Use Of Analgesic Drugs Research Articles

Laparoscopic vs Open Treatment for Gastric and Non-Gastric Gastrointestinal Stromal Tumors: a Two-Center Experience.

We retrospectively reviewed the medical records of 109 patients who underwent curative laparoscopic or open resection for different types of gastrointestinal stromal tumors (GIST). Only primary GIST patients who did not receive preoperative chemotherapy or oral imatinib treatment were included in the analysis. We divided the patients into 2 groups according to the surgical approach:a laparoscopic group (LAP) and a laparotomic group (OPEN). Our aim was to confirm the feasibility and safety of laparoscopic surgery for GISTs that differed in size and location, and to assess its long-term oncologic outcome in terms of overall survival (OS) and disease-free survival (DFS). Furthermore, we performed a surgical short-term outcome analysis. The two groups did not differ with respect to age at operation, gender, BMI or comorbidities. Even the NIH and AFIP risk classifications were not significantly different between the two groups. Furthermore, in our analysis, there was no significant difference in mean tumor size or location between the two groups. Wedge resection was the most frequently performed procedure. The conversion rate was 7.8%. The operative time was 194.75 (60- 350) min for the open group and 181.70 (57-480) min for the laparoscopic group. Our data clearly indicated that the long-term oncologic outcome and DFS of laparoscopic resection were not inferior to those of traditional open operations and laparoscopic resection was still feasible in cases with large tumors: the median size of the tumor was 4.5 cm (3-25) and the tumor was larger than 4.5 cm in 47.7% of the cases in the LAP group. With regard to short-term outcomes, our study demonstrated that the LAP group had fewer complications, faster gastrointestinal recovery, reduced use of analgesic drugs and shorter postoperative hospital stay (each p<0.05). In conclusion, our experience confirms that GISTs are very uncommon cancers for which the prognosis is closely related to size, localization and class of risk. In light of our clinical data, laparoscopic resection for gastric and non-gastric GISTs is a safe, feasible and oncologically correct procedure. The most important advantage of this technique is that it ensures a better postoperative outcome compared with open surgery, without worsening the prognosis.

Early and late results of direct superior approach versus direct lateral approach in total hip arthroplasty – single-center, prospective study

Introduction. Total hip arthroplasty (THA) is an established treatment for severe hip osteoarthritis (OA ). Traditionally, surgical approaches involved extensive soft tissue damage. New, less invasive approaches were introduced, facilitating fast recovery, reducing postoperative pain and incision length. Aim. Comparative analysis of postoperative pain and long-term results in patients undergoing total hip arthroplasty (THA) utilizing direct superior approach (DSA) and direct lateral approach (DLA). Materials and methods. Sixty-one patients scheduled for primary THA were included in the study. THA was performed utilizing the approach chosen by experienced orthopedic surgeons. After the procedure, pain intensity and use of analgesics were recorded daily. Patients were contacted 18 months following surgery to collect data on SF-36 score, pain intensity and complications (dislocations, infections, periprosthetic fractures, and revision surgeries). Fifty-two patients were included in the final analysis. Group A (DSA) consisted of 27 patients, whereas group B (DLA) consisted of 25 patients. Results. There were no significant differences between groups in terms of demographic parameters, preoperative pain intensity, Harris Hip Score, and SF-36 score. Significant differences were observed in pain intensity during the first three days post-operation. The use of non-opioid analgesics did not differ; however, the use of tramadol was lower in group A on the 1st and 2nd day post-operation. No significant differences were found in SF-36 score and pain intensity after 18 months post-surgery. Conclusions. DSA approach in THA is superior in comparison with the direct lateral approach in terms of early postoperative pain intensity and use of analgesic drugs. Late results of both approaches are comparable.

Development and Validation of a Predictive Model for Chronic Postsurgical Pain After Arthroscopic Rotator Cuff Repair: A Prospective Cohort Study.

