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Assessment of proadrenomedullin as diagnostic or prognostic biomarker of acute appendicitis in children with acute abdominal pain Acute appendicitis (AA) is one of the most frequent surgical pathologies in pediatrics.To investigate the utility of proadrenomedullin (pro-ADM) for the diagnosis of AA.Prospective, analytical, observational, and multicenter study conducted in 6 pediatric emergency departments. Children up to 18 years of age with suspected AA were included. Clinical, epidemiological (...) , and analytical data were collected.We studied 285 children with an average age of 9.5 years (95% confidence interval [CI], 9.1-9.9). AA was diagnosed in 103 children (36.1%), with complications in 10 of them (9.7%). The mean concentration of pro-ADM (nmol/L) was higher in children with AA (0.51 nmol/L, SD 0.16) than in children with acute abdominal pain (AAP) of another etiology (0.44 nmol/L, SD 0.14; p < 0.001). This difference was greater in complicated cases compared with uncomplicated AA (0.64 nmol/L, SD
Comparison of intravenous lidocaine/ketorolac combination to either analgesic alone for suspected renal colic pain in the ED To compare analgesic efficacy and safety of intravenous lidocaine and ketorolac combination to each analgesic alone for ED patients with suspected renal colic.We conducted a randomized, double-blind trial comparing analgesic efficacy of a combination of intravenous lidocaine (1.5 mg/kg) and ketorolac (30 mg), to ketorolac (30 mg), and to lidocaine (1.5 mg/kg) in patients (...) aged 18-64 presenting to the ED with suspected renal colic. Primary outcome included difference in pain scores between the groups at 30 min. Secondary outcomes included a comparative reduction in pain scores in each group from baseline to 30 and 60 min as well as rates of adverse events and need for rescue analgesia at 30 and 60 min.We enrolled 150 subjects (50 per group). The difference in mean pain scores at 30 min between Lidocaine and Lidocaine/Ketorolac groups was -2.89 (95% CI: -4.39 to -1.39
Is Low-Dose Ketamine an Effective Alternative to Opioids for Acute Pain? Is Low-Dose Ketamine an Effective Alternative to Opioids for Acute Pain? - Annals of Emergency Medicine Email/Username: Password: Remember me Search Terms Search within Search Share this page Access provided by Volume 73, Issue 5, Pages e47–e49 Is Low-Dose Ketamine an Effective Alternative to Opioids for Acute Pain? x Jonathan M. Kirschner , MD (EBEM Commentator) , x Benton R. Hunter , MD (EBEM Commentator) Department (...) of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN DOI: | Publication History Published online: December 11, 2018 Expand all Collapse all Article Outline Take-Home Message In adult emergency department (ED) patients with acute pain, low-dose intravenous ketamine (0.3 to 0.5 mg/kg) may provide pain relief within 10 minutes that is similar to that of single-dose intravenous morphine (0.1 mg/kg). Methods Data Sources A medical librarian searched MEDLINE, EMBASE, Scopus, Cochrane
Comparison of high, medium and low mobilization forces for reducing pain and improving physical function in patients with hip osteoarthritis: Secondary analysis of a randomized controlled trial. Long-axis distraction mobilization (LADM) of the hip has been shown to reduce pain and improve physical function in hip osteoarthritis (OA). The optimal intensity of mobilization force necessary to reduce pain and improve physical function is unknown.To compare the effects on pain and physical function (...) of three different intensities of LADM mobilization force in hip OA patients.Randomized controlled trial.Sixty patients with unilateral hip OA were randomized to three groups: low, medium or high force mobilization group. Participants received three treatment sessions of LADM. Pressure pain thresholds (PPT) at hip, knee and heel, physical function (Western Ontario and McMaster Universities physical function subscale, timed up and go and 40 m self-placed walk test) and pain after the physical function
Peripheral nerve ablation for limb pain Final Peripheral nerve ablation for limb pain: findings and decision Page 1 of 9 Health Technology Clinical Committee Findings and Decision Topic: Peripheral nerve ablation for limb pain Meeting date: January 18, 2019 Final adoption: May 17, 2019 Meeting materials and transcript are available on the HTA website. Number and coverage topic: 20190118B – Peripheral nerve ablation for limb pain HTCC coverage determination: Peripheral nerve ablation, using any (...) technique, to treat limb pain including for knee, hip, foot, or shoulder due to osteoarthritis or other conditions, is not a covered benefit for adults and children. HTCC reimbursement determination: Limitations of coverage: N/A Non-covered indicators: N/A Agency contact information: Agency Phone Number Labor and Industries 1-800-547-8367 Public Employees Health Plan 1-800-200-1004 Washington State Medicaid 1-800-562-3022 WA - Health Technology Assessment May 17, 2019 Final Peripheral nerve ablation
