Intranasal lidocaine for the treatment of migraine headache: a randomized, controlled trial.
Administration; Adolescent; Adult; Anesthetics; Confidence Intervals; Double-Blind Method; Female; Hospitals; Humans; Intranasal; Lidocaine/*administration & dosage; Local; Male; Middle Aged; Migraine without Aura/diagnosis/*drug therapy; Ohio; Pain Measurement; Patient Satisfaction; Reference Values; Severity of Illness Index; Teaching; Treatment Outcome
OBJECTIVE: To evaluate the effect of intranasal lidocaine for immediate relief (5 minutes) of migraine headache pain. METHODS: A randomized, double-blind, placebo-controlled clinical trial at two university-affiliated community teaching hospitals enrolled patients 18-50 years old with migraine headache as defined by the International Headache Society. Patients who were pregnant, lactating, known to abuse alcohol or drugs, or allergic to one of the study drugs, those who used analgesics within two hours, or those with a first headache were excluded. Statistical significance was assessed by using chi-square or Fisher's exact test for categorical variables and Student's t-test for continuous variables. Patients rated their pain on a 10-centimeter visual analog scale (VAS) prior to drug administration and at 5, 10, 15, 20, and 30 minutes after the initial dose. Medication was either 1 mL of 4% lidocaine or normal saline (placebo) intranasally in split doses 2 minutes apart and intravenous prochlorperazine. Medications were packaged so physicians and patients were unaware of the contents. Successful pain relief was achieved if there was a 50% reduction in pain score or a score below 2.5 cm on the VAS. RESULTS: Twenty-seven patients received lidocaine and 22 placebo. No significant difference was observed between groups in initial pain scores, 8.4 (95% CI = 7.8 to 9.0) lidocaine and 8.6 (95% CI = 8.0 to 9.2) placebo (p = 0.75). Two of 27 patients (7.4%, 95% CI = 0.8, 24.3) in the lidocaine group and three of 22 patients (13.6%, 95% CI = 2.8 to 34.9) in the placebo group had immediate successful pain relief (p = 0.47), with average pain scores of 6.9 (95% CI = 5.9 to 7.8) and 7.0 (95% CI = 5.8 to 8.2), respectively. No difference in pain relief was detected at subsequent measurements. CONCLUSION: There was no evidence that intranasal lidocaine provided rapid relief for migraine headache pain in the emergency department setting.
Blanda M; Rench T; Gerson L W; Weigand J V
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2001
2001-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2001.tb02111.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2001.tb02111.x</a>
A single restraint stress exposure potentiates analgesia induced by intrathecally administered DAGO.
Ala(2)-MePhe(4)-Gly(5)-; Analgesics/*pharmacology; Analysis of Variance; Animals; Drug Synergism; Enkephalin; Enkephalins/*pharmacology; Injections; Male; Pain Measurement; Physical; Physiological/*physiopathology; Rats; Reaction Time; Restraint; Spinal; Sprague-Dawley; Stress
In rats, restraint exposure potentiates the magnitude and duration of analgesia following both the peripheral and intracerebroventricular administration of several opioid agonists as compared to non-stressed controls. It has been suggested that the site of action whereby restraint leads to potentiated opioid analgesia is located supraspinally. However, the possible contribution of spinal analgesic mechanisms also warrants investigation. Thus, the purpose of the present study was two-fold: (1) to determine whether a single exposure to restraint stress would result in the dose-dependent potentiation of analgesia following the intrathecal (i.t.) administration of the mu (mu)-receptor selective opioid agonist [D-Ala2,N-Me-Phe4,Gly5-ol]enkephalin (DAGO) and (2) to quantify the degree of analgesia in restrained vs. non-restrained rats using the tail-flick and hot-plate analgesic assays. Using rats implanted with chronic i.t. cannula, dose- and time-course curves were observed following the i.t. administration of DAGO. The results demonstrate that both the duration and magnitude of analgesia was significantly potentiated in restrained rats compared to non-restrained controls. Restraint-treated rats receiving 0.15-0.6 micrograms of DAGO i.t. showed 1.3-1.5-fold potentiation of analgesia in the tail-flick assay and a 2.3-5.6-fold potentiation using the hot-plate assay. Restraint immobilization potentiated the magnitude and duration of DAGO-induced analgesia administered by the i.t. route as measured by the tail-flick and hot-plate assays. These data suggest that spinal analgesic mechanisms significantly contribute to the enhanced analgesic potency of opioids in subjects exposed to restraint stress.
Calcagnetti D J; Stafinsky J L; Crisp T
Brain research
1992
1992-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/0006-8993(92)91689-c" target="_blank" rel="noreferrer noopener">10.1016/0006-8993(92)91689-c</a>
From mechanisms to management: translating the neuropathic pain consensus recommendations into clinical practice.
Adult; Female; Aged; Inflammation; Pain Measurement; Comorbidity; Education; Neoplasm Metastasis; Drugs; Perception; Clinical Trials; Middle Age; Sarcoidosis; Analgesics; Drug Therapy; Combination; Antidepressive Agents; Treatment Outcomes; Cancer Patients; Chronic Pain; Treatment Duration; Breast Neoplasms; Visual Analog Scaling; Lung Neoplasms; Melanoma; Rectal Neoplasms; Continuing (Credit); Transdermal Patches; Lidocaine – Administration and Dosage; Analgesics – Administration and Dosage; Analgesics – Adverse Effects; Cytokines – Physiology; Gabapentin – Administration and Dosage; Neural Transmission – Physiology; Neuralgia – Classification; Neuralgia – Drug Therapy; Neuralgia – Physiopathology; Opioid – Administration and Dosage; Peripheral Nervous System – Physiopathology; Tramadol – Administration and Dosage; Tricyclic – Administration and Dosage
Chronic neuropathic pain poses a treatment challenge, and is associated with significant psychologic distress, physical disability, and impaired functioning, which impact the activities of daily living. Efforts to provide relief are often inadequate and/or require polypharmacy. This has spurred interest among researchers and clinicians alike to develop early, intensive treatments that target the molecular and cellular mechanisms involved in pain transduction, transmission, and modulation, or ideally, that prevent neuropathic pain from occurring in the first place. Currently, researchers are attempting to capitalize on our understanding of neuropathic pain pathophysiology to develop drugs that interrupt distinct activities involved in its perpetuation. In this regard, several potential agents (eg, NMDA and AMPA/kainate antagonists) are in phase 2 and 3 clinical trials. In the interim, evolving data and evidence-based neuropathic treatment recommendations provide guidance for selecting first- and second-line medications that alone or in combination offer acceptable neuropathic pain control and allow clinicians to bridge the gap between current knowledge and its application in the clinical setting. Hopefully, as basic and clinical science progresses, further treatment advances and management tools will be found to improve the care of patients who live with neuropathic pain.
