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Article in English | AIM | ID: biblio-1257697


Background: Hypertension is a global health burden affecting developed and developing countries, and South Africa is no exception. Aim: This article aims to highlight the language and content used in health education on hypertension in primary healthcare (PHC) by health promoters and in pamphlets. Methods: The study design was quantitative descriptive. The population comprised a purposive selected sample of 12 health promoters in 12 PHC clinics and 50 pamphlets relating to health education on hypertension. An audio recorder was used to record health education provided by health promoters. Quantitative content analysis and frequency distribution was used to analyse the data. Results: The health promoters used various South African languages mixed with English (code switching). Patients were taught about lifestyle modifications and encouraged to adhere to management therapy. The switching in language usage may affect the understanding of those who do not speak the local language and that may explain the reason for lack of hypertension-suited life modification required by health education. Conclusion: It is important that heath education on hypertension should be standardised so that the content of health education in clinic A is similar to that in clinic B. Information contained in pamphlets should be summarised and standardised to the content presented by health promoters

Health Education , Hypertension , Language , Pain Clinics , Primary Health Care , South Africa
Niger. J. Dent. Res ; 5(2): 89-93, 2020. tab
Article in English | AIM | ID: biblio-1266991


Objective: This study reports the findings from the psychological assessment of temporomandibular pain dysfunction syndrome (TMJPDS) patients and the treatment outcome following a multidisciplinary team management of this condition. Methods: Three patients suffering from TMJPDS were administered the following psychological assessment questionnaires: Eysenck Personality Questionnaire (EPQ), Symptom Distress Checklist ­ 90 (SCL - 90), Spielberger's State-Trait Anxiety Inventory (STAI), Index of self Esteem (ISE) and Chronic Pain Grade (CPG). The completed questionnaires by the patients were analyzed by a Clinical Psychologist. Case Reports: Case 1 was a 32 years old male. Psychological assessment showed that he manifested high peak position to being anxious and high feeling of tension associated with dental treatment. He also showed an increased pain perception and disability caused by TMJPDS. Case 2 was a 61 years old female. Psychological test showed that despite her high level of trait anxiety, the feeling of tension associated with dental treatment was low. She perceived her abnormal pain and disability caused by the disease to be low. Case 3 was a 39 years old female. Psychological assessment revealed that her predisposition to being anxious was high; however, her anxiety related to dental care was low. She also reported a reduced pain perception and disability caused by the disease condition. Conclusion: This study shows that TMJPDS is often associated with psychological problems, such as anxiety, with or without tension related to dental care, abnormal pain perception and psychological disability. A multidisciplinary team approach including dentists and mental health experts in the management of patients suffering from TMJPDS is recommended

Nigeria , Pain Clinics , Resilience, Psychological , Temporomandibular Joint Disorders , Temporomandibular Joint Dysfunction Syndrome
Clinical Pain ; (2): 36-39, 2019.
Article in Korean | WPRIM | ID: wpr-785682


Chronic postoperative inguinal pain (CPIP) is a major complication after inguinal herniorrhaphy. We report the treatment of CPIP using ultrasonography-combined with nerve stimulator for injection of the genitofemoral nerve (GFN). A 59-year-old man underwent laparoscopic herniorrhaphy and presented with numbness from the inguinal region to the scrotum after operation. In the pain clinic, ultrasonography-guided GFN block and pharmacological treatments had little effect. Six month after operation, patient was referred to the Department of Physical Medicine and Rehabilitation, and ultrasonography-combined with nerve stimulator for GFN injection underwent to enhance the accuracy of neural approach. The induction of scrotal contraction and paresthesia on the GFN distribution was monitored by nerve stimulator and local anesthetic was injected. After the block, pain relief lasted for 6 months without analgesic use. Ultrasonography-combined with nerve stimulator is an effective approach to treat CPIP as it enhances precise localization and injection of small peripheral nerve like GFN.

Herniorrhaphy , Humans , Hypesthesia , Middle Aged , Pain Clinics , Paresthesia , Peripheral Nerves , Physical and Rehabilitation Medicine , Scrotum
The Korean Journal of Pain ; : 292-300, 2019.
Article in English | WPRIM | ID: wpr-761709


BACKGROUND: The aim of this study was to investigate the clinical characteristics of complex regional pain syndrome (CRPS) in young male patients in South Korea, especially focusing on the association with military service. METHODS: From January 2007 to May 2017, we investigated the electronic medical records of 430 consecutive patients, aged 18 to 30 years, who visited Seoul National University Hospital Pain Center, with a suspected diagnosis of CRPS at the initial visit. The following patient details were available for analysis: demographic and disease-related variables, relevance to military service, medications, and the treatment modalities received. RESULTS: Out of 430 patients, 245 (57.0%) were diagnosed with CRPS, of which, 200 were male patients and 45 were female patients. Of the male patients, 95 (47.5%) developed CRPS during military service. CRPS during military service was more likely to result from sprain/strain, and the incidence of CRPS was significantly higher in the lower extremities in patients from the military service group than in those from the non-military service group. During the follow-up period, 37.9% of male CRPS patients (n = 61/161) were treated successfully. Patients with moderate to severe initial pain intensity, and diagnosed during their military service, showed better outcomes. CONCLUSIONS: Our results demonstrated that manifestation of CRPS in the young Korean population was more common in male and among those male CRPS patients, about half the cases developed during the military service period.

