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

Idiopathic scrotal edema causes painful enlargement of the scrotum, as does torsion of the testis or of a testicular appendage, or epididymo-orchitis. Unilateral edema of the scrotum develops rapidly, the skin becomes pale pink or red, and there is discomfort rather than acute pain. Careful palpation reveals a nontender testis. The condition is usually self-limited, and resolves completely without treatment in 48 hours. It must be differentiated from testicular torsion, for which urgent surgical treatment is mandatory.
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PMID:[Idiopathic scrotal edema]. 150 24

Summary recommendations 1-5 and 7 should be implemented in every hospital where operations are performed on inpatients. The Acute Pain Management Guideline Panel recommends that any hospital in which abdominal or thoracic operations are routinely performed offer patients postoperative regional anesthetic, epidural or intrathecal opioids, PCA infusions, and other interventions requiring a similar level of expertise, under the supervision of an acute pain service as described in summary recommendation 6. For pain management to be effective, each hospital must designate who or which department will be responsible for all of the required activities. There are a number of alternative approaches to preventing or relieving postoperative pain, many of which can give good results if attentively applied. The following elements, however, apply to most cases and might serve as a focus for assessing the results of these guidelines: 1. Promise patients attentive analgesic care. Patients should be informed before surgery, orally and in printed format, that effective pain relief is an important part of their treatment, that talking about unrelieved pain is essential, and that health professionals will respond quickly to their reports of pain. It should be made clear to patients and families, however, that the total absence of any postoperative discomfort is normally not a realistic or even a desirable goal. 2. Chart and display assessment of pain and relief. A simple assessment of pain intensity and pain relief should be recorded on the bedside vital sign chart or a similar record that encourages easy, regular review by members of the health care team and is incorporated in the patient's permanent record. The intensity of pain should be assessed and documented at regular intervals (depending on the severity of pain) and with each new report of pain. The degree of pain relief should be determined after each pain management intervention, once a sufficient time has elapsed for the treatment to reach peak effect. A simple, valid measure of intensity and relief should be selected by each clinical unit. For children, age-appropriate measures should be used. 3. Define pain and relief levels to trigger a review. Each institution should identify pain intensity and pain relief levels that will elicit a review of the current pain therapy, documentation of the proposed modifications in treatment, and subsequent review of its efficacy. This process of treatment review and follow-up should include participation by physicians and nurses involved in the patient's care.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Acute pain management: operative or medical procedures and trauma, Part 2. Agency for Health Care Policy and Research. 158 31

Vertebral compression fractures (VCFs) may be defined radiographically or as a clinical event. The prevalence of these fractures in women aged 50 and over has been estimated at 26% when defined as a reduction in vertebral height greater than 15%. Retrospective reviews of case records have shown a clinical detection rate of VCF in white women of 153/100,000 person years. Of these clinically detected VCFs, 84% were associated with pain. VCF may be defined as a clinical event characterised by loss of height and acute pain. The pain of acute fracture usually lasts 4 to 6 weeks with intense pain at the site of fracture. Chronic pain may also occur in patients with multiple compression fractures, height loss and low bone density but is probably due to structural changes or osteoarthritis. Radiographic VCF may not be symptomatic. The greater the deformity, the greater the likelihood of pain and disability. As height is lost, patients experience discomfort from the rib cage pressing downward on the pelvis. Patients develop a thoracic kyphosis, a lumbar lordosis, and a protuberant abdomen with prominent horizontal skinfold creases. The reduced thoracic space may result in decreased exercise tolerance and reduced abdominal space may give rise to early satiety and weight loss. Sleep disorders may also occur. Patients lose self esteem. Self care may become difficult. They are often depressed. They become fearful of further fracture. They have distorted body image and poor health perception. Patients with one vertebral fracture are at increased risk of peripheral fracture and further vertebral fracture. The aims of acute management are to reduce symptoms and mobilise the patient as quickly as possible.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The clinical consequences of vertebral compression fracture. 162 11

