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1.
Acta Clin Croat ; 58(Suppl 1): 114-117, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31741569

RESUMO

Medico-legal responsibility in the management of acute or chronic pain in broad sense implies acting by the rules of good clinical practice and reducing the potential treatment side effects and complications that may entail health impairment and possible legal proceedings. Patients with acute or chronic obstetric or nonobstetric pain should be informed on the mode and method of treatment, possible side effects, and effects of drugs or procedures on fetal growth and development (informed consent). The principles of perinatal pharmacology and toxicology should be respected, choosing the mode of treatment associated with the lowest rate of side effects and a minimally invasive procedure (Accordingly, medico-legal responsibility is a professional and deontological category that should be fostered and implemented in line with professional guidelines and safety for both patients and medical staff.).


Assuntos
Dor Aguda/terapia , Dor Crônica/terapia , Responsabilidade Legal , Manejo da Dor , Complicações na Gravidez/terapia , Analgésicos/efeitos adversos , Feminino , Humanos , Consentimento Livre e Esclarecido , Obstetrícia , Manejo da Dor/efeitos adversos , Manejo da Dor/métodos , Educação de Pacientes como Assunto , Gravidez
3.
Postgrad Med ; 131(7): 438-444, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31482756

RESUMO

Pain is a subjective experience that is influenced by genetics, gender, social, cultural and personal parameters. Opposed to chronic pain, which by definition has to last for at least 3 months, acute pain is mostly because of trauma, acute medical conditions or treatment. The link between mood disorders and acute pain has proven to be increasingly significant since the link is bi-directional, and both act as risk factors for each other. Depression and anxiety are associated with increased perception of pain severity, whereas prolonged duration of acute pain leads to increased mood dysregulation. Although both depression and anxiety have a proven association with acute pain, the link between depression and acute pain is more thoroughly studied. Pain can be the presenting or sole complaint in depressed patients who present to primary care practices and is often overlooked by clinicians. However, reports on the perception of experimentally-induced pain in depressed patients are mixed, showing both an increased and decreased pain threshold and pain tolerance across various studies. Although less data is published about anxiety and pain, the relationship is consistent across studies as increased anxiety leads to increased severity of pain perceived and decreased pain tolerance. Anxiety as well as fear, stress, and catastrophizing are also shown to be mediators in the causal pathway between pain and disability.


Assuntos
Dor Aguda/psicologia , Transtornos de Ansiedade/psicologia , Transtorno Depressivo/psicologia , Dor Aguda/epidemiologia , Dor Aguda/fisiopatologia , Dor Aguda/terapia , Analgésicos/uso terapêutico , Antidepressivos/uso terapêutico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/terapia , Catastrofização/epidemiologia , Catastrofização/fisiopatologia , Catastrofização/psicologia , Terapia Cognitivo-Comportamental , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/fisiopatologia , Transtorno Depressivo/terapia , Humanos , Manejo da Dor , Limiar da Dor , Índice de Gravidade de Doença
4.
Curr Opin Anaesthesiol ; 32(5): 616-622, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31415046

RESUMO

PURPOSE OF REVIEW: During the past years, patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs) have become of growing awareness and importance in medical research and practice. This review summarizes recent developments concerning PROs and PROMs related to pain in the acute postoperative as well as chronic settings and indicates gaps and challenges relevant for future research and clinical applications. RECENT FINDINGS: There are core outcome sets (COSs) of PROs and PROMs developed for specific pain conditions but patients' perception is not sufficiently considered in the development of corresponding concepts and instruments. SUMMARY: COSs of PRO and PROMs are crucial in the field of research to enhance the comparability of results and reducing outcome reporting bias. In clinical practice PROs and PROMs are important for allocation of treatment. Concerning the development and implementation of PROs and PROMs patients' perspective should be thoroughly considered. Relating to acute as well as chronic pain there are some attempts to create COSs of PROs and PROMs but validity and reliability for both are still missing.


