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Acute Pain (acute + pain)

Distribution by Scientific Domains

Medical Sciences	82%
Life Sciences	12%
2 Other Domains	6%

Terms modified by Acute Pain

acute pain management

acute pain team

Selected Abstracts

Translating Research into Practice Intervention Improves Management of Acute Pain in Older Hip Fracture Patients

HEALTH SERVICES RESEARCH, Issue 1 2009
Marita G. Titler
Objective. To test an interdisciplinary, multifaceted, translating research into practice (TRIP) intervention to (a) promote adoption, by physicians and nurses, of evidence-based (EB) acute pain management practices in hospitalized older adults, (b) decrease barriers to use of EB acute pain management practices, and (c) decrease pain intensity of older hospitalized adults. Study Design. Experimental design with the hospital as the unit of randomization. Study Setting. Twelve acute care hospitals in the Midwest. Data Sources. (a) Medical records (MRs) of patients ,65 years or older with a hip fracture admitted before and following implementation of the TRIP intervention and (b) physicians and nurses who care for those patients. Data Collection. Data were abstracted from MRs and questions distributed to nurses and physicians. Principal Findings. The Summative Index for Quality of Acute Pain Care (0,18 scale) was significantly higher for the experimental (10.1) than comparison group (8.4) at the end of the TRIP implementation phase. At the end of the TRIP implementation phase, patients in the experimental group had a lower mean pain intensity rating than those in the comparison group ( p<.0001). Conclusion. The TRIP intervention improved quality of acute pain management of older adults hospitalized with a hip fracture. [source]

Infant Behaviors as Indicators of Established Acute Pain

JOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 3 2001
Barbara F. Fuller
ISSUES AND PURPOSE. Many infant pain assessment tools use infant behaviors indicative of increased arousal. These tools were developed and tested using clinical situations involving acute immediate pain responses. Are these behaviors valid, clinical indicators of acute established pain (non-procedurally caused) pain? Can these tools be used to assess acute established infant pain? This article explores research findings to answer these questions. CONCLUSIONS. Findings suggest that behaviors indicative of increased arousal (e.g., crying, facial expressions that accompany crying) are nonspecific indicators of distress rather than independent indicators of established acute pain. Thus, the use of behaviors representing acute immediate pain responses to assess acute established pain, or the use of tools that incorporate these behaviors, can be misleading. PRACTICE IMPLICATIONS. Always use acute immediate pain behavioral responses (behaviors indicative of increased arousal) in conjunction with clinical data concerning "likelihood of pain" and consolability. [source]

(204) Rofecoxib Was More Effective than Codeine with Acetaminophen in the Treatment of Acute Pain

PAIN MEDICINE, Issue 3 2001
David J. Chang
Rofecoxib (VIOXX®) is a selective inhibitor of cyclo-oxygenase-2 and is indicated for the treatment of acute pain. Prior acute pain studies showed similar analgesic efficacy of rofecoxib 50 mg compared with analgesics doses of non-selective NSAIDs. We performed a randomized, double-blind trial to evaluate the efficacy and safety of rofecoxib, a standard fixed formulation of codeine with acetaminophen, and placebo in the treatment of acute pain. Three-hundred ninety-three patients with moderate or severe pain after surgical extraction of at least two 3rd molars were randomized to receive a single dose of rofecoxib 50 mg (n = 182), codeine 60 mg with acetaminophen 600 mg (n = 180), or placebo (n = 31). Efficacy was assessed at 11 pre-specified time points after dosing by pain relief and pain intensity scores. Patient global assessment of study medication was also performed. Baseline characteristics were similar among the groups. The mean age was 21 years; 69.0% were female; and 78.6% had a pain intensity score of "moderate." For the primary endpoint, total pain relief over 6 hours, rofecoxib was more effective than codeine/acetaminophen (p < 0.001) and placebo (p < 0.001). Proportion of patients who rated the study medication as good, very good, or excellent at 6 hours was 64.6% on rofecoxib, 36.4% on codeine/acetaminophen, and 10.3% on placebo (rofecoxib> codeine/acetaminophen; p < 0.001). The time to rescue medication was longer for rofecoxib compared to codeine/acetaminophen (p < 0.001). More patients on codeine/acetaminophen experienced clinical adverse events than rofecoxib (p < 0.05). Patients receiving codeine/acetaminophen versus rofecoxib had higher incidences of nausea (25.0% vs 6.0%; p < 0.001) and vomiting (18.3% vs 3.8%; p < 0.001). In this study, rofecoxib had superior efficacy and gastrointestinal safety compared to codeine/acetaminophen, which provides support for the use of rofecoxib as an alternative option to opioid analgesics in the treatment of acute post-surgical pain. [source]

Ibuprofen Provides Analgesia Equivalent to Acetaminophen,Codeine in the Treatment of Acute Pain in Children with Extremity Injuries: A Randomized Clinical Trial

