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Pain related to fibromyalgia may consist of a complex interaction of nociceptive, neuropathic, dysregulatory central nervous system and psychosomatic mechanisms. Nociceptor pain is based on the excitation of nervous sensors specialized to signal potentially harmful stimuli, i.e., the nociceptors. Metabolic deficiencies in muscle and neurogenic inflammation induced by the release of substance P and other neuropeptides from the peripheral nerve endings may result in chemical sensitization of nociceptors and an ensuing hyperalgesia particularly present in tender points. ⋯ Persistent abnormal spinal reflex transmission due to, e.g., peripheral trauma or inappropriate postural habits may result in a vicious circle between muscle hypertension and pain. Similarly, a defective sympathetic control may result in disturbed microcirculation and nociceptor excitation (e.g., in sympathetic algodystrophy). Many symptoms of pain in fibromyalgia (trigger points, pain referral, pain associated with muscle spasm or neurogenic joint immobilization) can be attributed to abnormal control mechanisms in a complex cybernetic system.(ABSTRACT TRUNCATED AT 250 WORDS)
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Tohoku J. Exp. Med. · Oct 2006
Randomized Controlled TrialHemodynamic and anesthetic advantages of dexmedetomidine, an alpha 2-agonist, for surgery in prone position.
The alpha2-agonist dexmedetomidine (Dex), a sedative and analgesic, reduces heart rate (HR) and blood pressure, and has been used in the practice of anesthesia. In this study, we aimed to evaluate the effects of Dex on hemodynamic variables, anesthetic sparing effects, and recovery profiles in patients who underwent surgery in prone position. The prone position itself can cause a decrease in the systemic blood pressure. ⋯ Thus, the use of Dex caused no detrimental effects on the hemodynamic variables in prone position. In addition, Dex decreased pressure response to intubation, and anesthetic and analgesic requirements, shortened recovery times, and decreased postoperative pain level. Dex may be an alternative to currently used adjunctive anesthetic agents in lumbar discectomy operations.
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Assessment of pain is important in daily clinical practice and as an endpoint in clinical studies. Because pain perception is highly subjective, pain measurement is complex. Self-rating pain scales are currently of great importance but have limitations. They depend on many more factors than pain, which could lead to an incorrect assessment of therapies or clinical studies. Therefore, there is need for valid, reliable, safe, and low-cost methods to determine and quantify patients' pain more objectively. ⋯ Several devices and techniques compared pain intensity experienced by patients with an external pain stimulus that potentially could be used as a new objective pain measurement tool. Given the results of our review, electrical stimulators that have been tested extensively with high validity, reliability, and feasibility would be recommended for use for clinical and research purposes. Moreover, normalization of pain intensity scores for current perception is important. Pain intensity normalization leads to higher correlations with established pain scales and possibly to increased inter-patient reliability.Registration number: Registered in the PROSPERO database (PROSPERO 2016:CRD42016041974)KEY WORDS: Systematic review, objective pain measurement, pain scales; devices, techniques, validity, reliability, safety, feasibility.
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Anesthesia and analgesia · Nov 2020
Exposure to General Anesthesia for Cesarean Delivery and Odds of Severe Postpartum Depression Requiring Hospitalization.
General anesthesia for cesarean section delivery is associated with an over 50% increased odds of severe postpartum depression.
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Crowding in emergency departments (EDs) is associated with long lengths of stay (LOS); however, it is not known whether the effect is equal across different chief complaints. The aim of the study was to compare the effect of crowding on LOS in the 10 most common medical or surgical chief complaints in the ED. All adult visits to a university hospital ED on weekdays between 8 AM and 9 PM in 2012 (n = 19,200) were stratified based on chief complaint and triage priority. ⋯ During crowding, LOS increased the most among patients with extremity pain/swelling (145% among high-acuity patients, 125% among low-acuity patients) and flank pain (87% among high-acuity patients, 117% among low-acuity patients) and the least among patients with chest pain (32% among high-acuity patients, 45% among low-acuity patients) or arrhythmia (37% among high-acuity patients, 52% among low-acuity patients). The effect of ED crowding on LOS is unequal across different chief complaints. These findings could be used to improve the processing of specific chief complaints in the ED.