Chevlen E; Davies PS; Rhiner M
Journal of the American Academy of Nurse Practitioners
2005
2005-06-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
A novel method for treatment of lumbar spinal stenosis in high-risk surgical candidates: pilot study experience with percutaneous remodeling of ligamentum flavum and lamina.
Adult; Female; Humans; Male; Middle Aged; Aged; Pilot Projects; Follow-Up Studies; Risk Factors; Prospective Studies; Pain Measurement; Equipment Design; Comorbidity; Disability Evaluation; Conscious Sedation; Fluoroscopy; Ligamentum Flavum/*surgery; Lumbar Vertebrae/*surgery; Minimally Invasive Surgical Procedures/*instrumentation; Postoperative Complications/diagnosis/*prevention & control; Spinal Stenosis/*surgery; Anesthesia; Human; Pilot Studies; Middle Age; 80 and over; Local; Ligaments; Decompression; Surgical/*instrumentation; 80 and Over; Spinal Stenosis – Surgery; Postoperative Complications – Diagnosis; Articular – Surgery; Lumbar Vertebrae – Surgery; Minimally Invasive Procedures – Equipment and Supplies; Postoperative Complications – Prevention and Control; Surgical – Equipment and Supplies
OBJECT: treatment of lumbar spinal stenosis (LSS) in chronically ill or debilitated patients is challenging. The percutaneous remodeling of ligamentum flavum and lamina (PRLL) technique is a novel method for decompression of the hypertrophic ligamentum flavum component of LSS that is performed using a fluoroscopically guided percutaneous approach, local anesthesia, and minimal sedation. METHODS: fourteen patients deemed to be at high risk for complications related to open spine surgery and general anesthesia were treated using the PRLL technique. Prospectively collected visual analog scale (VAS) and Oswestry Disability Index (ODI) data were analyzed at the most recent follow-up. The average follow-up duration was 23.5 weeks. RESULTS: a statistically significant improvement in VAS scores was observed, with a reduction in pain of 53% compared with preoperative levels. In contrast, the ODI scores failed to improve. CONCLUSIONS: this pilot series points to a potential new therapeutic option for LSS in high-risk surgical patients.
Chopko Bohdan Wolodymyr
Journal of neurosurgery. Spine
2011
2011-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3171/2010.9.SPINE091012" target="_blank" rel="noreferrer noopener">10.3171/2010.9.SPINE091012</a>
Impact of reirradiation of painful osseous metastases on quality of life and function: a secondary analysis of the NCIC CTG SC.20 randomized trial.
*Quality of Life; 80 and over; Adult; Aged; Bone Neoplasms/complications/psychology/*radiotherapy/*secondary; Dose Fractionation; Emotions; Female; Health Status; Humans; Male; Mental Health; Middle Aged; Pain Measurement; Pain/diagnosis/etiology/*prevention & control/psychology; Radiation; Retreatment; Surveys and Questionnaires; Time Factors; Treatment Outcome; Young Adult
PURPOSE: We previously demonstrated that 48% of patients with pain at sites of previously irradiated bone metastases benefit from reirradiation. It is unknown whether alleviating pain also improves patient perception of quality of life (QOL). PATIENTS AND METHODS: We used the database of a randomized trial comparing radiation treatment dose fractionation schedules to evaluate whether response, determined using the International Consensus Endpoint (ICE) and Brief Pain Inventory pain score (BPI-PS), is associated with patient perception of benefit, as measured using the European Organisation for Resesarch and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and functional interference scale of the BPI (BPI-FI). Evaluable patients completed baseline and
Chow Edward; Meyer Ralph M; Chen Bingshu E; van der Linden Yvette M; Roos Daniel; Hartsell William F; Hoskin Peter; Wu Jackson S Y; Nabid Abdenour; Tissing-Tan Caroline J A; Oei Bing; Babington Scott; Demas William F; Wilson Carolyn F; Wong Rebecca K S; Brundage Michael
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
2014
2014-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1200/JCO.2014.57.6264" target="_blank" rel="noreferrer noopener">10.1200/JCO.2014.57.6264</a>
Single versus multiple fractions of repeat radiation for painful bone metastases: a randomised, controlled, non-inferiority trial.
