenac phonophoresis, group 2(n = 20) was received ultrasound and group 3(n = 20) was received placebo ultrasound therapies over trigger points, 10 min a day for 15 session during 3 weeks (1 MHz-1,5 watt/cm²). Additionally, all patients were given neck exercise program including isotonic, isometric and stretching. Patients were assessed by means of pain, range of motion (ROM) of neck, number of trigger points (NTP), algometric measurement and disability. Pain severity was measured by visual analog scale (VAS) and Likert scale. The neck pain disability index (NPDI) was used for assessing disability. Measurements were taken before and after treatment. After treatment, there were statistically significant improvements in pain severity, NTP, pressure pain threshold (PPT), ROM and NPDI scores both in phonophoresis and in ultrasound therapy groups (P < 0.05). Statistically significant increase in cervical lateral flexion and rotation was observed in the placebo US group. While there was no statistically significant improvement in the cervical flexion-extension joint movement, pain levels, number of trigger points and NPDI score, pressure pain threshold (P > 0.05), also there were no significant differences in all parameters between group 1 and 2 (P = 0.05). Both diclofenac phonophoresis and ultrasound therapy were effective in the treatment of patients with MPS. Phonophoresis was not found to be superior over ultrasound therapy.

  13. Acute non-traumatic gastrothorax: presentation of a case with chest pain and atypical radiologic findings.

    PubMed

    Singh, Deepwant; Mackeith, Pieter; Gopal, Dipesh Pravin

    2016-03-23

    A previously well 71-year-old woman presented to the Emergency Department with acute-onset left-sided chest pain. She was haemodynamically stable with unremarkable systemic examination. Her electrocardiogram and troponin were within normal limits and her chest radiograph showed a raised left hemi-diaphragm. Two hours after admission, this woman became acutely breathless, and suffered a pulseless electrical activity cardiac arrest. After cardiopulmonary resuscitation, there was a return of spontaneous circulation and regained consciousness. A repeat clinical assessment revealed a new left-sided dullness to percussion with contralateral percussive resonance on respiratory examination. CXR revealed a left pan-hemi-thoracic opacity whilst better definition using CT-pulmonary angiography (CTPA) indicated an acute tension gastrothorax secondary to a large left-sided diaphragmatic hernia. Nasogastric (NG) tube insertion was used to decompress the stomach and the patient underwent uncomplicated emergency laparoscopic hernia reduction. She remained well at 1-year follow-up.

  14. Depression impacts the course of recovery in patients with acute low-back pain.

    PubMed

    Melloh, Markus; Elfering, Achim; Käser, Anja; Salathé, Cornelia Rolli; Barz, Thomas; Aghayev, Emin; Röder, Christoph; Theis, Jean-Claude

    2013-01-01

    Little is known about the course of recovery of acute low back pain (LBP) patients as a function of depression. In a prospective study, 286 acute LBP patients were assessed at baseline and followed up over 6 months. Recovery was defined as improvement in the Oswestry Disability Index (ODI). Repeated-measures analysis of covariance was employed with ODI as repeated factor, age, sex, and body mass index as covariates, depression and all other potential prognostic factors as between-subject factors. Of study participants, 18% were classified as depressive (>33 points on the Zung Self-Rating Depression Scale). Of 286 participants, 135 were lost to follow-up. In the longitudinal sample of 151 patients the course of recovery was slower in depressive patients. Depression was associated with LBP especially after 6 weeks and should therefore be included in screening instruments for acute LBP patients to identify those at risk of delayed recovery at an early stage. PMID:23930900

  15. Anterior knee pain: an update of physical therapy.

    PubMed

    Werner, Suzanne

    2014-10-01

    Anterior knee pain is one of the most common knee problems in physically active individuals. The reason for anterior knee pain has been suggested to be multifactorial with patella abnormalities or extensor mechanism disorder leading to patellar malalignment during flexion and extension of the knee joint. Some patients complain mostly of non-specific knee pain, while others report patellar instability problems. The patients present with a variety of symptoms and clinical findings, meaning that a thorough clinical examination is the key for optimal treatment. Weakness of the quadriceps muscle, especially during eccentric contractions, is usually present in the majority of anterior knee pain patients. However, irrespective of whether pain or instability is the major problem, hypotrophy and reduced activity of the vastus medialis are often found, which result in an imbalance between vastus medialis and vastus lateralis. This imbalance needs to be corrected before quadriceps exercises are started. The non-operative rehabilitation protocol should be divided into different phases based on the patient's progress. The goal of the first phase is to reduce pain and swelling, improve the balance between vastus medialis and vastus lateralis, restore normal gait, and decrease loading of the patello-femoral joint. The second phase should include improvement of postural control and coordination of the lower extremity, increase of quadriceps strength and when needed hip muscle strength, and restore good knee function. The patient should be encouraged to return to or to start with a suitable regular physical exercise. Therefore, the third phase should include functional exercises. Towards the end of the treatment, single-leg functional tests and functional knee scores should be used for evaluating clinical outcome. A non-operative treatment of patients with anterior knee pain should be tried for at least 3 months before considering other treatment options.

