Chief Complaint Of Pain Research Articles

After-Hours Calls in a Joint Replacement Practice

BackgroundEarly discharge after joint arthroplasty requires additional resources to manage patients safely after surgery. Patient concerns must be addressed during nonbusiness hours to keep patients out of the emergency department and avoid readmissions. The goal of our study was to determine how type of system is utilized in a busy early discharge joint replacement practice. MethodsIn our total joint program, we have utilized a Google phone number to give patients access to a member of the surgical team after business hours and on weekends. The duration, chief complaint, and resolution of from the phone calls were collected prospectively for 3 months (July 3, 2017-October 3, 2017). ResultsSixty-eight calls were received from 55 patients during the 3-month study period. Three hundred twenty-five cases were performed. The average duration of a call was 3.9 minutes. The average length of time from surgery to call was 17.5 days (range 0-442 days). Suboptimal health literacy was associated with increased calls within the first week after surgery (odds ratio = 4.1, 95% confidence interval = 1.2-14.5, P = .022). A chief complaint of pain was associated with primary versus revision surgery. (odds ratio = 3.23, 95% confidence interval = 1.08-9.86). DiscussionAn “after-hours” telephone contact service with a member of the surgical team may help avoid unnecessary emergency department visits. About one phone call was received per day, with an average duration of 3.9 minutes per call. These additional resources are necessary to maintain patient safety and satisfaction in early discharge joint replacement.

DENTAL MANAGEMENT OF A PATIENT WITH DOWN SYNDROME: A CASE REPORT AND REVIEW OF LITERATURE

Down syndrome (DS) is the most common chromosomal abnormality which affects numerous organs, including the orofacial region. Patients with DS may not be cooperative during dental treatment, and in cases of complex treatment, it is necessary to use oral or inhaled sedation and/or general anesthesia, which represents safe and efficient treatment resources. This article reports a management of DS in a 7-year-old male patient who came to the Hospital of New Delhi with the chief complaint of pain in lower right back tooth region. Due to the uncooperative nature of the patient, dental treatment was done under general anesthesia in which multiple dental restoration and extraction were done.

Pachydermoperiostosis (Touraine\u2013Solente\u2013Gole syndrome): a case report

BackgroundPachydermoperiostosis (PDP) is a rare disorder characterized by clubbing of the fingers, thickening of the skin (pachyderma), and excessive sweating (hyperhidrosis). It typically appears during childhood or adolescence, often around the time of puberty, and progresses slowly. Clinical presentations of PDP can be confused with secondary hypertrophic osteoarthropathy, psoriatic arthritis, rheumatoid arthritis, thyroid acropachy, and acromegaly.Case presentationA Mongolian male, aged 19 years, resident of a hilly district of Nepal, with history of consanguinity, presented to our outpatient department with chief complaints of pain and swelling in both hands and feet for 6 years. The pain was insidious in onset, throbbing in nature, and not relieved by over-the-counter medications. The patient also complained of profuse sweating, progressive enlargement of hands and feet, and gradual coarsening of facial features. On examination there were marked skin folds in the forehead, face, and eyelids. Clubbing and swelling of bilateral knee joints and ankle joints was also evident. He was subsequently investigated extensively for acromegaly. Insulin-like growth factor-1 level and oral glucose tolerance test were normal. Radiography of various bones showed periosteal hypertrophy with subperiosteal bone formation.ConclusionsPDP should be considered as a differential diagnosis when a patient presents with hypertrophic osteoarthropathy and acromegalic features.

A 24 year old male patient with weakness in the left upper limb

This article has no abstract. The first 100 words appear below: A 24 year old male attended the outpatient department of a local hospital with the chief complaints of pain in the central chest for two years and easy fatigability of the left upper limb for one and half years. After performing various examinations and investigations, he was sent to Al Helal Specialized Hospital with the preliminary diagnosis of coarctation of the aorta. The pain was dull aching in nature, continuous in duration, mild in intensity mostly, but sometimes intense sharp stabbing, radiating to the back. There was no known aggravating factor but lying down relieved it partially.

