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1.
Artigo em Russo | MEDLINE | ID: mdl-34481441

RESUMO

Nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants (MR) are successfully used to relieve pain, both in monotherapy and in combinations. The use of fixed drug combinations not only greatly facilitates daily clinical practice and increases patient adherence, but due to the potentiation of pharmacological effects, it allows to achieve better treatment results. This paper presents 3 clinical cases of successful inpatient use of a fixed combination of diclofenac 75 mg and orphenadrine 30 mg in the form of an infusion solution (NEODOLPASSE) for relief of acute back musculoskeletal pain syndrome.


Assuntos
Dor Aguda , Diclofenaco , Dor Aguda/tratamento farmacológico , Anti-Inflamatórios não Esteroides/uso terapêutico , Diclofenaco/uso terapêutico , Humanos , Orfenadrina/uso terapêutico , Medição da Dor
2.
BMC Musculoskelet Disord ; 22(1): 666, 2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34372820

RESUMO

BACKGROUND: Chronic back pain is known to be associated with altered tactile acuity. Tactile acuity is measured using the Two-Point Discrimination (TPD) test in both clinical and research settings. In subjects with chronic low back pain, the TPD threshold (TPDT) is increased and is associated with persistent pain. It remains unknown, however, whether TPDT is also altered in cases of clinical acute pain, or whether it could be used as a predictor of future pain and disability at an early stage of LBP. The main objective of this study was to investigate the predictive value of baseline TPDT for pain and disability at 3 and 6 months after the onset of acute LBP. The TPDT in acute low back pain (LBP) and the development of TPDT over 6 months has also been assessed. METHODS: LBP participants (n = 124) with acute LBP (< 4 weeks) were included. Subjects were examined within 4 weeks of pain onset and followed-up after 3 and 6 months of pain onset. Horizontal and vertical TPDTs of the lower back were collected. Linear mixed models were subsequently used to evaluate the association of TPDT with pain and disability over time. RESULTS: The vertical TPDT showed a mean (SD) of 4.9 cm (1.6) and the horizontal TPDT a mean (SD) of 6.0 cm (1.5) at baseline. The vertical TPDT altered from baseline up to 6 months from 4.9 to 4.6 cm and the horizontal TPDT from 6.0 to 5.4 cm. The association between the TPDT and the Oswestry Disability Index (ODI) after 6 months was moderate. Linear mixed models revealed no association between TPDT, pain and disability over the progression of LBP. CONCLUSION: TPDTs appear to be raised in subjects with acute LBP. However, our study revealed no predictive capability of the TPDT for disability and pain. No comparisons are possible in the absence of similar studies, indicating the need for further research is in this area.


Assuntos
Dor Aguda , Dor Lombar , Dor Aguda/diagnóstico , Dor Aguda/tratamento farmacológico , Dor Aguda/epidemiologia , Avaliação da Deficiência , Humanos , Dor Lombar/diagnóstico , Dor Lombar/tratamento farmacológico , Dor Lombar/epidemiologia , Estudos Prospectivos
3.
Nurs Clin North Am ; 56(3): 357-367, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34366156

RESUMO

The opioid epidemic skyrocketed around 2017 when many pharmaceutical companies guaranteed effective pain relief with nonaddictive properties of prescription opioids. However, this has proven to be inadequate because opioid misuse has increased in the United States. These catastrophic consequences led many providers to take on a different approach to pain management in the acute and chronic setting. In the last few years, a great deal of research has focused more on a multimodal pain management approach, in hopes to decrease the rate of opioid misuse and related overdoses and help assist in putting an end to this public health crisis.


Assuntos
Transtornos Relacionados ao Uso de Opioides/epidemiologia , Manejo da Dor/métodos , Uso Indevido de Medicamentos sob Prescrição/prevenção & controle , Dor Aguda/tratamento farmacológico , Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Humanos , Padrões de Prática Médica , Estados Unidos
4.
Ned Tijdschr Geneeskd ; 1652021 05 19.
Artigo em Holandês | MEDLINE | ID: mdl-34346575

RESUMO

Topical NSAIDs are currently recommended in several national and international guidelines for knee osteoarthritis, hand osteoarthritis and acute musculoskeletal pain. However, there is still widespread skepticism about the effectiveness of this treatment. This article discusses different reasons for this skepticism, a short summary of the pharmacokinetics and pharmacodynamics of topical NSAIDs and an overview of available evidence regarding efficacy and safety. Based on this evidence topical NSAIDs have a clear place in the treatment of knee and hand osteoarthritis and acute musculoskeletal pain. Due to less systemic side effects they should be recommended before an oral NSAID is considered. Topical NSAIDs might even be an option for patients with contra-indications for oral NSAIDs. There is a large variety of available topical NSAIDs. Of the available topical NSAIDs in the Netherlands, diclofenac gel seems the most sensible choice.