  16. Evolving Therapies in Acute Myeloid Leukemia: Progress at Last?

    PubMed

    DeAngelo, Daniel J; Stein, Eytan M; Ravandi, Farhad

    2016-01-01

    Acute myeloid leukemia (AML) is an acquired disease characterized by chromosomal translocations and somatic mutations that lead to leukemogenesis. Systemic combination chemotherapy with an anthracycline and cytarabine remains the standard induction regimen for "fit" adults. Patients who achieve complete remission generally receive postinduction therapy with cytarabine-based chemotherapy or an allogeneic bone marrow transplant. Those unfit for induction chemotherapy are treated with hypomethylating agents (HMAs), low-dose cytarabine, or they are offered supportive care alone with transfusions and prophylactic antimicrobials. The revolution in understanding the genetics of AML, facilitated by next-generation sequencing, has led to many new drugs against driver mutations. Better methods of identification of leukemic blasts have provided us with better means to detect the disease left behind after cytotoxic chemotherapy regimens. This measurable residual disease has been correlated with poorer relapse-free survival, demonstrating the need for novel strategies to eradicate it to improve the outcome of patients with acute leukemias. In this article, we discuss adapting and improving AML therapy by age and comorbidities, emerging targeted therapies in AML, and minimal residual disease (MRD) assessment in AML. PMID:27249736

  17. Effectiveness of chelation therapy with time after acute uranium intoxication

    SciTech Connect

    Domingo, J.L.; Ortega, A.; Llobet, J.M.; Corbella, J. )

    1990-01-01

    The effect of increasing the time interval between acute uranium exposure and chelation therapy was studied in male Swiss mice. Gallic acid, 4,5-dihydroxy-1,3- benzenedisulfonic acid (Tiron), diethylenetriaminepentaacetic acid (DTPA), and 5-aminosalicylic acid (5-AS) were administered ip at 0, 0.25, 1, 4, and 24 hr after sc injection of 10 mg/kg of uranyl acetate dihydrate. Chelating agents were given at doses equal to one-fourth of their respective LD50 values. Daily elimination of uranium into urine and feces was determined for 4 days after which time the mice were killed, and the concentration of uranium was measured in kidney, spleen, and bone. The excretion of uranium was especially rapid in the first 24 hr. Treatment with Tiron or gallic acid at 0, 0.25, or 1 hr after uranium exposure significantly increased the total excretion of the metal. In kidney and bone, only administration of Tiron at 0, 0.25, or 1 hr after uranium injection, or gallic acid at 1 hr after uranium exposure significantly reduced tissue uranium concentrations. Treatment at later times (4 to 24 hr) did not increase the total excretion of the metal and did not decrease the tissue uranium concentrations 4 days after uranyl acetate administration. The results show that the length of time before initiating chelation therapy for acute uranium intoxication greatly influences the effectiveness of this therapy.

  18. Intravenous lidocaine for the treatment of acute pain in the emergency department

    PubMed Central

    Fitzpatrick, Brendan Michael; Mullins, Michael Eugene

    2016-01-01

    Objective To evaluate intravenous lidocaine’s safety and efficacy as an analgesic agent in the treatment of a variety of painful conditions presenting to the emergency department. Methods This case series identified seventeen patients who received lidocaine over a six month period and recorded demographic data, amount of lidocaine administered, the amount of opioid medication administered before and after lidocaine, pre- and post-lidocaine pain scores, and any qualitative descriptors of the patient’s pain recorded in the record. Side effects and adverse events were also recorded. Results Of the seven patients who had a pre- and post-lidocaine pain score recorded, the mean reduction was 3 points on a 10 point scale. Patients who received lidocaine used less opioid medication. One patient received an improperly high dose of lidocaine and suffered a brief seizure and cardiac arrest, but was quickly resuscitated. Conclusion This series suggests that lidocaine may be a useful adjunct in the treatment of acutely painful conditions in the emergency department. PMID:27752626

