Subjective Complaints Of Pain Research Articles

Assessment of Quality of Pain and Patient Satisfaction using ASSIST Questionnaire Following Intraperitoneal Instillation of Ropivacaine Compared with the Addition of Adjuncts Ketamine versus Dexmedetomidine in Laparoscopic Cholecystectomy patients

Background: Evaluation of patient satisfaction score and to assess quality of pain relief following intraperitoneal instillation of Ropivacaine with adjuncts Dexmedetomidine vs Ketamine using modified version of revised APS-POQ in patients undergoing laparoscopic cholecystectomy. Methods: Sixty patients undergoing laparoscopic cholecystectomy were randomised into three groups of 20 each and received Ropivacaine 0.2 % (group R), Ropivacaine 0.2 % with Dexmedetomidine 0.7µg/ kg (group RD) and Ropivacaine with Ketamine 0.5 mg/kg (group RK) in a total volume of 40 ml. Pain severity, subjective pain complaints, pain interference in physical activity, and patient's and caregiver's satisfaction were evaluated using a modified version of the revised APS-POQ at 24 hours postoperatively. Result: Mean pain scores for worst pain were observed to be least in Group RD, with mean values being 1.75±1.743, followed by 5.45±1.701 in Group R and mean value of 5.60±0.754 in Group RK. Mean patient satisfaction scores were found to be highest in Group RD (94.00±8.826), followed by Group R (80.00±15.218), and least in Group RK (78.50±12.258). This difference was observed to be statistically significant (p<0.05) in all groups. Primary care physicians caring for the RD group had higher satisfaction scores (9.40±0.883) compared to Group RK (7.85±1.226) and Group R (8.05±1.468) Conclusion: Quality of pain relief improved the best with Dexmedetomidine followed by Ketamine and least when Ropivacaine used alone for intraperitoneal instillation. The overall patients' satisfaction was found to be more with Ropivacaine with Dexmedetomidine when compared to Ropivacaine alone or with Ketamine

Decreased nerve conduction velocity may be a predictor of fingertip dexterity and subjective complaints

We examined the causes of decreased fingertip dexterity in elderly individuals with an aim to improve their quality of life by improving their activities of daily living. We calculated nerve conduction velocity, absolute error during force adjustment tasks, and fingertip dexterity test scores for 30 young (21–34 years old) and 30 elderly (60–74 years old) participants to identify age-related changes. We also assessed subjective complaints of pain, motor function, and numbness. Motor nerve (young: 55.8 ± 3.7 m/s; elderly: 52.2 ± 5.0 m/s) and sensory nerve (young: 59.4 ± 3.4 m/s; elderly: 55.5 ± 5.3 m/s) conduction velocities decreased in an age-dependent manner. Moreover, the decrease of motor nerve conduction velocity was associated with decreased fingertip dexterity (objective index), while the decrease of sensory nerve conduction velocity was associated with subjective complaints of pain and motor function (subjective index).

Extended Work Shifts Increase Subjective Pain Complaints Among Cabin Crewmembers, but Not Among Airline Pilots or Healthcare Workers: A Repeated-Measures Study.

To determine whether four consecutive extended work shifts are associated with an increased risk of subjective pain complaints, sleep duration, and sleep disturbances. Forty-three healthcare workers, 41 cabin crewmembers, and 18 airline pilots working 4 consecutive extended workdays reported subjective pain complaints and sleep after the 1st and 4th workday. The risk of headache (odds ratio [OR] 21.4, 95% confidence interval [CI] 1.85 to 246.5) and pain in the hands, arms, or wrists (OR 3.78, 95% CI 1.84 to 7.76) increased after workday 4 versus workday 1 in cabin crewmembers. Sleep duration was longer (0.6 to 1.1 hours), and sleep disturbances fewer, the night before the fourth extended workday, compared with before the first workday, in all occupations. We found no general support for an association between extended work shifts and subjective pain, whereas sleep duration was improved, and sleep disturbances reduced after 4 consecutive extended workdays.