Assuntos
Dor Aguda , Dor Musculoesquelética , Osteoartrite do Joelho , Administração Tópica , Anti-Inflamatórios não Esteroides/efeitos adversos , Diclofenaco , Humanos , Osteoartrite do Joelho/tratamento farmacológico
6.
Scand J Trauma Resusc Emerg Med ; 29(1): 121, 2021 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-34419130

RESUMO

BACKGROUND: Physical trauma is associated with mortality, long-term pain and morbidity. Effective pain management is fundamental in trauma care and opioids are indispensable for treating acute pain; however, the use and misuse of prescribed opioids is an escalating problem. Despite this, few studies have been directed towards trauma patients in an early phase of rehabilitation with focusing on experiences and perspectives of health and recovery including pain and persistent use of prescribed opioids with abuse potential. To explore pre- and post-discharge trauma care experiences, including exposure to opioids, physical trauma survivors were recruited from a major trauma centre in Norway that provides the highest level of surgical trauma care. METHOD: Qualitative exploratory study. Individual semi-structured interviews were conducted among 13 trauma patients with orthopedic injuries, known to be associated with severe pain, six weeks post-discharge. The interviews were recorded, transcribed verbatim, and thematically analyzed with an interdisciplinary approach. RESULTS: The overarching theme was that discharge from the trauma centre and the period that immediately followed were associated with feelings of insecurity. The three main themes that were identified as contributing to this was (a) unmet information needs about the injury, (b) exposure to opioids, and (c) lack of follow-up after discharge from the hospital. Participants experienced to be discharged with prescribed opioids, but without information about their addictive properties or tapering plans. This, and lack of attention to mental health and psychological impact of trauma, gave rise to unmet treatment needs of pain management and mental health problems during hospitalization and following discharge. CONCLUSION: The findings from this study suggest that in addition to delivery of high-quality biomedical trauma care, health professionals should direct more attention to psychosocial health and safe pain management, including post-discharge opioid tapering and individually tailored follow-up plans for physical trauma survivors.


Assuntos
Dor Aguda , Analgésicos Opioides , Assistência ao Convalescente , Analgésicos Opioides/uso terapêutico , Seguimentos , Humanos , Alta do Paciente , Sobreviventes , Centros de Traumatologia
7.
Medicina (Kaunas) ; 57(8)2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34440950

RESUMO

Background and Objectives: The current options for acute pain control of vertebral compression fracture include hard brace, vertebroplasty, early surgery, and analgesic injection. We hypothesize that the gray ramus communicans nerve block (GRNB) controls the acute pain experienced during vertebral compression fractures. This study assessed the time course of pain control after injection and evaluated the risk factors affecting pain control failure. Materials and methods: Sixty-three patients (24 male, 66.19 ± 15.17 y) with a thoracolumbar vertebral fracture at the T10-L5 spine, who presented to our hospital from November 2018 to October 2019, were included in this retrospective cohort study. GRNB was performed within 1 week of the trauma. The patients were followed up on days 3, 14, 30, 90, and 180 and assessed with the serial visual analog scale (VAS, resting and motion), Oswestry Low Back Disability (ODI) questionnaire, and Roland-Morris Disability Questionnaire (RDQ). The failure group was defined by the need for an additional block or cement injection after a single GRNB. The failure group's risk factors, such as body mass index, initial thoracolumbar injury classification and severity score, Kummel's disease, age, bone marrow density (BMD), and underlying disease, were analyzed. Results: The motion VAS score improved from preoperative to three months post-procedure, but the resting VAS was affected by the procedure for only three days. The quality of life index improved at postoperative six months. A lower BMD was the only risk that affected treatment failure in the logistic regression analysis (p = 0.0038). Conclusion: The effect of GRNB was maintained even at three months after trauma based on motion VAS results. The only risk factor identified for GRNB failure was lower BMD.


