Forms Of Acute Pain Research Articles

HUBUNGAN USIA, MASA KERJA, WAKTU KERJA, SIKAP KERJA DAN AKTIVITAS PEKERJAAN DENGAN KEJADIAN NYERI PUNGGUNG BAWAH PADA PETANI PADI DESA SEMEN

Indonesia is an agrarian country so that agriculture is one of the sectors with the largest number of workers. Agriculture is an informal sector job that still uses a lot of manual handling methods so that it has the potential to cause complaints of low back pain. Low back pain is a health problem in the form of acute pain that is felt in the lower back (lumbosacral) area in the form of local or radicular pain. Risk factors for low back pain include individual factors, occupational factors and environmental factors. This research is a quantitative-research with analytic observational method and cross-sectional approach. The population is farmers from of Semen village and registered on rukun tani group. The sample is 30 people using total sampling. Independent variables is age, working period, working time, work attitudes and work activities with dependent variable Low Back Pain. Data collection techniques used individual characteristic questionnaires, nordic body map, VAS scale and OWAS method. Data analysis technique uses Fisher’s Exact Test statistical test. The results showed a greater distribution of independent variables age > 35 years, work experience > 5 years, work attitudes requiring improvement, and heavy work activities. The results of the bivariate analysis showed that there was a significant relationship between age (p-value = 0.035), working period (p-value = 0.002) and working time (p-value = 0.004) with complaints of low back pain in rice farmers in hamlet X Semen Village as evidenced by p-value <0.05. Keywords: Low Back Pain, Rice Farmes, VAS scale, OWAS method.

EFFECT OF ADDITION OF DEXAMETHASONE TO LEVOBUPIVACAINE ON POST-OPERATIVE ANALGESIA IN ULTRASONOGRAPHY-GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK FOR INGUINAL HERNIA REPAIR: A PROSPECTIVE RANDOMIZED COMPARATIVE STUDY

NTRODUCTION- Postoperative pain is literally a form of acute pain which follows surgical insult with an inammatory reaction and initiation of an afferent neuronal signal bombardment. Due to inadequate management of postoperative pain many patients continue to suffer unnecessarily. Hence it is understood that managing the post operative pain effectively is the need of the hour to reduce postoperative morbidity. AIMS - To evaluate and compare the duration of sensory blockade of 0.25% levobupivacaine with and without dexamethasone in ultrasonography-guided transversus abdominis plane(TAP) block. METHODS-After obtaining approval from Institutional ethical committee, a prospective randomized comparative study was carried out in 60 patients of ASA Grade I & II undergoing inguinal hernia repair under spinal anaesthesia. Patients were randomly divided into 2 groups; Group L(n=30) received 30ml of 0.25% Levobupivacaine with 2ml of Normal saline (NS) while Group D (n=30) received 30ml of 0.25% Levobupivacaine with 8mg Dexamethasone. RESULTS- Patients in group D (8.07±1.34 hr) had prolonged duration of analgesia in comparison to group L (5.33±1.92 hr) (p= 0.000). CONCLUSION- In the inguinal hernia repair surgeries performed under spinal anaesthesia with ultrasonography-guided TAP block, addition of dexamethasone was superior to levobupivacaine alone in providing better and prolonged post-operative analgesia with minimal post-operative nausea and vomiting

Moving Toward a Multimodal Analgesic Regimen for Acute Sickle Cell Pain with Non-Opioid Analgesic Adjuncts: A Narrative Review.

Purpose of ReviewSickle cell disease (SCD) is an inherited hemoglobinopathy with potential life-threatening complications that affect millions of people worldwide. Severe and disabling acute pain, referred to as a vaso-occlusive crisis (VOC), is a fundamental symptom of the disease and the primary driver for acute care visits and hospitalizations. Despite the publication of guidelines for VOC management over the past decade, management of VOCs remains unsatisfactory for patients and providers.Recent FindingsAcute SCD pain includes pain secondary to VOCs and other forms of acute pain. Distinguishing VOC from non-VOC pain may be challenging for both patients and clinicians. Further, although opioids have been the gold-standard for VOC pain management for decades, the current highest standard of care for all acute pain is a multimodal approach that is less dependent on opioids, and, instead incorporates analgesics and adjuvants from different mechanistic pathways. In this narrative review, we focus on a multimodal pharmacologic approach for acute SCD pain management and explore the evidence for existing non-opioid pharmacological adjuncts. Moreover, we present an explanatory model of pain, which is not only novel in its application to SCD pain but also captures the multidimensional nature of the SCD pain experience and supports the need for such a multimodal approach. This model also highlights opportunities for new investigative and therapeutic targets – both pharmacological and non-pharmacological.SummaryMultimodal pain regimens that are less dependent on opioids are urgently needed to improve acute pain outcomes for individuals with SCD. The proposed explanatory model for SCD pain offers novel opportunities to improve acute pain management for SCD patients.

