Kinesiologic tape for labor pain control: Randomized controlled trial

Background: Kinesiologic taping has been studied for managing diverse types of dysfunctions and pain, but not for managing pain during labor. Objective: This study evaluated the effectiveness and safety of using kinesiologic tape (KT) during labor relative to pain, maternal satisfaction, and obstetric and neonatal outcomes. Method: The study was a single-blind randomized controlled trial composed of 60 pregnant women divided into two groups. In the kinesiologic tape group (KTG), the tape was applied to the region of spinal nerves T10–L1 and S2–S4; in the control group (CG), the tape was applied to the region of spinal nerves T1–T4. Study participants were low-risk pregnant women with spontaneous onset of labor and no previous Cesarean section. Outcomes evaluated were pain, duration of labor, type of delivery, uterotonic and anesthetic requirement, neonatal vitality, and satisfaction with delivery and tape use. Intention-to-treat analysis was performed, and risk ratios with a 95% CI were estimated. Results: After the first hour of tape use, a significant increase in pain was observed in the CG (p = 0.002). However, there were no differences between groups relative to the remaining outcomes assessed. In the KTG, 59% of participants reported satisfaction with tape use, whereas in the CG, 44% reported satisfaction with tape use. Conclusion: Despite its safety, the KT technique did not prove to effectively control labor pain.     

Validation of the brief pain inventory in patients six months after cardiac surgery

The Brief Pain Inventory (BPI) is a questionnaire developed to assess the severity of pain and the impact of pain on daily function. The purpose of the current study was to evaluate the psychometric properties of the BPI for use in patients undergoing cardiac surgery. Between September 2004 and September 2005, 534 patients completed the BPI before surgery and 462 responded six months after surgery. The BPI was validated with respect to construct validity, internal consistency, criterion validity, and responsiveness. To evaluate the criterion validity, the BPI was validated against the bodily pain (BP) scale of the Medical Outcomes Study Short-Form Health Survey (SF-36). The factor analysis resulted in two distinct factors, supporting the validity of the two-factor structure of the original BPI, with high loadings on pain severity and pain interference. Results indicated acceptable internal consistency, with Cronbach's alpha coefficients between 0.84 and 0.94. The association between the BPI and the SF-36 BP dimension supported the criterion validity, with correlation coefficients between 0.47 and 0.65. The pain severity scale and the pain interference scale declined from baseline to follow-up. These results supported the responsiveness of the BPI. The study confirmed that the BPI shows good psychometric properties of reliability, validity, and responsiveness, enabling it to be used to measure pain in patients after cardiac surgery. Validating pain measures for use in this population is an important part of establishing a foundation for future studies on chronic pain after cardiac surgery.     

综合性护理干预对口腔颌面术后病人创面愈合、并发症及生活质量的影响

[目的]探讨综合性护理干预对口腔颌面术后病人创面愈合、并发症发生情况及生活质量的效果影响。[方法]选取我院2013年1月—2014年6月在口腔科行口腔颌面手术的200例病人作为研究对象,随机分为对照组与观察组各100例。对照组予以常规护理,观察组予以综合性护理干预。比较两组病人的创面愈合情况、并发症发生率以及健康调查简易量表(SF 36)评分。[结果]观察组病人口腔创面愈合情况明显高于对照组(95%和77%),并发症发生率低于对照组(7%和24%),差异有统计学意义(P<0.01);干预前两组 SF 36量表评分差异无统计学意义(P >0.05);干预后观察组 SF 36评分明显高于对照组,差异有统计学意义(P <0.01)。[结论]口腔颌面外科术后病人应用口腔冲洗能促进创面愈合,减少感染的发生率,提高病人的生活质量。     

