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1.
Br J Anaesth ; 124(2): 222-226, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31759614

RESUMO

BACKGROUND: The QNox score (Quantium Medical S.L., distributed by Fresenius Kabi) has recently been introduced as a tool to quantify intraoperative analgesia. Being based on the analysis of electroencephalographic data, QNox is distinctly different to other methods of nociception monitoring that rely almost entirely on the assessment of sympathetic activity. However, there are currently no published data to validate use of QNox in a clinical setting. We investigated the value of pre-arousal QNox data at the end of surgery for prediction of acute postoperative pain in the PACU. METHODS: A total of 150 patients scheduled for non-emergency surgery under sevoflurane-opioid general anaesthesia were included in the study. At the end of surgery but before patient arousal, QNox was measured minutely for 5 min. After admission to the recovery room, pain scores (numeric rating scale [NRS], 0-10) were obtained 5 minutely for 15 min. RESULTS: Data from 144 patients were analysed. QNox before arousal showed no correlation (ρ=0.057) with acute postoperative pain in the PACU. Furthermore, the score was found to have no value for the prediction of acute postoperative pain (area under the receiver operating curve, 0.501; 95% confidence interval, 0.406-0.597). CONCLUSION: QNox at the end of surgery before arousal showed no association with and allowed no prediction of acute pain in the PACU. CLINICAL TRIAL REGISTRATION: ACTRN12618001662257.


Assuntos
Dor Aguda/diagnóstico , Eletroencefalografia/métodos , Medição da Dor/métodos , Dor Pós-Operatória/diagnóstico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Adulto Jovem
2.
J Appl Oral Sci ; 28: e20190025, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31778442

RESUMO

INTRODUCTION: Periodontal therapy usually requires local anesthesia. If effective, a non-invasive, liposomal anesthetic gel could increase the levels of acceptance of patients in relation to periodontal therapy. OBJECTIVE: This study investigated the efficacy of liposomal anesthetic gel for pain control during periodontal therapy. METHODOLOGY: Forty volunteers with moderate to severe chronic periodontitis were recruited, of which at least three sextants required periodontal therapy. At least one of the selected teeth had one site with a probing depth of ≥4 mm. The volunteers received the following three gels: a placebo, lidocaine/prilocaine (Oraqix®), or a liposomal lidocaine/prilocaine, which were applied to different sextants. Pain frequency was registered during treatment and the volunteers received a digital counter to register any painful or uncomfortable experiences. At the end of each session, the volunteers indicated their pain intensity using rating scales (NRS-101 and VRS-4). The volunteers had their hemodynamic parameters measured by a non-invasive digital monitor. RESULTS: Pain frequency/intensity did not show statistical difference between intervention groups. The tested gels did not interfere with the hemodynamic indices. Dental anxiety, suppuration and probing depth could influence pain during periodontal therapy. CONCLUSION: Our results suggest limited indications for the use of non-invasive anesthesia when used for scaling and root planing. Intra-pocket anesthetic gel could be a good option for anxious patients, or those who have a fear of needles.


Assuntos
Anestesia Dentária/métodos , Anestésicos Locais/administração & dosagem , Raspagem Dentária/efeitos adversos , Géis/administração & dosagem , Dor/prevenção & controle , Aplainamento Radicular/efeitos adversos , Adulto , Idoso , Periodontite Crônica/complicações , Periodontite Crônica/terapia , Método Duplo-Cego , Feminino , Humanos , Lidocaína/administração & dosagem , Combinação Lidocaína e Prilocaína , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Bolsa Periodontal , Placebos , Prilocaína/administração & dosagem , Adulto Jovem
3.
Emerg Med Clin North Am ; 38(1): 167-191, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757249

RESUMO

Neck and back pain are among the most common symptom-related complaints for visits to the emergency department (ED). They contribute to high levels of lost work days, disability, and health care use. The goal of ED assessment of patients with neck and back pain is to evaluate for potentially dangerous causes that could result in significant morbidity and mortality. This article discusses the efficient and effective evaluation, management, and treatment of patients with neck and back pain in the ED. Emphasis is placed on vertebral osteomyelitis, epidural abscess, acute transverse myelitis, epidural compression syndrome, spinal malignancy, and spinal stenosis.