Pain complaints after consecutive nights and quick returns in Norwegian nurses working three-shift rotation: an observational study

ObjectivesTo determine whether nurses working consecutive night shifts, or short transitions between shifts (quick returns (QRs)), yielded higher risk for pain complaints when compared with regular morning shifts. Sleep duration...

End-of-Life Care of Persons With Alzheimer Disease: An Update for Clinicians.

While end-of-life (EOL) care has been a relatively common option for patients with terminal cancer, the utilization of EOL care in Alzheimer disease and other dementias has become available more recently. By the time end-stage dementia is present, the clinicians and caregivers become faced with multiple clinical issues-their inability to provide subjective complaints of pain and discomfort, behavioral symptoms, delirium, food refusal, and so on. In addition to providing quality EOL care to the patients, clinicians need to work with their families in an open and empathic manner, assuring that their loved ones will receive supportive measures to keep them comfortable.

Pain complaints are associated with quick returns and insomnia among Norwegian nurses, but do not differ between shift workers and day only workers.

To determine whether common work schedule characteristics among Norwegian nurses were associated with subjective pain complaints. A cross-sectional study in a sample of 1585 nurses, part of the longitudinal questionnaire-based cohort project 'Survey of Shift work, Sleep and Health' (SUSSH). Pain from six regions were assessed: 'headache', 'neck/shoulder/upper back', 'upper extremities', 'lower back', 'lower extremities', and 'abdomen'. Logistic and negative binomial regression (adjusted for age, sex, percentage of full-time equivalent, marital status and children living at home) were conducted where work schedule, number of night shifts last year, number of quick returns (QR) last year (< 11h between shifts) and insomnia were predictors of localized pain, widespread pain and number of pain sites. Localized pain, widespread pain and number of pain sites were associated with insomnia (OR 2.06, 95% CI 1.66-2.55, OR 2.14, 95% CI 1.47-3.09, IRR 1.70, 95% CI 1.51-1.91, respectively). Work schedule and number of night shifts worked last year were not associated with any of the three pain measures. Number of QRs worked last year tended to be associated with number of pain sites. The study did not support the hypothesis that non-daytime work schedules are associated with pain complaints. Neither was there support for the hypothesis linking number of night shifts, or the number of QRs, to pain complaints. Future studies should aim to determine the association between QRs and pain in more detail. Pain complaints were associated with insomnia.

Surgical Outcome of External Dacryocystorhinostomy With Silicone Intubation for Recurrent Lacrimal Abscess in Children Younger Than 6 Years.

To assess the success rate of external dacryocystorhinostomy (DCR) with silicone intubation for recurrent lacrimal abscess in children younger than 6 years. A single-center retrospective analysis of 46 eyes of 40 children who underwent DCR with silicone tube intubation for recurrent lacrimal abscess was done. Probing done previously in these cases was unsuccessful. Only those children who underwent incision and drainage of the abscess at least once with antibiotic treatment were included in the study. In all cases, silicone tube removal was done after 3 months. A successful outcome was defined as the absence of subjective complaints of pain and swelling over the medial canthal area and watering and discharge at 6 months postoperatively. Objective assessment of patency of the lacrimal apparatus was done by sac syringing at 6 months postoperatively. The mean age at surgery was 4.93 ± 0.93 years (range: 3 to 6 years) and the mean follow-up duration was 11.80 ± 11.87 months (range: 6 to 84 months). Intra-operative difficulties encountered were excessive perisac adhesion (n = 28) and severe bleeding/hemorrhage (n = 24). A total of 82.61% cases had a successful outcome after DCR with silicon tube intubation. One child had granuloma formation at the wound. Spontaneous tube extrusion occurred in three children. DCR with silicone tube intubation is a safe and effective surgical approach with satisfactory outcomes for treating recurrent lacrimal abscess with congenital nasolacrimal duct obstruction in children younger than 6 years. [J Pediatr Ophthalmol Strabismus. 2019;56(3):188-193.].

