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

The high economical costs produced by the impact of low back pain on sick-listing and loss of manpower at work encouraged the search for personal or situational characteristics that indicate an increased risk for an acute onset of back pain or for its continuation towards chronicity. Risk factors for the onset of acute pain identified at the workplace refer to mechanical and psychomental strain. Vibration as well as lifting and carrying of heavy loads, especially if combined with a twisting of the trunk, are the most prominent mechanical risks, whereas dissatisfaction with the job or the working conditions, especially if there is a lack of social support either at the workplace or at home by the family or the spouse, increase the risk on a psychosocial level. Although these risks continue to be effective in the process of chronicity, other risks pertaining to behavioral and emotional reactions to the acute pain episode gain in importance. At the acute level, avoidance of physical and social activities are often encouraged by physicians who prescribe bed rest or give advice to regulate the active reinvolvement in daily life by assessing pain levels ('let the pain guide'). On the other hand, with regard to the prevention of chronicity, a strategy of graded early activation aiming at a reinforcement of healthy behaviors has more beneficial effects. After a short period of bed rest, no longer than two days, if at all necessary, patients are taught to maintain their daily activities and to practice specified exercises, while receiving time-contingent pain medication.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Chronification process of backache]. 804 19

Spectral parameters of the surface electromyographic (EMG) signal from lumbar back muscles assessed during a fatiguing isometric contraction can be used to classify different categories of low back pain (LBP) subjects and control subjects without LBP. In the test protocol currently used at the NeuroMuscular Research Center at Boston University, subjects contract their back muscles at 80% of their maximal voluntary contraction (MVC) force. This fatigue-based protocol has been successfully applied to persons with subacute or chronic LBP; those in acute pain, however, have not been included because of their inability to perform a maximal exertion. In this paper we will examine the force sensitivity of the currently used EMG parameters and also give an overview of some of our efforts to develop new test procedures. Our goal is to develop force-insensitive surface EMG parameters that can be used for classification purposes in populations of subjects who develop low trunk extension forces. In addition, the development of a model to predict MVC from anthropometrical measurements will be presented.
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PMID:Development of new protocols and analysis procedures for the assessment of LBP by surface EMG techniques. 932 45

Patients suffering from vascular disease are often a challenge for the acute pain service. Ischaemia, impaired wound healing, stump and phantom limb pain often require a complex analgesic regimen. Invasive measures such as spinal or epidural catheters can be very helpful but carry the risk of infection, as shown by this case report. A 53-year-old woman with a ten-year history of diabetes developed arterial vascular disease. Her right lower leg had been amputated two years previously. She was now admitted with necroses of the left forefoot. A bypass operation was performed under general anaesthesia. Because of intractable ischaemic pain, she was provided with an epidural catheter by the acute pain service. The bypass occluded, however, and a few days later her left lower leg also had to be amputated, this operation being performed under epidural anaesthesia with bupivacaine. The catheter was subsequently used for postoperative pain control and as a means to prevent phantom limb pain. When signs of superficial catheter infection were noticed days later, the catheter was immediately removed. Intractable pain then developed in the left leg which could not be sufficiently controlled with opioids and NSAIDs, and so a second epidural catheter was inserted one segment rostrally. Several days later the infected vascular prosthesis had to be removed followed by amputation of the thigh, this operation also being performed in epidural anaesthesia. Eleven days after insertion of the first epidural catheter, the patient complained of low back pain and headache. Examination by a neurologist revealed no signs of intraspinal infection. The second epidural catheter dislocated at this point in time and it was decided to introduce a third one, this being the only means to treat the otherwise intractable stump pain. Ten days later meningism, Kernig's sign and leucocytosis developed. NMR tomography detected intraspinal fluid in the epidural space at the dorsal border of the spinal canal. A hemilaminectomy was performed. The spinal epidural space showed signs of inflammation of the adipose tissue, but no pus. A little necrotic material and residues of an old haematoma were removed and the epidural space was lavaged. Specimens taken from the epidural material revealed colonisation with staphylococcus epidermidis, which was sensitive to the broad spectrum antibiotics formerly given to the patient to treat the infection in the left stump. By the next day, all signs of epiduritis had disappeared and the patient recovered completely.
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PMID:[Epiduritis after long-term pain therapy with an epidural catheter--review of the literature with a current case report]. 932 67

