RESUMEN
OBJECTIVE: While considerable focus has been placed on pain due to inflammation in psoriatic arthritis (PsA), less is reported on pain despite inflammation control. Here, we aimed to investigate the occurrence/predictors of persistent pain, including non-inflammatory components, after starting anti-tumour necrosis factor (anti-TNF) therapy. METHOD: Bionaïve PsA patients starting a first anti-TNF therapy 2004-2010 were identified (South Swedish Arthritis Treatment Group register; N = 351). Outcomes included unacceptable pain [visual analogue scale (VAS) pain > 40 mm], and unacceptable pain despite inflammation control (refractory pain; VAS pain > 40 mm + C-reactive protein < 10 mg/L + ≤ 1 swollen joint of 28), assessed at 0, 3, 6, and 12 months. Baseline predictors were estimated by logistic regression. RESULTS: Upon starting anti-TNF therapy, 85% of patients reported unacceptable pain, falling to 43% at 3 months and then remaining stable. After 12 months, refractory pain constituted 63% of all unacceptable pain. Higher baseline VAS pain/global, worse physical function and lower health-related quality-of-life were associated with a higher risk of unacceptable/refractory pain at 12 months. More swollen joints and higher evaluator's global assessment were associated with a lower risk of 12-month refractory pain. CONCLUSIONS: A substantial proportion of PsA patients reported unacceptable pain throughout the first anti-TNF treatment year. At 12 months, refractory pain constituted about two-thirds of this remaining pain load. More objective signs of inflammation at anti-TNF initiation were associated with less future refractory pain. This highlights insufficient effect of biologics in patients with inflammation-independent pain, warranting alternative treatments.
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Antirreumáticos , Artritis Psoriásica , Dolor Intratable , Humanos , Artritis Psoriásica/complicaciones , Antirreumáticos/uso terapéutico , Dolor Intratable/inducido químicamente , Dolor Intratable/complicaciones , Dolor Intratable/tratamiento farmacológico , Inhibidores del Factor de Necrosis Tumoral/uso terapéutico , Resultado del Tratamiento , Factor de Necrosis Tumoral alfa , Inflamación/tratamiento farmacológico , Necrosis/inducido químicamente , Necrosis/complicaciones , Necrosis/tratamiento farmacológico , Índice de Severidad de la EnfermedadRESUMEN
INTRODUCTION AND OBJECTIVES: To determine the disease burden and costs in patients with hip or knee OA and chronic moderate-to-severe refractory pain, receiving strong opioids in Spain. MATERIALS AND METHODS: This was a 36-month longitudinal secondary analysis of the real-word OPIOIDS study. Patients aged ≥18 years with hip or knee OA and chronic moderate-to-severe refractory pain receiving strong opioids were considered. The disease burden included analgesia assessments (NRS scale), cognitive functioning (MMSE scale), basic activities of daily living (Barthel index), and comorbidities (severity and frequency). Costs due to the use of healthcare resources and productivity loss were estimated. RESULTS: 2832 patients were analyzed; age was 72.0 years (SD=14.3), 76.8% were women. Patients had mainly been treated with fentanyl (n=979; 37.6%), tapentadol (n=625; 24.0%), oxycodone (n=572; 22.0%), and buprenorphine (n=425; 16.3%). Pain intensity decreased by 1 point (13.7%), with a 2.6-point decline in the cognitive scale (14.3%, with a 5.3%-increase in patients with cognitive deficit) over a mean treatment period of 384.6 days (SD: 378.8). Barthel scores decreased significantly yielding to a slightly increase in proportion of patients with severe-to-total dependency; 1.2%-2.9%. In the first year of treatment, average healthcare costs were 2013/patient, whereas the average productivity loss cost was 12,227/working-active patient. DISCUSSION AND CONCLUSIONS: Strong opioids resulted in high healthcare costs with a limited reduction in pain, an increase in cognitive deficit, and a slight increase of patients with severe to total dependency over 36 months of treatment.
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Osteoartritis de la Cadera , Osteoartritis de la Rodilla , Dolor Intratable , Humanos , Femenino , Adolescente , Adulto , Anciano , Masculino , Analgésicos Opioides/uso terapéutico , Analgésicos Opioides/efectos adversos , Osteoartritis de la Rodilla/complicaciones , Osteoartritis de la Rodilla/tratamiento farmacológico , Osteoartritis de la Cadera/complicaciones , Osteoartritis de la Cadera/tratamiento farmacológico , España , Actividades Cotidianas , Dolor Intratable/inducido químicamente , Dolor Intratable/complicaciones , Costo de EnfermedadRESUMEN
PURPOSE: To report a case of early postoperative scleral buckle slippage because of the dehiscence of scleral belt loop tunnels. METHOD: Case report. RESULTS: A 54-year-old woman presented with painful diplopia after a combination pars plana vitrectomy and scleral buckling procedure. Ocular movements were limited. Forced duction testing was restricted in all directions. Anterior slippage of the silicone band was suggested on computed tomography (CT) scans and was confirmed with surgical exploration. During surgery, it was found that thin-roofed scleral belt loop tunnels were dehisced in three quadrants leading to anterior slippage of the buckle. The displaced buckle was removed. Diplopia and pain resolved, and ocular motility improved immediately afterward. The retina remained attached at six months follow-up. A supplemental video summarizes the surgical findings and postoperative results. CONCLUSION: Spontaneous dehiscence of scleral belt loops may occur in thinly dissected scleral tunnels. Painful eye movement, diplopia, and a positive forced duction test should raise suspicion about a displaced scleral buckle. A CT scan may help with the diagnosis. Early diagnosis and immediate surgical intervention are needed to minimize patient discomfort and to improve long-term ocular motility.
