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Items 1 - 10 of 10 |
One page. |
Healthcare professionals' perceptions of pain in infants at risk for neurological impairment.
Breau LM, McGrath PJ, Stevens B, Beyene J, Camfield CS, Finley GA, Franck L, Howlett A, O'brien K, Ohlsson A.
BACKGROUND: To determine whether healthcare professionals perceive the pain of infants differently due to their understanding of that infant's level of risk for neurological impairment. METHOD: Neonatal Intensive Care Units (NICU's) at two tertiary pediatric centers. Ninety-five healthcare professionals who practice in the NICU (50 nurses, 19 physicians, 17 respiratory therapists, 9 other) participated. They rated the pain (0-10 scale and 0-6 Faces Pain Scale), distress (0-10), effectiveness of cuddling to relieve pain (0-10) and time to calm without intervention (seconds) for nine video clips of neonates receiving a heel stick. Prior to each rating, they were provided with descriptions that suggested the infant had mild, moderate or severe risk for neurological impairment. Ratings were examined as a function of the level of risk described. RESULTS: Professionals' ratings of pain, distress, and time to calm did not vary significantly with level of risk, but ratings of the effectiveness of cuddling were significantly lower as risk increased [F (2,93) = 4.4, p = .02]. No differences in ratings were found due to participants' age, gender or site of study. Physicians' ratings were significantly lower than nurses' across ratings. CONCLUSION: Professionals provided with visual information regarding an infants' pain during a procedure did not display the belief that infants' level of risk for neurological impairment affected their pain experience. Professionals' estimates of the effectiveness of a nonpharmacological intervention did differ due to level of risk.
PMID: 15541179 [PubMed - as supplied by publisher]
 
Video assisted thoracic surgery for treatment of pneumothorax and lung resections: systematic review of randomised clinical trials.
Sedrakyan A, van der Meulen J, Lewsey J, Treasure T.
Health Services Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT.
OBJECTIVES: To determine if video assisted thoracic surgery is associated with better clinical outcomes than thoracotomy for three common procedures: surgery for pneumothorax, minor resections, and lobectomy. DESIGN: Systematic review of randomised clinical trials. DATA SOURCES: Medline, Embase, Cochrane database of systematic reviews, Cochrane controlled trials register. Reference lists of relevant articles and reviews. METHODS: Criteria for inclusion were random allocation of patients and no concurrent use of another experimental medication or device. At least two authors performed and confirmed data abstraction and analyses. Information on quality of trials, demographics, frequency of the events, and numbers randomised were collected. RESULTS: 12 trials randomised 670 patients. Video assisted thoracic surgery was associated with shorter length of stay (reduction ranged from 1.0 to 4.2 days) and less pain or use of pain medication than thoracotomy in the five out of seven trials in which the technique was used for pneumothorax or minor lung resection. In the treatment of pneumothorax, video assisted thoracic surgery was associated with substantially fewer recurrences than pleural drainage in two trials (from 20 to 53 events prevented per 100 treated patients). No substantial advantages were observed for video assisted thoracic surgery in lobectomies. CONCLUSIONS: Video assisted thoracic surgery is associated with better outcomes and seems to have a complication profile comparable with that of thoracotomy for the treatment of pneumothorax and minor resections. As for lobectomy, further studies are needed to determine how it compares with thoracotomy.
Publication Types:
PMID: 15385408 [PubMed - indexed for MEDLINE]
A 32-Year-Old Man with Knee Pain.
Adams JE, Lopez-Ben R, Meyer RD, Siegal GP.
From the Departments of *Resident in Pathology, section signProfessor and Division Director, Pathology, daggerAssistant Professor, Radiology, and double daggerAssociate Professor of Surgery, Surgery, Division of Orthopaedic Surgery, The University of Alabama School of Medicine.
PMID: 15547366 [PubMed - as supplied by publisher]
Local transcutaneous electrical stimulation (TENS) effects in experimental inflammatory edema and pain.
