A slipped upper femoral epiphysis (SUFE) is a known hip disorder in adolescents in which the proximal femoral epiphysis slips and displaces relative to the metaphysis. We report an obese 12-year-old boy who presented with acute pain in the left hip after a fall. He was otherwise healthy with no prior joint pain. Pelvic radiography was misread twice before a second fall led to a severe SUFE.
Post-stroke shoulder pain is associated with either a peripheral or central pathology. However, most of the time, it is challenging to establish a cause-and-effect relationship between the suggested pathology and shoulder pain reported. We report a 66 year-old man who developed a right hemiplegic shoulder pain two months post stroke with initial investigations suggestive of peripheral pathologies. Pharmacological and non-pharmacological treatment did not improve his shoulder pain. Later he developed complex regional pain syndrome (CRPS) of the right hand and the initial shoulder pain subsequently relieved following resolution of the CRPS.
Acquired haemophilia (AH) is a rare bleeding disorder characterized by the presence of acquired inhibitors against Factor VIII causing disruption of coagulation cascade. It has no known genetic inheritance, and diagnosis remains a challenge. The peculiar presentations are later age of onset as acute pain in weight-bearing joints and spontaneous muscle haematoma with isolated prolonged activated partial thrombin time (APTT). Prevalence is 1 per million per year affecting both genders equally where blood product transfusion is seen in almost 87% of cases. The direct cause of AH is still unknown, and autoimmune dysregulation has been postulated, which predisposes to the development of the factor inhibitors. Being extremely rare, we are reporting two consecutive patients diagnosed by unusual bleeding episodes with isolated prolonged APTT due to Factor VIII inhibitors. AH deserves a special mention as high index of suspicion is required. More studies are required to provide better guidance in diagnosis and management of this condition.
Post operative pain is an expected adverse outcome following surgery and it often delays mobilization and overall recovery. Acute post operative pain is subjective and cannot be measured directly. The objective of this study was to determine nurses’ knowledge and attitude towards post operative pain management. A cross sectional study was conducted in surgical wards and the Intensive Care Unit of Universiti Kebangsaan Malaysia Medical Centre from February to April 2008. A 28 item questionnaire which comprised of two domains: knowledge and attitude towards post operative pain management was used. Eighty four respondents successfully responded to the study. Twenty respondents (25%) possessed high level, 58 respondents (69%) possessed moderate level and 5 respondents (6%) had low knowledge level of post operative pain management. Positive attitude towards post operative pain management was reported by 66 respondents (78.5%). There was a significant relationship between nurses’ academic qualifications and attitude towards post operative pain management (χ² =29.96, p
STUDY DESIGN: Meta-analysis methodology was extended to derive comparative effectiveness information on spinal manipulation for low back pain.
OBJECTIVE:
Determine relative effectiveness of spinal manipulation therapies (SMTs), medical management, physical therapies, and exercise for acute and chronic nonsurgical low back pain.
SUMMARY OF BACKGROUND DATA: Results of spinal manipulation treatments of nonsurgical low back pain are equivocal. Nearly 40 years of SMT studies were not informative.
METHODS: Studies were chosen on the basis of inclusion in prior evidence syntheses. Effect sizes were converted to standardized mean effect sizes and probabilities of recovery. Nested model comparisons isolated nonspecific from treatment effects. Aggregate data were tested for evidential support as compared with shams.
RESULTS: Of 84% acute pain variance, 81% was from nonspecific factors and 3% from treatment. No treatment for acute pain exceeded sham's effectiveness. Most acute results were within 95% confidence bands of that predicted by natural history alone. For chronic pain, 66% of 98% was nonspecific, but treatments influenced 32% of outcomes. Chronic pain treatments also fit within 95% confidence bands as predicted by natural history. Though the evidential support for treating chronic back pain as compared with sham groups was weak, chronic pain seemed to respond to SMT, whereas whole systems of clinical management did not.
CONCLUSION: Meta-analyses can extract comparative effectiveness information from existing literature. The relatively small portion of outcomes attributable to treatment explains why past research results fail to converge on stable estimates. The probability of treatment superiority matched a binomial random process. Treatments serve to motivate, reassure, and calibrate patient expectations--features that might reduce medicalization and augment self-care. Exercise with authoritative support is an effective strategy for acute and chronic low back pain.
