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Concept: Pain management

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The ActiPatch(®) (BioElectronics Corporation, MD, USA) pulsed shortwave therapy device has been shown to be clinically effective in three double-blind randomized controlled pain studies. However, the effectiveness of this device in a broader population of chronic musculoskeletal pain sufferers, affected by a variety of etiologies in different regions of the body, has not been studied.

Concepts: Medicine, Effect, Effectiveness, Pain, Cultural studies, Suffering, Chronic pain, Pain management

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At the end of life, patients with dementia often experience high levels of pain due to complex interplay of disease processes and numerous barriers to symptom management. In the hospice setting, informal caregivers play an essential role in pain management. This study describes their experience managing pain in hospice patients with dementia.

Concepts: Alzheimer's disease, Pain management

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BACKGROUND: Bilateral midportion Achilles tendinopathy/tendinosis is not unusual, and treatment of both sides is often carried out. Experiments in animals suggest of the potential involvement of central neuronal mechanisms in Achilles tendinosis. OBJECTIVES: To evaluate the outcome of surgery for Achilles tendinopathy. METHODS: This observational study included 13 patients (7 men and 6 women, mean age 53 years) with a long duration (6-120 months) of chronic painful bilateral midportion Achilles tendinopathy. The most painful side at the time for investigation was selected to be operated on first. Treatment was ultrasound-guided and Doppler-guided scraping procedure outside the ventral part of the tendon under local anaesthetic. The patients started walking on the first day after surgery. Follow-ups were conducted and the primary outcome was pain by visual analogue scale. In an additional part of the study, specimens from Achilles and plantaris tendons in three patients with bilateral Achilles tendinosis were examined. RESULTS: Short-term follow-ups showed postoperative improvement on the non-operated side as well as the operated side in 11 of 13 patients. Final follow-up after 37 (mean) months showed significant pain relief and patient satisfaction on both sides for these 11 patients. In 2 of 13 patients operation on the other, initially non-operated side, was instituted due to persisting pain. Morphologically, it was found that there were similar morphological effects, and immunohistochemical patterns of enzyme involved in signal substance production, bilaterally. CONCLUSION: Unilateral treatment with a scraping operation can have benefits contralaterally; the clinical implication is that unilateral surgery may be a logical first treatment in cases of bilateral Achilles tendinopathy.

Concepts: Anesthesia, Pain, Suffering, Tendon, Pain management, Tendinosis, Tendinopathy, Tendinitis

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Racial disparities in use of analgesia in emergency departments have been previously documented. Further work to understand the causes of these disparities must be undertaken, which can then help inform the development of interventions to reduce and eradicate racial disparities in health care provision.

Concepts: Health care, Health, Human, Health disparities, Pain, Pain management

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To determine the prevalence of chronic pain, its causes, severity, management, impact on sleep, mood and activity levels, and general practitioner (GP) and patient satisfaction with pain management.

Concepts: Medical terms, Patient, Physician, Pain, General practitioner, Chronic pain, Pain management, General practice

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Interscalene brachial plexus block (ISBPB) provides excellent analgesia after rotator cuff surgery but is associated with diaphragm dysfunction. In this study, ISBPB with 20 mL of 0.125% or 0.25% bupivacaine were compared to assess the effect on diaphragm function, oxygen saturation, pain control, opioid requirements, and patient satisfaction.

Concepts: Anesthesia, Opioid, Pain, Thoracic diaphragm, Pain management, Rotator cuff, Brachial plexus, Plexus

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PURPOSE: Chemical denervation is not recommended as part of the routine care of chronic non-cancer pain. Physicians face a dilemma when it comes to repeated interventions in cases of recurrent thoracolumbar facet joint pain after successful thermal radiofrequency ablation (RFA) in medial branch neurotomy. This study was performed to compare the effects of alcohol ablation (AA) with thermal RFA in patients with recurrent thoracolumbar facet joint pain after thermal RFA treatment. METHODS: Forty patients with recurrent thoracolumbar facet joint pain after successful thermal RFA defined as a numeric rating scale (NRS) score of ≥7 or a revised Oswestry disability index (ODI) of ≥22 % were randomly allocated to two groups receiving either the same repeated RFA (n = 20) or AA (n = 20). The recurrence rate was assessed with NRS and ODI during the next 24 months, and adverse events in each group were recorded. RESULTS: During the 24-month follow-up after RFA and AA, one and 17 patients, respectively, were without recurring thoracolumbar facet joint pain. The median effective periods in the RFA and AA groups were 10.7 (range 5.4-24) and 24 (range 16.8-24) months, respectively (p < 0.000). No significant complications were observed with the exception of injection site pain, which occurred in both groups. CONCLUSION: In our patient cohort, alcohol ablation in medial branch neurotomy provided a longer period of pain relief and better quality of life than repeated radiofrequency medial branch neurotomy in the treatment of recurrent thoracolumbar facet joint pain syndrome after successful thermal RFA without significant complications during the 24-month follow-up.