Chronic pain management continues to present a significant challenge following arthroscopic shoulder surgery. Our purpose was to detect chronic postsurgical pain (CPSP) in patients who had undergone arthroscopic rotator cuff repair (ARCR) and develop a nomogram capable of predicting the associated risk. We collected the demographic and clinical data of 240 patients undergoing ARCR in our hospital from January 2021 to May 2022. The pain level was monitored and evaluated three months after ARCR. LASSO regression was used to screen out pain-predictingfactors, which were subsequently used to construct a nomogram. Internal validation was carried out using Bootstrap resampling. The data of 78 patients who underwent ARCR in our hospital from August 2022 to December 2022 were also collected for external verification of the nomogram. The predictive model was evaluated using the receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis (DCA). Age, duration of preoperative shoulder pain (DPSP), C-reactive protein (CRP), number of tear tendons, and American Shoulder and Elbow Surgical Score (ASES) were screened by LASSO regression as predictive factors for CPSP. These factors were then used to construct a chronic pain risk nomogram. The area under the curve (AUC) of the predictive and validation models were 0.756 (95% CI: 0.6386-0.8731) and 0.806 (95% CI: 0.6825-0.9291), respectively. Furthermore, the calibration curves and decision curve analysis (DCA) for both models indicated strong performance, affirming the reliability of this predictive model. The CPSP risk model that has been developed exhibits strong predictive capabilities and practical utility. It offers valuable support to clinical healthcare professionals in making informed treatment decisions, reducing the unnecessary use of analgesic drugs, and optimizing the allocation of medical resources.

Perioperative analgesia in the elderly.

The administration of analgesic drugs in elderly patients should take into account age-related physiological changes, loss of efficiency of homeostatic mechanisms, and pharmacological interactions with chronic therapies. Underestimation of pain in patients with impaired cognition is often linked to difficulties in pain assessment. In the preoperative phase, it is essential to assess the physical status, cognitive reserve, and previous chronic pain conditions to plan effective analgesia. Furthermore, an accurate pharmacological history of the patient must be collected to establish any possible interaction with the whole perioperative analgesic plan. The use of analgesic drugs with different mechanisms of action for pain relief in the intraoperative phase is a crucial step to achieve adequate postoperative pain control in older adults. The combined multimodal and opioid-sparing strategy is strongly recommended to reduce side effects. The use of various adjuvants is also preferable. Moreover, the implementation of non-pharmacological approaches may lead to faster recovery. High-quality postoperative analgesia in older patients can be achieved only with a collaborative interdisciplinary team. The aim of this review is to highlight the perioperative pain management strategies in the elderly with a special focus on intraoperative pharmacological interventions.

Five-Year Trajectories of Prescription Opioid Use

There are known risks of using opioids for extended periods. However, less is known about the long-term trajectories of opioid use following initiation. To identify 5-year trajectories of prescription opioid use, and to examine the characteristics of each trajectory group. This population-based cohort study conducted in New South Wales, Australia, linked national pharmaceutical claims data to 10 national and state data sets to determine sociodemographic characteristics, clinical characteristics, drug use, and health services use. The cohort included adult residents (aged ≥18 years) of New South Wales who initiated a prescription opioid between July 1, 2003, and December 31, 2018. Statistical analyses were conducted from February to September 2022. Dispensing of a prescription opioid, with no evidence of opioid dispensing in the preceding 365 days, identified from pharmaceutical claims data. The main outcome was the trajectories of monthly opioid use over 60 months from opioid initiation. Group-based trajectory modeling was used to classify these trajectories. Linked health care data sets were used to examine characteristics of individuals in different trajectory groups. Among 3 474 490 individuals who initiated a prescription opioid (1 831 230 females [52.7%]; mean [SD] age, 49.7 [19.3] years), 5 trajectories of long-term opioid use were identified: very low use (75.4%), low use (16.6%), moderate decreasing to low use (2.6%), low increasing to moderate use (2.6%), and sustained use (2.8%). Compared with individuals in the very low use trajectory group, those in the sustained use trajectory group were older (age ≥65 years: 22.0% vs 58.4%); had more comorbidities, including cancer (4.1% vs 22.2%); had increased health services contact, including hospital admissions (36.9% vs 51.6%); had higher use of psychotropic (16.4% vs 42.4%) and other analgesic drugs (22.9% vs 47.3%) prior to opioid initiation, and were initiated on stronger opioids (20.0% vs 50.2%). Results of this cohort study suggest that most individuals commencing treatment with prescription opioids had relatively low and time-limited exposure to opioids over a 5-year period. The small proportion of individuals with sustained or increasing use was older with more comorbidities and use of psychotropic and other analgesic drugs, likely reflecting a higher prevalence of pain and treatment needs in these individuals.

