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1.
Rev. colomb. anestesiol ; 49(4): e501, Oct.-Dec. 2021. tab
Artigo em Inglês | LILACS, COLNAL | ID: biblio-1341246

RESUMO

Abstract Introduction: The use of intravenous lidocaine infusion has increased over the past decade as part of a multimodal approach to analgesia in adults; however, information about its safety and tolerability in the pediatric population is limited. Methods: Acute pain management using lidocaine infusion in eleven patients treated in the pediatric intensive care unit. Results: Five cases of postoperative abdominal pain and six cases of non-operative abdominal pain. Two cases were cancer patients affected by neutropenic colitis. Analgesic control achieved was good. Conclusion: Lidocaine infusions are apparently a safe option for the management of acute pain, either post-operative or not, in the pediatric population.


Resumen Introducción: El uso de la infusión de lidocaína endovenosa ha aumentado en la última década como parte de un enfoque analgésico multimodal en los adultos; sin embargo, se dispone de información limitada sobre su seguridad y tolerabilidad en la población pediátrica. Métodos: Se presentan once casos de manejo de dolor agudo con lidocaína en infusión tratados en unidad de cuidado intensivo pediátrico. Resultados: Cinco casos fueron postoperatorio abdominal y seis casos tenían dolor abdominal no postoperatorio. Dos pacientes tenían cáncer y cursaban con colitis neutropénica. El control analgésico alcanzado fue bueno. Conclusión: Las infusiones de lidocaína parecen ser una opción segura para el manejo del dolor agudo ya sea posquirúrgico o no en la población pediátrica.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Anestesia Intravenosa , Lidocaína , Cuidados Pós-Operatórios , Unidades de Terapia Intensiva Neonatal , Dor Aguda , Analgesia
2.
BMC Musculoskelet Disord ; 22(1): 983, 2021 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-34819061

RESUMO

BACKGROUND: Clinical guideline recommendations are against early magnetic resonance imaging (eMRI) within the first 4 to 6 weeks of conservative management of acute low back pain (LBP) without "clinical suspicion" of serious underlying conditions (red flags). There is some limited evidence that a significant proportion of patients with LBP receive eMRI non- indicated by clinical guidelines, which could be associated with increased length of disability (LOD). The aim of this systematic review was to investigate whether eMRI for acute LBP without red flags is associated with increased LOD. The LOD was defined as the number of disability days (absence from work). METHODS: Medline, EMBASE, and CINAHL bibliographic databases were searched from inception until June 5, 2021. Two reviewers independently assessed the methodological quality of included studies using the Newcastle-Ottawa scale and extracted data for the review. The search identified 324 records, in which seven studies met the inclusion criteria. Three of the included studies used the same study population. Owing to between-study heterogeneity, a narrative synthesis of results was used. RESULTS: All included studies were of good methodological quality and consistently reported that patients with acute LBP without red flags who received eMRI had increased LOD compared to those who did not receive eMRI. Three retrospective cohort studies reported that the eMRI groups had a higher mean LOD than the no eMRI groups ranging from 9.4 days (95% CI 8.5, 10.2) to 13.7 days (95% CI 13.0, 14.5) at the end of 1-year follow-up period. The remaining studies reported that the eMRI groups had a higher hazard ratio of work disability ranging between 1.75 (95% CI 1.23, 2.50) and 3.57 (95% CI 2.33, 5.56) as compared to the no eMRI groups. CONCLUSION: eMRI is associated with increased LOD in patients with acute LBP without red flags. Identifying reasons for performing non-indicated eMRI and addressing them with quality improvement interventions may improve adherence to clinical guidelines and improve disability outcomes among patients with LBP.


Assuntos
Dor Aguda , Dor Lombar , Humanos , Dor Lombar/diagnóstico por imagem , Imageamento por Ressonância Magnética , Estudos Retrospectivos
3.
Am J Case Rep ; 22: e933233, 2021 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-34711795

