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Sample records for greater trochanteric pain

  1. Greater trochanteric pain syndrome diagnosis and treatment.

    PubMed

    Mallow, Michael; Nazarian, Levon N

    2014-05-01

    Lateral hip pain, or greater trochanteric pain syndrome, is a commonly seen condition; in this article, the relevant anatomy, epidemiology, and evaluation strategies of greater trochanteric pain syndrome are reviewed. Specific attention is focused on imaging of this syndrome and treatment techniques, including ultrasound-guided interventions. PMID:24787333

  2. Greater trochanteric pain syndrome diagnosis and treatment.

    PubMed

    Mallow, Michael; Nazarian, Levon N

    2014-05-01

    Lateral hip pain, or greater trochanteric pain syndrome, is a commonly seen condition; in this article, the relevant anatomy, epidemiology, and evaluation strategies of greater trochanteric pain syndrome are reviewed. Specific attention is focused on imaging of this syndrome and treatment techniques, including ultrasound-guided interventions.

  3. [Greater trochanteric pain syndrome of the hip].

    PubMed

    Haviv, Barak; Bronak, Shlomo; Thein, Rafael

    2014-02-01

    Lateral pain of the hip with point tenderness at the Greater Trochanter is a common musculoskeletal complaint. It is frequently diagnosed as trochanteric bursitis; however, this term is inaccurate because of evident non-inflammatory pathologies, particularly of the abductor tendons of the hip. It is important to differentiate this extra-articular source from an intra-articular or a lower back source of pain. Imaging is useful in cases of trauma, prolonged pain or uncertain diagnosis. Non-operative treatment that involves modifying activities, physiotherapy, analgesics, steroid injections and shock wave therapy is usually helpful. Nevertheless, despite the above treatments, about one third of the patients suffer from chronic pain and disability. These patients may be candidates for operative intervention. Currently, there are endoscopic surgical techniques for local decompression, bursectomy and suture of torn tendons similar to surgery used in the shoulder. PMID:24716427

  4. Greater trochanteric pain syndrome: more than bursitis and iliotibial tract friction.

    PubMed

    Ho, Garry Wai Keung; Howard, Thomas Michael

    2012-01-01

    Disorders causing lateral hip pain are encountered frequently by physicians. Evaluating these problems can be challenging because of the myriad of potential causes, the complex anatomy of the peritrochanteric structures, and the inconsistently described etiologic factors. Misconceptions about the causes of lateral hip pain and tenderness are common, frequently leading to approaches that only provide temporary solutions rather than address the underlying pathology. Trochanteric bursitis is implicated frequently but is seldom the primary cause of pain in chronic cases. It is important to address hip rotator cuff tendinopathy and pelvic core instability. Treatment options include therapeutic exercise, physical modalities, corticosteroid injections, extracorporeal shock wave therapy, and regenerative injection therapies. For recalcitrant cases, surgery may be appropriate. By understanding the anatomy of the peritrochanteric structures, and the pathologic processes most likely responsible for symptomatology and dysfunction, the physician will be prepared to provide effective long-term solutions for this common problem.

  5. Retro-trochanteric sciatica-like pain: current concept.

    PubMed

    Meknas, Khaled; Johansen, Oddmund; Kartus, Jüri

    2011-11-01

    The aim of this manuscript is to review the current knowledge in terms of retro-trochanteric pain syndrome, make recommendations for diagnosis and differential diagnosis and offer suggestions for treatment options. The terminology in the literature is confusing and these symptoms can be referred to as 'greater trochanteric pain syndrome', 'trochanteric bursitis' and 'trochanteritis', among other denominations. The authors focus on a special type of sciatica, i.e. retro-trochanteric pain radiating down to the lower extremity. The impact of different radiographic assessments is discussed. The authors recommend excluding pathology in the spine and pelvic area before following their suggested treatment algorithm for sciatica-like retro-trochanteric pain.

  6. Endoscopic bursectomy and iliotibial tract release as a treatment for refractory greater trochanteric pain syndrome: a new endoscopic approach with early results.

    PubMed

    Govaert, Louise H M; van Dijk, C Niek; Zeegers, Adelgunde V C M; Albers, Gerardus H R

    2012-12-01

    Greater trochanteric pain syndrome (GTPS) is associated with excessive tension between the iliotibial band (ITB) and the greater trochanter. Several endoscopic procedures have been reported, but in most cases the endoscopic approach only consists of a bursectomy. The ITB and fascia lata act as a lateral tension band to resist tensile strains on the concave aspect of the femur and are often implicated as the source of GTPS. We therefore believe that the ITB must be addressed. We describe an endoscopic technique to release the ITB and remove the bursa and conclude that endoscopic bursectomy with cross incision of the ITB is a safe approach to treat patients with refractory GTPS. PMID:23766989

  7. Endoscopic bursectomy and iliotibial tract release as a treatment for refractory greater trochanteric pain syndrome: a new endoscopic approach with early results.

    PubMed

    Govaert, Louise H M; van Dijk, C Niek; Zeegers, Adelgunde V C M; Albers, Gerardus H R

    2012-12-01

    Greater trochanteric pain syndrome (GTPS) is associated with excessive tension between the iliotibial band (ITB) and the greater trochanter. Several endoscopic procedures have been reported, but in most cases the endoscopic approach only consists of a bursectomy. The ITB and fascia lata act as a lateral tension band to resist tensile strains on the concave aspect of the femur and are often implicated as the source of GTPS. We therefore believe that the ITB must be addressed. We describe an endoscopic technique to release the ITB and remove the bursa and conclude that endoscopic bursectomy with cross incision of the ITB is a safe approach to treat patients with refractory GTPS.

  8. Fixation systems of greater trochanteric osteotomies: biomechanical and clinical outcomes.

    PubMed

    Jarit, Gregg J; Sathappan, Sathappan S; Panchal, Anand; Strauss, Eric; Di Cesare, Paul E

    2007-10-01

    The development of cerclage systems for fixation of greater trochanteric osteotomies has progressed from monofilament wires to multifilament cables to cable grip and cable plate systems. Cerclage wires and cables have various clinical indications, including fixation for fractures and for trochanteric osteotomy in hip arthroplasty. To achieve stable fixation and eventual union of the trochanteric osteotomy, the implant must counteract the destabilizing forces associated with pull of the peritrochanteric musculature. The material properties of cables and cable grip systems are superior to those of monofilament wires; however, potential complications with the use of cables include debris generation and third-body polyethylene wear. Nevertheless, the cable grip system provides the strongest fixation and results in lower rates of nonunion and trochanteric migration. Cable plate constructs show promise but require further clinical studies to validate their efficacy and safety.

  9. Greater Trochanteric Fixation Using a Cable System for Partial Hip Arthroplasty: A Clinical and Finite Element Analysis

    PubMed Central

    Ozan, Fırat; Koyuncu, Şemmi; Pekedis, Mahmut; Altay, Taşkın; Yıldız, Hasan; Toker, Gökhan

    2014-01-01

    The aim of the study was to investigate the efficacy of greater trochanteric fixation using a multifilament cable to ensure abductor lever arm continuity in patients with a proximal femoral fracture undergoing partial hip arthroplasty. Mean age of the patients (12 men, 20 women) was 84.12 years. Mean follow-up was 13.06 months. Fixation of the dislocated greater trochanter with or without a cable following load application was assessed by finite element analysis (FEA). Radiological evaluation was based on the distance between the fracture and the union site. Harris hip score was used to evaluate final results: outcomes were excellent in 7 patients (21.8%), good in 17 patients (53.1%), average in 5 patients (15.6%), and poor in 1 patient (9.3%). Mean abduction angle was 20.21°. Union was achieved in 14 patients (43.7%), fibrous union in 12 (37.5%), and no union in 6 (18.7%). FEA showed that the maximum total displacement of the greater trochanter decreased when the fractured bone was fixed with a cable. As the force applied to the cable increased, the displacement of the fractured trochanter decreased. This technique ensures continuity of the abductor lever arm in patients with a proximal femoral fracture who are undergoing partial hip arthroplasty surgery. PMID:25177703

  10. Evaluation and management of greater trochanter pain syndrome.

    PubMed

    Mulligan, Edward P; Middleton, Emily F; Brunette, Meredith

    2015-08-01

    Greater trochanteric pain syndrome is an enigmatic but common cause of lateral hip symptoms in middle-aged active women. The most common manifestation of this syndrome is a degenerative tendinopathy of the hip abductors similar to the intrinsic changes seen with rotator cuff pathology in the shoulder. There are no definitive tests to isolate the underlying pathology and palpation is a non-specific means by which to differentiate the source of the pain generator. The physical examination must comprehensively evaluate for a cluster of potential impairments and contributing factors that will need to be addressed to effectively manage the likely functional limitations and activity challenges the syndrome presents to the patient. Compressive forces through increased tension in the iliotibial band should be avoided. Intervention strategies should include education regarding postural avoidance, activity modifications, improvement of lumbopelvic control, and a patient approach to resolving hip joint restrictions and restoring the tensile capabilities of the deep rotators and abductors of the hip. A number of reliable and validated hip-specific self-report outcome tools are available to baseline a patient's status and monitor their progress. Further investigations to identify the epidemiological risk factors, establish effective treatment strategies, and predict prognosis are warranted. PMID:25497431

  11. Evaluation and management of greater trochanter pain syndrome.

    PubMed

    Mulligan, Edward P; Middleton, Emily F; Brunette, Meredith

    2015-08-01

    Greater trochanteric pain syndrome is an enigmatic but common cause of lateral hip symptoms in middle-aged active women. The most common manifestation of this syndrome is a degenerative tendinopathy of the hip abductors similar to the intrinsic changes seen with rotator cuff pathology in the shoulder. There are no definitive tests to isolate the underlying pathology and palpation is a non-specific means by which to differentiate the source of the pain generator. The physical examination must comprehensively evaluate for a cluster of potential impairments and contributing factors that will need to be addressed to effectively manage the likely functional limitations and activity challenges the syndrome presents to the patient. Compressive forces through increased tension in the iliotibial band should be avoided. Intervention strategies should include education regarding postural avoidance, activity modifications, improvement of lumbopelvic control, and a patient approach to resolving hip joint restrictions and restoring the tensile capabilities of the deep rotators and abductors of the hip. A number of reliable and validated hip-specific self-report outcome tools are available to baseline a patient's status and monitor their progress. Further investigations to identify the epidemiological risk factors, establish effective treatment strategies, and predict prognosis are warranted.

  12. Treatment of trochanteric bursitis: our experience

    PubMed Central

    Nurkovic, Jasmin; Jovasevic, Ljubisa; Konicanin, Admira; Bajin, Zoran; Ilic, Katarina Parezanovic; Grbovic, Vesna; Skevin, Aleksandra Jurisic; Dolicanin, Zana

    2016-01-01

    [Purpose] Trochanteric bursitis is a disease for which there are no effective standardized therapy protocols. Very often pain persists in spite of applying all therapeutic treatments. The purpose of this study was to determine whether treatment of trochanteric bursitis with a local injection of bicomponent corticosteroid and 2% lidocaine would improve patients’ conditions and relieve pain symptoms in the trochanteric area. [Subjects and Methods] A retrospective observational study was conducted of 2,217 patients in a 6 year follow-up period at the Special Hospital “Agens”, Mataruska Banja, Serbia. [Results] Of 2,217 examined patients, 58 (2.6%) patients were found to suffer from trochanteritis associated with low back pain, and 157 (7%) were found to suffer from trochanteric pains without low back pains. Local corticosteroid therapy followed by physical therapy was effective in 77 (49%) of these patients, and only corticosteroid injection in 61 (39%) patients. A single injection was given to 47 (29.9%) of the patients. Two injections were given to 9 (5.7%) patients, and from 3 to 5 injections were given repeatedly every 4–6 weeks to 7 (4.5%) patients. [Conclusion] For most patients, local injections of corticosteroids with lidocaine alone or followed by physical therapy gave satisfactory results. PMID:27512268

  13. Treatment of trochanteric bursitis: our experience.

    PubMed

    Nurkovic, Jasmin; Jovasevic, Ljubisa; Konicanin, Admira; Bajin, Zoran; Ilic, Katarina Parezanovic; Grbovic, Vesna; Skevin, Aleksandra Jurisic; Dolicanin, Zana

    2016-07-01

    [Purpose] Trochanteric bursitis is a disease for which there are no effective standardized therapy protocols. Very often pain persists in spite of applying all therapeutic treatments. The purpose of this study was to determine whether treatment of trochanteric bursitis with a local injection of bicomponent corticosteroid and 2% lidocaine would improve patients' conditions and relieve pain symptoms in the trochanteric area. [Subjects and Methods] A retrospective observational study was conducted of 2,217 patients in a 6 year follow-up period at the Special Hospital "Agens", Mataruska Banja, Serbia. [Results] Of 2,217 examined patients, 58 (2.6%) patients were found to suffer from trochanteritis associated with low back pain, and 157 (7%) were found to suffer from trochanteric pains without low back pains. Local corticosteroid therapy followed by physical therapy was effective in 77 (49%) of these patients, and only corticosteroid injection in 61 (39%) patients. A single injection was given to 47 (29.9%) of the patients. Two injections were given to 9 (5.7%) patients, and from 3 to 5 injections were given repeatedly every 4-6 weeks to 7 (4.5%) patients. [Conclusion] For most patients, local injections of corticosteroids with lidocaine alone or followed by physical therapy gave satisfactory results. PMID:27512268

  14. Pain hypervigilance is associated with greater clinical pain severity and enhanced experimental pain sensitivity among adults with symptomatic knee osteoarthritis

    PubMed Central

    Herbert, Matthew S.; Goodin, Burel R.; Pero, Samuel T.; Schmidt, Jessica K.; Sotolongo, Adriana; Bulls, Hailey W.; Glover, Toni L.; King, Christopher D.; Sibille, Kimberly T.; Cruz-Almeida, Yenisel; Staud, Roland; Fessler, Barri J.; Bradley, Laurence A.; Fillingim, Roger B.

    2014-01-01

    Background Pain hypervigilance is an important aspect of the fear-avoidance model of pain that may help explain individual differences in pain sensitivity among persons with knee osteoarthritis (OA). Purpose The purpose of this study was to examine the contribution of pain hypervigilance to clinical pain severity and experimental pain sensitivity in persons with symptomatic knee OA. Methods We analyzed cross-sectional data from 168 adults with symptomatic knee OA. Quantitative sensory testing was used to measure sensitivity to heat pain, pressure pain, and cold pain, as well as temporal summation of heat pain, a marker of central sensitization. Results Pain hypervigilance was associated with greater clinical pain severity, as well as greater pressure pain. Pain hypervigilance was also a significant predictor of temporal summation of heat pain. Conclusions Pain hypervigilance may be an important contributor to pain reports and experimental pain sensitivity among persons with knee OA. PMID:24352850

  15. Arthroscopic bursectomy with concomitant iliotibial band release for the treatment of recalcitrant trochanteric bursitis.

    PubMed

    Farr, Derek; Selesnick, Harlan; Janecki, Chet; Cordas, Daniel

    2007-08-01

    Trochanteric bursitis with lateral hip pain is a commonly encountered orthopaedic condition. Although most patients respond to corticosteroid injections, rest, physical therapy (PT), stretching, and anti-inflammatory medications, those with recalcitrant symptoms may require operative intervention. Studies have explored the use of the arthroscope in the treatment of these patients. However, these reports have not addressed the underlying pathology in this chronic condition. We believe that the iliotibial band must be addressed and is the main cause of pain, inflammation, and trochanteric impingement leading to the development of bursitis. We report a new technique for arthroscopic trochanteric bursectomy with iliotibial band release. Our technique involves 2 incisions--one 4 cm proximal to the greater trochanter along the anterior border of the iliotibial band, and the other 4 cm distal and along the posterior border. The 30 degrees arthroscope is introduced through the inferior portal, and a cannula is introduced through the superior portal. A 5.5-mm arthroscopic shaver is inserted through the superior cannula to clear off the surface of the iliotibial band, so that it may be adequately visualized. A hooked electrocautery probe is then used to longitudinally incise the iliotibial band until it no longer rubs, causing impingement over the greater trochanter.

  16. Arthroscopic bursectomy for recalcitrant trochanteric bursitis after hip arthroplasty.

    PubMed

    Van Hofwegen, Christopher; Baker, Champ L; Savory, Carlton G; Baker, Champ L

    2013-01-01

    This study evaluated the use of arthroscopic bursectomy for pain relief in patients with trochanteric bursitis after hip arthroplasty. In this retrospective case series of 12 patients undergoing arthroscopic treatment of recalcitrant trochanteric bursitis after hip arthroplasty, outcomes were assessed via phone interview with a numeric pain rating scale from 1 to 10 and were compared with preoperative pain ratings. Patients were asked the percentage of time they had painless hip function and whether they would have the surgery again. At an average 36-month follow-up (range, 4-85 months), the average numeric pain scale rating improved from 9.3 to 3.3. At an average of 62% of the time, patients had painless use of the hip. Ten of 12 patients in the study felt the pain relief gained was substantial enough to warrant having procedure again. In these patients, arthroscopic bursectomy was a viable option for patients with recalcitrant bursitis after hip arthroplasty. PMID:23628567

  17. Severe Pain Predicts Greater Likelihood of Subsequent Suicide

    ERIC Educational Resources Information Center

    Ilgen, Mark A.; Zivin, Kara; Austin, Karen L.; Bohnert, Amy S. B.; Czyz, Ewa K.; Valenstein, Marcia; Kilbourne, Amy M.

    2010-01-01

    Using data from the 1999 Large Health Survey of Veterans, Veterans Affairs' medical records, and the National Death Index (N = 260,254), the association between self-reported pain severity and suicide among veterans as examined, after accounting for demographic variables and psychiatric diagnoses. A Cox proportional hazards regression demonstrated…

  18. Trochanteric bursitis after total hip arthroplasty: incidence and evaluation of response to treatment.

    PubMed

    Farmer, Kevin W; Jones, Lynne C; Brownson, Kirstyn E; Khanuja, Harpal S; Hungerford, Marc W

    2010-02-01

    We examined the efficacy of corticosteroid injection as treatment for postarthroplasty trochanteric bursitis and the risk factors for failure of nonoperative treatment. There were 32 (4.6%) cases of postsurgical trochanteric bursitis in 689 primary total hip arthroplasties. Of the 25 hips with follow-up, 11 (45%) required multiple injections. Symptoms resolved in 20 (80%) but persisted in 5. We found no statistically significant differences between patients who did and did not develop trochanteric bursitis, or between those who did and did not respond to treatment. There was a trend toward younger age and greater limb-length discrepancy in nonresponders. In conclusion, (1) corticosteroid injection(s) for postoperative trochanteric bursitis is effective; and (2) nonoperative management may be more likely to fail in young patients and those with leg-length discrepancy.

  19. Effect of prophylactic trochanteric epiphyseodesis in older children with Perthes' disease.

    PubMed

    Shah, Hitesh; Siddesh, Nandi D; Joseph, Benjamin; Nair, Sreekumaran N

    2009-12-01

    To evaluate the effect of prophylactic epiphyseodesis of the greater trochanter in Perthes' disease, 62 children with unilateral Perthes' disease who underwent trochanteric epiphyseodesis combined with varus osteotomy of the femur during the active stage of the disease (mean age at surgery: 8.4 y) and 20 controls were followed up until skeletal maturity. On radiographs taken at skeletal maturity, the articulo-trochanteric distance, the center-trochanteric distance, the length of the abductor lever arm, the neck-shaft angle, the radius of the femoral head, and the Reimer's migration index of normal and affected hips were measured. The shape of the femoral head was assessed according to the criteria of Mose. The range of hip motion, the strength of hip abduction, and limb lengths were measured and the Trendelenburg sign was elicited. The mean values of articulo-trochanteric distance and center-trochanteric distance were greater and the frequency of a positive Trendelenburg sign was less in children who had undergone trochanteric epiphyseodesis than in children who had no surgery (P<0.01). Trochanteric epiphyseodesis achieved optimal trochanteric growth arrest in 60% of operated children; the procedure was not effective in 30%, and in 10% of children there was overcorrection. Logistic regression analysis showed that the size of the femoral head at healing and the age at surgery were variables that significantly influenced the effectiveness of trochanteric growth arrest. At skeletal maturity, the mean shortening of the affected limb in operated children was 0.44 cm (SD 0.68 cm), whereas that of non-operated children was 0.86 cm (SD 0.78 cm) (P<0.05). The range of motion of the hip was excellent and there were no significant differences in the range of motion among children with optimal correction, under-correction, and overcorrection. A probability curve plotted on the basis of a logistic regression model suggests that effective trochanteric arrest may be achieved in a

  20. Trans trochanteric approach with coronal osteotomy of the great trochanter

    PubMed Central

    Steffann, Francois; Prudhon, Jean-Louis; Puch, Jean-Marc; Ferreira, André; Descamps, Loys; Verdier, Régis; Caton, Jacques

    2015-01-01

    Several surgical approaches could be used in hip arthroplasty or trauma surgery: anterior, anterolateral, lateral, posterior (with or without trochanterotomy), using or not an orthopedic reduction table. Subtrochanteric and extra-capsular trochanteric fractures (ECTF) are usually treated by internal fixation with mandatory restrictions on weight bearing. Specific complications have been widely described. Mechanical failures are particularly high in unstable fractures. Hip fractures are a major public health issue with a mortality rate of 12%–23% at 1 year. An alternative option is to treat ECTF by total hip arthroplasty (THA) to prevent decubitus complications, to help rapid recovery, and to permit immediate weight bearing as well as quick rehabilitation. However, specific risks of THA have to be considered such as dislocation or cardiovascular failure. The classical approach (anterior or posterior) requires the opening of the joint and capsule, weakening hip stability and the repair of the great trochanter is sometimes hazardous. For 15 years, we have been treating unstable ECTF by THA with cementless stem, dual mobility cup (DMC), greater trochanter (GT) reattachment, and a new surgical approach preserving capsule, going through the fracture and avoiding joint dislocation. Bombaci first described a similar approach in 2008; our trans fractural digastric approach (medial gluteus and lateral vastus) is different. A coronal GT osteotomy is performed when there is no coronal fracture line. It allows easy access to the femoral neck and acetabulum. The THA is implanted without femoral internal rotation to avoid extra bone fragment displacement. With pre-operative planning, cup implantation is easy and stem positioning is adjusted referring to the top of the GT after trial reduction and preoperative planning. The longitudinal osteotomy and trochanteric fracture are repaired with wires and the digastric incision is closed. This variant of Bombaci approach could be

  1. Lateral Hip Pain in an Athletic Population

    PubMed Central

    Grumet, Robert C.; Frank, Rachel M.; Slabaugh, Mark A.; Virkus, Walter W.; Bush-Joseph, Charles A.; Nho, Shane J.

    2010-01-01

    Context: Historically, the term greater trochanteric pain syndrome has been used to describe a spectrum of conditions that cause lateral-sided hip pain, including greater trochanteric bursitis, snapping iliotibial band, and/or strains or tendinopathy of the abductor mechanism. Diagnosis of these conditions may be difficult because clinical presentations are variable and sometimes inconclusive. Especially difficult is differentiating intrinsic pain from pain referred to the greater trochanteric region. The purposes of this article are to review the relevant anatomy and pathophysiology of the lateral hip. Evidence Acquisition: Data were collected through a thorough review of the literature conducted through a MEDLINE search of all relevant papers between 1980 and January 2010. Results: Recent advances in imaging and an improved understanding of pathomechanics have helped to guide the evaluation, diagnosis, and appropriate treatment for patients presenting with lateral hip pain. Conclusion: Various diagnostic tools and treatment modalities can be used to effectively manage the athletic patient presenting with lateral hip pain. PMID:23015937

  2. Traumatic subchondral fracture of the femoral head in a healed trochanteric fracture

    PubMed Central

    Lee, Sang Yang; Niikura, Takahiro; Iwakura, Takashi; Kurosaka, Masahiro

    2014-01-01

    An 82-year-old woman sustained a trochanteric fracture of the left femur after a fall. Fracture fixation was performed using proximal femoral nail antirotation (PFNA) II, and she was able to walk with a T-cane after 3 months. Eleven months following the operation, the patient presented with left hip pain after a fall. Radiographs showed a subchondral collapse of the femoral head located above the blade tip. The authors removed the PFNA-II and subsequently performed cemented bipolar hemiarthroplasty. Histological evaluation of the femoral head showed osteoporosis with no evidence of osteonecrosis. Repair tissue, granulation tissue and callus formation were seen at the collapsed subchondral area. Based on these findings, a traumatic subchondral fracture of the femoral head in a healed trochanteric fracture was diagnosed. A traumatic subchondral fracture of the femoral head may need to be considered as a possible diagnosis after internal fixation of the trochanteric fracture. PMID:25015169

  3. Individuals with patellofemoral pain exhibit greater patellofemoral joint stress: a finite element analysis study

    PubMed Central

    Farrokhi, S.; Keyak, J.H.; Powers, C.M.

    2016-01-01

    Summary Objective To test the hypothesis that individuals with patellofemoral pain (PFP) exhibit greater patellofemoral joint stress profiles compared to persons who are pain-free. Methods Ten females with PFP and ten gender, age, and activity-matched pain-free controls participated. Patella and femur stress profiles were quantified utilizing subject-specific finite element (FE) models of the patellofemoral joint at 15° and 45° of knee flexion. Input parameters for the FE model included: (1) joint geometry, (2) quadriceps muscle forces, and (3) weight-bearing patellofemoral joint kinematics. Using a nonlinear FE solver, quasi-static loading simulations were performed to quantify each subject’s patellofemoral joint stress profile during a static squatting maneuver. The patella and femur peak and mean hydrostatic pressure as well as the peak and mean octahedral shear stress for the elements representing the chondro-osseous interface were quantified. Results Compared to the pain-free controls, individuals with PFP consistently exhibited greater peak and mean hydrostatic pressure as well as peak and mean octahedral shear stress for the elements representing the patella and femur chondro-osseous interface across the two knee flexion angles tested (15° and 45°). Conclusions The combined finding of elevated hydrostatic pressure and octahedral shear stress across the two kneeflexion angles supports the premise that PFPmay be associated with elevated joint stress. Therefore, treatments aimed at decreasing patellofemoral joint stress may be indicated in this patient population. PMID:21172445

  4. Increased pain intensity is associated with greater verbal communication difficulty and increased production of speech and co-speech gestures.

    PubMed

    Rowbotham, Samantha; Wardy, April J; Lloyd, Donna M; Wearden, Alison; Holler, Judith

    2014-01-01

    Effective pain communication is essential if adequate treatment and support are to be provided. Pain communication is often multimodal, with sufferers utilising speech, nonverbal behaviours (such as facial expressions), and co-speech gestures (bodily movements, primarily of the hands and arms that accompany speech and can convey semantic information) to communicate their experience. Research suggests that the production of nonverbal pain behaviours is positively associated with pain intensity, but it is not known whether this is also the case for speech and co-speech gestures. The present study explored whether increased pain intensity is associated with greater speech and gesture production during face-to-face communication about acute, experimental pain. Participants (N = 26) were exposed to experimentally elicited pressure pain to the fingernail bed at high and low intensities and took part in video-recorded semi-structured interviews. Despite rating more intense pain as more difficult to communicate (t(25)  = 2.21, p =  .037), participants produced significantly longer verbal pain descriptions and more co-speech gestures in the high intensity pain condition (Words: t(25)  = 3.57, p  = .001; Gestures: t(25)  = 3.66, p =  .001). This suggests that spoken and gestural communication about pain is enhanced when pain is more intense. Thus, in addition to conveying detailed semantic information about pain, speech and co-speech gestures may provide a cue to pain intensity, with implications for the treatment and support received by pain sufferers. Future work should consider whether these findings are applicable within the context of clinical interactions about pain. PMID:25343486

  5. Bursectomy, Curettage, and Chemotherapy in Tuberculous Trochanteric Bursitis.

    PubMed

    Ramos-Pascua, Luis R; Carro-Fernández, José A; Santos-Sánchez, José A; Casas Ramos, Paula; Díez-Romero, Luis J; Izquierdo-García, Francisco M

    2016-03-01

    We presented three patients with trochanteric tuberculosis and described the clinical and imaging findings of the infection. Histology revealed a necrotizing granulomatous bursitis and microbiology confirmed tuberculosis. All cases were successfully treated with bursectomy and curettage of the trochanteric lesion and antituberculous chemotherapy including isoniazid, pyrazinamide, rifampicin, and ethambutol. PMID:26929807

  6. Bursectomy, Curettage, and Chemotherapy in Tuberculous Trochanteric Bursitis

    PubMed Central

    Carro-Fernández, José A.; Santos-Sánchez, José A.; Casas Ramos, Paula; Díez-Romero, Luis J.; Izquierdo-García, Francisco M.

    2016-01-01

    We presented three patients with trochanteric tuberculosis and described the clinical and imaging findings of the infection. Histology revealed a necrotizing granulomatous bursitis and microbiology confirmed tuberculosis. All cases were successfully treated with bursectomy and curettage of the trochanteric lesion and antituberculous chemotherapy including isoniazid, pyrazinamide, rifampicin, and ethambutol. PMID:26929807

  7. Association of depression with sleep quality might be greater than that of pain intensity among outpatients with chronic low back pain

    PubMed Central

    Wang, Hsin-Yu; Fu, Tsai-Sheng; Hsu, Shih-Chieh; Hung, Ching-I

    2016-01-01

    Purpose No study to date has compared the associations of pain intensity, depression, and anxiety with insomnia among outpatients with chronic low back pain (CLBP). This study aimed to investigate this issue. Patients and methods A total of 225 outpatients with CLBP were enrolled from a general orthopedics clinic. The Insomnia Severity Index was used to evaluate sleep quality. Major depressive disorder (MDD) and anxiety disorders were diagnosed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision, Axis I Disorders. Two psychometric scales were used to evaluate depression and anxiety. The Visual Analog Scale was employed to assess pain intensity. Multiple linear regressions were performed to determine the association of insomnia with pain intensity, depression, and anxiety. Results Among the 225 subjects, 58 (25.8%) had clinical insomnia; 83 (36.9%) had severe low back pain; 49 (21.8%) had MDD, including 21 (9.3%) with a current major depressive episode (MDE); and 52 (23.1%) had anxiety disorders. More than half (56.9%) of the subjects with CLBP and clinical insomnia had MDD and/or anxiety disorders. Subjects with a current MDE or anxiety disorders had greater severities of pain and insomnia as compared with subjects without these conditions. After controlling for demographic variables, MDE was more strongly associated with insomnia than severe low back pain; moreover, the severity of depression had a greater association with insomnia than pain intensity. Conclusion The association of depression with insomnia was not inferior to that of pain intensity with insomnia. Among patients with CLBP and insomnia, integration of depression and anxiety treatment into treatment of pain might help to improve sleep quality. PMID:27563244

  8. Trochanteric Stress Fracture in a Female Window Cleaner

    PubMed Central

    Lee, Bong-Jin

    2016-01-01

    Stress fractures may occur at various sites in the femur including the head, neck, shaft, supracondylar and condylar regions. To the best of our knowledge, stress fracture occurring in the trochanteric region has not been previously reported. We report here a case of trochanteric stress fracture in a 53-year-old female window cleaner treated with hip nailing without adverse consequences. Careful consideration of this entity is needed when evaluating patients who have repetitive jumping up and down. PMID:27536646

  9. [Hemiarthroplasty for treatment of comminuted trochanteric fractures in elderly patients].

    PubMed

    Szczesny, Grzegorz; Górski, Radosław; Biedrzycki, Jerzy; Górecki, Andrzej

    2009-01-01

    Successful operative stabilization of the comminuted, trochanteric fractures in elderly patients is problematic due to advanced osteoporosis and poor physical activity excluding the cooperation in the postoperative rehabilitation. Stable fixation with dynamic hip screw or gamma nail, or flexible Ender nailing requires relieve of load during forthcoming several postoperative weeks needed for bone union, that reduced their usefulness in elderly patients. The aim of study was to analyze the usefulness of the cemented hemiartrhoplasty for the treatment of patients with comminuted trochanteric fractures. We analyzed 18 patients (16 women and 2 men, aged 69- 93-years-old (mean 83.3 years) treated in our Department in 2007 with cemented hemiathroplasty due to comminuted trochanteric fractures. Patients were intensively rehabilitated bearing their body weights from 3rd-5th, and consequently discharged on 9th-12th postoperative day. Due to the possibility of almost immediate mobilization in the postoperative period, cemented hemiathroplasty could be a method of choice for the treatment of the comminuted trochanteric fractures in elderly patients. PMID:20201331

  10. Polymer cable/grip-plate system with locking screws for stable fixation to promote healing of trochanteric osteotomies or fractures in revision total hip arthroplasty.

    PubMed

    Berend, Keith R; Willen, Jacob L; Morris, Michael J; Adams, Joanne B; Lombardi, Adolph V

    2014-11-01

    Multiple methods have been proposed to establish stable fixation to promote healing of trochanteric osteotomies or fractures in revision total hip arthroplasty (revTHA), from wiring techniques through cable-plate systems with or without supplemental locking screws. The purpose of this study is to report the clinical results of a single cable-plate system with locked screw fixation in revTHA. Between 2009 and 2012, 27 grip-plates (Supercable® System, Kinamed Inc., Camarillo, CA) were used in 26 patients in 27 revTHA procedures. Utilization was 12 1-hole (50 mm) grip-plates, 10 2-hole (135 mm) grip-plates, four 4-hole (190 mm) grip-plates, and one 6-hole (245 mm) grip-plate. There were 14 women and 12 men. Age averaged 63.2 years and BMI averaged 29.4 kg/m2. At average 2.5 year follow-up, grip-plate fixation was considered successful in 22 hips (81%) with five failures. Three failures consisted of 50 mm/short grip-plates used in one trochanteric slide, and two intraoperative trochanteric fractures during revTHA. The two additional failures were related to pre-revision trochanteric avulsion from bony necrosis of the proximal femur. An additional three grip-plates were removed electively for soft-tissue irritation and pain but with successful fixation and bony healing. Thus 70% of hips were free of reoperation related to the grip-plate. All other hips had successful fixation and the grip-plate was not symptomatic. In this study, the cable-grip system and isoelastic Supercables provided reliable fixation for adequate healing of difficult ETO and trochanteric fractures with an 81% rate of mechanical success with radiographic and clinical healing observed.

  11. [Problems with treatment of trochanteric femur fractures at elderly patients].

    PubMed

    Zieńczuk, Witold; Cetnar, Tomasz; Kawik, Łukasz; Kotela, Ireneusz

    2010-01-01

    Authors analyzed patients complications with trochanteric fractures of femur treated in Department Orthopedic and Casualty of St. Lukas Hospital in Tarnów from 01.01.2008 to 31.12.2009 in this study. During this period were treated 167 patients. In most of cases operative treatment such as: Dynamic Hip Screw fixation, Gamma nailing, Ender's method and angle plate with screws were used. Prosthetic replacement was also used and 9 patients weren't operated because of coexisting pathological states. Basing on a done analyze of clinical material it was pronounced that independently from used surgical procedure regional and general complications are being occurred. PMID:20684339

  12. Structural allograft and cemented long-stem prosthesis for complex revision hip arthroplasty: use of a trochanteric claw plate improves final hip function

    PubMed Central

    Lemoine, Camille Thevenin; Kerboull, Marcel; Courpied, Jean Pierre

    2007-01-01

    Extensive bone loss raises formidable challenges in total hip revision. The aim of this study was to evaluate the results of reconstruction using a cemented long-stem and massive structural allograft implanted in a filleted proximal femur, with and without the use of a trochanteric claw plate. Between 1988 and 2001, 44 revisions were performed in 42 patients. After a transtrochanteric approach, the femur was cut longitudinally. A long, cemented Charnley-type prosthesis was used, and flaps of the residual femur were folded around the allograft. The greater trochanter was reinserted with wires in all revisions, and with both wires and a claw plate in 20 revisions. Mean follow-up was 7.15 years (range: 3–16); seven patients, died and four were lost to follow-up. The follow-up exceeded five years in 34 patients. The major complication was nonunion of the greater trochanter, which occurred in 25 cases. Six dislocations, one recurrence of infection, two mechanical loosening, and two fractures below the stem were also recorded. The use of a trochanteric claw plate significantly improved final hip stability, even in patients with nonunion. Femoral reconstruction with a massive structural allograft is reliable and long-lived, and serious complications and long-term resorption are uncommon. The use of a trochanteric claw plate significantly improves final hip stability. Level of evidence: Therapeutic study, level III (retrospective comparative study). PMID:18008098

  13. Low Vitamin D levels are associated with greater pain and slow walking speed in patients with knee osteoarthritis (KOA)

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The clinical status of patients with knee OA is primarily predicated by their level of pain and their muscle function. Recent studies have shown that vitamin D influences both musculoskeletal health and neuromuscular function. Vitamin D deficiency is common among elders and those with comorbidities....

  14. [Resurfacing of a trochanteric pressure sore by a pedicled fasciocutaneous anterolateral thigh flap: a case report].

    PubMed

    Zeitoun, J; Faghahati, S; Burin Des Roziers, B; Daoud, G; Cartier, S

    2013-06-01

    The anterolateral thigh flap is usually used as a free flap for various kinds of reconstruction and resurfacing of distant areas. Cover of a deep trochanteric pressure sore is commonly made by muscular or musculocutaneous flaps such as tensor of fascia lata or vastus lateralis. We report the case of a trochanteric pressure sore covered by a fasciocutaneous pedicled anterolateral thigh flap after negative pressure therapy in a 58-year-old paraplegic patient. After 6 months, a good quality of coverage was obtained with minimal morbidity of donor site. The pedicled fasciocutaneous anterolateral flap appears as a reliable option for the treatment of trochanteric pressure sore.

  15. [Assessment of mechanical complications of intramedullary osteosynthesis in trochanteric fractures of the femur in elderly people].

    PubMed

    Hładki, Waldemar; Bednarenko, Marcin; Kotela, Ireneusz

    2011-01-01

    Operational treatment of trochanteric fractures of the femur, independently of the applied connecting implant, carries the risk of various types of complications. In this paper the incidence of mechanical complications in performed osteosynthesis of trochanteric fractures of the femur was analyzed as well as the risk factors influencing them and their extent were assessed. The results showed statistically significant influence of the type of implant, the type of fracture and the patients' age. It has been proven that the use of Gamma nail decreases the risk of mechanical complications almost twofold in comparison with the Ender's posts, disregarding the type of trochanteric fracture of the femur. PMID:21751513

  16. Association between trochanteric bursitis, osteoarthrosis and total hip arthroplasty☆☆☆

    PubMed Central

    Schwartsmann, Carlos Roberto; Loss, Felipe; de Freitas Spinelli, Leandro; Furian, Roque; Silva, Marcelo Faria; Zanatta, Júlia Mazzuchello; Boschin, Leonardo Carbonera; Gonçalves, Ramiro Zilles; Yépez, Anthony Kerbes

    2014-01-01

    Objective this was an epidemiological study on trochanteric bursitis at the time of performing total hip arthroplasty. Methods sixty-two sequential patients who underwent total hip arthroplasty due to osteoarthrosis, without any previous history of trochanteric bursitis, were evaluated. The bursas were collected and evaluated histologically. Results there were 35 female patients (56.5%) and 27 male patients (43.5%), with a mean age of 65 years (±11). Trochanteric bursitis was conformed histologically in nine patients (14.5%), of whom six were female (66.7%) and three were male (33.3%). Conclusions 14.5% of the bursas analyzed presented inflammation at the time that the primary total hip arthroplasty due to osteoarthrosis was performed, and the majority of the cases of bursitis were detected in female patients. PMID:26229811

  17. High volume image-guided injections and structured rehabilitation improve greater trochanter pain syndrome in the short and medium term: a combined retrospective and prospective case series

    PubMed Central

    Morton, Sarah; Chan, Otto; Price, Jessica; Pritchard, Melanie; Crisp, Tom; Perry, John D.; Morrissey, Dylan

    2015-01-01

    Summary Background the aim of this study was to measure the effects of high volume image-guided injections and structured rehabilitation (HVIGI&SR) for greater trochanter pain syndrome (GTPS). Methods 31 consecutive subjects were recruited (23 retrospectively; 8 prospectively) over 5 months. GTPS was diagnosed based on history and examination findings, alongside radiological examination. The HVI-GI used a 22-gauge spinal needle to administer 10ml of 0.5% Marcaine and 50 mg hydrocortisone just deep to the periosteum underlying the gluteal tendon insertion under ultrasound guidance, followed by structured rehabilitation. A visual analogue scale (VAS) for pain was used as the main outcome measure. Results the mean VAS improved from 81.7 mm (±17.6) to 42.3 mm (±28.3), (p<0.05) in the prospective subjects at a mean of 6 weeks, considered clinically significant. In the retrospective subjects the mean VAS had improved from 74.6 (±10.9) mm to 38.2(±31.2) mm at two weeks (p<0.01) and 31.3 (±27.6) mm at the final time point, a mean of 60 weeks (p<0.01). The Hip and Groin Outcome Score in the prospective group showed a non-significant increase from 173.2 to 296.1 (p=0.12). Conclusion HVIGI&SR should be considered when short- and medium-term pain-relieving treatment for GTPS is required. Controlled studies are warranted to fully establish effectiveness, and assess long term effects. Level of evidence case series. PMID:26261785

  18. Knee pain

    MedlinePlus

    Pain - knee ... Knee pain can have different causes. Being overweight puts you at greater risk for knee problems. Overusing your knee can trigger knee problems that cause pain. If you have a history of arthritis, it ...

  19. Ultrasonography-assisted arthroscopic proximal iliotibial band release and trochanteric bursectomy.

    PubMed

    Weinrauch, Patrick; Kermeci, Sharon

    2013-01-01

    We describe arthroscopic iliotibial band release and trochanteric bursectomy assisted by intraoperative ultrasonography for accurate placement of arthroscopic portals and to ensure adequate decompression of the peritrochanteric space. We have found ultrasonography for endoscopic iliotibial band release a useful tool to assist with localizing the site and length of decompression. PMID:24400195

  20. Ultrasonography-assisted arthroscopic proximal iliotibial band release and trochanteric bursectomy.

    PubMed

    Weinrauch, Patrick; Kermeci, Sharon

    2013-01-01

    We describe arthroscopic iliotibial band release and trochanteric bursectomy assisted by intraoperative ultrasonography for accurate placement of arthroscopic portals and to ensure adequate decompression of the peritrochanteric space. We have found ultrasonography for endoscopic iliotibial band release a useful tool to assist with localizing the site and length of decompression.

  1. Influence of Lateral Muscle Loading in the Proximal Femur after Fracture Stabilization with a Trochanteric Gamma Nail (TGN)

    NASA Astrophysics Data System (ADS)

    Sitthiseripratip, Kriskrai; Mahaisavariya, Banchong; Suwanprateeb, Jintamai; Bohez, Erik; Vander Sloten, Jos

    The purpose of this study was to investigate the influence of lateral muscle loading on the stress/strain distributions of the trochanteric Gamma nail (TGN) fixation within the healed, trochanteric and subtrochanteric femoral fractures by means of a finite element method. The effect of three muscle groups, the abductors (ABD), the vastus lateralis (VL) and the iliotibial band (ITB), were investigated. The analytical results showed that addition of lateral muscle forces, iliotibial band and vastus lateralis, produced compensation of forces and reduction of bending moments in the bone and in the trochanteric Gamma nail especially in the lateral aspect. The iliotibial band produced a higher impact as compared to the vastus lateralis. Therefore in the finite element analysis of the proximal femur with the trochanteric Gamma nail fracture fixation should include the lateral muscle forces to simulate load condition with maximal physiological relevance to the closed nailing technique.

  2. The administration of intermittent parathyroid hormone affects functional recovery from trochanteric fractured neck of femur

    PubMed Central

    Chesser, T. J. S.; Fox, R.; Harding, K.; Halliday, R.; Barnfield, S.; Willett, K.; Lamb, S.; Yau, C.; Javaid, M. K.; Gray, A. C.; Young, J.; Taylor, H.; Shah, K.; Greenwood, R.

    2016-01-01

    Aims We wished to assess the feasibility of a future randomised controlled trial of parathyroid hormone (PTH) supplements to aid healing of trochanteric fractures of the hip, by an open label prospective feasibility and pilot study with a nested qualitative sub study. This aimed to inform the design of a future powered study comparing the functional recovery after trochanteric hip fracture in patients undergoing standard care, versus those who undergo administration of subcutaneous injection of PTH for six weeks. Patients and Methods We undertook a pilot study comparing the functional recovery after trochanteric hip fracture in patients 60 years or older, admitted with a trochanteric hip fracture, and potentially eligible to be randomised to either standard care or the administration of subcutaneous PTH for six weeks. Our desired outcomes were functional testing and measures to assess the feasibility and acceptability of the study. Results A total of 724 patients were screened, of whom 143 (20%) were eligible for recruitment. Of these, 123 were approached and 29 (4%) elected to take part. However, seven patients did not complete the study. Compliance with the injections was 11 out of 15 (73%) showing the intervention to be acceptable and feasible in this patient population. Take home message: Only 4% of patients who met the inclusion criteria were both eligible and willing to consent to a study involving injections of PTH, so delivering this study on a large scale would carry challenges in recruitment and retention. Methodological and sample size planning would have to take this into account. PTH administration to patients to enhance fracture healing should still be considered experimental. Cite this article: Bone Joint J 2016;98-B:840–5. PMID:27235530

  3. Dynamic Hip Screw with Trochanteric Stablization Plate Fixation of Unstable Inter-Trochanteric Fractures: A Prospective Study of Functional and Radiological Outcomes

    PubMed Central

    Shetty, Ashwin; Sadasivan, Anand Kumar; Hegde, Anoop

    2016-01-01

    Introduction Management of unstable intertrochanteric fractures have posed a unique challenge to orthopaedicians over years. Several surgical techniques and implants have been developed for the same. Fractures of the lateral wall have been considered as the major cause of femoral medialization after fixation by Dynamic Hip Screw (DHS). Studies have shown that supplementation of trochanteric stabilization plate reduces the incidence of femoral medialization. Aim To assess the radiological union and hip function after fixation of unstable intertrochanteric fractures with DHS and Trochanteric Stabilization Plate (TSP). Materials and Methods A prospective study was conducted with a total of 32 patients between age groups of 30-70 years with Evan Jensen unstable and very unstable type of intertrochanteric fractures, between August 2013 to March 2015 in the Department of Orthopaedics ARS Hospital, Tirupur, Tamil Nadu, India. They underwent open reduction and DHS and TSP fixation. They were started on full weight bearing mobilization on post op day three. They were reviewed at post-op weeks 3,6,12 and 24. Hip mobilization and rehabilitation exercises were instituted during course of reviews. Radiographs were taken to assess fracture union and hip function was evaluated during follow-ups. At the end of 24 weeks, degree of radiographic union was scored as per Radiological Union Score for Hip (RUSH). Hip function was scored with Harris hip score. Analyses were done using frequency and proportions. Chi-square tests were used to assess the test of association. Results Fifteen patients had RUSH scores between 10-20 and 17 patients had scores between 20-30 points. RUSH score had mean of 21.03+/- 2.132 points. 9 of 32 patients had excellent results as per Harris hip score, 10 had good, nine had fair and four had poor. On comparison of Harris hip score with RUSH score: Interval between 10-20 points, of 15 patients; two had excellent results, five had good, five had fair and three

  4. Trochanteric bursitis

    MedlinePlus

    ... walking Joint stiffness Swelling and warmth of the hip joint Catching and clicking sensation You may notice the ... physical therapy if you have trouble moving the joint. Other ... your hip will function just fine without the inflamed bursa. ...

  5. Effects of lag screw design and lubrication on sliding in trochanteric nails.

    PubMed

    Kummer, Frederick J

    2010-01-01

    This study compared the sliding characteristics of three lag screw designs used with trochanteric nails and determined the effects of lubrication on sliding. They were tested by an established method to measure initiation and ease of lag screw sliding. These tests were then repeated with calf serum lubrication. There were significant differences (p < 0.05) between the loads required to initiate lag screw sliding that appeared to be related to design. Screw sliding was similar for all three designs; however, the presence of lag screw locking slots affected sliding in that region. Lubrication did not affect either parameter. Lag screw design aspects, such as diameter and, particularly, surface finish, affect sliding. Due to the small contact area between the lag screw and nail creating high interface stresses, lubrication had no effect on lag screw sliding.

  6. Use of the trochanteric flip osteotomy to facilitate internal fixation of a femoral head fracture

    PubMed Central

    Gillespie, James A.; Marsh, Andrew G.; Patil, Sanjeev R.

    2016-01-01

    We report the case of a 42-year-old male who suffered a fracture–dislocation of the femoral head. After a closed reduction of the hip, this proceeded to an open reduction with internal fixation of the fractured femoral head, in addition to labral repair and micro-fracture of an articular cartilage defect. After considering the risks to the femoral head blood supply, the trochanteric flip osteotomy was used. This provided ample and safe exposure. At 14 months follow-up, the patient-reported outcome measures are favourable: modified Harris Hip Score (81/100), the non-arthritic hip score (92.5/100) and SF-12 (41/48). PMID:27470013

  7. Use of the trochanteric flip osteotomy to facilitate internal fixation of a femoral head fracture.

    PubMed

    Gillespie, James A; Marsh, Andrew G; Patil, Sanjeev R

    2016-01-01

    We report the case of a 42-year-old male who suffered a fracture-dislocation of the femoral head. After a closed reduction of the hip, this proceeded to an open reduction with internal fixation of the fractured femoral head, in addition to labral repair and micro-fracture of an articular cartilage defect. After considering the risks to the femoral head blood supply, the trochanteric flip osteotomy was used. This provided ample and safe exposure. At 14 months follow-up, the patient-reported outcome measures are favourable: modified Harris Hip Score (81/100), the non-arthritic hip score (92.5/100) and SF-12 (41/48). PMID:27470013

  8. [Comparison of the Ender's nailing and Dynamic Hip Screw (DHS) fixation in the treatment of trochanteric fractures in elderly patients].

    PubMed

    Sliwka, Andrzej; Zgoda, Marcin; Górski, Radosław; Purski, Karol; Wasilewski, Piotr; Górecki, Andrzej

    2006-01-01

    The aim of this study was an evaluation which operative method of treatment: stabilisation with the Dynamic Hip Screw or with Ender's nails is less invasive procedure in elderly patients with trochanteric fractures. 100 consecutive patients with trochanteric fracture were enrolled into the study, of which 53 patients (49 women, 4 men; mean age 89 years) were stabilised intramedullarily with the use of Ender's nails and 47 patients (26 women, 21 men; mean age 76 years) were treated operatively with the use of Dynamic Hip Screw. The factors compared the mean length of hospital stay, the mean duration of the surgery, post-operative blood loss, early local and general complication rate and mortality in both groups. We took into account their general health and coexisting illnesses according to the American Society of Anesthesiologists (ASA) classification, type of fracture according to AO and Evan's classifications and the surgeon's experience. The mean duration of the surgery was 27 minutes longer in the case of DHS stabilisation. The complication rate was higher and the mean length of postoperative hospital stay was longer after Ender nailing. The mean blood loss: the drop in Red Blood Cells (RBC), Haematocrit (Ht) and the Mean Haemoglobin Concentration (Hb) was also higher in patients treated with the use of Ender nails. The mean rate of blood units that had to be transfused postoperatively was also higher in "Ender" group. The difference was statistically significant, especially in the group of patients treated as emergency procedure at the day of admission (p < 0.05). The operative treatment of trochanteric fractures in elderly patients with the use of DHS device showed to be a less invasive procedure in comparison to Ender nailing. In conclusion, the indications for this method of trochanteric fractures' treatment should be expanded, especially in the case of unstable fractures. PMID:17455526

  9. 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

  10. Chronic pain.

    PubMed

    Russo, C M; Brose, W G

    1998-01-01

    Chronic pain is an emotional experience and is defined as pain lasting greater than six months. It is important to understand the neurophysiology of pain in order to treat it. Nociceptors in the periphery travel to the substantia gelatinosa of the spinal cord while secondary and tertiary afferents transmit information from the dorsal horn to the brain. Modification of pain information may take place in these ascending pathways or in descending pathways. Treatment of chronic pain is most successful when it is approached in a multidisciplinary fashion with the focus not only on treatment of underlying etiology, but also on the secondary impacts of pain on the patient's life. The management of chronic pain requires special expertise. Most of the experts in chronic pain assessment and management organize themselves into pain treatment centers. These centers vary widely in their approach to the problem. The most sophisticated is a multidisciplinary center that is university-based and includes teaching and research. Treatment of chronic pain includes a variety of medications, psychological support, and rehabilitation. Multidisciplinary pain management is also an integral part of the palliative care and hospice concept used to treat cancer pain.

  11. Differences in monthly variation, cause, and place of injury between femoral neck and trochanteric fractures: 6-year survey (2008–2013) in Kyoto prefecture, Japan

    PubMed Central

    Horii, Motoyuki; Fujiwara, Hiroyoshi; Mikami, Yasuo; Ikeda, Takumi; Ueshima, Keiichiro; Ikoma, Kazuya; Shirai, Toshiharu; Nagae, Masateru; Oka, Yoshinobu; Sawada, Koshiro; Kuriyama, Nagato; Kubo, Toshikazu

    2016-01-01

    Summary Background The incidence of femoral neck and trochanteric fractures reportedly differ by age and regionality. We investigated differences in monthly variations of the occurrence of femoral neck and trochanteric fractures as well as place and cause of injury in the Kyoto prefecture over a 6-year period. Methods Fracture type (neck or trochanteric fracture), age, sex, place of injury, and cause of injury were surveyed among patients aged ≥ 65 years with hip fractures that occurred between 2008 and 2013 who were treated in 1 of 13 participating hospitals (5 in an urban area and 8 in a rural area). The proportion of sick beds in the participating hospitals was 24.7% (4,151/16,781). Monthly variations in the number of patients were investigated in urban and rural areas in addition to the entire Kyoto prefecture. Place of injury was classified as indoors or outdoors, and cause of injury was categorized as simple fall, accident, or uncertain. Results There were 2,826 patients with neck fractures (mean age, 82.1 years) and 3,305 patients with trochanteric fractures (mean age, 85.0 years). There were similarities in the monthly variation of the number of fractures in addition to the place and cause of injury between neck and trochanteric fractures. Indoors (approximately 74%) and simple falls (approximately 78%) were the primary place and cause of injury, respectively. The place of injury was not significantly different by fracture type with each age group. Significantly more patients with neck fracture had “uncertain” as the cause of injury than trochanteric fracture in all age groups. Conclusions Based on the results of the present study, the injury pattern might not have a great effect on the susceptibility difference between neck and trochanteric fractures. PMID:27252738

  12. Tuberculous bursitis of the greater trochanter mimicking ankylosing spondylitis

    PubMed Central

    Tayfur, Öykü; Kılıç, Levent; Karadağ, Ömer; Akdoğan, Ali; Kerimoğlu, Ülkü; Uzun, Ömrüm

    2015-01-01

    Tuberculous trochanteric bursitis (TTB) is a rare condition that accounts for 1% of musculoskeletal tuberculosis cases. Extrapulmonary TB is usually diagnosed late because of reduced diagnostic suspicion, particularly in the absence of signs of systemic infection. Herein, we report a case of right hip pain that was misdiagnosed as ankylosing spondylitis. The patient had a history of inflammatory back pain with morning stiffness. However, HLA-B27 was negative. Sacroiliac magnetic resonance imaging (MRI) revealed a giant multiloculated collection (27×16×10 cm). Percutaneous drainage was performed and Mycobacterium tuberculosis was observed in fluid culture. The patient was treated by drainage along with antituberculosis therapy. After 1 year of antituberculosis therapy, control MRI revealed total resolution of the large fluid collection. It is important to emphasize that fever or general symptoms are absent in patients with TTB, as observed in the present case. In endemic countries, TTB should be kept in mind in the differential diagnosis of a patient presenting with chronic hip pain without fever, weight loss, and constitutional symptoms.

