ABSTRACT
The fecal microbiome of the horse is reflective of the large colon and plays an important role in the health of the horse. The microbes of the gastrointestinal tract digest fiber and produce energy for the host. Healthy horses have Firmicutes, Bacteroidetes, and Verrucromicrobia as the most common phyla. During gastrointestinal disease such as colic or colitis, the microbiome shows less diversity and changes in bacterial community composition.
Subject(s)
Colic , Horse Diseases , Microbiota , Horses , Animals , Colic/veterinary , Horse Diseases/microbiology , Bacteria , Feces/microbiologyABSTRACT
OBJECTIVE: This study examined which patient characteristics are associated with traveling further to attend a metropolitan, publicly funded pain management service, and whether travel distance was associated with differences in treatment profile, duration, and percentage of appointments attended. DESIGN: Cross-sectional observational cohort study. METHOD: Patients ≤70 years of age with a single referral between January 2014 and June 2018 who had not died within 12 months of their first appointment and who had a usual place of residence were included (N = 1,684; mean age = 47.2 years; 55.5% female). Travel distance was calculated with the HERE Routing API on the basis of historical travel times for each scheduled appointment. RESULTS: Median travel time was 27.5 minutes (Q1, Q3: 12.5, 46.2). Ordinal regression showed that women had 20% lower odds of traveling further, but people who were overweight or obese (odds ratio [OR] = 1.4-2.3), unemployed (OR = 1.27), or taking higher opioid dosages (OR = 1.79-2.82) had higher odds of traveling further. People traveling >60 minutes had fewer treatment minutes (median = 143 minutes) than people living within 15 minutes of the pain clinic (median = 440 minutes), and a smaller proportion of those traveling >60 minutes attended group programs vs. medical appointments only (n = 35, 17.0%) relative to those living within 15 minutes of their destination (n = 184, 32.6%). People living 16-30 minutes from the clinic missed the highest proportion of appointments. CONCLUSIONS: Although people traveling further for treatment may be seeking predominantly medical treatment, particularly opioid medications, the present findings highlight the need to further explore patient triage and program models of care to ensure that people living with persistent disabling pain can access the same level of care, regardless of where they live.
Subject(s)
Pain Clinics , Referral and Consultation , Cross-Sectional Studies , Female , Humans , Male , Middle AgedABSTRACT
BACKGROUND: Knee osteoarthritis is a major cause of pain and disability. Pain control is poor, with most patients remaining in moderate to severe pain. This may be because central causes of pain, a common contributor to knee pain, are not affected by current treatment strategies. Antidepressants, such as amitriptyline, have been used to treat chronic pain in other conditions. The aim of this randomised, double blind, controlled trial, is to determine whether low dose amitriptyline reduces pain in people with painful knee osteoarthritis over 3 months compared to benztropine, an active placebo. METHODS/DESIGN: One hundred and sixty people with painful radiographic knee osteoarthritis will be recruited via clinicians, local and social media advertising. Participants will be randomly allocated in a 1:1 ratio to receive either low dose amitriptyline (25 mg) or active placebo (benztropine mesylate, 1 mg) for 3 months. The primary outcome is change from baseline in knee pain (WOMAC pain subscale) at 12 weeks. Secondary outcomes include change in function (total WOMAC) and the proportion of individuals achieving a substantial response (≥ 50% reduction in pain intensity, measured by Visual Analog Scale, VAS, from no pain to worst pain imaginable, 0-100 mm) and moderate response (≥ 30% reduction in pain intensity, measured by VAS) at 12 weeks. Intention to treat analyses will be performed. Subgroup analyses will be done. DISCUSSION: This study will provide high level evidence regarding the effectiveness of low dose amitriptyline compared to benztropine in reducing pain and improving function in knee OA. This trial has the potential to provide an effective new therapeutic approach for pain management in knee osteoarthritis, with the potential of ready translation into clinical practice, as it is repurposing an old drug, which is familiar to clinicians and with a well described safety record. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry prior to recruitment commencing ( ACTRN12615000301561 , March 31, 2015, amended 14 December 2018, February 2021). Additional amendment requested 18 July 2021.