Assuntos
Dor Aguda/diagnóstico , Dor Crônica/diagnóstico , Medição da Dor/métodos , Dor Pós-Operatória/diagnóstico , Medidas de Resultados Relatados pelo Paciente , Dor Aguda/terapia , Dor Crônica/terapia , Humanos , Manejo da Dor , Dor Pós-Operatória/terapia , Qualidade de Vida , Reprodutibilidade dos Testes , Resultado do Tratamento
5.
Trials ; 20(1): 470, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31366405

RESUMO

BACKGROUND: As a common cause of low back pain, lumbosacral disc herniation (LDH) is usually dealt with using non-surgical interventions. In the face of concerns about prescription opioid abuse, alternative and complementary treatments may be promising, among which silver-needle warm acupuncture is considered as an upgrading option for its potential anti-inflammatory and strong analgesic effect for patients with chronic pain. In this proposed study, we aim to assess its clinical efficacy in comparison with conventional stainless steel filiform-needle warm acupuncture. METHODS/DESIGN: This is a randomized, two-armed, patient- and assessor-blinded trial. One hundred and sixty eligible patients recruited from December 2018 to June 2020 in three centers will be assigned for warm acupuncture treatment with either stainless steel filiform or silver needles. Nine sessions of 20-min treatment will be conducted during 3 consecutive weeks. Assessments with instruments including the Oswestry Disability Index, the visual analog scale, and the Japanese Orthopedic Association Back Pain Evaluation Questionnaire will be performed at four time points to explore the difference of clinical efficacy between two groups. DISCUSSION: If the results show that participants treated with silver-needle warm acupuncture gain a greater improvement in terms of pain intensity, physical function, and quality of life, this study is expected to offer reliable evidence to widely push this treatment for LDH in clinical practice. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1800019051 . Registered on 24 October 2018.


Assuntos
Terapia por Acupuntura/instrumentação , Dor Aguda/terapia , Deslocamento do Disco Intervertebral/terapia , Disco Intervertebral/fisiopatologia , Dor Lombar/terapia , Vértebras Lombares/fisiopatologia , Agulhas , Sacro/fisiopatologia , Prata , Terapia por Acupuntura/efeitos adversos , Dor Aguda/diagnóstico , Dor Aguda/fisiopatologia , Adulto , China , Avaliação da Deficiência , Desenho de Equipamento , Feminino , Humanos , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/fisiopatologia , Dor Lombar/diagnóstico , Dor Lombar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
6.
Chiropr Man Therap ; 27: 35, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31462989

RESUMO

Background: Muscle energy techniques are applied to reduce pain and increase range of motion. These are applied to a variety of pathological conditions and on asymptomatic subjects. There is however limited knowledge on their effectiveness and which protocol may be the most beneficial. Objective: The aim of this review is to determine the efficacy of muscle energy techniques (MET) in symptomatic and asymptomatic subjects. Design: Systematic Review. Methods: A literature search was performed using the following database: Cochrane Library, MEDLINE, NLM Pubmed and ScienceDirect. Studies regarding MET in asymptomatic and symptomatic patients were considered for investigation. The main outcomes took into account range of motion, chronic and acute pain and trigger points. Two trained investigators independently screened eligible studies according to the eligibility criteria, extracted data and assessed risk of bias. Randomized control trials (RCT's) were analyzed for quality using the PEDro scale. Results: A total of 26 studies were considered eligible and included in the quantitative synthesis: 14 regarding symptomatic patients and 12 regarding asymptomatic subjects. Quality assessment of the studies through the PEDro scale observed a "moderate to high" quality of the included records. Conclusions: MET are an effective treatment for reducing chronic and acute pain of the lower back. MET are also effective in treating chronic neck pain and chronic lateral epicondylitis. MET can be applied to increase range of motion of a joint when a functional limitation is present. Other techniques seem to be more appropriate compared to MET for trigger points.