*Dose Fractionation; *Radiotherapy; Aged; Analgesics – Therapeutic Use; Analgesics/therapeutic use; Australia; Bone Neoplasms; Bone Neoplasms – Complications; Bone Neoplasms – Radiotherapy; Bone Neoplasms/complications/*radiotherapy/*secondary; Brief Pain Inventory; Canada; Cauda Equina; Chi Square Test; Chi-Square Distribution; Clinical Assessment Tools; Clinical Trials; Computer-Assisted; Computer-Assisted – Adverse Effects; Computer-Assisted/adverse effects; Europe; Female; Fractures; Funding Source; Human; Humans; Intention to Treat Analysis; Israel; Logistic Models; Logistic Regression; Male; Middle Age; Middle Aged; New Zealand; Odds Ratio; Pain – Diagnosis; Pain – Drug Therapy; Pain – Etiology; Pain – Radiotherapy; Pain Measurement; Pain/diagnosis/drug therapy/*etiology/*radiotherapy; Questionnaires; Radiation; Radiation Dosage; Radiotherapy; Radiotherapy Planning; Risk Factors; Scales; Spinal Cord Compression – Etiology; Spinal Cord Compression/etiology; Spontaneous – Etiology; Spontaneous/etiology; Surveys and Questionnaires; Time Factors; Treatment Outcome; Treatment Outcomes
BACKGROUND: Although repeat radiation treatment has been shown to palliate pain in patients with bone metastases from multiple primary origin sites, data for the best possible dose fractionation schedules are lacking. We aimed to assess two dose fractionation schedules in patients with painful bone metastases needing repeat radiation therapy. METHODS: We did a multicentre, non-blinded, randomised, controlled trial in nine countries worldwide. We enrolled patients 18 years or older who had radiologically confirmed, painful (ie, pain measured as \textgreater/=2 points using the Brief Pain Inventory) bone metastases, had received previous radiation therapy, and were taking a stable dose and schedule of pain-relieving drugs (if prescribed). Patients were randomly assigned (1:1) to receive either 8 Gy in a single fraction or 20 Gy in multiple fractions by a central computer-generated allocation sequence using dynamic minimisation to conceal assignment, stratified by previous radiation fraction schedule, response to initial radiation, and treatment centre. Patients, caregivers, and investigators were not masked to treatment allocation. The primary endpoint was overall pain response at 2 months, which was defined as the sum of complete and partial pain responses to treatment, assessed using both Brief Pain Inventory scores and changes in analgesic consumption. Analysis was done by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00080912. FINDINGS: Between Jan 7, 2004, and May 24, 2012, we randomly assigned 425 patients to each treatment group. 19 (4%) patients in the 8 Gy group and 12 (3%) in the 20 Gy group were found to be ineligible after randomisation, and 140 (33%) and 132 (31%) patients, respectively, were not assessable at 2 months and were counted as missing data in the intention-to-treat analysis. In the intention-to-treat population, 118 (28%) patients allocated to 8 Gy treatment and 135 (32%) allocated to 20 Gy treatment had an overall pain response to treatment (p=0.21; response difference of 4.00% [upper limit of the 95% CI 9.2, less than the prespecified non-inferiority margin of 10%]). In the per-protocol population, 116 (45%) of 258 patients and 134 (51%) of 263 patients, respectively, had an overall pain response to treatment (p=0.17; response difference 6.00% [upper limit of the 95% CI 13.2, greater than the prespecified non-inferiority margin of 10%]). The most frequently reported acute radiation-related toxicities at 14 days were lack of appetite (201 [56%] of 358 assessable patients who received 8 Gy vs 229 [66%] of 349 assessable patients who received 20 Gy; p=0.011) and diarrhoea (81 [23%] of 357 vs 108 [31%] of 349; p=0.018). Pathological fractures occurred in 30 (7%) of 425 patients assigned to 8 Gy and 20 (5%) of 425 assigned to 20 Gy (odds ratio [OR] 1.54, 95% CI 0.85-2.75; p=0.15), and spinal cord or cauda equina compressions were reported in seven (2%) of 425 versus two (\textless1%) of 425, respectively (OR 3.54, 95% CI 0.73-17.15; p=0.094). INTERPRETATION: In patients with painful bone metastases requiring repeat radiation therapy, treatment with 8 Gy in a single fraction seems to be non-inferior and less toxic than 20 Gy in multiple fractions; however, as findings were not robust in a per-protocol analysis, trade-offs between efficacy and toxicity might exist. FUNDING: Canadian Cancer Society Research Institute, US National Cancer Institute, Cancer Council Australia, Royal Adelaide Hospital, Dutch Cancer Society, and Assistance Publique-Hopitaux de Paris.
Chow Edward; van der Linden Yvette M; Roos Daniel; Hartsell William F; Hoskin Peter; Wu Jackson S Y; Brundage Michael D; Nabid Abdenour; Tissing-Tan Caroline J A; Oei Bing; Babington Scott; Demas William F; Wilson Carolyn F; Meyer Ralph M; Chen Bingshu E; Wong Rebecca K S
The Lancet. Oncology
2014
2014-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/S1470-2045(13)70556-4" target="_blank" rel="noreferrer noopener">10.1016/S1470-2045(13)70556-4</a>
Gender and age make no difference in the re-irradiation of painful bone metastases: A secondary analysis of the NCIC CTG SC.20 randomized trial.
*Age; *Bone metastases; *Gender; *Pain response; *Quality of life; *Radiotherapy; *Re-irradiation; Age Factors; Aged; Bone Neoplasms/physiopathology/*radiotherapy/*secondary; Cancer Pain/etiology/*radiotherapy; Female; Humans; Male; Middle Aged; Pain Measurement; Palliative Care/methods/statistics & numerical data; Patient Reported Outcome Measures; Physicians'/*statistics & numerical data; Practice Patterns; Quality of Life; Re-Irradiation; Sex Factors
BACKGROUND AND PURPOSE: Patient's gender and age may influence physicians in prescribing palliative radiotherapy. The purpose of this secondary analysis of the National Cancer Institute of Canada Clinical Trials Group Symptom Control Trial SC.20 was to explore the gender and age differences in pain and patient reported outcomes in cancer patients with bone metastases undergoing re-irradiation. MATERIALS AND METHODS: Response to radiation was evaluated using the International Bone Metastases Consensus Endpoint Definitions. Patients completed the Brief Pain Inventory (BPI) and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (C30) before and 2months after re-irradiation. RESULTS: A total of 847 patients were analyzed. At baseline, men had more dyspnea, and mild pain. Older patients consumed less analgesic. More women reported clinically significant improvement in mood and enjoyment of life in the BPI after radiation. Similarly, younger patients reported better improvement in enjoyment of life. There were no significant gender or age differences in overall survival, response to radiation, or in C30 scores at 2months. CONCLUSION: Similar benefit in terms of pain relief was observed across all patient groups. Cancer patients with bone metastases should be offered palliative re-irradiation irrespective of gender or age. TRIAL REGISTRATION: NCT00080912; https://clinicaltrials.gov/ct2/show/NCT00080912.
Chow Ronald; Ding Keyue; Ganesh Vithusha; Meyer Ralph M; van der Linden Yvette M; Roos Daniel; Hartsell William F; Hoskin Peter; Wu Jackson S Y; Nabid Abdenour; van Acht Manouk; Wanders Rinus; Babington Scott; Demas William F; Wilson Carolyn F; Wong Rebecca K S; Brundage Michael; Zhu Liting; Chow Edward
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
2018
2018-03
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<a href="http://doi.org/10.1016/j.radonc.2017.10.006" target="_blank" rel="noreferrer noopener">10.1016/j.radonc.2017.10.006</a>
effect of an interprofessional pain service on nonmalignant pain control.