Sex and age differences in the use of analgesic drugs before and after primary total hip arthroplasty in 105,520 Danish patients

BackgroundWe examined analgesic drug use before and after total hip arthroplasty (THA) by sex and age, and impact of comorbidity in that context. MethodsUsing Danish nationwide medical registries, we included 105,520 THA patients (1996–2018). We calculated prevalence of overall analgesic drug use and use of NSAIDs and opioids separately in four quarters before (–Q4 to –Q1) and after THA (Q1 to Q4). –Q4 and Q4 was compared using prevalence rate ratios (PRR) with 95% confidence interval (CI). ResultsAmong women, analgesic drug use was 46% in –Q4, 65% in Q1, but decreased to 31% in Q4 (PRR: 0.68 (CI: 0.67–0.69)). Among men, these numbers were 39% in –Q4, 62% in Q1, and 23% in Q4 (PRR: 0.61 (CI: 0.60–0.63)). Analgesic drug use was higher among older patients in all quarters except Q1. Analgesic drug use decreased from 40% in –Q4 to 25% in Q4 (PRR: 0.62 (CI: 0.59–0.64)) in patients <55 years, and from 44% to 30% in patients >85 years, (PRR: 0.67 (CI: 0.63–0.71)). Women used more NSAIDs and opioids than men. Older patients used more opioids compared to younger, while variation in NSAID use by age was small. Decrease in analgesic drug use from -Q4 to Q4 was least pronounced in patients with comorbidity history. ConclusionsWomen and older patients have higher prevalence of analgesic drug use before and after THA, and a smallest reduction in analgesic drug use from before to after THA. Comorbidity history modified these associations.

Outcome of Partial Pulpotomy in Immature Permanent Teeth with Symptomatic Irreversible Pulpitis: A Prospective Case Series Assessment

IntroductionThe aim of this prospective case series was to assess the clinical and radiographic outcome of partial pulpotomy in caries-exposed symptomatic, vital, immature, permanent molars. MethodsThirty-four immature molars with deep caries and symptoms of irreversible pulpitis were treated by partial pulpotomy and ProRoot MTA as a capping material. After complete caries removal, the inflamed part of the pulp was removed. Complete hemostasis was achieved using a sterile cotton pellet moist initially with sodium hypochlorite 1.5% and then with sterile saline. ProRoot MTA (Dentsply Sirona, Charlotte, NC) was placed as a capping material onto the remaining pulp tissue. The cavity was sealed using a light-curing resin-modified Ca(OH)2 cavity liner, and patients were referred to a pediatric dentist for permanent restoration. Descriptive statistics and cross tabulations were performed including variables examined before, during, and after the procedure. ResultsAll examined teeth presented a favorable clinical and radiographic outcome with normal periapical tissues, complete apical closure, and formation of a dentinal bridge beneath the capping material. Signs of partial pulp chamber calcification were only detected in 2 cases. Postoperatively, most patients did not report any pain (23/34, 67.7%), whereas the rest reported minor intensity pain (11/34, 32.3) and the use of analgesic or anti-inflammatory drugs only for 1 day (10/34, 29.4%). ConclusionsPartial pulpotomy seems to provide a universally successful outcome when managing symptomatic vital immature teeth with no signs of complications and completion of apical closure. It could be a viable treatment of choice in cases of caries-exposed vital immature teeth with symptoms of irreversible pulpitis.

