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Am J Emerg Med 2002 Jun;20(4):388
Department of Care of Elderly, Lister Hospital, Stevenage, UK.
[Medline record in process]
PMID: 12098205, UI: 22091704
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Am J Emerg Med 2002 Jun;20(4):287-90
Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY.
The objective of the study was to assess the validity and reliability of the visual analog scale (VAS) in the measurement of acute abdominal pain, and to identify the minimum clinically significant difference in VAS scores among patients with acute abdominal pain. The study was undertaken in preparation for a randomized clinical trial of opioid use in acute abdominal pain. A prospective, observational cohort study of a convenience sample of patients presenting to 2 urban EDs with the chief complaint of acute abdominal pain was conducted. At time 0 and 1 minute later each subject indicated pain severity on a 100mm VAS. This was repeated every 30 minutes for 2 hours. Patients were also asked to contrast their current pain severity with their pain in the preceding 30 minutes using one of 5 graded verbal descriptors: "much less pain," "little less pain," "the same pain," "little more pain," and "much more pain." Validity was assessed by performing an analysis of variance for linear trend on the association between the 5 categorical pain descriptors and change in VAS scores. Reliability was assessed using the intra-class correlation coefficient (ICC) between VAS scores taken 1 minute apart, supplemented by a Bland-Altman analysis. The minimum clinically significant difference in pain was defined as the mean difference between sequential VAS scores obtained 30 minutes apart when the patient noted a "little less" or "little more" pain. Differences in VAS scores increased linearly as pain descriptors escalated from "much less" to "much more" pain (P <.001). Reliability was high, ICC = 0.99 [95%CI 0.989 to 0.992] for 0 and 1 minute VAS scores. The minimum clinically significant difference in acute abdominal pain was 16 mm (95% CI 13, 18 mm). VAS measures of acute abdominal pain are valid and reliable. The 95% CI surrounding the minimum clinically significant difference of approximately 16mm overlaps with the 95% CI of minimum clinically significant difference of approximately 13mm reported previously in traumatic and other types of acute pain. We conclude that the VAS is a methodologically sound instrument for quantitative assessment of acute abdominal pain and for detecting clinically important changes in such pain. (Am J Emerg Med 2002;20:287-290. Copyright 2002, Elsevier Science (USA). All rights reserved.)
PMID: 12098173, UI: 22091672
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Eur J Anaesthesiol 2002 May;19(5):384-6
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PMID: 12095024, UI: 22089456
Eur J Anaesthesiol 2002 May;19(5):368-70
Akdeniz University School of Medicine, Department of Emergency Medicine, Antalya, Turkey. oeray@med.akdeniz.edu.tr
BACKGROUND AND OBJECTIVE: Comparison of the effectiveness of tramadol with meperidine given intravenously to emergency patients with suspected renal colic. METHODS: A double-blind, randomized clinical trial was performed in the Emergency Department of a tertiary-care university hospital. Consecutive patients with suspected renal colic (n = 47) were randomized to receive intravenously an initial dose of tramadol 50 mg (n = 23) or meperidine 50 mg (n = 24). After 30 min, additional doses of meperidine 50 mg were given intravenously as a rescue medication in an open fashion. Pain relief was assessed using a 10 cm visual analogue scale, the primary outcomes being pain relief at 15 and 30 min after the analgesics. Secondary outcomes were the frequency of rescue meperidine use and the development of side-effects. RESULTS: Visual analogue scale pain scores after 15 and 30 min decreased in both tramadol and meperidine groups (P < 0.05). However, pain relief was better in the meperidine group at the 15 and 30 min evaluations (P < 0.05). Only 11 patients (48%), initially receiving meperidine, needed more meperidine compared with 16 patients (67%) initially receiving tramadol. Both drugs were well tolerated with no adverse effects occurring in either group. CONCLUSIONS: Meperidine 50 mg was superior to tramadol 50 mg for acute pain relief in patients with suspected renal colic when given intravenously. Because many patients in both groups received supplemental meperidine and the response to tramadol alone cannot be predicted, clinicians may want to choose higher doses of meperidine alone or other alternative combinations.
