Episodes Of Pain Research Articles

Knowledge, Attitude, and Practice of Patients Suffering From Sickle Cell Disease in an Endemic Zone.

Sickle cell disease (SCD) is a genetically inherited disorder that is associated with morbidity and mortality. This cross-sectional study was conducted on patients diagnosed with SCD to evaluate the knowledge, attitude, and practice of patients/guardians using a pretested questionnaire. Of the 111 participants, 56 (50.4%) were male. Forty-five participants reported SCD as a hereditary disease, and only 31 (37%) subjects reported that SCD could be prevented. Fourteen (70%) married patients reported that their children had been screened. Ninety-three (84%) children reported fatigue in the past 1 year. Seventy-four of them reported no absence from work/school in the past 1 year. Fifty-seven participants (52%) experienced 1 to 4 episodes of pain in the past 1 year, 62 and the majority (55.86%) of them visited a nearby doctor for the pain episode. Ninety-four participants were taking regular hydroxyurea as medication, and 72% had not missed any dose in the past 1 month, while 14.4% missed 1 to 2 doses in the past 1 month. Only 19 participants (17%) were aware that transplantation was a curative option. The majority (78%) reported undergoing blood and other investigations irregularly in the preceding year. The knowledge and attitude of patients/guardians regarding the nature of the disease, preventive measures, curative options for transplantation, and screening of family members are low. At the same time, most people are educated. In contrast to the world data, adherence to hydroxyurea is extremely good. Patient and family education and counseling are the needs of the hour.

Comparative study between silodosin, tamsulosin, silodosin plus tadalafil, and tamsulosin plus tadalafil as a medical expulsive therapy for lower ureteral stones: a prospective randomized trial.

To examine the safety and efficiency of a single-drug therapy with silodosin or tamsulosin versus combined therapy with silodosin plus tadalafil and tamsulosin plus tadalafil as a medical expulsive therapy (MET) for lower ureteral stones. This research was a prospective randomized clinical trial carried out at Fayoum University Hospital, Egypt, over one year. Patients with lower ureteral stones (5-10mm) were randomly allocated into one of four treatment groups. Group A received silodosin 8mg per day; Group B received tamsulosin 0.4mg per day; Group C received silodosin 8mg plus tadalafil 5mg daily, and Group D received tamsulosin 0.4mg plus tadalafil 5mg daily. Treatment was prescribed for up to 4weeks. The study outcomes were the stone expulsion rate, stone expulsion time, the amount of analgesics used, the frequency of pain episodes, hospital visits, and any treatment-related adverse effects. One hundred eighty patients who fulfilled the inclusion criteria completed the study. Group C had a significantly elevated stone expulsion rate (91.1%) compared to Group A (57.8%) and Group B (71.1%) [P = 0.015, P < 0.001, respectively]. Group D had a significantly elevated stone expulsion rate (86.7%) compared to Group B (57.8%) [P = 0.002] and higher than Group A (71.1%). Group C and Group D had significantly less stone expulsion time, analgesic needs, and episodes of renal colic, and fewer hospital visits than Group A and Group B. No significant differences were found in adverse effects like orthostatic hypotension, dizziness, backache, headache, myalgia, and nausea between the patient groups. Combining silodosin with tadalafil and tamsulosin with tadalafil was more efficient as MET for lower ureteric stones than a single treatment with silodosin or tamsulosin.

Causes and management of acute oncological pain: a narrative review.

Acute pain in cancer is an important but often overlooked feature of many patients' oncological journey. Cancer-related pain is associated commonly with more persistent pain states caused by both the disease and its treatment, but there are numerous causes of acute pain which can develop in patients with cancer. This pain is frequently severe, can be challenging to manage and its suboptimal control can directly impact on oncological outcomes. This narrative review provides an overview of several causes of acute pain in patients with cancer and management approaches. A focused literature review was conducted to encompass the search terms 'acute pain', 'oncology' and 'cancer' in adult and paediatric populations. Acute pain is common in patients with cancer with a number of pain generators identified. Broadly, these are disease- and treatment-related but commonality in pain mechanisms and features are present. Importantly, these pain states do not occur in isolation; a patient may experience multiple acute pain episodes during their oncology journey. As the oncological treatment landscape shifts and increasing numbers of novel treatments are employed, the number of causes of acute pain in patients with cancer rises. This pain is often managed by non-pain specialists and suboptimal control has a variety of deleterious effects. It is important that awareness of acute pain in the oncological population is increased and treatment approaches, which adopt a biopsychosocial structure, are optimised.

