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

Day-case surgery involves a considerable amount of stress not only for the children who undergo surgery but also for their parents. In a prospective survey analysis performed in 1995/1996, we identified the following main factors influencing the amount of stress experienced by parents: feelings of insufficient preparation and problems with postoperative pain at home. As a consequence, measures were taken regarding information and pain management, including the creation of an interactive CD-ROM. We then analysed the consequences of our interventions regarding parental stress. In this study we collected the data of all patients who underwent day-case surgery during two additional 13-month periods in 1997/1998 and 1999/2000. The methods of data collection remained unchanged for all three periods and included a questionnaire for the parents. In total, 1,490 questionnaires were analysed. Comparing the three time periods, parents' feelings of being well-informed improved significantly (91% vs. 98% vs. 97%, P < 0.0001). However, the percentage of those experiencing moderate to severe stress did not change substantially (16% vs. 9% vs. 19%, not significant). Analgaesics were given more frequently over the years in a general as well as a prophylactic manner (20% vs. 35% vs. 43%, P < 0.0001). Nevertheless, problems with pain control at home remained unchanged (33% vs. 23% vs. 29%, not significant). Despite considerable efforts to improve information, parental stress did not significantly decrease. It cannot be assessed yet whether wrong information was given or whether a certain degree of stress cannot be prevented. There is some evidence that improvements in coping with pain-related problems might be a promising next step.
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PMID:Parental stress in paediatric day-case surgery. 1563 51

Predictors of outcome following whiplash injury are limited to socio-demographic and symptomatic factors, which are not readily amenable to secondary and tertiary intervention. This prospective study investigated the predictive capacity of early measures of physical and psychological impairment on pain and disability 6 months following whiplash injury. Motor function (ROM; kinaesthetic sense; activity of the superficial neck flexors (EMG) during cranio-cervical flexion), quantitative sensory testing (pressure, thermal pain thresholds, brachial plexus provocation test), sympathetic vasoconstrictor responses and psychological distress (GHQ-28, TSK, IES) were measured in 76 acute whiplash participants. The outcome measure was Neck Disability Index scores at 6 months. Stepwise regression analysis was used to predict the final NDI score. Logistic regression analyses predicted membership to one of the three groups based on final NDI scores (<8 recovered, 10-28 mild pain and disability, >30 moderate/severe pain and disability). Higher initial NDI score (1.007-1.12), older age (1.03-1.23), cold hyperalgesia (1.05-1.58), and acute post-traumatic stress (1.03-1.2) predicted membership to the moderate/severe group. Additional variables associated with higher NDI scores at 6 months on stepwise regression analysis were: ROM loss and diminished sympathetic reactivity. Higher initial NDI score (1.03-1.28), greater psychological distress (GHQ-28) (1.04-1.28) and decreased ROM (1.03-1.25) predicted subjects with persistent milder symptoms from those who fully recovered. These results demonstrate that both physical and psychological factors play a role in recovery or non-recovery from whiplash injury. This may assist in the development of more relevant treatment methods for acute whiplash.
Pain 2005 Mar
PMID:Physical and psychological factors predict outcome following whiplash injury. 1573 39

Surgical treatment of painful idiopathic and post-traumatic arthritis with joint replacement of the proximal interphalangeal joint has become increasingly important. Due to shortcomings of former constrained and partially constrained prostheses with regard to abrasion and durability we have been using an unconstrained prosthesis since April 2002. This model is an almost abrasion free, biocompatible 2-component prosthesis. The surface is shaped like the condyles and the position is secured in a press-fit technique. During October 2004 we reviewed the results of 20 out of 29 patients with idiopathic or post-traumatic arthritis who had been treated with a pyrolytic carbon proximal interphalangeal joint prosthesis from April 2002 to April 2004 retrospectively. Clinical, subjective and radiological parameters were studied. On follow-up after 0.5 to 2.5 years the patients were satisfied with the pain relief. The range of motion varied. However, with an average ROM of 50 degree it was equivalent to the results in literature. Signs of periprosthetic cysts, osteophytes and loosening of the proximal as well as of the distal component could be seen in the radiograms of some patients. There was no correlation between these radiological observations and range of motion, pain or grip strength. In three cases the joint prosthesis had to be converted to an arthrodesis of the proximal interphalangeal joint. Bearing in mind the correct indications (intact collateral ligaments, stable bone stock and sufficient extensor and flexor tendons), pyrocarbon prosthesis are a treatment option for idiopathic and posttraumatic arthritis preserving motion and reducing pain. Radiological results seem to indicate an absence of osteointegration and tension forces at the prosthesis/bone interface. Further investigation will be necessary to improve surface and design to increase radiological results in long-term follow-up. Additional surveys are required to improve indications, surgical approach and intraoperative control of correct component positioning.
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PMID:[Early results of proximal interphalangeal joint replacement with pyrolytic carbon prosthesis (Ascension) in idiopathic and post-traumatic arthritis]. 1574 54

