Articles: pain-clinics.
-
J Clin Monit Comput · Feb 2015
Observational StudyThe use of a clinical database in an anesthesia unit: focus on its limits.
Anesthesia information management system (AIMS) can be used a part of quality assurance program to improve patient care, however erroneous or missing data entries may lead to misinterpretation. This study assesses the accuracy of information extracted for six consecutive years from a database linked to an automatic anesthesia record-keeping system. An observational study was conducted on a database linked AIMS system. ⋯ However exhaustivity/completeness of some other variable, such as nausea and vomiting started as low as 50% to reach 20% at 2008. After cross analysing pain and post-operative nausea and vomiting scores with related medication consumption, (morphine and ondansetron) we conclude that missing data was due to omission of a zero score rather than human error. The follow-up of quality assurance program may use data from AIMS provided that missing or erroneous values be mentioned and their impact on calculations accurately analysed.
-
The aim of this study was to explore the nociceptive system of patients affected by trigeminal neuralgia (TN) secondary to documented vascular contact who underwent microvascular decompression. For that purpose, we used the classical trigeminal reflexes and the trigeminal laser-evoked potentials (tLEPs) before and after surgery, in order to verify any possible change after decompression and determine if there was any correlation between the neurophysiological parameters and the clinical outcome. ⋯ This study demonstrates that TN caused by trigeminovascular compression may be related to Aδ fibres impairment, and tLEPs are more sensitive than conventional trigeminal reflexes to reveal small fibre dysfunction and to monitor the post-surgical outcome in these patients.
-
Effective reassurance of patients reporting symptoms, for which no clear etiological origin is available, is one of the most important challenges in the early phases of nonspecific back pain. However, there is a lack of empirical studies on the effects of reassurance and, also, the effects shown were small. Improvements are needed with respect to the process of physician-patient interaction and to the methods used by the physician. ⋯ Reassurance of patients in early phases of persistent back pain might improve from affective and cognitive parts of communication and individually tailored information. Subgroup differences with respect to different prognosis, associated patterns of adaptive or maladaptive pain coping, and levels of health-promoting versus harmful physical activity should be considered more carefully.
-
Review
What outcomes are important in the assessment of Enhanced Recovery After Surgery (ERAS) pathways?
The purpose of this narrative review is to provide a framework from which to measure the outcomes of Enhanced Recovery After Surgery (ERAS) programs. ⋯ Recovery after surgery is a complex construct. Different outcomes are important at different phases along the recovery trajectory. Measures for quantifying recovery in hospital and after discharge are available. A consensus-based core set of outcomes with input from multiple stakeholders would facilitate research reporting.
-
Ankylosing spondylitis is associated with back pain and fatigue and impacts mobility but can be treated with tumor necrosis factor inhibitors (TNFi). The differential effects of TNFi treatment on multiple symptoms and the brain is not well delineated. Thus, we conducted a 2-part study. ⋯ Pain intensity reduction was associated with cortical thinning of the secondary somatosensory cortex, and pain unpleasantness reduction was associated with the cortical thinning of motor areas. In contrast, fatigue reduction correlated with cortical thinning of the insula, primary sensory cortex/inferior parietal sulcus, and superior temporal polysensory areas. This indicates that TNFi treatment produces changes in brain areas implicated in sensory, motor, affective, and cognitive functions.