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Query: UMLS:C0184567 (acute pain)
 3,962 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Quality of life (QOL) after video-assisted thoracic surgical (VATS) lobectomy remains to be defined. Forty-four consecutive patients with clinical stage I lung cancer underwent lobectomy by the VATS approach (n = 22 patients) or thoracotomy approach (n = 22 patients). Acute pain was quantitated by postoperative narcotic requirements and the need for epidural anesthesia. Long-term QOL was assessed by questioning patients about the presence of chronic chest pain, ongoing limitations in arm or shoulder function, time until return to preoperative activity, and satisfaction with the operation. Patients who underwent VATS lobectomy had significant decreases in both acute and chronic chest pain and time until return to preoperative activity. Patients also had more confidence regarding wound size and their overall impression of the operation. In this series, VATS lobectomy was associated with long-term benefits for the QOL in patients with lung cancer. However, the exact role of this approach should be defined by carefully-designed controlled trials studying long-term survival.
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PMID:Long-term benefits for the quality of life after video-assisted thoracoscopic lobectomy in patients with lung cancer. 1087 23

Angina, the prototypic vasoocclusive pain, is a radiating chest pain that occurs when heart muscle gets insufficient blood because of coronary artery disease. Other examples of vasoocclusive pain include the acute pain of heart attack and the intermittent pains that accompany sickle cell anemia and peripheral artery disease. All these conditions cause ischemia - insufficient oxygen delivery for local metabolic demand - and this releases lactic acid as cells switch to anaerobic metabolism. Recent discoveries demonstrate that sensory neurons innervating the heart are richly endowed with an ion channel that is opened by, and perfectly tuned for, the lactic acid released by muscle ischemia.
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PMID:ASIC3: a lactic acid sensor for cardiac pain. 1280 43

The tako-tsubo syndrome (transient left ventricular apical ballooning with normal coronary arteries), initially described in Japanese patients, is now being increasingly observed worldwide and should be considered in the differential diagnosis of acute coronary syndromes. Angina-like chest pain, electrocardiographic changes and an increase in myocardial markers are often present, as well as history of acute stressful events preceding symptom onset. We report the case of an Asiatic woman in whom typical, reversible abnormalities in left ventricular motion were associated with symptomatic junctional bradycardia. Nevertheless, the patient was completely free from angina and excluded acute pain or emotions in the previous weeks. Coronary angiography showed absence of significant disease and left ventricular function was found to be unremarkable 1 month after the acute event. Although infrequent, atypical presentations of tako-tsubo syndrome have occasionally been reported and, in our opinion, they could provide interesting insights into the ill-defined pathophysiology of the disease.
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PMID:[An atypical case of tako-tsubo syndrome presenting with symptomatic bradycardia]. 1769 5

This article presents the case of a 41-year-old female physician complaining about frequent chest pain attacks and breathing difficulties. Disorders started six months previously after inexpert manipulation of the thoracic spine performed by a physiotherapist while massaging the patient's back. Numerous diagnostic examinations (CT of the thorax, MRI of the thoracic spine, esophagography, cardiological examination, pulmological examination) did not explain the cause of subjective symptoms. Although the patient, who came to our private practice setting for examination of the spine and possible manual therapy, did not complain about disorders in the region of cervical spine, on the basis of clinical examination, we suspected the cervicogenic angina (CA; the attacks of chest pain caused by cervical radiculopathy; earlier term "cervical angina" is terminologically inappropriate). Namely, by means of clinical examination, we found very restricted active and passive mobility of the cervical spine, hyperalgic skin zones in the dermatomes C6-TH4, spasm of the cervical extensors and upper parts of the trapezius muscle, hypoesthesia in the dermatomes C6-TH1 and decreased left triceps reflex. MRI examination of the cervical spine showed left side disc herniation at the C6-C7 segment. Using manual therapy (traction mobilization of the cervical spine, segmental mobilization, distraction manipulation in full Nelson position), the complete regression of subjective symptoms was achieved which confirmed cervical origin of the pain. By analyzing anamnestic data, we concluded that the inexpert manipulation of the thoracic spine (the patient was lying in prone position), which caused strong local pain, induced sudden extension-flexion reflex movement of the cervical spine which the patient did not notice at that moment because of the acute pain in the region of the thoracic spine, resulting in herniation of already degeneratively altered disc at the C6-C7 segment with consequential CA.
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PMID:[Cervicogenic angina. Chest pain caused by unrecognized disc herniation at the segment c6-c7: a case report]. 1906 59