Delivery of Multimodal Analgesia to Effectively Treat Acute Pain: A Review From Roma Pain Days.

It is crucial that acute pain be promptly and adequately treated in order to prevent it from transitioning to chronic pain, a devastating and sometimes permanent condition that is challenging to treat and associated with disability, reduced quality of life, and depression. Guidelines for the treatment of acute low-back pain (LBP) are predicated on assumptions that all acute LBP is benign, temporary, and traditionally treated with a “wait and see” approach. LBP is far from a monolithic condition: etiology, the presence of underlying conditions, mental health status, social situation, patient’s age and occupation, and comorbidities all present different risk factors for chronic LBP that should be considered in treating acute LBP or other forms of acute pain. A multimodal approach to acute pain has been shown to be safe and effective. In particular, the combination product of oral dexketoprofen and tramadol has been shown effective in controlling acute pain, which spares the use of opioids and is well tolerated. Chronic pain must be viewed as a global health crisis, and the timely and adequate control of acute painful conditions is a good strategy to reduce its prevalence. Experts at Roma Pain Days discussed this important topic which is the foundation of this review.

Efficacy of Biosilicate Glass-Ceramic and Gluma in the Treatment of Cervical Dentin Hypersensitivity: An Interim Results of Randomised Control Trial

Introduction: Dentin Hypersensitivity (DH) is known to be a relatively common condition that affects a considerable portion of the population, and manifests itself in the form of acute pain, due to the exposure of dentin and open dentinal tubules, after the removal of enamel or root cement. It has a multifactorial aetiology. Aim: To compare the efficacy in DH treatment using Biosilicate and Gluma Desensitiser. Materials and Methods: This randomised clinical trial pilot study with a split-mouth design included seven participants. Two teeth presenting Gingival Recession (GR)-related DH were selected in each participant and allocated to treatment groups by simple randomisation. Gluma® desensitiser (GD) and Biosilicate® (BIO) were applied once a week for four weeks. The pain intensity under a volatile stimulus was measured using a Visual Analogue Scale (VAS) at baseline and after treatment, at 15 days and 6 months follow-up. Data analysis were performed by means of descriptive statistics, Paired t-test for inter-group comparison and Friedman test for intra-group comparison (p-value <0.05). Results: The mean age of seven participants were 19.9 years, from which five were women (71.4%). The GD and BIO groups presented initial mean VAS values of 4.86±2.55 and 6.14±1.57, respectively. Fifteen days after treatment, both groups showed a significant improvement (GD group p-value=0.03 and BIO group p-value=0.02, Wilcoxon test) in pain intensity, with 71.4% teeth without sensitivity (VAS=0). Conclusion: Both treatments resulted in a reduction in painful sensitivity under volatile stimuli 15 days after treatment. BIO group presented a better outcome regarding reduction in DH, without recurrence at the 6th month evaluation, when compared to GD group.

Knowledge, attitudes and practices of health professionals towards postoperative pain management at a referral hospital in Ethiopia

BackgroundPostoperative pain (POP) is a form of acute pain following surgery. It results from tissue injury during surgical procedure like skin incision, tissue dissection, manipulation and traction. It is one of the immediate postoperative complications. Despite new standards, guidelines and different strategies the practice of postoperative pain management is found to be inadequate. We aimed to assess knowledge, attitude and practice on postoperative pain management practice among Health professionals working at Debre Tabor Referral Hospital. MethodInstitution based cross-sectional study was conducted to assess Knowledge, Attitudes and Practices of Health professionals regarding to Post-operative pain management at Debre Tabor Referral Hospital 2020 from 118 health professionals. Data was collected using structured self-administered questionnaire and was verified, coded and entered to Epi Info Software version 3.5.4 and then it was exported and analyzed by SPSS version 20 Software. After analysis frequency and percentages was used to summarize the finding. ResultThe overall finding of the study revealed that health professionals had good knowledge (58.4%), unfavorable attitude (44.9%), and poor practice (24.58%) towards post-operative pain management. ConclusionNon physician anesthetists have good knowledge, attitude and practice towards post-operative pain management. But the overall attitude and practice of health professionals’ towards post-operative pain management is poor.