PMID: 12095018, UI: 22089450
J Pediatr 2002 Jul;141(1):135-40
Pain Treatment Service and the Departments of Physical Therapy, Orthopaedic Surgery, and Psychiatry, Children's Hospital, Boston, Massachusetts.
Complex regional pain syndromes (CRPS; type 1, reflex sympathetic dystrophy, and type 2, causalgia) involve persistent pain, allodynia, and vasomotor signs. We conducted a prospective, randomized, single-blind trial of physical therapy (PT) and cognitive-behavioral treatment for children and adolescents with CRPS. Children 8 to 17 years of age (n = 28) were randomly assigned to either group A (PT once per week for 6 weeks) or group B (PT 3 times per week for 6 weeks). Both groups received 6 sessions of cognitive-behavioral treatment. Assessments of pain and function were repeated at two follow-up time periods. Outcomes were compared at the three time points through the use of parametric or nonparametric analysis of variance and post hoc tests. All five measures of pain and function improved significantly in both groups after treatment, with sustained benefit evident in the majority of patients at long-term follow-up. Recurrent episodes were reported in 50% of patients, and 10 patients eventually received sympathetic blockade. Most children with CRPS showed reduced pain and improved function with a noninvasive rehabilitative treatment approach. Long-term functional outcomes were also very good.
PMID: 12091866, UI: 22086389
J Pediatr 2002 Jul;141(1):76-83
Western Psychiatric Institute and Clinic, the Children's Hospital of Pittsburgh, and the Center for Research on Healthcare, University of Pittsburgh School of Medicine, and the UPMC Health System, Pittsburgh, Pennsylvania.
OBJECTIVES: To determine the psychosocial correlates of recurrent pediatric pain and its relationship to health service use and medical presentations for "unexplained" symptoms in primary care.Study design: Children 4 to 15 years of age who complained frequently of aches and pains to parents were compared with those with infrequent or no pain on measures of demographics, psychopathology, school attendance and performance, perceived health, and service use. Univariate analysis was followed by logistic regression. RESULTS: Children who complained often of aches and pains used more health services, had more psychosocial problems, missed more school, and did worse academically. After controlling for health service use and demographics, recurrent pain was significantly associated with negative parental perceptions of child health and the presence of internalizing psychiatric symptoms. Higher levels of ambulatory health service use were associated with negative perceptions of child health, recurrent pain, visits for "unexplained" symptoms, and internalizing psychiatric symptoms. CONCLUSIONS: Pediatric recurrent pain challenges traditional service delivery models characterized by segregated systems of care for physical and mental disorders. Longitudinal and psychobiological studies of the relationship between recurrent pain, internalizing psychopathology, and health beliefs are warranted to direct future treatment efforts.
PMID: 12091855, UI: 22086378
N Engl J Med 2002 Jun 27;346(26):2079-82
PMID: 12087146, UI: 22082207
N Engl J Med 2002 Jun 27;346(26):2047-52
Department of Cardiology, the Cleveland Clinic Foundation, Cleveland, OH 44951, USA.
BACKGROUND: Among patients with suspected acute coronary syndromes, cardiac troponin T levels have prognostic value. However, there is concern that renal dysfunction may impair the prognostic value, because cardiac troponin T may be cleared by the kidney. METHODS: We analyzed the outcomes in 7033 patients enrolled in the Global Use of Strategies to Open Occluded Coronary Arteries IV trial who had complete base-line data on troponin T levels and creatinine clearance rates. The troponin T level was considered abnormal if it was 0.1 ng per milliliter or higher, and creatinine clearance was assessed in quartiles. The primary end point was a composite of death or myocardial infarction within 30 days. RESULTS: Death or myocardial infarction occurred in 581 patients. Among patients with a creatinine clearance above the 25th percentile value of 58.4 ml per minute, an abnormally elevated troponin T level was predictive of an increased risk of myocardial infarction or death (7 percent vs. 5 percent; adjusted odds ratio, 1.7; 95 percent confidence interval, 1.3 to 2.2; P<0.001). Among patients with a creatinine clearance in the lowest quartile, an elevated troponin T level was similarly predictive of increased risk (20 percent vs. 9 percent; adjusted odds ratio, 2.5; 95 percent confidence interval, 1.8 to 3.3; P<0.001). When the creatinine clearance rate was considered as a continuous variable and age, sex, ST-segment depression, heart failure, previous revascularization, diabetes mellitus, and other confounders had been accounted for, elevation of the troponin T level was independently predictive of risk across the entire spectrum of renal function. CONCLUSIONS: Cardiac troponin T levels predict short-term prognosis in patients with acute coronary syndromes regardless of their level of creatinine clearance.