Current research suggests that pain is a relatively common phenomenon with 60-90% of patients presenting to emergency departments reporting pain (e.g., chest pain, trauma, extremity fractures and migraine headache) that require treatment [Hogan, S.L., 2005. Patient satisfaction with pain management in the emergency department. Advanced Emergency Nursing Journal 27(4), 284-294]. This article explores the use of conceptual theoretical empirical (C-T-E) framework to guide a senior nursing student in a case study of patient with chest pain. The Middle Range Theory of Pain described by Good [Good, M., 1998. A middle-range theory of acute pain management: use in research. Nursing Outlook 46(3), 120-124] and Melzack's [Melzack, R., 1987. The short-form McGill pain questionnaire. Pain, 30, 191-197] short form McGill pain questionnaire were applied along with the Prince Edward Island conceptual model (PEICM) for nursing. Results indicate that the nursing student increased her ability to work in partnership, assess relevant and specific information, and identify a number of strategies to help the patient achieve pain control by using a complement of pharmacological and non-pharmacological interventions. Moreover, the C-T-E approach provided an organized and systematic theoretical approach for the nursing student to assist a patient in pain control.
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PMID:Nursing patients with acute chest pain: practice guided by the Prince Edward Island conceptual model for nursing. 1939 96

The authors examined the prevalence of respiratory symptoms and determined whether respiratory symptoms were associated with prevalence of chest pain and number of acute painful episodes in children and adolescents with sickle cell disease. Participants (N = 93; 44 females, 49 males; mean age 9.8 +/- 4.3 years) reported coughing in the morning (21.5%), at night (31.2%), and during exercise (30.1%). Wheezing occurred both when they had a cold or infection (29.0%) and when they did not have (23.7%) a cold or infection. Sleep was disturbed by wheezing in 20.4%. Among the 76 patients who were school-age (>5 years), 19.7% of patients missed more than 4 days of school because of respiratory symptoms. The majority of patients reported having acute painful episodes (82.8%), and most (66.7%) reported having chest pain during acute painful episodes in the previous 12 months. Participants with acute pain episodes greater than 3 during the previous 12 months had significantly higher reports of breathing difficulties (P = .01) and chest pain (P = .002). The high number of respiratory symptoms (cough and wheeze) among patients with sickle cell disease may trigger acute painful episodes. Early screening and recognition, ongoing monitoring, and proactive management of respiratory symptoms may minimize the number of acute painful episodes.
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PMID:Respiratory symptoms and acute painful episodes in sickle cell disease. 2003 72

The NICE guidance on recent onset chest pain urges GPs to assess the nature and timing of acute pain rapidly and arrange urgent admission for suspected acute coronary syndrome. A 12-lead ECG should be performed and treatment commenced with 300 mg aspirin and GTN spray. Other pain relief such as opiates should be considered. However, starting management and recording a resting ECG should not delay transfer to hospital. Patients should be monitored while awaiting transfer. GPs can diagnose stable angina either on clinical assessment alone or combined with diagnostic testing (anatomical testing for obstructive coronary disease and/orfunctional testing for myocardial ischaemia). The presence or absence of the following three factors should be noted: a constricting discomfort in the front of the chest, or in the neck, shoulders, jaw, or arms; the discomfort is precipitated by physical exertion; the discomfort is relieved by rest or GTN within about 5 minutes. If all three factors are present the symptoms should be classified as typical angina, two factors atypical angina and one or none of these factors non-anginal chest pain. Once the initial assessment is complete the guidance recommends estimating the likelihood of coronary disease based on risk factors, age, sex and symptom classification. If clinical assessment suggests typical angina and the estimated likelihood of coronary disease is >90%, NICE advises that further diagnostic investigation is unnecessary. These patients should be managed as having angina. If the estimated likelihood of coronary disease is <10% then other non-ischaemic causes of chest pain should be considered.
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PMID:Chest pain of recent onset requires prompt diagnosis. 2066 20

