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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A multivariate analysis of inadequate extradural analgesia was carried out prospectively on 1051 patients undergoing lumbar extradural anaesthesia for surgery performed on structures innervated by T10-S5. Ninety-six patients (9%) experienced pain during surgery. Age, extradural fentanyl, diazepam sedation and duration of surgery had no significant influence. We found some weak evidence that the type of surgery affects the risk of feeling pain. The probability of pain increased with increasing weight, except in overweight women, and was significantly greater for both shorter and taller patients, relative to patients of average height. The probability of pain decreased with increasing dose of local anaesthetic, increasing spread of extradural analgesia, addition of adrenaline, and fentanyl or thiopentone sedation. In conclusion, patient-, surgery- and anaesthesia-related factors influence the risk of inadequate extradural analgesia. If such factors are taken into account, an increase in the success rate may be anticipated.
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PMID:A multifactorial analysis to explain inadequate surgical analgesia after extradural block. 754 42

This study was carried out to determine whether levels of physical activity of patients with various chronic diseases are associated with subsequent functioning and well-being. It was an observational 2-year longitudinal design. The setting was offices of medical and mental health practices within health maintenance organizations, large multispecialty groups, and solo practices or small single-specialty group practices in three U.S. cities. Included in the study were 1758 adult patients with one or more of the following: diabetes, hypertension, congestive heart failure, recent myocardial infarction, depressive symptoms, or current depressive disorder. Outcome measures included physical, role, and functioning; energy/fatigue; pain intensity; sleep problems; depressed affect, anxiety, positive affect, and overall psychological distress/well-being; health distress; and current health perceptions. Cross-sectional (base-line), 2-year endpoint, and change score relationships were evaluated between baseline levels of physical activity and each outcome, controlling for chronic conditions, comorbidity, smoking, alcohol use, overweight, self-reported adherence, and other patient and study characteristics. Higher baseline levels of exercise were uniquely associated with better functioning and well-being at baseline and 2 years later for some measures. The magnitude of the differences varied by disease group, but tended to be between 0.17 and 0.39 of the baseline SD. Greater levels of exercise are associated with feeling and functioning better for patients with chronic conditions over a 2-year period, suggesting that this is a fruitful area for further study using controlled interventions.
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PMID:Long-term functioning and well-being outcomes associated with physical activity and exercise in patients with chronic conditions in the Medical Outcomes Study. 772 85

The purpose of this paper is to assess symptomatic macromastia, the relief of symptoms by operation, and predictors of symptom relief. The methods used have been retrospective chart review and a self-assessment patient questionnaire. One-hundred and thirty-three patients underwent an average 1660-gm reduction. Ninety-three percent reported a postoperative decrease in symptoms such as shoulder grooves and shoulder, neck, and back pain. Correlation between breast size and sign or symptom severity achieved significance only for the preoperative submammary rash (r = 0.33, p < 0.001). Patients lost an average of 8.9 lb postoperatively and were less overweight (49 versus 40 percent). Activity level increased postoperatively in 63 percent. Postoperative chest size correlated inversely with activity level (r = 0.35, p < 0.001). Thirty-nine percent of patients who took pain medications preoperatively were able to eliminate these postoperatively. The quantity of tissue removed did not correlate with outcome. A model predictive of symptom relief could not be developed (total R2 = 0.03). Reduction mammaplasty promoted relief of signs and symptoms of macromastia, but a predictive model of successful operation could not be developed.
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PMID:Breast reduction for symptomatic macromastia: can objective predictors for operative success be identified? 780 71