Assuntos
Dor Aguda , Fraturas por Compressão , Bloqueio Nervoso , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Fraturas por Compressão/complicações , Fraturas por Compressão/cirurgia , Humanos , Masculino , Fraturas por Osteoporose/cirurgia , Qualidade de Vida , Estudos Retrospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
8.
Adv Emerg Nurs J ; 43(3): 217-224, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34397500

RESUMO

Acute pain is a common presenting complaint in the emergency department (ED) and is most often treated with opioid or nonopioid analgesia. However, studies have shown that receiving analgesia alone does not always influence patient satisfaction with pain management in the ED. Pain anxiety and catastrophizing have been shown to affect pain intensity and patients' response to analgesia. The objective of this study was to determine whether a brief therapeutic conversation would improve patient satisfaction with pain management compared with standard care for adult patients presenting to the ED with moderate to severe acute pain. Adult (18 years or older) patients presenting to the ED with moderate to severe acute pain were randomized to either the standard care group or the intervention group. Patients in the intervention group participated in a brief therapeutic conversation with an ED nurse to discuss their perceived cause of pain, level of anxiety, and expectations of their pain management. Prior to discharge, all patients were asked to complete a self-reported, 9-item questionnaire to assess their level of satisfaction with their overall ED experience. A total of 166 patients (83 in each group) were enrolled. Patient satisfaction with ED pain management and the proportion of patients who received analgesia in the ED were similar in both the control (n = 57; 68.7%) and intervention (n = 58; 69.9%) groups (Δ 1.2%; 95% CI [12.6, 15]). Qualitative findings demonstrate that patients place high importance on acknowledgment from ED staff and worry about the unknown cause of pain. This study suggests that patient satisfaction with pain management in the ED is multifactorial and complex. Further research should investigate additional methods of integrating nurse-led interventions into the care of patients in acute pain.


Assuntos
Dor Aguda/enfermagem , Serviço Hospitalar de Emergência , Relações Enfermeiro-Paciente , Manejo da Dor/enfermagem , Satisfação do Paciente , Adulto , Idoso , Enfermagem em Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Inquéritos e Questionários
9.
Pain ; 162(9): 2397-2404, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34448753

RESUMO

ABSTRACT: Pain is a subjective experience with significant individual differences. Laboratory studies investigating pain thresholds and experimental acute pain have identified structural and functional neural correlates. However, these types of pain stimuli have limited ecological validity to real-life pain experiences. Here, we use an orthodontic procedure-the insertion of an elastomeric separator between teeth-which typically induces mild to moderate pain that peaks within 2 days and lasts several days. We aimed to determine whether the baseline structure and resting-state functional connectivity of key regions along the trigeminal nociceptive and pain modulatory pathways correlate with subsequent peak pain ratings. Twenty-six healthy individuals underwent structural and resting-state functional MRI scanning before the placement of a separator between the first molar and second premolar, which was kept in place for 5 days. Participants recorded pain ratings 3 times daily on a 100-mm visual analogue scale. Peak pain was not significantly correlated with diffusion metrics of the trigeminal nerve or gray matter volume of any brain region. Peak pain did, however, positively correlate with baseline resting-state functional connectivity between the thalamus contralateral to the separator and bilateral insula, and negatively correlated with connectivity between the periaqueductal gray (PAG) and core nodes of the default mode network (medial prefrontal and posterior cingulate cortices). The ascending (thalamic) nociceptive and the descending (PAG) pain modulatory pathways at baseline each explained unique variation in peak pain intensity ratings. In sum, preinterventional functional neural architecture of both systems determined the individual pain experience to a subsequent ecologically valid pain stimulus.


Assuntos
Dor Aguda , Descanso , Dor Facial , Humanos , Imageamento por Ressonância Magnética , Modelos Teóricos
10.
Clin Drug Investig ; 41(9): 817-823, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34368943