PMID: 12087140, UI: 22082201
Pain 2002 Jun;98(1-2):233-4
Department of Psychiatry, NJ Medical School, University of Medicine and Dentistry of New Jersey, 183 South Orange Avenue, BHSB F-1512, 07103, Newark, NJ, USA
PMID: 12098638, UI: 22093491
Pain 2002 Jun;98(1-2):231-3
Department of Psychiatry, UMDNJ-New Jersey Medical School, Newark, NJ, USA
PMID: 12098637, UI: 22093490
Pain 2002 Jun;98(1-2):229-30
Department of Neurology, 600 Highland Avenue, 53792, Madison, WI, USA
PMID: 12098635, UI: 22093488
Pain 2002 Jun;98(1-2):217-28
Orofacial Pain Laboratory, Center for Sensory-Motor Interaction, Aalborg University, Fredrik Bajers Vej 7, D-3, DK-9220, Aalborg, Denmark
Cutaneous laser stimulation activates predominantly the A-delta and C mechano-heat nociceptors. Applied to the perioral region, low intensity CO(2)-laser pulses evoke reproducible trigeminal cortical evoked potentials (LEPs). High intensity CO(2)-laser stimuli induce a reflex response in the contracted jaw-closing muscle, the so-called laser silent period (LSP). Both LEPs and LSP provide a useful tool to study the physiology of the trigeminal nociceptive system. In ten healthy subjects we recorded the subjective ratings of the perioral laser stimulation and the trigeminal LEPs and LSP before, during and after homotopic experimental tonic muscle (infusion of hypertonic saline into the masseter muscle) and tonic skin pain (topical application of capsaicin to the cheek). LEPs were recorded from the vertex at two stimulus intensities: low (1.1xpain threshold, PTh) and high (1.5xPTh). LSP from masseter and temporalis muscles were recorded bilaterally through surface electromyographic (EMG) electrodes. CO(2)-laser pulses were applied to the perioral region (V2/V3) on the painful and non-painful side. The amplitude of LEPs increased with higher stimulus intensities (P<0.0001), but were suppressed by 42.3+/-5.3% during experimental muscle pain (P<0.0001) and by 41.6+/-3.2% during skin pain (P<0.0001). No pain-related effects were observed for the N and P latency of the LEPs (P>0.20). The LSP in the masseter and temporalis muscles had similar onset-latency (80+/-5ms), offset-latency (111+/-5ms) and duration (31+/-4ms). Experimental pain had no effect on the onset- and offset-latency (P>0.05). Experimental pain, whether from muscle or from skin, reduced the degree of suppression (P<0.01) and the area under the EMG curve (P<0.005) of the LSP. The LSP was still suppressed during the post-pain recordings when the skin pain had disappeared (P<0.05). In all experiments experimental tonic pain decreased the subjective ratings of the perioral laser stimulation (P<0.001). Experimental tonic pain, either from muscle or from skin, induced bilateral inhibitory effects on the trigeminal laser evoked potentials and brainstem reflex responses and on the subjective ratings of the laser pulses. These effects could be mediated through the activation of segmental and suprasegmental inhibitory systems that may function interdependently.
