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1.
Front Psychol ; 10: 2153, 2019.
Article in English | MEDLINE | ID: mdl-31616348

ABSTRACT

Fifty-seven level I trauma center nurses/physicians participated in a 4-day intervention to learn relaxed alertness using mindfulness-based instructions and EEG neurofeedback. Neurofeedback was provided by a Bispectral IndexTM (BIS) system that continuously displays a BIS value (0-100) on the monitor screen. Reductions in the BIS value indicate that power in a high-frequency band (30-47 Hz) is decreased and power in an intermediate band (11-20 Hz) is increased. A wellbeing tool with four positive affect and seven negative affect items based on a 5-category Likert scale was used. The wellbeing score is the sum of the positive affect items (positive affect score) and the reverse-scored negative affect items (non-stress score). Of functional concern were four negative affect items rated as moderately, quite a bit, or extremely in a large percent. Of greater concern were all four positive affect items rated as very slightly or none at all, a little, or moderately in over half of the participants. Mean and nadir BIS values were markedly decreased during neurofeedback when compared to baseline values. Post-session relaxation scores were higher than pre-session relaxation scores. Post-session relaxation scores had an inverse relationship with mean and nadir BIS values. Mean and nadir BIS values were inversely associated with NFB cognitive states (i.e., widening the visual field, decreasing effort, attention to space, and relaxed alertness). For all participants, the wellbeing score was higher on day 4 than on day 1. Participants had a higher wellbeing score on day 4 than a larger group of nurses/physicians who did not participate in the BIS neurofeedback trial. Eighty percent of participants demonstrated an improvement in the positive affect or non-stress score on day 4, when compared to day 1; the wellbeing, non-stress, and positive affect scores were substantially higher on day 4 than on day 1. Additionally, for that 80% of participants, the improvements in wellbeing and non-stress were associated with reductions in day 3 BIS values. These findings indicate that trauma center nurses/physicians participating in an EEG neurofeedback trial with mindfulness instructions had improvements in wellbeing. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03152331. Registered May 15, 2017.

2.
Am J Emerg Med ; 33(5): 663-6, 2015 May.
Article in English | MEDLINE | ID: mdl-25744149

ABSTRACT

BACKGROUND: Electronic medical records (EMRs) implementation in hospitals and emergency departments (EDs) is becoming increasingly more common. The purpose of this study was to determine the impact of an EMR system on patient-related factors that correlate to ED workflow efficiency. METHODS: A retrospective chart review assessed monthly census reports of all patients who registered and were treated to disposition during conversion from paper charts to an EMR system. The primary outcome measurement was an analysis of the time of registration to discharge or total ED length of stay as well as rate of those who left without being seen, eloped, or left against medical advice. These data were recorded from 3 periods, for 18 months: before installation of the EMR system (pre-EMR), during acclimation to the EMR, and post acclimation (post-EMR). RESULTS: A total of 61626 individual patient records were collected and analyzed. The total ED length of stay across all patient subtypes was not significantly affected by the installation of the hospital-wide EMR system (P = .481); however, a significant decrease was found for patients who were admitted to the hospital from the ED (P < .00001). The percentage of patients who left without being seen between the pre-EMR and post-EMR periods was 1.8% and 2.7%, respectively, representing a significant increase (P < .0001). The number of patients who left against medical advice did not change across the periods of the present investigation (P > .25). CONCLUSIONS: Installation of a hospital-wide EMR system had minimal impact on workflow efficiency parameters in an ED.