RESUMO

BACKGROUND AND OBJECTIVE: Ketamine is an N-methyl-D-aspartate receptor (NMDA) antagonist used widely as an intravenous analgesic for treatment of acute pain. Its use as oral and sublingual analgesics is not well studied. This study aims to compare the clinical efficacy and tolerability of oral (PO) versus sublingual (SL) ketamine lozenges in adult patients with moderate-to-severe breakthrough pain. METHODS: The study had a randomized, double-blind crossover design in 23 inpatients requiring ketamine as rescue analgesics when pain scores exceeded 4/10 on the Numerical Rating Scales. Each participant received either SL 50 mg ketamine lozenge and PO placebo lozenge or SL placebo lozenge and PO 50 mg ketamine lozenge in two treatment periods with a minimum 24-h washout. Pain scores and adverse effects were documented half hourly for the first 2 h, then one hourly for the next 2 h after treatment. The time to first effect and time to meaningful pain relief were recorded. Patients reported their satisfaction and a global impression of change (GIC) at the end of each treatment period. Data were analysed using random effects regression models. RESULTS: Sixteen subjects completed both days, 7 completed 1 day. Time to first effect was 13.1 min PO versus 6.6 min SL (p = 0.069), time to meaningful pain relief was 29.4 min PO versus 10.8 min SL (p = 0.02). Pain scores were not significantly different at all time points post-treatment. Satisfaction and GIC scores were similar for both groups. Overall, adverse events occurred more often with SL administration (p = 0.02). CONCLUSIONS: Sublingual administration of ketamine led to a faster onset of pain relief (but also a higher adverse event rate), but in all other aspects treatment with ketamine given sublingually and orally produced similar analgesic effects. ACTRN: ACTRN12621000240842, 08/03/2021, retrospectively registered.


Assuntos
Dor Aguda , Ketamina , Dor Aguda/diagnóstico , Dor Aguda/tratamento farmacológico , Administração Sublingual , Adulto , Analgésicos/uso terapêutico , Analgésicos Opioides/uso terapêutico , Método Duplo-Cego , Humanos , Ketamina/uso terapêutico , Manejo da Dor , Resultado do Tratamento
11.
J Bodyw Mov Ther ; 27: 368-387, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34391260

RESUMO

PURPOSE: This review aimed to evaluate the certainty of evidence for the use of cryotherapy in patients with musculoskeletal disorders. METHODS: PubMed, Embase, Cochrane Library and AMED were searched from January 2000 to January 2018 (update June 2019) for systematic reviews (SRs) and randomized controlled trials (RCTs) reporting outcomes on pain, swelling, range of motion (ROM), function, blood loss, analgesic use, patient satisfaction and adverse advents. The papers were categorised into: surgical procedures, acute pain or injury and long-term pain or dysfunction. Methodological quality and risk of bias were assessed using the AMSTAR and the Swedish Health Technology Assessment instruments. Level of certainty of evidence was synthesized using GRADE. STUDY SELECTION: Eight SRs and 50 RCTs from a total of 6027 (+839) were included. In total 34 studies evaluated cryotherapy in surgical procedures, twelve evaluated cryotherapy use in acute pain or injury and twelve studies evaluated cryotherapy in long-term pain and dysfunction. RESULTS: The certainty of evidence is moderate (GRADE III) after surgical procedures to reduce pain, improve ROM, for patient satisfaction and few adverse events are reported. Cryotherapy in acute pain and injury or long-term pain and dysfunction show positive effects but have a higher number of outcomes with low certainty of evidence (GRADE II). CONCLUSION: Cryotherapy may safely be used in musculoskeletal injuries and dysfunctions. It is well tolerated by patients. More advanced forms of cryotherapy may accentuate the effect. Future research is needed where timing, temperature for cooling, dose (time) and frequency are evaluated.


Assuntos
Dor Aguda , Dor Aguda/terapia , Crioterapia , Humanos , Satisfação do Paciente , Revisões Sistemáticas como Assunto
12.
J Bodyw Mov Ther ; 27: 705-709, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34391310

RESUMO

According to various side effects of medication in low back pain, respecting conservative therapy, owing to the widespread use of laser therapy in recent decades, related therapeutic outcomes were different and contradictory. The current study aimed at comparing the effect of non-steroidal drugs and laser therapy with different doses in patients with acute low back pain. METHODS: The current randomized, placebo-controlled study was conducted on 65 patients randomly assigned to four groups. In group 1(N = 20), only drug therapy and in group 2(N = 15), laser therapy (3 J/cm 2) in addition to medication was administrated to the patients. For group 3(N = 15), a therapeutic plan similar to that of group 2 was given; however, the laser dose was 6 J/cm 2. Finally, drug therapy plus placebo laser therapy was applied to group 4(N = 15). Pain was compared among the groups using visual analogue scale and Oswestry low back pain disability questionnaire. RESULTS: Significant difference between baseline pain scores and those of the weeks 1, 2, 3, and 4 of laser therapy in all intervention groups. Also, the results of the intergroup analyses showed a significant difference between group 1 compared with groups 2 and 3. There was a significant ODI difference between the groups after laser therapy. CONCLUSION: Findings showed that laser therapy plus drug therapy in comparison with drug therapy alone was a more effective method to relieve pain and disability in patient with acute low back pain; however, evidence to support this finding is still inadequate.


