Am J Emerg Med 2002 May;20(3):252-62
Department of Emergency Medicine, University of Virginia, Charlottesville, VA.
[Medline record in process]
Inverted T waves produced by myocardial ischemia are classically narrow and symmetric. T-wave inversion (TWI) associated with an acute coronary syndrome (ACS) is morphologically characterized by an isoelectric ST segment that is usually bowed upward (ie, concave) and followed by a sharp symmetric downstroke. The terms coronary T wave and coved T wave have been used to describe these ischemic TWIs. Prominent, deeply inverted, and widely splayed T waves are more characteristic of non-ACS conditions such as juvenile T-wave patterns, left ventricular hypertrophy, acute myocarditis, Wolff-Parkinson-White syndrome, acute pulmonary embolism, cerebrovascular accident, bundle branch block, and later stages of pericarditis. (Am J Emerg Med 2002;20:252-262. Copyright 2002, Elsevier Science (USA). All rights reserved.)
PMID: 11992349, UI: 21987626
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Am J Emerg Med 2002 May;20(3):165-9
Department of Emergency Medicine and daggerDivision of Biostatistics, Indiana University School of Medicine, Indianapolis, IN.
Although there is a widely held belief that pain is the number 1 complaint in emergency medical care, few studies have actually assessed the prevalence of pain in the emergency department (ED). We conducted an analysis of secondary data by using explicit data abstraction rules to determine the prevalence of pain in the ED and to classify the location, origin, and duration of the pain. This retrospective cross-sectional study was conducted at an urban teaching hospital in Indianapolis, IN. Charts from 1,665 consecutive ED visits during a 7-day period were reviewed. Pain was defined as the word pain or a pain equivalent word (including aching, burning, and discomfort) recorded on the chart. Of the 1,665 visits, 61.2% had pain documented anywhere on the chart, 34.1% did not have pain, and 4.7% were procedures. Pain was a chief complaint for 52.2% of the visits. This high prevalence of pain has important implications for the allocation of resources as well as educational and research efforts in emergency medical care. (Am J Emerg Med 2002;20:165-169. Copyright 2002, Elsevier Science (USA). All rights reserved.)
PMID: 11992334, UI: 21987611
Br J Anaesth 2002 Mar;88(3):455; discussion 456
Publication Types:
PMID: 11990289, UI: 21985667
Br J Anaesth 2002 Mar;88(3):455-6; discussion 456
PMID: 11990288, UI: 21985668
Br J Anaesth 2002 Mar;88(3):374-8
Department of Anaesthesia, Southmead Hospital, Westbury-on-Trym, Bristol, UK.
BACKGROUND: The pharmacokinetics of remifentanil suggests that it may be suitable for analgesia during labour. METHODS: In an open pilot study, 36 women requesting meperidine for analgesia were recruited early in labour and randomized to receive either meperidine i.m. or remifentanil given as patient-controlled analgesia (PCA). Pain severity, sedation and anxiety were assessed with visual analogue scales and overall effective analgesia was assessed by the woman and midwife. RESULTS: The pain scores were lower in the remifentanil group: median pain score at 60 min was 72 mm for meperidine and 48 mm for remifentanil (P=0.004) and median maximum pain score during the first 2 h was 82.5 mm for the meperidine group and 66.5 mm for the remifentanil group (P=0.009). Both the midwives' and the women's assessments of overall effective analgesia were higher in the remifentanil group [Likert scale (5 = excellent to 1 = poor): chi2=12.10, P=0.002 for mothers' assessment; chi2=12.80, P=0.002 for midwives' assessment]. CONCLUSION: In this pilot study, remifentanil by PCA gave better pain relief to mothers in labour than intramuscular meperidine. However, remifentanil is a potent respiratory depressant and adequate continuous monitoring is necessary.