  13. Hemolymphangioma of Greater Omentum

    PubMed Central

    Pandey, Sagar; Fan, Miao; Chang, Dandan; Zhu, Junfeng; Zhu, Ying; Li, Ziping

    2016-01-01

    Abstract Hemolymphangioma is a rare vascular developmental error. It comprises malformed venous and lymphatic component in various proportion. To the best of our knowledge, only a few cases have been reported in the literature so far. Here, we report a case of huge intraperitoneal cystic mass in a 3-year-old boy that was presented to hospital with intractable abdominal pain. On examination, he had fever along with associated symptoms like cough and sputum. Abdomen was distended with no tenderness or rebound tenderness. On computed tomography scan, huge cystic mass was seen and was diagnosed as intraperitoneal benign cystic lesion. Excisional surgery of the lesion was planned. On surgery, lesion was found to be originated from greater omentum and no adhesion was seen in surrounding tissue. Complete excision of the lesion was done. Histopathological specimen after surgery suggested it to be hemolymphangioma. Follow-up for 6 months showed no recurrence. Hemolymphangioma of the greater omentum is benign tumor and accurate diagnosis before surgery is still a challenge. Presentation of disease may vary from simple well-defined cystic lesion to aggressive ill-defined lesion mimicking malignancy. Therefore, further research is needed to help doctor with preoperative radiological diagnosis and avoid unnecessary radical surgery. PMID:27124058

  14. Force attenuation properties of various trochanteric padding materials under typical falling conditions of the elderly.

    PubMed

    Parkkari, J; Kannus, P; Poutala, J; Vuori, I

    1994-09-01

    The purpose of this study was to determine and compare the force attenuation properties of various external trochanteric padding materials under in vitro conditions simulating characteristic falling of the elderly. The selected materials had to be practically suitable for external hip padding so that the main criteria for the materials were good energy absorbing capacity, good durability, low weight, good recovery after compression, easy availability, and reasonable price. Eight materials met these requirements. The first six were flexible cross-linked polyethylene foams with densities from 30 to 200 kg/m3. The seventh material was Plastazote polyethylene foam, and the eight foam was made of ethylene-vinyl acetate (EVA) copolymer. With a pendulum effective mass of 39 kg, impact velocity of 3.0 m/s, and impact force of 8.2 kN, the force attenuation provided by the 20 mm thick hip-padding materials was quite small, ranging from 22 to 38%. With all these materials the peak femoral force remained above 5 kN, more than two times above the femoral fracture threshold (2 kN). In the second set of experiments, the impact force was gradually reduced until the tested materials lowered the impact force below the fracture threshold. With the most efficient material this critical falling velocity was found to be 1.6 m/s. To go below the fracture threshold with the realistic impact velocity of 3.0 m/s, the padding materials had to be 100-140 mm thick.(ABSTRACT TRUNCATED AT 250 WORDS)

  15. [Early weight-bearing after osteosynthesis by THS hip screw in cervico-trochanteric fractures].

    PubMed

    Langlais, F; Burdin, P; Levasseur, M; Chagneau, F; Colmar, M; Lenormand, H

    1992-01-01

    A second generation hip screw was designed in the laboratory to allow unlimited immediate weight-bearing in elderly patients with cervico-trochanteric fractures. The use of this device in 300 operated patients demonstrated that it provided the same capacity for weight-bearing as total hip prostheses, but with a lower morbidity and better and longer lasting functional results. Thus, in patients with a mean age of 77 years, one half of whom suffered from an unstable fracture: the operation was minimally traumatic (reduction on an orthopaedic table, no surgical access to the fracture site, operating time less than one hour); complications were consequently rare (no deep sepsis, no dislocation) in contrast with 5 to 10% of deep sepsis or dislocation with prostheses; early unlimited weight-bearing was permitted by the 5th day in every case and was achieved by the 10th day in more than 80% of cases (30% of whom were able to walk unassisted with crutches); an essential point, the design of the material prevented dismantling on weight-bearing and preserved the morphology of the hip (telescoping of the fracture site never exceeded 20 mm, mean:11 mm). Consolidation was obtained in every case by 6 to 8 weeks. The mortality at 3 months was identical to that observed with prostheses (18%, related to physiological age). The length of hospital stay and the duration of rehabilitation were considerably shortened, as 37% of patients returned to their previous residence by the 45th postoperative day. This resulted in a marked saving in medical costs for each patient (as patients previously returned home after an average of 145 days).(ABSTRACT TRUNCATED AT 250 WORDS)

  16. Chronic Pain

    MedlinePlus

    ... adults. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting ... Institute of Neurological Disorders and Stroke (NINDS). Low Back Pain Fact Sheet Back Pain information sheet compiled by ...

  17. Evaluating the patient with low back pain.

    PubMed

    Shaikh, Maliha; Östör, Andrew J K

    2015-12-01

    In the UK, low back pain is the most common cause of disability in young adults and every year 6-9% of adults consult their GP about back pain. A thorough history and examination is required to exclude an alternative diagnosis, such as pain arising from the hip or trochanteric bursa and to categorise patients as having: serious spinal pathology, nerve root/radicular pain or non-specific back pain. Inflammatory back pain is often missed, particularly in the early stages when examination may be normal. The primary features are pain arising in patients under 40, thoracolumbar or sacroiliac pain and alternating buttock pain. Stiffness in the early morning and after rest is a hallmark of inflammatory back pain. There may also be peripheral joint involvement with evidence of inflammatory arthritis as well as extra-articular manifestations such as iritis, psoriasis and colitis. Sphincter disturbance leading to loss of bladder or bowel control should also be explored as it is a sign of spinal cord compression or cauda equina syndrome. Both of these are neurosurgical emergencies and need urgent referral for further investigation and possible intervention. The majority of patients with low back pain can be managed in primary care as the pain will usually be self-limiting. Patients with suspected inflammatory back pain should be referred to rheumatology as soon as possible in order to institute early management and prevent long-term deformity and disability. Patients with suspected serious spinal pathology should be referred urgently for further investigation. Red flag symptoms should raise concerns regarding a possible sinister cause such as malignancy and more than one red flag mandates urgent further investigation. PMID:26882775

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

    PubMed

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

    2012-08-01

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

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

    PubMed

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

    2012-08-01

    Healthy children are often required to repeatedly undergo painful medical procedures (eg, immunizations). Although memory is often implicated in children's reactions to future pain, there is a dearth of research directly examining the relationship between the 2. The current study investigated the influence of children's memories for a novel pain stimulus on their subsequent pain experience. One hundred ten healthy children (60 boys) between the ages of 8 and 12 years completed a laboratory pain task and provided pain ratings. Two weeks later, children provided pain ratings based on their memories as well as their expectancies about future pain. One month following the initial laboratory visit, children again completed the pain task and provided pain ratings. Results showed that children's memory of pain intensity was a better predictor of subsequent pain reporting than their actual initial reporting of pain intensity, and mediated the relationship between initial and subsequent pain reporting. Children who had negatively estimated pain memories developed expectations of greater pain prior to a subsequent pain experience and showed greater increases in pain ratings over time than children who had accurate or positively estimated pain memories. These findings highlight the influence of pain memories on healthy children's expectations of future pain and subsequent pain experiences and extend predictive models of subsequent pain reporting. PMID:22560288

  20. A comparative study of trochanteric and basicervical fractures of the femur treated with the Ender and McLaughlin techniques.

    PubMed

    Indemini, E; Clerico, P; Fenoglio, E; Mariotti, U

    1982-09-01

    Endomedullary nailing as proposed by Ender is an important alternative in the treatment of trochanteric and basicervical fractures of the femur (Amici et al., 1980; Carret et al., 1980; Ender, 1970; Kempf et al., 1979; Zinghi et al., 1979). Rush's concept (Eiffel Tower, for the distal epiphysis) is reproposed with some variations and transposed to the femoral neck. The aim of the operation differs from that of the nail and plate technique in that, instead of trying to achieve anatomical reconstruction, an immediate functional by-pass of the fractured part is attempted. After using this technique for three years, we compared the old method, which we had not abandoned, the McLaughlin nail and plate, with the new Ender nail.

  1. Pain catastrophizing and pain coping among methadone-maintained patients*

    PubMed Central

    Garnet, Brian; Beitel, Mark; Cutter, Christopher J.; Savant, Jonathan; Peters, Skye; Schottenfeld, Richard S.; Barry, Declan T.

    2010-01-01

    Objective The aim of this study was to examine the association of pain catastrophizing and pain coping strategies with characteristic pain intensity (an average of worst, least, and typical pain intensity in the past week) and recent pain-related disability (an average of three measures of past week pain interference) in opioid dependent patients enrolled in a methadone maintenance treatment program (MMTP) who reported recent pain. Design Cross-sectional survey. Patients One hundred and eight MMTP patients who reported recent pain. Measures Participants completed measures of demographics, pain status (i.e. “chronic severe pain” [pain lasting at least 6 months with at least moderate pain intensity or significant pain interference in the past week] vs. “some pain” [pain in the past week not meeting the threshold of chronic severe pain]), characteristic pain intensity, recent pain-related disability, somatization, depression, catastrophizing, and pain coping strategies. Results Catastrophizing explained a significant proportion of the variance in characteristic pain intensity (14%) and recent pain-related disability (11%) after controlling for demographics, pain status, somatization, and depression. Mirroring the findings of studies of non-opioid dependent chronic pain patients, greater catastrophizing was associated with greater pain intensity and increases in recent pain-related disability. On average, the chronic severe pain group reported higher levels of catastrophizing than the some pain group. Conclusion Consistent with studies of patients with chronic pain who are not opioid dependent, our findings emphasize the importance of assessing and addressing catastrophizing in MMTP patients with pain. PMID:21087402

  2. Groin pain

    MedlinePlus

    Pain - groin; Lower abdominal pain; Genital pain; Perineal pain ... Common causes of groin pain include: Pulled muscle, tendon, or ligaments in the leg: This problem often occurs in people who play sports such as ...

  3. Pain Catastrophising Affects Cortical Responses to Viewing Pain in Others

    PubMed Central

    Fallon, Nicholas

    2015-01-01

    Pain catastrophising is an exaggerated cognitive attitude implemented during pain or when thinking about pain. Catastrophising was previously associated with increased pain severity, emotional distress and disability in chronic pain patients, and is also a contributing factor in the development of neuropathic pain. To investigate the neural basis of how pain catastrophising affects pain observed in others, we acquired EEG data in groups of participants with high (High-Cat) or low (Low-Cat) pain catastrophising scores during viewing of pain scenes and graphically matched pictures not depicting imminent pain. The High-Cat group attributed greater pain to both pain and non-pain pictures. Source dipole analysis of event-related potentials during picture viewing revealed activations in the left (PHGL) and right (PHGR) paraphippocampal gyri, rostral anterior (rACC) and posterior cingulate (PCC) cortices. The late source activity (600–1100 ms) in PHGL and PCC was augmented in High-Cat, relative to Low-Cat, participants. Conversely, greater source activity was observed in the Low-Cat group during the mid-latency window (280–450 ms) in the rACC and PCC. Low-Cat subjects demonstrated a significantly stronger correlation between source activity in PCC and pain and arousal ratings in the long latency window, relative to high pain catastrophisers. Results suggest augmented activation of limbic cortex and higher order pain processing cortical regions during the late processing period in high pain catastrophisers viewing both types of pictures. This pattern of cortical activations is consistent with the distorted and magnified cognitive appraisal of pain threats in high pain catastrophisers. In contrast, high pain catastrophising individuals exhibit a diminished response during the mid-latency period when attentional and top-down resources are ascribed to observed pain. PMID:26186545

  4. Low back pain - chronic

    MedlinePlus

    ... Medical problems, such as fibromyalgia or rheumatoid arthritis Piriformis syndrome, a pain disorder involving a muscle in the buttocks called the piriformis muscle You are at greater risk for low ...

  5. Flank pain

    MedlinePlus

    Pain - side; Side pain ... Flank pain can be a sign of a kidney problem. But, since many organs are in this area, other causes are possible. If you have flank pain and fever , chills, blood in the urine, or ...

  6. Abdominal pain

    MedlinePlus

    Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps; Bellyache; Stomachache ... Almost everyone has pain in the abdomen at some point. Most of the time, it is not serious. How bad your pain is ...

  7. Heel pain

    MedlinePlus

    Pain - heel ... Heel pain is most often the result of overuse. However, it may be caused by an injury. Your heel ... on the heel Conditions that may cause heel pain include: Swelling and pain in the Achilles tendon ...

  8. Contextual determinants of pain judgments.

    PubMed

    Martel, M O; Thibault, P; Roy, C; Catchlove, R; Sullivan, M J L

    2008-10-31

    The objective of this study was to examine the influence of variations in contextual features of a physically demanding lifting task on the judgments of others' pain. Healthy undergraduates (n=98) were asked to estimate the pain experience of chronic pain patients who were filmed while lifting canisters at different distances from their body. Of interest was whether contextual information (i.e., lifting posture) contributed to pain estimates beyond the variance accounted for by pain behavior. Results indicated that the judgments of others' pain varied significantly as a function of the contextual features of the pain-eliciting task; observers estimated significantly more pain when watching patients lifting canisters positioned further away from the body than canisters closest from the body. Canister position contributed significant unique variance to the prediction of pain estimates even after controlling for observers' use of pain behavior as a basis of pain estimates. Correlational analyses revealed that greater use of the contextual features when judging others' pain was related to a lower discrepancy (higher accuracy) between estimated and self-reported pain ratings. Results also indicated that observers' level of catastrophizing was associated with more accurate pain estimates. The results of a regression analysis further showed that observers' level of catastrophizing contributed to the prediction of the accuracy of pain estimates over and above the variance accounted for by the utilisation of contextual features. Discussion addresses the processes that might underlie the utilisation of contextual features of a pain-eliciting task when estimating others' pain. PMID:18701219

  9. Neurological diseases and pain

    PubMed Central

    2012-01-01

    Chronic pain is a frequent component of many neurological disorders, affecting 20–40% of patients for many primary neurological diseases. These diseases result from a wide range of pathophysiologies including traumatic injury to the central nervous system, neurodegeneration and neuroinflammation, and exploring the aetiology of pain in these disorders is an opportunity to achieve new insight into pain processing. Whether pain originates in the central or peripheral nervous system, it frequently becomes centralized through maladaptive responses within the central nervous system that can profoundly alter brain systems and thereby behaviour (e.g. depression). Chronic pain should thus be considered a brain disease in which alterations in neural networks affect multiple aspects of brain function, structure and chemistry. The study and treatment of this disease is greatly complicated by the lack of objective measures for either the symptoms or the underlying mechanisms of chronic pain. In pain associated with neurological disease, it is sometimes difficult to obtain even a subjective evaluation of pain, as is the case for patients in a vegetative state or end-stage Alzheimer's disease. It is critical that neurologists become more involved in chronic pain treatment and research (already significant in the fields of migraine and peripheral neuropathies). To achieve this goal, greater efforts are needed to enhance training for neurologists in pain treatment and promote greater interest in the field. This review describes examples of pain in different neurological diseases including primary neurological pain conditions, discusses the therapeutic potential of brain-targeted therapies and highlights the need for objective measures of pain. PMID:22067541

  10. Back Pain

    MedlinePlus

    ... Back Pain Find a Clinical Trial Journal Articles Back Pain March 2015 Handout on Health: Back Pain This publication is for people who have back ... to discuss them with your doctor. What Is Back Pain? Back pain is an all-too-familiar problem ...

  11. Chest pain

    MedlinePlus

    ... provider may ask questions such as: Is the pain between the shoulder blades? Under the breast bone? Does the pain ... How long does the pain last? Does the pain go from your chest into your shoulder, arm, neck, jaw, or back? Is the pain ...

  12. Pain Relievers

    MedlinePlus

    Pain relievers are medicines that reduce or relieve headaches, sore muscles, arthritis, or other aches and pains. There ... also have a slightly different response to a pain reliever. Over-the-counter (OTC) medicines are good for ...

  13. Elbow pain

    MedlinePlus

    Pain - elbow ... Elbow pain can be caused by many problems. A common cause in adults is tendinitis . This is inflammation and ... a partial dislocation ). Other common causes of elbow pain are: Bursitis -- inflammation of a fluid-filled cushion ...

  14. Eye pain

    MedlinePlus

    Ophthalmalgia; Pain - eye ... Pain in the eye can be an important symptom of a health problem. Make sure you tell your health care provider if you have eye pain that does not go away. Tired eyes or ...

  15. Ankle pain

    MedlinePlus

    Pain - ankle ... Ankle pain is often due to an ankle sprain. An ankle sprain is an injury to the ligaments, which ... the joint. In addition to ankle sprains, ankle pain can be caused by: Damage or swelling of ...

  16. Foot pain

    MedlinePlus

    Pain - foot ... Foot pain may be due to: Aging Being on your feet for long periods of time Being overweight A ... sports activity Trauma The following can cause foot pain: Arthritis and gout . Common in the big toe, ...

  17. Wrist pain

    MedlinePlus

    Pain - wrist; Pain - carpal tunnel; Injury - wrist; Arthritis - wrist; Gout - wrist; Pseudogout - wrist ... Carpal tunnel syndrome: A common cause of wrist pain is carpal tunnel syndrome . You may feel aching, ...

  18. Back Pain

    MedlinePlus

    ... BACK PAIN? There are many possible causes of low back pain, including stretched (strained) muscles, torn or stretched (sprained) ... appear to be at an increased risk for low back pain in comparison to the general population (estimates range ...

  19. Leg pain

    MedlinePlus

    Pain - leg; Aches - leg; Cramps - leg ... Leg pain can be due to a muscle cramp (also called a charley horse ). Common causes of ... a long time An injury can also cause leg pain from: A torn or overstretched muscle ( strain ) ...

  20. Depression, Pain, and Pain Behavior.

    ERIC Educational Resources Information Center

    Keefe, Francis J.; And Others

    1986-01-01

    Examined the degree to which depression predicted pain and pain behavior. The Beck Depression Inventory was administered to 207 low back pain patients. Depression and physical findings were the most important predictors of pain and pain behavior. Depression proved significant even after controlling for important demographic and medical status…

  1. Patellofemoral pain.

    PubMed

    Crossley, Kay M; Callaghan, Michael J; van Linschoten, Robbart

    2016-02-01

    Patellofemoral pain refers to pain behind or around the patella (also known as patellofemoral pain syndrome, anterior knee pain, runner's knee, and, formerly, chondromalacia patellae). Patellofemoral pain is common, accounting for 11-17% of all knee pain presentations to general practice.(1 2) While it typically occurs in physically active people aged <40 years, it also affects people of all activity levels and ages.(1 2) Patellofemoral pain can be diagnosed in the clinic, and evidence based treatments can reduce pain and improve function, allowing patients to maintain a physically active lifestyle. PMID:26834209

  2. Do doctors undertreat pain?

    PubMed

    Ruddick, William

    1997-01-01

    Routinely, physicians discount patients' pain reports and provide too little analgesia too late. Critics call them callous, sadistic, and Puritanical, but the causes of these clinical pratices are different -- namely, a psychological need to distance themselves from the pain they encounter and inflict, and more subtly, a peculiar concept of pain acquired in medical training. Physicians learn to think of pain as a symptom to observe and explore in diagnosing and monitoring disease -- not as a complaint to relieve quickly or fully. Moreover, pain-relief is regarded as subordinate to, and competing with, efforts to cure or maintain the life of a patient. This training, I suggest, gives physicians a new, clinical concept of pain at odds with their prior, lay concept of pain whose manifestations standardly call for sympathetic efforts at relief. The conceptual nature of this difference is obscured by thinking of pain as a solely private sensation, rather than as a sensation with public and social aspects (à la Wittgenstein). Although suppressed in certain clinical circumstances, these standard public and social aspects are shown in the very tests used in clinical pain research. This clinical pain concept is rooted in Medicine conceived as preeminently curative and life-prolonging. Physicians are, however, themselves undermining this professional self-definition (by treating AIDS and Alzheimer's patients; by no longer pressing their patients to 'fight to the end'; by collaborating with non-medical healers). Accordingly, pain-relief may gain greater therapeutic status, and, so too, the ordinary concept of pain that medical training has suppressed.

  3. Pelvic Pain

    MedlinePlus

    Pelvic pain occurs mostly in the lower abdomen area. The pain might be steady, or it might come and go. If the pain is severe, it might get in the way ... re a woman, you might feel a dull pain during your period. It could also happen during ...

  4. Shoulder pain

    MedlinePlus

    Pain - shoulder ... changes around the rotator cuff can cause shoulder pain. You may have pain when lifting the arm above your head or ... The most common cause of shoulder pain occurs when rotator cuff tendons ... The tendons become inflamed or damaged. This condition ...

  5. Back Pain

    MedlinePlus

    ... Awards Enhancing Diversity Find People About NINDS NINDS Back Pain Information Page Condensed from Low Back Pain Fact ... en Español Additional resources from MedlinePlus What is Back Pain? Acute or short-term low back pain generally ...

  6. Greater trochanter apophysitis in the adolescent athlete.

    PubMed

    Young, Simon W; Safran, Marc R

    2015-05-01

    Lower limb traction apophysitis is common in young athletes, occurring at sites such as the tibial tubercle (Osgood-Schlatter disease) and distal patella (Sinding-Larsen-Johansson disease). Around the hip, iliac apophysitis is well recognized, but no cases of greater trochanter apophysitis have previously been reported. We describe the case of a 15-year-old male basketball player with a 2-month history of the right hip pain and significant functional limitation. X-rays revealed widening of the greater trochanter apophysis with subchondral sclerosis, consistent with a diagnosis of traction apophysitis. The patient was treated with a period of relative rest and anti-inflammatory medication. He gradually returned to full athletic activity, including basketball, without recurrence of pain or limitation. We describe the first reported case of traction apophysitis of the greater trochanter. The unique muscular anatomy of this apophysis with balanced forces explains the rarity of this condition. If encountered, rest and activity modification is the recommended treatment.

  7. Future Directions for Pain Management: Lessons from the Institute of Medicine Pain Report and the National Pain Strategy.

    PubMed

    Mackey, Sean

    2016-02-01

    According to the Institute of Medicine Relieving Pain in America Report and the soon to be released National Pain Strategy, pain affects over 100 million Americans and costs our country in over $500 billion per year. We have a greater appreciation for the complex nature of pain and that it can develop into a disease in itself. As such, we need more efforts on prevention of chronic pain and for interdisciplinary approaches. For precision pain medicine to be successful, we need to link learning health systems with pain biomarkers (eg, genomics, proteomics, patient reported outcomes, brain markers) and its treatment.

  8. Putting pain assessment into practice: Why is it so painful?

    PubMed Central

    Franck, Linda S; Bruce, Elizabeth

    2009-01-01

    OBJECTIVE: To explore some of the reasons for poor compliance with the use of standardized pain assessment tools in clinical practice, despite numerous guidelines and standards mandating their use. METHODS: First, a review of research and clinical audit literature on the effects of standardized pain assessment tools on patient or process outcomes was conducted, and findings were critiqued. Second, a synthesis of recent literature on the biopsychosocial mechanisms of human detection and recognition of pain in others was presented. Third, the implications for pain assessment in pediatric clinical settings were discussed. RESULTS: There is a lack of good-quality evidence for the efficacy, effectiveness or cost-benefit of standardized pain assessment tools in relation to pediatric patient or process outcomes. Research suggests that there may be greater variability than previously appreciated in the ability and motivation of humans when assessing pain in others. It remains unknown whether pain detection skills or motivation to relieve pain in others can be improved or overcome by standardized methods of pain assessment. DISCUSSION: Further research is needed to understand the intra- and interpersonal dynamics in clinical assessment of pain in children and to test alternative means of achieving diagnosis and treatment of pain. Until this evidence is available, guidelines recommending standardized pain assessment must be clearly labelled as being based on principles or evidence from other fields of practice, and avoid implying that they are ‘evidence based’. PMID:19262911

  9. Predictors of Genital Pain in Young Women

    PubMed Central

    Farmer, Melissa A.; Meston, Cindy M.

    2010-01-01

    Despite the high prevalence of genital pain in healthy young adult women, limited research has addressed genital pain during intercourse using contemporary models of multidimensional sexual function. The objectives of this study were threefold: (1) to identify differences in sexual functioning in women who experience genital pain compared to pain free women; (2) to identify predictors of sexual functioning in women with and without genital pain; and (3) to identify predictors of sexual satisfaction in women with and without genital pain. Sexually active female undergraduates (n = 651) were administered the Female Sexual Function Index and the Derogatis Sexual Functioning Inventory. We evaluated the sexual factors that impact the sexual function of women with any pain (including high and low pain groups) versus women with no history of pain. Women with genital pain reported greater rates of sexual dysfunction as compared to pain-free women; however, sexual functioning in the high versus low pain groups was distinguished primarily by vaginal lubrication. Women in the high pain group showed negative correlations between domains of sexual satisfaction and genital pain frequency and intensity that were not found in the low pain group. For pain-free women, intercourse played a strong role in sexual satisfaction, whereas non-intercourse sexual behavior was central to sexual satisfaction in women who reported pain. The evaluation of levels of genital pain may provide insight into the mechanisms underlying the impairment of sexual function, sexual behavior, and sexual satisfaction. PMID:17674182

  10. Back Pain

    MedlinePlus

    ... Oh, my aching back!", you are not alone. Back pain is one of the most common medical problems, ... 10 people at some point during their lives. Back pain can range from a dull, constant ache to ...

  11. [Oral pain].

    PubMed

    Benslama, Lotfi

    2002-02-15

    Pain, a major symptom of stomatological disease, usually leads to a specialist consultation. Most commonly it is caused by dental caries and differs in nature and in intensity according to the stage of disease: dentinitis, pulpitis, desmodontitis and dental abscess. Added to this is peridental pain and the pre- and post-operative pains related to these diseases. Almost all oral-maxillary pathology is painful, be it boney such as in osteomyelitis and fractures, mucosal in gingivo-stomatitis and aphthous ulcers, or tumourous. However, besides the "multidisciplinary" facial pains such as facial neuralgia and vascular pain, two pain syndromes are specific to stomatology: pain of the tempero-mandibular joint associated with problems of the bite and glossodynia, a very common somatic expression of psychological problems.

  12. Pain Management

    MedlinePlus

    ... the brain played a role in producing the perception of pain. In the 19th century, physician-scientists ... they are experiencing. Discoveries of differences in pain perceptions and responses to treatment by gender has have ...

  13. Finger pain

    MedlinePlus

    Pain - finger ... Nearly everyone has had finger pain at some time. You may have: Tenderness Burning Stiffness Numbness Tingling Coldness Swelling Change in skin color Redness Many conditions, such ...

  14. Pain Assessment

    MedlinePlus

    ... as a result of the pain, and the nature of other medical and psychiatric problems, should be ... information helps the health care provider understand the nature of the pain or the potential benefits of ...

  15. Breast pain

    MedlinePlus

    Pain - breast; Mastalgia; Mastodynia; Breast tenderness ... There are many possible causes for breast pain. For example, hormone level changes from menstruation or pregnancy often cause breast tenderness. Some swelling and tenderness just before your period ...

  16. Patellofemoral Pain.

    PubMed

    Dutton, Rebecca A; Khadavi, Michael J; Fredericson, Michael

    2016-02-01

    Patellofemoral pain is characterized by insidious onset anterior knee pain that is exaggerated under conditions of increased patellofemoral joint stress. A variety of risk factors may contribute to the development of patellofemoral pain. It is critical that the history and physical examination elucidate those risk factors specific to an individual in order to prescribe an appropriate and customized treatment plan. This article aims to review the epidemiology, risk factors, diagnosis, and management of patellofemoral pain. PMID:26616176

  17. Patellofemoral Pain.

    PubMed

    Dutton, Rebecca A; Khadavi, Michael J; Fredericson, Michael

    2016-02-01

    Patellofemoral pain is characterized by insidious onset anterior knee pain that is exaggerated under conditions of increased patellofemoral joint stress. A variety of risk factors may contribute to the development of patellofemoral pain. It is critical that the history and physical examination elucidate those risk factors specific to an individual in order to prescribe an appropriate and customized treatment plan. This article aims to review the epidemiology, risk factors, diagnosis, and management of patellofemoral pain.

  18. Humour and Connecting with Kids in Pain

    ERIC Educational Resources Information Center

    Digney, John

    2009-01-01

    Emotional pain which manifests itself in problem behaviours is, for many children and youth, a part of their everyday struggle through life. Kids growing up in residential care or in a dysfunctional family or setting suffer this pain. Connecting with kids in pain, the primary task for youth workers, is made all the more difficult, the greater the…

  19. Temporomandibular pain

    PubMed Central

    Prasad, S Raghavendra; Kumar, N Ravi; Shruthi, HR; Kalavathi, SD

    2016-01-01

    Temporomandibular joint pain has various medical and dental etiological factors. The etiology of the temporomandibular joint pain is enigmatic, no single etiological factor is regarded as the cause. Its distribution is also not confined to a single area. This article presents the basic etiologic factors, its epidemiology, distribution of pain, classification of patients and the psychosocial behavior of patients suffering with temporomandibular pain. As overwhelming majority of medical and dental conditions/issues related to etiology of temporomandibular pain in patients have traditionally been presented and interpreted from the clinician's point of view. PMID:27601822

  20. Temporomandibular pain

    PubMed Central

    Prasad, S Raghavendra; Kumar, N Ravi; Shruthi, HR; Kalavathi, SD

    2016-01-01

    Temporomandibular joint pain has various medical and dental etiological factors. The etiology of the temporomandibular joint pain is enigmatic, no single etiological factor is regarded as the cause. Its distribution is also not confined to a single area. This article presents the basic etiologic factors, its epidemiology, distribution of pain, classification of patients and the psychosocial behavior of patients suffering with temporomandibular pain. As overwhelming majority of medical and dental conditions/issues related to etiology of temporomandibular pain in patients have traditionally been presented and interpreted from the clinician's point of view.

  1. Temporomandibular pain.

    PubMed

    Prasad, S Raghavendra; Kumar, N Ravi; Shruthi, H R; Kalavathi, S D

    2016-01-01

    Temporomandibular joint pain has various medical and dental etiological factors. The etiology of the temporomandibular joint pain is enigmatic, no single etiological factor is regarded as the cause. Its distribution is also not confined to a single area. This article presents the basic etiologic factors, its epidemiology, distribution of pain, classification of patients and the psychosocial behavior of patients suffering with temporomandibular pain. As overwhelming majority of medical and dental conditions/issues related to etiology of temporomandibular pain in patients have traditionally been presented and interpreted from the clinician's point of view. PMID:27601822

  2. Ion channel therapeutics for pain

    PubMed Central

    Skerratt, Sarah E; West, Christopher W

    2015-01-01

    Pain is a complex disease which can progress into a debilitating condition. The effective treatment of pain remains a challenge as current therapies often lack the desired level of efficacy or tolerability. One therapeutic avenue, the modulation of ion channel signaling by small molecules, has shown the ability to treat pain. However, of the 215 ion channels that exist in the human genome, with 85 ion channels having a strong literature link to pain, only a small number of these channels have been successfully drugged for pain. The focus of future research will be to fully explore the possibilities surrounding these unexplored ion channels. Toward this end, a greater understanding of ion channel modulation will be the greatest tool we have in developing the next generation of drugs for the treatment of pain. PMID:26218246

  3. Imaging Pain.

    PubMed

    Martucci, Katherine T; Mackey, Sean C

    2016-06-01

    The challenges and understanding of acute and chronic pain have been illuminated through the advancement of central neuroimaging. Through neuroimaging research, new technology and findings have allowed us to identify and understand the neural mechanisms contributing to chronic pain. Several regions of the brain are known to be of particular importance for the maintenance and amplification of chronic pain, and this knowledge provides novel targets for future research and treatment. This article reviews neuroimaging for the study of chronic pain, and in particular, the rapidly advancing and popular research tools of structural and functional MRI. PMID:27208709

  4. Pediatric nurses' knowledge and practice related to infant pain.

    PubMed

    McCain, G C; Morwessel, N J

    1995-01-01

    A convenience sample of 181 registered nurses completed questionnaires about their knowledge, attitudes, and clinical practice related to infant pain. The majority of respondents thought infants felt pain with the same intensity as adults and were comfortable administering narcotic and nonnarcotic pain medications. The most frequently identified infant pain cues were: crying, irritability, and inability to be consoled. There were associations between greater numbers of pain cues and higher pain severity ratings and between postlicensure education about pain and number of strategies proposed to relieve pain. There were no associations for noncritical versus critical care unit assignment or participation in postlicensure education about pain with number of assessment cues. There were no associations for pain severity or noncritical versus critical care unit assignment with pain management strategies. Until the research base about management of infant pain is expanded, nurses should continue to use and evaluate a variety of pain management interventions on a case-by-case basis.

  5. Neck Pain

    MedlinePlus

    ... get better. No 7. Did you have a whiplash-type injury in the past, or do you have pain and/or stiffness every day in your neck, hands, knees, hips or other joints? Yes Your pain may be from DEGENERATIVE CERVICAL ARTHRITIS, a disorder that affects the bones and ...

  6. Pain acceptance-based coping in complex regional pain syndrome Type I: daily relations with pain intensity, activity, and mood.

    PubMed

    Cho, Sungkun; McCracken, Lance M; Heiby, Elaine M; Moon, Dong-Eon; Lee, Jang-Han

    2013-10-01

    This study aimed to examine the temporal patterning of pain acceptance-based coping, activity, and mood in patients with complex regional pain syndrome Type I (CRPS-I), by using a daily diary method. A total of 30 patients with CRPS-I seeking treatment in a tertiary pain management center located in Seoul, Korea participated in the study. Multilevel random effects analyses indicated that (a) engagement in pain acceptance-based coping was significantly associated with lower same-day pain and negative mood and greater same-day activity and positive mood; (b) pain acceptance-based coping predicted increases in activity on the following day; (c) greater pain intensity was significantly associated with lower same-day pain acceptance-based coping and activity and greater same-day negative mood; and (d) pain intensity did not predict pain acceptance-based coping, activity, or mood on the following day. These findings suggest that patients with CRPS-I may benefit from responding to pain with acceptance. Further study and eventual application of this process in CRPS-I may improve upon the success of current approaches to this problem. PMID:22854886

  7. Spinal pain.

    PubMed

    Izzo, R; Popolizio, T; D'Aprile, P; Muto, M

    2015-05-01

    The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic pain, much more difficult to treat. The clinical assessment of pain source can be a challenge because of the complex anatomy and function of the spine; the advanced imaging methods are often not sufficient for a definitive diagnosis because similar findings could be present in either asymptomatic and symptomatic subjects: a clinical correlation is always mandatory and the therapy cannot rely uniquely upon any imaging abnormalities. Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally

  8. What a Pain! Kids and Growing Pains

    MedlinePlus

    ... Here's Help White House Lunch Recipes What a Pain! Kids and Growing Pains KidsHealth > For Kids > What a Pain! Kids and ... something doctors call growing pains . What Are Growing Pains? Growing pains aren't a disease. You probably ...

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

    PubMed

    Witte, W

    2011-06-01

    developed by the American psychiatrist George Engel, defined chronic pain as an illness rather than a disease. Concurrently, the radical behaviorism of the late 1960s affected both the therapy of chronic and of acute pain. Based on this theory, patient-controlled analgesia (PCA) was introduced in the 1970s and 1980s. Acute pain services (APS) in hospitals, were developed beginning in the 1980s using the continuous release of opioids. Regional anesthesia played a greater role than general anesthesia in developing pain therapy in the twentieth century and paved the way for pain therapy. The restriction to nerve blocks in pain centers was overcome by the expansion of theoretical foundations beyond the framework of anesthesiology. Impulses from psychology and psychosomatic medicine were crucial. The evolution of cancer pain therapy was distinct from non-cancer pain therapy.

  10. Prevent Back Pain

    MedlinePlus

    ... Back Pain Print This Topic En español Prevent Back Pain Browse Sections The Basics Overview Am I at ... Health: Back Pain . There are different types of back pain. Back pain can be acute or chronic. It ...

  11. Chronic pain - resources

    MedlinePlus

    Pain - resources; Resources - chronic pain ... The following organizations are good resources for information on chronic pain: American Chronic Pain Association -- www.theacpa.org National Fibromyalgia and Chronic Pain Association -- www.fmcpaware.org ...

  12. Differential pain modulation properties in central neuropathic pain after spinal cord injury.

    PubMed

    Gruener, Hila; Zeilig, Gabi; Laufer, Yocheved; Blumen, Nava; Defrin, Ruth

    2016-07-01

    It seems that central neuropathic pain (CNP) is associated with altered abilities to modulate pain; whereas dysfunction in descending pain inhibition is associated with the extent of chronic pain distribution, enhanced pain excitation is associated with the intensity of chronic pain. We investigated the hypothesis that CNP is associated with decreased descending pain inhibition along with increased neuronal excitability and that both traits are associated with spinothalamic tract (STT) damage. Chronic spinal cord injury subjects with CNP (n = 27) and without CNP (n = 23) and healthy controls (n = 20) underwent the measurement of pain adaptation, conditioned pain modulation (CPM), tonic suprathreshold pain (TSP), and spatial summation of pain above injury level. Central neuropathic pain subjects also underwent at and below-lesion STT evaluation and completed the questionnaires. Central neuropathic pain subjects showed decreased CPM and increased enhancement of TSP compared with controls. Among CNP subjects, the dysfunction of CPM and pain adaptation correlated positively with the number of painful body regions. The magnitude of TSP and spatial summation of pain correlated positively with CNP intensity. STT scores correlated with CNP intensity and with TSP, so that the more affected the STT below injury level, the greater the CNP and TSP magnitude. It seems that CNP is associated with altered abilities to modulate pain, whereas dysfunction in descending pain inhibition is associated with the extent of chronic pain distribution and enhanced pain excitation is associated with the intensity of chronic pain. Thus, top-down processes may determine the spread of CNP, whereas bottom-up processes may determine CNP intensity. It also seems that the mechanisms of CNP may involve STT-induced hyperexcitability. Future, longitudinal studies may investigate the timeline of this scenario. PMID:26894913

  13. Orofacial Pain

    MedlinePlus

    ... time. Signs that may indicate a headache of dental origin include: ; Pain behind the eyes Sore jaw muscles or "tired" ... t Sleep? Check Your Bite What Causes a Toothache? Your Posture May Be the Cause of Jaw ...

  14. Abdominal Pain

    MedlinePlus

    ... can help the overall situation for the child. Teaching kids self-hypnosis [8] or guided imagery [8a] ... related topics? Functional Abdominal Pain (English, French or Spanish)—from The North American Society for Pediatric Gastroenterology, ...

  15. Testicle pain

    MedlinePlus

    ... be caused by a hernia or kidney stone. Testicular cancer is almost always painless. But any testicle lump ... Read More Abdominal pain Scrotum Testes Testicle lump Testicular cancer Testicular torsion Update Date 8/31/2015 Updated ...

  16. Pain Control

    MedlinePlus

    ... have tried to find relief from cancer pain. ■■ Physical Therapy. Exercises or methods used to help restore strength, ... that you see a licensed expert when trying physical therapy, massage, hypnosis, or acupuncture. 25 To learn more ...

  17. Neck pain

    MedlinePlus

    A common cause of neck pain is muscle strain or tension. Most often, everyday activities are to blame. Such activities include: Bending over a desk for hours Having poor posture while watching TV or ...

  18. Face pain

    MedlinePlus

    ... gets worse when you bend forward) Tic douloureux Temporomandibular joint dysfunction syndrome Sometimes the reason for the face pain ... is persistent, unexplained, or accompanied by other unexplained symptoms. Call your primary provider. What to Expect at ...

  19. Pain and pain tolerance in professional ballet dancers.

    PubMed Central

    Tajet-Foxell, B; Rose, F D

    1995-01-01

    Pain experience in sport had been the subject of increasing research in recent years. While sports professionals have generally been found to have higher pain thresholds than control subjects the reasons for this are not entirely clear. The present study seeks to investigate one possible explanatory factor, the importance of the popular image of the physical activity and of the self-image of its participants, by examining pain experience in professional ballet dancers. Like sports professionals, dancers were found to have higher pain and pain tolerance thresholds than age matched controls in the Cold Pressor Test. However, they also reported a more acute experience of the sensory aspects of the pain. Explanations of this apparent paradox are discussed both in terms of the neuroticism scores of the two groups and in terms of the dancers' greater experience of pain and its relationship with physical activity. The results illustrated the importance of using multidimensional measures of pain in this type of investigation. PMID:7788215

  20. Neonatal pain.

    PubMed

    Walker, Suellen M

    2014-01-01

    Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and long-term outcomes. Painful stimuli activate nociceptive pathways, from the periphery to the cortex, in neonates and behavioral responses form the basis for validated pain assessment tools. However, there is an increasing awareness of the need to not only reduce acute behavioral responses to pain in neonates, but also to protect the developing nervous system from persistent sensitization of pain pathways and potential damaging effects of altered neural activity on central nervous system development. Analgesic requirements are influenced by age-related changes in both pharmacokinetic and pharmacodynamic response, and increasing data are available to guide safe and effective dosing with opioids and paracetamol. Regional analgesic techniques provide effective perioperative analgesia, but higher complication rates in neonates emphasize the importance of monitoring and choice of the most appropriate drug and dose. There have been significant improvements in the understanding and management of neonatal pain, but additional research evidence will further reduce the need to extrapolate data from older age groups. Translation into improved clinical care will continue to depend on an integrated approach to implementation that encompasses assessment and titration against individual response, education and training, and audit and feedback.

  1. Bison in the greater Yellowstone

    USGS Publications Warehouse

    Meagher, Mary

    1994-01-01

    In the Greater Yellowstone Area, free-ranging bison occur in Jackson Hole, Wyoming, and Yellowstone National Park. The Yellowstone population is discussed, with emphasis on changes in numbers from approximately 400 in 1968 to about 3500 now. Major influences for change initially were natural; more recently the winter road system used by snowmobiles appeared to be the dominant factor. The situation is in a state of flux. Interagency planning is in progress to address management alternatives for conflicts outside the park.

  2. Postoperative pain management.

    PubMed

    Joshi, G P

    1994-01-01

    Inadequately treated pain is a major cause of unanticipated hospital admissions after ambulatory surgery. The ability to provide adequate pain relief by simple methods that are readily available to the day-care patient in his or her home environment is one of the major challenges for providers of ambulatory surgery and anesthesia. The increasing number of extensive and painful surgical procedures (e.g., laparoscopic cholecystectomy, laminectomy, knee construction, hysterectomies) being undertaken on an ambulatory basis presents new challenges with respect to acute postoperative pain. Hence the availability of more sophisticated and effective treatment modalities, such as ambulatory PCA and continuous local and regional anesthetic blocks, with minimal side effects, are necessary to optimize the benefits of ambulatory surgery for both patient and health care provider. However, outcome studies are needed to evaluate the effect of these newer therapeutic approaches with respect to postoperative side effects and other important recovery parameters. Recent studies suggest that factors other than pain per se must be controlled to reduce postoperative morbidity and facilitate the recovery process. Not surprisingly, the anesthetic technique can influence analgesic requirement in the early postoperative period. Although oral analgesic agents will continue to play an important role, the adjunctive use of local anesthetic agents is likely to assume an even greater role in the future. Use of drug combinations (e.g., opiates and local anesthetics, opiates and NSAIDs) may provide improved analgesia with fewer side effects. Finally, safer and simpler analgesic delivery systems are needed to improve our ability to provide cost-effective pain relief after ambulatory surgery. In conclusion, as a result of our enhanced understanding of the mechanisms of acute pain and the physiological basis of nociception, the provision of "stress-free" anesthesia with minimal postoperative

  3. Comparison of pain, kinesiophobia and quality of life in patients with low back and neck pain

    PubMed Central

    Uluğ, Naime; Yakut, Yavuz; Alemdaroğlu, İpek; Yılmaz, Öznur

    2016-01-01

    [Purpose] The purpose of this study was to compare patients with low back and neck pain with respect to kinesiophobia, pain, and quality of life. [Subjects and Methods] Three-hundred patients with low back (mean age 43.2±11 years) and 300 with neck pain (mean age 42.8±10.2 years) were included in this study. Pain severity was evaluated by using the Short-Form McGill Pain Questionnaire, which includes a Visual Analogue Scale, quality of life by the Nottingham Health Profile, and kinesiophobia by the Tampa Scale for Kinesiophobia. [Results] Pain severity was similar in both groups, with a Visual Analogue Scale score of 6.7±2 in the low back pain and 6.8±2 in the neck pain group. Nottingham Health Profile pain [z=−4.132] and physical activity scores [z=−5.640] in the low back pain group were significantly higher. Kinesiophobia was also more severe in the low back pain group, with a mean 42.05±5.91 versus 39.7±6.0 Tampa Scale for Kinesiophobia score [z=−4.732]. [Conclusion] Patients with low back pain developed more severe kinesiophobia, regardless of the pain severity, and had greater pain perception and lower physical activity levels. Kinesiophobia adversely affects the quality of life and requires effective management of low back pain. PMID:27064399

  4. Comparison of pain, kinesiophobia and quality of life in patients with low back and neck pain.

    PubMed

    Uluğ, Naime; Yakut, Yavuz; Alemdaroğlu, İpek; Yılmaz, Öznur

    2016-01-01

    [Purpose] The purpose of this study was to compare patients with low back and neck pain with respect to kinesiophobia, pain, and quality of life. [Subjects and Methods] Three-hundred patients with low back (mean age 43.2±11 years) and 300 with neck pain (mean age 42.8±10.2 years) were included in this study. Pain severity was evaluated by using the Short-Form McGill Pain Questionnaire, which includes a Visual Analogue Scale, quality of life by the Nottingham Health Profile, and kinesiophobia by the Tampa Scale for Kinesiophobia. [Results] Pain severity was similar in both groups, with a Visual Analogue Scale score of 6.7±2 in the low back pain and 6.8±2 in the neck pain group. Nottingham Health Profile pain [z=-4.132] and physical activity scores [z=-5.640] in the low back pain group were significantly higher. Kinesiophobia was also more severe in the low back pain group, with a mean 42.05±5.91 versus 39.7±6.0 Tampa Scale for Kinesiophobia score [z=-4.732]. [Conclusion] Patients with low back pain developed more severe kinesiophobia, regardless of the pain severity, and had greater pain perception and lower physical activity levels. Kinesiophobia adversely affects the quality of life and requires effective management of low back pain.

  5. Painful Issues in Pain Prediction.

    PubMed

    Hu, Li; Iannetti, Gian Domenico

    2016-04-01

    How perception of pain emerges from neural activity is largely unknown. Identifying a neural 'pain signature' and deriving a way to predict perceived pain from brain activity would have enormous basic and clinical implications. Researchers are increasingly turning to functional brain imaging, often applying machine-learning algorithms to infer that pain perception occurred. Yet, such sophisticated analyses are fraught with interpretive difficulties. Here, we highlight some common and troublesome problems in the literature, and suggest methods to ensure researchers draw accurate conclusions from their results. Since functional brain imaging is increasingly finding practical applications with real-world consequences, it is critical to interpret brain scans accurately, because decisions based on neural data will only be as good as the science behind them. PMID:26898163

  6. Children's selective attention to pain and avoidance behaviour: the role of child and parental catastrophizing about pain.

    PubMed

    Vervoort, Tine; Trost, Zina; Van Ryckeghem, Dimitri M L

    2013-10-01

    The present study investigated selective attention to pain in children, its implications for child avoidance behaviour, and the moderating role of dimensions comprising child and parental catastrophizing about pain (ie, rumination, magnification, and helplessness). Participants were 59 children (31 boys) aged 10-16 years and one of their parents (41 mothers). Children performed a dot-probe task in which child facial pain displays of varying pain expressiveness were presented. Child avoidance behaviour was indexed by child pain tolerance during a cold-pressor task. Children and parents completed measures of child and parent pain catastrophizing, respectively. Findings indicated that both the nature of child selective attention to pain and the impact of selective attention upon child avoidance behaviour were differentially sensitive to specific dimensions of child and parental catastrophizing. Specifically, findings showed greater tendency to shift attention away from pain faces (i.e.,, attentional avoidance) among children reporting greater pain magnification. A similar pattern was observed in terms of parental characteristics, such that children increasingly shifted attention away from pain with increasing levels of parental rumination and helplessness. Furthermore, child attentional avoidance was associated with greater avoidance behaviour (i.e., lower pain tolerance) among children reporting high levels of pain magnification and those whose parents reported greater rumination about pain. The current findings corroborate catastrophizing as a multidimensional construct that may differentially impact outcomes and attest to the importance of assessing both child and parental characteristics in relation to child pain-related attention and avoidance behaviour. Further research directions are discussed.

  7. [Myofascial pain syndrome--fascial muscle pain].

    PubMed

    Partanen, Juhani; Ojala, Tuula; Arokoski, Jari P A

    2010-01-01

    Symptoms of myofascial pain syndrome, i.e. fascial muscle pain may occur in several areas of the body, particularly in the neck-shoulder region. The muscle pain symptom in the neck-shoulder region is commonly termed tension neck pain or nonspecific neck pain, but myofascial pain syndrome can also be distinguished into its own diagnosis. This review deals with the clinical picture of myofascial pain syndrome along with pathophysiological hypotheses and treatment options.

  8. Sex differences in endogenous pain modulation by distracting and painful conditioning stimulation

    PubMed Central

    Quiton, Raimi L.; Greenspan, Joel D.

    2007-01-01

    Sex differences in endogenous pain modulation were tested in healthy volunteers (32 men, 30 women). Painful contact heat stimuli were delivered to the right leg alone, and then in combination with various electrical conditioning stimuli delivered to the left forearm. Four conditioning protocols were applied to each subject in separate sessions: mild, nonpainful (control); distracting; stressful-yet-nonpainful; strongly painful. Thermal stimuli were rated on visual analog scales for pain intensity (INT) and unpleasantness (UNP). Distracting and painful conditioning stimuli significantly reduced heat pain INT and UNP ratings for both sexes, with significantly larger distraction effects on INT ratings for men than women (p=0.004). No sex differences in pain-evoked hypoalgesia were detected (p>0.05). The stress protocol did not consistently reduce heat pain ratings, possibly because the protocol was not sufficiently stressful to activate endogenous modulatory systems. Regression analysis revealed that the magnitude of pain-evoked hypoalgesia was predicted by the perceived distraction (p=0.003) and stress (p=0.04) produced by the painful conditioning stimulation, providing evidence that distraction and stress contribute to pain-evoked hypoalgesia. However, the contribution of stress to pain-evoked hypoalgesia differed by sex (p=0.02), with greater perceived stress associated with greater hypoalgesia in men and the opposite trend in women, suggesting sex differences in the mechanisms underlying pain-evoked hypoalgesia. This study provides indirect evidence that multiple neural mechanisms are involved in endogenous pain modulation and suggests that sex-specific aspects of these systems may contribute to greater pain sensitivity and higher prevalence of many chronic pain conditions among women. PMID:17951004

  9. Comparison of patients with orofacial pain of different diagnostic categories.

    PubMed

    Karibe, Hiroyuki; Goddard, Greg; McNeill, Charles; Shih, Sandy Thai

    2011-04-01

    The authors compared the pain intensity and difficulty experienced in performing activities of daily living (ADL) among 237 patients with orofacial pain. The patients underwent comprehensive examinations and recorded their subjective symptoms on a form (five items for pain intensity and six for ADL-related difficulty). On the basis of the primary diagnosis, the patients were divided into the temporomandibular joint dysfunction (TMJ), myofascial pain (MP), neuropathic pain (NP), and fibromyalgia (FM) groups. The intensity of pain in the jaw/face, tightness in the jaw/face, pain in the neck, and toothache significantly differed among the groups (p < 0.01, Kruskal-Wallis test). Compared to other patients, the FM and NP groups reported greater pain intensity, whereas those in the TMJ group reported lesser pain intensity. The ADL-related difficulty was not significantly different among the groups. Thus, compared to pain due to joint-related disorders, myalgic and neuropathic pain seem to be of higher intensity.

  10. 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 ...

  11. [Forefoot pain].

    PubMed

    Damiano, Joël

    2010-03-20

    Forefoot chronic pain is a frequent problem in daily clinical practice. Mechanical pathology of the forefoot, usually called static metatarsalgia, represents the most frequent reason for consultation in pathology of the foot. The cause is a functionnal disorder or anatomic derangement of the forefoot architecture. Metatarsalgia can originate from a wide range of affections. Etiologies of chronic pain are described from medial to lateral with first ray pathologies (hallux valgus, hallux rigidus and sesamoid pathology) and first ray insufficiency, pathologies of the second, third and fourth ray and intermetatarsal spaces (second ray syndrome, Freiberg's disease, Morton neuroma, stress or bone insufficiency metatarsal fractures, intermetatarsal bursitis) and fifth ray pathology (lateral bursitis, quintus varus). Sometimes forefoot pain could also be caused by chronic inflammatory rheumatic diseases (rheumatoid and psoriatic arthritis) with a risk of structural metatarsophalangeal joints alteration. The pathology of the toes can, more rarely, explain a forefoot pain. So, several pathologic conditions can produce forefoot pain and the diagnostic approach must always be based on the anamnesis and clinical examination. In a second time if the cause is difficult to establish based solely on clinical findings, radiography and ultrasonography are today the most usefull auxiliary investigations.

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

    PubMed

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

    2015-12-01

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

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

    PubMed

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

    2015-12-01

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

  14. Chronic Pain Medicines

    MedlinePlus

    ... Treatment of chronic pain usually involves medicines and therapy. Medicines used for chronic pain include pain relievers, antidepressants and anticonvulsants. Different types of medicines help ...

  15. Pain charts (body maps or manikins) in assessment of the location of pediatric pain.

    PubMed

    von Baeyer, Carl L; Lin, Vivian; Seidman, Laura C; Tsao, Jennie Ci; Zeltzer, Lonnie K

    2011-01-01

    This article surveys the use of pain charts or pain drawings in eliciting information about the location of pain symptoms from children and adolescents. While pain charts are widely used and have been incorporated in multidimensional pediatric pain questionnaires and diaries, they present a number of issues requiring further study. These include, in particular, the number and size of different locations or areas of pain that need to be differentiated; the age at which children are able to complete pain charts unassisted; and whether the intensity and other qualities of pain can be accurately recorded on pain charts by children and adolescents. Based on data currently available, it is suggested that the unassisted use of pain charts be restricted to children aged 8 years or over, while for clinical purposes many younger children can complete pain charts with adult support. Where the investigator's interest is restricted to a few areas of the body, checklists of body parts may have greater utility than pain charts. A new pain chart adapted for use in studies of pediatric recurrent and chronic pain is presented.

  16. [Autoerotic fatalities in Greater Dusseldorf].

