Moderate Degree Of Pain Research Articles

Clinical and epidemiological profile of herpes zoster cases and its complications: A prospective study

Background: The varicella-zoster virus, which is known to lie dormant in the dorsal root ganglia after primary chickenpox infection or immunization, and in rare instances, intrauterine infection, is the source of the common viral infection known as herpes zoster (HZ). In healthy people, the illness usually goes away on its own, but in severely immunocompromised patients, it can cause persistent debilitation through multi-dermatomal, severe, vesiculo-pustular, nodular, crusted, and ecthymatous manifestations. Aims and Objectives: The aim of this study was to better understand the clinical profile and epidemiological patterns of HZ and various postherpetic complications. Materials and Methods: A prospective cross-sectional study was conducted at a tertiary care hospital in Karnataka for 24 months during August 2013–August 2015. Seventy-five patients with HZ and postherpetic complications attending the dermatology outpatient department were included in the study. Pre-existing comorbidities and patient details were recorded. The Hayes and Patterson Visual Analog Scale (VAS) was used to record the kind, duration, and intensity of the pain. Results: The current cross-sectional study was done in a tertiary care hospital, and a total of 75 patients were considered for the study. The youngest patient was a 12-year-old male and the eldest patient was a 90-year-old male. The average age of patients was 52.45 ± 12.5 years. Cutaneous examination showed erythema (84%) and vesicles (84%). The intensity of pain was classified based on the VAS. About 54.6% of patients had a moderate degree of pain. Conclusion: Acute vesicles with erythema and radicular pain with a unilateral dermatomal distribution are the most typical presentation of HZ infection, and they are most frequently seen in the thoracic area.

Role of Neurectomy in Inguinodynia Following Hernioplasty: A Randomized Controlled Trial.

IntroductionTo date, Lichtenstein tension-free mesh hernioplasty is being adopted widely for inguinal hernia repair in adults, although it is accompanied by procedural complications such as recurrences, infection, testicular atrophy, post-operative pain, and nerve injury. As the recurrence rate decreased after Lichtenstein's tension-free hernioplasty, surgeons’ point of focus shifted more toward postoperative groin pain (inguinodynia) after inguinal hernia repair, as it has become a quite significant problem. The nerves of interest in the inguinal region are ilioinguinal, iliohypogastric, genitofemoral, and lateral femoral cutaneous nerves. Out of all the nerves, the ilioinguinal nerve is at the greatest risk of entrapment during meshplasty. Chronic groin pain is quite significant following hernia repair, and irrespective of the severity, it can interfere with normal daily activity. The traditional surgical technique recommends the preservation of the ilioinguinal nerve to avoid the morbidity associated with the cutaneous sensory loss supplied by the nerve. One popular belief is that if we excise the ilioinguinal nerve, then the chance of getting post-operative neuralgia due to entrapment, inflammation, neuroma, or fibrotic reactions will almost become zero. Hence, this study was conducted to evaluate the effect of prophylactic excision of the ilioinguinal nerve in the patients undergoing Lichtenstein hernioplasty for inguinal hernias.MethodsAll consecutive male patients presenting to the Department of Surgery with inguinal hernia and age above 18 years were included in the study. All the patients were operated on under spinal anesthesia. Lichtenstein tension-free hernia repair was taken as the standard procedure for hernia repair. Patients in whom the nerve was preserved were kept in group A, whereas group B comprised patients who had undergone neurectomy. Patients were followed up regarding pain at first, third, and sixth months, at rest, and after exercise. The pain was graded according to the VAS (visual analog scale) scoring.ResultsIn the present study, out of a total of 92 patients, 80 patients were included. In the first month, 15% of the patients in group A had mild pain, while 5% in group B had experienced a moderate degree of pain at rest. After exercise, the result was 30% in group B. Similarly, in the third month of follow-up, it was found that 25% of the patients in group A experienced mild pain, while 12.5% complained about a moderate degree of pain who had to take analgesics for a longer period. After putting them to exercise and then grading the pain, it was found that 32.5% in group A and 15% in group B experienced pain. After follow-up for six months in both groups, it was revealed that there was no significant difference in post-operative pain at rest (10% and 7.5% in groups A and B, respectively). After exercise, 20% of patients in group A complained of pain, while in group B, only 10% experienced pain. There was no significant difference between both the groups while comparing chronic groin pain at rest and after exercise, and after different time intervals in follow-up (p = 0.4513 and 0.548, respectively).ConclusionProphylactic excision of the ilioinguinal nerve in Lichtenstein tension-free meshplasty decreased the incidence of chronic groin pain after surgery but it was statistically insignificant. Furthermore, this procedure did not affect the quality of life after surgery.