PMID: 11990269, UI: 21985648
Cancer 2002 Apr 15;94(8):2295-2304
Department of Symptom Research, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
[Record supplied by publisher]
BACKGROUNDMinority patients with cancer are at risk for undertreatment of cancer-related pain. Most studies of patient-related barriers to pain control have surveyed primarily non-Hispanic Caucasian patients. The purpose of the current study was to explore barriers to optimal pain management among African-American and Hispanic patients with cancer through the use of structured patient interviews. Structured interviews allowed the authors to probe for previously unidentified barriers to pain management in these populations.METHODSThirty-one socioeconomically disadvantaged minority patients with cancer (14 African-American patients and 17 Hispanic patients) who had cancer-related pain completed structured interviews that assessed three main content areas: information and communication regarding cancer pain, treatment of cancer pain, and the meaning of cancer pain.RESULTSThe African-American and Hispanic patients reported severe pain and many concerns about pain management. The majority of patients in both ethnic groups expressed a belief in stoicism and concerns about possible addiction to opioid medications and the development of tolerance. The patients described their physicians as the most frequent and trusted source of information about cancer pain. However, patients also reported difficulties with communication and a reluctance to complain of pain.CONCLUSIONSThe reported barriers to pain management indicate that socioeconomically disadvantaged African-American and Hispanic patients can benefit from educational interventions on cancer pain that dispel myths about opioids and teach patients to communicate assertively about their pain with their physicians and nurses. Cancer 2002;94:2295-304. Copyright 2002 American Cancer Society.DOI 10.1002/cncr.10414
PMID: 12001130
Cephalalgia 2001 Nov;21(9):917-20
Servico de Neurologia, Departamento de Clinica Medica, Hospital de Clinicas da Universidade Federal de Parana, Curitiba, Brazil. pak@cwb.palm.com.br
PMID: 11903287, UI: 21900728
Cephalalgia 2001 Nov;21(9):911-6
Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany.
Despite the intensity with which many scholars have studied the evolution of Egyptian medicine, interdisciplinary studies on the history of headache are scarcely extant. Following a short discussion of historiographical issues, the main objective of this paper is to present a comprehensive and detailed overview on this subject. Scattered references to headache are extracted from so-called magical papyri and from medical texts of the New Kingdom. Although little is known about the quality of headache and about accompanying symptoms, four predominant localizations are distinguished. Due to the lack of precise descriptions it is impossible to establish the retrospective diagnosis of migraine. Explanations of the origin of cephalalgia and of the corresponding therapeutic actions differ according to the nature of the source. In magical papyri, headaches are attributed to the action of demons and supernatural forces, whereas medical papyri emphasize the role of head trauma and of 'pain matter' occurring in the body. Treatment could be magical, pharmacological or surgical. Examples of incantations and prescriptions are analysed in detail.
PMID: 11903286, UI: 21900727
Eur J Anaesthesiol 2002 Feb;19(2):147-8
PMID: 11999600, UI: 21994247
J Pain Symptom Manage 2002 Apr;23(4):346-50
Pain and Palliative Care Service, Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
In cancer patients, cognitive impairment, psychological distress, and anxiety may accompany and aggravate pain. Neuroleptics are frequently used to control these symptoms and may be used to treat pain that has been unresponsive to more conventional approaches. Because of prominent side effects of traditional neuroleptics and conflicting data regarding their analgesic efficacy, their use in the treatment of pain remains controversial. Olanzapine, an atypical neuroleptic, might offer advantages because of its safer side effect profile. It has also been shown to have an independent antinociceptive activity in animals. The use of olanzapine in the management of cancer pain has not been previously described. We prospectively collected the data on 8 cancer patients with severe pain, uncontrolled in spite of aggressive opioid titration, who received olanzapine to treat severe anxiety and mild cognitive impairment. Patients did not meet criteria for delirium and their cognitive impairment was defined as cognitive disorder not otherwise specified (NOS) according to DSM-IV. Patients received 2.5 to 7.5 mg of olanzapine daily. In all patients, opioid requirements had escalated rapidly prior to starting olanzapine. Levels of pain, sedation, and opioid use were measured 2 days before and 2 days after olanzapine was started. Cognitive state was assessed daily. All 8 patients had marked reduction of the daily pain scores. The average daily opioid use decreased significantly in all patients. Cognitive impairment and anxiety resolved within 24 hours of initiating olanzapine. In these 8 patients, decreased pain scores and opioid requirements may have resulted from improvement in cognitive function and the known anxiolytic effect of olanzapine. Other mechanisms may include independent or adjuvant analgesic effects of olanzapine. We conclude that olanzapine may be useful in the treatment of patients with uncontrolled cancer pain associated with cognitive impairment or anxiety. Further studies to evaluate possible analgesic effect of olanzapine are needed.