ACADEMIC EMERGENCY MEDICINE, Issue 8 2009
Janet H. Friday MD
Abstract Objectives:, This study compared the analgesic effectiveness of acetaminophen,codeine with that of ibuprofen for children with acute traumatic extremity pain, with the hypothesis that the two medications would demonstrate equivalent reduction in pain scores in an emergency department (ED) setting. Methods:, This was a randomized, double-blinded equivalence trial. Pediatric ED patients 5 to 17 years of age with acute traumatic extremity pain received acetaminophen,codeine (1 mg/kg as codeine, maximum 60 mg) or ibuprofen (10 mg/kg, maximum 400 mg). The patients provided Color Analog Scale (CAS) pain scores at baseline and at 20, 40, and 60 minutes after medication administration. The primary outcome measured was the difference in changes in pain score at 40 minutes, compared to a previously described minimal clinically significant change in pain score of 2 cm. The difference was defined as (change in ibuprofen CAS score from baseline) , (change in acetaminophen,codeine CAS score from baseline); negative values thus favor the ibuprofen group. Additional outcomes included need for rescue medication and adverse effects. Results:, The 32 acetaminophen,codeine and the 34 ibuprofen recipients in our convenience sample had indistinguishable pain scores at baseline. The intergroup differences in pain score change at 20 minutes (,0.6, 95% confidence interval [CI] = ,1.5 to 0.3), 40 minutes (,0.4, 95% CI = ,1.4 to 0.6), and 60 minutes (0.2, 95% CI = ,0.8 to 1.2) were all less than 2 cm. Adverse effects were minimal: vomiting (one patient after acetaminophen,codeine), nausea (one patient after ibuprofen), and pruritus (one after acetaminophen,codeine). The three patients in each group who received rescue medications all had radiographically demonstrated fractures or dislocations. Conclusions:, This study found similar performance of acetaminophen,codeine and ibuprofen in analgesic effectiveness among ED patients aged 5,17 years with acute traumatic extremity pain. Both drugs provided measurable analgesia. Patients tolerated them well, with few treatment failures and minimal adverse effects. [source]

On functional motor adaptations: from the quantification of motor strategies to the prevention of musculoskeletal disorders in the neck,shoulder region

ACTA PHYSIOLOGICA, Issue 2010
P. Madeleine
Abstract Background:, Occupations characterized by a static low load and by repetitive actions show a high prevalence of work-related musculoskeletal disorders (WMSD) in the neck,shoulder region. Moreover, muscle fatigue and discomfort are reported to play a relevant initiating role in WMSD. Aims: To investigate relationships between altered sensory information, i.e. localized muscle fatigue, discomfort and pain and their associations to changes in motor control patterns. Materials & Methods:, In total 101 subjects participated. Questionnaires, subjective assessments of perceived exertion and pain intensity as well as surface electromyography (SEMG), mechanomyography (MMG), force and kinematics recordings were performed. Results:, Multi-channel SEMG and MMG revealed that the degree of heterogeneity of the trapezius muscle activation increased with fatigue. Further, the spatial organization of trapezius muscle activity changed in a dynamic manner during sustained contraction with acute experimental pain. A graduation of the motor changes in relation to the pain stage (acute, subchronic and chronic) and work experience were also found. The duration of the work task was shorter in presence of acute and chronic pain. Acute pain resulted in decreased activity of the painful muscle while in subchronic and chronic pain, a more static muscle activation was found. Posture and movement changed in the presence of neck,shoulder pain. Larger and smaller sizes of arm and trunk movement variability were respectively found in acute pain and subchronic/chronic pain. The size and structure of kinematics variability decreased also in the region of discomfort. Motor variability was higher in workers with high experience. Moreover, the pattern of activation of the upper trapezius muscle changed when receiving SEMG/MMG biofeedback during computer work. Discussion:, SEMG and MMG changes underlie functional mechanisms for the maintenance of force during fatiguing contraction and acute pain that may lead to the widespread pain seen in WMSD. A lack of harmonious muscle recruitment/derecruitment may play a role in pain transition. Motor behavior changed in shoulder pain conditions underlining that motor variability may play a role in the WMSD development as corroborated by the changes in kinematics variability seen with discomfort. This prognostic hypothesis was further, supported by the increased motor variability among workers with high experience. Conclusion:, Quantitative assessments of the functional motor adaptations can be a way to benchmark the pain status and help to indentify signs indicating WMSD development. Motor variability is an important characteristic in ergonomic situations. Future studies will investigate the potential benefit of inducing motor variability in occupational settings. [source]

Rheumatological presentations of anticoagulation related hemorrhages

INTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 2 2003
S. R. Cox
Abstract Background: Joint, back and muscle pain are common in patients referred to a rheumatology unit. Acute pain due to hemorrhage may be difficult to distinguish from more common causes of pain in these patients. This article describes a small case-series of patients who presented acutely with hemarthroses, spinal hemorrhage or muscle hematomas while receiving anticoagulant treatment. Methods: Case notes of nine patients were reviewed retrospectively. The demographic characteristics, indication for anticoagulation, international normalized ratio, and management were evaluated. Results: The majority of hemorrhages occurred when the INR was within the therapeutic range. Anticoagulation was held in all cases. Joint aspiration was performed in all cases of hemarthrosis. Surgical intervention was required in management of the spinal epidural bleed and also in one case of muscle hematoma. Conclusion: Cases described represent major hemorrhages in anticoagulated patients. There is little literature on specific treatment and prognosis, particularly with respect to hemarthrosis, and further studies are needed. [source]

On functional motor adaptations: from the quantification of motor strategies to the prevention of musculoskeletal disorders in the neck,shoulder region