Assuntos
Dor Aguda , Dor Lombar , Terapia com Luz de Baixa Intensidade , Preparações Farmacêuticas , Anti-Inflamatórios não Esteroides/uso terapêutico , Humanos , Dor Lombar/tratamento farmacológico , Resultado do Tratamento
13.
Anesthesiology ; 135(3): 547-548, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34270702
14.
Anesthesiology ; 135(3): 547, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34270688
15.
Ann Intern Med ; 174(9): 1207-1213, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34224261

RESUMO

BACKGROUND: Patients with sickle cell disease (SCD) have vaso-occlusive crises (VOCs). Infusion centers (ICs) are alternatives to emergency department (ED) care and may improve patient outcomes. OBJECTIVE: To assess whether care in ICs or EDs leads to better outcomes for the treatment of uncomplicated VOCs. DESIGN: Prospective cohort. (ClinicalTrials.gov: NCT02411396). SETTING: 4 U.S. sites, with recruitment between April 2015 and December 2016. PARTICIPANTS: Adults with SCD living within 60 miles of a study site. MEASUREMENTS: Participants were followed for 18 months after enrollment. Outcomes of interest were time to first dose of parenteral pain medication, whether pain reassessment was completed within 30 minutes after the first dose, and patient disposition on discharge from the acute care visit. Treatment effects for ICs versus EDs were estimated using a time-varying propensity score adjustment. RESULTS: Researchers enrolled 483 participants; the 269 who had acute care visits on weekdays are included in this report. With inverse probability of treatment-weighted adjustment, the mean time to first dose was 62 minutes in ICs and 132 minutes in EDs; the difference was 70 minutes (95% CI, 54 to 98 minutes; E-value, 2.8). The probability of pain reassessment within 30 minutes of the first dose of parenteral pain medication was 3.8 times greater (CI, 2.63 to 5.64 times greater; E-value, 4.7) in the IC than the ED. The probability that a participant's visit would end in admission to the hospital was smaller by a factor of 4 (0.25 [CI, 0.18 to 0.33]) with treatment in an IC versus an ED. LIMITATION: The study was restricted to participants with uncomplicated VOCs. CONCLUSION: In adults with SCD having a VOC, treatment in an IC is associated with substantially better outcomes than treatment in an ED. PRIMARY FUNDING SOURCE: Patient-Centered Outcomes Research Institute.


Assuntos
Dor Aguda/tratamento farmacológico , Dor Aguda/etiologia , Instituições de Assistência Ambulatorial , Analgésicos/administração & dosagem , Anemia Falciforme/complicações , Serviço Hospitalar de Emergência , Manejo da Dor/métodos , Feminino , Humanos , Infusões Intravenosas , Masculino , Fatores de Tempo , Estados Unidos
17.
Biomed Pharmacother ; 139: 111710, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34243616

RESUMO

PURPOSE: Postoperative pain is typically treated with multimodal analgesia, using systemic acetaminophen and/or nonsteroidal anti-inflammatory drugs in conjunction with opioids as required. The present study aimed to determine the safety and tolerability of repeated doses of an intravenous fixed-dose combination (FDC) of acetaminophen and ibuprofen. METHODS: This multicenter, open-label, single arm, multiple dose study was conducted at 4 centers across New Zealand and the United States between July 2019 and July 2020. Adults (>18 years) requiring multiple doses of parenteral nonopioid analgesics over multiple days following non-laparoscopic general, plastic or orthopedic surgery were eligible. The study drug (acetaminophen 1000 mg+ibuprofen 300 mg) was administered 6-hourly as a 5 min infusion for between 48 h and 5 days. Adverse event data was collected throughout the study, in addition to scheduled vital sign assessments, laboratory tests and electrocardiograms. Participants completed a global evaluation of the FDC at the end of the treatment period. FINDINGS: 232 participants received ≥ 1 dose of the FDC. Most were female (62.1%), White (56.5%) or Black or African American (39.2%), and had undergone orthopedic surgery (85.3%). There was a broad age range (19-87 years), with a mean age of 53.4 years, and 26.3% of participants aged ≥ 65 years. The FDC was safe when used for 48 h to 5 days. Treatment-emergent adverse events (TEAEs) affected 56.0% of participants, the most common were infusion site pain, nausea, infusion site extravasation, constipation, and headache. Minimal changes in vital signs were observed at scheduled timepoints. No clinically significant changes in electrocardiogram assessments occurred. Transient elevations in the hepatic enzymes ALT and AST to < 3 times the upper limit of normal (ULN) affected 10.5% and 9.6% of subjects, elevations to ≥ 3 times the ULN affected 2.6% and 2.2% of subjects, respectively. There were no apparent differences in the safety profile of the FDC in older participants. The FDC was well tolerated; most TEAEs were mild or moderate in severity. Five participants discontinued treatment due to TEAEs, none were considered treatment-related. The FDC was perceived well by study participants; the majority rated their experience as 'excellent' (40.1%) or 'very good' (35.3%). IMPLICATIONS: The safety profile was comparable to previous studies with no novel safety concerns. The FDC was safe, well tolerated, and perceived positively by participants treated for acute pain between 48 h and 5 days following orthopedic or plastic surgery, supporting a favorable risk benefit profile.