Acute low back pain is a common problem in the emergency department (ED). Effective management of acute pain enhances early rehabilitation and recovery. Given the importance of inflammatory mediators in pain generation and the adverse effects associated with opioids, it is logical to expect that a non-opioid agent with antiinflammatory and analgesic properties would provide excellent analgesia with fewer adverse effects. This double-blind, randomized, multicenter clinical trial, performed in six university and community hospital EDs, compares the analgesic efficacy and adverse effects of ketorolac to those of acetaminophen-codeine in ED patients with acute musculoskeletal low back pain. Our hypothesis was that ketorolac would provide superior analgesia with fewer adverse effects. One hundred twenty-three patients with acute low back pain were randomized to receive ketorolac (KET, N = 63) or acetaminophen-codeine (ACOD, N = 60). Most (79%) were males, and the mean age was 34.5 years. After baseline clinical assessment, patients were treated with ketorolac (10 mg every 4 to 6 h as needed, up to four daily doses) or acetaminophen-codeine (600 mg-60 mg, respectively, every 4 to 6 h as needed, up to six daily doses) and followed for one week. Pain intensity was assessed on visual analogue and categorical scales. Functional capacity, overall pain relief, and overall medication rating were assessed on categorical scales. Adverse events were documented. Primary outcomes included: 1) Pain intensity differences, based on visual analogue scores, for the 0 to 6 h treatment phase. 2) Incidence of adverse events. Secondary outcomes included analgesic efficacy, functional capacity, and overall subjective drug evaluation at one week. Both drugs provided substantial pain relief, with maximal effect 2.2 h after oral dosing. There were no significant differences in analgesic efficacy, functional capacity, or overall pain relief between the two groups. Sixteen patients (10 KET vs. 6 ACOD, NS) withdrew prematurely because of drug inefficacy. Patients in the ACOD group reported significantly more adverse drug events and serious adverse drug events. Seven patients--all in the ACOD group--withdrew from the study because of adverse drug events. Based on comparable efficacy and a superior adverse event profile, ketorolac was preferable to acetaminophen with codeine for the treatment of acute low back pain in the ED.
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PMID:Ketorolac versus acetaminophen-codeine in the emergency department treatment of acute low back pain. 969 69

Clinical significance of lumbar lordosis has not been agreed on. Our purpose is to compare lordotic measurements of normal and pain subjects and to test the validity of a new anthropometric model of lumbar curvatures. Digitized radiographic points (body corners) from standing lateral lumbar radiographs were modeled with ellipses in a least-squares method and were used to create segmental angles, a global angle at L1-L5, a Cobb angle from T12 to S1, Ferguson's sacral base angle, and an angle of pelvic tilt. Fifty normal subjects were matched in age, sex, weight, and height with 50 acute pain subjects, 50 chronic pain subjects, and 24 pain subjects with radiographic abnormalities. Of 11 angles, 2 distances, and 2 ratios, statistical analysis was significantly different across groups for 12 of these measurements, with the alternative hypotheses accepted for the other 3 measurements. The lordosis of both normal and low back pain subjects can be successfully modeled with a portion (approximately 86 degrees) of an ellipse, but with different major and minor axis ratios. The normal group's average elliptic lordosis has the smallest least-squares error, approximately 1 mm per digitized point, with (minor axis)/(major axis) ratio = 0.39, L1-L5 global angle = 40 degrees, and Cobb angle = 65 degrees. The chronic and radiographic abnormalities pain groups have an elongated ellipse with hypolordosis, reduced L1-L5 global angle = 29.6-35 degrees, reduced Cobb angle = 57-58 degrees, and elliptic axis ratio = 0.27-0.30. The acute pain group is hyperlordotic with the largest L1-L5 global angle, largest Cobb angle = 70 degrees, largest Ferguson's angle, and largest pelvic tilt angle.
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PMID:Elliptical modeling of the sagittal lumbar lordosis and segmental rotation angles as a method to discriminate between normal and low back pain subjects. 981 Nov 4

This structured review addresses the issue of whether antidepressants have an antinociceptive (analgesic) effect for chronic pain independent of their antidepressant effect. In order to answer this question, human acute pain studies, individual placebo-controlled studies for the treatment of specific chronic pain syndromes, and metaanalytic studies were reviewed and placed into table format. Analysis of this evidence led to the following conclusions: The evidence was consistent in indicating that overall antidepressants may have an antinociceptive effect in chronic pain, and that these drugs were effective for neuropathic pain. There was also some evidence that these drugs could be effective for psychogenic or somatoform disorder-associated pain. This evidence also strongly suggested that serotonergic-noradrenergic antidepressants may have a more consistent antinociceptive effect than the serotonergic antidepressants. Finally, this evidence indicated that antidepressants could be effective for pain associated with some specific pain syndromes, such as chronic low back pain, osteoarthritis or rheumatoid arthritis, fibrositis or fibromyalgia, and ulcer healing. Possible reasons for the conflicting results of studies in this area are presented, and problems that could limit the validity of the conclusions of this review are discussed.
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PMID:Evidence-based data on pain relief with antidepressants. 1094 61