Ultrasound-Guided Transversus Abdominis Plane (TAP) Block for Chronic Post-Operative Surgical Pain: Review of 20 Cases

Abstract Background: Post-operative surgical pain of at least 2- month duration in absence of clear causes was defined as Chronic Post-operative Surgical Pain syndrome (CPSP). Transversus Abdominis Plane (TAP) block is a new imple-mented regional anaesthetic technique included in the analgesic regimen for many abdominal surgeries to reduce immediate post-operative pain and opioid requirements. Aim of Study: To assess the feasibility and efficacy of US guided TAP block in the management of chronic post-operative surgical pain. Patients and Methods: US-guided TAB block done for 20 patients complaining of chronic lower abdominal pain around 3-months to one-year duration after surgical operation with injection of 20ml of bupivacaine 0.25% and 2ml of methyl prednisolone (40mg/ml). Unilateral injection done for 12 patients & bilateral injections done for 8 patients. Second injection done for 6 patients after 3 months (three unilateral & three bilateral). Patient's pain intensity was assessed by Visual Analogue Score (VAS) before procedure & during follow-up visits for the next six months. Results: Three months after US-guided TAP block; 5 patients with mild degree of pain & 2 out of 10 patients with moderate degree of pain became completely pain free, while other 13 patients acquired relative improvement (5 patients with mild degree of pain and 8 patients with moderate degree of pain). Six months after US-guided TAP block; 6 patients (accepted second injection) improved with mild degree of pain while other 2 patients showed little improvement with still moderate degree of pain. Conclusion: Ultrasound guided TAP block is safe and effective method in management of chronic post-operative surgical pain.

A randomised controlled trial to assess the feasibility of utilising virtual reality to facilitate analgesia during external cephalic version

External cephalic version (ECV) is associated with a moderate degree of pain. Virtual reality (VR) is a technology that has shown promise in offering procedural analgesia. We undertook a clinical pilot to assess the viability of VR to reduce pain during ECV. In an open randomised controlled trial (RCT), we randomised 50 women to either VR or standard care each (25 per group). Women receiving VR were administered VR content (Skylights) via a headset. Pre- and post-procedural measures of pain, anxiety, device experience and vital signs were measured. There were no significant differences between groups (VR/no VR) in pain scores (60.68 vs 49.76; p = 0.2), ECV success rates (80% vs 76%; p = 0.7) or anxiety levels. The women receiving VR had a significantly higher anticipation of pain pre-procedurally (70.0 vs 50.0; p = 0.03). 20 (80%) of the VR women indicated that they would use VR again and 22 (88%) indicated they would recommend it to a friend having ECV. There were no significant differences between groups for side effects encountered or changes in vital signs. We have shown that using VR during ECV is feasible and appears safe. Our results inform the design of future RCTs.

Prevalence of dysmenorrhoeal pain and its impact on school performance: A cross-sectional study

BangladeshABSTRACTMenstruation is normal biological phenomena for girls and women. During menstruation, girls and women feel a certain degree of pain (dysmenorrhea) that can be minor to severe resulting obstacles in carrying daily life activities including school. This study was conducted to determine how dysmenorrheal pain has affected the students’school as well as daily life along with prevailing social and cultural norms during menstruation. Following a cross-sectional design, this study took place among 366 students of Kathmandu (66.1%) and Dhading (33.9%) in Nepal of aged from 13 to 20 years. Of all the samples, 89% of the students complained of having dysmenorrhea where moderate degree of pain had the highest frequency of 49.7%. Nonetheless of the degree of pain, 45.1% missed school because of it. Besides missing classes, 81% didn’t participate in sports activities during their period. 38% students regularly followed restrictions applied during period while 34% followed them sometimes only. 83% complained about school administration failing to address periodic problems. I would recommend the school administration to have an infirmary where the students can take rest and continue their classes after that. Adding on to it, the administration should be able to provide emergency sanitary pads and heat pads, so that the students dont have to go back home and miss their classes.