Assuntos
Dor Aguda/terapia , Doenças Assintomáticas/terapia , Dor Crônica/terapia , Manipulação Osteopática , Músculos/metabolismo , Dor Aguda/metabolismo , Dor Aguda/fisiopatologia , Dor Crônica/metabolismo , Dor Crônica/fisiopatologia , Humanos , Músculos/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Resultado do Tratamento
8.
Curr Opin Anaesthesiol ; 32(5): 661-667, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31343464

RESUMO

PURPOSE OF REVIEW: This article discussed how the knowledge and technique of a few chronic pain procedures benefited the perioperative clinicians in their care of patients receiving specific orthopaedic surgical procedures. RECENT FINDINGS: Recent emerging interest in hip and knee denervation for chronic pain management secondary to osteoarthritis stimulates publications on the new understanding of hip and knee joint innervation. The improved understanding of the anatomy allows better precision in targeting the articular branches. The procedures for chronic joint pain such as radiofrequency ablation, chemical neurolysis and neuromodulation procedure have recently been applied to the perioperative care in orthopaedic procedures because of the potential long-lasting analgesia, opioid-sparing effect and consequent improvement in physical function and health-related quality of life after surgery. SUMMARY: Despite the widespread use of regional anaesthesia and multimodal analgesia in the perioperative pain management, more than two-third of the patients reported severe postoperative pain. Therefore, other therapeutic strategies used in chronic pain management such as radiofrequency ablation and neuromodulation have been proposed to optimize acute postsurgical pain. The early experience with those techniques is encouraging, and more studies are required to explore the incorporation of these procedures in the perioperative care.


Assuntos
Dor Aguda/terapia , Dor Crônica/terapia , Procedimentos Ortopédicos/efeitos adversos , Manejo da Dor/métodos , Dor Pós-Operatória/terapia , Dor Aguda/diagnóstico , Humanos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Assistência Perioperatória/métodos , Qualidade de Vida , Índice de Gravidade de Doença , Resultado do Tratamento
9.
BMJ Case Rep ; 12(7)2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31296627

RESUMO

We present a case of transient osteoporosis of the hip in a 38-year-old recreational trail runner. Shortly after a trail running competition, he developed acute hip pain, functional disability and an antalgic gait. Diagnosis was made with MRI showing bone marrow oedema, plain radiographs demonstrating osseous demineralisation and bone scintigraphy showing uniform radioactive uptake. Treatment included off-loading of the anatomical site for 6 months until symptom resolution, analgaesia, Vitamin D, bisphosphonates and pulsed electromagnetic field therapy. He recovered fully and returned to running activities 8 months after initial presentation. Transient osteoporosis of the hip is rare but benign, self-limiting condition; however, awareness and exact diagnosis are important as runners often present with hip pain and other more serious pathologies such as avascular necrosis or stress fractures need to be excluded.


Assuntos
Dor Aguda/complicações , Artralgia/complicações , Osteoporose/complicações , Osteoporose/diagnóstico por imagem , Corrida , Dor Aguda/terapia , Adulto , Analgesia , Artralgia/terapia , Conservadores da Densidade Óssea/uso terapêutico , Doenças da Medula Óssea/complicações , Doenças da Medula Óssea/diagnóstico por imagem , Doenças da Medula Óssea/terapia , Ácido Clodrônico/uso terapêutico , Edema/complicações , Edema/diagnóstico por imagem , Edema/terapia , Radiação Eletromagnética , Articulação do Quadril/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Osteoporose/terapia , Radiografia , Cintilografia , Vitamina D/uso terapêutico
11.
Trials ; 20(1): 306, 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31142359