Evaluation of pain in patients with oral squamous cell carcinoma

In this study we have developed and tested a novel pain questionnaire to measure the pain experienced by patients with oral squamous cell carcinoma. The questionnaire consisted of 8 questions rated by the patient on a visual analog scale. Patients completed the questionnaire at the time of initial presentation before surgical treatment. None of the patients were taking analgesics. The responses were then scored and compiled with patient data and pathology reports. Of the 15 completed questionnaires, 14 patients reported some level of functional restriction from pain (mean, 46.6 +/- 25.2, scale of 0 to 100 mm). On average, patients experienced significantly higher function-related, rather than spontaneous, pain intensity and sharpness. Men (n = 8) had a significantly higher level of function-related pain intensity and sharpness than women had (n = 7). There was a strong correlation between nodal disease and increased levels of spontaneous intensity, sharpness, throbbing, and overall functional restriction. PERSPECTIVE: The results of this study indicate the heterogeneous nature and function dependence of oral cancer pain. The questionnaire we have developed in this study will allow for correlations between pain parameters and specific tumor biology in future studies.     

地塞米松对口腔颌面部术后应激反应及炎症反应的影响

目的分析地塞米松对口腔颌面部术后应激反应及炎症反应的影响。方法选取本院2018年6月至2019年6月收治的100例口腔颌面部手术患者,将其随机分为试验组(50例)和对照组(50例)。对照组患者术后予以常规处理,试验组患者在对照组基础上予以地塞米松。比较两组的应用效果。结果治疗3 d后,试验组血浆皮质醇、去甲肾上腺素水平、血清IL-1、IL-6、TNF-α水平、VAS评分均明显低于对照组(P<0.05)。试验组并发症总发生率明显低于对照组(P<0.05)。结论地塞米松应用于口腔颌面部术后,可有效减轻患者应激反应、炎症反应,降低并发症发生率。     

Health-related quality of life in persons with long-term pain after a stroke

Background. No study has, to our knowledge, previously been published on health‐related quality of life (HRQoL) in a group suffering from long‐term pain after a stroke. Aim. The aim of the present study was to describe HRQoL in persons with long‐term pain after a stroke, and to compare this with different types of pain conditions, age, gender and household status. Design. This study has a design combining qualitative and quantitative methods. Methods. Forty three participants suffering from long‐term pain after a stroke were included. A qualitative interview was performed and then analysed by means of latent content analysis. In addition, two self‐report questionnaires, SF‐36 and the Hospital Anxiety and Depression Scale (HAD Scale), were used. Results. The qualitative data revealed that physical and cognitive functioning, economic security and good relationships, support and having the ability to be together with family and friends were important factors with regard to experienced HRQoL. No significant differences were found in SF‐36 and the HAD Scale with regard to the different types of pain. The older age group had decreased physical functioning in SF‐36. The men had more decreased vitality than the women. Conclusion. The results show, that the participants in this study have a lower HRQoL due to their long‐term pain than those in previous studies on stroke survivors. It is evident that further research is needed with longitudinal studies and larger populations to gain more knowledge and thereby provide better supportive care. Relevance to clinical practice. Awareness and understanding of the patients’ perceptions and transitions with regard to their life situation and suffering from long‐term pain after a stroke is important in order to support a maintained or increased HRQoL. This is also important after the acute stage and rehabilitation, including quality of life of the relatives, especially to older and dependent persons.     

脊柱前路病灶清除植骨融合内固定术对脊柱结核患者生活质量的影响

目的探讨脊柱前路病灶清除植骨融合内固定术对脊柱椎体结核患者生活质量、腰椎功能及疼痛的影响。方法收集2008年1月~2011年3月,采用脊柱前路病灶清除植骨融合内固定术治疗胸腰椎结核患者17例,术前、术后1个月和术后6个月采用健康调查简表(SF-36)、日本骨科学会下腰椎评分(JOA腰椎功能评价-29分法)、视觉模拟评分(VAS)对患者的生活质量、腰部功能、疼痛改善状况等进行对比分析。结果 17例患者SF-36中生理功能(PF)、生理职能(RP)、躯体疼痛(BP)、总体健康(GH)、活力(VT)、社会功能(SF)、情感职能(RE)、精神健康(MH)、JOA主观症状、JOA临床体征、JOA日常活动受限、VAS评分术后6个月较术后1个月、术前相比均改善(P<0.05);PF、BP、GH、VT、SF、MH、JOA主观症状、JOA临床体征、JOA日常活动受限、VAS评分术后1个月与术前相比均改善(P<0.05)。结论行脊柱前路病灶清除植骨融合内固定术可以有效改善患者的生活质量、腰椎功能及减轻疼痛。     