Prehospital care (PHC) pain evaluation is an essential patient assessment to be performed by paramedics. Pain intensity is frequently assessed using Verbal Numerical Rating Scale (VNRS) or Visual Analog Scale (VAS).
Subcutaneous (SC) administration of tramadol was compared with intravenous (IV) administration to evaluate analgesia following canine ovariohysterectomy (OHE). Healthy female dogs (n = 12) between 1 and 3 years of age (1.95 ± 0.65 years), weighing between 10.5 and 17.1 kg (13.12 ± 1.95 kg), were used. Pain was assessed at baseline before surgery and then hourly for 8 hr after surgery. Tramadol was administered both SC and IV at a dose of 3 mg/kg and provided significant postoperative analgesia, as indicated by analgesiometry, β-endorphin levels, and interleukin 6 (IL-6) levels. The respiratory rates and rectal temperatures remained normal and were not significantly different between or within the groups. A significant increase in heart rate was observed at 4 hr for dogs in both groups relative to the baseline, but there was no significant difference in heart rates between the groups at any time point. A significant decrease in mechanical pain threshold was observed within each group after surgery, but both groups responded similarly, suggesting that SC administration of tramadol is as effective as IV administration. Increased serum levels of both IL-6 and β-endorphin 3 hr postoperatively further indicate that both routes of administration achieve similar pain control. Thus, the relative analgesic efficacy of SC tramadol is comparable to that of IV administration and can be used to achieve similar effects for postsurgical pain management in dogs undergoing OHE.
Introduction: The aim of this study was to determine the effects of gamat extract on pain behaviour and Fos like immunoreactivity (FLI) expression in the ventral posterolateral thalamus using the acute pain model. Materials & Methods: Fourteen Sprague-Dawley male rats (220-300 gram) were given intraplantar injection of 0.05ml formalin (1%) followed by intraperitoneal administration of either 4 mg/kg gamat extracts (Holothuria spp.) or saline (control). Behavioural changes were observed and rats were sacrificed 2 hours post-formalin injection. Immunohistochemistry testing was done on the brain sections. FLI was examined using a light microscope attached to an image analyser. The behaviour and FLI data were analysed using repeated measure analysis of variance and independent t-test respectively. Significance level was taken as p
Transient osteoporosis of the hip (TOH) is a benign, selflimiting condition characterised by acute onset groin pain in adults. Early diagnosis is important to differentiate it from progressive conditions such as osteonecrosis. We report on a middle-aged male who presented with right groin pain without any prior trauma. The diagnosis of transient osteoporosis of hip was confirmed by Magnetic Resonance Imaging (MRI) and he was successfully treated with a course of Alendronate sodium, anti-inflammatory analgesics and a period of non-weight bearing ambulation.
The use of patient-controlled analgesia (PCA) has been reported to provide effective pain relief, often resulting in less opioid consumption, and is associated with greater patient satisfaction when it is compared to other techniques of analgesia delivery.
Pain is a sensation that is difficult to remember. Pain exposure is a stimulus that can damage the development of the baby's brain and contribute to learning disorders and behavior in childhood. Therefore nursing intervention is needed that can reduce the pain response in infants, especially during hospital treatment. The aim of the study was to determine the effect of non-nutritive sucking (NNS) and ASI (Air Susu Ibu or Breast Milk) on oral responses to acute pain in the neonate when invasive actions were performed. The benefits of research as evidence-based practiced about administering NNS and ASI orally to pain responses in neonates when experiencing pain. The research design uses experimental nonequivalent control group before and after design. The population of all neonates admitted to Dr. Soekardjo Tasikmalaya, with a total sample of 30 respondents consisting of 15 ASI respondents and 15 respondents for the NNS group. Pain assessments instruments CRIES (Crying, Requiring an increase in oxygen, Increased vital sign, Expression, Sleeplessness) was applied. Data analysis used non parametric tests Mann Whitney and Wilcoxon. The results of the study showed no significant differences in pain response before and after the intervention (p-value 0.236). It was suggested that nurses can improve health education for parents to be able to provide breastfeeding during treatment, especially when the baby receives invasive action