European journal of pain : EJP
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Comparative Study
Adherence of Irish general practitioners to European guidelines for acute low back pain: a prospective pilot study.
There are no national low back pain (LBP) clinical guidelines in Ireland, and neither the level of adherence of General Practitioners (GPs) to the European guidelines, nor the cost of LBP to the patient and the state, have been investigated. A prospective pilot study was conducted on 54 consenting patients (18M, 36F: mean age (SD): 40.5 (14.3) years) with a new episode of acute LBP (<3 months) attending one of nine participating GPs. Baseline demographic, LBP classification [i.e. simple back ache (SBA), nerve root pain (NRP), serious spinal pathology (SSP)] and primary care management data were recorded over a three month period. ⋯ The average total cost (direct and wage replacement) for a single episode of LBP over 12 weeks was 20,531 Euros (20,300-20,762). Direct costs accounted for 43% [8874.36 Euros, (8643.37-9105.37 Euros)] and wage replacement costs 57% (11,657 Euros). In conclusion, management of acute LBP in a cohort of GPs in Ireland was not consistent with European clinical guideline recommendations, and warrants higher levels of postgraduate education among GPs, as well as restructuring of primary care services, which should improve patient outcome and reduce costs.
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At the University of Helsinki, pain-related topics are taught throughout medical studies but without a formal pain curriculum. The purpose of this study was to assess medical students' attitudes towards pain. A questionnaire using a 6-point Likert scale was constructed to measure pain-related attitudes and beliefs described in previous studies. ⋯ The general attitudes of students mature as hoped for during medical studies. Attitudes towards treating the pain of cancer patients and elderly patients are positive. Attention should be paid to helping students to cope with their emotions and to reducing their anxiety about meeting patients with chronic pain.
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Randomized Controlled Trial
Intravenous ketoprofen as an adjunct to patient-controlled analgesia morphine in adolescents with thoracic surgery: a placebo controlled double-blinded study.
Surgery to correct pectus deformities entail substantial destruction of the thoracic skeleton and thus may cause significant postoperative pain. ⋯ Intravenous ketoprofen in adjunct to PCA morphine provided a significant opioid sparing effect and improved analgesia in children having chest wall correction surgery.
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Anterior knee pain, diagnosed as Patellofemoral Pain Syndrome (PFPS), is one of the most common musculoskeletal problems found in adolescents and young adults. There is no consensus in medical literature concerning the aetiology of the PFPS. ⋯ This study demonstrated an abnormal sensory function in the painful and non-painful knee in some individuals with long lasting unilateral Patellofemoral Pain Syndrome using Quantitative Sensory Testing supported by clinical neurological examinations. A dysfunction of the peripheral and/or the central nervous system may cause neuropathic pain in some subjects with PFPS.
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Alleviating chronic pain is a global healthcare priority. Understanding the medical profile and current treatment patterns in patients with painful neuropathic disorders (PNDs) is crucial to the development of effective pain management strategies. Thus, our objective was to describe the demographic and clinical characteristics of persons with PNDs and their use of pain medications. ⋯ Use of medications with clinically demonstrated efficacy in PNDs was higher among patients with Pure PNDs (tricyclic antidepressants [Pure, 16.6%; Mixed, 10.1%]; 2nd generation antidepressants [Pure, 11.0%; Mixed, 9.7%]; and antiepileptics [Pure, 12.2%; Mixed, 2.6%]), whereas use of NSAIDs (Pure, 43.1%; Mixed, 65.2%) and opioids (Pure, 8.5%; Mixed, 14.3%) was higher among patients with Mixed PNDs. Average daily doses of select neuropathic pain-related medications among PND patients (Pure and Mixed) were lower than those recommended for neuropathic pain. Among both Pure and Mixed PND patients, use and doses of evidenced-based neuropathic pain-related medications was low, and lower than the use of NSAIDs (a medication class with no proven efficacy for PNDs) in each group, suggesting possible sub-optimal neuropathic pain management among these patients.