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Dolor Intratable , Desprendimiento de Retina , Femenino , Humanos , Persona de Mediana Edad , Curvatura de la Esclerótica/efectos adversos , Curvatura de la Esclerótica/métodos , Diplopía/diagnóstico , Diplopía/etiología , Diplopía/cirugía , Dolor Intratable/complicaciones , Dolor Intratable/cirugía , Desprendimiento de Retina/cirugía , Estudios Retrospectivos , Resultado del Tratamiento , Vitrectomía/métodosRESUMEN
BACKGROUND: Oral mucositis (OM) in patients receiving cancer therapy is thus far not well managed with standard approaches. We aimed to assess the safety and effectiveness of methylene blue (MB) oral rinse for OM pain in patients receiving cancer therapy. METHODS: In this randomized, single-blind phase 2 clinical trial, patients were randomized to one of four arms: MB 0.025%+conventional therapy (CTx) (n = 15), MB 0.05%+CTx (n = 14), MB 0.1%+CTx (n = 15), or CTx alone (n = 16). Intervention groups received MB oral rinse every 6 h for 2 days with outcomes measured at days 1-2; safety was evaluated up to 30 days. The primary outcome measured change in the pain numeric rating scale (0-10) from baseline to day 2. Secondary outcome measured change in oral function burden scores from baseline to day 2, World Health Organization OM grades, morphine equivalent daily doses, and adverse events. The trial was registered with ClinicalTrials.gov ID: NCT03469284. RESULTS: Sixty patients (mean age 43, range 22-62 years) completed the study. Compared with those who received CTx alone, those who received MB had a significant reduction of pain scores at day 2 of treatment (mean ± SD); 0.025%: 5.2 ± 2.9, 0.05%: 4.5 ± 2.9, 0.1%: 5.15 ± 2.6) and reduction of oral function burden scores (0.025%: 2.5 ± 1.55, 0.05%: 2.8 ± 1.7, 0.1%: 2.9 ± 1.60). No serious adverse events were noted, but eight patients reported burning sensation of the oral cavity with the first dose, and this caused one patient to discontinue therapy. CONCLUSIONS: MB oral rinse showed significant pain reduction and improved oral functioning with minimal adverse effects. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03469284.
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Neoplasias , Dolor Intratable , Estomatitis , Humanos , Adulto Joven , Adulto , Persona de Mediana Edad , Dolor Intratable/complicaciones , Dolor Intratable/tratamiento farmacológico , Azul de Metileno/efectos adversos , Método Simple Ciego , Método Doble Ciego , Estomatitis/tratamiento farmacológico , Estomatitis/etiología , Neoplasias/complicaciones , Analgésicos/uso terapéuticoRESUMEN
BACKGROUND: Genicular artery embolization emerges as an innovative technique described for the treatment of refractory pain in patients with knee osteoarthritis. This review summarizes the available data on the efficacy of genicular artery embolization in patients with knee osteoarthritis (OA) and refractory pain as an alternative treatment or associated with pharmacological treatment. METHODS: Review according to PRISMA® standards on genicular artery embolization and knee osteoarthritis. RESULTS: Thirteen publications out of a total of 63 studies reporting data from 914 patients were analyzed according to inclusion criteria. The indication of embolization was performed in patients with severe chronic pain refractory to conservative treatment and moderate-to-severe knee OA. Only minor complications have been reported. CONCLUSION: Genicular artery embolization is a possible and potentially very effective alternative in the treatment of chronic refractory pain in patients with knee OA, without serious complications. All studies conclude in favor of embolization of the genicular arteries in the treatment of chronic refractory pain in patients with knee OA.