EVALUASI UPAYA PENGOBATAN SENDIRI (SWAMEDIKASI) MENGGUNAKAN OBAT ANALGETIKA-ANTIPIRETIKA PADA MASYARAKAT DESA JERUJU BESAR KALIMANTAN BARAT

Self-medication requires a good knowledge in order to run well. This study was conducted to determine the relationship and strength of the relationship in the selection of antipyretic analgesic drugs associated with age, education and occupation by the people of Jeruju Besar Village. This type of research is non-experimental with a questionnaire tool. Sampling using purposive sampling method. Respondents in this study were 378 respondents. The results showed that the people of Jeruju Besar Village were right in choosing the medicine for fever, headache and pain. Respondents received information on drug selection through health workers by 58.7% and the reasons for self-medication to recover quickly were 74%. The majority of respondents aged 40 years 52.6%, while the level of education is moderate - high 52.4%. Based on the Multiple Correlation test the strength of the relationship was obtained Perfect Correlation or perfect knowledge (0.981) and education (0.872), Strong Correlation occupation (0.698) and age (0.633). The conclusion of this study is that there is a relationship between the level of education, knowledge, on the use of antipyretic analgesic drugs.

Effects of Corrective Exercises on Work-Related Musculoskeletal Disorders and Quality of Life in Surgical Residents: A Pilot, Quasi-Experimental Study

Work-related musculoskeletal disorders (WMSDs) are one of the most important reasons for absenteeism, high costs of health care and human injuries; the latter are very common in medical staff. The present study was designed to evaluate the effects of corrective exercises on quality of life and work-related musculoskeletal disorders in surgical residents. In a quasi-experimental study with a one-group pretest-posttest design, we assessed the eligibility of 135 surgical assistants. All recruited participants performed corrective exercises and were followed for 12 months. The primary outcome of the study was any change in the surgical residents' work-related musculoskeletal disorders, which was assessed using the Nordic Musculoskeletal Questionnaire(NMQ) and the Numerical Pain Rating Scale (NPRS) prior to, and 3, 6, and 12 months after intervention. The secondary outcome was any change in the surgical residents' quality of life (QOL) score, which was assessed at baseline, 6 and 12 months after the intervention using the World Health Organization Quality of Life - BREF (WHOQOL-BREF) questionnaire. One hundred eligible surgical residents were enrolled, of whom 67 (67%) completed the study. At baseline the majority of the participants were female and >30 years of age. Fifty-five percent of them used analgesic drugs. The use of analgesic drugs per week fell by 14.7% from baseline to 12 months; the change was statistically significant (p = 0.042). The effect of corrective exercises on the intensity of pain in the shoulder (p = 0.002), hand/wrist (p = 0.001), upper back (p = 0.03), lower back (p = 0.02) and knee (p = 0.01) was significant. Corrective exercises also led to a significant rise in the quality-of-life score (p < 0.019). This study demonstrated the effectiveness of corrective exercises in reducing work-related musculoskeletal disorders and improving quality of life among surgical residents.

Postoperative Chronic Pain Syndrome and Risk Factors in Patients with Breast Surgery.