PMID: 12098634, UI: 22093487
Pain 2002 Jun;98(1-2):205-16
Pain and Neurosensory Mechanisms Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, 20892, Bethesda, MD, USA
The reproducibility of both the conscious experience of pain and the reproducibility of psychophysical assessments of pain remain critical, yet poorly characterized factors in pain research and treatment. To assess the reproducibility of both the pain experience and two methods of pain assessment, 15 subjects evaluated experimental heat pain during four weekly sessions. In each session, both brief (5s) and prolonged (90s) heat stimuli were utilized to determine effects of stimulus duration on reproducibility. Multiple presentations of the brief heat stimuli in each session were used to evaluate effects of response averaging. Both visual analog scales (VAS) and randomized verbal descriptor scales (VDS) were employed to better distinguish variations in the pain experience from variations in pain scale usage. Subjects also rated the intensity of visual stimuli in order to provide an independent assessment of the session-to-session variation in the use of both types of scales. Within-subjects analyses revealed that ratings of visual stimuli exhibited significantly less session-to-session variation than ratings of heat pain. Thus, pain perceptions were more variable than perceptions of visual stimuli after controlling for session-to-session variations in scale usage. Comparisons between scales indicated that intensity ratings acquired with the VAS had significantly smaller session-to-session variation than those acquired with the VDS, although VDS ratings were spread across a larger range of the scale. For both scales, analyses of the effects of stimulus averaging and stimulus duration revealed that averaging multiple assessments of the same stimulus substantially reduces session-to-session variation and that multiple assessments of brief stimuli produce responses which are more reproducible than a single presentation of a prolonged stimulus. However, the VAS was significantly more sensitive to small differences in perceived pain intensity and pain unpleasantness, and did not exhibit some of the order effects present with the VDS. Taken together, these results indicate that the reproducibility of psychophysical ratings of pain can be maximized: (1) by averaging responses to multiple, brief stimuli; (2) by providing subjects with a training period distinct from the study period; and (3) by ensuring that interpretation of scale parameters remains constant over time. Thus, although the experiences of both experimental and clinical pain are highly variable, pain assessment procedures can be structured to minimize session-to-session variability.
PMID: 12098633, UI: 22093486
Pain 2002 Jun;98(1-2):169-78
Pain Prevention and Treatment Research, Duke Medical Center, University of North Carolina at Chapel Hill, Box 3159, 27710, Durham, NC, USA
This study examined the degree of correspondence between lung cancer patients and their family caregivers in their perceptions of the patients' self-efficacy for managing pain and other symptoms of lung cancer, and the association of this correspondence to demographic, disease, and psychosocial variables. Thirty patients who were newly diagnosed with lung cancer and their primary family caregivers completed telephone interviews assessing the patient's symptoms, the patient's self-efficacy for managing symptoms, the quality of the relationship between the patient and caregiver, patient and caregiver psychological distress, and caregiver strain. Although patients and their caregivers showed a moderate degree of agreement in their perceptions of the patient's self-efficacy for managing pain and other symptoms, there was considerable variability in the degree of congruence. Factors that contributed to lower levels of congruence included low patient-rated self-efficacy, female gender of the patient, high patient psychological distress, and high caregiver strain. Caregivers were about evenly split in their tendency to overestimate versus underestimate the patient's self-efficacy. A poorer quality of relationship between the caregiver and the patient (as rated by the patient), high levels of patient-rated symptoms, and high levels of caregiver strain were associated with caregivers overestimating patient self-efficacy.