Efficacy and Safety of Epidural Analgesia versus Traditional Analgesia for Relief of Labour Pain

Background: Labour pain, a form of acute pain, intensity of the pain is perceived by many women as very severe or intolerable especially in nulliparous. Providing effective and safe analgesia during labour has remained an ongoing challenge. Multiple pharmacologic and non-pharmacologic options are available to manage labour pain. Epidural analgesia have reported nearly complete pain relief with effective labour conduction. Objective: Purpose of this study was to evaluate the effectiveness of epidural analgesia and pethidine during labour and delivery. Materials & Methods: This cross sectional comparative study was conducted to compare the efficacy and safety between epidural and traditional analgesia on nulliparous women in labour. Subjects were grouped into two, group A received epidural & group B received traditional analgesia, each group comprising with 40 patients. Then the subjects were followed up and outcomes were recorded in a preformed data collection sheet. Results: The two groups were almost identical. Maternal age, gestational age and preinduction pain score (p = 0.127, p = 0.454 and p = 0.186 respectively). Study demonstrated earlier onset, pain score at different time intervals and the time of delivery were lower in epidural group than traditional (p < 0.001). No significant difference of complications (p = 0.431). Two(5%) patients in the epidural and five(12.5%) in the traditional group required caesarean delivery (p=0.455). No significance on neonatal outcome. Conclusion: Epidural analgesia induces a much earlier onset, intensity of pain reduced to a tolerable level and maintained up to delivery which not attained in the traditional method of analgesia. KYAMC Journal.2021;12(02): 66-70

The magnitude and associated factors of post-operative pain at Debre Tabor compressive specialized hospital, Debre Tabor Ethiopia, 2018.

Objectives:Post-operative pain is a form of acute pain following surgical intervention. And it is due to skin incision, tissue dissection, manipulation, and traction during the surgical procedure. The magnitude may reach up to 85.5% globally. Age, gender, duration of surgery, and length of skin incision were the common factors for post-operative pain. This study aims to assess the magnitude and associated factors of post-operative pain among surgical patients.Methods:Institutional-based cross-sectional study design was used. The study was conducted on a total of 159 surgical patients aged 8 years and above. The data were collected using chart review and recording the status of post-operative pain by the result of the Numeric Rating Scale at 1, 6, 12, 24, and 72 h of the post-operative period. Descriptive statistics, bivariate, and multivariable logistic regression were used. An adjusted odds ratio with a 95% confidence interval was used to determine the association. A p-value of less than 0.05 was used to declare statistical significance.Results:The majority (58.5%) of the study participants were females. The percentage of moderate to severe post-operative pain (Numeric Rating Scale: 4 and above) was between 37.7% within 1 h and 76.7% at 6 h of post-operative period. On multivariable logistic regression being female gender, preoperative pain and large skin incision were significantly associated with post-operative pain.Conclusions:Post-operative pain is still high which needs the attention of health professionals working on surgical patients and considering factors associated with post-operative pain.

In an exploratory randomized, double-blind, placebo-controlled, cross-over study, psychoactive doses of intravenous delta-9-tetrahydrocannabinol fail to produce antinociceptive effects in healthy human volunteers.

