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Pain Duration (pain + duration)
Selected AbstractsPhotodynamic therapy of multiple actinic keratoses: reduced pain through use of visible light plus water-filtered infrared A compared with light from light-emitting diodesBRITISH JOURNAL OF DERMATOLOGY, Issue 3 2010V. Von Felbert Summary Background, Photodynamic therapy (PDT) with methyl aminolaevulinate (MAL) is an effective treatment for multiple actinic keratoses (AKs). Pain, however, is a major side-effect. Objectives, To compare pain intensity, efficacy, safety and cosmetic outcome of MAL PDT with two different light sources in an investigator-initiated, randomized, double-blind study. Methods, Eighty patients with multiple AKs grade I,II were assigned to two groups: group 1, MAL PDT with visible light and water-filtered infrared A (VIS + wIRA); group 2, MAL PDT with light from light-emitting diodes (LEDs), with a further division into two subgroups: A, no spray cooling; B, spray cooling on demand. MAL was applied 3 h before light treatment. Pain was assessed before, during and after PDT. Efficacy, side-effects, cosmetic outcome and patient satisfaction were documented after 2 weeks and 3, 6 and 12 months. Where necessary, treatment was repeated after 3 months. Results, Seventy-six of the 80 patients receiving MAL PDT completed the study. Patient assessment showed high efficacy, very good cosmetic outcome and high patient satisfaction. The efficacy of treatment was better in the group of patients without spray cooling (P = 0·00022 at 3 months, P = 0·0068 at 6 months) and showed no significant differences between VIS + wIRA and LED. VIS + wIRA was significantly less painful than LED: the median of maximum pain was lower in the VIS + wIRA group than in the LED group for PDT without spray cooling. Pain duration and severity assessed retrospectively were less with VIS + wIRA than with LED, irrespective of cooling. Conclusions, All treatments showed high efficacy with good cosmetic outcome and high patient satisfaction. Efficacy of treatment was better without spray cooling. VIS + wIRA PDT was less painful than LED PDT for PDT without spray cooling. [source] Treatment of Recurrent Ingrown Great Toenail Associated with Granulation Tissue by Partial Nail Avulsion Followed by Matricectomy with Sharpulse Carbon Dioxide LaserDERMATOLOGIC SURGERY, Issue 5 2002Kuo-chia Yang MD background. The effectiveness of partial nail avulsion followed by matricectomy with carbon dioxide (CO2) laser for the treatment of ingrown great toenails remains unclear. objective. This study sought to determine the effectiveness of partial nail avulsion followed by matricectomy with sharpulse CO2 laser in the treatment of recurrent ingrown great toenails associated with granulation tissue. materials and methods. Fourteen patients with a total of 18 recurrent ingrown great toenails were randomly selected for participation in this study. Partial nail avulsions followed by matricectomy with sharpulse CO2 laser were performed on the involved nails. After at least 6 months, we evaluated the recurrence of ingrown toenails, regrowth of the nail spike, duration of post-treatment pain and post-treatment infection. results. Partial nail avulsion followed by matricectomy with sharpulse CO2 laser in the treatment of ingrown toenails resulted in a high cure rate, short postoperative pain duration and low risk of postoperative infection. conclusion. This method we advocate is convenient and effective for the treatment of recurrent ingrown great toenail associated with granulation tissue. [source] Pretreatment Psychosocial Variables as Predictors of Outcomes Following Lumbar Surgery and Spinal Cord Stimulation: A Systematic Review and Literature SynthesisPAIN MEDICINE, Issue 4 2009James Celestin MD ABSTRACT Background., In the multimodal treatment approach to chronic back pain, interventional back procedures are often reserved for those who do not improve after more conservative management. Psychological screening prior to lumbar surgery or spinal cord stimulation (SCS) has been widely recommended to help identify suitable candidates and to predict possible complications or poor outcome from treatment. However, it remains unclear which, if any, variables are most predictive of pain-related treatment outcomes. Objective., The intent of this article is to perform a systematic review to examine the relationship between presurgical predictor variables and treatment outcomes, to review the existing evidence for the benefit of psychological screening prior to lumbar surgery or SCS, and to make treatment recommendations for the use of psychological screening. Results., Out of 753 study titles, 25 studies were