chronic pain; chronic pain; DISCHARGE planning; HEALTH literacy; HEALTH occupations students; INTERDISCIPLINARY education; LENGTH of stay in hospitals; MEDICAL appointments & schedules; MEDICAL care; MEDICAL personnel & patient; MEDICAL protocols; MEDICAL records; MEDICAL referrals; MEDICALLY underserved persons; medication therapy management; MORPHINE; opioid; pain management; pain management; PAIN measurement; PATIENT education; PATIENT satisfaction; pharmacist; pharmacists; RETROSPECTIVE studies; SUBSTANCE abuse; SURVEYS; TELEPHONES; THERAPEUTIC use of narcotics
Purpose The primary objective of this project was to evaluate an existing interprofessional, nonmalignant pain service by measuring the difference in patient pain scores (numeric rating scale-11) before and after a pharmacist-led pain education class and medication therapy management (MTM) visit. Secondary objectives included determining the percentage of pharmacist recommendations approved, patient satisfaction, and difference in immediate release (IR) and extended release (ER) opioid use before and after enrollment. Methods Baseline data were obtained from a retrospective chart review. Enrolled patients attended an educational pain class with the pharmacist. At the MTM visit with the pharmacist 3–14 days after the initial education class, the patient's pain score was assessed along with his/her medication use, and a care plan was developed and forwarded to the referring provider for implementation. Three months after the pain class and participation in the MTM visit, patients were contacted via telephone to complete a survey. The survey questions assessed patient satisfaction with the pain education program, their current pain score, and their knowledge of information covered during the pain class. Results Patients reported an average preenrollment pain score of 8.3/10 (n = 39) and a post-survey pain score of 5.6/10 (n = 39). The IR opioid use averaged 19.7 morphine equivalent daily dose (MEDD) at enrollment and decreased by 40% to 11.8 MEDD. The provider approval rate of the pharmacist-recommended interventions ranged from 80% to 92%, depending on the predesignated disease state category. Conclusion An interprofessional, nonmalignant-pain service including a pharmacist-led class resulted in a decrease in average pain scores and MEDD in an underserved population. [ABSTRACT FROM AUTHOR]
Coffey Cory P; Ulbrich Timothy R; Baughman Kristin R; Awad Magdi H
American Journal of Health-System Pharmacy
2019
2019-06
<a href="http://doi.org/10.1093/ajhp/zxy084" target="_blank" rel="noreferrer noopener">10.1093/ajhp/zxy084</a>
Using established predictors of post-traumatic stress to explain variations in recovery outcomes among orthopedic patients.
*Recovery of Function; 80 and over; 80 and Over; activity; Adult; adults; Aged; Arthroplasty; Clinical Assessment Tools; Coefficient Alpha; Comorbidity; Depression; Descriptive Statistics; disability; Disabled; distress; Female; Funding Source; health care; Hip Fractures – Surgery; Hip/*psychology; Human; Humans; Knee; Knee/*psychology; Male; Middle Age; Middle Aged; Ohio; Orthopedic Surgery; outcomes; P-Value; Pain; Pain Measurement; Post-Traumatic – Risk Factors; Post-Traumatic/*etiology; Prospective Studies; Record Review; Recovery; Regression; Regression Analysis; Replacement; Risk Assessment; Scales; Stress Disorders; T-Tests; Treatment Outcomes; Walking
The present studies examine whether information contained in medical records can be used to predict outcomes following two orthopedic procedures: repair of hip fracture and total knee replacement. Study 1 reports the acute, in-hospital recovery data from the medical records of 119 hip fracture patients. Study 2 is a prospective, longitudinal investigation of 3-month postoperative recovery of 110 total knee replacement patients. Patients characterized by a greater number of post-traumatic stress risk factors experienced poorer outcomes following orthopedic surgery. Our results suggest that patients at risk for negative outcomes can be identified by information readily available to medical personnel.
Cremeans-Smith Julie K; Contrera Kevin; Speering Leann; Miller Eric T; Pfefferle Kiel; Greene Kenneth; Delahanty Douglas L
Journal of Health Psychology
2015
2015-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/1359105313511135" target="_blank" rel="noreferrer noopener">10.1177/1359105313511135</a>
Trauma history as a resilience factor for patients recovering from total knee replacement surgery.
Female; Male; Ohio; Aged; Risk Factors; Pain Measurement; Arthroplasty; Psychological Tests; Human; Descriptive Statistics; Funding Source; Scales; Middle Age; Coefficient Alpha; Effect Size; Clinical Assessment Tools; Impact of Events Scale; T-Tests; Trauma; Stress; Recovery; Replacement; Psychological; Post-Traumatic; Stress Disorders; STATISTICS; RESEARCH funding; POST-traumatic stress disorder; DESCRIPTIVE statistics; TREATMENT effectiveness; CONVALESCENCE; CORRELATION (Statistics); EFFECT sizes (Statistics); LIFE change events; LIFE skills; OHIO; PAIN measurement; PSYCHOLOGICAL tests; REHABILITATION; RESILIENCE (Personality trait); STRESS (Psychology); T-test (Statistics); TOTAL knee replacement; WOUNDS & injuries; Treatment Outcomes; Bivariate Statistics; Center for Epidemiological Studies Depression Scale; Functional Status; Hardiness; 80 and Over; Knee – Psychosocial Factors; Knee – Rehabilitation; TOTAL knee replacement – Psychological aspects
Research concerning the impact of trauma history on individuals' ability to cope with subsequent events is mixed. While many studies find that trauma history increases vulnerability for conditions such as post-traumatic stress disorder and chronic pain, others reveal that there are benefits associated with moderate levels of stress (e.g. development of coping skills). Objective: The present study investigated whether the experience of prior traumatic stressors would serve as a risk or resilience factor based on physical and emotional outcomes among patients recovering from total knee replacement surgery (TKR). Design: 110 patients undergoing unilateral, TKR completed surveys before surgery, as well as one and three months following the procedure. Results: Contrary to hypotheses, patients who reported more prior traumas experienced less severe pain and functional limitations at one- (β = −.259,p = .006) and three-month follow-up assessments (β = −.187,p = .04). A similar pattern emerged when specific types of traumas (e.g. interpersonal) were examined in relation to physical recovery. Further, patients’ trauma history was negatively related to symptoms of post-traumatic stress three-months following surgery (e.g. Avoidance:β = −.200,p = .037). Conclusion: Trauma history represents a source of resilience, rather than vulnerability, within the context of arthroplastic surgery. [ABSTRACT FROM PUBLISHER]
Cremeans-Smith Julie K; Greene Kenneth; Delahanty Douglas L
Psychology & Health
2015
2015-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1080/08870446.2014.1001391" target="_blank" rel="noreferrer noopener">10.1080/08870446.2014.1001391</a>
Analgesic effects of serotonin and receptor-selective serotonin agonists in the rat spinal cord.