Animal studies and anecdotal human reports suggest that cannabinoids have antinociceptive effects. Controlled human studies have produced mixed results. We sought to reduce existing variability by investigating the effects of intravenous delta-9-tetrahydrocannabinol (THC) in several pain paradigms within the same human subjects, addressing some of the limitations to the published literature. In this exploratory randomized, double-blind, placebo-controlled, cross-over study, healthy human subjects received 0.01mg/kg or 0.03mg/kg intravenous THC or placebo (ethanol vehicle) infused over 10min on three test days, each separated by at least 72h. Capsaicin (250μg) was injected intradermally to induce chemical pain and hyperalgesia. Four other forms of acute pain were induced: mechanical (von Frey filament), hot and cold (thermode), and electrical (pulse generator). Pain ratings were obtained before drug administration, at peak drug effects, and 2h after drug administration and included both objective and subjective measures. THC drug effects and vital signs were also collected during experimental sessions. Nonparametric analysis with repeated measures was performed. THC induced euphoria, perceptual and cognitive alterations, and tachycardia in a dose-related manner, but failed to have significant effects in experimentally induced acute chemical, mechanical, thermal, or electrical pain and capsaicin-induced hyperalgesia. In this exploratory controlled study, intravenous THC lacked significant antinociceptive properties in experimental models of acute pain and capsaicin-induced hyperalgesia in healthy human subjects. Continued study of THC and other cannabinoids through high-quality, controlled studies in both healthy volunteers and patients with pain conditions is warranted to inform the growing demand for the clinical application of cannabinoids in pain management.

PER HENRIK LING - PIONEER OF PHYSIOTHERAPY AND GYMNASTICS

In the early 1800s, Peter Henry Ling (also known as Per Henrik Ling) was perhaps the first to notice what numerous others pioneers of physiotherapy have already observed in the past centuries: massage and physical exercises are critical for healing many chronic and acute forms of pain. Even in some way controversial, Ling is widely considered the Father of Massage . Like many massage therapists and body workers today, he used his own knowledge and experience with pain and injury to craft methods and techniques that shaped the basis of his practice and, ultimately, of massage itself. Article visualizations:

Diclofenac sodium injection (Akis®, Dicloin®) in the management of pain: a guide to its use in the EU

A novel formulation of diclofenac sodium suitable for subcutaneous (SC) or intramuscular (IM) injection (Akis®, Dicloin®) has been developed using the complexing agent hydroxypropyl-β-cyclodextrin (HPβCD) as a solubility enhancer. Diclofenac HPβCD is available in several European countries, where it is indicated for use in adults with acute forms of pain, including postoperative pain. In clinical trials, SC or IM diclofenac HPβCD demonstrated analgesic efficacy in moderate to severe acute postoperative pain following dental surgery or minor orthopaedic surgery, and in moderate to severe neuropathic pain. Diclofenac HPβCD was generally well tolerated. Although injection-site reactions were among the most commonly reported adverse events with diclofenac HPβCD, its local tolerability profile was consistently rated as ‘good’ or ‘excellent’ across all studies. SC administration of diclofenac is a valid alternative to IM delivery, with the advantages of easier administration, the availability of additional body sites suitable for injection and the potential for self-administration. Thus, diclofenac HPβCD 25, 50 or 75 mg/mL solution for SC or IM injection extends the treatment options available for use in the management of acute pain in adults.

Diclofenac sodium injection (akis(®), dicloin (®)): a review of its use in the management of pain.

A novel formulation of diclofenac sodium suitable for subcutaneous or intramuscular injection (Akis(®), Dicloin(®)) has been developed using the complexing agent hydroxypropyl-β-cyclodextrin (HPβCD) as a solubility enhancer. Diclofenac HPβCD is available in several European countries, where it is indicated for use in adults with acute forms of pain, including postoperative pain. Clinical trials have demonstrated the analgesic efficacy of diclofenac HPβCD in terms of relieving moderate to severe postoperative pain in patients undergoing dental surgery or minor orthopaedic surgery. Subcutaneous diclofenac HPβCD also effectively relieved moderate to severe neuropathic pain, related to cancer or not. Diclofenac HPβCD was generally well tolerated in clinical trials, with injection-site reactions among the most commonly reported adverse events. The local tolerability of diclofenac HPβCD was consistently rated as 'good' or 'excellent' across all studies. Subcutaneous administration of diclofenac is a valid alternative to intramuscular delivery, with the advantages of easier administration, the availability of additional body sites suitable for injection and the potential for self-administration. Thus, diclofenac HPβCD 25, 50 or 75mg/mL solution for subcutaneous or intramuscular injection extends the treatment options available for use in the management of pain in adults.

Global Nav1.7 knockout mice recapitulate the phenotype of human congenital indifference to pain.

