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1.
Emerg Med Clin North Am ; 38(1): 223-241, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757252

RESUMO

Pain management in acute orthopedic injury needs to be tailored to the presentation and patient. Subjective and objective assessment, in conjunction with pathophysiology, should be used to provide symptom control. Ideally, treatment should be administered in an escalating fashion, attempting to manage pain with the lowest dose of the safest medication available. There are also adjunctive therapies, including those that are nonpharmacologic, that can provide additional relief.


Assuntos
Analgesia/métodos , Manejo da Dor/métodos , Medição da Dor/métodos , Dor/etiologia , Ferimentos e Lesões/complicações , Humanos , Dor/diagnóstico , Ferimentos e Lesões/diagnóstico
2.
Mayo Clin Proc ; 94(12): 2437-2443, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31685265

RESUMO

OBJECTIVE: To evaluate trends in the clinical development of new pain and reformulated pain medications given the ongoing opioid crisis and the public health burden of inadequately controlled pain. METHODS: We conducted a retrospective cohort study of new drugs starting clinical testing between January 1, 2000, and December 31, 2015. We searched two comprehensive commercial databases of global research and development activity. The primary outcomes were trends in new and reformulated pain drugs starting clinical testing, proportion of new pain drugs targeting a novel biological pathway, and rates and reasons for discontinuation of development. RESULTS: The proportion of new pain drugs entering phase 1 testing (relative to all new drug trials) declined from 2.5% between 2000 and 2002 to 1.7% between 2013 and 2015. No significant changes in the proportion of new pain drugs entering phase 2 or phase 3 trials were observed. Most new pain drugs failed to reach late-stage clinical development, with 52% of pain drugs successfully advancing from phase 1 to phase 2 and 11% advancing from phase 2 to phase 3 trials. The number of reformulated products starting clinical testing increased over the study period and was greater than that for new analgesics in 2012 and every year thereafter. CONCLUSION: Pain drug development activity has largely shifted from new therapeutics to reformulated ones. New policies, such as increased funding for basic pain research, may help address the urgent need for new therapies for pain.


Assuntos
Analgésicos Opioides/uso terapêutico , Desenvolvimento de Medicamentos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Dor/tratamento farmacológico , Humanos , Dor/diagnóstico , Dor/epidemiologia , Estudos Retrospectivos
3.
Unfallchirurg ; 122(11): 860-863, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31712851

RESUMO

A small portion of patients suffer from severe knee pain following previous knee surgery or a trauma. Awareness among traumatologists regarding a neuropathic origin of this persistent knee pain is poor. Ongoing pain close to the knee may be caused by damage of the infrapatellar nerve (IN). This branch of the saphenous nerve is purely sensory and is at risk for iatrogenic damage due to its superficial medial course. Once recognized using simple tests during physical examination, a variety of treatment modalities may be proposed. However, a standard treatment algorithm was hitherto absent. This study includes 15 patients having IN damage who were offered a step-up regimen including lidocaine injections, pulsed radiofrequency (PRF) or neurectomy. Success (>50% drop in numeric rating scale pain score) was attained in 11 (73% success rate, 9 month median follow-up). The aim of this contribution is to increase knowledge regarding this illusive entity and to discuss the efficacy of our treatment protocol.


Assuntos
Nervo Femoral/lesões , Dor/etiologia , Traumatismos dos Nervos Periféricos/terapia , Denervação , Humanos , Perna (Membro)/inervação , Dor/diagnóstico , Manejo da Dor , Medição da Dor , Traumatismos dos Nervos Periféricos/etiologia , Resultado do Tratamento
4.
Br J Radiol ; 92(1104): 20190722, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31596120

