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Interdisciplinary pain

Vickie R Driver, Lisa J Gould, Peggy Dotson, Latricia L Allen, Marissa J Carter, Laura L Bolton
Patients with wounds bear significant clinical, personal, and economic burdens yet complete wound healing is the only United States Food and Drug Administration (FDA) recognized primary clinical trial endpoint. The overall goal of this project is to work with FDA to expand the list of acceptable primary endpoints, recognizing that new and innovative treatments, devices and drugs may not have complete healing as the focus. Part 1 of the project surveyed 628 wound care experts who identified and content-validated 15 endpoints most relevant to clinical practice and benefitting patients' lives as primary outcomes in clinical trials...
October 13, 2018: Wound Repair and Regeneration
N Zoremba, M Coburn, G Schälte
Delirium is the most common form of cerebral dysfunction in intensive care patients and is a medical emergency that must be avoided or promptly diagnosed and treated. According to current knowledge the development of delirium seems to be caused by an interplay between increased vulnerability (predisposition) and simultaneous exposure to delirogenic factors. Since delirium is often overlooked in the clinical routine, a continuous screening for delirium should be performed. Due to the close connection between delirium, agitation and pain, sedation and analgesia must be evaluated at least every 8 h analogous to delirium screening...
October 8, 2018: Der Anaesthesist
Tonya M Palermo, Margaret Slack, Chuan Zhou, Rachel Aaron, Emma Fisher, Sade Rodriguez
Chronic pain during childhood is prevalent and costly but access to interdisciplinary pain care is limited. Studies investigating adults waiting for pain clinic evaluation found that symptoms and quality of life deteriorate over the waiting period, but little is known about the experience of adolescents. Therefore, we aimed to determine waitlist times and longitudinal trends of pain, physical, mental and social health over a 12-week period. Ninety-seven adolescents, ages 10-18 years (M age= 14.7 years; 82% female) waiting for evaluation at an interdisciplinary pediatric pain clinic completed assessments at enrollment, four, eight, and 12-week follow-up...
October 3, 2018: Journal of Pain: Official Journal of the American Pain Society
Martin Schwarze, Dierk F Hollo, Marcus Schiltenwolf
Interdisciplinary multimodal pain therapy is the gold standard in the treatment of chronic pain. Due to an overall increase in case numbers, the number of MDK examinations leading to the assessment of primary incorrect occupancy is also increasing. This results in a multitude of social court disputes in which medical assessments are required. With knowledge of the legal norms and relevant guidelines or other recommendations, the expert can take this topic step by step. The starting point here is the evaluation of the patient file, followed by the examination of the medical indication, the implementation of the therapy and, finally, the answers to the questions of proof...
October 5, 2018: Zeitschrift Für Orthopädie und Unfallchirurgie
Cate Sinclair, Pamela Meredith, Jenny Strong, George A Chalkiadis
OBJECTIVES: Sensory modulation patterns contribute to altered pain perception and disengagement in activities; atypical sensory modulation patterns have been associated with higher pain sensitivity, catastrophizing, and reduced function. Objectives of this study were to ascertain whether: adolescents with persistent pain had atypical sensory modulation patterns, atypical sensory modulation was associated with reduced functioning and higher pain, and pain catastrophizing mediated the relationship between sensory modulation and functional disability...
October 3, 2018: Clinical Journal of Pain
Veit Phillip, Rickmer Braren, Nikolaus Lukas, Roland M Schmid, Fabian Geisler
The formation of pancreatic pseudocysts and (pseudo-)aneurysms of intestinal vessels are rare but life-threatening complications in acute and chronic pancreatitis. Here we report the rare case of a patient suffering from chronic pancreatitis with an arterial pseudoaneurysm within a pancreatic pseudocyst and present its successful therapeutic management by angioembolization to prevent critical bleeding. A 67-year-old male with a history of chronic pancreatitis presented with severe acute abdominal pain and vomiting to the emergency department...
May 2018: Case Reports in Gastroenterology
Steven W Brose, Heather Schneck, Dennis J Bourbeau
BACKGROUND: The increasing use of prescription opioids has contributed to the epidemic of opioid abuse in the United States. Efforts to reduce opioid prescriptions and offer alternatives for pain management are needed. OBJECTIVE: To determine the success of a multidisciplinary project to manage chronic pain while reducing reliance on opioids in a population of patients with spinal cord injury. DESIGN: Retrospective analysis. SETTING: This study was conducted in an SCI system of care in northeast Ohio...