Primary Oral Manifestation of Histoplasmosis

A 46-year-old man consulted a general dentist with the chief complaint of pain in the mouth, of 2 months' duration. Clinically, numerous irregular nodules were observed, distributed in the edentulous alveolar maxillary and mandibular ridges. Incisional biopsy was performed, and microscopic evaluation revealed an intense chronic inflammatory infiltrate in the submucosa with a granulomatous pattern, including giant multinucleated cells and macrophages containing a fungus. Special stains, the Grocott-Gomori methenamine silver and periodic acid–Schiff were reactive for Histoplasma capsulatum. Based on the clinical presentation and microscopic features, the final diagnosis was histoplasmosis. The patient was referred to an infectious disease specialist for treatment. This case report reinforces the importance of microscopic analysis to investigate primary oral manifestations of fungal diseases to establish an accurate diagnosis and treatment for the patient.

Evaluating Emergency Department Opioid Prescribing Behaviors After Education About Mandated Use of the Pennsylvania Prescription Drug Monitoring Program.

Prescription drug monitoring programs (PDMPs) are among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk for prescription drug misuse, overdose, and death. In 2016, Pennsylvania launched an initiative mandating all prescribers to search the PDMP for each patient when the patient is prescribed controlled substances. The primary aim of this project was to support the Pennsylvania PDMP mandate by educating emergency department (ED) providers regarding the opioid epidemic and use of the PDMP and measure opioid prescriptions posteducation. Secondary aims were to evaluate provider knowledge and identify barriers to PDMP use. This quality improvement project was conducted through a retrospective chart review of patients 18-85 years old discharged from the ED with a chief complaint of pain. A pretest and a posttest measured provider knowledge change after an education program and assessed barriers to PDMP use. Numbers of opioid prescriptions written at discharge were examined. Provider knowledge scores increased significantly (p = .000). Barriers to PDMP use focused on access and process issues. A statistically significant decrease was observed in opioid prescriptions written (p = .002) during the project. An education program increased ED providers' knowledge of the opioid epidemic and the Pennsylvania PDMP mandate and identified barriers to use. A decrease in opioid prescriptions written may have been associated with improved knowledge and suggests that providers can change prescribing behaviors. More research is needed in this area, and future projects may want to focus on prescriber attitudes toward PDMP usefulness.

Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults.

Background:The visual analog scale (VAS) is a validated, subjective measure for acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between “no pain” and “worst pain.”Methods:One hundred consecutive patients aged ≥18 years who presented with a chief complaint of pain were asked to record pain scores via a paper VAS and digitally via both the laptop computer and mobile phone. Ninety-eight subjects, 51 men (age, 44 ± 16 years) and 47 women (age, 46 ± 15 years), were included. A mixed-model analysis of covariance with the Bonferroni post hoc test was used to detect differences between the paper and digital VAS scores. A Bland–Altman analysis was used to test for instrument agreement between the platforms. The minimal clinically important difference was set at 1.4 cm (14% of total scale length) for detecting clinical relevance between the three VAS platforms. A paired one-tailed Student t-test was used to determine whether differences between the digital and paper measurement platforms exceeded 14% (P < 0.05).Results:A significant difference in scores was found between the mobile phone–based (32.9% ± 0.4%) and both the laptop computer– and paper-based platforms (31.0% ± 0.4%, P < 0.01 for both). These differences were not clinically relevant (minimal clinically important difference <1.4 cm). No statistically significant difference was observed between the paper and laptop computer platforms. Measurement agreement was found between the paper- and laptop computer–based platforms (mean difference, 0.0% ± 0.5%; no proportional bias detected) but not between the paper- and mobile phone–based platforms (mean difference, 1.9% ± 0.5%; proportional bias detected).Conclusion:No clinically relevant difference exists between the traditional paper-based VAS assessment and VAS scores obtained from laptop computer– and mobile phone–based platforms.

Endodontic management of mandibular canine with two roots and two canals: a rare case report