RESUMO

OBJECTIVE: It has been stated that the distal 1-2 cm of the tibialis posterior tendon (TPT) does not have a tendon sheath but rather a paratenon, and that any fluid seen around this segment on ankle MRI is considered to represent paratendonitis. The prevalence and clinical significance of isolated TPT paratendonitis diagnosed on ankle MRI is unknown. This study aims to correlate the presence of isolated distal segment TPT paratendonitis on ankle MRI, with the presence or absence of medial midfoot pain. METHODS: A retrospective database of 195 consecutive 3 T ankle MRI studies was assessed for the presence of isolated TPT paratendonitis. Relevant clinical notes were available in 159 of these cases, and were reviewed for the absence or presence of medial midfoot pain. RESULTS: Of 133 patients with both ankle MRI studies and clinical notes available, 53 (33.3%) patients had isolated TPT paratendonitis based on MRI. Of these, 37 (69.8%) had reported no medial foot pain on review of clinical records, while medial foot pain was recorded in 16 cases (30.2%). The comparison of TPT paratendonitis with clinically evident medial midfoot pain showed no statistically significant association (p = 0.19). CONCLUSION: Fluid signal intensity around the distal 1-2 cm of the TPT is a relatively common finding on ankle MRI. Therefore, care should be taken when reporting ankle MRI studies not to overstate the relevance of this finding. ADVANCES IN KNOWLEDGE: There was no statistically significant relationship between medial midfoot pain and the presence of isolated TPT paratendonitis.


Assuntos
Articulação do Tornozelo/diagnóstico por imagem , Líquidos Corporais/diagnóstico por imagem , Dor/diagnóstico , Tendinopatia/diagnóstico por imagem , Tendões/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Estudos Retrospectivos , Tendinopatia/complicações , Tenossinovite/diagnóstico por imagem , Adulto Jovem
5.
Bratisl Lek Listy ; 120(7): 523-526, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31602988

RESUMO

OBJECTIVES: Circadian rhythms modulate the activity of pain pathways. But there appears to be a lack of understanding of how the perception of pain varies in neonates during the day. To assess circadian variations in pain perception we analyzed intensities of pain at 3 h intervals in neonates (within 24 hours). We also followed up the nursing interventions practiced for pain reduction and their effectivity within a day. METHODS: We have analyzed the clinical observations of pain in 16 neonates during 62 days of hospitalization (with Mean = 3.87, Min = 1, Max = 19). The pain was assessed by a modification of the Comfort scale supplemented with Wong-Baker scale. Procedure used for acute pain elimination was administration of 24% sucrose to the neonates. This procedure was centralized and performed in an incubator or neonatal bed. RESULTS: We confirmed statistically significant difference in pain scores in our group of neonates at 10:00 am, 4:00 pm, 4:00 am as compared to 10:00 pm (p values being 0.02603; 0.02885, 0.01673). The pain score was highest at 10:00 pm (Mean = 18.86, Max = 34) and at 1:00 am (Mean = 18.89, Max = 33). There was no significant difference in the pain score at 10:00 pm and 1:00 am (p = 0.2951). CONCLUSION: The results of our studies provided further evidence of circadian rhythm in the pain scores in neonates. A better understanding of circadian control of pain in neonates can help promote a more frequent use of time-contingent pain treatment strategies to help improve neonates care (Tab. 1, Fig. 2, Ref. 28) Keywords: circadian rhythm, neonate, nursing care, pain, the Comfort scale.


Assuntos
Ritmo Circadiano , Medição da Dor , Dor/diagnóstico , Dor/enfermagem , Humanos , Recém-Nascido
6.
Medicine (Baltimore) ; 98(39): e17328, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574868

RESUMO

INTRODUCTION: Gastric leiomyosarcoma (LMS) is a rare malignancy with minimal therapeutic options and has poor prognosis once metastasis develops. PATIENT CONCERNS: A case of gastric LMS with multiple metastases, pain, and progressive anemia 13 months after the initial diagnosis in a 43-year-old woman. DIAGNOSIS: Gastric LMS with liver metastases and multiple retroperitoneal lymphatic metastases. INTERVENTIONS: Minimally invasive therapies of repeated tetrahydropalmatine and oxaliplatin-based transarterial chemoembolization and high-intensity focused ultrasound treatment were performed. OUTCOMES: The treatments resulted in significant pain relief (numerical rating scale from 8-2 points) after the initial treatment, improvement in performance status and quality of life, and a progression-free survival of 4 months after treatment. CONCLUSION: This combined modality palliative treatment approach was well tolerated with noticeable pain relief.