Subject(s)
Chronic Pain , Osteoarthritis, Knee , Amitriptyline , Australia , Benztropine , Chronic Pain/diagnosis , Chronic Pain/drug therapy , Double-Blind Method , Humans , Osteoarthritis, Knee/diagnostic imaging , Osteoarthritis, Knee/drug therapy , Randomized Controlled Trials as Topic , Treatment OutcomeABSTRACT
The purpose of this prospective, blinded, randomized clinical trial was to compare the effects of low dose detomidine to xylazine on recovery quality and duration in a castration procedure. Horses were administered either detomidine [0.015 mg/kg body weight (BW)] or xylazine (1.1 mg/kg BW) intravenously (IV) before IV induction with ketamine (2.2 mg/kg BW) and diazepam (0.05 mg/kg BW). Two anesthesiologists who were unaware of treatment allocation scored the recoveries using a simple descriptive scale (with a low number representing the most desirable recovery) and recoveries were timed. Horses in the detomidine group (n = 16) had a median recovery score of 16 (range: 11 to 26), whereas horses in the xylazine group (n = 12) had a median recovery score of 12 (range: 10 to 16) (P = 0.001). There was no difference in surgery time (P = 0.52), time from the end of surgery to standing (P = 0.45), or time from induction to standing (P = 0.48) between the groups.
Les effets de la xylazine ou de la détomidine lors d'utilisation comme sédatif pré-anesthésique sur la qualité et la durée de la récupération chez les chevaux soumis à une castration équine élective. Le but de cet essai clinique prospectif, en aveugle et randomisé était de comparer les effets de la détomidine à faible dose à la xylazine sur la qualité et la durée de la récupération dans une procédure de castration. Les chevaux ont reçu soit de la détomidine [0,015 mg/kg de poids corporel (PC)] soit de la xylazine (1,1 mg/kg de PC) par voie intraveineuse (IV) avant l'induction IV avec de la kétamine (2,2 mg/kg de PC) et du diazépam (0,05 mg/kg de PC). Deux anesthésistes qui ignoraient l'attribution du traitement ont noté les récupérations à l'aide d'une échelle descriptive simple (avec un petit nombre représentant la récupération la plus souhaitable) et les récupérations ont été chronométrées. Les chevaux du groupe détomidine (n = 16) avaient un score de récupération médian de 16 (éventail de valeurs : 11 à 26), tandis que les chevaux du groupe xylazine (n = 12) avaient un score de récupération médian de 12 (éventail de valeurs : 10 à 16) (P = 0,001). Il n'y avait aucune différence dans le temps de chirurgie (P = 0,52), le temps entre la fin de la chirurgie et la position debout (P = 0,45) ou le temps entre l'induction et la position debout (P = 0,48) entre les groupes.(Traduit par Dr Serge Messier).
Subject(s)
Anesthetics , Xylazine , Animals , Horses , Hypnotics and Sedatives/pharmacology , Imidazoles , Male , Orchiectomy/veterinary , Prospective Studies , Xylazine/pharmacologyABSTRACT
OBJECTIVES: To evaluate whether educating junior doctors and hospital pharmacists about analgesic prescribing improved discharge prescribing of opioids for opioid-naïve patients after surgical admissions. DESIGN: Cluster randomised controlled trial, undertaken during the first half of 2019. SETTING: The Alfred Hospital, a major Melbourne teaching hospital with 13 surgical units. PARTICIPANTS: Opioid-naïve patients discharged from surgical units after a stay of at least 24 hours. INTERVENTION: Surgical units were randomised to the intervention or control arms. Interns, residents, and clinical pharmacists assigned to intervention arm units attended education sessions, presented by the hospital analgesic stewardship pharmacist, about appropriate analgesic prescribing for patients in hospital surgical units. MAIN OUTCOME MEASURES: The patients prescribed slow release opioids on discharge from hospital during the baseline (1 February - 30 April 2018) and post-intervention periods (17 February - 30 April 2019). RESULTS: During the baseline period, 1369 intervention unit and 1014 control unit admissions were included in our analysis; during the evaluation period, 973 intervention unit and 706 control unit episodes were included. After adjusting for age, length of stay, pain score, acute pain service involvement, and use of immediate release opioids prior to admission, patients in the intervention group were prescribed slow release opioids at discharge less frequently than patients in the control group (adjusted odds ratio [aOR], 0.52; 95% CI, 0.35-0.77) and were more frequently discharged without any prescribed opioids following the intervention (aOR, 1.69; 95% CI, 1.24-2.30). Providing de-escalation plans was more frequent for intervention than control group patients prescribed slow release opioids on discharge post-intervention (OR, 2.36; 95% CI, 1.25-4.45). CONCLUSIONS: Specific education for clinicians and pharmacists about appropriate analgesic prescribing for surgical patients is effective in reducing prescribing of opioids at discharge. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12618000876291 (prospective).