    PubMed

    Hartung, Benno; Hellen, Florence; Borchard, Nora; Huckenbeck, Wolfgang

    2011-01-01

    Autoerotic fatalities in the Greater Dusseldorf area correspond to the relevant medicolegal literature. Our results included exclusively young to middle-aged, usually single men who were found dead in their city apartments. Clothing and devices used showed a great variety. Women's or fetish clothing and complex shackling or hanging devices were disproportionately frequent. In most cases, death occurred due to hanging or ligature strangulation. There was no increased incidence of underlying psychiatric disorders. In most of the deceased no or at least no remarkable alcohol intoxication was found. Occasionally, it may be difficult to reliably differentiate autoerotic accidents, accidents occurring in connection with practices of bondage & discipline, dominance & submission (BDSM) from natural death, suicide or homicide. PMID:22039693

  17. Planning for greater confinement disposal

    SciTech Connect

    Gilbert, T.L.; Luner, C.; Meshkov, N.K.; Trevorrow, L.E.; Yu, C.

    1985-01-01

    A report that provides guidance for planning for greater-confinement disposal (GCD) of low-level radioactive waste is being prepared. The report addresses procedures for selecting a GCD technology and provides information for implementing these procedures. The focus is on GCD; planning aspects common to GCD and shallow-land burial are covered by reference. Planning procedure topics covered include regulatory requirements, waste characterization, benefit-cost-risk assessment and pathway analysis methodologies, determination of need, waste-acceptance criteria, performance objectives, and comparative assessment of attributes that support these objectives. The major technologies covered include augered shafts, deep trenches, engineered structures, hydrofracture, improved waste forms, and high-integrity containers. Descriptive information is provided, and attributes that are relevant for risk assessment and operational requirements are given. 10 refs., 3 figs., 2 tabs.

  18. Integrating Pain Management in Clinical Practice

    PubMed Central

    Jamison, Robert N.; Edwards, Robert R.

    2014-01-01

    There is much evidence to suggest that psychological and social issues are predictive of pain severity, emotional distress, work disability, and response to medical treatments among persons with chronic pain. Psychologists can play an important role in the identification of psychological and social dysfunction and in matching personal characteristics to effective interventions as part of a multidisciplinary approach to pain management, leading to a greater likelihood of treatment success. The assessment of different domains using semi-structured clinical interviews and standardized self-report measures permits identification of somatosensory, emotional, cognitive, behavioral and social issues in order to facilitate treatment planning. We briefly describe measures to assess constructs related to pain and intervention strategies for the behavioral treatment of chronic pain and discuss related psychiatric and substance abuse issues. Finally, we offer a future look at the role of integrating pain management in clinical practice in the psychological assessment and treatment for persons with chronic pain. PMID:22383018

  19. Pain and 'hassles' in the United States: findings of the Nuprin pain report.

    PubMed

    Sternbach, R A

    1986-10-01

    A national survey of pain in the United States has been conducted, using a sample of 1254 persons 18 years of age or more, statistically constructed so as to permit projections to be made to the entire adult population of 174 million with a predicted accuracy of +/- 2-3%. Pain prevalence and severity, and its impact on work and other activities were obtained and correlated with demographic variables. This paper reports the portion of the study examining the association of pain with stress, daily hassles, measures of health locus of control, and various health habits. There was a very strong association between stress and pain and hassles and pain. The greater the stress and hassles, the greater the incidence, frequency and severity of all pains reported. Those with high internal health locus of control are more likely to have healthy behavior, are less likely to have all kinds of pain, and have less severe pain. Stress was voluntarily mentioned by respondents as a major cause of pain in headaches, backaches, stomach pains, and menstrual pains, but not for muscle, joint or dental pains.

  20. Effect of psychological processes on chronic pain.

    PubMed

    Jones, S E

    The influence of psychological factors on the evolution of acute to chronic pain is reviewed with respect to attributional style. Training patients in coping strategies can help them to alter their beliefs and develop greater confidence in their own ability to manage their pain. PMID:8324360

  1. Facts and Figures on Pain

    MedlinePlus

    ... adults. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting ... Institute of Health Statistics survey indicated that low back pain was the most common (27%), followed by severe ...

  2. [Social pain].

    PubMed

    Shimoyama, Naohito; Shimoyama, Megumi

    2011-09-01

    This chapter focuses on what social pain is and how it should be managed. In order to understand social pain in a cancer patient, it is necessary to recognize the change in the patient's daily life after the diagnosis of cancer. Because the degree of suffering and the relationships with family members and the people he or she worked with differ from patient to patient, it is important to note that the context of social pain is different in each patient. Five points shown below are essential in managing social pain. 1. Economical suffering may be alleviated by utilization of the social security system while taking into account each patient's standard of living. 2. Burdens on family members should be lessened, such as by not having them stay at the patient's bedside every day and letting them go home occasionally. 3. The normal patterns of communication, support, and conflict in the family should be identified, and the extent to which they have been disrupted by the illness should be assessed. 4. It is important to understand the ethnic, cultural, and religious background of the patient and the potential impact of their influence on the individual and the illness. 5. Practical or emotional unfinished business that the patient has needs to be identified, and efforts should be made to support fulfillment.

  3. Breast pain

    PubMed Central

    2007-01-01

    Introduction Breast pain may be cyclical (worse before a period) or non-cyclical, originating from the breast or the chest wall, and occurs at some time in 70% of women. Cyclical breast pain resolves spontaneously in 20-30% of women, but tends to recur in 60% of women. Non-cyclical pain responds poorly to treatment but tends to resolve spontaneously in half of women. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for breast pain? We searched: Medline, Embase, The Cochrane Library and other important databases up to January 2006 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 22 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: a low-fat diet, antibiotics, bromocriptine, danazol, diuretics, evening primrose oil, gestrinone, gonadorelin analogues, hormone replacement therapy, lisuride, progestogens, pyridoxine, tamoxifen, tibolone, topical non-steroidal anti-inflammatory drugs, toremifene, and vitamin E. PMID:19454068

  4. Breast pain

    PubMed Central

    2011-01-01

    Introduction Breast pain may be cyclical (worse before a period) or non-cyclical, originating from the breast or the chest wall, and occurs at some time in 70% of women. Cyclical breast pain resolves spontaneously in 20% to 30% of women, but tends to recur in 60% of women. Non-cyclical pain responds poorly to treatment but tends to resolve spontaneously in half of women. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for breast pain? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 24 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics, bromocriptine, combined oral contraceptive pill, danazol, diuretics, evening primrose oil, gestrinone, gonadorelin analogues, hormone replacement therapy (HRT), lisuride, low-fat diet, progestogens, pyridoxine, tamoxifen, tibolone, topical or oral non-steroidal anti-inflammatory drugs (NSAIDs), toremifene, and vitamin E. PMID:21477394

  5. Breast pain

    PubMed Central

    2014-01-01

    Introduction Breast pain may be cyclical (worse before a period) or non-cyclical, originating from the breast or the chest wall, and occurs at some time in 70% of women. Cyclical breast pain resolves spontaneously in 20% to 30% of women, but tends to recur in 60% of women. Non-cyclical pain responds poorly to treatment but tends to resolve spontaneously in half of women. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for breast pain? We searched: Medline, Embase, The Cochrane Library, and other important databases up to February 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 11 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: bra wearing, combined oral contraceptive pill, danazol, gonadorelin analogues, progestogens, tamoxifen, and topical or oral non-steroidal anti-inflammatory drugs (NSAIDs).

  6. Achilles Pain.

    ERIC Educational Resources Information Center

    Connors, G. Patrick

    Five ailments which can cause pain in the achilles tendon area are: (1) muscular strain, involving the stretching or tearing of muscle or tendon fibers; (2) a contusion, inflammation or infection called tenosynovitis; (3) tendonitis, the inflammation of the tendon; (4) calcaneal bursitis, the inflammation of the bursa between the achilles tendon…

  7. Illness perceptions, negative emotions, and pain in patients with noncardiac chest pain.

    PubMed

    Israel, Jared I; White, Kamila S; Gervino, Ernest V

    2015-03-01

    Illness-specific cognitions are associated with outcomes in numerous health conditions, however, little is known about their role in noncardiac chest pain (NCCP). NCCP is prevalent, impairing, and associated with elevated health care utilization. Our objective was to investigate the relations between illness perceptions, emotion, and pain in a sample of 196 adult patients diagnosed with NCCP. We found that negative illness perceptions were associated with greater anxiety, depression, chest pain, and pain-related life interference while controlling for the effects of demographic and pain-related variables. These results expand current NCCP theory and may inform future treatment development.

  8. Painful menstrual periods

    MedlinePlus

    ... related activities for a few days during each menstrual cycle. Painful menstruation is the leading cause of lost ... when did the pain begin? When in your menstrual cycle do you experience the pain? Is the pain ...

  9. Complex Regional Pain Syndrome

    MedlinePlus

    Complex regional pain syndrome (CRPS) is a chronic pain condition. It causes intense pain, usually in the arms, hands, legs, or feet. ... in skin temperature, color, or texture Intense burning pain Extreme skin sensitivity Swelling and stiffness in affected ...

  10. Back Pain During Pregnancy

    MedlinePlus

    ... Management Education & Events Advocacy For Patients About ACOG Back Pain During Pregnancy Home For Patients Search FAQs Back ... Pain During Pregnancy FAQ115, January 2016 PDF Format Back Pain During Pregnancy Pregnancy What causes back pain during ...

  11. When Sex Is Painful

    MedlinePlus

    ... AQ FREQUENTLY ASKED QUESTIONS GYNECOLOGIC PROBLEMS FAQ020 When Sex Is Painful • How common is painful sex? • What causes pain during sex? • Where is pain during sex felt? • When should ...

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

    PubMed

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

    2014-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  14. Chronic pain patient-spouse behavioral interactions predict patient disability.

    PubMed

    Romano, J M; Turner, J A; Jensen, M P; Friedman, L S; Bulcroft, R A; Hops, H; Wright, S F

    1995-12-01

    Based on behavioral theory, it has been hypothesized that spouse solicitous responses to the pain behaviors of chronic pain patients may contribute to the maintenance of pain behaviors and disability. Self-report data support this hypothesis, but direct observational measures have not been used to study this association. In this study, 50 chronic pain patients and their spouses were videotaped while engaging in common household activities. and patient pain behaviors and spouse solicitous behaviors were coded from the tapes. Spouse solicitous responses to non-verbal pain behaviors were significant predictors of physical disability in the more depressed patients, and were significant predictors of rate of non-verbal pain behavior in patients who reported greater pain. Spouse solicitous responses did not predict psychosocial dysfunction or total self-reported pain behaviors. The result support behavioral theory and indicate the need for further study of the association between spouse solicitousness and patient pain behaviors/disability.

  15. Empathy gaps for social pain: why people underestimate the pain of social suffering.

    PubMed

    Nordgren, Loran F; Banas, Kasia; MacDonald, Geoff

    2011-01-01

    In 5 studies, the authors examined the hypothesis that people have systematically distorted beliefs about the pain of social suffering. By integrating research on empathy gaps for physical pain (Loewenstein, 1996) with social pain theory (MacDonald & Leary, 2005), the authors generated the hypothesis that people generally underestimate the severity of social pain (ostracism, shame, etc.)--a biased judgment that is only corrected when people actively experience social pain for themselves. Using a social exclusion manipulation, Studies 1-4 found that nonexcluded participants consistently underestimated the severity of social pain compared with excluded participants, who had a heightened appreciation for social pain. This empathy gap for social pain occurred when participants evaluated both the pain of others (interpersonal empathy gap) as well as the pain participants themselves experienced in the past (intrapersonal empathy gap). The authors argue that beliefs about social pain are important because they govern how people react to socially distressing events. In Study 5, middle school teachers were asked to evaluate policies regarding emotional bullying at school. This revealed that actively experiencing social pain heightened the estimated pain of emotional bullying, which in turn led teachers to recommend both more comprehensive treatment for bullied students and greater punishment for students who bully. PMID:21219077

  16. Understanding pain, part 2: pain management.

    PubMed

    Godfrey, Helen

    This article is the second in a two-part series which explores pain and its management from a physiological perspective. Nurses play an important role in assessing and managing pain. Effective pain management by nurses requires them to have an understanding of the biological basis of the pain interventions which may be used to control pain. This article emphasizes the importance of pain assessment as a precursor for effective pain management and explores the biological basis of pain interventions which contribute to pain control. The role of non-pharmacological approaches in alleviating pain and their actions which contribute to pain relief are explored. The three main types of pharmaceutical agents used, non-opioids, opioids and adjuvant drugs, are introduced and their mechanisms of actions discussed. PMID:16224328

  17. Neck pain

    PubMed Central

    2008-01-01

    Introduction Non-specific neck pain has a postural or mechanical basis and affects about two thirds of people at some stage, especially in middle age. Acute neck pain resolves within days or weeks, but may become chronic in about 10% of people. Whiplash injuries follow sudden acceleration–deceleration of the neck, such as in road traffic or sporting accidents. Up to 40% of people continue to report symptoms 15 years after the accident, although this varies between countries. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for people with non-specific neck pain without severe neurological deficit? What are the effects of treatments for acute whiplash injury? What are the effects of treatments for chronic whiplash injury? What are the effects of treatments for neck pain with radiculopathy? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2007 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 91 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of the evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, biofeedback, drug treatments (analgesics, antidepressants, epidural steroid injections, muscle relaxants, non-steroidal anti-inflammatory drugs [NSAIDs]), early mobilisation, early return to normal activity, exercise, heat or cold, manipulation (alone or plus exercise), mobilisation, multimodal treatment, patient education, percutaneous radiofrequency neurotomy

  18. Shoulder pain

    PubMed Central

    2006-01-01

    Introduction Shoulder pain covers a wide range of problems and affects up to 20% of the population. It is not a specific diagnosis. Shoulder pain can be caused by problems with the acromioclavicular joint, shoulder muscles, or referred pain from the neck. Rotator cuff problems account for 65-70% of cases of shoulder pain. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral drug treatment; topical drug treatment; local injections; non-drug treatment; and surgical treatment? We searched: Medline, Embase, The Cochrane Library and other important databases up to February 2006 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 53 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: arthroscopic laser subacromial decompression, corticosteroid injections (intra-articular), corticosteroids (oral, subacromial injection), electrical stimulation, extracorporeal shock wave therapy, guanethidine (intra-articular), ice, laser treatment, manipulation under anaesthesia (plus intra-articular injection in people with frozen shoulder), multidisciplinary biopsychosocial rehabilitation, nerve block, non-steroidal anti-inflammatory drugs (oral, topical or intra-articular injection), opioid analgesics, paracetamol, phonophoresis, physiotherapy (manual treatment, exercises), surgical arthroscopic decompression, transdermal glyceryl trinitrate, ultrasound.

  19. Shoulder pain

    PubMed Central

    2010-01-01

    Introduction Shoulder pain is a common problem with an estimated prevalence of 4% to 26%. About 1% of adults aged over 45 years consult their GP with a new presentation of shoulder pain every year in the UK. The aetiology of shoulder pain is diverse and includes pathology originating from the neck, glenohumeral joint, acromioclavicular joint, rotator cuff, and other soft tissues around the shoulder girdle. The most common source of shoulder pain is the rotator cuff, accounting for over two-thirds of cases. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral drug treatment, topical drug treatment, local injections, non-drug treatment, and surgical treatment? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 71 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, arthroscopic subacromial decompression, autologous whole blood injection, corticosteroids (oral, subacromial injection, or intra-articular injection), electrical stimulation, excision of distal clavicle, extracorporeal shock wave therapy, ice, laser treatment, manipulation under anaesthesia, suprascapular nerve block, non-steroidal anti-inflammatory drugs (oral, topical or intra-articular injection), opioid analgesics, paracetamol, physiotherapy (manual treatment, exercises), platelet-rich plasma injection

  20. Free greater omental flap for treatment of mandibular osteoradionecrosis

    SciTech Connect

    Moran, W.J.; Panje, W.R.

    1987-04-01

    Osteoradionecrosis can involve the mandible following radical irradiation for treatment of oral cavity cancer. The radionecrosis of the mandible is often associated with severe intractable pain, local or extensive deformity, including pathologic fracture, orocutaneous fistula formation, and frequent loss of function. Treatment has ranged from analgesia and antibiotics to hyperbaric oxygen treatments to local or extensive sequestrectomies with partial or total mandibulectomy and restoration of tissue losses with unirradiated tissue. To our knowledge, this is the first report of the successful use of a free greater omental flap for immediate treatment of mandibular osteoradionecrosis and concomitant reconstruction. We found the omentum to be an excellent vascular bed that rapidly resolved the osteoradionecrosis and pain, promoted healing, and restored mandibular function with minimal discomfort to the patient.

  1. Neuropathic pain referrals to a multidisciplinary pediatric cancer pain service.

    PubMed

    Anghelescu, Doralina L; Faughnan, Lane G; Popenhagen, Mark P; Oakes, Linda L; Pei, Deqing; Burgoyne, Laura L

    2014-03-01

    Neuropathic pain (NP) in children with cancer is not well characterized. In a retrospective review of patient data from a 3.5-year period, we describe the prevalence of NP and the characteristics, duration of follow-up, and interventions provided for NP among patients referred to a pediatric oncology center's pain management service. Fifteen percent (66/439) of all referrals to our pain service were for NP (56/323 patients [17%]; 34 male, 22 female). The NP patient group had 1,401 clinical visits (778 inpatient visits [55.5%] and 623 outpatient visits [44.5%]). Patients with NP had a significantly greater mean number of pain visits per consultation (p = .008) and significantly more days of pain service follow-up (p < .001) than did other patients. The most common cause of NP was cancer treatment rather than the underlying malignancy. Pharmacologic management of NP was complex, often comprising three medications. Nonpharmacologic approaches were used for 57.6% of NP referrals. Neuropathic pain is less frequently encountered than non-NP in children with cancer; nevertheless, it is more difficult to treat, requiring longer follow-up, more clinical visits, complex pharmacologic management, and the frequent addition of nonpharmacologic interventions.

  2. Incorporation of pain in dreams of hospitalized burn victims.

    PubMed

    Raymond, Isabelle; Nielsen, Tore A; Lavigne, Gilles; Choinière, Manon

    2002-11-01

    It has been shown that realistic, localized painful sensations can be experienced in dreams either through direct incorporation or from past memories of pain. Nevertheless, the frequency of pain dreams in healthy subjects is low. This prospective study was designed to evaluate the occurrence and frequency of pain in the dreams of patients suffering from burn pain. Twenty-eight nonventilated burn victims were interviewed for 5 consecutive mornings during the first week of hospitalization. A structured-interview protocol was used to collect information on dream content, quality of sleep, and pain intensity and location. Patients were also administered the Impact of Event Scale to assess posttraumatic symptoms. Thirty-nine percent of patients reported 19 pain dreams on a total of 63 dreams (30%). Patients with pain dreams showed evidence of worse sleep, more nightmares, higher intake of anxiolytic medication, and higher scores on the Impact of Event Scale than did patents reporting dreams with no pain content. Moreover, patients with pain dreams also had a tendency to report more intense pain during therapeutic procedures. Although more than half of our sample did not report pain dreams, these results suggest that pain dreams do occur at a greater frequency in suffering populations than in normal volunteers. More importantly, dreaming about pain may be an added stress for burn patents and may contribute to both poor sleep and higher pain intensity, which could evolve into a cycle of pain-anxiety-sleeplessness.

  3. Psychological factors associated with orofacial pains.

    PubMed

    Carlson, Charles R

    2007-01-01

    This article develops the case for why trigeminal pain is a unique and challenging problem for clinicians and patients alike, and provides the reader with insights for effective trigeminal pain management based on an understanding of the interplay between psychologic and physiologic systems. There is no greater sensory experience for the brain to manage than unremitting pain in trigeminally mediated areas. Such pain overwhelms conscious experience and focuses the suffering individual like few other sensory events. Trigeminal pain often motivates a search for relief that can drain financial and emotional resources. In some instances, the search is rewarded by a treatment that immediately addresses an identifiable source of pain; in other cases, it can stimulate never-ending pilgrimages from one health provider to another. PMID:17185064

  4. Pain and Hand Function.

    PubMed

    Howland, Nicholas; Lopez, Mariela; Zhang, Andrew Y

    2016-02-01

    Pain is a unique somatosensory perception that can dramatically affect our ability to function. It is also a necessary perception, without which we would do irreparable damage to ourselves. In this article, the authors assess the impact of pain on function of the hand. Pain can be categorized into acute pain, chronic pain, and neuropathic pain. Hand function and objective measurements of hand function are analyzed as well as the impact of different types of pain on each of these areas.

  5. [Pain assessment and training: the impact on pain control after cardiac surgery].

    PubMed

    Silva, Magda Aparecida Dos Santos; Pimenta, Cibele Andrucioli de Mattos; Cruz, Diná de Almeida Lopes Monteiro da

    2013-02-01

    We analyzed the effects of training and the application of a form for the systematized assessment of pain control after cardiac surgery on pain intensity and supplementary use of morphine. Three patient groups underwent a non-randomized clinical trial with standardized analgesic prescription. In Group I, the nursing staff did not receive specific training regarding the assessment and management of pain, and patients were treated following the established protocol of the institution. In Groups II and III, the nursing staff received targeted training. In Group II the nursing staff used a form for the systematized assessment of pain, which was not used in Group III. Group II presented a lower intensity of pain and greater consumption of supplementary morphine compared to Groups I and II. Training associated with the systematized assessment form increased the chance of identifying pain and influenced nurses' decision-making process, thus promoting pain relief among patients.

  6. Knee Muscle Forces during Walking and Running in Patellofemoral Pain Patients and Pain-Free Controls

    PubMed Central

    Besier, Thor F.; Fredericson, Michael; Gold, Garry E.; Beaupré, Gary S.; Delp, Scott L.

    2009-01-01

    One proposed mechanism of patellofemoral pain, increased stress in the joint, is dependent on forces generated by the quadriceps muscles. Describing causal relationships between muscle forces, tissue stresses, and pain is difficult due to the inability to directly measure these variables in vivo. The purpose of this study was to estimate quadriceps forces during walking and running in a group of male and female patients with patellofemoral pain (n=27, 16 female; 11 male) and compare these to pain-free controls (n=16, 8 female; 8 male). Subjects walked and ran at self-selected speeds in a gait laboratory. Lower limb kinematics and electromyography (EMG) data were input to an EMG-driven musculoskeletal model of the knee, which was scaled and calibrated to each individual to estimate forces in 10 muscles surrounding the joint. Compared to controls, the patellofemoral pain group had greater co-contraction of quadriceps and hamstrings (p=0.025) and greater normalized muscle forces during walking, even though the net knee moment was similar between groups. Muscle forces during running were similar between groups, but the net knee extension moment was less in the patellofemoral pain group compared to controls. Females displayed 30-50% greater normalized hamstring and gastrocnemius muscle forces during both walking and running compared to males (p<0.05). These results suggest that some patellofemoral pain patients might experience greater joint contact forces and joint stresses than pain-free subjects. PMID:19268945

  7. Chronic Pain in Persons With Myotonic Dystrophy and Facioscapulohumeral Dystrophy

    PubMed Central

    Jensen, Mark P.; Hoffman, Amy J.; Stoelb, Brenda L.; Abresch, Richard T.; Carter, Gregory T.; McDonald, Craig M.

    2009-01-01

    Objective To determine the nature and scope of pain in working-aged adults with myotonic muscular dystrophy (MMD) and facioscapulohumeral muscular dystrophy (FSHD). Design Retrospective, cross-sectional survey. Setting Community-based survey. Participants Convenience sample of subjects with MMD and FSHD. Interventions Not applicable. Main Outcome Measures Overall intensity and duration of pain, pain inference, pain sites, pain treatments, and relief provided by pain treatments. Results More subjects with FSHD (82%) than with MMD (64%) reported pain. The most frequently reported pain sites for both diagnostic groups were lower back (66% MMD, 74% FSHD) and legs (60% MMD, 72% FSHD). Significant differences in pain intensity were found between the diagnostic groups in the hands, legs, knees, ankles, and feet, with patients with MMD reporting greater pain intensity at these sites than patients with FSHD. Age was related to the onset of pain (participants reporting pain were younger than those not reporting pain in the FSHD sample), but pain severity was not significantly associated with age in those reporting pain. Respondents with both diagnoses that reported mobility limitations and used assistive devices (eg, wheelchair, cane) reported more pain severity than those with mobility limitations who did not use assistive devices, who, in turn, reported more pain severity than respondents who reported no mobility limitations at all. The treatments that were reported to provide the greatest pain relief were not necessarily those that were the most frequently tried or still used. Conclusions The findings indicate that pain is a more common problem in persons with FSHD than in persons with MMD, although it is common in both populations. In addition, these pain problems are chronic, underscoring the need to identify and provide effective pain treatments for patients with these neuromuscular diseases. PMID:18226657

  8. Association of Leptin with Body Pain in Women

    PubMed Central

    Kapphahn, Kristopher; Brennan, Kathleen; Sullivan, Shannon D.; Stefanick, Marcia L.

    2016-01-01

    Abstract Leptin, an appetite-regulatory hormone, is also known to act as a proinflammatory adipokine. One of the effects of increased systemic leptin concentrations may be greater sensitivity to pain. We report the results of two studies examining the association between leptin and pain: a small pilot longitudinal study, followed by a large cross-sectional study. In Study 1, three women with physician-diagnosed fibromyalgia provided blood draws daily for 25 consecutive days, as well as daily self-reported musculoskeletal pain. Daily fluctuations in serum leptin were positively associated with pain across all three participants (F (1,63) = 12.8, p < 0.001), with leptin predicting ∼49% of the pain variance. In Study 2, the relationship between leptin and body pain was examined in a retrospective cross-sectional analysis of 5676 generally healthy postmenopausal women from the Women's Health Initiative. Leptin levels obtained from single blood draws were tested for a relationship with self-reported body pain. Body mass index (BMI) was also included as a predictor of pain. Both leptin and BMI were found to be independently associated with self-reported pain (p = 0.001 and p < 0.001, respectively), with higher leptin levels and greater BMI each being associated with greater pain. Leptin appears to be a predictor of body pain both within- and between-individuals and may be a driver of generalized pain states such as fibromyalgia. PMID:27028709

  9. Anatomical and Physiological Factors Contributing to Chronic Muscle Pain

    PubMed Central

    Gregory, Nicholas S.; Sluka, Kathleen A.

    2015-01-01

    Chronic muscle pain remains a significant source of suffering and disability despite the adoption of pharmacologic and physical therapies. Muscle pain is mediated by free nerve endings distributed through the muscle along arteries. These nerves project to the superficial dorsal horn and are transmitted primarily through the spinothalamic tract to several cortical and subcortical structures, some of which are more active during the processing of muscle pain than other painful conditions. Mechanical forces, ischemia, and inflammation are the primary stimuli for muscle pain, which is reflected in the array of peripheral receptors contributing to muscle pain-ASIC, P2X, and TRP channels. Sensitization of peripheral receptors and of central pain processing structures are both critical for the development and maintenance of chronic muscle pain. Further, variations in peripheral receptors and central structures contribute to the significantly greater prevalence of chronic muscle pain in females. PMID:24633937

  10. Postoperative pain control.

    PubMed

    Lovich-Sapola, Jessica; Smith, Charles E; Brandt, Christopher P

    2015-04-01

    Prevention and control of postoperative pain are essential. Inadequate treatment of postoperative pain continues to be a major problem after many surgeries and leads to worse outcomes, including chronic postsurgical pain. Optimal management of postoperative pain requires an understanding of the pathophysiology of pain, methods available to reduce pain, invasiveness of the procedure, and patient factors associated with increased pain, such as anxiety, depression, catastrophizing, and neuroticism. Use of a procedure-specific, multimodal perioperative pain management provides a rational basis for enhanced postoperative pain control, optimization of analgesia, decrease in adverse effects, and improved patient satisfaction.

  11. 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.

  12. Pain and the ethics of pain management.

    PubMed

    Edwards, R B

    1984-01-01

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

  13. Prevalence and determinants of pain and pain-related disability in urban and rural settings in southeastern Ontario

    PubMed Central

    Tripp, Dean A; VanDenKerkhof, Elizabeth G; McAlister, Margo

    2006-01-01

    BACKGROUND: Canadian chronic pain prevalence estimates range from 11% to 66%, are affected by sampling and measurement bias, and largely represent urban settings. OBJECTIVES: To estimate chronic pain prevalence and factors associated with pain in southeastern Ontario, a region with a larger rural than urban residence. METHODS: A systematic sampling with a random start was used to contact households. A telephone-administered questionnaire using the Graded Chronic Pain Scale, with questions on health care and medication use, health status, depression and demographics, was administered to consenting adults (18 to 94 years of age; mean age 50.2±16.6 years). RESULTS: The response rate was 49% (1067 of 2167), with 76% reporting some pain over the past six months. Low pain intensity with low pain interference prevalence was 34% (grade I), high pain intensity with low pain interference was 26% (grade II), and high pain intensity with high pain interference was 17% (grades III and IV). Of those reporting pain, 49% reported chronic pain (ie, pain for a minimum of 90 days over the past six months) representing 37% of the sample. Being female, unmarried, lower income, poorer self-reported health status and rural residence were associated with increasing pain. Once depression was considered in this pain analysis, residence was no longer significant. Lower rates of health care utilization were reported by rural residents. In those reporting the highest pain grades, poor health, greater medication and health care use, depression and more pain sites were associated with higher odds for pain-related disability. CONCLUSION: There is an elevated prevalence of pain in this almost equally split rural/urban region. Further examination of health care utilization and depression is suggested in chronic pain prevalence research. PMID:17149455

  14. Dyadic analysis of child and parent trait and state pain catastrophizing in the process of children's pain communication.

    PubMed

    Birnie, Kathryn A; Chambers, Christine T; Chorney, Jill; Fernandez, Conrad V; McGrath, Patrick J

    2016-04-01

    When explored separately, child and parent catastrophic thoughts about child pain show robust negative relations with child pain. The objective of this study was to conduct a dyadic analysis to elucidate intrapersonal and interpersonal influences of child and parent pain catastrophizing on aspects of pain communication, including observed behaviours and perceptions of child pain. A community sample of 171 dyads including children aged 8 to 12 years (89 girls) and parents (135 mothers) rated pain catastrophizing (trait and state versions) and child pain intensity and unpleasantness following a cold pressor task. Child pain tolerance was also assessed. Parent-child interactions during the cold pressor task were coded for parent attending, nonattending, and other talk, and child symptom complaints and other talk. Data were analyzed using the actor-partner interdependence model and hierarchical multiple regressions. Children reporting higher state pain catastrophizing had greater symptom complaints regardless of level of parent state pain catastrophizing. Children reporting low state pain catastrophizing had similar high levels of symptom complaints, but only when parents reported high state pain catastrophizing. Higher child and parent state and/or trait pain catastrophizing predicted their own ratings of higher child pain intensity and unpleasantness, with child state pain catastrophizing additionally predicting parent ratings. Higher pain tolerance was predicted by older child age and lower child state pain catastrophizing. These newly identified interpersonal effects highlight the relevance of the social context to children's pain expressions and parent perceptions of child pain. Both child and parent pain catastrophizing warrant consideration when managing child pain. PMID:26713422

  15. Low Back Pain

    MedlinePlus

    ... Low Back Pain Overview What is low back pain? Low back pain is a common problem for many people. It can be caused by many ... lift and exercise correctly. Symptoms When is low back pain serious? Call your family doctor if: Pain goes ...

  16. Race Effects on Conditioned Pain Modulation in Youth.

    PubMed

    Morris, Matthew C; Walker, Lynn; Bruehl, Stephen; Hellman, Natalie; Sherman, Amanda L; Rao, Uma

    2015-09-01

    Race and ethnicity shape the experience of pain in adults. African Americans typically exhibit greater pain intensity and evoked pain responsiveness than non-Hispanic whites. However, it remains unclear whether there are racial differences in conditioned pain modulation (CPM) and if these are present in youth. CPM refers to a reduction in perceived pain intensity for a test stimulus during application of a conditioning stimulus and may be especially relevant in determining risk for chronic pain. The present study assessed CPM to evoked thermal pain in 78 healthy youth (ages 10-17 years), 51% of whom were African American and 49% of whom were non-Hispanic white. African American youth reported lower mean conditioning pain ratings than non-Hispanic white youth, controlling for mean preconditioning pain ratings, which is consistent with stronger CPM. Multilevel models demonstrated stronger CPM effects in African American than non-Hispanic white youth, as evident in more rapid within-person decreases in pain ratings during the conditioning phase. These findings suggest that diminished CPM likely does not account for the enhanced responsiveness to evoked thermal pain observed in African American youth. These results may have implications for understanding racial differences in chronic pain experienced in adulthood. Perspective: This study evaluated conditioned pain modulation to evoked thermal pain in African American and non-Hispanic white youth. Findings could have implications for the development of personalized chronic pain treatment strategies that are informed by race and ethnicity.

  17. Pain in Sleepwalking: A Clinical Enigma

    PubMed Central

    Lopez, Régis; Jaussent, Isabelle; Dauvilliers, Yves

    2015-01-01

    Study Objectives: Sleepwalking is a disorder characterized by arousal specifically from slow wave sleep with dissociated brain activity that may be related to lower nociceptive state. Our objectives were to assess the frequency of chronic pain, headache, and migraine in sleepwalkers compared to controls, examine the impact and determinants of pain in sleepwalkers, and report analgesia frequency during injurious parasomnia episodes. Design: Cross-sectional case-control study. Setting: Data were collected at the Sleep Disorders Center, Montpellier, France. Participants: One hundred patients with sleepwalking were assessed for disease characteristics, sleep (polysomnography, sleepiness, and insomnia), pain (chronic pain, multidimensional pain inventory, headache, and migraine), depressive symptoms, and quality of life compared to 100 adult controls. Pain perception was retrospectively assessed during injurious parasomnia episodes. Measurements and Results: Raw association data showed that lifetime headache, migraine, and chronic pain at time of study were significantly associated with sleepwalking (also called somnambulism). Compared to controls, sleepwalkers reported more frequent daytime sleepiness, and depressive and insomnia symptoms. After adjustments, sleepwalking was associated with increased risk for headache and migraine only. Compared to pain-free sleepwalkers, sleepwalkers with chronic pain were more likely to be older and to have greater daytime sleepiness, insomnia, and depressive symptoms, with no difference in polysomnography assessment. Of the 47 sleepwalkers with at least one previous violent parasomnia episode, 78.7% perceived no pain during episodes, allowing them to remain asleep despite injury. Conclusion: Our results highlight the clinical enigma of pain in sleepwalking patients with complaints of frequent chronic pain, migraine, and headache during wakefulness but who report retrospectively experience of analgesia during severe parasomnia

  18. 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.

  19. 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

  20. Hydromorphone levels and pain control in patients with severe chronic pain.

    PubMed

    Reidenberg, M M; Goodman, H; Erle, H; Gray, G; Lorenzo, B; Leipzig, R M; Meyer, B R; Drayer, D E

    1988-10-01

    To better understand the use of narcotic analgesics, the hydromorphone concentration was measured in serum samples from 43 patients with chronic severe pain who were receiving this drug. At the time of blood sampling, pain intensity, mood, and cognitive performance were assessed. There was large individual variation in the dose-drug level relationship. Seven patients with bone or soft tissue pain and drug levels of greater than or equal to 4 ng/ml had good pain control, whereas 10 did not. None of 15 patients with levels less than 4 ng/ml had pain control, despite drug doses similar to those given patients with higher levels. Thus 60% of the patients without control of their pain had hydromorphone levels below the lowest level that produced pain control. No patient with pain from nerve infiltration or compression had good pain control, irrespective of the drug level or dose. Poor mood correlated with high pain intensity and low drug level. Impaired cognitive performance was not related to drug level. Knowing that there is a low concentration of narcotic in the blood of a patient with chronic severe pain who is receiving high drug doses and who shows lack of both efficacy and side effects may reassure health care professionals that further narcotic dosage escalation is appropriate.

  1. Central Pain Syndrome

    MedlinePlus

    ... intolerable bursts of sharp pain similar to the pain caused by a dental probe on an exposed nerve. Individuals may have numbness in the areas affected by the pain. The burning and loss of touch sensations are ...

  2. Low Back Pain

    MedlinePlus

    ... focuses on their pain as well as their perception of its severity. Pain that becomes chronic also ... that stimulating the nervous system can modify the perception of pain. Early studies of TENS suggested that ...

  3. Pain: Hope through Research

    MedlinePlus

    ... illness, our very lives. Pain is a complex perception that differs enormously among individual patients, even those ... that the two peptides are involved in the perception of pain sensations, especially moderate-to-severe pain. ...

  4. Pain medications - narcotics

    MedlinePlus

    Painkillers; Drugs for pain; Analgesics; Opioids ... Narcotics are also called opioid pain relievers. They are used only for pain that is severe and is not helped by other types of painkillers. When used ...

  5. What Is Back Pain?

    MedlinePlus

    ... Back Pain Find a Clinical Trial Journal Articles Back Pain PDF Version Size: 127 KB Audio Version Time: ... Size: 12.5 MB November 2014 What Is Back Pain? Fast Facts: An Easy-to-Read Series of ...

  6. Fighting Chronic Pain

    MedlinePlus

    ... leg pain from clogged arteries Stomach/Digestive: Gallstones, intestinal obstruction, diverticulitis, ulcers, severe indigestion, severe gas pain, inflammatory bowel disease, colitis Urinary/Reproductive: Kidney stones, pelvic pain, vulvodynia, ...

  7. Medications for back pain

    MedlinePlus

    ... doses of these medicines can help with chronic low back pain , even if the person does not feel sad ... notices pain. Antidepressants most commonly used for chronic low back pain also help you sleep. Antidepressants most often used ...

  8. Could Stress Contribute to Pain-Related Fear in Chronic Pain?

    PubMed Central

    Elsenbruch, Sigrid; Wolf, Oliver T.

    2015-01-01

    Learning to predict pain based on internal or external cues constitutes a fundamental and highly adaptive process aimed at self-protection. Pain-related fear is an essential component of this response, which is formed by associative and instrumental learning processes. In chronic pain, pain-related fear may become maladaptive, drive avoidance behaviors and contribute to symptom chronicity. Pavlovian fear conditioning has proven fruitful to elucidate associative learning and extinction involving aversive stimuli, including pain, but studies in chronic pain remain scarce. Stress demonstrably exerts differential effects on emotional learning and memory processes, but this has not been transferred to pain-related fear. Within this perspective, we propose that stress could contribute to impaired pain-related associative learning and extinction processes and call for interdisciplinary research. Specifically, we suggest to test the hypotheses that: (1) extinction-related phenomena inducing a re-activation of maladaptive pain-related fear (e.g., reinstatement, renewal) likely occur in everyday life of chronic pain patients and may alter pain processing, impair perceptual discrimination and favor overgeneralization; (2) acute stress prior to or during acquisition of pain-related fear may facilitate the formation and/or consolidation of pain-related fear memories; (3) stress during or after extinction may impair extinction efficacy resulting in greater reinstatement or context-dependent renewal of pain-related fear; and (4) these effects could be amplified by chronic stress due to early adversity and/or psychiatric comorbidity such depression or anxiety in patients with chronic pain. PMID:26733831

  9. Dental (Odontogenic) Pain

    PubMed Central

    Renton, Tara

    2011-01-01

    This article provides a simple overview of acute trigeminal pain for the non dentist. This article does not cover oral mucosal diseases (vesiculobullous disorders) that may cause acute pain. Dental pain is the most common in this group and it can present in several different ways. Of particular interest for is that dental pain can mimic both trigeminal neuralgia and other chronic trigeminal pain disorders. It is crucial to exclude these disorders whilst managing patients with chronic trigeminal pain. PMID:26527224

  10. Orofacial pain: a primer.

    PubMed

    De Rossi, Scott S

    2013-07-01

    Orofacial pain refers to pain associated with the soft and hard tissues of the head, face, and neck. It is a common experience in the population that has profound sociologic effects and impact on quality of life. New scientific evidence is constantly providing insight into the cause and pathophysiology of orofacial pain including temporomandibular disorders, cranial neuralgias, persistent idiopathic facial pains, headache, and dental pain. An evidence-based approach to the management of orofacial pain is imperative for the general clinician. This article reviews the basics of pain epidemiology and neurophysiology and sets the stage for in-depth discussions of various painful conditions of the head and neck.

  11. Fetal pain perception and pain management.

    PubMed

    Van de Velde, Marc; Jani, Jacques; De Buck, Frederik; Deprest, J

    2006-08-01

    This paper gives an overview of current science related to the concept of fetal pain. We have answered three important questions: (1) does fetal pain exist? (2) does management of fetal pain benefit the unborn child? and (3) which techniques are available to provide good fetal analgesia?

  12. Pain and musculoskeletal pain syndromes in adolescents.

    PubMed

    Zapata, Aura Ligia; Moraes, Ana Julia Pantoja; Leone, Claudio; Doria-Filho, Ulysses; Silva, Clovis Artur Almeida

    2006-06-01

    The presence of musculoskeletal pain was evaluated in adolescents. Pain was reported by 40% of respondents, benign joint hypermobility syndrome by 10%, myofascial syndrome by 5%, tendonitis by 2%, and fibromialgia by 1%. Logistical regression analysis indicated that sex and age were predictive of pain.

  13. Pain anticipatory phenomena in patients with central poststroke pain: a magnetoencephalography study.

    PubMed

    Gopalakrishnan, Raghavan; Burgess, Richard C; Lempka, Scott F; Gale, John T; Floden, Darlene P; Machado, Andre G

    2016-09-01

    Central poststroke pain (CPSP) is characterized by hemianesthesia associated with unrelenting chronic pain. The final pain experience stems from interactions between sensory, affective, and cognitive components of chronic pain. Hence, managing CPSP will require integrated approaches aimed not only at the sensory but also the affective-cognitive spheres. A better understanding of the brain's processing of pain anticipation is critical for the development of novel therapeutic approaches that target affective-cognitive networks and alleviate pain-related disability. We used magnetoencephalography (MEG) to characterize the neural substrates of pain anticipation in patients suffering from intractable CPSP. Simple visual cues evoked anticipation while patients awaited impending painful (PS), nonpainful (NPS), or no stimulus (NOS) to their nonaffected and affected extremities. MEG responses were studied at gradiometer level using event-related fields analysis and time-frequency oscillatory analysis upon source localization. On the nonaffected side, significantly greater responses were recorded during PS. PS (vs. NPS and NOS) exhibited significant parietal and frontal cortical activations in the beta and gamma bands, respectively, whereas NPS (vs. NOS) displayed greater activation in the orbitofrontal cortex. On the affected extremity, PS (vs. NPS) did not show significantly greater responses. These data suggest that anticipatory phenomena can modulate neural activity when painful stimuli are applied to the nonaffected extremity but not the affected extremity in CPSP patients. This dichotomy may stem from the chronic effects of pain on neural networks leading to habituation or saturation. Future clinically effective therapies will likely be associated with partial normalization of the neurophysiological correlates of pain anticipation. PMID:27358316

  14. Cryoanalgesia for relief of pain after thoracotomy.

    PubMed Central

    Maiwand, O; Makey, A R

    1981-01-01

    One hundred patients undergoing thoracotomy had their intercostal nerves blocked by cryoanalgesia before closure and the effect of this on their postoperative pain was evaluated. Of the 100 patients, 79 were free of pain, 12 had some discomfort, and nine reported severe pain necessitating narcotic analgesia (mean 1.5 injections per patient). Only five patients needed assisted removal of sputum, though eight showed retention of sputum or subsegmental collapse of lung radiographically. Overall, lack of pain and greater alertness much enhanced the value of physiotherapy, which resulted in a low incidence of complications and a smooth recovery. The technique of cryoanalgesia is simple, extremely effective, and apparently offers benefits not conferred by other methods of preventing pain after thoracotomy. Images FIG 1 PMID:6786605

  15. Cryoanalgesia for relief of pain after thoracotomy.

    PubMed

    Maiwand, O; Makey, A R

    1981-05-30

    One hundred patients undergoing thoracotomy had their intercostal nerves blocked by cryoanalgesia before closure and the effect of this on their postoperative pain was evaluated. Of the 100 patients, 79 were free of pain, 12 had some discomfort, and nine reported severe pain necessitating narcotic analgesia (mean 1.5 injections per patient). Only five patients needed assisted removal of sputum, though eight showed retention of sputum or subsegmental collapse of lung radiographically. Overall, lack of pain and greater alertness much enhanced the value of physiotherapy, which resulted in a low incidence of complications and a smooth recovery. The technique of cryoanalgesia is simple, extremely effective, and apparently offers benefits not conferred by other methods of preventing pain after thoracotomy.

  16. Children's selective attention to pain and avoidance behaviour: the role of child and parental catastrophizing about pain.

    PubMed

    Vervoort, Tine; Trost, Zina; Van Ryckeghem, Dimitri M L

    2013-10-01

    The present study investigated selective attention to pain in children, its implications for child avoidance behaviour, and the moderating role of dimensions comprising child and parental catastrophizing about pain (ie, rumination, magnification, and helplessness). Participants were 59 children (31 boys) aged 10-16 years and one of their parents (41 mothers). Children performed a dot-probe task in which child facial pain displays of varying pain expressiveness were presented. Child avoidance behaviour was indexed by child pain tolerance during a cold-pressor task. Children and parents completed measures of child and parent pain catastrophizing, respectively. Findings indicated that both the nature of child selective attention to pain and the impact of selective attention upon child avoidance behaviour were differentially sensitive to specific dimensions of child and parental catastrophizing. Specifically, findings showed greater tendency to shift attention away from pain faces (i.e.,, attentional avoidance) among children reporting greater pain magnification. A similar pattern was observed in terms of parental characteristics, such that children increasingly shifted attention away from pain with increasing levels of parental rumination and helplessness. Furthermore, child attentional avoidance was associated with greater avoidance behaviour (i.e., lower pain tolerance) among children reporting high levels of pain magnification and those whose parents reported greater rumination about pain. The current findings corroborate catastrophizing as a multidimensional construct that may differentially impact outcomes and attest to the importance of assessing both child and parental characteristics in relation to child pain-related attention and avoidance behaviour. Further research directions are discussed. PMID:23792243

  17. Present-day challenges and future solutions in postoperative pain management: results from PainForum 2014

    PubMed Central

    Kuusniemi, Kristiina; Pöyhiä, Reino

    2016-01-01

    This paper is a summary of presentations on postoperative pain control by the authors at the 2014 PainForum meeting in People’s Republic of China. Postoperative pain is often untreated or undertreated and may lead to subsequent chronic pain syndromes. As more procedures migrate to the outpatient setting, postoperative pain control will become increasingly more challenging. Evidence-based guidelines for postoperative pain control recommend pain assessment using validated tools on a consistent basis. In this regard, consistency may be more important than the specific tool selected. Many hospitals have introduced a multidisciplinary acute pain service (APS), which has been associated with improved patient satisfaction and fewer adverse events. Patient education is an important component of postoperative pain control, which may be most effective when clinicians chose a multimodal approach, such as paracetamol (acetaminophen) and opioids. Opioids are a mainstay of postoperative pain control but require careful monitoring and management of side effects, such as nausea, vomiting, dizziness, and somnolence. Opioids may be administered using patient-controlled analgesia systems. Protocols for postoperative pain control can be very helpful to establish benchmarks for pain management and assure that clinicians adhere to evidence-based standards. The future of postoperative pain control around the world will likely involve more and better established APSs and greater communication between patients and clinicians about postoperative pain. The changes necessary to implement and move forward with APSs is not a single step but rather one of continuous improvement and ongoing change. PMID:26893579

  18. Pain and Emotion: A Biopsychosocial Review of Recent Research

    PubMed Central

    Lumley, Mark A.; Cohen, Jay L.; Borszcz, George S.; Cano, Annmarie; Radcliffe, Alison M.; Porter, Laura S.; Schubiner, Howard; Keefe, Francis J.

    2011-01-01

    Objective and Method Research on emotion and pain has burgeoned. We review the last decade’s literature, focusing on links between emotional processes and persistent pain. Results Neurobiological research documents the neural processes that distinguish affective from sensory pain dimensions, link emotion and pain, and generate central nervous system pain sensitization. Psychological research demonstrates that greater pain is related to emotional stress and limited emotional awareness, expression, and processing. Social research shows the potential importance of emotional communication, empathy, attachment, and rejection. Conclusions Emotions are integral to the conceptualization, assessment, and treatment of persistent pain. Research should clarify when to eliminate or attenuate negative emotions, and when to access, experience, and express them. Theory and practice should integrate emotion into cognitive-behavioral models of persistent pain. PMID:21647882

  19. Social influence and pain response in women and men.

    PubMed

    McClelland, Laura E; McCubbin, James A

    2008-10-01

    The purpose of this study was to examine the effects of social influence on responses to acute pain in women and men in a randomized experimental design. Sixty-eight undergraduates (32 women; 36 men) were randomly assigned to perform a cold pressor task either alone or in the presence of a same-sex friend. Expressions of pain were assessed with the short form of the McGill Pain Questionnaire. Overall social support was measured using the Krause social support assessment scale. The presence of a same-sex friend significantly increased pain reports in women, but not in men. Persons who reported high levels of social support on the Krause scale also reported greater cold pressor pain. Results suggest that the presence of a friend can increase pain report to an acute laboratory pain stimulus in women. These findings are consistent with models of social reinforcement in chronic pain syndromes. PMID:18587638

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

    PubMed

    Witte, W

    2011-06-01

    developed by the American psychiatrist George Engel, defined chronic pain as an illness rather than a disease. Concurrently, the radical behaviorism of the late 1960s affected both the therapy of chronic and of acute pain. Based on this theory, patient-controlled analgesia (PCA) was introduced in the 1970s and 1980s. Acute pain services (APS) in hospitals, were developed beginning in the 1980s using the continuous release of opioids. Regional anesthesia played a greater role than general anesthesia in developing pain therapy in the twentieth century and paved the way for pain therapy. The restriction to nerve blocks in pain centers was overcome by the expansion of theoretical foundations beyond the framework of anesthesiology. Impulses from psychology and psychosomatic medicine were crucial. The evolution of cancer pain therapy was distinct from non-cancer pain therapy. PMID:21630064

  1. Primary torsion of the greater omentum.

    PubMed Central

    al-Husaini, H.; Onime, A.; Oluwole, S. F.

    2000-01-01

    Primary omental torsion is a rare cause of acute abdominal pain. A case of omental torsion in a 49-year-old woman who presented with clinical features consistent with acute appendicitis is discussed with a review of the literature. Images Figure 1 PMID:10918767

  2. Painful Traumatic Trigeminal Neuropathy.

    PubMed

    Rafael, Benoliel; Sorin, Teich; Eli, Eliav

    2016-08-01

    This article discusses neuropathic pain of traumatic origin affecting the trigeminal nerve. This syndrome has been termed painful traumatic trigeminal neuropathy by the International Headache Society and replaces atypical odontalgia, deafferentation pain, traumatic neuropathy, and phantom toothache. The discussion emphasizes the diagnosis and the early and late management of injuries to the trigeminal nerve and subsequent painful conditions.

  3. Pain syndromes in children.

    PubMed

    Malleson, Pete; Clinch, Jacqui

    2003-09-01

    This review discusses the recent literature on pain conditions in children that should be of interest to rheumatologists. The focus of the review is therefore on musculoskeletal pains in children, particularly chronic or recurrent musculoskeletal pain. Articles that have a broader focus on pain are discussed when these are likely to be of general interest to rheumatologists. Chronic or recurrent pain in childhood is common and can be caused by a wide variety of conditions, several of which are discussed here. The importance of being able to measure pain in children has been emphasized repeatedly in the recent literature. With increased understanding of how to evaluate pain in children has come the recognition that pain in children is multifactorial and that even when there are obvious "organic" causes of the pain (such as arthritis), psychosocial factors are critical in how pain is perceived, and they influence the extent to which pain leads to dysfunction. There is also increasing evidence that cognitive-behavioral therapies are effective in managing chronic pain in children. The frequency of back pain in children is increasingly recognized, and the role of children's work and play, carrying heavy backpacks, and sitting for long periods of time at computers in causing back pain is of interest. The studies reviewed here add to an increasingly rich and informative literature on musculoskeletal and other chronic pain in children, and they help emphasize the importance of proper evaluation and management of pain in children. PMID:12960483

  4. The Brain in Pain

    PubMed Central

    AHMAD, Asma Hayati; ABDUL AZIZ, Che Badariah

    2014-01-01

    Pain, while salient, is highly subjective. A sensation perceived as painful by one person may be perceived as uncomfortable, not painful or even pleasant to others. Within the same person, pain may also be modulated according to its threat value and the context in which it is presented. Imaging techniques, such as functional magnetic resonance imaging and positron emission tomography, have identified a distributed network in the brain, the pain-relevant brain regions, that encode the sensory-discriminative aspect of pain, as well as its cognitive and affective/emotional factors. Current knowledge also implicates the prefrontal cortex as the modulatory area for pain, with its subdivisions forming the cortico-cortical pathway, an alternative pain modulatory pathway distinct from the descending modulatory pathway of pain. These findings from neuroimaging in human subjects have paved the way for the molecular mechanisms of pain modulation to be explored in animal studies. PMID:25941463

  5. Focused review of interdisciplinary pain rehabilitation programs for chronic pain management.

    PubMed

    Stanos, Steven

    2012-04-01

    Interdisciplinary pain rehabilitation programs (IPRPs) are based on a functional restoration approach to treating complex chronic pain conditions. With a greater appreciation for a biopsychosocial approach to more effectively manage patients with chronic pain has come the development of more comprehensive treatment programs with less of a biomedical emphasis (i.e., interventional therapy, unimodal physical therapy, and passive modalities) and more of a biopsychosocial one. Interdisciplinary programs involve the use of multiple disciplines such as physical and occupational therapy, pain psychology, medical pain management, vocational rehabilitation, relaxation training, and nursing educations. Multiple psychometric tools are used in the assessment process and along treatment to better assess outcomes. This article will examine components of IPRPs, discuss desirable features of successful programs and teams, and more closely review four established outpatient pain programs in the United States. A greater understanding of the unique features and shared values of successful programs will help one better understand how these programs can be more widely used and available. The review will also highlight common psychometric outcomes tools used in assessing patients and monitoring outcomes. Most importantly, the review will help to answer a common question, even among pain physicians: "What goes on in those chronic pain programs?"

  6. Nonsurgical Management of Knee Pain in Adults.

    PubMed

    Jones, Brandon Q; Covey, Carlton J; Sineath, Marvin H

    2015-11-15

    The role of the family physician in managing knee pain is expanding as recent literature supports nonsurgical management for many patients. Effective treatment depends on the etiology of knee pain. Oral analgesics-most commonly nonsteroidal anti-inflammatory drugs and acetaminophen-are used initially in combination with physical therapy to manage the most typical causes of chronic knee pain. The American Academy of Orthopaedic Surgeons recommends against glucosamine/chondroitin supplementation for osteoarthritis. In patients who are not candidates for surgery, opioid analgesics should be used only if conservative pharmacotherapy is ineffective. Exercise-based therapy is the foundation for treating knee osteoarthritis and patellofemoral pain syndrome. Weight loss should be encouraged for all patients with osteoarthritis and a body mass index greater than 25 kg per m2. Aside from stabilizing traumatic knee ligament and tendon tears, the effectiveness of knee braces for chronic knee pain is uncertain, and the use of braces should not replace physical therapy. Foot orthoses can be helpful for anterior knee pain. Corticosteroid injections are effective for short-term pain relief in patients with osteoarthritis. The benefit of hyaluronic acid injections is controversial, and recommendations vary; recent systematic reviews do not support a clinically significant benefit. Small studies suggest that regenerative injections can improve pain and function in patients with chronic knee tendinopathies and osteoarthritis. PMID:26554281

  7. 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

  8. Sex Differences and Correlates of Pain in Patients with Comorbid Obesity and Binge Eating Disorder.

    PubMed

    Masheb, Robin M; White, Marney A; Grilo, Carlos M

    2016-05-01

    Sex differences and correlates of pain were examined in a sample of patients with comorbid binge eating disorder (BED) and obesity. One hundred fifty-two treatment-seeking patients with BED completed the Brief Pain Inventory. Analysis of covariance was utilized to compare women and men on pain, and correlational analysis, overall and by sex, was performed to examine relationships among pain, eating behaviour and metabolic risk factors. Women reported significantly greater pain severity and pain interference than men. Among women, eating behaviour and metabolic markers were not associated with pain. Among men, however, binge frequency was significantly associated with pain, as was high-density lipoprotein cholesterol and fasting glucose. In sum, while women in this sample had more pain than men, the presence of pain in men was associated with increased behavioural and metabolic risk factors. Findings have clinical implications for the assessment of comorbid pain and obesity-related health risks among individuals with BED.

