Articles: pain-measurement.
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Randomized Controlled Trial
Effect of Different Volumes on Pain Relief in Patient Receiving Fluoroscopic Guided Interlaminar Lumbar Epidural Steroid Injection.
Epidural steroids injections (ESI) are frequently used to treat lumbar radicular pain. Although different volume have been used for interlaminar ESI in adults, there is no controlled trial comparing the effect of different volumes on pain relief for the same dose of steroid . ⋯ Epidural steroid, volume, low back pain, interlaminar.
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Observational Study
Short-term Impact of Assisted Deliveries: Evaluation Based on Behavioral Pain Scoring and Heart Rate Variability.
Assisted deliveries (ADs) are used in current practice by obstetrical teams during labor when the fetus is likely to face difficulties. In this study, we hypothesized that pain related to instrumental delivery could impair autonomic nervous system (ANS) activity. ⋯ ADs (vacuum, forceps, or both) are associated with persistent pain after birth, unlike normal vaginal deliveries. Moreover ADs are associated with reduced NIPE. Taken together, our results suggest that pain related to instrumental delivery impairs the ANS activity.
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Randomized Controlled Trial
"It Encourages Them to Complain": A Qualitative Study of the Unintended Consequences of Assessing Patient-Reported Pain.
The "Pain as the 5th Vital Sign" initiative intended to address undertreatment of pain by encouraging routine pain assessment and management. In the Veterans Health Administration, routine pain screening has been practiced in primary care for more than a decade, but has not improved the quality of pain management measured using several process indicators, and some have expressed concerns of potentially fostering undesirable use of prescription opioids. ⋯ We identified 5 themes reflecting 1 intended and 4 unintended consequences of routine pain screening: it 1) facilitates identification of patients with pain who might otherwise be overlooked, 2) may need to be targeted toward specific patients and contexts rather than universally applied, 3) often shifts visit focus away from more emergent concerns, 4) may encourage "false positives" and prompt providers to intervene when treatment is not a priority, and 5) engenders a "pain problem" and hinders patients from considering alternative strategies. These findings suggest changes to support patient-centered pain assessment and improve targeted screening and interventions for population pain management.
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This systematic review with meta-analysis was performed to evaluate the efficacy and safety of using opioid analgesics in older adults with musculoskeletal pain. We searched Cochrane Library, MEDLINE, EMBASE, Web of Science, AMED, CINAHL, and LILACS for randomized controlled trials with mean population age of 60 years or older, comparing the efficacy and safety of opioid analgesics with placebo for musculoskeletal pain conditions. Reviewers extracted data, assessed risk of bias, and evaluated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. ⋯ The odds of adverse events were 3 times higher (odds ratio = 2.94; 95% CI = 2.33-3.72) and the odds of treatment discontinuation due to adverse events 4 times higher (odds ratio = 4.04; 95% CI = 3.10-5.25) in patients treated with opioid analgesics. The results show that in older adults suffering from musculoskeletal pain, using opioid analgesics had only a small effect on pain and function at the cost of a higher odds of adverse events and treatment discontinuation. For this specific population, the opioid-related risks may outweigh the benefits.
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Fine-grained observational approaches to pain assessment (e.g. the Facial Action Coding System; FACS) are used to evaluate pain in individuals with and without dementia. These approaches are difficult to utilize in clinical settings as they require specialized training and equipment. Easy-to-use observational approaches (e.g. the Pain Assessment Checklist for Limited Ability to Communicate-II; PACSLAC-II) have been developed for clinical settings. Our goal was to compare a FACS-based fine-grained system to the PACSLAC-II in differentiating painful from non-painful states in older adults with and without dementia. ⋯ Examining older adults with and without dementia, a brief observational clinical approach was found to be valid and accounted for more variance in differentiating pain-related and non-pain-related states than did a detailed time-consuming fine-grained approach.