Neuropathic pain and diabetes

DIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue S1 2003
Dilip Kapur
Abstract Neuropathic pain is a common phenomenon resulting from injury to the central or peripheral nervous system. The means by which diabetes results in nerve injury is unclear but the effect is to cause injury at all levels of the nervous system from the level of the peripheral nerves to the brain. Nerve injury causes pain through a cascade of mechanisms resulting in altered processing of sensory input into the nervous system. This alteration occurs through chemical and anatomical changes in the nervous system that are similar to some of the processes seen in central sensitisation following acute pain. Following nerve injury, neuropathic pain occurs not only when these mechanisms are activated but also when sensitisation is maintained. Other processes occurring in neuropathic pain appear to be a loss of normal inhibitory controls as seen by a reduction in local GABA-ergic and descending monoaminergic influences. There are also important changes mediated via glial cells that can maintain neuropathic pain. Diabetes affects all areas of the nervous system and the contribution of higher levels of the nervous system is often overlooked. Neurophysiological and MRI evidence strongly suggest that these may contribute to the pain of diabetic neuropathy. Psychological dysfunction in diabetic patients is an important factor in increasing the suffering associated with all aspects of the disease, but treatment and control of pain can greatly improve the quality of life. Copyright © 2003 John Wiley & Sons, Ltd. [source]

Neuropathic pain: symptoms, models, and mechanisms

DRUG DEVELOPMENT RESEARCH, Issue 4 2006
Simon Beggs
Abstract Peripheral neuropathic pain is the most debilitating of all clinical pain syndromes and affects a large and growing number of people worldwide. There are diverse causes for peripheral neuropathic pain, which may be experienced after traumatic nerve injury or from diseases that affect peripheral nerves, such as diabetes, HIV/AIDS, and cancer, and it can also result from toxic chemicals, such as cancer chemotherapy agents. Despite these varying causes, it is clear that neuropathic pain is due to persistent pathological alterations resulting in hyperexcitability in the peripheral and central nervous systems, and it is the neuropathology that must be targeted for effective therapy of which there is none presently available. Mechanistically, neuropathic pain is distinct from acute pain and inflammatory pain, for which many effective therapies are known. In this review, we describe the relationships between clinical symptoms and experimental models of peripheral neuropathic pain, and we provide a framework for understanding the potential mechanisms that involve primary neuronal dysfunction as well as pathological changes in neuron-glial signaling. Drug Dev. Res. 67:289,301, 2006. © 2006 Wiley-Liss, Inc. [source]

Parents and Practitioners Are Poor Judges of Young Children's Pain Severity

ACADEMIC EMERGENCY MEDICINE, Issue 6 2002
Adam J. Singer MD
Objective: Visual analog pain scales are reliable measures in older children and adults; however, pain studies that include young children often rely on parental or practitioner assessments for measuring pain severity. The authors correlated patient, parental, and practitioner pain assessments for young children with acute pain. Methods: This was a prospective, descriptive study of a convenience sample of 63 emergency department patients aged 4-7 years, with acute pain resulting from acute illness or painful invasive procedures. A trained research assistant administered a structured pain survey containing demographic and historical features to all parents/guardians. Children assessed their pain severity using a validated ordinal scale that uses five different faces with varying degrees of frowning (severe pain) or smiling (no pain). Each face was converted to a numeric value from 0 (no pain) to 4 (severe pain). Parents and practitioners independently assessed their child's pain using a validated 100-mm visual analog scale (VAS) marked "most pain" at the high end. Pairwise correlations between child, parent, and practitioner pain assessments were performed using Spearman's or Pearson's test as appropriate. The association between categorical data was assessed using ,2 tests. Results: Sixty-three children ranging in age from 4 to 7 were included. Mean age (±SD) was 5.7 (±1.1); 42% were female. Fifty-seven successfully completed the face scale. The distribution of the children's scores was 0-17%, 1-9%, 2-30%, 3-14%, and 4-30%. Mean parental and practitioner scores (±SD) on the VAS were 61 (±26) mm and 37 (±26) mm, respectively (maximal = 100 mm). Correlation between child and parent scores was 0.47 (p < 0.001). Correlation between child and practitioner scores was 0.08 (p = 0.54). Correlation between parent and practitioner scores was 0.04 (p = 0.001). Conclusions: There is poor agreement between pain ratings by children, parents, and practitioners. It is unclear which assessment best approximates the true degree of pain the child is experiencing. [source]

Local and descending circuits regulate long-term potentiation and zif268 expression in spinal neurons

EUROPEAN JOURNAL OF NEUROSCIENCE, Issue 3 2006
Lars Jørgen Rygh
Abstract Long-term potentiation (LTP), a use dependent long-lasting modification of synaptic strength, was first discovered in the hippocampus and later shown to occur in sensory areas of the spinal cord. Here we demonstrate that spinal LTP requires the activation of a subset of superficial spinal dorsal horn neurons expressing the neurokinin-1 receptor (NK1-R) that have previously been shown to mediate certain forms of hyperalgesia. These neurons participate in local spinal sensory processing, but are also the origin of a spino-bulbo-spinal loop driving a 5-hydroxytryptamine 3 receptor (5HT3-R)- mediated descending facilitation of spinal pain processing. Using a saporin-substance P conjugate to produce site-specific neuronal ablation, we demonstrate that NK1-R expressing cells in the superficial dorsal horn are crucial for the generation of LTP-like changes in neuronal excitability in deep dorsal horn neurons and this is modulated by descending 5HT3-R-mediated facilitatory controls. Hippocampal LTP is associated with early expression of the immediate-early gene zif268 and knockout of the gene leads to deficits in long-term LTP and learning and memory. We found that spinal LTP is also correlated with increased neuronal expression of zif268 in the superficial dorsal horn and that zif268 antisense treatment resulted in deficits in the long-term maintenance of inflammatory hyperalgesia. Our results support the suggestion that the generation of LTP in dorsal horn neurons following peripheral injury may be one mechanism whereby acute pain can be transformed into a long-term pain state. [source]