To investigate the incidence of chronic postoperative pain after different types of breast surgery, and investigate the risk factors associated with chronic postoperative pain. Descriptive study. Place and Duration of the Study: Ankara University, Faculty of Medicine, Ibnisina Hospital, from January to May 2021. Postoperative chronic pain syndrome and risk factors were investigated in 200 female patients who underwent breast surgery for different reasons. The relationships between preoperative chronic pain, analgesic drug use, number of previous surgeries, anxiety, depression levels, lifestyle, age, height, body mass index, education level, postoperative acute pain, and postoperative sixth-month pain level were statistically analysed. Chronic postoperative pain was observed at a rate of 30%. Postmastectomy syndrome was observed with a rate of 31.6%. A statistically significant relationship was found between preoperative chronic pain, smoking, analgesic use, and postoperative chronic pain (p<0.001). Total mastectomy, mastectomy and simultaneous reconstructive surgery, axillary surgery were associated with chronic pain (p<0.001). A strong correlation was observed between preoperative anxiety (r=0.758, p<0.001), depression (r=0.773, p<0.001), and chronic pain. Chronic postoperative pain and postmastectomy pain syndrome are found in almost one-third of the operated patients mainly related to preoperative smoking, analgesic use, breast cancer, and psychological state. Chronic pain, Breast neoplasms, Mastectomy, Anxiety, Depression.

REAC Neurobiological Modulation as a Precision Medicine Treatment for Fibromyalgia.

Fibromyalgia syndrome (FS) is a disorder characterized by widespread musculoskeletal pain and psychopathological symptoms, often associated with central pain modulation failure and dysfunctional adaptive responses to environmental stress. The Radio Electric Asymmetric Conveyer (REAC) technology is a neuromodulation technology. The aim of this study was to evaluate the effects of some REAC treatments on psychomotor responses and quality of life in 37 patients with FS. Tests were conducted before and after a single session of Neuro Postural Optimization and after a cycle of 18 sessions of Neuro Psycho Physical Optimization (NPPO), using evaluation of the functional dysmetria (FD) phenomenon, Sitting and Standing (SS), Time Up and Go (TUG) tests for motor evaluation, Fibromyalgia Impact Questionnaire (FIQ) for quality of life. The data were statistically analyzed, and the results showed a statistically significant improvement in motor response and quality of life parameters, including pain, as well as reduced FD measures in all participants. The study concludes that the neurobiological balance established by the REAC therapeutic protocols NPO and NPPO improved the dysfunctional adaptive state caused by environmental and exposomal stress in FS patients, leading to an improvement in psychomotor responses and quality of life. The findings suggest that REAC treatments could be an effective approach for FS patients, reducing the excessive use of analgesic drugs and improving daily activities.

Transvaginal natural orifice endoscopic surgery for ovarian cystectomy: a more suitable surgical approach for the day-care procedure.

Although previous studies have shown that vaginal natural orifice transluminal endoscopic surgery (vNOTES) has the advantages of causing less pain, faster recovery, and better concealment of surgical incisions, which aligns with the concept of the day-care procedure, this approach poses a greater risk of damaging adjacent organs (i. e., rectum and bladder) due to its anatomical specificity. Moreover, the day-care procedure may lead to relatively less preoperative evaluation and postoperative care. Hence, it is necessary to explore the safety and effectiveness of vNOTES for ovarian cystectomy in the day-care procedure, to provide a theoretical basis for the wider development of vNOTES surgery. This retrospective study included 131 patients at our hospital who underwent ovarian cystectomy from September 2021 to October 2022. Based on the surgical approach, patients were classified into transumbilical laparoendoscopic single-site surgery (LESS) and vNOTES groups. The patients' demographic characteristics and follow-up data were collected during the perioperative period and 1-month postoperatively. Vaginal natural orifice transluminal endoscopic surgery has less postoperative exhaust time, a lower postoperative 6-hour pain score, and a lower incidence of analgesic drug use, with higher surgical conversion incidence. Multiple linear regression analysis showed that the surgical conversion, chocolate cyst, bilateral cyst, and pelvic adhesion increased the operation duration by ~43 (95% CI: 10.309, 68.152, p < 0.001), 15 (95% CI: 6.342, 45.961, p = 0.036), 10 (95% CI: 3.07, 40.166, p = 0.019), and 8 (95% CI: 4.555, 26.779, p = 0.035) min, respectively. Interestingly, vNOTES decreased the operation duration by ~8.5 min (95% CI: -18.313, -2.699, p = 0.033). Vaginal natural orifice transluminal endoscopic surgery was equally safe and effective for ovarian cystectomy compared to LESS. vNOTES aligned with the concept of the day-care procedure due to its reduced postoperative pain, shorter exhaust time, and absence of scarring. However, surgeons should conduct a comprehensive preoperative evaluation and exclude patients suspected to have severe pelvic adhesions.