This paper reviews published studies on the intramuscular use of meloxicam in acute rheumatic conditions. Data were obtained from 68 healthy volunteers and >800 patients with conditions such as arthritis, sciatica and lumbago who were treated with intramuscular injections of meloxicam compared with oral formulations. Intramuscular meloxicam appears to have a more rapid onset of action than oral meloxicam in acute inflammatory rheumatism. Local tolerance of im meloxicam was consistently good in both volunteers and patients, with respect to creatine phosphokinase levels and local reactions. Meloxicam im was also superior to other drugs such as piroxicam with respect to local tolerance. The incidence of adverse events, including gastrointestinal events, was low. Therefore, im meloxicam is an alternative to achieve rapid relief of acute pain in patients with acute inflammatory rheumatism. However, the recurrent use of im meloxicam is not recommended and patients should be switched to the oral formulation for chronic use.
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PMID:Meloxicam: a review of its pharmacokinetics, efficacy and tolerability following intramuscular administration. 1133 21

Pain is a common complaint in patients with autosomal-dominant polycystic kidney disease, and a systematic approach is needed to differentiate the etiology of the pain and define an approach to management. A thorough history is the best clue to the multifactorial causes of the pain, superimposed upon an understanding of the complex innervation network that supplies the kidneys. The appropriate use of diagnostic radiology (especially MRI) will assist in differentiating the mechanical low back pain caused by cyst enlargement, cyst rupture and cyst infection. Also, the increased incidence of uric acid nephrolithiasis as a factor in producing renal colic must be considered when evaluating acute pain in the population at risk. MRI is not a good technique to detect renal calculi, a frequent cause of pain in polycystic kidney disease. If stone disease is a possibility, then abdominal CT scan and/or ultrasound should be the method of radiologic investigation. Pain management is generally not approached in a systematic way in clinical practice because most physicians lack training in the principles of pain management. The first impulse to give narcotics for pain relief must be avoided. Since chronic pain cannot be "cured," an approach must include techniques that allow the patient to adapt to chronic pain so as to limit interference with their life style. A detailed stepwise approach for acute and chronic pain strategies for the patient with autosomal dominant polycystic kidney disease is outlined.
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PMID:Pain management in polycystic kidney disease. 1170 80

Low back pain may present as acute pain or as an acute exacerbation of a chronic pain problem. Acute low back pain is self-limited, with 90% of affected individuals recovering within 3 weeks to 3 months. Pain duration of more than 4 weeks warrants a more complete work-up, including ruling out malignancy. Pain duration of more than 6 months defines chronic pain, which is frequently associated with affective and behavioral components. When taking the history, determine pain intensity, location, pattern of radiation, onset, and duration. A gentle physical exam may help locate the source of pain through palpation and maneuvers, such as the straight leg raise test. Imaging is recommended for patients with a clinical finding that raises suspicion of spinal malignancy.
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PMID:Primary care work-up of acute and chronic symptoms. 1171 Aug 12

According to previous studies pain symptoms were a problem in multiple sclerosis (MS) patients. This is an important issue since symptom control, especially pain, assume high priorities in MS. The aim of study was to assess the incidence and type of pain symptoms in MS. In the study 104 consecutive patients with clinically definite MS, according to Posers criteria, were evaluated by questionnaire. In all patients brain MRI strongly suggested MS. 76% of patients had relapsing-remitting (RR) course of the disease. At any stage of the disease pain syndromes occurred in 70.2% of MS patients. In 8% patients pain was the first symptom of MS. The most common acute pain syndromes were: Lhermitte sign (26%) and painful tonic spasm (19%). The incidence of migraine was 8% and 26% had tension headache. Chronic pain occurred in 60% of MS patients. Most common were dysaesthetic extremity pain (45%), low back pain (34%) and painful leg spasm (22%). There was no correlation with age, sex, and duration of disease. Pain symptoms were more frequent in MS patients with higher EDSS score and spinal cord involvement. Pain syndromes are common in MS patients. There was no correlation with age, sex, and duration of the disease. Pain occurred more frequent in MS patients with higher EDSS score and in patients with spinal cord involvement.
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PMID:[Pain in the course of multiple sclerosis]. 1204 4


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