Articles: pain-clinics.
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Variability in labor pain has been associated with demographic, clinical, and psychological factors. Polymorphisms of the β2-adrenergic receptor gene (ADRB2) influence sensitivity to experimental pain in humans and are a risk factor for chronic pain. The authors hypothesized that polymorphisms in ADRB2 may influence labor pain. ⋯ ADRB2 genotype correlates with labor pain but explained less than 1% of the intersubject variance in the model.
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Reg Anesth Pain Med · Jul 2014
Comparative StudyAn Ex Vivo Comparison of Cooled-Radiofrequency and Bipolar-Radiofrequency Lesion Size and the Effect of Injected Fluids.
Radiofrequency (RF) neuroablation is a common therapy for alleviating chronic pain. Larger lesion volumes lead to higher chance of ablating small sensory nerves; therefore, bipolar-RF and cooled-RF are improved alternatives to conventional monopolar-RF. This work provides an ex vivo comparison of bipolar-RF to cooled-RF lesioning in the presence of bone structure using some conventional temperature and time programs and in conjunction with injection of a variety of clinically used substances. ⋯ Cooled-RF yields larger lesions than bipolar-RF under the conditions used in this study. The spherical shape of cooled-RF lesions provides larger volume coverage than lesions obtained with bipolar-RF at IED equals 5, 10, or 15 mm under similar electrode tip temperature and lesioning time.
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To investigate whether obesity is associated with musculoskeletal pain in children. ⋯ Obesity in children was associated with increased overall and lower limb musculoskeletal pain, for which body mass index was a stronger predictor than adiposity. Clinicians treating obese children should screen for pain and prescribe exercise programs that take their symptoms into account.
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Spontaneous pneumothorax is a well-recognized entity with a classical presentation of acute onset chest pain and shortness of breath. It may be complicated by the development of a tension pneumothorax or a haemopneumothorax. We report an interesting case of a spontaneous tension haemopneumothorax which presented atypically and was diagnosed on computed tomography (CT) scan of the chest. The clinical and pathophysiological characteristics and treatment of this unusual entity is discussed.
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Curr Opin Anaesthesiol · Jun 2014
ReviewThe perioperative management of patients maintained on medications used to manage opioid addiction.
The substantial increase in prescription and illicit opioid abuse observed over the last 2 decades has significantly increased the number of patients in recovery from addiction and now maintained on opioid replacement or agonist therapy. These patients present unique challenges to perioperative pain management. ⋯ When possible, patients maintained on buprenorphine should be evaluated preoperatively to assess the feasibility of discontinuing the buprenorphine 72 h before surgery. If buprenorphine is continued during the perioperative period, patients may require significantly increased doses of standard opioids for analgesia. Patients maintained on methadone are at increased risk for respiratory-related complications and should receive a higher level of monitoring during the perioperative period. Patients who are on chronic methadone should continue their maintenance dose during the perioperative period. Where possible, nonopioid medications and regional anesthetic blockade are effective alternatives for analgesia in this population.