Ability of Patients to Accurately Recall the Severity of Acute Painful Events

ACADEMIC EMERGENCY MEDICINE, Issue 3 2001
Adam J. Singer MD
Abstract. Objective: Pain studies require prospective patient enrollment to ensure accurate pain assessment. The authors correlated pain assessments of an acute painful episode over a one-week period and determined the accuracy of patient pain severity recall over time. Methods: This was a prospective, descriptive, longitudinal study. Participants were a convenience sample of 50 emergency department patients with acute pain resulting from injuries or painful invasive procedures. A trained research assistant administered a structured pain survey containing demographic and historical features to all patients. Patients sequentially assessed their pain severity using a vertical 100-mm visual analog scale marked "most pain" at the top, a verbal numeric rating scale ranging from 0 to 100 from none to worst (NRS100), and a verbal numeric rating scale ranging from 0 to 10 from none to worst (NRS10). Patients were contacted by phone and asked to reassess their initial pain severity one and seven days later using the two verbal numeric rating scales. Analysis of pain assessments using the various scales at the three time intervals was performed with Pearson's and Spearman's coefficients and repeated-measures analysis of variance (ANOVA). Results: There were 50 patients with a mean age of 41 years. Correlation between initial pain assessments on the three scales ranged from 0.83 to 0.92. Correlations between the initial and 24-hour assessments were NRS100-0.98 and NRS10-0.98. Correlations between the initial and one-week assessments were NRS100-0.96 and NRS10-0.97. Repeated-measures ANOVA showed no significant change in pain assessments over time for both verbal numeric scales. Conclusions: Pain severity assessments of acute painful events one and seven days later were similar and highly correlated with initial assessments using both verbal numeric scales. Patients accurately recall the severity of an acute painful episode for at least one week after its occurrence, which may allow retrospective pain assessments. [source]

Opioids and the skin , where do we stand?

EXPERIMENTAL DERMATOLOGY, Issue 5 2009
Paul L. Bigliardi
Abstract:, The common ectodermal origin of the skin and nervous systems can be expected to predict likely interactions in the adult. Over the last couple of decades much progress has been made to elucidate the nature of these interactions, which provide multidirectional controls between the centrally located brain and the peripherally located skin and immune system. The opioid system is an excellent example of such an interaction and there is growing evidence that opioid receptors (OR) and their endogenous opioid agonists are functional in different skin structures, including peripheral nerve fibres, keratinocytes, melanocytes, hair follicles and immune cells. Greater knowledge of these skin-associated opioid interactions will be important for the treatment of chronic and acute pain and pruritus. Topical treatment of the skin with opioid ligands is particularly attractive as they are active with few side effects, especially if they cannot cross the blood,brain barrier. Moreover, cutaneous activation of the opioid system (e.g. by peripheral nerves, cutaneous and immune cells, especially in inflamed and damaged skin) can influence cell differentiation and apoptosis, and thus may be important for the repair of damaged skin. While many of the pieces of this intriguing puzzle remain to be found, we attempt in this review to weave a thread around available data to discuss how the peripheral opioid system may impact on different key players in skin physiology and pathology. [source]

Overview of adverse reactions to nefopam: an analysis of the French Pharmacovigilance database

FUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 5 2007
G. Durrieu
Abstract Nefopam is widely used for the relief of moderate acute pain. Its safety profile remains to be specified. The objective of the study was to review adverse reactions to nefopam spontaneously reported to the French Pharmacovigilance system. All cases of adverse drug reactions (ADRs) associated with nefopam, registered in the French Pharmacovigilance database from January 1, 1995 to December 31, 2004, were reviewed. For each reported ADR, information about patient (age, gender, medical history), drug exposure (suspected and concomitantly used drugs), characteristics of ADRs (imputability score, time of onset, seriousness, outcome) were collected. A total of 114 ADRs with an imputability rated from ,plausible' (I2) to ,likely' (I3) and ,very likely' (I4) was analysed. The most frequent ADRs included ,expected' ADRs such as sweating, nausea, tachycardia, malaise or vomiting; 61 ADRs were ,unexpected. No overdose was reported; 26 ADRs (23%) were considered as ,serious'. Most of them were ,unexpected', including neuropsychiatric (hallucinations, convulsions) or cutaneous (pruritus, erythema, urticaria) ADRs. Six cases of anaphylactic ADRs (two angioedema and four anaphylactic shocks) were reported, all occurring shortly after use of nefopam during the post-operative period. Physicians should be aware of the possible occurrence of some serious ADRs when using nefopam such as convulsions and anaphylactic shocks, especially when the drug is used in special medical conditions, like post-operative periods. [source]

Caregiving behavior and interactions of prenatally depressed mothers (antidepressant-treated and non-antidepressant-treated) during newborn acute pain,