Subject(s)
Efficiency, Organizational , Electronic Health Records , Emergency Service, Hospital/organization & administration , Length of Stay/statistics & numerical data , Adult , Female , Humans , Male , Middle Aged , Retrospective Studies , Trauma Centers
3.
Eur J Pain ; 14(8): 792-8, 2010 Sep.
Article in English | MEDLINE | ID: mdl-20060762

ABSTRACT

Soy consumption is said to prevent or treat atherosclerosis, cancer, pain, and memory deficits, but experimental and clinical evidence to support these claims are lacking. We used in vivo models of inflammation to determine whether a soy diet reduces primary or secondary hyperalgesia. In all three experiments, rats were fed either a soy- or casein-based diet for at least 2 weeks before induction of inflammation and for the duration of experiments. Mechanical and heat paw withdrawal thresholds and edema were measured before and several times after induction of inflammation. Primary hyperalgesia was assessed in two models: unilateral intraplantar injection with 0.1 ml of 25% complete Freund's adjuvant (CFA) or 0.1 ml of 1% carrageenan. Unilateral injection of the intra-articular knee space with 25% CFA (0.1 ml) was used to determine the effects of soy in a model of secondary hyperalgesia. Following intraplantar injection of CFA, soy-fed animals exhibited significantly less paw edema, mechanical allodynia, and heat hyperalgesia compared to casein-fed animals. In the carrageenan model of paw inflammation, soy-fed animals were also less allodynic to mechanical stimuli, than were casein-fed animals, but showed no diet based differences in paw edema or heat hyperalgesia. Soy diet did not affect any of the outcome measures after the intra-articular injection of CFA. Our results suggest that a soy diet significantly decreases aspects of inflammation-induced primary, but not secondary, hyperalgesia in rats.


Subject(s)
Diet , Hyperalgesia/physiopathology , Inflammation/physiopathology , Soy Foods , Analysis of Variance , Animals , Freund's Adjuvant/pharmacology , Hyperalgesia/chemically induced , Inflammation/chemically induced , Male , Pain Measurement , Physical Stimulation , Rats , Rats, Sprague-Dawley , Statistics, Nonparametric
4.
Behav Brain Res ; 197(1): 230-3, 2009 Jan 30.
Article in English | MEDLINE | ID: mdl-18773924

ABSTRACT

Previous reports have demonstrated that pain is influenced by environmental factors. This investigation examined the effects of housing supplementation, via the inclusion of objects to the home cage environment, on inflammation-induced nociceptive behaviors. The degree of thermal hyperalgesia was significantly lower in rats housed in a supplemented home cage environment, as compared to rats housed in basic cages. These data indicate that environmental enrichment significantly affects nociceptive responses.


Subject(s)
Environment , Housing, Animal , Pain Threshold/psychology , Analysis of Variance , Animals , Exploratory Behavior/physiology , Inflammation/physiopathology , Male , Pain Threshold/physiology , Physical Stimulation , Random Allocation , Rats , Rats, Long-Evans , Single-Blind Method , Statistics, Nonparametric
5.
J Pain ; 8(12): 931-7, 2007 Dec.
Article in English | MEDLINE | ID: mdl-17693138

ABSTRACT

UNLABELLED: In certain patients with neuropathic pain, the pain is dependent on activity in the sympathetic nervous system. To investigate whether the spared nerve injury model (SNI) produced by injury to the tibial and common peroneal nerves and leaving the sural nerve intact is a model for sympathetically maintained pain, we measured the effects of surgical sympathectomy on the resulting mechanical allodynia, mechanical hyperalgesia, and cold allodynia. Decreases of paw withdrawal thresholds to von Frey filament stimuli and increases in duration of paw withdrawal to pinprick or acetone stimuli were observed in the ipsilateral paw after SNI, compared with their pre-SNI baselines. Compared with sham surgery, surgical lumbar sympathectomy had no effect on the mechanical allodynia and mechanical hyperalgesia induced by SNI. However, the sympathectomy significantly attenuated the cold allodynia induced by SNI. These results suggest that the allodynia and hyperalgesia to mechanical stimuli in the SNI model is not sympathetically maintained. However, the sympathetic nervous system may be involved, in part, in the mechanisms of cold allodynia in the SNI model. PERSPECTIVE: The results of our study suggest that the SNI model is not an appropriate model of sympathetically maintained mechanical allodynia and hyperalgesia but may be useful to study the mechanisms of cold allodynia associated with sympathetically maintained pain states.


