Articles: pain-clinics.
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Reg Anesth Pain Med · Mar 2002
Editorial CommentAcute pain services revisited--good from far, far from good?
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The two main goals of chest pain units are the early, accurate diagnosis of acute coronary syndromes and the rapid, efficient recognition of low-risk patients who do not need hospital admission. Many clinical, practical, and economic reasons support the establishment of such units. Patients with chest pain account for a substantial proportion of emergency room turnover and their care is still far from optimal: 8% of patients sent home are later diagnosed of acute coronary syndrome and 60% of admissions for chest pain eventually prove to have been unnecessary. ⋯ Initial triage is based on the clinical characteristics, the ECG and biomarkers of myocardial infarct. Risk stratification in the second phase selects patients to be admitted to the chest pain unit for 6-12 h. Finally, we propose treadmill testing before discharge to rule out the presence of acute myocardial ischemia or damage in patients with negative biomarkers and non-diagnostic serial ECGs.
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This study was designed to evaluate the psychological status of 50 individuals without chronic pain and without psychotherapeutic drug therapy, Group I, the control group; and Group II, a chronic pain group with 100 chronic pain patients. All the participants were tested utilizing Millon Clinical Multiaxial Inventory III (MCMI-III). Results were analyzed and compared for various clinical personality patterns, including personality traits and personality disorders; severe personality pathology for schizotypal, borderline and paranoid personality pathology; and multiple clinical syndromes, including generalized anxiety disorder, somatization disorder, major depression, bipolar manic disorder and dysthymic disorder, etc. ⋯ The prevalence of psychological disorders in the control group was 24%, compared to 55% in chronic pain group. In conclusion, this evaluation showed that clinical personality patterns are present in both groups of patients. Psychological abnormalities such as generalized anxiety disorder, somatization disorder, and major depression are commonly seen in chronic pain patients.
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Comparative Study
An audit of activity and outcome from a daily and a weekly "one stop" rapid assessment chest pain clinic.
The recent National Service Framework for coronary heart disease advocates the establishment of rapid assessment clinics for chest pain. But how should these clinics be organised and do they fulfil their objectives? The aim of this study was to compare referral patterns to a daily and a weekly "one stop" rapid access chest pain clinic (RACPC), and to examine clinical outcome in patients attending these clinics. ⋯ (1) RACPCs do provide an effective tool for the early assessment of patients with possible angina. (2) The frequency with which clinics are scheduled may be an important factor in determining how the service is utilised in practice.
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Chronic low back pain secondary to involvement of the facet joints is a common problem. Facet joints have been recognized as potential sources of back pain since 1911. Multiple authors have described distributions of pain patterns of facet joint pain. ⋯ Multiple studies utilizing controlled diagnostic blocks have established the prevalence of lumbar facet joint involvement in patients with chronic low back pain, as ranging from 15% to 52%, based on type of population and setting studied. Long-term therapeutic benefit has been reported from three types of interventions in managing lumbar facet joint pain, including intraarticular injections, medial branch blocks and neurolysis of medial branches. This review will discuss chronic low back of facet joint origin and covers anatomy, pathophysiology, diagnosis, and various aspects related to treatment, including clinical effectiveness, cost effectiveness, technical aspects and complications.