Subject(s)
Analgesics, Opioid/therapeutic use , Education, Pharmacy/methods , Inappropriate Prescribing/prevention & control , Medical Staff, Hospital/education , Pharmacists/statistics & numerical data , Adult , Australia , Cluster Analysis , Drug Prescriptions/statistics & numerical data , Female , Hospitals, Teaching , Humans , Male , Pain, Postoperative/drug therapy , Patient Discharge/statistics & numerical data , Pharmacy Service, Hospital , Practice Patterns, Physicians'/statistics & numerical data , Prospective StudiesABSTRACT
OBJECTIVES: To evaluate the efficacy and safety of electroacupuncture in reducing opioid consumption in patients with chronic musculoskeletal pain. DESIGN: A randomized, participant-assessor-blinded, three-arm trial. SETTING: Participants from three pain clinics and from the public. SUBJECTS: One hundred and eight adults with chronic pain who were taking opioids. METHODS: All participants received pain and medication management education. Participants were randomly allocated to electroacupuncture (N = 48), sham electroacupuncture (N = 29), or education alone (N = 31) to receive relevant treatment for 12 weeks. The last group received electroacupuncture during the three-month follow-up. Analysis of covariance and paired t tested were used. RESULTS: Opioid dosage, that is, the primary outcome measure, was reduced by 20.5% (P < 0.05) and 13.7% (P < 0.01) in the two acupuncture groups and by 4.5% in the education group at the end of the treatment phase, but without any group difference. Intensity of pain of all three groups did not change over time. No group differences were found in dosage of nonopioid analgesics, pain intensity, function, and opioid-related adverse events. During follow-up, the education group had a 47% reduction of opioids after a course of electroacupuncture. Adverse events to electroacupuncture were minor. CONCLUSION: It is safe to reduce opioid medication use in patients with chronic pain. Due to the small sample size, we could not confirm if electroacupuncture offers extra benefit in addition to education. This nondrug therapy could be a promising adjunct to facilitate opioid tapering in patients who are willing to reduce opioids.
Subject(s)
Analgesics, Opioid/therapeutic use , Chronic Pain/therapy , Electroacupuncture , Musculoskeletal Pain/therapy , Pain Management/methods , Adult , Aged , Female , Humans , Male , Middle Aged , Patient Education as TopicABSTRACT
OBJECTIVE: While much research has addressed asthma medication adherence, few have combined quantitative and qualitative data, and none has addressed the triad of child, caregiver, and clinician simultaneously. This study assessed, with mixed methods, barriers to medication adherence within this triad. METHODS: We conducted interviews with publicly-insured children with asthma, their caregivers, and their primary-care clinicians. Children (7-17 years) had been prescribed daily inhaled corticosteroids and visited the ED for asthma (past year). Participants answered open-ended and survey questions, rating suggested barriers to medication use (never vs. ever a barrier). McNemar's tests compared report of barriers by each group (children, caregivers, clinicians), and assessed concordance within triads. RESULTS: Fifty child-caregiver dyads participated (34 clinicians). Children (40% female; median age 10 years) had mostly non-Hispanic black (90%) caregivers with less than or equal to high-school education (68%). For barriers, children and clinicians were more likely than caregivers to report medications running out. Clinicians were also more likely to cite controllers being a "pain to take" (vs. children) and forgetfulness (vs. caregivers) (all p < .05). There was a lack of within-triad concordance regarding barriers to adherence, especially regarding medication running out, worrying about taking a daily medication, and medication being a pain to take. Qualitative data revealed themes of competing priorities, home routines, and division of responsibility as prominent contributors to medication adherence. CONCLUSIONS: There was significant disagreement among children, caregivers, and clinicians regarding barriers to daily use of asthma medications. To tailor asthma management conversations, clinicians should understand family-specific barriers and child-caregiver disagreements.