Clinical genetic studies have shown that loss of Nav1.7 function leads to the complete loss of acute pain perception. The global deletion is reported lethal in mice, however, and studies of mice with promoter-specific deletions of Nav1.7 have suggested that the role of Nav1.7 in pain transduction depends on the precise form of pain. We developed genetic and animal husbandry strategies that overcame the neonatal-lethal phenotype and enabled construction of a global Nav1.7 knockout mouse. Knockouts were anatomically normal, reached adulthood, and had phenotype wholly analogous to human congenital indifference to pain (CIP): compared to littermates, knockouts showed no defects in mechanical sensitivity or overall movement yet were completely insensitive to painful tactile, thermal, and chemical stimuli and were anosmic. Knockouts also showed no painful behaviors resulting from peripheral injection of nonselective sodium channel activators, did not develop complete Freund’s adjuvant-induced thermal hyperalgesia, and were insensitive to intra-dermal histamine injection. Tetrodotoxin-sensitive sodium current recorded from cell bodies of isolated sensory neurons and the mechanically-evoked spiking of C-fibers in a skin-nerve preparation each were reduced but not eliminated in tissue from knockouts compared to littermates. Results support a role for Nav1.7 that is conserved between rodents and humans and suggest several possibly translatable biomarkers for the study of Nav1.7-targeted therapeutics. Results further suggest that Nav1.7 may retain its key role in persistent as well as acute forms of pain.

Role of pre-emptive analgesia in post operative Pain management - a review of literature

DOI: http://dx.doi.org/10.3329/jbsa.v23i2.18176 Journal of BSA, 2009; 23(2): 62-66

Dental note: Combination analgesics in adults

Most patients presenting to dentists with pain have some form of acute pain. This can usually, and predictably, be...

Childrenʼs experiences of their postoperative pain management: a qualitative systematic review

Childrenʼs experiences of their postoperative pain management: a qualitative systematic review

Perceptions of Pain

What could be more subjective than the appreciation of art, except possibly the experience of pain? And not only subjective, but indescribable—how could I possibly explain to someone else what it feels like when I hit my thumb with a hammer, except to say that it hurts? Our best attempts to make pain objective, for example using pain scores and visual analogue scales, merely reinforce the futility of the exercise, for whilst certain forms of acute pain may conform to such measurement, pain generally—and chronic pain in particular—is more than just a sensation. How we feel about our pain, our situation, even ourselves, affects how we experience pain, and vice versa. Pain management programmes recognize this and aim to show sufferers how better to cope with their pain, and the INPUT Pain Management Unit at St Thomas' Hospital in London offers such a programme. Attending the INPUT programme was one Deborah Padfield, her theatre career disrupted by chronic pain. Now a photographer, she undertook a project with the support of Dr Charles Pither, Consultant Anaesthetist and Medical Director of the unit, and a Sciart grant [www.sciart.org]. Over eight months, Ms Padfield worked with ten fellow sufferers designing, creating and reworking photographic images that they felt captured the essence of their pain. Originally presented in an exhibition, these images now appear in Perceptions of Pain along with commentaries by Professor Brian Hurwitz (D'Oyly Carte Professor of Medicine and the Arts, King's College, London), Ms Padfield, Dr Pither and the patients themselves. Once one gets past the hyperbole (‘These images should galvanise clinicians into ensuring... the resources required for appropriate medical treatment of pain’), these are indeed provocative images. One is faced with pictures, both ‘natural’ and distorted or abstract, of frozen limbs, hot barbed wire, daggers, broken machinery and piles of rubbish, interspersed with patients' vignettes that describe the context of their pain. It was these tales, even more than the images, that affected me most, revealing as they do the dreadful impact that chronic, unremitting pain can have on one's life and making me feel guilty for spotting glimpses of bitterness with a medical system that has apparently failed (mentions of ‘unfortunate surgery and aftercare’, ‘operations that went wrong’ and ‘why won't they listen?’). Not that the images aren't disturbing in themselves—readers will find the ones that especially touch them but in my case it was a bruised apple, hospital sticker on the outside, the inside of which was rotten to the core. This book could be useful on several levels. First, as an exercise for the patients involved in the project to think of their pain in new ways, to describe it and therefore to share it. Although the number of patients is small, their words describe how creating the pictures has helped them, suggesting that such activity may have value in pain management programmes. Second, these pictures might perhaps help other patients to describe their own pain to their doctors and others; this is alluded to in a BBC radio programme that discusses the book [www.bbc.co.uk/radio4/womanshour/28_07_03/wednesday/infol.shtml] although more work is needed to evaluate this. Third, those who treat patients in pain might gain better understanding of what their patients are feeling by looking through these pages, and thereby perhaps engender less bitterness in their ‘difficult’ cases. Finally, the challenge of portraying pain visually is a provocative intellectual exercise in itself. How would you present yours?