Effective removal of selected pharmaceuticals from sewerage treatment plant effluent using natural clay (Na-montmorillonite)

The consumption of pharmaceuticals has rapidly increased on a global scale due to the serious increase in Covid-19, influenza and respiratuar sinsityal virus, which is called “triple epidemic” in the world. The use of non-prescription analgesic and anti-inflammatory drugs (AAIDs), especially paracetamol, is higher compared to pre-pandemic. This increased the AAIDs load discharged to the aqueous media through sewerage treatment plant (STP). Therefore, simple and effective treatment options for removing AAIDs from STP effluents are needed. The aim of the study was to remove AAIDs (paracetamol, acetylsalicylic acid, codeine, diclofenac, ibuprofen, indomethacin, ketoprofen, mefenamic acid, naproxen, and phenylbutazone) from STP effluents by nearly pure natural clay Na-montmorillonite. The Na-montmorillonite taken from the Ordu region in the northern part of Turkey. Surface area of the Na-montmorillonite is 99.58 m2/g and CEC is 92.40 meq/100 g. The removal efficiencies of AAIDs using Na-montmorillonite were between 82 ± 5% (ibuprofen) and 94 ± 4% (naproxen). Paracetamol was used as a model compound in kinetic and isotherm model studies. Freundlich isotherm model and the pseudo second order kinetic model were the best-fit using the obtained experimental data. Film diffusion governed its rate mechanism. The paracetamol adsorption capacity was acquired as 244 mg/g at 120 min contact time at pH 6.5 at 25 °C. With this study, it could be shown that montmorillonite can be used effectively to eliminate paracetamol from STP effluent. Natural clay can be used as a simple, inexpensive and effective adsorbent for removing AAIDs from STP effluents.

Comparative analysis of clinical efficacy between laparoscopic and open pancreaticoduodenectomy.

Laparoscopic pancreaticoduodenectomy (LPD) is a technically demanding procedure but is gradually gaining acceptance in clinical practice. This study was performed to compare the short-term outcomes of LPD with open pancreaticoduodenectomy (OPD). The perioperative data of the patients who underwent LPD (n = 25) and OPD (n = 40) from January 1, 2017 to December 31, 2021 at Zhangjiagang Hospital Affiliated to Soochow University were collected and retrospectively analyzed. All patients received R0 resection, and none of the patients died within the perioperative period. The preoperative data (gender, age, body mass index [BMI], and preoperative bilirubin), the intraoperative data (operative time, number of retrieved lymph nodes), and postoperative data (level 1 monitoring time, postoperative fluid diet time, postoperative fluid feeding time, and hospitalization cost) were comparable between the 2 groups (P > .05). The estimated blood loss, abdominal drainage tube removal time, postoperative hospital stay, catheter removal time, and analgesic drug use were significantly lesser in the LPD group, when compared to the OPD group (P < .05). LPD is safe and feasible. Compared to OPD, LPD has less surgical trauma, less intraoperative bleeding, and faster postoperative recovery.