Subject(s)
Asthma/drug therapy , Attitude of Health Personnel , Caregivers/psychology , Medication Adherence/psychology , Adolescent , Black or African American , Child , Female , Humans , Interviews as Topic , Male , Medication Adherence/statistics & numerical data , Severity of Illness Index , Socioeconomic Factors , Urban PopulationABSTRACT
INTRODUCTION: Receipt of housing assistance from the US Department of Housing and Urban Development (HUD) is associated with improved health among adults and lower rates of unmet medical need among adults and young children. However, it is unclear whether HUD housing assistance is associated with healthier behaviors. The objective of our study was to assess whether participation in HUD housing assistance programs is associated with increased physical activity among low-income adults. METHODS: In 2017, we pooled cross-sectional data from the 2004-2012 National Health Interview Survey (NHIS) linked to administrative records of HUD housing assistance participation. Our primary sample was low-income adults (aged ≥18; <200% of federal poverty level). Using multivariate logistic regression, we calculated the odds of being physically active (≥150 min/week of moderate-intensity activity or equivalent combination of moderate- and vigorous-intensity activity) among current HUD housing assistance residents compared with a control group of future residents (adults who would receive assistance within the next 2 years). In a secondary analyses, we examined neighborhood socioeconomic status as a modifier and conducted a subanalysis among nonsenior adults (aged <65). RESULTS: Among all low-income adults, the adjusted odds of being physically active were similar for current and future residents (odds ratio =1.17; 95% confidence interval, 0.95-1.46). Among nonseniors, current residents were more likely to be physically active than future residents (odds ratio = 1.47; 95% confidence interval, 1.10-1.97). Associations did not differ by neighborhood socioeconomic status. CONCLUSION: Receiving HUD housing assistance is associated with being physically active among nonsenior low-income adults.
Subject(s)
Exercise , Poverty , Public Assistance , Public Housing , Adolescent , Adult , Cross-Sectional Studies , Health Behavior , Health Knowledge, Attitudes, Practice , Health Status , Humans , Logistic Models , Odds Ratio , Poverty Areas , Young AdultABSTRACT
Objective: Chronic pain is experienced by one in five Australians and is estimated to be the nation's third most costly health problem. In 2013, a chronic pain treatment outcomes registry was established, with the goals of evaluating treatment of chronic pain in multidisciplinary centers, establishing a benchmarking system to drive quality improvement and providing answers to important questions regarding types of treatment ("dose," intensity, and response) and which treatment is appropriate for different patients. This paper describes the development and the first-phase implementation of the registry. Methods: A minimum data set of primarily patient-rated measures was developed for use within pain management services. Governance structures and protocols for data collection were established, and software and resources created, to support pain management services. Results: Data collection commenced in 21 centers in Australia and is being implemented in over 20 others across Australia and New Zealand within the first two years. Feedback in the initial phase has already resulted in improvements to the software and reports, as well as minor changes to the data set. Centers have submitted high-quality data describing the demographic and clinical characteristics of patients referred to specialist pain services. Conclusions: The electronic Persistent Pain Outcomes Collaboration has been established for Australasia and is strongly supported by specialist societies and consumer groups. The next phase will increase the proportion of follow-up data in order to realize the registry's goals of evaluation, benchmarking, and research to improve outcomes and services for patients experiencing persistent pain.