RESUMO

BACKGROUND Septic arthritis needs to be recognized early because a delay in the treatment leads to significant morbidity and mortality. We present a case of primary septic arthritis of the tarsometatarsal joints in a middle-aged man who presented multiple times to outpatient clinics and the Emergency Department with worsening foot pain. His condition was misdiagnosed several times, and he only received definitive treatment 3 weeks after the onset of his symptoms. CASE REPORT A middle-aged man developed sudden-onset atraumatic left ankle pain that later localized to his foot. Despite analgesics, his foot pain became severe and persistent, affecting his ambulation and sleep. He had multiple consults with his primary care physician, orthopedic specialists, and emergency physicians. Initial radiological and magnetic resonance imaging (MRI) showed degenerative changes, and osteoarthritis was diagnosed. Despite regular analgesics, he experienced worsening pain, prompting his revisit to the Emergency Department. Upon admission, his inflammatory markers were more elevated and a repeat MRI of the foot showed extensive joint effusion, periarticular marrow edema, and bony erosions. He underwent second to third tarsometatarsal joint debridement, washout, drainage, and biopsy. Intraoperative findings showed purulent fluid and clumps of debris within the joint. He received a 6-week course of intravenous antibiotics and was transferred to a rehabilitation center. CONCLUSIONS Septic arthritis of the midfoot is rare. Laboratory and radiological investigations have limitations and should be guided by appropriate clinical findings and judgment. It is important to maintain a high index of suspicion for these cases to prevent morbidity in affected patients.


Assuntos
Dor Aguda , Artrite Infecciosa , Artrite Infecciosa/diagnóstico , Diagnóstico Tardio , , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
4.
Orthopedics ; 44(6): 353-359, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34618639

RESUMO

The misuse of opioids continues to be a public health problem. Acute post-surgical pain management requires a careful balance between the benefits and risks of opioids. Opioids should be part of a multimodal treatment plan, including the use of nonopioid and nonpharmacologic treatment options. Multimodal pain management allows for individualized treatment and improved patient satisfaction while limiting the risks inherent to opioids, including diversion. Surgeons should avoid overprescribing opioids and have a plan for decreasing the use of opioids in the postsurgical time frame. With careful consideration of the risks, opioids can be prescribed to treat acute postsurgical pain effectively. [Orthopedics. 2021;44(6):353-359.].


Assuntos
Dor Aguda , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Humanos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Manejo da Dor , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle
5.
Artigo em Russo | MEDLINE | ID: mdl-34481441

RESUMO

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


Assuntos
Dor Aguda , Diclofenaco , Dor Aguda/tratamento farmacológico , Anti-Inflamatórios não Esteroides/uso terapêutico , Diclofenaco/uso terapêutico , Humanos , Orfenadrina/uso terapêutico , Medição da Dor
6.
Br J Radiol ; 94(1127): 20210281, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34491817

RESUMO

Acute pelvic pain (APP) requires urgent medical evaluation and treatment. Differential diagnosis of APP is broad, including a variety of gynecologic and non-gynecologic/ urinary, gastrointestinal, vascular and other entities. Close anatomical and physiological relations of pelvic structures, together with similar clinical presentation of different disorders and overlapping of symptoms, especially in the emergency background, make the proper diagnosis of APP challenging. Imaging plays a crucial role in the fast and precise diagnosis of APP. Ultrasonography is the first-line imaging modality, often accompanied by CT, while MRI is utilized in specific cases, using short, tailored protocols. Recognizing the cause of APP in females is a challenging task, due to the wide spectrum of possible origin and overlap of their imaging features. Therefore, the radiologist has to be familiar with the possible causes of APP, and, relying on clinical presentation, together with laboratory findings, choose the best imaging strategy in order to establish a fast and accurate diagnosis.


Assuntos
Diagnóstico por Imagem/métodos , Gastroenteropatias/complicações , Doenças dos Genitais Femininos/complicações , Dor Pélvica/etiologia , Doenças Urológicas/complicações , Doenças Vasculares/complicações , Dor Aguda/etiologia , Feminino , Gastroenteropatias/diagnóstico por imagem , Doenças dos Genitais Femininos/diagnóstico por imagem , Humanos , Masculino , Doenças Urológicas/diagnóstico por imagem , Doenças Vasculares/diagnóstico por imagem
8.
ANZ J Surg ; 91(11): 2514-2517, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34585831