A 17-year old soccer-player sustained a fracture and dislocation of the ulnar epicondyle combined with a bone bruises at the radial head and the capitellum. An open reduction and internal fixation was performed using two K-wires. Initial recovery was uneventful. After the operation he was discharged home and reviewed on a regular basis. When bony union had occurred the two K-wires were removed. However, on follow up he continued to complain of pain on the radial aspect of the joint and did not regain his normal range of movement. A further MRI was performed. Now a grade II osteochondritis dissecans not visible on the previous MRI taken 12 weeks earlier was clearly visualised. Treatment was continued conservatively with physiotherapy but avoiding aggressive mobilisation. On final review 6 months later he was able to move painfree with residual limitation of movement (ROM 0-5-130 degrees). Another MRI taken now was assessed as normal.
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PMID:Are bone bruises a possible cause of osteochondritis dissecans of the capitellum? A case report and review of the literature. 1614 76

In recent years, there has been increased popularity for use of alternative treatment modalities for low back pain with limited investigation into whether they are effective in returning the worker to normal functionality. The objective of this study was to investigate the short-term impact on the restoration of the functional ability of common treatment modalities including physical therapy, acupuncture, chiropractic treatment, and massage therapy. A within subjects design was used that compared a baseline assessment to three follow-up assessments: immediately following treatment, two days and seven days post treatment. Individuals suffering from low back pain were recruited from local clinics that specialize in one of the four treatment modalities. Twenty-four individuals who were suffering from low back pain and had started one of the treatment modalities were recruited into the study. Three-dimensional motions (ROM, velocity, and acceleration) during a standardized functional capacity protocol were measured prior to and during three follow-up periods. The results show the effectiveness of the treatments was dependent upon time and were predominantly in the non-sagittal motion planes (velocities and accelerations). Individual subjective pain levels also indicate all the treatment modalities were effective after the 1-week follow-up. Findings suggest those modalities primarily focused on the back musculature (acupuncture, massage, physical therapy) were more effective with respect to functional capacity restoration. The current results provide a quantitative evaluation, based upon trunk dynamics, of the effectiveness of these four treatment modalities.
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PMID:Preliminary evidence of the short-term effectiveness of alternative treatments for low back pain. 1634 89

To determine if the functional outcome of total knee replacement (TKR) was affected by the level of preoperative symptom severity, the association between preoperative Oxford Knee Scores (OKS), and 2 year OKS, American Knee Society clinical and function scores (AKSS) was assessed. Data were prospectively collected on 45 cases who had single joint osteoarthritis and no other comorbidities. We have specifically focused on patients with single knee involvement to remove the effect of multiple joint involvement and comorbidities on the OKS. The mean preoperative OKS was 21.4, postoperative OKS 40.0 and postoperative ROM 117 degrees. The postoperative mean AKSS was 86.7 and mean function score was 85.0. The 'usual pain' and 'limp' components of the OKS had the greatest rises and the 'kneel' component had the least improvement. Rather than all patients achieving uniform results post-TKR, patients with more severe symptoms achieved poorer absolute outcomes. The Spearman correlation coefficient between pre- and postoperative OKS was r = 0.4 (p = 0.006). Although the results suggest that waiting too long before intervention compromises the final outcome, a correlation of 0.4 is not strong enough to necessitate change in current practice.
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PMID:The effect of preoperative symptom severity on functional outcome of total knee replacement--patients with the lowest preoperative scores achieve the lowest marks. 1651 55

Higher initial levels of pain and disability, older age, cold hyperalgesia, impaired sympathetic vasoconstriction and moderate post-traumatic stress symptoms have been shown to be associated with poor outcome 6 months following whiplash injury. This study prospectively investigated the predictive capacity of these variables at a long-term follow-up. Sixty-five of an initial cohort of 76 acutely injured whiplash participants were followed to 2-3 years post-accident. Motor function (ROM; kinaesthetic sense; activity of the superficial neck flexors (EMG) during cranio-cervical flexion), quantitative sensory testing (pressure, thermal pain thresholds and brachial plexus provocation test), sympathetic vasoconstrictor responses and psychological distress (GHQ-28, TSK and IES) were measured. The outcome measure was Neck Disability Index (NDI) scores. Participants with ongoing moderate/severe symptoms at 2-3 years continued to manifest decreased ROM, increased EMG during cranio-cervical flexion, sensory hypersensitivity and elevated levels of psychological distress when compared to recovered participants and those with milder symptoms. The latter two groups showed only persistent deficits in cervical muscle recruitment patterns. Higher initial NDI scores (OR 1.00-1.1), older age (OR 1.00-1.13), cold hyperalgesia (OR 1.1-1.13) and post-traumatic stress symptoms (OR 1.03-1.2) remained significant predictors of poor outcome at long-term follow-up (r2=0.56). The robustness of these physical and psychological factors suggests that their assessment in the acute stage following whiplash injury will be important.
Pain 2006 May
PMID:Physical and psychological factors maintain long-term predictive capacity post-whiplash injury. 1652 97