Chronic Pain , Diagnosis , Electronic Health Records , Epidemiology , Female , Follow-Up Studies , Humans , Incidence , Korea , Lower Extremity , Male , Military Medicine , Military Personnel , Neuralgia , Pain Clinics , Retrospective Studies , Seoul , Stress, Psychological
The Korean Journal of Pain ; : 187-195, 2019.
Article in English | WPRIM | ID: wpr-761699


BACKGROUND: Steroid injections are commonly used in pain clinics to relieve pain and treat inflammation. In Korea, these steroid injections are well known as ‘ppyeojusa’, which means to inject into the bone in Korean. Some patients often have a negative perception of this treatment method due to inaccurate information about the treatment and side effects of steroids. The purpose of this study is to investigate patients’ perception and knowledge of ppyeojusa. METHODS: A questionnaire about ppyeojusa was completed by patients who visited one of the pain clinics in nine university hospitals, from August 1 to September 10, 2017. RESULTS: Three-hundred seventy-four patients completed the survey. Eighty-five percent of patients had had ppyeojusa, and 74% of the respondents had heard of ppyeojusa from the mass media, friends or relatives. Only 39% of the patients answered that this injection was safe without side effects if properly spaced. Of the patients surveyed, 21% responded that ppyeojusa are “injections into the bone”; while 15% responded that ppyeojusa are “terrible injections that melted ‘the bone if used a lot’”. Half of the patients did not know what the active constituent is in ppyeojusa. If steroid injections are advised by the pain specialists, 89% of the patients would consent. CONCLUSIONS: Most pain clinic patients have heard of ppyeojusa. Most patients obtained information about ppyeojusa from mass media, rather than their physicians. Therefore, it is likely that most patients have inaccurate knowledge.

Friends , Hospitals, University , Humans , Inflammation , Korea , Mass Media , Methods , Pain Clinics , Specialization , Steroids , Surveys and Questionnaires
Dolor ; 28(70): 16-22, dic. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-1117891


La ansiedad y la depresión son las formas más frecuentes de alteraciones psicológicas que se ven en pacientes con dolor crónico, en general; y lumbalgia crónica, en particular. No existen, en nuestro medio, reportes sobre estos trastornos psicológicos en pacientes con lumbalgia crónica, siendo pocos los estudios en latinoamérica. El objetivo del presente estudio piloto fue evaluar la presencia de ansiedad y depresión en pacientes con lumbalgia crónica, acompañada o no de dolor radicular, que consultaron en el servicio de tratamiento del dolor de nuestro hospital universitario. La escala de ansiedad y depresión Hospitalaria (EADH, versión en español de la hospital anxiety and depression scale, HADS) fue el instrumento utilizado para la valoración de ansiedad y depresión. La muestra fue de 25 pacientes. De éstos, 16 (64 por ciento) presentaron diagnóstico de ansiedad y 7 (28 por ciento) de depresión. La frecuencia de ansiedad en esta muestra fue más alta que la de depresión que, sin contar los casos probables, fue de 28 por ciento. Se registraron 3 casos de diagnóstico probable de ansiedad y 7 de depresión. Los pacientes estudiados presentaban dolor intenso e incapacitante, evaluado por el Inventario abreviado de dolor. Se observó una correlación lineal positiva moderada a débil, pero estadísticamente significativa entre ansiedad y depresión, y la intensidad del dolor medido el Índice de Intensidad. Se encontró una correlación positiva débil, aunque estadísticamente significativa entre ansiedad y depresión y el Índice de Interferencia. En conclusión, en este estudio piloto en pacientes con lumbalgia crónica se detectaron, utilizando la escala de ansiedad y depresión hospitalaria, niveles elevados de ansiedad, con niveles menores de depresión, trastornos que se correlacionan con la intensidad del dolor y la incapacidad derivada de éste de manera moderada a débil. Este es el primer estudio en nuestro medio que evalúa ansiedad y depresión en pacientes con lumbalgia crónica, utilizando la escala de ansiedad y depresión hospitalaria validada en español. Los hallazgos obtenidos exigen un abordaje interdisciplinario de la lumbalgia crónica, que podrá incluir el uso de antidepresivos con acción ansiolítica como la duloxetina.

Anxiety and depression are frequent disorders in patients with chronic pain, in particular in the spine. No studies evaluating these psychological disorders have been performed in our country in chronic low back pain patients, and a few were found in latin America. The goal of the present pilot study was to evaluate the presence of anxiety and depression in chronic back pain patients with or without radicular pain, utilizing the hospital anxiety and depression scale, in the Spanish validated version. 25 patients were chosen of the ambulatory consultation of the chronic pain treatment unit of the university hospital. 16 (64 percent) presented anxiety and 7 depression (28 percent). The probable cases were 3 for anxiety and 7 for depression. All the patients had intense pain and functional impairment, evaluated by the brief pain Inventory instrument. A moderate to weak, statistically significant, positive correlation, were observed between anxiety and depression and pain intensity and interference, measured by the Intensity and interference scores. In conclusion, in the present pilot study in chronic low back pain patients, high levels of anxiety was observed, with lower frequency of depression, utilizing, for first time in our country, the hospital anxiety and depression scale in Spanish. Weak to moderate positive correlations were observed between anxiety and depression and pain intensity and interference in patient daily activities. Under the light of these findings, an interdisciplinary approach of chronic low back pain patients is mandatory, including the use of antidepressants with a tranquilizer profile, as it is duloxetine.