Subject(s)
Intersectoral Collaboration , Pain Measurement/methods , Pain/diagnosis , Pain/epidemiology , Adult , Australasia/epidemiology , Female , Humans , Male , Middle Aged , Pain Management/methodsABSTRACT
BACKGROUND: Opioids are increasingly prescribed for chronic noncancer pain across the developed world. Clinical guidelines for management of these patients focus on over-use. However, research into other types of long-term medication indicates that many patients minimize drug use whenever possible. OBJECTIVE: To identify the varying influences on patients' decisions about their use of prescribed opioids and explore whether concepts of resistance and minimization of intake apply to these patients. DESIGN: A multiprofessional team performed a qualitative interview study using the constant-comparative method. Patient's decision making was explored in depth and with a thematic analysis utilizing a published "Model of medicine-taking." SETTING AND PARTICIPANTS: A purposive sample of 20 participants drawn from two pain clinics in Melbourne, Australia. The sample was biased toward patients interested in nonmedication pain management options. FINDINGS: Patients' needs to obtain relief from severe pain, maintain function, and minimize side effects could lead to under-use as well as over-use of prescribed opioids. In keeping with the published Model of medicine-taking, resistance to taking opioids was a common and important influence on behavior. In the face of severe chronic pain, many participants used a variety of strategies to evaluate, avoid, reduce, self-regulate, and replace opioids. Furthermore, participants perceived a resistance to opioids within the system and among some healthcare professionals. This sometimes adversely affected their adherence. CONCLUSIONS: Both patients and doctors exhibit aspects of resistance to the use of prescribed opioids for chronic noncancer pain, suggesting that this shared concern could be the basis of a productive therapeutic alliance to improve communication and shared decision making. SUMMARY: Clinical guidelines for opioids use for chronic noncancer pain focus on over-use. Our qualitative interview study found that many patients resisted and minimized the use of opioids. Using a published "Model of medicine-taking," we identified various influences on patient decision making. Both patients and doctors had concerns about using opioids for chronic noncancer pain. These could be the basis of a productive therapeutic alliance to improve communication and shared decision making.
Subject(s)
Analgesics, Opioid/therapeutic use , Chronic Pain/drug therapy , Decision Making , Health Knowledge, Attitudes, Practice , Medication Adherence , Adult , Aged , Female , Humans , Male , Middle Aged , Qualitative ResearchABSTRACT
OBJECTIVE AND DESIGN: Individuals seeking treatment for chronic pain in multidisciplinary pain management services are typically already on high doses of pain medications. This cross-sectional cohort study of patients with long-term chronic pain examined profiles of polypharmacy and pain medication-related harm exposure. SETTING: Multidisciplinary pain management service. SUBJECTS: The cohort comprised 224 patients taking medications for their pain (1-9 medications; mean = 3.19) with an average pain duration of 10.33 years. METHODS: The Medication Quantification Scale III (MQS-III) was used to examine potential harm exposure. We generated detriment scores for simple analgesics, adjunctive therapies (e.g., anticonvulsants), opioids, and benzodiazepines. RESULTS: The total MQS-III score was correlated with the total number of medications, but not with age. Almost 10% of patients took medications from all four categories, with most taking medications from two (37%) to three (35%) classes. Eighty percent of patients were taking opioids, accounting for 41% of total MQS scores. Five primary profiles of potential medication-related harms were identified: high harm from all medication categories (N = 12); above average harm from single category-simple analgesics (N = 76), adjunctive analgesics (N = 59), or opioids (N = 46); and above average opioid and benzodiazepine harm (N = 31). CONCLUSIONS: While treatment with multiple medications for synergistic or adjunctive effects may assist in medical management of chronic pain, this approach generates increased potential harm exposure. We show that the majority of detriment comes from medications other than opioids and highlight the importance of profiling all pain medications contributing to polypharmacy in clinical pain studies.