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Dolor Crónico , Osteoartritis de la Rodilla , Dolor Intratable , Humanos , Articulación de la Rodilla , Dolor Intratable/complicaciones , Resultado del Tratamiento , Osteoartritis de la Rodilla/complicaciones , Osteoartritis de la Rodilla/terapia , Dolor Crónico/etiología , Dolor Crónico/terapia , ArteriasRESUMEN
In 10% to 30% cancer-pain cases standard analgesic therapy fails to provide effective pain relief. Interventional techniques, such as peripheral nerve blocks, neuraxial analgesia along with neurolytic blocks may be used for such refractory pain. Peripheral nerve blocks can be used when pain occurs in the territory of one or more peripheral nerves, but rarely as main therapy. Neuraxial analgesia is a valid option for progressive cancer pain, and healthcare possibilities and costs call into question the utility of intrathecal infusion pumps. Neurolysis is the targeted destruction of a nerve or nerve plexus, using chemicals, radiofrequency ablation (RFA), cryoablation, and neurosurgical procedures; however, it rarely completely eliminates pain because patients frequently experience coexisting somatic and neuropathic pain as well. Complex conditions of palliative patients along with limited high-quality randomized controlled trials limit the use of interventional procedures. Even so, some cancer patients benefit from interventional procedures to achieve pain alleviation and consequently improve quality of life.
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Dolor en Cáncer , Dolor Intratable , Cuidados Paliativos , Humanos , Dolor en Cáncer/complicaciones , Dolor en Cáncer/terapia , Neoplasias , Dolor Intratable/complicaciones , Dolor Intratable/terapia , Cuidados Paliativos/métodos , Calidad de VidaRESUMEN
Primary and secondary malignant tumors of the spine are relatively uncommon in the pediatric population but are associated with high morbidity and significantly decreased quality of life due to pain. Local management of these tumors is often challenging due to the importance of maintaining vertebral mechanical integrity as well as the spinal growth potential. Typically, surgery and/or radiation therapy have been used in the primary management of these tumors. However, treatment options become more limited when there is relapse or refractory disease, with re-resection or additional radiotherapy often not being viable therapies. Vertebroplasty is a currently underutilized modality that might provide significant pain palliation in cases of relapsed cancer in the spine.
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Neoplasias del Sistema Nervioso Central , Dolor Intratable , Neoplasias de la Médula Espinal , Neoplasias de la Columna Vertebral , Vertebroplastia , Neoplasias del Sistema Nervioso Central/complicaciones , Niño , Humanos , Recurrencia Local de Neoplasia , Dolor Intratable/complicaciones , Dolor Intratable/terapia , Cuidados Paliativos , Calidad de Vida , Neoplasias de la Columna Vertebral/complicaciones , Neoplasias de la Columna Vertebral/radioterapia , Neoplasias de la Columna Vertebral/cirugía , Resultado del TratamientoRESUMEN
OBJECTIVES: The purpose of the study was to evaluate any comorbid psychiatric disorders in patients with chronic pain and to examine the effects of sociodemographic details and the level of somatic sense perception on the severity of these diseases. METHODS: In this study, 51 chronic pain patients were evaluated in a consultation with a psychiatrist. Sociodemographic characteristics of the patients, such as age, gender, education level, and marital status were recorded, and Structured Clinical Interview for DSM-IV results were assessed. The patients' chronic pains were classified as idiopathic or secondary to organic etiology. In addition, the Symptom Checklist-90, Somatosensory Amplification Scale (SSAS), Hamilton Depression Rating Scale, and the Hamilton Anxiety Scale (HAM-A) were used. RESULTS: The incidence of psychiatric disorders in chronic pain patients was found to be 74.5%. Somatoform disorders were the most frequently diagnosed, at 37.3%. The rate of depressive and anxiety disorders was, respectively, 29.4% and 23.5%. Comorbid anxiety scores (p=0.019) and SSAS scores (p=0.046) were significantly higher in chronic pain patients with a somatoform disorder. HAM-A scores were found to be significantly higher in patients with depression (p=0.004). A positive and linear relationship was determined between the SSAS score and depression, anxiety, and the severity of mental symptoms. CONCLUSION: Structured or semi-structured interviews can be performed in pain polyclinics or psychiatric outpatient clinics to determine the level of perception of somatic sensations. This could be beneficial in the treatment of chronic pain and comorbid psychiatric disorders.
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Dolor Intratable/epidemiología , Trastornos Somatomorfos/complicaciones , Adulto , Comorbilidad , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Incidencia , Entrevistas como Asunto , Masculino , Dimensión del Dolor , Dolor Intratable/complicaciones , Dolor Intratable/psicología , Prevalencia , Escalas de Valoración Psiquiátrica , Encuestas y Cuestionarios , Turquía/epidemiologíaRESUMEN
SPECIFIC CLINICAL ISSUE: The purpose of this clinical consultation is to offer nurses evidence-based strategies to provide holistic care to their patients with comorbid depression and pain. The combination of depression and pain is common and, if not managed effectively, has negative outcomes. Treatment-resistance is one negative outcome. The worst-case scenario for unrelieved depression and/or pain is suicide. MAJOR PRACTICE RECOMMENDATIONS BASED ON BEST EVIDENCE: Antidepressants, particularly duloxetine, have had efficacy for pain and depression. Cognitive behavioral therapy, an evidence-based treatment for depression, has been found to decrease pain. Examples of additional interventions include exercise, relaxation techniques, mindfulness, and music. Providing holistic nursing care and working with other disciplines optimizes more effective management of these co-occurring conditions.