PMID: 11997204, UI: 21993054
J Pain Symptom Manage 2002 Apr;23(4):329-36
City of Hope National Medical Center, Duarte, CA, USA
Pain education for patients and the public is an essential element of improved pain management. This article reports on the implementation of a national training project, Cancer Pain Education for Patients and the Public (CPEPP). The CPEPP curriculum was designed to address the multiple opportunities for pain education and to provide resources and support for successful implementation.
PMID: 11997202, UI: 21993052
J Pain Symptom Manage 2002 Apr;23(4):318-28
Department of Pharmacology, Therapeutics and Toxicology, Autonomous University of Barcelona, Bellaterra, Spain
Several epidemiological studies have shown that pain is a very common complaint in patients who seek medical care. However, the characteristics of how pain is treated in the general population have been studied less. The present survey was conducted to describe and analyze how the general population of Catalonia (Spain) approaches the treatment of their pain complaints. The study was carried out in 1964 adults who were surveyed by phone about the presence of painful events in the last six months, the intensity and location of their pain, what they did to treat their pain, and their resulting level of relief. Data were compared by age and gender. Pain prevalence was high (78.6%) and more frequent in women. The therapeutic strategy most commonly used was a visit to the physician (66.3%), followed by self-medication (27.6%) and alternative medicines (20.5%). Drugs were the primary treatment used by physicians (86.5%), followed by physical therapy (18.1%). Pain in the extremities, back and neck pain were often unsuccessfully treated. Self-medication was often performed with acetylsalicylic acid and paracetamol (acetaminophen), and was commonly used in conjunction with other therapeutic approaches (51.9%). Age (low use of paracetamol in the elderly) and gender (low use of paracetamol in men) were related to the type of drug used in self-medication. Older men, and those with severe pain located in the chest, required hospital admission more commonly. In conclusion, pain is a common reason for seeking medical care and using drugs. Therapeutic approaches are often related to the type of pain, but also to age or gender. Knowledge of these characteristics may allow for a more efficient use of available resources.
PMID: 11997201, UI: 21993051
J Pain Symptom Manage 2002 Apr;23(4):292-300
Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY, USA
Extended-release morphine formulations are widely used in the management of chronic pain. Avinza (morphine sulfate extended-release [MSER, Morphelan]) is a new, once-a-day, extended-release morphine formulation designed to reach target concentrations rapidly and maintain concentrations throughout a 24-hour period. The primary objective of this study was to compare the 24-hour steady-state pharmacokinetic (PK) profiles of morphine and its metabolites (morphine-6-glucuronide [M6G] and morphine-3-glucuronide [M3G]) following ingestion of MSER once-a-day and MS Contin(R) (controlled-release morphine sulfate [CRM]) twice-a-day in patients with chronic moderate-to-severe pain. Ten patients with chronic moderate-to-severe pain were recruited into an open-label, multiple-dose, nonrandomized, two-period, single-center study. All patients were stabilized for a minimum of 7 days on a twice-daily dose of CRM associated with an optimal balance between pain control and side effects. Patients were then switched to the closest equivalent once-daily dose of MSER for a minimum of 10 days. Twenty-four hour steady-state PK profiles were obtained on the last day of each treatment period and additional clinical and safety assessments were performed. PK data were normalized to a 100-mg total daily dose prior to statistical analysis. Nine of the 10 patients completed the entire study. MSER and CRM demonstrated similar bioavailability (AUC) of morphine and its metabolites. Compared to CRM, MSER demonstrated a 19% lower maximum concentration (C(max)), a 66% higher minimum concentration (C(min)), and a 44% lower peak-to-trough fluctuation (%FI) over the 24-hour period. In addition, MSER maintained concentrations above 50% and 75% of the C(max) longer than CRM. Clinical efficacy and safety were comparable for MSER and CRM. Once-daily MSER approaches maximum morphine concentration more quickly, approximates maximum concentration longer, and demonstrates less fluctuation in morphine concentration during a 24-hour period than CRM dosed twice daily. The pharmacodynamic implications of this profile deserve further study.