Subject(s)
Analgesics, Opioid/administration & dosage , Chronic Pain/diagnosis , Chronic Pain/drug therapy , Pain Management/methods , Polypharmacy , Adult , Aged , Aged, 80 and over , Analgesics/administration & dosage , Analgesics/adverse effects , Analgesics, Opioid/adverse effects , Anticonvulsants/administration & dosage , Anticonvulsants/adverse effects , Cohort Studies , Combined Modality Therapy/methods , Cross-Sectional Studies , Female , Humans , Male , Middle AgedABSTRACT
The objective of this case series was to characterize the population, case presentations, and outcomes of 28 equids diagnosed with cleft palate over a 25-year period. The incidence of cleft palate was 0.04%. The median age at presentation was 2 mo (range: 1 d to 3 y). Fifty percent of the animals were < 2 mo old, 21% were ≥ 2 mo but < 1 y old, and 29% were 1 y of age or older. Males and females were nearly equally represented. Short-term outcomes included euthanasia in 50%, surgical repair in 11%, supportive care in 4%, and no treatment in 32% of cases; 46% of the animals survived to discharge. Defects involving both the hard and soft palate and/or aspiration pneumonia generally had less favorable outcomes. Though cleft palate is rare in horses, it should be considered as a differential diagnosis in horses of all ages with nasal discharge, a cough, a history of recurrent respiratory infections, poor growth, or chronic submandibular lymphadenopathy. Endoscopic evaluation of the pharynx may aid in earlier diagnosis and prognostication for owners.
Caractéristiques cliniques des chevaux et des poulains diagnostiqués avec une fente palatine dans une population de référence : 28 cas (19882011). L'objectif de cette série de cas était de caractériser la population, la présentation des cas et les résultats de 28 équidés diagnostiqués avec une fente palatine sur une période de 25 ans. L'incidence de la fente palatine était de 0,04 %. L'âge moyen à la présentation était de 2 mois (plage : 1 jour à 3 ans). Cinquante pour cent des animaux étaient âgés de < 2 mois, 21 % étaient âgés de ≥ 2 mois mais avaient < 1 an et 29 % avaient 1 an ou plus. Les mâles et les femelles affichaient une représentation pratiquement égale. Les résultats à court terme incluaient l'euthanasie dans 50 % des cas, la réparation chirurgicale dans 11 % des cas, des soins de soutien dans 4 % des cas et aucun traitement dans 32 % des cas; 46 % des animaux ont survécu au congé. Les défauts du palais dur et mou et/ou de la pneumonie par aspiration affichaient généralement des résultats moins favorables. Même si la fente palatine est rare chez les chevaux, elle devrait être considérée comme un diagnostic différentiel chez les chevaux de tous les âges avec un écoulement nasal, une toux, une anamnèse d'infections respiratoires récurrentes, une mauvaise croissance ou une lymphadénopathie sous-mandibulaire chronique. Une évaluation endoscopique du pharynx peut faciliter le diagnostic et la pronostication anticipés pour les propriétaires.(Traduit par Isabelle Vallières).
Subject(s)
Cleft Palate/veterinary , Horse Diseases/pathology , Animals , Female , Horses , MaleSubject(s)
Early Detection of Cancer/statistics & numerical data , Housing/statistics & numerical data , Mass Screening/statistics & numerical data , Social Determinants of Health/statistics & numerical data , Aged , Cross-Sectional Studies , Female , Health Surveys , Humans , Male , Middle Aged , Poverty/statistics & numerical data , United StatesABSTRACT
BACKGROUND: Most of what we know about the psychiatric consequences of injury is limited to the first year. Determining the prevalence of and risk factors for psychiatric morbidity beyond one year will aid service development and facilitate timely diagnosis and treatment. The aim of this prognostic study was to determine the prevalence of mental disorders in the three years following serious injury and to identify risk factors for the onset of new disorders after 1 year. METHODS: Of 272 patients assessed in hospital following serious injury, 196 (72.1%) were reassessed at 3 years. Assessment involved gold standard semi-structured interviews for psychiatric diagnoses, risk factors for mental disorder, injury measures and pain scores. RESULTS: More than a quarter of all patients were diagnosed with at least one mood or anxiety disorder at some stage during the three years following their injury. The most common diagnoses were major depression (20.0%), generalised anxiety disorder (6.7%) and panic disorder (6.7%). For a third of these patients, the disorder appeared after 12 months, for which persistent physical disability was an independent risk factor. CONCLUSION: Although there is a necessary focus on the early detection and treatment of mental disorders after injury, attention to later onset disorders is also required for those with persistent pain and physical disability.