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Trastorno Depresivo/terapia , Proceso de Enfermería , Dolor Intratable/terapia , Terapia Cognitivo-Conductual , Comorbilidad , Trastorno Depresivo/complicaciones , Trastorno Depresivo/enfermería , Clorhidrato de Duloxetina/uso terapéutico , Humanos , Dolor Intratable/complicaciones , Dolor Intratable/enfermería , Inhibidores de Captación de Serotonina y Norepinefrina/uso terapéuticoRESUMEN
AIM: Limb amputation traumatically alters body image. Sensations rapidly prevail that the limb is still present and 85% of patients portray phantom limb pain. Throughout the testimonies of amputated patients with intense phantom limb pain, we show the difficulty in treating this chronic pain with current pharmacological and nonpharmacological therapies. PATIENTS & METHODS: We qualitatively analyzed the therapeutic choices of five amputees, the effectiveness of the treatments chosen and the impact on patients' quality-of-life. RESULTS & CONCLUSION: In general, patients who are refractory to pharmacological treatments are in favor of trying alternative therapies. It is therefore crucial to design a combined and personalized therapeutic plan under the coordination of a multidisciplinary team for the wellbeing of the patient.
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Miembro Fantasma/psicología , Miembro Fantasma/terapia , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Intratable/complicaciones , Atención al Paciente , Miembro Fantasma/complicaciones , Resultado del TratamientoRESUMEN
OBJECTIVE: This study sought to explore the prevalence and clinical manifestations of endometriosis in young women with chronic pelvic pain (CPP) refractory to conventional medical therapy. METHODS: This prospective clinical interventional study was conducted in two general and private hospitals in the city of Al-Karak in Jordan. A total of 28 female patients aged ≤21 who had CPP refractory to conventional medical therapy were recruited during the years 2010-2014. The intervention used in the study was laparoscopy. Endometriosis was staged according to the American Society for Reproductive Medicine classification. The main outcome measures were the presence and stage of endometriosis at laparoscopy, the presence of cold intolerance, and the severity and duration of pain symptoms. RESULTS: The mean age of participants was 18.4 (range 15 to 21). Endometriosis was found in 20 of 28 participants (71.4%), as follows: stage I, 9 of 20 (45.0%); stage II, 8 of 20 (40%); stage III, 2 of 21 (10%); and stage IV, 1 of 21 (5%). Notably, 16 of 28 (57.1%) of all participants reported cold intolerance, including 14 of 20 (70%) with endometriosis and 2 of 8 (25%) without endometriosis (Fisher exact [1-tail] P = 0.039). There was no association between stage of disease and age distribution (≤18 and >19 to 21; P = 0.7) or with duration of symptoms (≤2 and >2 years) and the presence of cold intolerance (P > 0.05). However, severity of pain symptoms (<7 vs. ≥7, as measured by the visual analogue scale [VAS]) was associated significantly with stage of disease (P = 0.011). CONCLUSION: The prevalence of endometriosis among young women with CPP refractory to conventional therapy was high, mainly in the mild stage. Cold intolerance was highly associated with endometriosis.
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Endometriosis , Dolor Intratable , Dolor Pélvico , Adolescente , Adulto , Frío/efectos adversos , Endometriosis/complicaciones , Endometriosis/epidemiología , Femenino , Humanos , Jordania , Dolor Intratable/complicaciones , Dolor Intratable/epidemiología , Dolor Pélvico/complicaciones , Dolor Pélvico/epidemiología , Estudios Prospectivos , Adulto JovenRESUMEN
Malignant psoas syndrome is a rare malignant condition presenting as lumbosacral plexopathy and painful fixed flexion of the hip. Metastasis to the psoas muscle is observed, which damages the nerve bundles in the lumbosacral plexuses. The syndrome presents as refractory lower back pain with several other neurological symptoms. The pain is difficult to control because it is a mixture of nociceptive and neuropathic pain, which indicates that treatment requires a versatile approach. The authors report a case of severe back pain caused by metastasis to the psoas muscle of advanced gastric cancer in a patient who underwent palliative radiotherapy under epidural analgesia. Despite conventional analgesics and subcutaneous oxycodone, he had difficulties in maintaining supine position because of the back pain and had a problem to receive radiotherapy, which required him to stay still in the same position during the treatment. By epidural analgesia, he could remain in supine position and complete radiotherapy without increasing opioid administration. His back pain was improved after the radiotherapy. Epidural analgesia is an effective treatment choice for a patient who is unable to keep the position during palliative radiotherapy.