Assuntos
Dor nas Costas/diagnóstico , Gerenciamento Clínico , Emergências , Cervicalgia/diagnóstico , Procedimentos Ortopédicos/métodos , Medição da Dor/métodos , Dor nas Costas/terapia , Humanos , Cervicalgia/terapia
4.
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
5.
Braz Oral Res ; 33: e113, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800864

RESUMO

The objective of this study was to compare the scores of the Helplessness, Magnification, Rumination, and Catastrophizing factors of the Pain Catastrophizing Scale (PCS) between samples with different pain characteristics. The psychometric properties of the PCS were evaluated in 1,151 Brazilian adults (78.9% female; 38.6 (SD = 10.8) years): 335 had no pain, 390 had been in pain for less than 3 months, 250 had been in recurring pain for more than 3 months, and 176 had been in continuous pain for more than 3 months. Confirmatory factor analysis (CFA) was conducted to verify the fit of the PCS models. Convergent validity and reliability were evaluated. Multi-group analysis was used to estimate the invariance of the factorial model. The global score for the PCS factors was obtained using the regression weight matrix for estimating factor scores from CFA. Analysis of variance was used to compare scores between samples. After excluding three items, the tri-factorial model showed adequate fit. The model parameters were invariant (Δχ2(λ,i,ß,Res); p≥0.05). Individuals experiencing pain showed higher scores for catastrophic thoughts. Individuals with pain for less than 3 months had the highest scores for Rumination (p < 0.001). The PCS showed valid, reliable, and invariant results for the sample of Brazilian adults in no pain or with different pain conditions. The PCS adequately discriminated individuals in pain from those without pain. Among those in pain, Rumination was the only discriminating factor.


Assuntos
Catastrofização/psicologia , Desamparo Aprendido , Medição da Dor/psicologia , Dor/psicologia , Ruminação Cognitiva , Exacerbação dos Sintomas , Adulto , Análise de Variância , Brasil , Estudos Transversais , Análise Fatorial , Feminino , Humanos , Masculino , Medição da Dor/métodos , Escalas de Graduação Psiquiátrica , Psicometria , Valores de Referência , Reprodutibilidade dos Testes , Inquéritos e Questionários
6.
Anticancer Res ; 39(12): 6751-6757, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810940

RESUMO

BACKGROUND/AIM: Our original hypothesis was that the rectus sheath block (RSB) analgesia could enhance patient satisfaction and decrease pain following midline laparotomy. PATIENTS AND METHODS: Initially, 56 patients were randomized into four groups; control group (n=12), single-dose (n=16), repeated-dose (n=12) and continuous infusion (n=16) RSB analgesia groups. The BPI (Brief Pain Inventory) survey was conducted preoperatively and at one and four weeks and 12 months postoperatively. The patients pain 24 h postoperatively and satisfaction 48 h postoperatively was filled on an 11-point numeric rating scale (NRS). RESULTS: The repeated-dose group had lower BPI severity score (p=0.045) and BPI interference score (p=0.043) mean values postoperatively compared to the three other groups separately. Also, the time effect on the linear mixed model in BPI interference score mean values was statistically significant (p=0.008), which means that in the repeated dose group preoperative BPI severity score [2.7 (3.9)] and interference score [4.3 (4.2)] mean (SD) values were significantly higher than the BPI severity score [1.3 (0.8)] and interference score [1.5 (1.8)] mean (SD) values following surgery. CONCLUSION: The higher elevation in BPI severity score and decrease in interference score values in the repeated dose group and also the time effect in a linear mixed model in BPI interference score were statistically significant.