Assuntos
Quimioembolização Terapêutica/métodos , Tratamento por Ondas de Choque Extracorpóreas/métodos , Leiomiossarcoma/patologia , Manejo da Dor/métodos , Dor , Qualidade de Vida , Neoplasias Gástricas/patologia , Adulto , Terapia Combinada/métodos , Feminino , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/fisiopatologia , Neoplasias Hepáticas/secundário , Imagem Multimodal/métodos , Estadiamento de Neoplasias , Dor/diagnóstico , Dor/etiologia , Dor/psicologia , Medição da Dor/métodos , Cuidados Paliativos/métodos , Intervalo Livre de Progressão , Resultado do Tratamento
7.
Spine (Phila Pa 1976) ; 44(20): E1206-E1210, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31574066

RESUMO

STUDY DESIGN: This was a correlational study. OBJECTIVE: Determine the range of pediatric Patient-Reported Outcomes Measurement Information System (PROMIS) scores for patients treated for adolescent idiopathic scoliosis (AIS) and assess correlation with Scoliosis Research Society-22 (SRS-22) domain scores. SUMMARY OF BACKGROUND DATA: Patient reported outcome (PRO) measures are important metrics for measuring health status in diverse patient populations. PROMIS is increasingly being used in orthopedic practice. Existing literature compares PROMIS measures favorably to legacy measures in numerous adult orthopedic conditions. This study sought to define the range of PROMIS mobility, pain interference, and peer relationships scores for adolescents treated for AIS. Furthermore, correlations between these domains and equivalent domains in the legacy PRO, SRS-22, were determined. METHODS: Pediatric PROMIS and SRS-22 were obtained at routine clinical visits for AIS at a tertiary care children's hospital from January 2017 to October 2017. Spearman correlations were performed to examine the associations between three pediatric PROMIS domains and the SRS-22 domains. Only patients who completed both PRO measures were included in the analyses. Radiographic measurements were performed at each visit assessing sagittal and coronal deformity and overall spinal balance. RESULTS: One hundred thirteen patients with a mean age of 14.4 (standard deviation [SD] = 2.1) years completed the assessments. The mean pediatric PROMIS domain scores included: mobility 50.9 (interquartile range [IQR] 36.2-65.6); pain interference 45.9 (IQR 28.9-62.9); peer relations 52.6 (IQR 38.3-64.9).PROMIS mobility was strongly correlated with SRS-22 function (r = 0.65; P < 0.001). PROMIS pain interference was strongly correlated with SRS-22 pain (r = 0.70; P < 0.001). PROMIS peer relations was moderately correlated with SRS-22 Mental Health (r = 0.41; P < 0.001) and self-image (r = 0.34; P < 0.001). CONCLUSION: In AIS patients pediatric PROMIS pain interference and mobility correlate strongly with SRS-22 pain and function domains, while PROMIS peer relationships demonstrates moderate correlations with SRS-22 mental health and self-image. LEVEL OF EVIDENCE: 2.


Assuntos
Nível de Saúde , Sistemas de Informação/normas , Medidas de Resultados Relatados pelo Paciente , Escoliose/diagnóstico , Escoliose/cirurgia , Sociedades Médicas/normas , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Dor/diagnóstico , Dor/epidemiologia , Dor/cirurgia , Medição da Dor/métodos , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Escoliose/epidemiologia
8.
Schmerz ; 33(6): 563-575, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31515604

RESUMO

The diagnostics of pain in older people with cognitive impairments should always consist of a subjective self-report of pain and a structured observation of pain behavior. It is important to note that the subjective self-report of pain becomes less valid with increasing cognitive decline (starting with a moderate degree of dementia). The external observation of pain behavior should include at least the three behavioral domains facial expressions, body movements and vocalization and should be performed during resting situations and during activities of daily living. Moreover, the patient should be observed for at least 3 min. Online forms of training have recently been developed and are freely available for training in external observation.


Assuntos
Disfunção Cognitiva , Demência , Medição da Dor , Dor/diagnóstico , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Humanos
9.
Res Vet Sci ; 126: 155-163, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31494378