Subject(s)
Cold Temperature/adverse effects , Hyperalgesia/surgery , Pain/surgery , Sciatic Neuropathy/surgery , Sympathectomy/methods , Animals , Blood Vessels/pathology , Disease Models, Animal , Glyoxylates , Hyperalgesia/etiology , Male , Nerve Fibers/pathology , Pain/etiology , Rats , Rats, Sprague-Dawley , Sciatic Neuropathy/complications , Sciatic Neuropathy/pathology , Time Factors
6.
Behav Brain Res ; 153(1): 181-8, 2004 Aug 12.
Article in English | MEDLINE | ID: mdl-15219719

ABSTRACT

The use of complementary and alternative medicine (CAM) has increased in the United States and more patients are seeking CAM therapies for control of pain. The present investigation tested the efficacy of orally administered anthocyanins extracted from tart cherries on inflammation-induced pain behavior in rats. Paw withdrawal latency to radiant heat and paw withdrawal threshold to von Frey probes were measured. The first set of experiments examined the effects of tart cherry anthocyanins (400 mg/kg) on the nociceptive behaviors and edema associated with inflammation induced by intraplantar injection of 1% carrageenan. These studies also included tests of motor coordination. The second set of experiments determined if tart cherry anthocyanins (15, 85, and 400 mg/kg) dose-dependently affected the inflammation induced by intraplantar injection of 25% complete Freund's adjuvant. We found that tart cherry extracts reduce inflammation-induced thermal hyperalgesia, mechanical hyperalgesia and paw edema. The suppression of thermal hyperalgesia was dose-dependent and the efficacy of highest dose (400 mg/kg) was similar to indomethacin (5 mg/kg). The highest dose anthocyanin (400 mg/kg) had no effects on motor function. These data suggest that tart cherry anthocyanins may have a beneficial role in the treatment of inflammatory pain. The antihyperalgesic effects may be related to the anti-inflammatory and antioxidant properties of anthocyanins. A better understanding of the modulatory role of dietary constituents and phytonutrients on pain will offer further therapeutic options for treating patients with persistent and chronic pain conditions.


Subject(s)
Anthocyanins/administration & dosage , Pain Measurement/drug effects , Pain/drug therapy , Prunus/chemistry , Administration, Oral , Analysis of Variance , Animals , Anthocyanins/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Behavior, Animal/drug effects , Carrageenan , Disease Models, Animal , Dose-Response Relationship, Drug , Edema/drug therapy , Edema/etiology , Indomethacin/administration & dosage , Inflammation/chemically induced , Inflammation/complications , Male , Motor Activity/drug effects , Pain/etiology , Pain Threshold/drug effects , Rats , Rats, Sprague-Dawley , Time Factors
7.
Anesthesiology ; 100(4): 905-11, 2004 Apr.
Article in English | MEDLINE | ID: mdl-15087626

ABSTRACT

BACKGROUND: The efficacy of opioids for neuropathic pain remains controversial. The effects of morphine on pain behavior were investigated in two animal models of neuropathic pain: the spared nerve injury (SNI) model and the spinal nerve ligation (SNL) model. METHODS: Nerve injuries were created in rats either by tight ligation and section of the left tibial and common peroneal nerves (SNI) or by unilateral ligation of L5 and L6 spinal nerves (SNL). Paw withdrawal threshold to mechanical stimuli was measured using the up-down method in the hairy and glabrous skin territories of the sural nerve for SNI rats or in the mid-plantar paw of SNL rats. RESULTS: Before SNI, the median paw withdrawal thresholds in hairy and glabrous skin were similar (26 g [25%, 75% quartiles: 26, 26 g]). The paw withdrawal threshold decreased after SNI in both hairy and glabrous skin (P < 0.001). Thirty days after the SNI, the threshold in hairy skin (0.3 g) was significantly lower than in glabrous skin (1.9 g; P < 0.001). In blinded experiments, both subcutaneous and intrathecal morphine (0.1-10 microg) dose-dependently attenuated mechanical allodynia induced by SNI measured in the hairy skin, an effect that was naloxone reversible. The ED50 for the intrathecal morphine was 0.52 microg (95% confidence interval, 0.31-0.90 microg). Morphine (1 microg intrathecal) attenuated SNI-induced mechanical allodynia in glabrous skin with potency similar to that in hairy skin. In SNL rats, morphine (30 microg intrathecal) almost completely reversed the SNL-induced mechanical allodynia. CONCLUSIONS: (1) SNI-induced mechanical allodynia is characterized by a lower paw withdrawal threshold in hairy versus glabrous skin; (2) systemic and intrathecal morphine reverse SNI-induced mechanical allodynia in a dose-dependent fashion; and (3) intrathecal morphine also reverses SNL-induced mechanical allodynia. These results suggest that intrathecal opioids are likely to be effective in the treatment of neuropathic pain.