RESUMO

BACKGROUND: Total knee arthroplasty (TKA) is an optimal option for patients with middle-to-end-stage knee osteoarthritis. However, the management of postoperative acute pain remains inefficient. Transcutaneous electrical acupoint stimulation (TEAS) is a nonpharmacological method to manage postoperative acute pain. Different frequencies of TEAS have been tested using varying parameters, but the optimal analgesic frequency remains controversial. The aim of this study was to explore the optimal analgesic frequency of TEAS for treating acute pain after the primary unilateral TKA. METHODS/DESIGN: This is a double-blind, randomized controlled trial. A total of 156 patients are randomly assigned to: G1, 5 Hz TEAS; G2, 100 Hz TEAS; G3, mixed TEAS (alternative use of daily 5 Hz and 100 Hz TEAS) and G4, placebo TEAS. In the G1, G2 and G3 groups, TEAS is conducted at acupoints SP9 and GB34 of the leg that was operated on (at a wave of continuous, balanced and asymmetrical biphasic square, with a pulse width of 200 µs, and a strong but comfortable current) for 30 min prior to a 30-min rehabilitation session per day for 2 weeks. In G4 group, TEAS is delivered at a strong but comfortable current for 30 s, then the current is gradually decreased to none over the next 15 s. The primary outcomes are measured before surgery, at baseline (POD 3, before TEAS intervention), week 1 and 2 after TEAS intervention with the Numeric Pain Rating Scale and The American Knee Society Score. The secondary outcomes include: (1) Active range of motion of the knee that was operated on; (2) Surface electromyography of both quadriceps; (3) Modified 30-s sit to stand test; (4) Additional usage of analgesia; and (5) SF-36. The additional outcomes include: (1) Patients' satisfaction rate; (2) Patient's expectation rate; and (3) Incidence of analgesia-related side effects. To test the blinding of participants and assessors, they are asked to guess whether the subjects received active or placebo TEAS within 5 min after the latest intervention. The safety and financial cost of TEAS are assessed. DISCUSSION: Mixed TEAS has more favorable effect on acute pain control than the placebo or 5 Hz or 100 Hz TEAS. TRIAL REGISTRATION: ChiCTR1800016347 . Date of registration was 26 May 2018. Retrospectively registered.


Assuntos
Dor Aguda/terapia , Artroplastia do Joelho , Dor Pós-Operatória/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Estimulação Elétrica Nervosa Transcutânea/métodos , Pontos de Acupuntura , Método Duplo-Cego , Eletromiografia , Humanos , Amplitude de Movimento Articular
12.
Trials ; 20(1): 256, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060589

RESUMO

BACKGROUND: Low back pain (LBP) is a public health concern because it is highly prevalent and the leading cause of disability worldwide. Psychologically informed physical therapy (PIPT) is a secondary prevention approach that first aims to identify individuals at high risk for transitioning to chronicity and then provides tailored treatment to reduce that risk. Training models that are feasible to implement with acceptable training quality are needed to improve scalability for widespread implementation of PIPT. This manuscript describes the PIPT training program that was developed for training physical therapists providing PIPT in the TARGET trial. METHODS: The PIPT training program was developed, tested, and modified using an iterative process. Content development consisted of stakeholder engagement, beta testing, modification of training, and confirmation of final course objectives. Methods of delivery consisted of a website that included brief online educational modules followed by a live 8-h workshop that included video-based mock case scenarios and case-based role playing. Attitudes, beliefs, and confidence in implementing PIPT principles were assessed before and immediately after training to measure training quality and impact. RESULTS: Early stakeholder engagement and beta testing indicated the need for increased emphasis on experiential learning opportunities and patient-centered communication training. Booster training varied extensively across TARGET sites with involvement of 'clinician champions' providing brief follow-up sessions identified as best practice. Favorable post-training changes in physical therapist attitudes and beliefs toward biopsychosocial treatment orientation and increased confidence in implementing PIPT principles were observed. CONCLUSIONS: PIPT training for provider participation in the TARGET trial was feasible to deliver. Course content was acceptable to physical therapists and resulted in improved beliefs and confidence in applying PIPT skills during clinical practice. Ongoing consultation and site-based continuing education were methods by which specific TARGET sites maintained or augmented PIPT skill training; however, implementing ongoing training was challenging in general. Due to the pragmatic nature of the TARGET trial, it was not possible to directly measure the effect of PIPT training on treatment fidelity, which was a limitation of our approach. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02647658 . Registered on 6 January 2016.