  9. 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

  10. Sex Differences and Correlates of Pain in Patients with Comorbid Obesity and Binge Eating Disorder.

    PubMed

    Masheb, Robin M; White, Marney A; Grilo, Carlos M

    2016-05-01

    Sex differences and correlates of pain were examined in a sample of patients with comorbid binge eating disorder (BED) and obesity. One hundred fifty-two treatment-seeking patients with BED completed the Brief Pain Inventory. Analysis of covariance was utilized to compare women and men on pain, and correlational analysis, overall and by sex, was performed to examine relationships among pain, eating behaviour and metabolic risk factors. Women reported significantly greater pain severity and pain interference than men. Among women, eating behaviour and metabolic markers were not associated with pain. Among men, however, binge frequency was significantly associated with pain, as was high-density lipoprotein cholesterol and fasting glucose. In sum, while women in this sample had more pain than men, the presence of pain in men was associated with increased behavioural and metabolic risk factors. Findings have clinical implications for the assessment of comorbid pain and obesity-related health risks among individuals with BED. PMID:26841114

  11. Sex Differences and Correlates of Pain in Patients with Comorbid Obesity and Binge Eating Disorder

    PubMed Central

    Masheb, Robin M.; White, Marney A.; Grilo, Carlos M.

    2016-01-01

    Sex differences and correlates of pain were examined in a sample of patients with comorbid binge eating disorder (BED) and obesity. One hundred fifty-two treatment-seeking patients with BED completed the Brief Pain Inventory. Analysis of covariance was utilized to compare women and men on pain, and correlational analysis, overall and by sex, was performed to examine relationships among pain, eating behaviour and metabolic risk factors. Women reported significantly greater pain severity and pain interference than men. Among women, eating behaviour and metabolic markers were not associated with pain. Among men, however, binge frequency was significantly associated with pain, as was high-density lipoprotein cholesterol and fasting glucose. In sum, while women in this sample had more pain than men, the presence of pain in men was associated with increased behavioural and metabolic risk factors. Findings have clinical implications for the assessment of comorbid pain and obesity-related health risks among individuals with BED. PMID:26841114

  12. Sex differences in masticatory muscle pain after chewing.

    PubMed

    Karibe, H; Goddard, G; Gear, R W

    2003-02-01

    Neither the etiology of muscle-related temporomandibular disorders (TMD) nor the reason for the disproportionate number of women suffering from these disorders is well-established. We tested the hypothesis that physiologically relevant exercise (i.e., chewing bubble gum for 6 min) increases masticatory muscle pain in patients, but not in asymptomatic control subjects, and that female patients experience a significantly greater increase than males. Chewing increased pain in both female and male patients and, unexpectedly, also in female control subjects. One hour after chewing, the pain remained above pre-test levels for female patients but not for the other groups. Thus, sex differences in chewing-induced pain were found in control subjects but not as hypothesized in patients. Because chewing-induced masticatory muscle pain was significantly greater in female control subjects than in males, and persisted longer in female patients than in males, these results suggest greater susceptibility in women. PMID:12562883

  13. Pediatric pain management.

    PubMed

    Lederhaas, G

    1997-01-01

    It is now recognized that from the newborn period onwards, children are capable of experiencing pain. This includes the premature infant. The challenge for healthcare providers is to incorporate methods of pain assessment and treatment into their daily practices. The child's understanding of pain closely follows the cognitive and behavioral model developed by Jean Piaget. Based on these developmental stages, pain assessment measures have been developed. Pharmacologic advances have accompanied this improved understanding of infant, child, and adolescent psychology. While acute pain accounts for the majority of children's experiences, recurrent/chronic pain states do occur (e.g. sickle cell related and neuropathic) and can be effectively treated.

  14. Pediatric pain management.

    PubMed

    Lederhaas, G

    1997-01-01

    It is now recognized that from the newborn period onwards, children are capable of experiencing pain. This includes the premature infant. The challenge for healthcare providers is to incorporate methods of pain assessment and treatment into their daily practices. The child's understanding of pain closely follows the cognitive and behavioral model developed by Jean Piaget. Based on these developmental stages, pain assessment measures have been developed. Pharmacologic advances have accompanied this improved understanding of infant, child, and adolescent psychology. While acute pain accounts for the majority of children's experiences, recurrent/chronic pain states do occur (e.g. sickle cell related and neuropathic) and can be effectively treated. PMID:9037997

  15. Chiropractic care for back pain

    MedlinePlus

    ... Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. ...

  16. Managing your chronic back pain

    MedlinePlus

    ... Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. ...

  17. Menstrual cycle, beta-endorphins, and pain sensitivity in premenstrual dysphoric disorder.

    PubMed

    Straneva, Patricia A; Maixner, William; Light, Kathleen C; Pedersen, Cort A; Costello, Nancy L; Girdler, Susan S

    2002-07-01

    This study examined pain sensitivity and pain modularity mechanisms (e.g., beta-endorphin levels, blood pressure) in women with premenstrual dysphoric disorder (PMDD; n = 27) and healthy controls (n = 27) during the follicular and luteal phases of the menstrual cycle. Physiological measures were taken during rest and ischemic pain testing. In both cycle phases, PMDD women (a) displayed lower resting cortisol and beta-endorphin levels and (b) exhibited shorter pain threshold and tolerance times and greater pain unpleasantness ratings during pain. PMDD women also reported greater pain unpleasantness and intensity and had lower beta-endorphin levels in their luteal phase and tended to display higher blood pressure levels at rest and during pain testing. Results suggest that endogenous opioids may be pathophysiologically relevant to PMDD and that the hypothalamic-pituitary-gonadal axis may modulate pain sensitivity in PMDD.

  18. Pain recurrence: a quality of life issue in endometriosis.

    PubMed

    Damario, M A; Rock, J A

    1995-09-01

    Studies reveal endometriosis to be present in 38-51% of women undergoing laparoscopy for chronic pelvic pain. Symptoms attributable to endometriosis include dysmenorrhea, dyspareunia, generalized pelvic pain, dyschezia, and radiation of pain to the back or leg. Psychological factors may also contribute to a more intense pain experience. Medical therapy provides symptom relief in 72-93% of patients, although recurrence is common following treatment discontinuation. Surgical therapy has had varying results for long-term pain relief; adequacy of the initial surgical treatment appears to be a critical factor. Important adjunctive measures include presacral neurectomy and excisional techniques to remove deep, fibrotic, retroperitoneal lesions. The quality of life of women with endometriosis will improve with greater focus on achieving the long-term relief of pelvic pain. Limitation of pain recurrence would benefit the patient greatly, by providing symptom relief and preventing the cycle of its probably adverse effects on physical activity, work productivity, sexual fulfilment, and mood.

  19. The effects of menstrual-related pain on attentional interference.

    PubMed

    Keogh, Edmund; Cavill, Rebecca; Moore, David J; Eccleston, Christopher

    2014-04-01

    Pain-related attentional interference has been found in both chronic pain and laboratory-inducted pain settings. However, few studies have examined such interference effects during common everyday painful episodes. Menstrual cycle-related pain is a common pain that affects a large number of women on a regular basis. The purpose of the current study was, therefore, to examine the effects of menstrual pain on attentional interference. Fifty-two healthy adult women were tested during 2 different phases of their menstrual cycles: once during a nonpain phase (mid follicular), and once while experiencing menstrual pain (late luteal/early follicular). On each testing session, participants received a battery of 4 attentional interference tasks that included selective attention (flanker task), attention span (n-back task), attentional switching (switching task), and divided attention (dual task). Greater attentional interference effects were found to occur during the menstrual pain phase compared to the nonpain phase. Interestingly, the nature of this effect was a general worsening in performance (e.g., slowing, less accurate), rather than a specific attentional deficit. These results add to a growing literature that generally indicates that attentional interference occurs across a range of different types of pain, including common painful episodes. However, they also highlight that the specific nature of this interference effect may depend on the type pain under consideration. Implications of these findings are also considered.

  20. The impact of daily arthritis pain on spouse sleep.

    PubMed

    Martire, Lynn M; Keefe, Francis J; Schulz, Richard; Parris Stephens, Mary Ann; Mogle, Jacqueline A

    2013-09-01

    Although chronic pain has been linked to poorer psychosocial well-being in the spouse, the extent to which patient pain affects spouse sleep is unknown. The aim of the present study was to test the hypothesis that greater daily knee pain would be associated with poorer sleep for the spouse that evening. We also tested the hypothesis that this pain contagion is exacerbated in couples who have a close relationship. A total of 138 knee osteoarthritis (OA) patients and their spouses completed baseline interviews and a 22-day diary assessment. Multilevel lagged models indicated that greater knee OA pain at the end of the day was associated with spouses' poorer overall sleep quality that night and feeling less refreshed after sleep. In contrast, there was no evidence that spouse sleep was related to greater patient pain the next day. The effects of patient pain on spouse sleep were not due to disturbances in patient sleep and were also independent of spouse sex, depressive symptoms, and physical comorbidities; both partners' negative affect; and the quality of marital interactions throughout the day. As predicted, we also found that patient pain was more strongly related to less refreshing sleep for spouses who were in a close relationship. Findings illustrate that chronic pain may place the spouse's health at risk and suggest an important target for couple-oriented interventions.

  1. Men Face Greater Risk of Cardiac Arrest

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_159651.html Men Face Greater Risk of Cardiac Arrest: Study Heart ... 30, 2016 THURSDAY, June 30, 2016 (HealthDay News) -- Men are significantly more likely to have their heart ...

  2. Low back pain during labor and related factors.

    PubMed

    Tzeng, Ya-Ling; Su, Tsann-Juu

    2008-09-01

    A substantial proportion of women in labor suffer from low back pain, yet this issue has only been specifically evaluated in a few Western studies. The purpose of this research was to (1) describe the following characteristics of low back pain during labor: prevalence, anatomic region(s) affected, type, pattern, intensity trend, effective interventions, and exacerbating factors; (2) identify the factors relating to intrapartum low back pain in Taiwan women. A correlational design with repeated measures was used to conduct this investigation. Ninety-three low-risk women in labor were recruited from a medical center in central Taiwan. Low back pain was repeatedly measured during the latent phase (cervix dilated 2-4 cm), early active phase (cervix dilated 5-7 cm), and late active phase (cervix dilated 8-10 cm) of labor. Data were analyzed using descriptive statistics, repeated measurement ANOVA, and logistic regression. The results showed as many as 75.3% of the participants suffered episodes of low back pain during labor. The mean pain scores were 36.66-76.20 in the various stages of labor. Pain intensified as labor progressed. The location of the pain also changed with the progression of labor. The type of low back pain in 54.29% of women in labor was "muscle soreness and pain"; The pattern of pain in 45.71% women was continuous. Massage was chosen as the most effective intervention to alleviate low back pain by 65.3% of women. The women in labor who suffered from low back pain during pregnancy (OR = 3.23; p < .01) and had greater body weight when hospitalized (OR = 1.13; p = .02) were most likely to be in the low back pain group. In conclusion, our study demonstrates low back pain intensified with the progression of labor, suggesting early prevention is necessary, especially in the case of women who had low back pain during pregnancy and heavier body weight when hospitalized.

  3. Acupuncture for Pediatric Pain

    PubMed Central

    Golianu, Brenda; Yeh, Ann Ming; Brooks, Meredith

    2014-01-01

    Chronic pain is a growing problem in children, with prevalence as high as 30.8%. Acupuncture has been found to be useful in many chronic pain conditions, and may be of clinical value in a multidisciplinary treatment program. The basic principles of acupuncture are reviewed, as well as studies exploring basic mechanisms of acupuncture and clinical efficacy. Conditions commonly treated in the pediatric pain clinic, including headache, abdominal pain, fibromyalgia, juvenile arthritis, complex regional pain syndrome, cancer pain, as well as perioperative pain studies are reviewed and discussed. Areas in need of further research are identified, and procedural aspects of acupuncture practice and safety studies are reviewed. Acupuncture can be an effective adjuvant in the care of pediatric patients with painful conditions, both in a chronic and an acute setting. Further studies, including randomized controlled trials, as well as trials of comparative effectiveness are needed. PMID:27417472

  4. Pain in Parkinson's Disease

    MedlinePlus

    ... for increased overall health care costs. A person’s perception of pain can be affected by emotional factors. ... medications such as levodopa can affect a person’s perception of pain. People with Parkinson’s who are in ...

  5. Rib cage pain

    MedlinePlus

    ... not cause the pain in someone who has pleurisy (swelling of the lining of the lungs) or ... Inflammation of cartilage near the breastbone ( costochondritis ) Osteoporosis Pleurisy (the pain is worse when breathing deeply) Home ...

  6. Sacroiliac joint pain - aftercare

    MedlinePlus

    SIJ pain - aftercare; SIJ dysfunction - aftercare; SIJ strain - aftercare; SIJ subluxation -aftercare; SIJ syndrome - aftercare ... little movement at the SIJ. Major reasons for pain around the SIJ include: Muscle tightness Pregnancy: the ...

  7. Pain in cancer survivors.

    PubMed

    Brown, Matthew Rd; Ramirez, Juan D; Farquhar-Smith, Paul

    2014-11-01

    Cancer and its treatment exert a heavy psychological and physical toll. Of the myriad symptoms which result, pain is common, encountered in between 30% and 60% of cancer survivors. Pain in cancer survivors is a major and growing problem, impeding the recovery and rehabilitation of patients who have beaten cancer and negatively impacting on cancer patients' quality of life, work prospects and mental health. Persistent pain in cancer survivors remains challenging to treat successfully. Pain can arise both due to the underlying disease and the various treatments the patient has been subjected to. Chemotherapy causes painful chemotherapy-induced peripheral neuropathy (CIPN), radiotherapy can produce late effect radiation toxicity and surgery may lead to the development of persistent post-surgical pain syndromes. This review explores a selection of the common causes of persistent pain in cancer survivors, detailing our current understanding of the pathophysiology and outlining both the clinical manifestations of individual pain states and the treatment options available. PMID:26516548

  8. Eldercare at Home: Pain

    MedlinePlus

    ... of pain, and may be best treated with physical therapy without taking any medicine at all. Pain can ... medicine and non-medicine strategies. Treatments such as physical therapy, massage, heat and/or cold packs, exercise, and ...

  9. Lower Back Pain

    MedlinePlus

    ... doctor. Get plenty of rest and use an anti-inflammatory medicine to relieve pain. If your pain is ... or a HERNIATED DISK. Apply heat, use an anti-inflammatory medicine and get rest. If you don't ...

  10. Alternative medicine - pain relief

    MedlinePlus

    ... relieve pain due to: Cancer Carpal tunnel syndrome Fibromyalgia Childbirth (labor) Musculoskeletal injuries (such as the neck, ... pain for: After surgery or labor Arthritis Cancer Fibromyalgia Irritable bowel syndrome Migraine headache Tension headache Both ...

  11. Perspectives in Pancreatic Pain

    PubMed Central

    1997-01-01

    This review describes some of the mechanisms which are thought to be important in the causation of pain in chronic pancreatitis. Both medical and surgical techniques for treating this pain are described. PMID:9298380

  12. Complex Regional Pain Syndrome

    MedlinePlus

    ... block. This is an injection of an anesthetic (pain reliever) into certain nerves to block the pain signals. If the injection works, it may be repeated. Physical therapy and psychological counseling are also helpful. However, a ...

  13. Employees with Chronic Pain

    MedlinePlus

    ... related, condition. Chronic Pain and the Americans with Disabilities Act Is chronic pain a disability under the ADA? The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of ...

  14. Ketogenic Diets and Pain

    PubMed Central

    Masino, Susan A.; Ruskin, David N.

    2014-01-01

    Ketogenic diets are well-established as a successful anticonvulsant therapy. Based on overlap between mechanisms postulated to underlie pain and inflammation, and mechanisms postulated to underlie therapeutic effects of ketogenic diets, recent studies have explored the ability for ketogenic diets to reduce pain. Here we review clinical and basic research thus far exploring the impact of a ketogenic diet on thermal pain, inflammation, and neuropathic pain. PMID:23680946

  15. Back pain: osteoarthritis.

    PubMed

    Bandilla, K K

    1977-02-01

    Back pain is one of the chief complaints of the elderly. It may be either a chronic deep skeletal muscular pain or an acute circumscribed pain arising from nerve-root irritation. The main causes of back pain in older people are: 1) degenerative changes (spondylosis, osteoarthritis, ankylosing hyperostosis); 2) malignancy (multiple myeloma, metastases from carcinoma or lymphoma); and 3) metabolic disorders (osteoporosis, osteomalacia, chondrocalcinosis, Paget's disease). Mechanisms and variations are discussed in detail.

  16. Low back pain, radiculopathy.

    PubMed

    Selkirk, Stephen M; Ruff, Robert

    2016-01-01

    Low back pain is a pervasive problem in the adult population. Most patients with low back pain will not require imaging as spontaneous recovery within 12 weeks is the rule. However, a small percentage of patients with low back pain will have serious underlying pathology requiring more intensive investigation. This chapter delineates the signs and symptoms related to potential serious underlying causes and discusses appropriate imaging modalities that should be utilized in patients with low back pain. PMID:27430456

  17. Definitions and Types of Pain

    MedlinePlus

    ... Types of Pain Defining Pain Pain is a perception that signals the individual that tissue damage has ... in the body that are involved in the perception of pain are called "nociception." Basic and clinical ...

  18. Back Pain Facts and Statistics

    MedlinePlus

    ... Pain and Depression Preventing Travel Aches and Strains Back Pain Facts and Statistics Although doctors of chiropractic (DCs) ... time. 1 A few interesting facts about back pain: Low back pain is the single leading cause of disability ...

  19. Taking narcotics for back pain

    MedlinePlus

    ... pain - chronic - narcotics; Pain - back - chronic - narcotics; Chronic back pain - low - narcotics ... compared to placebo or other treatments for chronic low-back pain: an update of the Cochrane Review. Spine . 2014;( ...

  20. Mindfulness and Cognitive-behavioral Interventions for Chronic Pain: Differential Effects on Daily Pain Reactivity and Stress Reactivity

    PubMed Central

    Davis, Mary C.; Zautra, Alex J.; Wolf, Laurie D.; Tennen, Howard; Yeung, Ellen W.

    2014-01-01

    Objective This study compared the impact of cognitive-behavioral therapy for pain (CBT-P), mindful awareness and acceptance treatment (M), and arthritis education (E) on day-to-day pain- and stress-related changes in cognitions, symptoms, and affect among adults with rheumatoid arthritis (RA). Method 143 RA patients were randomized to one of the three treatment conditions. CBT-P targeted pain coping skills; M targeted awareness and acceptance of current experience to enhance coping with a range of aversive experiences; and E provided information regarding RA pain and its management. At pre- and post-treatment, participants completed 30 consecutive evening diaries assessing that day's pain, fatigue, pain-related catastrophizing and perceived control, morning disability, and serene and anxious affects. Results Multilevel models compared groups in the magnitude of within-person change in daily pain- and stress-reactivity from pre- to post-treatment. M yielded greater reductions than did CBT-P and E in daily pain-related catastrophizing, morning disability, and fatigue, and greater reductions in daily stress-related anxious affect. CBT-P yielded less pronounced declines in daily pain-related perceived control than did M and E. Conclusions For individuals with RA, M produces the broadest improvements in daily pain- and stress-reactivity relative to CBT-P and E. These findings also highlight the utility of a diary-based approach to evaluating the treatment-related changes in responses to daily life. PMID:25365778

  1. Forebrain Pain Mechanisms

    PubMed Central

    Neugebauer, Volker; Galhardo, Vasco; Maione, Sabatino; Mackey, Sean C.

    2009-01-01

    Emotional-affective and cognitive dimensions of pain are less well understood than nociceptive and nocifensive components, but the forebrain is believed to play an important role. Recent evidence suggests subcortical and cortical brain areas outside the traditional pain processing network contribute critically to emotional-affective responses and cognitive deficits related to pain. These brain areas include different nuclei of the amygdala and certain prefrontal cortical areas. Their roles in various aspects of pain will be discussed. Biomarkers of cortical dysfunction are being identified that may evolve into therapeutic targets to modulate pain experience and improve pain-related cognitive impairment. Supporting data from preclinical studies in neuropathic pain models will be presented. Neuroimaging analysis provides evidence for plastic changes in the pain processing brain network. Results of clinical studies in neuropathic pain patients suggest that neuroimaging may help determine mechanisms of altered brain functions in pain as well as monitor the effects of pharmacologic interventions to optimize treatment in individual patients. Recent progress in the analysis of higher brain functions emphasizes the concept of pain as a multidimensional experience and the need for integrative approaches to determine the full spectrum of harmful or protective neurobiological changes in pain. PMID:19162070

  2. [Myofascial pain syndrome].

    PubMed

    Kehler, Tatjana

    2013-01-01

    It is unable to identify any kind of structural abnormalities in about 85% patients affected with muscle pain. Sometimes is one mucle received with pains, commonly because of stress or fatigue (epecially after intensive training process). It is called myfascial pain syndrom (MPS). When more muscles are affected it is called fibromyalgia.

  3. Pain inhibits pain; human brainstem mechanisms.

    PubMed

    Youssef, A M; Macefield, V G; Henderson, L A

    2016-01-01

    Conditioned pain modulation is a powerful analgesic mechanism, occurring when a painful stimulus is inhibited by a second painful stimulus delivered at a different body location. Reduced conditioned pain modulation capacity is associated with the development of some chronic pain conditions and the effectiveness of some analgesic medications. Human lesion studies show that the circuitry responsible for conditioned pain modulation lies within the caudal brainstem, although the precise nuclei in humans remain unknown. We employed brain imaging to determine brainstem sites responsible for conditioned pain modulation in 54 healthy individuals. In all subjects, 8 noxious heat stimuli (test stimuli) were applied to the right side of the mouth and brain activity measured using functional magnetic resonance imaging. This paradigm was then repeated. However, following the fourth noxious stimulus, a separate noxious stimulus, consisting of an intramuscular injection of hypertonic saline into the leg, was delivered (conditioning stimulus). During this test and conditioning stimulus period, 23 subjects displayed conditioned pain modulation analgesia whereas 31 subjects did not. An individual's analgesic ability was not influenced by gender, pain intensity levels of the test or conditioning stimuli or by psychological variables such as pain catastrophizing or fear of pain. Brain images were processed using SPM8 and the brainstem isolated using the SUIT toolbox. Significant increases in signal intensity were determined during each test stimulus and compared between subjects that did and did not display CPM analgesia (p<0.05, small volume correction). The expression of analgesia was associated with reduction in signal intensity increases during each test stimulus in the presence of the conditioning stimulus in three brainstem regions: the caudalis subdivision of the spinal trigeminal nucleus, i.e., the primary synapse, the region of the subnucleus reticularis dorsalis and in the

  4. Occult fractures of the greater tuberosity of the humerus

    PubMed Central

    Carbone, S.; Postacchini, F.

    2008-01-01

    We studied the highest reported number of patients with occult fracture of the greater tuberosity of the humerus and we analysed why fracture was not diagnosed, shoulder function and prevalence of eventually associated rotator cuff tear (RCT). Twenty-four patients with a missed fracture of the greater tuberosity underwent MR study for a suspect RCT. We evaluated shoulder function and self-assessed comfort with the Constant score (CS) and Simple Shoulder Test (SST). Nine patients showed evidence of cuff tendinosis, 11 of partial (p) RCT (2: subscapularis; 6: supraspinatus and 3: supraspinatus and infraspinatus). All patients with pRCT were older than 40. Initially, the mean CS and SST were 54% and 5/12; at follow-up, values increased to 36% and 5 points. MR should be performed in patients apparently negative for fracture but with painful shoulders and decreased ROM. Of our patients, 45.8% had pRCT; nevertheless function recovery was verified in 16 weeks. PMID:18256834

  5. Resting-State EEG Delta Power is Associated with Psychological Pain in Adults with a History of Depression

    PubMed Central

    Meerwijk, Esther L.; Ford, Judith M.; Weiss, Sandra J.

    2015-01-01

    Psychological pain is a prominent symptom of clinical depression. We asked if frontal alpha asymmetry, frontal EEG power, and frontal fractal dimension asymmetry predicted psychological pain in adults with a history of depression. Resting-state frontal EEG (F3/F4) was recorded while participants (N=35) sat upright with their eyes closed. Frontal delta power predicted psychological pain while controlling for depressive symptoms, with participants who exhibited less power experiencing greater psychological pain. Frontal fractal dimension asymmetry, a nonlinear measure of complexity, also predicted psychological pain, such that greater left than right complexity was associated with greater psychological pain. Frontal alpha asymmetry did not contribute unique variance to any regression model of psychological pain. As resting-state delta power is associated with the brain’s default mode network, results suggest that the default mode network was less activated during high psychological pain. Findings are consistent with a state of arousal associated with psychological pain. PMID:25600291

  6. Ethnic differences in pain and pain management

    PubMed Central

    Campbell, Claudia M; Edwards, Robert R

    2012-01-01

    SUMMARY Considerable evidence demonstrates substantial ethnic disparities in the prevalence, treatment, progression and outcomes of pain-related conditions. Elucidating the mechanisms underlying these group differences is of crucial importance in reducing and eliminating disparities in the pain experience. Over recent years, accumulating evidence has identified a variety of processes, from neurophysiological factors to structural elements of the healthcare system, that may contribute to shaping individual differences in pain. For example, the experience of pain differentially activates stress-related physiological responses across various ethnic groups, members of different ethnic groups appear to use differing coping strategies in managing pain complaints, providers’ treatment decisions vary as a function of patient ethnicity and pharmacies in predominantly minority neighborhoods are far less likely to stock potent analgesics. These diverse factors, and others may all play a role in facilitating elevated levels of pain-related suffering among individuals from ethnic minority backgrounds. Here, we present a brief, nonexhaustive review of the recent literature and potential physiological and sociocultural mechanisms underlying these ethnic group disparities in pain outcomes. PMID:23687518

  7. Pain in the cancer patient.

    PubMed

    Ho, R C

    1994-01-01

    In summary, the ACS has acknowledged the magnitude and severity of the cancer pain problem nationally and recognized that cancer pain can be relieved. It has identified cancer pain control as a priority and has devised programs that emphasize the importance of pain assessment, recognize the availability of pain relief programs, and encourage treatment to achieve optimum pain relief for the cancer patient.

  8. Psychological Aspects of Chronic Pain

    PubMed Central

    Jacobs, Rosevelt

    1983-01-01

    Since its inception in June 1979, over 500 patients have been treated at the King/Drew Pain Center in Los Angeles. Based upon the treatment and observations of this patient group, this paper describes the psychologic aspects in patients suffering from chronic abdominal pain, low back pain, phantom limb pain, chest pain, and arthritic pain. PMID:6864816

  9. Depression among Chronic Pain Patients: Cognitive-Behavioral Analysis and Effect on Rehabilitation Outcome.

    ERIC Educational Resources Information Center

    Kerns, Robert D.; Haythornthwaite, Jennifer A.

    1988-01-01

    Examined relevance of depression to chronic pain. Found significant differences among 131 depressed, mildly depressed, and nondepressed chronic pain sufferers on instrumental activities and coping skills, with more depressed subjects reporting lower levels of functioning and less support. Depressed pain patients showed greater tendency to drop out…

  10. [Neurorehabilitation for Neuropathic Pain].

    PubMed

    Hozumi, Jun; Osumi, Michihiro; Ogata, Toru; Sumitani, Masahiko

    2015-07-01

    Deafferentation, like as in limb amputation, brachial plexus avulsion injury and spinal cord injury, is usually followed by neuropathic pain. Neuropathic pain is a debilitating condition and it impairs the quality of life profoundly. Based on recent advances in the cognitive neuroscience, we explain intimate relationships among neuropathic pain, reorganization of primary sensory and motor cortices and the sensorimotor integration of the deafferentated limb. From the standpoint of the sensorimotor integration theory for emerging phantom limb pain, we further discuss the analgesic mechanism of neurorehabilitation techniques such as mirror visual feedback treatment and its related neurorobotics advancement for neuropathic pain. PMID:26422941

  11. Myofascial low back pain.

    PubMed

    Ramsook, Ryan R; Malanga, Gerard A

    2012-10-01

    Low back pain is a common condition that is encountered by both primary care physicians as well as various specialists, which include: orthopedic surgeons, physical medicine and rehabilitation specialists, neurologists, rheumatologists, and pain management specialists. Associated muscular pain is very common and often a reactive response from nociception from other structures. Myofascial pain may arise, which is characterized by the presence of myofascial trigger points (MTrPs) that are located in fascia, tendons, and/or muscle. This article reviews the current evidence regarding the pathophysiology, assessment, and recommended treatment options for myofascial low back pain.

  12. Pain Behind Bars: The Epidemiology of Pain in Older Jail Inmates in a County Jail

    PubMed Central

    Ahalt, Cyrus; Stijacic-Cenzer, Irena; Smith, Alexander K.; Goldenson, Joe; Ritchie, Christine S.

    2014-01-01

    Abstract Background: The number of older jail inmates in poor health is increasing rapidly. Among older adults, pain is common and leads to greater acute care use. In jail, pain management is complicated by concerns about misuse and diversion. A lack of data about the prevalence and management of pain in older jail inmates limits our ability to develop optimal palliative care strategies for this population. Objective: To describe the prevalence of and factors associated with pain and analgesic use in a population of older jail inmates. Design: Cross-sectional study. χ2 tests assessed association between characteristics, pain, and analgesic use. Setting/Subjects: Two hundred ten jail inmates age 55 or older. Measurements: “Severe frequent pain” defined as “severe or very severe” pain experienced “frequently or constantly” using the validated Memorial Symptom Assessment Scale. Medical conditions, substance use, and analgesic treatment determined through self-report and jail medical records. Results: Participants' mean age was 59 years; 69% had multimorbidity; 75% reported any pain; 39% reported severe frequent pain. Report of severe frequent pain was associated with multimorbidity, functional impairment, and pre-jail acute care use (p<0.05), but not with substance use (57% versus 56%, p=0.89). Within a week of their interview, most participants with severe frequent pain had received an analgesic (87%) and many received an opioid (70%). Conclusion: High rates of pain in a rapidly growing population of older jail inmates with multimorbidity and functional impairment suggest that jails are an important site for assessing symptom burden and developing appropriate palliative care interventions. PMID:25265035

  13. 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

  14. [Postoperative pain in craniotomy].

    PubMed

    Peón, Andréa Ungaro; Diccini, Solange

    2005-01-01

    In the postoperative period, 47% to 75% of the patients report some degree of pain. This study aimed to evaluate pain in the pre and postoperative period of patients submitted to craniotomy. This prospective research was carried out at the neurosurgery unit of a large Brazilian hospital. For a quantitative evaluation of pain, the verbal numeric 0-10 rating scale was used. Forty patients with a mean age of 36 years were evaluated. In the preoperative period, 34 (85%) patients indicated headache as the main cause of pain. In the postoperative period, 37 (93%) patients complained of pain while three (7%) reported absence of pain. Pain peaks were observed on the 2nd postoperative day, when 12 (32%) of the patients reported severe pain and 10 (27%) moderate pain. Absence of severe pain occurred after the 8th postoperative day. It was concluded that protocols of analgesia in craniotomy are needed, such as training nurses to better evaluate and handle pain. PMID:16211171

  15. Pain, Nicotine, and Smoking: Research Findings and Mechanistic Considerations

    PubMed Central

    Ditre, Joseph W.; Brandon, Thomas H.; Zale, Emily L.; Meagher, Mary M.

    2011-01-01

    Tobacco addiction and chronic pain represent two highly prevalent and comorbid conditions that engender substantial burdens upon individuals and systems. Although interrelations between pain and smoking have been of clinical and empirical interest for decades, research on the topic of pain, nicotine, and tobacco smoking has increased dramatically over the past five years. We conceptualize the interaction of pain and smoking as a prototypical example of the biopsychosocial model. Accordingly, the current review extrapolated from behavioral, cognitive, affective, biomedical, and social perspectives to propose causal mechanisms that may contribute to the observed comorbidity between these two conditions. Research in the broad area of pain and smoking was first dichotomized into investigations of either "effects of smoking on pain" or "effects of pain on smoking." We then integrated the extant literature to present a reciprocal model of pain and smoking that is hypothesized to interact in the manner of a positive feedback loop, resulting in greater pain, increased smoking, and the maintenance of tobacco addiction. Finally, we proposed directions for future research, and discussed clinical implications for smokers with comorbid pain disorders. We observed modest evidence to support the notions that smoking may be a risk factor in the multifactorial etiology of some chronically painful conditions, and that the experience of pain may come to serve as a potent motivator of smoking. We also found that whereas animal studies yielded consistent support for direct pain-inhibitory effects of nicotine and tobacco smoke, results from human studies were much less consistent. Future research in the emerging area of pain and smoking has the potential to inform theoretical and clinical applications with respect to tobacco smoking, chronic pain, and their comorbid presentation. PMID:21967450

  16. Neurogenic facial pain.

    PubMed

    Schott, G D

    1980-07-01

    Neurogenic facial pain can be classified as either paroxysmal or persistent. Trigeminal neuralgia is the commonest example of the former, and postherpetic neuralgia, atypical facial pain, and tension head and facial pains are examples of the latter. The cause of many of these pains is poorly understood, the complex neuroanatomy of the head and neck being a contributory factor. Even when the aetiology is known, the mechanism whereby pain is produced is usually obscure. While treatment with drugs and surgical measures for trigeminal neuralgia are often satisfactory, and acupuncture for pain due to "muscle tension" may be beneficial, there is often little effective treatment for a considerable proportion of patients with neurogenic facial pain. PMID:6943844

  17. Avicenna's concept of pain

    PubMed Central

    Tashani, Osama A.; Johnson, Mark I.

    2010-01-01

    Ibn Sina (Latin name – Avicenna, 980–1037) is a famous Muslim physician who wrote The Canon of Medicine. Pain-related writings within The Canon were identified and analysed and compared to Galen and Modern Pain Theory. We found evidence in The Canon that Avicenna challenged Galen's concept of pain. Galen insisted that injuries (breach of continuity) were the only cause of pain. In contrast, Avicenna suggested that the true cause of pain was a change of the physical condition (temperament change) of the organ whether there was an injury present or not. Avicenna extended Galen's descriptions of 4 to 15 types of pain and used a terminology that is remarkably similar to that used in the McGill Pain Questionnaire. PMID:21483573

  18. Avicenna's concept of pain.

    PubMed

    Tashani, Osama A; Johnson, Mark I

    2010-09-08

    Ibn Sina (Latin name - Avicenna, 980-1037) is a famous Muslim physician who wrote The Canon of Medicine. Pain-related writings within The Canon were identified and analysed and compared to Galen and Modern Pain Theory. We found evidence in The Canon that Avicenna challenged Galen's concept of pain. Galen insisted that injuries (breach of continuity) were the only cause of pain. In contrast, Avicenna suggested that the true cause of pain was a change of the physical condition (temperament change) of the organ whether there was an injury present or not. Avicenna extended Galen's descriptions of 4 to 15 types of pain and used a terminology that is remarkably similar to that used in the McGill Pain Questionnaire.

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

    PubMed Central

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

    2015-01-01

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

  20. Pain in aquatic animals.

    PubMed

    Sneddon, Lynne U

    2015-04-01

    Recent developments in the study of pain in animals have demonstrated the potential for pain perception in a variety of wholly aquatic species such as molluscs, crustaceans and fish. This allows us to gain insight into how the ecological pressures and differential life history of living in a watery medium can yield novel data that inform the comparative physiology and evolution of pain. Nociception is the simple detection of potentially painful stimuli usually accompanied by a reflex withdrawal response, and nociceptors have been found in aquatic invertebrates such as the sea slug Aplysia. It would seem adaptive to have a warning system that allows animals to avoid life-threatening injury, yet debate does still continue over the capacity for non-mammalian species to experience the discomfort or suffering that is a key component of pain rather than a nociceptive reflex. Contemporary studies over the last 10 years have demonstrated that bony fish possess nociceptors that are similar to those in mammals; that they demonstrate pain-related changes in physiology and behaviour that are reduced by painkillers; that they exhibit higher brain activity when painfully stimulated; and that pain is more important than showing fear or anti-predator behaviour in bony fish. The neurophysiological basis of nociception or pain in fish is demonstrably similar to that in mammals. Pain perception in invertebrates is more controversial as they lack the vertebrate brain, yet recent research evidence confirms that there are behavioural changes in response to potentially painful events. This review will assess the field of pain perception in aquatic species, focusing on fish and selected invertebrate groups to interpret how research findings can inform our understanding of the physiology and evolution of pain. Further, if we accept these animals may be capable of experiencing the negative experience of pain, then the wider implications of human use of these animals should be considered.

  1. An equine pain face

    PubMed Central

    Gleerup, Karina B; Forkman, Björn; Lindegaard, Casper; Andersen, Pia H

    2015-01-01

    Objective The objective of this study was to investigate the existence of an equine pain face and to describe this in detail. Study design Semi-randomized, controlled, crossover trial. Animals Six adult horses. Methods Pain was induced with two noxious stimuli, a tourniquet on the antebrachium and topical application of capsaicin. All horses participated in two control trials and received both noxious stimuli twice, once with and once without an observer present. During all sessions their pain state was scored. The horses were filmed and the close-up video recordings of the faces were analysed for alterations in behaviour and facial expressions. Still images from the trials were evaluated for the presence of each of the specific pain face features identified from the video analysis. Results Both noxious challenges were effective in producing a pain response resulting in significantly increased pain scores. Alterations in facial expressions were observed in all horses during all noxious stimulations. The number of pain face features present on the still images from the noxious challenges were significantly higher than for the control trial (p = 0.0001). Facial expressions representative for control and pain trials were condensed into explanatory illustrations. During pain sessions with an observer present, the horses increased their contact-seeking behavior. Conclusions and clinical relevance An equine pain face comprising ‘low’ and/or ‘asymmetrical’ ears, an angled appearance of the eyes, a withdrawn and/or tense stare, mediolaterally dilated nostrils and tension of the lips, chin and certain facial muscles can be recognized in horses during induced acute pain. This description of an equine pain face may be useful for improving tools for pain recognition in horses with mild to moderate pain. PMID:25082060

  2. Waste Management in Greater Dhaka City.

    ERIC Educational Resources Information Center

    Rahman, M. H.

    1993-01-01

    This study focuses on the environmental degradation of Greater Dhaka City (GDC) resulting from pollution created by the indiscriminate disposal of industrial wastes, open dumping of solid wastes, inadequate treatment and disposal of domestic sewage, and unplanned disposal of leachate from agricultural land. Measures to protect the GDC environment…

  3. Paleotectonic and paleogeographic evolution of greater China

    SciTech Connect

    Yilmaz, P.O.; Norton, I.O. )

    1996-01-01

    In this study, we utilize plate tectonic history of Central Asia to constrain understanding of sedimentary basin development and to show how regional scale tectonic events affect play elements for major basins of greater China. Tectonic framework and paleogeography are used as a constraint on models for basin formation, climate distribution and accommodation which in turn control distribution of reservoir, source, seal and trap. Greater China is an artifact of Phanerozoic tectonics. It has a protracted history of continental deformation as amalgamation of crustal blocks and island arc/subduction and accretion complexes occurred. Early Paleozoic hydrocarbon systems are dominated by extensive carbonate platform and Permian and younger systems are dominated by continental and lacustrine sedimentation. The basement of greater China consists of continental and accretion crust. The crustal blocks include South and North China, Indochina, Tibet and Tarim, and accretion blocks include the Altaids and Manchurides. The relative positions and interactions of these blocks during Paleozic and Mesozoic time resulted in formation of greater China. Final amalgamation and deformation occurred in Eocene time when India collided with Asia. The discussions consist of presentation of a model for tectonic evolution of these blocks and their paleogeography through Phanerozoic time. This is done with maps at 1:8 million scale covering nine time slices, three in the Paleozoic, three in the Mesozoic and three in the Cenozoic.

  4. Paleotectonic and paleogeographic evolution of greater China

    SciTech Connect

    Yilmaz, P.O.; Norton, I.O.

    1996-12-31

    In this study, we utilize plate tectonic history of Central Asia to constrain understanding of sedimentary basin development and to show how regional scale tectonic events affect play elements for major basins of greater China. Tectonic framework and paleogeography are used as a constraint on models for basin formation, climate distribution and accommodation which in turn control distribution of reservoir, source, seal and trap. Greater China is an artifact of Phanerozoic tectonics. It has a protracted history of continental deformation as amalgamation of crustal blocks and island arc/subduction and accretion complexes occurred. Early Paleozoic hydrocarbon systems are dominated by extensive carbonate platform and Permian and younger systems are dominated by continental and lacustrine sedimentation. The basement of greater China consists of continental and accretion crust. The crustal blocks include South and North China, Indochina, Tibet and Tarim, and accretion blocks include the Altaids and Manchurides. The relative positions and interactions of these blocks during Paleozic and Mesozoic time resulted in formation of greater China. Final amalgamation and deformation occurred in Eocene time when India collided with Asia. The discussions consist of presentation of a model for tectonic evolution of these blocks and their paleogeography through Phanerozoic time. This is done with maps at 1:8 million scale covering nine time slices, three in the Paleozoic, three in the Mesozoic and three in the Cenozoic.

  5. Primary torsion of the greater omentum.

    PubMed

    Aoki, Y; Oka, S; Nakamura, M; Nakatsuka, H; Yamade, N; Maeda, Y

    1991-11-01

    A case with primary torsion of the greater omentum is reported. This pathological condition is an uncommon cause of acute abdominal emergency and it is very difficult even for general surgeons to differentiate this from other acute abdomen. The etiology remains unknown and the treatment of choice is resection of the affected organ. PMID:1820017

  6. Greater Capital Region Career Pathways Initiative

    ERIC Educational Resources Information Center

    Workforce Strategy Center, 2005

    2005-01-01

    This case study documents the activities of the Greater Capital Region Career Pathways Initiative (CPI), a partnership to develop regional, demand driven career pathways for the biotechnology sector in and around Albany, NY. This document is written for three primary audiences. First, it provides a report to the New York State Department of Labor…

  7. [Latest pain management for painful bony metastases].

    PubMed

    Ikenaga, Masayuki

    2006-04-01

    Pain management for painful bony metastases is the most important problem for symptom relief of terminally-ill cancer patients. Pathological fractures often decrease the activity of daily life (ADL) of patients, and cause deterioration of the quality of life (QOL) and prognosis. Basically pharmacological therapies of the World Health Organization (WHO) method are essential for symptom relief from cancer pain. This article provides the latest pain managements (palliative irradiation, bisphosphonate, orthopedic surgery, percutaneous vertebroplasty and radiopharmaceutical therapy) of bony metastases, and mentions the indications and the problems of these interventions. In consideration to prognosis, the QOL and patient's needs, medical staffs have to perform multidisciplinary approach for providing suitable palliative care. PMID:16582515

  8. Pain Management: Post-Amputation Pain

    MedlinePlus

    ... common complaints heard by the staff of the Amputee Coalition, and how to manage the pain is ... one of the frequent topics of conversation at amputee support group meetings and on amputee discussion list ...

  9. Pain in hospitalized children: Effect of a multidimensional knowledge translation strategy on pain process and clinical outcomes.

    PubMed

    Stevens, Bonnie J; Yamada, Janet; Estabrooks, Carole A; Stinson, Jennifer; Campbell, Fiona; Scott, Shannon D; Cummings, Greta

    2014-01-01

    Hospitalized children frequently receive inadequate pain assessment and management despite substantial evidence to support effective pediatric pain practices. The objective of this study was to determine the effect of a multidimensional knowledge translation intervention, Evidence-based Practice for Improving Quality (EPIQ), on procedural pain practices and clinical outcomes for children hospitalized in medical, surgical and critical care units. A prospective cohort study compared 16 interventions using EPIQ and 16 standard care (SC) units in 8 Canadian pediatric hospitals. Chart reviews at baseline (time 1) and intervention completion (time 2) determined the nature and frequency of painful procedures and of pain assessment and pain management practices. Trained pain experts evaluated pain intensity 6 months post-intervention (time 3) during routine, scheduled painful procedures. Generalized estimating equation models compared changes in outcomes between EPIQ and SC units over time. EPIQ units used significantly more validated pain assessment tools (P<0.001) and had a greater proportion of patients who received analgesics (P=0.03) and physical pain management strategies (P=0.02). Mean pain intensity scores were significantly lower in the EPIQ group (P=0.03). Comparisons of moderate (4-6/10) and severe (7-10/10) pain, controlling for child and unit level factors, indicated that the odds of having severe pain were 51% less for children in the EPIQ group (adjusted OR: 0.49, 95% CI: 0.26-0.83; P=0.009). EPIQ was effective in improving practice and clinical outcomes for hospitalized children. Additional exploration of the influence of contextual factors on research use in hospital settings is required to explain the variability in pain processes and clinical outcomes.

  10. The genetics of pain and pain inhibition.

    PubMed Central

    Mogil, J S; Sternberg, W F; Marek, P; Sadowski, B; Belknap, J K; Liebeskind, J C

    1996-01-01

    The present review summarizes the current state of knowledge about the genetics of pain-related phenomena and illustrates the scope and power of genetic approaches to the study of pain. We focus on work performed in our laboratories in Jastrzebiec, Poland; Portland, OR; and Los Angeles, which we feel demonstrates the continuing usefulness of classical genetic approaches, especially when used in combination with newly available molecular genetic techniques. PMID:8610166

  11. Decreased pain sensitivity among people with schizophrenia: a meta-analysis of experimental pain induction studies.

    PubMed

    Stubbs, Brendon; Thompson, Trevor; Acaster, Sarah; Vancampfort, Davy; Gaughran, Fiona; Correll, Christoph U

    2015-11-01

    parameters = 2). Finally, greater psychiatric symptoms moderated increased pain threshold, and younger patient age moderated increased pain tolerance. Decreased pain sensitivity seems to be an endophenotype of schizophrenia spectrum disorders. How this alteration links to other dimensions of schizophrenia and physical comorbidity-related help-seeking behaviour/morbidity/mortality requires further study.

  12. 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

  13. Basic science of pain.

    PubMed

    DeLeo, Joyce A

    2006-04-01

    The origin of the theory that the transmission of pain is through a single channel from the skin to the brain can be traced to the philosopher and scientist René Descartes. This simplified scheme of the reflex was the beginning of the development of the modern doctrine of reflexes. Unfortunately, Descartes' reflex theory directed both the study and treatment of pain for more than 330 years. It is still described in physiology and neuroscience textbooks as fact rather than theory. The gate control theory proposed by Melzack and Wall in 1965 rejuvenated the field of pain study and led to further investigation into the phenomena of spinal sensitization and central nervous system plasticity, which are the potential pathophysiologic correlates of chronic pain. The processing of pain takes place in an integrated matrix throughout the neuroaxis and occurs on at least three levels-at peripheral, spinal, and supraspinal sites. Basic strategies of pain control monopolize on this concept of integration by attenuation or blockade of pain through intervention at the periphery, by activation of inhibitory processes that gate pain at the spinal cord and brain, and by interference with the perception of pain. This article discusses each level of pain modulation and reviews the mechanisms of action of opioids and potential new analgesics. A brief description of animal models frames a discussion about recent advances regarding the role of glial cells and central nervous system neuroimmune activation and innate immunity in the etiology of chronic pain states. Future investigation into the discovery and development of novel, nonopioid drug therapy may provide needed options for the millions of patients who suffer from chronic pain syndromes, including syndromes in which the pain originates from peripheral nerve, nerve root, spinal cord, bone, muscle, and disc.

  14. Pain in Cancer Survivors

    PubMed Central

    Glare, Paul A.; Davies, Pamela S.; Finlay, Esmé; Gulati, Amitabh; Lemanne, Dawn; Moryl, Natalie; Oeffinger, Kevin C.; Paice, Judith A.; Stubblefield, Michael D.; Syrjala, Karen L.

    2014-01-01

    Pain is a common problem in cancer survivors, especially in the first few years after treatment. In the longer term, approximately 5% to 10% of survivors have chronic severe pain that interferes with functioning. The prevalence is much higher in certain subpopulations, such as breast cancer survivors. All cancer treatment modalities have the potential to cause pain. Currently, the approach to managing pain in cancer survivors is similar to that for chronic cancer-related pain, pharmacotherapy being the principal treatment modality. Although it may be appropriate to continue strong opioids in survivors with moderate to severe pain, most pain problems in cancer survivors will not require them. Moreover, because more than 40% of cancer survivors now live longer than 10 years, there is growing concern about the long-term adverse effects of opioids and the risks of misuse, abuse, and overdose in the nonpatient population. As with chronic nonmalignant pain, multimodal interventions that incorporate nonpharmacologic therapies should be part of the treatment strategy for pain in cancer survivors, prescribed with the aim of restoring functionality, not just providing comfort. For patients with complex pain issues, multidisciplinary programs should be used, if available. New or worsening pain in a cancer survivor must be evaluated to determine whether the cause is recurrent disease or a second malignancy. This article focuses on patients with a history of cancer who are beyond the acute diagnosis and treatment phase and on common treatment-related pain etiologies. The benefits and harms of the various pharmacologic and nonpharmacologic options for pain management in this setting are reviewed. PMID:24799477

  15. Pain after earthquake

    PubMed Central

    2012-01-01

    Introduction On 6 April 2009, at 03:32 local time, an Mw 6.3 earthquake hit the Abruzzi region of central Italy causing widespread damage in the City of L Aquila and its nearby villages. The earthquake caused 308 casualties and over 1,500 injuries, displaced more than 25,000 people and induced significant damage to more than 10,000 buildings in the L'Aquila region. Objectives This observational retrospective study evaluated the prevalence and drug treatment of pain in the five weeks following the L'Aquila earthquake (April 6, 2009). Methods 958 triage documents were analysed for patients pain severity, pain type, and treatment efficacy. Results A third of pain patients reported pain with a prevalence of 34.6%. More than half of pain patients reported severe pain (58.8%). Analgesic agents were limited to available drugs: anti-inflammatory agents, paracetamol, and weak opioids. Reduction in verbal numerical pain scores within the first 24 hours after treatment was achieved with the medications at hand. Pain prevalence and characterization exhibited a biphasic pattern with acute pain syndromes owing to trauma occurring in the first 15 days after the earthquake; traumatic pain then decreased and re-surged at around week five, owing to rebuilding efforts. In the second through fourth week, reports of pain occurred mainly owing to relapses of chronic conditions. Conclusions This study indicates that pain is prevalent during natural disasters, may exhibit a discernible pattern over the weeks following the event, and current drug treatments in this region may be adequate for emergency situations. PMID:22747796

  16. Toll-like Receptor 4 and Comorbid Pain in Interstitial Cystitis/Bladder Pain Syndrome: A Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network Study

    PubMed Central

    Schrepf, Andrew; Bradley, Catherine S.; O'Donnell, Michael; Luo, Yi; Harte, Steven E.; Kreder, Karl; Lutgendorf, Susan

    2015-01-01

    Background Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) is a condition characterized by pelvic pain and urinary symptoms. Some IC/BPS patients have pain confined to the pelvic region, while others suffer widespread pain. Inflammatory processes have previously been linked to pelvic pain in IC/BPS, but their association with widespread pain in IC/BPS has not been characterized. Methods Sixty-six women meeting criteria for IC/BPS completed self-report measures of pain as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP), collected 3 days of saliva for cortisol assays, and provided blood samples. Peripheral blood mononuclear cells (PBMCs) were stimulated with Toll-Like Receptor (TLR) 2 and 4 agonists and cytokines were measured in supernatant; IL-6 was also measured in plasma. Associations between inflammatory variables and the likelihood of endorsing extra-pelvic pain, or the presence of a comorbid syndrome, were tested by logistic regression and General Linear Models, respectively. A subset of patients (n=32) completed Quantitative Sensory Testing. Results A one standard deviation increase in TLR-4 inflammatory response was associated with a 1.59 greater likelihood of endorsing extra-pelvic pain (p = .019). Participants with comorbid syndromes also had higher inflammatory responses to TLR-4 stimulation in PBMCs (p = .016). Lower pressure pain thresholds were marginally associated with higher TLR-4 inflammatory responses (p = .062), and significantly associated with higher IL-6 in plasma (p = .031). Conclusions TLR-4 inflammatory responses in PBMCs are a marker of widespread pain in IC/BPS, and should be explored in other conditions characterized by medically unexplained pain. PMID:25771510

  17. Pain management in patients with chronic kidney disease

    PubMed Central

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

    2009-01-01

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

  18. Environmental planning and management in Greater Johannesburg.

    PubMed

    Von Schirnding, Y E

    1996-03-01

    This article describes the actions among urban environmental, management, and development planners in Greater Johannesburg, South Africa. Initiatives, such as the Healthy Cities Project and Model Communities, are being integrated into an environmental management and development approach that attains the goals of Agenda 21. Greater Johannesburg has housing shortages and homelessness. Priority needs include the areas of housing, water, electricity, public transportation, and sanitation. Clean water and air are inequitably distributed. Other key environmental problems include illegal dumping, inadequate waste disposal, poor environmental hygiene in overcrowded inner city areas, lack of open spaces, flooding, and water scarcities. The newly formed metropolitan authority offers opportunities to improve coordination and integration of environmental problems. Stakeholders from government at all levels, politicians, nongovernmental organizations, and the business sector formed an intersectoral, interdepartmental environment management committee in 1995. Stakeholders will integrate Agenda 21 within broader urban development plans and processes. The executive committee and the full council approved a set of guiding principles on environmental policy and an administrative framework for management. Four workshops were held to ensure a participatory consultation process in 1995. The WHO Collaborating Center for Urban Health will be used to facilitate the work of the Greater Johannesburg Metropolitan Council. Changes are being made in the way local governments work.

  19. [Physiological Basis of Pain Mechanisms for Pain Management].