Chronic use of tramadol after acute pain episode: cohort study. To determine the risk of prolonged opioid use in patients receiving tramadol compared with other short acting opioids.Observational study of administrative claims data.United States commercial and Medicare Advantage insurance claims (OptumLabs Data Warehouse) January 1, 2009 through June 30, 2018.Opioid-naive patients undergoing elective surgery.Risk of persistent opioid use after discharge for patients treated with tramadol alone (...) =0.013).People receiving tramadol alone after surgery had similar to somewhat higher risks of prolonged opioid use compared with those receiving other short acting opioids. Federal governing bodies should consider reclassifying tramadol, and providers should use as much caution when prescribing tramadol in the setting of acute pain as for other short acting opioids.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http
Using Public Cost Information During Low Back Pain Visits: A Qualitative Study. Patients desire information about health care costs because they are increasingly responsible for these costs. Public Web sites that offer cost information could inform provider-patient discussions of costs at the point of care.To evaluate tools to facilitate the use of publicly available cost information during clinical visits for low back pain (LBP).Qualitative study using individual and group interviews
The Impact of Surgical Amputation and Valproic Acid on Pain and Functional Trajectory: Results from the Veterans Integrated Pain Evaluation Research (VIPER) Randomized, Double-Blinded Placebo-Controlled Trial To determine if the perioperative administration of valproic acid reduces the incidence of chronic pain three months after amputation or revision surgery.Multicenter, randomized, double-blind, placebo-controlled trial.Academic, military, and veteran medical centers.One hundred twenty-eight (...) patients undergoing amputation or amputation revision surgery at Duke University Hospital, Walter Reed National Military Medical Center, or the Durham Veterans Affairs Medical Center for either medical disease or trauma.Patients were randomized to placebo or valproic acid for the duration of hospitalization and treated with multimodal analgesic care, including regional anesthetic blockade. Primary outcome was the proportion of patients with chronic pain at three months (average numeric pain score
Radiofrequency ablation of genicular nerves prior to total knee replacement has no effect on postoperative pain outcomes: a prospective randomized sham-controlled trial with 6-month follow-up Refractory chronic knee pain from osteoarthritis (OA) is commonly treated with total knee arthroplasty (TKA). TKA can be associated with severe postoperative pain and persistent postsurgical knee pain. Poorly controlled postoperative pain can negatively effect functional outcomes following TKA (...) , and effective opioid-sparing analgesia is key to the ideal recovery. Genicular nerve radiofrequency ablation (GN-RFA) has been shown in several trials to be clinically effective in patients with severe refractory knee pain from OA. We aimed to assess if preoperative GN-RFA would improve postoperative pain outcomes following TKA.This was a sham-control prospective clinical trial in which blinded participants were randomized to image-guided GN-RFA or a simulated sham procedure 2-6 weeks prior to elective TKA
Effect of adding interferential current stimulation to exercise on outcomes in primary care patients with chronic neck pain: a randomized controlled trial To evaluate the effect of adding interferential current stimulation to exercise on pain, disability, psychological status and range of motion in patients with neck pain.A single-blinded randomized controlled trial.Primary care physiotherapy units.A total of 84 patients diagnosed with non-specific mechanical neck pain. This sample was divided (...) into two groups randomly: experimental (n = 42) versus control group (n = 42).Patients in both groups had a supervised therapeutic exercise programme, with the experimental group having additional interferential current stimulation treatment.The main measures used were intensity of neck pain according to the Visual Analogue Scale; the degree of disability according to the Neck Disability Index and the CORE Outcome Measure; anxiety and depression levels according to the Goldberg scale; apprehension
