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Items 1 - 10 of 10 |
One page. |
Chronic pain in the ED.
Bernard AM, Wright SW.
There has been increasing awareness concerning the problem of acute pain in ED patients. There has, however, been little attention devoted to chronic pain in ED patients. Our purpose was to determine the extent and severity of chronic pain in adult ED patients. Adult noncritical patients were interviewed to determine if they had chronic pain. The Chronic Pain Grade scale was used to grade the severity of the pain. Four hundred seventy-six patients were enrolled. One hundred ninety-three (40.6%) had chronic pain. Sixty-five (13.7%) identified their chronic pain as the reason for the ED visit. The spine and abdomen were the most common sites of chronic pain. Those with chronic pain were more likely to be unemployed (relative risk [RR], 1.77; 95% confidence interval [CI], 1.34-2.34), disabled (RR, 3.24; 95% CI, 1.95-5.40), and have had four or more ED visits in the past year (RR, 2.47; 95% CI, 1.76-3.47). A total of 32.1% had class 3 pain (high disability, moderately limiting) and 58.0% had class 4 pain (high disability, severely limiting). Many noncritical ED patients have chronic pain. They are high users of ED services and most have not been seen in a pain clinic. Further studies are indicated to further delineate the demographics of this population and determine which patients would best be served in other healthcare settings. In an effort to improve care, ED physicians should be educated in diagnosing and treating chronic pain.
PMID: 15520937 [PubMed - in process]
Surgeon found liable for not warning of partial paralysis risk.
Dyer C.
Publication Types:
PMID: 15499098 [PubMed - indexed for MEDLINE]
Comment on:
Placebos in practice.
Spiegel D.
Publication Types:
PMID: 15499085 [PubMed - indexed for MEDLINE]
Opioid switching from transdermal fentanyl to oral methadone in patients with cancer pain.
Benitez-Rosario MA, Feria M, Salinas-Martin A, Martinez-Castillo LP, Martin-Ortega JJ.
Palliative Care Unit and Research Unit, Hospital La Candelaria, Canary Health Service, Tenerife, Spain.
BACKGROUND: Patients with cancer often are rotated from other opioids to methadone to improve the balance between analgesia and side effects. To the authors' knowledge, no clear guidelines currently exist for the safe and effective rotation from transdermal fentanyl to methadone. METHODS: The authors evaluated a protocol for switching opioid from transdermal fentanyl to oral methadone in 17 patients with cancer. Reasons for switching were uncontrolled pain (41.1% of patients) and neurotoxic side effects (58.9% of patients). Methadone was initiated 8-24 hours after fentanyl withdrawal, depending on the patient's previous opioid doses (from < 100 mug per hour to > 300 mug per hour). The starting methadone dose was calculated according to a 2-step conversion between transdermal fentanyl:oral morphine (1:100 ratio) and oral morphine:oral methadone (5:1 ratio or 10:1 ratio). The correlation between previous fentanyl dose and the final methadone dose or the fentanyl:methadone dose ratio was assessed by means of Pearson and Spearman correlation coefficients (r), respectively. A Friedman test was used to compare pain intensity before and after the switch and the use of daily rescue doses. RESULTS: Opioid rotation was fully or partially effective in 80% and 20%, respectively, of patients with somatic pain. Neuropathic pain was not affected by opioid switching. Delirium and myoclonus were reverted in 80% and 100% of patients, respectively, after opioid switching. A positive linear correlation was obtained between the fentanyl and methadone doses (Pearson r, 0.851). Previous fentanyl doses were not correlated with the final fentanyl:methadone dose ratios (Spearman r, - 0.327). CONCLUSIONS: The protocol studied provided a safe approach for switching from transdermal fentanyl to oral methadone, improving the balance between analgesia and side effects in patients with cancer. Cancer 2004. (c) 2004 American Cancer Society.
PMID: 15529307 [PubMed - as supplied by publisher]
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Key role of the dorsal root ganglion in neuropathic tactile hypersensibility.
Sukhotinsky I, Ben-Dor E, Raber P, Devor M.
Department of Cell and Animal Biology, Institute of Life Sciences, Hebrew University of Jerusalem, Jerusalem 91904, Israel.