Male; Animals; Rats; Pain Measurement; Piperazines/pharmacology; Spinal Cord/*physiology; Tetrahydronaphthalenes/pharmacology; Injections; Amphetamines/pharmacology; Biguanides/pharmacology; Serotonin Antagonists/pharmacology; Reaction Time/drug effects; *Analgesics; 8-Hydroxy-2-(di-n-propylamino)tetralin; Serotonin/*pharmacology; Inbred Strains; Receptors; Spinal; Serotonin/*drug effects/physiology
1. Serotonin (5-HT) and selective 5-HT receptor agonists were administered intrathecally (i.t.) in rats, and the antinociceptive efficacy of these agents was assessed on the tail-flick and hot plate tests. 2. The 5-HT receptor agonists examined in this study included the 5-HT1A agonist
Crisp T; Stafinsky J L; Spanos L J; Uram M; Perni V C; Donepudi H B
General pharmacology
1991
1905-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/0306-3623(91)90441-8" target="_blank" rel="noreferrer noopener">10.1016/0306-3623(91)90441-8</a>
Efficacy of intravenous lidocaine to reduce pain and distress associated with propofol infusion in pediatric patients during procedural sedation.
Female; Male; Child; Infant; Prospective Studies; Pain Measurement; Analysis of Variance; Placebos; Injections; Human; Chi Square Test; Preschool; Intravenous; Anesthetics; Treatment Outcomes; Double-Blind Studies; Hypnotics and Sedatives – Administration and Dosage; Lidocaine – Administration and Dosage; Local – Administration and Dosage; Propofol – Administration and Dosage
BACKGROUND: Research suggests that young children experience an increased incidence and severity of discomfort during propofol infusion. Evaluations of varied interventions to reduce or eliminate this discomfort with adult subjects suggest that premedication with intravenously administered lidocaine (0.5 mg/kg) offers the best overall effectiveness. OBJECTIVE: Because this regimen's efficacy in a pediatric population is undocumented, we conducted a randomized, double-blind, placebo-controlled study to determine the effectiveness of intravenous lidocaine pretreatment to alleviate pain in pediatric subjects before propofol infusion. METHODS: Subjects (aged 2-7 years) scheduled for painless diagnostic procedures received either a saline placebo or 1 of 2 lidocaine doses before administering propofol. To capture the patient's baseline behavioral state, a trained observer administered the validated Face, Legs, Activity, Cry, Consolability Pain Assessment Scale before propofol infusion. During deep sedation induction, the sedating physician, a trained research assistant, and the patient's parent documented maximum distress using a 100-mm visual analog scale (VAS). RESULTS: Ninety-one subjects participated. We found no difference in VAS pain scores between groups pretreated with lidocaine 0.25 mg/kg, lidocaine 0.5 mg/kg, and placebo. Statistical analysis also found no interrater differences between parents, physician, or observer VAS scores. CONCLUSIONS: Our data do not support using lidocaine pretreatment to alleviate pain/discomfort in pediatric patients during propofol infusion.
Depue K; Christopher NC; Raed M; Forbes ML; Besunder J; Reed MD
Pediatric emergency care
2013
2013-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/PEC.0b013e31827b227e" target="_blank" rel="noreferrer noopener">10.1097/PEC.0b013e31827b227e</a>
Phase I/II prospective trial of autologous platelet tissue graft in gynecologic surgery.
80 and over; Adult; Aged; Autologous/*adverse effects/methods; Case-Control Studies; Female; Gynecologic Surgical Procedures/adverse effects/*methods; Humans; Middle Aged; Pain; Pain Measurement; Platelet-Rich Plasma/*physiology; Postoperative/*therapy; Transplantation
STUDY OBJECTIVE: To perform the original phase I/II trial of autologous platelet tissue graft in gynecologic surgery to evaluate toxicity and efficacy on decreasing pain. DESIGN: Prospective nonrandomized trial (Canadian Task Force classification II-A). SETTING: Teaching hospital. PATIENTS: Fifty-five consecutive patients undergoing major gynecologic surgery were entered into this prospective phase I/II trial and were matched with 55 patients from the previous 6 months. INTERVENTION: After anesthesia was induced, peripheral venous blood (55 mL) was obtained from the patient producing, autologous platelet tissue graft (20 mL). At completion of surgery, autologous platelet tissue graft was directly applied to the surgical site. MEASUREMENTS AND MAIN RESULTS: Median pain on the day of surgery was 2.7 (mild) in the autologous platelet tissue graft group vs 6.7 (severe) in the control group, p \textless.001. Likewise, pain on postoperative day 1 was 2.1 (mild) in the autologous platelet tissue graft group vs 5.5 (moderate) in the control group, p \textless or =.001. Median of morphine per hospital stay for the autologous platelet tissue graft group was 17 mg (range 1-98 mg) vs 26 mg (range
Fanning James; Murrain Luis; Flora Robert; Hutchings Timothy; Johnson Jil M; Fenton Bradford W
Journal of minimally invasive gynecology
2007
2007-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jmig.2007.05.014" target="_blank" rel="noreferrer noopener">10.1016/j.jmig.2007.05.014</a>
The assessment and treatment of back and neck pain: an initial investigation in a primary care practice-based research network.
*Research; 80 and over; acute back and neck pain; Acute Disease; Adult; Aged; Back Pain; chronic back and neck pain; Chronic Pain; Chronic Pain/diagnosis/therapy; Female; Human; Humans; Logistic Regression; Low Back Pain; Low Back Pain/*diagnosis/*therapy; Male; Middle Aged; Neck Pain; Neck Pain/*diagnosis/*therapy; non-malignant back and neck pain; Pain Measurement; primary care providers; Primary Health Care; Primary Health Care/*methods; Prospective Studies; Surveys; T-Tests; Treatment Outcome; Young Adult
AIM: The purpose of this study was to conduct an exploratory examination of the current state of non-malignant acute and chronic back and neck pain assessment and management among primary care providers in a multi-site, practice-based research network. BACKGROUND: Acute and chronic pain are distinct conditions that often require different assessment and management approaches, however, little research has examined assessment and management of acute and chronic pain as separate conditions. The large majority of patients with acute and chronic back and neck pain are managed in primary care settings. Given the differences between acute and chronic pain, it is necessary to identify differences in patient characteristics, practitioner evaluation, treatment and management in primary care settings. METHODS: Over a two-week period, 24 practitioners in a multi-site practice-based research network completed 196 data cards about 39 patients experiencing acute back and neck pain and 157 patients suffering from chronic back and neck pain. Findings There were significant differences between the patients experiencing acute and chronic pain in regards to practitioner evaluation, current medication management and current treatment for depression. In addition, diagnostics differed between patients experiencing acute versus chronic back and neck pain. Further, primary care providers' review of online drug monitoring program reports during the current visit was associated with current medication management using short term opioids, long-term opioids or tramadol. Most research examining acute and chronic pain focuses on the low back. Additional research needs to be conducted to explore and compare acute and chronic pain across the whole spine.