Changes in Quality of Life after 3 months of Usual Care in a Large Sample of Patients with Noncancer Pain: The “QOOL: Quality of Life and Pain” Study

Large‐scale observational studies can provide useful information on changes in health outcomes over time. The aim of this study was to investigate the effect of 3 months of usual care on quality of life (QOL) and pain outcomes in noncancer chronic pain patients managed by pain specialists and to examine factors associated with changes in QOL. This was assessed using the EQ‐5D and pain outcomes using the Brief Pain Inventory (BPI). Changes in QOL and pain were studied for the overall sample and in subgroups defined by baseline pain severity. Multivariate regression was used to investigate factors associated with change on EQ‐5D. Three thousand and twenty‐nine patients were included for analysis. After 3 months of usual care, a mean of 40.9% of patients showed improvement on individual EQ‐5D dimensions, with the highest rates of improvement seen on the pain/discomfort (50.8%) and anxiety/depression (48.3%) dimensions. The EQ‐5D Index increased from a mean (SD) of 0.35 (0.2) to 0.58 (0.21) points between baseline and month 3, and the thermometer from 41.5 (19.4) to 58.7 (17.8), indicating a large effect. Improvements in QOL were larger in those with severe baseline pain. The BPI severity summary score improved from a mean (SD) of 6.5 (1.4) to 4.1 (1.7) and the interference summary score from 6.6 (1.5) to 4.2 (1.9). Changes on the BPI severity and interference scores were associated with changes in the EQ‐5D Index and thermometer. In conclusion, 3 months of usual care in noncancer pain patients led to substantial improvements in QOL and pain outcomes.     

Intravenous acetaminophen for pain after major orthopedic surgery: an expanded analysis

Background and Methods: From the time that Sinatra et al. (Anesthesiology. 2005; 102 :822) was published to FDA apaproval of intravenous (IV) acetaminophen, an expanded analysis of the original raw study data became necessary for the regulatory submission. The following analyses were conducted: (1) sum of pain intensity differences over 24 hours (SPID24) using currently accepted imputation methods to account for both missing data and the effects of rescue; (2) efficacy results after the first 6 hours; (3) effects of gender, race/ethnicity, age, weight, surgical site, ASA Class, and serotonin antagonists; and (4) a stepwise regression analysis of why adverse events of nausea and vomiting were numerically (although not statistically) higher in the IV acetaminophen group compared with placebo. Results: Sum of pain intensity differences over 24 hours using a 0‐ to 100‐mm visual analog scale was statistically significantly (P < 0.001) in favor of IV acetaminophen (n = 49) compared with placebo (n = 52). Time to rescue was found to be 3.9 and 2.1 hours, respectively, for total hip and knee arthroplasty compared with 0.8 hours for the placebo group. Rescue medication consumption, requests, and actual administration were all significantly lower in the IV acetaminophen group compared with placebo for each dosing interval, except in the 6‐ to 12‐hours interval where a numerical trend was observed. Analysis of various subset variables demonstrated similar efficacy for each variable. A stepwise regression analysis demonstrated that AE reports of nausea and vomiting were most likely due to prerandomization events, particularly opioid consumption and presence of nausea prior to randomization. Conclusion: Repeated‐dose 24‐hours end points were found to be as robust as previously published results. IV acetaminophen efficacy and safety appeared to be unaffected by specific subset variables.?     