Concepts: Medical terms, Pain, Suffering, Myofascial pain syndrome, Pain management, Recurrence relation, Radiofrequency ablation

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Pain qualities may reflect neurobiological mechanisms and guide therapy. The objective was to assess whether pain qualities were associated with satisfaction with pain relief in subjects with neuropathic pain.

Concepts: Pain, Suffering, Pain management, Peripheral neuropathy, Neuropathic pain

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AIMS AND OBJECTIVES: To compare the effects of two pain management methods, intravenous patient-controlled analgesia and conventional intravenous injection, in terms of pain level, adverse reactions experienced, nursing care time spent for pain management, satisfaction with pain management and total cost of pain management for patients who underwent total abdominal hysterectomy. BACKGROUND: Patient-controlled intravenous analgesia has been used most commonly for management of postoperative pain. Although it can be very effective in management of postoperative pain, patients still complained of many adverse reactions. DESIGN: A quasi-experimental study design was used. METHODS: Seventy female participants were recruited for each group and were randomly assigned to one of the pain management methods. Data regarding pain level, adverse reactions experienced and level of satisfaction with pain management methods during a 48-hour postoperative period were collected. Calculation of cost for each pain management method was based on the cost of the device, drugs for both analgesics and antiemetics, and time spent by nurses for both pain management methods. Frequencies, percentages and means of the data were calculated, and chi-squared test and t-test were performed for homogeneity. RESULTS: Mean postoperative pain levels at 2, 6 and 12 hour were significantly lower in patients who used patient-controlled analgesic compared with patients who received intravenous injection; however, after that, there was no significant difference between the two methods. The cost for pain management was much higher for patients who used patient-controlled analgesic; however, satisfaction level with pain control was lower than that for patients who received intravenous injection. CONCLUSIONS: For patients who underwent total hysterectomy, patient-controlled analgesia was not cost-effective for management of postoperative pain for 48 hour, compared with conventional intravenous injection. RELEVANCE TO CLINICAL PRACTICE: For nurses caring for patients with pain, adaptation of diverse methods of pain management that will increase patients' satisfaction with pain management as well as lower the cost and occurrence of adverse reactions should be considered.

Concepts: Opioid, Pain, Hysterectomy, Route of administration, Analgesic, Suffering, Pain management, Patient-controlled analgesia

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BACKGROUND: Chronic pain is distressing for patients and a burden on healthcare systems and society. Recent research demonstrates different aspects of the negative impact of chronic pain and the positive impact of successful treatment, making an overview of the costs and consequences of chronic pain appropriate. OBJECTIVE: To examine recent literature on chronic noncancer and neuropathic pain prevalence, impact on quality and quantity of life, societal and healthcare costs, and impact of successful therapy. METHODS: Systematic reviews (1999 to February 2012) following PRISMA guidelines were conducted to identify studies reporting appropriate outcomes. RESULTS: Chronic pain has a weighted average prevalence in adults of 20%; 7% have neuropathic pain, and 7% have severe pain. Chronic pain impeded activities of daily living, work and work efficiency, and reduced quality and quantity of life. Effective pain therapy (pain intensity reduction of at least 50%) resulted in consistent improvements in fatigue, sleep, depression, quality of life, and work. CONCLUSION: Strenuous efforts should be put into obtaining good levels of pain relief for people in chronic pain, including the opportunity for multiple drug switching, using reliable, validated, and relatively easily applied patient-centered outcomes. Detailed, thoughtful and informed decision analytic policy modeling would help understand the key elements in organizational change or service reengineering to plan the optimum pain management strategy to maximize pain relief and its stream of benefits against budgetary and other constraints. This paper contains the information on which such models can be based.

Concepts: Medicine, Management, Pain, Suffering, Chronic pain, Pain management, Neuropathic pain