    PubMed

    Kawamata, Mikito

    2016-05-01

    Physician anesthesiologists should ensure a future leadership position in perioperative medicine and pain medicine. In order to establish the missions, anesthesiologists need to know how to relieve pain in surgical patients, critically ill patients and patients with cancer and non-cancer chronic pain. Thus, anesthesiologists should realize physiology of pain representation from pain management I will review physiological basis of pain mechanisms in this manuscript which includes 1) evolutional aspect of pain perception, 2) transduction of noxious stimuli, 3) the types of nociceptors and conduction of noxious stimuli, 4) the ascending pathway of pain and central modulation of pain, 5) the descending inhibitory pain system, and 6) various types of pain. Finally, anesthesiologists should manage pain from physiological basis of pain mechanisms. PMID:27319092

  20. Quality of postoperative pain management in American versus European institutions.

    PubMed

    Chapman, C Richard; Stevens, Duncan A; Lipman, Arthur G

    2013-12-01

    Management of postoperative pain remains an important clinical problem throughout the world. Using the PAIN-OUT acute pain registry database to examine perioperative pain management in orthopedic surgery patients, we compared patient-reported outcomes (PROs) in a pooled sample obtained from four American hospitals (N = 473) with PROs in a pooled sample of 20 European institutions (N = 8799). Most American hospitals consistently assess acute pain in surgical patients due to Joint Commission accreditation guidelines. Therefore, we hypothesized that this practice would create a climate of clinical staff sensitivity to patients' pain and a greater readiness to intervene when pain is higher than one would find in Europe as a whole. American institutions might then provide better control of postoperative pain after orthopedic surgery than European institutions. Because of the large sample sizes, our analyses focused on effect size rather than statistical significance. Evaluation of the pain PROs revealed that European patients reported much lower Worst Pain on the first day after orthopedic surgery than American patients. The mean Worst Pain (± SD) for Europeans was 5.4 (2.5) but for Americans the mean was 7.4 (2.7), p < .0001, a large effect size. Europeans also reported significantly less emotional discomfort, less interference of pain with activity and lower Least Pain. Nonetheless, 98.3% of American patients received opioids on the ward on the first postoperative day compared to 70.2% of European patients, and 41.1% received regional analgesia on the ward while 15.9% of European patients received regional analgesia (both small effect sizes). Overall, the results are clear in demonstrating much better pain control in the ensemble of European countries as compared to the United States. PMID:24143928

  1. EVALUATION OF PAINFUL SHOULDER IN BASEBALL PLAYERS

    PubMed Central

    Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; da Silva, Luciana Andrade; do Val Sella, Guilherme; Junior, Adriano Fernando Mendes; Soares, André Lopes; Aihara, Leandro Jun; Checchia, Sérgio Luiz

    2015-01-01

    Objective: To assess the relationship between shoulder mobility and strength and the presence of pain among baseball players. Methods: Between April and July 2009, 55 baseball players were assessed by the Shoulder and Elbow Group of the School of Medical Sciences, Santa Casa de Misericórdia, São Paulo. They were all males, aged between 15 and 33 years (mean of 21); they attended an average of three training sessions per week and had been doing this sport for a mean of 10 years. Results: 14 of the 55 players evaluated were pitchers, and 20 reported pain during the pitching motion. The mean values for lateral and medial rotation and range of motion (ROM) in the dominant shoulder were, respectively, 110 °, 61 ° and 171 °, with a statistically significant difference in relation to the non-dominant limb. Pitchers had greater gains in lateral rotation and deficits in medial rotation than did non-pitchers. Pain presented a statistically significant correlation with diminished ROM, greater length of time playing the sport and situations of “shoulder at risk”. Conclusions: Statistically significant differences in dominant shoulder mobility were found, with increased lateral rotation, diminished medial rotation and smaller ROM, in relation to the contralateral limb. There was a statistically significant relationship between the pitcher's position and greater gain in lateral rotation and diminished medial rotation. There were statistically significant correlations between pain and diminished ROM, greater length of time playing the sport and situations of “shoulder at risk”. There was a statistical tendency suggesting that players with diminished medial rotation of the dominant shoulder presented a relationship with pain. PMID:27028320

  2. Abdominal pain - children under age 12

    MedlinePlus

    Stomach pain in children; Pain - abdomen - children; Abdominal cramps in children; Belly ache in children ... When your child complains of abdominal pain, see if they can describe ... kinds of pain: Generalized pain or pain over more than half ...

  3. Neonatal pain in very preterm infants: long-term effects on brain, neurodevelopment and pain reactivity.

    PubMed

    Grunau, Ruth Eckstein

    2013-01-01

    Effects of early life psychosocial adversity have received a great deal of attention, such as maternal separation in experimental animal models and abuse/neglect in young humans. More recently, long-term effects of the physical stress of repetitive procedural pain have begun to be addressed in infants hospitalized in neonatal intensive care. Preterm infants are more sensitive to pain and stress, which cannot be distinguished in neonates. The focus of this review is clinical studies of long-term effects of repeated procedural pain-related stress in the neonatal intensive care unit (NICU) in relation to brain development, neurodevelopment, programming of stress systems, and later pain sensitivity in infants born very preterm (24-32 weeks' gestational age). Neonatal pain exposure has been quantified as the number of invasive and/or skin-breaking procedures during hospitalization in the NICU. Emerging studies provide convincing clinical evidence for an adverse impact of neonatal pain/stress in infants at a time of physiological immaturity, rapidly developing brain microstructure and networks, as well as programming of the hypothalamic-pituitary-adrenal axis. Currently it appears that early pain/stress may influence the developing brain and thereby neurodevelopment and stress-sensitive behaviors, particularly in the most immature neonates. However, there is no evidence for greater prevalence of pain syndromes compared to children and adults born healthy at full term. In addressing associations between pain/stress and outcomes, careful consideration of confounding clinical factors related to prematurity is essential. The need for pain management for humanitarian care is widely advocated. Non-pharmacological interventions to help parents reduce their infant's stress may be brain-protective. PMID:24228168

  4. Treatment of myofascial pain.

    PubMed

    Desai, Mehul J; Bean, Matthew C; Heckman, Thomas W; Jayaseelan, Dhinu; Moats, Nick; Nava, Andrew

    2013-01-01

    SUMMARY The objective of this article was to perform a narrative review regarding the treatment of myofascial pain syndrome and to provide clinicians with treatment recommendations. This paper reviews the efficacy of various myofascial pain syndrome treatment modalities, including pharmacological therapy, injection-based therapies and physical therapy interventions. Outcomes evaluated included pain (visual analog scale), pain pressure threshold and range of motion. The evidence found significant benefit with multiple treatments, including diclofenac patch, thiocolchicoside and lidocaine patches. Trigger point injections, ischemic compression therapy, transcutaneous electrical nerve stimulation, spray and stretch, and myofascial release were also efficacious. The authors recommend focusing on treating underlying pathologies, including spinal conditions, postural abnormalities and underlying behavioral issues. To achieve maximum pain reduction and improve function, we recommend physicians approach myofascial pain syndrome with a multimodal plan, which includes a combination of pharmacologic therapies, various physical therapeutic modalities and injection therapies.

  5. Treatment of myofascial pain.

    PubMed

    Desai, Mehul J; Bean, Matthew C; Heckman, Thomas W; Jayaseelan, Dhinu; Moats, Nick; Nava, Andrew

    2013-01-01

    SUMMARY The objective of this article was to perform a narrative review regarding the treatment of myofascial pain syndrome and to provide clinicians with treatment recommendations. This paper reviews the efficacy of various myofascial pain syndrome treatment modalities, including pharmacological therapy, injection-based therapies and physical therapy interventions. Outcomes evaluated included pain (visual analog scale), pain pressure threshold and range of motion. The evidence found significant benefit with multiple treatments, including diclofenac patch, thiocolchicoside and lidocaine patches. Trigger point injections, ischemic compression therapy, transcutaneous electrical nerve stimulation, spray and stretch, and myofascial release were also efficacious. The authors recommend focusing on treating underlying pathologies, including spinal conditions, postural abnormalities and underlying behavioral issues. To achieve maximum pain reduction and improve function, we recommend physicians approach myofascial pain syndrome with a multimodal plan, which includes a combination of pharmacologic therapies, various physical therapeutic modalities and injection therapies. PMID:24645933

  6. Characterizing individual painDETECT symptoms by average pain severity

    PubMed Central

    Sadosky, Alesia; Koduru, Vijaya; Bienen, E Jay; Cappelleri, Joseph C

    2016-01-01

    Background painDETECT is a screening measure for neuropathic pain. The nine-item version consists of seven sensory items (burning, tingling/prickling, light touching, sudden pain attacks/electric shock-type pain, cold/heat, numbness, and slight pressure), a pain course pattern item, and a pain radiation item. The seven-item version consists only of the sensory items. Total scores of both versions discriminate average pain-severity levels (mild, moderate, and severe), but their ability to discriminate individual item severity has not been evaluated. Methods Data were from a cross-sectional, observational study of six neuropathic pain conditions (N=624). Average pain severity was evaluated using the Brief Pain Inventory-Short Form, with severity levels defined using established cut points for distinguishing mild, moderate, and severe pain. The Wilcoxon rank sum test was followed by ridit analysis to represent the probability that a randomly selected subject from one average pain-severity level had a more favorable outcome on the specific painDETECT item relative to a randomly selected subject from a comparator severity level. Results A probability >50% for a better outcome (less severe pain) was significantly observed for each pain symptom item. The lowest probability was 56.3% (on numbness for mild vs moderate pain) and highest probability was 76.4% (on cold/heat for mild vs severe pain). The pain radiation item was significant (P<0.05) and consistent with pain symptoms, as well as with total scores for both painDETECT versions; only the pain course item did not differ. Conclusion painDETECT differentiates severity such that the ability to discriminate average pain also distinguishes individual pain item severity in an interpretable manner. Pain-severity levels can serve as proxies to determine treatment effects, thus indicating probabilities for more favorable outcomes on pain symptoms. PMID:27555789

  7. Low-back pain.

    PubMed

    Violante, Francesco S; Mattioli, Stefano; Bonfiglioli, Roberta

    2015-01-01

    Low-back pain is one of the most common painful conditions experienced by humans throughout their life. Some occupational risk factors (namely, heavy manual material handling) may also contribute to the development of low-back pain: due to the high prevalence of both low-back pain and manual material handling in the adult working population, it has been estimated that low-back pain is probably the most common occupational disorder worldwide. Lifetime prevalence of low-back pain has been reported to be as high as 84%, depending on the case definition used, and no age group is spared, even children. Although low-back pain is not a lethal condition, it was estimated at the third rank among all diseases by disability-adjusted life-years in 2010 in the USA, after ischemic heart disease and chronic obstructive pulmonary disease, and at the first rank by years lived with disability. It also ranked high (13th) globally for the same year, in disability-adjusted life-years. Low-back pain is currently classified as nonspecific/specific as to putative cause and as acute (lasting less than 6 weeks), subacute (6-12 weeks), or chronic (more than 12 weeks) according to duration of symptoms. The distinction between nonspecific/specific and acute/subacute/chronic low-back pain is useful not only for epidemiologic studies, but also (mainly) for choosing the appropriate strategy for the diagnosis and treatment of the disorder. Workplace risk factors for low-back pain include manual lifting and whole-body vibration exposure. This chapter will provide an overview of modern concepts of low-back pain (in general) and will then outline some distinctive features of work-related low-back pain. PMID:26563799

  8. Low-back pain.

    PubMed

    Violante, Francesco S; Mattioli, Stefano; Bonfiglioli, Roberta

    2015-01-01

    Low-back pain is one of the most common painful conditions experienced by humans throughout their life. Some occupational risk factors (namely, heavy manual material handling) may also contribute to the development of low-back pain: due to the high prevalence of both low-back pain and manual material handling in the adult working population, it has been estimated that low-back pain is probably the most common occupational disorder worldwide. Lifetime prevalence of low-back pain has been reported to be as high as 84%, depending on the case definition used, and no age group is spared, even children. Although low-back pain is not a lethal condition, it was estimated at the third rank among all diseases by disability-adjusted life-years in 2010 in the USA, after ischemic heart disease and chronic obstructive pulmonary disease, and at the first rank by years lived with disability. It also ranked high (13th) globally for the same year, in disability-adjusted life-years. Low-back pain is currently classified as nonspecific/specific as to putative cause and as acute (lasting less than 6 weeks), subacute (6-12 weeks), or chronic (more than 12 weeks) according to duration of symptoms. The distinction between nonspecific/specific and acute/subacute/chronic low-back pain is useful not only for epidemiologic studies, but also (mainly) for choosing the appropriate strategy for the diagnosis and treatment of the disorder. Workplace risk factors for low-back pain include manual lifting and whole-body vibration exposure. This chapter will provide an overview of modern concepts of low-back pain (in general) and will then outline some distinctive features of work-related low-back pain.

  9. Pain and Associated Substance Use among Opioid Dependent Individuals Seeking Office-Based Treatment with Buprenorphine-Naloxone: A Needs Assessment Study

    PubMed Central

    Barry, Declan T.; Savant, Jonathan D.; Beitel, Mark; Cutter, Christopher J.; Moore, Brent A.; Schottenfeld, Richard S.; Fiellin, David A.

    2012-01-01

    Background and Objectives A paucity of studies has examined the pain experiences of opioid dependent individuals seeking office-based buprenorphine-naloxone treatment (BNT). We set out to examine, among those seeking BNT: (a) the prevalence of pain types (i.e., recent pain, chronic pain), (b) the characteristics of pain (intensity, frequency, duration, interference, location, and genesis), and (c) substance use to alleviate pain. Methods We surveyed 244 consecutive individuals seeking office-based buprenorphine-naloxone treatment (BNT) for opioid dependence about physical pain and associated substance use. Results Thirty-six percent of respondents reported chronic pain (CP) (i.e., pain lasting at least 3 months) and 36% reported “some pain” (SP) (i.e., past week pain not meeting the threshold for CP). In comparison to SP respondents, those with CP were, on average, older; reported greater current pain intensity, pain frequency, typical pain duration, typical pain intensity, and typical pain interference; were more likely to report shoulder or pelvis and less likely to report stomach or arms as their most bothersome pain location; and were more likely to report accident or nerve damage and less likely to report opioid withdrawal as the genesis of their pain. Both pain subgroups reported similarly high rates of past-week substance use to alleviate pain. Conclusions and Scientific Significance The high rates of pain and self-reported substance use to manage pain suggest the importance of assessing and addressing pain in BNT patients. PMID:23617861

  10. The relationship between knowledge of pain neurophysiology and fear avoidance in people with chronic pain: A point in time, observational study.

    PubMed

    Fletcher, Claire; Bradnam, Lynley; Barr, Christopher

    2016-05-01

    Chronic pain is prevalent in the western world; however fear of pain often has a greater impact than the degree of initial injury. The aim of this study was to explore the relationship between knowledge of the neurophysiology of pain and fear avoidance in individuals diagnosed with chronic pain. Twenty-nine people with chronic musculoskeletal pain were recruited and completed questionnaires to determine their understanding of pain neurophysiology and the degree of their fear avoidance beliefs. There was an inverse relationship between knowledge of pain neurophysiology and the level of fear avoidance. Patients with higher pain knowledge reported less fear avoidance and lower perceived disability due to pain. There was no relationship with the educational level or compensable status for either variable. The findings suggest that fear avoidance is positively influenced by neurophysiology of pain education, so that a higher level of pain knowledge is associated with less activity-related fear. The clinical implication is that reducing fear avoidance/kinesiophobia using neurophysiology of pain education in people with chronic pain may provide an effective strategy to help manage fear avoidance and related disability in the chronic pain population in order to improve treatment outcomes. PMID:27049810

  11. The relationship between knowledge of pain neurophysiology and fear avoidance in people with chronic pain: A point in time, observational study.

    PubMed

    Fletcher, Claire; Bradnam, Lynley; Barr, Christopher

    2016-05-01

    Chronic pain is prevalent in the western world; however fear of pain often has a greater impact than the degree of initial injury. The aim of this study was to explore the relationship between knowledge of the neurophysiology of pain and fear avoidance in individuals diagnosed with chronic pain. Twenty-nine people with chronic musculoskeletal pain were recruited and completed questionnaires to determine their understanding of pain neurophysiology and the degree of their fear avoidance beliefs. There was an inverse relationship between knowledge of pain neurophysiology and the level of fear avoidance. Patients with higher pain knowledge reported less fear avoidance and lower perceived disability due to pain. There was no relationship with the educational level or compensable status for either variable. The findings suggest that fear avoidance is positively influenced by neurophysiology of pain education, so that a higher level of pain knowledge is associated with less activity-related fear. The clinical implication is that reducing fear avoidance/kinesiophobia using neurophysiology of pain education in people with chronic pain may provide an effective strategy to help manage fear avoidance and related disability in the chronic pain population in order to improve treatment outcomes.

  12. Emotional mimicry signals pain empathy as evidenced by facial electromyography

    PubMed Central

    Sun, Ya-Bin; Wang, Yu-Zheng; Wang, Jin-Yan; Luo, Fei

    2015-01-01

    Facial mimicry has been suggested to be a behavioral index for emotional empathy. The present study is the first to investigate the link between facial muscle activity and empathy for pain by facial electromyographic (EMG) recording while observers watched videos depicting real-life painful events. Three types of visual stimulus were used: an intact painful scene and arm-only (needle injection) and face only (painful expression) scenes. Enhanced EMG activity of the corrugator supercilii (CS) and zygomaticus major (ZM) muscles was found when observers viewed others in pain, supporting a unique pain expression that is distinct from the expression of basic emotions. In the intact video stimulus condition, CS activity was correlated positively with the empathic concern score and ZM activity, suggesting facial mimicry mediated empathy for pain. Cluster analysis of facial EMG responses revealed markedly different patterns among stimulus types, including response category, ratio, and temporal dynamics, indicating greater ecological validity of the intact scene in eliciting pain empathy as compared with partial scenes. This study is the first to quantitatively describe pain empathy in terms of facial EMG data. It may provide important evidence for facial mimicry as a behavioral indicator of pain empathy. PMID:26647740

  13. Mental Motor Imagery Indexes Pain: The Hand Laterality Task

    PubMed Central

    Coslett, H. Branch; Medina, Jared; Kliot, Dasha; Burkey, Adam R.

    2010-01-01

    Mental motor imagery is subserved by the same cognitive systems that underlie action. In turn, action is informed by the anticipated sensory consequences of movement, including pain. In light of these considerations, one would predict that motor imagery would provide a useful measure pain-related functional interference. We report a study in which 19 patients with chronic musculoskeletal or radiculopathic arm or shoulder pain, 24 subjects with chronic pain not involving the arm/shoulder and 41 normal controls were asked to indicate if a line drawing was a right or left hand. Previous work demonstrated that this task is performed by mental rotation of the subject’s hand to match the stimulus. Relative to normal and pain control subjects, arm/shoulder pain subjects were significantly slower for stimuli that required greater amplitude rotations. For the arm/shoulder pain subjects only there was a correlation between degree of slowing and the rating of severity of pain with movement but not the non-specific pain rating. The hand laterality task may supplement the assessment of subjects with chronic arm/shoulder pain. PMID:20638306

  14. Emotional mimicry signals pain empathy as evidenced by facial electromyography.

    PubMed

    Sun, Ya-Bin; Wang, Yu-Zheng; Wang, Jin-Yan; Luo, Fei

    2015-12-09

    Facial mimicry has been suggested to be a behavioral index for emotional empathy. The present study is the first to investigate the link between facial muscle activity and empathy for pain by facial electromyographic (EMG) recording while observers watched videos depicting real-life painful events. Three types of visual stimulus were used: an intact painful scene and arm-only (needle injection) and face only (painful expression) scenes. Enhanced EMG activity of the corrugator supercilii (CS) and zygomaticus major (ZM) muscles was found when observers viewed others in pain, supporting a unique pain expression that is distinct from the expression of basic emotions. In the intact video stimulus condition, CS activity was correlated positively with the empathic concern score and ZM activity, suggesting facial mimicry mediated empathy for pain. Cluster analysis of facial EMG responses revealed markedly different patterns among stimulus types, including response category, ratio, and temporal dynamics, indicating greater ecological validity of the intact scene in eliciting pain empathy as compared with partial scenes. This study is the first to quantitatively describe pain empathy in terms of facial EMG data. It may provide important evidence for facial mimicry as a behavioral indicator of pain empathy.

  15. The phenotypic and genetic signatures of common musculoskeletal pain conditions

    PubMed Central

    Diatchenko, Luda; Fillingim, Roger B.; Smith, Shad B.; Maixner, William

    2014-01-01

    Musculoskeletal pain conditions, such as fibromyalgia and low back pain, tend to coexist in affected individuals and are characterized by a report of pain greater than expected based on the results of a standard physical evaluation. The pathophysiology of these conditions is largely unknown, we lack biological markers for accurate diagnosis, and conventional therapeutics have limited effectiveness. Growing evidence suggests that chronic pain conditions are associated with both physical and psychological triggers, which initiate pain amplification and psychological distress; thus, susceptibility is dictated by complex interactions between genetic and environmental factors. Herein, we review phenotypic and genetic markers of common musculoskeletal pain conditions, selected based on their association with musculoskeletal pain in previous research. The phenotypic markers of greatest interest include measures of pain amplification and ‘psychological’ measures (such as emotional distress, somatic awareness, psychosocial stress and catastrophizing). Genetic polymorphisms reproducibly linked with musculoskeletal pain are found in genes contributing to serotonergic and adrenergic pathways. Elucidation of the biological mechanisms by which these markers contribute to the perception of pain in these patients will enable the development of novel effective drugs and methodologies that permit better diagnoses and approaches to personalized medicine. PMID:23545734

  16. Detecting deception in facial expressions of pain: accuracy and training.

    PubMed

    Hill, Marilyn L; Craig, Kenneth D

    2004-01-01

    Clinicians tend to assign greater weight to nonverbal expression than to patient self-report when judging the location and severity of pain. However, patients can be successful at dissimulating facial expressions of pain, as posed expressions resemble genuine expressions in the frequency and intensity of pain-related facial actions. The present research examined individual differences in the ability to discriminate genuine and deceptive facial pain displays and whether different models of training in cues to deception would improve detection skills. Judges (60 male, 60 female) were randomly assigned to 1 of 4 experimental groups: 1) control; 2) corrective feedback; 3) deception training; and 4) deception training plus feedback. Judges were shown 4 videotaped facial expressions for each chronic pain patient: neutral expressions, genuine pain instigated by physiotherapy range of motion assessment, masked pain, and faked pain. For each condition, the participants rated pain intensity and unpleasantness, decided which category each of the 4 video clips represented, and described cues they used to arrive at decisions. There were significant individual differences in accuracy, with females more accurate than males, but accuracy was unrelated to past pain experience, empathy, or the number or type of facial cues used. Immediate corrective feedback led to significant improvements in participants' detection accuracy, whereas there was no support for the use of an information-based training program. PMID:15502685

  17. Endoscopic Treatment of Gluteus Medius Tears: A Review.

    PubMed

    Lerebours, Frantz R; Cohn, Randy; Youm, Thomas

    2016-03-01

    Greater trochanteric pain syndrome (GTPS) is a term used to describe disorders of the peritrochanteric region. This constellation of conditions includes greater trochanteric bursitis, gluteus medius (GM) tears, and external coxa saltans or snapping hip syndrome. Tears of the abductor mechanism, more specifically gluteus medius tears, have recently gained a considerable amount of interest in the orthopaedic literature. Abductor tears were first described by Bunker and Kagan in the late 1990s. They used the rotator cuff as an analogous structure to describe the pathological process associated with gluteus medius tears. Tears of the gluteus medius tendon can often be difficult to recognize. The clinical presentation is often attributed to trochanteric bursal inflammation, without any further workup. Provocative hip physical examination findings are an important key to proper diagnosis of abductor injuries. Depending on the size of the tear, patients with abductor tendon pathology may present with a Trendelenburg gait and reduced resisted abduction strength accompanied by pain. Initial noninvasive management of greater trochanteric pain syndrome includes oral or topical anti-inflammatory medication and activity modification. Physical therapy or other treatment modalities can be considered, with a focus on core strengthening, truncal alignment, and iliotibial band stretching. Gluteus medius tears have historically been repaired in an open fashion; however, the advent of new endoscopic surgery techniques has allowed for a less invasive approach. Access to the peritrochanteric space affords the surgeon with access to pathology associated with the greater trochanter, iliotibial band, trochanteric bursa, sciatic nerve, short external-rota tors, iliopsoas tendon, and the gluteus medius and minimus tendon attachments. Over the last decade, we have seen rapid technological advances in hip arthroscopy, improved diagnostic imaging and interpretation, and an improved

  18. [Neurosurgical treatment of pain].

    PubMed

    Siegfried, J

    1981-12-12

    Chronic pain may be considered a disease and its treatment a necessity. Neurosurgical treatment of chronic pain is justified in cases where conservative treatment is no longer effective or causes excessive side effects. The new percutaneous methods involve no stress, minimal risk and short hospitalization. Destructive neurosurgical procedures are mainly used for cancer pain, with the exception of trigeminal neuralgia. Non-destructive neurostimulating methods to control pain are well on the way to achieving their optimum clinical potential and preserve the integrity of the nervous system. PMID:7330647

  19. Myofascial pelvic pain.

    PubMed

    Spitznagle, Theresa Monaco; Robinson, Caitlin McCurdy

    2014-09-01

    Individuals with pelvic pain commonly present with complaints of pain located anywhere below the umbilicus radiating to the top of their thighs or genital region. The somatovisceral convergence that occurs within the pelvic region exemplifies why examination of not only the organs but also the muscles, connective tissues (fascia), and neurologic input to the region should be performed for women with pelvic pain. The susceptibility of the pelvic floor musculature to the development of myofascial pain has been attributed to unique functional demands of this muscle. Conservative interventions should be considered to address the impairments found on physical examination.

  20. Hypnosis for pain management.

    PubMed

    Valente, Sharon M

    2006-02-01

    Nurses are in a key position to learn and use hypnosis with patients to reduce pain and enhance self-esteem. However, most nurses lack knowledge about the clinical effectiveness of hypnosis and may seek continuing education to become skilled in its use. Painful procedures, treatments, or diseases remain a major nursing challenge, and nurses need complementary ways to relieve pain from surgery, tumors, injuries, and chemotherapy. This article examines the evidence base related to hypnosis for pain management, as well as how to assess and educate patients about hypnosis. PMID:16526529

  1. Patellofemoral pain syndrome.

    PubMed

    Collado, Hervé; Fredericson, Michael

    2010-07-01

    Patellofemoral pain (PFP) syndrome is a frequently encountered overuse disorder that involves the patellofemoral region and often presents as anterior knee pain. PFP can be difficult to diagnose. Not only do the etiology, diagnosis, and treatment remain challenging, but the terminology used to describe PFP is used inconsistently and can be confusing. Patellofemoral pain syndrome (PFPS) seems to be multifactorial, resulting from a complex interaction among intrinsic anatomic and external training factors. Although clinicians frequently make the diagnosis of PFPS, no consensus exists about its etiology or the factors most responsible for causing pain. This article discusses the pathophysiology, diagnosis, and management of PFP.

  2. Athletes' leg pains.

    PubMed Central

    Orava, S.; Puranen, J.

    1979-01-01

    The frequency and nature of exertion pains of the leg in athletes were studied in 2,750 cases of overuse injuries treated at the Sports Clinic of the Deaconess Institute of Oulu, Finland, during the years 1972-1977. 465 cases of exertion pain (18%) were located in the shin. The medial tibial syndrome was the most common overuse injury among these athletes, comprising 9.5% of all exertion injuries and 60% of the leg exertion pains. Together with stress fracture of the tibia, the second most common exertion pain of the leg, it accounted for 75% of the total leg pains. There are certain difficulties in differentiating between the medial tibial syndrome and stress fracture of the tibia. They both occur at the same site with similar symptoms. Radiological examination and isotope scanning are needed. The medial tibial syndrome is an overuse injury at the medial tibial border caused by running exercises. The pain is elicited by exertional ischaemia. The pathogenesis is explained by increased pressure in the fascial compartment of the deep flexor muscles due to prolonged exercise. Similar chronic ischaemic pains from exercise are also found in other fascial compartments of the leg, especially in the anterior compartment. The only treatment needed for stress fractures is rest from training. Fascial compartment pains also usually subside. If chronic fascial syndromes prevent training, fasciotomy is recommended as a reliable method to restore the athlete to normal training without pains. PMID:486888

  3. Painful Boney Metastases

    PubMed Central

    Smith, Howard S.

    2013-01-01

    Boney metastasis may lead to terrible suffering from debilitating pain. The most likely malignancies that spread to bone are prostate, breast, and lung. Painful osseous metastases are typically associated with multiple episodes of breakthrough pain which may occur with activities of daily living, weight bearing, lifting, coughing, and sneezing. Almost half of these breakthrough pain episodes are rapid in onset and short in duration and 44% of episodes are unpredictable. Treatment strategies include: analgesic approaches with "triple opioid therapy", bisphosphonates, chemotherapeutic agents, hormonal therapy, interventional and surgical approaches, steroids, radiation (external beam radiation, radiopharmaceuticals), ablative techniques (radiofrequency ablation, cryoablation), and intrathecal analgesics. PMID:23861996

  4. Greater Sage-Grouse National Research Strategy

    USGS Publications Warehouse

    Hanser, Steven E.; Manier, Daniel J.

    2013-01-01

    The condition of the sagebrush ecosystem has been declining in the Western United States, and greater sage-grouse (Centrocercus urophasianus), a sagebrush-obligate species, has experienced concurrent decreases in distribution and population numbers. This has prompted substantial research and management over the past two decades to improve the understanding of sage-grouse and its habitats and to address the observed decreases in distribution and population numbers. The amount of research and management has increased as the year 2015 approaches, which is when the U.S. Fish and Wildlife Service (FWS) is expected to make a final decision about whether or not to protect the species under the Endangered Species Act. In 2012, the Sage-Grouse Executive Oversight Committee (EOC) of the Western Association of Fish and Wildlife Agencies (WAFWA) requested that the U.S. Geological Survey (USGS) lead the development of a Greater Sage-Grouse National Research Strategy (hereafter Research Strategy). This request was motivated by a practical need to systematically connect existing research and conservation plans with persisting or emerging information needs. Managers and researchers also wanted to reduce redundancy and help focus limited funds on the highest priority research and management issues. The USGS undertook the development of this Research Strategy, which addresses information and science relating to the greater sage-grouse and its habitat across portions of 11 Western States. This Research Strategy provides an outline of important research topics to ensure that science information gaps are identified and documented in a comprehensive manner. Further, by identifying priority topics and critical information needed for planning, research, and resource management, it provides a structure to help coordinate members of an expansive research and management community in their efforts to conduct priority research.

  5. Hospital design to support greater operating efficiency.

    PubMed

    Skaggs, R L

    1984-12-01

    With the new imperative on cost containment and particular emphasis on prospective payment, hospital design must support greater productivity. It is incumbent on architects and engineers to reduce construction costs; but more importantly, to design facilities that improve personnel productivity. Several approaches to designing for efficiency are discussed including improving the development process; systems building, ease of maintenance, and conserving energy; developing the model hospital; minimizing travel throughout the hospital; centralization vs. decentralization; automating support systems; designing for growth and change; analyzing workflow; utilizing swing space; and emphasizing consumer centered care.

  6. Interspecific hybridization between greater kudu and nyala.

    PubMed

    Dalton, Desiré L; Tordiffe, Adrian; Luther, Ilse; Duran, Assumpta; van Wyk, Anna M; Brettschneider, Helene; Oosthuizen, Almero; Modiba, Catherine; Kotzé, Antoinette

    2014-06-01

    Hybridization of wildlife species, even in the absence of introgression, is of concern due to wasted reproductive effort and a reduction in productivity. In this study we detail an accidental mating between a female nyala (Tragelaphus angasii) and a male greater kudu (T. strepsiceros). The hybrid was phenotypically nyala and was identified as such based on mitochondrial DNA. Further genetic analysis based on nine microsatellite markers, chromosome number and chromosome morphology however, confirmed its status as an F1 hybrid. Results obtained from a reproductive potential assessment indicated that this animal does not have the potential to breed successfully and can be considered as sterile.

  7. Greater auricular nerve masquerading as lymph node

    PubMed Central

    Saxena, Shilpi; Deb, Prabal; Nijhawan, Vijay Shrawan; Kharayat, Veena; Verma, Rajesh

    2015-01-01

    Hansen's disease is on the verge of being eliminated from India and often missed by clinicians due to low index of suspicion. We present an unusual case in which greater auricular nerve thickening masqueraded as enlarged lymph node in the neck. The patient was referred for fine needle aspiration cytology, which revealed epithelioid cell granulomas suggestive of Hansen's disease. Further clinical examination and investigations including the skin biopsy confirmed the disease, highlighting the role of pathologist in the management of such unusual presentation of a common disease. PMID:26229249

  8. The Painful Tweet: Text, Sentiment, and Community Structure Analyses of Tweets Pertaining to Pain

    PubMed Central

    Goldsmith, Ryan C; Gravenstein, Michael; Bernard, H Russell; Fillingim, Roger B

    2015-01-01

    Background Despite the widespread popularity of social media, little is known about the extent or context of pain-related posts by users of those media. Objective The aim was to examine the type, context, and dissemination of pain-related tweets. Methods We used content analysis of pain-related tweets from 50 cities to unobtrusively explore the meanings and patterns of communications about pain. Content was examined by location and time of day, as well as within the context of online social networks. Results The most common terms published in conjunction with the term “pain” included feel (n=1504), don’t (n=702), and love (n=649). The proportion of tweets with positive sentiment ranged from 13% in Manila to 56% in Los Angeles, CA, with a median of 29% across cities. Temporally, the proportion of tweets with positive sentiment ranged from 24% at 1600 to 38% at 2400, with a median of 32%. The Twitter-based social networks pertaining to pain exhibited greater sparsity and lower connectedness than did those social networks pertaining to common terms such as apple, Manchester United, and Obama. The number of word clusters in proportion to node count was greater for emotion terms such as tired (0.45), happy (0.43), and sad (0.4) when compared with objective terms such as apple (0.26), Manchester United (0.14), and Obama (0.25). Conclusions Taken together, our results suggest that pain-related tweets carry special characteristics reflecting unique content and their communication among tweeters. Further work will explore how geopolitical events and seasonal changes affect tweeters’ perceptions of pain and how such perceptions may affect therapies for pain. PMID:25843553

  9. Social stress exacerbates the aversion to painful experiences in rats exposed to chronic pain: the role of the locus coeruleus.

    PubMed

    Bravo, Lidia; Alba-Delgado, Cristina; Torres-Sanchez, Sonia; Mico, Juan Antonio; Neto, Fani L; Berrocoso, Esther

    2013-10-01

    Stressful experiences seem to negatively influence pain perception through as yet unknown mechanisms. As the noradrenergic locus coeruleus (LC) nucleus coordinates many components of the stress response, as well as nociceptive transmission, we evaluated whether the sensory and affective dimension of chronic neuropathic pain worsens in situations of stress due to adaptive changes of LC neurons. Accordingly, male rats were socially isolated for 5 weeks, and in the last 2 weeks, neuropathic pain was induced by chronic constriction injury. In this situation of stress, chronic pain selectively heightened the animal's aversion to painful experiences (affective pain), as measured in the place escape/avoidance test, although no changes were observed in the sensory dimension of pain. In addition, electrophysiological recordings of LC neurons showed a low tonic but exacerbated nociceptive-evoked activity when the injured paw was stimulated. These changes were accompanied by an increase in tyrosine hydroxylase and gephyrin expression in the LC. Furthermore, intra-LC administration of bicuculline, a γ-aminobutyric acid-A receptor antagonist, attenuated the negative affective effects of pain. These data show that changes in the LC are greater than those expected from the simple summation of each independent factor (pain and stress), revealing mechanisms through which stressors may exacerbate pain perception without affecting the sensorial dimension. PMID:23792242

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

    PubMed Central

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

    2015-01-01

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

  11. Social stress exacerbates the aversion to painful experiences in rats exposed to chronic pain: the role of the locus coeruleus.

    PubMed

    Bravo, Lidia; Alba-Delgado, Cristina; Torres-Sanchez, Sonia; Mico, Juan Antonio; Neto, Fani L; Berrocoso, Esther

    2013-10-01

    Stressful experiences seem to negatively influence pain perception through as yet unknown mechanisms. As the noradrenergic locus coeruleus (LC) nucleus coordinates many components of the stress response, as well as nociceptive transmission, we evaluated whether the sensory and affective dimension of chronic neuropathic pain worsens in situations of stress due to adaptive changes of LC neurons. Accordingly, male rats were socially isolated for 5 weeks, and in the last 2 weeks, neuropathic pain was induced by chronic constriction injury. In this situation of stress, chronic pain selectively heightened the animal's aversion to painful experiences (affective pain), as measured in the place escape/avoidance test, although no changes were observed in the sensory dimension of pain. In addition, electrophysiological recordings of LC neurons showed a low tonic but exacerbated nociceptive-evoked activity when the injured paw was stimulated. These changes were accompanied by an increase in tyrosine hydroxylase and gephyrin expression in the LC. Furthermore, intra-LC administration of bicuculline, a γ-aminobutyric acid-A receptor antagonist, attenuated the negative affective effects of pain. These data show that changes in the LC are greater than those expected from the simple summation of each independent factor (pain and stress), revealing mechanisms through which stressors may exacerbate pain perception without affecting the sensorial dimension.

  12. Systematic review of family functioning in families of children and adolescents with chronic pain

    PubMed Central

    Lewandowski, Amy S.; Palermo, Tonya M.; Stinson, Jennifer; Handley, Susannah; Chambers, Christine T.

    2010-01-01

    Disturbances in family functioning have been identified in youth with chronic pain and are associated with worse child physical and psychological functioning. Assessment measures of family functioning used in research and clinical settings vary. This systematic review summarizes studies investigating relationships among family functioning, pain and pain-related disability in youth with chronic pain. Sixteen articles were reviewed. All studies were cross-sectional, seven utilized between-group comparisons (chronic pain versus healthy/control) and twelve examined within-group associations among family functioning, pain and/or pain-related disability. Studies represented youth with various pain conditions (e.g., headache, abdominal pain, fibromyalgia) aged 6 – 20 years. Findings revealed group differences in family functioning between children with chronic pain and healthy controls in five of seven studies. Significant associations emerged among family variables and pain-related disability in six of nine studies with worse family functioning associated with greater child disability; relationships between family functioning and children’s pain were less consistent. Different patterns of results emerged depending on family functioning measure used. Overall, findings showed that families of children with chronic pain generally have poorer family functioning than healthy populations, and that pain-related disability is more consistently related to family functioning than pain intensity. PMID:21055709

  13. Negative affect, pain and sex: the role of endogenous opioids.

    PubMed

    Frew, Ashley K; Drummond, Peter D

    2007-11-01

    Opioid neurotransmission modulates pain and negative affect during psychological stress. To determine whether these effects differ between men and women, the opioid receptor antagonist naltrexone or placebo was administered double-blind to 21 men and 22 women before they completed 30 min of difficult mental arithmetic. To heighten negative affect, participants received seven moderately noxious electric shocks during the math task, which were believed to be contingent upon performance. Before and after the math task, participants rated pain intensity and unpleasantness while their left hand was immersed in 2 degrees C water for up to 4 min. Anxiety, discouragement and anger were also rated before, during and after the math task. Tolerance of cold-induced pain was greater in men, whereas discouragement during the math task was greater in women. Opioid blockade did not influence ratings of negative affect, which increased in line with the intensity and unpleasantness of shock-induced pain. The intensity and unpleasantness of cold-induced pain increased after the math task only in women administered naltrexone. Within the naltrexone condition, pain ratings increased most in the most discouraged subjects. However, this relationship was absent in placebo recipients, implying that the hyperalgesic effect of psychological distress was tempered by opioid release. Greater stress-evoked discouragement in women than men may explain why cold-induced pain increased after the math task only in women administered naltrexone.

  14. Investigating the Burden of Chronic Pain: An Inflammatory and Metabolic Composite

    PubMed Central

    Sibille, Kimberly T.; Steingrímsdóttir, Ólöf A.; Fillingim, Roger B.; Stubhaug, Audun; Schirmer, Henrik; Chen, Huaihou; McEwen, Bruce S.; Nielsen, Christopher S.

    2016-01-01

    Background. Chronic pain is associated with increased morbidity and mortality, predominated by cardiovascular disease and cancer. Investigating related risk factor measures may elucidate the biological burden of chronic pain. Objectives. We hypothesized that chronic pain severity would be positively associated with the risk factor composite. Methods. Data from 12,982 participants in the 6th Tromsø study were analyzed. Questionnaires included demographics, health behaviors, medical comorbidities, and chronic pain symptoms. The risk factor composite was comprised of body mass index, fibrinogen, C-reactive protein, and triglycerides. Chronic pain severity was characterized by frequency, intensity, time/duration, and total number of pain sites. Results. Individuals with chronic pain had a greater risk factor composite than individuals without chronic pain controlling for covariates and after excluding inflammation-related health conditions (p < 0.001). A significant “dose-response” relationship was demonstrated with pain severity (p < 0.001). In individuals with chronic pain, the risk factor composite varied by health behavior, exercise, lower levels and smoking, and higher levels. Discussion. The risk factor composite was higher in individuals with chronic pain, greater with increasing pain severity, and influenced by health behaviors. Conclusions. Identification of a biological composite sensitive to pain severity and adaptive/maladaptive behaviors would have significant clinical and research utility. PMID:27445627

  15. Chronic pain disorders in HIV primary care: clinical characteristics and association with healthcare utilization.

    PubMed

    Jiao, Jocelyn M; So, Eric; Jebakumar, Jebakaran; George, Mary Catherine; Simpson, David M; Robinson-Papp, Jessica

    2016-04-01

    Chronic pain is common in HIV, but incompletely characterized, including its underlying etiologies, its effect on healthcare utilization, and the characteristics of affected patients in the HIV primary care setting. These data are needed to design and justify appropriate clinic-based pain management services. Using a clinical data warehouse, we analyzed one year of data from 638 patients receiving standard-of-care antiretroviral therapy in a large primary care HIV clinic, located in the Harlem neighborhood of New York City. We found that 40% of patients carried one or more chronic pain diagnoses. The most common diagnoses were degenerative musculoskeletal disorders (eg, degenerative spinal disease and osteoarthritis), followed by neuropathic pain and headache disorders. Many patients (16%) had multiple chronic pain diagnoses. Women, older patients, and patients with greater burdens of medical illness, and psychiatric and substance use comorbidities were disproportionately represented among those with chronic pain diagnoses. Controlling for overall health status, HIV patients with chronic pain had greater healthcare utilization including emergency department visits and radiology procedures. In summary, our study demonstrates the high prevalence of chronic pain disorders in the primary care HIV clinic. Colocated interventions for chronic pain in this setting should not only focus on musculoskeletal pain but also account for complex multifaceted pain syndromes, and address the unique biopsychosocial features of this population. Furthermore, because chronic pain is prevalent in HIV and associated with increased healthcare utilization, developing clinic-based pain management programs could be cost-effective.

  16. Chronic pain disorders in HIV primary care: clinical characteristics and association with healthcare utilization.

    PubMed

    Jiao, Jocelyn M; So, Eric; Jebakumar, Jebakaran; George, Mary Catherine; Simpson, David M; Robinson-Papp, Jessica

    2016-04-01

    Chronic pain is common in HIV, but incompletely characterized, including its underlying etiologies, its effect on healthcare utilization, and the characteristics of affected patients in the HIV primary care setting. These data are needed to design and justify appropriate clinic-based pain management services. Using a clinical data warehouse, we analyzed one year of data from 638 patients receiving standard-of-care antiretroviral therapy in a large primary care HIV clinic, located in the Harlem neighborhood of New York City. We found that 40% of patients carried one or more chronic pain diagnoses. The most common diagnoses were degenerative musculoskeletal disorders (eg, degenerative spinal disease and osteoarthritis), followed by neuropathic pain and headache disorders. Many patients (16%) had multiple chronic pain diagnoses. Women, older patients, and patients with greater burdens of medical illness, and psychiatric and substance use comorbidities were disproportionately represented among those with chronic pain diagnoses. Controlling for overall health status, HIV patients with chronic pain had greater healthcare utilization including emergency department visits and radiology procedures. In summary, our study demonstrates the high prevalence of chronic pain disorders in the primary care HIV clinic. Colocated interventions for chronic pain in this setting should not only focus on musculoskeletal pain but also account for complex multifaceted pain syndromes, and address the unique biopsychosocial features of this population. Furthermore, because chronic pain is prevalent in HIV and associated with increased healthcare utilization, developing clinic-based pain management programs could be cost-effective. PMID:26683238

  17. Investigating the Burden of Chronic Pain: An Inflammatory and Metabolic Composite.

    PubMed

    Sibille, Kimberly T; Steingrímsdóttir, Ólöf A; Fillingim, Roger B; Stubhaug, Audun; Schirmer, Henrik; Chen, Huaihou; McEwen, Bruce S; Nielsen, Christopher S

    2016-01-01

    Background. Chronic pain is associated with increased morbidity and mortality, predominated by cardiovascular disease and cancer. Investigating related risk factor measures may elucidate the biological burden of chronic pain. Objectives. We hypothesized that chronic pain severity would be positively associated with the risk factor composite. Methods. Data from 12,982 participants in the 6th Tromsø study were analyzed. Questionnaires included demographics, health behaviors, medical comorbidities, and chronic pain symptoms. The risk factor composite was comprised of body mass index, fibrinogen, C-reactive protein, and triglycerides. Chronic pain severity was characterized by frequency, intensity, time/duration, and total number of pain sites. Results. Individuals with chronic pain had a greater risk factor composite than individuals without chronic pain controlling for covariates and after excluding inflammation-related health conditions (p < 0.001). A significant "dose-response" relationship was demonstrated with pain severity (p < 0.001). In individuals with chronic pain, the risk factor composite varied by health behavior, exercise, lower levels and smoking, and higher levels. Discussion. The risk factor composite was higher in individuals with chronic pain, greater with increasing pain severity, and influenced by health behaviors. Conclusions. Identification of a biological composite sensitive to pain severity and adaptive/maladaptive behaviors would have significant clinical and research utility. PMID:27445627

  18. Six lessons learned for greater success.

    PubMed

    Leander, W J

    1993-01-01

    These six lessons learned for greater success with your Patient Focused communications can help keep your cultural change process in sync with your operational change process. Of course, there are other key elements of the former, including: formal Patient Focused educational programs; restructured Human Resources "systems" (e.g., job descriptions and compensation programs); and migration toward greater organizational empowerment and more self-directed work teams. Still, your Patient Focused communications campaign will spearhead the cultural change process. As such, it will have the opportunity to make the very first impact. Basically, your communications can make or break your Patient Focused Care program from Day One. It's up to you--learn the lessons learned by others and your organization may follow the words of Marx rather than those of Brand: "Workers of the world, unite (on behalf of your Patient Focused Care program)!" Karl Marx.p6 "Workers of the world, fan out (in formation against your Patient Focused Care program)!" Stewart Brand. PMID:10133393

  19. Proximal and Distal Kinematics in Female Runners with Patellofemoral Pain

    PubMed Central

    Noehren, Brian; Pohl, Michael B.; Sanchez, Zack; Cunningham, Tom; Lattermann, Christian

    2014-01-01

    Background Female runners have a high incidence of developing patellofemoral pain. Abnormal mechanics are thought to be an important contributing factor to patellofemoral pain. However, the contribution of abnormal trunk, hip, and foot mechanics to the development of patellofemoral pain within this cohort remains elusive. Therefore the aim of this study was to determine if significant differences during running exist in hip, trunk and foot kinematics between females with and without patellofemoral pain. Methods 32 female runners (16 patellofemoral pain, 16 healthy control) participated in this study. All individuals underwent an instrumented gait analysis. Between-group comparisons were made for hip adduction, hip internal rotation, contra-lateral pelvic drop, contra-lateral trunk lean, rearfoot eversion, tibial internal rotation, as well as forefoot dorsiflexion and abduction Findings The patellofemoral pain group had significantly greater peak hip adduction and hip internal rotation. No differences in contra-lateral pelvic drop were found. A trend towards reduced contra-lateral trunk lean was found in the patellofemoral pain group. No significant differences were found in any of the rearfoot or forefoot variables but significantly greater shank internal rotation was found in the patellofemoral pain group. Interpretation We found greater hip adduction, hip internal rotation and shank internal rotation in female runners with patellofemoral pain. We also found less contra-lateral trunk lean in the patellofemoral pain group. This may be a potential compensatory mechanism for the poor hip Control seen. Rehabilitation programs that correct abnormal hip and shank kinematics are warranted in this population. PMID:22071426

  20. The pain management approach to chronic pelvic pain.

    PubMed

    Rapkin, A J; Kames, L D

    1987-05-01

    Chronic pelvic pain remains a difficult management problem that is often refractory to traditional medical or surgical therapy. The pain management center approach used successfully for the treatment of cancer pain and headache can be adapted to the treatment of chronic pelvic pain. The results of this pilot study suggest that the multidisciplinary techniques of pain management promise to be an effective modality for the treatment of chronic pelvic pain. PMID:2439689

  1. Ethnographies of pain: culture, context and complexity

    PubMed Central

    2015-01-01

    This article briefly introduces and discusses the value of ethnographic research, particularly research hailing from the discipline of social and cultural anthropology. After an introduction to ethnography in general, key ethnographic studies of pain are described. These show that ethnography provides a set of techniques for data collection and analysis, as well as a way of thinking about pain as socially and culturally embedded. Modern ethnographic writing is far removed from the literature of the past that sometimes described stereotypes rather than process and complexity. Ethnography provides the chance to describe the complexity and nuance of culture, which serves to counter stereotypes. The article concludes with an example from pain research conducted in a clinical setting. Through the use of ethnographic techniques, the research study provided greater insight than other methods alone might have achieved. The article includes references for further reading should readers be interested in developing their engagement with ethnographic method and interpretation. PMID:26516554

  2. Anginal pain of esophageal origin: clinical presentation, prevalence, and prognosis.

    PubMed

    Davies, H A

    1992-05-27

    Since 1768, when Heberden recognized a relationship of angina pectoris with eating, the close resemblance between angina-like pain of esophageal and cardiac origin has led to diagnostic confusion, with the role of the esophagus being, in turn, over- and underemphasized as a cause of symptoms. Although the classic features of angina do not distinguish the origin of the pain, certain other symptoms may identify esophageal pain. These include an inconsistent correlation of exercise with pain, periods of prolonged remission, provocation of pain by posture, association with other esophageal symptoms, relief by antacids, radiation of pain down the right arm and into the back, occurrence of pain at night, continuation of pain as a background ache, and relief from nitroglycerine delayed by 10 minutes or longer. However, while certain symptoms may alert the clinician to the possibility that angina-like pain is due to esophageal disease, no single symptom or combination of symptoms is infallible; there is no alternative to careful assessment. Esophageal disease accounts for the greatest number of patients with chest pain of unknown origin. The prevalence of angina-like esophageal pain in unselected emergency admissions with suspected myocardial infarction is 10-20%. Approximately one third or more of patients with angina and normal coronary arteries have esophageal problems. We have followed patients with angina-like esophageal pain for 9 years. Although prognosis remains good, confirming the original noncardiac diagnosis, greater than 80% of patients continue to have chest pain of undiminished intensity, and half are limited in their ability to work. Reassurance appeared to have one beneficial result: Patients were less likely to consult a physician after a positive diagnosis had been made.

  3. Greater Influence of Aerosol on Cloud Microphysics

    NASA Astrophysics Data System (ADS)

    Jha, V.; Hudson, J. G.; Noble, S.

    2009-12-01

    CCN and cloud microphysics measurements are presented from four projects: RICO, PASE,ICE-L and POST. Correlations coefficients (R) between 1% supersaturation CCN concentrations and total cloud droplet concentrations were 0.80 in all four projects and for the combined data. R between CCN and larger cloud droplet concentrations progressively decreased with increasing sizes (Fig. 1A). At ~20 µm R was maximum negative and then reversed to smaller negative and even positive at larger drop sizes. R is positive for CCN with total cloud droplets because droplets are proportional to the concentrations of nuclei that they condensed upon, CCN. The negative R for CCN with larger droplets is due to competition among droplets for condensate. Competition for condensate is greater when CCN concentrations are higher and this limits droplet sizes, more so for higher concentrations. Negative R ensues because this reduces droplet concentrations above specific sizes to a greater extent for higher CCN concentrations. The greatest negative R thus occurs at the size range where droplet concentrations are the largest, the mode of the droplet size distributions. In Fig. 1 this is just beyond the average mode. At larger sizes droplet concentrations are lower (Fig. 1B) and thus there is less competition for condensate. The more numerous small sized droplets do not have enough surface area to affect the growth of the larger less numerous droplets. Thus at larger sizes with reduced competition, droplet concentrations are again proportional to the concentrations of the nuclei that they condensed upon. Often particle concentrations at various sizes are proportional. When this is the case there will be a positive R for CCN at 1% with such larger droplet concentrations such as PASE in Fig. 1A. Thus there are two directly conflicting influences on R; the usual positive R between CCN and droplets and the negative R due to competition for condensate. Thus lower R between CCN and droplet

  4. [Mechanisms of myofascial pain].

    PubMed

    Boureau, F; Delorme, T; Doubrère, J F

    2000-01-01

    The aim of this paper is to review available data and current hypotheses concerning myofascial pain syndrome pathophysiology and implications for clinical practice. A muscular hypothesis has been proposed for episodic and chronic tension headache as well as for myofascial syndrome and fibromyalgia. These different syndromes may be compared as, besides their frequent combination, they have common features characterized by spontaneous pain, painful points, and lack of objective findings. They must be distinguished because each has its own diagnostic criteria. Pressure algometry appears to be a reliable method for assessing pressure sensitivity in myofascial pain. Pressure pain is not specific to tension headache and can be observed in other chronic headaches. It has not been demonstrated that the trigger points of fibromyalgia are specific in idiopathic cases. It is difficult to find an electrophysiological investigation which is specific for myofascial pain. For daily practice, the clinical approach with interview and examination remain the advisable attitude. Pathophysiological hypotheses help in better understanding of referred pain by sensitization of nociceptive central pathways according to the Ruch convergence projection theory (1965), modified by Mense in 1994. These theories do not however provide an explanation of the primary muscular mechanisms. Implications for myofascial pain patient management is discussed. PMID:11139741

  5. Chemical Interventions for Pain.

    ERIC Educational Resources Information Center

    Aronoff, Gerald M.; And Others

    1986-01-01

    Reviews properties and pharmacological effects of medications for pain, including peripherally acting analgesics, centrally acting narcotics, and adjuvant analgesics including antidepressants. Discusses the role of the endogenous opioid system in pain and depression. Explores clinical management issues in both inpatient and outpatient settings,…

  6. Is this phantom pain?

    PubMed

    Choudhury, Nabajit; Talukdar, Rupjyoti; Hagjer, Sumitra

    2012-12-01

    Right upper quadrant abdominal pain may be due to many causes, and at times may give rise to diagnostic dilemma. We present here a young lady with biliary type of pain who was eventually found to have gall bladder agenesis with aerobilia, in the absence of prior biliary intervention. PMID:24293906

  7. Language and pain expression.

    PubMed

    Waddie, N A

    1996-05-01

    This paper arose during work for a BSc(Hons) dissertation, and considers the theoretical approach of Wittgenstein to pain analysis. This paper seeks to discuss one aspect of the research undertaken representing some of the findings which illustrate the association between pain and language.