The original Bassini and Shouldice methods for inguinal herniorrhaphy were tested against each other and against their respective variants that avoid permanent suturing of the internal oblique muscle. Seven hundred fifty inguinal hernia repairs were prospectively allocated to 1 of 4 groups: group A: Bassini with absorbable sutures (polyglycolic acid); group B: Bassini with nonabsorbable sutures (polyester); group C: Shouldice with four rows of polypropylene sutures; and group D: Shouldice with two rows of polypropylene sutures. Outcome was correlated to prospectively defined types and risk factors such as direct hernia, repair for recurrent hernia, hernial sac diameter greater than 8 cm, age greater than 70 years, overweight, and chronic bronchitis. Actual (not actuarial) recurrence rates were determined through clinical examination by hospital staff surgeons (not through information by letter or phone) for 93.6% of surviving patients. Local complications exclusive of recurrence, but including the redoubtable and litigious sequelae of testicular atrophy and chronic ilioinguinal pain, were significantly reduced from 6.3% (group B and C) to 2.3% by omitting permanent muscle sutures (groups A and D; P < 0.05). However, the use of slowly absorbable suture material resulted in a disproportionately high recurrence rate of 12.8% in the modified Bassini group A. The original Bassini method, ie, division of the transversalis fascia and repair with nonabsorbable sutures, as was used in group B, had an actual 2-year recurrence rate of 8.7%, still a highly significant difference compared with 3.6% and 2.3% for Shouldice groups C and D, respectively (P = 0.012). For repair of recurrent hernia, the superiority of the Shouldice technique was not statistically significant: re-recurrence rate 7.6% versus 13.5% for the original Bassini group B. Repair of recurrent hernia was the only patient-related risk factor of equal significance as the method of repair. The Shouldice technique is superior to and more than merely a reinvention of Bassini's original method. The omission of muscle sutures is physiologically sound and recommended for the Shouldice operation.
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PMID:Shouldice is superior to Bassini inguinal herniorrhaphy. 802 92

Rheumatic symptoms are often associated with obesity. The usual symptom is pain in the knee due to gonarthrosis, of which one of the causes is obesity; there is a correlation between the degree of overweight and the severity of gonarthrosis. It is likely, though not demonstrated, that overweight aggravates the arthrosis of supporting joints. On the other hand, obesity limits the post-menopausal bone loss. The intestinal bypass created to obtain a loss of weight may generate complications, and in particular an inflammatory rheumatism due to proliferation of bacteria in a blind intestinal loop, and osteomalacia caused by disorders of vitamin D absorption sometimes develops. The risk of perioperative complications is increased in obese patients. The mid-term results of hip or knee surgical replacement seem to be good. In the present state of our knowledge, its seems to be rational to convince obese patients complaining of rheumatic illness that they should lose weight.
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PMID:[Osteoarticular pathology and massive obesity]. 831 Feb 46

The lipoprotein (Lp) pattern was analysed in patients with suspected unstable coronary artery disease (UCAD), to compare the pattern as a prognostic instrument regarding subsequent coronary events with smoking, hypertension, diabetes mellitus and with the result of an early exercise test. Included were 295 patients with UCAD. Blood samples for Lp values were obtained in the acute phase and after one year. Apolipoprotein-A1, Apolipoprotein-B (Apo-B), Lipoprotein(a) (Lp[a]) HDL-Cholesterol, Cholesterol (Chol) and Triglycerides (TG). were estimated in serum. During the 1-year follow-up coronary events (myocardial infarction, cardiac death, coronary artery by-pass surgery) occurred in 48 patients. The severity of CAD, overweight, smoking and beta-blockade influenced the Lp-pattern. Chol-, TG- and Apo-B-levels were highest in the group with a coronary event. Apo-B turned out to be the second best predictive variable in multiple regression analysis, in men. In women no such analysis was done because of very few coronary events during follow-up. Nevertheless, the exercise test variables, ST depression and pain were more predictive of coronary events than Apo-B in men.
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PMID:Prognostic importance of plasma lipoprotein-analyses in patients with unstable coronary artery disease. 831 57

Eighty-seven valgus osteotomies of the tibia were performed in seventy-three patients for osteoarthrosis of the medial compartment of the knee; the median follow-up was ten years (range, three to fourteen years). The data were subjected to univariate and multivariate statistical analysis and to survivorship analysis. For these calculations, the end-point of failure was defined as an arthroplasty of the knee, and additional calculations were performed with the end-point defined as the performance of an arthroplasty or moderate or severe pain in patients who had declined an arthroplasty. None of the many risk factors that were evaluated could be found to be associated with the duration of survival, except for relative weight and angular correction. The median loss of correction after the osteotomy was 1 degree. If, at one year after the operation, the valgus angulation was 8 degrees or more, or if the patient's weight was 1.32 times the ideal weight or less, the probability of survival five years thereafter was at least 90 per cent and the probability ten years thereafter was at least 65 per cent. However, when valgus angulation at one year was less than 8 degrees in a patient whose weight was more than 1.32 times the ideal weight, the rate of survival decreased to 38 per cent five years thereafter and to 19 per cent ten years thereafter. There is a considerable risk of failure of a proximal tibial osteotomy if the alignment is not overcorrected to at least 8 degrees of valgus angulation and if the patient is substantially overweight.
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PMID:Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. 842 80