PMID: 12098629, UI: 22093482
Pain 2002 Jun;98(1-2):151-61
Department of Pharmacology, NeuroSearch A/S, Pederstrupvej 93, DK-2750, Ballerup, Denmark
The spared nerve injury (SNI) model involves a lesion of two of the three terminal branches of the sciatic nerve (tibial and common peroneal nerves) leaving the sural nerve intact. The changes in pain-like sensation of the injured animals appear to correlate with a number of symptoms presented in human patients with neuropathic pain syndromes. In order to characterise the SNI model pharmacologically, reflex nociceptive responses to mechanical and cold stimulation were measured after systemic administration of morphine, mexiletine, gabapentin and the glutamate receptor antagonists, MK-801 and NS1209. We observed that injection of morphine (6mg/kg, s.c.) in non-sedative doses significantly attenuated mechanical hypersensitivity in response to von Frey hair and pin prick stimulation and cold hypersensitivity in response to ethyl chloride. The sodium-channel blocker, mexiletine (37.5mg/kg, i.p.), relieved both cold allodynia and mechanical hyperalgesia, but the most distinct and prolonged effect was observed on mechanical allodynia. Gabapentin (100mg/kg, i.p.) significantly alleviated mechanical allodynia for at least 3h, while no significant effects were observed for either mechanical hyperalgesia or cold allodynia. In contrast, the NMDA receptor antagonist MK-801 (0.1mg/kg, i.p.) and the AMPA receptor antagonist NS1209 (6mg/kg, i.p.) did not relieve any of the pain-like behaviours of the SNI animals. The present study has shown that a variety of drugs with proven analgesic potency in other models of chronic pain, have differing analgesic profiles in the SNI model of neuropathic pain.
PMID: 12098627, UI: 22093480
Pain 2002 Jun;98(1-2):145-9
Avon and Wiltshire Mental Health Partnership NHS Trust, Department of Child and Family Psychiatry, Royal United Hospital, Combe Park, BAI 3NG, Bath, UK
A previous study found that parents of communicatively impaired children with severe cognitive impairments identified six core cues as indicating definite or severe pain in their child (J. Pediatr. Psychol. 27 (2002) 209). The frequency of each cue was assessed by 67 caregivers of communicatively impaired children, twice per day over a 1 week period. On each occasion the caregivers also rated whether they considered their child to be in pain and the severity of any pain. There was a statistically significant relationship between five of the cues and the presence and severity of pain. The single cue of screwed up or distressed looking face was the strongest predictor and on its own correctly classified 87% of pain and non-pain episodes. The study highlights the potential clinical utility of a short carer completed assessment to assess pain in this vulnerable group of children.
PMID: 12098626, UI: 22093479
Pain 2002 Jun;98(1-2):135-44
Arthritis Institute, St. Joseph's Hospital, 268 Grosvenor St, P.O. Box 5777, Ontario, N6A 4V2, London, Canada
Clinicians tend to assign greater weight to non-verbal expression than to patients' self-report when judging the location and severity of pain. Judgments can misrepresent the actual experience because patients can successfully alter their pain expressions. The present research provides a basis for discriminating genuine and deceptive pain expressions by expanding detailed accounts of facial expressions to include previously unexamined variables, including study of temporal patterns and contiguity of facial actions as well as the occurrence of specific deception cues. Low back patients' facial expressions (n=40) were videotaped at rest and while undergoing a painful straight leg raise with instructions to: (1) genuinely express their pain, or (2) pretend that it did not hurt. As well, they were asked to fake pain without moving. The Facial Action Coding System was used to describe and quantify facial activity. The different types of expression were compared on the frequency, type, intensity, temporal pattern and contiguity of facial actions, as well as on the frequency of specific deception cues. Findings confirmed the difficulty of discriminating the facial expressions, but indicated that faked pain expressions show a greater number of pain-related and non-pain-related actions, have a longer peak intensity and overall duration, and the facial actions observed tend to be less temporally contiguous than are those in genuine pain expressions. The differences between masked pain and neutral expressions were subtle, with a greater frequency of mouth opening and residual eyebrow movement in masked pain expressions. Thus, there is an empirical basis for discriminating genuine and deceptive facial displays.