  8. Patients' perspectives on pain.

    PubMed

    Norrbrink, Cecilia; Löfgren, Monika; Hunter, Judith P; Ellis, Jaqueline

    2012-01-01

    Nociceptive and neuropathic pain (NP) are common consequences following spinal cord injury (SCI), with large impact on sleep, mood, work, and quality of life. NP affects 40% to 50% of individuals with SCI and is sometimes considered the major problem following SCI. Current treatment recommendations for SCI-NP primarily focus on pharmacological strategies suggesting the use of anticonvulsant and antidepressant drugs, followed by tramadol and opioid medications. Unfortunately, these are only partly successful in relieving pain. Qualitative studies report that individuals with SCI-related long-lasting pain seek alternatives to medication due to the limited efficacy, unwanted side effects, and perceived risk of dependency. They spend time and money searching for additional treatments. Many have learned coping strategies on their own, including various forms of warmth, relaxation, massage, stretching, distraction, and physical activity. Studies indicate that many individuals with SCI are dissatisfied with their pain management and with the information given to them about their pain, and they want to know more about causes and strategies to manage pain. They express a desire to improve communication with their physicians and learn about reliable alternative sources for obtaining information about their pain and pain management. The discrepancy between treatment algorithms and patient expectations is significant. Clinicians will benefit from hearing the patient´s voice. PMID:23459087

  9. Managing pain during labor

    MedlinePlus

    ... health care provider about the different types of pain relief for your labor and delivery. The health and safety of you and your ... so your doctor may recommend one type of pain relief for you over ... so you can make the best plan for your labor and delivery.

  10. Communicating pain and pain management needs after surgery.

    PubMed

    McDonald, D D; McNulty, J; Erickson, K; Weiskopf, C

    2000-05-01

    This descriptive study explored how patients communicate their pain and pain management needs after surgery. Thirty postoperative patients were interviewed. The majority described avoiding or delaying communicating their pain at some point during their hospitalization. Reasons for decreased pain communication included not wanting to complain; not wanting to take the provider away from other patients; avoiding unpleasant analgesic side effects; and not wanting to take "drugs." Postoperative patients may be unclear about their role in pain management. Pain management communication problems identified in this study could be used to design intervention studies to improve pain communication and consequent pain relief. PMID:10842902

  11. Altered Pain Sensitivity in Elderly Women with Chronic Neck Pain

    PubMed Central

    Uthaikhup, Sureeporn; Prasert, Romchat; Paungmali, Aatit; Boontha, Kritsana

    2015-01-01

    Background Age-related changes occur in both the peripheral and central nervous system, yet little is known about the influence of chronic pain on pain sensitivity in older persons. The aim of this study was to investigate pain sensitivity in elders with chronic neck pain compared to healthy elders. Methods Thirty elderly women with chronic neck pain and 30 controls were recruited. Measures of pain sensitivity included pressure pain thresholds, heat/cold pain thresholds and suprathreshold heat pain responses. The pain measures were assessed over the cervical spine and at a remote site, the tibialis anterior muscle. Results Elders with chronic neck pain had lower pressure pain threshold over the articular pillar of C5-C6 and decreased cold pain thresholds over the cervical spine and tibialis anterior muscle when compared with controls (p < 0.05). There were no between group differences in heat pain thresholds and suprathreshold heat pain responses (p > 0.05). Conclusion The presence of pain hypersensitivity in elderly women with chronic neck pain appears to be dependent on types of painful stimuli. This may reflect changes in the peripheral and central nervous system with age. PMID:26039149

  12. Epidural injections for back pain

    MedlinePlus

    ESI; Spinal injection for back pain; Back pain injection; Steroid injection - epidural; Steroid injection - back ... pillow under your stomach. If this position causes pain, you either sit up or lie on your ...

  13. Post surgical pain treatment - adults

    MedlinePlus

    Postoperative pain relief ... Pain that occurs after surgery is an important concern. Before your surgery, you and your surgeon may have discussed how much pain you should expect and how it will be ...

  14. Abdominal Pain, Long-Term

    MedlinePlus

    MENU Return to Web version Abdominal Pain, Long-term See complete list of charts. Ongoing or recurrent abdominal pain, also called chronic pain, may be difficult to diagnose, causing frustration for ...

  15. Planning for greater-confinement disposal

    SciTech Connect

    Gilbert, T.L.; Luner, C.; Meshkov, N.K.; Trevorrow, L.E.; Yu, C.

    1984-01-01

    This contribution is a progress report for preparation of a document that will summarize procedures and technical information needed to plan for and implement greater-confinement disposal (GCD) of low-level radioactive waste. Selection of a site and a facility design (Phase I), and construction, operation, and extended care (Phase II) will be covered in the document. This progress report is limited to Phase I. Phase I includes determination of the need for GCD, design alternatives, and selection of a site and facility design. Alternative designs considered are augered shafts, deep trenches, engineered structures, high-integrity containers, hydrofracture, and improved waste form. Design considerations and specifications, performance elements, cost elements, and comparative advantages and disadvantages of the different designs are covered. Procedures are discussed for establishing overall performance objectives and waste-acceptance criteria, and for comparative assessment of the performance and cost of the different alternatives. 16 references.

  16. Greater confinement disposal of radioactive wastes

    SciTech Connect

    Trevorrow, L.E.; Gilbert, T.L.; Luner, C.; Merry-Libby, P.A.; Meshkov, N.K.; Yu, C.

    1985-01-01

    Low-level radioactive waste (LLW) includes a broad spectrum of different radionuclide concentrations, half-lives, and hazards. Standard shallow-land burial practice can provide adequate protection of public health and safety for most LLW. A small volume fraction (approx. 1%) containing most of the activity inventory (approx. 90%) requires specific measures known as greater-confinement disposal (GCD). Different site characteristics and different waste characteristics - such as high radionuclide concentrations, long radionuclide half-lives, high radionuclide mobility, and physical or chemical characteristics that present exceptional hazards - lead to different GCD facility design requirements. Facility design alternatives considered for GCD include the augered shaft, deep trench, engineered structure, hydrofracture, improved waste form, and high-integrity container. Selection of an appropriate design must also consider the interplay between basic risk limits for protection of public health and safety, performance characteristics and objectives, costs, waste-acceptance criteria, waste characteristics, and site characteristics.

  17. Health and Greater Manchester in Historical Perspective

    PubMed Central

    Snow, Stephanie J.

    2015-01-01

    This article maps the history of health organisation across Greater Manchester (GM), primarily since the Second World War, to show how against a continuing backdrop of health inequalities, services have been driven (and constrained) by the needs and the politics of each period. Defining ‘success’ as benefits for patients the article identifies examples such as Salford’s mental health services (1950s and 1960s), public health in North Manchester (1970s and 1980s), the creation of centres for diabetes, sickle-cell and thalassaemia (1980s) and the formation of the Joint Health Unit in 2002. What this history shows is that over the period the common factors influencing the ‘success’ of health organisation across GM have been the championing of particular issues by multi-disciplinary groups working across health and social care and stability in structures and personnel. PMID:27499557

  18. 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

  19. An archaeology of pain

    NASA Astrophysics Data System (ADS)

    Gruber, Dennis Michael

    Pain is a discursive construct of science and medicine. Through the discourses of biopower and technoscience pain is used to construct and maintain the social body. Biopower and technoscience are discursive practices that are enveloped within the disciplines of Western society. Specifically, the disciplines of education, science, and medicine use biopower and technoscience to normalize the body and construct binaries which create the abnormal. The cyborg is a discursive practice used to implode the binaries of the disciplines which maintain the social body. Through the implosion of binaries, the binary of mind/body is no longer plausible in the explanation of pain. Neuropathic chronic pain and phantom limb pain become cyborg discourses which operate to deconstruct the pedagogies of science and medicine.

  20. Musculoskeletal chest wall pain

    PubMed Central

    Fam, Adel G.; Smythe, Hugh A.

    1985-01-01

    The musculoskeletal structures of the thoracic wall and the neck are a relatively common source of chest pain. Pain arising from these structures is often mistaken for angina pectoris, pleurisy or other serious disorders. In this article the clinical features, pathogenesis and management of the various musculoskeletal chest wall disorders are discussed. The more common causes are costochondritis, traumatic muscle pain, trauma to the chest wall, “fibrositis” syndrome, referred pain, psychogenic regional pain syndrome, and arthritis involving articulations of the sternum, ribs and thoracic spine. Careful analysis of the history, physical findings and results of investigation is essential for precise diagnosis and effective treatment. ImagesFig. 3Fig. 4Fig. 5 PMID:4027804

  1. Postoperative pain management

    PubMed Central

    Kolettas, Alexandros; Lazaridis, George; Baka, Sofia; Mpoukovinas, Ioannis; Karavasilis, Vasilis; Kioumis, Ioannis; Pitsiou, Georgia; Papaiwannou, Antonis; Lampaki, Sofia; Karavergou, Anastasia; Pataka, Athanasia; Machairiotis, Nikolaos; Katsikogiannis, Nikolaos; Mpakas, Andreas; Tsakiridis, Kosmas; Fassiadis, Nikolaos; Zarogoulidis, Konstantinos

    2015-01-01

    Postoperative pain is a very important issue for several patients. Indifferent of the surgery type or method, pain management is very necessary. The relief from suffering leads to early mobilization, less hospital stay, reduced hospital costs, and increased patient satisfaction. An individual approach should be applied for pain control, rather than a fix dose or drugs. Additionally, medical, psychological, and physical condition, age, level of fear or anxiety, surgical procedure, personal preference, and response to agents given should be taken into account. The major goal in the management of postoperative pain is minimizing the dose of medications to lessen side effects while still providing adequate analgesia. Again a multidisciplinary team approach should be pursued planning and formulating a plan for pain relief, particularly in complicated patients, such as those who have medical comorbidities. These patients might appear increase for analgesia-related complications or side effects. PMID:25774311

  2. Pain in systemic sclerosis.

    PubMed

    Stisi, S; Sarzi-Puttini, P; Benucci, M; Biasi, G; Bellissimo, S; Talotta, R; Atzeni, F

    2014-01-01

    Chronic pain is a healthcare problem that significantly affects the mental health, and the professional and private life of patients. It can complicate many disorders and represents a common symptom of rheumatologic diseases, but the data on its prevalence is still limited. Pain is a ubiquitous problem in systemic sclerosis (SSc). SSc-related pain has been studied on the basis of biomedical models and is considered a symptom caused by the disease activity or previous tissue damage. Effective pain management is a primary goal of the treatment strategy, although this symptom in SSc has not yet been investigated in detail. However, these patients do not all respond adequately to pharmacological pain therapies, therefore in these cases a multimodal approach needs to be adopted. PMID:24938196

  3. The Neurobiology of Cancer Pain.

    PubMed

    Schmidt, Brian L

    2015-12-01

    Oral cancers are often severely painful and clinically difficult to manage. Few researchers have investigated the neurobiologic factors responsible for cancer pain; however, the study of oral cancer pain might inform us about the fundamental biology of cancer. The purpose of the present report was to summarize the clinical challenges inherent in oral cancer pain management, oral cancer pain mechanisms and mediators, and the convergence of the investigation of carcinogenesis and pain. PMID:26608142

  4. Evidence for indirect effects of pain catastrophizing on clinical pain among myofascial temporomandibular disorder participants: the mediating role of sleep disturbance.

    PubMed

    Buenaver, Luis F; Quartana, Phillip J; Grace, Edward G; Sarlani, Eleni; Simango, Mpepera; Edwards, Robert R; Haythornthwaite, Jennifer A; Smith, Michael T

    2012-06-01

    Sleep disturbance and pain catastrophizing are important mediators of the chronic pain experience. To date, these factors have not been considered concurrently despite compelling theoretical rationale to do so. In the present study, we examined whether pain catastrophizing not only has direct effects on clinical pain and pain-related interference, but also indirect effects through its association with sleep disturbance. We evaluated this hypothesis using a cohort (n=214) of myofascial temporomandibular disorder participants using a statistical bootstrapping technique recommended for tests of indirect effects. Results suggested that pain catastrophizing was associated with greater sleep disturbance, and that a significant portion of variance in clinical pain severity and pain-related interference attributable to pain catastrophizing was mediated by sleep disturbance. Supplementary analyses revealed that the rumination component of catastrophizing seemed to be indirectly related to clinical outcomes through sleep disturbance. No evidence for indirect effects was observed for helplessness and magnification components. These results suggest that rumination about pain may contribute to clinical pain indirectly through alterations in sleep. Prospective studies are needed to examine lagged associations between these constructs. These findings have important theoretical and clinical implications. Critically, interventions that reduce pain catastrophizing may concurrently improve sleep and clinical pain. PMID:22417656

  5. 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

  6. Spirituality and Religion in Pain and Pain Management

    PubMed Central

    Dedeli, Ozden; Kaptan, Gulten

    2013-01-01

    Pain relief is a management problem for many patients, their families, and the medical professionals caring for them. Although everyone experiences pain to some degree, responses to it vary from one person to another. Recognizing and specifying someone else’s pain is clinically a well know challenge. Research on the biology and neurobiology of pain has given us a relationship between spirituality and pain. There is growing recognition that persistent pain is a complex and multidimensional experience stemming from the interrelations among biological, psychological, social, and spiritual factors. Patients with pain use a number of cognitive and behavioral strategies to cope with their pain, including religious/spiritual factors, such as prayers, and seeking spiritual support to manage their pain. This article provides an overview of the complex phenomenon of pain, with a focus on spiritual and religious issues in pain management. PMID:26973914

  7. Validity of pain drawings for predicting psychological status outcome in patients with recurrent or chronic low back pain

    PubMed Central

    Abbott, J.H.; Foster, Megan; Hamilton, Lucien; Ravenwood, Michael; Tan, Nicholas

    2015-01-01

    Objectives: To investigate the association between baseline pain drawings and future psychological status, and estimate the prognostic value of pain drawing assessment for predicting somatization, distress, and depression at one-year follow-up, in patients with recurrent or chronic low back pain (RCLBP). Methods: This was a multi-center prospective cohort study of 138 patients with RCLBP. Participating patients completed at baseline and one-year follow-up: a blank pain drawing; the Modified Somatic Perceptions Questionnaire; modified Zung Depression Scale; and Distress and Risk Assessment Method. Pain drawings were analyzed quantitatively using the Pain Sites Score (PSS) and Simple Body Region (SBR) method. The association between baseline pain drawing assessment and one-year psychological status was estimated using correlation and Relative Risk (RR) statistics. Results: We obtained complete data from 81 patients (59%). Psychological status and pain drawings did not differ significantly between completers and non-completers. Pain drawing area at baseline was associated with depression and somatization at one-year follow-up (Spearman’s Rho 0.25, P = 0.022; 0.31 P = 0.006, respectively). Stronger associations resulted from analyses using the PSS, compared with the SBR. Patients with abnormal PSS pain drawings at baseline had significantly greater RR of depression (RR 6.1, 95% CI 1.1, 33.5), somatization (RR 4.1, 95% CI 1.7, 9.9) and distress (RR 6.8, 95% CI 1.9, 25.3) at one-year follow-up. Discussion: These results provide the first evidence that abnormal baseline pain drawings predict greater risk of abnormal psychological states or poor psychological outcome at one-year follow-up, in patients with RCLBP. PMID:26309377

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

    PubMed Central

    Montgomery, William; Vietri, Jeffrey; Shi, Jing; Ogawa, Kei; Kariyasu, Sawako; Alev, Levent; Nakamura, Masaya

    2016-01-01

    Objective The aim of this study was to quantify the impact of pain severity on patient-reported outcomes among individuals diagnosed with chronic low back pain in Japan. Methods Data were provided by the 2012 Japan National Health and Wellness Survey (N=29,997), a web-based survey of individuals in Japan aged ≥18 years. This analysis included respondents diagnosed with low back pain of ≥3-month duration. Measures included the revised Medical Outcomes Study 36-Item Short-Form Survey Instrument, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 scale, the Work Productivity and Activity Impairment: General Health questionnaire, and self-reported all-cause health care visits (6 months). Generalized linear models were used to assess the relationship between outcomes and severity of pain in the past week as reported on a numeric rating scale ranging from 0 (no pain) to 10 (pain as bad as you can imagine), controlling for length of diagnosis, sociodemographics, and general health characteristics. Results A total of 290 respondents were included in the analysis; mean age was 56 years, 41% were females, and 56% were employed. Pain severity was 3/10 for the first quartile, 5/10 for the median, and 7/10 for the third quartile of this sample. Increasing severity was associated with lower scores for mental and physical component summaries and Short-Form 6D health utility, higher depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7) scores, greater absenteeism and presenteeism, greater activity impairment, and more health care provider visits (all P<0.0001). Conclusion The impact of chronic low back pain on health-related quality of life, depression and anxiety symptoms, impairment to work and daily activities, and health care use increases with the severity of pain. Interventions reducing the severity of pain may improve numerous health outcomes even if the pain cannot be eliminated. PMID:27330326

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

    PubMed Central

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

    2012-01-01

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

  10. MRI and low back pain

    MedlinePlus

    Backache - MRI; Low back pain - MRI; Lumbar pain - MRI; Back strain - MRI; Lumbar radiculopathy - MRI; Herniated intervertebral disk - MRI; Prolapsed intervertebral disk - MRI; Slipped disk - MRI; Ruptured ...

  11. Nonpharmacologic interventions for pain management.

    PubMed

    Doody, S B; Smith, C; Webb, J

    1991-03-01

    Managing pain is a complex and inexact science. Acute and chronic pain physically and psychologically affects and disables an overwhelming number of people. Nonpharmacologic interventions for pain management have been reviewed. These methods can be used independently or in combination with other nonpharmacologic or pharmacologic methods of pain control. The goals of nonpharmacologic interventions for pain management include the reduction of pain, minimal adverse effects, and allowing patients to become active participants in their own care. Nurses are called on many times to comfort patients in pain. It is through their expertise and intervention that the goals of pain management succeed. PMID:2043331

  12. Low back pain: pharmacologic management.

    PubMed

    Miller, Susan M

    2012-09-01

    Adequate treatment of low back pain is essential, but has been challenging for many primary care physicians. Most patients with low back pain can be treated in the primary care environment, provided the physician has enough knowledge of the medications used to treat low back pain. The main treatment goal for acute low back pain is to control the pain and maintain function. For patients with chronic back pain, the goal is continual pain management and prevention of future exacerbations. This article reviews current pharmacological options for the treatment of low back pain, and possible future innovations. PMID:22958559

  13. Chronic Pain, Psychopathology, and DSM-5 Somatic Symptom Disorder

    PubMed Central

    Katz, Joel; Rosenbloom, Brittany N; Fashler, Samantha

    2015-01-01

    Unlike acute pain that warns us of injury or disease, chronic or persistent pain serves no adaptive purpose. Though there is no agreed on definition of chronic pain, it is commonly referred to as pain that is without biological value, lasting longer than the typical healing time, not responsive to treatments based on specific remedies, and of a duration greater than 6 months. Chronic pain that is severe and intractable has detrimental consequences, including psychological distress, job loss, social isolation, and, not surprisingly, it is highly comorbid with depression and anxiety. Historically, pain without an apparent anatomical or neurophysiological origin was labelled as psychopathological. This approach is damaging to the patient and provider alike. It pollutes the therapeutic relationship by introducing an element of mutual distrust as well as implicit, if not explicit, blame. It is demoralizing to the patient who feels at fault, disbelieved, and alone. Moreover, many medically unexplained pains are now understood to involve an interplay between peripheral and central neurophysiological mechanisms that have gone awry. The new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, somatic symptom disorder overpsychologizes people with chronic pain; it has low sensitivity and specificity, and it contributes to misdiagnosis, as well as unnecessary stigma. Adjustment disorder remains the most appropriate, accurate, and acceptable diagnosis for people who are overly concerned about their pain. PMID:26174215

  14. Extended cortical activations during evaluating successive pain stimuli.

    PubMed

    Lötsch, Jörn; Walter, Carmen; Felden, Lisa; Preibisch, Christine; Nöth, Ulrike; Martin, Till; Anti, Sandra; Deichmann, Ralf; Oertel, Bruno G

    2012-08-01

    Comparing pain is done in daily life and involves short-term memorizing and attention focusing. This event-related functional magnetic resonance imaging study investigated the short-term brain activations associated with the comparison of pain stimuli using a delayed discrimination paradigm. Fourteen healthy young volunteers compared two successive pain stimuli administered at a 10 s interval to the same location at the nasal mucosa. Fourteen age- and sex-matched subjects received similar pain stimuli without performing the comparison task. With the comparison task, the activations associated with the second pain stimulus were significantly greater than with the first stimulus in the anterior insular cortex and the primary somatosensory area. This was observed on the background of a generally increased stimulus-associated brain activation in the presence of the comparison task that included regions of the pain matrix (insular cortex, primary and secondary somatosensory area, midcingulate cortex, supplemental motor area) and regions associated with attention, decision making, working memory and body recognition (frontal and temporal gyri, inferior parietal lobule, precuneus, lingual cortices). This data provides a cerebral correlate for the role of pain as a biological alerting system that gains the subject's attention and then dominates most other perceptions and activities involving pain-specific and non-pain-specific brain regions.

  15. Multisensor Arrays for Greater Reliability and Accuracy

    NASA Technical Reports Server (NTRS)

    Immer, Christopher; Eckhoff, Anthony; Lane, John; Perotti, Jose; Randazzo, John; Blalock, Norman; Ree, Jeff

    2004-01-01

    Arrays of multiple, nominally identical sensors with sensor-output-processing electronic hardware and software are being developed in order to obtain accuracy, reliability, and lifetime greater than those of single sensors. The conceptual basis of this development lies in the statistical behavior of multiple sensors and a multisensor-array (MSA) algorithm that exploits that behavior. In addition, advances in microelectromechanical systems (MEMS) and integrated circuits are exploited. A typical sensor unit according to this concept includes multiple MEMS sensors and sensor-readout circuitry fabricated together on a single chip and packaged compactly with a microprocessor that performs several functions, including execution of the MSA algorithm. In the MSA algorithm, the readings from all the sensors in an array at a given instant of time are compared and the reliability of each sensor is quantified. This comparison of readings and quantification of reliabilities involves the calculation of the ratio between every sensor reading and every other sensor reading, plus calculation of the sum of all such ratios. Then one output reading for the given instant of time is computed as a weighted average of the readings of all the sensors. In this computation, the weight for each sensor is the aforementioned value used to quantify its reliability. In an optional variant of the MSA algorithm that can be implemented easily, a running sum of the reliability value for each sensor at previous time steps as well as at the present time step is used as the weight of the sensor in calculating the weighted average at the present time step. In this variant, the weight of a sensor that continually fails gradually decreases, so that eventually, its influence over the output reading becomes minimal: In effect, the sensor system "learns" which sensors to trust and which not to trust. The MSA algorithm incorporates a criterion for deciding whether there remain enough sensor readings that

  16. Painful faces-induced attentional blink modulated by top-down and bottom-up mechanisms.

    PubMed

    Zheng, Chun; Wang, Jin-Yan; Luo, Fei

    2015-01-01

    Pain-related stimuli can capture attention in an automatic (bottom-up) or intentional (top-down) fashion. Previous studies have examined attentional capture by pain-related information using spatial attention paradigms that involve mainly a bottom-up mechanism. In the current study, we investigated the pain information-induced attentional blink (AB) using a rapid serial visual presentation (RSVP) task, and compared the effects of task-irrelevant and task-relevant pain distractors. Relationships between accuracy of target identification and individual traits (i.e., empathy and catastrophizing thinking about pain) were also examined. The results demonstrated that task-relevant painful faces had a significant pain information-induced AB effect, whereas task-irrelevant faces showed a near-significant trend of this effect, supporting the notion that pain-related stimuli can influence the temporal dynamics of attention. Furthermore, we found a significant negative correlation between response accuracy and pain catastrophizing score in task-relevant trials. These findings suggest that active scanning of environmental information related to pain produces greater deficits in cognition than does unintentional attention toward pain, which may represent the different ways in which healthy individuals and patients with chronic pain process pain-relevant information. These results may provide insight into the understanding of maladaptive attentional processing in patients with chronic pain. PMID:26082731

  17. Posttraumatic stress disorder symptoms in youth with vs without chronic pain.

    PubMed

    Noel, Melanie; Wilson, Anna C; Holley, Amy Lewandowski; Durkin, Lindsay; Patton, Michaela; Palermo, Tonya M

    2016-10-01

    Chronic pain and posttraumatic stress disorder (PTSD) symptoms have been found to co-occur in adults; however, research has not examined this co-occurrence in adolescence, when pediatric chronic pain often first emerges. The aims of this study were to compare the frequency and intensity of PTSD symptoms and stressful life events in cohorts of youth with (n = 95) and without (n = 100) chronic pain and their parents and to determine the association between PTSD symptoms, health-related quality of life, and pain symptoms within the chronic pain sample. All participants completed questionnaire measures through an online survey. Findings revealed that youth with chronic pain and their parents had significantly higher levels of PTSD symptoms as compared with pain-free peers. More youth with chronic pain (32%) and their parents (20%) reported clinically significant elevations in PTSD symptoms than youth without chronic pain (8%) and their parents (1%). Youth with chronic pain also reported a greater number of stressful life events than those without chronic pain, and this was associated with higher PTSD symptoms. Among the chronic pain cohort, higher levels of PTSD symptoms were predictive of worse health-related quality of life and were associated with higher pain intensity, unpleasantness, and interference. Results suggest that elevated PTSD symptoms are common and linked to reduced functioning among youth with chronic pain. Future research is needed to examine PTSD at the diagnostic level and the underlying mechanisms that may explain why this co-occurrence exists.

  18. Painful faces-induced attentional blink modulated by top–down and bottom–up mechanisms

    PubMed Central

    Zheng, Chun; Wang, Jin-Yan; Luo, Fei

    2015-01-01

    Pain-related stimuli can capture attention in an automatic (bottom–up) or intentional (top–down) fashion. Previous studies have examined attentional capture by pain-related information using spatial attention paradigms that involve mainly a bottom–up mechanism. In the current study, we investigated the pain information-induced attentional blink (AB) using a rapid serial visual presentation (RSVP) task, and compared the effects of task-irrelevant and task-relevant pain distractors. Relationships between accuracy of target identification and individual traits (i.e., empathy and catastrophizing thinking about pain) were also examined. The results demonstrated that task-relevant painful faces had a significant pain information-induced AB effect, whereas task-irrelevant faces showed a near-significant trend of this effect, supporting the notion that pain-related stimuli can influence the temporal dynamics of attention. Furthermore, we found a significant negative correlation between response accuracy and pain catastrophizing score in task-relevant trials. These findings suggest that active scanning of environmental information related to pain produces greater deficits in cognition than does unintentional attention toward pain, which may represent the different ways in which healthy individuals and patients with chronic pain process pain-relevant information. These results may provide insight into the understanding of maladaptive attentional processing in patients with chronic pain. PMID:26082731

  19. Tramadol and acetaminophen tablets for dental pain.

    PubMed Central

    Medve, R. A.; Wang, J.; Karim, R.

    2001-01-01

    The purpose of this work was to compare the efficacy and time to analgesia of a new tramadol/acetaminophen combination tablet to those of tramadol or acetaminophen (APAP) alone. A meta-analysis was performed of 3 separate single-dose, double-blind, parallel-group trials in patients with moderate or severe pain following extraction of 2 or more third molars. Patients in each study were evenly randomized to a single dose of tramadol/APAP (75 mg/650 mg), tramadol 75 mg, APAP 650 mg, ibuprofen 400 mg, or placebo. Active control with ibuprofen was used to determine model sensitivity. Pain relief (scale, 0-4) and pain intensity (scale, 0-3) were reported at 30 minutes after the dose and then hourly for 8 hours. Total pain relief over 8 hours (TOTPAR8) and the sum of pain intensity differences (SPID8) were calculated from the hourly scores. Time to onset of pain relief was determined by the double-stopwatch technique, and patients were advised to wait at least 2 hours before taking supplemental analgesia. Patients assessed overall efficacy (scale, 1-5) upon completion. In all, 1197 patients (age range, 16-46 years) were evaluable for efficacy; treatment groups in each study were similar at baseline. Pain relief was superior to placebo (P < or = .0001) for all treatments. Pain relief provided by tramadol/ APAP was superior to that of tramadol or APAP alone, as shown by mean TOT-PAR8 (12.1 vs 6.7 and 8.6, respectively, P < or = .0001) and SPID8 (4.7 vs 0.9 and 2.7, respectively, P < or = .0001). Estimated onset of pain relief was 17 minutes (95% CI, 15-20 minutes) for tramadol/APAP compared with 51 minutes (95% CI, 40-70 minutes) for tramadol, 18 minutes (95% CI, 16-21 minutes) for APAP, and 34 minutes (95% CI, 28-44 minutes) for ibuprofen. Median time to supplemental analgesia and mean overall assessment of efficacy were greater (P < .05) for the tramadol/APAP group (302 minutes and 3.0, respectively) than for the tramadol (122 minutes and 2.0) or APAP (183 minutes and 2

  20. Postoperative Pain Control

    PubMed Central

    Garimella, Veerabhadram; Cellini, Christina

    2013-01-01

    The effective relief of pain is of the utmost importance to anyone treating patients undergoing surgery. Pain relief has significant physiological benefits; hence, monitoring of pain relief is increasingly becoming an important postoperative quality measure. The goal for postoperative pain management is to reduce or eliminate pain and discomfort with a minimum of side effects. Various agents (opioid vs. nonopioid), routes (oral, intravenous, neuraxial, regional) and modes (patient controlled vs. “as needed”) for the treatment of postoperative pain exist. Although traditionally the mainstay of postoperative analgesia is opioid based, increasingly more evidence exists to support a multimodal approach with the intent to reduce opioid side effects (such as nausea and ileus) and improve pain scores. Enhanced recovery protocols to reduce length of stay in colorectal surgery are becoming more prevalent and include multimodal opioid sparing regimens as a critical component. Familiarity with the efficacy of available agents and routes of administration is important to tailor the postoperative regimen to the needs of the individual patient. PMID:24436674

  1. TMJ pain and cryoanalgesia.

    PubMed

    Sidebottom, Andrew J

    2013-01-01

    Temporomandibular (TMJ) joint pain is a complex issue involving several factors in a spectrum including myofascial pain, internal derangement and degenerative disease, all of which are reciprocally affected by psychological factors. Current assessment of TMD (temporomandibular disorder) can be assisted by standardised protocols, but often there is a combination of disease processes which each need to be addressed. Initial management should always be conservative with a preference for non-invasive measures which do no harm and have evidential support. Subsequent management of myofascial pain could involve tricyclic anti-depressants or botulinum injection into areas of muscle spasm. Joint related pain is diagnosed by relief of pain following intra-articular local analgesia. Where this is successful arthroscopy/arthrocentesis are successful in relieving the pain in up to 90% of cases. In addition arthroscopy is an accurate diagnostic tool. Where this fails, open surgery is less successful and ultimately joint replacement may be required. Where the latter are not indicated, but pain is relieved by LA, cryoanalgesia to the joint capsule may be beneficial. PMID:25737900

  2. TMJ pain and cryoanalgesia

    PubMed Central

    Sidebottom, Andrew J.

    2013-01-01

    Temporomandibular (TMJ) joint pain is a complex issue involving several factors in a spectrum including myofascial pain, internal derangement and degenerative disease, all of which are reciprocally affected by psychological factors. Current assessment of TMD (temporomandibular disorder) can be assisted by standardised protocols, but often there is a combination of disease processes which each need to be addressed. Initial management should always be conservative with a preference for non-invasive measures which do no harm and have evidential support. Subsequent management of myofascial pain could involve tricyclic anti-depressants or botulinum injection into areas of muscle spasm. Joint related pain is diagnosed by relief of pain following intra-articular local analgesia. Where this is successful arthroscopy/arthrocentesis are successful in relieving the pain in up to 90% of cases. In addition arthroscopy is an accurate diagnostic tool. Where this fails, open surgery is less successful and ultimately joint replacement may be required. Where the latter are not indicated, but pain is relieved by LA, cryoanalgesia to the joint capsule may be beneficial. PMID:25737900

  3. [Neural basis of pain].

    PubMed

    Calvino, Bernard

    2006-03-01

    Main elements concerning the physiology of pain are described, as well as the structures of the nervous system at the origin of the central control of pain: peripheral fibres (small diameter myelinated A delta and unmyelinated C fibres); spinal ascending pathways; cerebral structures relaying nociceptive information (medial and ventro-postero-lateral thalamic relays); SI and SII cortical areas; spinal segmentary and supraspinal excitatory and inhibitory controls; diffuse noxious inhibitory controls (DNIC). Chronic pain is a result of two processes: peripheral and central sensitization, in relation with inflammation and nerve injury at peripheral level and with neuroplasticity at central level. Neurotrophins, mainly NGF and BDNF and their receptors (LNTR, TrkA and TrkB) are involved in these processes. Pain is a result of an unpleasant emotional experience: its various components, mainly the emotional one, may be increased or decreased considering the different characteristics of the stimulus and of the affective state of the patient, as well as the context in which this stimulus is applied. The role of physiological systems, unconnected with those classically involved in the physiology of nociception and pain, such as the motor cortex in phantom limb pain, are described in conclusion, to focus on the extreme complexity of the control systems of pain in humans. PMID:16556514

  4. Low back pain.

    PubMed Central

    Ehrlich, George E.

    2003-01-01

    Low back pain is a leading cause of disability. It occurs in similar proportions in all cultures, interferes with quality of life and work performance, and is the most common reason for medical consultations. Few cases of back pain are due to specific causes; most cases are non-specific. Acute back pain is the most common presentation and is usually self-limiting, lasting less than three months regardless of treatment. Chronic back pain is a more difficult problem, which often has strong psychological overlay: work dissatisfaction, boredom, and a generous compensation system contribute to it. Among the diagnoses offered for chronic pain is fibromyalgia, an urban condition (the diagnosis is not made in rural settings) that does not differ materially from other instances of widespread chronic pain. Although disc protrusions detected on X-ray are often blamed, they rarely are responsible for the pain, and surgery is seldom successful at alleviating it. No single treatment is superior to others; patients prefer manipulative therapy, but studies have not demonstrated that it has any superiority over others. A WHO Advisory Panel has defined common outcome measures to be used to judge the efficacy of treatments for studies. PMID:14710509

  5. Pharmacogenomics in pain treatment.

    PubMed

    Peiró, Ana M; Planelles, Beatriz; Juhasz, Gabriella; Bagdy, György; Libert, Frédéric; Eschalier, Alain; Busserolles, Jérôme; Sperlagh, Beata; Llerena, Adrián

    2016-09-01

    The experience of chronic pain is one of the commonest reasons for seeking medical attention, being a major issue in clinical practice. While pain is a universal experience, only a small proportion of people who felt pain develop pain syndromes. In addition, painkillers are associated with wide inter-individual variability in the analgesic response. This may be partly explained by the presence of single nucleotide polymorphisms in genes encoding molecular entities involved in pharmacodynamics and pharmacokinetics. However, uptake of this information has been slow due in large part to the lack of robust evidences demonstrating clinical utility. Furthermore, novel therapies, including targeting of epigenetic changes and gene therapy-based approaches are further broadening future options for the treatment of chronic pain. The aim of this article is to review the evidences behind pharmacogenetics (PGx) to individualize therapy (boosting the efficacy and minimizing potential toxicity) and genes implicated in pain medicine, in two parts: (i) genetic variability with pain sensitivity and analgesic response; and (ii) pharmacological concepts applied on PGx. PMID:27662648

  6. Greater Green River Basin Production Improvement Project

    SciTech Connect

    DeJarnett, B.B.; Lim, F.H.; Calogero, D.

    1997-10-01

    The Greater Green River Basin (GGRB) of Wyoming has produced abundant oil and gas out of multiple reservoirs for over 60 years, and large quantities of gas remain untapped in tight gas sandstone reservoirs. Even though GGRB production has been established in formations from the Paleozoic to the Tertiary, recent activity has focused on several Cretaceous reservoirs. Two of these formations, the Ahnond and the Frontier Formations, have been classified as tight sands and are prolific producers in the GGRB. The formations typically naturally fractured and have been exploited using conventional well technology. In most cases, hydraulic fracture treatments must be performed when completing these wells to to increase gas production rates to economic levels. The objectives of the GGRB production improvement project were to apply the concept of horizontal and directional drilling to the Second Frontier Formation on the western flank of the Rock Springs Uplift and to compare production improvements by drilling, completing, and testing vertical, horizontal and directionally-drilled wellbores at a common site.

  7. Malaria situation in the Greater Mekong Subregion.

    PubMed

    Hewitt, Sean; Delacollette, Charles; Chavez, Irwin

    2013-01-01

    The epidemiology of malaria in the Greater Mekong Subregion is complex and rapidly evolving. Malaria control and elimination efforts face a daunting array of challenges including multidrug-resistant parasites. This review presents secondary data collected by the national malaria control programs in the six countries between 1998 and 2010 and examines trends over the last decade. This data has a number of limitations: it is derived exclusively from public sector health facilities; falciparum-specific and then pan-specific rapid diagnostic tests were introduced during the period under review; and, recently there has been a massive increase in case detection capability as a result of increased funding. It therefore requires cautious interpretation. A series of maps are presented showing trends in incidence, mortality and proportion of cases caused by Plasmodium falciparum over the last decade. A brief overview of institutional and implementation arrangements, historical background, demographics and key issues affecting malaria epidemiology is provided for each country. National malaria statistics for 2010 are presented and their robustness discussed in terms of the public sector's share of cases and other influencing factors such as inter-country variations in risk stratification, changes in diagnostic approach and immigration. Targets are presented for malaria control and where appropriate for elimination. Each country's artemisinin resistance status is described. The epidemiological trends presented reflect the improvement in the malaria situation, however the true malaria burden is as yet unknown. There is a need for continuing strengthening and updating of surveillance and response systems. PMID:24159830

  8. Water quality improvement plan for Greater Vancouver

    SciTech Connect

    Foellmi, S.N. . Environmental Div.); Neden, D.G. ); Dawson, R.N. )

    1993-10-01

    The Greater Vancouver Regional District commissioned an 18-month planning and predesign study to define the components in a comprehensive water and predesign study to define the components in a comprehensive water quality improvement plan for its 2,500-ML/d (660-mgd) system. The study included three primary tasks: (1) predesign of disinfection and corrosion control facilities, (2) a 12-month pilot testing program using parallel pilot plants at the Seymour and Capilano water supply reservoirs, and (3) planning for future filtration plants. The results of the study identified chlorine, ammonia, sulfur dioxide, soda ash, and carbon dioxide in a two-stage treatment approach as the recommended disinfection and corrosion control scheme for the low-pH, low-alkalinity water supplies. The pilot-plant studies confirmed that direct filtration using deep-bed monomedium filters operating at a loading rate of 22.5 m/h provided excellent treatment performance and productivity over a wide range of raw-water quality. Ozonation was studied extensively and found not to be beneficial in the overall treatment performance. The phased improvement plan for the disinfection, corrosion control, and filtration facilities has an estimated capital cost of about Can$459 million.

  9. Systematic pain assessment in horses.

    PubMed

    de Grauw, J C; van Loon, J P A M

    2016-03-01

    Accurate recognition and quantification of pain in horses is imperative for adequate pain management. The past decade has seen a much needed surge in formal development of systematic pain assessment tools for the objective monitoring of pain in equine patients. This narrative review describes parameters that can be used to detect pain in horses, provides an overview of the various pain scales developed (visual analogue scales, simple descriptive scales, numerical rating scales, time budget analysis, composite pain scales and grimace scales), and highlights their strengths and weaknesses for potential clinical implementation. The available literature on the use of each pain assessment tool in specific equine pain states (laminitis, lameness, acute synovitis, post-castration, acute colic and post-abdominal surgery) is discussed, including any problems with sensitivity, reliability or scale validation as well as translation of results to other clinical pain states. The review considers future development and further refinement of currently available equine pain scoring systems. PMID:26831169

  10. Interactions between the immune and nervous systems in pain

    PubMed Central

    Ren, Ke; Dubner, Ronald

    2010-01-01

    Immune cells and glia interact with neurons to alter pain sensitivity and to mediate the transition from acute to chronic pain. In response to injury, resident immune cells are activated and blood-borne immune cells are recruited to the site of injury. Immune cells not only contribute to immune protection but also initiate the sensitization of peripheral nociceptors. Through the synthesis and release of inflammatory mediators and interactions with neurotransmitters and their receptors, the immune cells, glia and neurons form an integrated network that coordinates immune responses and modulates the excitability of pain pathways. The immune system also reduces sensitization by producing immune-derived analgesic and anti-inflammatory or proresolution agents. A greater understanding of the role of the immune system in pain processing and modulation reveals potential targets for analgesic drug development and new therapeutic opportunities for managing chronic pain. PMID:20948535

  11. Pain and Psychological Outcomes After Rehabilitative Treatment for a Woman With Chronic Pelvic Pain With Stage III Cervical Cancer: A Case Report

    PubMed Central

    Alappattu, Meryl J.

    2016-01-01

    Background Chronic pelvic pain and sexual dysfunction are adverse effects of treatment of cervical cancer. Surgery and radiation therapies may result in soft tissue pain and dysfunction, including spasms and trigger points of the pelvic floor muscles that result in pain. In addition to physical restrictions, negative mood associated with pain is believed to intensify and prolong the pain experience. Study Design The purpose of this case report was to describe outcomes of pelvic physical therapy in a 58-year-old woman with chronic pelvic pain after medical treatments for cervical cancer. Case Description The patient reported dyspareunia, hip pain, and lower abdominal, pelvic pain, and fatigue with activities lasting greater than 30 minutes. Interventions included pelvic floor massage, dilator use, and patient education. Symptoms were assessed at baseline and completion of physical therapy, using the Female Sexual Function Index, Fear of Pain Questionnaire–III, Pain Catastrophizing Scale, and Numerical Pain Rating Scale. Outcomes The Female Sexual Function Index score decreased from 7.8 to 2.8, the Fear of Pain Questionnaire– III score decreased from 85 to 73, the Pain Catastrophizing Scale score decreased from 18 to 8, and lower abdominal and pelvic pain decreased from 4 of 10 to 0 of 10, while bilateral hip pain remained at 4 of 10. In addition, she exhibited increased tolerance to mechanical pressure, evidenced by progression in size of a vaginal dilator. Discussion These results suggest that pelvic physical therapy may be useful in treating chronic pelvic pain after cervical cancer treatments and may also help decrease the magnitude of negative mood aspects such as pain-related fear and catastrophizing. PMID:27134605

  12. Sodium channels and pain.

    PubMed

    Habib, Abdella M; Wood, John N; Cox, James J

    2015-01-01

    Human and mouse genetic studies have led to significant advances in our understanding of the role of voltage-gated sodium channels in pain pathways. In this chapter, we focus on Nav1.7, Nav1.8, Nav1.9 and Nav1.3 and describe the insights gained from the detailed analyses of global and conditional transgenic Nav knockout mice in terms of pain behaviour. The spectrum of human disorders caused by mutations in these channels is also outlined, concluding with a summary of recent progress in the development of selective Nav1.7 inhibitors for the treatment of pain. PMID:25846613

  13. Intraoral Pain Disorders.

    PubMed

    Edens, Mary Hil; Khaled, Yasser; Napeñas, Joel J

    2016-08-01

    Those experiencing intraoral pain associated with dental and oral diseases are likely to pursue treatment from medical and dental providers. The causes for intraoral pain include odontogenic, periodontal, oral mucosal, or contiguous hard and soft tissue structures to the oral cavity. Providers should be vigilant when diagnosing these, as they should be among the first in their differential diagnoses to be ruled out. This review provides brief overviews of frequently encountered oral/dental diseases that cause intraoral pain, originating from the teeth, the surrounding mucosa and gingivae, tongue, bone, and salivary glands and their causes, features, diagnosis, and management strategies. PMID:27475507

  14. Nonspecific Arm Pain

    PubMed Central

    Moradi, Ali; Ebrahimzadeh, Mohammad H; Ring, David

    2013-01-01

    Nonspecific activity-related arm pain is characterized by an absence of objective physical findings and symptoms that do not correspond with objective pathophysiology. Arm pain without strict diagnosis is often related to activity, work-related activity in particular, and is often seen in patients with physically demanding work. Psychological factors such as catastrophic thinking, symptoms of depression, and heightened illness concern determine a substantial percentage of the disability associated with puzzling hand and arm pains. Ergonomic modifications can help to control symptoms, but optimal health may require collaborative management incorporating psychosocial and psychological elements of illness. PMID:25207288

  15. Chronic Post Surgical Pain

    PubMed Central

    2011-01-01

    Chronic post-surgical pain (CPSP) is a recognised adverse consequence of surgery; surgery is common, therefore the population at risk is considerable. Putative risk factors for CPSP include genetic predisposition, demographic, clinical (pain history, type of surgery, anaesthesia, acute pain severity), and psychological factors (vulnerability vs resilience). Evidence of prevention is limited: long-term benefit from pre-emptive/perioperative analgesia has not been demonstrated consistently. Large scale prospective studies with detailed pre, intra and postoperative multifactorial assessments are required to refine understanding of the aetiology and prognosis of CPSP. PMID:26526062

  16. Pain and functional limitations in individuals with rheumatoid arthritis.

    PubMed

    MacKinnon, J R; Avison, W R; McCain, G A

    1994-03-01

    The focus of this investigation was to determine if health status variables such as pain and functional limitations are correlated with an individual's occupational profile (work, activities of daily living and leisure), and psychological adjustment (depression, anxiety and dissatisfaction with life). This study reports our findings for 143 individuals with rheumatoid arthritis (RA). It would appear from the results of this study that functional limitations have an even greater impact on individuals with RA than pain. This findings and its implications are discussed.

  17. Maintenance of pain in children with functional abdominal pain

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A significant proportion of children with functional abdominal pain develop chronic pain. Identifying clinical characteristics predicting pain persistence is important in targeting interventions. We examined whether child anxiety and/or pain-stooling relations were related to maintenance of abdomina...

  18. Role of satellite glial cells in gastrointestinal pain

    PubMed Central

    Hanani, Menachem

    2015-01-01

    Gastrointestinal (GI) pain is a common clinical problem, for which effective therapy is quite limited. Sensations from the GI tract, including pain, are mediated largely by neurons in the dorsal root ganglia (DRG), and to a smaller extent by vagal afferents emerging from neurons in the nodose/jugular ganglia. Neurons in rodent DRG become hyperexcitable in models of GI pain (e.g., gastric or colonic inflammation), and can serve as a source for chronic pain. Glial cells are another element in the pain signaling pathways, and there is evidence that spinal glial cells (microglia and astrocytes) undergo activation (gliosis) in various pain models and contribute to pain. Recently it was found that satellite glial cells (SGCs), the main type of glial cells in sensory ganglia, might also contribute to chronic pain in rodent models. Most of that work focused on somatic pain, but in several studies GI pain was also investigated, and these are discussed in the present review. We have shown that colonic inflammation induced by dinitrobenzene sulfonic acid (DNBS) in mice leads to the activation of SGCs in DRG and increases gap junction-mediated coupling among these cells. This coupling appears to contribute to the hyperexcitability of DRG neurons that innervate the colon. Blocking gap junctions (GJ) in vitro reduced neuronal hyperexcitability induced by inflammation, suggesting that glial GJ participate in SGC-neuron interactions. Moreover, blocking GJ by carbenoxolone and other agents reduces pain behavior. Similar changes in SGCs were also found in the mouse nodose ganglia (NG), which provide sensory innervation to most of the GI tract. Following systemic inflammation, SGCs in these ganglia were activated, and displayed augmented coupling and greater sensitivity to the pain mediator ATP. The contribution of these changes to visceral pain remains to be determined. These results indicate that although visceral pain is unique, it shares basic mechanisms with somatic pain

  19. History of physical and sexual abuse in women with chronic pelvic pain.

    PubMed

    Rapkin, A J; Kames, L D; Darke, L L; Stampler, F M; Naliboff, B D

    1990-07-01

    The history of physical and sexual abuse in childhood and adulthood was assessed in 31 women with chronic pelvic pain, 142 women with chronic pain in other locations, and 32 controls. Thirty-nine percent of patients with chronic pelvic pain had been physically abused in childhood. This percentage was significantly greater than that observed in other chronic-pain patients (18.4%) or controls (9.4%), though the prevalence of childhood sexual abuse did not differ among the groups (19.4, 16.3, and 12.5%, respectively). Abuse in adulthood was less common and was not significantly more likely to have occurred in patients with chronic pelvic pain than in other chronic-pain patients or controls. These data suggest that pelvic pain is unlikely to be specifically and psychodynamically related to sexual abuse but that the pernicious nature of abuse, whether physical or sexual, may promote the chronicity of painful conditions. PMID:2359571

  20. Pain and anxiety with burn dressing changes: patient self-report.

    PubMed

    Weinberg, K; Birdsall, C; Vail, D; Marano, M A; Petrone, S J; Mansour, E H

    2000-01-01

    Pain and anxiety are integral parts of burn dressing care. Descriptions of pain and anxiety from the patients' perspectives enhance our understanding of their experiences. This descriptive study measured relationships between self-reported pain and anxiety. Twenty-four patients who had an uncomplicated flame or scald wound reported scores immediately before, immediately after, and 1/2 hour after dressing changes. Results indicated that pain and anxiety increased until day 4. Pain correlated with anxiety. Self-report scores showed that pain and anxiety are perceived by patients in a similar manner. Self-report scores are of great value because they indicate the degree of relief achieved with medication. Through the descriptive study, we found that the pain score immediately after dressing changes was greater than 3 on all study days. This finding indicates a need to further examine the way pain is managed with dressing changes. PMID:10752749

  1. Fibromyalgia pain and its modulation by hypnotic and non-hypnotic suggestion: an fMRI analysis.

    PubMed

    Derbyshire, Stuart W G; Whalley, Matthew G; Oakley, David A

    2009-05-01

    The neuropsychological status of pain conditions such as fibromyalgia, commonly categorized as 'psychosomatic' or 'functional' disorders, remains controversial. Activation of brain structures dependent upon subjective alterations of fibromyalgia pain experience could provide an insight into the underlying neuropsychological processes. Suggestion following a hypnotic induction can readily modulate the subjective experience of pain. It is unclear whether suggestion without hypnosis is equally effective. To explore these and related questions, suggestions following a hypnotic induction and the same suggestions without a hypnotic induction were used during functional magnetic resonance imaging to increase and decrease the subjective experience of fibromyalgia pain. Suggestion in both conditions resulted in significant changes in reported pain experience, although patients claimed significantly more control over their pain and reported greater pain reduction when hypnotised. Activation of the midbrain, cerebellum, thalamus, and midcingulate, primary and secondary sensory, inferior parietal, insula and prefrontal cortices correlated with reported changes in pain with hypnotic and non-hypnotic suggestion. These activations were of greater magnitude, however, when suggestions followed a hypnotic induction in the cerebellum, anterior midcingulate cortex, anterior and posterior insula and the inferior parietal cortex. Our results thus provide evidence for the greater efficacy of suggestion following a hypnotic induction. They also indicate direct involvement of a network of areas widely associated with the pain 'neuromatrix' in fibromyalgia pain experience. These findings extend beyond the general proposal of a neural network for pain by providing direct evidence that regions involved in pain experience are actively involved in the generation of fibromyalgia pain.

  2. Neck pain or spasms - self care

    MedlinePlus

    ... chronic pain . Some with ongoing neck pain take narcotics to control the pain . It is best if only one health care provider is prescribing your narcotic pain medicines. If you have chronic neck pain, ...

  3. Over-the-counter pain relievers

    MedlinePlus

    ... Analgesics; Acetaminophen; NSAID; Nonsteroidal anti-inflammatory drug; Pain medicine - over-the-counter; Pain medicine - OTC ... Pain medicines are also called analgesics. Each kind of pain medicine has benefits and risks. Some types of pain ...

  4. The neurobiology of pain perception in normal and persistent pain.

    PubMed

    Fenton, Bradford W; Shih, Elim; Zolton, Jessica

    2015-01-01

    Pain is a significant national burden in terms of patient suffering, expenditure and lost productivity. Understanding pain is fundamental to improving evaluation, treatment and innovation in the management of acute and persistent pain syndromes. Pain perception begins in the periphery, and then ascends in several tracts, relaying at different levels. Pain signals arrive in the thalamus and midbrain structures which form the pain neuromatrix, a constantly shifting set of networks and connections that determine conscious perception. Several cortical regions become active simultaneously during pain perception; activity in the cortical pain matrix evolves over time to produce a complex pain perception network. Dysfunction at any level has the potential to produce unregulated, persistent pain. PMID:26088531

  5. Bilateral Thoracoscopic Splanchnotomy to Alleviate Pain in Chronic Pancreatic Disease.

    PubMed

    Bosanquet, David C; Wilcox, Christopher R M; Rasheed, Ashraf

    2016-03-01

    Chronic intractable pain is a common problem in severe pancreatic disease. Bilateral thoracoscopic splanchnotomy, a thoracoscopic neurotomy of the splanchnic nerves, is rarely performed but may provide significant pain relief in these patients. We present a safe strategy that uses prone positioning and two thoracoscopic ports for either hemithorax, permitting easy exposure and simple dissection of the greater and lesser splanchnic nerves. In our experience, this technique provides excellent pain relief with a minimal postoperative stay and few postoperative adverse events. This intervention has the potential to reduce dependency on opioid agents and improve quality of life in carefully selected patients. PMID:26897240

  6. Assessment and treatment of hip pain in the adolescent athlete.

    PubMed

    Giordano, Brian D

    2014-12-01

    Hip pain in the adolescent athlete is a common source of functional impairment and can limit athletic performance. In the past, many intra- and extra-articular hip abnormalities went unrecognized and were left untreated because of insufficient diagnostic imaging and limited surgical options. However, over the past 20 years, there has been a tremendous expansion research, and the understanding of the etiology of hip pain among such athletes has grown. Improvements in imaging modalities and technical innovations have led to greater diagnostic insights and creative new treatment strategies. This article explores the etiology and treatment of hip pain in the adolescent athlete. PMID:25439016

  7. Intrathecal clonidine and adenosine: effects on pain and sensory processing in patients with chronic regional pain syndrome.

    PubMed

    Rauck, Richard L; North, James; Eisenach, James C

    2015-01-01

    Chronic pain may be accompanied by hyperalgesia and allodynia, and analgesic interventions may reduce these hypersensitivity phenomena. Preclinical data suggest that intrathecal clonidine and adenosine reduce hypersensitivity, but only clonidine reduces pain; therefore, we tested the effects of these interventions in patients with chronic pain. Twenty-two subjects with pain and hyperalgesia in a lower extremity from complex regional pain syndrome were recruited in a double-blind crossover study to receive intrathecal clonidine, 100 μg, or adenosine, 2 mg. Primary outcome measure was proportion with ≥30% reduction in pain 2 hours after injection, and secondary measures were pain report, areas of hypersensitivity, and temporal summation to heat stimuli. Treatments did not differ in the primary outcome measure (10 met success criterion after clonidine administration and 5 after adenosine administration), although they did differ in pain scores over time, with clonidine having a 3-fold greater effect (P = 0.014). Both drugs similarly reduced areas of hyperalgesia and allodynia by approximately 30% and also inhibited temporal summation. The percentage change in pain report did not correlate with the percentage change in areas of hyperalgesia (P = 0.09, r = 0.08) or allodynia (P = 0.24, r = 0.24) after drug treatment. Both intrathecal clonidine and adenosine acutely inhibit experimentally induced and clinical hypersensitivity in patients with chronic regional pain syndrome. Although these drugs do not differ in analgesia by the primary outcome measure, their difference in effect on pain scores over time and lack of correlation between effect on pain and hypersensitivity suggest that analgesia does not parallel antihyperalgesia with these treatments.