INFANT MENTAL HEALTH JOURNAL, Issue 4 2009
Fay F. Warnock
This exploratory study aimed to examine time-based measures of the behaviors and interactions of prenatally depressed serotonin reuptake inhibitors (SRI)-medicated mothers to their infant's pain (n = 10) by comparing them with similar measures obtained from prenatally depressed nonmedicated mothers and their infants (n = 10), and nondepressed mothers and their infants (n = 10). During the second trimester of their pregnancy, the 30 study mothers were assessed for depression and anxiety, with no further measures of maternal mood taken. Maternal and infant interactions were continuously videorecorded while the infant underwent a scheduled heel lance for routine blood screening that occurred when study infants were between the ages of 24 and 60 hr. Maternal behavior and infant cry, for all 30 cases, were coded second-by-second for the full duration of each infant's heel lance using a reliable coding system and analyzed using odds ratio and regression analyses. Infants exposed to prenatal SRIs and depressed maternal mood were more likely to have lower Apgar scores and to exhibit weak and absent cry. Even when duration of the heel lance was controlled for, women with depression during the second trimester were more likely to exhibit depressed behavior at 2 days' postpartum despite sustained SRI antidepressant treatment. Both groups of prenatally depressed mothers were more likely to exhibit diminished response to their infants' pain cue although nonmedicated mothers' expressions of depressed behavior were more similar to healthy controls. Comprehensive understanding is essential to optimize the clinical care of mothers and their infants in this complex setting. This study contributes preliminary new findings that warrant prospective and longitudinal studies to clarify further the impacts of prenatal SRI and maternal mental mood (e.g., chronic depression and anxiety) effects on the mother,infant interaction and infant pain and stress reactivity. [source]

Efficacy and tolerability of diclofenac potassium sachets in acute postoperative dental pain: a placebo-controlled, randomised, comparative study vs. diclofenac potassium tablets

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2006
C. M. Hofele
Summary This double-blind, randomised, parallel-group trial compared the analgesic efficacy of single 50 mg doses of diclofenac potassium sachets and tablets with placebo in 184 patients with moderate/severe pain after third molar extraction. The primary efficacy variable was the average pain reduction from baseline during the first 2-h postdose, using a visual analogue scale (VAS). During the first 2-h postdose, sachets and tablets significantly reduced pain (p < 0.05) vs. placebo with an incremental benefit seen for sachets over tablets (p < 0.05). Onset of analgesic effect (VAS) was at 30 min for sachets and 45 min for tablets. Pain reduction vs. placebo (VAS) was maintained for 8 h for sachets and tablets (p < 0.05). VAS-findings were confirmed by pain relief and intensity verbal scale assessments. Fewer patients remedicated vs. placebo. No safety issues were identified. This study demonstrates that both diclofenac potassium sachets and tablets offer patients suffering from acute pain conditions an effective treatment with incremental analgesic benefits seen for sachets. [source]

,I think PCA is great, but . . .',Surgical nurses' perceptions of patient-controlled analgesia

INTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 5 2007
Sue King RGON MA(Appl)
This qualitative study investigated surgical nurses' perceptions of patient-controlled analgesia as a strategy for managing acute pain in a tertiary care hospital. Patient-controlled analgesia is commonly used and nurses play an essential role in caring for patients prescribed it. The study was divided into two parts. First, audiotaped semistructured interviews were conducted with 10 nurses. The interviews were followed by a postal questionnaire to 336 nurses with 171 returned. Thematic analysis was the chosen methodology. The audiotaped transcripts and questionnaires surfaced five themes, with the dominant one being ,I think PCA is great, but . . .'. The paper outlines and explores these themes and addresses the implications arising from the research for both clinical practice and education. [source]

Infant Behaviors as Indicators of Established Acute Pain

Persistent Nonmalignant Pain and Analgesic Prescribing Patterns in Elderly Nursing Home Residents

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2004
(See editorial comments by Dr. Debra Weiner on pp 1020, 1022)
Objectives: To determine the prevalence of analgesics used, their prescribing patterns, and associations with particular diagnoses and medications in patients with persistent pain. Design: Cross-sectional study. Setting: Nursing homes from 10 U.S. states. Participants: A total of 21,380 nursing home residents aged 65 and older with persistent pain. Measurements: Minimum Data Set (MDS) assessments on pain, analgesics, cognitive, functional, and emotional status were summarized. Logistic regression models identified diagnoses associated with different analgesic classes. Results: Persistent pain as determined using the MDS was identified in 49% of residents with an average age of 83; 83% were female. Persistent pain was prevalent in patients with a history of fractures (62.9%) or surgery (63.6%) in the past 6 months. One-quarter received no analgesics. The most common analgesics were acetaminophen (37.2%), propoxyphene (18.2%), hydrocodone (6.8%), and tramadol (5.4%). Only 46.9% of all analgesics were given as standing doses. Acetaminophen was usually prescribed as needed (65.6%), at doses less than 1,300 mg per day. Nonsteroidal antiinflammatory drugs (NSAIDs) were prescribed as a standing dose more than 70% of the time, and one-third of NSAIDs were prescribed at high doses. Conclusion: In nursing home residents, persistent pain is highly prevalent, there is suboptimal compliance with geriatric prescribing recommendations, and acute pain may be an important contributing source of persistent pain. More effective provider education and research is needed to determine whether treatment of acute pain could prevent persistent pain. [source]