A case of renovascular hypertension due to polyarteritis nodosa.

In renal vasculitis, luminal narrowing can reduce blood flow and activate the renin-angiotensin-aldosterone system, causing renovascular hypertension. We present the case of a 47-year-old man with previous intestinal tuberculosis and episodes of lumbar pain, tender erythematous nodules and arthralgias. He had grade 3 hypertension, unresponsive to treatment, with left ventricular concentric hypertrophy and chronic kidney disease. He was admitted to the ICU due to a hypertensive emergency, with acute kidney failure and a large peri-renal hematoma. The computed tomography and angiography showed bilateral renal scarring, intrarenal pseudoaneurysms and irregularities in the renal, common hepatic and mesenteric arteries, suggesting a medium-vessel vasculitis, namely polyarteritis nodosa. Cyclophosphamide and corticosteroids were started. His blood pressure was controlled, and his kidney function remained stable. Renovascular hypertension is, in infrequent cases, caused by an inflammatory systemic disease. When this is the case, the diagnosis must be considered and appropriately addressed.

Acute pancreatitis in patient with malignant obstructive jaundice following percutaneous trans-hepatic biliary drainage: A case report.

Percutaneous Trans hepatic biliary drainage (PTBD) is a successful palliative treatment for malignant obstructive jaundice. Despite the past that PTBD complications occur more frequently. Currently, with the help of an ultrasound guide, these side effects and possibility of adjacent organ damages have decreased interestingly. One of the rare complications of this procedure is acute pancreatitis. We discuss an uncommon case of acute pancreatitis following PTBD in an elderly woman who presented to the hospital with jaundice and anorexia. Conservative therapy without decatheterization was the treatment of choice in our patient. Eventually after receiving conservative therapy for her pancreatitis, she was discharged from the hospital in good general condition and she has not experienced any episodes of abdominal pain again. Acute pancreatitis is one of the causes of sepsis during PTBD catheterization. Early management of this complication after PTBD can decrease morbidity and mortality of the patients.

Case presentation of acute ischemia induced ST-depression masking Brugada syndrome ECG pattern in a relatively young patient.

ECG in Brugada syndrome (BrS) is characterized by a ST-segment elevation in the right precordial leads. Overlap between ST-segment changes in BrS and ischemia may lead to diagnostic challenges. We report a case of a male patient presented with recurrent chest pain episodes and ST elevation in the right precordial leads consistent with Brugada ECG pattern type 1 and was clinically diagnosed with BrS at the age of 30years. During follow up the patient developed acute myocardial infarction with pronounced ST depression in the right precordial leads, masking the Brugada pattern of the baseline ECG.

Successful treatment of Cervical Type Cervical Spondylosis with Meridian Balancing Acupuncture: A significant case study with excellent outcomes

This case report presents an office worker diagnosed with Cervical Type Cervical Spondylosis who underwent Meridian Balancing Acupuncture therapy. The patient had experienced recurrent episodes of pain and stiffness over several years, with exacerbations in the past three years, which were managed with conventional, modern medical treatments. However, these interventions did not result in long-term resolution, as symptoms consistently relapsed within a few days. Due to the increasing burden of the condition, the patient opted for acupuncture treatment and was administered a prescribed Meridian Balancing Acupuncture regimen. The treatment protocol consisted of three 30-minute acupuncture sessions, administered every other day over the course of one week. Distal acupuncture points on the limbs were selected and manipulated every 5-10 minutes. During palpation of sensitive/reactive points, as well as during needling and manipulation, the patients were instructed to gradually rotate their neck in various directions to assess symptom relief. After the initial treatment, the patient experienced complete resolution of pain and stiffness, though a mild relapse was observed before the second and third sessions. By the conclusion of the treatment course, both pain and stiffness were fully resolved. A follow-up conducted four weeks post-treatment revealed no recurrence of Cervical Spondylosis symptoms.