Resende MA, Sabino GG, Candido CR, Pereira LS, Francischi JN.
Departamento de Fisioterapia da Escola de Educacao Fisica, Fisioterapia e Terapia Ocupacional da Universidade Federal de Minas Gerais. Av. Antonio Carlos, 6627, CEP: 31270-901, Belo Horizonte, M.G., Brazil.
Few studies in the literature associated transcutaneous electrical stimulation (TENS) use with an antiinflammatory activity. The purpose of this study was to investigate the effects of low (10 Hz)- and high (130 Hz)-frequency TENS on hyperalgesia and edema that occur after injection of carrageenan in rat paw. After induction of inflammation, either low- or high-frequency TENS was applied in the rat paw for 20 min, and the effect of TENS treatment on escape or paw withdrawal and edema was measured. Both low- and high-frequency TENS inhibited by 100% the hyperalgesia but not the edema response. However, low-frequency TENS presented longer lasting effect as compared with high-frequency TENS. Naltrexone-treated animals showed a complete reversion of the analgesic effect induced by low- but not high-frequency TENS. Thus, our data demonstrated absence of an antiinflammatory effect associated to TENS use and confirmed the participation of endogenous opioids on low TENS-induced analgesia.
PMID: 15541425 [PubMed - in process]
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Bone morphogenetic proteins in anterior lumbar interbody fusion: old techniques and new technologies. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004.
Burkus JK.
Spine Service, The Hughston Clinic, Columbus, Georgia 31908-9517, USA. jkb66@knology.net
OBJECT: The author reports the clinical and radiographic outcomes obtained in three prospective multicenter clinical trials in which recombinant human bone morphogenetic protein-2 (rhBMP-2) was used in anterior lumbar interbody fusion (ALIF). METHODS: Stand-alone interbody fusion cages were used, and supplemental fixation was not performed as part of the study protocol. Patients were randomly assigned to one of two ALIF groups: one in which autologous iliac crest bone graft was used (control) and one in which an rhBMP-2-coated absorbable collagen sponge was placed (investigational group). In all patients who underwent rhBMP-2-augmented fusion, imaging demonstrated evidence of bone induction and early incorporation of the cortical allografts. Overall, more expedient clinical improvements and higher success rates were observed in the rhBMP-2 group. CONCLUSIONS: In these studies it was shown that rhBMP-2 is a safe and effective material for facilitating ALIF and for decreasing pain and improving clinical outcomes.
Publication Types:
PMID: 15478362 [PubMed - indexed for MEDLINE]
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Complex regional pain syndromes--how do we escape the diagnostic trap?
Baron R, Janig W.
Department of Neurological Pain Research and Therapy, Neurological Clinic, Christian-Albrechts-Universitat zu Kiel, 24105 Kiel, Germany. r.baron@neurologie.uni-kiel.de
PMID: 15541435 [PubMed - in process]
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Pelvic pain during pregnancy: a descriptive study of signs and symptoms of 870 patients in primary care.
Rost CC, Jacqueline J, Kaiser A, Verhagen AP, Koes BW.
Practice for Physiotherapy, Oegstgeest, The Netherlands.