From neuroanatomy to gene therapy: searching for new ways to manipulate the supraspinal endogenous pain modulatory system

JOURNAL OF ANATOMY, Issue 2 2007
I. Tavares
Abstract The endogenous pain modulatory system is a complex network of brain areas that control nociceptive transmission at the spinal cord by inhibitory and facilitatory actions. The balance between these actions ensures effective modulation of acute pain, while during chronic pain the pronociceptive effects appear to prevail. The mechanisms underlying this imbalance were studied as to the role of two medullary components of the pain modulatory system: the dorsal reticular nucleus and the caudal ventrolateral medulla, which function primarily as pronociceptive and antinociceptive centres, respectively. Both areas are connected with the spinal dorsal horn by closed reciprocal loops. In the spino-dorsal reticular nucleus loop, the ascending branch is strongly inhibited by spinal GABAergic neurons, which may act as a buffering system of the dorsal reticular nucleus-centred amplifying effect. In the spino-caudal ventrolateral medulla loop, the ascending branch is under potent excitation of substance P (SP) released from primary afferents, which is likely to trigger the intense descending inhibition detected in acute pain. During chronic pain, the activity in the lateral reticular formation of the caudal ventrolateral medulla changes, so that the action of the caudal ventrolateral medulla upon SP-responsive spinal neurons shifts from inhibitory to excitatory. The mechanisms of this modulatory shift are unknown but probably relate to the decresed expression of µ-opioid, ,-opioid and GABAB receptors. Normalizing receptor expression in the caudal ventrolateral medulla or controlling noci-evoked activity at the dorsal reticular nucleus or caudal ventrolateral medulla by interfering with neurotransmitter release is now possible by the use of gene therapy, an approach that stands out as a unique tool to manipulate the supraspinal endogenous pain control system. [source]

Decreases in Cortisol Variability Between Treated and Untreated Jaw Pain Patients,

JOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH, Issue 3-4 2006
Richard C. Robinson
The study evaluated the impact of treatment on cortisol levels in acute pain patients at high risk for chronic jaw-related pain. Twenty-five patients with jaw pain or facial discomfort (< 6 months) participated in the study. Patients at high risk for chronic pain received biobehavioral intervention, and those at lower risk received standard care. Cortisol levels increased over time in both conditions, F(1, 429) = 6.614, p = .010; however, cortisol variability decreased among those receiving biobehavioral treatment (p < .043), whereas variability increased among those receiving standard treatment. Together, these findings underscore the potential role of cortisol activity in that it may influence the transition from acute pain to chronic pain. [source]

Adding Gabapentin to a multimodal regimen does not reduce acute pain, opioid consumption or chronic pain after total hip arthroplasty

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2009
H. CLARKE
Background: Gabapentin (GPN) is effective in reducing post-operative pain and opioid consumption, but its effects with regional anesthesia for total hip arthroplasty (THA) are not known. We designed this study to determine whether (1) gabapentin administration reduces pain and opioid use after THA using a multimodal analgesic regimen including spinal anesthesia; (2) pre-operative administration of gabapentin is more effective than post-operative administration. Methods: After REB approval and informed consent, 126 patients were enrolled in a double-blinded, randomized-controlled study. Patients received acetaminophen 1 g per os (p.o.), celecoxib 400 mg p.o. and dexamethasone 8 mg intravenously, 1,2 h pre-operatively. Patients were randomly assigned to one of three treatment groups (G1: Placebo/Placebo; G2: GPN/Placebo; G3: Placebo/GPN). Patients received gabapentin 600 mg (G2) or placebo (G1 and G3) 2 h before surgery. All patients had spinal anesthesia [15 mg (3cc) of 0.5% hypobaric bupivacaine with 10 ,g of fentanyl]. In the post-anesthetic care unit, patients received gabapentin 600 mg (G3) or placebo (G1 and G2). On the ward, patients received acetaminophen 1000 mg p.o. q6h, celecoxib 200 mg p.o. q12h and a morphine PCA device. Patients were interviewed 6 months post-surgery to determine the incidence and severity of chronic post-surgical pain. Results: Mean±SD cumulative morphine (mg) consumption (G1=49.4±24.8, G2=47.2±30.1 and G3=56.1±38.2) at 48 h and pain scores at 12, 24, 36 and 48 h post-surgery were not significantly different among the groups [G1 (n=38), G2 (n=38) and G3 (n=38)]. Side effect profiles were similar across groups. Six months after surgery, the number of patients who reported chronic post-surgical pain (G1=10, G2=12 and G3=9) and the severity of the pain (G1=4.2±2.9, G2=4.1±2.2 and G3=4.9±2.2) did not differ significantly among the groups (P>0.05). Conclusions: A single 600 mg dose of gabapentin given pre-operatively or post-operatively does not reduce morphine consumption or pain scores in hospital or at 6 months after hip arthroplasty within the context of spinal anesthesia and a robust multimodal analgesia regimen. [source]

Intravenous magnesium sulfate for post-operative pain in patients undergoing lower limb orthopedic surgery