Assuntos
Dor Aguda/terapia , Dor Crônica/terapia , Educação Profissionalizante , Dor Lombar/terapia , Assistência Centrada no Paciente , Fisioterapeutas/educação , Modalidades de Fisioterapia/educação , Prevenção Secundária/educação , Dor Aguda/diagnóstico , Dor Aguda/fisiopatologia , Dor Aguda/psicologia , Adulto , Atitude do Pessoal de Saúde , Dor Crônica/diagnóstico , Dor Crônica/fisiopatologia , Dor Crônica/psicologia , Currículo , Progressão da Doença , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Dor Lombar/diagnóstico , Dor Lombar/fisiopatologia , Dor Lombar/psicologia , Pessoa de Meia-Idade , Fisioterapeutas/psicologia , Medição de Risco , Fatores de Risco , Estados Unidos
13.
Trials ; 20(1): 276, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31109368

RESUMO

BACKGROUND: Quadratus lumborum block (QLB) is increasingly gaining popularity as a novel abdominal truncal block in abdominal surgery; however, the mechanism of QLB is not yet thoroughly illustrated. The focus of our study is transmuscular QLB (TMQLB), as the latest anatomical evidence shows that anesthetics spread into the thoracic paravertebral space to exert an analgesic effect. Therefore, we designed this study to compare TMQLB with thoracic paravertebral block (TPVB) in laparoscopic renal surgery in the hope of providing clinical evidence on the analgesic mechanism of TMQLB and its application in laparoscopic renal surgery. METHODS: This trial is a prospective, randomized, single-center, open-label, parallel, three-arm, non-inferiority trial. We intend to include 120 participants undergoing laparoscopic nephrectomy and before surgery they will be randomized into three groups for postoperative pain control: TMQLB experimental group 1 (0.4 ml/kg body weight 0.5% ropivacaine), TMQLB experimental group 2 (0.6 ml/kg body weight 0.5% ropivacaine) or TPVB control group (0.4 ml/kg body weight 0.5% ropivacaine at vertebra T10). Patients will be excluded if they have allergy to anesthetics, infection at the injection site, are on coagulopathy or anticoagulants, on analgesics for chronic illness, have history of substance abuse or have a barrier to communication. Morphine is given in boluses of 1.5~2 mg by intravenous patient-controlled analgesia (IPCA) in the first 48 h after surgery. The primary outcome is the difference between TMQLB group 1 and the TPVB group in the mean visual analogue scale (VAS) pain score in the first 24 h after surgery. Secondary outcomes are the difference between TMQLB group 2 and the TPVB group in the mean VAS score in the first 24 h after surgery, cumulative morphine consumption, long-term pain control, dermatomal distribution of sensory loss, nausea score, pruritus score, ambulation time, time till recovery of bowel movement, quality of recovery, postoperative length of hospital stay and patient satisfaction with anesthesia. Safety data on procedure-related complications will also be summarized. DISCUSSION: This will the first randomized controlled trial to compare TMQLB with TPVB for analgesia in laparoscopic surgery. This trial aims to provide important clinical evidence to elaborate on the analgesic mechanism of TMQLB. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03414281 . Registered on 9 January 2018.


Assuntos
Dor Aguda/terapia , Laparoscopia , Nefrectomia , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Músculos Abdominais/inervação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Laparoscopia/efeitos adversos , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Estudos Prospectivos , Adulto Jovem
14.
Lancet ; 393(10180): 1537-1546, 2019 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-30983589

RESUMO

Over the past decade there has been an increasing reliance on strong opioids to treat acute and chronic pain, which has been associated with a rising epidemic of prescription opioid misuse, abuse, and overdose-related deaths. Deaths from prescription opioids have more than quadrupled in the USA since 1999, and this pattern is now occurring globally. Inappropriate opioid prescribing after surgery, particularly after discharge, is a major cause of this problem. Chronic postsurgical pain, occurring in approximately 10% of patients who have surgery, typically begins as acute postoperative pain that is difficult to control, but soon transitions into a persistent pain condition with neuropathic features that are unresponsive to opioids. Research into how and why this transition occurs has led to a stronger appreciation of opioid-induced hyperalgesia, use of more effective and safer opioid-sparing analgesic regimens, and non-pharmacological interventions for pain management. This Series provides an overview of the epidemiology and societal effect, basic science, and current recommendations for managing persistent postsurgical pain. We discuss the advances in the prevention of this transitional pain state, with the aim to promote safer analgesic regimens to better manage patients with acute and chronic pain.