identified, of which none were randomized controlled trials and only four SCS studies met inclusion criteria. The methodological quality of the studies varied and some important shortcomings were identified. A positive relationship was found between one or more psychological factors and poor treatment outcome in 92.0% of the studies reviewed. In particular, presurgical somatization, depression, anxiety, and poor coping were most useful in helping to predict poor response (i.e., less treatment-related benefit) to lumbar surgery and SCS. Older age and longer pain duration were also predictive of poorer outcome in some studies, while pretreatment physical findings, activity interference, and presurgical pain intensity were minimally predictive. Conclusions., At present, while there is insufficient empirical evidence that psychological screening before surgery or device implantation helps to improve treatment outcomes, the current literature suggests that psychological factors such as somatization, depression, anxiety, and poor coping, are important predictors of poor outcome. More research is needed to show if early identification and treatment of these factors through psychological screening will enhance treatment outcome. [source] Impact of Chronic Musculoskeletal Pathology on Older Adults: A Study of Differences between Knee OA and Low Back PainPAIN MEDICINE, Issue 4 2009Natalia E. Morone MD ABSTRACT Objectives., The study aimed to compare the psychological and physical characteristics of older adults with knee osteoarthritis (OA) vs those of adults with chronic low back pain (CLBP) and to identify psychological and physical predictors of function as measured by gait speed. Design., Secondary data analysis. Method and Patients., Eighty-eight older adults with advanced knee OA and 200 with CLBP who had participated in separate randomized controlled trials were selected for this study. Measures., Inclusion criteria for both trials included age ,65 and pain of at least moderate intensity that occurred daily or almost every day for at least the previous 3 months. Psychological constructs (catastrophizing, fear avoidance, self-efficacy, depression, affective distress) and physical measures (comorbid medical conditions, pain duration, pain severity, pain related interference, self-rated health) were obtained. Results., Subjects with CLBP had slower gait (0.88 m/s vs 0.96 m/s, P = 0.002) and more comorbid conditions than subjects with knee pain (mean 3.36 vs 1.97, P < 0.001). All the psychological measures were significantly worse in the CLBP group except the Multidimensional Pain Inventory,Affective Distress score. Self-efficacy, pain severity, and medical comorbidity burden were associated with slower gait regardless of the location of the pain. Conclusions., Older adults with chronic pain may have distinct psychological and physical profiles that differentially impact gait speed. These findings suggest that not all pain conditions are the same in their psychological and physical characteristics and may need to be taken into consideration when developing treatment plans. [source] (647) Evaluation of the Long-Term Efficacy and Safety of Transdermal Fentanyl in the Treatment of Noncancer Pain: The Interim AnalysisPAIN MEDICINE, Issue 2 2000Article first published online: 25 DEC 200 Authors: K Milligan, South Cleveland Hospital, L Haazen and L Bijnens, Janssen Research Foundation Aim of Investigation: To document long-term efficacy and safety of transdermal (TTS) fentanyl for the management of noncancer pain. Methods: The study was an open-label, international, multi-center, phase III trial in 532 patients (mean age 51.5 years) with a median pain duration of 6 years. Two hundred sixty-two patients (50%) had neuropathic pain and 367 (70%) had predominantly somatic, nociceptive pain. TTS-fentanyl was started at an equi-analgesic dose to the pretrial opioid, and given for 12 months. Main outcome measures were weekly assessment of pain control, global treatment satisfaction and quality of life scores. Results: At interim analysis, 120 patients had completed the trial, 211 were continuing treatment, and 201 patients had discontinued. The mean dose of TTS-fentanyl increased from 48 ,g/h to 105 ,g/h over 12 months, with most increases occurring in the first months. During treatment the number of subjects reporting very good, good, or moderate pain control remained stable at 65% (range 61% to 75%). Global satisfaction (very good or good) was also stable at 42% (range 38% to 46%). Eighty-six percent of patients reported preference for TTS-fentanyl over their previous treatment, stating the main reason as better pain relief. SF-36 scores improved from baseline for physical pain and