Fischbein Rebecca; McCormick Kenelm; Selius Brian A; Schrop Susan Labuda; Hewit Michael; Baughman Kristin; Meeker James
Primary health care research & development
2015
2015-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1017/S1463423614000504" target="_blank" rel="noreferrer noopener">10.1017/S1463423614000504</a>
Racial differences in performance-based function and potential explanatory factors among individuals with knee osteoarthritis.
Female; Humans; Male; Aged; Middle Aged; Socioeconomic Factors; Pain Measurement; African Americans; Body Mass Index; European Continental Ancestry Group; Exercise Test; Knee Joint/physiopathology; Osteoarthritis Knee/physiopathology; Physical Functional Performance
Objective: In individuals with knee osteoarthritis (OA), self-reported physical function is poorer in African Americans than in whites, but whether this difference holds true for objective assessments is unclear. The purpose of this study was to examine racial differences in performance-based physical function as well as potential underlying factors contributing to these racial differences.; Methods: Participants with knee OA from a randomized controlled trial completed the 2-minute step test (2MST), timed-up-and-go (TUG), and 30-second chair stand (30s-CST) at baseline. Race differences in performance-based function were assessed by logistic regression. Separate models were adjusted for sets of demographic, socioeconomic, psychological health, and physical health variables.; Results: In individuals with knee OA (n = 322; 72% women, 22% African American, mean ± SD age 66 ± 11 years, mean ± SD body mass index 31 ± 8 kg/m 2 ), African Americans (versus whites) had greater unadjusted odds of poorer function (30s-CST odds ratio [OR] 2.79 [95% confidence interval (95% CI) 1.65-4.72], 2MST OR 2.37 [95% CI 1.40-4.03], and TUG OR 3.71 [95% CI 2.16-6.36]). Relationships were maintained when adjusted for demographic and psychological health covariates, but they were either partially attenuated or nonsignificant when adjusted for physical health and socioeconomic covariates.; Conclusion: African American adults with knee OA had poorer unadjusted performance-based function than whites. Physical health and socioeconomic characteristics diminished these differences, emphasizing the fact that these factors may be important to consider in mitigating racial disparities in function. (© 2019, American College of Rheumatology.)
Flowers PPE;Schwartz TA;Arbeeva L;Golightly YM;Pathak A;Cooke J;Gupta JJ;Callahan LF;Goode AP;Corsi M;Huffman KM;Allen KD
Arthritis Care & Research
2020
2020-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1002/acr.24018" target="_blank" rel="noreferrer noopener">10.1002/acr.24018</a>
Injury-induced gp130 cytokine signaling in peripheral ganglia is reduced in diabetes mellitus.
*Axon regeneration; *Axotomy; *Diabetes; *Neuropathy; *Peripheral nervous system; Animal; Animals; Antibiotics; Antineoplastic/toxicity; Blood Glucose/drug effects; Body Weight/drug effects; Cytokine Receptor gp130/genetics/*metabolism; Cytokines/metabolism; Diabetes Mellitus; Disease Models; Experimental/chemically induced/complications/*pathology; Fasting/blood; Gene Expression Regulation/*physiology; Hyperalgesia/etiology; Hyperglycemia/etiology; Inbred C57BL; Male; Mice; Nerve Degeneration/*etiology/pathology; Nerve Tissue Proteins/metabolism; Pain Measurement; Signal Transduction/drug effects/*physiology; Streptozocin/toxicity; Superior Cervical Ganglion/drug effects/*metabolism; Sweating/drug effects
Neuropathy is a major diabetic complication. While the mechanism of this neuropathy is not well understood, it is believed to result in part from deficient nerve regeneration. Work from our laboratory established that gp130 family of cytokines are induced in animals after axonal injury and are involved in the induction of regeneration-associated genes (RAGs) and in the conditioning lesion response. Here, we examine whether a reduction of cytokine signaling occurs in diabetes. Streptozotocin (STZ) was used to destroy pancreatic beta cells, leading to chronic hyperglycemia. Mice were injected with either low doses of STZ (5x60mg/kg) or a single high dose (1x200mg/kg) and examined after three or one month, respectively. Both low and high dose STZ treatment resulted in sustained hyperglycemia and functional deficits associated with the presence of both sensory and autonomic neuropathy. Diabetic mice displayed significantly reduced intraepidermal nerve fiber density and sudomotor function. Furthermore, low and high dose diabetic mice showed significantly reduced tactile touch sensation measured with Von Frey monofilaments. To look at the regenerative and injury-induced responses in diabetic mice, neurons in both superior cervical ganglia (SCG) and the 4th and 5th lumbar dorsal root ganglia (DRG) were unilaterally axotomized. Both high and low dose diabetic mice displayed significantly less axonal regeneration in the sciatic nerve, when measured in vivo, 48h after crush injury. Significantly reduced induction of two gp130 cytokines, leukemia inhibitory factor and interleukin-6, occurred in diabetic animals in SCG 6h after injury compared to controls. Injury-induced expression of interleukin-6 was also found to be significantly reduced in the DRG at 6h after injury in low and high dose diabetic mice. These effects were accompanied by reduced phosphorylation of signal transducer and activator of transcription 3 (STAT3), a downstream effector of the gp130 signaling pathway. We also found decreased induction of several gp130-dependent RAGs, including galanin and vasoactive intestinal peptide. Together, these data suggest a novel mechanism for the decreased response of diabetic sympathetic and sensory neurons to injury.
Niemi Jon P; Filous Angela R; DeFrancesco Alicia; Lindborg Jane A; Malhotra Nisha A; Wilson Gina N; Zhou Bowen; Crish Samuel D; Zigmond Richard E
Experimental neurology
2017
2017-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.expneurol.2017.06.020" target="_blank" rel="noreferrer noopener">10.1016/j.expneurol.2017.06.020</a>
Posttraumatic kyphosis: current state of diagnosis and treatment: results of a multinational survey of spine trauma surgeons.