Subject(s)
Morphine/administration & dosage , Pain/drug therapy , Animals , Disease Models, Animal , Dose-Response Relationship, Drug , Injections, Spinal , Male , Rats , Rats, Sprague-Dawley , Spinal Nerves/injuries
8.
J Pain ; 5(2): 104-10, 2004 Mar.
Article in English | MEDLINE | ID: mdl-15042518

ABSTRACT

UNLABELLED: Bone is a common metastatic site for prostate and breast cancer, and bone cancer is usually associated with severe pain. Traditional treatments for cancer pain can sometimes be ineffective or associated with side effects. Thus an increasing number of patients seek alternative therapies. In this study we investigated the analgesic effects of a soy diet on 3 experimental models of bone cancer pain. Mice were fed a diet in which the protein source was either soy or casein. After 1 week on the diet, sarcoma cells (NCTC 2472) were injected into the medullary cavity of the humeri, femur, or calcaneus. Experimenters blinded to diet of the animal assessed the pain behavior in these animals, forelimb grip force in the humerus model and paw withdrawal frequency to mechanical stimuli in the calcaneus and femur models. The effect of morphine on cancer-induced pain behavior was investigated in calcaneus and femur models. In addition, in the femur model, the effects of soy on tumor size and bone destruction were studied. The soy diet reduced secondary mechanical hyperalgesia in the femur model but had no effect on primary mechanical hyperalgesia in the calcaneus model or on movement-related hyperalgesia in the humerus model. No dietary impact was discerned in measurements of tumor size, bone destruction, and body weight in the femur model, suggesting that the soy diet had no effect on cancer growth. Morphine dose-dependently reduced hyperalgesia with no diet-based difference. These results suggest that a soy diet might provide analgesia in certain forms of hyperalgesia associated with bone cancer. PERSPECTIVE: The study raises the possibility of dietary supplements influencing aspects of cancer pain. Further research will help determine if use of nutritional supplements, such as soy proteins, can reduce opioid analgesic use in chronic pain states and help minimize the side effects associated with long term use of opioids.


Subject(s)
Analgesics/pharmacology , Bone Neoplasms/complications , Pain/diet therapy , Sarcoma/complications , Soybean Proteins/pharmacology , Analgesics, Opioid/pharmacology , Animal Feed , Animals , Body Weight , Bone Neoplasms/pathology , Calcaneus/pathology , Caseins/pharmacology , Chronic Disease , Disease Models, Animal , Femur/pathology , Humerus/pathology , Hyperalgesia/drug therapy , Hyperalgesia/etiology , Male , Mice , Mice, Inbred C3H , Morphine/pharmacology , Motor Activity , Pain/drug therapy , Pain/etiology , Sarcoma/pathology
9.
Neurosci Lett ; 354(3): 239-41, 2004 Jan 16.
Article in English | MEDLINE | ID: mdl-14700740

ABSTRACT

The effects of gender and gonadal hormones on nociceptive responses to intraplantar carrageenan in the rat were investigated. A plantar analgesic meter was used to measure carrageenan-induced changes in paw withdrawal latency (PWL) values, and von Frey monofilaments were used to assess changes in paw withdrawal threshold (PWT) values in response to tactile-evoked (mechanical) stimuli. The data revealed that PWL values were significantly greater in gonadally-intact females than in gonadally-intact males, and this response was abolished by surgical gonadectomies. Gonadally-intact as well as gonadectomized male and female rats also exhibited significant carrageenan-induced decreases in PWT, but neither sex- nor gonadectomy-related differences were detected in the development of mechanical allodynia. These findings demonstrate that intraplantar carrageenan induces nociceptive behaviors in rats that are differentially affected by sex and gonadal hormones.