Core im hoofbeats: a 66m w ruq pain, a 41m in afib w rvr and a 50m w syncope Core IM Hoofbeats: A 66M w RUQ pain, a 41M in Afib w RVR and a 50M w Syncope – Clinical Correlations Search Core IM Hoofbeats: A 66M w RUQ pain, a 41M in Afib w RVR and a 50M w Syncope April 10, 2019 1 min read Podcast: | Subscribe: | By Cindy Fang MD, David Kudlowitz MD, John Hwang MD || Illustration by Amy Ou MD || Audio Editing by Richard Chen, Harit Shah For a transcript of the podcast and show notes: Time Stamps (...) New features in this episode [0:30] Case one: 66M w RUQ pain [1:09] Case two: 41M w Afib in RVR [9:26] Case three: 50M w Syncope [14:33] Reveal [19:57] Retrieving illness scripts [22:29] Typical versus Atypical presentation of diseases [26:12] References Feinstein, A R. “An analysis of diagnostic reasoning. I. The domains and disorders of clinical macrobiology.” The Yale journal of biology and medicine vol. 46,3 (1973): 212-32. Nayar, et al. Venous Thromboembolism in Upper Extremity Fractures
Are opioids effective in the treatment of chronic low back pain? Are Opioids Effective in the Treatment of Chronic Low Back Pain? – Clinical Correlations Search Are Opioids Effective in the Treatment of Chronic Low Back Pain? April 17, 2019 4 min read By Anna Hirsch Peer Reviewed The use of opioid medications for chronic low back pain, or for any chronic non-cancer pain complaint, is still a source of controversy in the medical community, with a large divide between the recommendations (...) of professional societies and actual physician prescribing data. In the , 1 the 2 and the 3 have all issued guidelines urging caution with the use of opioids for chronic back pain, specifically emphasizing the poor-to-moderate quality of the evidence demonstrating benefit from this therapeutic modality. All three organizations reinforce that opioids should only be used after failure of other non-opioid and non-pharmacologic treatment options and recommend that if physicians choose to prescribe opioids
Timing of periarticular injection has no effect on postoperative pain and functional recovery in simultaneous bilateral total knee arthroplasty: a prospective randomized, double-blinded trial Given no consensus on optimal timeframe of periarticular multimodal drug injection (PMDI) in knee osteoarthritis patients undergoing total knee arthroplasty (TKA), this study was aimed to compare the postoperative pain and the functional recovery in patients who underwent simultaneous bilateral TKA (SBTKA (...) ) and received PMDI at the different intraoperative time points.This prospective, randomized, double-blinded controlled trial study included 48 patients who underwent SBTKA and received PMDI mixture, either before prosthetic implantation (late PMDI), or just after knee arthrotomy (early PMDI). Each subject's knees were randomly selected to different PMDI administration time points. The outcome parameters were postoperative pain assessed by using a visual analog scale (VAS), the maximal angle of knee flexion
Subdissociative-dose Ketamine Is Effective for Treating Acute Exacerbations of Chronic Pain Subdissociative-dose ketamine (SDDK) is used to treat acute pain. We sought to determine if SDDK is effective in relieving acute exacerbations of chronic pain.This study was a randomized double-blind placebo-controlled trial conducted May 2017 to June 2018 at a public teaching hospital (ClinicalTrials.gov #NCT02920528). The primary endpoint was a 20-mm decrease on a 100-mm visual analog scale (VAS) at 60 (...) minutes. Power analysis using three groups (0.5 mg/kg ketamine, 0.25 mg/kg ketamine, or placebo infused over 20 minutes) estimated that 96 subjects were needed for 90% power. Inclusion criteria included age > 18 years, chronic pain > 3 months, and acute exacerbation (VAS ≥ 70 mm). Pain, agitation, and sedation were assessed by VAS at baseline and 20, 40, and 60 minutes after initiation of study drug. Telephone follow-up at 24 to 48 hours used a 10-point numeric rating scale for pain.A total of 106
Insular and anterior cingulate cortex deep stimulation for central neuropathic pain: Disassembling the percept of pain To compare the analgesic effects of stimulation of the anterior cingulate cortex (ACC) or the posterior superior insula (PSI) against sham deep (d) repetitive (r) transcranial magnetic stimulation (TMS) in patients with central neuropathic pain (CNP) after stroke or spinal cord injury in a randomized, double-blinded, sham-controlled, 3-arm parallel study.Participants were (...) randomly allocated into the active PSI-rTMS, ACC-rTMS, sham-PSI-rTMS, or sham-ACC-rTMS arms. Stimulations were performed for 12 weeks, and a comprehensive clinical and pain assessment, psychophysics, and cortical excitability measurements were performed at baseline and during treatment. The main outcome of the study was pain intensity (numeric rating scale [NRS]) after the last stimulation session.Ninety-eight patients (age 55.02 ± 12.13 years) completed the study. NRS score was not significantly