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2009
A. DABBAGH
Introduction: This study looks at the effect of supplementary intravenous magnesium sulfate on acute pain when administered in patients undergoing lower limb orthopedic surgery using spinal anesthesia with bupivacaine. Method and materials: In this double-blind, randomized, placebo-controlled clinical trial, 60 patients were selected and randomly divided into two groups. Efforts were made to place both groups under the same method of anesthesia. One group received 8 mg/kg intravenous magnesium sulfate, started before the incision and continued up to the end of the surgical procedure, using a 50 ml syringe, via a peripheral large bore catheter; the second group received the same volume of placebos using the same method. To present the results, mean (± SD) was used; a P value of <0.05 was considered significant. Results: There was no difference between the two groups in terms of the basic variables. Pain reported by the first group that received magnesium sulfate was significantly less at the first, third, sixth and 12th hours after the operation in comparison with the group that received placebo. Also, the intravenous morphine requirements in the first 24 h after the surgery were less in the magnesium group (4.2 ± 1.6 mg) than in the control group (9.8 ± 2.1 mg). Conclusion: Intravenous magnesium sulfate can serve as a supplementary analgesic therapy to suppress the acute post-operative pain, leading to less morphine requirements in the first 24 h. [source]

Prescription pattern of codeine for non-malignant pain: a pharmacoepidemiological study from the Norwegian Prescription Database

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2009
O. M. S. FREDHEIM
Background: Opioid prescription for pain relief is increasing. Codeine is the dominating opioid in several European countries, with Norway being among the highest codeine users. Aim: To determine whether codeine is primarily used for acute pain or whether there is a prescription pattern indicating problematic opioid use. Methods: All pharmacies in Norway are obliged to submit data electronically to the Norwegian Prescription Database at the Norwegian Institute of Public Health on all dispensed prescriptions. Because all prescriptions are identified with a unique person identifier, it is possible to identify all prescriptions to one subject. All subjects who had prescription(s) of codeine dispensed to them in 2004, 2005 or 2006 are included in the study. Results: 385 190 Norwegian persons had at least one prescription of codeine dispensed to them due to non-cancer pain in 2005, corresponding to a 1-year periodic prevalence of 8.3%. 223 778 (58%) received only one prescription in 2005, 121 025 (31%) received more than one prescription but <120 defined daily doses (DDDs), 30 939 (8%) received between 120 and 365 DDDs, 7661 (2%) between 365 and 730 DDDs, while only 1787 (0.5%) exceeded the maximum recommended dose of 730 DDDs. In the latter group, co-medication with benzodiazepines (65%) and carisoprodol (45%) was prevalent. Conclusion: About one in 10 adult persons in Norway were dispensed codeine in 2005. A majority (58%) received codeine only once, most likely for acute pain, whereas a small minority (0.5%) had a prescription pattern indicating problematic opioid use. [source]

The Implementation of Intranasal Fentanyl for Children in a Mixed Adult and Pediatric Emergency Department Reduces Time to Analgesic Administration

ACADEMIC EMERGENCY MEDICINE, Issue 2 2010
Anna Holdgate MBBS, FACEM
ACADEMIC EMERGENCY MEDICINE 2010; 17:1,4 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, The objective was to determine whether the introduction of intranasal (IN) fentanyl for children with acute pain would reduce the time to analgesic administration in a mixed adult and pediatric emergency department (ED). Methods:, A protocol for IN fentanyl (1.5 ,g/kg) for children age 1,15 years presenting with acute pain was introduced to the department. All children who received intravenous (IV) morphine in the 7 months prior to the introduction of the protocol and either IV morphine or IN fentanyl in the 7 months after the introduction of the protocol were identified from drug registers. Time to analgesic administration, time to see a doctor, and the ages of patients were compared between the periods before and after the introduction of IN fentanyl. Results:, Following implementation, 81 patients received IN fentanyl and 37 received IV morphine, compared to 63 patients receiving morphine in the previous 7 months. The median time to analgesic administration for IN fentanyl was significantly shorter than for morphine (32 minutes vs. 63 minutes, p = 0.001). Children receiving fentanyl were significantly younger than those receiving morphine (median = 8.5 years vs. 12 years, p < 0.001). Conclusions:, This study demonstrates that children treated with IN fentanyl received analgesic medication faster than those treated with IV morphine in a mixed ED. Younger children were more likely to receive opioid analgesia following the introduction of fentanyl. [source]

Microinjection of morphine into thalamic nucleus submedius depresses bee venom-induced inflammatory pain in the rat

JOURNAL OF PHARMACY AND PHARMACOLOGY: AN INTERNATI ONAL JOURNAL OF PHARMACEUTICAL SCIENCE, Issue 10 2008
Jie Feng
Previous studies have provided evidence of the existence of a pain modulatory feedback pathway consisting of thalamic nucleus submedius (Sm),ventrolateral orbital cortex-periaqueductal grey pathway, which is activated during acute pain and leads to depression of transmission of nociceptive information in the spinal dorsal horn. The aim of this study was to test the hypothesis that morphine microinjection into the Sm decreased spontaneous pain and bilateral thermal hyperalgesia, as well as ipsilateral mechanical allodynia, induced by subcutaneous injections of bee venom into the rat hind paw. Morphine (1.0, 2.5 or 5.0 m,g in 0.5 ,L) injected into the Sm, contralateral to the bee venominjected paw, depressed spontaneous nociceptive behaviour in a dose-dependent manner. Furthermore, morphine significantly decreased bilateral thermal hyperalgesia and ipsilateral mechanical allodynia 2 h after bee venom injection. These morphine-induced effects were antagonized by 1.0 ,g naloxone (an opioid antagonist) microinjected into the Sm 5 min before morphine administration. The results provided further support for the important role of the Sm and Sm-opioid receptors in inhibiting nociceptive behaviour and indicated for the first time that Sm opioid receptors were also effective in inhibiting the hypersensitivity provoked by bee venom-induced inflammation. [source]

