Pain medicine : the official journal of the American Academy of Pain Medicine
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Comment
Overriding the Jehovah's Witness patient's refusal of blood: a reply to Cahana, Weibel, and Hurst.
This article is a response to a survey on moral reasoning among Swiss health professionals that appeared in a recent issue of this journal. The authors of that survey inquired whether or not their respondents would give a blood transfusion to a Jehovah's Witness patient who clearly refused it. ⋯ The present article examines the two ethical rationales that were offered to explain the overriding respondents' answers and argues that neither one is ethically acceptable. It concludes with an account of the phenomenon of "motivated reasoning" that, so it is argued, better explains why the overriders would refuse to honor the Jehovah's Witness patient's transfusion refusal.
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We performed a prevalence estimate of chronic pain with neuropathic pain (NeP) symptoms to determine its frequency and associations with morbidity. ⋯ Despite limitations of the DN4Q, symptoms of NeP may be more prevalent in the general population than expected and has a greater impact upon patients' lives than non-NeP. Limitations of the DN4Q may relate to the concept of a spectrum of NeP existent amongst heterogenous NeP and non-NeP syndromes.
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Case Reports
Loss of resistance technique for paravertebral nerve blockade using the Episure Autodetect Syringe--a case report.
Postoperative pain is a frequent occurrence following breast surgery. Some authors have reported the incidence of postoperative pain following mastectomy and breast reconstruction to be as high as 50% when general anesthesia and intravenous narcotics are the primary anesthetic. An alternative anesthetic technique for breast surgery and postoperative analgesia is paravertebral nerve blockade (PVB). Greengrass and Weltz have described improved patient satisfaction, less analgesic requirement, and less total anesthetic use in those patients with preoperative PVBs. One of the challenges in providing successful analgesia from PVBs is the ability to correctly identify the paravertebral space. Landmark-based anatomy with penetration of the superior costotransverse ligament 1 cm past the transverse process has been previously described. Boezaart has described the use of loss of resistance (LOR) when performing PVBs. One potential difficulty with this technique is the reliance on the subjective feel of resistance loss as the needle passes into the paravertebral space. ⋯ To our knowledge, this is the first described use of the ADS for performing PVB.
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Fibromyalgia (FM) is a form of nonarticular rheumatism characterized by chronic widespread musculoskeletal aching and tender points. The aim of the present study was to investigate the effect of arginase and nitric oxide synthase (NOS) enzyme activities in FM with respect to their importance in pathogenesis, and the relationship with FM-related clinical parameters. ⋯ Animal experiments have suggested that nitric oxide (NO) is an important transmitter in pain pathways. It can also stimulate cyclooxygenase activity. We observed increased NOS activity and reduced arginase activity in FM patients, which may be due to increased cyclooxygenase enzyme activity and oxidant/antioxidant imbalance. In conclusion, we think that future studies concerning clinical control of pain with selective NOS inhibitors are needed in order to determine new therapeutic approaches and the exact pathophysiologic mechanisms in FM patients.