Exploring the Interplay Between Catastrophizing and Endometriosis Pain Through Two-Wave and Intensive Longitudinal Data.

Endometriosis, characterized by the presence of endometrial-like tissue outside the uterus, results in chronic pelvic pain. However, lesion characteristics alone cannot fully explain the complexity of endometriosis-related pain. Pain catastrophizing, a cognitive process that influences pain perception, has traditionally been studied through cross-sectional or two-wave designs, which struggle to capture its dynamic interplay with endometriosis pain. To address these gaps, our study explores the bidirectional relationship between pain catastrophizing and pain outcomes-including intensity, frequency, and flares-over a detailed four-week period, an aggregated 30-day timeframe, and across sensory and affective dimensions. A Latent Growth Curve Model assessed the relationship between pain catastrophizing, initial pain levels, and endometriosis pain trajectories over four weeks. Additionally, four mediator models explored how baseline pain catastrophizing affects various pain aspects, including sensory and affective dimensions, and its subsequent influence on pain catastrophizing. Results indicate that high levels of pain catastrophizing significantly escalate endometriosis pain over four weeks, affecting average pain intensity, episode frequency, and flares over 30 days. Pain catastrophizing also adversely impacts sensory and affective dimensions. These elements partially mediate baseline pain catastrophizing's effect on week five levels, revealing a bidirectional relationship. Notably, while the affective dimension amplifies subsequent pain catastrophizing, the sensory dimension exerts a contrasting negative influence. The study highlights the bidirectional influence between pain catastrophizing and several aspects of endometriosis-related pain. Sensory and affective dimensions play distinct roles, with implications for personalized interventions. Limitations and clinical relevance are discussed.

Patterns of initial treatment and subsequent care escalation among medicare beneficiaries with neck pain: a retrospective cohort study.

To compare long-term care escalation encounters among three care patterns for new episodes of neck pain among Medicare beneficiaries. We examined Medicare claims spanning a four-year period for beneficiaries with new episodes of neck pain beginning in 2019. All patients were continuously enrolled under Medicare parts A, B, and D and aged 65-99years. We calculated the cumulative frequency and propensity- weighted rate ratios for escalated care encounters across three distinct, index-visit related neck pain treatment cohorts: 1) Spinal manipulative therapy; 2) Primary care without prescription analgesics within 7days; 3) Primary care with prescription analgesics within 7days. When compared to the primary care without analgesics cohort, the spinal manipulative therapy cohort was associated with a 64% lower rate (RR 0.36, 95% CI 0.35,0.37) for long-term care escalation encounters, while the primary care with prescription analgesics cohort was associated with an 8% higher rate (RR 1.08; 95% CI 1.05,1.10). Initial spinal manipulative therapy was associated with a significant reduction in downstream care escalation encounters among Medicare beneficiaries with new episodes of neck pain. Our study contributes to a growing body of evidence supporting the integration of non-pharmacological care strategies for neck pain management.

Therapeutic Effects of Superinductive Magnetic Filed on Low Back Pain

Low back pain is one of the major public health problems, with approximately 1 in 3 adults experiencing an episode of low back pain during their lifetime. The aim of this study was to evaluate the effect on pain and physical function of a therapeutic protocol including analgesic electrotherapy, lumbar deconstrictor manual therapy and kinetic therapy and the superinductive magnetic field therapy. Patients were divided into two groups of 20 and 20 respectively. Group 1 was treated with the conventional protocol, while the second group received in adition the superinductive magnetic field therapy. Pain was assessed by VAS scale at admission and every 2 days, and functional deficit was assessed by the Fingertips to floor (FTF) test at admission, at 6 days and at discharge at 12 days. The Activities of Daily Living (ADL) scale was also used to assess physical function at admission and discharge. 40 patients (24 female, 16 male), average age 61 years ( ± 5.7), average BMI of 32.11± 7.38 SD, kg participated and their data were analyzed. An average percentage decrease in VAS was noticed after the 12 days of treatment of 67% for group1 and of 88% for group 2. The deficit in FTF was also better in group 2 (FTF= 16+5cm ) compared to FTF=22+3 in the control group. On ADL assessment, no significant differences were noted. Superinductive magnetic field therapy is effective in the treatment of low back pain relieving pain syndrome and improving physical function.