Assuntos
Dor Aguda/terapia , Dor Crônica/terapia , Dor Pós-Operatória/terapia , Dor Aguda/diagnóstico , Dor Aguda/etiologia , Analgésicos Opioides/uso terapêutico , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Humanos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia
15.
Mol Pain ; 15: 1744806919845739, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31012383

RESUMO

Effective pharmacological treatment options for chronic pain remain very limited, and continued reliance on opioid analgesics has contributed to an epidemic in the United States. On the other hand, nonpharmacologic neuromodulatory interventions provide a promising avenue for relief of chronic pain without the complications of dependence and addiction. An especially attractive neuromodulation strategy is to optimize endogenous pain regulatory circuits. The prefrontal cortex is known to provide top-down control of pain, and hence neuromodulation methods that selectively enhance the activities in this brain region during pain episodes have the potential to provide analgesia. In this study, we designed a low-frequency (2 Hz) electrical stimulation protocol to provide temporally and spatially specific enhancement of the prefrontal control of pain in rats. We showed that low-frequency electrical stimulation of the prelimbic region of the prefrontal cortex relieved both sensory and affective responses to acute pain in naive rats. Furthermore, we found that low-frequency electrical stimulation of the prefrontal cortex also attenuated mechanical allodynia in a rat model of chronic pain. Together, our findings demonstrated that low-frequency electrical stimulation of the prefrontal cortex represents a promising new method of neuromodulation to inhibit pain.


Assuntos
Dor Aguda/terapia , Dor Crônica/terapia , Córtex Pré-Frontal/metabolismo , Analgesia/métodos , Animais , Estimulação Elétrica , Hiperalgesia/terapia , Masculino , Córtex Pré-Frontal/efeitos da radiação , Ratos , Ratos Sprague-Dawley
16.
J Trauma Acute Care Surg ; 87(2): 430-439, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30939572

RESUMO

Acute and chronic pain in trauma patients remains a challenging entity, particularly in the setting of the escalating opioid epidemic. It has been reported that chronic opioid use increases the likelihood of hospital admissions as a result of traumatic injuries. Furthermore, patients admitted with traumatic injuries have a greater than average risk of developing opioid use disorder after discharge. Practitioners providing care to these patients will encounter the issue of balancing analgesic goals and acute opioid withdrawal with the challenge of reducing postdischarge persistent opioid use. Additionally, the practitioner is faced with the worrisome prospect that inadequate treatment of acute pain may lead to the development of chronic pain and overtreatment may result in opioid dependence. It is therefore imperative to understand and execute alternative nonopioid strategies to maximize the benefits and reduce the risks of analgesic regimens in this patient population. This narrative review will analyze the current literature on pain management in trauma patients and highlight the application of the multimodal approach in potentially reducing the risks of both short- and long-term opioid use. LEVEL OF EVIDENCE: Narrative review, moderate to High.


Assuntos
Manejo da Dor , Ferimentos e Lesões/terapia , Dor Aguda/terapia , Analgésicos/uso terapêutico , Dor Crônica/terapia , Humanos , Manejo da Dor/métodos , Ferimentos e Lesões/complicações
17.
An. sist. sanit. Navar ; 42(1): 69-73, ene.-abr. 2019. ilus
Artigo em Inglês | IBECS | ID: ibc-183048

RESUMO

Torus or buckle fractures typically affect children who have suffered indirect minor wrist injuries. They are axial compression-type metaphyseal fractures of cortical and cancellous bone, which are stable and their treatment therefore consists in immobilisation of the joint for three to four weeks. We present an atypical case of distal radius torus fracture in a 19-year-old adult male, which has not been previously reported in adults and can be considered a new type of occult fracture. Knowledge of this possibility is mandatory to be able to make a differential diagnosis of wrist sprain in adults, and avoid performing superfluous complementary tests due to the persistence of pain and functional incapacity