The effect of Pilates exercises on treating low back pain

Introduction: Back pain is now a common problem. The study aimed to examine the effectiveness of Pilates exercises on the subjective spinal pain discomfort, degree of quality-of-life impairment and the lower back mobility. Material and methods: It was conducted in a group of 30 participants with chronic low back pain in whom, before and after the twelve-week Pilates exercise interventions, the level of subjective pain tolerance (VAS scale), lumbar spine mobility and the degree of quality-of-life impairment were assessed. Results: Involvement in the Pilates exercise programme helped to reduce subjective pain complaints, improved the spinal range of motion in all planes and enhanced the quality of life in all participants. Conclusions: The Pilates method is an effective tool in treating chronic low back pain.

Assessment of malpractice claims associated with rotator cuff surgery.

Rotator cuff surgery is a commonly performed and may lead to malpractice litigation. Despite this, there is a paucity of data evaluating outcomes of malpractice litigation following rotator cuff surgery.A retrospective investigation of the VerdictSearch legal claims database following rotator cuff surgery was performed. Plaintiff demographics, reason for litigation, and the effect of surgical complications were assessed as were the proportion of plaintiff rulings and size of payments.In total, 40 cases were analyzed. Mean age of plaintiffs was 52±11.2 years; 30 (75%) plaintiffs were male. Twenty-six cases (65% of suits) named pain and weakness as a complication of the procedure. In total, 60% (24) resulted in a defendant ruling, 25% (10) in a plaintiff ruling, and 15% (6) in a settlement. Total liabilities of the 40 cases were $15,365,321 with individual awards ranging from $75,000 to $5,000,000. Mean plaintiff award was $694,032±$586,835 (range: $75,000 to $1,900,000). Mean settlement amount was $1,404,167±$1,816,481 (range: $75,000 to $5,000,000).This study is the first examination of legal claims following rotator cuff surgery. Objective symptoms following surgery, such as decreased range of motion and rotator cuff weakness, as well as subjective complaints of pain and suffering were the most common reason for litigation, and when successful, led to indemnity payments averaging under $1 million each.

Severe Acne Inversa - Dermatosurgical Approach in a Bulgarian Patient.

We present a 55-year-old male patient - a smoker, admitted to a Medical Institute of MVR (Ministry of the interior, Sofia, Bulgaria), on occasion of pain and swellings, located in the area of both axillae, accompanied by purulent discharge, with bloody admixtures. Bilateral localised cystic rose above the skin surface, hyperpigmented nodules interconnected with multiple fistulas, was observed within the dermatological examination, resulting in a limitation of the possibility of movement of the hands in all directions. A subjective complaint of pain was obtained on palpation. Solid bilateral axillar cicatrices - formation was also established, which additional impeded the movements of the upper limbs. The disease was generalised affecting additional inguinal, femoral and perineal areas, while at this stage the patient refused categorically eventual photo documentation of them. The diagnosis of acne inversa was made based on the available clinical and para-clinical data, as dual antibiotic therapy with Clindamycin 300 mg, two times per day was initiated for two months, in combination with rifampicin 300 mg, two times per day also for two months. This led to a significant improvement in the clinic symptoms and the patient was hospitalised for radical surgery. A surgical management of the clinical findings was planned by an interdisciplinary team including surgeons and dermatologists. The procedure was performed under general anaesthesia. After a thorough cleaning of the operative field, a radical excision of the lesion in the left axillary and para axillar region was performed, comprising the skin and subcutaneous tissue forward the fascia pectoralis. Tissue was dissected in depth in the form of number 4, thereby creating the conditions for adaptation of the initially encountered communicating with each other skin defects. Two tubular drains were placed, followed by gradual suturing of skin and subcutaneous tissue with final applying of a sterile dressing. Effective medical treatment of patients (as in our case) with severe AI is limited. Adalimumab is the first biological approved for moderate to severe AI but does not result in stable CR (cure rate). Therefore its use in a neoadjuvant setting is under investigation. Wide local excision significantly reduces pain and improves the quality of life of AI patients. While local recurrences rate is low, the satisfaction with the cosmetic results is high. The recurrence rate is dependent on the region affected and the type of surgery. While in the axillary region primary closure may be used to reduce the time to healing, anogenital AI has the lowest recurrence rate of healing by secondary intention.