RESUMO

BACKGROUND: Acute scrotal pain is a common emergency presentation in paediatric surgery. Torsion of the testicular appendage (TTA) is the most common cause for pain, with testicular torsion (TT) being the sinister pathology to exclude. Outcomes are time dependent, and a delayed scrotal exploration could result in testicular loss. METHODS: We performed a review on a large retrospective cohort of 449 surgical scrotal explorations at a large referral paediatric surgical centre over three years. RESULTS: Only about a quarter of children with testicular pain presented within 4 h. TT is commonly associated with nausea and an abnormal lie. Two children with a classical 'blue dot' sign were later found to have a testicular torsion. 19% of all children with a TTA were also seen to have Bell clapper anomaly (BCA). Recurrent testicular pain was associated with 84.7% (p < 0.001) of BCA. Intra-operative diagnosis of TTA correlated with histopathology in 84.6% (p=0.021). The sensitivity of intraoperative diagnosis was 90.9% with a specificity of 75.3%. CONCLUSION: Routine histopathology for a classic TTA may not be required especially in resource poor situations. All children presenting with recurrent episodes of testicular pain must be considered for surgical scrotal exploration. And in view of the incidence of BCA in this cohort, all scrotal explorations for acute scrotal pain should include an assessment for BCA.


Assuntos
Dor Aguda , Torção do Cordão Espermático , Criança , Humanos , Masculino , Estudos Retrospectivos , Escroto/cirurgia , Torção do Cordão Espermático/diagnóstico , Torção do Cordão Espermático/cirurgia , Testículo
10.
PLoS One ; 16(9): e0257585, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34550982

RESUMO

BACKGROUND: Surgical procedures play an increasing role among health technologies to treat diseases. Pain often accompanies such diseases, both as a result of their pathology, but also as the side-effect of the intervention itself, and it is not only a burdensome subjective feeling, but adversely affects the recovery process, can induce complications and increases treatment costs. Acute Pain Service Teams are becoming increasingly widespread in hospitals to address post-operative pain, yet we have so far no data on how many hospitals have actually adopted this technology in Hungary. OBJECTIVES: The main objectives of our study were to assess the prevalence of Acute Pain Service Teams, map their structure and operation, as well as to understand the barriers and conducive factors of their establishment in Hungarian hospitals. METHODS: We carried out a survey among the 72 hospitals with surgical departments. The questionnaire was filled in by 52 providers, which gave us a response rate of 72.2%. RESULTS: Our results show, that only two of the responding hospitals have Acute Pain Service Teams albeit their structure and operation are in line with the literature. In the 50 hospitals without such teams, financing difficulties and human resources shortages are mentioned to be the most important obstacles of their establishment, but the lack of initiative and interest on the part of the specialities concerned are also an important barrier. CONCLUSIONS: Lagging behind the more affluent EU member states, but similarly to other Central and Eastern European countries, Acute Pain Service has been hardly adopted by Hungarian hospitals. Hungarian health professionals know the technology and would support its wider introduction, if the technical feasibility barriers could be overcome. Health policy should play a more active role to facilitate change in this area, the investment in which promises a substantial return in terms of health gains and cost savings.


Assuntos
Dor Aguda/terapia , Pessoal de Saúde/psicologia , Política de Saúde , Hospitais , Humanos , Hungria , Clínicas de Dor/normas , Manejo da Dor , Projetos Piloto , Inquéritos e Questionários
11.
Cochrane Database Syst Rev ; 9: CD013264, 2021 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-34499349

