Articles: chronic.
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In recent years, the influence of doctors' and therapists' attitudes and beliefs for the treatment of chronic low back pain patients has been increasingly investigated. Attitudes and beliefs of health care providers have been identified as important contributors for an activity based, guideline-oriented therapeutic approach and different questionnaires were developed to evaluate this interaction. Recent reviews discuss the quality of those questionnaires as well as the impact of attitudes towards therapeutic choices and activity recommendations by health care professionals. ⋯ Overall, it must be assumed that attitudes and beliefs of clinicians are also important in the care of older patients in pain. With regards to activity recommendations, ageism and the special situation of older people should also be taken into account including possible risk of falling, multimorbidity, polypharmacy, and cognitive impairment. These topics should all be considered in adapted or newly developed questionnaires for the evaluation of attitudes and beliefs of health care providers regarding back pain in older persons.
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Semin Respir Crit Care Med · Aug 2015
ReviewNew Pharmacotherapeutic Approaches for Chronic Obstructive Pulmonary Disease.
The last 5 years have seen a proliferation of data about the best way to treat chronic obstructive pulmonary disease (COPD). New long-acting inhaled β-agonist and antimuscarinic drugs have been developed as a once-daily inhaled corticosteroid. ⋯ New data are beginning to define which patients benefit from which treatments and this will help us develop more appropriate treatment regimes. These topics are considered in this review which provides an overview of the latest data and some direction as to how these findings can be applied in practice.
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Curr Opin Anaesthesiol · Aug 2015
ReviewAnalgesic management of acute pain in the opioid-tolerant patient.
The management of acute pain in the opioid-tolerant patient is an area in perioperative medicine that is growing, as the use of opioids for chronic noncancer pain has been tolerated in the USA. Adding to this population is an increase in opioid abusers, addicts and those in recovery and maintenance programmes. These patients will continue to present for surgery and with acute pain that anaesthesiologists and other members of the healthcare team must become more adept at managing. ⋯ There is a need for more high-level evidence-based guidelines to help practitioners achieve the best care of this growing high-risk population of patients.
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Quantitative sensory testing is widely used in human research to investigate the state of the peripheral and central nervous system contributions in pain processing. It is a valuable tool to help identify central sensitization and may be important in the treatment of low back pain. The aim of this study was to evaluate changes in local and segmental hypersensitivity and endogenous pain inhibition in people with chronic nonspecific low back pain. ⋯ During CPM, people with chronic low back pain have significantly lower PPT than controls in lumbar region [118.6 kPa (mean difference) 95 % CI 77.9-159.2 kPa]. Women had significantly lower PPTs than men in both lumbar region [101.7 kPa (mean difference) 95 % CI 37.9-165.7 kPa] and over the TA [189.7 kPa (mean difference) 95 % CI 14.2-145.2 kPa]. There was no significant difference in PPTs in men between healthy controls and those with low back pain, suggesting the significant differences are mediated primarily by difference between women.
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Lymphangioleiomyomatosis (LAM) is a manifestation of tuberous sclerosis complex (TSC) that causes destruction of the lung and chronic respiratory failure. Population-based estimates of demographics, clinical outcomes, and health-care utilization are lacking for TSC and LAM. ⋯ The prevalence of TSC in Quebec, Canada, is similar to estimates from previously published surveys. LAM is likely underreported, perhaps due to suboptimal case identification or referral. Health-care utilization and mortality for LAM are high, suggesting that timely diagnosis and therapy could be beneficial. Mental health disorders may be an unrecognized clinical feature of LAM. These results provide a population-based background for policymakers and researchers to better address the needs of patients with TSC and LAM.