RESUMO

A score system was used to evaluate pain, distress and discomfort in healthy pigs and pigs with two different diseases: lameness and rectal prolapse. In addition, correlations between the results of this score and a panel of salivary biomarkers and severity of disease were studied. This panel included biomarkers of stress (cortisol, salivary alpha-amylase (sAA), total esterase activity (TEA), butyrylcholinesterase (BChE) and lipase (Lip)), immunity (adenosine deaminase isozymes 1 (ADA1) and 2 (ADA2)) and oxidative status (uric acid (UA), Trolox equivalent antioxidant capacity (TEAC), cupric reducing antioxidant capacity (CUPRAC), ferric reducing ability of saliva (FRAS), advanced oxidation protein products (AOPP) and hydrogen peroxide (H2O2)). Based on their score, diseased animals were subdivided in those without and with evident pain. Lame pigs and prolapsed pigs with pain showed higher salivary levels of cortisol, sAA, TEA, BChE, ADA1 and ADA2 compared with the healthy pigs. In addition, the prolapsed pigs with pain showed higher levels of FRAS, AOPP and H2O2 compared with the healthy animals. Salivary cortisol, TEA, BChE, ADA isozymes 1 and 2, FRAS and AOPP correlated with the pain score. This five-point pain score system can be easily applied to lame and prolapsed pigs, and salivary biomarkers could be used as an additional tool for pain assessment in those pigs.


Assuntos
Bem-Estar do Animal , Coxeadura Animal/fisiopatologia , Medição da Dor/veterinária , Dor/veterinária , Prolapso Retal/veterinária , Sus scrofa/fisiologia , Doenças dos Suínos/diagnóstico , Animais , Biomarcadores/análise , Masculino , Dor/diagnóstico , Medição da Dor/métodos , Prolapso Retal/fisiopatologia , Saliva/química , Índice de Gravidade de Doença , Suínos
10.
Schmerz ; 33(6): 523-532, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31478144

RESUMO

BACKGROUND: Self-reporting is the gold standard in pain assessment. However, this is not possible among adults who are unable to respond. Thus, the method of choice is to observe behavior in order to assess pain. Nurses rarely conduct pain observations because they do not feel educated enough to use such tools in vulnerable groups. The aim of the study is to analyze the pain situation among older adults (≥65 years) in need of care who are cognitively or physically unable to respond in the outpatient care setting. MATERIALS AND METHODS: Our cross-sectional study is based on data from ACHE, a study on pain in outpatient older adults in need of care. Of 355 care-dependent older adults with chronic pain, 81 (22.8%) who were unable to respond received a pain assessment with the Pain Assessment in Advanced Dementia (PAINAD, German: Beurteilung von Schmerz bei Demenz [BESD]) scale. RESULTS: The study population (n = 81) was very old (mean age = 84.2 years), female (77.8%), and widowed (50.0%). We observed pain-related behavior among 61.7% of older adults in need of care. The mean BESD score was 2.8 ± 2.5 (range 0-8). We identified a significant difference in the BESD score observed calmly (mean = 1.7 ± 2.5) and under mobilization (mean = 3.4 ± 2.3, p = 0.001). Moreover, only 21 older adults in need of care received a pain assessment 4 weeks prior to our study. CONCLUSION: Our findings indicate a deficit in regularly conducted pain assessment among older adults who are unable to respond and are in need of care in the outpatient care setting. An observation tool in that setting is urgently needed and would be a first step in optimizing pain assessment. We recommend conducting observations during regular nursing mobilization.


Assuntos
Demência , Pacientes Ambulatoriais , Manejo da Dor , Dor , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Estudos Transversais , Demência/complicações , Feminino , Humanos , Masculino , Dor/diagnóstico , Dor/psicologia , Medição da Dor
11.
Enferm. intensiva (Ed. impr.) ; 30(3): 99-107, jul.-sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-182968

