Articles: pain-measurement.
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Anterior cruciate ligament tears are one of the most frequent soft tissue injuries of the knee. A torn anterior cruciate ligament leaves the knee joint unstable and at risk for further damage to other soft tissues manifested as pain, dislocation, and osteoarthritis. A better understanding of the anatomical details of knee joints suffering anterior cruciate ligament tears is needed to understand and develop prediction models for anterior cruciate ligament injury and/or tear. ⋯ Anterior cruciate ligament injury has been shown to be caused by the forces which act on the ligament. These forces can result from hyperextension of the tibia or the internal rotation of tibia. The anatomical parameters of the knee joint (i.e., notch width index, anterior cruciate ligament width and length) have no role in the cause of an injury.
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The relationships among chronic pain, anxiety, and school functioning are complex, and school functioning is often negatively impacted in youth with chronic pain. The objective of this study was to empirically test a model of associations between constructs predicting school functioning in youth with chronic pain to examine the direct effect of anxiety on school attendance and other indicators of school-related disability. ⋯ Anxiety was a robust predictor of school functioning across a range of domains. Evaluating anxiety symptoms in pediatric chronic pain will likely facilitate case conceptualization and treatment planning. This study supports a shift in focus from pain to anxiety as the driving force of school impairment in youth with chronic pain.
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Self-report, the most widely used, gold standard measurement of pain, is crucial for pain research, diagnosis, and management. However, there are no accurate, reliable methods for detecting dishonesty in self-reports when there is incentive for pain deception. We introduce a novel approach to detecting pain deception by analyzing performance patterns of honest and dishonest psychophysical pain testing. Warmth sensation threshold (WST) and heat pain threshold (HPT) were measured in healthy individuals (N = 37) under 2 conditions: standard instruction (ie, provide sincere reports) and instructions to simulate intense pain (i.e., provide feigned reports) with the intention of deceiving. In the feigned compared with sincere condition, participants had significantly increased WST and decreased HPT. Repeatability and variability indices were indistinguishable between conditions. In a second, separate cohort (N = 24), measurements were repeated with the addition of a sensory interference to influence task performance. When sensory interference during HPT measurement was introduced, feigned pain reports had significantly higher variability and poorer repeatability compared with sincere reports and were distinguishable from sincere reports, with high sensitivity (83%) and specificity (84%). The statistical properties of psychophysical performance under sensory interference provide a method for identifying feigned performance and could be applied to evaluations of pain malingering. ⋯ This article introduces a method to detect whether individuals are being dishonest in psychophysical pain testing. The method could help clinicians to detect chronic pain malingering in contexts in which there is incentive to deceive.
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This case report deals with the unsatisfying pain management of a 44 year old patient with cardiac arrest and subsequent cardiopulmonary resuscitation. The patient has (1) a reduced consciousness, (2) is isolated due to an infection with multi-resistant germs, (3) has a tracheotomy and (4) contractures of the muscles in fingers and hands. During nursing care he shows facial expressions and body postures that indicate pain which is insufficiently addressed. ⋯ The present case report shows that pain can only be treated successfully if pain-triggering factors are recognized, systematically assessed and treated. An adequate external assessment of the pain situation is especially important when dealing with patients who suffer from disorders of consciousness. In complex cases, in which multiple factors influence the pain situation, interdisciplinary case conferences may help to improve the quality of pain management.
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Letter Case Reports
Aminophylline Injection Alleviates Pain in Postdural Puncture Headache.