physical summary measurements. The most frequently occurring adverse events were nausea (28%), sonmolence (17%), constipation (15%), vomiting (15%), and increased sweating (14%). Conclusions: Long-term treatment with TTS-fentanyl provides a stable degree of pain control in the majority of patients with moderate-to-severe noncancer pain. It was preferred by the majority of subjects to their previous medication and favorably improved their quality of life. Acknowledgments: Supported by the Janssen Research Foundation. [source] Endoscopic Surgery of the Anterior Skull Base,THE LARYNGOSCOPE, Issue 1 2005John D. Casler MD Abstract Objectives/Hypothesis: Traditional surgical approaches to the anterior skull base often involve craniotomy, facial incisions, disruption of skeletal framework, tracheotomy, and an extended hospital stay. As experience with endoscopic sinus surgery has grown, the techniques and equipment have been found to be adaptable to treatment of lesions of the anterior and central skull base. A minimally invasive endoscopic approach theoretically offers the advantages of avoiding facial incisions, osteotomies, and tracheotomy; surgery should be less painful, recovery quicker, and hospital stays should be shorter. The study attempted to assess endoscopic approaches to the anterior and central skull base for its ability to achieve those goals. Study Design: Retrospective review of 72 cases performed at a single institution from November 1996 to July 2003. A subgroup of 15 patients who underwent endoscopic approach to their pituitary tumors was compared with a similar group of 15 patients who underwent traditional open trans-sphenoidal surgery for their pituitary tumors. Methods: Patient records were analyzed and information tabulated for age, sex, disease, location of lesion, operative time, use of image-guided surgical systems, blood loss, length of intensive care unit stay, duration of operative pain, length of postoperative hospitalization, complications, and completeness of resection. Results: Of the cases, 86.1% were performed exclusively endoscopically, and 13.9% used a combination of endoscopic and open techniques. An image-guided surgical system was used in 83% of cases. Hospital length of stay was 2.3 days for the exclusively endoscopic group as opposed to 8 days for the combined group. With the patients with pituitary tumors, operative times were similar between the two groups (255.13 vs. 245.73 min), blood loss was less in the endoscopic group (125.33 vs. 243.33 mL), pain duration was shorter in the endoscopic group (10 of 15 patients pain free on postoperative day 1 vs. 2 of 15 patients pain free in the open group), and intensive care unit stay and hospital length of stay were both shorter in the endoscopic group. Complication rates and completeness of resection was similar in both groups, although the open group had a higher rate of complications related to the approach to the sella. Conclusion: The study demonstrated the safety and efficacy of judicious endoscopic approaches to anterior skull base lesions. An outcomes assessment in pituitary surgery demonstrates advantages of an endoscopic approach in appropriate cases. [source] A randomised controlled trial of vitamin E in the treatment of primary dysmenorrhoeaBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2005S. Ziaei Objective To study the effect of vitamin E in the treatment of primary dysmenorrhoea. Design A randomised, double-blind, placebo-controlled trial. Setting A secondary school in Tehran, Iran. Population Two hundred and seventy-eight girls aged 15,17 years who suffered from primary dysmenorrhoea. Methods Participants were given 200 units of vitamin E or placebo twice a day, beginning two days before the expected start of menstruation and continued through the first three days of bleeding. Treatment was continued over four consecutive menstrual periods. Main outcome measures The severity and duration of pain, and the amount of menstrual blood loss, at two and four months. A visual analogue scale (VAS) was used to record pain, and a validated Pictorial Blood Loss Assessment Chart (PBLAC) to measure menstrual loss. Results In the vitamin E group, pain severity was lower with vitamin E at two months (median VAS score 3 vs 5, P > 0.001) and four months (0.5 vs 6, P > 0.001), pain duration was shorter at two months (mean 4.2 [7.1] hours vs 15 [17], P > 0.001) and at four months (1.6 [4.0] hours vs 17 [18] hours, P > 0.0001), and blood loss assessed by PBLAC score was lower at two months (54 [31] vs 70 [40], P > 0.0001) and at four months (46 [28] vs 70 [37], P > 0.0001). Conclusion Vitamin E relieves the pain of primary dysmenorrhoea and reduces blood loss. [source] | ||||||||||