  8. Postamputation pain: studies on mechanisms.

    PubMed

    Nikolajsen, Lone

    2012-10-01

    Amputation is followed by both painful and non-painful phantom phenomena in a large number of amputees. Non-painful phantom sensations rarely pose any clinical problem, but 60-80% of all amputees also experience painful sensations (i.e. phantom pain) located to the missing limb. The severity of phantom pain usually decreases with time, but severe pain persists in 5-10% of patients. Pain in the residual limb (i.e. stump pain) is another consequence of amputation. Both stump and phantom pain can be very difficult to treat. Treatment guidelines used for other neuropathic pain conditions are probably the best approximation, especially for the treatment of stump pain. The aim of the present doctoral thesis was to explore some of the mechanisms underlying pain after amputation. Ten studies were carried out (I-X). My PhD thesis from 1998 dealt with pain before the amputation and showed that preamputation pain increases the risk of phantom pain after amputation (I). A perioperative epidural blockade, however, did not reduce the incidence of pain or abnormal sensory phenomena after amputation (II, III). The importance of sensitization before amputation for the subsequent development of pain is supported by study IV, in which pressure pain thresholds obtained at the limb before amputation were inversely related to stump and phantom pain after 1 week. Afferent input from the periphery is likely to contribute to postamputation pain as sodium channels were upregulated in human neuromas (VI), although neuroma removal did not always alleviate phantom pain (V). Sensitization of neurons in the spinal cord also seems to be involved in pain after amputation as phantom pain was reduced by ketamine, an NMDA-receptor antagonist. Another NMDA-receptor antagonist, memantine, and gabapentin, a drug working by binding to the δ2α-subunit of voltage-gated calcium channels, had no effect on phantom pain (VII-IX). Supraspinal factors are also important for pain after amputation as

  9. Palliative care - managing pain

    MedlinePlus

    ... aspirin, naproxen (Aleve) and ibuprofen (Advil, Motrin), diclofenac Narcotics or opioids , such as codeine, morphine, oxycodone, or ... stools, can be treated. Some people who take narcotics for pain become dependent on them. If you ...

  10. Anterior knee pain

    MedlinePlus

    ... as running, jumping or twisting, skiing, or playing soccer). You have flat feet. Anterior knee pain is ... to the kneecap Runners, jumpers, skiers, bicyclists, and soccer players who exercise often Teenagers and healthy young ...

  11. Veterans and chronic pain

    PubMed Central

    Wilson, Sarah

    2013-01-01

    Summary points 1. Musculoskeletal problems are the commonest reason for medical discharge in all the British armed forces. By definition, these problems are chronic and resistant to treatment. 2. Pain is also common in veterans who have experienced severe injuries (polytrauma), often accompanied by post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) orpostconcussive syndrome. 3. In veterans seeking treatment for chronic pain, PTSD is common. There is also evidence for elevated levels of alcohol misuse in veterans who have been deployed to conflict. However, most veterans do not have pain, PTSD or alcohol problems. 4. Pain clinicians would benefit from training in meeting veterans’ needs, in order to promote their engagement and successful treatment. This should include countering stereotypes, information about the military and support for the assessment and onward referral of PTSD and alcohol problems. PMID:26516504

  12. Migraines: What a Pain!

    MedlinePlus

    ... Got Homework? Here's Help White House Lunch Recipes Migraines: What a Pain! KidsHealth > For Kids > Migraines: What ... coming and how to avoid them. What's a Migraine? Almost everyone gets headaches . You might have one ...

  13. Hemiplegic shoulder pain.

    PubMed

    Griffin, J W

    1986-12-01

    This article reviews the literature relevant to the possible causes, prevention, and treatment of hemiplegic shoulder pain. Shoulder pain and stiffness impede the rehabilitation of patients with hemiplegia. The cause of this complication is unknown, but it may be related to the severity of neurological deficits, preexisting or posthemiplegic soft tissue injury, subluxation, brachial plexus injury, or shoulder-hand syndrome. Shoulder pain may be preventable if risk factors can be identified and appropriate prophylaxis applied. Resolution of the condition depends on diagnosis and effective treatment at the onset of the symptoms. More clinical research is needed to clarify the cause of hemiplegic shoulder pain and to document the efficacy of prophylactic and treatment methods.

  14. Complex Regional Pain Syndrome

    MedlinePlus

    ... an important role in sustaining the pain. Another theory is that CRPS is caused by a triggering ... All NINDS-prepared information is in the public domain and may be freely copied. Credit to the ...

  15. Patellofemoral Pain Syndrome

    MedlinePlus

    ... Physician January 15, 2007, http://www.aafp.org/afp/2007/0115/p194.html) Patellofemoral Pain Syndrome: A ... Physician November 01, 1999, http://www.aafp.org/afp/991101ap/2012.html) Written by familydoctor.org editorial ...

  16. American Chronic Pain Association

    MedlinePlus

    ... Cluttering Your Cabinets SAVE THE DATE - GivingTuesday - Global Day of Giving ALERT: Extortion Scam Access to Care Survey Results 2016 *NEW* Veterans In Pain Events Events for October 2016: View ...

  17. Pain management in photoepilation.

    PubMed

    Aimonetti, Jean-Marc; Ribot-Ciscar, Edith

    2016-06-01

    The hair follicle is a complex, hormonally active structure with permanent and cyclically renewed parts which are highly innervated by myelinated and unmyelinated afferent fibers. Hair removal, a very ancient practice, affects this sensory network and causes both acute and diffuse pain associated with inflammatory reaction. Optic permanent hair removal is becoming a popular alternative to traditional methods such as shaving, waxing, among other methods. These optical removal devices thermally destroy the target chromophore, that is, melanin, without damaging the surrounding skin. The increase in the skin surface temperature causes mild-to-severe pain, and optical hair removal has to be combined with pain relieving devices. Pain management relies on topical anesthetic agents, cooling devices, or non-noxious cutaneous stimulation whose mechanisms of action and efficiency are discussed in this article. PMID:26589969

  18. Treatments for Managing Pain

    MedlinePlus

    ... muscle massage. Electrical stimulation - Transcutaneous electrical nerve stimulation (TENS) is the most common form of electrical stimulation ... painful and does not require needles or medicine. TENS consists of a small, battery-operated device that ...

  19. Chronic Pelvic Pain

    MedlinePlus

    ... found. How is chronic pelvic pain diagnosed? Your health care provider will ask about your medical history. You will have a physical exam, including a pelvic exam . Tests also may be done to find the cause. ...

  20. Block That Pain!

    MedlinePlus

    ... combination produces a unique effect, blocking pain-sensing neurons without impairing signals from other cells. In contrast, ... surgical procedures block activity in all types of neurons. This can cause numbness, paralysis, and other nervous ...

  1. Pain Management Programs

    MedlinePlus

    ... the pain, but it takes a holistic approach meaning who you are and how you feel is as much a part of shaping your treatment as your physical self. The Team is made up of: "Patient" (person with ... members may ...

  2. Low back pain.

    PubMed

    Golob, Anna L; Wipf, Joyce E

    2014-05-01

    Low back pain is a common, frequently recurring condition that often has a nonspecific cause. Most nonspecific acute low back pain will improve within several weeks with or without treatment. The diagnostic workup should focus on evaluation for evidence of systemic or pathologic causes. Psychosocial distress, poor coping skills, and high initial disability increase the risk for a prolonged disability course. All patients with acute or chronic low back pain should be advised to remain active. The treatment of chronic nonspecific low back pain involves a multidisciplinary approach targeted at preserving function and preventing disability. Surgical referral is indicated in the presence of severe or progressive neurologic deficits or signs and symptoms of cauda equina syndrome. PMID:24758954

  3. Low back pain.

    PubMed

    Golob, Anna L; Wipf, Joyce E

    2014-05-01

    Low back pain is a common, frequently recurring condition that often has a nonspecific cause. Most nonspecific acute low back pain will improve within several weeks with or without treatment. The diagnostic workup should focus on evaluation for evidence of systemic or pathologic causes. Psychosocial distress, poor coping skills, and high initial disability increase the risk for a prolonged disability course. All patients with acute or chronic low back pain should be advised to remain active. The treatment of chronic nonspecific low back pain involves a multidisciplinary approach targeted at preserving function and preventing disability. Surgical referral is indicated in the presence of severe or progressive neurologic deficits or signs and symptoms of cauda equina syndrome.

  4. How Is Pain Managed?

    MedlinePlus

    ... Trials Pain Management Nutrition and Exercise Holistic Care Pathology Intraductal Papillary Mucinous Neoplasms Islet Cell Tumors & Endocrine ... 410-933-7262 Site Map Policies & Credits News Pathology Home Goldman Center © 2016 Johns Hopkins University

  5. Dysmenorrhea: Painful Periods

    MedlinePlus

    ... need surgery. In some cases, a mix of treatments works best. What medications are used to treat dysmenorrhea? Certain pain relievers, called nonsteroidal anti-inflammatory drugs (NSAIDs), target prostaglandins. ...

  6. Does association of opioid use with pain and function differ by fibromyalgia or widespread pain status?

    PubMed

    Turner, Judith A; Shortreed, Susan M; Saunders, Kathleen W; LeResche, Linda; Thielke, Stephen; Von Korff, Michael

    2016-10-01

    Many consider chronic opioid therapy (COT) to be ineffective for fibromyalgia, but empirical evidence is limited. Among patients identified as initiating COT, we examined whether fibromyalgia was associated with different relationships of opioid use to pain and activity interference outcomes 12 months later. We obtained electronic data on diagnoses and opioid prescriptions. We obtained patient self-report data, including pain and activity interference measures, at baseline, 4 months, and 12 months. Among 1218 patients, 429 (35%) met our definition of fibromyalgia. Patients with and without fibromyalgia who had intermittent/lower-dose or regular/higher-dose opioid use at 12 months had similar 12-month pain intensity scores. However, among patients with minimal/no opioid use at 12 months, 12-month pain intensity was greater for those with fibromyalgia (adjusted mean = 5.15 [95% confidence interval, 4.80-5.51]; 0-10 scale) than for those without (4.44 [4.15-4.72]). Similar patterns were observed for 12-month activity interference. Among patients who discontinued opioids by 12 months, those with fibromyalgia were more likely to report bothersome side effects and less likely to report pain improvement as important reasons for discontinuation (P < 0.05). In sum, at 12 months, among patients who had discontinued opioids or used them minimally, those with fibromyalgia had worse outcomes and were less likely to have discontinued because of pain improvement. Among patients continuing COT, pain and activity interference outcomes were worse than those of patients with minimal/no opioid use and did not differ for those with fibromyalgia vs those with diverse other chronic pain conditions.

  7. Does association of opioid use with pain and function differ by fibromyalgia or widespread pain status?

    PubMed

    Turner, Judith A; Shortreed, Susan M; Saunders, Kathleen W; LeResche, Linda; Thielke, Stephen; Von Korff, Michael

    2016-10-01

    Many consider chronic opioid therapy (COT) to be ineffective for fibromyalgia, but empirical evidence is limited. Among patients identified as initiating COT, we examined whether fibromyalgia was associated with different relationships of opioid use to pain and activity interference outcomes 12 months later. We obtained electronic data on diagnoses and opioid prescriptions. We obtained patient self-report data, including pain and activity interference measures, at baseline, 4 months, and 12 months. Among 1218 patients, 429 (35%) met our definition of fibromyalgia. Patients with and without fibromyalgia who had intermittent/lower-dose or regular/higher-dose opioid use at 12 months had similar 12-month pain intensity scores. However, among patients with minimal/no opioid use at 12 months, 12-month pain intensity was greater for those with fibromyalgia (adjusted mean = 5.15 [95% confidence interval, 4.80-5.51]; 0-10 scale) than for those without (4.44 [4.15-4.72]). Similar patterns were observed for 12-month activity interference. Among patients who discontinued opioids by 12 months, those with fibromyalgia were more likely to report bothersome side effects and less likely to report pain improvement as important reasons for discontinuation (P < 0.05). In sum, at 12 months, among patients who had discontinued opioids or used them minimally, those with fibromyalgia had worse outcomes and were less likely to have discontinued because of pain improvement. Among patients continuing COT, pain and activity interference outcomes were worse than those of patients with minimal/no opioid use and did not differ for those with fibromyalgia vs those with diverse other chronic pain conditions. PMID:27643834

  8. Hailstones across the Greater Sydney Metropolitan Area

    NASA Astrophysics Data System (ADS)

    Rasuly, A. A.; Cheung, K. K. W.; McBurney, B.

    2014-11-01

    This study addresses the recent climatology of hail occurrence in the Greater Metropolitan Severe Thunderstorm Warning Area (GMSTWA) of New South Wales, Australia, which is a sprawling suburban area, with a population of nearly 4.7 million and one of Australia's largest metropolis. The main objective is to highlight the recent temporal-spatial fluctuations of hailstone frequencies and magnitudes for each of recognized and vastly inhabited Local Government Areas (LGAs). The relevant hail event data from 1989 to 2013 were initially derived from the severe storm archive of Australian Bureau of Meteorology. A climatologically oriented GIS technique was applied in the examining and mapping procedure of all hail events and hail days reported throughout the study area. By applying a specific criterion, all severe hails (defined as 2 cm or more in diameter) were cautiously selected and then imported into the ArcGIS software for relevant analysis. Appropriate data layers were stored in a unique database to allow logical integration of the data directly into some geoprocessing functions, mainly for querying, analyzing and mapping purposes in a model-builder setting. The database includes 357 hailstones with sizes 2-11 cm and occurred in 169 hail days across the region during the past 25 years. The models have established that hailstones are neither temporally nor spatially uniform in magnitude throughout the study area. Temporal analysis indicated that most of hail events occurred predominately in the afternoons with peak time of 1-5 p.m. EST. They were particularly common in spring and summer, and reached maximum frequency in November and December. There was an average of 14.3 events each year, but a significant decreasing trend in terms of hail frequency and associated magnitude in the recent years has been identified. In turn, spatial models also established three main distribution patterns over the study area, which include the Sydney Metropolitan, coastal and pronounced

  9. [Pain - a neglected neurological issue].

    PubMed

    Birklein, F; Baron, R; Gaul, C; Maihöfner, C; Rommel, O; Straube, A; Tölle, T; Wasner, G

    2016-06-01

    Chronic pain represents a great challenge; according to epidemiological data increasing numbers of patients should be expected. Based on recent advances, a better understanding of the pathophysiology of chronic pain has been achieved and neurologists have made a major contribution to this understanding. Chronic pain is accompanied by substantial maladaptive plastic alterations in both the peripheral and central nervous systems; therefore, neurological knowledge is of paramount importance for pain therapists but this contrasts with the current treatment situation of pain patients in Germany. There are basically too few departments and practices undertaking treatment, and neurologists are an exception in most pain centers. Furthermore, due to economic reasons neurological hospitals are currently experiencing a dearth of inpatients suffering from chronic pain. Diagnostic and/or treatment procedures for neurological pain entities (e.g. headaches or neuropathic pain) are insufficiently represented in the German diagnosis-related groups (DRG) reimbursement system and the obstacles for an efficient pain therapy in neurological practices are too high. Finally, there are too few academic positions for pain medicine in neurological hospitals; therefore, career opportunities for motivated young neurologists with an interest in pain are lacking. In order to address the unmet therapeutic needs of patients with chronic pain there is a high demand for (i) establishment of departments for neurological pain medicine, (ii) modification of the German DRG system and (iii) education of young neurologists with expertise in pain. Pain medicine in particular should be especially appealing to neurologists .

  10. [Pain - a neglected neurological issue].

    PubMed

    Birklein, F; Baron, R; Gaul, C; Maihöfner, C; Rommel, O; Straube, A; Tölle, T; Wasner, G

    2016-06-01

    Chronic pain represents a great challenge; according to epidemiological data increasing numbers of patients should be expected. Based on recent advances, a better understanding of the pathophysiology of chronic pain has been achieved and neurologists have made a major contribution to this understanding. Chronic pain is accompanied by substantial maladaptive plastic alterations in both the peripheral and central nervous systems; therefore, neurological knowledge is of paramount importance for pain therapists but this contrasts with the current treatment situation of pain patients in Germany. There are basically too few departments and practices undertaking treatment, and neurologists are an exception in most pain centers. Furthermore, due to economic reasons neurological hospitals are currently experiencing a dearth of inpatients suffering from chronic pain. Diagnostic and/or treatment procedures for neurological pain entities (e.g. headaches or neuropathic pain) are insufficiently represented in the German diagnosis-related groups (DRG) reimbursement system and the obstacles for an efficient pain therapy in neurological practices are too high. Finally, there are too few academic positions for pain medicine in neurological hospitals; therefore, career opportunities for motivated young neurologists with an interest in pain are lacking. In order to address the unmet therapeutic needs of patients with chronic pain there is a high demand for (i) establishment of departments for neurological pain medicine, (ii) modification of the German DRG system and (iii) education of young neurologists with expertise in pain. Pain medicine in particular should be especially appealing to neurologists . PMID:27167885

  11. Facial pain: trigeminal neuralgia.

    PubMed

    Lee, K H

    1993-03-01

    Atypical facial pain is a loose term used to encompass a wide range of facial pain syndromes including those of dental and ear, nose and throat (ENT) aetiology. Often, it is associated with psychiatric conditions like depression and psychosomatic illnesses. This facial pain typically does not follow anatomical boundaries or its explainable by present day neurophysiological understanding. The pain is often constant with no remission and is aggravated by stress. Treatment is difficult and often directed to the psychiatric cause. Surgical treatment is contraindicated. Trigeminal neuralgia on the other hand, can be effectively treated. Pain in the trigeminal distribution is paroxysmal, precipitated by trigger factors and there is no pain in between attacks. The aetiology of trigeminal neuralgia is still unknown though current thinking is that there is a peripheral disturbance or damage with cerebral brainstem disinhibition of the trigeminal apparatus. This results in a paroxysmal discharge and reverberation of pain impulses when a trigger point is elicited. Therefore, anti-epileptic drugs like tegretol can be effective in controlling trigeminal neuralgia in the majority of patients, at least in the initial stages. For unknown reasons however, medical treatment either is not effective at all from the very beginning or fails after a few years. Surgery then becomes the only available therapeutic option. If the peripheral disturbance is due to an organic cause like a tumour, surgical approaches should be directed towards its removal. Often the pain will also resolve. If the trigeminal neuralgia is of the idiopathic variety, then the surgeon has a choice of either peripheral percutaneous retrogasserian ganglionectomies or central approaches like microvascular decompression and trigeminal tractotomy. PMID:8363331

  12. Groin pain in athletes.

    PubMed

    Macintyre, Jim; Johson, Chris; Schroeder, Erik L

    2006-12-01

    Groin pain is a common and often frustrating problem in athletes who engage in sports involving kicking, rapid accelerations and decelerations, and sudden direction changes. The most common problems are adductor strain, osteitis pubis, and sports hernia. Other causes must be considered, including nerve pain, stress fractures, and intrinsic hip pathology. There is significant overlap and multiple problems frequently coexist. Accurate diagnosis leads to directed treatment, with rehabilitation focused on functional closed-chain strengthening and core stability. PMID:17067496

  13. Management of Foot Pain

    PubMed Central

    Godfrey, Charles M.

    1987-01-01

    This paper deals chiefly with the young adult foot, the older adult foot, and pain of mechanical origin. It does not discuss treatment by surgical methods, but rather by the use of exercises, foot supports and shoe corrections. Foot pain resulting from mechanical disorders can be treated effectively by determination of the biomechanical causative factors, usually by simple physical examination. Relief can often be gained with simple mechanical devices, provided at low cost. ImagesFigure 1Figure 2Figure 4 PMID:21263862

  14. Methadone for Pain Relief.

    PubMed

    Johnson, Joseph; Sheth, Samir

    2016-06-01

    Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. In reply to a question, the authors discuss the use of methadone for pain management, outline how the body processes methadone, list interactions and side effects, and emphasize the importance of taking the medication as prescribed. PMID:27159280

  15. Low Back Pain

    PubMed Central

    Reuler, James B.

    1985-01-01

    Low back pain is one of the most common and costly afflictions of our Society. The majority of adults will have at least one episode of acute low back pain that will likely resolve regardless of treatment. Lumbar spine radiographs are overused and there is little scientific support for many of the therapeutic interventions advocated. Even for those patients with symptomatic herniated disc, only a small fraction will ultimately require surgical intervention. PMID:2930949

  16. Discogenic low back pain.

    PubMed

    Simon, Jeremy; McAuliffe, Matthew; Shamim, Fehreen; Vuong, Nancy; Tahaei, Amir

    2014-05-01

    Most lumbar disk herniations improve over time with or without medical treatment. Disk herniations and annular tears may not be symptomatic and are shown to exist in patients without any symptoms. In some patients, chronic low back pain may result from the syndrome of internal disk disruption. Treatment of chronic pain of diskal cause can be challenging and have varying results in terms of success. The diagnosis, cause, and treatment options are reviewed in this article. PMID:24787335

  17. Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings

    PubMed Central

    Fillingim, Roger B.; King, Christopher D.; Ribeiro-Dasilva, Margarete C.; Rahim-Williams, Bridgett; Riley, Joseph L.

    2009-01-01

    Sex-related influences on pain and analgesia have become a topic of tremendous scientific and clinical interest, especially in the last 10 to 15 years. Members of our research group published reviews of this literature more than a decade ago, and the intervening time period has witnessed robust growth in research regarding sex, gender, and pain. Therefore, it seems timely to revisit this literature. Abundant evidence from recent epidemiologic studies clearly demonstrates that women are at substantially greater risk for many clinical pain conditions, and there is some suggestion that postoperative and procedural pain may be more severe among women than men. Consistent with our previous reviews, current human findings regarding sex differences in experimental pain indicate greater pain sensitivity among females compared with males for most pain modalities, including more recently implemented clinically relevant pain models such as temporal summation of pain and intramuscular injection of algesic substances. The evidence regarding sex differences in laboratory measures of endogenous pain modulation is mixed, as are findings from studies using functional brain imaging to ascertain sex differences in pain-related cerebral activation. Also inconsistent are findings regarding sex differences in responses to pharmacologic and non-pharmacologic pain treatments. The article concludes with a discussion of potential biopsychosocial mechanisms that may underlie sex differences in pain, and considerations for future research are discussed. Perspective This article reviews the recent literature regarding sex, gender, and pain. The growing body of evidence that has accumulated in the past 10 to 15 years continues to indicate substantial sex differences in clinical and experimental pain responses, and some evidence suggests that pain treatment responses may differ for women versus men. PMID:19411059

  18. [Chronic pain in geriatrics].

    PubMed

    Kennes, B

    2001-06-01

    Pain is frequent in communicative or no-communicative, ambulatory, institutionalized or hospitalized veterans. It is associated with severe comorbidity so much more than chronic pain could be neglected and expressed of atypical manner or masked by the absence of classical symptoms in particular in case of dementia or of sensory disorders. Pain detection by clinic examination or by pain assessment's methods and adequate approach by pharmacological and non pharmacological therapies are essential for correct pain management. On pharmacological plan, the strategy of the O.M.S. landings is applicable owing to a more particular attention to secondary effects and drugs interactions. AINS must be manipulated with prudence. There are no reasons to exclude opioides from the therapeutic arsenal but with a reduction of the starting doses, a regular adaptation and a very attentive survey. In drugs of landing 2, tramadol reveals itself as efficient and better tolerated as the codeine and dextropropoxyphene has to be to avoid. The obtaining of a satisfactory result depends on a regular assessment of the pain in a context of polydisciplinar approach (physicians, nurses, paramedicals, other care givers).

  19. Mechanisms of Myofascial Pain

    PubMed Central

    Jafri, M. Saleet

    2014-01-01

    Myofascial pain syndrome is an important health problem. It affects a majority of the general population, impairs mobility, causes pain, and reduces the overall sense of well-being. Underlying this syndrome is the existence of painful taut bands of muscle that contain discrete, hypersensitive foci called myofascial trigger points. In spite of the significant impact on public health, a clear mechanistic understanding of the disorder does not exist. This is likely due to the complex nature of the disorder which involves the integration of cellular signaling, excitation-contraction coupling, neuromuscular inputs, local circulation, and energy metabolism. The difficulties are further exacerbated by the lack of an animal model for myofascial pain to test mechanistic hypothesis. In this review, current theories for myofascial pain are presented and their relative strengths and weaknesses are discussed. Based on new findings linking mechanoactivation of reactive oxygen species signaling to destabilized calcium signaling, we put forth a novel mechanistic hypothesis for the initiation and maintenance of myofascial trigger points. It is hoped that this lays a new foundation for understanding myofascial pain syndrome and how current therapies work, and gives key insights that will lead to the improvement of therapies for its treatment. PMID:25574501

  20. An experimental study of shared sensitivity to physical pain and social rejection.

    PubMed

    Eisenberger, Naomi I; Jarcho, Johanna M; Lieberman, Matthew D; Naliboff, Bruce D

    2006-12-15

    Recent evidence points to a possible overlap in the neural systems underlying the distressing experience that accompanies physical pain and social rejection (Eisenberger et al., 2003). The present study tested two hypotheses that stem from this suggested overlap, namely: (1) that baseline sensitivity to physical pain will predict sensitivity to social rejection and (2) that experiences that heighten social distress will heighten sensitivity to physical pain as well. In the current study, participants' baseline cutaneous heat pain unpleasantness thresholds were assessed prior to the completion of a task that manipulated feelings of social distress. During this task, participants played a virtual ball-tossing game, allegedly with two other individuals, in which they were either continuously included (social inclusion condition) or they were left out of the game by either never being included or by being overtly excluded (social rejection conditions). At the end of the game, three pain stimuli were delivered and participants rated the unpleasantness of each. Results indicated that greater baseline sensitivity to pain (lower pain unpleasantness thresholds) was associated with greater self-reported social distress in response to the social rejection conditions. Additionally, for those in the social rejection conditions, greater reports of social distress were associated with greater reports of pain unpleasantness to the thermal stimuli delivered at the end of the game. These results provide additional support for the hypothesis that pain distress and social distress share neurocognitive substrates. Implications for clinical populations are discussed. PMID:16890354

  1. Chronic pain in rehabilitation medicine.

    PubMed

    Geertzen, J H B; Van Wilgen, C P; Schrier, E; Dijkstra, P U

    2006-03-30

    In this paper the chronicity of pain in non-specific pain syndromes is discussed. Experts in the study of pain with several professional backgrounds in rehabilitation are the authors of this paper. Clinical experience and literature form the basis of the paper. Non-specific low back pain and Complex Regional Pain Syndrome type I (CRPS-I) are discussed in the light of chronic pain. Many definitions of chronic pain exist. Yellow flags are important factors to identify possible chronic pain. In the acute phase of a non-specific pain complaint one should try to identify possible psychosocial inciting risk factors. Behavioural and cognitive treatment seems to be effective for chronic pain patients. PMID:16492632

  2. Nociceptor sensitization in pain pathogenesis

    PubMed Central

    Gold, Michael S; Gebhart, Gerald F

    2016-01-01

    The incidence of chronic pain is estimated to be 20–25% worldwide. Few patients with chronic pain obtain complete relief from the drugs that are currently available, and more than half report inadequate relief. Underlying the challenge of developing better drugs to manage chronic pain is incomplete understanding of the heterogeneity of mechanisms that contribute to the transition from acute tissue insult to chronic pain and to pain conditions for which the underlying pathology is not apparent. An intact central nervous system (CNS) is required for the conscious perception of pain, and changes in the CNS are clearly evident in chronic pain states. However, the blockage of nociceptive input into the CNS can effectively relieve or markedly attenuate discomfort and pain, revealing the importance of ongoing peripheral input to the maintenance of chronic pain. Accordingly, we focus here on nociceptors: their excitability, their heterogeneity and their role in initiating and maintaining pain. PMID:20948530

  3. Their pain is not our pain: brain and autonomic correlates of empathic resonance with the pain of same and different race individuals.

    PubMed

    Azevedo, Ruben T; Macaluso, Emiliano; Avenanti, Alessio; Santangelo, Valerio; Cazzato, Valentina; Aglioti, Salvatore Maria

    2013-12-01

    Recent advances in social neuroscience research have unveiled the neurophysiological correlates of race and intergroup processing. However, little is known about the neural mechanisms underlying intergroup empathy. Combining event-related fMRI with measurements of pupil dilation as an index of autonomic reactivity, we explored how race and group membership affect empathy-related responses. White and Black subjects were presented with video clips depicting white, black, and unfamiliar violet-skinned hands being either painfully penetrated by a syringe or being touched by a Q-tip. Both hemodynamic activity within areas known to be involved in the processing of first and third-person emotional experiences of pain, i.e., bilateral anterior insula, and autonomic reactivity were greater for the pain experienced by own-race compared to that of other-race and violet models. Interestingly, greater implicit racial bias predicted increased activity within the left anterior insula during the observation of own-race pain relative to other-race pain. Our findings highlight the close link between group-based segregation and empathic processing. Moreover, they demonstrate the relative influence of culturally acquired implicit attitudes and perceived similarity/familiarity with the target in shaping emotional responses to others' physical pain.

  4. Epigenetic regulation of persistent pain

    PubMed Central

    Bai, Guang; Ren, Ke; Dubner, Ronald

    2014-01-01

    Persistent or chronic pain is tightly associated with various environmental changes and linked to abnormal gene expression within cells processing nociceptive signaling. Epigenetic regulation governs gene expression in response to environmental cues. Recent animal model and clinical studies indicate that epigenetic regulation plays an important role in the development/maintenance of persistent pain and, possibly the transition of acute pain to chronic pain, thus shedding light in a direction for development of new therapeutics for persistent pain. PMID:24948399

  5. The effects of slow breathing on affective responses to pain stimuli: an experimental study.

    PubMed

    Zautra, Alex J; Fasman, Robert; Davis, Mary C; Craig, Arthur D Bud

    2010-04-01

    This study examined whether breathing rate affected self-reported pain and emotion following thermal pain stimuli in women with fibromyalgia syndrome (FM: n=27) or age-matched healthy control women (HC: n=25). FM and HC were exposed to low and moderate thermal pain pulses during paced breathing at their normal rate and one-half their normal rate. Thermal pain pulses were presented in four blocks of four trials. Each block included exposure to both mild and moderate pain trials, and periods of both normal and slow paced breathing. Pain intensity and unpleasantness were recorded immediately following each pain trial, and positive and negative affect were assessed at the end of each block of trials. Compared to normal breathing, slow breathing reduced ratings of pain intensity and unpleasantness, particularly for moderately versus mildly painful thermal stimuli. The effects of slow breathing on pain ratings were less reliable for FM patients than for HCs. Slow versus normal breathing decreased negative affect ratings following thermal pain pulses for both groups, and increased positive affect reports, but only for healthy controls with high trait negative affect. Participants who reported higher levels of trait positive affect prior to the experiment showed greater decreases in negative affect as a result of slow versus normal breathing. These experimental findings provide support for prior reports on the benefits of yogic breathing and mindful Zen meditation for pain and depressed affect. However, chronic pain patients may require more guidance to obtain therapeutic benefit from reduced breathing rates.

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

    PubMed

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

    2016-01-01

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

  7. Feasibility of collecting vulvar pain variability and its correlates using prospective collection with smartphones.

    PubMed

    Nguyen, Ruby H N; Turner, Rachael M; Sieling, Jared; Williams, David A; Hodges, James S; Harlow, Bernard L

    2014-01-01

    Context. Vulvar pain level may fluctuate in women with vulvodynia even in the absence of therapy; however, there is little evidence suggesting which factors may be associated with variability. Objective. Determine the feasibility of using smartphones to collect prospective data on vulvar pain and factors that may influence vulvar pain level. Methods. 24 clinically confirmed women were enrolled from a population-based study and asked to answer five questions using their smartphones each week for one month. Questions assessed vulvar pain level (0-10), presence of pain upon wakening, pain elsewhere in their body, treatment use, and intercourse. Results. Women completed 100% of their scheduled surveys, with acceptability measures highly endorsed. Vulvar pain ratings had a standard deviation within women of 1.6, with greater variation on average among those with higher average pain levels (P < 0.001). On the weeks when a woman reported waking with pain, her vulvar pain level was higher by 1.82 on average (P < 0.001). Overall, average vulvar pain level was not significantly associated with the frequency of reporting other body pains (P = 0.64). Conclusion. Our smartphone tracking system promoted excellent compliance with weekly tracking of factors that are otherwise difficult to recall, some of which were highly associated with vulvar pain level.

  8. Validation of the Wisconsin Brief Pain Questionnaire in a multilingual South African population.

    PubMed

    Mphahlele, Noko; Mitchell, Duncan; Kamerman, Peter

    2008-10-01

    Assessment of pain intensity and its effect on quality of life is important for proper management of pain, but no validated pain assessment tools that assess pain intensity and the interference pain has on daily life are available in indigenous South African languages. Therefore, the aim of this study was to validate translated versions of the Wisconsin Brief Pain Questionnaire (WBPQ) in South African HIV-positive patients. The WBPQ was translated into three indigenous South African languages, Setswana, isiZulu, and Xitsonga. We interviewed 452 ambulatory HIV-positive patients (327 urban and 125 rural patients) between the ages of 20 and 76 years old. Factor analysis to assess construct validity identified a two-factor structure (pain intensity and pain interference) for the isiZulu (n=132), Xitsonga (n=125), and Setswana (n=66) versions of the WBPQ, whereas a three-factor structure (pain intensity, mood interference, and activity interference) was identified for the English (completed by English second-language speakers, n=129) version of the WBPQ. Cronbach alphas, calculated to assess the reliability of the pain intensity and pain interference scales, were greater than 0.70 for all scales in all four versions of the WBPQ, showing internal consistency within the dimensions. These results provide evidence of validity for an easily administered questionnaire, which assesses pain intensity and pain interference, in three indigenous South African languages, and for English second-language speakers, in a population of South African HIV-positive patients.

  9. Fear of pain in children and adolescents with neuropathic pain and complex regional pain syndrome.

    PubMed

    Simons, Laura E

    2016-02-01

    A significant proportion of children and adolescents with chronic pain endorse elevated pain-related fear. Pain-related fear is associated with high levels of disability, depressive symptoms, and school impairment. Because of faulty nerve signaling, individuals with neuropathic pain and complex regional pain syndrome may be more prone to develop pain-related fear as they avoid use of and neglect the affected body area(s), resulting in exacerbated symptoms, muscle atrophy, maintenance of pain signaling, and ongoing pain-related disability. Not surprisingly, effective treatments for elevated pain-related fears involve exposure to previously avoided activities to downregulate incorrect pain signaling. In the context of intensive interdisciplinary pain treatment of youth with neuropathic pain, decreasing pain-related fear is associated with improved physical and psychological functioning, whereas high initial pain-related fear is a risk factor for less treatment responsiveness. An innovative approach to targeting pain-related fear and evidence of a neural response to treatment involving decoupling of the amygdala with key fear circuits in youth with complex regional pain syndrome suggest breakthroughs in our ability to ameliorate these issues.

  10. Laughter, Humor and Pain Perception in Children: A Pilot Study

    PubMed Central

    Hilber, Sherry Dunay; Mintzer, Lisa Libman; Castaneda, Marleen; Glover, Dorie; Zeltzer, Lonnie

    2009-01-01

    Although there are many clinical programs designed to bring humor into pediatric hospitals, there has been very little research with children or adolescents concerning the specific utility of humor for children undergoing stressful or painful procedures. Rx Laughter™, a non-profit organization interested in the use of humor for healing, collaborated with UCLA to collect preliminary data on a sample of 18 children aged 7–16 years. Participants watched humorous video-tapes before, during and after a standardized pain task that involved placing a hand in cold water. Pain appraisal (ratings of pain severity) and pain tolerance (submersion time) were recorded and examined in relation to humor indicators (number of laughs/smiles during each video and child ratings of how funny the video was). Whereas humor indicators were not significantly associated with pain appraisal or tolerance, the group demonstrated significantly greater pain tolerance while viewing funny videos than when viewing the videos immediately before or after the cold-water task. The results suggest that humorous distraction is useful to help children and adolescents tolerate painful procedures. Further study is indicated to explore the specific mechanism of this benefit. PMID:18955244

  11. Neck pain in children: a retrospective case series

    PubMed Central

    Cox, Jocelyn; Davidian, Christine; Mior, Silvano

    2016-01-01

    Introduction: Spinal pain in the paediatric population is a significant health issue, with an increasing prevalence as they age. Paediatric patients attend for chiropractor care for spinal pain, yet, there is a paucity of quality evidence to guide the practitioner with respect to appropriate care planning. Methods: A retrospective chart review was used to describe chiropractic management of paediatric neck pain. Two researchers abstracted data from 50 clinical files that met inclusion criteria from a general practice chiropractic office in the Greater Toronto Area, Canada. Data were entered into SPSS 15 and descriptively analyzed. Results: Fifty paediatric neck pain patient files were analysed. Patients’ age ranged between 6 and 18 years (mean 13 years). Most (98%) were diagnosed with Grade I–II mechanical neck pain. Treatment frequency averaged 5 visits over 19 days; with spinal manipulative therapy used in 96% of patients. Significant improvement was recorded in 96% of the files. No adverse events were documented. Conclusion: Paediatric mechanical neck pain appears to be successfully managed by chiropractic care. Spinal manipulative therapy appears to benefit paediatric mechanical neck pain resulting from day-today activities with no reported serious adverse events. Results can be used to inform clinical trials assessing effectiveness of manual therapy in managing paediatric mechanical neck pain. PMID:27713576

  12. Assessment of pain during head and neck irradiation

    SciTech Connect

    Weissman, D.E.; Janjan, N.; Byhardt, R.W.

    1989-06-01

    Radiation therapy for patients with head and neck malignancies frequently results in painful mucositis, which is usually poorly controlled with standard analgesics or topical anesthetics. To better understand the temporal development of radiation-induced pain and the effects of this pain on activities of daily living, 14 patients undergoing radiation therapy for a newly diagnosed head and neck malignancy completed daily pain diaries during the course of irradiation. All patients developed painful mucositis, usually beginning during the second or third week of radiation. Despite the use of analgesics/anesthetics, pain was rated as moderate or severe on 37% of treatment days and was noted to be constant or present throughout most of the day on 58% of treatment days. Eating and sleep disturbances related to pain occurred on 55% and 34% of treatment days, respectively. Eight patients had greater than a 2-kg weight loss. Radiation induces a predictable pattern of pain and comorbidity, which may be amenable to earlier and more aggressive analgesic treatment.

  13. Treatment of temporomandibular myofascial pain with deep dry needling

    PubMed Central

    Gonzalez-Perez, Luis M.; Granados-Nuñez, Mercedes; Urresti-Lopez, Francisco J.

    2012-01-01

    Objectives: The present study was designed to evaluate the usefulness of deep dry needling in the treatment of temporomandibular myofascial pain. Study Design: We selected 36 patients with myofascial pain located in the external pterygoid muscle (30 women/6 men, mean age=27 years with SD±6,5). We studied differences in pain with a visual analog scale and range of mandibular movements before and after intervention. Results: We found a statistically significant relationship (p<0,01) between therapeutic intervention and the improvement of pain and jaw movements, which continued up to 6 months after treatment. Pain reduction was greater the higher was the intensity of pain at baseline. Conclusions: Although further studies are needed, our findings suggest that deep dry needling in the trigger point in the external pterygoid muscle can be effective in the management of patients with myofascial pain located in that muscle. Key words:Temporomandibular joint, myofascial pain, external pterygoid muscle, trigger point, deep dry needling. PMID:22549679

  14. Effect of Preoperative Pain on Inferior Alveolar Nerve Block.

    PubMed

    Aggarwal, Vivek; Singla, Mamta; Subbiya, Arunajatesan; Vivekanandhan, Paramasivam; Sharma, Vikram; Sharma, Ritu; Prakash, Venkatachalam; Geethapriya, Nagarajan

    2015-01-01

    The present study tested the hypothesis that the amount and severity of preoperative pain will affect the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. One-hundred seventy-seven adult volunteer subjects, actively experiencing pain in a mandibular molar, participated in this prospective double-blind study carried out at 2 different centers. The patients were classified into 3 groups on the basis of severity of preoperative pain: mild, 1-54 mm on the Heft-Parker visual analog scale (HP VAS); moderate, 55-114 mm; and severe, greater than 114 mm. After IANB with 1.8 mL of 2% lidocaine, endodontic access preparation was initiated. Pain during treatment was recorded using the HP VAS. The primary outcome measure was the ability to undertake pulp access and canal instrumentation with no or mild pain. The success rates were statistically analyzed by multiple logistic regression test. There was a significant difference between the mild and severe preoperative pain group (P = .03). There was a positive correlation between the values of preoperative and intraoperative pain (r = .2 and .4 at 2 centers). The amount of preoperative pain can affect the anesthetic success rates of IANB in patients with symptomatic irreversible pulpitis. PMID:26650491

  15. Hazards for pain severity and pain interference with daily living, with exploration of brief pain inventory cutpoints, among women with metastatic breast cancer.

    PubMed

    Castel, Liana D; Abernethy, Amy P; Li, Yun; Depuy, Venita; Saville, Benjamin R; Hartmann, Katherine E

    2007-10-01

    Few longitudinal studies have assessed risk factors for pain outcomes in tumor-specific populations. Such studies are needed to improve clinical practice guidelines for cancer pain management over the course of treatment. Among patients with metastatic breast cancer, we assessed the impact of baseline clinical and demographic risk factors on patients reaching different pain severity and interference scores. We analyzed data originally collected in a clinical trial of two bisphosphonate therapies. Pain was measured by the Brief Pain Inventory (BPI) severity and interference with daily living 0-10 subscales. We fit univariate (per-cutpoint) and multivariate (cutpoints 3, 4, 5, 6, and 7 on the BPI) proportional hazards models to identify predictors of pain outcomes over 51 weeks among 1,124 women with metastatic breast cancer. Predictors included race, age, education, geographic region, performance status, chemotherapy versus hormonal therapy only, time from first bone metastasis to randomization, and previous skeletal-related event (SRE, e.g., fractures, spinal cord compression). Non-Caucasian women had greater hazards for reaching higher cutpoints (5 and above) on the severity scale than Caucasian women (hazard ratio [HR] for cutpoint 5 interaction term=1.76; 95% confidence interval [CI]=1.37-2.26). For the interference scale, these hazards were greater for those patients with restricted (versus active) baseline Eastern Cooperative Oncology Group (ECOG) performance status (HR for cutpoint 5 interaction term=2.51; 95% CI=2.01-3.13). In the multivariate severity model, other factors associated with higher pain severity were restricted baseline ECOG performance status, previous SRE, and not being employed full-time at baseline (HRs=1.70, 1.23, and 1.33, respectively). Our findings that non-Caucasian race and restricted performance status were associated with greater pain hazards over time confirm previous cross-sectional findings that these characteristics are pain

  16. Pain as social glue: shared pain increases cooperation.

    PubMed

    Bastian, Brock; Jetten, Jolanda; Ferris, Laura J

    2014-11-01

    Even though painful experiences are employed within social rituals across the world, little is known about the social effects of pain. We examined the possibility that painful experiences can promote cooperation within social groups. In Experiments 1 and 2, we induced pain by asking some participants to insert their hands in ice water and to perform leg squats. In Experiment 3, we induced pain by asking some participants to eat a hot chili pepper. Participants performed these tasks in small groups. We found evidence for a causal link: Sharing painful experiences with other people, compared with a no-pain control treatment, promoted trusting interpersonal relationships by increasing perceived bonding among strangers (Experiment 1) and increased cooperation in an economic game (Experiments 2 and 3). Our findings shed light on the social effects of pain, demonstrating that shared pain may be an important trigger for group formation. PMID:25193943

  17. 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.

  18. Association Between Smoking and Back Pain in a Cross-Section of Adult Americans

    PubMed Central

    Johnson, Claire D; Snodgrass, Jeff; Smith, Monica; Dunn, Andrew S

    2016-01-01

    Purpose: Back pain is the leading cause of global years lived with disability. This cross-sectional study assessed if a greater exposure to smoking cigarettes was associated with a greater prevalence of back pain. Methods: This study examined data from 34,525 United States adults from the 2012 National Health Interview Survey. Analyses assessed the difference in back pain prevalence among current smokers, former smokers, and never smokers and the number of cigarettes smoked between current smokers with and without back pain. Results: Back pain prevalence was 28%. There was a significant association between back pain and smoking, X2 (2, 599, n = 34, 241) = 546.3, p < .001. Back pain increased with increased smoking exposure; back pain was present in 23.5% of never-smokers, 33.1% of former smokers, and 36.9% of current smokers. The number of cigarettes smoked per day for current daily smokers was higher for those with back pain (Md = 13) than those without back pain (Md = 10), U = 2701065, z = -3.70, p < .001, r = .05. Conclusions: Our findings suggest that there may be a biological gradient associated with exposure to smoking cigarettes and back pain in adult Americans. PMID:27790393

  19. [The groin pain syndrome].

    PubMed

    Janković, S; Delimar, D; Hudetz, D

    2001-12-01

    Groin pain is defined as tendon enthesitis of adductor longus muscle and/or abdominal muscles that may lead to degenerative arthropathy of pubic symphises in an advanced stage. Pubic region is a point where kinematic forces cross. The balance between the adductor and abdominal muscles is of great importance, as well as the elasticity of pubic symphises which enables movement of up to 2 mm and rotation of up to 3 degrees. The weakness of the abdominal muscle wall, known as the sportsman's hernia, is the most common cause of painful groin. Groin pain is the most common in soccer players (6.24% in Croatia). Most authors believe that the main cause of groin pain is the adductor muscle overload. When active, sportsmen start to feel a dull pain in the groin region. The adductor test is of great importance for physical examination; the patient should be lying supine with his hips abducted and flexed at 80 degrees. The test is positive if the patient, while attempting to pull his/her legs against pressing in the opposite direction, feels a sharp pain in the groins. The treatment of groin pain is complex and individual, as its causes may vary from patient to patient. Gradual physical therapy combined with pharmacotherapy should be effective in most cases. The latter includes nonsteroid anti-inflammatory drugs and muscle relaxants. A physical therapy programme usually involves stretching and strengthening of adductor muscles, abdominal wall muscles, iliopsoas muscle, quadriceps, and hamstrings. In case that physical therapy and pharmacotherapy fail, surgery is needed, depending on the cause. PMID:11831125

  20. [The groin pain syndrome].

    PubMed

    Janković, S; Delimar, D; Hudetz, D

    2001-12-01

    Groin pain is defined as tendon enthesitis of adductor longus muscle and/or abdominal muscles that may lead to degenerative arthropathy of pubic symphises in an advanced stage. Pubic region is a point where kinematic forces cross. The balance between the adductor and abdominal muscles is of great importance, as well as the elasticity of pubic symphises which enables movement of up to 2 mm and rotation of up to 3 degrees. The weakness of the abdominal muscle wall, known as the sportsman's hernia, is the most common cause of painful groin. Groin pain is the most common in soccer players (6.24% in Croatia). Most authors believe that the main cause of groin pain is the adductor muscle overload. When active, sportsmen start to feel a dull pain in the groin region. The adductor test is of great importance for physical examination; the patient should be lying supine with his hips abducted and flexed at 80 degrees. The test is positive if the patient, while attempting to pull his/her legs against pressing in the opposite direction, feels a sharp pain in the groins. The treatment of groin pain is complex and individual, as its causes may vary from patient to patient. Gradual physical therapy combined with pharmacotherapy should be effective in most cases. The latter includes nonsteroid anti-inflammatory drugs and muscle relaxants. A physical therapy programme usually involves stretching and strengthening of adductor muscles, abdominal wall muscles, iliopsoas muscle, quadriceps, and hamstrings. In case that physical therapy and pharmacotherapy fail, surgery is needed, depending on the cause.

  1. Effectiveness of core muscle strengthening for improving pain and dynamic balance among female patients with patellofemoral pain syndrome.

    PubMed

    Chevidikunnan, Mohamed Faisal; Al Saif, Amer; Gaowgzeh, Riziq Allah; Mamdouh, Khaled A

    2016-05-01

    [Purpose] Patellofemoral pain syndrome is a frequent musculoskeletal disorder, which can result from core muscles instability that can lead to pain and altered dynamic balance. The objective of this study is to assess the effect of core muscle strengthening on pain and dynamic balance in female patients with patellofemoral pain syndrome. [Subjects and Methods] Twenty female patients with age ranging from 16 to 40 years with patellofemoral pain syndrome were divided into study (N=10) and control (N=10) groups. Both groups were given 4 weeks of conventional physical therapy program and an additional core muscle strengthening for the study group. The tools used to assess the outcome were Visual Analogue Scale and Star Excursion Balance Test. [Results] The results of the study show that participants in the study group revealed a significantly greater improvement in the intensity of pain and dynamic balance as compared to the control group. [Conclusion] Adding a core muscle-strengthening program to the conventional physical therapy management improves pain and dynamic balance in female patients with patellofemoral pain syndrome. PMID:27313363

  2. Effectiveness of core muscle strengthening for improving pain and dynamic balance among female patients with patellofemoral pain syndrome

    PubMed Central

    Chevidikunnan, Mohamed Faisal; Al Saif, Amer; Gaowgzeh, Riziq Allah; Mamdouh, Khaled A

    2016-01-01

    [Purpose] Patellofemoral pain syndrome is a frequent musculoskeletal disorder, which can result from core muscles instability that can lead to pain and altered dynamic balance. The objective of this study is to assess the effect of core muscle strengthening on pain and dynamic balance in female patients with patellofemoral pain syndrome. [Subjects and Methods] Twenty female patients with age ranging from 16 to 40 years with patellofemoral pain syndrome were divided into study (N=10) and control (N=10) groups. Both groups were given 4 weeks of conventional physical therapy program and an additional core muscle strengthening for the study group. The tools used to assess the outcome were Visual Analogue Scale and Star Excursion Balance Test. [Results] The results of the study show that participants in the study group revealed a significantly greater improvement in the intensity of pain and dynamic balance as compared to the control group. [Conclusion] Adding a core muscle-strengthening program to the conventional physical therapy management improves pain and dynamic balance in female patients with patellofemoral pain syndrome. PMID:27313363

  3. A novel model of combined neuropathic and inflammatory pain displaying long-lasting allodynia and spontaneous pain-like behaviour.

    PubMed

    Allchorne, Andrew J; Gooding, Hayley L; Mitchell, Rory; Fleetwood-Walker, Sue M

    2012-12-01

    Many clinical cases of chronic pain exhibit both neuropathic and inflammatory components. In contrast, most animal models of chronic pain focus on one type of injury alone. Here we present a novel combined model of both neuropathic and inflammatory pain and characterise its distinctive properties. This combined model of chronic constriction injury (CCI) and intraplantar Complete Freund's Adjuvant (CFA) injection results in enhanced mechanical allodynia, thermal hyperalgesia, a static weight bearing deficit, and notably pronounced spontaneous foot lifting (SFL) behaviour (which under our conditions was not seen in either individual model and may reflect ongoing/spontaneous pain). Dorsal root ganglion (DRG) expression of Activating Transcription Factor-3 (ATF-3), a marker of axonal injury, was no greater in the combined model than CCI alone. Initial pharmacological characterisation of the new model showed that the SFL was reversed by gabapentin or diclofenac, typical analgesics for neuropathic or inflammatory pain respectively, but not by mexiletine, a Na(+) channel blocker effective in both neuropathic and inflammatory pain models. Static weight bearing deficit was moderately reduced by gabapentin, whereas only diclofenac reversed mechanical allodynia. This novel animal model of chronic pain may prove a useful test-bed for further analysing the pharmacological susceptibility of complicated clinical pain states. PMID:23131427

  4. Sex Differences in the Incidence of Severe Pain Events Following Surgery: A Review of 333,000 Pain Scores

    PubMed Central

    Tighe, Patrick J.; Riley, Joseph L.; Fillingim, Roger B.

    2015-01-01

    Objective/Background Prior work has not addressed sex differences in the incidence of severe postoperative pain episodes. The goal of this study was to examine sex differences in clinical postoperative pain scores across an array of surgical procedures using direct comparisons of numeric rating scale pain scores as well as using the incidence of severe pain events (SPEs). Design/Setting Retrospective cohort study of over 300,000 clinical pain score observations recorded from adult patients undergoing nonambulatory surgery at a tertiary care academic medical center over a 1-year period. Methods/Patients To test the hypothesis that the number of SPE on postoperative day (POD) 1 differed by sex after controlling for procedure, we calculated Cochran–Mantel–Haenszel statistics of sex by count of SPE, controlling for type of surgery. Assessment Tools/Outcomes Pain scores were collected from clinical nursing records where they were documented using the numeric rating scale. Results In female patients, 10,989 (25.09%) of 43,806 POD 1 pain scores were considered SPE compared with 10,786 (22.45%) of 48,055 POD 1 pain scores in male patients. This produced an overall odds ratio of 1.16 (99% confidence interval 1.11–1.20) for females vs males to report an SPE for a pain score on POD 1. Estimates of the odds that a given pain observation represents an SPE for female vs male patients after controlling for type of surgery yielded an odds ratio of 1.14 (99% confidence interval, 1.10–1.19). Conclusion Female patients experience greater mean pain scores, as well as a higher incidence of SPE, on POD 1 for a variety of surgical procedures. PMID:25039440

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

    SciTech Connect

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

    2008-09-01

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

  6. Ocular neuropathic pain

    PubMed Central

    Rosenthal, Perry; Borsook, David

    2016-01-01

    As the biological alarm of impending or actual tissue damage, pain is essential for our survival. However, when it is initiated and/or sustained by dysfunctional elements in the nociceptive system, it is itself a disease known as neuropathic pain. While the critical nociceptive system provides a number of protective functions, it is unique in its central role of monitoring, preserving and restoring the optical tear film in the face of evaporative attrition without which our vision would be non-functional. Meeting this existential need resulted in the evolution of the highly complex, powerful and sensitive dry eye alarm system integrated in the peripheral and central trigeminal sensory network. The clinical consequences of corneal damage to these nociceptive pathways are determined by the type and location of its pathological elements and can range from the spectrum known as dry eye disease to the centalised oculofacial neuropathic pain syndrome characterised by a striking disparity between the high intensity of symptoms and paucity of external signs. These changes parallel those observed in somatic neuropathic pain. When seen through the neuroscience lens, diseases responsible for inadequately explained chronic eye pain (including those described as dry eye) can take on new meanings that may clarify long-standing enigmas and point to new approaches for developing preventive, symptomatic and disease-modifying interventions for these currently refractory disorders. PMID:25943558

  7. Neuropathic pain in children.

    PubMed

    Howard, Richard F; Wiener, Suzanne; Walker, Suellen M

    2014-01-01

    Neuropathic pain (NP), due to a lesion or disease of the somatosensory nervous system, is not well documented or researched in children. NP is a clinical diagnosis that can be difficult, especially in younger children. Nevertheless, it is important to recognise NP, as pain mechanisms and consequently management and prognosis differ from other types of long-term pain. NP is common in adult pain clinics but many of the underlying disease states in which it occurs are infrequently or never encountered in paediatric practice. However, NP in childhood has been reported, even in the very young in certain clinical situations. Causes of NP include traumatic injury, complex regional pain syndrome type II, cancer and chemotherapy, chronic infection, neurological and metabolic disease, and inherited sensory nerve dysfunction. The clinical and laboratory study of traumatic peripheral nerve injury has revealed important age-related differences in clinical presentation and prognosis. It is clear that mechanisms operating during development can profoundly modify the consequences of nerve damage and NP. Clinically, diagnosis, assessment and treatment of NP are based on methods and evidence derived from data in adults. Improvements in the understanding and management of NP are likely to come from developmentally appropriate improvements in the clarity and consistency of diagnosis and systematic, well-researched approaches to treatment.