  19. Acute caffeine ingestion enhances performance and dampens muscle pain following resistance exercise to failure.

    PubMed

    Duncan, M J; Oxford, S W

    2012-06-01

    This double-blind, within-subjects experiment examined the effects of acute caffeine ingestion on perceptions of muscle pain following a bout of high-intensity, upper-body resistance exercise to failure. Moderately trained males (N.=18) ingested a dose of caffeine (5 mg · kg-1) or placebo in a randomised and counterbalanced order and 1 hour later completed bench press exercise to failure at an intensity of 60% 1 repetition maximum. Repetitions completed was taken as a measure of performance, peak heart rate was determined via heart rate telemetry during the exercise bout, rating of perceived exertion (RPE) and upper body muscle pain was recorded immediately upon failure of the exercise task and peak blood lactate concentration was determined post-exercise. Caffeine resulted in improved repetitions to failure (t [17]=3.119, P=0.006), greater peak blood lactate (t [17] =5.080, P=0.0001) and lower RPE (t 17=-3.431, P=0.003) compared to placebo. Muscle pain perception was also significantly lower in the caffeine condition compared to placebo (t [17]=-2.567, P=0.04). These results support prior studies using aerobic based exercise modes in suggesting that caffeine ingestion can dampen exercise-induced muscle pain. Specifically, caffeine ingestion enhances muscular strength performance and reduces upper body muscle pain perception immediately following a bout of high-intensity resistance exercise to failure.

  20. Amygdala lesions produce analgesia in a novel, ethologically relevant acute pain test.

    PubMed

    Hebert, M A; Ardid, D; Henrie, J A; Tamashiro, K; Blanchard, D C; Blanchard, R J

    1999-08-01

    Acute pain tests using mechanical stimuli typically do not involve objects important in the evolutionary history of the subjects, and may fail to evaluate the contribution of biobehavioral defensive reactions to the total pain response. Spines are common structural defenses that protect plants and animals against predation. The present studies examined the reaction to contact with such natural, mechanical pain stimuli in the laboratory rat, utilizing a floor board with protruding pins located in the middle of a novel alley (the "fakir" test). Behavioral responses were characterized in 10-min tests (Experiment 1). Subjects showed voluntary contact with the pins followed by patterns of avoidance and risk assessment (stretch attend and stretch approach). Few subjects crossed the array of pins. The amygdala has been implicated in the perception of pain, particularly in stressful or fearful contexts. In Experiment 2, the fakir test was used to examine, concurrently, the effects of amygdala lesions on analgesiometric (frequency and duration of pin crossings) and anxiometric (risk assessment) measures. Large, bilateral, lesions of the amygdala significantly increased both the number of pin crossings and time spent on the pins without affecting the risk assessment measures. These findings suggest a possible dissociation between anxiety and pain perception with an important (nonaffective) role for the amygdala in the latter.

  1. Acute spinal cord compression: a rare complication of dual antiplatelet therapy.

    PubMed

    Iskandar, Muhammad Zaid; Chong, Victor; Hutcheon, Stuart

    2015-01-01

    A 73-year-old woman presented with acute shortness of breath and exacerbation of chronic back pain. She was diagnosed with pulmonary oedema and a non-ST-elevation myocardial infarction following chest X-ray, ECG and high sensitivity troponin levels. She subsequently underwent coronary angioplasty with deployment of drug-eluting stents to her circumflex and left anterior descending arteries and was started on aspirin and clopidogrel for her dual antiplatelet therapy. Unfortunately, following the procedure, she gradually lost power and sensation in both lower limbs. MRI of her spine confirmed an extradural haematoma causing thoracic cord compression. She was managed conservatively following discussions with neurosurgeons and developed further complications secondary to her immobility. PMID:26202314

  2. [Acute extremity compartment syndrome: current concepts in diagnostics and therapy].

    PubMed

    Sellei, R M; Hildebrand, F; Pape, H-C

    2014-07-01

    Acute compartment syndrome of the upper and lower limbs is observed following trauma, reperfusion or as an intraoperative complication caused by positioning. The pathophysiology of the disorder has been extensively described and is well known as a loss of perfusion due to rising compartmental pressures. It is a serious and potentially limb- and life-threatening complication. Early diagnosis is made primarily based on clinical findings. Early and focused therapy is crucial to prevent the devastating complications of this acute condition. However, diagnosis can be difficult, particularly in unconscious patients. Thus, in uncertain cases, pressure measurements are essential. Dermato-fasciotomy is the routine method to decompress the compartmental space. This review article examines the clinical findings, diagnostic techniques, and management options for the patient with musculoskeletal injuries.

  3. Fasinumab (REGN475), an antinerve growth factor monoclonal antibody, for the treatment of acute sciatic pain: results of a proof-of-concept study