RESUMO

Introducción: La evaluación y tratamiento del dolor es imprescindible para una atención de calidad, además de para mejorar la satisfacción del paciente y los resultados clínicos. Objetivos: 1) Describir la percepción de dolor de los pacientes posquirúrgicos ingresados en nuestra Unidad de Cuidados Intensivos (UCI). 2) Comparar la percepción del paciente con la valoración realizada por la enfermera. 3) Comparar los resultados de la encuesta International Pain Outcomes con los datos sociodemográficos. Metodología: Estudio descriptivo prospectivo observacional en la UCI de un hospital universitario de nivel terciario durante 3 meses. Se estudió la percepción del dolor en los pacientes posquirúrgicos, a las 24 h de ingreso en la unidad, a través de la encuesta International Pain Outcomes traducida al español. Resultados: La puntuación de mayor dolor registrada de los 109 pacientes fue 4,47 ± 2,75 y la de menor de 0,69 ± 1,25 frente a 5,59 ± 2,72 y 2,13 ± 2,03 que refirieron los pacientes, con diferencias significativas (p < 0,001). La puntuación del mayor de dolor registrado está relacionada con el tipo de cirugía (p = 0,027). Hay diferencias significativas en la valoración del menor dolor y la edad (p = 0,005 r = -0,270). Igualmente s22ucede con el sexo y la percepción de mayor dolor (p = 0,004). Los pacientes que refirieron que el dolor les hizo sentir muy ansiosos o indefensos fueron los que tuvieron las mayores puntuaciones en la percepción de mayor dolor, 7,35 ± 1,98 7,44 ± 1,85, respectivamente, con diferencias estadísticamente significativas (p = 0,001; p < 0,001). Con relación a la puntuación de menor dolor, se encuentra asociación con el sentimiento de ansiedad (p = 0,032) y no con el sentimiento de indefensión (p = 0,088). Conclusiones: Los pacientes posquirúrgicos refieren dolor durante las primeras 24 h de ingreso en la UCI (puntuación máx 5,59 ± 2,72). Las enfermeras infravaloran el dolor que el paciente refiere. Una formación adecuada ayudaría a dotar estrategias de valoración para un mejor tratamiento. La edad, el sexo, la ansiedad y la indefensión que el dolor provoca fueron variables que condicionaron el dolor de manera significativa


Introduction: Pain assessment and treatment are essential for ensuring quality of care as well as for improving patient's satisfaction and clinical outcomes. Objectives: 1) To describe pain perception of surgical patients admitted to our Intensive Care Unit(ICU). 2) To compare the patients' pain perception with the assessment carried out by nurses. 3) To correlate International Pain Outcomes Questionnaire results with socio-demographical data. Methodology: A prospective descriptive observational study was carried out in the ICU of a third level university hospital over a period of 3 months. Surgical patients' pain-perception was assessed 24hours after their admission to the ICU using the Spanish translation of International Pain Outcomes Questionnaire. Results: The highest pain score recorded among 109 patients by nurses was 4.47 ± 2.75, while, the lowest was .69 ± 1,25. However, the highest and lowest pain scores reported by patients were 5.59 ± 2.72 and 2.13 ± 2.03, which showed significant differences (P < 0.001). The highest pain score seemed to be related to the type of surgery (P < 0.027). There are significant variations in the lowest pain score depending on age (P = 0.005 r= -0.270). Likewise, the worst pain score correlated with the patients' sex (P = 0.004). Patients who reported that pain made them feel very anxious or helpless scored highest with the worst pain, 7.35±1.98, 7.44±1.85 respectively. These differences were statistically significant (P = 0.001, P < 0.001). Regarding to the score of less pain, there is an association with feeling anxiety (P = 0.032) and not with feeling helpless (P = -0.088). Conclusions: The post-surgical patients reported pain during the first 24 hours following admission to ICU (max score 5.59 ± .26). The nurses underestimated the patients' reported pain. Improving nurses' education would provide them with assessment strategies for better pain management. Age, sex, anxiety and helplessness caused by pain, were variables that significantly influenced pain


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Percepção da Dor , Unidades de Terapia Intensiva/estatística & dados numéricos , Dor/diagnóstico , Manejo da Dor , Avaliação em Enfermagem , Cuidados Pós-Operatórios , Satisfação do Paciente , Estudos Prospectivos , Medição da Dor , Hospitais Universitários , Inquéritos e Questionários , Análise de Dados , Análise de Variância
12.
Neurology ; 93(12): e1180-e1192, 2019 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-31409737

RESUMO

OBJECTIVE: To determine the frequency and relative importance of the most meaningful symptoms in facioscapulohumeral muscular dystrophy (FSHD) and to identify the demographic and clinical features that are associated with the greatest disease burden in this population. METHODS: We performed a cross-sectional study involving 328 participants with FSHD. Collectively, participants reported the prevalence and relative importance of 274 symptoms and 15 symptomatic themes. We assessed the association between symptomatic theme prevalence and participants' age, sex, disease duration, pain level, employment status, and education. RESULTS: Participants answered >48,000 questions regarding their disease burden. The symptomatic themes with the highest prevalence in our sample were problems with shoulders or arms (96.9%), limitations with activities (94.7%), core weakness (93.8%), fatigue (93.8%), limitations with mobility and walking (93.6%), changed body image due to the disease (91.6%), and pain (87.7%). Problems with shoulders and arms and limitations with mobility and walking had the greatest effect on participants' lives. Employment status and the report of pain had the most extensive association with the prevalence of symptoms, with employment being associated with 8 of 15 of the symptomatic themes and pain being associated with 7 of 15 of the symptomatic themes. Men and women with FSHD experienced a similar prevalence of all symptomatic themes. CONCLUSIONS: Adults with FSHD experience a variety of symptoms that play an important role in their disease burden. These symptoms have a variable prevalence and importance in the FSHD population and are associated with disease duration, employment status, and pain level.