Humans , Male , Female , Adult , Middle Aged , Anxiety/diagnosis , Low Back Pain/psychology , Depression/diagnosis , Chronic Pain/psychology , Anxiety/epidemiology , Uruguay , Pain Measurement , Surveys and Questionnaires , Pain Clinics , Depression/epidemiology , Hospitals, University
Rev. cuba. enferm ; 34(3): e1395, jul.-set. 2018. tab
Article in Spanish | LILACS, BDENF, CUMED | ID: biblio-1099051


RESUMEN Introducción: La cefalea es uno de los trastornos más comunes del sistema nervioso en todo el mundo, frecuentemente es signo de otras enfermedades. Mientras la medicina occidental trata los síntomas con medicamentos, los médicos alternativos tratan la causa con acupuntura para proporcionar alivio duradero. Objetivo: Evaluar la efectividad de la acupuntura con microsistema de cara como tratamiento de pacientes con cefalea migrañosa. Métodos: Estudio cuasiexperimental de tipo casos-controles con 100 pacientes que asistieron a la Clínica del Dolor del Hospital "Dr. Ambrosio Grillo Portuondo", en Santiago de Cuba, con diagnóstico de cefalea migrañosa, desde enero de 2014 a noviembre de 2015. Al grupo estudio se aplicó acupuntura con microsistema de cara; al grupo control, medicamentos. La información se obtuvo de las historias clínicas, el dolor se valoró con la escala analógica visual del dolor. Se aplicó Ji cuadrado de homogeneidad para la identificar diferencias significativas entre las proporciones de efectividad de uno y otro tratamiento, con un nivel de significación (α;= 0,05). Resultados: Predominó el sexo femenino (70,00 por ciento), el grupo etareo 18-39 años, de ellos 40 en el grupo estudio (80,00 por ciento), 43 en el control (86,00 por ciento). En el grupo estudio el 82,00 por ciento de los pacientes quedó sin dolor desde la primera sesión del tratamiento, el 18,00 por ciento con dolor disminuido. Al final del tratamiento el 98,00 por ciento del grupo estudio quedó sin dolor contra el 96,00 por ciento del grupo control. Conclusión: La acupuntura con microsistema de cara es un método alternativo efectivo en el tratamiento de la cefalea migrañosa(AU)

ABSTRACT Introduction: Headache is one of the most common nervous system disorders worldwide. It is frequently a sign of other diseases. While Western medicine treats symptoms with medications, alternative practitioners treat the cause with acupuncture to provide long-lasting relief. Objective: To evaluate the effectiveness of acupuncture with a facial microsystem as a treatment for patients with migraine headache. Methods: Quasiexperimental case-control study with 100 patients who attended the Pain Clinic at Dr. Ambrosio Grillo Portuondo Hospital in Santiago de Cuba, with a diagnosis of migraine headache, from January 2014 to November 2015. The study group was applied acupuncture with a facial microsystem. The control group was treated with medicines. The information was obtained from the medical records. The pain was assessed using the Visual Analogue Scale. Chi-square test of homogeneity was applied in order to identify significant differences between the proportions of effectiveness of one treatment and another, with a level of significance α =0.05. Results: There was predominance of the female sex (70.00 percent), age group 18-39 years, among them 40 in the study group (80.00 percent) and 43 in the control group (86.00 percent). In the study group, 82.00 percent of patients remained without pain from the first session of treatment and 18.00 percent with pain decreased. At the end of the treatment, 98.00 percent of the study group remained without pain in opposition to 96.00 percent of the control group. Conclusion: Acupuncture with a facial microsystem is an effective alternative method in the treatment of migraine headache(AU)

Humans , Female , Adult , Acupuncture Therapy/methods , Pain Clinics , Evaluation of the Efficacy-Effectiveness of Interventions , Migraine Disorders/diagnosis , Acupuncture Analgesia/adverse effects , Treatment Outcome , Medicine, Chinese Traditional/methods
Pers. bioet ; 22(1): 29-38, ene.-jun. 2018.
Article in Spanish | LILACS, BDENF, COLNAL | ID: biblio-955268


Resumen La investigación en medicina tiene por objetivo generar nuevos conocimientos que ayuden al diagnóstico, el tratamiento y la prevención de enfermedades. Pero la medicina no es una ciencia exacta, sino una actividad humana heterogénea que se basa solo parcialmente en la ciencia, con varios factores no científicos que influyen en la forma de desarrollar esta actividad. El dolor, como síntoma o como enfermedad, es probablemente el trastorno que más afecta y preocupa a las personas y el que con mayor frecuencia motiva una consulta médica. A pesar de la magnitud del problema, y del interés médico y social por el dolor, la atención y el tratamiento de las personas con dolor crónico es un tema infravalorado o tratado inadecuadamente. Con base en múltiples preguntas que se plantean a lo largo del desarrollo del presente documento, nuestro objetivo es, por un lado, el de señalar que los cambios que se han producido en el manejo del dolor crónico hacen de los llamados protocolos de consenso un ejercicio obsoleto en la medicina del siglo XXI. Por otro lado, en términos de bioética, responder a la pregunta ¿se ajustan los protocolos de consenso al principio de beneficencia del paciente individual?