    PubMed Central

    Tiseo, Paul J; Ren, Haobo; Mellis, Scott

    2014-01-01

    Objective To evaluate the efficacy and safety of subcutaneously administered fasinumab (REGN475), a nerve growth factor-neutralizing antibody, in patients with acute sciatic pain receiving standard of care therapy. Methods This was a double-blind, parallel-group, proof-of-concept study. Patients with unilateral, moderate-to-severe sciatic pain of 2–16 weeks’ duration were randomized to a subcutaneous dose of placebo (n=51), fasinumab 0.1 mg/kg (n=53), or 0.3 mg/kg (n=53); follow-up was 12 weeks. Pain was assessed in a daily diary using a numerical rating scale (NRS) (0= no pain, 10= worst pain) for average and worst leg and back pain. The primary efficacy end point was the area under the curve of NRS scores for average leg pain from baseline to week 4. Key secondary end points included changes in average and worst leg and back pain from baseline to the end of week 4 and to each weekly study visit. Patient functioning (Oswestry Disability Index) and concomitant analgesic use were also assessed. Safety and tolerability were evaluated by treatment-emergent adverse events (TEAEs). Results Demographic and clinical characteristics were similar among the treatment groups; 141 (88.7%) patients completed the study. For the primary end point, mean ± standard deviation area under the curve values from baseline to week 4 were not significantly different between placebo (96.8±6.0) and fasinumab 0.1 mg/kg (112.7±58.3; P=0.0610) or fasinumab 0.3 mg/kg (112.4±55.8; P=0.0923). All secondary efficacy end points of changes in pain and function demonstrated responses that were similar between placebo and fasinumab groups. Incidence of TEAEs was 45.1%, 50.9%, and 64.8% in the placebo, fasinumab 0.1mg/kg, and fasinumab 0.3 mg/kg groups, respectively. The most commonly reported TEAEs included paresthesia, arthralgia, pain in extremity, and headache. Conclusion Administration of fasinumab provided no significant clinical benefit compared with placebo for the pain or functional

  4. Dopamine and pain sensitivity: neither sulpiride nor acute phenylalanine and tyrosine depletion have effects on thermal pain sensations in healthy volunteers.

    PubMed

    Becker, Susanne; Ceko, Marta; Louis-Foster, Mytsumi; Elfassy, Nathaniel M; Leyton, Marco; Shir, Yoram; Schweinhardt, Petra

    2013-01-01

    Based on animal studies and some indirect clinical evidence, dopamine has been suggested to have anti-nociceptive effects. Here, we investigated directly the effects of increased and decreased availability of extracellular dopamine on pain perception in healthy volunteers. In Study 1, participants ingested, in separate sessions, a placebo and a low dose of the centrally acting D2-receptor antagonist sulpiride, intended to increase synaptic dopamine via predominant pre-synaptic blockade. No effects were seen on thermal pain thresholds, tolerance, or temporal summation. Study 2 used the acute phenylalanine and tyrosine depletion (APTD) method to transiently decrease dopamine availability. In one session participants ingested a mixture that depletes the dopamine amino acid precursors, phenylalanine and tyrosine. In the other session they ingested a nutritionally balanced control mixture. APTD led to a small mood-lowering response following aversive thermal stimulation, but had no effects on the perception of cold, warm, or pain stimuli. In both studies the experimental manipulation of dopaminergic neurotransmission was successful as indicated by manipulation checks. The results contradict proposals that dopamine has direct anti-nociceptive effects in acute experimental pain. Based on dopamine's well-known role in reward processing, we hypothesize that also in the context of pain, dopamine acts on stimulus salience and might play a role in the initiation of avoidance behavior rather than having direct antinociceptive effects in acute experimental pain.

  5. Acute compartment syndrome--presenting as severe pain in an extremity out of proportion with the injury.

    PubMed

    Khan, M; Hodkinson, S L

    1997-10-01

    A 24 year old combat medic was admitted to the field hospital at Tomislavgrad in Bosnia, with a suspected forearm, fracture. Radiographs did not show any bony injury. Clinical examination showed marked swelling and tenderness over the extensor compartment. The pain became more severe over the following 12 hours with the pain becoming most intensely felt in the extensors on passive extension. Fasciotomy for suspected acute compartment syndrome was carried out. Acute compartment syndrome is a common complication of extremity injury, and is a clinical diagnosis which should be suspected in all injuries with marked swelling and severe pain.

  6. Intranasal ketamine for the treatment of patients with acute pain in the emergency department

    PubMed Central

    Shrestha, Roshana; Pant, Samita; Shrestha, Ashis; Batajoo, Kabita Hada; Thapa, Rashmi; Vaidya, Sumana