Las fracturas en rodete afectan típicamente a niños que sufren un traumatismo leve indirecto en la muñeca. Son fracturas metafisarias por compresión axial del hueso cortical y esponjoso que son estables y que, por tanto, su tratamiento consiste en inmovilizar la articulación durante un periodo de tres a cuatro semanas. Presentamos un atípico caso de fractura distal de radio en rodete en un hombre de 19 años, que no ha sido previamente descrita en adultos y puede ser considerada un nuevo tipo de fractura oculta. El conocimiento de esta posibilidad es esencial para poder realizar el diagnóstico diferencial con un esguince de muñeca en adultos, y evitar la realización de pruebas complementarias innecesarias ante la persistencia del dolor y de incapacidad funcional


Assuntos
Humanos , Masculino , Adulto Jovem , Fraturas do Rádio/diagnóstico , Traumatismos do Punho/diagnóstico , Diagnóstico Diferencial , Fraturas Fechadas/diagnóstico , Dor Aguda/terapia , Manejo da Dor/métodos , Imobilização/métodos
18.
J Pediatr Nurs ; 44: 22-30, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30683278

RESUMO

PROBLEM: Current research suggests behavioral and environmental interventions to prevent neonatal pain prior to an invasive procedure are rarely administered and seldom documented. The aim of this study was to systematically review findings from published randomized controlled trials that tested the effects of behavioral and environmental procedural pain management interventions on behavioral pain response in preterm infants. ELIGIBILITY CRITERIA: Randomized controlled trials examining the effects of behavioral and environmental pain management interventions on behavioral pain response in preterm infants were identified. Articles accepted for inclusion met the following criteria: English language, original, peer refereed, randomized controlled clinical trials published within the past 5 years, study sample: preterm infants, setting: neonatal intensive care units, study intervention behavioral and environmental, outcome pain measurement score from valid and reliable pain scale. SAMPLE: Fourteen randomized controlled trials from a literature search of PubMed and Medline databases were included in this review. RESULTS: Across all age groups, facilitated tucking, oral sucrose, and kangaroo care decreased behavioral and physiologic pain response alone and in combination with other behavioral and environmental interventions. CONCLUSION: Among preterm infants, facilitated tucking, oral sucrose, and kangaroo care significantly mitigates biobehavioral pain response associated with acutely painful procedures. IMPLICATIONS: Evidence suggests that behavioral and environmental interventions can decrease biobehavioral pain response associated with acutely painful procedures in preterm infants. This review highlights the need for rigorous studies to help healthcare providers to build a tailored pain treatment plan for preterm infants.


Assuntos
Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Método Canguru/métodos , Manejo da Dor/métodos , Sacarose/administração & dosagem , Dor Aguda/psicologia , Dor Aguda/terapia , Dor Crônica/psicologia , Dor Crônica/terapia , Cuidados Críticos/métodos , Exposição Ambiental/efeitos adversos , Feminino , Humanos , Comportamento do Lactente , Cuidado do Lactente/métodos , Recém-Nascido , Masculino , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
19.
PLoS One ; 14(1): e0211042, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30677095