Validation of the Wong-Baker FACES Pain Rating Scale in Pediatric Emergency Department Patients

ACADEMIC EMERGENCY MEDICINE, Issue 1 2010
Gregory Garra DO
Abstract Objectives:, The Wong-Baker FACES Pain Rating Scale (WBS), used in children to rate pain severity, has been validated outside the emergency department (ED), mostly for chronic pain. The authors validated the WBS in children presenting to the ED with pain by identifying a corresponding mean value of the visual analog scale (VAS) for each face of the WBS and determined the relationship between the WBS and VAS. The hypothesis was that the pain severity ratings on the WBS would be highly correlated (Spearman's rho > 0.80) with those on a VAS. Methods:, This was a prospective, observational study of children ages 8,17 years with pain presenting to a suburban, academic pediatric ED. Children rated their pain severity on a six-item ordinal faces scale (WBS) from none to worst and a 100-mm VAS from least to most. Analysis of variance (ANOVA) was used to compare mean VAS scores across the six ordinal categories. Spearman's correlation (,) was used to measure agreement between the continuous and ordinal scales. Results:, A total of 120 patients were assessed: the median age was 13 years (interquartile range [IQR] = 10,15 years), 50% were female, 78% were white, and six patients (5%) used a language other than English at home. The most commonly specified locations of pain were extremity (37%), abdomen (19%), and back/neck (11%). The mean VAS increased uniformly across WBS categories in increments of about 17 mm. ANOVA demonstrated significant differences in mean VAS across face groups. Post hoc testing demonstrated that each mean VAS was significantly different from every other mean VAS. Agreement between the WBS and VAS was excellent (, = 0.90; 95% confidence interval [CI] = 0.86 to 0.93). There was no association between age, sex, or pain location with either pain score. Conclusions:, The VAS was found to have an excellent correlation in older children with acute pain in the ED and had a uniformly increasing relationship with WBS. This finding has implications for research on pain management using the WBS as an assessment tool. ACADEMIC EMERGENCY MEDICINE 2010; 17:50,54 © 2009 by the Society for Academic Emergency Medicine [source]

Clinical trial: the glucagon-like peptide-1 analogue ROSE-010 for management of acute pain in patients with irritable bowel syndrome: a randomized, placebo-controlled, double-blind study

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2009
P. M. HELLSTRÖM
Summary Background, There is currently no treatment available to manage acute pain attacks in IBS patients regardless of subtype. Aims, To evaluate efficacy and safety of the GLP-1 analogue ROSE-010 in patients with irritable bowel syndrome (IBS) through a randomized, double-blind, placebo-controlled study. Methods, Eligible patients (n = 166) meeting Rome II criteria were randomly assigned to receive single subcutaneous injections of ROSE-010 100 ,g, 300 ,g and placebo in a cross-over design. Safety was assessed from spontaneously reported adverse events and measurement of vital signs. Patient-rated pain relief and intensity were measured on a 100-mm visual analogue scale. The primary efficacy variable was proportion of patients with >50% maximum total pain relief response from 10 to 60 min after treatment. Secondary endpoints included the maximum summed pain intensity difference, time to meaningful pain relief and patient ratings of satisfaction with treatment. Results, Twice as many patients were responders in the primary efficacy endpoint after both ROSE-010 injections compared to placebo (24%P = 0.011, 23%P = 0.005, and 12% after 300 ,g, 100 ,g and placebo injections, respectively). Similar results were obtained for the proportion of patients with total pain intensity response. Times to meaningful and total pain relief were shorter for both doses of ROSE-010 compared with placebo. Compared with placebo, more patients (P < 0.05) were satisfied with ROSE-010 and considered ROSE-010 better than previous IBS medications used. Conclusion, ROSE-010 was well tolerated and provided fast and effective relief of acute pain attacks on demand in IBS patients. [source]

(204) Rofecoxib Was More Effective than Codeine with Acetaminophen in the Treatment of Acute Pain

Hydroxyurea therapy lowers circulating DNA levels in sickle cell anemia,

AMERICAN JOURNAL OF HEMATOLOGY, Issue 9 2008
Pinar Ulug
Hydroxyurea reduces the frequency of acute pain in sickle cell disease (SCD). We sought to determine if hydroxyurea therapy affects cell free DNA (cfDNA) levels in SCD. cfDNA levels fell in all 10 patients studied; before hydroxyurea, mean was 1,879 (95% CI 1,104,3,199) GE/mL; after hydroxyurea, mean was 780 (95% CI, 634,959) GE/mL (P = 0.002). Mean cfDNA level in the 10 HbSS adults prior to starting hydroxyurea was also significantly higher than that in 115 HbSS case controls who had never taken hydroxyurea (1,879 vs 975 GE/mL, P = 0.02). cfDNA levels may be useful in monitoring response to hydroxyurea therapy in SCD. Am. J. Hematol., 2008. © 2008 Wiley-Liss, Inc. [source]