*Pain Management; Humans; Kyphosis/*diagnosis/etiology/*therapy; Osteotomy; Pain Measurement; Pain/diagnosis/etiology; Radiography; Spinal Injuries/*complications/therapy; Spine/diagnostic imaging/surgery; Surveys and Questionnaires
STUDY DESIGN: Multinational survey of spine trauma surgeons. OBJECTIVES: To survey a multinational group of spine trauma surgeons and develop an updated consensus definition of posttraumatic kyphosis (PTK), and the most current methods for diagnosis and treatment. SUMMARY OF BACKGROUND DATA: PTK remains a potential problematic sequela of thoracolumbar trauma. Although most surgeons have devised their own approaches for detecting and treating this condition, broad agreement in terms of the diagnosis and management of PTK has not been achieved. There is a lack of consensus-based guidelines, as the current literature largely consists of small case series or anecdotal expert opinions. METHODS: A survey questionnaire was circulated among 35 multinational spine trauma surgeons. The questionnaire consisted of 29 questions divided into 8 domains: definition, diagnosis, risk factors, symptoms, radiographic evaluation, surgical indications, treatment, and expected outcome. Answers from respondents were compiled and evaluated to generate a consensus. RESULTS: All 35 surgeons completed the survey. Consensus was achieved that PTK represents "a painful kyphotic angulation that can occur anywhere in the posttraumatic spine." Agreement was also reached that asymptomatic PTK can exist, although no true consensus could be reached on the extent of angular deformity that results in PTK. Untreated or maltreated flexion-distraction injuries, or severe burst fractures of the thoracolumbar spine, were felt to be the 2 injuries most likely to produce PTK. Computed tomography, magnetic resonance, and dynamic radiographs were all recommended for evaluation. If surgery is necessary, posteriorly based osteotomies, especially pedicle subtraction osteotomies, have become the principal means of correction. CONCLUSIONS: An updated understanding of PTK and its treatment has been achieved. Posterior osteotomies seem to be the most popular means of surgical correction. In the future, multicenter prospective studies are necessary to ascertain, with greater precision, the most appropriate treatment for this condition.
Schoenfeld Andrew J; Wood Kirkham B; Fisher Charles F; Fehlings Michael; Oner F C; Bouchard Kim; Arnold Paul; Vaccaro Alexander R; Sekhorn Lali; Harris Mitchel B; Bono Christopher M
Journal of spinal disorders & techniques
2010
2010-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/BSD.0b013e3181c03517" target="_blank" rel="noreferrer noopener">10.1097/BSD.0b013e3181c03517</a>
Neuropathic pain in aged rats: behavioral responses and astrocytic activation.
Aging/*physiology; Animal; Animal/*physiology; Animals; Astrocytes/*metabolism; Behavior; Cell Count; Disease Models; Functional Laterality/physiology; Glial Fibrillary Acidic Protein/metabolism; Hyperalgesia/physiopathology; Immunohistochemistry; Inbred F344; Lumbar Vertebrae; Male; Nerve Crush/methods; Neuralgia/*metabolism/pathology/physiopathology; Pain Measurement; Peripheral Nervous System Diseases/*metabolism/pathology/physiopathology; Posterior Horn Cells/*metabolism; Rats; Thermosensing/physiology; Touch/physiology; Up-Regulation/*physiology
We used the Bennett and Xie (1988) model of chronic neuropathic pain to study the effect of age on thermal and tactile sensitivity and on astrocytic activation in the dorsal horn of the spinal cord after nerve injury. Fischer 344 FBNF1 hybrid rats in three age groups, 4-6, 14-16, and 24-26 months, were studied. Rats were either unligated (day 0, control) or the left sciatic nerve was loosely ligated to cause a chronic constriction injury (CCI). CCI causes a neuropathic pain condition characterized by tactile allodynia and thermal hyperalgesia. Rats were behaviorally assessed for tactile and thermal sensitivity of their ligated and unligated hind paws up to 35 days postligation. Rats were sacrificed before or at various days postligation, and activated astrocytes were identified at the L4-L5 levels of their spinal cords by use of an antibody to glial fibrillary acid protein (GFAP). The number of GFAP-ir astrocytes in the dorsal horn of the spinal cord in the control, uninjured condition decreased with age (P \textless or = 0.001) but increased after CCI in all three age groups. After CCI, astrocytic activation in the cord was less robust in aged rats than in younger ones (P \textless or = 0.01). Not all the CCI rats displayed hyperalgesia to touch and to heat. Rats with an increased sensitivity to heat had increased levels of GFAP-ir in their cords; however, rats with decreased thermal sensitivity also displayed increased
Stuesse S L; Crisp T; McBurney D L; Schechter J B; Lovell J A; Cruce W L
Experimental brain research
2001
2001-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/s002210000630" target="_blank" rel="noreferrer noopener">10.1007/s002210000630</a>
A comparison of EMLA cream versus nitrous oxide for pediatric venous cannulation.
Administration; Analgesics; Anesthetics; Anxiety/prevention & control; Catheterization; Child; Drug Combinations; Humans; Lidocaine; Lidocaine/administration & dosage/*therapeutic use; Local/administration & dosage/*therapeutic use; Nitrous Oxide/administration & dosage/*therapeutic use; Non-Narcotic/administration & dosage/*therapeutic use; Pain Measurement; Pain/*prevention & control; Peripheral/*adverse effects; Prilocaine Drug Combination; Prilocaine/administration & dosage/*therapeutic use; Topical
STUDY OBJECTIVE: To compare the analgesic and anxiolytic effects of nitrous oxide (N2O) when inhaled by face mask with those of a cutaneous application of a eutectic mixture of local anesthetics (EMLA) cream with lidocaine and prilocaine during pre-operative venous cannulation in children. DESIGN: Prospective, randomized study. SETTING: Outpatient presurgical area and operating rooms of a freestanding children's hospital. PATIENTS: 50 unpremedicated ASA status I and II outpatients, aged 6 to 12 years, undergoing an elective surgical procedure. INTERVENTIONS: Each patient received either 70% N2O in 30% oxygen (O2) administered by face mask for 120 seconds or an application of 2.5 g of EMLA cream under an occlusive dressing for a minimum of 60 minutes. All patients then underwent a single attempt at venous cannulation in the dorsum of the hand with a
Vetter T R
Journal of clinical anesthesia
1995
1995-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/0952-8180(95)00086-w" target="_blank" rel="noreferrer noopener">10.1016/0952-8180(95)00086-w</a>
Spinous process osteotomies to facilitate lumbar decompressive surgery.