Assuntos
Laparotomia/efeitos adversos , Bloqueio Nervoso/métodos , Medição da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Atividades Cotidianas , Nível de Saúde , Inquéritos Epidemiológicos , Humanos , Laparotomia/métodos , Satisfação do Paciente , Período Pós-Operatório , Estudos Prospectivos , Qualidade de Vida , Reto do Abdome/inervação , Índice de Gravidade de Doença
7.
Medicine (Baltimore) ; 98(51): e18237, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860970

RESUMO

BACKGROUND: This review aims to evaluate the effectiveness and safety of acupuncture treatment for reducing opioid consumption in patients with chronic pain. METHODS: We will search the following electronic databases from their inception to November 2019: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, the China National Knowledge Infrastructure (a Chinese database), the Japan Science and Technology Information Aggregator (a Japanese database), and five Korean databases (KoreaMed, Research Information Service System, Korean Studies Information Service System, Database Periodical Information Academic, and Oriental Medicine Advanced Searching Integrated System). Randomized controlled trials comparing acupuncture to no treatment, sham acupuncture, and other active interventions for the reduction of opioid consumption in chronic pain patients will be included. The risk of bias will be assessed using the Cochrane risk of bias tool. The primary outcomes will include the prescribed or consumed dose of opioids and withdrawal symptoms related to opioid reduction. A meta-analysis will be performed to estimate a pooled effect, if possible. CONCLUSION: This study may provide important practical guidance for patients, practitioners, and health-policy makers regarding the use of acupuncture in opioid taper support programs. DISSEMINATION: The results will be disseminated through a peer-reviewed journal or conference presentations. TRIAL REGISTRATION NUMBER: PROSPERO 2019: CRD42019143486.


Assuntos
Analgesia por Acupuntura , Analgésicos Opioides/uso terapêutico , Dor Crônica/terapia , Analgesia por Acupuntura/métodos , Analgésicos Opioides/administração & dosagem , Dor Crônica/tratamento farmacológico , Humanos , Medição da Dor/métodos
8.
Pain Res Manag ; 2019: 5050979, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687057

RESUMO

Introduction: Pain is one of the most common and unpleasant symptoms that distress the well-being of patients with cancer. Considerable evidence supports the validity and reliability of the McGill Pain Questionnaire (MPQ) and its short forms, the SF MPQ and SF MPQ-2-which are the most widely used tools for pain assessment-in terms of patients with cancer. Pain and its characteristics are best assessed using validated and culturally adapted tools developed in participants' mother tongue. Although many pain assessment tools are available worldwide, only a limited number of them have been translated into Sinhala language and validated in Sri Lanka. We aimed to translate SF MPQ-2 into Sinhala language and validate using Sinhala-speaking patients suffering from cancer pains in Sri Lanka. Materials and Methods: Translation has been conducted according to the guidelines laid down by Mapi Research Trust, in five stages, namely, forward translation, backward translation, expert opinion, cognitive debriefing interviews, and proofreading. The questionnaire was administered among 207 patients attending Apeksha Hospital, Sri Lanka, who are suffering from cancer pain. Content validity was tested using expert opinion, and face validity, by interviewing patients with cancer pain. Factor structure was tested through a factor analysis, and reliability, by internal consistency with Cronbach's alpha. Results: A total of 207 participants (112 males and 95 females), aged between 20 and 80 years, were included in the study. Factor analysis identified four factors compatible with studies done in other countries, which explained 53.5% of the variance. The analysis of data indicated Cronbach's alpha of neuropathic, affective, intermittent, and continuous subscales as 0.768, 0.791, 0.824, and 0.789, respectively, which were over the acceptable threshold of 0.70. Confirmatory factor analysis supported the four-factor model. Conclusion: SF MPQ-2-Sinhala version is a statistically proven reliable and valid pain descriptor which can be utilized to evaluate pain suffered by patients with cancer in Sri Lanka whose mother tongue is Sinhala.