    2016-01-01

    BACKGROUND: Pain in the emergency department (ED) is common but undertreated. The objective of this study was to examine the efficacy and safety of intranasal (IN) ketamine used as an analgesic for patients with acute injury with moderate to severe pain. METHODS: This study was a cross sectional, observational study of patients more than 8 years old experiencing moderate to severe pain [visual analog score (VAS) >50 mm]. The initial dose of IN ketamine was 0.7 mg/kg with an additional dose of 0.3 mg/kg if VAS was more than 50 mm after 15 minutes. Pain scores and vital signs were recorded at 0, 15, 30 and 60 minutes. Side-effects, sedation level and patient’s satisfaction were also recorded. The primary outcome was the number of patients achieving ≥ 20 mm reductions in VAS at 15 minutes. Other secondary outcome measures were median reduction in VAS at 15, 30 and 60 minutes, changes of vital signs, adverse events, satisfaction of patients, and need for additional ketamine. RESULTS: Thirty-four patients with a median age of 29.5 years (IQR 17.5–38) were enrolled, and they had an initial median VAS of 80 mm (IQR 67–90). The VAS decreased more than 20 mm at 15 minutes in 27 (80%) patients. The reduction of VAS from baseline to 40 mm (IQR 20–40), 20 mm (IQR 14–20) and 20 mm (IQR 10–20) respectively at 15, 30 and 60 minutes (P<0.001). No critical changes of vital signs were noted and adverse effects were mild and transient. CONCLUSION: This study showed that IN ketamine is an analgesic choice for patients with acute injury in moderate to severe pain in an overcrowded and resource limited ED. PMID:27006733

  7. Acute pain management in opioid-tolerant patients: a growing challenge.

    PubMed

    Huxtable, C A; Roberts, L J; Somogyi, A A; MacIntyre, P E

    2011-09-01

    In Australia and New Zealand, in parallel with other developed countries, the number of patients prescribed opioids on a long-term basis has grown rapidly over the last decade. The burden of chronic pain is more widely recognised and there has been an increase in the use of opioids for both cancer and non-cancer indications. While the prevalence of illicit opioid use has remained relatively stable, the diversion and abuse of prescription opioids has escalated, as has the number of individuals receiving methadone or buprenorphine pharmacotherapy for opioid addiction. As a result, the proportion of opioid-tolerant patients requiring acute pain management has increased, often presenting clinicians with greater challenges than those faced when treating the opioid-naïve. Treatment aims include effective relief of acute pain, prevention of drug withdrawal, assistance with any related social, psychiatric and behavioural issues, and ensuring continuity of long-term care. Pharmacological approaches incorporate the continuation of usual medications (or equivalent), short-term use of sometimes much higher than average doses of additional opioid, and prescription of non-opioid and adjuvant drugs, aiming to improve pain relief and attenuate opioid tolerance and/or opioid-induced hyperalgesia. Discharge planning should commence at an early stage and may involve the use of a 'Reverse Pain Ladder' aiming to limit duration of additional opioid use. Legislative requirements may restrict which drugs can be prescribed at the time of hospital discharge. At all stages, there should be appropriate and regular consultation and liaison with the patient, other treating teams and specialist services. PMID:21970125

  8. Randomized Controlled Trial of Education and Feedback for Implementation of Guidelines for Acute Low Back Pain

    PubMed Central

    Schectman, Joel M; Schroth, W Scott; Verme, Dante; Voss, John D

    2003-01-01

    OBJECTIVE The effect of clinical guidelines on resource utilization for complex conditions with substantial barriers to clinician behavior change has not been well studied. We report the impact of a multifaceted guideline implementation intervention on primary care clinician utilization of radiologic and specialty services for the care of acute low back pain. DESIGN Physician groups were randomized to receive guideline education and individual feedback, supporting patient education materials, both, or neither. The impact on guideline adherence and resource utilization was evaluated during the 12-month period before and after implementation. PARTICIPANTS Fourteen physician groups with 120 primary care physician and associate practitioners from 2 group model HMO practices. INTERVENTIONS Guideline implementation utilized an education/audit/feedback model with local peer opinion leaders. The patient education component included written and videotaped materials on the care of low back pain. MAIN RESULTS The clinician intervention was associated with an absolute increase in guideline-consistent behavior of 5.4% in the intervention group versus a decline of 2.7% in the control group (P = .04). The patient education intervention produced no significant change in guideline-consistent behavior, but was poorly adopted. Patient characteristics including duration of pain, prior history of low back pain, and number of visits during the illness episode were strong predictors of service utilization and guideline-consistent behavior. CONCLUSIONS Implementation of an education and feedback-supported acute low back pain care guideline for primary care clinicians was associated with an increase in guideline-consistent behavior. Patient education materials did not enhance guideline effectiveness. Implementation barriers could limit the utility of this approach in usual care setttings. PMID:14521638

  9. Novel Noxipoint Therapy versus Conventional Physical Therapy for Chronic Neck and Shoulder Pain: Multicentre Randomised Controlled Trials.