Osteoarthritis is the most common form of arthritis. It increases in prevalence with age. About 5% of the US population is affected with hip or knee osteoarthritis; 9.5% of adults aged > 62 y have knee osteoarthritis. Because of its frequency and associated pain and disability, osteoarthritis accounts for much of the disability in lower extremities in the elderly. More than 70% of total hip and knee replacements are for osteoarthritis. Because osteoarthritis is so common, the modification of factors that increase osteoarthritis risk could prevent substantial pain and disability in the elderly and the use of costly health care services. Overweight persons are at high risk of osteoarthritis in the knee and probably also in the hips and hands. The mechanism by which overweight causes osteoarthritis is poorly understood; a contribution from both local increased force across the joint and systemic factors is likely. Better evidence is needed on the effects of weight loss, but preliminary studies suggest that weight loss can both prevent the onset of symptomatic disease and alleviate symptoms when present.
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PMID:Weight and osteoarthritis. 861 35

The possibility that a patient during general anaesthesia is aware of the operation going on and aware of severe pain that might be remembered postoperatively must be very alarming to patients and anaesthetists alike. Furthermore, there is experimental evidence showing that conscious recall of intraoperative events is only the tip of an iceberg; it seems very probable that there is even a higher incidence of unconscious perception during general anaesthesia. Therefore, the following stages of intraoperative awareness must be distinguished: (1) conscious awareness with explicit recall and with severe pain; (2) conscious awareness with explicit recall but no complaints of pains; (3) conscious awareness without explicit recall and possible implicit recall; (4) subconscious awareness without explicit recall and possible implicit recall; (5) no awareness. The incidence of conscious awareness with explicit recall and severe pain has been estimated at less frequent than 1/3000 general anaesthetics. Conscious awareness with explicit recall but no complaints of pain has been reported in the literature with an incidence of 05-2%. With 7-72%, conscious awareness without explicit recall and possible implicit recall shows a very wide range of variation and its occurrence probably depends on the anaesthetic drugs used. Subconscious awareness with possible implicit recall has an incidence of up to 80%, but there are many methodological problems in demonstrating implicit memory of intraoperative events. Reports of intraoperative awareness do not come exclusively from cardiac surgery and obstetrics, but also from all other operative specialties. Postoperatively, patients who experience intraoperative awareness may develop a so-called post-traumatic stress syndrome. Symptoms involve re-experiencing the event awake or in dreams, sleep disturbances, depression, avoidance of stimuli associated with the event. The probability of the development of the post-traumatic stress syndrome seems to coincide with the experience of severe pain. When a patient complains of intraoperative awareness postoperatively the anaesthesiologist should discuss the event frankly with the patient. When the symptoms of the post-traumatic stress syndrome persist a psychotherapy should follow. Causes for intraoperative awareness may be: equipment failure, too-light anaesthesia, e.g. for a caesarean section or for emergency surgery in severely injured or polytraumatized patients, during cardiac surgery, bronchoscopy of difficult intubation. There is interindividual variability in anaesthetic effect; for example, chronic drug or alcohol abuse or overweight may make increased anaesthetic doses necessary. They are at risk for intraoperative awareness. Some general anaesthetics or anaesthetic procedures, e.g. the combination of a relaxant and N2O, opioid mono-anaesthetics, or opioids combined with benzodiazepines, seem to involve a higher risk of intraoperative awareness than do volatile anaesthetics. The bases of litigation are medical malpractice, breach of contract by the anaesthesiologist or lack of informed consent from the patient. Therefore, patients who are at risk of intraoperative awareness should be given detailed information on this special risk before the operation.
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PMID:[Awareness during general anesthesia. Definition, incidence, clinical relevance, causes, avoidance and medicolegal aspects]. 867 65

EMG recordings, typically obtained in biofeedback training sessions, tend to underestimate actual muscle activity in overweight and female pain patients. If unadjusted, these measures will likely result in erroneous diagnostic conclusions.
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PMID:Electromyography and chronic pain: do current electromyographic diagnostic techniques discriminate against injured female workers? 887 70


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