Cutting spinal nerves just distal to the dorsal root ganglion (DRG) triggers, with rapid onset, massive spontaneous ectopic discharge in axotomized afferent A-neurons, and at the same time induces tactile allodynia in the partially denervated hindlimb. We show that secondary transection of the dorsal root (rhizotomy) of the axotomized DRG, or suppression of the ectopia with topically applied local anesthetics, eliminates or attenuates the allodynia. Dorsal rhizotomy alone does not trigger allodynia. These observations support the hypothesis that ectopic firing in DRG A-neurons induces central sensitization which leads to tactile allodynia. The question of how activity in afferent A-neurons, which are not normally nociceptive, might induce allodynia is discussed in light of the current literature.
PMID: 14987623 [PubMed - indexed for MEDLINE]
Comment on:
Enoxaparin vs unfractionated heparin in acute coronary syndrome.
Pedrini M, Hartig F, Pechlaner C.
Publication Types:
PMID: 15507578 [PubMed - indexed for MEDLINE]
Comment on:
Enoxaparin vs unfractionated heparin in acute coronary syndrome.
Kanna B, Sharma P.
Publication Types:
PMID: 15507577 [PubMed - indexed for MEDLINE]
Relief of pain and anxiety in pediatric patients in emergency medical systems.
Zempsky WT, Cravero JP; American Academy of Pediatrics Committee on Pediatric Emergency Medicine and Section on Anesthesiology and Pain Medicine.
Whether a component of a disease process, the result of acute injury, or a product of a diagnostic or therapeutic procedure, pain should be relieved and stress should be decreased for pediatric patients. Control of pain and stress for children who enter into the emergency medical system, from the prehospital arena to the emergency department, is a vital component of emergency care. Any barriers that prevent appropriate and timely administration of analgesia to the child who requires emergency medical treatment should be eliminated. Although more research and innovation are needed, every opportunity should be taken to use available methods of pain control. A systematic approach to pain management and anxiolysis, including staff education and protocol development, can have a positive effect on providing comfort to children in the emergency setting.
PMID: 15520120 [PubMed - in process]
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Preemptive strike in the war on pain: is it a safe strategy for our vulnerable infants?
Aly H.
Department of Neonatology, George Washington University and Children's National Medical Center, Washington, DC 20037, USA. haly@mfa.gwu.edu
PMID: 15520116 [PubMed - in process]
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Children with unexplained chronic pain: do pediatricians agree regarding the diagnostic approach and presumed primary cause?
Konijnenberg AY, De Graeff-Meeder ER, Kimpen JL, van der Hoeven J, Buitelaar JK, Uiterwaal CS; Pain of Unknown Origin in Children Study Group.
Department of General Pediatrics, University Medical Center Utrecht, Utrecht, Netherlands.
OBJECTIVE: To investigate the opinions of general pediatricians regarding children with unexplained chronic pain (UCP), with respect to the presumed cause of the pain and the optimal diagnostic approach for these children. DESIGN: Diagnostic follow-up study. SETTING: Outpatient clinic of a university children's hospital. PARTICIPANTS: A total of 134 consecutive patients, 8 to 18 years of age, referred for pain of > or =3-month duration without a satisfactory explanation at presentation. METHODS: A full copy of the patient records from routine medical practice and data from standardized psychiatric assessments, standardized questionnaires, and standardized follow-up assessments were provided to 17 pediatricians assigned to 3 panels. MAIN OUTCOME MEASURES: Agreement regarding the presumed primary cause and diagnostic approach for children with UCP, with consensus being defined as > or =80% agreement among the pediatricians. RESULTS: The mean age of the children (73% girls) was 11.8 years (SD: 2.6 years). Psychiatric (co)morbidity was present for 60% of the children. Consensus regarding the presumed primary cause was reached for 43% of the patients (58 of 134 patients), ie, 72% (42 of 58 patients) primarily dysfunctional, 17% (10 of 58 patients) primarily psychologic, and 10% (6 of 58 patients) primarily somatic. Consensus regarding the diagnostic approach was reached for 63% of the children (84 of 134 children), leaving more than one-third of the children (37%) without diagnostic consensus. CONCLUSIONS: The relatively high rates of disagreement regarding the optimal diagnostic approach and presumed primary cause illustrate the difficulties of diagnostic evaluation and subsequent therapeutic strategy design for this patient group. Therefore, children with UCP might be at risk for suboptimal care.
PMID: 15520099 [PubMed - in process]
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