    PubMed

    Koo, Charles C; Lin, Ray S; Wang, Tyng-Guey; Tsauo, Jau-Yih; Yang, Pan-Chyr; Yen, Chen-Tung; Biswal, Sandip

    2015-01-01

    As chronic pain affects 115 million people and costs $600B annually in the US alone, effective noninvasive nonpharmacological remedies are desirable. The purpose of this study was to determine the efficacy and the generalisability of Noxipoint therapy (NT), a novel electrotherapy characterised by site-specific stimulation, intensity-and-submodality-specific settings and a immobilization period, for chronic neck and shoulder pain. Ninety-seven heavily pretreated severe chronic neck/shoulder pain patients were recruited; 34 and 44 patients were randomly allocated to different treatment arms in two patient-and-assessor-blinded, randomised controlled studies. The participants received NT or conventional physical therapy including transcutaneous electrical nerve stimulation (PT-TENS) for three to six 90-minute sessions. In Study One, NT improved chronic pain (-89.6%, Brief Pain Inventory, p < 0.0001, 95% confidence interval), function (+77.4%, range of motion) and quality of life (+88.1%) at follow-up (from 4 weeks to 5 months), whereas PT-TENS resulted in no significant changes in these parameters. Study Two demonstrated similar advantages of NT over PT-TENS and the generalisability of NT. NT-like treatments in a randomised rat study showed a similar reduction in chronic hypersensitivity (-81%, p < 0.01) compared with sham treatments. NT substantially reduces chronic neck and shoulder pain, restores function, and improves quality of life in a sustained manner. PMID:26552835

  10. Novel Noxipoint Therapy versus Conventional Physical Therapy for Chronic Neck and Shoulder Pain: Multicentre Randomised Controlled Trials

    PubMed Central

    Koo, Charles C.; Lin, Ray S.; Wang, Tyng-Guey; Tsauo, Jau-Yih; Yang, Pan-Chyr; Yen, Chen-Tung; Biswal, Sandip

    2015-01-01

    As chronic pain affects 115 million people and costs $600B annually in the US alone, effective noninvasive nonpharmacological remedies are desirable. The purpose of this study was to determine the efficacy and the generalisability of Noxipoint therapy (NT), a novel electrotherapy characterised by site-specific stimulation, intensity-and-submodality-specific settings and a immobilization period, for chronic neck and shoulder pain. Ninety-seven heavily pretreated severe chronic neck/shoulder pain patients were recruited; 34 and 44 patients were randomly allocated to different treatment arms in two patient-and-assessor-blinded, randomised controlled studies. The participants received NT or conventional physical therapy including transcutaneous electrical nerve stimulation (PT-TENS) for three to six 90-minute sessions. In Study One, NT improved chronic pain (−89.6%, Brief Pain Inventory, p < 0.0001, 95% confidence interval), function (+77.4%, range of motion) and quality of life (+88.1%) at follow-up (from 4 weeks to 5 months), whereas PT-TENS resulted in no significant changes in these parameters. Study Two demonstrated similar advantages of NT over PT-TENS and the generalisability of NT. NT-like treatments in a randomised rat study showed a similar reduction in chronic hypersensitivity (−81%, p < 0.01) compared with sham treatments. NT substantially reduces chronic neck and shoulder pain, restores function, and improves quality of life in a sustained manner. PMID:26552835

  11. Novel Noxipoint Therapy versus Conventional Physical Therapy for Chronic Neck and Shoulder Pain: Multicentre Randomised Controlled Trials.

    PubMed

    Koo, Charles C; Lin, Ray S; Wang, Tyng-Guey; Tsauo, Jau-Yih; Yang, Pan-Chyr; Yen, Chen-Tung; Biswal, Sandip

    2015-01-01

    As chronic pain affects 115 million people and costs $600B annually in the US alone, effective noninvasive nonpharmacological remedies are desirable. The purpose of this study was to determine the efficacy and the generalisability of Noxipoint therapy (NT), a novel electrotherapy characterised by site-specific stimulation, intensity-and-submodality-specific settings and a immobilization period, for chronic neck and shoulder pain. Ninety-seven heavily pretreated severe chronic neck/shoulder pain patients were recruited; 34 and 44 patients were randomly allocated to different treatment arms in two patient-and-assessor-blinded, randomised controlled studies. The participants received NT or conventional physical therapy including transcutaneous electrical nerve stimulation (PT-TENS) for three to six 90-minute sessions. In Study One, NT improved chronic pain (-89.6%, Brief Pain Inventory, p < 0.0001, 95% confidence interval), function (+77.4%, range of motion) and quality of life (+88.1%) at follow-up (from 4 weeks to 5 months), whereas PT-TENS resulted in no significant changes in these parameters. Study Two demonstrated similar advantages of NT over PT-TENS and the generalisability of NT. NT-like treatments in a randomised rat study showed a similar reduction in chronic hypersensitivity (-81%, p < 0.01) compared with sham treatments. NT substantially reduces chronic neck and shoulder pain, restores function, and improves quality of life in a sustained manner.

  12. Building better therapy for children with acute lymphoblastic leukemia.

    PubMed

    Carroll, William L; Raetz, Elizabeth A

    2005-04-01

    Childhood acute lymphoblastic leukemia is one of the most curable of all human cancers, but new approaches are urgently needed for children who relapse and to avoid severe side effects of curative therapy. Work from the laboratories of Rob Pieters and William Evans, including a paper in this issue of Cancer Cell, has led to the identification of genes whose expression correlates with drug crossresistance and long term outcome. The goal is now to integrate these and other findings using gene expression technology into the care of children with the most common pediatric malignancy. PMID:15837616

  13. [Electromagnetic and mechanical vibrations in the therapy of myofascial pains].