Abstract Research in medicine is intended to generate new knowledge to help in the diagnosis, treatment and prevention of disease. However, medicine is not an exact science; rather, it is a heterogeneous human activity based only partially on science and involves several non-scientific factors that influence the way it is developed. Pain, as a symptom or as a disease, is probably the disorder that most affects and worries people, and is what most often prompts medical consultation. Despite the magnitude of the problem, and the medical and social interest in pain, the care and treatment of persons with chronic pain is an issue that is undervalued or inadequately addressed. Based on variety of questions posed throughout this document, the objective is, on the one hand, to point out that the changes that have occurred in the way chronic pain is managed make the so-called consensus protocols an obsolete exercise in 21st century medicine. On the other hand, in terms of bioethics, the authors answer the question: Do consensus protocols conform to the principle of beneficence for the individual patient?

Resumo A pesquisa em medicina tem por objetivo gerar novos conhecimentos que ajudem no diagnóstico, tratamento e prevenção de doenças. Porém, a medicina não é uma ciência exata, mas sim uma atividade humana heterogênea que está apenas parcialmente baseada na ciência, com vários fatores não científicos que influenciam na maneira em que essa atividade é desenvolvida. A dor, como sintoma ou como doença, é provavelmente o transtorno que mais afeta e preocupa as pessoas e o que com maior frequência motiva uma consulta médica. Apesar da magnitude do problema e do interesse médico e social pela dor, o atendimento e o tratamento das pessoas com dor crônica é um tema subestimado ou tratado inadequadamente. Com base em múltiplas perguntas que são levantadas ao longo do desenvolvimento do presente trabalho, nosso objetivo é, por um lado, indicar que as mudanças que ocorreram na abordagem da dor crônica fazem dos chamados "protocolos de consenso" um exercício obsoleto na medicina do século XXI. Por outro lado, em termos de bioética, buscamos responder à pergunta: os protocolos de consenso se ajustam aos princípios de beneficência do paciente individual?

Humans , Patients , Disease , Pain Clinics , Evidence-Based Medicine , Pain Management
Rev. ADM ; 75(3): 164-167, mayo-jun. 2018. ilus
Article in Spanish | LILACS | ID: biblio-908932


Antecedentes:La neuralgia del trigémino (NT) es una enfermedad que se caracteriza por dolor altamente intenso en la región orofacial, unilateral, intermitente, con sensación de descargas eléctricas, brusco al empezar y terminar. Se limita a la distribución de una o más ramas del NT y es provocado por estímulos inocuos. Objetivo: Exponer la dificultad para diagnosticar de manera efectiva la NT, ya que se confunde con dolor aparentemente odontogénico. Material y métodos: Paciente masculino de 73 años que refi ere historia de dolor desde hace dos años en el lugar que ocupaba el órgano dental (OD) 24. De acuerdo con la escala visual análoga (EVA) el dolor muestra una intensidad de entre 3/10 hasta 10/10 puntos, de tipo punzante acompañada de descargas eléctricas con duración de 3 a 5 segundos, de 30 a 50 veces al día. Para aliviar el dolor, el paciente acudió a varios especialistas del área odontológica y médica sin tener cura. Para llegar a un diagnóstico y tratamiento certero se realizó un interrogatorio que incluyó historial médico, historial odontológico, examen clínico, examen radiográfico, tomografía computarizada, resonancia magnética y pruebas de laboratorio. Resultados: Con el apoyo de estas herramientas diagnósticas, se emite el diagnóstico de neuralgia del trigémino tipo 1, comenzando un esquema de tratamiento farmacológico con carbamazepina. En la última cita de control el paciente refiere ausencia completa del dolor. Conclusión: La neuralgia del trigémino se caracteriza por dolor intenso en la región orofacial que frecuentemente se presenta con aparente etiología odontogénica. Es responsabilidad del gremio odontológico tener conocimiento de los síntomas de la enfermedad para proporcionar un diagnóstico certero y evitar tratamientos odontológicos innecesarios e irreversibles (AU)

Background: Trigeminal neuralgia (TN) is a disease that is characterized by a highly intense pain in the orofacial region, unilateral, intermittent with electric shocks, abrupt in onset and termination. It is limited to one or more of the distributions of the TN and is triggered by innocuous stimuli. Objective: To show the diffi culty to eff ectively diagnose TN in which the patient apparently presents with tooth pain. Material and methods: A 73 year-old male patient refers pain in tooth number 24 for two years. The intensity of the pain using the visual analog scale is between 3/10 up to 10/10 stabbing pain accompanied by an electric shock sensation, which lasts 3 to 5 seconds, 30 to 50 times a day. In order to treat the present pain in tooth number 24, the patient has seen various medical and dental specialists without relief. In order to come to the correct diagnosis patient interrogation which includes medial history, dental history, separately a clinical exam, radiographic exam, computerized tomography and magnetic resonance imaging as well as blood laboratory testing. Results: Based on fi ndings of the clinical exam, radiographic examinations a diagnosis of type-1 TN was issued. After a review of the blood laboratory testing the patient was started on a schedule of carbamazepine. In the last follow-up appointment the patient refers a complete reduction of his pain. Conclusion: Trigeminal neuralgia is characterized by intense pain in the orofacial region that frequently presents with apparent odontogenic etiology. It is the responsibility of the dental profession to have knowledge of the symptoms of the disease in order to provide an accurate diagnosis and avoid unnecessary and irreversible dental treatments (AU)

