Articles: acute-pain.
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Minerva anestesiologica · Nov 2021
Pain, the unknown: epistemological issues and related clinical implications.
Despite the huge development of pain management in the past decades, pain remains elusive and many patients still remain in the middle of the ford struggling between low drug efficacy and their overuse. A reason for pain elusiveness is its nature of subjective phenomenon, escaping the meshes of the objectivist, mechanist-reductionist net prevailing in medicine. Actually, pain is not only a symptom but an essential aspect of life, consciousness and contact with the world and its noetic and autonoetic components play a key role in the development of the concepts of pleasure-unpleasure and good-evil. ⋯ The outstanding effects of placebo and nocebo, behavioral and non-pharmacological techniques warrant the need for a shift from the traditional positivist idea of patient as passive carrier of disease to the patient as active player of recovery and move toward a patient's centered approach exploiting individual resources for recovery. Among the mentioned techniques, hypnosis has proved to increase pain threshold up to the level of surgical analgesia, improve acute and chronic pain as well as coping and resilience, helping to decrease both drug overuse and the costs of pharmacological therapy. The plethora of available data suggests the need for a holistic approach, aiming to take care of the individual as an inseparable mind-body unit in its interplay with the environment, where patient's inner world, his/her experience and cognition are taken into due account as powerful resources for recovery through a phenomenological-existential approach.
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A growing number of adolescents are being diagnosed with acute myocarditis following mRNA COVID-19 vaccinations. This case describes an adolescent who presented to the emergency department with chest pain and tachycardia following the Pfizer-BioNTech COVID-19 vaccination. Point-of-care ultrasound was performed prior to the return of laboratory studies and revealed depressed left ventricular systolic function. Point-of-care ultrasound may be a tool used to rapidly diagnose or risk stratify patients with potential post-COVID-19 vaccine myocarditis.
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Randomized Controlled Trial
A randomized controlled trial of ibuprofen versus ketorolac versus diclofenac for acute, nonradicular low back pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line medication for acute low back pain (LBP). It is unclear if the choice of NSAID impacts outcomes. We compared ibuprofen, ketorolac, and diclofenac for the treatment of acute, nonradicular LBP. ⋯ There were no important differences between groups with regard to the primary outcome. These data do not rule out that possibility that ketorolac results in better pain relief and less stomach irritation than ibuprofen.
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Reg Anesth Pain Med · Nov 2021
Waking Up in Pain: a prospective unselected cohort study of pain in 3702 patients immediately after surgery in the Danish Realm.
Acute and persistent pain after surgery is well described. However, no large-scale studies on immediate postoperative pain in the operating room (OR) exist, hindering potential areas of research to improve clinical outcomes. Thus, we aimed to describe the occurrence and severity of immediate postoperative pain in a large, unselected cohort. ⋯ Moderate or severe pain in the immediate postoperative phase occurred in 20% of all cases with procedure and anesthesiological technique variations, suggesting a need for identification of relevant procedure-specific risk factors and development of preventive treatments.