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Analgesia Epidural , Enfermedades Neurodegenerativas/tratamiento farmacológico , Manejo del Dolor/métodos , Dolor Intratable/tratamiento farmacológico , Neoplasias Gástricas/radioterapia , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Neurodegenerativas/complicaciones , Dolor Intratable/complicaciones , Cuidados Paliativos , Neoplasias Gástricas/complicaciones , SíndromeRESUMEN
Fluoroquinolones are widely prescribed antibiotics, used for various infectious etiologies. These antibiotics carry the possibility of the serious adverse effect of peripheral neuropathy, with a true incidence not known owing to its rare existence. Recently, the Food and Drug Administration (FDA) has required alterations to drug labels to highlight this adverse effect of fluoroquinolones. This is a case report of a single patient at an inpatient neurology service at an urban academic medical center in the United States. The patient is a 20-year-old male, with well-controlled type 1 diabetes mellitus, presenting with a short duration of bilateral lower extremity pain following a 10-day course of levofloxacin for suspected epididymitis. The patient was initially diagnosed with complex regional pain syndrome and treated with a variety of pain medications, including lidocaine infusions, hydromorphone, methadone, and ketamine infusions. After review of the patient's history and limited response to medical management, the patient's condition was reclassified as an adverse effect from fluoroquinolone treatment. Pain of unknown etiology can be perplexing, both for the physician and the patient. Reporting of similar incidents attributed to medication adverse effects will increase the awareness of this type of neuropathy, avoid future cases of misdiagnosis, and enable early detection and treatment.
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Fluoroquinolonas/efectos adversos , Levofloxacino/efectos adversos , Dolor Intratable/inducido químicamente , Dolor Intratable/complicaciones , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Enfermedades del Sistema Nervioso Periférico/complicaciones , Antibacterianos/efectos adversos , Humanos , Masculino , Adulto JovenRESUMEN
OBJECTIVE: Treating chronic testicular pain is often challenging, and few treatment options have been reported. We report a case of intractable testicular pain successfully treated with spinal cord stimulation (SCS). CASE: A 59-year-old male with a 40-year history of bilateral testicular pain after ruptured epididymitis presented for consultation after failing multiple medical and surgical treatments. Repeat genitofemoral nerve block gave him temporary relief. SCS trial to target this distribution resulted in complete pain relief, and the patient was referred for implantation. He reported continued relief nine months after implantation. DISCUSSION: This is the third reported case of intractable chronic testicular pain successfully treated with SCS. Although evidence is scarce, SCS appears to be a potential treatment for patients with testicular pain presenting with a clear distribution of pain.
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Dolor Intratable/complicaciones , Nervios Periféricos/fisiología , Estimulación de la Médula Espinal/métodos , Enfermedades Testiculares/complicaciones , Lateralidad Funcional , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Nonpharmacologic interventions for symptom management in patients with rheumatoid arthritis are underinvestigated. Limited data suggest that aromatherapy massage and reflexology may help to reduce pain and fatigue in patients with rheumatoid arthritis. The aim of this study was to examine and compare the effects of aromatherapy massage and reflexology on pain and fatigue in patients with rheumatoid arthritis. The study sample was randomly assigned to either an aromatherapy massage (n = 17), reflexology (n = 17) or the control group (n = 17). Aromatherapy massage was applied to both knees of subjects in the first intervention group for 30 minutes. Reflexology was administered to both feet of subjects in the second intervention group for 40 minutes during weekly home visits. Control group subjects received no intervention. Fifty-one subjects with rheumatoid arthritis were recruited from a university hospital rheumatology clinic in Turkey between July 2014 and January 2015 for this randomized controlled trial. Data were collected by personal information form, DAS28 index, Visual Analog Scale and Fatigue Severity Scale. Pain and fatigue scores were measured at baseline and within an hour after each intervention for 6 weeks. Pain and fatigue scores significantly decreased in the aromatherapy massage and reflexology groups compared with the control group (p < .05). The reflexology intervention started to decrease mean pain and fatigue scores earlier than aromatherapy massage (week 1 vs week 2 for pain, week 1 vs week 4 for fatigue) (p < .05). Aromatherapy massage and reflexology are simple and effective nonpharmacologic nursing interventions that can be used to help manage pain and fatigue in patients with rheumatoid arthritis.