Humans , Male , Aged , Carbamazepine , Facial Pain , Trigeminal Neuralgia , Clinical Diagnosis , Diagnosis, Differential , Pain Clinics , Signs and Symptoms
Article in English | WPRIM | ID: wpr-716809


BACKGROUND: Polymyalgia rheumatica (PMR) is a common systemic inflammatory disease of the elderly; however, the clinical characteristics and therapeutic response of PMR in Korea have been rarely studied. METHODS: We reviewed the medical records of 54 Korean patients diagnosed with PMR between January 2009 and February 2017 in a locomotive pain clinic of one tertiary referral hospital. We analyzed epidemiologic and clinical characteristics, therapeutic responses, and prognostic factors for remission-failure at one-year after oral prednisolone treatment. RESULTS: In 54 patients with PMR, 32 (59.3%) were female. The average age at diagnosis was 65.0 ± 10.5 years. Duration of symptoms before diagnosis was 8.1 ± 8.6 months. All patients had shoulder pain (54 patients, 100.0%); 49 patients (90.7%) had hip girdle pain, while 19 patients (35.2%) had peripheral joint pain. Four patients (7.4%) were accompanied by the giant cell arteritis (GCA). There was no seasonal preference for symptom development. Only 19 patients were diagnosed with PMR at initial symptom presentation. At one-year follow-up after oral prednisolone treatment, the remission rate was 35.3% (12/34). Multivariate analysis showed that history of relapse (odds ratio, 6.81; 95% confidence interval, 1.035–44.804) was a significant predictor of remission-failure. CONCLUSION: The rate of remission (35.3%) after oral prednisolone treatment was similar to previous reports in western countries; and GCA is not a rare condition in Korean PMR patients. Misdiagnosis of PMR is common, and heightened consideration for PMR is needed in elderly patients who present inflammatory features of bilateral shoulder pain.

Aged , Arthralgia , Cohort Studies , Diagnosis , Diagnostic Errors , Female , Follow-Up Studies , Giant Cell Arteritis , Hip , Humans , Korea , Medical Records , Multivariate Analysis , Pain Clinics , Polymyalgia Rheumatica , Prednisolone , Recurrence , Seasons , Shoulder Pain , Tertiary Care Centers , Treatment Outcome
Article in English | WPRIM | ID: wpr-719043


Breast cancer related lymphedema (BCRL) is one of the most intractable complications after surgery. Patients suffer from physical impairment, as well as psychological depression. Moreover, a recent study revealed that cellulitis significantly increased the risk of BCRL, and cellulitis has been suggested as a risk factor of BCRL development. We describe a patient treated with stellate ganglion blocks (SGBs) without steroid for relief of symptoms and reduction of the arm circumference of breast cancer-related infectious lymphedema in a month. We measured the arm circumference at four locations; 10 cm and 5 cm above and below the elbow crease, numeric rating scale (NRS) score, lymphedema and breast cancer questionnaire (LBCQ) score on every visit to the pain clinic. A serial decrease of the arm circumference and pain score were observed after second injection. In the middle of the process, cellulitis recurred, we performed successive SGBs to treat infectious lymphedema. The patient was satisfied with the relieved pain and swelling, especially with improved shoulder range of motion as it contributes to better quality of life. This case describes the effects of SGB for infectious BCRL patients. SGB could be an alternative or ancillary treatment for infectious BCRL patients.

Arm , Breast Neoplasms , Breast , Cellulitis , Depression , Elbow , Humans , Lymphedema , Pain Clinics , Quality of Life , Range of Motion, Articular , Risk Factors , Shoulder , Stellate Ganglion
Article in English | WPRIM | ID: wpr-742180


BACKGROUND: An epidural steroid injection (ESI) is a commonly administered procedure in pain clinics. An unintentional lumbar facet joint injection during interlaminar ESI was reported in a previous study, but there has not been much research on the characteristics of an unintentional lumbar facet joint injection. This study illustrated the imaging features of an unintentional lumbar facet joint injection during an interlaminar ESI and analyzed characteristics of patients who underwent this injection. METHODS: From December 2015 to May 2017, we performed 662 lumbar ESIs and we identified 24 cases (21 patients) that underwent a lumbar facet joint injection. We gathered data contrast pattern, needle approach levels and directions, injected facet joint levels and directions, presence of lumbar spine disease as seen on magnetic resonance images (MRI), and histories of lumbar spine surgeries. RESULTS: The contrast pattern in the facet joint has a sigmoid or ovoid contrast pattern confined to the vicinity of the facet joint. The incidence of unintentional lumbar facet joint injection was 3.6%. The mean age was 68.47 years. Among these 21 patients, 14 (66.7%) were injected in the facet joint ipsilaterally to the needle approach. Among the 20 patients who received MRI, all (100%) had central stenosis and 15 patients (75%) had severe stenosis. CONCLUSIONS: When the operator performs an interlaminar ESI on patients with central spinal stenosis, the contrast pattern on the fluoroscopy during interlaminar ESI should be carefully examined to distinguish between the epidural space and facet joint.