Assuntos
Linguagem , Medição da Dor , Psicometria , Traduções , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor do Câncer/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Reprodutibilidade dos Testes , Sri Lanka , Inquéritos e Questionários , Adulto Jovem
9.
Ann R Coll Surg Engl ; 101(8): 606-608, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31672035

RESUMO

INTRODUCTION: The 12-mm AirSeal® port is widely used in robotically assisted laparoscopic prostatectomy due to its ability to maintain stable pneumoperitoneal pressures and smoke evacuation. However, it creates a potential risk of port site hernia. We have traditionally used EndoClose™ to perform full thickness closure of this port, but noted that patients experienced increased pain related to this procedure, which sometimes persisted for several months. Using the Da Vinci Si we performed peritoneal closure with 2-0 vicryl by switching the fourth arm to the right master controller. The external oblique sheath was closed outside with 1 Ethibond. MATERIALS AND METHODS: We performed this closure in 20 consecutive patients (group 1). Postoperative day 1, 2 and post-discharge telephone consultation pain scores (1-10) were recorded and compared with the previous 20 consecutive patients who had the EndoClose closure (group 2). RESULTS: We recorded an instructional video to enable reproduction of the new technique. The mean length of stay was 1.5 days for patients in group 1 and 1.9 days for those in group 2 (P = 0.04). There was no difference in operating time or average day 1 pain scores. Post-discharge follow-up call revealed 1 of 20 patients who had AirSeal port site pain in group 1 and 5 of 17 in group 2 (P = 0.04). Pain scores also tended to be higher for group 2. CONCLUSIONS: Our preliminary analysis of this novel technique to close the AirSeal port in two separate layers improves postoperative pain related to this port site.


Assuntos
Laparoscopia/métodos , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Técnicas de Fechamento de Ferimentos , Idoso , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Medição da Dor/métodos , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos/efeitos adversos
10.
Undersea Hyperb Med ; 46(5): 647-654, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683363

RESUMO

Introduction: The effects of hyperbaric oxygen (HBO2) therapy on sprains, ligament injuries, and muscle strains have been reported in several animal studies. In a dog model of compartment syndrome and in a rat contused skeletal muscle injury model, the significant effects of HBO2 therapy on the reduction of edema and muscle necrosis have been reported. In basic research HBO2 therapy stimulated fibroblast activity to improve the healing process. Because of this it expected that HBO2 therapy might improve focal edema and pain in the acute phase and accelerate the healing of injured tissues in athletes with a medial collateral ligament (MCL) injury of the knee. This study aimed to examine the short-term effects of HBO2 application subjectively, and the long-term effects of HBO2 therapy in Japanese professional or semi-professional rugby players with grade 2 MCL injury of the knee. Methods: Thirty-two professional or semi-professional rugby players with grade 2 MCL injury of the knee were investigated. First, in the HBO2 group (n=16), HBO2 therapy was performed during the acute phase. Visual analog scales (VASs) immediately before and after HBO2 therapy on the same day were compared. Next, we retrospectively evaluated the time to return to play in the HBO2 (n=16) and non-HBO2 (n=16) groups. Results: VAS scores for pain while walking immediately before and after HBO2 therapy on the same day were 37.4 ± 20.1 (mean ± standard deviation) and 32.4 ± 21.8, respectively (p⟨0.001). The VAS scores for pain while jogging were 50.7 ± 25.6 and 43.9 ± 25.0, respectively (p⟨0.001). The time to return to play was 31.4 ± 12.2 days in the HBO2 group and 42.1 ± 15.8 days in the non-HBO2 group, indicating a significant difference between the groups (p⟨0.05). Conclusion: HBO2 therapy may reduce pain and accelerate the return to play in athletes with grade 2 MCL injury of the knee in this non-randomized study.


Assuntos
Futebol Americano/lesões , Oxigenação Hiperbárica , Ligamento Colateral Médio do Joelho/lesões , Dor Musculoesquelética/terapia , Volta ao Esporte , Cicatrização/fisiologia , Adulto , Grupo com Ancestrais do Continente Asiático , Estudos de Casos e Controles , Humanos , Japão , Corrida Moderada , Instabilidade Articular/classificação , Masculino , Dor Musculoesquelética/reabilitação , Medição da Dor/métodos , Caminhada , Adulto Jovem
11.
Medicine (Baltimore) ; 98(42): e17621, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626143