RESUMO

BACKGROUND: Postoperative administration of non-steroidal anti-inflammatory drugs (NSAIDs) reduces patient opioid requirements and, in turn, may reduce the incidence and severity of opioid-induced adverse events (AEs). OBJECTIVES: To assess the analgesic efficacy and adverse effects of single-dose intravenous (IV) ibuprofen, compared with placebo or an active comparator, for moderate-to-severe postoperative pain in adults. SEARCH METHODS: We searched the following databases without language restrictions: CENTRAL, MEDLINE, Embase and LILACS on 10 June 2021. We checked clinical trials registers and reference lists of retrieved articles for additional studies. SELECTION CRITERIA: We included randomized trials that compared a single postoperative dose of intravenous (IV) ibuprofen with placebo or another active treatment, for treating acute postoperative pain in adults following any surgery. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Two review authors independently considered trials for review inclusion, assessed risk of bias, and extracted data. Our primary outcome was the number of participants in each arm achieving at least 50% pain relief over a 4- and 6-hour period. Our secondary outcomes were time to, and number of participants using rescue medication; withdrawals due to lack of efficacy, adverse events (AEs), and for any other cause; and number of participants reporting or experiencing any AE, serious AEs (SAEs), and specific NSAID-related or opioid-related AEs. We were not able to carry out any planned meta-analysis. We assessed the certainty of the evidence using GRADE. MAIN RESULTS: Only one study met our inclusion criteria, involving 201 total participants, mostly female (mean age 42 years), undergoing primary, unilateral, distal, first metatarsal bunionectomy (with osteotomy and internal fixation). Ibuprofen 300 mg, placebo or acetaminophen 1000 mg was administered intravenously to participants reporting moderate pain intensity the day after surgery. Since we identified only one study for inclusion, we did not perform any quantitative analyses. The study was at low risk of bias for most domains. We downgraded the certainty of the evidence due to serious study limitations, indirectness and imprecision. Ibuprofen versus placebo Findings of the single study found that at both the 4-hour and 6-hour assessment period, the proportion of participants with at least 50% pain relief was 32% (24/76) for those assigned to ibuprofen and 22% (11/50) for those assigned to placebo. These findings produced a risk ratio (RR) of 1.44 (95% confidence interval (CI) 0.77 to 2.66 versus placebo for at least 50% of maximum pain relief over the 4-hour and 6-hour period (very low-certainty evidence). Median time to rescue medication was 101 minutes for ibuprofen and 71 minutes for placebo (1 study, 126 participants; very low-certainty evidence). The number of participants using rescue medication was not reported within the included study. During the study (1 study, 126 participants), 58/76 (76%) of participants assigned to ibuprofen and 39/50 (78%) assigned to placebo reported or experienced any adverse event (AE), (RR 0.98, 95% CI 0.81 to 1.19; low-certainty evidence). No serious AEs (SAEs) were experienced (1 study, 126 participants; very low-certainty evidence). Ibuprofen versus active comparators Ibuprofen (300 mg) was similar to the active comparator, IV acetaminophen (1000 mg) at 4 hours and 6 hours (1 study, 126 participants). For those assigned to active control (acetaminophen), the proportion of participants with at least 50% pain relief was 35% (26/75) at 4 hours and 31% (23/75) at 6 hours. At 4 hours, these findings produced a RR of 0.91 (95% CI 0.58 to 1.43; very low-certainty evidence) versus active comparator (acetaminophen). At 6 hours, these findings produced a RR of 1.03 (95% CI 0.64 to 1.66; very low-certainty evidence) versus active comparator (acetaminophen). Median time to rescue medication was 101 minutes for ibuprofen and 125 minutes for the active comparator, acetaminophen (1 study, 151 participants; very low-certainty evidence). The number of participants using rescue medication was not reported within the included study. During the study, 8/76 (76%) of participants assigned to ibuprofen and 45/75 (60%) assigned to active control (acetaminophen) reported or experienced any AE, (RR 1.27, 95% CI 1.02 to 1.59; very low-certainty evidence). No SAEs were experienced (1 study, 151 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS: There is insufficient evidence to support or refute the suggestion that IV ibuprofen is effective and safe for acute postoperative pain in adults.


Assuntos
Dor Aguda , Ibuprofeno , Acetaminofen/uso terapêutico , Dor Aguda/tratamento farmacológico , Adulto , Analgésicos Opioides/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Feminino , Humanos , Ibuprofeno/efeitos adversos , Masculino , Dor Pós-Operatória/tratamento farmacológico
12.
Clin J Oncol Nurs ; 25(5): 605-607, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34533511

RESUMO

Owing to the lack of specialized care and the unpredictable nature of acute pain episodes in adults with sickle cell disease (SCD), emergency departments have been largely used to provide care for these patients. The lack of specialized care for patients with SCD portends higher healthcare costs and lower health-related quality of life. Although study findings have shown that using multiple models for SCD care is feasible and cost-effective, nurses' awareness of evidence-based guidelines and care models for acute pain management in ambulatory settings is lacking.


