Gender differences in symptom experiences of patients with acute coronary syndromes

To compare the symptom experiences between men and women with acute coronary syndromes (ACS), we surveyed a convenience sample of 112 subjects with a final diagnosis of ACS in four hospitals. Our study found that after adjusting for cardiac diagnosis, diabetes, and age, women were more likely than men to experience chest discomfort rather than chest pain; pain/discomfort only in areas of the body other than the chest; pain/discomfort that started first either in the arm(s) or in areas of the body other than the chest; and unexplained anxiety. Women were less likely than men to experience chest pain/discomfort, pain/discomfort in the left side of the chest, and chest pain/discomfort as the most worrisome symptom. Significant gender differences were observed in the reports of several symptoms associated with ACS. This study is the first to identify different pain/discomfort referral patterns between men and women that require further validation.     

The ergonomics of caring for children: an exploratory study.

BACKGROUND: Caring for one's children is among the most ubiquitous of occupations. However, few studies have examined the ergonomic risks involved in parents caring for children at home. PURPOSE: The purpose of this study was to identify the frequency, type, and severity of musculoskeletal symptoms in parents of children less than 4 years old. The study further examined the factors that contribute to musculoskeletal pain in this sample. METHODS: A convenience sample of 130 parents with children younger than 4 years old completed a seven-page survey that included questions related to the parents' demographics, their musculoskeletal discomfort, their performance of child-care tasks with high biomechanical risks (such as carrying a child in a car seat), and parents' perceived psychological strain related to caring for their children. RESULTS: Ninety-two percent (92%) of the providers were mothers. Sixty-six percent (66%) of the sample reported the presence of musculoskeletal pain. The parts of the body most affected were the low back (48%), neck (17%), upper back (16%), and shoulders (11.5%). Factors associated with musculoskeletal pain were performing child-care tasks defined as having high biomechanical risks (p = .001), the perception that caring for children is highly demanding (p = .003), and performing hobbies less than 1 hour per week (p = .04). Parents' working status, age, and participation in other daily activities were not significantly related to musculoskeletal discomfort. CONCLUSION: This study demonstrates the high prevalence of musculoskeletal pain in parents of children under the age of 4 years. It underscores the association between physical and psychological factors in the development of musculoskeletal discomfort. It suggests the need for occupational therapy wellness programs that focus on preventing musculoskeletal discomfort and providing support for the parenting role.     

重症监护室患者不适体验及其与事实记忆的关系

目的探讨重症监护室（intensivecareunit，ICU）患者不适体验及其与事实记忆（factual recollection，FR）的相关性。方法对55例ICU患者及63例普通病房患者进行标准化FR问卷调查，并对结果进行分析。结果64％的ICU转出患者有ICU不适体验，其中以气管内导管、疼痛及幻觉所引起的不适较为常见；ICU患者FR评分平均为7．25分，普通病房患者FR评分平均为13．50分，二者比较差异有统计学意义（t=3．34，P〈0．01）；Logistic回归分析表明，FR评分与ICU患者不适体验，尤其是与气管内导管、疼痛及幻觉所引起的不适的发生显著相关，0R95％CI（1．2～2．1），P〈0．01。结论ICU患者的不适体验主要来自于气管内导管、疼痛和幻觉等；ICU患者相对于普通病房患者可能存在记忆减退；FR可能与ICU不适体验的发生具有相关性。     

重症监护室患者不适体验及其与事实记忆的关系

目的 探讨重症监护室(intensive care unit,ICU)患者不适体验及其与事实记忆(factual recollection,FR)的相关性.方法 对55例ICU患者及63例普通病房患者进行标准化FR问卷调查,并对结果进行分析. 结果 64%的ICU转出患者有ICU不适体验,其中以气管内导管、疼痛及幻觉所引起的不适较为常见;ICU患者FR评分平均为7.25分,普通病房患者FR评分平均为13.50分,二者此较差异有统计学意义(t=3.34,P<0.01);Logistic回归分析表明,FR评分与ICU患者不适体验,尤其是与气管内导管、疼痛及幻觉所引起的不适的发生显著相关,OR95%CI(1.2～2.1),P<0.01. 结论 ICU患者的不适体验主要来自于气管内导管、疼痛和幻觉等;ICU患者相对于普通病房患者可能存在记忆减退;FR可能与ICU不适体验的发生具有相关性.     

Recurrent Abdominal Pain in Children: Forerunner to Adult Irritable Bowel Syndrome?

ISSUES AND PURPOSE Review the etiology and pathophysiology of recurrent abdominal pain (RAP) and its potential role as a precursor to irritable bowel syndrome (IBS) in adults. CONCLUSIONS Physiological mechanisms not easily identifiable as an organic cause may underlie symptoms in RAP patients. They may be triggered by psychosocial factors that result in greater functional disability, more clinic visits, and lower academic and social competence. Of these children, 25% will experience similar symptoms as adults; many will be diagnosed with IBS. PRACTICE IMPLICATIONS Nurses can provide early and efficient management of these children's care if they view the issues of abdominal pain/discomfort from a broader focus that includes the context of the child's experiences.     