RESUMO

While the pain after gynecological laparoscopy is assumed to be minor, many women suffer from unexpected postoperative pain in the post-anesthesia care unit (PACU). Prior identification of these patients is significant for effective analgesia. Therefore, we sought to determine the predictors for acute postoperative pain after gynecological laparoscopy. The data of 280 patients undergoing gynecological laparoscopy were analyzed. Data included demographic characteristics, previous obstetric/gynecologic surgical history, menstruation pattern including dysmenorrhea severity, gynecological hormone administration history, and surgical data (surgical time, endometriosis severity, adhesion, drainage insertion, and surgery type). Univariate analysis and binary logistic regression were used to evaluate predictors for substantial pain in the PACU after gynecologic laparoscopy. Among the 280 patients, 115 (41%) suffered from substantial postoperative pain in the PACU. Whenever the level of dysmenorrhea became more severe (none → mild → moderate → severe), the risk of substantial pain in the PACU increased 2.9-fold (odds ratio [OR] 2.92, 95% confidence interval [CI] 2.11-4.03, P < .001). Moreover, patients undergoing laparoscopy for ectopic pregnancy had a higher risk of substantial pain compared with the others (OR 3.11, 95% CI 1.36-7.12, P = .007). Other factors did not show a significant association with substantial pain. Patients with preoperative severe dysmenorrhea and those undergoing laparoscopy for ectopic pregnancy should be considered to have a high risk of substantial postoperative pain in the PACU so that they receive prompt and aggressive analgesic intervention. In particular, dysmenorrhea severity is clinically valuable as a useful predictor for substantial pain after gynecological laparoscopy.


Assuntos
Dor Aguda/diagnóstico , Analgésicos/uso terapêutico , Doenças dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Laparoscopia/efeitos adversos , Medição da Dor/métodos , Dor Pós-Operatória/diagnóstico , Dor Aguda/tratamento farmacológico , Dor Aguda/etiologia , Adulto , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Estudos Retrospectivos
12.
BMJ ; 367: l5654, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619437

RESUMO

OBJECTIVE: To assess the efficacy of three months of antibiotic treatment compared with placebo in patients with chronic low back pain, previous disc herniation, and vertebral endplate changes (Modic changes). DESIGN: Double blind, parallel group, placebo controlled, multicentre trial. SETTING: Hospital outpatient clinics at six hospitals in Norway. PARTICIPANTS: 180 patients with chronic low back pain, previous disc herniation, and type 1 (n=118) or type 2 (n=62) Modic changes enrolled from June 2015 to September 2017. INTERVENTIONS: Patients were randomised to three months of oral treatment with either 750 mg amoxicillin or placebo three times daily. The allocation sequence was concealed by using a computer generated number on the prescription. MAIN OUTCOME MEASURES: The primary outcome was the Roland-Morris Disability Questionnaire (RMDQ) score (range 0-24) at one year follow-up in the intention to treat population. The minimal clinically important between group difference in mean RMDQ score was predefined as 4. RESULTS: In the primary analysis of the total cohort at one year, the difference in the mean RMDQ score between the amoxicillin group and the placebo group was -1.6 (95% confidence interval -3.1 to 0.0, P=0.04). In the secondary analysis, the difference in the mean RMDQ score between the groups was -2.3 (-4.2 to-0.4, P=0.02) for patients with type 1 Modic changes and -0.1 (-2.7 to 2.6, P=0.95) for patients with type 2 Modic changes. Fifty patients (56%) in the amoxicillin group experienced at least one drug related adverse event compared with 31 (34%) in the placebo group. CONCLUSIONS: In this study on patients with chronic low back pain and Modic changes at the level of a previous disc herniation, three months of treatment with amoxicillin did not provide a clinically important benefit compared with placebo. Secondary analyses and sensitivity analyses supported this finding. Therefore, our results do not support the use of antibiotic treatment for chronic low back pain and Modic changes. TRIAL REGISTRATION: ClinicalTrials.gov NCT02323412.