STUDY DESIGN: The authors conducted a cross-sectional analysis. OBJECTIVE: The objective of this study was to describe the signs and symptoms of pregnant women with pain and dysfunction in the pelvic area. SUMMARY OF BACKGROUND DATA: Pelvic pain during pregnancy is common with incidence rates of 48% to 56%. The exact cause of pelvic pain during pregnancy is still unclear. Also unclear is the association between physical examination and the occurrence of pelvic pain during pregnancy. METHODS: Pregnant women with pelvic pain were sent for treatment to 2 physical therapy practices between January 1997 and January 2002. A standardized clinical examination protocol and an extensive questionnaire were used to obtain relevant clinical and demographic characteristics. RESULTS: In total, 870 women were included. The average score of the overall severity of the complaints was 7.8 (scale 0-15). Main complaints were located around the sacroiliac joints (76.6%) and the pubic symphysis (57.2%). The area of pain was not related to positive signs in passive hip movements and sacroiliac tests. The highest positive test results were found for Patrick sign (71.7%), active straight leg raise (ASLR) test (66.4%), resisted adduction (54.4%), and passive hip abduction (36.9%). Overall severity of complaints was related to age, number of weeks pregnant, passive hip flexion and internal rotation, and swimming. The total explained variance of these factors was 15.9%. No relationship was found between overall complaints and sacroiliac tests, pelvic pain during a previous pregnancy, extremely painful or type of previous deliveries. CONCLUSIONS: Pregnant patients with pelvic pain show a considerable level of complaints. The overall severity of complaints is not related to previous peripartum pelvic pain or type of deliveries or to commonly used tests. Further study on the role of clinical examination, including passive flexion and internal rotation of the hip joints, is recommended.
PMID: 15543075 [PubMed - as supplied by publisher]
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Changes in recruitment of the abdominal muscles in people with low back pain: ultrasound measurement of muscle activity.
Ferreira PH, Ferreira ML, Hodges PW.
Department of Physiotherapy, University of Queensland, Brisbane, Australia.
STUDY DESIGN: Ultrasound and electromyographic (EMG) measures of trunk muscle activity were compared between low back pain (LBP) and control subjects in a cross-sectional study. OBJECTIVES: To compare the recruitment of the abdominal muscles (measured as a change in thickness with ultrasound imaging) between people with and without low back pain and to compare these measurements with EMG recordings made with intramuscular electrodes. SUMMARY OF BACKGROUND DATA: Although ultrasonography has been advocated as a noninvasive measure of abdominal muscle activity, it is not known whether it can provide a valid measure of changes in motor control of the abdominal muscles in LBP. METHODS: Ten subjects with recurrent LBP and 10 matched controls were tested during isometric low load tasks with their limbs suspended. Changes in thickness from resting baseline values were obtained for transversus abdominis (TrA), obliquus internus (OI), and obliquus externus (OE) using ultrasonography. Fine wire EMG was measured concurrently. RESULTS: Study participants with LBP had a significantly smaller increase in TrA thickness with isometric leg tasks compared with controls. No difference was found between groups for OI or OE. Similar results were found for EMG. People with LBP had less TrA EMG activity with leg tasks, and there was no difference between groups for EMG activity for OI or OE. CONCLUSIONS: This study reinforces evidence for changes in automatic control of TrA in people with LBP. Furthermore, the data establish a new test of recruitment of the abdominal muscles in people with LBP. This test presents a feasible noninvasive test of automatic recruitment of the abdominal muscles.
PMID: 15543074 [PubMed - as supplied by publisher]
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Modeling of the sagittal cervical spine as a method to discriminate hypolordosis: results of elliptical and circular modeling in 72 asymptomatic subjects, 52 acute neck pain subjects, and 70 chronic neck pain subjects.
Harrison DD, Harrison DE, Janik TJ, Cailliet R, Ferrantelli JR, Haas JW, Holland B.
Biomechanics Laboratory, Department of Sciences of Physical Activity, Universite du Quebec a Trois Rivieres, Quebec, Canada.