RESUMO

BACKGROUND: A well-known supportive treatment for acute nonspecific back pain, elastic back support belts, are valued for their ability to accelerate natural self-healing, but there are concerns of a deconditioning effect due to their reliance on passive stabilization. METHODS: To evaluate the systematic effects of elastic abdominal belts on the trunk musculature, a total of 36 persons with acute lumbar back pain (no longer than one week) were divided into two groups: an abdominal belt wearing group (B) and a non-abdominal belt wearing control group (C). All were examined over a period of three weeks at three time points: T1 just after assignment, T2 one week later, and T3 further two weeks later. Surface EMG (sEMG) was used to record trunk muscle activation when walking on a treadmill at walking speeds of 2, 3, 4, 5, and 6 km/h. Similarly, pain intensity (VAS) and functional impairment (ODI) over time were recorded in both groups. RESULTS: Over the observation period, a slight advantage for decreased pain intensity (C: p<0.05 T2 vs. T1; B: p<0.01 T2 vs. T1, p<0.05 T3 vs. T1) and decreased functional impairment (Cohen's d vs. T1, C: T2 0.45, T3 0.86; B: T2 1.1, T3 1.0) was observed for the belt group. For the belt group both oblique abdominal muscles exhibited significantly lower sEMG throughout the observation period (external abdominal oblique muscle: (T1), T2, (T3), internal abdominal oblique muscle: T1, (T2), (T3)) and the sEMG for the back muscles ranged from unchanged to slightly elevated for this group, but never reached statistical significance. DISCUSSION: The reduced abdominal amplitude levels in the belt group likely result from the permanent elastic stabilization provided by the belt: the required elevated intra-abdominal pressure to enhance spinal stability is then provided by lessened abdominal muscle activity complemented by the belt's elastic support. With regard to the back muscles, the belt, due to its movement-restricting effect, tends to activate the paravertebral musculature. In this respect, the effect of elastic abdominal belts on the trunk muscles is not uniform. Therefore, the present results suggest that the effect of elastic abdominal belts appears to be more of a temporary neutral alteration of trunk muscle coordination, with some trunk muscles becoming more active and others less, and not a case of uniform deconditioning as is suspected.


Assuntos
Dor Aguda , Músculos do Dorso/fisiopatologia , Eletromiografia , Dor Lombar , Aparelhos Ortopédicos , Caminhada , Dor Aguda/fisiopatologia , Dor Aguda/terapia , Adulto , Feminino , Humanos , Dor Lombar/fisiopatologia , Dor Lombar/terapia , Masculino , Pessoa de Meia-Idade
20.
JMIR Mhealth Uhealth ; 7(1): e11412, 2019 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-30632970

RESUMO

BACKGROUND: Pain drawings (PDs) are an important tool to evaluate, communicate, and objectify pain. In the past few years, there has been a shift toward tablet-based acquisition of PDs, and several studies have been conducted to test the usefulness, reliability, and repeatability of electronic PDs. However, to our knowledge, no study has investigated the potential role of electronic PDs in the clinical assessment and treatment of inpatients in acute pain situations. OBJECTIVE: The aim of this study was to evaluate whether knowledge of the patients' electronic PD has the potential to improve the doctors' understanding of their patients and to influence their clinical decision making. Furthermore, we sought to identify differences between electronic PDs of patients and their treating pain specialists in an acute pain situation and to find those specific characteristics derived from the PDs that had the largest impact on doctors' understanding. METHODS: We obtained electronic PDs from 47 inpatients in acute pain situations before their consultation with a pain specialist on a tablet personal computer with a stylus. Before looking at their patients' drawings, these specialists drew their own conception of the patients' pain after anamnesis and physical examination. Patients' drawings were then revealed to the doctors, and they were asked to evaluate how much the additional information improved their understanding of the case and how much it influenced their clinical decision on an 11-point Likert scale (0="not at all" and 10="very much"). Similarities and differences of patients' and doctors' PDs were assessed by visual inspection and by calculating Jaccard index and intraclass correlation coefficient (ICC) of the pain area and the number of pain clusters. Exploratory analyses were conducted by means of correlation tables to identify specific factors that influenced doctors' understanding. RESULTS: Patients' PDs significantly improved the doctors' understanding (mean score 4.81, SD 2.60, P<.001) and to a lesser extent their clinical decision (mean 2.68, SD 1.18, P<.001). Electronic PDs of patients and doctors showed fair to good similarity for pain extent (r=.454, P=.001) and widespreadness (P=.447, r=.002) were important factors helping doctors to understand their patients. CONCLUSIONS: In a clinical setting, electronic PDs can improve doctors' understanding of patients in acute pain situations. The ability of electronic PDs to visualize differences between doctors' and patients' conception of pain has the potential to improve doctor-patient communication.


Assuntos
Arte , Medição da Dor/instrumentação , Relações Médico-Paciente , Médicos/psicologia , Dor Aguda/psicologia , Dor Aguda/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Computadores de Mão/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Medição da Dor/normas , Médicos/normas , Inquéritos e Questionários
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