Particulated Juvenile Articular Cartilage Allograft Transplantation for Osteochondral Talar Lesions.

To report on our institution's early results from juvenile particulate cartilage allograft transplantation of the talus. Because of the relative rarity of the procedure at the talus, it was decided to provide a comprehensive understanding of the currently available evidence via a 2-part study with (1) a systematic review of the literature and (2) a retrospective single-center cohort study of the authors' patients, their demographics, and their early outcomes. (1) Four studies were included with 33 ankles with a weighted mean follow-up of 14.3 months. Only 1 ankle (3.3%) was converted to a revision open osteochondral allograft with medial malleolar osteotomy at 16 months postoperative; 6 (18.2%) required nonrevision type reoperations at an average of 15 months postoperative. (2) Six patients with mean age 35.7 ± 14.4 years were evaluated from the authors' institution at mean 13.04 ± 8.35 months' follow-up. All reported subjective improvements in pain and motion, and functional improvements, although postoperative magnetic resonance imaging in 3 patients at time points between 3 months and 2 years postoperative demonstrate persistent subchondral edema and nonuniform chondral surface in the talus. There were no intraoperative or postoperative complications, and there have been no reoperations. Preliminary data suggest that treatment of large, traumatic or atraumatic, symptomatic osteochondral talar defects with particulated juvenile cartilage transplantation may improve patient subjective complaints of pain and function. Systematic review of the available literature highlights the need for future prospective, larger cohort studies of its use on the talus but suggests similar potential for the technology.

Examining outcome of early physician specialist assessment in injured workers with shoulder complaints.

BackgroundThere is minimal research on demographics, type of injury and diagnosis of injured workers with shoulder problems. The purposes of this study were: 1) to document the demographics of patients with shoulder complaints referred to an Early Shoulder Physician Assessment (ESPA) Program and to describe the recommended management, and 2) to examine the relationship between patient characteristics and their subjective complaints of pain and functional difficulty.MethodsThis study involved a retrospective review of electronic files of injured workers mostly seen within the first 16 weeks of injury or recurrence. Measures of functional difficulty and pain were the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Numeric Pain Scale (NPS).ResultsFiles of 550 consecutive patients, 260 females (47%), 290 men (53%) were examined. The average age was 49 (SD = 11, range 22–77), with 28 (5%) patients being 65 years of age or older. Patients who were not working were the most disabled group based on Quick DASH (F = 49.93, p < 0.0001) and NPS (F = 10.24, p = 0.002). Patients who were working full time performing regular duties were the least disabled according to both measures, the QuickDASH (F = 10.24, p = 0.002) and NPS (F = 7.57, p = 0.006).Patients waiting more than 16 weeks were slightly older (53 years of age vs. 49, p = 0.045) than those who met the criteria for early assessment with similar levels of pain and functional difficulty. Biceps pathology had the highest prevalence (37%). Full thickness tear had a prevalence of 14%. Instability, labral lesions and osteoarthritis of glenohumeral joint were uncommon conditions (3, 2 and 1% respectively). Fifty-five patients (10%) were surgical candidates and had higher scores on QuickDASH (F = 7.16, p = 0.008) and NPS (F = 4.24, p = 0.04) compared to those who did not require surgery.ConclusionsThis study provides information on characteristics and prevalence of important variables in injured workers with shoulder problems and highlights the impact of these characteristics on pain and disability.