PMID: 11997198, UI: 21993048
J Pain Symptom Manage 2002 Apr;23(4):278-91
Radiant Research, Daytona Beach, FL, USA
A randomized, 4-week, double-blind trial followed by an open-label extension trial assessed the efficacy and safety of a once-daily, extended-release morphine formulation (Avinza (previously referred to as Morphelan)) in 295 patients with chronic, moderate-to-severe osteoarthritis pain who had failed to obtain adequate pain relief with NSAIDs and acetaminophen. Participants received one of four treatments: Avinza 30 mg once daily (QAM or QPM), MS Contin(R) 15 mg twice daily, or placebo twice daily. Patients (n =181) received Avinza QAM or QPM during the 26-week open-label extension trial and could increase their dose to optimize pain control. Avinza and MS Contin reduced pain and improved several sleep measures versus placebo. Analgesic efficacy was comparable between Avinza and MS Contin; however, Avinza QAM demonstrated greater improvements in overall quality of sleep. The most common adverse events were constipation and nausea. The majority of AEs occurred at a similar incidence among the active treatment groups.
PMID: 11997197, UI: 21993047
J Pain Symptom Manage 2002 Apr;23(4):273-7
Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
PMID: 11997196, UI: 21993046
J Pain Symptom Manage 2002 Apr;23(4):272
Department of Psychology University of Texas-Pan American, Edinburg, TX, USA
PMID: 11997195, UI: 21993045
J Pain Symptom Manage 2002 Apr;23(4):270-2
PMID: 11997194, UI: 21993044
J Pain Symptom Manage 2002 Mar;23(3):177; discussion 178
PMID: 11888712, UI: 21886510
Lancet 2002 Apr 20;359(9315):1379-87
BACKGROUND: The Long-term Intervention with Pravastatin in Ischaemic Disease (LIPID) study showed that pravastatin therapy over 6 years reduced mortality and cardiovascular events in patients with previous acute coronary syndromes and average cholesterol concentrations. We assessed the longer-term effects of initial treatment with pravastatin on further cardiovascular events and mortality over a total follow-up period of 8 years. METHODS: In the main trial, 9014 patients with previous myocardial infarction or unstable angina and a baseline plasma cholesterol concentration of 4.0-7.0 mmol/L were randomly assigned pravastatin 40 mg daily or placebo and followed up for 6 years. Subsequently, all patients were offered open-label pravastatin for 2 more years. Major cardiovascular events and adverse events were compared according to initial treatment assignment. FINDINGS: 7680 (97% of those still alive) had 2 years of extended follow-up. 3766 (86%) of those assigned placebo and 3914 (88%) assigned pravastatin agreed to take open-label pravastatin. During this period, patients originally assigned pravastatin had almost identical cholesterol concentrations to those assigned placebo, but a lower risk of death from all causes (219 [5.6%] vs 255 [6.8%], p=0.029), coronary heart disease (CHD) death (108 [2.8%] vs 137 [3.6%], p=0.026), and CHD death or non-fatal myocardial infarction (176 [4.5%] vs 196 [5.2%], p=0.08). Over the total 8-year period, all-cause mortality was 888 (19.7%) in the group originally assigned placebo and 717 (15.9%) in the group originally assigned pravastatin, CHD mortality was 510 (11.3%) versus 395 (8.8%), myocardial infarction was 570 (12.7%) versus 435 (9.6%; each p < 0.0001), and stroke was 272 (6.0%) versus 224 (5.0%; p=0.015). Stronger evidence of separate treatment benefits than in the main trial was seen in important prespecified subgroups (women, patients aged > or = 70 years, and those with total cholesterol < 5.5 mmol/L). Pravastatin had no significant adverse effects. INTERPRETATION: The evidence of sustained treatment benefits and safety of long-term pravastatin treatment reinforces the importance of long-term cholesterol-lowering treatment for almost all patients with previous CHD events.