Assuntos
Amoxicilina , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Dor Lombar , Vértebras Lombares , Adulto , Amoxicilina/administração & dosagem , Amoxicilina/efeitos adversos , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Dor Crônica/diagnóstico , Dor Crônica/tratamento farmacológico , Dor Crônica/etiologia , Avaliação da Deficiência , Método Duplo-Cego , Feminino , Humanos , Dor Lombar/diagnóstico , Dor Lombar/tratamento farmacológico , Dor Lombar/etiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Noruega , Medição da Dor/métodos , Resultado do Tratamento
13.
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
14.
Clin Interv Aging ; 14: 1729-1740, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31631992

RESUMO

Purpose: To evaluate the effects of Myofascial Release Technique (MRT) with a roller massager combined with core stabilization exercises (CSE) in elderly with non-specific low back pain (NSLBP). Patients and methods: A total of forty-five participants were randomly divided into two groups (CSE and CSE+MRT). A core stabilization exercise program was applied for the participants in the CSE group for 3 days per week for a total of 6 weeks. In addition to the core stabilization exercises, myofascial relaxation technique with a roller massager was performed for 3 days per week for 6 weeks for the participants in the CSE+MRT group. Participants were assessed in terms of pain, low back disability, lower body flexibility, kinesiophobia, core stability endurance, spinal mobility, gait characteristics and quality of life both pre- and post-treatment. Results: It was found that the improvement in core stability endurance (p=0.031) and spinal mobility (in the sagittal plane) (p=0.022) was greater in the CSE+MRT group compared to the CSE group. There was no significant difference between the two groups in terms of pain, low back disability, lower body flexibility, kinesiophobia, gait characteristics and quality of life (p>0.05). Conclusion: The current study suggests that myofascial release technique with a roller massager combined with core stabilization exercises can be a better choice in the treatment of NSLBP in elderly. ClinicalTrialsgov Identifier: NCT03898089.


Assuntos
Terapia por Exercício/métodos , Dor Lombar/terapia , Força Muscular/fisiologia , Manipulações Musculoesqueléticas/métodos , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Humanos , Masculino , Medição da Dor/métodos , Qualidade de Vida , Método Simples-Cego , Resultado do Tratamento
15.
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
16.
Medicine (Baltimore) ; 98(41): e17503, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593120

RESUMO

BACKGROUND: The local injection of multimodal cocktail is currently commonly used in the treatment of postoperative pain after total knee arthroplasty (TKA). It is still inconclusive whether the morphine added to the intraoperative injection mixture could make some difference. This meta-analysis aimed to evaluate the efficacy and safety of additional morphine injection on postoperative analgesia in TKA, and provide some useful information on morphine usage in clinical practice. METHODS: The randomized controlled trials (RCTs) in databases including PubMed, Web of Science, Embase, Cochrane Library, Chinese biomedical literature database (CBM), and Chinese National Knowledge Infrastructure (CNKI) databases were systematically searched. Of 623 records identified, 8 RCTs involving 1093 knees were eligible for data extraction and meta-analysis according to criteria included. RESULTS: Meta-analysis showed that the use of local morphine injection was not associated with significant pain relief within 48 hours postoperatively at rest and on motion (P > .05, all). The use of morphine reduced postoperative total systemic opioids consumption (P < .05). This study found no significant differences in other outcomes including knee flexion range of motion (ROM) (P > .05), extension ROM (P > .05), The Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores (P > .05), Post-operative nausea and vomiting occurrence (P > .05) regardless of the presence of morphine or not in the injections. CONCLUSION: Additional morphine added to multimodal cocktail did not decrease the postoperative pain scores significantly based on our outcomes, but it reduced the systemic postoperative opioids consumption in total knee arthroplasty.