Sociodemographic and Clinical Factors Predictive of Poor Health-Related Quality of Life of Children with Sickle Cell Anemia in The Gambia

Children with sickle cell anemia (SCA) experience recurrent vaso-occlusive crises and complications, significantly impacting their health-related quality of life (HRQoL). This study determined HRQoL in 130 children aged 5 -15 years with SCA in The Gambia, compared to 130 age- and sex-matched hemoglobin AA (HbAA) children. HRQoL was measured using the Pediatric Quality of Life Inventory (PedsQL), with scores below 69.7 defined as poor HRQoL. Predictors of poor HRQoL were analyzed using binary logistic regression. The mean ages of children with SCA and HbAA were similar (9.83 ± 2.79 years vs. 9.65 ± 2.84 years, p = 0.598), with a male-to-female ratio of 1.1:1. SCA children showed significantly higher rates of underweight (p = 0.019) and stunting (p = 0.045) compared to HbAA children. HRQoL scores were significantly lower in the SCA group across physical, emotional, social, school, and overall domains (p < 0.001). A majority (57.7%) of SCA children had poor HRQoL. Key predictors of poor HRQoL among SCA children included frequent pain episodes (>3 episodes in the past 12 months; odds ratio [OR] = 1.9, p = 0.028), late diagnosis of SCA (OR = 1.8, p = 0.012), and clinical stroke (OR = 69.3, p = 0.037). This study demonstrates that SCA significantly reduces HRQoL in all domains. Early diagnosis, effective pain management, and prevention of complications like stroke are critical to improving outcomes. Tailored interventions are needed to mitigate the physical and psychosocial burdens of SCA among children in The Gambia.

Technique imagination guided to decline painful response on patient fracture at dr. central general hospital Wahidin Sudirohusodo Makassar

Painful can caused from the triggering factors from something stress response, where response This will influence all body systems . Patient And member team health tend For looking drug as the only one method For remove painful. However Lots action nursing non pharmacological can help in remove painful like technique imagination guided by those who have very risky low For shorten the duration of the pain episode only a number of second or minute . Objective study This is For know influence technique imagination guided to decline response painful on patient fracture. Design research used in study This is is Pre-experiment One Group Pre test posttest Design. Taking sample study This use total sampling technique with amount sample as many as 15 respondents . Respondent selected previous done pretest Then done action technique imagination guided Then done posttest for evaluate decline response pain, then the data was analyzed with Wilcoxon test in SPSS version 12.00. Based on results test statistics obtained that There is difference decline response painful between before done action and after done action technique imagination guided, where obtained level meaning that is between p = 0.002 (p&lt;0.005). Conclusion study This is There is influence giving technique imagination guided to decline response painful on patient fracture . Suggestions for power health at home sick to get it teach technique imagination guided with Correct to use lower response the pain experienced beside action pharmacological.

A Telemedicine Triage Model for Infusion Center-Based Management of Adult Sickle Cell Pain Episodes.

A Telemedicine Triage Model for Infusion Center-Based Management of Adult Sickle Cell Pain Episodes.

Transfusions, disease-modifying treatments, and curative therapies for sickle cell anemia in Africa: where are we now?