Colon, Sigmoid , Constriction, Pathologic , Epidural Space , Fluoroscopy , Humans , Incidence , Magnetic Resonance Imaging , Needles , Pain Clinics , Retrospective Studies , Spinal Stenosis , Spine , Zygapophyseal Joint
The Korean Journal of Pain ; : 116-124, 2018.
Article in English | WPRIM | ID: wpr-742176


BACKGROUND: We aimed to investigate the prevalence of unrecognized depression in patients with chronic pain, but with no history of psychiatric diseases. METHODS: Patients with chronic pain who did not have a history of psychiatric disease were selected for this study. The Beck Depression Index (BDI) was used to evaluate depression. Participants' socio-demographic characteristics and pain-related characteristics were also recorded. RESULTS: The study included 94 consecutive patients with chronic pain (28 men and 66 women). Based on the BDI scores, 33/94 (35.1%) patients with chronic pain had comorbid depression. The prevalence of depression was significantly higher in our cohort than it was in the general population (P < 0.001). The standardized incidence ratio, adjusted for age and sex, was 2.77 in men and 2.60 in women. Patients who were unmarried (odds ratio [OR] = 3.714, P = 0.044), and who had subjective sleep disturbance (OR = 8.885, P < 0.001), were more likely to have moderate to severe depression. Patients with high education levels (OR = 0.244, P = 0.016), and who were economically active (OR = 0.284, P = 0.023), were less likely to have moderate to severe depression. CONCLUSIONS: Our results indicate that unrecognized depression in patients with chronic pain is common. Therefore, pain physicians should actively seek to identify these problems rather than relying on the patient to volunteer such information.

Age Factors , Ambulatory Care Facilities , Chronic Pain , Cohort Studies , Delayed Diagnosis , Depression , Education , Female , Humans , Incidence , Male , Marital Status , Mental Disorders , Pain Clinics , Prevalence , Single Person , Volunteers
Article in English | WPRIM | ID: wpr-739423


Disseminated herpes zoster commonly occurs in patients with decreased immunity, but rarely in patients without any evidence of immunosuppression. We reported a case of disseminated herpes zoster with visceral organ involvement in a non-immunocompromised patient. An 83-year-old man visited our pain center, with chief complaints of painful rashes on the L3–L4 and S2–S4 due to acute herpes zoster. Even though intravenous antiviral therapy was initiated immediately upon hospitalization, his lesion deteriorated and systemic cluster formed. Urinary retention and hyponatremia occurred, and he was diagnosed with zoster cystitis and severe inappropriate antidiuretic hormone syndrome. Conservative treatment, including Foley catheter insertion and correction of hyponatremia with antiviral therapy, was initiated, and he was discharged without any complications at the 33rd day of hospitalization. Old age can be a risk factor of disseminated herpes zoster, and visceral organ involvement should also be considered.

Aged , Aged, 80 and over , Catheters , Cystitis , Exanthema , Herpes Zoster , Hospitalization , Humans , Hyponatremia , Immunocompetence , Immunosuppression , Inappropriate ADH Syndrome , Pain Clinics , Risk Factors , Urinary Bladder , Urinary Retention
Coluna/Columna ; 16(1): 48-51, Jan.-Mar. 2017. tab, graf
Article in English | LILACS | ID: biblio-840156


ABSTRACT Objective: To evaluate the results of an interdisciplinary program administered to patients with failed back surgery syndrome, aiming at functional improvement, modulation of pain, reduction of anxiety symptoms and depression, and improvement of quality of life. Method: This is a non-randomized prospective study with a sample of patients with failed back surgery pain syndrome diagnosed with persistent or recurrent pain after surgery to the lumbar spine (laminectomy and arthrodesis) referred to liaison in the Pain Clinic (n= 26). The instruments used were Brief Pain Inventory, Roland-Morris Questionnaire and Beck Anxiety and Depression Inventories. The generic WHOQOL-bref13 questionnaire was used to evaluate the quality of life and the fear of moving was assessed by the Tampa Scale for Kinesiophobia. Results: There was a predominance of females, the mean age was 42.3 ± 5.8 years, 43% were married and average schooling was 7 ± 4.5 years. The mean time of pain reported was 8 ± 6.8 months in addition to high levels of anxiety, depression and kinesiophobia. After the intervention, there was a significant improvement in the perception of quality of life and of all parameters evaluated (p<0.05), with functional gains as well as decreased pain threshold. Conclusion: The interdisciplinary intervention in patients with failed back surgery syndrome provides better functional performance, decreases the intensity of pain, anxiety and depression symptoms, and improves quality of life. The inclusion of this intervention associated with drug therapy may the patient develop an active and independent lifestyle.