    PubMed

    Miriutova, N F; Levitskiĭ, E F; Abdulkina, N G

    2000-01-01

    Low-frequency vibration effectively stimulates in a direct way or via reflexes neuromuscular apparatus in patients with muscular-tonic manifestations of spinal osteochondrosis. Long-term myofixation forms foci of denervation disorders as painful muscular consolidations with active center the irritation of which gives rise to phenomenon of reflected pain. In this case it is better to begin treatment with optic red and infrared radiation on the reflexogenic zones and muscular consolidations for reduction of trophic abnormalities. This creates favourable conditions for subsequent vibrostimulation of affected nerves and muscles.

  14. Emerging therapies for treatment of acute lung injury and acute respiratory distress syndrome.

    PubMed

    Bosma, Karen J; Lewis, James F

    2007-09-01

    Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is a life-threatening form of respiratory failure that affects a heterogeneous population of critically ill patients. Although overall mortality appears to be decreasing in recent years due to improvements in supportive care, there are presently no proven, effective pharmacological therapies to treat ARDS and prevent its associated complications. The most common cause of death in ARDS is not hypoxemia or pulmonary failure, but rather multiple organ dysfunction syndrome (MODS), suggesting that improving survival in patients with ARDS may be linked to decreasing the incidence or severity of MODS. The key to developing novel treatments depends, in part, on identifying and understanding the mechanisms by which ARDS leads to MODS, although the heterogeneity and complexity of this disorder certainly poses a challenge to investigators. Novel therapies in development for treatment of ALI/ARDS include exogenous surfactant, therapies aimed at modulating neutrophil activity, such as prostaglandin and complement inhibitors, and treatments targeting earlier resolution of ARDS, such as beta-agonists and granulocyte macrophage colony-stimulating factor. From a clinical perspective, identifying subpopulations of patients most likely to benefit from a particular therapy and recognising the appropriate stage of illness in which to initiate treatment could potentially lead to better outcomes in the short term.

  15. A Study on Factors Affecting Low Back Pain and Safety and Efficacy of NSAIDs in Acute Low Back Pain in a Tertiary Care Hospital of Western Nepal

    PubMed Central

    Bhattarai, Srijana; Chhetri, Himal Paudel; Alam, Kadir; Thapa, Pabin

    2013-01-01

    Introduction: Low back pain is characterized by a range of symptoms which include pain, muscle tension or stiffness, and is localized between the shoulder blades and the folds of the buttocks, with or without spreading to the legs. Non-Steroidal Anti Inflammatory Drugs (NSAIDs) are the drugs of choice which provide an analgesic effect for acute low back pain. Aim: To study the factors affecting low back pain, efficacy and safety of different non-steroidal anti-inflammatory drugs (aceclofenac, diclofenac, naproxen and nimesulide) in low back pain. Methodology: Data collection form and numeric pain rating scale were used as study tools for studying patients’ demographies and severities of pain respectively. Patients prescribed with aceclofenac 100 mg , diclofenac 100 mg, naproxen 500 mg and nimesulide 100 mg for acute low back pain at Orthopaedics Outpatients Department of Manipal Teaching Hospital, Nepal, were enrolled in this study. The decrease in pain scores was recorded on 5th and 10th days of follow-up and pain scores were calculated. Descriptive statistics and Kruskal Wallis non parametric test were used for analysis. Results: Among 150 patients, 67.3% were females (n=101). Low back pain was more prevalent (24.7%) in age-group of 59-68 years and a positive correlation was seen. Similarly, low back pain was found to be high among people involved in agriculture, heavy weight lifters and non smokers. The decrease in average pain scores was more in the patients treated with aceclofenac (4.83 ± 0.537), followed by that in those who were treated with naproxen (4.13 ± 0.067) and diclofenac (3.84 ± 0.086). The decrease in pain scores was found to be lowest among patients who were treated with nimesulide (2.11 ± 0.148). Nimesulide presented more number of side-effects than the comparative drugs. Conclusion: Different factors affect low back pain, such as age, gender, personal habit, posture, occupation, weight lifting. Aceclofenac showed greater decrease in pain

  16. Striatal opioid receptor availability is related to acute and chronic pain perception in arthritis: does opioid adaptation increase resilience to chronic pain?