1 Physiology of pain in labour

Labour pain is the result of many complex interactions. Although not fully determined, the pain arises from distension of the lower uterine segment and cervical dilatation. The neural mechanism of labour has some features similar to other forms of acute pain; nociceptive information is relayed in small A delta and C afferent fibres to the dorsal horn of the spinal cord, mediated by neurotransmitters; from there it may be involved in the initiation of segmental spinal reflexes or pass through the spinothalamic tract to the brain. Many factors are activated during labour which may modify the nociceptive impulse at different stages of its passage. Some of these factors act synergistically to promote anti-nociception that peaks at delivery.

Chronic back pain, acute postoperative pain and the activation of diffuse noxious inhibitory controls (DNIC)

The effect of the presence of either chronic or acute clinical pain on pain threshold and on the nociceptive flexion reflex (RIII) threshold was studied. The experimental pain sensation and the flexion reflex were evoked by trains of short electrical pulses. It was hypothesized that both kinds of clinical pain would be able to induce ‘diffuse noxious inhibitory controls’ (DNIC) and thereby raise the 2 experimental thresholds. Patients with chronic low back pain, patients with postoperative pain from oral surgery, and pain-free subjects were tested in 3 conditions: during baseline, after i.v. administration of a placebo, and after i.v. administration of naloxone. In comparison with 2 pain-free control groups, the 2 pain groups had a significantly higher pain threshold in all conditions. However, the RIII threshold was not significantly elevated in chronic or acute pain patients compared to controls. Naloxone had no effect on the RIII or pain threshold in any of the groups. It is concluded that the increased pain threshold which is frequently found in chronic pain patients, and which could be confirmed in the present study, does not result from a DNIC effect. The adaptation level theory offers an alternative explanation. Also, the acute postoperative pain in this study did not seem to induce DNIC. Because other forms of acute pain have been found to be effective in activating DNIC, future research should establish which pains are and which pains are not effective.

Evaluation of zomepirac sodium

The chemistry, pharmacokinetics, pharmacology, clinical efficacy, adverse effects, physical dependence and tolerance, drug interactions, dosing, and cost of zomepirac sodium (Zomax, McNeil) are reviewed. Zomepirac is a new nonsteroidal anti-inflammatory agent (NSAIA) approved for the treatment of mild to moderately severe pain. The drug is well absorbed when given orally. It undergoes extensive biotransformation in the liver. Zomepirac shares the pharmacology of the other NSAIAs by decreasing prostaglandin synthesis. The efficacy of zomepirac has been demonstrated primarily in acute forms of pain with associated inflammatory processes including postdental-extraction, postpartum, and postoperative pain. Many of these studies have been single-dose evaluations. Zomepirac sodium 100 mg has been reported to be approximately equivalent to one to two tablets of aspirin-phenacetin-caffeine (APC) with codeine 30 mg. In two studies, zomepirac sodium 100 mg compared favorably with morphine sulfate 8 and 16 mg i.m. It has been shown to be superior to aspirin 650 mg in oral-surgery patients. In osteoarthritis, daily doses of zomepirac sodium 400-600 mg are approximately equivalent to aspirin 3200-4800 mg. Zomepirac has side effects similar to high-dose aspirin. Zomepirac is associated with an increased incidence of urogenital symptoms such as dysuria and pyuria. Because of tumorigenicity in rats, the drug is contraindicated in children, pregnant women, and nursing mothers. The drug has not demonstrated any potential for physical dependence, withdrawal, or tolerance. Zomepirac may provide a suitable alternative to aspirin, narcotic/NSAIA combinations, and narcotics in the treatment of mild to moderately severe pain. It is unlikely that zomepirac will replace narcotics in more severe types of pain.