Subject(s)
Mental Disorders/diagnosis , Mental Disorders/epidemiology , Wounds and Injuries/psychology , Accidental Falls , Accidents, Traffic , Adult , Female , Humans , Injury Severity Score , Male , Middle Aged , Prevalence , Risk FactorsABSTRACT
In modern times there is increasing acceptance that music-based interventions are useful aids in the clinical treatment of a range of neurological and psychiatric conditions, including helping to reduce the perception of pain. Indeed, the belief that music, whether listening or performing, can alter human pain experiences has a long history, dating back to the ancient Greeks, and its potential healing properties have long been appreciated by indigenous cultures around the world. The subjective experience of acute or chronic pain is complex, influenced by many intersecting physiological and psychological factors, and it is therefore to be expected that the impact of music therapy on the pain experience may vary from one situation to another, and from one person to another. Where pain persists and becomes chronic, aberrant central processing is a key feature associated with the ongoing pain experience. Nonetheless, beneficial effects of exposure to music on pain relief have been reported across a wide range of acute and chronic conditions, and it has been shown to be effective in neonates, children and adults. In this comprehensive review we examine the various neurochemical, physiological and psychological factors that underpin the impact of music on the pain experience, factors that potentially operate at many levels - the periphery, spinal cord, brainstem, limbic system and multiple areas of cerebral cortex. We discuss the extent to which these factors, individually or in combination, influence how music affects both the quality and intensity of pain, noting that there remains controversy about the respective roles that diverse central and peripheral processes play in this experience. Better understanding of the mechanisms that underlie music's impact on pain perception together with insights into central processing of pain should aid in developing more effective synergistic approaches when music therapy is combined with clinical treatments. The ubiquitous nature of music also facilitates application from the therapeutic environment into daily life, for ongoing individual and social benefit.
ABSTRACT
OBJECTIVE: To describe the indications for and surgical technique of mastectomy of mares and to describe the outcome of 10 mares that underwent mastectomy in a retrospective case series. ANIMALS: 10 mares having disease of one or both mammary glands. CLINICAL PRESENTATION: Medical records (1995 to 2022) from 2 university teaching hospitals were searched to identify mares that had undergone unilateral or bilateral mastectomy. Data regarding history, signalment, diagnostic tests, preoperative treatment, surgical procedure, and postoperative management were reviewed. Follow-up information was obtained by interviewing the owners by telephone. RESULTS: One (n = 4 mares) or both mammary glands (6 mares) were excised for the following reasons: chronic bacterial mastitis (4), neoplasia (3), lymphangiectasia (1), pythiosis (1), and lymphoid hamartoma (1). None of the mares experienced intraoperative complications. The surgical site was closed primarily in 2 mares and left unsutured in 8 mares. Both sutured wounds developed a seroma, and 1 dehisced. The owners reported that the surgical wound, whether sutured or unsutured, was healed within 3 months. All mares returned to use for their intended purpose, but 3 mares were euthanized 2 to 4 years after surgery due to progression of disease. One mare drowned 1 year after discharge. CLINICAL RELEVANCE: Mastectomy can be an effective treatment for mares suffering from disease of one or both mammary glands when the mare is refractory to medical treatment.
ABSTRACT
Chronic pain and major depression commonly occur together. Major depression in patients with chronic pain is associated with decreased function, poorer treatment response and increased health care costs. The experience and expression of chronic pain vary between individuals, reflecting complex and changing interactions between physical, psychological and social processes. The diagnosis of major depression in patients with chronic pain requires differentiation between the symptoms of pain and symptoms of physical illness. Antidepressants and psychological therapies can be effective and should be delivered as part of a coordinated, cohesive, multidisciplinary pain management plan.