Assuntos
Dor Aguda , Anemia Falciforme , Hematologia , Dor Aguda/terapia , Anemia Falciforme/complicações , Anemia Falciforme/terapia , Humanos , Manejo da Dor , Qualidade de Vida
13.
Pain Physician ; 24(6): 417-424, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34554682

RESUMO

BACKGROUND: Florida House Bill 21 (HB21) was implemented in July 2018 to limit Schedule II opioids prescriptions for patients with acute pain to a 3-day supply. Little is known about the potential unintended effects that such opioid restriction policies may have on chronic pain patients, who are exempt from the law. OBJECTIVE: We aimed to evaluate the effect of HB21 on opioid utilization measures among a cohort of chronic opioid therapy (COT) patients. STUDY DESIGN: A quasi-experimental design with interrupted time series analyses. SETTING: Pharmacy claims from January 1, 2015 to June 31, 2019 from a large employer-based health plan in Florida. METHODS: COT patients were those who received a ≥ 70 days' supply of opioids in the prior 90 days, representing 15,310 patients. Interrupted time series analyses were conducted to compare the following monthly measures among COT patients before and after HB21 implementation: 1) number of COT patients, 2) daily Morphine Milligram Equivalents [MMEs], 3) days' supply of prescriptions. RESULTS: There was a significant 25% reduction in the trend (pre-HB21 RR: 0.95, 95% CI: 0.93, 0.96 versus post-HB21 RR: 0.70, 95% CI: 0.65, 0.76) and an 8% immediate decrease (RR: 0.92, 95% CI: 0.88, 0.97) in the monthly prevalence of COT patients after HB21 implementation. However, no significant change was observed in trends for monthly number of days supplied per prescription, monthly MMEs per COT patient-day, or total MMEs per prescription. LIMITATIONS: Our study used data from employer-based private health insurance and did not include a longer post-policy period to adjust for implementation lag. CONCLUSION: Fewer patients received COT after HB21; however, patients who continued to receive COT experienced no significant changes in their regimen. The study did not assess whether COT patients were appropriately tapered or if therapeutic alternatives were initiated for new chronic pain patients.


Assuntos
Dor Aguda , Dor Crônica , Uso Indevido de Medicamentos sob Prescrição , Dor Aguda/tratamento farmacológico , Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Humanos , Análise de Séries Temporais Interrompida , Padrões de Prática Médica , Prescrições
14.
Ned Tijdschr Geneeskd ; 1652021 05 19.
Artigo em Holandês | MEDLINE | ID: mdl-34346575

RESUMO

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


Assuntos
Dor Aguda , Dor Musculoesquelética , Osteoartrite do Joelho , Administração Tópica , Anti-Inflamatórios não Esteroides/efeitos adversos , Diclofenaco , Humanos , Osteoartrite do Joelho/tratamento farmacológico
16.
Scand J Trauma Resusc Emerg Med ; 29(1): 121, 2021 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-34419130

RESUMO

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


Assuntos
Dor Aguda , Analgésicos Opioides , Assistência ao Convalescente , Analgésicos Opioides/uso terapêutico , Seguimentos , Humanos , Alta do Paciente , Sobreviventes , Centros de Traumatologia
17.
BMC Musculoskelet Disord ; 22(1): 666, 2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34372820

RESUMO

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


Assuntos
Dor Aguda , Dor Lombar , Dor Aguda/diagnóstico , Dor Aguda/tratamento farmacológico , Dor Aguda/epidemiologia , Avaliação da Deficiência , Humanos , Dor Lombar/diagnóstico , Dor Lombar/tratamento farmacológico , Dor Lombar/epidemiologia , Estudos Prospectivos
18.
J Bodyw Mov Ther ; 27: 368-387, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34391260

RESUMO

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


Assuntos
Dor Aguda , Dor Aguda/terapia , Crioterapia , Humanos , Satisfação do Paciente , Revisões Sistemáticas como Assunto
19.
J Bodyw Mov Ther ; 27: 705-709, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34391310

RESUMO

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


Assuntos
Dor Aguda , Dor Lombar , Terapia com Luz de Baixa Intensidade , Preparações Farmacêuticas , Anti-Inflamatórios não Esteroides/uso terapêutico , Humanos , Dor Lombar/tratamento farmacológico , Resultado do Tratamento
20.
Medicina (Kaunas) ; 57(8)2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34440950

RESUMO

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


Assuntos
Dor Aguda , Fraturas por Compressão , Bloqueio Nervoso , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Fraturas por Compressão/complicações , Fraturas por Compressão/cirurgia , Humanos , Masculino , Fraturas por Osteoporose/cirurgia , Qualidade de Vida , Estudos Retrospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
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