An audit of pain and vomiting in paediatric day case surgery

Three hundred and thirteen paediatric day case patients were prospectively audited to assess postoperative pain, nausea and vomiting using data sheets completed by nursing staff, anaesthetists and parents. The incidence of nausea and vomiting was 7.3% and was commoner in older children and those who had received opioids. Forty per cent of patients had some degree of postoperative pain; 17% of these patients were scored as having severe pain. Of children who had pain on returning home (31.4%), 85% of these required paracetamol. Fifteen per cent of children had a disturbed night due to pain and/or vomiting after their operation and 28.5% of children had pain on the following day. Boys undergoing circumcision were responsible for a disproportionately high percentage of the severe pain scores. Audit has helped to highlight deficiencies in the service provided and has led staff to try and improve their methods of analgesia.     

正常人颈段脊柱结构内CGRP和SP阳性神经纤维的分布

目的 为深入探讨颈肩痛的发病机理。方法 用免疫组织化学方法观察人颈段脊柱结构内CGRP和SP阳性神经末梢存在的情况。结果 人颈段脊柱结构的纤维层内均有CGRP和SP免疫反应阳性神经末梢存在，多数神经末梢独立行走，呈树枝状或念珠状，少量神经末梢交织网状。结论 CGRP和SP可能参与了人颈段脊柱结构的伤害性感觉信息的传递。当人颈段脊柱结构的神经末梢受刺激时，可能引起CGRP和SP的释放和传递，这可能是引起原发性颈肩痛的原因之一。     

Long-term Outcomes of Patients Undergoing War-related Amputations of the Foot and Ankle

Long-term clinical and functional outcomes for patients undergoing foot and ankle amputations are not well documented. We attempted to document long-term outcomes for patients who required lower extremity amputations as a result of wounds suffered during wartime. For this study, 27 Iranian soldiers who had wounds requiring amputation of the foot and ankle were selected for follow-up. The participants' wartime medical records were reviewed, a clinical examination was performed, and each participant completed a questionnaire. Postamputation follow-up averaged 17.5 years. The most prevalent (66.6%) cause of injury was a land mine. The prevalences of different clinical symptoms reported by the amputees at the time of the last follow-up were as follows: 11 (40.7%) with phantom sensation, 6 (22.2%) with phantom pain, 12 (44.4%) with stump pain, 12 (44.4%) with back pain, 9 (33.3%) with contralateral knee pain, and 4 (14.8%) with ipsilateral knee pain; 20 (74%) reported treatment for psychological conditions. In regard to social conditions, 13 (48.1) were currently employed, or had been employed, for a number of years after the amputation; 26 (96%) had children, and all of the patients were married. The results of this observational study indicate that individuals have significant long-term pain and discomfort after war-related lower extremity amputation. Although all 27 (100%) of the amputees were able to maintain satisfactory family functioning, only 13 (48.1%) of the study participants were able to remain productively employed after undergoing amputation, and 20 (74%) reported long-term psychological problems in addition to their physical pain.     

多巴胺对正常和吗啡成瘾大鼠疼痛相关电活动的不同作用(英文)

目的研究多巴胺对正常大鼠和吗啡成瘾大鼠中枢的伤害性刺激的传递的影响。方法在给予坐骨神经伤害性刺激后,记录中枢痛兴奋神经元的电活动,观察多巴胺对正常大鼠和吗啡成瘾大鼠中枢痛兴奋神经元电活动的影响。结果正常大鼠中,多巴胺使尾核痛兴奋神经元的痛诱发放电潜伏期缩短,说明多巴胺可使正常大鼠尾核痛兴奋神经元的活动增强,多巴胺受体拮抗剂氟哌利多可以阻断这种作用。吗啡大鼠中,多巴胺使尾核痛兴奋神经元的痛诱发放电潜伏期延长,说明多巴胺可使吗啡大鼠尾核痛兴奋神经元的活动减弱。结论脑室注射多巴胺后,正常大鼠和吗啡成瘾大鼠的尾核对痛刺激的反应存在着差异。     

Pain induced by low-grade stress in patients with fibromyalgia and chronic shoulder/neck pain, relation to surface electromyography.

The mechanisms of pain causation in fibromyalgia (FMS) and chronic shoulder/neck pain (SNP) are still debated. We wanted to compare muscle activity and pain development during and after low-grade mental stress in FMS and SNP patients. Twenty-three women with FMS, 29 women with chronic SNP and 35 healthy women performed a stressful task lasting 60 min followed by a 30 min recovery period. We recorded surface electromyography over the trapezius, neck, temporalis and frontalis muscles. Subjects reported their pain at the corresponding locations together with the development of fatigue and perceived tension. Significant differences between FMS and SNP groups were not observed either for muscular or subjective responses. SNP patients and controls responded with more pain in the trapezius and neck regions than in the forehead, in contrast to FMS patients who had a more generalized pain response. Development of pain, tension and fatigue was not related to muscle activity for any group. We conclude that FMS and SNP patients have similar pain and electromyographic responses. The results suggest that similar pathophysiological mechanisms are involved although the responses are more generalised in FMS than in SNP patients. Muscular activity did not explain the pain which developed during the stressful task for either group. Pain lasted longer during recovery in both FMS and SNP patients compared to healthy controls, possibly a result of disease-related sensitisation in pain pathways.     

An animal model of chronic inflammatory pain: pharmacological and temporal differentiation from acute models.

Clinically, inflammatory pain is far more persistent than that typically modelled pre-clinically, with the majority of animal models focussing on short-term effects of the inflammatory pain response. The large attrition rate of compounds in the clinic which show pre-clinical efficacy suggests the need for novel models of, or approaches to, chronic inflammatory pain if novel mechanisms are to make it to the market. A model in which a more chronic inflammatory hypersensitivity phenotype is profiled may allow for a more clinically predictive tool. The aims of these studies were to characterise and validate a chronic model of inflammatory pain. We have shown that injection of a large volume of adjuvant to the intra-articular space of the rat knee results in a prolonged inflammatory pain response, compared to the response in an acute adjuvant model. Additionally, this model also results in a hypersensitive state in the presence and absence of inflammation. A range of clinically effective analgesics demonstrate activity in this chronic model, including morphine (3mg/kg, t.i.d.), dexamethasone (1mg/kg, b.i.d.), ibuprofen (30mg/kg, t.i.d.), etoricoxib (5mg/kg, b.i.d.) and rofecoxib (0.3-10mg/kg, b.i.d.). A further aim was to exemplify the utility of this chronic model over the more acute intra-plantar adjuvant model using two novel therapeutic approaches; NR2B selective NMDA receptor antagonism and iNOS inhibition. Our data shows that different effects were observed with these therapies when comparing the acute model with the model of chronic inflammatory joint pain. These data suggest that the chronic model may be more relevant to identifying mechanisms for the treatment of chronic inflammatory pain states in the clinic.     

静滴1,6-二磷酸果糖局部疼痛对急性心肌梗死患者心肌耗氧量的影响

目的评估急性心肌梗死（AMI）患者静滴1,6-二磷酸果糖（FDP）时局部轻度、中度、重度疼痛对心肌耗氧量的影响。方法用长海痛尺评估120例AMI患者静滴FDP过程中疼痛程度,并对患者进行心电监护,对静滴FDP的患者在输液前、后的心率、血压、心肌耗氧量进行比较。结果输液后心肌耗氧量均高于输液前。结论AMI患者静滴FDP时局部疼痛的发生率高。轻度、中度、重度时均能引起心肌耗氧量的增加。