Reflecting on whiplash associated disorder through a QoL lens: an option to advance practice and research

Purpose: To examine the constructs of quality of life (QoL) as applied to whiplash associated disorder (WAD), its current state of measurement and suggestions for future application. Method: Narrative literature review. Results: The burden of WAD on the healthcare system is substantive. Assessment of QoL issues for people with WAD may provide a broader understanding of the patient experience. No consistent framework for QoL in WAD has been adopted, nor has preference for any QoL instrument been established. Inconsistent use of terminology for what is being measured, and the measures themselves hamper clarity on the issue. Options for assessing QoL currently include a meaningful condition-specific scale that has not undergone sufficient psychometric evaluation (Whiplash Disability Questionnaire (WDQ), or generic scales with strong psychometric properties that have not undergone sufficient relevancy evaluation (e.g. SF-36, WHOQOL BREF). Generic measures can measure overlapping constructs including heath status, utility, health-related quality of life or generic QoL. The inter-relationships between these in WAD have not been defined. Conclusions: Given the impact of WAD on QoL, additional clarity on tools and approaches are needed. There is a need for research on the relevance and clinical measurement properties of available condition-specific and generic tools to define a preferred measurement approach in WAD.

Implications for Rehabilitation

• Whiplash associated disorder (WAD) results in physical and psychological dysfunction impacting on a persons quality of life (QoL).

• There is currently no framework or standard tool with which to evaluate QoL in people with WAD.

• Use of the Whiplash Disability Questionnaire and a generic QoL tool such as the WHOQOL BREF is proposed as a means for comprehensive evaluation of QoL in people with WAD.

     

Quality of life and maintenance of improvements after early multimodal rehabilitation: a 5-year follow-up

Purpose. There is a paucity of long-term evaluations on rehabilitation of musculoskeletal disorders, e.g., neck, shoulder or back pain. The aim of this study was to assess quality of life and the effect of early multimodal rehabilitation on 91 patients with musculoskeletal pain and disability at a 5-year follow-up.

Method. The follow-up assessment, which included questions on pain, function, quality of life, perceived health, sick leave and psychosomatic symptoms, was performed 5 years after the assessment of baseline status.

Results. Improvements in pain, perceived health and psychosomatic symptoms were maintained at the 5-year follow-up. In addition, improvements in function, quality of life, and level of acceptable pain were significant in comparison to baseline. At the time of the baseline assessment all patients were on sick leave (13% were on partial sick leave). At the 5-year follow-up, 58% of the patients were at work part or full time. The results show that those working differed significantly from those not working at the 5-year follow-up on almost all variables, indicating that those working enjoy better health. The most salient prognostic factors for return to work were perceived health and educational level at the time of the baseline evaluation.

Conclusions. These results show that treatment improved quality of life and the effects were basically maintained at 5 years. Work capacity as reflected in return to work increased greatly (81%) at a 1-year follow-up and was substantial (58%) at the 5-year follow-up. Moreover, perceived health and educational levels were important prognostic factors. Finally, the fact that patients working reported better health underscores the probable importance of return to work. Our results imply that it may be feasible to obtain long-term benefits from such a primary care-based intervention.     

Pain in Europe: A Public Health Priority

ABSTRACT

The prevalence and socioeconomic impact of chronic pain are Europe is described. Effects on quality of life and a proposed strategy for the future are discussed. Recommendations come from the OPENMinds group.

?This feature is adapted from paineurope 2011; Issue 4, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be accessed via the Web site: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication.     

Health related quality of life after lumbar disc surgery: a prospective study of 145 patients

Purpose: This study compared health related quality of life (HRQOL) among lumbar disc surgery patients to general population, and assessed the relationships between HRQOL and other outcome measures 2 and 14 months after surgery.