Assuntos
Acetaminofen/administração & dosagem , Acetaminofen/efeitos adversos , Ibuprofeno/administração & dosagem , Ibuprofeno/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Dor Aguda/tratamento farmacológico , Administração Intravenosa/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos não Narcóticos/administração & dosagem , Analgésicos não Narcóticos/efeitos adversos , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Medição da Dor/métodos , Adulto Jovem
19.
Sensors (Basel) ; 21(12)2021 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-34201268

RESUMO

The subjectiveness of pain can lead to inaccurate prescribing of pain medication, which can exacerbate drug addiction and overdose. Given that pain is often experienced in patients' homes, there is an urgent need for ambulatory devices that can quantify pain in real-time. We implemented three time- and frequency-domain electrodermal activity (EDA) indices in our smartphone application that collects EDA signals using a wrist-worn device. We then evaluated our computational algorithms using thermal grill data from ten subjects. The thermal grill delivered a level of pain that was calibrated for each subject to be 8 out of 10 on a visual analog scale (VAS). Furthermore, we simulated the real-time processing of the smartphone application using a dataset pre-collected from another group of fifteen subjects who underwent pain stimulation using electrical pulses, which elicited a VAS pain score level 7 out of 10. All EDA features showed significant difference between painless and pain segments, termed for the 5-s segments before and after each pain stimulus. Random forest showed the highest accuracy in detecting pain, 81.5%, with 78.9% sensitivity and 84.2% specificity with leave-one-subject-out cross-validation approach. Our results show the potential of a smartphone application to provide near real-time objective pain detection.


Assuntos
Dor Aguda , Punho , Resposta Galvânica da Pele , Humanos , Smartphone , Articulação do Punho
20.
Am Fam Physician ; 104(1): 63-72, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34264611

RESUMO

Pharmacologic management of acute pain should be tailored for each patient, including a review of treatment expectations and a plan for the time course of prescriptions. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatment options for most patients with acute mild to moderate pain. Topical NSAIDs are recommended for non-low back, musculoskeletal injuries. Acetaminophen is well tolerated; however, lower doses should be used in patients with advanced hepatic disease, malnutrition, or severe alcohol use disorder. Nonselective NSAIDs are effective but should be used with caution in patients with a history of gastrointestinal bleeding, cardiovascular disease, or chronic renal disease. Selective cyclooxygenase-2 NSAIDs are a more expensive treatment alternative and are used to avoid the gastrointestinal adverse effects of nonselective NSAIDs. Adjunctive medications may be added as appropriate for specific conditions if the recommended dose and schedule of first-line agents are inadequate (e.g., muscle relaxants may be useful for acute low back pain). For severe or refractory acute pain, treatment can be briefly escalated with the use of medications that work on opioid and monoamine receptors (e.g., tramadol, tapentadol) or with the use of acetaminophen/opioid or NSAID/opioid combinations. The opioid epidemic has increased physician and community awareness of the harms of opioid medications; however, severe acute pain may necessitate short-term use of opioids with attention to minimizing risk, including in patients on medication-assisted therapy for opioid use disorder.


Assuntos
Dor Aguda/tratamento farmacológico , Analgésicos/uso terapêutico , Manejo da Dor/métodos , Humanos
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