Assuntos
Distrofia Muscular Facioescapuloumeral/diagnóstico , Distrofia Muscular Facioescapuloumeral/fisiopatologia , Medidas de Resultados Relatados pelo Paciente , Inquéritos e Questionários , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Fadiga/complicações , Fadiga/diagnóstico , Fadiga/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distrofia Muscular Facioescapuloumeral/complicações , Dor/complicações , Dor/diagnóstico , Dor/fisiopatologia , Adulto Jovem
13.
Int J Med Inform ; 129: 69-74, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31445291

RESUMO

BACKGROUND: Pain gained recognition as a vital sign in the early 2000s, underscoring the importance of accurate documentation, characterization, and treatment of pain. No prior studies have demonstrated the utility of the 0-10 pain scale with respect to discharge opioid prescriptions, nor characterized the most influential factors in discharge prescriptions. METHODS: Inpatient and emergency department(ED) encounters from July 1, 2012 to April 1, 2018 resulting in a discharge prescription for tablet opioid medications were identified. The primary outcome was to determine if pain levels in 24 h prior to discharge correlated with opioids (in milligrams of morphine equivalents (MME)) prescribed. Secondary outcomes included the impact of patient and prescriber demographics, demographics. A generalized linear model was created to investigate factors affecting the quantity of prescribed opioids. RESULTS: n = 78,691 patient encounters. Overall mean adjusted MME for non-ED visits was 378 versus 197 for ED visits. Whites received the highest quantities; those identifying as non-white and non-black received the lowest. Women received significantly fewer discharge MMEs in both the ED and inpatient cohorts. Provider prescribing patterns exhibited the most profound effect on discharge MMEs. The most prolific (≥300 prescriptions over the study period) writing the largest amount. In the ED, there was a significant negative correlation between documented pain levels and discharge MMEs(ρ = 0.074,p < 0.001). CONCLUSIONS: Pain scale was significantly negatively correlated with discharge MMEs in the ED and positively correlated in the inpatient population. Individual prescriber characteristics were the more influential variable, with prolific high prescribers writing for the largest MME amounts. The inverse association of pain and MMEs at discharge in the ED, and the large effect pre-existing prescriber patterns exhibited, both improved methodology for assessing and appropriately treating pain, and effective prescriber-targeted interventions, must be a priority.


Assuntos
Analgésicos Opioides/uso terapêutico , Medição da Dor , Dor/diagnóstico , Alta do Paciente , Sinais Vitais , Adulto , Idoso , Idoso de 80 Anos ou mais , Erros de Diagnóstico , Prescrições de Medicamentos , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
14.
Handb Clin Neurol ; 161: 121-148, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31307596

RESUMO

Clinical neurophysiologic investigation of pain pathways in humans is based on specific techniques and approaches, since conventional methods of nerve conduction studies and somatosensory evoked potentials do not explore these pathways. The proposed techniques use various types of painful stimuli (thermal, laser, mechanical, or electrical) and various types of assessments (measurement of sensory thresholds, study of nerve fiber excitability, or recording of electromyographic reflexes or cortical potentials). The two main tests used in clinical practice are quantitative sensory testing and pain-related evoked potentials (PREPs). In particular, PREPs offer the possibility of an objective assessment of nociceptive pathways. Three types of PREPs can be distinguished depending on the type of stimulation used to evoke pain: laser-evoked potentials, contact heat evoked potentials, and intraepidermal electrical stimulation evoked potentials (IEEPs). These three techniques investigate both small-diameter peripheral nociceptive afferents (mainly Aδ nerve fibers) and spinothalamic tracts without theoretically being able to differentiate the level of lesion in the case of abnormal results. In routine clinical practice, PREP recording is a reliable method of investigation for objectifying the existence of a peripheral or central lesion or loss of function concerning the nociceptive pathways, but not the existence of pain. Other methods, such as nerve fiber excitability studies using microneurography, more directly reflect the activities of nociceptive axons in response to provoked pain, but without detecting or quantifying the presence of spontaneous pain. These methods are more often used in research or experimental study design. Thus, it should be kept in mind that most of the results of neurophysiologic investigation performed in clinical practice assess small fiber or spinothalamic tract lesions rather than the neuronal mechanisms directly at the origin of pain and they do not provide objective quantification of pain.