PMID: 11978335, UI: 21975531
Neurology 2002 Apr 23;58(8):1302-4
Section of Neurology, Virginia Mason Medical Center, Seattle, WA 98111, USA. Michael.Elliott@vmmc.org
Carotid dissection is a well-described complication of head and neck trauma. Two cases of carotid dissection that occurred after use of shiatsu-type massagers are described. This potential cause should be considered when evaluating patients with idiopathic carotid dissection.
PMID: 11971108, UI: 21966408
Spine 2002 May 15;27(10):1110-5
Spine and Joint Centre, the Netherlands, and the Departments of; Biomedical Physics and Technology,; Rehabilitation Medicine, and; Radiology, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, the Netherlands.
STUDY DESIGN: A cohort study was conducted. OBJECTIVE: To develop a test battery for evaluating the course of posterior pelvic pain since pregnancy. SUMMARY OF BACKGROUND DATA: Properly validated scales to evaluate the course of posterior pelvic pain since pregnancy are scarce. Moreover, the use of many tests would be too strenuous for the patient and has an unfavorable cost-benefit ratio. METHODS: The ability of 48 effect measures to detect clinically relevant changes over time (responsiveness) was tested in patients with posterior pelvic pain since pregnancy. In this test, 35 measures were evaluated in a group of 44 patients, and 16 measures in a group of 56 patients (three measures were evaluated in both groups). All the tests were performed at baseline and after 8 weeks treatment. A global impression of improvement (improved or not improved) scored by the patient was used as the standard for assessing the course of the disease. Responsiveness was examined by calculating the standardized response mean of the improved patients and by using a two-tailed Mann-Whitney nonparametric test to compare the patients who had improved and those who had not improved. RESULTS: Of the 48 effect measures, 26 measures of five categories (activities of daily living, pain, hip muscle strength, spine mobility, and spine muscle strength) showed good correlation with the patient's global impression of improvement. The measures in the "mobility of the pelvic joints" category were insufficient for assessing clinical change in posterior pelvic pain since pregnancy. The measures in the "fatigue" and "pain provocation tests" categories correlated only moderately with clinical change. CONCLUSIONS: It seems possible to gain appropriate information about the course of posterior pelvic pain since pregnancy with a small test battery. The usefulness of the Quebec Back Pain Disability Scale, the hip adduction strength assessment, and the active straight-leg-raise test was proved by the current study. The value of 23 other instruments was substantiated, but further studies are needed to confirm their usefulness. The correlation of 22 evaluated measures with the patient's global improvement was too weak for them to be recommended as measures of clinical changes over time in posterior pelvic pain since pregnancy. It is recommended that clinicians and investigators compile a small test battery by selecting the best representatives of the five measurement categories that have good correlation with the patient's global impression of improvement.
PMID: 12004181, UI: 21999577
Spine 2002 May 15;27(10):1102-9
Finnish Institute of Occupational Health, Helsinki, Finland.