Evaluation of Cardiorespiratory Effects of Dexmedetomidine Isolated and Associated With Morphine in Bitches Submitted to Elective Ovariossalpingohisterectomy under General Inhalation Anesthesia

Background: Elective ovariossalpingohysterectomy is one of the most accomplished surgeries in veterinary practice, presenting moderate degree of pain. Aiming at balanced anesthesia, α2-agonists have been increasingly used, with dexmedetomidine being characterized by its sympatholytic, sedative, analgesic properties and synergism with opioids, benzodiazepines and other drugs. The objective of this study was to evaluate the effects of dexmedetomidine alone and associated with morphine under the cardiovascular, respiratory and body temperature variables in the pre and trans-operative periods in bitches submitted to elective ovariossalpingohisterectomy under general inhalation anesthesia.Materials, Methods & Results: Sixteen bitches were used in this study, which were submitted to elective ovariossalpingohisterectomy, all of which were clinically healthy based on clinical and hematological results. The animals were randomized into two groups, in which intramuscular dexmedetomidine alone and 5 µg/kg (DG) and 0.3 mg/kg morphine (GDM). In both groups, anesthesia was induced with propofol administered and maintained with isoflurane diluted in 100% oxygen administered through a calibrated vaporizer and appropriate anesthetic system based on the weight of the animal and kept under spontaneous ventilation. After stabilization of the patient, the surgical procedure started, which lasted 45 minutes. The parameters evaluated were heart rate (HR), respiratory rate (ƒ), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), body temperature (TºC), expired isoflurane concentration , partial carbon dioxide gas pressure (ETCO2) and oxygen saturation in hemoglobin (SatO2), which were measured before and after the application of preanesthetic medication and at specific surgical times: 5 and 15 min after anesthetic induction; during the incision of the skin; muscle incision; ligation of the left ovary; ligation of the right ovary; ligation of the uterine body; laparorrafia; suture and at the end of surgery. A significant difference was observed between the groups in respiratory rate, systolic blood pressure, body temperature, partial pressure of carbon dioxide, saturation of oxygen in hemoglobin and pH, only in some times evaluated. GDM bradycardia occurred 30 min after preanesthetic medication; acidemia and mild to moderate hypercapnia in both groups, being more pronounced in GDM, although without statistical difference, and hypothermia. The concentration of isoflurane expired in both groups was higher during the muscle incision until laparorrhaphy compared to the other surgical times.Discussion: The results of this study show that there was adequate analgesia during the elective ovarian resection procedure, considering that the values found during the surgery were relatively lower than the baseline values and within the physiological limits for the species, even during the moments of greater painful stimulation, such as ligation of the ovaries and ligation of the uterine body. In the GDM group, bradycardia occurred after 30 min of pre-anesthetic medication, but its occurrence was transient and without interfering with blood pressure, increasing to the next evaluation time and stabilizing in physiological values for the species. There was also a gradual reduction in respiratory rate in both groups over time, with an increase in PaCO2 in GDM at the end of surgery, indicating respiratory depression, as well as a reduction in pH in both groups at all times.

Correlates of Physical Activity and Degree of Pain among Older Adults

Objective: To determine the degree of pain presented by the people selected in the present study and to establish a possible relation between this first variable with other socio-demographic ones (age, gender, civil status and occupation), as well as whether or not they practice physical activity, and if so, what type of activity; To check the relationship between the practice and type of physical activity, with the socio-demographic factors; age, gender, civil status and occupation. Methology: 564 participants, with an average age of 61.05 years and an age range between 40 and 88 years from the Sabah, Malaysia, was made by a sampling technique intended to provide a natural composition with a criterion of inclusion, that is to say, people aged 40 or older. Various measuring instruments were chosen (pain scale and questionnaire) to collect the variables selected. Results: The results indicated that 80.9% of the participants presented with a moderate degree of pain, the cervical area and knees being the structures most affected. On the other hand, 73.2% of the sample population habitually carried out physical and sporting tasks, with no differences according to gender, but showing differences according to age and occupation. The most common activities were walking (88.64%) and keep fit (25.65%). There was no correlation between physical activity and the degree of pain. Conclusion: The main conclusions highlight the need to create exercise and health protocols and programmes with a multidisciplinary approach, adapted to the individual needs of each person and the promotion of the construction of new, modern sporting facilities in rural areas so that people may enjoy better sporting opportunities.

Correlates of Physical Activity and Degree of Pain among Older Adults

Objective: To determine the degree of pain presented by the people selected in the present study and to establisha possible relation between this first variable with other socio-demographic ones (age, gender, civil status andoccupation), as well as whether or not they practice physical activity, and if so, what type of activity; To checkthe relationship between the practice and type of physical activity, with the socio-demographic factors; age,gender, civil status and occupation.Methology: 564 participants, with an average age of 61.05 years and an age range between 40 and 88 years fromthe Sabah, Malaysia, was made by a sampling technique intended to provide a natural composition with acriterion of inclusion, that is to say, people aged 40 or older. Various measuring instruments were chosen (painscale and questionnaire) to collect the variables selected.Results: The results indicated that 80.9% of the participants presented with a moderate degree of pain, thecervical area and knees being the structures most affected. On the other hand, 73.2% of the sample populationhabitually carried out physical and sporting tasks, with no differences according to gender, but showingdifferences according to age and occupation. The most common activities were walking (88.64%) and keep fit(25.65%). There was no correlation between physical activity and the degree of pain.Conclusion: The main conclusions highlight the need to create exercise and health protocols and programmeswith a multidisciplinary approach, adapted to the individual needs of each person and the promotion of theconstruction of new, modern sporting facilities in rural areas so that people may enjoy better sportingopportunities.