The mortality burden of sickle cell anemia (SCA) is centered in sub-Saharan Africa. In addition to a lack of systematic programs for early diagnosis, access to disease-modifying treatments is limited to only a few urban centers. Providing a safe and adequate blood supply is a major challenge, heightening mortality from SCA-associated complications that require urgent blood transfusion and making the delivery of regular transfusion therapy for stroke prevention nonfeasible. Hydroxyurea therapy with proven clinical benefits for pain episodes, acute chest syndrome, malaria, transfusions, hospitalizations, and stroke prevention is the most feasible treatment for SCA in Africa. Access barriers to hydroxyurea treatment include poor availability, unaffordable costs, health professionals' reluctance to prescribe, a lack of national guidelines, and exaggerated fears about drug toxicities. Strategies for the local manufacture of hydroxyurea combined with the systematic education and training of health professionals using guidelines supported by the World Health Organization can help surmount the access barriers. Hematopoietic stem cell transplantation as a curative therapy is available in only 7 countries in Africa. The few patients who have suitable sibling donors and can afford a transplant must usually travel out of the country for treatment, returning to their home countries where expertise and resources for posttransplant follow-up are lacking. The recently developed ex-vivo gene therapies are heavily dependent on technical infrastructure to deliver, a daunting challenge for Africa. Future in-vivo gene therapies that bypass myeloablation and ex-vivo processing would be more suitable. However, enthusiasm for pursuing these gene therapies should not overlook strategies to make hydroxyurea universally accessible in Africa.

A 5-day course of repetitive transcranial magnetic stimulation before pain onset ameliorates future pain and increases sensorimotor peak alpha frequency.

Repetitive transcranial magnetic stimulation (rTMS) has shown promise as an intervention for pain. An unexplored research question is whether the delivery of rTMS prior to pain onset might protect against a future episode of prolonged pain. The present study aimed to determine whether (1) 5 consecutive days of rTMS delivered prior to experimentally induced prolonged jaw pain has a prophylactic effect on future pain intensity and (2) whether these effects were accompanied by increases in corticomotor excitability (CME) and/or sensorimotor peak alpha frequency (PAF). On each day from day 0 to 4, 40 healthy individuals received a single session of active (n = 21) or sham (n = 19) rTMS over the left primary motor cortex. Peak alpha frequency and CME were assessed on day 0 (before rTMS) and day 4 (after rTMS). Prolonged pain was induced via intramuscular injection of nerve growth factor in the right masseter muscle after the final rTMS session. From days 5 to 25, participants completed twice-daily electronic diaries including pain on chewing and yawning (primary outcomes), as well as pain during other activities (eg, talking), functional limitation in jaw function and muscle soreness (secondary outcomes). Compared to sham, individuals who received active rTMS subsequently experienced lower pain on chewing and yawning. Furthermore, active rTMS led to an increase in PAF. This is the first study to show that rTMS delivered prior to prolonged pain onset can protect against future pain. Our findings suggest that rTMS may hold promise as a prophylactic intervention for pain.

The use of alpha-adrenergic antagonists in pediatric nephrolithiasis: a systematic review.

To evaluate existing clinical evidence for the efficacy of alpha blockers in the management of pediatric stone disease. We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Cohort and randomized control trials of patients less than 18 years old with kidney stones managed with alpha-adrenergic antagonists were included. Outcomes included stone expulsion time, stone passage rate, mean number of pain episodes, and mean need for analgesics. We performed data extraction of the selected articles, and results were assimilated and synthesized qualitatively. Data extraction and risk of bias assessment was conducted by two independent reviewers. Of 257 relevant studies, 9 studies with 1,039 patients were included. Six studies measured stone expulsion time, with 5 studies noting statistically significant decreases in stone expulsion time for the treatment group compared to the control. Seven studies measured the stone expulsion rate, and 5 reported a statistically significant increased expulsion rate in the treatment group. Four studies reported a decrease in the mean number of pain episodes in the treatment group and two studies showed a decreased analgesic requirement compared to control. Two studies found alpha blockers not superior to watchful waiting after shock wave lithotripsy. Risk of bias was high in some studies, primarily due to incomplete reporting on methodology and study design. Alpha blockers are supported by a growing body of evidence to be effective against nephrolithiasis in children, however large-scale, well-designed studies are needed to confirm these findings. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=330068, PROSPERO (CRD42022330068).