PMID: 12098625, UI: 22093478
Pain 2002 Jun;98(1-2):127-34
Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington School of Medicine, Seattle, WA 98195-6560, USA
Little research has examined the role of patient cognitive and behavioral responses, including catastrophizing, in adjustment to chronic pain associated with spinal cord injury (SCI). The objective of this study was to examine the associations of catastrophizing and specific pain coping strategies with pain intensity, psychological distress, and pain-related disability among individuals with chronic pain and SCI, after controlling for important demographic and SCI-related variables that might affect outcomes. Participants in this study were 174 community residents with SCI and chronic pain who completed a mailed questionnaire that included the SF-36 Mental Health scale, Coping Strategies Questionnaire, and Graded Chronic Pain Scale. The pain coping and catastrophizing measures explained an additional 29% of the variance in pain intensity after adjusting for the demographic and SCI variables (P<0.001). The coping and catastrophizing scales accounted for an additional 30% of the variance in psychological distress (P<0.001) and 11% of the variance in pain-related disability (P<0.001), after controlling for pain intensity and demographic and SCI variables. Catastrophizing, but not any other single pain coping strategy, was consistently strongly and independently associated with the outcome measures. Potentially, the assessment and treatment of catastrophizing may reduce psychological distress and pain-related disability among individuals with chronic pain and SCI.
PMID: 12098624, UI: 22093477
Pain 2002 Jun;98(1-2):119-26
Department of Neurology, UCSF Pain Clinical Research Center, 1701 DivisaderoStreet, Suite 480, University of California, 94115, San Francisco, CA, USA
We present a case of longstanding PHN treated by skin excision of the area of greatest pain (11.3x26.0 cm(2)). The operation reduced pain, eliminated tactile allodynia, and facilitated greatly reduced medication use over a 1-year follow-up period. Fourteen punch biopsies and 10 strips of skin (each 10 mm long) from the excised painful PHN skin were qualitatively assessed by double-label immunofluorescence using antibodies against protein-gene-product 9.5 (PGP9.5), 200 kDa neurofilament protein (NF), calcitonin gene-related peptide (CGRP) and vanilloid receptor-1 (VR-1). Comared with a punch biopsy from mirror image skin, the pattern of cutaneous innervation in PHN skin was consistently and substantially different. The results may explain the anatomical basis of the capsaicin-response test and have implications for our understanding of clinical mechanisms underlying PHN pain.
PMID: 12098623, UI: 22093476
Pain 2002 Jun;98(1-2):79-88
Department of Pharmacology, University of Arizona Health Sciences Center, Tucson, AZ 85724, USA
Recent studies indicate that sustained opioid administration produces increased expression of spinal dynorphin, which promotes enhanced sensitivity to non-noxious and noxious stimuli. Such increased 'pain' may manifest behaviorally as a decrease in spinal antinociceptive potency. Here, the possibility of similar mechanisms in the antinociception of spinal cannabinoids was explored. Response thresholds to non-noxious mechanical and noxious thermal stimuli were assessed. Antinociception was determined using the 52 degrees C tail-flick test. Mice received repeated WIN 55,212-2, its inactive enantiomer, WIN 55,212-3 or vehicle (i.th., bid, 5 days). WIN 55,212-2, but not WIN 55,212-3 or vehicle, produced a time-related increased sensitivity to non-noxious and noxious stimuli. WIN 55,212-2, but not WIN 55,212-3 or vehicle, elicited a significant increase in lumbar spinal dynorphin content at treatment day 5. Increased sensitivity to mechanical and thermal stimuli produced by WIN 55,212-2 was reversed to baseline levels by i.th. MK-801 or dynorphin antiserum; control serum had no effect. WIN 55,212-2, but not WIN 55,212-3 or vehicle, produced dose-related antinociception and repeated administration resulted in antinociceptive tolerance. While MK-801 and dynorphin antiserum did not alter acute antinociception produced by WIN 55,212-2, these substances significantly blocked antinociceptive tolerance when given immediately prior to WIN 55,212-2 challenge on day 5. Daily MK-801 pretreatments, prior to WIN 55,212-2 injection, also produced a significant block of antinociceptive tolerance. These data suggest that like opioids, repeated spinal administration of a cannabinoid CB1 agonist elicits abnormal pain, which results in increased expression of spinal dynorphin. Manipulations that block cannabinoid-induced pain also block the behavioral manifestation of cannabinoid tolerance.
