Articles: acute-pain.
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Many commissions and groups throughout the world have proposed clinical guidelines on the management of low back pain, spinal pain, and chronic pain. Practice guidelines are systematically developed statements to assist the practitioner and patient decisions about appropriate healthcare for specific clinical circumstances. The American Society of Interventional Pain Physicians developed practice guidelines for interventional techniques which are professional practice recommendations for practices for prevention, diagnosis and treatment of acute and chronic painful disorders, and in some cases, disability management. ⋯ The results consistently showed decrease in number of visits from 1999 to 2000 and 2001 with 5.5 +/- 0.18, 5.1 +/- 0.17, and 4.3 +/- 0.15 respectively. The average expenditure also decreased from per visit of $872 in 1999 to $891 in 2000, to $810 to 2001. further, the average expenditure per year also decreased as expected due to decrease in frequency of visits, as well as the average expenditure per visit from $4751 +/- $231 in 1999 to $4505 +/- $214 in 2000 and to $3514 +/- $193 in 2001 even without consideration of inflation. Thus, it is concluded that guidelines describing the interventional techniques in the management of chronic pain are effective in reducing the cost and frequency of visits with improvement or at least maintenance of similar outcomes, physician decision making abilities, and patient preferences.
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We report an unusual case of a 27-year-old male with an acute presentation of choriocarcinoma. The patient presented with unstable vital signs, severe anemia and a widened arterial pulse pressure following a several day history of testicular pain. ⋯ A literature review indicates that metastatic testicular choriocarcinoma is a rare but aggressive malignancy that often presents with acute symptoms and signs that cause patients to seek emergency care. We summarize the reported cases of "acute" testicular choriocarcinoma presentation and briefly discuss its relationship to widened arterial pulse pressure.
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Alpha(2) agonists have been in clinical use for decades, primarily in the treatment of hypertension. In recent years, alpha(2) agonists have found wider application, particularly in the fields of anesthesia and pain management. It has been noted that these agents can enhance analgesia provided by traditional analgesics, such as opiates, and may result in opiate-sparing effects. ⋯ The clinical utility of these agents is ever expanding, as they are gaining broader use in neuraxial analgesia, and new applications are continuously under investigation. The alpha(2) agonists that are currently employed in anesthesia and pain management include clonidine, tizanidine, and dexmedetomidine. Moxonidine and radolmidine, which are not currently in clinical use in humans, may offer favorable side-effect profiles when compared with traditional alpha(2) agonists, and may thereby allow for more widespread pain management applications.
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Different anatomical structures and pathophysiological functions can be responsible for lumbar pain, each producing a distinctive clinical profile. Pain can arise from the intervertebral disc, either acutely as a primary disc related disorder, or as result of the degradation associated with chronic internal disc disruption. In either case, greatest pain provocation will be associated with movements and functions in the sagittal plane. ⋯ Either of these conditions will produce the greatest pain provocation during three-dimensional movements, due to maximal stress to either the synovium or joint cartilage. Finally, patients can experience different symptoms associated with irritation to the dural sleeve, dorsal root ganglion, or chemically irritated lumbar nerve root. Differential diagnosis of these conditions requires a thorough examination and provides information that can assist the clinician in selecting appropriate management strategies.
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According to the fear avoidance model, prolonged disability among patients with chronic nonmalignant pain is due, in part, to an exaggerated fear of pain. At issue in the present study was an attempt to refine the fear-avoidance hypothesis by eliciting estimates of anticipated pain as well as anticipated injury. Along with scores on the Fear Avoidance Beliefs Questionnaire-Work (FABQ-W), a validated measure of fear avoidance, pain and injury expectancies were used as predictors of work disability in a hierarchical regression model. ⋯ After controlling for pain duration, depression, somatization, and current pain severity, pain expectancy alone accounted for 16% of the variance in patients in the chronic group (P < .001) and 33% of the variance in patients in the acute group (P < .001). Both pain and injury expectancies were associated equally with work disability for patients in the acute group (P < .001), but only pain expectancy accounted for variance in the chronic group (P < .001). Fear-avoidance beliefs, in the form of cognitive expectancies, may have as much influence on the duration of disability in patients with acute pain as they do in patients with chronic pain.