Effect of 6-week retro or forward walking program on pain, functional disability, quadriceps muscle strength, and performance in individuals with knee osteoarthritis: a randomized controlled trial (retro-walking trial) Previous studies reported the beneficial effects of walking in individual with mild to moderate knee osteoarthritis (OA). The current study aimed to compare the effect of 6-week retro versus forward walking program versus control group on pain, functional disability, quadriceps (...) . The control group received a routine physiotherapy program. This program comprises a combination of closed and open kinematic chain exercises, including straight leg raising, isometric quadriceps, isometric hip adduction, terminal knee extension, semi-squat, and leg press. The primary outcomes were mean pain and knee function score measured by the numerical rating scale and the Western Ontario and McMaster Universities Osteoarthritis Index, respectively. The secondary outcomes were mean score
Improving paediatric pain management in the emergency department: An integrative literature review Children presenting to the emergency department continue to experience suboptimal pain management. While evidence-based pain management interventions are available to clinicians, effective and sustainable practice change is yet to be achieved. This practice gap requires a collaborative approach to knowledge translation targeting systems of care.The purpose of this review was to explore systems (...) level change in the emergency department for improved paediatric pain management.Integrative review.CINAHL, Embase, PubMed/Medline, Dynamed, Cochrane, Scopus, Prospero and Joanna Briggs Institute were systematically searched, and clinical guidelines and reference lists scanned.Studies were screened and selected according to the inclusion criteria, and independently appraised for risk of bias. Integrative review methodology informed data extraction and synthesis, focused on organisational context
Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome Clinical Practice Guidelines MIA ERICKSON, PT , EdD • MARSHA LAWRENCE, PT , DPT • CAROLINE W. STEGINK JANSEN, PT , PhD DIANE COKER, PT , DPT • PETER AMADIO, MD • CARLA CLEARY, PT , DPT Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Hand and Upper Extremity Physical Therapy and the Academy of Orthopaedic (...) their patients regarding the effects of mouse use on carpal tunnel pressure and assist pa- tients in developing alternate strategies, including the use of ar- row keys, touch screens, or alternating the mouse hand. Clinicians may recommend keyboards with reduced strike force for patients with CTS who report pain with keyboard use. INTERVENTIONS – ORTHOSES B Clinicians should recommend a neutral-positioned wrist orthosis worn at night for short-term symptom relief and functional improvement for individuals
Pooled analysis of tanezumab efficacy and safety with subgroup analyses of phase III clinical trials in patients with osteoarthritis pain of the knee or hip A pooled analysis was conducted to evaluate tanezumab efficacy and safety in patients with osteoarthritis (OA), including subgroup analyses of at-risk patients with diabetes, severe OA symptoms, and those aged ≥65 years.Data from phase III placebo-controlled clinical trials of patients with moderate-to-severe OA of the knee or hip were (...) pooled to evaluate tanezumab efficacy (four trials) and safety (nine trials). Patients received intravenous tanezumab, tanezumab plus an oral NSAID (naproxen, celecoxib, or diclofenac), active comparator (naproxen, celecoxib, diclofenac, or oxycodone), or placebo. Efficacy assessments included change from baseline to week 16 in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and physical function scores, Patient's Global Assessment (PGA) of OA, and percentage of patients
Pain Management for Ambulatory Arthroscopic Anterior Cruciate Ligament Reconstruction: Evidence-Based Recommendations From the Society for Ambulatory Anesthesia Ambulatory arthroscopic anterior cruciate ligament reconstruction is associated with moderate pain, even when nonopioid oral analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs are used. Regional analgesia can supplement nonopioid oral analgesics and reduce postoperative opioid requirements, but the choice