    PubMed

    Brown, Christopher A; Matthews, Julian; Fairclough, Michael; McMahon, Adam; Barnett, Elizabeth; Al-Kaysi, Ali; El-Deredy, Wael; Jones, Anthony K P

    2015-11-01

    The experience of pain in humans is modulated by endogenous opioids, but it is largely unknown how the opioid system adapts to chronic pain states. Animal models of chronic pain point to upregulation of opioid receptors (OpR) in the brain, with unknown functional significance. We sought evidence for a similar relationship between chronic pain and OpR availability in humans. Using positron emission tomography and the radiotracer (11)C-diprenorphine, patients with arthritis pain (n = 17) and healthy controls (n = 9) underwent whole-brain positron emission tomography scanning to calculate parametric maps of OpR availability. Consistent with the upregulation hypothesis, within the arthritis group, greater OpR availability was found in the striatum (including the caudate) of patients reporting higher levels of recent chronic pain, as well as regions of interest in the descending opioidergic pathway including the anterior cingulate cortex, thalamus, and periaqueductal gray. The functional significance of striatal changes were clarified with respect to acute pain thresholds: data across patients and controls revealed that striatal OpR availability was related to reduced pain perception. These findings are consistent with the view that chronic pain may upregulate OpR availability to dampen pain. Finally, patients with arthritis pain, compared with healthy controls, had overall less OpR availability within the striatum specifically, consistent with the greater endogenous opioid binding that would be expected in chronic pain states. Our observational evidence points to the need for further studies to establish the causal relationship between chronic pain states and OpR adaptation.

  17. Neck pain in military helicopter aircrew and the role of exercise therapy.

    PubMed

    Salmon, Danielle M; Harrison, Michael F; Neary, J Patrick

    2011-10-01

    Neck pain is a growing aeromedical concern for military forces on an international scale. Neck pain prevalence in the global military helicopter community has been reported in the range of 56.6-84.5%. Despite this high prevalence, historically, research examining helicopter aircrews has focused predominantly on low back pain. A number of recent studies have emerged examining flight-related factors that are hypothesized to contribute to the development of flight-related neck pain. Loading factors such as the posture adopted during flight, use of night vision goggles, and vibration have all been found to contribute to neck pain and muscular fatigue. Prolonged or repeated exposureto these loading factors has been hypothesized to perpetuate or contribute to the development of neck pain. Despite the high number of helicopter aircrew personnel that suffer from neck pain, very few individuals seek treatment for the disorder. The focus of medical personnel should, therefore, be directed toward a solution that addresses not only the issue of muscular fatigue, but the hesitancy to seek treatment. Previous research in military and civilian populations have used exercise therapy as a treatment modality for neck pain and have found improved endurance capacity in the neck musculature and reduced self-reported neck pain.

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

    PubMed

    Chang, Yu-Ping; Compton, Peggy

    2013-12-16

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

  19. Influence of shoulder pain on muscle function: implications for the assessment and therapy of shoulder disorders.

    PubMed

    Struyf, Filip; Lluch, Enrique; Falla, Deborah; Meeus, Mira; Noten, Suzie; Nijs, Jo

    2015-02-01

    Shoulder pain is often a challenging clinical phenomenon because of the potential mismatch between pathology and the perception of pain. Current evidence clearly emphasizes an incomplete understanding of the nature of shoulder pain. Indeed, the effective diagnosis and treatment of shoulder pain should not only rely upon a detailed knowledge of the peripheral pathologies that may be present in the shoulder, but also on current knowledge of pain neurophysiology. To assess and treat shoulder pain, a comprehensive understanding of the way in which pain is processed is essential. This review reflects modern pain neurophysiology to the shoulder and aims to answer the following questions: why does my shoulder hurt? What is the impact of shoulder pain on muscle function? What are the implications for the clinical examination of the shoulder? And finally, what are the clinical implications for therapy? Despite the increasing amount of research in this area, an in-depth understanding of the bidirectional nociception-motor interaction is still far from being achieved. Many questions remain, especially related to the treatment of nociception-motor interactions.

  20. Neck pain in military helicopter aircrew and the role of exercise therapy.

    PubMed

    Salmon, Danielle M; Harrison, Michael F; Neary, J Patrick

    2011-10-01

    Neck pain is a growing aeromedical concern for military forces on an international scale. Neck pain prevalence in the global military helicopter community has been reported in the range of 56.6-84.5%. Despite this high prevalence, historically, research examining helicopter aircrews has focused predominantly on low back pain. A number of recent studies have emerged examining flight-related factors that are hypothesized to contribute to the development of flight-related neck pain. Loading factors such as the posture adopted during flight, use of night vision goggles, and vibration have all been found to contribute to neck pain and muscular fatigue. Prolonged or repeated exposureto these loading factors has been hypothesized to perpetuate or contribute to the development of neck pain. Despite the high number of helicopter aircrew personnel that suffer from neck pain, very few individuals seek treatment for the disorder. The focus of medical personnel should, therefore, be directed toward a solution that addresses not only the issue of muscular fatigue