Chest pain is a worrisome symptom that often causes parents to bring their child to emergency department(ED) for evaluation. In the majority of cases, the etiology of the chest pain is benign, but in one-fourth of the cases symptoms are distressing enough to cause children to miss school. The clinician's primary goal in ED evaluation of chest pain is to identify serious causes and rule out organic pathology. The diagnostic evaluation includes a thorough history and physical examination. Younger children are more likely to have a cardiorespiratory source for their chest pain, whereas an adolescent is more likely to have a psychogenic cause. Children having an organic cause of chest pain are more likely to have acute pain, sleep disturbance due to pain and associated fever or abnormal examination findings, whereas those with non-organic chest pain are more likely to have pain for a longer duration. Chest radiograph is required in some, especially in patients with history of trauma . In children, myocardial ischemia is rare, thus routine ECG is not required on every patient. However, both pericarditis and myocarditis can present with chest pain and fever. Musculoskeletal chest pain, such as caused by costochondritis and trauma, is generally reproducible on palpation and is exaggerated by physical activity or breathing. Pneumonia with or without pleural effusion, usually presents with fever and tachypnea; chest pain may be presenting symptom sometimes. In asthmatic children bronchospasm and persistent coughing can lead to excess use of chest wall muscles and chest pain. Patients' who report acute pain and subsequent respiratory distress should raise suspicion of a spontaneous pneumothorax or pneumomediastinum. ED management includes analgesics, specific treatment directed at underlying etiology and appropriate referral.
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PMID:Acute chest pain. 2154 47

This article reports a rare case of the use of low-dose ketamine infusion as an adjuvant to opioids to treat pain in sickle cell disease. A 31-year-old African-American male with history of sickle cell disease presented to the emergency department with complaints of chest tightness, multiple joint pain, and headache for 1 week. His vital signs and physical examination were unremarkable. His admission lab included hemoglobin of 8.4 g/dl, reticulocyte count of 16.3%, bilirubin of 1.7 mg/dl, and LDH of 1,267 U/l. Chest X-ray showed middle and lower lobe opacity and interstitial thickening. He was treated for acute pain crisis and community-acquired pneumonia with intravenous fluids, supplemental oxygen, and intravenous levofloxacin. He was placed on fentanyl patient-controlled analgesia (PCA), oxycodone, ketorolac, and methadone with co-analgesic gabapentin and venlafaxine. Over the course of his hospitalization, his chest pain resolved, but the joint pains continued. He was then transferred to the ICU and was discharged a day later after 7 days of ketamine infusion. Ketamine is a noncompetitive antagonist at the N-methyl-D-aspartate (NMDA) receptor. This property has been shown to modulate opioid tolerance and opioid-induced hyperalgesia. There have been a very few published reports on the use of low-dose ketamine in sickle cell pain management. A PubMed search revealed four published articles (Table 1). Fourteen out of the 17 cases (82.35%) who received ketamine infusion showed improvement in self-reported pain intensity and significant reduction in opioid dosage. Only one patient (5.9%) developed serious side effect leading to discontinuation of the drug. A low-dose ketamine can be an option for pain control in sickle cell disease. Randomized trial is required to establish this benefit of ketamine over currently available therapies.
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PMID:Ketamine infusion for sickle cell pain crisis refractory to opioids: a case report and review of literature. 2423 6

It is well known that a number of patients affected by hemodynamic stable pulmonary embolism are admitted to the emergency department presenting chest pain without further symptoms of pulmonary embolism, such as dyspnea, cough, hemoptysis, syncope, and tachycardia, but in a few cases, the presenting symptoms are even more unusual. The gold standard for pulmonary embolism diagnosis is computed tomography pulmonary angiogram resulting in significant exposure to ionizing radiation and contrast, but recently bedside ultrasound has shown to be useful in diagnosing pulmonary embolism in the emergency department. We describe two cases of pulmonary embolism in young men evaluated in the emergency department for acute pain of the upper abdomen, preliminarily diagnosed as abdominal colic, in which bedside ultrasound ruled out abdominal diseases and showed basal pulmonary abnormalities consistent with infarction, suggesting the need of diagnostic completion with computed tomography pulmonary angiogram. Bedside ultrasound was useful as complementary imaging test in diagnosing pulmonary embolism in young patients admitted for abdominal pain of unknown origin.
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PMID:Abdominal pain as pulmonary embolism presentation, usefulness of bedside ultrasound: a report of two cases. 2691 52


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