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Aromaterapia , Artritis Reumatoide/terapia , Fatiga/terapia , Masaje , Dolor Intratable/terapia , Adolescente , Adulto , Artritis Reumatoide/complicaciones , Artritis Reumatoide/enfermería , Fatiga/complicaciones , Fatiga/enfermería , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor Intratable/complicaciones , Dolor Intratable/enfermería , Aceites de Plantas , Resultado del Tratamiento , Escala Visual Analógica , Adulto JovenRESUMEN
Few studies have provided a detailed characterization of pain in patients with chronic obstructive pulmonary disease (COPD). The aims of this cross-sectional study were to describe the occurrence, intensity, locations, and level of interference associated with pain, as well as pain relief; to identify differences in demographic, clinical, and symptom characteristics between COPD patients with and without pain; and to determine which demographic, clinical, and symptom characteristics were associated with average pain, worst pain, and pain interference. A total of 258 patients with COPD provided information on demographic characteristics; comorbidities; respiratory parameters including dyspnea; body mass index; and symptom characteristics (i.e., anxiety, depression, sleep disturbance, and fatigue). Pain was measured using the Brief Pain Inventory. Of these 258 COPD patients, 157 (61%) reported pain. Multiple linear regression analyses were performed to determine which demographic, clinical, and symptom characteristics were associated with average pain severity, worst pain severity, and mean pain interference. Lower stages of COPD were associated with higher worst pain and higher pain interference scores. Higher depression scores were associated with higher average pain and higher pain interference scores. In addition, higher number of pain locations was associated with higher average and higher worst pain severity scores. Findings from this study confirm that pain is a significant problem and highlights the need for specific pain management interventions for patients with COPD. More research is needed about specific pain characteristics and symptoms to gain an increased knowledge about the causes of pain in these patients.
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Dimensión del Dolor , Dolor Intratable/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Dolor Intratable/complicaciones , Dolor Intratable/enfermería , Valor Predictivo de las Pruebas , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/enfermería , Encuestas y CuestionariosRESUMEN
OBJECTIVE: An association between endometriosis and psychiatric disturbances has been identified by some researchers. The purpose of this systematic review was to consolidate existing empirical findings to clarify the association between endometriosis and psychiatric conditions. DATA SOURCES: We searched three electronic databases (Medline/PubMed, PsychInfo, and ClinicalTrials.gov) using the following search items: "endometriosis" combined with "mood," "bipolar disorder," "major depressive disorder," "anxiety," "psychiatric," "psychosocial," "antidepressants," "antianxiety," "pharmacotherapy," or "psychotherapy." STUDY SELECTION: We included all relevant articles published in English. We identified 18 original research studies examining the association between endometriosis and psychiatric symptoms, with a combined total of 999 endometriosis patients being examined. DATA EXTRACTION AND SYNTHESIS: Of the 18 studies examined, 14 reported that endometriosis was associated with at least some aspect of reduced psychological functioning or mental health quality of life. Tabulation of raw frequencies of the studies using clinical diagnostic criteria and a comparison group revealed that at least 56.4% of women (44/78) with a diagnosis of endometriosis and 43.6% of women (48/110) without such a diagnosis met the criteria for a psychiatric disorder. CONCLUSION: The limited research suggests that women presenting with endometriosis are at risk for psychosocial disturbances or psychiatric distress. Whether such disruptions are a consequence of endometriosis, the associated chronic gynaecological pain, or another factor such as inflammation remains to be delineated. In the interim, women presenting with symptoms of endometriosis should also be screened for psychosocial and psychiatric disturbances.
Objectif : Une association entre l'endométriose et des perturbations psychiatriques a été identifiée par certains chercheurs. Cette analyse systématique avait pour but de consolider les constatations empiriques existantes en vue de clarifier l'association entre l'endométriose et des troubles psychiatriques. Sources de données : Nous avons mené des recherches dans trois bases de données électroniques (Medline/PubMed, PsychInfo et ClinicalTrials.gov) au moyen des termes suivants : « endometriosis ¼ en combinaison avec « mood ¼, « bipolar disorder ¼, « major depressive disorder ¼, « anxiety ¼, « psychiatric ¼, « psychosocial ¼, « antidepressants ¼, « antianxiety ¼, « pharmacotherapy ¼ ou « psychotherapy ¼. Sélection des études : Nous avons inclus tous les articles pertinents publiés en anglais. Nous avons identifié 18 études originales s'étant penchées sur l'association entre l'endométriose et des symptômes psychiatriques (pour un total combiné de 999 cas d'endométriose soumis à une analyse). Extraction et synthèse des données : Parmi les 18 études examinées, 14 ont signalé que l'endométriose était au moins d'une certaine façon associée à une atténuation du fonctionnement psychologique ou de la qualité de vie liée à la santé mentale. La tabulation des fréquences brutes de ces études au moyen de critères diagnostiques cliniques et d'un groupe de comparaison a révélé qu'au moins 56,4 % des femmes (44/78) ayant obtenu un diagnostic d'endométriose et 43,6 % des femmes (48/110) n'ayant pas obtenu un tel diagnostic satisfaisaient aux critères permettant d'établir la présence d'un trouble psychiatrique. Conclusion : Les recherches limitées semblent indiquer que les femmes qui présentent une endométriose sont exposées à des risques de perturbations psychosociales ou de détresse psychiatrique. La question de savoir si de telles perturbations sont une conséquence de l'endométriose, de la douleur gynécologique chronique connexe ou d'autres facteurs tels que l'inflammation demeure à élucider. Entre-temps, les femmes qui présentent des symptômes d'endométriose devraient également faire l'objet d'un dépistage visant des perturbations psychosociales et psychiatriques.