BackgroundIn general, mandibular canines have a single root and a single canal. The occurrence of two roots and two canals is a rare entity ranging from 1 to 5%. The anatomy of root canal morphology plays a decisive role in determining the conditions under which endodontic treatment can be performed effectively. Successful endodontic treatment comprises proper diagnosis, meticulous cleaning and shaping followed by three dimensional obturation. Failure to do so may lead to postoperative diseases, pain and further complications. This paper reports successful management of a mandibular canine with two roots and two canals.Case presentation45-year-old Nepalese women with a non-significant medical history presented with a chief complaint of pain in a lower left front tooth. The pain disturbed her sleep and lingered for several minutes even after removal of a thermal stimulus. Clinical examination and testing revealed generalized severe attrition with tenderness to percussion in the mandibular left canine. Electric pulp test for all the mandibular anteriors revealed almost no response in the mandibular left canine. Intraoral periapical radiographs in different angulations were taken which revealed two roots and two canals. A clinical diagnosis of chronic irreversible pulpitis with symptomatic apical periodontitis was made and root canal therapy was performed following the standard protocols.ConclusionAlthough the prevalence of two roots and two canals in mandibular canine is very low, the clinician should always be mindful of variations in the number of roots and canals for proper management of such cases.

Management of Separated Instruments in Apical Third of Extremely Curved Canals: A Case Report

This report describes the case of a 23 years old male patient who presented with the chief complaint of pain in mandibular right lower first molar tooth. Detailed clinical and radiographic examination revealed acute pulpitis in lower right second premolar and first molar teeth. During root canal instrumentation, a rotary instrument separated at the apical third of mesiobuccal canal. After careful assessment, it was decided to bypass the instrument and obturate the root canal space with warm vertical compaction using thermoplasticized gutta percha and resin based sealer materials. After considering the curvature of canal, thin root of tooth and location of broken instrument in the apical third of canal space, attempts of instrument removal were ruled out as a treatment option for the patient. Bypassing the broken instrument fragment with pre-curved hand files of small sizes was chosen as a predictable treatment option since it is not associated with removal of excessive remaining dentin from the roots of the teeth. Hence, teeth do not become weak and risk of post-operative root fracture is minimized. Due to successful bypassing and preparation of root canal space beyond broken instrument, canal was shaped, cleaned and disinfected adequately. Decision of instrument bypassing or removal should be taken with extreme care. Bypassing the instrument in apical third of root canal space with thin rooted teeth is the most conservative and practical approach, and objectives of adequate shaping and cleaning of canals can be achieved successfully without compromising remaining tooth structure.

Oral squamous cell carcinoma with myiasis

Myiasis is a rare condition that occurred with advanced ulcerated lesions of the oral cavity caused by the larvae in human tissue that evolve to a parasite and is commonly found in tropical countries. Poor oral hygiene is a primary cause for the growth of maggots leading to the development of myiasis. These cases are reported with chief complaint of pain and irritation in a localized area and diagnosed clinically based on the presence of the maggots. Treatment option is manual removal of maggots to cure the inflammatory process and prevent secondary infections. Here, we present a case of oral squamous cell carcinoma with myiasis diagnosed in a 50-year-old female patient.

Ectopic Tooth in the Anterior Wall of Maxillary Sinus

AbstractA 16-year-old male patient reported to our department with a chief complaint of pain and swelling in the upper left cheek region. On examination, a maxillary canine was found ectopically in the anterior wall of maxillary sinus. Ectopic eruption of teeth into regions other than the oral cavity is rare. We present one such case of ectopic eruption of maxillary canine.

Rare presentation of cementoblastoma associated with the deciduous maxillary second molar

Cementoblastoma is a benign odontogenic neoplasm accounting for less than 0.69%–8% of all odontogenic tumours and is characterised by the presence of sheets of cementum-like tissue demonstrating large number of...

Bilateral fungal keratitis with ring infiltrates: a rare scenario

A 12-year-old boy presented to the emergency department with chief complaints of pain, redness, discharge and diminution of vision in both eyes over the previous 20 days. There was no...

Use of Prophylactic Ondansetron with Intravenous Opioids in Emergency Department Patients: A Prospective Observational Pilot Study