CLINICAL APPLICATIONS OF MINERAL TRIOXIDE AGGREGATE IN ENDODONTICS: A CASE SERIES

In recent years, mineral trioxide aggregate (MTA) has been used extensively in endodontic treatment applications and satisfactory results have been obtained. This case series aims to describe the recovery of patients with the nonsurgical endodontic management of different endodontic cases using MTA. Case Report: Case 1. A 72-year-old female patient presented with cold and sweet sensitivity. A reversible pulpitis diagnosis was made, and direct pulp capping with MTA was performed. A 12-month follow-up showed positive clinical outcomes. Case 2. A 16-year-old female patient presented with prolonged throbbing pain and a history of episodic severe pain. Diagnosed with irreversible pulpitis and an immature apex, apexification was performed using MTA. A 14-month follow-up revealed successful healing. Case 3. A 14- year-old male patient presented with a broken tooth, intermittent swelling, and pain. Diagnosed with chronic apical periodontitis, root canal treatment was conducted on tooth 21, while regenerative endodontic treatment was applied to tooth 22. A 15-month follow-up showed lesion healing. Conclusion: These cases suggest that MTA may be a substitute material for the treatment of endodontic problems (vital and necrotic conditions); however, more clinical studies with larger sample size and longer follow-ups are needed.

Understanding Trigeminal Neuralgia: A Comprehensive Review of Symtoms, Diagnosis, and Management

Trigeminal neuralgia (tic douloureux) is a rare and debilitating facial pain condition affecting one or more branches of the trigeminal nerve. It is frequently misdiagnosed as a dental issue or temporomandibular disorder due to overlapping symptoms, delaying appropriate treatment. Diagnosis is primarily clinical, often requiring the expertise of a neurologist to distinguish it from other causes of facial pain. Imaging studies such as MRI or CT scans are not diagnostic but play a crucial role in ruling out secondary causes and identifying pathological changes in the affected nerve root. Although not life-threatening, trigeminal neuralgia significantly impacts the quality of life, causing severe, recurrent pain episodes that can be challenging to manage. Timely and accurate diagnosis, along with the implementation of effective therapeutic strategies, is essential to alleviate symptoms and improve patient outcomes. This review highlights the clinical presentation, diagnostic approach, and current treatment modalities for trigeminal neuralgia, emphasizing the importance of a multidisciplinary approach to care.

A seventeen-year, population-based study to identify dynamic patterns of interfering neck pain and its burden in South Korea

AimThe aim of this study were to introduce a profile of a nationwide cohort for patients with neck pain and to identify the patterns of recurrent neck pain over time. MethodsHealth insurance data for 1,127,323 patients (43.5 ± 11.5 years, 60.8% females) with neck pain in 2010 were extracted from the National Health Information Database of South Korea. Data on the duration and frequency of neck pain and the number of healthcare visits recorded between 2002 and 2018 were screened and used for descriptive analysis. ResultsDuring the study period, patients experienced 4.1 episodes of neck pain, and 74% of patients experienced multiple episodes. The duration of one episode was 12.1 ± 35.7 days. Following each episode, more than 73% of patients experienced a subsequent episode of neck pain. As patients experienced more episodes, the recurrence rate increased gradually from 73% to 80%, and subsequent episodes occurred in a shorter time and lasted longer with a higher number of healthcare visits, compared to a preceding episode. ConclusionThe study highlighted the dynamic pattern of interfering neck pain, with episodes occurring more frequently and lasting longer over time. Early intensive management with a long-term follow-up is recommended to prevent a dynamic pattern of interfering neck pain.

Evaluation of Postanesthesia Handoff Checklist on Patient Outcomes in an Adult Postanesthesia Care Unit

PurposeThe use of handoff communication tools, such as checklists, has been shown to improve communication and decrease the omission of critical patient care information. However, the effect these tools have on patient outcomes has not been investigated. After successfully implementing a handoff checklist in an adult postanesthesia care unit, patient outcomes were retrospectively measured before and after the implementation. DesignRetrospective chart review. MethodsSeven hundred and ninety-one prechecklist patients in September 2017 were compared to 828 postchecklist patients in September 2018. Pain scores, oxygen saturation, and end-tidal CO2 readings were collected for postanesthesia care unit patients in both groups. FindingsPostchecklist patients exhibited less severe pain (30.8% vs 42.4%) and fewer desaturation episodes (36.4% vs 44.8%). Time to rescue for both did not show a significant difference. ConclusionsThis retrospective comparison showed an improvement in measurable patient outcomes in the immediate postoperative period after the implementation of a handoff communication tool. More research is needed to determine the direct correlation between handoff tool use and measurable patient outcomes.