English

BACKGROUND AND OBJECTIVES: Present clinical study was conducted to evaluate advantages of field block for inguinal hernia repair, with respect to duration and quality of analgesia, haemodynamic stability, and speed of recovery by using 1% lidocaine with adrenaline. METHODS: Study was conducted on 50 patients posted for elective inguinal hernia repair. Field block was instituted with 1% lidocaine with adrenaline with mean volume of 35.48 ml to block ilioinguinal, iliohypogastric, genital branch of genitofemoral nerve with subcutaneous infiltration. Patients were observed for duration and quality of analgesia. Haemodynamic stability with PR, systolic and diastolic BP. Post anaesthesia recovery was assessed by using “criteria for fast track eligibility for ambulatory anaesthesia” after the surgery. Duration of analgesia was assessed with subjective complaint of pain (duration of onset of analgesia till the subjective complaint of pain). RESULTS: In the present study, the quality of analgesia was excellent in 72% of cases, good in 16%, fair in 8% and poor in 4%. The mean duration of analgesia was 201.02 min (160 min to 280 min). All patients were haemodynamically stable throughout the surgery. Using fast tract eligibility criteria for recovery all the patient had a score of 12 at 0 min and all of them had score of > 12 at 15 min and 30 min and were ready to be shifted toward from the OR bypassing the post anaesthesia recovery room. CONCLUSION: Thus field block for inguinal hernia repair is a safe technique, that provides excellent quality and prolonged analgesia, with rapid recovery and minimal to nil complications.

Postural Compensations and Subjective Complaints Due to Backpack Loads and Wear Time in Schoolchildren

This study investigated the effects of carrying weighted backpacks of up to 20% of body weight on the posture and pain complaints of elementary-school children. Craniovertebral, forward trunk lean and pelvic tilt angles were measured from sagittal photographs of 62 children (8-11 years old) before and after walking while carrying backpacks containing 10%, 15%, or 20% of body weight. Pain severity after a 6-minute walk with the loaded backpack was recorded. Subjective complaints of pain were assessed using a visual analog scale after walking. Repeated-measures ANOVA revealed statistically significant differences in postural angles and increased complaints of pain after walking with increased backpack loads. These results indicate that typical backpack loads create worsening postural changes due to backpack loads and time spent carrying those loads, putting children at increased risk for injury and pain, the latter of which is a strong predictor for back pain in adulthood.

Providing Quality Palliative Care in End-Stage Alzheimer Disease

Providing quality palliative care is a daunting task profoundly impacted by diminished patient capacity at the end of life. Alzheimer disease (AD) is a disorder that erases our memories and is projected to increase dramatically for decades to come. By the time the patients with AD reach the end stage of the disease, the ability of patients to provide pertinent subjective complaints of pain and discomfort would have vanished. Historical perspectives of palliative care, exploration of the AD process, ethical issues, and crucial clinical considerations are provided to improve the understanding of disease progression and quality of care for patients with end-stage AD.

Differential Reports of Pain and Depression Differentiate Mild Cognitive Impairment From Cognitively Intact Elderly Participants

Positive associations between pain and depression in the general population have been well characterized; however, the interplay between pain, depression, and early cognitive decline, characterized as mild cognitive impairment (MCI), is poorly understood. The current study examined the association of self-reported pain complaints (measured by the 36-item Short Form Health Survey) and self-reported depressive symptoms (measured by the 30-item Geriatric Depression Scale) in cognitively intact participants (n = 492) and participants with a clinical diagnosis of MCI (n = 83). Depressive symptoms and subjective reports of pain were significantly associated in the entire sample (r = .29; P < .0001). Multiple logistic regression modeling (adjusted for age, education, and APOE4 status as covariates) demonstrated that while depressive symptoms were positively associated with the diagnosis of MCI (P < .001), subjective pain reports were negatively associated with MCI (P < .002). While the negative association of subjective pain complaints with MCI might arguably be explained by the development of anosognosia, self-reports of depressive symptoms were actually increased in these participants, suggesting preserved insight into cognitive decline-associated symptoms. It is possible that preferential involvement of limbic circuitry in MCI could explain these findings. Future studies are needed to elucidate the reasons for the dissociation of pain and depressive symptoms in MCI described in the present article.