BackgroundThe current literature suggests that the prophylactic use of antiemetics is ineffective at preventing nausea or vomiting caused by opioids in the emergency department (ED). While there is no data evaluating ondansetron's efficacy for preventing opioid-induced nausea and vomiting, this practice remains common despite a lack of supporting evidence. ObjectivesThis study aimed to identify if prophylactic ondansetron administered with intravenous (IV) opioids prevents opioid-induced nausea or vomiting. MethodsThis prospective observational study was conducted in the ED at two academic medical institutions. Patients were eligible for enrollment if they were prescribed an IV opioid with or without IV ondansetron and absence of baseline nausea. Patients' level of nausea was evaluated at baseline, 5 min, and 30 min after an IV opioid was administered and then observed for 2 hours. ResultsOne hundred thirty-three patients were enrolled, with 90% of patients presenting with a chief complaint of pain. Sixty-four (48.1%) patients received an IV opioid alone and 69 (51.9%) patients received both IV ondansetron and an IV opioid. Twenty-three (17.3%) patients developed nausea caused by opioid administration. One (0.75%) patient had an emetic event and 3 (2.3%) patients required rescue antiemetics during their observation period. Rate of nausea was similar between treatment groups 5 min after the opioid was administered (p = 0.153). There was no statistical difference in emesis, rescue medication requirements, or nausea severity between treatment groups. ConclusionOur trial found that ondansetron did not appear to be effective at preventing opioid-induced nausea or vomiting. These findings and previous literature suggest prophylactic ondansetron should not be given to ED patients who are receiving IV opioids.

EFFECT OF VARMAM THERAPY IN SANTHU VATHAM (OSTEO ARTHRITIS–KNEE JOINT)-A SINGLE CASE STUDY

Santhu vatham is a vatha disease mentioned in the Siddha text book Yugi vaidhya chindhamani. The clinical features can be equated to osteo arthritis of knee joint. Varmam therapy is one of the external therapies mentioned in Siddha literature. A 68 y old male from chennai reported to the varmam, narambiyal matrum enbumurivu OPD of Siddha Central Research Institute (SCRI) on 2.5.2015 with chief complaints of pain and swelling in both knee joints since 5 y. He was given varmam therapy. Varma points are points where the pranan, ie, vital energy of our body is concentrated (residing). The treatment is given for 45 d for once in 2 d for 15 min. The pain was assessed using visual analogue score before and after treatment. The pain was markedly reduced after treatment. The range of movements of the knee joint was also improved.

Factors Associated with the Efficacy of Trigger Point Injection in Advanced Cancer Patients

Few studies have reported the efficacy of trigger point injection (TPI) to myofascial trigger points (MTrPs) in advanced cancer patients. Factors that are associated with TPI efficacy have not yet been elucidated. The study was aimed at evaluating factors that are associated with TPI efficacy to MTrPs in advanced cancer patients. Factors that are associated with TPI efficacy were retrospectively identified based on a comparison between clinically relevant responders and nonresponders by using multivariate regression analysis. One hundred five advanced cancer patients who visited the Palliative Care Department with a chief complaint of pain and who received TPI treatment to the MTrP at the pain site. The TPI efficacy rate on the day after TPI treatment was 0.59 (95% confidence interval [CI]: 0.50-0.68). Significant factors associated with TPI efficacy were coexistence of cancer pain with MTrP at the pain site (odds ratio [OR]: 3.87, 95% CI: 1.21-12.4), MTrP at areas other than lower back or hip (OR: 6.45, 95% CI: 1.98-21.0), and fewer MTrPs (OR: 0.64, 95% CI: 0.42-0.99). Coexistence of cancer pain at the pain site of the chief complaint was observed in 64% of study subjects (95% CI: 0.55-0.73). The TPI efficacy is likely high when advanced cancer patients have fewer MTrPs together with cancer pain at areas other than the lower back or hip. MTrPs in advanced cancer patients are more commonly observed together with cancer pain rather than independently. Healthcare providers should recognize the relationship between MTrP and cancer pain and proactively perform physical examinations to detect MTrPs for potential TPI.

Oral rehabilitation of a patient with temporomandibular joint ankylosis caused by ankylosing spondylitis: A case report

Introduction. Ankylosing spondylitis (AS)/Morbus Bechterew is a chronic inflammatory rheumatoid disease. The temporomandibular joint (TMJ) dysfunction is involved in 4?35% of AS cases, and is correlated to the severity and extension of AS. Even though AS-caused TMJ ankylosis is exceptional, one should have high index of suspicion of TMJ ankylosis in AS for an early detection, because it is an extremely serious and disabling condition that causes problems with mastication, swallowing, digestion, speech, appearance and poor oral hygiene with heavy caries. Case report. A 54-year-old male patient sought medical attention at the Department of Periodontology and Oral Medicine, Clinic for Dentistry at the Military Medical Academy, Belgrade, Serbia, with the chief complaint of pain in the area of the upper left canine in the presence of limited mouth opening. The treatment plan consisted of upper left canine management and rehabilitation of the remaining teeth in the frontal and the premolar region in both, the upper and lower jaw. Even though molar region needed to be treated, unfortunately it was not in the treatment plan because ankylosis of TMJ made the treatment impossible. Conclusions. The patients with AS-caused TMJ ankylosis are considered a diagnostic challenge to routine dentistry. Accent should be given to early diagnosis and multidisciplinary approach in the treatment of the AS patients towards the favorable disease course and outcome.