The relationship between pain and physical activity in older adults that begin a program of physical activity

There is no doubt that the population is progressively aging. This study evaluates the relationship between the variables of the level and type of physical activity and the degree of pain, with a series of socio-demographic variables, such as age, gender, civil status and occupation. The final selection of the sample, composed of 564 participants, with an average age of 61.05 years and an age range between 40 and 88 years from the province of Almeria, Southern Spain, was made by a sampling technique intended to provide a natural composition with a criterion of inclusion, that is to say, people aged 40 or older. Various measuring instruments were chosen (pain scale and questionnaire) to collect the variables selected. The results indicated that 80.9% of the participants presented with a moderate degree of pain, the cervical area and knees being the structures most affected. On the other hand, 73.2% of the sample population habitually carried out physical and sporting tasks, with no differences according to gender, but showing differences according to age and occupation. The most common activities were walking (88.64%) and keep fit (25.65%). There was no correlation between physical activity and the degree of pain. The main conclusions highlight the need to create exercise and health protocols and programmes with a multidisciplinary approach, adapted to the individual needs of each person and the promotion of the construction of new, modern sporting facilities in rural areas so that people may enjoy better sporting opportunities.

Maternal experience of pain during external cephalic version at term

This study was designed to investigate maternal pain perception during external cephalic version (ECV). This prospective study included 97 pregnant women with singleton breech presentation at or above 36 weeks of gestation undergoing ECV. No analgesia or anesthesia were used during ECV. The women were asked to rate the degree of pain on a 10-cm visual analog scale after ECV. Ninety-eight ECVs were performed and the overall success rate was 66%. The median pain score was 5.7 (interquartile range 2.7-6.8). The visual analog pain score was significantly lower among those with a successful ECV than those with a failed procedure (median score 4.6 vs. 6.8, p < 0.001). Similarly, those procedures rated as easy by the operator were associated with a significantly lower pain score (3.4 vs. 6.4, p < 0.001). However, the pain score was not found to be related to the operator, parity or placental site. Among the five subjects with a pain score of 8.5 and beyond, the ECV procedure was still successful in four (80%). ECV performed without analgesia was associated with a moderate degree of pain that was well tolerated by the majority of patients because of its short duration.

Missed lumbar transverse process fractures in a high school football player

Objective: To discuss the case of a football player who had suffered a transverse process fracture of the lumbar spine that was overlooked on initial chiropractic and medical examination. Clinical Features: A 17-year-old male football player had been speared in the back by another player. He reported severe initial pain that caused him to fall to the ground, and there was a moderate degree of pain at the time of his chiropractic examination 1 week after injury. Intervention and Outcome: Initial chiropractic treatment consisted of spinal manipulation to the lumbar spine. Follow-up care consisted of lumbar spine radiographs that showed evidence of a lumbar transverse process fracture at 2 levels. The boy was referred to his medical doctor, who was not convinced of the presence of a fracture and returned him to play. A computed tomography scan was subsequently performed; this confirmed fractures of the transverse processes of L2 and L3. The patient was precluded from contact sports for 4 weeks. Chiropractic care 3 weeks after injury included physiotherapy and drop table mobilization to the sacroiliac joints. The patient returned to play 4 weeks after the injury. Conclusion: Transverse process fractures commonly occur secondary to blunt trauma in contact sports such as football. With high-force direct trauma, radiographs should be performed to rule out fracture before returning the athlete to play or commencing spinal manipulation.(J Manipulative Physiol Ther 2001;24:123-6)

Lengthening of Below-the-Knee Amputation Stumps Using the Ilizarov Technique

Patients with short, traumatic, below-the-knee amputations (BKAs) frequently function as if they have knee disarticulations. The goal of this study was to evaluate the results in patients who had lengthening of their BKA stumps to improved prosthesis fit and increase ambulation. Three patients with traumatic BKAs, who were left with insufficient stumps for proper prosthesis wear, have had their stumps lengthened by Ilizarov's technique of distraction osteogenesis. The lengthening process produced a moderate degree of pain, and all patients had a temporary decrease in their range of motion. Two patients lost a substantial amount of gained length secondary to early full weight-bearing. Despite these difficulties, the procedure produced longer, more durable stumps in all patients with no final loss of knee range of motion.