Subject(s)
Estrous Cycle/physiology , Gonadal Steroid Hormones/physiology , Pain/physiopathology , Sex Characteristics , Animals , Behavior, Animal , Carrageenan , Castration/methods , Female , Male , Pain/chemically induced , Pain Measurement/methods , Pain Threshold , Physical Stimulation , Rats , Rats, Inbred F344 , Reaction Time
10.
Clin J Pain ; 20(1): 19-26, 2004.
Article in English | MEDLINE | ID: mdl-14668652

ABSTRACT

The use of complementary and alternative medicine has dramatically increased in the United States. The effects of select dietary constituents in animal models and clinical pain states are reviewed. Specifically, the antinociceptive and analgesic properties of soybeans, sucrose, and tart cherries are discussed. The potential actions of dietary constituents as antiinflammatory and antioxidant agents are presented.


Subject(s)
Anti-Inflammatory Agents/therapeutic use , Antioxidants/therapeutic use , Dietary Sucrose/therapeutic use , Dietary Supplements , Glycine max/chemistry , Pain/diet therapy , Plant Extracts/therapeutic use , Prunus/chemistry , Animals , Anti-Inflammatory Agents/chemistry , Antioxidants/chemistry , Fruit/chemistry , Humans , Isoflavones/chemistry , Isoflavones/therapeutic use , Pain Management , Soybean Oil/chemistry , Soybean Oil/therapeutic use , Soybean Proteins/chemistry , Soybean Proteins/therapeutic use
11.
Exp Neurol ; 184(2): 839-45, 2003 Dec.
Article in English | MEDLINE | ID: mdl-14769376

ABSTRACT

Intraplantar formalin injection is widely used as an experimental model of tonic pain. We investigated the role of endogenous micro-opioid receptor mechanisms in formalin-induced nocifensive behavior in mice. The flinching response induced by formalin (2%, 20 microl) was studied in mice with normal (wild type, n = 8) and absent (homozygous micro-opioid receptor knockout, n = 8) micro-opioid receptor levels. The flinch responses were counted every 5 min for 60 min post-formalin injection. Lumbar spinal cord (L4, 5) was harvested 2 h post-formalin injection to examine c-Fos expression using immunohistochemistry. The effects of naloxone (5 mg/kg, sc) administered 30 min before the intraplantar formalin injection on the flinching response of wild-type mice (n = 7) were also recorded. The second-phase formalin response (10-60 min after formalin) was higher in homozygous micro-opioid receptor knockout mice compared to the wild-type mice (P < 0.01). Naloxone administration in wild-type mice before formalin injection resulted in pain behavior similar to that observed in homozygous micro-opioid receptor knockout mice (P > 0.05). The c-Fos expression induced by formalin injection in the knockout mice was not different from that observed in wild-type mice. Our results suggest that the endogenous micro-opioid system is activated by intraplantar formalin injection and exerts a tonic inhibitory effect on the pain behavior. These results suggest an important modulatory role of endogenous micro-opioid receptor mechanisms in tonic pain states.


Subject(s)
Pain/physiopathology , Receptors, Opioid, mu/physiology , Spinal Cord/metabolism , Animals , Behavior, Animal/physiology , Formaldehyde/pharmacology , Immunohistochemistry , Male , Mice , Mice, Knockout , Naloxone/pharmacology , Narcotic Antagonists/pharmacology , Pain/chemically induced , Pain/drug therapy , Pain Measurement , Proto-Oncogene Proteins c-fos/biosynthesis
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