  8. Painful Lumbosacral Plexopathy

    PubMed Central

    Ehler, Edvard; Vyšata, Oldřich; Včelák, Radek; Pazdera, Ladislav

    2015-01-01

    Abstract Patients frequently suffer from lumbosacral plexus disorder. When conducting a neurological examination, it is essential to assess the extent of muscle paresis, sensory disorder distribution, pain occurrence, and blocked spine. An electromyography (EMG) can confirm axonal lesions and their severity and extent, root affliction (including dorsal branches), and disorders of motor and sensory fiber conduction. Imaging examination, particularly gadolinium magnetic resonance imaging (MRI) examination, ensues. Cerebrospinal fluid examination is of diagnostic importance with radiculopathy, neuroinfections, and for evidence of immunoglobulin synthesis. Differential diagnostics of lumbosacral plexopathy (LSP) include metabolic, oncological, inflammatory, ischemic, and autoimmune disorders. In the presented case study, a 64-year-old man developed an acute onset of painful LSP with a specific EMG finding, MRI showing evidence of plexus affliction but not in the proximal part of the roots. Painful plexopathy presented itself with severe muscle paresis in the femoral nerve and the obturator nerve innervation areas, and gradual remission occurred after 3 months. Autoimmune origin of painful LSP is presumed. We describe a rare case of patient with painful lumbar plexopathy, with EMG findings of axonal type, we suppose of autoimmune etiology. PMID:25929915

  9. 15. Amygdala pain mechanisms

    PubMed Central

    Neugebauer, Volker

    2015-01-01

    A limbic brain area the amygdala plays a key role in emotional responses and affective states and disorders such as learned fear, anxiety and depression. The amygdala has also emerged as an important brain center for the emotional-affective dimension of pain and for pain modulation. Hyperactivity in the laterocapsular division of the central nucleus of the amygdala (CeLC, also termed the “nociceptive amygdala”) accounts for pain-related emotional responses and anxiety-like behavior. Abnormally enhanced output from the CeLC is the consequence of an imbalance between excitatory and inhibitory mechanisms. Impaired inhibitory control mediated by a cluster of GABAergic interneurons in the intercalated cell masses (ITC) allows the development of glutamate- and neuropeptide-driven synaptic plasticity of excitatory inputs from the brainstem (parabrachial area) and from the lateral-basolateral amygdala network (LA-BLA, site of integration of polymodal sensory information). BLA hyperactivity also generates abnormally enhanced feedforward inhibition of principal cells in the medial prefrontal cortex (mPFC), a limbic cortical area that is strongly interconnected with the amygdala. Pain-related mPFC deactivation results in cognitive deficits and failure to engage cortically driven ITC-mediated inhibitory control of amygdala processing. Impaired cortical control allows the uncontrolled persistence of amygdala pain mechanisms. PMID:25846623

  10. Comfort over Pain in Pregnancy.

    PubMed

    Charles, Niamh A; Yount, Susan; Morgan, Anne

    2016-06-01

    Pregnancy is often a time when chronic pain is exacerbated, or when acute pain appears. Frequently the easiest intervention within reach, for both chronic and acute pain, is a prescription. However, medication cannot correct the cause of the pain; instead it alters the person's experiential perception of the pain. In addition, medication exposes both mother and fetus to risks. To provide simple, evidence-based, holistic/alternative remedies for women who experienced nonemergent pain during pregnancy. Holistic/alternative techniques for increasing comfort were taught to the participants and individualized during three sessions. Levels of pain and comfort were measured before and after the treatment, using the validated General Comfort Questionnaire and Pain Outcomes Profile. Pain scores decreased from an average of 5.8/10 to 3.5/10 (p = .00). Comfort scores increased from an average of 17.5 to 30 (p = .00). PMID:27105573

  11. Prilocaine reduces injection pain caused by propofol.

    PubMed

    Eriksson, M

    1995-02-01

    Propofol, which is commonly used for outpatient anaesthesia, may evoke pain during infusion. Forty-eight patients (ASA-I-II) undergoing elective uterine dilatation and curettage received randomly in a standardised fashion: A: Propofol mixed with prilocaine; B: Propofol and lidocaine; C: Propofol with prilocaine+lidocaine (equal amounts) or D: Propofol and saline. The final ratio of propofol:local anaesthetic/saline was 9:1 in all mixtures. Pain on injection was significantly decreased in the three groups receiving propofol and local anaesthetic(s) compared to the one given propofol and saline. Propofol is required in greater amounts when mixed with lidocaine than when mixed with saline. A binding between the algesic part of the propofol molecule and the local anaesthetic agent may explain these findings. Another twenty-two comparable patients were given 30 mg of ketorolac or an equal volume of saline intramuscularly 45-60 minutes prior to propofol. Ketorolac given before propofol did not reduce pain on injection. This indicates that inhibition of the cyclooxygenase pathway of arachidonic acid metabolism does not play a major role in the reduction of this pain.

  12. Positive Traits Linked to Less Pain through Lower Pain Catastrophizing

    PubMed Central

    Hood, Anna; Pulvers, Kim; Carrillo, Janet; Merchant, Gina; Thomas, Marie

    2011-01-01

    The present study examined the association between positive traits, pain catastrophizing, and pain perceptions. We hypothesized that pain catastrophizing would mediate the relationship between positive traits and pain. First, participants (n = 114) completed the Trait Hope Scale, the Life Orientation Test- Revised, and the Pain Catastrophizing Scale. Participants then completed the experimental pain stimulus, a cold pressor task, by submerging their hand in a circulating water bath (0º Celsius) for as long as tolerable. Immediately following the task, participants completed the Short-Form McGill Pain Questionnaire (MPQ-SF). Pearson correlation found associations between hope and pain catastrophizing (r = −.41, p < .01) and MPQ-SF scores (r = −.20, p < .05). Optimism was significantly associated with pain catastrophizing (r = −.44, p < .01) and MPQ-SF scores (r = −.19, p < .05). Bootstrapping, a non-parametric resampling procedure, tested for mediation and supported our hypothesis that pain catastrophizing mediated the relationship between positive traits and MPQ-SF pain report. To our knowledge, this investigation is the first to establish that the protective link between positive traits and experimental pain operates through lower pain catastrophizing. PMID:22199416

  13. SPORT Lumbar Intervertebral Disk Herniation and Back Pain

    PubMed Central

    Pearson, Adam M.; Blood, Emily A.; Frymoyer, John W.; Herkowitz, Harry; Abdu, William A.; Woodward, Randy; Longley, Michael; Emery, Sanford E.; Lurie, Jon D.; Tosteson, Tor D.; Weinstein, James N.

    2009-01-01

    Study Design Diskectomy candidates with at least 6 weeks of sciatica and confirmatory imaging were enrolled in a randomized or observational cohort. Objective This study sought to determine: (1) whether diskectomy resulted in greater improvement in back pain than nonoperative treatment, and (2) whether herniation location and morphology affected back pain outcomes. Summary of Background Data Previous studies have reported that lumbar diskectomy is less successful for relief of back pain than leg pain and patients with central disc herniations or protrusions have worse outcomes. Methods Patients underwent diskectomy or received “usual” nonoperative care. Data from the randomized cohort and observational cohort were combined in an as-treated analysis. Low back pain was recorded on a 0 to 6 point scale, and changes in low back pain were compared between the surgical and nonoperative treatment groups. The effects of herniation location and morphology on back pain outcomes were determined. Results The combined analysis included 1191 patients with 775 undergoing surgery within 2 years, whereas 416 remained nonoperative. Overall, leg pain improved more than back pain in both treatment groups. Back pain improved in both surgical and nonoperative patients, but surgical patients improved significantly more (treatment effect favoring surgery -0.9 at 3 months, -0.5 at 2 years, P < 0.001). Patients who underwent surgery were more likely to report no back pain than nonoperative patients at each follow-up period (28.0% vs. 12.0% at 3 months, P < 0.001, 25.5% vs. 17.6% at 2 years, P = 0.009). At baseline, central herniations were associated with more severe back pain than more lateral herniations (4.3 vs. 3.9, P = 0.012). Patients with central herniations and protrusions had a beneficial treatment effect from surgery similar to the overall surgical group. Conclusion Diskectomy resulted in greater improvement in back pain than nonoperative treatment, and this difference was

  14. Dynamic sonography of snapping hip due to gluteus maximus subluxation over greater trochanter.

    PubMed

    Chang, Connie Y; Kreher, Jeffrey; Torriani, Martin

    2016-03-01

    We report on the dynamic sonographic findings of a 10-year-old avid female dancer who presented with symptoms of abrupt left hip motion and associated painful snapping sensation while performing lateral motions of the pelvis suggesting external snapping hip syndrome. Dynamic sonographic evaluation of both hips demonstrated that symptoms were due to gluteus maximus subluxation over the greater trochanter. This etiology of external snapping hip syndrome is rare with limited imaging descriptions in the literature. We present case history, physical examination, and dynamic ultrasound examination, including multiple still images and cine clips, comprehensively characterizing this uncommon source of external snapping hip syndrome. PMID:26490678

  15. Identifying important outcome domains for chronic pain clinical trials: an IMMPACT survey of people with pain.

    PubMed

    Turk, Dennis C; Dworkin, Robert H; Revicki, Dennis; Harding, Gale; Burke, Laurie B; Cella, David; Cleeland, Charles S; Cowan, Penney; Farrar, John T; Hertz, Sharon; Max, Mitchell B; Rappaport, Bob A

    2008-07-15

    This two-phase study was conducted to identify relevant domains of patient-reported outcomes from the perspective of people who experience chronic pain. In Phase 1, focus groups were conducted to generate a pool of patient outcome-related domains and their components. The results of the focus groups identified 19 aspects of their lives that were significantly impacted by the presence of their symptoms and for which improvements were important criteria they would use in evaluating the effectiveness of any treatment. Phase 2 was conducted to examine the importance and relevance of domains identified from a much larger and diverse sample of people with chronic pain. A survey was developed and posted on the American Chronic Pain Association website. Participants were asked to rate the importance of each item or domain identified by the focus groups on a scale of 0 to10 (i.e., 0="not at all important" and 10="extremely important"). The survey was completed by 959 individuals. The results indicate that all 19 aspects of daily life derived from the focus groups were considered important with a majority of respondents indicating a score of 8 or greater. In addition to pain reduction, the most important aspects were enjoyment of life, emotional well-being, fatigue, weakness, and sleep-related problems. Chronic pain clearly impacts health-related quality of life. The results of the two phases of the study indicate that people with chronic pain consider functioning and well-being as important areas affected by the presence of symptoms and as appropriate targets of treatment. These multiple outcomes should be considered when evaluating the efficacy and effectiveness of chronic pain treatments.

  16. [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.

  17. [Leading symptom shoulder pain].

    PubMed

    Wittke, R

    2003-09-25

    Pain in the shoulder should prompt a systematic clinical examination that adheres closely to the functional anatomy. The basic examination of the shoulder joint comprises active and passive movements and isometric resistance tests with the aid of which external and internal rotation and abduction/adduction can be investigated. The results of these tests provide the physician with a "pattern of findings" which unequivocally identifies the pain-triggering structure. Accordingly, shoulder pain can be classified into four categories as proposed by Cyriax. As treatment, intra-articular injections of corticoids or local anesthetics as determined by findings, where necessary supported by physiotherapeutic measures. Rupture of a tendon, in particular in the case of an active patient, is an indication for surgery.

  18. Loin pain hematuria syndrome

    PubMed Central

    Zubair, Adeel S.; Salameh, Hassan; Erickson, Stephen B.; Prieto, Mikel

    2016-01-01

    Loin pain hematuria syndrome (LPHS), first described in 1967, is a rare pain syndrome, which is not well understood. The syndrome is characterized by severe intermittent or persistent flank pain, either unilateral or bilateral, associated with gross or microscopic hematuria. LPHS is a diagnosis of exclusion as there still is not a consensus of validated diagnostic criteria, though several criteria have been proposed. The wide differential diagnosis would suggest a meticulous yet specific diagnostic work-up depending on the individual clinical features and natural history. Several mechanisms regarding the pathophysiology of LPHS have been proposed but without pinpointing the actual causative etiology, the treatment remains symptomatic. Treatment modalities for LPHS are diverse including simple analgesia, opioid analgesic and kidney autotransplantation. This review article summarizes the current understanding regarding the pathophysiology of LPHS along with the steps required for proper diagnosis and a discussion of the different therapeutic approaches for LPHS. PMID:26798473

  19. Fainting After Chest Pain

    PubMed Central

    Wang, Ko-Fan; Chang, Chun-Chin; Hsu, Chien-Yi; Lee, Ching-Wei; Lin, Chung-Hsing; Chiang, Chern-En

    2015-01-01

    Variant angina presenting acute chest pain and ST elevation on electrocardiogram accounts for an underdiagnosed scenario in acute coronary syndrome and contributes to syncope as a consequence of ventricular arrhythmia. Here, we report a case of a 48-year-old man with a recent onset of chest pain and palpitations followed by syncope. Holter monitoring documented 2 episodes of evolving ST elevation associated with non-sustained ventricular tachycardia. Emergent cardiac catheterization indicated insignificant coronary narrowing. A non-invasive brachial artery ultrasound, which demonstrated endothelial dysfunction that was salvaged by exogenic nitrate, was used instead of intracoronary provocation. There was no clinical or electrocardiographic recurrence of variant angina after vasodilator treatment. In conclusion, variant angina represents an important but overlooked etiology for syncope. Holter monitoring facilitates the diagnostic and prognostic assessment in patients with syncope precipitated by chest pain. PMID:27122877

  20. Hypnosis and pain management.

    PubMed

    Sharma, Suresh K; Kaur, Jasbir

    2006-06-01

    Nurses have used complementary therapies for many years to relieve anxiety, promote comfort, and reduce or alleviate pain. Physical therapies are most commonly used in our scenario but behavioral approach had been less customary, since familiarity of health personnel is very less (36%) with these techniques (Zaza et al, 1999). Hypnosis is empirically proved best therapy for pain management. Hypnosis is a process involving a hypnotist and a subject who agrees to be hypnotized. Being hypnotized is usually characterized by intense concentration, extreme relaxation and high suggestibility. This paper initially address hypnosis from an historical perspective to give the reader a decent background in which to view current trends in research in the field. Then will explain how hypnosis work followed by the empirical evidences and problems encountered in use of hypnosis when used for pain management. PMID:17058581

  1. Loin pain hematuria syndrome.

    PubMed

    Zubair, Adeel S; Salameh, Hassan; Erickson, Stephen B; Prieto, Mikel

    2016-02-01

    Loin pain hematuria syndrome (LPHS), first described in 1967, is a rare pain syndrome, which is not well understood. The syndrome is characterized by severe intermittent or persistent flank pain, either unilateral or bilateral, associated with gross or microscopic hematuria. LPHS is a diagnosis of exclusion as there still is not a consensus of validated diagnostic criteria, though several criteria have been proposed. The wide differential diagnosis would suggest a meticulous yet specific diagnostic work-up depending on the individual clinical features and natural history. Several mechanisms regarding the pathophysiology of LPHS have been proposed but without pinpointing the actual causative etiology, the treatment remains symptomatic. Treatment modalities for LPHS are diverse including simple analgesia, opioid analgesic and kidney autotransplantation. This review article summarizes the current understanding regarding the pathophysiology of LPHS along with the steps required for proper diagnosis and a discussion of the different therapeutic approaches for LPHS. PMID:26798473

  2. The Self in Pain

    PubMed Central

    Morley, Stephen

    2010-01-01

    The self is not a unitary concept but has different facets, encompassing potentially contradictory states, intentions or desires. The ensuing contradictory facets of the self lead to internal discrepancies which can have both motivational and emotional consequences. Self-Discrepancy Theory (SDT) explains emotional consequences by considering discrepancies between the actual, ideal or ought self. Depression can be part predicted by considering the extent an individual regards their self as enmeshed with their pain. Individuals who place a high value on independence or social interaction are more likely to experience a high anxious state in the presence of the “mere threat” of pain enmeshment. Consequently pain can rapidly come to infiltrate and affect a person's sense of self. PMID:26527455

  3. Resilience does not explain the dissociation between chronic pain and physical activity in South Africans living with HIV

    PubMed Central

    Mitchell, Duncan

    2016-01-01

    Pain burden is high in people living with HIV (PLWH), but the effect of this pain on functionality is equivocal. Resilience, the ability to cope with adversity, may promote adaptation to pain, so we hypothesised that higher resilience would correlate with less pain-related impairment of activity. We recruited 197 black South African PLWH, 99 with chronic pain (CP) and 98 patients without. We measured pain intensity and interference using the Brief Pain Inventory, and resilience using the Resilience Scale. Participants were generally highly resilient. Greater resilience correlated with better health-related quality of life, but not with pain intensity or interference. We also measured physical activity objectively, by actigraphy, in a subset of patients (37 with chronic pain and 31 without chronic pain), who wore accelerometers for two weeks. There was no difference in duration or intensity of activity between those with and without pain, and activity was not associated with resilience. In this sample, pain was not associated with altered physical activity. Resilience did not explain differences in pain intensity or pain interference but was associated with improved quality of life. Financial stresses and the fear of HIV stigma may have driven patients to conceal pain and to suppress its expected impairment of activity. PMID:27672513

  4. Resilience does not explain the dissociation between chronic pain and physical activity in South Africans living with HIV

    PubMed Central

    Mitchell, Duncan

    2016-01-01

    Pain burden is high in people living with HIV (PLWH), but the effect of this pain on functionality is equivocal. Resilience, the ability to cope with adversity, may promote adaptation to pain, so we hypothesised that higher resilience would correlate with less pain-related impairment of activity. We recruited 197 black South African PLWH, 99 with chronic pain (CP) and 98 patients without. We measured pain intensity and interference using the Brief Pain Inventory, and resilience using the Resilience Scale. Participants were generally highly resilient. Greater resilience correlated with better health-related quality of life, but not with pain intensity or interference. We also measured physical activity objectively, by actigraphy, in a subset of patients (37 with chronic pain and 31 without chronic pain), who wore accelerometers for two weeks. There was no difference in duration or intensity of activity between those with and without pain, and activity was not associated with resilience. In this sample, pain was not associated with altered physical activity. Resilience did not explain differences in pain intensity or pain interference but was associated with improved quality of life. Financial stresses and the fear of HIV stigma may have driven patients to conceal pain and to suppress its expected impairment of activity.

  5. Resilience does not explain the dissociation between chronic pain and physical activity in South Africans living with HIV.

    PubMed

    Wadley, Antonia L; Mitchell, Duncan; Kamerman, Peter R

    2016-01-01

    Pain burden is high in people living with HIV (PLWH), but the effect of this pain on functionality is equivocal. Resilience, the ability to cope with adversity, may promote adaptation to pain, so we hypothesised that higher resilience would correlate with less pain-related impairment of activity. We recruited 197 black South African PLWH, 99 with chronic pain (CP) and 98 patients without. We measured pain intensity and interference using the Brief Pain Inventory, and resilience using the Resilience Scale. Participants were generally highly resilient. Greater resilience correlated with better health-related quality of life, but not with pain intensity or interference. We also measured physical activity objectively, by actigraphy, in a subset of patients (37 with chronic pain and 31 without chronic pain), who wore accelerometers for two weeks. There was no difference in duration or intensity of activity between those with and without pain, and activity was not associated with resilience. In this sample, pain was not associated with altered physical activity. Resilience did not explain differences in pain intensity or pain interference but was associated with improved quality of life. Financial stresses and the fear of HIV stigma may have driven patients to conceal pain and to suppress its expected impairment of activity.

  6. Resilience does not explain the dissociation between chronic pain and physical activity in South Africans living with HIV.

    PubMed

    Wadley, Antonia L; Mitchell, Duncan; Kamerman, Peter R

    2016-01-01

    Pain burden is high in people living with HIV (PLWH), but the effect of this pain on functionality is equivocal. Resilience, the ability to cope with adversity, may promote adaptation to pain, so we hypothesised that higher resilience would correlate with less pain-related impairment of activity. We recruited 197 black South African PLWH, 99 with chronic pain (CP) and 98 patients without. We measured pain intensity and interference using the Brief Pain Inventory, and resilience using the Resilience Scale. Participants were generally highly resilient. Greater resilience correlated with better health-related quality of life, but not with pain intensity or interference. We also measured physical activity objectively, by actigraphy, in a subset of patients (37 with chronic pain and 31 without chronic pain), who wore accelerometers for two weeks. There was no difference in duration or intensity of activity between those with and without pain, and activity was not associated with resilience. In this sample, pain was not associated with altered physical activity. Resilience did not explain differences in pain intensity or pain interference but was associated with improved quality of life. Financial stresses and the fear of HIV stigma may have driven patients to conceal pain and to suppress its expected impairment of activity. PMID:27672513

  7. 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.

  8. 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

  9. Pain management in older adults.

    PubMed

    Schilling, Margo L

    2003-05-01

    Pain is a common complaint of older adults. Persistent pain has a significant negative impact on elderly individuals' sense of well being, physical function, and quality of life. Increasing age and cognitive impairment are risk factors for undertreatment of persistent pain. Safe and effective therapy is available for pain syndromes that commonly affect older adults. Recognition of failure of health providers to appropriately assess and manage persistent pain has led to the recent development and adoption of regulatory guidelines for the implementation of effective pain management programs.

  10. Pain management in neurocritical care.

    PubMed

    Petzold, Axel; Girbes, Armand

    2013-10-01

    The core challenge of pain management in neurocritical care is to keep the patient comfortable without masking or overlooking any neurological deterioration. Clearly in patients with a neurological problem there is a conflict of clinical judgement and adequate pain relief. Here we review the presentation, assessment, and development of pain in the clinical spectrum of patients with associated neurological problems seen in a general intensive care setting. Many conditions predispose to the development of chronic pain. There is evidence that swift and targeted pain management may improve the outcome. Importantly pain management is multidisciplinary. The available non-invasive, pharmacological, and invasive treatment strategies are discussed.

  11. Association of neuropathic pain with ultrasonographic measurements of femoral cartilage thickness and clinical parameters in patients with knee osteoarthritis.

    PubMed

    Mesci, Nilgün; Mesci, Erkan; Külcü, Duygu Geler

    2016-08-01

    [Purpose] The aim of this study was to investigate whether neuropathic pain is associated with femoral condylar cartilage thickness, electrical pain threshold, and clinical parameters in patients with knee osteoarthritis. [Subjects and Methods] Sixty patients over the age of 40 diagnosed with knee osteoarthritis were enrolled. The PainDETECT questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index, Hospital Anxiety and Depression Scale, and Short Form-36 questionnaire were completed for all patients. Electrical sensory threshold and electrical pain threshold measurements were obtained. Femoral condylar cartilage thickness was determined by means of ultrasound. [Results] PainDETECT scores of 13 or greater were observed in 28 (46.7%) patients, indicating the presence of neuropathic pain. These patients were found to have greater average pain severity, Western Ontario and McMaster Universities Osteoarthritis Index, and depression and anxiety scores and lower Short Form-36 scores than patients without neuropathic pain. Patients with neuropathic pain showed lower knee electrical sensory threshold and pain threshold values on average than patients without neuropathic pain. Femoral condylar cartilage thickness was not different between the two groups. [Conclusion] Neuropathic pain is associated with increased pain severity and decreased functional capacity and adversely affects quality of life and mood in patients with knee osteoarthritis. PMID:27630395

  12. Association of neuropathic pain with ultrasonographic measurements of femoral cartilage thickness and clinical parameters in patients with knee osteoarthritis

    PubMed Central

    Mesci, Nilgün; Mesci, Erkan; Külcü, Duygu Geler

    2016-01-01

    [Purpose] The aim of this study was to investigate whether neuropathic pain is associated with femoral condylar cartilage thickness, electrical pain threshold, and clinical parameters in patients with knee osteoarthritis. [Subjects and Methods] Sixty patients over the age of 40 diagnosed with knee osteoarthritis were enrolled. The PainDETECT questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index, Hospital Anxiety and Depression Scale, and Short Form-36 questionnaire were completed for all patients. Electrical sensory threshold and electrical pain threshold measurements were obtained. Femoral condylar cartilage thickness was determined by means of ultrasound. [Results] PainDETECT scores of 13 or greater were observed in 28 (46.7%) patients, indicating the presence of neuropathic pain. These patients were found to have greater average pain severity, Western Ontario and McMaster Universities Osteoarthritis Index, and depression and anxiety scores and lower Short Form-36 scores than patients without neuropathic pain. Patients with neuropathic pain showed lower knee electrical sensory threshold and pain threshold values on average than patients without neuropathic pain. Femoral condylar cartilage thickness was not different between the two groups. [Conclusion] Neuropathic pain is associated with increased pain severity and decreased functional capacity and adversely affects quality of life and mood in patients with knee osteoarthritis.

  13. Association of neuropathic pain with ultrasonographic measurements of femoral cartilage thickness and clinical parameters in patients with knee osteoarthritis

    PubMed Central

    Mesci, Nilgün; Mesci, Erkan; Külcü, Duygu Geler

    2016-01-01

    [Purpose] The aim of this study was to investigate whether neuropathic pain is associated with femoral condylar cartilage thickness, electrical pain threshold, and clinical parameters in patients with knee osteoarthritis. [Subjects and Methods] Sixty patients over the age of 40 diagnosed with knee osteoarthritis were enrolled. The PainDETECT questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index, Hospital Anxiety and Depression Scale, and Short Form-36 questionnaire were completed for all patients. Electrical sensory threshold and electrical pain threshold measurements were obtained. Femoral condylar cartilage thickness was determined by means of ultrasound. [Results] PainDETECT scores of 13 or greater were observed in 28 (46.7%) patients, indicating the presence of neuropathic pain. These patients were found to have greater average pain severity, Western Ontario and McMaster Universities Osteoarthritis Index, and depression and anxiety scores and lower Short Form-36 scores than patients without neuropathic pain. Patients with neuropathic pain showed lower knee electrical sensory threshold and pain threshold values on average than patients without neuropathic pain. Femoral condylar cartilage thickness was not different between the two groups. [Conclusion] Neuropathic pain is associated with increased pain severity and decreased functional capacity and adversely affects quality of life and mood in patients with knee osteoarthritis. PMID:27630395

  14. Botulinum toxin for pain.

    PubMed

    Casale, Roberto; Tugnoli, Valeria

    2008-01-01

    Botulinum toxin (BTX) injection is being increasingly used 'off label' in the management of chronic pain. Data support the hypothesis of a direct analgesic effect of BTX, different to that exerted on muscle. Although the pain-reducing effect of BTX is mainly due to its ability to block acetylcholine release at the synapse, other effects on the nervous system are also thought to be involved. BTX affects cholinergic transmission in both the somatic and the autonomic nervous systems. Proposed mechanisms of action of BTX for pain relief of trigger points, muscular spasms, fibromyalgia and myofascial pain include direct action on muscle and indirect effects via action at the neuromuscular junction. Invitro and invivo data have shown that BTX has specific antinociceptive activity relating to its effects on inflammation, axonal transport, ganglion inhibition, and spinal and suprasegmental level inhibition. Our review of the mechanisms of action, efficacy, administration techniques and therapeutic dosage of BTX for the management of chronic pain in a variety of conditions shows that although muscular tone and movement disorders remain the most important therapeutic applications for BTX, research suggests that BTX can also provide benefits related to effects on cholinergic control of the vascular system, autonomic function, and cholinergic control of nociceptive and antinociceptive systems. Furthermore, it appears that BTX may influence the peripheral and central nervous systems. The therapeutic potential of BTX depends mainly on the ability to deliver the toxin to the target structures, cholinergic or otherwise. Evidence suggests that BTX can be administered at standard dosages in pain disorders, where the objective is alteration of muscle tone. For conditions requiring an analgesic effect, the optimal therapeutic dosage of BTX remains to be defined. PMID:18095750

  15. Experimental tonic hand pain modulates the corticospinal plasticity induced by a subsequent hand deafferentation.

    PubMed

    Mavromatis, N; Gagné, M; Voisin, J I A V; Reilly, K T; Mercier, C

    2016-08-25

    Sensorimotor reorganization is believed to play an important role in the development and maintenance of phantom limb pain, but pain itself might modulate sensorimotor plasticity induced by deafferentation. Clinical and basic research support this idea, as pain prior to amputation increases the risk of developing post-amputation pain. The aim of this study was to examine the influence of experimental tonic cutaneous hand pain on the plasticity induced by temporary ischemic hand deafferentation. Sixteen healthy subjects participated in two experimental sessions (Pain, No Pain) in which transcranial magnetic stimulation was used to assess corticospinal excitability in two forearm muscles (flexor carpi radialis and flexor digitorum superficialis) before (T0, T10, T20, and T40) and after (T60 and T75) inflation of a cuff around the wrist. The cuff was inflated at T45 in both sessions and in the Pain session capsaicin cream was applied on the dorsum of the hand at T5. Corticospinal excitability was significantly greater during the Post-inflation phase (p=0.002) and increased similarly in both muscles (p=0.861). Importantly, the excitability increase in the Post-inflation phase was greater for the Pain than the No-Pain condition (p=0.006). Post-hoc analyses revealed a significant difference between the two conditions during the Post-inflation phase (p=0.030) but no difference during the Pre-inflation phase (p=0.601). In other words, the corticospinal facilitation was greater when pain was present prior to cuff inflation. These results indicate that pain can modulate the plasticity induced by another event, and could partially explain the sensorimotor reorganization often reported in chronic pain populations. PMID:27291642

  16. Chronic Pain in Neurosurgery.

    PubMed

    Grodofsky, Samuel

    2016-09-01

    This review includes a summary of contemporary theories of pain processing and advocates a multimodal analgesia approach for providing perioperative care. A summary of various medication classes and anesthetic techniques is provided that highlights evidence emerging from neurosurgical literature. This summary covers opioid management, acetaminophen, nonsteroidal antiinflammatories, ketamine, lidocaine, dexmedetomidine, corticosteroids, gabapentin, and regional anesthesia for neurosurgery. At present, there is not enough investigation into these areas to describe best practices for treating or preventing chronic pain in neurosurgery; but providers can identify a wider range of options available to personalize perioperative care strategies. PMID:27521193

  17. Complex regional pain syndrome.

    PubMed

    Sebastin, Sandeep J

    2011-05-01

    Complex regional pain syndrome (CRPS) previously known as reflex sympathetic dystrophy is a chronic neurological disorder involving the limbs characterized by disabling pain, swelling, vasomotor instability, sudomotor abnormality, and impairment of motor function. CRPS is not uncommon after hand surgery and may complicate post-operative care. There is no specific diagnostic test for CRPS and the diagnosis is based on history, clinical examination, and supportive laboratory findings. Recent modifications to diagnostic criteria have enabled clinicians to diagnose this disease more consistently. This review gives a synopsis of CRPS and discusses the diagnosis, pathophysiology, and treatment options based on the limited evidence in the literature. PMID:22022040

  18. Complex regional pain syndrome

    PubMed Central

    Sebastin, Sandeep J

    2011-01-01

    Complex regional pain syndrome (CRPS) previously known as reflex sympathetic dystrophy is a chronic neurological disorder involving the limbs characterized by disabling pain, swelling, vasomotor instability, sudomotor abnormality, and impairment of motor function. CRPS is not uncommon after hand surgery and may complicate post-operative care. There is no specific diagnostic test for CRPS and the diagnosis is based on history, clinical examination, and supportive laboratory findings. Recent modifications to diagnostic criteria have enabled clinicians to diagnose this disease more consistently. This review gives a synopsis of CRPS and discusses the diagnosis, pathophysiology, and treatment options based on the limited evidence in the literature. PMID:22022040

  19. Groin pain in athletes.

    PubMed

    Hureibi, K A; McLatchie, G R

    2010-05-01

    Groin pain in athletes is a common problem in sport medicine, and remains a diagnostic challenge. It is more common with sports that involve kicking, rapid accelerations and decelerations, and sudden direction changes. There is an extensive differential diagnosis and overlap in signs between possible diagnoses. It is important to appreciate the anatomy of the groin and undertake a careful history and examination. Adductor strain, groin disruption and osteitis pubis are among the common causes. The aim of this article is to briefly review the most common causes of groin pain in athletes. The diagnosis and management of these conditions are briefly discussed. PMID:20533693

  20. Myofascial pain syndrome treatments.

    PubMed

    Borg-Stein, Joanne; Iaccarino, Mary Alexis

    2014-05-01

    Myofascial pain syndrome (MPS) is a regional pain disorder caused by taut bands of muscle fibers in skeletal muscles called myofascial trigger points. MPS is a common disorder, often diagnosed and treated by physiatrists. Treatment strategies for MPS include exercises, patient education, and trigger point injection. Pharmacologic interventions are also common, and a variety of analgesics, antiinflammatories, antidepressants, and other medications are used in clinical practice. This review explores the various treatment options for MPS, including those therapies that target myofascial trigger points and common secondary symptoms.

  1. Imaging central pain syndromes.

    PubMed

    Veldhuijzen, Dieuwke S; Greenspan, Joel D; Kim, Jong H; Coghill, Robert C; Treede, Rolf-Detlef; Ohara, Shinji; Lenz, Frederick A

    2007-06-01

    Anatomic, functional, and neurochemical imaging studies have provided new investigative tools in the study of central pain. High-resolution imaging studies allow for precise determination of lesion location, whereas functional neuroimaging studies measure pathophysiologic consequences of injury to the central nervous system. Additionally, magnetic resonance spectroscopy evaluates lesion-induced neurochemical changes in specific brain regions that may be related to central pain. The small number of studies to date precludes definitive conclusions, but the recent findings provide information that either supports or refutes current hypotheses and can serve to generate new ideas.

  2. [Groin pain in athletes].

    PubMed

    Ziltener, J-L; Leal, S

    2007-08-01

    Groin pain is a common problem in athletes who engage in sports involving accelerations, decelerations and sudden direction changes. It is still a frustrating pathology which has significant overlap and multiple problems coexist frequently. The pathogeny remains unclear, but the hypothesis that imbalances between abdominal muscles and adductors exist, has a certain success. Some anatomic and biomechanic factors may play a role in this pathology. A good clinical examination is an important part of the diagnosis and imaging may be helpful to eliminate other causes of groin pain that wouldn't be mechanic. The conservative treatment is long and difficult and must be focused on functional strengthening and core stabilisation. PMID:17850006

  3. Differential effects of expressive anger regulation on chronic pain intensity in CRPS and non-CRPS limb pain patients.

    PubMed

    Bruehl, Stephen; Chung, Ok Yung; Burns, John W

    2003-08-01

    Research has shown that the anger management styles of both anger-in (suppression of anger) and anger-out (direct verbal or physical expression of anger) may be associated with elevated chronic pain intensity. Only the effects of anger-out appear to be mediated by increased physiological stress responsiveness. Given the catecholamine-sensitive nature of pain mechanisms in complex regional pain syndrome (CRPS), it was hypothesized that anger-out, but not anger-in, would demonstrate a stronger relationship with chronic pain intensity in CRPS patients than in non-CRPS chronic pain patients. Thirty-four chronic pain patients meeting IASP criteria for CRPS and 50 non-CRPS (predominantely myofascial) limb pain patients completed the McGill Pain Questionnaire-Short Form (MPQ), the Anger Expression Inventory (AEI), and the Beck Depression Inventory (BDI). Analyses revealed no diagnostic group differences in mean scores on the anger-in (AIS) and anger-out (AOS) subscales of the AEI, or on the BDI (values of P>0.10). Results of general linear model analyses revealed significant AOS x diagnostic group interactions on both the sensory (MPQ-S) and affective (MPQ-A) subscales of the MPQ (values of P<0.05). In both cases, higher AOS scores were associated with more intense chronic pain in the CRPS group, but with less intense pain in the non-CRPS limb pain group. Inclusion of BDI scores as a covariate did not substantially alter the AOS x diagnostic group interactions, indicating that these AOS interactions were not due solely to overlap with negative affect. Although higher AIS scores were associated with elevated MPQ-A pain intensity as a main effect (P<0.05), no significant AIS x diagnostic group interactions were detected (values of P>0.10). The AIS main effect on MPQ-A ratings was accounted for entirely by overlap with negative affect. Results are consistent with a greater negative impact of anger-out on chronic pain intensity in conditions reflecting catecholamine

  4. Sex differences in experimental pain among healthy children: a systematic review and meta-analysis.

    PubMed

    Boerner, Katelynn E; Birnie, Kathryn A; Caes, Line; Schinkel, Meghan; Chambers, Christine T

    2014-05-01

    Sex differences in response to experimental pain are commonly reported in systematic reviews in the adult literature. The objective of the present research was to conduct a systematic review and meta-analysis of sex differences in healthy children's responses to experimental pain (e.g., cold pressor, heat pain, pressure pain) and, where possible, to conduct analyses separately for children and adolescents. A search was conducted of electronic databases for published papers in English of empirical research using experimental pain tasks to examine pain-related outcomes in healthy boys and girls between 0 and 18 years of age. Eighty articles were eligible for inclusion and were coded to extract information relevant to sex differences. The systematic review indicated that, across different experimental pain tasks, the majority of studies reported no significant differences between boys and girls on pain-related outcomes. However, the meta-analysis of available combined data found that girls reported significantly higher cold pressor pain intensity compared to boys in studies where the mean age of participants was greater than 12 years. Additionally, a meta-analysis of heat pain found that boys had significantly higher tolerance than girls overall, and boys had significantly higher heat pain threshold than girls in studies where the mean age of participants was 12 years or younger. These findings suggest that developmental stage may be relevant for understanding sex differences in pain.

  5. The lateral prefrontal cortex mediates the hyperalgesic effects of negative cognitions in chronic pain patients

    PubMed Central

    Loggia, Marco L.; Berna, Chantal; Kim, Jieun; Cahalan, Christine M.; Martel, Marc-Olivier; Gollub, Randy L.; Wasan, Ajay D.; Napadow, Vitaly; Edwards, Robert R.

    2015-01-01

    While high levels of negative affect and cognitions have been associated in chronic pain conditions with greater pain sensitivity, the neural mechanisms mediating the hyperalgesic effect of psychological factors in patients with pain disorders are largely unknown. In this cross-sectional study, we hypothesized that 1) catastrophizing modulates brain responses to pain anticipation, and that 2) anticipatory brain activity mediates the hyperalgesic effect of different levels of catastrophizing, in fibromyalgia (FM) patients. Using functional Magnetic Resonance Imaging, we scanned the brains of 31 FM patients exposed to visual cues anticipating the onset of moderately intense deep-tissue pain stimuli. Our results indicated the existence of a negative association between catastrophizing and pain-anticipatory brain activity, including in the right lateral prefrontal cortex (IPFC). A bootstrapped mediation analysis revealed that pain-anticipatory activity in lateral prefrontal cortex (IPFC) mediates the association between catastrophizing and pain sensitivity. These findings highlight the role of IPFC in the pathophysiology of FM related hyperalgesia, and suggest that deficits in the recruitment of pain-inhibitory brain circuitry during pain-anticipatory periods may play an important contributory role in the association between various degrees of widespread hyperalgesia in FM and levels of catastrophizing, a well validated measure of negative cognitions and psychological distress. Perspective This article highlights the presence of alterations in pain-anticipatory brain activity in FM. These findings provide the rationale for the development of psychological or neurofeedback-based techniques aimed at modifying patients' negative affect and cognitions towards pain. PMID:25937162

  6. Neonatal invasive procedures predict pain intensity at school age in children born very preterm

    PubMed Central

    Valeri, Beatriz Oliveira; Ranger, Manon; Chau, Cecil MY; Cepeda, Ivan L.; Synnes, Anne; Linhares, Maria Beatriz Martins; Grunau, Ruth E.

    2016-01-01

    Children born very preterm display altered pain thresholds. Little is known about neonatal clinical and psychosocial factors associated with their later pain perception. OBJECTIVE We aimed to examine whether the number of neonatal invasive procedures, adjusted for other clinical and psychosocial factors, was associated with self-ratings of pain during a blood collection procedure in children born very preterm at school age. METHODS 56 children born very preterm (24–32 weeks gestational age) at age 7.5 years, followed longitudinally from birth, and free of major neurodevelopmental impairments, underwent a blood collection by venipuncture. The children’s pain was self-reported using the Coloured Analog Scale and Facial Affective Scale. Parents completed the Child Behavior Checklist and State-Trait Anxiety Inventory. Pain exposure (number of invasive procedures) and clinical factors from birth to term-equivalent age were obtained prospectively. Multiple linear regression was used to predict children’s pain self-ratings from neonatal pain exposure after adjusting for neonatal clinical and concurrent psychosocial factors. RESULTS Greater number of neonatal invasive procedures and higher parent trait-anxiety were associated with higher pain intensity ratings during venipuncture at age 7.5 years. Fewer surgeries and lower concurrent child externalizing behaviors were associated with higher pain intensity. CONCLUSION In very preterm children, exposure to neonatal pain was related to altered pain self-ratings at school age, independent of other neonatal factors. Neonatal surgeries and concurrent psychosocial factors were also associated with pain ratings. PMID:26783986

  7. Extenuating Circumstances in Perceptions of Suicide: Disease Diagnosis (AIDS, Cancer), Pain Level, and Life Expectancy.

    ERIC Educational Resources Information Center

    Martin, Stephen K.; Range, Lillian M.

    1991-01-01

    Examined whether illness type, pain level, and life expectancy affected reactions of undergraduates (n=160) toward a terminal illness suicide with Acquired Immune Deficiency Syndrome (AIDS) or cancer. AIDS patients were more stigmatized than cancer patients; suicide was more tolerated if victim was suffering greater pain. (Author/ABL)

  8. Vicarious pain while observing another in pain: an experimental approach

    PubMed Central

    Vandenbroucke, S.; Crombez, G.; Van Ryckeghem, D. M. L.; Brass, M.; Van Damme, S.; Goubert, L.

    2013-01-01

    Objective: This study aimed at developing an experimental paradigm to assess vicarious pain experiences. We further explored the putative moderating role of observer's characteristics such as hypervigilance for pain and dispositional empathy. Methods: Two experiments are reported using a similar procedure. Undergraduate students were selected based upon whether they reported vicarious pain in daily life, and categorized into a pain responder group or a comparison group. Participants were presented a series of videos showing hands being pricked whilst receiving occasionally pricking (electrocutaneous) stimuli themselves. In congruent trials, pricking and visual stimuli were applied to the same spatial location. In incongruent trials, pricking and visual stimuli were in the opposite spatial location. Participants were required to report on which location they felt a pricking sensation. Of primary interest was the effect of viewing another in pain upon vicarious pain errors, i.e., the number of trials in which an illusionary sensation was reported. Furthermore, we explored the effect of individual differences in hypervigilance to pain, dispositional empathy and the rubber hand illusion (RHI) upon vicarious pain errors. Results: Results of both experiments indicated that the number of vicarious pain errors was overall low. In line with expectations, the number of vicarious pain errors was higher in the pain responder group than in the comparison group. Self-reported hypervigilance for pain lowered the probability of reporting vicarious pain errors in the pain responder group, but dispositional empathy and the RHI did not. Conclusion: Our paradigm allows measuring vicarious pain experiences in students. However, the prevalence of vicarious experiences of pain is low, and only a small percentage of participants display the phenomenon. It remains however unknown which variables affect its occurrence. PMID:23781187

  9. 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

  10. Pain Mechanisms and Centralized Pain in Temporomandibular Disorders.

    PubMed

    Harper, D E; Schrepf, A; Clauw, D J

    2016-09-01

    Until recently, most clinicians and scientists believed that the experience of pain is perceptually proportional to the amount of incoming peripheral nociceptive drive due to injury or inflammation in the area perceived to be painful. However, many cases of chronic pain have defied this logic, leaving clinicians perplexed as to how patients are experiencing pain with no obvious signs of injury in the periphery. Conversely, there are patients who have a peripheral injury and/or inflammation but little or no pain. What makes some individuals experience intense pain with minimal peripheral nociceptive stimulation and others experience minimal pain with serious injury? It is increasingly well accepted in the scientific community that pain can be generated and maintained or, through other mechanisms, suppressed by changes in the central nervous system, creating a complete mismatch between peripheral nociceptive drive and perceived pain. In fact, there is no known chronic pain condition where the observed extent of peripheral damage reproducibly engenders the same level of pain across individuals. Temporomandibular disorders (TMDs) are no exception. This review focuses on the idea that TMD patients range on a continuum-from those whose pain is generated peripherally to those whose pain is centralized (i.e., generated, exacerbated, and/or maintained by central nervous system mechanisms). This article uses other centralized chronic pain conditions as a guide, and it suggests that the mechanistic variability in TMD pain etiology has prevented us from adequately treating many individuals who are diagnosed with the condition. As the field moves forward, it will be imperative to understand each person's pain from its own mechanistic standpoint, which will enable clinicians to deliver personalized medicine to TMD patients and eventually provide relief in even the most recalcitrant cases. PMID:27422858

  11. Widespread pain in chronic epicondylitis.

    PubMed

    Pienimäki, Tuomo; Siira, Pertti; Vanharanta, Heikki

    2011-10-01

    We studied the associations of widespread pain with other pain and functional measures among patients with chronic epicondylitis. A total of 190 patients (66% females) participated in the study; with a mean age 43.7, mean duration of symptoms 48weeks, chronic lateral (n=160) and medial (n=30) epicondylitis. We analysed clinical status, grip strength and cubital pain thresholds and interviewed pain and disability, leisure time physical activity, strenuous hobby activities for arms, duration of symptoms, other systemic and upper extremity disorders, arm operations, and work ability. The location of pain was analysed using a whole-body pain drawing, categorized into three groups; the highest of which was classified as widespread pain. A total of 85 patients (45%) reported widespread pain. It was highly associated with female gender, high pain scores, decreased grip strength and pain thresholds (p<0.001 for all), with increased number of positive manual tests, low level of hobby strain for arms and physical activity, long duration of symptoms, and sick leave (p for all <0.05). It was also related to upper extremity disorders and arm surgery, but not with operated epicondylitis, other systemic diseases, workload or work ability. In addition, 39% of patients without other disease reported widespread pain. Widespread pain is common in chronic epicondylitis with and without other diseases, and is related to high pain scores, decreased function of the arm, long duration of symptoms, sick leave, and with a low level of physical activity.

  12. New advances in musculoskeletal pain

    PubMed Central

    Bove, Susan E.; Flatters, Sarah J.L.; Inglis, Julia J.; Mantyh, Patrick W.

    2015-01-01

    Non-malignant musculoskeletal pain is the most common clinical symptom that causes patients to seek medical attention and is a major cause of disability in the world. Musculoskeletal pain can arise from a variety of common conditions including osteoarthritis, rheumatoid arthritis, osteoporosis, surgery, low back pain and bone fracture. A major problem in designing new therapies to treat musculoskeletal pain is that the underlying mechanisms driving musculoskeletal pain are not well understood. This lack of knowledge is largely due to the scarcity of animal models that closely mirror the human condition which would allow the development of a mechanistic understanding and novel therapies to treat this pain. To begin to develop a mechanism-based understanding of the factors involved in generating musculoskeletal pain, in this review we present recent advances in preclinical models of osteoarthritis, post-surgical pain and bone fracture pain. The models discussed appear to offer an attractive platform for understanding the factors that drive this pain and the preclinical screening of novel therapies to treat musculoskeletal pain. Developing both an understanding of the mechanisms that drive persistent musculoskeletal pain and novel mechanism-based therapies to treat these unique pain states would address a major unmet clinical need and have significant clinical, economic and societal benefits. PMID:19166876

  13. Emotional pain without sensory pain--dream on?

    PubMed

    Borsook, David; Becerra, Lino

    2009-01-29

    The article by Danziger and colleagues in this issue of Neuron evaluates empathy in a unique population--individuals with congenital insensitivity to pain. As such, it provides insights into the brain's ability to evaluate others' feeling to observed pain without having a specific sensory experience of pain itself.

  14. Impact of Biopsychosocial Factors on Chronic Pain in Persons With Myotonic and Facioscapulohumeral Muscular Dystrophy

    PubMed Central

    Miró, Jordi; Raichle, Katherine A.; Carter, Gregory T.; O’Brien, Sarah A.; Abresch, Richard T.; McDonald, Craig M.; Jensen, Mark P.

    2010-01-01

    To assess the role of biopsychosocial factors in patients with type 1 myotonic and facioscapulohumeral muscular dystrophy (MMD1/FSHD) with chronic pain. Associations between psychosocial factors were found to be important in other samples of persons with pain and both psychological functioning and pain interference in a sample of patients suffering from MMD/FSHD. Prospective, multiple group, survey study of 182 patients with confirmed MMD1 and FSHD. Participants completed surveys assessing pain interference and psychological functioning, as well as psychosocial, demographic, and injury-related variables. Analyses indicated that greater catastrophizing was associated with increased pain interference and poorer psychological functioning, pain attitudes were significantly related to both pain interference and psychological functioning, and coping responses were significantly related only to pain interference. In addition, greater perceived social support was associated with better psychological functioning. The results support the use of studying pain in persons with MMD/FSHD from a biopsychosocial perspective, and the importance of identifying psychosocial factors that may play a role in the adjustment to and response to pain secondary to MMD/FSHD. PMID:19414560

  15. Impact of biopsychosocial factors on chronic pain in persons with myotonic and facioscapulohumeral muscular dystrophy.

    PubMed

    Miró, Jordi; Raichle, Katherine A; Carter, Gregory T; O'Brien, Sarah A; Abresch, Richard T; McDonald, Craig M; Jensen, Mark P

    2009-01-01

    To assess the role of biopsychosocial factors in patients with type 1 myotonic and facioscapulohumeral muscular dystrophy (MMD1/FSHD) with chronic pain. Associations between psychosocial factors were found to be important in other samples of persons with pain and both psychological functioning and pain interference in a sample of patients suffering from MMD/FSHD. Prospective, multiple group, survey study of 182 patients with confirmed MMD1 and FSHD. Participants completed surveys assessing pain interference and psychological functioning, as well as psychosocial, demographic, and injury-related variables. Analyses indicated that greater catastrophizing was associated with increased pain interference and poorer psychological functioning, pain attitudes were significantly related to both pain interference and psychological functioning, and coping responses were significantly related only to pain interference. In addition, greater perceived social support was associated with better psychological functioning. The results support the use of studying pain in persons with MMD/FSHD from a biopsychosocial perspective, and the importance of identifying psychosocial factors that may play a role in the adjustment to and response to pain secondary to MMD/FSHD. PMID:19414560

  16. Patellar maltracking is prevalent among patellofemoral pain subjects with patella alta: an upright, weightbearing MRI study

    PubMed Central

    Pal, Saikat; Besier, Thor F.; Beaupre, Gary S.; Fredericson, Michael; Delp, Scott L.; Gold, Garry E.

    2012-01-01

    The purpose of this study is to determine if patellar maltracking is more prevalent among patellofemoral (PF) pain subjects with patella alta compared to subjects with normal patella height. We imaged 37 PF pain and 15 pain free subjects in an open-configuration magnetic resonance imaging scanner while they stood in a weightbearing posture. We measured patella height using the Caton-Deschamps, Blackburne-Peel, Insall-Salvati, Modified Insall-Salvati, and Patellotrochlear indices, and classified the subjects into patella alta and normal patella height groups. We measured patella tilt and bisect offset from oblique-axial plane images, and classified the subjects into maltracking and normal tracking groups. Patellar maltracking was more prevalent among PF pain subjects with patella alta compared to PF pain subjects with normal patella height (two-tailed Fisher’s exact test, p < 0.050). Using the Caton-Deschamps index, 67% (8/12) of PF pain subjects with patella alta were maltrackers, whereas only 16% (4/25) of PF pain subjects with normal patella height were maltrackers. Patellofemoral pain subjects classified as maltrackers displayed a greater patella height compared to the pain free and PF pain subjects classified as normal trackers (two-tailed unpaired t-tests with Bonferroni correction, p < 0.017). This study adds to our understanding of PF pain in two ways - 1) we demonstrate that patellar maltracking is more prevalent in PF pain subjects with patella alta compared to subjects with normal patella height; and 2) we show greater patella height in PF pain subjects compared to pain free subjects using four indices commonly used in clinics. PMID:23165335

  17. Older adults' pain communication during ambulatory medical visits: an exploration of communication accommodation theory.

    PubMed

    Hehl, Jennifer; McDonald, Deborah Dillon

    2014-06-01

    The purpose of this descriptive secondary analysis was to explore the use of Communication Accommodation Theory as a framework to examine pain communication strategies used by older adults and their primary care practitioners during medical ambulatory care visits. Ambulatory medical visits for 22 older adults with moderate or greater osteoarthritis pain were audiotaped, transcribed verbatim, and coded by two independent raters for six a priori communication strategies derived from the attuning strategies of Communication Accommodation Theory: (1) patient selecting the pain topic; (2) patient taking a turn; (3) patient maintaining focus on the pain topic; (4) practitioner using an open-ended question without social desirability to start the pain discussion; (5) practitioner encouraging the patient to take a turn by asking open-ended questions; and (6) practitioner interruptions. The majority of practitioners did not start the pain discussion with an open-ended question, but did not interrupt the older adults as they discussed their pain. Five (22.7%) of the older adults did not discuss their osteoarthritis pain during the ambulatory medical visit. The majority of patients took their turn during the pain discussion, but did not maintain focus while describing important osteoarthritis pain information to their practitioner. Practitioners might assist older adults to communicate more information about their pain by initiating the pain discussion with an open-ended pain question. Older adults might provide more pain information to their practitioner by staying on the pain topic until they have completed all of the pain information they wish to discuss with the practitioner.

  18. Older adults' pain communication during ambulatory medical visits: an exploration of communication accommodation theory.

    PubMed

    Hehl, Jennifer; McDonald, Deborah Dillon

    2014-06-01

    The purpose of this descriptive secondary analysis was to explore the use of Communication Accommodation Theory as a framework to examine pain communication strategies used by older adults and their primary care practitioners during medical ambulatory care visits. Ambulatory medical visits for 22 older adults with moderate or greater osteoarthritis pain were audiotaped, transcribed verbatim, and coded by two independent raters for six a priori communication strategies derived from the attuning strategies of Communication Accommodation Theory: (1) patient selecting the pain topic; (2) patient taking a turn; (3) patient maintaining focus on the pain topic; (4) practitioner using an open-ended question without social desirability to start the pain discussion; (5) practitioner encouraging the patient to take a turn by asking open-ended questions; and (6) practitioner interruptions. The majority of practitioners did not start the pain discussion with an open-ended question, but did not interrupt the older adults as they discussed their pain. Five (22.7%) of the older adults did not discuss their osteoarthritis pain during the ambulatory medical visit. The majority of patients took their turn during the pain discussion, but did not maintain focus while describing important osteoarthritis pain information to their practitioner. Practitioners might assist older adults to communicate more information about their pain by initiating the pain discussion with an open-ended pain question. Older adults might provide more pain information to their practitioner by staying on the pain topic until they have completed all of the pain information they wish to discuss with the practitioner. PMID:24882026

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

    PubMed Central

    2013-01-01

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

  20. Back pain and backpacks in children: biomedical or biopsychosocial model?

    PubMed

    Reneman, M F; Poels, B J J; Geertzen, J H B; Dijkstra, P U

    2006-10-30

    Public press, professional organisations and journals have been sending alarming messages about the rising prevalence of back pain in school age children. Carrying backpacks has been suggested as one of the key factors contributing to back pain in children. The basic assumption based on the biomedical model is that the maturing spine cannot handle the mechanical load of the backpack sufficiently. A review of the evidence in the professional literature, however, revealed very limited evidence to support this assumption. On the contrary, the literature does suggest that psychological and social factors may be of greater importance to explain back pain in children. We conclude this clinical commentary postulating that the public, children and their parents are better served with a more modest and balanced perspective of the professionals, and propose that back pain in children (as it is in adults) should be viewed from a biopsychosocial model. PMID:17023376