Assuntos
Analgesia/métodos , Artroplastia do Joelho/efeitos adversos , Morfina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Analgesia/efeitos adversos , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Anestesia Local/métodos , Artroplastia do Joelho/métodos , Terapia Combinada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Medição da Dor/efeitos dos fármacos , Medição da Dor/métodos , Náusea e Vômito Pós-Operatórios/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular/efeitos dos fármacos
17.
Fisioterapia (Madr., Ed. impr.) ; 41(5): 299-302, sept.-oct. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-183939

RESUMO

Antecedentes y objetivo: La tenosinovitis estenosante (TE) es un trastorno inflamatorio que afecta a vainas y tendones flexores de los dedos. Los tratamientos no quirúrgicos presentan una efectividad limitada. Se ha evidenciado que las ondas de choque (OC) extracorpóreas reducen la presencia de fenómenos inflamatorios crónicos. Dado sus efectos, se postula como una alternativa al tratamiento de la TE. El objetivo de este trabajo es presentar el caso de una paciente con TE la cual fue tratada mediante OC. Descripción: Mujer de 77 años, jubilada, con diagnóstico de TE del tercer dedo de la mano derecha, presenta dolor palmar y chasquido asociado a bloqueo del dedo al realizar actividades que involucren flexoextensión. Se evaluó la intensidad del dolor, umbral de dolor a la presión, capacidad funcional, rango de movimiento, fuerza prensil y de pinza. Intervención: Se realizaron 6 sesiones de tratamiento con una frecuencia de una sesión/semana utilizando una programación de 2.000 pulsos, 6 Hz y 2,2 bar. No se realizó ningún otro tipo de intervención. Resultados: Se evidenció una reducción en la intensidad del dolor, aumento en el umbral del dolor a la presión, rango de movimiento, capacidad funcional, fuerza prensil y de pinza, así como cambios en el aspecto ecográfico de la polea y tendón afectados. Conclusión: La aplicación de OC presentó resultados positivos en el tratamiento de la paciente. En consecuencia, podría ser una opción para el manejo de sujetos con TE


Background and objective: Stenosing tenosynovitis (ST) is an inflammatory disorder that affects the sheaths and tendons of the flexor muscles of the fingers. Conservative treatments have limited effectiveness. It has been shown that extracorporeal shockwave therapy (ESWT) reduces the presence of chronic inflammatory phenomena. Given its effects, it is postulated as treatment alternative for stenosing tenosynovitis. The aim of this report is to present the case of a patient with ST which was treated with ESWT. Description: 77-year-old woman, retired, diagnosed with ST of the third right finger. The patient presented with palmar pain and clicking associated with finger lock when performing activities involving flexion-extension. Pain intensity, pressure pain threshold, functional capacity, range of motion, grip and pinch muscle strength were evaluated. Intervention: Six sessions of treatment were performed with a frequency of 1 session/week using a programming of 2000 pulses, 6 Hz and 2.2 bar. No other intervention was performed. Results: Reduction in the intensity of the pain, increase in pressure pain threshold, range of motion, functional capacity, grip and pinch force, as well as changes in the echographic appearance of the affected pulley and tendon were observed. Conclusion: Application of ESWT presented positive results in this patient. It could therefore be an option for the management of subjects with ST


Assuntos
Humanos , Feminino , Idoso , Ondas de Choque de Alta Energia/uso terapêutico , Tenossinovite/terapia , Limiar da Dor/fisiologia , Medição da Dor/métodos , Inquéritos e Questionários , Dinamômetro de Força Muscular
18.
Med. clín (Ed. impr.) ; 153(8): 312-318, oct. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185415

RESUMO

Antecedentes y objetivos: El dolor postoperatorio es frecuente en los hospitales. Se han desarrollado guías de práctica clínica para el control del dolor postoperatorio (GPCDP) y para mejorar su tratamiento. El objetivo fue evaluar la prevalencia e intensidad del dolor postoperatorio y las pautas analgésicas, antes y después de la implementación de una GPCDP. Material y método: Estudio observacional que incluyó 2estudios transversales realizados en 2períodos (anterior y posterior a la implementación de una GPCDP). Incluyó a pacientes adultos postoperados el primer día de ingreso en plantas de cirugía. Las variables demográficas, clínicas y farmacológicas se recogieron de las historias clínicas; la intensidad del dolor, mediante entrevista con los pacientes. Resultados: Se incluyó a 306 pacientes en el primer período y 317 en el segundo. No hubo diferencias respecto a las variables demográficas y clínicas de los pacientes en los 2períodos. La prevalencia del dolor fue del 92% (IC 95%: 87-95%) en el primer período y del 77% (IC 95%: 72-82%) en el segundo (p <0,05). El dolor más frecuente en las últimas 24 h fue moderado o intenso en el 53% (IC 95%: 48-59%) de los pacientes en el primer período y en el 33% (IC 95%: 28-38%) de los pacientes en el segundo (p <0,05). Conclusiones: Tras la implementación de la GPCDP se observó un descenso de la prevalencia e intensidad del dolor de los pacientes, pero sin llegar a ser óptimo. Son necesarias medidas continuadas de formación y evaluación del dolor para un tratamiento adecuado a lo largo del tiempo


