Articles: pain-measurement.
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With the approval of coronavirus disease 2019 (COVID-19) vaccine for children 5 to 11 years of age and concerns among parents in the past year following reported cases of myocarditis and pericarditis in adolescents, should my office continue to encourage all children and young adults to receive the COVID-19 messenger RNA vaccine? ⋯ Since April 2021 reports have documented cases of myocarditis and pericarditis in adolescents and young adults after messenger RNA COVID-19 vaccination, and several hundred such reports were documented in Canada. Clinical presentations were mostly mild, with rare instances of admission to the hospital, and were typically among male adolescents 16 years of age and older within several days after the second dose of the vaccine. After vaccination, children and adolescents with symptoms of chest pain, shortness of breath, or palpitations should be evaluated with a physical examination, an electrocardiogram, and measurement of cardiac troponin levels. If results are abnormal, an echocardiogram or cardiac magnetic resonance imaging should be considered. Myocarditis and pericarditis after vaccination are much less common, and much milder, than cardiac complications of COVID-19 infection, and vaccines should continue to be recommended to all those eligible.
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Clinical Trial Observational Study
Pediatric pain screening tool: A simple 9-item questionnaire predicts functional and chronic postsurgical pain outcomes after major musculoskeletal surgeries.
Reliable, clinic-friendly screening for Chronic postsurgical pain (CPSP) risk is unavailable. Within a prospective, observational study, we evaluated Pediatric Pain Screening Tool (PPST), a concise 9-item questionnaire, as a preoperative screening tool to identify those at higher risk for CPSP (Numerical Rating Scale > 3/10 beyond 3 months post-surgery) and poor function (disability/Functional Disability Inventory [FDI]/quality of life/ Pediatric Quality of Life) after spine fusion and Nuss procedures. Incidence of CPSP was 34.86% (38/109). ⋯ PERSPECTIVE: The article supports Pediatric Pain Screening Tool, a simple 9-item questionnaire, as a preoperative screening tool for CPSP and function 6-12 months after spine/pectus surgeries. PPST measures correlate with known risk factors for CPSP. Risk stratification and targeted preventive interventions in high-risk subjects are proposed.
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Randomized Controlled Trial
Physiotherapeutic Reduction of Orofacial Pain Using Extremely Low-Frequency Electromagnetic Field and Light-Emitting Diode Therapy-A Pilot Study.
Pain is a natural response of the body to injury and one of the symptoms defining an inflammatory reaction. It is almost always present after orthognathic surgeries (OGS), but its severity is subjective in each patient. Postoperative care of the patient is aimed at minimizing of postoperative pain relief orofacial region. Options of physiotherapy include extremely low-frequency electromagnetic field (ELF EMF) and high-energy light-emitting diode (LED). Aim of the Study. The aim of this study was to evaluate the effects of physiotherapy combining ELF EMF and LED to reduce pain of the orofacial region in patients after OGS. Material and Methods. The study was conducted in thirty-two patients who underwent OGS to treat morphological defects. The participants were randomly divided into two groups: Physiotherapy group (PT) and Control group (CG). In both groups, patients were prescribed Paracetamol and nonsteroidal analgesics (NSAID-ibuprofen). Patients from the PT group additionally received postoperative physiotherapy immediately after leaving the surgical clinic in the form of ELF EMF and LED therapy. Physiotherapeutic treatments were performed for 10 days, three applications a day, at no cost to the patient. Pain intensity was assessed using the visual analogue scale (VAS), which is a reliable instrument for the measurement of pain intensity self-reported by the patient. ⋯ The conducted research revealed that the combined use of ELF EMF and LED is beneficial in the reduction of pain of patients after OGS. The analgesic effects of physiotherapy in the treatment after OGS are necessary to continue research in this area and analyze the possibility of extending the indications for its use in other surgically treated maxillofacial diseases.
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Nocebo refers to non-pharmacological adverse effects of an intervention. Well-intended procedural warnings frequently function as a nocebo. Both nocebo and placebo are integral to the generation of 'real' treatment effects and their associated 'real' side-effects. ⋯ Anaesthesia as a profession has always prided itself on practicing evidence-based medicine, yet for decades anaesthetists and other healthcare staff have communicated in ways counter to the evidence. The premise of every interaction should be 'primum non nocere' (first, do no harm). Whether the context is research or clinical anaesthesia practice, the nocebo can be ignored no longer.
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As the population ages, the number of elderly people undergoing surgery increases. Literature on the incidence and intensity of postoperative pain in the elderly is conflicting. This study examines associations between age and pain-related patient reported outcomes and perioperative pain management in a dataset of surgical patients undergoing four common surgeries: spinal surgery, hip or knee replacement, or laparoscopic cholecystectomy. Based on the authors' clinical experience, they hypothesize that pain scores are lower in older patients. ⋯ The authors' findings indicate that postoperative pain decreases with increasing age. The change is, however, small and of questionable clinical significance. Additionally, there are still too many patients, at any age, undergoing common surgeries who suffer from moderate to severe pain, which interferes with function, supporting the need for tailoring care to the individual patient.