PMID: 12098619, UI: 22093472
Pain 2002 Jun;98(1-2):9-17
Purdue Pharma, L.P., One Stamford Forum, 06901-3431, Stamford, CT, USA
Pain is a common and pervasive symptom for persons infected with the human immunodeficiency virus (HIV). Individuals with persistent pain are known to be at heightened risk for posttraumatic stress disorder (PTSD), an anxiety disorder that manifests itself following exposure to a traumatic event. Moreover, research suggests that patients with persistent pain who develop PTSD often experience greater pain intensity and pain-related disability than those who do not develop PTSD. The purpose of this study was to assess the relation of PTSD to pain intensity and pain-related interference in HIV-infected persons suffering from persistent pain. Study participants included 145 ambulatory persons living with HIV/AIDS (PWHAs) who were enrolled in a randomized clinical trial assessing the impact of a pain communication intervention. Participants completed a series of self-report measures including the Stressful Life Events Checklist (SLE), the Posttraumatic Stress Disorder Checklist-Civilian (PCL-C), the Mental Health Inventory (MHI), and the Brief Pain Inventory (BPI). On average, participants reported being exposed to 6.3 different types of trauma over the course of their lifetime, of which receiving an HIV diagnosis was rated as being among the most stressful. Over half (53.8%) merited a PTSD diagnosis according to the PCL-C. Those with PTSD reported having significantly higher pain intensity and greater pain-related interference in performance of daily activities (i.e., working, sleeping, walking ability and general activity), and affect (i.e., mood, relations with other people, enjoyment of life) over time than those who did not meet the diagnostic criteria. Possible explanations for these findings are discussed along with implications for clinical care.
PMID: 12098612, UI: 22093465
Pain 2002 Jun;98(1-2):1-8
Department of Anatomy and Neurosciences and Marine Biomedical Institute, The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-1069, USA
PMID: 12098611, UI: 22093464
Pediatrics 2002 Jul;110(1 Pt 1):e3
Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California 90509, USA. inkelis@emedharbor.edu
OBJECTIVE: Early recognition of invasive meningococcal disease in children may be difficult. Extremity pain and refusal to walk (extremity symptoms) are uncommonly mentioned as clinical findings in children who present with this disease. We sought to determine 1) the frequency of extremity symptoms as part of the clinical presentation in children with invasive meningococcal disease and 2) whether these symptoms help identify children with otherwise unsuspected meningococcal disease. METHODS: We reviewed the medical records of patients who were younger than 20 years and had invasive meningococcal disease from 1985 to 1996 at 3 pediatric referral centers. Children with extremity symptoms were identified and described. We compared clinical and laboratory findings and frequency of adverse outcomes between these children and those with invasive meningococcal disease without extremity symptoms. RESULTS: We identified 274 children with invasive meningococcal disease, 45 (16%) of whom had either history or physical examination evidence of extremity pain (31) or refusal to walk (14) as part of their clinical presentations. Five of the 45 patients had arthritis at the time of presentation. Patients with extremity symptoms at presentation were significantly older (77.9 +/- 62.2 vs 44.0 +/- 56.9 months), had lower temperatures (38.8 +/- 1.2 degrees C vs 39.2 +/- 1.2 degrees C), and had higher band counts (28.2 +/- 15.2% vs 18.1 +/- 12.4%) than did patients without extremity symptoms. There were no significant differences, however, between groups with regard to rash, white blood cell counts, coagulation parameters, prevalence of meningitis, or adverse outcomes. Seventy-three (27%) of the 274 patients had unsuspected disease, and 5 (7%) of these had extremity symptoms at the time of diagnosis. CONCLUSIONS: Sixteen percent of children with invasive meningococcal disease have extremity symptoms at the time of diagnosis. These symptoms may help to identify some patients with otherwise unsuspected invasive meningococcal disease.
PMID: 12093984, UI: 22089042
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