September 25, 2018: PM & R: the Journal of Injury, Function, and Rehabilitation
T Zippelius, W Weschenfelder, S O Eicker, M Putzier, E Röhner, G Matziolis, P Strube
PURPOSE OF THE STUDY Back pain and pathologies of the spine are among the main reasons why people consult a doctor, both general practitioners and paediatricians, as well as, specifically, orthopaedists, surgeons, and neurosurgeons. This involvement of different faculties calls for a high degree of interdisciplinary co-operation. In order to mediate these aspects of spine-specific diagnostics, therapy, and research to students during their studies and to promote up-and-coming specialists, the compulsory elective subject 'Spine' was established...
2018: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Sara Rubin, Nancy Burke, Meredith Van Natta, Irene Yen, Janet K Shim
The subjective nature of pain has always rendered it a point of entry for power and corresponding stratifying processes within biomedicine. The opioid crisis has further exacerbated these challenges by increasing the stakes of prescribing decisions for providers, which in turn has resulted in greater treatment disparities. Using the theoretical frame of cultural health capital (CHC) to account for these disparities in pain management as they unfold at both the macro- and the microlevel, we present findings from an interdisciplinary study of two complex care management programs in urban safety-net hospitals that serve high-utilizing patients...
September 19, 2018: Journal of Health and Social Behavior
Marjoleine J C Pieper, Wilco P Achterberg, Jenny T van der Steen, Anneke L Francke
Background: A stepwise, multidisciplinary and multicomponent intervention (called STA OP!) was implemented in Dutch nursing home units, which included a comprehensive multidisciplinary team training. A cluster-randomised controlled trial showed that the intervention reduced symptoms of pain and challenging behaviour. Objectives: To describe the experiences around the implementation of the intervention; to examine the extent to which the STA OP! intervention was delivered and implemented as intended (at the level of the team, and the individual resident/professional); and to understand factors influencing the implementation process...
September 7, 2018: International Journal of Integrated Care
Richard Masoetsa, Ala AʼGroof, Madan Kapoor, Grace Messenger, Imtiaz Hussain
BACKGROUND: Calciphylaxis is a potentially life-threatening condition involving painful necrotic skin ulcerations, especially of the lower extremities. It is generally associated with chronic kidney failure but may be seen in nonuremic cases. CASE REPORT: We report a case of calciphylaxis in a 60-year-old man with diabetes on dialysis for end-stage renal disease and known to have other typical combination of risk factors associated with calciphylaxis syndrome. On examination, he presented with multiple intensely painful calciphylaxis wounds on his legs and ankles...
September 13, 2018: Journal of Wound, Ostomy, and Continence Nursing
Mayandi Sivaguru, Jessica J Saw, James C Williams, John C Lieske, Amy E Krambeck, Michael F Romero, Nicholas Chia, Andrew L Schwaderer, Reinaldo E Alcalde, William J Bruce, Derek E Wildman, Glenn A Fried, Charles J Werth, Richard J Reeder, Peter M Yau, Robert A Sanford, Bruce W Fouke
More than 10% of the global human population is now afflicted with kidney stones, which are commonly associated with other significant health problems including diabetes, hypertension and obesity. Nearly 70% of these stones are primarily composed of calcium oxalate, a mineral previously assumed to be effectively insoluble within the kidney. This has limited currently available treatment options to painful passage and/or invasive surgical procedures. We analyze kidney stone thin sections with a combination of optical techniques, which include bright field, polarization, confocal and super-resolution nanometer-scale auto-fluorescence microscopy...
September 13, 2018: Scientific Reports
Imke Galazky, Christina Caspari, Hans-Jochen Heinze, Joerg Franke
PURPOSE: This observational study was aimed at quantification of low back pain (LBP) in Parkinsonian patients and its morphological correlation. BACKGROUND: Parkinson's disease (PD) is a common disabling condition in the elderly population. Parkinsonian patients frequently are troubled by LBP. Causes for LBP in PD are muscular imbalances by the movement disorder itself and skeletal degeneration. METHODS: Ninety-seven PD patients and 97 controls were inquired about low back pain through the Oswestry Low Back Pain Disability Questionnaire and visual analogue scales...
September 8, 2018: European Spine Journal
Machelle Wilchesky, Gerhard Mueller, Michèle Morin, Martine Marcotte, Philippe Voyer, Michèle Aubin, Pierre-Hugues Carmichael, Nathalie Champoux, Johanne Monette, Anik Giguère, Pierre Durand, René Verreault, Marcel Arcand, Edeltraut Kröger
BACKGROUND: Medication regimens in nursing home (NH) residents with severe dementia should be frequently reviewed to avoid inappropriate medication, overtreatment and adverse drug events, within a comfort care approach. This study aimed at testing the feasibility of an interdisciplinary knowledge exchange (KE) intervention using a medication review guidance tool categorizing medications as either "generally", "sometimes" or "exceptionally" appropriate for NH residents with severe dementia...