RESUMO Objetivo: Avaliar os resultados de um programa interdisciplinar aplicado a pacientes com síndrome pós-laminectomia, visando melhora funcional, modulação da dor, redução de sintomas de ansiedade e depressão e aumento da qualidade de vida. Método: Trata-se de um estudo prospectivo não randomizado, com amostra constituída por um grupo de pacientes com síndrome dolorosa pós-laminectomia diagnosticados com dor persistente ou recorrente após cirurgias da coluna lombar (laminectomia e artrodese) encaminhados para interconsultas na Clínica da Dor (n= 26). Os instrumentos utilizados foram: Inventário Breve de Dor, Questionário Roland-Morris e Inventários Beck de ansiedade e depressão. Para avaliar a qualidade de vida, foi utilizado Questionário Genérico Whoqol-bref13 e o medo de se movimentar foi avaliado pela Escala Tampa para Cinesiofobia. Resultados: Houve predomínio de mulheres, a média de idade foi 42,3 ± 5,8 anos, 43% eram casados e a média de escolaridade foi de 7 ± 4,5 anos. O tempo médio de dor relatado foi de 8 ± 6,8 meses, além de níveis altos de ansiedade, depressão e cinesiofobia. Após a intervenção houve melhora significativa na percepção da qualidade de vida e de todos os parâmetros avaliados (p < 0,05) observando-se ganhos funcionais, assim como a diminuição do limiar de dor. Conclusão: A intervenção interdisciplinar nos pacientes com síndrome pós-laminectomia proporciona melhor desempenho funcional, diminui a intensidade da dor, os sintomas de ansiedade e depressão, melhorando a qualidade de vida. A inclusão desta intervenção associada ao tratamento farmacológico pode desenvolver um estilo de vida ativo e independente.

RESUMEN Objetivo: Evaluar los resultados de un programa interdisciplinario subministrado a pacientes con síndrome postlaminectomía que busca la mejora funcional, la modulación del dolor, la reducción de los síntomas de ansiedad y depresión y calidad de vida. Método: Se trata de un estudio prospectivo no aleatorio de una muestra compuesta por un grupo de pacientes con síndrome doloroso postlaminectomía diagnosticados con dolor persistente o recurrente después de la cirugía de la columna lumbar (laminectomía y fusión) referidos a interconsultas en la Clínica del Dolor (n= 26). Los instrumentos utilizados fueron: Cuestionario breve del dolor, Cuestionario Roland-Morris e inventarios de ansiedad y depresión de Beck. Para evaluar la calidad de vida se utilizó el cuestionario genérico WHOQOL-BREF13 y el miedo de moverse fue evaluado por la Escala de Tampa de Kinesiofobia. Resultados: Hubo un predominio de mujeres, la edad promedio fue de 42,3 ± 5,8 años, 43% eran casados y la educación promedio fue de 7 ± 4,5 años. Se reportó una duración promedio del dolor de 8 ± 6,8 meses, además de altos niveles de ansiedad, depresión y kinesiofobia. Después de la intervención se observó una mejoría significativa en la percepción de la calidad de vida y de todos los parámetros (p < 0,05), siguiendo las ganancias funcionales, así como la disminución del umbral del dolor. Conclusión: La intervención interdisciplinaria en pacientes con síndrome postlaminectomía mejora la funcionalidad, disminuye la intensidad del dolor, los síntomas de ansiedad y depresión y mejora la calidad de vida. La inclusión de esta intervención asociada con el tratamiento farmacológico puede proporcionar una vida activa e independiente.

Humans , Failed Back Surgery Syndrome , Chronic Pain , Interdisciplinary Research , Pain Clinics
Article in English | WPRIM | ID: wpr-166099


BACKGROUND: To provide a platform for the dissemination of basic knowledge of pain management, a WhatsApp group was created by residents and consultants. Common clinical scenarios, resident queries, and important instructions to be followed by residents with respect to running the Acute Pain Service were discussed in the group. This study evaluates the benefits of this interaction. METHODS: This study was approved by the hospital ethics board and was registered with the Clinical Trial Registry of India. Second- and third-year anesthesia residents were included in a WhatsApp group, along with consultants (board certified anesthesiologists with a special interest in pain). Pain knowledge assessment was performed pre- and post-discussion using a standard 22-point questionnaire. A feedback form, which included self-rated confidence scores (1–10, 10-most confident) and opinions about the 3-month WhatsApp discussion, was collected. Improvements in the documentation in clinical sheets post-discussion were also analyzed. RESULTS: A total of 38 residents were included in the WhatsApp group. An improvement in the percentage of correct answers from 69.1% (pre-discussion) to 73.6% (post-discussion) was observed (P = 0.031). Improvements in the self-rated residents' confidence levels were also noted (P < 0.05). A total of 37 residents felt that the WhatsApp-based discussion was useful. Documentation of the details of epidural blockade in clinical sheets improved from 30% to 100%. CONCLUSIONS: The WhatsApp discussion improved residents' knowledge and confidence levels, and also resulted in improved documentation of essential details in the clinical notes. This form of education is promising and should be explored in future studies.