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Endometriosis/psicología , Trastornos Mentales/psicología , Dolor Intratable/psicología , Endometriosis/complicaciones , Femenino , Humanos , Trastornos Mentales/complicaciones , Dolor Intratable/complicaciones , Servicios de Salud para MujeresRESUMEN
OBJECTIVE: Sexual pain secondary to provoked vestibulodynia (PVD) is a chronic pain condition affecting up to 16% of women. Women with PVD may report other chronic pain conditions. The goals of this study were (1) to identify the prevalence of self-reported chronic pain conditions in a sample of women with a diagnosis of PVD and seeking treatment, and (2) to compare demographic and clinical characteristics and health care needs of women with PVD alone and women with PVD and two or more self-reported chronic pain conditions. METHODS: We assessed the characteristics of 236 women with PVD alone and 55 women with PVD and comorbid chronic pain using a standardized questionnaire, the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Pain Vigilance and Awareness Questionnaire, and the Female Sexual Distress Scale. RESULTS: Compared with women with PVD alone, women with PVD and other concurrent pain reported a significantly longer duration of pain, pain radiating to other parts of the vulva, and pain interfering in a variety of daily activities. This group was also significantly more likely to have seen more gynaecologists, and to have had more office visits with their gynaecologist than women with PVD alone. They were more likely to have tried anticonvulsants, antidepressants, and stress/relaxation therapy for their PVD and were also more likely to have allergies and skin sensitivities. Finally, this group of women had higher symptoms of depression, trait anxiety, and showed a trend towards more pain vigilance. CONCLUSION: Taken together, these findings suggest that physicians caring for women with PVD and concurrent chronic pain must be alert to the potentially greater health needs among this subsample of women.
Objectif : La douleur sexuelle attribuable à la vestibulodynie provoquée (VDP) est un trouble de douleur chronique qui affecte jusqu'à 16 % des femmes. Les femmes qui présentent une VDP pourraient en venir à signaler d'autres troubles de douleur chronique. Cette étude avait pour objectif (1) d'identifier la prévalence des troubles de douleur chronique auto-signalés au sein d'un échantillon de femmes ayant obtenu un diagnostic de VDP et cherchant à obtenir un traitement; et (2) de comparer les caractéristiques démographiques et cliniques et les besoins en soins de santé des femmes qui ne présentent qu'une VDP et des femmes qui présentent une VDP et au moins deux troubles de douleur chronique auto-signalés. Méthodes : Nous avons évalué les caractéristiques de 236 femmes ne présentant qu'une VDP et de 55 femmes présentant une VDP et une douleur chronique comorbide au moyen d'un questionnaire standardisé, de l'Inventaire de dépression de Beck, du State-Trait Anxiety Inventory, du Pain Vigilance and Awareness Questionnaire et de la Female Sexual Distress Scale. Résultats : Par comparaison avec les femmes qui ne présentaient qu'une VDP, les femmes qui présentaient celle-ci et une autre douleur concomitante ont signalé une douleur d'une durée significativement prolongée, une douleur irradiant vers d'autres parties de la vulve et une douleur nuisant à diverses activités de la vie quotidienne. Les femmes de ce groupe étaient également significativement plus susceptibles que les femmes ne présentant qu'une VDP d'avoir consulté un plus grand nombre de gynécologues et de s'être rendues un plus grand nombre de fois au cabinet de leur gynécologue. Elles étaient plus susceptibles d'avoir fait l'essai d'anticonvulsivants, d'antidépresseurs et d'une thérapie anti-stress / de relaxation pour contrer leur VDP, et également plus susceptibles de connaître des allergies et des sensibilités cutanées. Enfin, les femmes de ce groupe présentaient des symptômes accrus de dépression, une anxiété réactionnelle et une tendance envers une vigilance accrue en ce qui concerne la douleur. Conclusion : Considérées dans leur ensemble, ces constatations semblent indiquer que les médecins qui offrent des soins à des femmes qui présentent une VDP et une douleur chronique concomitante doivent être sensibles aux besoins de santé potentiellement accrus au sein de ce sous-groupe de femmes.