Subject(s)
Chronic Pain/psychology , Depressive Disorder, Major/epidemiology , Disease Management , Humans , Nociceptive Pain/epidemiology , Risk Factors , Stress, Psychological/epidemiologyABSTRACT
OBJECTIVE: Patients with pain 3 years after injury are at risk of lifetime pain. It is not known if the predictors of chronic pain at 3 years are the same as those for earlier time points or whether other factors become important. Clarifying these factors will aid our understanding of the development of long-term pain and further inform the development of models for screening and early intervention for pain in the aftermath of injury. DESIGN: Patients admitted to two trauma centers underwent a comprehensive physical and psychological assessment of known and potential risk factors for chronic pain during their index admission. Three years after injury, these patients were assessed for the presence of chronic pain (score was ≥5 on an 11-point numerical rating scale during the last episode of pain, and present in the last month and at least two times in the past week) and pain-related disability. Logistic regression was used to identify independent risk factors for the presence of chronic pain and disability. RESULTS: Two hundred and twenty patients (75.9% of the original cohort) were assessed at 3 years. Of these, 146 (66.7%) reported some pain and 52 (23.7%) reported chronic pain. Factors (present at the time of injury) that predicted chronic pain were lower socioeconomic status, pain severity, and injury severity. The predictive power of these combined factors was modest. CONCLUSIONS: Three years after serious injury, almost a quarter of patients report chronic pain, and more than a third report at least moderate pain-related disability. The predicative power of measures taken in the acute setting is not enough to support discharge screening alone as a method of triaging high-risk patients to early intervention.
Subject(s)
Chronic Pain/etiology , Wounds and Injuries/complications , Adult , Aged , Cohort Studies , Female , Humans , Injury Severity Score , Logistic Models , Longitudinal Studies , Male , Middle Aged , Risk Factors , Sex Factors , Socioeconomic Factors , Young AdultABSTRACT
AIMS: To investigate the progression of the illness and opioid journeys of people who are taking opioids for chronic non-cancer pain. METHODS: In-depth qualitative interviews were conducted with 20 people who were taking opioids for non-cancer pain. A purposive sample was drawn from patients attending two pain clinics in Melbourne, Australia. Transcripts were analyzed within case, as individual narratives, and across case, as a thematic analysis. Conceptual explanatory variables were developed. RESULTS: The experience of taking opioids for chronic non-cancer pain varies greatly between individuals and these diverse narratives-chaos, restitution, and quest narratives-raise questions about why and how some individuals find a way forward, while others remain in situations of chaotic and worsening ill health. We offer an explanation for this variability in terms of four key influences: support from individual health professionals and the health system; medical explanation or solutions; social support and social responsibilities; and the use of non-pharmaceutical interventions and self-help strategies. A unifying theme was the importance of maintaining hope. CONCLUSION: The four key factors influencing the progress of people taking opioids for chronic non-cancer pain are rooted in the provisions made by society for caring for this patient group and involve relationships between patient and provider, between patients and their social world, and between different providers and their professional knowledge. In our patient sample, effective support involved the provision and maintenance of hope, and professionals who are knowledgeable about opioids and chronic pain, good communicators, and cognizant with their patients' social support and responsibilities.
Subject(s)
Analgesics, Opioid/therapeutic use , Chronic Pain/drug therapy , Chronic Pain/psychology , Narration , Adult , Aged , Female , Humans , Male , Middle Aged , Qualitative ResearchABSTRACT
OBJECTIVE: To report technique for, and outcome after, nephrectomy through a ventral median celiotomy in equids. STUDY DESIGN: Case series. ANIMALS: Equids with unilateral renal disease (n = 6), aged 2 months to 18 years, weighing 90-434 kg. METHODS: A ventral median celiotomy was used to access the left or right kidney. To facilitate surgical exposure, the small intestine was reflected towards the diaphragm using laparotomy sponges and the ascending colon was exteriorized and in some cases evacuated. The peritoneum over the affected kidney was incised and blunt dissection used to free the kidney from the retroperitoneal fat, then the renal artery, vein, and ureter were isolated and ligated. Abdominal lavage with sterile saline solution was performed before abdominal closure. RESULTS: Four horses, 1 donkey, and 1 mule had unilateral nephrectomy to treat verminous nephritis (1), idiopathic hematuria (1), and ectopic ureter (4). A ventral median approach provided adequate access to the kidney in all 6 cases. Two horses had postoperative complications (peritonitis, chylous abdominal effusion) that resolved with medical therapy. No complications attributable to nephrectomy were reported by the owners upon follow-up 1-8 years after surgery. CONCLUSIONS: A ventral median approach for nephrectomy can be used for unilateral nephrectomy in equids weighing up to 434 kg.