A prospective randomized study comparing the efficacy between povidone-iodine gargling and benzydamine hydrochloride for mucositis prevention in head and neck cancer patients receiving concurrent chemoradiotherapy

BackgroundConcurrent chemoradiation (CCRT) has been the standard treatment for organ preservation or locally advanced head and neck cancer (LAHNC). Radiation-induced oral mucositis (RIOM) is an important treatment-limiting toxicity. Benzydamine hydrochloride was recommended to prevent oral mucositis. Povidone-iodine had also been adopted to use as an oral rinse to prevent mucositis. ObjectiveThis study compared the efficacy between benzydamine hydrochloride and 0.1% povidone-iodine to prevent RIOM in HNC patients who received concurrent chemoradiotherapy. MethodsWe conducted a randomized control study in HNC patients receiving CCRT with curative intent. The stratification factors were primary site of disease, treatment modality, chemotherapy regimen, and schedule. The primary outcome was RIOM assessed by Oral Mucositis Assessment Scale (OMAS). Secondary outcomes included RIOM assessed by NCI-CTCAE, use of analgesic, antibiotics and anti-fungal drugs, hospitalization, and participant satisfaction. ResultsThere were 83 participants recruited for this study with 71 completing the trial. Demographic characteristics were well-balanced between both arms. The univariate regression analysis revealed that povidone-iodine correlated with less RIOM compared to benzydamine hydrochloride (coefficient −2.25, 95% CI -4.37 to −0.012, p-value 0.03). The incidence of grade III-IV CTCAE RIOM during the study period was 51.4% with benzydamine hydrochloride compared to 26.5% with 0.1% povidone iodine (p-value 0.032). The peak incidence of grade III-IV CTCAE RIOM occurred in the 7th week of treatment (40.5% vs. 11.8%, p-value 0.01). This indicated the efficacy of povidone-iodine to prevent severe RIOM which usually most severity in the last week of CCRT treatment. The multivariate analysis revealed that the CCRT setting (definitive vs. adjuvant) and gargling agents (povidone-iodine vs. benzydamine hydrochloride were the factors associated with RIOM. ConclusionThis study demonstrated higher efficacy of 0.1% povidone-iodine gargle than benzydamine hydrochloride in mucositis prevention.

The mediating role of early maladaptive schemas on the relationship between illness perception and pain coping strategies among adolescents diagnosed with migraine.

This study aimed to examine the mediating role of early maladaptive schemas on the relationship between illness-related perceptions and pain coping strategies among adolescents diagnosed with migraine. A total of 134 adolescents (aged 12-18 years) diagnosed with migraine with and without aura participated in the study. The Illness Perception Questionnaire, the Pain Coping Questionnaire, and the Early Maladaptive Schema Questionnaires Set for Children and Adolescents were used. The intensity of using desperate ways of coping with pain was higher among adolescents who perceive migraine as a chronic disease (β = 0.199, p < 0.05) even if they have episodic attacks and who have higher levels of coherency in understanding the illness (β = 0.256, p < 0.01). First, full mediations of over-vigilance/inhibition and impaired autonomy/performance schema domains on these relations were observed. Second, the increases in negative cognitive (β = 0.199, p < 0.05) and emotional (β = 0.280, p < 0.01) representations related to the consequences of the illness lead to an increase in the uncontrolled and frequent use of analgesic drugs where the partial mediating role of over-vigilance/inhibition schema domain on this correlation is observed. The perceptions about the negative as well as serious consequences of migraine are related to both the self-active behaviors (β = 0.181, p < 0.05) and the conscious cognitive attempts (β = 0.207, p < 0.05) as effective coping strategies, which is an unexpected finding. The disconnection/rejection schema domain had a full mediation role on both relations. The results suggest that early maladaptive schemas are essential factors that affect the migraine coping processes of adolescents.

Analgesic drug use in patients with STEMI: Current perspectives and challenges.

Therapy for patients with ST-elevation myocardial infarction (STEMI) has been a controversial topic since the introduction of thrombolytic agents in the 1980s. The use of morphine, fentanyl and lidocaine has increased substantially during this period. However, there is still limited evidence on their advantages and limitations. In this review, the clinical application, as well as future considerations of morphine, fentanyl and lidocaine in patients with ST segment elevation myocardial infarction were discussed.