A two-phase assay was developed in the rat to evaluate parenteral formulations intended for intramuscular administration for the induction of both acute pain-on-injection and delayed pain/discomfort at the injection site (secondary to muscle damage). Phase 1 of the assay assessed pain-on-injection using a modified version of the previously published rat paw-lick assay. Adult male CD rats (10/group) were given subplantar (footpad) injections of 0.1 ml and then observed for 15 min for paw-lick responses. To increase assay sensitivity, responses more subtle than paw licks (ie., paw lifts) were scored, and injection-site clinical signs were recorded 6, 24, and 48 hr after injection. Phase 2 of the assay assessed myotoxic potential, using the same rats after a 1-week recovery period. The rats were injected intramuscularly in the anterior thigh with 0.2 ml, bled from the orbital sinus at 2, 6, and 24 hr for analysis of serum creatine kinase (CK), and then necropsied at 24 hr to prepare tissue sections of the injection site for microscopic examination. A series of cephalosporin-type antibiotics produced pain-on-injection and muscle damage consistent with reported clinical experience (cefazolin less than cephalothin less than cefoxitin). Several nonantibiotic parenteral formulations (diazepam, digoxin, phenytoin, and lidocaine) tested in the paw-lick/muscle irritation model also produced responses that correlated with the clinic, i.e., virtually no acute pain but moderate to marked muscle damage. The results indicate that the two-phase rat paw-lick/muscle irritation model is effective in evaluating parenteral formulations for clinical acceptability, and that both phases of the assay are necessary to optimize predictability of the assay for human clinical experience.
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PMID:Rat paw-lick/muscle irritation model for evaluating parenteral formulations for pain-on-injection and muscle damage. 208 14

Discovery of the endogenous opiate system of the brain has revolutionized the study of pain and pain management. In this study a convenience sample of 10 pregnant women, 16 nonpregnant women, and 18 men were studied to determine if changes in plasma beta-endorphin-like immunoreactivity affected pain perception during labor. Pregnant women had plasma levels of beta-endorphin significantly higher than nonpregnant women at the midpoint of their menstrual cycle, t = 3.74, df = 31, p = .007. Self-reported pain perception scores were not correlated with plasma beta-endorphin levels. However, as labor progressed, the women reported increased discomfort between contractions and during contractions while beta-endorphin levels increased only slightly. Close examination of the pain pattern indicates that pain perceived by the women between contractions increased at a greater rate than during contractions. This pattern suggests that opiate-active beta-endorphin may increase the ability of women to tolerate acute pain.
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PMID:Beta-endorphin levels during pregnancy and labor: a role in pain modulation? 252 22

We provided a microanalytic description of facial reactions to a series of painful and nonpainful electric shocks and examined the impact of these as discrete facial cues for observer judgments of acute pain. Thirty female volunteers were videotaped and reported their discomfort in response to electric shocks after earlier exposure to one of three social influence conditions: a tolerant model, an intolerant model, or neutral peer presence. We coded the videotapes for facial activity using the Facial Action Coding System (Ekman & Friesen, 1978b), and peer judges rated them for painful discomfort. Subjects exposed to a tolerant model reported no more discomfort than did subjects exposed to an intolerant model, despite receiving more intense levels of shock, but were judged by observers to be in more pain. Analyses of facial activity yielded consistent findings: Tolerant-model subjects, though reporting discomfort equivalent to that reported in other groups, displayed more pain-related facial activity (brow lowering, narrowing of the eye aperture from below, raising the upper lip, and blinking). There was a substantial direct relation between observer judgments of distress and discrete, pain-related facial actions (mean multiple R = .74 for the various shock levels rated). These data indicate that nonverbal expression yields information about the response to noxious stimulation that is non-redundant with self-report.
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PMID:Observer judgments of acute pain: facial action determinants. 372 41

An adolescent girl with chronic myelogenous leukemia was treated with hypnosis for several disease- and treatment-related problems during the last 4 months of her life. Data were collected before and after hypnosis on the nature and intensity of the patient's acute pain and anxiety during bone marrow aspirations, chronic headache and backache, nausea and vomiting during chemotherapy, anorexia, and the discomfort associated with spiking temperatures. Comparisons of baseline and posthypnosis reports suggest that hypnosis was successfully used for acute and chronic pain, anxiety, unpleasant body sensations and, possibly, nausea and vomiting. The hypnotic techniques used, the limitations of hypnosis and clinical issues in this case are presented and discussed.
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PMID:Use of hypnosis for multiple symptoms in an adolescent girl with leukemia. 645 20