The complaint of pain.

All patients with pain must be taken seriously, and both organic and emotional factors investigated. Cultural aspects, early developmental experience, and highly personal meanings may influence the individual's perception of and reaction to pain; specific psychiatric pain states may be identified as well. Treatment is aimed at curing the underlying cause of the discomfort or allowing maximal rehabilitation in chronic conditions.     

Cophenylcaine spray vs. placebo in flexible nasendoscopy: a prospective double-blind randomised controlled trial

Practices vary across the UK on the use of topical preparation prior to flexible fibreoptic nasendoscopy. In this double-blind study, we randomised 98 patients to receive cophenylcaine or placebo nasal spray before flexible nasendoscopy. A visual analogue scale (1-100) was used to record pain, unpleasantness of taste and overall discomfort experienced. Overall, the procedure was associated with minimal pain and discomfort in both groups. There was no significant difference in pain or overall discomfort experienced between the two groups; however, the sensation of bad taste was significantly worse in the cophenylcaine group. In linear regression, factors that predicted the overall unpleasantness of the experience were primarily pain experienced and secondarily unpleasantness of taste. We conclude that the routine use of cophenylcaine for nasal preparation is not justified before flexible nasendoscopy.     

Caregivers' beliefs regarding pain in children with cognitive impairment: relation between pain sensation and reaction increases with severity of impairment

OBJECTIVES: To determine whether caregivers of children with cognitive impairment (CI) have systematic beliefs regarding the pain of this special group of children and whether these beliefs are related to their general attitudes towards people with mental challenges, or their experience with, or knowledge about, children with CI .PARTICIPANTS: Sixty-five caregivers (52 parents and 13 health care providers) of children with significant CI. MEASURES: Caregivers completed the Mental Retardation Attitude Inventory-Revised and provided information regarding their previous experience and learning about children with CI. They also completed the Pain Opinion Questionnaire, indicating the percentage of children with mild, moderate, or severe/profound CI that they believe experience 5 facets of pain "less than", "the same as", or "more than" children without CI: sensation, emotional reaction, behavioral reaction, communication, and frequency. RESULTS: Caregivers believed children's pain Sensation becomes greater, relative to children without CI, as severity of CI increases and that pain reaction is most consistent with pain sensation for children with severe CI. They also believed children with mild CI may over-react to pain. Caregivers' beliefs regarding pain were not influenced by their general attitudes about people with mental challenges or by their experience with children with CI, but those with more learning regarding children with CI believed that they experience pain less than children without CI. CONCLUSIONS: Caregivers have a priori beliefs regarding pain in children with CI that vary with level of cognitive impairment and pain facet. These beliefs could impact children's care.     

Pain during mammography: the role of coping strategies

This study examined the pain/discomfort ratings during mammography and their relationship to pain-coping strategies. Prior to their mammogram in order to assess how they cope with day-to-day pain experience 220 women completed an Iranian translation of the Coping Strategies Questionnaire (IR-CSQ). Immediately after mammography, all subjects completed a modified version of the IR-CSQ to assess their coping style with pain during mammography. Ratings of pain/discomfort during the mammogram were also collected, using a 100-mm Visual Analog Scale and a 6-point Pain/Discomfort Rating Scale (PRDS). Up to 92% of the women reported that the mammogram examination was painful. However, considerable variability in pain ratings was found, with some women reporting severe pain and others reporting little or no pain. While the ratings of coping effectiveness in facing day-to-day pain experience were not significantly related to mammography pain ratings, there was a significant association between the ratings of coping efficacy in facing mammography pain specifically and measures of mammography pain. Multiple hierarchical regression analyses revealed that while higher use of catastrophising and coping self-statements in facing mammography pain were predictors of more severe pain during mammography, higher use of ignoring pain sensations was predictive of less severe pain during mammography. The potential significance of these findings for identifying patients at risk of poor adjustment to chronic pain is discussed.     

Reducing pain and discomfort following percutaneous transluminal coronary angioplasty

Although percutaneous transluminal coronary angioplasty (PTCA) has been found to be an effective alternative to open-heart surgery for patients with coronary artery disease, the procedure itself can be associated with severe anxiety and discomfort for the patient. The authors report the discomfort patients experience during recovery from PTCA and suggest nursing interventions to reduce pain for these patients.     