Asunto(s)
Dolor Intratable/epidemiología , Aceptación de la Atención de Salud , Vulvodinia/epidemiología , Adulto , Colombia Británica/epidemiología , Comorbilidad , Demografía , Femenino , Humanos , Dimensión del Dolor , Dolor Intratable/complicaciones , Dolor Intratable/psicología , Prevalencia , Psicometría , Encuestas y Cuestionarios , Vulvodinia/complicaciones , Vulvodinia/psicologíaRESUMEN
INTRODUCTION: Idiopathic testicular/groin pain can be a difficult entity for children, their families, and caregivers. The role of interdisciplinary pain management has previously been demonstrated in treating chronic orchialgia at the present pediatric pain clinic. OBJECTIVE: To evaluate the role of interdisciplinary pain management in managing refractory orchialgia. It was hypothesized that children with refractory orchialgia might respond well. Interdisciplinary care was defined as that which crosses two medical disciplines such as a surgical specialty and specialist in analgesia. SUBJECTS AND METHODS: Pediatric patients were identified who were: ≥ 10 years old; evaluated in the pediatric urology clinic between 2002 and 2012; were diagnosed wtih ICD code 608.9 or had the diagnosis of male genital disorder NOS. Children were included if they presented with orchialgia without an identifiable cause and failed conservative management (rest, scrotal support, Sitz bath, timed voiding, constipation avoidance) including conventional anti-nociceptive analgesics (acetaminophen, non-steroidal anti-inflammatory drugs, opioids). Patient electronic medical records were reviewed retrospectively. RESULTS: Twenty-two children met inclusion criteria. Mean age was 13.7 years (range 10-17). Nearly half (45%) of the children had chronic medical conditions such as asthma, allergies, and obesity. Twenty-one of the 22 children were referred to the pediatric pain clinic; 15 were evaluated, and one refused treatment. All children evaluated in the pediatric pain clinic were initially offered an empiric anti-neuropathic anti-convulsant (i.e. gabapentin) and/or an anti-depressant (i.e. amitriptyline) before being offered a nerve block. Of the 14 children accepting treatment in the pediatric pain clinic, six were treated solely with an empiric anti-neuropathic anti-convulsant and/or anti-depressant; eight received medications followed by nerve block (seven ilioinguinal-iliohypogastric blocks, one spinal and ilioinguinal-iliohypogastric block) (see Fig. 1). A total of eight of the 14 children (57%) treated by the pain clinic had resolution of pain, with 50% of those treated with medications alone (three out of six children) responding (two responding to gabapentin and a tricyclic antidepressant, one to gabapentin alone); and five out of eight (63%) treated with medications and then nerve block (ilioinguinal-iliohypogastric block) responding. Of the eight children undergoing nerve block, five required more than one block. The time between each block ranged from 4 to 22.6 weeks. Response to nerve block required an average of 1.4 procedures (range 1-2); mean follow-up after nerve block was 2.4 months (range 0.1-4.8). DISCUSSION: Children with refractory orchialgia often have comorbidities that suggest a multidisciplinary approach would be useful for treating them. The present study found that the majority of children with refractory orchialgia treated in the pediatric pain clinic responded to management. Major limitations, however, included small cohort size and short follow-up, particularly in those children undergoing nerve block. There was also no objective assessment of pain improvement or improvement in quality of life, which could be rectified with a prospective study. CONCLUSION: Collaboration and early referral for interdisciplinary pain management as one of these multidisciplinary approaches may help to coordinate care and ease patient suffering.
Asunto(s)
Manejo del Dolor , Dolor Intratable/terapia , Enfermedades Testiculares/terapia , Adolescente , Niño , Enfermedad Crónica , Humanos , Masculino , Dolor Intratable/complicaciones , Dolor Intratable/diagnóstico , Estudios Retrospectivos , Enfermedades Testiculares/complicaciones , Enfermedades Testiculares/diagnóstico , Resultado del TratamientoRESUMEN
OBJECTIVES: The aim of the present study was to determine the effects of perceived pain on quality of sleep and life in patients hospitalized in a pain clinic. METHODS: Population of the present descriptive study composed of patients (>18 years old) treated as inpatients in the algology clinic of a university located at the city center of Sivas, who consented to participate in the study (122 patients). Data were collected through Personal Information Form, Visual Analog Scale (VAS), Pittsburg Sleep Quality Index (PSQI) and Short Form 36. Data were analyzed using independent t-test, Mann Whitney U test, Kruskal Wallis test and Pearson correlation test. Statistical significance level was set at p<0.05. RESULTS: A moderate negative correlation was found between VAS and three dimensions of SF-36, namely Physical Functioning, Role-Physical and Role-Emotional. VAS was weakly and negatively correlated to Vitality and Mental Health. There was a good linear correlation between VAS and quality of life (QoL), pain score while there was a moderate linear correlation between VAS and the total sleep score. It was found that quality of life was not statistically significantly correlated to General Health and Social Functioning. CONCLUSION: There is a relationship between pain, sleep quality and quality of life. Quality of sleep and life was found to decrease as the level of pain increased, and quality of life was affected negatively when the quality of sleep was poor. Applications towards resolving pain would have a positive effect on the quality of sleep and life.