September 4, 2018: BMC Geriatrics
Helen R Gilpin, Daniel R Stahl, Lance M McCracken
BACKGROUND: Psychological treatments are known to be effective for chronic pain, but little is understood about which patients are most likely to benefit from which ones. METHODS: The study reported here included 609 people who attended a residential, interdisciplinary, pain management programme based on Acceptance and Commitment Therapy between January 2012 and August 2014. A flexible and theoretically guided approach to model building based on fractional polynomials was used to identify potential predictors of outcome in domains of emotional, physical, and social functioning, and pain intensity...
September 3, 2018: European Journal of Pain: EJP
Odette Fründt, Tina Mainka, Beate Schönwald, Bianca Müller, Polina Dicusar, Christian Gerloff, Carsten Buhmann
To close a gap between inpatient and outpatient care, the Hamburg Parkinson day-clinic (HPDC) has been developed as a new and comprehensive, individual, interdisciplinary type of treatment for patients with complex Parkinsonian syndromes (PS). First, we describe the HPDC concept, in which a multi-professional medical team of PD specialists provide a time- and personnel-wise intensive care and focuses on the patients' individual deficits and resources. Second, we present short-term outcome results of the first 184 PS patients enrolled during 16 months including objective clinical motor and non-motor scores taken before and after participation in the HPDC, as well as the patients' subjective evaluation of the HPDC...
October 2018: Journal of Neural Transmission
Line Caes, Emma Fisher, Jacqui Clinch, Christopher Eccleston
Purpose of review: We review the prevalence of pediatric chronic musculoskeletal pain, the clinical need, the evidence for pharmacological, psychological, physical and, complementary approaches to pain management, and the possible future development of interdisciplinary and distance care. Recent findings: We summarize the Cochrane Systematic Reviews on pharmacological interventions, which show a lack of evidence to support or refute the use of all classes of medication for the management of pain...
2018: Current Treatment Options in Rheumatology
Tobias Wehrhahn, Mario Bargetzi, Carlos Buitrago-Tellez, Gianni Cantelmi
Patients with plasma cell myeloma may initially present to their dentists or dental surgeons with toothache, loose teeth, or gingival masses. An X-ray of the jaw can reveal osteolyses. In addition, accumulation of monoclonal light chains in AL-amyloidosis can lead to macroglossia. It is prudent that the dentist or dental surgeon recognizes the underlying disease and refers the patient to the oncologist or hematologist for further workup to prevent the complications of plasma cell myeloma such as renal impairment, fractures, bone pain, infections, hypercalcemia, anemia, or heart failure...
July 2018: European Journal of Dentistry
Ethan Benore, Erin E Webster, Lu Wang, Gerard Banez
BACKGROUND: -Many children suffering from chronic headache and migraine present with comorbid functional disability, including physical, social, emotional, and academic activities. For children severely impaired by headache, intensive interdisciplinary pain rehabilitation treatment (IIPT) can improve functioning. However, there are limited data evaluating children's response to rehabilitation across several time points. OBJECTIVE: -This study aims to evaluate the trajectory of recovery for children undergoing IIPT for chronic headache, as well as to examine the proposed assumption that physical and psychosocial functioning improves prior to a reported reduction in pain...
August 23, 2018: Headache
John W Devlin, Yoanna Skrobik, Céline Gélinas, Dale M Needham, Arjen J C Slooter, Pratik P Pandharipande, Paula L Watson, Gerald L Weinhouse, Mark E Nunnally, Bram Rochwerg, Michele C Balas, Mark van den Boogaard, Karen J Bosma, Nathaniel E Brummel, Gerald Chanques, Linda Denehy, Xavier Drouot, Gilles L Fraser, Jocelyn E Harris, Aaron M Joffe, Michelle E Kho, John P Kress, Julie A Lanphere, Sharon McKinley, Karin J Neufeld, Margaret A Pisani, Jean-Francois Payen, Brenda T Pun, Kathleen A Puntillo, Richard R Riker, Bryce R H Robinson, Yahya Shehabi, Paul M Szumita, Chris Winkelman, John E Centofanti, Carrie Price, Sina Nikayin, Cheryl J Misak, Pamela D Flood, Ken Kiedrowski, Waleed Alhazzani
OBJECTIVE: To update and expand the 2013 Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the ICU. DESIGN: Thirty-two international experts, four methodologists, and four critical illness survivors met virtually at least monthly. All section groups gathered face-to-face at annual Society of Critical Care Medicine congresses; virtual connections included those unable to attend. A formal conflict of interest policy was developed a priori and enforced throughout the process...
September 2018: Critical Care Medicine
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