Spontaneous intramural rupture or intramural haematoma of the oesophagus is a rare cause of acute pain in the chest and upper abdomen. Much less ominous than spontaneous complete rupture from which it must be distinguished, it seldom if ever necessitates operation. Five new cases are described and reviewed together with 15 collected from published reports. The dominant symptom of every case was severe and constant retrosternal or epigastric pain; concomitant dysphagia was mentioned in 11 cases. In seven the pain was preceded by or coincided with vomiting. The condition was related to other stresses in three and appeared to be truly spontaneous in 10. In approximately one-third of cases it started suddenly but more often it began as discomfort worsening rapidly. Fourteen patients vomited blood after experiencing pain but only four were given transfusions. In contradistinction to complete rupture, none had surgical emphysema and plain chest radiographs were unremarkable. All had abnormal gastrografin or barium swallows. Intramural haematomas with or without mucosal tears were seen in the 11 cases in which oesophagoscopy was performed. Fifteen patients made rapid and complete recoveries on conservative management. Of the four who did not respond satisfactorily, one had the oesophagus repaired, two had drainage of the mediastinum after failure to find the false lumen at thoracotomy, and one had only an abdominal exploration. The only death in the whole series occurred after a disastrous emergency exploration and subsequent total oesophagectomy.
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PMID:Spontaneous intramural rupture and intramural haematoma of the oesophagus. 697 33

Inadequately treated pain is a major cause of unanticipated hospital admissions after ambulatory surgery. The ability to provide adequate pain relief by simple methods that are readily available to the day-care patient in his or her home environment is one of the major challenges for providers of ambulatory surgery and anesthesia. The increasing number of extensive and painful surgical procedures (e.g., laparoscopic cholecystectomy, laminectomy, knee construction, hysterectomies) being undertaken on an ambulatory basis presents new challenges with respect to acute postoperative pain. Hence the availability of more sophisticated and effective treatment modalities, such as ambulatory PCA and continuous local and regional anesthetic blocks, with minimal side effects, are necessary to optimize the benefits of ambulatory surgery for both patient and health care provider. However, outcome studies are needed to evaluate the effect of these newer therapeutic approaches with respect to postoperative side effects and other important recovery parameters. Recent studies suggest that factors other than pain per se must be controlled to reduce postoperative morbidity and facilitate the recovery process. Not surprisingly, the anesthetic technique can influence analgesic requirement in the early postoperative period. Although oral analgesic agents will continue to play an important role, the adjunctive use of local anesthetic agents is likely to assume an even greater role in the future. Use of drug combinations (e.g., opiates and local anesthetics, opiates and NSAIDs) may provide improved analgesia with fewer side effects. Finally, safer and simpler analgesic delivery systems are needed to improve our ability to provide cost-effective pain relief after ambulatory surgery. In conclusion, as a result of our enhanced understanding of the mechanisms of acute pain and the physiological basis of nociception, the provision of "stress-free" anesthesia with minimal postoperative discomfort is now possible for most patients undergoing elective surgical procedures. The aim of an analgesic technique should be not only to lower the pain scores but also to facilitate earlier mobilization and reduce perioperative complications. If future clinical investigations clarify the issues that have been raised by laboratory studies, clinicians may be able to effectively treat postoperative pain using combinations of "balanced," "preemptive," and "peripheral" analgesia. More important, improved analgesic techniques will increase patient satisfaction and enhance their perception of ambulatory anesthesia and surgery.
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PMID:Postoperative pain management. 796 Jan 70

As more extensive and painful surgical procedures (e.g., laparoscopic cholecystectomy, laminectomy, knee and shoulder reconstruction, hysterectomy) are being performed on an outpatient basis, the availability of sophisticated postoperative analgesic regimens are necessary to optimize the benefits of day-case surgery for both the patient and the health care provider. However, outcome studies are needed to evaluate the effects of these newer therapeutic approaches with respect to postoperative side effects, cost and important recovery variables. Recent studies suggest that factors other than pain per se must be controlled in order to reduce postoperative morbidity and facilitate the recovery process. Not surprisingly, the anaesthetic technique can influence the analgesic requirements and the likelihood of emesis in the early postoperative period. Although opioid analgesics will continue to play an important role, the adjunctive use of both local anaesthetic agents and NSAIDs will probably assume an even greater role in the future. Use of drug combinations (e.g., opioids with local anaesthetics, alpha2 agonists and/or NSAIDs) may provide for improved analgesia with fewer opioid-related side effects than narcotic analgesics alone. Finally, safer and simpler analgesic delivery systems are needed to improve our ability to provide cost-effective pain relief after day-case surgery in the future. In conclusion, as a result of our enhanced understanding of the mechanisms of acute pain and the physiological basis of nociception, the provision of "stress free" anaesthesia with minimal postoperative discomfort is now possible for most patients undergoing ambulatory surgical procedures. The aim of any analgesic technique should not only be to lower the pain scores but also to facilitate earlier mobilization and to reduce perioperative complications, in particular PONV. In future, clinicians should be able to effectively treat postoperative pain using a combination of "balanced," "preemptive," and "peripheral" analgesia techniques without producing emetic sequelae.
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PMID:Management of postoperative pain and emesis. 859 Apr 97


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