Presence of depression and anxiety with distinct patterns of pharmacological treatments before the diagnosis of chronic fatigue syndrome: a population-based study in Taiwan

ObjectiveAn increased prevalence of psychiatric comorbidities (including depression and anxiety disorder) has been observed among patients with chronic fatigue syndrome (CFS). However, few studies have examined the presence of depression and anxiety disorder before the diagnosis of CFS. This study aimed to clarify the preexisting comorbidities and treatments associated with patients with subsequent CFS diagnosis in a population-based cohort in Taiwan.MethodsAn analysis utilizing the National Health Insurance Research Database of Taiwan was conducted. Participants included were 6303 patients with CFS newly diagnosed between 2000 and 2010 and 6303 age-/sex-matched controls.ResultsCompared with the control group, the CFS group had a higher prevalence of depression and anxiety disorder before the diagnosis of CFS. Sampled patients who took specific types of antidepressants, namely, selective serotonin reuptake inhibitors (adjusted odds ratio [aOR] = 1.21, 95% confidence interval [CI] 1.04–1.39), serotonin antagonists and reuptake inhibitors (SARI; aOR = 1.87, 95% CI 1.59–2.19), and tricyclic antidepressants (aOR = 1.46, 95% CI 1.09–1.95), had an increased risk of CFS. CFS risk was also higher among participants taking benzodiazepine, muscle relaxants, and analgesic drugs. A sub-group analysis revealed that SARI use was related to an increased risk of CFS in the depression, anxiety disorder, male, and female groups. In the depression and anxiety disorder groups, analgesic drug use was associated with an increased CFS risk. Nonpharmacological treatment administration differed between men and women.ConclusionThis population-based retrospective cohort study revealed an increased risk of CFS among populations with preexisting depression and anxiety disorder, especially those taking SARI and analgesic drugs.

The efficacy and safety of peri-tonsillar administrated agents on pain treatment after pediatric tonsillectomy: A network meta-analysis

We assessed the pain control efficacies and associated morbidities of drugs administered locally (around the tonsils) in pediatric patients undergoing a tonsillectomy. Randomized controlled trials up to April 2022 were retrieved from six databases. The treatment networks featured six interventions (ropivacaine, bupivacaine, levobupivacaine, ketamine, tramadol, and dexamethasone) and a control (placebo). The outcomes were the postoperative pain scores, the time to use of the first analgesic drugs, and postoperative nausea/vomiting. Both pairwise and network meta-analyses were performed. All treatments controlled pain at 1h and 1 day postoperatively. Although all agents tended to delay the time to the first analgesic drug, only bupivacaine, dexamethasone, ketamine, and tramadol significantly reduced the need for analgesics. No agent caused significant postoperative nausea or vomiting. The ranking hierarchy revealed that tramadol was superior in terms of pain control 1h postoperatively, the time to the first analgesic drug, and the number of analgesic doses required; however, it ranked third in terms of operative time. All drugs reduced postoperative pain. Tramadol was optimal in pain control, and dexamethasone also afforded good pain control with low incidences of nausea and vomiting.

Teknologi Augmented Reality Untuk Terapi Pijat Wajah Ibu Hamil Dengan Preeklamsia

Preeclampsia is a disease of pregnant women, causing many complaints, including dizziness. Massage is the right solution to reduce dizziness since the use of analgesic drugs is not recommended. Submission of massage information can be more effective through digital technology. The purpose of this research is to build an application based on Augmented Reality (AR) as a guide for facial massage movements for midwives and pregnant women to deal with complaints of dizziness for pregnant women. The method used is the Multimedia Development Life Cycle (MDLC), which consists of the stages of making a concept, making a design, collecting materials, combining materials, testing, and distribution. Black box testing on 10 scenarios produces a value of 100%, which means the application can run properly. In addition, usability testing using the System Usabilities Scale (SUS) method shows a value of 69.5, which means that the application has the "good" criteria and is acceptable to users.