Paracetamol efficacy and safety in children: the first 40 years

Paracetamol (acetaminophen) has a unique role in children because it is the first-line choice for the treatment of both fever and pain. When used in the recommended doses, it has few side effects and is remarkably well tolerated. While fever alone requires no treatment, when associated with discomfort or pain, paracetamol offers relief. Also, for mild to moderate pain, paracetamol, either alone or in combination with another drug, is effective. Even in severe pain, paracetamol offers a significant additive analgesic effect to opiates. Globally, the pediatric dose varies between 10 and 15 mg/kg. In the United Kingdom, 10 mg/kg is given every 4 hours, up to a maximum of four doses per day; in Australia, 15 mg/kg is administered 4-hourly up to a total dose of 60 mg/kg/day. In overdose, paracetamol is hepatotoxic. Single ingestions of more than ten times the recommended dose are potentially toxic. The development of specific antidotes and the universal availability of the Rumack-Matthew Nomogram have made the early treatment of overdose effective without long-term sequelae. There are sporadic case reports of chronic overdosing resulting in liver failure. Although the specific predictors are still being defined, exposures greater than 140 mg/kg/day for several days carry a risk of serious toxicity. In children, aspirin use has almost disappeared with the concurrent decline in Reye Syndrome. Less clinical experience has accumulated with ibuprofen, and it remains the second-line treatment for fever and pain. In conclusion, paracetamol remains the first-choice over-the-counter treatment for analgesia and antipyresis in children.     

Mothers and pain: the effect of a mother's pain experience on the child

How does the preceding experience of pain by the mother affect the child''s response to the painful event? This work intends to be a preliminary answer to this problem. A questionnaire with 10 items was administered to 217 mothers aged 26/45 years, with 1 (44%) or 2 (47%) children, and from different regions of central and southern Italy. The majority of the mothers had a memory of a supporting response by her family to her experience of pain. 50% of the mothers recalled an episode of physical pain and 20% an episode of moral pain. The memory of moral pain was more widespread in the South (71% of all the mothers). The definition of pain was negative (62%): pain was experienced either as a threat to health or a limitation to one''s freedom. The children, conversely, dealt with pain in 67% of the cases by looking for their parents and asking for help; 33% dealt with pain alone. 91% of the mothers who become upset when they have pain have children who, when they are ill, behave in the same manner.It is in the South that the relationships in the family remain mainly unchanged (68%) on the occasion of an illness of a child, while it is in central Italy that these improve more easily. For mothers, pain is a substantially negative experience. The study shows that a family experience of pain is passed, as far as the manner of dealing with it is concernec, from one generation to another.     

The influence of children's pain memories on subsequent pain experience

Healthy children are often required to repeatedly undergo painful medical procedures (eg, immunizations). Although memory is often implicated in children's reactions to future pain, there is a dearth of research directly examining the relationship between the 2. The current study investigated the influence of children's memories for a novel pain stimulus on their subsequent pain experience. One hundred ten healthy children (60 boys) between the ages of 8 and 12 years completed a laboratory pain task and provided pain ratings. Two weeks later, children provided pain ratings based on their memories as well as their expectancies about future pain. One month following the initial laboratory visit, children again completed the pain task and provided pain ratings. Results showed that children's memory of pain intensity was a better predictor of subsequent pain reporting than their actual initial reporting of pain intensity, and mediated the relationship between initial and subsequent pain reporting. Children who had negatively estimated pain memories developed expectations of greater pain prior to a subsequent pain experience and showed greater increases in pain ratings over time than children who had accurate or positively estimated pain memories. These findings highlight the influence of pain memories on healthy children's expectations of future pain and subsequent pain experiences and extend predictive models of subsequent pain reporting.     

Neuro- und Psychophysiologie des Schmerzes bei Kindern

In the past the view has often been expressed that children are less sensitive to pain than adults as a result of the assumption that their nervous system is not as well developed. According to this theory, newborns were not supposed to feel pain at all, and for this reason minor surgery was often performed with inadequate anesthesia. Evidence in the more recent literature and the regular choice of "pain in children" as a topic for congresses exemplify the more and more widespread belief that children of all ages can feel pain and, relative to their developmental stage, suffer accordingly. However, there are significant differences in the way children experience and react to pain in comparison to adults, e.g., because of the difference in ability to evaluate acute or chronic pain cognitively. At birth, all human sensory organs have developed far enough to be full functional-as a result of the long gestational period, which is far longer than most other mammalian species. The results of animal experiments and observations in newborns have led to the conclusion that in humans and other mammals, the sensory pain system is fully developed at birth. Pain-related reactions can be seen in the motor, vegetative and endocrine pain parameters, and in the infant's crying. As the experience of pain increases, conditioned avoidance reactions can be noted, as can the child's experience of psychosomatic pain reinforcement by the care-givers, e.g., when a crying child in pain receives more attention from the persons around it. In pre-school children, the level of pain can be measured using appropriate instruments, as demonstrated in cases of chronic arthritis. As cognition develops further, the patient's own concept of health and sickness changes, as does the ability to express feelings of pain. In the pathogenesis of pain in children, the dominant types are nociceptor pain (e.g., as a result of trauma or infection) and pain resulting from malfunction (e.g., physical malposition, migraine), whereas nervous pain occurs less frequently. Pediatricians should pay particular attention to the treatment of acute and chronic pain in children.