Assuntos
Medição da Dor/métodos , Dor/diagnóstico , Dor/fisiopatologia , Humanos
15.
Nurs Res ; 68(5): 365-373, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31283720

RESUMO

BACKGROUND: Chronic pain in adults with sickle cell disease (SCD) may be the result of altered processing in the central nervous system, as indicated by quantitative sensory testing (QST). Sensory pain quality descriptors on the McGill Pain Questionnaire (MPQ) are indicators of typical or altered pain mechanisms but have not been validated with QST-derived classifications. OBJECTIVES: The specific aim of this study was to identify the sensory pain quality descriptors that are associated with the QST-derived normal or sensitized classifications. We expected to find that sets of sensory pain quality descriptors would discriminate the classifications. METHODS: A cross-sectional quantitative study of existing data from 186 adults of African ancestry with SCD. Variables included MPQ descriptors, patient demographic data, and QST-derived classifications. RESULTS: The participants were classified as central sensitization (n = 33), mixed sensitization (n = 23), and normal sensation. Sensory pain quality descriptors that differed statistically between mixed sensitization and central sensation compared to normal sensitization included cold (p = .01) and spreading (p = .01). Aching (p = .01) and throbbing (p = .01) differed statistically between central sensitization compared with mixed sensitization and normal sensation. Beating (p = .01) differed statistically between mixed sensitization compared with central sensitization and normal sensation. No set of sensory pain quality descriptors differed statistically between QST classifications. DISCUSSION: Our study is the first to examine the association between MPQ sensory pain quality descriptors and QST-derived classifications in adults with SCD. Our findings provide the basis for the development of a MPQ subscale with potential as a mechanism-based screening tool for neuropathic pain.


Assuntos
Anemia Falciforme/complicações , Medição da Dor , Dor/diagnóstico , Adulto , Idoso , Sensibilização do Sistema Nervoso Central , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Reprodutibilidade dos Testes , Adulto Jovem
16.
J Dermatol ; 46(9): 745-751, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31282051

RESUMO

Hidradenitis suppurativa (HS) is a chronic skin disease characterized by recurrent painful inflamed nodules/abscesses and draining fistulas that negatively impact quality of life. Adalimumab, a monoclonal antibody against tumor necrosis factor-α, has been approved in the EU, USA and Japan for the treatment of moderate to severe HS. This is an interim analysis of an ongoing phase 3, multicenter, open-label, single-arm study of the safety and efficacy of adalimumab weekly dosing in Japanese patients with moderate to severe HS. Fifteen patients received adalimumab 160 mg at week 0, 80 mg at week 2 and 40 mg every week thereafter starting at week 4. The fulfillment of Hidradenitis Suppurativa Clinical Response was assessed under adalimumab treatment; clinical response was assessed by skin pain, total abscess and inflammatory nodule count and modified Sartorius score; and quality of life and safety were assessed. At week 12, 86.7% of patients achieved clinical response, with improvements at week 12 across the primary and secondary end points generally sustained through week 24. Adalimumab weekly dosing was generally safe and well tolerated with no new safety findings through week 24. These results suggest that adalimumab is effective and well tolerated in Japanese patients with moderate to severe HS.