Methods: The 15D instrument was used to measure HRQOL in 145 lumbar disc surgery patients. Subjective outcome was also assessed by the Oswestry index, Short Depression Inventory (SDI) and pain, and objective outcome by trunk muscle strength and mobility of the spine.

Results: The mean (SD) 15D score among the patients 2 months after surgery was 0.880 (0.104) compared to 0.941 (0.076) among general population (p = 0.016). The 15D, Oswestry and SDI scores remained unchanged during the follow-up, while the improvements in the spine mobility and trunk muscle strength were significant. Back pain decreased by 68% and leg pain by 74% from preoperative level to 2 months check-up. Leg pain further decreased during the following 12 months, while back pain remained unchanged. HRQOL was associated with age, pain, Oswestry and SDI indices, but not with physical function.

Conclusion: HRQOL measured by 15D was lower in the lumbar disc surgery patients compared to general population. 15D was associated with the subjective outcome measures of pain, Ostwestry and SDI indices, but not with the objective measures of physical function. Thus, a combination of “disease specific” and “generic” measures is recommended to be used to obtain more accurate information about the overall welfare of an individual.     

The Psychological and Psychiatric Morbidity Questionnaire (PPMQ): a measure to assess and predict psychological and psychiatric morbidity in individuals following burn trauma

Summary A pilot study is described which aims to:

• ? assess the predictors of psychological and psychiatric morbidity of patients following burn trauma;
• ? assess the reliability of the Psychological and Psychiatric Morbidity Questionnaire (PPMQ). Implications for training, supervision and post-burn rehabilitation are discussed.

     

Results of a multidisciplinary pain management program: a 6- and 12-month follow-up study.

The aim of this study was to evaluate an 8-week multidisciplinary pain management program offered to patients suffering from chronic pain. The study initially included 88 participants, and 61 of the sample completed a follow-up program conducted at 6 and 12 months after the initial programs. The pain management program was based on a cognitive behavioral approach with active patient participation in learning new coping skills. The intervention consisted of supervised dialog, physical activity, and education. The main goals were change of focus from pain and disability to resources and functional coping strategies. It was hypothesized that the positive changes gained at posttest registration after an 8-week program on coping, health-related quality of life, and pain intensity would be maintained during follow-up sessions. The results indicated that these hypotheses were mainly supported and further pain reduction, decreased emotion-focused coping, better social functioning, and overall physical and mental health gains were observed. The participants who did not complete the follow-up program did not differ from the patients who completed the program on background variables investigated. The study also supported the claim that professional nurses are competent to lead such programs and to evaluate treatment results. Clinical and research implications are discussed.     

智能化疼痛管理决策与质量监测系统在跟骨骨折内固定手术患者中应用

目的 探讨智能化疼痛管理决策与质量监测系统在跟骨骨折内固定手术患者中的应用效果。方法 选取2019年1-6月收治的跟骨骨折内固定术患者40例为对照组,行常规性疼痛干预,选取2019年7-12月骨科收治的跟骨骨折内固定术患者42例为研究组,应用智能化疼痛管理决策与质量检测系统对患者实施疼痛管理,比较2组干预前后疼痛评分、睡眠质量、术后锻炼依从率、并发症发生率、足踝功能恢复情况及患者满意率。结果 研究组干预后数字疼痛评分量表(numerical rating scale, NRS)评分、匹兹堡睡眠质量指数(Pittsburgh sleep quality index, PSQI)、并发症发生率均低于对照组(t=5.464,P<0.001;t=16.940,P<0.001;χ²=5.550,P=0.018),术后锻炼依从率、Morrey评分、MaryLand评分及满意率均高于对照组(χ²=9.217,P=0.002;t=12.906,P<0.001;t=10.687,P<0.001;χ²=6.717,P<0.001)。结论 智能化疼痛管理决策与质量监测系统能有效减轻患者跟骨骨折内固定术后的疼痛感,提高锻炼的依从性,降低并发症的发生率,有利于患者术后的康复,提高患者的满意度。