STUDY DESIGN: Computer analysis of digitized vertebral body corners on lateral cervical radiographs. OBJECTIVES: Using elliptical and circular modeling, the geometric shape of the path of the posterior bodies of C2-C7 was sought in normal, acute pain, and chronic pain subjects. To determine the least squares error per point for paths of geometric shapes, minor axis to major axis elliptical ratios (b/a), Cobb angles, sagittal balance of C2 above C7, and posterior tangent segmental and global angles. SUMMARY OF BACKGROUND DATA: When restricted to cervical lordotic configurations, normal, acute pain, and chronic pain subjects have not been compared for similarities or differences of these parameters. Conventional Cobb angles provide only a comparison of the endplates of the distal vertebrae, while geometric modeling provides the shape of the entire sagittal curves, the orientation of the spine, and segmental angles. METHODS: Radiographs of 72 normal subjects, 52 acute neck pain subjects, and 70 chronic neck pain subjects were digitized. For normal subjects, the inclusion criteria were no kyphotic cervical segments, no cranial-cervical symptoms, and less than +/- 10 mm horizontal displacement of C2 above C7. In pain subjects, inclusion criteria were no kyphotic cervical segments and less than 25 mm of horizontal displacement of C2 above C7. Measurements included segmental angles, global angles of lordosis (C1-C7 and C2-C7), height-to-length ratios, anterior weight bearing, and from modeling, circular center, and radius of curvature. RESULTS: In the normal group, a family of ellipses was found to closely approximate the posterior body margins of C2-C7 with a least squares error of less than 1 mm per vertebral body point. The only ellipse/circle found to include T1, with a least squares error of less than 1 mm, was a circle. Compared with the normal group, the pain group's mean radiographic angles were reduced and the radius of curvature was larger. For normal, acute, and chronic pain groups, the mean angles between posterior tangents on C2-C7 were 34.5 degrees, 28.6 degrees, and 22.0 degrees, C2-C7 Cobb angles were 26.8 degrees, 16.5 degrees, and 12.7 degrees, and radius of curvature were r = 132.8 mm, r = 179 mm, and r = 245.4 mm, respectively. CONCLUSIONS: The mean cervical lordosis for all groups could be closely modeled with a circle. Pain groups had hypolordosis and larger radiuses of curvature compared with the normal group. Circular modeling may be a valuable tool in the discrimination between normal lordosis and hypolordosis in normal and pain subjects.
PMID: 15543059 [PubMed - as supplied by publisher]
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Changes in the Cross-Sectional Area of Multifidus and Psoas in Patients With Unilateral Back Pain: The Relationship to Pain and Disability.
Barker KL, Shamley DR, Jackson D.
From the *Physiotherapy Research Unit, Nuffield Orthopaedic Centre NHS Trust; and daggerSchool of Physiotherapy, Oxford Brookes University, Oxford, UK.
STUDY DESIGN.: Prospective, cross-sectional observational study. OBJECTIVES.: The aim of this study was to determine if there was an association between wasting of psoas and multifidus as observed on MRI scans and the presenting symptoms, reported pathology, pain, or disability of a cohort of patients presenting with unilateral low back pain. SUMMARY OF BACKGROUND DATA.: Current physiotherapy practice is often based on localized spine stabilizing muscle exercises; most attention has been focused on transversus abdominus and multifidus with relatively little on psoas. METHOD.: Fifty consecutive patients presenting to a back pain triage clinic with unilateral low back pain lasting more than 12 weeks were recruited. The cross-sectional surface area (CSA) of the muscles was measured. Duration of symptoms, rating of pain, self-reported function, and the presence of neural compression were recorded. RESULTS.: Data analysis compared the CSA between the symptomatic and asymptomatic sides. There was a statistically significant difference in CSA between the sides (P < 0.001). There was a positive correlation between the percentage decrease in CSA of psoas on the affected side and with the rating of pain (rho = 0.608, P < 0.01), reported nerve root compression (rho = 0.812, P < 0.01), and the duration of symptoms (rho = 0.886, P < 0.01). There was an association between decrease in the CSA of multifidus and duration of symptoms. CONCLUSIONS.: Atrophy of multifidus has been used as one of the rationales for spine stabilization exercises. The evidence of coexisting atrophy of psoas and multifidus suggests that a future area for study should be selective exercise training of psoas, which is less commonly used in clinical practice.
PMID: 15543053 [PubMed - as supplied by publisher]
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