Anesthesia , Consultants , Education , Education, Medical , Ethics, Institutional , Humans , India , Pain Clinics , Pain Management , Pilot Projects , Running , Social Media
The Korean Journal of Pain ; : 116-125, 2017.
Article in English | WPRIM | ID: wpr-192935


BACKGROUND: Spinal pain is most common symptom in pain clinic. In most cases, before the treatment of spinal pain, physician explains the patient's disease and treatment. We investigated patient's satisfaction and physician's explanation related to treatments in spinal pain patients by questionnaires. METHODS: Anonymous questionnaires about physician's explanation and patient's satisfaction in each treatment and post-treatment management were asked to individuals suffering from spinal pain. Patients who have spinal pain were participated in our survey of nationwide university hospitals in Korea. The relationships between patient's satisfaction and other factors were analyzed. RESULTS: Between June 2016 and August 2016, 1007 patients in 37 university hospitals completed the questionnaire. In the statistical analysis, patient's satisfaction of treatment increased when pain severity was low or received sufficient preceding explanation about nerve block and medication (P < 0.01). Sufficient explanation increased patient's necessity of a post-treatment management and patients' performance rate of post-treatment management (P < 0.01). CONCLUSIONS: These results show that sufficient explanation increased patients' satisfaction after nerve block and medication. Sufficient explanation also increased the practice of patients' post-treatment management.

Anonyms and Pseudonyms , Hospitals, University , Humans , Korea , Nerve Block , Pain Clinics , Patient Satisfaction
The Korean Journal of Pain ; : 214-219, 2017.
Article in English | WPRIM | ID: wpr-64612


BACKGROUND: As herpes zoster progresses via postherpetic neuralgia (PHN) to well-established PHN, it presents its recalcitrant nature to the treatment. At this point, the well-established PHN is fixed as a non-treatable, but manageable chronic painful neuropathic disorder. This study evaluated the incidence of complete relief from PHN according to PHN duration at their first visit, and the other factors influencing it. METHODS: A retrospective chart review was performed on patients with PHN at a university-based pain clinic over 7 years. The responders were defined as patients who had complete relief from pain after 1 year of active treatment. Age, sex, PHN duration at their first visit, dermatomal distribution, and underlying disorders were compared in the responder and non-responder groups. Responders were also compared according to these factors. RESULTS: Among 117 PHN patients (M/F = 48/69), 35 patients (29.9%) had complete relief from PHN. Mean ages were 64.3 ± 10.6 and 66.9 ± 10.7 years, numbers of male to female patients were 11/24 and 37/45, and mean durations of PHN at their first visit were 8.5 ± 6.3 and 15.3 ± 10.7 months in the responder and non- responder groups, respectively. In addition, PHN patients who visited the clinic before 9 months showed a better result. Dermatomal distribution and underlying disorders did not show significant differences. CONCLUSIONS: Almost 30% of PHN patients received complete relief. Those who sought treatment in a pain clinic before 9 months received a better result.

Chronic Pain , Exanthema , Female , Herpes Zoster , Humans , Incidence , Male , Neuralgia, Postherpetic , Pain Clinics , Retrospective Studies
Cienc. enferm ; 22(3): 77-84, set. 2016. tab
Article in Spanish | LILACS | ID: biblio-839757


Objetivo: Conocer la asociación entre el nivel socioeconómico que presentaban los pacientes diagnosticados de dolor crónico que acudían a la Unidad del Dolor y su adaptación al dolor crónico en términos de dolor, discapacidad y estado de ánimo. Material y método: Se realizó un estudio correlacional con una muestra de pacientes con dolor crónico que acudían a la Unidad del Dolor del Hospital Carlos Haya de Málaga. Mediante el uso de autoinformes que fueron administrados de forma oral, se midieron las siguientes variables: el nivel socioeconómico, el dolor, la discapacidad y el estado de ánimo. Se aplicó un ANOVA para comparar a los pa cientes en función del nivel socioeconómico (NSE). Resultados: El grupo NSE bajo, formado mayoritariamente por mujeres (85,7%), presentaban un dolor más incapacitante para las actividades de la vida diaria y consumían más medicación. Conclusión: Los resultados revelan que las condiciones socioeconómicas pueden suponer un factor de riesgo de una experiencia más desadaptativa del dolor crónico.

Objective: To determine the association between the socioeconomic status of patients diagnosed with chronic pain entering the Pain Unit and their adaptation to chronic pain in terms of pain, disability and mood. Method: This is a cross-sectional study of 133 chronic pain patients attending the Pain Unit at the Carlos Haya Hospital in Málaga. By means of oral self-reports the following variables were measured: socioeconomic level, pain and discomfort, disability and mood. An ANOVA test was used to compare patients according to their Socioeconomic Status (SES). Results: The low SES group had more disabling pain for daily activities and took more medication. The low NSE group consisted mainly of women (85.7%). Conclusion: The results reveal that socioeconomic conditions may be a risk factor for more disabling chronic pain.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Chronic Pain/epidemiology , Chronic Pain/psychology , Pain Clinics , Adaptation, Psychological , Affect , Analysis of Variance , Chronic Pain/nursing , Disability Evaluation , Sex Distribution , Social Class , Socioeconomic Factors , Surveys and Questionnaires