80 and over; Aged; Decompression; Female; Humans; Laminectomy/adverse effects/methods; Low Back Pain; Lumbar Vertebrae/*surgery; Magnetic Resonance Imaging; Male; Middle Aged; Osteotomy/adverse effects/instrumentation/*methods; Pain Measurement; Prospective Studies; Spinal Stenosis/*surgery; Surgical/adverse effects/instrumentation/*methods; Treatment Outcome
STUDY DESIGN: A technique for lumbar decompression using spinous process osteotomies is described, and the outcomes are studied prospectively. OBJECTIVE: To describe a technique that affords a wide exposure for decompression while minimizing damage to surrounding tissues, and to analyze the outcomes formally using the technique. SUMMARY OF BACKGROUND DATA: Commonly used techniques of lumbar decompression, which include bilateral takedown of paraspinal musculature and aggressive bony resection, can result in significant iatrogenic sequelae, whereas minimally invasive techniques often provide inadequate visualization and/or decompression. METHOD: Unilateral limited takedown of the multifidus is undertaken, followed by spinous process osteotomies at the involved levels. The spinous processes with the attached interspinous/supraspinous ligaments are then retracted. A complete "trumpeted" decompression is then undertaken. Fifty consecutive patients undergoing the procedure were analyzed prospectively and at follow-up by an independent observer using a validated functional outcome measure, a visual analog pain scale, and a patient satisfaction score. RESULTS: Functional outcome scores improved on average by 47%, pain levels were reduced by 66%, and high satisfaction rates were reported by 83% of patients. CONCLUSIONS: The technique affords excellent visualization and a wide area available for Kerrison use and angulation while minimizing destruction to tissues not directly involved in the pathologic process, including the paraspinal musculature as well as the interspinous/supraspinous ligament complex and facets. Additionally, it minimizes dead space and improves the cosmetic result.
Weiner B K; Fraser R D; Peterson M
Spine
1999
1999-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/00007632-199901010-00015" target="_blank" rel="noreferrer noopener">10.1097/00007632-199901010-00015</a>
Reclining chairs reduce pain from gurneys in older emergency department patients: a randomized controlled trial.
Ohio; Aged; Sensitivity and Specificity; Prospective Studies; Pain Measurement; Patient Satisfaction; Outpatients; Hospitals; Self Report; Confidence Intervals; Human; Descriptive Statistics; Funding Source; Scales; Data Analysis Software; Surveys; Coefficient Alpha; Summated Rating Scaling; Emergency Service; Community; Treatment Outcomes; Emergency Patients; Beds and Mattresses; Interior Design and Furnishings; Patient Positioning; Single-Blind Studies; 80 and Over; Pain – Prevention and Control – In Old Age
OBJECTIVES: Pain related to the gurney is a frequent complaint of older emergency department (ED) patients. The authors hypothesized that these patients may have less pain and higher satisfaction if allowed to sit in a reclining hospital chair. METHODS: A single-blind, randomized controlled trial was performed. Patients 65 years old or older who were able to sit upright, transfer, and engage in normal conversation were eligible. Severely ill or cognitively impaired patients were excluded. Patients were randomized to either remain on the gurney or transfer to the chair after initial evaluation. Patients reported pain at arrival (t0), at one hour (t1), and at two hours (t2) using a 0-10 pain scale, and satisfaction at study completion on a 0-10 scale. The primary outcome was a decrease in pain between t0 and t1 or no pain at both t0 and t1. This outcome was analyzed using a 95% confidence interval for the difference between proportions; exclusion of zero was considered significant. RESULTS: Sixty-six patients in each group were enrolled. There was no difference in demographics between groups, but the chair patients were more likely to have pain at t0 than the gurney patients. More chair patients than gurney patients had a successful primary outcome (97% vs. 76%, 21% difference, 95% CI=10% to 32%). The mean satisfaction score was higher in the chair group than in the gurney group (8.1 vs. 6.0, 2.1 difference, 95% CI=1.4% to 2.8%). CONCLUSIONS: The simple modification of allowing older ED patients to sit in reclining chairs resulted in less pain and higher satisfaction.
Wilber S T; Burger B; Gerson L W; Blanda M
Academic Emergency Medicine
2005
2005-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2005.tb00846.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2005.tb00846.x</a>
Reclining chairs reduce pain from gurneys in older emergency department patients: a randomized controlled trial.
*Emergency Service; *Wheelchairs; Aged; Female; Hospital; Humans; Male; Pain Measurement; Pain/*prevention & control; Patient Satisfaction; Prospective Studies
OBJECTIVES: Pain related to the gurney is a frequent complaint of older emergency department (ED) patients. The authors hypothesized that these patients may have less pain and higher satisfaction if allowed to sit in a reclining hospital chair. METHODS: A single-blind, randomized controlled trial was performed. Patients 65 years old or older who were able to sit upright, transfer, and engage in normal conversation were eligible. Severely ill or cognitively impaired patients were excluded. Patients were randomized to either remain on the gurney or transfer to the chair after initial evaluation. Patients reported pain at arrival (t0), at one hour (t1), and at two hours (t2) using a 0-10 pain scale, and satisfaction at study completion on a 0-10 scale. The primary outcome was a decrease in pain between t0 and t1 or no pain at both t0 and t1. This outcome was analyzed using a 95% confidence interval for the difference between proportions; exclusion of zero was considered significant. RESULTS: Sixty-six patients in each group were enrolled. There was no difference in demographics between groups, but the chair patients were more likely to have pain at t0 than the gurney patients. More chair patients than gurney patients had a successful primary outcome (97% vs. 76%, 21% difference, 95% CI=10% to 32%). The mean satisfaction score was higher in the chair group than in the gurney group (8.1 vs. 6.0, 2.1 difference, 95% CI=1.4% to 2.8%). CONCLUSIONS: The simple modification of allowing older ED patients to sit in reclining chairs resulted in less pain and higher satisfaction.
Wilber Scott T; Burger Barbara; Gerson Lowell W; Blanda Michelle
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2005
2005-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1197/j.aem.2004.10.016" target="_blank" rel="noreferrer noopener">10.1197/j.aem.2004.10.016</a>