STUDY DESIGN: In this prospective study, a cohort of 2077 workers free of sciatic pain and another cohort of 327 workers with severe sciatic pain were followed up for 1 year. OBJECTIVE: To evaluate the effects of different risk factors on the incidence and persistence of sciatic pain. SUMMARY OF BACKGROUND DATA: Sciatic pain seems to differ from other types of low back pain in terms of etiology, occurrence, and prognosis. Yet only a few studies of sciatic pain exist. The role of individual characteristics, occupational loading, and participation in different sports has rarely been assessed in a study with a prospective design among a working population. METHODS: The subjects of this study, Finnish forest industry workers, replied to a modified version of the Nordic Questionnaire at the baseline of this study and after 1 year. The effects of the predictors on the 1-year incidence and persistence of sciatic pain were studied with multivariable logistic regression modeling. RESULTS: Greater age, mental stress, smoking of long duration, and work-related twisting of the trunk increased the risk of incidental sciatic pain. Joggers had a lower risk for incidental sciatic pain, but a higher risk for persistent symptoms. Walking was positively associated with the risk of incidental pain. Greater age, mental stress, former smoking, jogging, and poor job satisfaction increased the risk for persistent severe sciatic pain. CONCLUSIONS: The findings from this study suggest that mental stress and smoking are independent risk factors for incidental sciatic pain. Overall physical exercise and most of the sports activities, except jogging and walking, had no effect on sciatic pain. Physical workload factors seemed to be more involved in the onset of sciatic pain, whereas psychosocial factors were related to the persistence of symptoms.
PMID: 12004179, UI: 21999575
Spine 2002 May 15;27(10):1012-7
Department of Physical Medicine and Rehabilitation, UMDNJ-NJ Medical School, the; Research Testing Laboratories, Great Neck, New York, and the; the Procter and Gamble Health Sciences Institute, Cincinnati, Ohio.
STUDY DESIGN: A prospective, randomized, single (investigator) blind, comparative efficacy trial was conducted. OBJECTIVE: To compare the efficacy of continuous low-level heat wrap therapy (40 C, 8 hours/day) with that of ibuprofen (1200 mg/day) and acetaminophen (4000 mg/day) in subjects with acute nonspecific low back pain. SUMMARY OF BACKGROUND DATA: The efficacy of topical heat methods, as compared with oral analgesic treatment of low back pain, has not been established. METHODS: Subjects (n = 371) were randomly assigned to heat wrap (n = 113), acetaminophen (n = 113), or ibuprofen (n = 106) for efficacy evaluation, or to oral placebo (n = 20) or unheated back wrap (n = 19) for blinding. Outcome measures included pain relief, muscle stiffness, lateral trunk flexibility, and disability. Efficacy was measured over two treatment days and two follow-up days. RESULTS: Day 1 pain relief for the heat wrap (mean, 2) was higher than for ibuprofen (mean, 1.51; P = 0.0007) or acetaminophen (mean, 1.32; P = 0.0001). Extended mean pain relief (Days 3 to 4) for the heat wrap (mean, 2.61) also was higher than for ibuprofen (mean, 1.68; P = 0.0001) or acetaminophen (mean, 1.95; P = 0.0009). Lateral trunk flexibility was improved with the heat wrap (mean change, 4.28 cm) during treatment (P </= 0.009 vs acetaminophen [mean change, 2.93 cm], P </= 0.001 vs ibuprofen [mean change, 2.51 cm]). The results were similar on Day 4. Day 1 reduction in muscle stiffness with the heat wrap (mean, 16.3) was greater than with acetaminophen (mean, 10.5; P = 0.001). Disability was reduced with the heat wrap (mean, 4.9), as compared with ibuprofen (mean, 2.7; P = 0.01) and acetaminophen (mean, 2.9; P = 0.0007), on Day 4. None of the adverse events were serious. The highest rate (10.4%) was reported in the ibuprofen group. CONCLUSION: Continuous low-level heat wrap therapy was superior to both acetaminophen and ibuprofen for treating low back pain.
PMID: 12004166, UI: 21999562
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