Non-Syndromic Multiple Odontomes

Clinical Image: A 10 year old male patient visited the department of oral medicine and radiology with a chief complaint of pain and swelling on right side of face (Figure 1). Patient gave history of swelling on right side of lower 1/3rd of face since 7-8 years with dull, intermittent pain which aggravates on taking food since 1 month. Patient had undergone radiographic investigations and biopsy on right side of face 15 days back. On extra oral examination, swelling on right side of lower 1/3rd of face extending anteroposteriorly from a straight line drawn from inner canthus of eye, posteriorly 1 cm beyond outer canthus of eye (Figure 2). Supero-inferiorly from a straight line drawn from commissure of lip to 1 cm beyond inferior border of mandible. Swelling is approximately 4 × 4 cm in size. Overlying skin has increase pigmentation with sinus opening, tender on palpation, bony hard. Right submandibular lymph node palpable, mobile and tender. On intra-oral examination, obliteration of vestibule from 44 to 47. Provisional diagnosis of chronic supparative osteomyelitis. OPG reveals dense, homogeneous radio-opaque mass on right side of body with surrounding radiolucent halo extending from 44 to 47. Supero-inferiorly from superior border of mandible to inferior border of mandible to inferior border of mandible with multiple tooth like structures at inferior border of mandible. There is thinning of inferior cortex of mandible with divergence of 43, 44, 47. CECT reveals a well define lobulated mass with few hypodense areas, measures approximately 37 × 36 × 29 mm. the mass is causing significant bi-cortical expansion of mandible (Figure 3). Radiographic diagnosis-odontomes. Excisional biopsy was performed and histopathologic diagnosis was compound composite odontome (Figure 4).

A Case of Buccal Mucosal Swelling: The Diagnostic Conundrum

Buccal mucosal swellings are more often noticed in day to day practice. Routinely they are associated with buccal space, buccal fat pad, buccinator muscle and minor/major salivary glands etc. Certain common oral swelling presenting in this region leads us to a prompting concern about the tumors. A 62 year old female patient reported with a chief complaint of pain in left cheek region since 2 years. A diffuse swelling approximately 2 × 2 cm in the buccal mucosa near to the retro-molar area was noticed. With this a working diagnosis of chronic sialadinitis of minor salivary gland or fibroma secondary to traumatic denture flanges was given. Surgically lesion was separated from underlying tissue and was excised into. The histopathological picture of the lesion was sclerosing variant of mucoepidermoid carcinoma of minor salivary gland which was unexpected and therefore probably the consideration of malignancy in the differential diagnosis even though the clinical presentation is not in favor is a take home message.

Irritation fibroma: Report of a case

Traumatic or irritation fibroma is the healed end product of the inflammatory hyperplastic lesion which can occur at any age from almost any soft-tissue site, tongue, gingiva, and buccal mucosa being the most common. The aim of this case report is to present the clinical features and management of the benign lesion which was posteriorly positioned in the interdental papillary region of mandibular premolars. A female patient, 40 years old, reported to the department with a chief complaint of pain and swelling in the right lower back tooth region for the past 1 year. On examination, the lesion was found to be a well circumscribed, smooth, tender, firm and lobulated pink swelling measuring 2 cm × 2 cm in its greatest diameter in relation to right mandibular premolar region. Surgical therapy was carried out for the management of the same. There was no recurrence reported at the end of 2 months showing that treatment with electrocautery was highly effective as it was a relatively simple and safe method with easy handling of the electrodes without any bleeding or scarring. Irritation fibroma clinically resembles as pyogenic granuloma, peripheral giant cell granuloma, or odontogenic tumors, so radiographic and histopathological examination is essential for accurate diagnosis. Furthermore, complete excision is the choice of treatment as recurrence has been associated with incomplete removal of the lesion.