PM02 ASSESSMENT OF PAIN IN THE AMA6 GUIDES

Pain related impairment has been a divisive issue for the editors of the AMA Guides. While the First Edition was published in 1971, it was not until the Fourth Edition (1993) that pain was included. Modifications in the Fifth Edition (2000), Chapter 18, were confusing. The inclusion of the pain chapter is at odds with the editorial principles, based on evidence‐based medicine, validation and interrater physician reliability. The move towards disability in the Sixth Edition ensures the inclusion of Chapter 3 which is now simplified. In the absence of an objective anatomically based impairment assessed under Chapters 4 to 17, the subjective complaint of pain is allocated an impairment to a maximum of 3%. This is based on the written responses to the validated pain disability rating scale. Special pain rating impairments are allocated for migraine, trigeminal neuralgia, chronic regional pain syndrome and spinal cord injury.

Comparison of Patient and Surgeon Assessments of Pain in Oral and Maxillofacial Surgery

Pain perception is a physical sensation interpreted in the light of experience and is influenced by a great number of interacting factors. Clinicians are constantly required to combine subjective and objective information to determine optimal treatment of pain. In this study, the authors prospectively compare patients' subjective complaints of pain using the visual analog scale to the surgeons' assessment of pain using standard history and physical examination findings.

Comparison of SAGB QC "Classic" Titanium Port and Velocity&lt;SUP&gt;™&lt;/SUP&gt; Port: Pilot Phase Prospective Randomized Study on Perioperative and Short-term Postoperative Implantation Outcomes

Port implantation in adjustable gastric banding (AGB) is usually considered as the least compelling, however, it is one of the very important parts of the operation. Port placement can take up to 10% of the overall AGB operating time, and inadequate technique can result in complications in the short- and long-term postoperative period (port torsion, infection, protrusion, port-site persistent pain, etc). From Dec 2005-Feb 2006, 40 consecutive patients were recruited into a Pilot phase prospective randomized study and operated in a single institution by bariatric teams with >300 SAGB experience. In 2 patient groups, intraoperative and immediate postoperative outcomes of the SAGB QuickClose (SAGB QC) "classic" titanium port and Velocity port were compared. Recorded parameters were: preoperative BMI and sex; duration of port implantation (min); length of incision (mm); complications (signs of infection/skin reaction, port-torsion, protrusion, etc); port-site pain scoring (day 1, end of week 1 and 6 postoperatively). 1) Velocity port implantation time was significantly shorter than that in "classic" titanium port (mean 2.5 min vs 6 min, P<0.01). 2) Port-site skin incision was longer in the Velocity group (45 mm) compared to the "classic" titanium port group (35 mm). 3) Reduction in patient subjective pain complaints in favor of Velocity port recipients was noted in the immediate postoperative period but no difference at 6 weeks after the operation. 4) Port-site infection occurred in 1 patient from the "classic" titanium port group and in none in the Velocity group.

Poster 133: Sciatic nerve injury in an adolescent after airbag deployment: a case report.

Setting: Tertiary care pediatric hospital. Patient: 13-year-old girl with no significant prior medical history. Case Description: The patient was a restrained front-seat passenger involved in a motor vehicle collision; her feet were positioned on the dashboard of the car at the time of airbag deployment and her ankles were briefly forced to either side of her head. Radiographs for acute fractures were negative. She began to experience difficulty walking and required a walker and physical therapy. Temperature change (cool), dusky discoloration, and pain complaints were noted in her distal lower extremities. Vascular studies and spinal magnetic resonance imaging were without significant findings. Improvement was seen after several months, but she remained with toe walking and foot pain. Assessment/Results: Significant findings at time of exam included bilateral plantarflexion deformities, early fatigue of ankle dorsiflexors, mottled dark red coloring at feet and ankles, decreased ankle reflexes, and gait abnormality. Sensation was intact to touch and proprioception with subjective pain complaints over dorsal feet. Repeat Doppler studies were without significant findings, electromyography and nerve conduction studies demonstrated findings consistent with previous injury to the bilateral sciatic nerves. Discussion: Previous reports of nerve injury after airbag deployment have documented nerve injury in the shoulders, head, and neck areas. This case is the first report of nerve injury in the lower extremity. Conclusion: There is a risk of lower-extremity nerve injury from airbag deployment in persons who place their feet on vehicle dashboards. This behavior may be more prevalent among children and teenagers and therefore parental and general education as to the potential danger of this behavior should be considered.