Background and objectives: Postoperative pain is common in hospitals. Clinical practice guidelines for the control of postoperative pain (CPGPP) have been developed to improve its treatment. The objective of this study was to evaluate the prevalence and intensity of postoperative pain and analgesic norms, before and after the implementation of a CPGPP. Material and method: An observational study was carried out that included 2cross-sectional studies in 2separate periods, before and after implementation of the CPGPP. Adult patients postoperated on the first day of admission in the surgery plants were included. Demographic, clinical and pharmacological variables were collected from clinical histories. The intensity of the pain was collected through individual interviews with patients. Results: We included 306 patients in the first period and 317 in the second. There were no differences between patients' demographic and clinical variables and the 2periods. The prevalence of pain was 92% (IC 95%: 87%-95%) in the first period and 77% (IC 95%: 72%-82%) in the second (P <0.05). The most frequent pain in the last 24hours was moderate or intense in 53% (IC 95%: 48%-59%) of patients in the first period and in 33% (IC 95%: 28%-38%) of the patients in the second (P <0.05). Conclusions: After the implementation of the CPGPP, a decrease in the prevalence and intensity of pain in patients was observed, but without reaching an optimal level. Continued pain training and assessment measures are therefore necessary for proper pain treatment over time


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Padrões de Prática Médica , Analgesia/métodos , Estudos Transversais , Medição da Dor/métodos , Análise Estatística , Análise de Variância
19.
Medicine (Baltimore) ; 98(37): e17092, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517832

RESUMO

BACKGROUND: Low back pain (LBP) is a major health problem around the world. Two previous meta-analyses showed that the spa therapy has a positive effect on reducing pain among patients with LBP based on studies published before 2006 and studies published between 2006 and 2013. In recent years, more studies reported the effect of spa therapy on treating chronic low back pain (CLBP). Our study aimed to update the meta-analysis of randomized controlled trials (RCTs) about the effect of spa therapy on treating CLBP and to examine the effect of spa therapy based on different interventions. METHODS: PubMed, Embase, Web of Science, and Cochrane Library were searched until May 2018 to identify RCTs about spa therapy among patients with CLBP. Summary effect estimates were calculated by using a random-effects model. The quality of each eligible study was evaluated by Jadad checklist. RESULTS: Twelve studies met the inclusion criteria for the systematic review and were included in meta-analysis. There was a significant decrease in pain based on visual analogue scale (VAS) (mean difference [MD] 16.07, 95% confidence interval [CI] [9.57, 22.57], P < .00001, I = 88%, n = 966), and lumbar spine function in Oswestry disability index (ODI) (MD 7.12, 95% CI [3.77, 10.47], P < .00001, I = 87%, n = 468) comparing spa therapy group to control group. Methodological assessment for included studies showed that the study's quality is associated with lacking blinding. CONCLUSION: This updated meta-analysis confirmed that spa therapy can benefit pain reliving and improve lumbar spine function among patients with CLBP. Physiotherapy of subgroup analysis indicated that it can improve lumbar spine function. However, these conclusions should be treated with caution due to limited studies. More high-quality RCTs with double-blind design, larger sample size, and longer follow-up should be employed to improve the validity of study results.


Assuntos
Banhos/normas , Dor Lombar/terapia , Banhos/métodos , Dor Crônica/terapia , Humanos , Medição da Dor/métodos
20.
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
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