The integration of traditional Chinese and Western medicine and their clinical effects have been widely evaluated. Many studies have shown that using a combination of these two remedies has resulted in better outcomes than using only one of them. Acupuncture is a traditional Chinese medical technique, which plays an important role in enforcing pain control, prevention and functional improvement. In 1979, the World Health Organization (WHO) journal introduced acupuncture as a remedy for 43 diseases, including frozen shoulder. This study aims to assess the therapeutic outcomes of combining acupuncture and physical therapy to treat frozen shoulder, and hopes to establish an evidence-based study of the integration of acupuncture and western medicine in the future. A total of 75 frozen shoulder patients treated in a medical center were recruited for the study between January 2002 and December 2002. The average age of these patients was 54.8 years. The average duration of the condition was 25.8 weeks before treatment. Of the 75 patients, 30 were treated by physical therapy, 30 by acupuncture and 15 by both remedies. Before the treatment began, all patients were evaluated by assessing static pain scale, motion pain scale, active and passive ROM (range of motion) and quality of life scale sheet SF-36 (Short Form-36). The outcome was evaluated by follow-up assessments conducted at the 2nd week and 4th week of treatment sessions. All patients showed improvement in quality of life (Short Form-36). Pain was controlled better by acupuncture while ROM improved following physical therapy. However, patients treated by both methods had the best outcome. The integration of acupuncture and physical therapy to treat frozen shoulder leads to a better outcome than using only one method. The author suggests that an evidence-based foundation of the integration of Chinese and Western medicine should be established in the future, to encourage the integration of Chinese and Western medicine.
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PMID:A study on the clinical effects of physical therapy and acupuncture to treat spontaneous frozen shoulder. 1708 May 43

We present 33 children with 34 elbow dislocations. In 22 cases concomittant fractures around the elbowe were noted: 13 displaced medial epicondyle fractures, 5 radial neck fractures, 2 radial head fractures, 2 coronoid process fractures, 1 olecranon fracture, 1 lateral condyle fracture, 1 medial condyle fracture. In 5 children more than one concomittant fracture were noted. The mean age during dislocation was 11 years (from 4 to 15), the mean follow up period was 3.5 years (from 2 to 5). On follow up a clinical examination of the elbow was performed including axis assesment and elbow ROM. X-ray were taken in all children in AP and lateral view. All children had a satisfying function of the extremity and no pain was noted. No difference in ROM was noted in children with isolated elbow dislocation or with concomittant medial epicondyle fractures however in 3 of those children a persistent flexion contracture was observed. Among children with other fractures poorer results occured in 3 patients, specially after displaced radial neck fractures. In one of them there was slight supination and pronation restriction, in second a complete ankylosis of proximal radioulnar joint occured in neutral forearm position. In one child after elbow dislocation and medial condyle fracture a late radial dislocation occured. We think that concomitant medial epicondyle fracture does not impare good results of elbow dislocation treatment if well recognised and treated. Other fractures, specially radial neck fractures, increase the risk of complications.
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PMID:[Does coexistant fractures impair the results of treatment of elbow dislocations in children?]. 1713 38

Wrist stiffness is a complication of wrist trauma or surgery. Rehabilitation is the treatment of choice to improve the wrist range of motion. Since 1988 we used the arthroscopic wrist arthrolysis. Criteria for patient inclusion in our preop and postop study were wrist stiffness with or without pain, unsuccessful results from rehabilitation after 3 to 6 months. From 1988 to 2003, 47 cases (45 patients: 35 males and 10 females), with a mean age of 36 years were operated on. All the radiocarpal, midcarpal and DRUJ portals were used in relationship with the site of rigidity. At a mean follow up of 58 months (range from 3 to 176 months) no complications were documented. Pain was almost absent in all the cases, mean flexion-extension ROM increased from 92 degrees preop to 106 degrees postop, mean pronation/supination increased from 145 degrees preop to 155 degrees postop, and mean grip strength increased from 25 to 31 kg postop. The average modified Mayo Wrist Score improved from 39 to 87, and the postop DASH Questionnaire obtained an average of 21 points.
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PMID:[Arthroscopic wrist arthrolysis.] 1734 1


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