Assuntos
Adalimumab/administração & dosagem , Hidradenite Supurativa/tratamento farmacológico , Dor/tratamento farmacológico , Adalimumab/efeitos adversos , Adulto , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Hidradenite Supurativa/complicações , Hidradenite Supurativa/diagnóstico , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/etiologia , Medição da Dor , Satisfação Pessoal , Qualidade de Vida , Índice de Gravidade de Doença , Inquéritos e Questionários/estatística & dados numéricos , Resultado do Tratamento
17.
World Neurosurg ; 130: 150-153, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295589

RESUMO

BACKGROUND: Glossopharyngeal neuralgia (GPN) and trigeminal neuralgia (TN) can result from mechanical stimulation of the glossopharyngeal nerve (GPNv) and trigeminal nerve (TNv) by blood vessels. TN can cause severe pain in the orofacial region, whereas GPN manifests as pain in the tongue, throat, tonsil, and ear. Although these 2 neuralgias can occur concurrently, concurrence of recurrent TN and GPN that develops postoperatively has not been previously described. CASE DESCRIPTION: A 68-year-old male complained of right glossalgia and pain in the pharynx radiating to the right auricular area. The patient had previously undergone microvascular decompression (MVD) for right TN. Medication and intraoral xylocaine spray did not relieve the symptoms. An oral surgeon was unable to find any disease related to the glossalgia. The anesthesiologist pointed out that the symptoms could be from partial recurrence of the TN because the patient also complained of pain in the inferior alveolus. Magnetic resonance angiography indicated that the right GPNv seemed to be compressed by the right posterior inferior cerebellar artery (PICA); hence, MVD for both GPN and TN was performed. Intraoperatively, the right PICA was found to be adherent to the GPNv because of the thickened arachnoid membrane and was subsequently detached. The TNv was also examined, but only a Teflon ball was found, which was detached from the TNv. The GPN disappeared postoperatively, although TN persisted after the second operation. CONCLUSIONS: GPN can result from adhesions between the GPNv and arachnoid membrane following previous MVD.


Assuntos
Doenças do Nervo Glossofaríngeo/cirurgia , Nervo Glossofaríngeo/cirurgia , Neuralgia do Trigêmeo/cirurgia , Artéria Vertebral/cirurgia , Idoso , Humanos , Masculino , Cirurgia de Descompressão Microvascular/métodos , Dor/diagnóstico , Dor/cirurgia , Período Pós-Operatório , Nervo Trigêmeo/cirurgia
18.
Spine (Phila Pa 1976) ; 44(13): 908-914, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31205166

RESUMO

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To evaluate whether Patient-Reported Outcomes Measurement Information System (PROMIS) health domains can effectively estimate health utility index values for patients presenting for spine surgery. SUMMARY OF BACKGROUND DATA: Stable estimates of health utility are required to determine cost-effectiveness of spine surgery. There are no established methods to estimate health utility using PROMIS. METHODS: We enrolled 439 patients with spine disease (mean age, 54 ±â€Š18 yrs) presenting for surgery and assessed their health using the Medical Outcomes Study Short Form-12, version 2 (SF-12v2) and PROMIS domains. Standard health utility values were estimated from the SF-12v2. Participants were randomly assigned to derivation or validation cohort. In the derivation cohort, health utility values were estimated as a function of PROMIS domains using regression models. Model fit statistics determined the most parsimonious health utility estimation equation (HEE). In the validation cohort, values were calculated using the HEE. Estimated health utility values were correlated with SF-12v2-derived health utility values. RESULTS: Mean preoperative health utility was 0.492 ±â€Š0.008 and was similar between the two cohorts. All PROMIS health domains were significantly associated with health utility except Anxiety (P = 0.830) and Sleep Disturbance (P = 0.818). The final HEE was:Health Utility (est) = 0.70742 - 0.00471 × Pain + 0.00647 × Physical function - 0.00316 × Fatigue - 0.00214 × Depression + 0.00317 × Satisfaction with Participation in Social Roles.The estimation model accounted for 74% of observed variation in health utility. In the validation sample, mean health utility was 0.5033 ±â€Š0.1684 and estimated health utility was 0.4966 ±â€Š0.1342 (P = 0.401). These measures were strongly correlated (rho = 0.834). CONCLUSION: Our results indicate that PROMIS provides a reasonable estimate of health utility in adults presenting for lumbar or cervical spine surgery. LEVEL OF EVIDENCE: 1.


Assuntos
/métodos , Aceitação pelo Paciente de Cuidados de Saúde , Medidas de Resultados Relatados pelo Paciente , Doenças da Coluna Vertebral/cirurgia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/epidemiologia , Dor/cirurgia , Medição da Dor/métodos , Estudos Prospectivos , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/epidemiologia
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